Final
STAFF SUMMARY OF MEETING

COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES

Date:01/15/2015
ATTENDANCE
Time:01:30 PM to 05:39 PM
Aguilar
X
Brown
X
Place:
Conti
*
Crowder
X
This Meeting was called to order by
Danielson
X
Senator Lundberg
Esgar
X
Everett
X
This Report was prepared by
Ginal
X
Elizabeth Haskell
Humphrey
X
Joshi
X
Keyser
X
Klingenschmitt
X
Landgraf
X
Lontine
X
Martinez Humenik
*
McCann
X
Melton
X
Mitsch Bush
*
Moreno
X
Newell
X
Ransom
X
Ryden
*
Singer
X
Tyler
X
Windholz
X
Primavera
X
Lundberg
X
X = Present, E = Excused, A = Absent, * = Present after roll call
Bills Addressed: Action Taken:
Introduction by Fiscal Analysts and OLLS Staff
Briefing by JBC on Department Budget Requests
Briefing on the Waiting Lists for Persons with IDD
State Auditor Presentation on Unimplemented Audit Recommendations
Presentation by the Behavioral Health Transformation Council
Presentation by Connect for Health Colorado of Annual Report		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


01:32 PM -- Introduction by Fiscal Analyst and the Office of Legislative Legal Services

Senator Lundberg, chairman, called the meeting to order. Lauren Schreier, Fiscal Analyst, Legislative Council Staff, discussed the role of the fiscal analysts and explained the fiscal note. She explained that a bill's fiscal note is a tool to help legislators make informed decisions about the legislation. She stated that fiscal notes are generally released to the bill sponsor 48 hours prior to the scheduled committee hearing, and released to all members 24 hours prior to the committee meeting. Ms. Schreier clarified that this timeline may vary during the last days of session. Ms. Schreier explained that fiscal analysts consider information from the effected state departments and stakeholders but ultimately prepare an independent, unbiased analysis of the fiscal impact of the legislation. Ms. Schreier explained that the text of the fiscal note identifies the assumptions used by the analyst in preparing the note, and that if any information in the note is unclear, legislators may discuss concerns with the analyst. She also explained that fiscal notes for bills that contain a fee or revenue impact will have a TABOR impact section. Ms. Schreier told the committee that fiscal analysts will try to attend all committee hearings.

Duane Gall, Managing Senior Attorney, Office of Legislative Legal Services (OLLS), introduced other OLLS staff members, and discussed the role of OLLS staff. He explained that the core functions of OLLS are bill and amendment drafting, and providing legal advice for the members. Mr. Gall provided a handout (Attachment A) that explains the ancillary materials and services provided by OLLS to the member of the General Assembly. Some of the ancillary materials provided by OLLS include: tables comparing bill provisions; explanations of state or federal statutes; summaries of case law; legislative histories of issues or bills; and legal opinions regarding legislation. Mr. Gall explained that OLLS may provide both informal and formal legal opinions to members of the General Assembly.

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01:40 PM -- Briefing by JBC on Department Budget Requests

Representative Young, member, Joint Budget Committee (JBC), explained that the purpose of the JBC briefing is to give an overview of the work the JBC has been doing regarding the budgets of the three departments for which the health committees have oversight: the Department of Health Care Policy and Financing (HCPF); the Department of Human Service (DHS); and the Department of Public Health and Environment (CDPHE). Representative Young introduced the other members of the JBC: Senator Lambert, chairman, Representative Hamner, vice-chairman, Representative Rankin, Senator Steadman, and Senator Grantham. Representative Young also acknowledged the JBC staff members who were in attendance.

Representative Young handed out the State of Colorado Joint Budget Committee FY 2015-16 Staff Budget Briefing Summary (Attachment B) to the committee. He explained that this document provides a high level overview of the budget requests of state departments. He referred the committee to page 36 of the report which discusses the budget request for CDPHE. He pointed out the table on page 36 which lists the FY 2014-15 appropriation and the FY 2015-16 budget request for CDPHE. Representative Young explained that additional briefing documents are available on the JBC's website. He told the committee that JBC members were not supporting or denying requests at this time, but just presenting information to help the committee understand the request.

