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Health at the Capitol Week 2 (January 2020)

Week 2 of the 2020 Legislative Session

By Linda J. Sheppard, J.D., Hina B. Shah, M.P.H., Sydney McClendon, Peter F. H. Barstad | January 29, 2002

Health at the Capitol Week 2 (January 2020)

Week 2 of the 2020 Session

With Martin Luther King Jr. Day last Monday, the second week of the session was a short one. On Tuesday, January 21, former Kansas City area TV weatherman Mike Thompson was sworn in for the 10th District Senate seat resigned by Sen. Mary Pilcher-Cook (R-Shawnee). On Thursday, January 23, House Republican leaders released plans for five new pieces of legislation called the “Make Kansas Work Plan.” One of the bills would create an “Innovation Fund” to provide grants to rural communities to innovate and preserve health care, and another bill, entitled the “Kansas Promise Act,” would provide scholarships to Kansas high school graduates who attend a Kansas trade school, technical college or community college and who focus on one of ten high-need areas of labor in the state.

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

On Wednesday, January 22, the committee heard a presentation from Kansas Department of Health and Environment (KDHE) Secretary Lee Norman on the “State of the Health of Kansas.” Drawing on information in the 2019 report “America’s Health Rankings,” Sec. Norman shared that Kansas dropped in the overall state health rankings from 12th in 1990 to 29th in 2019 — the largest decline of any state. He also described how Kansas fares for each domain in the health rankings. Those domains include behaviors, community and environment, policies that drive health, and clinical care. The Kansas ranking is impacted by high rates of sexually transmitted infections (STI), smoking, obesity, children living in poverty, low rates of immunizations, low funding levels for public health, poor access to care for certain services (e.g., dental), and a high incidence of diabetes. A few of the policy ideas that Sec. Norman included in the presentation were scope of practice legislation to address access to care issues, expedited partner therapy to treat STIs, and support for tobacco cessation efforts. Committee members asked questions about the effectiveness of tobacco taxes and HPV immunizations, and how to expand the use of telemedicine. They also inquired about who has authority over sexual education content in schools and whether there is a relationship between STI rates and the content and frequency of sexual education. The committee requested that Sec. Norman provide information about the top policy priorities for KDHE in the coming year following the meeting.

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

On Tuesday, January 21, the committee heard a presentation similar to the one heard in House Health and Human Services on January 22, about the State of the Health of Kansas from KDHE Secretary Lee Norman. Committee members asked questions about e-cigarettes, combustible marijuana, air quality, local public health funding, STIs, primary care workforce, and how Kansas compares to its neighboring states.

On Thursday, January 23, the committee held the first of five days of hearings on Senate Bill (SB) 252, the Medicaid expansion compromise bill negotiated by Gov. Laura Kelly and Senate Majority Leader Jim Denning. Proponents testifying the first day included KDHE Sec. Norman, Sen. Denning, Senate Minority Leader Anthony Hensley, State Medicaid Director Adam Proffitt, representatives of the Kansas Hospital Association, the Alliance for a Healthy Kansas Coalition, the Overland Park Chamber of Commerce, and the American Cancer Society. Committee members’ questions primarily focused on various elements of SB 252, including the differences between it and 20rs1873, which was reviewed and amended by the Senate Select Committee on Healthcare Access. They also posed questions about whether KDHE or the KanCare managed care organizations (MCOs) would collect the monthly hospital fee; the Rural Transformation component; and eligibility for HCBS waivers.

On Friday, January 24, the SB 252 hearing continued with proponent testimony from representatives of the Kansas Academy of Family Physicians, the Kansas Sheriff’s Association, the Greater Kansas City Chamber of Commerce, the Kansas Association of Community Mental Health Centers (CMHCs), the Community Care Network of Kansas, the Kansas Medical Society, and the Kansas League of Municipalities. Committee members asked questions about the IMD exclusion waiver, medical bills paid by county sheriff departments across the state, and the availability and willingness of Kansas physicians to provide services to Medicaid beneficiaries.

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

On Wednesday, January 22, Senior Assistant Attorney General Melissa Johnson presented the Child Death Review Board Annual Report to the committee. In 2017, Kansas had 396 child fatalities classified into one of the following six categories: natural causes such as congenital conditions; sudden infant death syndrome (SIDS); unintentional injury such as motor vehicle accidents; homicide; suicide; and undetermined. Ms. Johnson highlighted recommendations from the Board including:

  • Clarifying K.S.A. 22a-243(j) to allow the release of information to the county or district attorney in the jurisdiction where the death occurred if it appears that the information is necessary for the county or district attorney to prosecute the perpetrator, or the cause of the child’s death was from abuse or neglect, or cases where there is known criminal activity -- particularly for homicides;
  • Providing additional funding and coordination of investigations between the Kansas Department for Children and Families (DCF) and law enforcement;
  • Increasing crisis and mental health services to combat the rise in youth suicides; and
  • Considering recommendations from Child Welfare System Task Force report presented in 2019.

