Committee Reports to the 2017 Kansas Legislature -- Supplement · 2017. 3. 8. · fellowships, and other collaborative ventures. Recruitment through fellowships and internships. The

Committee Reportsto the

2017 Kansas Legislature

Supplement

Kansas Legislative Research DepartmentMarch 2017

2016 Legislative Coordinating Council

Chairperson

Representative Ray Merrick, Speaker of the House

Vice-chairperson

Senator Susan Wagle, President of the Senate

Terry Bruce, Senate Majority LeaderAnthony Hensley, Senate Minority Leader

Jene Vickrey, House Majority LeaderPeggy Mast, Speaker Pro Tem

Tom Burroughs, House Minority Leader

Kansas Legislative Research Department300 SW 10th, Room 68-West, Statehouse

Topeka, Kansas 66612-1504

Telephone: (785) 296-3181FAX: (785) [email protected]

http://kslegislature.org/klrd

Supplement

Special Committee on Larned and Osawatomie State HospitalsSpecial Committee on Organization of Public Health Boards

Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight

Kansas Legislative Research Department300 SW 10th, Room 68-West, Statehouse

Topeka, Kansas 66612-1504

Telephone: (785) 296-3181FAX: (785) 296-3824

[email protected]://kslegislature.org/klrd

Foreword

This publication is the supplement to the Committee Reports to the 2017 Legislature. It contains thereports of the following committees: Special Committee on Larned and Osawatomie State Hospitals;Special Committee on Organization of Public Health Boards; and Robert G. (Bob) Bethell JointCommittee on Home and Community Based Services and KanCare Oversight.

This publication is available in electronic format at http://www.kslegresearch.org/KLRD-web/Publications.html.

TABLE OF CONTENTS

Special Committee on Larned and Osawatomie State HospitalsReport..............................................................................................................................................1-1

Special Committee on Organization of Public Health BoardsReport..............................................................................................................................................2-1

Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight

Annual Report.................................................................................................................................3-1

Summary of Conclusions and Recommendations

Special Committee on Larned and Osawatomie State Hospitals

The Committee made recommendations related to funding, partnerships, recruiting, and workplacebullying, as listed below.

Request for proposal. The Committee recommended, before vendors submit bids for the KansasDepartment for Aging and Disability Services (KDADS) request for proposal for operations atOsawatomie State Hospital (OSH), they consult with Community Mental Health providers.

Crisis center funding. The Committee recommended full funding of all crisis centers, includingRainbow Services Inc. in Kansas City, COMCARE in Wichita, and Valeo Behavioral Health Center inTopeka.

OSH beds. The Committee recommended KDADS provide an interim plan to utilize 20 additional bedsat OSH or through third-party facilities and such plan be included in the 2017 rescission bill.

Partnership with University of Kansas. The Committee recommended the University of Kansas and thestate hospitals establish a working relationship that will create partnerships such as internships,fellowships, and other collaborative ventures.

Recruitment through fellowships and internships. The Committee noted staffing shortages at the statehospitals and urged Larned State Hospital and OSH to establish programs such as internships,fellowships, and similar initiatives to enhance recruitment measures.

Recruitment through salary schedule. The Committee recommended KDADS develop acomprehensive salary and benefits schedule to enhance recruitment.

Workplace bullying. The Committee noted the destructive nature of bullying in the workplace andcondemned it at all employment levels in state hospitals. The Committee recommended KDADSinvestigate incidents of employee bullying and develop policies to curtail such behavior.

Special Committee on the Organization of Public Health Boards

The Committee recommended the Board of Nursing and the State Board of Healing Arts not beconsolidated at this time. Additionally, the Committee recommended the House Committee on Health andHuman Services and the Senate Committee on Public Health and Welfare review and consider combiningthe Board of Examiners in Fitting and Dispensing of Hearing Instruments with the Kansas Department forAging and Disability Services.

Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services andKanCare Oversight

The Committee made recommendations on several topics.

Kansas Legislative Research Department i 2016 Interim Committee Reports Supplement

Managed care organization (MCO) operations. The Committee recommends the Secretary of Healthand Environment develop standards to be utilized uniformly by each MCO serving the State of Kansaspursuant to a contract with the Kansas medical assistance program for each of the following:documentation to be provided to a health care provider by any MCO when it denies a claim forreimbursement submitted by such provider, with the requirement that denial reason codes be compliantwith the Health Insurance Portability and Availability Act and MCOs consistently apply denial reasoncodes in the same manner to ensure accurate reporting to the state; and documentation to be provided to ahealth care provider by any MCO when recoupments are made pursuant to a post pay audit of suchprovider, to include transparency of methodology used in the audit and a specific explanation of thereason for recoupment, and requiring that MCOs may not arbitrarily remove codes (e.g., ICD-10, CPT,DRG) submitted by the provider or change the level of care provided to reduce payment without using theproper appeal protections in place.

The Committee further recommends the Secretary complete a quarterly review of claims denials andappeals to determine whether a high percentage of denials are overturned on appeal and, if so, address theissue with the MCO(s) and, if a certain procedure or codes are denied more often than others, whetherthose denials are appropriate and address the issue with the MCO(s). A notice of a right to appeal,including the details and specific action required, is to be sent no later than December 15, 2016, toindividuals who were assessed under the Capable Person Policy and, as a result, had their plans of careadversely affected. MCOs are to report to the Committee on the first pass denial rate. The Committeefurther recommends all MCOs work together to develop one standardized credentialing application,respond to all submissions within 15 working days, use a Council for Affordable Quality Healthcareportal for processing credentialing applications, standardize the underpayment and overpayment process,and provide notices of changes to a Plan of Care to both individuals and providers.

Mental health. The Committee recommends legislation be introduced by the House and Senate healthcommittees to work on the Mental Health 2020 Initiative plan from the community mental health centers.

Medicaid Clearinghouse operations. The Committee recommends eligibility applications over 45 daysold be sent to a team formed exclusively to get applications through the process and finished. KansasDepartment of Health and Environment officials should set a goal that 75 percent of long-term careapplications be cleared in the first 45 days.

Administration of KanCare. The Committee recommends extending the current 1115 Waiver for oneyear and delay the request for proposal until the State clearly understands federal changes to theAffordable Care Act and Medicaid; delaying expansion of the Kansas Eligibility and Enforcement Systemto Phase 3 until there has been a clear demonstration of system functionality, operational integrity isdetermined, and all problems have been resolved; and requesting the Legislative Division of Post Auditupdate the information technology audit on the Kansas Eligibility and Enforcement System (KEES)published in December 2015 and report satisfactory performance before Phase 3 expansion can occur.

KanCare reporting and rates. The Committee recommends all uncompensated care numbers presentedto the Committee be based on 100 percent of Medicare allowable and the 4 percent Medicaidreimbursement cut and corresponding policies be reversed.

Kansas Legislative Research Department ii 2016 Interim Committee Reports Supplement

SPECIAL COMMITTEE

Report of theSpecial Committee on Larned and

Osawatomie State Hospitalsto the

2017 Kansas LegislatureCHAIRPERSON: Senator Jim Denning

VICE-CHAIRPERSON: Representative J. R. Claeys

OTHER MEMBERS: Senators Mitch Holmes, Laura Kelly, Caryn Tyson, and Ralph Ostmeyer(substitute); and Representatives Pete DeGraaf, Nancy Lusk, Charles Macheers, and JackThimesch

STUDY TOPIC

Study of Various Issues Regarding Larned State Hospital and Osawatomie StateHospital

The Committee’s study includes the following:

● Monitor the patient populations and review and study the activities and plans of thetreatment programs and correlation to patient outcomes;

● Tour each state psychiatric hospital, considering the evaluating facility issues relating toplan management and safety;

● Review and study the Kansas Department for Aging and Disability Services’ (KDADS’)policies relating to each state psychiatric hospital;

● Review and study KDADS’ responsiveness and efforts in identifying and resolving issuesrelating to facility, staff, and patients;

● Review and study KDADS’ staffing and policies relating to staffing, recruitment,retention, employee morale, and employee relations issues;

● Review and identify patient and employee safety concerns; and

● Review and study any other issues brought to the attention of the Committee concerningstate psychiatric hospital oversight.

February 2017

Special Committee on Larned and OsawatomieState Hospitals

REPORT

Conclusions and Recommendations

The Committee makes the following recommendations:

● Before vendors submit bids for the Kansas Department for Aging and Disability Services’(KDADS’) request for proposal (RFP) for operations at Osawatomie State Hospital(OSH), they consult with community mental health providers;

● Full funding of all crisis centers, including Rainbow Services Inc. in Kansas City,COMCARE in Wichita, and Valeo Behavioral Health Center in Topeka;

● KDADS provide an interim plan to utilize 20 additional beds at OSH or through third-party facilities and such plan be included in the 2017 rescission bill;

● The University of Kansas and the state hospitals establish a working relationship that willcreate partnerships, such as internships, fellowships, and other collaborative ventures;

● Noting staffing shortages at the state hospitals, urge Larned State Hospital and OSH toestablish programs, such as internships, fellowships, and similar initiatives, to enhancerecruitment measures;

● KDADS develop a comprehensive salary and benefits schedule to enhance recruitment;and

● Noting the destructive nature of bullying in the workplace and condemning it at allemployment levels in state hospitals, KDADS investigate incidents of employee bullyingand develop policies to curtail such behavior.

Proposed Legislation: None

BACKGROUND

The Legislative Coordinating Council (LCC)in 2016 appointed a Special Committee on LarnedState Hospital (LSH) and Osawatomie StateHospital (OSH), composed of nine members. TheCommittee was tasked by the LCC to studyvarious issues regarding LSH and OSH as follows:

● Monitor the patient populations andreview and study the activities and plansof the treatment programs and correlationto patient outcomes;

● Tour each state psychiatric hospital,considering and evaluating facility issuesrelating to plan management and safety;

Kansas Legislative Research Department 1-1 2016 Larned/Osawatomie State Hospitals

● Review and study the policies of theKansas Department for Aging andDisability Services’ (KDADS’) policiesrelating to each state psychiatric hospital;

● Review and study KDADS’responsiveness and efforts in identifyingand resolving issues relating to facility,staff, and patients;

● Review and study KDADS’ staffing andpolicies relating to staffing, recruitment,retention, employee morale, and employeerelations issues;

● Review and identify patient and employeesafety concerns; and

● Review and study any other issues broughtto the attention of the Committeeconcerning state psychiatric hospitaloversight.

The Committee was granted four meeting daysby the LCC and met on December 19 and 20,2016, at the Statehouse. The Committee did nottour the state psychiatric hospitals.

COMMITTEE ACTIVITIES

The Committee held all-day meetings onDecember 19 and 20, 2016, at the Statehouse.

Osawatomie State Hospital

History and virtual tour of OSH. At theDecember 19 meeting, the Superintendent of OSHprovided a history of OSH, stating it is the oldestmental hospital in Kansas, having admitted its firstpatient on November 5, 1866. The campuscurrently consists of 2 hospitals with a 146-bedcapacity, OSH and Adair Acute Care (Adair) atOSH. The campus is licensed for 206 beds;however, 60 beds are being kept vacant due to theself-imposed moratorium on admissions above146 patients.

The Superintendent provided a virtual tour ofthe OSH campus, commenting on the age of mostof the buildings and focusing on the seven-

building Adair complex where most of the patientsare housed.

Decertification. On December 21, 2015, thefederal Centers for Medicare and MedicaidServices (CMS) decertified OSH. The ActingSecretary for Aging and Disability Servicesreviewed the events following decertification ofOSH by CMS. He stated, for the previous year,KDADS had been working with staff at OSHtoward recertification and OSH is ready to besurveyed by CMS; however, CMS has not set adate to conduct the survey required to recertifyOSH. The Acting Secretary did not have a timeline for when a date will be set.

Responding to Committee members’questions, the Acting Secretary stated The JointCommission (a third-party agency that certifiesand accredits state hospitals) will accede to CMSfor recertification. The initial plan is recertificationand then accreditation. The Acting Secretary statedOSH has a maximum capacity of 206 beds,including the 146 currently in use, none of whichare currently certified. Adair has 60 beds ready tobe recertified; the preparation cost for 30 beds was$700,000. All 206 beds are needed to meet theadult-continuum-of-care goals.

Time line. The OSH Superintendent discussedthe time line of The Joint Commission complaintsurvey (October 2014) and the State FireMarshal’s findings (October 2014) that led to acomprehensive survey by CMS in January 2015.The CMS survey found OSH to have the followingconditions out of compliance: governing body;quality assessment/performance improvement;medical records (active treatment); dischargeplanning; staffing; and physical environment. Thesurvey findings resulted in the decertification ofOSH in December 2015.

Cost. The KDADS Director of Finance andBudget reviewed the costs of the decertification ofOSH. The Director of Finance and Budget notedbudget enhancements are needed to compensatefor loss of funding and provide budget allocationsfor OSH and LSH. She stated the budget shortfallin FY 2016 for OSH was $7.2 million and isestimated to be $20.1 million in FY 2017 and$14.2 million in FY 2018, assuming recertificationof 60 beds by July 1, 2017.


Progress toward recertification. The ChiefExecutive Officer, Adair, OSH, stated one step inthe process of recertification was to divide OSHinto two distinct entities, one of which is AdairAcute Care, and to institute a moratorium onadmissions at 146 patients. He outlined changesmade by OSH in an effort to move toward CMSrecertification as follows: reviewed close to 200policies, revising at least half; revised medicalstaff bylaws; revised the Risk Management Plan(approved by the Kansas Department of Healthand Environment); revised several positiondescriptions; increased physician coverage (sevendays a week); implemented internal monitoringchanges (new metrics and satisfaction surveys);increased the staffing schedule on units, resultingin reduced mandates and reduced overtime;reduced nursing staff caseloads; increased safetyfor patients and staff on units; increased focus onindividualized treatment planning; increased focuson patient and staff safety; refined the triageprocess; increased communication and streamlinedworkflow; strengthened focus on determining themedical stability of patients prior to admission;revised pharmacy protocols; strengthened thedischarge planning process; implemented a newdress code; implemented vigorous training;developed support tools that will monitordistribution of admissions, admission/triageprocess effectiveness, and staffing variance; anddefined OSH’s mission and vision.

Audit. A Senior Auditor for the LegislativeDivision of Post Audit (LPA) reviewed thefindings of an audit, released in July 2016, ofOSH’s loss of funding as a result of CMSdecertification. The Senior Auditor stated thedecertification was prompted by OSH’s failure tocomply with federal regulations relating to staffand patient safety. He explained noncomplianceresulted in an estimated $15.0 million loss offunding and additional expenses to address thedeficiencies present as of June 2016, an impactthat will continue in some degree until the entirefacility is recertified. He stated no Medicare orMedicaid funding will be available for OSH untilthe facility is recertified.

Request for proposal (RFP). The ActingSecretary for Aging and Disability Servicesindicated KDADS was pursuing recertification ofthe facility but also looking at other options,including through the release of a RFP.

Enacted 2016 House Sub. for SB 161 includedproviso language that, for FY 2016, FY 2017, andFY 2018, prohibits the expenditure of any moneysappropriated for the relevant fiscal years toprivatize the operations of LSH or OSH withoutprior specific authorization in an act of theLegislature or in an appropriation act of theLegislature.

Enacted 2016 House Sub. for SB 249 alsoincluded proviso language that, for FY 2017 andFY 2018, prohibits the expenditure of any moneysappropriated for the relevant fiscal years toKDADS to enter into any agreement or take actionto outsource or privatize the operations or facilitiesof LSH or OSH without prior specificauthorization by an act of the Legislature or anappropriation act of the Legislature. At the RobertG. (Bob) Bethell Joint Committee on Home andCommunity Based Services and KanCareOversight meeting on November 18, 2016, theActing Secretary for Aging and Disability Servicesindicated the agency’s interpretation of thisprovision was that the agency may not privatizeeither hospital without legislative approval butmay pursue a RFP to evaluate options. OnNovember 14, 2016, KDADS issued the RFP titled“Operation of Osawatomie State Hospital (OSH).”The bidding closed at 2 p.m. on December 29,2016.

