Category Archives: Government

KDHE Quarantine Notices and Testing Prioritization

KDHE updates the public on testing prioritization;

issues new quarantine notices

TOPEKA – The Kansas Department of Health and Environment (KDHE) is issuing several updates today, including the addition of new states to the quarantine mandates as well as a prioritization for COVID-19 tests submitted to the Kansas Health and Environmental Laboratories.

Two states added to 14-day home quarantine

KDHE is now mandating 14-day home quarantine for Kansans who have:

  • Traveled to a state with known widespread community transmission (California, Florida, New York and Washington state) on or after March 15.
  • Traveled to Illinois or New Jersey on or after March 23.
  • Visited Eagle, Summit, Pitkin and Gunnison counties in Colorado in the week of March 8 or after.
  • Traveled on a cruise ship or river cruise on or after March 15.
    • People who have previously been told by Public Health to quarantine because of their cruise ship travel should finish out their quarantine.
  • Traveled internationally on or after March 15.
    • People who have previously been told by Public Health to quarantine because of their international travel to China, South Korea, Japan, Italy and Iran should finish out their quarantine.
  • Received notification from public health officials (state or local) that you are a close contact of a laboratory-confirmed case of COVID-19. You should quarantine at home for 14 days since your last contact with the case.  (A close contact is defined as someone who has been closer than 6 feet for more than 10 minutes while the patient is symptomatic.)

Important Note: These mandates do not apply to critical infrastructure sectors needed to continue operations during this pandemic. Public health, including hospitals, clinics, etc. need to have the staffing resources to continue serving Kansans. While KDHE strongly recommends these quarantine restrictions for everyone, we do recognize that medical care needs to continue and no healthcare facility should ever be to a point where it would need to close due to staff being quarantined. We ask facilities to ensure they have updated their Emergency Preparedness Plans and implement protocols to ensure that no employee comes to work symptomatic. Other examples of critical infrastructures include pharmaceutical and food supply, along with others defined by the Department of Homeland Security.

 

Testing Prioritization Change

Due to widescale shortages of laboratory supplies and reagents, testing for COVID-19 at the state lab is being prioritized for public health purposes and urgent need. KDHE will be prioritizing specimens for COVID-19 testing based upon those who meet Kansas’ patient under investigation (PUI) criteria starting today, March 23.

Those include:

  • Healthcare workers and first responders who have COVID-19 symptoms
  • Potential clusters of unknown respiratory illness, with priority given to long-term care facilities and healthcare facilities
  • Hospitalized patients with no alternative diagnosis
  • Individuals over the age of 60 who have symptoms of COVID-19 with priority given to people who reside in a nursing home, long-term care facility, or other congregate setting, and
  • Individuals with underlying health conditions that would be treated differently if they were infected with COVID-19.

Specimens that were sent to KDHE prior to March 23, will still be tested. However, moving forward healthcare providers should:

  • Send specimens to a commercial reference laboratory.
  • Inform all patients who present with symptoms compatible with COVID-19 (e.g., measured fever of 100.4 (F) or greater and lower respiratory symptoms including cough or shortness of breath) who are not a high priority for testing to:
    • Self-isolate at home or another appropriate location for 7 days after illness onset or for 72 hours after resolution of fever (without fever-reducing medication) and significant improvement in symptoms, whichever is longer.

“KDHE has been in contact with the CDC, FEMA, manufacturers and distributors of the testing supplies and reagents to find ones our laboratory needs to run the specimens collected for COVID-19 testing,” Dr. Lee Norman, KDHE Secretary, said. “We are doing everything in our power to get supplies for our state. We are focusing testing in our lab on higher risk individuals at this time.”

For more information, please visit the KDHE website at www.kdheks.gov/coronavirus. KDHE has a phone bank that is staffed Monday – Friday, 8 a.m. – 7 p.m. The phone number is 1-866-534-3463 (1-866-KDHEINF). KDHE also has an email address for general inquiries, [email protected].  Please note these contacts are for general questions and cannot provide you with medical evaluations. If you are feeling ill, please stay home and call your healthcare provider.

Governor’s Executive Order Limits Mass Gatherings To 10

Governor Kelly announces Executive Order to further improve public safety regarding COVID-19 pandemic

 

Governor Kelly today announced new measures to protect Kansas families from the spread of  COVID-19, the novel coronavirus.

