Last week, Kansas legislators were briefed on interim committee work related to services for Kansas older adults, children and persons with intellectual and developmental disabilities. Hearings were held on several bills, including one related to maternal deaths. This edition of Health at the Capitol looks at those health policy issues and more that were discussed during the second 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.
When legislators returned to work on Tuesday, January 18, following the Martin Luther King. Jr. Day holiday, they immediately focused on passing Senate Bill (SB) 2477 to codify the provisions of Governor Laura Kelly’s executive orders (EOs) addressing the staffing shortages at health care facilities around the state caused by the pandemic. With the EOs set to expire on Friday, January 21, the bill was passed by the House on a vote of 106-5 on Tuesday, January 18. After the Senate Federal and State Affairs Committee approved amendments to the bill on Thursday, January 20, the bill was unanimously approved by the Senate and approved once again by the House. The bill was forwarded to the Governor for her signature on Friday and became effective immediately following its publication in the Kansas Register. This was the first bill signed by Gov. Kelly this session.
On Wednesday, January 19, the House and Senate Redistricting Committees introduced maps for the four Kansas congressional districts and on Friday, January 21, the Senate passed its map on a vote of 26-9.
House Health and Human Services Committee
(Rep. Brenda Landwehr, Chair)
On Tuesday, January 18, the Committee was introduced to Janet Stanek, Acting Secretary, Kansas Department of Health and Environment (KDHE), who joined Gov. Kelly’s Cabinet in November 2021. She shared remarks about her experience in the health care sector and state government as well as provided comments about agency priorities. The Committee also heard a presentation from Camille Russell, Long-Term Care Ombudsman. Russell provided an overview of the Ombudsman’s role, duties and responsibilities to seniors and their families and then addressed a few key issues, including the lack of sufficient workforce in long-term care facilities and the failure of some corporate owners of facilities to support their staff in complying with Kansas laws and regulations, to the detriment of both the employees and residents. She also discussed the state of the guardianship program and the lack of progress in assigning and evaluating the need for guardianship. Russell noted that the Kansas Department for Aging and Disabilities Services (KDADS) does not need more regulations, but resources to enforce the regulations that already exist. She also stated there is a need for more regulations for state licensed nursing homes regarding involuntary discharges and advocating for a person-centered approach when addressing seniors admitted with mental health conditions.
Senate Public Health and Welfare Committee
(Sen. Richard Hilderbrand, Chair)
On Tuesday, January 18, the Committee was introduced to KDHE Acting Secretary Janet Stanek, who announced that KDHE will be advising school districts that while it would like for them to continue COVID-19 contact tracing, it may be discontinued. She stated that this decision will be reevaluated in 30 days. She also announced that KDHE will discontinue contact tracing on February 1 as the public has become less willing to share information and current efforts are futile. She noted this decision also will be reevaluated.
The Committee then heard a presentation on the “State of Health in Kansas” by Ashley Goss, Deputy Secretary for Public Health at KDHE. Goss provided an overview of the Division of Public Health, which includes the bureaus of Community Health Systems, Epidemiology and Public Health Informatics, Health Promotion, Disease Control and Prevention, Family Health, and Oral Health. She also provided an overview of the state’s health ranking nationally, with Kansas ranked 30th overall, 31st in health behaviors, 24th in social and economic factors, 39th in physical environment, 31st in clinical care and 33rd in health outcomes. Goss then stated that KDHE is currently working on a state health assessment and state health improvement plan, which is conducted every five to 10 years. This is an 18-month process that began in 2021. Goss also shared some opportunities for improvements through 2022 legislative initiatives, including supporting public health practices and supporting and funding existing programs through budget enhancements for maternal and child health home visiting and to extend Medicaid eligibility for pregnant women to 12 months postpartum. Committee members asked questions regarding the accuracy of COVID-19 tests, the safety and effectiveness of COVID-19 vaccines, KDHE’s marketing expenses for COVID-19 vaccines, and the agency’s initiatives to improve the state’s health ranking.
