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Minutes for HB2463 - Committee on Health and Human Services
Short Title
Prohibiting changes to the medical assistance program and requiring the extension of the current medical assistance program.
Minutes Content for Wed, Jan 26, 2022
Sarah Fertig, State Medicaid Director, Kansas Department of Health and Environment, provided testimony in opposition to HB2463 (Attachment 2). The Department's opposition is based on concerns about the breadth and vagueness of the bill, as well as the likely impacts on the Medicaid program if enacted. There is a concern as to what would be prohibited under the bill. These included: adding new drugs, treatments or services; increasing provider reimbursement rates; updating MCO capitation rates; completing projects in process; implementing recent recommendations from legislative committees; and, if approved by CMS, finally implementing (2020) HB2168 and (2020) HB2246 which would draw more federal dollars into the state to support hospitals and allow the state to make changes needed to ensure the Health Care Access Improvement Program (HCAIP) is solvent. Ms. Fertig continued the bill would likely significantly delay changes our constituents have been asking for that have been discussed in various committees and task forces. A list of potential projects was provided. These projects would be considered a "substantive or material change" that would be barred by Section 1(a) of the bill. The bill would also place federal funding at risk for Medicaid. Because Medicaid is a state-federal partnership, CMS may not allow the state to implement HB2463. CMS must approve all contract amendments with the state's Medicaid MCOs and CMS must also approve the federal authority under which Medicaid operates in the state. This impacts KanCare that currently operates under the authority of Section 1115 of the Social Security Act. The current waiver expires on December 31, 2023. HB2463 would require the Medicaid program to remain as it exists until December 31, 2025. CMS has said it will not authorize a two year extension to the waiver, so the state would be required to look to other options to continue federal authority. HB2463 would also block routine competitive bidding for Medicaid MCOs. The bill would also prevent the state from terminating a MCO contract even in the case of egregious contract violations. Ms. Fertig stated that HB2463 would require sweeping changes to normal Medicaid operations. The bill could jeopardize federal funding and place the state Medicaid program in an awkward position of being unable to comply with either state or federal law.
Ms. Fertig responded to questions from the committee.
Heather Braum, Health Policy Advisor, Kansas Action for Children, provided testimony in opposition to HB2463 (Attachment 3). Kansas Action for Children opposes the bill for two reasons: it delays the MCO re-procurement process and waiver renewal; and the bill language is very broad. The delay in the procurement process prevents important improvements to and the accountability for the services that the MCOs provide. There may also need to be changes to the waivers to address ongoing budget neutrality constraints on the current 1115 waiver. Ms. Braum stated a concern as to what "substantive and material change" means. There is no definition of what would constitutes a change. This could cause the KanCare program to lose timely and responsive flexibility to prevent possible program changes to be implemented.
Sean Gatewood, KanCare Advocates Network, stated that his organization is in opposition to HB2463 (Attachment 4). HB2463 would prohibit "any substantive or material change" to the Kansas Medicaid program by limiting the contracting ability of the Kansas Medicaid agency and the Kansas Department of Health and Environment. The concern is that the bill would halt current initiatives that have broad support among legislators, providers, advocates and the State such as extending postpartum care, rate adjustments and strengthening oversight and enforcement responsibilities. It could also suspend efforts to reduce the waiting lists for persons served through the waivers for physical, intellectual and developmental disabilities. HB2463 also defeats the purpose of the 1115 waiver. The bill removes most of the competition created in the bidding process for the MCOs. One must also be concerned with how CMS will respond to the bill.
The following provided written only opponent testimony:
David Jordan, President and CEO, United Methodist Health Ministry Fund (Attachment 5)
Laura Howard, Secretary, Kansas Department for Aging and Disability Services (Attachment 6)
Denise Cyzman, CEO, Community Care Network of Kansas (Attachment 7)
Tanya Dorf Brunner, Executive Director, Oral Health Kansas (Attachment 8)
DeAngela Burns-Wallace, Secretary, Kansas Department of Administration (Attachment 9)
