Week 6 of the 2021 Session
While Kansans dealt with days of bitter, subzero temperatures, threatening wind chills, and power outages, lights were dimmed in the Capitol to conserve energy and activity was limited during the early part of the week but returned to business as usual as the week wore on. Legislators, many working from home, considered bills related to rural emergency hospitals, a new provider type recently created by federal law; scope of practice for advanced practice registered nurses (APRN); telemedicine; and licensure of dental therapists.
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During a press conference on Monday, February 15, Gov. Kelly talked about the State of Disaster Emergency Declaration she had issued on Sunday, February 14, and asked Kansans to cut their use of power as much as possible to ensure the continued supply of natural gas and electricity during the cold spell. Andrew French, Chairman of the Kansas Corporation Commission, noted that rolling blackouts had begun.
On Wednesday, February 17, Gov. Kelly announced her “Back to School Vaccine Plan” to get all K-12 schools back to meeting in person. Under her plan, counties will receive additional supplies of COVID-19 vaccine specifically for teachers and school staff, and schools will receive rapid results testing kits. She stated this plan was possible because the number of doses of vaccine being made available to the state has continued to increase. She noted the state received 90,000 doses the previous week and expects the number to rise to as many as 115,000 per week in the near future.
On Monday, February 22, the Kansas Department of Health and Environment (KDHE) reported 291,715 COVID-19 cases (up 4,265 from February 15) from 105 counties with 4,643 deaths (up 237 from February 15).
House Health and Human Services
(Rep. Brenda Landwehr, Chair)
On Tuesday, February 16, the Committee held a hearing on House Bill (HB) 2261, which would provide for the licensure of rural emergency hospitals (REH), a new Medicare provider type created by the Consolidated Appropriations Act of 2021 passed by Congress in December 2020. Small, rural hospitals — such as critical access hospitals or other hospitals with fewer than 50 beds — would be eligible to convert to REHs, which would allow existing hospitals to get rid of their inpatient beds while maintaining other critical services (e.g., emergency department services) in exchange for a new Medicare reimbursement system.
Proponents included representatives from the Kansas Hospital Association (KHA) and Kansas hospitals; no neutral or opponent testimony was provided. Proponents indicated that allowing for the licensure of these new facilities would provide small hospitals at risk of closure an additional option to remain viable. Committee members asked questions about how many Kansas hospitals were expected to convert to REHs, whether hospitals that have closed within the last few years would be eligible to become REHs, who in communities would have to sign off on a hospital transitioning to the REH model, what the patient experience would be like seeking care in an REH, whether law enforcement agencies have provided feedback on the new model and what partnerships REHs would be required to have.
On Wednesday, February 17, the Committee held a hearing on HB 2256, which would allow APRNs to practice without a collaborative practice agreement (CPA) with a physician. Proponents included representatives from the Kansas Advance Practice Nurses Association, the National Council of State Boards of Nursing, Grow Midwives, the Kansas Affiliate of the American College of Nurse-Midwives, AARP Kansas, Americans for Prosperity Kansas, the Kansas Chamber of Commerce and current APRNs. Proponents indicated the bill would improve access to care while not diminishing quality of care and highlighted issues some APRNs have encountered in finding a physician willing to participate in a CPA with them. Neutral testimony was provided by the Kansas Academy of Physician Assistants.
Opponents, including representatives of the Kansas Medical Society, the Kansas Academy of Family Physicians, the Kansas Chapter of American Academy of Pediatrics and practicing physicians, indicated that removing the requirement to have a CPA would not improve access to care in rural areas and would result in lower-quality care and dis-incentivize team-based health care. The opponents also requested that if the bill were to be passed, that oversight of APRNs be handled by the Kansas State Board of Healing Arts (BOHA) which regulates the practice of medicine in the state.
Committee members asked questions about how many individuals in Kansas currently lack access to care; the difference between the practice of medicine and allowing APRNs full practice authority; whether there are other legislative solutions being considered to address access to care issues; whether modifications could be made to CPAs to alleviate issues raised by some APRNs (e.g., if the physician who has signed their CPA dies or retires); how many CPAs one physician can have with APRNs at any given time; how current relationships between physicians and APRNs function; if there have been any issues since the start of the pandemic when executive orders and temporary statute provisions allowed APRNs to practice without a CPA; what the outcome of having the BOHA provide oversight of independent certified nurse midwives has been; whether the bill would require APRNs to contribute to the healthcare stabilization fund; and what statutes look like in other states that have granted APRNs full practice authority.
