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

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

behavioral health courts General Assembly legislation legislature mental health mental illness

Gusty 13:19 Add Comment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Princess Health and Bacteria that can't be treated by any antibiotic now in U.S.; Kentucky ranks first in one type of antibiotic-resistant infection. Princessiccia

Princess Health and Bacteria that can't be treated by any antibiotic now in U.S.; Kentucky ranks first in one type of antibiotic-resistant infection. Princessiccia

antibiotics bacterial infections federal budget healthcare-associated infections hospital acquired infections legislation

Gusty 19:52 Add Comment

A colorized scanning  of E.Coli
Credit: CDC/Jancie Haney Carr

For the first time, researchers have found a person in the United States carrying bacteria that can't be treated by "last resort" antibiotics.

The antibiotic-resistant bacteria found in the 49-year-old Pennsylvania woman's urine was from a strain of E.coli bacteria that is resistant to an antibiotic called colistin, a last-resort drug with serious side effects that is used only when other antibiotics don't work.

For example, colistin is used to treat the superbug carbapenem-resistant Enterobacteriaceae, commonly called CRE, which health officials call a "nightmare bacteria."

Nearly half of patients who become infected with CRE die from it, Lena H. Sun and Brady Dennis report for The Washington Post.

The Pennsylvania woman was able to be treated with other antibiotics, but the discovery of the colistin-resistant strain has placed health officials on alert.

Health officials say it's not time to panic, but there is great concern that this colistin-resistance gene could spread to other bacteria that are also antibiotic-resistant creating many more bacteria strains that are untreatable, reports the Post.

The colistin-resistant strain was first found in pigs, raw pork and a few people in China in November. It has also been found in Europe.

�It basically shows us that the end of the road isn�t very far away for antibiotics � that we may be in a situation where we have patients in our intensive care units, or patients getting urinary-tract infections for which we do not have antibiotics,� CDC Director Tom Frieden told the Post.

Separate research found that the same colistin-resistant strain was found in a sample from one pig intestine in the United States. Colistin is widely used in Chinese livestock, but is not used in the United States, though plenty other antibiotics are, Tom Philpott reports for Mother Jones.

"Around 80 percent of the antibiotics sold in the United States go to livestock farms, and of that, 60 percent are considered crucial to human medicine," Philpott writes. Farmers mostly use antibiotics to help their livestock grow faster.

Yohei Doi, an infectious-disease doctor at the University of Pittsburgh, told the Post that he thought the widespread use of the antibiotic in Chinese livestock is likely what has led to the bacteria evolving and gaining resistance to the drug, and then leaping from livestock to humans through food.

Dr. Kevin Kavanagh, a retired physician and chairman of HealthWatch USA, said he isn't convinced that the U.S. pig was infected by livestock from China. He noted that colistin is commonly used to treat CRE, cystic fibrosis and that a form of colistin can be found in many over-the-counter topical antibiotics.

"It's probably more likely that the pig in the U.S. obtained this from the farmer's medicine cabinet than from another pig in China," Kavanagh said.

Experts in infectious diseases have called for action to curb the overuse of antibiotics in livestock worldwide. They have also warned that if these antibiotic-resistant bacteria continue to spread, treatment options could be severely limited.

Kavanagh  recognized the importance of research around the overuse of antibiotics in livestock but said that he thought more emphasis should be placed on the human side of healthcare related to antibiotic-resistance bacteria than the agriculture side of it.

 "The foremost emphasis should be placed on controlling antibiotic usage, controlling the spread of these organisms and surveillance of these organisms. ... We don't really know how many infections exist because we have a fragmented reporting system, but you know how many cows there are in each county," he said.

The federal Centers for Disease Control and Prevention estimates that at least 2 million people are infected with antibiotic-resistant bacteria each year, and 23,000 die.

Kentucky ranked first in MRSA cases, July 2014 - June 2015.

HealthWatchUSA

Kentucky has one of the highest prescribing rates of antibiotics in the nation and also leads the nation in another antibiotic resistant infection called MRSA (methicillin-resistant staphylococcus areus).

"Overuse of antibiotics has got to stop," says Kavanagh said. "The use of antibiotics needs to be curtailed to only when it is necessary. ... Every time you take an antibiotic you remove your good bacteria and run a real risk of activating a superbug in your body which can cause you extreme harm and even death. You should only take antibiotics when you have to take them."

