From KMS Executive Director Rachelle Colombo:
Although the legislature has long since adjourned, the implementation of newly passed laws can be a long and often confusing process. This is certainly the case with HB 2279, regarding APRN practice, which took effect on July 1 under temporary regulations promulgated by the Kansas State Board of Nursing.
July 12 is the last day to register to vote or make changes to your voter information for the August 2 primary election. You can view your registration status here: https://myvoteinfo.voteks.org/VoterView If you're not registered yet, you may do so here: https://www.kdor.ks.gov/apps/voterreg/
From KMS Executive Director Rachelle Colombo:
As we explained in our last newsletter, the implementation process of the recently enacted legislation, HB 2279, regarding APRN practice is likely to be somewhat confusing for all, especially physicians who work with and/or employ APRNs, as well as hospitals, nursing, and other health care facilities and the APRNs themselves. Because the Kansas State Board of Nursing (KSBN) must promulgate regulations to implement the changes contained in the legislation, it requires a complicated, multi-step administrative process that involves several state agencies and review committees. Following is a status report on where things stand as of today, July 1.
From KMS Executive Director Rachelle Colombo:
With the passage of House Bill 2279 by the 2022 Kansas Legislature there is a lot of confusion regarding this new law, and how it affects the practice of Advanced Practice Registered Nurses (APRNs).
We’ve heard from many of you with specific questions about the implications of the new law. To help bring some clarity to what the law says and what it may mean for your practice, we’ve created an FAQ at www.kmsonline.org/APRN to address such questions as best as we can know at this point.
From KMS Executive Director Rachelle Colombo:
Lawmakers returned to the Statehouse last week for their wrap-up session. They then adjourned early Friday morning until May 23, at which time they will come back to complete work on a congressional district map.
From KMS Executive Director Rachelle Colombo:
As you may have read in the media, a state legislator who is also a physician sent a letter to other health care providers regarding COVID-19 treatment. Local media reports this week indicate Senator Mark Steffen, MD — a Hutchinson anesthesiologist — sent a letter on official Senate stationery to numerous Kansas health care providers telling them that the standard of care for treatment of COVID-19 patients had changed and that they will be shielded from “interference” by the Kansas State Board of Healing Arts (KSBOHA). He also suggests that a physician’s “failure to treat” according to the new standard will be considered “wanton disregard.”
From KMS Executive Director Rachelle Colombo:
The Kansas Legislature adjourned the main portion of the 2022 regular session in the early hours of Saturday morning. Lawmakers will reconvene April 25 for a few days to wrap up any unfinished business and consider any bills vetoed by the Governor.
Among the contentious issues passed by lawmakers this week was the APRN bill, Senate Substitute for House Bill 2279.
From KMS Executive Director Rachelle Colombo:
On Tuesday, the Kansas House voted to non-concur with the Senate Substitute for House Bill 2279, which would amend the APRN practice statute to permit the prescribing of drugs without a collaborative practice agreement with a physician. The bill, which did not have a public hearing in the Senate on its specific provisions, represents a significant change in health care law which needs more thorough vetting. The House signaled they agreed by voting 91-26 to send it to the conference committee for further consideration.
From KMS Executive Director Rachelle Colombo:
After March 18, the regular session of the Legislature should be over for the most part. Then begins the process of reconciling bills in conference committees and in final floor vote activity. After the coming week there will likely be few (if any) new bills considered in 2022. Last week, the Senate voted to approve Senate Substitute for House Bill 2279 (the so-called APRN bill), which would amend the APRN practice statute to permit the prescribing of drugs without a collaborative practice agreement with a physician. While the bill’s impact is limited to prescribing, KMS believes that the prescribing of drugs is fundamental to the practice of medicine, and cannot be simply and safely parsed out to non-physician practitioners working without the collaboration or involvement of physicians.
From Rachelle Colombo, KMS Executive Director:
This KMS update is to ask you — yet again — to take a moment now to remind Kansas lawmakers of what they need to know as they consider what would be sweeping legislation, now under consideration, implicating the practice of medicine in our state. HB 2279 would amend Kansas's advanced practice registered nurse (APRN) authorized scope of practice statute to permit their prescribing of drugs without a collaborative practice agreement (CPA) with a physician, among other things.
