Legislature passes bill requiring ads against nursing homes to include their correction plan and when problem was corrected

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The 2017 General Assembly has passed two bills long supported by the nursing-home industry and other health-care providers -- one to impose another obstacle on medical-malpractice lawsuits, and one that would require law firms to publish "complete information" in advertisements about long-term care facilities. Both bills are on their way to Gov. Matt Bevin.

Sen. Ralph Alvarado

Senate Bill 4 would require a panel of three medical-care providers and a non-voting attorney to review a malpractice claim before submitting it to a court. The panel would have nine months to render an opinion, but could be bypassed if all sides agreed. Trial judges would decide on the opinion's admissibility.

Similar legislation from Republican Sen. Ralph Alvarado, a Winchester physician, had passed the Senate in earlier sessions, but wasn't heard in the House, which was led by Democrats. Both chambers now have GOP majorities, but some House Republicans doubted the measure's constitutionality, so it was amended in that chamber and passed by only 51-45, with 11 Republicans joining 34 Democrats in voting against it. The Senate concurred with the changes March 3.

Proponents of medical review panels say they will cut down on frivolous lawsuits and lower malpractice insurance costs. Opponents say such laws have proven ineffective in other states and that they delay a person's right to a trial by jury.

Sen. Danny Carroll

The "truth in advertising" legislation, SB 150, would require that any advertising about a long-term care facility that includes information about surveys, inspections or investigations, also include the date of any report, the facility's plan of correction and the date the deficiency was corrected. The ad must also state that it is not authorized or endorsed by any government agency. And all of this information must be in the same color, type font and size as the other language on the publication and be equally prominent.

The bill, which raises constitutional questions about freedom of speech, is aimed at ads from lawyers seeking plaintiffs to file lawsuits against nursing homes. It awaits Bevin's signature or veto.

The sponsor, Sen. Danny Carroll, R-Paducah, said during the bill's Senate hearing that most of these "unscrupulous and unethical" advertisements come from out-of-state law firms and that this measure "creates a level playing ground." In his legislative update, Carroll said this bill "will in no way restrict civil discourse or lessen accountability for long-term care facilities."

Bills can still be passed when legislators reconvene March 29 and 30 to reconsider any bills the governor has vetoed.

Alvarado is the sponsor of SB 18, which would ban doctors' peer reviews at hospitals from being used as evidence in malpractice cases.

Rep. Chad McCoy (Image from KET)

This bill has passed the Senate and a House committee and is before the House, with an amendment filed by freshman Rep. Chad McCoy, R-Bardstown, that would exempt statements of fact from the ban.

In effort to get around McCoy's amendment, language from SB 18 has been included in amendments to several other bipartisan bills that involve children. One of those includes House Bill 524, sponsored by Rep. Addia Wuchner, R-Florence, aimed at protecting children from sex trafficking. The bill awaits a vote on the Senate floor.

Bill passes to decrease smoking; one doesn't; lawmakers set to pass resolution for feds to ditch plan to limit tobacco carcinogen

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Smoke-free advocates would say that this legislative session's record is 1-2.

That's because Kentucky lawmakers have passed one bill that will increase access to smoking-cessation treatments, but can't find enough support to pass one that would make Kentucky schools 100 percent tobacco-free -- and are poised to pass a resolution that asks federal officials to withdraw a proposal that would reduce the carcinogen levels in smokeless-tobacco products.

Sen. Julie Raque Adams' bill to decrease insurance barriers to smoking-cessation treatments is one of two tobacco-related bills that passed this legislative session and is on its way to the Governor for his signature.

The Patient Protection and Affordable Care Act requires all insurance policies to cover smoking-cessation treatments, but insurance barriers, like co-payments, prior authorization requirements and limits on length of treatment, make them not readily available.

Senate Bill 89 would require barrier-free access to all U.S. Preventive Services Task Force-recommended smoking cessation treatments in all Kentucky health plans, including Medicaid.

The other tobacco bill, sponsored by Sen. Ralph Alvarado, R-Winchester, which would have banned tobacco use on all school properties and at school events, is all but dead in the state House, despite its quick passage in the Senate.

Just over half of Kentucky's public-school students are in school districts with tobacco-free policies: 62 of the state's 173 districts, covering 654 schools.

Kentucky's high school students have a higher smoking rate than the national average, 17 percent compared to 15 percent; and 24 percent of them use electronic cigarettes, according to the 2015 Youth Risk Behavior Survey. The survey also found that 22.5 percent of the state's middle-school students have tried smoking.

Alvarado called Senate Bill 78 "low-hanging fruit" because it involves the health and safety of Kentucky's children and polling shows that 85 percent of Kentuckians support such an effort, but House Speaker Jeff Hoover said, "There was just not enough support in the caucus right now to do it."

Another piece of tobacco-related legislation introduced this session is a resolution that urges the the U.S. Food and Drug Administration to withdraw its proposal to reduce the levels of N-nitrosonornicotine, or NNN, a carcinogen, in all smokeless tobacco products sold in the U.S.

The FDA's proposal states,"NNN is a potent carcinogenic agent found in smokeless tobacco products and is a major contributor to the elevated cancer risks associated with smokeless tobacco. The FDA estimates that, in the 20 years following implementation of its proposed product standard, approximately 12,700 new cases of oral cancer and approximately 2,200 oral cancer deaths would be prevented in the U.S. because of this rule."

The resolution notes that the majority of farmers who raise the dark tobacco that makes up the main ingredient of smokeless tobacco products live in Kentucky and "raise approximately 24,000 acres of the crop with an estimated cash value of approximately $173 million per year."  It also says that the proposed standards in the FDA proposal are "technically unachievable" and that the impact of this rule would be "far-reaching and onerous because of the negative impact on agriculture and on manufacturing jobs in Kentucky."

House Concurrent Resolution 48, sponsored by Walker Thomas, R-Hopkinsville, passed the House 69-3 and is expected to pass the Senate in the final two days of the session, after the veto recess. The FDA is accepting public comment on this proposal until April 10, 2017. Click here for directions. 

Study of Ohio's Medicaid expansion: Enrollees have better health, more financial security, and say it's easier to keep or find work

By Melissa Patrick
Kentucky Health News

Ohio's Medicaid expansion enrollees say having health coverage made it easier for them to keep or find work, and most said it gave them better health and financial security.

Their experience is part of a report Ohio's legislature ordered to evaluate the impact of Gov. John Kasich's 2014 decision under federal health reform to cover those who earn up to 138 percent of the federal poverty level. Previously, only Ohioans who fell under 90 percent of the poverty line qualified for Medicaid, unless they were disabled or pregnant.

Kentucky, under then-Gov. Steve Beshear, also expanded Medicaid, from a previous threshold of 69 percent of poverty. That added 440,000 people to the program; Ohio added 702,000.

