Bills to become law on vaping, pharmacy reform, vaccinations, drugs, at-home blood testing, coverage of cancer screening, more

Kentucky State Capitol (Photo via Wikipedia)

By Melissa Patrick
Kentucky Health News

In its 2024 session the Kentucky General Assembly has passed dozens of health-related bills that address a range of topics. With one day left in the session, here are some of them: 

Vaping: House Bill 11 limits legal sale of vaping products to those approved by the U.S. Food and Drug Administration. It also creates a database of retailers that sell the products and sets fines for retailers, manufacturers and wholesalers who violate the law.

HB 142 requires school districts to adopt specific policies that penalize students for possession of "alternative nicotine products, tobacco products or vapor products" and report nicotine-related incidents to the state Department of Education. Changes in the Senate, accepted by the House, allow schools and their governing bodies to apply for grants related to nicotine usage and remove the mandate that schools suspend students with a third possession violation. 

Pharmacy reform: Senate Bill 188 changes laws governing commercial pharmacy benefit managers, with requirements aimed at saving the state's independent pharmacies from closing.  It provides for dispensing fees, bans PBMs from forcing patients to get their drugs through mail order, and keeps them from steering patients to pharmacies that they own.

The bill, sponsored by Sen. Max Wise, R-Campbellsville, also prohibits a PBM from reimbursing a pharmacy that it owns at a higher rate than a community pharmacy, or from keeping a community pharmacy from filling a 90-day prescription for a maintenance drug. And PBM will not be able to penalize a community pharmacy from sharing information with a patient on the cheapest option to pay for their medications.

Cancer detection: HB 52 will require health-insurance plans to cover all preventive cancer screenings and tests that are consistent with nationally recognized clinical practice guidelines without requiring patients to pay any cost-sharing requirements, including a deductible charge for the services.

The sponsor, Rep. Deanna Frazier Gordon, a Republican from Richmond, told Kentucky Health News in February that the cost for screenings is often a barrier for people who often don't get screened because they don't have symptoms.

HB 115 will eliminate co-payments and cost-sharing requirements for high-risk individuals who need follow-up diagnostic imaging to rule out breast cancer. Currently, screening mammograms are covered by insurance, but follow-up exams are often not. 

“Thousands of Kentuckians require diagnostic and supplemental breast imaging every year, yet many forgo them due to out-of-pocket costs. Not any more,"  Molly Guthrie, vice president of policy and advocacy at the breast-cancer foundation Susan G. Komen, said in a news release. "This life-saving legislation means they will now receive the breast imaging they require, leading to an earlier breast cancer diagnosis and often better health outcomes."  

Vaccinations: HB 274 will allow Kentucky pharmacists to order and administer vaccinations to children as young as 5. The state's routine vaccination rates for kindergarteners remain below pre-pandemic levels.

Pseudoephedrine: HB 386 will raise the annual purchase limits on pseudoephedrine to help people with chronic allergies legally obtain enough of the medication to meet their needs. The bill changes the current 24-gram annual limit to an 86.4 grams, and remove the limit on the number of packages per transaction, said sponsor Robert Duvall, R-Bowling Green.

Kratom: HB 293 will regulate kratom, a natural herbal supplement that is not currently regulated. It is often used for anxiety, pain, PTSD and opioid withdrawal. The bill defines kratom, prohibits sales to people under 21, puts it behind the counter and provides guidelines for manufacturing and labeling. It also says federal law supersedes state law on the matter. 

Blood thinners: HB 31 allows Medicaid patients in Kentucky who are on blood thinners to use at-home machines to test their blood. Patients on some blood thinners, like warfarin, now require a weekly trip to the doctor's office for blood work that looks at how fast their blood clots.

Amanda Crabtree, a registered nurse at University of Kentucky Chandler Hospital, told WKYT-TV that she hopes that other states will follow Kentucky's example in this legislation. Crabtree said she expects that Medicaid patients could receive their at-home machines as soon as this summer. 

