[{"_1":2,"_124":-5,"_125":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100,112],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6518930,"mediaKeyId","5383711-8a96a61a4ff059cce721911b75ac877a","parentId",5383711,"title","State hospital leaders report heavy reliance on contract nursing, expanded bonuses and an in‑progress regional hospital project","audioSeconds",919,"startMs",10514000,"endMs",11433000,"viewUrl","/Search/View?dp=1&key=5383711-8a96a61a4ff059cce721911b75ac877a&start=10514&end=11433","thumbnailUrl","https://assets.pipeline.soar.com/5383711-8a96a61a4ff059cce721911b75ac877a/thumbnail_10514000.jpg","articleUrl","/articles/6518930/Kansas/State-hospital-leaders-report-heavy-reliance-on-contract-nursing-expanded-bonuses-and-an-inprogress-regional-hospital-project","mediaUrl","https://secure.pipeline.soar.com/6518930-e5e18dae45a999f80bf194d186176f88/orig.mp4?Expires=1770992768&Signature=Z0Nwo7DTJeGMK2IVvTgxF02Y4TEDgS1bsEgSsPu1wRg38-cHrLvKBvqx2mVO0EE-GqoHUt2vKUgqkVOQEJXl5UcRw3rynaXBNGcmZJ5GRjCd2zU7vn2rjikKBaBOBwgmYNCprhqpyWHY7n-HU4rBGEPoOaYYI-0glTVGeUaNxbkYNnzYx9J72bLIbhCvLTHK1RxAJgqf-aPndON-ZMcoO2L5y9qyzeDS33~qgR5fWkMpmck2zF-d3PyIegelpA4mXO-3lRIztXHRoQO~1E52JjacWmWi1v-B~eFwWCx8bbJYjELz07WdVaAQy0dM5Ksx21mo0uP~sojD2WM9sDGQsA__&Key-Pair-Id=KUT5TJCACFTXG","author","Joint Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight ","date","2025-07-14T17:52:06Z","article","Scott Bruner, deputy secretary for hospitals and facilities at KDADS, reported that the state hospitals have continued to rely on contract nursing to preserve bed capacity even as the department implemented pay and incentive changes intended to retain staff.

Bruner said the state has invested in base-pay increases and 24/7 facility incentives and that the department has used recruitment and retention tools including sign-on bonuses, referral bonuses and targeted shift pickup bonuses. He provided figures showing thousands of retention and sign-on payments across campuses and said pickup-shift bonuses — $100 for selected shifts — were intended to give staff flexible overtime options and reduce forced overtime.

On contract staffing, KDADS reported large expenditures in fiscal 2025: Larned State Hospital’s contract-nursing cost was presented as roughly $44.9 million for the fiscal year (approximately 232 contract nursing positions), and Osawatomie State Hospital’s contract-labor spend was presented at about $15.2 million (about 105 contract nursing positions). KDADS said it has capped contract nurse rates on state contracts and attempted conversions of some agency nurses to state staff where possible.

Bruner also outlined progress on a South Central Regional Mental Health Hospital (a 104‑bed project). The state budget has provided multi‑year construction funding; KDADS plans partial staffing budget entries in FY26 and full operational budgets in FY27 to reflect a planned January 2027 opening.

On the justice- and hospital-related operations side, Bruner described mobile competency initiatives and reimbursement programs: KDADS has supported pilot mobile competency evaluations and contracted with community mental health centers for competency work to reduce long waits for court‑ordered competency evaluations and restorations. The department also administers reimbursements under statutes that pay counties for days defendants wait for admission and payments that reimburse observation and transport costs for providers when patients are waiting for state hospital beds.

Ending: Committee members asked KDADS for additional breakdowns: line‑by‑line contract‑labor details, the county and hospital reimbursement totals by recipient, and evidence of how bonuses and pay changes have affected vacancy and turnover rates.

