During Weeks 3 and 4 of the session, legislators were busy with informational and bill hearings on a variety of health-related topics, including addiction and mental health programs and facilities, veterans’ health benefits, annual reports prepared by interim committees that met during the summer and fall, the 988 Coordinating Council, a new program option for youth aging out of the foster care system, interstate compacts for social workers and dental professionals, controlled substances, certified community behavioral health centers, child welfare, homelessness, eligibility for public assistance programs, and pharmacy benefit manager practices. This edition of Health at the Capitol looks at health-related policy issues announced or discussed during the third and fourth weeks of the session, from Jan. 22 through Feb. 2.
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 Tuesday, Jan. 23, Senate President Ty Masterson and House Speaker Dan Hawkins formally signed the tax bill, House Bill (HB) 2284, and sent it to Gov. Laura Kelly. The Governor subsequently vetoed the bill on Friday, Jan. 26 and restated her call for a tax bill that would “meaningfully” cut taxes for middle-class families. GOP leadership have indicated they will attempt to override the veto.
On Wednesday, Jan. 24, Gov. Kelly introduced her tax cut package in both chambers — HB 2586 and Senate Bill (SB) 377. A week later, the Senate Assessment and Taxation Committee held a two-day hearing on SB 377, which would reduce retail sales, compensating use, individual income, property, and financial institutions privilege taxes, including reducing the state retail sales tax and compensating use tax rate for food and food ingredients to 0 percent on April 1, 2024.
On Friday, Jan. 26, the Kansas Department for Aging and Disability Services (KDADS) announced that a location in southwest Wichita has been selected as the site of the South Central Regional Psychiatric Hospital and Sedgwick County officials had authorized the county to begin negotiations on the property. In August 2023, Gov. Kelly signed an executive order establishing an advisory panel to guide the development of the proposed 50-bed hospital.
Also on Friday, Lt. Governor and Commerce Secretary David Toland announced that applications for another $10 million in grants to enhance broadband infrastructure in the state are being accepted. During the first three years of the program, $15 million in grants have been awarded to help bring high-speed internet to 8,000 homes. Applications will be open until March 11.
On Monday, Jan. 29, the Capitol hosted several events to celebrate Kansas Day. Kansas became the 34th U.S. state on Jan. 29, 1861.
On Thursday, Feb. 1, the Kansas Department of Revenue reported that the state’s total tax collections for January were $64.1 million below estimates and total tax collections were down 11.3 percent from January 2023.
House Health and Human Services Committee
(Rep. Brenda Landwehr, Chair)
On Monday, Jan. 22, the Committee heard a presentation from John Calvert, Kansas State Department of Education, regarding the Mental Health Intervention Team (MHIT) Program. Calvert reported that the program has grown and is now available in 90 school districts with 182 liaisons. During the 2023 fall semester, the program served 5,732 students, including 477 students in foster care. Committee members asked questions regarding how school social workers connect with services when their schools are or are not participating in the MHIT program, whether the MHIT program should continue as a standalone program or connect with certified community behavioral health centers to ensure financial sustainability, how liaisons deal with language barriers, the metrics or data used to evaluate the effectiveness of the program, how mental health providers are selected by the schools, how parents are involved and kept informed about the services being provided to their children, and the cost of just placing mental health providers in schools. Chair Landwehr noted that just placing providers in the schools would not provide the 24/7 crisis intervention services that the mental health providers that contract with the schools are required to provide. She also noted that those mental health providers are required to treat all children referred to the program, regardless of ability to pay.
On Tuesday, Jan. 23, the Committee held a hearing on HB 2484, which would add Kansas to a Social Work Licensure Compact that would provide interstate social work practice privileges and include multi-state licensing fees. The bill would permit Compact member-states the authority to create a new multi-state license that would allow individuals to practice in all other Compact member-states without obtaining a separate license in those states. Proponent testimony was provided by David Fye, Behavioral Sciences Regulatory Board (BSRB), representatives of the Council of State Governments, Fresenius Medical Care, Integrated Psychiatric Consultants, Kansas Chapter of the National Association of Social Workers and one private citizen. Written-only proponent testimony was submitted by AdventHealth Shawnee Mission, Pittsburg State University, Fort Hays State University, U.S Department of Defense, and five private citizens. Fye stated the Compact will likely mean the number of social workers directly licensed in Kansas will decrease significantly since they will only need to be licensed in their home state but will be able to provide services in Kansas through the multi-state license model. He also stated the BSRB will likely lose $153,640 in revenue every two years that it currently receives from the 1,794 out-of-state social workers that currently hold a Kansas license. The Compact will come into effect when it is enacted by seven states, but Missouri is currently the only state in the Compact. Legislation has been introduced in 22 other states and Fye expects that around 15 states will adopt the Compact by the end of the year. There was no opponent or neutral testimony. Committee members asked questions regarding the fees that may be charged for multi-state licenses, requirements for fingerprinting and background checks, the cost of continuing education hours, education costs, license reinstatement fees, and the need for multiple licenses across states.
