H_PHC_2018A 12/11/2018 09:03:39 AM Committee Summary

Kim Bimestefer, Executive Director, HCPF, presented on HCPF's long term goals and distributed a packet of information to the committee (Attachment D).  Tom Massey, Deputy Executive Director, HCPF, provided data on enrollment and eligibility requirements for Medicaid and the Child Health Plan Plus to the committee.  

 

 

 

 

Bonnie Silva, Office of Community Living Interim Director, HCPF, described HCPF's long term services and supports programs and the recipients of these programs.  She explained that these supports can be provided at home, in the community, or in facilities, and described the different payers for the services.  Ms. Bimestefer responded to questions regarding the Program for All-inclusive Care for the Elderly, service provider rates, and eligibility requirements for child heath programs.

Director Bimestefer discussed HCPF's goals, including rural hospital sustainability, reducing the uninsured rate, and providing substance use disorder treatment.  She also discussed challenges, including the rising federal deficit and the rising cost of care.  Ms. Bimestefer provided demographic and enrollment data for Health First Colorado, and discussed major program expenditures.

Dr. Tamaan Osbourne-Roberts, Chief Medical Officer, HCPF, described the top categories of care for Health First Colorado clients to the committee and noted that many clients have more than one medical condition.  Ms. Bimestefer described HCPF's performance plan strategic policy initiatives.  She discussed progress with Senate Bill 18-266, which authorized technological innovations that will help HCPF to compete with private insurers.  The bill also created a cost control and quality improvement office in HCPF.

Stephanie Ziegler, Cost Control and Quality Improvement Office Director, HCPF, described the provisions of Senate Bill 18-266 that will allow HCPF to implement programs to improve quality and control costs.  Laurel Karabatsos, Interim Medicaid Director, HCPF, updated the committee on progress with the Accountable Care Collaborative (ACC), which coordinates care regionally and utilizes data to make certain medical decisions.  She described Phase II ACC objectives, including integrating physical and behavioral health care under Regional Accountable Entities and strengthening the coordination of care.

Cathy Traugott, Pharmacy Manager, HCPF, gave an overview of the pharmacy benefit for the Colorado Medicaid program, including spending on specialty drugs.  She described HCPF initiatives to control drug costs including implementation of a new claims system and utilizing a preferred drug list and supplemental rebates.  Ms. Traugott explained HCPF's policy to reduce opioid prescriptions and the number of pills distributed to Medicaid clients. She responded to questions about medically necessary prescribed drugs and chronic pain patients.

Director Bimestefer described efforts to drive down health care costs for employers, consumers, and the Medicaid program.  Efforts include controlling hospital and prescription costs, implementing alternative and innovative payment methods, and focusing on population behavioral health.

Chris Underwood, Health Information Office Director, HCPF, described customer service improvements to the PEAK eligibility and application system.  He described HCPF's regional field representatives that assist Medicaid providers.  Mr. Massey explained HCPF's legislative agenda, including extending the breast and cervical cancer prevention and treatment program, increasing access to the low income senior dental program, and increasing oversight of host homes.

Mr. Massey summarized HCPF's budget requests and the regulatory agenda for 2019.  He provided an update on House Bill 18-1321 regarding urgent non-emergent medical transportation, and Senate Bill 17-121 regarding improving Medicaid client correspondence.  Mr. Massey highlighted HCPF's legislator resource center.  

Mr. Massey, Mr. Underwood, and Ms. Silva responded to committee questions.

Ki'i Powell, Department of Human Services, and Jean Robinson, Department of Revenue, presented the Report on Electronic Benefits Transfers Cards.

Ms. Powell and Ms. Robinson responded to questions.

Bree Wilson, representing herself, testified regarding access to opioid medication for patients with chronic pain.  Ms. Wilson responded to committee questions.

Maureen Welch, representing herself, testified regarding the performance audit of the CCBs.

Rob Hernandez, representing himself, testified regarding recent health studies from the University of Denver.  Mr. Hernandez responded to committee questions.

Joshua Ewing, Colorado Hospital Association (CHA), testified regarding CHA support for Senate Bill 18-266 and current hospital initiatives affecting Medicaid clients.

