Princess Health and Essential-benefits rule expands mental-health and substance-abuse coverage; Ky. needs more facilities to treat newly eligible.Princessiccia

Princess Health and Essential-benefits rule expands mental-health and substance-abuse coverage; Ky. needs more facilities to treat newly eligible.Princessiccia

Affordable Care Act health care law health insurance insurance insurance exchange KCHIP mental health mental illness Patient Protection and Affordable Care Act substance abuse

Gusty 12:02 Add Comment

The Department of Health and Human Services has defined the 10 "essential health benefits" insurance plans must provide, and it included benefits for mental health and treatment of substance-abuse disorders..

Nearly 20 percent of Americans don't have access to mental-health services and over 30 percent have no coverage for substance-abuse treatment. This rule will expand mental health and substance-abuse treatment benefits to 62 million Americans, according to HHS.

Expanded coverage for mental health and substance abuse treatment programs in Kentucky could bring about a dramatic shift in the delivery of these services. There is already a shortage of treatment options and centers for Kentuckians, and those suffering from addiction have not had coverage for such treatment; the proposed rule will change that.

Recovery Kentucky, a public-private partnership with residential facilities, was created to help Kentuckians recover from substance abuse. It has 10 centers, in Campbellsville, Erlanger, Florence, Harlan, Henderson, Hopkinsville, Morehead, Owensboro, Paducah, and Richmond, according to the 2012 Justice & Public Safety Cabinet report, which included the map below. 

Health-insurance plans must cover the 10 essential benefits beginning in 2014, so the state must prepare for the newly insured in addition to newly covered services. The rule defines what must be covered in insurance plans and bans discrimination based on age or pre-existing conditions. Among the core package of items and services, known as �essential health benefits" are items and services in the following categories:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

States are given flexibility in implementing the federal health-care reform law with a benchmark approach. The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization plan serve as the �benchmark� plan for the Kentucky Health Benefit Exchange. HHS will review the recommendation and accept public comments prior to making a final decision. (Read more)

Princess Health and Medicaid expansion brings primary care access to the forefront.Princessiccia

Princess Health and Medicaid expansion brings primary care access to the forefront.Princessiccia

Affordable Care Act health care health care access health care law Medicaid Patient Protection and Affordable Care Act primary care state government

Gusty 08:00 Add Comment

The federal health reform law will usher at least seven million more Americans into Medicaid, and as states like Kentucky debate Medicaid expansion, policymakers are struggling with the question of whether there will even be enough primary care doctors to provide care, reports Michael Ollove of Stateline.

The country is already short of primary-care doctors. Although many primary-care physicians would take on new Medicare or privately-insured patients, only two out of three primary-care physicians surveyed in 2011 were willing to accept new Medicaid patients.

Why? Poor compensation is one reason; on average, Medicaid pays physicians 59 percent of the amount Medicare pays for primary care services, reports Ollove. Many Kentucky primary-care providers are also deterred by existing Medciaid problems. Providers report being burdened by a lack of or delayed payments from the new managed-care system.

Congress hopes to lure practitioners to primary care with a provision that raises primary-care providers' Medicaid fees to Medicare levels. This is only a temporary fix, which went into effect at the beginning of the year and will remain in effect for two years, reports Ollove.

The impact in Kentucky remains uncertain. Lawrence Kissner, Kentucky's commissioner for health and family services, says the state�s Medicaid pay raise in 2005 resulted in a 36 percent increase in the number of primary care doctors accepting Medicaid patients, reports Ollove. This is precisely what the health-law authors hope will happen now.

Kentucky is addressing the health coverage issue in other ways.  The General Assembly is considering a bill that would repeal a burdensome supervision requirement and encourage more independent physician assistants to remain in Kentucky to serve medically underserved areas.

