(Jan. 20, 2025) – Today, the House Health and Human Services Committee, chaired by Representative Will Carpenter (R-El Dorado), heard a presentation on the Southeast Kansas Mental Health Center. The committee heard from Nathan Fawson about the center's history, mission, and recent changes to its service model as Community Mental Health Centers have transitioned to Certified Community Behavioral Health Clinics.

The committee asked Fawson about the purchase of the Ashley Clinic and the dismissal of clinicians. Fawson responded they had coordinated to ensure those services would be better provided by a local hospital. He shared that specialty services aren't a good fit for the CCBHC or CMHC models, and hospitals are better able to sustain those services in specialty care. Fawson said primary care is different, noting the whole-person care model is better suited to the CCBHC model.

Representatives on the committee from the Southeast Kansas area suggested that the board's composition must be governed by county commissioner appointments and highlighted differences in board composition between the CCHBC and CMHC models. Fawson responded that when they applied for the new access point grant, funding was suspended, so they applied for the FQHC look-alike program. They had to prove that 51 percent of the board members were receiving care from the clinic. Fawson shared that the threshold was being met. Committee members noted that state law and federal criteria may conflict, with state law requiring county commissioners to appoint CCHC boards, while federal mandates require the board to be made up of patients. Fawson said he feels confident they can meet both, with county commissioners appointing people, as long as commissioners understand that 51 percent of county appointees must also be patients of the Federally Qualified Health Center.

Committee members asked about the change in billing from a fee-for-service model to a cost-based formula and how it affects costs for Medicaid patients. Fawson explained the Medicaid-specific formula. For CCBHC services, reimbursement is at a day rate; for non-CCBHC services, a traditional fee-for-service methodology applies. Committee members also asked how administrative salaries are calculated in the formula. Fawson explained that all employee expenses are factored into the day rate, and each employee either provides CCBHC services or does not, so only those providing CCBHC services are included in that formula. Fawson reminded committee members that primary care is a requirement and gave an example in which, if a primary care visit occurs and the patient identifies mental health needs, the visit transitions to a behavioral health service. In years one and two, that was a supported service. Recently, that service has been questioned as to whether it should be included in the CCBHC rate calculation. To sustain integrated care, they are exploring other ways to carry out that service, whether by partnering with hospitals to employ primary care providers or through another approach.

Committee members questioned the cost of non-contracted administrative expenses for Southeast Kansas CCBHC. Fawson provided a history of CEO salaries, noting they were 1.1 percent to 1.3 percent of overall operational costs, and suggested that this percentage is lower today. They determined these costs by using a third party to analyze if wages were at fair market levels. He gave an example of a therapy position opening that was not competitive with healthcare or market comparables. The group analyzed all positions, and the board approved global wage adjustments. He suggested that while in 2020 they had trouble getting staff, they now have the ability to recruit and retain, highlighting that fee-for-service kept wages stagnant while expenses climbed.

Legislators also inquired about the local pregnancy resource center partnership; the leadership's professional background; the board's oversight of compensation beyond salary; expanding care into the school systems; the authority and operation of the Ashley Clinic under the CCBHC model; whether Ashley Clinic services are billed under the CCBHC prospective payment services rate; whether Ashley Clinic has been flagged by any state agencies or managed care organizations for higher-than-expected cost utilization or service intensity; mental health outcomes in Southeast Kansas as services have been provided; why FQHCs can't be CCBHCs but Ashley Clinic can; diversion rates from state hospitals; the approval process for the Centers for Medicare & Medicaid Services; costs per patient data; and what will happen if Ashley Clinic cannot be a CCBHC.

Committee bill introductions for today included:

• Allowing an addiction counselor apprenticeship program
• Allowing chiropractors to sign return to activities physical forms
• Parental consent for medical care for minors, and this would be taking language that applied to schools and applying it to other clinics.

These bills will be read in and assigned bill numbers going forward.

The committee will meet again tomorrow.