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Legislature returns to Topeka for 2015 session

ColomboRachelleWEBRachelle Colombo; KMS Director of Government Affairs

The 2015 Legislative Session began on Monday, January 12 with all its usual pomp and circumstance. Much of the first week is consumed by inaugural activities, office relocations, committee introductions and bill drafting. The Governor delivered his State of the State speech on Thursday evening, focusing primarily on two central problems before the legislature. Though 2015 has just begun, the state faces a more than $700 million dollar budget shortfall over the next two fiscal years and has received a district court opinion that education funding is constitutionally inadequate. Much of the legislative attention will be absorbed by these two issues and the challenges that surround them.

The House of Representatives saw its Republican majority increase to 97 members after the November election. House leadership remains the same, headed by Speaker Ray Merrick from Johnson County, but the committees were reorganized, yielding a new Chair of the House Health Committee. Rep. Dan Hawkins (R-Wichita) will direct which health policy issues the committee will study. The Senate saw fewer changes, but also has new leadership on the Health committee, with Sen. Michael O'Donnell, also from Wichita, being appointed Vice Chair.

Five days into the 90-day session, both committees have met and become acquainted with their new leaders but have not yet determined which issues to prioritize. Legislative work will begin in earnest next week when more bills are introduced and scheduled for hearings. We expect to see proposals allowing for APRN independent practice, legalizing medical marijuana and encouraging Medicaid expansion to name just a few.

As always, we will carefully monitor these issues and communicate both with you and our legislative leaders to promote high quality patient care and to ensure that the practice of medicine remains in physicians' hands.

For more information or questions about the elections or legislative matters, please contact Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

 

Second legislative week brings more activity

ColomboRachelleWEBRachelle Colombo; KMS Director of Government Affairs

The Legislature began their work in earnest this week introducing bills and holding committee hearings on a variety of issues. As expected, the advanced practice registered nurses have re-introduced their proposal which in effect removes any limitation on APRN scope of practice and eliminates the legal requirement that APRNs work in collaborative practice agreements with physicians. Their bills (SB 69 and HB 2122) have been introduced in both chambers, and the Senate Public Health and Welfare committee will hold a hearing on the APRN issue Thursday, January 29.

As we outlined in our meetings with the nurses during the past year, KMS remains opposed to their legislation because it allows APRNs-- who have a fraction of the training of physicians--to practice medicine and surgery without any physician collaboration, oversight or supervision. KMS believes meaningful collaborative practice agreements or protocols are essential to promote patient safety in most clinical situations, and that physician-led, team-based care is the best model to safely and efficiently meet the health care needs of our state, including primary care in rural and underserved areas. KMS also believes that the Board of Healing Arts should have a role in approving the regulations governing APRN practice because much of what APRNs do are delegated medical acts which constitute the practice of medicine.

The Senate Health Committee held an informational hearing on marijuana last week. Advocates focused on the hope they have in cannabinoids that might bring relief and improvement that other drugs have not delivered, particularly for children with dravet syndrome and other rare but debilitating diseases. The committee heard from non-advocates the following day, including Eric Voth, MD (Topeka) on behalf of KMS, who outlined the negative effects of legalizing marijuana, particularly of circumventing the FDA process of establishing medical efficacy, and instead approving medicines by popular vote. As with many issues that come before the legislature, the problem presented by the pro-marijuana advocates was complex and compelling. And as is also often the case, the solution presented was broad and rife with potential for abuse and unintended consequences. The Kansas Medical Society does not support circumventing the rigorous research required by the FDA process designed to protect patients.

Amendments to the School Sports Head Injury Prevention Act were introduced (HB 2016) which would allow chiropractors to clear and return injured students to practice or play after a concussion. The House Health committee has scheduled a hearing for this coming Wednesday, January 28. KMS opposes the bill.

The state's revenue shortfall has the potential to complicate the legislature's consideration of the proposed Medicaid expansion issue somewhat. Kansas is one of about 22 states that have not yet expanded Medicaid to take advantage of higher federal financial support that was made available under the Affordable Care Act. The state's difficult fiscal situation just adds more complexity to any issues that have budget implications. The Kansas Hospital Association has been working hard to build legislative support for an innovative approach which expands KanCare in a way that will cover more low-income working Kansans, bring in significantly more federal dollars and reduce the growing burden of providing uncompensated care by hospitals. KMS supports KHA's efforts to find a fiscally sustainable solution that covers more uninsured working Kansans, while providing critically needed financial support to ensure the viability of our state's community hospitals.

At its bi-weekly meeting the KMS Legislative Committee, chaired by Kevin Hoppock, MD (Wichita), considered HB 2004, the so-called "Right to Try" bill. The bill is part of a national effort (enacted thus far in five states) to establish state-based laws intended to help terminally ill patients obtain access to experimental (non FDA-approved) drugs and devices. It is unclear whether such bills will actually be effective, since federal laws control all drug/device approvals in the United States. In addition, federal law already allows "expanded access" to investigational drugs through an FDA administered program. KMS will be neutral on the bill, but will seek amendments to clarify the legal liability protections for physicians who participate under the bill's provisions.

Of note, Rep. Susan Concannon (R-Beloit), House Health Committee Vice-Chair and spouse of Craig Concannon, MD, was elected by her colleagues as Chair of the House Rural Caucus. In addition to helping to direct the focus of the Health Committee, Rep. Concannon will seek to educate and establish consensus among her peers on issues affecting rural parts of the state.

New bills are being introduced daily, some of which will advance, many more of which will languish. As issues affecting the practice of medicine emerge and move through the legislative process, we will keep you apprised. We always welcome your input, engagement and encourage your participation in the legislative process. If you have questions or comments about legislative matters, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

 

Legislative session enters fourth week

ColomboRachelleWEBRachelle Colombo; KMS Director of Government Affairs

Keeping the practice of medicine in the hands of physicians and promoting access to high quality care for all Kansans is the central work of the Kansas Medical Society. Among the hundreds of bills authored and considered by legislators, there are dozens that directly pertain to that objective and allow us the opportunity to partner with our citizen legislature to protect patients and ensure that Kansas physicians are leading the team in the delivery of medical care.

