As state works to secure Medicaid managed-care contracts, Senate passes bill to only allow three of them, down from five

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Only three firms would get multi-billion-dollar contracts to manage Medicaid in Kentucky under a bill that passed the state Senate Feb. 12.

Five managed-care organization now oversee care for most Medicaid beneficiaries, and seven have submitted bids for the contracts that will be awarded later this year.

Sen. Stephen Meredith presents SB 30 to limit Medicaid managed-
care contracts to three. (Photo from Legislative Public Information Office)

Senate Bill 30, sponsored by Sen. Stephen Meredith, R-Leitchfield, would limit the number of MCO contracts to three. The bill went to the House on a 29-7 vote after Meredith argued it is needed to reduce administrative burdens for health-care providers.

"Let's reduce the bureaucracy," said Meredith, a retired hospital administrator. "We don't need five managed-care organizations; they bring no value to the system whatsoever. All they do is deny and delay payment."

The bill has an emergency clause to make it take effect immediately if passed into law. That would keep the administration of Democratic Gov. Andy Beshear, which is working to secure its MCO contracts, from signing more than three.

Those contracts have already been offered once. Just days before Beshear took office, then-Gov. Matt Bevin's administration awarded the $8 billion in contracts to five insurance companies that excluded two companies with current contracts, Passport Health of Louisville and Anthem Inc., the state's largest health insurer. Both had said they would appeal the the awards. Beshear has since cancelled the contracts and reopened the bidding process.

Meredith has long lamented the burdens of manged care, particularly on rural hospitals, because they have such tight budgets. He said the United States spends 30 cents of every health-care dollar on administrative fees, five times what other industrialized nations spend.

And to those who would say, just fix the existing problems, Meredith pointed to a 2018 law that was supposed to improve the MCO credentialing and enrollment process, along with requiring monthly reports that showed claims, denials, and grievances. All those issues still exist, he said.

Minority Leader Morgan McGarvey, D-Louisville, voted against the measure and said that while he understands providers' ongoing frustrations, "My fear is that this bill wont' fix those problems."  He also did not like that this bill ties the hands of the executive branch.

Sen. Danny Carroll, R-Paducah, speaking for the bill, said that as someone who runs a small organization for children with disabilities, he battles with MCOs "every day" over wrongly denied claims and delays in payments. He said it would be helpful to only have to deal with three sets of rules, instead of five.

"It will make it less complicated. It will save money," Carroll said. "At a time when Medicaid reimbursements are so low, I think we owe it to providers at every level to allow them to save money wherever they can, and reducing administrative cost by limiting these numbers ... will allow money to be saved."   

Medical marijuana bill expected to pass House; Senate uncertain

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A medical-marijuana bill described by supporters as one of the tightest in the nation is out of committee and is expected to pass the state House. The Senate is another matter.

Reps. Jason Nemes and John Sims Jr. presented the medical
marijuana bill, HB 136, in the House Judiciary Committee.
(Photo from Legislative Public Information Office)

"This is a question for the Senate," Rep. Jason Nemes, R-Louisville, told reporters after the House Judiciary Committee approved the bill. "It's going to pass the House; I have no doubt about it."

House Bill 136 , with a committee substitute, passed Feb. 12 by a vote of 17-1-1, with Rep. Joseph Fisher, R-Fort Thomas, passing. Fisher had expressed concern about people driving under the influence of marijuana and how this would be effectively managed.

Rep. Kim Moser, R-Taylor Mill, was the lone no vote. Moser, who has consistently said she would like to see more evidence-based research on medical marijuana that includes guidelines for prescribing, called the medical-marijuana laws in other states a "popular national social experiment."

Senate President Robert Stivers, who has long been the key obstacle to the bill in the Senate, reiterated Feb. 12 that he thought there could be a "path forward" for this bill in the Senate, though he said they haven't talked about this bill yet. (Later in the day, Nemes said he had a long, encouraging conversation with Senate Majority Floor Leader Damon Thayer.)

Stivers said that while he recognized that there are some real medical benefits to it, he said he wished the federal government would conduct a three-tier, double-blind study so that people would know how it really needs to be used.

House Concurrent Resolution 5, sponsored by Rep. Danny Bentley, R-Russell, asks the federal government to expedite research on the safety and efficacy of medical marijuana. It has passed out of the House and has been assigned to the Senate Health and Welfare Committee.

"It's a balancing test of: Do the goods outweigh the bads?" Stivers said.

Kentucky would be the 34th state, plus the District of Columbia, with legalized medical marijuana. So far, only 11 states and D.C. have legalized it for recreational use. A recent poll shows that 90 percent of Kentucky adults favor legalizing medical marijuana, or cannabis.

The latest version of the bill removed a list of conditions that could be treated with cannabis or its psychoactive ingredient, THC, and says any list of conditions will be determined by a panel of doctors and advisers established under the state health department.