That was the main factor in reducing from 21 percent to 8 percent the share of Kentuckians without health insurance. Among low-income, working-age people, the rate dropped from 38 percent to 13 percent. The Ohio report noted that the state's uninsured rate dropped to its lowest rate ever, 14.1 percent.

Ohio's expansion enrollees "overwhelmingly reported that access to medical care had become easier since enrolling in Medicaid," with 43 percent saying they had fewer unmet health-care needs, the report said.

Group VIII is the Medicaid expansion population. Graphic is from the Ohio report.

The report also found that Medicaid expansion enrollees used hospital emergency rooms less often because they were "better integrated into the health care system." According to the report, 34 percent said they used the emergency department less often, and Medicaid claims data proved it.

Nearly half of expansion enrollees reported that their health had improved; only 3.5 percent that said their health had worsened. Just over a fourth said they had been diagnosed with at least one chronic health condition after obtaining coverage. They also showed fewer instances of high blood pressure and high cholesterol.

"Because they were able to obtain treatment for previously untreated conditions, several of the enrollees stated that they did not think they would be alive today if Medicaid expansion had not occurred," the report said.

Enrollment in Medicaid also made it easier for its participants to work and to seek work, with 75 percent of those who were unemployed but looking for work reporting that Medicaid made it easier to seek employment. And 52 percent of those who were currently employed said having Medicaid made it easier to keep working.

They also reported that having Medicaid made it easier to meet other basic needs, like food (59 percent) or paying the rent (48 percent) or to pay off other debts (44 percent). Also, the share of expansion enrollees with medical debt fell by nearly half since they enrolled in Medicaid, from 56 percent to 31 percent.

In conclusion, the report said,"These results suggest that Medicaid expansion has and will continue to improve the health of low-income Ohioans enrolled."

The assessment was independently developed and carried out by a partnership of the Ohio Colleges of Medicine Government Resource Center, The Ohio State University College of Public Health, Ohio University, and RTI International. The data in the report came from a 7,508-person telephone survey, biometric screenings, medical-records reviews, analysis of Medicaid records, and interviews with Medicaid enrollees and stakeholders.

Paducah Sun editor calls for higher cigarette tax in Kentucky

The executive editor of a West Kentucky newspaper known for its conservative editorials is taking a stand against cigarette taxes, but not in the way you might expect.

In a Sunday column, Steve Wilson of The Paducah Sun lambasted the state's low cigarette tax of 60 cents per pack.

"The average tax in all states is now $1.65 a pack. The tax in neighboring Illinois is $1.98. New York has the nation's highest at $4.35," Wilson writes. "With a tax so much less, Kentucky is not doing right by its citizens in terms of revenue, public health and health-care costs."

Noting that Kentucky has the second-highest smoking rate in the country, 26.5 percent, Wilson suggests that a higher cigarette tax would generate greater revenue for the state and would spark a decline in smoking.

"If people have to pay more for cigarettes, they are less likely to buy them. That's especially true for younger smokers who have lower incomes and are less addicted. And when people smoke less, the benefits to their health and the state's health care costs are huge," he says.

Wilson cites research indicating that health-care costs directly related to smoking in Kentucky are nearly $2 billion a year. He says the state's annual Medicaid costs related to smoking are almost $600 million and paid by taxpayers.

The state set up a Blue Ribbon Commission on Tax Reform in 2012. It spent nearly a year evaluating Kentucky's tax policies and recommended a 40-cent raise, to $1 a pack, which would have brought the state an extra $120 million a year, but the General Assembly didn't bite. Wilson advocates passing that 40-cent increase now and committing a portion of the revenue to smoking-cessation programs.

"Given the staunch anti-tax attitude of the legislature and governor, an increase of any amount is a long shot in the next session," he writes. "It's so much easier for the lawmakers to do nothing and proudly say they stand firm against all tax increases. What they don't say is that such a low tax helps maintain a high rate of smoking, the nation's highest rate of smoking illness and ever-increasing medical bills pushed on the backs of taxpayers."

Issues between managed care companies and Kentucky Medicaid providers still mar the state's implementation of the program

By Molly Burchett
Kentucky Health News

For many health care providers in the state, implementation of Kentucky’s Medicaid Managed Care system has been taxing, but Cabinet for Health and Family Services officials say the state is taking steps to resolve disputes between these medical providers and managed care organizations.

Despite previous attempts by state officials to address these issues, providers like Sen. Danny Carroll, chief executive officer of Easter Seals West Kentucky, an organization that provides care for disabled adults and youths, continue to complain about both delayed or denied Medicaid payments and burdensome bureaucratic hurdles, Kevin Wheatley reports for cn|2's Pure Politics.

Carroll, a Paducah Republican who chaired Thursday's legislative committee meeting, is not alone. Other nonprofits and providers serving the Medicaid population say they are still struggling to stay financially viable and deal with managed-care organizations that are not state-based and that have different rules.

“It’s very frustrating trying to navigate the rules of all the different MCOs and all the different requirements, and it’s taxing on staff, it costs more money,” Carroll said. “Being a nonprofit, we need those funds to operate, and we’re having to focus more and more on how to navigate the system to get prior authorizations approved. One MCO requires a prior authorization every 60 days. Some it’s longer, and the rules have changed fairly frequently over the last few years,” said Carroll.

Medicaid Commissioner Lisa Lee

Lisa Lee, commissioner of the Department for Medicaid Services, told the legislative panel that the state has attempted to resolve many of those criticisms in new MCO contracts that took effect July 1. These efforts included provisions like "requiring standardized forms for all five managed care groups, utilizing national uniform standards to credential health professionals and adding stiffer penalties for non-compliance," Wheatley reports.

Lee noted that Medicaid has 1.2 million members "and we have thousands of providers, and I know that we do have some issues and when we have those issues, they seem to be bigger than what they are. But we are able to do provide many services that were not provided by the traditional fee-for-service model," citing one MCO that sent a case worker to the emergency room at midnight to help one Kentuckian during a crisis situation.

Carroll and others on the committee complimented the cabinet for its work to resolve issues between providers and MCOs, but Carroll said he wished the state had greater oversight of MCOs.

He cited one Medicaid provider who has seen an increase in the percentage of Medicaid patients in his practice and has had to borrow money to make payroll: "So you tell me, is the system working under those circumstances?"



Such questions are part of the overall discussion of Medicaid expansion and the millions of dollars it may cost the state as the federal dollars decline, said Carroll. The state will begin paying a portion of expansion expenses in 2017, when the federal government will cover 95 percent, decreasing to the federal health reform law's floor of 90 percent in 2020.

Lee said the Medicaid expansion has put $2 billion into the state's economy and “has been very positive because we know that a dollar’s not spent once,” she said. “The Medicaid program pays the providers, the providers pay their employees, their employees go to the grocery store, they go spent that money in other ways out into our economy.”

However, if fewer providers are available to Medicaid patients because of managed care, regulatory requirements and low Medicaid reimbursements, critics say the Medicaid expansion won't give people the care they need and will be a continuing burden on hospital emergency rooms.

