New coronavirus cases in Ky. rose 46% last week, and CDC says two counties have a medium level of risk: Montgomery and Bath

Centers for Disease Control and Prevention map from data gathered March 29 through April 4

By Melissa Patrick

Kentucky Health News

New coronavirus cases rose 46 percent in Kentucky last week, and deaths attributed to Covod-19 also increased. And after the state had a week in which every county was estimated to have a low risk of infection, two counties, Bath and Montgomery in east-central Kentucky, moved into the medium-risk zone. 

The state Department for Public Health's latest report showed there were 3,245 new confirmed cases of the coronavirus last week, or 463 cases per day. In the prior week, the state reported 2,222 new cases, or 317 per day. 

While the number of new cases went up, the new-case rate fell to 5.5 cases per 100,000 residents from 6.91 the week before. The top 10 counties were Nelson, 12.05 cases per 100,000; Wayne, 11.94; Henry, 11.52; Bath, 11.43; Clinton, 11.18; Hardin, 10.94; Union, 10.93; Adair, 9.67; Taylor, 9.42; and Powell, 9.25. 

The weekly Centers for Disease Control and Prevention risk map shows that all but two of Kentucky's 120 counties have a low risk of Covid-19. The two counties with a medium risk, shown in yellow, are Montgomery and Bath. Low-risk counties are shown in green.

The CDC continues to advise those in medium-risk counties, and those anywhere who are at high risk of getting very sick, to wear a well-fitting mask when indoors and in public; and to consider getting tested before having social contact with someone at high risk for getting very sick, and consider wearing a mask when indoors when you are with them.

The CDC also provides a community level transmission map, largely used by health-care facilities and researchers, that shows the level of virus in each county, at one of four levels. The latest map shows 10 counties with a low level of transmission and 70  with a medium level; the rest are either substantial or high. The state says residents should take their guidance from the other map.

The state attributed 57 more deaths to Covid-19 last week, up from 49 the week before. The state's death toll from Covid-19 is now 18,349. Attribution of a death can be weeks later than the date of death.

Overdose deaths in Ky. workplaces tripled in 2019-2021; in the latter year they were the 2nd leading cause of occupational fatality

Graph by Kentucky Injury Prevention Research Center

By Melissa Patrick

Kentucky Health News

Drug-overdose deaths in Kentucky workplaces tripled from 2019 to 2021, according to the latest annual report from the Kentucky Fatality Assessment and Control Evaluation program.

The program, part of the Kentucky Injury Prevention and Research Center, found that from 2017 to 2021, the state had 47 overdose fatalities in the workplace, reaching its highest number ever of 18 fatalities in 2021. That was a 260 percent increase from 2017.

Of the 96 occupational fatalities recorded in Kentucky in 2021, drug-overdose deaths accounted for 19%, an increase from 13% in 2020 and 8% in 2019. That put overdose deaths second to motor-vehicle crashes, which were 29% of the total. In third place (17%) were "struck by" and "striking against" injuries, forcible contact or impact with an object that creates an injury.

Most of the occupational drug-overdose deaths in 2017-2021 occurred in the trade, transportation and utilities industries (38%), followed by manufacturing (19%), construction (19%) and the leisure and hospitality industry (11%). The remaining 13% took place in services and public administration.

The report notes that all of the occupational overdose deaths in the leisure and hospitality industries happened in 2020 and 2021.

It also points to the jump of occupational-overdose deaths in Jefferson County. In 2021, seven of the state's occupational overdose deaths, nearly 40% of the total, occurred in Jefferson County. That was one short of the total for the previous four years combined.

Drinking while pregnant can have long-lasting effects on children, but almost 1/2 of pregnant Kentuckians report consuming alcohol

Centers for Disease Control and Prevention illustration

Did you know that children of mothers who drink alcohol during pregnancy can undergo changes to their facial features, accompanied by a variety of lifelong mental and physical challenges? And some other changes may not be visible. Exposure to alcohol before birth can also affect systems throughout the body and have lasting impact, Emma Yasinski reports for National Geographic.

"Studies have estimated that fetal alcohol spectrum disorders, or FASD, affect between 1 and 5 percent of the population, though experts suspect the prevalence is even higher," Yasinski reports. 

The FASD United Policy and Training Center website says FASD is the "most commonly known cause of developmental disabilities in the United States," and recent research shows up to one in 20 first graders have a disability from it.

Almost half of Kentucky women with a recent live birth consumed alcohol during the three months before pregnancy. The figure was 48.7% in 2019, according to the America's Health Rankings report from the United Health Foundation. The national rate was even worse, 56.7%.  

