SENATE SPECIAL COMMITTEE ON

ACCESS TO THE OREGON HEALTH PLAN

 

 

September 07, 2002   Hearing Room 50

1:30 p.m.      Tapes 9-10

 

MEMBERS PRESENT:            Sen. John Minnis, Chair

                                                Sen. Bev Clarno

                                                Sen. Ted Ferrioli

Sen. Gary George

Sen. Avel Gordly

Sen. Rick Metsger

Sen. Frank Shields

Sen. Cliff Trow

 

MEMBER EXCUSED:            Sen. Bill Fisher

 

STAFF PRESENT:                  Rick Berkobien, Administrator

                                                Bill Taylor, Counsel

                                                Patsy Wood, Committee Assistant

 

GUESTS:                                Jim Neely, Deputy Assistant Director, Dept. of Human Services (DHS)

                                                Vicky Green, Program Manager, Oregon Health Plan, (DHS)

 

MEASURE/ISSUES HEARD:            Informational Meeting

   OHP Eligibility

   OHP Mental Health

 

 

These minutes are in compliance with Senate and House Rules.  Only text enclosed in quotation marks reports a speaker’s exact words.  For complete contents, please refer to the tapes.

 

TAPE/#

Speaker

Comments

TAPE 1, A

005

Chair Minnis

Calls meeting to order at 1:31 p.m.

010

Rick Berkobien

Committee Administrator.  Describes handouts given to the committee (EXHIBITS A-F).

035

Jim Neely

Deputy Assistant Director, Department of Human Services (DHS).  Submits materials (EXHIBITS G & H). 

085

Vicky Green

Program Manager, Oregon Health Plan (OHP), Department of Human Services (DHS).  Explains process of acquiring OHP services.

110

Chair Minnis

Asks if the screening process is done manually.

113

Green

Responds affirmatively, and summarizes the automated process that will eventually replace manual input.

135

Sen. George

Questions how assets of applicants are verified. Specifically addresses OHP applicants owning property in California.

145

Green

Responds negatively. States that workers are only mandated to screen:

  • Social Security
  • Wage match
  • Child Support

170

Chair Minnis

Asks what the process is for suspected abuse of services (fraud).

175

Green

Explains any information received is an automatic referral to the investigation unit.

185

Chair Minnis

Asks if there are links to other states and state agencies.

190

Neely

Says the American Public Human Services prints a yearly guide to help verify names.

195

Chair Minnis

Asks if fraud/abuse reports are taken by telephone.

200

Green

Responds affirmatively.

203

Chair Minnis

Asks if notice is sent back to the complainant for follow up.

205

Green

Responds negatively and states it is confidential information.

210

Sen. George

Questions if complainant can be anonymous, for safety reasons.

215

Green

Confirms that investigations can be done anonymously, but a name is preferred in the event the case is taken to court.

222

Sen. George

Asks if applicants are notified of the serious penalties of false or omitted information.

225

Green

Confirms that applicants are notified on the application itself of the law and the penalties.

230

Chair Minnis

Asks how many persons have been prosecuted.

235

Neely

States that there have been a few.

240

Bill Taylor

Committee Counsel.  Asks about income verification.

243

Green

Indicates that income is verified using pay stubs for the current month, and the two previous months of employment.

246

Taylor

Asks if the agency is allowed to check Oregon Dept. of Revenue.

247

Green

Answers, no.

248

Taylor

Asks if it is prohibited by state statute or federal statute to work with Revenue.

250

Neely

Answers that Revenue could address the prohibition rules.  Says the information from Employment is timelier.

260

Taylor

Asks if employment records can be obtained without permission of enrollee.

265

Neely

Confirms and cites online access to information.

285

Sen. Trow

Asks what the agency does if fraud is verified, and asks if termination is immediate.

290

Green

Explains the recourse if fraud is proven, and explains that termination is issued with a ten-day notice to client. Overpayments are pursued for reimbursement, and fraud is determined by the investigation unit, which will report to the district attorney’s office.

