Health Care Exchange (09/11/2015)

Final
STAFF SUMMARY OF MEETING

HEALTH CARE EXCHANGE

Date:	09/11/2015	ATTENDANCE

Time:	09:00 AM to 11:30 AM	Aguilar	*
		Kefalas	X
Place:	RM 271	Landgraf	X
		Lundberg	X
This Meeting was called to order by		Martinez Humenik	*
	Senator Roberts	Primavera	*
		Ryden	X
This Report was prepared by		Sias	X
	Elizabeth Haskell	McCann	X
		Roberts	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Update on C4HCO CEO Search and Next Open Enrollment Audit Follow-up, Customer Experience, and Sustainability and Budget Overview of Interim Committee Bill Drafting Process Committee Discussion and Vote on Motions to Request Bill Drafts		Witness Testimony and/or Committee Discussion Only Witness Testimony and/or Committee Discussion Only Witness Testimony and/or Committee Discussion Only Committee Presentation and Approval/Denial of Bill Drafts

09:01 AM

Senator Roberts called the meeting to order and requested that the committee members observe a moment of silence in remembrance of the events of September 11, 2001.

09:03 AM -- Update on Connect for Health Colorado CEO Search and Next Open Enrollment

Sharon O'Hara, Chair, Connect for Health Colorado Board of Directors, Adela Flores-Brennan, member, Connect for Health Colorado Board of Directors, Steven ErkenBrack, Vice-chair, Connect for Health Colorado Board of Directors, and Kevin Patterson, Interim Chief Executive Officer (CEO), Connect for Health Colorado came to the table.

Ms. O'Hara explained that the initial Connect for Health Colorado (the exchange) CEO resigned in July 2014. Following the resignation, the board conducted a search for a new CEO during which time the board engaged Gary Drews as interim CEO through June 2015. She explained that the board suspended the search for the CEO to focus on the 2015-16 open enrollment period and hired Kevin Patterson to replace Gary Drews as interim CEO. She explained that the agenda for the September 14, 2015, board meeting includes a discussion about how to proceed with the CEO search.

09:05 AM

Mr. Erkenbreck stated that he has been involved in the CEO search from the beginning and told the committee that the search was suspended because four of the board members' terms ended July 1, 2015, and the board needed to focus on the next open enrollment period. He told the committee that there were two new board members appointed and that two members were reappointed in July. He explained that the board will be moving forward with the CEO search, but the members have not yet discussed how to proceed with the search.

In response to committee questions about the board utilizing the executive management search firm which had previously assisted the board in the CEO search, Ms. O'Hara responded that the contract with the firm remains in place until a permanent CEO is found, but since the search is suspended, the board is not actively working with the firm. Mr. Erkenbreck explained that Mr. Drews was not interested in the permanent CEO position, but Mr. Patterson has expressed interest in the position. He explained that the board will discuss its options related to the CEO search at its next meeting. Committee discussion followed about whether the Subcommittee Concerning Executive Director Appointment should reconvene. It was decided that the subcommittee would not reconvene.

09:18 AM

The committee members asked whether the CEO search would need to be reopened if it was decide that Mr. Patterson would be hired as the permanent CEO. Ms. O'Hara told the committee that the board is not required to reopen the search, but there must be a 15 day public comment period prior to bringing a candidate forward to the oversight committee for approval.

09:28 AM -- Respond to Committee Questions about Audit Follow-up, Improvements to Customer Experience, and Sustainability and Budgeting

Mr. Patterson spoke about the actions taken by the exchange to improve the customer experience. He explained that the exchange conducted functional tests of all joint systems used by the exchange to communicate with various vendors and the Department of Health Care Policy and Financing (HCPF). He stated that there has been advancement in resolving firewall issues. Mr. Patterson discussed the role of insurance brokers and navigators. Committee discussion followed regarding the number of navigators in the state and their ability to effectively assist customers with selecting an insurance plan that meets their health care needs. Mr. Patterson explained that the exchange has been developing tools to help customers more easily review health insurance plans.

