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Health at the Capitol Week 6 (February 2020)

Week 6 of the 2020 Legislative Session

By Linda J. Sheppard, J.D., Hina B. Shah, M.P.H., Sydney McClendon, Peter F. H. Barstad | February 25, 2020

Health at the Capitol Week 6 (February 2020)

Week 6 of the 2020 Session

Committees were busy working bills and passing them out of committee or preparing to work them on Monday, February 24, before Turnaround Day on Thursday, February 27. There will be no committee hearings after the 24th, and bills from non-exempt committees must be approved by their house of origin by February 27 to stay active. 

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

On Wednesday, February 19, the Committee held a roundtable discussion regarding Advanced Practice Registered Nurses (APRN) and collaborative practice agreements. Current Kansas law requires APRNs to have collaborative practice agreements with physicians in order to independently develop and manage plans of care for patients, but House Bill (HB) 2412, introduced in 2019, includes a provision that would eliminate this requirement. Proponents, including the National Council of State Boards of Nursing, the Kansas Advanced Practice Nurses Association, and individual nurse practitioners, highlighted studies from other states that have passed similar legislation that show no increase in unsafe care or decrease in quality and noted that removing the requirement would not fundamentally change the work that APRNs are already doing. Opponents, including the Kansas Medical Society, the Kansas Academy of Physician Assistants and individual physicians, indicated that removing the requirement could create safety concerns for patients due to training differences between APRNs and physicians, and argued that differences in the care allowed to be provided by physicians and APRNs would not be clear if the agreement is removed.

Committee members asked about the difference between the scope of practice for APRNs and physicians; how physicians currently guarantee patient safety when they have agreements with APRNs located long distances away; whether states with similar legislation have put in place any practice limitations on APRNs; how often APRNs communicate currently with the physicians they have agreements with; and how the agreements are developed.

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

On Tuesday, February 18, the Committee held a hearing on Executive Reorganization Order (ERO) No. 44, which would combine the Kansas Department for Children and Families (DCF) and the Kansas Department for Aging and Disability Services (KDADS) into a new Kansas Department of Human Services (DHS), and also would transfer juvenile services programs and juvenile facilities and institutions, except the Larned facility, from the Department of Corrections to the new DHS. Proponents, including the Kansas Association of Area Agencies on Aging and Disabilities (K4AD), DCCCA, the Kansas State Alliance of YMCAs, Interhab, the Children’s Alliance of Kansas and KVC Kansas, stated the new agency would integrate services and strengthen referrals, improve access to services in rural parts of the state and streamline processes to better serve high need and  crossover youth. Opponents, including Stuart Little of Little Government Relations and Melody Pappan, Cowley County Director of Juvenile Community Corrections, stated they oppose the provisions in the ERO related to moving juvenile correctional services because it might interrupt the progress made in juvenile justice reform in 2016 under Senate Bill (SB) 367 and could cause juvenile services to lose its voice with leadership in the larger agency. Committee members asked questions about the fiscal note, the Larned juvenile correction facility and juvenile justice reform reinvestment funds.

On Wednesday, February 19, DCF and KDADS Sec. Laura Howard briefed the Committee on the goals of ERO 44 and discussed the focus on prevention, enhancing access to services, creating stronger connections with community partners and removing barriers to data sharing across agencies. Committee members asked about existing DCF offices serving as local service centers, the impact of the transition on juvenile justice reform and how the community integrated approach would work.
 
On Thursday, February 20, the Committee worked ERO 44 and Chair Suellentrop’s motion to disapprove the ERO was approved. The Committee then worked SB 252 regarding Medicaid expansion and implementation of a reinsurance program, and heard a presentation from Kansas Legislative Research Department staff regarding whether other states were using their state funds to pay for abortions. The Committee then approved five amendments to the bill to (1) prohibit the use of Medicaid funds for abortions; (2) establish a 20 hour per month “participation requirement” for able-bodied adults; (3) protect conscience and religious exemptions for providers; (4) make the enactment of Medicaid expansion contingent upon passage of the constitutional amendment and the outcome of the Texas v. United States lawsuit; and (5) state that the previous amendments are non-severable. Chair Suellentrop suspended further work on the bill and there was no final action taken.

House Insurance Committee
(Rep. Jene Vickrey, Chair)

On Monday, February 17, the Committee held a hearing on HB 2598, a 20-page bill that would amend 13 Kansas statutes related to the regulation and licensure of pharmacy benefit managers (PBMs). Proponents of the bill, including representatives of the Kansas Pharmacists Association, Community Care Network of Kansas, National Alliance of State Pharmacy Associations, National Community Pharmacists Association, independent pharmacies, and patients and advocates, spoke of the need for patients to be able to choose where they purchase their medications, to require PBMs to provide information to patients and the Kansas Insurance Department about their claims processing procedures, and expand oversight of PBMs. Representatives of independent pharmacies expressed concerns about how PBMs establish their provider networks and shared concerns from patients about being able to purchase their prescriptions at their local pharmacy and the cost of prescription drugs.

