Princess Health and Panel considers involuntary, court-ordered outpatient treatment for mentally ill; foe says would infringe on personal rights. Princessiccia

Princess Health and Panel considers involuntary, court-ordered outpatient treatment for mentally ill; foe says would infringe on personal rights. Princessiccia

behavioral health courts General Assembly legislation legislature mental health mental illness

Gusty 13:19 Add Comment

            Princess Health and  Panel considers involuntary, court-ordered outpatient treatment for mentally ill; foe says would infringe on personal rights. Princessiccia

Representatives from five groups involved in mental health offered legislators solutions June 15 for ending the revolving door between hospitalization, incarceration and homelessness that often exist for those with severe mental-health conditions.

Many who spoke at the three-hour meeting of the  Interim Joint Committee on Health and Welfare said judges should be able to order mentally ill adults who meet strict criteria into an "assisted outpatient treatment" program. Others said that would add costs and a burden to the judicial system, and infringe on personal liberties. But all agreed that the state lacks resources to care for such adults.

Shelia Schuster, executive director of the Kentucky Mental Health Coalition, voiced strong support for the idea. She said its main goal would be to create a narrowly defined program "to access supported outpatient treatment under a court order, again without having to be involuntarily committed or coming through criminal justice system."

Now, a mentally ill person who needs care but does not want it can only be court-ordered into treatment after being released from a hospital or jail.

Various versions of this legislation have have been filed in the General Assembly since 2013. Last year's version, House Bill 94, passed out of the Democrat-led House, but died in the Republican-led Senate. The bills are often referred to as "Tim's Law," named for Tim Morton, a schizophrenic who was hospitalized involuntarily 37 times by his mother because this was the only way she could get him the treatment he needed. Morton died in 2014.

�We do want to make sure that those individuals, like Tim Morton, who are very ill and who are unable to recognize it, who spend much of their lives in the revolving door of hospitalization, homelessness, or incarceration, are afforded a new opportunity to stay in treatment long enough to see the positive effects and the road to recovery,� Schuster said.

Steve Shannon, executive director for the Kentucky Association of Regional Programs, said the state needs assisted outpatient treatment to keep those with mental-health conditions out of the criminal justice system.

"If we can keep a person out of criminal justice involvement, it is better for them, " he said. "Folks have enough challenges already; why add that piece to it? . . . It affects housing, it affect employment."

Shannon also proposed that the state seek a Medicaid waiver to help pay for housing and supported employment for such adults, and a spend-down option to allow the poor on Medicare to also get Medicaid, which offers more services.

Jeff Edwards, division director of Kentucky Protection and Advocacy, who supports does not support Tim's Law said "assertive community treatment" teams are already available to this population, but only on a voluntary basis. He also noted that the ACT program is laden with issues, including geographical access, wait times to get services, and frequent staff turnover.

"Right now, you have to live in one of 56 counties to get the ACT services," he said. "We have to expect quality services, no matter where a person lives in the state."

Ed Monohan of the Department of Public Advocacy, a long-time opponent of the court-ordered treatment model, said  he supports enhancing the ACT teams, which provide a comprehensive array of community supports to this population through individual case managers who are available 24 hours a day.

"Long-term, engagement with clients, with people, is a far superior long-term strategy than coercion through a court system," Monohon said. "The mental-health system, rather than the court system, is the better place to really address this long-term. ... Their liberty is at stake with this coercion."

"I know it is about civil liberties and the rights of individuals, but for them, in the disease process, they have lost the ability sometimes to make those decisions clearly for themselves," said Rep. Addia Wuchner, R-Florence, after sharing deeply personal stories about a family member who had severe mental illness.

During an impassioned plea of support for Tim's Law, Kelly Gunning, director of Advocacy National Alliance on Mental Illness in Lexington, told the story of how her son, while under the care of an ACT team, "brutally assaulted" both her and her husband in January. She emphasized that while the ACT program does offer a "robust array of services," it is based on voluntary compliance.

"They are voluntary. Do you hear me? They are voluntary! If my son doesn't want to open the door for his ACT team, or his doctor who comes to his home, he doesn't have to," she said. "And (as) we were cleaning out his home, we found a years stockpile of medication untouched, untaken because he doesn't believe he has an illness."

Allen Brenzel, clinical director with the state Department for Behavioral Health, Development and Intellectual Disabilities, along with many others at the meeting, acknowledged that a lack of resources is a large part of the problem.

