Kansas 2023-2024 Regular Session

Kansas Senate Bill SB355 Compare Versions

Only one version of the bill is available at this time.

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1	1	Session of 2024
2	2	SENATE BILL No. 355
3	3	By Committee on Ways and Means
4	4	1-17
5	5	AN ACT concerning health and healthcare; relating to health insurance
6	6	coverage; expanding medical assistance eligibility; enacting the cutting
7	7	healthcare costs for all Kansans act; directing the department of health
8	8	and environment to study certain medicaid expansion topics; adding
9	9	meeting days to the Robert G. (Bob) Bethell joint committee on home
10	10	and community based services and KanCare oversight to monitor
11	11	implementation of expanded medical assistance eligibility; amending
12	12	K.S.A. 39-7,160, 40-3213, 65-6207, 65-6210, 65-6211, 65-6212 and
13	13	65-6217 and K.S.A. 2023 Supp. 65-6208, 65-6209 and 65-6218 and
14	14	repealing the existing sections.
15	15	Be it enacted by the Legislature of the State of Kansas:
16	16	New Section 1. (a) Sections 1 through 13, and amendments thereto,
17	17	shall be known and may be cited as the cutting healthcare costs for all
18	18	Kansans act.
19	19	(b) The legislature expressly consents to expand eligibility for receipt
20	20	of benefits under the Kansas program of medical assistance, as required by
21	21	K.S.A. 39-709(e)(2), and amendments thereto, by the passage and
22	22	enactment of the act, subject to all requirements and limitations established
23	23	in the act.
24	24	(c) The secretary of health and environment shall adopt rules and
25	25	regulations as necessary to implement and administer the act.
26	26	(d) As used in sections 1 through 13, and amendments thereto, unless
27	27	otherwise specified:
28	28	(1) "138% of the federal poverty level," or words of like effect,
29	29	includes a 5% income disregard permitted under the federal patient
30	30	protection and affordable care act.
31	31	(2) "Act" means the cutting healthcare costs for all Kansans act.
32	32	New Sec. 2. (a) The secretary of health and environment shall submit
33	33	to the United States centers for medicare and medicaid services any state
34	34	plan amendment, waiver request or other approval request necessary to
35	35	implement the act. At least 10 calendar days prior to submission of any
36	36	such approval request to the United States centers for medicare and
37	37	medicaid services, the secretary of health and environment shall submit
38	38	such approval request application to the state finance council.
39	39	(b) For purposes of eligibility determinations under the Kansas
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76	76	program of medical assistance on and after January 1, 2025, medical
77	77	assistance shall be granted to any adult under 65 years of age who is not
78	78	pregnant and whose income meets the limitation established in subsection
79	79	(c), as permitted under the provisions of 42 U.S.C. § 1396a, as it exists on
80	80	the effective date of the act, and subject to a 90% federal medical
81	81	assistance percentage and all requirements and limitations established in
82	82	the act.
83	83	(c) The secretary of health and environment shall submit to the
84	84	United States centers for medicare and medicaid services any approval
85	85	request necessary to provide medical assistance eligibility to individuals
86	86	described in subsection (b) whose modified adjusted gross income does
87	87	not exceed 138% of the federal poverty level.
88	88	New Sec. 3. (a) The secretary of health and environment shall require
89	89	each applicant for coverage under the act to provide employment
90	90	verification at the time of initial application or renewal application. Such
91	91	verification shall be a prerequisite for coverage under the act.
92	92	(b) "Employment verification" means documentation demonstrating
93	93	employment during the preceding 12 months that meets the eligibility
94	94	requirements of the act. "Employment verification" includes, but is not
95	95	limited to:
96	96	(1) Federal form W-2 wage and tax statement;
97	97	(2) a pay stub demonstrating gross income;
98	98	(3) employment records;
99	99	(4) federal form 1099 demonstrating payments for contract labor;
100	100	(5) compliance with the requirements of K.S.A. 39-709(b), and
101	101	amendments thereto; and
102	102	(6) any other documentation as determined by the secretary of health
103	103	and environment.
104	104	(c) The following individuals shall be exempt from the requirements
105	105	of this subsection:
106	106	(1) A full-time student enrolled in a postsecondary educational
107	107	institution or technical college, as defined by K.S.A. 74-3201b, and
108	108	amendments thereto, for each year the student is enrolled in such
109	109	educational setting;
110	110	(2) a parent or guardian of a dependent child under 18 years of age or
111	111	a parent or guardian of an incapacitated adult;
112	112	(3) an individual who is mentally or physically unfit for employment,
113	113	as defined by the secretary of health and environment, or has a pending
114	114	application for supplemental security income or social security disability
115	115	insurance;
116	116	(4) an individual who has a permanent partial disability, as such term
117	117	is used in K.S.A. 44-510e, and amendments thereto;
118	118	(5) an individual who is engaged in volunteer work for at least 20
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162	162	hours per week at a nonprofit organization, as such term is defined in
163	163	K.S.A. 17-1779, and amendments thereto;
164	164	(6) an individual experiencing homelessness, as such term is defined
165	165	in 42 U.S.C. 11302, as in effect on the effective date of this act;
166	166	(7) an individual who served in the active military, naval, air or space
167	167	service and was discharged or released from such military service under
168	168	conditions other than dishonorable;
169	169	(8) an individual who is not more than 22 years of age and in the
170	170	custody of the secretary of children and families on the date that the
171	171	individual reached 18 years of age; and
172	172	(9) any individual who the secretary determines is experiencing
173	173	hardship.
174	174	New Sec. 4. (a) The secretary of health and environment may
175	175	establish a health insurance coverage premium assistance program for
176	176	individuals who meet the following requirements:
177	177	(1) The individual has an annual income that is 100% or greater than,
178	178	but does not exceed 138% of, the federal poverty level, based on the
179	179	modified adjusted gross income provisions set forth in section 2001(a)(1)
180	180	of the federal patient protection and affordable care act; and
181	181	(2) the individual is eligible for health insurance coverage through an
182	182	employer but cannot afford the health insurance coverage premiums, as
183	183	determined by the secretary of health and environment.
184	184	(b) A program established under this section shall:
185	185	(1) Contain eligibility requirements that are the same as in sections 2
186	186	and 3, and amendments thereto; and
187	187	(2) provide that an individual's payment for a health insurance
188	188	coverage premium may not exceed 2% of the individual's modified
189	189	adjusted gross income, not to exceed 2% of the household's modified
190	190	adjusted gross income in the aggregate with any premium charged to any
191	191	other household member participating in the premium assistance program.
192	192	New Sec. 5. (a) Except to the extent prohibited by 42 U.S.C. §
193	193	1396u-2(a)(2), as it exists on the effective date of this act, the secretary of
194	194	health and environment shall administer medical assistance benefits using
195	195	a managed care delivery system using organizations subject to assessment
196	196	of the privilege fee under K.S.A. 40-3213, and amendments thereto. If the
197	197	United States centers for medicare and medicaid services determines that
198	198	the assessment of a privilege fee provided in K.S.A. 40-3213, and
199	199	amendments thereto, is unlawful or otherwise invalid, then the secretary of
200	200	health and environment shall administer state medicaid services using a
201	201	managed care delivery system.
