I_COMedicaidCL_2016A 09/29/2016 09:06:44 AM Committee Summary

09:07 AM -- Call to Order and Opening Remarks



Representative Primavera, Chair, called the meeting to order and reviewed the meeting agenda (Attachment A).



160929 AttachA.pdf



09:09 AM -- Bill 1 - Correct Technical Issues with Medicaid Appeals



Brita Darling, Office of Legislative Legal Services (OLLS), presented Bill 1 (Attachment B). She discussed the provisions of the bill and amendment 1 (Attachment C). The bill clarifies that Medicaid benefits must automatically continue without requiring an affirmative request by a client who is appealing a termination or reduction in benefits. The Department of Health Care Policy and Financing (HCPF) must send the recipient written confirmation of the continuing benefits. The electronic filing form for appeals must include a check box or other method to opt out of continuing benefits, to request an accommodation for submitting an appeal or participating in a hearing, and to request dispute resolution. The electronic appeals website must additionally allow for the attachment of as many documents as necessary to support the appeal.



160929 AttachB.pdf160929 AttachC.pdf











09:12 AM



Bill Zepernick, Legislative Council Staff (LCS), discussed the fiscal note that was prepared for Bill 1 (Attachment D). Committee discussion followed.



160929 AttachD.pdf



09:15 AM -- Julie Reiskin, Colorado Cross-Disability Coalition (CCDC), discussed the process CCDC follows when assisting clients with filing appeals. She discussed the challenges Medicaid clients face when filing appeals. She expressed her support for the bill.



09:18 AM -- Matthew Azer, Chief Judge, Office of Administrative Courts (OAC), Department of Personnel and Administration, discussed the role of OAC in Medicaid appeals. He explained that the OAC is an independent reviewer of actions taken by state agencies. He told the committee that individuals may file an appeal either electronically, on paper, or by fax. He stated that once the OAC receives a request for an appeal, staff files a notice of appeal and sends a notice of appeal to the involved parties. OAC staff then sends a notice of hearing to the parties involved. Judge Azer explained additional details about the appeals process. He told the committee that the appeal form used by his office is an internal form and is not distributed to other state or county agencies. He explained that the state department involved in the appeal is responsible for providing accommodations for an appellant, not the OAC. Judge Azer indicated that OAC would need to install a new computer system to allow for more than two documents to be filed with the case Initiation Form. He explained that once an appeal is filed, an appellant may file as many documents as needed by using the OAC website. He also addressed concerns about allowing appellants to send hearing documents and information via e-mail.



09:28 AM



Judge Azer responded to questions from the committee about the cost to OAC to update the computer system to include functionality that would allow for more that two documents to be attached to the initial filing. He continued to discuss the OAC hearing process and the process appellants may use to submit information regarding their appeal to OAC.



09:38 AM



Committee discussion continued about filing documents with OAC and the efforts employed by OAC to notify applicant when crucial documents are missing from their case file.





09:44 AM -- Elizabeth Arenales, Colorado Center on Law and Policy, discussed the need to work through the issues addressed in the bill.

09:48 AM



Representative Danielson and Senator Crowder will be the prime sponsors for Bill 1.







09:49 AM -- Bill 2 - Review of Legal Sufficiency Of Medicaid Appeals



Brita Darling, OLLS, presented Bill 2 and responded to questions (Attachment E). Bill 2 requires administrative law judges to review the legal sufficiency of Medicaid notices of action when a client appeals a termination or reduction in benefits (adverse action). The legal review of notices will take place at the start of an appeal. If the administrative law judge determines that the notice is not legally sufficient, he or she shall inform the client that the adverse action may be set aside. The client may then ask the administrative law judge to decide the case in his or her favor on the basis of the insufficient notice. Alternately, the client may waive his or her defense on the basis of insufficient notice and request that the appeal proceed to a hearing on the merits of the case. Administrative law judges must inform clients that HCPF may issue a legally sufficient notice in the future and that the client may be required to repay any benefits received, as provided under current law, if the adverse action is upheld after the new notice is issued.



160929 AttachE.pdf



09:52 AM



Bill Zepernick, LCS, presented the fiscal note prepared on Bill 2 and responded to questions (Attachment F).



160929 AttachF.pdf



09:53 AM -- Judge Azer, OAC, discussed the provisions of the bill. He explained that, currently, Medicaid clients need to raise the issue about insufficient notice, but under the bill, the judge is required to review all notices and determine if the notice is valid. Judge Azer responded to questions about the definition of legal sufficiency. He explained that a notice is considered legally sufficiency if it contains seven specific pieces of information, for example, the date of the action, a statement about the reason for the action, and statutory citations. Committee discussion followed about the criteria used to determine sufficient notice and the judicial process involved in an appeal.





10:06 AM -- Jack Regenbogen, Colorado Center on Law and Policy, spoke in favor of Bill 2. He stated that an affirmative defense for an insufficient notice is useless to an appellant that does not know that the option to claim it exists. He stated that, in his opinion, the definition of legally sufficient does include the readability of the document. Mr. Regenbogen responded to questions from the committee.

10:16 AM



Representative Danielson and Senator Crowder will be the prime sponsors for Bill 2.



