During week 4 of the session, legislative committees continued to hold informational hearings on topics such as child welfare, healthcare workforce, and staffing at nursing facilities, and the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight held its quarterly meeting to hear updates on the state Medicaid program and other state healthcare programs.
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On Monday, January 30, Gov. Kelly announced that the Kansas Children’s Cabinet and Trust Fund has been awarded a $4 million 2023 Preschool Development Birth through Five Planning Grant from the U.S. Department of Health and Human Services Administration for Children and Families. The grant will be used to strengthen the early childhood sector’s workforce recruitment and growth and fund a study on how to better coordinate the state’s delivery of early childhood services for Kansas families.
On Wednesday, February 1, the Kansas Department of Revenue reported that state tax-only revenues for January were $1.047 billion, $56.2 million above estimates. Corporate income taxes were up, while individual income and sales taxes were below estimates for the month. Gov. Kelly reiterated her support for the immediate elimination of the state sales tax on groceries, diapers and feminine hygiene products.
Also on Wednesday, the Governor announced that the 988 Suicide and Crisis Lifeline has experienced a nearly 27 percent increase in call volume compared to the six months before its launch on July 16, 2022. She noted that Vibrant, the current administrator of the 988 Lifeline, is reporting that the 988 contact centers in Kansas have maintained an in-state call-answer rate of 85 to 91 percent month-over-month with the increased call volume, while other states have struggled with call volume, causing higher rates of sending calls to an out-of-state center.
House Health and Human Services Committee
(Rep. Brenda Landwehr, Chair)
On Monday, January 30, the Committee heard a presentation from David Fye, Executive Director, Kansas Behavioral Sciences Regulatory Board (BSRB). While one of the board’s roles is to approve licenses, Fye said the main focus is protecting the public, in the form of investigating complaints and reports of alleged violations (e.g., falsifying continuing education requirements, practicing with an expired license, conflicts of interest, confidentiality violations). He reported that in fiscal year (FY) 2022, the BSRB issued 1,536 permanent licenses, 328 temporary licenses, 97 out-of-state temporary permits, and 4 provisional licenses. Of the 1,536 permanent licenses, 1,112 were initial licenses (typically for new graduates or people new to the field) and 424 were through reciprocity (those moving to Kansas with licenses from other states or those who provide telehealth within the state). Since July 2015, the number of permanent licenses has increased by 21.6 percent. Fye noted that in FY 2022, BSRB received 205 complaints, which is in line with previous years, with the exception of 2021 when these numbers were extremely low (132). He noted that the goal for BSRB this session is to change some statutes and regulations related to workforce and find innovative licensing techniques. Committee members asked questions about school certifications for those entering the profession, the complaint and appeals process, and the funding of the Board.
On Wednesday, February 1, the Committee heard a presentation from Stanley Goldfarb, M.D., Do No Harm, who said his organization, based in Pennsylvania, is focusing on problems they see arising from a focus on political ideology in workplaces, access to care, medical school admission standards, and patients being seen as members of groups rather than being treated as individuals. Committee members asked questions related to cultural competence, health disparities among some populations (e.g., Black infant mortality), medical school admissions, rural disparities, and ways to solve the access to care problem.
Senate Public Health and Welfare Committee
(Sen. Beverly Gossage, Chair)
On Tuesday, January 31, the Committee heard presentations from representatives of the Kansas Health Care Association (KHCA), Kansas Center for Assisted Living (KCAL) and LeadingAge Kansas. Linda MowBray, KHCA/KCAL, reported that a study using State of Skilled Nursing Facility Companion data from 2019 shows that 51 percent of Kansas nursing facilities weren’t sure if they could keep operating or had insufficient staff to take in new residents, as compared to 18 percent nationally. She stated that between 2020 and 2023, there have been 19 nursing home closures, representing the loss of over 1,000 nursing home beds, and one additional home in Alma appears to be closing in March. She also noted that there are nursing homes that are decertifying beds, primarily due to insufficient staffing.
Rachel Monger, LeadingAge Kansas, the state association for not-for-profit and faith-based aging services, provided an overview of the impact of the pandemic on members and the results of a survey of Kansas adult care homes. Monger stated that since the start of the pandemic all or part of at least 47 facilities have closed or reduced their number of available beds in Kansas and she also attributed the closures and reduced services to workforce and funding. She noted that since the start of the pandemic, labor costs have grown by double digits and contract labor has grown by 270 percent. She also stated that since the pandemic, the aging services workforce has shrunk by more than 10 percent.
To address workforce and loss of beds, Monger stated that her organization is proposing fully funding Medicaid reimbursement rates and provider costs, regulating the labor practices of temporary staffing agencies, and focusing on workforce development and workforce-friendly policies.
