Final
STAFF SUMMARY OF MEETING

HEALTH CARE EXCHANGE

Date:10/27/2015
ATTENDANCE
Time:09:31 AM to 12:45 PM
Aguilar
X
Kefalas
X
Place:HCR 0112
Landgraf
X
Lundberg
X
This Meeting was called to order by
Martinez Humenik
X
Senator Roberts
Primavera
X
Ryden
X
This Report was prepared by
Tate
*
Amanda King
McCann
X
Roberts
X
X = Present, E = Excused, A = Absent, * = Present after roll call
Bills Addressed: Action Taken:
Call to Order and Opening Remarks
Public Comment
Committee Bill Drafts -- Discussion and Vote - Bill 1
Committee Bill Drafts -- Discussion and Vote - Bill 2
Committee Bill Drafts -- Discussion and Vote - Bill 3
Committee Bill Drafts -- Discussion and Vote - Bill 4
Committee Bill Drafts -- Discussion and Vote - Letter to Congress
Approval of Connect for Health Colorado CEO
Discussion with Commissioner of Insurance
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
Recommendation(s) Approved
Witness Testimony and/or Committee Discussion Only
Recommendation(s) Approved
Witness Testimony and/or Committee Discussion Only

09:31 AM -- Call to Order and Opening Remarks

Senator Roberts called the meeting to order. The meeting agenda (Attachment A) and an online public feedback survey response (Attachment B) were distributed to the committee members. She announced that Representative Tate would be temporarily replacing Representative Sias on the committee for this meeting only.

151027 AttachA.pdf151027 AttachA.pdf151027 AttachB.pdf151027 AttachB.pdf

09:33 AM -- Public Comment

Joel Ryan, Mountain Midwifery Center, testified before the committee. He discussed how independent nurse midwives have been excluded from the health insurance market and the plans offered on the health insurance exchange. Mr. Ryan answered questions about how improvements could be made to include more independent nurse midwives in the health insurance market. He discussed the lack of contracting by health insurance carriers with independent nurse midwives. He discussed his interactions with the Division of Insurance (DOI) in the Department of Regulatory Agencies about his concerns and Centers for Medicare and Medicaid Services guidance concerning the issue. Mr. Ryan responded to additional questions from the committee about the issues he raised and the efforts his center has made to contract with various health insurance plans. He answered questions about the costs of the services provided at his center. Committee discussion about the issue ensued.




09:48 AM -- Committee Bill Drafts -- Discussion and Vote - Bill 1

Bill Zepernick, Legislative Council Staff, discussed the interim committee bill approval process. Senator Roberts commented on the process. Kristen Forrestal, Office of Legislative Legal Services, responded to questions about voting on and amending bills.

09:55 AM

Ms. Forrestal provided an overview of the Bill 1 (Attachment C). Mr. Zepernick explained the fiscal note for the bill (Attachment D). The bill requires the Commissioner of Insurance to apply for a waiver to the federal Patient Protection and Affordable Care Act (PPACA) to change the open enrollment period for consumers purchasing health coverage on the Colorado health benefit exchange to the birthday month of the primary policyholder. Mr. Zepernick answered questions about the projected costs for Connect for Health Colorado to implement the changes required by the bill.

151027 AttachC.pdf151027 AttachC.pdf151027 AttachD.pdf151027 AttachD.pdf

09:58 AM

Representative Landgraf, who initially suggested the bill concept, stated her intent to withdraw the bill. The committee dialogued about the bill. Representative Landgraf provided an explanation about why she originally thought the bill would be beneficial. No motion was made to forward the bill to Legislative Council.

