Joint Committee Committee on Joint Health and Human Services (01/18/2006)

Final
STAFF SUMMARY OF MEETING

COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES

Date:	01/18/2006	ATTENDANCE

Time:	09:44 AM to 12:07 PM	Berens	X
		Clapp	X
Place:	HCR 0112	Cloer	*
		Frangas	X
This Meeting was called to order by		Green	X
	Senator Hagedorn	Hanna	*
		Johnson	X
This Report was prepared by		Lundberg	X
	Whitney Gustin	McGihon	X
		Mitchell	*
		Riesberg	X
		Sandoval	X
		Shaffer	X
		Soper	X
		Stafford	X
		Sullivan	X
		Traylor	*
		Weissmann	X
		Boyd	X
		Hagedorn	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Oversight Presentation by Dept. of HCPF Oversight Presentation by Dept. of Human Services Oversight Presentation of Dept. of PHE		- - -

09:47 AM -- Presentation by the Department of Health Care Policy and Financing

Stephen Tool, Executive Director, Department of Health Care Policy and Financing (HCPF), began his departmental presentation with comments about Medicaid. He distributed a summary document to members (Attachment A). He stated Medicaid reform is largely up to the states. He discussed current national challenges for Medicaid, including issues regarding prescription drugs, long-term care, tailored benefit packages, and health information and technology. He discussed HCPF's work on a Health Insurance Flexibility and Accountability (HIFA) waiver to combine Medicaid and Child Health Plan Plus (CHP+). He stated allowing children to enroll in a single program will benefit enrollees. Mr. Tool continued with a discussion of Medicaid case load growth. Changes in caseload levels typically reflect state economic cycles. Colorado's case loads have increased greatly in recent years, but per capita costs have dropped.

09:58 AM

Mr. Tool described Colorado's Medicaid program as one of the leanest in the country. Senator Hagedorn commented on Colorado Medicaid's eligibility criteria and benefit levels. Compared to other states, Colorado has more stringent eligibility criteria and fewer benefits. Mr. Tool discussed CHP+ marketing. Marketing activities should be underway before the end of the month. Mr. Tool discussed HB 05-1262, the bill that established the allocations of tobacco tax funding passed by the voters through Amendment 35. New policies adopted as a result of Amendment 35 include removing the Medicaid asset test for children and families. Mr. Tool discussed the expected date of removal: July 1, 2006. Other policies include increased marketing of CHP+ and an increased income eligibility level for families.

10:08 AM

Barbara Prehmus, Medical Assistance Office, answered questions about waiting lists for children's waiver programs. The waiver capacity currently does not allow complete elimination of these waiting lists. Additional state funding and federal approval is required to increased the capacity levels. Mr. Tool said state-only funds are currently paying for the expansion coverage for pregnant women enrolled in CHP+. Mr. Tool answered questions about prenatal benefits for illegal immigrants. John Bartholomew, Operations and Financing Office, answered questions about the health care expansion fund. Mr. Tool answered questions about current efforts to combine the Medicaid and CHP+ programs. The single program will be know as Colorado Family Care. Representative Boyd discussed provisions of the upcoming bill that will implement the new program. Mr. Tool and committee members discussed actuarial issues related to Colorado Family Care and reimbursements to managed care organizations.

10:22 AM

Ms. Prehmus answered questions about the "non-citizen" budget category. She stated the category includes legal immigrants who are not yet eligible for full Medicaid benefits and illegal immigrants receiving emergency services (mostly labor and delivery). Mr. Tool answered questions about the sustainability of Colorado Medicaid. He listed programs and benefits that will support the program's sustainability, including home- and community-based services and the new Colorado Family Care. He answered questions about 05-1131 a bill that addressed redispensing unused prescription drugs.

10:33 AM

Mr. Tool answered questions about efforts to minimizing Medicaid costs. He discussed efforts to route Medicaid enrollees away from emergency rooms and toward community providers for non-emergency care.

10:37 AM -- Presentation by the Department of Human Services

Marva Livingston Hammons, Executive Director, Department of Human Services (DHS), distributed a notebook of information to members (Executive Summary appears in Attachment B). She reviewed the contents of the notebook. She described DHS as the last of the umbrella agencies in Colorado. It focuses on services to vulnerable people, but those services vary widely. Priorities for 2006 include providing quality services through performance measures and "front-end" investments. Ms. Hammons described federal oversight of DHS programs and services such as foster care. The department continues to await legislation continuing Temporary Assistance to Needy Families (TANF). There are concerns that federal support for TANF child care may be reduced through new legislation. A representative of Colorado's executive branch is present in Washington, DC, and continues to communicate to Congressional members the state's desire to pass favorable TANF legislation.