FASD-related problems

It wasn't until the early 1970s that researchers found a pattern among babies born to mothers with severe alcohol-use disorders, including hallmark facial features such as a smooth upper lip, a small head, and a flat nasal bridge. These features were generally accompanied by a variety of lifelong mental and physical challenges such as learning disabilities, difficulty reasoning, growth deficiencies, and heart and kidney problems," Yasinski reports.

Since then, researchers have found that prenatal alcohol exposure can disrupt development of the brain and body even without affecting the face, and include a broad range of conditions that are often inconsistent from one patient to another. Yasinski also delves into the details of how FASD changes the brain. 

The FASD center says people with the disorder often have difficulty learning and remembering, understanding and following directions, shifting attention, controlling emotions and impulsivity, communicating and socializing, and performing daily life skills. It says FASD cases are seriously under-diagnosed and often hard to distinguish from other developmental disorders. 

Further, Yasinski reports that diagnosis requires complex tests and treatments that, due to limited resources and awareness, many patients never get.

“Alcohol affects the brain in different ways, depending on when the brain is exposed in pregnancy and how much it's exposed, and what else is going on, like nutritional factors, genetic factors, other things about the mom and the fetus,” Jeffrey Wozniak, a neurobehavioral development researcher at the University of Minnesota, told Yasinski. “So there's a lot of variety in terms of the brain effects.”

How prevalent is drinking during pregnancy? 

According to Kentucky's 2020 births report from the Public Health Neonatal Abstinence Syndrome Reporting Registry, "Alcohol use was reported by mothers of 4.8% of infants with NAS in Kentucky, which may be lower than the actual rate of use."

Centers for Disease Control and Prevention data show that in 2018-20, 13.5% of pregnant U.S. adults reported that they were currently drinking and 5.2% reported they had engaged in binge drinking.

Many women drink without knowing they are pregnant, and that harm a fetus. About half of all U.S. pregnancies are unintended, and most women don't know they are pregnant until four to six weeks into the pregnancy.

While binge drinking and regular heavy drinking put a fetus at the greatest risk for sever problems, even lesser amounts can also cause damage, says the National Institute on Alcohol Abuse and Alcoholism. 

"In fact, there is no known safe level of alcohol consumption during pregnancy" says the institute. 

Looking forward

The good news is that in the early 2000s, "Studies started to show that targeted therapies could help people who were prenatally exposed to alcohol," Yasinski reports.  

For example, Julie Kable, a neurodevelopmental exposure researcher at Emory University in Atlanta, told Yasinski that she and her team found with the CDC that offering adaptive support helped people with FASD better learn and understand math. Yasinski says researchers have also found ways to help people with FASD with executive function and decision making. 

Kanle told Yasinski, “No longer could we allow pediatricians to say, Well, why should I diagnose it when there's nothing we can do about it?”

But Yasinski reports that the U.S. has too few places that can diagnoise FASD, "and some states don’t even have a single FASD diagnostic center. Since diagnosis requires comprehensive evaluations, the centers that do exist have limited capacity to complete them. Many will only see patients who they know were very likely to have been exposed to alcohol in utero, which accounts for a fraction of those believed to be affected."

She adds,, "While most experts agree on the basic characteristics of FASD, there are also minor differences in diagnostic criteria between states, countries, and clinics, with slightly different cutoffs."  And this, she reports "can create challenges for researchers working to build large data sets, but it also has more immediate impact." For example, one FASD specialist told her that individuals with FASD in some states don't qualify for disability services because " the CDC only has consistent diagnostic criteria for fetal alcohol syndrome, not the whole spectrum of disorders." 

Some in Congress are working to provide resources for screening, research and other supportive services for people with FASD, in a bill called the FASD Respect Act. The FASD United Policy and Training Center says a new version of this bill is to be introduced.

Susan Shepard Carlson, who was a district court judge and first lady of Minnesota, told Yasinski that she is advocating for this bill largely because she realized in 1997 that a many children coming through the courts "had the same kind of profile [as] someone with FASD . . . but we weren't really looking at the underlying cause." 

Because of this, Carlson convened a task force that led to the state funding FASD research and treatment. "The court was able to screen children suspected of having an undiagnosed FASD, and she says about 25 percent of the kids they chose to screen did have an undiagnosed disorder," writes Yasinski.

Kable told Yasinski, “It’s really important to know that we can still have dramatic differences in the developmental outcome of these children, if we get them recognized, and get them services as early as possible.” 

Information for this story was also gathered by Melissa Patrick of Kentucky Health News.

Maternal deaths up in Ky., U.S., especially among Blacks; state's rate is sixth in nation; drug and substance abuse are big factors

National Center for Vital Statistics graph, via Centers for Disease Control, adapted by Ky. Health News

By Melissa Patrick

Kentucky Health News

Pregnancy-related deaths continue to be on the rise across the nation, going up nearly 40 percent between 2020 and 2021, according to the Centers for Disease Control and Prevention.  

