Appalachian Food for Health Diabetes Prevention virtual event is Tuesday, April 26; it's free, but registration is required

The fourth Appalachian Food for Health Diabetes Prevention event will take place Tuesday, April 26 from 10 a.m. to 12 p.m. ET.

The virtual event will focus on food and nutrition policy that impact diabetes. It will also include a discussion about diabetes prevention and how better access to fresh, healthy foods can play a role in deterring this disease. The event is free, but registration is required. Click here to register. 

The agenda for the event includes presentations from Tyler Offerman, food justice organizer for the Kentucky Equal Justice Center, who will give an overview of 2022 Kentucky legislation related to food and nutrition; Martin Richards and Kimberly Ishmael of the Community Farm Alliance, who will discuss the healthy farm and food fund; and Pamela Spradling, director of planning and grant management at Big Sandy Health Care, who will discuss community health workers and diabetes prevention. 

The Appalachian Food for Health Diabetes Prevention Convening series is a collaboration between the Community Farm Alliance, the Foundation for a Healthy Kentucky and Shaping Our Appalachian Region, the regional economic-development group for Kentucky's 54 Appalachian counties. 

Beshear and Senate president discuss medical marijuana, hero pay; Stivers says PBM bill stuck in Senate over cost concerns

By Melissa Patrick
Kentucky Health News

FRANKFORT — State Senate President Robert Stivers said he favors funding more research on medical marijuana before making it legal in Kentucky, but Gov. Andy Beshear says medical cannabis has overwhelming support in the state and should pass when the legislature returns to reconsider vetoed bills. 

At separate press conferences in Frankfort Thursday, the two leaders also discussed the Republican legislature's rejection of the Democratic governor's plan to give Kentuckians who worked throughout the pandemic a "hero bonus;" and Stivers said a House bill to rein in pharmacy benefit managers died in the Senate for fear it would raise consumers' and employers' costs.

Medical marijuana: Stivers said the House-passed cannabis bill "would be difficult" to pass the Senate next week, but he supports a bill by Rep. Kim Moser, R-Taylor Mill, to create a cannabis research center at the University of Kentucky and expects it to pass. "I think it not only would be good locally but nationally and internationally to understand the medicinal and therapeutic values of marijuana," he said.

Senate President Robert Stivers

Stivers acknowledged that studies show cannabis helps with certain medical conditions, "but every study I've read said the sample sizes have been too small, the duration is too long and therefore more study is needed."

Moser's House Bill 604 has had two of its three required readings, so it could clear the Senate Appropriations and Revenue Committee and the full Senate quickly on April 13 and/or 14.

Beshear urged the legislature to pass the medical-cannabis bill in those two remaining days, which would require suspension of the three-readings rule. "Its time has certainly come."  

He added, "Kentuckians deserve the passage of a medical-marijuana bill. They overwhelmingly support it. When 70-plus percent of a state is in favor of something, it's time for the General Assembly to step up and do something about it. Represent the people." 

Asked later if he could do anything by executive order to make it easier for people with certain conditions to have access to medical cannabis, Behsear said, "We're going to explore that. . . . I am for medical marijuana and I will continue to push it until we make it a reality." 

The House passed its cannabis bill, HB 136, by a vote of 59-35, with just over half of the Republicans who voted on the bill favoring it. A similar bill passed the House in 2020 but died in the Senate. 

Pharmacy benefit managers: House Bill 457 would ensure that patients could pick their pharmacy, instead of being required to use one affiliated with a pharmacy benefit manager; increase transparency between insurers and PBMs; and ban PBMs from retroactively denying a pharmacy claim after adjudication, commonly referred to as "clawing back." It passed the House 88-3.

Asked why the bill didn't gain any traction in the Senate after such overwhelming support in the House, Stivers said, "When it got here, we started getting, from business sector and provider sector, various questions and comments about what the overall cost would be to various plans." 

The bill was opposed by one of the session's heaviest lobbying campaigns. The Pharmaceutical Care Management Association, the PBM trade group, spent $38,369 to get its message to lawmakers before March, when it ran television commercials urging voters to ask their legislators to defeat it.  

Stivers said it had been assigned to the Appropriations and Revenue Committee "because it has potential fiscal impact -- local, individual, personal and state fiscal impact." He indicated that the bill would not pass, since that would require suspension of the three-readings rule, and more education would be needed among Republican senators about what it would do. 

Hero bonuses: Stivers said the General Assembly took a different approach to hero bonuses that he said would benefit everybody, mainly because it was too hard to determine just who would qualify for bonuses. He said the legislature is giving income-tax reductions and workforce incentives, and investing in  infrastructure and higher education. 

Gov. Andy Beshear

Beshear disagreed, reflecting on how scary it was early in the pandemic when the mortality rate from the virus was 10 percent in some places and essential workers were asked to show up at work every day.

"I believe this legislature needs to spend some of the last two days including hero bonuses. They deserve those hero bonuses. . . . I think it's really disappointing."

Health bills become law: Beshear signed three more health-related bills into law Thursday.

House Bill 525, sponsored by Moser, would allow Medicaid to pay certified community health workers. CHWs aren't trained medically, but are trained as patient advocates who come from the communities they serve. They help 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.

Senate Bill 10, sponsored by Sen. Robby Mills, R-Henderson, addresses the nursing shortage with both short-term and long-term solutions, including streamlining the process for out-of-state and foreign trained nurses to practice in Kentucky without compromising the standards of care; improving access to nursing education by removing "arbitrary" enrollment limits without compromising the quality of the programs; and adding term limits and geographic requirements for the Board of Nursing.

Senate Bill 105, sponsored by Sen. Max Wise, R-Campbellsville, will increase awareness and screenings for the cytomegalovirus (CMV), a virus that can cause childhood deafness and other health conditions. Most CMV infections are not diagnosed without newborn screening, resulting in missed opportunities for needed care. It is titled Bella Dawn Streeval’s Law, after a woman who died two years ago Thursday after suffering from CMV.

Latest bill to aid independent pharmacies stalls in Senate after running into one of the session's heaviest lobbying campaigns

By Melissa Patrick
Kentucky Health News

FRANKFORT – The latest bill to help independent pharmacies compete with pharmacy benefit managers sailed out of the House with overwhelming support but came to a resounding halt in the Senate. No one is saying why, but the PBMs mounted one of the session's heaviest lobbying campaigns.

PBMs determine what drugs are offered in insurance plans, where and how a patient gets their drugs, how much is paid for the drug, and how much the pharmacist gets. The leading PBM in Kentucky is CVS Caremark, a sister company to one of the nation's largest pharmacy chains.

House Bill 457 passed the House 88-3 on March 21, with 56 sponsors. The next day it went to the Senate Appropriations and Revenue Committee, not a usual location for such a bill, and never got a hearing. It has had none of its regularly required three daily readings, and only two legislative days remain. 

Key parts of the bill would ensure that patients could pick their pharmacy, instead of being required to use one affiliated with the PBM; increase transparency between insurers and PBMs; and ban PBMs from retroactively denying a pharmacy claim after adjudication, commonly referred to as "clawing back." Opponents say the bill would raise costs for consumers.

