Senate Sub for HB 2149: Amended by Senate Public Health and Welfare March 17 to include new language designed to replace SB 123.

Senate debated and amended the bill March 23. Bill passed Senate 40-0 March 24.

Advocates knew that there would have to be another proposal brought forward in order to preserve the $6.5 million fiscal note, which is included in both the Senate and House budget bills. 

Section 3: includes the provisions of SB 181, which had already passed the Senate:

Access to New Prescription-only Drugs under the Kansas Medicaid Program  The Secretary of Health and Environment (Secretary) would be allowed to implement prior authorization of any new prescription-only drugs until such drugs are reviewed by the Board at its next scheduled meeting. During the period before the new drugs are reviewed by the Board, the drugs would be approved for use as indicated in package insert guidelines approved by the federal Food and Drug Administration and clinically reputable compendia, as approved by the Secretary in rules and regulations. 

Under existing law, the Secretary is prohibited from restricting patient access to prescription-only drugs through a program of prior authorization or a restrictive formulary, except by rules and regulations. The current requirement that these proposed rules and regulations be submitted to the Board for written comment would be eliminated. Board Meeting Requirements The Board would be required to meet at least quarterly. The meetings would be open to the public and provide an opportunity for public comments. The Board would be required to post notice of its meetings at least 14 business days before the scheduled meetings.

Section 4: includes new proposal for managing mental health medications in Medicaid (replacing SB 123) Prior Authorizations or Other Restrictions on Mental Health Medications for Medicaid Recipients

The bill would provide that no requirements for prior authorizations or other restrictions on medications used to treat mental illnesses may be imposed on Medicaid recipients, except on medications subject to guidelines developed by the Board in accordance with provisions of the bill.

Existing law prohibits requirements for prior authorization or other restrictions on medications used to treat individuals with mental illnesses who are Medicaid recipients. Medications in the existing statute available without prior authorization or other restrictions include atypical medications, conventional antipsychotic medications, and other medications used for the treatment of mental illness

The bill specifies the following would not be construed as restrictions: ● Any alert to a pharmacist that does not deny the claim and can be overridden by the pharmacist; ● Prescriber education activities; or ● Consolidation of dosing regimens to equivalent doses.

Adoption of Guidelines and Medication Review The Committee would be required to provide the Board with recommendations for the development of guidelines. With regard to the recommendations from the Committee, the Board would have the following options: ● Accept the recommendations in whole, to become effective immediately upon approval; or ● Reject the recommendations in whole, requiring referral back to the Committee for further consideration.

The Board would be prohibited from adopting medication guidelines related to mental health medications without recommendations made by the Committee. 

Prior to July 1, 2016, the Board would be required to review all medications used to treat mental illness available for use on July 1, 2015. The Board would be required to review all medications used to treat mental illness that do not exist on July 1, 2015, but are later developed or believed to be effective in the treatment of mental illness within six months of presentation to the Board.

Concept: Will the agency commit to: 

1. Provide the same public notice as required for the DUR Committee? 

2. Formalize language of the “guard rails” in the formal charter of the mental health medication advisory committee created by Senate Sub for HB 2149? 

3. Begin process with informational briefings – including consumer/family input? 

List of guard rails from the most recent workgroup meeting: 

 Patients who are already on stable, safe regimens will be able to continue their prescribed treatment. 

 Creation of a Mental Health Medication Advisory Committee made up of mental health practitioners and pharmacists with specific experience in providing service to the mental health community. 

 Review certain medications for safety and dose optimization. 

 New prescriptions or changes in medication will be subject to evidence-based guidelines developed by the Drug Utilization Review Board with the counsel of the Mental Health Medication Advisory Committee. 

 Increase length of emergency prescription fills from 3 days to 5 days to allow for processing time in situations where prior authorizations are required and assure that these are paid to the pharmacies. 

 Hold the number of prior authorizations needed to a minimum, while still providing for the appropriate protections. 

 The three MCOs will be required to follow policies set by the state, and no changes to the current system will be allowed until such time that policies are put in place to assure minimal disruptions to providers and patients. 

Bill Language: 

Sec. 3. K.S.A. 2014 Supp. 39-7,120 is hereby amended to read as follows: 39-7,120. (a) The secretary of health and environment shall not restrict patient access to prescription-only drugs pursuant to a program of prior authorization or a restrictive formulary except by rules and regulations adopted in accordance with K.S.A. 75-5625, and amendments thereto. 

