House Committee on Health and Human Services
(Rep. Will Carpenter, Chair)
On Monday, March 2, the Committee heard an informational presentation on maternal health care access from David Jordan, president and CEO of the United Methodist Health Ministry Fund, and Dr. Karen Weis, Dean of the School of Nursing and Director of the Rural Maternal Obstetrical Management Strategies (MOMS) program at the University of Kansas Medical Center in Salina. The presentation focused on findings from a report mapping maternal health care access across Kansas that examined the full continuum of care, including prenatal services, inpatient obstetrics and postpartum care, and assessed the availability of each component of the provider team required to deliver that care. Dr. Weis highlighted several key findings, including:
- Women today are twice as likely to die during pregnancy than they were 20 years ago, driven by increasing rates of hypertension, diabetes, obesity and advanced maternal age. Longer travel distances further worsen outcomes.
- In Kansas, 41 percent of counties lack direct access to prenatal care and 59 percent lack access to inpatient obstetrics, with 13 percent of ZIP codes located more than 30 miles from inpatient maternity care.
- In Kansas, 61 percent of counties have no obstetrician or gynecologist and the state has only 330 pediatricians, limiting the pipeline for subspecialists such as neonatologists and maternal-fetal medicine physicians.
Jordan outlined several policy opportunities the Committee could consider, including:
- Maximizing telehealth services and ensuring reimbursement covers all appropriate provider types and payers for maternity care
- Expanding collaborative regional health networks using hub-and-spoke models
- Addressing transportation barriers for prenatal and postpartum care
- Developing innovative Medicaid reimbursement models specific to obstetrics
- Adding new workforce roles such as community health workers, community paramedics and peer support specialists
Committee members asked questions regarding whether the access map improves when adjacent states are taken into account (Weis said northern Kansas hospitals near the Nebraska border do draw on Omaha for tertiary care, and western Kansas draws on Denver, but those distances are still very long and cross-state insurance coverage creates additional complexity); what midwife access looks like in Kansas (there are approximately 81 certified nurse midwives licensed through the Board of Nursing but lay and professional midwives were not mapped because they are not licensed in Kansas); whether outcome metrics such as infant and maternal mortality are tracked (Kansas ranks in the middle nationally on those measures and has used that data to secure grants from the Health Resources and Services Administration, but Jordan added that Kansas ranks last in the nation for maternal mortality among African American women, and that significant rural disparities also exist); whether the Kansas Department of Health and Environment (KDHE) tracks outcomes by county (Weis confirmed KDHE has a county-level dashboard and noted the MOMS program could map the data in an accessible format for the Committee); and how grant-funded programs can be made sustainable (Jordan said grant dollars should be used to test models and demonstrate efficacy and that sustainability requires both Medicaid and private-payer reimbursement for evidence-based services).
The Committee also held a hearing on Senate Bill (SB) 271, which, as amended by the Senate, would change the household gross income eligibility requirement for CHIP from 250.0 percent of the 2008 federal poverty level (FPL) to 250.0 percent of the current federal poverty income guidelines with coverage subject to appropriation of funds and eligibility requirements. The bill passed the Senate on Feb. 18 on a vote of 40-0.
Read testimony submitted by all conferees.
Proponents, including Christine Osterlund, Deputy Secretary of Agency Integration and Medicaid Director at KDHE, stated the bill would remove outdated statutory language to raise the CHIP income limit to 250.0 percent of the current year’s FPL and each successive year. There was no opponent or neutral testimony presented.
Committee members asked questions regarding whether the Senate floor amendment changing premiums from per child to per family was consistent with federal rules (Osterlund confirmed that both per-child and per-family premiums are permitted under federal law as long as the total premium does not exceed 5 percent of household income); current premium tiers ($0, $20, $30 and $50 per month based on income level); and whether families who cannot pay premiums have any recourse or income reassessment options (families are obligated to notify the state of income changes, which can trigger a reassessment. While disenrollment during the year is now prohibited, unpaid premiums accumulate and must be paid at renewal or the child cannot complete re-enrollment).
The Committee then worked the bill, amended it to clarify that verification of pregnant Kansas children by the Secretary would be as allowed by the Centers for Medicare and Medicaid Services (CMS), and passed it favorably out of committee.
