Jan. 7, 2019
FRANKFORT, Ky. — A Democrat elected to Kentucky's House of Representatives by a one-vote margin is preparing for a potential confrontation with the GOP-controlled legislature on Tuesday as he tries to take his seat amid an ongoing election challenge.
Jim Glenn said he plans to show up for work Tuesday when the Kentucky House of Representatives gavels in for the first time in 2019. But Republican DJ Johnson, who lost to Glenn, has asked the House to oversee a recount. Glenn and his attorney, Anna Whites, said Republican leaders have refused to say if they will allow Glenn to take his seat Tuesday.
"The citizens of Owensboro have a right to have continuous representation. They have a right to make sure that their issues are being heard by their local representative," Glenn said.
House GOP spokeswoman Laura Leigh Goins would not say whether GOP leaders would allow for Glenn to take his seat.
"The House Majority Caucus will address issues regarding this election contest in a legal, ethical and appropriate manner," Goins said. "We will continue to follow the requirements of the Kentucky Constitution and statutes as they apply to contested House seats."
Glenn's fate is likely to dominate the first few days of the 2019 legislative session, a time usually reserved for lawmakers to organize themselves before returning to Frankfort in February to consider legislation. Democrats control 39 of the chamber's 100 seats, so it is unlikely they will be able to stop the Republican majority if it decides not to seat Glenn. On Monday, a joint statement by the House's top three Democratic leaders said refusing to seat Glenn "would undermine our democracy and cause long-lasting damage to the House of Representatives."
The drama surrounding Kentucky's 13th House district coincides with a similar situation in North Carolina, where a Republican has not been seated by the Democratic majority in the U.S. House of Representatives over concerns about ballot tampering.
Glenn got 6,319 votes on election day while Johnson got 6,318 votes. A recanvas by local election officials, a process to double check the totals from voting machines, did not change the results. The Kentucky State Board of Elections later certified Glenn as the winner.
But Johnson has asked for a recount. He said local election officials should have disqualified six ballots because voters did not sign the precinct voter roster, as required by law. He also said election officials should not have rejected 17 absentee ballots.
Under state law, the House of Representatives is the only entity that can oversee a recount for its members. The law requires the House to appoint a board of between six and nine members to oversee the recount. But any findings from the board must be approved by the full House of Representatives.
Johnson said he plans to be in Frankfort on Tuesday and could watch the proceedings from the gallery. He said he is not opposed to Glenn taking his seat, but said GOP leaders have not told him what they plan to do. He said taxpayers are not paying for his lawyer, adding the Republican Party of Kentucky Party of Kentucky is helping cover his expenses. While Republicans control 61 of the 100 House seats, Johnson said he is confident he won't get special treatment because of his party affiliation.
"I have faith in the fact when it comes to the electoral process, legislators are going to do the right thing," he said.
Despite the uncertainty, Glenn said he has been given a specific seat on the House floor and three committee assignments. He had a local judge swear him into office on Jan. 2 in Owensboro, a common practice for some lawmakers so family and friends can attend the ceremony without traveling to the state Capitol in Frankfort. But for Glenn, the swearing-in had a dual purpose.
"We wanted to make sure everybody was aware I was sworn in," he said.
CMS shared a new MLNMatters learning handout, “Medicare Coverage of Substance Abuse Services.” The topic is of interest to providers as states transition away from the cash-only model of addiction treatment and towards services appropriately covered under the parity laws. Education on this topic helps ensure that patients and providers are educated about the right of a patient to have the care provided covered by Medicare or comparable commercial payers.
The handout, MLNMatters Number SE 1604, provides information on services for substance abuse disorders available under Medicare and Medicare information about substance abuse disorders available online, including links to additional educational materials and sites.
CMS makes clear that services for substance abuse disorders are available and covered under Medicare as long as those services are “reasonable and necessary.” Current Medicare coverage includes inpatient treatment, with a bundled or per diem payment that includes professional services not recognized for separate billing, such as peer counselors, and medications used in the course of the inpatient treatment.
Outpatient treatment is not payable to a provider as an independent facility or as an integrated bundle of services payment, but is payable on a service basis for those services recognized by Medicare. This includes counseling by a licensed and enrolled clinical social worker, psychologist, or psychiatrist, as well as services by auxiliary personnel incident to a physician’s services. The types of providers who can offer services that are entitled to Medicare reimbursement include physicians, clinical psychologists, clinical social workers, clinical nurse specialists, physician assistants, and certified nurse midwives. This expanded list of service providers make it easier for all patients to access the care needed.
Recently, CMS clarified payments for Partial Hospitalization Programs (PHPs), which are intensive outpatient psychiatric day programs furnished as an alternative to inpatient psychiatric hospitalization. These services include a minimum of 20 hours per week of PHP therapeutic services, as evidenced by a plan of care. Both hospital outpatient departments and Community Mental Health Centers are qualified to provide this type of service under Medicare. MLNMatters Special Article SE 1512 provides additional guidance for billing Medicare for PHP services.
CMS also affirmed the importance of initial Screening, Brief Intervention, and Referral to Treatment (SBIRT) services. This simple screening can be performed by any licensed provider and allows analysis of whether the patient would benefit from referral to a specialist in behavioral health or substance abuse treatment. Medicare covers SBIRT performed by physicians, non-physician providers, and outpatient hospitals.
The Medicare coverage also includes Medicare Part D drugs, as defined in the “Medicare Prescription Drug Benefit Manual,” Ch. 6, Section 10.8, as well as clinical laboratory services that are reasonable and necessary for the diagnosis or treatment of illness or injury. CMS confirmed that testing for drugs of abuse where reasonable and necessary can help manage the treatment of patients with substance abuse.
The CMS guidance will assist providers in ensuring that patients receive covered medical treatment in this fast-growing field.