Sports Betting Alliance

Since the ruling of the US Supreme Court allowing sports betting to move to the state level, Member companies of the Sports Betting Alliance have been successful in passing enabling legislation in 37 states. The Commonwealth of Kentucky became number 35 in the 2023 General Assembly. The Top Shelf team, working with the Sports Betting Alliance, was able to formulate a strategy and implement a plan for passing sports betting, enabling legislation on the final day of Kentucky’s  2023 General Assembly. Garnering a super majority in both chambers of the General Assembly, the legislation came about after a full court press educating legislators who were “on the fence” in their support for Sports Betting.  Efforts included grassroots, grass tops, earned media, and paid media.  

“The Top Shelf Team put together a strategic plan and implemented it masterfully in Kentucky.  Their relationships from the top down in Kentucky’s legislature proved invaluable to our Sports Betting Alliance.”

– Jeremy Kudon, President, Sports Betting Alliance


With the workforce shortage that has occurred as a result of the worldwide pandemic, The American Association of International Healthcare Recruiters needed emergency legislation in Kentucky to protect more than 400 of their foreign educated nurses, nurse aides and medical technologists who are currently working in Kentucky.  Through the Top Shelf Team Approach, within two weeks in the short Session of the General Assembly, strategies were implemented using a common sense approach and solution to a problem no members of the Legislature even knew existed.  Our team knew the Health Services Committee was very full, so we made a workforce investment issue allowing the measure to pass quickly through the House and into the Senate.  The Top Shelf team approached a Freshman legislator who is a nurse in a large hospital system.  She was the right champion for the issue and passed her first piece of legislation as a member of the House of Representatives and signed into law by the Governor. 

“The efficiency, professionalism and quick action by the Top Shelf Team allowed our Industry to advocate for change during this workforce crisis of healthcare worker shortages throughout our Country and specifically in Kentucky.”   

– Patty Jeffrey, Board Chair, AAIHR

Fertility Fraud

“It is hard to put into words exactly how wonderful Makenzie has been to work with on legislative issues. In 2022, she had the heart to take on a pro bono lobbying project – helping a small group of victims to pass legislation allowing physicians to be held criminally and civilly accountable for fraudulent activities in fertility treatment. A law prohibiting this conduct did not exist. Makenzie was eager to take on the project, stepped up to the plate, swung for the stands, and hit a home run – the legislation was passed that same year. Simply put, Makenzie had the critical connections, created comprehensive strategies, educated us on the ins and outs of the Kentucky statehouse, and was there for us in every possible way. She patiently guided us through every step of the process, accompanied us to every meeting, provided essential advice and direction, and in every way served as a dedicated, passionate, and tireless advocate. This legislation would never have passed without her assistance, and the fact that she invested so much into this project on a pro bono basis speaks volumes about her selfless commitment to helping others. We were so fortunate to partner with her on this project.”

– Dr. Jody Maderia, IU Bloomington


The Issue:

Patients across Kentucky who needed to access physical therapy (PT) were being charged specialty-level co-pays every time they visited a PT clinic. For example, if a patient had a knee injury and visited their primary care doctor and paid the original co-pay (never more than Twenty dollars) for that visit he/she did not pay another co-pay for any follow up visits or for visits to an orthopedic doctor. If surgery was then required the original co-pay continued to cover the services that were needed.

However, after most surgeries of this nature physical therapy is required for several weeks after the operation. In some cases patients were told to access physical therapy three to four times per week for several weeks. Once patients realized that each time they visited the PT they were required to pay a specialty co-pay rate (typically between Fifty and Seventy-Five dollars) they discontinued their therapy services. Some patients were paying as much as Seventy-Five dollars per visit – totaling hundreds of dollars per week.

The Action:

The KY Association of Physical Therapists joined forces with the KY Association of Occupational Therapists and we set forth a strategy that involved meeting with the Department of Insurance and the KY Association of Health Plans to determine if there was a way to remove the specialty level co-pay without having to introduce legislation. The KY DOI revealed that there were only two levels of co-payments – Primary Care Doctor levels (Range Five Dollars to Twenty Five Dollars) and Specialty Level co-payments that encompassed specialty doctors such as heart and brain surgeons (Range Fifty to Seventy Five Dollars). It was clear that without legislation both DOI and Health Plans would continue to treat PT’s and OT’s as specialty level practitioners.

