Joint Committee Committee on Joint Health and Human Services (03/05/2009)

Final
STAFF SUMMARY OF MEETING

COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES

Date:	03/05/2009	ATTENDANCE

Time:	01:35 PM to 04:05 PM	Acree	X
		Carroll M.	X
Place:	LSB A	Gagliardi	X
		Gerou	X
This Meeting was called to order by		Green	*
	Senator Boyd	Kefalas	X
		Kerr J.	X
This Report was prepared by		Lundberg	X
	Elizabeth Burger	McGihon	E
		Mitchell	E
		Morse	X
		Newell	X
		Nickell	X
		Primavera	X
		Schultheis	*
		Swalm	X
		Tochtrop	E
		Riesberg	X
		Boyd	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Report on the Platte Valley Youth Services Center Medicaid Managed Care Colorado Alliance for Health and Independence		- - -

01:37 PM -- Report on the Platte Valley Youth Services Center

Senator Boyd made introductory comments. Karen Beye, Executive Director of the Department of Human Services, began the department's report on the Platte Valley Youth Services Center. A handout was distributed to the committee (Attachment A). She stated that the department was restricted from sharing some information about specific incidents at the center due to the fact that a lot of individuals involved are minors. She gave an overview of the Division of Youth Corrections, stating that Colorado has been well recognized for the continuum of care provided through the division.

01:42 PM

George Kennedy, Deputy Executive Director of the Department of Human Services, reiterated that the department would not be able to discuss specific incidents due to confidentiality restrictions. He described the youth detention system. He explained that the detention system serves children between the ages of 10 and 17 who have been found by courts to be a danger to themselves or the community. Mr. Kennedy gave some examples of why children may be in a detention facility. He stated that the Division of Youth Corrections has set a goal to reduce recidivism.

01:52 PM

John Gomez, Director of the Division of Youth Corrections within the Department of Human Services, introduced staff members of the Division of Youth Corrections. He described the contents of the department's handout to the committee, and noted that the handout contains written responses to questions previously submitted to the department. He described the structure of the Division of Youth Corrections, stating that the system is divided into four management regions. Mr. Gomez described the Platte Valley Youth Services Center, noting that it is a multipurpose center. He described the facilities operated by the division, including three detention-only facilities. Within the division there are two major service continuums: detention and commitment. Detention is short term, much like jail. These facilities serve youth who are arrested on suspicion of committing a criminal offense. The average daily population in detention is about 415. There are about 11,000 admissions annually and the average length of stay is 14 days. Commitment is when legal custody of the youth is transferred to the division. The average daily population in commitment was 1,264 in the last year, and the division served a total of 2,200 individuals during the year. He described the division's principles and current initiatives. He stated that over time, the number of youth entering commitment with mental health and drug abuse issues has grown. He stated that the division has advocated for resources to provide treatment to these youth while they are in the custody of the division. Mr. Gomez discussed issues related to gang activity at Division of Youth Corrections facilities and stated that over 70 percent of the individuals entering the Division of Youth Corrections have had a previous out-of-home placement. He described the requirements for employment in a Division of Youth Corrections facility.

02:09 PM

Mr. Gomez described a number of photographs of the Platte Valley Youth Services Center that were included in the department's handout (Attachment A). Mr. Gomez responded to committee questions regarding the photographs and double-bunking of youth in the Platte Valley Services Center. Mr. Gomez noted that in the past, some of the Division of Youth Corrections facilities were very overcrowded and that the division was required to accept any youth who was brought to a detention facility. As a result of a lawsuit, the population at one Division of Youth Corrections facility was capped. In addition, the state passed legislation in 2003 capping the daily detention population at 479. Mr. Gomez described services provided through "Senate Bill 94" programs, which serve youth in detention in the community.

02:24 PM

Mr. Gomez responded to committee questions regarding whether or not younger children are separated from older children in facilities, overcrowding in facilities, and brain injuries among youth. He further responded to questions from Representative Nikkel regarding incidents at youth corrections facilities, and whether such incidents are reported to county departments of social services. Mr. Gomez responded to additional questions from Representative Nikkel regarding potential conflicts of interest between the Weld County Department of Social Services and the Platte Valley Youth Services Center. He noted that Division of Youth Corrections employees are "mandatory reporters" of child abuse and neglect, and described the process of investigation of reports of abuse or neglect by county departments of social services. He noted that 40 allegations of abuse and neglect at the Platte Valley Youth Services Center were reported over a four-year period, and of those, three were found to be substantiated. He described the actions the Division of Youth Corrections took in response to those incidents.

