The fourth meeting of the Blue Ribbon Panel on Public Employee Health Benefits was held on Tuesday, July 19, 2005, at 9:00 AM, in Room 131 of the Capitol Annex. Senator Tom Buford, Co-Chair, called the meeting to order, and the secretary called the roll. Senator Buford and Representative Harry Moberly, Co-Chair, jointly chaired the meeting.
Present were:
Members: Senator Tom Buford, Co-Chair; Representative Harry Moberly, Jr, Co-Chair; Senators Julie Denton and Daniel Mongiardo; Representatives Bob DeWeese and Jimmie Lee; Bob Arnold, Jerry Bailey, Carol Carman, Brad Collins, Victor Cooper, Shawn Crouch, William Hanes, Gary Harbin, Cheryl Hayes, Lee Jackson, J. D. Jones, Arletta Kennedy, Susan Lehmann, Thomas Loving, Michael Mayo, Brent McKim, Wanda Mitchell-Smith, Richard Remmers, Jim Sproul, Jude Thompson, Nancy Toombs, Nancye Vincent, and J. P. Wiles.
Guests: Christine Wilcoxson and Sharley Hughes, Personnel Cabinet.
LRC Staff: Joyce Crofts, Alisha Miller, Karen Powell, Betsy Johnson, Greg Freedman, Rhonda Franklin, Frank Willey, David Wille, and Peggy Sciantarelli.
The minutes of the July 13 meeting were approved without objection.
The purpose of the meeting was to adopt recommendations proposed by the Blue Ribbon Panel's five subcommittees for inclusion in the final report of the Panel. The recommendations were outlined in a document entitled, "Suggested Consolidation of Proposed Recommendations of the Blue Ribbon Panel on Public Employee Health Benefits." Christine Wilcoxson, Commissioner of the Department for Employee Insurance, and Sharley Hughes of her staff represented the Personnel Cabinet. Senator Buford led the proceedings, and he and Representative Moberly assisted in explaining the recommendations.
The following recommendations were adopted for the final report. (They are numbered to correspond with the working document, and some have been edited for clarity.) Key elements of the discussion and a description of the action taken on each recommendation are as follows:
#1 - Recommend that the plan year not be changed from the calendar year unless concerns about a plan year based on a fiscal year are resolved. Discussion was brief. This recommendation was adopted by unanimous voice vote (motion by Senator Denton).
#2 - Retain similar plan structures after June 30, 2006, and retain co-pay and co-insurance structures as currently used. This recommendation was adopted by unanimous voice vote (motion by Senator Denton). Representative Moberly pointed out that the words "as currently used" had been inadvertently stricken in the working document.
#10 (NOTE: This recommendation was discussed out of sequence.] Modify the co-pay structure for drugs to encourage the use of therapeutically equivalent alternatives, and develop a program to inform members about the cost of therapeutically equivalent alternatives. An amendment offered by Mr. Remmers to substitute "therapeutically equivalent alternatives" for "generic alternatives" was adopted without objection. The recommendation, as amended, was adopted by unanimous voice vote (motion by Representative Lee).
#3 - Permit adoption of health reimbursement accounts (HRAs) and health savings accounts (HSAs) instead of the Essential plan. Premiums for all plans will continue to be based on the experience of the entire state group. Mr. McKim and Ms. Kennedy expressed concern over the fees and costs associated with HSAs and said that KEA would be more comfortable with the HRA concept. Ms. Kennedy moved to delete "HSA." Mr. McKim offered an amendment to add after "entire state group" the following language: "so that participants in other plan options, such as PPO plans, will not pay higher premiums as a result of offering HRA/HSA plan options." Mr. McKim said he is concerned about the need for balance in the premium structure. There was a lengthy period of discussion. Mr. Remmers explained the importance of making both HRA and HSA options available to the consumer. Representative Moberly and Senator Buford advised that the recommendation would meet Mr. McKim's concerns without his proposed amendment. The consensus was that the additional language was vague and unnecessary. Ms. Kennedy and Mr. McKim withdrew their motions to amend. Senator Denton moved to substitute the word "and" for the slash mark in HRA/HSA, and the amendment was adopted without objection. A motion to adopt the recommendation, as amended, passed by unanimous voice vote.
