When legislators finally returned to Topeka for the sine die session on May 21, Senate Democrats attempted to pass Medicaid expansion by amending it into HB 2585, dealing with electric utilities. However, the amendment was found to be not germane to the underlying bill, and an effort to overturn the Rules Committee’s decision failed on a vote of 26-14.
When legislators returned for the 2020 Special Session on June 3, Rep. Ward made one final attempt in the House to pass Medicaid expansion by introducing an amendment to insert the contents of SB 252 into Special Session HB 2016. Once again, the amendment was challenged and found not germane, and an effort to overturn the Rules Committee’s decision failed, officially ending any last hopes of expanding Medicaid before the 2021 session.
While most KanCare discussion was centered on Medicaid expansion, KDHE staff and stakeholder organizations made several presentations to legislators on other KanCare issues during the 2020 session, including past and impending changes to how KanCare applications are processed, shortages in the direct care workforce and behavioral health issues.
HB 2550, as originally introduced, would have increased reimbursement rates for providers of home and community-based services under the Intellectual/Developmental Disability (I/DD) waiver. The House Social Services Budget Committee held a hearing on the bill on February 12, and later amended it to require that the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight review the number of individuals on the waiting list for the I/DD waiver and to require any findings and recommendations be included in written reports to the 2021 and 2022 Legislature. The committee subsequently recommended the bill be passed on February 24, but it was stricken from the House Calendar on February 27. Although HB 2550 was not passed, SB 66, the final budget bill, included $22.1 million, including $9 million SGF, to provide a 5 percent increase in the provider reimbursement rates for the I/DD waiver. However, the $9 million SGF was eliminated in Gov. Kelly’s Expenditure Allotments for FY 2021.
The committee also recommended that HB 2549, which would have permanently placed in statute the increase made last year to raise the protected income level (PIL) for any person receiving home and community-based services (HCBS) under KanCare from $727 per month to $1,177 per month (150 percent of supplemental security income [SSI]), be passed out favorably, but it too was stricken from the House Calendar on February 27. However, SB 66 also included a provision maintaining the increased PIL at $1,177 per month for HCBS waiver services recipients and individuals in PACE for FY 2021.
The final budget bill also included:
- A proviso requiring KDHE to facilitate a detailed review of the costs and reimbursement rates for behavioral health services in Kansas by January 2021;
- A proviso requiring KDHE to use funds to suspend, and not terminate, Medicaid coverage for inmates; and
- A proviso modifying the traumatic brain injury HCBS waiver, including lowering the waiver’s entry age to birth, restoring the unduplicated waiver slot count to 723, adding acquired brain injuries to the waiver and setting financial eligibility requirements for those under 18 to match the Serious Emotional Disturbance (SED) waiver.
Executive Reorganization Orders — Restructured Agencies
On January 30, Gov. Kelly submitted three Executive Reorganization Orders (EROs) to the Legislature. ERO 44 would have renamed the Department of Children and Families as the Department of Human Services (DHS) and transferred the functions of the Kansas Department for Aging and Disability Services (KDADS) and the Kansas Department of Corrections (KDOC) functions regarding juvenile services programs, juvenile facilities and institutions, excluding the Larned juvenile correctional facility, to the new DHS. ERO 45 moved the state employee health plan and workers compensation program from the Kansas Department of Health and Environment (KDHE) to the Kansas Department of Administration (KDA) and ERO 46 would have moved the Energy Office out of the Kansas Corporation Commission (KCC) and into a separate, independent entity.
On March 18, the House disapproved ERO 44 on a vote of 82-35 and also disapproved ERO 46 on a vote of 74-44. The House took no action on ERO 45 and it took effect on July 1, 2020.
In February, the House Insurance Committee considered HB 2459, which would have limited utilization review conducted by insurers under certain circumstances involving the treatment of mental illness and substance abuse, especially for individuals who are actively suicidal. Although the bill died in committee on February 20, a subcommittee convened to study the bill recommended a task force of legislators and various stakeholders be assembled to study the topic of mental health parity.
