Bill Summary – FastDemocracy

Session of 2024
                            HOUSE BILL No. 2002
                              By Representative Stogsdill
                                         6-18

 AN ACT concerning health and healthcare; relating to health insurance
   coverage; expanding medical assistance eligibility; enacting the cutting
   healthcare costs for all Kansans act; directing the department of health
   and environment to study certain medicaid expansion topics; adding
   meeting days to the Robert G. (Bob) Bethell joint committee on home
   and community based services and KanCare oversight to monitor
   implementation of expanded medical assistance eligibility; amending
   K.S.A. 39-7,160, 40-3213, 65-6207, 65-6210, 65-6211, 65-6212 and
   65-6217 and K.S.A. 2023 Supp. 65-6208, 65-6209 and 65-6218 and
   repealing the existing sections.
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 Be it enacted by the Legislature of the State of Kansas:
     New Section 1. (a) Sections 1 through 13, and amendments thereto,
 shall be known and may be cited as the cutting healthcare costs for all
 Kansans act.
     (b) The legislature expressly consents to expand eligibility for receipt
 of benefits under the Kansas program of medical assistance, as required by
 K.S.A. 39-709(e)(2), and amendments thereto, by the passage and
 enactment of the act, subject to all requirements and limitations established
 in the act.
     (c) The secretary of health and environment shall adopt rules and
 regulations as necessary to implement and administer the act.
     (d) As used in sections 1 through 13, and amendments thereto, unless
 otherwise specified:
     (1) "138% of the federal poverty level," or words of like effect,
 includes a 5% income disregard permitted under the federal patient
 protection and affordable care act.
     (2) "Act" means the cutting healthcare costs for all Kansans act.
     New Sec. 2. (a) The secretary of health and environment shall submit
 to the United States centers for medicare and medicaid services any state
 plan amendment, waiver request or other approval request necessary to
 implement the act. At least 10 calendar days prior to submission of any
 such approval request to the United States centers for medicare and
 medicaid services, the secretary of health and environment shall submit
 such approval request application to the state finance council.
     (b) For purposes of eligibility determinations under the Kansas
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 program of medical assistance on and after January 1, 2025, medical
 assistance shall be granted to any adult under 65 years of age who is not
 pregnant and whose income meets the limitation established in subsection
 (c), as permitted under the provisions of 42 U.S.C. § 1396a, as it exists on
 the effective date of the act, and subject to a 90% federal medical
 assistance percentage and all requirements and limitations established in
 the act.
     (c) The secretary of health and environment shall submit to the
 United States centers for medicare and medicaid services any approval
 request necessary to provide medical assistance eligibility to individuals
 described in subsection (b) whose modified adjusted gross income does
 not exceed 138% of the federal poverty level.
     New Sec. 3. (a) The secretary of health and environment shall require
 each applicant for coverage under the act to provide employment
 verification at the time of initial application or renewal application. Such
 verification shall be a prerequisite for coverage under the act.
     (b) "Employment verification" means documentation demonstrating
 employment during the preceding 12 months that meets the eligibility
 requirements of the act. "Employment verification" includes, but is not
 limited to:
     (1) Federal form W-2 wage and tax statement;
     (2) a pay stub demonstrating gross income;
     (3) employment records;
     (4) federal form 1099 demonstrating payments for contract labor;
     (5) compliance with the requirements of K.S.A. 39-709(b), and
 amendments thereto; and
     (6) any other documentation as determined by the secretary of health
 and environment.            (c) The following individuals shall be exempt
 from the requirements of this subsection:
     (1) A full-time student enrolled in a postsecondary educational
 institution or technical college, as defined by K.S.A. 74-3201b, and
 amendments thereto, for each year the student is enrolled in such
 educational setting;
     (2) a parent or guardian of a dependent child under 18 years of age or
 a parent or guardian of an incapacitated adult;
     (3) an individual who is mentally or physically unfit for employment,
 as defined by the secretary of health and environment, or has a pending
 application for supplemental security income or social security disability
 insurance;
     (4) an individual who has a permanent partial disability, as such term
 is used in K.S.A. 44-510e, and amendments thereto;
     (5) an individual who is engaged in volunteer work for at least 20
 hours per week at a nonprofit organization, as such term is defined in
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 K.S.A. 17-1779, and amendments thereto;
     (6) an individual experiencing homelessness, as such term is defined
 in 42 U.S.C. 11302, as in effect on the effective date of this act;
     (7) an individual who served in the active military, naval, air or space
 service and was discharged or released from such military service under
 conditions other than dishonorable;
     (8) an individual who is not more than 22 years of age and in the
 custody of the secretary of children and families on the date that the
 individual reached 18 years of age; and
     (9) any individual who the secretary determines is experiencing
 hardship.
