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 Court of Appeals orders Lexington abortion clinic closed for now. Princessiccia

Princess Health and Court of Appeals orders Lexington abortion clinic closed for now. Princessiccia

abortion courts

Gusty 18:46 Add Comment

By Al Cross
Kentucky Health News

Reversing a lower court's ruling Wednesday, the Kentucky Court of Appeals said Lexington's only location for legal abortions must stop performing them pending a lawsuit by the state that seeks to require it to be licensed as an abortion facility.

Fayette Circuit Judge Ernesto Scorsone declined in March to issue an injunction to close EMW Women�s Clinic on Burt Road, saying that the state failed to show that it was likely to win its lawsuit and that allowing it to stay open in the meantime would cause any irreparable injury. He found that the clinic was operating legally, and closing it would be �against the public interest� because it is the only clinic that routinely provides abortion services in the eastern half of the state and the right to an abortion is constitutionally protected.

But the facility is licensed as a physician's office, not as an abortion clinic, and a three-judge panel of the Court of Appeals, all of them women, unanimously agreed with the administration of Gov. Matt Bevin that it needs the latter license to operate legally. The judges said Scorsone had misinterpreted the licensing requirements and didn't give proper weight to the evidence, which was that all the clinic does is perform abortions and related procedures.

The clinic's owner, Dr. Ernest Marshall of Louisville, testified that the Lexington business "originated as a doctor's office" but has narrowed its line of work in recent years, especially after his partner died in December 2013. He said it was a simple facility compared to his EMW Women's Surgical Center in Louisville, which is licensed as an abortion facility and performed 2,773 abortions last year compared to 411 at the Lexington facility, which does abortions only in the first 12 weeks of pregnancy.

Scorsone said Marshall "has a strong argument" that he didn't need an abortion license because the Cabinet for Health and Family Services reached that conclusion after its last previous inspection in 2006 and the clinic doesn't have $1.5 million worth of equipment, at which point an abortion-clinic license is required. But the appeals court pointed out that state law says an abortion facility is "any place in which an abortion is performed" and "We see no reason why an exemption determination should be determinative a decade later," after the nature of the facility had changed.

The appeals court said Scorsone also erred in saying denial of an injunction wouldn't cause irreparable injury, because the cabinet and the citizens would be harmed "if the cabinet is not allowed to correct the alleged violations of its licensing requirements." It said that is a legal presumption that Marshall could have rebutted but did not. It also cited the cabinet's latest inspection, which found "expired medications, defective equipment, [a] torn examination table and dust accumulation."

In granting the injunction prohibiting abortions at the facility, the court said "There is a substantial legal issue as to whether EMW Lexington qualifies as a private physician's office, where it performed only abortions in the last year."

As for the availability of abortions in the eastern half of the state, the three judges said Marshall presented no evidence regarding "the location of the women EMW Lexington serves" and noted that it refers women past the 12th week of pregnancy to its Louisville facility. "As the cabinet points out, this case is not about a woman's right to an abortion," Judge Allison Jones wrote.  "The cabinet is not seeking to prevent women from obtaining abortions [but] to enforce its right to regulate the manner in which abortions are performed in this commonwealth." Judges Sara Combs and Debra Lambert joined in the opinion.

Princess Health and Insurance commissioner sues contractor for failed Kentucky Health Cooperative, alleging gross negligence in handling claims. Princessiccia

Princess Health and Insurance commissioner sues contractor for failed Kentucky Health Cooperative, alleging gross negligence in handling claims. Princessiccia

Congress courts health insurance health reform obamacare politics state government

Gusty 19:41 Add Comment

State Insurance Commissioner Brian Maynard, acting as liquidator of the failed Kentucky Health Cooperative, filed suit in Franklin Circuit Court Friday against against the company that the co-op hired to process and pay claims. The suit contends that CGI Technologies and Solutions Inc. was "grossly negligent" in processing and paying claims and thus breached its contract.

The co-op, created by federal health reform to compete with insurance companies and hold down premium costs, had financial problems from the start. This year Republicans accused former Gov. Steve Beshear, a Democrat who embraced health reform, of holding down co-op premiums to make the reforms look good. Beshear denied the charge.

The co-op announced in October 2015 that it would close because Congress did not provide sufficient "risk corridor" payments to insurers with disproportionately sick policyholders and the Obama administration was unwilling or unable to make up the difference. The co-op, which had a deficit of $50 million in 2014, was expecting a risk-corridor payment of $77 million but got only $9.7 million. Most other co-ops also failed.

�We have a duty to investigate the causes of the co-op�s collapse and to hold responsible those individuals who caused the collapse,� Maynard said in a press release. �This includes recovering funds from responsible parties so that the doctors, nurses, and hospitals that treated Kentuckians insured by the co-op are fairly compensated for their services.�

Thousands of patients and thousands of providers will have to wait until Oct. 15 or later to find out how much of their medical bills sent to the co-op will be paid, Kentucky Health News reported in February. The co-op "left thousands of providers waiting for payment," Stephanie Armour reported for The Wall Street Journal. It covered about 51,000 people through the end of 2015. Franklin Circuit Judge Phillip Shepherd will decide how much will be paid to whom.

Princess Health and Legal clinic for cancer patients, families and caregivers in Louisville April 13 is free, but requests RSVP if you plan to attend. Princessiccia

Princess Health and Legal clinic for cancer patients, families and caregivers in Louisville April 13 is free, but requests RSVP if you plan to attend. Princessiccia

cancer courts

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A free legal clinic for people facing cancer, and their families and caregivers, will be held in Louisville April 13. The Kentucky Cancer Program at the University of Louisville, the Louisville Bar Association and the Louisville Pro Bono Consortium are sponsoring the clinic at Gilda�s Club of Louisville, 633 Baxter Ave., from 5:30 to 7:30 p.m. Wednesday, April 13. Free parking is available behind the building and across the street from the club.

