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Legislators returned to work on Tuesday, January 17, following Martin Luther King Jr. Day and held hearings on a variety of issues, including behavioral health and the implementation of the 988 Suicide and Crisis Lifeline, child welfare, juvenile justice, and the lack of sufficient childcare options in the state. They also began to hear recommendations from several interim committees that met during the summer and fall of 2022 related to a new community supports waiver for KanCare, mental health inpatient beds and workforce development.

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 FacebookTwitter and LinkedIn. Previous editions of Health at the Capitol can be found on our ARCHIVE PAGE.

On Wednesday, January 18, Gov. Laura Kelly announced that $44.5 million in grant funds will be awarded to nine service providers to extend high-speed internet to 18,468 locations in 15 underserved counties and economically disadvantaged areas of the state. This is the third and final award phase of the Kansas Capital Project Funds (CPF) Broadband Infrastructure Program. The CPF program, which resulted from the U.S. Department of Treasury’s approval of the state’s Coronavirus CPF broadband infrastructure plan, provides funding to make broadband connections in critical areas of Kansas that lack access to high-speed internet. Counties that will benefit from this third phase of the CPF program include: Sedgwick, Butler, Cowley, Sumner, Jackson, Shawnee, Wabaunsee, Mitchell, Pawnee, Stafford, Doniphan, Miami, Decatur, Saline and Johnson. These high-speed internet projects will allow more Kansans to participate in health-related activities, such as telehealth, researching health information or accessing health insurance, as well as remote work and educational opportunities.

House Health and Human Services Committee

(Rep. Brenda Landwehr, Chair)

On Tuesday, January 17, the Committee heard presentations from Laura Howard, Secretary for the Department for Children and Families (DCF) and the Department for Aging and Disability Services (KDADS). Sec. Howard gave an overview of the six DCF regions and 36 service centers that are located across the state, as well as the four primary program areas (economic and employment services, rehabilitation services, child support services, and prevention and protection). She noted that there has been a dramatic decrease in the number of children in foster care (just over 6,200 currently, down from 7,600 four years ago) and fewer children entering care. She also noted that the state is in the last year of the current foster care grants with their case management providers, so DCF will be submitting a request for proposal (RFP) in May for rebidding of those contracts, with award in December and the new grant start date of July 1, 2024. Sec. Howard stated that DCF is close to issuing an RFP for a new Comprehensive Child Welfare Information System (CCWIS). CCWIS is intended to modernize the state’s child welfare systems and develop interfaces between the various agencies serving the child welfare and adult protective services programs. Committee members asked questions regarding DCF staffing, contract lengths and performance guarantees for foster care case management providers, DCF’s relationships with faith-based organizations, TANF requirements, the timeline for full implementation of CCWIS (four years), and the status of the Office of the Child Advocate.

Sec. Howard also presented an overview of the KDADS organizational structure, the state hospitals, and the four major program areas (long-term services and support commission, behavioral health services commission, survey, certification and credentialing commission, and state hospitals commission). She also noted KDADS’ oversight of the implementation of the state’s 988 plan to expand the national suicide prevention lifeline (NSPL) contact centers.  In response to the recommendations of the 2022 Special Committee on Intellectual and Developmental Disabilities (I/DD) Waiver Modernization, which met during the interim period, the Secretary reported that KDADS is close to completing cost estimates for the 11 services identified by the Special Committee to be included in the development of a community supports waiver as an additional home and community based services waiver. Committee members asked questions regarding workforce, mental health competency evaluations in jails, site selection for the new mental health hospital beds, and mobile vendors for hospitals.

On Wednesday, January 18, the Committee heard from Kyle Kessler, Executive Director, and Sue Murnane, Manager, Youth Behavioral Health Services, Association of Community Mental Health Centers of Kansas, and Greg Hennen, Executive Director, Four County Mental Health Center, one of the first centers to become a certified community behavioral health center (CCBHC) in the state. Kessler provided an overview of the community mental health centers (CMHCs) located throughout the state and provided a history of the loss of state hospital beds in Kansas. Kessler noted that the current workforce of the CMHCs is about 5,000 people and the center managers are reporting a 20-25 percent vacancy rate in their workforce. Hennen reported that Four County provided services to 5,669 patients in 2022, which was up 5.2 percent from the previous year. He also provided other data about the center, including the wait times for individuals to receive services, improvement in functional stabilization of patients, and services being provided to veterans. Murnane provided an update on the school mental health intervention team programs currently operating in 67 school districts around the state. She noted that during the first semester of the 2022-23 school year, 4,863 students have received services through the program. Committee members asked questions regarding services being provided to veterans, whether additional data regarding the outcomes for CCBHCs will be available in the future, and how the CCBHC crisis intervention teams are interacting with the new 988 lifeline system.

