HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

 

February 26, 2003   Hearing Room D

8:30 A.M. Tapes 34 – 36

 

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

Rep. Ben Westlund

 

STAFF PRESENT:                  Sandy Thiele-Cirka, Committee Administrator

Mara McGraw, Committee Assistant

 

ISSUES HEARD:                     INFORMATIONAL MEETING

·         Overview of Seniors and People with Disabilities, Department of Human Services (DHS)

                                                            James Toews, Deputy Assistant Director, DHS

Cathy Cooper, Acting Deputy Assistant Director

Julia Huddleston, Administrator of Rate Setting

                                                OTHER INVITED TESTIMONY

Jacqueline Zimmer-Jones, Director, Oregon Association of Area Agencies on Aging and Disabilities (O4AD)

John DeGroot, Director, Senior and Disability Services Division, Douglas County Health and Social Services Department

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 34, A

005

Chair Kruse

Calls meeting to order at 8:39 A.M. and opens informational meeting.

INFORMATIONAL  MEETING

014

James Toews

Acting Assistant Director, Senior and People with Disabilities (SPD), Department of Human Services (DHS).  Submits overview packet (EXHIBIT A).  Offers organizational and legislative history of SPD.  Explains structural types A, B, and C which provide local control over service delivery system.    

093

Chair Kruse

Comments on three administration structural types.

100

Toews

States effectiveness at local level. Addresses issues of equity as a barrier to structural coordination. 

135

Chair Kruse

Comments on counties of significant population and questions Medicare.

142

Toews

Responds Medicare is not included in the SPD budget.

146

Chair Kruse

States Medicare as disconnect in the coordination of the service package. Questions Medicaid dollars.

162

Rep. Monnes Anderson

Questions reasons smaller counties have not combined.

171

Toews

Explains local planning evolved over number of years. Addresses Medicaid service issues in small counties. Restates issues of equity related to consolidation. Explains rural communities concerned with getting absorbed by large multi-county agencies. 

270

Toews

Continues overview of Medicaid program (EXHIBIT A). Addresses issues related to use of survival levels as a method of budget reduction.  Reports renegotiation of federal Medicaid waivers. Explains budget caps prevent growth for new newly eligible clients in the 2003-05 biennium.   

342

Chair Kruse

Inquires on Medicaid clients that are Medicare eligible.

345

Toews

Reports figure at 40 percent.

356

Chair Kruse

Questions Medicaid clients that are Social Security Insurance (SSI) eligible.

373

Toews

Explains clients are Social Security Disability Insurance (SSDI) eligible. Reports impact of objective income standard across eligibility assessment. 

406

Rep. Monnes Anderson

Requests clarification of SSI and SSDI.

412

Julia Huddleston

Administrator, Office of Rate Setting, SPD, DHS.  Explains income differences for eligibility between SSI and SSDI.  Details waiver standard to qualify for services.

435

Toews

Reports income standards for long term care services. Details multiple eligibility standards which confuse providers and clients.

472

Rep. Tomei

Inquires on impact of home ownership and Medicaid eligibility.

TAPE 35, A

024

Toews

Explains Medicaid assets assessment.

041

Rep. Tomei

Clarifies General Fund and total fund figures.

042

Toews

Concurs with Rep. Tomei’s.

045

Chair Kruse

Requests detailed explanation of budget reductions.

048

Rep. Anderson

Question reversal of numbers in bold (EXHIBIT A).

053

Toews

Reviews levels 10-14 and staffing for medically needy program restored. Explains areas in which reductions are falling short of target and subsequent impact on current budget.

094

Chair Kruse

Inquires on impact if federal government does not approve the waivers.

102

Toews

Reports state transition steps in reductions. Explains federal fund match. Reports on approval of specific levels. 

128

Chair Kruse

Comments on potential litigation and costs of shifts to long-term care.

138

Toews

Reports cuts impact on current long-term care.  Explains Medicaid core service requirements.  Details impact of service shifts on other public and private service systems. 

187

Rep. Westlund

Questions specificity in client survival levels. 

211

Cathy Cooper

Acting Deputy Assistant Director, SPD, DHS. Explains training and qualification of staff in regard to evaluation. Describes standardized, computerized assessment tool. Explains comprehensive assessment techniques and discusses the eligibility levels.

