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CME
Posted on Thursday, June 22, 2017

Continuing Medical Education – Research Update on the DASH Dietary Pattern

AAFP/Midwest Dairy Council

The Dietary Approaches to Stop Hypertension (DASH) dietary eating pattern, which emphasizes low-fat and non-fat dairy products, fruit, vegetables and whole grains is one of the most widely prescribed dietary modifications for reducing blood pressure and cardiovascular disease risk.

Ronald M. Krauss, MD, senior scientist and director of atherosclerosis research at Children’s Hospital Oakland Research Institute, presented the latest research that supports the DASH Eating Plan as a tool for the prevention of a variety of health conditions, with a specific focus on key food components. In this recorded webinar Dr. Krauss, reviewed research on the modification of the DASH diet to allow for more liberal total and saturated fat intake, in conjunction with moderate carbohydrate intake resulting in similar benefits to blood pressure and no deleterious effects on lipid risk factors. Becky Schaffer, MS, RDN, LD, Clinical Dietitian at the Mayo Clinic working in the Division of Endocrinology with a focus on hypertension and nephrology will provide guidance on translating the DASH diet into real-life situations for dietitians and other health professionals. Follow this link to view the webinar. To download the slide deck for this webinar please click here.

 

Posted on Monday, June 19, 2017

U.S. Senate: Advocacy Action Needed

AAFP

The United States Senate is in the process of developing legislation aimed at repealing major portions of the Patient Protection and Affordable Care Act (ACA). 

The next ten days are crucial.  It is our understanding that the Senate may attempt to vote on this legislation the week of June 26.  Now is the time to speak up and speak out!  Thank you for your help!

1.    AAFP Speak Out Campaign – Write and call your Senators Pat Roberts and Jerry Moran – urging them to reject any legislation that would result in the loss of health care coverage for people in Kansas.  The goal should be to increase, not decrease health care coverage. http://www.aafp.org/advocacy/involved/toolkit/advocacy-resources/speak-out.html

 2.  Letter to the Editor – please use the sample letter provided [CLICK HERE] to communicate with your local papers. 

While there are many actions that could be taken to build upon the ACA and improve our health care system, the United States Congress has chosen a different path.  A path that leads towards greater numbers of uninsured, the dismantling of Medicaid, increased instability in our insurance markets, and higher costs for everyone.  These are all outcomes that the AAFP is committed to preventing.  The AAFP has been aggressively advocating on behalf of you and your patients on these issues.  We are asking you as a family physician to collaborate with the AAFP on this important work.  Here is why:

  • The AHCA is bad legislation that would have a negative impact on millions of people and our health care system generally.  According to the Congressional Budget Office (CBO), the House approved AHCA would result in 14 million people losing their health care coverage in 2018 and 23 million by 2026. 
  •  The AHCA would significantly harm Medicaid, the safety-net health care program for children, the elderly, and low-income adults.  The legislation proposes to cut over $800 billion from Medicaid in the next ten years.  Cuts of this size would result in millions losing their health care coverage and would place substantial strain on state budgets.
  • This bill has been and continues to be developed without an opportunity for public debate or amendment. To date, there have been no Committee hearings and no public briefings on the content of the Senate legislation.  While we recognize that the basis for the Senate’s work will be the American Health Care Act (AHCA), which was approved by the House of Representatives on May 4, we must rely on rumors and leaks to ascertain what changes might be proposed by the Senate.  The AAFP has been very successful in our efforts to communicate directly with numerous Senators, but the public deserves an opportunity to understand the impact the legislation would have on them and our nation well in advance of a vote. 

 A list of resources that demonstrate the impact of the AHCA on the states and the country.  Please use these as appropriate in your advocacy efforts. 

 

Sincerely,

John Meigs, Jr, MD                                                   Douglas E. Henley, MD

President                                                                    Executive Vice President/CEO

 


 

Posted on Monday, June 19, 2017

By: Dodie Wellshear, Government Relations Consultant

2017 Legislature Adjourns

The Legislature finally adjourned after 113 days of work, just one day shy of the record set in 2015. The major obstacle of the session ended up being the passage of a revenue package that would restore fiscal stability to the state and support vital state programs.

As final days melded into one another, the state was facing an $800 million shortfall over the next two years. Earlier in the session, the Legislature passed HB 2178, but the governor vetoed that tax proposal and the Legislature couldn’t muster the needed votes in both chambers to override that veto.

After numerous attempts at other revenue proposals, the Legislature was able to muster needed votes to pass a revenue package that provides enough to cover the projected two-year shortfall and fund the school finance package also passed near the session’s end. (See below for more detail on that tax bill.)

The 2016 elections proved vital to the restoration of fiscal responsibility in Kansas. Most of the new legislators came into the session with a sense of mission, believing they had been sent with a mandate to establish a constitutionally viable school finance plan and to structurally fix the state’s financial picture.

A clear challenge to those tasks throughout the session was a governor who held the power of the veto pen and was clear he would use it on any legislation that didn’t include his ideas for improvement. That threat loomed large as leaders in both chambers were challenged to cobble together, not just simple majorities – 63 in the House and 21 in the Senate – but super-majorities that would override potential vetoes.

Following the session’s adjournment, the governor did sign into law HB 2079, restoring the four-percent cuts to KanCare providers. The bill increases the privilege fee on MCOs, with additional balances going back into the program to support mental health and other critical medical services. A conference committee report that further details the final bill may be found here.

