j_lc_2016a_2016-10-14t09:09:40z2 Hearing Summary

Date: 10/14/2016

09:47 AM -- Communication Between HCPF and Medicaid Clients Committee



Representative Primavera, chair of the Communication Between the Department of Health Care Policy and Financing (HCPF) and Medicaid Clients Committee, presented Bills A, B, C, and D recommended by the committee. The summary report prepared for the Legislative Council Committee, copies of the bills, and the committee's charge can be found in Attachment B. Representative Primavera answered questions from the committee. The committee discussed the fiscal note for Bill D.



161014 AttachB.pdf



The bills are as follows:



Bill A - Technical issues filing Medicaid appeals. This bill clarifies that Medicaid benefits must automatically continue without requiring an affirmative request by a client who is appealing a termination or reduction in benefits. HCPF must send the recipient written confirmation of the continuing benefits. The electronic filing form for appeals must include a check box or other method to opt out of continuing benefits, to request an accommodation for submitting an appeal or participating in a hearing, and to request dispute resolution. The electronic appeals website must additionally allow for the attachment of as many documents as necessary to support the appeal.



Bill B - Medicaid appeal review legal notice requirements. This bill requires administrative law judges to review the legal sufficiency of Medicaid notices of action when a client appeals a termination or reduction in benefits (adverse action). The legal review of notices will take place at the start of an appeal. If the administrative law judge determines that the notice is not legally sufficient, he or she shall inform the client that the adverse action may be set aside. The client may then ask the administrative law judge to decide the case in his or her favor on the basis of the insufficient notice. Alternately, the client may waive his or her defense on the basis of insufficient notice and request that the appeal proceed to a hearing on the merits of the case. Administrative law judges must inform clients that HCPF may issue a legally sufficient notice in the future and that the client may be required to repay any benefits received, as provided under current law, if the adverse action is upheld after the new notice is issued.



Bill C - Audits of Medicaid client correspondence. This bill requires the Office of the State Auditor (OSA) to conduct performance audits of client communications concerning eligibility for Medicaid programs. These audits will be conducted in 2020 and 2023, with any future audits occurring at the discretion of the state auditor. These audits will encompass communications generated both in and outside of the Colorado Benefits Management System (CBMS). The performance audits will determine whether client communications comply with state and federal requirements, and they will review the understandability, readability, and accuracy of client communications. As a part of these audits, OSA will review available county data related to confusing communications received by Medicaid clients. The OSA will report audit findings and recommendations to various legislative committees.



Bill D - Improve Medicaid client correspondence. This bill requires HCPF to engage in an ongoing process to create, test, and improve Medicaid client communications. HCPF must ensure that communications with clients are accurate, readable, understandable, and consistent. Contact information for client questions, and, to the extent practicable, legal, privacy, and educational information must be provided separately from the main content of the correspondence. In all communications regarding denial, reduction, suspension, or termination of benefits, the following must be included:

· an understandable explanation of denial, reduction, suspension, or termination;

· detailed information on the client’s household composition and income sources; and

· a specific description of any information or documents needed from the client.

When modifying Medicaid communications, HCPF is required to test the changes and solicit feedback from clients and stakeholders. HCPF is also required to appropriately prioritize communications that only affect a small number of clients or vulnerable populations. HCPF is encouraged to promote client communications electronically and through mobile applications. As a part of HCPF’s annual presentation made to General Assembly, it must present information on its ongoing process to improve client communications.



Committee Letter A - Align public assistance eligibility. This letter requests that the federal government find ways to align eligibility requirements for public assistance programs to decrease confusion among clients who are applying for multiple programs.