Final
STAFF SUMMARY OF MEETING

HEALTH BENEFIT EXCHANGE

Date:08/31/2011
ATTENDANCE
Time:10:02 AM to 11:58 AM
Aguilar
X
Gardner D.
X
Place:HCR 0112
Kerr J.
X
Lundberg
*
This Meeting was called to order by
McCann
X
Senator Boyd
Nicholson
X
Roberts
X
This Report was prepared by
Summers
X
Kelli Kelty
Gardner B.
X
Boyd
X
X = Present, E = Excused, A = Absent, * = Present after roll call
Bills Addressed: Action Taken:
Board Member Update
Committee Discussion on Proposed DHHS Rules
Public Testimony
Other Business		Witness Testimony and/or Committee Discussion Only
Witness Testimony and/or Committee Discussion Only
Witness Testimony and/or Committee Discussion Only
Witness Testimony and/or Committee Discussion Only


10:03 AM -- Board Member Update

Senator Boyd called the meeting to order. She noted that Representative Gerou was present at the meeting.

10:04 AM -- Gretchen Hammer, Interim Chair of the Colorado Health Benefits Exchange Board, came to the table. Ms. Hammer gave a brief overview of the board's bylaw process and election of the board chair. She said that the board has established a subcommittee structure, including a Board Governance & Bylaws Committee and an Executive Director Search Committee. She explained the intent of the subcommittees. She spoke about the reports from work groups who have been working on issues since earlier in the year. She said the board has established two subcommittees related to grants. She discussed the ongoing commitments to public engagement by the board. She indicated that the board will meet twice a month and it has begun the executive director search process.

10:12 AM

Representative B. Gardner thanked Ms. Hammer for her work on the board. He conveyed a concern of stakeholders regarding subcommittee meetings, stating that the notice for these meetings has not been in compliance with the 24-hour meetings notice. Ms. Hammer responded that she will work with staff to implement a 24-hour notice period.


10:13 AM -- Steve Erhenbreck, representing Rocky Mountain Health Plans and the Health Benefits Exchange Board, came to the table. He gave a brief overview of the board's work concerning the federal regulations. Mr. Erhenbreck stated that the board exchange and that the Exchange Board agrees. The subcommittee identified the following issues to focus on:

10:21 AM

Senator Roberts asked whether using volunteers in the role as navigators is something that the subcommittee is seriously considering. She also wanted to know what the board is thinking in regard to long-term sustainability. Mr. Erhenbreck responded that yes, there was discussion on what the subcommittee needs to consider when crafting the navigator role and whether the state wants the flexibility to define the role of the navigator.

10:23 AM

Senator Boyd commented on the issue of potentially licensing navigators. Mr. Erhenbreck emphasized that there is a spectrum of options to consider when crafting the navigator role. Ms. Hammer commented that the characteristics of a navigator have been a hot topic in discussion and ensuring flexibility.

10:24 AM

Representative Summers asked for more information about the role of insurance brokers that provide a critical service in health care selections and what the restrictions are concerning compensation.

10:28 AM

Senator Roberts asked whether the board has any ideas on how the committee should focus on the rules and regulations. Mr. Erhenbreck responded that the board has the challenge of looking at the regulations and determining what they solicit comments on. He said that the commission's approach is to identify and prioritize the issues.

10:33 AM

Senator Boyd mentioned that Joel Ario from the Department of Health and Human Services (HHS) was here last week participating on a federal panel. She commented that the committee needs to be watching the decisions that have yet to be made by the board.

10:35 AM

Discussion turned to the make up of the board. Representative B. Gardner commented that the committee has been characterized as "perfectly balanced" by the federal government.

10:36 AM

Representative D. Gardner confirmed that it is the consumer that is a driver in a lot of the flexibility, particularly in the case of the navigator role. Mr. Erhenbreck concurred that this is the charge of the board.





10:37 AM

Representative Gerou asked about the comment period on the rules and whether the board is posting its comments and responses online. Mr. Erhenbreck responded that the board is focusing their comments in terms of a manageable number because the board has limited resources. Representative Gerou asked whether the subcommittee will be giving the committee the comments prior to the board meeting. Mr. Erhenbreck responded that the comments will be provided to the committee, although they have not yet decided on a format.

10:41 AM

Representative Summers commented on the process of commenting on the HHS rules.

10:42 AM

Representative B. Gardner commented on the rules and said there are things about the regulations that are clear promulgations of statute that cannot be changed. Mr. Erhenbreck concurred. Representative B. Gardner said that he appreciated the subcommittee's work.