#4 - Continue to provide fully paid individual coverage. Increase the state contribution for family coverage, including providing the same level of subsidies for retirees. There was brief discussion about whether this recommendation was affordable to the Commonwealth. A motion to adopt passed by unanimous voice vote.
#5 - Change the current employer contribution to the flexible spending account for those waiving coverage under the state plan to an HRA and reduce incrementally over five years the state contribution for persons who opt out of the state plan. Investigate the feasibility of providing a larger HRA employer contribution to those employees who do not have other coverage and who use their employer contribution to provide medical services for their dependents. Employer shall deposit the difference in the self insurance fund. Discussion focused mainly on the importance of capturing unused funds for use in the self-insurance premium pool fund. Senator Mongiardo said that some of his constituents had expressed concern about reducing the amount of the benefit for those who waive coverage. A motion to adopt this recommendation passed by unanimous voice vote.
#6 - Recommend that the membership and responsibilities of the group evaluating the drug formulary be established by statute. Stipulate that this group may consider factors other than medical necessity for therapeutically equivalent drugs. Senator Denton suggested alternative approaches, out of concern that this recommendation might open the formulary to being politicized. Ms. Wilcoxson and Senator Mongiardo concurred. Representative Lee said he would be totally opposed to changing this recommendation. After a lengthy period of discussion, the recommendation was adopted by voice vote (motion by Mr. McKim). Two members dissented but did not request that their "no" votes be noted for the record.
#7 - Subject the state plan to the utilization review statutes, KRS 304.17A-600 to 304.17A-633, that provide for internal and independent external appeal processes. The decisions made as a result of the external review are to be binding and based upon medical necessity. This recommendation was adopted by unanimous voice vote (motion by Representative Lee).
#8a - Develop consumer-friendly information tools so members can compare providers relative to their cost and quality. A motion to adopt this recommendation passed by unanimous voice vote.
#8b - Include the branding of providers who implement information technology (IT) or meet specific certifications of quality for state health insurance in the third-party administrator (TPA) contract. The "branding" information should then be made available to patients. - This recommendation was discussed at length. Several members expressed support, and some said they believed that this recommendation would bring cost savings to the health insurance program. Ms. Wilcoxson said that although the RFP did not address the "branding" concept, the Cabinet could work with the TPA toward implementing it. Senator Mongiardo suggested that an emblem or logo might be used to designated providers that are IT compliant. Mr. Mayo, who represents a provider hospital, said that "branding" is a national movement and that quality providers are already moving in that direction. Mr. Arnold said that KACO wholeheartedly endorses this recommendation. Representative DeWeese said it is the wave of the future, but he cautioned that "branding" should not be the sole indication of quality care. Ms. Wilcoxson and Mr. Remmers advised that it would be difficult to implement this recommendation for the 2006 plan year but that it could be in use for 2007. There was also discussion of financial incentives for IT compliant providers and their patients, and Ms. Wilcoxson and Mr. Crouch pointed out that the state would be responsible for the cost of such incentives. Ms. Wilcoxson suggested that this recommendation should probably be in a separate bill when the Panel's recommendations are drafted into legislation. The recommendation was adopted by unanimous voice vote (motion by Mr. Sproul).
#9 - Require the Commonwealth, not the members, to pay any out-of-pocket administrative fees, including any fees associated with HRAs or HSAs, and require the accounts be offered through the Commonwealth. - This recommendation was adopted by unanimous voice vote (motion by Ms. Kennedy).
#11 - Keep the current reduction of prescription drug co-pays after 75 prescriptions during the plan year Ms. Wilcoxson said the Cabinet is not opposed to this recommendation. It was adopted by unanimous voice vote (motion by Mr. McKim).
#12 - Explore the possibility of participation in a multi-state consortium to purchase prescription drugs. This recommendation was adopted by unanimous voice vote (motion by Mr. Collins).
#13 - Require the Secretary of the Personnel Cabinet to promulgate administrative regulations to establish the state employee health insurance plan. Discussion was brief, with no opposition expressed. This recommendation was adopted by unanimous voice vote (motion by Representative Lee).
#14 - (NOTE: The following recommendation consists of sections 1-6.) There was an extended period of discussion relating to Section #1, which was amended as indicated. A motion to adopt all sections of this recommendation, as amended, passed by unanimous voice vote.
