Interim Joint Committee on Health and Welfare


Subcommittee on Families and Children


Minutes of the<MeetNo1> 2nd Meeting

of the 2002 Interim


<MeetMDY1> September 18, 2002


The<MeetNo2> 2nd meeting of the Subcommittee on Families and Children of the Interim Joint Committee on Health and Welfare was held on<Day> Wednesday,<MeetMDY2> September 18, 2002, at<MeetTime> 10:00 AM, in<Room> Room 113 of the Capitol Annex. Representative Tom Burch, Chair, called the meeting to order, and the secretary called the roll.


Present were:


Members:<Members> Senator Katie Stine, Co-Chair; Representative Tom Burch, Co-Chair; Representatives Joni Jenkins, Mary Lou Marzian, Ruth Ann Palumbo, and Jon David Reinhardt.


Guests:  Norma France for Impact Plus; Sandra Durerge for First Steps; Laura Crawford, parent; Margaret Wilson, parent; Sarah Cordle, Impact Plus Provider; Laurie Spezzano, parent; Bart Baldwin for the Children’s Alliance; Ann Gordon for the Cabinet for Health Services; and Dietra Paris for the Department for Community Based Services.


LRC Staff:  DeeAnn Mansfield, Murray Wood, and Cindy Smith.


The minutes of the August 20th, 2002 meeting were approved without objection.

First on the agenda was a presentation on Impact Plus – Update on the Autism Waiver by Tricia Salyer, Director of Medicaid Services for Mental Health/Mental Retardation.  She said Impact Plus was implemented in January, 1998 for children with severe emotional problems.  The goal of Impact Plus is to return children to the communities and prevent institutionalization.  The Cabinet looked at the growth of the program and a Program Review study was completed in November.  The Cabinet reviewed the recommendations from that study and planned program changes.  They also looked at the service delivery for autistic children and decided if Impact Plus is the appropriate vehicle to provide for children’s needs.  Impact Plus is a short term and intensive program designed to meet children’s needs. 


Ms. Salyer said there is a new program within the Cabinet, but there is no new money to implement it.  Impact Plus dollars are going to be reallocated.  They are going to begin the waiver with reallocated funds and will have $2 million to start.  She said the waiver draft is not complete and they are still working on the financial area.  They are finalizing the draft and have a meeting with the consortium on September 26, when side by side comparisons when will done, and changes will be made.  It will be submitted to CMS on October 1.


Senator Stine asked when the Legislature will have the report.  Ms. Salyer said after the first waiver year, or when it is requested by the Legislature.


Representative Burch asked if any family was forced to leave the program.  Ms. Salyer said no, they are not, and families are newly diagnosed can be served under the new waiver. 


Representative Reinhardt asked how many children will be served with the $2 million.  Ms. Salyer said 150 children will be served and that there is more interest in the program  than ability to serve.


Next, David Lane, parent of an autistic child, commended the Impact Plus program.  He said there are still many children in Kentucky that need services, but the program is growing and moving in a positive direction.


Next, Margaret Wilson, mother of an autistic child, thanked the Cabinet for the waiver.  She said Impact Plus spends $36,000 a year on her child, and she still spends $10,000 out of pocket in order to get a forty hour a week program for her child, which is needed.


Next, Crystal Johnson, mother of an autistic child, noted that she had not seen a Best Practice Manual, and wasn’t sure that there was one.  She also said she is encouraged to hear that people currently served under Impact Plus will stay in the program.


Next, Paul Brown, parent of a ten year old autistic son, said he was encouraged by the program.  Because of Impact Plus, he is able to receive three hours a week of respite care, and all his child’s pull ups are paid for.


Next, Norma France, a licensed clinical social worker for Impact Plus spoke about the program.  She said there are currently 22 kids under her care, and three have been hospitalized.  She stressed that the kids need an intensive long-term program.


