Week 6 of the 2025 Session

During Week 6, despite bitter cold temperatures and more snow, committees met during the early part of the week to work bills and pass them to the full House and Senate before Turnaround Day on Thursday, Feb. 20. Bills sent to the floor dealt with the future operation of the South Central Mental Health Hospital, scope of practice for anesthetist assistants and registered nurse anesthetists, policies for placement or custody of children in foster care and the Water Program Task Force. This edition of Health at the Capitol looks at health-related policy issues addressed by the Legislature the week of Feb. 17.

On Tuesday, Feb. 18, the Senate, on a vote of 31‒9, and the House, on a vote of 85‒34, overrode Gov. Laura Kelly’s veto of Senate Bill (SB) 63, the Help Not Harm Act, which:

• Prohibits health care providers from providing certain treatments to a child who has a perceived gender or perceived sex that is different than the child’s biological sex.
• Prohibits recipients of state funds, including the Kansas Medicaid program and its managed care organizations, from using such funds to provide or subsidize the prohibited treatment.
• Prohibits recipients of state funds for the treatment of children for psychological conditions from prescribing, dispensing or administering medication as defined in the bill, performing surgery or providing a referral to another health care provider for the identified medication or surgery for a child whose perceived gender or perceived sex is inconsistent with the child’s sex.
• Except to the extent required by the First Amendment to the United States Constitution, prohibits state property, facilities or buildings from being used to promote or advocate the use of social transitioning, medication or surgery.
• Prohibits certain state employees, while in their official capacities, from providing or promoting medication or surgery as a treatment.
• Defines that a health care provider in violation of the Act would be engaged in unprofessional conduct and provide authority to sanction the licensee.
• Provides exceptions to the prohibited treatment.
• Establishes a treatment protocol for a provider to follow for a patient currently receiving the prohibited treatment.
• Establishes a strict liability standard, establishes a statute of limitations of 10 years from the child’s 18th birthday and creates a private cause of action.
• Prohibits a professional liability insurance policy issued to a health care provider from providing coverage for damages assessed against a health care provider who provided the prohibited treatment.

The bill will take effect upon publication in the Kansas Register.

On Wednesday, Feb. 19, under the new expedited budget process, the House passed House Bill (HB) 2007, its budget bill, on a vote of 83‒36. The bill appropriates $27 billion, including $10.8 billion State General Funds (SGF), for fiscal year (FY) 2025. For FY 2026, $25.5 billion, including $10.6 billion SGF, is appropriated. A motion to amend the budget bill to include Medicaid expansion failed on a vote of 34‒82.

Also on Feb. 19 , the Senate passed SB 161, which would require legislative approval prior to any state agency seeking or implementing a public assistance program waiver or other authorization from the federal government that expands eligibility for any public assistance program or increases cost to the state or making certain changes in services for persons with intellectual or developmental disabilities. A motion to amend the bill to include Medicaid expansion failed on a vote of 12‒28.

House Committee on Health and Human Services
(Rep. Will Carpenter, Chair)

On Monday, Feb. 17, the Committee held a hearing on House Bill (HB) 2365, which would establish the South Central Regional Mental Health Hospital in statute as a state hospital. The bill would create a fee fund managed by the Kansas Department for Aging and Disability Services (KDADS), which would oversee an extension of the hospital for criminal defendants needing competency evaluations or treatment. The hospital was approved for construction in fiscal year 2023, and site clearing began this month. Proponent testimony was provided by representatives of KDADS and the Kansas Mental Health Coalition (KMHC). Written-only proponent testimony was submitted by a representative of the Kansas Association of Chiefs of Police, Kansas Sheriff’s Association and Kansas Peace Officers Association. Proponents generally stated that the hospital would help alleviate overcrowding in existing state hospitals, reduce the number of individuals with mental illness held in county jails and ensure timely competency restoration services for criminal defendants. There was no opponent or neutral testimony submitted.