10:45 AM

Senator Boyd clarified that the subcommittee's comments will be available on the board's website. Mr. Erhenbreck said that staff will prepare a draft to be brought before the exchange board on September 16th and that the public will have an opportunity to comment at the meeting.

10:47 AM

Senator Roberts asked whether people can participate by phone and if the proposed comments are on the board's website. Ms. Hammer responded yes.

10:47 AM

Senator Boyd asked Ms. Hammer to identify board members present at the meeting.

10:47 AM -- Committee Discussion on Proposed DHHS Rules

Attachments A and B were distributed to the committee. Senator Roberts asked staff to summarize the handouts and discuss the related process concerning where Colorado stands once the federal government has implemented these the rules.

110831AttachA.pdf110831AttachB.pdf

10:50 AM

Senator Boyd asked if staff would like to discuss the rules. Senator Roberts clarified that she would be interested in having staff summarizing the document for the committee.








10:51 AM -- Christie Lee and Kerry White, Legislative Council Staff, came to the table to provide a summary of the rules to the committee. Ms. Lee explained that she and Elizabeth Burger, Legislative Council Staff, compiled the memorandum that provides information regarding specific areas in which Colorado has flexibility in establishing its Health Benefit Exchange and summarizes the proposed HHS rules. Ms. White explained the table appended to the memorandum.

10:54 AM

Senator Roberts commented that the committee should focus on the areas that need to be commented on by September 28 and asked staff to give general background information on these areas.

10:55 AM

Representative B. Gardner commented that he would also appreciate it is staff could summarize the table and help the committee determine its focus.

10:56 AM

Representative Summers asked staff to focus on page 4 of the table to begin the discussion.

10:57 AM

Ms. White said that each state is required to submit an exchange plan and noted that page 4 addresses the process for submitting and reviewing the exchange plan.

10:58 AM

Senator Roberts asked whether Senate Bill 11-200 already addresses the exchange plan. Ms. White responded that the board is developing the implementation and financial plan that the committee is required to approve.

10:59 AM

Senator Boyd clarified that the implementation and financial plan is different from the board's work plan.

11:00 AM

Senator Roberts asked whether the state plan amendment process currently used for Medicaid is detailed and wondered how cumbersome the process will be if used for the exchange plan. Ms. White responded that staff can look into this issue and provide information to the committee at a later date.

11:01 AM

Senator Boyd commented on the process for submitting and reviewing the exchange plan.

11:01 AM

Senator Roberts stated that she would like to confirm that the process is 90 days.


11:02 AM

Senator Boyd commented that members of the audience shook their heads in agreement concerning comments about the process being 90 days.

11:03 AM

Representative B. Gardner talked about his concern with the HHS 90-day approval process. He said that he does not like the idea that the state has to notify HHS before significant changes are made and commented that it is a cumbersome process.

11:04 AM

Representative Summers said he is not familiar with the details of the process and appreciates these comments.

11:04 AM

Representative D. Gardner said it might be helpful to get departmental input on this issue.

11:05 AM

Senator Boyd commented that a representative from the Colorado Department of Health Care Policy and Financing is in the room.

11:05 AM -- Carrie Cortiglio, from the Colorado Department of Health Care Policy and Financing, responded to questions from the committee concerning the 90-day process. Discussion ensued between Ms. Cortiglio and Senator Roberts.

11:08 AM -- Joan Henneberry, representing the Colorado Health Institute, came to the table and gave a brief explanation of the process, including the 90 day timeframe. Ms. Henneberry said it is appropriate for the committee to say that the timing could not work as well as it does with Medicaid due to legislative timelines.

11:11 AM

Representative Gerou asked staff to provide a list of what the state is required to pay for under the Affordable Care Act (ACA) and what the federal government is intending to pay for.

11:14 AM -- Ms. Hammer came back to the table to respond to questions from the committee concerning the use of state funds and what the federal government is requiring the state to provide. Ms. Hammer said that the initial planning is paid through Level 1 and 2 grants which the board is currently applying for. Representative Gerou responded that she wants to know what the federal government intends to pay for and what it doesn't intend to pay for.

11:17 AM

Representative Summers commented on Ms. Hammer's statement concerning the financial plan.


11:17 AM

Senator Aguilar commented that it would be worthwhile to look at what is being created at the federal level and what the state could piggy-back on when developing its exchange.

