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.