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Jan. 9, 2012
TOPEKA With the launch of the 2012 Legislature this week, policymakers face a variety of health-related issues.
Perhaps the most significant among them will be Gov. Sam Brownback’s proposed realignment of the state’s Medicaid program, which includes reorganization of three major agencies. But there also will be a raft of other issues ranging from legislation to expand the work that can be done by dental technicians to efforts to boost spending on tobacco-use prevention and a possible move to limit medical malpractice awards should the state Supreme Court strike down the existing cap.
KHI News Service has compiled and summarized the agendas of the administration and the state’s major health-related groups and agencies.
The Brownback agenda
The governor is scheduled to give the State of the State address on Wednesday and then release the details of his administration’s budget plan to legislative spending committees.
But administration officials already announced their top health agenda item for the session: to reform the Medicaid program by expanding managed care to the disabled and elderly.
As part of the plan, which is called KanCare, they are seeking three companies to provide Medicaid services statewide. The companies’ contract bids are due Jan. 31, and administration officials want KanCare operational by Jan. 1, 2013.
“We are putting our attention on Medicaid reform and the proposed executive reorganization order,” said Sara Arif, spokesperson for the Kansas Department on Aging, which is slated to grow significantly as part of the makeover and become the new Kansas Department for Aging and Human Services.
“Our primary legislative priority for the 2012 session is the governor’s proposal to reorganize state government and establish KanCare,” said Angela de Rocha, spokesperson for the Kansas Department of Social and Rehabilitation Services.
Key legislators have said they intend to put in place this session an oversight committee to monitor the governor’s reforms. And some legislators, including members of the Joint Committee on Home and Community Based Services, have voiced concerns about including services for the developmentally disabled in the managed care expansion.
Apart from that, the governor’s plan is expected to go largely unopposed, especially since the administration signaled it would not add new responsibilities to SRS as part of its Medicaid agency reorganizations.
Nonetheless, the proposed Medicaid reforms are of such scale that they have become a top legislative issue for a variety of provider groups, including the nursing home industry, the hospital and doctor associations, the state’s safety net clinics, mental health advocates and social workers.
“Our top priority (for the session) is going to be making sure that in all the discussions that go on about the managed care changes in Medicaid, we don’t put ourselves in a position of the state paying for services that are provided by people who are not licensed,” said Sky Westerlund, executive director of the Kansas Chapter of the National Association of Social Workers.
Cindy Luxem, chief executive of the Kansas Health Care Association, a nursing home trade group, said the organization’s priority for the session would be “working on maintaining the integrity of the Medicaid program. No reductions.”
Administration officials have said they expect their reform plan to be executed without significant cuts in payments to nursing homes, doctors, hospitals, social workers or other Medicaid service providers.
But that doesn’t mean the provider groups won’t be on alert this session for changes that might hurt them.
“As the state moves toward Medicaid managed care expansion, KHA plans to continue working closely with the state and provide information as to how the transition may impact Kansas hospitals and health care providers,” said Cindy Samuelson of the Kansas Hospital Association.
Jerry Slaughter, executive director of the Kansas Medical Society, the state’s largest doctor group, also said the Medicaid reform was at the top of the society’s priority list, though he gave the administration high marks for its plan so far.
“I think they're doing all the right things to create an environment where providers will say, ‘OK, I'll do my part. I'll make sure I have some Medicaid patients,’” he said. “I don't think they're going to lose any (doctors from the Medicaid program), and quite possibly they could pick up some.”
'Biggest long-term impact'
But other provider groups, especially those likely to be most affected, are fighting the Medicaid plan, or at least the parts that include them.
For the 2012 session, “managed care is the highest visibility stuff with the biggest long-term impact,” said Tom Laing, executive director of Interhab, the association that represents most of the state’s community programs for the developmentally disabled.
KHI News Service
Laing said the result would be a “train wreck” if the state hires insurance companies to manage services for the developmentally disabled. But he also said he was confident Brownback officials would reconsider their plan to include services for the developmentally disabled in the new managed care contracts. Ultimately, he predicted, the administration will “carve them out” of the plan, as some legislators have endorsed doing.