Next on the agenda was a presentation by John Burke of the Kentucky Autism Training Program.  He said the mission of the Kentucky Autism Training Center (KATC) is to enhance supports for person with autism by providing information and technical assistance to families and service providers across Kentucky.  In 1997, three priority goal areas were set including: (1) school based team trainings; (2) family consultations; and (3) early identification.  He pointed out that the assessment of needs and services of identified children with autism has greatly increase since 1992.  The four basic assumptions that guide the development of the KATC are: (1) approach the task in phases; (2) keep stakeholder involved; (3) initiative should be coordinated; and (4) strive to benefit more children.  He said since 1997 they have kept their priority areas,  yet they have sought to expand their services by obtaining additional funding from the Commonwealth of Kentucky as well as from other sources for specific projects.  There are three general categories: (1) family based technical assistance; (2) statewide information dissemination and professional training; and (3) school based team consultations.  Participants in the program suggested the following ways for the KATC to more effectively serve schools and families of students with autism: (1) entire school staff receive training; (2) increased awareness of KATC services; and (3) work directly with families.


Next on the agenda was a presentation by Dr. Kimberly Alumbaugh, obstetrician, and the Chairman of the Kentucky Section of the American College of Obstreticians and Gynecologist.  She stressed that there is a crisis with respect to malpractice insurance for OB/GYNs.  In 1999, the total number of live births was 54,492.  This number has gone up since 1997.  In Kentucky, there are 520 licensed OBGs, and approximately 75 percent do both OB and GYN.  That leaves 390 Obs to take care of 54,492 life births, or 140 deliveries per each and every OB.  If you lose even one OB, that means 140 patients have to relocate to a different doctor.  She said in Louisville, the busiest provider of Medicaid OB discontinued providing OB services this year because of the outrageous cost of his malpractice premium.  He represented 500 deliveries each year.  Doctors are leaving OB because the liability risks and the costs to bear that burden have clearly begun to outweigh any incentive to continue delivering babies.


Representative Marzian asked if OB/GYNs were the hardest hit group buying malpractice insurance.  Dr. Alumbaugh said they are not the hardest hit monetarily, but have the biggest access problem.


Next on the agenda was a presentation by Stephen Hanson, CEO, Appalachian Regional Hospital.  He said Kentucky’s health care providers are facing a liability insurance crisis.  The current liability insurance crisis threatens to tighten the access creating a stranglehold in rural communities and creates a system where only those who have the ability to travel outside the community can access health care.  The number of claims and lawsuits against health care providers has remained stable over the past five years.  The number of claims have remained stable, but the cost of liability insurance coverage has continued to rise because malpractice awards are skyrocketing.  There have been eight verdicts of over $1 million in medical negligence cases against physicians and hospitals in Kentucky.  Another cause of the current crisis is the increasing costs of defending a medical liability case.  Another cause is the decreasing options for insurance coverage are driving the costs up.  There are few options for hospital and physicians looking for liability coverage regardless of the cost.  Currently there are 19 insurance companies licensed to write medical malpractice coverage in Kentucky, but many of those carriers do not provide coverage for hospitals, are not taking new business, or are non-renewing accounts. 


Next on the agenda was a discussion of Child Support, Guidelines, Collection and Enforcement.  First Steve Veno, Director of the Division of Child Support said his office has had a successful  year, and has collected $300 million, which is $26 million more than the previous year.  There has also been a 70-78 percent increase in paternity establishment.  The Division of Child Support is working with the Revenue Cabinet to collect support.  He also noted that Boone County was the number one county in collection of child support. 


Next, Vickie Wise  of the Child Support Enforcement Commission spoke.  She said there has been a $28 - $29 million increase this year in collections.  She also noted that due to Senate Bill 218 of the 2000 session, which allowed the publication of Kentucky’s most wanted child support offenders, many evaders of child support have been caught.  Of the fourteen pictured on the list, ten have been apprehended.


Next on the agenda, Natalie Wilson of the Child Support Guidelines Commission spoke. The Child Support Guidelines Commission has no budget and no regular staff.  They are strictly a volunteer commission.  She said KRS 403.213 gives the Child Support Guidelines Commission the ability to review child support guidelines once every four years.  After review, they refer their recommendations to the General Assembly.  Guidelines are updated based on new economic data. 


Representative Marzian asked that the Commission be careful when changing child support guidelines.

            Representative Burch told the members that the Child Support Guidelines Commission meets monthly and encouraged all members to attend.


The meeting was adjourned at 12:22 p.m.