Kansas 2024 1st Special Session

Kansas House Bill HB2002 Compare Versions

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

Old	New	Differences
1	1	Session of 2024
2	2	HOUSE BILL No. 2002
3	3	_Could Not Get Sponsors._
4	4	Requested by Representative Stogsdill
5	5	6-18
6	6	AN ACT concerning health and healthcare; relating to health insurance
7	7	coverage; expanding medical assistance eligibility; enacting the cutting
8	8	healthcare costs for all Kansans act; directing the department of health
9	9	and environment to study certain medicaid expansion topics; adding
10	10	meeting days to the Robert G. (Bob) Bethell joint committee on home
11	11	and community based services and KanCare oversight to monitor
12	12	implementation of expanded medical assistance eligibility; amending
13	13	K.S.A. 39-7,160, 40-3213, 65-6207, 65-6210, 65-6211, 65-6212 and
14	14	65-6217 and K.S.A. 2023 Supp. 65-6208, 65-6209 and 65-6218 and
15	15	repealing the existing sections.
16	16	Be it enacted by the Legislature of the State of Kansas:
17	17	New Section 1. (a) Sections 1 through 13, and amendments thereto,
18	18	shall be known and may be cited as the cutting healthcare costs for all
19	19	Kansans act.
20	20	(b) The legislature expressly consents to expand eligibility for receipt
21	21	of benefits under the Kansas program of medical assistance, as required by
22	22	K.S.A. 39-709(e)(2), and amendments thereto, by the passage and
23	23	enactment of the act, subject to all requirements and limitations established
24	24	in the act.
25	25	(c) The secretary of health and environment shall adopt rules and
26	26	regulations as necessary to implement and administer the act.
27	27	(d) As used in sections 1 through 13, and amendments thereto, unless
28	28	otherwise specified:
29	29	(1) "138% of the federal poverty level," or words of like effect,
30	30	includes a 5% income disregard permitted under the federal patient
31	31	protection and affordable care act.
32	32	(2) "Act" means the cutting healthcare costs for all Kansans act.
33	33	New Sec. 2. (a) The secretary of health and environment shall submit
34	34	to the United States centers for medicare and medicaid services any state
35	35	plan amendment, waiver request or other approval request necessary to
36	36	implement the act. At least 10 calendar days prior to submission of any
37	37	such approval request to the United States centers for medicare and
38	38	medicaid services, the secretary of health and environment shall submit
39	39	such approval request application to the state finance council.
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75	75	(b) For purposes of eligibility determinations under the Kansas
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. (c) The following individuals shall be exempt
104	104	from the requirements of this subsection:
105	105	(1) A full-time student enrolled in a postsecondary educational
106	106	institution or technical college, as defined by K.S.A. 74-3201b, and
107	107	amendments thereto, for each year the student is enrolled in such
108	108	educational setting;
109	109	(2) a parent or guardian of a dependent child under 18 years of age or
110	110	a parent or guardian of an incapacitated adult;
111	111	(3) an individual who is mentally or physically unfit for employment,
112	112	as defined by the secretary of health and environment, or has a pending
113	113	application for supplemental security income or social security disability
114	114	insurance;
115	115	(4) an individual who has a permanent partial disability, as such term
116	116	is used in K.S.A. 44-510e, and amendments thereto;
117	117	(5) an individual who is engaged in volunteer work for at least 20
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161	161	hours per week at a nonprofit organization, as such term is defined in
162	162	K.S.A. 17-1779, and amendments thereto;
163	163	(6) an individual experiencing homelessness, as such term is defined
164	164	in 42 U.S.C. 11302, as in effect on the effective date of this act;
165	165	(7) an individual who served in the active military, naval, air or space
166	166	service and was discharged or released from such military service under
167	167	conditions other than dishonorable;
168	168	(8) an individual who is not more than 22 years of age and in the
169	169	custody of the secretary of children and families on the date that the
170	170	individual reached 18 years of age; and
171	171	(9) any individual who the secretary determines is experiencing
172	172	hardship.
173	173	New Sec. 4. (a) The secretary of health and environment may
174	174	establish a health insurance coverage premium assistance program for
175	175	individuals who meet the following requirements:
176	176	(1) The individual has an annual income that is 100% or greater than,
177	177	but does not exceed 138% of, the federal poverty level, based on the
178	178	modified adjusted gross income provisions set forth in section 2001(a)(1)
179	179	of the federal patient protection and affordable care act; and
180	180	(2) the individual is eligible for health insurance coverage through an
181	181	employer but cannot afford the health insurance coverage premiums, as
182	182	determined by the secretary of health and environment.
183	183	(b) A program established under this section shall:
184	184	(1) Contain eligibility requirements that are the same as in sections 2
185	185	and 3, and amendments thereto; and
186	186	(2) provide that an individual's payment for a health insurance
187	187	coverage premium may not exceed 2% of the individual's modified
188	188	adjusted gross income, not to exceed 2% of the household's modified
189	189	adjusted gross income in the aggregate with any premium charged to any
190	190	other household member participating in the premium assistance program.
191	191	New Sec. 5. (a) Except to the extent prohibited by 42 U.S.C. §
192	192	1396u-2(a)(2), as it exists on the effective date of this act, the secretary of
193	193	health and environment shall administer medical assistance benefits using
194	194	a managed care delivery system using organizations subject to assessment
195	195	of the privilege fee under K.S.A. 40-3213, and amendments thereto. If the
196	196	United States centers for medicare and medicaid services determines that
197	197	the assessment of a privilege fee provided in K.S.A. 40-3213, and
198	198	amendments thereto, is unlawful or otherwise invalid, then the secretary of
199	199	health and environment shall administer state medicaid services using a
200	200	managed care delivery system.
201	201	(b) In awarding a contract for an entity to administer state medicaid
202	202	services using a managed care delivery system, the secretary of health and
203	203	environment shall:
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247	247	(1) Not provide favorable or unfavorable treatment in awarding a
248	248	contract based on an entity's for-profit or not-for-profit tax status;
249	249	(2) give preference in awarding a contract to an entity that provides
250	250	health insurance coverage plans on the health benefit exchange in Kansas
251	251	established under the federal patient protection and affordable care act; and
252	252	(3) require that any entity administering state medicaid services
253	253	provide tiered benefit plans with enhanced benefits for covered individuals
254	254	who demonstrate healthy behaviors, as determined by the secretary of
255	255	health and environment, to be implemented on or before July 1, 2026.
256	256	New Sec. 6. If the federal medical assistance percentage for coverage
257	257	of medical assistance participants described in section 1902(a)(10)(A)(i)
258	258	(VIII) of the federal social security act, 42 U.S.C. § 1396a, as it exists on
259	259	the effective date of this act, becomes lower than 90%, then the secretary
260	260	of health and environment shall terminate coverage under the act over a
261	261	12-month period, beginning on the first day that the federal medical
262	262	assistance percentage becomes lower than 90%. No individual shall be
263	263	newly enrolled for coverage under the act after such date.
264	264	New Sec. 7. (a) Section 6, and amendments thereto, shall be
265	265	nonseverable from the remainder of the act. If the provisions of section 6,
266	266	and amendments thereto, are not approved by the United States centers for
267	267	medicare and medicaid services, then the act shall be null and void and
268	268	shall have no force and effect.