Hope is high for a House floor vote and passage of a statewide smoking ban, but the Senate remains doubtful

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to ban smoking in public places and places of employment is headed to the House floor yet again, and its sponsor says it will finally get a vote. But its chances in the Senate remain doubtful.

Rep. Susan Westrom

"I feel very confident that we will get a floor vote," Rep. Susan Westrom, D-Lexington, five-year sponsor of the legislation, said after Thursday's committee meeting. "I am shooting for next Wednesday."

House Bill 145 passed the Health and Welfare Committee 11-4, with all Democrats and two Republicans on the panel for it and four Republicans opposed.

Westrom said the bill is not a smoking ban, but simply asks smokers to step 15 feet outside to smoke. She said, this is "not a huge sacrifice, but the benefits are so incredible."

The bill also requires those smoking electronic cigarettes and hookahs to step outside, which could cause a "battle," Westrom said.

The legislation got to the House floor last year, but didn't get a vote, and has never gotten out of committee in the Senate. Polling shows a clear majority of Kentuckians support banning smoking in indoor public places, but almost 30 percent of Kentuckians smoke, tops in the nation. The state also is No. 1 in lung cancer and deaths from it.

Two Republican senators, pediatrician Ralph Alvarado of Winchester and lawyer Julie Raque Adams of Louisville, chair of the Senate Health and Welfare Committee, sat with Westrom and Rep. David Watkins, D-Henderson, a retired physician, before the committee.

Alvarado gave an impassioned reading of his op-ed that was in the same day's Lexington Herald-Leader to the committee. "Smoking is killing Kentucky, literally and fiscally," he said.

He said an estimated 950 Kentuckians die every year because of secondhand smoke; exposure to it costs Kentucky more than $128 million every year; children exposed to secondhand smoke suffer from repeated ear infections, bronchitis, pneumonia and asthma; and secondhand smoke is a proven cause of heart disease, cancer and stroke in non-smoking adults.

By passing the bill, "The General Assembly can save more lives with this legislation than I can throughout my entire medical career," Alvarado said. Democratic Gov. Steve Beshear supports it.

Adams, who will be sponsoring the legislation in the Senate, told the committee, "We need to see a vote on the floor. We need to talk to our senators. We need to keep up the advocacy because Kentuckians deserve better."

Senate Republican Floor Leader Leader Damon Thayer told Jack Brammer of the Herald-Leader that there is "not much sentiment" for the bill in the Senate: "Let the free market work this out."

Republican Bob DeWeese, a doctor from Louisville, voted for the bill. He said the title of representative was fleeting, but "I'm a doctor for life."

Newly elected Rep. George Brown Jr., D-Lexington, noted that he voted against the smoking ban in Lexington many years ago. "Since that time, I've had an awakening and I understand that the collective rights of citizens are much more important than those of individuals."

Rep. Robert Benvenuti III, R-Lexington, said "liberty interests have to be balanced" between the rights of smokers to smoke in the workplace versus the rights of others to be healthier.

Newly elected Rep. Phil Moffett, R-Louisville, said "I support it at the local level and that is where is should reside," and asked Westrom why the legislature shouldn't just make tobacco illegal "if it is that devastating."

Westrom suggested Moffett ask the Kentucky Farm Bureau Federation about that. She said in December that Farm Bureau has been the main obstacle to the bill.

About 5,000 farmers in Kentucky grow tobacco, a greatly reduced number from the days of the federal tobacco program, which ended 10 years ago. Farm Bureau spokesman Dan Smaldone said in December that the organization continues to oppose the legislation because it invades the private-property rights of business owners.

Asked why a farm organization cares about that, Smaldone wrote in an email, "KFB's membership supports policy for rural issues that fall outside of the agriculture industry, including educational and economic issues that impact their local communities. The organization has policy on the issue because its membership determined it was important to take a position on it."

As for the local approach, Westrom said after the meeting that too many local communities have not taken the initiative to pass smoking bans.

About one-third of Kentuckians are covered by strong local smoke-free laws, with 24 communities with smoke-free laws that cover all workplaces and enclosed public places, according to the Smoke-Free Kentucky Coalition website.

Westrom, Alvarado and committee Chair Tom Burch, D-Louisville, said they thought the bill would pass the House, but none were sure about the Senate. Westrom noted that Senate President Robert Stivers, R-Manchester, has been vocal against the bill.

"The wonderful thing about Sen. Stivers is that he understands how important the cancer research center is at the University of Kentucky," Westrom said, noting Stivers' call to reopen the 2014-16 state budget to authorize the project: "If we are going to invest that amount of money for a cancer research center, the best thing we can do . . . is make sure the entire state is setting the example of a smoke-free state."

Smoke-Free Kentucky Chair Amy Barkley said, "If the House passes it and puts the ball in their court . . . I'm just going to be optimistic that they will listen to their voters. We know that 66 percent of the voters support a statewide smoke-free law and that crosses all parties and regions of the state." That is the figure in the latest Kentucky Health Issues Poll; a Bluegrass Poll put the figure at 57 percent.

Public opinion will make the difference this year, Westrom said. "Some portions of the state are more that 74 percent approval; 70 percent of the people who used to smoke are in favor of this; and an average of 60 percent of those in rural areas are in favor of smoke-free."

Medicaid expansion has been more popular than expected, but that raises a question of whether it will really pay for itself

Kentucky officials say the state’s Medicaid expansion under the federal health-reform law has enrolled more residents and created more jobs than expected, but a study will see whether the expansion will pay for itself, as an earlier study and Gov. Steve Beshear predicted.

Eric Friedlander, deputy secretary of the Cabinet for Health and Family Services, reported both a larger-than-expected Medicaid enrollment in every county and an increase of 17,000 jobs in Kentucky from Medicaid expansion at Monday's meeting of the legislature's Interim Joint Committee on Appropriations and Revenue.

Friedlander also discussed other benefits of Medicaid expansion, saying Kentucky health-care providers had received $892,973,500 in reimbursements from January to October of 2014, reports Brad Bowman of The State Journal in Frankfort.

Cabinet Secretary Audrey Haynes told Kentucky Health News on Tuesday that on the previous Friday, the cabinet had passed $1 billion in payments of federal money to health-care providers for treatment of people newly eligible for Medicaid: those with household incomes between 69 percent and 138 percent of the federal poverty level. About half the money has gone to hospitals, she said.

Still, many providers, particularly in rural areas, have reported cash-flow problems caused by delays in payment from Medicaid managed-care companies, lower-than-cost reimbursements and increased administrative burdens.

Also, some legislators have expressed concern about the cost of expanding Medicaid rolls, which grew more than predicted by a study that Beshear cited in his expansion decision. As the law outlines, the federal government will pay 100 percent of the costs until Jan. 1, 2017, when the state will begin paying a small share rising to the law's limit of 10 percent in 2020.

