The3rd meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, October 16, 2002, at 1:00 PM, in Room 129 of the Capitol Annex. Representative Tom Burch, Chair, called the meeting to order at 1:15 PM, and the secretary called the roll.
Members:Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Charlie Borders, Tom Buford, Paul Herron, Jr., David K. Karem, Daniel Mongiardo, Joey Pendleton, Richard Roeding, and Katie Stine; Representatives Paul Bather, Brian Crall, Robert Damron, Bob DeWeese, James Gooch, Bob Heleringer, Joni Jenkins, Mary Lou Marzian, Stephen Nunn, Jon David Reinhardt, Kathy Stein, and Susan Westrom.
Guest Legislator: Representative Ron Crimm.
Guests: Shirley Eldridge, Charlene Manuel, and Sharon Chisley, Cabinet for Families and Children; Bob Esterhay and Peter Hasselbacher, University of Louisville; Bill Doll, Kentucky Medical Association; Beecher Hudson, Louisville Red Cross and KPTA; Carol Steltenkamp, M.D., and Claire Pomeroy, M.D., University of Kentucky; Germaine O’Connell, Janet Luttrell, Sue Billings, Danna Droz, and Betty H. Olinger, Department for Public Health, Cabinet for Health Services; Matthew Hall, Humana, Louisville; Paula Bendl Smith, Kentucky Association of Child Care Resource and Referral Agency, Frankfort; Floyd Parrish, Office of the Inspector General; Bart Baldwin, Children’s Alliance, Frankfort; Nathan Goldman and Michael Bloyd, Kentucky Board of Nursing, Louisville; Ellen Kershaw, Alzheimer’s Association, Louisville; Cathy Allgood Murphy, American Association of Retired Persons, Louisville; David Allgood, Center for Accessible Living, Louisville; Nancy L. Black, Psychology Board and Social Workers Board, Frankfort; John Sammons, Office of Aging Services, Long-Term Care Ombudsman, Cabinet for Health Services; Jack Marston, CDP, Frankfort; Steve Shannon, Kentucky Association of Regional MH-MR Programs, Inc., Lexington; Prentice Harvey, Norton Healthcare, Frankfort; Natalie Kelly, Department for Mental Health/Mental Retardation Services, Cabinet for Health Services; Anne Joseph, Kentucky Task Force on Hunger, Lexington; Donna G. Brown, Kentucky Association of Health Care Facilities; Rosanne Barkley, Cabinet for Families and Children; Darla Bailey, Kaleidoscope, Inc., Louisville; Ann Hunsaker, Cabinet for Health Services; Bill Bowers, Astra Zeneca Pharmaceuticals, Ohio; Karen Lentz, J & J, Louisville; J.K. Millard, Verified Prescription Safeguards, Lexington; Stephanie Bell, Kentucky Academy of Trial Lawyers; Sarah Nicholson, Kentucky Hospital Association, Louisville; and Sheila Schuster, Kentucky Mental Health Coalition, Louisville.
LRC Staff: Robert Jenkins, CSA; Barbara Baker, Eric Clark, DeeAnn Mansfield, Gina Rigsby, Cindy Smith, and Murray Wood.
A motion was made to approve the minutes of the September 18, 2002 meeting by Senator Buford, seconded by Representative Crall, and approved by voice vote.
The first agenda item was the report of each subcommittee. Representative Burch, Co-Chair, Families and Children Subcommittee, reported that the subcommittee met and reviewed the changes to the Impact Plus Program, heard testimony about changes and short timeframes regarding the Cabinet for Families and Children contracts with private agencies for child placement and treatment, and heard testimony that the number of vacancies in private agencies and in cabinet foster homes has increased and that the cabinet is working to meet federal mandates to reduce the amount of time children spend in out-of-home care. A motion to accept the report was made by Senator Buford, seconded by Representative Nunn, and approved by voice vote.
Senator Denton, Co-Chair, End-of-Life/Long-Term Care Subcommittee, reported that the subcommittee met and received presentations on the case-mix index with the Department for Medicaid Services and on issues confronting the long-term care community. A motion to accept the report was made by Senator Buford, seconded by Representative Marzian, and approved by voice vote.
