Bill Summary – FastDemocracy

Special Session of 2020
                               HOUSE BILL No. 2006
       By Representatives Ward, Amyx, Bishop, Carlin, Carmichael, Clayton, Curtis,
      Finney, Frownfelter, Highberger, Kuether, Ohaebosim, Ousley, Parker, Pittman,
     Probst, S. Ruiz, Sawyer, Stogsdill, Victors, Warfield, Wolfe Moore, Xu and Yeager
                                           6-3

 AN ACT concerning health and healthcare; relating to health insurance
   coverage; expanding medical assistance eligibility; implementing a
   health insurance plan reinsurance program; 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; making and concerning appropriations for the fiscal
   years ending June 30, 2020, June 30, 2021, and June 30, 2022;
   amending K.S.A. 65-6207, 65-6208, as amended by section 9 of 2019
   House Bill No. 2246, 65-6209, 65-6210, 65-6211, 65-6212, 65-6217
   and 65-6218, as amended by section 2 of 2019 House Bill No. 2168,
   and K.S.A. 2019 Supp. 39-7,160 and 40-3213 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 16 through 19, and
 amendments thereto, shall be known and may be cited as the Kansas
 innovative solutions for affordable healthcare 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 16 through 19, 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 Kansas innovative solutions for affordable
 healthcare act.
     New Sec. 2. (a) The secretary of health and environment and the
 insurance commissioner shall submit to the United States centers for
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 medicare and medicaid services and the United States department of the
 treasury 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 or the United States department of the
 treasury, the secretary of health and environment or the insurance
 commissioner, as applicable, shall submit such approval request
 application to the state finance council.
     (b) For purposes of eligibility determinations under the Kansas
 program of medical assistance on and after January 1, 2021, 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) (1) 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.
     (2) (A) Following submission to and approval by the state finance
 council in accordance with sections 20 and 22, the insurance commissioner
 shall submit to the United States department of the treasury and the United
 States centers for medicare and medicaid services a waiver request under
 section 1332 of the federal patient protection and affordable care act, 42
 U.S.C. § 18052, as it exists on the effective date of the act, for a
 reinsurance program for health insurance plans sold in the Kansas
 individual market that are qualified health plans, as defined in 42 U.S.C. §
 18021(a). The insurance commissioner shall design the reinsurance
 program in coordination with the secretary of health and environment to
 offset any cost of the section 1115 waiver described in this paragraph to
 the United States government in order to meet federal budget neutrality
 requirements for medicaid waivers. The insurance commissioner shall
 implement the reinsurance program to begin on January 1, 2022.
     (B) The secretary of health and environment shall submit to the
 United States centers for medicare and medicaid services a waiver request
 under section 1115 of the federal social security act, 42 U.S.C. § 1315, as
 it exists on the effective date of the act, to provide medical assistance
 eligibility to individuals described in subsection (b) whose modified
 adjusted gross income does not exceed 100% of the federal poverty level
 and to transition those individuals described in subsection (b) whose
 modified adjusted gross income is greater than 100% but does not exceed
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 138% of the federal poverty level to health insurance plans on the health
 benefit exchange in Kansas established under the federal patient protection
 and affordable care act. The secretary of health and environment shall
 implement medical assistance eligibility under this subparagraph to begin
 on January 1, 2022, in conjunction with the implementation of the
 reinsurance program under subparagraph (A).
     (C) If the waiver request submission under subparagraph (A) is not
 approved by the state finance council in accordance with sections 20 and
 22, or if both waiver requests under subparagraphs (A) and (B) are not
 approved by the United States centers for medicare and medicaid services
 and the United States department of the treasury, as applicable, then
 medical assistance eligibility under the act shall continue to be determined
 in accordance with paragraph (1).
     (d) The insurance commissioner shall identify and procure a
 contractor for services to prepare the section 1332 waiver for a reinsurance
 program described in this section. Such contractor shall have experience in
 developing and submitting section 1332 waivers for reinsurance programs.
     New Sec. 3. (a) The secretary of health and environment shall refer
 each non-disabled adult applying for or receiving coverage under the act
 who is unemployed or working less than 20 hours per week to the
 Kansasworks program administered by the department of commerce. The
 secretary of commerce shall coordinate with the secretary of health and
 environment to certify to the secretary of health and environment each
 covered individual's compliance with this section. The secretary of
 commerce shall maintain a unique identifier for Kansasworks participants
 who are covered individuals under the act to track employment outcomes
 and progress toward employment.
