HOUSE COMMITTEE ON

AUDIT & HUMAN SERVICES BUDGET REFORM

 

April 23, 2003 Hearing Room 50

6:00pmTapes98 - 100

 

MEMBERS PRESENT:††††††††††† Rep. Ben Westlund, Chair

Rep. Steve March, Vice-Chair

Rep. Jeff Merkley

Rep. Alan Bates

 

MEMBERS EXCUSED:††††††††††† Rep. Randy Miller

Rep. Susan Morgan, Vice-Chair

Rep. Jeff Kruse

 

GUEST MEMBERS:†† ††††††††††† Rep. Mitch Greenlick

 

STAFF PRESENT:††††† ††††††††††† Rick Berkobien, Committee Administrator

Kelly Fuller, Committee Assistant

 

ISSUES/MEASURES HEARD:HB 3624 - Public Hearing

 

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

 

TAPE/#

Speaker

Comments

TAPE 98, A

003

Chair Westlund

Calls the meeting to order and opens the meeting for public hearing.

HB 3624 - PUBLIC HEARING

029

Berkobien

Gives information about HB 3624 and an explanation about the materials presented at the dais. (EXHIBIT A).

097

Rep. Greenlick

Asks if there is room for the fully capitated health systems to have capacity here.

102

Chair Westlund

Comments that if they could not assign an enrollee to a PCP within 21 days and elaborates.

114

Rep. Bates

States a concern that at times their capacity was being defined in such way that they really could take more patients but because they had restraints on them about how fast the patient had to be seen and elaborates.

125

Karen Whitaker

OHSU/Rural Health Services, presents written testimony (EXHIBIT B) and begins presentation.

204

Rep. Bates

Asks why are you concerned with type A and type Bís they are specifically excluded from this bill.

210

Whitaker

Understands they are not in this bill, but type A and B reimbursement is eliminated in the Governorís budget and the Co-Chairs budget.

215

Rep. Bates

Wants to make sure that there is nothing in this bill that you are worried about.

216

Whitaker

Just urging the committee to consider it all in context.

221

Chair Westlund

Tends to disagree that most rural counties do not have fully capitated health plans.

230

Whitaker

States that, that is not what she has meant to say, she meant most plans have left rural areas.

246

Rep. Merkley

Asks what she thinks the issue really is, this bill or the Governorís budget.

260

Whitaker

Would like to see some provision put in this bill to protect some of the Rural hospitals.

263

Chair Westlund

Asks do we not do that.

268

Whitaker

Responds that no we do not do that now, we do have the type A and B cost reimbursement now, but we need to be very definite about preserving that.

269

Chair Westlund

Do the answer is yes, we do that in the bill, but we need to be emphasize that we need to be vigilant in protecting that provision which is in the bill.

272

Whitaker

Yes, but we need to protect them from the loss of the presumptive eligibility requirement as well.

273

Rep. March

Asks if they would rather operate with or without a Medicaid program..

285

Whitaker

Comments of course they would need a Medicaid program, but with the changes that are currently forecasted in the OHP, with so many people losing coverage, they are certainly going to seek primary care in emergency hospital care.

289

Ed Patterson

Oregon Rural Health Association, presents testimony (EXHIBIT C) and begins his presentation.Questions section ten of the bill and explains why.

357

Rep. Bates

Comments that he will check with Legislative Council and make sure that this is written correctly.

367

Patterson

Looks forward to seeing the attachment.

372

Chair Westlund

Re-reads the bill and states how he reads it, comments that it still reads the same, but is happy to work with them to achieve the result that was intended.

TAPE 99, A

002

Cedric Hayden

from Fall Creek Oregon, would like to direct his comments to the delivery system of this bill.Would like this bill to reflect dentists listed as well as doctors.We hold these facts to be self evident:

1.That the health care delivery system should include dental as well.

2. Would urge that the delivery system maintain the skeletal system of dental care.

3.Would urge that the delivery system include the SCHIP kids.

4.Would also urge that the delivery system include kids through age 20 years of age.

Continues though the bill and points out items that he agrees with and items that may need a slight change.

057

Chair Westlund

Would like to clarify that he stated that every square inch of this state is covered by a Managed Care Dental System.

059

Hayden

Responds yes, and elaborates.

067

Dr. Mike Shirtcliff

Northwest Dental Services, here to support a bill that supports Managed Care.

133

Chair Westlund

Sends compliments to Dr. Cedric Hayden and Dr. Mike Shirtcliff and appreciates all that they have done.

145

Shirtcliff

Makes comments about dentistry being considered health care.

156

Tom Holt

Oregon State Pharmacists Association, coming here with concerns about the drug portion of this bill and states the sections that they are most concerned with.

200

Chair Westlund

Disagrees with his interpretation of this and understands that they just got this bill and elaborates.