On Thursday Jan. 25, the Committee held a hearing on 2023 HB 2453, which would enact the Dentist and Dental Hygienist Compact to facilitate the interstate practice of dentistry and dental hygiene and improve public access to services by providing dentists and dental hygienists licensed in a participating state the ability to practice in other participating states in which they are not licensed. Proponent testimony was provided by representatives of the Council of State Governments, Association of Dental Support Organizations, Kansas Dental Association and Oral Health Kansas. Written only testimony was submitted by the Kansas Dental Hygienists Association, the U.S. Department of Defense and a private citizen. The Compact will come into effect when it is enacted by seven states and three states (Iowa, Tennessee and Washington) have already enacted the Compact. Twelve states have introduced legislation this session, including Kansas, Colorado, Nebraska and Missouri. Chair Landwehr asked Lane Hemsley, Executive Director of the Kansas Dental Board, to explain the Board’s position on the bill. Hemsley stated the Board is neutral on the bill, but no formal testimony was submitted. Committee members asked Hemsley questions regarding background checks and fingerprinting requirements for applicants, whether joining the Compact would impact the effectiveness of identifying dentists accused of professional misconduct, and the current fees charged by the Board for new applicants and renewals. Hemsley stated that if the state joins the compact, the Board intends to retain its current fee structure for both in-state and multistate professionals. Committee members also asked questions regarding whether joining the Compact would increase the number of dental professionals in the 94 Kansas counties that are currently identified as underserved and the number of continuing education hours currently required for dental hygienists and the associated costs.
The Committee also held a hearing on HB 2596, which would add 35 new substances to the state Uniform Controlled Substances Act, including 23 fentanyl-related controlled substances, and remove other substances, including Fenfluramine (brand name Fitelpla), a medication approved by the U.S. Food and Drug Administration used to treat seizures. Proponent testimony was provided by Alexandra Blasi, Kansas Board of Pharmacy, who stated that the Board works with the Kansas Bureau of Investigation (KBI) to review changes made to the federal Controlled Substances Act and the bill would make changes needed to reflect the federal updates. Written-only proponent testimony was submitted by the KBI and neutral testimony regarding the inclusion of cannabis and marijuana-related drugs as controlled substances was submitted by a private citizen. The bill was then passed favorably out of Committee.
On Tuesday, Jan. 30, 2024, the Committee held a hearing on HB 2547, which would allow certain school personnel to administer albuterol or epinephrine to students who are displaying respiratory distress anaphylaxis. The bill also would allow pharmacists to distribute a stock supply of these medicines to a school upon a prescription from a physician or mid-level practitioner and also would provide a level immunity from liability for a pharmacist, physician or a mid-level practitioner who would prescribe the medicines for the school, as well as the school personnel who would administer the drugs under specific circumstances. Proponent testimony was provided by Alexandra Blasi, Kansas Board of Pharmacy, and a representative of the Kansas School Nurses Organization. Written-only proponent testimony was submitted by representatives of the Kansas Association of School Boards, Kansas State Board of Nursing, Kansas Chapter American Academy of Pediatrics, Kansas Action for Children and four private citizens. There was no neutral or opponent testimony. Committee members asked questions regarding secure storage of the medications in schools, whether schools are required to administer the medications (no), whether individual children would need a personal prescription (no), the risks of administering the medications (minimal risk), and timing for parental notification required under the bill.
The Committee then held a hearing on HB 2578, which would amend law regarding certification of Certified Community Behavioral Health Centers (CCBHCs) and allow only Community Mental Health Centers (CMHCs) licensed by KDADS that provide certain services to be certified as CCBHCs. Current law requires KDADS to certify any licensed CMHC that provides certain services. The bill also would require KDADS to adopt rules and regulations to implement and administer the certification process and specify that programs and treatments provided by a CCBHC may be granted a certification renewal if such programs and treatments have been:
- Previously certified by the Secretary of KDADS; and
- Accredited by the Commission on Accreditation of Rehabilitation Facilities, the Joint Commission, or another national accrediting body approved by the Secretary.