     New Sec. 4. (a) The secretary of health and environment may
 establish a health insurance coverage premium assistance program for
 individuals who meet the following requirements:
     (1) The individual has an annual income that is 100% or greater than,
 but does not exceed 138% of, the federal poverty level, based on the
 modified adjusted gross income provisions set forth in section 2001(a)(1)
 of the federal patient protection and affordable care act; and
     (2) the individual is eligible for health insurance coverage through an
 employer but cannot afford the health insurance coverage premiums, as
 determined by the secretary of health and environment.
     (b) A program established under this section shall:
     (1) Contain eligibility requirements that are the same as in sections 2
 and 3, and amendments thereto; and
     (2) provide that an individual's payment for a health insurance
 coverage premium may not exceed 2% of the individual's modified
 adjusted gross income, not to exceed 2% of the household's modified
 adjusted gross income in the aggregate with any premium charged to any
 other household member participating in the premium assistance program.
     New Sec. 5. (a) Except to the extent prohibited by 42 U.S.C. §
 1396u-2(a)(2), as it exists on the effective date of this act, the secretary of
 health and environment shall administer medical assistance benefits using
 a managed care delivery system using organizations subject to assessment
 of the privilege fee under K.S.A. 40-3213, and amendments thereto. If the
 United States centers for medicare and medicaid services determines that
 the assessment of a privilege fee provided in K.S.A. 40-3213, and
 amendments thereto, is unlawful or otherwise invalid, then the secretary of
 health and environment shall administer state medicaid services using a
 managed care delivery system.
     (b) In awarding a contract for an entity to administer state medicaid
 services using a managed care delivery system, the secretary of health and
 environment shall:
     (1) Not provide favorable or unfavorable treatment in awarding a
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 contract based on an entity's for-profit or not-for-profit tax status;
     (2) give preference in awarding a contract to an entity that provides
 health insurance coverage plans on the health benefit exchange in Kansas
 established under the federal patient protection and affordable care act; and
     (3) require that any entity administering state medicaid services
 provide tiered benefit plans with enhanced benefits for covered individuals
 who demonstrate healthy behaviors, as determined by the secretary of
 health and environment, to be implemented on or before July 1, 2026.
     New Sec. 6. If the federal medical assistance percentage for coverage
 of medical assistance participants described in section 1902(a)(10)(A)(i)
 (VIII) of the federal social security act, 42 U.S.C. § 1396a, as it exists on
 the effective date of this act, becomes lower than 90%, then the secretary
 of health and environment shall terminate coverage under the act over a
 12-month period, beginning on the first day that the federal medical
 assistance percentage becomes lower than 90%. No individual shall be
 newly enrolled for coverage under the act after such date.
     New Sec. 7. (a) Section 6, and amendments thereto, shall be
 nonseverable from the remainder of the act. If the provisions of section 6,
 and amendments thereto, are not approved by the United States centers for
 medicare and medicaid services, then the act shall be null and void and
 shall have no force and effect.
     (b) A denial of federal approval or federal financial participation that
 applies to any provision of the act not enumerated in subsection (a) shall
 not prohibit the secretary of health and environment from implementing
 any other provision of the act.
     New Sec. 8. (a) On or before January 10, 2026, and on or before the
 first day of the regular session of the legislature each year thereafter, the
 secretary of health and environment shall prepare and deliver a report to
 the legislature that summarizes the cost savings achieved by the state from
 the movement of covered individuals from the KanCare program to
 coverage under the act, including, but not limited to, the MediKan
 program, the medically needy spend-down program and the breast and
 cervical cancer program.
     (b) State cost savings shall be determined by calculating the cost of
 providing services to covered individuals in the KanCare program less the
 cost of services provided to covered individuals under the act.
     (c) If the secretary of health and environment implements other
 initiatives using cost savings achieved through the implementation of the
 act, the secretary shall include such initiatives as part of the report required
 in subsection (a).
     New Sec. 9. (a) The secretary of corrections and the secretary of
 health and environment shall coordinate with a county sheriff or such
 sheriff's deputy who requests assistance in facilitating medicaid coverage
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 for any individual committed to a county jail or correctional facility
 during any time period that such individual is eligible for coverage under
 state or federal law.
     (b) If an individual is enrolled in medicaid when such individual is
 committed to a county jail or correctional facility, such medicaid status
 shall not be suspended or terminated based on such individual's
 incarceration for a minimum of 30 days. After 30 days, medicaid coverage
 may be suspended, but not terminated, up to the maximum amount of time
 permitted by state and federal law.
