HIFA Waiver Committee (07/12/2005)

Final
STAFF SUMMARY OF MEETING

HIFA WAIVER COMMITTEE

Date:	07/12/2005	ATTENDANCE

Time:	10:24 AM to 04:08 PM	Berens	X
		Clapp	E
Place:	SupCt	Cloer	E
		Frangas	X
This Meeting was called to order by		Green	X
	Senator Hagedorn	Hanna	X
		Johnson	E
This Report was prepared by		Kester	A
	Elizabeth Burger	Lundberg	A
		McGihon	X
		Mitchell	A
		Riesberg	X
		Sandoval	X
		Shaffer	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Introduction Presentation by DHCPF Public Testimony Department Response		- - - -

10:25 AM

Senator Hagedorn gave an introduction and discussed the purpose of the meeting. He discussed a Medicaid reform proposal from the National Governor's Association (Attachment A).

10:32 AM

Karen Reinertson, Executive Director of the Department of Health Care Policy and Financing, began the Department's discussion of the proposed Colorado Family Cares Program, a program that will be developed under a Health Insurance Flexibility and Accountability (HIFA) Medicaid waiver. Four handouts were distributed to the committee, including an outline of the presentation, a list of the individuals who comprised the Rose Community Foundation External Advisory Committee, a fact sheet, and commonly asked questions concerning the program (Attachments B through E). She discussed the differences between Medicaid and the Children's Basic Health Plan (CHP+) and described the population that will be served under the waiver program, specifically children and their families. She discussed how providers will contract to provide services under the program.

10:42 AM

Barbara Laydon, Department of Health Care Policy and Financing, continued the discussion of the waiver program. She gave an overview of materials that were previously provided to the committee, including the waiver application. She discussed federal requirements for HIFA waivers and described recent research completed by the Department on the population enrolled in CHP+ and Medicaid. She listed a number of benefits of the Colorado Family Care Program for providers including: a stable provider network, streamlined administrative requirements, adequate reimbursement, and a consistent benefit package. She further discussed advantages for participants of the Colorado Family Care Program including a medical home, continuity of coverage, stable provider networks, a benefit expansion for CHP+, and a co-payment structure that will not change.

10:58 AM

Ms. Laydon continued her discussion of the Colorado Family Care Program by describing the program's benefit package. Under the program, children and adults will receive a basic benefit package, known as Core benefits, that includes such services as routine physical examinations, immunizations, prescription drug coverage, and hospital care. Children with higher medical needs will receive an expanded benefit package, known as Core Plus, that includes expanded mental health services, extended physical and speech therapies, additional durable medical equipment, and additional oral health care. Ms. Laydon listed the overall benefits of the Colorado Family Care Program, including the expansion of eligibility of persons for CHP+ and Medicaid and creating a continuum of care with a medical home and a choice of primary care providers for participants. She gave a brief financial analysis of the program, stating that the program is not a block grant, but allows for normal anticipated growth in both mandatory and optional populations.

11:09 AM

Ms. Laydon and Ms. Reinertson responded to questions from the committee regarding the benefits offered under the program to adults and children, provider reimbursement rates, competitive bidding for providers, and the length of provider contracts. They further responded to questions from the committee regarding the design of the Core benefits package and the employer-sponsored insurance pilot program that will be implemented as part of the HIFA waiver. Ms. Laydon and Ms. Reinertson addressed committee questions regarding the competitive bidding process, Medicaid and CHP+ eligibility, budget neutrality, mental health benefits, community health centers, and the costs of the program.

11:43 AM

The committee discussed future meeting dates.

11:48 AM

The committee recessed.

01:05 PM

The committee reconvened. Senator Hagedorn opened public testimony and explained how the public testimony period would operate.

01:06 PM -- Elisabeth Arenales, Colorado Center on Law on Policy, distributed a handout to the committee members (Attachment F). An additional handout listing questions concerning the waiver was also distributed to the committee (Attachment G). She stated that the changes implemented under the Colorado Family Cares Program are very significant and will have a lasting impact on the state. She discussed the requirement that the waiver be budget neutral, and possible consequences of that requirement. She stated that the waiver program may affect disproportion share funding the state receives from the federal government and that the waiver program will reduce benefits to Medicaid-eligible adults. Ms. Arenales discussed concerns with how children will move between the Core and Core Plus set of benefits as well as the process for determining reimbursement rates for safety net providers. She expressed concern that the Department has not provided the committee with a list of the state statutes that the Department is requesting be waived in order to implement the program. She responded to questions from the committee regarding the transition of children from Core to Core Plus benefit package.

01:25 PM -- Dr. Patricia Gabow, Chief Executive Officer and Director of Medicine, Denver Health, testified that Medicaid payments are the largest source of income for Denver Health, and the loss of this revenue would endanger Denver Health's ability to serve indigent patients. She suggested that the waiver program be amended to require that patients who are receiving treatment at facilities that qualify for the federal 340B prescription drug pricing program receive their prescription drugs from that facility. Dr. Gabow responded to questions from the committee regarding uncompensated care provided by Denver Health and the ability of managed care organizations to produce savings.

01:38 PM -- David Myers, Metro Community Provider Network, testified regarding his concerns with the waiver program, including the reimbursement rates paid to community health centers.

