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. 

Legislature passes bill to support state response to covid-19; includes many suspensions and changes in health-care rules

Rep. Patti Minter, D-Bowling Green, wears a mask as she uses her phone on the House floor during a recess. At right is Rep. Chris Fugate, R-Chavies. (Kentucky Health News photos by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill supporting and enhancing Gov. Andy Beshear's executive orders to address the coronavirus pandemic passed without dissent in both chambers of the legislature Thursday, with a caution that more measures will likely be needed.

"Things evolve as we know day to day on this issue, and I'm sure there will be more needs," Sen. Ralph Alvarado, R-Winchester, said in describing the bill. Senate President Robert Stivers told Kentucky Health News that this is likely the first step of many to address this issue, and Senate Democratic Leader Morgan McGarvey of Louisville, said,  "This a good bill and it's a good start."

Senate Bill 150, generally called the "Covid-19 relief bill," was gutted of its original language about surprise medical billing and amended to offer relief on several fronts for covid-19 response.

The bill has several health-care provisions, including one to make it easier for providers to serve patients through telehealth, including one to allow out-of-state providers to practice telehealth in Kentucky.

It also clarifies language on what is considered emergent or urgent care, stating that a health-care procedure can be performed it it meets this criteria. It also allows services like physical therapy, occupational therapy, or alcohol- and drug-abuse treatment to be administered if they are ordered by a physician licensed in Kentucky.

Those provisions are in response to Beshear's order for medical facilities and providers to cease all elective procedures as a way to keep hospital beds available and preserve personal protective equipment.

The bill also has provisions aimed at expanding the state's health-care workforce.

For example, it allows the state Board of Medical Licensure, the Board of Emergency Medical Services and the Board of Nursing to waive or modify licensure or certification requirements for health-care providers who are licensed or certified in other states to provide those services in Kentucky.

It also relaxes the scope of practice requirements to allow health-care providers to practice in all settings of care; allows physicians to supervise a larger number of other providers and to do it by telephone; allows rapid certification, licensing, re-certification or re-licensing of providers; allows medical students to care for patients under a provider's supervision; and allows reactivation of licenses for inactive and retired health-care providers so that they may render service.

The bill also provides immunity for health-care providers who render care in good faith to covid-19 patients during the state of emergency, as well as immunity for Kentucky businesses acting in good faith to make or provide personal protective equipment or personal-hygiene supplies related to covid-19, and that don't make or provide such products.

A time of crisis

The bill passed on a day that Kentucky reported 50 new cases of covid-19, its largest one-day increase so far, for a total of 248. It also came at a time that Beshear warns the public daily that the next few weeks are expected to get worse.

“The next two to possibly three weeks is gonna be absolutely critical in our battle against the coronavirus,” Beshear said at his daily press conference March 25, repeating the point several times.

Rep. Terri Branham Clark, D-Catlettsburg, also wore a mask.

The bill also has provisions to help those who have lost their jobs or have had their hours decreased because of covid-19. It waives the seven-day waiting period for unemployment benefits, extends benefits to those who are self-employed, and allows those who were not let go, but simply had their hours cut back, to also apply.

"The number of workers who filed for unemployment jumped to 48,847 from 2,785 the week before, according to non-seasonally adjusted figures from the Labor Department," Alfred Miller reported March 26 for the Louisville Courier Journal.

Among other provisions, the bill also extends the state deadline for filing income taxes to be the same as the new federal deadline, July 15, and removes all penalties and interest that could result from such extensions; permits restaurants with a license to sell alcoholic beverages in conjunction with takeout food orders; authorizes funds to support the state's covid-19 hotline; and extends the length of time government entities have to respond to an open-records request to 10 days, from three.

The bill also:

• Allows the governor to direct the suspension or waiving of the collection of licensing fees, renewal fees, application fees, and other administrative requirements where they are required by the state. Licensees may continue working without interruptions, and shall be granted at least 30 days after the expiration of the state of emergency to pay any fees or complete any administrative obligation before any action is taken.
• Allows a public agency to delay on-site inspections during the emergency. Public agencies may conduct their meetings by live audio or live video teleconference, with information on how the public and media can access the meeting.
• Suspends deadlines related to land use, planning and zoning, and deadlines for code enforcement proceedings and hearings.
• Allows taxing districts to suspend or otherwise extend applicable deadlines.
• Suspends the rule that a notary certify a signature after face to contact, if they can communicate via a video teleconference in real time.
• Requires Beshear to declare when the state of emergency has ceased, and if he has not done so by the first day of the next regular legislative session, the General Assembly may make that determination.

The report from the House-Senate conference committee that wrote the bill points out that its actions "are not statements of approval or disapproval relative to any executive order or action," but are necessary to support Beshear's actions during the state of emergency because the General Assembly is  responsible for creating or modifying law and for creating policy.

Asked as the bill was nearing passage what he needed from it, Beshear said, "I need maximum flexibility. We are living this battle and we are fighting it day by day. I need the maximum amount of financial flexibility. I need the maximum amount of flexibility if we have to take more restrictive steps. We need the flexibility to be able to move very fast to work with local governments … and local law enforcement when needed."

The bill has an emergency clause, which means it will become law as soon as Beshear signs it.

Opioid epidemic keeps shadowing Ky. policy, as Senate removes opioids from list of drugs physician assistants could prescribe

By Melissa Patrick
Kentucky Health News

A House bill to let physician assistants prescribe some highly regulated drugs is moving through the Senate, but without application to some highly addictive drugs like oxycodone and hydrocodone, showing how the opioid epidemic continues to influence state health policy.