Pharmaceutical companies have stepped away from developing new antibiotics because they aren't very profitable. But William Schaffner, medical director of the National Foundation for Infectious Diseases, told WebMD, "The Infectious Diseases Society of America has been working with Congress and with industry to create incentives for the pharmaceutical industry to reopen its antibiotic research laboratories."

In addition, "Late last year, as part of a broader budget deal, Congress agreed to give hundreds of millions of dollars to the federal agencies engaged in the battle against antibiotic-resistant bacteria," reports the Post.

Princess Health and Justice secretary, drug-policy chief and ex-health boss back needle exchanges but 'political rhetoric' can trump science. Princessiccia

Princess Health and Justice secretary, drug-policy chief and ex-health boss back needle exchanges but 'political rhetoric' can trump science. Princessiccia

drug abuse health departments hepatitis c heroin HIV legislation needle exchanges

Gusty 15:57 Add Comment

By Melissa Patrick
Kentucky Health News

CORBIN, Ky. � Local officials and legislators continue to debate and sometimes reject needle exchanges, but two state officials and a former state health commissioner voiced their strong support of them at a pubic forum May 17 in Corbin.

Dr. William Hacker:
"Needle exchanges work."

"Needle exchanges work," said Dr. William Hacker, chair of Shaping Our Appalachian Region's Health and Wellness Advisory Committee and former state health commissioner. "We would, as a public health role, encourage them to be extended."

Hacker spoke at the "Cumberland River Forum on Opioid Use Disorders: A Time for Community Change," one of three public forums on the subject in Kentucky in May.

The General Assembly authorized needle exchanges in the 2015 anti-heroin bill, as a way to decrease the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. They require both local approval and funding.

Kentucky's rate of hepatitis C is the highest in the nation, and a recent federal Centers for Disease Control and Prevention report said that of the 200 counties in the nation that are most susceptible to a hepatitis C or HIV outbreak, 54 of them are in Kentucky.

So far, only 14 counties in Kentucky have either approved or are operating needle exchanges: Jefferson, Fayette, Jessamine, Franklin, Clark, Kenton, Grant, Harrison, Pendleton, Carter, Boyd, Elliott, Pike and Knox.

Justice Secretary John Tilley:
"Real facts and real science"

Justice Secretary John Tilley, who was instrumental in getting the heroin bill passed when he was a state representative from Hopkinsville, encouraged communities to look at the evidence-based research that supports needle-exchange programs and to not listen to the political rhetoric.

"We've got to push aside this political rhetoric on topics like this one and talk about real facts and real science," he said. "These programs have been validated by meta-analysis. ... Those who seek out a needle exchange are five times more likely to enter treatment. These programs continue to beat back blood-borne illnesses like hepatitis C and HIV, at rates we cannot duplicate without these programs. They are universally successful at what they do."

Tilley said after the meeting that addiction is a chronic disease and should be treated as a public-health crisis, noting that other diseases are treated based on science and medicine, not opinion.

"When you go to the doctor, you don't ask him his political view of a particular health program," he said. "Well, this is no different. And for me to substitute my judgment for the science is dangerous."

Van Ingram changed his mind

Van Ingram, executive director of the Governor's Office of Drug Control Policy, said his opinion about needle exchanges changed after he researched them and learned how effective they are at decreasing the spread of hepatitis C and HIV. He also noted that these programs provide testing and treatment referral for these infectious diseases, and also help participants get treatment.

"Eleven years ago I left law enforcement, and if you had told me that I would end up being the poster boy for syringe exchange, I would have said you were crazy," he said. "But quite honestly, they do work."

Ingram also noted the CDC study and reminded the audience of the "enormous" HIV outbreak that occurred last year in Scott County, Indiana, 30 miles north of Louisville.

"So if a syringe exchange can keep us from having a rapid HIV outbreak, I think that is probably a good trade-off," Ingram said.

But evidence-based research isn't always enough to convince policy makers that needle exchange programs don't condone or perpetuate drug use.

The Georgetown newspaper answered its
question in its story. The answer is yes.