The National Center for Health Statistics found that 1,205 women in the U.S. died from pregnancy-related causes in 2021, up from 861 deaths in 2020 and up from 754 deaths in 2019, or nearly 60%.

The national maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births, compared with a rate of 23.8 in 2020 and 20.1 in 2019. The report also found that maternal death rates increased with maternal age.

The report did not provide state-level data, but data provided to Kentucky Health News by the CDC shows that in 2018-21, 38.9 Kentucky women out of 100,000 died while they were pregnant or within 42 days after childbirth.

During that period, Kentucky had the nation's sixth highest maternal mortality rate, one that was 65% higher than the national rate of 23.5 deaths per 100,000 births. And when compared to surrounding states, Kentucky had the third highest rate, behind Virginia and Tennessee, both with rates of 41.7 deaths per 100,000 births. 

That said, the CDC calls for caution when comparing state maternal-death data because the actual numbers are small and reporting systems vary by state.  

The United Health Foundation's America's Health Ranking report, using federally available data, shows Kentucky's annual maternal death rates were 24.3 per 100,000 births in 2020; 29.7 in 2021; and 34.6 deaths in 2022. 

To address this issue, Kentucky legislators established the Maternal Mortality Review Committee in 2018 to review all maternal deaths from any cause that occurred during pregnancy or within a year of delivery.

Key findings in the annual 2021 report, for 2013-19, include: 91% of maternal deaths in 2018 were deemed to be preventable; 16% were pregnancy-related; 52% were pregnancy-associated, meaning that the death resulted from a cause unrelated to pregnancy; and 52% had substance-use disorder linked to the death. 

It also found that of the 339 maternal deaths that occurred in 2013-19, 21 of them, or 6%, were by suicide and 128 of them, or nearly 38%, were accidental, meaning that the death occurred from an "inadvertent event," which includes, among other things, overdose deaths. For example, in 2019 alone, the report found that 44% of the accidental deaths were from drug overdose. 

A bill to ensure greater access to information and resources for mental-health care before and after the birth of a child passed out of the legislature this year and has already been signed into law. 

Senate Bill 135, sponsored by Sen. Shelley Funke Frommeyer, R-Alexandria, calls on the state Cabinet for Health and Family Services to create written information on perinatal mental-health disorders, including postpartum depression, and make it available on its website. It also requires the cabinet to provide access to online clinical assessment tools to help providers detect the symptoms of perinatal mental-health disorders.

The cabinet is also charged with creating a panel of maternal- and infant-health experts to explore the issue of perinatal mental-health disorders, including prevention, treatment and gaps in service. The panel is required to report its findings to the Interim Joint Committee on Health, Welfare and Family Services and the Advisory Council for Medicaid Services on or before Nov. 1 of each year.

CDC photo

In 2018, Black women in Kentucky had a maternal pregnancy-related death rate of 40.2 deaths per 100,000 births -- three times the rate of white women, at 13.1 deaths per 100,000 births. 

Maternal deaths among black women are higher across the nation. In 2021, the CDC report found that the maternal mortality rate for Black women was was 69.9 deaths per 100,000 births, which was 2.6 times the rate for white women, at 26.6 deaths per 100,000 births. 

Black Maternal Health Week is April 11-17 and the Louisville Coalition for Black Maternal Health is holding programs each day to bring awareness to this issue. The list of events can be found on their Facebook page. 

The state report points to a number of risk factors impacting maternal mortality, including, "tobacco use, obesity, racial disparities, depression, opioid use, and other social determinants of health such as transportation, access to care, domestic violence, and a rural state."  It also notes that conditions such as diabetes, hypertension, or other health conditions require additional follow-up and management during the pregnancy.

That said, the state report found that 21% of the women who died had received no prenatal care and 26% of them had had less than four visits during their pregnancy.

Medicare Advantage TV ads and other marketing will have to follow new rules aimed at stopping deception of beneficiaries

Cover of report asking Medicare to act

Kentucky Health News

Those incessant ads and phone calls about Medicare, and other marketing devices that the federal government considers deceptive, are about to get makeovers. At least that's what the feds have in mind.

On April 5, the Centers for Medicare and Medicaid Services "finalized a slew of Medicare Advantage marketing reforms for the upcoming 2024 Medicare open enrollment season, including plans to crack down on general television advertisements after concerns over such marketing kicked into high gear last year, Michalle M. Stein reports for Inside Health Policy.

CMS said last fall that it was worried about marketing practices, particularly concerned about TV commercials for Medicare Advantage, which most Medicare beneficiaries now have. Private insurance companies run MA plans, making money by getting a flat fee from Medicare for covering each beneficiary, then controlling costs by limiting claims payments and taking other measures.

