During week 3 of the session, legislators held informational hearings on long-term care facilities and providers, local health departments, the home and community based services (HCBS) waivers managed by the Kansas Department for Aging and Disability Services, and the unwinding of the increased enrollment in KanCare during the federal public health emergency. They also began hearings on bills related to child welfare issues.
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On Tuesday, January 24, Gov. Kelly delivered her 2023 State of the State address and highlighted her legislative priorities for the session, including immediate elimination of the sales tax on food as well as the tax on diapers and feminine hygiene products, a four-day state sales tax holiday for school supplies, full funding for Special Education, increased funding for the Office of Registered Apprenticeship to grow the state’s skilled workforce, Medicaid expansion, legalization of medical marijuana, the expansion of Mental Health Intervention Teams in schools, funding for adult psychiatric services in the Wichita area and addressing the shortage of mental health workers across the state, and decriminalization of fentanyl test strips.
On Wednesday, January 25, Gov. Kelly announced that Camber Children’s Mental Health (previously KVC Hospitals) may begin accepting patients and providing care in early February at its new youth mental health hospital in Hays. The opening of this facility, which is intended to meet the needs of youth up to 18 years of age in the western part of the state, arose from a partnership announced in December 2021 between Camber and the Kansas Department for Aging and Disability Services (KDADS).
Also on Wednesday, the Governor announced that 10 Kansas communities are receiving a total of $1,762,212 in grants from the Kansas Department for Children and Families (DCF) to assist with the creation of Family Resource Centers. The goal of these grants is to provide support for families in their own neighborhoods and decrease the need for families to have formal contact with the agency.
On Thursday, January 26, the Senate Republican Caucus elected Sen. Rick Kloos to the position of Senate Majority Whip.
House Health and Human Services Committee
(Rep. Brenda Landwehr, Chair)
On Monday, January 23, the Committee heard a presentation by Sonja Bachus, CEO, Community Care Network of Kansas (CCNK), who provided an overview of the three types of community-based primary care clinics that are members of CCNK, including 19 federally qualified health centers (FQHCs), 3 look-alikes (LALs), and 10 community-based clinics. In 2022, 332,087 unique patients received care in 1,043,199 visits to the clinics. She also noted that of the patients accessing healthcare services, 30.46 percent have coverage through Medicaid/CHIP, 29.08 percent have private insurance, 29.16 percent are uninsured, 10.91 percent have Medicare, and 0.40 percent have other public coverage (e.g., TriCare, VA Health Care). In 2021, FQHCs and LALs wrote off more than $50 million in sliding fee discounts and bad debt. Bachus explained that in addition to healthcare services, the clinics also provide translation services, care coordination, transportation and food pantries. She also shared that the biggest challenges for the clinics are workforce shortages, threats to the 340B program (a federal program that allows qualifying healthcare facilities to purchase prescription drugs at a discounted price), and lack of funding. Committee members asked questions regarding the 340B program concerns, the competition for grant funds among clinics, reimbursement rates for Medicaid patients, practicums for students, and potential cost savings if Medicaid were expanded.
On Thursday, January 26, the Committee heard from Linda MowBray, CEO, Kansas Healthcare Association and Kansas Center for Assisted Living, who noted that her organizations represent not only individuals living in nursing homes and assisted living facilities, but also the staff, management and profession as a whole. MowBray presented information regarding the classifications of care in Kansas, a risk map published by the Agency for Health Care Administration (AHCA) showing that 51 percent of long-term care facilities in Kansas are at risk for closure (either a wing or whole facility), a census of currently available beds, a recent jobs report showing the loss of workforce, and a document describing the future population of Kansas and the increase in older age groups.
