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 1st 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.