Legislature Overrides Tax Bill Veto

In what is now likely considered the most notable achievement of the 2017 session, the House and Senate mustered the two-thirds majority votes to override the governor’s veto of SB 30. Effective for the current tax year, most of the governor’s dramatic 2012 tax reforms were turned back, including the exemption for non-wage business income afforded to 330,000 businesses statewide.

The bill restores the individual itemized deduction for federally allowable medical expenses to 50% in 2018, 75% in 2019, and 100% in 2020. The itemized deductions for mortgage interest and property taxes paid would be increased from 50% to 75% in 2019, and to 100% in 2020.

Key to many legislators is the return of the child care tax credit that was repealed in 2012. The credit will be incrementally increased to 12.5% in 2018, 18.75% in 2019, and 25% in 2020.

Beginning in 2018, the low-income income tax exclusion would be reduced from $12,500 to $5,000 on married filers and from $5,000 to $2,500 on individuals.

The law expands income taxes to a three-bracket structure, rather than the two brackets instituted in the 2012 reform. Those rates and brackets are set as follows:

  • Up to $30,000 – 2.9% in 2017 and 3.10% in 2018 (was 3.5% before 2013);
  •       $30,001 - $60,000 – 4.6% in 2017 and 5.25% in 2018 (was 6.25% before 2013); and,
  •       $60,001 and above – 4.6% in 2017 and 5.7% in 2018 (was 6.45% before 2013).

The bill is expected to generate $591 million in FY2018; $633 million in FY2019; $617.4 million in FY2020; $584.4 in FY2021; and $590.3 million in FY2022. The slightly downward estimates for 2020 and beyond will again require the state to find additional revenues just to sustain state expenditures.

While the governor continued to hold to what most see as a failed tax policy, the majority of legislators were adamant that the 2012 law needed to be repealed. Many new legislators ran on a platform of adequately funding education and structurally fixing the state’s fiscal picture, and these continued to push for the needed rollbacks.

In the Senate, Majority Leader Jim Denning (R-Overland Park) led the effort to pass SB 30, as well as the Senate override vote of 27-13, admitting he had voted for the tax reform in 2012, but now sees that it didn’t work and needs to be fixed.

In the House, Speaker Ron Ryckman (R-Olathe) stepped up, as well, leading his chamber to an 88-31 override vote.

SB 30 did not include a $1.50 cigarette tax increase supported by KAFP and other advocates, which had the potential of raising upwards of $61 million in the next year and providing another tool in the battle against tobacco addiction in our state.

Last Legislative Update

This will be the last legislative update in 2017. Thank you for choosing me to represent your interests before the Kansas Legislature. It truly is a privilege I do not take lightly.

 

 

Posted on Monday, June 19, 2017

 Still time to register for Community Health Summit

KAFP

Please join KAFP and partner organizations for a Community Health Summit Wednesday, June 28, 2017, in Wichita, Kansas, focused on improving collaborative community health work in our state.

By attending this half-day summit, you will have the opportunity to network with health leaders from across the state, and learn how to plan and implement a Clinical Town Hall in your own community.  Register

Posted on Monday, June 19, 2017

Mark your calendars for these KAFP fall activities

KAFP

It is not to early to look ahead to fall upcoming KAFP activities!

Friday, September 29, 2017: KSA Group Learning Session: Preventive Care
Location TBD, Kansas City area - 1 p.m. - 4:30 p.m.

Friday, October 13, 2017: KSA Group Learning Session: Preventive Care
Marriott Hotel, Wichita, KS - 9 a.m. - 12:30 p.m.

Friday, October 13, 2017: Panel Highlight on Vaccination 4 Teens
Marriott Hotel, Wichita, KS - 2 p.m. - 5 p.m. 

Saturday, October 14, 2017: LET'S MOVE, KANSAS 3RD ANNUAL RUN/WALK
Sedgwick County Park, Wichita, KS - 9:00 a.m.

Posted on Monday, June 19, 2017

AAFP FMX Early Bird Deadline: June 30

AAFP

Early Bird Deadline: June 30The early bird deadline is approaching for FMX—the AAFP’s largest annual meeting, September 12-16 in San Antonio, TX. Register by June 30 to save $200 off the on-site price*. You don’t want to miss this chance to expand your family medicine knowledge, get energized by inspiring speakers, and network with peers.

Act soon to save $200.

    Register Now    

 

This offer includes the $200 early bird discount. This offer does not apply to students, residents, inactive, or life members.


Posted on Monday, June 19, 2017

Join a KAFP Committee: Respond by July 6

KAFP

You are invited! KAFP is pleased to offer the opportunity for you to get involved with your organization by volunteering to serve on a committee. Through committee involvement you can help determine the direction of family medicine. Click here to indicate the committees in which you are interested. Appointed committee members help form policy and make recommendations to keep the organization at the forefront of the specialty on a variety of topics affecting the specialty.

Please respond by Monday, July 6 to ensure that your request is reviewed during our upcoming appointment process. If you have questions, please contact us at kafp@kafponline.org or 316.721.9005. Thank you for your interest!