SB 407, which received a hearing in the Senate PH&W Committee on March 11, would have directed the Kansas Department for Aging and Disability Services (KDADS), using existing resources, to operate 12 acute inpatient psychiatric care beds for children in Hays and Garden City or surrounding communities. The bill died in committee.
Although no bills related to the state hospitals were passed this session, SB 66, the final budget bill, includes $5.3 million, all from the State Institutions Building Fund, to remodel the Biddle Building at Osawatomie State Hospital in preparation for ending the moratorium on voluntary admissions and certifying additional beds for federal reimbursements.
On June 18, 2020, the Legislative Coordinating Council approved the creation of the Kansas Mental Health Modernization and Reform Interim Committee. The committee, which will be chaired by Rep. Brenda Landwehr, is charged with analyzing the state’s behavioral health system “to ensure that both inpatient and outpatient services are accessible in communities, review the capacity of current behavioral health workforce, study the availability and capacity of crisis centers and substance abuse facilities, assess the impact of recent changes to state policies on the treatment of individuals with behavioral needs,” and make recommendations focusing on how Kansas should modernize its behavioral health delivery system.
Although the Special Committee on Federal and State Affairs that met in October 2019 had recommended that the standing Judiciary Committees consider legislation related to medical marijuana during the 2020 Session, no bills were considered by those committees.
SB 449 and HB 2709, introduced in the Senate Agriculture and Natural Resources Committee and House Agriculture Committee, respectively, would have removed marijuana products containing up to 0.3 percent THC from the list of controlled substances in Schedule 1 of the Uniform Controlled Substances Act. Neither bill passed out of committee.
Two medical marijuana-related bills were introduced in the House Committee on Federal and State Affairs in early March but neither received a hearing. HB 2740 would have created the Kansas medical marijuana regulation act, providing for the licensure and regulation of the manufacture, transportation and sale of medical cannabis. HB 2742 would have enacted the Kansas equal access act, providing for the licensure and regulation of the manufacture, transportation and sale of medical cannabis. A duplicate of HB 2742, introduced during the Special Session as HB 2017, also received no action.
Two bills related to e-cigarettes were considered this session but neither passed. HB 2563, as amended by the House Federal and State Affairs Committee on February 21, was a comprehensive bill that would have amended the Kansas Cigarette and Tobacco Products Act and the Kansas Indoor Clean Air Act to increase the minimum age to purchase or possess cigarettes and tobacco products from 18 to 21 (referred to as “Tobacco 21”), added the use of an electronic cigarettes to the definition of smoking in the Clean Air Act, and prohibited cigarette vending machines and flavored vaping products, except for tobacco or menthol flavors. The bill passed out of committee on February 21 and was placed on General Orders in the House but received no further action.
HB 2450, which would have amended the Kansas Indoor Clean Air Act to add “use of an electronic cigarette” to the definition of smoking and define “electronic cigarette” as “a battery-powered device that can provide inhaled doses of nicotine by means of cartridges or other chemical delivery systems,” was amended and recommended for passage by the House Judiciary Committee on February 13 but was stricken from the House Calendar on February 27.
Licensing & Scope of Practice
During the 2019 session, two bills were introduced that would have allowed advanced practice registered nurses (APRN) to practice and prescribe without being supervised by or having a collaborative practice agreement with a physician, sometimes referred to as “full practice authority.” Although one of these bills — HB 2412 — was still alive in the House Health and Human Services (HHS) Committee at the start of the 2020 session, it did not receive a hearing or vote. However, the committee held a roundtable discussion on February 19 to discuss full practice authority for APRNs and heard testimony from APRNs, physicians and physician assistants (PA) but ultimately took no action on the legislation.
As a part of her response to the COVID-19 pandemic, Gov. Kelly issued multiple executive orders (EOs) that impacted licensure and scope of practice for health care providers. EO 20-08, issued on March 22, created a temporary emergency license for any professions regulated by the Kansas State Board of Healing Arts (e.g., physicians, PAs), which allowed individuals to qualify for emergency licensure if they held an active or exempt license in Kansas within the last two years, had an active license in another state or an active federal license, met licensure requirements but were unable to pay licensure fees due to COVID-19 , or met all requirements for licensure except for completing a necessary examination that was canceled due to COVID-19. EO 20-08 also permitted the board to temporarily waive some regulations, and under that authority it waived select regulations for PAs, including the physician supervision requirement. The ability of the board to administer an emergency license was subsequently extended beyond the expiration of EO 20-08 and is now in effect through January 26, 2021, as a part of Special Session HB 2016.
