3.30.23 – Kansas Health Institute
This edition of Health at the Capitol looks at health-related bills that were discussed during the week beginning March 20, 2023.
During week 11 of the Kansas legislative session, committees were very busy conducting hearings and working bills from the other chamber and sending them to the floor leading up to First Adjournment on April 6. Health-related issues, including vaccination requirements and exemptions, childcare licensing requirements, child welfare, adoption procedures, licensing for behavioral health professionals, abortion, and the sale of tobacco, continued to be a priority for many of the committees.
On Monday, March 20, construction of the new State of Kansas Health and Environment Laboratory (KHEL) began with the groundbreaking ceremony attended by Gov. Laura Kelly and representatives of the Kansas Department of Health and Environment (KDHE), Department of Administration and McCownGordon Construction. The KHEL, which will contain high-tech biology, chemistry, and diagnostic laboratories, offices, and training rooms, is expected to be complete by Spring 2025.
On Thursday, March 23, the Senate confirmed the appointment of Adam Proffitt as Secretary of Administration. Proffitt, who has been serving as state budget director since 2020, will also retain that position.
House Health and Human Services Committee
(Rep. Brenda Landwehr, Chair)
On Monday, March 20, the Committee held a hearing on House Bill (HB) 2439, which would require any facility, clinic, or pharmacy where mifepristone is prescribed, dispensed, or administered for the purposes of inducing a medication abortion to post a sign clearly visible to patients and customers with language that outlines mifepristone effects may be reversible and directs patients to the Women’s Right to Know website and other resources for more information. The bill also would require physicians to tell women in writing and in person at least 24 hours before providing the medication (except in the case of medical emergencies), as well as after the initial dose. The bill would have criminal penalties for violations. The Committee worked the bill, and following lengthy discussion and consideration of an amendment, the bill was passed favorably out of Committee, without amendment.
The Committee then held a hearing on HB 2452, which would eliminate the requirement that the Kansas State Employees Health Care Commission (Commission) offer as a benefit the option to purchase long-term care insurance and indemnity insurance. The bill passed favorably out of Committee.
On Tuesday, March 21, the Committee held an informational briefing on Senate Bill (SB) 282, which would establish new training and education requirements for childcare center staff of licensed childcare facilities, as well as general facility requirements, including requirements for inspections. The bill also would set capacity limits for day care homes and facilities based on the ages of children and type of facility. The bill would allow for a waiver from the requirements as approved by the Secretary of KDHE and the Secretary also would be authorized to develop and operate pilot programs as outlined in the bill, designed to increase the availability or capacity of day care facilities in the state. SB 282 also would amend the current fee schedule for licensure for childcare facilities to include only maternity centers, child placement agencies, and childcare resource and referral agencies. In addition, beginning July 1, 2026, the bill would require all inspections of facilities licensed under provisions of the bill to be conducted by employees of KDHE. Proponent testimony was provided by Sen. Kristen O’Shea, representatives of Stormont Vail Health, Opportunity Solutions Project, the Kansas Chamber, and Americans for Prosperity Kansas, and two private citizens. Neutral written-only testimony was submitted by a representative of the Kansas Hospital Association. Opponent testimony was provided by a representative of Kansas Action for Children, who stated that certain changes in the bill would prevent the State from being nimble and responsive to changing federal requirements, research and practices and the evolving needs of the system. He also expressed concern that stakeholders and policy experts were not engaged in creating the bill. Committee members asked questions regarding a study of the existing childcare regulations that is currently being conducted by KDHE, whether an interim committee could be appointed to study these issues prior to the 2024 session, barriers childcare employees are facing, increasing number of children in facilities without a required increase in staff, and how the extra revenue for facilities may be used to retain the workforce. The Committee inserted the contents of SB 282 into SB 96 (related to tax credits for contributions to nonprofit pregnancy centers or residential maternity centers) and struck the language of SB 96 to create House Substitute (H. Sub.) for SB 96 and passed it favorably out of Committee.