Last week the House Health and Human Services Committee held a hearing on HB 2016, which amends the School Sports Head Injury Prevention Act. The bill would allow chiropractors the authority to clear an injured student athlete to return to play. Chiropractors contend that they treat concussions, can follow the protocol for diagnosing and managing a head injury and are often more widely available than physicians in small, rural communities. However, when the bill was enacted in 2011 after careful consideration of all health care providers, the authority for "return to play" was limited to those with the highest standards for training and education: physicians. Additionally, because concussion is not an isolated event, but a brain injury that affects the whole body, it is important that a head injury becomes part of the patient's medical record and is managed with respect to their overall and long-term health. Bart Grelinger, MD (Wichita–Neurology) testified for KMS at the committee hearing about the physiology of concussion, sub-concussive events and the long- term associated effects, such as Parkinson's disease, ALS and chronic traumatic encephalopathy. His testimony outlined the significance of these types of injuries, the growing amount of medical research about long-term impact and the importance of continuing to support access to the most qualified provider for student athletes. The bill has not been scheduled for further committee consideration at this time.

The Senate Public Health and Welfare committee held a hearing on SB 69, the advanced practice registered nurses' proposal allowing for independent practice. Lynn Fisher, MD (Plainville-Family Medicine) and Mary Beth Miller, MD (St. Francis-Family Medicine) appeared before the committee in opposition to the bill on behalf of KMS and the Kansas Academy of Family Physicians. Dr. Miller spoke about the differences in education and training between APRNs and physicians, and Dr. Fisher shared how he collaborates daily with advanced practice nurses and the benefit to his patients from a physician-led team approach.

KMS opposes SB 69 as introduced by the nurses. While APRNs are essential members of the healthcare team, they are not a substitute for a fully trained physician. Their training lacks the clinical depth and breadth to prepare them to practice medicine independent of any physician collaboration or direction.

APRNs contend that collaborative practice agreements are a meaningless barrier to full practice for nurses, while KMS believes strongly in a team-based healthcare delivery model. The committee hearing allowed KMS the opportunity to outline an alternative approach to regulating APRNs, involving the adoption of joint regulations by the Board of Healing Arts and the Board of Nursing governing APRN scope of practice. The proposal provides a means for the two professions to work together through the regulatory structure to strike an appropriate balance that promotes patient safety, acknowledges the evolving role of APRNs, and also ensures that the collaboration or direction required is appropriate to the clinical setting and patient care needs. The KMS-proposed approach will be included in a separate bill which should be printed and available in the next few days.

Two weeks remain for bills to be introduced this legislative session, and the process of hearings and committee action will intensify throughout the month of February. The KMS Legislative Committee, chaired by Kevin Hoppock, MD (Family Medicine-Wichita), meets every two weeks to discuss bills, proposed amendments and legislative developments.

For more information about legislative matters, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

 

One month in, first deadline looms

ColomboRachelleWEBRachelle Colombo; KMS Director of Government Affairs

One month in to the legislative session, committee action slowed as both chambers turned their attention to a rescission bill necessary to address compounding revenue shortfalls and resulting cash flow obstacles for the state. The bill required nearly $250 million in cuts for the current fiscal year and was followed by additional allotments from the Governor for both K-12 and higher education. Though this action addresses the state's financial obligations through the current fiscal year which ends June 30, work now begins in earnest on a budget bill making appropriations for the next two years and must consider the projected $700 million dollar revenue shortfall ahead.

KMS introduced HB 2205, establishing a joint regulatory authority of the Kansas Board of Healing Arts and the Kansas Board of Nursing, for the purpose of developing jointly adopted regulations specifying those services and clinical settings which require a collaborative practice agreement between an APRN and a physician. For several years, the APRNs have pushed legislation allowing for independent practice, putting legislators in the very difficult position of trying to decide where the outer limits of advanced practice nursing are as they begin to overlap with the practice of medicine. Though most everyone acknowledges the significant difference in education and training between APRNs and physicians, APRNs insist their training is adequate to prepare them to practice medicine without the confining limits of a collaborative practice agreement. Because APRN practice includes delegated medical acts, HB 2205 provides an essential role for the Board of Healing Arts in defining APRN scope of practice, developing practice regulations and ensuring collaborative practice agreements appropriately reflect differing clinical settings. A hearing on HB 2205 has not yet been scheduled.

The coming week will bring a flurry of activity as legislative deadlines begin to approach. Unless exempted from deadlines or "blessed" by the House Speaker or Senate President, bills must be introduced, heard by the appropriate committee and favorably passed to the full chamber of origin within the next two weeks. Though many issues relating to health and physicians have been introduced, activity in the next two weeks will determine whether they are "alive" for the remainder of the session.

The House Health Committee is expected to take action on HB 2004, the Kansas Right to Try Act. KMS provided neutral testimony on the bill allowing terminally ill patients access to experimental, non-FDA approved drugs or devices that have passed phase 1 of clinical trials. KMS offered an amendment strengthening liability protection for physicians recommending this kind of treatment and striking references to "standard medical care." Twenty-two states are considering similar legislation though there is little agreement as to whether the laws will have the desired effect of broadened, timely access to investigational drugs that do not meet federal standards.

The Senate Public Health and Welfare Committee will hold hearings this week on SB 122, a bill which requires that patients receiving care at a hospital-owned medical practice disclose in advance that a "facility" fee could be charged in addition to the normal professional fees. The bill also requires a notification that medical services and diagnostic testing provided at hospital facilities can result in a greater financial liability for the patient than if those services were rendered elsewhere. KMS has not yet taken a position on this bill.

Senate Public Health and Welfare will also hear SB 123, repealing the limitations on the restrictions on psychotropic drugs under the state Medicaid plan. Current law prohibits requirements for prior authorization or other restrictions on medications used to treat mental illnesses for Medicaid patients. Concerns about the cost and volume of psychotropic drug prescriptions for the Medicaid patient population precipitated the proposed repeal. KMS does not support restricting physicians from prescribing those medications they deem best for their patients as long as cost, efficacy and disproportionate prescribing patterns are considered and addressed.

There will likely be other bills scheduled for hearings and possible committee action this week and next as advocates push to see their issues make it through the first third of the legislative process. For more information on additional bills affecting the practice of medicine, please reference our bill tracker here.

For more information about legislative matters, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

 

CMS to reduce meaningful use reporting burden

CMS, responding to pressure from organized medicine, announced it plans to modify rules for the Electronic Health Record Incentive Programs by reducing the reporting burden on physicians. Expected to be released this spring, the modified rules will include:

  • Shortening the 2015 reporting period from a full year to 90-days
  • Realigning hospital reporting periods to the calendar year to allow eligible hospitals more time to incorporate 2015 Edition software into their workflows and to better align with other quality programs,
  • Modifying other aspects of the programs to match long-term goals, reduce complexity, and lessen providers’ reporting burden.

This rulemaking is separate from the Stage 3 rules expected to be published in early March.

Physicians need to be aware of an approaching deadline for the meaningful use program; February 28, 2015 at 10:59pm CST is the last date to attest for a 90-day reporting period in 2014. 