Although Kentucky already allows nurse practitioners to practice independently, the Medicaid rate increase applies only to physicians who provide primary care services. It does not apply to nurse practitioners, who have been touted as a potential solution to the primary care problem and often provide care in underserved areas of the state. (Read more)

Princess Health and Foundation for a Healthy Kentucky gives UK $1 million for endowed co-chairs in rural health policy.Princessiccia

Princess Health and Foundation for a Healthy Kentucky gives UK $1 million for endowed co-chairs in rural health policy.Princessiccia

Foundation for a Healthy Kentucky health policy public health rural health University of Kentucky

Gusty 06:16 Add Comment

Tyrone "Ty" Borders in the University of Kentucky College of Public Health's Department of Health Services Management, and Brady Reynolds in the UK College of Medicine's Department of Behavioral Science, have been named the Foundation for a Healthy Kentucky endowed co-chairs in rural health policy.

A $1 million gift from the foundation to the College of Medicine was matched by the state Research Challenge Trust Fund, better known as "Bucks for Brains." The gift has the goal of enriching Kentucky's research capabilities in regards to rural health issues and rural health policy.

Reynolds earned doctoral and master's degrees in life-span developmental psychology from West Virginia University. He also holds a master's degree in general/experimental psychology and a bachelor's degree (magna cum laude and with distinction) from James Madison University. His research has focused on nicotine use by adolescents, drug use, gambling and other addictive behaviors. In recent years Reynolds has begun research to promote smoking cessation among pregnant smokers in rural Appalachia.

Borders earned doctoral and master's degrees in health administration, as well as a master's degree in epidemiology from the University of Iowa, and a bachelor's degree in psychology from the University of Kansas. His research focuses on the conduct and analysis of population-based studies to identify subgroups of persons at risk for poor health and problems obtaining health services, with an emphasis on rural populations.

�Drs. Reynolds and Borders have skills in intervention research and rural health policy expertise that can help the University remain at the forefront of rural health policy work in today�s rapidly changing healthcare environment,� said Susan Zepeda, president and CEO of the foundation.

The mission of the foundation is to addresses the unmet health care needs of Kentuckians. Mission objectives are advanced through two initiative areas: promoting responsive health policy and a new children�s initiative named �Investing in Kentucky�s Future.� Foundation work aims to improve access to health care, reduce risks and disparities, promote health equity and healthy lifestyles. Since 2001, over $22 million has been invested in health policy research and demonstration grant projects across Kentucky

Princess Health and If Republican governors are agreeing to expand Medicaid after lobbying by hospitals, can Beshear be far behind?.Princessiccia

Princess Health and If Republican governors are agreeing to expand Medicaid after lobbying by hospitals, can Beshear be far behind?.Princessiccia

Affordable Care Act federal spending General Assembly health care access health insurance health reform hospitals legislature Medicaid politics state budget state governments

Gusty 07:29 Add Comment

By Al Cross
Kentucky Health News

Florida Gov. Rick Scott's surprising announcement that he would use federal health-care reform money to expand the Medicaid program to households earning up to 138 percent of the poverty level "means the dominoes are falling," says Ron Pollack, executive director of Families USA, a consumer group that lobbied for the law. And another domino seems likely to be Democratic Kentucky Gov. Steve Beshear, without involvement by the state legislature.

Beshear has said he will expand Medicaid if Kentucky can afford it, and has mentioned that the state can reserve the right to pull out of the deal in 2017, when it must start paying a small but increasing share of the cost, reaching 10 percent in 2020. Scott used the same qualification.

Pollack told The New York Times that the message sent by seven Republican governors' acceptance of the deal is  �Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn�t opt into taking these very substantial federal dollars to help people who truly need it.� The GOP governors (of states outlined in Times map below) have said they will expand the program partly to protect rural hospitals and the poor.

"The change of heart for some Republican governors has come after vigorous lobbying by health industry players, particularly hospitals," the Times notes. "Hospital associations around the country signed off on Medicaid cuts under the health care law on the assumption that their losses would be more than offset by new paying customers, including many insured by Medicaid. . . . Every few days, state hospital associations and advocates for poor people issue reports asserting that the economic benefits of expanding Medicaid would outweigh the costs." (Read more)

Kentucky Hospital Association President Michael Rust said the trade group is for "universal coverage" by whatever means but is not lobbying Beshear for Medicaid expansion. "We assume he is" going to expand it, Rust said in an interview today. He said the association has not taken a position on bills that would require legislative approval of expansion and the health-insurance exchange being set up under the reform law. The legislation, Senate Bill 39 and SB40, passed the Republican-controlled Senate on party-line votes today, and are expected to die in the Democratic-majority House.

