H_PHC_2016A 01/07/2016 Committee Summary

09:06 AM -- Introductory Comments



Representative Primavera called the meeting to order. She reviewed the agenda (Attachment A) for the day and announced that the Joint Health and Human Services Committee will be meeting on January 14 and January 21.



160107 AttachA.pdf



09:07 AM -- SMART Government Act Briefing - Department of Human Services



Reggie Bicha, Executive Director, Colorado Department of Human Services (DHS), made introductory remarks and provided three handouts to the committee (Attachments B, C, and D). Director Bicha referred to attachment A throughout his presentation and discussed the organizational structure, oversight responsibilities, and the budget of the department. He told the committee that DHS has service sites throughout the state. Director Bicha discussed the need to update DHS facilities. He listed the strategic priorities of the department, explained that DHS strives to provide every Coloradan with the opportunity to thrive in the community of their choice, achieve economic security through meaningful work, and prepare for education success throughout their lives.



160107 AttachB.pdf160107 AttachC.pdf160107 AttachD.pdf



09:19 AM



The committee discussed the services provided to youth who are in the care of the Division of Youth Corrections (DYC) and that all of the children who serve time in DYC are returned to the community. He explained that DHS has made strides in the areas of engaging family members of a child who is in the care of DYC, working with DYC residents toward obtaining a high school diploma or a GED, and promoting post secondary education. The committee briefly discussed restorative justice practices.



The committee discussed funding and oversight for community center boards (CCB). Director Bicha stated that, in light of a recent audit of a local CCB by the Denver Auditor, he is reviewing the oversight mechanizes that are in place to ensure that CCBs are acting in a fiscally responsible way.



Committee discussion ensued about whether food services workers at the state's regional centers earned a living wage. Discussion also focused on the Grand Junction Regional Center and the recent report highlighting the cost of keeping the campus open. It was noted that there are 25 clients being served at the facility that is designed to house 900 individuals. Director Bicha discussed ways to provide Intermediate Care Facility (ICF) services on the western slope without maintaining a 900 bed facility. The committee then revisited the issue of wages earned by food services employees at the Pueblo Regional Center and discussed issues around involuntary commitments.





09:33 AM



Committee discussion continued about the procedures for administering medications to youth in the care of DYC. Dr. Patrick Fox, Chief Medical Officer for DHS, came to the table to discuss the medication needs of individuals who move between DYC, local law enforcement jurisdictions, and the Colorado Department of Corrections (DOC). He explained that DHS has been working to create uniform formularies that can be accepted across the different systems. Dr. Fox explained that there is no authority to make different systems of care use the same drug formularies, but DHS is working with DOC and the Denver jails to evaluate the feasibility of a shared formulary, as well as exploring a buying cooperative for medication to limit the budgetary impact a single formulary may place on rural law enforcement jurisdictions.



09:39 AM



Director Bicha continued his presentation. He discussed the current status of the implemented recommendations made by the State Auditor, and the Governor's budget request for DHS. He told the committee about DHS' effort to create a Children's Savings Account program for children who are enrolled in the Head Start program. Committee discussion about the provisions of the Children's Savings Accounts followed. Director Bicha told the committee that parents can access the money that they put in their child's savings account for any reason, but they would only be able to access the matching dollars to pay for the child's education. He told the committee that matching funds would be donated to the program by private organizations and foundations, and that parents who save regularly will receive bonuses.



09:52 AM



Committee discussion about the budget decision item "Institute Suicide Mitigation Phase II" followed. Director Bicha stated that this funding is used to updated DHS institutions to prevent residents for harming themselves. He continued his presentation and discussed the federal Child Care Block Grant Reauthorization Act of 2014 and extending ReHire Colorado program.