Dr. Jeffrey Block, an anesthesiologist with the University of Miami, offered a short list of conditions for which there is conclusive or substantial evidence that THC is an effective treatment, including intolerable nausea or vomiting, intractable epilepsy, intractable chronic pain and intolerable muscle spasm, particularly from multiple sclerosis.

The bill wouldn't allow patients to smoke marijuana. Nemes said this concession was necessary to get votes, even though smoking is usually the quickest and most efficient way to get the drug into the system. It also does not allow colorful packaging or formulations that would be attractive to children.

Nemes said 13.5 percent of the money that comes in from the program would be used to help those who can't afford it get medical marijuana, since insurance won't cover it. Another 13.5% would go to law enforcement. The bill also includes an opt-in or opt-out provision for local governments.

Eric Crawford, an advocate for medical marijuana, told the group that an automobile accident in 1994 had left him paralyzed, and he used marijuana instead of opioids for his constant pain and muscle spasms.

"Narcotics make me out of my mind. They make me high and unable to function at all," he said. "Cannabis allows me to get out of bed and make the most of my life."

Crawford said if HB 136 became law, "I would not be a criminal. I would not have to live in fear. I would not have to lay awake at night worrying about law enforcement coming to my home. I would not have to stress about going to jail, or losing my home, work or freedom."

Joe Trigg, a 30-year veteran with 15 deployments, said, "Thousands of other veterans and myself would benefit from this bill." But he also said, "House Bill 136 can do better and should do better."

First, he said because it is written so tightly, it will likely result in higher prices and a larger black market. He also suggested that the rules against smoking and limiting growing are a result of lobbying, and said that rules on how it can be grown do not benefit Kentucky farmers.

Kent Ostrander of the Family Foundation of Kentucky, urged caution and called for more evidence-based research, saying, "We cannot use anecdotal based assumptions" when it comes to medications.

The bill would make marijuana legal medicine in Kentucky on Jan. 1, 2021.

Federal appeals court strikes down Medicaid work requirements

Gov. Matt Bevin announced his plan in 2016. (WFPL photo)

A federal appeals court ruled Friday against the work requirements that then-Gov. Matt Bevin tried to impose on Medicaid enrollees who were not "medically frail" and had no dependents.

The Trump administration was arbitrary and capricious when it approved Bevin's plan and one in Arkansas, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit ruled unanimously.

The U.S. Department for Health and Human Services essentially ignored the main purpose of Medicaid, which “was to provide health-care coverage to populations that otherwise could not afford it,” wrote Senior Judge David Sentelle, who was appointed to the court by Ronald Reagan.  The Trump administration is expected to ask the Supreme Court to hear the case.

The ruling upheld several by a judge in the D.C. District Court, which scuttled a program Arkansas had started and kept Kentucky's from taking effect. Democratic Gov. Andy Beshear, who defeated Bevin in the November election, rescinded Kentucky's plan soon after taking office in December. Republicans control the state legislature but have shown no interest in enacting Bevin's plan.

The plan had been challenged by 16 Medicaid beneficiaries in the state, who noted the Bevin administration's initial forecast that Kentucky Medicaid rolls would have 95,000 fewer people in five years than without the plan, in large measure because of noncompliance with the requirements to work, attend school or perform community service 80 hours a month and report monthly.

Bill to cap insulin co-pays in some health plans to $100 per month per prescription moves to full House with 74 sponsors

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to limit the cost-sharing requirements for insulin prescriptions has passed out of committee and is before the full House.

Charlotte Whittaker, Rep. Danny Bentley and Mary Beth Lacey
 present HB 12. (Twitter photo by Lawrence Smith, WDRB-TV)  

House Bill 12, sponsored by Rep. Danny Bentley, R-Russell, would require state-regulated health-insurance plans to cap a patient's cost for a 30-day supply of each insulin prescription drug at $100 "regardless of the amount or type of insulin needed to meet the covered person's insulin needs." The bill does not include Medicaid, Medicare or self-insured government plans.

Insulin is a hormone that regulates the amount of glucose in the blood, and a lack of it causes diabetes. People with Type I diabetes can't make any insulin so they must inject it to control their blood sugar -- and to stay alive. People with Type II diabetes, which is more common, can produce some insulin, but not enough. Type II is usually treated with diet, exercise and oral medications.

More than one in eight Kentucky adults have been diagnosed with diabetes, according to the 2017 Kentucky Behavioral Risk Factor Survey. In that year, diabetes was the fifth leading cause of death in Kentucky, according to the federal Centers for Disease Control and Prevention.

Bentley, who is a pharmacist with Type I diabetes, said HB 12 is supported by the American Association of Retired Persons, the American Diabetes Association, the Kentucky Medical Association, the Kentucky Pharmacy Association and Insulin4All.

Holding up a $290 box of insulin, Bentley said it's not uncommon for a person to use up to five boxes a month, which could end up costing about $1,200 monthly without insurance. The woman who loaned him the box said she paid about $300 a month for her monthly supply or about $3,600 a year, with help from insurance. But that does not include all the other supplies and equipment she needs to treat her diabetes, which also comes at a great, ongoing cost.