Rep. Steve Sheldon presents House Bill 135 at the March 3
meeting of the Senate licensing and occupations committee.
(Photo: Legislative Research Commission Public Information)

As amended by a Senate committee March 3, House Bill 135, sponsored by Rep. Steve Sheldon, R- Bowling Green, would allow physician assistants "modified prescriptive authority" for controlled substances in federal Schedules III, IV, and V after the PAs have practiced for a year.

The Senate Licensing, Occupations and Administrative Regulations Committee removed Schedule II drugs, which include a long list of narcotics used for pain management as well as several psycho-stimulants that are used to treat attention deficit hyperactivity disorder, or ADHD -- a condition for which Kentucky has the highest rate in the nation.

Sen. Chris McDaniel, R-Taylor Mill, told the committee that he would not have voted for the bill if the Schedule II drugs had not been removed. He warned, "Know if we come back for Schedule II next year, I will oppose it as vigorously as possible."

McDaniel acknowledged that only a few PAs would likely abuse their Schedule II prescriptive authority, but said that isn't worth the risk because it was only a small percentage of physicians that not so long ago flooded the state with pain pills.

"The damage that they did was monstrous and we're still working to overcome it," McDaniel said. "The fact is, one step toward where we were, for me, is a step too many."

Majority Floor Leader Damon Thayer said likewise: "I thought the bill that came flying out of the House was a bridge too far, and going to Schedule II is not going to fly in the Senate right now, and I hope you don't come back and try it again next year; it won't be received very well by this body."

Andrew Rutherford, vice-president of the Kentucky Academy of Physician Assistants, told the committee that the PAs would keep seeing Schedule II authority.

"Our ultimate goal is always to provide the best patient care we can to our patients, that includes allowing us to practice to our full scope of practice," he said.

Rutherford told the committee that Kentucky is losing its PAs to other states because it does not allow them to practice at their full scope of care. Kentucky is the only state in the nation that does not allow PAs to prescribe any controlled substances.

The bill passed the House 91-1 on Feb. 6, with Rep. Lynn Bechler, R-Marion, voting against it. This was the fourth time the legislation had been filed, and the first time it's gained any traction.

Sen. Michael Nemes, R-Shepherdsville, noted that the Kentucky Medical Association, which has opposed this bill in the past, isn't necessarily for the bill but is "not fighting it."

Asked about its stance on the bill, the KMA told Kentucky Health News in an e-mail that it "continues to have concerns regarding the expansion of prescriptive authority for controlled substances among non-physician groups. KMA did work, however, with the Kentucky Academy of Physician Assistants on House Bill 135 with two objectives in mind – promoting public safety and preserving the 'physician-led team model.' KMA will monitor the progress of this bill and urge that principles such as these be included as the legislative process continues."

Adam Haley, government-affairs coordinator for KAPA, told Kentucky Health News that PAs were still working with lawmakers to try to carve out the Schedule II drugs that are used to treat ADHD.

"We obviously heard loud and clear from our members of Senate leadership in committee that there are strong reservations about some of the opioids in Schedule II, and while we believe the gold standard of care does include full Schedule II authority, we're sensitive to those concerns and are working with those legislators on addressing the issue of some of the psycho-stimulants in Schedule II and whether or not those can be broken out separately," Haley said.

Sheldon, the bill's prime sponsor, noted that 49 states allow full prescriptive authority for PAs and Kentucky would become the sixth state to place restrictions on Schedule II if this bill were to become law.

The KAPA's Rutherford said, "Changing this legislation will allow Kentucky to be more attractive for PA practice and will hopefully keep many of those PAs from going to practice in neighboring states. This would allow for more providers in Kentucky, which we all know is much needed."

The bill includes several restrictions on how PAs can prescribe drugs, and new continuing-education requirements, including a number of required hours related to controlled substances. It also leads to a more accurate account of who actually prescribes drugs; now, all scheduled drugs prescribed by a PA are attributed to the supervising physician.

Under the regulation, PAs would still have to work under the supervision of a physician who would be allowed to limit which controlled substances they can prescribe.

Sen. Paul Hornback, R-Shelbyville, said he supported the bill as a way to increase access to care in rural Kentucky and that he hoped the House bill to expand the scope of practice for nurse practitioners would also pass.

Nurse practitioners have been able to prescribe Schedule II drugs, the highest level of painkillers, since 2006, under the supervision of a physician. HB 286, a bipartisan bill sponsored by Rep. Russell Webber, R-Shepherdsville, would allow them to do that without a supervising physician after four years, if their license is in good standing. The General Assembly approved similar authority in 2014 for non-scheduled drugs. This bill is posted in the House Licensing, Occupations and Administrative Regulation Committee.

Bill to let physician assistants prescribe controlled substances passes House on fourth try; doctors say they 'have concerns'

By Melissa Patrick
Kentucky Heath News

The state House has passed a bill to let physician assistants to prescribe highly regulated drugs, a step advocates say is needed to improve health-care access in rural Kentucky, the only state where PAs lack such authority.

Sheldon offered his bill. (KET image)

House Bill 135, sponsored by Rep. Steve Sheldon, R- Bowling Green, would allow "modified prescriptive authority" of controlled substances in federal Schedules II, III, IV, and V after the assistant has been licensed and has practiced for one year.

