Themeeting of the Medicaid Oversight and Advisory Committee (HB 90) was held on<Day> Monday, April 18, 2005, at 1:00 PM, in Room 131 of the Capitol Annex. Representative Rick Rand, Co-Chair, called the meeting to order, and the secretary called the roll.
Members:Senator Richard Roeding, Co-Chair; Representative Rick Rand, Co-Chair; Senators Walter Blevins, Tom Buford, Julie Denton, and Dan Seum; Representatives James Bruce, Joni Jenkins, Jimmie Lee, and Stephen Nunn.
Guest Legislator: Representative Tom Burch.
Guests: Jan Gould and Gay Dwyer for the Kentucky Retail Federation; Tom Canine for UNISYS; Jim Carloss for Pfizer; Prentice Harvey for Norton Healthcare; Mike Porter for the Kentucky Dental Association; Ellen Kershaw for the Alzheimer's Association; Mary Henderson, parent; Sarah Nicholson for the Kentucky Hospital Association; Sean Cutter for McBrayer, McGinnis, Leslie and Kirkland; and Marty White for the Kentucky Medical Association.
LRC Staff: Barbara Baker, Eric Clark and Cindy Smith.
The minutes of the September 20, 2004, November 15, 2004, and February 7, 2005 meeting were approved without objection.
The first item on the agenda was a Medicaid Update by Shannon Turner, Commissioner, Department for Medicaid Services, Cabinet for Health and Family Services. Commissioner Turner said the goal of Medicaid Modernization is to bring Medicaid administration into the 21st century by implementing approaches and practices that have proven to be successful in other states and the commercial sector. The components include benefit management, care management and improvements in technology. In regard to benefit management, she said that the implementation date for the point-of-sale system was December 4, 2004. First Health has implemented point-of-sale edits to prevent duplication of prescription, drug interactions and excessive dosing. Since December, Kentucky's per prescription cost has dropped by $2. Additionally, 1,700 of the top 2,000 pharmacy utilizers realized a decrease in the number of prescriptions. The three brand allowance and 90 day supply polices were implemented this week. Delays in implementation of these initiatives have caused slippage on our budget projections. Utilization and eligibles continue to grow. The next avenue for change is additional copays. In regard to care management, she reported that Medicaid currently has an active procurement for an administrative agent to provide the following services: (1) utilization review; (2) provider enrollment; (3) provider and member education; (4) call center operations for both members and providers; and (5) disease and case management. Additionally, Medicaid has implemented a pilot disease management program for over 6,100 diabetics in Floyd and Bell counties. Member and provider education is the focus of the first stage of the program. Feedback from members and providers has been very positive. Also, Medicaid has awarded the MMIS contract to EDS. However, a protest was entered and all work has ceased until the issue is resolved through the Finance Cabinet.
Senator Roeding asked about the disbursement of the plastic member cards. Commissioner Turner said Clay and Fayette Counties have introduced the use of the cards through pilot projects. The first batch was sent out last week and will be sent in three sets, with the last group going out in June. Senator Roeding asked about lost cards. Commissioner Turner said lost cards would be replaced and everyone will have their own card. Senator Roeding asked if a picture would be on the card. Commissioner Turner replied that a period is available to facilitate the adding of pictures in the future.
Senator Denton asked if the Cabinet is still looking into Medical spending accounts for Medicaid recipients. Commissioner Turner said they will look at the infrastructure and then at more creative ways and also copays for non-emergent services.
Representative Lee asked about the smart card and how providers are notified. Commissioner Turner said they can access eligibility information online or by phone or calling the Department directly.
Representative Lee asked about co-pays for emergency department visits. Commissioner Turner said there is no time frame for ER co-pays, and some other states have a triage fee. Medicaid is exploring how to work out triage fees. Representative Lee asked about patients with no money. Commissioner Turner said Medicaid patients can't be treated any differently and are seen just like all people without insurance.
Representative Burch asked if a primary care physician is assigned to everyone. Commissioner Turner said they are not assigned to everyone.
Senator Blevins asked where dental emergencies rank in the emergency department categories. Commissioner Turner said dental ranks at number ten in tier one visits. Senator Blevins asked what information will be available on the magnetic strip on the cards. Commissioner Turner said they are going to try to move toward having more health history information on the cards. The department needs to consider HIPPA issues. It is expected that the new MMIS system will be in place by December, 2006.
Senator Blevins asked if there is a portal for pictures on the cards. Commissioner Turner said that was looked at, but the logistics of getting the people photographed presented a problem.
