Kentucky House passes landmark bill to limit prescription drug abuse

Frankfort – With the goal of stopping prescription drug abuse in Kentucky, the House of Representatives voted overwhelmingly today for Speaker Greg Stumbo’s House Bill 1.

The legislation, one of two issues being considered in the special legislative session, is largely similar to what the chamber passed earlier this year during the regular session, which ended April 12th.  It has the strong backing of law enforcement, prosecutors, city and county officials and the Kentucky Chamber of Commerce, all of whom testified in support of the bill yesterday before it was approved by the House Judiciary Committee. Governor Beshear, Attorney General Jack Conway and the Judiciary Committee’s chairman, Rep. John Tilley, have also been key supporters.

“All of us feel it is imperative to return to our original proposal as much as possible, after efforts to reach a compromise with the Senate in the regular session’s final hours were hindered by the Kentucky Medical Association’s lobbyists,” said Speaker Stumbo, D-Prestonsburg.  “The result then was legislation too weak for the scale of the problem we are facing.  It would have left us with a system less effective than what we already have.”

“If enacted, House Bill 1 will be another major step forward in the state’s push to limit drug abuse on all fronts,” said Chairman Tilley, D-Hopkinsville, who presented the bill on the House floor.  “We just passed two new laws targeting synthetic drugs and meth; we need to add this as well.  Lives literally are at stake.”

The hallmark of House Bill 1 is moving KASPER, the state’s prescription drug monitoring system, from the Cabinet for Health and Family Services to the Attorney General’s office.

In addition, all physicians who prescribe controlled substances would be required to register – only about a third does now – and they could pay a maximum $50 annual fee to help cover costs if other revenue sources are insufficient.  They would then consult KASPER reports to ensure that patients are taking their medicine safely and appropriately. Doctors would use KASPER to confirm that patients are suitable candidates to receive potentially addictive drugs. The bill also calls for periodic KASPER checks on patients requiring long-term use of Schedule II and III drugs, which include such medicine as OxyContin.  This requirement would exclude such situations as hospice and emergency care.

Speaker Stumbo noted that a 2010 survey found that nearly 90 percent of physicians who use KASPER say its reports caused them to change what they had originally planned to prescribe.  The Kentucky Board of Medical Licensure, meanwhile, already recommends doctors take this step with every patient.

In an attempt to close down illegitimate pain clinics, Speaker Stumbo’s bill would require those in this field to be owned by a physician licensed in Kentucky, and the physician would have to be on the premises treating patients at least half of the time.  The pain clinics would also be required to accept health insurance as a form of payment instead of just accepting cash.  Together, these changes would keep the fly-by-night owners from setting up shop quickly in a community and replacing doctors who may get in trouble with the law.

All prescribers of controlled substances, meanwhile, could not dispense more than a 48-hour supply of this medicine from their offices.  This provision has been especially effective in such states as Florida, which had seen in-office dispensing skyrocket.

House Bill 1 also includes several provisions designed to increase medical oversight of prescription drugs and greater cooperation among licensing boards and law enforcement.

It calls on physician and nursing licensing boards to set standards on proper prescribing and dispensing practices, and to bar prescribing by anyone convicted of drug felonies, either here or in another state.  These boards would also set regulations on how to handle complaints – which would no longer have to be publicly sworn and notarized – and decide how to suspend licenses when public or patient health is in immediate danger.  In addition, the boards would include pain and addiction specialists, and the boards would have to establish continuing-education requirements on addiction and pain management.

For law enforcement, House Bill 1 would allow county and commonwealth’s attorneys to have access to KASPER if they are conducting an official investigation.  The Attorney General, the licensing boards and the Kentucky State Police also would work more closely to target prescription drug abuse.

Other aspects of the bill call on Medicaid officials to monitor the prescribing practices of doctors treating those enrolled in the healthcare program, and coroners would be called upon to report drug overdoses and deaths to the State Registrar of Vital Statistics and Kentucky State Police.  This will be designed to protect individual privacy while giving the public a much clearer picture of the number of those dying.  Speaker Stumbo said he suspected it is three to five times higher than the nearly 1,000 deaths now being reported annually.

“This bill will go a long way to putting a stop to a problem that has taken so many of our citizens and left a void in so many families,” Speaker Stumbo said.  “We cannot afford to ignore it any longer.”

The bill now heads to the state Senate for its consideration.

Speaker Stumbo Champions Strong KASPER Legislation

Frankfort – Today I am filing my bill to protect Kentucky families from the horrors of drug abuse and addiction. It will be House Bill 1, to underscore its importance to Kentucky’s families and communities. The most important thing we can do to protect the public is to ensure that doctors use our award-winning KASPER system as a diagnostic tool to protect their patients. If the doctors do not consult KASPER – and currently many do not – they cannot be guided by it.  There is strong reason to believe doctors need this; in a 2010 KASPER-satisfaction survey, 88.6% say obtaining a KASPER report changed a decision to prescribe controlled substances to a patient.

This bill will correct damage caused by lobbyists for the Kentucky Medical Association in the final days of the regular session, when KMA inserted last minute language that prevented mandatory use of this basic tool.  It is vital that this provision remain in whatever is enacted.