Provider liability: HB 159 will protect health-care providers from criminal liability when a medical error harms a patient unless the harm results from gross negligence or wanton, willful, malicious or intentional misconduct. 

This effort was led by the Kentucky Nurses Association, which said the bill "will prevent health-care professionals from being charged criminally for making a medical error; that makes it good for nurses and nursing, and puts Kentucky at the forefront of developing laws to protect health-care workers." 

Workplace violence: HB 194 extends to contract workers, such as travel nurses, the law that makes violence against health-care workers a third-degree assault. It also extends this protection, now limited to hospitals, to contract employees at health clinics, doctor offices, dental offices and long-term care facilities. 

Sepsis: HB 477 establishes diagnostic criteria for sepsis allow hospitals to preserve current rules used for reimbursement of sepsis care, which allow payment when it is detected early, instead of only allowing reimbursement after organ failure occurs. 

"We know that if sepsis is caught early, the likelihood of survival is great," Jim Musser, vice president for policy with the Kentucky Hospital Association, told Kentucky Health News in March. "But for every hour that we wait, the chance of mortality increases by 7 percent." In sepsis, "The body responds improperly to an infection," says the Mayo Clinic. "Sepsis may progress to septic shock . . . When the damage is severe, it can lead to death."

Youth medical records: HB 174 allows parents have access to their child’s medical records until they turn 18. Right now, children 13 and older must sign a waiver for parents to have access to them. HB 174 also updates the state's Medical Orders for Scope of Treatment form, which defines a person's end-of-life wishes.

Veteran suicide prevention: HB 30 calls on the state Department of Veterans Affairs to create a suicide prevention program for service members, veterans and their families.

Stuttering: SB 111 eliminates some insurance coverage limits on speech therapy for stuttering. It was promoted by former UK basketball star Michael Kidd-Gilchrist, who has overcome stuttering.

Medicaid: SB 71 is designed to keep people from coming to Kentucky to establish residence so that they can sign up for drug treatment to be paid for by Medicaid. One challenge resulting from this practice, according to Rep. Shane Baker, R-Somerset, is that when they leave the program, they are often homeless. 

SB 280 will allow Level II trauma centers that partner with a  university to get the university-hospital rate for services delivered as part of that residency program.

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The more health-related social needs factors a woman has, the less likely she is to get a mammogram; that matters in Kentucky

Centers for Disease Control and Prevention graphic

By Melissa Patrick
Kentucky Health News

A Centers for Disease Control and Prevention study says the more health-related social needs a woman has, the less likely she is to get a mammogram. 

The study defines health-related social needs, or HRSNs, as social conditions that adversely affect a person's health. Examples include feeling socially isolated, loss of work or reduced hours, dissatisfaction with life, the cost to access health care, a lack of transportation, and receiving food stamps. HRSNs are some of the social determinants of health. 

Using data from the CDC's 2022 Behavioral Risk Factor Surveillance System, a continuing national survey, the researchers found that mammogram use was almost 20% lower among women between the ages of 50 and 74 who had three or more HRSNs, compared to women who had no such needs.

The report did not provide state-level data, but health-related social needs are more prevalent in Kentucky than in most states.

In Kentucky, 59% of women aged 40-49 and and 72% of women aged 50-74 reported having had a mammogram within the previous two years, according to the 2022 BRFSS data. The rate for younger women 40-49 was the same as the national average, but the rate for those 50-74 was 4.6 percentage points less.

Among U.S. women aged 50 to 74 with no adverse HRSNs, 83 percent had a mammogram in the last two years, while that was true for only 66 percent of those with three or more adverse HRSNs.

“We have to address these health-related social needs to help women get the mammograms they need,” Dr. Debra Houry, chief medical officer at the CDC, said in a news release. “Identifying these challenges and coordinating efforts between health care, social services, community organizations, and public health to help address these needs could improve efforts to increase breast cancer screening and ultimately save these tragic losses to families.”

Breast cancer causes more than 40,000 deaths in U.S. women each year, according to the news release. 