Proponent testimony was provided by representatives of the Association of Community Mental Health Centers of Kansas, COMCARE, Four County Mental Health Center, The Guidance Center, and Johnson County Mental Health Center, who highlighted the positive impact of CCBHCs on workforce expansion, improved crisis response, and enhanced mental health services, and also expressed support for the unique characteristics of the CCBHC model of care and streamlining of the recertification process. Neutral testimony was provided by Andy Brown, Deputy Secretary of KDADS. Opponent testimony was provided by representatives of the Behavioral Health Association of Kansas, Community Care Network of Kansas, Community Health Center of Southeast Kansas, and CFK Addiction Treatment, who expressed concerns with limiting new CCBHC certifications only to CMHCs and expressed a desire to increase patient access to the model. Written-only opponent testimony was provided by DCCCA, Greeley County Health Services, Health Ministries Clinic Community Health Center, Heartland Community Health Center, Kansas Association of School Boards, and KVC Kansas. Committee members asked questions regarding whether the state’s CMHCs are able to meet the needs of Kansans, the availability of behavioral health workers and the location of federally qualified health centers in the state. The Committee subsequently worked the bill on Jan. 31 and expressed concerns about limiting access to behavioral health services and border states moving CCBHCs into Kansas, but then passed the bill favorably out of committee.
On Wednesday, Jan. 31, the Committee held a hearing on HB 2579, which would amend current law to add the distribution of non-prescription over the counter (OTC) medications to the list of interventions that emergency medical service (EMS) providers may provide, as approved by the EMS medical director. However, the bill would not authorize the medical director to approve OTC medications that contain any compound, mixture, or preparation that has a detectable quantity of ephedrine or pseudoephedrine and is exempt from being reported to the statewide electronic logging system for the sale of methamphetamine precursors. Proponent testimony was provided by an EMS medical director and representatives of the Johnson County Department of Emergency Services, the Kansas EMS Association, and the Mid-American Regional Council, who stated the bill would provide clarification to EMS providers regarding the distribution of OTC medication and allow the EMS medical director to determine which OTC medications would be available. Written-only proponent testimony was submitted by representatives of the Kansas Association of Local Health Departments, Kansas Medical Society, Kansas Public Health Association (KPHA), and Kansas Region III EMS Council. Opponent testimony was provided by a representative of the Emergency Medical Services Board, who stated the proposed bill language is unnecessary, that implementation of the bill would create obstacles to providing care, and the Board could issue a guidance document to address the issue. Written-only neutral testimony was submitted by the State Board of Pharmacy. The Committee asked questions regarding training needed to administer the OTC medications, whether the bill will allow EMS providers to “leave behind” OTC medications, including naloxone (yes), and why there is confusion regarding whether administration of OTC medications is or is not allowed under current law. The Committee then amended the bill to remove the language “when authorized by a physician” and passed the bill, as amended, favorably out of committee. However, on Feb. 1, the Committee reconsidered the bill, removed the previously approved amendment, and passed the bill favorably out of committee as originally introduced.
Senate Public Health and Welfare Committee
(Sen. Beverly Gossage, Chair)
On Thursday, Jan. 25, the Committee voted to approve the Kansas Commission on Veterans Affairs budget for FY 2024 and 2025 and passed it favorably out of committee. The Committee then heard presentations regarding the youth suicide prevention program and the 988 Suicide & Crisis Lifeline. Sara Hortenstine, Division Chief of Youth Services in the Office of the Attorney General and Director of the Kansas Child Death Review Board, provided a brief history of youth suicide prevention efforts in the state and reported that suicides in children under 18 peaked in 2018 with 35 deaths and declined in 2019, 2020 and 2021 (28, 25 and 29 respectively). Committee members asked questions regarding the efforts to identify and assist students who are already receiving mental health services, whether “guardrails” or recommendations for parents related to social media are being considered, and the position description for the youth suicide prevention coordinator that is currently unfilled.
The Committee then heard a presentation from Andy Brown, Deputy Secretary, KDADS, and chair of the 988 Coordinating Council, regarding the Council’s Annual Report for the 2024 Legislature and the Secretary’s Annual Report on 988. Brown noted the state’s success in meeting goals for the Lifeline’s in-state answer rates and average speed of response but also noted that the in-state response rates for chat and text services were not as positive. The in-state chat answer rate for texts was 80 percent by June 30, 2023, but the November 2023 answer rate was 43 percent. He stated that additional staffing is planned to increase the in-state answer rate for chat and text. He noted that a new call center in Wyandotte County is scheduled to go live in mid-February. He also noted that total calls to the Lifeline between November 2022 and November 2023 were 24,511 and total in-state answered calls during that period were 22,194 and stated that the services provided in response to calls include emergency rescue, referrals for mobile crisis response, and referrals for mental health or related services.
