Source: Adapted by KHI from https://bit.ly/2JPmWCR. Accessed December 4, 2020
Educators and public health officials continue to be concerned about the rapidly changing e-cigarette product landscape and the rising rates of e-cigarette use — especially vaping of nicotine or marijuana among young people. Now, some evidence suggests that e-cigarette use and dual use of e-cigarettes and traditional cigarettes may be an underlying risk factor for COVID-19. During the 2021 session, Kansas lawmakers may have an opportunity to consider another comprehensive bill that could include amending Kansas law to conform with the federal Tobacco 21 (T21) law, adding the use of electronic cigarettes to the Kansas Indoor Clean Air Act and prohibiting cigarette vending machines.
While banning flavored vaping products continues to be highly debated, the Legislature also might consider addressing the regulatory gap in the federal flavor ban, which does not apply to disposable products (e.g., Puff Bar). They also could consider restricting online sales and shipments of e-cigarettes, as well as regulating on-demand or delivery services, which sell e-cigarettes through internet apps and are unregulated at the federal level.
Scope of Practice and Licensing
Scope of practice issues have been debated in the Kansas Legislature for many years. During the 2020 session, the House Health and Human Services Committee held a roundtable discussion on providing “full practice authority” to advanced practice registered nurses (APRN), which would allow them to practice and prescribe without being supervised by or having a collaborative practice agreement with a physician. That roundtable discussion did not result in consideration of a bill during the regular session.
However, APRN full practice authority was granted in executive orders issued by Gov. Kelly in response to the pandemic. Then, during the 2020 Special Session, legislators included provisions in House Bill (HB) 2016 that extended APRN full practice authority and temporarily waived supervision requirements for additional providers, including physician assistants (PA), registered nurses (RN) and licensed practical nurses (LPN) to respond to the COVID-19 pandemic. Those provisions will sunset on January 26, 2021.
Other licensure changes were temporarily enacted in Special Session HB 2016, including some related to telehealth (see next section) and some that allowed registered nurses and licensed practical nurses with inactive, exempt or lapsed (within the past five years) licenses to provide services. The temporary grants of expanded authority and licensure included in Special Session HB 2016 — including the allowance of APRN full practice authority — likely will add a new dynamic to future discussions on this issue.
While the Kansas Legislature did not consider telehealth legislation during the 2020 regular session, beginning in March, Gov. Kelly issued multiple executive orders to increase access to telehealth services during COVID-19. Provisions from these orders that were included in Special Session HB 2016 allowed physicians under quarantine and out-of-state physicians without a Kansas license to practice telemedicine. The bill also directed the Kansas State Board of Healing Arts to not enforce statutes, rules or regulations that require in-person examinations to prescribe medications, including controlled substances. Because many of the provisions codified in HB 2016 are set to expire on January 26, 2021, legislators have expressed interest in revisiting telehealth issues during the 2021 session.
Though not enacted in HB 2016, lawmakers also may consider legislation extending changes made during COVID-19 by the KanCare program and other insurers that increase access to telehealth by mandating payment parity and expanding the services allowed under telehealth.
Over the last few years, several task forces and working groups have made recommendations to improve the lives of children in the foster care program. From August through October 2020, the Special Committee for Foster Care Oversight, chaired by Rep. Susan Concannon, met six times to develop recommendations for program improvement and oversight to present to the 2021 Legislature. Kansas lawmakers again may consider creating an independent agency, like Missouri and Nebraska have done, to monitor child welfare services and complaints. Senate Bill (SB) 2187, which would have established the Office of the Child Advocate for Children’s Protection and Services, was introduced in 2019, received a hearing in 2020, but ultimately died in committee. The Special Committee will continue to meet in the coming months to discuss other recommendations around funding, evidence-based prevention services, and better collaboration with health care and schools.
Private Health Insurance Regulation
President-Elect Joe Biden is expected to protect and build on the Affordable Care Act (ACA) by creating a public health insurance option. He also supports federal legislation protecting consumers from surprise medical bills (see next section) and allowing private health insurance plans to access “reasonable” pricing for prescription drugs that will be developed for the Medicare and public option programs. Kansas lawmakers likely will be paying close attention to actions taken by President-Elect Biden that impact private health insurance, which is regulated by the state. They also may be presented with opportunities to respond to changes in the ACA that impact coverage options, benefits and consumer protections available to Kansans.
Surprise Medical Bills
As of November 2020, 32 states have enacted laws to protect consumers from surprise medical bills and balance billing that arise when consumers with private health insurance unknowingly receive care from an out-of-network provider resulting in higher-than-expected out-of-pocket costs.
Although there has been wide support for enacting legislation to protect consumers from surprise medical bills, both Congress and states have struggled to balance the interests of insurance companies and providers when determining the amount an out-of-network provider will be paid by the insurer for providing services to enrollees. During the 2020 legislative session, a comprehensive bill related to surprise medical bills was introduced but failed to receive a hearing. However, on December 11, key House and Senate members of Congress announced a bipartisan agreement in principle on surprise billing legislation, known as the No Surprises Act, and a revised version of that legislation was included in H.R. 133, the Consolidated Appropriations Act, 2021, and signed by President Trump on December 27. Under this new federal law, which goes into effect on January 1, 2022, health plans, including both fully insured and self-funded plans, are required to hold patients harmless from balance billing for all out-of-network air ambulance and emergency services and for out-of-network services provided at in-network facilities.
KHI recently published an issue brief on surprise medical bills, which discussed legislation enacted by other states, past efforts by Congress to enact federal legislation, and actions taken by the Trump administration to prohibit hospitals and other providers who receive grants through the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) from sending surprise medical bills to patients treated for COVID-19.