Legislators returned to work on Tuesday, Jan. 16, following Martin Luther King, Jr. Day and immediately went to work on a tax bill that is on its way to Gov. Laura Kelly. After the somewhat slow start during week one, committees began meeting on their regular schedule during week two and received briefings on many health-related topics, including community paramedicine, palliative care, the community support waiver, homelessness and the rising use of fentanyl in the state. This edition of Health at the Capitol looks at health-related policy issues announced or 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, LinkedIn, and Instagram. Previous editions of Health at the Capitol can be found on our ARCHIVE PAGE.
On Wednesday, Jan. 17, the Senate passed House Bill 2284, which includes a single-rate 5.25 percent income tax, on a vote of 25-11. The bill also would eliminate the sales tax on food effective April 1. The House then passed the bill on a vote of 81-37 on Thursday, Jan. 18.
Also on Wednesday, Gov. Kelly stated she wants Medicaid expansion hearings in both chambers by Kansas Day on Jan. 29. Companion bills to expand Medicaid were introduced on Jan. 17 (Senate Bill 355) and Jan. 19 (House Bill 2556) and were referred to the Senate Public Health and Welfare and House Health and Human Services committees, respectively. The Governor noted that more than 100 heath professionals and hospital or clinic administrators had issued a letter on Tuesday, Jan. 16, asking for bipartisan support for Medicaid expansion.
House Health and Human Services Committee
(Rep. Brenda Landwehr, Chair)
On Wednesday, Jan. 17, the Committee heard presentations regarding community paramedicine/mobile integrated health (MIH) programs from representatives of Kansas EMS Association (KEMSA), Mid-America Regional Council, TECHS EMS in Holton, Kansas City Kansas Fire Department, Johnson County MED-ACT, Lawrence-Douglas County Fire EMS, and Community Care Network of Kansas. Community paramedicine is a patient-centered care model that uses trained emergency medical services (EMS) personnel in an expanded role to provide care, facilitate more efficient delivery of care, and enhance access to community resources that address the social determinants of health. Individuals that may benefit from participating in community paramedicine programs are those who are high EMS utilizers or high-risk emergency department discharges, or who struggle with managing their own health, have high-risk social needs, or have community mental health needs.
Jason White, Mid-America Regional Council, reported that EMS agencies that are already operating these programs have seen better outcomes for patients and savings in health care systems spending. White also mentioned that start-up costs for these programs can sometimes be covered by grants from the federal government or other organizations but there is not often an ongoing revenue stream to maintain them.
Committee members asked questions regarding the employment of community paramedics and what services they are allowed to perform, the amount of uncompensated care provided annually by EMS providers in Kansas, and requirements and barriers to expanding community paramedicine services to other communities.
The Committee also heard a presentation from Chuck Schmidt, Silver Haired Legislture, who provided an overview of the history and mission of the organization and reported that its legislative priorities for the 2024 session include expanding Medicaid, expanding the grandparents as caregivers act to include other relatives, and establishing a medical cannabis advisory board.
On Thursday, Jan. 18, the Committee heard presentations on the state of cancer in Kansas from Megan Word, American Cancer Society (ACS) Cancer Action Network Kansas and Nebraska, and Dr. Roy Jensen, University of Kansas Cancer Center. Word shared statistics from the 2024 ACS report that projects 2,000,000 new cancer cases in the U.S. in 2024, including 16,840 new cases in Kansas and 5,690 deaths. She said the most prevalent cancers in Kansas are prostate, female breast, lung and bronchial cancers, while the deadliest are lung, colon and pancreatic cancers. Dr. Jensen reported on the KU Cancer Center’s plans to consolidate the cancer center staff from the current 12 buildings to one central location to enhance collaboration and research. He noted that the Governor’s proposed budget includes $75 million for the new building, to be matched with $75 million in philanthropic funds.
