Legislature moving bills to address health-care worker shortage

Centers for Disease Control and Prevention illustration

By Melissa Patrick
Kentucky Health News

In the final days of the 2022 legislative session, three bills to address Kentucky's healthcare workforce shortages are moving. One addresses the nursing shortage directly, one works toward recruitment and retention more broadly, and one addresses Medicaid payments for community health workers. 

Senate Bill 10 addresses the nursing shortage with both short-term and long-term solutions, Rep. Kim Moser, R-Taylor Mill, said in presenting the bill to the House Wednesday, March 23. 

Moser said the key components of SB 10 would streamline the process for out-of-state and foreign trained nurses to practice in Kentucky without compromising the standards of care; would improve access to nursing education by removing "arbitrary" enrollment limits without compromising the quality of the programs; and add term limits and geographic requirements for the Board of Nursing. 

The Kentucky Nurses Association says Kentucky will need as many as 16,000 more nurses by 2024.

Rep. Kim Moser

Asked how many new nurses these provisions would produce, Moser said that the effort is just "a piece of the puzzle" to increase the health-care workforce in Kentucky. "While I don't have hard and fast numbers, I do think that this will certainly help," she said. 

SB 10, sponsored by Sen. Robbie Mills, R-Henderson and Senate President Robert Stivers, R-Manchester, passed out the House 93-1. It awaits Senate concurrence with some minor changes related to the nursing board. UPDATE, March 29: The Senate concurred, giving the bill final passage.

Another bill, sponsored by Moser, would impact the health-care workforce more broadly by establishing a Healthcare Worker Loan Relief Program for qualifying health-care workers.

"House Bill 573 establishes a much needed recruitment and retention tool for addressing healthcare worker shortage, especially in rural and underserved areas of Kentucky," Moser said in presenting the bill to the House March 23. "It provides financial incentives to attract and retain health-care providers."

The loan program would be aligned with the Kentucky State Loan Repayment Program and administered by the University of Kentucky's Center of Excellence in Rural Health. 

The program would be set up as a trust fund in the state treasury that would consist of state general fund appropriations, gifts and grants from public and private sources and federal funds. 

Moser said this program would supplement federal funding, which requires a state match for scholarships and loan forgiveness; would expand the list of  health-care workers eligible to participate; and require recipients to work in under-served areas of Kentucky. 

The bill's House committee substitute calls for the loan relied fund to get $2 million a year, and adds ophthalmologists, optometrists and audiologist to the list of eligible recipients. 

The House passed HB 573 91-3, but at week's end, it had not received any of its three required readings in the Senate or been assigned to a committee. UPDATE, March 30: HB 573 has been placed in the Senate Appropriations & Revenue Committee and has received two readings. 

Moser's HB 525, which would allow Medicaid to pay certified community health workers, passed the Senate on its March 25 consent calendar and is back to the House for concurrence with Senate changes. UPDATE, March 29: The House concurred, giving the bill final passage. 

CHWs aren't trained medically, but are trained as patient advocates who come from the communities they serve. They help their clients coordinate care, provide access to medical, social and environmental services, work to improve health literacy, and deliver education on prevention and disease self-management.

HB 525 would require the state Department for Medicaid Services to seek federal approval for a state plan amendment, waiver or alternative payment model, including public-private partnerships, for services delivered by certified CHWs. It would also streamline their certification process.

Health bills were among those that passed (some with overrides of vetoes) and failed in the last two days of the legislative session

By Melissa Patrick
Kentucky Health News

The Republican legislature overrode more than two dozen of Democratic Gov. Andy Beshear's vetoes Wednesday and Thursday, including a wide-ranging abortion bill that was immediately challenged in court and another that sets new rules for public-assistance programs, including Medicaid. 

Tulips in front of the state Capitol

The General Assembly ended its session after passing a number of health-related bills on a wide range of topics, including youth mental health, increased access to mental health and addiction recovery care, a behavioral-health pilot program for low-level offenders, postpartum care for low-income Kentuckians, research into medical marijuana, and the recruitment and retention of health-care providers. 

The anti-abortion measure, House Bill 3, bans mailing of medications that have become the means for most abortions in Kentucky, strengthens parental-consent rules and bans abortion after the 15th week of pregnancy, mimicking a Mississippi law that is awaiting a decision from the U.S. Supreme Court. 