202	202	(b) In awarding a contract for an entity to administer state medicaid
203	203	services using a managed care delivery system, the secretary of health and
204	204	environment shall:
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248	248	(1) Not provide favorable or unfavorable treatment in awarding a
249	249	contract based on an entity's for-profit or not-for-profit tax status;
250	250	(2) give preference in awarding a contract to an entity that provides
251	251	health insurance coverage plans on the health benefit exchange in Kansas
252	252	established under the federal patient protection and affordable care act; and
253	253	(3) require that any entity administering state medicaid services
254	254	provide tiered benefit plans with enhanced benefits for covered individuals
255	255	who demonstrate healthy behaviors, as determined by the secretary of
256	256	health and environment, to be implemented on or before July 1, 2026.
257	257	New Sec. 6. If the federal medical assistance percentage for coverage
258	258	of medical assistance participants described in section 1902(a)(10)(A)(i)
259	259	(VIII) of the federal social security act, 42 U.S.C. § 1396a, as it exists on
260	260	the effective date of this act, becomes lower than 90%, then the secretary
261	261	of health and environment shall terminate coverage under the act over a
262	262	12-month period, beginning on the first day that the federal medical
263	263	assistance percentage becomes lower than 90%. No individual shall be
264	264	newly enrolled for coverage under the act after such date.
265	265	New Sec. 7. (a) Section 6, and amendments thereto, shall be
266	266	nonseverable from the remainder of the act. If the provisions of section 6,
267	267	and amendments thereto, are not approved by the United States centers for
268	268	medicare and medicaid services, then the act shall be null and void and
269	269	shall have no force and effect.
270	270	(b) A denial of federal approval or federal financial participation that
271	271	applies to any provision of the act not enumerated in subsection (a) shall
272	272	not prohibit the secretary of health and environment from implementing
273	273	any other provision of the act.
274	274	New Sec. 8. (a) On or before January 10, 2026, and on or before the
275	275	first day of the regular session of the legislature each year thereafter, the
276	276	secretary of health and environment shall prepare and deliver a report to
277	277	the legislature that summarizes the cost savings achieved by the state from
278	278	the movement of covered individuals from the KanCare program to
279	279	coverage under the act, including, but not limited to, the MediKan
280	280	program, the medically needy spend-down program and the breast and
281	281	cervical cancer program.
282	282	(b) State cost savings shall be determined by calculating the cost of
283	283	providing services to covered individuals in the KanCare program less the
284	284	cost of services provided to covered individuals under the act.
285	285	(c) If the secretary of health and environment implements other
286	286	initiatives using cost savings achieved through the implementation of the
287	287	act, the secretary shall include such initiatives as part of the report required
288	288	in subsection (a).
289	289	New Sec. 9. (a) The secretary of corrections and the secretary of
290	290	health and environment shall coordinate with a county sheriff or such
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334	334	sheriff's deputy who requests assistance in facilitating medicaid coverage
335	335	for any individual committed to a county jail or correctional facility
336	336	during any time period that such individual is eligible for coverage under
337	337	state or federal law.
338	338	(b) If an individual is enrolled in medicaid when such individual is
339	339	committed to a county jail or correctional facility, such medicaid status
340	340	shall not be suspended or terminated based on such individual's
341	341	incarceration for a minimum of 30 days. After 30 days, medicaid coverage
342	342	may be suspended, but not terminated, up to the maximum amount of time
343	343	permitted by state and federal law.
344	344	(c) The secretary of health and environment shall coordinate with a
345	345	county sheriff or such sheriff's deputy and the department of corrections to
346	346	assist any individual who is committed to a county jail or correctional
347	347	facility in applying for medicaid coverage prior to such individual's release
348	348	from custody if such individual is likely to meet the requirements for
349	349	medicaid coverage to allow adequate time for medicaid coverage to begin
350	350	promptly upon release.
351	351	(d) The secretary of health and environment shall adopt any rules and
352	352	regulations and supporting policies and procedures as necessary to
353	353	implement and administer this section prior to January 1, 2025.
354	354	New Sec. 10. On or before February 15, 2026, and on or before
355	355	February 15 of each year thereafter, the secretary of health and
356	356	environment shall present a report to the house of representatives standing
357	357	committee on appropriations and the senate standing committee on ways
358	358	and means that summarizes the costs of the act and the cost savings and
359	359	additional revenues generated during the preceding fiscal year.
360	360	New Sec. 11. (a) The department of health and environment shall
361	361	remit all moneys received by the department of health and environment
362	362	from drug rebates associated with medical assistance enrollees to the state
363	363	treasurer in accordance with the provisions of K.S.A. 75-4215, and
364	364	amendments thereto. Upon receipt of each such remittance, the state
365	365	treasurer shall deposit the entire amount into the state treasury to the credit
366	366	of the state general fund.
367	367	(b) The department of health and environment shall certify the
368	368	amount of moneys received by such agency from drug rebates associated
369	369	with medical assistance enrollees on a monthly basis and shall transmit
370	370	each such certification to the director of legislative research and the
371	371	director of the budget.
372	372	(c) Upon receipt of each such certification, the director of legislative
373	373	research and the director of the budget shall include such certified amount
374	374	on any monthly report prepared by the legislative research department or
375	375	the division of the budget that details state general fund receipts as a
376	376	separate item entitled "drug rebates" under a category of other revenue
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420	420	sources.
421	421	(d) This section shall take effect and be in force on and after July 1,
422	422	2025.
423	423	New Sec. 12. (a) There is hereby established the rural health advisory
424	424	committee.
425	425	(b) The rural health advisory committee shall consist of 15 members
426	426	appointed by the governor. The membership shall be comprised of
427	427	individuals with a variety of backgrounds including medicine, education,
428	428	farming, finance, business and individuals representing community
429	429	interests in rural Kansas.
430	430	(c) The governor shall designate one of the appointed members to be
431	431	chairperson of the committee. The members of the advisory committee
432	432	shall select a vice chairperson from the membership of the advisory
433	433	committee.
434	434	(d) Upon first appointment, five of the members shall serve for a term
435	435	of one year, five of the members shall be appointed for a term of two years
436	436	and five of the members shall be appointed for term of three years, as
437	437	designated by the governor. The member designated as chairperson shall
438	438	serve for a term of three years. Subsequent appointees shall serve terms of
439	439	three years.
440	440	(e) (1) The advisory committee may meet at any time and at any
441	441	place within the state on the call of the chairperson. The advisory
442	442	committee shall meet regularly, but shall meet at least once every calendar
443	443	quarter.
444	444	(2) A quorum of the advisory committee shall be eight voting
445	445	members. All actions of the advisory committee shall be adopted by a
446	446	majority of those voting members present when there is a quorum.
447	447	(f) The advisory committee shall:
448	448	(1) Advise the governor and other state agencies on rural health
449	449	issues;
450	450	(2) recommend and evaluate mechanisms to encourage greater
451	451	cooperation between rural communities and rural health providers;
452	452	(3) recommend and evaluate approaches to rural health issues that are
453	453	sensitive to the needs of local communities;
454	454	(4) develop methods to identify individuals who are underserved by
455	455	the Kansas rural healthcare system; and
456	456	(5) beginning in 2025, provide an annual report to the governor
457	457	containing the advice, recommendations and conclusions of the advisory
458	458	committee.
459	459	(g) The secretary of health and environment shall facilitate the work
460	460	of the committee by providing access to meeting space and other necessary
461	461	staff and office support. The secretary of health and environment may
462	462	adopt any rules and regulations and supporting policies and procedures
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506	506	that are necessary to support the work of the advisory committee.
507	507	New Sec. 13. The cutting healthcare costs for all Kansans act shall
508	508	not provide coverage for abortion services, except in cases where coverage
509	509	is mandated by federal law and federal financial participation is available.
