HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

February 24, 2003 Hearing Room D

8:30 A.M. Tapes 32 – 33

MEMBERS PRESENT: Rep. Jeff Kruse, Chair

Rep. Billy Dalto, Vice-Chair

Rep. Carolyn Tomei, Vice-Chair

Rep. Gordon Anderson

Rep. Jeff Barker

Rep. Laurie Monnes Anderson

MEMBER EXCUSED: Rep. Ben Westlund

STAFF PRESENT: Sandy Thiele-Cirka, Committee Administrator

Mara McGraw, Committee Assistant

ISSUES HEARD: INFORMATIONAL MEETING

· Overview of Oregon Medical Assistance Program (OMAP)

Lynn Read, Administrator, OMAP

Joan Kapowich, Manager, Program and Policy Section

Ruby Haughton, CareOregon

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 32, A
005	Chair Kruse	Calls meeting to order at 8:39 A.M. and opens informational meeting.
INFORMATIONAL MEETING
017	Lynn Read	Administrator, Office of Medical Assistance (OMAP). Submits written testimony on changes to Oregon Health Plan (OHP) (EXHIBIT A). Begins presentation regarding January 2003 reductions.
038	Chair Kruse	Inquires on number of people impacted by changes.
042	Rep. Monnes Anderson	Inquires on effectiveness of co-pay policy.
044	Read	Explains co-pay policy. Reports there is no systematic co-payment data collection method.
056	Joan Kapowich	Manager, Program and Policy Section, OMAP. Discusses provider survey regarding co-pay policy. Relates success in collection of co-pay fees.
065	Read	Continues presentation on January changes. Explains OHP’s February changes (EXHIBIT A-p 1). Reports expanded prenatal coverage.
080	Rep. Monnes Anderson	Inquires on cost to General Fund.
081	Read	Provides figures.
097	Chair Kruse	Estimates cost of expansion to General Fund.
100	Read	Approximates cost figure. Continues discussion of February changes. Explains OHP2 mandatory fee-for-services.
125	Chair Kruse	Inquires on physician and specialist co-pay policy.
128	Read	Defines co-pay fees for OHP Standard and OHP Plus.
132	Rep. Tomei	Inquires on application of policy to client population.
133	Read	Explains eligible populations.
143	Rep. Tomei	Clarifies coverage not covered by Medicaid.
146	Chair Kruse	Inquires on impact of co-pays in the future.
151	Kapowich	Informs OMAP Has not yet developed a structure to acquire data.
158	Chair Kruse	Comments on cost shift and need for data to establish success of fee-for-service policy.
172	Read	Further explains co-pay policy regarding provider obligation to offer services regardless of collection of co-pay.
188	Chair Kruse	Restates need for estimates on policy impact as it relates to possible cost shift.
204	Read	Explains two month timeline for claims processing. Continues presentation on February changes to OHP (EXHIBIT A-page 1). Explains changes in client premium payment policy.
232	Chair Kruse	Points out exception process for premium payments is broad.
237	Read	Explains OHP2 excludes exception process for premiums. Explains policy regarding uninsured status. Details delays in expansion of clients at a higher income level. Defines senior prescription drug assistance program. Reports level of pharmacy participation.
308	Rep. Monnes Anderson	Inquires on annual fee charged to seniors for program participation.
310	Read	Explains application process for senior prescription program. Discusses elimination of General Assistance program (GA) as it relates to medical coverage for persons with disabilities.
352	Chair Kruse	Inquires on cost difference between coverage of OHP Plus or GA clients.
358	Read	Explains cost for medical coverage is same regardless of categorization with GA or OHP Plus.
401	Chair Kruse	Request clarification on rule change for GA clients rolled into OHP Plus program.
407	Read	Explains rule changes and litigation regarding presumptive eligibility.
418	Chair Kruse	Inquires on time frame clients receive GA versus OHP Plus.
427	Read	Further relates process of eligibility in regard to GA and SSI and resulting medical benefits during eligibility assessment process.
TAPE 33. A
005	Read	Continues explanation of GA presumptive eligibility. Discusses elimination of Oregon Project Independence (OPI) (EXHIBIT A- page 2).
027	Rep. Monnes Anderson	Requests tracking the OPI client status in relation to Medicaid eligibility.
032	Read	Defers tracking to Seniors and People with Disabilities (SPD), Department of Human Services (DHS).
036	Chair Kruse	Estimates percent of OPI clients eligible.
037	Read	Reports minimal OPI client eligibility for OHP2. Discusses OHP changes for seniors and people with disabilities at specific levels of care. Continues with February changes to OHP (EXHIBIT A-page 2).
068	Chair Kruse	Inquires on marketing of new policies and programs.
075	Kapowich	Reports active promotion of new programs.
084	Chair Kruse	Further questions outreach to clients dropped from OHP coverage.
092	Read	Explains broad based outreach did not occur. Explains other outreach efforts.
104	Chair Kruse	Comments on offering service alternatives simultaneously with OHP termination notice.
113	Read	Reports on diverted safety-net funds. Explains OHP changes for March 2003 (EXHIBIT A-page 2).
132	Chair Kruse	Inquires on partners involved in determining list of cuts.
137	Read	Explains prioritized list established by the Health Services Commission. Explains changes in coverage listed in prioritized order.
151	Chair Kruse	Comments prioritized list versus benefit package model.
178	Read	Explains changes in eligibility date in regard to payment of provider services.
197	Chair Kruse	Notes policy is a cost shift.
