This section presents an overview of the state that is served by the Commonwealth of Kentucky Department for Public Health (KDPH); its demographics, healthcare landscape, geography, economic, and cultural conditions relative to the social determinants of health, that affect the Maternal and Child Health (MCH) population(s) in Kentucky. This section also gives an overview of the public health and healthcare infrastructure that supports the delivery of Title V services, and lists the various regulations and statutes related to Title V services and DPH-MCH.

 

Geography

 

 

KDPH-MCH is located in Frankfort, the capital of KY. Geographically, the state of KY is in the south-central United States along the west side of the Appalachian Mountains. Its area of 39,436 square miles includes some of the most diverse topography in the eastern half of the nation. The eastern part of the state, the Eastern Coal Field, is a rugged, mountainous area covered with forests and dissected by streams. In the gently rolling central part of the state, the Bluegrass region to the north and the Mississippi Plateau to the south are separated by a chain of low, steep hills called the Knobs. The western part of the state or the Western Coal Field is comprised of less rugged mountains enclosed by the Mississippi Plateau. The southwest corner of the state, the Jackson Purchase, is a low flat plain. The Central part of the State, identified as the Bluegrass Region, is the most populous region. Kentucky’s two largest cities, Louisville and Lexington, are in the Bluegrass Region, as are the majority of Kentucky’s educational and cultural resources, in addition to better access to healthcare than in other regions of the Commonwealth. The Northern Kentucky Region is an extension of the Greater Cincinnati Area. Combined with Louisville to the southwest and Lexington to the south, the three Metropolitan Statistical Areas (MSAs) form what is referred to as the “Golden Triangle.” KY is bordered by seven other States and is often included as part of the South Region of the United States. However, KY shares some geographic and cultural aspects with its neighbors to the north, making it a favored location for logistical services in healthcare, manufacturing, and transportation. KY has three major interstate highways, the I-75 and I-65 corridors that run north to south, and the I-64 corridor, which runs east to west. Historically, KY’s economy was largely driven by coal mining and mineral production. Today, KY’s three signature industries are automotive manufacturing, healthcare, and logistical (shipping) services.

 

Socioeconomic Conditions & Challenges for Delivery of Services

 

Healthy People 2030 goals focus on creating a strong public health infrastructure. The Public Health Infrastructure objectives address high-performing health departments, workforce development and training, data and information systems, planning, and partnerships. “A strong public health infrastructure includes a capable and qualified workforce, up-to-date data and information systems, and agencies that can assess and respond to public health needs. While a strong infrastructure depends on many organizations working together, public health departments play a central role in the nation’s public health system. Federal agencies rely on a solid public health infrastructure in state, tribal, local, and territorial jurisdictions.”

 

Disparities such as geographic, or urban/rural divide, economic, workforce, racial and cultural affect nearly all MCH populations in KY. This has made the public health infrastructure and healthcare delivery system a central focus in order to align the Commonwealth to the goals of Healthy People 2030. The pandemic and subsequent natural disasters have demonstrated how essential a strong public health infrastructure and healthcare delivery system is to the people of KY.  

 

Population:

 

The US Census Bureau July 2023, Population Estimates for KY is 4,540,745. KY’s population is 87.1% White, 8.6% African American, and 4.2% Hispanic. The poverty rate is 16.5%, and 41% of Kentuckians live in a rural area (United States Census Quick Facts, 2020). The per capita income in the past 12 months is $30,634, with the median household income at $55,454. KY’s unemployment rate, not unlike many other states increased dramatically during the pandemic. While KY has rebounded in terms of jobless numbers, it has not recovered as quickly as other parts of the country. As of December 2022, KY’s unemployment rate stood at 3.9%. 