Senate Public Health and Welfare Committee
(Sen. Beverly Gossage, Chair)
On Tuesday, Jan. 17, the Committee heard a presentation by Douglas Neal, Palliative Care Program Manager, Kansas Department of Health and Environment (KDHE), Dr. Karin Porter-Williamson, Chair of the Palliative Care & Quality of Life Interdisciplinary Advisory Council, and Donna Yadrich, Co-Chair of the Palliative Care & Quality of Life Interdisciplinary Advisory Council. Neal explained that palliative care is a comprehensive interdisciplinary approach to improve the quality of life for patients with serious, potentially life-threatening conditions but differs from hospice care, which is a subset of palliative care. He described the membership of the Advisory Council and said the 5-Year Palliative State Plan focuses on four priority areas – access, education and health care workforce training, public and community awareness, and emergency preparedness and disaster planning. Dr. Porter-Williamson said the 2024 Palliative Care Legislative Priorities are to establish a mechanism to fund the sustainable delivery of primary palliative care education across the state, including using Project ECHO and building on an ECHO series on palliative care conducted during 2022, and to designate a portion of existing licensure continuing education requirements to be focused on pain and symptom management and/or serious illness conversation and communication skills. Dr. Porter-Williamson also commented on the value of palliative care to health care, including bringing value in KanCare.
Committee members asked questions regarding the difference between hospice and palliative care, what is included in a “serious illness” conversation between a physician and patient leading to a plan of care, whether palliative care services are covered by private insurance, Medicaid or Medicare (generally yes), whether mandating palliative care as a part of continuing education credits could be implemented by the Board of Healing Arts or if legislation would be required, and the fiscal estimate to establish a Project ECHO Palliative Care Center of Excellence. Yadrich explained it is difficult to develop a specific fiscal estimate because the composition of the training team and the types of training provided will vary across the state.
On Wednesday, Jan. 18, Michele Heydon, Commissioner, Long-Term Services and Supports, Kansas Department for Aging and Disability Services (KDADS), provided the Committee with an update on the new home and community-based services (HCBS) community support waiver process. Heydon reported that of the seven current HCBS waivers administered by KDADS, the intellectual and developmental disability (I/DD) waiver is the largest and the current waiver serves over 8,800 individuals with intellectual and developmental disabilities with an average cost of $53,244 per person. She also stated there are currently 5,187 people on the waiting list and the number has not dropped below 3,000 in a decade. Heydon noted that the community support waiver was a recommendation of the 2022-2023 Special Committee on I/DD Waiver Modernization to better meet the current needs of those on the I/DD waiting list and that the waiver would serve an estimated 3,600 to 7,461 individuals. She said KDADS has approval from the Centers for Medicare and Medicaid Services (CMS) to use federal matching funds to hire staff and a contractor for the community support waiver process and that KDADS plans to have the contractor hired by April. The contractor will form and convene stakeholder groups to provide feedback regarding services and draft the community support waiver. Committee members asked questions regarding the 18-to-24-month timeline for implementation of the waiver, whether Medicaid expansion could reduce the number of individuals on the I/DD waiting list, the location of the individuals currently on the waiting list, average wages for direct care workers and current staffing needs.
House Insurance Committee & Senate Financial Institutions and Insurance Committee
(Rep. William Sutton & Sen. Jeff Longbine, Chairs)
On Wednesday, Jan. 17, Insurance Commissioner Vicki Schmidt made a presentation in each committee, which included an update on the Insurance Department’s implementation of recently enacted legislation that lowered various regulatory fees, continuing education offerings for law enforcement individuals to help them detect insurance fraud and for insurance agents to help them meet their licensing requirements, and the work of the Consumer Assistance Division, including the recovery of $16 million for Kansas consumers in 2023.
In House Insurance, Committee members asked questions regarding the Department’s role in assisting consumers with prior authorization requirements in their health insurance plans, and whether the Department has seen an uptick in complaints from health care providers related to “clean claims” associated with services provided to patients. Commission Schmidt noted that the Department is collaborating with various stakeholders to hold public discussions related to the types of issues identified by the Committee.
In Senate Financial Institutions and Insurance, Committee members asked questions regarding the cancellation of Medicare supplement policies, the information required to determine whether a deceased family member had an active life insurance policy, and whether the Department can assist consumers with complaints related to the marketing of Medicare Advantage policies. Commissioner Schmidt said complaints regarding Medicare Advantage products are among the fastest growing complaints they receive, and that the Department is working to educate seniors on these products. She also mentioned that there is some movement at the federal level that may result in the return of some regulatory authority over Medicare Advantage products back to the states.
House Social Services Budget Committee
(Rep. Les Mason, Chair)
On Tuesday, Jan. 16, Chair Mason announced that he had asked KDHE, KDADS and the Kansas Department for Children and Families (DCF) to present regarding budget enhancements that had been requested and which ones were or were not included in the Governor’s proposed budget. He also stated these presentations would assist the Committee members when the full budget presentations are made later in the session.
