Call to Order and Roll Call
The sixth meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, November 20, 2013, at 1:00 p.m., at the University of Louisville Health Sciences Center, Clinical and Translational Research Building, 505 South Hancock Street, Seminar Room 101/102, Louisville, Kentucky. Senator Julie Denton, Co-Chair, called the meeting to order at 1:09 p.m., and the secretary called the roll.
Present were:
Members: Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Perry B. Clark, David P. Givens, Jimmy Higdon, Alice Forgy Kerr, and Katie Stine; Representatives Julie Raque Adams, Robert Benvenuti III, Bob M. DeWeese, Kelly Flood, Joni L. Jenkins, Mary Lou Marzian, Tim Moore, Darryl T. Owens, Russell Webber, Susan Westrom, and Addia Wuchner.
Guests: Don Miller, M.D., Ph.D., Director, James Graham Brown Cancer Center;
Ken Marshall, President, University of Louisville Hospital & James Graham Brown Cancer Center/KentuckyOne Health; Craig Blakely, Dean of the University of Louisville School of Public Health and Information Sciences; Audrey Haynes, Secretary, Cabinet for Health and Family Services; Mary Begley, R.N., Commissioner, and Allen Brenzel, M.D., MBA, Medical Director, Deputy Commissioner, Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services; Carrie Banahan, Executive Director, Office of the Health Benefit Exchange, Cabinet for Health and Family Services; Barbara Bowers, Brennan Greene, Mark Prussian, and John Meyer, Opthalmologists; Don Putnam, Kentucky Concerned Family Network; John Buvicit, Passport Health Plan; Sherri Craig, KentuckyOne Health; Don Rogers, Bluegrass.org; Greg Wells, KBLLTCA; Shannon Buzard, citizen; Carol Mueller, Council on Developmental Disabilities; Barbara Gordon, KIPDA; Sarah S. Nicholson, Kentucky Hospital Association; Gasmets Alcalde, Foundation for a Healthy Kentucky; Adrienne Gilbert, Take Back Kentucky; Katie Carter, Kentucky Youth Advocates; Jeffrey Bumpous, University of Louisville; Donovan Fornwalt, The Council on Developmental Disabilities; Jill Seyfred, Prevent Child Abuse Kentucky; Eric Clark, Kentucky Association of Healthcare Facilities; Becky Bearblossom, Home Instead Senior Care; and Kip McNally, Attorney.
LRC Staff: DeeAnn Wenk, Ben Payne, Jonathan Scott, Sarah Kidder, Gina Rigsby, Cindy Smith, and Wesley Whistle.
Welcome
Don Miller, M.D., Ph.D., Director, James Graham Brown Cancer Center, and Ken Marshall, President, University of Louisville Hospital & James Graham Brown Cancer Center/KentuckyOne Health stated that University of Louisville Hospital and the James Graham Brown Cancer Center are both teaching facilities. The center is nine months into an operating contract with KentuckyOne Health, and has seen the benefits of being part of a larger healthcare system. The center is the region’s cancer center with state-of-the art programs focused on patients. According to the NCI Seer Database, between the years of 2005 to 2009, Kentucky was number one in the United States for cancer-related deaths. In 2012, there was a 25 percent decrease in the cancer death rate. The center has a multidisciplinary clinic with a laboratory for the translational scientist. There is a multidisciplinary team approach to specific tumor types. Clinical trials are used whenever possible. Support is provided to the entire family through the entire course of the disease. The University of Louisville has had a lot of success in developing new cancer drugs. The center is part of a Kentucky Dataseam initiative to help high school students in participating counties to research and find drugs to cure cancer. There is a satellite cancer center located in Owensboro. The oral HPV vaccine can change cervical cancer nationwide. Future cancer treatments will be directed by genome analysis, personalized and much less toxic. Cancer will be diagnosed much earlier so that advanced disease will be less common; therefore, cancer incidence will continue to decline. Multidisciplinary care will become normal. The ultimate benefit is better health for Kentuckians. The center is aware of the urgency for a cure for all types of cancer.