"The Senate Finance Committee fanned those flames with a report that alleged bad actors in 14 states were taking advantage of loopholes and lax rules around marketing and enrollment, “badgering seniors on the phone, confusing them on television, and inundating them with mountains of mail,” and noting complaints to CMS doubled between 2020 and 2021.

"Widespread television advertisements with celebrities claim that seniors are missing out on benefits, including higher Social Security payments," the report said, calling the ads deceptive. It urged CMS to act.

CMS said, “The proliferation of certain television advertisements generically promoting enrollment in MA plans has been a specific topic of concern. To address these concerns, CMS is prohibiting ads that do not mention a specific plan name as well as ads that use words and imagery that may confuse beneficiaries or use language or Medicare logos in a way that is misleading, confusing, or misrepresents the plan.”

The proposed regulations would, also require insurers to:

• Notifying enrollees annually and in writing of their ability to opt out of phone calls regarding Medicare Advantage and Part D;
• Explain the effect of an enrollee’s enrollment choice on their current coverage when they make an enrollment decision;
• Simplifying plan comparisons by requiring medical benefits be in a specific order and listed at the top of plans’ Summary of Benefits;
• Ban marketing of savings information based on a comparison of typical expenses for uninsured individuals or the unpaid costs of beneficiaries eligible for both Medicare and Medicaid;
• Limit the use of the Medicare name, logo and card in ads.

UK is ‘Centering and Celebrating Cultures in Health’ during National Public Health Week, which runs through Sunday

Advocates celebrated a National Public Health Week at the University of Kentucky.

By Grace Colville

University of Kentucky

From fostering collaborations to increase lifesaving cancer screenings, to examining the impact of an environmental disaster, to shedding light on vaccine hesitancy in Eastern Kentucky, experts in public health are all around us, seeking ways to improve and health and well-being of the population.

April 3 marks the beginning of the annual National Public Health Week, a time to recognize the contributions of public health and highlight issues that are important to improving our nation's health. This week, organizations across the country — including the University of Kentucky College of Public Health — are hosting events to promote public health's passion, purpose and pathway for a healthier life.

Each year, a different theme is chosen to recognize and celebrate public health in a different capacity. This year, the theme is "Centering and Celebrating Cultures in Health." The goal of this theme is to celebrate how we learn from the communities we are born in and the ones we build together.

“This year’s theme means inclusiveness and coming together,” said Acting College of Public Health Dean Heather Bush. “We feel strongly that community is a big part of what we do in public health and we see essential value in hearing from communities.”

“Everyone belongs here,” said Jonathan Gent, chief of staff at the college and organizer of UK’s National Public Health Week events. “Inclusive excellence is only possible with diversity of thought and creating a welcoming atmosphere — for everyone. We aim to be a champion of diversity, equity and inclusion, in line with our vision to be the catalyst of positive change for population health for all.”

The UK College of Public Health has been celebrating National Public Health Week for nearly 20 years. Its mission of developing health champions, conducting multidisciplinary and applied research and collaborating with partners to improve health in Kentucky and beyond is furthered by awareness of the field and support of its patrons.

“National Public Health Week is about celebrating our public health heroes and champions. It’s about taking time to say thank you,” said Bush. “Communities matter and what happens in our communities is important. We are all part of coming together for a solution. We recognize that groups of people are different and what makes them different is beautiful. We want to celebrate and recognize those differences, and use that for our understanding in what makes public health great.”

This week, UK has multiple events open to all students, faculty, staff and community members. These virtual and in-person events will allow attendees to explore the role of strong communities on physical and mental health. The events include:

Tuesday, April 4: Music Bingo | 3:30-5:30 p.m. College of Public Health, Room 115
Music bingo is very popular for relaxation and mental health. It's just like regular bingo, but instead of shouting out numbers, songs are played. Each round takes on a different genre of song choices; these could be based on either a decade, theme or just a random quirky topic (for example, movie theme tunes or Disney songs). Prizes are available for winners.
Facilitated by the Office of Student Engagement and Academic Success (SEAS) within the College of Public Health.

April 4: Mennonite Population of Kentucky and Celebrating Care | 2-3 p.m., Virtual (Zoom Link)
Facilitated by Jenn Harris, director of the Todd County Health Department, and M. Susan Jones, professor emerita, School of Nursing, Institute for Rural Health at Western Kentucky University.
Kentucky's Mennonite populations is listed as the eighth largest in North America, one of the fastest growing in the past 20 years. What is it like to work with such a unique culture within our own borders? What can health care students learn from this population? How can we celebrate the care given to this population?

