Showing posts with label health care access. Show all posts
Showing posts with label health care access. Show all posts

Wednesday, 8 June 2016

Princess Health and Official praises needle exchanges and medication-assisted treatment for addiction: 'Treatment works. Recovery is possible.' . Princessiccia

Scott Hesseltine
Scott Hesseltine, the new vice-president of addiction services at Louisville's Seven Counties Services, talked on Kentucky Educational Television about needle exchanges and a new model of addiction treatment that combines medication assisted treatment with an abstinence-based model of care.

"We are in the midst of a tragic public-health crisis and it's claiming the lives of our citizens at astronomical rates," he said, noting that more than 1,000 people die from drug overdoses in Kentucky each year and that the state has the highest rate of hepatitis C in the nation.

Seven Counties Services provides behavioral-health services, primarily for people on Medicaid, in Jefferson County and six neighboring counties: Henry, Oldham, Trimble, Spencer, Shelby and Bullitt.

The interview on "Connections with Renee Shaw" was part of KET's "Inside Opioid Addiction" initiative, which is funded in part by a grant from the Foundation for a Healthy Kentucky. It aired in June.

Hesseltine, who came to Seven Counties Services from the Hazelden Betty Ford Foundation, a nationally recognized drug and alcohol treatment center, commended Kentucky's "forward thinking" in passing an anti-heroin bill last year.

Among other things, the bill allows needle exchanges to decrease the spread of infectious diseases, like hepatitis C and HIV, that are commonly spread by drug users sharing needles. They require both local approval and funding and have met with some resistance because many think they condone or perpetuate drug use.

Asked about that, Hesseltine said research shows that needle exchanges do what they are meant to do -- reduce the incidence of infectious disease among intravenous drug users.

He noted that Justice Secretary John Tilley, who was instrumental in passing the heroin bill as a state representative, said at a recent community forum in Corbin that research found that addicts who are involved in needle exchange programs are five times more likely to enter treatment.

"And we know treatment works and recovery is possible, so any avenue to slow the spread of disease and to help more people find the solution in recovery is a positive thing," he said.

Another point of contention among some lawmakers is that some of the state's needle-exchange programs don't adhere to a needle-for-needle exchange, which they say was the intent of the law,but instead provide as many needles as the addict needs for a week.

Hesseltine said the needs-based model decreases needle sharing and thus disease, so "Needs-based is more appropriate; it is more evidence based."

Hesseltine told Shaw that while working at Hazelden, he was part of an initiative that completely "altered the way we provided care." The new program, called COR-12, combines medication-assisted treatment with the 12-step abstinence model, which had been the only accepted recovery treatment program at Hazelden.

Hesseltine brought the new model with him to Seven Counties Services and said he likes to call it "medicated assisted recovery." He said "It has to be done appropriately so we are helping to stabilize someone from their biological symptoms of addiction so they can then engage in the recovery process."

Hesseltine told Shaw that addiction isn't curable, but is treatable.

"I would say it is a chronic disease that can be put into remission with structure, support, accountability and behavioral interventions," he said. "Curable? No, but like diabetes -- not curable, but certainly manageable."

Shaw asked if any addict is beyond reach. "Only someone who is not alive," Hesseltine replied. "Treatment works. Recovery is possible." He said that is why access to naloxone, the overdose-reversal drug branded as Narcan, is so important.

Asked what policy changes he would like to see, Hesseltine listed increased funding for drug treatment, "high level" models of care that shift addiction services to local communities, and repeal of the Medicaid rule that doesn't allow any reimbursement for mental-health and substance-use-disorder residential treatment facilities with more than 16 beds.

With treatment, Hesseltine said, "People can go from a pitiful and incomprehensible demoralization, a state where they have no hope to one of having hope, to being a productive member of society and to really regaining a place where they feel good about themselves and they are leading a life full of joy and freedom."

Wednesday, 18 May 2016

Princess Health and Feds strengthen anti-discrimination health rules. Princessiccia

Photo from mdxipe.wordpress.com
By Danielle Ray
Kentucky Health News

The Department of Health and Human Services issued rules Friday in an effort to ensure equality in health care for women, the disabled and people who speak English as a second language.

The new provisions protect women from discrimination not only in the health coverage they obtain but in the health services they seek from providers. They also prohibit denial of health care or health coverage based on a person's sex, including discrimination based on pregnancy, gender identity and sex stereotyping.

The rule also requires providers to take reasonable steps to provide communication access to people with limited English proficiency. In addition, it requires that providers make electronic information and newly constructed or altered facilities accessible to individuals with disabilities, including providing auxiliary aids and services.

HHS Secretary Sylvia Burwell called the rule "a key step toward realizing equity within our health care system." She said in an agency news release that it reinforces the central goal of the Patient Protection and Affordable Health Care Act, to improve access to quality health care.

The rule covers any health program or activity that receives federal funding, such as providers who accept Medicare or Medicaid; any health program that HHS administers; and federal- and state-based health insurance marketplaces and insurers that participate in them.

The new rule implements Section 1557 of the 2010 health-reform law, which is the first federal civil-rights law to prohibit discrimination based on sex in federally-funded health programs. Previously, civil rights laws enforced by the agency's civil rights office barred discrimination based only on race, color, national origin, disability, and age.

The rule does not resolve whether discrimination on the basis of an individual�s sexual orientation status alone is a form of sex discrimination under the reform law. However, the provisions leave room for the agency's civil-rights office to evaluate complaints that allege sex discrimination related to a person�s sexual orientation to determine if they can be considered sex stereotyping, which the rule prohibits. In cases where religious freedom would be violated, health-care providers are not required to follow the regulation.

A summary of the new rule can be accessed here.

Wednesday, 11 May 2016

Princess Health and Study shows uninsured rate keeps falling, preventive services are popular and rural hospitals have more uncompensated care. Princessiccia

By Melissa Patrick
Kentucky Health News

The share of Kentuckians without health insurance continues to drop, and new Medicaid enrollees continue to take advantage of free preventive health services, according to an ongoing study of federal health reform's impact in the state.

The Foundation for a Health Kentucky is paying the State Health Access Data Assistance Center at the University of Minnesota more than $280,000 for a three-year study of how the Patient Protection and Affordable Care Act is affecting Kentuckians.

The report found that the rate of people without health insurance in Kentucky continues to drop.
In December 2015, the uninsured rate was 7.5 percent, down from 9 percent in June 2015. The national rate in December was 11.7 percent. In 2013, before the implementation of the PPACA, Kentucky's uninsured rate was 20.4 percent.