On Wednesday, January 19, the Committee heard a presentation on the interim report of the Kansas Senior Care Task Force. Iraida Orr, Kansas Legislative Research Department (KLRD), provided an overview of the Kansas Senior Care Task Force and its charge from 2021 House Bill (HB) 2114. The Task Force approved an offer from KDADS to coordinate a contract with the Kansas Health Institute to establish working groups for the Task Force and to facilitate their discussions. Two working groups – Quality of Care and Protective Services, and Access to Services – were established on December 7, 2021, along with a subgroup that was formed to study workforce issues. Orr noted that the working groups began to meet in December 2021 and will continue to meet during the 2022 session with the goal of finalizing the Task Force report in July 2022. The Quality of Care and Protective Services working group will focus on the administration of antipsychotic medication to adult care home residents; safeguards to prevent abuse, neglect and exploitation of seniors in the state; and adult care home surveys and fines. The Access to Services working group will focus on the provision of care for seniors in the state who suffer from Alzheimer’s disease, dementia, and age-related mental health conditions; funding and implementation of the Kansas Senior Care Act; senior day care resources in the state; and the state rebalancing of home and community-based services (HCBS). Orr also summarized the recommendations adopted by the Task Force during its December 7 meeting. The report can be viewed on the KLRD website.
The Committee then heard a report from Matthew Moore, KLRD, on the work of the 2021 Special Committee on Home and Community Based Services Intellectual and Developmental Disability (I/DD) Waiver. Moore provided an overview of the creation of the Special Committee and its charge to review and study issues including, but not limited to, the HCBS I/DD waitlist, adequate provider networks, and waiver reimbursement rates. Moore noted that the Special Committee met for two days in October 2021 and heard from representatives of stakeholder organizations, people on the waitlist, providers, and budget agencies. The Special Committee generally agreed that the state should explore how to move individuals from the HCBS I/DD waitlist onto the waiver and provided 10 specific recommendations. The Special Committee’s report can be viewed on the KLRD website.
On Thursday, January 20, the Committee held a hearing on SB 42, relating to the study and investigation of maternal deaths in the state. Jenna Moyer, Office of Revisor of Statutes, provided a bill overview and stated that it would expand the investigative duties of the Secretary of KDHE regarding cases of maternal death. The bill also would amend existing law to direct the Secretary of KDHE to take several actions, including working with health care providers and facilities to develop and implement performance measures, strengthening the ability of local health officers to generate and compile maternal health performance indicators, and establishing an external community review committee. Proponents of the bill, including Sen. Oletha Faust-Goudeau; Sapphire Garcia, Wichita Birth Justice Society; Dr. Sharla Smith, Kansas Birth Equity Network; Stacey Knoell, Kansas African American Affairs Commission; and Lucrecia Nold, Kansas Catholic Conference, expressed their support for SB 42 and stated that the bill would allow for the collection of data and information regarding why the maternal mortality rate is high and find a resolution to the issue in Kansas. The conferees also supported the bill’s provisions related to the development of statewide performance measures to improve the quality of maternal and child health care and increase access to Kansas-specific data on maternal mortality and morbidity. Committee members asked questions regarding the implementation of similar legislation in other states; availability of data related to disparities based on race; how the data collected will help determine the services needed; why Kansas data isn’t already available; who will be collecting the data; and whether there were any efforts by the previous KDHE Secretary to make the data available. Neutral testimony was provided by KDHE and there was no opponent testimony.
House Children and Seniors Committee
(Rep. Susan Concannon, Chair)
On Tuesday, January 18, the Committee heard a presentation from Chardae Caine, KLRD, regarding the work and recommendations of the Joint Committee on Child Welfare System Oversight. The Joint Committee, which was charged with several tasks in 2021 HB 2158, met for four days during October and November 2021 and adopted 18 recommendations for the 2022 Legislature, including proposed legislation to amend Adrian’s Law and expand it to require pediatric physician examination from a pediatrician with specialized training in examining abused children; clarify the interpretation of current statutory language for sharing information with local law enforcement; and amend K.S.A. 22a-243 to address the issue regarding extending confidentiality rules and regulations to local child fatality review organizations. Committee members asked questions regarding where the pediatrician examination described in the recommendation to amend Adrian’s Law would be conducted; whether the document described in the first recommendation (which describes the requirements to accomplish reintegration or regain custody of children) would be a generic document or customized to the specific child; and the Joint Committee’s proposal for the establishment of the independent Office of the Child Advocate.