Last week it was reported that two Kentucky counties decided against needle exchanges. Boone County's Fiscal Court silently said no to a needle exchange by refusing to call up a resolution to support one, Mark Hansel reported for NKyTribune. And the Scott County Fiscal Court voted 5-3 against one, Dan Adkins reported for the Georgetown News-Graphic. Adkins followed up with a featured front-page story about the county's heroin problem.

A point of contention among Republicans in the General Assembly is that some of the exchanges don't require a needle-for-needle exchange, which they say was their intent.

Then-Attorney General Jack Conway said Dec. 18 that needle exchanges did not have to be one-for-one. It is also widely accepted that not requiring one-for-one is considered a best practice across the country to prevent the spread of HIV and hepatitis C and to stop intravenous drug users from sharing and reusing needles, Dr. Sarah Moyer, the interim director of the Louisville Metro Department of Public Health and Wellness, told Kentucky Health News in March.

Last session, as the Senate voted to amend House Bill 160 to require one-to-one exchanges, Senate Republican Floor Leader Damon Thayer of Georgetown threatened to file a bill to eliminate them altogether next session if they don't make this change during the upcoming year.

In its original form, HB 160 was a bill to educate the public about how to safely dispose of hypodermic needles in order to keep them out of landfills. The House let the bill die without another vote.

Tilley said after the meeting, "Culture and change takes a while," and noted that while he respected his colleagues differing opinions, he said it is likely that this topic is not in their "wheelhouse."

"So, I think the more they learn the more they will come along," he said. "What we should do is all come back to the table and talk about how the programs that are now in place in Kentucky are working and how the reliance on science and evidence based policy makes them work."

Princess Health and Beshear calls for transparency as Bevin and feds work on Medicaid changes and stakeholders prepare to meet Thursday. Princessiccia

Princess Health and Beshear calls for transparency as Bevin and feds work on Medicaid changes and stakeholders prepare to meet Thursday. Princessiccia

Foundation for a Healthy Kentucky health reform legislation Medicaid obamacare Patient Protection and Affordable Care Act

Gusty 18:40 Add Comment

By Melissa Patrick
Kentucky Health News

Former Gov. Steve Beshear sent an open letter to Gov. Matt Bevin and Health and Human Services Secretary Sylvia Burwell May 9, accusing his Republican successor and President Obama's appointee of working "in secret" and with "no public input of any kind" to change the Medicaid program that Beshear expanded under Obama's reforms.

"On behalf of all who care about the health of Kentuckians, we demand the Bevin and Obama administrations pull back the curtain, stop the back-room deals, and allow for full disclosure and transparency throughout the development of this Medicaid waiver proposal that will impact the lives of hundreds of thousands of Kentuckians, and the future of the entire commonwealth," Beshear wrote.

Beshear asked Bevin to release the details of his plan before Thursday, May 12, when the Foundation for a Health Kentucky is scheduled to host a stakeholders' meeting to discuss what they would like to see in the plan. He also asked Burwell to "demand" that Bevin provide details of the plan before any "formal or informal" decisions are made.

"This meeting of stakeholders should mark the beginning of the the process to solicit input from as many Kentuckians as possible, and the Bevin administration must create future opportunities for other interested stakeholders to weigh in before taking any next steps in the process," he wrote.

Bevin's office declined to comment, but told Kentucky Health News that stakeholder meetings have occurred and more formal ones are in the works. Bevin has said that he wants to announce his plan this summer.

According to the website on the type of waiver Kentucky is seeking, states are required to post their proposed plans for a 30-day comment period before sending them to the federal government. Once the Center for Medicare & Medicaid Services accepts the application, it is required to post the proposal for another 30-day comment period.

Under federal health reform, Beshear expanded Medicaid to Kentuckians with incomes up to 138 percent of the federal poverty level, adding about 400,000 people. 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.

Bevin told reporters in early May that he had "gone to the mat" with federal officials but remains optimistic they will agree. "If it does not happen it will be because CMS does not want to see expanded Medicaid continue in Kentucky," he said.

Burwell's press secretary, Ben Wakana, "indicated any changes to Kentucky's Medicaid plan should not weaken it," Deborah Yetter reports for The Courier-Journal. Wakana told her, "Kentucky's Medicaid expansion has led to one of the biggest reductions of uninsured people in America, and any changes to the program should maintain or build on the historic improvements Kentucky has seen in access to coverage, access to care and financial security."

