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April 9, 2018

Many health-related bills have passed and two have been vetoed; many still wait on the governor; here's a roundup


FRANKFORT, Ky. -- Health-related bills passed by Kentucky lawmakers this year address transparency, access to care, the opioid epidemic, teen suicide, organ donation, abortion and sex education, among other topics. Gov. Matt Bevin has signed several into law, but many await his signature or veto and a possible override vote when legislators return Friday, April 13.

Legislators may also meet April 14, the last possible day. They could pass additional legislation, but it would be subject to a veto without the opportunity for an override.


Health bills vetoed


Opioids and Hospice: HB 148, sponsored by Rep. Addia Wuchner, R-Florence, would shift ownership of controlled substances from deceased hospice patients to hospice for disposal. Bevin's veto message recognized the "well-meaning" intent of the bill, but said the bill was illegal because according to the U.S. Drug Enforcement Agency, "transferring unused controlled substances to home health or hospice programs would be illegal" because the "DEA does not register hospice providers" and the DEA does not allow for this process. He also wrote that the Department for Public Health, which was to be used as a reporting agency for individuals who refused to shift ownership of their drugs, "has no statutory or regulatory authority over hospice, home health or controlled substances."

Rare Disease Advisory Council: SB 7, sponsored by Sen. Julie Raque Adams, R-Louisville, would establish the Kentucky Rare Disease Advisory Council. The governor's veto message called the intent of the bill "laudable," but said it was "an unnecessary expansion of bureaucracy." He added that the bill does not provide any funding for the council, and that the state health department "does not currently have the expertise to support activities in the specialized field of rare diseases."

Bills on the governor's desk

State guardianship program: HB 5, sponsored by Rep. Daniel Elliott, R-Danville, more clearly defines state guardianship for disabled adults. It adds a provision to allow jury trials to be waived if all parties agree that it is in the best interest of the person being considered for guardianship, and a trial would be granted if requested. Kentucky is one of the only states that still required a jury trial for guardianship.

Pharmacists and medication-assisted therapies: HB 246, sponsored by Rep. Danny Bentley, R-Russell, creates a pilot program to allow community pharmacists to provide medication-assisted therapy for substance abuse, as members of a community team of "wrap-around services." The program would be implemented by the state as funds are available. Bentley, a pharmacist, has said this program will increase access to MAT and could be a model for the nation.

Pharmacy benefit managers: Senate Bill 5, sponsored by Sen. Max Wise, R-Campbellsville, would put the Medicaid program in charge of reimbursement rates for pharmacists. Rates are now set by pharmacy benefit managers, hired by managed-care organizations. The bill also sets reporting requirements for PBMs and MCOs and the $1.7 billion they get annually for pharmacy benefits. It also would allow the Medicaid program to approve contracts and fees between MCOs, PBMs and pharmacists.

Pharmacy transparency: HB 463, sponsored by Rep. Michael Meredith, R-Brownsville, would prohibit pharmacy benefit managers from requiring clients to make a co-payment that is higher than a lesser cash-payment amount, and keep PBMs from penalizing a pharmacy for telling patients if that option is available. HB 463 is often referred to as the "clawback" bill, referring to the practice of the PBM "clawing back" the difference between the higher co-pay and the lower price of the drug.

Guidelines for opioid disposal: SB 6, sponsored by Sen. Alice Forgy Kerr, R-Lexington, would require pharmacists to inform customers how to safely dispose of unused opioids and other controlled substances, and either provide or offer to sell them a product designed to neutralize drugs for disposal, or provide on-site disposal. More than 70 percent of all opioid addictions result from misuse of prescription drugs.

Abortion: HB 454, sponsored by Wuchner, would prohibit the most common kind of second-trimester abortion, known as a D&E, or dilation and evacuation. Wuchner says the bill is necessary for the "humane treatment of an unborn child, to protect that unborn child from dismemberment." Similar legislation has been challenged in other states and was found unconstitutional in Texas.

Pregnancy and hepatitis C tests: SB 250, sponsored by Adams, would require all pregnant women to be tested for hepatitis C, and put test results in' the mother's records and the child's, with recommendations that the child be tested at 2 years if the mother tests positive. Hepatitis C can be transmitted from mother to baby during childbirth, and most new cases of hepatitis C are a result of intravenous drug use. Laura Ungar of the Courier Journal reports that in 2014-2016, one in 56 Kentucky births were to mothers with a history of hepatitis C; as many as 55,000 babies are born in Kentucky each year.

