TOPEKA — A Kansas bill signed in late April would bring sweeping changes to provide new funding sources and increased access to rural health care and mental health services across the state.
A centerpiece provision of House Bill 2208 would allow Kansas hospitals to take advantage of federal action in December, which created the designation of “Rural Emergency Hospitals.” The similarly named Rural Emergency Hospital Act would enable certain Kansas hospitals to certify under this umbrella, allowing them to lower the number of mandated beds and better control costs.
Proponents of the measure say significant shifts in population, and a growing number of uninsured residents in Kansas are driving up uncompensated care costs. Current financing does not allow rural hospitals to adapt and threaten rural health care in Kansas, said David Jordan, president of the Hutchinson-based United Methodist Health Ministry Fund.
“A strong health system is critical to thriving rural communities and the health of rural Kansans,” Jordan said. “Even before COVID-19 began surging in rural Kansas, it was becoming more difficult to sustain health care services in a changing Kansas, where the rural health system is starved of resources with limited opportunity to innovate.”
The bill passed the House on a vote of 120-2 and the Senate on a vote of 34-4. In late April, Gov. Laura Kelly signed it into law. It also established certification for community behavioral health clinics, or CCBHCs, authorized licensed out-of-state physicians with telemedicine waivers to practice, and provides grants for economically distressed rural hospitals.
The rural hospital innovation grant fund would offer $10 million in funding to increase access to health care services in eligible counties and to maintain optimal health by providing transitional assistance to hospitals. Any county in Kansas other than Douglas, Johnson, Sedgwick, Shawnee or Wyandotte would be eligible to apply for the funds to help an area hospital.
An amendment requires that federal funds, if available, be used before monies are pulled from the state coffers. Counties would also be required to provide updates on the success of the program within a year after funds are awarded.
Still, Sen. Mark Steffen, R-Hutchinson, was strongly against the idea of possibly funneling millions of taxpayer dollars to these hospitals. He also was apprehensive about allowing out-of-state providers to continue to practice using telemedicine.
“The Rural Emergency Hospital Act does not put a monetary burden on the hospitals that voluntarily opt in to this designation. The $10 million giveaway is inappropriate,” Steffen said. “Telemedicine by out of state physicians and licensed in Kansas is a threat to our rural providers.”
Should the county not use these funds properly, the law dictates they would be on the hook for repayments.
Tara Mays, vice president of state legislative relations for the Kansas Hospital Association, however, championed the grants as a necessary step to addressing financial dilemmas.
According to a report by The Chartis Center for Rural Health, the percent of rural hospitals nationally operating at a financial loss has risen to 47%; an increase of 9% over the past five years. The same report suggests that the percentage for Kansas hospitals is 74%.
Mays said the grants would work in concert with the new rural emergency hospital designation.
“The health care delivery system in rural communities are a tremendous asset to Kansas, the communities they support, and the individual patients they serve,” Mays said. “For those communities that decide a new approach is needed, House Bill 2174 could be a tool to assist in analyzing options and preparing for a new model of care delivery.”
Mental health services
Through the newly established certification process for Kansas CCBHCs, the measure would also mark what some called the “most significant transformation” of the state mental health system in decades.
The 1990 Kansas Mental health Reform Act established Community Mental Health Centers to provide “safety net” services to those with mental health needs in all 105 counties. The act marked a transition from institutional services to a community-based care approach to mental health issues.
Many of the 26 licensed CMHCs across the state are facing challenges with increased demand for services and workforce shortages. The measure will aid the six of these centers already working to implement the CCBHC model by May 2022 and, over the next three years, the rest of the clinics.
“Access to mental health services are integral to building stronger communities, especially as we continue to recover from the pandemic,” Kelly said in signing the bill. “I’m proud we are the first state to establish this model as another step in the right direction toward addressing the mental health crisis we face.”
By enacting the bill, Kansas became the first state to pass legislation to identify the CCBHC model as a primary opportunity to address the mental health and substance abuse crises.
CCBHCs are designed to aid in breaking down barriers to timely or adequate mental health treatment, relieve pressure on overburdened jails and emergency departments and provide outlets for those dealing with addictions. These clinics offer an integrated care approach focused on wellness, trauma-informed care, recovery and integrating physical and behavioral health.
“CCBHCs provide a high return on investment, both in terms of patient care and cost to the state,” said Laura Howard, secretary for the Kansas Department for Aging and Disability Services. “The expanded service array allows for vulnerable individuals to receive care in the most appropriate setting in their own communities and fill a gap in the unmet need for care.”