HIFA Waiver Committee (08/31/2005)

Final
STAFF SUMMARY OF MEETING

HIFA WAIVER COMMITTEE

Date:	08/31/2005	ATTENDANCE

Time:	09:09 AM to 11:05 AM	Berens	X
		Clapp	*
Place:	SCR 356; Old Supreme Court Chambers	Cloer	X
		Frangas	X
This Meeting was called to order by		Green	X
	Senator Hagedorn	Hanna	X
		Johnson	*
This Report was prepared by		Kester	X
	Elizabeth Burger	Lundberg	X
		McGihon	*
		Mitchell	*
		Riesberg	X
		Sandoval	X
		Shaffer	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Sarah Schulte's Presentation Department's Presentation Department's Presentation Public Testimony Committee Discussion		- - - - -

09:09 AM

Senator Hagedorn called the committee to order and gave an overview of the agenda for the meeting. A number of handouts were distributed to the committee prior to the meeting, including a letter from the Board of Directors of the Health District of Northern Larimer County (Attachment A), a fiscal analysis of the HIFA waiver prepared by the Department of Health Care Policy and Financing (Attachment B), a policy statement regarding the HIFA waiver from the Department of Health Care Policy and Financing (Attachment C), answers to questions submitted to the Department at the August 26 hearing on the HIFA waiver in Pueblo (Attachment D), the report "A Review of the Colorado HIFA Proposal," by Schulte Consulting, (Attachment E), and an article concerning Medicaid reform (Attachment F).

09:12 AM

Sarah Schulte, Schulte Consulting, began her presentation by describing the data sources she used to complete the analysis of the HIFA waiver proposal. Ms. Schulte was hired by the Colorado Legislative Council to review the HIFA waiver and make recommendations regarding its implementation. A copy of her presentation was distributed to the committee (Attachment G). She discussed her conclusions regarding the HIFA wavier, including that the Colorado Family Care program relies on purchasing strategies of large employers in Colorado, successful implementation of a private-sector strategy requires adequate managed care organization and health care provider participation, implementing Colorado Family Care through a HIFA waiver requires a per capita growth cap on federal funding, most elements of the program could be implemented with state plan amendments that do not require a cap, the amount of savings created by the program will be revised by the Department of Health Care Policy and Financing in September, and thoughtful implementation of the program is key to achieving the goals of the program. She discussed her recommendations for the program, including implementing Colorado Family Care using state plan amendments, closely monitoring health plan interest and provider participation, and developing an implementation plan. In summary, Ms Schulte concluded that Colorado Family Care is modeled after the private sector, core concepts of the proposal are supported by the public, state plan amendments do not limit federal funding, and successful implementation will be key to achieving program goals.

09:20 AM

Steve Tool, Executive Director of the Department of Health Care Policy and Financing, and Barbara Ladon, Department of Health Care Policy and Financing, began their presentation by stating the Department's reasons for seeking the HIFA waiver. Mr. Tool highlighted an article from Governing Magazine (Attachment F) which discussed the need for Medicaid reform. He described the advantages of the Colorado Family Cares program, including the expansion of benefits to children enrolled in the Children's Basic Health Plan (CHP+). He stated that Medicaid must do a better job of tailoring benefits to the needs of the clients within the program and that the state needs to be more cost conscious when purchasing health care.

09:24 AM

The committee recessed in order for the committee to relocate to the Old Supreme Court Chambers.

09:34 AM

The committee reconvened in the Old Supreme Court Chambers.

09:35 AM

Mr. Tool and Ms. Ladon continued their presentation on the HIFA waiver. Mr. Tool stated that the program will provide a Medical home for children and stop children from bouncing back and forth between Medicaid and CHP+ as their family's income changes. He discussed the per member/per month costs of Medicaid and CHP+ clients and demonstrated how the per member/per month costs and provider rates were determined for the Colorado Family Cares Program. Mr. Tool responded to questions from the committee regarding whether or not providers would participate in the Colorado Family Cares Program. Ms. Ladon responded to questions from the committee regarding whether the Colorado Family Cares Program accounts for the growing caseload of Medicaid and CHP+., stating that the program does not cap enrollment. Mr. Tool and Ms. Ladon responded to questions from the committee regarding whether some current Medicaid and CHP+ clients would lose coverage under the program and other elements of the program which may produce savings.