01:42 PM -- Annette Kowal, Executive Director, Colorado Community Health Network, testified regarding the reimbursement rates paid to federally qualified health centers. Mr. Myers and Ms. Kowal responded to questions from the committee regarding cuts to provider rates for federally qualified health centers and payments to community health centers pursuant to Amendment 35.

01:51 PM -- Dr. Gary VanderArk, Colorado Coalition for the Medically Underserved, testified that Colorado ranks last among the states in providing Medicaid to low-income individuals. He testified regarding his concerns with budget neutrality and value-based purchasing, and stated that there are many provisions of the waiver which are exciting, including creating a medical home for Medicaid and CHP+ recipients.

01:54 PM -- Julia Green, Colorado for Health Care, Service Employees International Union, testified regarding her concerns with federal budget neutrality requirements in the waiver program. She expressed concern that provider reimbursement rates will be reduced under the program and discussed reimbursement rates for federally qualified health care centers. She stated that using private health plans to provide Medicaid and CHP+ benefits has not produced cost savings in other states.

02:02 PM -- Carol Meredith, The ARC of Arapahoe and Douglas Counties, testified regarding her concerns with managed care. She described her experiences trying to access services in Medicaid managed care and suggested that the waiver program have an ombudsman to address problems with service access. She responded to questions from the committee.

02:07 PM -- Kelly Stahlman, Family Voices, testified regarding the Early, Periodic Screening, Diagnosis, and Treatment (EPSDT) program in Medicaid. She distributed two handouts to the committee (Attachments H and I). She stated that the waiver program may create barriers to EPSDT services for low-income families. She stated that more information about the program is necessary before the waiver program is implemented. She responded to questions from the committee regarding the EPSDT program.

02:27 PM -- Robin Bolduc, citizen, testified regarding the HIFA waiver process. She stated that it is unclear how children will transition from Core to Core Plus benefits. She expressed concern about the use of a prescription drug formulary in the program and responded to questions from the committee regarding prescription drug formularies.

02:38 PM -- Brandon Williams, citizen, listed his questions concerning the waiver program. He stated that the process for qualifying for Medicaid can be lengthy.

02:45 PM -- George DelGrosso, Colorado Behavioral Health Care Council, testified that there are questions about how individuals will access mental health services in the program, but that the Department has been willing to work with his organization to address those questions.

02:48 PM -- Jeanne Rohner, Mental Health Association of Colorado, testified regarding the importance of access to mental health services and prescription drugs. She stated the Association's objection to restrictive formularies, tiered co-pays, fail first methods, and monthly medication limits. She spoke regarding her concern that costs could increase if individuals do not have access to Medicaid pricing for prescription medications.

02:52 PM -- A.W. Schnellbacher, Colorado AARP, stated that the waiver program does much to insure uninsured individuals and spoke regarding the components that AARP believes comprise quality health care. He stated that the waiver program should promote high quality preventative services, but that there are questions as to how this goal will be achieved. He spoke regarding the importance of consumer-friendly marketing materials and continuity of care under the program. He listed other concerns of AARP with regard to the waiver program.

03:07 PM -- Gary Cummins, Colorado Dental Association, testified in support of a simplified system of access to Medicaid and CHP+. He testified regarding his concerns with the dental benefits and reimbursement rates for dentists provided under the program. He responded to questions from the committee.

03:15 PM -- Monica Restivo, Service Employees International Union, testified regarding the uninsured and distributed a handout to the committee (Attachment J).

03:18 PM -- Michael Kingsbury, Service Employees International Union, raised a number of questions regarding the waiver program, including whether or not the state will reduce services under the program, how the program will affect the scope and amount of services children receive, and the impact of budget neutrality requirements.

03:25 PM -- Kate Paul, Delta Dental Plan of Colorado, testified in support of the HIFA waiver. She stated the importance of addressing the oral health needs of children and responded to questions from the committee.

03:30 PM -- Lorez Meinhold, Executive Director, Colorado Consumer Health Initiative, stated that it is important to streamline Medicaid and CHP+, but that the implementation of the program may be problematic. She stated that a number of the program changes can be done through the state plan amendment process rather than a HIFA waiver. She discussed a number of concerns with the waiver program including the lack of information as to how children will transition between Core and Core Plus, provider reimbursement rates, and budget neutrality.

03:38 PM -- Dr. Susan Agrama, Denver and Colorado Medical Societies, testified that a review of Medicaid is overdue and that the concerns of Medicaid patients cannot be overlooked in the process. She responded to questions from the committee regarding provider reimbursement rates.

03:44 PM -- Larry Wall, Colorado Health and Hospital Association, testified that a lot of information concerning the implementation of the program has yet to be provided by the Department. He discussed federal budget neutrality requirements and stated that it is important to streamline and expand Medicaid, but such changes should be made without reductions in payments to providers and hospitals. Mr. Wall responded to comments from the committee.

03:51 PM -- Pam Perry, Amerigroup Corporation, testified in support of the HIFA waiver concept. She described the benefits available to members of Amerigroup's managed care plan. She responded to questions from the committee regarding limits on durable medical equipment in other states

.03:58 PM

Barbara Laydon, Department of Health Care Policy and Financing, discussed the Core benefit package and EPSDT. She responded to comments from the committee.

04:08 PM

The committee adjourned.