"I mostly hear unity around the issue that we must do better," he said, adding that not only assisted outpatient treatment is needed: "It's going to be the allocation of resources and the moving of resources to appropriate places."

Committee Co-Chair Sen. Julie Raque-Adams, R-Louisville, encouraged the group to examine this issue "holistically" and committed to working on a solution. "Across the board, this is one of those issues that we can no longer stick our heads in the sand and ignore,"' she said.

Princess Health and Kentucky is the only truly Appalachian state to have put a brake on fatal overdoses from narcotics. Princessiccia

Princess Health and Kentucky is the only truly Appalachian state to have put a brake on fatal overdoses from narcotics. Princessiccia

Appalachia doctors drug abuse drugs General Assembly legislature narcotics pain pain clinics physicians prescription drug abuse prescription drugs state government

Gusty 12:08 Add Comment

Kentucky is the only truly Appalachian state to have put a brake on fatal drug overdoses, report Rich Lord and Adam Smeltz of the Pittsburgh Post-Gazette as part of a series in the about the deadly epidemic of prescription painkillers in the region.

A chart with the series' story about Kentucky shows that fatal drug overdoses were less numerous in the state in 2013 than in 2012, when the General Assembly cracked down on "pill mills," and that while fatal overdoses rose in 2014, they were still not as numerous as in 2012. Official numbers for 2015 are expected soon, and may rise because of the spread of heroin.

The series also credited a crackdown by the Kentucky Board of Medical Licensure, which "took disciplinary action for prescribing irregularities against 135 of the state�s roughly 10,600 doctors" from 2011 to 2015. "The board also moved against 33 doctors during that time for abusing narcotics themselves."

"Getting tough on doctors works," Lord wrote in the series' main story. The state story reported, "Kentucky�s per-capita opioid consumption -- though still seventh in the nation -- dropped by a steepest-in-Appalachia 12.5 percent from 2012 to 2014, according to IMS Health Inc.," Lord and Smeltz report. "Kentucky is the only state, among the seven studied by the Pittsburgh Post-Gazette, in which fatal overdoses have plateaued. Elsewhere, they have climbed relentlessly."

The story quotes Kerry B. Harvey, U.S. attorney for the eastern half of Kentucky: �In much of Eastern Kentucky, the workforce is engaged in difficult, manual labor,� like mining, farming and logging, �so people would injure themselves and be prescribed these very potent narcotics, because the medical profession changed the way it looked at prescribing these kinds of narcotics for pain.� The drugs dulled the �sense of hopelessness� people had about the area�s economy, �and so for whatever reason, this sort of culture of addiction took hold.�

"Harvey said that as physicians have gone to jail, and others have faced board discipline, the painkiller business model has adapted. . . . Now the doctors take insurance, and bill the insurer or the government not just for the office visit, but for the MRI, urine screen and back brace they use to justify the addictive narcotic." Harvey said, �So instead of a cash business, in many cases now the taxpayers or the insurance companies pay. The result is the same. We end up with our communities flooded with these very potent prescription narcotics.�

Princess Health and State and national smoke-free leaders tell Ky. advocates to focus on local smoking bans because of political climate in Frankfort. Princessiccia

Princess Health and State and national smoke-free leaders tell Ky. advocates to focus on local smoking bans because of political climate in Frankfort. Princessiccia

advertising cigarettes General Assembly governor health policy legislature local government politics smoking smoking ban smoking bans smoking ordinances tobacco tobacco prevention

Gusty 19:04 Add Comment

By Melissa Patrick
Kentucky Health News

More Kentucky localities are likely to see efforts for smoking bans, as a statewide ban appears less likely and leading advocates are saying to go local.

Stanton Glantz
photo: ucsf.edu

Stanton Glantz, one of the nation's leading advocates of smoke-free policies, said at the Kentucky Center for Smoke-Free Policy's spring conference April 28 that California initially had trouble passing a statewide indoor smoke-free law, which forced advocates to move their efforts to the local level. By the time the statewide law passed, 85 percent of the state was covered by local ordinances.

"I'm glad it worked out that way, because we are really talking about values and social norms and community norms and you just can't impose that from the outside," Glantz said during his keynote address. "And so all of these fights that you are having in all of these towns. ... In the end, when you win, you've won. And the fight itself is an important part of making these laws work."

Ellen Hahn, a University of Kentucky nursing professor and director of the smoke-free policy center, also encouraged her colleagues to shift their efforts to localities, saying the political situation doesn't support a statewide law. New Republican Gov. Matt Bevin doesn't support a statewide ban on smoking on workplaces, saying the issue should be decided locally.