Attorneys will be available to offer help with life-planning documents under Medicare Part D, including wills, powers of attorney, health care surrogacy and living wills. They also will provide guidance on employee benefits during illness and government assistance that is available such as Medicaid, Medicare and Social Security disability insurance.

Admission is free, but RSVPs in advance are needed; call 502-852-6318. For additional information, contact the Kentucky Cancer Program at jlcaud02@louisville.edu or 502-852-6318.

Princess Health and Judge denies Bevin's bid to close Lexington abortion provider, citing difficulty that would create for Eastern Ky. women. Princessiccia

Princess Health and Judge denies Bevin's bid to close Lexington abortion provider, citing difficulty that would create for Eastern Ky. women. Princessiccia

abortion courts doctors physicians

Gusty 09:58 Add Comment

UPDATE, June 15: A three-judge panel of the state Court of Appeals reversed the ruling.

A Lexington judge has rejected Gov. Matt Bevin's request to close the city's only abortion facility, saying that it is operating legally and that closing it would restrict access to abortions by residents of Eastern Kentucky.

Circuit Judge Ernesto Scorsone said Friday that he wouldn't issue an injunction to close EMW Women�s Clinic on Burt Road because the state failed to show that it is likely to win its lawsuit or that allowing it to stay open in the meantime would cause any irreparable injury.

�In addition to the evidence indicating that EMW is operating legally and in conformity with the most important regulations of a licensed abortion facility, closing the clinic is against the public interest,� Scorsone wrote. �EMW is the only physician�s office that routinely provides abortion services in the Eastern half of the state, and both parties agree that a right to an abortion during the first trimester of pregnancy is constitutionally protected. Closing EMW would have a severe, adverse impact on the women in the eastern part of the state.�

The clinic's attorney, Scott White, said it only performs first-trimester abortions and would reopen next week. It had closed in response to the lawsuit because of potential fines. Bevin spokeswoman Jessica Ditto said the administration would take the case to the state Court of Appeals.

The state claims the clinic needs to be licensed as an abortion clinic because that is all it does.

At a hearing Wednesday, "Clinic owner Ernest Marshall said the clinic used to do more regular gynecological health care, and is open to doing more, but he said that since his partner died a few years ago, the clinic�s primary work is abortions," Linda Blackford reports for the Lexington Herald-Leader. "On Feb. 17, state inspectors with the Cabinet for Health and Family Services visited the clinic, where they reported that employees told them the clinic only performs abortions. Inspectors also found dirty conditions and expired medicine."

Scorsone wrote that he was sure the clinic would address those issues, which typically do not lead to efforts to shut down medical facilities. He wrote, �The uncontroverted testimony presented at the hearing is that it is within the standard of care to perform first trimester abortions in a doctor�s office and that these procedures are less dangerous than others routinely performed in an office setting. The procedures used do not require sedation or the services of an anesthesiologist, factors that indicate EMW is a private physician�s office exempt from the licensing requirements for ambulatory surgical centers.�

"Scorsone said that the facility is already in compliance with the two most important requirements of an abortion clinic � that it has in place a transfer agreement with a hospital and a transportation agreement with an ambulance service in case there are complications with a procedure," Joseph Gerth reports for The Courier-Journal.

The clinic performed 411 of the 3,187 abortions reported to state officials last year. Most (2,773) were done by the EMW Women's Surgical Center in Louisville, which Marshall owns.

"The Bevin administration has targeted abortion clinics for regulatory action in the first months of his term," Gerth notes. "In February, he sought to block Planned Parenthood from offering abortions at a new clinic it opened in Louisville." That clinic has suspended abortions while the suit proceeds.

Princess Health and Bill for review of medical lawsuits dies from special elections. Princessiccia

Princess Health and Bill for review of medical lawsuits dies from special elections. Princessiccia

courts doctors elections General Assembly hospitals legislation legislature malpractice nursing homes physicians politics

Gusty 09:35 Add Comment

A bill that would create panels of experts to review lawsuits against health-care providers is going nowhere, again.

State Senate President Robert Stivers said Friday that he and other leaders of the Senate's Republican majority sent Senate Bill 6 back to committee because last week's special elections continued Democratic control of the House. They did likewise with a bill for a "right to work" law that would ban union membership or fees as a condition of employment.

�The reality is the House does not see as the majority party in this Senate does, that right-to-work would even be another tool that could increase and expand on job recruitment and retention,� Stivers said. �The other thing is we�ve had Senate Bill 6 sitting on the board for quite some time. But, because of the elections two weeks ago, the consequences are, they would pass this chamber but die in the House.�

Princess Health and Three doctors, nine others in western half of Kentucky are indicted in the largest-ever federal 'takedown' of Medicaid fraud.Princessiccia

Princess Health and Three doctors, nine others in western half of Kentucky are indicted in the largest-ever federal 'takedown' of Medicaid fraud.Princessiccia

accidents controlled substances courts doctors drug abuse drugs federal government fraud Medicaid Medicare narcotics pain physicians prescription drug abuse

Gusty 06:07 Add Comment

Former Dr. Fred Gott of Bowling Green was arrested.
(Photo: Miranda Pederson, Bowling Green Daily News)

Twelve people in the western half of Kentucky, including three doctors, have been charged with Medicaid fraud in what the federal government calls its biggest-ever "takedown" of the problem, Andrew Wolfson of The Courier-Journal reports.

The indictments allege "a half-dozen schemes involving nearly $8 million in alleged fraudulent billings," Wolfson writes. "The offenses include $5 million in false billings for muscle-relaxant injections that were never delivered to patients, as well as a staged car wreck in which three people allegedly conspired to get controlled substances and fraudulent reimbursements."