10:48 AM

Reginald Jefferson, Office of Financial Services, described the department's efforts to restore its facilities. Robert Wonnett, Office of Performance Improvement, discussed his office's efforts to improve workings within the department and services provided by counties. Mr. Wonnett and Ms. Hammons answered questions about county child welfare programs and required review committees. Ms. Hammons described methods the department uses to ensure every county has formed such committees.

10:58 AM

Ron Huston, Office of Information Technology and Services, discussed strengths of the office, including excellent staff and a good strategic planning process to anticipate Coloradans' future needs. He stated one of the office's challenges in 2006 is to improve emergency preparedness. Ongoing meetings and surveys keep the department apprised of the quality of DHS's services. Mr. Huston answered questions about emergency preparedness. Currently the department is prepared to handle low to moderated situations.

11:05 AM

Steve Bates, Office of Children, Youth, and Family Services, discussed the broad range of services overseen by his office. They include child care and youth corrections. Child care facilities are licensed and monitored, and child care assistance is available to low-income families to help them maintain gainful employment. He discussed computer programs used to determine applicants' program eligibility. He and Ms. Hammons stated that as the scope of the Colorado Benefits Management System (CBMS) was reduced for budgetary reasons, additional computer systems were required for certain programs, including child care. Mr. Bates answered questions about background checks for child care workers. Ms. Hammons reminded members that not all child care providers are required to be licensed. She stated the department often relies on families for feedback on child care providers. Mr. Bates discussed the residential treatment program.

11:19 AM

Mr. Bates discussed the plan to improve DHS services and recidivism rates of youths who have come out of corrections. He answered questions about mental health services to youth. He stated the acuity level of mental illness has grown significantly in recent years. Pauline Burton, Office of Self-Sufficiency, listed the programs within her office and described challenges for 2006. They include a decline in federal dollars for refugee services.

11:30 AM

John Daurio, Adult Disability and Rehabilitation Services, described staffing levels and numbers of persons served. He discussed challenges in 2006, including the meeting the needs of very low-income persons, low reimbursement rates to providers, and increasing numbers of the mentally ill. He answered questions about the availability of health care services.

11:37 AM

Deborah Trout, Office of Behavioral Health and Housing, listed the programs within her office. She described the office's strengths, including excellent staff and collaboration with other programs with whom they share constituents. Challenges for the office include sustaining adequate services and maintaining facilities through recent budget cuts. She described the benefit of preventive measures. Office goals include decreasing drunken driving, the use of restraints in institutes, and youths' access to tobacco products.

11:45 AM -- Oversight Presentation by the Department of Public Health and Environment

Dennis Ellis, Executive Director, Department of Public Health and Environment, distributed his biography (Attachment C) and began his presentation by addressing bioterrorism issues. He stated Colorado was the first state to pass a bioterrorism law. In recent years, the department's bioterrorism focus has been on a possible Avian Flu pandemic. The department is currently working to refine their plan to handle such a pandemic. He discussed the possibility of eliminating the department's vehicle emissions program. The program currently requires Denver metro area residents to have their vehicle emissions tested periodically. At this time, very few vehicles fail the tail pipe test. Because the metro area is now in compliance with air quality standards, the program in no longer necessary. Mr. Ellis and Howard Roitman, Environmental Programs Director, answered questions about how counties may currently drop out of the vehicle emissions program. Mr. Ellis discussed state contracts with Envirotest, the emissions tester.

11:55 AM

Mr. Ellis discussed the state's recently increased immunization rates. He described grants to local agencies to enhance immunization availability and services. One local program allows parents to bring children to fire stations to receive their immunizations. By 2010, the state hopes to have a 80 percent childhood immunization rate. Mr. Ellis discussed tobacco tax funding for public health programs such as the Tony Grampsas Program's smoking prevention efforts among youth. Other programs are granting money to reduce rates of cancer and cardiovascular disease and reduce health disparities experienced by minority populations. Senator Traylor commented on the state's childhood immunization tracking system.

12:07 PM

The joint committee adjourned.