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

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

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

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

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

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

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

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

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

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

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

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

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

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

Carol Riker

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

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

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

State Rep. Susan Westrom

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

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

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

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

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

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

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

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

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


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

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

By Molly Burchett and Al Cross
Kentucky Health News

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

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

Kentucky's transition to Medicaid managed care

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

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

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

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

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

State officials' response: meet with the MCOs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Future forums

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

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

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

Poll shows strong support for medical marijuana in Kentucky

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Both bills are expected to see action in the Senate.

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

By Molly Burchett

Kentucky Health News

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

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

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

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

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



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

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

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

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

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

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

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

By Molly Burchett and Al Cross
Kentucky Health News

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

House Bill 5 would apply the prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The legislation would also require Medicaid managed care companies to:

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

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

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

Senate advances bill to allow Christian heath coverage cooperative back into Kentucky

Without dissent, the state Senate approved a bill Wednesday, Feb. 13, that would grant Christian health cost-sharing organization Medi-Share an exemption from the state's insurance laws and enable it to resume operation in Kentucky.

The Florida-based health care ministry was forced out of Kentucky last year by Franklin Circuit Judge Thomas Wingate, who ordered Medi-Share to stop operating in Kentucky. He acted at the request of the state Department of Insurance, which said the organization didn't comply with insurance regulations.

Sen. Tom Buford, R-Nicholasville, chairman of the Banking and Insurance Committee and sponsor of the bill, said the legislation would allow about 800 Kentuckians to rejoin Medi-Share. It would remove Medi-Share and two similar ministries operating in Kentucky out from oversight of the insurance department.

"The Department of Insurance regulates insurance companies. This is not an insurance company," Buford told the committee. Medi-Share does not include any contractual agreement to pay medical bills, but users are matched with each other to help pay for medical expenses through community giving, according to its website.

Medi-Share's plans resembles secular insurance in some ways but only allows participation by people who pledge to live Christian lives with no smoking, drinking, using drugs or engaging in sex outside of marriage, reports Beth Musgrave of the Lexington Herald-Leader.

The bill would require Medi-Share to tell members it's not an insurance company and does not guarantee that all medical bills would be paid, notes Roger Alford of The Associated Press.

The Rev. Dewayne Walker, pastor of Mount Olivet Baptist Church in Lexington, told the committee Medi-Share paid about $250,000 in medical bills for his wife, who had cancer. Medi-Share President Tony Meggs testified in court last year that the group has helped arrange to pay for some $25 million in medical bills for Kentuckians over the past 10 years, Alford reports.

Republicans moving to gain a say over Beshear's decisions about insurance exchange, Medicaid expansion; Democrat dismissive

Kentucky Senate Health and Welfare Committee Chair Julie Denton, R-Louisville, left, said yesterday that she would file legislation that would block Democratic Gov. Steve Beshear from setting up a health-insurance exchange or expanding Medicaid coverage without legislative approval, Joseph Gerth of The Courier-Journal reports. Beshear has already established an exchange under the federal health reform, but hasn't announced whether he will expand Medicaid.

Denton said the exchanges and Medicaid expansion would be too costly for the state and shouldn't be something Beshear can set up unilaterally. But her effort will likely face opposition in the Democrat-controlled House, Gerth writes. Liberal Rep. Tom Burch, D-Louisville, said Denton "should save the ink that it would take to print the bills," and House Democrats would not receive the bill favorably. Burch has been in the legislature longer than any other current member.

State health-insurance exchanges will allow the uninsured to buy insurance from private companies and perhaps get government subsidies to help pay for it. If Medicaid were expanded in Kentucky, hundreds of thousands of more people would be covered, with the fedreal government paying all the extra cost in 2014-16, decreasing to 90 percent by 2020. Gerth reports that Senate Republicans said they will make it a priority "to rein in Beshear on Medicaid," which they fear would be unsustainable if it were expanded. Denton said requiring legislative approval of these parts of "Obamacare" would give Kentucky citizens a greater voice in the process. (Read more)

Pill-mill bill causing problems for patients who have long-term prescriptions: expensive drug-screening tests

In July, Kentucky started making long-time holders of certain controlled-substances prescriptions submit to urine tests to determine if they were actually taking the drugs, rather than selling them. Because insurance companies don't consider the tests medically necessary, patients often have to pay for them out of pocket. It can be expensive, reports John Cheves of the Lexington Herald-Leader, citing one couple that had to pay $533.

The tests are required under emergency regulations issued to implement House Bill 1, the "pill mill bill," and Gov. Steve Beshear has said he understands the financial burden the tests can bring on those who are not abusing prescriptions. Changes could happen in January when the emergency regulations expire and are replaced with permanent rules, Cheves reports. The Kentucky Medical Licensure Board is hearing complaints, and has extended a grace period for compliance for doctors until Nov. 1.

