House Committee on Health and Human Services (03/01/2010)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	03/01/2010	ATTENDANCE

Time:	02:38 PM to 05:41 PM	Acree	E
		Apuan	X
Place:	LSB A	Gerou	X
		Kefalas	X
This Meeting was called to order by		Kerr J.	X
	Representative Riesberg	Primavera	E
		Roberts	X
This Report was prepared by		Swalm	X
	Kelly Stapleton	Tyler	X
		Gagliardi	*
		Riesberg	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB10-1146 HB10-1217		Amended, Referred to Appropriations Referred to the Committee of the Whole

02:39 PM -- House Bill 10-1146

William Browning, Office of Information Technology, Governor's Office, described the Colorado Benefits Management System (CBMS) and provided a handout to the committee (Attachment A). Mr. Browning explained the complexity of CBMS. He stated that there have been approximately 44 functional releases of the system. He explained why the changes to CBMS that House Bill 10-1146 requires will cost the state approximately $490,000. He explained that several different system components have to be developed and tested, some of which include changes to how caseworkers use the system. He explained that changes to the database, rule engines, decision tables, and batch correspondence also have to be modified. He explained that these necessary changes are billed by the hour. He stated that the development costs will be about $340,000 or 3,400 hours. He referred to his handout that provides a breakdown of costs.

02:51 PM

Mr. Browning responded to Representative Gagliardi's question regarding the Program Eligibility and Application Kit or PEAK program. Mr. Browning explained that the PEAK program allows individuals to apply for food assistance programs on-line. He stated that the program was to be deployed March 2010 and that individuals are already using the on-line application. He stated that the department has not deployed the Medicaid eligibility piece, but the department has rescheduled the deployment to May 2010. He explained that the department is waiting for the educational awareness program to get going in full force and that the department does not want to release a program that is not fully functional as that would put too much pressure on county departments.

02:56 PM

Representative Hullinghorst presented House Bill 10-1146 which responds to a Legislative Audit committee report. She described the Home Care Allowance (HCA) and the Home- and Community-Based Services (HCBS) programs. She stated that the bill streamlines and focuses the state-funded HCA program to serve seniors and disabled populations who are not receiving assistance under the Medicaid-funded HCBS waiver programs. She stated that the legislation addresses overlap and redundancy of services in the HCA and the HCBS programs raised in the January 2009 legislative audit. Representative Hullinghorst stated that the bill expands HCA benefits to Social Security Income (SSI) eligible populations who meet the program's functional needs criteria; and maximizes taxpayer dollars for in-home care. She provided a fact sheet on the bill to the committee (Attachment B).

03:03 PM -- Jeanette Hensley, Director, Aging and Adult Services, Department of Human Services, responded to Representative Gerou's question regarding the bill. She stated that there are approximately 1,400 individuals who will be transferred from the HCA program to the HCBS waiver programs. She stated that an additional 1,400 individuals could be served under the HCA program. Ms. Hensley stated that participants of the HCA program receive between $150 to $400 to purchase in-home care. She clarified that participants of the HCA cannot purchase skilled nursing assistance with HCA funding. She stated that individuals on the HCBS waiver program can purchase both skilled and non-skilled services. Representative Hullinghorst commented that the the reason why the HCA program can be expanded is because as individuals move from the HCA program, which is a state-funded program, to the HCBS waiver program, the federal government matches state funds. Ms. Hensely responded that many of the individuals who are eligible for the HCA program do not need the full spectrum of skilled nursing services, but rather help around their house. She stated that by providing these services, it can often reduce the numbers of individuals who require skilled nursing and therefore it is less expensive for the state.

03:16 PM -- Cheryl Duncan, Financial Director, Aging and Adult Services, Department of Human Services, came to the table and responded to committee questions. Specifically, Representative Roberts asked how the department determines who will be eligible for the HCA program when spots become available. She stated that the program is available statewide and it depends upon whether an individual meets the criteria of the program and how long they have been on the waiting list for funding.


