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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

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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

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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

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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

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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

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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

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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

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By Melissa Patrick
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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