Rep. Steve Sheldon, R-Bowling Green

Republican Rep. Steve Sheldon of Bowling Green, the bill's prime sponsor, said he was surprised that it didn't move in the Senate after getting such overwhelming support in the House. He said he couldn't say why leaders of the Senate's Republican majority had not supported it, but did say that many big companies opposed it. 

Those companies' heavy lobbying efforts appear to have worked. 

The Pharmaceutical Care Management Association, PBMs' trade group, was one of the state's top 10 lobbying spenders in the first two months of the legislative session, spending $38,369 to get their messages to lawmakers, according to reports they filed with the Kentucky Legislative Ethics Commission.

That ranked the PCMA ninth in spending, and it seems likely to end the session at a higher rank, because it spent thousands of dollars from March 21 to April 1 on television commercials asking viewers to contact their legislators and ask them to vote against HB 457, saying it would raise drug prices.

Sheldon fought back on his Facebook page March 28, pleading with senators to consider the bill.

"I would appreciate the Senate looking at HB 457," he said. "We are down to 2-3 days … I realize bills that inject millions back into Kentucky and allow our seniors patient choice are not as glamorous as the status quo, but please take a real close look at this. Don’t let your Kentucky dollars get mandated by PBMs out of state while our seniors wait by the mailbox for their medicine !! Don’t believe the lies, propaganda and rhetoric. It’s not TOO late." 

The only group that appeared to spend money lobbying in favor of the bill through February was EPIC Pharmacies, a nonprofit buying group for independent pharmacies, which reported spending $7,416. Lobbying groups' spending reports for March are due April 15.

CVS Health reported spending $21,528 through February. In a statement dated March 21, it said, "House Bill 457 will only increase the costs of prescription drugs in Kentucky, making it more difficult for Kentuckians to access affordable medications. Dozens of Kentucky employers are opposed to this bill because it does not help control the cost of prescription drugs and hurts their employees. We urge the Senate to reject HB 457. We should protect consumers from increased health care costs, and lawmakers should focus on the high prices set by big drug companies."

The Kentucky Association of Health Plans, comprising companies selling health insurance in the state, reported spending $11,316 on legislative lobbying through February, and the Kentucky Association of Health Underwriters reported spending $5,000. Both spoke against the bill in a House committee. 

Individual insurance companies, which have a wide range of interests, also opposed the bill. Anthem Inc. and its affiliates reported spending $35,597 on lobbying in the first two months, ranking 11th; United Healthcare reported spending $14,000.

Senate Appropriations and Revenue Committee Chair Sen. Chris McDaniel, R-Ryland Heights, did not respond to several e-mails from Kentucky Health News asking why he did not give the bill a hearting. 

Angela Billings, spokeswoman for the Senate majority, said in an e-mail that she had reached out to McDaniel with the question and that it would have to be "tabled" until the General Assembly returns April 13 to reconsider bills and budget lines vetoed by Gov. Andy Beshear.

"I daresay that he was extraordinarily busy with the budget and could not get to many bills worthy of hearing," Billings said. 

Sen. Max Wise, R-Campbellsville, who has been instrumental in getting PBM-control bills passed in prior legislative sessions, said he didn't know why this one hadn't moved in the Senate, but said in a text message, "I do support the concept and the language of HB 457." Asked if it was discussed in Republican senators' private caucus, he said, "Policy discussions stay within the caucus."

Kentucky lawmakers have been working on PBM issues for years, most recently passing 2020 Senate Bill 50 to make the state hire a single PBM to manage Kentucky Medicaid's prescription-drug business of more than $1 billion a year. A 2019 state analysis found PBMs made $123 million through spread pricing.

During the bill's House hearing, Sheldon, a pharmacist and businessman who is not seeking re-election, said it had taken three years of collaboration to produce, with upwards of 20 organizations supporting it. Not all of them lobby.

Lobbying groups must list the bills on which they are lobbying, but not whether they are for or against them. Other than those above, those that listed HB 457, and their total expenses between Jan. 1 and Feb. 28, were: American Pharmacy Services Corp., $550; Appalachian Regional Healthcare, $10,209; Chewy Inc., $10,000; Ford Motor Co., $17,500; GE Appliances, $5,000; St. Elizabeth Healthcare of Northern Kentucky, 16,358; and University of Louisville Health, $6,000.

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.

Republicans end state of emergency by overriding veto, say Beshear can get one more month of extra food benefits from feds

By Melissa Patrick
Kentucky Health News

Kentucky's overwhelmingly Republican legislature has overridden Democratic Gov. Andy Beshear's veto of a resolution ending the Covid-19 state of emergency about one month early, resulting in a $100 monthly food assistance cut for 544,000 people. Legislators say he can get that money back another way. 

"It is my very clear understanding from reading the federal guidance that every governor across the state has the opportunity to extend the access to those additional benefits for a one-month period beyond the state's declaration of the end of emergency," Senate President Pro Tem David Givens of Greensburg, said during the Senate floor debate Monday.

Givens later added, "And if I'm not mistaken, I think 28 other states have ended their state of emergency and successfully received that one-month extension if they have so applied."

Beshear's office did not respond directly to questions about Givens' remarks, instead referring Kentucky Health News to Beshear's veto letter and a letter sent to every legislator Monday by S. Travis Mayo, general counsel to the governor, suggesting that they still disagree with this assertion. 

Beshear wrote in his March 16 veto message that "without the state declaration of emergency related to the Covid-19 global pandemic, the emergency SNAP Allotments will end." SNAP stands for Supplemental Nutrition Assistance Program, formerly called food stamps.

The counsel's letter said the emergency allotment requires "a State declaration of an emergency related to Covid-19." The legislature has barred Beshear from declaring another Covid-19 emergency without its OK.

State Sen. Donald Douglas

Presenting Senate Joint Resolution 150 for the override, sponsor Donald Douglas of Nicholasville said that when the emergency allotments go away, benefits will return to the normal level, and to suggest otherwise is "fearmongering."

"Ask yourself, should SNAP benefits be a way of life?" Douglas asked. "Now we know it is for some; should it be a way of life for adults? Just ask yourself that question.”

The resolution will cut the current monthly benefit of $243 by about $100.

Douglas did not answer Democratic Leader Morgan McGarvey's question about what restrictions are currently in place due to the state of emergency (there are none), but said, "Ending emergency is just as important to the psychological well being of our state as it is to anything else."

Addressing the presiding officer, the normal legislative custom, Douglas said, "This is really not about what restrictions, Mr. President, this is about the commonwealth moving forward." 

McGarvey replied, "Let's not play politics with this bill. Let's not put at risk the federal dollars needed by families and kids across Kentucky in all of our districts to make this point three weeks before the decision we set and made in January of this year," referring to the legislature's decision to end the state of emergency on April 14.

The Senate overrode the veto 25-8, along party lines. Five Republicans did not vote: Sens. Matt Castlen of Owensboro, C.B. Embry of Beaver Dam, Paul Hornback of Shelbyville, Alice Forgy Kerr of Lexington, and Adrienne Southworth of Lawrenceburg.

