Joint Committee Committee on Joint Health and Human Services (01/12/2012)

Final
STAFF SUMMARY OF MEETING

COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES

Date:	01/12/2012	ATTENDANCE

Time:	01:35 PM to 05:08 PM	Acree	X
		Aguilar	X
Place:	LSB A	Bradford	X
		Brown	X
This Meeting was called to order by		Fields	X
	Senator Boyd	Foster	*
		Joshi	X
This Report was prepared by		Kefalas	X
	Elizabeth Burger	Kerr J.	*
		Lundberg	*
		Massey	X
		McCann	X
		Mitchell	*
		Newell	X
		Nicholson	X
		Peniston	X
		Roberts	X
		Schafer S.	X
		White	X
		Young	X
		Summers	X
		Boyd	X

		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Presentation by the State Auditor's Office Briefing by the Deptment of Health Care Policy and Financing Briefing by the Department of Public Health and Environment		Witness Testimony and/or Committee Discussion Only Witness Testimony and/or Committee Discussion Only Witness Testimony and/or Committee Discussion Only

01:37 PM -- Presentation by the State Auditor's Office

Senator Boyd called the meeting to order and made announcements related to the committee's schedule.

01:39 PM

Representative Gerou introduced herself to the committee and noted that she is the Joint Budget Committee's liaison to the Senate Health and Human Services and the House Health and Environment Committees. Representative Summers noted that the goal of the SMART Government Act (House Bill 10-1119) is to create communication between the departments and the committees.

01:41 PM

Monica Bowers, Office of the State Auditor, explained that the Legislative Audit Committee requested that the State Auditor's Office brief committees of reference regarding audit recommendations for state departments that are past due. She discussed the performance and financial recommendations for the Department of Health Care Policy and Financing that it had agreed to implement, but had not (Attachments A and B). She noted that there is one performance audit recommendation for the department, concerning data reporting for the Children's Basic Health Plan. Ms. Bowers noted that the recommendation was related to the information that the department needs to effectively manage the program and the expectation of the department to develop an appropriate plan to collect the data. She stated that the department is in the process of implementing the recommendation, but the required changes had not yet been made in the Colorado Benefits Management System (CBMS).

01:46 PM

Marisa Neff, Office of the State Auditor, described the finding classification levels for audit findings in financial audits: a material weakness, which is the most serious level, a significant deficiency, which is not as serious as a material weakness, and a deficiency in internal control, which is the least serious finding. Ms. Neff noted the report provided to the committee contains 51 financial recommendations that had not been implemented by the department in FY 2009 and FY 2010, including 15 material weaknesses in FY 2010, and 21 in FY 2009, 12 significant deficiencies in both FY 2010 and FY 2009, and 24 deficiencies in internal control in FY 2010 and 18 in FY 2009. She described the report in more detail, and the recommendations that were classified as material weaknesses. She described Recommendation 58 from the FY 2010 report, which concerns reporting of provider licensing information to the Medicaid Management Information System. She noted that this recommendation had been made in FY 2008, FY 2009, and FY 2010, and was classified as a material weakness in each year. She discussed audit findings related to eligibility processes for Medicaid and CHP+, and further described recommendations related to provider licensing, participation agreements, and certifications. She urged the committee to review the recommendations contained in the report that were classified as significant deficiencies.

02:00 PM

Ms. Neff responded to questions from Senator Aguilar regarding the State Auditor's annual process for auditing Medicaid eligibility processes. Ms. Neff further responded to questions from the committee regarding the significance of the audit recommendations and the failure of the department to implement the recommendations from year to year. The committee discussed the financial auditing process and how the audits relate to the performance of departments in administering certain programs.

02:12 PM

Ms. Bowers responded to questions from the committee regarding whether the department had requested a waiver from the audit recommendations based on financial constraints. Ms. Bowers responded to questions from the committee regarding the citizenship documentation of clients served in programs administered by the Department of Health Care Policy and Financing.

