Sunday, April 15, 2018

Legislature tosses health departments and mental-health centers a budget lifeline; bills on disposal of opioids become law

By Al Cross
Kentucky Health News

FRANKFORT, Ky. – As it wrapped up its business, the Kentucky General Assembly threw a financial lifeline to health departments and mental-health centers, passed a telehealth bill without an amendment favored by insurance companies, and overrode the governor's veto of a drug-disposal bill.

Budget: In a revision of the budget it passed earlier, the legislature froze for one year the pension contributions of health departments and 11 of the state's 14 community mental health centers, which were facing increases in pension payments of 49.5 to 83.4 percent, averaging 69 percent.

That would have been a double whammy with the 6.25 percent across-the-board cut proposed by Gov. Matt Bevin and included in the budget, which is likely to force cuts in personnel and services.

Bevin could veto the revision bill, but he suggested Friday evening that it was making the budget better. And he indicated that he would still have to make cuts because the budget will be unbalanced. Legislative leaders have disputed that.

Home care for the disabled: In a rare gain among programs, the budget adds $10.5 million to the General Fund to generate an extra $24.6 million in federal Medicaid money each fiscal year for the Supports for Community Living program, which enables developmentally and intellectually disabled Kentuckians to receive care in homes rather than health-care facilities.

The money will "raise reimbursement rates to SCL service providers who have not seen an increase since 2004, even as costs have risen 27 percent through inflation since that time," says the Kentucky Center for Economic Policy. "The stagnant payment rates have contributed to a 45 percent turnover rate among providers and a 41 percent decrease in services offered to intellectually and developmentally disabled Kentuckians."

Telehealth: By a vote of 65-20, he House gave final passage to SB 112aimed at increasing access to health care and saving money by requiring the state to develop policies on health care by telecommunication –including a reimbursement model, with similar expectations for the public insurance market. The House did not consider an insurance-company floor amendment filed by Rep. Jim Gooch, R-Providence, that would have removed a key provision, requiring telehealth visits to be paid for at same level as regular visits unless otherwise negotiated. Bevin could still veto the bill.

Drug disposal: The legislature overrode Bevin's veto of House Bill 148, sponsored by Rep. Addia Wuchner, R-Florence, to shift ownership of controlled substances from deceased hospice patients to the hospice for disposal. Bevin's veto message said the bill was contrary to federal law and U.S. Drug Enforcement Agency policy, but Senate President Robert Stivers cited a DEA memo that cleared the way for the bill.

Bevin allowed to become law without his signature Senate Bill 6, sponsored by Sen. Alice Forgy Kerr, R-Lexington, to make pharmacists tell customers how to safely dispose of unused opioids and other controlled substances, and either provide or offer to sell them a product designed to neutralize drugs for disposal, or provide on-site disposal. More than 70 percent of all opioid addictions result from misuse of prescription drugs.

Other health bills: In the days before the legislature reconvened to consider vetoed bills and pass others, Bevin signed several health-related bills into law, including:

SB 5, sponsored by Sen. Max Wise, R-Campbellsville, to put the Medicaid program in charge of reimbursement rates for pharmacists. Rates are now set by pharmacy benefit managers, firms hired by managed-care organizations (mainly insurance-company subsidiaries). The bill sets reporting requirements for PBMs and MCOs and the $1.7 billion a year they get from the state. It also would allow the Medicaid program to approve contracts and fees between MCOs, PBMs and pharmacists.

HB 463, sponsored by Rep. Michael Meredith, R-Brownsville, to prohibit PBMs from requiring clients to make a co-payment that is higher than a lesser cash-payment amount, and keep them from penalizing a pharmacy for telling patients if that option is available. It is called the "clawback" bill, because PBMs "claw back" the difference between the higher co-pay and the lower price of the drug.

SB 71, sponsored by Sen. Steve Meredith, R-Leitchfield, would require the inclusion of abstinence only education in any sex-ed classes taught in Kentucky. Kentucky has no comprehensive sexual health education standards; the state Department of Education is reviewing proposed rules.

Failed bills: Health-related bills that were poised for passage but did not make it included SB 95, sponsored by Kerr, to require health insurers to cover standard fertility preservation services for patients who have become infertile by means of surgery, radiation, chemotherapy or any other medical treatment affecting reproductive organs and processes; and SB 149, sponsored by Sen. Julie Raque Adams, R-Louisville, chair of the Senate Health and Welfare Committee, to establish an advisory council for palliative care, given to make patients with incurable illnesses more comfortable.

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

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