In another case, Wolfson reports, "a medical practice that treated car wreck patients is accused of using the DEA numbers of nurse practitioners to order hydrocodone for herself and falsely billing it to an insurance company. Nationally, the sweep resulted in charges against 243 people, including 46 doctors, nurses and other licensed medical professionals."

John Kuhn, acting U.S. attorney for the Western District of Kentucky, told Wolfson that about $1 billion of annual Medicare and Medicaid expenses are fraudulent. Medicare is the federal health-insurance program for people over 65; Medicaid is the federal-state program for the poor and disabled.

Former Dr. Fred Gott of Bowling Green, a 63-year-old cardiologist, was charged with "conspiracy to dispense controlled substances, health care fraud and money laundering," Deborah Highland reports for the Bowling Green Daily News. "The Bowling Green-Warren County Drug Task Force opened an investigation into Gott�s practices after Warren County Coroner Kevin Kirby alerted the task force about drug overdose deaths involving Gott�s patients, task force director Tommy Loving said."

Princess Health and Bevin says he will end all Obamacare programs in Ky., including Medicaid expansion that has added more than 400,000 to rolls .Princessiccia

Princess Health and Bevin says he will end all Obamacare programs in Ky., including Medicaid expansion that has added more than 400,000 to rolls .Princessiccia

Affordable Care Act courts doctor shortages elections governor governor's race health insurance health reform insurance exchange Medicaid politics

Gusty 13:00 Add Comment

Matt Bevin, the Republican nominee for governor, has made clear that if elected he would end the Medicaid expansion that has provided free health coverage for more than 400,000 poor Kentuckians.

During his primary campaign, Bevin never made that quite plain, saying he would close the state's health-insurance exchange, Kynect, because it would cost "hundreds of millions of dollars." Kynect is paid for by insurance companies, so Bevin was alluding to to the state's projected cost of expanding Medicaid, which enrolls through Kynect.

The Washington-based publication Politico reported on June 10, after interviewing Bevin, that he would not only close Kynect but roll back the Medicaid expansion: �You may or may not have access to Medicaid going forward,� he said. �People are not on it for extended periods of time. It�s not meant to be a lifestyle. It really isn�t. The point of it is to provide for those who truly have need.�

Democratic nominee and Attorney General Jack Conway, with Gov.
Steve Beshear; GOP nominee Matt Bevin (AP photos via Politico)

Gov. Steve Beshear "is furious" about Bevin's plan, Politico reported. �I am not going to allow someone to become governor of this state who wants to take us back to the 19th century,� the governor said in a telephone interview. �For a serious candidate for governor to be advocating a simple repeal of the whole program without offering any kind of alternative which will continue health care for these people is irresponsible.�

Beshear expanded the eligibility rules for Medicaid as part of implementing the Patient Protection and Affordable Care Act, raising the income limit to the law's required 138 percent of the federal poverty level, from the state's previous level of 69 percent.

The federal government is paying the entire cost of the newly eligible Medicaid recipients though next year. In 2017, the state would begin to pay 3 percent, rising to the reform law's cap of 10 percent by 2020. A study by Deloitte Consulting and the Urban Institute at the University of Louisville  � "which Republican critics have rejected as spin," Politico says � has said the expansion more than pays for itself through 2020 by expanding health-care jobs and generating tax revenue.

Jobs are growing as projected by the study, according to the Cabinet for Health and Family Services, which handles Medicaid.

Cabinet spokeswomnan Jill Midkiff said the study estimated that 32,000 jobs would be created through 2015 as a result of the expansion. "U of L projected this growth would primarily be in the areas of retail trade, finance and insurance, administrative services, health and social services, accommodations and food services and other services," Midkiff said. "These sectors were estimated to account for more than 28,000 of the 32,000 jobs created." She said the latest Bureau of Labor Statistics figures show that "these sectors have grown by more than 29,000 jobs from 2013 until April 2015. Therefore, the most recent BLS numbers indicate that UofL�s estimates are on target to meet projections."

Politico says a Bevin victory could "blot an Obamacare bright spot," since Kynect has "worked virtually glitch-free." Through April, 106,000 Kentuckians had obtained tax-subsidized, private insurance coverage through Kynect, which is also the portal for enrolling in Medicaid.

Bevin says he would move those people to the federal exchange, which has been marred by technological issues and charges insurance companies much more to use it than Kynect does. But that plan would not work if the U.S. Supreme Court rules this month that the tax subsidies are not legally available through the federal exchange.

"That doesn�t worry Bevin," Politico reports, quoting him: �You�re worrying about a hypothesis. Let�s let the Supreme Court rule.�

And what about the new Medicaid recipients who would lose their benefits if Bevin wins? He "insists that Obamacare is coverage in name only � that Kentuckians still lack access to high-quality health care, partly because Medicaid pays doctors such low rates, partly because he says too many people rely on emergency rooms," Politico reports, quoting him: �Just having health insurance doesn�t mean you�re going to get health care.�

Attorney General Jack Conway, the Democratic nominee, declined Politico's request for an interview. Campaign spokesman Daniel Kemp said, �Jack wants to make sure that the hundreds of thousands of Kentuckians who now have health insurance through Kynect, especially kids, keep their health insurance � not play politics or push an ideology that�s out of touch with Kentucky�s values.�

Politico observes, "Conway is in the tricky spot of embracing Kynect while trying to keep his distance from Obama and Obamacare, a term that still generates ire among Kentucky residents. A September 2014 Marist [College] poll found that 61 percent of registered Kentucky voters had an unfavorable impression of Obamacare. Only 17 percent had negative feelings about Kynect."