Several Eastern Kentucky senators said they were able to vote yes on the override because of the assurance that these food benefits could be obtained by other means. The region has some of the highest rates of SNAP participation, according to an interactive map by the Kentucky Center for Economic Policy. 

"I would normally vote no against this, but based upon the governor having the authority to extend this and nobody losing any benefits I'm going to vote aye," said Sen. Johnnie Turner, R-Harlan.

Sen. Brandon Smith, R-Hazard, said, "I believe wholeheartedly like many other governors that have shown leadership, this governor has the full authority within his wheelhouse to extend this past another 30 days."

Sen. Phillip Wheeler, R-Pikeville, said "This is a very simple fix that our governor could do. Our people deserve to move on from the state of emergency." 

Sen. David Yates, D-Louisville, encouraged his colleagues to vote no, saying passage of the resolution would impact "the weakest among us" and that the rationale for passing it is "purely political." Douglas has a primary-election opponent who has been an outspoken foe of pandemic restrictions, but Yates said the political motive is directed at Beshear.

“It makes me sick to my stomach,” Yates said, that Republicans are hurting people “for no reason whatsoever other than to take a political shot at the governor.”

Sen. John Schickel, R-Union, said, "I would admit that this bill is largely a symbol, but it's a very important symbol; the symbolism is we're ready to move forward." 

 

Sen. Ralph Alvarado, R-Winchester, said, "There is no more state of emergency here. What you have is legislators that are here today, asking us to tell the federal government that we still have one so we can get more money. That amounts to lying by some people's standards. I think that's wrong. . . . I don't think we should be asking for help when we're no longer needing it." 

The House overrode the veto of SJR 150 by a 68-16 vote with no discussion. The state of emergency will end as soon as Secretary of State Michael Adams signs it.

Senate sends House a bill to create a pilot program for treatment of offenders with mental-health or substance-use disorders

By Melissa Patrick
Kentucky Health News

A bill moving through the state legislature would create a pilot program to divert some qualifying low-level offenders away from jail and into treatment for substance-use disorder or mental-health issues.

State Sen. Whitney Westerfield

While getting his bill through the Senate March 18, Judiciary Committee Chair Whitney Westerfield said he had been working on the problem for several years when he realized, at an unrelated meeting about bail issues, that everyone there recognized the need to address behavioral-health issues among prisoners. 

"The long and short of it is this," he told his colleagues. "Everyone in the room, the most hard-nosed prosecutor, the most soft-hearted defense attorney, every judge at every level, everyone agrees that the vast majority of our prison population could benefit from some sort of behavioral-health intervention."

Westerfield's Senate Bill 90 would create a pilot program in at least 10 counties, determined by the state Supreme Court, that would require a mental-health and substance-use disorder assessment for low-level offenders.

If an offender qualified for the new Behavioral Health Conditional Dismissal Program, the prosecution and the defense attorney must agree for the offender to join it.

Charges against the offender would be deferred, meaning that the prosecution would be "set on the shelf," Westerfield said. Those who successfully complete the program would have their charges dismissed. 

To qualify, offenders can't be charged with a felony higher than Class D (punishable by one to five years in prison), and can't have a previous conviction for a higher felony. Also, those charged with violent offenses or sex offenses, among others, would not be eligible.

In addition to treatment, the program would have educational, vocational and recovery-housing supports. Westerfield said it's been said over and over that getting someone a job is the single most effective thing we can do to prevent offenders from committing another crime: "If we can keep them from coming back, we've saved us all a bunch of trouble and we've saved a future victim."

With some exceptions, the program must last at least a year and cannot exceed the person's maximum incarceration time unless the defendant agrees in writing to extend the treatment period. 

That's important, said Senate President Robert Stivers, a co-sponsor of the bill, who said he had also been working on the problem for several years.

"Every study you will read will say that a person is less likely to be a recidivist or a relapser once you get beyond a year," he said. "If you get them . . . some type of skills and training and a job, your likelihood of relapsing or recidivism even drops greater than that." 

Stivers added, "I don't know if it goes far enough or too far. But truly, if we're thinking about getting into changing the trajectory of people's lives, getting people back to work, getting them off the welfare rolls, medical assistance, Medicaid, this is an alternative that I believe we should try."

Sen. David Yates, D-Louisville, said the program has the potential to be "transformative to the Commonwealth of Kentucky," because a tough-on-crime approach often does not work for people with mental health or substance-use disorder issues. Yates is a lawyer, as are Westerfield and Stivers. 

"This is just an excellent step in the right direction to get people out of jail, into the workforce, into our economy and stopping this terrible cycle that we hear over and over again," Yates said. 

Sen. Robin Webb, D-Grayson, a lawyer who voted against the bill, asked who would have access to the mental-health evaluation that is taken within 72 hours of intake, often before the offender has an attorney. 

Westerfield said that would be medical information, so only the medical provider would have access to it unless the offender committed a crime during the assessment. He said he would be willing to adjust the bill in the House to ensure that the commonwealth's attorney does not have access to the assessment. 

SB 90 passed the Senate 27-4. In addition to Webb, Republicans Chris McDaniel of Ryland Heights, John Schickel of Union and Majority Floor Leader Damon Thayer of Georgetown voted no.

The bill is now in the House. It has a data-collection component to help determine its effectiveness. The program would begin in October and last four years unless extended or limited by the legislature.

Bill to reform public-assistance programs, including Medicaid, is approved by a committee and the House in the same day

By Melissa Patrick

Kentucky Health News

Legislation aimed at tightening Kentucky's rules for public-assistance programs passed out of committee and the full House just hours later on Thursday, with strong opposition from advocates and many Democrats and cries of "fear-mongering" from the prime sponsor. 

House Speaker David Osborne and Speaker Pro Tem David
Meade presented House Bill 7 in committee. (LRC photo)

“The only way that you would lose benefits in this bill is that you were either doing something that is illegal, or you are an able-bodied adult with no dependents that is not willing to participate in the work programs," House Speaker Pro Tem David Meade of Stanford said multiple times on the floor while presenting the bill.

Meade and other supporters of House Bill 7 said it aims to ensure that Kentuckians who are receiving safety-net services such as health and food assistance qualify for them, and to move more able-bodied Kentuckians into jobs, especially as extensions provided because of the pandemic phase out. 

A similar bill passed the House in 2020, but stalled in the Senate. Like last time, this bill is sponsored by Meade and  House Speaker David Osborne of Prospect. Rep. Melinda Gibbons Prunty of Belton in Muhlenberg County recently added her co-sponsorship to this bill. All are Republicans. 

The 27-page bill moved to the Senate on a 71-26 vote. Norma Kirk-McCormick, R-Inez, was the only Republican voting against the measure. 

The bill would require the Cabinet for Health and Family Services to apply for a federal waiver so Kentucky could require able-bodied adults without dependents to participate in at least 80 hours a month of qualifying "community engagement" activities to get Medicaid coverage if they have been enrolled in the program for more than 12 months.