1. Require the Secretary of the Personnel Cabinet to provide detailed calculations outlining the development of the funding rates, including base claims, trend assumptions, administrative fees, and any other plan adjustments every six months to the Legislative Research Commission, Kentucky Group Health Insurance Board, Advisory Committee of State Health Insurance Subscribers, and as requested by legislative committees of the General Assembly. At Senator Denton's suggestion, this section was amended by unanimous voice vote to include the Legislative Research Commission as a recipient of the information every six months from the Personnel Cabinet (motion by Representative Lee).
2. Require that the information on the administrative fees shall include, among other relevant information, specific data on administrative oversight of the third-party administrator, disease management programs, wellness programs, case management audits, a comparison of actual results to performance guarantees, and educational and communication efforts.
3. Require the Secretary of the Personnel Cabinet to make quarterly financial reports, including information on claims, enrollment, and expenditures to the Legislative Research Commission, Advisory Committee of State Health Insurance Subscribers, and Kentucky Group Health Insurance Board.
4. Require all information reported by the Secretary of the Personnel Cabinet to be included in the annual report of the Kentucky Group Health Insurance Board.
5. Require that the Kentucky Group Health Insurance Board annual report be sent to local government and non-executive branch state agencies participating in the public employee health insurance program.
6. Change the deadline for the Kentucky Group Health Insurance Board annual report from October 1 to December 1.
#15 - Require an ongoing evaluation of network requirements and provider reimbursements to assure access to quality care and to evaluate cost effectiveness of the care. Determinations of the evaluation shall be included with any report provided to the General Assembly or other interested parties. Dr. Cooper moved to amend this recommendation by adding the language following "quality care." The motion passed by unanimous voice vote. Mr. Crouch noted that "cost effectiveness" is difficult to define but said that the general value of the cost of care will be looked at when evaluating the network. The recommendation, as amended, was adopted by unanimous voice vote.
#16 - Establish, by statute, a Self Insurance Premium Pool Fund for deposit of any funds appropriated to a budget unit for health insurance benefits funded by the employer, all employee paid premiums, drug rebates and other program income. These funds would be restricted to payments for claims, direct administrative payments of the Public Employee Health Insurance program, and reserves required for the self-insurance program. Any funds that remained in the pool after all claims had been paid would not lapse; and all interest, investment proceeds, and other income shall accrue to the pool to be utilized to fund future health benefits. Require that a quarterly report be provided to the Appropriations and Revenue Committee detailing all receipts to the Premium Pool Fund, claims payments and administrative payments made from the Premium Pool Fund. Representative Moberly explained this recommendation. It was adopted by unanimous voice vote (motion by Mr. McKim).
#17 - Evaluate member cost sharing so members can continue to receive preventive and cost-effective care so their conditions do not worsen. Ms. Wilcoxson suggested that this recommendation might need further clarification. A motion to adopt passed by unanimous voice vote.
#18 Provide a network for retirees and other covered individuals who are outside of Kentucky. This recommendation was adopted by unanimous voice vote (motion by Senator Denton).
#19 - Provide clear, consistent, and easily accessible coverage and provider network information. - This recommendation was adopted by unanimous voice vote (motion by Senator Denton).
#20 - Require Medicare to be the primary coverage for dependents eligible for Medicare, except where prohibited by federal law. Require this information to be clearly communicated to members. - This recommendation was adopted by unanimous voice vote (motion by Senator Denton).
#21 - Require the Personnel Cabinet and the Cabinet for Health and Family Services to study for future implementation a tiered co-payment system for hospitals based on outcomes and report to the General Assembly. Ms. Carman expressed concern about the potential impact on local and regional hospitals across the state. Ms. Wilcoxson said that "outcomes" needs to be defined and that they would differ in rural and urban hospitals. Mr. Crouch pointed out that this is a broad recommendation that only calls for a study. Mr. McKim said the recommendation is intended to incentivize quality but not be punitive. Representative Lee said that the Benefits Subcommittee drafted this recommendation broadly, realizing that it is an issue that will need additional discussion. A motion to adopt passed by unanimous voice vote.