Posted on Monday, June 19, 2017

Annual Meeting evaluation - complete by June 23

KAFP

2017 KAFP Annual Meeting attendees are encouraged to complete the online evaluation to help us plan for future meetings. If you fill out an evaluation and submit  it with your name by midnight June 23, you will be placed into a drawing.  The prize is FREE REGISTRATION to the 2018 Annual Meeting, June 14-16 in Overland Park. Thank you for your time. Good luck!  CLICK HERE for evaluation.

Posted on Monday, June 19, 2017

Meningococcal toolkit available

Immunize Kansas Coalition

The Immunize Kansas Coalition (IKC) announces the availability
of a new meningococcal toolkit focused on increasing the Kansas immunization
rates for the conjugate meningococcal (A,C,W,Y) vaccine. Kansas has one of the lowest meningococcal immunization rates in the country. Let's change that.  The goal is to increase the immunization rate in Kansas youth from 64 percent currently to 80 percent by the year 2020. You can access the toolkit at http://www.immunizekansascoalition.org/meningitis‐toolkit.asp.

Posted on Monday, June 12, 2017

2017 Summary | Bill Tracker

By: Dodie Wellshear, Government Relations Consultant

Summary of Legislation

This document contains a summary of legislation relevant to the policy priorities and professional practice of the Kansas Academy of Family Physicians.  Included are bills passed by the Legislature and some that did not advance in 2017.

Legislation Passed

SB 32 – Medical Student Loan Act and Medical Residency Bridging Program—Eligible Practice Areas; Restrictions on Outsourcing and Privatization

SB 32 amends the Medical Student Loan Act (Act) and the statute establishing the Kansas Medical Residency Bridging Program (Program), and restricts the outsourcing and privatization of certain state operations and facilities.

Medical Student Loan Act

The bill amends the Act by expanding the eligible practice areas loan recipients may engage in to meet their loan obligations under the Act. The bill adds general psychiatry and child psychiatry to the definitions of “approved postgraduate residency training program” and “service commitment area.” The bill also allows a loan recipient under the Act to meet the loan obligation to engage in the full-time practice of medicine and surgery in a service commitment area if the person served as a full-time faculty member of the University of Kansas School of Medicine (KUMC) in general or child psychiatry. Additionally, the bill allows a loan recipient to satisfy the obligation to engage in the full-time practice of medicine and surgery in a service commitment area by performing at least 100 hours per month of on-site mental health care at a medical facility, a community mental health center, Larned State Hospital (LSH), Osawatomie State Hospital (OSH), or any facility that provides mental health services and is operated by a state agency.

The bill requires, subject to appropriations, KUMC to enter into medical student loan agreements with six individuals who commit to satisfying their loan obligations by practicing or teaching, as described above, general or child psychiatry. The bill creates the Psychiatry Medical Loan Repayment Fund in the State Treasury, and all moneys credited to the Fund shall be expended only for expenses associated with general or child psychiatry students under the Act. The bill specifies that no moneys shall be transferred from the Comprehensive Grant Program account of the State Board of Regents to the Medical Loan Repayment Fund or the Psychiatry Medical Loan Repayment Fund or expended for any related purposes.

Kansas Medical Residency Bridging Program

The bill amends the statute establishing the Program by expanding the eligible practice areas. The bill adds persons in a mental health care residency training program in general or child psychiatry to the list of persons with whom KUMC may enter into residency bridging loan agreements.

The bill requires, subject to appropriations, KUMC to enter into residency bridging loan agreements with three medical residents training in general or child psychiatry. The bill creates the Rural Health Bridging Psychiatry Fund in the State Treasury, and all moneys credited to the Fund shall be expended only for expenses associated with general psychiatry or child psychiatry residents under the Program. The bill specifies that no moneys shall be transferred from the Comprehensive Grant Program account of the State Board of Regents to the Rural Health Bridging Psychiatry Fund or expended for any related purposes.

Restrictions on Outsourcing and Privatization of Certain State Operations and Facilities

The bill prohibits the outsourcing or privatization of any operation or facility of LSH, OSH, or any facility that provides mental health services and is operated by a state agency, including, but not limited to, any action to transfer all or any part of the rated bed capacity at LSH or OSH without specific authorization by the Legislature. Additionally, the Secretary for Aging and Disability Services shall not be allowed to transfer or assign any person admitted to an institution for the purpose of circumventing the outsourcing or privatization restrictions imposed in KSA 2016 Supp. 75-3373.

The bill takes effect upon publication in the Kansas Register.

HB 2026 - Medicaid (KanCare) Process and Contract Requirements

HB 2026 changes the Kansas Program of Medical Assistance (KMAP) by amending law and creating in law processes for managed care organizations (MCOs) providing Medicaid services by providing for the services of an independent auditor, and by creating an external independent third-party review process (external review).

Kansas Department of Health and Environment (KDHE) Processes

The bill requires the Secretary of Health and Environment (Secretary) to provide accurate and uniform patient encounter data to participating health care providers upon request within 60 calendar days, including, but not limited to, the amount billed by revenue code and procedure code. The bill authorizes KDHE to charge a reasonable fee for furnishing the data.

Managed Care Organization Processes

Education

The bill requires the Secretary to compel the MCOs to provide quarterly in-person education for participating health care providers regarding billing guidelines, reimbursement requirements, and program policies and procedures utilizing a format approved by the Secretary and incorporating information collected through semi-annual surveys of participating health care providers.

Each MCO is required to offer quarterly in-person training on remark codes and Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard denial reasons and any other denial reasons or remark codes specific to the MCO.