09:38 AM

Committee discussion continued about the difference between health coverage guides and navigators. Mr. Patterson told the committee that although some people use the terms interchangeable, health coverage guides are usually individuals who have in-depth knowledge of health insurance coverage, while navigators simply help customers navigate through the Connect for Health Colorado website and the application process. Mr. Patterson agreed with committee members who suggested that navigators should receive more extensive training so that they can more efficiently assist consumers.

09:43 AM

In response to committee questions about navigators and the number of different insurance plans available on the exchange, Mr. Patterson stated that last year there were 176 products offered through the exchange, but that he would need to get back to the committee regarding the number of navigators, the pay range for navigators, and the turnover rate for navigators.

The committee discussed the difference between the criteria used to determine income eligibility for Medicaid and the criteria used to determine income eligibility for the health insurance subsidy. Mr. Patterson stated that he is not sure how or when this discrepancy will be resolved, but the exchange and HCPF are working together to find a solution to this problem.

09:51 AM

In response to questions about the Medicaid eligibility process, Mr. Patterson told the committee that questions were added to the Medicaid application that will more quickly identify those customers who clearly do not qualify for Medicaid. He stated that questions about whether the general Medicaid application will be shortened should be directed to HCPF staff. He continued by explaining to the committee that the Small Business Health Options Program (SHOP) function of the exchange does not have a defined open enrollment period and that the exchange has been engaging in outreach to these potential customers. He also stated that there have been improvements in the SHOP function of the exchange in regard to its billing capabilities.

Committee discussion continued about whether the exchange and HCPF have engaged Colorado's congressional delegation in conversation about aligning income eligibility standards and the Centers for Medicare and Medicaid Services (CMS) cooperation in providing federal matching funds to the exchange for work done on behalf of Medicaid. Mr. Patterson stated that the exchange and HCPF are working together with CMS to resolve these issues, but have not yet requested congressional involvement.

10:01 AM

The committee discussed the complicated nature of written communication sent to customers by the exchange and HCPF regarding eligibility for Medicaid and subsidies. Mr. Patterson responded to questions about the role of the SHOP and the recent audit conducted by the Office of the State Auditor. He explained that the exchange's financial staff has increased communication with the auditor's office regarding the implementation of the audit recommendations and that exchange staff will be reporting back to the auditor in three months about the progress that has been made on the audit recommendations (See Attachment A - Audit Recommendation Status Report). Committee discussion followed regarding whether the Office of the State Auditor is currently conducting additional audits of the exchange.

150911 AttachA.pdf

10:13 AM

Committee discussion continued regarding the exchange's response to question 7 listed in the Responses to Question for Connect for Health Colorado At September 11, 2015, Meeting (Attachment B). In response to committee concerns that Colorado's congressional delegation should be involved in discussions with CMS regarding recovering expenses related to Medicaid, Mr. Patterson explained that the exchange and HCPF are actively involved in a project to request approval from CMS to cost share and that he does not think that it is the right time to request assistance from Colorado's congressional delegation. Discussion about options for systemic changes to the exchange followed. Mr. Patterson spoke about exploring different operational models and evaluating both the benefits and disadvantages of making changes to the existing system. In response to committee questions, he stated that there has not been any changes to the budget since it was presented to the committee in July. Discussion continued about the role of insurance brokers under the current system, compensation for insurance brokers, and the change in the chairmanship of the committee in January 2016.

150911 AttachB.pdf

10:22 AM

The committee engaged Mr. Paterson in discussion about exploring ways to reduce overall cost of the exchange, differentiating between the tasks of the exchange, and different operational models available to deliver the services provided by the exchange. The committee discussed the best way to track the effectuated enrollment, which ages groups purchase coverage on the exchange, and the idea that young people want insurance, but have difficulty affording insurance.