Bentley said in the last 14 years, the cost of insulin has gone up 550 percent.

In a detailed blog post about how this cap would help many thousands of Kentuckians with diabetes, Dustin Pugel of the Kentucky Center for Economic Policy reports that from 2012 to 2016, insulin prices at point of sale more than doubled in Kentucky, growing from $352 to $721 for a 30-day supply.

He adds that nearly one in three Kentucky adults with health insurance have plans with large cost-sharing requirements, whether it's in the form of a high deductible, large co-payment or a plan that covers only a fixed percentage of the cost through co-insurance.

The bill passed unanimously out of the House Health and Family Services Committee Feb. 13 with a committee substitute. Including Bentley, the bipartisan bill has 74 sponsors. If passed into law, it would go into effect Jan. 1, 2021.

Charlotte Whittaker, volunteer state president of AARP Kentucky, said older Americans with diabetes are hit especially hard with these growing cost, noting that Medicare Part D enrollees take an average of four to five prescriptions per month, with an annual income of about $26,000.

"Prescription drugs don't work if you can't afford them -- that's the bottom line," she said, later adding, "No Kentuckian should be forced to choose between putting food on the table or buying a lifesaving medication."

Mary Beth Lacey of the American Diabetes Association reminded the panel that people who need insulin need it to live and to avoid devastating complications, like blindness, kidney failure, lower limb amputation, heart attack, stroke and even death

Lacey, who described herself as a 43-year survivor of Type I diabetes, showed the committee a device that allows her to constantly monitor her insulin level through her cell phone. She stressed that such technology should be available to everyone, but isn't when people with diabetes are still simply trying to figure out how to pay for their insulin.

"We should not be struggling to stay alive, we should be thriving," she said, "Without insulin, people with diabetes die, and scaling back on insulin can lead to costly and sometimes deadly complications."

Research shows that about one in seven adults under 65 diagnosed with diabetes skipped doses, took less of their medicine or delayed filling a prescription to save money. Lacey said research shows that for one in four insulin users say cost has affected their use of it.

Lacey said 1.7 million Kentuckians either have or are at risk of having diabetes. The ADA estimates that the cost of caring for diabetes in Kentucky based on 2017 data was greater than 6.1 billion a year. 

"By keeping insulin affordable, we can help keep people with diabetes out of the ER and the hospital and away from expensive and potentially disabling or deadly complications," she said.

She added that the ADA would like to see a $100 a month collective cap, rather than a $100 per month per prescription cap.

Rep. Robert Goforth, R-East Bernstadt, said he would like to see assistance for people who have no insurance, which Bentley said was not addressed in this bill. Bentley said HB 423, sponsored by Rep. Steve Sheldon, R-Bowling Green, also addresses the cost of insulin and would help the cash customer. He added that House Bills 398, 399, 400 and 423 also deal with the price of insulin.

Sheldon, a co-sponsor of HB 12, called it a great first step.

"Drug pricing all across this nation has gotten completely out of hand," he said. "Until we get away from the way we price all drugs, it's going to be difficult and insulin is probably the most extreme example."

The bill's fiscal note estimates that capping the co-pay for insulin to $100 each month will increase premiums for health plans, excluding Medicaid and the state employee plan, 7 to 24 cents per member per month.

Asked who would absorb this, Sheldon said because insulin prices are so inflated and because so many groups have "their hands in the cookie jar," the industry "will find a way to eat that 24 cents for sure."

Saint Joseph Hospital listed as one of America's 250 best

Saint Joseph Hospital of Lexington announced Feb. 13 that it was the only facility in Kentucky to be included in the lost of "America’s 250 Best Hospitals" list by Healthgrades 2020 for the second consecutive year. "The distinction places Saint Joseph Hospital in the top 5 percent of nearly 4,500 hospitals assessed nationwide for its superior clinical performance as measured by Healthgrades, the leading resource that connects consumers, physicians and health systems," the hospital said in a news release.

“This is an honor for our highly experienced and dedicated physicians and employees, who make awards like this possible,” hospital President Bruce Tassin said. “We are committed to providing our patients with quality care and services, and to be recognized among top 5 percent of hospitals in the country to receive this award is exciting for us all. We cannot thank our team enough for their hard work and dedication. As Lexington’s first hospital since 1877, we are honored to continue serving this community more than a century later.”

From 2016 through 2018, Medicare patients in hospitals receiving the 250 Best Hospitals award averaged a 26.6 percent lower risk of dying than if they were treated in hospitals that did not receive the award, as measured across 19 conditions and procedures for which death is the outcome.

In addition to being named one of America’s 250 Best Hospitals, Saint Joseph also was ranked in the best 100 hospitals, the top 2 percent, for pulmonary and cardiac care. Its sister hospital, Saint Joseph East in Lexington, won a pulmonary care award for the last two years.