Committee members asked questions regarding how the hospital’s operations would be funded (KDADS stated that while construction funding is secured, an operational budget will be proposed for fiscal year 2027); whether the new hospital would reduce strain on existing facilities (KDADS stated that it would ease capacity issues at Osawatomie and Larned State Hospitals); how many psychiatric beds Kansas currently has (KMHC stated fewer than 200 are available statewide); and how the state plans to address staffing shortages (KDADS is working on recruitment strategies, including partnerships with local universities). The Committee then worked HB 2365 and amended the bill to update the catchment areas for Osawatomie State Hospital and Larned State Hospital, and passed it favorably out of Committee, as amended. The House passed the bill, 121‒2, on Feb. 20.

The Committee also held a hearing on HB 2316, which would establish the Disability Community Services Providers Civil Monetary Penalty Reinvestment Fund and the Adult Care Homes Civil Monetary Penalty Reinvestment Fund. Civil penalties collected for violations of correction orders by the State Fire Marshal would be deposited into these funds and the funds used exclusively for grants awarded to current licensees for projects that benefit the health, safety and welfare of individuals served by adult care homes or disability services providers. Proponent testimony was provided by representatives of KDADS and LeadingAge Kansas. Written-only proponent testimony was submitted by a representative of Midwest Health. Proponents stated that redirecting civil penalties into reinvestment funds would provide financial support to improve resident health, safety and facility operations. They also said the bill would not increase the number of citations issued but would ensure that penalties collected would be reinvested into the industry rather than absorbed into the State General Fund. There was no opponent or neutral testimony submitted.

Committee members asked questions regarding how much revenue the fines generate (KDADS provided data showing that civil penalties from 2021‒2024 ranged from $231,900 to $667,000 annually); whether for-profit entities with repeated violations could receive grants (KDADS stated that facilities with excessive infractions could lose their licenses, but theoretically, any licensed provider could apply for a grant); and who would determine which facilities receive funding (KDADS would review applications). The Committee took no action on the bill, but it was subsequently referred to Federal and State Affairs on Feb. 25.

The Committee then held a hearing on HB 2368, which would enact the Anesthesiologist Assistant Licensure Act, which would add the regulation and licensure of anesthesiologist assistants (AAs) under the Kansas State Board of Healing Arts (KSBHA). The bill would provide related definitions, create license types, specify requirements and restrictions for licenses and licensees, and set maximum fees for licensure. The bill also would include provisions related to violations of the Act. Proponent testimony was provided by representatives of the Kansas Medical Society (KMS), Kansas Academy of Anesthesiologist Assistants, Kansas Society of Anesthesiologists, Liberty Hospital, University of Missouri Kansas City, and Missouri Society of Anesthesiologists, as well as Sen. Chuck Hufstetler (Georgia State Senate) and nineteen private citizens, practicing anesthesiologists and certified anesthesiologist assistants (CAAs). Proponents stated that licensing AAs would enhance the anesthesia care team model and emphasized that AAs already practice in many other states, including Missouri and Oklahoma, and their integration into Kansas would increase capacity in urban surgical centers without increasing costs. They also said current law allows physicians to delegate medical tasks to unlicensed personnel, whereas licensure would provide regulation, oversight and accountability. Opponent testimony was provided by representatives of the Kansas Association of Nurse Anesthetists (KANA) and five private citizens, who stated that adding AAs to the workforce would take away training opportunities from certified registered nurse anesthetist (CRNA) students, who are already facing limited access to high-acuity cases in Kansas City hospitals due to competition for clinical training sites. They also warned that allowing AAs in Kansas could weaken the existing CRNA workforce by reducing training opportunities for nurse anesthetists, ultimately decreasing rural anesthesia coverage. Neutral testimony was provided by a representative of KSBHA.

Committee members asked questions regarding how many AAs an anesthesiologist could supervise at one time (proponents stated the bill limits supervision to a 4:1 ratio, which is standard in other states); whether there is a cost difference between CRNAs and AAs (proponents stated that under the anesthesia care team model, billing and salaries are the same); whether AAs are trained to practice independently (opponents said AAs require constant physician oversight); and how the bill would impact rural access to care (opponents argued it would not benefit rural areas because AAs can only work where anesthesiologists are present). On Tuesday, Feb. 18, the bill was withdrawn from the Committee and referred to the Committee on Federal and State Affairs, which keeps it eligible for consideration after Turnaround Day.