09:59 AM



Mary Anne Snyder, Director, Office of Early Childhood, joined Director Bicha at the witness table. Director Bicha explained that the role of the Office of Early Childhood is to improve child care, offer training to providers, educated parents about the advantages to high quality child care, and administer the child care assistance program for low-income families who are going to school or working. He explained that the office is working to help providers move up to higher ratings in the quality rating program. Committee discussion focused on efforts to reduce the cost of child care and the study being conducted by Colorado State University to determine what factors are involved in the cost of child care.



10:07 AM



Ms. Snyder told the committee about the Colorado Shines Quality Rating program. She explained that all licensed child care facilities receive a Level 1 rating, and that in order to receive a higher rating, a facility must meet specific criteria. She explained that federal grant money is available to help providers increase their quality rating. The committee discussed wages for child care workers and the fees associated with relicensure.



10:12 AM



Levetta Love, Director, Office of Economic Security, came to the table. Director Bicha explained the assistance programs administered by the Office of Economic Security. He explained that Colorado Works provides cash assistance to needy families and the federal methodology used to determine work participation rates for recipients of Colorado Works benefits. He explained that this formula does not accurately reflect the work participation of recipients in Colorado.





10:20 AM



Ms. Love responded to questions about the process of determining work participation rates. Committee discussion followed about the types of activities that count as work participation. Director Bicha further discussed the federal methodology used to determine work participation rates and the most recent work participation rate in Colorado.



10:27 AM



Director Bicha told the committee that the Refugee Resettlement program administered by DHS is a federal program funded by the federal government.



10:28 AM



Nancy VanDeMark, Ph.D., Director, Office of Behavioral Health, DHS, came to the table. Director Bicha provided an overview of the needs of the behavioral health system in Colorado. He discussed the need for additional behavioral health beds. He highlighted the Crisis Response System which includes the statewide crisis hotline, walk-in crisis stabilization centers, mobile crisis services, and crisis respite. Discussion ensued about the steps taken to train behavioral health providers in suicide management and prevention, the population served by the Crisis Response System, whether the Crisis Response System staff can initiate an mental health M-1 involuntary hold, and accessibility to crisis services. Dr. VanDeMark told the committee that there are 14 crisis stabilization units across the state. Committee discussion then focused on whether law enforcement officials can place individuals in stabilization centers.



10:44 AM



Discussion about funding options for behavioral health services, the use of mental health M-1 involuntary holds in the rural areas of the state, and the lack of beds for individuals who need to be placed on a mental health M-1 involuntary hold followed. Director Bicha responded to concerns about the lack of behavioral health beds available in the state. He explained that DHS is working with the Colorado Hospital Association to alleviate the shortage of behavioral health beds. Further committee discussion focused on the need to increase the number of behavioral health beds.



10:54 AM



Director Bicha discussed the challenges DHS faces with court order competency evaluations. He told the committee that although the courts are ordering more competency assessments, there is not an increase of those being found incompetent. He also stated that DHS had received supplemental funding to hire three new psychologist to conduct competency evaluations of individuals in jails.



11:00 AM



Mark Wester, Director, Office of Community Access and Independence, DHS, came to the table. Director Bicha discussed the following Regional Centers Task Force's recommendations that are specific to DHS: enhancing the transition care coordination and crisis intervention processes, and pursuing consolidation and efficiency opportunities. The committee discussed the possibility of converting regional center facilities in to psychiatric care facilities.



11:09 AM



Director Bicha discussed the difference between the use of background checks and protections for caregivers who work with juveniles and those caregivers who work in facilities for at-risk adults.







11:13 AM



Robert Werthwein, Ph.D., Director, Office of Children, Youth, and Families, DHS, came to the table. Director Bicha discussed the Colorado Child Abuse Reporting Hotline System and the steps taken to reduce the number of children in congregate care. He reviewed the county child welfare workload. He discussed the idea that DHS should be allowed to use funding earmarked for caseworkers to hire other child welfare professionals, such as nurses.