Overview of the RFP. Staffing: The contractormust maintain adequate staffing levels to meet theneeds of OSH, and it must provide monthlystaffing reports to the Secretary for Aging andDisability Services for the first year of thecontract, followed with quarterly staffing reportsevery year thereafter. Penalties may be assessed ifa staffing shortage persists longer than 45 days.

Treatment b eds : Currently, OSH is licensed for206 inpatient psychiatric treatment beds. Allsubmitted proposals must include at least 206inpatient psychiatric beds in the OSH catchmentarea. The contractor must maintain a minimum of94 inpatient beds at the current OSH campus, andthe remaining inpatient beds may be maintained atthe current OSH campus or at another KDADS-approved facility within the OSH catchment area.

Certification: The RFP requires the contractorto bring OSH into accreditation with The Joint


Commission and certification under CMS within24 months of the effective date of the contract.Additionally, the contractor could be fined if itfails to maintain federal certification and quality orif inspectors find issues that could harm patients.

Incentives and p enalties : Incentives areoutlined in the RFP for reducing the number ofpreventable readmissions and the number ofpatients residing in the hospital long term.Penalties for several types of damaging events areincluded in the RFP.

Staffing ratios, recruitment, and retention.A representative from KDADS stated OSH’s2016-2018 strategic goals include fillingvacancies, increasing staff satisfaction, andreducing turnover. The representative explainedthe steps taken to fill vacancies, which included amental health developmental disability technicianand registered nurse wage increase and new jobadvertising practices. She stated these changesimproved hiring rates.

The Acting Secretary presented vacancy andturnover rates for mental health technicians at bothOSH and LSH. He noted, in one year, vacancyrates dropped from 40 percent to 10 percent andturnover rates were lowered from 70 percent to 30percent. He also stated overtime costs weresteadily decreasing and the patient to staff ratiohad improved from 15:1 to 12.5:1.

Public comment. A representative from theAssociation of Community Mental Health Centersof Kansas cited the experiences of Indiana andOregon to express concern regarding the negativeeffect privatization might have on Kansas’ statehospitals. He also expressed concern regarding thedeleterious effects that state hospital overcrowdingcreates for community mental health centers.

A representative from Equi-Venture Farmsexplained Equi-Venture Farms acts as a facilitator,providing placement options for those dischargedfrom a state hospital.

A representative of the Kansas Mental HealthCoalition and co-chair of the Adult Continuum ofCare Task Force addressed issues raised in theKDADS’ Adult Continuum of Care Committeefinal report. She stated gaps in the continuum of

care, staffing issues, the staffing moratorium, andthe waiting list create serious obstacles inproviding the continuum of care the reportrecommends. The representative recommended thepatient moratorium be ended at the OSH facility.She stated the moratorium has created a crisis forlaw enforcement officials and violates the AdultContinuum of Care Task Force recommendations.She noted only 6 of the 26 community mentalhealth centers have residential housing available.Answering questions, the representative said shewas aware of no partnerships between universitiesand mental health hospitals and an ancillary effectof budget cuts is the loss of grant funding.

A representative of Valeo Behavioral HealthCare (Valeo) provided a community mental healthcare perspective. He outlined a variety of servicesprovided by Valeo, and he noted Valeo offers“upstream” services for those not yet needing statehospitalization. He commented on a pilot programpartnering with OSH to accept patients ready tomove into a community setting. Responding toquestions, the representative stated 60 percent ofValeo funding comes from Medicaid and stategrants account for 10 percent Valeo’s funding.

A mental health advocate, who also was thesuperintendent of OSH from 1993 to 1997, statedthe goal of mental health treatment is not to avoidinstitutional care, but to offer a continuum of care,which includes state hospitals. He expressed hopeOSH could again become a quality treatmentcenter and a center of excellence for mental health.

Written-only testimony was provided by theKansas Hospital Association (KHA). KHA’swritten-only testimony stated that last year KHAformed a Behavioral Health Task Force consistingof behavioral health providers in the state as wellas representatives from the Association ofCommunity Mental Health Centers, lawenforcement, KVC Health Systems, Prairie ViewInc., the Kansas Mental Health Coalition, and theGovernor’s Behavioral Health Service PlanningCouncil. The following comments were providedby the KHA Task Force members after they touredthe renovated Adair Unit at OSH on November 9,2016:

● Task Force members were very surprisedto see the cramped common area, voiced


concerns about seeing curtains in patientrooms which could be used by patients toharm themselves or other patients, andthought it was unsafe to have an unpaddedbrick wall in a seclusion room; and

● The Task Force members were told thatsince OSH is seeking CMS recertificationfor just the Adair Unit, this area has beenclassified as a separate hospital from therest of the campus. In essence, patients arenot permitted to use any of therecreational and activity services providedin other buildings, such as the indoorswimming pool, or walk to activities inother buildings. In fact, patients on theAdair Unit are not permitted to go outside.The group felt strongly that keeping 50involuntary patients housed closelytogether indoors, around the clock, wasunsafe and did not foster a therapeuticenvironment. There is no avenue forpatients to benefit from exercise other thanwalking the short hallways on Adair. Infact, a OSH staff member mentioned thatat least one patient assault takes placedaily. An outdoor patio is being built forthe Adair Unit and, when weather permits,will provide another area for patients touse.

Larned State Hospital

History and virtual tour of LSH. At theDecember 20 meeting, the Superintendent of LSHrelated his experience with mental hospitals. Henoted LSH is unique in that, besides the juvenilefacility operated by the Kansas Department ofCorrections, there are three separate hospitalprograms with three distinct sets of staff on thegrounds: the Psychiatric Services Program (PSP),the State Security Program (SSP), and the SexualPredator Treatment Program (SPTP). He gave abrief history of the facilities, which began as astate hospital and farming operation in 1914.

The Superintendent gave a virtual tour of thegrounds, explaining the services offered for eachof the programs. He stated the PSP patientsgenerally are civilly committed adults with mentalillness and receive services for crisis stabilization,treatment, and rehabilitation. The SSP patientsgenerally are criminally committed persons, and

the hospital provides a secure setting for forensicevaluations and psychiatric inpatient treatment.The SPTP’s mission is two-fold: to provide for thepublic safety to prevent further victimization ofothers by sexual offenders assigned to the programand to work with those residents willing to engagein the work of personal change through qualitytreatment programing, with the ultimate aim ofreducing the individual’s risk for re-offense to alevel that would allow the return of the individualto society as a contributing, productive citizen.

Answering questions, the Superintendentstated the SPTP census is 261 individuals,including patients in the 4 reintegration facilities.One reintegration facility is located at OSH, twofacilities are on the grounds of Parsons StateHospital, and the fourth facility is located at LSH.When asked about affiliations between the statehospital and Kansas universities with applicabledegree programs, the Superintendent noted LSH ispursuing a partnership with the University ofKansas. He noted University of Kansas School ofMedicine doctors had provided telepsychiatricservices for LSH patients for several weeks.

Summary of recent LPA audits of LSH. APerformance Audit Manager, LPA, reviewed atwo-part comprehensive audit of the SPTP at LSH.Noting the patients were involuntary but civil,rather than criminal, commitments, she reportedthe first audit (2013) found the facility hadinadequate control over access doors and keys andinadequate oversight over prohibited items, andstaff felt unprepared to deal with residentaltercations. Further, direct-care vacancies resultedin significant overtime. The program often failedto meet its internal minimum staffing goals, evenwith significant overtime. The audit reportindicated the SPTP resident population has grownsteadily, adding an average of about 18 residentsper year from 2002 to 2012. Further, the auditpredicted, based on the average growth rate, theprogram would reach its current physical capacityduring 2018. As a result of few residents beingreleased, resident population growth wasanticipated to exceed LSH’s physical capacity. Shestated the follow-up audit documented allrecommendations had been met or were being met.

Regarding the second part of the audit (2015),the audit found, unlike other states with similarprograms, Kansas did not emphasize


individualized treatment programs. Although theSPTP met most statutory requirements, thoserelated to education and rehabilitation may nothave been adequately addressed. Residents whowere ready for the reintegration program lackednecessary skills for finding a job or simple lifeskills, such as knowing how to cook. Further, theSPTP, which as of December 2014 housed 243residents, would soon reach maximum capacityand program costs were estimated to more thandouble by 2025.

The 2015 audit offered 6 options for reducingthe SPTP census, such as placing low-riskresidents in a community setting, removingmedically infirm residents to a separate securenursing facility, and increasing the reintegrationallocation from 16 to 32. The audit recommendedbetter alignment of the program with currentresearch-based recommended practices and thatthe program identify the need for additionalresources and develop a strategy for obtainingthose resources. The implementation and reviewof various processes to address management of theprogram was also recommended. Additionally, thedevelopment of a strategic plan to addressprogram growth and limited labor force issues wasrecommended.

SPTP update; response to LPA reports;update on litigation; update on new program.The Chief Forensic Psychologist, LSH, providedan update regarding the SPTP. He reported thetreatment program has been revised with a three-tiered individualized treatment program thatprovides special accommodations for those withintellectual or other disabilities. He noted stafftraining includes enhanced assessments andtesting.

The Chief Forensic Psychologist explainedeach of the tiers in the three-tiered individualizedtreatment program. Tier One provides residentswith the skills to live an offense-free life throughtherapy and supplemental groups focused on theresident’s individual risk and needs. Tier Twobegins the process of moving from a highlystructured inpatient treatment program toward anessentially independent lifestyle through agraduated series of individualized and escortedcommunity outings where residents demonstratethe ability to make appropriate decisions withinthe community. Tier Three (community

reintegration) provides continued treatment andcommunity integration by establishingemployment, a viable means of transportation,financial stability, and an approved supportnetwork. Successful Tier Three residents arerecommended to the court for transitional release,and those who complete an approved conditionalrelease plan may be recommended to the court forconditional release into the community.Conditional release requires the individualsdischarged from the SPTP live in the communityunder court supervision for a minimum of fiveyears.

The Senior Litigation Counsel, KDADS,responded to the LPA recommendations for theSPTP. Actions by KDADS to address the LPArecommendations include providing individualizedresident treatment plans that are reviewed andupdated every 90 days, conducting the annualmental exams using impartial clinical staff,implementing specific curriculum for anyindividual with an intellectual or developmentaldisability, providing residents with the skillsneeded for successful reintegration during TierTwo classes and supervised outings, implementinga roster system to track data related to treatmentservices and tier progression and participation, andforming a committee that has met periodically toevaluate the recommendations of the LPA reportand the SPTP Task Force report related topopulation growth and program location.

The Senior Litigation Counsel explained theSPTP is statutorily prescribed, and the programaccepts only high-risk residents and focusesexclusively on treatment, with the goal ofreintegration into the community. She noted the 80percent program participation rate, adding that 90percent of residents have enrolled in classes orgroups for the next quarter. She stated KDADScontinues to evaluate LPA’s six options to reducethe census. Answering questions, the SeniorLitigation Counsel replied low- and medium-riskindividuals are not eligible for the SPTP, and onlyhigh-risk individuals are in the program. Shestated eight individuals have completed theprogram, three of whom have finished the programin the previous three months. Typically, it takes aresident three to five years to complete theprogram.


When asked, given the new changes to theSPTP, how long it should take a patient to be ableto complete the program, the Chief ForensicPsychologist stated a range of four to six years, butnoted the range could be shorter or longerdepending on unique factors for a particularpatient.

Review of programs at LSH: PSP and SSP.The Clinical Director, LSH, reviewed the servicesprovided by the PSP and the SSP. He said the PSPdaily census averages 75 to 82, with a readmissionrate of 10 percent. (The national average is 15 to20 percent.) He explained the ActiveTreatment/Activity Therapy approach focuses onimproving behavioral and emotional skills.Regarding the SSP, he reported the daily censusaverages around 90, which is approachingcapacity. The Clinical Director outlined staff andtreatment needs and announced new recruitmentand training initiatives, such as working towardbecoming a residency training site for post-graduate students. Responding to questions, hereplied the new treatment approach is evidence-based and follows best practices.

Current status of LSH. The Superintendentrelated the process for improving staff morale. Hestated town hall meetings, small groups, andindividual contacts identified a negative workingenvironment and staff feelings of hopelessness andbeing ignored. By developing a series of reportsevery two weeks over a period of several months,the following initiatives were developed to addressstaff concerns:

● Volunteers from the other hospitals wererecruited;

● Salaries were improved;

● The practice of mandating overtime andpulling staff from other units wasdiscontinued;

● A float pool was created;

● Staffing agencies provided 258 newemployees;

● A career path was instituted to licensemental health technicians;

● Supervisors took steps to create a morepositive environment; and

● Statewide notices of vacancies andreferrals produced 565 new employees.

The Superintendent also announced that acontract with the University of Kansas will createa partnership to provide a residency-type trainingfacility.

Community, staff, and other operationalmeetings. The Acting Secretary commented onhuman resources (HR) issues, noting HR staff hada turnover rate of 100 percent. Citing a recentcentralization of HR resources by the Departmentof Administration in Topeka rather than at LSH,the Acting Secretary noted the agency wasexperiencing some complications and complaintsby staff. He emphasized the importance of keepinglines of communication open among staff,leadership, and the community. The ActingSecretary noted quarterly meetings by the CitizensAdvisory Committee, and he referenced training tomatch law enforcement with mental healthinformation and resources.

Future of LSH; juvenile corrections facility;no privatization. The Acting Secretary,commenting on the future of LSH, expressedgratitude for the dedicated staff at LSH. He statedleadership training was being instituted and apartnership with Wichita State University willenhance leadership training. With the imminentclosing of the juvenile correctional facility, theSPTP might be able to utilize the vacant building.Responding to a question, he replied workingtoward recertification and accreditation willcontinue regardless of the outcome of the recentlyissued RFP by KDADS.

Public comment. The Executive Director forthe Kansas Organization of State Employees(KOSE) expressed appreciation for the recentinitiatives to improve working conditions foremployees. Then, she identified continuingconcerns: excessive overtime, increases in healthinsurance premiums, unpredictable days off, andtimely release of vacancy reports.


The Executive Director noted employees havenot felt the increase in their take-home pay, suchas in 2016 when the Legislature appropriatedfunds for a pay increase, because the full increaseplus some has been absorbed by increases in stateemployee health insurance premiums. She statedthe State Employee Health Plan financial reportreflects the plan’s intention to increase theemployees’ share of plan costs over the next tenyears, resulting in annual de facto pay cuts. TheExecutive Director noted this is not a favorableenvironment for employee recruitment andretention.

Although progress had been made fromAugust 2016 through October 2016 in the staffvacancy rates, the Executive Director noted thereare still significant vacancy rates for direct carepositions, as reflected in the overtime experienceof both state hospitals. She noted KOSE iscautiously optimistic about staffing and overtimetrend reductions at LSH. Her testimony mentionedKDADS does not provide KOSE with weeklyvacancy rate reports on a regular basis and doesnot provide turnover rates by position for eitherstate hospital. The Executive Director noted theoverall turnover rates for both OSH and LSH areover 30 percent.

A LSH employee and KOSE representativeoffered praise to the Acting Secretary andsuperintendents for reducing overtime. He thenidentified concerns needing to be addressed:workplace bullying (usually by a supervisor);ineffective promotion practices; and punitive,rather than instructive, disciplinary practices. Responding to a question, the Acting Secretaryreplied a bullying policy can be developed.