269	269	(b) A denial of federal approval or federal financial participation that
270	270	applies to any provision of the act not enumerated in subsection (a) shall
271	271	not prohibit the secretary of health and environment from implementing
272	272	any other provision of the act.
273	273	New Sec. 8. (a) On or before January 10, 2026, and on or before the
274	274	first day of the regular session of the legislature each year thereafter, the
275	275	secretary of health and environment shall prepare and deliver a report to
276	276	the legislature that summarizes the cost savings achieved by the state from
277	277	the movement of covered individuals from the KanCare program to
278	278	coverage under the act, including, but not limited to, the MediKan
279	279	program, the medically needy spend-down program and the breast and
280	280	cervical cancer program.
281	281	(b) State cost savings shall be determined by calculating the cost of
282	282	providing services to covered individuals in the KanCare program less the
283	283	cost of services provided to covered individuals under the act.
284	284	(c) If the secretary of health and environment implements other
285	285	initiatives using cost savings achieved through the implementation of the
286	286	act, the secretary shall include such initiatives as part of the report required
287	287	in subsection (a).
288	288	New Sec. 9. (a) The secretary of corrections and the secretary of
289	289	health and environment shall coordinate with a county sheriff or such
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333	333	sheriff's deputy who requests assistance in facilitating medicaid coverage
334	334	for any individual committed to a county jail or correctional facility
335	335	during any time period that such individual is eligible for coverage under
336	336	state or federal law.
337	337	(b) If an individual is enrolled in medicaid when such individual is
338	338	committed to a county jail or correctional facility, such medicaid status
339	339	shall not be suspended or terminated based on such individual's
340	340	incarceration for a minimum of 30 days. After 30 days, medicaid coverage
341	341	may be suspended, but not terminated, up to the maximum amount of time
342	342	permitted by state and federal law.
343	343	(c) The secretary of health and environment shall coordinate with a
344	344	county sheriff or such sheriff's deputy and the department of corrections to
345	345	assist any individual who is committed to a county jail or correctional
346	346	facility in applying for medicaid coverage prior to such individual's release
347	347	from custody if such individual is likely to meet the requirements for
348	348	medicaid coverage to allow adequate time for medicaid coverage to begin
349	349	promptly upon release.
350	350	(d) The secretary of health and environment shall adopt any rules and
351	351	regulations and supporting policies and procedures as necessary to
352	352	implement and administer this section prior to January 1, 2025.
353	353	New Sec. 10. On or before February 15, 2026, and on or before
354	354	February 15 of each year thereafter, the secretary of health and
355	355	environment shall present a report to the house of representatives standing
356	356	committee on appropriations and the senate standing committee on ways
357	357	and means that summarizes the costs of the act and the cost savings and
358	358	additional revenues generated during the preceding fiscal year.
359	359	New Sec. 11. (a) The department of health and environment shall
360	360	remit all moneys received by the department of health and environment
361	361	from drug rebates associated with medical assistance enrollees to the state
362	362	treasurer in accordance with the provisions of K.S.A. 75-4215, and
363	363	amendments thereto. Upon receipt of each such remittance, the state
364	364	treasurer shall deposit the entire amount into the state treasury to the credit
365	365	of the state general fund.
366	366	(b) The department of health and environment shall certify the
367	367	amount of moneys received by such agency from drug rebates associated
368	368	with medical assistance enrollees on a monthly basis and shall transmit
369	369	each such certification to the director of legislative research and the
370	370	director of the budget.
371	371	(c) Upon receipt of each such certification, the director of legislative
372	372	research and the director of the budget shall include such certified amount
373	373	on any monthly report prepared by the legislative research department or
374	374	the division of the budget that details state general fund receipts as a
375	375	separate item entitled "drug rebates" under a category of other revenue
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419	419	sources.
420	420	(d) This section shall take effect and be in force on and after July 1,
421	421	2025.
422	422	New Sec. 12. (a) There is hereby established the rural health advisory
423	423	committee.
424	424	(b) The rural health advisory committee shall consist of 15 members
425	425	appointed by the governor. The membership shall be comprised of
426	426	individuals with a variety of backgrounds including medicine, education,
427	427	farming, finance, business and individuals representing community
428	428	interests in rural Kansas.
429	429	(c) The governor shall designate one of the appointed members to be
430	430	chairperson of the committee. The members of the advisory committee
431	431	shall select a vice chairperson from the membership of the advisory
432	432	committee.
433	433	(d) Upon first appointment, five of the members shall serve for a term
434	434	of one year, five of the members shall be appointed for a term of two years
435	435	and five of the members shall be appointed for term of three years, as
436	436	designated by the governor. The member designated as chairperson shall
437	437	serve for a term of three years. Subsequent appointees shall serve terms of
438	438	three years.
439	439	(e) (1) The advisory committee may meet at any time and at any
440	440	place within the state on the call of the chairperson. The advisory
441	441	committee shall meet regularly, but shall meet at least once every calendar
442	442	quarter.
443	443	(2) A quorum of the advisory committee shall be eight voting
444	444	members. All actions of the advisory committee shall be adopted by a
445	445	majority of those voting members present when there is a quorum.
446	446	(f) The advisory committee shall:
447	447	(1) Advise the governor and other state agencies on rural health
448	448	issues;
449	449	(2) recommend and evaluate mechanisms to encourage greater
450	450	cooperation between rural communities and rural health providers;
451	451	(3) recommend and evaluate approaches to rural health issues that are
452	452	sensitive to the needs of local communities;
453	453	(4) develop methods to identify individuals who are underserved by
454	454	the Kansas rural healthcare system; and
455	455	(5) beginning in 2025, provide an annual report to the governor
456	456	containing the advice, recommendations and conclusions of the advisory
457	457	committee.
458	458	(g) The secretary of health and environment shall facilitate the work
459	459	of the committee by providing access to meeting space and other necessary
460	460	staff and office support. The secretary of health and environment may
461	461	adopt any rules and regulations and supporting policies and procedures
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505	505	that are necessary to support the work of the advisory committee.
506	506	New Sec. 13. The cutting healthcare costs for all Kansans act shall
507	507	not provide coverage for abortion services, except in cases where coverage
508	508	is mandated by federal law and federal financial participation is available.
509	509	Sec. 14. K.S.A. 39-7,160 is hereby amended to read as follows: 39-
510	510	7,160. (a) There is hereby established the Robert G. (Bob) Bethell joint
511	511	committee on home and community based services and KanCare
512	512	oversight. The joint committee shall review the number of individuals who
513	513	are transferred from state or private institutions and long-term care
514	514	facilities to the home and community based services and the associated
515	515	cost savings and other outcomes of the money-follows-the-person
516	516	program. The joint committee shall review the funding targets
517	517	recommended by the interim report submitted for the 2007 legislature by
518	518	the joint committee on legislative budget and use them as guidelines for
519	519	future funding planning and policy making. The joint committee shall have
520	520	oversight of savings resulting from the transfer of individuals from state or
521	521	private institutions to home and community based services. As used in
522	522	K.S.A. 39-7,159 through 39-7,162, and amendments thereto, "savings"
523	523	means the difference between the average cost of providing services for
524	524	individuals in an institutional setting and the cost of providing services in a
525	525	home and community based setting. The joint committee shall study and
526	526	determine the effectiveness of the program and cost-analysis of the state
527	527	institutions or long-term care facilities based on the success of the transfer
528	528	of individuals to home and community based services. The joint
529	529	committee shall consider the issues of whether sufficient funding is
530	530	provided for enhancement of wages and benefits of direct individual care
531	531	workers and their staff training and whether adequate progress is being
532	532	made to transfer individuals from the institutions and to move them from
533	533	the waiver waiting lists to receive home and community based services.
