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SENATE BILL No. 271
AN A CT concerning public assistance; relating to the eligibility and oversight thereof;
updating income requirements for the state children's health insurance program;
relating to the Robert G. (Bob) Bethell joint committee on home and community
based services and KanCare oversight; requiring the committee hold meetings each
quarter; amending K.S.A. 38-2001 and 39-7,160 and repealing the existing sections.
Be it enacted by the Legislature of the State of Kansas:
Section 1. K.S.A. 38-2001 is hereby amended to read as follows:
38-2001. (a) The department of health and environment shall develop
and submit a plan consistent with federal guidelines established under
section 4901 of public law 105-33 (, 42 U.S.C. § 1397aa et seq. ;, title
XXI).
(b) The plan developed under subsection (a) shall be a capitated
managed care plan covering Kansas children from zero to 19 years
which of age that:
(1) Contains benefit levels at least equal to those for the early and
periodic screening, diagnosis and treatment program;
(2) provides for presumptive eligibility for children where
applicable;
(3) provides continuous eligibility for 12 months once a formal
determination is made that a child is eligible subject to subsection (e);
(4) has performance based performance-based contracting with
measurable outcomes indicating age appropriate utilization of plan
services to include, including, but not limited to, such measurable
services as immunizations, vision, hearing and dental exams,
emergency room utilization, annual physical exams and asthma;
(5) shall use the same prior authorization standards and
requirements as used for health care services under medicaid to further
the goal of seamlessness of coverage between the two programs;
(6) shall provide targeted low-income children, as defined under
section 4901 of public law 105-33 ( , 42 U.S.C. § 1397aa , et seq. ),
coverage subject to appropriations; and
(7) shall provide coverage, subject to appropriation of funds and
eligibility requirements, for children residing in a household having a
gross household income (A) for 2009, at or under 225% of the 2008
federal poverty income guidelines and (B) for 2010 and subsequent
years, at or under 250% of the 2008 federal poverty income
guidelines;. The participants receiving coverage shall contribute to the
payment for such coverage through a sliding-fee scale based upon
ability to pay as established by rules and regulations of the secretary of
health and environment; and
(8) contains a provision which requires the newly enrolled
participants with a family income over 200% of the federal poverty
income guidelines to wait at least 8 months before participating in this
program, if such participants previously had comprehensive health
benefit coverage through an individual policy or a health benefit plan
provided by any health insurer as defined in K.S.A. 40-4602, and
amendments thereto. This waiting period provision shall not apply
when the prior coverage ended due to loss of employment other than
the voluntary termination, change to a new employer that does not
provide an option for dependent coverage, discontinuation of health
benefits to all employees, expiration of COBRA coverage period or any
other situations where the prior coverage ended due to reasons
unrelated to the availability of this program . Rules and regulations
adopted by the secretary shall establish a sliding-fee scale that charges
per family; and
(8) provides coverage to pregnant Kansas children provided that
the secretary requests and receives verification of such pregnancy as
allowed by the centers for medicaid and medicare services.
(c) The secretary of health and environment is authorized to
SENATE BILL No. 271—page 2
contract with entities authorized to transact health insurance business in
this state to implement the health insurance coverage plan pursuant to
subsection (a) providing for several plan options to enrollees which are
coordinated with federal and state child health care programs, except
that when contracting to provide managed mental health care services
the secretary of health and environment shall assure that contracted
entities demonstrate the ability to provide a full array of mental health
services in accordance with the early and periodic screening, diagnosis
and treatment plan. The secretary of health and environment shall not
develop a request for proposal process which excludes community
mental health centers from the opportunity to bid for managed mental
health care services.
(d) When developing and implementing the plan in subsection (a),
the secretary of health and environment to the extent authorized by law:
(1) Shall include provisions that encourage contracting insurers to
utilize and coordinate with existing community health care institutions
and providers;
(2) may work with public health care providers and other
community resources to provide educational programs promoting
healthy lifestyles and appropriate use of the plan's health services;
(3) shall plan for outreach and maximum enrollment of eligible
children through cooperation with local health departments, schools,
child care facilities and other community institutions and providers;
(4) shall provide for a simplified enrollment plan;
(5) shall provide cost sharing as allowed by law;
(6) shall not count the caring program for children, the Kansas
health insurance association plan or any charity health care plan as
insurance under subsection (e)(1);
(7) may provide for payment of health insurance premiums,
including contributions to a health savings account if applicable, and, in
conjunction with an employer sponsored insurance premium assistance
plan, may provide that supplemental benefits be purchased outside of
the capitated managed care plan, if it is determined cost effective,
taking into account the number of children to be served and the benefits
to be provided;
(8) may provide that prescription drugs, transportation services
and dental services are purchased outside of the capitated managed care
plan to improve the efficiency, accessibility and effectiveness of the
program; and
(9) shall include a provision that requires any individual to be a
citizen or an alien lawfully admitted to the United States for purposes
of establishing eligibility for benefits under the plan and to present
satisfactory documentary evidence of citizenship or lawful admission
of the individual. The criteria for determining whether the
documentation is satisfactory shall be no more restrictive than the
criteria used by the social security administration to determine
citizenship. A document issued by a federally-recognized Indian tribe
evidencing membership or enrollment in, or affiliation with, such tribe,
such as a tribal enrollment card or certificate of degree of Indian blood
shall be satisfactory documentary evidence of citizenship or lawful
admission.
