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I_COMedicaidCL_2016A 08/02/2016 01:35:48 PM Committee Summary




Date: 08/02/2016
Time: 01:35 PM to 04:40 PM
Place: HCR 0112
This Meeting was called to order by
Representative Primavera
This Report was prepared by
Bill Zepernick
X = Present, E = Excused, A = Absent, * = Present after roll call
Bills Addressed: Action Taken:
Call to Order

Presentation of the Final Report from the Center for Health Literacy

Overview of Joint Noticing Requirements and Limitations

County Departments of Human Services Experiences with Noticing

Public Comment
Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

01:36 PM -- Call to Order

Representative Primavera, committee chair, called the meeting to order and provided opening remarks.

01:37 PM -- Presentation of the Final Report from the Center for Health Literacy

Chris Underwood, Director of the Health Information Office at the Department of Health Care Policy and Financing (HCPF) came to the table with Marivel Klueckman, Eligibility Division Director at HCPF, Rachel Reiter, External Relations Division Director at HCPF, and Kevin Patterson, Executive Director of Connect for Health Colorado. HCPF provided a copy of their presentation to the committee (Attachment A). Mr. Underwood gave introductory remarks about the final report of the Center for Health Literacy and Ms. Klueckman began her presentation. She discussed stakeholders in the process for reviewing Medicaid notices and how HCPF focused its review on four main types of eligibility correspondence. Representative Primavera asked about other types of letters beyond the four main letters and about the accuracy of notices. Ms. Klueckman discussed the accuracy of letters and various causes for actual or perceived inaccuracies. Ms. Klueckman highlighted the research phases for the plain language initiative. Ms. Reiter presented the findings of the Center for Health Literacy report, including findings from other states. She stated that no single state can claim to be the gold standard for noticing, but that there are lessons that can be learned, both good and bad, from other states. She described the usability testing conducted and revisions to the notices based on feedback. Ms. Reiter outlined key findings such as that bold headers were useful and that readers appreciated having a single combined notice for multiple agencies. She described challenges concerning health insurance literacy, use of acronyms, and the length of the notice.

160808 AttachA.pdf160808 AttachA.pdf

01:56 PM

Ms. Reiter presented a copy of a revised letter and several recommendations for improving the notice of action sent to Medicaid clients. These recommendations touched on items such as the use of the state seal, a visible date, a personal greeting, and the consistent location of case number and letter topic. She stated that grouping eligibility by person, rather than by program, improved understanding. She presented several documents to the committee, including the client correspondence research findings (Attachment B) and the appendix of original and revised notices (Attachment C). Senator Lundberg asked about the 11 page "short" notice and why it was that length. Representative Landgraf asked about the information included in the letter and the examples in the handout. Ms. Reiter described the types of letters in the appendix, the progress of the revisions, and the final versions of the letters.

160802 AttachB.pdf160802 AttachB.pdf160802 AttachC.pdf160802 AttachC.pdf

02:08 PM

Mr. Patterson from Connect for Health Colorado began his presentation and highlighted the various types of information and communications provided by Connect for Health Colorado. He discussed the need for health insurance literacy and the organization's efforts to promote understanding of these issues. He described his organization's use of YouTube videos and social media to inform consumers. He discussed communications with persons who are eligible, but not enrolled, with a health plan through Connect for Health Colorado. Representative Landgraf asked about information provided to consumers about Medicaid enrollment and Mr. Patterson responded to this question. Representative Primavera asked about the definition of "APTC" and the statutory citations in the letter. Ms. Reiter answered that it was "advanced premium tax credit" and provided other information on the topic. Representative Primavera asked about the use of the state seal and the change of the Medicaid program name. Mr. Underwood responded by discussing the use of the different types of logos. Ms. Reiter stated that the transition to the new name for Medicaid was funded through a grant from the Colorado Health Foundation. She stated that counties will transition to the new name as part of the normal course of business as existing materials are used up. Senator Lundberg expressed surprise about the name change and stated that maybe the legislature should step in to give more direction about this issue. He ask about the rationale for the change. Mr. Underwood and Ms. Reiter discussed the reasons for the change, including consumer confusion with the federal Medicare program. Senator Lunderg asked who had the authority to make the change and Mr. Underwood responded that it was the executive team at HCPF. Representative Primavera also expressed concern about lack of involvement of the legislature. Representative Landgraf ask why "Health First Colorado" was selected. Ms. Reiter described the focus group testing used to select the name. Representative Danielson asked about the status of the transition. Ms. Reiter stated that it will be unveiled over time as material is exhausted and that a website featuring the new name is now active. Further discussion of the new branding ensued.