 

Geography:

 

Appalachian communities are unique and deserve special attention given the rural, resource-limited, socio-economically impoverished nature of families in this part of KY. This affects access to employment, health care, higher education, and other services. Limited access to local providers (especially for specialized care) and transportation are barriers imposed by a rural community. The rurality of the population created a need for communities to rely on LHDs for primary care and prevention services. With Public Health Transformation, LHDs have moved away from direct services such as preventive health examination to population health through preventive measures. Because of these barriers, Kentucky’s identified distressed counties correspond with higher indicators of poor health.

 

Economy:

 

Social determinants of health (SDoH) for rural KY have large impacts on health outcomes as many counties are part of the highest poverty and at-risk areas of KY. The Appalachian Regional Commission (ARC) monitors the economic status of Appalachian counties in all 13 Appalachian states. A designation of a “distressed county”” means this area has a median family income no greater than 67% of the United States average and a poverty rate 150% of the US average or greater.

 

According to ARC, in FY23 there were 82 distressed counties across 13 states, with KY having the highest number with 37 distressed counties, slightly improved from the previous year, when there were 38 distressed counties. All these distressed counties are located in eastern KY. West Virginia, KY’s eastern neighboring state, has only 16 distressed counties.

Healthcare Landscape

 

KY operates a decentralized public health system, with independent, district, and local health departments (LHDs) serving all 120 counties which are accountable to their local boards of health. Most boards of health are taxing districts in KY, which utilize local funds to supplement and leverage federal and state dollars to operate programs to meet the needs of their citizens.

 

There are14 regional health departments incorporating 73 counties and 47 county health departments that operate individually, for a total of 61 LHDs in the Commonwealth.

 

The 14 regional health departments are:

 

Northern Kentucky  WEDCO

Three Rivers   Buffalo Trace

North Central   Gateway

Lincoln Trail   Kentucky River

Green River   Cumberland Valley

Pennyrile   Lake Cumberland

Barren River   Purchase

 

 

KDPH operates the financial systems for LHDs and supports their role in state and federally funded programs via allocations, standards of practice, training, and technical assistance. It should be noted that KDPH-MCH does not count LHD funds toward the match of Title V Block Grant funds, rather matching funds are derived by either State General Fund dollars or program derived revenues. The Office for Children with Special Health Care Needs (OCSHCN), an agency within CHFS, administers the state’s Children and Youth with Special Health Care Needs (CYSHCN) program. OCSHCN’s central office is in the state’s largest city, Louisville, with 11 regional sites throughout the state (serving all 120 counties) and six other satellite clinic locations. All KY citizens are within, at most, 95 miles of an OCSHCN clinic.

 

 

Some recent changes in the Kentucky health care landscape include:

 

• 2011: Implementation of Managed Care Organizations (MCOs) for Medicaid beneficiaries
• 2013: Kentucky Medicaid expansion
• 2014: Implementation of provisions for coverage for mental health and substance abuse services, as required by the Affordable Care Act (ACA) in the Medicaid State Plan, utilizing a state-based health exchange (KYNECT)
• 2016: Transition to the federal insurance exchange (Healthcare.gov) secondary to cost of maintaining the state-based exchange
• 2020: Due in large part to COVID-19, KY experienced a 26.7% increase in enrollment in Medicaid
• 2020: Relaunch of KYNECT for enrollment in Medicaid, KCHIP, and TANF benefits
• 2021-22: Planning and coordination for Medicaid unwinding post-federal emergency
• 2022: Expended coverage for pregnant women to 12 months post-partum
• 2023: Instituted continuous coverage for children through 12 months
• Expanded services in schools with a focus on childhood behavioral health

 

Medicaid

 

The Medicaid program in KY has historically focused on providing healthcare to subgroups of the lowest income individuals including the elderly, disabled, children, and pregnant women. KY now operates under an expanded Medicaid eligibility framework, by extending coverage to individuals with incomes up to 138% of the federal poverty level (FPL). The Mission of the KY Department for Medicaid Services (DMS) is:

 

• To elevate the quality of life for all Kentuckians by expanding access to healthcare, leading innovating policy initiatives that drive change throughout the healthcare industry and improving equitable outcomes for members.