"At this point, there's not a chance really that the Biden administration is going to approve" the application, said Dustin Pugel, senior policy analyst at the left-leaning Kentucky Center for Economic Policy. "There's Supreme Court precedent now against it. But that says nothing about what perhaps a future administration or future Supreme Court might decide." 

Anticipating rejection of the application, the bill would require the state to keep applying annually.

KCEP estimates nearly 200,000 people could lose Medicaid coverage, and tens of thousands of Kentuckians could lose Supplemental Nutrition Assistance Program (SNAP) benefits should HB7 pass.

 "If 200,000 Kentuckians lose Medicaid coverage because of HB7, fewer people will be able to go to the doctor for care. That could result in lost jobs at provider offices and more patients seeking uncompensated care in high-cost emergency departments," the Foundation for a Healthy Kentucky said in a statement opposing the bill.

"For the reasons outlined above, the foundation opposes HB7 as it is currently written and we urge legislators to oppose any new policies that would prevent Kentuckians from accessing care and food assistance," said the foundation.

HB 7 would also establish a Benefits Cliff Task Force to find ways to bridge the "benefits cliff" that results when a small change in income can cause a big loss of benefits. There is also language directing work on child-care assistance programs for people as their incomes increase above the current limits.

"The goal is to get those folks who are able-bodied adults with no dependents back out into the workforce and to assist them in that when we develop the bridge insurance program and the child-care assistance programs as well," said Meade. 

Rep. Lisa Willner, D-Louisville, told the House that she worries that the consequences of the bill will be different than the stated intentions and will result in people getting kicked off their benefits.

At the earlier Health and Family Services Committee meeting, Health Secretary Eric Friedlander estimated that the original bill would probably require the health cabinet to double its current workforce and would cost tens of millions of dollars to simply be able to answer the phones.

"I just think we have the potential for a real disaster situation," Friedlander said.

On the floor, Meade called this estimate "puzzling" because they had removed the most costly part of the bill and some of the work required of the cabinet would also be required by the federal government. He said that the rest of the bill is the same as the 2020 bill, which carried a cost estimate of $20 million, with $15 million of that to be funded by the federal government. 

Asked in committee what problems the bill is trying to solve, Meade said his goal is to reduce the number of ineligible people who are on Medicaid; to put both Medicaid and SNAP benefits on the same EBT card to eliminate any possibility of selling them; and to create a task force to develop a "bridge program" for people who make too much money for Medicaid, but not enough to purchase insurance and to work on the child-care gap to help people work.

Asked on the floor how many people are on the Medicaid rolls who shouldn't be, Meade said discussions with researchers at the University of Kentucky suggest that it could be upwards of 200,000 of the 1.6 million Kentuckians on Medicaid. 

Rep. Kim Moser of Taylor Mill, chair of the health committee, said "We're really trying to streamline and make sure that this is creating efficiencies and not creating barriers." 

Rep. Tom Burch, D-Louisville, scoffed at that: "It is not a bill to streamline our system. It's an evil bill. It's a bill that's going to hurt people."

In support of the bill in committee, Rep. Ryan Dotson, R-Winchester, said, "I think this commonwealth is long overdue with welfare reform and purging those out of the system that really don't need to be there. . . . I do believe this is a good first step." 

Speaking against the bill in committee, several advocates painted a picture of the challenges faced by people on public assistance. 

"I'm here to ask that we don't punish Kentucky's hardworking people who are in transition or trouble," said Mike Wynn of Grace Health in Eastern Kentucky. "Don't punish them for the few bad actors that abuse the system." Wynn said he had been a Kynector for seven years, helping people get health coverage. 

"This bill would make a very complex process even harder and nearly impossible for some," said Celine Mutuyemariya, a community policy strategist with the Louisville Urban League. "I urge the members of this committee to think about the very real consequences of this bill." She added that she has worked as a community health worker and Kynector in the past. 

Christina Libby, a certified community health worker and Kynector with the Homeless and Housing Coalition of Kentucky, said it's important to dispel the myth that everyone who is eligible for benefits are getting them or can get them easily. Further, she said it is an "unnecessarily complicated" process. 

"Getting help is already hard, very hard," she said. "It's a demoralizing and discouraging process." 

Kentucky Voices for Health provided lawmakers with a letter signed by 60 organizations and 64 constituents across the state stating their concerns about the bill.

Here are some key provisions related in HB 7 related to Medicaid: 

• After the federal government lifts the pandemic-era limit of the state's ability to disenroll individuals from Medicaid, the health cabinet would have 12 months to do a full audit of Medicaid rolls. 
• Medicaid coverage for treatment of substance-use disorder in prisoners, included in the 2020 budget, would be put into law. 
• The cabinet could not accept self-attestation of income, residency, age, household composition, caretaker or relative status or coverage for the purpose of determining Medicaid eligibility, except for residents of assisted-living and long-term care facilities. 
• The cabinet would have to use only the most recent income verification data available when determining eligibility.
• The cabinet could not make presumptive eligibility determinations, to approve someone for Medicaid before their qualifying paperwork is completed. 
• New rules would be established for for presumptive eligibility determinations by hospitals. 
• The attorney general, currently Republican Daniel Cameron, could bring action against the cabinet if he thinks provisions of the bill are not appropriately implemented.

Beshear signs more than 35 bills amid pandemic, many related to health care; physician assistants get limited prescribing power

By Melissa Patrick
Kentucky Health News

The Kentucky legislature continues to pass bills despite Gov. Andy Beshear's plea that it just pass a budget and anything related to the coronavirus, due to the social distancing needed to thwart it. He announced Saturday that he had signed more than 35 bills into law, many of them related to health.

“While all of us should be focused on responding to the coronavirus as the number of cases grows in Kentucky, I will continue to evaluate the dozens of bills lawmakers are passing and sign those I believe will benefit the people of the commonwealth,” he said in a news release. “While all of these issues could be addressed after we defeat the coronavirus, my staff and I will continue to look out for the best interests of all Kentuckians in deciding which bills should become law.”

Beshear, a Democrat, earlier rebuffed the request of Republican legislative leaders to call a special session after the threat abates, if they adjourned early. He said it might not be safe to call them back in time to pass a budget, which must be done by June 30. They plan to pass the budget and other bills April 1, and return April 14 to reconsider vetoed bills; he has vetoed two.

Here are some of the health-related bills Beshear signed:

Senate Bill 50, sponsored by Sen. Max Wise, R-Campbellsville, requires the state to hire a single pharmacy benefit manager to manage Kentucky Medicaid's $1.7 billion-a-year prescription drug business. This bill is designed to address many of the billing practices between pharmacy benefit managers and pharmacists, which pharmacists have long said are so unfair that they are putting some of them out of business.

House Bill 135, sponsored by Rep. Steve Sheldon, R-Bowling Green, gives physician assistants "modified prescriptive authority" for controlled substances in Schedules III, IV and V after they've practiced a year. Sheldon said all other states allow prescriptive authority for PAs and Kentucky will become the sixth state to place restrictions on them for Schedule II drugs, which includes a long list of narcotics used for pain management as well as several psycho-stimulants that are used treat attention deficit hyperactivity disorder, or ADHD.

