Joint Committee Committee on Joint Health and Human Services (01/06/2015)

Final
STAFF SUMMARY OF MEETING

COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES

Date:	01/06/2015	ATTENDANCE

Time:	09:04 AM to 04:57 PM	Conti	X
		Crowder	X
Place:	HCR 0112	Everett	E
		Fields	E
This Meeting was called to order by		Ginal	X
	Senator Aguilar	Hill	E
		Humphrey	*
This Report was prepared by		Joshi	X
	Elizabeth Burger	Kefalas	*
		Landgraf	*
		Lundberg	*
		McNulty	E
		Newell	X
		Nicholson	E
		Primavera	X
		Schafer	E
		Singer	*
		Stephens	E
		Swalm	E
		Tyler	*
		Wilson	X
		Young	X
		McCann	X
		Aguilar	X

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

Bills Addressed:		Action Taken:
Presentation by the Dept Health Care Policy and Fin Government Access to Personal Medical Information Task Force Presentation by the Department of Human Services Presentation by the Office of the State Auditor Presentation 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 Witness Testimony and/or Committee Discussion Only Witness Testimony and/or Committee Discussion Only

09:08 AM -- Presentation by the Department of Health Care Policy and Financing

Senator Aguilar called the committee to order. Additional members of the General Assembly who joined the committee included: Representative-elect Brown, Representative-elect Lontine, Representative Ryden, Representative-elect Klingenschmitt, Representative-elect Keyser, and Representative Mitch Bush. Sue Birch, Executive Director of the Department of Health Care Policy and Financing, began the department's SMART Government Act presentation and distributed a packet of information to the committee (Attachment A). Copies of the performance plan (Attachment B) and regulatory agenda (Attachment C) for the Departments of Health Care

Policy and Financing, Human Services, and Public Health and Environment were also distributed to the committee. She described the Medicaid and Child Health Plan Plus Programs, and noted that the department works with other state departments on health-related issues. She discussed the populations served in and the income requirements for each program.

150106 AttachA.pdf

150106 AttachB.pdf

150106 AttachC.pdf

09:19 AM

Ms. Birch continued by discussing Medicaid caseload and the expenditures related to caseload. She responded to questions from the committee regarding Medicaid expenditures and match rates and discussed the newly enrolled populations in Medicaid. The committee discussed the hospital provider fee and the increase in Medicaid enrollment.

09:33 AM

Ms. Birch discussed 1332 Medicaid waivers, and noted that some states are in the early stages of implementing the waivers. She continued by discussing the Accountable Care Collaborative (ACC), and described the importance of the patient-centered medical home. She described the Regional Care Collaborative Organizations (RCCOs) and the specific regions in which the RCCOs are located. She noted that 58 percent of Medicaid clients are members of the ACC, and described the department's efforts to pay for value rather than volume. She explained that the department has achieved medical expense and administrative cost savings totalling between $29 and $33 million through the ACC.

09:46 AM

Ms. Birch gave the Report on Reducing Unnecessary Duplicative Service in the Accountable Care Collaborative Program, which is required by Section 25.5-5-417, C.R.S. She gave an example of how the ACCs are working to reduce duplicative services. Ms. Birch responded to questions from the committee regarding shortages of medical professionals. The committee continued to discuss Medicaid provider shortages and Medicaid provider payments. The committee continued to discuss Medicaid provider reimbursement rates and the number of providers in the state that accept Medicaid patients.

10:11 AM

Laurel Karabatsos, Medicaid Deputy Director, Department of Health Care Policy and Financing, responded to questions from the committee regarding the RCCOs and the reimbursement rates within the RCCOs. Ms. Birch and Dr. Judy Zerzan, Department of Health Care Policy and Financing, responded to questions from the committee regarding medical directives. The committee further discussed the availability of private and public psychiatric beds.

10:19 AM

Ms. Birch continued by discussing the long-term care services and supports system. She discussed the Colorado State Innovation Model (SIM), which has the goal of providing access to integrate primary care and behavioral health services in coordinated community systems, and described the federal SIM funding that the state has received to coordinate behavioral health and primary care.

10:36 AM

Ms. Birch discussed the waiting list for the Children with Autism Medicaid Waiver, and discussed that associated budget request to provide additional funding for the services. She further discussed expanding the Teen Pregnancy and Dropout Prevention Program, which was successfully piloted in Mesa, Montrose, and Delta counties.
10:40 AM

Ms. Birch continued by discussing the department's budget requests to increase provider rates. She continued by discussing the department's 2015 regulatory agenda.

10:45 AM

Chris Underwood, Deputy Finance Director, Department of Health Care Policy and Financing, came to the table to respond to questions from the committee regarding the department's budget request related to personal health information records. Ms. Birch continued to respond to questions from the committee regarding savings in the Medicaid program generated by the ACC.