On Tuesday, Jan. 30, the Committee heard an update on the foster care system from Kansas Department for Children and Families (DCF) Secretary Laura Howard, including the number of children currently in foster care (5,895, 22 percent decrease since 2019), number of children entering care (2,890 in FY 2023, 28 percent decrease since 2019), the rate of entry of children entering foster care (4.36 per 1,000 child population, national rate is 2.37 per 1,000 child population), primary reason for children being removed from home (abuse and neglect), number of adoptions finalized in FY 2023 (880, primarily with relative or foster family), prevention services, status of foster care contracts (bidders were four current contractors – KVC Kansas, St. Francis Ministries, TFI Family Services and Cornerstones of Care – and new bidder EmberHope, expect to award new contracts in April 2024, new contracts to begin on July 1), and the Child Welfare Summit scheduled for April 15-16. Sec. Howard also noted legislative priorities for this year include permitting DCF to release information to the public related to child fatalities caused by abuse or neglect when criminal charges have been filed. She said this would allow more transparency with the public in the case of a child’s death and the agency’s involvement prior to the death. Committee members asked questions regarding the factors considered in the contractor request for proposals (RFP) review process, the average length of time for adoption, the number of children who have died in foster care in the last year, changes in communications and process following the October 2023 death of a five-year-old girl in Topeka, and the number of youth who become homeless after aging out of foster care.
House Child Welfare and Foster Care Committee
(Rep. Susan Concannon, Chair)
On Monday, Jan. 22, KLRD staff presented the Report of the Joint Committee on Child Welfare System Oversight to the 2024 Legislature to the Committee, and Secretary Laura Howard, DCF, provided an update regarding the foster care system, similar to her presentation to the Senate Public Health and Welfare Committee. Committee members asked questions regarding strategies that could be used to shorten the length of time in custody (corrective actions plans are being developed) and why the state has such a high rate of intake, particularly for neglect, as compared to other states. Sec. Howard referred to variations in the interpretation of “family in need of assessment” across states, which affects the entry into custody. She also pointed to delays arising from case management, inability to identify adoptive resources, and complex legal proceedings, which contribute to the timeline for adoption and stated that efforts and initiatives like adoption accelerators have been implemented and other strategies are being developed to address prolonged stays in care. Chair Concannon asked about practices for placing a child (e.g., runaways) in secure centers for safety, and Sec. Howard referred to the state’s Secure Care Statute, but noted Kansas only has one Secure Care Center, which is in Geary County.
On Wednesday, Jan. 24, the Committee heard a presentation from Kerrie Lonard, Kansas Child Advocate, who presented a summary of the Division of the Child Advocate’s 2023 Annual Report. Lonard stated the office received 214 complaints in 2023, involving 335 children, and that complaints primarily involved concerns regarding DCF and the foster care case management providers, but also included concerns regarding judicial court partners (i.e., judges, attorneys, and court clerk practices), law enforcement, the Kansas Department of Health and Environment (KDHE), KDADS, KanCare MCOs, and community mental health centers. Committee members asked questions regarding changes made by DCF in response to the survey cited in the Best Interest Staffing (BIS) Report. BIS is the process for selecting the adoptive resource for a child. Lonard stated that some recommendations were reviewed and led to changes in DCF’s policies and procedures effective January 1, including clarification of the definition of consensus (defined as the absence of objection from any member of the BIS Team) and clarification regarding the parties who are required or may be invited to participate in the BIS, what roles they play, and what information they receive. Lonard was also asked about the appeal process after termination of parental rights or relinquishment. She noted that the Kansas statutes provide a right to appeal for some decisions made before termination or relinquishment but that after these decisions are made parties must file an appeal with the Kansas Court of Appeals or the Kansas Supreme Court.
The Committee then held a hearing on HB 2536, which would establish Support, Opportunity, Unity, Legal (SOUL) family legal permanency as an option for children in need of care who are 16 years of age or older, allow courts to establish SOUL family legal permanency, and define SOUL family legal permanency. The goal of the SOUL option is to build permanent, long-term relationships with adults who can provide support for these children as they transition to adulthood. Proponents providing testimony included representatives of Children’s Alliance of Kansas, Cultural Creations/Alexandia Ware Speaks, the SOUL Team, FosterAdoptConnect, Kansas Action for Children, KVC of Kansas, Deputy Secretary Tanya Keys, DCF, Center for the Rights of Abused Children, Kansas Appleseed and two private citizens. The representative for the Center for the Rights of Abused Children reported that in 2023, 455 Kansas children exited foster care without a family. He also noted that national statistics for teens who age out of the system show that 29 percent report being homeless from ages 19 to 21, one in five between the ages of 19 and 21 are incarcerated, and 43 percent are unemployed by age 21. Written-only proponent testimony was submitted by representatives of Cornerstones of Care, Ministry of Kansas Family Advisory Network, Custody to Transition Citizen Review Panel, and a private citizen, and written-only neutral testimony was provided by St. Francis Ministries. There were no opponents.
On Monday, Jan. 29, Sara Hortenstine, Executive Director, Kansas Child Death Review Board, and Jane Wieler, Assistant Attorney General, provided the Committee with an overview of the 2023 Child Death Review Board Annual Report, based on 2021 data. The Report showed that in 2021:
- There were 349 child fatalities.