Princess Health and Citing costs, Bevin has said he would shut down Kynect; actually, insurance companies pay for it; Medicaid is another matter.Princessiccia

Princess Health and Citing costs, Bevin has said he would shut down Kynect; actually, insurance companies pay for it; Medicaid is another matter.Princessiccia

Affordable Care Act courts elections health insurance insurance coverage insurance exchange Kynect Medicaid politics

Gusty 06:46 Add Comment

By Molly Burchett and Al Cross
Kentucky Health News

The governor's race between Democrat Jack Conway and Republican Matt Bevin will spotlight the Patient Protection and Affordable Care Act, an issue that affects all Kentuckians at least indirectly.

Conway, in his eighth year as attorney general, says he would have voted for the law. Bevin, who was the most conservative candidate in his primary, has said he would shut down the state's health-insurance exchange, Kynect, that was established under the law, because it will cost the state hundreds of millions of dollars.

Actually, Kynect is paid for by insurance companies that sell policies in Kentucky. Bevin appears to be referring to the projected cost of expanding Medicaid, another Obamacare-related move that Democratic Gov. Steve Beshear made at the same time he created Kynect. It raised the program's income limit to 138 percent of the federal poverty level, from 69 percent.

The federal government is paying the entire cost of the Medicaid expansion for the first three years. In 2017, the state will pay 3 percent, gradually rising to the law's cap of 10 percent in 2020. A study for the state projects that the expansion will pay for itself until 2021 by expanding health-care jobs and generating economic activity and tax revenue.

Bevin has scoffed at those projections. Conway has said the state needs to provide health coverage, but only what it can afford.

As Kentuckians, voters, and consumers of health insurance, you may be asking: What's going on with Obamacare in the state? Are we able to afford it? Who and what should we believe? While the cost of Medicaid expansion is debatable, it's becoming clear that Kynect has avoided the problems plaguing other state-run exchanges.

So far, the Centers for Medicare and Medicaid Services has dispensed more than $4.9 billion in grants to help launch state-run exchanges. Kentucky received $253 million for the initial planning and development phases of Kynect. Now its $28 million annual cost is covered by a fee on insurance companies, state officials say.

Despite federal support and their own revenue sources, many of the 17 state-based exchanges are expecting deficits this year and in the future. Many will continue to rely on leftover federal funds to pay for operations this year, report Darius Tahir and Paul Demko of Modern Healthcare. Hawaii announced this week that it would close its exchange and transfer clients to the federal exchange because of continued funding problems.

Kynect officials say it isn't having such problems because the state has ensured that Kynect is self-supporting through fees on insurance plans.

"The governor committed that the exchange would be self-supporting and would not rely on state General Fund dollars," said Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services. "Kentucky�s sustainability plan employs an existing assessment on insurers that was previously used to fund Kentucky Access, the state�s high-risk pool, which was closed [since] individuals previously enrolled are now eligible to purchase a plan through Kynect."

But to transform Kentucky Access into Kynect, Beshear used executive orders that bypassed the General Assembly, where Republicans control the Senate. They have questioned his use of executive powers but generally have not been critical of Kynect.

The fee on insurers is a 1 percent, broad-based assessment on all policies sold by companies offering plans through the exchange. While insurers don't pass this fee directly to consumers, it almost certainly figures into their calculation of premium calculation and thus is indirectly paid by policyholders. The federal exchange is financed in a similar way, but its fee is 3.5 percent, meaning higher costs for insurers and policyholders.

In most cases, premiums for Kynect policies are reduced by a federal income-tax subsidy that is a key part of Obamacare.

"The vast majority of Kentuckians buying health insurance through Kynect are eligible for some kind of payment assistance or subsidy," Beshear said in commenting on most health-insurance companies recent requests for premium increases. "That cost will vary from family to family, so talking about rate changes in a vacuum isn�t a very effective way to gauge how much those rate fluctuations may affect policyholders or those shopping for insurance."

Bevin says he would move Kynect customers to the federal exchange, but the U.S. Supreme Court could rule this month that the tax subsidies are not supposed to be available through the federal exchange. The plaintiffs in the case cite a passage of the law that opponents say was a drafting error and does not make sense when the law is viewed as a whole.

If the court agrees with the plaintiffs, and Congress doesn't change the law, states using the federal exchanges will see spikes in insurance premiums, and millions of people could be at risk of losing their insurance. Bevin has not said what he would do in case of such a ruling.

Independent Drew Curtis is also running for governor.

Princess Health and Princess Health andState Supreme Court says county boards of health cannot enact smoking bans by regulation.Princessiccia

Princess Health and Princess Health andState Supreme Court says county boards of health cannot enact smoking bans by regulation.Princessiccia

county health boards courts local government smoking smoking ban smoking bans tobacco

Gusty 19:10 Add Comment

By Al Cross
Kentucky Health News

County health boards in Kentucky do not have the power to ban smoking in public places, the Kentucky Supreme Court ruled without dissent Thursday.

The decision was a stiff blow to health officials who see smoking as the primary factor in making Kentucky one of the least healthy states, and have sought state and local smoking bans to limit exposure to second-hand smoke. It struck down a ban in Bullitt County and presumably will do likewise for those enacted by the Clark, Madison and Woodford county health boards, which joined the case. (Click on map for larger version)

Justice Bill Cunningham, who wrote the decision, noted that the U.S. surgeon general has found "many of the chemicals inhaled through second-hand smoke are known carcinogens" and "that even short-term exposure to second-hand smoke can result in serious health consequences. In 2009-10, overall second-hand smoke exposure by Kentucky adults was 51.4 percent, with 30 percent reporting exposure in the workplace and 32.8 percent reporting exposure in public places. Given such dismal data, it is understandable that many health-care professionals and government officials have sought to curtail the prevalence of this noxious fume. Promoting a smoke-free society is a reasonable goal grounded in sound research. However, when promotion becomes enactment, even the most virtuous causes must also be grounded in law."