On Thursday, January 20, the Committee heard from Randall Hardy, Silver Haired Legislature. Hardy spoke about the organization’s priorities, including Medicaid expansion, wireless broadband access and funding for rural and frontier areas of the state, and medical marijuana legalization. The Committee then heard a presentation by Connor Stangler, KLRD, who provided a report outlining the work of the Senior Care Task Force (see description above).
Senate Judiciary Committee
(Sen. Kellie Warren, Chair)
On Wednesday, January 19, the Committee held a hearing on HB 2477, which would codify provisions in EOs issued by Gov. Kelly that authorized expanded practice by certain health care professionals and suspended certain licensure and other requirements for adult care homes. The bill would be in effect upon publication in the Kansas Register and the provisions of the bill would expire on January 20, 2023. Proponents included Rachel Monger, LeadingAge Kansas, Linda MowBray, Kansas Healthcare Association, and Tara Mays, Kansas Hospital Association, who shared their support for HB 2477 because it would provide a “lifeline” for health homes, hospitals and nursing homes in Kansas. Proponent written testimony was submitted by Jim Klausman, Midwest Health, Inc, and Haely Ordoyne, Kansas Adult Care Executives Association.
Courtney Cyzman, Kansas Board of Healing Arts (BOHA), provided neutral testimony and stated there are provisions of the bill that BOHA supports but there also are legal substantive provisions that present public safety concerns. Cyzman requested several amendments to the bill that BOHA believes are necessary to protect public safety and provide a legal remedy if something were to go wrong while the professionals were practicing in Kansas. Committee members asked Cyzman questions regarding the potential impact of non-recognized licensed professionals, like certified anesthesiologist assistants, who may attempt to practice in Kansas under the current provisions of the bill; the impact of extending the Governor’s EOs beyond May 2022; and how HB 2477 could alleviate staffing shortages during this time. There was no opponent testimony presented. The Committee approved several amendments to the bill and then passed it favorably out of committee.
Note: HB 2477 was rushed to Final Action on January 20, as amended by the Senate Committee of the Whole, and passed on a vote of 36-2. The House concurred with a vote of 96-5 and the bill was enrolled and presented to Gov. Kelly for signature on January 21. It became effective immediately following its publication in the Kansas Register.
House Social Services Budget Committee
(Rep. Will Carpenter, Chair)
On Tuesday, January 18, the Committee heard a presentation from Sarah Fertig, Medicaid Director, KDHE, regarding issues discussed by the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight including adding a Medicaid medical and services procedure code for family therapy without the patient being present, and adding 10 more months of Medicaid coverage for pregnant women in the postpartum period. Fertig noted that this extension of postpartum coverage has been discussed in multiple states, with Georgia and South Carolina recently joining the ranks. Without this policy change, women’s coverage under regular KanCare policy would be terminated two months postpartum (after the federal Public Health Emergency ends). She also stated that $10.5 million will be needed to fund this amendment, which could impact 15,000 Kansans per year in the pregnant women eligibility group. She also noted the committee’s discussion of a recommendation to increase reimbursement rates for pediatricians, since the rate has not changed since the mid 1990s, although further research is needed before adjusting the rate.
House Insurance and Pensions Committee
(Rep. Steven Johnson, Chair)
On Wednesday, January 19, the Committee was briefed on the report of the Special Committee on Federal 340B Drug Program by Melissa Renick, KLRD. The 340B program was established by federal law in 1992 and was designed to reduce the amount that “covered entities” ─ such as federally qualified health centers, state AIDS drug assistance programs, critical access hospitals and disproportionate share hospitals ─ spend on outpatient drugs. Renick stated that the Special Committee met on October 20 and December 9, 2021, and heard from representatives of hospitals, safety net clinics, rural providers, pharmacists, pharmacy benefit managers (PBMs) and drug manufacturers. She then reviewed the creation of the Special Committee by the Legislature in 2021 SB 159 and summarized its charge, conclusions and recommendations. She noted that the Special Committee did not make any specific recommendation on two bills currently assigned to the Committee, HB 2260 and HB 2383, which would prohibit disparate treatment by PBMs of certain pharmacies and pharmaceutical services providers and would provide for enhanced regulation of PBMs, respectively. Committee members asked questions regarding how the revenue that flows to the covered entities is spent; the goal or intent of the two PBM related bills; and about similar legislation in other states. Reps. Bill Rhiley and Steven Howe encouraged the Chair to hold hearings on the 340B program and PBMs. Chair Johnson stated that pharmacists and PBM representatives are engaging in discussions related to the bills and other concerns to see if they can reach agreement on some issues and that the Committee will hold a hearing after that. The Special Committee’s report can be viewed on the KLRD website.
