The Medicaid Oversight and Advisory Committee meeting was held on Monday, October 22, 2007, at 1:00 PM, in the Brown and Williamson Club at Papa John's Cardinal Stadium. Senator Dick Roeding, Co-Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Dick Roeding, Co-Chair; Representative Jimmie Lee, Co-Chair; Senators Walter Blevins, Julie Denton, and Dan Seum; Representatives Bob DeWeese and Joni Jenkins.
Guests: Carle Herde, Chairperson, Hospital Technical Advisory Committee, Baptist Healthcare System; Pam Jenkins, Central Baptist Hospital; and Anne Joseph, Kentucky Task Force on Hunger and Covering Kentucky Kids and Families.
LRC Staff: Barbara Baker, Miriam Fordham, and Cindy Smith.
The minutes of the June 25, 2007 meeting were approved without objection.
First, Keith Inman, Vice President for University Advancement, University of Louisville welcomed the committee.
Next on the agenda was a presentation on Passport Health Plan. Shannon R. Turner, Executive Vice-President, University Health Care, Inc. introduced Joyce S. Hagen, President, Passport Health Plan, and Dr. Larry N. Cook, Chairman and Chief Executive Officer, University Health Care, Inc., and Executive Vice-President of Health Affairs for the University of Louisville. Dr. Cook stated that Kentucky has a contract with Passport Health Plan to provide services for Medicaid members in 16 counties. The Partnership Council is also a segment of this contract since that structure is a key component of the 1115 waiver. He noted that the Partnership Council is a group of committees made up of providers, advocates, and beneficiaries. AmeriHealth Mercy Health Plan provides day to day administration and all staffing for Passport Health Plan. Dr. Cook discussed the keys success factors of Passport. These included: being sole sourced and provider sponsored; being a partnership model; having extensive physician/clinician involvement in developing, implementing and managing the plan; collaborating with community agencies and health departments; having an extensive provider network and enhanced reimbursement; having a tremendous patient and provider satisfaction rate and involvement; and having care management programs. Dr. Cook provided a comparison of medical cost trends for 2007. He reported that Passport's current trend is 4.9 percent, compared to a regional trend of 10.3 percent and national trend of 8.2 percent. In regard to pharmacy cost containment, Dr. Cook reported that the trend from 2000 to 2006 has gone down to 5 percent from 22 percent, and generic usage has increased from 54 percent up to 72.3 percent. Generic usage has resulted in saving of over $8 million and reduced the rate at whish the cost was climbing. Also, each 1 percent of generic utilization equals cost avoidance of $400k per year. Dr. cook reported that Passport Health Plan provider payments have consistently equaled or exceeded those of Kentucky Medicaid, with 92 cents of every dollar going to providers.
Next, Ms. Hagan reported on the importance of chronic disease management. She reported that the top chronic conditions are asthma, diabetes, COPD, coronary artery disease and sickle cell anemia. She said that a population focused approach is utilized to determine the health care needs of members. In regard to member support, she said there are targeted interventions based on member's risk. There is customized, interactive management considering the needs of both urban and rural members. There is effective communication that includes: targeted member reminders; outreach; newsletters; member websites; health education programs; and culturally appropriate communication documents. In regard to provider support, Ms. Hagan said they have many reporting tools that enables them to get feedback. These include at risk member identification and identification of utilization use. They also identify high risk members, have a provider recognition program, a provider website, continual CME conferences and care coordination staff support. Ms. Hagan also discussed asthma disease management, which is population based and impacts 26,000 members. She presented data on the use of appropriate medications for people with asthma. Since 2004, the percentage of members receiving appropriate medications has risen from 77.89 percent to 91.15 percent. She also discussed cardiovascular disease management, which is population based and impacts 5,600 members. She presented data on cholesterol management for patients with cardiovascular conditions. She said the results have improved remarkably over the last few years. She also discussed diabetes disease management, which is population based and impacts 14,000 members. She presented data on comprehensive diabetes care and stated that they are working to get the annual testing up to par. Ms. Hagan also reported on the Women's Health Initiative, a focused program addressing women's issues. There are 29,500 members who are women 21 years and older. They have produced a women's health magazine, with great reviews. She also stated that Passport was awarded excellent accreditation, the highest level possible in the NCQA Accreditation. Passport improved its overall NCQA score by increasing the number of HEDIS measures that achieved NCQA's highest benchmark thresholds. Ms. Hagan also reported that Passport was recognized in the top 25 of America's best health plan for the second year in a row and is the only Medicaid health plan in Region 4 to achieve "America's Best Health Plan" badge.
