Between March 14-18, legislators were busy passing bills out of committees in preparation for Drop Dead Day on March 23, the deadline for consideration of nonexempt bills. They worked bills dealing with licensure and training of health care providers, scope of practice for pharmacists, limits on the authority of public health officials, changes to child welfare services and the foster care system, eligibility for food assistance programs, licensure and regulation of pharmacy benefit managers, and the regulation of medical marijuana. Legislators also continued to review redistricting plans for both the House and Senate for the 2024 election cycle, and the Senate passed its first budget bill. This edition of Health at the Capitol looks at health policy issues that were discussed during the 10th week of the session.
Health at the Capitol is a weekly summary providing highlights of the Kansas legislative session, with a specific focus on health policy related issues. Sign up here to receive these summaries and more, and also follow KHI on Facebook, Twitter and LinkedIn. Previous editions of Health at the Capitol can be found on our ARCHIVE PAGE.
On Thursday, March 17, the House passed Senate Bill (SB) 335, passed by the Senate on February 17, which would exempt certain qualified trade, merchant, retail, and professional associations and business leagues in the state from payment of the annual premium tax to the Kansas Insurance Department. These professional associations and business leagues provide health benefits through a self-funded health plan subject to the federal Employee Retirement Income Security Act of 1974 (ERISA) but are not subject to the jurisdiction of the Kansas Insurance Department.
House Health and Human Services Committee
(Rep. Brenda Landwehr, Chair)
On Monday, March 14, the Committee held a hearing on House Bill (HB) 2734, which would amend licensure requirements for certain professions licensed by the Behavioral Sciences Regulatory Board (BSRB). The bill would add to the list of requirements for licensure as a specialist clinical social worker an allowance for applicants who complete additional postgraduate supervised experience as determined by the Board in lieu of completing a graduate-level supervised clinical practicum as required by law. The bill also would allow a master social worker, specialist clinical social worker, professional counselor, clinical professional counselor, marriage and family therapist, clinical marriage and family therapist, master’s level psychologist, clinical psychotherapist, or psychologist currently licensed in Kansas to be eligible to take a Board-approved examination for licensure as an addiction counselor. Proponents included David Fye, BSRB, and Michelle Ponce, Association of Community Mental Health Centers of Kansas (ACMHCK). Fye noted that the bill was requested on behalf of BSRB, in part, to replace language deleted during the 2021 session related to requirements for licensed specialist clinical social workers. Ponce noted the shortage of staff available in the 26 community mental health centers (CMHCs) across the state and said that a recent internal survey of CMHCs showed they are operating at a 20-percent vacancy rate. She then stated that HB 2734 would reduce the burden on qualified clinical staff seeking licensure and enable them to enter the workforce more quickly. The Committee agreed to work the bill immediately and passed it favorably out of Committee.
The Committee also held a hearing on SB 200, passed by the Senate on February 15, which would expand pharmacist scope of practice to include initiation of therapy for influenza, strep throat, or urinary tract infection, pursuant to a statewide protocol adopted by the Collaborative Drug Therapy Management Advisory Committee. Proponents included Elizabeth Patton, Americans for Prosperity; Mitch DePriest, Kansas Association of Chain Drug Stores; and Amanda Applegate, Balls Food Stores. Patton stated the bill was “innovative” and would increase access to care, lower costs and produce better wellness outcomes. DePriest stated the bill would allow the conditions listed in the bill to be more easily addressed and noted that the Senate Public Health and Welfare Committee had asked the proponents and opponents of the bill to meet to work out differences. Written proponent testimony was submitted by representatives of the Kansas Pharmacists Association, Kansas State Board of Pharmacy, Kansas Chamber, Richey’s Drug Store, Currus, and Walmart. Neutral testimony was provided by Rachelle Colombo, Kansas Medical Society, who provided a summary of the discussions between proponents and physicians during the summer, and also offered an amendment to the bill based on those discussions. Written opponent testimony was submitted by representatives of the Kansas Academy of Family Physicians and the Kansas Chapter, American Academy of Pediatrics.
Committee members asked questions regarding how testing by pharmacists would be conducted, whether pharmacists would be contracting with insurers to bill for the services provided to patients, and how disposal of biohazard waste from on-site testing would be handled. The Committee then worked the bill, adopted the amendment offered by KMS with a few technical changes, and passed the bill favorably out of Committee, as amended.