534	534	The joint committee shall review and ensure that any proceeds resulting
535	535	from the successful transfer be applied to the system of provision of
536	536	services for long-term care and home and community based services. The
537	537	joint committee shall monitor and study the implementation and operations
538	538	of the home and community based service programs, the children's health
539	539	insurance program, the program for the all-inclusive care of the elderly
540	540	and the state medicaid programs including, but not limited to, access to
541	541	and quality of services provided and any financial information and
542	542	budgetary issues. Any state agency shall provide data and information on
543	543	KanCare programs, including, but not limited to, pay for performance
544	544	measures, quality measures and enrollment and disenrollment in specific
545	545	plans, KanCare provider network data and appeals and grievances made to
546	546	the KanCare ombudsman, to the joint committee, as requested.
547	547	(b) The joint committee shall consist of 11 members of the legislature
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591	591	appointed as follows: (1) Two members of the house committee on health
592	592	and human services appointed by the speaker of the house of
593	593	representatives; (2) one member of the house committee on health and
594	594	human services appointed by the minority leader of the house of
595	595	representatives; (3) two members of the senate committee on public health
596	596	and welfare appointed by the president of the senate; (4) one member of
597	597	the senate committee on public health and welfare appointed by the
598	598	minority leader of the senate; (5) two members of the house of
599	599	representatives appointed by the speaker of the house of representatives,
600	600	one of whom shall be a member of the house committee on appropriations;
601	601	(6) one member of the house of representatives appointed by the minority
602	602	leader of the house of representatives; and (7) two members of the senate
603	603	appointed by the president of the senate, one of whom shall be a member
604	604	of the senate committee on ways and means.
605	605	(c) Members shall be appointed for terms coinciding with the
606	606	legislative terms for which such members are elected or appointed. All
607	607	members appointed to fill vacancies in the membership of the joint
608	608	committee and all members appointed to succeed members appointed to
609	609	membership on the joint committee shall be appointed in the manner
610	610	provided for the original appointment of the member succeeded.
611	611	(d) (1) The members originally appointed as members of the joint
612	612	committee shall meet upon the call of the member appointed by the
613	613	speaker of the house of representatives, who shall be the first chairperson,
614	614	within 30 days of the effective date of this act. The vice-chairperson vice
615	615	chairperson of the joint committee shall be appointed by the president of
616	616	the senate. Chairperson and vice-chairperson vice chairperson shall
617	617	alternate annually between the members appointed by the speaker of the
618	618	house of representatives and the president of the senate. The ranking
619	619	minority member shall be from the same chamber as the chairperson. On
620	620	and after the effective date of this act Except as provided in paragraph (2),
621	621	the joint committee shall meet at least once in January and once in April
622	622	when the legislature is in regular session and at least once for two
623	623	consecutive days during each of the third and fourth calendar quarters, on
624	624	the call of the chairperson, but not to exceed six meetings in a calendar
625	625	year, except additional meetings may be held on call of the chairperson
626	626	when urgent circumstances exist which require such meetings. Six
627	627	members of the joint committee shall constitute a quorum.
628	628	(2) During calendar year 2025 and calendar year 2026, the joint
629	629	committee shall meet for one additional day per meeting pursuant to
630	630	paragraph (1) in order to monitor the implementation of the cutting
631	631	healthcare costs for all Kansans act and to review the following topics
632	632	relating to such implementation: Payment integrity and eligibility audits;
633	633	outcomes related to section 3, and amendments thereto; health outcomes
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677	677	for individuals covered under the act; budget projections and actual
678	678	expenditures related to implementation of the act; and expenses incurred
679	679	by hospitals arising from charity care and services provided to patients
680	680	who are unwilling or unable to pay for such services.
681	681	(e) (1) At the beginning of each regular session of the legislature, the
682	682	committee shall submit to the president of the senate, the speaker of the
683	683	house of representatives, the house committee on health and human
684	684	services and the senate committee on public health and welfare a written
685	685	report on numbers of individuals transferred from the state or private
686	686	institutions to the home and community based services including the
687	687	average daily census in the state institutions and long-term care facilities,
688	688	savings resulting from the transfer certified by the secretary for aging and
689	689	disability services in a quarterly report filed in accordance with K.S.A. 39-
690	690	7,162, and amendments thereto, and the current balance in the home and
691	691	community based services savings fund of the Kansas department for
692	692	aging and disability services.
693	693	(2) Such report submitted under this subsection shall also include, but
694	694	not be limited to, the following information on the KanCare program:
695	695	(A) Quality of care and health outcomes of individuals receiving state
696	696	medicaid services under the KanCare program, as compared to the
697	697	provision of state medicaid services prior to January 1, 2013;
698	698	(B) integration and coordination of health care procedures for
699	699	individuals receiving state medicaid services under the KanCare program;
700	700	(C) availability of information to the public about the provision of
701	701	state medicaid services under the KanCare program, including, but not
702	702	limited to, accessibility to health services, expenditures for health services,
703	703	extent of consumer satisfaction with health services provided and
704	704	grievance procedures, including quantitative case data and summaries of
705	705	case resolution by the KanCare ombudsman;
706	706	(D) provisions for community outreach and efforts to promote the
707	707	public understanding of the KanCare program;
708	708	(E) comparison of the actual medicaid costs expended in providing
709	709	state medicaid services under the KanCare program after January 1, 2013,
710	710	to the actual costs expended under the provision of state medicaid services
711	711	prior to January 1, 2013, including the manner in which such cost
712	712	expenditures are calculated;
713	713	(F) comparison of the estimated costs expended in a managed care
714	714	system of providing state medicaid services under the KanCare program
715	715	after January 1, 2013, to the actual costs expended under the KanCare
716	716	program of providing state medicaid services after January 1, 2013;
717	717	(G) comparison of caseload information for individuals receiving
718	718	state medicaid services prior to January 1, 2013, to the caseload
719	719	information for individuals receiving state medicaid services under the
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763	763	KanCare program after January 1, 2013; and
764	764	(H) all written testimony provided to the joint committee regarding
765	765	the impact of the provision of state medicaid services under the KanCare
766	766	program upon residents of adult care homes.
767	767	(3) The joint committee shall consider the external quality review
768	768	reports and quality assessment and performance improvement program
769	769	plans of each managed care organization providing state medicaid services
770	770	under the KanCare program in the development of the report submitted
771	771	under this subsection.
772	772	(4) The report submitted under this subsection shall be published on
773	773	the official website of the legislative research department.
774	774	(f) Members of the committee shall have access to any medical
775	775	assistance report and caseload data generated by the Kansas department of
776	776	health and environment division of health care finance. Members of the
777	777	committee shall have access to any report submitted by the Kansas
778	778	department of health and environment division of health care finance to
779	779	the centers for medicare and medicaid services of the United States
780	780	department of health and human services.