Also on Thursday, January 26, the Committee heard from Rachel Monger, President and CEO, LeadingAge Kansas. Monger stated that her organization, which has 160 members, is a state association for nonprofit and faith-based senior care organizations. She reported that since the pandemic, 49 facilities have either closed, de-licensed, or closed portions of their facilities and noted that funding and workforce appear to be the two main causes for these closures. Monger shared that not only have labor costs increased due to contract labor and healthcare staffing agencies, but workforce numbers have shrunk by 10 percent while reliance on staffing agencies has grown by 90 percent at a cost increase of 270 percent. She noted that in November, facilities had to turn away 1,191 individuals due to staffing shortages. She stated that her organization’s legislative agenda for this session includes continued full funding for Medicaid reimbursement rates and provider costs, prohibiting staffing agencies from having non-compete and buyout clauses in their contracts, and support for workforce development and worker-friendly policies. Committee members asked questions about efforts to keep people in their homes and out of nursing facilities, and how prohibiting non-compete and buyout clauses would help facilities and whether there are examples or models from other states addressing this issue. Monger stated that last year Iowa addressed the non-compete clause issue in a bill.
Senate Public Health and Welfare Committee
(Sen. Beverly Gossage, Chair)
On Tuesday, January 24, the Committee heard from Dennis Kriesel, Executive Director, Kansas Association of Local Health Departments (KALHD), about the key services provided by the association to the 100 local health departments (LHDs) in Kansas. He also described the local, federal and state funding provided to LHDs and noted that the funding through the state formula provides a minimum of $7,000 per LHD, although the minimum was temporarily raised to $12,000 by proviso since state fiscal year (FY) 2021. KAHLD is seeking a bill to make the base $12,000 and adjust the formula to base plus population. Kriesel also presented a list of services directly provided by LHDs, including blood lead testing, breastfeeding support, car seats, chronic disease management, dental preventative services, diabetes education, family planning/women’s health, health promotion, health screening, immunizations, laboratory services, preparedness, school health services, and senior services.
On Wednesday, January 25, the Committee heard presentations from Children’s Alliance of Kansas, KidsTLC, FosterAdopt Connect, and Children’s Advocacy Centers of Kansas. Rachel Marsh, CEO, Children’s Alliance of Kansas, reported that Kansas has an unusually high number of adolescents entering care compared to the national norm and stated that providers have noted that courts are more often ordering adolescents to enter care to access services, and less often for reasons attributed to child maltreatment or neglect. Committee members asked questions regarding the reasons Kansas has higher numbers of older children in foster care, the cost savings of providing assistance to families at risk of having a child enter foster care, census and average length of stay in a psychiatric residential treatment facility, and reasons for problematic sexual behaviors in children.
On Thursday, January 26, the Committee heard a presentation from Wyatt Beckman, Senior Analyst, Kansas Health Institute (KHI), who provided data regarding youth (age 15-24) suicide rates in Kansas, including trends and means of suicide. He noted that with 21.3 suicides per 100,000 for the period of 2016-2020, Kansas had the 10th highest suicide rate in the nation for that age group. Kansas had the 11th highest rate in the nation over the same time period for youth age of 10-14, at 3.6 suicides per 100,000. Committee members asked questions regarding the reasons why suicide rates are lower in some states, the gender differences when looking at suicide attempts and lethality of attempts, and the impact of the pandemic.
Also on Thursday, January 26, the Committee heard a presentation from Linda Sheppard, Senior Analyst & Strategy Team Leader at KHI, who presented information about the enrollment of 107,784 Kansans in health insurance coverage through the Kansas marketplace during the 2022 Open Enrollment Period, including demographic information, the use of Advanced Premium Tax Credits to pay for coverage, and premiums paid in the seven rating areas across the state. Committee members asked questions regarding the total number of health insurance plans available in Kansas, financial assistance specifically available to households with incomes of 100 to 250 percent of the federal poverty level, and whether the “family glitch” (the unaffordability of health insurance for family members of employees with employer coverage) had been addressed by the federal government.