Medicare meaningful use deadline quickly approaching

Ruth Cornwall; KMS Director of Health Care Finance

If you are an eligible professional participating in the Medicare EHR Incentive Program, February 28, 2015 is the deadline to attest to demonstrating meaningful use of the data collected during the 2014 calendar year. You must attest to demonstrate meaningful use every year to receive an incentive and avoid a payment adjustment.

Payment adjustments were applied beginning January 1, 2015 for those that did not successfully demonstrate meaningful use in 2013, or 2014 for first-time participants, and did not receive a 2015 hardship exception. Medicare eligible professionals that did not successfully demonstrate meaningful use in 2014 and do not receive a 2016 hardship exception will have payment adjustments applied beginning January 1, 2016. The application period opened in early January 2015. Check out the payment adjustment tipsheet for more information.

Use the eHealth interactive Timeline Tool to view the milestones for various eHealth Programs, including EHR incentive programs. The timeline is also available in PDF format Additional information regarding meaningful use, may be found here. CMS also has a list of Frequently Asked Questions available. 

PQRS penalty has begun

CMS’ Physician Quality Reporting System (PQRS) penalty has begun. The penalty is a reduction of 1.5 percent under the Medicare Physician Fee Schedule for eligible professionals who did not report or satisfactorily participate in the 2013 PQRS program year. Physicians receiving a PQRS payment adjustment who believe the penalty is being applied in error may appeal the determination and request an informal review from CMS until February 28, 2015. 

You may submit the request online here. CMS will make their decision and notify you, via email, of their decision within 90-days. If you need additional assistance, contact the CMS QualityNet Help Desk at 866.288.8912 or see CMS’ Informal Review Made Simple document. Additional information about the PQRS program is available at the CMS website

Legislative activity intensifies

ColomboRachelleWEBRachelle Colombo; KMS Director of Government Affairs

With the first major legislative deadline approaching, a flurry of activity is swirling around the statehouse. In addition to tracking each new issue as it emerges, is the challenge of differentiating between mere duplicates or "look-alikes" of already-authored bills, and those that are truly new proposals. A perfect example of this legislative phenomenon is demonstrated by the number of bills around the increasingly-complicated nurse practitioner issue.

A group claiming to represent the state's APRNs has introduced identical bills in both the House (HB 2122) and Senate (SB 69) to allow for independent practice for advanced practice registered nurses. The Kansas Medical Society opposes those bills, and has introduced an alternative proposal for regulating APRNs (HB 2205 and SB 218). The KMS-sponsored approach would direct the Board of Healing Arts and the Board of Nursing to jointly adopt regulations governing APRN scope of practice and the need for collaborative practice agreements in the differing clinical settings in which APRNs work. Adding to the confusion and controversy surrounding the APRN bills, a new bill (HB 2280) which only applies to nurse midwives has emerged which threatens to further complicate the discussions about APRN scope of practice. The bill was introduced by a Johnson County-based free-standing birthing center that seeks to allow nurse midwives to practice independent of any physician collaboration.

The nurse midwives hope to differentiate their proposal from the broader APRN proposal, contending that their bill is more limited and less controversial. They state that their goal is to limit their practice to low-risk, well-woman maternity care, arguing that pregnancy and childbirth are not a disease process and therefore their practice is not medical in nature. However, as with the other proposals for independent practice, their bill reaches far beyond their stated intent. HB 2280 would allow nurse midwives to:

provide a full range of primary health care services for women from adolescence to menopause and beyond, including primary care, gynecologic and family planning services, pre-conception care, care during pregnancy, childbirth and postpartum period, care of the normal newborn and treatment of male partners for sexually transmitted infections; and assessment, diagnosis, physical examinations, prescriptive authority; and the ability to admit, manage and discharge patients, order diagnostic testing, interpret results, and perform surgical procedures.

Simply put, their proposal lacks any legal distinction between the scope of practice of a nurse midwife and that of an obstetrician or family physician or any other medical doctor. Their proposal isn't any different than the other APRN bills which allow nurse practitioners to practice medicine without a requirement for physician collaboration or participation at any level.

Throughout all this the KMS policy has been clear: the independent practice of medicine should be limited to those with a medical education and training, to best ensure patient safety. APRN education and training lacks the clinical depth and breadth to prepare an APRN to practice medicine independent of any physician collaboration or involvement.

Many other issues remain before the legislature as we approach the end of the first third of the legislative session. On Monday the Senate Health committee will hear a bill to allow podiatrists to supervise PAs and APRNs (SB 141). Efforts to legalize hemp preparations for seizure disorders (HB 2282) will be considered by the House Health committee on Tuesday. On Wednesday, the Senate Public Health and Welfare committee will consider the KMS proposal (HB 2205/SB 218) that directs the Board of Healing Arts and the Board of Nursing to develop joint regulations governing APRN scope of practice. Also on Wednesday the Senate Commerce committee will consider a bill (SB 167) that would require physicians doing impairment ratings in workers compensation to use the older, 4th edition of the AMA Guides to the Evaluation of Permanent Impairment, instead of the most current 6th edition.

HB 2319, the Kansas Hospital Association's bill to implement Medicaid expansion was introduced last week and referred to the House Health committee. The bill directs the Brownback administration to develop a budget-neutral Medicaid expansion program, known as "KanCare 2.0," and submit it to the federal government for approval. The bill has not yet been scheduled for a hearing.

Additional bills affecting the practice of medicine, may be found here. For more information about legislative matters, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it.

Legislative deadline approaches

ColomboRachelleWEBRachelle Colombo; KMS Director of Government Affairs

Just two days remain for committees to take action on their assigned bills before both the House and Senate will debate and vote on those proposals which will advance beyond the first major deadline of the legislative session, the so-called "turnaround" deadline. By this Friday, most bills having failed to pass out of committee and pass the entire body of origin will be considered dead for the remainder of the session.

Though the majority of the bills focused on APRN collaborative practice agreements are exempt from the coming deadline, the Senate Health committee has held hearings on both sides of the issue, most recently considering KMS proposal SB 218. KMS testified in support of SB 218, underscoring the need for a new approach to APRN regulation and oversight that reflects the evolving nature of nursing practice in varying clinical settings while still ensuring physician collaboration, particularly when the practice of medicine is involved. Several APRNs testified in opposition to the bill's proposal for a joint advisory committee of the Board of Healing Arts and Board of Nursing, stating concerns that the promulgation of jointly-adopted regulations could result in disruptive restrictions to advanced nursing practice. The consensus of the Senate Health Committee following the most recent hearing was that the APRN and physician communities need to continue talking and searching for an approach that is acceptable to both professions. No further committee action is currently scheduled on any of the initiatives related to APRNs, though the bills are exempt from deadlines and may come up in the second part of the session.