781	781	(g) Members of the committee shall be paid compensation, travel
782	782	expenses and subsistence expenses or allowance as provided in K.S.A. 75-
783	783	3212, and amendments thereto, for attendance at any meeting of the joint
784	784	committee or any subcommittee meeting authorized by the committee.
785	785	(h) In accordance with K.S.A. 46-1204, and amendments thereto, the
786	786	legislative coordinating council may provide for such professional services
787	787	as may be requested by the joint committee.
788	788	(i) The joint committee may make recommendations and introduce
789	789	legislation as it deems necessary in performing its functions.
790	790	Sec. 15. K.S.A. 40-3213 is hereby amended to read as follows: 40-
791	791	3213. (a) Every health maintenance organization and medicare provider
792	792	organization subject to this act shall pay to the commissioner the following
793	793	fees:
794	794	(1) For filing an application for a certificate of authority, $150;
795	795	(2) for filing each annual report, $50; and
796	796	(3) for filing an amendment to the certificate of authority, $10.
797	797	(b) Every health maintenance organization subject to this act shall
798	798	pay annually to the commissioner at the time such organization files its
799	799	annual report, a privilege fee in an amount equal to the following
800	800	percentages 5.77% of the total of all premiums, subscription charges or
801	801	any other term that may be used to describe the charges made by such
802	802	organization to enrollees: 3.31% during the reporting period beginning
803	803	January 1, 2015, and ending December 31, 2017; and 5.77% on and after
804	804	January 1, 2018. In such computations all such organizations shall be
805	805	entitled to deduct therefrom any premiums or subscription charges
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849	849	returned on account of cancellations and dividends returned to enrollees. If
850	850	the commissioner shall determine at any time that the application of the
851	851	privilege fee, or a change in the rate of the privilege fee, would cause a
852	852	denial of, reduction in or elimination of federal financial assistance to the
853	853	state or to any health maintenance organization subject to this act, the
854	854	commissioner is hereby authorized to terminate the operation of such
855	855	privilege fee or the change in such privilege fee.
856	856	(c) For the purpose of insuring the collection of the privilege fee
857	857	provided for by subsection (b), every health maintenance organization
858	858	subject to this act and required by subsection (b) to pay such privilege fee
859	859	shall at the time it files its annual report, as required by K.S.A. 40-3220,
860	860	and amendments thereto, make a return, generated by or at the direction of
861	861	its chief officer or principal managing director, under penalty of K.S.A.
862	862	21-5824, and amendments thereto, to the commissioner, stating the amount
863	863	of all premiums, assessments and charges received by the health
864	864	maintenance organization, whether in cash or notes, during the year ending
865	865	on the last day of the preceding calendar year. Upon the receipt of such
866	866	returns the commissioner of insurance shall verify such returns and
867	867	reconcile the fees pursuant to subsection (f) upon such organization on the
868	868	basis and at the rate provided in this section.
869	869	(d) Premiums or other charges received by an insurance company
870	870	from the operation of a health maintenance organization subject to this act
871	871	shall not be subject to any fee or tax imposed under the provisions of
872	872	K.S.A. 40-252, and amendments thereto.
873	873	(e) Fees charged under this section shall be remitted to the state
874	874	treasurer in accordance with the provisions of K.S.A. 75-4215, and
875	875	amendments thereto. Upon receipt of each such remittance, the state
876	876	treasurer shall deposit the entire amount in the state treasury to the credit
877	877	of the medical assistance fee fund created by K.S.A. 40-3236, and
878	878	amendments thereto.
879	879	(f) (1) On and after January 1, 2018, In addition to any other filing or
880	880	return required by this section, each health maintenance organization shall
881	881	submit a report to the commissioner on or before March 31 and September
882	882	30 of each year containing an estimate of the total amount of all premiums,
883	883	subscription charges or any other term that may be used to describe the
884	884	charges made by such organization to enrollees that the organization
885	885	expects to collect during the current calendar year. Upon filing each March
886	886	31 report, the organization shall submit payment equal to ½ of the
887	887	privilege fee that would be assessed by the commissioner for the current
888	888	calendar year based upon the organization's reported estimate. Upon filing
889	889	each September 30 report, the organization shall submit payment equal to
890	890	the balance of the privilege fee that would be assessed by the
891	891	commissioner for the current calendar year based upon the organization's
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935	935	reported estimates.
936	936	(2) Any amount of privilege fees actually owed by a health
937	937	maintenance organization during any calendar year in excess of estimated
938	938	privilege fees paid shall be assessed by the commissioner and shall be due
939	939	and payable upon issuance of such assessment.
940	940	(3) Any amount of estimated privilege fees paid by a health
941	941	maintenance organization during any calendar year in excess of privilege
942	942	fees actually owed shall be reconciled when the commissioner assesses
943	943	privilege fees in the ensuing calendar year. The commissioner shall credit
944	944	such excess amount against future privilege fee assessments. Any such
945	945	excess amount paid by a health maintenance organization that is no longer
946	946	doing business in Kansas and that no longer has a duty to pay the privilege
947	947	fee shall be refunded by the commissioner from funds appropriated by the
948	948	legislature for such purpose.
949	949	Sec. 16. K.S.A. 65-6207 is hereby amended to read as follows: 65-
950	950	6207. As used in K.S.A. 65-6207 to through 65-6220, inclusive, and
951	951	amendments thereto, the following have the meaning respectively ascribed
952	952	thereto, unless the context requires otherwise:
953	953	(a) "Annual hospital medicaid expansion surcharge" means the
954	954	product of the number of unduplicated medicaid expansion enrollees
955	955	multiplied by $233.
956	956	(b) "Assessment revenues" means the revenues generated directly by
957	957	the assessment and surcharge imposed by K.S.A. 65-6208 and 65-6213,
958	958	and amendments thereto, any penalty assessments and all interest credited
959	959	to the fund under this act and any federal matching funds obtained
960	960	through the use of such assessments, surcharges, penalties and interest
961	961	amounts.
962	962	(c) "Department" means the Kansas department for aging and
963	963	disability services or the Kansas department of health and environment, or
964	964	both.
965	965	(b)(d) "Fund" means the health care access improvement fund.
966	966	(c)(e) "Health maintenance organization" has the meaning means the
967	967	same as provided in K.S.A. 40-3202, and amendments thereto.
968	968	(d)(f) "Hospital" has the meaning means the same as provided in
969	969	K.S.A. 65-425, and amendments thereto.
970	970	(e)(g) "Hospital provider" means a person licensed by the department
971	971	of health and environment to operate, conduct or maintain a hospital,
972	972	regardless of whether the person is a federal medicaid provider.
973	973	(f)(h) "Pharmacy provider" means an area, premises or other site
974	974	where drugs are offered for sale, where there are pharmacists, as defined in
975	975	K.S.A. 65-1626, and amendments thereto, and where prescriptions, as
976	976	defined in K.S.A. 65-1626, and amendments thereto, are compounded and
977	977	dispensed.
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1021	1021	(g) "Assessment revenues" means the revenues generated directly by
1022	1022	the assessments imposed by K.S.A. 65-6208 and 65-6213, and
1023	1023	amendments thereto, any penalty assessments and all interest credited to
1024	1024	the fund under this act, and any federal matching funds obtained through
1025	1025	the use of such assessments, penalties and interest amounts
1026	1026	(i) "Unduplicated medicaid expansion enrollee" means each
1027	1027	individual who becomes eligible for and enrolls in the Kansas program of
1028	1028	medical assistance under K.S.A. 39-709, and amendments thereto, and is
1029	1029	eligible for a 90% federal medical assistance percentage pursuant to 42
1030	1030	U.S.C. § 1396d(y)(1).
