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Health at the Capitol Week 3: February 2, 2019

By Linda J. Sheppard, J.D., Hina B. Shah, M.P.H., Sydney McClendon, Peter F. H. Barstad | January 01, 2019

Health at the Capitol Week 3: February 2, 2019

Throughout the 2019 Kansas legislative session, Kansas Health Institute (KHI) staff will prepare a weekly summary of the highlights, 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 and LinkedIn. Previous editions of Health at the Capitol can be found on our archive page.

Week 3 of the 2019 Session

Despite bitter cold temperatures throughout much of the week, legislators powered through and committees met as scheduled.

On Tuesday, Gov. Kelly’s KanCare expansion bills were introduced in the House and Senate. The expansion proposal, with initial funding of approximately $14 million, is very similar to the Medicaid expansion bill passed by the Legislature in 2017 but vetoed by Gov. Sam Brownback. Hearings for the bills in either chamber have yet to be scheduled.

On Wednesday, the Senate Ways and Means Committee forwarded a bill to the full Senate to spend $115 million this fiscal year to repay $97 million, plus interest, to KPERS. This complicates Gov. Kelly’s proposal for a 30-year re-amortization of the repayment to KPERS to make funds available for other funding priorities, including KanCare expansion.

House Health and Human Services Committee
(Rep. Brenda Landwehr, C​hair)

On January 28, the committee received an informational briefing from Kerrie Bacon, the KanCare Ombudsman.

On January 29, the committee heard from the Alzheimer’s Disease Plan Working Group, which submitted multiple recommendations, including a recommendation that the working group should continue to convene and that the state should create an Alzheimer’s Disease Advisory Council. The Kansas State Board of Healing Arts also provided an overview of their role.

On January 30, the committee heard about Neonatal Abstinence Syndrome (NAS) from the Kansas Chapter of the American Academy of Pediatrics. NAS is a condition in which in utero exposure to drugs creates withdrawal-like symptoms in newborns. The committee heard information on the prevalence, cost and potential treatment options. Questions from committee members included criteria for removing infants from their families, differences in treatment depending on the drug of abuse, long-term impacts of NAS, and the impact of Medicaid expansion on outcomes for infants and mothers. Committee members were updated on the Senator Stan Clark Pregnancy Maintenance Initiative (PMI) and asked questions about the availability of PMI services across the state and whether PMI grantees discuss abortion in their clinics.

On January 31, the committee received a presentation from the Kansas State Board of Pharmacy on K-TRACS, the state’s prescription drug monitoring program.

Senate Public Health and Welfare Committee
(Sen. Gene Suellentrop, Chair)

On January 28, Kari Bruffett from KHI provided an overview of KanCare and CHIP.

On January 29, the committee heard testimony from Ascension Via Christi and COMCARE on a plan to implement a regional behavioral health service model in the Wichita/Sedgwick County area. The model would be based on the San Antonio Mental Health Project which provides treatment at the grassroots level. Committee members asked questions about what components of the San Antonio project could be replicable in Kansas, the cost, savings to the state, locations in Kansas and ways to track the mobility of individuals in the program. There also was discussion about the current capacity of the state hospitals and the waiting list for admittance.

On January 30, the committee received an informational briefing on KanCare by Jon Hamdorf, former Medicaid Director (now with the Kansas Association of Medicaid Health Plans) and representatives of the three KanCare managed care organizations (MCOs). Committee members asked questions about oversight of moving from fee-for-service to managed care, the single credentialing system, and the impacts of pre-authorization and changes in opioid use. Chair Suellentrop asked each of the MCOs to provide written testimony regarding what they are doing specifically to get people off Medicaid and what impediments exist to doing so.

House Children and Seniors Committee
(Rep. Susan Concannon, Chair)

On January 28, the committee heard presentations from Rachel Monger of Leading Age Kansas, Cindy Luxem of the Kansas Health Care Association/Kansas Center for Assisted Living, and Mitzi McFatrich of Kansas Advocates for Better Care regarding nursing facilities and senior care.

On January 29, the committee heard from Dr. Lee A. Norman, Interim Secretary of Health and Environment, and staff from KDHE. Committee members asked questions about next steps for the KanCare clearinghouse run by Maximus, interagency communication, Federal Medical Assistance Percentage (FMAP) fluctuations, consensus caseload estimates and hospital surveys.

On January 30, the committee heard a presentation from Ann Elifrits of the Commission on Aging about the Kansas Alzheimer's Disease Plan. Committee members asked questions about how the plan will move forward, clarification on aspects of the disease, early intervention and prevention, and how legislators can assist with implementation of the plan

House Social Services Budget Committee
(Rep. Will Carpenter, Chair)

On January 28, the committee heard from Alexandra Blasi and Lori Haskett of the Board of Pharmacy who provided an overview of K-TRACS. The discussion focused on the need to establish a stable funding source. The committee also heard from Christie Appelhanz of the Children’s Alliance, who discussed the organization’s priorities for the session, including (1) additional funding for the child welfare system (included in the governor’s budget recommendations), (2) implementation of the Families First Prevention Services Act (FFPSA), and (3) increasing Psychiatric Residential Treatment Facilities (PRTF) capacity.

On January 29, the committee heard organizational overviews from Kyle Kessler with the Kansas Association of Community Mental Health Centers, Sean Gatewood with the KanCare Advocates Network, Matt Fletcher of InterHab and Chad Austin from the Kansas Hospital Association.