Senate Committee on Public Health and Welfare
(Sen. Beverly Gossage, Chair) 

On Monday, Feb. 17, the Committee worked SB 67, which would authorize independent practice authority and the prescribing of drugs by registered nurse anesthetists but prohibit them from performing an abortion or prescribing drugs for an abortion. The Committee created a substitute bill, which would amend law regarding registered nurse anesthetists to expand certain independent prescription authority to align the scope of practice more closely to an advanced practice registered nurse (APRN) and passed the substitute bill out of Committee. On Wednesday, Feb. 19, the substitute bill was passed by the Senate on a vote of 36‒4.

House Committee on Child Welfare and Foster Care
(Rep. Cyndi Howerton, Chair)

On Monday, Feb. 17, the Committee held a hearing on HB 2311, which would prohibit the Secretary for the Department for Children and Families (DCF) from adopting, implementing or enforcing certain policies with respect to who can be considered for selection as out-of-home or adoptive placement, custody or appointment as permanent or Support, Opportunity, Unity, Legal Relationships (SOUL) custodian for a child in need of care. Policies that would be prohibited include any that:

• Require a person to affirm, accept or support any governmental policy regarding sexual orientation or gender identity that may conflict with the person’s sincerely held religious or moral beliefs.
• Prohibit selection, appointment or licensure, if otherwise eligible, of a person because of such person’s sincerely held religious or moral beliefs regarding sexual orientation or gender identity or intent to guide or instruct a child consistent with such beliefs.

The bill also would specify that nothing could be construed to prohibit the Secretary from considering the religious or moral beliefs of a child or the child’s biological family or community, including beliefs regarding sexual orientation and gender identity, in relation to those persons who are being considered for out-of-home or adoptive placement, custody or appointment when determining what placement is in the best interests of the child. The bill also would allow a person aggrieved by a violation of the prohibited conduct in the bill to recover actual and punitive damages, injunctive relief, costs and reasonable attorney fees.

Proponent testimony was provided by representatives of Kansas Family Voice, Lifeline Children’s Services, First Amendment Partnership and three private citizens. Written-only proponent testimony was submitted by a representative of the Kansas Catholic Conference. Proponents stated that the bill protects religious freedom by ensuring that individuals and families are not excluded from fostering or adopting due to their beliefs. Opponent testimony was provided by representatives of Kansas Interfaith Action, Equality Kansas and Mainstream and six private citizens. Written-only opponent testimony was submitted by representatives of Unitarian Universalist Fellowship of Manhattan, Great Plains Conference, Loud Light Civic Action, Planned Parenthood Great Plains Votes, United Church of Christ, Psychedelic Veterans of Kansas, Kansas Appleseed Center for Law and Justice and 43 private citizens. Opponents generally stated the bill could impact LGBTQ+ youth in foster care by allowing placements in homes that may not affirm their identities and may be placing a caregiver’s beliefs over a child’s well-being.

Committee members asked questions regarding whether proponents had adopted children with beliefs different from their own and how they navigated those differences (proponents responded that while they had not personally adopted children with differing identities, they said they would parent all children with love and consistency, regardless of differences); whether the bill protects only religious and moral beliefs regarding sexual orientation and gender identity or applies more broadly (proponents clarified the bill is limited to these two areas); whether Kansas currently excludes foster or adoptive parents based on religious beliefs (proponents said Kansas does not currently impose such exclusions but the bill is intended to prevent future policies that could); whether the bill could lead to discrimination (proponents argued that the bill prevents discrimination against religious individuals and ensures that all qualified families can foster or adopt); how foster families would know if they were being discriminated against (proponents explained that in other states, disqualifications based on religious beliefs have been explicit, making it clear when discrimination occurs); whether opponents recognized that Section B of the bill allows the Secretary to consider a child’s beliefs and best interests when making placements (opponents responded that while Section B offers some protections, the primary concern is that the bill preemptively prevents stronger policies to safeguard children); whether it would be preferable for the Secretary to exclude families who do not affirm a child’s identity (opponents stated that while no family should be excluded outright, policies should protect children from a potentially harmful environment); whether excluding non-affirming families would reduce the number of available foster homes (opponents countered that the priority should be ensuring safe and supportive placements rather than simply increasing the number of available homes); and if there were known cases in Kansas where LGBTQ+ youth experienced issues in religious foster placements (opponents did not provide specific Kansas cases but highlighted broader concerns that non-affirming placements could replicate the rejection children might have faced from their biological families).

