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Kentucky Regulatory, Legislative and Reimbursement Report – March-April 2015

Kentucky Legislative Session 2015

  • Collaborative Care Agreements:
    • House Bill 377, the bill to make it easier for pharmacists and physicians to enter into Collaborative Agreements to cooperatively manage patients’ care, is set to become law. It streamlines the process for establishing Collaborative Care Agreements by allowing multiple pharmacists to enter into an agreement with multiple practitioners. The measure was sponsored by freshman Representative Dean Schamore (D-Hardinsburg) and was the top legislative priority of KPhA. House Bill 377 passed both chambers without a dissenting vote.
  • Medication Synchronization:
    • Also set to become law is a bill to require insurance companies to pay for pharmacy claims to “synchronize” refills to a common date. Senate Bill 44, sponsored by Senator Julie Raque Adams (R-Louisville) easily passed the Senate but temporarily stalled in the House after an unrelated floor amendment was filed to the bill by Representative Johnny Bell (D-Glasgow). Bell later withdrew the amendment paving the way for the final passage of the bill. An identical bill, HB 140, was filed in the House but died in committee. Senate Bill 44 has an effective date of Jan. 1, 2016. KPhA was part of the coalition that sought the passage of the bill and testified in favor of the proposal in committee.
  • HIV/AIDS Education:
    • The legislature passed legislation to eliminate mandatory HIV/AIDS continuing education(CE) for health care providers. House Bill 248 repealed the current law that requires all licensed health care providers to obtain HIV/AIDs CE once every 10 years. The bill was amended in the Senate to include the provisions of HB 139 which permits authorized entities such as restaurants and other places open to the public to stockpile epi-pens for use in the case of emergencies. The House agreed to the changes and the bill cleared its final legislative hurdle on the last night of the session.
  • Heroin/Naloxone (Pharmacist Dispensing)/Zohydro:
    • Prior to the legislative session, most political pundits would have bet that if the legislature did nothing else, they would pass comprehensive measures to address the heroin epidemic in Kentucky. More than a dozen bills dealing with the issue were introduced. But as the session drew to a close, it looked like the chances of passing a heroin bill were slim as the House and the Senate were deadlocked on the details. Each chamber had passed their own version of the bill but could not agree on key provisions such as penalties for trafficking, a needle exchange program and others. Late in the session, the House put forth a “compromise” proposal as an amendment to SB 192. It cleared the House but the Senate refused to agree with the changes made to the bill. It wound up in a free conference committee that appeared to be deadlocked. But shortly before the session ended, legislative leaders announced that the committee had reached consensus. The Free Conference Committee Report was quickly passed by both chambers and was signed by Governor Beshear on March 25.

Kentucky Regulatory Update

  • The Regulations Committee of the Kentucky Board of Pharmacy met on April 22, 2015.
  • Long Term Care Regulations
    • Board of Pharmacy President and Chair of the Regulations committee, Joel Thornbury, suggested starting with a draft regulation from February 2013 in order to remove the automated dispensing system language, so that the regulation can pass without it. After a 15 minute break, Committee member Lewis Wilkerson, along with the pharmacy workgroup, recommended using the latest version of the regulation from September 2014 and removing the automation language from that version. The recommendation was accepted. Chair Thornbury assured the pharmacy workgroup the committee will work timely to complete the automated dispensing system regulation.
    • Changes discussed:
      • Definition of Long Term Care Facility-will revise intermediate care facility for mental retardation to new accepted language and added Personal Care Home
      • Under Emergency Drugs, removed the controlled substances language and reduced the number to 30 items 6 deep.
      • Will add language to exempt Personal Care Homes from stocking emergency drugs.
      • Pharmacy Stock
        • Will add language to allow Personal Care Homes to have 30 drugs – 5 deep as pharmacy stock.
        • Will add language requiring pharmacy personnel to restock the pharmacy stock in a similar manner as emergency drug stock.
        • Leah Tolliver suggested that the KPhA Academy of Consultant Pharmacists thinks the 150 medication cap is too small. Committee member Cathy Hanna said she thinks 150 is very generous. President Thornbury suggested that the regulation move on with the 150 medicationcap, and the individual homes have the ability in the regulation to appeal to the board of pharmacy if a greater quantity is needed. Thte regulations committee can change the quantity in the regulataion if it is deemed to be too low for many facilities.
      • Removed Section 3, 4 and 5. related to automated dispensing system language.
  • HIV/AIDS CE requirement
    • Due to the recent change in law from the 2015 Kentucky Legislative Session, regulations were revised dealing with the requirement for pharmacists licensed in Kentucky to have 1 hour of continuing education on HIV/AIDS every ten years.
    • Regulations removing the requirement were approved at April 15 Kentucky Board of Pharmacy Meeting.
  • Naloxone Access
    • The comprehensive Heroin bill passed by the Kentucky Legislature at the end of the 2015 session included a provision to increase access to the overdose reversing drug Naloxone. The Board of Pharmacy was tasked with developing regulations and training programs to implement the regulations.
    • Draft regulations from Dr. Trish Freeman were shared with the Kentucky Board of Medical Licensure.
    • Board of Pharmacy President Joel Thornbury would like to approve regulations at the May 13 Board of Pharmacy meeting.
  • Collaborative Care Agreements
    • Trish Freeman is working on updating the current language to incorporate changes from the Legislative Session.
    • The update will allow multiple pharmacists to work with multiple physicians to treat multiple patients.
    • Board President Joel Thornbury wants to get this regulation passed as soon as possible.
  • Pharmacist/Patient Interaction
    • The Board of Pharmacy is discussing regulations that would increase pharmacist/patient interactions.
    • President Joel Thornbury said he talked to KPhA Executive Director Bob McFalls and Dr. Trish Freeman in San Diego at the APhA Annual Meeting. McFalls and Freeman are reviewing the proposal.
  • 2014 Regulation Update
    • During 2014, two regulations were amended. First, 201 KAR 2:030 License Transfer was amended. This amended regulation no longer requires a pharmacist reciprocating from another state to have worked a year in that state. He or she can apply for a Kentucky pharmacist license by initial examination by score transfer up to 90 days after passing the North American Pharmacist Licensure Examination®. After 90 days has passed, he or she can apply for reciprocation. For more information on the regulation or the process for initial licensure by examination or reciprocation, please visit the Board’s website at pharmacy.ky.gov.
    • The second regulation that was amended is 201 KAR 2:040 Registration of Pharmacist Interns. This amended regulation requires a pharmacist intern to notify the Board within 30 days of any charge of a) a felony, b) a violation of drug laws, or c) a violation of alcohol laws. To view 201 KAR 2:040, please visit the Board’s website at pharmacy.ky.gov.