On Wednesday, March 4, the Committee held a hearing on SB 327, which, as amended, would change the meeting time of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight to meet once in each quarter, while retaining the requirement for the meetings to be two consecutive days in the third and fourth quarters. The bill passed the Senate on a vote of 38-0 on Feb. 5. As there was no conferee testimony. The Committee worked the bill and passed it favorably out of committee.
The Committee also held a hearing on SB 430, which, as amended by the Senate, would permit licensed physical therapists to perform certain capillary blood tests. The bill passed the Senate on a vote of 40-0 on Feb. 18.
Read testimony submitted by all conferees.
Proponents stated that blood glucose and lactate testing via finger stick is a practical patient safety tool that gives physical therapists an additional data point to monitor exercise tolerance and adjust treatment in real time, particularly for patients with diabetes or cardiac conditions where standard markers such as heart rate are unreliable. Opponents, including Susan Gile, Executive Director of the Kansas State Board of Healing Arts (KSBHA), argued that there is no evidence-based information that this expansion of the scope of physical therapy practice is beneficial to the provision of physical therapy services and that no clinical protocols, education standards or decision-making guidelines currently exist for physical therapists performing these tests. No neutral testimony was presented.
Committee members asked questions regarding how a physical therapist would select which patients to test (American Physical Therapy Association representative said it would not be used for every patient, only those where it is clinically appropriate); how the testing would improve treatment planning (American Physical Therapy Association representative said it gives another data point to know whether to advance or modify a patient’s program and allows identification of which exercises generate the lactate response needed to trigger the hormonal benefits for muscle tissue growth); potential liability if a patient with an abnormal result refuses to follow the physical therapist’s advice (Gile said that if the physical therapist’s advice was sound, liability would generally fall on the patient); whether codifying the test as an available tool would create a standard of care obligation even though the bill uses “may” rather than “shall” (Gile said an adverse event combined with a failure to test could still form the basis of a disciplinary action); whether the KSBHA would look more favorably at the bill if it included recordkeeping and decision-making guidelines in statute (KSBHA representative said that would address some concerns and requirements could be placed either in statute or in board rules and regulations); and whether protocols similar to those governing pharmacist point-of-care testing could be developed by KSBHA to resolve the concerns (Physical Therapy Advisory Council representative said such protocols would need to come from statute rather than KSBHA rules alone).
The Committee subsequently worked the bill on March 5, amended it to require that a physical therapist obtain written consent from the patient or patient’s representative prior to performing point-of-care testing, and passed it favorably out of committee.
On Thursday, March 5, the Committee held a hearing on SB 328, which would permit pharmacists to distribute epinephrine delivery systems to schools for emergency medication kits and amend the definition of “medication” to expand the type of epinephrine that a pharmacist is allowed to distribute to a school, from epinephrine auto-injectors to epinephrine delivery systems. The bill passed the Senate on a vote of 40-0 on Feb. 10.
Read testimony submitted by all conferees.
Proponents stated the current statutory term locks schools into needle-based devices, that the FDA has already approved a needle-free nasal spray option with a sublingual form anticipated and that newer delivery systems are more temperature-stable for rural settings where medications may sit on buses during field trips or athletic events. No neutral or opponent testimony was submitted.
The Committee also held a hearing on SB 448, which would authorize the use of expedited partner therapy (EPT) to treat sexually transmitted diseases. The bill passed the Senate on a vote of 40-0 on Feb. 18.
Proponents, including Sen. Bill Clifford and Ashley Goss, KDHE, stated that Kansas and South Dakota are the only states that do not authorize EPT, that untreated partner reinfection is a primary driver of recurring sexually transmitted infection (STI) cases and that preventing and treating STIs in pregnant women reduces the risk of preterm birth, stillbirth and serious newborn complications. There was no opponent or neutral testimony presented.
Committee members asked questions regarding whether the singular use of “partner” in the bill limits treatment to one person (Revisor said that treating multiple partners would be within the provider’s judgment); whether the abstinence guidance in the written materials is enforceable (Revisor confirmed it is guidance only, not an enforceable requirement); and whether there are concerns about prescribing for a patient the provider has not examined (Rep. Bryce acknowledged he and others have done this in practice, and Goss confirmed the liability protection clause in the bill addresses situations where the provider acted in good faith with the information available).