"But critics say they warned last spring that HB 1 — intended to crack down on the illicit sale of prescription drugs — would treat everyone like a potential felon, including doctors and patients engaged in legitimate medical care," Cheves reports. Much debate about the bill has revolved around its implication on doctors, with little attention paid to patients. Cheves reports that soon may change.

Under the law, doctors are required to get an initial urine test from patients who have long-term controlled substance prescriptions. They must also get random drug tests once a year for "low-risk" patients who are most unlikely to abuse drugs based on test results, and three times a year for "high risk" patients. The amount of people requiring drug tests is "likely to be in the tens of thousands," Cheves reports. (Read more)

Legitimate pain patients having trouble getting prescription drugs because of 'pill mill bill,' some doctors say; hearing Wednesday

With lawmakers set to review the regulations of the "pill mill bill" Wednesday, doctors are saying some legitimate patients are having trouble getting access to prescription drugs as a result of the legislation. 

The law is aimed at cracking down on illegal pain-management clinics and curbing prescription-drug abuse. It requires physicians to use the state's prescription-drug monitoring system, KASPER, before prescribing certain drugs. 

But some doctors worry they may face criminal charges or penalties for prescribing the drugs or making clerical errors, reports Scott Wartman for the Kentucky Enquirer, an edition of The Cincinnati Enquirer. As a result, "There are already doctors saying no more prescriptions on green prescription pads," said Dr. Gregory Hood, a Lexington internist and governor for the Kentucky chapter of the American College of Physicians. The legislation also "adds layers of more work they or their staffs already have to do," said Dr. Elmer Martin, a Covington pediatrician who is the medical director of HealthPoint Family Care.

But state officials say the only criminal penalties in the bill would result only "from someone operating a pain clinic without a doctor's license and for intentional failure to input data into the state's prescription drug tracking system," Wartman reports. Since July 20, the number of KASPER reports requested by doctors has grown to 20,000 per day from 3,000. The reports show a patient's prescription history to indicate "doctor shopping."

The number of drugs prescribed has increased exponentially in Kentucky. "Last year there was enough doses of hydrocodone prescribed "to treat every man, woman and child in the state with 50 doses," said Van Ingram, executive director of the Kentucky Office of Drug Control Policy. Still, even physicians who supported the bill, like Dr. Robert Klickovich, say it needs to be tweaked. "Specialists may not be present in rural communities and if primary care physicians fear prescribing, even though in the appropriate case, for fear of a punitive action, they may hesitate to treat a patient," he told Wartman. (Read more)

To implement law aimed at prescription drug abuse, licensing boards issue regulations that some say are too expansive

Ambien and Ritalin are among the drugs that will be tracked through the state's drug monitoring system, with medical licensure boards issuing emergency regulations that are more expansive than originally required in a law aimed at curbing prescription drug abuse and so-called pill mills.

Rep. John Tilley, D-Hopkinsville, said "there's an honest debate" about why the Cabinet for Health and Family Services and the boards wish to track all Schedule II and III drugs and 15 more Schedule IV drugs. "The statute only called for tracking Schedule II drugs and those Schedule III drugs that contain hydrocodone," reports Ronnie Ellis for Community Newspaper Holdings Inc.

Among the 15 listed Schedule IV drugs are Ambien, Valium, Librium, anorexic drugs and Soma. Ritalin, usually used to help with Attention Deficit Disorder, is a Schedule II drug and will be tracked for patients who are prescribed it for more than 30 days. Lloyd Vest, the Kentucky Board of Medical Licensure's general counsel, said some parents "doctor shop" to get the drug. The new regulations have prompted "some prescribers to cease prescribing the drug, causing parents and children to scramble for prescriptions before school begins next month," Ellis reports.

Dr. Steven Sack, an emergency room doctor from St. Joseph East in Lexington, said the regulations "have gone well beyond the initial intent" of the legislation and will "result in unnecessary suffering in the commonwealth with patients not getting the care they need."

He said running a report in the drug-monitoring system known as KASPER takes an "enormous" amount of time. He asked why doctors must run reports on, say, an 80-year-old with chronic pain. Ellis reports the average KASPER report can be electronically transmitted in 15 seconds, and Tilley said running a report might "prevent prescriptions which might adversely interact with other medication the patient is taking."

Changes can be made to the regulations before the September deadline and they can be revised in the 2013 General Assembly. Physicians had until last week to sign up for a KASPER account. As of last Friday, there were 17,048 master accounts. In 2011, there were just 879.  (Read more)

Beshear issues order to create insurance exchange as GOP legislators carry symbolic vote against lease to house it

As Gov. Steve Beshear issued an executive order to establish a state insurance exchange this afternoon, lawmakers voted along party lines against a lease that would have housed employees of the exchange, once again illustrating the divisive nature of the controversial Affordable Care Act.

Members of the Capital Projects and Bond Oversight Committee voted 4-3 against the nearly $300,00-per-year lease, with Sen. Tom Buford of Nicholasville, Sen. Jared Carpenter of Berea, Rep. Steven Rudy of Paducah— all Republicans — voting no, along with Independent Sen. Bob Leeper of Paducah. Leeper caucuses with Senate Republicans.