On Tuesday, March 15, the Committee worked SB 453, related to unlicensed employees working in adult care homes: requiring them to take training courses to demonstrate certain skills to successfully complete such courses, requiring licensed nurses to teach and evaluate such courses, and allowing simulation experiences to be used as part of the training. Scott Brunner, Deputy Secretary for Hospitals and Facilities, Kansas Department for Aging and Disability Services (KDADS), stated the proponents and opponents met, as requested by Chair Landwehr, and developed compromise language to amend the bill. The Committee made several amendments to the bill, including:
- Requiring the Board of Nursing to submit an annual report, beginning on January 9, 2023, to the House Health and Human Services Committee and the Senate Public Health and Welfare Committee on the number and nature of disciplinary complaints filed, investigated or charged in the prior year;
- Replacing references to “certified aides” with “unlicensed employees” or “unlicensed employees working in an adult care home;”
- Requiring instructors of the certified nurse aide (CNA) training course to be licensed to practice in Kansas and in good standing and defining “in good standing” to mean “the possession of a license, certificate or registration that is subject to probation or non-disciplinary conditions, limitations or restrictions, but does not include a license, certificate or registration that is revoked, canceled or surrendered or subject to pending license-related disciplinary action;”
- Expanding the entities that can prepare and administer the training and the premises where such training can be conducted; and
- Prohibiting an unlicensed employee from providing direct, individual care to residents if they fail to make progress toward completion of training required by the Secretary of KDADS within four months of completion of the first 40 hours of training.
The bill was then passed favorably out of Committee, as amended.
Senate Public Health and Welfare Committee
(Sen. Richard Hilderbrand, Chair)
On Wednesday, March 16, the Committee worked Senate Bills 155 and 489. SB 155, which would update statutes related to newborn screening and designate those statutes as the Newborn Screening Act (Act), would establish the Universal Newborn Screening Program (UNSP) to be administered by the Secretary of the Kansas Department of Health and Environment (KDHE), would remove the list of conditions in the Act and authorize the Secretary to determine the conditions to be included in the UNSP, including, but not limited to, conditions listed in the recommended uniform screening panel recommended by the U.S. Secretary of Health and Human Services. The bill also would increase the amount available for transfer from the Medical Assistance Fee Fund to the Kansas Newborn Screening Fund from a maximum of $2.5 million to a maximum of $5 million in any one fiscal year. The bill was passed favorably out of Committee.
SB 489 would amend several existing statutes related to contagious or infectious diseases to restrict or limit the powers of the Secretary of KDHE and local health officials. The bill was further amended by the Committee replacing language in current law allowing local health officers to “issue” an order requiring quarantine or isolation in certain situations with language stating that such orders may only be “recommended.” The bill was passed favorably out of Committee, as amended.
On Thursday, March 17, the Committee worked HB 2386, SB 460, Senate Substitute (Sub) for HB 2280, and SB 501. HB 2386, related to requirements for the payment and reimbursement of dental services by a dental benefit plan, was amended to remove a provision that would have required a dental benefit plan to notify the dentist if the plan is sharing a part of the profit from the fee charged by credit card companies for processing payments and passed it favorably out of Committee, as amended.
SB 460 would require a forensic medical evaluation of an alleged victim of child abuse or neglect as part of an investigation, known as a child abuse review and evaluation (CARE) examination; create a program in KDHE for the training and payment for CARE examinations; and define child abuse review and evaluation providers, networks and examinations and child abuse medical resource centers. SB 460 was passed favorably out of Committee.