SB 56, sponsored by Sen. Ralph Alvarado, R-Winchester, brings Kentucky law in line with the new federal law raising the legal age to purchase tobacco products, including electronic cigarettes, from 18 to 21. It also removes status offenses for youth who "purchase, use or possess" tobacco products, which are often called PUP laws. The bill allows the products to be confiscated and shifts the penalty to retailers who fail to adequately check buyers' identifications. The bill had an emergency clause so it became law upon Beshear's signature.

SB 42, sponsored by Sen. Denise Harper Angel, D-Louisville, requires any student identification badge issued to a public middle- or high-school student to contain the contact information for national crisis hotlines specializing in domestic violence, sexual assault and suicide. This contact information must also be on all IDs issued by public or private postsecondary education establishments. This information must be included on the IDs beginning Aug. 1.

SB 60, sponsored by Sen. Jimmy Higdon, R-Lebanon, adds spinal muscular atrophy, also referred to as SMA, to the list of  required tests run on infants for heritable disorders. Early diagnosis of this genetic disease helps babies receive treatment when it is most effective. Including SMA, Kentucky will now do 60 newborn screenings. Alvarado said at the bill's Jan. 29 committee hearing that this condition affects five or six Kentucky babies each year. 

SB 82, sponsored by Sen. Julie Raque Adams, R-Louisville, establishes the Kentucky Eating Disorder Council to oversee development and implementation of eating-disorder awareness, education and prevention programs. It will also identify strategies for improving access to adequate diagnosis and treatment services. and make recommendations on legislative and regulatory changes. Adams said 900,000 Kentuckians, including nearly 30,000 children, have been diagnosed with an eating disorder but the state has no residential, partial-hospitalization or acute-care programs.

SB 134, sponsored by Sen. David Givens, R-Greensburg, establishes the Optometry Scholarship Program with a trust fund supplied by state appropriations (determined with each biennial budget) gifts, grants, and federal funds. A minimum of one-third of the amount appropriated for scholarships must go to eligible students at an in-state institution -- a boon to the University of Pikeville's Kentucky College of Optometry, the state's only optometry school.

SB 125, sponsored by Sen. Tom Buford, R-Nicholasville, allows the Kentucky Board of Medical Licensure to determine the allowable scope of practice for athletic trainers in Kentucky, particularly related to their training. This bill has been in the works for about 10 years.

HB 153, sponsored by Rep. Kim Moser, R-Taylor-Mill, establishes a mental-health first-aid training program to show people how to best meet the needs of someone in a mental-health or substance-use crisis. Funding will come through a trust supplied by state and federal appropriations, grants and private donations. Advocates' hope is that this training will become as common as CPR.

Beshear had already signed several other health-related bills into law, including:

HB 129, sponsored by Moser, will overhaul the state public-health system, including how health departments are funded and how they prioritize their resources.  It is called the public health transformation bill. It was fully funded in the House budget but falls about $9.4 million short in the Senate's proposal, according to Randy Gooch, director of the Jessamine County Public Health Department. HB 129 is part of a three-phase approach submitted in the state House to create a sustainable solution to local health departments' pension-driven financial crisis.

SB 122, sponsored by Adams, modifies Tim's Law of 2017, which allows judges to order assisted outpatient treatment for people who have been involuntarily hospitalized at least twice in the previous year. SB 122 would make that two years. The goal of Tim's Law is to stop the revolving door of these individuals in and out of jails and state psychiatric hospitals, allowing more participants. The law is named for Tim Morton of Lexington, who was hospitalized involuntarily 37 times by his mother because it was the only way she could get him the psychatric treatment he needed. He died in 2014.

HB 99, sponsored by House Speaker David Osborne, R-Prospect, authorizing a $35 million state loan to the University of Louisville to support its recent acquisition of Jewish Hospital and other Louisville health-care facilities.

House Concurrent Resolution 5, sponsored by Rep. Danny Bentley, R-Russell, asks the federal government to expedite research on the safety and efficacy of medical marijuana. A House-passed bill to make marijuana legal medicine in Kentucky has gotten nowhere in the Senate. 

Three anti-abortion bills advance out of legislative committees

Three abortion bills advanced in the legislature last week, one to give the state's attorney general more power to enforce abortion laws, one to require fetal remains to be buried or cremated after the procedure, and one to give the state auditor power to audit reports about abortions.

Abortion-rights supporters dressed as characters from "The
Handmaid's Tale" at the  March 4 House Judiciary committee,
which passed two abortion bills. (Photo by Melissa Patrick) 

House Bill 370, sponsored by Rep. Nancy Tate, R-Brandenburg, would require abortion providers to either cremate or bury aborted fetuses in a licensed funeral facility. Parents could also decide the final disposition of the fetal remains.

“The abortion provider currently has to provide for the disposal. This is merely directing respectful disposal as opposed to being incinerated with other medical waste,” Cathie Humbarger, an abortion opponent with Northeast Indiana Right To Life, told the House Judiciary Committee March 4.

HB 370 is similar to a 2016 Indiana law that was upheld by the U.S. Supreme Court last year.

No one spoke against the bills, though abortion-rights activists sat in the audience wearing white bonnets and red robes like characters from "The Handmaid's Tale," the dystopian novel and award-winning Hulu show in which women are treated as property of the state and forced to bear children. 

The committee also approved House Bill 451, sponsored by Rep. Stan Lee, R-Lexington, would expand the power of Attorney General Daniel Cameron, an anti-abortion Republican, to regulate abortion facilities, including bringing injunction relief as well as civil or criminal penalties for violations.

Current law only allows the attorney general this power if it requested by the Cabinet for Health and Family Services, which licenses and inspects health facilities.

"Several committee members expressed concern about expanding these powers, with Rep. Maria Solaris, D-Louisville, asking about the potential for a "rogue attorney general." Lee said the courts could handle such problems," Deborah Yetter reports for the Louisville Courier Journal. 

Cameron is the first Republican to hold the office since 1947, and "many of his staff members worked in former Republican Gov. Matt Bevin's legal team, defending abortion restrictions in several high-profile legal battles and attempting to close the state's only abortion facility," Ryland Barton reports for Louisville's WFPL.

Since taking office in December, Democratic Gov. Andy Beshear has ended the state's licensure battle with abortion providers and allowed Planned Parenthood of Indiana and Kentucky to offer abortions in Louisville.

Tamarra Wieder of Planned Parenthood told Yetter that the group chose to remain silent after members were cut off from speaking at a recent hearing on another abortion bill, with the chairman saying the committee was out of time.

"Today was a statement about how we've been treated in the past," said Wieder, the organization's public affairs and policy director. "It's a statement on the power grabs that are taking place around Kentucky on reproductive health."

Kate Miller, with the American Civil Liberties Union of Kentucky, told Yetter afterward that her organization also opposes both bills as "a continuing effort to force every Kentuckian to stay pregnant against their will."

