By John Celock
Following a debate that evolved into a lengthy discussion over future legislative procedure and who could practice medicine, Kansas lawmakers have advanced legislation that would create a state employee health care clinic.
The House Appropriations Committee voted Thursday to advance out the bill, which would create the clinic near the state Capitol complex in Topeka. The passage came after a lengthy debate over how the clinic would be run, which medical professionals could staff the clinic and the exact process future lawmakers would use to discuss the budget of the clinic.
“I’m hopeful that having a clinic nearby we allow for people to be treated at a much lower cost,” House Appropriations Committee Ranking Minority Member Kathy Wolfe Moore (D-Kansas City) said.
Under the legislation, the state Department of Administration would contract out for the creation of the clinic, which would be either housed in a state office building near the Capitol or in space leased by the state in downtown Topeka. The bill includes $2.7 million for starting up the clinic. Lawmakers said that the clinic –which would be open to all state employees – would be geared towards providing wellness checks and other health care options to state employees, with the goal of reducing health care costs for the state.
Onsite employee health care clinics have been a trend in the public and private sectors.
A successful amendment from House Appropriations Committee Vice Chairwoman Erin Davis (R-Olathe) to clarify who would be working in the clinic generated lengthy debate. Under Davis’ amendment, the scope of employees would include physicians, advanced nurse practitioners, physicians assistants, registered nurses, physical therapists and chiropractors. She said that expanding the definition would allow for more medical services and coverage
“There can many things that can be accomplished at this onsite clinic and we want to make sure that we can do that,” Davis said.
Rep. Sydney Carlin (D-Manhattan) questioned if Davis’ amendment would mean that there would be no doctors on site. She and other lawmakers also questioned if Davis’ amendment would mean nurses would be taking over the clinic and performing duties outside their normal role under state law.
Davis said that physicians would be on duty and that her amendment would not be changing the scope of duties of any medical professional employed in the clinic. She noted that nurse practitioners and physicians assistants can write prescriptions.
“The goal is for a physician on site. If there is not a physician on site, these are not rogue nurses, they are working with a practicing physicians,” Davis said. “The goal is if there is not a doctor on site. We want to have services if the doctor is at lunch.”
House Social Services Budget Committee Chairwoman Brenda Landwehr (R-Wichita) questioned why Davis wanted to change the wording from physicians to health care providers and why physicians could not remain in the bill. Davis said this was to reduce confusion with more words and said that physicians are considered health care providers. A proposal from Landwehr to restore the word physicians was defeated 8-9.
Davis and staffers said that health care providers is a commonly used phrase in Kansas law. Davis noted that the advanced nurse practitioners and physicians assistants are already required to be in a relationship with physicians to issue prescriptions and that would continue. She noted that the state clinic would be similar to clinics at pharmacies.
“If you are an APRN or a PA you have to be in a collaborative relationship with a physician,” Davis said. “They don’t have to be next to you but you have to be in a relationship.”
Davis’ amendment also included the authority for the state Department of Administration to lease office space for the clinic if there were no state owned space available. Rep. J.R. Claeys (R-Salina), a leading legislative critic of Department of Administration leasing policy, noted that he had “serious concerns” with the agency’s practices.
He questioned Davis on whether the clinic would be a new lease or be used in an existing lease. She said that would be up to the Department of Administration.
“Twenty four dollar a square foot 25 year leases that’s the practices of this agency. I am concerned that we’ll be locking taxpayers into sweetheart deals,” Claeys said. “I have concerns with the leases that exist today and I have concerns continuing this practice. I do not oppose this bill.”
Rep. Henry Helgerson (D-Eastborough) pushed an unsuccessful amendment to apply future savings from the clinic’s work to paying for the facility. Committee members questioned Helgerson’s amendment, noting he was assuming long-term fiscal savings to the state when determining a budget starting on July 1. Helgerson said that employee health clinics do save money in the future.
Lawmakers also got into a discussion over the long-term management of the clinic by the Department of Administration and how it would funded by the Legislature. Carlin questioned how exactly would the Legislature determine the funding for the clinic, including which House budget committee would be tasked with overseeing the process.
“What we’ve learned over time, we get a budget the governor has looked at and we approve or disapprove his appropriations,” she said.
Appropriations Committee Chairman Troy Waymaster (R-Russell) said that it would be up to future chairs of the Appropriations Committee on which budget panels would consider what issue. He noted that currently the General Government Budget Committee covers the Department of Administration but he said that if the clinic was moved to the Department of Health and Environment, the clinic’s budget could be moved to another budget panel, such as the Social Services Budget Committee.
The six legislative budget committees are formed by the House rules every two years. The scope of the budget committees has changed over the years.
The state Senate Ways and Means Committee has 14 budget subcommittees, with the Department of Administration covered by its own subcommittee, while other subcommittees cover general government, health and social services, among other topics.
The budget discussion included a review of the entire legislative budget process by Waymaster and how that would be used by future lawmakers to determine the funding for the clinic. Lawmakers had been expressing concern over the long term funding and how it would be handled. Committee members asked if anything could be done regarding the budget process in the future.
Waymaster, who said the discussion was “getting in the weeds,” noted that he can only make decisions for the committee during his tenure as chairman.
“It will be up to this committee now and in the future on how those funds will be allocated,” Waymaster said. “I cannot for the future chairs of the Appropriations Committee.”