Senate Sub for HB 2280 would allow prescribers to prescribe drugs approved by the U.S. Food and Drug Administration (FDA) ─ including, but not limited to, hydroxychloroquine sulfate and ivermectin ─ for the off-label use of preventing or treating COVID-19 infection. The bill would allow such prescriptions even if the patient has not been exposed to or tested positive for COVID-19. The bill also would provide that recommendations, prescriptions, uses or opinions of a prescriber related to the treatment of COVID-19, including treatment that is not recommended or regulated by the Kansas State Board of Healing Arts (BOHA), KDHE or the federal Food and Drug Administration, would not be considered unprofessional conduct. The bill also would amend the Pharmacy Act to prohibit pharmacists from refusing to fill or refill any prescription on the basis of such prescription being used to treat or prevent a COVID-19 infection and would amend law relating to child care facilities and schools to provide that children and students enrolling in a child care facility, school or preschool or day care facility operated by a school, would be exempt from immunizations required by the Secretary of KDHE if such immunizations would violate sincerely held religious beliefs and such an exemption would be granted without inquiring into the sincerity of the request. Following a discussion of additional proposed amendments, which were not adopted, the bill was passed out favorably, as amended on March 8.
SB 501 would require able-bodied adults without dependents to complete an employment and training program in order to receive food assistance; require state agencies to conduct cross-checks to verify public assistance eligibility; require KDHE to seek approval from the Centers for Medicare and Medicaid Services to eliminate mandatory hospital presumptive eligibility; require hospitals to follow standards established for presumptive eligibility determinations; and require state agencies to make data from fraud investigations relating to food assistance and medical assistance publicly available on their websites. An amendment offered by Sen. Molly Baumgardner to strike most of the text of the bill and retain only the portion related to the Supplemental Nutrition Assistance Program (SNAP) employment and training requirement for able-bodied individuals without dependents was adopted.
House Children and Seniors Committee
(Rep. Susan Concannon, Chair)
On Tuesday, March 15, the Committee held a hearing on SB 276, passed by the Senate on March 7, which would establish certain procedural safeguards, in compliance with the federal Americans with Disabilities Act, to protect the interests of children parented by blind individuals or children who could be parented by blind individuals, and to protect the rights of parents and prospective parents who are blind. Proponents included Robert Tabor and Tom Page, National Federation of the Blind, Kansas; Lou Ann Kibbee, SKIL Resource Center, Inc.; Mike Burgess, Disability Rights Center of Kansas; and two private citizens. In their testimony, Kibbee and Burgess requested that the Committee consider expanding the language of the bill to include all types of disabilities in addition to blindness. Committee members asked questions regarding clarification of how judges in Child in Need of Care cases currently address the issue of blindness in those cases; whether there is existing federal or state law addressing discrimination on the basis of disability in child welfare cases (yes); examples of independent living skills training in Kansas; and whether recipients of these services incur any costs (no). Additional written proponent testimony was submitted by 14 individuals and there was no neutral or opponent testimony.
The Committee then worked HB 2700, which would require the Kansas Department for Children and Families (DCF) to review certain needs and attachments of a child before consenting to an adoption and require the court to make a finding that such review was conducted by DCF before entering an order of adoption. The assessment should include (1) the child’s current relationships with caregivers, relatives, siblings and others; (2) whether a family can best meet the child’s medical, physical, emotional, cultural and other specific needs; and (3) the child’s need to maintain and strengthen current healthy attachments. The Committee amended the bill to:
- Specify the Secretary would be required to conduct an individualized assessment of the child’s needs and attachments prior to giving consent for a legal adoption of a child, and the court would be required to find such assessment has occurred, only when there is more than one prospective adoptive family;
- Remove siblings from the list of relationships the assessment must address; and
- Amend the definition of “kinship care placement” to include a foster placement with whom the child lived for more than six months.
The bill was then passed favorably out of Committee, as amended.
