H_PHC_2017A 01/09/2017 Committee Summary

09:09 AM -- Presentation on Electronic Benefit Card Transfer



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



170109 AttachA.pdf



Phyllis Albritton, Department of Human Services (CDHS), and Ron Kammerzell, Department of Revenue, provided an update on the electronic benefit card transfer (EBT) program, pursuant to House Bill 15-1255. An informational packet was distributed to the committee (Attachment B). Mr. Kammerzell described efforts to reduce client EBT transactions at prohibited locations, including liquor and marijuana stores, casinos, and race tracks.



170109 AttachB.pdf



09:12 AM



Ms. Albritton responded to questions from the committee regarding federal oversight of the program and moneys that have been recovered through the program. Mr. Kammerzell discussed educating clients and establishment owners about prohibited transactions. Ms. Albritton added that the county workers are informing clients about use of EBT cards, and clients receive notice if they use the card in a prohibited establishment. Mr. Kammerzell responded to committee questions regarding the ATM technology, signage requirements, and the use of EBT cards at adult entertainment venues.



09:31 AM -- CDHS SMART Act Presentation



Reggie Bicha, Director, CDHS, presented to the committee. Handouts were distributed to the committee (Attachments C and D). Mr. Bicha explained CDHS's three strategic priorities. He described the properties and buildings that the DHS owns or operates and the community programs that CDHS operates. Mr. Bicha summarized the CDHS annual budget and gave a breakdown of the FY 2016-17 state and federal appropriations. He explained CDHS' budget requests for FY 2017-18.



170109 AttachC.pdf https://drive.google.com/file/d/0B69gxe7dbcwHMTk4eWlrWWh5Q2M/view (Attachment D)



09:40 AM



Mr. Bicha detailed the six legislative priorities for CDHS, which include:

• instituting background checks for those working with at-risk adults;
• expanding the Colorado Works program;
• excluding certain non-violent youths from detention;
• cleaning up mandatory reporter statutes;
• easing regulatory burdens on home-based child care; and
• streamlining background checks for child care workers.

09:48 AM



Mr. Bicha responded to questions regarding properties that are owned but not utilized by the CDHS and the status of the Grand Junction regional center, and noted that he is planning to meet with the state architect regarding these properties. In response to a question, Mr. Bicha explained the process for creating licensing requirements for child care facilities.



10:02 AM



Mr. Bicha responded to questions from the committee regarding the at-risk adult population, home-base child care, state funding for child welfare, and statistics on nonviolent youth in detention. He discussed possible repurposing of CDHS properties to expand capacity for mental health services. The committee continued to discuss vacant properties and the future of the Grand Junction regional center.



10:25 AM



Mr. Bicha discussed the regulatory agenda for the past year and outstanding audit recommendations. He described the CDHS performance measurement system to the committee and training initiatives at CDHS, including online training, a new leadership development program, and ongoing division specific training.



10:34 AM



Mr. Bicha gave an overview of the Office of Early Childhood in the CDHS. Mr. Bicha responded to questions regarding Colorado Child Care Assistance Program allocations and how they vary by county. Mary Anne Snyder, CDHS, explained the two generation (2GRO) program in the Office. Mr. Bicha named the state departments that are participating in 2GRO.



10:49 AM



Mr. Bicha gave an overview of the Office of Economic Security in the CDHS. He described the settlement agreement that requires the CDHS to meet strict timeliness parameters for benefit enrollments, and explained that the CDHS has met those requirements as of December 2016. The committee discussed audit recommendations regarding CDHS employee training. Mr. Bicha explained the error and participation rates for the Supplemental Nutrition Assistance Program (SNAP). Ms. Albritton returned to the table to discuss SNAP enrollment in recent years. Mr. Bicha gave an update on Senate Bill 16-190, and discussed a CDHS budget request for county funding for administration of services. Mr. Bicha summarized a new initiative, the Child Support Pass Through, to the committee. He discussed the work participation rate, a federal performance measure requirement, and explained that the CDHS has not met this rate.



11:06 AM



Mr. Bicha gave an overview of the Office of Behavioral Health in the CDHS. He updated the committee on the statewide crisis response system and the Mental Health Hold Task Force. Mr. Bicha described the state inpatient psychiatric treatment facilities, and noted that forensic patients are court ordered to be treated in these facilities. Dr. Nancy VanDeMark, CDHS, responded to questions regarding state mental health facilities capacity.







