Call to Order and Roll Call
The 4th meeting of the Interim Joint Committee on Licensing and Occupations was held on Friday, September 9, 2016, 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 Joe Bowen, Jimmy Higdon, Ray S. Jones II, Christian McDaniel, Dan "Malano" Seum, and Damon Thayer; Representatives Tom Burch, Denver Butler, Larry Clark, Dennis Horlander, Joni L. Jenkins, Reginald Meeks, Jerry T. Miller, David Osborne, Darryl T. Owens, Ruth Ann Palumbo, Sal Santoro, Arnold Simpson, and Susan Westrom.
Guests: Jill Farmer, CTRS, Frazier Rehabilitation Institute, Louisville, KY, Cliff Burnham, CTRS, Cumberland Hall, Hopkinsville, KY, Dale Lynn, OTR/L, Lynn Occupational Therapy, Owensboro, KY, Leigh Ann Thacker, Kentucky Physical Therapy Association; Kathryn Warren, Certified Genetic Counselor, University of Louisville, Amanda Henson, VP Oncology, Baptist Health Lexington.
LRC Staff: Tom Hewlett, Bryce Amburgey, Jasmine Williams, Michel Sanderson, and Susan Cunningham.
Approval of minutes of August 30, 2016
A motion to approve the minutes of the August 30, 2016 meeting was made by Representative Dennis Keene and seconded by Senator Damon Thayer. The motion was adopted by voice vote.
Senator Schickel recognized Marc Guilfoil and Jamie Eads from the Kentucky Horse Racing Commission who had been put on the agenda to explain a Kentucky Administrative Regulation. Senator Schickel said that he had spoken with them regarding the regulation and that their testimony was not needed. He thanked them for coming to the meeting.
Recreation Therapists
Jill Farmer, manager of recreation therapy at Frazier Rehab Institute in Louisville, said that she has worked in the recreational and community settings for over 23 years and explained that recreation therapy is provided to individuals with disabilities and disabling conditions covered under the Americans with Disabilities Act. Therapists use a variety of techniques such as arts and crafts, trained therapy animals, dance, drama, and community outings. Recreation therapists should not be confused with recreational workers, who organize recreation activities for enjoyment or entertainment. Recreation therapists practice in hospitals, community based parks and recreation programs, mental health facilities, Veteran’s Administration facilities, schools, assisted living communities, and day care settings. Clients are people with brain injuries, mental illness, intellectual disabilities, dementia, spinal cord injuries, Alzheimer’s disease, and cardiovascular and pulmonary diseases, and veterans and other wounded military personnel.
Eastern Kentucky University is the sole provider of therapeutic recreation curriculum in the state. Kentucky has 113 professionals with certified therapeutic recreation specialists (CTRS) credentials. Recreation therapy is an integral component of health and wellness and recovery and quality of life. In recent years, Kentucky has hosted the National Wheelchair Basketball tournament, the United States Quad Rugby Championship, and the National Collegiate Wheelchair Tennis tournament.
Cliff Burnham, Director of Recreation Therapy Services at Cumberland Hall Hospital in Hopkinsville, said he has been practicing recreation therapy for 17 years. The American Therapeutic Recreation Association (ATRA) was incorporated in 1984 to recognize recreation therapy as a systematic process that utilizes recreation and other activity-based intervention to address the assessed needs of individuals with an illness and/or disabling condition, as a means to improve psychological and physical health, recovery, and well-being. ATRA defines recreation therapy as “a treatment service designed to restore, remediate, and rehabilitate a person’s level of functioning and independence in life activities.” It also helps to promote health and wellness and reduce or eliminate the activity limitations and restrictions to participation in life situations caused by an illness or disabling condition.
The National Certifying Body for Recreation Therapy (NCTRC), established in 1981, defines the scope of service for recreation therapy. The primary purpose of recreation therapy is to improve health and quality of life by reducing impairments of body function and structure and reducing activity limitations, participation restrictions, and environmental barriers to the clients. The goal is to facilitate full involvement in community life. This is consistent with standards of practice in the U.S. Department of Labor, and the Bureau of Labor Statistics according to the Occupation Outlook Handbook.
Certified therapeutic recreation specialists of Kentucky are asking for licensure in order to ensure the safety and protection of the public. Licensure will provide a clear and concise definition for the scope of practice for the profession and will set minimum standards for education, experience, and testing of those practicing therapeutic recreation. Other states with licensure for recreation therapy include North Carolina, New Hampshire, Oklahoma, and Utah. Fifteen additional states pursuing licensure.
Senator Schickel said there are two sides in requesting licensure, one being public protection; however, he has learned that public protection is a code word for creating a bureaucracy to keep competitors out and use continuing education to charge fees. The committee is left to decide if these reasons are necessary reasons for licensure. It would be helpful if the committee could be provided with a draft of the proposed legislation as soon as possible.