510	510	Sec. 14. K.S.A. 39-7,160 is hereby amended to read as follows: 39-
511	511	7,160. (a) There is hereby established the Robert G. (Bob) Bethell joint
512	512	committee on home and community based services and KanCare
513	513	oversight. The joint committee shall review the number of individuals who
514	514	are transferred from state or private institutions and long-term care
515	515	facilities to the home and community based services and the associated
516	516	cost savings and other outcomes of the money-follows-the-person
517	517	program. The joint committee shall review the funding targets
518	518	recommended by the interim report submitted for the 2007 legislature by
519	519	the joint committee on legislative budget and use them as guidelines for
520	520	future funding planning and policy making. The joint committee shall have
521	521	oversight of savings resulting from the transfer of individuals from state or
522	522	private institutions to home and community based services. As used in
523	523	K.S.A. 39-7,159 through 39-7,162, and amendments thereto, "savings"
524	524	means the difference between the average cost of providing services for
525	525	individuals in an institutional setting and the cost of providing services in a
526	526	home and community based setting. The joint committee shall study and
527	527	determine the effectiveness of the program and cost-analysis of the state
528	528	institutions or long-term care facilities based on the success of the transfer
529	529	of individuals to home and community based services. The joint
530	530	committee shall consider the issues of whether sufficient funding is
531	531	provided for enhancement of wages and benefits of direct individual care
532	532	workers and their staff training and whether adequate progress is being
533	533	made to transfer individuals from the institutions and to move them from
534	534	the waiver waiting lists to receive home and community based services.
535	535	The joint committee shall review and ensure that any proceeds resulting
536	536	from the successful transfer be applied to the system of provision of
537	537	services for long-term care and home and community based services. The
538	538	joint committee shall monitor and study the implementation and operations
539	539	of the home and community based service programs, the children's health
540	540	insurance program, the program for the all-inclusive care of the elderly
541	541	and the state medicaid programs including, but not limited to, access to
542	542	and quality of services provided and any financial information and
543	543	budgetary issues. Any state agency shall provide data and information on
544	544	KanCare programs, including, but not limited to, pay for performance
545	545	measures, quality measures and enrollment and disenrollment in specific
546	546	plans, KanCare provider network data and appeals and grievances made to
547	547	the KanCare ombudsman, to the joint committee, as requested.
548	548	(b) The joint committee shall consist of 11 members of the legislature
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592	592	appointed as follows: (1) Two members of the house committee on health
593	593	and human services appointed by the speaker of the house of
594	594	representatives; (2) one member of the house committee on health and
595	595	human services appointed by the minority leader of the house of
596	596	representatives; (3) two members of the senate committee on public health
597	597	and welfare appointed by the president of the senate; (4) one member of
598	598	the senate committee on public health and welfare appointed by the
599	599	minority leader of the senate; (5) two members of the house of
600	600	representatives appointed by the speaker of the house of representatives,
601	601	one of whom shall be a member of the house committee on appropriations;
602	602	(6) one member of the house of representatives appointed by the minority
603	603	leader of the house of representatives; and (7) two members of the senate
604	604	appointed by the president of the senate, one of whom shall be a member
605	605	of the senate committee on ways and means.
606	606	(c) Members shall be appointed for terms coinciding with the
607	607	legislative terms for which such members are elected or appointed. All
608	608	members appointed to fill vacancies in the membership of the joint
609	609	committee and all members appointed to succeed members appointed to
610	610	membership on the joint committee shall be appointed in the manner
611	611	provided for the original appointment of the member succeeded.
612	612	(d) (1) The members originally appointed as members of the joint
613	613	committee shall meet upon the call of the member appointed by the
614	614	speaker of the house of representatives, who shall be the first chairperson,
615	615	within 30 days of the effective date of this act. The vice-chairperson of the
616	616	joint committee shall be appointed by the president of the senate.
617	617	Chairperson and vice-chairperson shall alternate annually between the
618	618	members appointed by the speaker of the house of representatives and the
619	619	president of the senate. The ranking minority member shall be from the
620	620	same chamber as the chairperson. On and after the effective date of this act
621	621	Except as provided in paragraph (2), the joint committee shall meet at
622	622	least once in January and once in April when the legislature is in regular
623	623	session and at least once for two consecutive days during each of the third
624	624	and fourth calendar quarters, on the call of the chairperson, but not to
625	625	exceed six meetings in a calendar year, except additional meetings may be
626	626	held on call of the chairperson when urgent circumstances exist which
627	627	require such meetings. Six members of the joint committee shall constitute
628	628	a quorum.
629	629	(2) During calendar year 2025 and calendar year 2026, the joint
630	630	committee shall meet for one additional day per meeting pursuant to
631	631	paragraph (1) in order to monitor the implementation of the cutting
632	632	healthcare costs for all Kansans act and to review the following topics
633	633	relating to such implementation: Payment integrity and eligibility audits;
634	634	outcomes related to section 3, and amendments thereto; health outcomes
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678	678	for individuals covered under the act; budget projections and actual
679	679	expenditures related to implementation of the act; and expenses incurred
680	680	by hospitals arising from charity care and services provided to patients
681	681	who are unwilling or unable to pay for such services.
682	682	(e) (1) At the beginning of each regular session of the legislature, the
683	683	committee shall submit to the president of the senate, the speaker of the
684	684	house of representatives, the house committee on health and human
685	685	services and the senate committee on public health and welfare a written
686	686	report on numbers of individuals transferred from the state or private
687	687	institutions to the home and community based services including the
688	688	average daily census in the state institutions and long-term care facilities,
689	689	savings resulting from the transfer certified by the secretary for aging and
690	690	disability services in a quarterly report filed in accordance with K.S.A. 39-
691	691	7,162, and amendments thereto, and the current balance in the home and
692	692	community based services savings fund of the Kansas department for
693	693	aging and disability services.
694	694	(2) Such report submitted under this subsection shall also include, but
695	695	not be limited to, the following information on the KanCare program:
696	696	(A) Quality of care and health outcomes of individuals receiving state
697	697	medicaid services under the KanCare program, as compared to the
698	698	provision of state medicaid services prior to January 1, 2013;
699	699	(B) integration and coordination of health care procedures for
700	700	individuals receiving state medicaid services under the KanCare program;
701	701	(C) availability of information to the public about the provision of
702	702	state medicaid services under the KanCare program, including, but not
703	703	limited to, accessibility to health services, expenditures for health services,
704	704	extent of consumer satisfaction with health services provided and
705	705	grievance procedures, including quantitative case data and summaries of
706	706	case resolution by the KanCare ombudsman;
707	707	(D) provisions for community outreach and efforts to promote the
708	708	public understanding of the KanCare program;
709	709	(E) comparison of the actual medicaid costs expended in providing
710	710	state medicaid services under the KanCare program after January 1, 2013,
711	711	to the actual costs expended under the provision of state medicaid services
712	712	prior to January 1, 2013, including the manner in which such cost
713	713	expenditures are calculated;
714	714	(F) comparison of the estimated costs expended in a managed care
715	715	system of providing state medicaid services under the KanCare program
716	716	after January 1, 2013, to the actual costs expended under the KanCare
717	717	program of providing state medicaid services after January 1, 2013;
718	718	(G) comparison of caseload information for individuals receiving
719	719	state medicaid services prior to January 1, 2013, to the caseload
720	720	information for individuals receiving state medicaid services under the
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764	764	KanCare program after January 1, 2013; and
765	765	(H) all written testimony provided to the joint committee regarding
766	766	the impact of the provision of state medicaid services under the KanCare
767	767	program upon residents of adult care homes.