     (c) The secretary of health and environment shall coordinate with a
 county sheriff or such sheriff's deputy and the department of corrections to
 assist any individual who is committed to a county jail or correctional
 facility in applying for medicaid coverage prior to such individual's release
 from custody if such individual is likely to meet the requirements for
 medicaid coverage to allow adequate time for medicaid coverage to begin
 promptly upon release.
     (d) The secretary of health and environment shall adopt any rules and
 regulations and supporting policies and procedures as necessary to
 implement and administer this section prior to January 1, 2025.
     New Sec. 10. On or before February 15, 2026, and on or before
 February 15 of each year thereafter, the secretary of health and
 environment shall present a report to the house of representatives standing
 committee on appropriations and the senate standing committee on ways
 and means that summarizes the costs of the act and the cost savings and
 additional revenues generated during the preceding fiscal year.
     New Sec. 11. (a) The department of health and environment shall
 remit all moneys received by the department of health and environment
 from drug rebates associated with medical assistance enrollees to the state
 treasurer in accordance with the provisions of K.S.A. 75-4215, and
 amendments thereto. Upon receipt of each such remittance, the state
 treasurer shall deposit the entire amount into the state treasury to the credit
 of the state general fund.
     (b) The department of health and environment shall certify the
 amount of moneys received by such agency from drug rebates associated
 with medical assistance enrollees on a monthly basis and shall transmit
 each such certification to the director of legislative research and the
 director of the budget.
     (c) Upon receipt of each such certification, the director of legislative
 research and the director of the budget shall include such certified amount
 on any monthly report prepared by the legislative research department or
 the division of the budget that details state general fund receipts as a
 separate item entitled "drug rebates" under a category of other revenue
 sources.
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     (d) This section shall take effect and be in force on and after July 1,
 2025.
     New Sec. 12. (a) There is hereby established the rural health advisory
 committee.
     (b) The rural health advisory committee shall consist of 15 members
 appointed by the governor. The membership shall be comprised of
 individuals with a variety of backgrounds including medicine, education,
 farming, finance, business and individuals representing community
 interests in rural Kansas.
     (c) The governor shall designate one of the appointed members to be
 chairperson of the committee. The members of the advisory committee
 shall select a vice chairperson from the membership of the advisory
 committee.
     (d) Upon first appointment, five of the members shall serve for a term
 of one year, five of the members shall be appointed for a term of two years
 and five of the members shall be appointed for term of three years, as
 designated by the governor. The member designated as chairperson shall
 serve for a term of three years. Subsequent appointees shall serve terms of
 three years.
     (e) (1) The advisory committee may meet at any time and at any
 place within the state on the call of the chairperson. The advisory
 committee shall meet regularly, but shall meet at least once every calendar
 quarter.
     (2) A quorum of the advisory committee shall be eight voting
 members. All actions of the advisory committee shall be adopted by a
 majority of those voting members present when there is a quorum.
     (f) The advisory committee shall:
     (1) Advise the governor and other state agencies on rural health
 issues;
     (2) recommend and evaluate mechanisms to encourage greater
 cooperation between rural communities and rural health providers;
     (3) recommend and evaluate approaches to rural health issues that are
 sensitive to the needs of local communities;
     (4) develop methods to identify individuals who are underserved by
 the Kansas rural healthcare system; and
     (5) beginning in 2025, provide an annual report to the governor
 containing the advice, recommendations and conclusions of the advisory
 committee.
     (g) The secretary of health and environment shall facilitate the work
 of the committee by providing access to meeting space and other necessary
 staff and office support. The secretary of health and environment may
 adopt any rules and regulations and supporting policies and procedures
 that are necessary to support the work of the advisory committee.
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    New Sec. 13. The cutting healthcare costs for all Kansans act shall
 not provide coverage for abortion services, except in cases where coverage
 is mandated by federal law and federal financial participation is available.
    Sec. 14. K.S.A. 39-7,160 is hereby amended to read as follows: 39-
 7,160. (a) There is hereby established the Robert G. (Bob) Bethell joint
 committee on home and community based services and KanCare
 oversight. The joint committee shall review the number of individuals who
 are transferred from state or private institutions and long-term care
 facilities to the home and community based services and the associated
 cost savings and other outcomes of the money-follows-the-person
 program. The joint committee shall review the funding targets
 recommended by the interim report submitted for the 2007 legislature by
 the joint committee on legislative budget and use them as guidelines fo