Bills aimed at reducing youth 'vaping' pass first hurdles

By Melissa Patrick
Kentucky Heath News

FRANKFORT, Ky. -- Two House bills aimed at reducing teen use of electronic cigarettes have cleared committee and are before the full House. One would place a 25 percent tax on the products, which is projected to bring in nearly $50 million in the next two-year state budget; the other adds regulations aimed at making it harder for teens to obtain e-cigarettes.

Abby Piper, with Jefferson County Public Schools; state
Rep. Jerry Miller; and Bonnie Hackbarth, of the Foundation
 for a Healthy Kentucky, presented HB 69 in committee.

The sponsor of both bills, Rep. Jerry Miller, R-Louisville, says both bills are needed, to protect independent "vape" shops. House Bill 32 has the tax and HB 69 the regulations.

"These are two pieces of a whole," he said. "While 32 may hurt independent vape shops, HB 69 will help independent vape shops."

HB 69 would require makers and retailers of "enhanced vapor products" with flavorings, other than tobacco or menthol, to register with the state Department of Alcoholic Beverage Control and pay a registration fee of $210 per location annually.

The bill refers to e-cigarettes as "enhanced vapor products," but they actually produce an aerosol that contains volatile organic compounds, ultrafine particles, heavy metals and potential cancer-causing agents, not a vapor.

HB 69 would also prohibit registered retailers or manufacturers of e-cigarettes from selling them online, through catalog sales or by phone; prohibit home delivery by outside vendors; require real-time age verification for purchase through an electronic third-party source no later than Jan. 1, 2021; require flavored products other than tobacco and menthol, and those with more than 4% nicotine content to only be sold in "vape" shops; and authorize fines on any person under 21 who tries to purchase e-,cigarettes or related products.

Miller added that the bill also allows the state to track purchases back to the store that sold them as a way to thwart those who might buy them in bulk and then sell them to minors.

"This bill simply seeks to regulate a product which adults should be able to use, but is such that it is very prone to abuse by underage people," Miller said. "We have a crisis of youth using these nicotine products, and that's what this bill is about."

Data from Kentucky Incentives for Prevention survey, graphic from
from Sept. 18 Department for Public Health PowerPoint presentation

The Kentucky Incentives Prevention Survey found that from 2016 to 2018, Kentucky teens nearly doubled their e-cig use, with more than one in four high-school seniors and one in seven eighth-graders reporting use in 2018.

The House Committee on Licencing, Occupations and Administrative Regulations Committee approved HB 69 Feb. 12 with no dissent.

Kentucky Smoke-Free Association Board Chair Tony LeBlanc defended the industry, which he said is considered "evil" in the U.S., but promoted in the United Kingdom as 95% safer than cigarettes, and a way to quit smoking, citing a 2013 British study that he acknowledged some have disputed.

"We're doing everything we can to keep these out of teen hands, but I'm telling you right now, this is a device that is saving lives. It's saving lives and people are trying to tax it and ban it and smear it through the mud. I don't understand," he said.

The British study was debunked in a recent American Journal of Public Health article, which included an appendix of research to back up its conclusions. It said, "The evidence-lacking estimate derived in 2013 cannot be valid today and should not be relied upon further."

After the meeting, Bonnie Hackbarth, vice-president of external affairs at the Foundation for a Healthy Kentucky, pointed out that it is illegal in the U.S. to advertise e-cigarettes as a smoking-cessation device, citing the recent 700-page U.S. Department of Health and Human Services report that says more research is needed before it can be concluded that e-cigs help people stop smoking.

E-cigarette tax 

The day before HB 69 passed, HB 32 passed out of the House Appropriations and Revenue Committee with a committee substitute that would impose a 25% wholesale tax on e-cigarettes, instead of the 27.5% it first proposed.

The bill would also raise the wholesale tax for "other tobacco products," such as cigars, to 25% from the current 15%, and add e-cigarettes to that list. It would also double the per-unit tax on non-smokeable and chewable products, as was proposed in Democratic Gov. Andy Beshear's budget.

Miller said the aim of the bill is to decrease youth e-cigarette use. "The most effective way to attack use by those under 21 is through raising the price," he said.

Representatives from the Kentucky Smoke Free Association, which represents about 400 independent vape shops statewide, told the panel that while they support the added regulations in HB 69 because they address teen access issues, they do not support the tax because it would hurt their businesses, while doing little to hurt leading e-cig maker Juul Labs or grocery and gas-station chains, which will still be allowed to sell e-cigs with tobacco and menthol.

"It's going to do nothing but hurt them and increase the [money in the] pockets of companies like Juul, who can absorb a 25% tax easily," said LeBlanc, who spoke at both meetings.

(Juul is not happy with the bills; recently it sent a message to its customers asking them to reach out to their legislators in opposition of the bills. The website includes a link to a message that states opposition to the bills.)

The opponents said their goal is to help people quit smoking cigarettes, and argued that the tax would discourage adults who want to use them as a smoking-cessation device. Further, they said it will push teens into purchasing their products online.