Another LSH employee and KOSErepresentative expressed appreciation for theimprovements evident at LSH. She expressed thefollowing concerns: a long vacancy list ofpositions, unqualified HR employees, anincomplete investigation before disciplining anemployee, and disciplining an employee forcalling in sick. She expressed special concernregarding supervisors bullying employees and

hiring and advancement decisions based onfavoritism.

CONCLUSIONS AND RECOMMENDATIONS

The Committee adopted the followingrecommendations:

● Before vendors submit bids for theKDADS’ RFP for operations at OSH, theyconsult with community mental healthproviders;

● Full funding of all crisis centers, includingRainbow Services Inc. in Kansas City,COMCARE in Wichita, and ValeoBehavioral Health Center in Topeka;

● KDADS provide an interim plan to utilize20 additional beds at OSH or throughthird-party facilities and such plan beincluded in the 2017 rescission bill;

● The University of Kansas and the statehospitals establish a working relationshipthat will create partnerships, such asinternships, fellowships, and othercollaborative ventures;

● Noting staffing shortages at the statehospitals, urge LSH and OSH to establishprograms, such as internships,fellowships, and similar initiatives toenhance recruitment measures;

● KDADS develop a comprehensive salaryand benefits schedule to enhancerecruitment; and

● Noting the destructive nature of bullyingin the workplace and condemning it at allemployment levels in state hospitals,KDADS investigate incidents of employeebullying and develop policies to curtailsuch behavior.


SPECIAL COMMITTEE

Report of theSpecial Committee on Organization of Public

Health Boardsto the

2017 Kansas Legislature

CHAIRPERSON: Representative Daniel Hawkins

VICE-CHAIRPERSON: Senator Elaine Bowers

OTHER MEMBERS: Senators Steve Fitzgerald, David Haley, and Michael O’Donnell; andRepresentatives John Barker, Gail Finney, Kyle Hoffman, and John Whitmer

STUDY TOPIC

Combining Certain Health Boards

● Consider the combination of the Board of Nursing and the State Board of Healing Artsunder one administrative entity for the purpose of potential reduction of administrativecosts and increased efficiency over time.

February 2017

Special Committee on Organization of PublicHealth Boards

REPORT


The Committee makes the following recommendations:

● The Board of Nursing and the State Board of Healing Arts not be consolidated at thistime; and

● The House Committee on Health and Human Services and the Senate Committee onPublic Health and Welfare review and consider combining the Board of Examiners inFitting and Dispensing of Hearing Instruments with the Kansas Department for Agingand Disability Services.

Proposed Legislation: None.

BACKGROUND

The Legislative Coordinating Council (LCC)in 2016 appointed a Special Committee on theOrganization of Public Health Boards, composedof nine members. The LCC tasked the Committeewith considering the combination of the Board ofNursing (KSBN) and the State Board of HealingArts (BHA) under one administrative entity for thepurpose of potential reduction of administrativecosts and increased efficiency over time.

Interest in considering the combination ofpublic health boards arose from one of thenumerous recommendations made in the KansasStatewide Efficiency Review commissioned by theLegislature and conducted by Alvarez & Marsal(A&M Study). The A&M Study recommendedcreating an umbrella board, the Public HealthBoard, with the following boards consolidatedunder this umbrella board: Behavioral SciencesRegulatory Board (BSRB), Kansas Dental Board(KDB), BHA, Board of Examiners in Fitting andDispensing of Hearing Instruments (KBHAE),KSBN, and the State Board of Pharmacy (KBP).The A&M Study noted other states (such as Utah,

Iowa, and Virginia) align boards and commissionsthematically in order to optimize resources andprevent needless redundancies in services. Thisconsideration provided a starting point for theCommittee discussion.

The Chairperson indicated one considerationfor the consolidation that has been discussedwould create an umbrella board with 12 to 14public health boards under the umbrella board.Fees still would be submitted to the individualboards, which would operate much as they docurrently. However, employees would performcross-functions for each of the boards, such aslicensing teams, legal teams, and others. Anexecutive director would manage all the sharedservices for all the boards, such as personnelfunctions.

As a result of the A&M Studyrecommendation, other public health boardscontacted the Chairperson inquiring about thecharge of the Committee. The Chairperson invitedthe additional health boards to present testimonyto the Committee on how each board operates andtheir views on the key aspects for a successfulreorganization of public health boards.

Kansas Legislative Research Department 2-1 2016 Organization of Public Health Boards

The Committee was granted two meeting daysby the LCC and met on December 6 and 14, 2016,at the Statehouse.


The Committee held all-day meetings onDecember 6 and 14, 2016, at the Statehouse. Inaddition to the KSBN and the BHA, theCommittee received testimony from additionalpublic health boards.

December 6, 2016, Committee Meeting

Presentation from Governor’s Office

The Policy Director from the Office of theGovernor discussed the role of the Governor, astasked by the Legislature, in appointing somemembers of public health boards and councilsacross state government. An appointmentsdirector, two support staff, and, occasionally,interns from universities focus primarily on theappointments. The Policy Director’s testimonycontained information on the state public healthboards in existence, including the boards’authorizing statutes, the activities regulated, thefee schedules, and the licensing requirements. Hestated the Administration believes these boardsserve a dual purpose of public safety and healthand create an economic benefit, making access tothe professions easier for Kansans.

Public Health Boards’ Presentations

Board of Examiners in Optometry. The VicePresident of the Board of Examiners in Optometry(Optometry Board), stated the activities of theOptometry Board to protect the public includedannually reviewing and updating the licensingexamination (Kansas is one of ten states thatadministers a test), reviewing all continuingeducation classes, and acknowledging complaintsby the public within one week.

The Vice President of the Optometry Boardstated the most important aspect of an umbrellaboard structure is that the same level of service ismaintained. He noted the Optometry Board feels itprovides a high level of service, and the umbrella

structure may make it difficult to maintain currentstandards, as each board has its own volume ofrules and regulations. He said the public, licensees,and companies seeking to do business in Kansasrely on the Optometry Board for answers.

In response to questions, the Vice President ofthe Optometry Board noted the Optometry Boardhas only one employee and gave an example ofincreased efficiency gained by changing fromannual licensing and auditing to biennial. In 2017,staff will propose going to an online program forcontinuing education classes.

Emergency Medical Services Board. TheExecutive Director of the Emergency MedicalServices (EMS) Board testified the EMS Boardoversees all aspects of EMS services in Kansas. Itspurpose is public safety first, to protect andpromote the welfare of Kansans through efficientand effective regulation of EMS, and to ensurequality out-of-hospital care is available statewide.The activities of the EMS Board include certifyingEMS providers, licensing ambulances, permittingentities to provide ambulance service, andapproving EMS education. EMS providers includeall who respond to a 911 call; some are full-timeEMS employees and others are volunteers.

The Executive Director noted the EMS Boardsets the standards for EMS education and the EMScommunication system. Two grants are offered forassistance to local EMS services. The EMS Boardalso researches, develops, and maintains adatabase on pre-hospital patient care, which isused to make recommendations on clinicalguidelines for patient care specific to differententities.

With regard to the A&M Studyrecommendation, the Executive Director stated theEMS Board supports efforts to improve efficiency.However, the EMS Board strongly believes aspecialized agency to administer EMS as anindustry is beneficial to and necessary for theprotection of Kansans. He stated employees wearmany hats within the agency, with 14 employeesalready sharing services. The EMS Board believesit has already created an umbrella organizationstructure within the agency.


In response to questions, the ExecutiveDirector noted funding for the EMS Board isthrough a percentage of fire insurance premiumssubmitted to the State and not from the StateGeneral Fund (SGF). The current agency budget is$2.1 million with a grant fund of $900,000.

Board of Nursing. The ExecutiveAdministrator of KSBN stated the agency wasdeveloped by legislative action in 1913. Theagency’s mission is to assure Kansans receive safeand competent care by nurses and mental healthtechnicians through licensure and regulations. TheKSBN meets 4 times a year, and all 11 boardmembers are appointed by the Governor. Sixcommittees assist the workings of the KSBN. Theagency is fee funded and receives no SGF moneys.Ten percent of fees, up to $100,000, and all finesgo to the SGF. In FY 2015 and FY 2016, theKSBN transferred $100,000 each year from theNursing Fee Fund to the SGF.

The Executive Administrator stated the KSBNis the largest health care fee-funded board withapproximately 72,000 active licensees (at a cost of$33 per year) and only 26 staff. Seveninvestigators have an average of 321 complaintsper year to investigate, and 421 of 2,248 wereassigned to the Assistant Attorney General forpossible discipline. The agency’s budget in FY2015 was $2.2 million, compared to the BHA with27,480 licensees, 58 staff, and a budget slightlyover $5.0 million. The KSBN reduced its fees in2014 from $60 to $55 for every two years due toagency efficiencies that were implemented.

The Executive Administrator said the KSBNwas the first health care regulatory board to havereal-time online renewals, which were launched in2001 and won a national award. The onlinerenewals are three to five times faster, andthousands of dollars were saved with paperlessrenewal cards. She noted the numerous agencyefficiencies accomplished.

The Executive Administrator stated the KSBNhas participated in Commitment to OngoingRegulatory Excellence (CORE) since 2000, whichbenchmarks performance to other boards ofnursing with umbrella boards, independent boards,and boards similar to the size of the KSBN.Kansas processes initial exam applications is an

average of 1.6 days compared to other independentboards at 6.2 days, with umbrella boards at 9.1days and boards of similar size at 3.0 days. Shesaid the CORE report indicates an umbrella boardarrangement is not as efficient. The completereport was attached to her testimony.

In summary, the Executive Administratorstated combining the fee-funded boards mightnegatively impact consumer safety; decreaseefficiency in nursing due to loss of the currentlevel of service, allowing unsafe nurses tocontinue to practice; separate discipline processeswould consume staff time and decrease consumersafety; and conflicts of interest between boardscould arise. She stated the KSBN has had positiveoutcomes and is willing to continue to shareagency efficiencies and assist other agencies, andthat can be done without consolidation. KSBNsupports the continuation of an independentagency.

In response to questions, the ExecutiveAdministrator stated, of the seven investigators,six are registered nurses and one is a licensedpractical nurse. She noted the investigations aretimely because the seven investigators know thescope of the nursing practice. An AssistantAttorney General and a Special Assistant AttorneyGeneral are housed in the KSBN office, and theirsalaries are paid by the KSBN.

State Board of Healing Arts. The ExecutiveDirector of the BHA gave a presentation of thework of the agency. The BHA’s mission is publicprotection and strengthening through educationthose who practice medical professions under theBHA. The Executive Director noted publicprotection and economic benefit are key facets ofprofessional regulation. She stated there is ashortage of health care providers, so it isincumbent upon the BHA to license qualifiedmedical professionals efficiently to meet patientneeds, without creating overly burdensomeregulations that inhibit the practice.

The Executive Director discussed thedifferences between the BHA and KSBN withregard to agency size, licensing population,budget, and the public protection and safetyrequirements for the different professions. Shenoted, as one moves up the continuum of health


care complexity, there is a vast difference on whatis necessary and appropriate to ensure the basicmission of public protection. The requirements forlicensing and regulating the professions varysignificantly.

The Executive Director responded to questionsregarding the differences between an umbrellaboard and an independent board. She stated thereare several different regulatory agency structuresnationwide. She noted Oklahoma has separateregulatory boards for medical doctors and doctorsof osteopathic medicine, each of which have acouple of allied professions. She said Missouri hasa regulatory commission with a wide range ofprofessions. The Executive Director noted theagency’s experience, from a regulatory perspectivewith the licensing of multiple professions andsome states that have the global regulatoryagencies, is that these states struggle withefficiencies, bureaucracy, and “red tape.” Shestated the BHA has struggled to get verification forsomeone previously licensed in Illinois or in otherstates with large regulatory agencies.

The Executive Director provided a briefhistory of the Kansas Healing Arts Act (Act),noting the Act itself is specific to threeprofessions, but each profession has its ownpractice act that governs and regulates it. Shestated this requires the agency staff to worktogether to provide a multitude of functions for thedifferent professions, such as processingapplications and online renewals, performingintake and reviews, and investigating complaints.The staff perform all these functions for allprofessions, which vary significantly byprofession.

According to the Executive Director,approximately 3,000 new licenses were issued forFY 2016. The agency processes licenseapplications on average within three days,including weekends and holidays, and typicallythe same day or the next. She noted 95 percent ofthe renewals are completed online, and the agencyhas become more efficient in the last few yearswith the use of technology. The BHA websitecontains information from 1997 forward on allpublic documents for licensee actions, and licensesmay be verified online.

In regard to the disciplinary investigations, theExecutive Director stated individuals investigatetheir own profession because they best know thestandard for their profession. Review committeesfor specific professions make decisions based onthe standards for that profession, and experts in thesame field are used to provide an appropriatereview. Part of the peer review process is thedisciplinary panel, which is a subgroup of boardmembers that reviews cases where standard ofcare is not met or there is a serious concern.Experts, who may come from out of state, must behired by the hour to review the complex medicalcomplaints, making these complaints resourceintensive. She noted the importance of autonomyin the BHA’s multi-professional regulatoryenvironment.

The Executive Director responded to questionsregarding software use, stating the BHA has thesame software as KSBN. When asked about thepotential to use this software for all healthagencies, she stated KSBN, BHA, the Board ofTechnical Professions, the Kansas State Board ofCosmetology (KSBOC), and the Real EstateBoard use the same database and platform. TheOffice of Information Technology Services (OITS)approached BHA because of agency in-houseexpertise of the software and it was a challenge forOITS to host and maintain for the agencies.

In response to a question about the reason forthe disparity between KSBN and BHA with regardto the number of licenses, employees, and otherareas, the Executive Director replied it hinges onthe complexity of the licensed professions.

State Board of Pharmacy. The ExecutiveSecretary of the KBP stated KBP’s mission is toensure all persons and entities conducting businessrelating to the practice of pharmacy in the state areproperly licensed and registered. The KBP alsostrives to assure compliance with pharmacystandards regarding the compounding,manufacturing, and dispensing of prescriptiondrugs, eliminating unlicensed and unqualifiedpractice in Kansas, educating licensees, and settingvery high standards for examination andqualification for licensure.

The Executive Secretary stated the KBPlicenses qualified individuals to be pharmacists,


students or interns, or technicians, and alsoevaluates competency and character at the time oflicensure and throughout licensure or registration.The agency also registers resident and non-resident pharmacies dispensing drugs to Kansans,as well as durable medical equipment providers,pharmacy drug manufacturers, wholesaledistributors, labs, ambulances, researchinstitutions, and clinics. The agency also providesregulatory oversight for canine units required topractice and train with both legal and illegalsubstances for which KBP monitors compliance.

The Executive Secretary stated the agencyregulates the profession by conducting inspectionsof all registered facilities on an annual basis,audits continuing education compliance, andconducts investigations on all complaints or othersuspicious activities reported to the KBP. The KBPmanages the unused medication donation programthat allows pharmacies to donate unusedmedications to clinics which then provide them toindigent patients. To date, the program has seenmore than $18.0 million in donated medications inthe past five or six years.

The KBP membership, meetings, and termswere described by the Executive Secretary. TheKBP has seven members: six are licensedpharmacists from various practices and one is apublic member. KBP meetings are held quarterly;however, meetings usually occur five to six timesa year, with some meetings by phone conference.The agency has been working to have virtualmeetings to decrease costs. The agency is a fee-funded agency, so expenditures are based on grantfunding or licensure and registration fees. TheKBP appoints an executive secretary and employsfive inspectors, three of whom are licensedactively practicing pharmacists and two arepharmacy inspectors. Licensing staff are alsoemployed. The KBP utilizes outside counsel forlegal work; however, there is access to severallawyers in the firm who provide counsel to otherpublic health agencies. To decrease costs, the KBPhas hired two part-time law students to helpfacilitate legal matters.