On Wednesday, February 19, the Committee worked HB 2053 related to the definition and requirements for short-term, limited duration insurance plans. The bill, which would extend the permitted length of the term of such insurance plans to conform with federal regulations finalized in 2018, was amended by the Committee to revise the required notice to consumers when the policy is marketed and sold. The Committee then continued the hearing on HB 2598, related to the regulation and licensure of PBMs. Opponents of the bill — including the Pharmaceutical Care Management Association (PCMA), the national association that represents PBMs, Prime Therapeutics, a PBM owned by 18 not-for-profit Blue Cross and Blue Shield insurers, including Blue Cross and Blue Shield of Kansas, America’s Health Insurance Plans, and representatives of health insurance companies doing business in Kansas — argued that the bill would impact the ability of PBMs to contract with network providers and that the transparency provisions of the bill would create problems for competition in the drug supply chain. They also argued that the bill would not address concerns about the cost of prescription drugs and that it could have unintended consequences that result in increased costs. Committee members asked why the prices of drugs vary so much depending on where they are purchased, how drugs are priced, why drugs are more expensive in the U.S, and about PBM legislation enacted in other states.

Following the Committee meeting, a subcommittee met to discuss HB 2459, which would limit utilization review conducted by health insurers under certain circumstances involving the treatment of mental illness or substance abuse, especially for individuals who are actively suicidal. Subcommittee members asked follow-up questions of conferees including the Kansas Insurance Department (KID). Justin McFarland, General Counsel for KID, was asked how KID oversees and handles complaints related to mental health parity, the number of patients who encounter problems with their insurers, and the insurers involved in these complaints. Mr. McFarland indicated that KID had conducted a data call to try to obtain this type of information from the insurance companies but was not satisfied with the results of that effort.

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

No health-related issues were addressed this week.

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

On Monday, February 17, the Committee approved Gov. Kelly’s recommendations for the KDHE Budget, with the following adjustments: $3 million SGF for a Primary Care Grant, which would be void if Medicaid expansion or SB 363, which appropriates funds for primary care or dental clinics for fiscal years (FYs) 2021 and 2022, is enacted; added language to allow the agency to maintain the Medicaid reimbursement rate at FY 2020 levels until after the first quarter following approval of CMS adjusted rates; inclusion of language to encourage KDHE to establish the brain injury registry; $1.2 million SGF for dental reimbursements, which would be void if SB 349, which includes a provision to adjust provider rates for dental services, is enacted; $1.9 million increase in SGF funds for local health departments for FY 2021; and $2 million SGF for the tiny-k program. 

On Wednesday, February 19, the Committee held a hearing on HB 2549 which would set the protected income level for persons receiving home and community-based services at 150 percent of supplemental security income. Chair Carpenter explained that this change was made last session as a budget proviso, but the bill would make it permanent. Proponent testimony was provided by representatives of the KanCare Advocates Network, Midland Care Connection, Inc., and the Disability Rights Center of Kansas.

On Thursday, February 20, the Committee worked HB 2549 and passed it out favorably. It then worked HB 2550, which would increase reimbursement rates for providers of home and community-based services (HCBS) under the Intellectual/Developmental Disability (I/DD) waiver and passed it out favorably as amended. 

House Federal and State Affairs
(Rep. John Barker, Chair)

On Thursday, February 20, the Committee worked HB 2563, which would amend 21 existing statutes to increase the minimum age to purchase or possess cigarettes and tobacco products from 18 to 21; prohibit vending machine sales of cigarettes, e-cigarettes and other regulated products; and prohibit the sale of e-cigarettes containing any flavored consumable material except tobacco or menthol flavors. The bill was amended to conform with federal law increasing the minimum age to 21; to maintain licensing fees at $25; to include gaming floors in the Kansas indoor clean air act provisions and exempt vape shops; and move the effective date to July 1, 2021. Chair Barker encouraged the carrier of an amendment related to flavor ban exemptions in vape shops to submit language for consideration on the House floor and the bill, as amended, passed favorably out of Committee.

House Rural Revitalization Committee
(Rep. Adam Smith, Chair)

On Monday, February 17, the Committee held a hearing on HB 2677, regarding the establishment of primary health centers and enacting the primary health center pilot program act contingent upon state acceptance into a demonstration program under the Center for Medicare and Medicaid Innovation (CMMI). This new primary health center model would not have inpatient beds like a traditional hospital, but would provide emergency services, transitional care, emergent and non-emergent transportation and outpatient and ambulatory services (e.g., primary care, diagnostic testing). It also could include behavioral health and dental services. Proponent testimony was provided by Chad Austin, Senior Vice President Government Relations of the Kansas Hospital Association, who stated the goal of the program is to provide access to primary health care and emergency services and this bill would enable Kansas to participate in the CMMI pilot program as soon as it is rolled out. Legislators asked about the definition of rural used in the bill, the cost and necessity of this model, how a primary health center would differ from a federally qualified health center, the payment model, what changes would have to be approved by CMS, maternal health, and measures of quality. 

On Thursday, February 20, the Committee worked HB 2677. A motion to amend the bill to require primary health centers to have policies and systems in place regarding the treatment of the uninsured and underinsured, similar to “charity care” policies already in place in many hospitals, failed and the bill was passed out favorably.

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.