Health boards enacting bans have relied on a 1954 state law that gives them to power to adopt regulations "necessary to protect the health of the people." To find that law as "sufficient grounding for the regulation," Cunningham wrote, the court would have to construe the law "as delegating the totality of the Commonwealth's police power to the health boards. Nothing would remain to be ceded by the General Assembly, including the critical legislative charge of distinguishing virtue from vice."

Cunningham said such a ruling would "promote an overly broad delegation of legislative sovereignty," in violation of the state constitution. He said the authorization of regulations was limited, and was based that view on what he called the law's legislative history. In 1954, he wrote, "It would have been
commonplace for members of the General Assembly to indulge in a cigarette or cigar in their offices, committee rooms, or even on the floors of the House and Senate chambers. Most likely, the . . . legislation was debated and voted in chambers fogged with a haze of smoke."

Thursday's decision overturned a 2-1 ruling of a Court of Appeals panel that relied partly on the 1984 Supreme Court decision that upheld a Jefferson County regulation on lead paint. Cunningham said that was based on a law that "specifically addressed lead poisoning and expressly authorized and encouraged action at the local level," and "There is no similar statutory mandate" in state law for smoking bans.

Cunningham also noted that most of the Jefferson County board is appointed by local officials, while health boards in other counties are appointed by the state health secretary "and not by duly elected representatives. When regulating controversial issues traditionally within the province of state or local legislative entities, this structure is constitutionally problematic in that it does not comport with traditional notions of representative government." In this case, the Bullitt County Fiscal Court filed a lawsuit challenging the health board's authority.

The appeals court, in rejecting the fiscal court's case and overturning the local circuit court, also relied on a 1967 decision upholding a local health board's regulation of private sewage disposal systems. Cunningham said that decision was strongly based on earlier cases on the topic, and in contrast, there is no "well-established line of authority regarding the need for administrative regulation of smoking and second-hand smoke."

Finally, Cunningham said legal precedents in Kentucky say that "Where reasonable doubt exists concerning the proper scope of an administrative agency's authority, it should be resolved against the agency," and "An increase in the aggregate power of administrative agencies over the recent decades, if left unchecked, invites the ascendance of a fourth branch of government�the regulatory state."

Princess Health and Princess Health andElizabethtown cancer clinic pays $3.7 million to resolve claims it diluted drugs, prolonged chemotherapy to make more money.Princessiccia

Princess Health and Princess Health andElizabethtown cancer clinic pays $3.7 million to resolve claims it diluted drugs, prolonged chemotherapy to make more money.Princessiccia

cancer courts hospitals law enforcement Medicaid Medicare

Gusty 08:11 Add Comment

Elizabethtown Hematology Oncology PLC and its owners has paid $3,739,325 to settle claims "that they submitted false claims for payment to the Medicare, Medicaid and the military's medical provider for extending the duration of chemotherapy infusion treatment to patients and inappropriately billing office visits for infusion therapy," Andrew Wolfson reports for The Courier-Journal.

"To subject cancer patients to unnecessary treatments that are physically draining and emotionally stressful is utterly unconscionable," said Patrick McFarland, inspector general of the U.S. Office of Personnel Management.

The settlement agreement not only explains that the clinic's owners, Dr. Rafiz Ur Rahman and Dr. Yusuf K. Deshmukh, extended the time period of chemotherapy and infusion treatments for patients just to make more money but also says the clinic wrongly billed for office evaluations of patients getting chemotherapy, Wolfson writes.

"Manipulating treatment protocols and lengthening infusion times to increase reimbursement reflect an extraordinary lack or regard for patient welfare and the integrity of our health care system," David Hale, U.S. attorney for the western half of Kentucky, said in a news release.

In 2011, Dr. Ijaz Mahmood of Elizabethtown filed a lawsuit against the clinic, saying it created written protocols designed to prolong chemotherapy infusion times "by a factor of three or more beyond what is generally recognized." Mahmood said Deshmukh and Rahman provided patients with the correct dose of chemotherapy but administered it over a longer period of time by diluting it. They could make more money that way because Medicaid and Medicare pay partially based on how long a procedure takes.

Aside from the $3.7 million payment, the inspector general of the U.S. Department of Health and Human Services will monitor the clinic for three years. The clinic will still be allowed to bill federal medical programs, Wolfson writes. The government could still potentially prosecute the doctors. (Read more)

Princess Health and Princess Health andConway funnels $1.5 million in drug-company settlements to develop prevention and treatment plan for kids' substance abuse.Princessiccia

Princess Health and Princess Health andConway funnels $1.5 million in drug-company settlements to develop prevention and treatment plan for kids' substance abuse.Princessiccia

courts drug abuse drugs state government substance abuse

Gusty 20:27 Add Comment

With two lawsuit settlements from drug makers, Attorney General Jack Conway is giving the University of Kentucky $1.5 million over two years to develop a comprehensive plan for the prevention and treatment of substance abuse by adolescents.

�Adolescent substance use is at epidemic proportions,� Conway said in a press release. �A 2011 study from the Centers for Disease Control documented that 66 percent of Kentucky kids have used alcohol, 37 percent have used marijuana, and 19 percent have abused prescription drugs. This grant will allow us to explore all of the resources available to Kentuckians to fight this growing problem.�

The grant is intended to address all aspects of adolescent substance abuse, including community and physician outreach and education, treatment plans, and outcomes measurement. Funding of $19 million from the $32 million in settlements is already being used to create a program that addresses every stage of adolescent substance abuse, KY Kids Recovery.

