"Turnaround" deadline approaches
Committees have until a week from tomorrow to hear and work bills before non-exempt bills will be subjected to the first legislative deadline, "turnaround." By the end of next week, non-exempt bills failing to have been advanced by a vote of the full House or Senate will be considered "dead" for the Session. As a result, this week will be full of hearings and committee action to determine the course of which issues will advance. Below is a summary of priority and emerging issues on which the Kansas Medical Society has taken a position.
The following issues are currently working through the Kansas Senate:
SB 311, which increases the cap on noneconomic damages by $100,000 over the next eight years, was favorably passed out of Senate Judiciary and now goes to the full Senate for consideration. KMS introduced this bill in response to the Kansas Supreme Court's 2012 ruling in Miller v. Johnson with the intention of preserving the integrity of the cap on noneconomic damages well into the future.
HB 2516, the Health Care Stabilization Fund bill which serves as a companion to the cap bill, was introduced by KMS to add three provider groups to the list of those purchasing professional liability insurance from the Fund and thereby receiving the protection of the cap on noneconomic damages. The bill was passed without opposition by the full House of Representatives and has now moved to the Senate, where it will be heard by the Financial Institutions and Insurance Committee this Wednesday.
SB 350 was introduced last week by the Chiropractor's Association to allow them, physicians assistants and APRNs to evaluate students after a sports related head injury and determine when the student can "return to play." Though these types of injuries are nothing new, they are becoming increasingly common and relevant medical information about their long term impact is growing. As research develops around these types of injuries children are sustaining, physicians are best equipped to determine a child's readiness to re-engage in regular and sport-related activity. Neither SB 350 or an identical bill, HB 2375, have yet been scheduled for a hearing; KMS opposes the proposal.
SB 251 would require insurers to provide an explanation of benefits to providers in "real time" via an electronic interface. KMS supports making information about out-of-pocket costs more readily available to providers in advance of service. As a growing number of individuals are moving to high deductible plans and are having to pay higher amounts for covered services, providers are seeing growth in their accounts receivable. SB 251 would allow interested practices with the necessary technology to make and receive electronic predetermination requests to help avoid this problem. The bill has been heard by Senate Insurance and is now being further considered by a subcommittee, but is expected to have a vote of the full committee later this week.
KMS appeared before the Senate Health committee last week to discuss SB 316, which amends the podiatry act to authorize podiatrists who have completed an accredited residency in foot and ankle surgery to perform surgery on the ankle. Under current Kansas law, podiatrists are limited to performing surgery on the foot and toes, and may not operate on the ankle. KMS is taking no position on SB 316 at this time, pending the results of a working group of orthopedic surgeons and podiatrists which has been meeting for the past few months. Although the group has not agreed on any legislation yet, a draft proposal is under consideration, and the group has agreed to continue working on the proposal which has been circulated.
Today, KMS will testify before Senate Public Health and Welfare in support of SB 317, which would establish prompt pay requirements for the managed care organizations contracting with KanCare, the state's medicaid program. The bill was introduced by the Kansas Hospital Association to make private payors contracting with the state subject to the same prompt pay rules as other private insurers. Under the bill, the MCOs would be given thirty days to pay clean claims, and ninety days to adjudicate all claims or be subject to a 12 percent annual late payment penalty.
Several issues are also working through the Kansas House of Representatives. Recent years have also brought several discussions and proposals to establish an apology law. The most recent version, HB 2523 would protect a physician's expression of sympathy in the event of an adverse or unanticipated outcome from being admitted as evidence in a court proceeding. KMS testified in support of the bill when it was heard in House Judiciary last week. Previous versions of this proposal would have allowed the presiding judge to determine whether the expression could be admitted into evidence after the fact. If physicians are to be encouraged to make sincere expressions of sympathy in the event of an adverse outcome, they must be assured their expressions will not be used against them. The bill has not yet been scheduled for a committee vote.
The House Judiciary committee held hearings on a related bill, HB 2376, when it considered the apology bill. HB 2376, which KMS opposed, would require providers to disclose to the patient any unanticipated or adverse outcome within seven days of the event. The bill also dictated how all subsequent conversations between patients and providers would be required to proceed. Though KMS supports informing patients about their care and disclosing unanticipated outcomes, mandating these conversations in this fashion is not the best approach. The number of providers participating in patient care, the required reporting timeline and the penalties for failure to disclose all create unworkable barriers to the implementation of this bill. It has not been scheduled for further action at this time.
KMS testified before the House Corrections and Juvenile Justice Committee in support of HB 2526, which would increase penalties for assault and aggravated battery on a health care provider. The bill was brought in response to the increased incidence of violence in health care facilities. According to the Bureau of Labor Statistics, the rate for violence against health care workers is more than triple the rate for all of private industry. For this reason, it is appropriate that those who would assault health care providers are penalized at the same level as those who assault law enforcement as stipulated in HB 2526. The bill will likely be voted on by the full committee this week.
HB 2685, identical to SB 326, was introduced last week by the APRN task force. These bills seek to dissolve the collaborative practice agreement and establish APRNs as primary care providers. The bills have been referred to Health committees in the House and Senate and neither chamber has scheduled hearings on the proposal as of yet. Though the APRNs continue to assert that they would like to practice to the full extent of their training, it is clear to many that this legislative proposal would allow them to practice far beyond their training. Rural access is often cited as the need for this bill despite the fact that Kansas law already allows for APRNs to practice quasi-independently anywhere they choose in the state, as long as they collaborate with a physician to ensure that patients are effectively diagnosed and treated. Five weeks into session, the arguments in favor of APRN independent practice are the same, but the pressure to consider their proposal increases with each additional bill introduced to force the subject. If you have no done so already, please contact your legislator today to discuss the benefits of collaborative practice and your opposition to these bills. As health care moves toward better integration of providers and a team-based approach, it would be counter-intuitive and unproductive to further fragment care as the APRNs have suggested. Thanks to the time you have spent communicating with your legislators, most of them understand that this bill simply goes too far to ensure the best care for patients. Legislative contact information can be found here.