 

Through the ACA, KY has been successful in reducing uninsured rates by expanding Medicaid and using the HealthCare.gov enrollment platform. As of April 22, 2024, KY Medicaid has 1,572,013 members enrolled.

 

Since implementing the ACA requirements to provide mental health and substance abuse services, KY has successfully improved provider enrollment by increasing behavioral health and substance abuse disorder providers. In collaboration with many partners, KY launched the findhelpnowky.org website in 2018 to provide a link for KY providers, court officials, families, or individuals to locate substance use disorder (SUD) treatment programs. This site has informational resources, developed for professionals or individuals, such as contact information and definition of common terms as well as additional resources.

 

KY has provided free or low-cost health insurance for children younger than 19 without health insurance through the KY Children's Health Insurance Program (KCHIP) for nearly twenty-five years. Children in families with incomes less than 213 percent of the federal poverty level are eligible, ($66,456 for a family of 4, or $43,300 for a family of 2, 2024). KYNECT now affords the opportunity to enroll in Medicaid/KCHIP, SNAP, KTAP, Child Care Assistance, and KI-HIPP (KY Integrated Health Insurance Premium Payment). In 2022 Kentucky Medicaid went through a reorganization to better serve the population and created a maternal and child health branch as well as an equity and determinants of health branch. We anticipate both branches will work closely with DPH.

 

In 2021, DMS contracted with six Managed Care Organizations (MCOs) to provide healthcare services to Kentuckians eligible for Medicaid. These included Aetna, Anthem, Humana, Passport by Molina, United Health Care and WellCare. As of April 22, 2024, there were 1,399,096 Kentuckians enrolled with one of these MCOs (KY Dept. for Medicaid Services, 2024). Medicaid expansion has been successful. KY has reduced the uninsured rate from 2013 to 2017 by 62%. Over the past 12 months Medicaid has gone through and completed unwinding. While some residents have dropped off the Medicaid roles many still qualify. Children account for 627,730 of the members and 23,685 of those are in foster care.

 

In 2023, Medicaid expanded care in schools with a focus on behavioral health. This allows schools to provide physical and behavioral health care within the school and bill for services. Prior to the expansion, only IEP services were billable to Medicaid. This not only increases access to care but allows the school to have another revenue stream.

 

Rates of maternal mortality (MM) and severe maternal morbidity (SMM) are rising and disproportionately affecting African American and rural moms. Recognizing these challenges, the Kentucky Department of Medical Services has strengthened its partnerships with the Kentucky Department of Public Health (DPH) and its established Maternal Mortality Review Committee and Perinatal Quality Collaborative; Medicaid has built its analytic capacity to examine MM and SMM.

 

• Kentucky Medicaid extended postpartum coverage to 12 months postpartum in April 2022.

 

• A key challenge and major intervention for this population is in increasing both the quantity and quality of postpartum care visits, as well as continued screening and support systems for women in this population.

 

• Beginning in 2021, Medicaid’s managed care organization partners all have value added services for pregnant and parenting women. Women with high-risk pregnancies will receive care management services, and all women will receive incentives for attending prenatal care visits and postpartum care visits.

 

• As of the beginning of 2024, a number of MCOs offer doula services to their pregnant members.

 

The 2020-2025 Needs Assessment showed that OCSHCN respondents are less likely than other MCH populations to experience problems obtaining insurance via the exchange. Subsequent OCSHCN surveys have indicated that OCSHCN enrollees are more satisfied with the adequacy of their child’s coverage than CYSHCN families sampled through the National Survey of Children’s Health. OCSHCN contracts with a trusted nonprofit, Accessia Health, formerly Patient Services, Inc., to provide insurance case management and premium assistance solutions for those with eligible conditions, specifically bleeding disorders, and cystic fibrosis. Insurance coverage is an issue among MCH populations. OCSHCN is working toward greater (appropriate) coverage by guiding and advocating for CYSHCN on an individual basis and on a state level, through participation in ongoing dialogue with Medicaid and the MCOs to minimize barriers such as pre-authorization requirements for medical procedures, specifically those from which previously CYSHCN may have been exempted. OCSHCN continues to participate in learning collaborative opportunities alongside Medicaid partners, state partners, and national experts.