Wednesday, April 5: Yoga Therapy | 3-4 p.m. Wethington Commons, Room 127
Enjoy this therapeutic experience, which empowers individuals to progress toward improved health and well-being through the application of the teachings and practices of yoga. No experience? No problem! Bring your mat and move at your own pace for a stress-busting round of yoga.
Facilitated by UK Campus Recreation and Wellness.

Thursday, April 6: Express Your Culture Through Art | 8:30 a.m.-4 p.m. CPH Room 120
Using the materials provided, express how your culture has shaped your health. Think about the foods you eat, the traditions you have with your family and friends or your community, the activities and hobbies you engage in, or how you unwind and decompress.

April 6: Move Your Body Today | 11 a.m.-noon, Bradley Bowman Quad
Stop by for a fun, body-weight workout that you can do anywhere. Also, learn ways to engage and motivate others into daily physical activity. Facilitated by Ketrell McWhorter, assistant professor, UK College of Public Health, American Council on Exercise certified personal trainer.

Foundation for a Healthy Kentucky and state agency start effort to encourage Kentuckians to improve immunity and overall health

One of the graphics used to promote the campaign

A new campaign encourages Kentuckians to boost their overall health and immunity to combat chronic conditions and Covid-19, the effects of which are still being felt across the state.

“Raise Your Guard, Kentucky” is a partnership between the Foundation for a Healthy Kentucky and the state Cabinet for Health and Family Services to encourage Kentuckians to adopt habits that will improve their health and reverse negative health impacts.

Since the pandemic began about three years ago, chronic conditions such as diabetes, obesity and cardiovascular disease have increased in Kentucky, especially among African Americans. 

“Kentuckians have long struggled with chronic conditions, but the pandemic has certainly made it worse,” said Ben Chandler, president and CEO of the foundation. “We don’t have to accept this as status quo. We can take action to help our bodies be in better condition to fight off the next virus – whether that’s a new Covid-19 variant, the flu, or another illness, as well as combat chronic disease.”

“Raise Your Guard, Kentucky” encourages people to:

• Eat well: Emphasize fruits and vegetables, lean protein, whole grains and low-fat or fat-free dairy. Limit saturated fats, cholesterol, salt and added sugars.
• Move more. Physical activity is one of the most important aspects of overall health.
• Stay up to date on all immunizations. Children and adults need protection from vaccine-preventable diseases including measles, shingles, flu, and Covid-19.
• Schedule annual check-ups and screenings: Preventive check-ups with your health-care provider and dentist can catch potential issues in the early stages. Get recommended screenings, including mammograms, colonoscopies, bone density and lung cancer screenings.
• Maintain a healthy weight: Excess weight can affect how your body functions. It can also lower vaccine effectiveness for numerous diseases including influenza, hepatitis B and tetanus.
• Drink lots of water: Getting enough water every day is important to prevent dehydration, a condition that can cause unclear thinking, mood change, your body to overheat, and lead to constipation and kidney stones.
• Get enough sleep: Studies show not getting enough sleep can negatively affect the immune system and is linked with many chronic diseases and conditions.
• Quit smoking and vaping. They harm the immune system and can make the body less able to fight off disease.
• If you drink alcohol, drink in moderation. Over time, excessive alcohol use can weaken the immune system and lead to various short- and long-term health impacts such as heart disease, cancer, and increased risk of getting sick from a cold or virus.
• Try to minimize stress. Long-term, stress promotes inflammation and an imbalance of immune cell function. Learning to cope with everyday stressors and challenges is vital for success in life, school and work.
• Wash your hands. Good personal hygiene can prevent the spread of infection.

“Small healthy choices add up to a big positive impact to ensure that every Kentuckian has the opportunity to reach their full human potential,” said Dr. Steven Stack, commissioner of the state Department for Public Health. “Working together, we can create the conditions that enable every Kentuckian to thrive.”

The “Raise Your Guard, Kentucky” campaign includes a video series featuring everyday people from across the state who share why and how they stay healthy:

• Lacretia Dye, an associate professor at Western Kentucky University, hosts a community yoga class each week.
• Fannie Callahan, a Beattyville retiree, walks every day to prevent diabetes and improve her overall health.
• Kota Young, the Caldwell County judge-executive, has a passion for his community. He shares how he stays healthy so he can better serve.
• Harlan Holmes, a Bowling Green man who learned at 25 that his blood pressure was alarmingly high. He began a “couch to 5K” program, reduced his blood pressure to healthy levels, and has continued running to maintain his health.
• Bethany Pratt of Louisville, an urban farmer, teaches others how to grow their own food, even with limited space.
• Mike Wilkinson of Lexington visits Red River Gorge to climb and hike for physical and mental stress relief.