HB 2319, the Kansas Hospital Association's bill directing the Brownback administration to expand Medicaid in a budget-neutral way, is not subject to the normal legislative deadlines and will remain alive for legislative consideration later this session. KMS continues to encourage legislators to begin the dialogue about expanding Medicaid in a financially responsible, sustainable manner, such as that contained in HB 2319.

SB 123 allows for restrictions to be placed on psychotropic medications prescribed to Medicaid participants. State Medicaid officials, who are the main proponents of the measure, cite concerns over high costs and disproportionately high utilization of pyschotropics for this patient population. KMS opposed the bill, because the care of patients with severe mental illness is highly individualized, complex and not without risk. Further, subjecting psychotropic medications to the existing KanCare prior authorization requirements threatens to further increase time, cost and hassle for physicians treating the Medicaid population. KMS suggested that a committee of psychiatrists, primary care physicians and pharmacists should be established to consider cost and utilization prior to the development of new restrictions. The committee opted to pass the bill out of committee but noted their desire to see KDHE ensure such a structure will be established before the bill is acted upon by the full Senate.

The Senate Commerce committee heard SB 167, which amends the workers compensation statutes to require a return to the 4th edition of the AMA guides to the evaluation of permanent impairment from the 6th edition, which took effect January 1 this year. Mark Melhorn, MD, an orthopedic surgeon from Wichita, testified for KMS in support of using the 6th edition of the AMA Guides, and how the impairment ratings differ, most notably through the utilization of the most recent science to establish treatment and evaluate overall loss of function. The committee heard from a number of plaintiff's attorneys in support of the bill but it has not been scheduled for further action.

The House Corrections Committee held a hearing on HB 2313, which establishes higher criminal penalties for battery or assault of a health care provider, emergency medical respondent or firefighter. Because these professionals are exposed to heightened risk in the customary course of their duties, the bill would protect these professions with penalties equal to those of assaulting a police officer. The hearing centered on the frequency and severity of these types of situations and how lawmakers might best deter this kind of violence. The committee may take action this week on the bill.

There are several other issues affecting the practice of medicine that await action in the House and Senate. A full list of issues KMS has a position on can be found here. If you have further comments or questions pertaining to legislative matters, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it.

CME: Update work comp rating guide

Ruth Cornwall; KMS Director of Health Care Finance

The American Academy of Disability Evaluating Physicians (AADEP) is offering a course in the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, in Wichita on Saturday, March 14 at the Wesley Medical Center. KMS members are eligible to receive a $100 discount off the original cost. The presenters will be Kansas physicians Mark Melhorn, MD, Chris Fevurly, MD and John McMaster, MD.

Upon completing this course, the learner will be able to:

  • Identify/learn necessary skills to apply AMA Guides Sixth Edition accurately;
  • Identify/navigate potential problem areas of the AMA Guides Sixth Edition;
  • Complete at least one case study during each impairment segment;
  • Assess the medical-legal impact of the AMA Guides to the Evaluation of Permanent Impairment;
  • Identify/change practice patterns necessary to improve outcomes.

Click here to download the registration form. To receive the discount, please write "KMS Member" on the registration form.

KMS to host Medicare ICD-10 education

KMS, in partnership with the Missouri State Medical Association & CMS, will host an educational event related to ICD-10 on April 8, 2015. This 1.5 hour webinar is free and will include an overview of ICD-10, identify the clinical and business impacts of ICD-10 as well as provide attendees a customizable preparedness plan for the conversion. More information is available here or by contacting Ruth Cornwall at This email address is being protected from spambots. You need JavaScript enabled to view it..

Legislative passes halfway point

ColomboRachelleWEBRachelle Colombo; KMS Director of Government Affairs

Turnaround, a procedural deadline marking the halfway point of the 2015 legislative session, has now occurred and gives us the first glimpse of which issues are unlikely to advance for the remainder of the session. After last Friday, only bills having been passed by either the House or the Senate, and those which have been exempted from legislative deadlines by House or Senate leadership, remain in play beyond this point. The majority of bills introduced in the legislative session do not survive this first, important deadline.

All of the bills pertaining to APRN scope of practice (SB 69, HB 2122, HB 2280, SB 218 and HB 2205) were exempted from the turnaround deadline and remain alive, although it is uncertain whether any will advance further this session. The Senate Health committee has held hearings on the APRN's proposal, as well as the KMS alternative establishing a joint regulatory structure governing APRN practice involving the Boards of Healing Arts and Nursing. No action has been taken or scheduled on either of these proposals, though many of the Senate committee members expressed a desire to see the two professions continue to discuss the issue throughout this year and explore the potential for future compromise. Although the legislature is not formally meeting the first two days of this week, the House Health Committee has scheduled a committee visit to the independent birthing center in Johnson County operated by the authors of HB 2280, the bill allowing nurse midwives independent practice. Then on Wednesday, the House Health Committee is planning to have a follow-up "informational" hearing on midwifery. However, because the nurse midwife bill has not been referred to the Health Committee, it cannot take action on that bill as a result of the informational hearing.

HB 2225, clarifying that medical retainer agreements for "concierge" or "direct" medical practices do not constitute insurance, has passed the full House with 122 votes and now goes to the Senate for further consideration. HB 2282, legalizing the manufacture and distribution of hemp preparations for seizure disorders was passed out of the House Health committee. Though the bill was not debated by the full House, it was exempted or "blessed" by the House Speaker and could be considered at a later date. SB 141, allowing podiatrists to supervise physician assistants, was not acted on the by the Senate Health Committee, but remains alive for further action if the committee chooses to work the bill in the remaining weeks of the regular session.

It now looks like the House Health Committee will hold a public hearing on Medicaid expansion sometime in the next few weeks. Proponents of the issue were able to obtain a commitment from the House leadership that the topic would receive a formal hearing. No date has been set yet for the hearing.

Several issues, failing to have emerged this first part of the process are now considered dead. Though the content of such bills could conceivably be amended onto related legislation, the following bills will not advance:

  • SB 123, allowing KDHE to place restrictions on psychotropic drugs prescribed to Medicaid patients, was defeated on the floor of the Senate 25-15.
  • HB 2016, allowing chiropractors to return an injured student athlete to play after sustaining a head injury, was passed out the House Health Committee but was not considered by the full House or given an exemption from the turnaround deadline.
  • SB 167, reverting from the 6th Edition to the 4th Edition of the American Medical Association Guides to Evaluation of Permanent Impairment for the purposes of evaluating patients injured under workers compensation, was heard by the Senate Commerce Committee, but was not passed by the committee or exempted from the deadline.
  • HB 2313, establishing increased penalties for assault of a health care worker was not passed out of the House Corrections Committee.
  • HB 2004, which is intended to make it easier for terminally ill patients to obtain experimental drugs passed out of the House Health Committee but was not passed by the full House or exempted from the deadline.