Republican Sen. Chris McDaniel of Taylor Mill, who is running for lieutenant governor on the gubernatorial slate headed by Agriculture Commissioner James Comer, asked Friedlander what Kentucky’s financial obligations would be because of the expansion in the next few years. He said that is uncertain.

Under initial estimates, based on the study by PriceWaterhouse Coopers, expansion was expected to cost the state only about $150 million a year when it was paying 10 percent of the cost. But the study only forecast that fewer than 300,000 newly eligible Kentuckians would sign up for Medicaid in the first year, but about 337,419 did.

To get updated cost projections, Beshear has contracted for a second analysis by an independent agency, which Friedlander said should be completed by mid-January, reports Ronnie Ellis of CNHI News Service.

The governor said the new study will speak for itself, reports Tom Loftus of The Courier-Journal. "I was confident after that initial report that we could certainly afford down the road over the next eight years to expand Medicaid and stay within our budget. I'm still confident," Beshear said.

Health-care forum examines 'incredible change' in Kentucky's health-care system, looks forward to more access to care

By Molly Burchett and Al Cross
Kentucky Health News

What does health-care reform mean to Kentucky? What impact has Medicaid expansion had? Can we work together to do care differently in Kentucky? Answers to these questions and more were offerd by national, regional, and local health care experts Sept. 16 in Louisville at the Foundation for a Healthy Kentucky's annual Howard L. Bost Health Policy Forum.

This year's topic was "Doing Care Differently," but as foundation chair David Bolt, deputy director of the Kentucky Primary Care Association, told the crowd, "It could have just as easily been named after the Bob Dylan song, 'The Times They Are A-Changin'."

As a health-care provider for 44 years, Bolt said, "I have lived through almost every change since the implementation of Medicare and Medicaid. And I am actually excited about the changes I see on the horizon." He said he thinks the late Dr. Bost would look at what Kentucky is doing and say," It's about time we moved away from a treat-'em-and-street-'em mentality to integrated health care delivery services and systems rooted in accountable outcomes and founded in a value-drive system of improving health."

One of the biggest recent changes in Kentucky health care is Gov. Steve Beshear's expansion Medicaid at the beginning of the year, which offered coverage to Kentuckians under 65 in households up to 138 percent of the federal poverty level. As a result, Medicaid is now the largest health-care payer in the state, serving 1.1 million Kentuckians, one out of every four, Cabinet for Health and Family Services Deputy Secretary Eric Friedlander told the crowd.

"We had incredible enrollment. It's an incredible change." said Friedlander. "We hope it is a change for the better."

Friedlander said enrollment in every county exceede estimates for the state by the accounting firm PriceWaterhouse Coopers, based on estimates from the Congressional Budget Office. Those estimates anticipated 55 percent of eligible persons enrolling in the first year, leveling out at 70 percent in future years. Instead, enrollments through June were almost double the prediction.

Medicaid paid more than $284 million to Kentucky health-care providers in the first half of this year for treating the newly eligible Medicaid beneficiaries, with hospitals receiving 48 percent of those reimbursements, Friedlander said. He said that number will be $1 billion to $2 billion by the end of the year. (Medicaid payments sometimes take months to complete.)

The federal government is paying the entire cost of the newly eligibles through 2016. State officials have said that they won't be able to update cost estimates for 2017 a few more months because additional data must be collected about enrollees after the insured population has stabilized.

"Medicaid expansion is not static," Friedlander said. "It is dynamic, and the individuals that make up that enrollment are constantly changing."

Friedlander said employment in Kentucky health care has increased by 3,800 jobs, but the study estimated that 7,600 jobs would be added in the first year. This means enrollment is almost double what was projected yet job expansion is almost half. That undercuts Beshear's contention, based on the study, that Medicaid expansion will pay for itself by adding heath-care jobs.

As more Kentuckians get insurance, there may be shortages of primary-care doctors, especially in rural areas of states like Kentucky, reports Kaiser Health News. That need could be overstated, Sheila Schuster, a clinical psychologist and executive director of the Advocacy Action Network, said at the forum.

Kentucky has 3,929 advanced practice registered nurses, Schuster said, 54 percent more APRNs than in 2010. A new state law that took effect July 15 "removed a barrier that was keeping them from opening practices," she said. The law allows APRNs to prescribe non-narcotic drugs independently after they have prescribed under physician supervision for four years.

The law was passed after negotiations among the Kentucky Medical Association, the Kentucky Academy of Family Physicians and the Kentucky Coalition of Nurse Practitioners and Nurse Midwives. Schuster suggested that other such compromises are needed to expand access to health care.

"We aren't playing very well with each other in the sandbox," she said, adding that turf battles need to be set aside to keep health-care innovation people-centered.

The forum was co-sponsored by KET, Louisville's Health Enterprises Network, the Kentucky Health Information Exchange, the Kentucky Medical Association and Leadership Kentucky.

Bill to create panels to review medical-malpractice lawsuits passes Senate committee

UPDATE, Feb. 20: The Senate passed the bill 23-13, but House Speaker Greg Stumbo said he does not expect it to make any progress in the House.

By Melissa Patrick
Kentucky Health News

The state Senate Health and Welfare Committee approved an expanded bill Wednesday to put a hurdle in front of medical malpractice lawsuits in Kentucky.

Senate Bill 119, sponsored by committee chair Julie Denton, R-Louisville, would establish medical review panels to offer initial opinions on the merit of medical-malpractice lawsuits. A panel would consist of three medical experts. Each side in the lawsuit would choose one, and the chosen two would choose the third.

Chamber President Dave Adkisson
testifies for the bill. (KET image)

The bill is the fallback position for nursing homes (and earlier, doctors) who have been unable to get the General Assembly to offer the voters a constitutional amendment that would allow the legislature to limit damages in lawsuits. They want to decrease the number of cases that they consider frivolous but sometimes settle to limit legal fees. Hospitals and doctors recently joined the lobbying effort; the Kentucky Chamber of Commerce is also on board.

"This is common sense legislation to make sure there is merit, " Denton said. The bill passed on a 6-4 vote, with Sen. Julian Carroll, D-Frankfort, not voting after a two-hour debate.

Supporters of the bill told the committee that Kentucky's liability laws make it difficult to recruit physicians and health-care providers to the state, increase malpractice- and health-insurance premiums, and take money away from actual health care because providers spend so much on defensive practices. They said the bill would decrease the time it takes to resolve cases and decrease health-care costs.

Lawyer Larry Forgy, who represents 13 nursing homes, said lawyers from states like Florida and Texas that have passed limits on liability lawsuits were moving to Kentucky and suing the nursing homes. He said, "We have had a gator invasion in Kentucky."

Opponents of the bill said that nursing homes improved the quality of care, there would be no need for these panels. Another opponent said it would not allow adequate time for the panels to make sure all information submitted was factual.

Wanda Delaplane of Frankfort, who won a $20 million malpractice judgment, said it took four years to gather the facts for her father's case because the nursing home gave her and the state false information. She said the panel would only get information that the medical provider gave them and that this was "information that has a high degree of probability to be falsified."

