SESSION OF 2023
SUPPLEMENTAL NOTE ON HOUSE BILL NO. 2259
As Amended by House Committee on Health
and Human Services

Brief*
HB 2259, as amended, would amend the Medicaid Drug
Utilization Review Program regarding the requirement to have
prior authorization for mental health medications. The bill
would remove the requirement for the Medicaid Drug
Utilization Review Board to review and approve any proposed
policy, rule, or regulation regarding medications used to treat
mental illness as submitted to the electronic pharmacy claims
management system. The bill would remove the prior
authorization requirement for authorized prescribers of mental
health medications for Medicaid recipients. The bill would
also eliminate the Mental Health Medication Advisory
Committee (MHMAC) in its entirety.

Prior Authorization
The bill, as amended, would state that a prescriber shall
not be required to obtain prior authorization for medications
used for mental illness. Medications would include, but would
not be limited to, conventional antipsychotic medications and
atypical antipsychotic medications. The prior authorization for
mental health medication would only be removed for persons
who are Medicaid recipients.


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*Supplemental notes are prepared by the Legislative Research
Department and do not express legislative intent. The supplemental
note and fiscal note for this bill may be accessed on the Internet at
http://www.kslegislature.org
Elimination of MHMAC
The bill would eliminate the MHMAC on July 1, 2023.
[Note: Current law provides that the MHMAC is charged with
providing recommendations to the drug utilization review
board on medications used to treat mental illnesses.]

Definition of Prescriber
The bill, as amended, would provide that the term
“prescriber” would have the same definition as used in the
Regulation of Pharmacy Act as follows:
“Prescriber” means a practitioner or a mid-level
practitioner.
“Practitioner” means a person licensed to practice
medicine and surgery, dentist, podiatrist, veterinarian,
optometrist, or scientific investigator or other person
authorized by law to use a prescription-only drug in teaching
or chemical analysis or to conduct research with respect to a
prescription-only drug.
“Mid-level practitioner” means a certified nurse-midwife
engaging in the independent practice of midwifery under the
Independent Practice of Midwifery Act, an advanced practice
registered nurse issued a license pursuant to KS. 65-1131,
and amendments thereto, who has authority to prescribe
drugs under KSA 65-1130, and amendments thereto, or a
physician assistant licensed pursuant to the physician
assistant licensure act who has authority to prescribe drugs
pursuant to a written agreement with a supervising physician
under KSA 65-28a08, and amendments thereto.

Background
The bill was introduced by the House Committee on
Health and Human Services at the request of Representative

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Bryce on behalf of the Association of Community Mental
Health Centers of Kansas.

House Committee on Health and Human Services
In the House Committee on Health and Human Services
hearing on February 14, 2023, proponent testimony was
provided by two representatives of the Association of
Community Mental Health Centers of Kansas and
representatives of Kansas Mental Health Coalition and the
National Alliance of Mental Illness Kansas, who stated the
objective of the bill is to decrease the administrative burden
on prescribers and decrease the negative clinical outcomes
including delayed patient care pending the completion of the
prior authorization process.
Written-only proponent testimony was submitted by a
private citizen.
A representative of the Kansas Department of Health
and Environment (KDHE) provided opponent testimony. The
conferee stated the bill would impact monitoring of Medicaid-
covered outpatient drug spend and recommendations on cost
containment.
No other testimony was provided.
The House Committee amended the bill to allow any
prescriber of mental health medications to be exempt from
prior authorizations.

Fiscal Information
According to the fiscal note prepared by the Division of
the Budget on the bill, as introduced, KDHE states enactment
of the bill would result in additional expenditures of at least
$7.1 million, including $2.8 million from the State General
Fund and $4.3 million from federal funds, in FY 2024. KDHE

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notes that the current policy to require the generic product of
the brand reference product (when available) was used when
determining the estimate, as the agency did not interpret the
bill to prohibit this policy. If the policy was no longer allowed,
the estimate would be significantly higher. KDHE also notes
that the estimate does not reflect the elimination of patient
safety edits that are also part of prior authorization, as the
prescribing behavior of physicians cannot be predicted.
To determine the estimate, KDHE estimated that the
impact is best represented by beneficiaries who had a least
one denied claim for the specific drug requested and never
received that specific requested drug. The average amount
paid for each product was used to extrapolate monthly costs
and then converted to annual costs. The current Wholesale
Acquisition Cost was used for instances when there were no
paid claims or insufficient claims. The estimates considered
data over approximately four years. Drugs were included if
they had Step Therapy, Preferred Drug List, or a
supplemental rebate agreement. For Step Therapy, an
appropriate step-through drug was assumed to have been
used instead of the requested drug, and the net cost
difference was used as the impact. For each non-preferred
drug, it was assumed that the patient tried one or two
preferred drugs and were adequately treated with a preferred
agent. Two preferred agents from the corresponding class
were selected and the average cost per claim was used to
calculate the net cost difference. There were limitations for
several drugs that were either not available or not utilized at
all during the four years.
The Kansas Department for Aging and Disability
Services, the Kansas State Board of Healing Arts, and the
Kansas Board of Pharmacy report the bill would not result in
a fiscal effect on the operations of any of the respective
agencies. Any fiscal effect associated with the bill is not
reflected in The FY 2024 Governor’s Budget Report.
Medicaid; mental health; prior authorization; prescribers; kancare

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Statutes affected:
As introduced: 39-7
As Amended by House Committee: 39-7, 65-1626