Sex education and abstinence: SB 71, sponsored by Sen. Steve Meredith, R-Leitchfield, would require the inclusion of abstinence only education in any sex-ed classes taught in Kentucky. Comprehensive sexual health education standards are currently being reviewed by the state education department.

Bills that will become law

Medicaid manged care: House Bill 69, sponsored by Rep. Ken Fleming, R-Louisville, improves the Medicaid managed care organization credentialing and enrollment process and requires monthly reports that show claims, denials and grievances. Health-care providers have long asked for such changes to make MCOs more accountable.

Malpractice lawsuits: HB 4, sponsored by Wuchner, will keep doctors' reviews of other doctors from being used in malpractice lawsuits. Kentucky is the 49th state to adopt such a law. Lawmakers have tried to pass similar legislation for years. Unlike previous bills, this one has language like federal law, saying providers can claim the privilege only for safety and quality.

Substance-use programs: HB 124, sponsored by Wuchner, calls for a comprehensive review of all state programs for substance-use disorders, and requires the state to pay for and license only those that follow nationally recognized, evidence-based protocols. An amendment was added to allow the Department of Corrections to buy long-acting medication for substance-use disorders that are resistant to diversion, including unspecified new ones not yet available.

Autism coverage: HB 218, sponsored by Rep. Bart Rowland, R-Tompkinsville, requires all health plans to cover autism and removes dollar and age limits. It also modifies the definition of "autism spectrum disorder" and ties it to the most recent diagnostic tool. It is estimated that one in 68 people nationally is on the autism spectrum, with about 69,000 of them in Kentucky. April is World Autism Awareness Month. The law will take effect January 1, 2019.

Online eye exams: HB 191, sponsored by Rep. Jim Gooch, R-Providence, is Kentucky's first law regulating online eye exams and prescriptions. It requires that a patient be 18, give a medical history, and have had an in-person eye exam in the last two years. It also bans them from getting contacts for the first time through an online exam. After much debate, the bill was amended to remove a rule for "simultaneous" consultation between the online provider and their patients, which critics said would have limited access to eye care and tele-health technologies.

Organ donation: HB 84, sponsored by Rep. Lynn Belcher, R-Marion, requires coroners and medical examiners to contact the Kentucky Organ Donor Affiliates if they know that a decedent wished to be an organ donor. Current law only requires hospitals to contact KODA when a documented would-be donor dies. It is called "Courtney's Law," for Courtney Flear of Princeton, who was killed in an automobile accident in 2015; due to the current law her organs were not donated despite her wishes.

Veterans with brain injuries: HB 64, sponsored by Rep. Stan Lee, R-Lexington, allows veterans with traumatic brain injuries to get hyperbaric oxygen treatment. The treatment is regularly prescribed to veterans with a TBI, but many don't get it because it is considered "off-label" treatment not covered by insurance. The law will allow veterans access to the treatment, but does not require insurance to cover it.

Disabled parking: HB 81, sponsored by Rep. Jerry Miller, R-Louisville, establishes new rules for disabled parking placards, limiting eligible individuals or organizations to one free permanent or temporary placard and requiring $10 for each additional placard. It also replaces hand-written placards with ones that are more difficult to alter. Placards can be given for up to six years for those who qualify, and the process has been updated to make it easier to get a temporary one. Placards will now be issued for the applicant, not the applicant's vehicle, and will expire in the applicant's birth month. It also expands who can issue a statement of need for a placard to physician assistants, physical therapists and occupational therapist. Miller said the bill is needed because the number of them grew from 32,600 to 298,000 after the state removed fees 10 years ago.

School suicide prevention: HB 30, sponsored by Rep. Regina Huff, R-Williamsburg, requires one hour of "high-quality" suicide-prevention training in middle and high schools beginning with the 2018-19 school year, and every other year thereafter. The training is be in person or video. The bill removes the current requirement for two hours of self-study for suicide prevention. It was reported in the House Education Committee that Kentucky had more than 600 suicides among 10- to 24-year-olds in 2005-2013.

Ambulance cost transparency: HB 176, sponsored by Rep. Rob Rothenburger, R-Shelbyville, to require ambulance services to post a comprehensive, up-to-date fee schedule, and to provide a copy to a beneficiary upon request at the time of service.

