In the 2017 legislative term, Kansas sought to expand its state Medicaid program. The bill, HB 2044, passed in the House and the Senate, but was vetoed by the Governor. In recent legislative sessions, the state introduced, but did not pass, legislation that would have advanced price transparency. SB172 would require healthcare entities to disclose to patients the “allowed amount” an entity may charge patients for services, and SB122 would require hospitals to disclose facility fees to patients.
Kansas’s current regular legislative session runs from 1/8/2018 – 4/8/2018.
Recent Legislative Developments
|2018||SB 351||KANSAS PHARMACY PATIENTS FAIR PRACTICES ACT: Prohibits pharmacy benefits managers from requiring, or restricting actions of pharmacists and pharmacies that that would be detrimental to a covered person’s ability to make an informed decision regarding prescription and pharmacy services.||Passed – Enrolled and presented to Governor on 3/26/18.|
|2017||HB2300||RX TRANSPARENCY ACT: The Rx transparency act requires that PBMs contracting with the state (employee) health care benefits program act as a fiduciary and disclose any payment or benefit received for the dispensing of a prescription drug. The PBM would also disclose all financial and utilization information requested by the program. Any payment or benefit received by the PBM for the dispensing of a prescription drug will be passed-through in full to the state.||Inactive –Died.|
|THE PATIENT RIGHT TO SHOP ACT: would require health care entities to disclose, within two working days, the allowed amount or charge of a patient or prospective patient’s admission, procedure, or service if the patient so requests. If the health care entity were not able to predict a specific code, it would still be required to disclose the maximum allowed amount.
SB172 would also require health carriers establish a toll-free phone number and a website that enables its insureds to request and obtain carrier information on the average price paid to a participating provider for a proposed admission, procedure, or service in each provider network area established b the carrier and an estimated cost. The carrier would be required to respond to an insured’s request with a binding estimate for the maximum allowed amount or charge within two business days—and would include facility fees, copayments, deductibles, coinsurances, and other out-of-pocket amounts.
If an insured were to elect to receive health care services from a participating provider that cost less than the average cost for a particular admission, procedure or service, a carrier would have to pay to an insured 50% of the saved cost except that a carrier would not required to make such payment if the saved cost is $25 or less. If an insured were to elect to receive health care services from an out-of- network provider that costs less than the average cost for a particular admission, procedure or service, a carrier would have to apply the insured’s share of the cost of those health care services as specified in the insured’s health benefit plan toward the insured’s out-of-pocket limit as if the health care services were provided by a participating provider.
|FEES AND CHARGES FOR SERVICES PROVIDED AT HOSPITAL-BASED FACILITIES: would require hospitals and health systems that charge a facility fee that utilize a current procedural terminology evaluation and management (CPT E/M) code for outpatient or diagnostic testing provided at a hospital-based facility where a professional fee is also expected to be charged to provide the patient with a written notice that includes information about: the patient’s potential financial liability and the fee likely to be charged. This would also need to be prominently displayed in locations that are readily accessible to and easily visible by patients. For emergency care, such written notice would need to be provided to the patient as soon as practicable after the patient is stabilized or is determined not to have an emergency medical condition before the patient leaves the hospital-based facility.||Inactive -Died.|
- None identified.
|2017||HB 2044||MEDICAID EXPANSION – KANCARE BRIDGE TO A HEALTHY KANSAS PROGRAM: Establishes the KanCare Bridge to a Healthy Kansas Program (Program). The Kansas Department of Health and Environment (KDHE) is required to administer and promote the Program and provide information to potential eligible individuals who live in medically underserved areas of the state. The bill modifies the eligibility requirements for the Kansas Medical Assistance Program, on or after January 1, 2018, to include any non-pregnant adult under 65 years of age who is a U.S. citizen or legal resident and who has been a resident of Kansas for at least 12 months, whose income does not exceed 133 percent of the federal poverty level (FPL), to the extent allowed under the federal Social Security Act as it exists on the effective date of the bill, and subject to the requirements of the Program.||Inactive – Vetoed by Governor on 3/30/17.|
We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.
Transparency in Healthcare
- Kansas Stat. Ann. § 65-6801 through 6809 creates a health care database called the Data Analytic Interface (DAI), organized as an all-payer claims database (APCD) within the department of health services administration, with inputs from Medicaid/SCHIP, the State Employee Health Plan/Worker’s Compensation system, and the Kansas Health Insurance Information System (KHIIS). An all-payer claims database (APCD) is a database for aggregating health care claims data from payers, providers, and other reporting entities in order to compare costs among physicians and health care systems, promote cost containment and facilitate quality improvement. The Kansas Health Data Consortium publishes healthcare market reports derived from the DAI.
- Kansas Stat. Ann. § 40-5108 directs insurers that use insurance scores to underwrite and rate risks to file such score with the department of insurance; provided, however, that such filings relating to insurance scoring models or processes shall be considered to be trade secret and confidential open records acts, shielding them from consumer access.
- Kansas Stat. Ann. § 65-4955 through 4961 permits the state attorney general to authorize cooperative agreements between health care providers by issuing a certificate of public advantage (COPA) if the “likely benefits resulting from the agreements outweigh the disadvantages attributable to a reduction in competition that may result from such agreements.” A COPA is typically issued to cooperating or merging entities to confer state action immunity from prosecution under federal antitrust laws.
- Kansas Stat. Ann. § 40-2215 provides that a policy or certificate of health insurance may not be issued or delivered to consumers without prior approval of the Director of Insurance. Premium rates applicable to the health insurance policy or certificate may not be used unless they have been approved by the Director, who may disapprove a filing if the benefits provided in the policies or certificates are unreasonable in relation to the premiums charged.
- Kansas Stat. Ann § 65-1626 deletes, adds, and modifies definitions to be consistent with federal standards; modifies the requirements for processing prescription orders to prohibit pharmacists from exercising brand exchange for a biological product; inserts provisions to bring the Act into compliance with the federal Drug Supply Chain Security Act. The bill also amends the Act to allow a pharmacist to exercise brand exchange (substitution) of biological products without prior approval from the prescriber, unless certain conditions exist. The bill requires pharmacists to notify the patient and prescriber of the substitution of a biological product after the exchange has occurred and establishes recording requirements for biological product substitutions.
FY 2018 BUDGET
Kansas’ fiscal year begins on July 1 and ends on June 30 of the following year. Kansas enacted its FY 2018 Budget during the regular legislative session. To view Kansas’s FY 2018 Budget, click here.
- As a condition of the sale of the Sisters of Charity of Leavenworth Health System, Inc., which owned and operated two hospitals in Wyandotte and Leavenworth counties, California-based Prime Healthcare Services, Inc. have agreed with the Attorney General in 2013 to provide charitable care in the Kansas City and Leavenworth communities “at a level at least equal to that provided by the hospitals’ prior owner” for the next 5 years.