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KMS Update: Legislature and COVID-19 updates

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.

1) The APRN bills (House Bill 2256 and Senate Bill 174) were not passed out of either chamber's health committee, although the Senate bill has been "blessed" by leadership, which keeps it alive for the possibility of continued consideration this session. We would like to thank all of you who took time to respond to our call to action regarding the APRN bill in the House last week. We know from our email analytics and from hearing from legislators firsthand that many of you contacted legislators and your message was heard.

The APRN bills 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, nor any physician oversight or supervision.

After hearings on the bills held two weeks ago in each chamber’s health committee, House legislative leadership asked APRN representatives to work with KMS to see if an agreement could be reached on a workable compromise for such a bill. To that end, KMS proposed several potential means to address some of the concerns APRN proponents have expressed. The essence of the APRN bills is centered on two key points: the desire for completely independent practice (no physician supervisory or collaborative practice agreements) and no statutory limits on APRN scope of practice. In other words, their authorized practice status would be identical to that of a physician and there would not be any limits on what they could do clinically, as long as the Kansas Nursing Board allowed it. 

At every point in this process KMS has consistently emphasized our longstanding principles regarding this issue—namely, that nurses seeking to independently perform acts which constitute the practice of medicine and surgery should have their scope of practice defined in statute and be regulated by the Kansas State Board of Healing Arts.

While KMS assured legislators that it remains willing to continue discussions with the APRN bill proponents, our suggestions for alternative approaches to the legislation under consideration have thus far been rejected by the proponents.

While the probability of the APRN issue advancing this session has been somewhat diminished, we continue to monitor it closely. As we know from recent years, developments are possible even quite late in the session.

2) The pharmacy bill was not blessed and is therefore unlikely to receive further consideration this session. That bill (Senate Bill 200) sought to expand a pharmacist's scope of practice, allowing independent initiation of treatment (prescribing) by pharmacists, presumably for any health condition approved by the Kansas Board of Pharmacy.

3) The Kansas Emergency Management Act, or KEMA, remains under consideration this session. Two bills have passed their respective chambers (Senate Bill 273 and House Bill 2416) and so now are moving to conference committee, where negotiators will seek to align the bills for final passage. All of the provisions that KMS opposed (such as altering scope of practice) were not included in the current bills.

With the KEMA bill and similar ones, KMS has been working to correct a false premise that has emerged amid COVID-19 among advocates seeking expansion of scope of practice. The premise is that providers who were granted some temporary expansion in scope of practice amid COVID-19 emergency declarations should have such exceptions made permanent. Our view remains that once the extraordinary circumstances of the pandemic which caused lawmakers to relax longstanding limits on scope of practice no longer exist, the temporary expansions should sunset.

For more information on the primary bills that we are following in the Legislature, please see our bill tracker at: www.kmsonline.org/billtracker. Also, if you have not done so already, you may register for Legislative Update meetings for KMS members at: www.kmsonline.org/legislative-updates-registration.

CMS to hold physicians harmless from MIPS penalties amid COVID-19 PHE
CMS has announced it will hold physicians harmless from up to 9% MIPS penalties due to the significant disruptions of the COVID-19 public health emergency on physician practices’ performance in 2020. The American Medical Association strongly advocated for this automatic relief from MIPS penalties.

The Extreme and Uncontrollable Circumstances Hardship Exception policy will be automatically applied to ALL MIPS-eligible clinicians who do not submit any MIPS data for the 2020 performance period and avoid a 2022 payment penalty. CMS is also reopening the hardship exception application for group practices, virtual groups, and alternative payment model entities who missed the previous 2020 deadline. The re-opened application deadline is March 31, 2021. Note: groups and eligible clinicians who submit data in at least two MIPS categories will override the hardship exception and be eligible to earn a bonus from the exceptional performance bonus pool or potentially be subject to a penalty.

Executive order on COVID-19 vaccinators
Gov. Kelly issued Executive Order No. 21-06 regarding the authority of those who can administer the COVID-19 vaccination. This order applies to the following personnel:

  1. Pharmacist
  2. Pharmacy Student or Intern
  3. Podiatrist
  4. Dentist
  5. Dental Hygienist
  6. Physician’s Assistant
  7. Advanced Practice Registered Nurse
  8. Nurse
  9. Advanced Emergency Medical Technician
  10. Emergency Medical Technician
  11. Paramedic

View the full order here:  EO-21-06-Covid-Vaccinators-Executed.pdf.

No-cost HPV and Flu vaccine training available for CME and CNE
The Immunize Kansas Coalition is offering no-cost training to help improve vaccination among young people: one module for HPV vaccination (approx.. 30 min.) and one module for influenza vaccination (approx. 15 min.). The training modules are intended for medical and nursing staff members and teams addressing vaccine hesitancy and providing a strong recommendation for vaccination. There is no cost, and CME and CNE are available. The Preventing Flu module takes about 15 minutes to complete; and the Shutting the Door on HPV Cancers is 25-30 minutes.

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 If you have questions about this update or other matters, please contact KMS Executive Director Rachelle Colombo: This email address is being protected from spambots. You need JavaScript enabled to view it..