Expanded Access
Coalition Meeting
October 28,
2003, 9:30-11:30 a.m., OHAC
MINUTES
Attending:
Sandy Wood (OMAP)
Linda Herman (Clackamas County Health Dept)
Marcy Sugarman (Multnomah County Health Dept)
Kristi Jamison (Central City Concern)
Laura Brennan (DHS)
Robert Gassner (National Psoriasis Foundation)
Heather Dominnique (Central City Concern)
Sheila Kirk (NARA-OP)
Lela Buser (NARA)
Debbie Lamberger (OHSU)
Robert Judge (Wellpartner)
Mary Olson (FHIAP)
Rhonda Walker (OHAP/LC-CKF Coalition)
Kaaren Driscoll (OHSU)
Katie Gautnier (Oregonians for Health Security)
Joy Soares (CareOregon)
LoriAnn Sheridan (OHAP)
Carlos Medina (YVFWC)
Lorey Freeman (Oregon Law Center)
Ellen Pinney (OHAP)
Jennie Hamilton (OPCA)
Ileana Henriguez (YVFWC)
Elena Gainy (YVFWC)
Lupita Lescher (YVFWC)
Tim Miller (OHAP)
Jim Rocha (OHAP)
Michele Wallace (OHP Processing Center)
I. Call To
Order & Introductions: Jennie
called the meeting to order at 9:35 a.m. Sandy
Wood said she will be attending on behalf of OMAP, replacing Nancy Horn. Ellen Pinney briefly reviewed the handouts for the meeting.
II. Enrollment
Numbers – OHP & FHIAP: The
coalition briefly reviewed the OMAP Medically Eligibles for September and
Michele Wallace handed out the OHP Central Quarterly Report, illustrating
trends. Laura explained the
state’s definition of “eligibles” is “enrolled” individuals.
Ellen passed out enrollment trends LoriAnn compiled from September
2002-September 2003. Jennie
requested that the trends be compiled and presented at the next EAC meeting
covering OHP standard, broken out by FPL and elderly.
Mary Olson gave a brief update of FHIAP enrollments: Currently, there are 5,851 enrolled lives (2,441 in group and
3,410 in individual). There are 795
lives approved: 660 in group and
135 in individual. She told the EAC
they have been doing extensive outreach statewide, and enrollment numbers are
posted on-line on their website, under “weekly snapshots,” at www.ipgb.state.or.us.
She added their maximum capacity is 10,000 in group and 1,000 in
individual, and there’s no longer a requirement to have a 50/50 split between
group and individual coverage. Ellen asked Mary if she would bring the FHIAP outreach
materials to the next EAC meeting. Mary
said she would also bring a video of their marketing materials.
Ellen expressed her concerns that there were no references to OHP or
SCHIP in the FHIAP outreach materials. Mary
pointed out these programs are included in the Covering Oregon brochure FHIAP
distributes. She added the problem
with marketing FHIAP is that people don’t think of OHP or SCHIP and when they
talk about all these programs, people get confused.
Jennie asked Mary to bring the outreach letters to the next EAC meeting.
III. Premium
Issues– Jennie addressed the agency meeting she attended with Linda
Herman, Marcy Sugarman, Laura Brennan, Tim Miller and Sandy Wood to discuss
“sponsoring organizations”, groups that can pay premiums on behalf of OHP
Standard enrollees. She explained that until
January 2004, providers of health services to OHP Standard clients will continue
to be allowed to pay premiums for their clients.
Hopefully, before January 1st, an agreement will be reached
outlining the requirements for future
sponsoring organizations. She
added they hope non-profit organizations will step up to pay premiums.
The group recommended at intake, having standard procedures to ask
clients if they need premium assistance.
Laura
explained Washington’s program, which is state funded.
Carlos said Yakima Valley Farmworkers Clinic, which is integral to the
sponsorhip model in that State, is currently doing research in Oregon.
They are also in talks with OMAP relative to opening their new clinic in
Portland.
Ellen
asked what the state is doing to encourage sponsorships.
Jennie said nothing was clarified at the meeting.
Sandy explained the Attorney General wants non-profits to consider
sponsorships, which is a legal approach. Laura
mentioned OHPPR is still receiving funds from the HRSA grant that explored
sponsorship organizations. Ellen
pointed out Nancy Rudolf said anyone can pay premiums and was going to look into
check by phone. Laura mentioned
there’s information on the OHPPR website on Washington’s sponsorship
organizations.
Sandy
pointed out the state is in danger of losing OHP completely, so anything the
state can do to hold down OHP costs including cost-sharing options are at least
a viable alternative. Rhonda shared
her concerns about the complexity of Earhart’s processing of premium payments.
Joy added the reason for the cost-sharing is that the Legislature
believes clients should be responsible in sharing costs.
Lorey addressed Senate Bill 2919, explaining there was never a mandate
for cost-sharing. Marcy explained
Multnomah County’s process of paying premiums.
Lorey questioned what was going to change in January.
Sandy explained it was just a transitional period.
Ellen
asked how many in attendance pay premiums for clients.
There were several hands raised. She
reminded everyone that the 20th of the month is the deadline for
paying premiums. She suggested
relationships be formed between outlying Community Based Organizations and
non-profits in Portland to facilitate payment of premiums , and encouraged EAC
participants to think creatively about other ways to facilitate premium
payments.
Kristi
Jamison, from Central City Concern, said they are a provider as well as a
foundation, and pay premiums for 300 clients per month.
She indicated one challenge is that Earhart won’t accept their
information until the 19th and clients get penalized.
Ellen suggested they write a letter to Nancy Rudolf.
Rhonda told the EAC about a client who was charged variable premium
statements monthly, ranging from $18 to $6 per month.
