The Medicaid Oversight and Advisory Committee meeting was held on Monday, December 8, 2008, at 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; Representative Jimmie Lee, Co-Chair; Senators Walter Blevins Jr., Tom Buford, Julie Denton, and Dan Seum; Representatives Bob M. DeWeese.
Guests: Eric Clark and Wayne Johnson for the Kentucky Association of Health Care Facilities; Bill Doll for the Kentucky Medical Association; Sarah Nicholson for the Kentucky Hospital Association; and Jan Gould for the Kentucky Retail Federation.
LRC Staff: Miriam Fordham and Cindy Smith.
The minutes of the November 12, 2008 meeting were approved without objection.
First, Representative Lee presented a Resolution from the committee in honor of Senator Roeding’s retirement. The members spoke about Senator Roeding and his accomplishments.
Next on the agenda was a discussion of the Passport Advantage Plan by Shannon R. Turner, JD, Executive Vice President, University Health Care, Inc., Ruth Atkins, Executive Director, Passport Health Plan; and Jill Bell, Executive Vice President, Passport Health Plan. Ms. Turner said that the mission of Passport is to improve the health and quality of life of its members. She reviewed the organizational structure and governance of Passport. She said that as a Medicare Advantage Special Needs Plan, Passport Advantage is able to manage both Medicare and Medicaid benefits, thereby providing better coordinated care for that vulnerable population. Absent a CMS contract, Passport Health Plan would have lost the ability to manage pharmacy benefits and ultimately, quality and continuity of care for these dual eligible members. Ms. Adkins spoke about eligibility. She said that in order to be eligible, members must have Medicaid Part A and Part B and be enrolled in Passport Health Plan (Medicaid). All members have a special election period and can enroll or disenroll each month. Passport Advantage members are full benefit dual eligibles and more members are eligible due to disability rather than age. Currently there are 170 ESRD members. The total disenrollment rate for Passport Advantage is 1.73 percent. The Plan uses a team approach for delivery of quality care and services. It addresses the needs and challenges of members with chronic illnesses and disabilities. It provides member assessments and interventions prior to major high-impact events and it minimizes problems that occur when care systems are fragmented by using a comprehensive coordinated care system. In addition to Medicare Advantage requirements, special needs plans must also provide a model of care and undergo selected standard review by NCQA. Key factors to its success are: a provider sponsored model; a partnership model; extensive physician and clinician involvement in developing, implementing and managing the plan; a proactive care coordination model; member satisfaction and involvement; collaboration with community agencies and health departments; and an extensive provider network and enhanced reimbursement.
Senator Denton asked who pays for dialysis reimbursement. Ms. Atkins said that Passport Advantage pays like a Medicare plan, and anything else is considered by Passport for payment.
Senator Roeding asked how dental services are covered. Ms. Atkins said they are covered under the traditional Medicaid Passport plan.
Senator Buford asked if there has been any talk with the Cabinet about Passport expanding to cover more of the state. Ms. Turner said there have been no talks yet, but the Passport program has been given an additional three year extension in the region they currently cover.
Senator Blevins asked how many new recipients per month there have been under the Passport plan. Ms. Turner said the eligibles have been steady, but from July through August the numbers increased dramatically. For calendar year 2008, there have been about 4,000 to 5,000 more recipients than anticipated.
The next item on the agenda was a discussion on the use of atypical anti-psychotic drugs for children by Dr. Thomas Badgett, Medical Director, and Elizabeth Johnson, Commissioner, Department for Medicaid Services, Cabinet for Health and Family Services. Dr. Badgett began by showing a map of the 104 counties that participate in the Behavioral Pharmacy Management Program (BPMP). The counties covered by Passport do not participate. Dr. Badgett discussed data on drug classes for children 18 and under from April, 2005 through June, 2005. Of the drug classes discussed, stimulants were the highest prescribed at 19,108 for children with a cost of almost $4 million dollars for three month usage. There were almost 9,000 patients on atypicals for the same three month period, which cost over $4 million dollars for three months. He reported that the number of pediatric recipients, as well as drug costs have increased since 2005. He said the BPMP analyzes six additional behavioral drug classes: ADHD non-stimulants; mood stabilizers; insomnia agents; benzodiazepine; antidyskinetics; and any substance abuse drug. He also said that seven of 23 quality indicators are designed for pediatric data analysis.
Senator Roeding asked how pharmacists are used. Dr. Badgett said they put data into the system.
Senator Roeding asked if there has been a trend in possible over prescribing of ADHD drugs for children. Dr. Badgett said the pediatric area has not been launched yet. But, they expect it to be in the coming weeks, and they will watch for that.
The last item on the agenda was a discussion on Medicaid budget issues by Elizabeth Johnson, Commissioner, Department for Medicaid Services, Cabinet for Health and Family Services. Commissioner Johnson reported that there is a $183 million anticipated deficit in Medicaid for 2009 and she said that figure may worsen in the future. The Cabinet is diligently working towards efforts to maintain Kentucky Medicaid for the long term. She said that even if all the new programs were implemented immediately, a cost savings would not be seen by the end of the fiscal year, but regardless, all systems need to be implemented. She also reported that Kentucky is seeing the highest unemployment rate in 30 years, with a 6.8 percent rate for October, 2008. A rising unemployment rate means there are higher numbers enrolling in Medicaid and CHIP. They have seen a 3,000 per month increase in enrollees, while their budget is only figured for a 1,000 per month increase.
Senator Roeding asked if they are working on a plan to balance the budget. Commissioner Johnson said the Cabinet is working with GOPM and the Governor’s Office, but there are not definite plans thus far.
Senator Roeding noted that Kentucky was frugal with its spending in the CHIP program, and the state needs to look into additional ways to pay for it. He also noted that Passport would be interested in entering into an agreement to look at ways to possibly save the state money.
The meeting was adjourned at 2:15 p.m.