Call to Order and Roll Call
Thesixth meeting of the Interim Joint Committee on Health and Welfare and Family Services was held on Wednesday, November 15, 2017, at 10:00 a.m., in Room 129 of the Capitol Annex. Representative Addia Wuchner, Co-Chair, called the meeting to order at 10:04 a.m., and the secretary called the roll.
Members:Senator Julie Raque Adams, Co-Chair; Representative Addia Wuchner, Co-Chair; Senators Ralph Alvarado, Danny Carroll, Julian M. Carroll, David P. Givens, Denise Harper Angel, Alice Forgy Kerr, Stephen Meredith, and Reginald Thomas; Representatives Danny Bentley, Robert Benvenuti III, George Brown Jr, Chad McCoy, Russ A. Meyer, Melinda Gibbons Prunty, Steve Riley, and Russell Webber.
Guest Legislators: Representative Donna Mayfield.
Guests: Diane Nelson, Executive Director, Visually Impaired Preschool Services; Kathy Mullen, Director of Education, Visually Impaired Preschool Services; Brittany and Addy Clarkson, VIPS Parent and child; Hatim Omar, MD, Professor, Pediatrics, Obstetrics/Gynecology, Chief, Division of Adolescent Medicine, University of Kentucky; Dusty Phelps, Licensed Psychological Practitioner, District PBIS Coordinator, Pulaski County Schools; Lori Price, Licensed Psychological Practitioner, Student/Family Support Services Coordinator, Advancing Wellness and Resilience in Education (AWARE) Grant, Pulaski County Schools; Allen Brenzel, MD, Clinical Director, Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services; Joyce Robl, EdD, MS, CGC, Maternal and Child Health Data and Evaluation Officer, Division for Maternal and Child Health, Department for Public Health, Cabinet for Health and Family Services; Greg Mitchell, Regional Business Director, and Greg Lamping, Field Reimbursement Manager, Mitsubishi Tanabe Pharma America; Bob Babbage, Babbage Cofounder; Michele Blevins M.S., LMFT, Assistant Director, Division of Behavioral Health, Cabinet for Health and Family Services; Elizabeth M. Caywood, MSW/CSW, Executive Advisor, Department for Community Based Services, Cabinet for Health and Family Services; Nathan Goldman, Kentucky Board of Nursing; Louis Kelly, Kentucky Board of Physical Therapy; Koleen Slusher, Phyllis Millspaugh, Branch Manager, Behavior Health Prevention and Promotion Branch, Department for Behavioral Health, Developmental and Intellectual Disability, Cabinet for Health and Family Services; and Eric Clark, Chief of Staff, Cabinet for Health and Family Services.
Approval of the Minutes from the October 11, 2017 Meeting
A motion to approve the minutes of the October 11, 2017 meeting was made by Senator Alvarado, seconded by Senator Raque Adams, and approved by voice vote.
Services for the Visually Impaired Preschool Services (VIPS)
Addy Clarkson, VIPS Graduate, sang the National Anthem.
Diane Nelson, Executive Director, Visually Impaired Preschool Services, stated that VIPS mission is to empower families by providing educational excellence to young children with blindness and low vision in order to build a strong foundation for reaching their highest potential. VIPS was founded in 1985 because there were no services available to help a parent whose child was diagnosed with blindness. Ninety percent of what a child learns is through vision and 85 percent of brain development occurs before 6 years of age. Kentucky is only one of five states with a program for babies of blindness. VIPS is a nationally accredited and a 5-star rated program. VIPS services include direct services, family support, play and learn, and center-based programs for preschool, pre-K, Two-Day-2’s, Little Learners, and summer enrichment. VIPS teachers travel approximately 118,000 miles per year to see children and families. VIPS serves nearly 550 children in all 120 counties in Kentucky and Indiana. The opioid crisis has increased new referrals. The Department of Education gives $100,000 to VIPS. The Kentucky School for the Blind does not serve children from birth to three years of age, and refer these children to VIPS. States are looking for leadership from VIPS to help develop the same services for children. VIPS’ strategic plan is to serve 1,000 children by 2020, and the state’s responsibility to support the solution in the Commonwealth to help serve these children.
Kathy Mullen, Director of Education, Visually Impaired Preschool Services, and Brittany Clarkson, Family Service Coordinator and VIPS Parent, were present to answer any questions.
Senator Raque Adams stated that it is important to note that children are served in all 120 Kentucky counties.