Read more here: http://www.kentucky.com/latest-news/article76530622.html#storylink=cpy

Bevin has said many times that the state can't afford its Medicaid population. He appointed Mark Birdwhistell, a University of Kentucky health executive and former state health secretary, in December to help his administration design a new Medicaid program.

Since then, no details have been released, but Bevin has said Kentucky's revised program should require its members to have "skin in the game" and that the state cannot continue to pay for the health insurance of "able-bodied adults."

He has also referred to Indiana's plan, which has monthly fees, co-payments and refers its participants to a work program, as a model for Kentucky. However, spokeswoman Jessica Ditto told Kentucky Health News in March that, "The Indiana model is just one of many models that we are looking at for influence in crafting a plan that is specifically tailored for the needs of Kentucky."

Beshear said evidence suggests a move to a plan like Indiana's will "lead to increased cost for enrollees, and less access to healthcare for the most vulnerable Kentuckians."

He noted that "federal rules prohibit waivers for the sole purpose of saving money or shrinking the size of the program, both of which Gov. Bevin has publicly stated are his goals." He suggested that it is "precisely these types of changes" that are in the proposal, and calls again for "public review and debate." In addition, he calls for CMS to not approve changes that "would leave beneficiaries worse off than they are under a state's existing Medicaid program."

Beshear writes in conclusion, "Transparency, openness and honest conversation with the people of Kentucky is not only the right thing to do on such a critical decision, the people demand it."

Princess Health and Governor kills bill that would have encouraged donation of organs and bone marrow; sponsor's primary foe is son of Bevin appointee. Princessiccia

Princess Health and Governor kills bill that would have encouraged donation of organs and bone marrow; sponsor's primary foe is son of Bevin appointee. Princessiccia

governor legislation legislature; General Assembly organ donation

Gusty 06:56 Add Comment

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin has vetoed a bill that would have allowed Kentuckians to take time off of work to be "living donors" or donate bone marrow without risk of losing jobs or income. The bill would have required paid leave of absence for such reasons, and offset the cost to the employer with tax credits.

Rep. Ron Crimm

"I was deeply disappointed," Republican Rep. Ron Crimm, sponsor of the bill, said in a telephone interview. "I thought it was a very good bill."

Crimm, from Louisville, said the Republican governor called him and told him it was a good bill, but that he wasn't accepting anything that would generate a cost to the state.

Bevin said in his veto message, "House Bill 19 is a noble and well-intentioned piece of legislation designed to encourage the generosity of time and financial resources by both individuals and employers. However, the financial costs and administrative burden on the Department of Revenue to implement House Bill 19 far outweigh the limited benefit this legislation can provide."

The Legislative Research Commission's fiscal note on HB 19 says it would cost about $100,000 to set up the system, but future cost would be "minimal." Crimm said he didn't think it would cost that much to set it up and that he told the governor so.

HB19 is modeled after a similar program in Pennsylvania, which allowed LRC staff to look at the fiscal impact of its tax credit as a point of comparison. They found that in a four-year period, Pennsylvania had only three taxpayers claiming a donor credit for a total of $3,505.

"Therefore,staff estimates that the revenue impact of the credit permitted by HB 19 would also be minimal," says the fiscal note. Crimm said, "It's nothing."

Tom Loftus of The Courier-Journal noted that Crimm faces a "stiff primary election" May 17 against Jason Nemes and that Nemes' father, Mike Nemes, a former state representative, is Bevin's deputy labor secretary.

Asked if he thought this might have influenced the governor's veto, Crimm laughed and said, "If that is true, then I'm very, very disappointed that I supported him." Then he said, "I don't think the governor would have done that." But then he said, using what he said is an old "Pennsylvania Dutch" expression, "It wonders me. ... Everybody, one-hundred-percent of the people in the House and the Senate, voted yea on the bill." The legislation passed 95-0 in the 100-member House and 37-0 in the 38-member Senate.

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

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

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

Gusty 13:57 Add Comment

By Melissa Patrick
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gusty 16:05 Add Comment

By Melissa Patrick
Kentucky Health News

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

Sen. Ralph Alvarado

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

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

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

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

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

CareSource, another MCO, declined to comment.

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

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

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

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

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

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

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

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

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

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

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

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