- The rate of homicide deaths was stable from 2017 through 2021, but showed a significant increase in 2021, when there were 32 child homicides, as compared to 22 homicides in 2020.
- Drug-related deaths significantly increased, with 20 times more deaths from fentanyl in 2020 and 2021 than in the three prior years.
- 29 children between the ages of 10 and 17 died by suicide.
- Of the 1,074 child fatalities reviewed by the Board between 2019 and 2021, 392 children (36 percent) had a history with DCF’s Division of Child Protective Services.
The Report included several recommendations related to preventing youth suicides, including urging law enforcement to enhance suicide investigations by considering social, mental health, and medical histories, as well as family stressors, trauma history, previous suicide attempts, mental health service involvement, and relevant social media information. The Board also proposed standardized training for law enforcement and coroner investigators to improve data collection and understanding of factors leading to youth suicides, which was a priority recommendation of the 2023 Special Committee on Mental Health during the interim session.
Committee members asked about the lag in data for the Report, and Hortenstine explained that the nature of investigations, particularly those involving homicides and suicides, require autopsies that can take six months or more for completion. Committee members also expressed concerns regarding the number of deaths of children with a history of involvement with DCF and referred to Texas’ policy of removing children from their families only during crisis situations. Hortenstine noted that involvement with DCF does not necessarily lead to removal and may include the provision of support services.
On Wednesday, Jan. 31, the Committee held a hearing on HB 2580, which would amend the revised Kansas Code for Care of Children by permitting a court to consent to mental, emotional or behavioral health screenings and treatment, including the release and inspection of mental, emotional or behavioral health records for children under the jurisdiction of the court, other than inpatient treatment at a state psychiatric hospital, including the release and inspection of medical or hospital records. A child or parent who is opposed to a mental health screening and/or treatment could request a hearing. The bill also would grant immunity to any health care providers who provide such screenings and treatment and would define “behavioral health crisis” and “behavioral health treatment.” Proponent testimony was provided by Tanya Keys, Deputy Director, DCF and a representative of Children’s Alliance of Kansas, who stated that the bill was addressing the need for DCF to have the authority to access mental, emotional and behavioral health screenings and treatment prior to adjudication in a Child in Need of Care (CINC) case. Written-only proponent testimony was submitted by a representative of Cornerstones of Care. Committee members asked several questions regarding notification to a child’s parents regarding the requested services, the requirement for parents to sign consent forms, and the timing of court hearings if a parent objects.
The Committee also held a hearing on HB 2581, which would eliminate the requirement that court-ordered child support be paid when a child is in DCF custody. The bill also would remove the requirement that child support payment requests be made in a CINC petition. Proponent testimony was provided by Tanya Keys, DCF, and a representative of Children’s Alliance of Care. Keys explained that the proposed changes would amend current law to align with recent federal guidance urging states to limit criteria for referring foster care cases to Child Support Services and referred to guidance from the U.S. Department of Health and Human Services suggesting that states avoid assessing child support for most foster care children, except in very rare instances to avoid adverse effects on the child’s welfare or permanency plan. Elimination of the requirement for child support assessments may expedite family reunification by reducing financial hardships on struggling families and providing courts with more flexibility to meet the family’s needs. Written only proponent testimony was submitted by representatives of Kansas Action for Children and Cornerstones of Care. Committee members asked several questions regarding the need for child support payments and the fiscal impact on DCF revenues from the reduction in foster care collections of support payments. The fiscal note indicates a 50 percent decrease in FY 2025 and complete elimination by FY 2026, leading to a corresponding decline in Child Support revenues of $1 million and $2 million, respectively.
House Welfare Reform Committee
(Rep. Francis Awerkamp, Chair)
On Tuesday, Jan. 23, the Committee held a joint meeting with the House Commerce, Labor, and Economic Development Committee to hear a presentation from a representative of the Foundation for Government Accountability, a think tank organization based in Naples, Florida, regarding reducing welfare fraud. The focus of the presentation was the growth in SNAP and Medicaid enrollment and spending in Kansas and a recommendation that Kansas increase its efforts to reduce fraud by increasing its review and verification of information provided by individuals applying for SNAP and Medicaid.
On Thursday, Jan. 25, the Committee heard presentations from KDHE officials, the Medicaid Inspector General, and DCF officials related to eligibility criteria and processes, eligibility verification, and investigation of eligibility fraud. Christine Osterlund, Medicaid Director, KDHE, described the eligibility criteria, document requirements, verification timeline, and quality control measures used by the state for eligibility determinations and renewals, and reported on the various eligibility criteria and the electronic verification process through a number of databases. According to a 2022 federal audit, Kansas had an error rate of 6.82 percent in eligibility decisions, and Osterlund noted that the national error rate is about 10 percent. Committee members asked questions regarding the definition of caretaker adults and their associated financial requirements for eligibility (household income of 38 percent FPL, or $11,856 for a family of four), the timeline for becoming ineligible when Medicaid beneficiaries find employment (income from last 30 days is considered and applicants are required to submit pay stubs), and availability of electronic data. Osterlund noted that eligibility involves more than just income, and also includes household composition, residency, and citizenship. (For more information regarding Medicaid eligible populations, see Kansas Medicaid: A Primer 2024.)