10:17 AM -- Bill 4 - Improve Medicaid Client Communications



Brita Darling, OLLS, presented Bill 4, Improve Medicaid Client Communications (Attachment G). The bill requires HCPF to engage in an ongoing process to create, test, and improve Medicaid client communications. HCPF must ensure that communications with clients are accurate, readable, understandable, and consistent. Contact information for client questions, and, to the extent practicable, legal, privacy, and educational information must be provided separately from the main content of the correspondence. In all communications regarding denial, reduction, suspension, or termination of benefits, the following must be included:



160929 AttachG.pdf

• an understandable explanation of denial, reduction, suspension, or termination;
• detailed information on the client’s household composition and income sources; and
• a specific description of any information or documents needed from the client.

When modifying Medicaid communications, HCPF is required to test the changes and solicit feedback from clients and stakeholders. HCPF is also required to appropriately prioritize communications that only affect a small number of clients or vulnerable populations. HCPF is encouraged to promote client communications electronically and through mobile applications. As a part of HCPF’s annual presentation made to General Assembly, it must present information on its ongoing process to improve client communications.









10:21 AM



Bill Zepernick, LCS, presented the fiscal note prepared for Bill 4 (Attachment H). Mr. Zepernick responded to committee questions about the assumptions made in the fiscal note. Committee discussion continued about the cost of implementing the provisions of the bill. Mr. Zepernick continued to respond to committee questions.



160929 AttachH.pdf



10:37 AM



Committee discussion continued about the cost to implement the provisions of Bill 4.



10:42 AM



Ms. Darling discussed amendment 1 and 2 (Attachments I and J). Amendment 1 made a technical change to the bill's reporting requirement and amendment 2 clarified that the focus of the bill is HCPF communications addressing eligibility, denial, reduction, suspension, or termination of Medicaid benefits.



160929 AttachI.pdf160929 AttachJ.pdf



10:44 AM -- Zach Lynkiewicz and Marivel Klueckman, HCPF, came to the table. Mr. Lynkiewicz provided a handout to the committee and discussed the provisions of the bill that HCPF has specific concerns about (Attachment K). Ms. Kluekman discussed HCPF's limitations in creating clear communications and explained that HCPF plans to utilize the services of a communication consultants to help craft these letters.



160929 AttachK.pdf



10:54 AM



Committee discussion continued about the provisions of the bill. The committee discussed the readability of the notifications sent by HCPF to Medicaid clients addressing eligibility, denial, reduction, suspension, or termination of benefits. Committee discussion followed about whether HCPF needs consultants to assist in developing clear correspondence. Committee members expressed frustration that HCPF could not make more progress on the letters without hiring a consultant.



11:05 AM -- Elisabeth Arenales, Colorado Center on Law and Policy, discuss the problems around the noticing of clients who receive several types of state assistance and the difficulties surrounding the Colorado Benefits Management System (CBMS). She discuss the challenges that state departments face when making technical changes to CBMS. She affirmed that there is a certain amount of expertise that is needed to identify the appropriate language and formatting for letters and other types of communication.





11:11 AM -- Julie Reiskin, CCDC, told the committee that the bill was important and that she appreciates the work put into this issue. She discussed community resources that are available to HCPF for focus groups.



11:14 AM



Representative Primavera discussed amendments 1 and 2 (Attachment I and J).

11:17 AM



Representatives Landgraf and Danielson, and Senators Crowder and Lundberg will be the co-prime sponsors of the bill.



11:18 AM -- Bill 3 - Audits of Correspondence sent to Medicaid Clients



Brita Darling, OLLS, discussed Bill 3 (Attachment L). The bill requires the Office of the State Auditor (OSA) to conduct performance audits of client communications concerning eligibility for Medicaid programs. These audits will be conducted in 2020 and 2023, with any future audits occurring at the discretion of the state auditor. These audits will encompass communications generated both in and outside of the Colorado Benefits Management System (CBMS).



160929 AttachL.pdf



The performance audits will determine whether client communications comply with state and federal requirements, and they will review the understandability, readability, and accuracy of client communications. As a part of these audits, OSA will review available county data related to confusing communications received by Medicaid clients. The OSA will report audit findings and recommendations to various committees.



11:22 AM



Bill Zepernick, LCS, discussed the fiscal note prepared for the bill (Attachment M).



160929 AttachM.pdf











11:25 AM



Ms. Darling responded to questions from the committee.

11:27 AM



Representative Landgraf and Senator Crowder will be the prime sponsors of the bill.



11:28 AM -- Committee Letter - Aligning Public Assistance Eligibility



Bill Zepernick, LCS, presented the letter from the committee to the Centers for Medicare and Medicaid requesting that the eligibility guidelines for Medicaid and the Supplemental Nutrition Assistance Program be aligned in order to avoid confusion among clients (Attachment N). The committee agreed to send the letter forward. The letter will also be sent to the federal Office of Policy Support, Food and Nutrition Services and the Colorado congressional delegation.



160929 AttachN.pdf



11:31 AM



Representative Landgraf recognized Representative Primavera's tenure in the House of Representative.



11:32 AM



The meeting adjourned.