Senate Public Health and Welfare Committee
(Sen. Beverly Gossage, Chair)
On Monday, March 20, the Committee worked HB 2390, which would enact the Kansas Overdose Fatality Review Board Act and exempt materials used to test for the presence of fentanyl, ketamine, flunitrazepam, and gamma hydroxybutyric acid (GHB) from the definition of “drug paraphernalia.” The bill would establish the Kansas Overdose Fatality Review Board to review information and data related to drug overdose fatalities in Kansas and to make recommendations regarding evidence-based strategies to prevent or mitigate the consequences of drug overdose. The bill would require the Board to be established before January 1, 2025. The Committee removed the contents of the bill and inserted language to require the Secretary of KDHE to study overdose deaths and maintain confidentiality of the records used by the Secretary in the study and restrict the duties and authority of local health officers regarding infectious and contagious diseases to create Senate Substitute (S. Sub.) for HB 2390. The Committee then amended the substitute bill by inserting the contents of SB 6, which would restrict the duties and authority of the Secretary of KDHE and local health officers regarding infectious and contagious diseases and amend several statutes related to infectious and contagious diseases to:
- Make it unlawful for any person to violate any provisions relating to tuberculosis;
- Remove the reporting requirement for teachers and school administrators regarding knowledge or suspicion of an infectious or contagious disease;
- Remove the requirement for enforcement of isolation and quarantine orders by law enforcement officers;
- Provide employment protection for employees who isolate or quarantine; and
- With regard to school closure, remove an order issued by the Secretary as a basis for a “disaster.”
Sub. for HB 2390, as amended, was then passed favorably out of Committee.
The Committee also held a hearing on SB 287, which would expand current provisions to permit the issuance of a silver alert for a vulnerable person. The Committee subsequently worked the bill on Tuesday, March 21, and amended the bill to replace “vulnerable person” with “a missing person who is 18 years of age or older and has dementia, a developmental disability such as autism spectrum disorder, or a cognitive impairment” as the persons to be included in a silver alert. The bill, as amended, was then passed favorably out of Committee.
The Committee also held a hearing on HB 2340, as amended by the House, which would modify several requirements for some of the professions licensed by the Behavioral Sciences Regulatory Board (BSRB), add new temporary licensure categories, and establish requirements for an expedited application process. Among the changes, the bill would reduce the number of months of practice prior to being eligible for reciprocity of licenses, increase the number of months that a temporary license is valid, reduce continuing education hours for professionals who diagnose, clarify the education requirements for marriage and family therapists, and clarify the disciplinary procedure for behavior analysts. The bill also would add provisions for some of the professions including adding a process and timeline for the BSRB to follow when processing applications, definitions for “extenuating circumstances” and “merits the public trust,” a process for licensees to request additional time to complete continuing education requirement due to extenuating circumstances, temporary licenses for social work graduates of education programs seeking accreditation, a temporary reinstatement license for expired licenses, a temporary student license for addiction counseling, and a temporary license for some licensees who are employed by community mental health centers. The Committee subsequently worked the bill on Wednesday, March 22, and amended the bill to add that no person may practice with a community-based license in professional counseling, social work, marriage and family therapy, or psychology if such person has practiced under a student temporary addiction counseling license, and also to disallow a person who practiced under a community-based license to practice addiction counseling under a student temporary addiction counselor license, and then passed the bill, as amended, favorably out of Committee.
The Committee also held a hearing on SB 297, which would amend the definition of abortion and statutory references to abortion and medical emergency within several Kansas statutes. “Abortion” would be updated to mean the use or prescription of any instrument, medicine, drug, or any other means to terminate the pregnancy of a woman knowing that such termination will, with reasonable likelihood, result in the death of the unborn child. The bill also would include exceptions for the use of certain prescriptions and would specify that the definition did not include the prescription, dispensing, administration, sale, or use of any method of contraception. The Committee subsequently worked the bill on Tuesday, March 21, and passed it favorably out of Committee.