 

On Tuesday, Governor Kelly will issue an Executive Order limiting mass gatherings to 10 persons. The decision was based on updated guidance from the Centers for Disease Control and Prevention, and modeling from the Kansas Department of Health and Environment (KDHE) that projected cases of COVID-19 in Kansas to sharply rise to a range of 300 to 900 by the end of the month.

 

“This is an escalating crisis, and we must make sacrifices and adjustments to ensure the safety of our neighbors,” Kelly said. “We all need to do what we can to reduce the spread of COVID-19.”

 

The Executive Order to be issued Tuesday also includes a framework counties will be required to use if local officials determine it is necessary to issue stay-at-home orders. The guidance will provide information on how to include these orders for essential infrastructure and businesses.

 

With 89 Kansas counties without a confirmed case as of today, the Governor does not plan to issue a statewide stay-at-home order at this time.

 

“The crisis continues to evolve by the hour, and a statewide stay-at-home order may indeed become necessary at some point soon,” Kelly said. “For now, the actions we are taking will ensure as much consistency as possible for local communities.

 

The Governor also reiterated the need for Kansans to be proactive and work together.

 

“The most effective way we can slow down the virus is to stay home,” Kelly said. “Continue practicing good hygiene and take all of these orders seriously. These actions will help mitigate the spread of COVID-19, save lives and help us all transition back to our normal routines.”

March 23, 2020 Public Update COVID-19

• This document is updated every afternoon and available on www.kdheks.gov/coronavirus.
• KDHE has created a toolkit of Kansas-specific guidance to help local public health departments engage with their community partners on COVID-19 planning. It can be found on the KDHE website: www.kdheks.gov/coronavirus. New information is added daily.

For more information: www.kdheks.gov/coronavirus
2019 Novel Coronavirus (COVID-19) in Kansas Test Results
Updated 3/23/20 at 10 a.m.

Total Positive Cases
82
Private Labs
47
Kansas Health and Environmental Lab
35
Deaths (included in above numbers)
Johnson and Wyandotte
2
Out-of-State Resident Positive Cases*
(not counted in Kansas numbers)
2

Positive Case Information
County Number
County

Bourbon
1
Linn County
2
Butler County
3
Lyon
2
Cherokee County
2
Mitchell County
2
Douglas County
8
Morris County
2
Franklin
1
Pottawatomie**
1
Jackson County
1
Reno County
2
Johnson County
32
Sedgwick
2
Leavenworth County
5
Wyandotte
16
*Ford and Miami Counties reported positive cases in out-of-state residents.
**The Pottawatomie case was labeled as Riley County’s yesterday. The person was determined to be a resident of Pottawatomie County and the chart is now reflective of that change.

Legislative Update by State Senator Caryn Tyson

Caryn Tyson

March 20, 2020

 

It was a busy week with the usual work in the legislature and because of issues arising as a result of the CODIV-19 virus.  One example, I had been working with a healthcare provider to get insurance payments for telemedicine and reached out to the Insurance Commissioner’s office.  They helped in solving the problem and the Governor’s latest Executive Order (EO) also addressed the issue.  Together we can and do make a difference.

 

To mitigate spread of the virus, the Governor has issued seven Executive Orders so far:

EO 20-03 declares a state of disaster, providing availability of additional resources.

EO 20-04 prohibits mass gatherings of 50 people or more and lists exclusions.

EO 20-05 directs and orders Kansas utility and internet providers to not disconnect services for non-payment and lists the types of services included.

EO 20-06 directs and orders all financial institutions to suspend initiating any mortgage foreclosures, evictions or judicial proceedings.

EO 20-07 closes all K-12 public and private schools until 5/29/2020, while continuing meal programs, childcare, online learning opportunities, and other exceptions.

EO 20-08 expands availability of telehealth medical services.

EO 20-09 removes or lessens certain motor carrier rules and regulations if participating in relief or restoration efforts as a result of the virus.

