SENATE SPECIAL COMMITTEE ON THE OREGON HEALTH PLAN

 

 

May 31, 2003                                                                                                          Hearing Room A

9:30 A.M.                                                                                                                       Tapes 19-20

 

MEMBERS PRESENT:         Sen. Peter Courtney, Co-Chair

Sen. Jackie Winters, Co-Chair

Sen. Kate Brown

Sen. Margaret Carter

Sen. Bill Fisher

Sen. Lenn Hannon

Sen. John Minnis

Sen. Bill Morrisette

 

STAFF PRESENT:                 Marjorie Taylor, Committee Administrator

Heather Gravelle, Committee Assistant

 

MEASURE/ISSUES HEARD:           SB 540 – Work Session

                                                HB 3624 A – Informational Meeting

                                               

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 19, A

005

Co-Chair Winters

Calls the committee to order at 9:40 A.M. Opens a work session on SB 540. Presents -1 amendments dated 5/30/03, -2 amendments dated 5/30/03 and -3 amendments dated 5/30/03 (EXHIBITS A, B, C).

SB 540 – WORK SESSION

060

Tech problems

***********************************************************

070

Mike Bonette

Policy Analyst, Senate Republican Office. States today they will walk through the revised Oregon Health Plan pricing list. Refers members to submitted testimony. Provides information as to when the programs will begin. States this means existing program must run for 3 months for over $200 million or 6 months at $424 million. States costs $70 million a month to run existing program on per month basis.

105

Bonette

Discusses program. States the populations, benefits covered and separate months of coverage.

110

Bonette

Explains the separate categories. Claims basic package comes in at $36 million a month. Differentiates between $70 million and $36 million and cost-savings goal.

115

Bonette

Discusses pricing for dental packages. Claims full for pregnant women only, emergency for all categories excluding pregnant women and full benefits for all categories. States the price and length of coverage.

135

Bonette

Discusses costs with add-ons.

145

Bonette

States the basic benefit package with full dental and optional services $42 million for 21 months and $36 million for 18 months.

155

Bonette

Discusses medical needy program. States co-chair budget is left at $21 million reference point. Discusses different benefit packages.

180

Bonette

Discusses pricing of packages and percentages of adult couples and families.

190

Bonette

Explains cost associated with each group. Claims if a new program was implemented in January it would cost $353 million on top of the co chair budget. Adds in October the cost would be $300 million. Discusses options and what adjustments could be made. States could look at eliminating total hospital benefit for all adults, couples and families. Claims optional services and dental would still be part of the package.

225

Bonette

States if eliminate hospital, optional and full dental for all adults, couples and families then buyback would be less for 21 months and 18 months. Points out if buy back categorically with mandatory benefit level it came in at $36 million and $48 million with other modification. Claims part of reason for expediting process is it is over $700,000 per day in cost savings if you implement in October rather than January.

240

Bonette

Discusses category of pregnant women and children. Mentions dental and states costs associated.

265

Co Chair Winters

RECESS 9:45 A.M. for 40 minutes.

270

Co Chair Winters

Re convenes the meeting at 10:50 AM. Mentions a question has been raised and want to make certain the employed persons with disability are a part of the categories looking at.

275

Bonette

Responds do not have language currently in the bill for that population but can be inserted to address that. 

290

Sen. Brown

Believes it was included in the context of the categories. 

295

Bonette

Responds that was the original intent.

300

Tina Kitchen

Medical Director for Seniors and People with Disabilities, Department of Human Services (DHS). Responds they are a separate optional category.

310

Sen. Morrisette

Asks about the cost factor for that segment of the population.

315

Kitchen

Believes continuing for 18 months would cost $3.5 million.

318

Co-Chair Winters

RECESS 10:55 AM for 10 minutes.

320

Co-Chair Winters

Re-convenes the meeting at 11:05 AM. Claims the documents have been reviewed and there are technical flaws with the -5 amendments. States SB 540 will be addressed on Monday. Closes the work session on SB 540 and opens informational meeting on HB 3624 A.

HB 3624 A – INFORMATIONAL MEETING

335

Holly Robinson

Legislative Counsel. Provides introduction of HB 3624 A. Refers to distributed material. Submits written material (EXHIBITS D, E).

355

Robinson

Refers to section 2 of the bill with new or revised definitions used in the body of the bill addressing use of prepaid managed care organizations to individuals receiving health services through Oregon Health Plan (OHP). Discusses section 3.

370

Robinson

Discusses section 4 of the bill which increases use of prepaid managed care plans and directs department to use capitated plans and continues authority of the department to maintain fee for service system when no capitated program available. Discusses section 5.

TAPE 20 A

005

Robinson

Discusses section 6 of the bill. Claims this entity will be able to enter into a physician care organization or contract with the department.

008

Sen. Minnis

Asks how many entities fit this description.

010

Robinson

Responds one.

012

Sen. Minnis

Asks which one.

014

Robinson

Responds Kaiser Permanente.

015

Sen. Carter

Asks if that advantage Kaiser over any other hospitals in the area. Claims not the best person to state what the ramifications are.

020

Robinson

Responds no in the way the question is being asked but not the best person to answer it.

025

Sen. Carter

Expresses concern in reason for asking the question because can see profit hospitals saying non-profit hospitals are being allowed to have an advantage. States everyone should be treated fair but want to treat a large organization who takes a large number of Medicaid patients in the area. Notes there should be further discussion.

028

Robinson

Responds there are a lot of people who can better answer Senator Carter’s question and concerns.