Edie Busam, Colorado Association of Medical Equipment, testified regarding Medicaid provider reimbursement rates.

Ruth Aponte, representing herself, testified regarding Medicaid provider reimbursement rates.  Ms. Aponte and Ms. Busam responded to committee questions.

Senator Smallwood recessed the meeting.

Senator Smallwood reconvened the meeting

Senator Smallwood called the meeting to order.

Monica Bowers, Deputy State Auditor, Office of the State Auditor (OSA), described audits that the office completes annually and distributed three handouts to the committee (Attachments A, B, and C).  

Attachment A:

http://leg.colorado.gov/sites/default/files/documents/audits/1751p_management_of_substance_abuse_treatment_data.pdf

Attachment B:

http://leg.colorado.gov/sites/default/files/documents/audits/1745p_community-centered_boards_0.pdf

Attachment C:

http://leg.colorado.gov/sites/default/files/documents/audits/1811s_status_of_outstanding_recommendations_report__0.pdf

Jenny Page, OSA, described the results of an audit regarding data collection by the Office of Behavioral Health (OBH) in the Department of Human Services (DHS). The audit focussed on OBH's handling of personal data of individuals receiving substance use disorder treatment.  Ms. Page described the OSA's recommendations for OBH.

Vickie Heller, OSA, described a performance audit on community centered boards (CCBs).  She explained that the audit found that the Department of Health Care Policy and Financing (HCPF) has not managed funds for the Supported Living Services program appropriately, and that CCBs did not always provide case management or monitoring visits for clients.  Ms. Heller descried OSA's recommendations for HCPF.

Ms. Heller responded to questions regarding HCPF funding, inaccurate submitted claims from CCBs, and HCPF's response to the audit findings.

Brad Walcher, OSA, presented on outstanding audit recommendations for the three health departments.  He explained that HCPF and DHS have outstanding recommendations but the Department of Public Health and Environment (CDPHE) and Connect for Health Colorado do not have any outstanding recommendations.  Mr. Walcher briefly summarized the outstanding recommendations for HCPF and DHS.  He responded to committee questions regarding the outstanding audit recommendations.

Reggie Bicha, Executive Director, DHS, presented the department's SMART Act presentation and distributed a handout to the committee [Attachment E].  He provided an overview of the functions of DHS. He told the committee that DHS owns 343 properties and leases 11.  He discussed the community partners DHS collaborates with and the administrative structure of the department.

Director Bicha provided an overview of the department's budget requests.

Phil Robinson, DHS, discussed the department's legislative priorities, which include increasing capacity for competency restoration, child welfare statutory revisions, implementing the children's code task force recommendations, child care assistance programs and the Supplemental Nutrition Assistance Program statutory alignments, and the Division of Youth Services' realignment.

Director Bicha discussed the department's regulatory report and agenda. He spoke about the department's performance measures and discussed the department's Wildly Important Goals.

Robert Werthwein, OBH Director, provided an overview of OBH and the settlement agreement regarding competency evaluations and restoration services. He reviewed issues related to competency restorations.

Mr. Werthwein discussed legislative strategies to reduce the backlog of individuals waiting for competency restorations. He discussed the efforts to increase beds through the Restoring Individuals Safely and Effectively (RISE) program, adding beds at the Colorado Mental Health Institute at Pueblo (CMHIP), and contracting with private hospitals.  He discussed legislative options under consideration to further address the backlog, such as, dismissing non-violent low level charges, providing inpatient restoration only for those that meet inpatient clinical need, and pursuing jail-base restoration. He responded to questions about the length of time from a finding of incompetency to restoration.

Director Bicha discussed issues related to extending time periods allowed for restoring to competency.  He discussed Senate Bill 18-252, which would have allowed jail-based restoration.  Committee discussion followed about allocation of beds at the Colorado Mental Health Institute at Fort Logan  and CMHIP.

Mr. Werthwein dialogued with the committee about mental health services and strategies to help individuals with mental health issues receive care.

Director Bicha spoke about the barriers facing individuals receiving care in CHMIP, guardianship issues, and mental health services and supports available to individuals in the community.