In response to a question by Representative Westrom, Dr. Miller stated that the center supports smoke-free Kentucky legislation.
In response to a comment by Senator Clark, Dr. Miller stated that the center will take answers for a cure for cancers wherever they can be found. Looking at the cannabis plant is a potential way to find new compounds to treat cancer.
In response to a question by Representative Burch, Dr. Miller stated that getting the HPV vaccine does not change the sexual behavior in teenagers. Boys need to get the vaccine as well as girls. The vaccine is 100 percent effective and affordable.
Dr. Craig Blakely, Dean of the University of Louisville School of Public Health and Information Sciences, stated that he encouraged looking at the entire spectrum of opportunities of diet and exercise strategies.
Minutes
A motion to approve the minutes of the October 16, 2013 meeting was made by Representative Owens, seconded by Representative Burch, and approved by voice vote.
Expansion of Behavioral Health Medicaid Providers
Audrey Haynes, Secretary, Cabinet for Health and Family Services, Mary Begley, R.N., Commissioner, Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services, and Allen Brenzel, M.D., MBA, Medical Director, Deputy Commissioner, Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services, stated that Medicaid has expanded the behavioral health services and providers. Substance abuse treatment has been added as a Medicaid benefit. Medicaid is providing increased flexibility in the provision of behavioral health services, with the goal of creating a continuum of care in behavioral health, including substance abuse, to include a wider array of interventions between outpatient and inpatient services. An open network is a continuum of care that ranges from consumer choice to open by service category, and/or the use of clearinghouse entities. Kentucky is one of only two states with a closed network. There are immediate providers with a Medicaid number in 35 counties, and Kentucky has the potential to create immediate capacity in most regions. The Deloitte Workforce study determined there is a significant shortage of behavioral health providers today. With the Medicaid expansion and fewer uninsured, more individuals will have behavioral health services as a covered benefit. The Mental Health and Substance Abuse Parity Act and final rule release will increase demand for behavioral health services in the commercial insurance market. Commerical insurers will be required to provide services. The addition of a substance abuse benefit increases demand substantially. The cabinet will submit a state plan amendment to describe new provider eligibility. It will take four to five months for providers to become eligible, credentialed, receive Medicaid provider status, and contract with a Managed Care Organization (MCO). Historically Kentucky has relied too much on high cost hospital and residential services and has limited lower intensity outpatient services such as crisis intervention and intensive outpatient programs. The goal is to add less costly, community-based services, and introduce flexibility to a wider array of providers to implement evidence-based practices.
In response to questions by Representative Burch, Secretary Haynes and Dr. Brenzel stated that she would supply the number of recipients who are currently being treated for behavioral health services, but Medicaid has a high behavioral health utilization rate. Approximately 20 to 25 percent of newly eligible Medicaid recipients will need behavioral health services. The 14 Community Mental Health Centers (CMHCs) receive $78 million in state general funds to serve $184,000 individuals. Currently, ten percent of the 750,000 MCO members seek behavioral health services each month. The MCOs served 60,000 individuals with behavioral health disorders at a cost of $220 million. Seventeen percent of emergency room visits paid by Medicaid were because of behavioral health disorders. About 80 percent of the emergency room superutilizers have both substance abuse and behavior health disorders. The Affordable Care Act will allow 308,000 of the 640,000 uninsured Kentuckians to receive Medicaid and 332,000 will be able to get private insurance coverage. Now private insurance coverage inside and outside of the exchange will provide a substance abuse benefit. Suboxone is the pharmaceutical treatment for substance abuse, but was not intended to be a long-term treatment.
In response to a question by Senator Clark, Secretary Haynes stated that a smoking cessation program is part of the current MCO contract. Individuals in MCOs that have been referred to smoking cessation programs have increased over the past year.