#22 - The Commonwealth should study implementing a sliding scale for contributions based on the employee's salary and retirement income, and report to the 2006 General Assembly. This would allow lower paid individuals to have a higher percentage of their premium subsidized, thereby encouraging enrollment into the plan. (As originally drafted, this recommendation called for the Commonwealth to consider implementing, rather than studying, a sliding scale.) There was a lengthy period of discussion. Mr. Hanes moved to amend the original language to strike the word "state" before "employee's" and add the language "and retirement income." Mr. Thompson said he is supportive of the sliding scale concept but noted that implementing a sliding scale for contributions would appear to conflict with a recommendation, already adopted, to continue to provide fully paid individual coverage. Mr. McKim said it would seem then that a sliding scale would apply only to dependent coverage, in view of the Panel's recommendation to fully pay single coverage. Senator Buford noted that the Governor's recommendation for a sliding scale initially indicated that the maximum an employee would have to pay for individual coverage would be approximately $94. There was also discussion of how a sliding scale would apply to retirees who have become reemployed ("double dippers"). Mr. Hanes' amendment was adopted by voice vote, with Mr. Jackson dissenting. Mr. Jackson moved to amend the recommendation to make it a study. Ms. Mitchell-Smith urged that a time limit be placed on the study. Ms. Wilcoxson said that the study could be completed by the end of the year but, because of shortness of time, the results could not be applied until the 2007 plan year. Representative Moberly suggested that the results be reported to the 2006 General Assembly for consideration in plan year 2007. Mr. Jackson reworded his amendment to specify that the results be reported to the 2006 General Assembly. The amendment was adopted by unanimous voice vote. Mr. McKim proposed to amend the study to apply only to dependent coverage, by adding the words "dependent coverage" before "contributions." Representative Moberly advised that it would be in the best interest of the Commonwealth for the study to look at all options, including what other states are doing relative to single and dependent coverage. A roll call vote was requested on Mr. McKim's amendment, and the amendment failed (9 yeas, 16 nays, 2 passes, 1 abstention). The recommendation, as amended by Mr. Hanes and Mr. Jackson, was adopted by voice vote. The following members voted against the amended recommendation: Carol Carman, Cheryl Hayes, J. D. Jones, Brent McKim, Nancy Toombs, and Nancye Vincent.
#23 - Require the Secretary of the Personnel Cabinet to submit to the Advisory Committee of State Health Insurance Subscribers at least 60 days, rather than 30 days, prior to issuing requests for proposals, the health benefit plans that will be submitted to carriers. Require the Advisory Committee to submit its recommendations to the Secretary at least 15 days, rather than 7 days, prior to issuance of the RFP. A motion to adopt this recommendation passed by unanimous voice vote.
#24 - Recommend that the membership of the Advisory Committee of State Health Insurance Subscribers and the Kentucky Group Health Insurance Board remain as currently established by statute and recommend that these two groups explore options for improving and promoting communication with state group members concerning the state health plan. This recommendation was adopted by unanimous voice vote (motion by Ms. Kennedy).
(NOTE: The Panel recessed for lunch at 12:00 noon, and the meeting resumed at 1:10 p.m.)
#25 - Recommend that legislative staff attend meetings of the Advisory Committee of State Health Insurance Subscribers and the Kentucky Group Health Insurance Board and receive copies of minutes and reports. This recommendation was adopted by unanimous voice vote (motion by Mr. Collins).
#26 - The Executive Branch should conduct a study of adverse selection in Public Employee Health Insurance (PEHI) plans, including the effect of current employees who waive coverage. A motion to adopt this recommendation passed by unanimous voice vote. (NOTE: Recommendations #26 and #28 were combined into a single study. See discussion for #28 for final wording of the recommendation.)
#27 - The premiums charged to retirement systems, local governments, and "quasi-governmental" agencies for different plan types and coverage tier levels shall be the same statewide as those charged to state agencies and local boards of education. Ms. Wilcoxson pointed out that the 2006 RFP requires that rates be the same statewide. Questions were raised about the cost impact of "quasi" and local government agencies on the health insurance pool. David Wille, consulting actuary for the House of Representatives, said that costs per member were lower for the quasi-governmental and local government agencies combined than for all other state agencies. The recommendation was adopted by unanimous voice vote (motion by Representative Lee).