In response to questions by Senator Meredith, Ms. Nelson stated that besides the $100,000 state funds, VIPS receives funding from grants, gifts, fundraisers, the First Steps program, some school systems that bus children to the day program, and tuition from the Jefferson County Public Schools for the 18 students enrolled in the program.
In response to a question by Representative Wuchner, Ms. Nelson stated that VIPS receives $100,000 state funds to serve Kentucky students, and Indiana contributes $121,000 for its students.
Adolescent Suicide Prevention
Hatim Omar, MD, Professor, Pediatrics, Obstetrics/Gynecology, Chief, Division of Adolescent Medicine, University of Kentucky, stated that it was thought that brain development was complete by adolescence, but it is now known maturation is not complete until about 24 years of age. Approximately 95 percent of youth will die by something they did, and at least half of the deaths are preventable. On an average day 127 people die from suicide and another 2,000 attempt suicide. Suicide took the lives of almost 42,000 Americans in 2016. There were 1.7 times as many suicides as homicides in 2000, and approximately 50 percent of suicides in the United States occur in people who are receiving psychiatric treatment according to information provided from the Suicide Awareness Voices of Education, the Centers for Disease Control and Prevention (CDC), and the Journal of American Medical Association (JAMA). More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia and influenza, and chronic lung disease combined. Suicide prevention spending needs to be increased nationwide. A recent trend shows that girls are turning to more lethal means of suicide. If this trend continues, the number of completed suicides will rise at an even higher pace. More 10 to 14 year olds are dying from suicide than anything else. One-third of suicide does not have to do with mental health issues. Do not wait until a child attempts suicide for the first time to intervene. Know the signs of suicide. Someone with a bipolar disorder has an increased risk of suicide. Major depression is not the leading cause of suicide.
Having a safe place to interact with a caring adult and having something to do will help teens have a better chance of not committing suicide. Youth need human contact to show that someone cares. An effective program of prevention must include the three main areas of influence in a young person’s life: youth, parents, educators. It is important to teach youth, parents, teachers, and counselors how to identify the signs of suicide and it is okay to ask for someone to ask for help when feeling suicidal. In October 2000, the University of Kentucky started a Stop Youth Suicide Campaign, and it has helped 20,000 children at risk of committing suicide. The program costs $50,000 per year and has never received state funds. The Youth Risk Behavior Surveillance System (YRBSS) monitors six types of health risk behaviors that contribute to the leading causes of death, disability, and social problems among youth and adults. It includes a national school-based survey conducted by CDC every two years of 9th through 12th grade students in public and private schools in the United States. The survey showed that 15 Kentucky students seriously considered attempting suicide, 13 made a plan about how to attempt suicide, 8 attempted suicide, and 3 attempted suicide that resulted in injury, poisoning, or overdose that had to be treated by a doctor. Kentucky’s statistics were lower compared to national data.
Lori Price, Licensed Psychological Practitioner, Student/Family Support Services Coordinator, Advancing Wellness and Resilience in Education (AWARE) Grant, Pulaski County Schools, stated that three years ago Pulaski County was awarded a “Now is the Time” Project AWARE-Community Grant by the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services. Pulaski County was awarded the grant because there have been school-based mental health services in the school districts since 2001, there are 16 outpatient facilities onsite that provide services to students, and the school district has provided positive behavioral interventions and supports since 2007. The grant is used to support the training of teachers, individuals who interact with youth through programs at the community level, parents, law enforcement, faith-based leaders, and other adults in Mental Health First Aid (MHFA) or Youth Mental Health First Aide (YMHFA). The goal is to expand the MHFA and YMHFA to achieve a wider community impact by training a more diverse group of adults who will reach a broader spectrum of adolescents or transition-aged youth within the community.
Mental illness is common during adolescence. Adolescence and young adulthood are critical periods for identification and intervention of mental illness. Early identification and treatment engagement is vital for improved quality of life. Students with mental illness need improved supports to succeed in school, career, college, and life. Project AWARE’s goal is to improve mental health literacy among youth-serving adults and to build cross-system capacity for comprehensive mental health approaches in states and communities. It is important to learn to recognize students who are at risk of suicide quicker. Other goals are to improve school safety, improve school climate, increase awareness of mental health issues, and connect children and youth with behavioral health issues with needed services.