BILL:	HB10-1146
TIME:	03:21:54 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt prepared amendment L.002 (Attachment C). The motion passed without objection.
SECONDED:	Kerr J.
		VOTE
	Acree	Excused
	Apuan
	Gerou
	Kefalas
	Kerr J.
	Primavera	Excused
	Roberts
	Swalm
	Tyler
	Gagliardi	Excused
	Riesberg
Not Final YES: 0 NO: 0 EXC: 3 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	HB10-1146
TIME:	03:22:50 PM
MOVED:	Riesberg
MOTION:	Moved to adopt prepared amendment L.004 (Attachment D). The motion passed without objection.
SECONDED:	Kerr J.
		VOTE
	Acree	Excused
	Apuan
	Gerou
	Kefalas
	Kerr J.
	Primavera	Excused
	Roberts
	Swalm
	Tyler
	Gagliardi	Excused
	Riesberg
Not Final YES: 0 NO: 0 EXC: 3 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	HB10-1146
TIME:	03:24:18 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt prepared amendment L.003 (Attachment E). The motion passed without objection.
SECONDED:	Kerr J.
		VOTE
	Acree	Excused
	Apuan
	Gerou
	Kefalas
	Kerr J.
	Primavera	Excused
	Roberts
	Swalm
	Tyler
	Gagliardi	Excused
	Riesberg
Not Final YES: 0 NO: 0 EXC: 3 ABS: 0 FINAL ACTION: Pass Without Objection

03:27 PM

Committee members and Representative Hullinghorst discussed how the American Recovery and Reinvestment Act dollars interact with this bill. Ms. Hensley returned to the table to clarify that the bill does not allow additional individuals to be served on the HCA program, but that it provides additional services, such as personal care or homemaker services.


BILL:	HB10-1146
TIME:	03:34:38 PM
MOVED:	Gagliardi
MOTION:	Moved to refer House Bill 10-1146, as amended, to the Committee on Appropriations. The motion passed on a 6-3 roll call vote.
SECONDED:	Kerr J.
		VOTE
	Acree	Excused
	Apuan	Yes
	Gerou	No
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	Excused
	Roberts	No
	Swalm	No
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes
Final YES: 6 NO: 3 EXC: 2 ABS: 0 FINAL ACTION: PASS

03:38 PM -- House Bill 10-1217

Representative McKinley presented House Bill 10-1217 which repeals the authority of the Department of Human Services (DHS) to sell the Trinidad State Nursing Home. Senate Bill 09-056 authorized the Executive Director of the DHS to divest the Trinidad State Nursing Home. Representative Riesberg noted that the state does not own Trinidad State Nursing Home and that the deed to the building states that if it is no longer used as a home for the aged, that the state's community colleges retain title to the building and own the land.

03:40 PM

Viki Manley, Director, State Nursing Homes, Department of Human Services, spoke in opposition to the bill and provided a handout to the committee and a graph depicting the financial situation of the state nursing home (Attachments F and G). Ms. Manley stated the department's goals in seeking a new owner for the Trinidad State Nursing Home are to maintain a long-term facility in Trinidad, address the fiscal reality of the ongoing operational losses and capital needs, and maintain a positive and mutually beneficial relationship with the Trinidad State Junior College for training and workforce development. Ms. Manley explained that the state nursing home is owned and operated by the the DHS and operates within the Enterprise 505 Fund. She stated that the Enterprise 505 Fund operates all of the state's veterans homes. She stated that the Enterprise 505 Fund has been subsidizing the Trinidad State Nursing Home and because of this, the United States Veterans Affairs (VA) per diem payments to the Enterprise Fund may be jeopardized. She explained that the VA per diem payments can only be applied to a certified Veterans Nursing Home case. She stated that the Trinidad State Nursing Home is not a certified VA home. Ms. Manley stated that the nursing home cannot make a profit at this time. She also stated that the deed of the property states that if the DHS is not the owner, the Trinidad Junior College would be deeded the property.

03:49 PM

Jenise May, DHS, responded to Representative Kerr's question regarding whether the state will be sued if the nursing home is sold stating that she cannot speak to what will happen in the future, but that if the property can be transferred to the community college, that perhaps it would be a win-win for the various stakeholders. Ms. Manley, in responding to Representative Riesberg's question, stated that the VA per diem funding could be cut off as it is intended to go to nursing homes that are certified by the VA. Ms. Manley also commented that the state nursing home is in need of significant capital improvements including a boiler that could cost $500,000.

04:01 PM -- James Bobick, Colorado Board of Veterans Affairs and United Veterans Committee of Colorado, spoke in opposition to the bill. He stated that it is important to keep the Trinidad Nursing home open. He stated that the home is funded by the VA. Mr. Bobick spoke to the per diem funding from the VA. He stated that the VA assistance has been used to keep the Trinidad Nursing home afloat. He stated his concern that the VA would cancel their per diem rate payments, which were about $10.5 million for FY 2009-10. He spoke to the Trinidad Nursing home loses. He stated that even if the nursing home were completely filled, it would still not be able to keep itself afloat. Mr. Bobick commented on the capital needs that the building requires. He stated that the goal is to maintain a long-term care facility. Mr. Bobick provided a handout to the committee regarding his testimony (Attachment H). The committee discussed the value of the property and whether the building could be sold.