"Our goal is to develop a start-to-finish plan with elements that offer evidence-based treatment, reach out to teachers, families, primary care providers and pharmacists, and target resources to communities with the highest need," said Dr. Catherine Martin, director of the new program and UK's Division for Child and Adolescent Psychiatry. �The program will utilize only treatments with a proven track record of success.�

The settlement is also providing $500,000 to complete construction of a Recovery Kentucky center in Ashland, $2.5 million for almost 900 scholarships over two years to Recovery Kentucky centers, and $560,000 to create 14 drug-free homes for people completing and transitioning out of residential substance abuse treatment programs.

In addition, the following entities will receive funds over the next two years from the settlement:
� $6 million to administer and upgrade KASPER, Kentucky�s electronic prescription drug monitoring program.
� $600,000 over two years to support substance abuse treatment for pregnant women by Chrysalis House in Lexington.
� $400,000 over two years to support substance abuse treatment for pregnant women by Independence House in Corbin.
� $1 million to develop a school-based substance abuse screening tool with the Kentucky Department of Education to intervene with at-risk children before they enter judicial or social services systems.
� $250,000 to create a database to evaluate outcomes of juvenile treatment.

Princess Health and Princess Health andIncreasingly common heroin addiction overwhelms agencies.Princessiccia

Princess Health and Princess Health andIncreasingly common heroin addiction overwhelms agencies.Princessiccia

addiction courts heroin hospital-a

Gusty 20:15 Add Comment

Jails, treatment facilities, drug courts and hospitals are struggling to provide the necessary help as more Kentuckians become addicted to heroin, Chris Kenning writes for The Courier-Journal: "In a state that already had a shortage of drug-treatment options, the heroin problem is badly outstripping Kentucky's ability treat it." A Kentucky Health Issues Poll found that 9 percent of Kentuckians and 15 percent aged 18 to 29 reported awareness of a family member of friend struggling with heroin.

"We're just bursting at the seams," said Karyn Hascal, who is head of The Healing Place, a Louisville drug-treatment center. "I've been around 35 years, and I've never seen anything hit this fast and this hard." Though heroin users were few and far between several years ago, now they take up 90 percent of The Healing Place's detox beds.

The Louisville jail deals with 30 to 90 inmates every day. It has hired four around-the-clock detox nurses, started new detox dorm programs and added training officers since 2012, and "increased our inmate health-care budget by hundreds of thousands of dollars," said Metro Corrections director Mark Bolton.

Heroin may be "the most addicting drug there is," said Dr. Christopher Stewart, an addiction psychiatrist and medical director at the Jefferson Alcohol and Drug Abuse Center. Heroin crosses the blood-brain barrier and becomes morphine, "binding to opioid receptors in the brain and sparking an intense rush of pleasure and euphoria�one that's far more sharp and immediate than opiate pills," Kenning writes. People become immune to its effects and need to take more of it, and withdrawal symptoms include pain, vomiting, insomnia, spasms and cravings.

While longer-term treatment for severe addictions often includes patient resident programs including counseling, Kentucky lacks this kind of care. "There are not enough open-entry detox and treatment beds in this community�I'm talking non-insurance beds," Bolton said. Dr. Eric Fulcher, an emergency room doctor said that providing emergency treatment for heroin addicts has become "the new normal" at Sts. Mary and Elizabeth in the South End. "We're so used to it, we're almost numb to it."

Although the former director of the Office of National Drug Control Policy, Gil Kerlikowske, recommended the increased availability of naloxone, used to counteract heroin overdoses, the General Assembly didn't pass a bill "that in part would have made naloxone more widely available, along with other heroin-related measures," Kenning writes.

Jefferson District Judge Stephanie Pearce Burke said that "heroin use is present in more than three-quarters of her cases." Something has to be done. "People still have the idea that it's a drug from the '60s and homeless people in the park," she said. "But the face of heroin has changed. It's suburban teens and middle-class housewives, too." (Read more)

Princess Health and Princess Health andFeds investigating possibility that Humana overbilled taxpayers for Medicare Advantage; firm says it reported information.Princessiccia

Princess Health and Princess Health andFeds investigating possibility that Humana overbilled taxpayers for Medicare Advantage; firm says it reported information.Princessiccia

courts health insurance Humana Medicare

Gusty 07:05 Add Comment

Louisville-based "Humana Inc. faces multiple federal investigations into allegations that it overbilled the government for treating elderly patients enrolled in its Medicare Advantage plans, court records reveal." So reports Fred Schulte of the Washington-based Center for Public Integrity, a non-profit, inevstigative news agency.

"The status of the investigations is not clear, but they apparently involve several branches of the Justice Department," Schulte reports, adding that federal prosecutors said in a document filed in March that they expect at least one of the investigations will be completed �in the next few months.�

Federal prosecutors in West Palm Beach have "opened a criminal case involving overbilling allegations that the government says is similar to the Miami investigation," Schulte writes. "Meanwhile, the criminal division of the Justice Department in Washington has reviewed fraud allegations against the company, according to court records. Humana, which insures more than 2 million people through the Medicare Advantage plans, is also the target of two Florida whistleblower civil lawsuits that allege similar overcharges."

Humana spokesman Tom Noland told Schulte that the company has made �several public disclosures about these matters over a long period of time� and �self-reported� them several years ago, but �Humana to our knowledge is not the subject of any criminal investigation.� (Read more)

Princess Health and Princess Health andKosair sues Norton over use of donations to Children's Hospital; Norton says charity weaseling out of obligation.Princessiccia

Princess Health and Princess Health andKosair sues Norton over use of donations to Children's Hospital; Norton says charity weaseling out of obligation.Princessiccia

children's health courts hospitals philanthropy

Gusty 14:10 Add Comment

Kosair Charities, which gives more than $6 million a year to Kosair Children's Hospital in Louisville, has sued the hospital's parent, Norton Healthcare, accusing it of misusing some of the money "to enhance its bottom line and 'line the pockets' of its executives," and has "refused to provide an accounting of how Kosair's donations are spent," Andrew Wolfson reports for The Courier-Journal.