Dusty Phelps, Licensed Psychological Practitioner, District Positive Behavioral Intervention and Supports (PBIS) Coordinator, Pulaski County Schools, stated that school-based mental health services are integrated into supports in the educational system. Mental health professionals are made available to students who need services. Supports can be offered so there is minimal interruption to the student’s educational process while providing them with the valuable and needed services onsite. Pulaski County wanted to create a model that could be replicated across Kentucky. Teachers and all staff are taught how to recognize warning signs of mental health challenges and how to interact with students who have experienced trauma in their lives. The University of Kentucky’s Center on Trauma and Children has provided training to all teachers and administrators on how to recognize signs of trauma, and how to screen for and respond to trauma in classrooms. Partnerships have been formed with community agencies to provide onsite supports. All schools know the process and are monitored in order to have a way to measure a student’s progress. Students are taught to become active participants in their mental health care during and after graduation from high school.
Allen Brenzel, MD, Clinical Director, Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services, stated that the CDC WONDER Compressed Mortality File, 1999-2015 shows suicide deaths for youth ages 10 to 19 years of age have trended upward despite increased dollars spent for prevention. It could also be attributed to more accurate accounting of suicide deaths across the county as a result of prevention and data surveillance efforts. The CDC WONDER Compressed Mortality File, 2000-2016 showed that Kentucky suicide deaths increased significantly in 2015. Between 2014 and 2015, suicide rates doubled in the 15 to 19 year old age group. The 10 to 14 year old suicide deaths have remained relatively stable since 2012. The Kentucky Incentives for Prevention (KIP) survey shows the percentage of school districts that responded to the survey shows that the Communicare and Pennyrole regions had an increase in rates for 10th graders that had seriously considered attempting suicide within the past year. One reason could be high military presence that add additional stressors. Compared to the Kentucky Youth Risk Behavior Survey (YRBS), the KIP survey trends are stable and lower. This could be attributed to fewer urban districts participating in the survey. Rates from the KIP survey are consistent with the YRBS that indicate that suicide attempts of 10th graders were higher in the western and northeastern areas of Kentucky. Of the districts that participated in the KIP survey, 6,952 students reported they attempted suicide at least once in the past year.
There is one Regional Prevention Center (RPC) in each of the Community Mental Health Centers (CMHCs). Each of the 14 RPCs receive $331,873 state funds that are used to leverage other available federal funds. The Unified Community Mental Health and Substance Abuse Prevention and Treatment Block Grant requires $3,642,982 to be used for prevention. State fund dollars were used to leverage federal funds to receive $735,018 annually until FFY 2019 for the Partnership for Success grant issued by the Substance Abuse and Mental Health Services Administration (SAMHSA). The Kentucky Zero Suicide Initiative aims to create suicide safer communities and suicide safer care services for youth and young adults 10 to 24 year of age who are at higher risk of suicide. It is a comprehensive system of care approach, integrating best practices in suicide care and prevention and works to bridge clinical competency in suicide care and increased suicide prevention awareness. Kentucky receives $736,000 annually until FFY 2019 for the Sources of Strength curriculum aimed at reducing suicide by promoting connections between peers and caring adult.
In response to a question by Senator Givens, Dr. Omar stated that the percentage of suicide attempt hospitalization rate was based on every 100,000 Kentucky 10 to 24 year olds.
In response to a question by Representative Wuchner, Dr. Brenzel stated that of the students who completed the survey, half of the students who had a plan to attempt suicide might follow through with the plan. Students need to be identified earlier to prevent them from progressing from thinking about committing suicide to actually following through with the plan.
In response to a question by Senator Thomas, Dr. Brenzel stated that 15.8 percent of 10th graders in the 2016 survey who responded in the Bluegrass Region seriously considered attempting suicide and 8 percent followed through with the plan. There is a difference between thinking about suicide and actually committing suicide.
In response to a question by Senator Meredith, Dr. Brenzel stated that participation in a religion decrease the risk of suicide. Phyllis Millspaugh, Branch Manager, Behavior Health Prevention and Promotion Branch, Department for Behavioral Health, Developmental and Intellectual Disability, Cabinet for Health and Family Services, stated that risk factors that might indicate academic issues would cause disparity, but not as much around race or ethnic demographics. It is about behaviors that are or are not demonstrated that push a person toward suicidality. There have been increased risk factors across all populations. Mr. Phelps stated that suicide does not discriminate across socio-economic or racial lines. Ms. Price stated that suicide can happen to anyone.
