HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

 

January 22, 2003   Hearing Room D

8:30 A.M.     Tapes 5 – 8

 

MEMBERS PRESENT:            Rep. Jeff Kruse, Chair

Rep. Billy Dalto, Vice-Chair

Rep. Carolyn Tomei, Vice-Chair

Rep. Laurie Monnes Anderson

Rep. Gordon Anderson

Rep. Jeff Barker

Rep. Ben Westlund

 

STAFF PRESENT:                  Sandy Thiele-Cirka, Administrator

Mara McGraw, Assistant

 

ISSUES HEARD:                     Informational Meeting

·         Continuation of DHS Overview

·         HB 5100 Reduction Implementation

                                                Public Comment

·         HB 5100 and DHS Budget Reductions

 

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 5, A

005

Chair Kruse

Chair calls meeting to order at 8:32 A.M. and opens informational meeting.

INFORMATIONAL MEETING

006

Chair Kruse

Reports no meeting scheduled for January 24, 2003. Notes revised matrix submitted by Department of Human Services (DHS) (EXHIBIT A).

023

Barry Kast

Assistant Director for Health Services, DHS. Discusses results of reductions in Oregon Medical Assistance Programs (OMAP) and Health Services, DHS. Highlights relationships between significant reductions (EXHIBIT A). 

048

Chair Kruse

Refers to loss of federal revenue (EXHIBIT A).

052

Lynn Read

Acting Administrator, OMAP, DHS. Offers clarification of difference between federal and General Fund and potential savings.

059

Kast

References Jean Thorne’s 1/20/03 testimony. Offers brief history on reductions (EXHIBIT A). Explains connections reductions have to first response and emergency services.  Continues discussion on:

  • methadone clinic closures;
  • elimination of medically needy program;
  • elimination of mental health drugs for OHP standard program;
  • children’s mental health;
  • school districts providing services via other funds;
  • closure of school based health center;
  • alternative revenue sources; and
  • Statistics on access to services.

153

Chair Kruse

Refers to certification issue discussed at 1/20/03 meeting.

155

Kast

Continues presentation. Notes reduction in access to safety net programs.  Discusses postponements in opening services until next biennium.

184

Read

Explains reductions related to OMAP (EXHIBIT A), voluntary co-pay regulations for clients and access issues.

216

Rep. Monnes Anderson

Inquires about tracking for data reported.

221

Read

Responds and elaborates on payment structure.

230

Rep. Dalto

Requests clarification on statistics.

233

Read

Responds DHS has only anecdotal information. Refers to elimination of service levels on OHP priority list and the federal restrictions regarding changes to priority levels.

251

Kast

Continues review of (EXHIBIT A).

331

Rep. Tomei

Requests clarification on state funds cut from the Office of Consumer Technical Assistance.

333

Kast

Clarifies state funding as it relates to program closure.

335

Rep. Dalto

Questions services offered by the Office of Consumer Technical Assistance.

338

Kast

Explains and identifies supports services and explains Office of Consumer Technical Assistance. Continues presentation (EXHIBIT A). 

389

Rep. Monnes Anderson

Inquires on county funds and discretion in providing services regarding acute care versus extended care.

399

Kast

Responds and explains types of financing and relationship to providing services. Continues presentation (EXHIBIT A).

480

Rep. Dalto

Requests information regarding patient options. 

486

Kast

Defers to testimony later in meeting on day treatment centers.  Offers information on service alternatives.

500

Rep. Anderson

Requests differentiation regarding reductions.

503

Kast

Explains day treatment and free standing education programs as they differ from residential treatment programs.

516

Rep. Anderson

Clarifies cost per patient.

TAPE 6, A

050

Kast

Explains difference in cost related to patient slots matched or unmatched by Medicaid.

055

Rep. Anderson

Clarifies time period.

057

Rep. Dalto

Readdresses impact of cuts on patients who lack service alternatives.

059

Kast

Reports school obligation to provide services and cuts as a cost shift to education.  Details cooperation between education and DHS.  Describes written format to mitigate reductions.  Refers to litigation and explains postponement of reduction implementation until negotiations are concluded.  Explains items 22-24 (EXHIBIT A).

116

Chair Kruse

Remarks on legislative decision to define administrative parity.

118

Rep. Barker

Inquires on elimination of all emergency mental health services.

121

Kast

Concurs emergency mental health programs eliminated. Explains clients must now access services via 911 or hospital emergency rooms.

130

Rep. Dalto

Requests information specific to Salem regarding the closure of emergency mental health service.

132

Kast

Discusses Salem services and alternative sources of revenue for emergency services. Continues review of (EXHIBIT A).

187

Read

Elaborates on the medically needy program. Explains Oregon Health Plan 2 (OHP2). Continues review of (EXHIBIT A).

248

Rep.  Westlund

Inquires on number of people included as a result of the prenatal care expansion.