11:20 AM



Mr. Bicha gave an overview of the Office of Community Access and Independence in the CDHS. He explained the adult protection services system and updated the committee on recent laws regarding the adult at-risk population. Mr. Bicha discussed the CDHS' responsibility in regard to the regional centers. He summarized the recommendations of the Regional Center Task Force and the Background Check Task Force to the committee. He gave an update on changes to mandatory reporting for at-risk adults, the work of the Program of All-Inclusive Care for the Elderly Ombudsman stakeholder group, and implementation of the respite care task force recommendations. Mr. Bicha gave an overview of progress with the Fitzsimons development site. Mr. Bicha responded to questions regarding veterans services.



11:34 AM



Mr. Bicha gave an overview of the Office of Children, Youth, and Families in the CDHS. Mr. Bicha updated the committee on the child abuse reporting hotline and child welfare workload trends. He explained that CDHS is requesting funding for additional county child welfare caseworkers. Dr. Robert Werthwien, CDHS, gave an update on the statewide youth development plan. Mr. Bicha gave an overview of the Division of Youth Corrections (DYC) and the legislative priorities and budget request for the DYC. He discussed the results of the DYC audit. Mr. Bicha responded to a question regarding seclusion and relaxation rooms. Mr. Bicha discussed CDHS's domestic violence program with the committee.



11:50 AM



Mr. Bicha responded to questions from the committee regarding adult substance use and co-occuring mental health disorder.



11:58 AM -- Behavioral Health Transformation Council Presentation



Camille Harding, CDHS, presented to the committee on the work of the Behavioral Health Transformation Council (BHTC). She described the accomplishments of the BHTC in the past year which included overseeing a medication consistency work group and working to streamline the licensing requirements for crisis stabilization units. Ms. Harding explained that the work of the BHTC duplicates existing groups' efforts. She outlined possible solutions to solve the duplication problem.



12:03 PM



Frank Cornelia, BHTC, described three recommendations made by the Mental Health Hold Task Force to BHTC, which include:

• ensure network adequacy for the Crisis Response System by conducting a need and capacity assessment;
• develop a workforce plan to expand and extend the behavioral health workforce; and
• identify and pilot transportation solutions that reduce cost, stigma, and trauma.

Ms. Harding responded to a question regarding medication consistency in the correctional system.







12:09 PM -- Early Childhood Leadership Commission Presentation



Kristina Muller, CDHS, described the work of the Early Childhood Leadership Commission (ECLC) and distributed handouts to the committee (Attachments E and F). She summarized the duties and membership of the ECLC.



170109 AttachE.pdf170109 AttachF.pdf



She described future projects for the ECLC, which include completing Phase II of the Early Childhood Colorado Framework and developing strategies for effective communication with parents and caregivers. Ms. Muller noted that the ECLC's annual final report will be released on January 20, 2017.



The committee recessed.



01:36 PM -- Presentation on the Health Cost and Geographic Areas Study



The committee came back to order.



Marguerite Salazar, Commissioner of Insurance, presented on the Colorado Total Health Cost and Geographic Areas 2016 Study. Handouts related to her presentation were delivered to the committee (Attachments G, H, and I). She explained that the Division of Insurance (DOI) in the Department of Regulatory Agencies (DORA) contracted with Lewis & Ellis, Inc. to evaluate the nine geographic areas in Colorado created by the Federal Patient Protection and Affordable Care Act. She introduced the health cost study, and summarized the findings for the committee.



170109 AttachG.pdf170109 AttachH.pdf170109 AttachI.pdf



01:44 PM



Ms. Salazar described the health insurance cost differences between the geographical regions. She went over statistics on cost of care and utilization of care in different regions, noting that region 9, the western part of the state, typically has the highest cost for care in the state. Michael Muldoon, DOI, described the data used for the study. He detailed the types of care that are more expensive in region 9.



01:53 PM



Ms. Salazer and Mr. Muldoon responded to questions from the committee regarding the contributing factors to high cost of care in region 9. In response to a question, Ms. Salazar discussed cost of care rates in Pueblo over time.