In response to a request from Representative Adams, Secretary Haynes stated that she would provide staff with a copy of the Deloitte Workforce study. Briefings on a companion facility study will be in early December. The study will look at acute care beds, critical care access hospitals, psychiatric beds in hospitals, and occupational and physical therapy at home health facilities and show where Kentucky is today, the utilization trends, and recommendations about what should be looked at in the future. There is a need to allow more established facilities to provide services. The CMHCs are meeting with the Department for Behavioral Health, Developmental and Intellectual Disabilities. The CMHCs contracts are good through June 30, 2014.
In response to questions by Representative Marzian, Secretary Haynes stated that the 14 Community Mental Health Centers (CMHCs) receive $78 million in state general funds to serve $184,000 individuals. The claims data submitted by providers from MCOs showed $220 million was billed for behavioral health services for 60,000 individuals. Currently, the MCOs are only allowed to contract with the CMHCs.
In response to a question by Representative Wuchner, Dr. Brenzel stated that medication assisted treatment is an important part of opioid treatment for opioid addiction and is a MCO covered benefit. MCOs have the choice of what agents are on the formulary and can require preauthorization and certain requirements for who receives medications. An individual has to be in treatment to get suboxone, but only a few can afford the treatment. The majority of individuals should be able to be successfully tapered off medications with the right services, especially adolescents. Eighty percent of adolescents have other behavior health diagnosis besides substance abuse. Family engagement is very important.
In response to a question by Representative Westrom, Dr. Brenzel and Secretary Haynes stated that there are 35 to 38 children in state custody in out-of-state facilities instead of in the hundreds, and the cabinet is making significant progress with the provider community to bring them home.
In response to questions by Senator Denton, Secretary Haynes and Dr. Brenzel stated that intensive case-specific review of children and the development of a comprehensive and intensive care coordination function would be needed in order for children to return to Kentucky. The intensive care coordination should be accountable and look at outcomes that can help develop a comprehensive, individualized, and customized community support plan. Some of the most challenging out-of-state children are the ones transitioning to adulthood. A barrier for out-of-state kids to come back to Kentucky is the availability of provider services that are funded throughout an individual’s lifespan. There will always be residential facilities. It is so much easier for a provider to get one bundled rate and give children lifetime services than to have to deal with managed care to pay for the child to stay at the facility. Children and adolescents need to be treated as individuals. Once a provider becomes engaged with managed care, the reporting requirements increase. The department is working on some quality indicators and outcomes for all providers that will be treated equally, but the CMHCs who receive general and federal funds will continue to have strengthened reporting requirements for those funds. Other providers will not have access to the same funds unless the CHMCs do not want to provide a program. State and federal block grant funds are offered first to CMHCs and will have additional reporting requirements separate from managed care. CMHCs already receive basically the Medicare rate which is the highest payment limit allowed by the federal government. CMHCs can use some providers and clinicians that are not fully independently licensed. The cabinet has been directing providers to contact the MCOs for informational packets to become Medicaid providers. IMPACT Plus providers will be eligible to enroll as direct Medicaid providers and will need to obtain Medicaid provider status in order to provide Medicaid services. The cabinet has used the MCO and Medicaid credentialing for IMPACT Plus providers. The Centers for Medicare and Medicaid Services (CMS) is very stringent with the MCOs and the cabinet that providers have to be credentialed and obtain Medicaid provider status to provider Medicaid services. IMPACT Plus providers will have until July 1, 2014 to get Medicaid credentialed. The federal government has heralded Kentucky as having the best credentialing process.
Update on Kentucky’s Health Benefit Exchange (kynect)
Carrie Banahan, Executive Director, Office of the Health Benefit Exchange, Cabinet for Health and Family Services, stated that an exchange is an organized marketplace for individuals and employees of small businesses to shop for health insurance offered by insurers and compare those plans based on price and quality. Individuals may also apply for Medicaid or the Kentucky Children’s Health Insurance Program (KCHIP) coverage through the exchange. The Affordable Care Act (ACA) requires states to create its own exchange or default to a federal exchange. Kentucky opted to create its own.