The Executive Secretary stated the KBPlicenses just under 6,000 pharmacists andapproximately 8,000 technicians and registers5,600 different kinds of facilities. About one-sixthof registered facilities are pharmacies in Kansas.

KBP also inspects ambulances only to assureproper storage and handling of pharmaceuticals.The agency currently prints licenses, but will stopthat process soon and move toward the in-houseonline verification process.

The Executive Secretary discussed theagency’s search for a database to replace an oldsystem. Staff reviewed software used by otheragencies, but the KBP needed additionalenhancements that would have been costly. TheKBP executed a contract with eSoftware Solutionsand has been customizing the database systemsince May 2016. Under the new system,applications are online and licensees are able toprint their own renewals. The database willinclude continuing education. It directly links aninternal case management system and has a staffaudit monitoring feature that electronically logs allactivity.

In reviewing other state reorganizationmodels, the Executive Secretary stated, with theone-size-fits-most models, agencies might berequired to use shared resources that fit the needsof most participants, but not all. She noted,although the agencies may perform the samefunctions, each license type and law is differentand unique and requires some specializedknowledge and understanding of the specificprofession.

The Executive Secretary answered questionsregarding the transferability of functions andwhether there are important distinctions requiringpreservation of independent boards. She statedspecialized knowledge is needed because it isimportant to have people trained in the professionwho can do the job with the necessary skills andensure compliance. She stated agencies need toknow when to waive a rule or make an exception;if they are not familiar with the profession, it isvery difficult to know when to make thoseallowances.

According to the Executive Secretary,consolidation often results in automated services,increased response time, decreased quality, anddecreased disciplinary actions. She stated theconsolidation process being discussed will not beas efficient as the structure currently in place.


The Executive Secretary added she would liketo see more data about the A&M Study analysis tobetter understand the recommendation. She statedto operate the higher level board like in Texas,most smaller groups under it are contributingmoney to the upper group to function, and this iscosting more money. She stated Texas is severalyears into its consolidation and has seen somestruggles and some benefits, but the consolidationwas not as expected. She noted KBP was part ofthe Kansas Department of Health andEnvironment (KDHE) and migrated out. Sheasked the KBP not be placed under an umbrellaorganization again.

In terms of a cost-benefit analysis ofconsolidation, the Executive Secretary indicatedKBP staff provided the following concerns:increased middle management for additional staff,slow processing time, inconsistency in messagewith more staff, license verification goes downdramatically, and less training and education forstaff. Consideration should be given to multi-lingual services, information technology, humanresources, legal support, shared meeting spaces,and collaboration of staff. The Executive Secretarystated the KBP already shares resources. She saidwhen the KBP has needed additional support,KSBN and BHA sent staff to assist. In terms ofoffice space and meeting space, it is difficult forlarger departments to locate the entire departmentin one building.

The Executive Secretary said efficienciescould be realized, and KBP would be willing toreview and would want to be a part of therecommendation if the change would work for allagencies involved.

In response to a question, the ExecutiveSecretary reported the agency has 12 employeesand 1 part-time pharmacy student. The KBPbudget is $2.4 million. The agency has, in the past,received grant funding upwards of $300,000 peryear. The operating budget for K-TRACS (theprescription monitoring program in Kansas) is$208,000.

Behavioral Sciences Regulatory Board. TheExecutive Director of the BSRB stated he had anopportunity to review the A&M Studyrecommendations with the BSRB and provided

background information about the agency toexplain in detail its opposition to therecommendations.

The Executive Director said the BSRB is thestate licensing agency for the mental healthprofessions and traces its roots back to 1980 whenthe Social Work Board and the Board ofPsychology were combined to form the BSRB.The BSRB licenses the following mental healthprofessionals: licensed psychologists; master levelpsychologists; clinical psychotherapists; bachelor,master, and specialist clinical level social workers;master and clinical level professional counselors;master and clinical level marriage and familytherapists; bachelor, master, and clinical leveladdiction counselors; and assistant behavioranalysts and behavior analysts.

The Executive Director stated there are 12members on the BSRB, 4 of whom are membersof the public. The BSRB meets every other month,and teleconferences are scheduled if a specialactivity needs to be discussed. During the monthsthe BSRB does not meet, the Complaint ReviewCommittee meets and determines if the activity inquestion violates the law. The BSRB can revoke,suspend, limit, condition, refuse to license orrefuse to renew a license, assess a penalty up to$1,000, and can take further disciplinary action ifthe activity is criminal in nature. There also is anadvisory committee for each profession that ischaired by a member of that profession who serveson the BSRB and provides input to the BSRBfrom each profession’s perspective.

The Executive Director noted the total numberof licenses effective June 1, 2016, was 12,630; abreakdown by licensed professional was providedin the testimony. Examinations to meet licensurerequirements are given through the nationalassociations as part of the membership fee.

According to the Executive Director, thebudget for FY 2017 is $734,909 and $754,454 forFY 2018. About 74 percent of the budget is forpersonnel. The agency is exclusively funded withlicensure fees, and receives no SGF, federal funds,or grants. Ten percent of the fees collected isdeposited into the SGF before the agency receivesthe remaining 90 percent.


The Executive Director stated the BSRB isone if the largest consolidated mental healthregulatory boards in North America. The BSRBstrives for efficiency by cross-training the othereight staff members to enable them to performmultiple jobs and to have the needed expertise tolicense many different mental health professionals.

The Executive Director stated representationfrom all professions would be a key considerationif the health boards were to consolidate. Increasedmanagerial layers could potentially decreaseefficiency. Managerial expertise is needed tomonitor and assist the staff, and this could add anadditional layer of managers of the umbrellaagency. He noted the more layers that exist, themore removed the board is from constituents. Hesaid it is difficult to obtain information onlicensure by reciprocity from the State of Illinois,which is one example of a consolidated system.

In considering administrative costs such asfiscal services, human resources, informationtechnology, and legal services, the ExecutiveDirector stated the agency does not have specificemployees in the agency to perform those tasks.Legal representation is provided by two attorneysfrom the Kansas Attorney General’s Office (AG’sOffice) who handle all legal matters. The BSRBcontracts with the Division of Personnel Servicesfor $1,200 a year for all Human Resourcesmatters. The BSRB utilizes OITS for alltechnology services and the Small AgencyAccounting Center for fiscal work.

In response to questions from the Committeeregarding the BSRB funding and expenditures, theExecutive Director stated the cost for personnelservices is $100 a month. There is no paymentmade directly to the AG’s Office or the SmallAgency Accounting Center. If additionalinformation technology expertise is required fromOITS, there is an hourly rate charge.

The Executive Director asked whetheradditional human relations and legal staff wouldneed to be hired in a larger consolidated agency,thus adding to the budget, to replace the cost-effective shared services now used by the BSRBand other agencies. He also stated theinvestigations are becoming more complex andtime consuming. He said the BSRB expects fiscal

oversight by the Legislature, but there will be nosavings to the SGF if consolidation of regulatoryboards occurs.

The Executive Director said regardless of theCommittee’s decision, the BSRB would work withthe Legislature and stand ready to assist in anyway.

State Board of Mortuary Arts. TheChairperson noted it was uncertain if the StateBoard of Mortuary Arts (SBMA) would beincluded should the Committee recommendconsolidation, but believed the ExecutiveSecretary of the SBMA should be invited topresent to the Committee. The Executive Secretarystated the SBMA does not believe it needs to bemerged with other agencies to become moreefficient, although the agency understands thecharge of the Committee.

The Executive Secretary stated the mission ofthe SBMA is to ensure licensees perform theirprofessional services in a manner providingmaximum protection for the health, safety, andwelfare of Kansans; inform the public of the lawsavailable to them when using the services of alicensed funeral professional; and provideadditional support whenever possible.

The Executive Secretary said the SBMA andstaff believe consumers and licensees deserveknowledgeable representatives who can becontacted about situations occurring within thefuneral profession and the area of licensure andregulation. He stated this is a most vulnerable timefor their consumers and they need to be able totimely speak to a professional who can guide themwhen dealing with the loss of a loved one.

The Executive Secretary stated there are threefull-time staff consisting of an inspector, an officemanager, and an executive secretary. The agencylicenses embalmers, funeral directors, assistantfuneral directors, crematories, crematoryoperators, funeral establishments, and branchestablishments. The agency also pre-registers andregisters students in mortuary college and registersboth apprentice embalmers and apprentice funeraldirectors. Quarterly examinations are administeredto funeral directors and monthly examinations areadministered to assistant funeral directors. The


SBMA works with approximately 1,000 non-licensee contacts annually, and more than twicethat many contacts on subjects dealing with thefuneral profession.

The Executive Secretary explained OITSprovides technology services for a fee when itcannot be handled in-house. The AG’s Officeprovides legal services of two attorneys. Theagency functions on licensee fees, and 90 percentof the fees go to the Mortuary Arts Fee Fund and10 percent goes to the SGF.

The Executive Secretary concluded by sayingthe SBMA and staff believe the current system isworking and excels, and the agency should beallowed to continue performing its mission in itscurrent manner.

Kansas Dental Board. The ExecutiveDirector of the KDB stated the KDB has ninemembers consisting of six dentists, two hygienists,and one public member. The KDB has three staffmembers consisting of an executive director,paralegal, and a licensing specialist. The chief roleof the KDB is to license and regulate dentists anddental hygienists across the state, which number2,200 and 3,000 respectively. He explained theKDB also performs disciplinary investigations, onwhich it spends most of its time and resources.

The Executive Director explained the KDB’sbudget is $400,000 each fiscal year. Unlike all ofthe other state agencies, the agency hiresindependent contractors. One licensed dentist ishired who performs 360 annual inspections ofdental offices across the state. He noted there istremendous value in having a dentist perform theinspection of a dental office. This dentist alsoserves as an expert witness in trials and worksthrough an in-depth quantity contract. An attorneyalso is contracted on an in-depth quantity contract.If additional funds are needed, they are requestedthrough the permission of the Budget Directorthrough an investigation reserve fund. The agencyreceives no SGF moneys, but exists on licenseefees; 90 percent of those fees are deposited in theagency fee fund, while 10 percent is paid to theSGF. He stated the fee split is more valuable to theKDB than a sweep of its funds because it is fasterand a guaranteed income. The 10 percent fee split

is intended for accounting, budgeting, payroll, andany incidental costs.

The Executive Director stated the KDB willdo what is necessary to move the state forward ifthe Committee decides consolidation is the bestroute.

In response to a Committee question regardingthe KDB complaint caseload, the ExecutiveDirector noted the caseload is variable, averaging125 complaints the last couple of years.Previously, the average was 150. He noted,although the number of cases has diminished, thecomplexity has increased tremendously.

Kansas State Board of Cosmetology. TheChairperson noted the Executive Director ofKSBOC was invited to provide a presentation, butthe agency probably fits in an area other thanunder an umbrella public health board. TheExecutive Director clarified there is someseparation between the public health boards andthe KSBOC, but the latter includes aspects withregulations and operations that cross over into thehealth industry. The KSBOC’s main focus is thebeauty industry, regulating the multiple beautyindustry professions that provide hair, skin, andnail services, as well as body art (tattooing,piercing, and permanent cosmetics) and tanningfacilities.

The Executive Director stated the KSBOC hasan eight-member board. The agency regulates,licenses, and also provides information to theprofessions to help them comply with the law. Theagency can take disciplinary action on those inviolation of rules and regulations. The goal hasbeen to work the agency out of the revenue arisingfrom disciplinary measures through the use of theeducation process. About four years ago, theagency began with a $130,000 revenue streamfrom disciplinary actions taken and were down to$59,000 last year from revenue for fines.

The Executive Director explained there are 14full-time staff members and 1 part-time person.The KSBOC budget is just under $1 million. Theagency is comprised of three sub-programs:administration, licensing, and enforcement. Theenforcement program does a good job ofinspecting 4,000 facilities statewide. The facility


inspections are completed annually, but thestatutory requirement is every two years. An effortis made to inspect every facility at least once ayear. There are approximately 30,000 to 32,000licensees including schools, facilities, andlicensees. The number of schools has become veryfluid, as many corporate-owned schools haveclosed nationwide.

The Executive Director noted centralization ofboard regulatory agencies is not something new.Many states have umbrella agencies. However, allof the agencies presenting before the Committeeare fee funded, do not draw from the SGF, and allcontribute 10 percent of their revenue stream tothe SGF. The KSBOC also utilizes those servicespaid through the contribution to the SGF fortechnology through OITS. The agency alsocontracts with the Department of PersonnelServices for $100 a month.

A question was raised about a previoushearing that included much debate about foldingthe Kansas Board of Barbering into the KSBOC.The Executive Director noted barbers want tomaintain autonomy.

Kansas Board of Examiners in Fitting andDispensing of Hearing Instruments. TheExecutive Officer of the KBHAE providedtestimony to the Committee. He noted the missionof the KBHAE is to establish and enforcestandards to ensure Kansans receive competentand ethical hearing aid care. The agency regulateshearing instrument specialists and audiologists.

The Executive Officer stated the KBHAE is afee-funded agency consisting of one part-timeexecutive officer. Statutorily, there are five boardmembers. Two licensure exams are administeredannually, and some of the examiners are alsoboard members. There are two KBHAE meetingsannually, and teleconference calls are held asneeded. He noted, although this agency is smaller,it is of great importance to Kansas consumers.Like other agencies, 90 percent of the revenue isdeposited in the fee fund and the remaining 10percent goes to the SGF. Revenue is generatedthrough licensure, application, exam, and otherregulated fees. In addition, the KBHAE processesconsumer and provider complaints.

The Executive Officer stated the opinion ofthe KBHAE is the State will not benefit fromplacing the KBHAE under the umbrella board ofthe public health agencies. The KBHAE is notfunded by the State, and all revenue is fromlicensing fees. The main concern is that theKBHAE retain authority over the licensure andexamination process and the discipline of thoselicensed by the KBHAE. Being self-sustaining, itdoes not appear there would be a benefit inmaking administrative changes to a board that hascompetently and efficiently served Kansans withhearing impairments for nearly 50 years.

December 14, 2016, Committee Meeting

Kansas Board of Veterinary Examiners. TheExecutive Director of Kansas Board of VeterinaryExaminers (KBVE) provided testimony to theCommittee. He discussed the development andmission of the KBVE, the composition ofmembership and staff, and meetings of the KBVE.

The Executive Director stated the agencyrecently completed a two-year trial merger withthe Kansas Department of Agriculture that hadnegative outcomes, including non-communication,disruption and downgrade of services, loss ofcontrol, overturning of decisions, dilution ofauthority, undermining of mission, potential legalliabilities, disorganization of meetings, and lack ofneeded board member orientation and training.

The Executive Director stated the AmericanAssociation of Veterinary State Boards surveysveterinary state boards and holds nationalmeetings where information and ideas areexchanged with other states, and has not found anybenchmark lines indicating the larger mergedagencies are any more efficient than the stand-alone agencies.

The Executive Director added the KBVE isvery efficient. The annual fee for licensure forveterinarians is $95; however, the average acrossthe nation is $140. In theory, he added, there mightbe some positives for forming a multi-agencygroup, but the agencies must be like-minded. Inconsolidating, some services might be viewed asredundant, but should be reviewed carefully. Henoted the fee fund balance changed dramaticallyfrom the time of the merger until July 1, 2016. The


KBVE began FY 2017 as a stand-alone regulatoryagency.

In response to a question from the Committee,the Executive Director stated he works an averageof 16 hours a week, which currently serves thepublic well, but strategic planning needs to happengoing forward that will require more hours.

