Joint Committee Committee on Joint Health and Human Services (11/05/2013)

Final
STAFF SUMMARY OF MEETING

COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES

Date:	11/05/2013	ATTENDANCE

Time:	09:02 AM to 05:08 PM	Conti	*
		Crowder	E
Place:	HCR 0112	Everett	*
		Fields	E
This Meeting was called to order by		Ginal	X
	Senator Aguilar	Hill	E
		Humphrey	E
This Report was prepared by		Joshi	X
	Elizabeth Burger	Kefalas	E
		Landgraf	E
		Lundberg	E
		May	E
		McNulty	*
		Newell	X
		Nicholson	E
		Primavera	X
		Schafer	X
		Singer	*
		Stephens	*
		Swalm	E
		Tyler	*
		Wilson	X
		Young	*
		McCann	X
		Aguilar	X

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

Bills Addressed:		Action Taken:
Overview of Changes to the SMART Government Act Dept. Human Services SMART Act Office of Colorado's Child Protection Ombudsman CDPHE SMART Act State Auditor SMART Act Medical Marijuana Registry Not Fully Implemented Audit Recommendations		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 Witness Testimony and/or Committee Discussion Only Witness Testimony and/or Committee Discussion Only

09:04 AM -- Overview of Changes to the SMART Government Act

Senator Aguilar called the committee to order. Erick Scheminske, Governor's Office of State Planning and Budgeting, provided the committee with an overview of the changes to the SMART Government Act that were enacted as part of House Bill 13-1299 and provided a handout to the committee (Attachment A). He discussed the Governor's goals regarding performance planning and taxpayer- and customer-focused performance management. He described the goals of the revisions to the SMART Act, which include simplicity, flexibility, visibility, and customer focus. He responded to questions from Representative Wilson regarding how state government can communicate better with customers. He described the new deadlines for the performance management system, performance plans, and annual performance reports required by the act. He noted that departments are not required to complete their first performance plans until July 1, 2014. He reviewed the deadlines for committees to meet with executive branch departments and noted that these hearings must now occur in November and December of each year.

131105 AttachA.pdf

09:20 AM

Mr. Scheminske explained that at the meetings with committees of reference, each department must review its performance plan, regulatory agenda, and budget request and associate legislative agenda. He responded to questions from the committee. The committee members and Mr. Scheminske discussed the departments' legislative agendas and the timelines for introducing legislation. Senator Aguilar asked Mr. Scheminske to communicate the Governor's Office's final legislative agenda to the committee members prior to the 2013 bill request deadline.

09:41 AM -- Department of Human Services SMART Government Act Briefing

Reggie Bicha, executive director of the Department of Human Services, introduced the department's SMART Government Act presentation. A copy of his presentation was distributed to the committee (Attachment B). He described the department's mission, vision, and values, and gave an overview of the department's organizational chart. He discussed the department's efforts to become more efficient through FTE reductions, review of rules, and completion of outstanding audit recommendations. He responded to questions from the committee regarding information technology-related audit recommendations and further discussed the department's efforts to respond to the recommendations from the Office of State Auditor.

131105 AttachB.pdf

09:55 AM

Mr. Bicha described the C-Stat Performance Management system. He stated that the system is aligned with the SMART Government Act performance goals, and noted that the department's performance objects are aligned with the C-Stat priorities and the department's budget. He discussed the department's relationships with counties and the Departments of Health Care Policy and Financing and Public Health and Environment.

09:58 AM

Mr. Bicha briefly described the department's 2013-14 strategic initiatives and discussed the development of the department's 2014-15 strategic plan. He highlighted the 2014-15 strategic initiatives which include: improving kindergarten readiness through quality early care; expanding community living options for all people with developmental disabilities; achieving economic security for more Coloradoans through employment; ensuring child safety through improved prevention, access, and permanency; achieving a statewide crisis response system and expanding community supports in mental health and substance abuse; and preparing Colorado to meet the needs of more seniors who choose to live and thrive in their homes and communities. He gave a brief overview of the department's FY 2014-15 budget requests and the 2014 legislative agenda. The department's 2014 legislative agenda includes: creating categorical eligibility for foster children to access child care; amending the names of the state veterans' nursing homes to community living centers; implementing recommendations regarding the state's involuntary civil commitment process; and granting greater authority for transfers of Medicaid moneys. He discussed the department's regulatory agenda (Attachment C). He responded to questions from the committee regarding the implementation of the child welfare hotline.

131105 AttachC.pdf

10:12 AM

Mr. Bicha discussed the Office of Long-term Care. He discussed the regional centers for individuals with developmental disabilities and the department's efforts to realign regional center services. He responded to questions from the committee about the transition of patients from the regional centers into the community. He noted that the Division of Developmental Disabilities is in the process of moving from the Department of Human Services to the Department of Health Care Policy and Financing.