#28 NOTE: The first paragraph of recommendation #28 originally called for the executive branch to "consider amending KRS Chapter 18A" but was amended to request that the executive branch instead conduct a study, to be combined with the study called for in recommendation #26, and reported to the General Assembly. Sections 1-3 of the recommendation were not amended.) As amended: The executive branch should conduct a study of adverse selection in Public Employee Health Insurance (PEHI) plans and report to the General Assembly during the 2006 Regular Session. The study should include how current employees who waive coverage and unescorted retirees affect the public employee health insurance program. The executive branch should also include in the study consideration of amending KRS Chapter 18A to provide that employees who begin membership in a state administered retirement system or an optional retirement plan authorized under the provisions of KRS 161.567 on or after July 1, 2006 shall be eligible to purchase coverage through the Public Employee Heath Insurance plan upon retirement providing the following conditions are met:
1. The employee must have participated in the PEHI plan for at least the last 10 years of qualifying service prior to termination or retirement or be vested in their retirement system for insurance purposes.
a. Time that the employee was on sick or military leave during this period would be qualifying service.
b. The 10-year or vesting requirement would be waived if the employee becomes disabled or is killed in the line of duty as defined in KRS 16.505(19) or 61.621.
c. The 10-year or vesting requirement would be waived for employees whose employer joins the PEHI program during the last 10 years of the employee's service as long as the employee does not waive coverage and maintains coverage from the time the employer joined the PEHI program and the termination/retirement date of the employee.
2. Retirees who are not eligible to participate in the PEHI plan shall be eligible to be reimbursed the dollar value of their earned benefit and obtain coverage through their former employer, the private market or through some other means based on authorized contributions.
3. Beginning with the 2006 actuarial report, the Kentucky Retirement Systems recommended employer contribution rate for CERS should be split between school board and non-school board based employers based on entering the CERS system after July 1, 2006.
Mr. McKim said that his organization has concerns about this recommendation and would like to know more about its actuarial impact and the implications for local school districts. He moved to make this recommendation a study and roll it into the study called for in recommendation #26. There was an extended period of discussion. Representative Moberly noted that the issues in #26 and #28 both relate to adverse selection. He said that Mr. Hanes, who proposed this recommendation, has done a service to the Panel by expanding the view of the adverse selection and "unescorted retiree" issues. Mr. Collins opposed changing the recommendation to a study. Mr. Harbin spoke in favor of a study, stating that the issue needs to be studied in depth. He noted that active teachers, unlike other public employees, contribute part of their salary to help pay for retiree medical benefits. Ms. Wilcoxson said the Cabinet also believes that a more in-depth study is needed. Regarding the timeline for the study, Mr. Hanes said he believes a lot can be accomplished before the General Assembly convenes in 2006. Representative Moberly and Mr. Loving suggested a six-month timeline. Mr. McKim added to his proposed amendment that the study results should be reported to the 2006 General Assembly. Ms. Wilcoxson said that if the Cabinet promptly receives the required information from the retirement systems, it should not be a problem to complete the study by then. Mr. McKim's motion to amend was adopted by voice vote, with Mr. Collins and Mr. Wiles dissenting. A motion to adopt the recommendation, as amended, passed by voice vote, with Mr. Collins and Mr. Wiles dissenting.
#30 - Indicate the state's full support of 2005 Senate Bill 2 in the TPA contract through a requirement that network providers use standards set by the Kentucky e-Health Network when they use information technology (IT). Senator Mongiardo briefed the Panel regarding SB 2 and the e-Health Network. A motion to adopt this recommendation passed by unanimous voice vote.
#31 - Include terms in the TPA contract that incentivize more rapid implementation of IT. Ms. Wilcoxson said her concerns are the same as for the "branding" recommendation (#8b). She said that the health insurance program will have to bear the cost of incentives and suggested that this recommendation could be proposed in separate legislation. Senator Mongiardo said incentives to decrease cost and improve quality of health care benefit everyone, both in the public and private sector, and that including this recommendation in the Panel's legislative package would be one way to promote thse goals and set example for others to follow. This recommendation was adopted by unanimous voice vote (motion by Mr. Sproul).
#32 - Request that the General Assembly pass a resolution to request that Congress amend those sections of the Health Insurance Portability and Accountability Act (HIPAA) and Stark legislation that prevent providers and institutions from sharing patient information and institutional IT systems. Senator Mongiardo said that information needs to flow from one provider to another, based on patient permission, but that to facilitate this would require changes to certain HIPAA regulations. He said that Stark laws also probably need to be changed to allow providers to use IT systems that are already in place. Senator Denton asked what type of information sharing would be restricted by HIPAA, since providers are already permitted to share patient records. Senator Mongiardo explained that HIPAA provisions are more stringent relating to electronic sharing of information. Senator Buford concurred in the merits of this recommendation and said that this issue had surfaced in meetings of the Medicaid Oversight Committee. Senator Denton asked whether the resolution would specify problematic areas of the law or just be a general statement. Senator Mongiardo said that it require more time but that it would be possible to review the law to pinpoint specific areas that should be modified. A motion to adopt this recommendation passed by unanimous voice vote.