“If you’re a family who believes your son or daughter is in a program for long-term services that has a longevity they can count on, these kinds of changes are very unsettling” Laing said. “Folks worry a lot about the future for a son or a daughter with a disability, and when things are going pretty well and then they see some dramatic changes coming, that’s very alarming. I’m not sure the administration is attuned to how that feels for folks.”
Parents in Johnson County, Wichita and elsewhere have been meeting with legislators and voicing their concerns. One meeting, before Christmas, drew about 300 people. So far, that opposition to including the developmentally disabled in the Medicaid reform has been the biggest public response to the administration’s makeover plan. Some lawmakers have taken notice and others likely will as they move deeper into the session and the election year.
Here are some other health-related items ahead for the 2012 Legislature:
Health insurance exchange
The governor last year rejected a $31 million federal planning grant for a Kansas-based health insurance exchange, saying the administration would do nothing to implement the Affordable Care Act until the U.S. Supreme Court rules on the health reform law’s constitutionality. But until that ruling comes or something else changes, states are being held to the federal deadlines for implementing an exchange. States that don’t create their own exchange are expected to default to a federally run exchange.
Insurance Commissioner Sandy Praeger said her department’s chief goal during the legislative session would be to inform lawmakers of the ramifications of defaulting to a federal exchange. If legislators would endorse a state-run approach, another federal grant could be available for Kansas to implement its exchange.
Republicans control the House and Senate, and conservatives, especially in the House, have made clear their opposition to the Affordable Care Act. Among the early business of the House is a pending resolution expressing support for the state’s ongoing legal opposition to the law. Kansas is among the more than 20 states that are party to the case before the high court.
“We haven't seen a lot of movement in terms of changing opinions (among legislators), but I feel like we really want a Kansas exchange, so we're going to continue to push the envelope,” Praeger said.
During the legislative interim, the Joint Health Policy Oversight Committee encouraged Praeger to apply for another implementation grant.
“We'll continue to make the case that a Kansas exchange is better for Kansans, and whether you like the Affordable Care Act or not, we think it makes sense to keep our options open by working for the exchange implementation,” Praeger said. “We don't have any major legislative agenda outside of this. We're trying to keep it simple because the legislators have got their plate full to overflowing.”
Lawmakers are looking at a number of weighty issues this session, ranging from redistricting to reforming the tax code, the school finance formula. state water laws and the state employees’ pension plan.
University of Kansas Medical Center
Officials at the state’s only medical school said they are under “enormous pressure” to educate the next generation of doctors, conduct research “and provide clinical care while competing with other academic medical centers for key resources.”
They said one of the school’s most effective programs for encouraging students to enter primary care specialties and then practice in rural or other underserved areas faces a funding shortfall of $1.8 million in the coming budget year, unless the Legislature acts.
Students who use the Kansas Medical Student Loan Program get loans and tuition assistance and can work off the loans by practicing in underserved areas once they graduate. Because more students are choosing to work off their loans instead of repaying them with cash, the program is coming up short on dollars.
“Unless this funding is restored, 38 fewer loans will be available,” said C.J. Janovy, spokesperson for the medical school. “This will have a direct impact on the future supply of primary care physicians in Kansas, exacerbating current shortages of health providers.”
In another move to address medical work force needs, Janovy said, medical center officials also will ask for state funding to help construct a new building on the Kansas City campus so each year’s class size can be increased by 50 students.
KU also will continue its support for the Kansas Bioscience Authority, which has provided funding for the KU Cancer Center.
'Break the glass' provision
Last year’s Legislature approved Senate Bill 133, which harmonized the state's patient privacy laws with the federal privacy law known as HIPPA.
The legislation was meant to ease liability fears among Kansas doctors so they would join newly forming digital networks for exchanging patient information.
Kansans who do not want their health information to be shared over networks with other providers may opt out. But the law is ambiguous as to whether doctors may "break the glass" and access patient information in response to life-threatening emergency situations.
Slaughter of the medical society, who also is a member of the Kansas Health Information Exchange Inc. board, said he and other KHIE officials plan to meet with legislative leaders early in the session to see if changes in the law are necessary to assure that KHIE’s “break the glass” policy is legally permissible.