Dr. Werthwein responded to questions about congregate care. Committee discussion continued about workloads for child welfare caseworkers and medical professionals. Dr. Werthwein discussed programs aimed at identifying at-risk families and providing services and supports prior to the occurrence of abuse or neglect. In response to questions from the committee, he explained that all calls reporting abuse to counties and to the state abuse hotline are tracked by the state. The committee discussed the number of children in foster care who also have an Individual Education Plan.



11:29 AM



Dr. Werthwein addressed the Colorado Statewide Youth Development Plan, homelessness among youth populations, and human trafficking concerns.



11:35 AM



Director Bicha discussed the Division of Youth Corrections Medication Management Audit. He explained the department's focus on developing clinical oversight of prescribing practices, a uniform system to strengthen medication administration practices, medical monitoring protocols, and best practices for handling and disposing of controlled substance. He told the committee about the budget request to add 100 new staff to DYC so that the department will be closer to the federally mandated staff-to-client ratio. He expressed his hope that the increased staff will reduce the number of fights and assaults in youth corrections facilities.



Discussion about the department's policy on strip searches and the current one to ten staffing ratio followed.

11:45 AM



The committee continued discussion about the staffing ratio in youth corrections facilities. Director Bicha told the committee that he would provide the committee with statistical information about the types of assaults that occur within DYC.



11:48 AM



Discussion returned to the funding of the congregate care program. Director Bicha discussed foster care provider reimbursement rates.



Discussion about seclusion policies within youth corrections followed. Director Bicha stated that the department has revamped its seclusion policy, and that he will provide the committee with additional statistical data about the number of clients who are placed in seclusion at a later date.



11:55 AM



Committee discussion focused on DYC's policy on isolating youth who are disruptive and threatening others, and the ability for DYC employees to protect themselves against aggressive youth. Director Bicha indicated that federal rules govern the use of seclusion for youth and that he would provide clarification about the federal rules to committee members at a later date.







12:00 PM



Representative Primavera state that no one from the public signed up to provide testimony. The committee recessed.



01:10 PM -- Presentation from the Behavioral Health Transformation Council



Dr. Liza Tupa, Division Director of Community Health, the Office of Behavioral Health, Colorado Department of Human Services and Chair of the Behavioral Health Transformation Council (BHTC); and Vicki Rodgers, Mental Health Partners and Co-Chair of the BHTC, presented on behalf of the BHTC. Dr. Tupa referenced a handout for the committee (Attachment E), and went over the goals of the BHTC, which include improving administrative processes, service delivery, and funding more efficient and effective outcomes health outcomes.



160107 AttachE.pdf



1:12 PM



Dr. Tupa explained that the BHTC is comprised of a steering committee and three subcommittees. She described the accomplishments and 2016 focus for the BHTC's three subcommittee activities. Dr. Tupa described the accomplishments of the Workforce Development Committee included participating in a federal behavioral health workforce summit, aligning with the State Innovation Model grant, working with the Department of Regulatory Agencies (DORA) to streamline credential processes, and working with higher education institutes to update their curriculum. She outlined the 2016 focus of subcommittee, which will include workforce recruitment and development, credentialing, education and training, and working on definitions in statute.



1:18 PM



Committee members asked about specific professional development and training in suicide prevention. Dr. Tupa responded that specific training depends on the credentials that are being obtained. Ms. Rogers explained that the BHTC recognizes the work of other commissions in suicide/crisis training, and that the BHTC is working to align DORA requirements. Dr. Tupa recognized the issue of suicide in Colorado and responded that there are multiple ways to get certification to work in suicide prevention.



1:21 PM



Dr. Tupa gave an overview of the Colorado Crisis Services Oversight Subcommittee. She described the successes of the subcommittee, which included identifying and coordinating key issues, improving data collecting and reporting, the addition of a traumatic brain injury screening program, developing processes to ensure system inclusiveness, and providing input on rule promulgation for Colorado Crisis Services. She outlined the 2016 goals for the subcommittee, which includes creating guiding values and monitoring and improving data collection and reporting on the Colorado Crisis System.



