SENATE SPECIAL COMMITTEE ON THE OREGON HEALTH PLAN

 

May 21, 2003                                                                                                          Hearing Room C

3:00 P.M.                                                                                                                          Tapes 5 - 6

 

MEMBERS PRESENT:         Sen. Peter Courtney, Co-Chair

Sen. Lenn Hannon, Co-Chair

Sen. Jackie Winters, Co-Chair

Sen. Kate Brown

Sen. Margaret Carter

Sen. Bill Fisher

Sen. John Minnis

 

MEMBERES VISITING:      Rep. Alan Bates

Rep. Jeff Kruse

 

MEMBER EXCUSED:          Sen. Bill Morrisette

 

STAFF PRESENT:                 Marjorie Taylor, Committee Administrator

Megan Jensen, Committee Assistant

 

ISSUES HEARD:                   Informational Meeting

                                                    Continuation of Overview of Population

    Population Prioritization Scenarios

    Introduction of Prioritization Benefits

 

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

004

Co-Chair Hannon

Calls meeting to order at 3:00 p.m. Opens informational meeting on Oregon Health Plan (OHP) Population Prioritization.

INFORMATIONAL MEETING

    Continuation of Overview of Population

023

Mike Bonetto

Policy Analyst, Senate Republican Office. Provides an explanation of the Population Prioritization draft plan (EXHIBIT A). Refers to page two and describes the categories.

097

Co-Chair Hannon

Poses question concerning waiver requirements.

110

Bonetto

Explains that any draft plan is based on some sort of revision of the waiver.

115

Co-Chair Hannon

Asks if the green numbers reflect a three or six month waiver.

117

Bonetto

Explains the green reflects the populations to be covered although the cost scenarios are laid out.

120

Sen. Fisher

Asks about the medically needy in the draft plan.

124

Bonetto

Replies that the adults/couples/families category precedes the medically needy category.

130

Sen. Carter

Clarifies the prioritization of the medically needy. 

133

Bonetto

Concurs.

140

Rep. Bates

Inquires about the categorization of the medically needy. States belief it is a category of people who will die if assistance is not received.

148

Bonetto

Responds with the premise behind the prioritization. Notes Medicare was already existent in most cases.

161

Sen. Bates

Speaks on medical support for the medically needy. Does not concur with the prioritization of the medically needy being fourth and not second.

167

Bonetto

Replies concerning the prioritization.

177

Rep. Bates

Suggests that the needs of the people in category four are equivalent to the needs of the people in two.

182

Sen. Fisher

Requests who established the priorities.

185

Bonetto

Explains the scenario was created to initiate discussion and is not an actual prioritization plan.  

192

Sen. Fisher

Remarks on the testimony.

195

Sen. Carter

Notes the presentation was to simplify information and promote discussion on the issue.

201

Co-Chair Hannon

Speaks on the scenario being for discussion purposes. Notes it is up to the committee to narrow focus and determine finality.

218

Sen. Fisher

Asks where the categories denoted on page one of EXHIBIT A went with respect to the prioritization on page two.

220

Bonetto

Answers it is incorporated into the pregnant women package.

232

Co-Chair Courtney

Remarks on prioritization.

245

Co-Chair Hannon

Concurs and adds that the population will have to be prioritized. Recalls decisions made in past session regarding assistance.

269

Bonetto

Refers to the Population Prioritization Draft Plan - 5/21 and speaks about the medical needs of the adults/couples/families population.

291

Sen. Carter

Asks if policy decisions will be based on income or on need.

317

Co-Chair Hannon

Elaborates on the decisions to made to determine inclusion and care.

348                    

Co-Chair Winters

Concurs. Speaks on prioritization of the medically needy.

361

Sen. Carter

Provides that the discussion is helpful.

367

Bonetto

Welcomes committee suggestions to begin discussion on prioritization. Recalls suggestion made by Rep. Bates.  

370

Rep. Bates

Requests the Chair’s consent to participate.

379

Co-Chair Hannon

Approves and states hope that both Rep. Bates and Rep. Kruse will participate. Notes importance in discussion towards a decision so that numbers can then be examined.

391

Rep. Bates

Appreciates work done by staff on the prioritization plan. Discusses concerns and suggests alternatives for prioritization.


 

TAPE 6, A

015

Sen. Brown

Expresses concerns regarding the medically needy category and suggests priorities.

025

Sen. Carter

Clarifies her suggestions.

027

Sen. Brown

Suggests the medically needy be placed at two with the adults/families/couples be placed at three and four. Notes it depends on the package.