Kentucky organizations are encouraged to download the videos, graphics, and other educational materials to share with their contacts and use on social media. Materials may be downloaded for free here. Additional videos will be added.

The foundation says it has engaged with nearly 2,000 Kentuckians through focus groups, surveys and polls to learn their perspectives on Covid-19 vaccines and boosters, as well as the pandemic, in general. “Raise Your Guard, Kentucky” messages and delivery vehicles reflect the insights gleaned from this input and are culturally relevant and responsive to the audience. The campaign's resources are available in English, Spanish and Swahili. Learn more at RaiseYourGuardKY.org.

Bill to legalize medical marijuana for some in 2025 becomes law

Democratic Gov. Andy Beshear shows his signature on the cannabis bill to state Sen. Stephen West, R-Paris, as legislators of both parties and others look on. (Kentucky Lantern photo by McKenna Horsley)

By Melissa Patrick
Kentucky Health News

After years of failed attempts, on the last day of the 2023 legislative session legislators passed a bill to legalize medical marijuana for people meeting certain qualifications in 2025, and Gov. Andy Beshear quickly signed it into law.

"Senate Bill 47 is probably one of the most vetted bills in the history of the General Assembly, going through numerous committees, being worked and reworked numerous times," bill sponsor Sen. Stephen West, R-Paris, said at the bill signing. "And I'm proud to be a part of that effort." 

House Majority Whip Jason Nemes, R-Louisville, who carried this bill for many years in the House, said he was "filled with emotion" as he noted the thousands of Kentuckians who will benefit from this bill. 

"We walk through the hallway --  Senator West, as you know -- in Frankfort and we hear so many people who whisper to us  'Please fight for us' because they don't want to be felons, they want to do right," he said. "This is such a good bill because there will be tens of thousands of Kentuckians who will never know our names, who will never walk these halls but will be helped. And so I'm happy to have played a small part in that. When the governor signs this bill and it becomes law -- what a glorious day it is." 

Eric Crawford, a longtime medical marijuana advocate, expressed a similar sentiment at a House committee that was held on the same day that it passed out of the House. 

“We need your help to make us be safer, so we don’t have to use all these pharmaceuticals and opioids," he said. “Help us not be criminals. Let’s legalize this for sick people.”

Senate Bill 47 passed the Senate 26-11 on March 16 and the House 66-33 on March 30.

The passage of SB 47 follows executive action taken last year by Beshear to use his pardon power to allow people with 21 specified medical conditions and a doctor's certificate to possess up to eight ounces of marijuana bought legally in another state. (Illinois is the only adjoining state where nonresidents can legally buy cannabis.)

The bill gives the Cabinet for Health and Family Services until January 2025 to get a medical marijuana up and running. 

It does not allow medical marijuana to be smoked and requires users to be 18 or older or be a caretaker for a child.

It also only allows it to be used by people with certain "qualifying medical conditions," including all cancers regardless of the stage; chronic, severe, intractable or debilitating pain; epilepsy or any other tractable seizure disorder; multiple sclerosis, muscle spasms or spasticity; chronic nausea or cyclical vomiting syndrome that has proven resistant to other conventional medical treatments; post-traumatic stress disorder; and any other medical condition or disease for which the new Kentucky Center for Cannabis Research at the University of Kentucky determines would benefit from medicinal marijuana.

At least 37 states in the United States have already legalized medical marijuana. 

West and Nemes have stressed that the delayed effective date allows the law to be revised in the next legislative session before the program begins. One issue they have promised to address is to make it clear that schools can prohibit employees, including school nurses, from administering the product to students. 

Guthrie, new chair of House health subcommittee, calls for more price transparency by pharmacy benefit managers and hospitals

By Melissa Patrick
Kentucky Health News

U.S. Rep. Brett Guthrie of Bowling Green is playing a priominent role as Congress investigates the role of pharmacy benefit managers in the growing cost of drugs.

PBMs are middlemen that negotiate drug prices with drug manufacturers and pharmacies, and design prescription drug benefits for health plans. 

On March 28, the House Energy and Commerce Committee's Subcommittee on Health, which Guthrie began chairing when Republicans took over the House in January, discussed the role that transparency and competition can play to help make health care more accessible and affordable.

Rep. Brett Guthrie (screenshot from March 28 committee meeting) 

"We are holding a bipartisan hearing to examine the rising costs of health care for patients and their families," Guthrie said in his opening remarks. "Rising cost of care for individuals is one of the single greatest threats to the overall economic security of Americans."

The hearing touched on some hidden aspects of the health-care system that Guthrie said drive up consumer costs, including hospital consolidation, lack of competition and practices of PBMs, which have been a hot topic in Kentucky for many years. 