","mediaType","Video","parentTitle","Robert G. Bethell Joint Committee on Home & Community Based Services & KanCare Oversight 07/14/2025","oneSentenceSummary","KDADS and state hospital officials told the committee about persistent vacancy rates, large contract‑nurse expenditures, incentives and plans for a new south‑central regional mental health hospital; they also described mobile competency work and county reimbursement programs.","taxTitle","Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight, Joint, Committees, Legislative, Kansas","taxId",21042,"location","Kansas","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6518935,"KDADS outlines HCBS waiver growth, IDD wait‑list and community care coordination plans",664,9044000,9708000,"/Search/View?dp=1&key=5383711-8a96a61a4ff059cce721911b75ac877a&start=9044&end=9708","https://assets.pipeline.soar.com/5383711-8a96a61a4ff059cce721911b75ac877a/thumbnail_9044000.jpg","/articles/6518935/Kansas/KDADS-outlines-HCBS-waiver-growth-IDD-waitlist-and-community-care-coordination-plans","https://secure.pipeline.soar.com/6518935-d4c180fac2a65842873fb0a8e41578a2/orig.mp4?Expires=1770992768&Signature=ANWDDLeLeMSyI23wVn74Wdz~whq-F-RWVtakxwvNGWdTpqvuM~U8xpnVKWUAtrjmJAAiA-OemRr7~Psp5r0~HFUM~njITHZlDAV-pqB3gPJM8NqxuUfBrQ93sE4gSeEv~1LYBh-3dJD5mpXlcboLV9PVkSZ-UF0Cps2XY6nMrGut5Y7oRv7L-pxSUGqhyuzTl3DqxmPx1VnPqAYS~fd~dJ0Yf1e-EblS9oc5g5yNGCNfcMwxFkzrsFMv6OBjzoDeHf~AAJ~8hVv-c-q2rI10LWQ-Ot5~4y5ZYVcMqQZl1mU71Ktf7cta3lK6JlavgSapvJ4zbyz8pd1yfBBV0wGqzg__&Key-Pair-Id=KUT5TJCACFTXG","Andy Brown, deputy secretary for programs at the Kansas Department for Aging and Disability Services (KDADS), briefed the committee on the state’s seven HCBS waivers and recent budget impacts.

Brown said the department manages seven waivers including the IDD (intellectual and developmental disability) waiver, the physical disability waiver, the brain injury waiver and others. He described recent additions that increased waiver costs: 500 slots added to the PD waiver in a prior year and new IDD slots (500 previously, 200 more in the current session). Brown said adding 482 more IDD waiver slots to keep the program under a statutory waiting-list cap was estimated at about $33.5 million all funds (about $13.1 million SGF).

Brown discussed KanCare 2 and KanCare 3 differences: some flexibilities used during the COVID public health emergency ended and KDADS has updated care coordination expectations, reporting and data appendices. He told the committee the community care coordination model originally planned under KanCare 2 was not implemented; KDADS estimates implementing a community care coordination program could cost about $20 million all funds.

On waivers with pending renewals, Brown listed renewal dates and said KDADS is working through the HCBS cap to position waiver renewals with CMS. He provided waiver-specific census and wait-list history, noting the IDD waiver wait list stood in the thousands and that addressing the wait list will require continued appropriations.

Ending: Brown said KDADS is evaluating waiver mixes and will provide more detailed fiscal estimates on slot additions, and committee members asked KDADS for an estimate of how many wait-list slots a community care coordination waiver would move off the IDD list if implemented.

","KDADS described growth in several home- and community-based services waivers, added IDD and PD slots, and said community care coordination remains unimplemented but could cost about $20 million if added.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6518940,"Federal reconciliation changes raise questions about provider taxes, state‑directed payments and audits",232,7048000,7280000,"/Search/View?dp=1&key=5383711-8a96a61a4ff059cce721911b75ac877a&start=7048&end=7280","https://assets.pipeline.soar.com/5383711-8a96a61a4ff059cce721911b75ac877a/thumbnail_7048000.jpg","/articles/6518940/Kansas/Federal-reconciliation-changes-raise-questions-about-provider-taxes-statedirected-payments-and-audits","https://secure.pipeline.soar.com/6518940-8e1fdd49ce6ed8fec1f734dd476cf369/orig.mp4?Expires=1770992768&Signature=KozCs6kC3~eMTzQ8XDAeUXEHcpVc2TaCUBeIJsWPxbEJtKwvjHcgXVUYIvhEpiX-wt~7w0epHw6xV7aeETz7oR-Y5rs1-qNON1pwYXTOkBpwlauWsW0XWTWcuSTBbN5XEadL0h1Yrb2kStr2bpjaL5H0WwLtMFHPJT7vMC5-swsWd~ttFSI6HknTQeQBeOJSEEdsmTdpfN~B10Zg~-A9Tee-wRcd~Voz-y3VdJ2x3bbDLE3jPRsCmdl7elHgnD1JtdkOEiixleNFrdGnh8i6y4HSNFqkFeg5p93OhiSARiSgUzKpRw1SEeyO~Il4ZFSuew5NHEohUfF2~s~EojpPJA__&Key-Pair-Id=KUT5TJCACFTXG","Christine Osterland, deputy secretary for agency integration and state Medicaid director at KDHE, told the committee the reconciliation package and proposed CMS rules carry several provisions that may affect Kansas Medicaid financing.

Osterland said Kansas’ provider assessment program — the state’s provider “tax” that draws federal matching funds — is likely protected at the 6% safe-harbor level for non‑expansion states, and KDHE submitted a 2026 preprint to CMS before the reconciliation effective date to preserve previously authorized payment arrangements. “We think our provider tax should be okay,” she said.