Between 2016 and 2020, Kentucky's breast-cancer rate was 126.7 per 100,000 people and its breast cancer death rate was 21.6 per 100,000, according to the National Cancer Institute State Cancer Profiles. The national rate was 19.6.

The report adds that Black women and women of lower socioeconomic status are more likely to die from breast cancer. 

The U.S. Preventive Services Task Force currently recommends that women aged 50 to 74 get a screening mammogram every two years and that women ages 40 to 49 talk to their health-care providers about when to start and how often to get a mammogram.

Most health-insurance plans cover the full cost of screening mammograms, but follow-up diagnostic imaging is not always covered.

To address this, Kentucky lawmakers recently passed House Bill 115, which eliminates co-payments and cost-sharing requirements for high-risk individuals who need follow-up diagnostic imaging to rule out breast cancer. Gov. Andy Beshear signed HB 115 into law on April 5. It takes effect Jan. 1, 2025. 

“Thousands of Kentuckians require diagnostic and supplemental breast imaging every year, yet many forgo them due to out-of-pocket costs. Not anymore," Molly Guthrie, vice president of policy and advocacy at the breast-cancer foundation Susan G. Komen, said in a news release. "This life-saving legislation means they will now receive the breast imaging they require, leading to an earlier breast cancer diagnosis and often better health outcomes."

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Kentucky's rate of teenagers having children is fourth in nation

Centers for Disease Control and Prevention chart, adapted by Kentucky Health News

By John McGary, WEKU

Kentucky has the fourth-highest teenage birth rate in the U.S., according to the latest figures from the Centers for Disease Control and Prevention, which show Kentucky’s teen birthrate to be 38 percent higher than the U.S. average.

At the same time, teen-birth rates are declining in Kentucky and the nation. The state's rate was 22.8 per 1,000 females aged 15 to 19 in 2019-21, down from 31.7 in 2014-16. This rate has decreased steadily since 2014-16 when that rate was 31.7 teen births per 1,000 females 15-19.

In 2020, Christian County had Kentucky's highest rate of birth to teens, 55 per 1,000 females aged 15-19. County-by-county teen birth rates since 2003 are available at https://www.cdc.gov/nchs/data-visualization/county-teen-births/.

Tamarra Wieder, state director for Planned Parenthood Alliance Advocates, said what children don’t learn in school is one reason Kentucky ranks high in teen births: “We're not having conversations around comprehensive sex education, and empowering our youth to know that they can say no to sex, that they can empower them to talk to their providers around birth control.”

Wieder said another reason for the high teen birthrate is a lack of proper medical care in much of the state. She said 73 of the     120 counties do not have practicing obstetrician-gynecologists, "so when you're already not having the these conversations in the classroom, and then you don't have access to providers, this is a huge problem for the commonwealth.”

Wieder said surveys show 83 percent of Kentuckians support comprehensive sex education supported by science and legitimate groups like the American College of Obstetricians and Gynecologists.

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Jefferson County Public Schools program will allow students to graduate high school with a licensed practical nurse degree

A program to bring more nurses into the workforce will be offered in the Jefferson County Public Schools. The program will allow high-school seniors to graduate with a licensed practical nurse degree, while they finish their remaining high school credit. 

“We are offering students the ability to graduate from high school ready for a practical nursing career — all while learning within an organization devoted to safe, quality nursing care," Brittany Burke, system director of the Norton Healthcare Institute for Education & Development, said in a news release. 

The LPN program is possible through a partnership with JCPS, Norton Healthcare and the Galen College of Nursing. Norton will provide tuition assistance to the students enrolled in the program, the release said.

LPNs, like registered nurses, are in short supply in Kentucky and across the nation. The Kentucky Hospital Association's 2023 Workforce Survey Report shows an estimated 300 LPN openings statewide, resulting in a nearly 21% vacancy rate. 