On April 22, Gov. Kelly issued EO 20-26, which temporarily waived certain restrictions and requirements governing medical services. Under this EO, supervision requirements for licensed health care providers — including PAs, APRNs, registered nurses (RN), licensed practical nurses (LPN) and pharmacists — were temporarily waived, allowing most to provide care appropriate to their education, training and experience without supervision or direction by, or written agreements with, a physician or nurse. In effect, EO 20-26 temporarily provided APRNs full practice authority, as proposed in HB 2412. EO 20-26 also allowed RNs and LPNs with inactive, exempt or licenses that had lapsed within the past five years to provide services, as well as allowing any health care professionals licensed and in good standing in any state to practice in Kansas. Additional provisions in EO 20-26 protected providers from liability due to allowances made by the order. Special Session HB 2016 extended the provisions outlined in EO 20-26 through January 26, 2021.
On the first day of the session, the Crossover Youth Working Group — convened by the 2019 Legislature — submitted their report of key findings related to the impact of SB 367 on crossover youth, defined as youth who interact at varying degrees with both the child welfare and juvenile justice systems. SB 367, enacted in 2016, revised Kansas juvenile justice law with a goal of reducing the number of youths placed in ‘out-of-home” confinement over a five-year period and creating community-based alternatives to detention centers. During numerous meetings beginning in June 2019 that were facilitated by staff of the Kansas Health Institute (KHI), the Working Group identified key findings that were presented by the Department for Children and Families (DCF) and KHI staff, on behalf of the Working Group, to the House Children and Seniors Committee. The Joint Committee on Corrections and Juvenile Justice Oversight, along with Kansas Legislative Research Department staff, also presented their recommendations to the House Corrections and Juvenile Justice Committee.
While bills that were introduced in the House Corrections and Juvenile Justice Committee received hearings, they died in committee. SB 384, which would have required the Kansas State Department of Education (KSDE) and DCF to prepare an annual academic report card on educational outcome data regarding foster care students, was amended and passed out favorably by both the House and Senate Education Committees but was stricken from the House calendar on May 1. The bill was introduced again on June 3 as a part of Special Session SB 5 and was passed out favorably by the Senate Education Committee on June 4 but died on General Orders. Although neither bill passed, Gov. Kelly issued EO 20-53 on July 7, 2020, directing DCF, in collaboration with KSDE, to produce an “Annual Academic Report Card” for children in DCF custody that includes the educational outcome data included in the bills.
On June 18, 2020, the Legislative Coordinating Council approved the creation of the Special Committee for Foster Care Oversight Interim Committee. The committee, which will be chaired by Rep. Susan Concannon, will seek input from “families, social workers, and other stakeholders on progress and shortfalls in the State’s child welfare system” and make recommendations to the Legislature on additional improvements and oversight needed to improve the system.
Health Insurance Regulation
The House Insurance Committee, chaired by Rep. Jene Vickrey, considered a handful of health insurance-related bills during the session, but none passed out of committee. HB 2053, which would have amended existing law to extend the permissible term of short-term, limited duration insurance (STLDI) to a policy period of less than 12 months, allow renewal or extension of the policies for periods up to a maximum of 36 months in duration, and require insurance companies issuing the policies to disclose specified information in their contracts and application materials notifying consumers that the coverage is not required to comply with the federal requirements for health insurance contained in the Affordable Care Act (ACA), received a hearing on January 21. While Kansas law currently allows this type of policy to be for a term of six months with only one renewal, the provisions of the bill were intended to conform Kansas law to federal regulations finalized by the Trump administration in 2018. The committee amended the consumer notice provisions of the bill on February 19 and recommended the bill be passed on February 21, but it was stricken from the House Calendar on February 27.