From KMS Executive Director Rachelle Colombo:
Yesterday the Legislature began the second half of its 2022 session. That means most bills that have not already been passed by their originating chamber are unlikely to receive further consideration this year.
Among the bills that are still very much alive this session is HB 2279, which would amend the advanced practice registered nurse (APRN) authorized scope of practice statute to permit the prescribing of drugs without a collaborative practice agreement (CPA) with a physician; it would also require such nurses to carry an unspecified level of liability insurance.
From KMS Executive Director Rachelle Colombo
Today the Senate Public Health and Welfare Committee approved a bill that would allow nurse practitioners (APRNs) to prescribe drugs and practice without collaborative practice agreements.
From KMS Executive Director Rachelle Colombo:
It was another busy week in the Legislature leading up to its first major deadline — Turnaround Day on Feb. 24 — when most bills must be passed out of their originating chamber to receive further consideration.
From KMS Executive Director Rachelle Colombo:
If you followed much of the media coverage of the Kansas legislature this week, you know just how tumultuous of a week it was. As we’ve detailed in previous legislative updates: this is an election year; it’s also a once-in-a-decade re-drawing of legislative and congressional districts; and the state’s response to the COVID-19 pandemic continues to be politically contentious. Each of these factors introduces variables into the legislative process that make this session particularly unpredictable.
A message from Rachelle Colombo
Thank you everyone who was able to attend the first annual KMS Advocacy Day last week. We recognize how difficult it is to take time away from practice and to navigate events in this environment. We were pleased to have a strong showing of physicians representing more than a dozen specialties join together to learn about legislation and meet with elected officials to advocate for the profession. In a time when so many proposals impact patient access and care, it is critical that physicians have relationships with their Representatives and Senators and can serve as a trusted source of factual information.
A look back at the first annual Advocacy Day
Last week, KMS and more than a dozen specialty societies hosted our first annual Advocacy Day. About 60 physicians, PAs, and medical students attended along with staff and guests from partner organizations — including from the event’s four generous sponsors: KAMMCO, HealthyBlue, Blue Cross and Blue Shield of Kansas, and UnitedHealthcare.
A message from Rachelle Colombo about Advocacy Day
We know it has been a long two years, particularly for physicians and others continuing to cope firsthand with fallout from the pandemic. Much has changed — and continues to change. However, the Kansas legislature continues to meet — where most of the public policy that affects the practice of medicine is enacted. Of course, we continue to advocate for you in the Statehouse and otherwise — and we will do so however circumstances may change.
New emergency declaration issued
On Thursday, Gov. Kelly issued a new 15-day state of emergency and signed two executive orders aimed at addressing staffing shortages at hospitals and nursing homes as COVID-19 cases climb in Kansas.
2022 Advocacy Day schedule now available
We are planning to hold the 2022 Advocacy Day in person on January 25 in Topeka. Among other things, Advocacy Day will offer a chance to hear from KMS leadership about the upcoming legislative session, to meet with legislative leaders, and to meet with your specialty society peers. While some specialty societies may also hold events later in the year, Advocacy Day is the one event of the year for all Kansas physicians. The event schedule is now available here: www.kmsonline.org/AdvocacyDay.
Physician Leaders Forum
Building on the information shared during the Physicians Leaders Forum in June, this virtual session will focus on physician resilience and wellbeing in a post-COVID environment. A panel discussion will highlight strategies currently being used in Kansas to address physician and health care worker resilience. This event—co-presented by KMS and the Kansas Hospital Association—will be from noon to 1:15 p.m. on Dec. 14, 2021. More information and free registration here: www.kmsonline.org/PhysicianLeadersForum.
New COVID-19 relief funding for rural communities
The Biden administration announced plans to distribute $25.5 billion in funding to physicians, hospitals, and other health care facilities affected by the COVID-19 pandemic as part of the Provider Relief Fund (PRF). The portal for funding applications opened Sept. 29 at: https://prfreporting.hrsa.gov.