In response to questions by Senator Julian Carroll, Dr. Brenzel stated that the challenge is to determine if it is an intentional or unintentional death, so intentional and unintentional deaths caused by a drug overdose are lumped together when compiling data. There is a need to take a closer look at unintentional deaths.
In response to questions by Senator Givens, Mr. Phelps stated that exposure to trauma and high levels of stress and cyberbullying increase the risk of suicide. Students who do not know how to report bullying/harassment have a 36 percent higher likelihood to commit suicide. Students who feel their school’s method of reporting bullying/harassment is not effective have a 66 percent higher likelihood of attempting suicide. Senator Givens expressed concerned that technology helps someone have the ability to create an alternate reality that shows everything in life is perfect, but in reality, it is not. Mr. Phelps stated that there needs to be more education about the effects of social media. Technology is hurting positive interactions between young persons and adults. Screen time is a deterrent to health while human interactions promote health. Dr. Brenzel stated that teens are vulnerable to isolation and end up only having virtual connections.
In response to a question by Senator Raque Adams, Dr. Brenzel stated that in 2014 there was a significant increase in suicide attempts and deaths. There needs to be better reporting to get more accurate data. The Community Mental Health and Substance Abuse Prevention and Treatment Block Grant funds are used for all types of prevention not just suicide prevention. Mr. Price stated that the Pulaski Suicide Prevention alliance has helped increase awareness by helping people know about available services.
Representative Benvenuti also expressed concern about society’s reliance on technology. There is a real need to focus on realty verses virtual reality where everyone’s life seems perfect. Suicides are increasing not decreasing. Ms. Price stated that there is a dark group on social media that feeds on depressed youth. The gaming world isolates and cuts individuals off from the world. There are allot of pressures on youth today.
In response to a question by Senator Thomas, Ms. Price stated that all the schools in Pulaski County have nurses who are trained to recognize signs of trauma or someone who is at risk of suicide. The nurses collaborate with the Family Resource and Youth Services Center (FRYSC) Coordinator who must have a bachelor’s degree in human services.
In response to a comment by Senator Alvarado, Dr. Brenzel stated that the risk of hopelessness, which including during economic downturns, is a major risk factor. A rise in suicide rates for adolescents is a universal problem. Mr. Phelps stated that other countries have some of the same suicide risks as the United States because of some of the same risk factors. Human connection and hope are needed to help reduce the risks.
Rising Rates of Sudden Infant Death Syndrome (SIDS)
Joyce Robl, EdD, MS, CGC, Maternal and Child Health Data and Evaluation Officer, Division of Maternal and Child Health, Department for Public Health, Cabinet for Health and Family Services, stated that for every 1,000 babies born in Kentucky in 2015, 379 babies died before their first birthday. Kentucky consistently has a higher infant mortality rate compared to the United States rates. Data from the Kentucky Vital Statistics, Birth Certificate Files from 2011 to 2015 and Death Certificate Files for the same period indicate that white infant mortality rate per 1,000 births went from 6.0 in 2011 to 6.6 in 2015. African American infant mortality rates for the same timeframe went from 13.3 to 10.8. Sudden Unexpected Infant Deaths (SUID) rates only include deaths to infants one year of age or less where the code is SIDS, accidental suffocation in bed, undetermined, other specified threats to breathing, or unspecified threat to breathing. Prematurity related deaths are an infant born before 37 weeks gestation. Kentucky infant deaths are caused by prematurity related conditions, SUID, birth defects, perinatal conditions, other medical conditions, injury, and unknown reasons.
Approximately 4,000 infants die suddenly and unexpectedly each year in the United States. In 2016, 103 Kentucky infants died suddenly and unexpectedly. A multidisciplinary local team or the state SUID Case Registry Review Team reviewed 95 of the 103 cases. SUID deaths include sudden infant death syndrome (SIDS), undetermined causes, or accidental suffocation and strangulation in bed. Ninety-four percent of infants have one or more sleep-related risk factors: 1) surface not designed for infant sleep; 2) sharing sleep surface; 3) sleep position; and/or 4) soft beddings and hazards. In 2015, Kentucky received a Sudden Unexpected Infant Death Case Registry grant from the CDC. The goals of the grant are to identify all Kentucky resident unexplained infant death cases, review all identified cases, collect consistent data elements on every case, and analyze, disseminate, and utilize SUID data to inform data-driven policy development and procedural best practices.