10:02 AM -- Committee Bill Drafts -- Discussion and Vote - Bill 2

Christy Chase, Office of Legislative Legal Services, provided an overview of the Bill 2 (Attachment E). The bill requires the Commissioner of Insurance to apply for a waiver from the requirement of the federal PPACA that mandates that certain employers offer health insurance coverage to their employees. In lieu of employer-sponsored health coverage, the waiver will allow employers to make a monetary contribution on behalf of their employees so that the employees can purchase health coverage for themselves on the Colorado health benefit exchange. The Commissioner of Insurance is required to develop a health insurance shared responsibility program through which employers of any size may opt to participate and provide a contribution for their employees to purchase health insurance. Participating large employers following the waiver program guidelines will not be subject to fines under the federal PPACA for failure to provide health coverage. The Department of Health Care Policy and Financing (HCPF) is required to assist in the development of the waiver and establishment of the program.

151027 AttachE.pdf151027 AttachE.pdf

10:04 AM

Mr. Zepernick reviewed the fiscal note for the bill (Attachment F).

151027 AttachF.pdf151027 AttachF.pdf






10:05 AM

Senator Kefalas, who initially suggested the bill draft, stated his intent to withdraw the bill. The committee discussed the bill. No motion was made to forward the bill to Legislative Council.

10:08 AM -- Committee Bill Drafts -- Discussion and Vote - Bill 3

Ms. Chase provided an overview of Bill 3 (Attachment G). The bill requires HCPF to apply for all necessary waivers under federal law by January 1, 2017, to align the methods used for assessing client income when determining eligibility for: Medicaid and other state medical assistance programs; and advanced premium tax credits for purchasing health insurance coverage on the Colorado health benefit exchange. In addition, HCPF is required to conduct a study on the potential benefits and costs of implementing 12-months continuous eligibility for adult Medicaid beneficiaries who would otherwise lose their eligibility due to income fluctuations. The study must also analyze other methods for reducing the effect of fluctuating income on continuity of coverage. The study must be completed by November 1, 2016.

151027 AttachG.pdf151027 AttachG.pdf

10:09 AM

Mr. Zepernick outlined the fiscal note for the bill (Attachment H).

151027 AttachH.pdf151027 AttachH.pdf

10:10 AM

Senator Aguilar, who initially suggested the bill, stated her intent to withdraw the bill. No motion was made to forward the bill to Legislative Council.


10:10 AM -- Committee Bill Drafts -- Discussion and Vote - Bill 4

Ms. Forrestal explained Bill 4 (Attachment I). The bill requires the Colorado health benefit exchange to establish a system for referring consumers to qualified insurance brokers to enroll consumers in health plans. To participate in the current system, a broker must be licensed by the DOI and be certified by the exchange. Ms. Forrestal referenced a handout from Connect for Health Colorado about its system to connect brokers to exchange consumers (Attachment J). Senator Roberts mentioned the fiscal note for the bill (Attachment K).

151027 AttachI.pdf151027 AttachI.pdf151027 AttachJ.pdf151027 AttachJ.pdf151027 AttachK.pdf151027 AttachK.pdf

10:12 AM

Representative Landgraf explained the bill on behalf of Representative Sias, who initially suggested the bill draft. She referenced a similar program in Maryland.





10:13 AM --
Marcia Benshoof, Connect for Health Colorado, answered questions about the difference between insurance brokers and navigators. Ms. Benshoof answered questions about efforts by Connect for Health Colorado to implement a similar program as the one outlined in the bill.

10:17 AM

The committee discussed the bill. Representative Landgraf highlighted the data collection requirements in the bill.
BILL:Committee Bill Drafts -- Discussion and Vote - Bill 4
TIME: 10:19:58 AM
MOVED:Landgraf
MOTION:Moved Bill 4 (Attachment I) be forward by the Colorado Health Insurance Exchange Oversight Committee to Legislative Council. The motion passed on a vote of 6-4.
SECONDED:
VOTE
Aguilar
No
Kefalas
No
Landgraf
Yes
Lundberg
Yes
Martinez Humenik
Yes
Primavera
Yes
Ryden
No
Tate
Yes
McCann
No
Roberts
Yes
Final YES: 6 NO: 4 EXC: 0 ABS: 0 FINAL ACTION: PASS

10:21 AM

Senator Roberts designated Representative Sias as the House sponsor and Senator Martinez Humenik as the Senate sponsor for the bill. Senators Lundberg and Roberts and Representatives Landgraf and Tate asked to be listed as co-sponsors on the bill. Senator Roberts determined that the bill would start in the Senate.

