Call to Order and Roll Call
The 10th meeting of the Task Force on Medicaid Cost Containment was held on Tuesday, November 16, 2010, at 10:00 AM, in Room 154 of the Capitol Annex. Representative Jimmie Lee, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Katie Kratz Stine, Co-Chair; Representative Jimmie Lee, Co-Chair; Senators Denise Harper Angel, Bob Leeper, and David L. Williams; Representatives Tom Burch, Rick Rand, Greg Stumbo, David Watkins, and Jill York.
Guests: Bryce McGowan for Kentuckians for Nursing Home Reform; Eric Clark for the Kentucky Association of Health Care Facilities; Stephen Zaricki for the Kentucky Association of Private Providers; Brad Hall for the Kentucky Pharmacists Association; Howard Bracco for Seven Counties Services; Dino Martis and Ed Biggins for Zen Health; Jim Kimbrough for ARMS; Bruce Scott for the Mental Health Association of Kentucky; Mary Hass for the Brain Injury Association of Kentucky; Russell Pal for Medimmune; Ramona Johnson for Bridgehaven; Dan Fox for Family and Children’s Place; Judy Tiell for Jewish Family and Career Services; Molly Clouse, mental health consumer; and Steve Shannon for Kentucky Association of Regional Mental Health Centers.
LRC Staff: Miriam Fordham, Cindy Murray, Mike Clark, Frank Willey, Jonathan Scott, LaShae Kittinger, and Cindy Smith.
The meeting agenda was devoted to public testimony from individuals and groups regarding Medicaid cost efficiencies. The testimony focused on the following areas of concern: sleep apnea; mental health issues; services for the disabled population; long-term-care for the elderly; and pharmacy.
One area of concern addressed was sleep apnea. Ed Biggins and Dino Martis of Zen Sleep and Ablecare Medical testified that sleep apnea treatment, not currently covered by Medicaid, could be cost effective if the state would cover the treatment under the Medicaid system.
The next area of concern addressed was Medicaid services for children. Dan Fox, President, Family and Children’s Place, recommended basing contracts on proven outcomes for time-limited, results oriented services; using a case rate reimbursement system for outpatient treatment; selective tendering of qualified applicants that can show positive outcomes; and using a managed care model for an integrated system of physical and behavioral health.
The next area of concern addressed was pharmacy. Brad Hall, CEO, Kentucky Pharmacists Association recommended the following for cost savings in the Medicaid system: diabetes management; disease management; intervention and medication therapy management; increased generic utilization; allowing select over the counter drugs to be dispensed to a Medicaid patient without a prescription; examination of the need for third party prior authorizations for certain drugs; removal of pharmacy level overrides of brand and prescription limits; and implementation of Medicaid payment for Medication Therapy Management.
In response to a question by Senator Leeper, Mr. Hall said that patient records are identified based on what the pharmacy fills, and disease state, and there are minimum standards that CMS requires.
The next area of concern addressed was services for the disabled. Mary Hass, Brain Injury Association of Kentucky, offered cost efficiency suggestions regarding acquired brain injury services and waivers. Stephen Zaricki, Kentucky Association of Private Providers, stated that continued support and increased funding for the Supports for Community Living program is critical both for cost containment within Medicaid and a quality of life for the citizens of Kentucky.
The next area of concern addressed was long-term care services for the elderly. Bryce McGowan, Kentuckians for Nursing Home Reform, stated that Kentuckians for Nursing Home Reform support the plans announced by the Secretary Miller to implement the Governor’s directives for the Medicaid program. He also suggested and noted the need for not only care, but also quality care for the elder population, and that all new Medicaid programs must offer maximum service care to the long-term-care population.
In response to a question by Representative Lee, Mr. McGowan said that the Kentuckians for Nursing Home reform group feels that managed care for long-term care residents is a good idea.
Mental health services for Medicaid recipients were a great area of concern. Bruce Scott, Interim Executive Director of the Kentucky chapter of Mental Health America, stated that health should be the focus of Medicaid cost containment. By managing Medicaid to optimize the health of individuals, more people will work, will pay taxes, and will keep themselves and their families safe.