768	768	(3) The joint committee shall consider the external quality review
769	769	reports and quality assessment and performance improvement program
770	770	plans of each managed care organization providing state medicaid services
771	771	under the KanCare program in the development of the report submitted
772	772	under this subsection.
773	773	(4) The report submitted under this subsection shall be published on
774	774	the official website of the legislative research department.
775	775	(f) Members of the committee shall have access to any medical
776	776	assistance report and caseload data generated by the Kansas department of
777	777	health and environment division of health care finance. Members of the
778	778	committee shall have access to any report submitted by the Kansas
779	779	department of health and environment division of health care finance to
780	780	the centers for medicare and medicaid services of the United States
781	781	department of health and human services.
782	782	(g) Members of the committee shall be paid compensation, travel
783	783	expenses and subsistence expenses or allowance as provided in K.S.A. 75-
784	784	3212, and amendments thereto, for attendance at any meeting of the joint
785	785	committee or any subcommittee meeting authorized by the committee.
786	786	(h) In accordance with K.S.A. 46-1204, and amendments thereto, the
787	787	legislative coordinating council may provide for such professional services
788	788	as may be requested by the joint committee.
789	789	(i) The joint committee may make recommendations and introduce
790	790	legislation as it deems necessary in performing its functions.
791	791	Sec. 15. K.S.A. 40-3213 is hereby amended to read as follows: 40-
792	792	3213. (a) Every health maintenance organization and medicare provider
793	793	organization subject to this act shall pay to the commissioner the following
794	794	fees:
795	795	(1) For filing an application for a certificate of authority, $150;
796	796	(2) for filing each annual report, $50; and
797	797	(3) for filing an amendment to the certificate of authority, $10.
798	798	(b) Every health maintenance organization subject to this act shall
799	799	pay annually to the commissioner at the time such organization files its
800	800	annual report, a privilege fee in an amount equal to the following
801	801	percentages 5.77% of the total of all premiums, subscription charges or
802	802	any other term that may be used to describe the charges made by such
803	803	organization to enrollees: 3.31% during the reporting period beginning
804	804	January 1, 2015, and ending December 31, 2017; and 5.77% on and after
805	805	January 1, 2018. In such computations all such organizations shall be
806	806	entitled to deduct therefrom any premiums or subscription charges
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850	850	returned on account of cancellations and dividends returned to enrollees. If
851	851	the commissioner shall determine at any time that the application of the
852	852	privilege fee, or a change in the rate of the privilege fee, would cause a
853	853	denial of, reduction in or elimination of federal financial assistance to the
854	854	state or to any health maintenance organization subject to this act, the
855	855	commissioner is hereby authorized to terminate the operation of such
856	856	privilege fee or the change in such privilege fee.
857	857	(c) For the purpose of insuring the collection of the privilege fee
858	858	provided for by subsection (b), every health maintenance organization
859	859	subject to this act and required by subsection (b) to pay such privilege fee
860	860	shall at the time it files its annual report, as required by K.S.A. 40-3220,
861	861	and amendments thereto, make a return, generated by or at the direction of
862	862	its chief officer or principal managing director, under penalty of K.S.A.
863	863	21-5824, and amendments thereto, to the commissioner, stating the amount
864	864	of all premiums, assessments and charges received by the health
865	865	maintenance organization, whether in cash or notes, during the year ending
866	866	on the last day of the preceding calendar year. Upon the receipt of such
867	867	returns the commissioner of insurance shall verify such returns and
868	868	reconcile the fees pursuant to subsection (f) upon such organization on the
869	869	basis and at the rate provided in this section.
870	870	(d) Premiums or other charges received by an insurance company
871	871	from the operation of a health maintenance organization subject to this act
872	872	shall not be subject to any fee or tax imposed under the provisions of
873	873	K.S.A. 40-252, and amendments thereto.
874	874	(e) Fees charged under this section shall be remitted to the state
875	875	treasurer in accordance with the provisions of K.S.A. 75-4215, and
876	876	amendments thereto. Upon receipt of each such remittance, the state
877	877	treasurer shall deposit the entire amount in the state treasury to the credit
878	878	of the medical assistance fee fund created by K.S.A. 40-3236, and
879	879	amendments thereto.
880	880	(f) (1) On and after January 1, 2018, In addition to any other filing or
881	881	return required by this section, each health maintenance organization shall
882	882	submit a report to the commissioner on or before March 31 and September
883	883	30 of each year containing an estimate of the total amount of all premiums,
884	884	subscription charges or any other term that may be used to describe the
885	885	charges made by such organization to enrollees that the organization
886	886	expects to collect during the current calendar year. Upon filing each March
887	887	31 report, the organization shall submit payment equal to ½ of the
888	888	privilege fee that would be assessed by the commissioner for the current
889	889	calendar year based upon the organization's reported estimate. Upon filing
890	890	each September 30 report, the organization shall submit payment equal to
891	891	the balance of the privilege fee that would be assessed by the
892	892	commissioner for the current calendar year based upon the organization's
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936	936	reported estimates.
937	937	(2) Any amount of privilege fees actually owed by a health
938	938	maintenance organization during any calendar year in excess of estimated
939	939	privilege fees paid shall be assessed by the commissioner and shall be due
940	940	and payable upon issuance of such assessment.
941	941	(3) Any amount of estimated privilege fees paid by a health
942	942	maintenance organization during any calendar year in excess of privilege
943	943	fees actually owed shall be reconciled when the commissioner assesses
944	944	privilege fees in the ensuing calendar year. The commissioner shall credit
945	945	such excess amount against future privilege fee assessments. Any such
946	946	excess amount paid by a health maintenance organization that is no longer
947	947	doing business in Kansas and that no longer has a duty to pay the privilege
948	948	fee shall be refunded by the commissioner from funds appropriated by the
949	949	legislature for such purpose.
950	950	Sec. 16. K.S.A. 65-6207 is hereby amended to read as follows: 65-
951	951	6207. As used in K.S.A. 65-6207 to through 65-6220, inclusive, and
952	952	amendments thereto, the following have the meaning respectively ascribed
953	953	thereto, unless the context requires otherwise:
954	954	(a) "Annual hospital medicaid expansion surcharge" means the
955	955	product of the number of unduplicated medicaid expansion enrollees
956	956	multiplied by $233.
957	957	(b) "Assessment revenues" means the revenues generated directly by
958	958	the assessment and surcharge imposed by K.S.A. 65-6208 and 65-6213,
959	959	and amendments thereto, any penalty assessments and all interest credited
960	960	to the fund under this act and any federal matching funds obtained
961	961	through the use of such assessments, surcharges, penalties and interest
962	962	amounts.
963	963	(c) "Department" means the Kansas department for aging and
964	964	disability services or the Kansas department of health and environment, or
965	965	both.
966	966	(b)(d) "Fund" means the health care access improvement fund.
967	967	(c)(e) "Health maintenance organization" has the meaning means the
968	968	same as provided in K.S.A. 40-3202, and amendments thereto.
969	969	(d)(f) "Hospital" has the meaning means the same as provided in
970	970	K.S.A. 65-425, and amendments thereto.
971	971	(e)(g) "Hospital provider" means a person licensed by the department
972	972	of health and environment to operate, conduct or maintain a hospital,
973	973	regardless of whether the person is a federal medicaid provider.
