The3rd meeting of the Subcommittee on Families and Children of the Interim Joint Committee on Health and Welfare was held on Wednesday, October 21, 2009, at 10:00 AM, in Room 129 of the Capitol Annex. Representative Tom Burch, Chair, called the meeting to order, and the secretary called the roll.
Guests: Eric Clark for the Kentucky Association of Health Care Facilities; and David Graves for Brooklawn.
LRC Staff: Ben Payne, Amanda Dunn, and Cindy Smith.
The first item on the agenda was an update on the First Steps Program by Ruth Ann Shepherd, MD, FAAP, Director, Maternal & Child Health, Acting Director, Division of Women's Health, Department for Public Health, Cabinet for Health and Family Services; and Paula Goff, Part C Coordinator, First Steps Program, Department for Public Health, Cabinet for Health and Family Services. Ms. Goff said that the First Steps Program is a statewide early intervention system that provides services to families with children from birth to age three who have developmental disabilities.
Ms. Goff discussed with the committee that First Steps focuses on providing family centered services by utilizing a Consultative Model. This is done by a therapist providing consultation and instruction to the child’s caregivers, who in turn actually provide the interventions throughout daily routines. The specific services provided through the Consultative Model are based upon the Individual Family Service Plan, known as an IFSP, which is developed for each child and family participating in the First Steps Program. The subcommittee learned that there is a national four tier ranking system for these types of programs. Kentucky is currently at level three and anticipates rising to level two by June 2010. Kentucky’s federal funding is not in danger as long as the state program does not drop to level four.
The subcommittee learned that 12,900 children are served each year by First Steps and that there are currently 6,462 Kentucky children with and active ISFP. First Steps is funded through a combination of General Fund dollars, Tobacco Settlement Funds, Family Share, Insurance, Medicaid, Federal Part C, and Federal ARRA funds.
Representative Burch asked about Kentucky’s rank and how it is determined. Ms. Goff said there are annual performance reports completed every February and after the next performance report, Kentucky should be able to move to a level two by June, 2010.
Representative Housman asked if Kentucky’s determination as a level three puts federal funding in jeopardy. Ms. Goff said the funding would only be in jeopardy if Kentucky dropped to a level four.
Representative Housman asked if there is a timeline for level movement. Ms. Goff said yes, and there are visits with OCEF every three months.
The final item on the agenda was a presentation on Psychiatric Residential Treatment Facilities (PRTF’s) by Kerry Harvey, General Counsel and Acting Inspector General, Office of Inspector General, Cabinet for Health and Family Services; and Stephanie Brammer-Barnes, Policy Analyst, Office of Inspector General, Cabinet for Health and Family Services. The subcommittee heard testimony that described what PRTF’s are and where they are located throughout the state. PRTF’s have existed in Kentucky since 1991 and are for patients age 6 to age 21 who have an emotional or severe emotional disability. Currently there are 21 PRTF’s in the Commonwealth. As of October 2009, there are approximately 189 PRTF patients. The state has a CON capacity for nearly 100 more patients.
Staffing requirements were discussed showing that the professional requirements range from high school diploma minimums for the majority of staff, to college degrees for those staff that run the facilities. The subcommittee learned that during 2008, 228 children were provided care in out-of-state facilities due to the fact that Kentucky PRTF’s cannot offer them the treatment services they need. Additionally the subcommittee learned that the average per day payment for out-of-state care is $340 and the average per day payment for in-state care is $400.
Representative Burch asked if there is a psychiatrist on site or on call. Ms. Brammer-Barnes said a psychiatrist is on call, but is also required to be there at least one day each week.
Representative Burch said after talking with providers, he learned that 18 girls could be worked into two different PRTF’s in Jefferson County from out-of-state facilities if the regulation was changed just a bit, and he requested to meet with Mr. Harvey and Ms. Brammer-Barnes after the meeting to discuss that.
Representative Burch asked if the $339.10 per day per resident includes parent transport. Mr. Harvey said the per diem does not included parent transport.
Representative Burch asked what the outcomes are of out-of-state children. Mr. Harvey said the outcomes are all over the board; some get better, while others do not. Mr. Harvey said that he is sure that outcomes data exists within the Cabinet, but that data is not in the Office of the Inspector General.
Representative Jenkins asked how many kids are out-of-state daily. Mr. Harvey said there are currently between 40 and 60 children from Kentucky in out-of-state facilities.
Representative Jenkins asked how much money is paid out-of-state for care of children from Kentucky. Mr. Harvey said he did not have any idea, and that information is not in the purview of the Office of the Inspector General.
Representative Jenkins asked if the kids that have been placed out of state are in PRTF’s or psychiatric hospitals. Mr. Harvey said some are in facilities similar to PRTF’s, and some are in facilities more like hospitals.
Representative Jenkins said the committee is going to need the answers to these questions in the coming week. Mr. Harvey said that the results from the survey on out –of-state kids could be provided to the subcommittee members.
Representative Burch said there are 100 beds that are still available and asked why they are not being utilized. Mr. Harvey said that the CON has been granted, and the beds are being built. Representative Burch said there are many beds available in rural areas and he asked why those beds are not online. Mr. Harvey said no provider has stepped forward to provide those beds.
Representative Burch asked if the Cabinet is actively looking for providers to fill the beds. Mr. Harvey said the providers must be committed to the project and the staffing can be taken care of.
Representative Housman asked if Kentucky has the capacity and the training to treat the children that are in out-of-state facilities. Mr. Harvey said the specialized treatment does not exist in Kentucky to treat that group of out-of-state children.
Representative Burch asked if all out-of-state kids are monitored. Mr. Harvey said efforts are in place, but it is very difficult to monitor children in other states.
The meeting was adjourned at 11:10 a.m.