H_PHC_2017A 02/02/2017 01:30 PM Committee Summary

01:40 PM -- Presentation by the Joint Budget Committee pursuant to Joint Rule 25



Senator Smallwood called the meeting to order and reviewed the agenda (Attachment A).



170202 AttachA.pdf



Senator Lambert introduce the members of the Joint Budget Committee (JBC) and the JBC staff.



01:42 PM



Representative Young discussed the JBC's responsibility in preparing the budget, including meeting with state departments, the supplemental process, and figure setting.



01:46 PM



Representative Young discussed the budget request for the Department of Health Care Policy and Financing (HCPF) as presented on page 25 of the JBC Staff Budget Briefing Summary (Attachment B). He explained that the briefing document summarizes the budget requests of the Executive and Judicial branches of state government, not the final budget. He responded to questions from the committee regarding the requests for medical services premiums, behavioral health, the children's basic health plan, and the regional center task force.



02:06 PM



Committee discussion followed about the various budget requests for HCPF. Discussion about annualized prior year budget actions followed.



02:14 PM



Representative Young presented the budget items for the Department of Human Services (DHS) as outlined on page 39 of the briefing document (Attachment B). Representative Young responded to questions about the Hospital Provider Fee narrative on page 31 of the briefing document. Committee questions and discussion followed.



https://leg.colorado.gov/sites/default/files/fy17-18-brfsum-12-21-16.pdf (Attach B)



02:22 PM



Representative Young discussed the Governor's budget amendments (Attachment C) and responded to questions about the budget requests related to the Colorado Commission on Criminal and Juvenile Justice and the Mental Health Hold Task Force. Committee discussion and questions followed about childhood expulsions from schools.



170202 AttachC.pdf





02:30 PM



Representative Young presented the budget request for the Colorado Department of Public Health and Environment (CDPHE) as outlined on page 75 of the briefing document (Attachment B). Committee questions followed about the waste tire program in CDPHE . Committee discussion and questions continued. Referencing page 82 in the briefing document, Senator Lambert responded to questions about Centrally Appropriated Line Items in the state budget.



02:41 PM



JBC members made closing comments and discussed the JBC staff documents that are available on the JBC website at https://leg.colorado.gov/agencies/joint-budget-committee.



02:48 PM -- Presentation by the Department of Health Care Policy & Financing about the DD Waiver



Jed Ziegenhagen, Director of the Office of Community Living, HCPF, and Jennifer Martinez, Director of the Division of Intellectual and Developmental Disabilities, HCPF, came to the table and provided a handout to the committee (Attachment D). Dr. Ziegenhagen explained that the role of the Office of Community Living includes aligning services and supports for individuals and families, administering 11 Medicaid Home and Community-Based Services waivers, and administering state funded programs for Supported Living Services and the Family Supports Services Program. He explained that the biggest barrier to eliminating the waiting list of the Adult Comprehensive waiver (DD waiver) is the cost.



170202 AttachD.pdf



02:52 PM



Jennifer Martinez discussed the three HCBS waivers for individuals with Intellectual and Developmental Disabilities (IDD): the Children's Extensive Supports waiver; the Supported Living Services (SLS) waiver; and the DD waiver. She indicated that the DD waiver is the only waiver with a waiting list. She clarified that about 88 percent of the individuals on the DD waiver waiting list are receiving some state services through other programs, such as regular Medicaid or the Aid to the Needy Disabled. Ms. Martinez discussed the Comprehensive Strategic Plan as established by House Bill 14-1051 and the progress made on the DD waiting list.



Referring to the slides in the handout (Attachment D), Ms. Martinez discussed the department's efforts to increase access to providers for individuals receiving services through the DD waiver and the pilot program designed to deliver and coordinate services including crisis intervention, stabilization, and follow-up services not covered in either the behavioral health system or one of the Medicaid waivers.





03:04 PM



Mr. Ziegenhagen responded to questions from the committee about the administrative costs of Community Centered Boards (CCBs) and stated that funding was the most important component of eliminating the waitlist.



03:07 PM -- Update from Community Centered Boards and Providers



Randy Brodersen, North Metro Community Services, discussed the process for individuals moving off the DD waitlist and into the DD system. He distributed a handout to the committee (Attachment E). He discussed the challenges facing the network of service providers, including provider capacity, reimbursement rates, and the labor pool. He discussed the funding challenges that service providers face when offering SLS services. He explained that the current reimbursement rates do not cover the cost of delivering SLS services. He spoke about clients who have been moved off the waitlist but are not receiving services due to the lack of providers.