Marc Altenbernt, General Counsel, DCF, described the application and verification processes for programs such as Temporary Assistance for Needy Families (TANF), food assistance (SNAP), child care subsidies, and employment and energy assistance. He stated that the verification procedures vary across programs and involve multiple interfaces and state agency information. He also referred to DCF’s Fraud Investigations Unit, which is tasked with detecting, investigating, preventing and prosecuting welfare recipient fraud across all public assistance programs administered by DCF. Committee members sought clarification regarding the rollover of uncollected funds, the use of Amazon Connect for telework, the effectiveness of fraud investigations, and the tracking of Electronic Benefit Transfer (EBT) transactions.
Steve Anderson, Medicaid Inspector General, briefed the Committee on the number of filed complaints, open and closed case investigations, results from recent audits, and types of Medicaid fraud seen since adding investigative staff in July 2023. Since that time, 186 cases have been opened and 67 closed. Cases involve several types of fraud, such as medical ID theft, a false pregnancy claim to receive benefits, and false reporting of household composition and income. The Office of the Medicaid Inspector General (OMIG) released several audit reports in 2021 through 2023, which identified $211.2 million in wasteful spending, $6.3 million in overpayments, and $12.2 million in potential savings. Anderson also reported that during 2023, the OMIG processed 1,447 complaints, primarily related to beneficiary eligibility fraud.
On Tuesday, Jan. 30, the Committee screened a 45-minute documentary, “Viewing Beyond Homeless,” produced by the Independent Institute, about homelessness, including in California, and a study of the Haven for Hope model in San Antonio, Texas. The Committee previously heard testimony from a representative of Haven for Hope on Jan. 18. Chair Awerkamp led the Committee in a discussion of the nationwide scope of homelessness and stated that the Committee will continue to hear from individuals who have worked on homelessness solutions at a national level, emphasizing the importance of understanding efforts from various cities, counties and states. The Committee also discussed plans for the $40 million in one-time funds for emergency housing infrastructure included in the Governor’s proposed budget to address a crisis with the state’s unhoused population. Committee members inquired about the annual budget for Haven of Hope and were told it is approximately $30 million annually, with half coming from public funds and half from private sources.
On Thursday, Feb. 1, Kansas Legislative Research Department (KLRD) staff responded to the Committee’s request for additional information about the eligibility and verification process for free and reduced-price lunch for school children. The National School Lunch Program is federally assisted and primarily funded through U. S. Department of Agriculture reimbursements to sponsors, including schools and nonprofit organizations. Students qualify by application or by being categorically eligible by currently participating in public assistance programs through DCF. In 2023, 28,000 Kansas students qualified for reduced lunch, and 195,000 qualified for free lunch, with 82 percent being categorically eligible. Committee members asked questions regarding the verification process, income-based eligibility, and income documentation during the initial approval process. Kelly Chaney, Director of Child Nutrition Wellness, Kansas State Department of Education (KSDE) stated that households are not required to provide income documentation at the time of application and approval, but documentation could become required if a household is selected for verification at a future date. Committee members were also told about “community eligibility,” which allows eligible schools to provide free meal benefits to all students based on specific criteria and members expressed concerns about the potential misuse of the program by families with higher incomes. Chaney explained that the goal of encouraging all children to participate, regardless of household income, was based on some evidence suggesting improved test performance and reduced absenteeism.
House Social Services Budget Committee
(Rep. Les Mason, Chair)
On Tuesday, Jan. 23, the Committee held an informational hearing on Valley Hope Foundation, which has addiction treatment and recovery facilities in Atchison, Moundridge, Norton, Overland Park and Wichita. Representatives of Valley Hope provided an overview of their services and expansion plans for the Atchison facility and noted they have raised $2 million of the $6.8 million needed from the private sector to complete the project and are seeking $2.5 million in funding from the state. In November 2023, Gov. Kelly toured the Atchison facility and indicated a willingness to work with the Legislature to support Valley Hope’s expansion campaign. The Atchison facility does not accept Medicaid patients, but they are accepted at the Norton and Moundridge locations. Valley Hope is agreeable to providing three beds for three years for Medicaid patients at the Atchison facility if they receive the requested $2.5 million.