On Tuesday, Amy Penrod, Director of Finance, KDHE, and Mark Heim, Division of Health Care Finance, KDHE, described the enhancements for FY 2024 and 2025 and noted that all of the enhancements described during their presentations were included in the Governor’s budget, including $1,535,000 ($383,750 SGF) for the Medicaid Eligibility Employment Data Contract for FY 2024 and $714.99 million, including savings of $61.8 million SGF, for Medicaid expansion for FY 2025.
On Wednesday, Jan. 17, Secretary Laura Howard presented the FY 2025 enhancements for DCF, including $17,000,000 all funds ($8,500,000 SGF) for the new Comprehensive Child Welfare Information System. Sec. Howard stated the agency expects to award the Design, Development and Implementation portion of the project by the end of March 2024 and other contracts, for Quality Assurance Contractor and Independent Verification and Validation Contractor, in April. An enhancement of $6,824,727 ($2,619,505 SGF) will allow recent child care assistance enhancements to continue. Sec. Howard noted that there are not enough federal funds to support child care assistance in the long term, but this enhancement would help bridge funding gaps in future years. An enhancement of $15,000,000 SGF will be used to fund child care sustainability payments to child care providers to support the operation and wages of child care workers. Sec. Howard noted that this funding would provide 3,500 providers with about $4,000 in grants.
On Thursday, Jan. 18, Secretary Howard, on behalf of KDADS, previewed the FY 2025 enhancements for KDADS for the Behavioral Health Services Commission, Long-Term Services and Supports Commission and State Hospital Commission, including $1,500,000 SGF to cover treatment costs associated with Family Treatment Courts that serve Children in Need of Care, $40,000,000 SGF to support housing initiatives to assist local governments and communities to gain long-term stability, $358,995 ($179,498 SGF) to hire an I/DD assistant director and community support waiver program manager and to sustain two quality assurance specialists positions, and $8.6 million ($3.3 million SGF) to provide supported employment funding for the HCBS I/DD Medicaid waiver. Sec. Howard noted that Cowley, Lyon and Miami counties will implement family treatment courts beginning in September 2024.
House Child Welfare and Foster Care Committee
(Rep. Susan Concannon, Chair)
On Wednesday, Jan. 17, the Committee heard a presentation by Linda Bass, KVC Kansas, regarding Adverse Childhood Experiences (ACEs), how they impact an individual throughout their lifetime, and the experiences of children who experienced trauma and their placement in the foster care system. Committee members asked questions regarding whether ACES may include in-utero alcohol and drug exposure, food insecurity and financial insecurity. They also asked whether children who experience ACES are likely to experience more trauma in adulthood, and whether strategies that assist pregnant women and parents can help the children.
The Committee also heard a presentation by Melissa Rooker, Kansas Children’s Cabinet and Trust Fund, regarding the Cabinet’s work in the prevention of child abuse and neglect, including a description of programs designed to support families and build resiliency. She also provided Committee members with copies of the Cabinet’s 2023 annual report. Rooker reported that data regarding the impact of the Families First Prevention Services Act program from October 2019 through June 2023 show that Kansas Families First received 4,280 referrals, and of the families served, only 6 percent of the children have been placed in foster care during an open Families First case. Eighty-nine percent of children and youth that reach the 12-month point from the time-of-service referral remain at home without the need for foster care.
Committee members asked questions regarding situations that lead to children being removed from their homes, whether getting social workers engaged with resources could reduce removals, whether all Families First programs are obtaining similar results in preventing children from being placed in foster care, and the information that is shared and required related to referrals through the IRIS app, which connects families to services. Gail Cozadd, Kansas Children’s Service League (KCSL), offered to respond to the question about making contact with resources and said KCSL is partnering with DCF on a data-driven training initiative for school district professionals and DCF officials and staff to shift the perspective regarding the reasons for removal and promoting the use of an app to connect social workers with immediate supports for families.
House Welfare Reform Committee
(Rep. Francis Awerkamp, Chair)
On Tuesday, Jan. 16, the Committee heard a presentation by Jessie Pringle, Office of the Revisor of Statutes, regarding the work being done to draft a bill that will reorganize and reformat the various statutes in Kansas law regarding eligibility, work requirements and other provisions related to public assistance programs. Chair Awerkamp said the final bill will be introduced after the bill draft has been made public and Committee members and interested parties have a chance to review the draft to ensure that all provisions in current statutes have been included in the bill draft.