#33 - Recommend to the General Assembly that tax credits for IT purchases by providers be implemented. Representative Moberly said it would be worthwhile for the House and Senate Appropriations & Revenue Committees to consider this recommendation in the 2006 Regular Session. Senator Mongiardo said that the tax credits would be "smart spending" that should result in savings to the state and also the private sector. A motion to adopt this recommendation passed by unanimous voice vote.
#34 - Implement incentives for reporting medical errors in the TPA contract. Ms. Wilcoxson again pointed out that the PEHI program would bear the expense of any incentives. Senator Mongiardo spoke about the high costs associated with medical errors and the need to find ways to reduce errors. A motion to adopt this recommendation passed by unanimous voice vote.
#35 - Recommend to the General Assembly that they provide for the reporting of medical errors, while protecting the information and without punishing providers. There was an extended period of discussion. Representative DeWeese said he supports recommendations to deal with the problem of medical errors but that he believes, in order to address the medical liability crisis, the Panel's recommendations should be included in a broader package that would include amending the Kentucky Constitution so that the legislature will have the proper tools to implement solutions that have worked successfully in other states. Senator Mongiardo said it is his understanding from constitutional law experts that a simple statute could be enacted which would privilege information to a reporting center, such as the University of Kentucky or the University of Louisville, and which would protect the information from being accessible by an attorney. He said that, in order to correct medical errors, improve quality care, and decrease cost, it is important that medical errors be reported and that the information be privileged. He said he would support a constitutional change, if necessary, to protect the information but that LRC experts have advised him that a constitutional change would not be required. There was discussion of amending the recommendation to specify reporting of medical errors to a research center/entity, but Mr. Jackson pointed out that the General Assembly would be able to add that type of language if needed. This recommendation was adopted by unanimous voice vote (motion by Ms. Kennedy).
#36 - Recommend to the General Assembly that the municipal tax on medical malpractice insurance be eliminated. A motion to adopt this recommendation passed by voice vote, with Mr. Collins dissenting.
#37 - Recommend to the General Assembly that they provide funding and authority for the Personnel Cabinet to pursue a grant for providing a pilot program to pay for e-mail consultations for state health insurance There was an extended period of discussion. Senator Denton expressed concern about potential liability issues and the possibility that patients would have to pay for services that are now freee.g., phoned in prescription refills. Senator Mongiardo said there will have to be parameters. He went on to say that the health care delivery system of the future will look much different than today. For example, devices are being developed that can connect electronically to the physician's office to monitor a patient's blood pressure and glucose levels. If e-mail consultations were to become standard of care, that would address the liability issue. Ms. Wilcoxson raised questions regarding proof of identity and the possibility of fraud. Representative DeWeese asked whether the required technology is now in place. Senator Mongiardo said it is available but not in place because no one pays for it. He said he thinks the underlying goal of the Panel is to promote changes in the health care system in order to reduce cost and improve quality, and that this recommendation has potential for reducing cost. Senator Denton said she supports the concept but has doubts about doing a pilot project until the technology is available to patients. Mr. McKim and Mr. Sproul spoke in favor of the pilot project.
The original language of this recommendation called for a pilot program. Mr. Bailey proposed an amendment to recommend that the General Assembly provide funding and authority for the Personnel Cabinet to pursue a grant for a pilot program. The amendment was adopted by unanimous voice vote. A motion to adopt this recommendation, as amended, passed by unanimous voice vote.
#38 - Recommend to the General Assembly that they connect the interest rate on judgments to the prime rate. Senator Mongiardo said this recommendation was proposed to the Technology Subcommittee by a leading medical malpractice defense attorney. A motion to adopt the recommendation passed by unanimous voice vote.
