The 4th meeting of the Interim Joint Committee on Licensing and Occupations was held on Friday, September 11, 2009, at 10:00 AM, in Room 129 of the Capitol Annex. Representative Dennis Keene, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Gary Tapp, Co-Chair; Representative Dennis Keene, Co-Chair; Senators Julian M. Carroll, Perry B. Clark, Julie Denton, Carroll Gibson, Denise Harper Angel, John Schickel, Dan "Malano" Seum, Kathy W. Stein, and Damon Thayer; Representatives Larry Clark, Ron Crimm, Tim Firkins, Dennis Horlander, Joni L. Jenkins, Adam Koenig, Reginald Meeks, David Osborne, Darryl T. Owens, Ruth Ann Palumbo, Sal Santoro, Arnold Simpson, and Ron Weston.
Guests: Representative Jimmy Higdon; Dennis Hagan, Pedorthist; Richard Moloney, Commissioner, Department of Housing, Buildings and Construction; Gregg Rogers, J. Ronald Pryor, Elevator Industry Work Preservation Fund; Tom Underwood, D.C. Elevator.
LRC Staff: Tom Hewlett, Bryce Amburgey, Michel Sanderson, Carrie Klaber, and Susan Cunningham.
Minutes of the August 11, 2009, were approved as submitted without dissent.
First on the agenda Representative Jimmy Higdon and Dennis Hagan, Pedorthist, spoke to committee members about licensure of pedorthists. Representative Higdon told the committee that all interested parties were working toward a compromise for licensure. Representative Higdon said that he has not been contacted by constituents regarding the need for licensure and was unaware of fraud in the industry. He said his proposed legislation was identical to legislation currently being considered in Pennsylvania and is similar to the proposal that was presented to the committee during the July meeting.
Dennis Hagan told committee members that the main difference between this bill and bill proposed in July is the educational requirements and the establishment of a board. Mr. Hagan said he was opposed to education requirements being written into the actual practice act. He said this had been done in Ohio, and the board for pedorthists was powerless to make changes without going to their General Assembly. Mr. Hagan said that no piece of legislation could protect a patient, adding that responsibility would always be with the individual practitioner. He said that Florida, which has one of the strictest practice acts, recently uncovered $122 million in prosthetic fraud. He felt that this was because Medicare and Medicaid ties durable medical equipment in with prosthetics and orthotics. Mr. Hagan added that funds would be limited to provide oversight of the licensees in Kentucky. He also said it would be hard to support a national education program.
Mike Veeder, retail pedorthists, told committee members that he has offices in Ohio and in Kentucky. He said that his experience in Ohio was that, "less is better." He said that the scope of practice in Ohio is very limiting for pedorthists. He said both the National Organization for Competency Assessment (NOCA) and the National Commission for Certifying Agencies (NCCA) have expanded the scope of practice for pedorthists, but Ohio law does not permit treatment above the ankle. He felt this limits what the practitioner can do for patients and harms patient care. Mr. Veeder said that the significant difference in the two proposed bills in Kentucky is the credentialing bodies. Representative Keene asked if Ohio is currently trying to repeal their pedorthic laws. Mr. Veeder said he would have to petition the board to change the law.
Rob Burnett, retail pedorthists, said his practice deals with the general public. He said people have a hard time finding quality practitioners and felt that the legislation proposed in July would limit the number of practitioners in the state of Kentucky. He said Representative Higdon's bill would allow existing practitioners to continue working and promote the profession.
Senator Harper-Angel asked if there was a grandfather clause that would cover current practitioners. Representative Higdon replied, yes.
Representative Higdon said that the two groups with legislation were arranging meetings to work together to come to a compromise.
Senator Gibson asked if the fraud in Florida was Medicare only and what the qualifications are to practice pedorthics. Mr. Hagan said yes, the fraud in Florida was limited to Medicare and Medicaid. Mr. Hagan responded that the qualifications were determined by the credentialing bodies located in Washington D.C. He further stated that without certification from one of the national boards the practitioner will not be reimbursed by Medicare or Medicaid. Representative Koenig asked for more details regarding the fraud in Florida. Mr. Hagan responded that he did not have the article, which was printed in a national association publication, with him. He offered to mail Representative Koenig that article.
Representative Koenig asked what the minimum education standards should be for pedorthists in Kentucky. Mr. Hagan responded that those requirements are set out by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) and the Board for Certification/Accreditation International (BOC). Mr. Hagan added that requirements for certification by either of these boards by the year 2013 are a bachelors degree.
Senator Seum asked if prosthetists, orthotists and pedorthists practice together and if they are certified by the same board. Mr. Hagan said his practice deals with footwear; however, prosthetists deal with artificial limbs and orthotists deal with braces and splints. Representative Higdon said it is a complicated issue.