Though some of these issues may re-surface as amendments to other bills, their failure to clear the first deadline makes their passage more difficult procedurally.

Both chambers have a short break but will return Wednesday to continue working on remaining bills. A full list of issues KMS has a position on can be found here. If you have further comments or questions pertaining to legislative matters, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it.

Legislature focused on advancing priority initiatives

ColomboRachelleWEBRachelle Colombo; KMS Director of Government Affairs

Only two weeks of committee hearings remain before the Legislature will begin the process of wrapping up the regular session for first adjournment. During this time, committees must finish business on previously exempted bills as well as bills that were passed by the opposite chamber. Even an exempt bill has little chance of advancing if it has not had a committee hearing and passed one chamber before the end of March. With first adjournment looming a little less than a month away, both bodies are scrambling to advance priority initiatives.

Last week, the House Health and Human Services Committee held an informational hearing on midwifery. The hearing was predominately comprised of advocates for HB 2280, which dissolves the collaborative practice agreement requirement for nurse midwives and allows them to function as primary care providers for women of all ages, with unlimited prescribing authority and some surgical authority. The conferees also provided historical information on the practice of midwifery, the role of midwifery globally and distinctions between the focus of midwifery and the medical practice of obstetrics. They pointed out that although both professions are trained for prenatal care and delivery, midwifery is predominately focused on natural childbirth for the low-risk, normal, uncomplicated pregnancy. The midwives discussed their belief that collaborative practice agreements are unnecessary and create a conflict for physicians who are unwilling to enter into such agreements with would-be competitors. It is unclear whether the committee intends to have further hearings or action this session on HB 2280 or any of the other bills pertaining to the independent practice of nursing and collaborative practice agreements.

The House Health Committee will hold a hearing this week on HB 2362, a bill which makes some additional changes to the Healing Arts Act as a result of the bill passed last year to comprehensively update and modernize the Act. Specifically, the bill creates a new licensure category which clarifies the conditions under which residents who have completed the first year of a postgraduate training program can obtain additional clinical experience outside of their residency program, such as moonlighting or doing locum tenens work. It also creates a new licensure pathway for physicians who have not been actively practicing medicine for more than two years to return to active practice after completing Board-imposed conditions such as additional education, training and monitoring–all designed to ensure clinical competency and patient safety.

KMS also plans to offer an amendment to the bill that would allow a graduate of the KU School of Medicine who has not yet been accepted into a residency program to obtain a special permit to practice under the supervision of a licensed physician in a medically underserved area of the state while awaiting acceptance into a residency. Although the number of medical students who don't "match" is relatively small now, it is expected to grow as medical school class sizes continue to expand faster than available residency positions. This special permit would allow these students the opportunity to obtain valuable clinical experience in a supervised environment for a limited period of time, while making additional medical manpower available to our rural and underserved areas of the state.

The House Health Committee will also hear HB 2118, which amends the podiatry act to authorize certain podiatrists to perform surgery on the ankle. Last year the legislature amended this same provision of the podiatry law to allow a specific category of three-year residency-trained podiatrists to perform surgery on the ankle. Prior to that time, all podiatrists were limited to diagnosing and treating, including surgically, conditions affecting the foot and toes. The change made last year represented an agreement that was reached between several groups including KMS, the Kansas Orthopaedic Society and two groups of podiatrists that represented individuals with different training backgrounds. We continue to support the compromise reached last year, and are opposed to HB 2118, which expands surgical privileges on the ankle to podiatrists with lesser training.

Finally, the House Health Committee has indicated the intention to hear HB 2319, the Kansas Hospital Association's Medicaid expansion bill, which directs the Brownback administration to expand Medicaid in a budget-neutral way. KMS will testify in support of expanding Medicaid in a financially responsible, sustainable manner such as that contained in HB 2319.

Both chambers have a short break but will return Wednesday to continue working on remaining bills. 

A full list of issues KMS has a position on can be found here. If you have further comments or questions pertaining to legislative matters, please contact KMS Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it.

Save the date: 1st Annual Members Forum

Calendar May 2On May 2, 2015 the Kansas Medical Society will host its first Members Forum—a brand new meeting which will bring together physicians from all over the state for networking, education and discussion. This one-day meeting (10am-2:30pm) will be held at the Wichita Hyatt and replaces the previously held KMS Annual Meeting; this new schedule was adopted by the 2014 House of Delegates upon recommendations from the Future Directions Task Force.

The meeting will have two components:

• Town Hall Forum--a facilitated, issue-oriented discussion of important topics facing medicine in Kansas

• Luncheon--includes the Presidents' Reception honoring the incoming KMS President and all Past Presidents; election of the 2015-2016 KMS Board of Trustees and a keynote address by Kevin Pho, MD, founder and editor of the popular health care blog, KevinMD.com.

All members and spouses are welcome at the event; there is no fee to attend but advance registration will be required. Registration will open on April 1, 2015.

If you have questions about the meeting, please contact Nancy Sullivan at This email address is being protected from spambots. You need JavaScript enabled to view it.

CMS limits documentation response window

CMS has announced, effective April 1, 2015, you'll have 45-days to respond to a request for additional documentation from WPS or the Medicare Zone Program Integrity Contractor (ZPIC). CMS has instructed these reviewers not to grant extensions to practices that need more time to comply with the request and to deny claims for which they do not receive the requested documentation by day 46. 

Legislative committees finish work

ColomboRachelleWEBRachelle Colombo; KMS Director of Government Affairs

With committee action on most bills now complete, the legislature begins the process of wrapping up the main part of the 2015 regular session. There are two full weeks left before the legislature's first adjournment, scheduled for April 3. As that date approaches, the legislature will complete action on most bills remaining to be considered, and then sharpen its focus on passing an appropriations bill to fund state government and services.

The last major policy debate before the House Health committee this week centered on the Kansas Hospital Association's bill expanding Medicaid, HB 2319. Their proposal would direct the Governor to apply for federal approval to expand coverage for about 145,000 low-income, uninsured Kansans in a budget-neutral way. KMS testified in support of the bill, along with more than 150 other health care, business and community organizations and many individuals. Proponents led by KHA made a strong case for expansion, citing the importance of this proposal to improving access to care for the uninsured and to supporting hospitals put at risk by reductions in Medicare and federal support for providing uncompensated care. Opponents of the measure focused heavily on the cost to the state of expansion, as well as concerns about trusting the federal government to stand by its commitment to fund 90 percent of the costs of covering the expansion population on into the future. The Kansas Department of Health and Environment, which didn't take a position on the bill, nevertheless expressed concerns about the costs of expansion and that the proposed expansion favored providing coverage to able-bodied, low-income individuals over the disabled population, of which there are about 6,000 on waiting lists to qualify for Medicaid. The bill has not been scheduled for action, but it remains alive and could be taken up again when the legislature returns at the end of April to complete action on budgets and consider any bills vetoed by the governor.