Individual plans are offered through kynect by Anthem, Kentucky Health Cooperative, and Humana. Small group plans are offered by Bluegrass Family Health, Kentucky Health Cooperative, Anthem, and United HealthCare through kynect. Small Business Health Option (SHOP) Program is available to employers with 50 or fewer employees who pay at least 50 percent of the employee premium, meet the 75 percent participation requirement, and have a choice of plans. The MCOs that participate in kynect are Passport, Humana, WellCare, Coventry, and Anthem. Individuals may qualify for premium assistance if a household income for the taxable year is between 138 percent and up to 400 percent of the federal poverty level (FPL). A small business may qualify for a tax credit if it pays at least 50 percent of the premium for each of its employees, has fewer than 25 full-time equivalent employees for the taxable year, and the average annual wage of the group is less than $50,000. Each plan has to provide ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care. Health benefit plans include catastrophic, bronze, gold, platinum, and silver. To date, Jefferson and Fayette Counties have the highest enrollment.
Insurance agents, kynectors, customer service representatives at the kynect call center can help an individual apply for insurance through the exchange. Beginning December 16, 2013 an individual can apply at the local DCBS office. The call center became operational on August 15, 2013. Open enrollment began October 1, 2013 and will end March 31, 2014 with coverage beginning as soon as January 1, 2014 depending on when an individual was approved for coverage. By visiting the kynect.ky.gov web site, an individual can find out who qualifies for Medicaid, KCHIP, or payment assistance through the exchange. After submitting an application, kynect will check an individual’s eligibility for programs that can help pay for health insurance.
In response to questions by Representative Benvenuti, Carrie Banahan and Secretary Haynes stated that individuals can check options on kynect if coverage was lost when the private insurance policies were cancelled because they did not include the essential benefits. The Department of Insurance (DOI) is meeting with the private insurance market to see what options are available. Kentucky ACCESS plans will sunset December 31, 2013. Approximately 10,000 individuals eligible for subsidies are waiting to the last minute to sign up for coverage because they will have to pay January’s premium. Of the 380,000 individuals who conducted preliminary screenings to determine eligibility, approximately 48,000 have enrolled in a health benefit plan. Approximately 39,000 were enrolled in the Medicaid expansion, including a lot of young people who were not eligible for coverage before the Affordable Care Act (ACA). When a person files an application on the kynect web site and are found eligible, the information is matched with federal databases for verification. If an individual’s information cannot be verified, the individual will have to supply additional information, often in person, to the local DCBS office. The ACA requires a bronze coverage to have an actuarial value of 60 percent, 70 percent for silver, 80 percent for gold, and 90 percent for platinum. The Department for Medicaid Services (DMS) has information on the annual cost per Medicaid recipient. It is up to the MCOs, not the cabinet, whether or not to have a co-pay collected by the provider from a Medicaid recipient. Co-pays can be applied for everything but preventive services. The cabinet has submitted a State Plan Amendment (SPA) to CMS with a list of co-pays for approval. The DOI provided approval of insurance plans. The goal is to insure as many of the 640,000 uninsured individuals as possible.
In response to questions by Senator Stine, Ms. Banahan stated that there is 20- to 24-hour training curriculum for the kynectors and insurance agents. As policy change, continuing education will be required. Criminal background checks are conducted for anyone applying to be a kynector. Approximately $80 million of the $253 million received from the federal government for the exchange has been spent with $60 million being spent on the development of the system.
In response to questions by Senator Givens, Secretary Haynes and Ms. Banahan stated that as of November 19, 2013, approximately 52,769 people have been determined eligible for coverage, including Medicaid and private insurance. The cabinet did not have a projected enrollment figure. The cabinet tested the system and all the vendors have gone through a special test to see how far the system can be stretched. The system can handle 2,000 to 3,000 enrollment applications per hour. Under the Motor Voter Law of 1993, state agencies that provide Medicaid coverage, TANF, SNAP, and WIC are required to provide a voter registration to applicants who fill out the application and send it to the county clerk’s office.