 

It is not unprecedented for the legislature to pass a resolution extending the Governor’s authority during a state of emergency while the legislature is not in session.  What appears to be unprecedented about House Concurrent Resolution (HCR) 5025 was the authority and length of time that was proposed.  During senate debate, three amendments were offered and passed.  The first was to decrease the length of time turning over legislative authority to the Governor, changing the date from January 25, 2021 to May 1, 2020.  The second amendment was to protect the sale of ammunition (firearm sales are protected by statute).  I offered the third amendment to protect us from government overreach.  It had several provisions including but not limited to protecting private property and protecting local government funds from being swept.  The HCR passed the Senate 37 Yes to 2 No votes with the amendments.  I voted yes.  After conference committee negotiations, the final product changed the third amendment somewhat but it does help protect our freedoms with oversight by the Legislative Coordinating Council (LCC), a committee made up of legislative leadership and the Governor, reviewing governing actions when the legislature is not in session.  The CCR HCR 5025 passed unanimously.

 

As President Reagan one said, “Can we solve the problems confronting us? Well, the answer is an unequivocal and emphatic ‘yes’”.  Yes we can in a constitutional way that protects our freedom – that’s why you have me here.

 

Take ownership of your situation and actions.  When growing up, I said a person made me mad. My Mom responded, “they didn’t make you mad, you chose to be mad.”  Let’s choose to be optimistic and respectful of others.  Stay safe.

It is an honor and a privilege to serve as your 12th District State Senator.

 

Caryn

After School Reading Programs Matter Resolved at KDCF

Statement from the Department for Children and Families and Hysell & Wagner, LLC

 

Today, the Kansas Department for Children and Families (DCF) and Hysell & Wagner, LLC, announced that they have entered into an agreement under which each party agrees that all issues with the 2014-15 draft audit are resolved.

In August of 2019, the Kansas Reading Roadmap grant to Hysell & Wagner, LLC was cancelled as allowed under the grant.

During announcement of the cancellation, certain preliminary findings from 2014-15 draft audit were shared.

After both parties conducted due diligence, DCF and Hysell & Wagner, LLC now agree that none of the audit issues warrant further action.

Hysell & Wagner, LLC appreciates the Agency’s efforts to resolve these matters and its decision to continue funding after-school reading programs directly with Kansas school districts.

DCF thanks Hysell & Wagner, LLC for its years of work helping Kansas children.

Neither party will have additional comment on the matter.

 

Non-Essential Businesses Closed, Restrictions Put In Place For Others Following First COVID 19 Report In Bourbon County

Rebecca Johnson, SEKMCHD Director.

Following the notification of the first COVID 19 positive test in Bourbon County, officials are requiring more stringent measures.

 

“We were saddened to learn of the resident in Bourbon County, KS who tested positive for COVID-19,” according to the Southeast Kansas Multi-County Health Department Facebook page.  “The resident and their family will be in our thoughts and prayers. Let’s use this time to all work towards the same goal of preventing the spread of the virus further. This will not be easy, nor very enjoyable, but for the health and future of our communities, we must at least try. Thank you for your continued support and understanding, as we continue to serve our counties.”

This morning on the City of Fort Scott Facebook page, Bourbon County Public Health Officer Rebecca Johnson said:

“Daycares should not take any new enrollees from out of county.

Hotels increase cleaning and disinfecting practices especially after every person checks out.

School staff, food service workers, and volunteers will be allowed to provide, prepare and deliver meals. Social distancing greater than six feet and less than 10 minutes shall be enforced.

There will be more guidelines to follow.”

The following was an order published at  8 p.m.last evening on March 22, 2020, by Bourbon County Public Health Officer Johnson.

The following actions are officially implemented by the Bourbon County Public Health Officer and shall be in official force and effect at 8:00 PM on Sunday, March 22, 2020.

This order shall remain in effect until modified or rescinded by the Public Health Officer.

This Order is made under the powers granted the Local Public Health Officer in KSA 65-119 et seq. and the Emergency Declarations of the governments of the United States, the State of Kansas, and Bourbon County, as well as the Home Rule powers of Bourbon County under state statute.

Bourbon County is now restricting or prohibiting business activities for all non-essential businesses and is making recommendations for essential business functions as follows:

Essential Businesses

The following have been determined to be essential business functions for Bourbon County:

Grocery Stores shall be allowed to remain open to the public for business to supply needed food and supplies to the citizens of Bourbon County. It is recommended that these stores take precautions to reduce in-person contacts as much as possible, maintain social distancing (6 foot or more) when practical, and consider using curb-side service whenever possible.

Convenient Stores/Gas Stations shall remain open to the public.