State guardianship program: House Joint Resolution 33, sponsored by Elliott, creates a pilot called Working Interdisciplinary Networks of Guardianship Stakeholders, or WINGS, to examine how the state's guardianship program is working and to identify any needed changes. The state is the guardian for 4,448 people, and social workers have 65 to 70 cases apiece, about three times more than recommended by national guidelines.

Bills that could still pass

Telehealth bill: SB 112, sponsored by Sen. Ralph Alvarado, R-Winchester, is a telehealth bill aimed at increasing access to care and saving the state money by requiring the state to develop telehealth policies, including a reimbursement model, with similar expectations for the public insurance market. This bill has been posted for House passage but with an insurance-company floor amendment filed by Gooch to remove a provision that says telehealth visits have to be paid for at same level as regular visit, unless otherwise negotiated.

Fertility coverage: SB 95, sponsored by Kerr, would require health insurers to cover standard fertility preservation services for patients who have become infertile by means of surgery, radiation, chemotherapy or any other medical treatment affecting reproductive organs and processes.

Palliative care: SB 149, sponsored by Adams, would establish the Palliative Care Interdisciplinary Advisory Council, which would make recommendations on how to improve and expand palliative care and educate patients about their options.

By Melissa Patrick
Kentucky Health News


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


April 7, 2018

FRANKFORT – The state Senate gave final passage today to a bill intended to ensure independent pharmacists are fairly reimbursed for filling prescriptions of Medicaid recipients.

“The (amendment) gives the Kentucky Medicaid department clear authority to police pricing terms and contracts while we are not in session,” Sen. Max Wise, R-Campbellsville, who sponsored the legislation said.“The (amendment) gives the Kentucky Medicaid department clear authority to police pricing terms and contracts while we are not in session,” Sen. Max Wise, R-Campbellsville, who sponsored the legislation said.


Senate Bill 5, as amended by the House, would make the Kentucky Department for Medicaid Services in charge of setting the reimbursement rates for a pharmacist. The rate is currently set by pharmacy-benefit managers (PBMs) hired by the state’s Medicaid managed-care organizations (MCOs).

“As many of you know, the Kentucky legislature has spent an inordinate amount of time over the past several sessions of the General Assembly trying to play the role of policeman between PBMs and pharmacists,” said Sen. Max Wise, R-Campbellsville, who sponsored the legislation. “The (amendment) gives the Kentucky Medicaid department clear authority to police pricing terms and contracts while we are not in session.”

He said Kentucky Medicaid spends $1.7 billion annually on prescriptions and SB 5 would help authorities track that money and determine whether locally-owned pharmacies were being reimbursed fairly.

Another provision would allow the state Medicaid and insurance departments to issue penalties if a PBM fails to comply with the legislation.

“This bill ... truly is a very transparent bill,” Wise said, adding SB 5 may become a model for the nation.

Independent pharmacies in several states have claimed in recent months that PBMs owned by national pharmacy chains are not fairly reimbursing them. The dominate PBM in Kentucky, for example, is only paying independent pharmacists a professional dispensing fee of 85 cents per prescription, Wise said. The Centers for Medicare and Medicaid Services states that fee should be around $10.64, plus the cost of the drug being dispensed.

The measure passed by a 37-0 vote.


April 7, 2018



As part of a larger tax bill, the Kentucky General Assembly voted April 2 to increase the state’s cigarette tax by 50 cents, to $1.10 per pack. That fell short of the $1 increase wanted by health The increase is estimated to generate about $132 million in 2019, and decline to $112 million in 2020, apparently on the fact that smokers are dying off and a belief that the tax hike will make some of them quit.The increase is estimated to generate about $132 million in 2019, and decline to $112 million in 2020, apparently on the fact that smokers are dying off and a belief that the tax hike will make some of them quit.advocates, who bemoaned “a missed opportunity” to improve the health of Kentuckians. And in the final hours, legislative leaders dropped a plan to tax electronic cigarettes.

Still, the advocates said the tax increase is historic.

“It’s the biggest increase in Kentucky history, and there is something to be said for that,” said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. “Having said that, I think it’s apparent to anybody who knows anything about this that it’s not going to get the health benefits that we had been seeking . . . and that’s a missed opportunity.”