10:32 AM -- Overview of Interim Committee Bill Drafting Process

Kristen Forrestal and Christy Chase, Office of Legislative Legal Service, came to the table. Ms. Forrestal presented an overview of the interim committee bill drafting process. She explained that there is no limit on the number of bills that can be requested for drafting, but the committee may only approve eight bills for introduction. Discussion about the deadlines and about when the drafters need to have information regarding the provision of the bill. Ms. Chase told the committee that the bill sponsors should provide the drafters with bill language by early next week. The bills will be distributed to the committee members by October 23 in preparation for the October 27 committee meeting. Committee discussion followed regarding whether bill requests can be made at a later date.

10:41 AM

Senator Roberts asked if anyone in attendance wanted to participate in the public testimony portion of the agenda. There was no response. Mr. Patterson and Ms. Flores-Bennan returned to the table and stated that the exchange staff and board did not have any policy suggestions at this time.

10:43 AM -- Committee Discussion and Vote on Motions to Request Bill Drafts

Representative Landgraf suggested drafting a bill that would change the open enrollment period from the fixed period of November through January to a rolling open enrollment period that would coincide with the date of the oldest family member's birthday. Committee discussion about the specifics of this suggestion followed. Representative Landgraf explained that she had insurance in the past for which the open enrollment worked this way. Senator Roberts told the committee that during today's meeting the committee will present ideas to be drafted into bills and, if approved, the bill drafts will be presented at the October 27, 2015, meeting for further consideration. Ms. Chase told the committee that the enrollment period for the exchange is set by federal law and that state statute was enacted to align with the federal law. There was no objection to Representative Langraf's proposal.


BILL:	Committee Discussion and Vote on Motions to Request Bill Drafts
TIME:	10:49:52 AM
MOVED:	Landgraf
MOTION:	Draft a bill creating a rolling open enrollment period. The motion passed without objection.
SECONDED:
		VOTE
	Aguilar
	Kefalas
	Landgraf
	Lundberg
	Martinez Humenik
	Primavera
	Ryden
	Sias
	McCann
	Roberts

YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

10:53 AM

Senator Lundberg distributed a bill draft regarding the exchange's authority to impose a tax to support its operations (Attachment C). Committee discussion followed about the provision in federal law that allows a fee to be assessed to support the exchange, and the state law governing taxation and voter approval. Ms. Chase told the committee that federal law does not mandate that a fee be assessed, but it does authorize the assessment. The bill draft was not approved by the committee.

150911 AttachC.pdf


BILL:	Committee Discussion and Vote on Motions to Request Bill Drafts
TIME:	10:59:25 AM
MOVED:	Lundberg
MOTION:	Concerning the Submission to the Voters of a Ballot Question Regarding Whether the Colorado Health Benefit Exchange Can Impose a Tax to Support its Operations (Attachment C). The motion failed on a vote of 4-6.
SECONDED:
		VOTE
	Aguilar	No
	Kefalas	No
	Landgraf	No
	Lundberg	Yes
	Martinez Humenik	Yes
	Primavera	No
	Ryden	No
	Sias	Yes
	McCann	No
	Roberts	Yes

YES: 4 NO: 6 EXC: 0 ABS: 0 FINAL ACTION: FAIL

11:01 AM

Senator Kefalas presented his idea that the committee should contact Colorado's congressional delegation either by resolution or letter to request the delegations' support in working with CMS and the Internal Revenue Service to expedite certain decisions, such as CMS approval of the use of federal matching funds by the exchange for work conducted on behalf of Medicaid and the alignment of income eligibility standards. It was decided that a letter would be sent to the delegation.

Senator Kefalas requested that the committee consider sponsoring a bill to implement the recommendations contained in the final report of the Senate Bill 08-135 Work Group to Develop a Standardized Electronic Identification System for Health Insurance. Committee discussion followed about the work group report and recommendations. The bill draft was not approved by the committee.