A Committee member stated he believed themerger between the Kansas Department ofAgriculture and the KBVE is not a good exampleof the potential with mergers.

Kansas Board of Barbering. The KansasBoard of Barbering (KBB) submitted written-onlytestimony for the December 6, 2016, meeting.Members of the KBB presented testimony at theDecember 14, 2016, meeting on behalf of the KBBand for the Kansas Barbers for Legislative Action(KBLA). One member stated he understands thereis significant pressure to reduce state spending andlessen the current deficit, but KBLA is opposed tothe changes recommended by the A&M Study. Heindicated the changes recommended would be oflittle benefit to Kansas consumers.

The KBB member stated the KBB consists offive members, four of whom are barbers and onepublic member-at-large. Three board membershave an instructor’s license to give exams. TheKBB is responsible for testing on live models,including the straight edge shave. He said some ofthis testing is done inside a maximum securityfacility, and such exams could not be effectivelytasked to another entity.

One KBB member also noted consideration isbeing given to the KBB administrator being a part-time position, with the office run by one person.He added KBB contributes to the State as a fee-funded agency. He stated barbers are a small groupand fear their identity will be lost if merged withthe KSBOC. He said a study was conducted ofbarbers, and about 98 percent do not want toconsolidate with the KSBOC. Some respondentssaid they would drop their license if KSBOC andKBB were consolidated.

The other KBB member added there is alsothe aspect of public health, and fairly significantdiseases can spread in the practice of barbering.

The second KBB member commented theA&M Study gave boards and commissions onlytwo pages in the Study, less than 1 percent of theentire A&M Study. She added Missouri hascombined boards and, if you were to call Missouri,the response time and expertise is reduced by thewatering down of process resulting from any sortof merger. She stated when she calls the KBB, thestaff is attuned to her questions and the applicablestatutes. The staff is more efficient and effectiveand is not overpaid, and no one on the board or itsagency is overpaid.

In response to a question, one KBB memberindicated there are about 1,600 licensed barbers.When asked whether barbers would lose autonomyand the art of barbering if placed under a biggeragency that handles barbers, cosmetologists, bodyart licensees, and others, one KBB member notedso many different professions would be handledunder one agency. The second KBB memberadded it is believed the KSBOC is assembleddifferently than the KBB, and its administrator isappointed by the Governor. The KBBadministrator is hired by the KBB.

In response to why the KBB and the KSBOCcould not easily be consolidated given their closeoffice locations in Topeka and similar board size,the second KBB member noted the KBB is a fee-funded agency. She said there is no redundancybecause the professions are different. Additionally,if licensees are willing to pay to fund their ownseparate licensing agency, they should have thatoption.

Stakeholders’ Presentations

Nursing Professions. The President of theKBSN gave a presentation on behalf of the KBSNin opposition to the proposal to combine theKSBN and the BHA or any other board. She citedseveral reasons for opposing consolidation.Nursing is a stand-alone profession, with its ownlegal standing, own body of knowledge, ownprofessional standards, and own areas ofspecialization. There are times when nurses worksynchronously with other health professions toprovide health care to patients, and there are timesnursing profession priorities may be in conflictwith other health care professionals. She saidnurses are the only health care professionals who


provide sustained continual contact and care topatients. Nurses are the coordinators and managersof direct care. She said because nursing is sopervasive and provides such critical care tocitizens of Kansas, safety is paramount.

The KBSN President stated, by combining theboards, nursing could potentially becomesubservient to other boards. She said it isimperative the KSBN continue to be autonomousand oversee the nurses in Kansas to keep thepublic safe and, to date, KSBN has done thateffectively.

The KSBN President stated two factors enableKSBN to deliver services the way it does: adetailed strategic plan and being able to leverageits expertise and experience within the professionto drive its decision making.

With regard to the strategic plan, the KSBNPresident stated, unlike the other boards in Kansas,KSBN has had a detailed strategic plan for 15years. It prioritizes KSBN’s initiatives and allowsfor the direction of personnel, board members, andresources to achieve these initiatives. If KSBNwere combined with other boards, including BHA,KSBN’s ability to strategically plan would besubstantially impaired. She asked who wouldestablish priorities among several boards and howresources and personnel would be given to carryout KSBN’s initiatives when other boards wouldhave priority.

With regard to the other factor involving theability to be able to leverage KSBN’s expertiseand experience within the profession to drive itsdecision-making, the KSBN President noted,unlike many other boards, the KSBN requires itsexecutive administrator to have both nursing andadministrative experience, and that is reflected inhow the KSBN is managed and operated.

As an example, the KSBN President noted, atthe December 6, 2016, meeting, the ExecutiveDirector of BHA said she considers BHA to be amini-umbrella board. The BHA has number ofhealth care professions under its umbrella. If BHAplans to conduct an investigation, it requiresmultiple committees, levels of committees, andhiring an expert. The process is long and costly.The BHA processes 700 cases a year. By contrast,

KSBN has expert nurse investigators and expertnurses sitting on one committee. It is a one-stepprocess. KBSN investigators bring data and thecommittee makes disciplinary decisions because ithas expertise in its profession to do so. She saidKSBN opens and processes around 2,000 cases ayear and does so very cost effectively. By placingKSBN under an umbrella where there are multipleongoing processes, KSBN’s ability to be efficientand effective could be significantly impaired andcost more. In addition, by slowing down thoseprocesses, the public is not kept safe, becauseinferior or unfit nurses would be working formonths longer, when KSBN could ordinarily stoplicensees from practicing sooner.

The KSBN President noted, at the December6, 2016, meeting, the Committee heard from manyother boards on how they are workingindependently to streamline processes, handlematters efficiently, and cut costs. Many of theboards collaborate to share innovations andsystems or operational perspectives. One exampleis the KSBN working in collaboration with theKBP and the BHA to develop policy for chronicpain management. These boards work moreefficiently and cost effectively together. She saidthe point is the boards made the decision aboutpriority collaborations, unlike an umbrella boardthat pits boards against each other in competitionfor resources, personnel, and priorities. Whenexpert boards driven internally collaborate, theydo so in a way that makes sense. She stated theboards show they collaborate and are committed tocontinuing to do so.

The KSBN President concluded by saying theKSBN has demonstrated its critical need foroversight, demonstrated it has done its job well,and shown it collaborates with other major boards.She respectfully requested the Committee rejectthe proposal to combine the KSBN with the BHAor any other board.

A representative of the National Council ofState Boards of Nursing (NCSBN) also providedtestimony. She noted the national organizationprovides data, service, and resources to the stateboards of nursing to assist in their functions and tohelp in their role of public protection. A great dealof research is conducted through Project CORE,which gathers data every other year from theboards of nursing to help establish their


performance measurement. The boards can seefrom the data how their own board is doing inrelation to other boards, especially in regard toefficiency. She added her testimony reflected notonly that the KSBN is efficient, but it is one of themost efficient boards in the country.

The NCSBN representative presented datacomparing KSBN with umbrella boards,independent boards, and three boards with thesame number of nurses as Kansas. The dataindicated KSBN processes licenses and resolvescomplaints faster and has the lowest licensure feeper year.

As an example of the complexity of the workby the KSBN staff, the NCBSN representativestated Advanced Practice Registered Nurses(APRNs) have 4 distinct roles and 32 certificationexams, but staff needs to know the other examsthat exist to ensure they are not approving an examthat is unqualified. Not only does staff need toknow Kansas’ licensure requirements, but alsothose across the nation. This does not include thework dealing with licensed mental healthtechnicians the KSBN also oversees.

The NCBSN representative said, from anational perspective, the KSBN is an exemplaryboard and has the respect of other state boardsbecause of its quality and its dedication to publicprotection.

The Chairperson of the Legislative Committeeof the Kansas State Nurses Association (KSNA)also provided testimony stating KSNA membersobject to the consolidation of boards because theresponsiveness of the KSBN is valued in order tofacilitate changes that enhance the ability to becurrent in practice and education.

The Chairperson said the KSNA LegislativeCommittee members telephoned states where theboard of nursing was in an umbrella structure.KSNA members were unable to speak to someonewho could answer questions, and were oftentransferred numerous times to voice mail. Severaltimes they were on hold for 15 minutes or no oneanswered the telephone. The Chairperson saidKansas nurses appreciate the respect,consideration, and efficiencies received from theKSBN and the responsiveness to questions and

concerns. She added KSNA is unable to identifyany advantages of placing KSBN in a potentiallycompetitive relationship with another agency orhaving an executive director in a position ofpossible biases and conflicts of interest. There isconcern such an umbrella arrangement wouldundermine the efficiencies KSBN has established.Additionally, she noted every health board shouldbe concerned that no fiscal analysis supporting anumbrella structure in Kansas has been provided.

Social Work Profession. The ExecutiveDirector of the Kansas Chapter NationalAssociation of Social Workers (KNASW)presented testimony. She noted there are over7,000 social workers licensed and regulated inKansas by the BSRB. She stated the BSRB is aconsolidated agency and a consolidated regulatoryboard because they regulate seven differentprofessions.

The Executive Director said KNASW does notbelieve a consolidated board is efficient for publicprotection and would promote an independentboard for social work if such would be consideredin the state. She stated the BSRB, by licensingmany different professions, loses the identity ofthe profession. She also noted social work isgrossly under-represented on the BSRB, with only2 social workers representing 7,400 licensed socialworkers. There are 2 psychologists representing900 psychologists.

The Executive Director stated 38 other stateshave independent boards for social work. Thethree states mentioned in the A&M Study haveindependent licensing and regulatory boards forsocial work, even though they are in an umbrellaadministrative agency. She noted, if there is anopportunity to make some change, KNASW wouldstrongly advocate for an independent regulatoryboard for social work.

Health Care Professions. A health careconsultant presented testimony in which she notedthe December 6, 2016, testimony was a loud andclear message there is no real support forconsolidation of regulatory boards under anumbrella board, but state agencies would bewilling to cooperate if that was the action taken bythe Legislature. The common theme was to protectthe public. She noted the testimony also identified


complexity and autonomy in doing this work allfunded by fees from those they license. No SGF isbeing expended, unless a task related to theirregulatory role has been added to the agency’swork, such as tracking prescription orders forscheduled drugs assigned to the KBP. She addedshe does not support an umbrella board for publichealth fee-funded agencies in Kansas.

Speech Language Pathology and AudiologyProfessions. The Executive Director of the KansasSpeech-Language-Hearing Association (KSHA)gave a presentation. The KSHA has 1,000members in the state representing speech languagepathologists and audiologists. Audiologists arerequired to hold a license through the KansasDepartment for Aging and Disability Services(KDADS) to practice in the state. Audiologistswho also wish to sell hearing aids must haveanother state license through the KBHAE.

The Executive Director stated KSHA proposesto consolidate the KBHAE with KDADS. Thereasons for the proposal include that KDADS is anexisting board that already regulates most of thespeech and hearing professionals in the state. Thiswould eliminate unnecessary duplication andredundancy. The second reason for thisconsolidation is consumer protection. At this time,it is very difficult to determine who to file acomplaint with if a consumer is dissatisfied withthe fit of hearing aids. She stated, by moving theKBHAE under KDADS, it would be much easierfor Kansas consumers to determine where thecomplaints should be filed. She noted KDADS isfully staffed with full-time employees, socomplaints will be handled efficiently andpromptly. The third reason she cited to advocatefor the consolidation of KBHAE with KDADS isprofessional access. She said she hears fromKSHA members that they are unable to get theinformation they need from the KBHAE or have adifficult time contacting KBHAE. She alsoreceived calls from numerous outside agencieswanting to hire a hearing aid professional that askher for license verification because KBHAE hasno website. She indicated KDADS already has anonline license verification tool, and there is noreason to build another website.

In summary, the Executive Director statedKSHA supports the idea of streamlining,consolidating, and simplifying the licensing

process, and placing audiologists under oneagency, preferably KDADS, because KDADSalready licenses audiologists.

A practicing audiologist also gave apresentation. He stated KDADS is a logicalagency to regulate hearing aid dispensing becauseit has licensed audiologists since 2012, and abouthalf of the licensees under the KBHAE are alreadylicensed under KDADS. Consolidation wouldallow for the efficient licensing of hearing aidspecialists in the state and also provide stateoversight over KBHAE by being located inTopeka. He noted KDADS can offer services nowprovided by the KBHAE and do so at a lower cost.KDADS also has a website consumers andprofessionals can access. The KBHAE does nothave a website to assist a consumer with an issuerelating to hearing aids or dispensing in Kansas.He also stated KDADS is cost efficient. The costof a license for an audiologist is $135 every twoyears. The KBHAE charges $100 per year, and hasproposed a 25 percent increase in fees beginningin 2017. He asked the Committee to act to moveKBHAE to KDADS.

Dental Profession. The Executive Director ofthe Kansas Dental Association (KDA) presentedtestimony, noting Kansas dentists have a verygood relationship with the KDB. He stated theKDA and KDB work together on peer review andthe well being program. He said KDA believes theKDB is very efficient.

The Executive Director stated, because ofeconomies of scale, the KDA understands why theA&M Study suggested placing public healthboards under one umbrella agency. However, thereis a point where efficiencies actually decrease. Hestated perhaps consolidating smaller boards wouldmake more sense as the Committee movesforward.

Funeral Services Profession. The ExecutiveDirector of the Kansas Funeral DirectorsAssociation (KFDA) provided testimony. TheKFDA represents approximately 300 funeralhomes across Kansas. She said KFDA is opposedto placing the SBMA under an umbrella agency.KFDA is supportive of finding efficiencies withinSBMA and in doing so, keeping licensing feespaid by members in check. She noted the SBMA is


extremely streamlined and makes a consciouseffort to work with the minimal amount of fundingnecessary to run operations since it is a fee-fundedagency. If more efficiencies are found, there is nofiscal impact to the State, and it only affectslicensees.

The Executive Director stated funeral serviceis a very specialized field and somewhat differentfrom other health-related professions that could beplaced in an umbrella agency. She noted it isimportant to KFDA members that the staff of theagency has funeral service experience, while thestaff of an umbrella agency would likely lackexpertise in the area of funeral service, which theExecutive Director of KFDA believes the memberlicensees and the public deserve.

The Executive Director noted when contactingother states’ consolidated agencies, there isfrustration that answers to questions cannot bereceived because the staff does not have the samelevel of expertise. Calls are transferred manytimes, and no one has an answer. In Kansas, aperson can always reach someone with expertise,and that holds true for the public and licensees.She said the current method of regulation isworking extremely well. A structural change in theregulatory system of fee-funded agencies willlikely lower the level of service and regulationprovided for the benefit of the public and tolicensees.

APRN Profession. A representative of theKansas Advanced Practice Nurses Association(KAPN) provided testimony. In Kansas, there arealmost 5,000 advanced practice registered nurses,certified nurse midwives, clinical nurse specialists,and nurse practitioners.

The representative stated the idea to mergepublic health boards, particularly the KSBN andthe BHA, is a proposal to solve a problem thatdoes not exist. The KSBN and the BHA bothoperate efficiently. There is no data or report thatfinds such a change to be more efficient. No fiscalnote is attached to this proposal and making achange of this magnitude would be costly. Shestated there is uncertainty as to how this proposalwould be more efficient.

The representative said the KSBN and BHAboth operate on the fees generated from licensingprofessions in the state, and both operate withintheir own budgets and are financially responsibleto maintain those budgets. She added the KSBNhas demonstrated efficiency of operations andprocesses handling 72,000 licensees. Kansas staffhave been responsive to questions and concerns. Ithas also implemented technology for streamliningprocesses.

The representative stated KSBN hassufficiently demonstrated the value of its work andthe efficiency of its staff, and firmly believesgovernance of nursing belongs with nursing. Shestated the KAPN does not support theconsolidation proposal.

