Call to Order and Roll Call
The5th meeting of the Interim Joint Committee on Licensing and Occupations was held on Friday, November 8, 2013, at 10:00 AM, at the Anheuser-Busch Distributor Warehouse, 4400 Produce Road, Louisville KY. Representative Dennis Keene, Chair, called the meeting to order, and the secretary called the roll.
Members:Senator John Schickel, Co-Chair; Representative Dennis Keene, Co-Chair; Senators Tom Buford, Julie Denton, Jimmy Higdon, Christian McDaniel, Morgan McGarvey, Dan "Malano" Seum, and Damon Thayer; Representatives Tom Burch, Denver Butler, Larry Clark, Jeffery Donohue, Dennis Horlander, Joni L. Jenkins, Charles Miller, Brad Montell, David Osborne, Darryl T. Owens, Sal Santoro, Arnold Simpson, Diane St. Onge, Ken Upchurch, and Susan Westrom.
Guests: Mike Peters, Anheuser-Busch Branch Manager; Jennifer Doering, General Manager, Charles Seligman Distributing Company, Daniel Harrison, Country Boy Brewing; Martha Graziano, C.A., Bob Rowland, Impact Government Relations; Nancy Swikert, M.D., Kentucky Academy of Family Physicians and Kentucky Medical Association, Sheila Schuster, Ph.D., Kentucky Coalition of Nurse Practitioners and Nurse Midwives.
Approval of minutes
A motion to approve the minutes from the October 11, 2013 meeting was made by Senator Schickel and seconded by Senator Buford. The motion carried by voice vote.
Welcome from Anheuser-Busch
Mike Peters, Director of Sales and Marketing, welcomed the committee to the distributor warehouse. Anheuser-Busch came to Louisville in 1978 with four percent of the market share, eight route trucks, and thirty-five employees. Today Anheuser-Busch has 59 percent of the market share, selling 5.3 million cases per year with 40 route trucks, 168 employees, and 1,896 retail accounts. Anheuser-Busch is proud to support the community, and alcohol responsibility is its biggest effort. Its employees pledge every year not to drink and drive. The company has a designated driver program, which is an alert cab program for employees who feel they have become impaired so that they will have a safe ride home. There is also an environmental program with a goal to reduce energy use by two percent a year. Community event sponsorship and charities are supported. Mr. Peters said there will be a tour of the facility after the meeting.
In response to a question from Representative Horlander, Mr. Peters said the industry in the state of Kentucky is down this year. He said sales fluctuate for a number of reasons.
Jennifer Doering, General Manager of Charles Seligman Distributing Company said that cider is a fermented alcoholic beverage made from fruit juice. Typically, apples are used, but pears can be used. Cider ranges in alcohol content from 1.2 to 8.5 percent by volume. The growth rate in the United States for cider has reached 69 percent. Sales of cider track nationally with beer. It is packaged and sold with the same appearance as beer--in six pack bottles. Cider is also sold in bars on tap like Sam Adams or Bud Light.
Consumers view cider as a parallel to beer. National brewers have also begun producing ciders, not only because cider is a growing category, but because it shares the same attributes as beer. The Federal Alcohol Act views cider over seven percent as a wine. The FAA defines wine as containing not less than seven and not more than 24 percent alcohol. The federal permit for wholesalers is not required for ciders under seven percent, but in Kentucky there must be a wholesale license to cover hard liquor and wine to sell cider. The industry is asking that cider under seven percent, or weak cider, be treated like malt beverages. Wholesalers and retailers with malt beverage licenses should be able to sell weak cider just like beer. Changing this language to allow cider sales by beer licensees will generate more revenue for the general fund.
Daniel Harrison, co-founder of Country Boy Brewing in Lexington, Kentucky, said the company started on February 10, 2012. It has grown 300 percent since that date, and in the next four months expects to double in size again. The production of cider is identical in production to beer. Therefore, there would be no new or extra equipment for Country Boy Brewing to purchase or install to produce cider. Small Kentucky brewers would like to have the opportunity to make a 100 percent Kentucky grown produce. Kentucky cider could have locally sourced, locally produced 100 percent apple cider.
In response to a question from Senator Buford, Ms. Doering said weak cider is sold only at retail licensees that have a wholesale license that covers hard liquor and wine. The legislation the industry is asking for would broaden distribution to people who have a malt beverage license.
In response to a question from Representative Clark, Ms. Doering said the industry supports the change and that the tax revenue would be the same as beer.
Senator Higdon commented that during the last meeting he had discussed a “catch all” bill that included cider language.