On Tuesday, March 21, the Committee held a hearing on HB 2288, which would establish the Counseling Compact to facilitate interstate practice of licensed professional counselors. The bill also would amend law to add a licensure fee relating to the privilege to practice under the Compact. The Compact would state the practice of professional counseling occurs in the state where the client is located at the time of the counseling services, and it would preserve the regulatory authority of states to protect public health and safety through the current system of licensure. The Committee subsequently worked the bill on Wednesday, March 22, and passed it favorably out of Committee.
The Committee also worked HB 2264, which would establish the No Patient Left Alone Act. The Act would establish who may visit a patient in a patient care facility and would require patient care facilities to provide for in-person visitation and provide parameters for patient care facilities as to what restrictions may be asked of visitors when visiting a patient. The bill would provide that patient care facilities may establish visitation policies by September 1, 2023, including, but not limited to, infection control protocols and education for visitors, a set schedule of dates and times when visitation is allowed, allowable visit length, and limits on number of visitors and would not prohibit a patient care facility from taking the steps necessary to ensure eligibility with federal programs or financial participation and would not supersede any federal laws, rules, regulations, or guidance regarding patient care facilities. The Committee considered amendments related to steps that patient care facilities could take to ensure eligibility with federal programs but tabled consideration of one of the amendments and then approved a motion to postpone working the bill until later in the week. On Wednesday, March 22, the Committee resumed working the bill and amended the bill to:
- Modify the option for patient care facilities to have visitor policies and make it a requirement;
- Remove the minimum requirements of what a patient care facility includes in the visitation policy and procedure, which were infection control protocols and education for visitors, a set schedule of dates and times when visitation is allowed, allowable visit length, and limits on number of visitors;
- Remove the circumstances of when a patient was to be permitted in-person visitors which were:
- Terminally ill or receiving end-of-life care;
- Making one or more major medical decisions;
- Experiencing emotional distress or grieving the recent loss of a friend or family member;
- Experiencing functional, cognitive, or nutritional decline;
- Struggling with the change in environment at the patient care facility after having previously lived with such patient’s immediate family member;
- Admitted to a medical care facility for childbirth, including care related to a miscarriage or stillbirth; or
- Under 18 years of age.
- Remove the provision that a patient care facility could modify visitation based upon a patient’s condition or need for rest;
- Remove the provision allowing a patient care facility to take the steps necessary to ensure eligibility with federal programs or financial participation and not superseding any federal law, rules, regulations, or guidance regarding patient care facilities; and
- Add provisions that would establish a patient’s bill of rights.
The bill, as amended, was then passed favorably out of Committee.
The Committee also worked HB 2263, which would amend a provision in the Pharmacy Act of the State of Kansas to add pharmacy technicians, at least 18 years of age and under the direct supervision and control of a pharmacist, to the list of those authorized to administer vaccinations after successfully completing a course of study and training in vaccination storage, protocols, injection technique, emergency procedures, recordkeeping, and cardiopulmonary resuscitation (CPR). The bill also would require a pharmacist, pharmacy student, or pharmacy intern to be at least 18 years of age to administer a vaccine. Pharmacy technicians would be added to pharmacists, pharmacy students, and pharmacy interns as authorized to administer the influenza vaccine to persons six years of age or older; and vaccines, other than the influenza vaccine, to persons 12 years of age or older pursuant to a vaccination protocol. The bill was passed favorably out of Committee, but the Chair stated that the Committee would reconsider the bill later in the week for possible amendment.
On Wednesday, March 22, the Committee approved a motion to reconsider the previous action of the Committee on the bill, amended the bill by inserting the contents of SB 233, which would allow an individual who had what the bill defines as a “childhood gender reassignment service” performed to bring a civil cause of action under the Act against the physician who performed such service, and then passed HB 2263, as amended, favorably out of Committee.