02:06 PM



Ms. Salazar described new insurance models that encourage partnership between carriers and providers. Mr. Muldoon explained that DOI plans to gather more data and perform detailed evaluations on cost in different areas of the state. In response to questions, Mr. Muldoon explained how insurance rates are set and told the committee of changes in the individual marketplace in 2017. The committee continued to discuss negotiation of rates for health care services in different geographical areas.



02:19 PM



Mr. Muldoon responded to questions regarding Medicaid rates, and explained the DOI's role in the insurance market. Matthew Mortier, DOI, responded to questions from the committee regarding network adequacy requirements.



02:31 PM -- CDPHE SMART Act Presentation



Dr. Larry Wolk, Executive Director, Colorado Department of Public Health and Environment (CDPHE), presented to the committee. Handouts related to the presentation were distributed to the committee (Attachments J, K, L, and M). Dr. Wolk reviewed the structure of CDPHE and summarized the budget, noting that the majority of funding goes toward prevention services. Dr. Wolk explained CDPHE's five goals, which include:

• implementing plans supporting health and environmental priorities;
• increasing CDPHE's efficiency, effectiveness, and elegance;
• improving employee engagement;
• promoting health equity and environmental justice; and
• preparing to respond to all emerging issues.

170109 AttachJ.pdf https://www.colorado.gov/pacific/sites/default/files/CDPHE_2017_Regulatory_Combined_Report.pdf (Attachment K) https://www.colorado.gov/pacific/sites/default/files/OPP_CDPHE-2016-2019-Strategic-Plan-FY2016-17.pdf (Attachment L)



170109 AttachM.pdf



02:45 PM



Dr. Wolk responded to a question from the committee regarding complaints in air quality. Dr. Wolk noted that a majority of the complaints tracked from October 2015 to October 2016 were related to eye, ear, nose and throat irritation. The committee continued to discuss CDPHE's response to complaints about air quality and regulations regarding oil and gas development. Dr. Wolk described how CDPHE partners with other state departments to address social determinants, in response to a question.





02:59 PM



Dr. Wolk gave an overview of CDPHE's performance management system, including the online dashboard, to the committee. He explained that the dashboard keeps track of performance goals in all division of CDPHE over time. Dr. Wolk responded to a question regarding establishment of metrics and targets.



03:13 PM



Martha Rudolph, CDPHE, responded to questions regarding permitting standards for Colorado bodies of water. Dr. Wolk answered questions about CDPHE's accreditation and updated goals for the immunization strategy.



03:24 PM



Dr. Wolk described CDPHE's customer service policy. He explained how CDPHE measures customer service, and the improvement initiatives that CPDHE has undertaken as a result of the customer feedback. Dr. Wolk detailed some of the initiatives, including use of a new debit card and moving environmental transactions to the internet.



03:28 PM



Dr. Wolk reviewed the CDPHE's decision items and funding requests for FY 2017-18. He detailed the funding requests for environmental programs, health programs, and technical adjustments. He explained the CDPHE's two legislative priorities and provided an update on the progress of the Suicide Prevention Commission.



03:32 PM



Dr. Wolk responded to questions from the committee regarding dialysis training and CDPHE audit requests. Chris Colclasure, CPDHE, responded to a question regarding an audit on automobile emissions testing. He noted that Colorado's emissions testing program is federally required, and he discussed results from previous audits. The committee continued to discuss emissions testing for vehicles in Colorado. Mr. Wolk responded to a question regarding a settlement from Volkswagen.



03:49 PM



Representative Primavera opened the floor for public testimony regarding CDPHE.



03:51 PM -- Phil Silberman, himself, testified regarding CDPHE.



03:58 PM -- Pam Long, herself, testified regarding CDPHE and distributed a handout to the committee (Attachment N). Ms. Long responded to questions from the committee.



170109 AttachN.pdf



04:08 PM -- Francis Sincere, himself, testified regarding CDPHE and distributed a handout to the committee (Attachment O).



170109 AttachO.pdf







04:13 PM -- Heather Lahdenpera, herself, testified regarding CDPHE. Ms. Lahdenpera responded to questions from the committee.



04:26 PM -- Kimberly LeBlanc, herself, testified regarding CDPHE.



04:32 PM -- Melissa Winefeldt, herself, testified regarding CDPHE.



04:41 PM -- Jonathan Singer, himself, commented on the committee.



04:43 PM



Representative Primavera gave concluding remarks and adjourned the meeting.