H_PHC_2017A 01/06/2017 Committee Summary

09:16 AM -- Presentation of Performance Audits



Representative McCann called the meeting to order. A meeting agenda was distributed to the committee members (Attachment A).



170106 AttachA.pdf



Monica Bowers, Office of the State Auditor, introduced herself and the members of the Office of the State Auditor's staff to the committee. She provided the committee with the Annual Report of the Office of the State Auditor (Attachment B). She explained the role of the Office of the State Auditor.



170106 AttachB.pdf



09:19 AM



Michelle Colin, Office of the State Auditor, presented the Division of Youth Corrections Performance Audit Report and distributed the Audit Report Highlights document (Attachment C).



170106 AttachC.pdf



09:24 AM



Ms. Colin answered questions from the committee regarding private contractor facilities and youth corrections facilities. She responded to questions about the process after an audit is completed, the use of seclusion in youth corrections facilities, and the difference between time outs and seclusion. In response to a question, Ms. Colin explained the time period that was reviewed under the audit. Committee discussion with Ms. Colin about the Division of Youth Corrections and the performance audit ensued.



09:45 AM



Jenny Page, Office of State Auditor, presented the Colorado Medicaid - The PEAK Application and Eligibility Verification Performance Audit Report and distributed the Audit Report Highlights document (Attachment D). Ms. Page answered questions about Colorado Benefits Management System (CBMS) and what is considered timely manner for disenrollments from Medicaid.



170106 AttachD.pdf





09:55 AM



Ms. Page presented the Annual Report: Status of Outstanding Audit Recommendations as of June 30, 2016 (Attachment E). She highlighted page 5 of the report, which lists the number of outstanding audit recommendations by department.



170106 AttachE.pdf



09:58 AM



Pooja Tulsian, Office of the State Auditor, reviewed the outstanding audit recommendations for the Department of Health Care Policy and Financing on Page V-2 of the report. Ms. Tulsian answered questions about the Department of Health Care Policy and Financing computer systems and the implementation of outstanding audit recommendations. Ms. Page answered questions about how areas of state government are selected for performance audits.



10:06 AM



Ms. Tulsian reviewed the outstanding audit recommendations for the Department of Human Services on Page VII-2 of the report. Ms. Tulsian answered questions about the transfer of the Division of Vocational Rehabilitation to the Department of Labor and Employment and the delay in implementing certain audit recommendations. Ms. Page and Ms. Bowers responded to questions about outstanding audit recommendations. Committee discussion with the audit staff ensued.



10:24 AM



Ms. Tulsian reviewed the outstanding audit recommendations for the Department of Public Health and Environment on Page XV-2 of the report.



10:28 AM



The committee took a brief recess.



10:58 AM -- Colorado Commission on Affordable Health Care



Representative McCann called the committee back to order.



Bill Lindsay and Cindy Sovine-Miller, Colorado Commission on Affordable Health Care, presented to the committee. They provided the committee with a handout (Attachment F). Ms. Sovine-Miller highlighted the areas of analysis listed on page 5 of the handout. Mr. Lindsay reviewed the commission's recommendations on issues related to transparency, pharmacy, payment reform, and social determinants of health. Ms. Sovine-Miller commented on issues related to social determinants of health. Mr. Lindsay discussed the commission's recommendations related to the healthcare workforce. He outlined the topic areas the commission will be reviewing before it terminates on June 30, 2017.



170106 AttachF.pdf









11:23 AM



Mr. Lindsay answered questions about reference pricing, specialty drugs, and the recommended pilot program for state employees related to transparency. The committee dialogued with Mr. Lindsay about the commission, the Patient Protection and Affordable Care Act, and administrative costs related to health care. He answered questions about implementing the commission's recommendations.



11:46 AM



Committee discussion with Mr. Lindsay ensued regarding defensive medicine and free standing emergency rooms. Ms. Sovine-Miller and Mr. Lindsay answered questions about issues related to social determinants of health. Mr. Lindsay answered questions about multi-state compacts for purchasing non-specialty drugs and hospital cost transparency. Ms. Sovine-Miller and Mr. Lindsay answered questions about the recommended pilot program for certain patients with asthma and the possible use of telehealth to reduce health care costs.