The Committee also took final action on HB 2208, which would authorize licensed out-of-state physicians with a telemedicine waiver issued by the State Board of Healing Arts to practice telemedicine in Kansas, amend the disciplinary authority of the Behavioral Sciences Regulatory Board, and modify licensure and temporary permit requirements of professional counselors, social workers, marriage and family therapists, addiction counselors, psychologists and master’s level psychologists. The Committee made several amendments to the bill, including insertion of language from HB 2066 concerning the practice of telemedicine by out-of-state licensed physicians, and passed it favorably out of Committee.
Senate Public Health and Welfare Committee
(Sen. Richard Hilderbrand, Chair)
On Wednesday, February 17, the Committee held a hearing on Senate Bill (SB) 129, which would provide for the licensure of dental therapists. Proponents, including representatives from the Kansas Dental Hygienist's Association, practicing dental hygienists and Oral Health Kansas, stated that creating the dental therapist licensure would improve access to oral health care in the state, particularly in underserved areas and for underserved populations, such as those with Medicaid coverage. Opponents included representatives from the Kansas Dental Association (KDA) and practicing dentists, who expressed concern about patient safety and indicated that other states that have added dental therapists have not increased access to care in underserved areas.
Committee members asked questions about the types of supervision included in the bill; a requirement for supervising dentists to accept Medicaid; the number of states that currently have dental therapists; the number of dental hygienists who have pursued existing higher-level care permits; whether dental therapists would improve access in rural areas; whether the price of a service changes based on whether it is provided by a dental therapist or a dentist; liability insurance; why KDA opposes the bill when it supported a similar bill in 2018; how dentist shortages are being addressed currently; and why dental hygienists would choose to pursue a dental therapist licensure.
On Thursday, February 18, the Committee held a hearing on SB 174, the companion bill to HB 2256, which would allow APRNs to practice without a CPA. The hearing included a similar slate of proponents, neutral conferees and opponents as the hearing on February 17 in the House Health and Human Services (HHS) Committee. Committee members asked questions about why CPAs are difficult to obtain; whether this is only an issue for APRNs who want to practice independently; whether the cost a patient pays to receive a service differs if the service is provided by a physician versus an APRN; whether physician assistants (PA) have to have an agreement with physicians to practice; whether PAs will want a similar change in the future; whether PAs and medical students take courses together when in school; whether current relationships between APRNs and physicians would change without the requirement of a collaborative practice agreement; what type of diagnoses the bill would allow APRNs to provide; and whether APRNs would be able to prescribe controlled substances under the bill.
On Friday, February 19, the Committee held a hearing on SB 175, the companion bill to HB 2261, which would provide for the licensure of REHs. The hearing included a similar slate of proponents as the hearing on February 16 in the House HHS Committee, with no neutral or opponent testimony provided. Committee members asked questions about how reimbursement would occur under the REH model; whether hospitals that move to the REH model would be able to later revert back to being a CAH or prospective payment system hospital; why the bill includes language requiring insurers to provide benefits for services rendered at an REH; and the impact the REH model would have on maternal care, including prenatal care, post-partum care and delivery services.
House Children & Seniors
(Rep. Susan Concannon, Chair)
On Wednesday, February 17, the Committee held a hearing on HB 2345, which would establish the Office of the Child Advocate for children's protection and services within the legislative branch. Proponents of the bill, including representatives from community-based organizations, private citizens, former foster youth, social workers, child advocacy organizations and the Missouri (MO) Child Advocate, discussed the benefits of an independent pair of eyes, an independent voice for children and support for frustrated family members. Neutral testimony from Tanya Keys, Deputy Director, Kansas Department for Children and Families (DCF), stated the agency's support for the bill but requested the office be housed under the Department of Administration instead of the Legislature. This change would align with 21 out of 22 states with similar positions (Nebraska houses their child welfare ombudsman in the legislative branch) and would simplify information sharing and start up. Ms. Keys also stated that DCF would need to provide three full time equivalents from the agency to support this new position. Committee members asked questions about how a private citizen would interact with this office and whether the office would be helpful. The members asked Kelly Schultz, the MO Child Advocate, about information sharing, accountability, tensions around confidentiality and having enough latitude as a part of the executive branch.