BILL:	Committee Discussion and Vote on Motions to Request Bill Drafts
TIME:	11:08:16 AM
MOVED:	Kefalas
MOTION:	Draft a bill containing the recommendations from the final report of the Senate Bill 08-135 Work Group to Develop a Standardized Electronic Identification System for Health Insurance. The motion failed on a vote of 2-8.
SECONDED:
		VOTE
	Aguilar	No
	Kefalas	Yes
	Landgraf	No
	Lundberg	No
	Martinez Humenik	No
	Primavera	No
	Ryden	Yes
	Sias	No
	McCann	No
	Roberts	No

YES: 2 NO: 8 EXC: 0 ABS: 0 FINAL ACTION: FAIL

11:09 AM

Senator Kefalas suggested that a bill be drafted to direct that a 1332 wavier request be developed allowing Colorado employers to be exempt from the employer mandate portion of the federal Patient Protection and Affordable Care Act (PPACA) and allow employees to get insurance through the exchange. Employers would be expected to pay a portion of the premium. Committee discussion followed about the provisions of the proposal. There was no objection to drafting this bill.


BILL:	Committee Discussion and Vote on Motions to Request Bill Drafts
TIME:	11:14:44 AM
MOVED:	Kefalas
MOTION:	Draft a bill to direct that a 1332 waiver be developed allowing Colorado employers to be exempt from the employer mandate provision of the PPACA. The motion passed without objection.
SECONDED:
		VOTE
	Aguilar
	Kefalas
	Landgraf
	Lundberg
	Martinez Humenik
	Primavera
	Ryden
	Sias
	McCann
	Roberts

YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

11:15 AM

Senator Aguilar asked to have a bill drafted that would direct HCPF to request, possibly via a 1332 waiver, the alignment of income eligibility standards so that the Advanced Premium Tax Credit (APTC), which is based on projected annual income, and Medicaid, which is based on a person's current monthly income, use the same way of measuring client income. There was no objection to drafting this bill.


BILL:	Committee Discussion and Vote on Motions to Request Bill Drafts
TIME:	11:16:25 AM
MOVED:	Aguilar
MOTION:	Draft a bill to align income eligibility standards so that the APTC and Medicaid use the same method to measure client income. The motion passed without objection.
SECONDED:
		VOTE
	Aguilar
	Kefalas
	Landgraf
	Lundberg
	Martinez Humenik
	Primavera
	Ryden
	Sias
	McCann
	Roberts

YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

11:17 AM

Representative Sias asked that the committee consider drafting a bill that would provide for more efficient ways to handle the interaction between customers and the purchase of insurance products. He suggested that certain functions of the exchange, other than providing an APTC eligibility determination, be provided by other sectors of the insurance industry. The committee voted 9-1 to draft the bill.


BILL:	Sias -- Draft a bill privatizing certain functions of the exchange.
TIME:	11:19:37 AM
MOVED:	Sias
MOTION:	Draft a bill that moves certain functions of the exchange, other than providing a APTC eligibility determination, to other sectors of the insurance industry. The motion passed on a vote of 9-1.
SECONDED:
		VOTE
	Aguilar	Yes
	Kefalas	Yes
	Landgraf	Yes
	Lundberg	Yes
	Martinez Humenik	Yes
	Primavera	Yes
	Ryden	No
	Sias	Yes
	McCann	Yes
	Roberts	Yes

YES: 9 NO: 1 EXC: 0 ABS: 0 FINAL ACTION: PASS

11:20 AM

Bill Zepernick, Legislative Council Staff, responded to questions about the number of meetings the committee is permitted to hold during the interim. Senator Roberts scheduled a meeting for December 16, 2015. At that time, Connect for Health Colorado staff and board members will provide a status update on the 2015-16 open enrollment period and HCPF staff will have time to respond to committee questions presented during the September 11 meeting.

11:30 AM

The meeting adjourned.