300

Sen. Shields

Asks what percentage of fraud cases go to trial.

305

Neely

Indicates it is a small percentage, but that information can be provided.

320

Sen. George

Asks if record of abuse stays on their permanent record.

328

Neely

Replies that is not procedure in the Medicaid program; once they are no longer in violation of eligibility criteria, they will qualify again.

337

Green

Points out that the information will show up in the narrative portion of their record, which will prompt screeners to check further than the three mandated screening options.

343

Sen. Shields

Asks why the client prime number does not show this information.

350

Neely

Says that information will be retained on that prime number.

365

Sen. Trow

Asks why so many people are turned down for enrollment.

369

Green

States reasons as: 1) too much income; and 2) not enough information provided.

380

Chair Minnis

Asks if there have been cases of employees enrolling someone who is not actually eligible.

390

Green

Says this has occurred and states that working environments are set up to allow peer reporting of violations.

405

Neely

Includes that the process for OHP is a mail-in system, so face-to-face conversations are very rare.

410

Chair Minnis

Asks if a database has ever shown a social security number occurring more than once.

415

Neely

Yes, social security numbers are checked once a month.

423

Sen. Shields

Requests the percentage of people who apply for OHP and turn out to be fraudulent. 

448

Neely

Offers to obtain those numbers. Clarifies that while someone may be denied, it may not be because of fraud.

460

Sen. Gordly

Asks if the Secretary of State’s Audit Recommendations (Exhibit H) are going to be discussed and asks for the source and what date it was prepared.

472

Neely

Answers that DHS produced this document March 26, 2002.

483

Sen. Ferrioli

Asks why the document is not identified as an agency document.

490

Neely

Acknowledges that the cover page is missing which identified the agency.

TAPE 10, A

035

Sen. Ferrioli

Discusses a document from Price Waterhouse that identifies health care fraud at 5%.  Asks if the agency people have seen that report.

045

Neely

Responds he is not familiar with that report.

055

Sen. Ferrioli

States that the agency should know about this report and asks again if 5% fraud is reasonable.

075

Neely

Concurs there could be some level of fraud and abuse, and states 5% seems reasonable.

081

Sen. Ferrioli

Asks for recommendations from the agency how fraud can be handled better.

090

Chair Minnis

Suggests linking with banking institutions and law enforcement to utilize common mechanisms to reduce fraud. 

099

Sen. Ferrioli

Suggests Price Waterhouse might be able to determine a mechanism to measure and combat fraud in the system.

132

Neely

States that it is possible to work with OMAP to work on a response to this.  Suspects the 5% includes provider issues as well.

145

Sen. George

Requests data on the total quantity of drugs prescribed through OHP. Offers personal knowledge of Vicadin being prescribed and resold in very large quantities for $10 a pill.

150

Neely

Responds affirmatively that drugs are tracked. Notes there is a utilization review team.

155

Sen. George

Asks if there are procedures to notify police of abuse.

165

Neely

States he is not certain of the procedure.

170

Sen. George

Asks the total amount expended this biennium for the drug program.

173

Chair Minnis

Responds it is $900 million.

177

Sen. Gordly

Referring to the section of the Price Waterhouse report, Impact of litigation as an expense, asks if there are pending lawsuits relating to the OHP that could affect the cost of the plan.

187

Neely

Responds in terms of the eligibility, none that he is aware of.

192

Chair Minnis

Refers to a large case highlighted in the paper today (EXHIBIT I).

200

Sen. Shields

Discusses page 10 of Price Waterhouse report, which indicates the cost driver from fraud and abuse is 5%.

235

Taylor

Asks what the department has done and will be doing regarding the recommendations made by the Secretary of State.

245

Neely

Indicates handout which addresses the recommendations (EXHIBIT H).

250

Chair Minnis

Asks about the first question of the application, which is, “Are you an Oregon Resident…yes or no.” Asks why we do not go into further detail, such as length of time in Oregon, or place of birth.

260

Neely

Replies that the Secretary of State audit tested addresses and did not find any persons fraudulent of residency.