Charles Britt, an amputee and prosthetic user speaking on behalf of himself, told committee members that he wanted to encourage them to look at the ABC and the BOC to use as a guideline. He said currently there was no way for a patient to know who they should consult to be fitted for devices. He told members that he held a real estate license and a nursing license and did not fear licensure for prosthetists, orthotists and pedorthists.
Representative Clark asked Mr. Britt how he located his prosthetists. Mr. Britt responded that his surgeon gave him a list of practitioners for him to choose from.
Bob Williams, another amputee and prosthetic user speaking on behalf of himself, told committee members he is a service connected veteran who lost his leg in war-time service. He said after surgery his surgeon released him with no recommendation for limb replacement. He said the Veterans Association provided him with a list of contract prosthetists. He said he is in favor of licensure and requiring continuing education to maintain that license for this field.
Next on the agenda, Ronald Pryor, Capital Solutions, LLC and Gregg Rogers, National Coordinator for the elevator industry, representing the Elevator Industry Work Preservation Fund gave an overview of elevator safety. Mr. Pryor stated that while Kentucky requires licensure for barbers, auctioneers, plumbers and many other occupations, it is in the minority of states that do not require those who work on and install elevators to be licensed. He said that the Department of Housing, Buildings and Construction inspects commercial elevators, but freight elevators are not inspected at all after the initial inspection when they are installed. Mr. Pryor said legislation for licensure is an issue of safety. He said a new board would not be necessary; however, like other professions there should be an advisory committee. Mr. Rogers stated that he was a licensed elevator mechanic with 35 years of experience in the elevator industry. He said that elevator safety legislation was important to implement minimum standards for people who work on conveyances. He said that, based on a report issued by the Center to Protect Workers' Rights, there are approximated 30 people killed and more than 17,000 injured each year while at work on or around conveyances. He said that the state should implement a law to inspect freight elevators routinely after inspection as well as imposing minimum standards for licensure of installers and inspectors. Mr. Rogers said this would help prevent future accidents and fatalities.
Senator Tapp asked if there would be any elevators exempt in proposed legislation. Mr. Pryor said there are discussions ongoing regarding exemptions for the distilling industry. Representative Simpson asked if regulation of elevators was a trend nationally. Mr. Rogers said that since 2000 legislation has been passed in 17 states and that currently only four states have no regulations governing elevators. Representative Simpson asked what the fee schedule would be for the industry. Mr. Pryor said that typically the mechanic license fee is $100 annually and for a contractor the license fee is four times the amount of the mechanic.
Tom Underwood, representing D. C. Elevator, an independent elevator contractor in Kentucky, said he and a group of independent elevator companies have been in discussions with Mr. Pryor and Mr. Rogers to come to a compromise on legislation for licensure of elevator mechanics and installers. He said his group is in favor of continuing education and licensure. Mr. Underwood said he was confident that there would be one bill that all parties were in agreement with for the 2010 legislative session. Mr. Underwood thanked Commissioner Moloney for facilitating the groups meetings.
Representative Clark asked about differences the two groups were discussing. Mr. Underwood said that one difference was the makeup of the Elevator Advisory Committee. He said that another area was the continuing education and which body; the National Elevator Industry Educational Program, or the National Association of Elevator Contractors, would credential installers and inspectors. Mr. Underwood said that both programs were approved by the Department of Labor. Representative Clark responded that the legislators should decide which body would provide the continuing education. Mr. Underwood stated that another point of discussion was the number of months of experience required for a mechanical elevator contractor's license as well as reciprocity with other states. Mr. Pryor stated that if Kentucky is going to be reciprocal they should have the same requirements as contiguous states. Representative Clark said the program should offer portability and job opportunities. Senator Stein asked if the freight elevator in the Annex had been inspected since it had been installed. Gregg Rogers responded that by state regulation it is not required; however, he could not answer positively that it had not been inspected since installation. Mr. Pryor said that is the potential, although the state may require inspection of state office buildings. Representative Meeks asked how many elevators inspectors are employed and how many elevators existed currently in the state. Commissioner Moloney said there are 10 inspectors for the state, and said there are thousands of conveyances. Mr. Pryor said that during a previous meeting among interested parties an elevator inspector noted that about 10,000 elevators are required to be inspected annually. Mr. Rogers said that there are a minimum of 5,000 freight elevators that are not inspected. Representative Owens asked if there would be minimum training for inspectors. Mr. Pryor said that the American Society of Mechanical Engineers has a qualification called Qualified Elevator Inspector that the proposal would require that all inspectors meet.
There being no further business to come before the committee the meeting was adjourned at 11:00 a.m.