974	974	(f)(h) "Pharmacy provider" means an area, premises or other site
975	975	where drugs are offered for sale, where there are pharmacists, as defined in
976	976	K.S.A. 65-1626, and amendments thereto, and where prescriptions, as
977	977	defined in K.S.A. 65-1626, and amendments thereto, are compounded and
978	978	dispensed.
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1022	1022	(g) "Assessment revenues" means the revenues generated directly by
1023	1023	the assessments imposed by K.S.A. 65-6208 and 65-6213, and
1024	1024	amendments thereto, any penalty assessments and all interest credited to
1025	1025	the fund under this act, and any federal matching funds obtained through
1026	1026	the use of such assessments, penalties and interest amounts
1027	1027	(i) "Unduplicated medicaid expansion enrollee" means each
1028	1028	individual who becomes eligible for and enrolls in the Kansas program of
1029	1029	medical assistance under K.S.A. 39-709, and amendments thereto, and is
1030	1030	eligible for a 90% federal medical assistance percentage pursuant to 42
1031	1031	U.S.C. § 1396d(y)(1).
1032	1032	Sec. 17. K.S.A. 2023 Supp. 65-6208 is hereby amended to read as
1033	1033	follows: 65-6208. (a) Subject to the provisions of K.S.A. 65-6209, and
1034	1034	amendments thereto, an annual assessment on services is imposed on each
1035	1035	hospital provider in an amount not less than 1.83% of each hospital's net
1036	1036	inpatient operating revenue and not greater than 3% of each hospital's net
1037	1037	inpatient and outpatient operating revenue, as determined by the healthcare
1038	1038	access improvement panel in consultation with the department of health
1039	1039	and environment, for the hospital's fiscal year three years prior to the
1040	1040	assessment year. In the event that a hospital does not have a complete 12-
1041	1041	month fiscal year in such third prior fiscal year, the assessment under this
1042	1042	section shall be $200,000 until such date that such hospital has completed
1043	1043	the hospital's first 12-month fiscal year. Upon completing such first 12-
1044	1044	month fiscal year, such hospital's assessment under this section shall be the
1045	1045	amount not less than 1.83% of each hospital's net inpatient operating
1046	1046	revenue and not greater than 3% of such hospital's net inpatient and
1047	1047	outpatient operating revenue, as determined by the healthcare access
1048	1048	improvement panel in consultation with the department of health and
1049	1049	environment, for such first completed 12-month fiscal year.
1050	1050	(b) (1) On and after January 1, 2027, an annual hospital medicaid
1051	1051	expansion support surcharge shall be imposed on each hospital provider
1052	1052	in an amount equal to its proportionate share as determined by the
1053	1053	healthcare access improvement panel in accordance with K.S.A. 65-
1054	1054	6218(d), and amendments thereto, except that such surcharge shall not
1055	1055	exceed $35,000,000 for any calendar year and no surcharge shall be
1056	1056	imposed for any period after the federal medical assistance percentage
1057	1057	described in 42 U.S.C. § 1396d(y)(1) is lower than 90%. Upon final
1058	1058	approval by the United States centers for medicare and medicaid services,
1059	1059	notice of the amount of such surcharge shall be transmitted by the
1060	1060	healthcare access improvement panel to the department. Upon receipt of
1061	1061	such notice, the department shall promptly provide notice to each hospital
1062	1062	provider in accordance with K.S.A. 65-6211(b), and amendments thereto.
1063	1063	(2) The department of health and environment shall submit to the
1064	1064	United States centers for medicare and medicaid services any approval
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1108	1108	request necessary to implement the surcharge authorized by this
1109	1109	subsection and shall not impose such surcharge prior to receiving
1110	1110	approval by the United States centers for medicare and medicaid services
1111	1111	and publishing such approval.
1112	1112	(c) Nothing in this act shall be construed to authorize any home rule
1113	1113	unit or other unit of local government to license for revenue or impose a
1114	1114	tax or assessment upon hospital providers or a tax or assessment measured
1115	1115	by the income or earnings of a hospital provider.
1116	1116	(c)(d) (1) The department of health and environment shall submit to
1117	1117	the United States centers for medicare and medicaid services any approval
1118	1118	request necessary to implement the amendments made to subsection (a) by
1119	1119	section 1 of chapter 7 of the 2020 Session Laws of Kansas and this act. If
1120	1120	the department has submitted such a request pursuant to section 80(l) of
1121	1121	chapter 68 of the 2019 Session Laws of Kansas or section 1 of chapter 7 of
1122	1122	the 2020 Session Laws of Kansas, then the department may continue such
1123	1123	request, or modify such request to conform to the amendments made to
1124	1124	subsection (a) by section 1 of chapter 7 of the 2020 Session Laws of
1125	1125	Kansas and this act, to fulfill the requirements of this paragraph.
1126	1126	(2) The secretary of health and environment shall certify to the
1127	1127	secretary of state the receipt of such approval and cause notice of such
1128	1128	approval to be published in the Kansas register.
1129	1129	(3) The amendments made to subsection (a) by section 1 of chapter 7
1130	1130	of the 2020 Session Laws of Kansas and this act shall take effect on and
1131	1131	after January 1 or July 1 immediately following such publication of such
1132	1132	approval.
1133	1133	Sec. 18. K.S.A. 2023 Supp. 65-6209 is hereby amended to read as
1134	1134	follows: 65-6209. (a) A hospital provider that is a state agency, the
1135	1135	authority, as defined in K.S.A. 76-3304, and amendments thereto, a state
1136	1136	educational institution, as defined in K.S.A. 76-711, and amendments
1137	1137	thereto, a critical access hospital, as defined in K.S.A. 65-468, and
1138	1138	amendments thereto, or a rural emergency hospital licensed under the rural
1139	1139	emergency hospital act, K.S.A. 2023 Supp. 65-481 et seq., and
1140	1140	amendments thereto, is exempt from the assessment imposed by K.S.A.
1141	1141	65-6208(a), and amendments thereto, but not the surcharge imposed by
1142	1142	K.S.A. 65-6208(b), and amendments thereto.
1143	1143	(b) A hospital operated by the department in the course of performing
1144	1144	its mental health or developmental disabilities functions is exempt from
1145	1145	the assessment imposed by K.S.A. 65-6208(a), and amendments thereto,
1146	1146	but not the surcharge imposed by K.S.A. 65-6208(b), and amendments
1147	1147	thereto.
1148	1148	Sec. 19. K.S.A. 65-6210 is hereby amended to read as follows: 65-
1149	1149	6210. (a) The assessment imposed by K.S.A. 65-6208(a), and amendments
1150	1150	thereto, for any state fiscal year to which this statute applies shall be due
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1194	1194	and payable in equal installments on or before June 30 and December 31,
1195	1195	commencing with whichever date first occurs after the hospital has
1196	1196	received payments for 150 days after the effective date of the payment
1197	1197	methodology approved by the centers for medicare and medicaid services.
