The meeting of the Medicaid Oversight and Advisory Committee (HB 90) was held on<Day> Monday, November 28, 2005, at 1:00 PM, in Room 131 of the Capitol Annex. Senator Richard "Dick" Roeding, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Richard "Dick" Roeding, Co-Chair; Representative Rick Rand, Co-Chair; Senators Walter Blevins Jr, Julie Denton, and Dan Seum; Representative Jimmie Lee.
Guests Legislator: Representative Tom Burch.
Guests: Sarah Nicholson, Kentucky Hospital Association; Shellie Potter and Kevin Sketters, Department for Medicaid Services; Patty Dempsey, Arc of Kentucky; Charles L. Smith, State Long-Term Care Ombudsman; Bill Doll, and John Cooper, Kentucky Medical Association; Mike Porter, Kentucky Dental Association; Jim Carloss, Pfizer; Anne Joseph, Kentucky Task Force on Hunger; and Prentice Harvey.
LRC Staff: Barbara Baker, Eric Clark, Miriam Fordham, and Cindy Smith.
On the agenda was an update on the Ky Health Choices-1115 Demonstration Waiver, and regulations 907 KAR 1:019 (Outpatient Pharmacy) and 907 KAR 1:014 (Emergency Services) by Commissioner Shannon Turner, Department for Medicaid Services, Cabinet for Health and Family Services. Commissioner Turner said that the waiver is posted on the internet and it is designed as a demonstration waiver. The goal is to make sure services are given to people that need them. She reported that currently there are 700,000 eligibles. There is a very distinct Medicaid population, divided into four groups: (1) Family; (2) Optimum; (3) Comprehensive; and (4) Global. The groups are set up according to income differences. The comprehensive group has a lower co-pay than the global group. She noted that disease management programs are very costly, therefore they are doing a regional waiver approach which will focus on areas with the most need and maximize resources. Commissioner Turner said the timeline of the waiver is aggressive. The waiver was submitted tot he federal Centers for Medicare and Medicaid Services on November 9, 2005. The projected date of approval is January 1, 2006.
Commissioner Turner reported that on Thanksgiving Day, the Unisys system was switched to EDS. It was a smooth and successful transition. The new computer system is expected to be operational October, 2006. The Pharmacy Benefit Administrator began December 4, 2004. The Kentucky Medicaid Administrative Agent began September, 2005 with a 1-800 call center and a nurse call line. She reported that the abandonment rates for calls has decreased.
Representative Burch asked if the regulations could be drafted now. Commissioner Turner said yes. Representative Burch asked about KCHIP and if it is been submitted for bids. Commissioner Turner said no, and there is no request for proposal (RFP) yet. Representative Burch asked what is being done differently. Commissioner Turner said there is a benefit design now and a defined benefit plan.
Senator Blevins asked about the difference in the diabetic plan. Commissioner Turner said that it is a regionalized disease management plan. She said the cost is not worth the return on the program.
Senator Roeding asked if the current process will be used for prior authorization of drugs beyond the four drug allowance. Commissioner Turner said they currently cover over-the-counter drugs.
Commissioner Turner informed the group that the Department for Medicaid Services plans to exempt the same diagnosis from the four drug limit that are currently exempted from the three brand limit. She also noted that the Cabinet will consider a 72 hour emergency supply for the 4th brand drug.
Senator Roeding asked how the disease management programs in the waiver will be different from the current pilots. Commissioner Turner responded that the disease management pilots are currently limited to administrative reminders. Under the waiver, these will include a nursing benefit. Potential diseases identified for disease management included diabetes, heart disease, pediatric obesity asthma, and high risk obstetrics.
Commissioner Turner concluded with an overview of the Get Healthy Accounts component of the waiver.
The meeting was adjourned at 1:50 p.m.