Michele suggested she get copies of the notices to Sandy Wood.
Ellen
addressed the need to get a copy of the Earhart contract, which she requested
last month. Jennie suggested
everyone document stories from their clients.
At the next meeting, she will bring a five-minute video of community
health centers that the Oregon Primary Care Association (OPCA) created.
IV. MEDS – Sandy addressed HB 2511, covering individuals over 65, the blind and disabled. She indicated she is the project manager and the letter sent to CMS requested coverage up to 135% FPL. There will be a sliding scale for cost-sharing for medications: if an individual makes less than $700/month, they pay 5% of Medicaid price with maximum out of pocket cost of $25; income @ $700-$850/month, cost share is 25% up to $50 maximum for all meds per month; $851+/month, 50% of Medicaid price up to $128/max. She added the dispensing fee adds into the match. She explained 7200 people were in the medically needy program with medical coverage previously. With $18 million for 21 months, people can’t have other medical coverage to participate. Debbie Lamberger said at OHSU, if a person qualifies for Medicaid, they are not eligible for pharmaceutical drug coverage. The state is hoping to cover at least 6,000 people with the new meds program. They will grandfather HIV and transplants over 135% FPL.
V. Waiver Ellen said DHS expects they need 75 days after CMS approves the waiver to implement the program, and it looks like it will not be January 1 at this point. If CMS approves waiver December 1st, it would mean a March 1st roll out. Chances are more likely the program will be rolled out in May. Jennie pointed out that many OHP changes are wrapped up in the waiver: medically needy; SCHIP and FHIAP expansion; reinstatement of mental health for standard population; reduction in line by 30 points. Concern that CMS may be reluctant to give waiver full attention while revenue recall is in progress. She asked if there’s any potential to advocate to CMS to approve part of the waiver (like SCHIP expansion) immediately. No clear answer.
VI. Ellen asked Sandy for the following items she had previously requested from Nancy Horn and Nancy Rudolf:
ØNumber of people dropped off OHP due to failure to pay premiums
ØDate for the elimination of the watermark on the OHP application on the OMAP website
ØDate stamp contracts for local pilot sites
Sandy said some of her staff already have answers to questioned posed to Lynn Read. She will ensure EAC receives this information.
V. OHP Standard Hospitalization – Joy said there is a group looking at reducing the line of covered services and changing the co-pays. There was a question whether the hospital tax will survive if the tax bill proposed to the voters fails in February.
VI. Other Business:
A. Resources/Training: Carlos questioned access of OHP application training, and if there’s an operations manual available. Jennie said lots of this information is available on the OMAP website. Ellen explained the EAC role is an open process to direct people to application resources, adding Helpline training is available through OHAP. Tim briefly explained the training. Michele said she would look into creating a simplified manual. Jennie offered to help as the FQHC’s could use such a manual. Jennie said the OPCA also has a listserv for questions about Medicaid.
B. Salem Hospital Charity Care Signage – Carlos commended Ellen and Tim on their efforts to get better signage at Salem Hospital relative to financial assistance/charity care.
C. Wellpartner – Robert Judge briefly explained the Wellpartner program: if an individual is on OHP Plus, they qualify for mail-order meds for 90 days at a time without co-pay, however, the program is not extended to the OHP Standard population. He explained on average, the state saves $11/month using this mail-order program instead of pharmacies. They are working with the state on outreach initiatives: (1) direct communications with members; and (2) going to providers who see a high density of OHP clients. He explained the Wellpartner service is focused on fee-for-service, not managed care. Managed care plans have their own ways of handling pharmaceuticals. He handed out information about the program.
D.
COER
– Laura addressed the list of requests COER (Committee on Outreach, Enrollment
& Retention) gave to Lynn Read in August.
She added she is following up on the responses Lynn gave and working with
the state on communicating with the Covering Kids & Families partners.
She asked if she can have a standing slot at the EAC meeting to present
updates on COER progress. Everyone
agreed this would be a good standing agenda item.
E.
Oregon Law Center Lawsuit – Lorey explained the lawsuit against the state on
premiums. A copy of the letter was
handed out. She explained the state
filed a motion to dismiss and she submitted a letter to settle, however, the
state could not agree to anything in the letter.
The case is against CMS and the Secretary of DHS.
She said the state filed for a summary judgment and the hearing was
October 6. She added it was the
first time she has heard a judge say to defendants, “I don’t buy your
argument.” It will be two months
before they know anything to issue an opinion on.
IV. Announcements
& Adjournment:
A. Oregon In Action Part 2
Conference – Laura announced the 0 Disparities/100% Access Conference will
take place in Portland 11/03-04. She
added there are scholarships available on a first come, first serve basis.
She will get information to anyone interested in attending.
B.
Next meeting:
December 2, 9:30-1:00 p.m., DHS Parkway Bldg., Upstairs, Room 6
Lunch
will be provided.
Tours
of OHP Central 12:30-1:00 p.m. to those interested.
Note:
Limited parking; overflow at Fred Meyer across the street
C.
Adjournment: 11:40 a.m.
Handouts:
OMAP Medically Eligibles Data (September 2003) COER Request List to Lynn Read
State Processing Center’s OHP Applications Processed (Aug 2003) FHIAP Outreach & Marketing Data
State Processing Center Quarterly Report (July-Sept. 2003) Sample Contract for Date Stampers
OMAP Medically Eligibles Data Sheet (Sept. 2002-Sept. 2003) Oregon Law Center lawsuit letter
Register-Guard article on OHP client loss Wellpartner Information on Prescription Meds
EACMtg102803-EP.doc Recorded by LoriAnn Sheridan, OHAP