It is recommended that these stores take precautions to reduce in-person contacts as much as possible, maintain social-distancing (6 foot or more) when practical, and shall eliminate gathering places within the store to prevent social grouping activities.

Funeral Homes are allowed to remain open but efforts should be made to reduce numbers (family only gatherings recommended) and shall work to limit crowds and shall strive to maintain the recommended social distancing as described above.

Health Care Facilities and Providers/Veterinary Clinics shall remain open and use social distancing and other techniques as applicable to help prevent the virus spread.

Providers may want to have patients/customers stay in cars until their turn to avoid waiting area congestion and issues with maintaining social distancing.

Utility Providers shall be allowed to remain open.

It is recommended that providers take steps to limit work-to-worker interactions to help reduce the chance for losing multiple workers and/or causing utility disruptions. Calls for service to individual residences should be pre-screened before entering those locations.

Banks & Pharmacies shall be allowed to remain open for business. Whenever possible, it is recommended to close lobbies and inside operations and use the drive-through’ s to conduct necessary business. People who are allowed to come inside the business should be prescreened before allowing entry.

Non-Essential Businesses (Allowed Open with Restrictions)

The following businesses have been determined to be non-essential businesses as related to this pandemic, however, they will be allowed to remain open with the following restrictions as described below.

These restrictions shall be implemented by no later than noon, Monday, March 23, 2020, and shall remain in a restricted status until this order is rescinded by the Public Health Officer.

Parts Stores/Lumber Yards/Hardware Stores shall be allowed to remain open, however, public access to the inside of the store shall be prohibited. These businesses should use delivery or curb-side service and maintain social distancing as much as possible during those activities.

Bars/Restaurants-These businesses shall be allowed to remain open for business, however, public access to the inside of the bar/restaurant shall be prohibited. These businesses should use delivery or curb-side service and maintain social distancing as much as possible during those activities.

Manufacturing-Manufacturing businesses shall be allowed to remain open, however, public access to the facilities shall be prohibited. All efforts should be made to maintain social distancing between workers whenever possible.

Agricultural Business shall be allowed to remain open, however, public access to the inside of the store shall be prohibited. These businesses should use delivery or curb-side service and maintain social distancing as much as possible during those activities.

Automotive Repair Shops shall be allowed to remain open, however, public access to the buildings and facilities shall be extremely limited. All efforts should be made to maintain social distancing between individual workers and between workers and customers whenever possible.

Other Retail Sales not identified above may remain in operation but the business shall keep doors closed and restrict business to one customer at a time inside the store. Examples include liquor stores, gun stores, pawn shops, and other similar business types.

Non-Essential Businesses (Closed/Shut-Down)

The following businesses types have been determined to be non-essential as related to the pandemic and shall be closed/shut down no later than noon, Monday, March 23, 2020, and shall remain shut until this order is rescinded by the Public Health Officer:

Barber/Beauty Shops shall be shut down as there is no practical way to maintain social distancing.

Fitness Centers/Gyms shall be shut down.

Libraries“-We appreciate the fact that the library in Bourbon County has already voluntarily shut down to help assist lessening the spread of COVID-19. Libraries shall close or remain closed to the public until the order is rescinded,” according to Johnson.

Other Businesses-Businesses not otherwise described that cannot maintain or attempt to maintain the 6-foot social distancing shall be closed until this order is rescinded. This would include any businesses that by its very nature direct person-to-person contact of fewer than 6 feet.

If your business type is not specifically included or defined by the above information and you have questions on what, if any restrictions apply, please call (620)223-4464 for guidance.

“If sick, stay home,” Johnson said. “Stay away from people that are ill, especially vulnerable populations (with diseases and the elderly), avoid face to face time, more than six feet apart for less than 10 minutues.”

“Practice personal hygiene habits of handwashing after bathroom, before eating, if you sneeze or cough or handshake. Don’t touch your eyes, nose or mouth.”

Johnson is part of the SEK Multi-County Health Department. Her office is located at 6th and Lowman Streets.

 

Bourbon County State of Emergency Declaration

 

Sunday , March 22, 20202, Bourbon County Emergency Management announced the first confirmed case of COVID-19, Coronavirus, in Bourbon County. The announcement was followed by a Bourbon County Commission meeting where, after a short executive session, a COVID-19 Emergency Resolution was unanimously adopted. The resolution declares a state of local health public emergency within Bourbon County for 60 days or until recovered earlier.