On Wednesday, Jan. 24, the Committee held an informational hearing on the Clubhouse Model programs, which are a working community that supports people living with serious mental illness to participate in their own recovery by working and socializing together in a safe space. Representatives of the Clubhouse program stated there are five clubhouses in Kansas that served 700 individuals during 2023. The state began providing funding for the Clubhouse programs in 2019 after passage of Substitute for HB 2194 by the 2018 Kansas Legislature that authorized money in the Lottery Operating Fund to be used for transfers to the Clubhouse Model Program and Community Crisis Stabilization Centers funds of KDADS that is currently capped at $8 million per year. The Clubhouses are requesting an increase in the cap to $12 million per year with $3 million of the additional funds going to the community mental health centers and $1 million to the Clubhouse model. Committee members asked questions regarding the structure of a typical day of activity for Clubhouse members, the managerial oversight of each Clubhouse location, how a client’s recovery progress is measured, how individuals can find information or are referred to the Clubhouse, and how the Clubhouse treatment differs from more traditional types of treatment.
On Thursday, Jan. 25, the Committee held an informational hearing on the Youth Core Community program, which works with individuals and families experiencing poverty and helps them to find solutions to get out of poverty. A representative of the program stated there are 12 active core communities in Kansas and explained that the process includes a 20-week course and connecting with middle class community members. Families can be involved with the program for 2 to 5 years and markers of success include obtaining a driver’s license and personal vehicle, obtaining a GED or furthering education, acquiring safe housing, opening a bank account, getting employment or promotion, and recovering custody of children. Youth Core is asking for $350,000 in funding to take the program statewide. Committee members asked questions regarding the strategies used to help their clients, how the $350,000 in funding will be used ($150,000 for marketing, $100,000 for fundraising and $100,000 for current operations), and how much is spent for each participant ($2,300 per person, including children).
On Tuesday, Jan. 30, the Committee heard a presentation from KLRD staff regarding the proposed budget for Larned State Hospital (LHS) and Osawatomie State Hospital for FYs 2024 and 2025. On Wednesday, Jan. 31, the Committee passed the proposed budget favorably out of committee, with the addition of $326,454, all from the State General Fund (SGF), for primary care medical staff at LSH.
House Appropriations Committee
(Rep. Troy Waymaster, Chair)
On Tuesday, January 30, the Committee held a hearing on SB 307, which would amend the Kansas Fights Addiction Act to add for-profit private entities to the definition of “qualified applicant” for grants awarded by the Kansas Fights Addiction Act Grant Review Board. The law currently states that eligible applicants are not-for-profit entities, state entities or municipalities. Proponent testimony was provided by a representative of Acadia Healthcare, which provides behavioral health services across the country and operates a medication-assisted treatment center in Wichita and recently began treatment for Kansans in rural areas with a mobile treatment program. Written-only opponent testimony was submitted by a private citizen who stated his opposition to the Kansas Fights Addiction Act and argued that the opioid settlement funds should only be used for opioid use disorder abatement. There was no neutral testimony.
Senate Ways and Means Committee
(Sen. Rick Billinger, Chair)
On Tuesday, Jan. 24, the Committee heard presentations from Brigadier General William Turner, Kansas Commission on Veterans Affairs, regarding critical care nursing staff; Scott Brunner, Deputy Secretary of Hospitals and Facilities, KDADS, regarding nursing staffing levels at the four state hospitals; and Yvonne Case, Director of Medicaid Operations, KDHE, regarding Medicaid unwinding. Gen. Turner reported on the number of licensed beds and staffing at the Kansas Veterans Home (KVH) and Kansas Soldiers Home (KSH) and stated that expenditures for temporary agency contract nursing staff for FY 2024, through December, was $510,000 for KSH and $677,000 for KVH. He also said that spending projected through the end of FY 2024 is $2.5 million total for both facilities but noted that this spending is trending down as compared to spending during FY 2021 and 2022. Brunner reported there are 1,400 direct care employees at the hospitals and noted the vacancy rates for each facility (Osawatomie – 38 percent, Larned – 44 percent, KNI – more than 25 percent, Parsons – 22 percent). He also said that the registered nurse vacancy rate for Larned is 67.9 percent and 57.4 percent for mental health developmental disability technicians.
Case provided an update on the Medicaid unwinding process and stated that as of Dec. 31, 2023:
- 467,818 individuals were sent a renewal notice.
- 214,835 individuals were approved.
- 53,444 individuals were discontinued (determined no longer eligible).
- 22,480 individuals were in the reinstatement window (did not submit a review timely but have 90 days to submit a review and have eligibility backdated).