Documentation

The bill requires the Secretary to compel any MCO providing state Medicaid or Children’s Health Insurance Program (CHIP) services under the KMAP to provide documentation to a health care provider when the MCO denies any portion of any claim for reimbursement submitted by the provider, including a specific explanation of the reasons for denial and utilization of remark codes, remittance advice, and HIPAA standard denial reasons.

 

Standards

The bill requires the Secretary to develop the following uniform standards to be utilized by the MCOs:

·         A standardized enrollment form and a uniform process for credentialing and re- credentialing health care providers who have signed contracts or participation agreements with any MCO;

·         Procedures, requirements, periodic review, and reporting of reductions in and limitations for prior authorization for health care services and prescriptions;

  • Retrospective utilization review of readmissions that complies with applicable federal statutory or regulatory requirements for the Medicaid program or CHIP, prohibiting such reviews for any individual covered by KMAP who is readmitted with a medical condition as an inpatient to a hospital more than 15 days after the patient’s discharge;
  • A grievance, appeal, and state fair hearing process that complies with applicable federal and state statutory procedure requirements, including any statutory remedies for timely resolution of grievances, appeals, and state fair hearings, imposed upon MCOs providing state Medicaid and CHIP services; and
  • Requirements that each MCO, within 60 calendar days of receiving an appeal request, provide notice and resolve 100 percent of provider appeals, subject to remedies, including, but not limited to, liquidated damages if provider appeals are not resolved within the required time.

Independent Auditor

The Secretary is required to procure the services of an independent auditor to review, at least once per calendar year, a random sample of all claims paid and denied by each MCO and the MCO’s subcontractors. Each MCO and its subcontractors are required to pay any claim the independent auditor determines to be incorrectly denied. The bill provides each MCO and its subcontractors may be required to pay liquidated damages, as determined by KDHE. Each MCO and its subcontractors are required to pay the cost of audits conducted under the provisions for an independent auditor.

The independent auditor provisions in the bill expire on January 1, 2020.

Payment to Nursing Facilities with a Change in Ownership

Under the bill, the Secretary requires each MCO to pay 100 percent of the State’s established per diem rate to nursing facilities for current Medicaid-enrolled residents during any re-credentialing process caused by a change in ownership of the nursing facility.

Licensed Pharmacy or Pharmacist

On and after July 1, 2017, a MCO providing state Medicaid or CHIP services under the KMAP is prohibited from discriminating against any licensed pharmacy or pharmacist located within the geographic coverage area of the MCO that is willing to meet the conditions for participation established by the KMAP and to accept reasonable contract terms offered by the MCO.

Rules and Regulations

Additionally, the Secretary is required to adopt rules and regulations as necessary to implement the requirements regarding data production and training, standardization, the provision of an independent auditor, payment to nursing facilities with a change in ownership, and non-discrimination against a licensed pharmacy or pharmacist, prior to January 1, 2018.

External Independent Third-party Review Process

The bill requires implementation of an external review process for providers who have received denial of KMAP services and have exhausted the MCO’s internal appeals process.

Managed Care Organizations Notification Requirements

Any letter from a MCO to a participating health care provider reflecting a final decision of the MCO’s internal appeal process is required to state:

  • The provider’s internal appeal rights within the MCO have been exhausted;
  • The provider is entitled to an external review; and
  • The requirements to request an external review.

MCOs are subject to a penalty paid to the provider, not to exceed $1,000, for failing to meet the above requirements in a final decision letter.

Eligibility

On and after January 1, 2020, a provider who has been denied a health care service to a recipient of medical assistance or a claim for reimbursement to the provider for a health care service rendered and who has exhausted the MCO internal written appeals process is entitled to an external review of the MCO’s final decision.

Request for External Review

To request an external review, an aggrieved provider is required to submit a written request to the MCO within 60 calendar days of receiving the final decision resulting from the MCO’s internal review process. The written request is required to include each specific issue and dispute directly related to the adverse final decision issued by the MCO, the basis upon which the provider believes the MCO’s decision to be erroneous, and the provider’s designated contact information.

Within five business days of receiving a request, the MCO is required to:

  • Confirm with the provider, in writing, receipt of the request;
  • Notify KDHE of the request; and
  • Notify the recipient of the medical assistance of the request, if related to denial of the health care service.

If the MCO fails to satisfy the notification requirements, the provider automatically prevails in the review.

Within 15 days of receiving a request, the MCO is required to submit to KDHE all documentation submitted by the provider in the course of the MCO’s internal appeal process and provide the MCO’s designated contact information. If the MCO fails to satisfy these requirements, the provider automatically prevails in the review.

Review by Office of Administrative Hearings

The bill requires an external review automatically extend the deadline to request a hearing before the Office of Administrative Hearings (OAH) of the Department of Administration pending the outcome of the external review and, upon conclusion of the external review, the external independent third-party reviewer (reviewer) is required to forward a copy of the decision and new notice of action to the provider, recipient, applicable MCO, KDHE, and the Kansas Department for Aging and Disability Services (KDADS). When a deadline to request a hearing before the OAH has been extended pending the outcome of an external review, all parties are granted an additional 30 days from receipt of the review decision and notice of action to request a hearing before the OAH.