Shannon Jones, executive director of the Statewide Independent Living Council of Kansas, said her group will push state officials to reduce the number of people with physical disabilities on the waiting list for Medicaid-funded home- and community-based services.
KHI News Service file photo.
“On December 1, there were 3,369 people on the waiting list,” she said. “A lot of them have been on the list for almost three years.”
Jones said in July 2010 there were about 6,700 people with physical disabilities receiving home- and community-based services. Today, that number is down to about 6,000.
“Back in 2010, we were in the budget for about $140 million,” she said. “In the projected budget for (fiscal) 2012 we’re at $115 million.”
Jones said she and other advocates for the physically disabled also will testify against a recent decision to cut payments to payroll agents who help people with physical disabilities recruit, hire and pay their caregivers. The agents also coordinate and oversee services.
In Kansas, there are 12 independent living centers that help people with physical disabilities live at home and avoid moves to nursing homes. Jones said recent budget cuts ordered by SRS could force some of the centers to close within six months.
The centers’ representatives will ask the Legislature to restore the cuts made to base funding grants.
Christie Applehanz, of the advocacy group Kansas Action for Children, said the organization would lead the push for certification of a new type of midlevel dental practitioner to help improve access to dental care.
“Right now, 93 Kansas counties don’t have enough dentists to serve their residents. Thirteen counties have no dentists at all,” she said.
KHI News file photo
Legislators last year considered a bill that would allow licensing of so-called registered dental practitioners, similar to physician assistants, who could provide various routine treatments.
The bill met stiff opposition from the Kansas Dental Association and likely will again this year. The bill is supported by the Kansas Health Foundation, which is a major funder of the Kansas Health Institute.
Kansas Action for Children also will lobby to maintain the earned income tax credit and to expand the KIDS College Savings Program to allow third-party contributions.
Tanya Dorf Brunner, executive director of Oral Health Kansas Inc., said the group would push to expand the scope of practice for dental hygienists so they can provide services without a dentist present in schools to children whose parents have granted permission. Dental hygienists, thanks to a 2003 law that was expanded in 2007, already are allowed to provide services in nursing homes, Head Start centers and some other locations where there are underserved populations.
Brunner said her group also would ask lawmakers to expand full dental coverage for all Medicaid enrollees.
Medical malpractice caps
The Kansas Supreme Court for almost three years has been weighing a case that could result in the nullification of a 25-year-old law that caps the amount of damages juries can award victims of medical malpractice.
The Kansas Medical Society and Kansas Hospital Association are watching the case closely and are expected to push new legislation seeking ways to limit awards in the event the court strikes down the current cap or otherwise rules in ways that would undermine it.
“Depending upon the ruling, a legislative initiative may be required to restore the cap on non-economic damages. KHA would be supportive in maintaining a cap on non-economic damages,” said Samuelson, spokesperson for the hospital group.
“It’s pretty frustrating,” said Slaughter, speaking for the medical society. “In April, it will be three years (since the court took up the case). It creates a lot of uncertainty in the insurance market and makes a huge difference in how (doctors) plan.”
Slaughter predicted a substantial increase in malpractice premiums if the law is negated.
“This adds another measure of uncertainty to a health care environment that’s already very much up in the air because of the Affordable Care Act,” he said. “We can’t do anything about it until we know how the court is going to rule.”
Hospital officials, rural librarians and others will ask lawmakers to continue the services provided by Kan-ed, which provides schools, libraries and hospitals with broadband connectivity and subscriptions to various online databases and services. The House last session voted to eliminate Kan-ed.
“The Kan-ed program has been a valuable program to Kansas hospitals since its inception in 2001,” said Samuelson, speaking for the hospital association. “Hospitals have used the program to access broadband services that have allowed for increased employee and patient education. Certain hospitals have also used the Kan-ed network for telemedicine purposes.”
The House Utilities Committee on Tuesday is scheduled to receive an interim study report that recommends merging Kan-ed with Kan-REN, the network that serves the state universities.
Local health departments
“As of right now, our overarching priority would be to ensure sufficient funding to sustain a strong public health system in Kansas,” said Michelle Ponce, executive director of the Kansas Association of Local Health Departments.
But there are a couple of other issues of concern to the group.