On Thursday, January 19, the Committee received presentations from Kansas Department of Health and Environment (KDHE) Sec. Janet Stanek, KDHE Deputy Secretary Ashley Goss, and Medicaid Director Sarah Fertig. Sec. Stanek provided an overview of KDHE and stated that current focus areas for the agency are workforce, rebuilding confidence in KDHE, adhering to regulations, and partner and interagency collaborations. Committee members asked questions regarding Medicaid statistics and eligibility (535,000 Kansans currently covered), KanCare rebidding for managed care contracts, increasing reimbursement rates for obstetric physicians, facility inspection requirements, hospital trauma levels, combining public health departments, and the fentanyl crisis. The Committee encouraged KDHE and KDADS to introduce a bill this session regarding the legalization of fentanyl testing strips.

The Committee also heard from Rachelle Colombo, Executive Director, Kansas Medical Society (KMS), who provided background about KMS and its role in advocating to the Legislature. Committee members asked questions regarding the differences between medical doctors and doctors of osteopathy, the demographics of physicians in KMS, Medicaid reimbursement advocacy, incentives for students, and access to care in rural Kansas.

Senate Public Health and Welfare Committee

(Sen. Beverly Gossage, Chair)

On Tuesday, January 17, the Committee heard from Andy Brown, Commissioner of Behavioral Health Services, KDADS, who presented the 2023 988 Coordinating Council Annual Report and 2023 Secretary’s Report on 988, both of which are based on five months of data beginning on July 1, 2022. Brown noted that the 988 suicide and crisis lifeline providers in the state are reporting a 91 percent in-state answer rate for calls and the average speed to answer calls is approximately 20 seconds. He stated that the total number of calls between November 2021 and November 2022 was 21,000, with 17,284 in-state answered calls. Brown noted that the state hopes to have mobile crisis teams in every county as part of the expansion of CCBHCs. He also stated that KDADS is not recommending any changes in funding and that replenishing the 988 fund up to $10 million should meet expected needs for fiscal year 2024. From the 988 Coordinating Council Report, Brown provided an overview of how the program has been funded, how resources are being used, and implementation of the 17-member council. Committee members asked questions regarding the number of individuals taking calls, future funding for the lifeline including federal funding opportunities, the number of calls from individuals contemplating suicide, the number of referrals made for services and the ability of callers to access services from referrals, and the number of abandoned calls.

On Wednesday, January 18, the Committee heard a presentation by Amanda Schlumpberger of the Kansas Legislative Division of Post Audit (LPA) regarding the March 2022 Performance Audit Report Reviewing Foster Care Services for the Health and Safety of Children. The objective of the audit, which was requested by Rep. Susan Concannon and Rep. Jarrod Ousley, was to answer two questions: 1) Are foster care stakeholders following adequate policies and procedures to ensure the safety of children in foster care? 2) Do foster care case management providers have sufficient capacity to provide necessary foster care services? Schlumpberger noted that LPA looked at the most recent grant period for DCF and its case management providers (October 2019 through present) and was focused only on safety and services for out-of-home placements (foster care) and did not include investigations of abuse and neglect, family preservation or aftercare. She also noted that LPA did not evaluate DCF or court decisions on the appropriateness of removal or reunification decisions.

The two major conclusions of the audit were:

  • Although DCF generally has adequate written policies, DCF and case management providers’ practices were not adequate to ensure the safety of children in foster care in several areas.
  • The state does not have the capacity to provide services to all children in foster care, especially those with specialized service needs.

Committee members asked questions regarding training for foster parents, whether caseload levels contribute to burnout of case managers, missing foster children, placement of children in foster care outside of their home communities, providing services to children in their homes, kinship placement, and lack of foster homes in some communities.

On Thursday, January 19, Elizabeth Cohn, KLRD, presented the reports of the 2022 Special Committee on I/DD Waiver Modernization, 2022 Special Committee on Mental Health Beds, and 2022 Special Committee on Workforce Development. Cohn described the charge of each of the committees and provided highlights of the recommendations of each.

Child Welfare and Foster Care Committee

(Rep. Susan Concannon, Chair)

On Wednesday, January 18, the Committee held a joint informational hearing with the Corrections and Juvenile Justice Committee regarding the impact of 2016 Senate Bill (SB) 367, which created and amended existing law related to the Kansas juvenile justice system. Conferees included representatives of O’Connell Children’s Shelter, DCCCA, FosterAdoptConnect, KVC, Saint Francis Ministries, Children’s Alliance of Kansas, and Wyandotte Behavioral Health Network, as well as Sedgwick County District Attorney Mark Bennett, Randy Bowman with the Kansas Department of Corrections, and Rice County Attorney Remington Dalke. In general, all conferees expressed concerns that the implementation of SB 367 had resulted in a lack of: 1) differentiation in response to different levels of juvenile crime; 2) alternative placements for certain types of crimes; 3) services or therapy/medication management when juveniles are sent back home from foster placement; and 4) consequences for conditional release violations despite repeated violations. Conferees also said that SB 367 had resulted in the placement of juvenile offenders in foster placements that resulted in harm to other children in the same setting or a return of the juveniles to their homes, putting their parents and siblings at risk.

The Corrections and Juvenile Justice Committee will meet on Monday, January 23, to hear a presentation regarding the Juvenile Justice Oversight Committee and to discuss the status of funding for juvenile justice and the use of juvenile crisis intervention centers for juveniles experiencing a behavioral health crisis. They also will be considering how to improve communication and collaboration between the Kansas Department of Corrections and DCF to address the increase in foster care placements.