209	Rep. Monnes Anderson	Inquires on impact to safety-net clinics.
220	Read	Explains eligibility date regarding OHP Standard versus OHP Plus. Explains largest impact will be on hospitals, followed by safety-net clinics.
229	Rep. Anderson	Comments on client delay in seeking services until eligibility date.
239	Chair Kruse	Reiterates cost shift during emergency services.
243	Rep. Monnes Anderson	Comments on planning for coverage as a behavior change.
253	Read	Explains provider reimbursement changes (EXHIBIT A-page 2). Explains implementation will not occur by March 1^st 2003.
267	Chair Kruse	Question choice of 17% average wholesale price (AWP) reduction figure.
274	Read	Explains the 17% figure relates to the average acquisition cost for single source, innovator brand drugs.
306	Chair Kruse	Expresses concern over drug chains dropping out of program.
310	Read	Explains mail order pharmacy rate at 21% and 60% reductions.
326	Rep. Barker	Inquires on mailing of Schedule II drugs.
328	Read	Explains Schedule II as controlled substances/narcotics.
342	Chair Kruse	Inquires on implementation date of program.
345	Read	Explains implementation will be postponed until federal approval. Reports impact on budget for postponing implementation. Explains hospital reimbursements (EXHIBIT A-page 2).
379	Rep. Monnes Anderson	Inquires on Diagnosis Related Group (DRG) hospital definition.
385	Read	Defines DRG, Type A and B hospitals. Explains changes in reimbursement for hospital types. Reports delay in implementation.
414	Chair Kruse	Questions process for change in rules regarding DRG hospitals.
418	Kapowich	Reports dates of hearings and rule changes regarding reimbursement.
431	Chair Kruse	Comments on hearing process for rule changes regarding hospital reimbursement.
449	Read	Reports DRG hospital reimbursement will move forward as scheduled.
468	Chair Kruse	Comments on statutory restraints and fixed provider reimbursement.
TAPE 32, B
040	Rep. Anderson	Questions flow of patients to major hospitals due to reimbursements.
044	Read	Explains patient flow to rural hospitals will not be affected. Explains payments will be made and legislature determines rate via statute.
054	Chair Kruse	Comments bill has not yet been scheduled.
058	Read	Refers to SB 819 in regard to prior authorization requirements for prescription drugs and fee-for-services program (EXHIBIT A-page 2). Defines drug authorization process.
088	Chair Kruse	Inquires on authority to move to prior authorization for fee-for-service.
090	Read	Explains authority to change to prior authorization. Details April 2003 changes (EXHIBIT A-page 3).
114	Chair Kruse	Inquires on Ways and Means process to make adjustments thus preventing loss of coverage.
123	Read	Reports elimination of Part B premiums will not be implemented. Explains changes in service for May 2003 (EXHIBIT A-page 3). Explains previous “pay and chase” policy as it relates to change in fee collection.
157	Chair Kruse	Inquires on percent of population impacted by change.
159	Kapowich	Offers cost savings figure.
162	Chair Kruse	Establishes that accounts were previously collected and policy allows for faster collection.
168	Read	Explains increased return rates of new policy. Explains changes related to Governor’s Technical Balanced Budget (EXHIBIT A-page 3).
186	Chair Kruse	Comments on utilization of services.
191	Rep. Anderson	Comments Technical Balanced Budget excludes prevention.
206	Read	Reports efforts in prevention.
211	Rep. Tomei	Inquires on smoking cessation programs.
216	Read	Reports on smoking cessation programs via OHP.
248	Ruby Haughton	Legislative and Public Affairs Director, Care Oregon. Offers organizational overview. Explains actions taken due to changes in OHP coverage. Relates impact on Care Oregon staff and its clients.
316	Rep. Monnes Anderson	Inquires on remaining client population.
318	Haughton	Reports 70-75,000 clients remaining after changes implemented. Explains figure is all OHP Plus clients.
322	Rep. Barker	Inquires on ability to sustain compassionate care programs.
329	Haughton	Relates compassionate care program is not expansive enough to handle client shift.
342	Rep. Anderson	Inquires on employees cut.
343	Haughton	Explains 22 of 130 were laid off.
345	Chair Kruse	Inquires if Care Oregon will survive reductions.
349	Haughton	Explains financial impact on Care Oregon and possibility that agency will not survive changes.
382	Chair Kruse	Defines categorical coverage. Inquires how categorical cliental will impact Care Oregon.
399	Haughton	Explains adverse selection of client population due to changes in coverage. Comments clients cut now may return at later time due to progressive deterioration of their condition.
429	Rep. Monnes Anderson	Comments on cost shifting.
445	Rep. Tomei	Inquires on transplant patients’ eligibility for OHP.
456	Haughton	Relates elimination of medication will result in severe disability making client eligible for OHP Plus. Relates cost for vulnerable patients in a fee-for-service environment.
TAPE 33, B
034	Rep. Anderson	Inquires on DHS staffing reductions.
035	Read	Explains DHS staff cuts and hiring freeze.
041	Chair Kruse	Announces meeting on 2/28/03 regarding Pharmaceutical Industry and prescription drug programs.
058	Rep. Anderson	Submits written testimony from Ray Whittemore (EXHIBIT B).
063	Chair Kruse	Closes informational meeting and adjourns at 10:18 A.M.

EXHIBIT SUMMARY

A – Informational, prepared testimony, Lynn Read, 3 pp.

B – Informational, prepared testimony, Ray Whittemore, 2 pp.