State Auditor Mike Harmon and Rep. Stan Lee present Lee's
bill to let the auditor audit abortion reports. (Melissa Patrick photo) 

House Bill 391, also sponsored by Lee, would  expand the state auditor's powers to audit reports about abortions, including audits of whether facilities that perform abortions are following state requirements to report all abortions to the state Office of Vital Statistics.

It was approved March 5 by the House Health and Family Services Committee.

Yetter reports in a separate article that the bill prompted "heated debate, largely along party lines, about it's true purpose."

"Rep. Tom Burch, D-Louisville, questioned whether the measure is a Republican "method of harassing providers" by the party of Ronald Reagan, the president who argued for smaller government.

Lee said it is to ensure abortion statistics are being reported accurately, citing Reagan's famous "'trust but verify' comment about nuclear disarmament with the former Soviet Union," Yetter writes. Lee said, "I would like to think that this piece of legislation is verifying abortion providers who are taking the lives of unborn babies are complying with the law."

Several Democratic women on the committee questioned why abortion clinics, already regulated by the health cabinet, would fall under the purview of the state auditor; one questioned why the auditor, whose main role is to ensure proper use of public funds, was being called to audit facilities that get no state money; another asked Lee and state Auditor Mike Harmon what other private entities his office investigates, and got no direct answer.

Yetter writes, "State law requires any facility where an abortion is performed to report information including the age, race and state of residence of the patient; age in weeks of the fetus; and the type of abortion, such as surgical or by medication. It does not include reporting any identifying information regarding the patient."

An annual report required by law shows that 3,203 abortions were reported in Kentucky in 2018, 18 of them at hospitals and the rest at EMW Women's Surgical Center in Louisville, the state's only abortion clinic.

Jackie McGranahan of ACLU-Kentucky, spoke against the bill, saying she believed it was part of an effort "to make abortions inaccessible to all Kentuckians."

This prompted Rep. Robert Goforth, R-East Bernstadt, to suggest strongly that McGranahan violated the oath she took to tell the truth before testifying. When McGranahan tried to reply, Goforth cut her off more than once before saying "That's your opinion."

Tamarra Wieder of Planned Parenthood, told Yetter that the bill is part of an ongoing effort by the legislature to erode reproductive rights and to expand authority over abortion. "It is a chilling prospect for the future of abortion in Kentucky," she said. At least eight anti-abortion bills are being considered in this legislative session.

House passes bill to loan money to struggling rural hospitals; funding is still in the works, but sponsor appears confident

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Spurred to action when the hospital in his county said it was closing, state Rep. Danny Bentley filed a bill to create a loan program for financially distressed rural hospitals. It went from the House to the Senate without dissent Feb. 28, and Bentley voiced confidence that it will be funded.

Rep. Danny Bentley

House Bill 387 would allow the state Cabinet for Economic Development to provide loans to struggling hospitals for three purposes: to maintain or upgrade their facilities; to maintain or increase staff; or to provide health-care services not currently available.

Loans could run 20 years and would be available to hospitals in counties with fewer than 50,000 people.

Bentley, R-Russell, said more than 60 hospitals would qualify for the loans, and 13 of them are vulnerable to closure. One is already closing: Our Lady of Bellefonte Hospital in his home town, a Greenup County suburb of Ashland.

Most questions about the bill dealt with funding. Bentley told Kentucky Health News that it will be funded. The next day, he said that while funding details are still in the works, "Let's put it this way: It's too important not to be funded."

The bill has a powerful co-sponsor, House Speaker David Osborne, R-Prospect. He told The Associated Press that funding could come from state bonds.

“It's the goal to help turnarounds when turnarounds are possible," Osborne told reporters. “That doesn't mean that we can save every hospital that is failing, just like we can't save every business that's failing. But there are some, when given the opportunity, that can succeed, and that's our goal ... to help those that can."

Osborne told the AP that the idea stems from discussions about the state's proposed $35 million loan to the University of Louisville to help it buy Jewish Hospital and other KentuckyOne Health facilities that were at risk of closing. He said concerns were voiced about how the state could also help struggling rural hospitals. The House has passed HB 99, which would approve the loan.

On the House floor, Bentley pointed to the closing of the only hospital in his county as an example of how devastating the loss of a rural hospital can be. Our Lady of Bellefonte will close on April 30, according to a press release from the Catholic group that owns it.

Bentley said that will kill about 1,000 jobs and about $700,000 in annual tax revenue, and make care less accessible. He added, "If they close a rural hospital on us, they will never re-open them. So we've got to be concerned."

If passed and signed into law, HB 387 would take effect immediately. Many rural hospitals in Kentucky are struggling to keep their doors open.

Kentucky Health News reported in October that a Navigant Consulting Inc. study concluded that 16 of Kentucky's rural hospitals, or about one-fourth of the total, are at high risk of closing unless their finances improve. Another study at the University of North Carolina said eight rural Kentucky hospitals are at high risk of financial distress and 23 more are considered to have mid-high risk. The Kentucky Hospital Association, using 2017-18 data, concluded that 35 of the 70 hospitals it considers to be rural are in poor financial health, with 14 of them "very vulnerable." The numbers vary because the studies measure financial distress differently.

Five rural Kentucky hospitals have closed since 2009, four of them since 2014, according to a UNC report.

Bentley said one reason rural hospitals struggle to make ends meet is because most of their patients are on Medicare or Medicaid, which pay less than the full cost of care.

But that's just part of the problem. The Navigant report pointed to other issues, including: a shift from inpatient to outpatient care, which has left hospitals overstaffed and underused; shrinking populations that tend to be older and poorer, meaning that there are more Medicaid and Medicare patients; and not enough money in their budgets to invest in updated, innovative technology.

The hospital association also says changes in federal reimbursement policies have also hurt Kentucky hospitals. It supports Bentley's bill.

KHA President Nancy Galvagni said in an e-mail. "We do not expect HB 387 to be a panacea for the challenges facing some rural hospitals, but it will be an important support for both the hospitals and for our rural communities." She added, "Kentucky’s hospitals are not just buildings where people seek health care; they are also crucial economic players in our communities across the commonwealth."

House passes medical-marijuana bill, 65-30, after specifying illnesses for its use; Senate passage remains much in doubt

Photo illustration from MedicalMarijuana.com

Kentucky would be the 34th state to make marijuana legal for medicinal purposes, under a bill the state House passed Thursday by a vote of 65 to 30. The long-debated proposal has never gotten this far before, and it probably faces a tougher go in the Senate.

"The bill’s sponsor, Republican Jason Nemes of Louisville, and co-sponsor, Democrat John Sims of Flemingsburg, faced opposition from socially conservative lawmakers who are philosophically opposed to any legislation that could expand the legal use of marijuana and fear that a push to legalize recreational use of the drug would come next," reports Daniel Desrochers of the Lexington Herald-Leader.

“I hope it doesn’t, but you know it’s going to come,” said Rep. Stan Lee, R-Lexington, in a debate that lasted more than an hour. “If you lift the tent up a little and let the nose in, it's not going to stop.”