Pursuant to the power granted to the Local Public Health Officer in KSA 65-119 et seq and the Emergency Declarations of the Governments, Becky Johnson, Public Health Officer, issued a mandate to go into full force and effect at 8:00 PM Sunday March 22, 2020. The order restricts or prohibits business activities for all non-essential businesses and made restrictions for essential business. The full mandate is available online at bourboncountyks.org/covid-19. Businesses with questions or concerns regarding the mandate can call the health department at (620)223-4464 for guidance.

Links to the United States Department of Labor (USDOL), the Centers for Disease Control (CDC), the Kansas Department of Health and Environment (KDHE), the Department for Children and Families and GetKansasBenefits.gov will be available on one page to make it easier for Kansans to keep updated on the virus and resources available to assist them during this challenging time. at www.getkansasbenefits.gov For the most up to date information on the COVID-19 Coronavirus, go to https://govstatus.egov.com/coronavirus.

We understand the substantial impact COVID-19 has on businesses. The Small Business Administration (SBA) have offered low interest loans as a response. SBA Disaster relief loans are now open for all Kansas communities and available to apply online at https://www.sba.gov/funding-programs/disaster-assistance. The loan is low interest; no higher than 3.75%.  Each loan is made on a case by case basis, with terms up to 30 years, are based on ability to pay.  The maximum amount of the loan is $2 million.  There are no lending institutions involved in this process, the loan is straight through the SBA.  

 

The State of Kansas is offering the Hospitality Industry Relief Emergency (HIRE) loan. This is a zero percent interest loan for a maximum of $20,000 for 36 months.  There will be no principle or interest payment due for the first four months. You can apply online here:  https://www.kansascommerce.gov/covid-19-response/hospitality-industry-relief-emergency-hire-fund/https://www.kansascommerce.gov/covid-19-response/hospitality-industry-relief-emergency-hire-fund/

Loan funds can be used for current fixed debt and short-term working capital. Examples include making payments to commercial loan payments, commercial lease payments, utility bills, payroll, accounts payable or inventory. “We are encouraging businesses to consolidate fix debts into lower interest rate loans, while including short term working capital, when applying for relief loans,” Jody Hoener, Economic Development Director said. “We have intentionally made ourselves available to assist in the application process. Every day more and more businesses are reaching out.”

More information on the Bourbon County Economic Development or Emergency Management resources and assistance is available by contacting Jody Hoener, Economic Development Director, at 620-215-5725/[email protected] or William Wallace, Emergency Management, at 620-223-3800 ext 124/[email protected]

# # #

About Bourbon County Emergency Management (EM)

There are four key purposes to emergency management: Preparedness. Response. Recovery. Mitigation. Bourbon County Emergency Management (EM) is trained for disaster preparedness, response, recovery, and mitigation. The COVID-19 pandemic poses a serious public health risk.  EM are the contact for state and federal emergency response programs for recovery of disaster situations. For most up to date information check out the Bourbon County Corona Virus Updates page.

Bourbon County Commission Special Meeting March 23 Agenda

Agenda

Bourbon County Commission Room

1st Floor, County Courthouse

210 S. National Avenue

Fort Scott, KS 66701

Tuesdays starting at 9:00

Date: March 23, 2020

1st District-Lynne Oharah Minutes: Approved: _______________

2nd District-Jeff Fischer Corrected: _______________

3rd District-Nick Ruhl Adjourned at: _______________

County Clerk-Kendell Mason

Special Meeting

For safety reasons, this meeting will be held via telephone, the public can view the meeting on Facebook at Bourbon County Kansas

9:00 the Commissioners to evaluate on when to re-open the Courthouse, a portion of this meeting will be in executive session

9:45 – Executive Session – Personnel matters of individual non-elected personnel

City of Fort Scott City Hall Closed To Public

The City of Fort Scott’s City Hall will closed to the public until further notice. This is due to the CoronaVirus pandemic.

City staff will still be working and feel free to call City Hall at 223-0550 with any concerns you may have.

You can pay your utility bill or Municipal Court fine online at www.fscity.org and click on the Online Bill Pay button. There is also a drop box in the alley behind City Hall.