223

Rep. Merkley

Asks about his first comments related to the fact that their no rebates under managed care, very you speaking to a particular provision in this bill.

233

Holt

Referring to the overriding Federal rebate law.

239

Rep. Bates

Fleshes out what the policy decision was.

262

Holt

Would agree, given all the existing laws & regulations in Oregon and took the same set of drugs in managed care and the same for fee for service, you would have a lot more tools for management in managedcare and that is a policy decision for all of you.If you allow to have management tools in fee for service, we believe you would come out ahead of the game.Comments on the language on Page 5 line 19 talking about bulk purchasing.

319

Chair Westlund

Thanks Tom for his testimony and calls the next witness.

340

Damiana Merryweather

Oregon Advocacy Center, presents testimony (EXHIBIT D) and begins presentation pointing out that section 1 subsection 4 does not have everything that it needs in it.

346

Chair Westlund

Has trouble envisioning a child with unique medical needs could be in a very rural community and that most of them would be transported to OHSU.

356

Rep. Bates

Asks if she has any examples of a family of the child that is enrolled in a managed care plan the family wanted a specific physician or a treatment that was not available through the plan and the plan would not make the referral for them.

365

Merryweather

Makes note that this is not her expertise and elaborates the issue to the best of her knowledge.

398

Jim Garnder

PhRMA, commends the committee on their work on this bill and states his feeling and concerns and issues about this bill.

TAPE 98, B

005

Chair Westlund

Wants the record to state that there was a lot of people working on this bill including Jim.

010

Gardner

Continues presentation.

065

Chair Westlund

The question is not how you buy drugs at the lowest price, it is how do produce drug utilization at the lowest cost.

087

Rep. Merkley

Asks if they can explain why is it that the Federal law has this rebate provision related to managed care and is this something we can apply for a waiver for.

101

Chair Westlund

Give an explanation of the Federal law to the best of his ability.

106

Rep. Bates

Gives more elaboration to provide a better understanding of this Federal law.

124

Rep. Greenlick

Takes a shot at explaining the Federal law to Rep. Merkley.

134

Rep. Merkley

Could you elaborate on your concerns with section 6.

140

Gardner

Elaborates on his concern with section 6.

159

Rep. Greenlick

Comments that at one point we had a proposal that said if you managed everything we will not capitate you for drugs, but we will capitate you for everything else and will pay you a fee for managing a drug program, he heard the physicians have to be a dollar risk for this and frankly he feels that this is not true, and asks is there some structural problem that you have with this.

173

Gardner

Responds yes, if you donít have a management inside of a risk environment it is the same problem of carving out the drug benefit for the fully capitated drug plan and elaborates.

187

Rep. Greenlick

Makes comments about financial risks and non financial risks.

202

Vice Chair March

Makes comments for clarification.

209

Rep. Greenlick

Wonders why we donít experiment with the other model, if it worked it may allow you to get both.

215

Gardner

Comments that it is a lot of money, but if there is a collaborative way to break even we should try.Continues presentation.

235

Barney Speight

Begins presentation and would like to make a couple of comments about what he has heard and didnít hear tonight.Would like to point to the provisions of the bill that provide greater flexibility in the concept of managed care primarily the issue of physician care organizations.

265

Chair Westlund

Would like to point out this may be the first step to getting into a fully capitated situation.

269

Speight

Continues presentation.

319

Chair Westlund

Makes comments to strengthen Mr. Speightís words.

345

Rep. Merkley

Would like to recap the fundamental story to make sure he has heard all of this correctly.

364

Speight

Comments that, that is a fair summary and gives more elaboration about the Kaiser Permanente System.

TAPE 99, B

002

Rep. Greenlick

Makes comments about the risks.He believes that in a well managed Individual Physician Association you could get the physician behavior changed even though the risk was not there.Is it his experience that the model could work without direct risk or a little bit of performance risk.

030

Speight

Comments that in the management of pharmaceuticals risk can be important, but the support that the physician community feels that it has over balancing good clinical care verses some external cost factor, and then how you manage the drugs makes the physicians feel more included in the process.

059

Chair Westlund

Comments that these are the issues we need to flesh out a little bit.

063

Speight

Comments that if there is doubt on the section six concepts maybe we should enter into a some limited demonstration areas and test the policies and see if they have merit, maybe that would be one more option.

080

Rep. Greenlick

Would like to see demonstrations that would allow test of the fully capitated health plans for their members being not capitated for drugs, but doing a section six program to get the maximum rebate.

086

Chair Westlund

Would like them to keep thinking about that and appreciates the suggestions.

098

Gina Firman

Director of the Association of Community Mental Health Programs would like to ask one clarifying question and make a couple of comments:As you know there is a Mental Health Organization (MHOís) in each county and this bill is peppered with the language that the intent would be to put MHOís out of business and asks if that is the intent.

