Joint Committee Committee on Joint Health and Human Services (01/28/2010)

Final
STAFF SUMMARY OF MEETING

COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES

Date:	01/28/2010	ATTENDANCE

Time:	01:35 PM to 03:50 PM	Acree	*
		Apuan	X
Place:	LSB A	Carroll M.	*
		Gagliardi	X
This Meeting was called to order by		Gerou	X
	Representative Riesberg	Kefalas	X
		Kerr J.	X
This Report was prepared by		Lundberg	*
	Elizabeth Burger	Mitchell	*
		Newell	X
		Primavera	X
		Roberts	X
		Sandoval	E
		Schultheis	*
		Swalm	X
		Tyler	X
		Boyd	X
		Riesberg	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Briefing by the Dept. of Hlth Care Policy and Fin. Dept. Pub Hlth & Envt. Presentation by the Chronic Care Collaborative		- - -

01:35 PM -- Briefing by the Department of Health Care Policy and Financing

Joan Henneberry, Executive Director of the Department of Health Care Policy and Financing, described the department and introduced her staff. The department administers the Medicaid program and Children's Basic Health Plan (CHP+). She gave an overview of current department initiatives. She explained that the department's budget is approximately $4 billion, and the department has approximately 300 employees. An overview of the department's presentation was distributed to the committee (Attachment A).

01:40 PM

She discussed current Medicaid eligibility limits, stating that much of the enrollment in Medicaid is driven by federal mandates. She described the benefits offered in the state's Medicaid program, stating that most of the benefits are offered as a result of federal mandates, although some optional benefits, such as prescription drugs, the department offers because it believes they are medically necessary. She discussed Medicaid waiver programs. Ms. Henneberry described the Colorado Regional Health Information Organization (COHRIO), which is an organization that facilitates the exchange of health information through technology in state. She explained that COHRIO is the designated state agency to build health information exchange technology in the state is qualified to receive funding under the federal stimulus package.

01:47 PM

Ms. Henneberry described the department's accomplishments in recent years, including the establishment of a preferred drug list in Medicaid and the establishment of the Center for Improving Value in Health Care. She stated that the department currently feels comfortable with its Medicaid provider enrollment rate, but that it is worried about the effect of future provider rate cuts on provider participation. She stated that in the last three years, the department has recovered $373 million related to fraud, abuse, and waste. Ms. Henneberry responded to questions from Senator Newell regarding whether the Medicaid eligibility limits in Colorado were correlated with childhood poverty rates. Ms. Henneberry stated that Colorado has not done many eligibility expansions in Medicaid, but has done expansions in CHP+ in recent years. She stated that growth in the Medicaid program in recent years is a result of the fact that more people are eligible for the program due to their income levels, rather than as a result of eligibility expansions. Ms. Henneberry responded to questions from Representative Gagliardi regarding current enrollment in the CHP+ program, stating about 70,000 individuals are currently enrolled in the program. She responded to questions from Senator Schultheis regarding restrictions on the state pertaining to the American Reinvestment and Recovery Act (ARRA) funding.

02:00 PM

John Bartholomew, Chief Financial Officer, Department of Health Care Policy and Financing, discussed recent enrollment growth in Medicaid. He discussed the effect of economic downturns on Medicaid enrollment and how the unemployment rate correlates with the Medicaid caseload. He described the current CHP+ caseload. He relayed a number of statistics regarding the Medicaid program, including that the Medicaid caseload is at is highest point in history. He discussed Medicaid expenditures, and described the per capita costs of various populations served in the Medicaid program. He discussed the budget reductions that occurred in FY 2009-10, including provider rate reductions and additional moneys received through ARRA that backfilled state funding cuts.

02:07 PM

Mr. Bartholomew discussed provider participation rates in Medicaid, saying that rates have increased in the past year. He discussed future Medicaid growth, stating that the state must focus on the activities which provide the most value. He discussed the Colorado Health Care Affordability Act, which allowed the department to collect a hospital provider fee which will be matched with federal funds and be used to expand public health programs. He responded to questions from Senator Carroll regarding services that are provided through contract. Mr. Bartholomew responded to questions regarding unemployment data and the hospital provider fee.