Jason Underwood, a lobbyist for the group, cited a study by the National Bureau of Economic Research that found higher e-cigarette taxes could lead to increased cigarette smoking. The study looked at Minnesota data, which imposed a 95% tax on e-cigs, much higher than proposed here.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, endorsed the 25% tax.

"We know that raising the price of tobacco products is one of the most effective measures for reducing tobacco use," he said, adding later, "An excise tax of 25 percent of the wholesale price is close enough to the current tax on cigarettes and would lead to a substantial enough price increase to create a considerable reduction in youth vaping."

Rep. Lynn Bechler, R-Marion, who cast the only vote against the tax bill, said he didn't think this "sin tax" was warranted because people are already taxed enough. He added that he had taken the testimony of the "vape" shop representatives to heart.

"I don't want to put those people out of work," he said. "So if we're putting people out of work and the epidemic isn't going to lessen, I don't understand the reason to do it."

Beshear's budget recommends a small increase in the existing tax on cigarettes and other tobacco products and a 10-cent-per-milliliter tax on vaping liquids. These hikes are projected to raise $57 million over the next two years.

E-cigarettes are subject to the state's 6 percent sales tax, but that's all; they are the only tobacco product in Kentucky that does not have an excise tax.

State health department issues caution regarding flooding

With polluted floodwaters rising in Kentucky, the state Department for Public Health is reminding residents of how to deal with it in healthful ways.

“We urge Kentuckians to use caution in flooded areas, and once floodwaters recede and the clean-up begins, to keep yourself and your family safe,” said Rebecca Gillis, director of the Division of Public Health Protection and Safety. “Taking the time to follow safety guidelines related to food safety, mold removal and other issues helps prevent unnecessary injury and illness.”

The guidelines include:

Flood Waters

• Flood cleanup poses risks of wounds, so cleanup workers should be sure that they are up-to-date with tetanus vaccinations, ideally before starting cleanup activities. Adults need a tetanus booster shot every 10 years. Td or Tdap can be used; getting the Tdap instead of Td for one tetanus booster during adulthood is recommended to maintain protection against pertussis (whooping cough). Being up-to-date for tetanus vaccine can greatly simplify wound treatment.
• Flood-related drowning can occur when people become trapped by rising flood waters or when voluntarily enter flooded areas. Never enter flood waters unless you are escaping immediate danger. Do not attempt to drive a vehicle through flood waters, even if they appear shallow. Monitor the weather conditions and water levels to avoid becoming surrounded by water.
• Floods can damage utilities, leading to downed power lines and a risk of electrocution. Stay clear of damaged power lines. Natural gas and propane systems can produce dangerous gas leaks. If you smell gas, open doors and windows and evacuate the area.

Home Clean-up and Mold Removal

• Wear proper safety equipment, such as work gloves, boots, helmets, eye and ear protection, and chainsaw chaps when operating power tools or machinery.
• Ensure that all electrical tools are properly grounded and use ground-fault interrupters if available. Never use electrically powered tools in or near standing water.
• Homeowners whose homes sustained water damage are urged to follow recommendations to limit mold growth. Mold fungi can be found both indoors and outside, and can accumulate in homes affected by water damage.
• Signs of mold include discolored walls, possibly showing water damage, or green or black spots on walls. Mold also has a musty, earthy smell or a foul stench. Allergy sufferers tend to be most affected by it.
• If mold is growing in your home, you will need to clean it up and fix the moisture problem. Mold can be removed from hard surfaces with commercial products, soap and water, or a bleach solution of no more than 1 cup of bleach in 1 gallon of water. Severe mold cases may require an expert.
• Doors and windows should be open while cleaning affected areas. Use protective glasses or goggles, rubber boots and waterproof gloves, and wash clothing afterwards. If there is heavy mold growth, use a respirator or suitable mask to prevent breathing the mold. Remove all wet items that have been wet for more than 48 hours and cannot be cleaned and dried.

Food Safety

• Think about food safety if you have been affected by power outages. Keep freezers closed to maintain proper temperature for frozen foods. A freezer will hold its appropriate temperature for approximately 48 hours when full, and for 24 hours when half full. If you have power outages, it is best to keep freezers closed to help keep frozen food from going bad.
• Refrigerated foods should be safe as long as power is out for no more than four hours. Throw away any perishable food in your refrigerator, such as meat, poultry, lunch meats, fish, dairy products, eggs and any prepared or cooked foods that have been above 40 degrees Fahrenheit for two hours.

For more on health issues and flooding, visit https://www.cdc.gov/disasters/floods/index.html or
https://healthalerts.ky.gov/Pages/FloodSafety.aspx.

List of top 100 rural hospitals by health-care analytics firm's rural-health center includes those in Cynthiana and Winchester

Clark Regional Medical Center in Winchester and Harrison Memorial Hospital in Cynthiana were named on a list of top 100 rural and community hospitals for 2020.

The Chartis Center for Rural Health, owned by health-care analytics consultancy The Chartis Group, announced the list today at the Rural Health Policy Institute's annual conference. The RHPI is part of the National Rural Health Association.