111

Rep. Bates

The intent of this bill is to stay away from Mental Health Organizations if we need to make amendments to this we will and elaborates.

122

Firman

Makes some additional comments on the language in section 1 4a, and section 6.

142

Rep. Greenlick

Asks if this is for persons on the fee for service and not the fully capitated.

146

Rep. Bates

He believes her concerns are the same throughout and comment that one of the processes that we are going through is to have a lot of people looking at this bill so if we have done something we didnít mean to do, we could go ahead and fix that.

147

Firman

Would like to make sure the intent is clarified.

155

Rep. Greenlick

You said something about wanting to use the experience of fully capitated health plans and their relationships with MCO in the context of commenting on 1a, what would make you think in 1a that if an MCO was managing a fee for service population rather than a fully capitated health plan population they would not be able to use whatever links they would have to the MCO, ask what is troubling you about this.

171

Firman

Has concern that their partnership with Department of Human Services could be in jeopardy.

173

Rep. Merkley

Asks how does Mental Health interface with this structure.

181

Rep. Bates

Responds to how Mental Health Services interface with this structure.

195

Rep. Merkley

Without the background of this issues, how does someone know that Mental Health is not included in this bill.

204

Rep. March

Believes that there is other sections stated in the ORS that deals with Mental Health.

210

Rep. Greenlick

Makes comments that we are not necessarily dealing with mental health services right, we are talking about services for the severely and chronically mentally ill.You are dealing within this services a variety of ongoing mental health services for people that are not so severely disabled.

215

Lynn Read

Administrator for the Office of Medical Assistance Programs within the Department of Human Services.Thanks the committee for all of their work on this bill.Presents testimony and begins presentation. (EXHIBIT E)

270

Ellen Lowe

Consumer representative, has a few brief comments, she is in support of coordinated care and begins presentation.

 

Chair Westlund

Comment that he appreciates all of the work Ellen did in the work group, thanks her for being our conscience.

400

Rep. Merkley

When you are talking about access to services, is it just a matter of being referred to appropriate specialists or is it being able to continue with a specialist that works with ones specific problems.

405

Lowe

Comments that she was referring to ones specific problems and elaborates.

414

Rep. March

Thanks Ellen for all of her work in the Capitol.

TAPE 100, A

017

Scott Gallant

Oregon Medical Association, makes comments about his membership and talks about the climate in Oregon that is not different than other states because of our economic time.Comments what is not being said about this bill is that other committees in this building may have to address other major components that will be the potential engine to have a system to deliver services to Oregonians that may not have an easy access to needed services.

034

Chair Westlund

Would like to flush out his comments and talk about the foundation that we are working on.

060

Gallant

Would like to mention fundamental issues about this bill.

  1. Physician capacity.
  2. Page 2 line 14, the elimination of providing the cost of care.
  3. The Medical Association have had a policy for years that multiple payment systems are a good thing, you should not drive them to one arena.

151

Chair Westlund

Appreciated working with Scott and comments that we will continue to talk and talks about the cultural shift that has to take place about he importance of fundamental health care awareness.

172

Rep. Merkley

If the states does not cover those costs, what keeps providers providing those services for fee for service.

181

Gallant

Comments that medical professionals have an obligation to treat Oregonians and will cost shift to make sure that those patients are taken care of.

197

Rep. Merkley

You donít think this will create a problem and that we are ok making this change, when you pointed out this language I assumed you thought this was a problem.I was assuming that you thought the problem was that under paid physicians will mean people canít get access to services.

209

Rep. Bates

The first part of the questions is do physicians get paid better in fee for service or managed care, and makes comments as a physician.Comments that there is an underlying problem, one that we certainly pay for our road to be paid at full cost and other needs of the state at full cost, for some reason we have chosen not to do that with medicine and have this cost shifted to the people who are buying health care, physicians do not shift it, when they take on these patients they take a decrease in income to do so and unhappily there are some physician that choose not to take these patients and elaborates what happens when they do so.

246

Gallant

Would like to make a couple of additional comments and would love to have a discussion of the medical world at another time.

292

Rep. Greenlick

Would like to second what Scott Gallant said about the policy issue and would like to comment about the other piece that OHP regarding to getting people covered.

326

Gallant

Comment that the Oregon Medical Association has had a long standing policy about universal access to medical services which is different that a constitutional mandate to health care benefits.Makes his final comments.

390

Chair Westlund

Makes closing comments and calls meeting to a close and adjourns 8:24 pm

 

 

EXHIBIT SUMMARY

 

A Ė HB 3624, Staff, 2 pp

B Ė HB 3624, written testimony, Karen Whitaker, 2 pp

C Ė HB 3624, written testimony, Ed Patterson, 1 p

D Ė HB 3624, written testimony, Damiana Merryweather 1 p

E Ė HB 3624, written testimony, Lynn Read, 13 pp