11:18 AM

Ms. White commented that staff has organized the rules in the best manner in which to summarize them to the committee.

11:19 AM

Senator Roberts spoke about the cost for automatic enrollment of state employees associated with the rules. Ms. Hammer said that the exchange is limited to businesses up to 50 people. Senator Roberts continued to comment on this cost. Ms. White clarified that the costs identified in the memo is an employer cost and that it is a preliminary estimate and relates to the entire ACA, not just the exchange.

11:21 AM

Senator Boyd asked for clarification concerning automatic enrollment. Ms. White said that the initial implementation of the exchange has a lower number of employees but the ACA requires automatic enrollment.

11:22 AM -- Ms. Henneberry said that there is a provision in the ACA concerning enrollment of businesses with over 200 people. She said that concerning the state employee benefit plan, there will be a cost associated with this when the law kicks in, but that this has nothing to do with the exchange.

11:24 AM

Senator Roberts commented on potential new costs to the state related to the exchange.

11:25 AM

Representative D. Gardner commented that she would like to bring the focus back to the charge of the committee.

11:25 AM

Senator Boyd commented on the discussion the committee had begun concerning page 4 of the memorandum.

11:26 AM

Representative B. Gardner commented that there may be a need for a different process.

11:27 AM

Ms. White provided a brief explanation of the context of the memo and the appended table.


11:29 AM

Senator Boyd asked for information concerning the eligibility determination. Ms. White summarized the table concerning this issue.

11:31 AM

Senator Aguilar commented that she was curious about Senator Robert's perspective on the rules.

11:32 AM

Senator Roberts explained that she is concerned about the September 28 deadline to respond to the rules.

11:35 AM

Representative B. Gardner commented on the process and suggested that perhaps HHS needs to extend the comment period.

11:35 AM

Senator Boyd concurred and suggested that the committee form a subcommittee to draft comments on the rules.

11:36 AM

Representative McCann asked whether the board's subcommittee is already commenting on the rules. Senator Boyd commented that Mr. Ehrenbreck had posed this question in his presentation.

11:37 AM

Representative D. Gardner wondered whether the committee should have a subcommittee to work with the board and stressed her concern about extending the deadline for comment.

11:39 AM

Senator Aguilar stated that she liked the idea of having a subcommittee to work with the board as a mechanism to have one set of comments to be provided to HHS.

11:40 AM

Senator Roberts commented on the committee's role in the process. Senator Boyd stated that the committee could have a subcommittee of four members (two from each house with a political balance) to digest the comments and formulate legislative comments on behalf of the committee. Senator Boyd acknowledged that there is consensus from the committee and offered to serve on the subcommittee.

11:44 AM

Representative B. Gardner offered to serve on the subcommittee. Senator Boyd compiled a list of members for the subcommittee, including herself, Representative B. Gardner, Representative McCann, and Senator Roberts along with alternates for members who are unable to attend.


11:46 AM -- Mr. Ehrenbreck noted that the board's subcommittee will be meeting on Tuesday, September 6, and would welcome the committee's subcommittee's participation in the meeting.

11:47 AM

Representative B. Gardner noted he would like to discuss writing a letter to DHHS to inform them of the short time-frame for the comments and request more time. Senator Boyd noted that the subcommittee will meet on Tuesday, September 6, at 1:30 PM. Representative B. Gardner noted the requirements of the state open meetings act. Senator Aguilar asked whether members should submit comments referencing the table to Ms. Lee to be compiled by section for Tuesday's meeting.

11:51 AM

Representative B. Gardner asked staff to draft a letter from the committee to HHS asking for an extended deadline on the comment period. Senator Boyd asked whether there was any objection to the committee sending a letter to HHS, recognizing that it could put the committee at a disadvantage in the long run. Representative B. Gardner stressed his concern for urgency in drafting this letter. Senator Boyd noted that there is no objection to the letter.

11:53 AM

Senator Roberts asked staff to provide the committee with six sets of the rules in time for the subcommittee's meeting on Tuesday, September 6. Ms. Lee noted that the proposed HHS rules that came out in August are included in the handout. Senator Aguilar asked staff to send the link electronically as well.

11:55 AM -- Public Testimony

The following individual testified:

11:55 AM -- Pat Ratliff, representing Colorado Counties, Inc. (CCI), came to the table. Ms. Ratliff said that on September 16, the board is going to look at horizontal integration. She stressed CCI's extreme concern.

11:58 AM -- Other Business

There was no other business.

11:58 AM

The committee adjourned.