The legislature will return May 26 for the official conclusion of the 2021 session, Sine Die, a traditionally ceremonial day albeit one that could entail some official business, such as votes to override vetoes.Otherwise, bills considered by the legislature this year have either expired or may carry over to next session. Following is a look back at the primary issues we were tracking this year and where things stand ahead of the 2022 session.
From KMS Executive Director Rachelle Colombo
The 2021 legislative session adjourned early Saturday morning, May 8th at nearly 2:00 a.m. During the final week of the session, the efforts to pass APRN legislation intensified considerably but, in the end, the legislature took no action on the issue. This late-session push for the APRN bill was for all practical purposes taken over and controlled by staff and lobbyists for the Kansas Chamber of Commerce and Americans for Prosperity. The two business groups wanted legislative leaders to circumvent the normal legislative process rules in order to pass an APRN bill even though such legislation had not been passed by either health committee nor debated on the floor of the House or Senate during the prior four months of the regular legislative session.
From KMS Executive Director Rachelle Colombo
As we reported last week, the legislature will return May 3 for a brief wrap-up session to complete work on bills awaiting final action, including legislation authorizing the independent practice of medicine and surgery by APRNs.
In recent weeks, legislators have been receiving hundreds of emails in support of the APRN issue in a statewide advocacy campaign conducted by Americans for Prosperity and the Kansas Chamber of Commerce. These business groups contend that physician-directed collaborative practice agreements are nothing more than unnecessary “permission slips,” which create access to care problems depriving Kansans of basic health care, particularly in rural and marginalized communities. Although no new APRN bill has surfaced yet, we expect one will be introduced as soon as the legislature returns.
From KMS Executive Director Rachelle Colombo
The Legislature reached first adjournment Friday and began a three week legislative break. They will return on May 3 for a brief, perhaps week-long wrap-up session to complete work on bills awaiting final action, as well as omnibus budget measures.
In the past couple of weeks—despite not having been passed by either the Senate or House Health Committee—efforts have intensified to pass some form of the APRN independent practice legislation, as an amendment to an unrelated bill now working through the process of reconciliation for consideration in the wrap-up session. Though our efforts have thus far stopped this issue from advancing before first adjournment, the work is not truly conclusive until the legislature completes its work in the first week of May.
New Kansas Emergency Management Act signed into law
This week, Gov. Kelly signed into law the updated Kansas Emergency Management Act (KEMA). The law extends the state of disaster declaration for COVID-19 through May 28, 2021, and gives the governor limited authority to issue executive orders in response to the ongoing pandemic. The new KEMA law revokes the governor’s current executive orders (which were set to expire on March 31), while allowing the governor to re-issue such orders via certain processes. The governor said this week that she intends to re-issue several executive orders, including one requiring face masks in most public places and in outdoor settings where adequate social distance cannot be maintained. She also said that this order would apply to all counties that opted out of the previous face mask order. Legislative leadership responded saying it would oppose such a mask mandate; under the new KEMA law, the legislature has the authority to rescind such executive orders.
From KMS Executive Director Rachelle Colombo
With Friday’s adjournment, the Legislature has passed its first major deadline of the session, when most bills need to have been approved by at least one chamber. After a short break, legislators will have about three weeks to further consider bills that are still alive this session. After the next deadline on March 31, typically only those bills that have fully moved through both chambers (as well as exempt bills, such as a budget bill) will be eligible for passage this session.
Given that timeline, here is the status of some of the bills we have been involved with this session.
From KMS Executive Director Rachelle Colombo
I’d like to preface this week’s update by noting that this is among the rare times that we are calling all KMS members to action—that is, to send a brief note to one or more legislators as suggested below. But first, I will give you the context from recent developments in the legislature.
From KMS Executive Director Rachelle Colombo
This week, three bills proposing to allow nonphysician practice of medicine were made public, two of which have hearings scheduled for next week.