In October 2015, the Kentucky Department for Public Health (DPH) launched the Safe Sleep Campaign. It is a statewide effort to raise awareness of the importance of Safe Sleep for babies and lower the number of SIDS-related deaths in Kentucky. The purpose of the Safe Sleep Kentucky campaign is to prevent infant deaths by educating the public in ABCD (sleep alone, on the back, in a crib, and free of danger), the four letters associated with the best practices to make sure infants sleep safely. The campaign aims to help inform new and experienced parents, grandparents, and caregivers on the importance of Safe Sleep for babies. The campaign also hopes to promote Safe Sleep through medical experts and professionals within the healthcare community so they and parents alike become familiar with, practice, and actively promote these simple steps to save babies lives.
In response to a question by Representative Benvenuti, Dr. Robl stated that among infants who experience SUID, there is at least a 30 percent have a substance abuse risk factor, but this percentage could be underestimated because not all of the cases have had a complete investigation. Henrietta Bada, MD, Director, Division of Maternal and Child Health, Department for Public Health, University of Kentucky, Professor, stated that the Department of Public Health, the Department for Behavioral Health, Developmental and Intellectual Disabilities, and the Department for Community Based Services are involved in a hospital’s plan of safe care. The major focus is the care of the pregnant woman who is abusing opioids or on treatment, activities or procedures done in the hospital for mothers and babies, and post discharge so there can be a safe environment for the child while the mother continues treatment. Representative Benvenuti stated that children need to be protected and not sent into an unsafe environment after birth.
In response to questions by Representative Gibbons Prunty, Dr. Bada stated that there are no uniform practices or policies that would automatically open a case with DCBS if a mother has a positive drug screen. Most physicians will contact DCBS if they have a child whose mother is using drugs during pregnancy or in a treatment program to ensure the child goes home to a safe environment. Dr. Robl stated that the department does not support the baby boxes that are distributed by pregnant crisis centers because of safety issues with the box. For a little bit more money, someone can get a pack n’ play through the Cribs for Kids program.
In response to questions by Senator Alvarado, Dr. Robl stated that in the past five years, four to six months is the typical age of unexpected infant deaths, but in 2016, the age dropped. The department has not specifically looked at home births, but the vast majority of cases recorded are in birthing hospitals. Senator Alvarado stated that the department should begin to look at this data, because there is a concern there is a higher risk of death in home births.
Advances in the Treatment of Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s Disease
Greg Mitchell, Regional Business Director, Mitsubishi Tanabe Pharma America, stated that very little progress has been made since Lou Gehrig’s diagnosis almost 20 years ago. ALS is a rapidly progressive neurodegenerative disease in which the majority of people die within two to five years of diagnosis. Over time, people with ALS lose their ability to perform the basic functions of daily living. Approximately 6,000 people are diagnosed with ALS yearly. It can take up to 12 months to receive a diagnosis. The ALS revised rating scale (ALSFRS-R) is based on speech, salivation, swallowing, handwriting, cutting food, dressing and hygiene, turning in bed, walking, climbing stairs, dyspnea, orthopnea, and respiratory insufficiency. In 2015, edaravone was approved for use as a treatment for ALS in Japan and South Korea. In May 2017, the Food and Drug Administration (FDA) approved Radicava (edaravone) as a treatment option for ALS. The most common side effects are bruising (contusion), problems walking (gait disturbance), and headache.
Greg Lamping, Field Reimbursement and Patient and Access and Services Manager, Mitsubishi Tanabe Pharma America, was present to answer questions.
In response to a question by Representative Wuchner, Mr. Mitchell stated that the clinical trial was a six-month study conducted in Japan. The Japanese Ministry of Health decided that for ethical reasons that the trial was designed in such a way that placebo patients should be allowed to convert to the active drug after six months.
In response to questions by Representative Bentley, Mr. Mitchell stated that Mitsubishi Tanabe Pharma Corporation is the second oldest pharmaceutical company that originated in 1678. In the clinical trials for Radicava, the primary measure of efficacy was preservation or reduction in the loss of physical function, so there were no mortality studies. Because of the nature of the disease, people can live with the disease different amounts of time.