10:23 AM -- Committee Bill Drafts -- Discussion and Vote - Letter to Congress

Senator Roberts discussed the letter to Colorado's Congressional delegation concerning Medicaid-related expenses incurred by Connect for Health Colorado and the advanced premium tax credit. Elizabeth Haskell, Legislative Council Staff, explained the letter (Attachment L). Senator Roberts discussed the letter.

151027 AttachL.pdf151027 AttachL.pdf

10:27 AM --
Kyla Hoskins, Connect for Health Colorado, answered questions about the advanced premium tax credits and how these credits are determined.





10:28 AM

Senator Kefalas, who initially suggested that the letter be drafted, discussed the letter. Senator Martinez Humenik expressed her desire to send the letter. The committee decided to send the letter to Colorado's Congressional delegation. Senator Lundberg asked the he not be included on the letter. All other committee members signed the letter.

10:31 AM

Senator Roberts returned to discussion about Bill 4. She indicated that the bill should contain a safety clause and the Office of Legislative Legal Services is permitted to make technical changes to the bill.

10:32 AM -- Approval of Connect for Health Colorado CEO

Sharon O'Hara, Chair, Connect for Health Colorado Board of Directors, discussed the board's actions related to the appointment of Kevin Patterson as Chief Executive Officer (CEO) of the exchange. Steve ErkenBrack, Vice-chair, Connect for Health Colorado Board of Directors, stated that Mr. Patterson was unanimously recommended by the board and discussed how the appointment would help create stability for the exchange. Adele Flores-Brennan, Member, Connect for Health Colorado Board of Directors, discussed the appointment of Mr. Patterson as CEO of the exchange. A copy of Mr. Patterson's resume was distributed (Attachment M).

151027 AttachM.pdf151027 AttachM.pdf

10:36 AM

Mr. Patterson discussed his appointment as CEO of Connect for Health Colorado. He responded to questions from the committee about his appointment. Committee members commented on the appointment of Mr. Patterson as CEO.
BILL:Approval of Connect for Health Colorado CEO
TIME: 10:43:36 AM
MOVED:McCann
MOTION:Moved to approve the appointment of Kevin Patterson as the CEO of Connect for Health Colorado. The motion passed on a vote of 10-0.
SECONDED:
VOTE
Aguilar
Yes
Kefalas
Yes
Landgraf
Yes
Lundberg
Yes
Martinez Humenik
Yes
Primavera
Yes
Ryden
Yes
Tate
Yes
McCann
Yes
Roberts
Yes
Final YES: 10 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS



10:44 AM

Mr. Patterson reviewed the Open Enrollment 3 Readiness Update handout (Attachment N). He discussed the exchange's preparation for open enrollment that starts on November 1, 2015. He outlined the customer service outreach that is occurring and the improved tracking of customer service tickets via e-mail.

151027 AttachN.pdf151027 AttachN.pdf

10:50 AM

Mr. Patterson discussed how the exchange is addressing the closure of Colorado HealthOP. Senator Roberts referenced the Colorado Health Institute's Rates on a Roller Coaster document (Attachment O). Mr. ErkenBrack commented on the departure of Colorado HealthOP from the insurance market. He discussed the various factors impacting the 2016 health insurance rates. Mr. ErkenBrack referenced private health insurance carriers that are leaving other states. He discussed the process used to set health insurance rates.

151027 AttachO.pdf151027 AttachO.pdf

11:02 AM

Senator Roberts commented on information contained in the Colorado Health Institute report regarding the risk corridor program. Mr. ErkenBrack discussed the health insurance market and referenced risk adjustment, the reinsurance program, and risk corridors.