The first item of discussion was an update on the Jefferson County Medicaid Transportation System with Kevin Flanery, Secretary of the Finance and Administration Cabinet; Mike Robinson, Commissioner of the Department for Medicaid Services, Cabinet for Health Services; and Vicky Bourne, Transportation Cabinet. Secretary Flanery stated that all interested parties had been communicating about the problems in Jefferson County. Senator Karem stressed that the number of complaints reflects a need to accurately evaluate the situation. Representative DeWeese stated that services should not be cancelled while waiting for a solution. Secretary Flanery said that a broker must develop and coordinate the network of providers, and if a subcontractor can no longer participate, the broker must replace the provider.
Representative Marzian said that recipients had been told not to call the 800 number so there would not be a log of complaints. Secretary Flanery stated that anyone can call 1-888-941-7433 to ask questions and voice concerns. This number will automatically connect to the Transportation Cabinet. Representative Marzian, Senator Herron, and Representative Crimm all stated that constituents have called to complain about waiting long periods of time before being picked up to go to and/or come from appointments. Representative Crimm asked why the broker was not bonded and how it was determined if the broker was capable of providing services. Secretary Flanery stated that someone is not chosen merely because the company has submitted the lowest bid, because there are additional requirements that must be met before qualifying to become a broker.
Senator Denton said that all cabinets involved have been aggressively addressing the problem to find a solution. Her concern was that the broker had not performed within the contract and had also refused to release information or appear before the committee. She asked if there was a way to take the contract away from CTG and, if so, if there is a back-up plan. Senator Roeding stated that if there are so many complaints, there should be language in the contract to be able to replace the broker. Secretary Flanery said that there is a regulatory process in place that will allow the cabinet to take action. If someone has a complaint, he can call the Department for Medicaid Services at 502-564-4321, Vicky Bourne, Transportation Cabinet at 502-564-7433, or 1-888-941-7433.
Senator Stine explained that Northern Kentucky has problems as well and that the Program Review Subcommittee has looked into the matter. She asked if there were any reason an adult day care could not have a contract. Secretary Flanery stated any willing provider is able to get a contract because choice is very important. Senator Karem stated that the broker has been paid, but the problem is that broker is not reimbursing the subcontractors. Secretary Flanery said that he would look into the matter. Representative Burch stated that the number of complaints is dropping each month since the Transportation Cabinet, Department for Medicaid Services within the Cabinet for Health Services, and the Finance and Administration Cabinet have been working together to address the problems.
A motion to approve 201 KAR 20:070, 201 KAR 20:095, 201 KAR 20:110, 201 KAR 20:215, 201 10:225, 201 KAR 26:160, 201 KAR 29:010, 201 KAR 29l060, 902 KAR 19:010, 921 KAR 2:019, and 921 KAR 3:042 referred on September 16, 2002 and 201 KAR 8:450, 201 KAR 23:075, 902 KAR 2:020, 902 KAR 8:150, 902 KAR 55:025, 902 KAR 55:030, 902 KAR 55:090, AND 907 KAR 1:055 & E referred on October 10, 2002 was made by Senator Karen, seconded by Representative Stein, and approved by voice vote.
The next agenda item was an update on the KIDS NOW Program achievements and the HANDS Program by Dr. Kim Townley, Executive Director, Governor’s Office of Early Childhood Development; Delilah Ramos, Jamie Edwards, and Kimiko Martin, HANDS participants; Debbie Greene, Nurse Coordinator, Georgetown Child Development Center; and Kim Copeland, Director at LaPetite Academy, Bowling Green.
Dr. Townley stated that, in order to reach the goal that all young children in Kentucky are healthy and safe, possess the foundation that will enable school and personal success, and live in strong families that are supported and strengthened within their communities, 25 percent of Kentucky’s Phase I Tobacco Settlement dollars had been designated to fund the early childhood development initiative. She gave updates on the Healthy Babies Campaign, the Folic Acid Campaign, the Substance Abuse Treatment Program for Pregnant and Post-partum Women, the Universal Newborn Hearing Screening, the Immunization Program for Underinsured Children, the Eye Examinations for Children Program, the Oral Health Education and Prevention Program, the HANDS Voluntary Home Visiting Program, the Early Childhood Mental Health Program, Children’s Advocacy Centers, Access to Child Care Subsidy, STARS for KIDS NOW, Scholarship Fund for Childcare Providers, Increased Licensing Personnel, Health Start in Childcare, Community Early Childhood Council Funding, First Steps: Kentucky’s Early Intervention System, the Early Childhood Development Authority, the Business Council, the Professional Development Council, the Evaluation of Initiative, training, and Child Safety in Childcare.
