Heading in to the fourth week of session, the Health committees have continued to work at a rapid pace. Below you will find a list of key issues KMS is following on behalf of the physician community.
Senate Bill 32 and its identical companion House Bill 2124 would extend the Medical Student Loan program and the Medical Residency Bridging Program to general and child psychiatry. Both programs were designed and implemented to attract primary care physicians to rural and underserved areas. Recognizing that there also exists a shortage of psychiatric care in the same areas, KMS worked with the Kansas Academy of Family Physicians and others on an approach that would expand the structure of the two programs and provide additional resources to attract psychiatrists to practice in underserved areas, so long as the current programs for primary care are maintained and financed at their current levels.
House Bill 2121 was introduced, heard and passed out of the House Health and Human Services committee, requiring physicians to participate in the state's immunization registry, Web-IZ, by July 1, 2020. Currently, all other dispensers and prescribers are required to report the administration of immunizations, unless the patient opts out. Physicians will have the next three years to either integrate their EMR systems or prepare for manual reporting.
Senate Bill 69, the KanCare compliance bill brought forth by a coalition of health care providers including KMS, was heard in Senate Public Health and Welfare. Several proponents, including KMS, discussed the importance of administrative simplification of the state's managed care Medicaid program, KanCare. The bill requires uniform credentialing, billing and appeals processes as well as increased communication and education between the MCOs and participating providers. Though the administration is working to reconcile these issues, proponents believe statutory accountability is necessary to maintain provider confidence in KanCare amidst difficulties and declining reimbursement.
Senate Bill 94, increasing the MCO privilege fee will be heard in Senate Ways and Means on Monday, February 6. The bill increases the tax that all managed care organizations (MCOs) pay. The tax proceeds will be used to draw down federal funds, providing new revenue to reverse the 4 percent provider reimbursement cut implemented in July, as well as support the overall Medicaid program. KMS supports the bill so long as the funds are used for the intended purposes.
House Bill 2064, the Kansas Hospital Association-led Medicaid expansion bill, will be heard in House Health and Human Services over the course of the coming week. KMS supports the bill and will continue to support efforts to insure more Kansans and expand coverage in a fiscally responsible way that does not cost-shift among providers.
In the past week two telemedicine bills were introduced, House Bill 2206 and House Bill 2254. Although there are several similarities in the bills, they are different in one significant way. HB 2206 contains a provision that stops just short of mandating that insurance plans provide coverage and payment "parity" for telemedicine services. It does, however, require Medicaid (KanCare) plans to provide such parity. HB 2254 is silent on the issue of insurance parity. At its regular, bi-weekly meeting the KMS Legislative Committee discussed the bills and identified the following points that should be included in any telemedicine bill that moves forward:
- Physicians or other clinicians providing telemedicine services must be licensed by the appropriate Kansas state regulatory agency and comply with all applicable scope of practice laws and regulations.
- Telemedicine must be provided consistent with recognized standards of practice expected in in-person encounters, and be medically necessary and appropriate for the patient's medical needs.
- With certain exceptions consistent with recognized standards of care, the telemedicine professional must be able to conduct an appropriate face-to-face examination prior to diagnosis or treatment via a real-time, interactive audio or video system (if a face-to-face encounter would otherwise be required if the same service were not delivered via telemedicine).
- There should be parity in insurance coverage and reimbursement for telemedicine services as compared to the same service provided in-person, and insurers should be prohibited from excluding coverage for a service solely because the service is provided via telemedicine.
- Patient informed consent, privacy and confidentiality must be protected at every stage of the telemedicine process.
- Physicians or other clinicians providing telemedicine services must obtain an appropriate medical history and properly document the telemedicine encounter.
- Physicians or other clinicians providing telemedicine services should take steps to promote continuity of care, such as with appropriate communication with the patient's primary care physician or other treating physicians for necessary follow-up.
- Because of issues related to the widespread use of opioids, the prescribing of controlled substances via telemedicine should be subject to regulations adopted by the Healing Arts Board, after consultation with the Pharmacy Board.
All of these bills and any other bills that are not exempted from legislative deadlines will have to be advanced from their committee and house of origin in the next two weeks to remain "alive" for the remainder of the session. Bills not yet scheduled for a hearing must either be granted an exemption or will be considered "dead" for this year.