Since December 2013, Kentucky's uninsured rate has dropped 12.9 percentage points, more than double the national decline of 5.6 percentage points, says the report. Uninsurance rates can vary depending on how they are measured. This study used data from the Gallup-Healthways Well-Being Index, which produces state-level estimates of coverage twice a year.

"Lack of insurance is a significant barrier to getting necessary health care and preventive services timely," Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in a news release. "Tracking this and other key information about access to and cost of care in Kentucky helps to inform health policy decisions."

Kentucky also continues to have a lower uninsured rate than its eight nearest surrounding states, although Ohio (7.6 percent) and West Virginia (7.7 percent) are catching up. Missouri (11.6 percent), Tennessee (13 percent) and Virginia (12.6 percent), the three states surrounding Kentucky that did not expand Medicaid, have the highest uninsured rates. (SHADAC map)

And while the state saw a smaller share of new health-insurance customers than the country overall (20 percent versus 39 percent), Kentucky had the largest percentage of re-enrollees (59 percent) return to Kynect, the state's health insurance marketplace, to select plans compared to the rest of the nation (36 percent). Twenty-two percent of Kentuckians were automatically re-enrolled in plans.

Kynect, created by the Democratic administration of Steve Beshear, is in the process of being dismantled by the administration of Republican Gov. Matt Bevin, so Kentuckians will have to sign up for their health insurance through the federal exchange, healthcare.gov, during the next enrollment period which begins Nov. 1, 2016 and runs through Jan. 31, 2017.

Traditional Medicaid enrollees will sign up through Benefind, the state's new one-stop-shop website that can be used to apply for Medicaid, the Kentucky Children's Health Insurance Program (KCHIP), the Supplemental Nutrition Assistance Program (SNAP, once known as food stamps) and Kentucky Transitional Assistance Program (KTAP).

Expansion of Medicaid added about 400,000 Kentuckians to the program, and many of them have taken advantage of its free services to get screened for diseases and have physical or dental examinations.

Dark blue: traditional Medicaid enrollees
Light blue: Medicaid expansion enrollees
The latest report, which covers the fourth quarter of 2015, says 823 traditional Medicaid enrollees got screened for diabetes, compared to 2,959 Medicaid expansion enrollees. This was also true for colorectal screenings (see graph).

Overall, the study found that Medicaid covered 41,493 dental preventive services, 9,708 breast cancer screenings, 8,276 substance-abuse treatment services, and 5,589 colorectal-cancer screenings to enrollees aged 19-64.

Under federal health reform, Beshear expanded Medicaid to include those with incomes up to 138 percent of the federal poverty level. The federal government pays for this expanded population through this year, but next year the state will be responsible for 5 percent of the expansion, rising in annual steps to the reform law's limit of 10 percent in 2020.

However, the future of the expansion is uncertain. Bevin has said that the state cannot afford its Medicaid population of about 1.3 million, and has charged his administration with designing a new Medicaid program, which will require federal government approval. He told reporters in early May that he was optimistic that the Centers for Medicare and Medicaid Services will approve the state's new plan, but if they don't it will be because "CMS does not want to see expanded Medicaid continue in Kentucky."

The study found that Medicaid enrollment continues to be the highest in Eastern Kentucky with 31 percent participation, followed by Western Kentucky at 26 percent participation.

It also notes that while levels of uncompensated care have dropped for both urban and rural hospitals since 2013, rural hospitals saw slight increases in uncompensated care in 2015. (SHADAC graphic)

For the full report, click here.

Tuesday, 10 May 2016

Princess Health and Many Americans, including those on Obamacare plans, can't afford their health-insurance deductibles, studies show. Princessiccia

The United States has entered the era of high out-of-pocket medical cost as a way to keep insurance premiums low, but recent studies have found that many Americans are having trouble paying them, and the presidential candidates are hardly talking about this issue, Harris Meyer reports for Modern Healthcare.

Graph: Urban Institue's Health Reform Monitoring Survey
Nearly 25 percent of Americans surveyed last September who had coverage through employer plans, the Affordable Care Act, or individual plans outside health-insurance exchanges reported problems paying family medical bills in the previous 12 months, according to the Urban Institute's Health Reform Monitoring Survey. That compared with 16 percent of people on Medicaid and 27.8 percent of the uninsured.

The Kaiser Family Foundation also found that people on Medicaid or policies bought through the federal or state exchanges, also called marketplaces, couldn't afford their deductibles. This 2016 focus group study of 91 low-income Medicaid and exchange-plan enrollees in six cities found that "all reported that they had trouble affording some aspect of their current coverage, including premiums, deductibles, and/or co-payments." It also found that "nearly all marketplace participants" said they had received unexpected bills for services they thought were covered, and fear of this often led them to forgo care.

The latest Kentucky Health Issues Poll found that affordability is also a problem in Kentucky, with 28 percent of Kentucky households having at least one person who reported struggling to pay their medical bills in the previous 12 months. This rate was about the same as in 2014 and didn't vary much between those with insurance or without insurance.  In addition, the poll found that 20 percent of Kentucky households did not get the medical care they needed, or delayed care because of cost in the past 12 months.

This lack of affordability also affects health-care providers. Meyer reports that the chief financial officer for Community Health System told analysts at the first-quarter earnings report meeting that the fourth quarter of 2016 will be his company's best quarter, because patients will have hit their insurance deductibles and only then be able to afford needed care at their facilities.

�As individuals take on high deductibles and higher co-pays, they are essentially taking on insurance risk they can't necessarily afford,� Trevor Fetter, CEO of Tenet Healthcare Corp., told Meyer. Fetter told Meyer that his company now focuses on helping patients understand how to pay their bills, "including pressing for cash payments at the point of service."

What are the presidential candidates saying?

Meyers writes that Democratic front-runner Hillary Clinton offers the most help for those who can't afford their high deductible. She says she "would require health plans to: cover three annual visits to a doctor for illness without applying the deductible; give insured people a $5,000-per-family refundable tax credit for out-of-pocket costs exceeding 5 percent of their income; cap out-of-pocket costs for prescription drugs; bar providers and insurers from charging patients out-of-network bills for services received at an in-network hospital; and strengthen states' authority to block excessive insurance premium increases."

"Vermont Sen. Bernie Sanders, Clinton's Democratic opponent, wants to eliminate premiums and cost-sharing entirely by establishing a tax-funded, government single-payer insurance program covering the full range of healthcare services, including long-term care," Meyer writes.

"Donald Trump, the presumptive Republican nominee, has released a seven-point health policy agenda that doesn't directly address out-of-pocket costs. It would offer households a tax deduction for buying coverage, expand health savings accounts, and let insurers sell plans across state lines," Meyers writes.