 

Health disparities are addressed by place-based initiatives such as the Federal Healthy Start program in Louisville, Federally Qualified Health Centers (FQHCs) such as Bluegrass Community Health Center in Lexington that provides a medical home for migrant workers in Central KY or other FQHCs in the eastern part of KY serving underserved populations with comprehensive services.

 

Illustrated in the Rural Healthcare Facilities map below, KY has 28 Critical Access Hospitals, 346 Rural Health Clinics, 322 FQHCs outside of urbanized areas, 44 short term hospitals outside of urbanized areas (data.HRSA.gov, 2023). Through the KY Office of Rural Health, efforts are made for rural hospital improvement grants and stabilization of the smallest and most vulnerable rural hospitals.

 

 

KY has three primarily urban areas: Louisville, Lexington, and Northern KY. Both Louisville and Lexington have a children’s hospital providing comprehensive pediatric care. KY has one specialty hospital, Shriners Hospital for Children, serving children (regardless of ability to pay) with orthopedic conditions

 

As indicated below, utilizing the Health Professional Shortage Area (HPSA) dashboard on the HRSA website, in 2023 the following number of HPSA were identified in KY: Primary Care: 254, Mental Health: 136, and Dental Health: 201.

 

Source: https://data.hrsa.gov/topics/health-workforce/shortage-areas

Temporary Assistance for Needy Families (TANF)

 

The Temporary Assistance for Needy Families program provides grant funds to states and territories to provide families with financial assistance and related services. Kentucky Transitional Assistance Program (KTAP) is the monetary assistance program established using federal funds from TANF. KTAP provides financial and medical assistance to needy and dependent children and their parents or relatives with whom the children live. Over the past year, Title V has revitalized its relationship with the TANF program in the state to identify critical need and client base.

 

State Health Agency Priorities

 

During Governor Andy Beshear’s tenure, his administration has advocated and worked to improve healthcare access. Since assuming the governorship, much of his time has been devoted to best practice measures and keeping all Kentuckians safe during the world-wide pandemic. The Governor, the CHFS Cabinet Secretary, and the Department for Public Health Commissioner, as well as countless administration officials and staff, have worked tirelessly toward this goal. The Governor, CHFS Secretary, and/or the Commissioner have consistently held daily media outreach that promoted safety measures and emergency regulations impacting access to care, telehealth, the status of health restrictions, as well as emergency responses to the pandemic and natural disasters in Kentucky.

 

KDPH evaluated target areas of concern for the state to develop the state health plan. Stakeholders identified the priority needs to improve the health of Kentuckians, which include substance use disorder, tobacco use, obesity, adverse childhood experiences, and integration of healthcare accessibility. All of these have significant impact on mothers and children, Kentucky’s identified priority, the MCH populations. With the rising opioid epidemic, an emphasis remains on decreasing the rates of Neonatal Abstinence Syndrome (NAS), Sudden Unexpected Infant Death (SUID), and the increasing identification and treatment of pregnant woman with a substance use disorder.

 

KDPH began meeting with every local health department and stakeholders in 2018 to address Public Health Transformation based on Public Health 3.0 principles. This transformation serves to address fiscal instability within local health departments, many of which face insolvency in one to two years. Public Health Transformation now enters its fourth year and has set a goal to improve public health leadership, prevent duplication of services, and support data driven decisions to promote positive community health outcomes.