Committee members asked questions regarding the challenges of contract labor and the impact to the facility, the types of benefits that nursing homes are able to provide to their employees (e.g., health insurance and childcare), types of jobs in a facility and the licensure or credentialing requirements of those jobs, the Medicaid formula, the wage of a certified nurse aide (CNA), incentives or disincentives for purchasing long-term care insurance, the contribution of fines from federal and state regulators to the closure of facilities, and innovative programs combining childcare facilities in the same building as long-term care facilities.
On Wednesday, February 1, the Committee heard from Stanley Goldfarb, M.D., who also presented to the House Health and Human Services Committee. As in the other presentation, he provided a critique of implicit bias training and diversity initiatives in medical schools and health sciences programs. Committee members asked questions regarding changes in admission policies to medical schools, what implicit bias training is, disparities due to bias, social determinants of health, differences in race/ethnicity in infant health and mortality, and questions about censorship of controversial opinions.
Child Welfare and Foster Care Committee
(Rep. Susan Concannon, Chair)
On Monday, January 30, the Committee held a hearing on House Bill (HB) 2194, which would enact the Representative Gail Finney Memorial Foster Care Bill of Rights. The bill provides a long list of a child’s existing rights or establishes actions a child may take and also provides rights for foster parents.
Proponents included representatives of the Children’s Alliance of Kansas and FosterAdoptConnect and written-only testimony was submitted by Saint Francis Ministry, Rep. Stephanie Clayton, TFI Family Services, Inc., Kansas Department for Children and Families, Kansas Appleseed, Kansas Division of the Child Advocate (KDCA), and the Center for Rights of Abused Children. There was no neutral or opponent testimony.
The Committee also worked HB 2024, which would amend the Newborn Infant Protection Act to provide an alternate means to legally surrender an infant, and amended the bill to modify terminology and definitions, and to:
- require a non-relinquishing parent to submit to genetic testing to verify biological parentage of a surrendered child when seeking to establish parental rights;
- require an employee taking custody of an infant surrendered to ask the relinquishing parent to provide certain information regarding tribal member status;
- require facilities maintaining a newborn safety device to provide the means for the relinquishing parent to provide such information; and
- require an employee of the facility taking custody of an infant to provide any such information to the Secretary of the Kansas Department for Children and Families (DCF).
The Committee then passed the bill, as amended, favorably out of committee.
On Wednesday February 1, the Committee heard presentations from representatives of the Children’s Alliance of Kansas (CAK), the Child Death Review Board, and the KDCA. Rachel Marsh, CAK, reported that in the U.S. the average rate of children being placed out-of-home is 5.6 children per 1,000 but is 8.2 per 1,000 in Kansas. She also stated that an emerging issue in child welfare is that more youth with intellectual and developmental disabilities (I/DD) are entering foster care and they are on the I/DD waiver waitlist and cannot get the care they need.
Jane Weiler, State Child Death Review Board, presented data from the Board’s 2020 annual report, including that Kansas had 365 child fatalities, with the majority being due to natural causes such as prematurity, congenital conditions, cancer and disease. Weiler also reported there were two deaths from COVID-19, 22 from homicide, 26 from suicide, and 57 from undetermined causes. Of the deaths classified as undetermined, 79 percent were children less than one year of age and were further classified as sleep-related Sudden Unexpected Infant Death. She also noted that in 2020, there were 11 deaths related to fentanyl. Prior to 2020, there had never been a reported death of a child related to fentanyl.
Kerrie Lonard, Child Advocate, provided the Committee with an overview of the KDCA, including its mission, purpose and function, and reported on the number and types of complaints the Division received in 2022, and the types of investigations it conducts.
Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight
(Sen. Beverly Gossage, Chair)
On Friday, February 3, the Joint Committee held its quarterly meeting and heard from providers, advocacy organizations, state agency staff, managed care organization (MCO) representatives, and other individuals who have interacted with KanCare. Conferees testified on issues related to Home and Community Based Services (HCBS), including reimbursement rate parity, workforce shortages, targeted case management, the community supports waiver and a registry for known perpetrators of abuse, neglect and exploitation of persons with a disability.
Matt Fletcher, InterHab, stated that a proposed reimbursement rate increase for targeted case management from $43.32/hour to $54.15/hour, while a significant increase, is still below the rate that would be required for sustainability. Leslie Anderson, Kansas Association of Area Agencies on Aging and Disabilities, described the challenges being faced by the long-term care industry including contract labor with price prohibitive buy-out clauses, loss of beds due to closures, rising cost of equipment, and Medicaid reimbursement rates. Committee members asked about how residents are relocated when a dementia wing or a facility closes and solutions to workforce shortages.