Prior to the promulgation of any such rules and regulations, the secretary of health and environment shall submit such proposed rules and regulations to the medicaid drug utilization review board for written comment may implement prior authorization of any new prescription-only drugs until such drugs are reviewed by the medicaid drug utilization review board at the next scheduled meeting. New drugs shall be approved for use when such drugs are used within package insert guidelines approved by the federal food and drug administration and clinically reputable compendia, such as the United States pharmacopeia, as approved by the secretary of health and environment in the rules and regulations, during the period before such drugs are reviewed by the medicaid drug utilization review board. 

The secretary of health and environment may not implement permanent prior authorization until 30 days after receipt of comments by the drug utilization review board. 

(b) When considering recommendations from the medicaid drug utilization review board regarding the prior authorization of a drug, the secretary of health and environment shall consider the net economic impact of such prior authorization, including, but not limited to, the costs of specific drugs, rebates or discounts pursuant to 42 U.S.C. § 1396r-8, dispensing costs, dosing requirements and utilization of other drugs or other medicaid health care services which may be related to the prior authorization of such drug. 

Sec. 4. K.S.A. 2014 Supp. 39-7,121b is hereby amended to read as follows: 39-7,121b. 

(a) No requirements for prior authorization or other restrictions on medications used to treat mental illnesses such as schizophrenia, depression or bipolar disorder may be imposed on medicaid recipients. Medications that will be available under the state medicaid plan without restriction for persons with mental illnesses shall include atypical antipsychotic medications, conventional antipsychotic medications and other medications used for the treatment of mental illnesses., except on medications subject to guidelines developed by the drug utilization review board according to subsection 

(c). None of the following shall be construed as restrictions under this subsection: (1) Any alert to a pharmacist that does not deny the claim and can be overridden by the pharmacist; (2) prescriber education activities; or (3) the consolidation of dosing regimens to equivalent doses and other such dose optimization policies. 

(b) The mental health medication advisory committee shall provide recommendations to the drug utilization review board for the purpose of developing guidelines. The drug utilization review board may accept the recommendations of the mental health medication advisory committee in whole and such recommendations shall take effect immediately upon such approval. The drug utilization review board may reject the recommendations of the mental health medication advisory committee in whole and such recommendations shall be referred back to the mental health medication advisory committee for further consideration. No medication guidelines related to mental health medications shall be adopted by the drug utilization review board without recommendations made by the mental health medication advisory committee. 

(c) For the medications used to treat mental illness that are available for use on July 1, 2015, the drug utilization review board shall review all such medications prior to July 1, 2016. For medications used to treat mental illness that do not exist on July 1, 2015, but are later developed or believed to be effective in the treatment of mental illness, the drug utilization board shall review all such medications within six months of presentation to the drug utilization review board. 

(d) The mental health medication advisory committee is hereby established. 

(1) The mental health medication advisory committee shall be appointed by the secretary of health and environment and consist of nine members; including the secretary of health and environment, or the secretary's designee, who shall be the chair of the committee; two persons licensed to practice medicine and surgery with board certification in psychiatry nominated by the Kansas psychiatric society, one of whom specializes in geriatric mental health; two persons licensed to practice medicine and surgery with board certification in psychiatry nominated by the association of community mental health centers of Kansas, one of whom specializes in pediatric mental health; two pharmacists nominated by the Kansas pharmacy association; one person licensed to practice medicine and surgery nominated by the Kansas medical society; and one advanced practice registered nurse engaged in a role of mental health nominated by the Kansas state nurses association. 

All nominating bodies shall provide two nominees for each position for which they provide nominations, with the secretary selecting the appointee from the provided nominees. 

(2) The mental health medication advisory committee shall meet upon the request of the chair of the mental health medication advisory committee, but shall meet at least one time each quarter. 

(3) Members of the mental health medication advisory committee are entitled to compensation and expenses as provided in K.S.A. 75-3223, and amendments thereto. Members of the committee attending committee meetings shall be paid mileage and all other applicable expenses, provided such expenses are consistent with policies established by the secretary of health and environment. 