033

Rep. Kruse

Offers that discrete populations within the medically needy category could be created depending on need.  

047

Co-Chair Winters

Comments that the medically needy category is in need of further definition and analysis.

053

Sen. Carter

Asks for a profile of the people in the medically needy category.

061

Dr. Bruce Goldberg

Office of Health Policy Administrator. Answers that the Medically Needy Program contains approximately 400 individuals, 250 of which have HIV and over 100 depending on transplant medications. Elaborates on medication claims.

097

Sen. Carter

Speaks on a prioritization change from four to two. Inquires as to categorization within the Medically Needy Program. 

107

Co-Chair Hannon

Echoes Sen. Winters’s comments on needed definition of medically needy category.

116

Dr. Goldberg

Believes the policy decisions are sound. Notes it is necessary to find out if the choices are in accordance with federal rules for the Medically Needy Program.

129

Co-Chair Hannon

Asks Dr. Goldberg to research the issue and the potential to amend a waiver to allow definition within the subcategory under federal law.

135

Dr. Goldberg

Offers to research the subject. Elaborates attaining benefits for those with the greatest medical need.

163

Rep. Kruse

Suggests that due to Medicaid funding for medically needy, the waiver should be a separate and distinct request.

173

Connie Seeley

Chief of Staff, Office of the Senate President. Clarifies staff assumptions made in terms of the medically needy program.

180

Co-Chair Hannon

Reviews the options for change and requests committee consensus.

189

Co-Chair Winters

Concurs as long as once the population has been defined the committee could revisit the plan if needed.

197

Sen. Carter

Concurs.

199

Co-Chair Hannon

Suggests staff work based on the prioritization list discussed as there is no objection.

215

Bonetto

Requests further clarification on the medically needy prioritization for pricing purposes.

222

Co-Chair Winters

Provides the committee would like information on the constitution of the medically needy pool. Speaks on different populations within the category.

239

Dr. Goldberg

Replies that it is necessary to not only define medical conditions but also to clarify definitions of spend down and its calculation.

258

Sen. Winters

Offers that is reason to define the population before making policy decisions.

266

Rep. Bates

Believes it will be difficult to define the medically needy. Suggests spend down and time be factors for consideration.

291

Bonetto

Clarifies his suggestion.

294

Rep. Bates

Speaks further on the suggestions.

307

Bonetto

Responds concerning the ‘spend down component’. 

312

Rep. Bates

Offers an assets test may be utilized.

319

Co-Chair Winters

Makes requests for staff.

331

Sen. Carter

Questions placing more specific decisions on population before policy choices.

355

Co-Chair Hannon

Understands and reiterates the need to decide on issues to allow staff to provide information. Clarifies her question of ‘need’.

369

Sen. Carter

Responds with her definition of ‘need’ in relation to population.

391

Sen. Fisher

Clarifies the assets are liquid.  

399

Bonetto

Affirms.

409

Sen. Fisher

Questions why the medically needy should be judged any differently than the other categories.

421

Co-Chair Winters

States the issue is that medical costs are greater for the medically needy and explains.

TAPE 5, B

009

Co-Chair Hannon

Requests clarification of assets versus spending down.

011

Dr. Goldberg

Differentiates assets and spending down.

020

Rep. Bates

Clarifies his suggestion concerning the medically needy.

030

Sen. Fisher

Explains how his idea of assets differed.

043

Co-Chair Hannon

Summarizes past discussion of the committee on prioritization.

049

Seeley

Responds with her interpretation of the decisions.

054

Co-Chair Winters

Moves the discussed prioritization plan be accepted and defines the recommendation.

065

Co-Chair Hannon

Requests discussion. Sees no objection to the recommendation and requests the staff work on the plan as adopted.

072

Bonetto

Asks if the committee would like a presentation on the medically needy.

074

Rep. Kruse

Believes the original program and rules should also be recounted.

085

Co-Chair Hannon

Asks for discussion of the introduction of prioritization benefits.


 

INFORMATIONAL MEETING

    Introduction of Prioritization Benefits

097

Dr. Goldberg

Discusses health care benefits (EXHIBIT B):

·         Mandatory services

·         Optional services

·         Primary care package

192

Co-Chair Hannon

Asks if mandatory services are covered in the green bar charts shown in EXHIBIT A.  

197

Dr. Goldberg

Explains those persons represented by green bars receive the mandatory services.

203

Co-Chair Hannon

Asks where the optional services are.

204

Dr. Goldberg

Explains the optional services are in addition to the ‘green’ bars denoting mandatory services on page one of EXHIBIT A. Informs of reasoning behind the inclusion of prescriptions drugs and Medicaid.

