Call to Order and Roll Call
The 4th meeting of the Interim Joint Committee on Licensing and Occupations was held on Friday, October 11, 2013, at 10:00 AM, in Room 129 of the Capitol Annex. Senator John Schickel, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator John Schickel, Co-Chair; Representative Dennis Keene, Co-Chair; Senators Tom Buford, Julian M. Carroll, Jimmy Higdon, Christian McDaniel, Morgan McGarvey, R.J. Palmer II, and Dan "Malano" Seum; Representatives Tom Burch, Denver Butler, Larry Clark, David Floyd, Dennis Horlander, Joni L. Jenkins, Charles Miller, Brad Montell, David Osborne, Darryl T. Owens, Ruth Ann Palumbo, Arnold Simpson, Ken Upchurch, and Susan Westrom.
Guests: Mike Townsend, President of Kentucky Association of Alcohol and Drug Professionals, Dr. Patrick McKiernan, Homeless Veterans Outreach Coordinator, Department of Veterans Affairs; Lara Barrow, CRNA, President, Kentucky Association of Nurse Anesthetists, Soren Campbell, Kentucky Academy of Anesthesiologists Assistants and Ross Cotton, M.D.
LRC Staff: Tom Hewlett, Bryce Amburgey, Michel Sanderson, and Susan Cunningham.
Approval of minutes
A motion to approve the minutes from the September 16, 2013 meeting was made by Representative Upchurch and seconded by Representative Owens. The motion was carried by voice vote.
Senator Schickel said that the Advanced Practice Registered Nurse discussion that was originally on the agenda was taken off as the interested parties have not come to an agreement. He added that the two groups have been meeting on a regular basis and are close to an agreement.
Licensing of alcohol and drug counselors
Representative Joni Jenkins introduced her bill, BR 9, AN ACT relating to alcohol and drug counseling. She said that very similar legislation had passed both chambers during the last regular session but was not enrolled before the session ended.
Mike Townsend told members there is an alcohol and drug problem in Kentucky, creating a growing need for licensed alcohol and drug counselors. The legislation establishes three categories for alcohol and drug counselors; a registered peer support specialist, a certified counselor, and a licensed status for individuals with a masters degree in behavioral science. This ensures the public that qualified people are treating clients who have substance abuse disorders. Also, the board will maintain a register of persons who want to become peer support specialists. These are individuals who have at least two years of sustained recovery from substance abuse who would work with professionals. The bill will promote academic training and encourage universities to develop curriculum relating to alcohol and drug abuse counseling.
Patrick McKiernan, Homeless Veterans Outreach Coordinator with the Department of Veterans Affairs said the mission of the department is serving Kentucky’s 340,000 veterans and their family members. The department has enrolled about one third of the veterans in Kentucky in its health care system, but none of their family members. Without this bill, veterans and their families, who will soon be able to enroll in health care, will not have access to licensed alcohol and drug counseling.
In response to a question from Senator Schickel, Mr. McKiernan said in talking with Eric Friedlander of the Cabinet for Health and Family Services it was his understanding that licensed individuals are recognized as independent practitioners which allow them to bill for reimbursement.
In response to a question from Representative Westrom, Mr. McKiernan responded that trauma informed care has become an area of focus in training in recent years.
In response to a question from Representative Simpson, Mr. Townsend said there are certified alcohol and drug counselors as well as social workers and others currently providing treatment services throughout the state. However, this bill recognizes a unique body of knowledge about substance abuse specific treatment of this disorder. The legislation would not prohibit other professionals from providing treatment in their area of expertise, but it would also allow other professionals to obtain licensure or certification demonstrating enhanced knowledge of substance abuse treatment.
In response to a question from Representative Floyd, Mr. Townsend said there will be no impact on churches that are providing recovery programs.
In response to a question from Representative Keene, Mr. Townsend said he does not have any information regarding reimbursement for drug rehab treatment.
Representative Jenkins said that she and Representative Owens had attended a conference on integrating primary health care with behavioral health and substance abuse. Healthcare professionals often need to work together to make a complex diagnosis of a chronic illness when it is connected to a behavioral health or substance abuse issue.
Senator Carroll opined that this legislation provides a mechanism to circumvent the final disease or condition that people with substance abuse problems will eventually encounter. This bill allows counseling and treatment by a professional and allows the professional to bill for reimbursement, to provide treatment early in the process before costly final stage care is needed.
Anesthesiologist Assistants
Lara Barrow, CRNA, President of the Kentucky Association of Nurse Anesthetists told committee members there are 850 CRNAs in Kentucky. Anesthesiologist Assistants can also currently practice in Kentucky, as long as they are also licensed as physician assistants. There must always be a supervising anesthesiologist present. The critical difference between an anesthesiologist assistant and a CRNA is that CRNAs may also practice independently of anesthesiologist supervision in both urban and rural settings. Access to health care in Kentucky is more important than ever, with more Kentuckians now having health coverage. CRNAs are the sole providers of anesthesia in 24 rural counties. Finally, anesthesiologist assistants are not allowed to bill Medicare for non-medically directed anesthesia services.