11:10 AM

The committee continued to dialogue with Mr. ErkenBrack about 2016 health insurance rates. Mr. Patterson answered questions about how Colorado HealthOP leaving the insurance market effects the tax credits offered through the exchange. Mr. ErkenBrack responded to questions about increased health insurance rates.

11:20 AM

The committee continued to dialogue with Mr. Patterson and Mr. ErkenBrack about Colorado HealthOP and the exchange. Mr. Patterson answered questions about the outreach that is being made to Colorado HealthOP members and referenced page 4 of Attachment M. Mr. ErkenBrack stated that consumers can access information about the providers and formularies covered by plans offered on the exchange. Senator Roberts asked Mr. ErkenBrack to be prepared to address questions about the sustainability of the exchange at the December 16, 2015, committee meeting.


11:31 AM

Senator Lundberg expressed concern about the letters sent to clients of the exchange and Medicaid regarding their coverage status. He provided a copy of a letter received by a constituent (Attachment P). Senator Lundberg discussed the interaction between the exchange and insurance brokers, and the required brokers agreement with the exchange. Mr. Patterson discussed how the various systems have been improved to address the issues raised by Senator Lundberg. Mr. Patterson and Mr. ErkenBrack discussed the non-disparagement clause in the exchange's insurance brokers agreement.

151027 AttachP.pdf151027 AttachP.pdf

11:41 AM -- Discussion with Commissioner of Insurance

Marguerite Salazar, Commissioner of Insurance, discussed the decision to not allow Colorado HealthOP plans to be offered on the health insurance exchange for 2016 and the pending closure of the Colorado HealthOP. She explained that current HealthOp plans will remain in effect until the end of the year.

11:43 AM

Commissioner Salazar and Scott Lloyd, DOI, answered questions about the possible cost to close down Colorado HealthOP. Commissioner Salazar responded to questions about when information was provided to the DOI about the funding shortfall for Colorado HealthOP. Commissioner Salazar answered questions about the communication between the DOI and the federal government about the reduced funding for the risk corridor program. The committee continued to dialogued about Colorado HealthOP leaving the health insurance market.

11:55 AM

Mr. Lloyd and Commissioner Salazar responded to questions about how the closing of Colorado HealthOP could impact other insurance carriers and the possible fee assessments against carriers to cover Colorado HealthOP's costs. Commissioner Salazar responded to questions about the DOI's actions related to the closing of Colorado HealthOP and potential cost impacts to customers.

12:02 PM

Tom Abel, DOI, answered questions about health insurance rate increases. He discussed the stratification of the market. Committee members continued to dialogue with Mr. Abel about health insurance rates and Colorado HealthOP. Commissioner Salazar discussed the DOI's role in working with Colorado HealthOP and the steps that were taken to address possible funding deficiencies.

12:19 PM

Commissioner Salazar and Mr. Abel responded to questions about the removal of transitional plans from the market. Commissioner Salazar answered questions about the ability of insurance brokers to provide plans prior to when they were posted on the exchange. Mr. Lloyd and Commissioner Salazar answered questions about the potential wind-down costs for Colorado HealthOP.


12:24 PM

Mr. Abel responded to questions about the impact of previously uninsured people entering the health insurance market. Commissioner Salazar addressed how Colorado HealthOP customers are being notified about its closing. Senator Roberts asked Commissioner Salazar to attend the December 16, 2015, committee meeting. Commissioner Salazar answered questions about network adequacy. Senator Kefalas asked for information about the rate variations in various regions of the state. Commissioner Salazar addressed questions about people choosing to pay the tax penalties rather than purchasing insurance. Mr. Abel discussed changes to Medicare supplemental plans. He addressed the tax penalties people may choose to pay rather than purchasing health insurance and discussed the efforts of other state agencies to address regional needs for providers and services. Mr. Abel addressed questions about Medicare advantage plans and supplemental plans.

12:44 PM

Representative McCann commented on the potential costs to closedown Colorado HealthOP. The committee adjourned.