SESSION OF 2023
SUPPLEMENTAL NOTE ON HOUSE BILL NO. 2034
As Amended by House Committee of the Whole
Brief*
HB 2034, as amended, would create in the Revised
Kansas Code for Care of Children (Code) a program within
the Kansas Department of Health and Environment (KDHE)
for the training of and payment for Child Abuse Review and
Evaluation (CARE) providers who conduct CARE exams. The
bill would establish definitions, requirements, and procedures
related to CARE examinations and CARE providers and
create the CARE Fund.
The bill also would make technical amendments.
Definitions (Section 2)
The bill would add the following definitions to the Code:
●“Child abuse medical resource center” would mean
a medical institution affiliated with an accredited
children’s hospital or a recognized institution of
higher education that has an accredited medical
school program with board-certified child abuse
pediatricians who provide training, support,
mentoring, and peer review to CARE providers on
CARE exams;
●“Child abuse review and evaluation exam” or
“CARE exam” would mean a forensic medical
evaluation of a child alleged to be a victim of abuse
or neglect conducted by a CARE provider;
____________________
*Supplemental notes are prepared by the Legislative Research
Department and do not express legislative intent. The supplemental
note and fiscal note for this bill may be accessed on the Internet at
http://www.kslegislature.org ●“Child abuse review and evaluation network” or
“CARE network” would mean a network of CARE
providers, child abuse medical resource centers,
and any medical provider associated with a child
advocacy center that has the ability to conduct a
CARE exam, that collaborate to improve services
provided to a child alleged to be a victim of abuse
or neglect;
●“Child abuse review and evaluation provider” or
“CARE provider” would mean a person licensed to
practice medicine and surgery, advanced practice
registered nurse, or licensed physician assistant
who performs CARE exams of and provides
medical diagnosis and treatment to a child alleged
to be a victim of abuse or neglect and who
receives:
○Kansas-based initial intensive training
regarding child maltreatment from the CARE
network;
○Continuous trainings on child maltreatment
from the CARE network; and
○Peer review and new provider mentoring
regarding medical evaluations from a child
abuse medical resource center; and
●“Child abuse review and evaluation referral” or
“CARE referral” would mean a brief written review
of allegations of physical abuse, emotional abuse,
medical neglect, or physical neglect submitted by
the Secretary for Children and Families or law
enforcement agency to a child abuse medical
resource center for a recommendation of such
child’s need for medical care that may include a
CARE exam.
2- 2034 CARE Referrals (Section 3)
Continuing law in the Code requires, as part of any
investigation of reports of child abuse or neglect, the
Secretary for Children and Families or the investigating law
enforcement agency to visually observe the child who is the
alleged victim of abuse or neglect.
The bill would amend the Code to require the Secretary
for Children and Families or a law enforcement agency, upon
investigation by law enforcement or assignment by the
Secretary of any investigation of physical abuse or physical
neglect, pursuant to this provision, that concerns a child five
years of age or younger, to make a CARE referral for such
child. The bill would allow, in any other investigation of
physical abuse, emotional abuse, medical neglect, or physical
neglect conducted pursuant to the section, the Secretary, the
law enforcement agency, or the agency’s designee to make a
CARE referral for such child.
CARE Exams (Section 1)
The bill would require a CARE provider, when a CARE
referral by a child abuse medical resource center
recommends a CARE exam be conducted by such CARE
provider during an investigation of child abuse or neglect, to
report a determination in a completed review that a child has
been subject to physical abuse, emotional abuse, medical
neglect, or physical neglect to the Secretary for Children and
Families, the local law enforcement agency, or the agency’s
designee, if such a determination is made. The bill would
require the Secretary, upon receipt of such review, to
consider and include the review in making recommendations
regarding the care, safety, and placement of the child and
maintain the review in the case record.
The bill would provide such review to be confidential and
not be disclosed, with certain exceptions outlined in the bill
and in continuing law.
3- 2034 The bill would specify that in order to provide forensic
evaluation services to a child alleged to be a victim of
physical abuse, emotional abuse, medical neglect, or physical
neglect in investigations that include a CARE exam:
●Child abuse medical resource centers be allowed
to collaborate directly or through technology with
CARE providers to provide forensic medical
evaluations, medical training, support, mentoring,
and peer review to enhance the skill and role of
child abuse medical resource centers and the
CARE providers in a multidisciplinary context;
●CARE providers and child abuse medical resource
centers be required to provide and receive
specialized training for medical evaluations
conducted in a hospital or child advocacy center, or
by a private health care professional without the
need for an agreement between such center and
provider; and
●The CARE network be required to develop
recommendations concerning the medical-based
screening process and forensic evidence collection
for a child and provide such recommendations to
CARE providers, child advocacy centers, hospitals,
and licensed practitioners.
Responsibilities of the Secretary of Health and
Environment (Section 1)
The bill would require the Secretary of Health and
Environment to implement and administer training for CARE
providers to establish and maintain compliance with the
requirements of the Code and assist in the implementation of
the bill’s provisions.
