S_HHS_2018A 01/04/2018 09:10:56 AM Committee Summary

Flavio Quintana, Department of Revenue (DOR), and Ki'i Powell, Department of Human Services (DHS) presented on the electronic benefit transfer (EBT) card services program and distributed handouts to the committee (Attachment B and C).  Mr. Quintana summarized House Bill 15-1255 to the committee and discussed EBT card usage in DOR-regulated industries.  Ms. Powell commented on DHS policies to educate and inform EBT card recipients about proper usage and noted that prohibited use of EBT cards has declined. 

Reggie Bicha, Executive Director, DHS, presented to the committee and handouts were distributed (Attachments D, E, F, and G).  Director Bicha discussed the mission of DHS and the three strategic priorities of DHS, which include helping people to stay in their communities, to achieve employment, and to prepare for educational success.  He described the facilities that DHS owns and leases in Colorado, noting that some properties are vacant.  Director Bicha gave an overview of DHS community partners and named the five program offices within DHS.

Attachment E

https://leg.colorado.gov/sites/default/files/5._2017_cdhs_regulatory_agenda.pdf

Attachment F

 

Director Bicha discussed the DHS budget requests for FY 2018-19, which include funding for programs in the Office of Community Access and Independence, the Office of Economic Security, and the Office of Administrative Solutions.  Director Bicha and Mark Wester, DHS, responded to questions regarding the funding and future of the DHS Regional Centers.  Dr. Robert Werthwein, DHS, responded to a question on contracting costs for a contractor to cultural change in the Office of Behavioral Health and the search for a superintendent.  Director Bicha responded to questions on the Pueblo state hospital, services for seniors with cognitive disorders, and use of vacant DHS buildings.

Director Bicha briefly explained the legislative priorities for DHS in 2018.  He went over the rule review process and noted that multiple rule packets will be revised, and discussed the status of DHS audit findings and recommendations.  Director Bicha explained the C-Stat performance measurement program to the committee, and discussed five important DHS goals, including comprehensive rule review, increased child support payments, reduced food insecurity, reduced use of seclusion, and increased opioid treatment options.  Director Bicha responded to questions on efforts to increase child support payments.

Director Bicha described the Office of Children, Youth, and Families and discussed the results of the child and family service review of county child welfare programs that occurred in 2017.  He updated the committee on the child abuse reporting hotline and public awareness campaign.  Director Bicha responded to a question on caseworker workload.  He discussed trends on children in out-of-home placements and congregate care utilization, and the costs and benefits of different out-of-home placement settings.  Director Bicha discussed proposals to adjust the child welfare block grant.  Dr. Werthwein and Director Bicha responded to questions regarding Pueblo out-of-home placements, Title IV-E waivers, and per capita numbers on out-of-home placements compared to other states.  Minna Castillo Cohen, DHS, responded to a question regarding tracking of youth in child welfare.

Director Bicha continued with the presentation and discussed the foster care system in Colorado, and explained initiatives to provide information and child care assistance for foster parents.  He discussed low graduation rates for children in foster care, and noted that the Governor has called for a task force to study the issue.

Director Bicha described the Division of Youth Services (DYS) and noted the performance measures that DYS uses regarding safety.  He noted that almost all safety incidents have declined in the last year including fights and assaults, seclusions, and use of physical restraint devices.  He explained that new training and increased staff have contributed to safety accomplishments.  Director Bicha responded to questions about suicide and sexual assault in DYS facilities.  Ms. Castillo Cohen updated the committee on the Statewide Youth Development Plan, and Director Bicha described changes to the Child Protection Teams.

Director Bicha described the Office of Behavioral Health, which oversees the statewide crisis response system.  He provided data on utilization of the crisis response system, including calls and visits to crisis facilities.  Dr. Werthwein updated the committee on enhancements to the crisis response system as a result of 2017 legislation.  Director Bicha explained other initiatives, including creation of the Crisis Response Executive Steering Committee and procurement of crisis response system contracts.  Dr. Werthwein responded to questions about DHS cooperation with the Law Enforcement Assisted Diversion program.  In response to a question, Director Bicha explained how DHS is using a $7.8 million grant for opioid use disorders.  He described other initiatives related to substance abuse including changes to the CIRCLE program and the need for more inpatient treatment beds.  He discussed the increase in court ordered competency evaluations, and the increased need for restoration.  Director Bicha noted that a budget request has been made to assist in providing beds for restoration patients, and discussed possible policy changes to address the increase in restoration requests.