On Wednesday, March 16, the Committee held hearings on HB 2468, which would create the Kansas foster youth bill of rights, and HB 2469, which would enact the Kansas foster parents bill of rights. Proponents for both bills included Rep. Gail Finney; Rachel Marsh, Children’s Alliance of Kansas; and Mike Fonkert, Kansas Appleseed Center for Law and Justice. Rep. Finney shared information about her experiences as a foster parent for the past eight years and explained why she believes the rights stated in these two bills, which are already part of the policies of DCF, should be codified. Marsh identified some amendments she would request for HB 2468 related to a foster child’s contacts with individuals who may pose a safety risk; inclusion of individuals who may not be blood relatives to the child as “important relationships” that should be maintained; and making sure a child has access to another attorney, beyond the guardian ad litem, to represent their interests. For HB 2469 Marsh suggested inserting language to indicate consistency with K.S.A. 38-2201 in the opening paragraph of the bill as included in HB 2468. Neutral testimony for both bills was provided by Tom Witt, Equality Kansas, who requested that a non-discrimination provision be inserted in both bills, including protection for sexual orientation and gender identity. Written proponent testimony was submitted by an individual foster parent and representatives of the Kansas Youth Advisory Board, FosterAdopt Connect and DCF. Committee members asked questions regarding whether the issues raised by Rep. Finney have improved in recent years; what accountability or enforcement mechanisms would be available to ensure compliance with the provisions of the bill and do they perhaps already exist in other parts of the Code for the Care of Children; whether the provisions of the bill would cause conflict or disputes between foster parents and foster children; whether the provisions of the bill could be included as part of the mandatory Model Approaches to Partnerships in Parenting (MAPP) curriculum for foster parents; and whether the bills conflict with provisions in the Adoption Protection Act passed by the Legislature in 2018.
On Thursday, March 17, the Committee worked SB 12, passed by the Senate on February 17, which would require DCF to collaborate with community partners and stakeholders to develop a plan by January 31, 2023, for implementation beginning on July 1, 2023, of performance-based contracts to provide an array of evidence-based prevention and early intervention services for families at risk for out-of-home placement, families that have a child in out-of-home care, and children awaiting adoption. The bill also would require DCF to provide a status update and recommendations for continued progress and submit a proposal for the reinvestment of savings from reduced foster care caseloads into evidence-based prevention and early intervention programs designed to prevent the need for or reduce the duration of out-of-home placements to the Governor and Legislature no later than January 31, 2024. The Committee amended the bill to make it effective upon publication in the Kansas Register and passed it out favorably, as amended.
The Committee also worked SB 276 (described above) and considered amendments to extend the provisions of the bill to other disabilities. The amendment was not adopted, and the bill was passed favorably out of Committee without amendment.
Senate Financial Institutions and Insurance Committee
(Sen. Jeff Longbine, Chair)
On Wednesday, March 16, the Committee worked HB 2110, passed by the House on February 23, which would require the State Employee Health Plan (SEHP), for plan year 2023, provide coverage for the diagnosis and prescribed treatment for pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), for the purpose of studying the utilization and cost of such coverage. The bill also would require the State Employees Health Care Commission to submit a report to the President of the Senate and the Speaker of the House on or before March 1, 2024, stating the impact that the mandated coverage for PANS and PANDAS had on the SEHP. The bill was passed favorably out of Committee.
House Insurance and Pensions Committee
(Rep. Steven Johnson, Chair)
On Monday, March 14, the Committee held a hearing on HB 2733, which would (1) end the registration of pharmacy benefit managers (PBMs) and instead require them to be licensed; (2) based upon licensure, the Kansas Insurance Department would have oversight over PBMs to allow it to hold them accountable to current law and a regulatory structure contained in the bill; and (3) amend the current maximum allowable cost (MAC) appeals process, related to reimbursement rates to pharmacies dispensing generic drugs. Proponents included Aaron Dunkel, Kansas Pharmacists Association (KPhA), and Whitney Damron, Pharmaceutical Care Management Association (PCMA). Dunkel noted that this bill is the result of a compromise reached during discussions between representatives of KPhA and PCMA. Damron noted that there are some jurisdictional issues that are still outstanding between the parties and Jonathan Buxton of PCMA explained that they are related to how the Kansas law would be applied in cases where individuals in Kansas are covered by a plan administered by an employer in another state. There was no neutral or opponent testimony. Committee members asked questions regarding whether any costs associated with the bill would be passed on to consumers (no); what the funds deposited in the PBM licensure fund would be used for (the costs to administer the program); whether issues raised by representative of PCMA regarding potential jurisdictional concerns could be addressed today (no); and whether the Insurance Department had any concerns or comments on the bill (no). The Committee then agreed to suspend the rules and work the bill, adopted some technical amendments, agreed to strike the contents of 2021 SB 28 (related to reinsurance) and insert the contents of HB 2733 to create House Sub for SB 28 and passed the substitute bill favorably out of Committee.