Meyers calls the issues surrounding high deductible plans and high prescription drug costs "the domestic policy elephant in the room," and says these issues are not getting enough attention.

Friday, 29 April 2016

Princess Health and Suicide rates are rising in the U.S.; experts attribute high rate in rural Ky. to poor mental health access, stigma and 'gun culture'. Princessiccia

By Melissa Patrick
Kentucky Health News

After a decade of decline, suicide is becoming more common in the United States, increasing by 24 percent from 1999 through 2014, according to the federal Centers for Disease Control and Prevention.

The CDC report looked at cause-of-death data between 1999 and 2014 and found that suicide rates increased for both males and females in all age groups from 10 to 74.

Graph: CDC Age-adjusted suicide rates by sex
Overall, the suicide rate increased from 10.5 per 100,000 people in 1999 to 13 per 100,000 in 2014, showing a steady 1 percent annual increase through 2006 and a 2 percent annual increase after that.

And while the suicide rates for males continues to be higher than those for females, the report notes that the gender gap is narrowing. Among females, the rate of increase was 45 percent, compared to 16 percent for males.

Suicide rates for middle-aged women aged 45-64 were the highest, in both 1999 (6 per 100,000) and 2014 (9.8 per 100,000), showing a 63 percent increase. In females, the largest increase occurred among girls 10-14 (200 percent), though the actual number of suicides in this group was relatively small, tripling from 0.5 per 100,000 in 1999 to 1.5 in 2014.

For men, suicide rates were highest for those 75 and over, with approximately 39 for every 100,000 men in 2014. However, men 45-64 had the greatest increase among males, increasing from 20.9 per 100,000 in 1999 to 29.7 in 2014, a rise of 43 percent.

In 2014, poisoning (34.1 percent) was the most common method of suicide in females and firearms (55.4 percent) was the most common in males.

The CDC report didn't address why suicides are up, but several studies offer clues about possible reasons among the middle-aged, including a study published in 2015 in the American Journal of Preventive Medicine that found that "job, financial, and legal problems" are most common in adults aged 40-64 who had committed suicide, and a 2011 CDC study which found that suicide rates increased during periods of economic recession and declined during economic growth among people aged 25-64 years.

Rural areas have highest suicide rates

Suicide is the 10th leading cause of death in the nation and the state, and with nearly 700 Kentuckians dying by suicide annually, Kentucky is one of the top 20 states for it.

Suicide is more prevalent in rural areas, where the rate is almost twice as high as in urban areas (17.6 suicides per 100,000 vs. 10.3 per 100,000), according to a separate CDC study.

"The myth is that suicide is an inner-city, urban problem, but the reality is that it is not," Melinda Moore, a licensed psychologist and assistant professor at Eastern Kentucky University, said in a telephone interview.

Moore, also the chair of the Kentucky Suicide Prevention Group, attributed some of the increase in suicide rates in rural Kentucky to its "gun culture."

"We have a culture that is very familiar with guns and that familiarity, unfortunately, can really lead to people using very lethal means when they are suicidal," she said.

And when you add gun culture to economic distress, which is common in much of rural Kentucky, it can be a "cocktail for disaster" for those who are suicidal, she said.

Another challenge is the lack of access to mental-health care in rural Kentucky, Moore said, noting that even if people have access to mental-health providers, many providers aren't trained to work with suicidal people. She said this should be improving, since the state now requires all behavioral health providers get suicide training when they renew their licenses.

Julie Cerel, psychologist and associate professor in the University of Kentucky College of Social Work, attributed the increase in rural suicides to several things, including the Gun culture, lack of access to mental-health care and the stigma that surrounds mental-health issues that deters people from seeking help.

Cerel, also president-elect of the American Association of Suicidology, said one reason for the national increase in suicides could be that coroners have become better trained on how to report them. She said that is very important, because people who were close to a person who died by suicide need to know so that they can seek their own mental-health support.

Cerel said 47 percent of Kentuckians knew someone who died by suicide, "and people who are exposed to suicide, especially if it is someone close to them, are more likely to have their own depression and anxiety and thoughts of suicide."

What should you do if you have suicidal thoughts or are concerned about someone?

Moore and Cerel said the first line of defense, especially in areas that don't have great mental-health resources, is to call the national suicide-prevention lifeline, 800-273-TALK (8255). This is a free, 24/7 service that can provide suicidal persons or those around them with support, information and local resources. It also offers a website at www.suicidepreventionlifeline.org .

Moore said community mental health centers are also great resources for those who are suicidal in rural Kentucky, and Cerel stressed the importance of telling someone if you are having suicidal thoughts, including your primary health-care provider.

Monday, 4 April 2016

Princess Health and Struggling Tenn. hospital takes care of Kentuckians, who get better care than Tennesseans thanks to expanded Medicaid. Princessiccia

Jellico Community Hospital, just across the Kentucky border in Tennessee along Interstate 75, was taken over by Community Hospital Corp. last May, but that's not a guarantee it will survive, especially since Tennessee refuses to expand Medicaid to its poorest citizens, as Kentucky has, Harris Meyer reports for Modern Healthcare.

Meyer notes that one of the contributing factors to the hospital's struggle is the Tennessee Legislature's refusal to expand Medicaid under health reform to those who make up to 138 percent of the federal poverty level. That would decrease the hospital's level of uncompensated care.

About half the hospital's patients come from Kentucky, and its administrators, doctors and nurses all told Meyer that it is easier to get testing and specialty care for Kentucky Medicaid patients than for uninsured Tennessee patients who would qualify for expanded Medicaid.

�We're able to do more for Kentucky patients,� Christy Elliott, the hospital's case management supervisor, told Meyer. �For Tennessee patients, it's a struggle. If you don't have insurance, you don't get services.�

One such patient was Rebecca Jarboe, a mother of three from Kentucky. She told Meyer that she went into a "difficult" labor during a snowstorm on Valentine's Day. Because of the weather and her condition, she said she and her husband decided to travel 14 miles from their home to Jellico to have the baby, instead of making the 70-mile-journey down I-75 to the University of Tennessee Medical Center in Knoxville, 20 miles of which would have been over snow-covered Pine Mountain (known locally as Jellico Mountain).

�The care here is excellent,� a tired-looking Jarboe told Meyer while lying in her hospital bed cradling 2-day-old Silas and surrounded by her family. �Whatever you need, they are right at the door, and everyone is really friendly.�

The 31 states that have expanded Medicaid have been able to "shore up finances" in many of their rural hospitals, Meyer writes, but others have not fared so well. Nationwide, more than 50 rural hospitals have closed in the past six years, and nearly 300 more are in deep financial trouble, according to the National Rural Health Association.