In response to a question from Senator Seum, Ms. Doering said there is no alcohol content limit in malt beverages. Most ciders are in the five percent range.
In response to a question from Representative Montell, Mr. Harrison said his brewery in Lexington produces anything from three percent alcohol up to 12 percent. However, most packaged malt beverages are going to fall in the range of five to seven percent. Cider would be capped at 6.9 percent.
Senator Buford commented that, depending on the Appeals Court ruling, this legislation may not be necessary.
Bob Rowland, representing the Kentucky State Acupuncture Association, said that 44 states have a practice act for acupuncturists. Kentucky is the only one of these states that regulates acupuncture as a certified profession. A change in Kentucky statutes, from certified to licensed, would bring Kentucky acupuncturists into conformity with the other 43 states. Most Kentucky acupuncturists practice in urban areas that border Indiana, Illinois, and Ohio. In these states, acupuncturists advertise as licensed, putting Kentucky practitioners at a competitive disadvantage. There will not be a change in the fee structure or any of the regulations or qualifications to become an acupuncturist. There is no difference in reimbursement from insurance companies for a licensed practitioner or a certified acupuncturist. Acupuncture is not covered by Medicare or Medicaid.
Martha Graziano, C.A., President of the Kentucky State Acupuncture Association, said acupuncture is a highly effective form of medical treatment. There are different styles of treatment with a high success rate. Acupuncture is a non-invasive method to deal with pain. Additionally, it has been used for drug detoxification, smoking cessation, and other addictive substances. Research also supports acupunctures effectiveness in migraine relief. The World Health Organization has recognized acupuncture as an effective modality for 44 conditions. Gen Care in Louisville has on-staff acupuncturists working with physicians.
Training for acupuncturists is a four year program. Continuing education is required for clean needle technique and HIV training. On January 16, 2014, the association will be in the Capitol to offer free demonstrations of acupuncture therapy for anyone who would like to learn more about the treatment.
In response to a question from Representative Clark, Mr. Rowland said that Kentucky’s education requirements meet or exceed national standards. At the time that the bill was originally filed, the grandfather clause was necessary; however, that provision has now sunset, and there are no practitioners who will be unable to practice if the provision is removed from the current legislation.
In response to a question from Senator McDaniel, Ms. Graziano said acupuncturists were given one year to pass a written test and become certified. By 2007, everyone will have met the 1,800 hours of training and will be certified.
Senator Buford said the cutoff date for the grandfather clause has sunset.
In response to a question from Senator Denton, Ms. Graziano said the location of a practitioner’s office is not addressed.
In response to a question from Representative St. Onge, Ms. Graziano said there would be no difference in education requirements by changing from certified to licensed. For acupuncturists from out of state to have reciprocity, they would have to meet the requirements for Kentucky certification or licensure.
Advanced Practice Registered Nurses
Nancy Swikert, representing the Kentucky Medical Association (KMA), said that after months of meetings the KMA and the coalition of nurse practitioners (APRNs) have reached an agreement. This agreement improves access to health care in Kentucky while maintaining the Collaborative Agreement for the Advanced Practice Registered Nurse’s Prescriptive Authority for Nonscheduled Legend Drugs, also known at the CAPA-NS. There will be a joint committee from both boards, three APRNs appointed by the board of nursing and three physicians appointed by the KMA to make recommendations to their boards regarding the CAPA-NS. APRNs, after meeting specified requirements, may opt to practice without the CAPA-NS.
Sheila Schuster, Kentucky Coalition of Nurse Practitioners and Nurse Midwives, said the coalition reached an agreement with the Kentucky Medical Association (KMA). The compromise preserves legislative intent. If an APRN is suddenly without a physician to sign the collaborative agreement, there will be a joint committee to refer to a physician. In this situation, the APRN can still prescribe without a CAPA-NS for 30 days; after a physician has been recommended, the APRN has 30 days to work out the new CAPA-NS. Additionally, language in the 2006 legislation regarding the CAPA-CS (controlled substances) was added to current language to strengthen the CAPA-NS. This adds more reporting with the new legislation. With this compromise, the people of Kentucky will have access to safe, quality health care closer to home.
Representative Keene commended all parties for coming together on the issue.
In response to a question from Senator McDaniel, Ms. Schuster said all APRNs will have a CAPA-NS for four years. At the end of four years, if the APRN chooses to practice without the CAPA-NS, the APRN must notify the Board of Nursing about prescribing without the CAPA-NS. The Kentucky Board of Nursing and the Kentucky Board of Medical Licensure will form a joint committee to supply physician names to APRNs who are unable to find a physician.
There being no further business to come before the committee the meeting was adjourned at 12:05 PM.