H_PHC_2016A 01/14/2016 Committee Summary

01:33 PM -- Joint Rule 25 Hearing with the JBC



Representative Hamner made opening comments and referenced the FY 2016-17 Staff Budget Briefing Summary (Attachment A). Representative Young introduced the members of the Joint Budget Committee (JBC) and the JBC staff. He discussed the budget request for the Colorado Department of Public Health and Environment (CDPHE) as shown on page 39 of Attachment A. He discussed the family planning budget item and the General Fund for clean water sectors budget item.



160114 AttachA.pdf



01:45 PM



Senator Lambert discussed the need for legislative changes for some of the budget items being requested for CDPHE. He explained that JBC recommendations needing legislative approval are the creation of separate cash funds for each clean water sector, and allowing the monitoring and collection of data of the health effects of marijuana to be done at a regional level rather than at the county level. Senator Steadman responded to questions about fines collected for water quality violations that are deposited into the cash fund and the fee structure for these water programs. Committee discussion followed about the statutory provisions governing the fee structure for the clean water sectors, and the insolvency of the Water Quality Control Fund. Senator Lambert told the committee that the JBC briefing documents for CDPHE provided additional information about these issues.



01:55 PM



The committee discussed increasing emergency cash fund spending authority for the emergency medical technician grant program.



01:57 PM



Representative Young directed the committee's attention to page 13 of Attachment A. He discussed the budget request for the Department of Health Care Policy and Financing (HCPF). He explained the funding sources for HCPF, including General Funds and federal funds. He discussed the Medicaid provider rate review process as established by Senate Bill 15-228.



Senator Steadman addressed the proposed provider rate reduction of one percent for most Medicaid providers. He stated that there are some exceptions to this reduction including nursing home rates, pharmacy rates, and primary care physician rates. Committee discussion followed about the enhanced rates that were in place for primary care physicians for the past two years. Senator Steadman explained that these rates were temporary and that the Governor's budget eliminates the enhanced rates.



02:05 PM



Representative Young discussed the federal Medicare Modernization Act as it relates to Colorado Medicaid clients who are dually eligible for Medicare and Medicaid. Committee discussion followed. The committee revisited the issue of decreased Medicaid rates for primary care physicians and access to care for many Medicaid patients.





02:21 PM



Committee discussion continued about the potential to cut other areas of the budget rather than cutting Medicaid provider fees. The committee discussed the expansion of Medicaid eligibility and the resulting increase in the Medicaid caseload. The committee dialogued with members of the JBC about the cost of insurance premiums, reducing the cost of providing medical care, and the Hospital Provider Fee.



02:35 PM



Representative Young referred to the Colorado Department of Human Services (DHS) proposed budget highlighted on page 20 of Attachment A. He highlighted the increased funding to counties to expand county child welfare staff. Discussion followed about the need for these caseworkers and the need for additional state employees to monitor the distribution of this funding and to train new child welfare staff. Representative Young spoke about DHS' request to use the funding to hire additional types of child welfare professionals rather than just case workers. Committee discussion followed about placing ancillary workers in the county child welfare system when the recent audit specifically identified the need for child welfare caseworkers. Committee discussion continued about the need for additional county child welfare workers, and the proposed community provider rate reduction.



02:47 PM



Committee discussion continued about the increased funding for child welfare case workers.



Committee members focused their attention on the methodology used to determine federal work participation rates for recipients of Colorado Works benefits and the recent news report that Colorado will be fined for not meeting federal participation rates. The committee discussed Colorado's efforts to meet work targets that determine participation and suggested that the federal government's targets do not adequately represent Colorado's efforts in this area. It was pointed out that 22 other states are out of compliance with federal work participation rates. Discussion about the cost of federal sanctions ensued.



02:54 PM



JBC members discussed a variety of issues involving the Division of Youth Corrections (DYC), including: staffing levels; youth violence within DYC; DYC medication distribution policies; and services provided to Intellectual and Developmentally Disabled (IDD) clients within DYC. Discussion about how DYC serves IDD clients followed. Committee discussion followed about the establishment of centers for independent living in Department of Labor and Employment. The committee dialogued about behavioral health issues as they relate to individuals held in DYC and the corrections system. The committee discussed the increase in court ordered competency hearings and restoration services. Members of the JBC discussed budget items that are funded by retail marijuana tax revenue including: intensive residential treatment of substance use disorders; sober living homes; and supported employment for people with severe substance use disorders.



03:07 PM



Representative Young discussed a town hall meeting conducted by the Office of Community Living in HCPF. He explained that during the meeting consumers expressed concerns about IDD services, waitlists, and the use of the supports intensity scale. Committee dialogue followed about the use of the supports intensity scale and the Colorado Benefits Management System.







03:19 PM -- Update on Waiting Lists for Services for People with IDD



Megan Davisson, JBC staff, distributed a JBC staff memorandum titled Joint Meeting with the Joint Budget Committee on the Waiting List for Individuals with Intellectual and Developmental Disabilities Pursuant to Section 25.5-10-207.5 (2), C.R.S. (Attachment B). Ms. Davisson discussed the number of individuals waiting for services under the various waivers. She explained that some individuals on the waiting lists are receiving services from other programs including food assistance, and some Medicaid services, while on the waiting list.



160114 AttachB.pdf



03:27 PM



Jed Ziegenhagen, Director, Office of Community Living, HCPF, provided a handout to the committee (Attachment C), and discussed the role of the Office of Community Living. He discussed the Home- and Community-Based (HCBS) waivers administered by his office. He stated that 2081 people are waiting for services. He explained that these individuals are eligible for services, but are not receiving services at the level they need.



160114 AttachC.pdf



03:34 PM



Barb Ramsey, Director, Division of Intellectual and Developmental Disabilities, HCPF, discussed steps HCPF has taken to build capacity within the Children's Extensive Support Waivers. She also explained the process used to enroll clients into waiver programs, and the emergency placement protocol for those individuals who are on the waitlist, but, due to a change in circumstances, need services immediately.



03:43 PM



Randy Brodersen, Executive Director, North Metro Community Services, Inc., discussed waiver waitlists, resources available to provide the waiver services, the desire of some clients to remain on the waitlist for an extended period of time, and the provider reimbursement rates.



03:48 PM



Debbie Spencer, Chief Executive Director, Overture, stated that her agency serves clients in Jefferson and Boulder Counties. She explained that her agency has difficulty finding adequate providers for clients due to low reimbursement rates. She discussed the assessment tools used to determine the needs of clients. She expressed her opinion that the wait list will not be eliminated until the issues around low provider rates and the appropriate determination of a clients needs are addressed.



03:59 PM



Committee discussion followed regarding the stress of caring for a family member with disabilities causes within the family and the need to provide supports for these families.













04:04 PM -- Public Testimony on Waiting Lists for Services for People with IDD



Harold Wright, Jr., representing himself, told the committee about his adult daughter who has been on the waiting list for the HCBS Waiver for Persons with Developmental Disabilities (HCBS-DD) since 2003. He explained that his daughter currently has an apartment she shares with a roommate and receives some services through the HCBS Supported Living Services (SLS) waiver. He explained that he and his wife are able to help support their daughter, but expressed his desire for her to be able to access more services through the SLS waiver so that she can remain independent. He stated his concern that, even though the HCBS-DD waiver would provide additional services for his daughter, her independence will be compromised if she receives services under that waiver rather than the SLS waiver. Mr. Wright responded to questions from the committee.



04:17 PM



The committee adjourned.