A state report by then-Auditor Adam Edelen last year found that one in three of Kentucky's rural hospitals were in poor financial condition. Since the release of the report, several Kentucky rural hospitals have merged with larger hospital groups to make ends meet and rural hospitals in Nicholas and Fulton counties have closed.

Meyer also notes that Jellico hospital's problems go deeper than just not expanding Medicaid. In its service area good-paying jobs with health benefits have dwindled, only 10 percent of the population has private health insurance, residents have higher-than-average rates of disease, and there is rampant obesity and drug abuse. A similar story could be told about many rural Kentucky communities.

In addition to providing health care, the 54-bed hospital with its staff of 232 is the community's largest employer, as is often the case. The mayor of nearby Williamsburg, where the hospital has a clinic, noted that new businesses will often not consider moving to a community without a hospital.

�A lot depends on economic development in these communities,� Alison Davis, a professor of agricultural economics who studies rural healthcare at the University of Kentucky, told Meyer. �What are they going to do to create jobs? It's the No. 1 issue besides substance abuse they are facing. It's a struggle, and not every community will make it through.�

Adventist Health System, out of Florida, announced in May 2014 that it wanted to get rid of the hospital because it was losing "millions a year." A year later, CHC, a Texas-based not-for-profit with a mission to preserve access to healthcare in rural communities, took over the hospital and its clinic. CHC owns, manages and provides support to 21 community hospitals nationwide, according to a news release.

CHC told Meyer that it is optimistic the hospital will survive because of the medical staff's commitment to keeping quality healthcare in their community. It has also implemented cost-saving measures, like decreasing staff and installing a less costly electronic health record system, and is exploring ways to further save money, while increasing its client base.

But several local business leaders told Meyer they weren't so sure the hospital will survive.

�There have been so many layoffs that they don't have enough people to do lab work or X-rays, and you have to wait and wait,� Elsie Crawford, business manager of the Wilkens Medical Group in Jellico and a member of the City Council, told Meyer. �You can't draw more patients if you don't have enough people to take care of them.�

Dr. Charles Wilkens, who helped establish and maintain the hospital, told Meyer, �People would die for lack of health care if we didn't have a hospital in this community.�

Sunday, 3 April 2016

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

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.

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.

Saturday, 16 May 2015

Princess Health andLaw requires equal access to mental-health and drug-abuse treatment, but is not always obeyed; Ky. says it's working on issue.Princessiccia

Princess Health andLaw requires equal access to mental-health and drug-abuse treatment, but is not always obeyed; Ky. says it's working on issue.Princessiccia

By Melissa Patrick
Kentucky Health News

By law, mental health benefits must be offered equally to medical and surgical benefits if the plan offers them, but this isn't always the case.

Not only does a 2008 federal law require most employer-sponsored plans to provide equal access to mental health benefits, but that parity was expanded and strengthened in 2010 by the Patient Protection and Affordable Care Act. Twenty-three states, including Kentucky since 2000, require some level of parity.

Common requirements of these laws prohibit insurers from charging higher co-payments and deductibles for mental-health services; require insurers to pay for mental-health treatment in the same scope and duration as medical treatments; ban insurers from requiring additional authorizations for mental-health services; and says they must offer an equal number of mental-health providers and approved drugs.

While insurers typically keep track of the copayment and deductible requirements, they struggle with keeping track of the compliance requirements related to actual delivery of medical services, Michael Ollove reports for Stateline.

The spokeswoman for the Kentucky Department of Insurance, Ronda Sloan, said in an e-mail that Kentucky is very diligent about parity requirements. "Kentucky insurance companies must cover mental-health treatment like other covered services," she wrote. "We review both provider networks and drug formularies for compliance and (make sure) both meet the requirements of the ACA."

A recent report by the National Alliance on Mental Illness found that this isn't always the case. Nearly one-third of those surveyed were denied authorization for mental health and substance abuse treatment, with this rate nearly twice as high for those on ACA plans.

It also found other barriers to care including the number of mental health providers in health insurance plan networks; more than half of the health plans analyzed covered less than 50 percent of anti-psychotic medications; high out-of-pocket costs for prescription drugs; high co-pays, deductible and co-insurance rates; and a lack of information about mental health coverage to consumers to help them make informed decisions in choosing their health plans.

The survey was conducted by Avalere Health and is based on a survey of 2,720 individuals with mental illness or with someone in their family with mental illness and an analysis of 84 insurance plan drug formularies in 15 states.

Sloan said that in Kentucky, "Work is being done on many fronts to increase access and progress is being made to address some of the access issues."

She said Kentucky monitors provider networks to make sure they are meeting their minimum requirements. She also said that a recent law passed by the 2015 General Assembly, which created three levels of drug and alcohol counselors with varying degrees of  certification, will have a "positive impact" on access to treatment.

Gwenda Bond, spokeswoman for the state Cabinet for Health and Family Services, said in an e-mail, "We also opened the provider network for behavioral-health services in early 2014 to a range of private providers of such services, increasing the number of options available for members, who previously could only receive treatment through the community mental health centers."

One of the main obstacles for consumers and providers is that it is not clear what criteria insurance companies and managed-care Medicaid organizations use to determine medical necessity for mental-health and substance-abuse care, and aren't transparent with this information.

"Without that information," Ollove wrotes, "it is difficult for regulators and consumers to determine whether the denial of coverage is warranted." 

Ollove also notes other problems include the federal governments delay in creating regulation guidelines, the challenges states and the federal government have had in simply implementing the ACA, let alone regulating parity and the stigma that is still associated with mental illness and addictions that make regulators not want to get involved.

Two states, New York and California, are leading the way in enforcing parity rules, Patrick Kennedy, a former Democratic congressman from Rhode Island, told Ollove, saying that they were the "only states that consistently enforce mental health parity."

Sloan took issue with that, saying, "We believe Kentucky consistently enforces the rules related to mental health and substance abuse parity." 

Kentuckians who believe they have been improperly denied mental-health and substance-abuse care should contact the Department of Insurance.

Friday, 8 May 2015

Princess Health andKentuckyOne Health is offering mobile screenings for risk of heart attack and stroke, and cancer prevention, for a price.Princessiccia

Princess Health andKentuckyOne Health is offering mobile screenings for risk of heart attack and stroke, and cancer prevention, for a price.Princessiccia

For a price, KentuckyOne Health is offering a new, mobile, preventive screening program at various locations around the state.

Screening packages range from $179 to $347 and are designed to evaluate an individual�s risk of heart attack, stroke and cancer. Patients are responsible for the cost, since KentuckyOne is not accepting Medicare, Medicaid or private insurance funding to pay for it at the time of service, but patients can submit their final report findings to their health provider and insurer for consideration of reimbursement.