House 2256 and Senate Bill 174 seek to remove the requirement for a collaborative practice agreement between an APRN and a physician, where the former seeks to treat patients independently with no statutory limits on their scope of practice. Currently the bills are scheduled for hearings on 2/17 in House Health and Human Services and on 2/18 in Senate Public Health and Welfare (note: it is possible one or both of these hearings will be delayed). We plan to testify in opposition to both. Live streams of all House and Senate health committee meetings are available on YouTube (under “Upcoming live streams”).
From KMS Executive Director Rachelle Colombo
Since our last update, several proposals have emerged in the legislature that may implicate the practice of medicine in Kansas.
First, you have likely seen in recent news reports that Gov. Kelly plans to again support a bill to expand Medicaid, but this time by tying the proposal to passing a medical marijuana bill and using tax revenue from marijuana sales to cover the state cost for expanding Medicaid. Although a specific bill(s) has yet to be introduced, for Kansas physicians and other proponents of Medicaid expansion, this approach may prove to be problematic. Clearly it is critical that Kansans have access to care—and therefore KMS has always supported Medicaid expansion—however, we oppose medical marijuana, while it remains unapproved by the FDA.
Legislative update from KMS Executive Director Rachelle Colombo
Just two weeks in to the 2021 legislative session and it is already unlike any before it. Within the first week, committees were meeting on priority issues, racing against what some have taken to calling the “COVID clock” — acknowledging the likelihood of legislators’ increased exposure to COVID-19 with each passing day under the dome. In addition to their constitutional duty to pass a budget funding state programs by the end of June, top legislative leaders identified two other priorities.
A message from KMS Executive Director Rachelle Colombo:
A little more than half over, this year has already been one for the books. The coronavirus pandemic and all of its health, economic, and other societal impacts have been exhausting and challenging for just about everyone—in particular for those in the health care community and their patients. Add to that the widespread protests, social upheaval, and civil unrest that have grown out of the tragic death of George Floyd while in police custody in Minneapolis. And, just for good measure, throw in a presidential election that is likely to further divide the country along deep political fault lines. It seems like every day there is another crisis to deal with. It’s no wonder so many feel frustrated and exhausted.
A message from KMS Executive Director Rachelle Colombo
Now that the Kansas Legislature has adjourned the Special Session, election season is in full swing. The incredible stress that has been placed on all aspects of American life in recent weeks and months makes the prospect of political engagement unappealing to many. But the importance of targeted advocacy and meaningful participation in policymaking is evident. KMS is the trusted voice for Kansas physicians—always working with lawmakers on policies affecting the practice of medicine so you can focus on patient care. Effective advocacy does not begin and end according to legislative sessions. Effective advocacy is rooted in relationship and requires investment in mutual understanding and support. Our voice as physician advocates is amplified by our political giving through KAMPAC. These funds are used to support state and federal legislative candidates that safeguard keeping the practice of medicine in physician hands. We support those lawmakers that want to ensure the highest level of care for Kansans. If you haven’t already, please consider becoming a KAMPAC member today so that our advocacy remains strong and effective for Kansas physicians.
The 2020 Kansas legislative session was anything but ordinary, even prior to the onset of COVID-19. Early on, two major issues—Medicaid expansion and abortion—consumed much of the political oxygen in the Statehouse, diminishing the number of bills that would be considered in committee and passed on to the House or Senate. All health-related bills were particularly affected as such bills were viewed as potential vehicles to force a floor vote on Medicaid expansion. Following is a brief summary of what happened—or did not happen—this session, centered around bills of interest to Kansas health care providers.
As we reported last week, KMS continued to urge lawmakers to address liability protections for health care providers during the COVID-19 emergency period. KMS developed and presented to the House and Senate Judiciary Committees a narrowly constructed immunity proposal that limits health care provider liability related to COVID-19 treatment, and for professional services otherwise medically necessary that were delayed or not provided due to the declared state of emergency. KMS also worked closely with the governor’s office to ensure that the administration’s questions and concerns about the proposal were addressed.