It passed the House Feb. 6 on a 91-1 vote, with Rep. Lynn Bechler, R-Marion, voting against it. This was the fourth time the legislation had been filed, and the first time it's gained any traction.

Sheldon said the Kentucky Board of Medical Licensure, the Kentucky Academy of Physician Assistants, the Kentucky Pharmacists Association and the Kentucky Medical Association were involved in the drafting of this bill.

Rep. Susan Westrom, D-Lexington, asked about KMA's position on the legislation, since it had opposed such bills in the past. Sheldon and other members assured her that KMA was not against it.

KMA told Kentucky Health News in an e-mail, "The KMA continues to have concerns regarding the expansion of prescriptive authority for controlled substances among non-physician groups. KMA did work, however, with the Kentucky Academy of Physician Assistants to ensure safeguards such as a “team approach” were included in House Bill 135 that promote public safety, along with oversight by the Kentucky Board of Medical Licensure. KMA will monitor the progress of this bill and urge that measures such as these be included as the legislative process continues."

Rep. Daniel Elliot, R-Danville, who has introduced the legislation in the past, summarized the benefits of this bill, as described in a letter from a PA. He said it would lead to better and more efficient access to care and allow a more accurate account of who is actually prescribing drugs, since now all scheduled drugs prescribed by a PA are attributed to the supervising physician.

"Kentucky is the only state in the nation which presently has a complete prohibition on physician assistants prescribing controlled medications," he noted.

Rep. John Blanton, R-Salyersville, said he once had reservations about changing that, having worked as a police officer on an investigation that sent a doctor to prison in 2001 for overprescribing opioids, but has since changed his mind.

"The first thought to me was that we don't need more people prescribing opioids, we've already got a problem," he said. "But I also realized that we can't punish the good people that are doing good work because of someone we fear to be a bad actor -- there are things in place to take care of those bad actors."

Also, he said of PAs, "In Eastern Kentucky, they are vitally important to us because oftentimes, when we go in, that's who we're seeing, rather than a doctor, and they need to have every tool in their toolbox they can to be able to administer good health care to the people that they see each and every day."

Rep. Tina Bojanowski, D-Louisville, said PAs have told her that if they can't practice to the full scope of their practice, as they can in other states, they will leave Kentucky.

Moser, who is known for her opposition to increasing the scope of practice for non-physicians, especially when it comes to prescribing controlled substances, said she could support the bill for several reasons: It requires PAs to get additional training and continuing education for prescribing at every level of drug classification; it maintains a strong collaborative agreement with a physician; a supervising physician can decide which drugs their PA prescribes, if at all; and they will be regulated under the Board of Medical Licensure.

Rep. Stan Lee, R-Lexington, cautioned that non-physician groups keep coming back to ask to expand their scope of practice and that while this piece of legislation provides a strong collaborative agreement between a PA and their supervising physician, "other collaborative agreements with other professions have been under assault."

Nurse practitioners are also asking to expand prescriptive authority

Lee apparently alluded to a bill to expand the prescriptive authority of advanced practice registered nurses, They too, say this would increase health care access for Kentuckians. So far, it hasn't gained any traction.

Nurse practitioners have been able to prescribe Schedule II drugs, the highest level of painkillers, since 2006, under the supervision of a physician. House Bill 286, a bipartisan bill sponsored by Rep. Russell Webber, R- Shepherdsville, would allow them to prescribe them without a supervising physician after four years, if their license is in good standing. The General Assembly approved similar authority in 2014 for non-scheduled drugs.

Lawmakers continue to express concerns that such a move would increase the opioid supply in the state, but that hasn't been the case, according to a fact sheet from the APRNs' lobbying group.

It says, "Although the number of APRNs in Kentucky has increased, the average APRN prescribing of Schedule II opioids has decreased 33 percent from 2015 through 2018, the last year for which we have complete data. In contrast, the average dentist prescribing Schedule II opioids has decreased 25.8% and the average physician prescribing of Schedule II opioids has decreased 21.2%."

HB 286 has 28 sponsors. It is in the House Licensing, Occupations and Administrative Regulations Committee.

What's in the PA bill?

The PA bill includes several restrictions, including only allowing PAs to prescribe a three-day supply of Schedule II drugs, with no refills. Schedule II and III non-narcotic substances would be limited to a 30-day supply with no refill; and Schedule IV and V drugs would be limited to the original prescription, with refills to not exceed a six-month supply.

It also carves out several Schedule IV drugs that can only be written as a 30-day supply without any refills, including: diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax) and carisoprodol (Soma).

A PA's license to prescribe such drugs would need to be renewed every two years. The measure also includes new rules around continuing education requirements, including a number of required hours related to controlled substances.

Under the regulation, PAs would still have to work under the supervision of a medical doctor and that physician would be allowed to limit which controlled substances their PAs can prescribe, or if they want to participate in the program.

Bill to let physician assistants prescribe passes first hurdle; Ky. is only state where they can't, causing health-care access issues

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to allow physician assistants to prescribe highly regulated drugs, a step advocates say is needed to improve health-care access in rural Kentucky, is finally moving through the legislature.

L-R: Andrew Rutherford, Rep. Steve Sheldon, Laurie Garner

"Kentucky is the last state in the U.S. where PAs don't have some form of controlled-substance delegation. The other 49 states have it already," said the bill's main sponsor, Rep. Steve Sheldon, R-Bowling Green. "And no state has ever reduced or rescinded the authority that has been given."