030

Co-Chair Winters

Comments this discussion will be at another meeting.

040

Robinson

Refers to section 7. Clarifies definition of “health services.” Discusses generic descriptions. Discusses list of services provided. States the intention of placing prescription drugs in that section is to identify situations where they would specifically be provided and make it clear they are provided.

050

Sen. Carter

States Kaiser needed to be asked a question in terms of whether they would be willing to provide such services to Medicaid eligible people. Claims do not want us to make assumptions in the bill. Notes Kaiser needs to be asked the question in terms of what they would be willing to provide in terms of services to this population in the area.

065

Robinson

Provides information on Section 8. Discusses use of actuary and capitation rates determination. 

070

Robinson

Discusses section 9. Comments new provisions are contained that directs Health Services Commission to hire an actuary to determine benchmarks for setting capitation rates. Refers to section 10. Claims it directs DHS to contract with fully capitated health plans to provide administrative services for individuals receiving service on fee for service basis.

095

Sen. Minnis

Asks for clarification on section 10 relating to prescription drug management services and utilization of Pharmacy Benefit Manager (PBM.).

105

Sen. Minnis

Responds to Senator Carter’s earlier comment on flagging section 10 of the bill for further discussion.

115

Robinson

Discusses contracts in section 10. Points out the requirement in section 10 if department enters into administrative services contract it must be cost neutral to the department so it won’t end up costing more money. Refers to section 11 regarding drugs. States it directs DHS to contract with fully capitated health plans at certain rates. Adds it places cost and administration of the anti-depression drugs into the cap rate and only withholds anti-psychotic drugs.

135

Robinson

Refers to section 12 which addresses hospital services with three primary policy decisions included stating there are three parts to it:

145

Sen. Minnis

Asks if other states have similar laws or rules.

150

Robinson

Responds she doesn’t know of any.

155

Sen. Minnis

Asks if it would be difficult to find the information. Asks if there is a problem constitutionally.

156

Robinson

Responds probably, and adds she will try and locate the information.

158

Sen. Minnis

Asks for opinion regarding constitutionality provisions such as this.

159

Robinson

Responds has not been asked that question but do not believe there is a problem. Claims to make certain there are no red flags. Refers to section 13 which is the subject of a use of a pharmacy benefit manager to manage prescription drug benefits for medical assistance program. Discusses section further.

175

Robinson

Refers to section 14 directs DHS to work with representatives of fully capitated health plan in developing PBM contracts. Section 15 directs DHS to enter into contracts with pharmaceutical manufacturers for supplemental rebates that may be available to the state above and beyond discounts available.

180

Sen. Minnis

Asks for clarification of language with respect to PBM’s. Wonders if that negates any policies regarding preauthorization represented in 819.

185

Robinson

Responds no at this point. Continues discussing section 15 regarding multi-state prescription drugs purchasing pools for purpose of negotiating supplemental rebates if the department agrees to that. Refers to section 16 which directs DHS to seek federal approval to get permission to move the line of health services from the current line to where assembly wants to take it.

195

Robinson

Refers to section 17 which directs DHS to fully document residency and financial eligibility for people enrolled in OHP.

211

Sen. Morrisette

Asks for clarification on section 4.   

215

Robinson

States section 4 establishes a policy that the state should move more towards direction of fully capitated health plans when they can and not rely to the degree they have currently on fee for service. Clarifies section 3 in regards to the Senator Morrisette’s question. Claims between section 3 and section 4 the section describing would be addressed.

240

Sen. Minnis

Asks for sections of the bill that are ambiguous or unclear to be highlighted.

255

Robinson

Responds she would be happy to attempt to clear this up. Claims much of the arena is fact driven.

265

Sen. Minnis

Expresses concern that not having specific statutory authorization given to the agency would be given to the agency to prevent the agency from drafting administrative rules contrary to law.

270

Robinson

Understands concerns expressed and will do her best to make things better.

280

Co-Chair Courtney

Appreciates everyone coming in today. Closes the informational meeting on HB 3624 A and adjourns the meeting at 11:00 AM.

 

 

The following prepared testimony is submitted for the record without public testimony for HB 3624 A.

                 Skip Klarquist              submits written testimony (EXHIBIT F).

                 Barney Speight             submits written testimony (EXHIBIT G).

                 Brandi Satterlund ……submits written testimony (EXHIBIT H).

                 Steven Duffin………… submits written testimony (EXHIBIT I).

                 Julie McFarlane………submits written testimony (EXHIBIT J).

                 Akhri Troncelliti           submits written testimony (EXHIBIT K).

                 William Simmons          submits written testimony (EXHIBIT L).

 

EXHIBIT SUMMARY

 

A – SB 540, -1 amendments dated 5/30/03, staff, 5 pp

B – SB 540, -2 amendments dated 5/30/03, staff, 5 pp

C – SB 540, -3 amendments dated 5/30/03, staff, 5 pp

D – HB 3624 A, written material, Holly Robinson, 5 pp

E – HB 3624 A, written material, Holly Robinson, 5 pp

F – HB 3624 A, written testimony, Skip Klarquist, 5 pp

G – HB 3624 A, written testimony, Barney Speight, 3 pp

H – HB 3624 A, written testimony, Brandi Satterlund, 2 pp

I – HB 3624 A, written testimony, Steven Duffin, 1 p

J – HB 3624 A, written testimony, Julie McFarlane, 2 pp

K – HB 3624 A, written testimony, Akhri Troncelliti, 2 pp

L – HB 3624 A, written testimony, William Simmons, 1 p