The bill would require the Secretary of Health and
Environment to pay for and manage a network referral
4- 2034 system and to adopt rules and regulations as necessary,
subject to available appropriations. A CARE provider would
be required to submit all charges for payment of reviews and
CARE exams to the Secretary within 90 days of performing a
CARE review or exam. The Secretary would be required to
pay all charges directly to a CARE provider within 30 days
after being submitted. The bill would specify such payment
amount to be only for the exam at the rate of a reasonable
cost for providing such exam, excluding treatment that may
be required due to the diagnosis, or any facility fees, supplies,
or laboratory or radiology testing.
CARE Fund (Section 1)
The bill would establish in the State Treasury the Child
Abuse Review and Evaluation Fund (Fund), to be
administered by the Secretary of Health and Environment.
The bill would require all expenditures from the Fund to be for
payments of CARE exams, training of CARE providers, and
the implementation and administration of the CARE program,
as described above. The bill would require all expenditures
from the Fund to be made in accordance with appropriation
acts upon warrants of the Director of Accounts and Reports
issued pursuant to vouchers approved by the Secretary or the
Secretary’s designee. The bill would require all moneys
received for CARE exams and CARE provider training to be
remitted to the State Treasurer and require the State
Treasurer to deposit the entire amount in the State Treasury
to the credit of the Fund.
Background
The bill was introduced by the House Committee on
Child Welfare and Foster Care at the request of a
representative of the Kansas Chapter of the American
Academy of Pediatrics (KAAP).
5- 2034 [Note: A similar bill, HB 2632, was introduced in 2022 by
the House Committee on Children and Seniors at the request
of KAAP. The bill passed the House, as amended by the
House Committee of the Whole, but died in the Senate
Committee on Public Health and Welfare. However, a proviso
was included in Section 24 of 2022 HB 2510 (the
Appropriations Bill for FY 2022, FY 2023, and FY 2024) that
required expenditures to be made in FY 2023 from the CARE
program account to train healthcare providers to recognize
signs of child abuse and reimburse reviews and examinations
conducted by such trained healthcare providers. The proviso
also required KDHE, on or before January 9, 2023, to submit
a report to the House Committee on Appropriations and the
Senate Committee on Ways and Means on services provided
and the location of services provided by the program.]
House Committee on Child Welfare and Foster Care
In the House Committee hearing, two representatives of
KAAP provided proponent testimony, stating KDHE, the
Department for Children and Families (DCF), and KAAP have
been collaborating on the coordination of the CARE program
since July 2022 to help assure that every potential case of
child maltreatment is thoroughly investigated. The
representatives stated the 2022 Legislature enacted a proviso
to help provide a foundation for the CARE provider network,
but enactment of this bill is needed to sustain the program
and for the network to reach its full potential to serve Kansas
children and save young lives. The KAAP representatives
reported on the accomplishments of the CARE program since
July 1, 2022, including the creation of the CARE network with
an increased number of CARE providers throughout the
state, a statewide referral system, and a payment system for
CARE exams.
Written-only proponent testimony was provided by
representatives of Children’s Alliance of Kansas, DCF, and
KDHE, and a representative of the Kansas Association of
6- 2034 Chiefs of Police, Kansas Sheriffs Association, and Kansas
Peace Officers Association.
No other testimony was provided.
House Committee of the Whole
The House Committee of the Whole amended the bill to
require the Secretary for Children and Families or a law
enforcement agency to require a CARE referral for a child five
years of age or younger upon any investigation by law
enforcement of physical abuse or physical neglect.
Fiscal Information
According to the fiscal note prepared by the Division of
the Budget on the bill, as introduced, KDHE estimates current
program expenditures of $757,000 in FY 2023 and $758,317
in FY 2024, all from the State General Fund (SGF), which is
fully funded in the Governor’s recommended budget. KDHE
notes enactment of the bill would not generate additional
expenditures in either fiscal year but would require the
addition of 2.0 FTE positions. These positions are funded, but
the agency’s position count was not increased when the
program was funded. KDHE estimates ongoing cost would be
determined by the number of providers that need training and
certification and also continuing education. Reimbursements
would fluctuate based on the number of child abuse cases in
which a CARE exam would be needed. KDHE notes the bill
does not specify the revenue source for the CARE Fund, and
the total revenue could not be estimated. Once an alternative
revenue source is identified, the SGF appropriation could be
reduced or eliminated based on program revenue and
expenditure estimates.
Although provisions of the bill would be added to the
Revised Kansas Code for the Care of Children, DCF reports
7- 2034 there would be no fiscal effect on agency operations, and all
costs for the program would be in KDHE.
Expenditures for the current program in operation at
KDHE are reflected in the agency’s budget in The FY 2024
Governor’s Budget Report; however, the 2.0 FTE positions
cited as needed by KDHE are not reflected in The FY 2024
Governor’s Budget Report.
Child abuse and neglect; child abuse investigation; Revised Kansas Code for the
Care of Children; child abuse review and evaluation
8- 2034