02:32 PM -- Overview of Joint Noticing Requirements and Limitations

Mr. Underwood began the next presentation on joint noticing and was joined at the table by several representatives from the Office of Information Technology (OIT) including Nancy Dierker, Colorado Benefit Management System (CBMS) Governance Manger, David McCurdy, Chief Technology Officer, Brandi Simmons, Senior Health Information Technology and Client Experience Manager, and Bill Stevens, Director of Health Information Systems and CBMS. Mr. Underwood described the executive steering committee for CBMS and the challenges and opportunities of combined noticing for multiple state programs. Representative Primavera asked about stakeholder involvement in CBMS issues. Mr. Underwood stated that program staff is usually the recipient of stakeholder feedback, which is then routed to the executive team and the steering committee.

02:38 PM

Mr. McCurdy explained the role of OIT in managing CBMS projects and meeting the needs of various programs and stakeholders. Ms. Dierker began her presentation and discussed the complexity of notices generated by CBMS, including the various combinations of program actions that may occur when people apply for health benefits, food assistance, and other programs. She described the different types of letters generated by CBMS, including formal notices of actions and various forms and speed letters used to convey information quickly to clients. She stated that CBMS creates about 6.5 million notices per year, about half of which involve Medicaid clients. Ms. Dierker provided example cases for representative households applying for assistance. She described the continuous improvement efforts for CBMS and stated that the accuracy of notices are only as accurate as the data provided at a given point in time. Representative Primavera asked about the appeal date and ability to appeal if incorrect information is provided. Senator Crowder stated that the goal of the committee should be to make things easier to understand. Ms. Dierker described the need for training and strategies for reducing erroneous or extraneous notices. Senator Crowder asked about electronic correspondence and the ability of clients to communicate with agencies if they have questions. In response to a question from Representative Landgraf, Ms. Dierker stated that most clients have not signed up for an online account at the Program Eligibility and Application Kit (PEAK) website and that most want to continue to receive paper notices in the mail.

02:59 PM

Ms. Dierker discussed the development life cycle and prioritization and request process for changes to CBMS. She stated that changes must be started at least six to nine months in advance. She described the need to evaluate downstream consequences for other CBMS functions and impacts on other agencies. Representative Landgraf asked about the cost of changing the name of Medicaid in CBMS. Ms. Dierker stated that she will provide that information to the committee. Discussion ensued about the cost of information system changes and how it is considered in the life cycle development process. Ms. Dierker discussed the financing of CBMS and prioritization of projects. Mr. McCurdy further elaborated on the role of OIT in serving its client agencies and the amount of work that goes into making projects successful. Representative Danielson asked about concerns raised by the committee at the previous meeting about multiple letters in a short time period and confusing language and noted that some of these concerns may have been addressed in the modified letters.

03:15 PM

Ms. Simmons began her presentation about CBMS governance. She described recent changes to CBMS governance and the use of integrated product teams to receive feedback from various groups and state agencies. She stated that there is a customer and community partner team to receive stakeholder feedback. She described the strategic planning process and the development of the CBMS work plan. She stated that the process is collaborative and that information flows up and down the governance structure. Further discussion ensued concerning the role of OIT in the recent Medicaid name change. Representative Primavera asked about the needs of the disability community and why their needs fall to the bottom of the priority list. Ms. Simmons stated that she would provide a list of participants in the stakeholder group and that they welcome new participants. Representative Danielson recommended that the Colorado Cross-Disability Coalition be included in the statekholder process for CBMS.