House Bill 135 would allow "modified prescriptive authority" of controlled substances in Schedules II, III, IV, and V after the PA has been licensed and has practiced for one year.

It passed the House Health and Family Services Committee Jan. 30 with a committee substitute. This was the fourth time the legislation had been filed, and the first time it had been brought up in committee for a vote.

Leaders of the Kentucky Academy of Physician Assistants urged passage of the bill, explaining that under the current system a supervising physician has to sign off on any controlled substance prescription written by a PA. They said this results in decreased access to care, delays in care, poor prescribing transparency, and ultimately results in Kentucky PAs moving to other states.

"Our graduating PA students are leaving the state of Kentucky to practice in other states where they have less restrictions and more job opportunities," said Laurie Garner, president of KAPA. "By passing this bill we will keep our best and our brightest in our state rather than seeing them leave for better opportunities elsewhere."

She also offered an example of how the system results in delayed care, noting that because she is often the only provider at her clinic, her patients who need a controlled substance prescription or a refill must wait until the supervising physician is able to co-sign for it, and often end up canceling appointments when she can't immediately help them.

Andrew Rutherford, vice-president of KAPA, said the bill would increase transparency, since drugs would be ordered under the PAs' Drug Enforcement Administration numbers instead of their supervising physicians' numbers.

"It will also allow PAs to be accountable for the controlled medications that they prescribe, based on their treatment plans," he said. "Currently a supervising physician signs off on all these prescriptions and this is falsely inflating many physicians' prescribing numbers."

The bill includes several restrictions, including only allowing PAs to prescribe a three-day supply of Schedule II drugs, with no refills. Schedule II and III non-narcotic substances would be limited to a 30-day supply with no refill; and Schedule IV and V drugs would be limited to the original prescription, with refills to not exceed a six-month supply.

It also carves out several Schedule IV drugs that can only be written as a 30-day supply without any refills, including: diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax) and carisoprodol (Soma).

Administration of the program would fall under the Kentucky Board of Medical Licensure, and a PA's license to prescribe such drugs would need to be renewed every two years. The measure also includes new rules around continuing education requirements, including a number of required hours related to controlled substances.

Under the regulation, PAs would still have to work under the supervision of a medical doctor and that physician would be allowed to limit which controlled substances their PAs can prescribe, or if they want to participate in the program.

43% of Ky. medical-school students become primary-care physicians; nationwide, the figure is only 20 percent

Kentucky seems to be dealing with the shortage of primary care physicians more effectively than the rest of the nation, but it's still uncertain if the state's efforts will be enough.

The problem is that fewer medical students are choosing to go into primary care. With the average medical student graduating with $200,000 or more in debt, many opt for higher-paying specialties, Sam Dick reports for Lexington's WKYT-TV. To make matters worse, older family physicians are retiring or dying and more patients are getting older and sicker.

In the next seven years, the United States will need 52,000 more family doctors and Kentucky will need about 1,400 more -- mostly in rural areas, Dick reports.

"You know, we're seeing a lot of health-care providers that are just burned out," Lexington Clinic physician recruiter Robert Bratton told Dick. "They're being asked to do more and more, in less and less amounts of time, and it's very difficult. . . . It's staggering. It really is. "

Dr. Hoellein, associate dean for student affairs at the University of Kentucky College of Medicine, told Dick that Kentucky is bucking this trend. He said that nationally 20 percent of medical school students choose primary care, but in Kentucky that number is up to 43 percent.

Toward that end, the UK medical school is expanding across the state. A two-year school is open at St. Claire Medical Center in Morehead, UK's Bowling Green campus opens this summer, and next summer UK Northern Kentucky will start taking medical students. The hope is that new, primary care doctors will train in those areas of the state and then remain in them to practice medicine.

Dick notes that physician assistants are helping to pick up some of the patient load, but Dr. Michael Eden, an "older family doctor," said, "Even at this point with them helping us out, we struggle some days to get everyone in."

Legislature moving bills targeting fentanyl sales, shortening length of most opioid prescriptions to three days

The General Assembly is moving bills to increase penalties for the sale of fentanyl and put a three-day limit on prescriptions of other high-potency painkillers, in an effort to stem the state's opioid epidemic.

Kim P. Moser

"This is a public-health crisis," freshman Rep. Kimberly Poore Moser, R-Taylor Mill, a former nurse who reminded the House Judiciary Committee that Kentucky has the nation's third highest rate of deaths from opioid overdoses.

Her legislation would raise the penalty for selling any amount of fentanyl, "a powerful synthetic opioid," reports Bruce Schreiner of The Associated Press. "Current law allows lesser felony charges, with lighter penalties, for people convicted of trafficking less than 2 grams."

"The bill would create a new crime of trafficking in a misrepresented controlled substance, a felony punishable by one to five years in prison," Schreiner writes. "It's aimed at drug dealers who sell fentanyl to buyers who think they're getting less-potent painkillers, with sometimes deadly results."

Read more here: http://www.kentucky.com/living/health-and-medicine/article133010659.html#storylink=cpy

Rep. Robert Benvenuti, R-Lexington, said at the House Judiciary Committee's Feb. 15 meeting, "We have people in this commonwealth who are actively marketing something that is the equivalent to shooting somebody. And we've got to have strict penalties for that. . . . And if it means longer terms of incarceration, there's one way not to get into that situation – don't traffic in this stuff."