Diabetes Prevention and Treatment
Representative Donna Mayfield stated that diabetes is a group of diseases characterized by high blood glucose levels that result from defects in the body’s ability to produce and/or use from insulin. The high levels of blood glucose can cause damage to various organs, including the eyes, kidneys, nerves, heart, and blood vessels. Weight, activity level, eating habits, smoking, stress, and/or high blood pressure can be changed to modify the risk of getting diabetes. Things that cannot be changed are age, race, family history, or gestational diabetes. Type 2 diabetes is usually diagnosed in adults over 40 years of age, but is becoming more common in younger adults and children. According to CDC, the 12 percent of adults in Kentucky had been diagnosed with diabetes by 2014. The Institute for Alternative Futures (IAF) projects over 14 percent of Kentuckians will be diagnosed with diabetes by 2030. IAF estimates the economic impact in Kentucky in 2020 could cost $6.5 billion. EMS should carry quick acting insulin with them at all times, because it could mean life or death for someone.
Representative Russ Meyer stated that almost 90 percent of people living with type 2 diabetes are overweight or have obesity. People who are overweight or have obesity have added pressure on their body’s ability to use insulin to properly control blood sugar levels, and are therefore more likely to develop diabetes. The total cost of obesity in Kentucky is $36.31 billion with $4.17 billion of the total in Medicare costs. The Diabetes Prevention Program is now covered by Medicare. Diabetes self management education (DSME) shows economic benefit and merits major support. Increase in diabetes screening in health plans and Medicare will identify new cases.
In response to questions by Representative George Brown, Representative Mayfield stated that her insurance covers the cost of the insulin pod and she only pays $1 every 3 days for the co-pay. There is a false sense of security that the insulin pod will take care of everything automatically so there is no need to carry extra supplies. The pod has a small meter that controls the pod. When the pod is put on, the controller tells it how much insulin is needed on a 24 hour basis and also integrates the blood sugar testing. She stated that she did not know how much it would cost for EMS vehicles to carry insulin but would get the information for the committee. Representative Bentley stated that the retail price is $799.50 for a pod of 30 that last 90 days.
Senator Alvarado stated that EMS vehicles are permitted to carry insulin. There are some concerns that EMTs do not want to administer high doses of insulin without knowing someone’s metabolic status, because it could cause more harm than good to administer the insulin. It is probably up to local directors to make the decision to carry it in the EMS vehicle.
Legislative Hearing on the FFY 2018-2019 Unified Community Mental Health and Substance Abuse Prevention and Treatment Block Grant
A motion that the FFY 2018-2019 Unified Community Mental Health and Substance Abuse Prevention and Treatment Block Grant does meet the standards and criteria set out in KRS 45.353 was made by Senator Raque Adams, seconded by Senator Alvarado, and accepted by voice vote. Michele Blevins M.S., LMFT, Assistant Director, Division of Behavioral Health, Cabinet for Health and Family Services, was present to answer questions.
Legislative Hearing on the FFY 2018-2020 Temporary Assistance for Needy Families (TANF) Block Grant
A motion that the FFY 2018-2020 Temporary Assistance for Needy Families (TANF) Block Grant does meet the standards and criteria set out in KRS 45.353 was made by Senator Raque Adams, seconded by Senator Alvarado, and accepted by voice vote. Elizabeth M. Caywood, MSW/CSW, Executive Advisor, Department for Community Based Services, Cabinet for Health and Family Services, was present to answer questions.
Consideration of Referred Administrative Regulations
The following administrative regulations were on the agenda for consideration: 201 KAR 9:260 – establishes the professional standards for prescribing and dispensing controlled substances; 201 KAR 13:040 – prescribes the forms, required examinations, experience, renewal requirements, and provisions for inactive status required for licensees; 201 KAR 13:060 – exempts from licensure renewal licenses for active members of the military service, provides reciprocity between the states, and provides licensure by endorsement; 201 KAR 20:057 – establishes the scope and standards of practice for an advanced practice registered nurse; 201 KAR 22:020 – establishes the criteria for eligibility, methods, and procedures of qualifying for a credential to practice physical therapy in Kentucky; 201 KAR 22:040 – establishes the requirements and procedures for the renewal and reinstatement of credentials; 201 KAR 22:070 – establishes the requirements a foreign-educated physical therapist shall satisfy to become credentialed in the state of Kentucky; and 900 KAR 11:010 – establishes the requirements for medical review panels in accordance with KRS Chapter 216C. A motion to accept the referred administrative regulations was made by Senator Raque Adams, seconded by Senator Alvarado, and accepted by voice vote.
There being no further business, the meeting was adjourned at 12:32 p.m.