10:58 AM

There were no witnesses present for public testimony. The committee took a short recess.

11:18 AM -- Government Access to Personal Medical Information Task Force

Kate Kiefert and Ronne Hines, co-chairs of the Government Access to Personal Medical Information Task Force, described the task force and distributed a handout to the committee (Attachment D). Ms. Hines described the key objectives of the task force, which including determining what existing laws governed access to health information, obtaining information on how state agencies implement policies and procedures ensuring the safety and privacy of health information, ensuring agencies have policies in place to mitigate the risk of privacy or security breaches and responding to breaches if they occur, and developing recommendations to ensure state and local governments are able to continue fulfilling their commitments to protect Colorado consumers and their health information. Ms. Hines further described the task force process.

150106 AttachD.pdf

11:22 AM

Ms. Kiefert discussed the key findings of the task force, which include that the privacy of personal information has long been an important issue and health information is particularly sensitive subset of information. She described the existing state and federal laws protecting health information. Ms. Hines discussed the state agencies that rely on medical information to determine eligibility for publicly funded benefits. She also discussed the ways in which state agencies use health information for program analysis and research. Ms. Hines continued by discussing the access of health information to promote public health and safety, and Ms. Keifert described the security controls in place for state and local government employees who access personal information.

11:35 AM

Ms. Keifert discussed the task force's recommendations, including continuing to ensure the security and privacy of Coloradan's health information; considering that additional regulations limiting access could inhibit or prevent an agency's ability to fulfill its legal duties, encumber day-to-day operations, or increase costs for Colorado taxpayers; continuing to abide by stringent procedures; targeting any future legislative initiatives primarily at increasing public awareness and education around how their health information is used by state and local government agencies; and informing the public about the uses of health information.

11:38 AM

John Vecchiarelli, Director of Taxpayer Services, Department of Revenue, responded to questions from the committee about the department's procedures for reviewing personal information related to taxation issues. He explained that if the department's audit staff needs information that is contained in a record containing personal health information, the personal medical information is redacted before it is provided to the department. Ms. Keifert responded to questions from the committee about government human resources policies related to communicable diseases.

11:41 AM

The committee recessed for lunch.

01:05 PM -- Presentation by the Department of Human Services

Reggie Bicha, Executive Director of the Department of Human Services, began the department's SMART Government Act Presentation and distributed a handout to the committee (Attachment E). Copies of the departments performance plan (Attachment B) and the regulatory agenda (Attachment F) were also distributed to the committee. Mr. Bicha provided an overview of the direct services and community programs the department provides. He stated that about a third of the department's budget is funded through federal funds. He discussed the organizational structure of the department. He discussed the location of the various department facilities. Mr. Bicha discussed the department's strategic plan and the listening tour that the department conducted and involved about 1,000 stakeholders. He discussed the performance management system called C-Stat that the department has in place. He discussed the community performance center that provides real-time data on the child welfare system, which is one of only a few operating in the nation. He discussed the strategic priorities for the department.

150106 AttachE.pdf

150106 AttachF.pdf

01:21 PM

Mr. Bicha discussed the implementation of audit recommendations and the progress the department has made over the last four years with regard to them. He explained that there was a spike in unimplemented audit recommendations after the Division of Vocational Rehabilitation audit was released. He provided an overview of the department's FY 2015-16 budget recommendations. Mr. Bicha highlighted the request for $4 million in state funding for senior services. He discussed the Colorado Commission on Aging study that is being conducted concerning the increasing number of seniors in the state. Mr. Bicha responded to questions about other entities that are addressing senior population. Mr. Bicha responded to questions about budget request concerning the child welfare workload study, which will include 130 new caseworks.

01:40 PM

Mr. Bicha responded to questions about adult protective services reports which have increased by 47 percent since July 1, 2014. He responded to questions about the budget requests for Division of Youth Corrections (DYC) staffing enhancements. He described the DYC population and staffing ratios. He explained the Collaborative Management Program that is currently funded through divorce fees, but because those fees have been declining in recent years there is budget request for $2 million to support this program. Mr. Bicha discussed the department's budget requests related to child care.

01:54 PM

The committee took a brief recess.

02:01 PM

The committee came back to order. Mr. Bicha provided an overview of the FY 2015-16 budget requests related to data, technology, and infrastructure. He highlighted the modernization of the child welfare case management system, the mental health institute electronic health records, and the facilities master plan. There was discussion about services for youth who are in need of mental health services and veterans services.

02:13 PM

Mr. Bicha presented the department's 2015 legislative requests. He described the department's efforts to address cases where dangerous mental health institutes' patients without criminal convictions had been transferred to the Department of Corrections. He discussed the legislative proposals to eliminate the county child protection teams and to restrict the use of electronic benefit transfer at ATMs at certain locations.