1198	1198	The surcharge imposed by K.S.A. 65-6208(b), and amendments thereto, for
1199	1199	any state fiscal year to which this statute applies shall be due and payable
1200	1200	in installments on or before June 30 and December 31, commencing with
1201	1201	June 30, 2027. The payment made by each hospital provider on or before
1202	1202	June 30 shall be in an amount not less than
1203	1203	1
1204	1204	/3 of such hospital provider's
1205	1205	proportionate share determined in accordance with K.S.A. 65-6218(d),
1206	1206	and amendments thereto. The payment made by each hospital provider on
1207	1207	or before December 31 shall be the remainder of the amount owed for
1208	1208	such hospital provider's proportionate share. No installment payment of
1209	1209	an assessment under this act shall be due and payable, however, until after:
1210	1210	(1) The hospital provider receives written notice from the department
1211	1211	that the payment methodologies to hospitals required under this act have
1212	1212	been approved by the centers for medicare and medicaid services of the
1213	1213	United States department of health and human services under 42 C.F.R. §
1214	1214	433.68 for the assessment imposed by K.S.A. 65-6208, and amendments
1215	1215	thereto, has been granted by the centers for medicare and medicaid
1216	1216	services of the United States department of health and human services; and
1217	1217	(2) in the case of a hospital provider, the hospital has received
1218	1218	payments for 150 days after the effective date of the payment methodology
1219	1219	approved by the centers for medicare and medicaid services.
1220	1220	(b) The department is authorized to establish delayed payment
1221	1221	schedules for hospital providers that are unable to make installment
1222	1222	payments when due under this section due to financial difficulties, as
1223	1223	determined by the department.
1224	1224	(c) If a hospital provider fails to pay the full amount of an installment
1225	1225	when due, including any extensions granted under this section, there shall
1226	1226	be added to the assessment or surcharge imposed by K.S.A. 65-6208(a) or
1227	1227	(b), and amendments thereto, unless waived by the department for
1228	1228	reasonable cause, a penalty assessment equal to the lesser of:
1229	1229	(1) An amount equal to 5% of the installment amount not paid on or
1230	1230	before the due date plus 5% of the portion thereof remaining unpaid on the
1231	1231	last day of each month thereafter; or
1232	1232	(2) an amount equal to 100% of the installment amount not paid on or
1233	1233	before the due date.
1234	1234	For purposes of subsection (c), payments will be credited first to unpaid
1235	1235	installment amounts, rather than to penalty or interest amounts, beginning
1236	1236	with the most delinquent installment.
1237	1237	(d) The effective date for the payment methodology applicable to
1238	1238	hospital providers approved by the centers for medicare and medicaid
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1281	1281	43 SB 355 16
1282	1282	services shall be the date of July 1 or January 1, whichever date is
1283	1283	designated in the state plan submitted by the department of health and
1284	1284	environment for approval by the centers for medicare and medicaid
1285	1285	services.
1286	1286	Sec. 20. K.S.A. 65-6211 is hereby amended to read as follows: 65-
1287	1287	6211. (a) After December 31 of each year, except as otherwise provided in
1288	1288	this subsection, and on or before March 31 of the succeeding year, the
1289	1289	department shall send a notice of assessment imposed under K.S.A. 65-
1290	1290	6208(a), and amendments thereto, to every hospital provider subject to
1291	1291	assessment under this act. (b) The hospital provider notice of assessment
1292	1292	shall notify the hospital provider of its assessment for the state fiscal year
1293	1293	commencing on the next July 1.
1294	1294	(b) On or before April 30 and October 31 of each year, the
1295	1295	department shall send a notice of surcharge imposed under K.S.A. 65-
1296	1296	6208(b), and amendments thereto, to each hospital provider subject to the
1297	1297	surcharge. The department shall send the first such notice on or before
1298	1298	April 30, 2027.
1299	1299	(c) If a hospital provider operates, conducts or maintains more than
1300	1300	one licensed hospital in the state, the hospital provider shall pay the any
1301	1301	assessment or surcharge imposed under K.S.A. 65-6208(a) or (b), and
1302	1302	amendments thereto, for each hospital separately.
1303	1303	(d) Notwithstanding any other provision in this act, in the case of a
1304	1304	person who ceases to operate, conduct or maintain a hospital in respect of
1305	1305	for which the person is subject to assessment in K.S.A. 65-6208(a), and
1306	1306	amendments thereto, as a hospital provider, the assessment for the state
1307	1307	fiscal year in which the cessation occurs shall be adjusted by multiplying
1308	1308	the assessment computed under K.S.A. 65-6208(a), and amendments
1309	1309	thereto, by a fraction, the numerator of which is the number of the days
1310	1310	during the year during which the provider operates, conducts or maintains
1311	1311	a hospital and the denominator of which is 365. Immediately upon ceasing
1312	1312	to operate, conduct or maintain a hospital, the person shall pay the
1313	1313	adjusted assessment for that state fiscal year, to the extent not previously
1314	1314	paid.
1315	1315	(e) Notwithstanding any other provision in this act, in the case of a
1316	1316	person who ceases to operate, conduct or maintain a hospital for which
1317	1317	the person is subject to surcharge in K.S.A. 65-6208(b), and amendments
1318	1318	thereto, as a hospital provider, the surcharge for the six-month period in
1319	1319	which the cessation occurs shall be adjusted by multiplying the surcharge
1320	1320	computed under K.S.A. 65-6208(b), and amendments thereto, by a
1321	1321	fraction, the numerator of which is the number of the days during the six
1322	1322	months during which the provider operates, conducts or maintains a
1323	1323	hospital and the denominator of which is the days in the same six-month
1324	1324	period. Immediately upon ceasing to operate, conduct or maintain a
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1367	1367	43 SB 355 17
1368	1368	hospital, the person shall pay the adjusted assessment for that six-month
1369	1369	period, to the extent not previously paid.
1370	1370	(f) Notwithstanding any other provision in this act, a person who
1371	1371	commences operating, conducting or maintaining a hospital shall pay the
1372	1372	assessment computed under subsection (a) of K.S.A. 65-6208(a), and
1373	1373	amendments thereto, in installments on the due dates stated in the notice
1374	1374	and on the regular installment due dates for the state fiscal year occurring
1375	1375	after the due dates of the initial notice.
1376	1376	Sec. 21. K.S.A. 65-6212 is hereby amended to read as follows: 65-
1377	1377	6212. (a) The assessment imposed by K.S.A. 65-6208(a), and amendments
1378	1378	thereto, shall not take effect or shall cease to be imposed and any moneys
1379	1379	remaining in the fund attributable to assessments imposed under K.S.A.
1380	1380	65-6208(a), and amendments thereto, shall be refunded to hospital
1381	1381	providers in proportion to the amounts paid by them if the payments to
1382	1382	hospitals required under subsection (a) of K.S.A. 65-6218(a), and
1383	1383	amendments thereto, are changed or are not eligible for federal matching
1384	1384	funds under title XIX or XXI of the federal social security act.
1385	1385	(b) The assessment and surcharge imposed by K.S.A. 65-6208(a)
1386	1386	and (b), and amendments thereto, shall not take effect or shall cease to be
1387	1387	imposed if the assessment is determined to be an impermissible tax under
1388	1388	title XIX of the federal social security act. Moneys in the health care
1389	1389	access improvement fund or the hospital medicaid expansion support
1390	1390	surcharge fund derived from assessments or surcharges imposed prior
1391	1391	thereto shall be disbursed in accordance with subsection (a) of K.S.A. 65-
1392	1392	6218(a) or (b), and amendments thereto, to the extent that federal
1393	1393	matching is not reduced due to the impermissibility of the assessments or
1394	1394	surcharges, and any remaining moneys shall be refunded to hospital
1395	1395	providers in proportion to the amounts paid by them.