04:17 PM -- Commissioner Jim Montoya, Chairman of the Board of County Commissioners, Las Animas County, spoke in support of the bill. He stated that no money from the General Fund was spent building the Trinidad Nursing Home. He spoke to the importance of the nursing home in the community. He stated that the nursing home helps the state by housing several individuals that would not be accepted in other places. He explained that several patients from the Colorado Mental Health Institute at Ft. Logan were transferred to the home. He provided a letter from Representative Jon Salazar supporting the retention of the state nursing home (Attachment I). He stated that the letter states that the home could house more veterans. Commissioner Montoya provided a copy of the deed to the committee (Attachment J).

04:25 PM -- Commissioner Jim Vigil, Las Animas County, spoke in support of the bill. A handout in support of the bill was provided to the committee (Attachment K). He suggested that the state divorce the Trinidad State Nursing Home from the Enterprise 505 Fund, but leave it in the DHS and allow it to be run as a state facility. He stated that this would alleviate the VA funds from being put in jeopardy and still allow it to be run by the DHS. He stated that the facility would require about $350,000 a year to run. Commissioner Vigil stated that the building is 50 years old and is in need of some capitol improvement, but disagreed with the assessment that the building would need $8.5 million worth of repair.

04:40 PM

The committee discussed how to fund the nursing home if it were to be divorced from the Enterprise 505 Fund. Commissioner Montoya commented that the state could contract with the VA to house an 20 additional beds for veterans. Commissioner Vigil responded to Representative Kefalas' question regarding the capital improvements by stating that the boiler was put in recently and is currently being paid off. Commissioner Vigil stated that they need more time.

04:45 PM -- Mack Louden, Citizens Representing Las Animas County, Board Member of the Hospital in Las Animas County, spoke in support of the bill. Mr. Louden stated that if the nursing home closes it would have the adverse effect of closing the local hospital in Las Animas County. He spoke to the cultural aspect of the Trinidad Nursing Home. He stated that several residents of the community spent their last days in the home. He stated that a private enterprise is there to make money, and the residents in the community cannot afford to go somewhere else. He commented that the residents will not have another place to go.

04:59 PM -- Thomas Martinez, representing citizens of Las Animas County and residents of the Trinidad State Nursing Home, spoke in support of the bill. Mr. Martinez read two letters from residents that currently live in the Trinidad State Nursing home (Attachments L and M).

05:05 PM -- Ann Aubuchon, employee of the Trinidad Nursing Home, spoke in support of the bill. Ms. Aubuchon stated that the mill levy ballot initiative that failed in the fall of 2009 may have passed had it just included the nursing home, but because it was tied to several other public health improvements, it was unsuccessful. She stated it failed 51 to 49 percent.

05:10 PM -- Barbara McKellar, State Board for Community Colleges, and Barbara McDonnell, attorney for the Colorado Community College System, introduced themselves to the committee. Ms. McDonnell spoke to the deed for the property and stated what was required for transfer of the property. Ms. McDonnell stated that the land cannot be sold without the approval of the State Board for Community Colleges. Ms. McDonnell stated that she could not foresee an entity purchasing the nursing home without the approval of the state board because they would not have possession of the title. Ms. McKellar explained the process that would occur if a buyer wanted to purchase the property.

05:21 PM

Representative McKinley provided concluding remarks to the bill. He stated that everyone that testified wants to dissolve the facility from the Enterprise 505 Fund and keep the facility up and running. Representative Riesberg stated that if the bill passes, the facility runs the risk of being closed immediately because the state does not have any room to address the situation. Representative Riesberg spoke to his concerns with the bill. Representative McKinley stated that he would like to see the nursing home divorced from the Enterprise Fund and kept open.


BILL:	HB10-1217
TIME:	05:33:36 PM
MOVED:	Kerr J.
MOTION:	Moved to refer House Bill 10-1217 to the Committee of the Whole. The motion passed on a 7-2 roll call vote.
SECONDED:	Kefalas
		VOTE
	Acree	Excused
	Apuan	Yes
	Gerou	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	Excused
	Roberts	Yes
	Swalm	No
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	No
Final YES: 7 NO: 2 EXC: 2 ABS: 0 FINAL ACTION: PASS

05:41 PM

Senate Bill 10-009 was laid over to Thursday, March 4, 2010. The committee adjourned.