"The LPN workforce is also among the professions with the highest rates of employees age 55 or older (21.8 %), behind psychiatric nurses (28.3 %) and ahead of OR/PACU (20.9 %)," says the report. "In other words, nurses that are likely to retire in the next ten years, and discounting new and younger entrants, professions that will experience significant shortages." 

Interested high-school students who will be seniors during the 2024-2025 school year can fill out a form online to learn more about the program. 

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Despite waiting list, a shortage of nurses and plenty of money, governor and legislature don't fund new building for KSU nursing

Kentucky State University’s nursing program has outgrown the Betty White Health Center, opened in 1971. Nursing classes are spread in buildings across campus. (Kentucky Lantern photo by Jamie Lucke)

By Sarah Ladd
Kentucky Lantern

Kentucky State University requested $50 million this year to build a nursing school for its growing class of future health care providers. The governor and legislature rejected the request, even though the KSU program has a waiting list and Kentucky suffers from a shortage of nurses but enjoys a record surplus.

“The real tragedy is that we had the money to do it,” Rep. George Brown Jr., a Lexington Democrat, told the Lantern last week. He called the omission “a travesty.” Brown and other lawmakers said the decision is part of a long pattern of neglect and underinvestment in historically Black colleges and universities (HBCUs) — a disparity the Biden administration also has highlighted.

It’s “always been the history,” said House Democratic Floor Leader Derrick Graham, a KSU alum who urged Republican legislative leaders to fund the nursing building.

During House debate, Black lawmakers pointed out that Kentucky’s only public HBCU was being denied $50 million for a project they deem critical to its future, while $125 million was quickly found for Northern Kentucky University and the University of Kentucky to open a biomedical center in downtown Covington, where plans also call for NKU to move its law school.

The Senate added the Covington project to House Bill 1, which moves $2.7 billion from the Budget Reserve Trust Fund into one-time spending over the next two years. HB 1 includes other higher education projects: $60 million for a veterinary tech facility at Murray State University, $25 million for a UofL Health cancer center in Bullitt County and $22 million for a livestock innovation center at a UK research farm.

“Kentucky State always seems to suffer and always has to wait,” Brown said March 29 on the House floor. “‘You have to wait your time; it’s not your time.’ … So the question is, when will it be Kentucky State’s time?”

When budget negotiators met in a free conference committee on March 26, Graham asked why KSU’s “top priority” was not included in budget legislation. Graham represents Frankfort where KSU sits on a hill overlooking the capital city. Sen. Chris McDaniel, chairman of the Senate budget committee, said KSU had also revised its budget request by asking for money to deal with failing infrastructure and other maintenance needs.

House Bill 6, the budget bill, sets aside $60 million in bonding for “asset preservation,” described by McDaniel as “cleaning up campus.” House Bill 1 includes $5 million to design a Health Science Center for the nursing program but nothing to build it. McDaniel vowed “full intent” to pay for construction of KSU’s nursing building in the 2026 budget bill. McDaniel’s district includes Covington; he was instrumental in obtaining the $125 million for the downtown project involving NKU.

“We have a great deal of confidence in the new president of Kentucky State,” McDaniel said in the March 26 meeting. He was speaking of Koffi Akakpo, who became KSU’s 19th president last year on July 1. Before that, he was president of Bluegrass Community and Technical College.

HB 6 provides all the public higher-ed institutions with asset preservation funding pools for renovation and maintenance of buildings and other infrastructure.

During the free conference committee meeting, Democratic Senate leaders Gerald Neal of Louisville and Reggie Thomas of Lexington, both of whom are Black, said that expanding KSU’s nursing program is critical to the school’s rebound from recent troubles. The construction delay will cost KSU new students and needed tuition revenue and disrupt Akakpo’s plan for the future, said Neal.

Neal and Thomas urged the budget negotiations to reconsider. Thomas suggested spending less on restoration and maintenance at KSU in this budget to free up $50 million over the next two years to design and build the nursing building.