Sec. 5. K.S.A. 2014 Supp. 39-7,119, 39-7,120 and 39-7,121b are hereby repealed. Sec. 6. This act shall take effect and be in force from and after its publication in the statute book.

March 18th and 19th - the House Health and Human Services Committee hosted hearings on Medicaid Expansion - HB 2319.  Each day, the committee room and hallway were packed with proponents and opponents to the bill.  Many observers do not expect to see any action on Medicaid Expansion during the Veto Session.  Currently, the bill has been referred to the Taxation Committee.

KMHC is cooperating with the Kansas Hospital Association and the Kansas Health Consumer Coalition to promote passage of HB 2319.  Now is the time to weigh in with your legislators and the committee members.

Click Here to read HB 2319.

Click Here to contact House Health Committee Members.  Click on the names.

Click Below to sign the petition to support Medicaid Expansion:

http://www.changekansas.org/action/petition/get-kansans-covered-expand-kancare-medicaid

More Information about Medicaid Expansion:

• KMHC Medicaid Expansion Issue Paper
  
• Kaiser Commission Report - The Coverage Gap: Uninsured Poor Adults in States that do not Expand Medicaid - an Update
  
• KHI Brief - Nearly 182,000 Kansans in the Eligibility Gap
  
• National Women's Law Center - What Medicaid Eligibility Expansion means for Women

If you've been watching the news, you know that the Kansas Legislature has rushed through a bill to change the way that K-12 Education is funded in Kansas.  The bill was introduced last week, inserted into a Senate Bill and passed by Appropriations, passed the full House by Friday, and the Senate voted to concur on Monday.  The bill freezes the current school finance formula and provides for block grants to school district, allowing more flexible use of funds.  It was highly controversial and many schools say it reduces their budgets.  This has opened the way for the Legislature to begin working on its major budget bill for the session.  

Yesterday and today, the House Appropriations Committee has been working through its Mega-Budget bill - combining the agency budget reports and adding amendments.   Today, a proviso offered by Social Services Subcommittee Chair Will Carpenter was adopted to preserve funding for NAMI in the KDADS Budget within existing resources.  The motion was seconded by Rep. Barbara Ballard.  The proviso that has been lobbied by mental health advocates also included funding for Keys for Networking, which had been earmarked for consideration at Omnibus.  Both NAMI and Keys for Networking have been notified that their contracts are ending and the funding will not be retained in its current structure in FY 16 and 17.  New contracts will be made available under an integrated prevention block grant format, but these have not yet been defined and may or may not encompass the services provided by these organizations.  Further advocacy will be needed to assure that the services are preserved and funded.

KMHC is watching this process closely - So far, there has been no effort to alter the Governor’s recommendation to add $1 million each year for FY 16 and FY 17 to expand behavioral health crisis and transitional services in the community.  We are also supporting the Governor's recommendation to retain the $1.9 million from the sale of Rainbow, which KDADS proposes to invest in crisis and transitional services in the community through a revolving loan fund.  

The Committee combined HB 2365 - Judiciary Budget and HB 2366 - Capitol Improvements Budget into HB 2370 the Mega-Budget Bill and passed it.  The bill will probably be debated in the full House next week. 

Last week, advocates testified in support of Sub. for HB 2170 before the Senate Education Committee.  KMHC co-signed joint testimony supporting the bill - read here.  The bill passed the House of Representatives 122-1.

The bill puts into statute rules for the use of seclusion and restraint and includes modifications recommended by the Kansas Association of School Boards.  The language incorporates many of the 2012 recommendations from the United States Department of Education (USDE) and regulations/policy of the Kansas Department of Education (KSDE) in order to improve the current policy in Kansas and to better ensure the safety of children and teachers in public schools. 

• The USDE recommendations are minimal standards.  The USDE acknowledges in its report that schools and states “may choose to exceed the framework set by the 15 principles” which make up its recommendations (see pages 12-13, “Restraint and Seclusion: A Resource Document,” USDE, 2012).
• One key USDE recommendation the bill includes is standard of use for restraint and seclusion.  The bill clarifies the currently nebulous standard by adding the USDE language of threat of “serious physical harm to self or others.”  

Rocky Nichols, Disability Rights Center, has been coordinating this effort.  He believes the language of the bill is a middle ground between what the advocates and parents would prefer and reasonable language for the schools to implement.  The bill does not include all of the minimal standards and recommendations of the USDE report because it is a "fair compromise".    