Practical Nurse Educators. The President ofthe Kansas Council of Practical Nurse Educators(KCPNE) gave testimony on behalf of the KansasCouncil of Associate Degree Nurse Educators(KCADNE) and KCPNE. She stated theseorganizations are concerned consolidation woulddiminish access and quality of services. She addedKCPNE and KCADNE acknowledge the effort topromote cost savings and efficiency to the State;however, including KSBN in this consolidationcould result in loss of proficiency, creating moreexpense, and increase risk of public safety. Shestated some boards might benefit from the process,but consolidation would not be an advantage to theKSBN. Consolidation would bring a loss of truepeer review to all disciplines involved.

Statutory Overview and Research

At the December 6, 2016, meeting, KansasLegislative Research Department (KLRD) staffprovided the Committee with informationregarding public health boards in other states,which was to be reviewed by Committee membersprior to the December 14, 2016, meeting.

An Office of Revisor of Statutes staff member,in response to questions that arose at theDecember 6, 2016, meeting, shared the history ofthe services provided and the 10 percent fee fundcredit statutes. The public health agencies operateon the fees they receive for licensing. He referredto KSA 2015 Supp. 75-3170a (use and purpose of10 percent charge to fee agencies and when charge


not applicable). The statute provides this credit isto reimburse the SGF for accounting, auditing,budgeting, legal, payroll, personnel, purchasing,and any other government services provided bythe State to the fee agencies. The informationprovided by Revisor staff includes pages relatingto a number of health-related fee agencies from the2016-2017 Kansas Legislature AppropriationsReport prepared by KLRD staff. The informationshows expenditures and FTE positions authorized,whether filled or not, and indicates no money ispaid to the agencies from the SGF.

The Revisor staff member said a limit of$100,000 per fiscal year for transfer to SGF wasestablished for the fee-funded agencies. Althoughoriginally enacted in 1973, the credit was 20percent and did not have a cap. In 1975, theLegislature created a $200,000 cap. This waschanged to the current law by the 2011 Legislaturewith a fee credit of 10 percent and a cap of$100,000.

There are a number of agencies thattransferred $100,000 per agency to the SGF in FY2015 and FY 2016: KSBN, BHA, KBP, BSRB,and the EMS Board. KSBOC transferred $100,000of fee fund revenue to SGF in FY 2016. All boards

contribute to the SGF as reimbursement forservices received from the State.

In response to requests made at the December6, 2016, meeting, KLRD staff prepared a listing byhealth agency that includes the number of FTEsand executives, budget, expenditures, amount paidto SGF per statute, and litigation costs. KLRDstaff also provided a spreadsheet containingagency board information, including number ofboard members, frequency of meetings, facilitylocation, and facility space by square footage.


The Committee recommends:

● The KSBN and the BHA not beconsolidated at this time; and

● The House Committee on Health andHuman Services and the SenateCommittee on Public Health and Welfarereview and consider combining KBHAEwith KDADS.


JOINT COMMITTEE

Report of theRobert G. (Bob) Bethell Joint Committee on

Home and Community Based Services andKanCare Oversight

to the2017 Kansas Legislature

CHAIRPERSON: Representative Daniel Hawkins

VICE-CHAIRPESON: Senator Michael O’Donnell

OTHER MEMBERS: Senators Jim Denning, Laura Kelly, Forrest Knox (substitute for SenatorLove at November 18, 2016, meeting), Jacob LaTurner, Garrett Love, and Mary Pilcher-Cook(January meeting only and served as Vice-chairperson); and Representatives Barbara Ballard,Will Carpenter, Willie Dove, John Edmonds, and Jim Ward

CHARGE

Oversee Long-Term Care Services and Medicaid Programs

KSA 2016 Supp. 39-7,160 directs the Committee to oversee long-term care services,including home and community based services (HCBS). The Committee is to oversee thesavings resulting from the transfer of individuals from state or private institutions toHCBS and to ensure that any proceeds resulting from the successful transfer be applied tothe provision of services for long-term care. Further, the Committee is to oversee theChildren’s Health Insurance Program, the Program for All-Inclusive Care for the Elderly,and the state Medicaid programs (KanCare), and to monitor and study theimplementation and operations of these programs including, but not limited to, access toand quality of services provided and any financial information and budgetary issues.

January 2017

Robert G. (Bob) Bethell Joint Committee onHome and Community Based Services and

KanCare Oversight

ANNUAL REPORT


The Committee makes the following conclusions and recommendations:

Managed Care Organization (MCO) Operations

The Committee made the following recommendations regarding MCO operations:

● The Secretary of Health and Environment shall develop standards to be utilizeduniformly by each MCO serving the State of Kansas pursuant to a contract with theKansas medical assistance program for each of the following:

○ Documentation to be provided to a health care provider by any MCO when it denies aclaim for reimbursement submitted by such provider. Denial reason codes must becompliant with the Health Insurance Portability and Accountability Act, and MCOsmust consistently apply denial reason codes in the same manner to ensure accuratereporting to the State; and

○ Documentation to be provided to a health care provider by any MCO whenrecoupments are made pursuant to a post pay audit of such provider to includetransparency of methodology used in the audit and a specific explanation of thereason for recoupment. MCOs may not arbitrarily remove codes (such as ICD-10,CPT, and DRG) submitted by the provider or change the level of care provided toreduce payment without using the proper appeal protections in place;

● The Secretary of Health and Environment shall complete a quarterly review of claimsdenials and appeals to determine:

○ Whether a high percentage of denials are overturned on appeal and, if so, address theissue with the MCO(s); and

○ If a certain procedure or codes are denied more often than others, whether thosedenials are appropriate, and address the issue with the MCO(s);

● A notice of a right to appeal, including the details and specific action required, be sent toindividuals who were assessed under the Capable Person Policy, as it is written in thecurrent Waiver and implemented by the MCOs, and as a result had their plans of careadversely affected. The notice is to be sent no later than December 15, 2016;

● MCOs report to the Committee on the first pass denial rate;

Kansas Legislative Research Department 3-1 2016 HCBS and KanCare Oversight

● All MCOs shall work together to develop one standardized credentialing application.MCOs will respond to all submissions within 15 working days. MCOs should use aCouncil for Affordable Quality Healthcare portal for processing credentialingapplications;

● MCOs standardize the under- and over-payment process; and

● Require notices of changes to a Plan of Care be provided to both individuals andproviders.

Mental Health

The Committee made the following recommendation regarding mental health:

● Legislation be introduced by the House and Senate health committees to work on theMental Health 2020 Initiative plan from the Community Mental Health Centers.

Medicaid Clearinghouse Operations

The Committee made the following recommendation regarding Clearinghouse operations:

● Eligibility applications over 45 days aging be sent to a team formed exclusively to getapplications through the process and finished. The Kansas Department of Health andEnvironment (KDHE) should set a goal that 75 percent of long-term care applications becleared in the first 45 days.

Administration of KanCare

The Committee made the following recommendations regarding the administration of KanCare:

● Extend the current 1115 Waiver for one year and delay the request for proposal until theState clearly understands federal changes to the Affordable Care Act and Medicaid; and

● The Kansas Eligibility and Enforcement System (KEES) not be expanded to Phase 3 untilthere has been a clear demonstration of system functionality and operational integrity isdetermined and all problems have been resolved. Request the Legislative Division of PostAudit update the Information Technology audit on KEES published in December 2015and report satisfactory performance before Phase 3 expansion can occur.

KanCare Reporting and Rates

The Committee made the following recommendations regarding KanCare reporting and rates:

● All uncompensated care numbers presented to the Committee be based on 100 percent ofMedicare allowable; and

● The 4 percent Medicaid reimbursement cut and corresponding policies be reversed.

Proposed Legislation: None.


BACKGROUND

The Robert G. (Bob) Bethell Joint Committeeon Home and Community Based Services (HCBS)and KanCare Oversight operates pursuant to KSA2016 Supp. 39-7,159, et seq. The previousJoint Committee on HCBS Oversight was createdby the 2008 Legislature in House Sub. for SB 365.In HB 2025, the 2013 Legislature renamed andexpanded the scope of the Joint Committee onHCBS Oversight to add the oversight ofKanCare (the state’s Medicaid managed careprogram). The Committee oversees long-term careservices, including HCBS, which are to beprovided through a comprehensive andcoordinated system throughout the state. Thesystem, in part, is designed to emphasize adelivery concept of self-direction, individualchoice, services in home and community settings,and privacy. The Committee also oversees theChildren’s Health Insurance Program (CHIP), theProgram for All-Inclusive Care for the Elderly(PACE), and the state Medicaid programs(KanCare).

The Committee is composed of 11 members:6 from the House of Representatives and 5 fromthe Senate. Members are appointed for terms thatcoincide with their elected or appointedlegislative terms. The Committee is statutorilyrequired to meet at least once in January and oncein April when the Legislature is in regular sessionand at least once for two consecutive daysduring both the third and fourth calendarquarters, at the call of the chairperson. However,the Committee is not to exceed six total meetingsin a calendar year, except additional meetings maybe held at the call of the chairperson when urgentcircumstances exist to require such meetings. Inits oversight role, the Committee is to oversee thesavings resulting from the transfer of individualsfrom state or private institutions to HCBS and toensure proceeds resulting from the successfultransfer be applied to the system for the provisionof services for long-term care and HCBS, as wellas to review and study other components of thestate’s long-term care system. Additionally, theCommittee is to monitor and study theimplementation and operations of the HCBSprograms, CHIP, PACE, and the state Medicaidprograms including, but not limited to, access toand quality of services provided and financialinformation and budgetary issues.

As required by statute, at the beginning ofeach regular session, the Committee is to submit awritten report to the President of the Senate, theSpeaker of the House of Representatives, theHouse Committee on Health and Human Services,and the Senate Committee on Public Health andWelfare. The report is to include the number ofindividuals transferred from state or privateinstitutions to HCBS, as certified by the Secretaryfor Aging and Disability Services, and the currentbalance in the HCBS Savings Fund. (SeeAddendum A for the 2016 Report.) The report alsois to include information on the KanCare Programas follows:

● Quality of care and health outcomes ofindividuals receiving state Medicaidservices under KanCare, as compared tooutcomes from the provision of stateMedicaid services prior to January 1,2013;

● Integration and coordination of health careprocedures for individuals receiving stateMedicaid Services under KanCare;

● Availability of information to the publicabout the provision of state Medicaidservices under KanCare, including accessto health services, expenditures for healthservices, extent of consumer satisfactionwith health services provided, andgrievance procedures, includingquantitative case data and summaries ofcase resolution by the KanCareOmbudsman;

● Provisions for community outreach andefforts to promote public understanding ofKanCare;

● Comparison of caseload information forindividuals receiving state Medicaidservices prior to January 1, 2013, to thecaseload information for individualsreceiving state Medicaid services underKanCare after January 1, 2013;

● Comparison of the actual Medicaid costsexpended in providing state Medicaid


services under KanCare after January 1,2013, to the actual costs expended underthe provision of state Medicaid servicesprior to January 1, 2013, including themanner in which such cost expendituresare calculated;

● Comparison of the estimated costsexpended in a managed care system ofproviding state Medicaid services beforeJanuary 1, 2013, to the actual costsexpended under KanCare after January 1,2013; and

● All written testimony provided to theCommittee regarding the impact of theprovision of state Medicaid servicesunder KanCare upon residents of adultcare homes.

All written testimony provided to theCommittee is available at LegislativeAdministrative Services.

In developing the Committee report, theCommittee also is required to consider theexternal quality review reports and qualityassessment and performance improvementprogram plans of each managed care organization(MCO) providing state Medicaid services underKanCare.

The Committee report must be published onthe official website of the Kansas LegislativeResearch Department (KLRD). Additionally, theKansas Department for Aging and DisabilityServices (KDADS), in consultation with theKansas Department of Health and Environment(KDHE), is required to submit an annual report onthe long-term care system to the Governor and theLegislature during the first week of each regularsession.


The Committee met twice during the 2016Session (January 22 and April 18) and twice fortwo days each during the interim (August 4 and 5and November 17 and 18). The Committeemembers toured Family Service & GuidanceCenter, in Topeka, and the Medicaid Eligibility

Clearinghouse on August 4. In accordance with itsstatutory charge, the Committee’s work focused onthe specific topics described in the followingsections.

KanCare overview and update. KanCareenrollment. Updates on Medicaid and CHIPmember eligibility and expenditure information;KanCare financial summaries; provider networks;claim processing and denials; utilization summary;value-added services and in-lieu-of services; andmember grievances, appeals, and hearings wereprovided to the Committee at all four meetings.

At the January meeting, the Division of HealthCare Finance (DHCF) Director, KDHE, reportedJanuary–February 2016 average annualmembership was 396,842. At the fourth quartermeeting, the Director reported January–September2016 average annual membership was 451,068.

Eligibility application backlog. TheLegislative Division of Post Audit (LPA)conducted an audit to review the timeliness ofMedicaid eligibility determinations. The auditreport states there was an application backlog of14,000 as of June 2016. The report states thefollowing as possible factors contributing to thebacklog:

● Technical glitches when the KansasEligibility Enforcement System (KEES)was implemented in 2015;

● An underestimation by KDHE of howmany people would apply for Medicaid asa result of the Affordable Care Act (ACA);and

● Transition of all Medicaid eligibilitydetermination responsibilities from theDepartment for Children and Families(DCF) to KDHE in January 2016.

The audit report states KDHE has made thefollowing changes in an effort to eliminate orreduce the backlog:

● Increased the number of staff to processthe applications;


● Stopped reviewing renewal applications;and

● Worked to improve KEES.

At the April meeting, several Committeemembers reported hearing complaints about longwait times when individuals call the Clearinghouseand asked KDHE officials to considerimplementing goals for answering the phones andwait times. A representative from KDHE agreed todiscuss the issue with the Clearinghousecontractor.

At the August meeting, the Secretary of Healthand Environment reported the backlog of 3,587unprocessed applications should be eliminated bySeptember 2016. Committee members expressedfrustration with the ongoing delays in processingapplications.

At the November meeting, Committeemembers again expressed concern with the fact thebacklog had not yet been eliminated. TheSecretary of Health and Environment providedinformation to the Committee indicating thebacklog had decreased to 1,970 unprocessedapplications and would never be eliminatedcompletely due to gaps in time when individualsare asked to provide additional information tomake an application complete.

The audit report states the Centers forMedicare and Medicaid Services (CMS) has beentracking the backlog since February 2016 andplans no further action once the backlog isresolved.

KanCare request for proposal (RFP). The RFPfor Medicaid MCOs was originally scheduled tobe released at the end of 2016 for a June 2017award; however, the DHCF Director indicatedKDHE intends to wait to release the RFP until aclear direction regarding the future of the ACA isdetermined.

CMS review. In October 2016, CMSconducted a review of KanCare focusing on 2013to the present. An exit review between KDHE andCMS occurred on November 16, 2016. KDHEstated CMS will prepare a final report regarding

the review. As of December 22, 2016, KDHE hadnot received the report from CMS.

Reimbursement rate cuts. Effective July 1,2016, the Medicaid reimbursement rate toproviders was cut 4.00 percent and the rate tonursing home providers was cut 4.47 percent.Multiple stakeholders provided comments to theCommittee regarding the rate cut, explaining thefinancial strain the cut has placed on providers,and requested the rate cuts to be reversed.

The Chairperson stated it is his intention tointroduce legislation during the 2017 Session toreverse the cuts.

Dental service providers. Several dentalproviders provided oral and written testimony tothe Committee about the financial hardship createdby the low reimbursement rates. One dentalprovider indicated she loses money each time sheprovides services to a Medicaid consumer.

