HOUSE COMMITTEE ON

AUDIT & HUMAN SERVICES BUDGET REFORM COMMITTEE

March 5, 2003 Hearing Room 50

3:00 PM Tapes 48 - 49

MEMBERS PRESENT: Rep. Ben Westlund, Chair

Rep. Steve March, Vice-Chair

Rep. Jeff Kruse

Rep. Jeff Merkley

Rep. Alan Bates

MEMBERS EXCUSED: Rep. Randy Miller

Rep. Susan Morgan, Vice Chair

GUEST MEMBERS: Rep. Mitch Greenlick

Rep. Gordon Anderson

Rep. Laurie Monnes Anderson

STAFF PRESENT: Rick Berkobien, Committee Administrator

Kelly Fuller, Committee Assistant

ISSUES HEARD: Informational Meeting

Seth Bernstein, Ph.D. Accountable Behavioral Health Alliance

Bruce Abel, LaneCare

“Mental Health Organizations: Programs and Individuals Served”

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 48, A
001	Chair Westlund	Calls meeting to order 3:13 pm and asks that Rick Berkobien explain the materials at the Dais.
INFORMATIONAL MEETING
006	Rick Berkobien	Gave an overview of the material at the Dais. (EXHIBIT A), (EXHIBIT B), (EXHIBIT C).
035	Chair Westlund	Introduces Seth Bernstein, Ph.D. Accountable Behavioral Health Alliance and Bruce Abel, LaneCare and opens the informational meeting. (EXHIBIT D)
045	Seth Bernstein	Introduces himself and Bruce Abel and begins presentation.
101	Chair Westlund	Looking at (EXHIBIT D) and asks what the logic is behind this complicated situation.
145	Bernstein	Responds to the questions on (EXHIBIT D).
150	Bruce Abel	Adds to the response.
155	Chair Westlund	Questions regarding Family Care.
158	Bernstein	Responds regarding Family Care.
160	Chair Westlund	Asks if Family care is then overlaid on top of Multnomah and Washington Counties.
165	Bernstein	Comments that this is really out of my area.
170	Abel	Comments that in some counties there is a single fully capitated health plan and elaborates.
175	Rep. Bates	Elaborates his understanding about fully capitated groups.
185	Abel	Responds yes that his comments and understanding is correct. Gives more elaboration.
200	Rep. Bates	Asks follow up questions about fully capitated health plans in regard to mental health.
208	Bernstein	Responds to the follow up questions.
216	Abel	Makes additional comments to the questions asked.
226	Chair Westlund	Under that explanation, you should have another box for COIS.
228	Abel	Responds yes and elaborates.
238	Chair Westlund	With Family care what are they doing different.
257	Rep. Greenlick	Asks if there is a difference in which professional you are insuring.
275	Bernstein	Comments about the differences.
278	Rep. Greenlick	Makes additional comments about the different coverage’s.
280	Abel	Responds that, that is a reasonable way to look at it.
287	Rep. Bates	Makes comments with concern and confusion.
353	Bernstein	Comment that by the end of the day, we will have more detail that will hopefully make this more clear.
360	Chair Westlund	Thanks Rep. Bates for his comment because he has the same concern and elaborates.
375	Rep. Bates	Comments that they think they have patients in two capitated plans.
374	Bernstein	One MHO and one fully capitated and elaborates.
378	Chair Westlund	Depending on the offering in the geographic area.
380	Rep. Bates	Would recommend that the map you look at is still confusing because Family care should not be on this map as they do not provide these services.
400	Rep. March	Comments that he thinks it is for a specific population determined by the county.
404	Berkobien	Makes comments about why he thinks Family Care might fit in.
TAPE 49, A
005	Chair Westlund	Comments that he know that Family Care was in various parts of the state at various times.
010	Rep. Greenlick	Makes additional comment to help clarify.
017	Chair Westlund	Comments on what other regions offer.
023	Berkobien	Makes comments about brining in someone that has created a web site that will help us clarify the issues.
031	Rep. Greenlick	Comments that the prime issue is, what is the population issues based in your capitation rate.
033	Abel	Asks if he is talking about their membership.
035	Rep. Greenlick	Comments that it is not sick people.
040	Bernstein	OHP members in their counties enrolled in managed care.
041	Rep. Greenlick	In your county you have in your capitation rate, 100 percent to the OHP members open or not for a capitated health benefit.
043	Rep. Merkley	Asks as we have come to understand medical condition as a disease of the brain are we finding any process through which these structures are moving together.
052	Bernstein	Comments that on a quarterly basis he has a meeting with top management of IHN and on a monthly basis we get together with staff and focus on complex case managed and elaborates.
064	Abel	Responds to Rep. Merkley in more detail.
087	Bernstein	Adds more information.