 

The KY General Assembly made LHDs and other quasi-governmental organizations its central focus in 2020 and throughout 2021. In an effort to address rising retirement costs, the resulting legislation allowed local health departments to either remain in the state retirement system, or to “opt-out” of the state pension system if their local boards of health desired. This appears to have alleviated some of the fiscal pressure at the local level.

 

At the state level, MCH collaborates with DMS on multiple projects to improve outcomes for women and children. The KY DMS medical director, Dr. Judy Theriot, was previously the OCSHCN medical director and is deeply familiar with the work and programs in MCH/OCSHCN to improve outcomes. She represents DMS on committee work to understand maternal morbidities and mortalities to drive prevention efforts and is on the KyPQC steering committee and MCH SDoH CoIIN projects. In the past year, she has chaired a DMS/MCH/DPH Medicaid Innovation Accelerator Program, and she provided continuing education in support of well child assessments for LHD nurses. Dr. Theriot supports and advocates for DMS changes to ensure improving access to care for Kentucky’s priority MCH populations. This relationship with a sister agency in CHFS has allowed MCH Title V to be influential in advising and guiding Medicaid policy changes.

 

Outreach and Enrollment

 

Since the initial rollout of health reform, Title V has primarily supported outreach and enrollment in services and has served to link LHD resources to fill gaps in services for mothers and children. LHDs provide support by assisting women and children with presumptive eligibility and offering ongoing education for access to and changes in Medicaid. To ensure that all families and CYSHCN have adequate resources for insurance, OCSHCN parent consultants and social workers connect families with state Medicaid services and work closely with other waiver programs that could benefit children with special needs. In the past three needs assessment cycles, statewide needs assessment survey data showed that OCSHCN respondents are less likely to experience problems with obtaining insurance than other groups. LHDs utilize Title V funds to provide education to assure they know how to enroll in Medicaid coverage. MCH and OCSHCN will continue to provide information to families on changes in the Medicaid program and assistance to assure continuity of coverage.

 

OCSHCN care coordinators and social workers work with direct-service enrollees to determine insurance adequacy on an individual and family level. Again, through their contract with Accessia, insurance case management and premium assistance solutions are provided for those with eligible conditions – specifically bleeding disorders and cystic fibrosis. Policies assure objective criteria for assistance, directing services to those persons with the most need.

 

Title V Gap Filling Services

 

While many LHDs provide direct gap filling services as funded by local and state tax dollars, Title V funds transitioned away from direct services to provide enabling services, using population health measures, evidence-based for best practices, and innovative programming or “MCH Packages.” These packages allow flexibility in the use of funds to address education, outreach, and health promotion regarding child injury prevention, obesity, safe sleep, community partnership activities, abusive head trauma, and much more. With limited direct services in many rural KY areas, LHDs are collaborating with their local FQHCs for direct services to provide assurance that core public health services continue to be available and accessible in their communities for Kentucky’s priority MCH populations.

 

OCSHCN recognizes the effect of managed care in the way in which care is financed. Through discussions and an initial orientation period with established MCOs, OCSHCN provided an explanation of services offered by each agency. This clarification of roles resulted in partnerships and integration of practices. For example, nursing assessments were completed to align documentation required by the existing MCOs. Nursing care plans demonstrated an individualized plan of care as developed in partnership with the patient and family to accomplish goals. To avoid duplication of services, documentation of case management provided by OCSHCN nurses is shared with the MCOs. Health financing through multiple MCOs has affected CYSHCN enrollment in multi-disciplinary clinics as not every provider is enrolled in every MCO network. One example of cooperation is OCSHCN’s work with the dental administrator for three MCOs to create policy specifically for CYSHCN with craniofacial anomalies, such as cleft lip and palate, to go beyond the once-in-a-lifetime orthodontia benefit and permit phased treatment. 