09:53 AM

Mr. Tool continued his presentation by discussing federal budget neutrality requirements. He stated that the federal spending cap is only on the per member/per month costs and that it is a cap on costs over the course of five years. Ms. Ladon responded to questions from the committee regarding how savings would be redistributed throughout the program. Mr. Tool responded to questions from the committee regarding federal budget neutrality requirements. He reiterated that the 8.4% federal cap is on the per member/ per month costs, not enrollment. Senator Shaffer asked why the Department felt it was important to pursue a waiver and not implement the program through state plan amendments. Mr. Tool responded that it was easier to incorporate all of the program elements under one waiver and that, in order to implement the program without using a HIFA waiver, a number of individual waivers would have to be submitted to the federal government. He further stated that he is confident that managed care organizations will bid on the Colorado Family Cares program as implemented through a HIFA waiver, but he is unsure whether the program would receive a bid if it is implemented in pieces.
10:03 AM

Senator Hagedorn explained that public testimony would be limited to five minutes a person, including questions.

10:04 AM -- John Monahan, Wellpoint and Anthem Blue Cross/Blue Shield of Colorado, expressed support for the Colorado HIFA waiver, and discussed the benefits of streamlining the Medicaid and CHP+ program. He stated that Wellpoint Medicaid networks always incorporate safety net clinics into their provider networks for Medicaid clients. He discussed the benefits that are available to Medicaid clients through managed care.

10:11 AM -- Alfred Gilcrest, Colorado Medical Society, testified regarding the HIFA waiver process. He stated that the Colorado Medical Society supports the goals of the waiver, but not the Colorado Family Cares product. He responded to questions from the committee regarding whether the Colorado Medical Society believes the HIFA waiver should go forward and whether increased provider reimbursement rates would encourage providers to participate in the Colorado Family Cares Program. He stated that provider network adequacy is vital to the success of any health care program.

10:17 AM -- Greg Fanselall, Platte Valley Medical Center, testified regarding the volume of Medicaid clients seen by Platte Valley Medical Center. He stated that reducing emergency room utilization will not produce enough savings to cover the actual costs of care for Medicaid patients and further stated a number of concerns with the Colorado Family Cares program. He responded to questions from the committee regarding whether any services receive higher reimbursement rates in Medicaid than in private plans; Mr. Fanselall responded that there are no services that are reimbursed more in Medicaid than in private plans.

10:23 AM -- Gary Cummins, Colorado Dental Association, stated a number of concerns with the HIFA waiver proposal. He suggested that the committee talk with other states regarding the implementation of Medicaid managed care dental networks and HIFA waivers. He distributed a handout to the committee (a copy of the handout was not available to staff ).

10:27 AM -- Annette Kowal, Colorado Community Health Network, stated that the Department has addressed some of the Community Health Clinic's concerns with reimbursement rates under the Colorado Family Cares Program. She stated that the Department has agreed to continue reimbursement rates for clinics at current rates and to include language in the request for proposals that would encourage managed care organizations to contract with community health clinics. She stated that she is of the belief that if Medicaid reform is not implemented by the state, changes could be forced upon the state in coming months.

10:30 AM -- Marguerite Salazar, Valley-wide Health Systems, stated that the HIFA waiver is a step in the process for reforming Medicaid, and that she has trust and confidence in the Department to implement the waiver. She stated her support for the committee to move forward with the waiver.

10:32 AM -- Linda Wilkinson, Colorado Dental Hygienists Association, testified that dental hygienists would not be included in the Colorado Family Cares program. She stated the importance of dental hygienists in providing dental services.