The bill would also "direct licensure boards overseeing doctors and others with prescriptive authority to write regulations setting guidelines to generally limit a patient's supply of painkillers to three days," Schreiner reports. "There would be exemptions in cases of chronic pain, end-of-life and cancer care and if a provider believes there's a medical necessity for a longer prescription."

Gov. Matt Bevin told the committee, "We've got to make it harder to get addicted." Schreiner reports, "Bevin said no amount of government money or rehabilitation programs will fix Kentucky's drug woes until action is taken to reduce the state's acute drug addiction rate."

The committee approved the bill on a bipartisan vote. The day before, the state Senate passed and sent to the House a bill to toughen penalties for people caught trafficking smaller amounts of heroin or fentanyl.

Legislator, citing rural doctor shortages, files bill to give physician assistants authority to prescribe controlled substances

A Republican recently elected to the state House has filed legislation that would allow physician assistants to prescribe controlled substances, something they can do in every other state beginning in January.

State Rep. Daniel Elliott

Rep. Daniel Elliott, R-Gravel Switch, says the bill would help relieve the doctor shortages in some rural areas of the state. “If we can give these professionals the ability to care for sick people then I can’t see why we wouldn’t do that in a state that tends to be at the bottom of some categories of health,” Elliott told Insider Louisville's Joe Sonka. “I don’t see the rationale in prohibiting very well educated and trained medical professionals from practicing medicine, and that’s what we’re saying they can’t do in Kentucky, to a certain extent.”

Physician assistants have two-year master’s degrees and are supervised by physicians. Kentucky has more than 1,200 of them. They have less prescribing authority in Kentucky than nurse practitioners, who have been able to prescribe controlled substances since 2006. Florida was the last state to extend the authority to physician assistants, effective in January.

"Ben Swartz, the executive director for the Kentucky Academy of Physician Assistants, tells IL that this difference makes it harder to hire physician assistants, and changing the law would 'bring parity in line with the two professions' and 'level the job market' in Kentucky," Sonka reports. "He adds that because Kentucky lags behind the rest of the country on this law, physician assistants in Kentucky often leave to find work in other states where they have full prescription authority, even though their training is more thorough than that of nurse practitioners."

Swartz acknowledges that the General Assembly has been reluctant to give PAs prescription authority "due to the state’s problem of prescription painkillers being over-prescribed and leading to opioid addiction and overdoses," Sonka writes. "However, he says this change would provide more accurate and responsible tracking of prescriptions by the state, as the supervising physicians’ prescriptions are often inflated when their assistant refers patients to them."

Elliott won a special election in March to fill the seat vacated by state Auditor Mike Harmon. Republicans are in the minority in the House but appear to have a good chance of winning a majority in the Nov. 8 elections.

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

By Melissa Patrick
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

New health-related laws deal with heroin, dating violence, end-of-life care, prescriptions, colon-cancer and newborn screening

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The Kentucky General Assembly passed several health-related bills this session, including high-profile measures on heroin and dating violence. It did not pass many others, including one that would have a great influence on the state's health: a statewide smoking ban, which passed the House for the first time ever, but never got out of an unfavorable committee in the Senate. Here's a roundup:

Heroin: Kentucky's heroin-overdose epidemic was caused partly by a 2012 legislative crackdown on prescription painkillers, which steered users to the illegal drug. Last year's bill died because of deadlock over sentences for traffickers and needle-exchange programs for addicts, and Gov. Steve Beshear and legislators gave this year's bill top priority. It was not finally negotiated until a few hours before passage, but Beshear signed Senate Bill 192 into law less than 12 hours after it passed so that its emergency clause could put it into effect immediately.

SB 192 includes both a needle-exchange program and harsher penalties against traffickers, the main points of contention between the House and Senate, but requires local governments to approve needle exchanges and allows judges to be lenient in sentencing addicts, to help them get treatment. It allocates money for drug-treatment programs, allows increased access to Naloxone, a drug that reverses the effects of an overdose, and allows jailers to provide medically assisted treatment for inmates with opiate addiction.

Dating violence: After 10 years of lobbying and debate, the dating violence bill will allow dating partners to get interpersonal protective orders from a judge if they have been the victim of dating violence, sexual abuse or stalking. This year's bill largely dissolved social conservatives' opposition by creating a new chapter in the law for dating violence, with the same protections as the domestic-violence law. Kentucky is the last state to offer protection to dating-violence victims. House Bill 8 was sponsored by Rep. John Tilley, D-Hopkinsville, who also sponsored the House heroin bill.

Beshear has signed these bills into law:

Prescription synchronization: SB 44, sponsored by Sen. Julie Raque Adams,R -Louisville, will allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

Medical order scope of treatment: SB 77, sponsored by Sen. Tom Buford, R-Nicholasville. will create a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care.

Colorectal cancer screening: SB 61, sponsored by Sen. Ralph Alvarado, R-Winchester, will require that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The governor also signed a similar measure, HB 69, sponsored by Rep. Tom Burch, D-Louisville, which contains an amendment by Sen. Julian Carroll, D-Frankfort, for a Medicaid savings study.

Newborn screenings for fatal disease: SB 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, will require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur.

Spina bifida: SB 159, sponsored by Adams, will require medical providers to supply written, up-to-date, accurate information to parents when their unborn child is diagnosed with spina bifida so they can make informed decisions on treatment.

Emergency care for strokes: SB 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, requires that local emergency services have access to a list of stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky. Emergency medical providers will set their own protocols for assessment, treatment and transport of stroke patients.