Director Bicha described the Office of Economic Security, which assists Coloradans in gaining permanent employment.  He described the ReHire Colorado program, which helps veterans and seniors gain employment and assists small business owners.  He updated the committee on the status of Temporary Assistance for Needy Families (TANF) reserves, which are approximately $100 million, and discussed possible changes to cash assistance programs.  Director Bicha noted that the Office of Economic Security also operates programs related to food security and child support.

Director Bicha described the Office of Early Childhood, and noted that accessing high quality child care is a main focus of the office.  He described the Colorado Child Care Assistance Program (CCCAP) to the committee and provided data on changes in appropriations and expenditures for the CCCAP.   Director Bicha explained that the demand for CCCAP is higher than budget allows and waitlists exists; he discussed different policy options to address the high demand for CCCAP services.  He updated the committee on the Colorado Children's Trust Fund (CCTF), which exists to prevent the abuse and neglect of children.  He suggested that the membership and organization of the CCTF be strengthened to better investigate child fatalities.

Director Bicha described the Office of Community Access and Independence and noted that a main component of the office is Adult Protective Services (APS).  He explained that counties oversee APS, in coordination with law enforcement.  Mr. Wester updated the committee on the closure of the Grand Junction Regional Center, explaining that other living options are being authorized for current residents.  He discussed progress on the Pueblo Regional Center Corrective Action Plan, including reducing staff turnover and burnout. Director Bicha provided data on caseloads for the Long-Term Care Ombudsman and the PACE Ombudsman, and updated the committee on the Respite Care Contract.

Director Bicha responded to committee questions regarding eligibility for the Supplemental Nutrition Assistance Program, utilization of Naloxone kits, marketing for the crisis response hotline, and the Pay for Success program

Reggie Bicha, Executive Director, DHS, presented to the committee and handouts were distributed (Attachments D, E, F, and G).  Director Bicha discussed the mission of DHS and the three strategic priorities of DHS, which include helping people to stay in their communities, to achieve employment, and to prepare for educational success.  He described the facilities that DHS owns and leases in Colorado, noting that some properties are vacant.  Director Bicha gave an overview of DHS community partners and named the five program offices within DHS.

Attach E

https://www.colorado.gov/pacific/sites/default/files/HCPF%20Fiscal%20Year%202018%20Department%20Performance%20Plan.pdf

 

 

Camille Harding, DHS, presented regarding the Behavioral Health Transformation Council (BHTC) and noted that there is currently no formal reporting structure for BHTC.  She reported on the 2017 goals for BHTC, including rewriting the bylaws, adjusting the BHTC structure and tasks, and collaborating with other groups.  Ms. Harding explained that the BHTC focused on a workforce survey, workforce shortages, and development of career pathways for behavioral health workers in 2017.  She discussed Mental Health Hold Task Force recommendations that require the participation of BHTC.  Ms. Harding responded to questions regarding dissolving or sunsetting the BHTC.

Kristina Heyl, DHS, presented on the Early Childhood Leadership Commission (ECLC) and distributed a packet to the committee (Attachment H).  She described the membership, statutory charge, and structure of the ECLC.  Ms. Heyl noted that there are subcommittees and working groups for different early childhood issues.  She described recent accomplishments, including developing a website for the Early Childhood Colorado Framework and supporting the Early Childhood and School Readiness Legislative Committee.  She described the four bills that came out of the committee in the interim.  Ms. Mueller explained future ECLC goals, including expanding early childhood awareness, elevating the early childhood professional workforce, and aligning early childhood systems.

Senator Smallwood called the meeting back to order.  Tom Massey, Interim Executive Director, Department of Health Care Policy and Financing (HCPF), presented to the committee and distributed handouts (Attachments I and J).  Director Massey described the mission of HCPF and recent reports and developments within HCPF, including state and federal legislation.  He provided data on Colorado insurance coverage rates.  He noted the programs that HCPF oversees, including Health First Colorado, Child Health Plan Plus (CHP+), Old Age Pension Medical Programs, and the Colorado Indigent Care program.  Director Massey went over membership demographics for Health First Colorado and CHP+.  John Bartholomew, HCPF, described the caseload and population costs for Health First Colorado and CHP+.  He explained the different funding sources for the programs, and the providers that receive funds from the programs.