Nemes tried to address such concerns by having Dr. Jeffery Block, a University of Miami anesthesiologist, "testify in committee that the bill would contain enough regulations to prevent it from being abused," Desrochers points out. "The bill is intended to only allow edibles or pills — it prohibits smoking the marijuana — and forbids colorful packaging that could attract children. It does not allow people to grow marijuana in their homes, but does allow for sale of the marijuana flower, which is often used to smoke."

"The bill would allow doctors to prescribe marijuana for a list of conditions yet to be determined by a panel of 13 people — eight doctors, a pharmacist and four public advocates," Desrochers notes. One of the mostly minor amendments that the House added to the bill "ensured that the list of conditions would include chronic pain, epilepsy, multiple sclerosis and nausea or vomiting. All of those conditions have substantial or conclusive evidence that they are effectively treated by marijuana, according to Block."

Nemes told the House, “House Bill 136, if it is passed, would be the tightest medical marijuana bill in the country.” But Rep. Danny Bentley, R-Russell, a pharmacist, "peppered Nemes with questions about the bill and raised concerns that medical marijuana would not be regulated" by the U.S. Food and Drug Administration," Desrochers reports. "Supporters said the bill would help ease the suffering of many Kentuckians."

The bill would “bring relief to many citizens in this commonwealth,” said Rep. Patti Minter, D-Bowling Green.

"All but two Democratic members of the House voted for the bill, as did a slight majority of the Republican members present," notes Joe Sonka of the Louisville Courier Journal. The bill got more votes from Democrats (34) than from Republicans (31) in a House that has a strong Republican majority; that count could hurt its prospects in the even more strongly Republican Senate.

Senate President Robert Stivers has said more research is needed to prove marijuana's medicinal value, but more recently he said the bill has a "narrow path" to passage in the Senate. “It’s a balancing test of do the goods outweigh the bads,” he said. “And we just haven’t had anything done on that.”

"The renamed Department of Alcoholic Beverage and Cannabis Control would implement and regulate the new state program," Sonka notes. At least 25 medical-marijuana dispensaries would be set up around the state. Federal law prohibits pharmacies from selling marijuana, even in the states that have legalized it for medical use.

Read more here: https://www.kentucky.com/news/politics-government/article240477986.html?utm_source=pushly&intcid=pushly_484855#storylink=cpy

Read more here: https://www.kentucky.com/news/politics-government/article240477986.html?utm_source=pushly&intcid=pushly_484855#storylink=cpy

Health departments get another year before pension hikes kick in, but some are already raising taxes in anticipation

By Melissa Patrick
Kentucky Health News

While local health departments are more than grateful that legislation passed in the recent special legislative session gives them another year to manage their looming pension crisis, several counties have already asked for a tax increase as a way to help pay for it.

The Kentucky Department of Public Health said in an email last week that it had received 63 of this year's 113 county tax resolutions and so far 10 counties have asked for a higher rate. Of those, the department said board minutes show that Boone, Boyd, Campbell and Kenton discussed the increase in the Kentucky Retirement System cost prior to voting on the tax rate.

"However, the other six counties mentioned in their board minutes there was a discussion, but did not mention in the minutes details of the discussion," the email said. They are Leslie, Muhlenberg, Ohio, Union, Wayne and Webster counties.

The new law, written and signed by Gov. Matt Bevin, freezes the pension cost of health departments for another year, at 49 percent of payroll, avoiding an increase to 83 percent.

That gives them one more year to decide whether to stay in the state retirement system, with an increase in their pension contribution to 83% of payroll, or leave it -- and either pay a lump sum equal to their projected pension liabilities, or pay it off over the next 30 years in installments.

Allison Adams, director of the Buffalo Trace District Health Department, which includes Mason and Robertson counties, explained that the state has a cap of 10 cents per $100 property value for health taxing districts, and some counties have set this cap even lower through referenda.

Adams, who is also the president of the Kentucky Public Health Association, said it is a fallacy to believe that health departments can simply double their tax rate to pay for their pension obligations, as some legislators have suggested.

Using Robertson County as an example, she said the tax rate there is already set at 8 cents per $100 property value, which would allow it to request 2 more cents per $100 property value, which she said would bring in about $90,000.

But that's not enough to make any real difference, since the cost of one clerk and one nurse in that department, figuring 83% of payroll for their pension, is $175.207 -- an amount that does not include any other costs for required programs and services, Adams said.

"For those who have the tax base, it would help them," she said. "But for those who don't, it wouldn't help."

And for those counties that are levying the maximum tax rate and still don't have enough resources, even after whittling down their staff, to deliver only core and statutorily required services, Adams said, "The next thing to do is to cut services."

The Anderson County Health Department  increased its tax rate in June to help pay for the pension increase that was set to kick in on July 1, but has since been delayed until next year. But the county Board of Health rescinded a portion of the requested 75% increase, reducing it from 52.5 cents per $1,000 in assessed property value to 47.5 cents, which represents a 58% increase from the original rate of 30 cents per $1,000, Ben Carlson reported on June 19 for The Anderson News.

Public Health Director Tim Wright made the request to lower the rate at a specially called meeting after discovering he had made a mistake in his request, explaining that he was unaware that the spreadsheet he used to build his annual budget already included the increase for pension costs, so when he computed his figures the pension had been added in twice, Carlson reported.

The new rate will keep the department from tapping into its reserves to pay the looming pension costs. The new rate will generate about $230,000, and $140,000 of that will go into pension funding, according to documents provided by Wright, Carson reports. Wright said that this is the county's first rate increase in about 20 years.

J Smith, the public health director of Garrard County Health Department, told John Cheves at the Lexington Herald-Leader: “The only reason we came in under budget this year is because of all the cuts we made. But we can’t keep doing that, we’ve done all we can do there,” Smith said. “I told our Board of Health that if we want to keep the services we have left, we’re going to have to have a tax increase.

Chris Crum, public health director at Greenup Health Department, told Rachel Adkins of The Daily Independent in Ashland that because Greenup County raised its health tax last year, it was no longer at risk of closing because of the looming pension costs.

Another challenge is that some counties don't have a separate taxing district to finance their health departments, Melinda J. Overstreet reports for the Glasgow Daily Times.

Barren County Judge-Executive Micheal Hale told Overstreet that Barren is one of three counties in the eight-county Barren River District Health Department that does not have a separate taxing district for health, and without that the county is fiscally responsible for its funding. The county's health department is one that the state health department put on a list that were at risk of closing within 12 months if they didn't get a reprieve from the bigger pension obligation.

Hale told Overstreet that an overnight jump to an 83% contribution would require the county to contribute well over $1 million, which he said would be "catastrophic" for the county's budget. He added that after the final budget is decided, he would ask the committee to look into the possibility of a health taxing district.

Depending on local tax dollars to fund public health would result in huge inequities, said Scott Lockard, director of the Kentucky River District Health Department, which covers some of the state's poorest and unhealthiest counties.