1031	1031	Sec. 17. K.S.A. 2023 Supp. 65-6208 is hereby amended to read as
1032	1032	follows: 65-6208. (a) Subject to the provisions of K.S.A. 65-6209, and
1033	1033	amendments thereto, an annual assessment on services is imposed on each
1034	1034	hospital provider in an amount not less than 1.83% of each hospital's net
1035	1035	inpatient operating revenue and not greater than 3% of each hospital's net
1036	1036	inpatient and outpatient operating revenue, as determined by the healthcare
1037	1037	access improvement panel in consultation with the department of health
1038	1038	and environment, for the hospital's fiscal year three years prior to the
1039	1039	assessment year. In the event that a hospital does not have a complete 12-
1040	1040	month fiscal year in such third prior fiscal year, the assessment under this
1041	1041	section shall be $200,000 until such date that such hospital has completed
1042	1042	the hospital's first 12-month fiscal year. Upon completing such first 12-
1043	1043	month fiscal year, such hospital's assessment under this section shall be the
1044	1044	amount not less than 1.83% of each hospital's net inpatient operating
1045	1045	revenue and not greater than 3% of such hospital's net inpatient and
1046	1046	outpatient operating revenue, as determined by the healthcare access
1047	1047	improvement panel in consultation with the department of health and
1048	1048	environment, for such first completed 12-month fiscal year.
1049	1049	(b) (1) On and after January 1, 2027, an annual hospital medicaid
1050	1050	expansion support surcharge shall be imposed on each hospital provider
1051	1051	in an amount equal to its proportionate share as determined by the
1052	1052	healthcare access improvement panel in accordance with K.S.A. 65-
1053	1053	6218(d), and amendments thereto, except that such surcharge shall not
1054	1054	exceed $35,000,000 for any calendar year and no surcharge shall be
1055	1055	imposed for any period after the federal medical assistance percentage
1056	1056	described in 42 U.S.C. § 1396d(y)(1) is lower than 90%. Upon final
1057	1057	approval by the United States centers for medicare and medicaid services,
1058	1058	notice of the amount of such surcharge shall be transmitted by the
1059	1059	healthcare access improvement panel to the department. Upon receipt of
1060	1060	such notice, the department shall promptly provide notice to each hospital
1061	1061	provider in accordance with K.S.A. 65-6211(b), and amendments thereto.
1062	1062	(2) The department of health and environment shall submit to the
1063	1063	United States centers for medicare and medicaid services any approval
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1107	1107	request necessary to implement the surcharge authorized by this
1108	1108	subsection and shall not impose such surcharge prior to receiving
1109	1109	approval by the United States centers for medicare and medicaid services
1110	1110	and publishing such approval.
1111	1111	(c) Nothing in this act shall be construed to authorize any home rule
1112	1112	unit or other unit of local government to license for revenue or impose a
1113	1113	tax or assessment upon hospital providers or a tax or assessment measured
1114	1114	by the income or earnings of a hospital provider.
1115	1115	(c)(d) (1) The department of health and environment shall submit to
1116	1116	the United States centers for medicare and medicaid services any approval
1117	1117	request necessary to implement the amendments made to subsection (a) by
1118	1118	section 1 of chapter 7 of the 2020 Session Laws of Kansas and this act. If
1119	1119	the department has submitted such a request pursuant to section 80(l) of
1120	1120	chapter 68 of the 2019 Session Laws of Kansas or section 1 of chapter 7 of
1121	1121	the 2020 Session Laws of Kansas, then the department may continue such
1122	1122	request, or modify such request to conform to the amendments made to
1123	1123	subsection (a) by section 1 of chapter 7 of the 2020 Session Laws of
1124	1124	Kansas and this act, to fulfill the requirements of this paragraph.
1125	1125	(2) The secretary of health and environment shall certify to the
1126	1126	secretary of state the receipt of such approval and cause notice of such
1127	1127	approval to be published in the Kansas register.
1128	1128	(3) The amendments made to subsection (a) by section 1 of chapter 7
1129	1129	of the 2020 Session Laws of Kansas and this act shall take effect on and
1130	1130	after January 1 or July 1 immediately following such publication of such
1131	1131	approval.
1132	1132	Sec. 18. K.S.A. 2023 Supp. 65-6209 is hereby amended to read as
1133	1133	follows: 65-6209. (a) A hospital provider that is a state agency, the
1134	1134	authority, as defined in K.S.A. 76-3304, and amendments thereto, a state
1135	1135	educational institution, as defined in K.S.A. 76-711, and amendments
1136	1136	thereto, a critical access hospital, as defined in K.S.A. 65-468, and
1137	1137	amendments thereto, or a rural emergency hospital licensed under the rural
1138	1138	emergency hospital act, K.S.A. 2023 Supp. 65-481 et seq., and
1139	1139	amendments thereto, is exempt from the assessment imposed by K.S.A.
1140	1140	65-6208(a), and amendments thereto, but not the surcharge imposed by
1141	1141	K.S.A. 65-6208(b), and amendments thereto.
1142	1142	(b) A hospital operated by the department in the course of performing
1143	1143	its mental health or developmental disabilities functions is exempt from
1144	1144	the assessment imposed by K.S.A. 65-6208(a), and amendments thereto,
1145	1145	but not the surcharge imposed by K.S.A. 65-6208(b), and amendments
1146	1146	thereto.
1147	1147	Sec. 19. K.S.A. 65-6210 is hereby amended to read as follows: 65-
1148	1148	6210. (a) The assessment imposed by K.S.A. 65-6208(a), and amendments
1149	1149	thereto, for any state fiscal year to which this statute applies shall be due
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1192	1192	43 HB 2002 15
1193	1193	and payable in equal installments on or before June 30 and December 31,
1194	1194	commencing with whichever date first occurs after the hospital has
1195	1195	received payments for 150 days after the effective date of the payment
1196	1196	methodology approved by the centers for medicare and medicaid services.
1197	1197	The surcharge imposed by K.S.A. 65-6208(b), and amendments thereto, for
1198	1198	any state fiscal year to which this statute applies shall be due and payable
1199	1199	in installments on or before June 30 and December 31, commencing with
1200	1200	June 30, 2027. The payment made by each hospital provider on or before
1201	1201	June 30 shall be in an amount not less than
1202	1202	1
1203	1203	/3 of such hospital provider's
1204	1204	proportionate share determined in accordance with K.S.A. 65-6218(d),
1205	1205	and amendments thereto. The payment made by each hospital provider on
1206	1206	or before December 31 shall be the remainder of the amount owed for
1207	1207	such hospital provider's proportionate share. No installment payment of
1208	1208	an assessment under this act shall be due and payable, however, until after:
1209	1209	(1) The hospital provider receives written notice from the department
1210	1210	that the payment methodologies to hospitals required under this act have
1211	1211	been approved by the centers for medicare and medicaid services of the
1212	1212	United States department of health and human services under 42 C.F.R. §
1213	1213	433.68 for the assessment imposed by K.S.A. 65-6208, and amendments
1214	1214	thereto, has been granted by the centers for medicare and medicaid
1215	1215	services of the United States department of health and human services; and
1216	1216	(2) in the case of a hospital provider, the hospital has received
1217	1217	payments for 150 days after the effective date of the payment methodology
1218	1218	approved by the centers for medicare and medicaid services.