Tonya Dorf Brunner, Oral Health Kansas, updated the Committee on the implementation of the new Medicaid dental benefit for adults that went into effect on July 1, 2022, and asked that the benefit be extended to include dentures and partials. Brunner stated that nearly a third of older adults in Kansas have lost six or more teeth due to tooth decay or gum disease and missing teeth leads to difficulty in eating and digesting food, which can lead to nutritional deficiencies. Later in the meeting, Sarah Fertig, Medicaid Director, Kansas Department of Health and Environment (KDHE), reported that KDHE has estimated that it would cost $1,712,436 all funds, including $686,584 State General Funds (SGF), to add dentures, partials, and adjustments and repairs to base Medicaid coverage beginning July 1, 2023.
Steven Anderson, Office of the Medicaid Inspector General (OMIG), reported that the OMIG’s 2022 annual report is currently being finalized and will be available during the week of February 6. He also stated that the OMIG has concluded its audit concerning eligibility determinations for Medicaid recipients that have moved out of the state and that report will be published later this month. Anderson noted that the OMIG has continued to see an increasing number of complaints of fraud, waste, abuse and illegal acts concerning KanCare, the MediKan program and the Children’s Health Insurance Program (CHIP). During 2022, the OMIG screened 1,419 complaints, an 18.7 percent increase over 2021 (1,195). He noted that most of the complaints involve eligibility fraud, but Kansas currently does not have sufficient resources to conduct Medicaid eligibility fraud investigations. He stated that OMIG would need investigators and an analyst to identify and investigate cases of eligibility fraud that warrant prosecution referrals. Committee members asked questions regarding the recouping of state dollars in fraud cases, the outcome of the complaints filed in 2022, and the number of employees needed to fully staff the OMIG.
In the afternoon session of the Joint Committee’s meeting, Kerri Lonard, Child Advocate, provided an overview of the KDCA like the one presented to the Child Welfare and Foster Care Committee on February 1 (see above). She noted that the Division had advocated for 321 children during 2022.
KDHE Secretary Janet Stanek, and other representatives of KDHE, provided information about KanCare, including that the state’s 1115 demonstration renewal application was submitted to the Centers for Medicare and Medicaid Services (CMS) on December 28 but won’t likely be approved until the fall of this year. A 1915(b) waiver is also being prepared for submission to CMS in July, along with some state plan amendments. The state anticipates going live with those changes on January 1, 2024.
With the expiration of the current managed care organization (MCO) contracts on December 31, 2023, the request to extend the current MCO contracts to December 31, 2024, will be submitted to CMS for approval. Since capitation rates for 2024 must be submitted with the extension request, KDHE is currently planning to finalize the rates and submit the request this spring or summer. The target date for release of a Request for Proposals for MCOs is planned for mid-September.
Secretary Laura Howard, Kansas Department for Aging and Disability Services (KDADS), and other KDADS representatives provided updates on several topics, including the regional state hospital project, the community supports waiver, and approval of certified community behavioral health centers (CCBHCs). The $15 million appropriated by the Legislature for the state hospital project (25 mental health beds in the Wichita area, plus space for expansion to a total of 50 beds, as recommended by the Special Committee on Mental Health Beds) was released to KDADS on December 21. The cost for the community supports waiver, as recommended by the Special Committee on Intellectual and Developmental Disability Waiver Modernization, is projected to be $72 million to $149 million all funds, including $29 million to $40 million SGF. Approval of the waiver will likely take two years and KDADS anticipates that 500 people would initially be provided with the new waiver services the first year of implementation, with another 1,000 the second year. The second round of CCBHCs will be approved by July 2023. Committee members asked questions regarding when Sedgwick County would receive the $15 million to start their planning for the regional state hospital project and whether there is a private entity that may want to operate the new facility.
Financial Institutions and Insurance Committee
(Sen. Jeff Longbine, Chair)
On Wednesday, February 1, the Committee worked Senate Bill (SB) 26, which would amend existing law related to the financial documentation demonstrating fiscal soundness that must be submitted by health maintenance organizations (HMOs) or Medicare provider organizations (MPOs) when applying for a certificate of authority to provide healthcare in the state. The bill was passed favorably out of committee.