The hospitals on each list are grouped by state, but not ranked, so there is no single "best" hospital. The rankings are based on Chartis' Hospital Strength Index, which considers performance based on 50 rural-relevant factors in eight broad market-, value-, and finance-based categories.

At the RHPI's annual Rural Health Conference in May, Chartis will recognize the top 20 rural and community hospitals on the list.

McConnell throws cold water on bills to control drug prices, rein in surprise medical billing

Senate Majority Leader Mitch McConnell says divisions within his Republican caucus are keeping the Senate from taking up bills to control drug prices and surprise medical billing.

The Kentuckian spoke "hours after Sen. Chuck Grassley (R-Iowa) said he is gathering GOP support for his bill (S. 2543), and Senate Minority Leader Chuck Schumer (D-N.Y.) insisted that senators also get a chance to vote on House Democrats’ Medicare drug-price negotiation plan if the Senate takes up-drug pricing legislation," John Wilkerson reports for Inside Health Policy.

McConnell said, “We have internal divisions within my party in the Senate on both the Grassley bill and the bill that came out of the HELP committee on surprise billing,” referring to the Health, Education, Labor and Pensions Committee.

Wilkerson reports, "Legislation to control drug prices and curb surprise billing are supposed to help pay for renewing a group of popular health care programs called the 'extenders,' and McConnell said the Memorial Day deadline for funding those programs will 'generate another discussion' on both policies. However, he said the division within the Republican party and between the two parties makes it difficult to get a deal on drug pricing."

The House has passed a bill to let Medicare negotiate drug prices using international prices as a reference, and Senate Democrats support it. "The House bill is more aggressive than the Senate Finance bill, which would let drug companies continue setting launch prices but would make companies pay the government back when prices rise faster than inflation," Wilkerson reports.

“We’ve also told Leader McConnell that if he wants to bring any drug pricing proposal to the floor for a vote, we will demand a vote on H.R. 3,” Schumer said.

During the markup of the Senate drug pricing bill (S. 2543), Finance Committee Ranking Democrat Ron Wyden (OR) said Democrats planned to tie a vote on drug pricing legislation to a vote on letting Medicare negotiate drug prices. Democrats also insisted Senate Majority Leader Mitch McConnell (R-KY) allow a vote on preexisting conditions legislation prior to a floor debate on drug pricing. -- John Wilkerson

To thwart coronavirus, an undisclosed number of Centre College students are quarantined after returning from China

The building called Old Centre (A-M photo by Ben Kleppinger)

Several Centre College students who recently returned to the Danville campus from China have been quarantined as a precaution against the fast-spreading and sometimes deadly coronavirus, reports Robin Hart of the Danville Advocate-Messenger. 

Centre officials said in the first week of February that they were “keeping a watchful eye” on the students, as well as other students who studied abroad during the school's winter break, Hart reports. “On Saturday we received a recommendation from the Kentucky Department for Public Health, in consultation with the Centers for Disease Control, asking that those with recent travel history from China be isolated for a period of 14 days after their arrival,” Centre spokesman Michael Strysick said Feb. 12. President John Roush told students and staff Feb. 9, “This is 14 days from an individual’s time of arrival, not 14 days from today. . . . I want to be very clear that no one has the coronavirus or even shows any symptoms.”

Hart writes, "Because of medical privacy laws, Strysick said he could not say how many students were quarantined. However, he did say that students will be able to continue with their classes."

Poll finds Ky. adults overwhelmingly favor legalizing medical marijuana; bill expected to be called up in committee this week

By Melissa Patrick
Kentucky Health News

As lawmakers move close to legalizing medical marijuana in Kentucky, a new poll shows that an overwhelming number of Kentucky adults would support such a measure, and that a solid majority would approve legalizing the drug under any circumstance.

The latest Kentucky Health Issues Poll found that nine in 10 of adults in the state favor legalizing marijuana for medical purposes and nearly six in 10 say it should be legalized generally. But when asked if they favored legalizing it just for recreational purposes, that number dropped to 49 percent.

Support for medical marijuana has increased since 2012, when 78% supported it for medicinal purposes, 38% supported it under any circumstances, and 26% supported it for recreational purposes.

Jennifer Chubisnki, vice-president of research and evaluation at Interact for Health, which co-sponsors the poll, said it was important to remember that the policy landscape around marijuana has shifted since 2012.

"In 2012, 18 states and the District of Columbia had legalized medical marijuana, compared to 33 states and the District of Columbia today," she said in a news release. "Further, in 2012, the first policies to legalize recreational marijuana were passed in Colorado and Washington state. Today, recreational use is legal in 11 states and the District of Columbia.”

The poll is timely since House Bill 136, the medical marijuana bill, is expected to be heard in the House Judiciary Committee on Wednesday, Feb. 12. Of the 100 members in the House, 50 are co-sponsors.

Rep. Jason Nemes

Republican Rep. Jason Nemes of Louisville, the bill's primary sponsor, said on Kentucky Educational Television Monday night that he thinks this is the year it will pass.