1219	1219	(b) The department is authorized to establish delayed payment
1220	1220	schedules for hospital providers that are unable to make installment
1221	1221	payments when due under this section due to financial difficulties, as
1222	1222	determined by the department.
1223	1223	(c) If a hospital provider fails to pay the full amount of an installment
1224	1224	when due, including any extensions granted under this section, there shall
1225	1225	be added to the assessment or surcharge imposed by K.S.A. 65-6208(a) or
1226	1226	(b), and amendments thereto, unless waived by the department for
1227	1227	reasonable cause, a penalty assessment equal to the lesser of:
1228	1228	(1) An amount equal to 5% of the installment amount not paid on or
1229	1229	before the due date plus 5% of the portion thereof remaining unpaid on the
1230	1230	last day of each month thereafter; or
1231	1231	(2) an amount equal to 100% of the installment amount not paid on or
1232	1232	before the due date.
1233	1233	For purposes of subsection (c), payments will be credited first to unpaid
1234	1234	installment amounts, rather than to penalty or interest amounts, beginning
1235	1235	with the most delinquent installment.
1236	1236	(d) The effective date for the payment methodology applicable to
1237	1237	hospital providers approved by the centers for medicare and medicaid
1238	1238	1
1239	1239	2
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1280	1280	43 HB 2002 16
1281	1281	services shall be the date of July 1 or January 1, whichever date is
1282	1282	designated in the state plan submitted by the department of health and
1283	1283	environment for approval by the centers for medicare and medicaid
1284	1284	services.
1285	1285	Sec. 20. K.S.A. 65-6211 is hereby amended to read as follows: 65-
1286	1286	6211. (a) After December 31 of each year, except as otherwise provided in
1287	1287	this subsection, and on or before March 31 of the succeeding year, the
1288	1288	department shall send a notice of assessment imposed under K.S.A. 65-
1289	1289	6208(a), and amendments thereto, to every hospital provider subject to
1290	1290	assessment under this act. (b) The hospital provider notice of assessment
1291	1291	shall notify the hospital provider of its assessment for the state fiscal year
1292	1292	commencing on the next July 1.
1293	1293	(b) On or before April 30 and October 31 of each year, the
1294	1294	department shall send a notice of surcharge imposed under K.S.A. 65-
1295	1295	6208(b), and amendments thereto, to each hospital provider subject to the
1296	1296	surcharge. The department shall send the first such notice on or before
1297	1297	April 30, 2027.
1298	1298	(c) If a hospital provider operates, conducts or maintains more than
1299	1299	one licensed hospital in the state, the hospital provider shall pay the any
1300	1300	assessment or surcharge imposed under K.S.A. 65-6208(a) or (b), and
1301	1301	amendments thereto, for each hospital separately.
1302	1302	(d) Notwithstanding any other provision in this act, in the case of a
1303	1303	person who ceases to operate, conduct or maintain a hospital in respect of
1304	1304	for which the person is subject to assessment in K.S.A. 65-6208(a), and
1305	1305	amendments thereto, as a hospital provider, the assessment for the state
1306	1306	fiscal year in which the cessation occurs shall be adjusted by multiplying
1307	1307	the assessment computed under K.S.A. 65-6208(a), and amendments
1308	1308	thereto, by a fraction, the numerator of which is the number of the days
1309	1309	during the year during which the provider operates, conducts or maintains
1310	1310	a hospital and the denominator of which is 365. Immediately upon ceasing
1311	1311	to operate, conduct or maintain a hospital, the person shall pay the
1312	1312	adjusted assessment for that state fiscal year, to the extent not previously
1313	1313	paid.
1314	1314	(e) Notwithstanding any other provision in this act, in the case of a
1315	1315	person who ceases to operate, conduct or maintain a hospital for which
1316	1316	the person is subject to surcharge in K.S.A. 65-6208(b), and amendments
1317	1317	thereto, as a hospital provider, the surcharge for the six-month period in
1318	1318	which the cessation occurs shall be adjusted by multiplying the surcharge
1319	1319	computed under K.S.A. 65-6208(b), and amendments thereto, by a
1320	1320	fraction, the numerator of which is the number of the days during the six
1321	1321	months during which the provider operates, conducts or maintains a
1322	1322	hospital and the denominator of which is the days in the same six-month
1323	1323	period. Immediately upon ceasing to operate, conduct or maintain a
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1366	1366	43 HB 2002 17
1367	1367	hospital, the person shall pay the adjusted assessment for that six-month
1368	1368	period, to the extent not previously paid.
1369	1369	(f) Notwithstanding any other provision in this act, a person who
1370	1370	commences operating, conducting or maintaining a hospital shall pay the
1371	1371	assessment computed under subsection (a) of K.S.A. 65-6208(a), and
1372	1372	amendments thereto, in installments on the due dates stated in the notice
1373	1373	and on the regular installment due dates for the state fiscal year occurring
1374	1374	after the due dates of the initial notice.
1375	1375	Sec. 21. K.S.A. 65-6212 is hereby amended to read as follows: 65-
1376	1376	6212. (a) The assessment imposed by K.S.A. 65-6208(a), and amendments
1377	1377	thereto, shall not take effect or shall cease to be imposed and any moneys
1378	1378	remaining in the fund attributable to assessments imposed under K.S.A.
1379	1379	65-6208(a), and amendments thereto, shall be refunded to hospital
1380	1380	providers in proportion to the amounts paid by them if the payments to
1381	1381	hospitals required under subsection (a) of K.S.A. 65-6218(a), and
1382	1382	amendments thereto, are changed or are not eligible for federal matching
1383	1383	funds under title XIX or XXI of the federal social security act.
1384	1384	(b) The assessment and surcharge imposed by K.S.A. 65-6208(a)
1385	1385	and (b), and amendments thereto, shall not take effect or shall cease to be
1386	1386	imposed if the assessment is determined to be an impermissible tax under
1387	1387	title XIX of the federal social security act. Moneys in the health care
1388	1388	access improvement fund or the hospital medicaid expansion support
1389	1389	surcharge fund derived from assessments or surcharges imposed prior
1390	1390	thereto shall be disbursed in accordance with subsection (a) of K.S.A. 65-
1391	1391	6218(a) or (b), and amendments thereto, to the extent that federal
1392	1392	matching is not reduced due to the impermissibility of the assessments or
1393	1393	surcharges, and any remaining moneys shall be refunded to hospital
1394	1394	providers in proportion to the amounts paid by them.
1395	1395	Sec. 22. K.S.A. 65-6217 is hereby amended to read as follows: 65-
1396	1396	6217. (a) There is hereby created in the state treasury the health care
1397	1397	access improvement fund, which . Such fund shall be administered by the
1398	1398	secretary of health and environment. All moneys received for the
1399	1399	assessments imposed by K.S.A. 65-6208(a) and 65-6213, and amendments
1400	1400	thereto, including any penalty assessments imposed thereon, shall be
1401	1401	remitted to the state treasurer in accordance with K.S.A. 75-4215, and
1402	1402	amendments thereto. Upon receipt of each such remittance, the state
1403	1403	treasurer shall deposit the entire amount in the state treasury to the credit
1404	1404	of the health care access improvement fund. All expenditures from the
1405	1405	health care access improvement fund shall be made in accordance with
1406	1406	appropriation acts upon warrants of the director of accounts and reports
1407	1407	issued pursuant to vouchers approved by the secretary of health and
1408	1408	environment or the secretary's designee.