1396	1396	Sec. 22. K.S.A. 65-6217 is hereby amended to read as follows: 65-
1397	1397	6217. (a) There is hereby created in the state treasury the health care
1398	1398	access improvement fund, which . Such fund shall be administered by the
1399	1399	secretary of health and environment. All moneys received for the
1400	1400	assessments imposed by K.S.A. 65-6208(a) and 65-6213, and amendments
1401	1401	thereto, including any penalty assessments imposed thereon, shall be
1402	1402	remitted to the state treasurer in accordance with K.S.A. 75-4215, and
1403	1403	amendments thereto. Upon receipt of each such remittance, the state
1404	1404	treasurer shall deposit the entire amount in the state treasury to the credit
1405	1405	of the health care access improvement fund. All expenditures from the
1406	1406	health care access improvement fund shall be made in accordance with
1407	1407	appropriation acts upon warrants of the director of accounts and reports
1408	1408	issued pursuant to vouchers approved by the secretary of health and
1409	1409	environment or the secretary's designee.
1410	1410	(b) There is hereby created in the state treasury the hospital medicaid
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1453	1453	43 SB 355 18
1454	1454	expansion support surcharge fund to be administered by the secretary of
1455	1455	health and environment. All moneys received for the surcharge imposed by
1456	1456	K.S.A. 65-6208(b), and amendments thereto, including any penalty
1457	1457	assessments imposed thereon, shall be remitted to the state treasurer in
1458	1458	accordance with K.S.A. 75-4215, and amendments thereto. Upon receipt of
1459	1459	each such remittance, the state treasurer shall deposit the entire amount
1460	1460	into the state treasury to the credit of the hospital medicaid expansion
1461	1461	support surcharge fund. All expenditures from the hospital medicaid
1462	1462	expansion support surcharge fund shall be made in accordance with
1463	1463	appropriation acts upon warrants of the director of accounts and reports
1464	1464	issued pursuant to vouchers approved by the secretary of health and
1465	1465	environment or the secretary's designee.
1466	1466	(c) The fund funds shall not be used to replace any moneys
1467	1467	appropriated by the legislature for the department's medicaid program.
1468	1468	(c)(d) The fund is funds are created for the purpose of receiving
1469	1469	moneys in accordance with this act and disbursing moneys only for the
1470	1470	purpose of improving health care delivery and related health activities,
1471	1471	notwithstanding any other provision of law.
1472	1472	(d)(e) On or before the 10
1473	1473	th
1474	1474	day of each month, the director of
1475	1475	accounts and reports shall transfer from the state general fund to the health
1476	1476	care access improvement fund and the hospital medicaid expansion
1477	1477	support surcharge fund interest earnings based on:
1478	1478	(1) The average daily balance of moneys in the health care access
1479	1479	improvement each such fund for the preceding month; and
1480	1480	(2) the net earnings rate of the pooled money investment portfolio for
1481	1481	the preceding month.
1482	1482	(e)(f) The fund funds shall consist of the following:
1483	1483	(1) All moneys collected or received by the department from the
1484	1484	hospital provider assessment and surcharge and the health maintenance
1485	1485	organization assessment imposed by this act;
1486	1486	(2) any interest or penalty levied in conjunction with the
1487	1487	administration of this act; and
1488	1488	(3) all other moneys received for the fund funds from any other
1489	1489	source.
1490	1490	(f)(g) (1) On July 1 of each fiscal year, the director of accounts and
1491	1491	reports shall record a debit to the state treasurer's receivables for the health
1492	1492	care access improvement fund and shall record a corresponding credit to
1493	1493	the health care access improvement fund in an amount certified by the
1494	1494	director of the budget which that shall be equal to the sum of 80% of the
1495	1495	moneys estimated by the director of the budget to be received from the
1496	1496	assessment imposed on hospital providers pursuant to K.S.A. 65-6208(a),
1497	1497	and amendments thereto, and credited to the health care access
1498	1498	improvement fund during such fiscal year, plus 53% of the moneys
1499	1499	1
1500	1500	2
1501	1501	3
1502	1502	4
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1541	1541	43 SB 355 19
1542	1542	estimated by the director of the budget to be received from the assessment
1543	1543	imposed on health maintenance organizations pursuant to K.S.A. 65-6213,
1544	1544	and amendments thereto, and credited to the health care access
1545	1545	improvement fund during such fiscal year, except that such amount shall
1546	1546	be proportionally adjusted during such fiscal year with respect to any
1547	1547	change in the moneys estimated by the director of the budget to be
1548	1548	received for such assessments under K.S.A. 65-6208(a) and 65-6213, and
1549	1549	amendments thereto, deposited in the state treasury and credited to the
1550	1550	health care access improvement fund during such fiscal year. Among other
1551	1551	appropriate factors, the director of the budget shall take into consideration
1552	1552	the estimated and actual receipts from such assessments for the current
1553	1553	fiscal year and the preceding fiscal year in determining the amount to be
1554	1554	certified under this subsection (f) paragraph. All moneys received for the
1555	1555	assessments imposed pursuant to K.S.A. 65-6208(a) and 65-6213, and
1556	1556	amendments thereto, deposited in the state treasury and credited to the
1557	1557	health care access improvement fund during a fiscal year shall reduce the
1558	1558	amount debited and credited to the health care access improvement fund
1559	1559	under this subsection (f) paragraph for such fiscal year.
1560	1560	(2) On July 1 of each fiscal year, the director of accounts and reports
1561	1561	shall record a debit to the state treasurer's receivables for the hospital
1562	1562	medicaid expansion support surcharge fund and shall record a
1563	1563	corresponding credit to the hospital medicaid expansion support
1564	1564	surcharge fund in an amount certified by the director of the budget that
1565	1565	shall be equal to 100% of the moneys estimated by the director of the
1566	1566	budget to be received from any surcharge imposed on hospital providers in
1567	1567	accordance with K.S.A. 65-6208(b), and amendments thereto, and credited
1568	1568	to the hospital medicaid expansion support surcharge fund during such
1569	1569	fiscal year, except that such amount shall be proportionally adjusted
1570	1570	during such fiscal year with respect to any change in the moneys estimated
1571	1571	by the director of the budget to be received for such surcharge in
1572	1572	accordance with K.S.A. 65-6208(b), and amendments thereto, deposited in
1573	1573	the state treasury and credited to the hospital medicaid expansion support
1574	1574	surcharge fund during such fiscal year. Among other appropriate factors,
1575	1575	the director of the budget shall take into consideration the estimated and
1576	1576	actual receipts from such surcharge for the current fiscal year and the
1577	1577	preceding fiscal year in determining the amount to be certified under this
1578	1578	paragraph. All moneys received for the surcharge imposed under K.S.A.
1579	1579	65-6208(b), and amendments thereto, deposited in the state treasury and
1580	1580	credited to the hospital medicaid expansion support surcharge fund during
1581	1581	a fiscal year shall reduce the amount debited and credited to the hospital
1582	1582	medicaid expansion support surcharge fund under this paragraph for such
1583	1583	fiscal year.
1584	1584	(3) On June 30 of each fiscal year, the director of accounts and
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1627	1627	43 SB 355 20
1628	1628	reports shall adjust the amounts debited and credited to the state treasurer's
1629	1629	receivables and to the health care access improvement fund and the
1630	1630	hospital medicaid expansion support surcharge fund pursuant to this
1631	1631	subsection (f), to reflect all moneys actually received for the assessments
1632	1632	and surcharge imposed pursuant to K.S.A. 65-6208 and 65-6213, and
1633	1633	amendments thereto, deposited in the state treasury and credited to the
1634	1634	health care access improvement fund and the hospital medicaid expansion
1635	1635	support surcharge fund during the current fiscal year.