Representative Burch commended Passport on their work. He said that Passport should take on more counties and their work should be duplicated in Northern Kentucky and the Lexington area. He noted that Kentucky has benefited since Passport's inception and could benefit even more if that plan was duplicated across the state.
Senator Denton asked about the decrease in LDL-C. Ms. Hagan replied that the plan had focused on other areas which caused this area to fall off.
Senator Seum asked if there is a men's health initiative. Shannon Turner said there is not a real mechanism for males to be on the plan and Ms. Hagan followed that there are just not many male members of Passport.
Senator Seum asked what the membership numbers were. Dr. Cook said
there are about 145,000 members, with 29,500 being women.
Senator Blevins asked about pharmacy rebates. Ms. Turner said Kentucky does not receive rebates for prescriptions purchased for members of Passport Health Plan; however, there are some supplemental rebates received.
Senator Blevins asked if dental is a smaller player. Dr.
Cook said there is excellent dental representation on the partnership council.
Senator Blevins reported that the state increased fees on children's dental
exams and asked how much money Passport spends on dentistry. Dr. Cook said he would
get those figures for the committee.
Representative DeWeese asked about patient and provider satisfaction. Ms. Hagan said they are constantly improving on both sides and that Passport would share the satisfaction survey graph results with the committee.
Senator Roeding suggested that the Medicaid department encourage men to get PSA's to screen for prostate cancer. He encouraged the use of physician assistants, and nurse practioners and the college of pharmacy for chronic disease management.
Senator Roeding asked about savings vs. spending and if it is possible to show that data because he knows that Passport is saving the state money. Dr. Cook said that savings accrue to the Commonwealth and the rest of the Medicaid program. He stated that the savings are calculated based on the current costs as compared to regional and national trends.
Next on the agenda was a presentation on the Provider Tax Hospital Reimbursement Methodology by Carl Herde, Vice-President of Finance, Baptist Health Care, and Chair, Hospital Technical Advisory Committee. Mr. Herde said that hospitals have a delicate responsibility - to balance the care of the indigent and to invest. One challenge is the provider tax. He said they have been working for years to convert to a broad based tax. He noted that $180 million from the provider tax, coupled with matching funds is a large amount of money. He said in the last several years they have worked with the Kentucky Hospital Association, along with Representative Lee to freeze the provider tax and to earmark funds. This came about through the budgetary and regulatory process, and resulted in an increase in the percentage of costs being reimbursed from 65 percent to 80 percent. He said they have been working with the Governor's Office, the Secretary of the Cabinet, Commissioner Crouch and his staff to develop a new reimbursement methodology, which has gone into effect. He also reported that the state has eliminated the 21 day hold for claims. He said they are meeting every two weeks to work out problems.
Representative Burch asked how quickly payments are received Mr. Herle said with a clean claim, payments are typically received within 30-35 days.
Senator Roeding asked if they are working with the Cabinet to resolve concerns regarding the hospital reimbursement regulations filed on October 15, 2007.