02:21 PM -- Briefing by the Department of Health Care Policy and Financing

Executive Director Sue Birch, Department of Health Care Policy and Financing, responded to the presentation by the auditor's office on unimplemented audit recommendations for the department. She noted that the department has approximately 20 FTE dedicated to audits, and the department takes audit findings very seriously. She discussed the issues the department faces in implementing the audit recommendations and noted that the State Auditor holds the department to a higher standard than the standard set by the federal government. She noted that many of the auditor's recommendations are duplicative and redundant, and that, considering that some audit recommendations touch on the same themes, there are actually six main outstanding audit recommendations. In response to the audit recommendations regarding verifying the credentials of Medicaid providers, Chris Underwood, Department of Health Care Policy and Financing, discussed the current verification practices of the department and stated that federal law does not require providers to submit annual information on their licensing status. Ms. Birch responded to questions from the committee regarding the audit recommendations and processes in place regarding verification of provider information.

02:39 PM

Antoinette Taranto, Department of Health Care Policy and Financing, discussed audit recommendations related to eligibility determinations for public health programs. Ms. Birch and Ms. Taranto responded to questions from Senator Mitchell regarding whether services are provided to persons who are not legally present in the country. Senator Mitchell requested additional information on the services that are provided to persons not legally present in the country.

02:47 PM

Ms. Birch discussed the ways in which the department leverages federal moneys.

02:48 PM

Ms. Birch began the SMART Government Act presentation for the Department of Health Care Policy and Financing (Attachment C). She discussed the eligibility levels for Medicaid and CHP+, the reasons why the caseloads for the programs are increasing, and the costs associated with various eligibility groups within the programs.

02:57 PM

John Bartholomew, Department of Health Care Policy and Financing, discussed the department's strategic plan (Attachment D). Suzanne Brennan, Department of Health Care Policy and Financing, discussed the department's strategic objectives, which include improving health outcomes, improving long-term services and supports, increasing access to health care, increasing the number of insured Coloradans, and containing health care costs. She described the initiatives related to health outcomes which included the Accountable Care Collaborative (ACC), integrated care for individuals eligible for both Medicare and Medicaid, health living initiatives, and long-term care redesign.

03:03 PM

Ms. Brennan provided further information on the ACC. The goal of ACC is to improve clients' health and contain health care costs through a coordinated system of care. The ACC is comprised of three parts: Regional Care Collaborative Organizations (RCCOs); Primary Care Medical Providers; and a Statewide Data and Analytics Contractor.

03:10 PM

Dr. Judy Zerzan, Chief Medical Officer for the Department of Health Care Policy and Financing, discussed the department's healthy living initiatives. Ms. Birch discussed the departments' goals related to improving long-term services and supports, including redesigning the long-term care payment structure, data systems, and delivery systems to transform long-term care from institution-based to efficient, person-centered, community-based care.

03:19 PM

Ms. Birch discussed the department's objectives related to access to health care services. She discussed the participation of providers in the Medicaid program and recent provider rate cuts. She continued by discussing the department's goals regarding enrolling individuals who are eligible for Medicaid and CHP+ into those programs.

03:22 PM

Dr. Zerzan discussed the department's utilization management and pharmacy payment reform. Ms. Brennan discussed reducing inappropriate emergency room utilization, reducing hospital readmissions, and reducing unintended pregnancies. Mr. Bartholomew discussed the R-6 initiative which is designed to prevent payment for unnecessary services.

03:28 PM

Ms. Birch responded to questions from the committee regarding the ACC and RCCOs. She further responded to questions from the committee regarding resources on reducing emergency room visits and unintended pregnancies. Ms. Brennan responded to committee questions regarding the ACC and provider participation. Ms. Birch responded to questions from the committee regarding the departments priority goals and how the department will measure its progress toward meeting its goals. Ms. Brennan responded to questions from the committee regarding the financial incentives for RCCOs and the payments RCCOs receive related to health outcomes.