In response to a question from Representative Owens, Ms. Farmer said Eastern Kentucky University has a four year bachelor degree in Parks and Recreation Administration with an emphasis in Recreation Therapy. There will be a fee for licensure. She added that currently hospital do require that recreation therapists have a certificate.
In response to a question from Representative Clark, Ms. Farmer said the scope of service and language appropriate to the profession need to be put in place.
In response to a question from Representative Burch, Mr. Burnham said the service animals used in his facility came from Canine Companions for Independence, a national organization that breeds, trains, and places their dogs to meet the needs of clients. Mr. Burnham’s facility does not train the dogs. Ms. Farmer said dogs are trained a minimum of two years to meet specific needs of clients such as mobility, emotional, or trauma issues.
In response to a question from Senator Higdon, Mr. Burnham said there would be a new board created. Ms. Frazier said all 113 certified therapists would seek licensure. Senator Higdon commented that there would be a fiscal impact due to the state paying 30 percent of the Medicaid cost.
In response to a question from Representative Horlander, Ms. Frazier said there are plans to work with representatives from the occupational therapy and recreation therapy associations.
Leigh Ann Thacker, legislative agent for the Kentucky Physical Therapist Association, said that KPTA is not opposed to recreation therapists being licensed or billing for their services. However, the KPTA has seen draft language and is concerned about scope of practice. It has attempted to meet with the recreation therapists several times, but meetings have been scheduled and then cancelled. Bills have passed in other states, so there is language that can be worked out.
Beth Ennis, private practitioner, Associate Professor at Bellarmine Physical Therapy Program and member of KPTA, said that KPTA has provided the recreation therapists with language from Utah and Oklahoma that are very specific to the scope of practice for recreation therapy, including a definition of recreation therapy. This language was not in the draft that KPTA saw. Neither was there a code of ethics.
Dale Lynn, OTR/L, Vice President of the Kentucky Occupational Therapy Association, said the recreation therapists have a draft. The description of recreation therapy is for occupational therapy licensed in Kentucky. The draft describes providing psycho-social services; however, requirements in a bachelor’s degree are not adequate to receive a minor in psychology.
Ed Dobrzykowski, representing the KPTA, said the proposed legislation should have language that would not preclude other licensed professionals from providing services.
Genetic Counselors
Kathryn Warren, MS, CGC, said that she is board certified as a Genetic Counselor and works at the University of Louisville. Genetic counselors are healthcare providers with a two year, Master’s level program, and have expertise in molecular biology, medical genetics, and psycho-social counseling. National accreditation of genetic counselors is administered by the American Board of Genetic Counseling. There are approximately 20 genetic counselors in Kentucky. Ms. Warren said she primarily works in prenatal genetic counseling, but is also contracted with Norton Healthcare. A prenatal genetic counselor meets with patients to discuss their personal or family history, ultrasound findings and test results, and how those findings might affect current or future pregnancies. Genetic counselors contact patients with results from the state mandated new born screening program to explain medical aspects of the results of the screening and provide psychological support during the next steps in treatment. There are cancer genetic counselors, and pediatric genetic counselors to name only a few.
Kentucky does not have a law for licensure of genetic counselors. There are 21 states, including Ohio, Indiana, Tennessee, and Virginia, that have licensure, 20 other states that have bills introduced. Licensure would provide greater access to genetic counselors in Kentucky. It is anticipated that genetic counselor fees for services would be lower than physician charges. There is rapid growth in the number of genetic tests available. In a survey of non-genetics physicians, 72 percent responded that their knowledge of genetics was fair to poor. Genetic counselors take the burden off physicians to research genetic conditions and treatment of genetic diagnosis to adequately inform patients. Licensure of genetic counselors will improve access to counseling and treatment.
Amanda Henson, Vice President of Cancer Services at Baptist Health Lexington, said that Baptist Health is fortunate to have two board certified genetic counselors on staff. These two counselors travel or provide telemedicine to hospitals at Hardin, Paducah, and Madisonville. With the changes in targeted cancer therapies and the genomic testing movement, these counselors are integral in planning patient treatment.
In response to a question from Senator McDaniel, Ms. Warren said counselors help with deciding which tests are appropriate to have done, then help with the interpretation and management of the results from the test. Ms. Henson added that counselors work with surgeons who do not have the expertise in knowing which genetic tests to order.
In response to a question from Representative Meeks, Ms. Warren said genetic counselors do not make recommendations, or tell someone they should not have children, or what to do with a pregnancy, or even to have a test. Genetic counselors are in the business of providing information. Kellie Jackson, Genetic Counselor at the University of Louisville, said part of the definition of genetic counselors is to not influence people’s decisions. Genetic counseling arose directly against the eugenic movement. They do not want to influence society but instead want to provide information and education.
In response to a question from Representative Westrom, Ms. Warren said there are 20 genetic counselors in the state and about 4,000 nationally. Ms. Henson added that there are nine positions in the state that employers have been unable to fill.
There being no further, the meeting was adjourned at 11:02 AM.