03:24 PM

Mr. Stevens began his segment of the presentation on the future vision and plans for CBMS. He discussed metrics and the need to understand different program concerns, such as lack of client use of electronic communication options. He described the use of technology to improve the client experience, including screen readers for the blind and the use of text messaging. He discussed the need to reduce wait times and call transfers when clients call for assistance. He discussed data tracking and analysis and the use of business intelligence to identify and act on trends. He stated that CBMS will never be static and that there is a need to be nimble and quickly resolve issues that arise, including responding to client concerns. He described the need to stay on top of technology trends so as to respond to agency and client needs. Mr. Underwood provided closing comments and further discussed the rebranding of Medicaid.

03:37 PM -- County Departments of Human Services Experiences with Noticing

Frank Alexander, Director of the Boulder County Department of Housing and Human Services, Patrick Kelly, Project Director at the Boulder County Department of Housing and Human Services, Janeen McGee, Director of the Lake County Department of Human Services, and Michelle Trujillo, Economic Assistance Division Director, Mesa County, came to the table. Mr. Alexander began his presentation (Attachment D) and discussed the goals of counties for improving client correspondence. He described the many services that counties are responsible for administering. He stated that increase efficiency of client correspondence frees up staff time to deal with more pressing client issues. He provided several examples of clients correspondences, including one client who received 24 notices over a two-day period and the confusion that ensued. Mr. Alexander described the governance of CBMS and the improvements that have occurred since the system was implemented in 2004. He stated that counties have two seats on the executive steering committee and various program teams and that much progress has been made to improve CBMS. He described the timeliness of eligibility determinations and increasing caseloads over the last several years. Despite these improvements, Mr. Alexander stated that individual experiences may not be positive and will reflect poorly on counties if they receive confusing or inaccurate notices.

160802 AttachD.pdf160802 AttachD.pdf

03:51 PM

Ms. Trujillo began her portion of the presentation about the influence of counties on client correspondence. She described the various types of letters and why they may be generated. She stated that CBMS users at counties and clients using the PEAK system have the ability to control certain information entered into the system and the accuracy of data. She discussed the verification checklist process and the ability of CBMS users at counties to request specific information for follow-up. Ms. Trujillo described the ability of county officials to preview notices and suppress notices from being sent if information is incorrect. She stated that they do not always have the ability to review notices if the user is not the person generating the notice. Discussion ensued between the committee and Ms. Trujillo about the difficulty of manually reviewing client communications. She described the ability to manually print verification checklists and the convenience of giving them in-person to clients rather than mailing them.

04:04 PM

Ms. McGee began her segment of the presentation about the impact of client correspondence at the local level, especially in rural communities. She describe how much workers care about the clients and the many personal connections that exist in small communities. She described some points of client confusion that counties must address. She highlighted the readability of notices, staff training, allocation of resources, and county administration funding as key issues. She described the challenges of recruiting human services staff and the need to find the right person and skills. She stressed the need for additional resources for counties to do their eligibility and client work. Representative Landgraf asked how the Medicaid name change will impact counties. Ms. McGee said that they will do their best to explain it to clients and stated that the most important thing is for clients to understand the overall process, regardless of the name of the program.

04:16 PM

Mr. Kelly began his presentation about data collection on client correspondence . He discussed the need for data in order to make improvements and explained how counties set out to measure the impact of client correspondence on their workload. He described county data collection in four counties of different sizes and the issues tracked. He stated that Connect for Health Colorado and several other partner organizations also participated in the data collection efforts. Mr. Kelly described some limitation to the data collection effort and presented his findings. He stated that their preliminary results seem to match the areas of concerns addressed in HCPF's readability study. He concluded the presentation by providing the committee with county recommendations concerning client communications.

04:29 PM -- Public Comment

Jack Regenbogen, Colorado Center on Law and Policy, came to the table. He provided a handout to the committee (Attachment E) expanding upon the recommendations presented by the Colorado Center on Law and Policy at the previous meeting. Representative Primavera asked about the need for legislation to implement the recommendations. Mr. Regenbogen responded and stated that legislation could be useful. Public testimony concluded.

Senator Lundberg noted that Canada recently undertook efforts to improve client correspondence and provided a handout to the committee (Attachment F). The committee discussed potential dates for the next meeting. Representative Primavera adjourned the meeting.