 

Another success was negotiating with two MCOs to wave pre-authorization for therapy services. For other MCOs that require pre-authorization, therapists are educated on consistently documenting medical necessity when requesting pre-authorization. Variability exists among the MCOs in terms of the authorizations required for durable medical equipment such as ear molds and hearing aids. When facing such barriers to securing prescribed interventions, OCSHCN staff and Family to Family Health Information Center Support Parents continue their diligent effort to work with families to resolve issues on an individual basis, such as obtaining Medicaid waivers where appropriate.

 

 

State Statutes and Other Regulations Relevant to Title V Program Authority

 

KY Revised Statutes (KRS) and KY Administrative Regulations (KAR) of relevance to KY’s Title V program authority are described in this section to provide the basis for MCH programs and their required activities.

 

• KRS 211.180 gives the CHFS the responsibility and authority to formulate, promote, establish, and execute policies, plans, and programs relating to all matters of public health. This KRS supports MCH population efforts. It states that the CHFS is responsible for “the protection and improvement of the health of expectant mothers, infants, preschool, and school-aged children” and “the protection and improvement of the health of the people through better nutrition.”
• KRS 211.180 authorizes MCH to protect and improve the health of expectant mothers. Decades ago, the legislature provided funding to MCH with the intent that no pregnant woman in KY will go without prenatal care due to lack of ability to pay.
• 902 KAR 4:100 established the public health prenatal program to administer these funds and set the financial eligibility for those in need of prenatal care at 185% and below the FPL who are not covered by Medicaid or any other funding source. The public health prenatal program serves as a core public health service and is the primary strategy for reducing maternal and infant morbidity and mortality.
• KRS 211.755 stipulates that a mother may breastfeed her baby or express breast milk in any location, public or private, where the mother is otherwise authorized to be; this is in addition to the nutrition provisions in KRS 211.180.
•  accommodation requirement in KY. This law became effective June 27, 2019.
• KRS 214.160 requires Hepatitis C screening for all pregnant women, the results of which are to be documented in the infant’s medical record to assure the child receives serologic testing at the 24-month well-child exam.
• KRS 214.160 permits the provider to administer toxicology screening to the pregnant woman or infant after delivery if the provider has reason to believe there was prenatal exposure of newborn or the mother used any substance for a nonmedical purpose. Positive toxicology findings shall be evaluated by the provider to determine if abuse or neglect of infant occurred and will be referred to DCBS as per KRS 600.020(1).
• KRS 344.030-.110 establishes the Pregnant Workers Act which prohibits discrimination to an employee for pregnancy, childbirth, or other related medical conditions and is the first lactation accommodation requirement in KY.
• KRS 214.155 requires Newborn Screening (NBS) and authorizes the NBS program to collect data for inborn errors of metabolism and other hereditary disorders and allows the state to add any conditions to the panel that are recommended by the American College of Medical Genetics. KY currently screens for 58 disorders.
• KRS 304.17 establishes the Metabolic Foods and Formula program to provide needed supplements and special foods to children with metabolic disorders as a payor of last resort. Medicaid and insurance companies are required to provide these for their enrolled patient population up to a cap of $25,000.
• KRS 211.645, 211.647, and 216.2970 established the Early Hearing Detection and Intervention Program (overseen by OCSHCN) which screens newborns for hearing loss prior to discharge from KY birthing hospitals.
• KRS 211.651 authorizes the KY Birth Surveillance Registry to obtain data on all children up to the age of five years with congenital anomalies or disabling conditions. Reporting sources include acute care hospitals, outpatient records, and laboratories.
• KRS 211.192 directs KDPH to make available up-to-date information on spina bifida.

