Time:09:06 AM to 11:44 AM
Place:HCR 0112
This Meeting was called to order by
Senator Aguilar
This Report was prepared by
Dave DeNovellis
X = Present, E = Excused, A = Absent, * = Present after roll call
Bills Addressed: Action Taken:
HCPF SMART Act PresentationWitness Testimony and/or Committee Discussion Only
09:08 AM -- HCPF SMART Act Presentation

Senator Aguilar, chair, called the meeting to order.

Susan Birch, Tom Massey, and Suzanne Brennan, representing the Department of Health Care Policy and Financing (HCPF), came to the table to discuss the department's SMART Act presentation. Copies of the department's presentation, legislative and budget agenda, and regulatory agenda were distributed to the committee (Attachments A, B, and C). Ms. Birch described the functions of the department, including administering Medicaid and the Children's Basic Health Plan (CHP+). She noted that HCPF is separate from the Colorado Health Benefit Exchange, also known as Connect for Health Colorado. Ms. Birch responded to questions from the committee regarding the previous year's Medicaid expansion and the federal matching funds associated with it.

131106 AttachA.pdf131106 AttachA.pdf131106 AttachB.pdf131106 AttachB.pdf131106 AttachC.pdf131106 AttachC.pdf

09:16 AM

Ms. Birch gave demographic and financial statistics for the populations HCPF serves. She said it is important for the department to focus on long-term care and services because it represents its largest expenditure. Ms. Birch discussed working with other departments to improve the health of all citizens in the state. She spoke about the department's "state of health" and what the department is focusing on, including promoting prevention and wellness; expanding coverage, access, and quality, improving health system integration and quality; and enhancing value and strengthening sustainability. Ms. Birch responded to questions from Representatives McNulty and Tyler about how the department is focusing on paying for value rather than quantity, and how the department is modernizing the Medicaid Management Information System (MMIS).

09:26 AM

Ms. Birch continued to respond questions from the committee regarding the MMIS modernization project. She discussed collaboration with organizations such as the Center for Improving Value in Health Care and the Colorado Health Institute. Mr. Massey discussed how "value in health care" is defined. Ms. Birch discussed recruiting dental professionals in light of the recent adult dental benefit expansion.

09:38 AM

Ms. Birch and Ms. Brennan responded to questions from the committee regarding the request for information and request for proposal process to administer the adult dental benefit program. Ms. Birch spoke about the department's five-year performance plan, which is including on slide 10 of Attachment A. She responded to questions from the committee about the department's plan to shift from a fee-for-service payment structure. Ms. Birch responded to questions from the committee regarding how HCPF is integrating behavioral health with physical health to assess health outcomes.

09:49 AM

Ms. Birch continued to discuss integrating behavioral health with physical health, including recruiting providers, payment reform, and addressing symptoms and circumstances. Ms. Birch spoke about designing benefits that provide better health outcomes. Ms. Brennan discussed the stakeholder process for a benefit design and the number of groups involved in the benefit-design process.

09:58 AM

Ms. Brennan responded to questions from the committee regarding payment reform, benefit design, and provider payment rates. She spoke about the Accountable Care Collaborative (ACC) initiative. Ms. Brennan discussed savings realized through the ACC primarily through reducing emergency room utilization. She spoke about Colorado's seven Regional Care Collaborative Organizations (RCCOs).

10:08 AM

Ms. Brennan spoke about the progress made on the department's 2013 goals. She responded to questions about the implementation of House Bill 12-1281. Ms. Brennan spoke about electronic health records and which parts of Colorado have electronic capability. She discussed how rural RCCOs address issues of access and payment. Ms. Brennan said the ACC initiative reduced hospital readmissions. high-cost imagining services, and the growth of emergency room visits.

10:18 AM

Ms. Brennan responded to questions from the committee about whether the department is taking into consideration client outcomes and client satisfaction in addition to cost savings and noted that the department is introducing client satisfaction surveys and well-child visits to the benefits. Mr. Massey responded to questions from the committee about whether stand-alone hospitals will accept Medicaid patients due to reimbursement rules.

10:26 AM

Ms. Brennan spoke about House Bill 13-1196 concerning waste prevention in ACCs. She discussed the efforts to reduce avoidable, duplicative, variable, and inappropriate uses of health care resources. Ms. Birch discussed the topics included in the department's budget requests and legislative agenda for the 2014 legislative session including health information technology; improving access to services for persons with intellectual and developmental disabilities; and strategically increasing provider rates. She stated that the components of improving access to services include eliminating the supported living services waiting list, additional funding to reduce the developmental disabilities waiting list, and restoring funding for family support services.

10:35 AM

Ms. Birch responded to questions from the committee about the number of people on the waiting lists for services for individuals with developmental disabilities and noted that wait lists are complex due to how people on the list access services. Representative Young asked if the department was collaborating with the Community Living Advisory Group regarding budget requests for wait lists. Ms. Birch responded to questions from Senator Aguilar regarding Consumer Directed Attended Support (CDAS) and the Affordable Care Act.

10:45 AM

Ms. Birch and Ms. Brennan responded to questions from the committee regarding audit recommendations from to the Office of the State Auditor and the children's hospice waiver. Ms. Birch spoke about the department's prospective increase in provider rates.

10:58 AM

Ms. Birch discussed the department's plan to have a 1 percent payment increase for all Medicaid providers and targeted .5 percent increases for specialty care providers. She also spoke about federal provider payment rates. The committee discussed hospice and palliative care provider rates.

11:03 AM

Mr. Massey discussed the department's 2014 legislative agenda including aligning state Medicaid eligibility categories with federal law; clarifying the nursing facility provider fee, and the transfer of authority from HCPF to the Department of Human Services regarding programs paid for by Medicaid. He responded to questions from the committee regarding where disabled persons fall in the new Medicaid eligibility categories.

11:09 AM

Mr. Massey provided the committee with updates on the Program Eligibility Application Kit (PEAK) and how the department is reaching out to Medicaid expansion clients, and how it is integrating with Connect for Health Colorado. He described the ways clients can access PEAK.

11:18 AM

Ms. Birch reiterated that HCPF does not operate the Connect for Health Colorado website and responded to questions about how PEAK functions.

11:26 AM

Mr. Massey and Ms. Brennan discussed the department's implementation progress on payment reform, the transfer of the Division of Developmental Disabilities to HCPF, and the Community Living Advisory Group.

11:36 AM

Ms. Brennan briefly discussed the Pediatric Assessment Tool and how that implementation is affecting home health agencies. She noted that they have revamped the tool and are expecting to re-release the tool in February 2014. Ms. Birch spoke about the department's provider network and noted that there has been an 8 percent growth in providers signing up to provide care to Medicaid clients. She noted that the Department of Public Health and Environment's Office of Primary Care places physicians in rural areas. Ms. Birch spoke about the State Innovation Model grant the department received.

11:44 AM

The committee adjourned.