House Committee on Insurance
(Rep. William Sutton, Chair)
On Wednesday, Jan. 31, the Committee heard presentations from representatives of the Kansas Pharmacists Association (KPA) regarding the increasing number of pharmacy closures in Kansas, and concerns regarding the impact of pharmacy benefit manager (PBM) business practices on locally owned pharmacies. A pharmacy owner in northeast Kansas testified that PBMs mandate detailed claim information sharing, which enables them to set pricing and co-pay structures, and direct patients to mail-order services or affiliated pharmacies, resulting in higher copayments for individuals choosing to do business with independent pharmacies. Another conferee described the practice of “white-bagging,” which requires patients to obtain medications from a PBM-chosen pharmacy and noted that this practice provides cost savings for PBMs. No PBM representatives were present.
The Committee also held a hearing on HB 2478, which would add “maternity center” to the definition of “healthcare provider” in statutes regarding professional liability insurance requirements for health care providers. The bill would allow maternity centers that are not organized as professional corporations to have access to coverage through the Heath Care Stabilization Fund, provided they meet certain requirements provided for in the Heath Care Provider Insurance Availability Act.
House Corrections and Juvenile Justice Committee
(Rep. Stephen Owens, Chair)
On Tuesday, Jan. 30, the Committee worked HB 2487, which would provide immunity from prosecution for possession of a controlled substance or drug paraphernalia if the person seeks or provides medical assistance to a person under the influence of a controlled substance or who is under the influence of a controlled substance and is in need of medical assistance. The bill also would provide civil immunity for law enforcement agencies and officers who comply or fail to comply with the provisions of the bill and would extend civil liability immunity to officers who arrest persons later determined to be immune from prosecution, unless such officer’s conduct was reckless or constituted intentional misconduct. Proponent testimony was provided by Rep. Nick Hoheisel, Rep. Jason Probst and Rep. Pat Proctor, as well as representatives of DCCCA, the Behavioral Health Association of Kansas, the Kansas Association of Chiefs of Police, Kansas Peace Officers Association, Kansas Sheriffs Association, Safe Streets Wichita Coalition, and eight private citizens, who stated that passage of the bill could save lives by encouraging persons experiencing an overdose to seek medical assistance. Written-only proponent testimony was submitted by the Board of Indigent Defense Services, Cross-Lines Community Outreach, Johnson County Mental Health Center, the KBI, KDADS, KDHE, KPHA, Lawrence-Douglas County Public Health, United Community Services of Johnson County, Wyandotte County Public Health Department, and three private citizens. Neutral testimony was provided by a representative of First Call Alcohol/Drug Prevention & Recovery, who stated their hope that the bill would result in persons seeking medical assistance without fear of reprisal. Opponent testimony was provided by a private citizen who expressed concerns regarding law enforcement discretion under the bill, the number of people who may receive immunity, and the quantity of controlled substances present. The Committee amended the bill to remove language limiting the number of people who would be eligible for immunity; specify that a person would be required to provide information necessary for medical assistance in addition to their full name; and specify that a person acting in accordance with the bill would not be taken into custody or have a warrant for arrest issued against them for a violation of certain release conditions, and then passed it favorably out of committee.
House Judiciary Committee
(Rep. Susan Humphries, Chair)
On Wednesday, Jan. 31, the Committee held a hearing on HB 2488, which would expand the definition of assisting suicide to include intentionally advising or encouraging another person to commit or attempt suicide. Current law defines assisting suicide as a physical act in which the offender causes by force, provides the means for, or participates in a victim’s suicide attempt. Under the bill, advising or encouraging suicide would be a severity level 7 person felony if it causes the victim to commit or attempt suicide. If the offender’s encouragement does not cause the victim to commit or attempt suicide, the offense would be a class A person misdemeanor. Proponents included six private citizens. Written-only proponent testimony was submitted by representatives of the Kansas Association of Chiefs of Police, Kansas Sheriffs Association, Kansas Peace Officers and the Kansas Catholic Conference, as well as 103 private citizens. Written-only opponent testimony was submitted by a representative of the Kansas State Board of Indigent Defense Services. There was no neutral testimony.
Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight
(Rep. Brenda Landwehr, Chair)
On Friday, Feb. 2, the Committee held its quarterly meeting hearing from state agencies, managed care organizations, advocacy groups, and other stakeholders who interact with KanCare. The Committee received updates regarding the Mental Health Intervention Team (MHIT) program and its impact on academics, attendance and behavioral indicators; updates regarding Medicaid expenditures and the waitlists for certain waivers; audits, MCO contract procurement; the transition from a Section 1115 demonstration to a 1915(b) waiver; vaccine requirements; Medicaid unwinding; eligibility applications; call center volume; site selection for the regional state hospital project; reimbursements to counties for persons confined in county jails awaiting examination, evaluation, or treatment for competency to stand trial; child care facility licensing and capacity; the judicial branch’s collaboration with DCF and KDADS related to family treatment courts; foster home recruitment and retention; and increased funding for training to support youth with serious emotional disturbance.