02:20 PM

Sue Williamson, Deputy Director, Client and Community Relations, Department of Health Care Policy and Financing, discussed the department's Medicaid eligibility modernization project. She stated the goals of the project are to increase enrollment and retention, increase administrative efficiencies, and leverage technology. She discussed the various "strands" of the project, including the systems strand, which includes changes to the Colorado Benefits Management System (CBMS) and the business process strand, which concerns requests for proposals for eligibility and enrollment in medical assistance programs. She stated that the department has implemented an online assessment tool to allow individuals to screen themselves for eligibility for public health programs. Phase 2 of the project will allow clients to apply online for the programs, and this phase is expected to be implemented in April 2010. Ms. Williamson discussed planned efficiencies in the data entry system.

02:26 PM

Ms. Williamson discussed a grant the state was awarded from the federal Health Resource and Services Administration. She described the activities that will be funded through the grant, including the CHP+ at Work program which provides premium assistance to individuals eligible for CHP+ to purchase insurance through their employer. Ms. Williamson discussed other grants received by the department from July 2007 to December 2009. She responded to questions from Representative Kerr regarding the current functionality of CBMS, explaining that CBMS has a new vendor, and the project has been reorganized and restructured. She stated that the system is now stable and determines eligibility accurately.

02:31 PM

Phil Kalin, Executive Director of the Center for Improving Value in Health Care (CIVHC), discussed the consensus around the "triple aim." The Triple Aim states that focus needs to be placed on population health, experience of care, and per capita costs. Mr. Kalin explained that CIVHC was formed as a recommendation from the Blue Ribbon Commission on Health Care Reform, and discussed the evolution of CIVHC. He described the role of CIVHC and the goals of the center, which include improving the consumer-centered experience, improving population health, bending the cost curve, and increasing transparency.

02:38 PM

Dr. Sandeep Wadhwa, Chief Medical Officer and State Medicaid Director, Department of Health Care Policy and Financing, discussed the department's project regarding medical homes for individuals with complex health needs. He stated that hospitalization rates have declined as a result of the program. He discussed emergency room visits among Medicaid clients and the reasons why clients visit the emergency room, stating that many of the conditions could be addressed in a doctor's office. He stated the rates of emergency room visits vary across the state, and discussed a stakeholder group that was convened to determine the reasons why hospitalizations vary. Dr. Wadhwa discussed the department's goals related to reducing hospital readmissions.

02:43 PM

Dr. Wadhwa discussed the department's policy with regard to serious reportable events, which was implemented in October of 2009. The policy specifies that the department will not provide reimbursement for certain preventable medical errors. He described the fluoride varnish program, which was implemented in July of 2009 and has treated 14,300 children. Dr. Wadhwa discussed efforts by the department to align provider rates for certain procedures to coordinate with Medicare rate reductions. In addition, the department is working to identify individuals who may be eligible for benefits through the Veteran's Administration.

02:47 PM

Dr. Wadhwa discussed the department's initiatives with regard to long-term care, including implementing presumptive eligibility for Medicaid long-term care benefits. Dr. Wadhwa discussed the department's goals for the upcoming year, including to maximize the health, functioning, and self-sufficiency of all clients, and optimizing efficiency in the expenditure of taxpayers' money. He discussed the department's efforts to modernize its utilization review system. He discussed the percentage of Medicaid clients who are enrolled in managed care systems, and discussed the department's efforts to implement an Accountable Care Collaborative which is slated to begin in November 2010. He described the Coordinated Payment and Payment Reform Initiative, which is an initiative to explore investments in payment reform and savings from coordinated billing and payments.

02:54 PM

Ms. Henneberry gave concluding remarks regarding the department's goals and initiatives. She stated that Colorado is well positioned should federal health care reform legislation pass.