Kentucky Department for Medicaid Services

  • Medicaid MMIS Approved Ancillary Claims in Error
    • The Kentucky Department for Medicaid Services informed LeadingAge Kentucky that in 2009, Medicaid required Nursing Facilities to obtain a prior authorization (PA) on ancillary services. Beginning February 2011 to current, claims stopped reviewing for a prior authorization on file. Even though Nursing Facilities should have continued to obtain a PA, the claims processing system may have erroneously paid claims without a PA.
    • On March 20, 2015, the ancillary services PA edit was put back into place to review for prior authorization. Providers that did not obtain a PA during this time period, that will be submitting new day claims, could see denials on their next claim submission.
    • If you have questions, please contact your HP representative.
  • Supreme Court Rules Providers Have No Right to Sue State Medicaid Programs
    • In a 5-4 decision issued last week, the United States Supreme Court ruled that health care providers can’t sue a state to mitigate rising costs with higher Medicaid rates.
    • Please click here for more information.
  • June Medicaid Cash Management Payment Withhold Announced
    • The Kentucky Department for Medicaid Services (DMS) will not issue the monthly Medicaid payment to Nursing Facilities during June 2015. DMS will make two payments in July for May & June 2015 services to restore payments to their routine schedule. This action is being taken as a budget balancing measure for State Fiscal Year 2015 which ends June 30th, 2015.
    • Please click here for more information.

Kentucky Department for Aging and Independent Living

  • Hart-Supported Living Grant Program
    • The Department for Aging and Independent Living is submitting for review and comment 910 KAR 1:270 Hart-Supported Living Grant Program. The amendment to this regulations updates definitions, eligibility requirements, responsibilities of the applicant, recipient, providers, employees, council and department, provides clarification on the review teams and application scoring as well as the criteria for the reduction or termination of a HSL grant.

Kentucky Office of the Inspector General

  • OIG Transfer Discharge Technical Changes Proposed
    • The Office of Inspector General recently filed 900 KAR 2:050 to correct a typographical error, replacing the word “or” with “through” in Section 2(2) as well as make other technical changes.
  • Notice of Recently Filed OIG Regulations
    • The Office of Inspector General recently filed 902 KAR 20:160 and 902 KAR 20:320 with the Legislative Research Commission. These administrative regulations, which establish licensure standards for chemical dependency treatment programs, psychiatric hospitals, and psychiatric residential treatment facilities, have each been amended to expand scope of services/allow designated outpatient behavioral health services to be provided under each licensure category.

APRN Guidelines

  • Advanced Practice Registered Nurse Guidelines
    • The Kentucky Board of Pharmacy office receives many questions regarding Advanced Practice Registered Nurse (APRN) prescriptive authority for CS. APRNs, pursuant to Kentucky law, have the following prescriptive authority for CS: KRS 314.011 and 201 KAR 20:059 (see actual laws for further details).
Drugs Days or Supply Refills
Schedule II 72 Hours No
Schedule II psychostimulants* 30 days No
Hydrocodone Combinations 30 days No
Schedule III 30 days No
Diazepam 30 days No
Clonazepam 30 days No
Lorazepam 30 days No
Alprazolam 30 days No
Carisoprodol 30 days No
Schedule IV-V Not to exceed six-month supply Not to exceed six-month supply
*APRN must be certified in psychiatric-mental health and serving in a health facility or regional mental health-intellectual disability services program

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