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Representative Young highlighted some of the budget requests listed on page 36. Committee discussion ensued.

01:50 PM

The committee discussed the following CDPHE budget requests listed on page 36:

Representative Young responded to questions from the committee and referred the committee to the JBC briefing documents, and JBC and CDPHE staff for more detailed information about each budget requests.

02:00 PM

Senator Lambert clarified for the committee that additional sources for information about the Governor's budget request are available on the Office of State Planning and Budgeting website and in the JBC staff briefings documents. He also told the committee that all JBC hearings are archived on the JBC website.

Representative Young referred the committee to page 18 of the state budget briefing summary (Attachment B) to discuss the DHS budget request. Representative Young highlighted the following recommendations:

Committee discussion followed. Members of the committee discussed recommendation R6 and R8 regarding child welfare case workers and workloads. The committee also discussed recommendation R18 regarding an increase in funding for senior services in order to provide more services through area agencies on aging. Representative Young discussed the additional programs highlighted on page 19 of the summary. He discussed the activities of the task force that is studying the role of the state's regional centers. He explained that the current funding formula for Centers for Independent Living is being reviewed since it currently requires General Fund dollars to be equally distribution among the ten centers regardless of the costs to run each center. He also told the committee that the JBC members have requested that a bill be drafted to move the vocational rehabilitation program from DHS to the Colorado Department of Labor and Employment. Committee discussion followed.


02:17 PM

In response to committee questions, Representative Young explained that the JBC members consider both the Governor's state budget request and JBC staff recommendations when creating the state budget. Representative Young discussed the recommendation of the Governor to expand the autism waiver. He referred to programs and funding recommendations detailed on page 20 of the summary (Attachment B). Representative Young discussed the 3+ initiative. The 3+ initiative is a program developed by Developmental Pathways which provides supports and services to children who have aged out of early intervention services at age three, but who do not yet qualify to receive special education services under the federal Individuals with Disabilities Education Act. Representative Young told the committee that the JBC members have requested a draft bill addressing the expansion of this program. He pointed out that the JBC would review the draft bill, and then decide whether to go forward with the bill.

The committee discussed the issue of provider rate increases. Representative Young clarified that providers include not only medical professionals, but also individuals who provide child care services, mental health and training services for the Department of Corrections and the Department of Public Safety, and other types of service providers. He explained that the JBC members have discussed alining Medicaid reimbursement rates more closely with Medicare reimbursement rates. Committee discussion followed regarding provider rates.

02:34 PM

Committee discussion continued regarding individuals with mental health concerns who are involved in the criminal justices system. The committee discussed the interaction between the Mental Health Institute at Pueblo and the Colorado Department of Corrections.

02:43 PM

Representative Young referred the committee to page 13 of the state budget briefing summary (Attachment B). He highlighted the following budget requests from the HCPF budget request:

Representative Young responded to questions from the committee. He told the committee members that they may contact him directly to discuss any portion of the budget request. Senator Lambert also told the committee members that they can contact JBC staff directly with questions about budget requests.


02:55 PM -- Briefing on the Waiting Lists for Persons with Intellectual and Development

Megan Davisson, JBC staff, presented the briefing on the Waiting Lists for Persons with Intellectual and Developmental Disabilities as required by Section 25.5-10-207.5 (2), C.R.S. Ms. Davisson provided the committee with a JBC Staff Memorandum (Attachment C) which details the following: the number of individuals with intellectual and developmental disabilities (IDD) waiting for waiver services and services through the Family Supported waiver; the number of individuals who are receiving some Medicaid services and who are also waiting for IDD waiver services and the Family Support Services Program; the JBC staff projected cost to provide services for all individuals currently waiting for services; and a summary of the FY 2015-16 funding request. Ms. Davisson responded to questions from the committee.