Patrick Clinch of Scott County, who said his father did not receive adequate health care while in a nursing home and subsequently died, reminded the committee that the debate is not just about lawsuits, but about people, often the elderly. He said medical experts on the panels would be biased toward their colleagues, and suggested the answer to this problem is improving the quality of care.

Jim Kimbrough, AARP Kentucky state president, agreed that quality of care was the problem.

"We believe the solution to implementing the issues of care in facilities lies within each facility to improve the quality of care," Kimbrough said. He said the bill would delay the aggrieved their rightful access to the court system, and "Justice delayed is justice denied."

Similar legislation passed the Senate in 2013, but didn't get out of a House committee. It remains to be seen whether the additional lobbying power of hospitals and doctors, who are leading campaign contributors to legislators, will make a difference.

Kentucky's Obamacare website's success resulted from careful and early testing, unlike the federal website, writers say

While Kynect, Kentucky's online health insurance marketplace, is being hailed as the country's best Obamacare website, the federal government's $634 million Healthcare.gov website continues to marred by technological glitches and bad press.

"The Kentucky Kynect likely takes the award for most written-about Obamacare marketplace -- and for good reason," reports Sarah Kliff of The Washington Post. "It had one of the most flawless launches of any state marketplace, posting robust application numbers on Oct. 1. So far, the state reports that 26,174 people have enrolled in private insurance or Medicaid." That figure was through Oct. 24.

Kentucky's success resulted from the creation and careful testing of a pared-down website before the Oct. 1 deadline, writes Dylan Scott on Talking Points Memo. Beshear officially created the marketplace, Kynect, without approval from the General Assembly on July 17, 2012, a few weeks after the U.S. Supreme Court upheld the law. In October 2012, the state hired software developers to build the technological infrastructure behind the marketplace.

Testing was undertaken throughout every step of the process, Carrie Banahan, Kynect's executive director, told Scott. The system was developed from January to March of these year, was developed by June, and began testing in July, he reports.

On the other hand, testing for the federal website began just two weeks before the launch. Private contractors in charge of building the federal online health insurance marketplace said that the administration went ahead with the Oct. 1 launch of HealthCare.gov despite warnings of insufficient testing, reports The Washington Post.

“This system just wasn’t tested enough,” said Julie Bataille, communications director for the federal Centers for Medicare and Medicaid Services. 

Frustration with the federal rollout continues to grow, but Sunday on NBC's "Meet the Press" Gov. Beshear defended Health and Human Services Secretary Kathleen Sebelius and President Obama and told Obamacare critics to take it easy.

“Look, this is going to take some time to get done, but everybody needs to chill out because it is going to work,” said Beshear.

Kentucky received $252 million from the federal government to set up Kynect, and about $23.8 million of that was applied to contracts and outside vendor payments. Although startup costs for the exchange are being covered by federal grants, the state will be responsible for all funding beginning in 2015. It plans to get the money with assessments on insurance companies using the exchange, but that may prompt a battle in the 2014 General Assembly.

Indoor air study is background for smoking-ban discussion in Elliott; statewide ban sponsor is optimistic about a vote

As the debate over a statewide smoking ban persists, a study shows evidence of harmful air quality levels from second-hand smoke in places where smoking is allowed in Elliot and Lawrence counties. The researcher, the sponsor of a statewide smoking-ban bill and a skeptical legislative leader talked about the issue this month at a meeting of the Elliott County Chamber of Commerce.

The study, funded by the Kentucky Cancer Consortium, found indoor air pollution that slightly exceeded the Environmental Protection Agency's national ambient air quality standard for outdoor air, reports Kenneth Hart of The Independent in Ashland. There is no EPA standard for indoor air,

The study also found that air pollution levels averaged higher in Elliott and Lawrence counties than in Georgetown and Lexington, where laws banning smoking in building have been implemented, Hart writes.

Carol Riker

The study was conducted by trained health department researchers in 11 public venues in the two counties, neither of which have laws prohibiting smoking, from July 2012 to January 2013, Carol Riker, a University of Kentucky nursing professor who reported on the study to the Elliott County chamber.

Smoking was observed in five of the 11 venues tested. Riker said one had a level that was more than double the national outdoor air standard. She said the study pointed to a need for anti-smoking ordinances in the two counties, especially to protect the health of workers in these smoke-filled environments, reports Hart.

According to the Kentucky Center for Smoke-Free Policy at UK, that 38 Kentucky communities have adopted any sort of smoke-free law, and 22 have passed comprehensive ordinances banning smoking in all workplaces and public places.

State Rep. Susan Westrom

The chamber also heard from state Rep. Susan Westrom, D-Lexington, longtime sponsor of a statewide smoking ban. "She was cautiously optimistic that 2014 will be the year the matter finally comes up for a vote in the General Assembly after twice failing to do so," Hart reports. "Westrom said she believed a statewide law was needed to provide some consistency in anti-smoking regulations and because cities and counties have generally been slow to adopt such laws on their own."

House Democratic Floor Leader Rocky Adkins, an Elliott County native, said such decisions should be made locally. "But Adkins — who told the chamber he spent many hours working in tobacco fields and barns as a younger man, but had never taken so much as a drag off a cigarette his entire life — said he was keeping an open mind on the idea a statewide smoke-free law and would consider changing his stance if his constituents indicated they were in favor of it," Hart reports.

Kentucky will soon require simple screening at birth to detect silent killers of newborns

A new state law taking effect in January will require all babies born in Kentucky to be screened for critical congenital heart disease, which is often a silent killer of newborns who appear to be healthy and who are discharged from the hospital with the unrecognizable disease.

Since Indiana became the first state in the nation to get such mandatory screening signed into law in May 2011, more than 20 states have passed legislation requiring a non-invasive, inexpensive screening test called pulse oximetry at birth, reports Laura Ungar of The Courier-Journal. The test can detect this life-threatening disease and allow health care providers to act quickly to save the baby's life.

Don Shieman, Kentucky state director of the March of Dimes, who helped lobby for the law with the state legislature, said about 65 infants are born with CCHD in Kentucky each year. “If we can detect the problem soon enough, we can save lives,” Shieman told Ungar. State Sen. Dennis Parrett, an Elizabethtown Democrat who helped sponsor the state’s new law, said this requirement is a simple solution to a deadly problem he know something about.

“My wife and I have some experience with this,” Parrett told Ungar. “Our younger daughter was born with a severe heart defect” called tricuspid atresia, and underwent surgery at Kosair Childen's Hospital and her heart is doing fine, Parrett told Ungar. “There’s a lot of infants whose heart defects are not caught,” Parrett said. “What we wanted to do is make it a part of normal infant screening.”

Each test costs about $4, so Parrett said there’s no real fiscal impact to adding pulse oximetry to the list or required screenings for newborns, says Ungar. In general, hospitals already have the equipment for the test, many of which are already doing the test.