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CMS delays final Medicare overpayment rule

Ruth CornwallRuth Cornwall; KMS Director of Health Care Finance

CMS announced a one-year delay in finalizing the rule addressing the 60-day deadline to return Medicare and Medicaid overpayments. The proposed rule, known as the 60-day rule, was proposed February 16, 2012 to implement components of the Affordable Care Act, and would require physicians and other health care providers to report and refund overpayments within 60-days from the date the overpayment was identified or the date the corresponding cost report is due. The proposed rule defined when an overpayment is "identified" and provided a 10 year look back period on claims that had not been identified, both of which were concerning for providers.

In the notice, CMS acknowledged that it must address "significant policy and operational issues" before finalizing a workable 60-day rule. The announcement delays the final rule until February 16, 2016. CMS reminded stakeholders of their responsibility to return overpayments according to existing Federal statute or face penalties that include False Claims Act violations and exclusion from Federal health care programs.

Resources: CMS 2015 PQRS & Value Modifier

CMS will be hosting a webinar on Tuesday, March 31, 2015 at 11amCST to provide an overview of the requirements of the 2015 Physician Quality Reporting System (PQRS) and the Value-based Payment Modifier (VM). This call is intended for eligible professionals, practice managers, and all other interested parties who deal with the PQRS and VM programs. The link to register for this can be found here.

CMS recently released guidance for Rural Health Clinics, Federally Qualified Health Centers, and Critical Access Hospitals regarding the PQRS 2013 reporting year and 2015 payment adjustment. Physicians and other eligible professionals must have reported certain quality data to the PQRS program to avoid a 1.5 percent payment reduction under the Medicare Physician Fee Schedule in 2015. Also available is CMS' Informal Review Made Simple guidance.

CMS has developed a document that provides a general overview of the 2015 payment adjustments for CMS quality reporting, including PQRS, Medicare Electronic Health Record (EHR) program, and the Value-Based Payment Modifier (VM) - available here. Additional payment adjustment information is available at the CMS website.

Contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance, with any questions or concerns.

Editorial: ACA hits five-year mark

JerrySlaughtercolorJerry Slaughter; KMS Executive Director

It's been five years today, March 23, since President Barack Obama signed the Affordable Care Act into law. Widely regarded as the President's signature achievement in office, it remains as polarizing today as it did then. As the controversial law continues its slow march into full implementation, the United States Supreme Court has rendered two major opinions on key parts of the law, and is expected to issue a third this summer. The current legal skirmish (King v. Burwell) will decide whether the federal insurance subsidies in the law can be legally applied in the thirty-four states that have opted not to create their own insurance exchanges.

It is an important question, because nationally about nine out of ten people enrolled in the ACA receive subsidies. In 2015, nearly 77,000 Kansans will receive almost $195 million in premium subsidies for their health insurance plans purchased on the federal exchange. In all, about 96,000 Kansans purchased coverage from the exchange. If the Court sides with the plaintiffs and invalidates the subsidies, those who oppose the law will feel vindicated. However, it is estimated that up to 8 million individuals nationally could lose their policies because it would make the insurance unaffordable.

That would present a very difficult political dilemma for Congress, which is now controlled by Republicans. The ACA was passed by a Democrat-controlled Congress five years ago with not one Republican vote. If the Court kills the subsidies will this Congress allow millions of Americans to lose their health insurance? It is easy to visualize the immense political pressure that will be heaped upon Republicans to amend the law later this year and continue the subsidies, but that would be an extremely bitter pill for them to swallow.

Either way, the outcome of this case and how Congress reacts to it, is sure to have implications for the 2016 presidential and Congressional election, which is only about a year and a half away.

SGR finally on the way out?

Last week the U.S. House of Representatives by an overwhelming margin passed the SGR repeal legislation, H.R. 2, the "Medicare Access and CHIP Reauthorization Act." Three of the four Kansas lawmakers, Reps. Lynn Jenkins, Kevin Yoder and Mike Pompeo voted for the bill, while Rep. Tim Huelskamp voted against the bill. Despite reservations about certain aspects of the bill, KMS supported it because it likely represents the best opportunity in years to repeal the flawed SGR payment formula.

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Medicare claims pended until SGR repeal complete

Congress is expected to finally pass the SGR repeal legislation (H.R. 2) when it returns from a two week break. In the meantime, CMS is instructing its Medicare carriers to "hold" for 10 business days any claims for services provided on or after April 1, until legislation can be passed and signed into law that reverses the 21 percent SGR cut. Since no claims by law can be paid sooner than 14 calendar days from their receipt, this hold should have little practical impact on Medicare remittance in the short-term, although billing for copayments and claims reconciliation will be more complicated.

Some practices are also asking what they should charge. By law, Medicare is required to pay physician the lesser of the submitted charge or the Medicare approved amount. For this reason, the American Medical Association is advising against submitting claims with reduced amounts reflecting the 21 percent cut. Instead, the AMA recommends physicians either continue charging the current 2015 rates for April dates of service or defer submitting claims until after final action on the legislation. In the unexpected event that Congress allows the 21 percent cut to take effect, Medicare could pay physicians at the reduced amount no matter what the physician billed and no further action would be necessary. However, non-participating physicians who have collected balance billing amounts for unassigned claims based on the currently-allowed amount could be required to make refunds to their patients based on new, lower balance billing limits.

Members who have questions should contact This email address is being protected from spambots. You need JavaScript enabled to view it., Director of Health Care Finance. 

Regular session wraps; veto session looms

ColomboRachelleWEBRachelle Colombo; KMS Director of Government Affairs

The legislature officially adjourned its regular session on Thursday, April 2, leaving many major policy questions unanswered until the Veto Session begins at the end of the month. Though both chambers have developed a budget bill, only the Senate has passed the measure, sending the discussion to a conference committee. In conference, House and Senate negotiators are tasked with establishing provisions acceptable to a majority of both legislative bodies. In addition to the remaining work on a budget bill, revenue enhancements (tax increases) may also be needed to support major state financial obligations. House and Senate tax committees have held hearings throughout the session on a number of tax policy proposals, but neither body has formally engaged in debate on the subject yet. While sometimes slated only for consideration of measures vetoed by the Governor, the Veto Session beginning April 27 will be fully focused on budget and tax negotiations and any other lingering priorities.