Child Welfare and Foster Care Committee
(Rep. Susan Concannon, Chair)
On Monday, January 23, the Committee held a hearing on House Bill (HB) 2024, which would amend the Infant Protection Act to allow for the surrender of infants in a designated Infant Refuge Bassinet without civil penalty. The Infant Refuge Bassinet, or Baby Box, is a device or container designed to safely accept infants being surrendered. The bill outlines requirements for facilities that chose to install the bassinet, such as the location of the bassinet and an automatic lock, temperature control and alarm on the bassinet. The facility must also be staffed 24 hours a day, seven days a week so the bassinet can be checked at least twice a day and the alarm system frequently tested. In jurisdictions that have implemented similar programs, local fire departments, health departments and hospitals are common locations for refuge bassinets to be located. Committee members asked questions regarding the facilities that may or may not install a refuge bassinet, the cost of installation and maintenance, how to hold child abusers accountable when surrendering their children, and current statistics on how many infants are surrendered (20 infants in Kansas between 2018 and 2021).
On Wednesday, January 25, the Committee held a hearing on HB 2034, which would require a referral of an alleged victim of physical child abuse or neglect for an examination as part of an investigation, and create a program housed under the Kansas Department of Health and Environment (KDHE) to provide training and payment for such examinations. The legislation does not include examination for sexual abuse. A similar bill introduced during the 2022 session died in committee. Conferees included representatives of Kansas law enforcement associations and the Kansas Chapter of American Academy of Pediatrics, as well as Alyson Dalrymple, Deputy Director of KDHE, and Deanne Dinkel, Director of Safety & Thriving Families and Performance Improvement at DCF (written only). Committee members asked questions regarding why KDHE and DCF are jointly involved in this program and why there is a special payment method for the exam, the care referral process, non-cooperation from parents, and potentially allocating funding for training law enforcement to identify signs of physical abuse.
Social Services Budget Committee
(Rep. Les Mason, Chair)
On Monday, January 23, Secretary Laura Howard, Kansas Department for Aging and Disability Services (KDADS), presented an overview of the agency’s budget and indicated that most of the funding is for services for aging, people with disabilities and behavioral health. KDADS oversees four state hospitals, including two for individuals with intellectual and developmental disabilities and two psychiatric state hospitals, each with individual budgets. Committee members asked questions about difficulties in hiring staff, masking requirements in facilities, contracted nursing staff, the state’s ranking in national suicide rates, the federal medical assistance percentage (FMAP), and the community supports waiver.
On Thursday, January 26, Secretary Howard made a presentation about HCBS waivers in Kansas, including each specific waiver and the population served by that waiver. She explained that an HCBS waiver is an authorization from Medicaid that allows a beneficiary to get services at home or in a community setting, rather than being required to enter an institution such as a nursing facility. Kansas currently administers seven HCBS waivers, including autism, frail elderly (FE), intellectual and developmental disability (I/DD), physical disability (PD), serious emotional disturbance (SED), technology assisted (TA) and brain injury (BI). Sec. Howard noted that the I/DD waiver currently serves 9,044 Kansans and has 4,813 on the waiting list and the PD waiver currently serves 6,051 individuals and has 2,542 on the waiting list. The FE waiver serves a little over 6,759 Kansans and does not have a waiting list. The smallest waiver is the autism waiver, currently serving 53 people with 432 on the proposed recipient list. The remainder of waivers do not have waiting lists.
Secretary Howard stated that the Kansas University Center on Developmental Disabilities (KUCDD) is conducting a study of the I/DD waiver waiting list to gain a better understanding of the current and future service needs of the individuals on the list, develop a methodology to identify individuals at risk for crises, inform decisions regarding system capacity building, and reduce the waiting list for services. This project began in July 2022 and runs through March 2023.