Alcohol and drug counselors: HB 92, sponsored by Rep. Leslie Combs, D-Pikeville, creates an enhanced licensing program to recognize three levels of certified alcohol and drug counselors, with different levels of education. The goal is to increase the number of counselors in the state.

UK cancer research center: HB 298, sponsored by Rep. Rick Rand, D-Bedford, revises the state budget to authorize $132.5 million, half of the cost, for a new medical research center at the University of Kentucky. The university says it will raise money to cover the other half.

These health bills awaited the governor's signature Monday morning:

Physician assistants: HB 258, sponsored by Rep. Denver Butler, D-Louisville, to allow physicians to supervise up to four physicians at the same time, rather than two.

In-home care: HB 144, sponsored by Burch, to establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services.

Pharmacist-practitioner collaboration: HB 377, sponsored by Rep. Dean Schamore, D-Hardinsburg, to allow collaboration between pharmacist and practitioners to manage patients' drug-related health needs.

Tax refund donations: SB 82, sponsored by Sen. Max Wise, R-Campbellsville, to put an income tax check-off box on tax forms to allow people the option of donating a portion of their tax refund to support pediatric cancer research, rape crisis centers or the Special Olympics.

Health related bills that were left hanging:

The smoking ban, HB 145, sponsored by Rep. Susan Westrom, D-Lexington, never got a hearing in the Senate Veterans, Military Affairs and Public Protection Committee, and neither did the Senate companion bill, SB 189, sponsored by Adams.

Three bills challenged Medicaid managed-care companies. SB 120, sponsored by Alvarado, would have created a process for health-care providers to appeal the companies' decisions to the state passed the Senate, but not the House.  And the following two bills that never got out of the Senate: SB 88, also sponsored by Alvarado, which challenged the $50 "triage fees" MCOs pay for emergency-room visits that they conclude were not emergencies, and would have required them to pay contracted fees instead and SB 31, sponsored by Buford, which would limited the amount of co-payments. Also not getting House action was Alvarado's SB 6 would have created review panels for lawsuits seeking damages from health-care providers.

As session nears end, bills on heroin, dating-violence orders, managed-care appeals and lawsuit review panels are hanging fire

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The General Assembly has sent Gov. Steve Beshear four health-related bills, and several more could reach his desk in the legislative session that ends Wednesday. Legislators will return briefly after 10 days to reconsider any bills Beshear vetoes; they could also pass more bills, but would not be able to override any vetoes.

Here are some of the health-related bills that were pending on Monday; bills with two readings are ready for floor action.

Heroin: tougher penalties and needle exchanges?

Both the Senate and the House have heroin bills and both remain in committee in the other chamber, but hope remains high in both chambers that a compromise can be reached so that a heroin bill will pass this session. Senate Bill 5 is sponsored by Sen. Christian McDaniel, R-Latonia; House Bill 213 is sponsored by Rep. John Tilley. The main differences are how traffickers would be punished and whether to start needle-exchange programs for addicts. The Senate's penalties are tougher and it has opposed needle exchanges, which advocates say prevent disease and death from dirty needles and can lead addicts to treatment.

Now the Senate is moving toward accepting needle exchanges, James Pilcher reports for The Cincinnati Enquirer. Rep. Dennis Keene, D-Wilder, and Sen. Wil Schroder, R-Wilder, said exchanges "are much more likely to be included than when the session started," Pilcher writes. Schroeder told him, "I think there is a real possibility that we could include needle exchanges and then get our tougher penalties." Pilcher reports, "The possible legislative position shift comes as health officials throughout the Tristate have expressed deep concerns about the spread of diseases that can be contracted using dirty needles."

Protective orders for dating violence

House Bill 8, sponsored by Rep. John Tilley, D-Hopkinsville, has received its second reading and is awaiting passage in the Senate. This bill would allow dating partners to petition for interpersonal protective orders if they have been the victim of domestic violence, sexual abuse or stalking. Such orders are now available only to those who are married, live together or have lived together, or an unmarried couple with a child in common.

Kentucky is the only state that offers no protection for such victims. Legislation to do that has stalled in the Senate in earlier sessions, but a Senate committee substitute addresses a key objection, by creating a new chapter in the statutes for the bill, separate from the existing domestic-violence chapter.

Advocates say domestic violence is a health issue not just because of the physical injuries it causes. They say victims are more likely to be depressed, have unplanned and premature pregnancies, go to fewer prenatal visits, and to miss more well-child visits with their children.

Prescription synchronization, managed-care appeals

Senate Bill 44, sponsored by Sen. Julie Raque Adams, R-Louisville, has had its second reading in the House. This bill would allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

House Majority Caucus Chair Johnny Bell, D-Glasgow, has filed a floor amendment on an unrelated issue, to create a state appeals process for health-care providers to appeal decisions of Medicaid managed-care companies. It is the same as or similar to Senate Bill 120, sponsored by Sen. Ralph Alvarado, which has given it a first reading without assigning it to a committee. The Cabinet for Health and Family Services opposes a state appeals process, saying it would have a conflict of interest (successful appeals would cost the state money) and providers have the courts available to them to resolve contractual issues. UPDATE: Bell withdrew his floor amendment to Senate Bill 44 March 9. 

Review panels for suits against health-care providers: Senate Bill 6, filed by Alvarado, remains in the House Judiciary Committee, but a discharge petition was filed March 4 to bring it to the floor, bypassing leaders of the House's Democratic majority. This bill would establish panels of three medical experts, two chosen by each side and the third chosen by the other two, to review suits against health-care providers to determine if the case has merit before the lawsuit can proceed. Panel findings would be admissible in court, but not legally binding. Opponents say that Kentucky already has laws to punish attorneys for filing frivolous cases and that this just adds another barrier for patients seeking justice.

