The Medicaid Oversight and Advisory Committee (HB 90) meeting was held on Wednesday, April 11, 2007, at<MeetTime> 1:00 PM, in Room 131 of the Capitol Annex. Senator Dick Roeding, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Dick Roeding, Co-Chair; Senators Walter Blevins, Tom Buford, Julie Denton, and Dan Seum; Representatives Bob DeWeese, Joni Jenkins, Jimmie Lee, Brandon Spencer, and David Watkins.
Guests: Mary C. Schmidt for the Bluegrass Area Agency on Aging; Jennifer Williams for the Green River Area on Aging; and Sarah Nicholson for the Kentucky Hospital Association.
LRC Staff: Barbara Baker, Miriam Fordham, and Cindy Smith.
The minutes of the October 31, 2006 meeting were approved without objection.
The first item on the agenda was the election of a House Co-Chair. There was a motion by Representative Jenkins, seconded by Representation Watkins to nominate Representative Lee as House Co-Chair. There was a motion by Representative DeWeese, seconded by Representative Jenkins, and approved by voice vote that nominations cease. Representative Lee was elected by acclamation.
The next item on the agenda was a Medicaid update regarding Medicaid Waivers, Consumer Directed Options and the Medicaid Buy-in for Individuals with Disabilities, by Commissioner Glenn Jennings, Department for Medicaid Services, Cabinet for Health and Family Services. First, Commissioner Jennings explained that waivers allow for the waiving of traditional Medicaid Services. There are constraints with the waivers, and waivers save money by offering different lower cost services to individuals. He noted that Passport operates under the 1115 waiver and that KENPAC was begun by an 1115 waiver, but it is no longer needed. He said it is important to veer away from waivers because of budget neutrality requirements and there is the burden of monitoring and administrative costs. Most waivers are 3-5 years long. He mentioned two new waivers, 1915I and 1915J. The 1915J is a self-directed options waiver, which is a step above the consumer-directed options waiver. The Cabinet is prepared to submit by May 1st the 1915J waiver for self-directed options for a pilot group of 200 Kentuckians.
In addition, the department will submit a 1915C waiver for individuals with acquired brain injuries, for residential services, and long-term care services. The current waiver provides rehabilitation services. The new waiver will be submitted in about three weeks. He noted that the money associated with the acquired brain injury waivers that were allocated by the General Assembly will be carried forward into the next fiscal year if the waiver is not approved by June 30.
Next, Commissioner Jennings talked about Consumer Directed Options (CDO), which began in 2004 with House Bill 116. He said the beginning of the implementation was rough, but things are better. Currently 185 people are receiving services under the CDO program. He reported that the Department for Medicaid Services contracts with the Division of Aging Services. The Area Agencies on Aging (AAA) serve as support brokers, who are responsible for assisting Medicaid recipients with budgets, treatment plans, and training Under the CDO program, individuals may hire a neighbor or family member to provide care for them. The CDO is available for the Home and Community Based (HCB) services, as well as the Supports for Community Living (SCL) services and the Acquired Brain Injury (ABI) services. Fifteen of the 185 people are receiving SCL services and the balance are receiving HCB services. Currently there is nobody receiving services under the ABI program. Commissioner Jennings mentioned that there will be a meeting on April 22 with support brokers and the Area Agencies on Aging (ADD). It was noted that the regulation was amended to allow the AAAs to provide assessment and reassessment services.
Senator Denton asked about exceptions to the usual methodology of determining the amount of the CDO budget. Commissioner Jennings replied that the differences in people's needs are recognized by the department. The support broker can send in justification for an increased budget. The turn around time is approximately two days. He noted that six requests have been made for and increased budgetary allowance and all were approved.
Representative Lee asked if legislators will receive a memo on that
meeting. Commissioner Jennings said they would.
Senator Roeding asked if all ADD's would be invited to the meeting. Commissioner Jennings said they would be.
Representative Burch asked how the ADD's that don't attend the meeting will be informed. Commissioner Jennings said their staff is willing to travel to conduct one-on-one trainings for ADD's that are not available to attend the meeting.