Long-term care facility providers. At theNovember meeting, nursing home providerstakeholders stated the rate cuts, combined withthe 150 percent higher provider assessment andthe application backlog, put an unsustainableburden on long-term care services for seniorKansans. Stakeholders also stated some progresson application determinations is being realized;however, some long-term facilities still arereporting between $1.0 million and $2.0 million inpending Medicaid claims.

In mid-2016, KDHE announced an advancedpayment program for long-term care facilities.This program allowed long-term care providers torequest advanced payments, half of the paymentfor which the individual was eligible, from KDHEwhile the Medicaid applications of their residentswere pending. Several facilities attempted toparticipate in the program. When requests foradvanced payment were received by KDHE,advanced payments were not granted; rather, theapplications of the residents at the requestingfacilities were prioritized for eligibilitydetermination.

Pharmacy providers. The DHCF Directorreviewed Medicaid provider pharmacy rates. Hereported the dispensing fee for large chain


pharmacies, defined as those companies with 30 ormore locations within the state of Kansas, werereduced from $10.50 to $4.50. All otherpharmacies’ dispensing fees were reduced from$10.50 to $9.25. The rate cuts were implementedJuly 1, 2016.

KEES update. The Secretary of Health andEnvironment reported throughout calendar year(CY) 2016 KDHE was working to update andimprove KEES. Since KEES was implemented in2015, the Secretary stated, KDHE and the KEESvendor have implemented 17 major enhancementsto improve system operations in eligibility,customer service, imaging, data entry, andregistration.

Capable Person Policy. In May, the Stateannounced a Capable Person Policy change as partof the $56.0 million in budget-balancing Medicaidcuts. At the August meeting, a representative ofKDADS indicated there would be rigorousenforcement of the Capable Person Policy, whichlimits reimbursements for routine daily taskscompleted for individuals with disabilities if ahousehold member is capable of performing thetasks. In a letter to KDHE dated October 12, 2016,CMS officials stated they found a number ofinconsistencies between Kansas’ approved waiversand the Capable Person Policy. CMS also statedwhen the Capable Person Policy disagrees with anapproved waiver, the waiver is the authorityregarding the services and providers for whichFederal Financial Participation matching funds canbe claimed. In the letter, CMS explained thatcorrecting these inconsistencies will requireamendment of either the policy or the waivers andadvised that, until the waiver amendments areapproved by CMS, KDADS must haltimplementation of the Capable Person Policy aswritten. Several stakeholders addressed the changeand expressed concern a change to the waiverwould adversely affect individuals with disabilitiesreceiving Medicaid benefits under one of thewaivers.

Health Homes. The DHCF Director reportedat the April meeting that the Health Homesprogram was ending, members and partners hadbeen notified, and the MCOs were working ontransition plans. A representative of KDHE statedthe Health Homes Learning Collaborativeactivities were focused on helping Health Home

providers transition their members to other formsof care coordination.

MCOs financial update. A representative ofKDHE provided information to the Committee atthe fourth quarter meeting indicating the MCOshad a total adjusted net income difference betweenthe first quarter of 2015 and the first quarter of2016 of $7,512,146. The information also statedthe total adjusted net income as of June 30, 2015,for the MCOs was $6,814,818.

KanCare Ombudsman. The KanCareOmbudsman provided information to theCommittee at all four meetings.

January meeting. The KanCare Ombudsman isavailable to members and potential members ofKanCare through phone, e-mail, and letters and inperson. During the fourth quarter of 2015, therewere 524 contacts through these various means,139 of which were related to an MCO issue (26.5percent). Review of the past two years by quartershowed the number of contacts during the quartersare very similar with the exception of the secondquarters in 2014 and 2015, which seem totypically have a decrease.

April meeting. During the first quarter of 2016,there were 1,130 contacts. This was a 117 percentincrease over the average number of contacts forthe past quarters. The top two categories resultingin contacts are Medicaid eligibility and “other.”The “other” contacts were often Clearinghouseconcerns not connected to eligibility, such aschange of address, disenrollment from KanCare,and spend-down questions.

In regard to outreach, the Ombudsman’s officehas created a flow chart for the KanCareapplication process and revised the information forKanCare members on grievances, appeals, andstate fair hearings.

The average number of days to resolve issuesduring the first quarter of 2016 was seven. Thepercentage of files resolved in one day or less was49.6 percent. The percentage of files closed duringthe first quarter was 76.5 percent.

August meeting. The number of contacts forthe second quarter was 846. That is a 63 percent


increase over the 2014-2015 average. It is alsodown from the first quarter increase of 117percent. The change seems to be fewer peoplecalling confused about the change with theClearinghouse and just wanting to know theirMedicaid status.

November meeting. The number of contactsfor third quarter was 687. That is a 32 percentincrease over the 2014-2015 average.

Step therapy. In its 2015 Annual Report, theCommittee recommended KDHE adopt a policyallowing MCOs and providers to use step therapyfor the non-waiver population. Step therapy is atiered system in which a patient must try a drugfrom Tier 1 before trying a drug from Tier 2,unless there is a clinical reason why a Tier 1medication is not appropriate for a particularpatient. The Deputy Secretary of Health andEnvironment reported step therapy ensures the useof proven and clinically effective drugs prior touse of more costly or riskier options for the samemedical condition. SB 402 (2016) went into effecton July 1, 2016, authorizing KDHE to implementstep therapy. KDHE began implementing a steptherapy policy as it relates to specific drugs in July2016 and will continue to phase in implementationthrough January 1, 2017.

Mental health issues. The Committee heardfrom the following organizations regarding mentalhealth issues: Association of Community MentalHealth Centers of Kansas, COMCARE, andFamily Service and Guidance Center.

Representatives from the above organizationsexpressed concern about the following:

● Four percent rate reduction in Medicaidreimbursement;

● Discontinuance of the Health Homesprogram;

● Decertification of Osawatomie StateHospital (OSH); and

● Change in KDADS policy regardingmental health screenings.

The representatives indicated these changeshave created unprecedented waiting lists forpsychiatric residential treatment facilities foryouth and adolescent patients, financial stress forcommunity mental health centers (CMHCs), andmental health patient capacity problems in thestate.

At the August meeting, the Deputy Secretaryfor Aging and Disability Services responded,stating KDADS received information from CMSindicating KDADS’ screening policy is a parityviolation and KDADS will work to determine thebest way to perform the screening function. Thethen-Interim Secretary for Aging and DisabilityServices indicated KDADS’ goal was to have OSHre-certified by August 2016.

Medicaid claims. Representatives fromLawrence Memorial Hospital (LMH) and the threeMCOs addressed claims processing and Medicaidas it relates to hospitals and medical centers.

The Health Plan Chief Executive Officer(CEO), UnitedHealthcare Community Plan(UnitedHealthcare), stated the claims data arerelatively stable. LMH is specifically concernedwith the clinical processes. During a meeting withLMH, UnitedHealthcare walked through itsprocess, and LMH walked through its process. Thefocus of UnitedHealthcare is where and when achange is needed to the communication process.The UnitedHealthcare CEO statedUnitedHealthcare’s goal is to maintain dialogueand discussion, and regarding inpatient stays,UnitedHealthcare wants complete transparency inmaking determinations, and, regarding claims,UnitedHealthcare hopes to clarify the clinicalprocesses disconnect throughout the hospitalsystem.

The CEO and President, Sunflower StateHealth Plan (Sunflower), stated when Sunflowerlooked at the yearly averages for claims paymentsand prior authorization processing times from yearto year, there were variances of no more than 10 to13 percent. The CEO further stated Sunflowerresponds in a reasonable range of time, from six toeight days on the average, for denial cases.Sunflower looked at its rates as being consistentover the course of three years.


The CEO, Amerigroup Kansas Plan(Amerigroup), reviewed Amerigroup’s operationalpoints looking for outliers from any previousactivity. Amerigroup has a denial rate of 7 percent.Of its prior authorization claims, only 4 percentwere denied. The CEO for Amerigroup statedAmericgroup’s operation techniques were good,but LMH may have perceived it otherwise andthere are issues on both sides that could beimproved with communication regarding billingand payment. The CEO stated Amerigroup isinterested in improving the relationship andservice process with all the hospitals it serves. TheCEO noted Amerigroup meets with its providerson an as-needed basis regarding billing concerns.

The Director of Compliance Management,LMH, spoke to the Committee regarding LMH’sinvestigative findings. The Director explainedspecific examples of the claims process problemsand the appeal process and how long it took to geta denial overturned and asked for someconsideration that correctly submitted claims notget caught up in the claims department. TheDirector stated LMH staff want to improve theefficiency of the process and make it better for thepatients. LMH is using three different sets ofbilling and denial processes to process claims, adifferent process for each MCO. The Directorasked for a set of systematically similar processesto reach conclusions on unresolved claims issuesand that each MCO offer regular update classes toproviders, so collaboration happens in problemsolving for LMH and other providers across thestate. The Director noted the new privatizedsystem is more complicated than when the Statehandled the claims. The Director of CareCoordination, LMH, noted LMH’s inpatient denialrate has probably quadrupled since the Statecontracted with the MCOs.

Presumptive eligibility for pregnant women.The DHCF Director stated a pregnant woman ispresumed eligible for prenatal services andreceives a reduced level of the benefit package.Once presumed eligible, she could apply for fullbenefits under Medicaid, as presumed eligibilitydoes not exist for full benefits. The DHCFDirector stated, even with the backlog in theprocessing of Medicaid eligibility applications,applications for pregnant women are givenpriority.

Age requirement for personal care serviceworkers. In 2015, KDADS implemented a policychanging the minimum age of personal careworkers from 16 to 18 and submitted waiveramendments that would be impacted. During theJanuary meeting, the DHCF Director informed theCommittee KDADS would be working with CMSto expeditiously reverse the policy to reinstate 16as the minimum age.

Non-payment of services provided whenpeople are receiving in-home health care. TheDHCF Director stated a policy effective sinceNovember 5, 2015, states if proper and timelynotification was not provided to a targeted casemanager (TCM) of a member being opted-in to aHealth Home and the TCM provided TCMservices, then the TCM would be held harmlessfinancially.

KanCare Waiver Integration project. At theAugust meeting, the Secretary of Health andEnvironment stated KDHE continued to examinehow to best combine the current seven waiversinto two waiver categories: children and adults.The Secretary stated the project would becoordinated with projects affecting the HCBSprogram. Committee members indicated there isno legislative interest for KDHE to continue topursue the Waiver Integration project. Further, aCommittee member explained the WaiverIntegration Subcommittee formed during the 2016Legislative Session recommended a bill beconsidered by the House Committee on Health andHuman Services requiring legislative approval ofwaiver integration and prohibiting implementationof waiver integration prior to January 1, 2018.

At the November meeting, the DHCF Directorstated KDHE then was not pursuing WaiverIntegration.

Osawatomie State Hospital (OSH). InJanuary 2016, CMS decertified OSH, citingreasons such as patient and staff safety concernsand appropriate facility concerns. At the Aprilmeeting, the then-Interim Secretary for Aging andDisability Services indicated a recertificationspecialist had been hired and he expected OSH tobe recertified within a couple of months. At theNovember meeting, the Acting Secretary forAging and Disabilities stated OSH was not yet


recertified but was ready for CMS to perform therequired recertification inspections. (As ofDecember 22, 2016, OSH had not been re-certified.)

Larned State Hospital (LSH). At the Aprilmeeting, the Executive Director of the KansasOrganization of State Employees spoke to theCommittee regarding staffing issues at LSH andthe recent shift of mental health inmates from theState Security Hospital to correctional facilities.The Executive Director reported LSH wassignificantly understaffed with a vacancy rate justunder 40 percent. She stated the high vacancy raterequired several employees to work mandatedovertime and made it difficult for employees to begranted vacation time. The Executive Directorfurther reported the classified employees at LSHhave not received an across-the-board cost-of-living pay increase since 2009, and the pay andworking conditions both contribute to highturnover.

The Executive Director stated, in an effort toaddress the mandatory overtime at LSH, KDADSclosed two units that house correctional inmates inneed of psychiatric care and moved severalinmates to Lansing Correctional Facility, which isnot equipped to handle the inmates withpsychiatric conditions.

The then-Interim Secretary for KDADSacknowledged staffing is an issue at both LSH andOSH. He provided documentation to theCommittee to show recruitment efforts andvacancy rates. The then-Interim Secretary furtherstated he expects employees to be treated withrespect and dignity.

In a follow up to questions by Committeemembers, KDADS officials provided informationabout overtime expenditures at both OSH andLSH.

Presentations on KanCare from individuals,providers, and organizations. Written and oraltestimony was presented at each quarterlymeeting. Some individuals and organizationsstated appreciation for the help and servicesprovided by the MCOs and relationshipsdeveloped with the MCOs that have allowedproblematic issues to be addressed and resolved

quickly. The following is a summary of theconcerns and suggested solutions.

Concerns. The various areas of concern andneed expressed by providers, organizations, andindividuals included the complexity of thedocumentation process for care services providedby in-home caregivers; lack of coordination ofservices; implementation of Waiver Integrationbefore a final policy and procedure manual waspublished and training and education werestandardized; inclusion of seniors in WaiverIntegration; delays in KanCare coverage forpregnant women and infants; Traumatic BrainInjury (TBI) waiver not being used to its fullpotential; KanCare failing older adults as isillustrated by the automation of the applicationprocess, application backlog, budget cuts, lack ofoversight, and enforcement; applicants not notifiedof their right to appeal when their eligibilitydeterminations exceed 45 days; lack of reliabilityof KEES; the Kansas Medical Assistance Programsystem frequently unable to be accessed so thatTCMs can enter billing information; for-profitMCOs are not person-centered; a policy restrictingpayments to providers unless there is a face-to-face visit could negatively impact individuals wholive semi-independently; implementation of theCapable Person Policy could negatively affectservices individuals receive; the detrimental affectof the 4.47 percent cut to reimbursement ratesnursing homes received combined with the higherprovider assessment; 4.00 percent reimbursementrate cut for providers; lack of adequate paymentfor emergency room services necessary to treat apatient as required under the Emergency MedicalTreatment and Active Labor Act; transparency ofquality metrics used by MCOs to report statisticsto KDHE; lack of standardization of providercredentialing requirements; lack of standardizationof prior authorization requirements; delay in priorauthorization for services; continual billing issues;ineffective MCO representatives who do notanswer phone messages or e-mails in a timelymanner; lack of rate increase forintellectual/developmental disabilities (I/DD)HCBS providers; funding cut to the Senior CareAct program; increase in I/DD waiting list; thedifficult process to become a Medicaid providerand be paid for claims is limiting the number ofproviders; and the treatment of patients at the stateand private psychiatric hospitals.


Recommended solutions. Various solutions toissues with KanCare expressed by providers,organizations, and individuals included repeal ofthe 4.00 percent reimbursement reduction;providers be part of MCO RFP developmentprocess; the I/DD population be carved out ofKanCare; not implement Waiver Integration;eliminate the Medicaid eligibility applicationbacklog; move the Office of the Inspector Generalto the Insurance Commissioner’s Office or otherneutral office and require the position to be filledby a non-partisan individual; move theOmbudsman’s Office to an outside organizationthat is qualified to inform and assist people in theirlegal rights; build a presumptive eligibility systemfor every category of KanCare and demonstrate itis operational; require standardized notification toconsumers regarding right to appeal and changesin their care coordinator; collect data on theadequacy of KanCare; increase the pay scale forproviders; have agencies vet policies with CMSprior to implementation; Medicaid expansion beconsidered by the 2017 Legislature; agenciesallow at least a six-month comment period whennew policies are proposed; agencies shift from aprovider-centric model of service delivery to aperson-centered model of services; and providemore funding to the Supported EmploymentProgram.