206

Co-Chair Hannon

Asks about the primary care package.

208

Dr. Goldberg

Explains that those represented in green possess the mandatory services and the blue represents additional services such as hospital care.

225

Sen. Brown

Poses situation to question specifics of primary care and pregnancy.

230

Dr. Goldberg

Suggests that pregnant women would need a package that includes hospital care.

234

Sen. Brown

Clarifies emergency care and dental are provided to pregnant women.

237

Dr. Goldberg

Believes the primary package would not include vision and dental. Notes the emergency issue could be resolved if dental was provided.

242

Sen. Brown

Asks if outpatient treatment would more economical.

245

Dr. Goldberg

Affirms. Adds mandatory services are a federal, not a state, mandate.

265

Goldberg

Speaks on prioritization of benefits.

288

Bonetto

Refers to page three and prefaces it is merely a starting point for discussion. Discusses the worksheet.

307

Co-Chair Hannon

Asks if the baselines present on page three are preexisting or recreated.  

310

Bonetto

Responds that the baselines on page three are new.

312

Co-Chair Hannon

Clarifies the Co-Chair Ways and Means budget encompasses the new baseline without the add backs.

313

Bonetto

Affirms.

325

Rep. Bates

Recalls Sen. Brown’s example to illustrate the need for consideration of unintended consequences.

345

Sen. Minnis

Poses question regarding the inclusion of dental.

348

Dr. Goldberg

Replies that there has been previous work done on tailoring a dental benefit. Agrees it could be done.

364

Sen. Minnis

Speaks on dental benefits and access.

376

Rep. Kruse

Asks Dr. Goldberg if the scenario would be covered.

381

Dr. Goldberg

Replies he is unsure, but is sure that the emergency care would be covered.

383

Rep. Kruse

Believes that under certain criteria it could be. Suggests information on the dental package be researched.

397

Co-Chair Hannon

Requests research on the dental package.

400

Bonetto

Refers to Benefit Prioritization Worksheet – 5/21 (EXHIBIT A):

·         Pregnant women health care package

·         Child health care benefits

·         Adults/couples/families health care package

430

Co-Chair Winters

Inquires if ‘durable medical’ is included in the adults/couples/families category.

440

Bonetto

Affirms. Discusses the medically needy category.

TAPE 6, B

007

Sen. Brown

Understands that currently adults/couples/families do not have chemical dependency assistance in the primary care package.

010

Bonetto

Affirms.

013

Sen. Brown

Poses situation regarding chemical dependency provisions for adults under federal law.

017

Seeley

Explains benefits and notes that there would be mental health and chemical dependency packages under the prioritization suggested.

024

Sen. Winters

Comments that provisions within the budget exist.

032

Rep. Bates

Comments on cost shifts and hospitals to illustrate the need for attention to options.

040

Dr. Goldberg

Notes there would be a cost shift without inclusion of hospitalization. Offers suggestion for prioritization.

045

Rep. Bates

Reiterates the unintended consequences that come without full consideration of options.

054

Sen. Minnis

Disagrees with Rep. Bates. Believes it is a theoretical argument that remains undocumented.

070

Rep. Kruse

Refers to Utah’s health care system. Notes a full analysis has not yet occurred and that consideration of the Utah model could be useful.

087

Co-Chair Hannon

Requests comparison numbers from Mr. Bonetto. Asks if pricing will follow.

096

Bonetto

Concurs and will supply the information at the next meeting.

099

Sen. Minnis

Requests overview of the issues discussed.

103

Co-Chair Hannon

Replies that staff will return with figures for discussion.

114

Sen. Minnis

Argues an abstract benefit package be created and priced.

118

Co-Chair Hannon

Explains time constraints and his preferences.

132

Co-Chair Winters

Recommends the packages be priced out individually.

143

Bonetto

Explains he can move forward as long as there is some consensus as to priorities.

147

Sen. Minnis

Asks for a set of assumptions behind the costs and explains reasoning behind the request.

157

Co-Chair Hannon

Poses situation.

167

Sen. Brown

Clarifies Mr. Bonetto will price the basic benefit package.

169

Bonetto

Affirms additional add backs will be priced.

180

Co-Chair Hannon

Closes informational meeting. Adjourns meeting at 4:48 p.m.

 

EXHIBIT SUMMARY

 

A – Oregon Health Plan, written testimony, Mike Bonetto, 3 pp.

B – Oregon Health Plan, written testimony, Dr. Bruce Goldberg, 1 p.