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Emily Blanford, Assistant Director, Division for Intellectual and Developmental Disabilities in HCPF, discussed the provisions of House Bill 14-1051, which require HCPF to develop a strategic plan to ensure that Coloradoans with IDDs and their families will be able to access the services and supports they need and want at the time they need and want those services and supports. Ms. Blanford provided a handout to the committee that outlines the recent efforts of HCPF in regard to House Bill 14-1051 (Attachment D). She told the committee that the goal is to have all eligible clients enrolled in a Medicaid waiver program by 2020.

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03:14 PM

Ms. Blanford also told the committee that House Bill 14-1252 provided an additional $4.2 million to increase system capacity. The funds were distributed to community-centered boards (CCBs) and to direct service providers. Thus far, 54 percent of the funding has been spent. The majority of the funding has been spent on recruiting and training new staff and building capacity with direct service providers. Committee discussion ensued regard expenditures related to the waivers. Ms. Blanford told the committee that the Adult Comprehensive Waiver is the most expensive waiver with an average cost of $66,000 per year per client. Committee discussion continued concerning direct services, administrative overhead, and the process used to eliminate the waitlists for the waivers.


03:21 PM

Randy Brodersen, Executive Director, North Metro Community Services, Inc., and Mark Wester, Regional Director, West Central Region, Bethesda Lutheran Communities, came to the table. Mr. Brodersen discussed the waitlist. He stated that progress has been made in the last two years on reducing the number of individuals on the waitlists. He talked about his experience of offering services to individuals on the supported living services (SLS) waiver waitlist who do not accept the services at the time they are offered because they have other supports provided through either other programs or family support. He further explained that these individuals sometimes do request services after they have declined the services due to a change in their circumstance, such as a caregiver passes away. He discussed the comprehensive waiver waitlist and explained that many individuals on the waitlist who were classified as needing emergency services have been provided with services. He told the committee that funds used by CCBs are spent mostly on case management and a portion is used for supported living services. Mr. Brodersen discussed the challenges that provider agencies face when providing services for inadequate rates. He told the committee that provider agencies are businesses and must make sound business decisions when deciding whether to hire more providers. He expressed his opinion about the adequacy of rates paid to service providers under the waivers.

03:30 PM

Mr. Wester discussed developing capacity to provide services to additional individuals. He explained that it takes time to identify adequate funding to expand programs and staff, and to develop new services. He told the committee that Bethesda is addressing work force development and was thankful for the government's recent focus on individuals in the disabled community. He explained that supported living services provided by his organization lose money, but that Bethesda continues to offer these services since they are part of the agency's mission. He explained that the agency makes up the cost from other areas and by fundraising.

03:35 PM

Marijo Rymer, Executive Director, the Arc of Colorado, told to committee about her experience being involved in the 2008 ballot initiative to end the developmental disabilities waitlist. She discussed how economic cycles and funding have affected waiver clients. She discussed the challenges related to educating individuals who are on the waitlists about the services they will be eligible for, as well as accurately maintaining the waitlist and keeping track of the individuals registered on the waitlist. She stated that she would like to see cooperation between DHS, the school districts, and other entities that serve the IDD population to identify individuals eligible for services and reach out to them. She told the committee that DHS, HCPF, and other stakeholders are working on developing a new waiver that would provide a continuum of services to individuals as situation in their lives change. She also suggested that the Medicaid state plan include some benefits for services and supports for developmentally disabled clients so they can receive supports without getting on a waiver.

03:42 PM -- Office of the State Auditor Presentation on Unimplemented Audit Recommendations

Kerri Hunter, Deputy State Auditor, Office of the State Auditor, presented Annual Report of Audit Recommendations Not Fully Implemented as of June 30, 2014 (Attachment E). She explained that her presentation will focus on the three departments for which the committees have oversight. She explained the scope of authority of the State Auditor. She told the committee that the recommendations in the report are the result of financial, performance, and information technology audits conducted between July 2008 through June 2013.