Mr. Werthwein discussed Senate Bill 17-019, concerning medication formularies used in jails, and Senate Bill 17-270, concerning the behavioral health crisis transition referral program.  He presented information about the utilization of Colorado Crisis Services, and the administration of the state opioid grants. He focused on the success of the distribution of Naloxone kits into the community, peer recovery services, and anti-stigma campaigns.

Minna Castillo Cohen, Office of Children Youth and Families Director, presented on the activities of the office.  She spoke about the Division of Child Welfare, including the child abuse reporting hotline, child welfare workload trends, out-of-home placement, and the federal Family First Prevention Services Act.

Ms. Castillo Cohen spoke about the Statewide Youth Development Plan.  She discussed the activities of the Division of Youth Services, including enhancing healthcare delivery, improving safety, building trauma responsive environments, and focusing on family and community connections.  She spoke about realigning Division of Youth Services' facilities and reducing the detention bed cap.  Ms. Castillo Cohen responded to questions about funding for domestic violence programs and human trafficking.  Committee members dialogued with Ms. Castillo Cohen and Director Bicha about the funding to increase the number of child welfare caseworkers.

Ki'i Powell, Office of Economic Security Director, provided an overview of the Division of Food and Energy Assistance, the Division of Child Support Services, and the Division of Employment and Benefits.  She spoke about the department's progress in meeting the federal deadlines associated with processing applications for Colorado Works and food assistance programs.

Director Bicha discussed the Colorado Works' work participation rates and the success of the program.

Ms. Powell discussed the Colorado Parent Employment Program and the basic cash assistance cost of living adjustment.  Ms. Powell responded to questions.

Mary Anne Snyder, Office of Early Childhood Director, presented on the Division of Early Care and Learning and the Division of Community and Family Support.  She told the committee that 28,662 families received assistance from the Colorado Child Care Assistance Program in FY 2017-18.  She discussed the Colorado Shines quality rating and improvement system for all of Colorado's licensed early care and learning programs serving children ages 0-5 years.  She discussed early intervention supports and services provided to families with children birth through age two who have developmental needs.

Director Bicha responded to questions. Ms. Snyder responded to questions about early intervention supports and services.

Mark Wester, Office of Community Access and Independence Director, presented on the Division of Disability Determination Services, Regional Center Operations, Veterans Community Living Centers, and Aging and Adult Services.

He discussed the implementation of Senate Bill 16-178, which requires DHS to vacate the Grand Junction Regional Center Campus by July 1, 2018, or as soon as all current resident are transitioned to settings that support their well-being and respect their individual choice.

Mr. Wester discussed Adult Protective Services. Director Bicha spoke about the Judicial Branch's efforts focused on creating a guardianship program outside of DHS for at-risk adults.

Mr. Wester discussed the Long-term Care Ombudsman, the PACE Ombudsman, and provided an update on the respite care task force. He discussed the the department's budget request for updated compensation for direct care employees, which would move the salary for these positions from the bottom of the salary range to the middle of the salary range. Committee discussion followed.

Direct Bicha made closing comments.

Kristina Mueller, Early Childhood Leadership Commission, provided a handout to the committee and presented on the Early Childhood Leadership Commission (Attachment F).  She explained the role of the commission, the membership of the commission, and the statutory duties of the commission.

Ms. Mueller reviewed the organizational structure of the commission and reviewed the accomplishments of the commission, including the Early Childhood Framework - Phase II. She discussed areas of opportunity including improving access to high quality early care and education for all families, elevating the early childhood workforce, and supporting improved family health and economic security.

There was no public testimony.

Eliza Schultz, Health Care Association of Colorado, discussed long-term home health care reimbursement rates and the financial burden home health care agencies have experienced due to delayed reimbursements from Medicaid.  Ms. Schultz responded to questions from the committee.

Carrie Barnhart-Lynch, representing herself, testified about the difficulty she experiences due to her disease and the level of pain she experiences. She spoke about the difficulty she has getting the proper medication to control her pain because of the limits placed on dispensing opioids by Medicaid. Ms. Barnhart-Lynch responded to questions.