Senate Federal and State Affairs Committee
(Sen. Rob Olson, Chair)
On Wednesday, March 16, the Committee began three days of hearings on SB 560, which would:
- Enact the medical marijuana regulation act;
- Provide for licensure and regulation of the cultivation, processing, distribution, sale and use of medical marijuana;
- Delegate administrative duties and functions to the Secretary of KDHE, Secretary of Revenue, Board of Healing Arts (BOHA), Board of Pharmacy, and Director of Alcohol and Cannabis Control (ABC);
- Impose fines and penalties for violations of the act;
- Establish the medical marijuana registration fund and medical marijuana business regulation fund;
- Create the crimes of unlawful storage and unlawful transport of medical marijuana; and
- Make exceptions to the crimes of unlawful manufacture and possession of controlled substances.
The bill would authorize the state agencies to regulate as follows:
- KDHE would regulate patients and caregivers, purchasing, possession, and use by registered patients;
- BOHA would regulate the physicians who are recommending treatment with medical marijuana;
- The Board of Pharmacy would regulate the pharmacist consultants who would be employed by the retail dispensaries for consultation; and
- ABC would license and regulate the business entities that would grow, process, and sell medical marijuana and medical marijuana products.
Proponents, including Sam Jones, Kansas Natural Remedies; R.E. “Tuck” Duncan, Kansas Cannabis Industry Association; James K. McEntire, DO, FAAP, Progressive Osteopathic Therapies; Bob Corkins, Frontier Peace Advisors; Daniel Shafton, Kansas Cannabis Business Association (KSCBA); Orland Yee, Kanha; Heather Steppe, Kansas Cannabis Chamber of Commerce; Shelby Story, Greenlight Corporation; and Jack Mitchell, BesaMe Wellness, expressed support for the bill because they said it provides opportunities for patients to seek different methods of treatment through the medical marijuana program while also providing a regulatory framework to mitigate black market sales and ensure safe usage of medical marijuana in Kansas. Committee members asked questions regarding the efficacy of integrating systems like K-TRACS, the state’s prescription drug monitoring program, to ease tracking of all medical marijuana grown and sold in Kansas; consideration of on-label use of medical marijuana; other methods of consuming medical marijuana; and what Kansas could learn from other states to prevent licensing lawsuits.
On Thursday, March 17, the Committee continued the hearing on SB 560 with proponents, including Margaret Sparrow, Kansas Cannabis Coalition, and Bryon Adinoff, M.D., Doctors for Cannabis Regulation, who stated their support for the bill because of the benefits for patients. Private citizens shared their experiences with chronic pain and how medical marijuana has improved their quality of life. Neutral conferees included Debbi Beavers, Alcoholic Beverage Control; Eric Stafford, Kansas Chamber; and John Goodyear, League of Kansas Municipalities. Beavers requested several amendments to the bill and expressed concerns regarding the effective date of the bill and the timing for hiring staff and adopting rules and regulations. Stafford requested removal of provisions that could interfere with employer drug testing policies and Goodyear stated that cities should have the ability to op-in to allowing the sale of medical marijuana in their city and restrict the locations where products can be sold. Opponent Robert Jacobs, Kansas Bureau of Investigation, asserted that the bill would increase accessibility to marijuana and increase crime rates and expressed concerns about the difficulty in enforcing Kansas drug laws if the bill is passed. Committee members asked questions regarding various products and methods of consuming medical marijuana; whether data showing deaths related to medical marijuana is available; and whether there is data on violent crimes attributed to medical marijuana use.