• KRS 211.676 requires birthing hospitals to report all diagnosed NAS cases to KDPH.
• KRS 211.690 established HANDS as a voluntary home visitation for first-time, at-risk parents as a primary service delivery strategy in 2000.
• 902 KAR 4:120 sets the definitions, eligibility criteria, and provider qualifications for the HANDS program.
• 907 KAR 3:140 established HANDS funding from the Master Tobacco Settlement and in accordance with Medicaid. Since 2011, the HANDS program has had federal support from the MIECHV grant.
• KRS 200.654 allows MCH, as part of the CHFS, to administer state and federal funds to the First Steps Program (Part C of the Individuals with Disabilities Education Act) to provide early intervention services for infants and toddlers with disabilities and their families.
• 902 KAR 30:150 defines First Steps (Kentucky Early Intervention Services) provider qualifications.
• 911 KAR 1:010 establishes application forms used for clinical programs, procedures for application and reapplication, eligibility criteria, assignment of pay category, and processes used to determine initial and continuing eligibility for services, as well as a process for reconsideration of an adverse decision.
• KRS 211.901 addresses the statewide Childhood Lead and Poisoning Prevention Program (CLPPP) for the prevention, screening, diagnosis, and treatment of lead poisoning.
  • KRS 211.900 defines at-risk populations for lead poisoning.
  • KRS 211.903 specifies the intervals of screening of at-risk children.
  • KRS 211.904 states that the CHFS shall establish an educational program to inform of the multiple dangers, frequency, and sources of lead poisoning and the methods of preventing such poisoning.
• KRS 211.686 established the Public Health Local Child Fatality Review (CFR) Program in 1996. This statute allows local teams to assist the coroner in determining an accurate manner and cause of death.
• KRS 213.161 initiated grief counseling through LHDs for families who have lost an infant to Sudden Infant Death Syndrome (SIDS), or SUID.
• KRS 211.686 was amended in 2018 to add Maternal Mortality Review to the child fatality review allowing for review of cases of maternal death to establish prevention activities and align with best practice guidelines as defined by the CDC. The legislation for child and maternal mortality protects against discoverability of review information.
• KRS 199.8945 establishes technical assistance for childcare providers through the Healthy Start in Child Care program. This statute mandates training and education of childcare providers in child health and safety to increase awareness and education for parents of children who attend childcare.
• KRS 211.190 (11) requires CHFS to provide public health services that include water fluoridation programs for the protection of dental health.
  • 902 KAR 115:010 sets forth the requirements for the water fluoridation program. KY has the highest percentage of fluoridated water systems in the country, at 98%.
• KRS 313.040 created a special licensure category for Public Health Registered Dental Hygienists (RDH) that expands the scope of preventative dental work that the public health RDH can do without requiring the presence of a dentist on site.
• KRS 156.160 states that proof of a dental screening or examination by a dentist, dental hygienist, physician, registered nurse, advanced registered nurse practitioner, or physician assistant. This evidence shall be presented to the school no later than January 1 of the first year that a five (5) or six (6) year old is enrolled in public school. The MCH State Dental Director provides training and technical assistance for LHD staff that provide this service.
• KRS 156.501 establishes that KDE provides leadership, while working in cooperation with the KDPH MCH to provide standardized protocols and guidelines for health procedures, quality improvement, and health data collection in schools. It establishes a full-time position in the KDE for a school nurse consultant MCH collaborates with the KDE school health staff to develop guidance for health management in schools.
• KRS 200.460-200.499 established program authority for CYSHCN services. The authorizing statute reads in part: that OCSHCN “shall provide through contractual agreement, or otherwise, such services as may be necessary to locate, diagnose, treat, habilitate, or rehabilitate children with disabilities, and may include any necessary auxiliary services.” Remaining statutes address conditions of acceptance for children, payment for care, confidentiality of records, and reporting.
• KRS 438.345 added language to prohibit use of tobacco products by students, school personnel, and visitors in schools, school vehicles, properties, and activities; require policies to be in place by the 2020-2021 school year; require that smoke-free policies and signage be adopted; and provides that existing bans are is not impacted.
• KRS 194A.030 established the reorganization of the Cabinet for Health and Family Services, under this statute the Office for Children with Special Health Care Needs will operate under the oversight of the Department for Public Health effective July 1, 2024. The Office for Children with Special Health Care Needs will continue to be led by an executive director appointed by the secretary with approval of the Governor.