Guthrie noted that the three largest PBMs have more than 80% of the market and have merged with insurance companies, specialty pharmacies, retail pharmacies, and even drug distributors.

“We should build on our bipartisan work to make pharmacy benefit managers be more transparent and ensure patients as well as employers are getting the best possible deal on their prescription drug benefits," he said. "This could also lead to greater access to biosimilars and generics when they come to market. Shining a light on middlemen who are making prescriptions more expensive is one important step to bolster competition and lower prices."

One focus of the meeting was "lack of compliance with two Trump-era rules created to require that hospitals and insurers follow through on various price transparency requirements," reports Gabrielle Wanneh of Inside Health Policy. One rule "requires hospitals to make their standard charges public through machine-readable files and make their payer-specific negotiated charges, including those for cash-paying patients, public for 300 shoppable services."

Another rule "requires insurance companies to disclose several machine-readable files, including a file on in-network rates for all covered services with in-network providers, a file containing allowed amounts and billed charges from out-of-network providers, and a file that covers the historical net price of covered prescription drugs, Inside Health Poliocy reports.

Guthrie said, “It is imperative for the Biden administration to conduct greater enforcement efforts on these rules to better serve patients with clear and actionable price information, ”Guthrie said. “It is also crucial for Congress to codify and strengthen these important transparency rules to support a more efficient price transparency regulatory environment.”

The day before Guthrie's committee met, Politico published a short primer that looked at the PBM issue from several angles. It noted that PBMs say they've been misunderstood, while Health and Human Services Secretary Xavier Becerra has said, "There is a growing concern that the middlemen … are skimming off a good deal of the money. We’re going to try to move to make sure that if there’s a middleman … that it’s done efficiently.”

Senate committees are also working on the issue, and the House Oversight and Accountability Committee has launched an investigation into the industry's effect on patients. The House Oversight committee is chaired by another Kentucky congressman, Rep. James Comer of the First District.

Kentucky lawmakers have been working on PBM issues for years, most recently passing 2020 Senate Bill 50 to make the state hire a single PBM to manage Kentucky Medicaid's prescription-drug business of more than $1 billion a year. Kentucky has saved at least $38 million from this move to one PBM. A 2019 state analysis found PBMs made $123 million through spread pricing.

That said, companion PBM bills were introduced in the House and Senate during the most recent legislative session and neither one of them were heard in their respective committees.

Legislature nixes Beshear's expansion of Medicaid dental, hearing and vision benefits; dentists' lobby says it took no stand on the bill

By Melissa Patrick
Kentucky Health News

The Republican-controlled General Assembly stood by its repeal of Democratic Gov. Andy Beshear's expansion of dental, hearing and vision benefits for 900,000 Kentucky adults on Medicaid.

Beshear expanded the benefits in October through an executive order and regulations that have been in effect since January. Senate Bill 65 declares the regulations deficient, which kills them because the legislature overrode Beshear's veto of the bill March 29 on party-line votes, 30-7 in the Senate and 75-20 in the House.

The bill allows providers to get paid for services initiated before its effective date, which was March 29 because the bill declared an emergency. Bills normally take effect 90 days after a legislative session ends.

Sen. Stephen West

While presenting SB 65 earlier in the legislative session, Sen. Stephen West, R-Paris, said the regulation was deficient because funding for it came from the $38 million in savings that came when the state moved to a single pharmacy benefit manager, a middleman between drug manufacturers and companies that manage Medicaid. West said lawmakers should  have been involved in how those savings were spent. 

Beshear's veto message said SB 65 "will harm Kentuckians and frustrate efforts to increase Kentucky's workplace," noting that research shows that on average nearly 100 million work hours are lost annually in the U.S. because of emergency dental care, that coverage of adult vision services increases a person's likelihood of working full time and that about 16% of Kentuckians have some degree of hearing loss."

Beshear wrote, "Since the regulation, more than 1,000 Kentuckians in all 120 counties have received nearly 3,330 dental services, including from a dentist in Clay County, who since January 1, 2023, has provided four sets of dentures for patients and has 44 more sets of dentures in progress." Clay County is the home of Senate President Robert Stivers, R-Manchester. 

Beshear added, "Nearly 7,000 Kentuckians have received vision services under these regulations, with nearly 43,000 services provided. And 40 Kentuckians have received hearing services with these regulations in place." He also contended that the regulation-deficiency law is unconstitutional.

Beshear said at a news conference March 23, "I believe a new regulation will allow for the continuation of vision, dental and hearing benefits." That said, SB 65 requires any new regulation to be substantially different from the original.

The Kentucky Dental Association said it took no position on the bill.

Asked if the association supported SB 65, KDA President Don Heine gave Kentucky Health News a letter to KDA members that said, "It doesn’t serve our members or their patients to opine upon the political question of whether a regulation is deficient or not. Accordingly, we took no position on that political question." 