1409	1409	(b) There is hereby created in the state treasury the hospital medicaid
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1452	1452	43 HB 2002 18
1453	1453	expansion support surcharge fund to be administered by the secretary of
1454	1454	health and environment. All moneys received for the surcharge imposed by
1455	1455	K.S.A. 65-6208(b), and amendments thereto, including any penalty
1456	1456	assessments imposed thereon, shall be remitted to the state treasurer in
1457	1457	accordance with K.S.A. 75-4215, and amendments thereto. Upon receipt of
1458	1458	each such remittance, the state treasurer shall deposit the entire amount
1459	1459	into the state treasury to the credit of the hospital medicaid expansion
1460	1460	support surcharge fund. All expenditures from the hospital medicaid
1461	1461	expansion support surcharge fund shall be made in accordance with
1462	1462	appropriation acts upon warrants of the director of accounts and reports
1463	1463	issued pursuant to vouchers approved by the secretary of health and
1464	1464	environment or the secretary's designee.
1465	1465	(c) The fund funds shall not be used to replace any moneys
1466	1466	appropriated by the legislature for the department's medicaid program.
1467	1467	(c)(d) The fund is funds are created for the purpose of receiving
1468	1468	moneys in accordance with this act and disbursing moneys only for the
1469	1469	purpose of improving health care delivery and related health activities,
1470	1470	notwithstanding any other provision of law.
1471	1471	(d)(e) On or before the 10
1472	1472	th
1473	1473	day of each month, the director of
1474	1474	accounts and reports shall transfer from the state general fund to the health
1475	1475	care access improvement fund and the hospital medicaid expansion
1476	1476	support surcharge fund interest earnings based on:
1477	1477	(1) The average daily balance of moneys in the health care access
1478	1478	improvement each such fund for the preceding month; and
1479	1479	(2) the net earnings rate of the pooled money investment portfolio for
1480	1480	the preceding month.
1481	1481	(e)(f) The fund funds shall consist of the following:
1482	1482	(1) All moneys collected or received by the department from the
1483	1483	hospital provider assessment and surcharge and the health maintenance
1484	1484	organization assessment imposed by this act;
1485	1485	(2) any interest or penalty levied in conjunction with the
1486	1486	administration of this act; and
1487	1487	(3) all other moneys received for the fund funds from any other
1488	1488	source.
1489	1489	(f)(g) (1) On July 1 of each fiscal year, the director of accounts and
1490	1490	reports shall record a debit to the state treasurer's receivables for the health
1491	1491	care access improvement fund and shall record a corresponding credit to
1492	1492	the health care access improvement fund in an amount certified by the
1493	1493	director of the budget which that shall be equal to the sum of 80% of the
1494	1494	moneys estimated by the director of the budget to be received from the
1495	1495	assessment imposed on hospital providers pursuant to K.S.A. 65-6208(a),
1496	1496	and amendments thereto, and credited to the health care access
1497	1497	improvement fund during such fiscal year, plus 53% of the moneys
1498	1498	1
1499	1499	2
1500	1500	3
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1540	1540	43 HB 2002 19
1541	1541	estimated by the director of the budget to be received from the assessment
1542	1542	imposed on health maintenance organizations pursuant to K.S.A. 65-6213,
1543	1543	and amendments thereto, and credited to the health care access
1544	1544	improvement fund during such fiscal year, except that such amount shall
1545	1545	be proportionally adjusted during such fiscal year with respect to any
1546	1546	change in the moneys estimated by the director of the budget to be
1547	1547	received for such assessments under K.S.A. 65-6208(a) and 65-6213, and
1548	1548	amendments thereto, deposited in the state treasury and credited to the
1549	1549	health care access improvement fund during such fiscal year. Among other
1550	1550	appropriate factors, the director of the budget shall take into consideration
1551	1551	the estimated and actual receipts from such assessments for the current
1552	1552	fiscal year and the preceding fiscal year in determining the amount to be
1553	1553	certified under this subsection (f) paragraph. All moneys received for the
1554	1554	assessments imposed pursuant to K.S.A. 65-6208(a) and 65-6213, and
1555	1555	amendments thereto, deposited in the state treasury and credited to the
1556	1556	health care access improvement fund during a fiscal year shall reduce the
1557	1557	amount debited and credited to the health care access improvement fund
1558	1558	under this subsection (f) paragraph for such fiscal year.
1559	1559	(2) On July 1 of each fiscal year, the director of accounts and reports
1560	1560	shall record a debit to the state treasurer's receivables for the hospital
1561	1561	medicaid expansion support surcharge fund and shall record a
1562	1562	corresponding credit to the hospital medicaid expansion support
1563	1563	surcharge fund in an amount certified by the director of the budget that
1564	1564	shall be equal to 100% of the moneys estimated by the director of the
1565	1565	budget to be received from any surcharge imposed on hospital providers in
1566	1566	accordance with K.S.A. 65-6208(b), and amendments thereto, and credited
1567	1567	to the hospital medicaid expansion support surcharge fund during such
1568	1568	fiscal year, except that such amount shall be proportionally adjusted
1569	1569	during such fiscal year with respect to any change in the moneys estimated
1570	1570	by the director of the budget to be received for such surcharge in
1571	1571	accordance with K.S.A. 65-6208(b), and amendments thereto, deposited in
1572	1572	the state treasury and credited to the hospital medicaid expansion support
1573	1573	surcharge fund during such fiscal year. Among other appropriate factors,
1574	1574	the director of the budget shall take into consideration the estimated and
1575	1575	actual receipts from such surcharge for the current fiscal year and the
1576	1576	preceding fiscal year in determining the amount to be certified under this
1577	1577	paragraph. All moneys received for the surcharge imposed under K.S.A.
1578	1578	65-6208(b), and amendments thereto, deposited in the state treasury and
1579	1579	credited to the hospital medicaid expansion support surcharge fund during
1580	1580	a fiscal year shall reduce the amount debited and credited to the hospital
1581	1581	medicaid expansion support surcharge fund under this paragraph for such
1582	1582	fiscal year.
1583	1583	(3) On June 30 of each fiscal year, the director of accounts and
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1626	1626	43 HB 2002 20
1627	1627	reports shall adjust the amounts debited and credited to the state treasurer's
1628	1628	receivables and to the health care access improvement fund and the
1629	1629	hospital medicaid expansion support surcharge fund pursuant to this
1630	1630	subsection (f), to reflect all moneys actually received for the assessments
1631	1631	and surcharge imposed pursuant to K.S.A. 65-6208 and 65-6213, and
1632	1632	amendments thereto, deposited in the state treasury and credited to the
1633	1633	health care access improvement fund and the hospital medicaid expansion
1634	1634	support surcharge fund during the current fiscal year.