House Appropriations Committee
(Rep. Troy Waymaster, Chair)
On Wednesday, January 25, the Committee heard a presentation by Christine Osterlund, Deputy Director of Medicaid Operations, KDHE, regarding the impact of the federal Omnibus Appropriations bill, passed in late December, on the Federal Medical Assistance Percentage (FMAP) for Medicaid. Osterlund noted that the state’s base rate is 59.76 percent but the state had been receiving 6.2 percentage point enhanced funding for Medicaid during the federal public health emergency. She reported that under the Omnibus bill, the enhanced funding will be reduced each quarter during 2023 until it ends on December 31. She noted that the federal Centers for Medicare and Medicaid Services will be providing guidance to states regarding reporting and notice requirements in conjunction with the state’s review of eligibility of the current 533,000 KanCare enrollees that will be occurring over 12 months and pointed out that the state’s failure to comply with all reporting and notice requirements could result in the loss of the enhanced funding. The first date that the state will be allowed to terminate coverage due to ineligibility will be April 1.
Senate Ways and Means Committee
(Sen. Rick Billinger, Chair)
On Tuesday, January 24, the Committee heard the same presentation by Christine Osterlund, KDHE, that was presented to the House Appropriations Committee (above), and also received a summary of the Report of the 2022 Special Committee on Intellectual and Developmental Disabilities Waiver Modernization from Dayton LaMunyon, Kansas Legislative Research Department. In response to questions from Committee members regarding the community supports waiver recommended by the interim committee, Mandy Flower, Assistant Commissioner, Long-Term Services and Supports, KDADS, stated that the new waiver could benefit some individuals and families who have been on the waiting list for the comprehensive I/DD waiver and could be an alternative for some individuals who are currently on the comprehensive waiver but do not need all the services provided under that waiver. She also responded to questions regarding the interim committee’s recommendation for a $20,000 cap on the community supports waiver, the removal of some children from the autism waiver, and whether other states are also experiencing waiting lists for an I/DD waiver.
The Committee also heard a presentation by John Calvert, Director of the Safe and Secure Schools Unit, Kansas State Department of Education, regarding the mental health intervention team program. Calvert stated that the program focuses on K-12 students and their families by identifying students who may need mental health services and linking them to the existing statewide behavioral health system and resources within the mental health providers network. He noted that the key to this program is the liaisons who work in each school district with students and their families to obtain services through existing community mental health centers. He noted that the program, which began with the 2018-2019 school year with nine pilot schools and 45 liaisons, served 1,708 students, including 212 foster care students. During the first half of the 2022-23 school year, the program included 67 school districts, 150 liaisons, and had served 4,801 students, including 447 foster care students.
Corrections and Juvenile Justice Committee
(Rep Stephen Owens, Chair)
On Monday, January 23, the Committee held a hearing on HB 2033, which would change the criteria used to refer and admit juveniles to a juvenile crisis intervention center. This bill is a reaction to 2016 Senate Bill (SB) 367, which changed the way youth with justice involvement enter the system. The bill would amend language in K.S.A. 65-536, which is the statute that creates juvenile crisis intervention centers and that allows juveniles who are experiencing a mental health crisis and are likely to cause harm to themselves or others to be admitted to an intervention center. This section would be amended to change the reference from mental health crisis to behavioral health crisis. A behavioral health crisis is defined to mean behavioral or conduct issues that impact the safety or health of a child, members of the child’s household or family or members of the community, including, but not limited to, non-life-threatening mental health and substance abuse concerns. Proponents included representatives of the Johnson County Mental Health Center, Children’s Alliance of Kansas, and Tanya Keys, Deputy Secretary, DCF, who all noted that amending this language will allow more youth to be served by the intervention centers operating in the state. There was no opposition or neutral testimony.
On Thursday, January 26, the Committee took final action on HB 2033, and passed it favorably out of committee. Rep. Carl Maughan, who voted against the bill, expressed concerns that the definition of behavioral health crisis was too broad and could potentially include things like smoking, drinking or acting out, which could result in too many youth entering the system.
House K-12 Education Budget Committee
(Rep. Kristey Williams, Chair)
On Tuesday, January 24, the Committee held a hearing on HB 2060, which would establish the special education and related services funding task force. The bill provides for a 10-member task force, with members appointed by legislative leadership and other organizations. Members would be appointed on or before July 1, 2023.