10:35 AM -- Dr. Harriet Hall, Colorado Behavioral Healthcare Council, testified that now is the time to move forward with Medicaid reform and that the mental health centers are in strong support of the HIFA waiver. She stated that the mental health benefit provided under the Colorado Family Care Program improves care for CHP+ recipients and that the waiver program allows children and adults to receive quality care regardless of whether they are eligible for Medicaid or CHP+. She reiterated that the HIFA waiver does not cap enrollment in CHP+ or Medicaid. She responded to questions from the committee.

10:40 AM -- Lorez Meinhold, Colorado Consumer Health Initiative, thanked the Department for their work developing the HIFA wavier, but stated that her organization does not support the submission of the HIFA waiver. She distributed a letter to the committee (Attachment H).

10:43 AM -- Barbara Ford, Colorado Association for School-based Healthcare, distributed a handout to the committee (Attachment I). She testified regarding the importance of school-based health centers.

10:46 AM

Senator Hagedorn closed public testimony and offered committee members the opportunity to voice their thoughts on the HIFA waiver. Representative Weissman stated his concerns with the HIFA waiver. Representative Stafford stated her support for the work of the Department, but stated that there is more work to be done in developing a reform proposal for Medicaid.

10:49 AM

Senator Johnson asked representatives from the Department to discuss what happens to the waiver after the committee vote. Mr. Tool stated that if the waiver is voted down, the waiver will not be submitted to the federal government. Senator Johnson stated that he believes that the proposed waiver program is sound and has been researched thoroughly. He stated that it is wrong for the committee to continue to ignore the benefits that children receive through the CHP+ program and to not extend the same benefits to children enrolled in Medicaid. Senator Mitchell made a number of comments regarding the HIFA waiver.

10:56 AM

Representative Cloer made a number of comments regarding the HIFA waiver. He expressed concern with provider reimbursement rates under Medicaid and CHP+. He stated that the HIFA waiver is an important first step in reforming Medicaid. Representative Berens stated that he is uncomfortable supporting a proposal that didn't gain the support of some constituencies, and that he believes that much of the Colorado Family Care program can be implemented without a waiver. Representative Soper stated that he would like to see a program developed that allows people to move off of Medicaid and CHP+ and on to private insurance programs. Representative Green made a number of comments on the HIFA waiver, and stated her concerns with budget neutrality requirements.

11:02 AM

Representative Boyd stated that she appreciates the work of the Department with regard to the HIFA waiver and stated her commitment to continuing the process if the HIFA waiver fails. Senator Hagedorn made comments regarding the HIFA waiver.


BILL:	HIFA Waiver
TIME:	11:03:26 AM
MOVED:	Johnson
MOTION:	Aprove the HIFA waiver as submitted. See substitute motion below.
SECONDED:
		VOTE
	Berens
	Clapp
	Cloer
	Frangas
	Green
	Hanna
	Johnson
	Kester
	Lundberg
	McGihon
	Mitchell
	Riesberg
	Sandoval
	Shaffer
	Soper
	Stafford
	Sullivan
	Weissmann
	Boyd
	Hagedorn
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: TIE


BILL:	HIFA Waiver
TIME:	11:04:26 AM
MOVED:	Stafford
MOTION:	Adopt a substitute motion to reject the HIFA Waiver.
SECONDED:
		VOTE
	Berens	Yes
	Clapp	Yes
	Cloer	No
	Frangas	Yes
	Green	Yes
	Hanna	Yes
	Johnson	No
	Kester	No
	Lundberg	No
	McGihon	Yes
	Mitchell	Yes
	Riesberg	Yes
	Sandoval	Yes
	Shaffer	Yes
	Soper	Yes
	Stafford	Yes
	Sullivan	No
	Weissmann	Yes
	Boyd	Yes
	Hagedorn	Yes
Final YES: 15 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: PASS

11:05 PM

Senator Hagedorn gave concluding remarks and the committee adjourned.