Division of the Budget
Landon State Office Building Phone: (785) 296-2436
900 SW Jackson Street, Room 504 adam.c.proffitt@ks.gov
Topeka, KS 66612 Division of the Budget http://budget.kansas.gov
Adam Proffitt, Director Laura Kelly, Governor


February 19, 2021
REVISED

The Honorable Brenda Landwehr, Chairperson
House Committee on Health and Human Services
Statehouse, Room 352C-S
Topeka, Kansas 66612
Dear Representative Landwehr:
SUBJECT: Revised Fiscal Note for HB 2256 by House Committee on Health and
Human Services
In accordance with KSA 75-3715a, the following revised fiscal note concerning HB 2256
is respectfully submitted to your committee.
HB 2256 would amend the Nurse Practice Act. The bill would authorize an Advanced
Practice Registered Nurses (APRNs) practice to be independent and no longer require a
collaborative agreement with a responsible physician. Proof of national certification would be
required for APRN licensure at the time of licensure and licensure renewal. The Board of Nursing
would need to recognize national certifying organizations whose certification standards are equal
to or greater than the corresponding standards established by the Board and approve these national
certifying organizations. The Board would also need to include in its rules and regulations the
federal Drug Enforcement Administration registration and monitor the APRN’s compliance with
this requirement. APRNs would also be able to prescribe medications independently and would
need to maintain malpractice insurance coverage at the time of licensure and renewal of licensure.
The Board would be required to monitor proof of malpractice insurance at the time of licensure
and renewal of licensure.
The Board of Nursing indicates that enactment of HB 2256 would require the Board to
expand its current licensure software to enable the Board to validate national certification,
compliance with federal drug enforcement requirements, and malpractice insurance.
Communication would need to occur with all licensed APRNs and their employers about the
change in requirements. The Board estimates that expenditures would total $38,116 from the
Nursing Fee Fund in FY 2022 only. These costs would include $30,000 for upgrading the software
and $8,116 for communication expenses.
The Honorable Brenda Landwehr, Chairperson
Page 2—HB 2256

The Kansas Insurance Department indicates that enactment of HB 2256 would require
advanced practice registered nurses to maintain a policy of professional liability insurance. This
would increase taxable insurance premiums, which would increase tax revenues deposited into the
State General Fund and the agency fee fund as the Department receives 1.0 percent of premium
tax revenues. However, the Department is unable to estimate the fiscal effect on State General
Fund and agency fee fund revenue.
The Office of Attorney General indicates there would be no fiscal effect on the Office from
passage of this bill. Under current law, the state would already be responsible for providing
defense to ARPNs practicing in positions covered by the Kansas Tort Claims Act.
The Kansas Health Care Stabilization Fund Board indicates that HB 2256 would increase
expenditures by $187,000 which would be offset by additional Health Care Stabilization Fund
revenue. Recognizing Advanced Practice Registered Nurses as defined health care providers
would cause a significant increase in the number of health care providers required to comply with
the Health Care Provider Insurance Availability Act. This change would cause an increase in the
agency’s workload by as much as 20.0 percent. The Board estimates that it would increase
expenditures by $160,000 for salary, fringe benefits, and other operating expenses for an additional
2.00 FTE positions plus $27,000 for additional actuarial analysis. The estimate for the fiscal effect
for the Kansas Health Care Stabilization Fund Board was not included in the original fiscal note.
The Kansas Department for Aging and Disability Services, the Board of Optometry, and
the Board of Pharmacy indicate that the bill would have no fiscal effect on the agencies. Any
fiscal effect associated with HB 2256 is not reflected in The FY 2022 Governor’s Budget Report.


Sincerely,

Adam Proffitt
Director of the Budget

cc: Jan Murray, Optometry
Susan Gile, Board of Healing Arts
Jill Simons, Board of Nursing
Alexandra Blasi, Board of Pharmacy
Bobbi Mariani, Insurance
Willie Prescott, Office of the Attorney General
Connie Hubbell, Aging & Disability Services


Statutes affected:
As introduced: 40-3401, 65-1113, 65-4101, 39-923, 75-6102, 65-1130