 

However, there may be some opposition to the current language.  It is not clear when the bill will be worked by the Senate Education Committee.

 

Click here to contact members of the Senate Education Committee.  Simply click on the names of committee members.

Republican-controlled committee offers Medicaid expansion bill

Beneficiaries could be required to work, under proposal 

Posted: February 9, 2015 - 10:37am By Jonathan Shorman jonathan.shorman@cjonline.com 

A Republican-controlled House committee put forward legislation Monday to expand Medicaid in Kansas, offering a proposal that would use no state general funds but could require recipients to either work or volunteer. 

The legislation expands the KanCare program – the state’s managed care program – to include individuals earning up to 138 percent of the federal poverty level. That’s the income threshold that will allow Kansas to receive additional federal funding to help pay for part of the cost of expansion. 

The legislation sets out to help extend coverage to approximately 169,000 people, and collect about $2.2 billion federal funds between 2016 and 2020. 

A number of moderate Republicans sit on the House Vision 2020 Committee, which put forward the bill after hearings on Medicaid expansion. The committee chairman, Rep. Tom Sloan, R-Lawrence, said the legislation attempts to balance the “political realities” within the state through the a requirement in addition to financial realities.

“It balances the need to pay for this expanded service without going into the state general fund because there is no money there,” Sloan said. 

Sloan said he hopes the bill is referred to a House Appropriations subcommittee that will keep the discussion going and the bill alive. 

The proposal works by establishing a health care administrative support fee on hospitals, safety net clinics and other recipients of federal or state health care reimbursements to help pay for it. 

The secretary of health and environment would also be tasked with creating a concierge-like statewide pilot program for KanCare beneficiaries and promoting tele-health monitoring for individuals with chronic conditions and individuals with disabilities.

The plan also calls for health care outcomes to be analyzed quarterly by the KU Medical Center to identifying the most successful patient treatment, monitoring and education programs in improving cost-effectiveness in terms of health outcomes. 

In addition, the secretary would be allowed -- but not mandated -- to require a work component for ablebodies beneficiaries. The work could include volunteering. 

Sloan said the bill directs the administration to seek any necessary federal waivers to allow the state to receive additional federal funding. Sloan said he has spoken with the federal Health and Human Services Administration about the plan. “They were very pleased that the Legislature is looking at expanding,” Sloan said. 

Sean Gatewood with the Kansas Health Consumer Coalition indicated he is receptive to the proposal. Gatewood said he appreciated any opportunity that creates conversation about insuring more Kansans. He said he is still getting up to speed on all the details, but did express some concern about potential work requirements and how they would interact with federal regulations. “So I’ve got some questions as to if that would work, things like that. But any attempt I’m extremely grateful for. Getting a new bill in the hopper makes a good day for me,” Gatewood said. 

The proposal comes after Rep. Jim Ward, D-Wichita, introduced his own plan last month to expand Medicaid. The Democratic proposal is unlikely to gain traction in the Republican-dominated Legislature. Rep. Pam Curtis, D-Kansas City, is the ranki

For years, mental health advocates have opposed managed care restrictions that could stand between mental health consumers and their preferred medications. This year, the state agency that oversees Kancare (Kansas' Medicaid program) is recommending the Kansas Legislature repeal the law that exempts mental health medications from prior authorizations or preferred drug lists.

A bill was introduced Thursday, Jan. 29th, in the Senate Public Health Committee to repeal the law that exempts mental health medications from prior authorizations or preferred drug lists. The language is not yet available but should be published soon.

Governor Brownback has made a mental health drug formulary part of his proposed budget. An article at KHI.org cites state officials estimate the repeal could save the Medicaid program more than $8 million - a surprising assessment since one of the most cited high cost medications will have a generic alternative in the next few months, whether or not the law is repealed.

Coalition members expressed their concerns about this proposal to Kari Bruffett, KDADS Secretary, at the January KMHC Meeting. The Secretary indicated an interest in receiving recommendations from Coalition members if an appropriate process can be identified. At this point, KDADS and KDHE are recommending the statute be repealed, citing the need to have full flexibility to implement prior authorization rules (PAs) and safety edits without any restrictions. It is unclear if a Preferred Drug List is intended. The Secretary also expressed an interest in deleting the prohibition for step therapy. In testimony to the Legislature, Secretary Mosier, KDHE, has indicated that they were not planning to change medications for individuals with chronic and persistent mental illness who are already on a successful medication plan. The rules for this exception would need to be developed. READ THE KHI ARTICLE.