In response to questions by Senator Higdon, Secretary Haynes and Ms. Banahan stated that the old Medicaid match is 70 percent federal funds and 30 percent state funds. The cabinet would like to wait until mid-January to compare the normal sign-up trend to the woodwork effect of approximately 44,000 people who qualified for Medicaid but had not signed up before the expansion.
In response to questions by Representative Jenkins, Secretary Haynes and Ms. Banahan stated that if someone loses coverage under the new insurance plans, an insurer has to notify an individual of available options. Some old plans did not meet the ten essential health benefits and/or do not have an actuarial value of 60 percent and had to be discontinued. Of the 640,000 uninsured individuals, all but 50,000 would qualify for a Medicaid or premium subsidy.
In response by a question by Representative Webber, enrollment is for individuals not households. A breakdown by county will be available January 15, 2014 to February 1, 2014.
Representative Burch stated that Kentucky is way ahead in implementation of the exchange. Some people’s costs will be lower through the exchange. Everyone should have access to affordable health care.
In response to a question by Representative DeWeese, Ms. Banahan stated that Kentucky has received approximately $254 million through five grants from the federal government: $1 million for planning, $7.6 million to draft the Request for Proposals (RFPs) to obtain the system, $57 million for the system, and $182 million for the system and one year of operation. To date, only $80 million has been spent.
In response to questions by Senator Denton, Secretary Haynes and Ms. Banahan stated that as of December 2014, the state will no longer be able to draw down funds from the $254 million grants. Forty-one percent of the total enrollees are under the age of 35 and 32 percent are between the age of 18 and 35. Information would be provided to members on how many of this total would be eligible for Medicaid. No co-pays are allowed for children and pregnant women. Information would be provided on the new rate for co-pays. Each MCO determines how to handle the reimbursement of co-pays from Medicaid recipients. There are appointment waiting time standards listed in the MCO contract about the length of time a Medicaid recipient has to wait for an appointment, but the cabinet is not aware of Medicaid patients receiving preferential treatment over non-Medicaid patients. The Kentucky Health Cooperative received a $57 million loan under the ACA to offer products in the individual and small group markets in every county in Kentucky that has to be repaid to the federal government. The Kentucky Health Cooperative is required to be a non-profit organization and be licensed as an HMO with the DOI. Aetna only offers coverage in the large market. Full-time employees do not count in the 75 percent participation rate in the Small Health Option Program (SHOP) if they have coverage under another insurance plan. A birth or adoption is a qualifying event for the child not the family. Approximately 10,011 individuals of the 20,506 who qualify for a health insurance plan are enrolled or eligible to enroll. Of the 640,000 uninsured individuals, 332,000 are not eligible for Medicaid. The 320,000 are eligible in the individual market inside and outside of the exchange. One percent surcharge on premiums is a broad-based assessment on health insurance plans offered in the market just like the Kentucky Access Program is currently assessed. A final decision has not been made about the one percent surcharge. The cabinet has been through extensive reviews by the federal government and is confident that people’s personal information in kynect is secure.
In response to a question by Representative Adams, Secretary Haynes and Ms. Banahan stated that the annual operating cost of the Kentucky Health Benefit Exchange Office will be $40 million a year after federal funds are no longer available. Due to the one percent assessment, the exchange will not use state general funds.
In response to questions by Representative Benvenuti, Secretary Haynes and Ms. Banahan stated that the $40 million to operate the exchange would come from the one percent rate filing and premium amount funds currently used for the Kentucky Access Program. Some insurance plans did not meet the new minimum requirements of the ACA established for all insurance plans and caused people to lose coverage. Individuals were then required to find a plan that had the ten essential benefits required in the ACA. Senator Denton stated that Kentucky does not have a choice but to implement the requirements of the ACA.