"We are in a very difficult political climate in Frankfort," Hahn said in her opening remarks."We all know it. We all recognize it. And while we would all like to see Frankfort do the right thing � and it will someday, I promise � it is not the time to let somebody else do it. It is the time to go to your local elected officials and say we want this."

Advocates made some headway last year when a smoking-ban bill passed the House, but it was placed in an unfavorable Senate committee and never brought up for discussion. This year's House version of the bill, in an election year with Bevin in the governor's office, was dead on arrival.

Glantz, a University of California-San Francisco professor and tobacco-control researcher, looked at the bright side: "You're in a tough political environment, but you are really doing pretty well." He reminded the advocates that one-third of the state is covered by indoor smoke-free ordinances, with 25 of them comprehensive and 12 of them including electronic cigarettes. He also commended the Kentucky Chamber of Commerce for supporting statewide and local bans.

What's next

Glantz urged the advocates to "empower and mobilize" the 73 percent of Kentuckians who don't smoke and get them to help change the social norms. Two-thirds of Kentucky adults support a comprehensive statewide smoking ban, according to latest Kentucky Health Issues Poll, and have since 2013.

�The whole battle is a battle about social norms and social acceptability, and once you win these fights, and you have a law that�s sticking � which takes a while � you don�t go back,' he said. "And the tobacco companies understand that, and that is why they are fighting us so hard.�

Glantz armed the smoke-free warriors with research data to support smoke-free laws, including: they decrease the number of ambulance calls; hospital admissions for heart attacks, stroke, asthma and chronic obstructive pulmonary disease; and the number of low-birth-weight babies and complications during pregnancy.

"In Kentucky communities with comprehensive smoke-free laws, there was 22 percent fewer hospitalizations for people with COPD," Glantz said, citing one of Hahn's studies. "That is a gigantic effect, absolutely gigantic, at almost no cost and it happened right away."

He noted that politicians are usually most interested in this short-term data, but he also cited long-term statistics about how smoke-free policies in California have decreased heart disease deaths by 9 percent "in just a few years," and lung cancer by 14 percent in about 10 years. Kentucky leads the nation in both of these conditions.

"I would argue that the economic argument is actually on our side," Glantz said, noting that economic benefits of smoke-free laws are almost immediate, especially because "every business, every citizen and every unit of government" is worried about health care costs. He also cited research that found "as you pass stronger laws, you get bigger effects.'

Princess Health and If legislature won't help protect Kentuckians from the health threat of tobacco, local governments should, Herald-Leader says. Princessiccia

Princess Health and If legislature won't help protect Kentuckians from the health threat of tobacco, local governments should, Herald-Leader says. Princessiccia

General Assembly health rankings legislature newspapers smoking smoking bans smoking ordinances tobacco tobacco prevention

Gusty 08:51 Add Comment

Since the Kentucky General Assembly "adjourned without tackling the addiction that kills the most Kentuckians, tobacco," local communities need to take up the challenge, the Lexington Herald-Leader said in an editorial Sunday.

To drive home the primary role that tobacco plays in Kentucky's poor health, the newspaper ran a map of the most recent County Health Rankings, showing that "the places where smoking rates are highest have the worst health outcomes."

The Democrat-controlled state House passed a statewide ban on smoking in workplaces last year, but the bill got nowhere in the Republican-controlled Senate, and with new Republican Gov. Matt Bevin opposed to it and all House seats on the ballot this year, the bill didn't get a vote in the House.

Bevin has said smoking bans should be a local decision. The editorial says, "One of the cheapest, most effective ways to do that (since the legislature won�t) would be to join the places across Kentucky that have enacted local smoke-free laws." About one-third of Kentucky's population lives in jurisdictions with comprehensive smoking bans.

Read more here: http://www.kentucky.com/opinion/editorials/article72143017.html#storylink=cpyThe

Read more here: http://www.kentucky.com/opinion/editorials/article72143017.html#storylink=cpy

Princess Health and Kenton County embraces its once-controversial smoking ban as chances of a statewide ban have dimmed. Princessiccia

Princess Health and Kenton County embraces its once-controversial smoking ban as chances of a statewide ban have dimmed. Princessiccia

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Gusty 14:01 Add Comment

Five years after Kenton County's smoking ban took effect over great opposition, the county has embraced it, Scott Wartman reports for the Cincinnati Enquirer.