�Through mobile screenings we can now expand cardiovascular and other health screenings throughout the commonwealth, including areas that may have limited access to these tests,� Alice Bridges, KentuckyOne's vice president for healthy communities said in a press release. �A major goal of this program is to help people become more aware of their health status and encourage active involvement in proactively managing their health.�

Tests included in the exam are: echocardiogram; electrocardiogram (ECG or EKG); hardening of the arteries test; stroke/carotid artery ultrasound; abdominal aortic aneurysm ultrasound; peripheral arterial disease test; Know Your Numbers�; high sensitivity c-reactive protein test (hs-CRP); thyroid-stimulating hormone test; testosterone test; and prostate specific antigen test (PSA).

The screening unit has  private exam rooms and the process takes less than an hour, according to the release. Technicians use painless ultrasound technology to examine the patient's heart and arteries to identify potential health risks, and then board certified physicians examine all results before providing patients with the report. The process takes approximately one week. Patients are encouraged to take their report back to their primary health provider for follow-up.

Mobile screenings are also available for partners of KentuckyOne Workplace Care.

 �Mobile screenings will allow us to bring services to the employer to help employees monitor their health and meet wellness goals," Shirley Kron, regional director of KentuckyOne Health Workplace Care, said in the release.

More information, including dates and locations, is available at Kentuckyonehealth.org/screenings or -855-721-8378.

Wednesday, 15 April 2015

Princess Health andFate of rural hospitals rests in the hands of community members, writes publisher of weekly Crittenden Press in Marion.Princessiccia

Princess Health andFate of rural hospitals rests in the hands of community members, writes publisher of weekly Crittenden Press in Marion.Princessiccia

Just like country grocery stores in rural areas often have to close because community members drive past them to chain stores to save a few cents, rural hospitals will also suffer and eventually disappear if citizens do not use them, Publisher Chris Evans writes for The Crittenden Press in Marion.

When Evans was growing up in northwest Tennessee, his grandparents had to close their grocery store, which had been the center of the community, because too many people chose to purchase their food and other items from the new Walmart eight miles down the road. "Our rural hospitals are headed down the same path of extinction unless we recognize and reverse the trend," Evans writes.

Charlie Hunt, volunteer chairman of Crittenden Health Systems, which owns the local hospital, told Evans, "The only way for rural hospitals to survive is through community support."

In Kentucky, one-quarter of the 66 rural hospitals are in danger of closing, according to state Auditor Adam Edelen. In general, "Country hospitals do not have a good record for making money or breaking even, for that matter," Evans writes in a front-page column for the weekly he and his wife own.

Based on the results of Obamacare, Evans opines, it appears that America is moving toward a single-payer health care system like Canada's. Then instead of the government paying for 85 percent of Crittenden Hospital's services, it will pay for 100 percent. "When that happens, hospitals will have to play solely by government rules or get completely out of the game," Evans writes. Most of the 50 rural hospitals that have been shuttered in the past few years have been in the rural South.

"Hunt, who chairs the board, said that approximately 10 percent of the future of this hospital rests in the hands of its leaders. The other 90 percent falls squarely on the shoulders of this community," Evans writes. The column is not online, but PDFs of the pages on which it appears are posted here.

Sunday, 5 April 2015

Princess Health andPlight of woman needing lung transplant, who has fallen through the cracks of the health-care system, gets attention from CNN.Princessiccia

Update: CNN reports that Kentucky issued a Medicaid provider number to the University of Pittsburgh Medical Center, and the hospital confirmed that they now have enrolled in Kentucky Medicaid and are working to complete the enrollment of some of their physicians, all of which helps clear the way for Katie Prager to get her lung transplant.  "Kentucky Medicaid executives are helping us to get this done in a streamlined fashion that overcomes previous administrative hurdles and misunderstandings in this complex case," Wendy Zellner, a spokeswoman for UPMC, told CNN. Dalton, Katie's husband, has since been discharged from the Pittsburgh hospital where he received his lung transplants in November and has returned to Kentucky. CNN reports Katie and Dalton were only able to communicate through the doorway of her University of Kentucky hospital room because of his risk of getting Katie's infection, which could kill him.

A 24-year-old Kentucky woman with cystic fibrosis who needs a lung transplant to live is caught in the middle of a financial and policy battle among Medicare, Medicaid, a state agency and the University of Pittsburgh Medical Center, one of only two hospitals in the United States qualified to do lung transplants on patients with her specialized condition.

Prager at University of Kentucky hospital (Image from CNN)
"I feel like they're putting a dollar sign on my life," Katie Prager of Ewing, in Fleming County, told CNN. "I don't want to die because of money. That's stupid. Nobody should have to do that." Katie's story was first reported by The Ledger Independent of Maysville and excerpted in Kentucky Health News.

Katie longs to be with her husband, Dalton Prager, but can't until she gets her lung transplant because in addition to cystic fibrosis, she has an infection, Burkholderia cepacia, that is "horribly dangerous" to him, Elizabeth Cohen and John Bonifield report for CNN. Dalton, who also has cystic fibrosis, received his lung transplants Nov. 17 at the Pittsburgh hospital, and the immunity-suppressing drugs he takes for the transplants make him highly vulnerable to infection.

"I just want to make it to see our four-year anniversary in July and be able to hold hands and just hug. That's all I really want -- to be able to hug my husband on our fourth anniversary," Katie told CNN.

Katie and Dalton met on Facebook in 2009 when they were 18 and Dalton lived in Missouri and Katie in Kentucky. And though Katie's doctors had warned her many times that it was dangerous to be around other CF patients because of the risk of shared infections, Katie decided to meet Dalton, even after he had told her he had Burkholderia cepacia, CNN reports. They married two years later.

Photo from CNN
"I told Dalton I'd rather be happy -- like really, really happy -- for five years of my life and die sooner than be mediocre happy and live for 20 years," she told CNN. "That was definitely something I had to think about, but when you have those feelings, you just know."

Their health "quickly deteriorated, and within months, they went on oxygen full time" and had to quit work, CNN reports. They entered the Pittsburgh hospital together in August 2014 to wait for new lungs. Dalton got his in November; Katie is still waiting.

One month after Dalton got his transplants, UPMC discharged Katie because they told her "It would be psychologically good for her to get out for a while," she told CNN. After only three days out she began to have "serious trouble breathing" and tried to go back into the hospital, but was told she could not return because "she had used up her supply of Medicare days."

Medicare wouldn't pay for another hospitalization until Katie had been out of the hospital for 60 days. She is too sick to do that, and has since been a patient at the University of Kentucky, where she relies on the federal-state Medicaid program for the poor and disabled to pay for her care, and doctors have predicted that she won't live a year without new lungs, CNN reports.