Representatives of the following organizationsand providers testified or provided writtentestimony before the Committee: AndersonCounty Hospital; Case Management Services;Community Living Opportunities;Communityworks, Inc.; Equi-Venture Farms,LLC; Flint Hills Community Health Center;Genesis Family Health; Genoa; GraceMed HealthClinic; Hutchinson Clinic, P.A.; InterHab; Jenian,Inc.; KanCare Advocates Network; Kansas Actionfor Children; Kansas Adult Care Executives;Kansas Advocates for Better Care; KansasAssociation of Area Agencies on Aging andDisabilities; Kansas Association of Centers forIndependent Living and the Self-Direction CareProviders of Kansas; Kansas Association ofPediatric Dentists; Kansas Council onDevelopmental Disabilities; Kansas Health CareAssociation and Kansas Center for AssistedLiving; Kansas Dental Association; Kansas HomeCare Association; Kansas Hospital Association;KVC Health Systems; LeadingAge Kansas; LifeCenters Family Support Organization;

MidAmerica Alliance for Access; NationalAssociation of Social Workers, Kansas Chapter;Oral Health Kansas; Residential TreatmentServices of Southeast Kansas; Riverfront SeniorResidence; and Wyandotte County Fetal and InfantMortality Review Board.

Agency responses to presentations byindividuals, organizations, and providers.KDHE and KDADS officials responded to variousconcerns during the course of testimony; however,when provided a specific opportunity during theApril, August, and November meetings to respondto stakeholders’ concerns, KDHE and KDADSrepresentatives did not provide additionalcomments.

MCO Testimony and Responses toPresentations By Individuals, Organizations,and Providers. April meeting. All three MCOsprovided oral-only comments about the situationwith LMH and Newman Medical Center. EachMCO expressed concern over the conflict andindicated either the issues had been resolved orthey were working to resolve the issues.

August meeting. Representatives fromAmerigroup and Sunflower responded to specificcomments made by stakeholders. A representativefrom UnitedHealthcare indicated he had noresponse.

November meeting. The CEO for Amerigroup,responding to concerns, stated HCBS providersshould be receiving Notices of Action andChanges in Service Plans and she would like to benotified if that is not happening. Amerigroupstated it is engaged in value-based purchasing and,if a facility changes ownership and subsequentlybecomes out-of-network, Amerigroup still pays100 percent of the Medicaid-approved claims.

The CEO for Sunflower, responding toconcerns, stated there had been improvement inthe approval rate and timeliness of claims andSunflower is interested in standardizingprocedures and credentialing.

The CEO for UnitedHealthcare, responding toconcerns, stated UnitedHealthcare has nurses, carecoordinators, and social workers performingassessments in nursing facilities to assure


members are receiving quality care andUnitedHealthcare utilizes value-based contractingand customer satisfaction surveys.

Human Services Consensus Caseload. Stafffrom the Division of the Budget, DCF, KDHE,KDADS, Kansas Department of Corrections, andKLRD met April 12, 2016, to revise the estimateson caseload expenditures for FY 2016 and FY2017 and on October 28, 2016, to revise estimateson caseload expenditures for FY 2017 and developestimates on caseload expenditures for FY 2018and FY 2019. The caseload estimates includeexpenditures for KanCare medical programs, non-KanCare programs, including Nursing Facilitiesfor Mental Health (state only) and Frail Elderly(FE)/Physical Disability (PD) WaiverAssessments, Temporary Assistance to Families,the Reintegration/Foster Care Contracts, and Out-of-Home Placements.

Spring estimates. At the April meeting, aKLRD staff member reviewed the estimates andprovided the following information. As the startingpoint for the spring estimate, the group used theapproved budget in 2016 House Sub. for SB 161.A chart summarizing the estimates for FY 2016and FY 2017 was provided to the Committee. Thenew estimate for FY 2016 is an increase of $100.2million from all funding sources, including anincrease of $3.3 million from the State GeneralFund (SGF). The estimate for FY 2017 is anincrease of $2.1 million from the SGF and $91.9million from all funding sources. The combinedestimate for FY 2016 and FY 2017 is an all fundsincrease of $192.1 million, including $5.4 millionfrom the SGF.

Fall estimates. At the November meeting, aKLRD staff member reviewed the estimates andprovided the following information. The estimatefor FY 2017 is an increase of $147.0 million fromall funding sources and $1.9 million from the SGFas compared to the budget approved by the 2016Legislature. (The approved amount reflects theGovernor’s May 2016 allotments.) The estimatefor FY 2018 is a decrease of $120.4 million fromall funding sources and an increase of $35.3million from the SGF above the FY 2017 revisedestimate. The estimate for FY 2019 is an increaseof $48.4 million from all funding sources and$165.8 million from the SGF above the FY 2018estimate. The combined estimate for FY 2017, FY

2018, and FY 2019 is an all funds increase of$75.0 million and an increase in SGF expendituresof $203.0 million.

Quarterly HCBS report. At each Committeemeeting, the Interim or Acting Secretary for Agingand Disability Services provided information onaverage monthly caseloads and average census forstate institutions and long-term care facilities. TheSecretary also provided information on savings ontransfers to HCBS waivers and the HCBS SavingsFund balance. (See Addendum A.)

Update on renewal of waivers. At theNovember meeting, KDADS officials providedinformation stating the Autism Waiver renewalapplication had been submitted and, if the Waiveris approved, three behavioral services will betransferred from the Waiver to the State Plan, andmore children will receive early interventionautism services.

As of November 2016, the Serious EmotionalDisturbance Waiver renewal had not beensubmitted, but CMS approved a 90-day extension.CMS indicated to KDADS that CMHCs can nolonger provide all eligibility determinations, planof care development, and provision of services.KDADS is working with CMS to address thispotential conflict of interest.

Update on amendments to renewed HCBSwaivers. At the April meeting, KDADS officialsreported CMS approved the following HCBSWaiver amendments in February 2016: TBI; PD;FE; Technology Assisted; and I/DD.

Waiting lists update. At the April meeting,KDADS officials reported 8,772 individuals werereceiving services on the HCBS I/DD program and3,481 individuals were on the waiting list; 5,686individuals were receiving services on the HCBSPD program and 475 individuals were on thewaiting list.

At the August meeting, KDADS officialsreported 8,896 individuals were receiving serviceson the HCBS I/DD program and 3,387 individualswere on the waiting list, and 5,975 individualswere receiving services on the HCBS PD programand 438 individuals were on the waiting list.


As of November 2016, KDADS officialsreported 8,936 individuals were receiving serviceson the HCBS I/DD program and 3,533 individualswere on the waiting list, and there were 6,204individuals receiving services on the HCBS PDprogram and 505 individuals on the waiting list.The information provided by KDADS indicatedevery individual on the PD waiting list had beencontacted; however, KDADS had receivedinformation that some individuals had not beencontacted. KDADS was working to resolve thisissue.


Based on testimony heard and Committeedeliberations, the Robert G. (Bob) Bethell JointCommittee on Home and Community BasedServices and KanCare Oversight made thefollowing conclusions and recommendations.

The Committee made the followingrecommendations regarding MCO operations:

● The Secretary of Health and Environmentshall develop standards to be utilizeduniformly by each MCO serving the Stateof Kansas pursuant to a contract with theKansas medical assistance program foreach of the following:

○ Documentation to be provided to ahealth care provider by any MCOwhen it denies a claim forreimbursement submitted by suchprovider. Denial reason codes must becompliant with the Health InsurancePortability and Accountability Act,and MCOs must consistently applydenial reason codes in the samemanner to ensure accurate reporting tothe State; and

○ Documentation to be provided to ahealth care provider by any MCOwhen recoupments are made pursuantto a post pay audit of such provider, toinclude transparency of methodologyused in the audit and a specificexplanation of the reason forrecoupment. MCOs may not

arbitrarily remove codes (such asICD-10, CPT, and DRG) submitted bythe provider or change the level ofcare provided to reduce paymentwithout using the proper appealprotections in place;

● The Secretary of Health and Environmentshall complete a quarterly review ofclaims denials and appeals to determine:

○ Whether a high percentage of denialsare overturned on appeal and, if so,address the issue with the MCO(s);and

○ If a certain procedure or codes aredenied more often than others,whether those denials are appropriate,and address the issue with theMCO(s);

● A notice of a right to appeal, including thedetails and specific action required, besent to individuals who were assessedunder the Capable Person Policy, as it iswritten in the current Waiver andimplemented by the MCOs, and as a resulthad their plans of care adversely affected.The notice is to be sent no later thanDecember 15, 2016;

● MCOs report to the Committee on the firstpass denial rate;

● All MCOs shall work together to developone standardized credentialing application.MCOs will respond to all submissionswithin 15 working days. MCOs should usea Council for Affordable QualityHealthcare portal for processingcredentialing applications;

● MCOs standardize the under- and over-payment process; and

● Require notices of changes to a plan ofcare be provided to both individuals andproviders.


The Committee made the followingrecommendation regarding mental health:

● Legislation be introduced by the Houseand Senate health committees to work onthe Mental Health 2020 Initiative planfrom the CMHCs.

The Committee made the followingrecommendation regarding MedicaidClearinghouse operations:

● Eligibility applications over 45 days agingbe sent to a team formed exclusively to getapplications through the process andfinished. KDHE should set a goal that 75percent of long-term care applications becleared in the first 45 days.

The Committee made the followingrecommendations regarding the administration ofKanCare:

● Extend the current 1115 Waiver for oneyear and delay the RFP until the State

clearly understands federal changes to theACA and Medicaid; and

● KEES not be expanded to Phase 3 untilthere has been a clear demonstration ofsystem functionality, operational integrityis determined, and all problems have beenresolved. Request LPA update theinformation technology audit on KEESpublished in December 2015 and reportsatisfactory performance before Phase 3expansion can occur.

The Committee made the followingrecommendations regarding KanCare reportingand rates:

● All uncompensated care numberspresented to the Committee be based on100 percent of Medicare allowable; and

● The 4 percent Medicaid reimbursementcut and corresponding policies bereversed.


ADDENDUM A

ROBERT G. (BOB) BETHELL JOINT COMMITTEE ON HOME ANDCOMMUNITY BASED SERVICES AND KANCARE OVERSIGHT

ANNUAL REPORT FOR THE 2016 LEGISLATIVE SESSION

The Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services andKanCare Oversight is charged by statute to submit an annual written report on the statewidesystem for long-term care services to the President of the Senate and the Speaker of the House ofRepresentatives at the start of each regular legislative session. The authorizing legislation (KSA2016 Supp. 39-7,159) creating a comprehensive and coordinated statewide system for long-termcare services became effective July 1, 2008.

The Committee’s annual report is to be based on information submitted quarterly to theCommittee by the Secretary for Aging and Disability Services. The annual report is to provide:

● The number of individuals transferred from state or private institutions to home andcommunity based services (HCBS), including the average daily census in stateinstitutions and long-term care facilities;

● The savings resulting from the transfer of individuals to HCBS as certified by theSecretary for Aging and Disability Services; and

● The current balance in the Home and Community Based Services Savings Fund.

The following table and accompanying explanations are provided in response to the Committee’sstatutory charge.

Number of Individuals Transferred from State or Private Institutions to Home andCommunity Based Services, Including the Average Daily Census in StateInstitutions and Long-term Care Facilities

Number of Individuals Transferred—The following table provides a summary of the number ofindividuals transferred from developmental disability (DD) institutional settings into home andcommunity based services during state fiscal year 2016, together with the number of individualsadded to home and community based services due to crisis or other eligible program movementduring state fiscal year 2016. The following abbreviations are used in the table:

● ICF/MR — Intermediate Care Facility for the Mentally Retarded

● SMRH — State Mental Retardation Hospital

● MFP — Money Follows the Person program

● SFY — State Fiscal Year


DD INSTITUTIONAL SETTINGS AND WAIVER SERVICES*

Private ICFs/MR: Avg. Mo. Caseload SFY 2016 137

State DD Hospitals – SMRH: Avg. Mo. Caseload SFY 2016 305

MFP: Number discharged into MFP program – DD SFY 2016 33

I/DD Waiver Community Services: Avg. Mo. Caseload SFY 2016 8,802

*Monthly averages are based upon program eligibility.

Sources: SFY 2016—Medicaid eligibility data as of November 30, 2016. The data include people codedas eligible for services or temporarily eligible.

The following table provides a summary of the number of individuals transferred from nursingfacility institutional settings into home and community based services during state fiscal year 2016. Theseadditional abbreviations are used in the chart:

● FE — Frail Elderly Waiver

● PD — Physical Disability Waiver

● TBI—Traumatic Brain Injury

FE / PD / TBI INSTITUTIONAL SETTINGS AND WAIVER SERVICES*

Nursing Homes-Avg. Mo. Caseload SFY 2016 10,235

MFP FE: Number discharged into MFP program receiving FE Services 49

MFP PD: Number discharged into MFP program receiving PD Services 148

MFP TBI: Number discharged into MFP program receiving TBIServices

10

Head Injury Rehabilitation Facility 29

FE Waiver: Avg. Mo. Caseload SFY 2016 5,049

PD Waiver: Avg. Mo. Caseload SFY 2016 5,647

TBI Waiver: Avg. Mo. Caseload SFY 2016 486

*Monthly averages are based upon program eligibility.

Sources: SFY 2016—Medicaid eligibility data as of November 10, 2016. The data include people codedas eligible for services or temporarily eligible.


AVERAGE DAILY CENSUS IN STATE INSTITUTIONS AND LONG-TERM CARE FACILITIES

Kansas Neurological Institute: Avg. Daily Census

FY 2010 – 157

FY 2011 – 153

FY 2012 – 152

FY 2013 – 145

FY 2014 – 143

FY 2015 – 144

FY 2016 – 141

Parsons State Hospital: Avg. Daily Census

FY 2010 – 186

FY 2011 – 186

FY 2012 – 175

FY 2013 – 176

FY 2014 – 174

FY 2015 – 173

FY 2016 – 164

Private ICFs/MR: Monthly Avg.

FY 2010 – 194

FY 2011 – 188

FY 2012 – 166

FY 2013 – 155

FY 2014 – 143

FY 2015 – 140

FY 2016 – 137

Nursing Facilities: Monthly Avg.

FY 2010 – 10,844

FY 2011 – 10,789

FY 2012 – 10,761

FY 2013 – 10,788

FY 2014 – 10,783

FY 2015 – 10,491

FY 2016 – 10,235

*Monthly Averages are based upon Medicaid eligibility data.


Savings Resulting from the Transfer of Individuals to HCBS

The “savings” through Money Follows the Person are realized only if and when an individual ismoved into a community setting from an institutional setting and the bed is closed. This processwould result in a decreased budget for private ICFs/MR and an increase in the MR/DD(HCBS/DD) Waiver budget as a result of the transfers.

For nursing facilities and state ICFs/MR, the process is consistent with regard to individualsmoving to the community. The difference is seen in “savings.” As stated above, savings are seenonly if the bed is closed. In nursing facilities and state ICFs/MR, the beds may be refilled whenthere is a request by an individual for admission that requires the level of care provided by thatfacility. Therefore, the beds are not closed. Further, even when a bed is closed, only incrementalsavings are realized in the facility until an entire unit or wing of a facility can be closed.

As certified by the Secretary for Aging and Disability Services, despite individuals moving intocommunity settings that does have the effect of cost avoidance, the savings resulting frommoving the individuals to home and community based services, as of December 31, 2016, was$0.

Balance in the KDADS Home and Community Based Services Savings Fund

The balance in the Kansas Department for Aging and Disability Services Home and CommunityBased Services Savings Fund as of December 31, 2016, was $0.


Documents

Committee Reports to the 2017 Kansas Legislature -- Supplement · 2017. 3. 8. · fellowships, and other collaborative ventures. Recruitment through fellowships and internships. The