But she flagged two areas of uncertainty. First, the reconciliation language tightens the federal review of states’ payment error rates and restricts waivers of certain PERM findings; the bill also authorizes the HHS secretary to designate additional state audits to be treated as payment-error findings. KDHE staff said the provision is broadly written and states are seeking clarification from CMS because it could increase the risk of federal recoveries.

Second, a new step-down is in the reconciliation language for state‑directed payments: over several years non‑expansion states’ state‑directed payments will be reduced toward a cap of 110% of Medicare (a maximum of 110% of Medicare rates) unless further congressional action changes the schedule. Osterland said Kansas hospitals that receive state‑directed payments could see material reductions over time if the provision is implemented as written; the step-down would begin Jan. 1, 2028, as drafted.

Osterland also said the administration’s changes to eligibility and documentation-related rules will require agency review. The committee asked for a tighter summary and an agency analysis; KDHE said it would publish a detailed analysis by the end of the week and coordinate with national associations for CMS guidance.

Ending: KDHE cautioned that much depends on forthcoming CMS guidance; staff and committee members said they will continue follow-up to quantify the state and provider impacts of the federal changes.

","KDHE staff briefed the committee on changes in the federal reconciliation package and proposed CMS rules that could limit provider‑tax arrangements, reduce some state‑directed payments and expand the universe of audits that recover federal funds.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6518944,"Committee hears list of recent legislative additions and revised KanCare caseloads",252,5364000,5616000,"/Search/View?dp=1&key=5383711-8a96a61a4ff059cce721911b75ac877a&start=5364&end=5616","https://assets.pipeline.soar.com/5383711-8a96a61a4ff059cce721911b75ac877a/thumbnail_5364000.jpg","/articles/6518944/Kansas/Committee-hears-list-of-recent-legislative-additions-and-revised-KanCare-caseloads","https://secure.pipeline.soar.com/6518944-fc6a714b8178d80bec1d5727d178225c/orig.mp4?Expires=1770992768&Signature=ghVKiiNw64FV1zs83nuP2xaPyOoUzEJQmMa7ekAtmPuHiPj1GXw3qrh9blabmp9wK8u~z09zY3MgV-7pQqmFTx3HTfMQAOWMU2px8wLe291ecn7QEDhV4SZTUQXviJK0f1pjxBI3ll-azkYq9DWaSBE~YprM8hJ5XYSXyKxun50AOXwp3s9215c1gbUWrPdq6VUW8rBQ3LjyaCo0UHD~lyA0aNvN2-yzEYQ3EspMS0FGQeoINzFyqzm8uxTzPHaz10S1p1PMQY3OWyhMw-xWrGwVOfCIAsC0X8zQJfY50H~B2d55JxTvdlbKpT3aPEGKFU01nwPsT0wutoo7FmflFg__&Key-Pair-Id=KUT5TJCACFTXG","Megan Leopold of the Kansas Legislative Research Department reviewed a multi-year list of legislative additions to Medicaid funding the committee had received in its packet and explained how those additions contributed to recent expenditure growth.

Leopold detailed additions by legislative session: examples cited included provider rate increases and rebases for nursing facilities, funding to convert community mental health centers to certified community behavioral health clinics (CCBHCs), and increases in provider assessment authority. She told the committee that large additions included nursing facility rebases and a community mental health center conversion in recent years. The committee packet included a table of specific additions back to 2019.

Leopold also gave the committee KLRD’s revised caseload estimates used for budget planning. For fiscal 2025 the revised estimate for KanCare medical was about $5.0 billion all funds and $1.3 billion in state general fund, a modest decrease from prior estimates largely because population increases were lower than anticipated. For fiscal 2026 the revised KanCare medical estimate was about $5.3 billion all funds and $1.5 billion SGF. She said some decreases in SGF were driven by higher HMO privilege-fee revenue that offsets SGF expenditures.

Leopold highlighted several line items that contributed to year-over-year SGF increases: nursing facility daily rate rebases, provider reimbursement increases for items such as physician and outpatient hospital provider codes, and additions that funded moving people from IDD waiver wait lists into services. She pointed the committee to a detailed, regularly updated medical assistance report that breaks out eligibility categories and capitation payments by code.

Committee members asked for additional detail, including exact historical state general fund dollar amounts behind the expenditure charts and whether caseload changes reflect changes in population mix rather than only total enrollment.

Ending: Leopold said she would provide the chart-level tables and clarified that the caseload estimates discussed were those made in April and not yet incorporated into any later appropriation changes.