Social Services Budget Committee
(Rep. Les Mason, Chair)
On Thursday, February 2, Clark Shultz, Executive Director, Health Care Stabilization Fund, presented the agency’s budget. Schultz also provided an overview of the Health Care Provider Insurance Availability Act, which requires all defined healthcare providers to maintain professional liability coverage, creates an available plan for those that cannot purchase coverage in the commercial market, and provides supplemental coverage above the primary coverage purchased by healthcare providers. The Stabilization Fund provides coverage for over 18,000 healthcare providers in Kansas. He reported that during the fiscal year ending June 30, 2022, the Fund closed 542 claim files and paid over $29 million in compensation to injured individuals. He also noted that Kansas is fourth in states with the least expensive annual malpractice liability insurance rates as reported by WalletHub in 2022.
Chardae Caine, Kansas Legislative Research Department (KLRD), presented the requested budget for the Kansas Board of Pharmacy for FYs 2023, 2024 and 2025 and a budget analysis of fiscal year 2022. The Board is responsible for the enforcement of the Pharmacy Act and the Controlled Substances Act, and the mission of the Board is to ensure all persons and entities conducting business relating to the practice of pharmacy in Kansas are properly licensed and registered to protect public health, safety, and welfare and to promote understanding of pharmacy-related practices.
Alexandra Blasi, Executive Secretary, Kansas State Board of Pharmacy, also presented information about the Kansas Prescription Drug Monitoring Program (K-TRACS), the Unused Medication Program, and highlighted performance measures. K-TRACS tracks scheduled controlled substances and drugs of concern in the state. She reported that the agency licenses and registers approximately 8,100 pharmacists, 7,100 pharmacy technicians, 900 pharmacy interns/students, and nearly 6,500 pharmacies and facilities in and outside of Kansas. She also stated that 100 percent of initial applications for military service members and spouses were processed within 15 days. The Unused Medication program allows pharmacies to donate unused prescription medications to a depot for distribution to safety-net clinics to be provided at low or no-cost to indigent care patients.
Federal and State Affairs Committee
(Rep. Will Carpenter, Chair)
On Wednesday, February 1, the Committee held hearings on two bills related to the regulation of kratom (mitragyna speciosa), a tropical evergreen tree in the coffee family native to Southeast Asia, which has properties as a narcotic substitute medication and has been used to treat patients with narcotic addiction.
HB 2084, which would be known as the Kratom Consumer Protection Act, would establish the regulation of the preparation, distribution, and sale of kratom products in the state. Mac Haddow, American Kratom Association, provided proponent testimony and stated that seven states (UT, GA, AZ, OK, NV, CO, OR) have enacted kratom regulation legislation and a bill entitled ‘‘Federal Clarity for Kratom Consumers Act’’ was filed in December 2022 in Congress. The federal bill would require the Secretary of the U.S. Department of Health and Human Services to convene at least one public hearing to address the scientific data on the public health risks and benefits of kratom and would have to include input from scientific researchers and consider topics such as the number of Americans who use kratom and substance misuse potential. Haddow stated that another 24 states are considering kratom legislation this session. Haddow noted that kratom can already be legally purchased in Kansas but there is no regulatory system in place to protect consumers from the dangerous adulteration of kratom with the addition of illegal substances such as fentanyl, cocaine and morphine. Neutral written testimony was provided by the Kansas Department of Agriculture. Committee members asked questions regarding the federal Food and Drug Administration’s current view of kratom, why kratom is considered a food product, the recommended serving size for use by consumers, whether use of kratom can result in overdose, what side effects can occur, and what type of packaging of kratom is required in other states.
For HB 2188, which would regulate the sale and distribution of kratom products and would be a part of the Kansas food, drug and cosmetic act, Rep. John Eplee provided proponent testimony and neutral testimony was submitted by the American Kratom Association and the Kansas Department of Agriculture. HB 2188 is a much more comprehensive bill and requires the Department of Agriculture to perform certain duties as a part of the regulatory scheme. Rep. Eplee noted that HB 2188 is similar to a bill that was passed by the House in 2021 on a vote of 97-24 but was not considered by the Senate. Committee members asked questions regarding the differences between the two bills, what would be considered false advertising under the provisions of the bill, and whether there have been reported deaths from the use of kratom. In response to a question related to the differences in the fiscal note for each bill, Kelsey Olson, Department of Agriculture, stated that the fiscal note for HB 2188 is less than the fiscal note for HB 2084 because regulatory tasks for kratom under HB 2188 would be similar to tasks that are already performed by the Department under its existing food regulation program. HB 2084 could require an entirely new regulatory process to be developed and implemented.
House K-12 Education Budget Committee
(Rep. Kristey Williams, Chair)
On Wednesday, February 1, the Committee worked HB 2060, which would establish the Special Education and Related Services Funding Task Force. The bill would outline the topics to be studied by the Task Force, provide for the appointment and compensation of Task Force members, establish the frequency and location of meetings, and require a report to the Legislature. The bill was passed favorably out of Committee.