The legislation could lead to success stories similar to that of Shooter Bratcher of Caneyville, right, who was treated for infection and underwent surgery for CCHD recently at Kosair. Shooter was born full-term and and seemed normal at birth, but about five days after going home, things just didn't seem right, and he kept getting worse. Shooter's parents took him to the ER at their local hospital, Twin Lakes Regional Medical Center in Leitchfield, where doctors didn't pick up on his CCHD, Ungar reports. A day later, he went by ambulance to Kosair, and could have died if his parents didn't notice the little signs of a problem. Unfortunately, such signs sometimes show up at night, when parents are asleep or not paying close attention. Other times, the disease isn't caught quickly enough, leading to serious serious problems such as infections, brain damage, disability or death, Ungar reports.


Pulse oximetry will allow health care providers to detect seven types of CCHD. For more information about the test, the law or to watch a video in which Shooter's parents share their story, click here.

State officials tell health-care providers to meet with managed-care companies to get paid, say new system is improving health

By Molly Burchett and Al Cross
Kentucky Health News

At the latest in a series of forums on Medicaid managed care, state officials said the new system has improved the quality of care, but you could cut the tension with a scalpel in the packed auditorium at the University of Kentucky as they fielded complaints and questions and urged the providers to work out the problems with managed-care companies themselves.

Gov. Steve Beshear and the Cabinet for Health and Family Services say the forums are designed to improve relations between providers and the managed-care organizations, but reactions from capacity crowd of health care providers and staff -- reactions that included a roomful of laughter about the MCOs' low count of transferred phone calls from providers -- suggested that the state’s solutions to providers' problems with the companies aren’t quite the solutions sought by providers.

Kentucky's transition to Medicaid managed care

In 2011, Kentucky was faced by spiraling Medicaid costs that gave the state two options: cut reimbursement rates to providers by a third or moving from a fee-for-service model to a managed- care system, in which MCOs get a specified fee for each patient they manage and use the money to pay providers, said Lawrence Kissner, commissioner of the Department for Medicaid Services.

The change is driving improvements in health for Medicaid clients while saving the state money, said Kissner: It has increased well-child visits for children aged 3-6 from 2 percent to 53 percent, has increased diabetes testing from 6 percent to 59 percent, and has improved adult access to preventative and ambulatory health services.

MCOs also have numerous quality initiatives underway, said Kissner, including one in improving anti-depressant medication management and compliance.  One company, Wellcare, has worked to improve oral health through a campaign that offered $10 gift cards for dental visits, but no one hears about this, he said.

What we've heard are complaints from physicians, hospitals, pharmacies and other health-care providers who aren’t getting some claims paid in a timely manner, or at all. Providers say manage care's complicated pre-approval process, designed to limit costs, delays critical treatment for patients and adds unsustainable administrative burdens.

Read more here: http://www.kentucky.com/2012/02/08/2061060/health-care-providers-say-medicaid.html#storylink=cpy

State officials' response: meet with the MCOs

Kissner said the new system denies 6 percent of providers' requests for pre-authorization, compared to the fee-for-service model that only denied 1 percent of such requests, but he says that's about the same as other states that use managed care.

About 20 percent of providers' claims have either been denied or suspended. In the first 14 months of managed care, 22 million of the 28.3 million claims, or 78 percent, were paid within 30 days. Kissner said 4.9 million (17 percent) were denied in 30 days and 1.2 million (4 percent) were suspended; he did not mention  the monetary amount of the denied or suspended claims.

Kissner speaks to crowd at UK; Cabinet Secretary Audrey Haynes looks on from first front-row seat.

When an audience member questioned the lack of payment for hospice services, Cabinet Secretary Audrey Haynes replied, “There are some providers around the state that have been quite vocal about how much we owe them, but when there’s been an attempt to sit down and work it out with them, they will not make an appointment.” She said it is a provider’s responsibility to reach out to MCOs about the payments they are owed.

“It is about you going to each one of them and setting an appointment for them to work out with them you’re accounts receivable," Haynes said. “If you really want to get paid and if you are really owed, and I believe most of you are, then let’s get an appointment set” with the MCO.

“We want this worked out,” said Haynes. “The time has come and gone for us to still be having problem getting payment if your contract says you deserve payment. These folks know they are on the hook. Let's all work together to get it fixed.”

Meetings with MCOs are part of the plan Beshear outlined after vetoing House Bill 5, which the last session of the General Assembly passed to help providers receive prompt payments from MCOs. The plan also requires the state Department of Insurance to investigate payment complaints and to conduct audits of this process. The department began this work in April and says it does not yet have statistics about 'clean claim' approval rates.

However, audits by the state's managed-care branch have shown Kentucky Spirit and Coventry Cares to be deficient in their financial management, and the state has implemented "corrective action plans" to address those deficiencies, said Kissner.
  
Providers' response to dispute-resolution plan

It may be an unwelcome change for providers as they now may have to set up consultations with MCOs to receive the money owed to them. They may ask: How many other business-to-business contracts require the service provider to meet face-to-face with the payor in order for the provider to be paid for contracted services that have already been provided? They argue that delayed payments and fee cuts could stretch medical practices and hospitals so thin that those needing care might be at more risk.

One provider in the audience addressed this concern, asking how general dentists are supposed to continue giving high-quality care to all patients if their fees are getting cut, but our expenses are going up? None of the officials on the panel answered the question.

Another audience member asked about provider fee cuts, and after the microphone was passed around to Kissner, he said the reductions are a part of the transition process to managed care, which was initiated to avoid a 35 percent Medicaid rate cut.

"When managed care enters into a a fee-for service environment, there's savings in a variety of pockets," Kissner said. "How do they control costs and try to make a profit in the system?"

The forum wrapped up with question from another skeptical audience member: Will this really make a difference?

"Well, you tell me, said Haynes. "And I'm sorry for those of you that feel like it will not make a difference because everyone in this room would have seen a 35 percent cuts in your rate, in all rates, had we not gone to managed care.  Not only that, our folks were not getting healthier, and we have proof of that." In her opening remarks, she said the state has spent billions of dollars on health care for the poor without seeing an improvement in the state's health status, so a different approach was needed.

Future forums

Kissner said the forums between the MCOs and providers are expected to resolve disputes by January, the deadline given to the cabinet by Rep. Bob Damron, D-Nicholasville, during a meeting of the joint Administrative Regulations Review Subcommittee. Damron and other legislators have "vowed to lead a legislative revolt" if the administration doesn't fix these late payment issues between providers and MCOs by then, reports Ronnie Ellis of CNHI News Service.