"I'm a smoker, but I'm glad we're non-smoking," Justin Meade, a bartender at Molly Malone's in Covington, told Wartman. "I don't want to smell like smoke."

Kenton is the only Northern Kentucky county with any type of indoor smoking ban. Its partial ban allows establishments that don't serve people under 18, like bars, to have smoking.

Wartman reports having trouble finding anyone who didn't support the smoking ban as he walked among the Covington bar scene, and noted that a Northern Kentucky Health Department report cites very few complaints.

"I think what folks should take away from this is comprehensive smoke-free laws are easy to enforce, that most people like them and that they protect everyone," Stephanie Vogel, population-health director for the health department, told Wartman.

"The nonchalant acceptance, and even enthusiasm from some, of the partial smoking ban in Kenton County contrast with the controversy when it was enacted five years ago," he writes, noting that five years ago some bar owners thought the ban would put them out of business and patrons "lamented" that it was "an attack on their rights."

Amy Kummler, owner of Up Over bar, which can still allow smoking because it doesn't serve anyone under 18, told Wartman that she wouldn't mind if indoor smoking were banned statewide, but "feels smoking bans limited to one county or city are unfair," he writes.

"I don't even want to sit in my bar when it's smoky a lot," Kummler said. "I would be thrilled if the state went non-smoking, but I don't think it would be fair unless everybody did it."

Kentucky legislators have tried to pass a statewide smoke-free workplace law for years, but to no avail. Last year a bill passed out of the House, but was not called up for a vote in the Senate. This year, an election year, the bill wasn't even called up for discussion in committee. New Republican Gov. Matt Bevin opposes a statewide smoking ban.

"Last year we thought it was our year," Heather Wehrheim, chairwoman of Smoke-Free Kentucky, told Wartman. "It was the perfect scenario ... the public support was there; we thought we had the votes. It was Senate leadership that blocked it. Their argument, and whether it's true or not, is that it should be left up to local communities to pass smoke-free laws. We know that is going to take years and years and years."

The latest Kentucky Health Issues Poll found that two-thirds of Kentucky adults support a comprehensive statewide smoking ban, and have since 2013. The ban has support from solid majorities in each political party and has majority support in every region of the state. But more than one-fourth of Kentucky adults are smokers.

Princess Health and Legislature's many health bills include some with life-saving potential, better prevention, greater access and help for children. Princessiccia

Princess Health and Legislature's many health bills include some with life-saving potential, better prevention, greater access and help for children. Princessiccia

assisted living autism cancer drugs General Assembly health care access influenza legislation legislature pharmaceuticals pharmacies pharmacists physician assistants smoking state government

Gusty 13:57 Add Comment

By Melissa Patrick
Kentucky Health News

One paragraph in this story was incorrect and has been stricken.

FRANKFORT, Ky. -- Kentucky legislators have all but ended their regular session without agreeing on a budget, but were able to pass a wide range of health bills that await Gov. Matt Bevin's signature or veto.

Legislators can still pass more bills, including a budget, when they return for one day, April 12, and reconsider any bills the governor vetoes (except the budget, if one passes that day).

Many of the health bills deal with regulation, such as which agency oversees home medical equipment and licensing rules for physicians. Others, like SB 211, sponsored by Sen. Alice Forgy Kerr, R-Lexington, establish a special day to encourage research for amytrophic lateral sclerosis by officially naming Feb. 21 "ALS Awareness Day."

But several others will impact the daily lives of Kentuckians, directly or indirectly. Some have the potential to save lives.

Senate Bill 33, sponsored by Sen. Max Wise, R-Campbellsville, requires every Kentucky high-school student to receive compression-only CPR training. "Each year nearly 424,000 people have sudden cardiac arrest outside of the hospital and only 10 percent of those victims survive," Wise said at a Jan. 13 Senate Health and Welfare Committee meeting. "Yet when a CPR trained bystander is near, they can double or triple these victims survival rate."

Another bill with life-saving potential would let Kentuckians take time off work to be "living donors" or donate bone marrow without the risk of losing jobs or income. House Bill 19, sponsored by Rep. Ron Crimm, R-Louisville, requires paid leave of absence for such reasons, and offsets this cost to the employer with tax credits.

(An amendment to this bill, illustrating how legislation gets passed in unusual ways during the closing days, would allow Lexington to impose an additional 2.5 percent hotel-room tax to improve its convention center.)