"Communities that need public-health services the most, that have the highest poverty rate, that have the poorest health outcomes, also have the least ability to raise local revenue," Lockard told Kentucky Health News in June.

Adams pointed out  that counties with high property values could raise their tax by 0.5 cents and generate more revenue than a county with low property values that double their rates.

With legislative session more than half over, most health-related bills are still on the table; here's a roundup

For KHN's complete chart of health bills, click here.

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Most health-related bills in the legislative session appear to be driven by the state's opioid epidemic, tort reform and issues of health-care providers, but only a bill that addresses organ donation has gone to the governor, and the session is more than half over.

If signed, House Bill 84, sponsored by Republican Rep. Lynn Bechler of Marion, would require coroners and medical examiners to contact the Kentucky Organ Donor Affiliates if they know that a decedent wishes to be an organ donor. The current law only requires hospitals to contact KODA when an organ donor dies.

The bill, called "Courtney's Law," is named for Courtney Flear of Princeton, an organ donor who was killed in an automobile accident in 2015, but because of the wording of the current law her organs were not donated despite her wishes, according to Bechler's legislative update.

The opioid epidemic in Kentucky rages on, prompting lawmakers to push for bills to curb it.

Two bills are aimed at early intervention and prevention in schools. HB 55, sponsored by Rep. James Tipton, R-Taylorsville, calls for the creation of an age-appropriate curriculum on drug abuse and prevention that would be taught in every school. HB 3, sponsored by Majority Floor Leader Jonathan Shell, R-Lancaster, would require drug education as part of an "essential skills" program. Both have passed the House and are in the Senate Education Committee.

HB 246, sponsored by Rep. Danny Bentley, R-Russell, would expand access to medication-assisted therapies for treatment of substance-abuse disorders by bringing a grant-funded pilot program to the state that allows pharmacists to administer non-controlled MATs. This bill awaits a floor vote in the House.

Rep. Addia Wuchner, R-Florence, has several bills that address the opioid epidemic. HB 364 would require all pregnant women to be tested for hepatitis C, with the results added to the child's records. It also recommends that the child be tested at 24 months if the mother tests positive. Hepatitis C can be transmitted from mother to baby during childbirth. Most new cases of hepatitis C are a result of illegal intravenous drug use. This bill awaits a floor vote in the House.

Wuchner is also the sponsor of HB 148, which shifts ownership of controlled substances from a deceased hospice patient to the hospice program for disposal. Currently these drugs belong to the estate. This bill has passed the House and is in the Senate Health and Welfare Committee.

Another Wuchner bill, HB 124, calls for a comprehensive review of all state substance use disorder programs and services, and would require the state to only pay for and licence ones that follow nationally recognized evidence based protocols.

Bills for tort reform are also moving in the Republican-led legislature, with votes largely split along party lines.

HB 4, sponsored by Wuchner, would keep doctors' reviews of other doctors from being used in medical-malpractice lawsuits. It has passed the House and a Senate committee and awaits a vote in the full Senate.

Senate Bill 2, sponsored by Sen. Ralph Alvarado, R-Winchester, would limit the amount of non-economic damages that could be awarded in personal-injury and wrongful-death lawsuits. the bill is a proposed constitutional amendment, requiring a three-fifths vote in each chamber and approval by a majority of voters in a statewide referendum at the November election. It is awaiting a vote on the Senate floor, but has been passed over seven times since Feb. 14.

SB 20, also sponsored by Alvarado, would do several things, including limiting attorney fees in malpractice cases, add a requirement for a sworn statement from a doctor saying that a lawsuit has merit before it could proceed, and keep apologies or expressions of regret made by a provider from being used in a lawsuit. This bill also awaits a Senate floor vote.

Insurance and provider-issue bills are also quite prevalent, as usual.

SB 5, sponsored by Sen. Max Wise, R-Campbellsville, which would put the state back in charge of its Medicaid drug program, came about because he said pharmacy-benefit managers hired by the state's Medicaid managed-care organizations, are not paying Kentucky's independent pharmacies a fair price for their drugs -- which is putting them at risk of closing. It also calls for more transparency. This bill has passed out of committee and awaits a vote on the Senate floor.

Other states are also dealing with this issue. The Arkansas Pharmacist Association held a news conference Feb. 21 and revealed that CVS Caremark paid their CVS locations an average of $60 more per prescription than they paid their local independent pharmacies. CVS Caremark is the pharmacy benefit manager for four of Kentucky's five managed-care organization.

A bill in the Senate that is getting some pushback from consumer groups is HB 191, which would restrict the growing practice of online eye examinations. This bill, sponsored by Rep. Jim Gooch, R-Providence, is in the Senate Health and Welfare Committee.

Other bills in this category would improve telehealth access and payment to providers; update state guardianship laws; increase access to autism benefits; improve some of the administrative challenges around managed-care organizations; change how hospitals are paid for charity care; and require ambulance providers to disclose fees, among other things.

HB 64, sponsored by Rep. Stan Lee, R-Lexington, would allow eligible veterans to use hyperbaric oxygen treatment for treatment of traumatic brain injuries. This treatment is currently not covered by insurance, and the bill would not require insurance to cover it. It awaits a vote in the full Senate.

Children's health: Several of the health-related bills are aimed at improving the health of the state's children.

HB 318, sponsored by Rep. Kim Moser, R-Taylor Mill, and and SB 51, sponsored by Alvarado, would require school properties and school events to be tobacco-free. Both are sitting in their respective education committees. Alvarado has said the House needs to pass its bill first, since the Senate passed a similar bill last year but the House didn't take it up. A recent Kentucky Health Issues Poll found that 87 percent of Kentucky adults support such a law.

In the wake of a 2016 Kentucky Incentives for Prevention survey that found one in 12 of Kentucky's high-school sophomores said they had attempted suicide, HB 30, sponsored by Rep. Regina Huff, R-Williamsburg, would require educators to have two hours of in-person suicide prevention training every other school year. Current law requires a minimum of two hours of self-study every year. This bill unanimously passed the House and is in the Senate Education Committee.

Other education-related bills would require abstinence until marriage to be taught in sex-education classes, set guidelines around training for seizure disorders; and require automated external defibrillators in every school with three trained employees. Another youth-safety bill would require children under the age of 12 to wear a bicycle helmet.

Taxes and budget: In addition to the many health-related bills on the table, the Coalition for a Smoke-free Tomorrow, comprising nearly 150 organizations trying to decrease smoking in the state, is lobbying hard to raise the cigarette tax by $1, to $1.60. They say this proven tactic would not only decrease the number of teen smokers by more than 23,000, but would also cause 29,000 adults to quit smoking. Smoking is the leading cause of lung cancer in Kentucky and is also responsible for one-third of all cancers in the state.

Advocates of the tax also say it would ease the state's revenue shortage. The House is expected to release this week its version of the proposed budget for the next two fiscal years. Republican Gov. Matt Bevin proposed to eliminate funding for more than 70 programs, including five for cancer screenings and research, and local health departments are warning that adding $38.5 million to their pension liability will result in significant cuts to their programs and overall staffing if they don't get any relief.