Medicaid cannot pay the Pittsburgh hospital because it is not in the state's network of health-care providers. CNN reports that Katie's doctor wrote a letter to Medicaid begging them to make an exception, but the state denied his plea. In a statement to CNN, a spokeswoman for the state Cabinet for Health and Family Services said the hospital had declined to enroll as a Kentucky Medicaid provider. "Medicaid policies allow for a simplified enrollment process for out-of-state providers in such situations," Gwenda Bond, spokeswoman for the cabinet wrote, offering to expedite their application when they choose to sign up.

Hospital officials counter that Kentucky officials said they would have to "sign up hundreds of their doctors to accept Kentucky Medicaid patients," which hospital spokeswoman Wendy Zellner said is "an unusually restrictive approach and contrary to single-case agreements that we have signed with other state Medicaid programs. . . . It is up to Kentucky Medicaid to address this situation."

Katie has also since had a discussion with a federal Centers for Medicare and Medicaid Services caseworker that "didn't go very well," CNN reports. Katie told CNN that the caller was "rude, mean, and angry" and "acted like it was just a pain to have to be talking to me," but said "she would look into her situation." On April 1, CMS spokesman Aaron Albright told CNN that the federal agency was "reaching out to the state agency," and later in the day Zellner said the state agency "has reached out to us to talk. So stay tuned."

The news cheered the Pragers, who continued to talk via Skype and work on their fundraising Facebook page, while dreaming of a future together, CNN reports.

Monday, 24 March 2014

Princess Health and Princess Health andHumana Inc. bus travels the rural roads of Mississippi, looking to enroll people in Obamacare by March 31 deadline.Princessiccia

Insurance providers have been scared off by Mississippi, one of the poorest and unhealthiest states in the country. Only nine percent of eligible residents have signed up for insurance under federal health reform, ranking Mississippi near the bottom of all states in Obamacare, with only 25,554 residents having signed up as of early March.

Politico photo by Madeline Marshall: Humana bus
Louisville-based insurance company Humana Inc. is attempting a unique way to try to get Mississippi residents signed up. The company has a bus that travels the state, having made more than 200 stops "pulling into hospital parking lots and Wal-Mart shopping centers, parking at churches large and small and hitting other obvious targets to find and convince the uninsured that President Barack Obama�s signature health achievement will benefit them," Jennifer Haberkorn reports for Politico. "Sometimes the company�s agents see dozens of people per stop. Other times, just a few individuals climb aboard."

Mississippi is the only state where Humana has a bus, Haberkorn writes. "It�s also the only state where the company is covering the co-pay for customers� first doctor�s visit before June, immediate cash savings that it hopes will get people to start a relationship with a primary-care physician. Officials declined to say exactly how much is being spent on the dual strategies."

Based on the dismal number of residents signing up, the bus hasn't exactly been a hit. Part of the problem is that rates in Mississippi are the third highest in the country, and that Humana is only one of two insurers in the state. "Despite all the political rhetoric about a government-run health program, Obamacare relies on private insurers to sell policies on the state and federal exchanges. If there�s no insurance company, then there�s really no Obamacare," Haberkorn writes. "And Mississippi is one of the last places the typical risk-averse health insurance company would choose to sell policies under the law. Statistically, it�s one of the unhealthiest states, topping the charts in all kinds of negatives such as obesity, diabetes, hypertension and cardiovascular disease � conditions that can be stabilized with treatment or kill without."

"But Humana has every incentive to sell as many policies as possible," Haberkorn writes. "The math involved is simple: Insurance works when there are more people enrolled, which spreads the risk of high costs across hundreds or thousands of customers. To succeed in a state like Mississippi, it had to go all out to get customers."

Humana originally offered policies in only four counties, but the state insurance commissioner persuaded it to go to 40. The company's Mississippi market director, told Haberkorn, �Back in August, when we added on an additional 36 counties, we had to act really quickly on how we would get to all of the people in those counties at such a last minute. Operating this mobile tour has allowed us to get to people, instead of waiting for them to come to us.� (Read more)

Wednesday, 12 June 2013

Princess Health and UK Board of Trustees OKs $31 million plan to outfit another floor of new hospital with eye toward federal certification for heart work.Princessiccia

Princess Health and UK Board of Trustees OKs $31 million plan to outfit another floor of new hospital with eye toward federal certification for heart work.Princessiccia

The University of Kentucky Board of Trustees has given UK HealthCare the green light for its $31 million plan to outfit the eighth floor of Pavilion A at UK Chandler Hospital over the next few months to make room for a growing cardiovascular program and to clear the way for a federal "Center of Excellence" certification.

After the project is complete, the floor will hold 64 beds, including 24 intensive-care beds for the cardiovascular program that offers heart transplantation, artificial hearts and ventricular devices, reflecting UK's focus on receiving the federal certification.

In the near future, such a designation will be necessary to get enough referrals from doctors and smaller hospitals to maintain important services, including cardiovascular services, and to guarantee that Kentuckians can get the care they need inside the state, Dr. Michael Karpf, executive vice president for health affairs, said in an interview with Kentucky Health News this spring.

Karpf and other UK HealthCare officials are also recommending a $30 million cost-reduction program for their system because Medicare and Medicaid reimbursements are expected to decline as competition stiffens over the next few years, reports Linda Blackford of the Lexington Herald-Leader.

In response to these forces, UK has a goal to secure half the available business from out-of-state competitive areas over the next 10 years to remain viable in a highly competitive market. And, focusing on complex care should drive revenue for the hospital because UK makes money on the complex stuff, Karpf told KHN.

Read more here: http://www.kentucky.com/2013/06/10/2673382/uk-healthcare-using-30-million.html#storylink=cpy

The $592 million, 12-floor patient tower has remained half-empty since 2010, and when the estimated $530 million project to fully occupy the tower is added to the initial cost of constructing Pavilion A, the total price tag will top $1 billion over 20 years, reports Blackford.

The overall construction and expansion is expected to support patient care for the next 100 years, says a recent UK press release. Once it's fully occupied, the the 1.2 million-square-foot facility will include 512 private patient rooms.

Read more here: http://www.kentucky.com/2013/06/10/2673382/uk-healthcare-using-30-million.html#storylink=cp

Monday, 3 June 2013

Princess Health and State officials tell health-care providers to meet with managed-care companies to get paid, say new system is improving health.Princessiccia

By Molly Burchett and Al Cross
Kentucky Health News

At the latest in a series of forums on Medicaid managed care, state officials said the new system has improved the quality of care, but you could cut the tension with a scalpel in the packed auditorium at the University of Kentucky as they fielded complaints and questions and urged the providers to work out the problems with managed-care companies themselves.