All the managed-care forums follow the same agenda, which can be found along with additional information at the Medicaid website. The dates and locations of the remaining forums are:

• Region 2, June 20: Main Lodge, Pennyrile Forest State Resort Park (20781 Pennyrile Lodge   Road., Dawson Springs) 
• Region 3, June 24: Kent School of Social Work, University of Louisville Shelby Campus (312 N. Whittington Pkwy., Louisville) 
• Region 4, June 26: VP Henry Auditorium, Lindsey Wilson College (210 Lindsey Wilson St., Columbia) 
• Region 6, June 27: Student Union Building, Northern Kentucky University (20 Kenton Drive, Highland Heights) 
• Region 1, July 15: Curris Center, Murray State University (102 Curris Center, Murray) 

Poll shows strong support for medical marijuana in Kentucky

A statewide poll has found that 78 percent of Kentucky adults support the use of marijuana for medicinal purposes if recommended by their doctor, while only 26 percent of favor it for recreational purposes.

There were no significant differences in the poll results among the regions of the state on the medical-marijuana question, but on the recreational-use question, the Louisville area and Northern Kentucky were more likely to favor it, at about 37 percent. For geographic and demographic breakdowns of the poll results, click here.

Nationally, 17 states and the District of Columbia allow medical marijuana, and three states have recently legalized it for recreational use.

“Our Kentucky Health Issues Poll is designed to be informative to Kentucky policymakers,” said Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. “Over the past several years, bills dealing with legalization of marijuana have been filed in the Kentucky General Assembly. This research gives policymakers a snapshot of Kentuckians’ views on this issue and should be helpful as lawmakers consider issues for the 2014 legislative session.”

For years, Sen. Perry Clark, D-Louisville, has introduced bills in the Kentucky Senate aimed to legalize medical marijuana. Although the bills, referred to as The Gatewood Galbraith Medical Marijuana Memorial Act, gained media coverage in the 2012 and 2013 legislative sessions, they have not received a committee hearing and have not passed.

The poll was funded by the foundation and the Health Foundation of Greater Cincinnati and was conducted last year from Sept. 20 to Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones, and the poll has a margin of error of plus or minus 2.5 percentage points.

Deadly, drug-resistant bacteria are becoming more common in Kentucky hospitals; key lawmaker wants to require public reporting

Nightmarish, drug-resistant bacteria that cause deadly infections are becoming more common in Kentucky hospitals, and a leading legislator on health issues says they should be required to report each case.

The state Department for Public Health and hospital officials are investigating the presence of carbapenem-resistant Enterobacteriaceae, or CRE, at Kindred Hospital Louisville, right, a long-term and transitional care facility.

“Since July, we have identified about 40 patients in whom we have cultured the organisms from one or more body fluids,” Dr. Sean Muldoon, chief medical officer for Kindred, told Laura Ungar of The Courier-Journal.

These superbugs kill about half of the patients who get infected. They have become resistant to nearly all the antibiotics available today, including drugs of last resort. CRE infections are caused by a family of germs that are a normal part of a person's healthy digestive system but can cause infections when they get into the bladder, blood or other areas where they don't belong, says the federal Centers for Disease Control. The presence of CRE in bodily fluids doesn’t mean someone is infected by the bacteria, because the patient could also be “colonized” by the bacteria without developing an infection, said Muldoon. CRE may be present in a patient before he or she is admitted to the hospital, or it can be transmitted from patient to patient at the hospital, Ungar notes.

Officials at several Louisville-area hospitals told The Courier-Journal last month that they have seen a growing number of CRE cases in recent years, reports Ungar. The CDC issued a warning report about the bacteria last month, but there has only been one "outbreak" of CRE listed for Kentucky. (Read more)

Given the threat of this bacteria, the CDC has called for quick action to stop these deadly infections, and the chairman of the House Health and Welfare Committee wants to tighten up CRE reporting requirements.

Rep. Tom Burch, D-Louisville, sent a letter to Gov. Steve Beshear proposing a new regulation that would mandate immediate reporting of CRE infection or colonization to the state. Burch said he plans to introduce a bill that would require such reporting by health-care facilities, and he is working with Dr. Kevin Kavanagh of the Somerset, Ky.-based watchdog group Health Watch USA, reports Ungar.

“If it gets in the community and spreads, we’re in trouble,” Kavanagh told Ungar. Burch emphasized this level of risk in his letter to the governor, saying that health-department involvement is crucial to preventing this deadly bacteria from "developing a foothold in Kentucky."

House sends Senate pill-mill and Medicaid managed-care fixes

The state House yesterday approved without dissent two bills aimed at improving Kentucky's health care.

House Bill 217 addresses some "unintended consequences" of last year's "pill mill bill" by easing some of the bills regualtions. The bill also tightens restricitions on prescription drugs, reports Ryan Alessi of cn|2.

The other measure, House Bill 5, deals with payment problems of the Medicaid managed care system. Itl would apply the prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints and disputes to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

Both bills are expected to see action in the Senate.

Lack of statewide smoking ban represents one part of Kentucky's struggle to deal with tobacco use and the health issues it creates

By Molly Burchett

Kentucky Health News

As the bill for a statewide smoking ban lies on its deathbed in the General Assembly, new federal data show Kentucky still has the highest percentage of smokers (29 percent) of any state, leads the nation in the share of smoking high school students (24 percent) and spends only a minuscule portion of their tobacco revenues to fight tobacco use. Those figures come from the federal Centers for Disease Control and Prevention's Tobacco Control State Highlights 2012 report. (For county-by-county figures, click here.)

The lack of a statewide smoking ban, which nevertheless has become popular among Kentuckians, represents only a small part of the struggle to address Kentuckians' tobacco use and resulting health problems. Kentucky's program to discourage tobacco use has been severely underfunded for years, contributing to the state's lack of or slow progress in reducing its smoking and tobacco use rates and subsequent health problems, said Dr. Ellen Hahn, director of the Kentucky Center for Smoke-Free Policy at the University of Kentucky.

State tobacco revenue (left bar) and spending (right bar)

The CDC says Kentucky should spend $57.2 million a year to have an effective, comprehensive tobacco-prevention program, but the state allocates only $2.1 million a year to such programs -- 3.7 percent of the recommended amount.

By another measure, the amount is only 0.6 percent of the estimated $381 million the state gets from tobacco taxes and the 1998 national settlement with cigarette manufacturers, according to a tobacco settlement report.



Meanwhile, Kentucky's health-care costs attributable to smoking add up to about $1.5 billion a year, and smoking-caused productivity losses total $2.3 billion a year. These amounts do not include health costs caused by exposure to secondhand smoke, smoking-caused fires, smokeless tobacco use or cigar and pipe smoking.

Despite the known health risks that tobacco use poses, smoking in Kentucky remains a part of everyday life in most places. But that is increasingly less so around the country, so there is an increasing gap between heavy-smoking and low-smoking states; smoking in Kentucky is about twice as prevalent as in Utah and California, reports Steven Reinberg of HealthDay. Click here for an interactive map of states' tobacco prevention efforts.

There are proven, multi-pronged strategies to curb smoking. They include combinations of higher tobacco taxes, smoke-free laws, media campaigns, and restricted access to tobacco products. However, Kentucky continues to lag behind other states due to "stagnant policies" and a lack of funding, said Hahn.