The bill requires KDHE and KDADS to immediately request a continuance from the OAH if a recipient of medical assistance or participating heath care provider files a request for a hearing before the OAH regarding a claim for which the provider has filed a request for external review. KDHE and KDADS are also required to forward the decision of the review to the OAH for consideration by the hearing officer together with any other facts of the case.

KDHE Requirements

Upon receiving notification of a request for an external review, KDHE is required to:

  •        Assign the review to a reviewer;
  •        Notify the MCO of the identity of the reviewer; and
  •        Notify the provider of the identity of the reviewer.

KDHE is required to deny a request for external review if the requesting provider fails to exhaust the MCO’s internal appeal process or submit a timely request for an external review.

Multiple Appeals

The bill allows multiple appeals to the external review process regarding the same recipient of medical assistance, a common question of fact, or interpretation of common applicable regulations or reimbursement requirements to be determined in one action upon request. The bill allows other initial denials of claims to be added to such review prior to final decision and after exhaustion of the MCO internal appeals process if the claims involve a common question of fact or interpretation of common applicable regulation or reimbursement requirements.

Reviewer Limitations and Requirements

The reviewer is allowed to review only the documentation submitted by the provider in the course of the MCO’s internal appeal process. The reviewer is required to conduct a review of any claim submitted to the reviewer and issue a final decision to the provider, the MCO, and KDHE within 30 calendar days from receiving the request for review from KDHE and the documentation submitted by the provider during the MCO internal review process. The reviewer is allowed to extend the time to issue a final decision by 14 calendar days upon agreement of both parties.

Final Decision

Within ten business days of receiving a final decision of the external review, the MCO is required to notify the impacted recipient of the medical assistance and the participating health care provider of the final decision, if related to the denial of the health care service.

A party is allowed to appeal the final decision to the OAH within 30 calendar days from receiving the final decision of the reviewer.

The final decision of any external review directs the losing party of the review to pay an amount equal to the costs of the review to the reviewer. Any payment ordered is stayed pending any appeal of the review. If the final outcome of any appeal is to reverse the decision of the external review, the losing party of the appeal is required to pay the costs of the review to the reviewer within 45 calendar days of entry of the final order.

Rules and Regulations

KDHE is required to adopt rules and regulations to implement the provisions of the external review process prior to January 1, 2020.

HB 2027 - Anatomic Pathology Billing; Institutional Licenses; Immunity from Civil Liability

HB 2027 makes several amendments to the Kansas Healing Arts Act.

The bill allows a physician providing services to a patient pursuant to a medical retainer agreement to bill for anatomic pathology services when the patient’s bill meets certain specifications. The patient’s bill for such services must identify the laboratory or physician that performed the services, disclose in writing to the patient the actual amount charged by the physician or laboratory that performed the service, and be consistent with rules and regulations adopted by the State Board of Healing Arts for appropriate billing standards applicable to such services when furnished under the agreement.

The bill also amends a statute governing institutional licenses and restrictions placed on practice privileges of these license holders. The bill reinserts language removed in 2014 to allow for reinstatement of an institutional license of an individual who was issued an institutional license prior to May 9, 1997, and who is providing mental health services under a written protocol with a person who holds a Kansas license to practice medicine and surgery other than an institutional license.

Finally, the bill amends the law regarding immunity from liability in civil actions for persons reporting, communicating, and investigating (reporting) certain information concerning alleged malpractice incidents. The bill provides immunity to a person reporting an alleged malpractice incident from civil liability that may otherwise be incurred in an action resulting from reporting such information and requires a court to allow the person reporting, whom the court finds to have reported in good faith, a reasonable amount for attorney’s fees and expenses incurred in defending a civil action.

HB 2030 - Minimum Age for Vaccination; Reporting Requirement; Opt Out

HB 2030 amends the Kansas Pharmacy Act to change, from 18 to 12 years of age, the minimum age for a person to whom a pharmacist or a pharmacy student or intern working under the direct supervision and control of a pharmacist is authorized to administer a vaccine, other than the influenza vaccine, pursuant to a vaccination protocol and with the requisite training. Continuing law requires immunizations provided under the authorization of the Kansas Pharmacy Act be reported to appropriate county or state immunization registries. The bill allows the person vaccinated or, if the person is a minor, the parent or guardian of the minor to opt out of the registry reporting requirement.

The bill also requires that, on and after July 1, 2020, physicians and other persons authorized in Kansas to administer vaccines to a person report the administration of a vaccine in the state to the state registry maintained for this purpose by the Secretary of Health and Environment (Secretary). However, the bill allows the person vaccinated or, if the person is a minor, the parent or guardian of the minor to opt out of the registry reporting requirement. The manner and form of the reporting is determined by the Secretary. For this purpose, the bill defines “physician” as a person licensed to practice medicine and surgery.

HB 2079 – Increasing Privilege Fees on HMOs; Restoring Medicaid Provider Cuts; KanCare Reform

HB 2079 would create law to allow supplemental Medicaid reimbursement for certain providers of ground emergency medical transportation services and would create an intergovernmental transfer program relating to Medicaid managed care, ground emergency medical transport services, and those services provided by certain emergency medical services personnel in prestablization and preparation for transport.

In addition, the bill would increase the annual privilege fee assessed on every health maintenance organization (HMO), change the privilege fee payment structure, create a priority system for use of revenue from the assessment, change accounting procedures for the portion of the assessment dedicated to the Kansas Newborn Screening Fund, and establish a limit on the amount to be transferred to the Kansas Newborn Screening Fund.