Beshear said he vetoed the bill because there were no exemptions for rape or incest, also noting that it is likely unconstitutional, among other reasons. 

Kentucky's only abortion providers said they had to stop conducting the procedure because other restrictions and reporting requirements in the 72-page bill went into effect as soon as it was finally passed because of an emergency clause.

EMW Women's Surgical Services and Planned Parenthood, both in Louisville, have each filed federal lawsuits challenging the new law and are asking a judge to suspend it. 

The American Civil Liberties Union of Kentucky said in a news release, "The lawsuits argue that the law would create unnecessary abortion requirements while simultaneously making those requirements impossible to comply with given the immediate effective date of the law, forcing providers in the state to stop offering abortion services. Because the law is impossible to comply with, it amounts to a de facto abortion ban, thus violating patients’ federal right to abortion under Roe v. Wade," the 1973 Supreme Court decision creating a constitutional right to abortion before a fetus can live outside the womb. 

Lawmakers also overruled Beshear's veto of HB 7, a public-assistance reform bill aimed at reducing fraud and getting able-bodied adults without dependents back into the workplace. Beshear vetoed the bill because, among other things, he said it will result in making it harder for people who need the benefits to get them and will result in people losing benefits. 

Health bills that passed in the last days of session

HB 44, sponsored by Bobby McCool, R-Van Lear (Johnson County), allows local school boards to include mental health as a reason for an excused absence. Rep. Lisa Willner, D-Louisville, praised the passage of this bill, noting that it came from students at several Kentucky schools. This bill also removed part of a new law that would have created criminal penalties for teachers who didn't teach racial history the way called for by the new law, Senate Bill 1, also passed over a veto. 

Senate Bill 102, sponsored by Sen. Max Wise, R-Campbellsville, requires local school superintendents to provide a yearly census of all school-based mental-health providers and their duties to the state Department of Education, not just a list of school counselors. 

SB 90, sponsored by Sen. Whitney Westerfield, R-Crofton, creates a pilot program to divert some qualifying low-level offenders away from jail and into treatment for substance-use disorder or mental-health issues. 

Negotiated in a late House-Senate conference committee, the bill gives the project $11 million a year from the settlement that Kentucky and other states received from opioid manufacturers and distributors.

HB 573, sponsored by Rep. Kim Moser, R-Taylor Mill, establishes the Healthcare Worker Loan Relief Program for qualifying health-care workers with jobs that require four-year degrees. This program is meant to help recruit and retain healthcare workers in rural and underserved areas of Kentucky.

The program would be aligned with the Kentucky State Loan Repayment Program and administered by the University of Kentucky's Center for Excellence in Rural Health. The budget has $2 million in each fiscal year from the American Rescue Plan Act of 2021, the last pandemic-relief bill.   

SB 178, sponsored by Sen. Julie Raque Adams, R-Louisville, ended up being a catch-all bill for several health-related issues. It requires Medicaid to provide coverage to new mothers up to 12 months after giving birth; sets new rules for certification of alcohol and drug counselors; allows licensed narcotic treatment programs to use buprenorphine products to treat patients; and requires third-party oversight over the state's single Medicaid pharmacy benefit manager; and bars termination of parental rights of a mother whose child suffers from neonatal abstinence syndrome if the mother agrees, prior to discharge from the hospital, to participate in a court-ordered treatment program that includes peer supports. 

HB 604, sponsored by Moser, also became a catch-all bill that at its core establishes the Kentucky Center for Cannabis Research at the University of Kentucky. The budget allocates $2 million in the fiscal year that begins July 1 to start the center. Other health provisions in this bill create the mobile crisis services fund and to the Commonwealth West Healthcare Workforce Innovation Center. 

Health bills that got stuck in the Senate

HB 136, sponsored by Rep. Jason Nemes, R-Louisville, which would have legalized medical cannabis in Kentucky did not gain any traction in the Senate after passing out of the House. Senate President Robert Stivers has long said that he believes more research is needed before such a bill should pass. 

HB 354, sponsored by Rep. Russell Webber, R-Shepherdsville, would have created a path for Kentucky's advanced practice registered nurses to prescribe controlled substances independently. "I'm sure that bill will come back some time in the future," said Senate Majority Floor Leader Damon Thayer in the closing hours of the session.

