I_StatewideHealth_2019A 10/02/2019 06:06:01 PM Committee Summary

Representative Lontine called the meeting to order.  She spoke about the health care facilities that the committee toured in Walsh, Lamar, Antonito, La Jara, and Alamosa on October 1 and October 2.  She expressed her gratitude to the community for providing feedback to the committee about issues related to accessing health care in Southeast Colorado and the San Luis Valley (SLV).  Representative Lontine reviewed the meeting agenda (Attachment A).

Della Vieira, Alamosa County Public Health Department, spoke about the community demographic and distributed a handout (Attachment B).  She discussed various statistics related to social determinants of health, the limited number of health care providers in the SLV, and the uninsured rate.  She commented on the grant funding established in Senate Bill 19-228 and Senate Bill 19-008, which provide funding for substance use disorder treatment and harm reduction efforts.  She also discussed the expansion of the medication-assisted treatment pilot program and recent legislation which established programs to improve access to behavioral health care and substance use disorder treatment. Ms. Vieira discussed the need to focus on ways to coordinate care for residents in the SLV.

Emily Brown, Rio Grande County Health Department, discussed issues related to the poverty rate in the SLV, food insecurity, foster care funding, and the need to safeguard funding for rural hospitals.  She told the committee that there are three hospitals in the SLV and rural hospital payments determine the viability of these hospitals.  She stated that the loss of rural hospital payments would directly impact patient care.

Ms. Vieira discussed the aging population in the SLV and family caregivers who are caring for both children and elderly parents.  She expressed the need to establish community support programs for these caregivers.  Ms. Vieira responded to questions about the immunization rates in the SLV.  She explained that the rates vary from community to community.  She discussed the collaboration between schools, local public health agencies, and health care providers to increase immunization rates. 

Committee questions and discussion followed regarding access to pharmacies, the maltreatment of children, the many stressors in SLV communities, including the opioid crisis, and programs focused on providing healthy recreational opportunities for SLV residents.  Discussion continued about the need to stabilize rural health care, managing substance use disorders in communities, and the lack of behavioral health care providers.

Victoria Romero, San Luis Valley Behavioral Health Group, told the committee about SLV Behavioral Health Group's efforts to provide out patient behavioral health services and community-based services.  She discussed the difficulties health care providers and behavioral health providers have providing integrated care due to federal privacy rules.

Committee discussion followed about federal privacy laws governing the sharing of patient medical information and the added protections related to behavioral health records.  Ms. Brown discussed the need to collect health outcome data specific to SLV. 

Jennifer Silva, San Luis Valley Behavioral Health Group, discussed case management, the crisis mobile team, and the increased acuity of patients with mental health conditions.  She spoke about the state pilot program designed to reduce the time a patient, who has been place on an involuntary mental health hold, spends in an emergency room or jail by providing transportation to a mental health facility.  She discussed the medication-assisted treatment vans that the Colorado Department of Human Services will be deploying early next year.  One of these vans will travel to six sites in the SLV each week to provided medication-assisted treatment to residents.  Ms. Silva told the committee that the confidentiality of patient records related to substance use disorders is governed by federal regulations, 42 CFR Part 2, that outline the limited circumstances that information about a client’s treatment may be disclosed to other providers with and without the client’s consent.

The committee discussed the need for more detoxification centers and services, including medical detoxification services, homelessness in the SLV, and affordable housing concerns.

Committee members and the panel discussed issues related to the retention of medical and behavioral health professionals; Medicare and Medicaid reimbursement rates; provider licensure requirements for reimbursement; problems with medical coding for individuals with a dual-diagnosis; and transportation issues for patients.

Committee discussion continued about suicide rates in the SLV, the use of methamphetamines and opioids in the area, and the use of the statewide crisis hotline and the crisis mobile units. 

Jania Arnoldi, Valley-Wide Health Systems Inc., stated that there are currently nine providers of medication-assisted treatment in the SLV and that several other providers are in training to provide this treatment.  Ms. Arnoldi distributed a handout to the committee (Attachment C). She discussed services and programs provided by Valley-Wide Health Systems; barriers to care for residents of the SLV; the limited number of medical providers providing specialty care; transportation limitations; the lack of reimbursement to Federally Qualified Health Centers for telemedicine; and the impact on the community of the opioid epidemic.  Ms. Arnoldi also pointed out that the number of uninsured residents is increasing, even though it is still lower than the rate was prior to the expansion of Medicaid.  She also discussed services offered at Federal Qualified Health Centers that are not reimbursed, such as group meetings for individuals with chronic diseases designed to education patients on how to manage their diseases.

Konnie Martin, San Luis Valley Health, presented on the SLV Health system.  She told the committee that SLV Health employees over 800 staff and delivers 500 babies a year.  She discussed the payer mix and told the committee that 60 percent of patients are insured through either Medicare or Medicaid.  She discussed the importance of revenue from the Healthcare Affordability and Sustainability Fee to the operating budget of rural hospitals.  Ms. Martin spoke about how SLV Health was able to make capital improvements without taking on debt.  She also told the committee that SLV Health has expanded its health care services by increasing specialty services over the past five years, including a cancer center, urology and cardiac services, and nephrology services.  She pointed out that this access allows patients to remain in the community for treatment.   She discussed the challenges of providing behavioral health services in emergency rooms and the reliance on community partnerships to provide care for residents of the SLV.

Ms. Martin and the committee members discussed the requirement that Federally Qualified Health Centers provided care face-to-face to qualify for reimbursement, which does not allow for the use of telehealth; the number of self-pay patients who are uninsured or underinsured; and ways to reduce the shortage of health care professions, such as creating a pathway to professions at the local community college.  Ms. Martin discussed programs at local higher education institutions that provide classes for nurses who wish to expand their credentials, as well as programs for respiratory therapist and radiology technicians.

Grantley Showalter, Center for Restorative Programs, discussed his role as a Law Enforcement Assisted Diversion (LEAD) case manager. He told the committee that statistics collected by the courts show that the more involved an individual with a substance use disorder becomes with the criminal justice system, the greater the likelihood the inidividual will reoffend. He explained that individuals who have low level drug offenses who are diverted into the LEAD program have better outcomes.  The LEAD program provides wrap-around case management to help these individuals get to a stable position in their lives. He explained that the program focuses on reducing the stigma around substance use disorders, and helps offenders get through the barriers preventing them from receiving substance use disorder treatment. Mr. Showlater responded to committee questions about the LEAD program.

Javiel Maes, representing himself, discussed his experience as a person with a substance use disorder, the difficulty he has had finding housing, his idea for establishing a sober living home, and the difficulty many SLV residents face accessing reliable transportation.  Mr. Maes responded to committee questions.  Committee discussion followed about the effort it takes to remain sober and the trauma experienced by individuals with substance use disorders.

Zoila Gomez, representing herself, discussed need for healthy recreational opportunities for youth living in the SLV and her efforts to support youth to become healthy, productive members of the community.