02:42 PM

Mr. Gomez discussed the division's responses to questions that had previously been submitted by members of the committee. He discussed a question related to medical care for injured youth. He further discussed other committee questions related to employee computer log-ins, reports of incidents of child abuse or neglect, and the TRAILS system, which tracks incidents of child abuse or neglect. Ms. Beye responded to additional questions from Representative Kefalas regarding how allegations are reported, and whether there is an appeals process if an allegation is found to be not substantiated. Mr. Gomez further responded to questions from Representative Kerr regarding incidents in which police reports may be filed. Ms. Beye concluded by stating that the division investigates incidents that have been "covered up" when they become aware of the incidents. She invited the committee to share methods for improving services to youth.

03:02 PM -- Medicaid Managed Care

Donna Checkett, Schaller Anderson, began the presentation on Medicaid managed care and distributed a handout to the committee (Attachment B). She gave an overview of Schaller Anderson. She described data related to the Medicaid program nationally, noting that 41 percent of all births are paid for by Medicaid and there are 8.8 million individuals who are dually eligible for both Medicaid and Medicare. She described the goals of Medicaid managed care, including slowing the rate of growth of cost trends, improving access to care, improving and assuring quality of care, and establishing and promoting the use of medical homes. She stated that by the end of 2006, 48 states and the District of Columbia had some form of Medicaid managed care.

03:09 PM

Ms. Checkett described models of Medicaid managed care, including risk-based, administrative services organization, and care management models. She described Schaller Anderson's care delivery system, which includes the use of medical homes for all enrollees and modeling systems. She described observations that the company has made regarding its managed care programs. She cautioned that the model makes it difficult to immediately quantify cost savings. Ms. Checkett described the essentials she believes must be part of a Medicaid delivery service system, including medical homes, 24-hour access to services, integration of claims and authorizations, and provider engagement. She responded to questions from Representative Gagliardi regarding whether, if the state contracts with Schaller Anderson, all Medicaid beneficiaries would be enrolled in Aetna. She further responded to questions from Representative Acree regarding improvement in client health outcomes.

03:25 PM

Craig Bass, Schaller Anderson, responded to questions from Representative Swalm regarding electronic medical records. He noted that the economic stimulus package includes funding to promote electronic medical records. Mr. Bass further responded to questions from Senator Carroll regarding the cost of Schaller Anderson's services. He stated that there will be an up-front expense, but over time, medical costs will be reduced.

03:35 PM -- Colorado Alliance for Health and Independence

The representatives of Colorado Alliance for Health and Independence (CAHI) introduced themselves. Larry Alflen, Executive Director of CAHI, introduced the CAHI board members who were in attendance. A copy of their presentation was distributed to the committee (Attachment C).

03:37 PM

Mark Simon, CAHI, described the creation of CAHI. He stated that it began in 2004 at the impetus of the executive director of the Department of Health Care Policy and Financing and the disability community. He explained that the CAHI program was originally based on a Massachusetts program that had a high satisfaction rate in serving individuals with disabilities. Mr. Simon explained that the program was statutorily authorized in 2006, and that by statute, CAHI must be a consumer-based, nonprofit entity. The organization has received an appropriation from the legislature and funding from grants.

03:39 PM

Larry Alflen, CAHI, introduced a video on caring for individuals with disabilities.

03:45 PM

Kelly Stahlman, CAHI, described how individuals with disabilities experience the current health care system. She stated that the vision of CAHI is to make the health care system make sense.

03:48 PM

Mr. Alflen noted that Senate Bill 06-128 was the impetus for the creation of CAHI. He explained that CAHI's strategy is to improve the quality of life and health care for people with disabilities by coordinating a cost-effective network of integrated care.

03:49 PM

Kelly Wilson, CAHI, described the benefits of CAHI. Ms. Stahlman described the primary care component of the CAHI system.

03:55 PM

Laurel Karabatsos, Department of Health Care Policy and Financing, stated the department's support for the CAHI program. She stated that the department's goals include developing systems to address the needs of disabled individuals. She stated that the department looks forward to contracting with CAHI next year. Mr. Alflen responded to questions from Representative Acree regarding the interaction of CAHI with the community centered boards. Mr. Alflen responded to questions from Representative Kefalas regarding whether a fiscal analysis of the CAHI program has been completed. Ms. Stahlman stated that the program will not necessarily save money, but will provide better value. Representative Riesberg commented on the CAHI initiative. The committee adjourned.