1:23 PM



Committee members asked about the location of crisis centers in Colorado. Dr. Tupa described the different types of crisis center facilities and their locations throughout the state. Dr. Tupa noted that mobile units are scattered across Colorado and must be accessible to anyone in the state within one to two hours. Dr. Tupa provided more information about the walk-in centers. She state that all crisis centers are open 24 hours, seven days a week, and the admit time is dependent on the condition of the person. Dr. Tupa explained that local law enforcement are aware of mobile and standing crisis centers.





1:31 PM



Dr. Tupa described the accomplishments of the Payment Reform Subcommittee, which included informing the BHTC about ten payment reform initiatives throughout the state, and establishing the subcommittee as a resource for multiple state work groups. She reviewed the 2016 goals for the subcommittee, which include providing communication with state payment reform work groups and providing feedback on payment reform initiatives. Committee members advised the BHTC to ensure services are being provided to rural Colorado, and noted issues with emergency room admits. Dr. Tupa recognized the challenges in rural Colorado. Dr. Tupa and Ms. Rogers concluded their presentation.



01:36 PM -- Presentation from the Regional Centers Task Force



Mark Wester, Director of the Office of Community Access and Independence, Department of Human Services, gave a brief overview of the Regional Center Task Force, which concluded its work in December. He provided a copy of the task force's final report to the committee (Attachment F). Mr. Wester discussed why the task force was formed and the task force membership.



160107 AttachF.pdf



01:39 PM



Mr. Wester discussed the charge of the task force. He explained the task force made ten recommendations in its final report. He discussed changes to Medicaid waivers, fully including services for individuals with intellectual and developmental disabilities (IDD) and in the mental health system, and developing guidelines and training for mental health professionals to provide services to IDD population.



01:42 PM



Mr. Wester responded to inquiries about whether the recommendations would assist families with a child with an IDD. Legislators expressed concern about the reported population being served in the Grand Junction Regional Center campus and the cost for providing services for Intermediate Care Facilities. Mr. Wester explained the different services and beds located at the Grand Junction campus. He noted that the large campus in Grand Junction drives the cost and offered to provide more details on the cost to the committee.



01:54 PM



Mr. Wester described the population being served at the Pueblo and Wheat Ridge Regional Centers, in response to a legislator's question.



01:56 PM



Mr. Wester gave additional information about how successful transitions are defined, and noted that 92 percent of individuals have been successful in their placement in the community. He explained the Regional Center's emergency intake process. Mr. Wester concluded his presentation.





01:58 PM -- Presentation from the Early Childhood Leadership Commission



Sheryl Shushan, manager of the Early Childhood Leadership Commission (ECLC), presented to the committee. She referenced a handout about the ECLC provided to the committee (Attachment G). Ms. Shushan explained the strategic task, goals, and membership of the ECLC.



160107 AttachG.pdf



02:00 PM



Ms. Shushan explained the role of the ECLC and its statutory charge. Ms. Shushan described some of the recommendations that the ECLC has made to the Office of Early Childhood, and the progress that the ECLC has made. Ms. Shushan discussed a 2015 accomplishment to create a public-private partnership: the Early Childhood Framework. The ECLC produced a website and communication materials for the Framework. Ms. Shushan noted that the ECLC will present an annual report next week.



02:07 PM



Committee members noted the importance of early childhood work, and closing the achievement gap. Ms. Shushan completed her presentation.



02:10 PM -- SMART Government Act Briefing for HCPF



Susan Birch, Executive Director, Health Care Policy and Financing Department (HCPF), provided a briefing on HCPF. She referenced a packet of materials for the committee (Attachment H). Director Birch noted that there are concerns with the health care system and the Colorado health system is undergoing great change and increase in health care costs.