Ms. Ramos said that she enjoyed the HANDS Program because it is nice to have someone come to the house who cares and has training to help with her child. She said that the HANDS worker is very helpful with questions and is always available. With the HANDS program, she said that she has access to other programs that will help her make more informed decisions for her and her child.
Ms. Edwards said that the HANDS program helps her find the resources she needs to help with her child. The staff has helped her complete worksheets to track the progression of her daughter, who was born premature.
Ms. Martin stated that she participated in the HANDS program in Lexington at the Family Care Center and that the information that these people leave at her home helps her and her fiancée to make informed decisions about their child. Every four to six weeks she must complete a goal sheet. She now has a full-time job and a permit. She said that she now serves on the Family Care Center/HANDS Advisory Council and is able to have input on how to reach more parents. Dr. Townley said that the data has shown that the HANDS program has worked.
Ms. Greene said that her goal as a director is to provide a safe, nurturing, and developmentally appropriate environment for the children in her care and for their parents. Being able to give parents peace of mind about their child’s first year is a huge responsibility and one that she enjoys. Watching a child grow and learn new things and being able to be a part of that is a very rewarding experience. She said that the first semester of college was financially draining for her and her husband but the KIDS NOW Scholarship Program then was formed and now covers the cost of her classes. Her center is able to apply money toward the cost of books. Going to college has been rewarding because no matter how long someone has been in child care, something new can always be learned. She stated that in order for a child to reach his or her fullest potential, a teacher must understand the growth and development of a child. Increasing knowledge and training through the child care initiatives has taught that the first three years of a child’s life are the most important part in their development. Participating in the scholarship program has helped identify children who may need referral services and how to discuss the process with parents.
Ms. Copeland said that the KIDS NOW scholarship program has given her the opportunity to pursue a degree in a field that means a great deal to her. Without the financial assistance provided by the program, those pursuing a career in early childhood education would not be able to better themselves or provide the best level of quality care for the children and families that are served every day. Giving children a good foundation is essential in their continuing education. The program has increased retention of staff by allowing them to see early childhood development as a career and also has given them credibility with the families. The KIDS NOW Scholarship Program has impacted her center by helping provide and implement a more enriching educational program and a higher level of quality of care for the children. Representative Marzian said that it is nice to know that the General Assembly has been able to help Kentucky’s children.
The next agenda item was prefiled legislation, 03 BR 107, AN ACT relating to the electronic health network and declaring an emergency, sponsored by Representative Steve Nunn. A presentation of the University of Kentucky’s and the University of Louisville’s health network was given by Dr. Carol Steltenkamp, Integrated Clinical Information System (ICIS) Project, University of Kentucky; and Dr. Bob Esterhay, Director, Health Informatics, University of Louisville. Representative Nunn explained the intent of his legislation.
Dr. Esterhay said that 105 of the 120 Kentucky counties are federally designated as medically underserved, and accessing specialty care often requires travel to distant medical centers. Rural clinicians experience professional isolation and recruitment, and retention is difficult. He said that telehealth technology extends resources of the university medical centers to bring specialty services to rural facilities. The telehealth network provides increased access to clinical and educational programming. The Kentucky Telehealth Organization consists of 60 participating sites, two training centers from the University of Kentucky, two training centers from the University of Louisville, the Kentucky Telehealth Network Board, and the Governor’s Office of Technology.
Dr. Esterhay said that the board mandated the development of an evaluation plan for the optimal deployment of telehealth resources. Literature was reviewed on state-of-the-art issues for telehealth evaluation. Stakeholders were identified and had input on elements of an evaluation plan, and were introduced to the broader vision of e-health for population health. Telemedicine is the use of electronic communication and information technologies to provide or support clinical care at a distance. Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration. E-health is the use of the internet to deliver all forms of electronic health care ranging from informational, educational, and commercial products to direct services.
