Sorry we missed last week, but the local flu bug got ahold of us and wouldn’t let go! This edition combines weeks 3 and 4 of the legislative session, and, as a result is a bit longer than usual. While the focus the past two weeks has been on Medicaid expansion, the proposed Constitutional amendment and initial budget reviews, lots of health-related bills have been introduced, and we expect there will be many hearings over the coming weeks, along with study of Gov. Kelly’s executive reorganization order for a new Kansas Department of Human Services (KDHS).
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Weeks 3 and 4 of the 2020 Session
On Wednesday, January 29, Senate Concurrent Resolution (SCR) 1613, the proposition to amend the bill of rights of the Kansas Constitution related to abortion, passed on a final vote of 28-12.
Legislators took a break on Wednesday, February 5, to give members a chance to participate in the celebratory activities for the Chiefs' Super Bowl victory. On Thursday, February 6, the House took up debate on SCR 1613 and voted 80-41 in favor of the resolution but fell short of the 84 votes (two-thirds majority) necessary to pass the resolution to put the amendment on the ballot for a statewide vote in the August primary.
House Health and Human Services Committee
(Rep. Brenda Landwehr, Chair)
On Tuesday, January 28, the committee heard presentations about the 2020 Alzheimer’s Disease State Plan from members of the Alzheimer's Disease Task Force established by Gov. Laura Kelly. The Task Force studied a number of issues including public awareness, access to care, family caregivers and training and workforce. Key recommendations from the Task Force include:
- The introduction of legislation that would make those under 60 years of age with younger-onset Alzheimer’s or other dementias qualify for services and supports in the Senior Care Act;
- The creation of a state website that would provide a central entry point to link to existing information and resources on Alzheimer’s and other dementias;
- The creation of a tax incentive (e.g., loan forgiveness) for family caregivers upon successful completion of a state-endorsed family caregivers training course;
- Requiring the training of Adult Protective Services workers and law enforcement personnel regarding the recognition of individuals with cognitive impairment and intervention in cases involving the abuse and exploitation of individuals who are cognitively impaired;
- Funding for Alzheimer’s specific respite programs at appropriate levels by increasing funding to Area Agencies on Aging for dementia caregiver services.
Committee members asked questions about the diagnosis and prevalence, the proportion of individuals with dementia cared for at home, incentivizing individuals to become Certified Nursing Assistants (CNAs), supports currently in place for caregivers and the fiscal impact and benefit of modifying the SCA.
On Tuesday, February 4th, the Committee heard an informational briefing on Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), infection-induced autoimmune disorders that can result in the abrupt onset of obsessive-compulsive disorder (OCD)-like symptoms, anxiety, behavioral issues, loss of sensory function, as well as a host of other symptoms. Conferees included physicians, parents of children with PANS or PANDAS and individuals and children with PANS or PANDAS who testified regarding the life-altering impacts of the disorder, difficulty receiving a diagnosis, lack of knowledge among providers and expensive treatment options not covered by insurance. They also requested that the state form an advisory council to explore potential legislation including mandating insurance coverage. Committee members asked about the age of onset, the national action regarding PANS or PANDAS and the content of legislation passed by other states. While the conferees did not have a bill prepared at the time of the hearing, legislators suggested they connect with committee members following the hearing to discuss potential legislation.
Senate Public Health and Welfare Committee
(Sen. Gene Suellentrop, Chair)
On Tuesday, January 28, the Committee resumed its hearing on SB 252, beginning with neutral testimony from Lee Modesitt, Director of Government Affairs for the Kansas Insurance Department (KID). Mr. Modesitt stated that KID has no objection to the proposed reinsurance program included in the bill, which requires KID to submit an Affordable Care Act (ACA) Section 1332 waiver request to the Centers for Medicare and Medicaid Services (CMS) for a reinsurance program for health plans sold in the individual market and to assist in the design and implementation of the program, which would begin January 1, 2022. However, he noted that KID is concerned the bill does not authorize funding to cover KID’s costs for the work required in the bill and asked that, if passed, sufficient funds be made available to KID for this purpose.