110	Chair Westlund	Makes comments that he thinks this is very helpful. This committee is really interested in that interface and relation between the MHO’s and the fully capitated health plans in any given area.
116	Abel	Continues presentation.
148	Bernstein	Continues presentation.
186	Berkobien	Asks for mental health, what is to prevent the organizations from reaching out to them at the fullest.
196	Bernstein	Responds about how the manage and evaluate their services.
211	Berkobien	Internally as people really need outreach and you need to go out and find them, is that part of that documentation and assurances that you are giving to the state about being proactive.
217	Bernstein	Comments in more detail about how they run their organization, the reports they generate and continues presentation.
287	Rep. Greenlick	Asks if there is any link to alcohol and drug use.
296	Bernstein	Comments to the link to alcohol and drugs.
322	Berkobien	Asks about percentages of those with co-occurring mental health problems.
330	Abel	Comments about co-occurring mental health problems and the percentages.
344	Bernstein	Continues presentation.
TAPE 48, B
024	Chair Westlund	Asks what the letters stand for in the material.
026	Bernstein	Gives an explanation of the letters. Continues presentation.
077	Chair Westlund	Asks how they are paid.
080	Bernstein	Relates information about how they are paid.
090	Chair Westlund	Asks if the county cuts them a check.
094	Bernstein	States that no, the state cuts them a check.
143	Rep. Bates	Asks in their system in the county level are they capitated for out patient care and who pays for that.
152	Bernstein	Responds yes, and makes comments about their system and who pays for it.
164	Rep. Bates	Asks at the county level you are seeing a patient that you hospitalize, it doesn’t come out of your local budget it comes out of the overall budget for the entire group and what hospitals do you use to hospitalize in your group.
170	Bernstein	Elaborates and explains.
180	Rep. Bates	Why did you decide to set up an organization in which you can get someone off your books by hospitalizing them and elaborates.
187	Bernstein	Explains why they are set up that way.
200	Rep. Bates	Asks if they saw a significant variation amongst the counties and what the program looks like on the ground and how many people are being hospitalized, and that are rolling out or was it rather uniformed.
208	Bernstein	Asks for clarification of the questions.
209	Chair Westlund	Clarifies by saying cost per member, per month, per county.
220	Rep. Bates	Comments about the vast difference between counties and would like to know what their best practices are.
225	Bernstein	Responds to the vast difference with other counties and elaborates.
244	Chair Westlund	Asks if the patients can go to Pioneer in Prineville.
248	Bernstein	Comments about where the patients can go.
265	Rep. Bates	Talks more about how the system works and has concerns that he elaborates.
297	Bernstein	Talks about the meetings that they have to review cases and discuss how they handled them to better assess how to make the system work best.
308	Chair Westlund	Makes comments to Bernstein about his presentation.
318	Abel	Has the answers to the question above and begins his presentation. (EXHIBIT E)
TAPE 49, B
090	Chair Westlund	Asks what the population of Lane County is.
093	Abel	Responds with the population of Lane County.
094	Chair Westlund	Makes comments about Lane County having all the items available to make this Managed Care program viable.
100	Abel	Continues presentation.
162	Rep. Bates	Comments that he has heard rumbles that they do as much paperwork as they see patients and asks do you think that is true statewide and if it is are those paperwork requirements Federal, State or County.
169	Abel	Comments about requirements and continues.
179	Rep. Bates	Would like to see what those requirements are and elaborates.
180	Abel	Comments it would be a tremendous benefit to everyone if you could find that.
182	Rep. March	Asks presumably they are documenting the fee for service for you also right.
185	Abel	Responds to documenting fee for service and other requirements.
190	Bernstein	Makes some ending statements about how to make the mental health system work better.
318	Rep. Anderson	Asks if the funds are coming from Federal sources or other sources.
325	Bernstein	Responds about funds and where they come from.
343	Abel	Makes additional comments to add to the presentations and makes a closing statement.
390	Chair Westlund	Makes three final comments closes the meeting and adjourns. 4:58 pm

EXHIBIT SUMMARY

A – Informational, prepared testimony, staff, 3 pp

B – Informational, prepared testimony, staff 2 pp

C – Informational, study, staff, 2 pp

D – Informational, prepared testimony, Seth Bernstein, 8 pp

E – Informational, Mental Health Organization, Bruce Abel, 14 pp