Community Health and Advocacy
The Kentucky Medical Association is the only association in Kentucky that represents all physicians and patients before the Kentucky General Assembly, the courts, governmental regulatory agencies, the media and Congress. The KMA works to protect the practice of medicine in Kentucky and to assure that patients have the access to the care they deserve.
KMA developed advocacy priorities for the 2016 legislative session and was successful in advocating for the passage of two of the four issues. Besides the advocacy priorities, KMA monitored and spoke on behalf of physicians on other issues that came before the Kentucky General Assembly in the 2016 session. Click here to see how legislators voted on issues important to physicians.
In recognition of the key role physicians play in leadership, KMA has developed the Community Connector Leadership Program (CCLP) to provide an opportunity for physicians to enhance their leadership skills through education and direct community involvement. Community Connectors are physicians who are engaged in their communities in an effort to promote KMA policies and the practice of medicine in Kentucky by working with business, government and civic leaders.
Bills that Improve Health Care in Kentucky Cross the Goal Line in Short Legislative Session
From an early drive that went deep into the legislative clock for one KMA priority bill to a last minute dash across the goal line for another, the Kentucky Medical Association had a second consecutive winning session that will lead to benefits for patients and physicians across the Commonwealth.
When the Senate convened in January, members passed the majority’s priority bills, which included Senate Bill (SB) 4, legislation that establishes Medical Review Panels. Medical Review Panels consist of a group of independent, expert health care providers who offer an opinion on the merit of medical malpractice cases before they can be filed in court. But the bill moved slowly through the House process and required strong offense on the part of KMA and other groups for passage of this important piece of tort reform.
Bill sponsor Sen. Ralph Alvarado, M.D., R-Winchester, quarterbacked the drive, with able assistance from KMA member physicians who contacted their legislators to push the bill along. The new Republican-led House of Representatives passed the bill 51-45 with some changes March 1 and the Senate concurred with those revisions 25-11 March 6. Gov. Matt Bevin signed the legislation March 16.
KMA has long supported efforts to improve Kentucky’s medical liability climate and that’s why the Association once again made tort reform central to its advocacy efforts in 2017. SB 4 is a critical part of that work and represents a significant first step in creating a more fair and consistent legal climate for Kentucky health care providers.
KMA scored its second touchdown of the short session March 21 when Gov. Bevin signed SB 89, which ensures patients who want to quit smoking have access to tobacco cessation medicines and services recommended by the U.S. Preventive Services Task Force. Studies show that smokers have more success quitting when they work with their physicians. This legislation, sponsored by Sen. Julie Raque Adams, R-Louisville, removes barriers to access for smoking cessation programs by requiring both private insurers and the state’s Medicaid MCOs to cover tobacco cessation treatments.
The Senate passed the bill 35-2 Feb. 22 and the House followed suit March 14 on a 90-1 vote. The bipartisan support for the measure indicates the impact smoking has on Kentucky, which has one of the nation’s highest smoking rates. The Commonwealth spends $1.92 billion annually in smoking-related health care expenditures.
The final score came in the closing days of the session when provisions in SB 86, legislation to change domestic violence reporting requirements, were added to House Bill 309 and passed the Senate with a committee substitute March 29 on a 37-1 vote; the House concurred with the Senate changes and approved the legislation 94-0 March 30.
The legislation, proposed by the Kentucky Coalition Against Domestic Violence and sponsored by Sen. Alvarado, removes a potential barrier for individuals who want to reach out for services. Research by the University of Kentucky found that if women know in advance that their case would be reported, they are significantly less likely to report abuse or contact a domestic violence shelter. The legislation amends the state’s domestic violence reporting law by eliminating direct reporting by health care providers to the Cabinet for Health and Family Services. Instead, providers would link victims of domestic and dating violence to protective services for those who choose to accept them.
Other Bills that Passed
Prescription Limitations: House Bill 333 would make it a felony to illegally sell or distribute any amount of fentanyl, carfentanil and related drugs tied to an increase in drug overdoses in Kentucky. The legislation also contains a provision to limit prescriptions for Schedule II controlled substances used to treat acute pain to three days. The legislation, however, provides several broad exceptions to the three day limitation, including for post-surgical acute pain, inpatient administration and for any other reason the physician believes it is medically necessary to deviate from the new rule. The bill was passed by the Senate on a 29-9 vote March 30 with a committee substitute. The House concurred with the changes and the bill was delivered to the governor.
Direct Primary Care: SB 79, which defines “direct primary care membership agreement” and sets conditions for services under such an agreement, was signed by Gov. Bevin March 17. Direct primary care allows physicians to contract directly with patients to provide services covered by a set monthly fee without the involvement of insurance. Seventeen states recognized direct primary care as a health care delivery model. This new law, sponsored by Sen. Alvarado, allows the model to be used more in the Commonwealth without added barriers such as being inaccurately characterized as an insurance product.
Mammography: HB 78, sponsored by Rep. Jim DuPlessis (R-Elizabethtown), requires providers of mammography services to provide specific information to patients whose X-ray mammogram shows dense breast tissue. The legislation passed the House 93-0 Feb. 27, and then 37-1 in the Senate, but with a committee substitute with which the House did not agree. Special teams—conference committees in the House and Senate and then a free conference committee—iron out differences and reach compromise. The legislation was passed by both chambers on the last night of the session and delivered to the governor March 30.
Experimental Treatments: SB 21, sponsored by Rep. C.B. Embry (R-Morgantown), would permit eligible patients to use investigational drugs, biological products or devices for a terminal illness and prohibit sanctions for health care providers who are working with the patient. The bill passed on a 38-0 vote Feb. 21 and the House on an 87-7 vote March 14. It was signed by the governor March 21.
Immunizations: SB 101, sponsored by Sen. Raque Adams, allows a pharmacist to administer any immunizations for children ages 9 to 17 pursuant to prescriber-approved protocols and consent of a parent or guardian. Under current law, pharmacists are permitted to provide flu shots to children within the 9 to 17 age range. For all other immunizations, pharmacists are only permitted to administer to individuals 14 to 17 years of age. SB 101 expands this age range. The Senate passed the legislation 37-0 Feb. 22 and the House passed it 97-0 March 7. Gov. Bevin signed the legislation March 20.
Significant Bills that Did Not Pass
Peer Review Protections: While not a formal KMA priority bill, one piece of legislation that fell short of the goal line would have improved the medical liability climate in Kentucky. SB 18, would have protected the peer review process to allow physicians and hospitals to assess their work without the possibility of their words being used in a medical malpractice claim. The bill passed the Senate, but stalled on the House floor and did not come to a vote. If it had passed, SB 18 would make discussions in medical peer review cases confidential and privileged; that would make them not subject to discovery, subpoena or introduction into evidence for lawsuits. It would have put Kentucky’s peer review statute in line with 48 states across the country.
Smoke-free Schools: Another tobacco-related bill, SB 78, made it just past the 50-yard line. It passed the Senate in February, but failed to make any movement in the House. SB 78, sponsored by Sen. Alvarado, would have prohibited the use of tobacco products at schools, in school vehicles and at school-sponsored activities.
Midwifery: KMA successfully played defense on SB 105, legislation regarding the licensure and regulation of Certified Professional Midwives (CPMs) and home birth services, which failed to make any movement in the Senate. KMA opposed this legislation because it, among other reasons, did not prohibit CPMs from assisting with certain high-risk births in an out-of-hospital setting; did not require CPMs to have a collaborative relationship with a more experienced health care provider; and did not require a CPMs to have transfer agreement with a birthing hospital for appropriate backup in the event of an emergency.