Supplemental Medicaid Reimbursements

In addition to the rate of payment that a provider would otherwise receive for Medicaid ground emergency medical transportation services, a provider would be eligible for supplemental Medicaid reimbursement to the extent provided by law, if a provider meets the following conditions during the reporting period:

  • Provides ground emergency medical transportation services to Medicaid beneficiaries;
  • Is enrolled as a Medicaid provider for the period being claimed; and
  •  Is owned or operated by the state, a political subdivision, or local government, that employs or contracts with persons or providers who are licensed or permitted to provide emergency medical services in the state of Kansas, including hospitals and private entities to the extent permissible under federal law.

An eligible provider’s supplemental reimbursement would be required to be calculated and paid as follows:

  • The supplemental reimbursement to an eligible provider would be equal to the amount of federal financial participation received as a result of the claims submitted pursuant to federal law;
  • The amount certified in conformity with federal regulations and eligible for federal financial participation, when combined with the amount received from all other sources of reimbursement from the Medicaid program, could not exceed or be less than 100.0 percent of actual costs for ground emergency medical transportation services, as determined pursuant to the Medicaid state plan; and
  •  The supplemental Medicaid reimbursement would be distributed exclusively to eligible providers under a payment methodology based on ground emergency medical transportation services provided to Medicaid beneficiaries by eligible providers on a per-transport basis or other federally permissible basis.

The Kansas Department of Health and Environment (KDHE) would be required to obtain approval from the federal Centers for Medicare and Medicaid Services (CMS) for the payment methodology to be utilized prior to making any supplement Medicaid reimbursement payments.

The bill would state the Legislature’s intent to enact the provisions of the bill without any State General Fund expenditures.

An eligible provider, as a precondition to receiving the supplemental Medicaid reimbursements, would be required to enter into and maintain an agreement with KDHE for the purposes of implementing the payments and reimbursing KDHE for the costs of administering the payments.

The non-federal share of the supplemental Medicaid reimbursement submitted to CMS for purposes of claiming federal financial participation would be paid only with funds from governmental entities owned and operated by the State, a political subdivision, or local government, that employs or contracts with persons or providers who are licensed or permitted to provide emergency medical services in Kansas, including hospitals and private entities to the extent permissible under federal law and who are certified as described below.

Participation in the supplemental Medicaid reimbursement program by an eligible provider would be voluntary. In order to seek supplemental Medicaid reimbursement, an applicable governmental entity would be required to do the following:

  • Certify, in conformity with federal regulations, the claimed expenditures for the ground emergency medical transportation services are eligible for federal financial participation;
  • Provide evidence supporting the certification as specified by KDHE;
  • Submit data, as specified by KDHE, to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation; and
  •  Keep, maintain, and have readily retrievable any records specified by KDHE to fully disclose reimbursement amounts to which the eligible provider is entitled, and any other records required by CMS.

KDHE would be required to promptly seek any necessary federal approvals for the implementation of supplemental Medicaid reimbursements and would be allowed to limit the reimbursements to those costs allowable under Title XIX of the federal Social Security Act. If federal approval is not obtained for implementation of the supplemental Medicaid reimbursements, the section of the bill related to the reimbursements would not be implemented.

KDHE would be required to submit claims for federal financial participation for the expenditures allowable under federal law for the services related to requirements for participation in the reimbursements. KDHE would also be required to submit any necessary materials to the federal government to provide assurances that claims for federal financial participation would include only those expenditures allowable under federal law.

KDHE would be able to utilize intergovernmental transfers or certified public expenditures to implement the supplemental Medicaid reimbursement subject to provisions and requirements of the bill.

Intergovernmental Transfer Program

KDHE would be required to design, and implement, in consultation and coordination with providers eligible for the program, an intergovernmental transfer program (Program) relating to Medicaid managed care, ground emergency medical transport services and those services provided by emergency medical services personnel at the emergency medical responder, emergency medical technician, advanced emergency medical technician, and paramedic levels in the prestabilization and preparation for transport.

A provider would only be eligible to transfer public funds to the State pursuant to the Program in an applicable reporting period if a provider meets both of the following conditions:

  •  Provides ground emergency medical transport services to Medicaid managed care enrollees pursuant to a contract or other arrangement with a Medicaid managed care plan; and
  •  Is owned or operated by the State, a political subdivision, or local government that employs or contracts with persons or providers who are licensed or permitted to provider emergency medical services in Kansas, including hospitals and private entities to the extent permissible under federal law.

To the extent intergovernmental transfers are voluntarily made by and accepted from, an eligible provider described above or a governmental entity affiliated with an eligible provider, KDHE would be required to make increased capitation payments to applicable Medicaid managed care plans. The increased capitation payments would be required to be at least actuarially determined amounts to the extent permissible under federal law. Funds associated with intergovernmental transfers would be required to be used to fund additional payments to Medicaid managed care plans.

Medicaid managed care plans would be required to enter into contracts or contract amendments with eligible providers for the disbursement of increased capitation payments related to intergovernmental transfers.

The Program developed would be implemented on the date federal approval is obtained, and only to the extent intergovernmental transfers from the eligible provider, or the governmental entity with which it is affiliated, are provided for that purpose.