The Committee then held a hearing on HB 315, which would expand K.S.A. 44-663 related to employer COVID-19 vaccine requirements to cover any vaccine requirement imposed by an employer. The bill would define “vaccine” as an immunization, vaccination, injection, or series thereof that is administered to stimulate immunity against a particular disease. The definition of “employee” also would be amended to include students in high school and postsecondary educational institutions who interact with patients and deliver care at healthcare facilities under the supervision of licensed individuals. In addition, the bill would amend provisions related to vaccine requirements for maternity centers, childcare facilities, and schools by requiring exemptions for sincerely held religious beliefs without inquiry into the sincerity of the request. Religious beliefs would include, but not be limited to, theistic and non-theistic moral and ethical beliefs as to what is right and wrong that are sincerely held with the strength of traditional religious views. Proponent testimony was provided by six private citizens and written-only proponent testimony was submitted by 15 private citizens and a representative of Kansans for Health Freedom. Opponent testimony was provided by representatives of the Kansas Chapter of the American Academy of Pediatrics, Immunize Kansas Coalition, Kansas School Nurses Organization, Kansas Chamber, Kansas Interfaith Action, and the Board of Regents. Written-only opponent testimony was submitted by 24 private citizens and representatives of Kansas Head Start Association, Sedgwick County Health Department, Unified Government of Wyandotte County/Kansas City Kansas Public Health Department, Kansas Association of Local Health Departments, Kansas Council of Health-System Pharmacy, Kansas Public Health Association, and Kansas Academy of Family Physicians. Written-only neutral testimony was submitted by KDHE. The Committee subsequently worked the bill on Thursday, March 23, amended it to remove the employer requirements to allow for an exemption for any vaccine, but the motion to pass it favorably out of Committee failed. On Friday, March 24, the Committee approved a motion to reconsider SB 315, as amended, and passed it favorably out of Committee.
On Wednesday, March 22, the Committee held a hearing on SB 314, which would prohibit the Secretary of KDHE from requiring a COVID-19 vaccine for any child cared for in a childcare facility, any student enrolling or enrolled in a school for the first time in Kansas, any child enrolling or enrolled for the first time in a preschool or daycare program operated by a school, and any other such students as may be designated by the Secretary, prior to admission or attendance at school. Written-only proponent testimony was submitted by a private citizen. Opponent testimony was provided by representatives of Kansas Action for Children and Immunize Kansas Coalition. Written-only opponent testimony was submitted by representatives of Nurture KC, Kansas Association of Local Health Departments, Kansas National Education Association, Kansas Chapter of the American Academy of Pediatrics, and Sedgwick County Health Department and 10 private citizens. Written-only neutral testimony was submitted by KDHE. Committee members asked questions regarding the legislation related to immunization requirements passed in 2021, the definition of vaccine and its interchangeability with the term immunization, and whether the bill applies to oral vaccines (yes). The Committee subsequently worked the bill on Thursday, March 23, and passed it favorably out of Committee.
The Committee then worked HB 2338, which would designate Sickle Cell Disease Awareness Week as the third full week of September and would require an annual review of the topic by an advisory council established by the Secretary of KDHE to advise KDHE on newborn screening guidelines. The bill would authorize KDHE, under the guidance of any appropriate advisory council, to develop a publicly available report from the advisory council meetings and activities. The Committee amended the bill to remove the requirement for the newborn screening advisory council to devote one regularly scheduled meeting a year to the discussion of sickle cell disease and removed authorization for a related public report. The bill, as amended, was then passed favorably out of Committee.
On Thursday, March 23, the Committee held a hearing on HB 2260, which would amend law regarding the Kansas Medical Student Loan program, which provides tuition and a stipend to undergraduate students enrolled in or admitted to the University of Kansas School of Medicine who have entered into agreements to practice primary care medicine or psychiatry in areas of need in the state. The bill would change the number of medical student loan agreements for psychiatry students from six to up to 12. The bill also would add a provision specifying that the University of Kansas School of Medicine may not prohibit or create substantial impediment to students in the program from switching between approved postgraduate residency training programs. The Committee worked the bill, amended it to add the contents of SB 98, which would include medical residency training programs in obstetrics and gynecology (OBGYN) as part of the postgraduate medical residency programs a person could enter into in order to qualify for state medical student and medical residency loan assistance, and then passed HB 2260, as amended, favorably out of Committee.
