Date: 01/28/2010
Final
Briefing by the Dept. of Hlth Care Policy and Fin.
COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES
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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.