Budget Process Underway and Dentists Fight Back
It was a moderately busy week at the statehouse as we saw an acceleration in budget subcommittee reports, including medicaid program budgets. The hearing on the antipsychotics “informed consent” bill was cancelled, and has been rescheduled for next Tuesday. The biggest drama of the week was the pushback from dentists in Wednesday’s hearing for the new dental therapist bill.
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Budget Committees Recommend Nursing Home Funding Increase
The social service budget subcommittees in the House and Senate finally made their recommendations to the full House Appropriations and Senate Ways and Means Committees. While both social service budget committees recommended an increase in nursing home medicaid reimbursement, the amounts are much different.
**Reminder: Any reference to State Fiscal Year 2019 represents the calendar dates of July 1, 2018 to June 30, 2019**
House Social Service Budget Recommendation:
- Freeze nursing home rebasing requirement for state fiscal year 2019, and increase the current reimbursement rate for every nursing home by 4.25%. This is a budget expenditure of $27.1 million ($12.3 million in state funds, $14.8 million from federal funds)
- Change state policy on pending eligibility cases for HCBS, allowing retroactive payment to the date of the Medicaid application. Current policy is that payment will only date back to the start date of the service plan after eligibility approval. This is a budget expenditure of $3 million ($1.3 million from state funds, and $1.7 million in federal)
- Restore targeted case management for Frail Elder, Physically Disabled and Traumatic Brain Injury HCBS Waivers. This is a budget expenditure of $9.6 million ($4.8 million in state funds, $4.8 million in federal funds)
- Support the addition of $501,133 ($160,426 in state funds) in order to fund a salary increase for nursing home surveyors. The salary increase is intended to help recruit and fill empty surveyor positions.
- Increase funding for Meals on Wheels by 5% ($200,000 in state funds)
The House Appropriations Committee accepted all of the above recommendations.
Senate Social Service Budget Recommendation:
- Fund full rebase for nursing homes in state fiscal year 2019. This is a budget expenditure of $86.6 million ($38.7 million in state funds, $47.9 million from federal)
- Restore targeted case management for Frail Elder, Physically Disabled and Traumatic Brain Injury HCBS Waivers. This is a budget expenditure of $9.6 million ($4.8 million in state funds, $4.8 million in federal funds)
- Recommend $433,000 ($138,000 state funds) for salary increase for nursing facility surveyors
- Increase funding for Meals on Wheels by 2.5% ($100,000 in state funds)
The Senate Ways and Means Committee accepted all of the above recommendations.
What’s next? A lot.
All of the above recommendations will now be inserted into a large budget bill. This bill will then be debated and amended in committee. After it is approved by the committee, the budget bills have to pass their respective chambers. After they pass, the house and senate will then negotiate their two conflicting budget bills. The negotiated compromise then has to go back to each chamber and pass another vote. The last round of negotiatiosn and chamber votes will repeat itself until a compromise is finally reached that can pass both the house and senate. When that is accomplished, the budget is sent to the Governor for signature or veto.
And remember, they still haven’t started work on the school funding issue.
Dental Therapist Bill Gets Push Back
After a relatively tame hearing and vote process on the Senate side, there was suddenly a lot of dentist drama during this week’s House hearing on SB 312, which creates a new license for “dental therapists.” Health advocates and social service providers have battled with the Kansas Dental Association for almost a decade to establish mid-level dental practitioners. This year, a compromise was finally reached between advocates and the KDA in senate bill 312. The bill passed the Senate with very little controversy. It is now in the House, and the drama-free ride ended this week in the House Health and Human Services Committee. Quite a few individual dentists testified at the hearing, adamantly opposed to SB 312. One dentist stated that the dental association was shoving the compromise down their throats, and that none of the dentists he called around the state were supportive of the bill. Another dentist from Western Kansas told the committee that people out his way enjoyed beautiful sunsets, and felt sorry for all of the people in bigger cities. He stated that the bill is aimed at providing more access in rural areas, but people in western Kansas don’t want it. They drive two hours to go to Starbucks, and they have no problem driving two hours to see a dentist.
What else happened this week?
- HB 2590, which makes changes to the ombudsman program to match new federal requirements was passed out of the Senate Public Health and Welfare with a minor amendment. It will now head to the full senate for consideration.
- The hearing on “informed consent” for antipsychotics (HB 2704) was cancelled, and has been rescheduled for next Tuesday. However, a meeting of the stakeholders took place on Thursday afternoon in order for the group to share their views on the bill. So far, we know that LeadingAge Kansas, Kansas Hospital Association, and Kansas Medical Society are strongly opposed to the bill. Kansas Health Care Association is neutral on the bill. Kansas Advocates for Better Care and the Long Term Care Ombudsman are in support.
Bill Tracker
SB 195 and HB 2508 Requires KDHE to suspend (rather than terminate) medicaid eligibility for persons in a state hospital, nursing facility for mental health, or a correctional facility
SB 300 and HB 2507 Prohibits major changes to the Medicaid program without the consent of the legislature, instructs KDHE to withdraw its KanCare 2.0 application to CMS, and instead apply for a one year extension of current KanCare
SB 312 Licensure of dental therapists
HB 2427 Amends background checks in adult care homes to require fingerprinting, increases fees, and adds various new misdemeanor and felonies to the exclusion list
HB 2232 Electronic monitoring in adult care homes
HB 2458 Expands the type of crimes that qualify as mistreatment of a dependent adult or elder person
HB 2496 Nurse licensure compact establishing a multi-state license category
HB 2512 Establishes the Kansas telemedicine act
HB 2590 Changes to the long term care ombudsman program
HB 2704 Informed consent requirements for antipsychotic drugs
SCR 1609 Constitutional amendment limiting the authority to close schools to locally elected boards of education