249

Read

Reports expansion. Discusses relationship of cuts to new OHP standard program and assistance with Medicare part B premiums.  Elaborates on prescription drug coverage offered via medically needy program not offered via Medicare.

295

Rep. Dalto

Questions alternatives for clients who don’t qualify for medically needy program.

298

Read

Explains privately funded alternatives and Medicare options.

351

Kast

Expands on available services for prescription drug support. 

363

Read

Adds information regarding additional funds for antipsychotic prescriptions. References potential extension of pharmacy mail order program. Continues review (EXHIBIT A).

414

Chair Kruse

Questions federal connection to safety-net clinics.

415

Read

Clarifies combination of federal and other safety-net clinics. 

424

Rep. Dalto

Requests overview of safety-net system. 

428

Chair Kruse

Invites committee members to sit with audit committee for more information.

444

Read

Explains OMAP start up programs and reductions referenced in items 2-5 (EXHIBIT A). Notes percentage of OHP chemical dependency budget expended on populations listed in items 2-5 (EXHIBIT A). Continues presentation

TAPE 5, B

060

Chair Kruse

Requests clarification regarding relationship to previous reductions.

062

Read

Defines relationship regarding inpatient and outpatient reimbursement reductions in both areas. 

071

Rep. Westlund

Requests clarification on item 5 (EXHIBIT A).

078

Read

Clarifies statistics for alcohol and drug treatment costs. Continues review (EXHIBIT A).

105

Chair Kruse

Notes committee will discuss last page at later date (EXHIBIT A).  Inquires on item 12 (EXHIBIT A) as it relates to legislation or rule.

111

Read

Explains implementation under existing statutory authority and rule.

113

Chair Kruse

Closes informational meeting and open public hearing.

PUBLIC HEARING – HB 5100 Reductions

136

Rep. Tom Butler

House District 60. Introduces self and constituents testifying. Reviews constituent concerns.

172

Cathleen Sullivan

Administrator, Presbyterian Community Care Center and Vice-President of Nursing Services for Oregon Alliance of Senior and Health Services (EXHIBIT B). Discusses proposed rate cuts on facilities in Eastern Oregon. Describes Medicaid funding of rural facilities, the current private pay system and the revenue shortfall due to Medicaid reduction.

253

Rep. Dalto

Clarifies the cost shifting of private pay to Medicaid patients.

258

Sullivan

Concurs.

262

Rep. Monnes Anderson

Asks for statistics on overall budget and residents served.

263

Sullivan

Provides budget and resident data.

268

Rep. Westlund

Requests information on Medicare reduction and translation into dollars per day.

271

Sullivan

Explains losses per month.

278

Rep. Westlund

Requests clarification on numbers.

279

Sullivan

Reports average number of Medicare patients.

284

Rep. Anderson

Inquires on cost to private patients in facility.

286

Sullivan

Provides cost figures. Explains average monthly cost as lower than others in state.

297

Ruth Gulyas

Executive Director of Alliance of Senior and Health Services. Reiterates and underscores cuts to senior programs. Submits patient’s personal stories.

330

Les Busch

Assistant Professor at Oregon Health and Sciences University (OHSU) Children’s Psychiatric Day Treatment Center. Preferences testimony with relationship to item 18 (EXHIBIT A). Discusses day care, day treatment, patient population and administrative rules.

359

Chair Kruse

Inquires as to acute risks population poses to self or others.

261

Busch

Describes current services and population. Explains result of cuts and impact on program and patients. Explains relationship of cuts to Medicaid eligible patients.

412

Stan Gilbert

Executive Director of Klamath Youth Development Center and Executive Administrator of DARTS program. Details (EXHIBIT C):

  • map of programs distributed throughout state;
  • graph detailing psychiatric day treatment programs and connection to system of care;
  • population of community and non-community programs;
  • alternatives and lack of services for patients;
  • shifts to more costly programs;
  • severity of need for patients requires treatment;
  • non-mental health handicapping conditions that require services; and
  • post treatment outcomes.

Points out facility is test site for new national assessment tool. Defines positive outcomes resulting from services provided.

TAPE 6, B

056

Rep. Monnes Anderson

Comments on graph regarding dual diagnosis and fetal alcohol and drug effected children (EXHIBIT C).

067

Rep. Anderson

Requests data on recidivism rates.

070

Gilbert

Defines recidivism rates

080

Rep. Dalto

Inquires on gender disparity.

085

Gilbert

Describes system wide issue regarding disparity.

102

George Longden

Executive Director of Family Friends. Describes program and budget reductions. Relates relationship of staff lay offs to future challenges in recruiting quality staff.

162

Gilbert

Reiterates importance of programs in rural area to maintain community and family involvement.

181

Linda Ellis

SSDI recipient. Details personal income and reviews prescription costs and loss of benefits. Describes medical conditions and prescriptions.   

250

Rep. Dalto

Comments on lack of DHS presence for personal testimony.