(e) A child shall not be eligible for coverage and shall lose
coverage under the plan developed under subsection (a) of K.S.A. 38-
2001, and amendments thereto, if such child's family has not paid the
enrollee's applicable share of any premium due. If the family pays all of
the delinquent premiums owed during the year, such child will again be
eligible for coverage for the remaining months of the continuous
eligibility period. If a family is otherwise eligible for coverage and
pays all of the delinquent premiums owed, such child will again be
SENATE BILL No. 271—page 3
eligible for coverage at the time of renewal.
(f)(f) The plan developed under section 4901 of public law 105-33
(, 42 U.S.C. § 1397aa et seq., and amendments thereto) is not an
entitlement program. The availability of the plan benefits shall be
subject to funds appropriated. The secretary of health and environment
shall not utilize waiting lists, but shall monitor costs of the program and
make necessary adjustments to stay within the program's
appropriations.
(g) Eligibility and benefits under the plan prescribed by subsection
(b)(7) are not and shall not be construed to be entitlements, are for legal
residents of the state of Kansas and are subject to availability of state
and federal funds and to any state and federal requirements and the
provisions of appropriation acts. If the secretary of health and
environment determines that the available federal funds and the state
funds appropriated are insufficient to sustain coverage for the income
eligibility levels prescribed by subsection (b)(7), a lower income level
shall be adopted and implemented by the secretary of health and
environment, within the limits of appropriations available therefor, and
all such changes shall be published by the secretary of health and
environment in the Kansas register.
Sec. 2. K.S.A. 39-7,160 is hereby amended to read as follows: 39-
7,160. (a) There is hereby established the Robert G. (Bob) Bethell joint
committee on home and community based services and KanCare
oversight. The joint committee shall review the number of individuals
who are transferred from state or private institutions and long-term care
facilities to the home and community based services and the associated
cost savings and other outcomes of the money-follows-the-person
program. The joint committee shall review the funding targets
recommended by the interim report submitted for the 2007 legislature
by the joint committee on legislative budget and use them such funding
targets as guidelines for future funding planning and policy making.
The joint committee shall have oversight of savings resulting from the
transfer of individuals from state or private institutions to home and
community based services. As used in K.S.A. 39-7,159 through 39-
7,162, and amendments thereto, "savings" means the difference
between the average cost of providing services for individuals in an
institutional setting and the cost of providing services in a home and
community based setting. The joint committee shall study and
determine the effectiveness of the program and cost-analysis of the
state institutions or long-term care facilities based on the success of the
transfer of individuals to home and community based services. The
joint committee shall consider the issues of whether sufficient funding
is provided for enhancement of wages and benefits of direct individual
care workers and their staff training and whether adequate progress is
being made to transfer individuals from the institutions and to move
them from the waiver waiting lists to receive home and community
based services. The joint committee shall review and ensure that any
proceeds resulting from the successful transfer be applied to the system
of provision of services for long-term care and home and community
based services. The joint committee shall monitor and study the
implementation and operations of the home and community based
service programs, the children's health insurance program, the program
for the all-inclusive care of the elderly and the state medicaid
programs, including, but not limited to, access to and quality of
services provided and any financial information and budgetary issues.
Any state agency shall provide data and information on KanCare
programs, including, but not limited to, pay payment for performance
measures, quality measures and enrollment and disenrollment in
specific plans, KanCare provider network data and appeals and
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grievances made to the KanCare ombudsman, to the joint committee, as
requested.
(b) The joint committee shall consist of 11 members of the
legislature appointed as follows: (1) Two members of the house
committee on health and human services appointed by the speaker of
the house of representatives; (2) one member of the house committee
on health and human services appointed by the minority leader of the
house of representatives; (3) two members of the senate committee on
public health and welfare appointed by the president of the senate; (4)
one member of the senate committee on public health and welfare
appointed by the minority leader of the senate; (5) two members of the
house of representatives appointed by the speaker of the house of
representatives, one of whom shall be a member of the house
committee on appropriations; (6) one member of the house of
representatives appointed by the minority leader of the house of
representatives; and (7) two members of the senate appointed by the
president of the senate, one of whom shall be a member of the senate
committee on ways and means.