On January 30, the committee heard testimony on four topics: Larned State Hospital, an overview of substance use disorders in Kansas, the Kansas Community Care Network and Neonatal Abstinence Syndrome.

On January 31, the committee heard from representatives from Kansas Advocates for Better Care, the Kansas Health Care Association, Kansas Centers for Assisted Living, Leading Age Kansas and Kansas Association of Area Agencies on Aging and Disabilities. All presenters addressed issues related to the KanCare clearinghouse and a need for elder care applications to be taken over by KDHE, nursing facility surveys, and reducing the use of antipsychotic prescription drugs.

House Insurance Committee
(Rep. Jene Vickrey, Chair)

The committee heard a brief presentation on association health plans (AHPs) and then held hearings on January 28 and 30 on House Bills 2054, 2055, 2056, 2057 and 2058, that would amend various Kansas laws related to AHPs. Proponents, including the Kansas and Wichita Chambers of Commerce, Blue Cross and Blue Shield of Kansas and the Kansas Dental Association, testified that the proposed amendments will allow the state to fully adopt the new federal AHP guidelines released by the Trump administration in 2018, could increase the number of Kansas sole proprietors and small businesses that participate in AHPs, and reduce their premiums. Opponents expressed concerns about the adequacy of the covered benefits in AHPs, which are not required to include the Essential Health Benefits (EHB) required by the Affordable Care Act (ACA). Committee members asked questions about the premium tax requirements and whether AHPs might “cherry-pick” healthy members from the individual and small group markets in Kansas, which are required to offer the EHBs required by the ACA.

Senate Financial Institutions and Insurance Committee
(Sen. Rob Olson, Chair)

On January 29 and 30, the committee held a hearing on Senate Bill 32 which amends K.S.A. 40-2222. Terry Holdren, CEO and general counsel for the Kansas Farm Bureau (KFB) stated KFB is seeking to be added to the statute to be exempt from the jurisdiction of the Kansas Insurance Department (KID) related to its proposed new member health plans, similar to plans currently offered by farm bureaus in Iowa and Tennessee. The KFB plans would not be required to comply with the ACA requirements nor the Kansas mandates enacted by the Legislature. Holdren stated members will be individually underwritten, may be denied coverage if they fail to pass underwriting, but if approved, would not have their coverage cancelled in the future. KFB anticipates the cost of their plans will be as much as 30 percent lower than the ACA compliant plans currently available in the market. In response to questions regarding oversight of the plan and how enrollee complaints would be investigated, Holdren stated that the plan would fall under the jurisdiction of the consumer protection division of the Kansas Attorney General’s office.

Opponents to the bill, including Medica and Blue Cross and Blue Shield of Kansas, testified about the importance of state regulatory oversight of health insurance products and their support for the expansion of association health plans in Kansas as the best approach to new coverage options for individuals and small businesses. Others raised concern that KFB members with certain conditions such as cancer and Multiple Sclerosis would not be allowed to get coverage through the KFB program, and that healthy enrollees from the individual and small group market may drop ACA compliant coverage for the KFB program. Chair Olson stated that the committee may work Senate Bill (SB) 32 during the week of February 4.

On January 30 and 31 the committee also held hearings on SBs 29, 30, 33 and 36 that would amend various Kansas statutes related to AHPS. These bills are parallel versions of the bills heard in the House Insurance Committee described above. Chair Olson stated the committee may work the AHP bills in two weeks.

On January 30, Lee Modesitt of KID announced the agency will be introducing a bill to repeal the Kansas Uninsurable Health Insurance Plan Act (K.S.A. 40-2118 and following). The act, originally enacted in 1992, establishes the framework for the Kansas high risk pool, which became inactive effective December 31, 2013.

House Education Committee
(Rep. Steve Huebert, Chair)

On January 31, the committee heard presentations from representatives of the Kansas Children Services League (KCSL) regarding Adverse Childhood Experiences (ACEs) and described ways that workforce development and family friendly workplaces are – in accord with federal Centers for Disease Control and Prevention findings – the most effective way to address those problems. Representatives of the United Methodist Health Ministry Fund described Attachment Biobehavioral Catch-Up (ABC), a treatment program for children age 0 to 3 who may be experiencing attachment disorder syndrome. The same presentation also was heard in the Senate Education Committee this week.

House K-12 Education Budget Committee
(Rep. Kristey Williams, Chair)

The committee heard from Dale Dennis with the Kansas State Department of Education (KSDE), liaisons from three school districts, Kyle Kessler with the Kansas Association of CMHCs, Joan Tammany and Rep. Brenda Landwehr on the Mental Health Intervention pilot program. The reports were very positive and centered on the importance and successes of the program so far. Kessler also gave some background information on the rapid increase in suicide and the prevalence of substance use disorders.

Senate Ways and Means Committee
(Sen. Carolyn McGinn, Chair)

The committee heard a presentation by Gary Henault, Children’s Community and Inpatient Program Manager for KDADS, related to psychiatric residential treatment facilities (PRTF), including an overview of PRTFs, current capacity and waitlist data. He also highlighted the key areas for improvement, including (1) an accurate and consistent waitlist, (2) fixing inconsistencies in the preauthorization process, (3) uniformity in the reauthorization process, and (4) early intervention. While responding to questions from committee members, which focused mainly on tracking children throughout the process, Henault frequently referred to the need for a new waitlist, which will enable better collection and analysis of data throughout the waitlist, stay and discharge process.

The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.