Health & Medicine

Beshear pushes new psychiatric facilities

FRANKFORT — Gov. Steve Beshear is pushing changes in a state regulation that would add additional psychiatric treatment facilities for youth despite the bipartisan disapproval of a legislative panel and opposition from the state's hospital and nursing home associations.

At its Sept. 8 meeting, the Administrative Regulations Review Subcommittee unanimously voted against a proposed change to a regulation that would allow the creation of eight new 50-bed psychiatric facilities in various regions of the state.

Those that apply to run the facilities would not have to go through the state's certificate of need process, a lengthy procedure that hospitals and health care facilities must complete before adding a new facility or additional beds.

The regulation also allowed a Northern Kentucky nursing home to move some of its beds from one county to another, something that is not allowed under the state's current rules.

Hospital officials, mental health advocates and nursing home providers decried the regulation changes, saying there was no emergency that required fast-tracking the psychiatric facilities.

Despite concerns about the lack of due process, Beshear, in a Sept. 23 letter to state leaders, said he was going to override the Administrative Regulations Review Subcommittee's vote and push the two initiatives forward.

To stop Beshear, lawmakers would likely have to approve a new law when they return to Frankfort in January. Rep. Leslie Combs, D-Pikeville and co-chair of the Administrative Regulation Review Subcommittee, said it's likely that will happen.

"We heard from a lot of people who were against it," Combs said.

Officials with the Cabinet for Health and Family Services said Friday that they have long planned to move an estimated 229 kids who are being served in long-term psychiatric facilities in other states back to Kentucky.

The state spends about $17 million a year for the treatment of adolescents in out-of-state facilities, said Janie Miller, the Secretary for the Cabinet for Health and Family Services.

Jay Blanton, a spokesman for Beshear, said the governor wants to push the regulation through now because it's time to bring the Kentucky kids home.

"We simply disagree with the idea of spending $17 million outside the state on the health care needs of Kentuckians when they can be taken care of here, providing quality care and creating jobs on top of that," Blanton said. "

Some in the mental health industry question why the push to add new psychiatric treatment facilities for adolescents was deemed an emergency when the concern about sending kids out of state for intensive, long-term care has been expressed for a decade.

Mike Rust, president of the Kentucky Hospital Association, said Friday that his group is not opposed to bringing kids back to Kentucky.

"We're all for that," Rust said. "But there is currently not a licensure category that would allow us to bring them back. ...We've got nine independent psychiatric facilities in the state already and 35 hospitals that have their own psych units that were never consulted."

Miller said her cabinet has been in the process of re-writing regulations for certificates of need over the past 18 months and decided to fast-track the psychiatric facilities by tacking them on to those proposed changes.

The state had been debating for too long what to do with these kids, she said.

"Really all we are trying to do is to get treatment services for children in state," Miller said. "If we were to try to create a separate licensure category for long-term treatment .... we could be here another two or three years and not have any program capacity"

But representatives of the psychiatric hospital industry and the nursing home industry say they were never given an opportunity to comment on the regulation changes.

Typically, the public has a period of time to comment on regulations, but the proposals to add the psychiatric facilities and move the nursing home beds were added after that public comment period, hospital officials said.

Hospital officials said they weren't notified of the changes until Aug. 27, a little more than a week before the Administrative Regulation Review Committee considered the bill.

A Kansas company called KVC applied for at least one 50-bed psychiatric unit in Mount Sterling on Aug. 30. KVC could not be reached for comment late Friday.

Miller said she did not know how the company knew it could apply to run the facility. She also said that she had not seen the application from KVC.

But Miller pointed out that other providers can still apply to run the adolescent psychiatric facilities. According to the regulation, groups have until March 2010. The provider would pay for the cost of building or renovating a facility, Miller said.

Miller said it is likely that only two 50-bed psychiatric facilities would be built.

Tim Veno, president of the Kentucky Association of Homes and Services for the Aging, said his group opposes a change in the same regulation that would allow a nursing facility to move some of its beds from Campbell to Boone County.

The facility had been shut down by the state, but new owners wanted to move half of the beds to Boone County.

Miller said the cabinet decided to add the nursing home change after several state legislators and county officials said the beds were needed in Boone County.

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