On Friday, March 24, the Committee held a hearing on HB 2313, which would create the Born-Alive Infants Protection Act, provide legal protections for infants born alive, require certain standards of care by healthcare providers for infants who are born alive, and provide criminal penalties and civil liability for violations of the act. “Born alive” as defined in the bill means the complete expulsion or extraction of a human being from its mother, at any stage of development, who, after such expulsion or extraction, breathes or has a beating heart, pulsation of the umbilical cord or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section or induced abortion. The Committee worked the bill, amended it to remove the requirement that the healthcare providers present at the time the child is born alive ensure the child is immediately admitted to a hospital after ensuring immediate transportation of the child to a hospital, and then passed the bill, as amended, favorably out of Committee.
The Committee then held a hearing on HB 2141, which would amend a statute governing eligibility for various public assistance programs administered by the Kansas Department for Children and Families (DCF). The bill would require custodial and non-custodial parents to cooperate with the child support enforcement program administered by DCF to be eligible for food assistance under the Supplemental Nutrition Assistance Program (SNAP). Proponent testimony was provided by a representative of Opportunity Solutions Project. Written-only proponent testimony was submitted by Rep. Francis Awerkamp. Opponent testimony was provided by representatives of Kansas Action for Children and the Kansas Appleseed Center for Law and Justice, and a private citizen. Written-only opponent testimony was submitted by representatives of the Kansas Public Health Association, Kansas Children’s Service League, DCF, Kansas National Education Association, Harvesters, Kansas Food Bank, and United Community Services of Johnson County, and two private citizens. Committee members asked questions regarding the status of similar legislation in other states, concerns about application of the bill to parents with safety concerns, the definition of “good cause”, and the costs of implementing the program. The Committee then worked the bill, approved a technical amendment to correct the bill title to accurately reflect the content of the bill, and passed it favorably out of Committee, as amended.
House Child Welfare and Foster Care Committee
(Rep. Susan Concannon, Chair)
On Monday, March 20, the Committee worked SB 115, which would amend the law governing the notice required in a hearing on a petition for adoption in the Kansas Adoption and Relinquishment Act. The bill would reorganize and clarify provisions related to notice required for independent and stepparent adoptions, private agency adoptions, and public agency adoptions. The Committee amended the bill to make it effective upon publication in the Kansas Register and passed it favorably out of Committee, as amended.
On Tuesday, March 21, the Committee heard a presentation from Darcy Olson, Center for the Rights of Abused Children, based in Arizona, regarding attorney representation for foster children. Olson asserted that Kansas children spend more time in foster care than the national average and that children with attorneys exit the system three times faster than those without. She also stated that the frequency of meetings between foster children and their guardian ad litem is a problem and noted there are two comprehensive study reports available on this topic.
On Wednesday, March 22, the Committee held a joint meeting with the House Committee on Juvenile Justice to discuss out-of-home placement instability in Kansas and heard from DCF Secretary Laura Howard, who identified the causes of placement instability, including inadequate community-based prevention services, a wide front door to foster care, and a lack of placement options for older youth with intensive behavioral health needs. The Committee then heard a presentation from Dr. Leanne Heaton, Center for State Child Welfare Data at Chapin Hall at the University of Chicago, including a look at national trends and national initiatives related to foster care system issues. Committee members asked questions regarding data on children with disabilities who experienced three or more placement moves in 12 months, the wide disparity in the number of removal requests by DCF between Wichita, Kansas City, and the rest of the state, the definition of non-DCF staff (judges, law enforcement), the impact of the use and manufacturing of methamphetamine (this is a separate issue and not directly related to drug abuse by youth), and the high percentage of non-abuse and neglect removals in Kansas (Heaton explained that this is not a common practice among other states.)
Senate Federal and State Affairs
(Sen. Mike Thompson, Chair)
On Wednesday, March 22, the Committee held a hearing on HB 2269, which would amend the Kansas Cigarette and Tobacco Products Act to raise the minimum age to 21 to sell, purchase, and possess cigarettes, electronic cigarettes, and tobacco products. Proponent testimony was provided by representatives of the Kansas Department of Revenue and Kansas Department for Aging and Disability Services. Committee members asked questions regarding the vote count when the House passed the bill (68-53), municipalities that have already enacted ordinances to raise the age from 18 to 21, funding that may be lost by not complying with federal law and regulations, tobacco and vaping in schools, and penalties for retailers that sell to minors. The Committee subsequently worked the bill on Thursday, March 23, and passed it favorably out of Committee.