Many other factors contribute to Kentucky's lack of tobacco-prevention progress. By failing to substantially reduce adult smoking, the state misses opportunities to encourage younger adults and children not to smoke, Hahn said. Kentucky needs to employ strategies that communicate the success and affordability of tobacco cessation programs, she said; people often lack the encouragement to quit smoking because they don't know how or they don't believe it is possible.

The latest tobacco report is a timely reminder that tobacco use remains a huge public health problem for Kentucky and there are proven strategies that, if implemented, could help Kentuckians live a healthier, tobacco-free life.

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.

Bill to make Medicaid managed-care firms pay up, and more promptly, nears final form in House and will get attention in Senate

By Molly Burchett and Al Cross
Kentucky Health News

The complaints by many health-care providers about Medicare managed-care firms' delay or denial of payment claims appears to be generating a bipartisan solution in the General Assembly. A bill on the House floor that would transfer late-payment complaints to the state Department of Insurance, which enforces Kentucky's prompt-payment laws, appears to have support in the Senate.

House Bill 5 would apply the 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.

Hospitals, doctors and other health care providers have complained that the cabinet is not resolving their payment disputes with managed-care firms. The bill cleared the House Health and Welfare Committee Feb. 21 and is awaiting a vote on the House floor. The bill is sponsored by House Speaker Greg Stumbo.

Sen. Julie Denton, chair of the Senate Health and Welfare Committee, told Kenny Colston of Kentucky Public Radio that she plans to give the bill a hearing and supports its intent to make managed care organizations pay providers. "I think anything we can do to have more oversight and more assistance in keeping them in compliance with their contracts is a welcome breath of fresh air," she said.

Senate President Robert Stivers said he has concerns about the bill affecting the MCOs contracts with the state. But he said his chamber will take a look at the bill, Colston reports. The cabinet has had the same concerns, and some other objections that are to be addressed by House floor amendments.

Kentucky providers report being burdened by a lack of or delayed payments from the new managed-care system. Kentuckians have called for immediate action by state government to help fix these issues on behalf of providers and patients, which has prompted this bipartisan legislative response.

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.

Bill to shield nursing homes from lawsuits clears Senate along party lines; not looking healthy in House despite TV, radio ads

Last week the state Senate approved on party lines a bill that would make lawsuits against nursing homes go through a review panel first. Republicans supported the bill and Democrats voted against it in a 23-12 vote that marked the clearest partisan split in the Senate in this year's legislative session.

Senate Bill 9 would create medical review panels of three physicians and an attorney moderator to hear complaints against long-term care facilities and vote on whether the suit had enough merit to go to court.  The bill's sponsor, Senate Health and Welfare Chairwoman Julie Denton, R-Louisville, declind to answer an opposign senator's questions about the bill. She said in introducing it that the panel would be advisory but its opinion would be admissible in court and would curb such lawsuits, reports Jack Brammer of the Lexington Herald-Leader.

Bills like this have failed in years past and could have diverse implications for Kentucky communities and nursing homes. At least one Kentucky newspaper looked around and found that lawsuits are one reason Extendicare Health Services Inc. shed management responsibilities last year for all 21 of its facilities in Kentucky, reports Nick Tabor of the Kentucky New Era in Hopkinsville.

Without Extendicare management in Western Kentucky, the volume of nursing-home lawsuits in the region appears to be shrinking, Tabor reports. In recent years, nearly all the Christian County cases that have been closed were dismissed through settlements, not by judges declaring them unfounded. This suggests the bill would minimally affect the county, writes Tabor. Other Kentucky communities may be affected differently; judges differ from circuit to circuit.

Although the bill passed the Senate, it appears to be on its deathbed in the House. Rep. Tom Burch, D-Louisville, who chairs the House Health and Welfare Committee, joked about its prospects to Tabor: “I can’t make any predictions about the bill this time, but I’ve called in three priests to have the last rites ready.” If nursing homes received this new layer of protection, he said, hospitals and day-care centers would want it too.

A similar bill died in Burch's committee last year; this version is being supported by television and radio commercials urging viewers and listeners to call their legislators in support. When Extendicare announced last spring it was transferring management of all its Kentucky facilities to a Texas company, it cited Kentucky’s “worsening litigation environment” and said tort reform seemed unlikely here.

Bernie Vonderheide, director of Kentuckians for Nursing Home Reform, said most so-called “frivolous” lawsuits would cease if the state imposed minimum staffing requirements on nursing homes, his group's main legislative goal. (Read more)

Herald-Leader says state running out of time to fix Medicaid managed care, with decision on expansion looming

A recent editorial in the Lexington Herald-Leader called for swift legislative action to fix the problems of Medicaid managed care. Timely action is even more necessary since the state is considering expanding the program, some critics have said.

Fifteen months ago the administration of Gov. Steve Beshear made a quick transition to managed care that privatized Medicaid for 550,000 poor, elderly and disabled people and was projected to save Kentucky $375 million in three years.  If the state expands Medicaid, that number of covered individuals could grow to more than 1 million — or roughly a quarter of all Kentuckians.

Although Medicaid is encouraging preventive care, such as more well-child visits and diabetes testing, providers haven't been paid for some of their services. The state recently granted the managed care companies a seven percent rate increase, and the companies have said they're losing money here and one is pulling out in July. But at the end of the first eight months of managed care Medicaid, the state had paid $500 million more to the companies than the companies had paid to providers.

"The delay and denial of payments are creating financial crises for providers and pharmacies and forcing small hospitals to lay off employees, deplete reserves and default on bonds," the editorial said. "This is creating a massive transfer of wealth from Kentucky medical practices and hospitals to for-profit companies based in other states. . . . For patients, the companies are putting up barriers to care that would be illegal in the private sector. The new burdens that have been placed on vulnerable Kentuckians and their medical providers threaten to unravel not just the safety net but, in some places, the whole health care system."

The editorial called on the General Assembly to pass legislation to curb abuses such as "the stiffing of hospitals that provide emergency care as required by federal law. . . . House Bill 299 and Senate Bill 178 would also curb the false economy of severely limiting in-patient mental-health care for children while referring them to nonexistent out-patient care."

The legislation would also require Medicaid managed care companies to:

• Meet the same provider network standards, including distance to hospitals and obstetrical care, as other insurers operating under Kentucky law.
• Decide claims based on nationally recognized clinical standards and provide specific reasons for denials so providers would know what's allowable.
• Participate in an appeals process for denied claims.

Appalachian Regional Healthcare wants to sue the U.S. Department of Health and Human Services and others, alleging that the new system is out of compliance with federal law.

"The feds shouldn't have to be dragged in," the editorial says. "The federal government covers roughly 70 percent of Kentucky’s $6 billion Medicaid program. Expanding Medicaid to include more low-income people is a linchpin of federal health care reform," and Beshear has said that he wants to expand Medicaid if the state can afford it. "Kentucky can't wait much longer to get Medicaid right." (Read more)