Dr. Esterhay stated that the proposal to the Kentucky Telehealth Network Board included the following: 1) expand electronic public health record system (e-PHRS) statewide for registrations and demographics; 2) make use of other e-PHRS applications such as patient referral and patient encounter for telehealth purposes; 3) add specific telehealth application to e-PHRS; and 4 ) utilize application service provider (ASP) hosting model. He said that telehealth is one means to address problems in health care and complements approaches to the larger vision of e-health. E-health encompasses interdisciplinary aspects of health information sciences, public health, and health care delivery. E-health is a way to improve health care with a local, regional, national, and ultimately global scope. The Kentucky e-health network is a strategy to reduce cost and improve quality in health care, and has administrative, financial, clinical, and research components.
Dr. Esterhay said that 03 BR 107 would reorganize the Telehealth Board as the Kentucky E-health Board, attach the board to the Governor’s Office of Technology, establish membership and responsibilities of the board, require the board to conduct a feasibility study of various network models, require selected models to comply with HIPAA regulations, and require submission of results of the study and selected models to the Legislative Research Commission. The vision of e-health is to improve personal clinical health and population health through efficient and effective management of health information needed to accomplish desired outcomes and results through optimal use of resources. The framework for e-health is more comprehensive than telehealth, represents different drivers and perspectives, acknowledges realities of the current economic climate, recognizes an environment where the patient-consumer makes demands based on better information, and evolves to deliver all forms of electronic health care ranging from informational, educational, and commercial products to direct services.
Dr. Steltenkamp stated that, like most United States health care systems, the University of Kentucky had a disjointed system of patient, financial, and administrative records. A goal was established to deliver high quality health care in a cost-effective manner to all Kentuckians consistent with national trends. She said that e-health is a system that offers an electronic patient medical record, a physician order entry, a clinical decision support, an electronic disease management, a new approach to improving access, an electronic billing and claims processing, insurance eligibility checking, and monitoring of and response to bioterrorism. The old system did not support quality, cost-effective care because of multiple medical records scattered across the enterprise. The strategic plan highlighted the lack of clinically-focused information systems and senior leadership endorsed enterprise-wide electronic medical record.
The mission of the Integrated Clinical Information System (ICIS) Project was to implement an integrated clinical information system as a tool to support quality patient care, facilitate business process redesign, and maximize benefit realization at the University of Kentucky Clinical Medical Center. The ICIS project began in 2000 with projected completion in 2006. The initial focus is to improve access and a knowledge-based physician order entry, while also being HIPAA-compliant. The cost of the project is $64 million, but will have a savings of $41 million to $193 million by a reduction in adverse drug events, reduction in paper forms, improved medication utilization, and reduction in ancillaries and LOS. The future of the ICIS Project is to have daily nurse and physician documentation on the computer, to explore expanding access to physicians with frequent referrals to the U.K. Medical Center, to explore a patient’s ability to access verified results and provide and update health history, and to explore linkages to a statewide e-health system. The potential benefits are improved quality of patient care and increased efficiency to the health care system.
Senator Karem said that all doctors and hospitals should have access to patient information. Senator Mongiardo stated that e-health is an economic development tool and that he has prefiled a similar bill in the Senate. Representative Bather said that e–health will lower health care costs and hopes that there will be cooperation in both chambers.
The next agenda item was an update on domestic violence by Carol Jordan, Executive Director, Governor’s Office of Child Abuse and Domestic Violence Services. Ms. Jordan stated that the mission of the Center for Research on Violence Against Women at the University of Kentucky is committed to preparing students and advancing scientific inquiry into the legal and clinical complexities presented by domestic violence, rape, stalking, and related crimes against women, and is dedicated to enhancing the welfare and safety of those impacted by the crime through research, scholarship, and public service.