1636	1636	(3)(4) The director of accounts and reports shall notify the state
1637	1637	treasurer of all amounts debited and credited to the health care access
1638	1638	improvement fund and the hospital medicaid expansion support surcharge
1639	1639	fund pursuant to this subsection (f) and all reductions and adjustments
1640	1640	thereto made pursuant to this subsection (f). The state treasurer shall enter
1641	1641	all such amounts debited and credited and shall make reductions and
1642	1642	adjustments thereto on the books and records kept and maintained for the
1643	1643	health care access improvement fund by the state treasurer in accordance
1644	1644	with the notice thereof.
1645	1645	Sec. 23. K.S.A. 2023 Supp. 65-6218 is hereby amended to read as
1646	1646	follows: 65-6218. (a) (1) Assessment revenues generated from the hospital
1647	1647	provider assessments under K.S.A. 65-6208(a), and amendments thereto,
1648	1648	shall be disbursed as follows:
1649	1649	(A) Not less than 80% of assessment revenues shall be disbursed to
1650	1650	hospital providers through a combination of medicaid access improvement
1651	1651	payments and increased medicaid rates on designated diagnostic related
1652	1652	groupings, procedures or codes;
1653	1653	(B) not more than 20% of assessment revenues shall be disbursed to
1654	1654	providers who are persons licensed to practice medicine and surgery or
1655	1655	dentistry through increased medicaid rates on designated procedures and
1656	1656	codes; and
1657	1657	(C) not more than 3.2% of hospital provider assessment revenues
1658	1658	shall be used to fund healthcare access improvement programs in
1659	1659	undergraduate, graduate or continuing medical education, including the
1660	1660	medical student loan act.
1661	1661	(2) On July 1 of each year, the department of health and environment,
1662	1662	with approval of the healthcare access improvement panel, shall make
1663	1663	adjustments to the disbursement of moneys in accordance with this
1664	1664	subsection to cause such disbursements to be paid solely from moneys
1665	1665	appropriated from the healthcare access improvement fund. The healthcare
1666	1666	access improvement fund shall not be supplemented by appropriations
1667	1667	from the state general fund for the purpose of making disbursements under
1668	1668	this subsection.
1669	1669	(b) Surcharge revenues generated from the hospital medicaid
1670	1670	expansion support surcharge under K.S.A. 65-6208(b), and amendments
1671	1671	1
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1713	1713	43 SB 355 21
1714	1714	thereto, shall be disbursed to offset the costs to the state related to
1715	1715	medicaid expansion beneficiaries as calculated in K.S.A. 65-6207(a), and
1716	1716	amendments thereto.
1717	1717	(c) For the purposes of administering and selecting the disbursements
1718	1718	described in subsections subsection (a) and (b), oversight of the
1719	1719	calculation of the annual hospital medicaid expansion support payment
1720	1720	and any surcharge under K.S.A. 65-6208(b), and amendments thereto, the
1721	1721	healthcare access improvement panel is hereby established. The panel shall
1722	1722	consist of the following: Three members appointed by the Kansas hospital
1723	1723	association, two members appointed by the Kansas medical society, one
1724	1724	member appointed by each health maintenance organization that has a
1725	1725	medicaid managed care contract with the department of health and
1726	1726	environment, one member appointed by the community care network of
1727	1727	Kansas, one member appointed by the president of the senate, one member
1728	1728	appointed by the speaker of the house of representatives, one member
1729	1729	from the office of the medicaid inspector general appointed by the attorney
1730	1730	general and one representative of the department of health and
1731	1731	environment appointed by the governor. The panel shall elect a
1732	1732	chairperson from among the members appointed by the Kansas hospital
1733	1733	association. A representative of the panel shall be required to make an
1734	1734	annual report to the legislature regarding the collection and distribution of
1735	1735	all funds received and distributed under this act, and such report shall
1736	1736	include analysis demonstrating that disbursements made in accordance
1737	1737	with subsection (a) are budget neutral to the state general fund.
1738	1738	(c)(d) The panel shall use the following procedure to approve
1739	1739	collection of surcharge revenues under K.S.A. 65-6208(b), and
1740	1740	amendments thereto, for each calendar year beginning with calendar year
1741	1741	2027 based upon the total number of unduplicated medicaid expansion
1742	1742	enrollees for such year:
1743	1743	(1) By March 31 and September 30, the department shall certify to
1744	1744	the panel the total number of unduplicated medicaid expansion enrollees
1745	1745	using data from the most recent end-of- month report.
1746	1746	(2) The panel shall review the number certified by the department,
1747	1747	consult with the department regarding any proposed deletions and certify
1748	1748	the final number of unduplicated medicaid expansion enrollees by April 15
1749	1749	and October 15.
1750	1750	(3) Each hospital's share of the annual hospital medicaid expansion
1751	1751	support surcharge shall be determined by the panel based upon such
1752	1752	hospital's proportion of total hospital revenues. The panel shall certify to
1753	1753	the department the amount of each hospital's surcharge by April 30 and
1754	1754	October 31. The surcharge for any hospital that has not yet filed a
1755	1755	medicare cost report shall pay the lowest surcharge payable by its hospital
1756	1756	licensure category as defined by K.S.A. 65-425, and amendments thereto.
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1800	1800	(4) For purposes of this subsection, the total surcharge revenues to
1801	1801	be certified for any calendar year shall not exceed $35,000,000, and any
1802	1802	annual hospital medicaid expansion support surcharge in excess of
1803	1803	$35,000,000 shall be disregarded.
1804	1804	(5) As used in this subsection:
1805	1805	(A) "Total hospital revenues" means the sum of inpatient and
1806	1806	outpatient revenues for all hospital providers as reflected in the applicable
1807	1807	medicare cost report.
1808	1808	(B) "Applicable medicare cost report" means, for calendar year
1809	1809	2025, such report filed by each hospital for calendar year 2023 or, if the
1810	1810	hospital did not file a medicare cost report for calendar year 2023, the
1811	1811	first year that the hospital filed a medicare cost report. For each calendar
1812	1812	year after 2025, the applicable medicare cost report shall advance by one
1813	1813	year.
1814	1814	(1)(e) The department of health and environment shall submit to the
1815	1815	United States centers for medicare and medicaid services any approval
1816	1816	request necessary to implement the amendments made to this section by
1817	1817	this act section 2 of chapter 7 of the 2020 Session Laws of Kansas. If the
1818	1818	department has submitted such a request pursuant to section 80(l) of
1819	1819	chapter 68 of the 2019 Session Laws of Kansas, then the department may
1820	1820	continue such request, or modify such request to conform to the
1821	1821	amendments made to subsections (a) and (b) by this act, to fulfill the
1822	1822	requirements of this paragraph.
1823	1823	(2)(f) The secretary of health and environment shall certify to the
1824	1824	secretary of state the receipt of such approval and cause notice of such
1825	1825	approval to be published in the Kansas register.
1826	1826	(3) The amendments made to subsections (a) and (b) by this act shall
1827	1827	take effect on and after January 1 or July 1 immediately following such
1828	1828	publication of such approval.
1829	1829	Sec. 24. K.S.A. 39-7,160, 40-3213, 65-6207, 65-6210, 65-6211, 65-
1830	1830	6212 and 65-6217 and K.S.A. 2023 Supp. 65-6208, 65-6209 and 65-6218
1831	1831	are hereby repealed.
1832	1832	Sec. 25. This act shall take effect and be in force from and after its
1833	1833	publication in the Kansas register.
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