The Committee worked the bill following the hearing and passed it favorably out of Committee. On Wednesday, Feb. 19, the House amended the bill to exclude DCF contractors from liability under the bill and remove punitive damages as a possible form of relief and on Thursday, Feb. 20, passed the bill, as amended, on a vote of 86‒37.

House Committee on Corrections and Juvenile Justice
(Rep. Bob Lewis, Chair)

On Monday, Feb. 17, the Committee held a hearing on HB 2329, which would increase the number of juveniles eligible for out-of-home placements and reinstitute the “case management” level of supervision, in which a juvenile is placed in the custody of the Secretary of Corrections for out-of-home placement. The Secretary would be required to contract for at least 40 non-foster home beds to accommodate these placements. The bill also would require the Secretary to pay for all expenses associated with out-of-home placements, up to $10.0 million per year from the Evidence-Based Programs account of the SGF. Proponent testimony was provided by representatives of the Children’s Alliance of Kansas, KVC Kansas, St. Francis Ministries, the Sedgwick County Department of Corrections, district attorneys, law enforcement officials and foster care service providers. Proponents stated that the bill would address a gap in the juvenile justice system by ensuring that youth with criminogenic behaviors receive appropriate placements and services rather than being placed in foster care, which could impact the safety of other children in foster care. Opponent testimony was provided by representatives Kansas Appleseed, the Kansas Department of Corrections, the Council of State Governments, the Juvenile Justice Oversight Committee and juvenile justice reform advocates. Opponents argued that the bill reverses progress made under 2016 SB 367, which was designed to reduce youth incarceration and prioritize community-based rehabilitation. They also expressed concerns that reinstating group home placements could lead to unnecessary institutionalization, poor long-term outcomes and increased costs.

Committee members asked questions regarding whether the bill would change how 18-year-old offenders currently in the system are handled (proponents clarified that the bill would not alter existing procedures for those charged as adults); whether the legislation conflicts with other juvenile justice reforms (proponents stated that the bill complements past reforms by providing necessary placement options); whether there is a financial incentive for providers to support the bill (proponents stated that agencies already serve this population through existing contracts); whether the bill would improve placement stability (proponents argued that creating more appropriate placement options would reduce disruptions and safety concerns in foster care settings); whether the bill could result in low-risk youth being placed with high-risk offenders (opponents confirmed that without specific risk criteria, this could happen); why previous attempts to contract for residential placements failed  (opponents stated that providers were reluctant due to low demand and financial sustainability concerns); and whether the bill diverts funding from other evidence-based programs (opponents stated that the proposed $10 million could deplete funds meant for community-based alternatives). The bill was withdrawn from the committee on Feb. 18 and referred to the Committee on Federal and State Affairs, keeping it eligible for consideration after Turnaround Day. It was referred back to the Committee on Corrections and Juvenile Justice on Feb. 20.

House Committee on Insurance
(Rep. William Sutton, Chair)

On Monday, Feb. 17, the Committee worked HB 2335, which would add maternity center to the definition of health care provider for purposes of the Health Care Provider Insurance Availability Act and passed it favorably out of Committee. The House passed the bill, 123‒0, on Feb. 20.

House Committee on Agriculture and Natural Resources
(Rep. Ken Rahjes, Chair)

On Monday, Feb. 17, the Committee worked HB 2172, which would establish the 29-member Water Program Task Force to evaluate the state’s water program and its funding. A report with recommendations on the water program’s long-term structure and funding would need to be submitted to the Legislature and Governor on or before Jan. 31, 2026. The bill would specify the number and appointment process for members of the Task Force. The Task Force would be required to evaluate risks to the State’s water supply, steps for ensuring a multi-generational water promise and funding sufficiency. The Committee amended the membership section of the bill to:

• Decrease the voting members from 29 to 23.
• Replace Kansans for Conservation with the Kansas Association of Conservation Districts.
• Replace “state conservation district” with “local conservation district.”
• Clarify that the Task Force shall consist of at least one member from each of the five conservation regions of the state.