258

Toews

Discusses SPD tracking of level shifts in eligibility. Notes tool was intended as diagnostic not elimination tool.

281

Rep. Westlund

Requests data on success of eligibility assessments.

285

Cooper

Explains field review process and other tracking measures to ensure proper evaluation of clients. 

304

Rep. Westlund

Inquires on misevaluation.

305

Cooper

Reports misevaluations are infrequent.

316

Rep. Westlund

Inquires on dementia in regard to survival levels.

327

Cooper

Discusses staff training in determination of areas of cognition. Relates shift to level 3 for clients assessed with cognitive issues.

355

Toews

Addresses revamp of service delivery rules in regard to cognition factors. 

420

Rep. Tomei

Inquires on objective criteria in defining levels.

432

Cooper

Restates use of detailed computerized assessment l that provides specific criteria for eligibility.

TAPE 34, B

028

Rep. Dalto

Inquires on reclassification of priority service levels.

036

Cooper

Offers figures of clients reassessed to higher levels and removed from services.

044

Rep. Anderson

Questions payments for different levels.

049

Huddleston

Explains levels are eligibility criteria. Reports the type of care determines payment level. 

059

Toews

Explains payment is also determined by supports available to client.

077

Rep. Anderson

Requests figure on client to case manager ratio.

080

Cooper

Explains case management ratios are determined by type of care setting.  Reports average ratio at 1:90.

092

Rep. Anderson

Inquires on evaluation timeline.

093

Cooper

Reports evaluations are annual with some exceptions.

097

Rep. Anderson

Inquires if care provider information is included in assessment process.

102

Cooper

Explains mandated independent annual financial and service assessment. Points out assessment rely on records of long-term care facility.

116

Rep. Barker

Comments on level adjustments via normal progression in end of life.

132

Rep. Monnes Anderson

Remarks on challenge of level assessments.  Comments on case load. 

152

Toews

Responds to concerns over work load and staff issues. 

163

Chair Kruse

Requests SPD organizational flow chart of staff and full time equivalency (FTE). 

182

Cooper

Notes direct funding data not included on organizational flow chart.

OTHER INVITED TESTIMONY

210

Jacqueline Zimmer-Jones

Director, Oregon Association of Area Agencies on Aging and Disabilities (O4AD). Submits system overview (EXHIBIT B).  Reports effort to stabilize population. Summarizes packet materials.  Discusses HB 2287 and HB 2288, the equity gap.

360

Zimmer-Jones

Continues presentation on service changes to seniors and people with disabilities. Presents Oregon Project Independence (OPI) profile.  Relates loss of services to clients with loss of staff. Addresses workload simplification. Reports on veteran’s services pilot program. 

TAPE 35, B

040

John DeGroot

Director, Senior and Disability Services Division, Douglas County Health and Social Services Department. Discusses statewide policy on local service delivery. Addresses rural participation in senior service delivery system. 

100

Zimmer-Jones

Speaks to expansion of local services and the equity issue. 

113

DeGroot

Addresses integration of medical and long-term care services via coordination of administration. Speaks to eligibility tools and systems changes in service delivery. 

218

Chair Kruse

Explains reasoning for Medicaid questions. Inquires on Douglas County status as B1 (EXHBIT A).

239

DeGroot

Discusses integrated model of care for seniors in Douglas County.  Reiterates issue of equity in county administration of state programs. 

331

Chair Kruse

Questions placement of counties in service delivery types (EXHIBIT A).

353

Cooper

Responds in Washington County service delivery is contracted. 

366

Chair Kruse

Inquires on Marion County type assignment.

372

Zimmer-Jones

Explains reorganization in terms of state contracts with county agencies.

367

DeGroot

Explains concerns on part of local governments in regard to reorganization. 

406

Zimmer-Jones

Comments on integrated services as compared to other states. 

TAPE 36, A

011

Chair Kruse

Closes informational meeting and adjourns at 10:29 A.M.

 

EXHIBIT SUMMARY

 

A – Informational, SPD Overview, James Toews, 12 pp.

B – Informational, Oregon Long Term Care System Overview, Jacqueline Zimmer-Jones,    

       34 pp.