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Minutes for SB300 - Committee on Ways and Means

Short Title

Prohibiting substantial change to the Kansas medical assistance program without prior legislative approval.

Minutes Content for Tue, Jan 30, 2018

Chairperson McGinn opened the hearing on SB 300.  Scott Abbott provided an overview of the bill.  (Attachment 1)

Janis DeBoer spoke in support of the bill.  Seniors have not fared well under KanCare but they have not had the data to support this assertion until recently when information was presented to the KanCare Oversight Committee last November.  Since 2010 the number of seniors on the frail/elderly waiver has dropped by approximately one thousand and funding for the ones who are on it is down.  The population of Kansas is aging so the numbers don't make sense.  Ms. DeBoer requested the targeted case management be returned to seniors and the physically disabled, which can happen now under KanCare 1.0.  (Attachment 2)

Sean Gatewood testified as a proponent of the bill.  His organization has serious concerns about several negative aspects of KanCare 2.0 including work requirements and time limits so they would like to see those removed.  They do support legislative oversight of the program.  Mr. Gatewood also expressed concern about the 3,000 missing seniors who are not being served now.  This number includes not only the frail/elderly population but also the nursing facility caseloads.  (Attachment 3)

Amanda Gress stood in support of the bill.  The stakes are incredibly high for our children in this program.  When children can access health care services it greatly improves their graduation rates and their ability to work later in life.  There are serious concerns about some of the provisions of the bill including work requirements and the potential impact this may have on parents and their children.  Legislative oversight and further discussion in needed before implementing KanCare 2.0.  (Attachment 4)

Mitzi McFatrich spoke in support of the bill on behalf of older adults who live at home and in nursing facilities.  KanCare has nearly insurmountable obstacles to older adults who are trying to apply for Medicaid and accessing support from nursing homes.  This has resulted in fewer seniors receiving support at a time when Kansas has a growing number of seniors.  She supports the return of targeted case management because for someone with dementia or physical limitations it can be difficult to work through this process.  Additionally, she is concerned about the lack of a legally-based, conflict-free independent ombudsman program for KanCare.  (Attachment 5)

Chad Austin testified as a proponent of the bill.  His organization put together a committee that worked closely with the MCOs and state agencies and the outcome was the passage of 2017 HB 2026 last year.  There are underlying issues outlined in that bill that need to be addressed before moving forward with KanCare 2.0.  There have been promising discussions with KDHE over the last few months and his organization is looking forward to continuing to work with them.  Mr. Austin responded to questions from Committee members.  (Attachment 6)

Timothy Graham stood in support of the bill as his organization wants to stop the expansion of KanCare.  There are failures in KanCare 1.0 so it should not be expanded until we fix some of the problems that currently exist.  Mr. Graham responded to questions from Committee members.  (Attachment 7)

Written testimony in support of the bill was submitted by:

Kyle Kessler, Association of Community Mental Health Centers of Kansas, Inc.  (Attachment 8)

Rick Cagan, NAMI Kansas  (Attachment 9)

Ernie Kutzley, AARP Kansas  (Attachment 10)

Mike Oxford, Topeka Independent Living Resource Center  (Attachment 11)

Cindy Luxem, Kansas Healthcare Association  (Attachment 12)

Rabbi Moti Rieber, Kansas Interfaith Action  (Attachment 13)

Rachelle Colombo, Kansas Medical Society  (Attachment 14)

David Jordan, Alliance for a Healthy Kansas  (Attachment 15)

Secretary Sarah Shipman spoke in opposition to the bill not because of KanCare but because of a process issue and the impact of the legislation on an ongoing Request for Proposals (RFP) for KanCare.  State agencies involved are already reviewing technical responses and proposals but no one has seen the cost proposals.  Cancellation of the RFP would result in all bids being subject to the Kansas Open Records Act.  That disclosure could diminish the bargaining power of the State in the future as each competitors' bids and price points will be available to all.  This could also result in companies being reluctant to bid on big contracts with the State in the future if there is the possibility of release of information.  The Department of Administration recommends the current procurement process move forward with the review of the technical proposals and then the cost proposals, which would insure competition without negatively impacting bargaining power in the  future.  Secretary Shipman responded to questions from Committee members.  (Attachment 16)

Jon Hamdorf stood in opposition of the bill.  He understands why the bill was proposed and the concerns of previous conferees.  There are several challenges with the bill, which are addressed in his testimony, including that it doesn't allow for any substantial changes from what it was on January 1, 2017.  This would eliminate the changes enacted by 2017 HB 2026.  There are also procedural issues relating to CMS guidelines that require a twelve month period of review before extensions go into effect.  Additionally, the bill does not allow for changes to eligibility, which takes away his ability to positively change eligibility.  Mr. Hamdorf responded to questions from Committee members.  (Attachment 17)

Chris Coffey testified in opposition to the bill.  In particular, the proposed one year extension would cause confusion and instability for the members.  This is particularly true for members in disease case management and home- and community-based service coordination.  It would also limit program administrators from making improvements that members and advocates have requested particularly for children in foster care that would increase stability.  (Attachment 18)

Written testimony in opposition to the bill was submitted by:

Carol Steckel, WellCare  (Attachment 19)

Kevin Sparks, UnitedHealthcare  (Attachment 20)

Frank Clepper spoke as a neutral conferee to provide some perspective.  There are challenges with coordination with the timeline but he is confident the administration, legislature and stakeholders can work together to move forward.  In his testimony, Mr. Clepper addressed the steps necessary to adhere to this bill and meet federal requirements.  (Attachment 21)

Written testimony neutral to the bill was submitted by:

Scott Anglemyer, Kansas Association of Community Action Programs  (Attachment 22)

There being no further conferees, Chairperson McGinn closed the hearing on SB 300.

Chairperson McGinn adjourned the meeting at 11:45.  The next meeting will be on January 31, 2018.