The Committee also heard an update from Renick regarding the Committee’s request for the State Employees Health Plan (SEHP) and the Health Care Commission to provide the Committee with the economic impact studies required under Kansas law related to HB 2110 and HB 2129. HB 2110 would require the SEHP to provide coverage for pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), and HB 2129 would require the SEHP to provide coverage for tobacco cessation treatments. Renick stated that the reports had just been received and include the information the Committee needs to move forward with those bills.
Senate Financial Institutions and Insurance
(Sen. Jeff Longbine, Chair)
On Thursday, January 20, the Committee held a hearing on SB 335, which would amend K.S.A. 40-2222b to exempt certain business entities that provide health insurance in the state but are not subject to the jurisdiction of the Kansas Insurance Commissioner (i.e., association health plans subject to regulation by the U.S. Department of Labor), from payment of the annual one percent premium tax. Proponents included Alex Orel, Kansas Bankers Association (KBA), and Brandi Miller, Kansas Cooperative Council. Orel stated that the KBA health plan, which is not regulated by the state, provides coverage for 12,000 Kansans and has annual premiums of approximately $64 million, which results in more than $630,000 in annual premium tax. He stated that payment of this tax is a barrier to the association being able to provide cost savings to their enrollees. Miller stated that the Council’s Agri-Business Benefit Group provides coverage for 6,000 employees of 65 cooperatives. Written testimony was provided by the Agri-Business Benefit Group and there was no opponent testimony. Sen. Gossage asked about other health plans in the state that would be affected by this bill and the response was that only the two plans providing testimony would be affected.
House Appropriations Committee
(Rep. Troy Waymaster, Chair)
On Wednesday, January 19, the Committee heard presentations from intellectual and developmental disability services providers regarding reimbursement rates. Conferees included Vicki Kiefer, Sunflower Diversified Services in Great Bend; Matt Fletcher, InterHab; and Doug Wisby, Multi Community Diversified Supports in McPherson. Kiefer stated that her organization, which serves adults with disabilities in five counties, is designed to have 160 employees but currently has only 125 and is struggling to hire and retain employees. She noted that Sunflower Diversified Services is currently paying its employees $10 per hour, but individuals can make more money working at fast food restaurants. She also noted other issues, such as lack of childcare and the need for these employees to work multiple jobs to earn a living wage, that make it difficult to retain employees for more than 90 days. She also suggested that education that results in certification for these direct care employees could make them feel more valued. Fletcher stated that Kansas ranks 44th in the nation for the level of reimbursement to community I/DD service providers and is lower than all contiguous states. He noted that a survey of InterHab members revealed that their turnover rate is 48 percent, the average length of stay of employees is 116 days, and that the providers are incurring significant costs related to onboarding new employees who are hired and then leave shortly thereafter. He also stated that the additional funding for reimbursement rates that was provided during the 2021 session was helpful and that 97 percent of those funds were used for wages and benefits for the direct care employees but resulted in only about a $1 per hour pay increase. Fletcher also stated that “over regulation” makes it more difficult for providers to operate. Wisby stated his organization normally employs 100-110 employees but currently has around 70. He noted that he has seen a profound shift in the availability of employees over the last two years and that in October 2021 they had to close programs and combine residential settings because there was not enough staff to man all locations. Committee members asked questions regarding what would be considered the ideal wage for direct care employees (response was $15-16 per hour); what other benefits or changes could be implemented to help employees; what efficiencies have the provider organizations implemented to address their workforce issues; whether the community-based model for providing services is the most efficient approach; whether the I/DD population is increasing (response was yes; the number of individuals needing services is increasing and the complexity of the needs of this population is increasing as these individuals age and start suffering from age-related health conditions); and whether the provider network is expanding (response was no; it is contracting).