256

Ellis

Elaborates on experience with case management and visits to Capitol.  Details understanding that disability payments and notes concern over prescription subsidies for multiple medications.

363

Don Keister

Director of Providence Elder Place (PEP). Describes program, eligibility and impact of cuts (EXHIBIT D).

TAPE 7, A

027

Keister

Reads personal stories of PEP patients (EXHIBIT D).

153

Cheri Folk

Goodwill Industries. Discusses proposed cuts to people with disabilities.  Refers to vocational services and loss of support. Discusses challenges in finding work and the desire and motivation to work. Details respite services for client families. Relates personal stories of clients.   

245

Tim Krall

Director of Oregon Rehabilitation Association (ORA). Describes program.  Relates ORA to item 1 (EXHIBIT A).  Introduces clients (EXHIBIT E). 

264

Debbie Wood

Client of ORA. Asks committee to save job.

270

Terry Hughes

Client of ORA. Describes job. 

343

Jeremy Gunn

Recipient of medically needy program. Describes condition and medications related to HIV positive status and impact of cuts in prescription costs (EXHIBIT F). Continues presentation of impact of elimination of services.

491

Rep. Dalto

Requests clarification from chair on medically needy program and relationship to Measure 28.

500

Rep.

Monnes Anderson

Concurs medically needy program is attached to Measure 28.

TAPE 8, A

045

Steve Austin

Executive Director of Marion Estates, Oregon Health Care Association.  Discusses impact of reductions on nursing homes which are dependent on Medicaid funding. Continues discussion on nursing home closures, staffing reductions and service reductions. Describes cuts in assisted living facility and adult foster homes.

162

Rep. Barker

Addresses rural/urban relationship regarding cuts  Refers to spend down that seniors use to access services. 

182

Austin

Remarks on family resources.

190

Karen Gillette

Chair of Coalition of Local Health Officials (CLHO). Presents concern over prenatal activities and 5100 cuts. References 2001 session, Sept 11 events, and relationship to funding gaps in public health improvement programs. Describes services not financed by the bioterrorism funds.

252

Chair Kruse

Questions small pox immunizations.

254

Gillette

Explains identification process in vaccination testing and implementation.

263

Rob Rockstroh

Lane County Community Services. Reviews (EXHIBIT G). Details the Marion County Methadone study on clients similar to the Lane County study. Suggests a revisit of Oregon Health Plan (OHP) and stabilizing alcohol and drug treatment programs. 

TAPE 7, B

022

 

 

 

 

 

 

 

 

 

 

 

 

150

Mary Lou Ritter

Director of Washington County Aging and Veteran’s Services and Chair of Oregon Association of Area Agencies on Aging and Disability (O4AD) legislative committee. Submits written testimony (EXHIBIT H). Reviews the following:

  • professional experience in aging services;
  •  infrastructure for aging and disability services, long term care and insurance;
  • Medicaid as the long term care system;
  • prescription coverage;
  • Oregon joint resolution related to prescription drug issue;
  • foster care and assisted living facilities;
  • cuts from geriatric mental health; and 
  • Oregon Project Independence (OPI) program, clients, and subsidies. 

Discusses:

  • client stories (EXHIBIT I-pink);
  • levels summary (EXHIBIT I-blue); and
  • profiles/case studies of levels (EXHIBIT I-yellow). 

Refers to overall cuts to OPI and closures of rural programs.

223

Karen Stevens

Psychiatric Crisis Center. Describes program, services and client population. Points out the positive impact of program on other acute care programs.

267

Scott Ricker

Clinical Supervisor for Aces Counseling Center. Describes population served and impact of cuts. Describes program and scope of services related to outpatient alcohol and drug programs. Details the patient discharge and relationship to crime Lane County drug court, population served and related reductions.

TAPE 8, B

001

Ricker

Continues presentation on Lane County reductions, staff reductions and program closures. Summarizes presentation.

074

Paul Potter

Regional Director for Addictions Treatment Services at Cascadia Behavioral Health Care. Presents information relating to HB 5100 reductions that will eliminate programs, the impact on outpatient services and the delay of services. Continues overview with explanation of service integration.

215

Elizabeth Byers

Project Equality and Mental Health Association of Oregon. Provides personal testimony. Describes programs and offers several revenue options..   

275

Chair Kruse

Closing remarks.  Closes public hearing and adjourns the meeting at 11:55 A.M.

 

EXHIBIT SUMMARY

 

A – DHS Budget Reduction Actions, B. Kast, 12 pp.

B –Overview, C. Sullivan, 1 p.

C – OATC Testimony, S. Gilbert, 23 pp. 

D – Written testimony, D. Kiester, 3 pp.

E – Photos, T. Krall, 4 pp.

F – Written testimony, J. Gunn, 1 p.

G – Pamphlet, R. Rockstroh, 4 pp.

H – Reductions Summary, M. Ritter, 1 p.

I - Written testimony, M. Ritter, 10 pp.