The Committee then heard from Kari Bruffett, Vice President of Policy for the Kansas Health Institute (KHI), who presented KHI’s recently updated estimate for Medicaid expansion enrollment and cost. KHI estimates that a total of 132,000 Kansans — including 93,000 adults and 39,000 children — will newly enroll in KanCare if Medicaid is expanded. Ms. Bruffett explained that KHI’s estimate differs from other estimates, including state fiscal notes, because it includes the indirect effect of expansion on children and currently eligible adults. Total net costs to the state in 2021, after accounting for new revenues, offsetting savings and additional administrative costs, are estimated to be $15.3 million for newly eligible adults; $14.1 million for currently eligible, newly enrolled adults; and $34.4 million for newly enrolled children.
The Committee also heard from Chuck Weber of the Kansas Conference of Catholic Bishops, who asked that legislators include a conscience exemption for providers. Beverly Gossage, HSA Benefits Consulting, then testified in opposition to the bill, citing concerns about the impact it would have on the individual private health insurance market.
On Wednesday, January 29, and Thursday, January 30, the Committee heard continuing opponent testimony on SB 252 from representatives of the Opportunity Solutions Project, the Kansas Policy Institute, Americans for Prosperity, the Kansas Chamber of Commerce and the Texas Public Policy Foundation. At the end of the hearing, Sen. Ty Masterson asked if the committee could hear from Attorney General Derek Schmidt regarding the status of litigation pending in other states related to the ACA, including work requirements.
On Thursday, February 6, the Committee returned to work on SB 252, and heard a presentation from Attorney General Schmidt regarding pending litigation related to the ACA. He noted that Kansas has been involved in litigation regarding the ACA since shortly after it was enacted. He then identified the three categories of litigation currently working through the courts, including questions regarding the constitutionality of the individual mandate, a challenge to the implementation of the health insurance provider fee and religious liberty cases challenging the requirements of certain provisions of the ACA and how they impact individuals and organizations. Legislators asked questions about how the outcome of the constitutionality challenge will impact Medicaid expansion, the status of litigation regarding work requirements and the role that the Attorney General’s office plays in Medicaid fraud cases. Chair Suellentrop announced that the Committee would begin working the bill on February 10, but subsequently announced that the bill would not be worked on that date.
House Children and Seniors
(Rep. Susan Concannon, Chair)
On Wednesday, January 29, the Committee received multiple presentations on youth behavioral health services and issues, including youth suicide. Kyle Kessler, Executive Director of the Association of Community Mental Health Centers (CMHCs) of Kansas, outlined their priorities, including requiring CMHCs to conduct screens for youth to enter Psychiatric Residential Treatment Facilities (PRTF) instead of managed care organizations (MCOs), continuing the Mental Health Intervention Team (MHIT) Program that allows CMHCs to partner with schools and supporting Gov. Kelly’s executive reorganization order, which would create KDHS. Michael Garrett, CEO of Horizons Mental Health Center, spoke about various services provided by Horizons, including partnerships with Head Start clinics, attachment interventions to improve relationships between children and parents and crisis stabilization services. Kathy Mosher, Executive Director of the Central Kansas Mental Health Center, described the experience of the Center as part of the MHIT program and reported that the program has resulted in more at-risk youth receiving services, improved attendance, academic and behavior outcomes and a reduction in youth suicide and stigma around mental health. Mosher indicated that the program has allowed them to efficiently fill gaps in the current system and encouraged the Committee to continue incentivizing partnerships between schools and CMHCs.
Dr. Sherrie Vaughn, Executive Director of the National Alliance on Mental Illness (NAMI) Kansas, presented statistics highlighting the rise in suicides in Kansas over the past few decades — particularly youth suicides — and described risk factors and protective factors for suicide. Dr. Vaughn requested that the Committee support recommendations from the 2019 Mental Health Task Force Report pertaining to suicide, increase funding for CMHCs and community-based non-profit organizations and expand community-based treatment.
Following the presentations, Committee members asked about the availability of different types of programs throughout the state, whether the CMHCs working with schools are engaging in planning with school administrations, whether a goal of school-based programs is to reduce suspensions, if there are programs available to support LGBTQ youth, how CMHCs are retaining their therapists and what the average salary is for psychiatrists.