Gov. Steve Beshear and the Cabinet for Health and Family Services say the forums are designed to improve relations between providers and the managed-care organizations, but reactions from capacity crowd of health care providers and staff -- reactions that included a roomful of laughter about the MCOs' low count of transferred phone calls from providers -- suggested that the state�s solutions to providers' problems with the companies aren�t quite the solutions sought by providers.

Kentucky's transition to Medicaid managed care

In 2011, Kentucky was faced by spiraling Medicaid costs that gave the state two options: cut reimbursement rates to providers by a third or moving from a fee-for-service model to a managed- care system, in which MCOs get a specified fee for each patient they manage and use the money to pay providers, said Lawrence Kissner, commissioner of the Department for Medicaid Services.

The change is driving improvements in health for Medicaid clients while saving the state money, said Kissner: It has increased well-child visits for children aged 3-6 from 2 percent to 53 percent, has increased diabetes testing from 6 percent to 59 percent, and has improved adult access to preventative and ambulatory health services.

MCOs also have numerous quality initiatives underway, said Kissner, including one in improving anti-depressant medication management and compliance.  One company, Wellcare, has worked to improve oral health through a campaign that offered $10 gift cards for dental visits, but no one hears about this, he said.

What we've heard are complaints from physicians, hospitals, pharmacies and other health-care providers who aren�t getting some claims paid in a timely manner, or at all. Providers say manage care's complicated pre-approval process, designed to limit costs, delays critical treatment for patients and adds unsustainable administrative burdens.


Read more here: http://www.kentucky.com/2012/02/08/2061060/health-care-providers-say-medicaid.html#storylink=cpy
State officials' response: meet with the MCOs

Kissner said the new system denies 6 percent of providers' requests for pre-authorization, compared to the fee-for-service model that only denied 1 percent of such requests, but he says that's about the same as other states that use managed care.

About 20 percent of providers' claims have either been denied or suspended. In the first 14 months of managed care, 22 million of the 28.3 million claims, or 78 percent, were paid within 30 days. Kissner said 4.9 million (17 percent) were denied in 30 days and 1.2 million (4 percent) were suspended; he did not mention  the monetary amount of the denied or suspended claims.
Kissner speaks to crowd at UK; Cabinet Secretary Audrey Haynes looks on from first front-row seat.
When an audience member questioned the lack of payment for hospice services, Cabinet Secretary Audrey Haynes replied, �There are some providers around the state that have been quite vocal about how much we owe them, but when there�s been an attempt to sit down and work it out with them, they will not make an appointment.� She said it is a provider�s responsibility to reach out to MCOs about the payments they are owed.

�It is about you going to each one of them and setting an appointment for them to work out with them you�re accounts receivable," Haynes said. �If you really want to get paid and if you are really owed, and I believe most of you are, then let�s get an appointment set� with the MCO.

�We want this worked out,� said Haynes. �The time has come and gone for us to still be having problem getting payment if your contract says you deserve payment. These folks know they are on the hook. Let's all work together to get it fixed.

Meetings with MCOs are part of the plan Beshear outlined after vetoing House Bill 5, which the last session of the General Assembly passed to help providers receive prompt payments from MCOs. The plan also requires the state Department of Insurance to investigate payment complaints and to conduct audits of this process. The department began this work in April and says it does not yet have statistics about 'clean claim' approval rates.

However, audits by the state's managed-care branch have shown Kentucky Spirit and Coventry Cares to be deficient in their financial management, and the state has implemented "corrective action plans" to address those deficiencies, said Kissner.
  
Providers' response to dispute-resolution plan

It may be an unwelcome change for providers as they now may have to set up consultations with MCOs to receive the money owed to them. They may ask: How many other business-to-business contracts require the service provider to meet face-to-face with the payor in order for the provider to be paid for contracted services that have already been provided? They argue that delayed payments and fee cuts could stretch medical practices and hospitals so thin that those needing care might be at more risk.

One provider in the audience addressed this concern, asking how general dentists are supposed to continue giving high-quality care to all patients if their fees are getting cut, but our expenses are going up? None of the officials on the panel answered the question.

Another audience member asked about provider fee cuts, and after the microphone was passed around to Kissner, he said the reductions are a part of the transition process to managed care, which was initiated to avoid a 35 percent Medicaid rate cut.

"When managed care enters into a a fee-for service environment, there's savings in a variety of pockets," Kissner said. "How do they control costs and try to make a profit in the system?"

The forum wrapped up with question from another skeptical audience member: Will this really make a difference?

"Well, you tell me, said Haynes. "And I'm sorry for those of you that feel like it will not make a difference because everyone in this room would have seen a 35 percent cuts in your rate, in all rates, had we not gone to managed care.  Not only that, our folks were not getting healthier, and we have proof of that." In her opening remarks, she said the state has spent billions of dollars on health care for the poor without seeing an improvement in the state's health status, so a different approach was needed.

Future forums

Kissner said the forums between the MCOs and providers are expected to resolve disputes by January, the deadline given to the cabinet by Rep. Bob Damron, D-Nicholasville, during a meeting of the joint Administrative Regulations Review Subcommittee. Damron and other legislators have "vowed to lead a legislative revolt" if the administration doesn't fix these late payment issues between providers and MCOs by then, reports Ronnie Ellis of CNHI News Service.

All the managed-care forums follow the same agenda, which can be found along with additional information at the Medicaid website. The dates and locations of the remaining forums are:
  • Region 2, June 20: Main Lodge, Pennyrile Forest State Resort Park (20781 Pennyrile Lodge   Road., Dawson Springs) 
  • Region 3, June 24: Kent School of Social Work, University of Louisville Shelby Campus (312 N. Whittington Pkwy., Louisville) 
  • Region 4, June 26: VP Henry Auditorium, Lindsey Wilson College (210 Lindsey Wilson St., Columbia) 
  • Region 6, June 27: Student Union Building, Northern Kentucky University (20 Kenton Drive, Highland Heights) 
  • Region 1, July 15: Curris Center, Murray State University (102 Curris Center, Murray) 

Friday, 24 May 2013

Princess Health and Health insurers could exclude one in four Americans from coverage because they don't have bank accounts .Princessiccia

By Molly Burchett
Kentucky Health News

Federal Deposit Insurance Corp. graphic
A new study says if corrective action isn't taken, health-insurance companies could exclude 27 percent of qualifying Americans now eligible for premium-assistance tax credits under the health-reform law because they plan to require customers to pay premiums automatically through a bank account. More than 1 in 4 of these people do not have a bank account.

