Date: 01/12/2012
Final
Briefing by the Deptment of Health Care Policy and Financing
COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES
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02:21 PM -- Briefing by the Department of Health Care Policy and Financing
Executive Director Sue Birch, Department of Health Care Policy and Financing, responded to the presentation by the auditor's office on unimplemented audit recommendations for the department. She noted that the department has approximately 20 FTE dedicated to audits, and the department takes audit findings very seriously. She discussed the issues the department faces in implementing the audit recommendations and noted that the State Auditor holds the department to a higher standard than the standard set by the federal government. She noted that many of the auditor's recommendations are duplicative and redundant, and that, considering that some audit recommendations touch on the same themes, there are actually six main outstanding audit recommendations. In response to the audit recommendations regarding verifying the credentials of Medicaid providers, Chris Underwood, Department of Health Care Policy and Financing, discussed the current verification practices of the department and stated that federal law does not require providers to submit annual information on their licensing status. Ms. Birch responded to questions from the committee regarding the audit recommendations and processes in place regarding verification of provider information.
02:39 PM
Antoinette Taranto, Department of Health Care Policy and Financing, discussed audit recommendations related to eligibility determinations for public health programs. Ms. Birch and Ms. Taranto responded to questions from Senator Mitchell regarding whether services are provided to persons who are not legally present in the country. Senator Mitchell requested additional information on the services that are provided to persons not legally present in the country.
02:47 PM
Ms. Birch discussed the ways in which the department leverages federal moneys.
02:48 PM
Ms. Birch began the SMART Government Act presentation for the Department of Health Care Policy and Financing (Attachment C). She discussed the eligibility levels for Medicaid and CHP+, the reasons why the caseloads for the programs are increasing, and the costs associated with various eligibility groups within the programs.
02:57 PM
John Bartholomew, Department of Health Care Policy and Financing, discussed the department's strategic plan (Attachment D). Suzanne Brennan, Department of Health Care Policy and Financing, discussed the department's strategic objectives, which include improving health outcomes, improving long-term services and supports, increasing access to health care, increasing the number of insured Coloradans, and containing health care costs. She described the initiatives related to health outcomes which included the Accountable Care Collaborative (ACC), integrated care for individuals eligible for both Medicare and Medicaid, health living initiatives, and long-term care redesign.
03:03 PM
Ms. Brennan provided further information on the ACC. The goal of ACC is to improve clients' health and contain health care costs through a coordinated system of care. The ACC is comprised of three parts: Regional Care Collaborative Organizations (RCCOs); Primary Care Medical Providers; and a Statewide Data and Analytics Contractor.
03:10 PM
Dr. Judy Zerzan, Chief Medical Officer for the Department of Health Care Policy and Financing, discussed the department's healthy living initiatives. Ms. Birch discussed the departments' goals related to improving long-term services and supports, including redesigning the long-term care payment structure, data systems, and delivery systems to transform long-term care from institution-based to efficient, person-centered, community-based care.
03:19 PM
Ms. Birch discussed the department's objectives related to access to health care services. She discussed the participation of providers in the Medicaid program and recent provider rate cuts. She continued by discussing the department's goals regarding enrolling individuals who are eligible for Medicaid and CHP+ into those programs.
03:22 PM
Dr. Zerzan discussed the department's utilization management and pharmacy payment reform. Ms. Brennan discussed reducing inappropriate emergency room utilization, reducing hospital readmissions, and reducing unintended pregnancies. Mr. Bartholomew discussed the R-6 initiative which is designed to prevent payment for unnecessary services.
03:28 PM
Ms. Birch responded to questions from the committee regarding the ACC and RCCOs. She further responded to questions from the committee regarding resources on reducing emergency room visits and unintended pregnancies. Ms. Brennan responded to committee questions regarding the ACC and provider participation. Ms. Birch responded to questions from the committee regarding the departments priority goals and how the department will measure its progress toward meeting its goals. Ms. Brennan responded to questions from the committee regarding the financial incentives for RCCOs and the payments RCCOs receive related to health outcomes.
03:38 PM
Ms. Birch and Dr. Zerzan responded to questions from the committee regarding provider rates in Medicaid and whether cuts in provider rates have reduced the number of providers who are participating in the program. Senator Aguilar asked for additional information regarding increases in Medicaid copayments, and Mr. Bartholomew responded that the department has a pending budget request related to copayment increases. Dr. Zerzan responded to a question from the committee regarding Medicaid reimbursement payments for primary care services and home health care services. Senator Roberts requested a map of provider participation in the Medicaid program in rural and in urban areas of the state and a map of the locations of the RCCOs in the state.
03:48 PM
The committee recessed briefly.