The committee also held hearings on House Bill (HB) 2438, which would amend K.S.A. 22a-243 to allow certain exceptions to the confidentiality of state child death review board documents, and HB 2229, which would amend K.S.A. 39-981 to remove the provision not allowing court or state agency admission into evidence of any tape or recording created using an electronic monitoring device in an adult care home.

On Thursday, January 23, the committee heard a presentation from Janis DeBoer, Deputy Secretary of the Kansas Department for Aging and Disability Services (KDADS), entitled "Seniors in Kansas: Projections, Impacts and Services." Dep. Sec. DeBoer’s presentation began with an overview of demographic trends in the U.S. and Kansas, indicating that by 2034, individuals age 65+ will outnumber individuals under age 18. Citing projections from the Center for Economic Development and Business Research at Wichita State University, she also stated that the number of adults age 65+ in Kansas is expected to increase by 106 percent (from 415,823 to 856,389) between 2014 and 2064 and described various programs available to older adults in Kansas, including nutrition services through the Older Americans Act, counseling programs for those who have Medicare, and services provided through the Kansas Senior Care Act (KSCA), the Frail Elderly (FE) Waiver, the Client Assessment, Referral and Evaluation (CARE) program and the Program of All-Inclusive Care for the Elderly (PACE). Finally, Dep. Sec. DeBoer provided a brief overview of investigation statistics for Adult Protective Services and highlighted the Kansas Alzheimer Disease Plan for 2020. Committee members asked questions regarding the availability of PACE across the state and the tax status of PACE providers, availability of services under and funding for the KSCA, and why the number of Adult Protective Services investigations is increasing.

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

On Tuesday, January 21, KDADS Secretary Laura Howard provided an update to the committee on Children’s Psychiatric Systems of Care. She provided background information on the child population in Kansas and the need for psychiatric care for children. Andrew Brown, Commissioner of Behavioral Health Services (BHS) at KDADS, then went into more detail on the Children’s Continuum of Care in Kansas and future steps to bolster behavioral health services for children, including youth mobile crisis services, juvenile crisis intervention centers, the Psychiatric Residential Treatment Facility (PRTF) work group, step down services for children after discharge from a PRTF or a CMHC, and the addition of more PRTF beds at the KVC Hospital in Hays. Legislators asked various questions about PRTFs and the difference between PRTF beds and acute care beds. Ryan Speier, President of KVC Hospitals, provided brief testimony about the work that KVC Hospitals does in Kansas and the different treatment programs available to youth and some of the challenges they have encountered in expanding those programs in Hays.

On Wednesday, January 22, the committee met to discuss Direct Care Workforce Initiatives. Matt Fletcher, Executive Director for InterHab, introduced 20rs2169, which would increase the reimbursement rate for intellectual and/or developmentally disabled (I/DD) care providers. The bill was accepted without objections. The committee also heard several presentations on direct care workforce issues from representatives of the Kansas Respite Coalition, the Kansas Council on Developmental Disabilities (KCDD), the Kansas Health Care Association, the Kansas Center for Assisted Living, InterHab, and the Independent College Association. The presentations shared many similar themes, including workforce projections and impending demand, the aging population in Kansas, and the need to offer employees higher wages. Questions from legislators centered on certification standards and educational requirements, staffing issues, comparisons to other industries, and promising practices or solutions. There was consensus that this is already a major issue which is projected to get worse and that it will take more funding in conjunction with creative solutions to meet the demand.

House Insurance Committee
(Rep. Jene Vickrey, Chair)

On Tuesday, January 21, the committee held a hearing on HB 2053, which would amend K.S.A. 40-2,193 to revise the definition of a short-term, limited-duration insurance (STLDI) policy to mean a policy with a policy period of “less than 12 months, . . . that offers renewal or extension periods up to a maximum policy period of 36 months total duration, with or without a requirement of medical re-underwriting or medical requalification.” Kansas law currently allows this type of policy to be for a term of six months with only one renewal and does not address the issue of underwriting. The bill also requires insurers issuing STLDI to provide a notice to consumers indicating that this coverage does not comply with certain requirements under the Affordable Care Act (ACA) for health insurance. Proponents for the bill included representatives of Blue Cross Blue Shield of Kansas City and the Kansas Chamber of Commerce and individual health insurance agents who sell STLDI. Opponents included representatives of the National Multiple Sclerosis Society, the Leukemia Association, American Heart Association, and the American Cancer Society. Committee members asked several questions regarding how the premiums for this type of policy would be calculated after the initial policy period, the intent of the consumer notice, and how many Kansans currently have this type of coverage.

House Federal and State Affairs and Senate Judiciary
(Rep. John Barker, Chair, and Sen. Rick Wilborn, Chair)

On Tuesday, January 21, the combined committees heard testimony from both proponents and opponents of House Concurrent Resolution (HCR) 5019 and Senate Concurrent Resolution (SCR) 1613, identical propositions to amend the bill of rights of the Kansas Constitution to state “that there is no constitutional right to abortion, and reserving to the people the ability to regulate abortion through the elected members of the legislature . . .” If the resolutions are adopted by a two-thirds majority of both the House and Senate, the constitutional amendment would be submitted to Kansas voters for approval or rejection at the 2020 primary election or at an earlier special election, if approved by the Legislature.