Senate Majority Floor Leader Damon Thayer said the bills were aimed at reining in "big daddy government." Here's a video from cn|2:

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Princess Health and Food Reward Friday. Princessiccia

Princess Health and Food Reward Friday. Princessiccia

Food reward Food reward Fridays

Gusty 03:00 Add Comment

This week, Food Reward Friday is going to be a little bit different. I've received a few e-mails from people who would like to see me write about some of the less obvious examples of food reward-- foods that are less extreme, but much more common, and that nevertheless promote overeating. Let's face it, even though they're funny and they (sometimes) illustrate the principle, most people reading this blog don't eat banana splits very often, much less pizzas made out of hot dogs.

So this week's "winner" is something many of you have in your houses right now, and which was also the subject of an interesting recent study... potato chips!

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Princess Health and Deaths by overdose, mainly of prescription drugs, hit a new record in U.S. in 2011; a huge problem in Kentucky.Princessiccia

Princess Health and Deaths by overdose, mainly of prescription drugs, hit a new record in U.S. in 2011; a huge problem in Kentucky.Princessiccia

drug abuse Oxycontin prescription drug abuse prescription drugs

Gusty 09:30 Add Comment

Drug overdose deaths in the U.S. rose for the 11th straight year and accidental deaths involving addictive prescription drugs overshadow deaths from illicit narcotics, new federal data show.

In 2010, there were 38,329 drug overdose deaths nationwide, and prescription drugs were the cause of nearly 60 percent of them.  As in recent years, opioid drugs such as OxyContin and Vicodin were the biggest problem, contributing to three-fourths of medication-overdose deaths, report Lindsey Tanner and Mike Stoppe of The Associated Press.

Anti-anxiety drugs including Valium were involved in almost 30 percent of medication-related deaths.  Most were unintentional overdoses; 17 percent were rules suicides. The data were reported Tuesday in the Journal of the American Medical Association.

In Kentucky, drug abuse is epidemic and more than 1,000 Kentuckians a year die from prescription-drug overdoses, more than the number who die in car accidents, according to a 2012 Kentucky Justice & Public Safety Cabinet report. About 85 percent of Kentucky's drug-related deaths were accidental and approximately 2 percent were suicides, according to federal Centers for Disease Control and Prevention data.

The number of drug-overdose deaths in Kentucky rose a staggering 296 percent from 2000 to 2010. In 2010, the record number of deaths reflected the national trend and also involved opioid painkillers, according to a study by the Kentucky Injury Prevention and Research Center. The highest rates of overdose deaths during the study period were concentrated in Eastern Kentucky and among men, reports Bill Estep of the Lexington Herald-Leader.

Many doctors and patients don't realize how addictive these prescription drugs can be, and that they're too often prescribed for pain that can be managed with less risky drugs, said Dr. Thomas Frieden, head of the CDC. He said the data show a need for more prescription drug monitoring programs at the state level, and more laws shutting down "pill mills" -- doctor offices and pharmacies that over-prescribe addictive medicines, AP reports.

That was the aim of House Bill 1, passed in last year's legislative session. The Kentucky All-Schedule Prescription Electronic Reporting  (KASPER) system has undergone several changes since the bill's passage to help crack down on so-called pill mills.

Last month, a federal panel of drug safety specialists recommended that Vicodin and dozens of other medicines be placed in a more restrictive drug category, which would make them harder to prescribe. Refills wouldn't be allowed without a new prescription, and faxed or called-in prescriptions wouldn't be accepted; only a handwritten prescription from a doctor would be allowed.

Princess Health and Body Fatness and Cardiovascular Risk Factors. Princessiccia

Princess Health and Body Fatness and Cardiovascular Risk Factors. Princessiccia

cardiovascular disease overweight

Gusty 19:00 Add Comment

I recently revisited a really cool paper published in the Lancet in 2009 on body fatness, biomarkers, health, and mortality (1). It's a meta-analysis that compiled body mass index (BMI) data from nearly 900,000 individual people, and related it to circulating lipids and various health outcomes. This is one of the most authoritative papers on the subject.

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