A minor housekeeping bill had an important health amendment attached to it that mandates assisted-living communities to provide residents with educational information about the flu by Sept 1 of each year. SB 22 is sponsored by Sen. Ralph Alvarado, R-Winchester. The CDC estimates that between 80 and 90 percent of seasonal flu-related deaths occur in people over 65.

Colon cancer, which kills more than 850 Kentuckians a year, remained in the spotlight with passage of HB115, sponsored by Rep. Tom Burch, D-Louisville. It would expand eligibility for screenings to age-eligible, under-insured Kentuckians, or uninsured persons deemed at high risk for the disease. This bill is aimed at the 7 percent of Kentuckians who have remained uninsured since the state expanded Medicaid under federal health reform, and those who have insurance but can't afford deductibles or co-payments.

Other bills intended to create better access to care for Kentuckians would expand the duties of advanced practice registered nurses (SB114); decrease the oversight of physician's assistants (SB154); create a pilot program to study telehealth and how it's paid for (HB 95); and better define who can perform administrative duties in pharmacies (HB 527).

Children: "Noah's Law," or SB 193, sponsored by Alvarado, mandates the coverage of amino-acid-based formulas for eosinophilic esophagitis and other digestive disorders. It will have an impact on more than 200 Kentucky families. It is called "Noah's Law" after 9-year-old Noah Greenhill of Pike County who suffers from the disease, which requires him to get this formula through a feeding tube four times a day because of severe food allergies, at a daily cost of more than $40. This bill has already been signed by the governor and took effect immediately.

HB148, sponsored by Rep. Linda Belcher, D-Shepherdsville, allows day-care centers to be able to obtain and store epinephrine auto-injectors for emergency use. This bill was amended to include "participating places of worship" as a location that newborns up to 30 days old can be left without threat of prosecution to the parent or family member who leaves them there.

The latest Centers for Disease Control and Prevention study found that one in 68 of the nation's children have autism, and Kentucky legislators passed two bills this session to address their needs. SB 185, sponsored by Sen. Julie Raque Adams, R-Louisville, creates the Office of Autism and guidelines for an Advisory Council on Autism Spectrum Disorders. This bill has already been signed by the governor. HB 100, sponsored by House Minority Leader Rep. Jeff Hoover, R-Jamestown, requires insurers to maintain a website to provide information for filing claims on autism coverage and make autism-benefit liaisons available to facilitate communications with policyholders.

Big bills: One of the high-profile health bills that passed this session is SB20, sponsored by Alvarado, which creates a third-party appeals process for providers to appeal denied Medicaid claims. Alvarado has said that 20 percent of Medicaid claims are denied, compared to the national average of around 6 percent. He suggest that bringing this bill will help bring these numbers more in line with each other and thus will encourage more providers to participate in Medicaid.

A bill that will eventually increase accessibility to drugs made from living tissues that are very expensive, but also very effective, also passed. SB 134, sponsored by Alvarado, would allow pharmacists to substitute a less-expensive "interchangeable biosimilar" drug for its name-brand "biologic" one, even though the U.S. Food and Drug Administration hasn't approved these interchangeables yet. Humira and Remicade for arthritis, and Enbrel for psoriasis, are a few of the most common biologics on the market.

Another bill is aimed to help small-town pharmacies stay competitive with chains. SB 117, sponsored by Wise, allows the state Insurance Department to regulate pharmacy benefit managers, like Express Scripts, much like insurance companies. It would also provide an appeal mechanism to resolve pricing disputes between pharmacies and PBMs. The state has more than 500 independent pharmacists that will be affected by this law.

Bigger issues: Health officials say the single most important thing that Kentucky can do to improve the state's health at no cost is to pass a statewide smoking ban for workplaces. Rep. Susan Westrom, D-Lexington, filed a smoke-free bill late in the session that didn't even get a hearing in committee, despite having passed the House last year. Bevin opposes a statewide ban.

Adams and Alvarado filed a bill to require insurance companies to pay for all evidence-based smoking cessation treatments in hopes of decreasing the state's smoking rate, but it was filed late in the session and only brought up for discussion.

Democratic Rep. David Watkins, a retired physician from Henderson, filed three bills to decrease smoking in the state: one to increase the cigarette tax, one to raise the legal age for buying tobacco products to to 21, and one to require retail outlets to conceal tobacco products until a customer requests them. All were to no avail.