Ms. Jordan said that, in 1996, Crowell & Burgess concluded that significant gaps exist in understanding the extent and causes of violence against women and the impact and effectiveness of preventive and treatment interventions. In order to begin filling those gaps, the Panel on Research on Violence Against Women recommended a research agenda to facilitate development in four major areas: 1) preventing violence against women; 2) improving research methods; 3) building knowledge about violence against women; and 4) developing the research infrastructure. She said that a significant need for outcome research will benefit the public policy domain, as will research on the role of professionals in violence against women cases and the attendant impact of work in the areas of mental health and criminal justice. The report stated that further examination of the criminal justice system and the application of criminal policy and law in violence against women cases are needed.
Ms. Jordan said that a $2.5 million Byrne Grant to address child sexual abuse was received at the request of Governor Paul Patton and First Lady Judi Patton in the spring of 2001, with funds provided to Kentucky under the grant in September, 2002. The projects funded under the Byrne Grant focus on technology, forensic interviewing, and multidisciplinary teams. The Byrne Grant technology initiatives and data systems allowed Kentucky to: 1) create a statewide data system for all child advocacy centers, 2) create a statewide data system for multidisciplinary teams; 3) access data for child protective services workers while on-site at a child advocacy center; and 4) create a statewide data system for prosecutors. The forensic interviewing initiative funded the Forensic Interviewing Training Project and will sponsor a statewide training for law enforcement on forensic interviewing of sex offenders. The initiatives to aid multidisciplinary teams developed 15 regional contracts locally and were submitted by regional children’s advocacy centers and contracted through the Kentucky Multidisciplinary Commission to create a model protocol for multidisciplinary teams.
The next agenda item was discussion on 907 KAR 1:019 & E with questions answered by Mike Robinson, Commissioner, Department for Medicaid Services, Cabinet for Health Services, Dr. Moore, and Troy Koch, Pharmacy Benefit Manager, Department for Medicaid Services, Cabinet for Health Services. An amendment to insert “unless the department has established a longer approval period for a specific drug” on page 15, Section 4(5), line 6, after “365 days” was offered Senator Roeding, seconded by Representative Heleringer, and approved by voice vote. Representative Damron asked why this amendment was not brought before the Administrative Regulation Review Subcommittee for its approval. Mr. Robinson stated that the Pharmacy and Therapeutics Committee of the Cabinet for Health Services did not meet until after the Administrative Regulation Review Subcommittee and, therefore, was not able to offer it then. Senator Roeding offered two further amendments that provided that: 1) a patient would not be required to fail on a drug for longer than five days before receiving prior authorization for another drug, and that therapeutic failure would be at the discretion of the prescribing practitioner who would make a determination of failure within one to five days; and 2) that failure of a drug would not be a prerequisite for prior authorization. The Cabinet for Health Services opposed both amendments stating that the Pharmacy and Therapeutics Committee knows best what drug needs to be placed on the prior authorization list. Senator Denton said that 907 KAR 1:019 would be deferred until the November meeting, with the cabinet approving the deferral and there being no objections from members.
Senator Roeding, Co-Chair, Senior Prescription Drug Subcommittee, reported that the subcommittee met and heard testimony from Dennis Smith, Director of the Center for Medicaid and State Operations and Deidre Duzor, Co-Leader of the Medicaid Pharmacy Team at the Centers for Medicare and Medicaid Services. A motion to accept the report was made by Senator Roeding, seconded by Representative Burch, and approved by voice vote.
The next agenda item was a presentation on the FY 2003 Community Mental Health Services Performance Partnership Block Grant by Lou Kurtz, Department for Mental Health/Mental Retardation Services, Cabinet for Health Services.
The next agenda item was a presentation of the FY 2003 Preventive Health and Health Services Block Grant by Janet Luttrell, Block Grant Coordinator, Division of Adult and Child Health, Chronic Disease Prevention and Control Branch, Department for Public Health, Cabinet for Health Services. Senator Stine expressed her concern about the “morning after” pill being covered by the grant and family planning not included in the block grant. Dr. Steve Davis said that the “morning after” pill does not fall under this block grant. He also said that the block grant is flexible to refocus funds on other areas as long as the objectives are met, and that other block grants address family planning.
There being no further business, a motion to adjourn at 3:35 was made by Representative Nunn, seconded by Representative Burch, and approved by voice vote.