The Committee also held a hearing on HB 2304, a companion bill to SB 116, which would provide that for the purposes of promoting the safety and protection of students and emphasizing how students should respond when encountering a firearm, school districts could provide firearm safety education programs. The State Board of Education would be required to establish curriculum guidelines for a standardized firearm safety education program that would include accident prevention. For students enrolled in kindergarten through grade five, the curriculum would be based on the “Eddie Eagle Gunsafe Program” offered by the National Rifle Association. For grades six through eight, the curriculum would be based on the “Eddie Eagle Gunsafe Program” or the “Hunter Education in Our Schools Program” offered by the Department of Wildlife and Parks. For grades nine through 12, the curriculum would be based on the “Hunter Education in Our Schools Program.” If a local board of education would elect to provide firearm safety education, the instruction would be required to be in accordance with the guidelines established by the State Board of Education. The local board of education also would be required to ensure that all students are provided the opportunity to take the course. The Committee worked the bill and passed it favorably out of Committee.
House Welfare Reform Committee
(Rep. Francis Awerkamp, Chair)
On Thursday, March 23, the Committee held a roundtable discussion on homelessness. Roundtable conferees included Christina Valdivia, Topeka City Council; Steve White, City Manager, City of Topeka; representatives of the Topeka Rescue Mission, Valeo Behavioral Health, Topeka Law Enforcement, Project Restore, and the Greater Topeka Chamber of Commerce; and Lawrence business owners representing Johnny’s Tavern, Yarn Barn and Weavers Department Store. Chair Awerkamp announced that the group would focus on the experiences of the conferees, rather than issues that may be outside the immediate control of the Legislature. Issues addressed or identified during the discussion included:
- The need for partnerships that are transparent to the public, taxpayers, and those most impacted in the community, to mitigate homelessness and overcome silos;
- The 2019 9th Circuit Court of Appeals case, Martin v. City of Boise, in which the federal appeals court held that an ordinance violates the Eighth Amendment (cruel and unusual punishment) when it imposes criminal sanctions against individuals experiencing homelessness for sleeping outdoors on public property when no alternative shelter is available to them;
- The need for housing before mental health care for those experiencing homelessness;
- Those experiencing homelessness are not pariahs or outcasts, but rather individuals who have fallen into hard times or have chronic conditions;
- Framing the issue as a homeless one may be constraining imaginations and emphasis should be on holding individuals accountable for sanitation and behavior;
- Students graduating from universities with social welfare degrees should be hired and paid a living wage and students should be provided with subsidies and encouraged to enter the social work field;
- There is a need for a coordinated effort among the numerous agencies that touch the issue of homelessness in some capacity;
- Law enforcement officers working in Behavioral Health and Crisis Intervention Units and Homeless Outreach Teams view their role as a liaison and relationship builder between those experiencing homelessness and the services available to them;
- Only a few entities are doing outreach services and case management for the homeless, and there is a need for increased case management on the streets;
- It is important to have discussions regarding the root causes of homelessness and understanding that most people who are unsheltered are experiencing emotional distress and trauma;
- There has been a significant shift in the demographics of the homeless population, and they are getting older – by 2030, the average age of people experiencing homelessness is projected to be over age 60, and the cost to provide healthcare will be significant;
- Because of the shift in the age of this population, the need for programs geared toward work readiness and employment is now being replaced by the need for programs to provide individuals with disability assistance;
- Social distancing requirements during the pandemic led to reduced capacity in shelter or their complete closure;
- There are no repercussions for individuals unsheltered on city property and emergency and low-barrier shelters are needed; and
- Mental health issues, drug use, and adverse childhood experiences are some of the major factors leading to homelessness.
The meeting concluded with a call for a collaborative effort between all stakeholders to address the issue and the development of legislation that would address these issues.