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We need your vote!

This year, for the second time in our history, all KMS members have the opportunity to vote on the election of the physicians who will lead our organization. Previously, only those physicians who attended the House of Delegates meeting as a delegate had the opportunity to vote. We are excited about this change and look forward to enhanced member engagement in this most-important process.

Ballots for the 2015 KMS Board of Trustees election were mailed last month to all members. If you did not receive yours and have not cast your vote, we urge you to do so today. You may visit our website at www.kmsonline.org/election to learn about the candidates and to cast your vote electronically. If you have questions, contact Allison Peterson at This email address is being protected from spambots. You need JavaScript enabled to view it. or by phone at 800.332.0156.

Registration open for all-new Members Meeting

Make plans to join us at the upcoming KMS Members Meeting on Saturday, May 2, 2015 from 10am-2:30pm at the Wichita Hyatt. (Click here to review a detailed schedule and register for the event.)

This is the first annual members meeting since the House of Delegates was replaced last year. In the past only delegates attended the meeting; now, this meeting is open to all members and there is no cost to attend. We are excited about our new one-day format, which will include CME, networking opportunities and time for members to share concerns or ideas directly with the KMS Board of Trustees. Our keynote speaker Kevin Pho, MD–founder and editor of the popular blog KevinMD.com–will cover one of the most challenging issues in health care today, that of social media.

This meeting has been re-designed with you in mind. The one-day schedule will allow you to participate in important KMS discussions without giving up your entire weekend. We're excited about these changes and hope that you'll make plans to attend.

Go to our website for complete meeting details and to register; registration is open until April 26, 2015. Contact This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it. if you have questions.

2014 mid-year QRURs released

CMS has released the 2014 Mid-Year Quality and Resource Use Reports (MYQRURs) to physician solo practitioners and groups of physicians nationwide who submitted claims to Medicare during the reporting period of July 1, 2013 – June 30, 2014. The mid-year report provides a preview of how physicians would perform on cost and quality measures under the value-based payment modifier.

The 2014 MYQRURs were made available for informational purposes only and contain information on a subset of the measures used to calculate the 2016 Value Modifier. The report provides interim information about performance on the six cost and three quality outcomes measures that CMS calculates from Medicare claims and are used in the calculation of the Value Modifier.

CMS plans to release annual 2014 QRURs late this summer, which will show impacted groups how the VBPM will affect their 2016 payments. If you’d like to look up your own mid-year report you can find information on the How to Obtain a QRUR webpage. CMS will host a webinar on how to interpret the MYQRUR on June 3, 2015, to register click here or CMS has provided a guide on how to use your mid-year QRUR. Additional information about QRUR can be found at the CMS website or contact This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance. 

CMS open payments deadline approaching

Physicians have until May 20, 2015 to register in the Open Payment System, also known as the Physician Payments Sunshine Act, and review their 2014 financial interactions with manufacturers of drugs and medical devices reported under the Open Payments Program. Disputes that are initiated by May 20th will be flagged in the public release on June 30, 2015.

The program is CMS’ attempt to increase transparency and accountability in health care, and last year’s initial report was riddled with inaccurate data and difficulties getting registered. The AMA website has step-by-step instructions on how to register and review your data.

 CMS has issued new frequently asked questions on when continuing medical education (CME) would be reportable under the program. The guidance states that reporting is not triggered unless the manufacturer requires, instructs, directs or otherwise causes the third party to provide the payment or transfer of value, in whole or in part, to a covered recipient. Additional information about the CMS Open Payment Program can be found here

No more SGR--what's in its place?

After 12 years, and 17 patches to avert steep cuts to physicians, the U.S. House and Senate passed H.R. 2 Medicare Access and CHIP Reauthorization Act (MACRA), repealing the flawed Sustainable Growth Rate (SGR), permanently. Under the provisions of the bill, the fee schedule conversion factor will increase by 0.5 percent on July 1, 2015, and by another 0.5 percent on January 1, 2016. The bill also directs the Secretary of HHS to establish a Merit-based Incentive Payment System (MIPS), in which eligible professionals will receive annual payment increases or decreases based on their performance. MIPS is not scheduled to take effect until 2019, and will consolidate and replace Physician Quality Reporting System (PQRS), Meaningful Use (MU), and the Value-Based Modifier (VBM). The bill also requires a specified incentive payment to eligible participants in an alternative payment model.

For more information, check out the following AMA resources: Bill summary; section-by-section analysis; bill comparison; and timeline.

If you have any questions or concerns regarding this legislation please contact, This email address is being protected from spambots. You need JavaScript enabled to view it., KMS Director of Health Care Finance. 

Gilbaugh elected KMS President; other trustees elected to Board

The Kansas Medical Society–the state's oldest and largest advocacy organization for physicians–recently elected new members to its governing Board of Trustees. The elections were finalized during the recent Members Meeting held on May 2, 2015. More than 1300 Kansas physicians cast votes in the election—the second in which all members have been eligible to vote.

  • James Gilbaugh III, MD was elected President; Dr. Gilbaugh is a practicing urologist from Wichita who will serve as President until May 2017.
  • Robert Gibbs, MD–a radiologist from Parsons–will serve as President-elect. Dr. Gibbs will assume the Presidency of KMS in May 2017.
  • LaDona Schmidt, MD (Family Medicine-Salina) was re-elected as a Trustee from the Central District.
  • James Longabaugh, DO (Family Medicine-Sabetha) was re-elected as a Trustee from the Eastern District.
  • Lynn Fisher, MD (Family Medicine-Plainville) was re-elected as a Trustee from the Western District.
  • Arthur Snow, Jr., MD (Family Medicine-Shawnee Mission) has been re-elected as a Kansas Delegate to the American Medical Association (AMA).
  • Richard Warner, MD (Psychiatry-Overland Park) has also been re-elected as a Kansas Delegate to the AMA.
  • Lambert Wu, MD (Cardiology-Topeka) will serve as Chair of the 2016 KMS Members Meeting.
  • Steen Mortensen, MD (Rheumatology-Wichita) will serve as Vice-Chair of the 2016 KMS Members Meeting.