"Norton spokesman Thomas Johnson said the company 'categorically' denies that 'money designated for Kosair Children's Hospital was somehow spent for any other purpose or in any other Norton Healthcare facility'," Wolfson writes. "In a statement the company called the lawsuit 'baseless' and said, 'Over the last few years Kosair Charities has engaged in a systematic pattern of raising baseless allegations in an effort to avoid its contractual obligations to the children's hospital that carries its name.'" (Read more)

Princess Health and Kentucky Spirit can't terminate its Medicaid contract with the state a year early without facing fines, judge rules.Princessiccia

Princess Health and Kentucky Spirit can't terminate its Medicaid contract with the state a year early without facing fines, judge rules.Princessiccia

courts managed care Medicaid state government

Gusty 14:20 Add Comment

By Molly Burchett
Kentucky Health News

A Frankfort circuit judge ruled Friday that Kentucky Spirit, one of three companies hired by the state in November 2011 to manage health care for more than 540,000 Medicaid recipients, cannot pull out of its contract with the state a year early with no financial penalty.

Kentucky Spirit, a subsidiary of St. Louis-based Centene Corp., announced in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing money, but the company could face fines if it terminates its three-year contract before expiration in July 2014, Franklin Circuit Judge Thomas Wingate said in his ruling.

Kentucky Spirit argued in its lawsuit that the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million. It made the lowest bid, and on average, gets about $100 less per month for each patient than the other two MCOs, Coventry Cares and WellCare.

The Cabinet for Health and Family Services replied that Kentucky Spirit had breached its contract with the state. Wingate said it had not, because it gave notice of early termination, but it will be subject to fines if it pulls out of the state before July 2014, reports Beth Musgrave of the Lexington Herald-Leader.

Kentucky Spirit had argued that its contract allows it to to be terminated with six months notice. The six-month provision could only be interpreted to mean six months prior to the end of the three-year contract, said Wingate, because there has to be enough time for the state to move hundreds of thousands of Medicaid patients from Kentucky Spirit to another managed-care provider.

Jill Midkiff, a spokeswoman for the cabinet, told Musgrave that state officials were thrilled with Wingate's decision. "The cabinet's priorities are the members who receive health care through Medicaid and the taxpayers who pay for the program," she told Musgrave. "This is the right decision for both."

Friday's decision came three days after another Franklin Circuit Court judge ruled that Kentucky Spirit must reimburse health departments for services provided by school nurses to Medicaid-eligible children, which is estimated include about $8 million in back payments.

Centene officials say they are considering options for both cases, which include appeals.

Kentucky Spirit's legal battles are part of ongoing tensions between health-care providers and managed-care companies, and providers have repeatedly complained that the companies are delaying payments for services. The cabinet is hosting a series of forums across the state designed to help providers resolve such issues with the managed care companies.

Princess Health and Judge orders Medicaid managed-care firm to pay for school health services, including $8 million in claims; appeal possible.Princessiccia

Princess Health and Judge orders Medicaid managed-care firm to pay for school health services, including $8 million in claims; appeal possible.Princessiccia

courts health insurance managed care Medicaid school health school nurses schools state government

Gusty 13:47 Add Comment

Medicaid managed care company Kentucky Spirit must cover preventive care services provided by local health departments in schools, a judge has ruled.

Circuit Judge Phillip Shepherd of Frankfort said the company must pay $8 million for the services already provided by school nurses, which would be only .07 percent of its estimated profit for 2013, according to the updated earnings report of Centene Corp. of St. Louis, the parent company for Kentucky Spirit. The company is the only one of the five managed care organizations in Kentucky  that had disputed the coverage of school health services.

Kentucky Spirit stopped providing coverage for school health services last summer, saying its state contract didn't require payment for such services,but Shepherd noted that the state reimbursed health departments for school services before it transitioned to managed care, reports Tom Loftus of The Courier-Journal. �Kentucky Spirit is not free to disregard this longstanding interpretation of Medicaid eligibility and unilaterally re-interpret these to the detriment of local health departments,� Shepherd wrote.

Health departments and school districts will now find some relief because many school nurse programs were threatened by cutbacks and closings as a result of Kentucky Spirits failure to pay for services. �It�s great news because there have been dozens of districts that have had to either say they are going to cut back on nurses, or that they are going to close clinics, or that they are going to dip into their reserves to try to cover the additional costs,� Kentucky School Boards Association spokesman Brad Hughes told Loftus.

Gov. Steve Beshear said Kentucky Spirit had �sought a loophole� in its contract to avoid paying for school health services covered by Medicaid, writes Loftus. Centene released a statement later Tuesday saying that the company is reviewing options and considering an appeal.

This isn't the only payment Centene is trying to avoid. A ruling is expected soon in a lawsuit the company filed against the state last year seeking to end its contract a year early, saying the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million.

Appalachian Regional Healthcare, the largest health-care system in Eastern Kentucky, filed suit in April of this year against Kentucky Spirit for $5.9 million in unpaid claims. This suit is still pending, and was filed just before Centene raised its full-year forecast for premium and service revenue to $10.1 billion to $10.4 billion, Reuters reports.