Senator Roeding commented that some Medicaid recipients visit the emergency department without the approval of a primary care physician.
Next on the agenda was an update on KASPER by Robert Benvenuti, Inspector General, Cabinet for Health and Family Services, and Zac Ramsey, Division Direction, Division of Fraud, Waste and Abuse, Identification and Prevention. Mr. Benvenuti said the KASPER program was designed to produce 2,000 reports per year and is currently producing in excess of 2,500 reports per week. He reported that over 450,000 requests have been made since the inception of KASPER. In 2003, the development of enhanced KASPER began after a $1.4 million funding initiative from the legislature. In 2004, KASPER program requests increased to 122,469. Enhanced KASPER (eKASPER) has been implemented. He reported that the 2004 Hal Rogers Grant will be completed June 30 and the report will be submitted to DOJ, and the 2005 Hal Rogers Grant application will be submitted. He reported that even with 87 percent of the total KASPER reports being run by physicians, they estimate less than 50 percent of the physicians prescribing controlled substances are using the system. When KASPER began in 1999, it was anticipated that one staff would be required to administer the program. Today the branch has eleven full-time personnel with five dedicated to KASPER report processing. Mr. Benvenuti also discussed the role of the Drug Enforcement and Professional Services Branch (DEPSB) in administering the Kentucky Controlled Substances Act. DEPSB will process more then 150,000 KASPER requests in 2005. They currently have over 200 ongoing prescription drug investigations. They also have a contract with the Kentucky Board of Medical Licensure to assist with the investigation of physician misconduct, serve as consultants in drug-related matters to various Public Health initiatives, and collect fees from and issue licenses to over 240 manufacturers, wholesalers, and distributors of controlled substances. He also discussed the economics of drug division and gave several examples of the street values of certain prescription drugs. He reported that since implementing eKASPER, there have been 23,300 requests for reports processed, an average of about 582 reports per day. There are approximately 180 requestors that have been credentialed and given Web access. Two training session have been conducted, one for the State Police Academy and one for second year students at the U of L Medical School. Numerous additional training session are planned. He also reported on the impact of eKASPER, such as the fact that physicians can discuss potential addictions with patents before patients leave the physician's office, and that pharmacists will be able to prevent a questionable prescription from being dispensed to a drug seeker.
Representative Burch asked if there was any obligation for pharmacists to report suspicious prescribing to the licensing board. Mr. Benvenuti indicated that monitoring is more of a licensure requirement.
Senator Roeding recommended that the Inspector General's Office contact the County and Regional Medical Associations and also the Pharmacist's Association to set up training sessions for those offices.
Senator Roeding asked about KASPER increases since eKASPER. Mr. Benvenuti said there has been a shift to electronic users.
Mr. Benvenuti also discussed the DETER program, determining eligibility through extensive review. He reported that Jefferson and Kenton Counties were selected for pilots due to their population, location and partly because of the number of complaints received from those areas. As of April 1, 2005, three DETER investigators are on staff. They are also developing an ongoing intelligence methodology for tracking DETER complaints and investigating outcomes that will define the future direction for DETER staffing, anti-fraud training, as well as assist in other OIG anti-fraud operations. The next steps are to analyze public assistance participation and complaint ratio to determine where best to locate investigators. After establishing DETER in the east and west regions they will begin the process of moving across the state. They will also assign DETER investigators to DCBS field offices when space is available to encourage a cooperative effort and provide real time investigative resources.
Senator Blevins asked about KASPER programs in other states. Mr. Ramsey said that Nevada has a good program and Ohio, Indiana and Tennessee are working on a program like KASPER. Mr. Benvenuti said because Kentucky has a strong system, it is pushing people into other states, so other surrounding states are in a hurry to develop good systems.
Senator Buford asked about the 450,000 requests how many convictions related to KASPER reports. Mr. Benvenuti said he does not have that answer because there is no requirement for the cases to come back at the final stage.
Mr. Benvenuti also discussed the Fraud and Abuse Hotline. He said the Office of Inspector General is responsible for maintaining and publicizing a 24 hour toll-free hotline for the purpose of receiving reports of alleged fraud and abuse. The Inspector General's office received over 5,300 calls on the hotline in 2004, a 700 call increase from 2003. There have been posters prepared and passed out throughout the state telling of the hotline, and two statewide press releases have been issued describing the Inspector General's office hotline, and additional releases are planned.
Representative Rand said the committee would possibly hold additional meetings in July, September and November.
The meeting was adjourned at 2:30 p.m.