KHDE would be required to implement the Program and increased capitation payments on a retroactive basis, as approved by CMS and to the extent permissible by federal law. Participation in the Program would be voluntary on the part of the transferring entities for purposes of all applicable federal laws.

The bill would specify the Program would be required to be implemented without any additional State General Fund expenditures. As a condition of participation in the Program, eligible providers or the governmental entity affiliated with an eligible provider, would be required to agree to reimburse KDHE for any costs associated with implementing the Program. Intergovernmental transfers would be subject to a fee of up to 20.0 percent of the non-federal share paid to KDHE and would not be allowed to count as a cost of providing the services not to exceed 120.0 percent of the total amount.

As a condition of participation in the Program, Medicaid managed care plans, eligible providers, and governmental entities affiliated with eligible providers would be required to comply with any requests for information or similar data requirements imposed by KDHE for purpose of obtaining supporting documentation necessary to claim federal funds or to obtain federal approvals.

The Program would be implemented only if and to the extent federal financial participation is available and would not otherwise be jeopardized and any necessary federal approvals had been obtained. KDHE would be allowed to return or not accept intergovernmental transfers, or adjust payments as necessary to comply with federal Medicaid requirements. The State and KDHE would be required to implement whatever program CMS approves for use under the act.

HMO Privilege Fee and Medical Assistance Fee Fund

The annual privilege fees assessed on every HMO would be increased to 5.77 percent for the reporting period beginning January 1, 2018.

The bill would direct the moneys collected from this annual assessment be deposited to the credit of the Medical Assistance Fee Fund (in KDHE). The bill would also create in the State Treasury, the Community Mental Health Center Improvement Fund to be used by the Kansas Department for Aging and Disability Services and would restrict use of the moneys in this fund for purposes related to Community Mental Health Centers.

The bill would specify moneys in the Medical Assistance Fee Fund must be expended in the following priority:

  • First, restore any reductions initiated during calendar year 2016 to provider reimbursement rates for state Medicaid services;
  • Second, $3.5 million in FY 2018, and $5.0 million every fiscal year thereafter, would be transferred to the Community Mental Health Center Improvement Fund to be used for purposes related to Community Mental Health Centers, the amount transferred could not exceed $5.0 million in any one fiscal year;
  • Third, the estimated amount necessary to fund the Newborn Screening Program for the ensuing fiscal year would be transferred to the Kansas Newborn Screening Fund and such amount could not exceed $2.5 million in any one fiscal year; and
  • Fourth, any remaining moneys would be expended for the purpose of Medicaid medical assistance payments.

The bill would also remove the July 1, 2018, sunset date on the increased privilege fee.

[Note: Under current law, the privilege fee is 3.31 percent for the period beginning January 1, 2015, and ending December 31, 2017, and 2.00 percent on and after January 1, 2018. In addition, the moneys collected from the privilege fee are to be deposited to the credit of the State General Fund, except during the period beginning July 1, 2015, and ending on June 30, 2018, when the moneys are to be deposited to the credit of the Medical Assistance Fee Fund.]

HMO Privilege Fee and Payments

On and after January 1, 2018, each HMO would be required to submit a report to the Commissioner of Insurance (Commissioner), on or before March 31 and September 30 each year, containing an estimate of the total amount of all charges to enrollees expected to be collected during the current calendar year.

Upon filing each March 31 report, HMOs would be required to submit payment equal to half of the privilege fee that would be assessed for the current calendar year based on the reported estimate. Upon filing each September 30 report, HMOs would submit a payment equal to the balance of the privilege fee that would be assessed for the current calendar year based upon the reported estimate.

Currently, privilege fee payments are submitted annually on or before March 1 and based on actual collections in the previous calendar year.

Any amount owed by an HMO during any calendar year in excess of the estimated amount would be assessed by the Commissioner and would be due and payable upon issuance of the assessment. Any amount overpaid by an HMO would be reconciled upon assessment of privilege fees in the ensuing calendar year and credited against future privilege fee assessments or refunded in cases when the HMO is no longer doing business in Kansas.

Kansas Newborn Screening Fund

On or before July 1 of each year, the Director of Accounts and Reports would be required to determine the amount credited to the Medical Assistance Fee Fund from the privilege fee assessment and transfer the estimated amount necessary to fund the Newborn Screening Program for the ensuing fiscal year to the Kansas Newborn Screening Fund. The amount could not exceed $2.5 million in any one fiscal year.

Currently, the transfers are to be determined and made monthly from a portion of the privilege fee revenue transferred to the State General Fund, although the revenue has been deposited in the Medical Assistance Fee Fund since July 1, 2015.

Conference Committee Action

The Conference Committee agreed to remove the contents of HB 2079 (pertaining to water district vehicles), insert the contents of HB 2180, as amended by the House Committee, and further agreed to amend the bill as follows:

  • Change the start date of the privilege fee increase from July 1, 2017, to January 1, 2018, and remove the January 1, 2023, decrease;
  • Add language to establish the semi-annual payment structure;
  •  Add language to specify the funding for the Newborn Screening Program would be transferred from the Medical Assistance Fee Fund and the maximum amount of the transfer would be $2.5 million per fiscal year;
  • Change the amount of the privilege fee revenue dedicated to Community Mental Health Centers from $15.0 million in FY 2019 and beyond to $5.0 million per fiscal year and establish the amount would not exceed $5.0 million per fiscal year; and
  • Add the contents of SB 186 (pertaining to supplemental Medicaid reimbursement), as passed by the Senate Committee of the Whole.

