Final
HIFA Waiver Hearing
HIFA WAIVER COMMITTEE
Votes:
Action Taken:
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NOTE: This meeting was not being broadcast over the internet; it was taped.
10:09 AM
Representative Boyd called the meeting to order and stated the purpose of the meeting. The committee was joined by Senator Owen and Representative Hall. The committee was provided with two handouts which included a letter from the Colorado Community Health Network and a summary of Colorado Family Care prepared by Sarah Schulte (Attachments AA and BB).
10:16 AM
Senator Hagedorn introduced Sarah Schulte, Schulte Consulting. He announced that she had been hired as a nonpartisan research consultant to the committee to analyze the waiver, summarize public testimony, and provide a final report. Her work is being funded through a grant from the Rose Community Foundation. Ms. Schulte arrived after the committee meeting began.
10:17 AM
Bill Heller, Department of Health Care Policy and Financing, began the department's presentation on the HIFA waiver — Colorado Family Care. This presentation was initially made in Denver at the committee's first meeting on July 12, 2005. Copies of the presentation were made available to the public in addition to copies of questions and answers posed at the July 12th meeting (Attachments A and B). Mr. Heller discussed the differences between the Medicaid and Children's Basic Health Plan (CHP+). He also provided a discussion of the Core and Core Plus benefit packages. Mr. Heller stressed that continued use of safety net providers was key to the success of implementing Colorado Family Care.
10:37 AM
Mr. Heller's presentation ended and he responded to questions from the committee members. Topics of interest included potential implementation costs, training of county staff, building in a disincentive for emergency room visits vs. office visits, the need to place tighter reins on the use of the emergency room by Medicaid clients, provider reimbursement rates, physician participation rates, and CHP+ reimbursement rates.
11:11 AM
Representatives from both the Weld and Larimer County Departments of Social Services began a presentation.
Mike Gile, Weld County, requested that the committee be focused on three items prior to any implementation of Colorado Family Care. Concerns were raised over: CBMS; increases in caseload; and the carve-out of children placed in foster care and/or subsidized adoption. He requested that an impact analysis be performed on CBMS prior to implementation of Colorado Family Care, the purpose of which would be to uncover any unintended consequences that would impact state and county resources. Second, he requested a caseload analysis be completed. He testified that with the elimination of the asset test in HB 05-1262, Weld County estimates the need for more county staff to serve the increased caseload. Third, children and youth in child welfare programs are to be "carved-out" As such, counties need to know how services for these children will be provided under Colorado Family Care.
11:15 AM
Judy Griego, Weld County Department of Social Services. Ms. Griego stressed the need to evaluate CBMS. Additionally, with managed care comes greater management of the caseload, requiring more county staff in order to comply with state and federal requirements. Eligibility is not the only issue — it will be managing the caseload. Ms. Griego provided a concept paper on Colorado Family Care (Attachment C).
11:20 AM
Ginny Riley, Larimer County Department of Social Services. Ms. Riley reiterated Ms. Griego's concerns over managing the increased caseload.
11:23 AM
Kim Walkenhorst, EPSDT Coordination for Weld County, Department of Public Health and Environment testified regarding provider participation and the movement of children between the Core and Core Plus benefit packages. She expressed concern that many of the current providers in Weld County will not be part of the managed care model.
11:27 AM
Dr. Mark Wallace, North Colorado Health Alliance, testified about public health services. He presented a resolution prepared by the alliance (Attachment D). His testimony centered around the need to continue to provide public health services. He testified that resources currently dedicated to public safety net providers should not be shifted to benefit private providers.
11:35 AM
Representative Boyd invited Bill Heller to comment on the concerns raised by the those testifying from Weld and Larimer counties. Mr. Heller testified that the department is committed to protecting and maintaining the safety net provider system.
11:37 AM
Committee recessed.
12:48 PM
The committee reconvened with testimony from the public.
12:51 PM
Dennis Reed, Colorado Association of Medical Equipment Services (CAMES), provided the committee with a list of questions needing to be asked prior to implementation of the waiver (Attachment E). He expressed concerns about the consequences the state might face if it fails to reach budget neutrality.
12:57 PM
Jeff Archambeau, Colorado Access. He testified in support of the HIFA waiver because it will streamline administration and access to services. He stated that his organization is committed to working with the Department of Health Care Policy and Financing to ensure that the safety net providers are not disrupted.
1:02 PM
Dr. Virgilio Licona, Salud Health Centers. His testimony focused on preservation of safety net providers, the need to maintain wrap-around services, the consequences of exceeding enrollment projections, the ability to sustain mental health services due to enrollment growth, and the shifting of resources from public to private providers.