1635	1635	(3)(4) The director of accounts and reports shall notify the state
1636	1636	treasurer of all amounts debited and credited to the health care access
1637	1637	improvement fund and the hospital medicaid expansion support surcharge
1638	1638	fund pursuant to this subsection (f) and all reductions and adjustments
1639	1639	thereto made pursuant to this subsection (f). The state treasurer shall enter
1640	1640	all such amounts debited and credited and shall make reductions and
1641	1641	adjustments thereto on the books and records kept and maintained for the
1642	1642	health care access improvement fund by the state treasurer in accordance
1643	1643	with the notice thereof.
1644	1644	Sec. 23. K.S.A. 2023 Supp. 65-6218 is hereby amended to read as
1645	1645	follows: 65-6218. (a) (1) Assessment revenues generated from the hospital
1646	1646	provider assessments under K.S.A. 65-6208(a), and amendments thereto,
1647	1647	shall be disbursed as follows:
1648	1648	(A) Not less than 80% of assessment revenues shall be disbursed to
1649	1649	hospital providers through a combination of medicaid access improvement
1650	1650	payments and increased medicaid rates on designated diagnostic related
1651	1651	groupings, procedures or codes;
1652	1652	(B) not more than 20% of assessment revenues shall be disbursed to
1653	1653	providers who are persons licensed to practice medicine and surgery or
1654	1654	dentistry through increased medicaid rates on designated procedures and
1655	1655	codes; and
1656	1656	(C) not more than 3.2% of hospital provider assessment revenues
1657	1657	shall be used to fund healthcare access improvement programs in
1658	1658	undergraduate, graduate or continuing medical education, including the
1659	1659	medical student loan act.
1660	1660	(2) On July 1 of each year, the department of health and environment,
1661	1661	with approval of the healthcare access improvement panel, shall make
1662	1662	adjustments to the disbursement of moneys in accordance with this
1663	1663	subsection to cause such disbursements to be paid solely from moneys
1664	1664	appropriated from the healthcare access improvement fund. The healthcare
1665	1665	access improvement fund shall not be supplemented by appropriations
1666	1666	from the state general fund for the purpose of making disbursements under
1667	1667	this subsection.
1668	1668	(b) Surcharge revenues generated from the hospital medicaid
1669	1669	expansion support surcharge under K.S.A. 65-6208(b), and amendments
1670	1670	1
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1712	1712	43 HB 2002 21
1713	1713	thereto, shall be disbursed to offset the costs to the state related to
1714	1714	medicaid expansion beneficiaries as calculated in K.S.A. 65-6207(a), and
1715	1715	amendments thereto.
1716	1716	(c) For the purposes of administering and selecting the disbursements
1717	1717	described in subsections subsection (a) and (b), oversight of the
1718	1718	calculation of the annual hospital medicaid expansion support payment
1719	1719	and any surcharge under K.S.A. 65-6208(b), and amendments thereto, the
1720	1720	healthcare access improvement panel is hereby established. The panel shall
1721	1721	consist of the following: Three members appointed by the Kansas hospital
1722	1722	association, two members appointed by the Kansas medical society, one
1723	1723	member appointed by each health maintenance organization that has a
1724	1724	medicaid managed care contract with the department of health and
1725	1725	environment, one member appointed by the community care network of
1726	1726	Kansas, one member appointed by the president of the senate, one member
1727	1727	appointed by the speaker of the house of representatives, one member
1728	1728	from the office of the medicaid inspector general appointed by the attorney
1729	1729	general and one representative of the department of health and
1730	1730	environment appointed by the governor. The panel shall elect a
1731	1731	chairperson from among the members appointed by the Kansas hospital
1732	1732	association. A representative of the panel shall be required to make an
1733	1733	annual report to the legislature regarding the collection and distribution of
1734	1734	all funds received and distributed under this act, and such report shall
1735	1735	include analysis demonstrating that disbursements made in accordance
1736	1736	with subsection (a) are budget neutral to the state general fund.
1737	1737	(c)(d) The panel shall use the following procedure to approve
1738	1738	collection of surcharge revenues under K.S.A. 65-6208(b), and
1739	1739	amendments thereto, for each calendar year beginning with calendar year
1740	1740	2027 based upon the total number of unduplicated medicaid expansion
1741	1741	enrollees for such year:
1742	1742	(1) By March 31 and September 30, the department shall certify to
1743	1743	the panel the total number of unduplicated medicaid expansion enrollees
1744	1744	using data from the most recent end-of- month report.
1745	1745	(2) The panel shall review the number certified by the department,
1746	1746	consult with the department regarding any proposed deletions and certify
1747	1747	the final number of unduplicated medicaid expansion enrollees by April 15
1748	1748	and October 15.
1749	1749	(3) Each hospital's share of the annual hospital medicaid expansion
1750	1750	support surcharge shall be determined by the panel based upon such
1751	1751	hospital's proportion of total hospital revenues. The panel shall certify to
1752	1752	the department the amount of each hospital's surcharge by April 30 and
1753	1753	October 31. The surcharge for any hospital that has not yet filed a
1754	1754	medicare cost report shall pay the lowest surcharge payable by its hospital
1755	1755	licensure category as defined by K.S.A. 65-425, and amendments thereto.
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1799	1799	(4) For purposes of this subsection, the total surcharge revenues to
1800	1800	be certified for any calendar year shall not exceed $35,000,000, and any
1801	1801	annual hospital medicaid expansion support surcharge in excess of
1802	1802	$35,000,000 shall be disregarded.
1803	1803	(5) As used in this subsection:
1804	1804	(A) "Total hospital revenues" means the sum of inpatient and
1805	1805	outpatient revenues for all hospital providers as reflected in the applicable
1806	1806	medicare cost report.
1807	1807	(B) "Applicable medicare cost report" means, for calendar year
1808	1808	2025, such report filed by each hospital for calendar year 2023 or, if the
1809	1809	hospital did not file a medicare cost report for calendar year 2023, the
1810	1810	first year that the hospital filed a medicare cost report. For each calendar
1811	1811	year after 2025, the applicable medicare cost report shall advance by one
1812	1812	year.
1813	1813	(1)(e) The department of health and environment shall submit to the
1814	1814	United States centers for medicare and medicaid services any approval
1815	1815	request necessary to implement the amendments made to this section by
1816	1816	this act section 2 of chapter 7 of the 2020 Session Laws of Kansas. If the
1817	1817	department has submitted such a request pursuant to section 80(l) of
1818	1818	chapter 68 of the 2019 Session Laws of Kansas, then the department may
1819	1819	continue such request, or modify such request to conform to the
1820	1820	amendments made to subsections (a) and (b) by this act, to fulfill the
1821	1821	requirements of this paragraph.
1822	1822	(2)(f) The secretary of health and environment shall certify to the
1823	1823	secretary of state the receipt of such approval and cause notice of such
1824	1824	approval to be published in the Kansas register.
1825	1825	(3) The amendments made to subsections (a) and (b) by this act shall
1826	1826	take effect on and after January 1 or July 1 immediately following such
1827	1827	publication of such approval.
1828	1828	Sec. 24. K.S.A. 39-7,160, 40-3213, 65-6207, 65-6210, 65-6211, 65-
1829	1829	6212 and 65-6217 and K.S.A. 2023 Supp. 65-6208, 65-6209 and 65-6218
1830	1830	are hereby repealed.
1831	1831	Sec. 25. This act shall take effect and be in force from and after its
1832	1832	publication in the Kansas register.
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