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Greg Fugate, Audit Supervisor, Office of the State Auditor, discussed the various tables presented in the first few pages of the report, and provided additional background on the number of audit recommendations and the implementation of these recommendations. He told the committee that 45 percent of recommendations from July 2008 to June 2013 were related to financial audits. He discussed the number of performance and IT audit recommendations that agencies and departments agreed to implement.

03:53 PM

Marisa Neff, Audit Manager, Office of the State Auditor, referred the committee members to tab V of the report. She discussed HCPF's outstanding recommendations, and the actions taken to address these recommendations. She responded to committee questions about the length of time it takes a department to implement a recommendation. Ms. Neff then referred to tab VII regarding the unimplemented recommendations of DHS, and responded to questions from the committee. Mr. Fugate responded to committee questions regarding the time involved to implement audit recommendations.

04:00 PM

Ms. Neff continued by referring the committee to tab XV of the report regarding CDPHE's unimplemented recommendations. She discussed the recommendation related to the cash funds uncommitted reserves performance audit. Mr. Fugate responded to committee questions regarding the Medical Marijuana Cash Fund. He made closing remarks regarding the limited authority the State Auditor has in enforcing the implementation of the recommendations.

04:05 PM -- Presentation by the Behavioral Health Transformation Council

Liza Tupa, Deputy Directory of Community Programs, DHS, discussed the Behavioral Health Transformation Council (BHTC). Ms. Tupa referred to power point slides during her presentation (Attachment F). She provided background on the creation of the BHTC through Senate Bill 10-153. Ms. Tupa discussed the goals and organization of the BHTC. She provided information about the activities and accomplishments of the various subcommittees. Ms. Tupa responded to committee questions about the activities and focus of the BHTC and the subcommittees.

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04:20 PM

Ms. Tupa continued her presentation by addressing the future focus of the BHTC, and the behavioral health workforce. Ms. Tupa responded to questions about the location of mental health crisis centers recently opened in accordance with Senate Bill 13-266. She told the committee that there are four regionally contracted providers who provide services through crisis centers. She told the committee that she would provide the committee with information about the exact location and number of the crisis centers at a later date.



04:28 PM -- Presentation by Connect for Health Colorado of Annual Report

Sharon O'Hara, Board Chair, Connect for Health Colorado Board of Directors, presented the Connect for Health Colorado 2014 Annual Report (Attachment G) to the committee. Ms. O'Hara introduced Gary Drews, Acting Executive Director, Connect for Health Colorado, and Steve ErkenBrack, board member, Connect for Health Colorado Board of Directors.

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Mr. Drews distributed a handout to the committee (Attachment H) which he used as a guide for his presentation. He highlighted the number of individuals and small businesses covered through the exchange. He also addressed the number of providers and plans available on the exchange. Mr. Drews discussed technology upgrades that were implemented. He addressed the difficulty some customers experienced when signing up for coverage. He talked about the federal tax credit and the cost of the plans offered on the exchange. Mr. Drews responded to questions from the committee. Steve ErkenBrack, responded to questions about premium increases and the auto renewal process.

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04:48 PM

Mr. Drews and members of the committee discussed the exchange's marketing budget. Mr. Drews discussed the shared eligibility system with HCPF. He discussed the glitches some individuals experience when trying to sign up during the recent open enrollment period. Mr. Drews and the committee discussed the sustainability of the exchange and the funding sources available to the exchange. He told the committee that the strategic planning for the exchange includes increasing enrollments; maintaining competition; and ensuring sustainability.

04:57 PM

The committee continued to discuss the difficulty some individuals had signing up for coverage. Mr. Drews responded to questions about the telephone wait times experienced by some customer. He discussed the challenges associated with staffing the call center.

05:12 PM

The committee discussed the amount of federal funding appropriated to the exchange, as well as the carrier fee and the premium fee assessed by the exchange. Committee discussion ensued.

Mr. Drews told the committee that the board of directors is searching for a new chief executive officer.

05:26 PM

Committee discussion continued about the number of enrolled individuals.

05:39 PM

The committee adjourned.