160107 AttachH.pdf



02:15 PM



Director Birch described statistics related to Medicaid caseloads and costs associated with different Medicaid populations. She gave statistics on health insurance coverage and Medicaid coverage in the state. Director Birch explained the mission of the Department, and described the goals of HCPF to improve health care access and outcomes for clients. She gave statistics on physical health outcomes, and noted that better outcomes lead to cost savings. She discussed the stewardship of financial resources of HCPF, and noted low administrative costs. She responded to questions on recoupment of funds used inappropriately.



02:23 PM



Gretchen Hammer, HCPF's Medicaid Director, walked the committee through HCPF's performance plan. Ms. Hammer described the HCPF's strategic policy initiatives which includes delivery system innovation, tools of transformation, and operational excellence. Ms. Hammer explained the Accountable Care Collaborative (ACC) structure. In response to a question, Ms. Hammer clarified that savings is cost avoidance within the Medicaid program.









02:29 PM



Josh Block, Budget Director, HCPF, explained how HCPF's budget setting process and forecasting for Medicaid works. He explained how the ACC savings are determined on a per client basis. He responded to further questions from the committee on the ACC savings. Director Birch noted that the savings are addressed in HCPF's budget.



02:37 PM



In response to a question, Director Birch explained that the provider network for Medicaid has increased for the past four to five years, and that HCPF has a provider engagement unit to aid the process. Ms. Hammer explained that the capacity for ACC is large and has allowed Medicaid expansion. Members expressed concern about the increase in Medicaid caseload and available providers, especially with a provider rate cut. Ms. Hammer explained that the situation is being monitored closely and HCPF is required by law to procure data about client access to care. In response to a question, Ms. Hammer noted that there is a Medicaid customer service center that tracks provider issues, and HCPF can track client complaints from website use. Ms. Hammer responded to further questions about savings from the ACC.



02:51 PM



The committee discussed the cost of Medicaid expansion in the state in the future. Director Birch and Mr. Block explained that the Medicaid expansion cost will increase from zero percent to a 10 percent state share by 2020 and how those costs will be paid for through the Hospital Provider Fee.



03:02 PM



Director Birch talked about rural palliative care as part of the Medicaid program, in response to a question.



03:04 PM



Ms. Hammer discussed the three major systems of medical care: behavioral health, physical health, and long term services and supports. Ms. Hammer discussed different payment reforms. Ms. Hammer talked about the community living program progress, and the use of waivers to provide cost effective services.



03:14 PM



Tom Massey, Policy, Communications, and Administration Office Director, HCPF, explained the 2016 budget request and the factors that influence the request, including provider rate reductions, end of temporary increased primary care payments, and Hospital Provider Fee collections. Mr. Massey responded to questions about the end of increased primary care payments, and noted that the increase was always temporary in nature and the state can no longer afford the increased payments. Mr. Block noted that the decrease in primary care payments amounts to about 23 percent. Member expressed concern about the one percent provider rate reduction. Mr. Massey noted that the primary care providers do not experience the one percent rate reduction. He confirmed that specialist providers will experience the rate cut, and discussed creative ways for providers to cut costs. Mr. Massey explained that the hospitals will increase reserves in anticipation of the expansion. Mr. Massey noted that primary care offices are very important to the health care system and HCPF is open to suggestions for balancing the budget.



03:28 PM



Mr. Massey continued by explaining the following three legislative proposals that focus on improving client experience while containing costs. He discussed non-emergency medical transport regulations, allowing health maintenance medication through the mail, and repealing obsolete reports.







03:32 PM



Ms. Hammer gave two statutory required updates. She gave an update on HB 13-1196 to reduce waste through the ACC, and HB 14-1360, regarding in home support services.



03:36 PM



In response to a question, Ms. Hammer noted that clients with disabilities or on waivers are required to be tracked, and very specific data is collected on these populations and their use of services. Ms. Hammer clarified that HCPF only has data on payments to providers.



03:41PM



Director Birch gave concluding remarks and ended the presentation.



03:52 PM



Representative Primavera concluded the meeting.