Consideration of Referred Administrative Regulations
The following administrative regulations were referred for consideration: 201 KAR 6:020 – establishes requirements for licensure by the Kentucky Board of Licensure for Long-Term Care Administrators and sets limits on the taking of the examination; 201 KAR 6:030 – establishes the requirements for issuance of a temporary permit for an individual to practice the art of long-term care administration; 201 KAR 6:040 – establishes the requirements for renewal, late renewal, inactive licensure, and reinstatement of a license by the Kentucky Board of Licensure for Long-Term Care Administrators; 201 KAR 6:050 – establishes the requirements for issuance of a license by endorsement by the Kentucky Board of Licensure for Long-Term Care Administrators; 201 KAR 6:060 – establishes fees and charges for processing application, examination, and issuance of licenses, including renewals by the Kentucky Board of Licensure for Long-Term Care Administrators; 201 KAR 6:070 – delineates the requirements for continuing education by the Kentucky Board of Licensure for Long-Term Care Administrators and prescribes methods and standards for the accreditation of continuing education courses; 201 KAR 6:080 – establishes a code of ethics by the Kentucky Board of Licensure for Long-Term Care Administrators as a portion of the standards which shall be met in compliance with KRS 216A.070(1)(a), (c), and (d); 201 KAR 6:090 – establishes procedures for the investigation of a complaint received by the Kentucky Board of Licensure for Long-Term Care Administrators; 900 KAR 10:010 & E – establishes the policies and procedures relating to the certification of a qualified health plan to be offered on the Kentucky Health Benefit Exchange, pursuant to and in accordance with 42 U.S.C. 18031 and 45 C.F.R. Parts 155 and 156; 900 KAR 10:020 – establishes the policies and procedures relating to the operation of a Small Business Health Options Program in accordance with 42 U.S.C. 18031 and 45 C.F.R. Parts 155 and 156; 900 KAR 10:050 & E - establishes the policies and procedures relating to the registration of a business entity or individual agent in accordance with 42 U.S.C. 18031 and 45 C.F.R. Part 155; and 906 KAR 1:190 – sets forth conditions for voluntary Kentucky Applicant Registry and Employment Screening (KARES) program participants in addition to the name-based, state only background check requirements in KRS 216.533, 216.712(2), 216.787, and 216.789.
After Senator Denton asked for a motion to approve 201 KAR 6:020, 201 KAR 6:030, 201 KAR 6:040, 201 KAR 6:050, 201 KAR 6:060, 201 KAR 6:070, 201 KAR 6:080 and 201 KAR 6:090, Representative Burch asked to be recognized to question the quorum. Senator Denton stated that he would not be recognized for the comment. Representative Burch stated that he still questioned the quorum. A motion to approve 201 KAR 6:020, 201 KAR 6:030, 201 KAR 6:040, 201 KAR 6:050, 201 KAR 6:060, 201 KAR 6:070, 201 KAR 6:080 and 201 KAR 6:090 was made by Representative Webber, seconded by Representative Benvenuti, and approved by voice vote. A motion to find 900 KAR 10:010 & E deficient was made by Senator Stine, seconded by Representative Webber, and approved by voice vote. A motion to find 900 KAR 10:020 deficient was made by Senator Stine, seconded by Representative Webber, and approved by voice vote. A motion to find 900 KAR 10:050 & E deficient was made by Senator Stine, seconded by Representative Webber, and approved by voice vote. A motion to find 906 KAR 1:190 deficient was made by Representative Wuchner, seconded by Representative Benvenuti, and approved by voice vote. After representatives from the Cabinet for Health and Family Services finished the update on the health benefit exchange, Representative Burch stated that the affirmative vote that found the regulations deficient was a vote in futility, and the regulations would still become effective. Senator Denton stated that legislators were used to having lots of things done in futility in Frankfort.
Update on Kentucky’s Health Benefit Exchange (kynect) continued
In response to questions by Senator Denton, Secretary Haynes stated that on November 15, 2013, the Finance and Administration Cabinet pulled the MMIS RFP contract for Medicaid. The RFP called for the top three scoring companies to be asked to orals. CMS said that the cabinet had an excellent RFP and process. The cabinet contacted CMS that the RFP had been pulled and would contact them to let them know when the cabinet would reissue the RFP.