10:28 AM

Mr. Bicha discussed the services for seniors provided by the department. He stated that the state does not have a plan for how to deal with the anticipated growth in the need for senior services. He responded to questions from the committee regarding the need for services for seniors and long-term care insurance.

10:34 AM

Mr. Bicha gave a brief overview of Adult Protective Services and Disability Determination Services. He explained that the department conducts disability determinations on behalf of the federal Social Security Administration and discussed the backlog of individuals waiting for these determinations. He noted that this function is entirely funded by the federal government and explained that Colorado is prohibited from using state money to hire additional employees to help with the backlog. He discussed a model the department is looking at to address the issue that involves the application process for Aid to Needy Disabled clients.

10:42 AM

Mr. Bicha discussed the vocational rehabilitation efforts of the department. He discussed that challenges that include fiscal fiduciary responsibilities and the resulting waitlist. He discussed the changes that include a new manager, a performance and fiscal audit, and replacements on the advisory council. He stated the department is looking to eliminate the waitlist. He discussed the elimination of workshop settings due to lack of federal support and the utilization of other coaching models.

10:48 AM

Mr. Bicha provided an overview of the Office of Children, Youth, and Families. He discussed the Keeping Kids Safe and Families Health 2.0 program and SafeCare Colorado. He discussed the sites that will receive funding for SafeCare Colorado. He discussed the statewide child abuse reporting hotline that will go into effect January 2015 if funding is received from the state. He discussed the reviews of child abuse calls to determine whether decisions were made appropriately. He discussed that the committee is still looking at issues concerning the hotline, including staffing. He discussed the efforts of the department to reduce the utilization of congregate care, which includes finding ways to keep children successfully in the home and utilizing other relatives for placements. He also discussed engaging the Judicial branch in the discussion about placements. Mr. Bicha stated that the Tony Grampsas Youth Services Program has moved to the Department of Human Services and how the program is outlined with the desired outcomes.

11:03 AM

Mr. Bicha discussed the reduction of placements in the Division of Youth Corrections, resulting a return of $11 million to the general fund annually. He discussed the department's efforts concerning family engagement throughout the entire duration of the children's placement with the Division of Youth Corrections. Mr. Bicha discussed trauma-informed care and the fact that many of the youth in the Division of Youth Corrections were previously involved in the child welfare system. He discussed the efforts to partner with a program in New York to improve Colorado's Division of Youth Corrections program. He discussed the efforts of the department to address issues concerning juvenile parole and the limited ability of the department to find youth who have absconded from the Division of Youth Corrections.

11:14 AM

Mr. Bicha gave an overview of the Office of Economic Security, including the ReHire Colorado program, which will involve five communities initially. He discussed Colorado Works and the Colorado Benefits Management System (CBMS) and the efforts of the state to rebuild CBMS. He discussed the budget request to allow for increased data collection about the Colorado Works program. He described the department's goals related to processing Colorado Works applications and discussed the number of households receiving food assistance. He responded to questions from the committee regarding the determination of eligibility for food assistance and the department's error rate in determining food assistance benefits.

11:31 AM

Mr. Bicha discussed the Office of Early Childhood. He discussed the importance of high quality child care and described the elements of the early childhood system, including safety, a quality workforce, and access for families. He stated that the state must increase its ability to regulate Colorado's child care centers. He explained that the industry standard is 1 licensing staff person to 50 child care centers with 2 licensing visits annually. He noted that Colorado's current ratio is 1 licensing staff person to 145 child care centers and 1 inspection every 2 years. He described the department's proposal to increase the licensing staff ratio to 1 staff person to 100 centers and 1 inspection every 18 months. He responded to questions from the committee regarding the relationship between the number of licensing staff persons and safety. The committee continued to discuss licensing inspections, the timing of the inspections, and whether there are duplicative state and county licensing processes. The committee recessed briefly.

11:56 AM

The committee reconvened. Mr. Bicha continued his discussion of the ratio of licensing inspectors to child care providers. He discussed the department's efforts related to improving the quality of child care and responded to questions from the committee. He continued by discussing access to child care and described the department's legislative proposal to allow foster children to access child care and described the department's early childhood literacy efforts. He described the Childcare Automated Tracking System (CHATS) and discussed issues with the system. He responded to questions from the committee regarding how the department is attempting to address problems with the system.

