The3rd meeting of the Subcommittee on Families and Children of the Interim Joint Committee on Health and Welfare was held on Wednesday, October 16, 2002, at 8:30 AM, in Room 113 of the Capitol Annex. Representative Tom Burch, Co-Chair, called the meeting to order, and the secretary called the roll.
Guests: Judith Bloor and Gail Huecker for the Home of the Innocents; Barbara Kaminer for the Department for Mental Health/Mental Retardation; LeAnn Magre for Impact Plus; Kathy Adams for the Cabinet for Families and Children, Department of Community Based Services; Cathy Vittitow, Vicki King and Jerry Cantrell for Bellewood; Margaret Pennington for the Department for Mental Health/Mental Retardation; Maureen Fitgerald for Protection and Advocacy; Judy Lambeth for Maryhurst; Donna Mullins and Rhonda Edwards for the Cabinet for Health Services, Rick Pack for the Cabinet for Families and Children; Eileen Moore for Holly Hill Children’s Homes and Melissa Lawson for the Children’s Alliance.
LRC Staff: DeeAnn Mansfield, Murray Wood, and Cindy Smith.
The minutes of the September 18, 2002 meeting were approved without objection.
The first item on the agenda was a discussion on the recent changes in the Impact Plus Program by Bart Baldwin, Executive Director of the Children’s Alliance, Dr. Eugene Foster, Chairman of the Children’s Alliance Board, and Tricia Salyer of the Cabinet for Health Services.
Dr. Foster began by saying that the intent of the Impact Plus program is to prevent the unnecessary use of psychiatric hospitalization and institutional care by providing community-based alternative treatment to Kentucky’s at-risk children and families. Impact Plus is cost effective, by preventing more expensive levels of care, and is compatible with best-practice standards in the field. The Cabinet for Families and Children recognized a need for better management of the Impact Plus program and to “gate keep” the flow of children into residential settings. Member agencies of the Children’s Alliance also recognized these problems and worked cooperatively with Secretary Morgan and her staff to develop a better management system. The idea was to tighten eligibility criteria to limit services to only those the program was intended to serve, to control access to residential care to only those needing it short term while preparing to return home from hospitals, and to develop community-based alternative to met the growing need. The Children’s Alliance and the Cabinet for Health Services recognized that a corresponding increase in community-based services would be required to offset the decrease in the use of residential care. This has not happened. Indeed, denials of access to community-based services by the Healthcare Review Corporation have greatly increased since the new e-regulations took effect May 22. In order for Impact Plus to fulfill its intent, it is necessary that the Cabinet for Health Services, the Healthcare Review Corporation and the provider community work together to remove the barriers that are now preventing access to community-based services.
Bart Baldwin said the Children’s Alliance totally supports the Impact Plus Program. He said they have met with the Cabinet for Health Services numerous times, and there have been changes over the last three years. There was a meeting last Friday with the Cabinet and the providers . The first meeting with the Cabinet was on October 17, and they are working on improving communications. The Children’s Alliance asked the Legislature to support the Cabinet in allowing them to operate and grow the Impact Plus program.
Representative Burch asked if more children are having stays in hospitals.
Tricia Salyer said psychiatric hospitals stays are increasing slightly, but not necessarily because of changes made in Medicaid. With any increase, it can be because there is an increase in the number of persons able to get services through Medicaid.
Representative Burch asked if the Cabinet and providers are working together. Bart Baldwin said there have been many discussions between the Cabinet and the Children’s Alliance, and he wants the Legislature to offer support to the provider community.
Representative Burch asked for the number of children in psychiatric hospitals currently and the number of children in psychiatric hospitals at this time last year. Ms. Salyer said she did not have those figures with her, but would get that information to the members of the Subcommittee.
The next item on the agenda was a discussion of out-of-home placement of Children by Bart Baldwin, Executive Director of the Children’s Alliance, Bonnie Hommrich, April Vandeventer, and Kathy Adams of the Cabinet for Families and Children.
Bart Baldwin said that out-of-home placement of children is an important issue. There are issues regarding transportation. They are working with the Cabinet on the requirement that transportation for children up to 90 miles away is provided by the providing agency. There is language to reduce that area to 40 miles or less. The main reasons to reduce this are due to staffing concerns in relation to long distance travel and the increase in dollars to provide the services.
Representative Burch asked what would happen if services are not available within 40 miles. Mr. Baldwin said that the Cabinet would reimburse the provider mileage above 40 miles.
Mr. Baldwin said that the Cabinet has several federal mandates to improve quality and to shorten the length of stay. The Children’s Alliance supports federal guidelines. The most appropriate placement for the child is a main concern, and there is placement coordination to find the best place for the child.
Bonnie Hommrich said there have been 550 adoptions this year, and 82% of children return home within six months. She said the Secretary Miller recommended the use of private child care foster homes to keep children in their home communities.
Representative Burch asked the 500 adoptions finalized this year, how many children still need to be adopted. Ms. Hommrich said there are over 1000 children waiting to be adopted.
Representative Damron voiced concern about the short turnaround time required for private child care agencies to submit their contracts with the Cabinet. He referred to the cover letter on the contract which stated that the contract should be signed and returned within one day. The Cabinet acknowledged that the short timeframe was a mistake, and they are working to improve their contracting processes and timeframes.
Representative Damron asked whether information on the cost of a placement was included when placement decisions are made. The Cabinet stated that the Children’s Review Program, a contracted service that establishes the level of care and suggests placement options, does not have a budgetary role. Cabinet staff make the final placement decisions.
The meeting was adjourned at 9:50 a.m.