On Thursday, Jan. 18, the Committee heard a presentation from Iraida Orr, Kansas Legislative Research Department, summarizing the Report of the Special Committee on Homelessness to the 2024 Kansas Legislature. Orr noted that the Special Committee made observations but did not make formal recommendations for the 2024 Legislature.
Chair Awerkamp noted that the U.S. Supreme Court has announced it will hear the case of Johnson v. City of Grants Pass, a case that deals with anti-camping and park exclusion ordinances passed by Grants Pass and that the outcome of this case may provide some clarity regarding what steps cities may or may not take to address homelessness. He also said one of the goals of the interim committee was to try to gain an understanding of what strategies work or don’t work in addressing homelessness.
The Committee also heard presentations from Paul Webster, Hope Street Coalition, an organization based in Los Angeles that advocates for policy change that addresses homelessness, mental illness and addiction, and Scott Ackerson, Haven for Hope, an organization based in San Antonio that provides, coordinates and delivers a system of care for people experiencing homelessness. Webster provided a brief history of efforts in Los Angeles to address homelessness, suggested that the policy of housing first, with no accountability for conduct, has not been successful, and that housing must be paired with treatment for mental illness and addiction. Ackerson described housing first as an effective policy that must be combined with wraparound services. He asserted that current federal policy through Housing and Urban Development does not support the use of funding to provide those wraparound services. He then provided a description of the Haven for Hope campus in San Antonio that provides dorm-style housing and low-barrier shelter, combined with services to address the root causes for homelessness. Ackerson stressed the importance of understanding that the approach to addressing homelessness cannot be a one-size-fits-all intervention. He also said much of the health care provided at Haven is provided through funding made available to their FQHCs and their local mental authority and Texas has a law that funds treatment for people who are homeless and have a mental illness diagnosis. Committee members asked questions regarding housing-first initiatives, data on services and programs being refused by individuals experiencing homelessness, and whether Medicaid expansion could address the cost of uncompensated care for behavioral health services for individuals experiencing homelessness.
House Corrections and Juvenile Justice Committee
(Rep. Stephen Owens, Chair)
On Tuesday, Jan. 16, the Committee heard presentations from Tony Mattivi, Director, Kansas Bureau of Investigation, Colonel Erik Smith, Kansas Highway Patrol, Sheriff Jeff Easter, Kansas Sheriffs Association, and Ed Klump, Kansas Association of Chiefs of Police, regarding the state of law enforcement in Kansas. Mattivi reported on the “pressing threats” to Kansans, which includes fentanyl trafficking and distribution, crimes against children (physical and sexual abuse and online exploitation), and cyberattacks, including attacks on hospitals. Easter and Klump said the challenges faced by law enforcement include the lack of mental health capacity, both at the community level and within the state hospital system, waiting lists for emergency commitments, backlogs for competency evaluations and restoration, need for programs to address the mental health of first responders, and mental health training for law enforcement. Klump reiterated the concerns regarding fentanyl (overdose/poisoning deaths, rising use by Kansas youth, lack of inpatient addiction treatment services), serious repeat juvenile offenders, and firearms use during illegal drug transactions.
Committee members asked questions regarding what steps the Legislature can take to address fentanyl trafficking and distribution, the status of the investigation of letters with white powder that were sent to Kansas legislators and other public officials last year, law enforcement’s attitude regarding fentanyl test strips, and what age group of youth most often using fentanyl (low to mid 20s).
On Wednesday, Jan. 17, Megan Miner, Deputy Secretary of Adult and Juvenile Community-Based Services, Kansas Department of Corrections, reported on the implementation of HB 2021, passed during the 2023 session. The bill created and amended law regarding the assessment and provision of services to children in the child welfare and juvenile justice system, including overall case length limits, the exchange of confidential data within the juvenile justice system, and the use of funds from the Evidence-based Programs Account of the State General fund. The bill also changed the criteria used to admit youths to a juvenile crisis intervention center by adding definitions for “behavioral health crisis” and changing the phrase “mental health crisis” to “behavioral health crisis.”
Committee members asked questions regarding the 72-hour risk assessment and 48-hour case plan provisions in the bill, the crossover youth model and what it does, whether there are risks to providing low-risk youth with fewer services than medium to high-risk offenders, and the effectiveness of the referral process across the state. Chair Owens asked what would be needed to develop a regularly updated master list of services available, by county.