S_HHS_2020A 01/10/2020 10:42:14 AM Committee Summary

Max Nardo, Legislative Council Staff, introduced the fiscal notes team and explained the fiscal note process to the committee.  He described the greenhouse gas emission reports and demographic notes that Legislative Council Staff will prepare this year.

Andrew Forbes, Joint Budget Committee Staff, introduced the staff that work with health departments.  He described the role and duties of the budget staff.

Mr. Nardo responded to committee questions regarding the demographic notes and greenhouse gas emission reports.

Kerri Hunter and Pooja Tulsian, Office of the State Auditor, presented to the committee regarding health department audits that have not been fully implemented and distributed a handout to the committee (Attachment B).  The Annual Report: State of Audits Recommendations Not Fullly Implemented is available online at: https://leg.colorado.gov/sites/default/files/documents/audits/1934s_status_of_audit_recommendations_not_fully_implemented.pdf. 

Ms. Tulsian discussed the total number of audit recommendations made to state departments, and the percentage of recommendations that are fully implemented.  She noted that the three health departments have 14 recommendations that are not fully implemented.  Ms. Tulsian described the seven recommendations that have not been implemented by the Department of Health Care Policy and Financing (HCPF).  The recommendations regard Medicaid eligibility, personnel costs, grants management, and provider eligibility.  Ms. Tulsian and Ms. Hunter responded to committee questions.

Ms. Tulsian discussed where to locate the audit reports on the website of the Office of the State Auditor.   Ms. Tulsian discussed the six audit recommendations that have not been fully implemented by the Department of Human Services (DHS).  These recommendations concern the Federal Child Care Program, federal grant recipient monitoring, and payroll controls. 

Ms. Tulsian presented the one audit recommendation that has not been fully implemented by the Department of Public Health and Environment (CDPHE).  This recommendation concerns financial reporting controls.

Michael Conway, Commissioner, Division of Insurance, and Kim Bimestefer, Executive Director, HCPF, presented on House Bill 19-1004: Proposal for Affordable Health Coverage Option and distributed handouts to the committee (Attachments C and D).  Comissioner Conway reviewed the language in House Bill 19-1004 requiring the development of a state health insurance option.  He described the stakeholder involvement in development of the state health insurance option.

Commissioner Conway described DOI and HCPF's recommendation for a state health insurance option (option) to the committee.  He explained that the option would be administered by private insurance companies and would result in at least two health insurers offering individual insurance plans in every county in Colorado.  Commissioner Conway further explained that under the option, the state would set hospital reimbursements rates.  He described a budget request for the state to begin implementing the option. 

Commissioner Conway responded to committee questions.

Commissioner Conway described the benefits that would be included in plans offered through the state health insurance option, and which Coloradans would be eligible to purchase the plans.  He discussed the possibility of obtaining a federal waiver prior to implementing the option. 

Ms. Bimestefer described the creation of an advisory board to guide implementation of the option.  She explained the cost containment measures in the option pertaining to drug manufacturers, insurance companies, and hospital reimbursements.  Ms. Bimesterfer further described hospital profits and reimbursements in Colorado, compared to other states.

Commissioner Conway described the transparency and reporting measures that would be required for the option.  He discussed the possibility of cost shifting and the amount of hospital reimbursements in the public option plan.  Commissioner Conway and Ms. Bimestefer responded to committee questions regarding federal subsidies, rebates from drug manufacturers, the advisory board, and competition in the private insurance marketplace.

Committee members continued to dialogue with Commissioner Conway and Ms. Bimestefer.  Commissioner Conway indicated that insurance companies would offer plans in rural areas of the state if the hospitals rates are negotiated in advance by a third party.  Discussion about the hospital rate setting method and cost shifting followed.

Committee questions continued about issues insurers will face when deciding to offer a plan through the option and continuing to offer traditional plans.  Committee discussion focused on the structure and role of the advisory board created under this option.

Committee questions continued regarding Colorado's hospital costs and profits compared to the national average of hospital costs and profits.  Ms. Bimestefer responded to questions about the value of the Colorado Healthcare Affordability and Sustainability (CHASE) fee to Colorado hospitals.

Representative Lontine told the committee that the remainder of questions regarding House Bill 19-1004 may be directed to Commissioner Conway and Ms. Bimestefer directly.

Representative Lontine recessed the meeting.

Representative Lontine called the meeting back to order.

Ms. Bimestefer presented on HCPF's performance plan and distributed handouts to the committee (Attachments E and F).  She briefly described the state health programs that HCPF administers.  Ms. Bimestefer discussed Medicaid program spendingl, including expenditures by client and provider type.  She described trends in Medicaid enrollment, and the increase in demand for long-term and home-based services.  Ms. Bimestefer discussed federal policy changes that present opportunities and challenges to HCPF programs.  She summarized the HCPF budget for the committee.  Ms. Bimestefer responded to committee questions.

Ms. Bimestefer gave a summary of the organizational structure at HCPF.  She discussed HCPF's strategic pillars, which include operational excellence, customer service, member health, Medicaid cost control, and health care affordability for Coloradans.  She summarized HCPF's wildly important goals.  Ms. Bimestefer responded to committee questions.  She described HCPF programs' cost containment measures.

Dr. Tracy Johnson, HCPF, discussed improving care support programs.  She noted programs that are in development, including maternity, newborn, diabetes, hypertension, anxiety and depression, chronic pain, and substance use disorders programs.  Dr. Johnson explained Medicaid Regional Accountable Entities (RAEs) to the committee. 

Ms. Bimestefer noted HCPF's successes, including decreased call wait times, decreased opioid use, increased use of the PEAK application, increase in Medicaid providers, and submittal of a substance use disorder waiver.  She summarized HCPF's partnerships with other state agencies.

Craig Domeracki, HCPF, discussed HCPF's purchasing and contracting processes.  He discussed results of state and federal audits, and noted that HCPF is working to improve program eligibility accuracy.  Mr. Domeracki described HCPF's customer service initiatives.

Dr. Johnson responded to committee questions and further described the role of the RAEs in behavioral health, and explained oversight of the RAEs.

Tom Massey, HCPF, described the legislative agenda of HCPF.  He explained that HCPF has proposed bills related to children's waivers, expenditure authority, skilled nursing, and health care affordability.  Mr. Massey summarized HCPF's regulatory agenda for 2020, and discussed the regulations that were reviewed in 2019. 

Mr. Massey provided updates on implementation of legislation related to HCPF, including Senate Bill 17-121 to improve HCPF correspondence.  Mr. Massey responded to committee questions.  He provided an update on Senate Bill 18-266 regarding controlling Medicaid costs, House Bill 18-1321 regarding urgent nonemergency transportation, and Senate Bill 19-195 regarding children and youth behavioral health system enhancements.

Ms. Bimestefer gave closing remarks.  Ms. Bimestefer and Dr. Johnson responded to committee questions regarding inpatient hospitals, electronic health records, provider rate setting, and health care issues in rural areas.

No members of the public testified at the meeting.