     (b) The secretary of health and environment shall evaluate each new
 applicant for coverage under the act for education status, employment
 status and any factors impacting the applicant's employment status, if less
 than full-time employment, and shall require each applicant to
 acknowledge the referral required under subsection (a). Such evaluation
 shall be a prerequisite for coverage under the act.
     (c) A full-time student enrolled in a postsecondary educational
 institution or technical college, as defined by K.S.A. 74-3201b, and
 amendments thereto, shall be exempt from the referral required under
 subsection (a) for each year the student is enrolled in such educational
 setting.
     (d) The secretary of health and environment shall report annually to
 the legislature, in coordination with the secretary of commerce, on or
 before the first day of each regular session of the legislature regarding the
 employment outcomes of covered individuals under the act.
     New Sec. 4. (a) (1) Except to the extent prohibited by 42 U.S.C.
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 1396o-1(a)(2) and (b)(3), as such provisions exist on the effective date of
 this act, the department of health and environment shall charge to each
 covered individual described in section 2(b), and amendments thereto, a
 monthly fee not to exceed $25 per individual, but not to exceed a
 maximum of $100 per month per family household, as a condition of
 participation in the program. The department may grant a hardship
 exemption from payment of the monthly fee, as determined by the
 secretary of health and environment.
     (2) The department of health and environment shall remit all moneys
 collected or received for monthly fees charged under this subsection,
 except for the federal share of such fees required to be remitted to the
 United States centers for medicare and medicaid services, to the state
 treasurer in accordance with K.S.A. 75-4215, and amendments thereto.
 Upon receipt of each such remittance, the state treasurer shall deposit the
 entire amount remitted into the state treasury to the credit of the state
 general fund.
     (b) The department of health and environment shall utilize the debt
 collection procedures authorized by K.S.A. 75-6201 et seq., and
 amendments thereto, for a covered individual under the act who is
 delinquent by 60 days or more in making a monthly fee payment.
     (c) The secretary of health and environment may require each
 managed care organization providing services under the act to collect the
 monthly fee charged under subsection (a) in lieu of the department.
     (d) In January of each year, the secretary of health and environment
 shall submit to the house of representatives standing committee on health
 and human services and the senate standing committee on public health
 and welfare an accounts receivable report for monthly fees collected under
 this section during the preceding calendar year.
     New Sec. 5. (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
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 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. 6. (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
 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, 2022.
     New Sec. 7. 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 section, 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. 8. (a) Section 7, and amendments thereto, shall be
 nonseverable from the remainder of the act. If the provisions of section 7,
 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. 9. (a) All moneys collected or received by the secretary of
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 health and environment for privilege fees collected pursuant to K.S.A. 40-
 3213, and amendments thereto, connected to covered individuals under the
 act shall be remitted 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 in
 the state treasury to the credit of the medicaid expansion privilege fee
 fund.
     (b) There is hereby created in the state treasury the medicaid
 expansion privilege fee fund as a reappropriating fund. Moneys in the fund
 shall be expended for the purpose of medicaid medical assistance
 payments for covered individuals under the act. All expenditures from the
 fund shall be made in accordance with appropriation acts upon warrants of
 the director of accounts and reports issued pursuant to vouchers approved
 by the secretary of health and environment or the secretary's designee.
     (c) The medicaid expansion privilege fee fund shall be used for the
 purposes set forth in the act and for no other governmental purposes. It is
 the intent of the legislature that the fund and the moneys deposited into the
 fund shall remain intact and inviolate for the purposes set forth in the act,
 and moneys in the fund shall not be subject to the provisions of K.S.A. 75-
 3722, 75-3725a and 75-3726a, and amendments thereto.
     (d) On or before the 10th day of each month, the director of accounts
 and reports shall transfer from the state general fund to the medicaid
 expansion privilege fee fund interest earnings based on:
     (1) The average daily balance of moneys in the fund for the preceding
 month; and
     (2) the net earnings rate of the pooled money investment portfolio for
 the preceding month.
     (e) On or before January 10, 2022, 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 all expenditures from the medicaid expansion privilege
 fee fund, fund revenues and recommendations regarding the adequacy of
 the fund to support necessary program expenditures.
     New Sec. 10. (a) On or before January 10, 2022, 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
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 cost of services provided to covered individuals under the act.
     New Sec. 11.