We now know that doctors who teach pain and addiction medicine at UK and U of L are supportive of having a voice in the critical task of controlling drug abuse, which is why my bill would make them eligible to be appointed by the governor to the boards that license doctors and nurses.  The  KMA’s lobbyists can no longer argue that such experts do not exist or, if they do, that they should not be on the licensing boards.  It is unfortunate that KMA lobbyists sought to obscure this provision.

Working together with the vast majority of health care professionals who put patient safety first, I am confident that we will pass a meaningful bill to make a major impact on drug abuse and addiction in Kentucky. I call on all Kentuckians to support this effort.

Rep. Leslie Combs’ bill to improve response to strokes set to become law

Frankfort – State Rep. Leslie Combs’ legislation to improve the state’s response to strokes – and to update the state’s Golden Alert system – is set to become law after getting final approval in the Kentucky House of Representatives on Thursday.

“Kentucky has seen its stroke rate improve significantly over the years, but it still remains one of the leading causes of death here in the Commonwealth,” said Rep. Combs, D-Pikeville.  “My goal with House Bill 467 is to see what more the state can do to bring these numbers down even further.”

 Her legislation calls on the state’s Department for Public Health to create and then implement a plan to improve stroke response and treatment statewide.  The department will also establish a statewide database to better track the rate of strokes and report on its findings each year.  Also, stroke healthcare providers will be called upon to better communicate with each other and share information.

In addition, the legislation modifies the Golden Alert program, which provides a quick emergency response when permanently impaired adults, such as those with Alzheimer’s or dementia, are reported missing.

The new law adds those with developmental disabilities, including autism and traumatic brain injury, to the list of qualified individuals, with these searches to be known as “Golden Alert D.”  Those to be contacted by law enforcement, however, remain the same: the local emergency management director, the local search and rescue coordinator and local media outlets.

To help those conducting these searches be better prepared, the state Division of Emergency Management is called upon to expand its training to include information on how to search for those with developmental disabilities who are missing.

“I’m proud to sponsor this bill, because it has a tremendous potential to really reduce one of the biggest killers in the state and to help our emergency personnel be better prepared when it comes to search and rescue,” Rep. Combs said.  “I’m really looking forward to seeing this law be put to use as quickly as possible.”

Speaker Stumbo’s False Claims Act targeting government fraud passes House

Frankfort – With overwhelming support, the Kentucky House of Representatives voted Monday for House Speaker Greg Stumbo’s effort to root our fraud across state government.

“The False Claims Act has proven to be a major success in the two dozen states that have it, and the federal government has relied on it in the modern era for nearly 30 years,” said Speaker Stumbo, D-Prestonsburg.  “Actually, its first use goes back to the Civil War, when President Lincoln first implemented it to stop war profiteering.”

House Bill 401 has two main goals: Rooting out fraud and reducing the state’s deficit by potentially millions of dollars by giving whistleblowers strong financial incentive to step forward if state tax dollars are being misused.

“Kentucky’s False Claims Act would extend far beyond Medicaid, which is the sole focus in a handful of states with this legislation,” he said.  “I want to see this used not just in that program, but anywhere fraud with state tax dollars is taking place.  “There is only so much our law enforcement and auditing officials can do and a limit to how far they can reach; this will put every citizen on the look-out for fraud.”

Under the Speaker’s bill, those found guilty would be liable for up to three times the amount they had fraudulently billed the state; whistleblowers will be eligible to receive anywhere from 15 to 30 percent of the monies recovered as a reward for their service.  Other civil penalties and attorney fees would be an additional cost for those found guilty.

Speaker Stumbo pointed to successes other states have seen using their False Claims Acts.  In 1998, for example, California recouped $30 million from a computer manufacturer found to have sold the state defective computers; and in 2005, that state got $43.1 million from a company not fulfilling a contract to provide energy-efficient heating and cooling equipment to San Francisco schools.  In 2001, Texas got $14.5 million from a hospital that had filed false paperwork, reported charity work it didn’t do and offered financial kickbacks.

Since 1986, according to the False Claims Act Legal Center, more than $25 billion has been recovered by False Claims Acts, with a substantial portion coming from healthcare companies.  More information can be found online at http://www.taf.org/statefca.htm.

The legislation calls for the whistleblower to begin legal proceedings and gives the Attorney General the option to join on behalf of the state, with that office eligible for a portion of any amount awarded.  Speaker Stumbo noted that he had pushed similar legislation last year and while he was Attorney General, and hoped that “this time we can get it across the finish line.”  He added that both the current Attorney General and the Cabinet for Health and Family Services – the main enforcers of the bill – have helped form the legislation.

The Speaker’s bill could make Kentucky eligible for 10 percent more money recovered under Medicaid fraud.  This is subject to federal approval, but it would let Kentucky receive up to 40 percent of the funds rather than 30 percent, which mirrors the traditional rate the state provides as part of its match for the $5 billion-plus program.  The remaining funds would principally go to the federal government and the one who brought the initial legal action.

He said that the law does not create new levels of fraud, but offers an avenue for more cases to be prosecuted.  It also does not apply in tax-related cases or those solely involving local governments.

“This legislation has a lot of potential, and I’m hoping we can move it through the Senate quickly,” Speaker Stumbo said.  “The sooner we can get it enacted, the sooner we can bring about the kind of accountability Kentuckians deserve – not just in Medicaid, but everywhere in state government.”

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