Attachment J

https://www.colorado.gov/pacific/sites/default/files/HCPF%20Fiscal%20Year%202018%20Department%20Performance%20Plan.pdf

Director Massey briefly discussed the Governor's health goals, which includes improving health coverage.  He explained HCPF's long-range goals and strategic initiatives, which include innovation of delivery systems, transformation tools, partnerships to improve population health, and operational excellence.  Director Massey described updates to the Health First Colorado website to improve customer experience.

Gretchen Hammer, HCPF, explained major HCPF initiatives, including the Accountable Care Collaborative (ACC).  She explained the goal of the ACC, to improve health and life outcomes and to use state resources wisely.  Ms. Hammer discussed regional entities that participate in the ACC, and explained how HCPF collects and utilizes data on outcomes and services related to the ACC.  She described another HCPF initiative: the provision of long-term services and support.  Ms. Hammer explained the eligibility for long-term services and supports and noted that services may be provided in the home, community, or institutions.  She described the eleven waiver programs that allow individuals to receive long-term services and supports through Medicaid.  Ms. Hammer responded to a question on the Children with Autism Waiver.  She discussed a vision for long-term services and supports which includes streamlining access to services, improving service coordination, and increasing service options and quality.

Mr. Bartholomew discussed different value-based payment initiatives for hospitals, federally qualified health centers, primary care, and pharmacies.  Dr. Judy Zerzan, HCPF, discussed hot topics in health care with the committee.  She explained a HCPF policy change to limit initial opioid prescriptions.  Dr. Zerzan responded to questions regarding the Prescription Data Monitoring Program (PDMP).  Chris Underwood, HCPF, updated the committee on the implementation of interChange, which is the new Heath First Colorado claims system.  He discussed common issues with the new system and explained the efforts HCPF has made to resolve problems with the system.  Mr. Underwood responded to questions from the committee regarding rural providers' concerns with the new system and the location of regional field representatives for interChange.

Ms. Hammer provided an update on funding for the CHP+ program.  She described the enrollment, eligibility, and federal funding for the program, which expired in the fall.  Ms. Hammer noted that the federal funds for CHP+ program will expire at the end of January, and she explained stakeholder conversations regarding the program.  She noted that Congress has recently allocated temporary funds for CHP+.  Ms. Hammer explained various options for customers should CHP+ program funding run out.  She responded to a question about customer communication regarding program funding.

Mr. Bartholomew summarized various HCPF budget requests that will result in an overall budget reduction for FY 2018-19.  Director Massey explained HCPF's 2018 legislative agenda.  He summarized the agenda items, including achieving cost savings through transition services; aligning managed care statute with federal regulations; implementing conflict-free case management for Single Entry Points; redesigning the Children's Habilitation Residential Program Waiver; and removing outdated waiver language from statute.  Director Massey described the regulatory review process, and noted that 2017 was the final year of a five year review cycle.  He updated the committee on House Bill 13-1196 to reduce waste through the ACC, and Senate Bill 17-121 to improve Medicaid client correspondence.  In response to questions, Mr. Underwood explained how HCPF tests correspondence for clients.  Committee members expressed concern with confusing Medicaid letters.

Director Massey described the HCPF legislator resource center to the committee and concluded his presentation.

Senator Smallwood initiaited public testimony regarding HCPF.

Douglas Coleman, Colorado Association of Medical Equipment Services, testified regarding HCPF and discussed federal regulation for Medicaid medical equipment. Mr. Coleman responded to committee questions.  Dr. Zerzan came to the table to provide comments. Committee discussion ensued.

Betsy Murray, Home Care Association, testified regarding HCPF and home care technology issues.

Dr. Randell Clark, Colorado Society of Anesthesiologists, testified regarding HCPF and distributed handouts (Attachments K and L).  He discussed provider rates for anesthesiology.  Dr. Clark responded to committee questions.  Ms. Hammer returned to the table to provide comments.  Committee discussion ensued.