Heine said KDA would like to see both an expansion of basic dental services in Medicaid and larger reimbursements for providers, saying, "I don't think there's been a reasonable increase in Medicaid fees in 20 years."

Low reimbursement rates are often cited as a reason dentists won't accept Medicaid patients, but Heine said, "I think we have plenty of providers." At other points in the interview, he said dental providers "will accommodate far more Medicaid patients when they're at least not losing money" and "We've got to get the legislature to work with Medicaid providers to at least make the funding where people can be seen and we can prevent them from going to the emergency room."

He cited a Texas A&M University study that found patients who go to the emergency room to treat preventable dental conditions costs U.S. taxpayers, hospitals and governments about $2 billion a year. 

Earlier, KDA Executive Director Richard Whitehouse told Kentucky Health News, "We are not opposed to expanding Medicaid services. However, to expand those services and meet the needs of that population, we need to expand the network. We believe incentivizing more providers to join that network and enabling those already in to take on more patients does that. It also lowers the cost of health care by detecting disease earlier and avoids more costly emergency room visits."

When the Senate initially passed the bill, Sen. Stephen Meredith, R-Leitchfield, said a reimbursement increase is especially needed in medically disadvantaged areas. In explaining his vote for SB 65, he also said the money could have been used to help the 5,000 children who are waiting for services from one of the state's special Medicaid waiver programs. 

In the House, as he supported Beshear's veto, Rep. Chad Aull, D-Lexington, said, "We know that Kentucky has many challenges when it comes to some of our health outcomes. Why do we continue to shoot ourselves in the foot by taking away the opportunity to pay for health care for our citizens? I do not understand this legislature's motive in trying to override this veto."

Cabinet for Health and Family Services spokeswoman Susan Dunlap told the Courier Journal in October that federal funds would cover 90% of the expansion's cost. Medicaid is primarily funded by the federal government.

Fentanyl test strips will no longer be drug paraphernalia under law

By Sarah Ladd
Kentucky Lantern

Fentanyl test strips will no longer be considered drug paraphernalia in Kentucky.

Gov. Andy Beshear on Friday signed a bipartisan bill decriminalizing fentanyl test strips in Kentucky after it easily passed both legislative chambers.

The state Senate passed House Bill 353 Thursday night. The House concurred unanimously in the final hours of the legislative session. It will take effect July 8, 90 days after the session's adjournment.

How one type of fentanyl test strip works

Fentanyl test strips are paper strips that can detect the presence of fentanyl in pills and other drugs within minutes. Fentanyl is a powerful synthetic opioid that contributed to 73% of Kentucky’s 2,250 overdoses in 2021. Using the test strips can help prevent overdoses, the Centers for Disease Control and Prevention says.

“Unwitting individuals may think they are ingesting one substance and unaware that it also contains fentanyl,” Jennifer Hancock, president and CEO of Volunteers of America Mid-States, said in a statement.

“With police departments and other emergency responders already carrying and administering Narcan, a medicine used for the treatment of a known or suspected opioid overdose emergency, it makes sense to prevent these overdoses on the front end,” she said. “It may afford another day where we can get an individual into recovery.”

Every Kentucky county has a low risk of Covid-19 transmission

CDC map shows all Kentucky counties and all but one adjoining county (Scott County, Tennessee)
at low risk, with the closest high-risk counties in northeast Missouri and West Virginia.

By Melissa Patrick
Kentucky Health News

Every county in Kentucky has a low risk of Covid-19 transmission, according to the latest weekly analysis of risk based on new cases and hospital capacity by the Centers for Disease Control and Prevention. 

The latest map shows the whole state is in green, a level that comes with recommendations to stay up to date with your Covid-19 vaccines and to avoid contact with people who have suspected or confirmed Covid-19. 

So does that mean the pandemic is over? The answer is, not yet. However, the leader of the World Health Organization said mid-March that he expects that the organization will declare an end to it later this year, WebMD reports. President Biden is letting the public-health emergency expire in May 11.

“I am confident that this year we will be able to say that Covid-19 is over as a public health emergency of international concern,” WHO Director General Tedros Adhanom Ghebreyesus told reporters at a Geneva briefing.

CDC map shows transmission levels of the virus.

The CDC also provides a community level transmission map, largely used by health-care facilities and researchers, that shows the level of virus in each county, at one of four levels. The latest map shows six counties with a low level of transmission and 53 with a medium level; the rest are either substantial or high. The state says residents should take their guidance from the other map.

On March 31, The New York Times, using CDC data, found Kentucky's new-case rate to be the 19th highest in the nation, at 46 coronavirus cases per 100,000 residents in the last seven days.