03:38 PM

Ms. Birch and Dr. Zerzan responded to questions from the committee regarding provider rates in Medicaid and whether cuts in provider rates have reduced the number of providers who are participating in the program. Senator Aguilar asked for additional information regarding increases in Medicaid copayments, and Mr. Bartholomew responded that the department has a pending budget request related to copayment increases. Dr. Zerzan responded to a question from the committee regarding Medicaid reimbursement payments for primary care services and home health care services. Senator Roberts requested a map of provider participation in the Medicaid program in rural and in urban areas of the state and a map of the locations of the RCCOs in the state.

03:48 PM

The committee recessed briefly.

03:58 PM -- Briefing by the Department of Public Health and Environment

The committee reconvened. Dr. Chris Urbina, Executive Director for the Department of Public Health and Environment, began the department's SMART Act briefing (Attachment E).

04:00 PM

Dr. Urbina discussed the department's vision and mission and described the department's budget and organizational structure.

04:02 PM

Dr. Urbina discussed the department's strategic plan (Attachment F). He described input the department received from internal groups within the department and the employee stakeholder process used to develop the plan. Dr. Urbina noted that the department also received input from external stakeholders. He listed the department's strengths which include staff, strong relationships with other agencies, and its status as a credible source of information. He described areas for improvement for the department, including that the department contains silos of information, retention and recruitment of high quality workers, bureaucratic practices, and the need for better communication. Critical issues for the department include workforce development, funding and resources, and the recruitment of new workers to replace retiring staff.

04:07 PM

Dr. Urbina described the strategic map for the department. He stated the core challenge for the department is aligning resources in the most effective way possible. The goals represented on the map include: achieving targeted improvements in Colorado's winnable battles; promoting programmatic excellence; strengthening the integrated public and environmental health system; fostering a competent, empowered workforce; and creating a more efficient, effective, customer-oriented department.

04:11 PM

Dr. Urbina described the department's efforts related to "winnable battles." He gave examples of winnable battles including improving air and water quality, infections disease prevention, injury prevention, mental health and substance abuse treatment, addressing obesity, promoting oral health, improving food safety, reducing tobacco use, and preventing unintended pregnancies. He noted that the department's full strategic plan contains specific metrics to measure progress relative to each of the winnable battles. He responded to questions from the committee regarding health disparities and the department's goals regarding environmental justice and equality. He responded to additional questions from the committee regarding potential cuts to the federal funds received by the department.

04:28 PM

Dr. Urbina continued to respond to questions from the committee regarding public health and primary care workforce issues in the state, and discussed the Colorado School of Public Health. He further discussed the implementation of Senate Bill 08-194, which reorganized the public health system in the state. Dr. Urbina discussed the public health impact of federal health care reform legislation. In response to a question from Representative Brown, Dr. Urbina discussed the department's measures of clean air and clean water. Martha Rudolph, Department of Public Health and Environment, discussed issues related to nutrient standards for water quality.

04:49 PM

Representative Bradford commented on water quality issues in rural areas of the state. Dr. Urbina continued the department's presentation and responded to questions from the committee regarding the department's legislative agenda. Ms. Rudolph discussed forthcoming bill to repeal the High Emitter Emissions Program. Dr. Urbina continued by discussing the department's successes and budget challenges.

04:57 PM

Representative Peniston discussed issues related to religious exemptions from vaccinations. Ms. Reynolds discussed a pending hearing before the State Board of Health related to vaccinations of medical providers for the influenza virus. Representative Acree asked for additional information on the amount of federal money received by the department to address winnable battles. Dr. Urbina responded to questions from Senator Roberts regarding the role of the department in end-of-life issues. Dr. Urbina responded to questions from Representative Joshi regarding unfunded mandates.

05:08 PM

The committee adjourned.