This week, the Senate canceled all committee meetings scheduled for after Tuesday. Therefore, the Public Health and Welfare Committee did not hold the hearing that had been scheduled for SB 493, the bill in response to the Hilburn ruling. In light of the fast-moving developments this week regarding COVID-19, the Legislature was focused on passing a budget (its sole state constitutional duty each session), which it accomplished on Thursday.
This week in the Public Health and Welfare Committee, a bill to respond to the Hilburn ruling was re-introduced (SB 493). The first bill introduced to that end was not approved in time to meet legislative deadlines.
Like the first proposal, we believe this bill represents the best response to the state Supreme Court's recent decision that struck down Kansas’ cap on non-economic damages in a motor vehicle personal injury case. Because there is uncertainty about whether the ruling also applies to medical malpractice actions, KMS is advocating for needed updates to the Health Care Stabilization Fund coverage requirements while we await further clarification from the Court.
After a short break, the Legislature resumed work on Wednesday this week. However, there was little action on bills under consideration, with the exception of a handful of committees. As has been the case for several weeks now, the impasse over Medicaid expansion and the constitutional amendment on abortion has left little room for movement on other issues.
This week, the Senate Public Health and Welfare Committee held its last meeting before “turnaround day,” the deadline by which health bills must be approved if they are to pass over to the other chamber. The committee adjourned without further considering the Medicaid expansion bill (SB 252), again signaling that an expansion bill appears unlikely to be approved until issues related to the constitutional amendment on abortion are resolved.
This week, the Senate Public Health and Welfare Committee made several changes to the Medicaid expansion bill, adjourning without further action. The amendments made to the bill include a work and education provision, a conscientious objection provision, and prerequisites that must be met before expansion could be implemented in our state.
More importantly though, the committee’s action makes clear that the expansion bill would likely continue to be delayed until issues related to the constitutional amendment on abortion are resolved. Proponents of the constitutional amendment argue that, if it is not passed, the state’s portion of expansion funding could be used on abortions.
This week, the Senate Public Health and Welfare Committee was expected to discuss—and potentially amend—the Medicaid expansion bill, SB 252. Instead, the committee will be seeking additional information pertaining to the expansion bill before moving forward with consideration of amendments.
This week, the Senate Public Health and Welfare Committee met for the first of three scheduled days to discuss the Medicaid expansion bill, SB 252. As a starting point, Committee Chair Sen. Gene Suellentrop (R-Wichita) invited Kansas Attorney General Derek Schmidt to brief members on the status of ongoing legal challenges to the Affordable Care Act (ACA), which provides for Medicaid expansion.
This week the Senate Public Health and Welfare Committee continued the hearing on SB 252, Medicaid expansion, with opponents testifying on both Wednesday and Thursday. With the hearing concluded, the process of discussing the bill and debating potential amendments among committee members begins. If the bill is favorably passed out of committee, the full Senate will debate it and proposed amendments before potentially passing it to the House, where the process would repeat and continue.
This week, KMS was among about 20 organizations to give oral testimony at the Senate Public Health and Welfare Committee in support of Medicaid expansion. Among the others testifying were KDHE secretary Lee Norman, MD, Tom Bell, President and CEO of the Kansas Hospital Association, and Lynn Fisher, MD, on behalf of the Kansas Academy of Family Physicians.
The 2020 legislative session began this week, highlighted by Gov. Laura Kelly’s State of the State address. In her 37-minute speech, the governor clearly indicated that her top priority this session is Medicaid expansion. She also signaled that she would continue to oppose tax reform proposals prioritized by Republicans. That sets up at least two points of contention between the governor and the Republican-controlled legislature.
On January 13, members of the Kansas Legislature will return to the Statehouse. KMS has spent the last several months preparing for the 2020 session and—as has been true for the last 40 years—we will be at the Capitol every day advocating for you and your patients. This promises to be a busy, complex session and several important health care discussions will be at the forefront.
Key to understanding which issues emerge and advance is the impact of the looming elections this summer and fall. In 2020, the entire legislature must stand for election—40 senators and 125 representatives. Nationally, Kansans will also cast ballots for the U.S. President, Vice President, one U.S. Senator and four U.S. Representatives.