A medical-marijuana bill passed the House Judiciary Committee 16-1 last year, but with only five days left in the legislative session and opposition in the Senate, it did not get a vote in the full House.

Senate President Robert Stivers has said he wouldn't support a medical-marijuana bill without medical studies to back it up. He told reporters last month that there could be a "narrow path" forward for Nemes' bill, but it will be a balancing act to weigh the good and bad of passing such a law.

A companion bill has been filed in the Senate, Senate Bill 107, with 11 of the Senate's 38 members signed on as co-sponsors; its primary sponsor is Sen. Stephen West, R-Paris.

The poll found that support for legalizing marijuana was strong across party lines. Support for medical marijuana was the highest in each group, with 95% of Democrats supporting it, 92% of independents and 90% of Republicans.

Those numbers dropped in each of the groups when asked if they supported it under any circumstance, with 68% of Democrats, 59% of independents and 51% of Republicans saying they would favor allowing residents to buy and use marijuana under any circumstances.

Only 60% of Democrats, 54% of independents and 38% of Republicans said they would support legalizing marijuana for recreational use.

The poll's margin of error for the statewide results is plus or minus 2.5 percentage points. It surveyed a random sample of 1,559 Kentucky adults via landlines and cell phones Oct. 16 through Dec. 6,.

Four in 10 Kentucky adults said they knew someone who regularly used marijuana. This was the first time this question has been asked.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll, said the results were consistent with what the foundation learned at its annual forum in September, which focused on the public-health impacts of legalizing medical marijuana.

"What we heard at the forum, and what this poll confirms, is that support for medical marijuana is very strong, but we also learned that it's well ahead of the science showing that marijuana is safe and effective for most of the medical conditions claimed by pro-legalization advocates," Chandler said in a news release.

He added, "Despite the continuing lack of evidence, dozens of states have legalized medical marijuana. If Kentucky follows suit, our goal must be to put in place measures to protect the public health going forward."

He also cautioned that if such a law were to pass in Kentucky, safeguards must be in place to protect the state's youth, since legalizing marijuana, even for medical purposes, makes it more available and socially acceptable.

About 16 percent of Kentucky high school students use marijuana monthly, according to the 2019 Youth Risk Behavior Survey. That's down from nearly 29 percent in 1997, but the rate has held fairly steady over the past 15 years.

Nemes and others have suggested that medical marijuana could help decrease the use of opioids in the state.

Rep. Scott Lewis, R-Hartford, told Jacob Mulliken of the Owensboro Messenger-Inquirer, "I have had people that I trust tell me that there are a lot of medical benefits to it, and with the opioid crisis that we have -- if that can be prescribed instead, it would sure make a lot of sense. I intend on voting on it," he said.

Sens. Matt Castlen, R-Owensboro, and Robby Mills, R-Henderson, told Mulliken they did not see themselves voting in favor of the bill. Mills called it "poor public policy" and said, "I'm opposed to that bill and I still think that there are a lot of questions as far as legalization in any form."

Castlen told Mulliken he couldn't vote for the current form of the bill, and said it needs more research. "There is no doubt that this plant has benefits, but I need entrusted sources and would like to see our universities have the opportunity to do trials," he said. "No one has brought any university studies to my office and I need facts to make a decision. I couldn't support it as written."

One study suggests the number of opioid prescriptions declines when medical marijuana is legalized, but Shanna Babalonis, a nationally recognized researcher who spoke at the foundation's conference, cautioned that the study only shows a correlation, not causation.

The American Marijuana study compared the states' opioid-prescribing rate one year before legalization and one year after legalization. It found that out of 19 states, 15 showed a fall of opioid prescribing rate one year after legalization, and only four increased their usage.

"It just says that if you live in a state with medical marijuana, there are more/less opioids prescribed," Babalonis said in an e-mail. "We have no idea if this has anything to do with medical marijuana or opioid policy, physician training, addiction awareness, patients being worried about becoming addicted, etc."

At the September conference, Babalonis called for more randomized, well-controlled, well-executed, placebo-controlled research on the medical benefits on marijuana, stating that at this time, "There is no evidence that suggests cannabis can help with any aspect of the opiod crisis."

Babalonis is an assistant professor at the University of Kentucky medical school, in its Center on Drug and Alcohol Research. She has a doctorate in behavioral neuroscience and psychopharmacology.

Pension bill has winners and losers among health departments; some counties may be asked to increase taxes to get state help

By Melissa Patrick
Kentucky Health News

Under a new pension funding proposal pending before the Kentucky General Assembly, some counties could be asked to increase their public-health taxes to help pay for their health departments' pension liability.

Reps. Graviss and DuPlessis tout their bill. (Photo by Melissa Patrick)

"Because we've been giving a free ride to some of these guys, they haven't had to go to their communities and ask for a tax increase," said Rep. Jim DuPlessis, R-Elizabethtown. "That needs to stop."