We mobilized our patient community by asking them to fill out post cards addressed to their legislators asking them to make a statutory change. We reached out in action alerts to our 2,000 members across the state and asked them to call their legislators. Students at UK, Hazard and WKU became involved and made multiple trips to the Capitol to lobby on behalf of the legislation. We created research documents that explained to legislators that it is less expensive for the health care insurance industry to rehabilitate patients to avoid costly surgeries, or in other cases, it is less expensive to rehabilitate them after surgery to avoid further damage.

The Result:

We were successful in passing legislation that removed the specialty-level co-payment from physical therapy and occupational therapy visits. Today a patient seeking rehab at one of our clinics cannot be charged higher co-pays than what they pay their primary care doctor. In most cases our patients are paying five dollar co-payments to access therapy. This has resulted in patients continuing their important therapy until the end of the prescribed time period.

Children’s Alliance

The Issue:

As 2014 began, there were over 7,000 children in out-of-home care in the custody of the Commonwealth. The Cabinet for Health & Family Services entrusts over half of those children to private child welfare providers throughout Kentucky. Services to keep these children safe are funded through a pure public/private partnership where many providers raise significant donor dollars to supplement the increasingly inadequate reimbursement rates paid by the Department for Community Based Services. The system that so many children and families depend on had reached a critical point where additional funds were necessary to avert a disastrous result.

The Action:

With a biennial budget system, the opportunity to obtain additional funding for services only comes around every two years. If the system was to survive the financial pressure it was enduring, we had to secure an appropriation and corresponding rate increase from the General Assembly during the 2014 Regular Session. We had spent years building a grassroots network consisting of local volunteer Board members from Children’s Alliance agencies, advocates, professionals, and child welfare staff. We invested months educating legislators and legislative staff about the need for additional resources, as well as the dire consequences for children if the already strained system wasn’t funded adequately.

After laying the groundwork through months of advocacy, education and relationship building, we developed a detailed plan of action to secure an appropriation in a very challenging fiscal environment.

The Result:

Despite a gloomy budget forecast, and amid a variety of budget cuts throughout state government, we were successful in our efforts to achieve an increase of $8 million of state general funds each year of the biennium. When matched with federal dollars, this infusion of funding made a substantial difference as the child welfare system continues to build resources to reach and treat Kentucky children in need.

SMG NKU Bank of KY Arena

The Issue:

Northern Kentucky University for years had been holding all of its graduation ceremonies in an Ohio arena.  Through aggressive advocacy, the Kentucky General Assembly appropriated the funds necessary to construct an 8,000 seat arena on the Campus of NKU.  Who could manage this new, state-of-the-art arena for the University?  A request for proposal for venue management was issued.   SMG, an affiliate of The Hyatt Hotel Company and ARAMARK Corporation, was one of three companies vying for the management contract.

The administration of NKU set up a committee to determine who would help shape the new Bank of Kentucky Arena on their campus.  SMG sought the help of Commonwealth Capitol Group to develop a strategic plan to ensure the end result would have SMG managing the new arena on the campus of NKU.

The Action:
Commonwealth Capitol Group built a strategy based on “grass-tops” support in the Northern Kentucky community at large.  Meetings were held with SMG officials and “grass-tops” leaders from the Chamber of Commerce, economic development groups, the Covington Convention and Visitors Bureau, as well as local government leaders.  The meetings had two objectives: 1. Fact finding to discover what was important to these leaders regarding the arena, giving them ownership, and 2. Create a buzz about the professionalism and abilities of the very qualified SMG team. After a combined effort of the SMG expertise coupled with the personal relationships of Commonwealth Capitol with community leaders, SMG was able to put together a presentation second to none for the NKU decision makers.

The Result:
SMG was awarded the contract for the management of the new Bank of Kentucky Arena on the Campus of Northern Kentucky University.  Furthermore, the SMG team was able to be involved in pre-construction planning and offer assistance in design for the new arena.  In May 2008, Northern Kentucky University held their first commencement ceremony in the new Bank of Kentucky Arena on the campus of NKU.