The Medicaid Oversight and Advisory Committee meeting was held on Wednesday, November 12, 2008, at 1:00 PM, in Room 129 of the Capitol Annex. Representative Jimmie Lee, Chair, called the meeting to order, and the secretary called the roll.
LRC Staff: Miriam Fordham, and Cindy Smith.
The minutes of the October 22, 2007 and August 18, 2008 meetings were approved without objection.
First on the agenda was an update on Medicaid reform by Elizabeth Johnson, Commissioner; Reina Diaz-Dempsey, Deputy Commissioner; and, Carol Muldoon, Deputy Commissioner, Department for Medicaid Services, Cabinet for Health and Family Services. Commissioner Johnson began by discussing the Deficit Reduction Act (DRA) of 2005. She said there is a concern over the rising federal deficit. The deficit needs to be cut and tax cuts need to be extended. The DRA promise is to reduce the growth in Medicaid spending by $5 billion over 5 years. She reported that the diabetes disease management pilot program has been fully implemented in targeted counties under the contract with First Health. Effective July 1, 2009, the diabetes disease management program will begin to be delivered through a partnership with the Diabetes Centers of Excellence in counties with the largest concentration of high-risk diabetes patients. Effective January 1, 2010, the final phase of the diabetes disease management program will be implemented, expanding it to other geographic areas where the program will be cost-effective. Commissioner Johnson reported that Kentucky is in the highest tier for the number of diabetes deaths per 100,000. Kentucky ranks 40th in the nation in the number of diabetes deaths. Kentucky Medicaid has more than 65,000 members with diabetes. Diabetes disease management should be a high priority for Kentucky Medicaid. She also reported that Kentucky ranks 35th in the nation in the percentage of adults who have been told they have asthma; and, more than 60,000 Medicaid members have an asthma diagnosis. Kentucky ranks 39th in the nation in the number of preterm births. Medicaid pays for approximately 40 percent of all births in Kentucky (nearly 50 percent when Passport numbers are included).
Representative Lee asked about the mechanics from the first visit to the provider and on to the Center of Excellence and how reporting is done. Commissioner Johnson said that there was no baseline with First Health; and, they will be pushing baselines. Medicaid will be partnering with the provider community and will give them tools to refer people to the Diabetes Excellence Centers. Electronic report cards will also be done. She also said they would have a true partnership with the Department for Public Health and will share data.
Senator Roeding asked about the partnership between providers, nurse practitioners, physician assistants, pharmacists and health departments. Commissioner Johnson said without the buy-in there would be no success. The provider community has seen an increase in reimbursement. There has to be a true partnership between all the parties involved to improve the overall health of Medicaid individuals.
Representative DeWeese asked if the Diabetes Center of Excellence will replace caseworkers. Deputy Commissioner Muldoon said everyone will be involved and that the Diabetes Center of Excellence will have a new program that will have registered nurses that will do telephone calls. They will also have nurse practitioners.
Representative Lee asked if the 65,000 members with diabetes are in the 20 percent of enrollees that are costing 80 percent of the money. Commissioner Johnson said that is correct.
Representative Lee asked about the University of Kentucky and University of Louisville grant for diabetes research, and if the state will be able to incorporate those universities’ expertise. Commissioner Johnson said that information is not in the model yet, but they recognize that the universities have the expertise to help.
Representative Lee asked if the state would furnish the necessary software to the universities and be able to get the same feedback as from the private providers. Commissioner Johnson replied yes.
Commissioner Johnson spoke about Medicaid modernization. The DRA promise for the Health Insurance Premium Program (HIPP) was to enroll 1,000 individuals by the end of three years. Currently, only 6 have been enrolled. Medicaid has identified barriers. The barriers include lack of true wrap around coverage; insufficient focus on high cost individuals; inadequate cost effectiveness methodology; and, required regulation change and state plan amendment needs revision.
In regard to expanded access to community based programs, Commissioner Johnson reported that the Michelle P. waiver was implemented August 1, 2008, the Money Follows the Person grant received was operational on August 13, 2008; and, the Acquired Brain Injury Waiver for those who have reached a plateau in rehabilitation was effective November 1, 2008.
Representative Lee encouraged that there not be a plateau for Acquired Brain Injury services. Commissioner Johnson said that the purpose of the waiver is to be able to provide more comprehensive services.
Senator Seum asked about the outcome of the Michelle P. Lawsuit. Commissioner Johnson said that there was a settlement in 2006; and, they are in full compliance with that settlement.
Commissioner Johnson also discussed program integrity. She said that effective June 16, 2008, the new Division for Program Integrity, formerly under the Office of Inspector General, was operational in the Department for Medicaid Services. She also said that the SURS vendor was obtained; the first set of HCE algorithms were identified; and, the TPL Vendor (HMS) recovered monies.
Deputy Commissioner Muldoon discussed the pharmacy management program. She said that reviews of new classes generating additional rebate savings has been completed in the Enhanced Preferred Drugs List Management Program; the generic utilization rate has improved to 72.18%; on-site pharmacy audits began in the first quarter of calendar 2008; enhanced program integrity coordination has begun; and academic detailing and educational programs to educate providers on the appropriate use of prescription drugs (CNS program) have been implemented.
Senator Roeding asked what prompted the on-site pharmacy audits. Deputy Commissioner Muldoon said they are a standard minimal audit. Notice is given beforehand to the pharmacies, and they are the least disruptive as possible.
In regard to the KENPAC Partnership Program development, Commissioner Johnson reported that modernization of the KenPAC Program will focus on emphasizing the importance of a medical home; engaging primary care providers effectively; designing program components that align incentives; sharing appropriate data to maximize clinical outcomes; and, establishing program baseline data and goals and routinely monitoring and reporting on progress.
Representative Lee said that it is vital that all components are discussed and that everyone remains active. He asked if Kentucky can expect the cost avoidance programs to be in place and be effective with the funding that is available. Commissioner Johnson said no; they can’t fill the hole on cost avoidance by 2010.
Senator Buford asked if more of the state could be covered by Passport. Commissioner Johnson said that she has not been in talks with Passport about that and currently they are trying to manage the statewide Medicaid program as well as possible.
Last on the agenda was a discussion on the activities of EDS and the Medicaid Management Information System (MMIS) by Glenn Jennings, Account Executive, EDS Information Services.
Representative Lee began by asking Mr. Jennings whether EDS can provide data on all services recipients are receiving that are in the 20 percent that are costing 80 percent of the money. Mr. Jennings said yes, it is called the 1115 Report. The federal government requires that EDS produce this report for Medicaid. This report can include all expenditures and all services in one report.
Representative Lee commented that with technology that is available, any given eligible could be looked at; by whom they are managed; and, the complete picture would be there of a particular eligible. Mr. Jennings said yes; everything can be done. He said a report could be done on the top 200 enrollees who are costing the state the most money, and a complete history on their health care could be in the report.
Representative Lee said there needs to be a simple way to look at eligibles and to keep the committee members current as to how the focus is being narrowed, so there is not disconnect between the programs.
Representative DeWeese asked when getting the information if there is other information available, such as their lifestyle, whether they smoke or are overweight. Mr. Jennings said that diagnosis codes are available; but, lifestyle issues are different.
Mr. Jennings said that good progress is being made at EDS. He said that over 19 million claims have been paid to date, and the average check written each week is about $70 million.
Representative Lee asked if EDS is maintaining on time payments of claims. Mr. Jennings said yes; most are being processed in a 21 day window.
The meeting was adjourned at 2:30 p.m.