The resolutions, both introduced during the first week of the session, are a response to the Kansas Supreme Court’s opinion in the case of Hodes & Nauser, et al, v. Schmidt, et al., announced in April 2019, that held that the “Kansas Constitution Bill of Rights protects all Kansans' natural right of personal autonomy, which includes the right for a woman to “make her own decisions regarding her body, health, family formation, and family life—decisions that can include whether to continue a pregnancy.”

The Hodes case challenged the constitutionality of Senate Bill (SB) 95, the 2015 Kansas Unborn Child Protection from Dismemberment Abortion Act, which banned “dilation and evacuation abortions.”

On January 22, both committees passed their respective resolutions to the full House and Senate, without amendments. 

House Appropriations Committee
(Rep. Troy Waymaster, Chair)

On Thursday, January 23, the committee received a presentation from Melissa Rooker, Executive Director of the Children’s Cabinet and Trust Fund, who provided information regarding the development of a strategic plan for early childhood care and education in Kansas, which is expected to be finalized in April. The development of the strategic plan is a collaborative project involving the Children’s Cabinet, the Department for Children and Families (DCF), KDHE, and the Kansas State Department of Education (KSDE). The strategic plan will be built on a statewide needs assessment conducted in 2019 by the Children’s Cabinet and will include a focus on universal home visiting, workforce development and a set of programs called “Connected Families, Connected Communities.” Rooker also indicated a desire to continue working collaboratively across agencies, with a goal to have a cross-agency data sharing agreement in place by the end of 2020 in order to leverage existing data on childcare and education in Kansas. Following the presentation, committee members asked questions about the performance measures used by the Children’s Cabinet, whether there is a case to be made for using part of the impending opioid settlement funds on childcare programs, the timeline for obtaining longitudinal data from agencies, and whether the Children’s Cabinet is interested in engaging with a statewide workforce directory.

The committee also heard from David Fye, Principal Fiscal Analyst with the Kansas Legislative Research Department (KLRD), about a joint Mental Health Facilities Tour attended by members of the Senate Ways and Means and House Appropriations Committees in September 2019. The tour consisted of stops in El Dorado, Wichita, Newton, Hutchinson, Larned, Hays, Salina and Manhattan, and attendees visited a variety of mental health care settings, ranging from corrections facilities to therapeutic learning centers for children. Following the update, committee members had the opportunity to ask questions of Fye and Laura Howard, Secretary of KDADS and DCF, and asked Sec. Howard about a master plan for the Kansas mental health system and for an update on the closure of acute psychiatric beds at KVC Hospitals Hays. Sec. Howard agreed that a plan to address the mental health system in Kansas is needed, and that KDADS will be presenting a plan for how to lift the moratorium at Osawatomie State Hospital next week in the Social Services Budget Committee. Sec. Howard also shared that following guidance from the Centers for Medicare and Medicaid Services (CMS) to not comingle youth with acute care needs and youth with longer-term psychiatric needs in the same facility, KVC eliminated its acute care beds due to financial reasons and converted the entire facility into a Psychiatric Residential Treatment Facility (PRTF). To address a gap in acute care services in western Kansas, KDADS will be hosting four stakeholder meetings over the next two weeks to identify locations for acute care psychiatric beds and potential stakeholder partnerships.

House Judiciary Committee
(Rep. Fred Patton, Chair)

On Thursday, January 23, the committee held a hearing on HB 2450, which would amend K.S.A. 21-6109, to revise the definition of smoking to include the use of electronic cigarettes. Proponent testimony was received from Attorney General Derek Schmidt and Rob Gilligan, on behalf of the Kansas Association of School Boards. Jordan Feuerborn, of the American Cancer Society Cancer Action Network, offered neutral testimony, but advocated for broader definitions of “smoking” and “electronic smoking devices.” Committee members asked questions about the proposed change to the law, especially whether it would allow for regulation of smoking marijuana by means of electronic devices, and also asked about exemptions and the scientific evidence that might be available regarding the impact of second-hand vapor resulting from use of electronic cigarettes.

House Rural Revitalization
(Rep. Adam Smith, Chair)

On Wednesday, January 22, the committee heard informational presentations on rural physician recruitment and sustaining rural healthcare from representatives of the University of Kansas School of Medicine and the Kansas Hospital Association (KHA). Chad Austin and Jennifer Findley of KHA suggested that a new model of patient care, referred to as Primary Care Centers, might be implemented in some communities in place of a traditional hospital model. They explained that these centers, which would focus on primary care and transportation, would provide certain core and optional services, and would need to partner with a full-service hospital and rely more heavily on telemedicine. They noted that this type of model would require approval by the Center for Medicare and Medicaid Innovation (CMMI), which may also be working on a new patient care model. They also stated that the Kansas Health Foundation (KHF) has provided funding to facilitate community conversations around KHA’s proposed model and suggested that initial state legislation to define primary health centers and other regulatory elements could be enacted.

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.