02:29 PM

Mr. Bicha provided an overview of the Keeping Kids Safe and Families Health Initiative and the child abuse reporting hotline. He discussed the child welfare workload study that was released in August 2014 and the need for an additional study to provide caseload ratio recommendations. He discussed the Office of Colorado's Child Protection Ombudsman audit and the DYC medication management audit. He stated that Dr. Patrick Fox is the acting medical director for the department, and there is a budget request for a medical director for the Office of Child, Youth, and Families. Discussion of the DYC medication management audit ensued.

02:54 PM

Mr. Bicha discussed the child welfare performance audit. He provided an overview of the redesign of behavioral health care and the statewide crisis response system. He dialogued with the committee about the crisis stabilization centers that operate 24 hours a day, seven days a week. Mr. Bicha provided an update on the Regional Center Task Force and the Colorado Statewide Youth Development Plan. A copy of the Colorado Statewide Youth Development Plan (Attachment G) was distributed to the committee. Mr. Bicha responded to questions about veterans services that are coordinated by the department.

150106 AttachG.pdf

03:14 PM

There were no witnesses present for public testimony.

03:15 PM -- Presentation by the Office of the State Auditor

Nina Frant, Office of the State Auditor, discussed the role of the Office of the State Auditor. She discussed the child welfare audit and provided an overview of the handout she provided to the committee on the audit (Attachment H). She discussed the findings from the child welfare audit that were related to the SMART Government Act of the child welfare performance audit from October 2014. Ms. Frant discussed the timeliness of assessment closure. Representative Singer discussed his experience as a caseworker. Ms. Frant discussed the Department of Human Services' C-Stat measure and the Community Performance Center, as they relate to the "Timeliness of Initial Contact" performance measure. The committee dialogued with Ms. Frant about the structure of the child welfare system as a state-supervised, county-administered system. Ms. Frant responded to questions about the sample size for the assessments and the interpretation of the department's authority related to certain State Board of Human Services rules. Monica Bowers, Office of the State Auditor, responded to questions about the Office of Colorado's Child Protection Ombudsman performance audit.

150106 AttachH.pdf

03:42 PM

Trey Standley, Office of the State Auditor, discussed the Waste Tire Processor and End User Program audit from June 2014 and provided an overview of the handout he distributed to the committee on the audit (Attachment I). He discussed some of the uses for waste tires. He referenced House Bill 14-1352 that made changes to the program. Mr. Standley discussed the findings from the audit related to the SMART Government Act. Mr. Standley responded to questions about the funding for the program and the number of tires recycled through the program. Committee discussion about waste tire recycling ensued.

150106 AttachI.pdf

04:00 PM -- Presentation by the Department of Public Health and Environment

Dr. Larry Wolk, Executive Director, Colorado Department of Public Health and Environment (CDPHE), began the department's SMART Government Act presentation and distributed a handout to the committee (Attachment J). Copies of the department's performance plan (Attachment B) and regulatory agenda (Attachment K) were also distributed to the committee. Dr. Wolk discussed the department's role and the department's efforts to become nationally accredited. He responded to questions about environmental justice. He provided an overview of the department's budget, which is primarily funded from federal funds and cash funds. Dr. Wolk outlined the department's divisions, the largest of which is the preventions services division.

150106 AttachJ.pdf

150106 AttachK.pdf

04:13 PM

Dr. Wolk discussed agency alignment under the Affordable Care Act, Ebola preparedness and decreased emergency preparedness funding, and air quality. He highlighted the Front Range Air Pollution and Photochemistry Experiment (FRAPPE) that was conduct by NASA. Will Allison, Director of the Air Pollution Control Division, CDPHE, responded to questions about the FRAPPE study and ground level ozone levels.

04:37 PM

Dr. Wolk discussed the department's efforts involving marijuana, including both recreational and medical marijuana. He outlined the department's FY 2015-16 budget requests related to health programs. Dr. Wolk responded to questions about the labeling of marijuana edibles, and said that he expects the Department of Revenue to make some recommendations. Joni Reynolds, Director of Public Health Programs, CDPHE, responded to questions about child fatality review teams. Dr. Wolk continued to discuss the department's FY 2015-16 budget requests related to environmental programs. He outlined the department's legislative priorities, which include an EMS provider interstate compact, health facility drug donation, long acting reversible contraceptives, and issues concerning marijuana. He discussed the radiation control act and the water quality fee structure. Dr. Wolk discussed the recommendations of the suicide prevention commission, the plan to resolve conflicts and gaps in the requirements applicable to community-centered boards and service agencies that provide in-home personal services, and the electronic death certificate program.

04:53 PM

There were no witnesses present for public testimony.

04:56 PM

The committee adjourned.