","KLRD and KDHE staff reviewed legislative rate increases, nursing facility rebases, CCBHC conversion funding and updated caseload estimates that together raise Medicaid spending pressures.",{"_33":113,"_35":36,"_37":38,"_39":114,"_41":115,"_43":116,"_45":117,"_47":118,"_49":119,"_51":120,"_53":121,"_55":56,"_57":58,"_59":122,"_61":62,"_63":64,"_65":123,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6518948,"Kansas legislators hear how capitation, rate cells and FMAP drive Medicaid costs",2124,82000,2206000,"/Search/View?dp=1&key=5383711-8a96a61a4ff059cce721911b75ac877a&start=82&end=2206","https://assets.pipeline.soar.com/5383711-8a96a61a4ff059cce721911b75ac877a/thumbnail_82000.jpg","/articles/6518948/Kansas/Kansas-legislators-hear-how-capitation-rate-cells-and-FMAP-drive-Medicaid-costs","https://secure.pipeline.soar.com/6518948-69f01c386618d561b530f8937b535ddd/orig.mp4?Expires=1770992768&Signature=NbqGZth5kYqaYPQYODdaB4UC3v9peRNU6qw-pPCKO6osYSguNTJw2WJkiUVcheeAYEtpB24nNnGrXRpGSryQu5FFE4dRb19HFOL59kOyI3UXPELKtOg2rmPUoPsdmP1UXLH3HRtwp-MoEcVHJDQKvxBBMtsFuOEje4JW4hfwcEmRzTO6kMgJUzaq6iUuwgMhcJ8fqTzwWt-n9q4HvCRqJh~cj22w7dC6Fm-um9OYBEVCoQCCiPm~f~qOPEXOrFvWAaGDBZT91-6kVisaqrg87WHw1oNIUMsMtQBfIdNw1OJgXtOwYuQu3lSzv-c~hgbJZaDbsfFACOokdmdKmCcf9g__&Key-Pair-Id=KUT5TJCACFTXG","Megan Leopold, analyst with the Kansas Legislative Research Department, told the Robert G. (Bob) Bethell Joint Committee that most state Medicaid spending flows through capitation payments the Kansas Department of Health and Environment (KDHE) sends to managed care organizations (MCOs).

The capitation payments are “per member per month” amounts set for groups of beneficiaries called rate cells, Leopold said, and those payments are the main driver of Medicaid costs. “These are the state payments or the payments that the state makes to the MCOs,” she said.

The committee then heard from Seth Adamson, managing director and actuary for CABIS Optimus, the actuarial firm that advises KDHE. Adamson described the regulatory and technical framework for setting capitation rates. He said federal law and CMS regulations require rates to be “actuarially sound”: reasonable, appropriate and attainable. “Every year we have to certify that the rates are actually sound,” Adamson said. He explained rates are set annually for a contract year even if a multi-year contract is in place for plan administration.

Adamson and Leopold outlined how rate cells are used to match payment to expected risk: relatively large, lower-cost populations such as children in poverty are paid a low per-member-per-month (PMPM) amount, while small, high-cost populations — long-term-care residents or waiver recipients — receive much higher PMPMs. The actuary demonstrated why making payments only on a statewide average can overpay some plans and underpay others if enrollment mixes differ by plan.

Both presenters flagged federal and state policy levers that materially change spending. Leopold reminded the panel that the federal medical assistance percentage (FMAP) — the federal match — shifts slightly each year and that incremental FMAP changes can move tens of millions of dollars because Kansas’ Medicaid program totals billions. Adamson said other drivers include provider assessment changes, legislative rate increases and federal policy changes.

Committee members pressed for more detail on several operational topics. Questions included how beneficiaries are assigned to MCOs (Leopold: members can choose; if they do not choose, the agency assigns them), why some providers are paid on a prospective payment system (PPS) rather than by service, and how much capitation accuracy the actuaries achieve. Adamson said his team targets a narrow prospective margin and performs midyear updates if policy changes occur.

Leopold and Adamson also discussed program design choices that affect incentives and costs: the state’s decision to give the three MCOs essentially the same per-rate-cell PMPM to preserve competition, and the role of Medicaid-managed care in transferring financial risk from the state to plans.

The presentations closed with the actuary noting that managed care can raise administrative and care-management costs initially but is intended to improve efficiency over time by reducing avoidable utilization.

Ending: The committee asked the agencies and actuarial vendor to provide additional materials — monthly Medicaid reports with code-level detail and historical capitation accuracy — which members referenced as useful for future oversight.

","Legislative staff and the state’s actuarial vendor explained how Kansas pays managed-care organizations, how rate cells are built and why small FMAP changes and legislative rate increases can materially affect the state general fund.","actionData","errors"]

Article not found

State hospital leaders report heavy reliance on contract nursing, expanded bonuses and an in‑progress regional hospital project

KDADS outlines HCBS waiver growth, IDD wait‑list and community care coordination plans

Federal reconciliation changes raise questions about provider taxes, state‑directed payments and audits

Committee hears list of recent legislative additions and revised KanCare caseloads

Kansas legislators hear how capitation, rate cells and FMAP drive Medicaid costs