Newborn screenings for fatal disease: Senate Bill 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, has had two readings. It would require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur. Treatment with stem cells from an umbilical cord blood transplant is sometimes successful it the infant is treated early enough. The cabinet opposes the bill, saying the screening will cost half a million dollars a year at a time when local health departments are suffering budget cuts.

Spina bifida: Senate Bill 159, sponsored by Sen. Julie Raque Adams, R-Louisville, is in the House and the three-day posting rule has been waived. This bill would require medical providers to supply written, up to date, accurate information to parents when their unborn child is diagnosed with spina bifida so parents can make informed decisions on treatment

Physician assistants: House Bill 258, sponsored by Rep. Denver Butler, D-Louisville, is awaiting Senate passage. This bill allows a physician to supervise up to four physician assistants at the same time, rather than two.

In-home care: House Bill 144, sponsored by Rep. Tom Burch, D-Louisville, is awaiting Senate passage. It would establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services. The daily cost would have to be less than the average daily nursing home payment allowed by Medicaid. The bill would also provide non-medical support services to the applicant as needed.

BILLS SENT TO THE GOVERNOR

Colorectal cancer screening: Senate Bill 61, sponsored by Sen. Ralph Alvarado, R-Winchester, received final passage in the House March 4. This bill requires that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The bill would apply to health plans issued or renewed on or after Jan. 1, 2016, if it becomes law. A similar measure, House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, is awaiting passage in the Senate with a committee substitute by Sen. Julian Carroll, D-Frankfort, calling for a Medicaid savings study.

Medical order scope of  treatment (MOST) form: Senate Bill 77, sponsored by Sen. Tom Buford, R-Nicholasville, received final passage in the House March 3. This bill creates a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care. It is considered a physician's order, travels with the patient between health care facilities, and must be reviewed annually. The bill clearly defines the order of controlling documents for end-of-life care: the living will first, the MOST form second and the health-care surrogate, which is chosen by the patient and listed on the form, third. The MOST form is already used in 32 states.

Emergency care for strokes: Senate Bill 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, received final passage in the House March 4. The bill requires that a list of all acute stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky be posted to the cabinet's website and be made available to all emergency medical services providers, who are required to set their own internal protocols toward assessment, treatment and transport of stroke patients.

Funding for UK cancer research center: House Bill 298, sponsored by Rep. Rick Rand, D-Bedford, received final passage in the Senate March 4. This bill authorizes the state to appropriate $132.5 million, half of the cost, for construction of a new medical research center at the University of Kentucky. The university will raise money to cover the other half. The facility will target prevalent diseases in Kentucky, including cancer, diabetes and cardiovascular disease. The bill required a 60 percent vote in each chamber because it affects the state budget and the legislature is in a non-budget session; it passed the House 83-9 and the Senate 36-1 (Sen. John Schickel, R-Union).

Legislature eases physician assistant rules; nurse practitioners' prescription power, Medicaid prompt-payment bills, others linger

By Molly Burchett and Al Cross
Kentucky Health News

The Kentucky General Assembly has joined other states in easing the restrictions on physician assistants’ medical practice, but has held up a similar move for advanced registered nurse practitioners. Both issues relate to the shortage of medical practitioners in many Kentucky counties, and the quality of medical care.

The Senate added the physician assistant language of Senate Bill 43 to House Bill 104, an art-therapy bill, in order to preserve an agreement between the Kentucky Medical Association and the Kentucky Academy of Physician Assistants. It will repeal the law that bans PAs from practicing for their first 18 months unless a physician is on site; one will still have to be available by telephone. The amended bill has been sent to Gov. Steve Beshear for his signature or veto.

The amendment was used because the House had tacked onto SB 43 an amendment from advance practice registered nurses that would have repealed the need for them to have a collaborative agreement with a physicians to prescribe non-narcotic drugs. The KMA opposes that idea.

"It's looking like the doctors win," said Sen. Julie Denton, R-Louisville, who favors the repeal. "I'm not hopeful" it can pass, she said, but added that some physicians also favor it: "With Obamacare coming in, we're going to need all the front-line physicians we can get." Leading opponents of the measure, Republicans Katie Stine of Fort Thomas and Carroll Gibson of Leitchfield, didn't return a call seeking comment.

Nurse practitioners say that SB 43 is necessary to allow them to fill health-care gaps in rural Kentucky and address the state's shortage of primary-care providers. The Kentucky Coalition of Nurse Practitioners and Nurse Midwives says in an article prepared for Kentucky newspapers that NPs have never been required to practice under physician supervision and 17 states allow full prescribing authority for non-scheduled medications.

The Medicaid prompt-payment bill, HB 5, went to a conference committee after the House refused to go along with Senate changes, and may be considered when the legislature returns later this month, ostensibly to consider any bills Beshear vetoes. The bill would apply prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

In the final crunch to pass legislation before the veto recess, lawmakers attached seven health care-related bills to HB 366, which had focused on identifying congenital heart disease in newborns. It had 10 additional measures "hung on it like a Christmas tree before the free conference committee of House and Senate members," reports Ryan Alessi of cn|2's "Pure Politics."