Next, Commissioner Jennings spoke about the Medicaid Buy-In. He said it is a vehicle that allows for disabled individuals that want to work whose income would preclude them from receiving benefits. He noted that the Balance Budget Act (BBA) and the Ticket to Work (TTW) can both be used to deal with the Medicaid Buy-In in Kentucky. The TTW is more advantageous than the BBA, which is more restrictive.
Senator Roeding asked if there is an employer buy-in. Commissioner Jennings said in the TTW employers can't participate.
Senator Buford asked how many people were estimated to enroll in the program. Commissioner Jennings said he is not sure of the number, and that the Cabinet is still waiting on further information from Price, Waterhouse, Cooper.
Senator Denton asked about the "brown bagging" issue. Commissioner Jennings said that the draft regulation was developed and the Cabinet is currently sharing it with the stakeholders. He said he is unsure when the regulation will be filed, and he would be sending a draft of the regulation after the meeting. Senator Denton asked what needed to happen to get the regulation submitted. Commissioner Jennings said that there needed to be agreement with the stakeholders.
Regarding other Medicaid issues, Commissioner Jennings said the Cabinet is moving forward with the MMIS system, and they are in the final weeks of the user acceptance training. He said they hope to announce the official date in a few weeks. He also noted that all new Medicaid cards would be issued shortly. The new cards will have a new ten digit personal identifier that will no longer be the recipients social security number.
Senator Denton asked about medical credentialing and noted complaints from doctors due to the length of the form and the long waiting period to get credentialing. She asked if anything could be done. Commissioner Jennings said that the mandated form is the same form that the insurance companies use. Senator Roeding reported that a regulation was just passed the day before the meeting which would cut the form from 100 pages to only seven pages. Commissioner Jennings said the Cabinet will continue to work to streamline the process.
Senator Roeding asked how the Cabinet will determine the budget for each person needing care under the CDO. Commissioner Jennings said the Cabinet will look at the historical pattern and determine a budget, minus 5 percent, and then it will be sent to the support broker. If the support broker feels that the historical budget does not cover all the necessary services, the support broker will look at the needs and add to the budget request. Representative Lee asked if the lengthy credentialing process is due to not enough help at First Health. Commissioner Jennings replied that was not his observations. Commissioner Jennings was asked to provide a comprehensive report on provider credentialing at the next meeting.
Representative Lee noted that this issue was discussed at the Administrative Regulation Review meeting. He noted that services in certain areas may be more than traditional services, and there should be enough play as long as the budget is not succeeded and asked if that would be permissible. Commissioner Jennings said that is not how it is currently structured, and they can't pay more for a service than is budged for that certain services.
Representative Lee asked about CDO budget process and whether a recipient could pay more than the Medicaid rate for a services. He noted that individuals may not be able to get services at the Medicaid rate. Access to goods and services was discussed. Commissioner Jennings stated that the department planned to amend the regulation in about two months. A request was submitted to the federal Centers for Medicare and Medicaid Services to add a provision for goods and services to the CDO waiver.
Next, Kathy Allgood Murphy, Jan Day, Mary Hass, and Darla Bailey, representatives of Advocates for Reforming Medicaid Services (ARMS), spoke about their areas of concern. Jan Day said she currently pays $700 monthly for her employee's insurance, and noted that the durable medical equipment (DME) is limited to $7000, and will be cut to $2000 next year. This will severely limit employees who need a power wheelchair which cost between $12,000 and $25,000 each. The buy-in would provide cost-savings to employers of people with disabilities.
Darla Bailey said they are very happy about the submission of the 1915I waiver and the ABI waiver. She said they are concerned about the methodology in the budget process. She said there are issues with fixing the program. She said they discovered that policies were not in place that were supposed to be. She said that budgets should not be based on historical usage, because many current budgets will exceed historical usage. She noted that the members of ARMS would like to be involved in talks and negotiations.
The meeting was adjourned at 2:48 p.m.