12:09 PM

Mr. Bicha discussed the Office of Behavioral Health. He discussed the current redesign of the behavioral health care system. The system has five components including: building a trauma-informed culture of care; enhancing community care; expanding hospital capacity; developing a statewide crisis response system; and providing the right services to the right people at the right time. He described a task force that met to review civil commitments, and discussed the task force's recommendations. Mr. Bicha discussed the development of a statewide crisis response system and the elements of the system, including a statewide crisis help line, walk-in crisis stabilization services, mobile crisis services, crisis respite and residential services, and a statewide awareness campaign. He discussed issues with procuring elements of the crisis response system.
12:30 PM

Mr. Bicha discussed the jail-based restoration program, which will provide competency evaluations and services to individuals involved in the criminal justice system. He noted that the program began providing services November 1, 2013, and will free up beds at the Colorado Mental Health Institute at Pueblo. He discussed statistics related to seclusion and restraint at the mental health institutes in Pueblo and Fort Logan. He described the Mental Health First Aid Colorado Program, which concerns the identification, understanding, and response to individuals in mental health and substance abuse crises. He responded to questions from the committee regarding the relationship of the program to crisis response services.

12:37 PM

Mr. Bicha described the Office of Administrative Solutions. He discussed efforts to provide career development training to department employees and responded to questions from the committee regarding the initiative. He provided a summary of the department's FY 2014-15 capital requests. The requests include suicide mitigation efforts at the mental health institutes and Division of Youth Corrections facilities, and a request to implement an electronic health record at the state mental health institutes. He responded to questions from the committee regarding the department's capital requests.

12:54 PM

Senator Aguilar announced that the committee would reconvene at 1:45 pm. The committee recessed.

01:50 PM -- Presentation from the Office of Colorado's Child Protection Ombudsman

The committee came back to order. Dennis Goodwin, Office of Colorado's Child Protection Ombudsman, provided an overview of the role of the ombudsman, as well as the history of the Office of the Colorado's Child Protection Ombudsman. He provided a packet of information to the committee (Attachment D). He discussed the office's work plan, the forthcoming state audit of the program, the office's staff, and the office's program objectives. Mr. Goodwin discussed the services the office provides, including systems navigation assistance. He stated the office does not respond directly to emergencies, nor does it get involved in custody disputes or offer legal advice. He stated that in 60 to 70 percent of the cases the office reviewed, the case worker did exactly what he or she was supposed to do. Mr. Goodwin discussed when investigations occur, and stated that a public report is issued when an investigation occurs.

131105 AttachD.pdf

02:06 PM

Sabrina Byrnes, Office of Colorado's Child Protection Ombudsman, responded to questions about the types of calls the office receives and the length of time it takes to complete an investigation. She stated that if a case is in the court system, it may delay access to information or releasing a report. Mr. Goodwin and Ms. Byrnes discussed the types of people who call the office and the nature of the calls. Mr. Goodwin discussed the ombudsman office's relationship with Department of Human Services in response to questions. Ms. Byrnes responded to questions about the call intake process. Ms. Byrnes stated that the office does not do home visits. She explained the process that is followed when a report of abuse or neglect is received by the office staff.

02:28 PM

Mr. Goodwin stated that the office received 130 calls in the first year, 297 calls in the second year, and expects 400 calls this year. In response to a question, he discussed the office's public awareness efforts and the ability of the office to review a criminal court case. Mr. Goodwin discussed the need for training, accountability, supervision, and case documentation. He discussed the office's role in the child fatality review process. He stated the office has monthly meetings with Department of Human Services, and discussed the safety assessment tool and the child welfare training academy. Mr. Goodwin responded to questions about a supervisor's ability to attend the child welfare training academy and whether the office has been involved in the child abuse hotline committee. He responded to questions about public awareness efforts. Ms. Byrnes stated the office also has oversight over the Division of Youth Corrections complaints. Mr. Goodwin responded to questions about funding levels for the office.

02:48 PM -- Department of Public Health and Environment SMART Government Act Briefing

Dr. Larry Wolk, executive director of the Department of Public Health and Environment (CDPHE), introduced himself to the committee. A copy of his presentation and a list of unimplemented legislation was provided to the committee (Attachments E and F). He discussed the department's efforts to improve health in Colorado. Dr. Wolk discussed flood recovery, efforts to make the department more efficient, health information technologies, and evidence-based information sharing. He discussed the department's website redesign. Dr. Wolk gave an overview of the department's budget requests, including the impact of federal shutdowns on the department, and responded to questions about sequestration. He highlighted the efforts of the department's winnable battles, and responded to a question about the department's efforts concerning exercise.

131105 AttachE.pdf

131105 AttachF.pdf

03:09 PM

Dr. Wolk discussed efforts to simplify the oil and gas permitting process and the technical challenges the department faces. Dr. Wolk responded to questions about the permitting process and whether the permitting data will be publicly available in the Colorado Information Marketplace. He gave an overview of the department's flood response efforts, including providing tetanus shots and assisting with debris removal. Dr. Wolk discussed incidents of hepatitis A and rabies. He discussed the department's efforts to provide oral health under the Old Age Pension funding. Dr. Wolk stated that suicide rates in Colorado continue to increase. He discussed the Man Therapy program and suicide statistics in Colorado.