#39 - Recommend to the Kentucky Supreme Court that they require an affidavit to be filed by an attorney in a medical malpractice complaint stating that the attorney has had the case reviewed by an expert and that there are reasonable grounds for going forward with the lawsuit. Recommend to the General Assembly that they enact a statute similar to Ohio's that tolls the statute of limitation for 180 days when an attorney sends a certified letter informing the provider that the provider's actions are being investigated. There was brief discussion. Senator Mongiardo said that attorneys on both sides of the malpractice issue have endorsed this recommendation, which is intended to reduce the number of frivolous lawsuits. Representative DeWeese said it would be advantageous but would probably require constitutional change. The recommendation was adopted by unanimous voice vote (motion by Mr. Loving).
#40 - Recommend to the General Assembly that it enact a Sorry Works! pilot project using a state university to gather the resulting data. Senator Mongiardo explained how the pilot project would work and what other states are doing. Mr. McKim spoke in support of the pilot project. He also urged that a hard look be taken at issues such as the one reported recently by Time magazine. He said the report indicated that from 2000-2004 total claims expenditures of the 15 largest malpractice insurance providers had increased less than six percent, while during that same time the premiums charged by those insurers increased 120 percent. A motion to adopt the recommendation passed by unanimous voice vote.
#41 - A wellness program, incentives, and a disease management program should be a part of any plan which is implemented for the state employee health insurance group. - After brief discussion, this recommendation was adopted by unanimous voice vote (motion by Representative Lee).
#42 - The Executive Branch should seek legal guidance in designing and implementing a wellness program and incentives to comply with HIPAA and other applicable federal and state laws. A motion to adopt this recommendation passed by unanimous voice vote.
#43 - Any wellness program that is implemented should include health risk assessments with the appropriate incentives similar to those in the University of Kentucky model. After brief discussion, a motion to adopt this recommendation passed by unanimous voice vote.
#44 - The Executive Branch should utilize public health departments and universities and other available resources when possible in implementing a wellness program. Ms. Wilcoxson said that public health departments have advised the Department for Employee Insurance that they could work with the Department but did not have the funding to support PEHI participants. A motion to adopt this recommendation passed by unanimous voice vote.
#45 - The use of information collected in the health risk assessment should follow HIPAA and federal guidelines on privacy and confidentiality. Representative DeWeese said there is some question whether the federal law would allow risk assessments to be mandatory. A motion to adopt this recommendation passed by unanimous voice vote.
#46 - The state should look at cost drivers among the state employee group in designing a disease management program Ms. Wilcoxson noted that this type of information was considered during development of the 2006 RFP. This recommendation was adopted by unanimous voice vote (motion by Representative Lee).
#47 - Focus should be given to outreach services on wellness and disease management for the 50-plus age group. A motion by Mr. Sproul to change "50-65 age group" to "50-plus age group" passed by unanimous voice vote. A motion to adopt the recommendation, as amended, passed by unanimous voice vote.
#48 - The General Assembly should consider including in the budget for state employee health insurance, money to provide incentives to those who participate in wellness programs. This recommendation was adopted by unanimous voice vote (motion by Representative Lee).
#49 - Hospice benefits should continue to be covered as they have in the past. Senator Buford said he had proposed this recommendation at the request of the Hospice organization. The recommendation was adopted by unanimous voice vote (motion by Representative Lee).
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For lack of a motion, proposed recommendation #29 was not adopted. It called for conducting a study to determine the feasibility of including state-sponsored foster parents in the Public Employee Health Insurance plan. During discussion, Mr. Wille said he would expect that the premium cost to the foster parents would be very highsimilar to Cobra premiumsand that there would also be a negative actuarial impact on the health insurance fund. Several members expressed concern about this recommendation. Senator Buford said it is a wonderful idea to provide insurance for foster parents but that he is concerned about the cost to the program. Mr. Thompson said that foster parents seeking health insurance might be able to obtain the best rates and coverage through the Kentucky Access program.
Senator Buford and Representative Moberly thanked everyone. Since the Panel would not be meeting again, motions were adopted by unanimous voice vote to incorporate the recommendations into the final report of the Panel; to give the Co-Chairs discretion to edit the report document as necessary to reflect the intent of the Panel as expressed in the recommendations; and to authorize the Co-chairs to direct the drafting of necessary legislation to effectuate the intent of the recommendations. Senator Buford said that the report would be mailed to the members as soon as it is complete and that it will include information about the anticipated cost impact of each recommendation. Business concluded, and the meeting was adjourned at 3:00 p.m.