Also serving on the 2015-2016 KMS Board of Trustees are:

  • Immediate Past President–John Eplee, MD; Family Medicine-Atchison
  • Secretary/Treasurer–Kimberly Templeton, MD; Orthopaedic Surgery-Kansas City
  • Central District Trustee–Jennifer Koontz, MD; Sports Medicine-Newton
  • Eastern District Trustee–James Barnett, MD; Internal Medicine-Topeka
  • Western District Trustee–James Zauche, MD; Pediatrics-Garden City
  • Chair, Legislative Committee–Kevin Hoppock, MD; Family Medicine-Wichita
  • Chair, KaMMCO–Daniel Suiter, MD; Gastroenterology-Pratt
  • Designated Trustee–Joe Davison, MD; Family Medicine-Wichita
  • Designated Trustee–Mark Brady, MD; Anesthesiology-Kansas City
  • AMA Delegate–Terry Poling, MD; Family Medicine-Wichita
  • AMA Alternate Delegate–Robert Gibbs, MD; Radiology-Parsons
  • EVC, KU Medical Center–Doug Girod, MD; Otolaryngology-Kansas City
  • Gleason Fellow–Fadi Joudi, MD; Urology-Wichita

Act now to avoid the CMS PQRS 2017 penalty

CMS will host a call which will provide guidance and instructions on how individual Eligible Professionals (EPs) and group practices can avoid the 2017 Physician Quality Reporting System negative payment adjustment, satisfy the clinical quality measure component of Medicare Electronic Health Records Incentive Program, earn an incentive based on performance and avoid the automatic 2017 negative payment adjustment under Value-Based Payment Modifier. The call is scheduled for September 24, 2015 from 12:30–2pm. To register, visit MLN Connects Event Registration. Space is limited, so please register early.

BOHA approves use of Vyvanse for binge eating disorder

The Healing Arts Act at KSA 65-2837 limits the prescribing of amphetamines or sympathomimetic amine controlled substances to treatments for specific diagnoses but allows non-specified disorders to be treated as well, as long as such treatment is safe, effective, supported by scientific research and with the general support of the scientific community.

These statutes were approved in 1984, before the American Psychiatric Association formally recognized Binge Eating Disorder (B.E.D.) in 2013 as a distinct psychiatric disorder. An estimated 2.8 million US adults suffer from B.E.D., making it more prevalent in the U.S. than anorexia nervosa and bulimia nervosa combined.

The FDA has since approved Vyvanse, a sympathomimetic amine, as a treatment for moderate to severe B.E.D. in adults.  There are no other pharmacologic treatments approved for this condition at this time. In light of these facts, at the August 14 meeting, the Board of Healing Arts considered and approved a petition allowing for use of Vyvanse in treating B.E.D.

If you have questions about this issue or other legislative matters, please contact Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..

UHC updates site of service guidelines

UnitedHealthcare (UHC) has announced it will update its Site of Service Guidelines for certain outpatient surgical procedures. UHC will be implementing prior authorization guidelines that encourage more cost-effective sites of service for certain outpatient surgical procedures, when medically appropriate.

The procedures will require prior authorization if performed in an outpatient hospital setting. No prior authorization will be required if they are performed at an ambulatory surgery center. Coverage determinations will consider availability of participating network facility, specialty requirements, physician privileges and whether a patient has an individual need for access to more intensive service.

The guidelines are effective for dates of service on or after October 1, 2015 and apply to commercial plans. A list of updated procedures can be found here. Additional information may also be found at the UHC Frequently Asked Questions

BCBS announces contract changes for 2016

Blue Cross Blue Shield of Kansas (BCBSKS) recently mailed their Competitive Allowance Program (CAP) contract changes for 2016 to all CAP providers. The document provides notice of changes to reimbursement or Maximum Allowance Payment (MAP) and policies for the upcoming year. KMS encourages its members to carefully review this and all contracts. According to the document, BCBSKS serves 975,997 Kansans across all lines of business as of May of 2015. Administrative expense was at 10.30 percent, a decrease from last year’s 11.32 percent.

The most positive component of the contract is the opportunity to receive incentive payments through the Quality Based Reimbursement Program (QBRP). BCBSKS is projecting $40 million in QBRP incentives for both physicians and hospitals in 2015. Providers, depending on specialty, can earn as much as 21.5 percent when all seventeen components of the program are met. The QBRP metrics are multiplied individually by the MAP then totaled with the MAP to determine the total reimbursement-not to exceed billed charges. 

One change to the QBRP program is the Kansas Health Information Exchange (KHIE) component where there is an opportunity to earn 6 percent. The incentives include 1.5 percent for providers who are querying at least 60 times a quarter for patients in the Kansas Health Information Network (KHIN) or another approved KHIE organization. There is also an additional incentive for providers who are sending HL7 data in real time. This includes patient demographics, visit information, diagnosis, procedures, lab results, progress notes and medications. You may contact KHIN at 877.520.5446 for information regarding KHIN membership and getting connected. 

Incentive payments begin on January 1, 2016; however, it is important to note that the period utilized to determine the qualifying period may differ depending on the component. Additional information is available here

A charge comparison report reflecting reimbursement changes for 2016 is available by contracting your professional relations representative or professional relations hotline at: 800.432.3587. The charge comparison is based on services billed by you during the first five months of 2015. As a reminder, the format of the charge comparison report changed in 2015. The new format provides the lesser of your charge or the MAP for each procedure code you performed thus far in 2015. In addition, the new report will show whether each procedure code qualifies for QBRP.

If you wish to terminate your provider contract, you must send a signed correspondence postmarked no later than midnight, September 3, 2015, to Doug Scott, Director of Professional Relations, cc480D2, 1133 Topeka Blvd., Topeka, KS 66629. 

In process: new regulations for Physician Assistants

Legislation passed in 2014 and 2015 updating the Physician Assistants Scope of Practice Act and the Healing Arts Act to provide uniformity across the regulated professions has necessitated the development of new regulations for physician assistants and the physicians supervising them. 

Members of the Kansas Academy of Physician Assistants, Kansas Medical Society and Kansas Association of Osteopathic Medicine worked together to address outdated language and provisions with the goal of establishing enforceable regulations that are clear, consistent, and appropriate for varied practice settings.  The newly drafted regulations must now receive approval from the Department of Administration and the Attorney General before moving to public hearings and a sixty-day comment period in advance of formal adoption and implementation. The law stipulates that regulations must be in place by January 2016.

Though the regulations have not completed the review process, there are several changes that will likely be included in the final version. The new regulations:

  • Reflect statutory change in title from “responsible” to “supervising” physician
  • Clarify content of written agreements between PA and physicians, delineating scope of practice
  • Add more information regarding practice location, supervising physician-PA relationship, levels of supervision and substitute supervision
  • Add dispensing authority
  • Remove limitation on specific number of physician assistants supervised

Prior to implementing any new regulations, the Kansas Board of Healing Arts will post notice of public hearings on their website, initiating a sixty-day comment period addressing any concerns.  We will notify you once the review process is complete and draft regulations can be disseminated for public comment.

For more information, please contact Director of Government Affairs, This email address is being protected from spambots. You need JavaScript enabled to view it..