265

Sen. Ferrioli

Asks if there is a law prohibiting the right to demand Oregon residency prior to applying for OHP.

275

Neely

States that the Supreme Court has upheld the notion that there cannot be a durational residency requirement for programs that are federally funded.

282

Sen. Ferrioli

Asks if there has been consideration for residency requirement based on actual residency versus durational residency.

292

Chair Minnis

Asks counsel to do some investigation regarding residency.

303

Taylor

Discusses the issue of residency v. domicile.  Says Mr. Neely is correct. 

330

Sen. George

Talks about the residency timeframe eligibility for the Oregon Trail card.

375

Neely

Says a resident had to have passed the eligibility requirements of Adult and Family Services if he has an Oregon Trail card.  Discusses the Secretary of State Audit Recommendations (EXHIBIT H).  Indicates documentation standards have improved (leading to a higher denial rate) since the audit.

430

Sen. Gordly

Asks what documentation would verify that.

435

Neely

States the agency keeps an ongoing tally of the denial rate and it has gone up steadily over the last year.

 

 

Comments on requirement two (EXHIBIT H), regarding requiring eligibility specialists to review on-line department wage information for re-applications.  States that information is reported by employers typically 30 to 60 days after the quarter. The information is not available to specialists during the application time frame. The recommendation suggests that when processing a re-application to go back and re-do the first application and the estimated costs would be approximately $2.6 million to re-review.

TAPE 9, B

012

Chair Minnis

Asks if this cost includes training and better screening process.

020

Neely

Claims that paying more attention to recent employment information has contributed to the increased denial rate.

025

Sen. Ferrioli

Asks if the $2.6 million cost of going back would be re-captured in savings.

031

Neely

States that it is impossible to say exactly what would be recovered.  Cites the difficulty of recouping money even if it is uncovered as most clients are low-income households and individuals.

040

Chair Minnis

Wonders if the process for re-application is tightened each six months (when renewal is due) the opportunity for fraud might be minimized.

050

Neely

Confirms the chairs observation. 

055

Sen. George

Asks how the percentage of increase in total applications compares to the percentage of increase in denial rates.

060

Neely

Assures that the percentage of denials is rising quicker than applications – that information can be provided.  Continues his discussion of the recommendations.

075

Green

Outlines the ‘Critical Thinking’ screening process being utilized by application screeners.

090

Sen. George

Asks how a person from Mexico could have an OHP card and get prescriptions.

100

Green

Answers that the application asks the applicant if it is their intent to stay in Oregon. If the applicant does have intent to stay, then policy does not allow denial.

107

Neely

Inquires if the person was a U.S. citizen.

109

Sen. George

Replies, no – client was a resident of Mexico, visiting her daughter. 

120

Neely

Offers to investigate the case, as it appears to be a case of fraud.

125

Sen. George

Asks if there are any prohibitions to shipping drugs outside the country.

131

Neely

Defers this question to OMAP.

135

Sen. Ferrioli

Expresses frustration over trying to get money from fraud cases when the people have no money.

160

Neely

Discusses the cost for an OHP eligibility check.

180

Chair Minnis

Asks if the agency has questionnaires for employee satisfaction.

192

Green

Notes the high turnover rate because it is an entry-level position.

202

Chair Minnis

Adds that training and retention is important.

210

Green

States that the position is not a high paying job.

215

Chair Minnis

Asks what the pay is for the position.

218

Green

Replies $1400 gross wage, but support staff is less.

220

Sen. Gordly

Points out there are staff classification rates on page 2 of Exhibit H.

235

Chair Minnis

Asks if there are state employees who qualify for assistance.

236

Green

Responds affirmatively.

237

Neely

States that food stamps go to people at 185% of the federal poverty level.

240

Sen. Clarno

Asks if the eligibility standards for OHP are the same as the old Medicaid system.

250

Neely

Replies, no, explaining there are 19 different categories of Medicaid programs.

265

Chair Minnis

Asks about the emergency eligibility.

270

Green

Describes the emergency eligibility requirements.