The Kansas Department on Aging and Disability Services has announced proposed changes to three HCBS waiver programs and has opened a public comment period from 1/26/15 through 2/25/15. The final proposal is summarized in the linked document: HCBS Transition Plan and Proposed HCBS Program Changes and Request for Public Comments. 

The final summary of the proposed changes in the HCBS renewals effects the following programs:  Autism   Technology Assisted (TA)  Severe Emotional Disturbance (SED).

Public comment opportunities include meetings February 4th and 5th from 10-12 and 2-4 in Wichita and Topeka, teleconferencing, email, mail, and fax.  See the document above.

SED Waiver changes includes: parents signature indicates their preferences were reflected in the Plan of Care, adding consumer's preferred outcomes to the Plan of Care, identifying less intrusive methods that were tried but not successful, adding a provision that - if there is a waiting list - eligible military families may bypass the waiting list, and significant added layers to the SED eligibility process. 

The current process is that the Community Mental Health Center (CMHC) completes the functional assessment and determines if a consumer is clinically eligible for the SED waiver. In the proposed process the CMHC will complete the functional assessment and send the information to KDADS for the clinical determination. Once a consumer is found to be clinically eligible for the waiver the Department of Children and Family will assess if that consumer if financially eligible to be on the waiver. Once a consumer is found to be both clinically and financially eligible for the waiver the CMHC will develop the Plan of Care and submit it to the Managed Care Organization (MCO) for review and approval. After the Plan of Care is approved by the MCO the CMHC will provide the waiver services to the consumer.

By JOHN HANNA

Online:

Kansas Hospital Association: http://www.kha-net.org/

Kansas Legislature: http://www.kslegislature.org

___

Follow John Hanna on Twitter at https://twitter.com/apjdhanna .

Patient Information   http://www.ksdentalfoundation.org/patients/ 

2015 Salina KMOM Clinic Location

Salina Bicentennial Center
800 The Midway
Salina, KS

KMOM-Salina, February 13-14, 2015

Answers to Patient Questions:

• Continue taking any prescription medication as directed so bring it along so a dose is not missed should the patient have to wait a good portion of the day.
• The patient will need to fill out a brief health history so bring a list of allergies, prescriptions, etc. to have this information available.
• Patients do not need to bring dental records or proof of income.
• Services are first come, first served and ALL patients must be able to wait in line – no appointments.
• The clinic opens at 4:30 am on both Friday and Saturday (February 13-14) and waiting in line or determining how early to get in line, is up to the patient.
• We only let in as many patients as we will be able to treat that day (approximately 1,000) and we will then close the doors. Standing in line on Friday and not getting in does not give the patient priority the next day. It is the same process on Saturday, first come, first served.
• Be prepared to wait and potentially be there all day. We let approximately 1,000 patients in the clinic so it may be mid-afternoon before a patient is treated.
• We will provide breakfast and lunch for the patients at no cost to them.
• After a medical screening, the patient will be examined by a dentist at KMOM and the patient’s greatest need will be treated. For example, if a patient needs extractions and fillings, the greatest need (probably the extractions) will be treated at KMOM. The patient does have the option to come back the next day to get the fillings but they must wait in line again like everybody else. No line priority is given.
• Services provided include cleanings, fillings, and extractions. No dentures will be provided at KMOM.
• Full mouth extractions will be done if determined necessary by the examining dentist. The patient will be able to discuss treatment/procedure options with the dentist prior to care.
• We typically have as many volunteers as we need registered prior to KMOM. Therefore, volunteering will not give priority or access to treatment. Registered volunteers who wish to be treated need to manage their schedule so they can wait in line for treatment.

Budget director says adjustments necessary to structurally balance budget

By Andy Marso | January 16, 2015   Read KHI Article

- See more at: http://www.khi.org/news/article/brownback-budget-includes-medicaid-changes-tobacco-tax-increase#sthash.1Lbu4vEY.dpuf