Dr. Howard Bracco, President and CEO, Seven Counties Services, stated that eligibility, benefits, and provider payments can be cut, but reducing Medicaid spending in the area of behavioral health and developmental services is counterproductive. Studies show that public funds spent on program to help these individuals create positive returns on investment. Without a properly funded and strategically managed Medicaid program, attainment of the goal of creating healthy communities by helping people impacted by mental illnesses, developmental disabilities, addictions and abuse, could not be reached.
Judy Tiell, Executive Director, Jewish Family and Career Services, stated that by opening up the Medicaid provider system, competition could lead to reduced costs and more innovation for groups to collaborate on one another’s strengths. Non-profit providers can leverage other funding so that Medicaid dollars could be spread further, consumers would have more choice, and quality and outcomes could be monitored more closely.
In response to a question by Representative Lee, Ms. Tiell said there could be a contracting system where providers could bid for services which would reduce the costs.
In response to a question by Representative Watkins, Ms. Tiell said people find mental health services through a variety of means. Partnerships are the way to go. By having partnerships, and working with the hospital systems, mental health services can be accessed.
Ramona Johnson, President and CEO of Bridgehaven Mental Health Services, spoke about providing mental health services to the state’s most vulnerable population. She urged the members to continue Medicaid investment in community based mental health services. She also encouraged replication of Bridgehaven’s model across the state as a cost containment measure to the Medicaid program.
Steve Shannon, Kentucky Association of Regional Mental Health Programs said that mental health centers are interested in pursuing further discussions of managed behavioral health care while ensuring that individuals continue to be served and the current behavioral health public safety net remain intact.
In response to a question by President Williams, Mr. Shannon there is overlap of the mental health centers in the Passport area. The contractual relationship needs to be figured out, and it would create an interesting contractual relationship to interface with Passport. This could also happen with public health departments.
In response to a question by President Williams, Mr. Shannon said the challenge is a learning process. The fear with the model that the mental health centers have is that they will end up with the very costly people. He also said the expansion of Medicaid is a concern, especially the benefit package available to those individuals.
Senator Stine said she hopes that Kentucky can move from a regional approach to one where the needs of the individuals are actually addressed.
Representative Lee commented that there is a place for managed care in mental health. But there will have to be a number of ways to look at how the individuals enter the program: what the program entails over a period of time; and then what the outcome is for that individual; and when that person moves on.
In response to a question by President Williams, Mr. Shannon said that providers can manage care because they have a specific specialty skill set. They have an expertise in serving individuals who are severally mentally ill, and are chronic substance abusers, as well as individuals who have mental retardation and developmental disabilities. It behooves the Commonwealth to contract with the people who are best equipped to provide that care. The association suggests a managed behavioral health organization and that would contract with providers. That entity would ensure the quality, do the utilization and management functions, and track the services that people are getting.
Molly Clouse, advocate, and mental health services recipient, asked that the members base their decisions on hope that people with mental illness can recover and said that the peer specialist program can contain Kentucky’s Medicaid cost by reducing hospitalizations and improving people’s lives.
Speaker Stumbo addressed the Passport Health Plan contract. He stated that he read a copy of the Passport contract, and said that in the contract, it is clear that the Cabinet has the authority and the responsibility to oversee the expenditures of the monies. Specifically, in the contract, travel expenses are not reimbursable expenses. The contract anticipates that the money that was spent was not to be spent in the way in which it was. When looking at cost containment, the contract also has a clause that allows for the recovery of monies which are misspent. He said the vendors need to be shown that they cannot misuse the monies. If they do, they will have to pay them back.
Representative Lee said there are a number of instances in the contract that gives control to the legislature that has been overlooked over the years.
President Williams said the audit brings to light some troubling tendencies. He requested that the Cabinet for Health and Family Services submit to the members a copy of the most recent letter in which it requested an extension of the waiver for Passport and see what it reported to the federal government concerning what it thought about Passport at that time.
The meeting was adjourned at 12:12 p.m.