If insurance companies won't do business with them, that will undermine efforts to expand health coverage and equalize access to health care, denying coverage to the more than 8 million "unbanked" Americans, says the report from tax firm Jackson Hewitt.

Unbanked households are those that lack any kind of deposit account, checking or savings, at an insured depository institution, so requiring a checking account for coverage could also worsen the existing disparities in both health-care access and health status of minority groups. African Americans and Hispanics are over 40 percent more likely than whites to be "unbanked," says the report.

Most health plans accept a credit card for the first month�s premium payment and thereafter require monthly payment from a checking account. An estimated 30 percent of U.S. households are "unbanked" or underbanked, with the highest rates among non-Asian minorities and lower-income, younger and unemployed households; underbanked households hold a bank account but also rely on alternative financial services, and one in five households use such check-cashing stores and money lenders instead of a traditional bank, says the Federal Deposit Insurance Corp.

This all goes against the basic ideals behind the health care law's "comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. The law allows all Americans to make health insurance choices that work for them while guaranteeing access to care for our most vulnerable, and provides new ways to bring down costs and improve quality of care," says the White House website.

Law doesn't protect Americans from discrimination

Federal officials are wary taking action that may discourage insurance companies from participating in the exchanges, current and former state health officers who have pressed the U.S Department of Health and Human Services for a ruling told Varney.

�I think there is a dawning awareness that this is a large problem,� Brian Haile told Varney; Haile is senior vice president for health policy at Jackson Hewitt Tax Service and has called on federal official to set a uniform standard requiring all insurers to accept all forms of payment.

Neither the health law nor other laws require insurance companies to accept all forms of payment, says Sarah Varney of Kaiser Health News. Alternative forms of payment include credit cards or pre-paid debit cards that people without bank accounts often use, and although health insurance companies are evaluating these options, they are not required to do so, reports Varney.

�I�ve not seen any specific guidance that says you have to be able to accept these types of payments,� Ray Smithberger, Cigna�s general manager of individual and family plans, told Sarah Kliff of The Washington Post.

Insurance carriers take a risk by accepting credit cards and pre-paid debit cards because transaction fees can run as high as 4 percent and pre-paid cards are popular among low-wage workers, Haile told Varney. 

�If you accept re-loadable debit cards, are you in fact getting folks with lower health status?� Haile told Varney. �That�s a real risk when you�re in the insurance business. So you can�t be the only one picking up those risks.�

The Jackson Hewitt report calls for immediate action by federal policy makers to ensure insurers cannot discriminate against the 'unbanked' through their payment acceptance policies by creating a system-wide rule requiring all forms of payment must be accepted.

"Given the dilemma presented to insurance companies by the strong financial incentives to discourage non-bank payment mechanisms, insurers are unlikely to resolve this issue without federal action," says the report.

Tuesday, 23 April 2013

Princess Health and Poll shows more than half of Ky. adults have no dental insurance and many go without essential dental care.Princessiccia

Princess Health and Poll shows more than half of Ky. adults have no dental insurance and many go without essential dental care.Princessiccia

Routine dental care is essential to overall health, but a new poll shows 1.7 million Kentucky adults do not have dental insurance. That is more than times the number of people who will be at Churchill Downs for the Kentucky Derby, notes the Foundation for a Healthy Kentucky, which co-sponsored the poll.

The poll also showed that many Kentucky adults are going without the dental care they need. While the poll found that few owe money for dental bills, only 61 percent said they visited a dentist or dental clinic within the past year. The national figure is 70 percent.

�Oral health is essential to overall health,� said Dr. Susan Zepeda, president and CEO of the foundation. �Yet, our research indicates a majority of Kentuckians do not have dental coverage, so it is not surprising that a large number of adults do not have a personal dentist or oral health provider.�

Poor oral health or oral pain can lead to poor nutrition and can reduce someone's quality of life by making it difficult to sleep, work or interact with others, and having dental insurance is an important factor in determining whether someone is getting the dental care they need.  More than 50 percent of poll respondents indicated not having dental insurance of any kind, and almost half of that group said they skipped getting dental care or check-ups in the past year due to its cost.

Whether or not someone has a normal source of care is also an important factor in determining health care outcomes because those with a personal dentist or doctor are more likely to seek care. Almost 40 percent of poll respondents, however, said they do not have a personal dentist or oral health provider, and almost 80 percent of those respondents said its been more than five years since they last visited a dentist or dental clinic.

The poll was funded by the foundation and the Health Foundation of Greater Cincinnati. The poll was conducted last year from Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones, and the poll has a margin of error of plus or minus 2.5 points.

Thursday, 18 April 2013

Princess Health and Business leaders discuss possibility of expanding Medicaid through private insurance.Princessiccia

Princess Health and Business leaders discuss possibility of expanding Medicaid through private insurance.Princessiccia

By Molly Burchett
Kentucky Health News

Some Kentucky business leaders are discussing a possible endorsement of expanding Medicaid through private insurance, in a plan similar to one the federal government approved for Arkansas.

The Health Policy Council of the Kentucky Chamber of Commerce discussed the idea last Friday. A talking paper for the meeting highlighted presumed benefits of the approach, in which people newly eligible for Medicaid could use federal funds to buy private insurance through the insurance exchange that the state is constructing.

The health council has yet to decide the chamber's position on Medicaid expansion, but the council's talking paper said expanding Medicaid privately might be a better option than expansion of traditional Medicaid, considering the state's tight budget and already problematic managed care system.

The paper says a private plan would be beneficial to Kentucky because it would allow market forces to control costs and ultimately result in better health care. Private expansion would also prevent a flood of newly eligible people from entering the managed care system. "If Kentucky accepts the traditional Medicaid expansion, everyone that qualifies would be put into the already struggling managed care system, which until changes are made, cannot support the influx," the paper asserted.

The Obama administration has encouraged states to consider the Arkansas approach, the paper says.  To do so, states need to apply for a waiver, and the administration has provided information on how a state would apply. "Florida, Ohio, Louisiana, Maine and Pennsylvania are all looking into this option," the paper said.

An estimated 181,000 uninsured adults would become eligible for Medicaid in 2014, if Kentucky decides to accept the funds offered by the health law to provide coverage to those earning up to 138 percent of the federal poverty level.

Gov. Steve Beshear has said he will make his decision about Medicaid expansion no later than July 1. His office has declined to say whether the privatized option is under consideration, saying, "The governor is considering multiple issues as he determines whether Kentucky will expand Medicaid eligibility.  Along with affordability for the state, he is also looking at potential economic impact through jobs and investment created by possible expansion, as well anticipated changes in health outcomes for newly-eligible Kentuckians."