I_COMedicaidCL_2016A 08/24/2016 01:37:40 PM Committee Summary

01:38 PM -- Call to Order



Representative Primavera called the meeting to order. An agenda was distributed to the committee (Attachment A). She discussed the purpose of the meeting.



160824 AttachA.pdf



01:40 PM -- Presentation of Legislative Recommendations by CCDC and CCLP



Elisabeth Arenales, Colorado Center on Law & Policy (CCLP), discussed the challenges of addressing client correspondence issues. She noted that clients have communication issues and notice issues with programs other than Medicaid. Jack Regenbogen, CCLP, distributed a handout to the committee (Attachment B) with a summary of recommendations to the committee. He discussed a proposal for a more detailed adverse action notice to clients. He discussed including client household information in notices.



160824 AttachB.pdf

















01:47 PM



Representative Primavera asked about housing, and eligibility of households. Mr. Regenbogen explained how households members are counted. The committee discussed the cost of the recommendations related to information technology changes. Representative Primavera discussed vague notices. Ms. Arenales explained that the focus of CCLP's recommendations is on the client experience, rather than making changes within state agencies. Representative Lundberg expressed concern about testing notices with clients to check their understanding. He discussed a possible bill idea to require proof of client understanding for new notices. Committee discussion ensued. Ms. Arenales mentioned that the Department of Health Care Policy and Financing (HCPF) has been working on the issue of client understanding.



01:59 PM



Mr. Regenbogen discussed a proposal to regularly audit client communication with state agencies and bring in a third party to inspect the legal sufficiency of the notices. Representative Primavera explained that the State Auditor's Office is receptive to undertaking the audit. Senator Newell discussed the need for regular internal audits by HCPF. Ms. Arenales described aspects of a possible audit.



02:03 PM



Mr. Regenbogen explained a recommendation to enable a process for reviewing the sufficiency of notices. He explained that a review process would ease administration burdens of appeal hearings and enable clients to continue receiving benefits while they appeal a ruling. He suggested allowing an administrative law judge to review notices before appeal hearings. Representative Primavera discussed having an Ombudsman undertake the review notices. Mr Regenbogen explained that a checklist of items that would render a notice insufficient would be helpful. Mr. Regenbogen offered a final suggestion to the committee to request a report on technical glitches that result in errors in client communication from HCPF. He gave examples of technical glitches. Representative Primavera commented on excessive notices to clients, and suggested an information technology fix.



02:16 PM



Josh Winkler, Colorado Cross-Disability Coalition (CCDC), provided handouts to the committee (Attachment C) and presented recommendations to the committee. Mr. Winkler discussed an example of a notice that he received that contained errors. He explained that HCPF should prioritize the disabled community's Medicaid programs because that community cannot function without Mediad. Mr. Winkler discussed a recommendation to move determination of eligibility for Medicaid buy-in programs to the state. He suggested that 'person-centered' be defined in statute, and that on-line appeal forms allow for special requests to be made. Mr. Winkler responded to a question regarding accommodations for appeal hearings, and the difficulties in scheduling hearings. He proposed that clients be allowed to send an e-mail as a response to a notice. Mr. Winkler explained HCPF's response to that suggestion. Representative Primavera asked about the dates and deadlines included in the notices.



160824 AttachC.pdf



02:32 PM



Mr. Winkler responded to a question regarding nontraditional Medicaid clients and problems with Prior Authorization Requests (PAR) and 803 notices. He discussed the difference between long-term care and other Medicaid clients. Ms. Arenales explained the difficulty with determining eligibility for the buy-in and the challenges clients have with PAR.









02:35 PM



Representative Primavera suggested continued work on client communication and HCPF beyond the interim. Senator Newell expressed support for ongoing conversation on the issue. Ms. Arenales and Mr. Winkler discussed the time frame for legislative recommendations.



02:41 PM -- Presentation of Legislative Recommendations by HCPF



Chris Underwood, Health Information Director, HCPF, and Tom Massey, Deputy Executive Director, HCPF, summarized previous testimony to the committee and presented a handout (Attachment D) with recommendations. Mr. Massey discussed a legislative recommendation to implement findings from the Center for Health Literacy. He explained that HCPF would like to continue testing client communication, including testing notices that do not originate from the Colorado Benefits Management System (CBMS).



160824 AttachD.pdf



02:49 PM



In response to a question, Mr. Massey explained that state agencies have internal groups and stakeholders to periodically review client notices. He discussed the consumer feedback group. Senator Lundberg commented on the need for clients to provide feedback directly to HCPF. Representative Primavera asked about the implementation of the Center for Health Literacy recommendations. Mr. Underwood responded that new language for notices has not been implemented because it needs a legal review, and implementation is planned in March of 2017.



02:56 PM



Mr. Underwood described a recommendation to promote electronic and mobile options for receiving notices. He explained that HCPF is exploring additional ways to communicate with clients, especially on-line. Mr. Underwood described the challenges of income and household determinations. Mr. Underwood suggested that HCPF report on their progress with improving client communication at the SMART Act hearing.



03:00 PM



Mr. Massey responded to a question regarding a regular meeting to discuss client communication. He noted that HCPF has organized a group of mostly Medicaid clients or former clients that meets regularly, and could take on the responsibility of discussing client communications. Mr. Massey explained that additional resources would be needed to conduct more client testing and that HCPF must also follow federal regulations for correspondence. In response to a question, Mr. Underwood described the role of the Ombudsman to the committee. Mr. Massey explained staffing issues with scheduling hearings in response to a question. Ms. Arenales and Mr. Underwood discussed continuation of benefits during appeal.









03:13 PM -- Review of Process for Requests for Interim Bills



Brita Darling, Office of Legislative Legal Services, informed the committee of their official charge, and discussed deadlines for the bill request process. She distributed a handout to the committee regarding the bill request process (Attachment E). Ms. Darling responded to questions regarding details needed for the bill requests. Representative Primavera discussed possible bill ideas. Senator Newell commented on the CCLP recommendations. Ms. Darling discussed the definition of 'person-centered' in response to a question.



160824 AttachE.pdf



03:24 PM -- Committee Discussion and Vote on Bill Requests

03:30 PM



Senator Crowder asked about state and federal alignment in regards to counting households. Mr. Underwood noted that federal programs utilize different definitions of households and incomes. Senator Newell suggested that the committee write a letter to the federal government regarding aligning household and income eligibility.

03:40 PM



The committee members discussed dates for the next meeting. Ms. Darling explained that the bill requests must be finalized by September 14, and noted that once they are finalized the bills will need to be amended to make any changes. In response to a question, Ms. Darling responded that members have three days to provide details to the bill drafters for bill requests. Representative Primavera noted that the bill drafters may speak with CCLP and CCDC regarding the content of the bill requests.



03:45 PM



Representative Primavera adjourned the committee.