Senate Republican Floor Leader Damon Thayer of Georgetown responded ​​that KSU was “probably lucky that they get the taxpayer money that they have been getting and continue getting. With the recent numbers and results that have come from K-State, I think we should be dubious moving forward.” He said the “numbers have been pretty embarrassing.”

KSU has faced a series of controversies, including misused funds under a former administration and a 2023 warning from its accreditation body. In 2022, the legislature put KSU under a management improvement plan and provided $23 million to help it recover from a budget deficit.

In an interview with the Lantern last week, Akakpo said he is “grateful” for the $60 million in bonding but that it will “go quickly” as he tackles a list of maintenance needs.

The HVAC system, he said, is “not quite up to par” and the dorms are “in really bad shape.” Sidewalks and entryways need fixing, he said, and “leaky roofs” have caused damage that needs attention. The $60 million does “not quite” cover these needs, he said. “But we will try the best we can.”

A new building for nursing students and money to address maintenance needs were “both equally crucial for us to move forward,” Akakpo told the Lantern.

KSU's 342 nursing students make up 24% of the university's enrollment, and the program is “only going to grow,” said Akakpo. Nursing students study in three separate buildings because no designated building is large enough.

The Betty White Health Center, which is 53 years old, has administrative offices and a learning lab. Students take classes in Bradford Hall, Carver Hall and Hathaway Hall. “The building is needed because the building that is assigned to the nursing program is too small,” Akakpo said. It’s also already full.

Kentucky is thousands of nurses short of what it needs. The state is short 5,391 registered nurses and licensed practical nurses, according to the Kentucky Hospital Association. And, the students going into nursing school aren’t enough to replace those retiring and leaving the workforce.

Brown said KSU’s backlog of maintenance needs stems from historic underinvestment. The historically Black university, he said, is “the redheaded stepchild, if you will” of Kentucky higher education.

The Biden administration last year documented roughly $12 billion in underfunding for HBCUs nationwide when compared with state funding of similar predominantly white institutions.

The study compared land-grant institutions created by Congress in the 19th century, first for white students and later for Black students. KSU and UK are Kentucky’s land-grant universities. In Kentucky the disparity in per student state funding from 1987 to 2020 was $172 million.

U.S. Education Secretary Education Miguel Cardona and Agriculture Secretary Tom Vilsack sent letters to governors, including Kentucky’s, asking for states to right the “historical underinvestment.”

A letter from Cardona to Gov. Andy Beshear cited “unbalanced funding” and “longstanding and ongoing underinvestment” as reasons KSU “has not been able to advance in ways that are on par with University of Kentucky.” It added that “unequitable funding” of KSU put it $172.1 million short of what it would have received in the last 30 years.

The budget Beshear introduced in December did not include money for the KSU nursing building. It did ask lawmakers to allocate about $1.2 million to KSU for nursing and social-work scholarships in 2024-26.

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Many Ky. water systems exceed new federal limits for 'forever chemicals'; all systems must test for 3 years, correct if needed

WKYT map, adapted by Kentucky Health News

By Al Cross
Kentucky Health News

Several Kentucky water systems, mostly on and near the Ohio River, will have to fund ways to reduce certain cancer-causing substaces for which the first federal limits were issued Wednesday, April 10.

The substances are PFAS, a joint acronym for per-fluoroalkyl and poly-fluoroalkyl substances, which are widespread and last a long time in the environment without breaking down, so they accumulate in the human body. They have been linked to low birth weights, liver disease and kidney cancer.

The substances have been used in waterproof clothing, nonstick frying pans and firefighting foam. For example, PFOS was the key ingredient in the fabric protector Scotchgard and related stain repellents, and PFOA was used in carpeting, cloth and sealants.

Public water systems will test for the chemicals for three years. If the limits are exceeded, the new Environmental Protection Agency rules will give them two more years to install treatment systems.