In response to a question from Senator Schickel, Ms. Barrow said in Kentucky an anesthesiologist assistant must also be a physician’s assistant.
In response to a question from Senator Carroll, Ms. Barrow said billing is no different for CRNAs and anesthesiologist assistants.
In response to a question from Representative Jenkins, Ms. Barrow said the CRNA is required to have a bachelor’s degree in Nursing, with one to two years of ICU experience, followed by graduate school.
In response to a question from Representative Owens, Ms. Barrow said that by 2020 all programs will be doctoral programs, but they are currently masters degree programs.
Soren Campbell, Anesthesiologist Assistant (AA) practicing at Christ Hospital in Cincinnati, Ohio told committee members that the statutes in Kentucky for AAs require AA to first have a physician assistant license from a four program before becoming an AA. There is no such four year program in Kentucky. AA programs are master level programs like the physician assistant programs. Kentucky is the only state that requires an AA to be a physician assistant first.
Independent billing should not be mistaken as a statement for the level of competence or practicing independently. AAs practice under an anesthesiologist at all times and can only receive payment through that setting. The AAs are not asking for independent practice but rather to be licensed.
Dr. Ross Cotton, Anesthesiologist, Nortons Hospital, said the educational requirements for an AA are a masters degree. This comes after a four year pre-med bachelor’s degree curriculum and requires re-certification every six years. In recent years, CRNAs come from Tennessee and other border areas to fill the need in Kentucky. However, there is a large turnover in CRNAs, and there is a need for additional qualified practitioners.
In response to a question from Senator McDaniel, Mr. Campbell said AAs are allowed to practice in Kentucky. However, Kentucky has a burdensome requirement of getting a physician’s assistant degree before the AA degree. Mr. Campbell said he is proposing elimination of the dual requirement and allowing AAs to be licensed after completing an AA program
AN ACT relating to alcoholic beverages
Senator Jimmy Higdon said that a task force recently studied Kentucky law pertaining to alcohol sales. The findings of that task force revealed antiquated laws in a number of areas, resulting in legislation during the 2013 regular session. That legislation, Senate Bill 13, made changes to multiple statutes. However, if an issue was judged to be controversial it was not added to the bill for fear of derailing all the other issues the bill addressed.
Senator Higdon said that he will be bringing a bill to the 2014 legislative session with some of the issues that were not in SB 13. The 2014 bill will allow by the drink alcohol sales at bed and breakfast establishments in wet territory. It will require the person or persons who request a local option election petition to pay for the cost of the election, taking that burden off of the county government. It will establish a uniform city or county population ratio for quota retail package licenses statewide, similar to the Alcoholic Beverage Control Administrative Regulation language regarding this topic. There are about 600 licenses that are not in use across the state. Because package liquor stores are becoming larger, there is not a need for as many licenses. The bill will also create a double random lottery for awarding quota package and quota drink licenses in areas that vote to go wet to prevent claims of bias in awarding a quota license.
The bill also addresses a growing part of the alcohol market, “cider.” There is a need to change current language to define “hard” cider as 7 percent or more alcohol, while “weak cider” would be defined as cider with more than 1 percent but less than 7 percent alcohol. Weak cider would then be defined as a malt beverage and could be sold by beer distributors.
Finally, the bill will make a change in the license fees for distilleries. The bill leaves the fee for distilleries that produce more than 50,000 gallons per year at the current amount of $3,090. A distillery that produced 50,000 gallons or less per year would pay a reduced fee of $1,000.
Senator Schickel said that during his time as co-chair of the committee he has been pleased with the approach the committee has taken with alcohol legislation.
In response to a question from Representative Keene, Senator Higdon said the bill mainly speaks to quota licenses in counties that have an increased population.
Representative Clark commented that consideration of an increase in the amount of ounces that micro breweries are able to sell might also be added to the bill. He cautioned that in doing this there should not be a conflict with the three-tier system. Also, allowing sales of alcohol in state parks would give parks control of the amount of alcohol consumed, as well as helping with tourism. Golfers and others bring their own beer and parks are losing that revenue opportunity. A wet/dry election would still be necessary.
In response to a question from Representative Westrom, Senator Higdon said that the sale of alcohol in groceries would not be addressed in his legislation.
In response to a question from Representative Burch, Senator Higdon said he did not know how many bed and breakfast businesses were in Kentucky.
Senator Buford commented that the language regarding sale by the drink in a bed and breakfast should clarify that only a guest with proof he or she is registered to stay at the establishment would be eligible to purchase alcohol by the drink.
There being no further business to come before the committee, the meeting was adjourned at 10:56 AM