Princess Health and Nursing homes push for lawsuit protection with fast-moving bill and broadcast ads; newspaper editorials excoriate sponsor, industry.Princessiccia

Princess Health and Nursing homes push for lawsuit protection with fast-moving bill and broadcast ads; newspaper editorials excoriate sponsor, industry.Princessiccia

courts elder abuse elderly General Assembly legislation legislature nursing homes state government

Gusty 05:37 Add Comment

A state Senate committee has approved a bill that would require lawsuits against nursing homes to clear a review panel before going to court, a move that has drawn very sharp criticism from the editorial pages of the state's two largest newspapers. Meanwhile, the nursing-home industry is running television and radio ads urging calls to legislators in favor of the measure, which the Senate Health and Welfare Committee approved 7-4 last Wednesday without hearing from its opponents.

"Slimy action on questionable bill" read the headline over Tuesday's Lexington Herald-Leader's editorial, which began, "Good ideas can withstand criticism. So, when lawmakers move a piece of legislation without hearing from any of its opponents, you have to wonder whether they're sneaking through a stinker."

The chairman of the committee and the bill's sponsor, Sen. Julie Denton, R-Louisville, said some members had to leave for other meetings. "But somehow they had time to listen to industry spokesmen before voting," the Herald-Leader noted. "The nursing home industry claims that it is under siege from frivolous lawsuits drummed up by attorneys advertising for clients and that this legal threat pushes up nursing homes' insurance and legal costs, taking money that otherwise could go into patient care." (Read more)

The Courier-Journal editorial, which first reported the committee's action, accused Denton of "a brazen abuse of her power as committee chairman" and said sarcastically that she was "humane" to spare members of he committee "the ugly details of nursing home neglect and abuse. . . . Why should members, before lunch, have to consider graphic testimony about bedsores, near-starvation, dehydration and bowel obstructions suffered by elderly, helpless people? But for members of the General Assembly who are interested in the facts, here are some:

� Kentucky currently has about 23,000, mostly frail, elderly people who are residents in about 280 nursing homes. About half the homes have been cited by federal inspectors for a serious deficiency since 2009.
� 40 percent of the homes are rated at below average by the U.S. Center for Medicare and Medicaid Services when it comes to basic health and safety.
� In 2012, Kentucky ranked first in overall federal fines for violations and one Kentucky nursing home racked up the nation�s highest fines for the year.
� Kentucky ranks first in serious nursing home deficiencies that threaten the safety of residents. (Read more)

Sen. Ray Jones, D-Pikeville, who called Denton's move "blatantly wrong." has filed several floor amendments to the bill, which remained in the Senate Rules Committee Monday.

The Kentucky Association of Health Care Facilities is pushing the bill with TV and radio commercials urging calls to legislators. It placed $9,464 worth of ads on Lexington TV stations through Feb. 14.

Princess Health and Nursing home chain says it will lease its Kentucky facilities because legislature didn't pass bill to filter lawsuits.Princessiccia

Princess Health and Nursing home chain says it will lease its Kentucky facilities because legislature didn't pass bill to filter lawsuits.Princessiccia

courts General Assembly legislature litigation lobbying long-term care nursing homes state government tort reform

Gusty 15:23 Add Comment

A major nursing-home chain says it will lease all of its Kentucky properties to a Texas company because a bill to insulate nursing homes from lawsuits did not pass the General Assembly this year,

Extendicare Health Services owns Pembroke Nursing and Rehabilitation Center, Shady Lawn Nursing Home in Cadiz and 19 other facilities in Kentucky, reports Nick Tabor of the Kentucky New Era in Hopkinsville. The company has been riddled with problems. A 2009 study ranked three of its Kentucky facilities among the country's worst nursing homes.

"The combination of a worsening litigation environment and the lack of any likelihood of tort reform in the state of Kentucky has made this the prudent decision for our company and its unitholders," said Tim Lukenda, president and CEO of Extendicare.

In this year's legislative session, nursing homes lobbied for a law that would have created medical review panels to evaluate potential lawsuits against nursing homes, personal-care homes and some facilities for the intellectually and developmentally disabled. The goal of the panel was to help eliminate frivolous lawsuits against the long-term care industry.

The Pembroke facility has been sued 20 times in Christian Circuit Court since 2002, and seven of the suits are still pending, Tabor reports. The others were dismissed, most with confidential settlements. (Read more)

Princess Health and Coventry agrees to keep covering ARH patients until June 30.Princessiccia

Princess Health and Coventry agrees to keep covering ARH patients until June 30.Princessiccia

Appalachia courts hospitals managed care Medicaid state government

Gusty 05:37 Add Comment

After a two-hour hearing in federal court, managed-care firm CoventryCares agreed yesterday to keep paying Appalachian Regional Healthcare for treating Medicaid patients at its hospitals through at least June 30 while negotiations continue.

"Coventry officials said the state allowed another managed-care provider not to include ARH in its network, which meant a lot of higher-risk, higher-cost patients ended up covered by Coventry," the Lexington Herald-Leader reports. "Blaming the state, Coventry had notified ARH that it was going to terminate its contract Friday. About 25,000 Medicaid recipients in the ARH service area would have been affected."

ARH then sued Coventry in U.S. District Court and asked for an injunction to continue coverage, which Coventry had said it would end yesterday. The state ordered it to maintain coverage for 30 days, and Senior Judge Karl Forester ordered ARH and Coventry to negotiate.

After yesterday's hearing, the adversaries and the state "all said the goal was for patients to continue receiving care through Appalachian Regional Healthcare's hospitals in Eastern Kentucky on a long-term basis," the Herald-Leader reports. "If the health care chain and Coventry reach an impasse, cabinet officials said procedures could be expedited with Coventry's cooperation. That would allow Coventry members to switch to another insurance provider and continue receiving services at ARH, considered the largest health care chain in Eastern Kentucky." (Read more)

ARH has hospitals in Harlan, Hazard, Hindman, McDowell, Middlesboro, West Liberty and Whitesburg, as well as three in West Virginia, including Williamson, on the Kentucky border.