03:27 PM

Dr. Wolk discussed the upcoming efforts concerning oil and gas rules and permitting. He discussed the shutdown of the toxicology lab and the utilization of private labs. He stated that most other state labs do not perform toxicology testing. In response to a question, he discussed childhood vaccines and the need to keep vaccines separate based on whether the patient has private insurance. Eliza Schultz, CDPHE, discussed the stakeholder process to address issues concerning access to childhood vaccines and the progress of the stroke and STEMI stakeholder groups.

03:39 PM

Dr. Wolk discussed state efforts to address prescription drug abuse and misuse. He discussed issues concerning synthetic marijuana. He discussed the recent audits of the department, which addressed the vehicle inspection and maintenance program, medical marijuana registry, the Colorado HIV and AIDS Prevention Grant Program, and Amendment 35. While providing an overview of the department's 2014-15 budget items, Dr. Wolk discussed medical marijuana research and the use of medical marijuana by children. He responded to a question about the potential for increased use of medical marijuana if proposition AA passes and the medical marijuana registry audit.

03:53 PM

Dr. Wolk discussed the budget requests to fund a contract compliance monitor and water infrastructure. He gave an overview of the department's legislative agenda. Dr. Wolk responded to questions about whether there is a budget request to analyze suicide-related data, issues concerning trauma care and emergency medical systems, and about the flight for life programs. Dr. Wolk stated he would respond after the meeting concerning the department's regulatory agenda (Attachment G).

131105 AttachG.pdf

04:05 PM

The committee recessed.

04:14 PM -- State Auditor SMART Act Report on the Medical Marijuana Registry Audit

Nina Frant, State Auditor's Office, provided an overview of the audit of the medical marijuana registry. She provided a handout to the committee (Attachment H) and stated that the full report is available on the State Auditor's website. She stated that at the time of the audit, the fees being collected exceeded the costs of the red card program. Ms. Frant discussed the recommendations that were made in the audit, including timely processing of applications. She stated the Department of Public Health and Environment is scheduled to give a status update to Legislative Audit Committee in January 2014. Ms. Frant responded to questions about the ability of the Department of Public Health and Environment to file a complaint with the Department of Regulatory Agencies about a physician. Monica Bowers, Office of the State Auditor, responded to questions about what can happen after an audit occurs. The committee discussed efforts to utilize funds to address enforcement issues and the limitations caused by the constitutional language to redirect the medical marijuana registry funds.

131105 AttachH.pdf

04:30 PM -- Not Fully Implemented Audit Recommendations for the Department of Human Services, Department of Health Care Policy and Financing, and Department of Public Health and Environment

Monica Bowers, Office of the State Auditor, provided an overview of the annual report of audit recommendations not fully implemented (Attachment I). She discussed the types of audits the office performs, which include performance audits, financial audits, and information technology (IT) audits.

131105 AttachI.pdf

04:35 PM

Sarah Aurich, Office of the State Auditor, discussed financial audits and said that the biggest decrease in outstanding financial audits occurred in the Department of Human Services (DHS). She stated that the Department of Health Care Policy and Financing (HCPF) has 15 outstanding financial audits. She discussed the performance and IT audits and stated that HCPF has 13 outstanding performance and IT audits.

04:43 PM

Cindi Radke, Office of the State Auditor, discussed the outstanding audits of the HCPF. Ms. Aurich responded to questions about the issues raised in the audit concerning home- and community-based long-term care services. Ms. Radke responded to questions about outstanding audit recommendations concerning the Medicaid Management Information System.

04:51 PM

Ms. Radke gave an overview of the outstanding audits for the DHS, including the issues related to eligibility determinations. According to the report, DHS has 19 outstanding financial audit recommendations and no outstanding performance and IT audit recommendations. She discussed the outstanding audits for the Department of Public Health and Environment (CDPHE). According to the report, CDPHE has three outstanding financial audit recommendations and seven performance and IT audit recommendations. In response to a question, Ms. Bower stated that the information about the medical marijuana registry audit was not included in the annual audit report due to when the reports were released. Ms. Bower responded to questions about the audit that is in progress concerning child welfare. Ms. Aurich responded to questions about the ability of parents to access grief counseling under the hospice waiver. Ms. Bower responded to questions about audits involving the Office of Information Technology, whether audit visits are announced or unannounced, and whether the auditors receive input from customers or stakeholders.

05:08 PM

Senator Aguilar discussed the committee's schedule for the November 6 meeting, and adjourned the committee.