03:03 PM -- Briefing by the Department of Public Health and Environment

Martha Rudolph, Executive Director of the Department of Public Health and Environment, began the briefing of the Department of Public Health and Environment and distributed an outline of the department's presentation to the committee (Attachment B). She discussed the department's objectives including building a strong public health system; having an effective climate change strategy; encouraging and leading Coloradans to healthier lifestyles from birth to old age; having an effective emergency response system to address communicable disease, epidemics, and other public health and environmental emergencies; protecting and improving air and water quality across the state; and eliminating health inequities in Colorado. Ms. Rudolph noted that the department works closely with local public health agencies. Ms. Rudolph discussed the challenges the department is facing due to budget cuts. She discussed the department's FY 2010-11 budget change requests and budget balancing proposals.

03:09 PM

Ms. Rudolph discussed the department's legislative priorities and described issues in Colorado's environmental programs. She described the department's efforts with regarding to ARRA funding and drinking water projects. She discussed recent interest in developing new uranium recovery facilities in Colorado. Ms. Rudolph addressed the Environmental Protection Agency's plan to establish new ozone standards, stating that Colorado has been out of compliance with requirements that are less stringent than those proposed by the agency. She stated that it is likely that Colorado's nonattainment area will increase under the new ozone standards. She discussed possible strategies that may be considered to help Colorado meet the new standards. Ms. Rudolph discussed climate change.

03:16 PM

Dr. Ned Calonge, Chief Medical Officer, Department of Public Health and Environment, updated the committee on health-related issues being addressed by the department. Dr. Calonge discussed issues related to medical marijuana. He stated that the medical marijuana program has been experiencing growth as a result of a series of changes, including a decision by the federal government not to prosecute individuals who use marijuana for medicinal purposes. Dr. Calonge discussed the state's efforts with regard to the H1N1 outbreak. Dr. Calonge discussed the department's involvement with the implementation of the 2008 Public Health Act, stating the goal of the act was to assure that public health services are available to every person in Colorado with a consistent standard of quality.

03:22 PM

Dr. Calonge discussed ARRA funding received by the department, noting that the department's Disease Control and Environmental Epidemiology Division received approximately $4 million in ARRA funds. He discussed the reemergence of rabies in the state, which has been spreading in skunks. Dr. Calonge described reductions in Amendment 35 funding, and related cuts to programs funded with Amendment 35 moneys. He discussed the Primary Care Office and the increase in funding for health professional loan repayment programs. He stated the department has been able to leverage funding provided by the state to expand loan repayment programs. He discussed the department's activities related to recalls of unsafe food products.

03:31 PM

Dr. Calonge responded to questions from Representative Riesberg regarding deaths caused by H1N1 flu.

03:32 PM -- Presentation by the Chronic Care Collaborative

Chris Sherwin, Vice-president of Advocacy for the American Heart Association Pacific/Mountain Affiliate, and representing the Chronic Care Collaborative, described the collaborative, which is a group of 27 organizations that advocate on behalf of individuals with chronic illness. A handout was distributed to the committee (Attachment C).

03:36 PM

Carrie Nolan, President of the Colorado Chapter of the National Multiple Sclerosis Society, discussed the collaborative's legislative priorities, including improving long-term care services. She explained that long-term care services are often utilized by individuals with chronic illness. She testified regarding the association's support for regulation of home care placement agencies. She discussed the association's position on limited benefit health care plans.

03:42 PM

Mr. Sherwin discussed Amendment 35 moneys and the transfers of these moneys to the General Fund in response to the states budget situation. He spoke in opposition to future cuts to Amendment 35 moneys. Ms. Nolan discussed her concerns with House Bill 10-1160, which concerns wellness incentives. She expressed the collaborative's support for House Bill 10-1008 which concerns the use of gender rating in health insurance.

03:49 PM

Senator Boyd and Representative Riesberg made announcements related to the schedule of the Senate and House Health and Human Services committees. The joint committee adjourned.