1:16 PM
Mike Bloom, Sunrise Community Health Center, Greeley, CO. His testimony centered on the criticality of maintaining safety net providers. Their work must be protected under the waiver, not undermined. The model of care for the Sunrise Community Health Center is consistent with the "medical home" goal of Colorado Family Care. He testified that community health centers consistently provide quality care in a cost effective manner. Additionally, for the waiver to succeed in northern Colorado, rates must cover costs because community health centers have no place to cost shift. Any reduction in funding will eliminate their ability to provide services. Mr. Bloom requested that at the beginning of the RFP process the contracts must include provision of care by community health centers. Behavioral and substance abuse services must be integrated into the benefit packages.
1:28 PM
Dr. John McFarland, DDS, Colorado Dental Health Network and Colorado Dental Association. Dr. McFarland testified in support of dentists and dental hygienists who provide services in Colorado's community health centers. He supports the waiver because it will provide oral health benefits to more children but is concerned about the oral health benefits that will be available under the waiver. He requested that his organization be involved in defining the scope of benefits/services. He testified that the oral health benefits as outlined in Appendix B of the HIFA waiver are inadequate to treat the oral health needs of Medicaid and CHP+ children.
1:37 PM
Patrick Gordon, Rocky Mountain Health Plans, testified that access to care is absolutely dependent on reimbursements to physicians. Colorado Family Care will require the good will of providers. Rate setting functions must adhere to best practice. He noted that CHP+ rates have been actuarially sound; Medicaid is the risk. In the bidding process, the state must take advantage of competitive market forces without undermining current providers. IT system functionality is key to successful implementation of the waiver, and that the department must be adequately funded if the waiver is to succeed.
1:45 PM
Janet Fox Stevens, Colorado Health and Hospital Association, testified about the need for more details about the program, especially the need to see improved patient outcomes as a result of Colorado Family Care. Ms. Stevens noted that the waiver is silent on hospital reimbursement, and would like to see the numbers on how budget neutrality will be achieved. She testified that MCOs show decrease in use when provider payments are inadequate.
1:50 PM
Mike Kingsbury, RN, Service Employees International Union - Nurse Alliance, testified that nurses do not have the necessary resources to care for their patients. He provided a handout summarizing his testimony
. Mr. Kingsbury wants to shift the paradigm from profiting to treat sick people to spending money to keep people well.
2:00 PM
Wayne Maxwell, North Range Behavioral Health, Greeley, CO. Mr. Maxwell testified that community mental health centers are safety net providers and should be considered as such in the HIFA waiver. He urged integration of behavioral health with other health services and noted that behavioral health issues are not adequately screened in the EPSDT process.
2:07 PM
Michele Longo, AAA Medical. Ms. Longo's testimony centered on billing matters, reimbursement to rehabilitation providers, the need for consumer choice, and durable medical equipment providers.
2:14 PM
Dr. Kenneth Kaplan, Weld County Medical Society, Greeley, CO. Dr. Kaplan testified that because Medicaid does not pay the cost of going to the doctor's office, there can be no reduction in reimbursement to physicians. His testimony centered on the need to maintain reimbursement rates to ensure physician participation.
2:17 PM
Menda Warne, parent, Gilcrest, CO. Ms. Warne is currently an advocate for uninsured parents and children. She discussed her own family's experience with the health care system and Medicaid after her daughter developed a rare spinal chord disease at the age of one. She expressed concern over Medicaid audits she's read identifying million of dollars spent in capitated payments for services without the full spectrum of services being delivered. She wants to see one definition of medical necessity. Ms. Warne testified that there is no competition in Weld County, only one HMO serves CHP+ children. She wants a healthy number of private providers caring for children enrolled in Medicaid and CHP+, not fewer in HMOs.
2:29 PM
Julia Green, Colorado for Health Care. Ms. Green's testimony centered on budget neutrality. She requested that the department identify the data around budget neutrality at both the state and federal level. She expressed concern that once the waiver is signed, there is no real opportunity to renegotiate cost components. The state will be locked into the waiver for 5 years with the ability to draw down its maximum allowable federal funds.
2:37 PM
Dr. Richard Budensiek, Weld County Medical Society, testified on behalf of Weld County community health clinics. He emphasized the need to maintain and protect the safety net providers and asked that community health clinics not be sacrificed to enroll private physicians into the waiver program.
2:44 PM
Dr. Anne Pendley, testified on behalf of speech and language therapists. Her testimony centered on how best to provide speech and language therapy using both medical and natural settings, billing problems with third-party payers, and the cost effectiveness of private practitioners.
2:51 PM
Kelly Stahlman, Family Voices Colorado, provided no testimony but did provide the members with a list of comments and questions on the waiver (Attachment Z).
2:52 PM
Representative Boyd reminded the committee of its next meeting in Durango on August 9th. The committee adjourned.