Last on the agenda was a Kentucky Children's Health Insurance update (KCHIP) by Shawn M. Crouch, Commissioner, Department for Medicaid Services, Cabinet for Health and Family Services and Lisa Lee, Division Director of the KCHIP program in the Cabinet for Health and Family Services. Commissioner Crouch said that KCHIP is a combination program, established in July, 1998. KCHIP uses the Medicaid infrastructure and is similar to Medicaid in the following areas: (1) eligibility determination at the local Department for Community Based Services Office; (2) same provider network as Medicaid; (3) KenPAC assignment; (4) Passport eligibility for members in Jefferson and surrounding counties. KCHIP differs from Medicaid in these areas: (1) KCHIP is a capped grant; (2) KCHIP is time limited: (3) Children of state employees are not eligible for KCHIP, however, Kentucky chooses to cover children of state employees who qualify for the program with 100 percent state funds; (4) KCHIP is for uninsured children; and (5) KCHIP has a match rate of 78 percent, compared to Medicaid's 70 percent match rate. Commissioner Crouch reported that in State Fiscal Year 2007, expenditures were $103 million compared to $99.5 million in 2006. Kentucky has served 261,379 children since the program's implementation. The current enrollment is approximately 54,000, with 34 percent of this population being within 151-200 percent of the federal poverty level. Kentucky's 2007 federal allotment was $70 million, compared to the 2006 federal allotment of $57.7 million. The total expenditures since the program's implementation are $620.5 million. Commissioner Crouch also reported on reauthorization efforts. The federal capped grant expired September 30, 2007. Prior to the expiration, Kentucky officials participated in a meeting of national SCHIP directors to discuss the program needs and participated in discussions with SGA and NGA regarding issues and the impact of proposed legislation. The House and Senate compromised and created the Children's Health Insurance Program Reauthorization Act of 2007 (CHIPRA). CHIPRA increases funding by $34.7 billion and decreases the availability of allotments from 3 to 2 years. CHIPRA allows for a redistribution of unused allotments to address the state funding shortfall. It also phases out coverage for non-pregnant childless adults and transitions parents to lower federal payments. No new parent waivers are permitted. The President vetoed CHIPRA and on October 18, 2007, the House was 16 votes short of an override of the veto. On October 1, 2007 CHIP began operating under a Continuing Resolution. States were allocated funds under the Resolution, but only those states that expended their current funds were awarded allotments. States with carryover allotments will continue to spend those funds and will not be awarded an allotment until the current carryover funds are depleted or until CHIP is reauthorized. Kentucky has enough carryover funds to get through most of state fiscal year 08. Kentucky continues to operate the program at the current levels and has no immediate plans to change the structure of the program. Kentucky will continue to participate in discussions concerning any new or proposed legislation and project the impact on the program at the national level.
Representative Lee asked if there is a continuing effort to find children that are not currently signed up for the program. Commissioner Crouch said they are working hard to locate those children and currently have two outreach contracts. They have a contract with the Department for Public Health and have brochures available about the program.
Representative Lee asked if KCHIP funding can be used to develop child health services in schools to find children that are overlooked by the outreach programs. Commissioner Crouch said there is a specific pilot program with schools to help identify eligible children. Lisa Lee added that outreach funds are very limited and that money has to be targeted for specific populations. She added that they are currently working with the Jefferson County School Nutrition Program to cross reference names of children that are on the free or reduced lunch program with the names of insured children under the KCHIP program, in order to find uninsured children who may be eligible.
Representative Lee asked how many more children could be identified as eligible. Ms. Lee said close to 69,000 eligible children who are not currently enrolled in KCHIP.
Representative Burch asked if insurance companies have been approached to cover the KCHIP children. Commissioner Crouch said that the Cabinet is thinking of all options. He reported that they are looking the best way to handle it, whether it is internally, or through insurance companies.
Senator Seum asked what the poverty level is for families to be eligible for KCHIP. Commissioner Crouch said for a family of four, the amount is $31,000. Senator Seum asked what the limit would be if the federal bill passes. Commissioner Crouch said it would depend on what programs Kentucky implements, but the limit should be between $31,000 and $41,000 for a family of four.
Representative Lee clarified that for anything to be expanded, the plan would have to be approved by federal Medicaid services. Commissioner Crouch said permission would have to be granted by the federal government, plus the 69,000 additional children in Kentucky would have to be covered first.
Senator Roeding asked if health departments are cooperating to help find kids that are not covered. Commissioner Crouch said health departments are good partners on outreach efforts, and they are helping to find uninsured children as well.
The meeting was adjourned at 2:32 p.m.