DuPlessis spoke Feb. 6 after the House State Government Committee unanimously approved his bipartisan bill to completely change the way health departments, regional universities and quasi-governmental agencies pay for their pensions.

The legislature has frozen health departments' pension contributions at 49.47 percent for the past two years, but on July 1, the day the next two-year budget starts, this is set to jump to 93%, a level many say would force them to close. Gov. Andy Beshear has proposed funding to make the effective rate 67%.

DuPlessis's House Bill 171 would move these entities away from the current "percentage of pay" formula and move them to a model that requires them to pay only what they owe the pension system, divided evenly over the next 27 years. This is often called "level dollar funding." "You pay what you owe, no more, no less," DuPlessis explained.

The plan is also designed to keep employees in the system; many health departments have shifted to contract labor to reduce their pension payments. It would require all new employees to have a pension obligation of 10.35%, which is dubbed the "normal cost." So, in essence, the departments would get two pension bills to cover their pension costs, one for the unfunded liability for current and past employees and the other for new employees.

Rep. Joe Graviss, D-Versailles, one of the legislation's three sponsors, said it will have winners and losers.

Randy Gooch, director of the Jessamine County Public Health Department, said under the proposed 27-year amortization schedule, about 45 of the 60 health departments in the Kentucky Retirement System would owe less money and about 15 would owe more -- and about six of them would need state assistance to help pay their pension obligation.

Gooch cautioned that his analysis involves "a lot of moving targets" and that it's important to keep an eye for the actuarial report on the bill, which wasn't available last week.

DuPlessis said legislators want to help health departments that aren't able to meet their pension obligations, but in order for them to get that help, their counties must have a public health tax of at least 8 cents per $100 assessed property value.

The state has established a minimum public-health tax of 1.8 cents per $100 worth of property, with a cap of 10 cents per $100. Several public-health directors have said they have been told that only one county in a district health department would need to levy the 8-cent tax to qualify the district for state help.

"We're not going to let the health departments go out of business," DuPlessis said after the meeting. "They're an integral part of the state. They are a statutory requirement of the state, and we're not going to let that happen."

At the same time, he said, "It's not fair for the state to keep sending money to people who aren't taxing those who they are serving. This bill says you pay what you owe. And for health departments that can still tax, they need to take care of it because they're supporting their local communities."

The committee removed language that would create an assistance fund to help struggling health departments and certain other groups pay their employer contribution rates. Rep. James Tipton, R-Taylorsville, assured colleagues that he would work to make sure that assistance was added in the Appropriations and Revenue Committee, where it is expected to go and where he is a member.

He said it will be the working group's recommendation for the A&R Committee to maintain the $50 million that is in the current budget to assist these entities, and to add another $50 million, as Beshear has proposed.

Jason Bailey, founder and executive director of the Kentucky Center for Economic Policy, said in an e-mail that a funding component is essential for the bill to work, since the costs are significant to protect the "losers" from unaffordable contribution levels.

"It’s important to note that funding will not just need to be there for this biennium but for the next few decades," he said. "By itself, it helps some, but deepens the problem for others."

The Kentucky River District Health Department would be a loser. Its public health director also stressed the importance of financial help from the state.

Scott Lockard

"As long as the funding is included in 171, we are very much in favor of it because it recognizes we can't raise it locally," Director Scott Lockard said. "If there is not a funding component . . . [House Bill] 171 closes our doors."

HB 171 would increase Kentucky River's pension liability to about $4.6 million, up from $2.6 million in the current funding arrangement.

"So if I was to try to pay my liability without a new funding source, it would literally close my doors in less than six months, with this increased pension liability," Lockard said.

Still, two of the seven counties in the district, Lee and Letcher, already have an 8-cent public-health tax, so it would qualify for state help under the suggested plan for fund distribution.

Dr. Kraig Humbaugh, director of the Lexington-Fayette County Public Health Department, said that while level-dollar funding will raise costs for his department, its fixed monthly payment is appealing. "We never know what our contribution is year to year, making it very difficult to plan or strategize," he said.

HB 129, the Public Health Transformation bill, which changes the way public health departments are funded, as well as how they prioritize their resources, would make local governments levy a public-health tax rate of at least 1.8 cents per $100, or equivalent alternative funding, which would be allocated toward basic programs.

Public health directors say passage of both bills is imperative.

"It is crucial for health departments that 129 and 171 are both passed," Lockard said. "They go hand in glove. So if 171 is passed without 129, then that is going to cause more financial hardship, and vice-versa. If 129 is passed, but 171 is not passed, then you're going to see health departments that are just not going to be able to meet that 93 percent" percentage-of-payroll pension funding.

Lockard added, "This will allow us to keep employees in the retirement system and not to contract out our future staffing needs because going forward our normal cost will be 10.35% for any employee. So I would start hiring all those employees back again and putting them in the retirement system that I'm now contracting out to a staffing company."

He said the bills "will allow my agency a path forward financially where we can take care of pension obligations and get the funding we need to focus on providing the core public health services to the people of Kentucky River District."