The bill passed favorably out of Committee, as amended. On Thursday, Feb. 20, the House made a technical amendment to the bill and passed it, as amended, on a vote of 109‒12.

Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight
(Sen. Beverly Gossage, Chair)

The Committee met on Friday, Feb. 21, and received follow-up responses from the October 2024 meeting. They heard presentations from Suzanne Lueker, KanCare Ombudsman and Executive Director, Office of the KanCare Ombudsman; Haely Ordoyne, Long-Term Care Ombudsman; and Steven Anderson, Medicaid Inspector General. They also heard updates from Christine Osterlund, Deputy Secretary of Agency Integration and State Medicaid Director, Kansas Department of Health and Environment; KDADS Secretary Laura Howard; and other KDADS staff. Presentations regarding networks and value-added benefits were given by representatives of the KanCare managed care organizations.

Haely Ordoyne, Long-Term Care Ombudsman

• In 2024, the program closed 625 cases, received 1,093 complaints and conducted 2,266 routine visits over the 298 nursing facilities and 504 residential care communities.
• Key issues include staffing shortages, care delays and violations of residents’ rights, often involving substitute decision-makers overriding residents’ preferences.
• Ongoing efforts will focus on safe staffing, guardian oversight and legislative measures such as HB 2359 (guardianship reforms), HB 2370 (memory care regulations) and SB 228 (supplemental staffing agency oversight).

Committee members asked questions regarding the number of staff to investigate complaints (12 staff members who cover the state); who the training for memory care in SB 88 is for (bill language states that the ombudsmen will be required to take the training); whether families can call when they have concerns about possible overuse of antipsychotics (the office does receive those calls and will take direction from the resident); and whether they report if they see signs of abuse as a non-mandated reporter (yes, if they have the resident’s or the substitute decision maker’s permission).

Steve Anderson, Medicaid Inspector General, Office of the Medicaid Inspector General (OMIG)

• In 2024, OMIG processed 1,454 complaints, with 1,318 related to beneficiary eligibility fraud, and identified $299.7 million in wasteful spending and $6.3 million in overpayments since 2021.
• Ongoing audits focus on prior authorization processes, Medicaid reimbursements for schools and improper billing practices.
• With Kansas Medicaid expenditures exceeding $5.5 billion annually, OMIG has requested additional funding to expand its oversight and investigation capacity.

Committee members asked questions regarding how much has been saved (Anderson said this year alone, $12 million has been saved in state general funds); what happens after OMIG makes a recommendation to an agency (OMIG can make recommendations, but agencies do not have to abide by them); and whether money can be recouped when referring to “potential savings” or if it gets written off (OMIG only can make recommendations to agencies and the Legislature).

Janet Williams, CEO, Minds Matter

Presentation on the Brain Injury Waiver program.

• Recent rate increases have reduced therapy waitlists from 800 to under 100 weekly hours and lowered staff turnover from 20 percent to 3 percent.
• A proposed 20 percent rate cut by Sunflower State Health Plan could hurt this progress, potentially impacting over 120 individuals.
• Currently, Kansas rates are lower than the national average and rates in Missouri.
• Williams encouraged the Committee to help establish competitive provider rates, prevent unilateral rate cuts and ensure Kansans with brain injuries have timely access to care. She also encouraged them to fund the Governor’s request of $719,000, which would fund 60 people on the waiver.

Committee members asked questions regarding how individuals end up connected to the organization (Minds Matter gets about 60 referrals a month); whether the request was in the budget that passed in the House (Williams said there was a slight rate increase included, but more is needed, and the Governor’s recommendation was not included); and how enrollment has grown since the waiver expanded (there are now more than 1,000 enrollees).