Bourbon County Commission Special Meeting March 22

Agenda

Bourbon County Commission Room

1st Floor, County Courthouse

210 S. National Avenue

Fort Scott, KS 66701

Tuesdays starting at 9:00

Date: March 22, 2020 – Special Meeting

1st District-Lynne Oharah Minutes: Approved: _______________

2nd District-Jeff Fischer Corrected: _______________

3rd District-Nick Ruhl Adjourned at: _______________

County Clerk-Kendell Mason

6:30 pm – Emergency Declaration Meeting; the location of the meeting is in the Emergency Preparedness building located at 221 S. Judson, Fort Scott, KS 66701 – the Commissioners will be present at the meeting by telephone.

March 22, 2020 Public Update COVID-19

Situation Overview
• This document is updated every afternoon and available on www.kdheks.gov/coronavirus.
• KDHE has created a toolkit of Kansas-specific guidance to help local public health departments engage with their community partners on COVID-19 planning. It can be found on the KDHE website: www.kdheks.gov/coronavirus. New information is added daily.

For more information: www.kdheks.gov/coronavirus
2019 Novel Coronavirus (COVID-19) in Kansas Test Results
Updated 3/22/20 at 10 a.m.

Total Positive Cases
64
Private Labs
34
Kansas Health and Environmental Lab
30
Deaths (included in above numbers)
Johnson and Wyandotte
2
Out-of-State Resident Positive Cases
(not counted in Kansas numbers)
2

Positive Case Information
County Number

Butler County
3
Linn County
1
Cherokee County
1
Mitchell County
1
Douglas County
4
Morris County
2
Franklin
1
Reno County
1
Jackson County
1
Riley County
1
Johnson County
28
Sedgwick
2
Leavenworth County
4
Wyandotte
14
* Ford and Miami Counties reported positive cases in out-of-state residents. Numbers included in cases home states. 2

Accessing Healthy, Safe Child Care

Guidance for Supporting Families in Accessing Healthy and Safe Child Care During the COVID-19 Outbreak

The Kansas Department of Health and Environment (KDHE) is recommending continuity of operations for licensed child care facilities at this time (centers, preschools, day care homes and school age programs). Child care facilities may accept new enrollees in accordance with the terms of their license. However, depending on the unique and changing situations of each community, local public health officers may implement more restrictive guidance and provisions for child care facilities, up to and including closure within their authority and jurisdiction.

 

Child care providers should direct all questions to their local child care surveyor. Surveyors will coordinate efforts and communication with local public health officials to provide guidance based on the rapidly changing situation at the community level.

 

“We know this is a stressful time, and especially for families who rely on child care and those whose work circumstances are changing,” Governor Laura Kelly said. “There are a number of child care resources available to help you meet the needs of your family. We’re all in this together and will help families access the support they need.”

 

KDHE continues to accept and process applications for new child care facilities. Individuals interested in becoming a licensed provider are encouraged to contact their local licensing surveyor. Visit the KDHE Child Care Licensing website and click on Local County Contacts to find the surveyor in your area.

 

 

“Child care professionals provide a critical service in our state,” Dr. Lee Norman, KDHE Secretary, said. “They allow parents who are our doctors, nurses, police officers, firefighters and more to respond to this pandemic. Child care facilities have very strict regulations regarding the number of children in the facility as well as health and safety guidelines that must continue to be met.”

 

For FAQs and guidance regarding child care operations during the pandemic, please visit the KDHE COVID-19 Resource Center website.

 

 

Options for families in need of child care

 

Many working families are facing challenges related to accessing healthy and safe child care during this time. We encourage everyone to assist with supporting families and communities as they work to develop creative solutions to meet the needs of working families.

 

Child Care Aware of Kansas provides assistance to families searching for licensed child care. They can be reached toll free at 877.678.2548.

KDHE has an online information system that serves as a tool to support families in making informed child care choices and can be used to review compliance history of a current licensed provider. The online tool is an important step to verifying that a facility is licensed and provides compliance history for parents and guardians.

Families that need flexible options or irregular care might consider having someone come into the home. Relatives, older siblings, and friends or neighbors currently not working due to COVID-19 related business closures might be available to help.

 

Other options for families that need limited care include informal care arranged between friends/neighbors on an irregular basis or someone to provide care in their own home for no more than two children for not more than 20 hours week. None of these options require a license from KDHE.