On January 30, the Committee heard presentations from Hina Shah of the Kansas Health Institute and Deputy Secretary Tanya Keys regarding crossover youth in the state. Ms. Shah and Dep. Sec. Keys presented the process, methodology and findings of the Crossover Youth Working Group convened to review the impact of SB 367 on crossover youth in Kansas. The Committee also heard from Don Hymer, Assistant District Attorney in Johnson County, regarding the recommendations of the Judicial Council's Juvenile Offender/Child in Need of Care Advisory Committee on Crossover Youth and modifications to relevant provisions of law in order to ensure the goals of SB 367 are met for crossover youth.
House Social Services Budget Committee
(Rep. Will Carpenter, Chair)
On Monday, January 27, the Committee met for an update on Qualified Residential Treatment Facilities (QRTPs) and Families First Services. One of the major goals of the Family First Prevention Services Act (FFPSA) is to change the way Title IV-E funds can be spent by states. Title IV-E funds previously could be used only to help with the costs of foster care maintenance for eligible children, administrative expenses to manage the program and training for staff, foster parents and certain private agency staff, adoption assistance and kinship guardianship assistance. Under FFPSA, states, territories and tribes with an approved Title IV-E plan have the option to use these funds for prevention services that would allow “candidates for foster care” to stay with their parents or relatives.
On Wednesday, January 29, Laura Howard, Sec. of the Kansas Department for Children and Families (DCF) and the Kansas Department for Aging and Disability Services (KDADS), provided an update on the state hospitals, including her plan to lift the moratorium at Osawatomie State Hospital (OSH). The plan includes a mix of bed capacity and increasing community-based capacity for inpatient treatment and has two primary goals: (1) to ensure there are high-quality, therapeutic spaces to provide treatment to individuals with serious mental illness in an impatient setting and, (2) to use existing resources and facilities as effectively as possible. To meet both goals, KDADS has requested additional funds to renovate unused space, convert most of the double occupancy rooms to single rooms to improve the environment and add certified beds at OSH. Committee members asked about the difference between licensed and certified beds, use of funds from lottery vending machines, workforce retention, staff turnover rates and the total need for beds in the state.
House Insurance Committee
(Rep. Jene Vickrey, Chair)
On Monday, February 3, the Committee held a hearing on HB 2480, which would amend K.S.A. 40-2227 to revise the definition of long-term care insurance to allow for the marketing and sale of policies with a term of less than 12 consecutive months. KID’s Lee Modesitt testified in favor of the bill and stated that KID was seeking this change to provide additional options for consumers. There was no neutral or opponent testimony.
Senate Financial Institutions and Insurance Committee
(Sen. Rob Olson, Chair)
No health-related issues were addressed this week.
House Federal and State Affairs
(Rep. John Barker, Chair)
On Thursday, January 30, the Committee held a hearing on HB 2400 which would enact the kratom consumer protection act. The law would establish definitions and requirements for the manufacture, preparation, labeling, distribution and sale of kratom products, as well as penalties for violation of the law. It would specifically make it unlawful to sell such products to individuals under 18 years of age. The Secretary of Agriculture would be responsible for adopting rules and regulations and enforcement. Pete Candland, Executive Director of American Kratom Association, testified about the uses of kratom and stated that kratom does not create a euphoric effect and is not very addictive. Kenneth Titus, Chief Legal Counsel for the Kansas Department of Agriculture (KDA), testified in opposition to the bill and stated that while KDA does not oppose the regulation of kratom it would require KDA to take on a regulatory and enforcement role that is currently beyond the agency’s capacity to meet. Committee members asked questions about the forms of kratom typically sold, which states currently allow the sale of kratom, kratom-related deaths, dosage and interaction with other controlled substances and specifically asked if KDA had any input for revisions to the bill and a fiscal estimate.
Senate Ways and Means Committee
(Sen. Carolyn McGinn, Chair)
On Thursday, January 30, the Committee held a hearing on SB 255, which would establish and fund the cancer research and public information trust fund to be administered by the University of Kansas Medical Center (KUMC) in the amount of $10 million each year beginning on July 1, 2020. All money credited to the fund would be used to enhance laboratory, clinical and population-based research at the KU Cancer Center, recruit and retain cancer researchers and fund education and outreach programs for Kansans. Proponents included representatives of the Masonic Cancer Alliance, KUMC and individual cancer survivors. There was no neutral or opponent testimony. Committee members asked about the timeframe for National Cancer Institute designation, patient catchment areas, public/private partnerships, matching funds and economic impact.