280

Chair Minnis

Clarifies and asks if a hospital fills out the form and faxes it to agency.

285

Green

Responds affirmatively.

287

Chair Minnis

Asks what is done upon receipt of an emergency eligibility fax.

290

Green

Describes the process after the information is received.

295

Chair Minnis

Asks how the agency follows up if information on the application turns out to be untrue. Cites an example of an unconscious patient coming to the hospital and is unable to provide accurate information.

300

Green

Replies that a relative or a family member would have to fill out the application if the person was unconscious. States the application would be held until the information is verified.

308

Chair Minnis

Asks if a hospital gets paid w/o information.

309

Green

Replies no.

315

Chair Minnis

Discusses regions in Oregon with higher unemployment.  Asks if it is possible to apply the OHP to certain regions.

322

Neely

Advises that could be a problem with a court challenge.

327

Chair Minnis

States that as this is a program above & beyond the federal program, could it be utilized where the highest need is – in the areas of highest unemployment.

333

Neely

Responds that in terms of eligibility it could be done by adjusting the eligibility threshold.

344

Chair Minnis

Wonders why we cannot determine what counties would be accepted if we can cap enrollment.

347

Neely

Expresses doubt of whether the federal government would consider this a possibility.

350

Chair Minnis

Claims that Portland has a higher access to physicians and facilities.

355

Sen. Ferrioli

Asks if Oregon’s assistance programs play a role in residency decisions. Wonders if a study should be done to measure demographic breakdowns with neighboring states.

417

Neely

Cites a public assistance study regarding cash assistance tracking where the majority of people coming on public assistance were from California, Washington and Arizona which had higher payment standards. States that he did not believe the OHP is a magnet for residents outside Oregon.

448

Sen. Ferrioli

Notes that the response to the Secretary of State audits is helpful.

TAPE 10, B

015

Sen. Gordly

Points out the information is six months old and asks when the next Secretary of State audit might occur. 

023

Neely

States he is unaware of a follow-up audit.

030

Sen. Gordly

Notes the information in Exhibit H only deals with two areas of the audit, and other recommendations made in the report were not provided.

050

Neely

Says this document can be added to if inadequate.

055

Sen. Clarno

Asks whether a change in director will trigger an audit, as the director will be changing.

060

Neely

States it is possible, and will verify.

062

Chair Minnis

Requests an organizational chart of DHS outlining where the OHP fits.

068

Neely

Offers to provide.

070

Rick Berkobien

Asks if the Secretary of State will have follow up to the audit.

073

Neely

States that the next audit topics are being set, but is unaware of follow-up for this particular audit.  If this topic is revisited, the committee will receive the information.

080

Chair Minnis

Suggests returning Monday for the OHP mental health piece.

101

Chair Minnis

Adjourns the meeting at 3:00 p.m.

 

Transcribed by,                       

 

 

 

 

Anna Suess

Committee Assistant         

 

Submitted by,                        Reviewed By,

 

 

 

 

Patsy Wood                        Rick Berkobien,

Committee Assistant                        Administrator

 

 

EXHIBIT SUMMARY

 

A – Federal Poverty Guidelines 2002, submitted by staff, 1p

B – Dept. of Human Services Acronym List, submitted by staff,  10 pp

C – Kaiser Daily Health Policy Report, kaiseernetwork.org, 1p

D – Abstract: Rationing medical care: rhetoric and reality in the Oregon Health Plan, 3pp

E – Joint Interim Com. on Health & Human Services Rural Health Care Field Trip, dated June 5-8, 2002, submitted by staff, 39 pp

F – Joint Interim Com. on Health & Human Services Coastal Region Rural Health Care Field Trip, dated October 17-18, 2002, submitted by staff, 32pp

G – Oregon Health Plan Eligibility Process, submitted by Jim Neely, DHS, 2pp

H – Secretary of States Audit Recommendations, Neely, 7 pp

I – Oregonian article (front page of Metro/NW), dated September 7, 2002, submitted by staff, 2 pp