170202 AttachE.pdf



03:17 PM



Doug McNeil, Laradon, discussed the cost of doing business including provider rates. He discussed the role of direct service providers, the impact on services due to the growing gap between the cost of doing business and reimbursement rates, and the high turn over rates of direct service providers compared to other industries. Mr. McNeil discussed the obstacles faced by the different populations his agency serves and the type of services these populations need to be independent. Mr. McNeil responded to questions regarding the affects of the minimum wage increase on the service provider labor pool and questions about the future for these service if funding is reduced.



03:21 PM



Committee discussion and comment followed regarding the difficult task of finding an adequate number of providers and the affects of the minimum wage increase on the labor pool, reduction in services due to possible changes in Medicaid funding, and the overall administrative cost for CCBs and provider agencies.



03:28 PM -- Update from Community Centered Boards Public Testimony



03:28 PM -- Maureen Welch, representing herself, told the committee about her experience as a parent of a child with intellectual and developmental disabilities (IDD). She discussed her concerns about the administration of CCBs and the concerns of members of the IDD community about the provision of services and access to policy makers. She discussed consumer direction in the DD waiver system. Ms. Welch responded to questions about service agencies and conflict free case management for CCBs. She discussed her experience with a CCB which provided both case management and direct services. She stated that the current system is a complicated and fragmented system, and suggested the focus of the system be more person centered.



03:43 PM -- Marijo Rymer, The Arc of Colorado, discussed her experience being involved with advocacy for individuals in the IDD community. Ms. Rymer responded to questions from committee members about the daily struggles that individuals with IDD face.



03:57 PM



Committee discussion and comments followed.











03:59 PM -- Presentation by Connect for Health Colorado Board of Directors



Kevin Patterson, Chief Executive Officer, Connect for Health Colorado, came to the table and made opening comments. A packet containing five documents was distributed to the committee (Attachments F, G, H, I, and J).



170202 AttachF.pdf170202 AttachG.pdf



http://connectforhealthco.wpengine.netdna-cdn.com/wp-content/uploads/2016/09/Connect-for-Health-Colorado-2016-Annual-Report_FINAL.pdf Attach H 170202 AttachI.pdf 170202 AttachJ.pdf



04:02 PM



Adela Flores-Brennan, Board Chair, referred to Attachment F during her presentations, and discussed the history and development of Connect for Health Colorado, the insurance carriers involvement in the marketplace, and the Advance Premium Tax Credit.



04:06 PM



Mr. Patterson discussed the consumer shopping tool that is available to customers on the exchange website. He stated that this tool was ranked at number two among the similar tools used by the 12 state-based exchanges and the federal exchange. Mr. Patterson responded to committee questions about the 2017 Insurance Exchange Websites Scorecard (Attachment G). In response to a question from the committee, Mr. Patterson stated that most of the insurance plans offered on the exchange are health maintenance organization plans and preferred provider organization plans. He responded to questions about the number of insurance companies that offer plans on the exchange, and the concern that, in some areas of the state, only one insurer offers individual insurance plans.



04:15 PM



Marc Reece, Connect for Health Colorado Board Member, responded to questions about the number of carriers offering plans on the exchange.



04:16 PM



Mr. Patterson discussed the financial details of Connect to Health Colorado referring to page 11 of Attachment F and responded to questions about other states' exchanges that have failed. He discussed the recent federal audit of the exchange which cited the exchange administration for not accurately accounting for the disbursement of federal grants during the startup period.



04:29 PM



Mr. Patterson responded to questions about the following: the demographic of exchange clients; the cost to eliminate the state-based exchange and utilizing the federal exchange; the carrier fee assessed by the exchange; the operating costs and sustainability of the exchange; and the cost to close the exchange and utilize the federal exchange. Committee discussion followed.











04:41 PM



Mr. Patterson referenced the 2016 Annual Report (Attachment H). He pointed to the number of both individual and small business enrollees in 2016, the reduction in the state's uninsured rate, the average insurance premium and the average tax credit received by enrollees. Mr. Patterson responded to questions about the 2017 budget projections. He discussed the actions taken by the exchange to reduce expenses and told the committee that he can provide updated financial information to the committee. Committee discussion followed about the impact to Colorado if the exchange closed.



04:41 PM



Mr. Reece responded to questions about whether insurers would offer more plans in certain areas of the state if Colorado utilized the federal exchange. Committee discussion and questions followed about Form 1095-A distributed to customers by the exchange, and large deductible plans.



04:52 PM -- Ian McMahon, Connect for Health Colorado, responded to questions about the cost sharing provision of the Affordable Care Act.



04:54 PM



Mr. Patterson responded to questions about whether the exchange will be required to repay federal funds if the exchange closes and Colorado utilizes the federal exchange.



04:56 PM



Senator Smallwood adjourned the meeting.