Rep. Jim Wayne, Sen. Julian Carroll of Frankfort and and Rep. Jim Glenn of Owensboro, all Democrats, voted yes. Discussion focused on the uncertainty of the cost of implementing provisions in the Affordable Care Act and the state budget.

The committee does not have the power to block the lease permanently, but Beshear will have to go through some additional procedural steps.

The exchange is considered one of the cornerstones of the federal health-care reform law aimed at containing costs by spurring competition among private insurers. It will be a marketplace to shop for different packages of state-approved health insurance and will be available to people who earn up to 400 percent of the federal poverty level. To offset the cost of their premiums, those participating in the exchange will receive subsidies in the form of tax credits. The Medicaid program will also fall under the exchange's umbrella. 

Small businesses with fewer than 100 employees can also qualify for the exchange, a move that is meant to boost their purchasing power.

 
Beshear said, "We will work closely with insurers, providers and consumers and other groups to develop a robust, responsive, and user-friendly portal that will help Kentuckians find the coverage that best suits their needs."

He said the exchange will be in operation starting Jan. 1, 2014 as the federal law requires. The state has already received more than $66 million to plan for the exchange. States had the option to run the exchange themselves or have the federal government do so for them. But Audrey Tayse Haynes, secretary for the Cabinet for Health and Family Services, said Kentucky is better geared to running its own program since it "is more in tune with the unique regional and economic needs of our citizens, as well as the health insurance needs of individuals, Kentucky small businesses and nonprofits." (Read more)

Kentucky first state to require license for diabetes educator; Beshear signed bill into law last week

Kentucky is the first state to require diabetes educators to be licensed, a move Gov. Steve Beshear that said will "raise the standards for diabetes management and care."

Beshear signed Senate Bill 198, which establishes the licensure requirements, last week. "For years, our certified diabetes educators have worked diligently to assist patients with diabetes. By adding the licensure requirement, we are taking an important step forward in terms of recognition for the diabetes educator."

The law defines the scope of practice for a qualified diabetes educator; establishes minimum quality standards for providing service; and offers more protection for the patient.

"This is truly a step forward in the field of diabetes management and care," said Dr. Steve Davis, acting commissioner of the Kentucky Department for Public Health. "Not only are we raising professional standards and heightening recognition for those working in the field, we are improving standards for patients." (Read more)

To fight meds-for-meth bill, Consumer Healthcare Products Association spent almost $500,000 in last session, a record

The biggest spender to lobby the Kentucky legislature in the 2012 session was the Consumer Healthcare Products Association, which represents the over-the-counter drug industry. Of the $8.8 million spent in 2012 overall, the group spent nearly $500,000, breaking the record it set in 2010 by spending $311,000.

The group was fighting a bill that would have made cold medicines that contain pseudoephedrine, the key ingredient to make methamphetamine, available only by prescription. Its report did not include several hundred thousand dollars spent on advertising to the general public, asking citizens to contact legislators. That does not fall under the state's legal definition of lobbying, which does include other methods CHPA used, such as phone banks, social media and other Internet activities.

The Senate and House ultimately passed a compromise bill that lowers the amount of pseudoephedrine a person can buy in a month from 9 grams to 7.2 grams. The maximum a person can buy in a year without a prescription is 24 grams. For a story from the Lexington Herald-Leader, click here. Gor one from The Courier-Journal, go here.

State prescription drug databases like KASPER cut back doctor shopping and drug abuse, new study shows

Photo by iStockphoto

Research from the University of North Carolina indicates drug databases like the Kentucky All Schedule Prescription Electronic Reporting system do reduce doctor shopping and change prescribing behavior.

Another article showed state drug databases "facilitate a relative decrease over time in prescription drug misuse, despite state differences in program administration," reports Maggie Clark for Stateline, the freshly revised news service of The Pew Center on the States.

A 2010 evaluation of KASPER showed 90 percent of doctors who used the system found it effective in preventing drug abuse and doctor shopping. A new Kentucky law "mandates that all physicians and pharmacists who prescribe schedule II and III drugs, such as oxycodone and hydrocodone, check the patient's prescription records before writing or filling a prescription," Clark reports. Dispensers must also register prescriptions in the state database without 24 hours of writing or filling the prescription.

Clark points out the legislation change sparked a debate about "how to balance patient privacy and law enforcements needs in fighting a serious criminal and public health problem." Attorney General Jack Conway, who wanted KASPER put into his office's hands, lost that fight as part of the legislative compromise. It will remain the responsibility of the Cabinet for Health and Family Services and, by extension, the doctor-run Kentucky Board of Medical Licensure.

Privacy issues have likewise surfaced in Vermont. "The discussion really is about what kind of access the police will have to electronic personal health information," said Allen Gilbert, executive director of the Vermont Civil Liberties Union. (Read more)