Beshear vetoes public-assistance, abortion bills; gets one more month of pandemic food benefits; more health bills could pass

Gov. Andy Beshear, signing and vetoing bills on Thursday, April 7 (KHN photo by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

Kentucky lawmakers will return to Frankfort Wednesday to consider overriding Gov. Andy Beshear's vetoes of several bills, including two related to health. They would put new limits on abortion and set new rules for public assistance programs, including Medicaid.

The General Assembly will also consider passing other bills, but because it is required to adjourn by Friday, the Democratic governor could veto them without fear of being overridden by the Republican legislature.

The wide-ranging anti-abortion measure, House Bill 3, would ban mailing of medications that have become the means for most abortions in Kentucky, strengthen parental-consent rules and ban abortion after the 15th week of pregnancy, mimicking a Mississippi law that is awaiting a decision from the U.S. Supreme Court. 

In his veto message, Beshear noted that the bill makes no exemptions for pregnancies caused by rape or incest, and described how the proposed parental-consent rules would require both parents to be notified if a girl under 18 wants an abortion. He said that could create a situation where a young girl who has been raped and impregnated by her father would have to notify him of her intent to get an abortion or go through an onerous process of getting a court order to allow it.

"Rape and incest are violent crimes," Beshear said. "Victims of these crimes should have options, not be further scarred through a process that exposes them to more harm from their rapists or that treats them like offenders themselves."

Further, he said the bill is likely unconstitutional and that the new reporting and oversight systems would create an "unfunded mandate" for the state Cabinet for Health and Family Services. 

Beshear said he vetoed the public-assistance reform bill, HB 7, "because it will hurt Kentuckians by threatening access to health care and making it harder for those in need to access crucial benefits." He said the administrative burdens could cause people to lose benefits, said the bill could violate federal Medicaid requirements, and said it provides no appropriations for the health cabinet to implement the bill's requirements. He pointed out that when Kentuckians lose health and food benefits, that not only affects them, but physicians, hospitals and the economy.

The bill's sponsor, Rep. David Meade, R-Stanford, has said the added rules in Medicaid and food-benefit programs are needed to reduce fraud and encourage able-bodied adults without dependents to get off Medicaid and other public-assistance programs and back into the workplace. 

It is expected that both bills, priorities for Republicans, will be repassed over Beshear's vetoes, just as they overrode his veto of a resolution ending the Covid-19 state of emergency about a month early, costing 544,000 Kentuckians an extra $100 a month in pandemic-related food benefits. 

Federal law required the state to have a state of emergency were needed to get those additional benefits as long as the national state of emergency is in place, but also allowed Kentucky to apply for a "phase out" month of the benefits after its state of emergency ended, and that has been approved. 

On March 30, a spokesperson for the U.S. Department of Agriculture, which houses the Supplemental Nutrition Assistance Program, formerly called food stamps, told Kentucky Health News that the additional month of Covid-19 benefits had been approved for April. 

Bills hanging fire 

One of the health bills to watch is HB 174, sponsored by Rep. McKenzie Cantrell, D-Louisville, that would extend Medicaid coverage to new mothers up to 12 months after giving birth. This bill sailed unanimously out of the House in February, passed out of its Senate committee unanimously on March 23 and was placed on the consent calendar, used to pass bills without debate.

Since then, five floor amendments have been filed, including one by Sen. Adrienne Southworth, R-Lawrenceburg, that includes provisions of HB 51, sponsored by Rep. Lynn Bechler, R-Marion, that would allow a parent or guardian to opt out of any masking, testing or vaccination requirements imposed in response to the coronavirus. HB 51 passed the House 56-35 on March 8, but has lingered in the Senate Health and Welfare committee without a hearing. 

Another bill to watch is HB 604, sponsored by Rep. Kim Moser, R-Taylor Mill. It would create the Kentucky Center for Cannabis Research at the University of Kentucky. It is supported by Senate President Robert Stivers, who has said the idea of medical marijuana needs more study to become law.

It also appears that three health bills that were added to a catch-all bill, Senate Bill 58, are set to pass. They are HB 645, sponsored by Rep. Danny Bentley, R-Russell, to create the mobile crisis service fund; HB 751, sponsored by Majority Caucus Chair Suzanne Miles, R-Owensboro, to create the Commonwealth West Healthcare Workforce Innovation Center; and HB 573, sponsored by Moser, to establish the Healthcare Worker Loan Relief Program for qualifying health-care workers.