Ophthalmology CON Exemption
Barbara Bowers, Ophthalmologist from Paducah, stated that the purpose of the proposed ophthalmology Certificate of Need (CON) legislation is to provide quality, affordable eye surgery to the citizens of Kentucky. The legislation will decrease the costs of eye surgery to both the state and its citizens, increase access to eye surgery in rural areas as well as larger cities in Kentucky, increase the quality of eye surgery, and keep Kentucky surgeons and their patients in Kentucky. Ophthalmologists want to provide the standard of care that higher technology can provide, but are unable to presently because the facilities where the operation is performed does not have up-to-date technology.
Mark Prussian, board-certified healthcare administrator for the Eye Care Institute in Louisville, stated that cataract surgery is one of the most commonly performed surgeries in the United States. Current CON law in Kentucky is an almost absolute barrier to entry except for those already grandfathered into operating room ownership. Kentucky’s CON laws are arbitrary, antiquated, and highly political and not in the best interest of Kentuckians. Many Louisville hospitals do not encourage cataract surgeries which is an outpatient procedure. Medicare reimburses free standing surgery centers $900 for cataract surgery and hospitals $1,600. The same cateract surgery can be performed cheaper ambulatory surgery centers in bordering states. Kentucky loses millions of dollars from surgeries because of current CON laws.
Brennan Greene, Opthalmologist in Louisville, stated that he has performed cataract surgery in hospitals the past 18 years. One hospital opted not to perform cataract surgery anymore, and another one quit training staff in cataract surgery. Now it is cheaper to take patients to Indiana for the same surgery.
In response to questions by Representative Westrom, Dr. Bowers stated that the CON law could be written so that optometrists would not be allowed to perform laser surgeries. Currently, 80 percent of cataract surgeries nationwide are performed in ambulatory surgical centers. There are no ambulatory surgical centers in Bowling Green.
In response to questions by Representative Benvenuti, Dr. Bowers stated that there is an exemption for ASCs who provide a service or procedure not provided anywhere else in the state and does not apply to opthalmologists. She would check to see if the legislature closed the loophole for the exception that allows a single specialty ASC.
In response to a question by Representative Burch, Dr. Bowers stated that a Letter of Intent had been filed for a CON with the cabinet, but the company had been told it would not be given a CON. Dr. John Meyer, Opthalmologist, stated that opthalmologists are interested in easing the CON process not necessarily exempting ophthalmologists but making it easier to get a CON to perform ophthalmology procedures in an operating room associated with their practices. Dr. Greene stated that doctors have no way of raising the cost of a procedure. The patient pays more to have the procedure done in a hospital than an ASC, because the cost for providing care at an ASC is significantly less.
In response to questions by Representative Wuchner, Dr. Prussian stated that he had requested in writing an opinion from the CON office and received a letter that stated the application had been denied because there are no openings for ASCs. Dr. Greene stated that cataract surgery is primarily a Medicare payor mix.
In response to a question by Senator Denton, Dr. Meyer stated that ophthalmologists want the option to perform procedures somewhere other than the hospital. Cataract surgery performed in a doctor’s office is not reimbursed.
Kip McNally, Attorney and licensed CPA, stated that the primary concern is patient safety. There is an extensive regulatory process. Senate Bill 143 from the 2013 Regular Session did not provide any supervision from the Office of Inspector General, Division of Licensure, or provide annual surveys. There is not a problem with access to care. Leave the process in place. A person should demonstrate there is a utilization need based on the current State Health Plan criteria. Proliferation of surgical facilities is not in the best interest of the state.
Senator Givens stated that someone from the CON office at the cabinet should come to testify on the process during the session.
Sarah Nicholson stated that the Kentucky Hospital Association opposes a special exemption in the CON process. The State Health Plan states that someone can apply for a special CON if it is a single service. Opthalmologists can get paid now for services, but not a facility fee.
Adjournment
There being no further business, the meeting was adjourned at 5:10 p.m.