Ponce said local health departments will oppose House Bill 2094, which would expand the exemptions for those who don’t want their children vaccinated against potential disease or illness.
They also will promote funding the Local Environmental Protection Program (LEPP), money for which was not included in the governor’s budget last year but was added by the Senate.
“Although we have not seen the governor’s budget for this year, I have been told no funding for LEPP will be included,” Ponce said.
KHI News file photo
Safety net clinics
“Our platform for this year is very, very simple,” said Cathy Harding, executive director at the Kansas Association for the Medically Underserved, a group that represents the state’s 38 safety-net clinics. “We are going to advocate to keep Medicaid reimbursements whole, and we’re going to request a slight increase in funding for the primary care grants.”
The clinics use the $6.8 million grant program to partially offset the costs of caring for the uninsured. The grants are administered by the Kansas Department of Health and Environment.
“There hasn’t been an increase in funding in the last three years, and there isn’t one in the fiscal year we’re in now,” Harding said. “And yet when you go back and look at the numbers from four years ago, you’ll see that we’re (now) serving 30 percent more people than we were back then.”
Harding said most of the state’s safety net clinics were struggling.
“Some are doing better than others,” she said. “What’s happening is that as the number of uninsured keeps increasing, demand goes up, but the financial ability to keep pace with that demand does not.”
Mental health advocates said they would ask legislators to restore funding previously cut for the state’s 27 community mental health centers.
“The loss of funds over the last three or four years has been devastating,” said Amy Campbell, who lobbies for the Mental Health Coalition of Kansas.
In 2008, mental health centers shared $31 million in state-funded reform grants that were used to offset the costs of caring for the insured and underinsured. The grants were pared to $10.8 million.
“That’s a cumulative reduction of 65 percent,” Campbell said, noting that in the past year many centers have responded by laying off employees and reducing access to services.
At the same time, she said, state hospitals for the mentally ill are full or near full.
“The system is short on both ends,” she said. “It’s really taken a toll on families, and anybody in law enforcement will tell you they’re having more and more encounters (with the mentally ill) with no way to handle them.”
Also on the coalition’s agenda:
· Add funding for substance abuse programs.
· Oppose the addition of mental health drugs to preferred formularies.
· Expand programs that encourage courts to modify sentences of mentally ill defendants in ways that keep them out of jail and ensure treatment.
· Support reopening the Rainbow Mental Health Facility in Kansas City at full capacity and keeping open a recently remodeled 30-bed unit at Osawatomie State Hospital.
In October, state officials announced the 36-bed Rainbow facility would be temporarily closed to accommodate repairs ordered by the State Fire Marshal’s Office. Rainbow patients were sent to a once-closed unit at Osawatomie State Hospital.
Rainbow is not expected to reopen for several months.
In February 2010, Rainbow had 50 beds. Officials closed 14 beds after federal inspectors concluded that the hospital was understaffed.
It’s unclear whether Rainbow will reopen as a 50-bed or 36-bed facility, and whether the 30-bed unit at Osawatomie will remain open after Rainbow reopens.
“It’s our hope, certainly, that the state will look at keeping the unit open,” Campbell said.
Keeping the Osawatomie unit open is expected to cost the state about $3.4 million, while remodeling at the Rainbow facility will cost $1.5 million.
Rainbow and Osawatomie are two of the three state-run hospitals for the mentally ill. The third is in Larned.
Campbell said advocates also would renew their call for expanding access to inpatient services by contracting with public and private hospitals’ psychiatric units.
“We have got to get away from the concept of centralizing inpatient services in two parts of the state: Larned or in the northeast corner (Kansas City and Osawatomie),” said Rick Cagan, executive director of the National Alliance for the Mentally Ill-Kansas. “We’ve got to get these services closer to the communities where people live and not be sending them halfway across the state.”
Representatives of anti-tobacco groups said their top agenda item would be to protect against new exemptions from the 2010 Kansas Indoor Clean Air Act and removing the existing exemption that allows smoking on the gaming floors of casinos.
Mary Jane Hellebust, head of the Tobacco Free Kansas Coalition, also said the group would push for a significant increase in the sales taxes placed on cigarettes and other tobacco products.
The coalition also will urge lawmakers to increase the dollars spent on tobacco-use prevention.