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Minutes for HB2578 - Committee on Health and Human Services
Short Title
Providing that programs and treatments provided by a certified community behavioral health clinic be granted a renewal certification if such programs and treatments have been previously certified or accredited.
Minutes Content for Tue, Jan 30, 2024
Jenna Moyer, Revisor of Statutes, provided an overview of HB2578.
Kyle Kessler, Executive Director, Association of Community Mental Health Centers of Kansas (ACMHCK), provided testimony in support of HB2578 (Attachment 11). In 2021, legislation was enacted to transform the community mental health system through the implementation of the Certified Community Behavioral Health Clinic (CCBHC) model. Currently 23 of the 26 CHMCs have at least achieved provisional certification status as CCBHC, with the remaining 3 to do so over the next several months. The Substance Abuse and Mental Health Services Administration (SAMHSA) outlines the requirements of the CCBHC model. The process for a CMHC to achieve CCBHC status was reviewed. The bill would clarify what is believed to be the original legislative intent to allow only licenses CMHCs to be certified as CCBHCs. Comparisons with other states was provided.
Mr. Kessler responded to questions from the committee.
Dr. Will Warnes, Medical Director, Association of Community Mental Health Centers of Kansas, provided testimony in support of HB2578 (Attachment 12). As also medical director for the Guidance Center in Leavenworth, Dr. Warnes stated that the center gained provisional status as a CCBHC last year. The FQHC sites in his area have expressed interest to the Kansas Legislature in obtaining CCBHC licensure. This is concerning. The reimbursement system is the calculation of a Prospective Payment System (PPS). While complicated, one important point is that the numerator for this rate is based on patient served. The PPS for FQHCs is also predicated on the number of patient served. The second concern is that of workforce. Dr. Warnes does not believe that northeast Kansas would be able to handle the burden of multiple facilities. FQHCs and CCBHCs can provide excellent integrated services while maintaining independent licensures. Examples of possible conflicts with FQHCs were provided.
Joan Tammany, Executive director, COMCARE, provided testimony in support of HB2578 (Attachment 13). COMCARE is a certified CCBHC and CMHC in Sedgwick County. It serves as a 988-lifeline center and a large crisis center in Wichita. Unlike other provider types, COMCARE understands the array of services required to be a CCBHC. The additional resources provided to CCBHCs has allowed us to strengthen our workforce from a vacancy rate of 41% to currently the vacancy rate is 13%. The number of intakes has increased 18% of the last year.The mobile crisis team has grown by 50%. The alternative co-responder teams have increased from 4 to 8.
Tim DeWeese, Director, Johnson County Mental Health Center, provided testimony in support of HB2578 (Attachment 14). The center is a provisionally certified CCBHC. It is also accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). The center has gone above and beyond by meeting certification requirements of both entities. The CCBHC legislation has been the biggest impact on mental health since 1991.
Mr. DeWeese responded to questions from the committee.
Greg Hennen, Executive Director, Four County Mental Health Center, provided testimony in support of HB2578 (Attachment 15). In its catchment area there are approximately 86,000 covered lives and approximately 6,800 individual patients are served each year. A list of the behavioral health safety net services provided by the center was given. Outcomes in general service access, crisis services, veteran specialty services and in-jail services were provided. CCBHC was born from efforts to modernize and reform the CMHC safety-net system. It was not adopted as an entrepreneurial opportunity for business entities. Allowing multiple CCBHCs in a single catchment area would not only dilute the gains made in securing the safety-net system's future but would fragment the continuity of established patient care.
Mr. Hennen responded to questions from the committee.
Andy Brown, Deputy Secretary of Programs, Kansas Department for Aging and Disability Services (KDADS), provide neutral testimony on HB2578 (Attachment 16). KDADS and KDHE are required by statute to apply to the federal CMS to create a process by which the state certifies CCBHCs and to certify all 26 CMHCs as CCBHCs by July 1, 2024. To date, 24 CMHC have been certified as CCBHCs. Since legislation was passed, CMS and SAMHSA have updated CCBHC criteria. All CCBHCs must meet the criteria to gain a CCBHC certification and benefit from the Medicaid Prospective Payment System (PPS). PPS is a method of reimbursement in which Medicaid payment is based on a predetermined, fixed amount. The payment amount for a particular service is based on the classification system of that service. The PPS rate for CCBHCs is cost based and pays CCBHCs an average rate for each qualified patient encounter they provide. In exchange for the PPS rate, CCBHCs must meet standards for the range of services they provide and they are required to get people into care quickly. An important feature of the model is it requires crisis services that are available 24 hours an day 7 days of the week.The eligible types an organization can be to apply to be a CCBHC were listed.
Sonja Baccus, CEO, Community Care Network of Kansas, provided testimony in opposition to HB2578 (Attachment 17). There is a need to increase access to mental health care. The Network is coordinating closely with other providers including CMHCs. Demonstrating their confidence that FQHCs and Rural Health Clinics (RHC), last year KDADS invited the Community Care Network and five of its members to participate in a SAMHSA grant to support expansion of high quality integrated behavioral health services. The network is opposed to the bill on two changes. KDADS is prevented from certifying any entity other than a CMHC as a CCBHC. This would cap the number of CCBHCs at 26. In research it was discovered that most states do not limit the entities that can be certified as a CCBHC. It is hard to understand why we would want to limit access to this improved care by artificially limiting the number of CCBHCs.
Stuart Little on behalf of the Kansas Behavioral Health Association provided testimony in opposition to HB2578 (Attachment 18). The organization believes the bill perpetuates behavioral health delivery in one system and strains a broad range of other Kansas groups working hard to provide services. Our members operate a full spectrum of services. The bill prevents its members from becoming certified as CCBHCs. While the process to become a CCBHC is long, complex and expensive, it should not restrict entities from applying.
Shane Hudson, President and CEO, CFK Addiction Treatment, provided testimony in opposition to HB2578 (Attachment 19). CFK partners with providers and community agencies across the state, including CMHC, FQHCs, hospitals, primary care clinics and criminal justice. The facility is also CARF accredited. Mr. Hudson provided examples of how other states approach CCBHCs.
Eric Thomason, Vice President of Behavioral Health and Addiction, Community Health Center of Southeast Kansas, provided testimony in opposition to HB2578 (Attachment 20). The center provided 44,158 provider level behavioral health visits to approximately 8500 individuals. Mr. Thomason recommended the removal of the word "only" from line13 and the creation of a public database to improve transparency in service delivery consistent with the original CCBHC implementation proposal.
The following provided written only testimony in opposition to the bill:
Lori Alvarado, CEO, DCCCA (Attachment 21)
Elizabeth Keever, Chief Development Officer, Heartland Community Health Center (Attachment 22)
Matthew Schmidt, Chief Executive Officer, Health Ministries Clinic (Attachment 23)
Leah Fliter, Assistant Executive Director of Advocacy, Kansas Association of School Boards (Attachment 24)
Chrysanne Grund, Greeley County Health Services (Attachment 25)
Linda Bass, President, KVC Kansas (Attachment 26)
The hearing for HB2578 was closed.
The meeting was adjourned at 3:11 PM.