And that’s “a huge understatement,” said Amy Barkley, a regional advocacy director for Campaign for Tobacco-Free Kids. “They voted for a tax increase that is just a tax increase,” she told Kentucky Health News after a news conference with Chandler.

Barkley’s group is part of the Coalition for a Smoke-Free Tomorrow, a group of more than 150 organizations chaired by Chandler. It argued that unless the price of a pack of cigarettes goes up by at least $1, tobacco companies can keep smokers hooked by giving discounts to retailers and coupons to consumers, and then gradually raise the price to make up the difference.

Chandler said the “price shock” of a $1 increase would have led to more than “50,000 people here in Kentucky either quitting or not starting.”

At 26 percent, Kentucky has the second highest smoking rate in the country. It also has the nation’s highest cancer rate, and cancer death rate. Chandler has often said that this is not a coincidence, since 34 percent of Kentucky’s cancer deaths are related to smoking.

“We are the cancer capital of this country and we’ve got to do something about it. . . . and I think every method available ought to be on the table to try to do that,” he said.

Despite the coalition’s lobbying and a recent poll that found nearly 70 percent of registered voters would support a $1 cigarette-tax increase, a 50 cent hike was the best the lawmakers could do. After the House passed it, the Senate rejected it, but after the House passed a surprise pension-reform bill, the Senate accepted the tax as part of a package of tax cuts and increases.

“We failed to make our case, or Philip Morris made theirs better,” Barkley said. The Altria Group subsidiary’s chief state-government lobbyist met with top legislative leaders in an effort to make sure the tax didn’t include smokeless tobacco (made in an Altria plant in Hopkinsville) or electronic cigarettes, in which the company has invested.

“It’s really discouraging, to say the least, that legislators continually yield to the tobacco industry, which we know no longer fights for no tobacco increase,” Barkley said. “They fight for a low tobacco increase that they can manage by doing the discounting and so forth.”

One version of the tax bill included a 15 percent tax on electronic cigarettes, which are now more popular among teenagers than cigarettes, but was removed before the final vote. — apparently not long before, because the list of effective dates for various provisions mentioned both cigarettes and e-cigarettes. One clause in the bill excludes e-cigs from the definition of cigarettes.

John Cox, spokesman for Senate Republican leaders, declined to say why the late changes were made, and Philip Morris declined to comment. Rudy didn’t return an e-mail seeking comment.

The tax measure, House Bill 366, narrowly passed the Senate 20-18 and out of the House 51-44, with no Democrats voting for it. Its main sponsor, House Appropriations and Revenue Committee Chair Steven Rudy, R-Paducah, said during his April 2 floor pitch that the 50-cent tax hike on cigarettes would improve Kentuckians’ health.

The increase is estimated to generate about $132 million in 2019, and decline to $112 million in 2020, apparently on the fact that smokers are dying off and a belief that the tax hike will make some of them quit.

Asked if a 50 cent hike was better than nothing, Chandler said the foundation’s view is that “It is better than zero,” but also said there are differences of opinion inside the coalition.

For example, Barkley said in an email, “Nothing would have been better from a health standpoint because we have lost our chance. They aren’t going to raise it by $1 or more so soon after the 50 cents.”

Chandler said the coalition and the foundation would keep working for a higher tax. “We don’t believe that it’s over because that’s not been the history of the cigarette tax in Kentucky,” he said, noting that this is the third time the cigarette tax has been raised since the last 20 years. “I don’t think it’s accurate to say that once you’ve had an increase somehow it’s over.”

Chandler said the foundation supports the increase because it raises revenue, which is often spent on things that improve “social determinants of health,” like providing school transportation. “It’s a good thing for health to have added revenue,” he said.

He said the foundation will also continue to work on tobacco-cessation efforts and “ramping up our efforts” on local smoke-free policies.

This is the first year the foundation has actively lobbied. Tom Loftus of the Louisville Courier Journal reported the foundation was the second-largest spender on lobbying for the first two months of the session, at $107,336, and that Altria spent “far more” than any other lobby, spending $156,000.

Asked why the foundation had made a shift to lobbying, Chandler said, “We believe that you can make a bigger impact on health through getting the government to act in certain ways, and adopt certain policies to get their people to be healthy, than you can by simply making grants and through solely philanthropic efforts. . . . We believe that we can have an outsize impact, we can punch above our weight if we are active in public policy matters.”

By Melissa Patrick
Kentucky Health News