Rep. Darryl Owens, D-Louisville, filed bills to continue the Kynect health-insurance exchange and the state's current expansion of the federal-state Medicaid program. The bills passed mostly among party lines in the House, but the Senate has not voted on them as Senate President Robert Stivers said he would if the House did.

Princess Health and Bevin gets bill to create third-party appeals process for denied Medicaid claims, which sponsor says are all too common. Princessiccia

Princess Health and Bevin gets bill to create third-party appeals process for denied Medicaid claims, which sponsor says are all too common. Princessiccia

behavioral health doctors General Assembly health insurance hospitals insurance legislation legislature Medicaid physicians

Gusty 16:05 Add Comment

By Melissa Patrick
Kentucky Health News

A bill to create an independent process for Kentucky health-care providers to appeal claims denied by Medicaid managed-care organizations is on its way to the governor's desk for his signature.

Sen. Ralph Alvarado

The only appeals process for providers now is through the MCOs themselves, and the only recourse for denied claims is through the courts.

"We are looking at almost 20 percent of the claims that are out there through Medicaid being denied to providers," the bill's sponsor, Republican Sen. Ralph Alvarado of Winchester, told Kentucky Health News. "So with that there are millions of dollars that all of those providers are losing out on. This finally gives them an opportunity to keep the MCOs accountable."

WellCare of Kentucky, one of the MCOs Alvarado targeted last year while trying to get a similar bill passed, denied that it has so many disputed claims, but says it will work with the Cabinet for Health and Family Services if Senate Bill 20 is enacted.

"WellCare of Kentucky rarely disputes claims for medical necessity, with only 1 percent of claims being denied for this reason," spokesperson Charles Talbert said in an e-mail. "We are supportive of initiatives that help to ensure our members get the right care, at the right time, in the right setting."

Another MCO that Alvarado targeted last year as having a high rate of denied claims, Aetna Better Health of Kentucky, formerly CoventryCares, said in an e-mail, "We work tirelessly, along with our network of providers to improve access to and quality of care for our Medicaid members and we are committed to continuing these valuable collaborations."

CareSource, another MCO, declined to comment.

Kentucky implemented managed care in 2011 mainly as a way to save money. In managed care, an MCO gets a lump sum per patient, a system that encourages them to limit payments to providers. Providers have complained about denied claims and slow payments, causing some to suggest that managed care creates an incentive to deny care.

"Kentucky Medicaid MCOs have a denial rate that is four times the national average," Alvarado said in an e-mail. "These MCOs, in general, are garnering massive profits on the backs of our providers by simply not paying for services; and then claiming that they are 'managing care'."

MCOs serve about 1.1 million Kentuckians and account for about 69 percent of the state's Medicaid budget, according to a state news release.

Last year the state renegotiated all MCO contracts in hopes of decreasing the number of disputes over rejected claims, but health-care providers told the Senate Health and Welfare Committee Jan. 13 that this is still an ongoing problem, especially with behavioral health.

Nina Eisner, CEO of The Ridge Behavioral Health Systems, told the committee that there are examples all over the state of patients with homicidal thoughts unable to get their care paid for by MCOs.

Senate Bill 20 says that after providers exhaust an MCO's internal appeals process for denied claims and a final decision has been made, the provider can then seek a third-party review from an administrative hearing tribunal in the cabinet. The appeals process would apply to all contracts or master agreements entered into or renewed on or after July 1, 2016.

Alvarado said the proposed appeals structure is very similar to the one for commercial insurance appeals at the Department of Insurance. He noted that Kentucky's commercial denial rates are around 6 percent, which are close to the national average, and said he hopes this independent appeals process will bring the MCO denial rates more in line with this.

"If we go from 20 percent to 6 percent, I think most providers will accept that," he said. "This is fair. It is fundamentally American to have an appeals process and it is needed."

Alvarado sponsored a similar bill last year, but it died in the House. A similar bill passed both chambers in 2013, but then-Gov. Steve Beshear vetoed it. Alvarado said he is confident Gov. Matt Bevin will sign this year's version.

Alvarado said that once this "fractured relationship between providers and Medicaid" has been mended "it might actually open up the door for more providers to participate with Medicaid."

Sheila Schuster, a Louisville mental-health advocate, agreed, and said that while Medicaid reimbursement rates are "not great," not being paid at all for services rendered is not acceptable and has been a deterrent for providers to participate.

She said the Kentucky Mental Health Coalition and the National Alliance on Mental Illness support SB 20 because "they want providers to be fairly treated and to be able to provide the services that they need."