The bills still hanging on the measure, dubbed the "healthy Christmas tree," are:

• HB 187, addressing a free prescription-drug program for under-insured Kentuckians.
• HB 79, which would exempt licensed health care providers from being disciplined for prescribing naloxone in the event of an overdose.
• HB 387, which aims to provide nutritional supplements for low-birth-weight newborns.
• SB 201, which addresses licensed diabetes educators.
• SB 38, to require Medicaid to accept provider credentialing by a Medicaid managed-care organization.
• SB 108, relating to managed-care contracts with the IMPACT Plus program, a behavioral health program for children.

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

Poll shows Kentucky health-care providers often fail to discuss HIV testing with patients

A new poll suggests that most Kentucky health-care providers follow guidelines for discussing HIV screening with their patients, despite the the importance of early treatment to prevent its progression to AIDS.

Although the Centers for Disease Control and Prevention recommends routine HIV screenings for most patients, just 32 percent of Kentucky adults aged 18 to 64 report discussing HIV testing with their medical provider, according to the Kentucky Health Issues Poll.

About 40 percent of Kentucky adults reported they had never been tested for HIV. It’s estimated that 4,500 Kentuckians are living with HIV infection and it is estimated nationally that one in five people who have HIV do not know they do.

“It made headlines earlier this month when a little girl - the second person in history - was cured of HIV. As exciting as this development was, for most people, HIV remains a life-long condition that must be managed through medication to keep it from progressing to AIDS. The CDC’s recommendations are meant to improve the overall population health by detecting HIV so treatment can begin,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll.

“It appears that Kentucky providers are either not adhering to the routine screening recommendations or not communicating this message clearly to patients,” she said.

The poll, co-sponsored by the Health Foundation of Greater Cincinnati, was taken Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by landline and cell telephones. The poll's margin of error is plus or minus 2.5 percentage points

Poll finds four out of five Kentuckians are comfortable seeing a nurse practitioner or physician assistant for routine care

New poll figures indicate the majority of Kentuckians are comfortable seeing a nurse practitioner, physician assistant or mid-level clinician for their routine care, especially if they have been treated by such clinicians. The findings come as the General Assembly considers a bill that would allow physician assistants to practice more independently.

In the Kentucky Health Issues poll last fall, 79 percent of Kentucky adults said they would be comfortable seeing a nurse practitioner for routine health care, and half of those people said they would be very comfortable. Eighty-one percent said they would be comfortable seeing a physician assistant for routine health care, and 42 percent of those respondents said they would be very comfortable.

Reported comfort was higher among people who had received care from a nurse practitioner or physician assistant in the past year; 86 percent of those people said they would be comfortable seeing an NP again for routine care. Eighty-eight percent of those who had received care from a PA in the past year said they would be comfortable doing that again.

The poll also inquired about a proposed new “mid-level” profession: advanced dental hygiene practitioners. These practitioners would provide routine dental care, including diagnostic and preventive services such as filling cavities. Although advanced dental hygiene practitioners cannot currently be licensed to practice in Kentucky, polling data indicated 73 percent of Kentucky adults would be comfortable with such a practitioner providing routine dental care.

"As providers move to create a system of care that includes a range of skill sets and training in its care teams, new strategies emerge that hold promise to increase access to affordable care – not just in urban centers but also in rural and underserved communities,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which sponsored the poll. “The data suggest that the public is very receptive to health care services from different types of clinicians.”

The poll, co-sponsored by the Health Foundation of Greater Cincinnati, was taken Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by landline and cell telephones. The poll's margin of error is plus or minus 2.5 percentage points. (Read more)

Physician assistants and some doctors urge lawmakers to pass bill that could ease provider shortage in rural Kentucky

Doctors and more than 150 physician-assistant students urged lawmakers Tuesday to pass a bill they stated involves dropping only one requirement in the law and could ease a physician shortage in Kentucky, reports Ryan Nick of cn|2's "Pure Politics."

Passage of Senate Bill 43 would repeal a law that allows physician assistants to treat patients only when a supervising physician is on site for the first 18 months after their certification. If passed, PAs would still be supervised but would be permitted to perform services in a location separate from the supervising physician, as long as that physician can be reached by phone at all times.

No other state requires PAs to have 18 months of on-site supervision. Colorado, the state with the next-longest mandate, requires supervision only for the first 1,000 hours after certification.

The bill's supporters say the burdensome supervision requirement has led to 55 out of Kentucky's 120 counties being medically underserved and has encouraged many PAs to practice in other states, reports Storm. They also say this rule needlessly complicates patient care, especially in rural areas where doctors are stretched thin, reports Melinda Beck of The Wall Street Journal.

The bill's sponsor, Sen. Tom Buford, R-Nicholasville, told Kentucky Health News that he expects the Kentucky Medical Association to seek some changes in the bill, but also expects it to pass because Senate Republican leaders, hospitals and universities support it. "We're educating these PAs at a lot of state expense just to work in other states," he said. House Speaker Greg Stumbo, D-Prestonsburg, told Storm he sees no reason why the bill shouldn't pass. Sen. Julie Denton, R-Louisville, chair of the Senate Health and Welfare Committee, told KHN that she supports the bill.

PAs are expected to be in even greater demand when the health-care reform law brings hundreds of thousands of Kentuckians into the health-insurance system. Beck notes the state is expected to face a greater shortage of physicians, particularly in primary care and rural areas. Buford said, "We're going to provide all this health care for everybody, and there's nobody to go see." For more from cn|2, including video interviews, click here.