Fiscal Information for HB 2079 Conference Committee Report

Staff estimated HB 2079, as modified by the action of this Conference Committee, would increase revenue for FY 2018 by $108.6 million, all to the Medical Assistance Fee Fund, and would increase expenditures by $161.3 million, including $71.8 million from the State General Fund, for additional managed care organization (MCO) expenditures and restoration of Medicaid provider rate reductions resulting from the May 2016 State General Fund allotment. After the $3.5 million transfer for Community Mental Health Centers, additional revenue could be used to offset State General Fund expenditures, making the net effect a reduction in State General Fund expenditures of $33.3 million. [Note: including the Governor’s recommendations for FY 2018, the net impact would be a reduction in State General Fund expenditures of $61.2 million.]

Staff estimated, for FY 2019, there would be increased revenue of $144.6 million, but a State General Fund revenue decrease of $72.5 million. There would be an estimated increase in expenditures of $226.7 million, including $100.6 million from the State General Fund. After the $5.0 million transfer for Community Mental Health Centers, the net effect would be a reduction in State General Fund expenditures of $111.5 million for FY 2019. [Note: including the Governor’s recommendations for FY 2019, the net impact would be increased State General Fund expenditures of $11.2 million.]

In addition, according to the fiscal note prepared by the Division of the Budget on SB 186, as introduced, enactment of provisions related to supplemental Medicaid reimbursement and the intergovernmental transfer program would increase expenditures for KDHE by $577,925, including $288,963 from the State General Fund, for FY 2018 for a contract to train staff and collect and analyze cost data. The increase in revenue and expenditures of $6.3 million for FY 2019 would net to no impact. KDHE also estimates an additional 0.5 FTE position would be necessary for both FY 2018 and FY 2019 to implement the provisions. Any fiscal effect associated with provisions from SB 186 is not reflected in The FY 2018 Governor’s Budget Report.

Legislation Not Passed

HB 2044 – KanCare Expansion, Bridge to a Healthy Kansas

HB 2044 would have established the KanCare Bridge to a Healthy Kansas Program (Program). The Kansas Department of Health and Environment (KDHE) would be required to administer and promote the Program and provide information to potential eligible individuals who live in medically underserved areas of the state. The bill modified the eligibility requirements for the Kansas Medical Assistance Program, on or after January 1, 2018, to include any non-pregnant adult under 65 years of age who is a U.S. citizen or legal resident and who has been a resident of Kansas for at least 12 months, whose income does not exceed 133 percent of the federal poverty level (FPL), to the extent allowed under the federal Social Security Act as it exists on the effective date of the bill, and subject to the requirements of the Program. The bill would require referral to workforce training programs, create a Program Drug Rebate Fund and a Program Privilege Fee Fund, create a health insurance coverage premium assistance program, address federal denial and approval of financial participation, require submission of a waiver request to the federal government, require various Program reports to the Legislature, and create a Program Working Group.

Additionally, the bill would have required the Secretary of Health and Environment (Secretary) to include reimbursement for clubhouse rehabilitation services within the Medicaid program on and after the effective date of the bill, subject to the limits of appropriations. The bill would authorize the Secretary to enter into contracts with certified clubhouse providers and require the contracts be entered into by July 1, 2017, with an expiration date of July 1, 2020. The bill would limit reimbursement under the contracts to $1.0 million for any one fiscal year. The bill defines “clubhouse” and requires a report be made to select legislative committees. The bill takes effect upon publication in the Kansas Register.

HB 2205 – Requiring Meningitis Vaccinations

HB 2205, as amended, would have added meningitis to the list of required vaccinations specified under KAR 28-1-20(b). The vaccination would be required at no earlier than age 11 with a booster at age 16 or later.

The Kansas Department of Health and Environment (KDHE) administrative regulation referenced in the bill would require each susceptible child to receive the following vaccinations before enrolling in any Kansas school: diphtheria, hepatitis B, measles (rubeola), mumps, pertussis (whooping cough), poliomyelitis, rubella (German measles), tetanus, and varicella (chickenpox). A religious exemption and an exemption for a child whose physical condition is such that tests or inoculations would seriously endanger the life or health of the child are specified under current law (KSA 72- 5209(b)).

HB 2231 – Increasing the Tax on Cigarettes and Other Tobacco Products

HB 2231 would increase the state’s cigarette and tobacco products taxes on July 1, 2017. The bill would increase the cigarette tax to $2.79 a pack (from $1.29 a pack) and increase the tobacco products tax to 65- percent of the wholesale price (from 10.0 percent). The bill would establish an inventory tax for all cigarette and tobacco products on hand as of July 1, 2017. The inventory tax would be $1.50 per pack for cigarettes and would be due on October 31, 2017. The inventory tax would be 55.0 percent of the wholesale sales price for tobacco products on hand as of July 1, 2017 and the inventory tax would be due on July 31, 2017.

The bill would also create the Cigarette and Tobacco Cessation Fund to be administered by the Kansas Department of Health and Environment (KDHE) to promote the cessation of cigarette and tobacco usage. The first $5.0 million in cigarette and tobacco products tax revenue collected each year would be deposited in the Cigarette and Tobacco Cessation Fund.

Note: Bill descriptions provided by the Kansas Legislative Research Department

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