The state Department for Environmental Protection listed these water systems as exceeding the new limits of 4 parts per trillion: Ashland (4.74 PFOA), Augusta (4.43 PFOA), Cynthiana (8.35 PFOS), Georgetown (5.46 PFOS), Lewisport (Hancock County, 12.7 PFOS), Maysville (5.09 PFOA), North Marshall County Water District (11.8 PFOA), Paducah (4.54 PFOS, 4.07 PFOA), Russell (5.62 PFOA), South Shore (23.2 PFOA, 18.9 PFOS). The last two towns are in Greenup County.

The Louisville Water Co.'s Payne Plant at Prospect had a PFOS level of 4.31, but the level at its Crescent Hill plant was only 2.75.

Some water systems exceeded the EPA requirements in at least one test in 2019 and 2023 but were not listed as exceeding the new limits during the period. Those were Brandenburg, the Graves County Water District, Hardin County Water District No. 2, Henderson (north), Kuttawa, Morganfield, Northern Kentucky Water District (Fort Thomas), Owensboro, Providence, Sturgis and Worthington (Greenup County).

Erin Haynes, chair of epidemiology and environmental health at the University of Kentucky, has studied the chemicals for many years. “It’s all around us,” she told WKYT. “So we need to just be conscientious of different sources and how we can do our best to reduce our exposure. But analyzing it and reducing the levels in our drinking water is a wonderful step in the right direction.”

"Some funds are available to help utilities," The Associated Press reports. "Manufacturer 3M recently agreed to pay more than $10 billion to drinking water providers to settle PFAS litigation. And the bipartisan infrastructure law includes billions to combat the substance. But utilities say more will be needed."

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Whether or not you smoke can be influenced by heredity; new research may help identify specific risks and ways to quit

Photo illustration by Gerd Altmann, Pixabay, via Newswise

Kentucky Health News

If your parents or grandparents smoke, you are more likely to smoke. Perhaps that's one reason smoking persists in Kentucky, which has a higher rate of adult smoking than any state but West Virginia. 

“Smoking is highly heritable, with genetic differences accounting for 40% to 75% of the differences in people’s smoking behaviors,” says Pamela Romero Villela, a doctoral student at the University of Colorado and main author of a new study of the phenomenon.

The university's Lisa Marshall writes, "Scientists have identified thousands of genetic variants believed to influence everything from when people first try smoking to how good that first cigarette feels to how often they light up and how hard it is to quit. Some variants influence how quickly we metabolize nicotine, while others underlie how sensitive we are to it. But little is known about how they interact with each other and with other genetic differences."

The new study "sheds unprecedented light on these interactions and provides new insight on the most well-known smoking-related variant to date," Marshall reports.

Romero Villela told Marshall, “The more we can understand what those genes do and how they interact, the better equipped we will be to develop personalized approaches to helping people quit.”

She and physiology Professor Marissa Ehringer, a longtime substance-use researcher, focused on the most widely replicated genetic variant associated with smoking behaviors, so important that researchers call it "Mr. Big."

"Mr. Big . . . influences how well nicotine binds to receptors in the brain," Marshall explains. "People with a certain version of Mr. Big, known as the AA version, are less sensitive to nicotine and have been shown to smoke more."

Romero Villela rold her, “It kind of numbs your response so in order for you to feel the same effect as someone who smoked one cigarette you might have to smoke almost one and a half cigarettes.”

The researchers found something new "when analyzing genetic information from about 165,000 current or former smokers of European, South Asian and Finnish descent," Marshall reports. "They discovered genes and variants in a completely different region of the genome that appear to interact with Mr. Big in a way that influences smoking habits. Notably, when people had the risk-boosting version of Mr. Big but also had a genetic variant called rs73586411, they smoked significantly less than expected."

Marshall writes, "More research is needed to understand just what the genes highlighted in the study do. Interestingly, one . . . has previously been associated with Parkinson’s disease. Nicotine is known to blunt some symptoms of the disease.

"The study authors imagine a day when people could be given a 'polygenic risk score' that would consider their gene variants and interactions to provide personalized recommendations for quitting. . . . Eventually, if researchers could determine what a variant does to dull the craving to smoke, they might be able to develop medications that mimic that action."

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