(c) Members shall be appointed for terms coinciding with the
legislative terms for which such members are elected or appointed. All
members appointed to fill vacancies in the membership of the joint
committee and all members appointed to succeed members appointed
to membership on the joint committee shall be appointed in the manner
provided for the original appointment of the member succeeded.
(d) The members originally appointed as members of the joint
committee shall meet upon the call of the member appointed by the
speaker of the house of representatives, who shall be the first
chairperson, within 30 days of the effective date of this act. The vice-
chairperson vice chairperson of the joint committee shall be appointed
by the president of the senate. Chairperson and vice-chairperson vice
chairperson shall alternate annually between the members appointed by
the speaker of the house of representatives and the president of the
senate. The ranking minority member shall be from the same chamber
as the chairperson. On and after the effective date of this act, The joint
committee shall meet at least once in January and once in April when
the legislature is in regular session and at least once for each quarter
with two consecutive days of meetings during each of the third and
fourth calendar quarters, on the call of the chairperson, but not to
exceed six meetings in a calendar year, except additional meetings may
be held on call of the chairperson when urgent circumstances exist
which that require such meetings. Six members of the joint committee
shall constitute a quorum.
(e) (1) At the beginning of each regular session of the legislature,
the committee shall submit to the president of the senate, the speaker of
the house of representatives, the house of representatives standing
committee on health and human services and the senate standing
committee on public health and welfare a written report on numbers of
individuals transferred from the state or private institutions to the home
and community based services , including the average daily census in
the state institutions and long-term care facilities, savings resulting
from the transfer certified by the secretary for aging and disability
services in a quarterly report filed in accordance with K.S.A. 39-7,162,
and amendments thereto, and the current balance in the home and
community based services savings fund of the Kansas department for
aging and disability services.
(2) Such report submitted under this subsection shall also include,
but not be limited to, the following information on the KanCare
program:
(A) Quality of care and health outcomes of individuals receiving
SENATE BILL No. 271—page 5
state medicaid services under the KanCare program, as compared to the
provision of state medicaid services prior to January 1, 2013;
(B) integration and coordination of health care procedures for
individuals receiving state medicaid services under the KanCare
program;
(C) availability of information to the public about the provision of
state medicaid services under the KanCare program, including, but not
limited to, accessibility to health services, expenditures for health
services, extent of consumer satisfaction with health services provided
and grievance procedures, including quantitative case data and
summaries of case resolution by the KanCare ombudsman;
(D) provisions for community outreach and efforts to promote the
public understanding of the KanCare program;
(E) comparison of the actual medicaid costs expended in
providing state medicaid services under the KanCare program after
January 1, 2013, to the actual costs expended under the provision of
state medicaid services prior to January 1, 2013, including the manner
in which such cost expenditures are calculated;
(F) comparison of the estimated costs expended in a managed care
system of providing state medicaid services under the KanCare
program after January 1, 2013, to the actual costs expended under the
KanCare program of providing state medicaid services after January 1,
2013;
(G) comparison of caseload information for individuals receiving
state medicaid services prior to January 1, 2013, to the caseload
information for individuals receiving state medicaid services under the
KanCare program after January 1, 2013; and
(H) all written testimony provided to the joint committee
regarding the impact of the provision of state medicaid services under
the KanCare program upon residents of adult care homes.
(3) The joint committee shall consider the external quality review
reports and quality assessment and performance improvement program
plans of each managed care organization providing state medicaid
services under the KanCare program in the development of the report
submitted under this subsection.
(4) The report submitted under this subsection shall be published
on the official website of the legislative research department.
(f) Members of the committee shall have access to any medical
assistance report and caseload data generated by the Kansas department
of health and environment division of health care finance. Members of
the committee shall have access to any report submitted by the Kansas
department of health and environment division of health care finance to
the centers for medicare and medicaid services of the United States
department of health and human services.
(g) Members of the committee shall be paid compensation, travel
expenses and subsistence expenses or allowance as provided in K.S.A.
75-3212, and amendments thereto, for attendance at any meeting of the
joint committee or any subcommittee meeting authorized by the
committee.
(h) In accordance with K.S.A. 46-1204, and amendments thereto,
the legislative coordinating council may provide for such professional
services as may be requested by the joint committee.
(i) The joint committee may make recommendations and
introduce legislation as it deems necessary in performing its functions.
Sec. 3. K.S.A. 38-2001 and 39-7,160 are hereby repealed.
SENATE BILL No. 271—page 6
Sec. 4. This act shall take effect and be in force from and after its
publication in the Kansas register.
I hereby certify that the above BILL originated in the
SENATE, and passed that body
__________________________
SENATE adopted
Conference Committee Report ________________
_________________________
President of the Senate.
_________________________
Secretary of the Senate.
Passed the HOUSE
as amended _________________________
HOUSE adopted
Conference Committee Report ________________
_________________________
Speaker of the House.
_________________________
Chief Clerk of the House.
APPROVED _____________________________
_________________________
Governor.