Welfare Reform Committee

(Rep. Francis Awerkamp, Chair)

On Tuesday, January 17, the Committee held an informational hearing regarding early childhood services and the TANF program. Dr. Carla Whiteside-Hicks, Director of Temporary Assistance for Needy Families and Early Childhood Programs, provided an overview of the TANF program, the determination of eligibility and verification for benefits, compliance with federal law, and coordination with other agencies. She noted that the TANF caseload in Kansas is typically made up of low-income, single-parent households with limited time on assistance (24 months). During the COVID-19 pandemic, the state did not extend the 24-month lifetime limit for TANF assistance. Dr. Whiteside-Hicks reported that the average monthly benefit for TANF recipients is $264.66 and the total program expenditure per year is approximately $10 million. She also noted that the caseload numbers are decreasing but the agency is unsure why this is occurring. Committee members asked questions regarding the definition of entitlement programs, state efforts to reduce the likelihood of unplanned pregnancies, costs to administer the program, whether other states have shorter lifetime limits, substance use disorder treatment and counseling for recipients who use medical marijuana, and detection of fraud.

On Thursday, January 19, the Committee held an informational hearing on the Supplemental Nutrition Assistance Program (SNAP) and DCF’s internal reforms. Shannon Connell, Food Security and Utility Assistance Director, DCF, provided an overview of the program and its eligibility requirements and reported there are currently 97,284 households receiving SNAP food assistance benefits. Committee members asked questions regarding monthly benefits for elderly clients, limits on the amount of food provided, the length of the application form, and the length of time for applications to be approved.

Social Services Budget Committee

(Rep. Les Mason, Chair)

On Thursday, January 19, the Committee heard presentations regarding targeted case management (TCM) services for special groups of KanCare enrollees from Mandy Flower, KDADS Interim Commissioner of Long-Term Services and Supports, Matt Fletcher, CEO, InterHab, and Roxanne Hidaka, Co-Owner, Case Management Services, Inc. The Governor’s budget includes $3.8 million, including $1.5 million State General Funds, for a 25 percent reimbursement rate increase for TCM services. Flower noted that individuals can receive TCM services while they are on the waiting list for the I/DD waiver and also stated that TCM reimbursement rates have been the same for 10 years. Fletcher stated that the current reimbursement rate ($43.32/hour) is not sustainable for providing these services and noted that Missouri’s reimbursement rate is more than $100/hour. He requested that legislators consider adjusting the rate to $75/hour during this session, which would allow providers to break even or be slightly above costs for the first time in years, and provide resources needed to recruit and retain case managers. Hidaka, speaking on behalf of the TCM providers across the state, provided an overview of TCM services, including the history and challenges of case managers. Committee members asked questions regarding provider billing practices, the loss of TCM providers in the last two years, the billing documentation provided to the managed care organizations, how reimbursement rates in Kansas compare to neighboring states, and the number of TCM agencies in the state (82).

Commerce, Labor and Economic Development Committee

(Rep. Sean Tarwater, Chair)

On Tuesday, January 17, Matthew Willis, KLRD, provided the Committee with a summary of the report of the 2022 Special Committee on Workforce Development. Willis provided highlights of the Committee’s recommendations, including comments regarding the need for more childcare options, the role of and funding for technical schools, expansion of the Promise Act, and the need to address the readiness of K-12 graduates for skilled jobs. The Committee also heard from Eric Stafford, Vice President of Government Affairs for the Kansas Chamber, who provided highlights from a report entitled, The Challenge to Compete – Kansas Workforce 2020, that was prepared for the Chamber. Stafford noted that recommendations in the report include consideration of immigration reform, registered apprenticeships, expansion of the Kansas Works program, additional childcare options, and consideration of actions taken by other states to increase workforce.

On Wednesday, January 18, the Committee heard from Melissa Rooker, Executive Director, Kansas Children’s Cabinet and Trust Fund, who discussed the need for additional childcare options and alternative funding for childcare in the state. Rooker noted that childcare is expensive for both families and providers and stated that wages and benefits for caretakers are insufficient and will not encourage additional caretakers to enter the market. She also requested that the Legislature consider a comprehensive review of the regulations applicable to the building of childcare facilities, childcare subsidies, and licensure of a new model of childcare centers that are larger than in-home facilities but smaller than large centers with 50 or more children.

House Appropriations Committee

(Rep. Troy Waymaster, Chair)

On Wednesday, January 18, the Committee received an update regarding the current status of Strengthening People and Revitalizing Kansas (SPARK) funding from Ethan Belshe, Director of Public Affairs, Office of Recovery. Belshe provided a summary of the role of the advisory committees, the executive committee and the State Finance Council in approving $374 million for four buckets of funding, including $109 million for health and education programs. He also noted that the process and timeline for applications for funding will be announced before the end of February. Committee members asked many questions regarding the process for arriving at the final distribution of funds for the various programs and how the final results have been communicated to the individuals and organizations that previously submitted proposals for funding to SPARK.

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The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.

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