Christine Osterlund, Deputy Secretary for Agency Integration and State Medicaid Director

• KanCare 3.0 has currently not cost the state any additional dollars due to community care coordination being the only element that had net new fiscal impact, and it has not been implemented yet.
• Healthy Blue, the new MCO, successfully launched on Jan. 1 and processed over 82,000 medical claims ($27 million) and 133,000 pharmacy claims ($11.7 million) so far.
• The KDHE rate study is in Phase 1 of analyzing Medicaid reimbursement rates in comparison to Medicare and neighboring states (Missouri, Nebraska, Iowa and Colorado) and identifying areas for adjustment.
• The study has identified that MCOs are paying above the Medicaid fee schedule on some codes, which means that rate increases may impact providers differently.
• Some comparison states have alternative payment methodologies, such as nonemergency transportation, which requires additional research.
• The Transforming Maternal Health (TMaH) Model grant, which provides $17 million over a 10-year period, will be implemented in a test region of 30 counties in southwest/central Kansas and a comparison region of 21 counties in northwest/central Kansas. Each of the 30 counties in the test region are in Health Professional Shortage Areas (HPSAs) for at least one discipline (primary care, dental or mental health), with 20 counties having a shortage in all three disciples. It is hoped that outcomes and improvements will be seen by year four.

KDADS Updates

• KDADS will continue to advocate throughout the legislative session for growth for the Frail Elderly, Technology Assisted and Brain Injury Waivers. They also will advocate for Home and Community Based Services (HCBS) provider grants to address the conflict of interest in targeted case management and also for HCBS provider expansion.
• Construction began this month on the South Central Regional Mental Health Hospital and is expected to be completed by October 2026. Additional appropriations were made by the 2024 Legislature, so the hospital will have 104 beds instead of the originally planned 52.
• As of June 21, 2024, the Centers for Medicare and Medicaid Services (CMS) requires 24/7 registered nurse coverage in nursing facilities and a minimum of 3.48 hours of nursing care per resident per day, with phased implementation deadlines of 2026 for non-rural facilities and 2027 for rural facilities. KDADS is actively monitoring provider challenges in meeting the new requirements and is awaiting communications with CMS to resume.
• Certified Community Behavioral Health Clinic (CCBHC) expansion saw a 15.4 percent increase in patients served from 2023 to 2024. By the end of 2025, all 26 CCBHCs will be fully onboarded.

Committee members asked questions regarding what goes into rate setting (actuaries look at what services are being provided, rate increases, acuity of the membership, utilization of services, medical inflation, etc.); what the capitation rate is this year (varies by rate cell and will follow up with the Committee); when the rate for an individual is determined — before choosing an MCO or after an evaluation (the rates lag and they look to previous years, not real time, unless implementing a new payment model like for CCBHCs); if MCOs can request additional dollars for more high-needs patients (no, but it typically works out in the aggregate); if MCOs have incentive programs or marketing for enrollees to push them toward less expensive treatment options, like primary care instead of the emergency department (that is the idea behind care coordination efforts); when the last time a rate study was conducted (2017), and whether there is a shortage of physicians who can see Medicaid patients, which makes enrollees more likely to utilize the ER (this is part of it, but there are also transportation issues, employment issues, etc.); whether the TMaH Model grant will focus on all three shortage disciplines at one time (one of the major things for the grant is telehealth, which will impact disciplines simultaneously, but there is flexibility to be creative); if KDHE is seeing an uptick in enrollees using the online responses as the agency increases their use (when alerts go out via text or email, they are seeing more individuals go to the portal to complete items); when renewal notifications are sent out (MCOs usually begin communication about 60 days out); whether $6.2 million for home and community based services waivers is in the House budget (no); which facilities the CMS staffing rules apply to (any facility that holds a provider agreement with CMS); how behavioral health services for the zero to five age group may be addressed (there is a working group currently looking at innovative delivery service models for this age group); and if the Mental Health Intervention Team (MHIT) program and CCBHCs are connected (they are usually working together through the referral process).

KanCare Ombudsman (written only)

During the fourth quarter of 2024 the Office:

• Handled 360 initial contacts, with significant inquiries related to HCBS waivers, Medicaid eligibility, billing issues, pharmacy concerns and pregnancy-related questions.
• Experienced a 7 percent increase in urgent medical need cases and elevated nursing facility related inquiries.
• Maintained a one-day average response time and resolved issues within an average of five days.
• Established KanCare Ombudsman Ambassadors across the state to improve outreach and accessibility, particularly in underserved areas, in collaboration with community organizations and higher education institutions.