House Social Services Budget
(Rep. Will Carpenter, Chair)
On Monday, February 15, the Committee began its hearing on the DCF budget. For fiscal year (FY) 2021, DCF requests $793.1 million ($348.6 million State General Funds (SGF)) and the Governor recommends it receive $817.2 million ($348.9 million SGF). For FY 2022, the agency requests $776.7 million ($355.5 million SGF) and the Governor recommends it receive $3.1 billion ($1.3 billion SGF), which assumes Executive Reorganization Order (ERO) 47 combining KDADS and DCF is approved. DCF Secretary Laura Howard then provided agency testimony on the DCF budget and responded to questions related to caseloads, temporary assistance for needy families (TANF) cash assistance caseloads, work requirements for TANF, modernizing the child welfare system, and child support program funding.
On Wednesday, February 17, the Committee approved the following recommendations for the KDHE Budget:
- Add language directing KDHE to pay hospitals and physicians at the Medicaid rate that was established in FY 2020 until the first calendar quarter following the Centers for Medicare and Medicaid Services (CMS) approval of the Health Care Access Improvement Program provider assessment rate adjustments.
- Add $2 million SGF for community-based primary care grants (replacing funds removed by the Governor from what was approved last year).
- Add $1 million SGF to increase funds available to local health departments using the state distribution formula in current law (replacing funds removed by the Governor from what was approved last year).
- Add $150,000 SGF for the Kansas trauma program for FY 2022.
- Add the following language: “The Committee recommends information be gathered to provide a clear understanding of the following: (1) the process by which Kansas adjusts and sets the rates paid to the managed care organizations (MCOs) providing KanCare services; (2) federal laws that guide the rate setting process for states with managed care; and (3) information on how other states with managed care sets rates and whether there is legislative oversight of the process.”
- Add language to transfer $19 million SGF, which is in the Governor’s budget recommendation for Medicaid expansion, to partially fund the agency’s enhanced request for the increased state share of the Children’s Health Insurance Program (CHIP) for FY 2022, if Medicaid expansion does not pass during the 2021 legislative session.
- Request an interim study on dental care for low-income and senior individuals.
The Committee then held a hearing on the Kansas Department for Aging and Disability Services (KDADS) budget. For FY 2021, the agency requests a revised estimate of $2.2 billion ($835.1 million SGF) and the Governor recommends $2.3 billion ($733.0 million SGF). The agency requests a revised estimate of $2.2 billion ($884.1 million SGF) for FY 2022, but the Governor recommends all expenditures be shifted to the budget of the proposed Department of Human Services, pursuant to ERO 47, which would combine KDADS and DCF in FY 2022 (approximately $2.4 billion).
On Thursday, February 18, Chair Carpenter made an additional recommendation for the KDHE budget requiring KDHE to establish a prospective payment system under the medical assistance program for funding certified community behavioral health clinics and submit any necessary approval requests to CMS.
Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and Kancare Oversight
(Sen. Richard Hilderbrand, Chair)
On Friday, February 19, the Joint Committee met for its quarterly meeting and heard presentations from individuals and representatives of provider and advocacy organizations and state agencies. Conferees testified about a variety of issues, including delayed home and community-based services (HCBS) payments, concerns about COVID-19 vaccine distribution, restoring funding removed by the Governor’s allotments, increasing provider reimbursement rates, funding the brain injury waiver, and protected income level (PIL) and client obligations. Committee members asked questions related to the brain injury waiver, visitation in nursing homes, provider rate increases, Intellectual / Developmental Disability (I/DD) waiver services, and HCBS wait lists.
(Rep. Steve Huebert, Chair)
On Tuesday, February 16, the Committee held a hearing on mental health in schools. Jonathan Smeeton, Director of Public Relations for the Kansas Association of School Psychologists, stated that the federal Centers for Disease Control and Prevention reported that from April to October 2020, it saw a nationwide increase of 24 percent in mental health emergency room visits by children ages five to 11, and 34 percent in those ages 12 to 17. According to the National Center for Health Statistics, he said, Kansas ranks ninth for the highest suicide rate among people age 10 to 24. Numerous conferees, representing school psychologists, counselors and social workers, stated that mental health professionals in schools are being asked to perform an increasing number of duties and expressed the need for additional qualified workers throughout the state. They also recommended that the state work toward a student to counselor ratio of 250:1 (currently 431:1) and provided suggestions regarding continued funding and expansion of the Kansas School Mental Health Intervention Team (MHIT) program; providing scholarship opportunities for students entering a school-based mental health profession; prioritizing efforts to create safe and supportive school environments for all students; and requesting that the Legislature support Medicaid expansion. Committee members asked questions about the MHIT program, impact of the pandemic and efforts to return to in-person instruction, certification standards for school counselors, role of school social workers, increased hospitalization rates for children, and various workforce challenges.
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.