On Friday, March 18, the Committee continued the hearing on SB 560 with opponents, including Deputy Sheriff Paul Schliffke, Kansas Peace Officers’ Association; Chief Darrell Atteberry, Kansas Association of Chiefs of Police; Sheriff Jeff Easter, Kansas Sheriffs’ Association; Eric Voth, M.D.; Catherine Antley, M.D., International Academy on the Science and Impact of Cannabis; and Elizabeth Stuyt, M.D., addiction psychiatrist. Schliffke, Atteberry and Easter expressed concerns about the 35 percent tetrahydrocannabinol (THC) content in plant material allowed to be dispensed in final form under the bill; the storage and packaging of medical marijuana; the ability for law enforcement to determine the validity of identification cards; and the number of qualifying conditions listed; and requested that law enforcement officials be included as members of the Medical Marijuana Advisory Committee. Voth stated that all the qualifying health conditions should be stricken from the bill and that providers should be held to a “Medical Standard of Care.” Antley questioned whether the Legislature was the best place to evaluate an “addictive, psychoactive drug,” and Stuyt stated that there is no legitimate research validating the use of THC greater than 10 percent for any medical condition. Proponent testimony was provided by Jacqueline Patterson, an individual with cerebral palsy. Committee members asked questions regarding how law enforcement officials would provide pain care for people in jail who are using medical marijuana; whether law enforcement officials have suggestions of how to address concerns regarding packaging of medical marijuana; whether the Kansas Bureau of Investigation has data regarding the number of deaths due to marijuana overdose and number of auto accidents and fatalities due to marijuana use; and the ability to test for impairment and levels of THC in the body.
House Energy, Utilities and Telecommunications Committee
(Rep. Blaine Finch, Chair)
On Tuesday, March 15, the Committee worked Sub for HB 2281, which would create the Living, Investing in Values, and Ending Suicide (LIVES) Act and implement the established 988 Suicide Prevention and Mental Health Crisis Hotline in Kansas. The bill also would outline the responsibilities of KDADS, hotline centers and service providers; impose a fee to support the hotline in the amount of $0.20 per month per subscriber account of any exchange telecommunications service and other voice services; establish the 988 Suicide Prevention and Mental Health Fund; and direct, in addition to the 988 fees, that $3 million from the State General Fund be transferred annually to the Hotline Fund. Additionally, the bill would provide certain protections from liability for service providers, prohibit the imposition of 988 fees other than those established by the bill, create the 988 Coordinating Council, and require an annual report from the Council to select legislative standing committees. The Committee amended the bill to:
- Clarify that KDADS must apply for and utilize any grants or financial assistance made available by the federal government, or other public or private sources for the purpose of the act, and make clear such funds shall be credited to the Hotline Fund;
- Remove provisions relating to remittance and collection of Hotline fees for subscribers’ telephone service within the state;
- Expand the list of services Hotline funds must be expended on to include mobile crisis response services for those persons with intellectual or developmental disabilities and persons with behavioral health needs;
- Increase the amount of state general funds (SGF) transferred to the Hotline Fund each fiscal year from $3.0 million to $10.0 million;
- Reduce the $10 million SGF demand transfer by the certified ending balance of the Hotline Fund beginning in fiscal year 2023 and every fiscal year thereafter;
- Specify information that must be contained in the KDADS report to certain legislative standing committees;
- Clarify that the 988 Coordinating Council, which would be established by the bill, shall advise the Secretary of KDADS on the 988 System;
- Remove provisions allowing the 988 council to adopt rules and regulations;
- Remove provisions relating to the requirement that each National Suicide Prevention Lifeline (NSPL) center file an annual report with the 988 council; and
- Make technical and conforming changes.
The Committee then removed the contents of SB 19 (originally related to the designation of a portion of US-77 in Marshall County as a memorial highway) and inserted the contents of Sub for HB 2281 to create House Sub for SB 19 and passed the substitute bill favorably out of Committee, as amended.
House Taxation Committee
(Rep. Adam Smith, Chair)
On Wednesday, March 16, the Committee worked HB 2711, which would lower the sales and compensating use tax rate to 6.3 percent for all sales and 3.5 percent for the sales of food and food ingredients, which does not include prepared foods. In addition, the bill would further reduce the state sales tax rate on food and food ingredients 1.2 percent commencing July 1, 2023, for any fiscal year in which the balance of the Budget Stabilization Fund is $100 million or greater on July 1 and the change in rate would go into effect the following January 1. The bill also would allow for the continued levying of city and countywide retailers’ sales tax by cities and counties and Washburn University, and the nonrefundable food sales tax credit would be made refundable starting in tax year 2023 and be discontinued if the state rate on food and food ingredients is lowered to 0 percent. The Committee considered several amendments and ultimately amended the definition of “food and food ingredients” in the bill to include bottled water, candy, dietary supplements, food sold through vending machines and soft drinks, and reset the state highway fund factor rate to 18 percent effective on or after July 1, 2022. The bill was then passed favorably out of Committee, as amended.