12:07 PM



Committee discussion with Mr. Lindsay and Ms. Sovine-Miller ensued about the commission, its recommendations, health care costs and quality, mental health, and Medicaid waivers. Committee members commented about the commission sharing information with Colorado's Congressional delegation.



12:26 PM



The committee recessed.



01:36 PM -- HCPF SMART Government Act Presentation



Representative McCann called the committee back to order.



Susan Birch, Executive Director, Department of Health Care Policy and Financing (HCPF) presented to the committee. The committee was provided an informational packet (Attachment G). She reviewed the programs HCPF administers, which are Health First Colorado, Child Health Plan Plus (CHP+), Colorado Indigent Care Program, and Old Age Pension and Medical Programs. She stated that Colorado's Medicaid Program is now called Health First Colorado. Director Birch discussed the populations served by CHP+ and Medicaid.



170106 AttachG.pdf



01:46 PM



Gretchen Hammer, HCPF, answered questions about Medicaid's asset limits and access to care for Medicaid clients.



01:50 PM



Director Birch discussed caseload and expenditure data. Director Birch and Ms. Hammer answered questions about caseload and expenditures and issues related to Medicaid expansion. Director Birch discussed the funding sources for HCPF and the different Medicaid populations. She reviewed information about payment for services and the services provided under Medicaid expansion.











02:04 PM



Ms. Hammer discussed HCPF's performance plan strategic policy initiatives. She reviewed information related to the Accountable Care Collaborative. She outlined the key concepts of Phase II of the Accountable Care Collaborative, which are:

• establishing a single regional administrative entity for physical health care and behavioral health services;
• strengthening coordination of services by advancing health neighborhoods;
• having a population health management approach;
• addressing payment for integrated care and value; and
• having greater accountability and transparency.

Ms. Hammer answered questions about behavioral health services and the Accountable Care Collaborative, the number of Medicaid providers, and network adequacy. Ms. Hammer answered questions about the Hospital Provider Fee.



02:25 PM



John Bartholomew, HCPF, answered questions about the Hospital Provider Fee and Medicaid expansion. Director Birch offered to set up a meeting for interested members to further discuss the Hospital Provider Fee. Ms. Hammer answered questions about the possible impacts in decreased federal funds.



02:41 PM



Tom Massey, HCPF, responded to questions about possible to changes to federal funding levels and the Hospital Provider Fee.



02:44 PM



Ms. Hammer continued reviewing the key concepts of Phase II of the Accountable Care Collaborative. She discussed Medicaid waivers for home- and community-based services. She stated that Colorado has 11 waivers. Ms. Hammer reviewed information about the Community Living Implementation Plan. Ms. Hammer answered questions about the children with autism waiver, conflict-free case management, waiver redesign, and waitlists for services.



03:01 PM



Mr. Bartholomew discussed matters related to cost control and value-based payment. He reviewed data related to Medicaid fraud and answered questions regarding the allocation of recovered funds.



03:07 PM



Mr. Massey reviewed HCPF's budget requests. Ms. Hammer answered questions about the budget request related to payment reform.





03:10 PM



Mr. Massey outlined HCPF's legislative agenda, which are:

• implementing conflict-free case management;
• improving program integrity efforts;
• reducing opioid overdoses by gaining access to the Prescription Drug Monitoring Program (PDMP);
• establishing a contingency plan for changes to the CHP+ funding; and
• aligning statute with federal home health rules.

Dr. Judy Zerzan, HCPF, answered questions about the legislative agenda item related to reducing opioid overdoses by gaining access to the PDMP. She referenced a similar program in Washington.



03:22 PM



Ms. Hammer answered questions about the legislative agenda item regarding aligning statute with federal home health rules. She answered questions about HCPF's efforts to address obesity and immunization rates for Medicaid clients. The committee continued to dialogue with the panelists about Medicaid fraud, opioid overdoses, and conflict-free case management.



03:34 PM



Director Birch answered questions about HCPF's outstanding audit recommendations.



03:35 PM



Mr. Massey reviewed information about HCPF's regulatory agenda and the update on reducing waste through the Accountable Care Collaborative, as required by House Bill 13-1196. Ms. Hammer answered questions about inpatient services for persons with severe mental illness. Ms. Hammer answered questions about possibly simplifying the process for providers who want to become Medicaid providers. Mr. Massey highlighted HCPF's legislator resource center.



03:49 PM



The committee adjourned.