Expanded Access Coalition Meeting

September 23, 2003, 9:30-11:30 a.m., OHAC

MINUTES

Attending:

Nancy Horn (OMAP)                                                  Linda Herman (Clackamas County Health Dept)

Marcy Sugarman (Multnomah County Health Dept)            Terry Layman (OMAP)

Laura Brennan (DHS)                                                  Angie Newton (Siskiyou CHC)

Carol Simila (DCBS/Insurance Division)                       Katie Gautnier (Oregonians for Health Security)

LoriAnn Sheridan (OHAP)                                               Nancy Rudolf (OMAP)

Lorey Freeman (Oregon Law Center)                         Ellen Pinney (OHAP)

Jennie Hamilton (OPCA)                                               Donna Harles (OMAP)

Karry Gillespie (United Way)                                        Kevin Earls (OAHHS)

Linda Carter (Health Network for Rural Schools)            Tim Miller (OHAP)

Rhonda Walker (Lincoln County CKF Coalition)            Michele Wallace (OHP Processing Center)

Shannon Stumpfer (Fund Oregon’s Future Today)            John Holmes (NAMI)

I.          Call To Order:  Jennie called the meeting to order at 9:35 a.m.

II.            Premium Issues, Tracking & Recommendations for Facilitating Client Payment Ability:  Ellen told the EAC she attended a meeting with 50 people to discuss the premium issues.  She pointed out that outreach needs to be pursued for the 40,000 uninsured who are eligible for public health care.  She, then, reviewed the COER requests to Lynn Read. 

a.       Outreach – Ellen said she spoke with Lynn yesterday, and they agreed that the vote in February will dictate whether or not we move ahead.  A lot also depends on whether or not the waiver is approved by CMS.  Once that is approved, they will work on a press strategy. 

b.       Simplification – Ellen pointed out that making applications available at community-based organizations is permissible, however, they need to deal with Nancy Horn in an effort to remove the watermark on the on-line application.  Nancy H. said application distribution will not take place as the questions are different and they will not be removing the watermark.  Ellen indicated if that’s the case, she wants applications available to everyone as they need to be accessible.  Nancy H. pointed out the application is on-line in 11 languages without the watermark.  Michele discussed getting the lists of date stampers.  Nancy said it is in the contract for non-state outreach to assist with applications, but it’s based on staff load.

                        Nancy Rudolf addressed #8 under simplification in the COER requests (six-moth re-enrollment date listed at top of OHP application).  She said any information set can be included on the premium notice, however, they’re trying to avoid false promise or be misleading.  They have been going one month at a time and trying to keep the bills simple, however, Earhart is willing to look at changes.  She explained Earhart’s contract is extended one year at a time and they can negotiate terms of the 5-year contract.  They have added 12 additional lines to the phone, but continue to work within the contract.  Jenny said it would be helpful to have a copy of the contract to better understand the parameters under which Earhart is working. 

Nancy R. told the EAC Earhart is paid $2.93 per bill processed ($1.33 previously).  She pointed out  that only 25% of the bills sent out last year were processed.  Collection rate is at 80%, however there has been a 300% increase in returned checks and it takes three people to deal with this process.  She explained they are going into the second year of the 5-year contract, and she is responsible for dealing with any problems with Earhart.  Ellen questioned whether or not the state could do the job cheaper.  Nancy R. explained they do not have the capacity at OMAP and they would need a $1 million upgrade and new equipment.  Linda Herman questioned the costs going up when 40,000 individuals have been dropped.  Nancy H. explained that collection costs have increased.  Nancy R. added a number of phases are involved and volume has increased.  She further said she has not seen a significant increase in enrollments, however, people are being more responsive to getting their premiums paid on time.

Jenny asked if the projected numbers and purpose were given to the Legislature.  Nancy R. said the numbers have decreased significantly, and an additional 13,000 are anticipated being dropped.  Nancy H. said many dropped off OHP due to the exclusion of prescription meds, then tried to get back on when it was reinstated.  Nancy R. said she can correlate the number of disqualified to the number of enrollees.  Rhonda pointed out some people are paying $30-40 per prescription.  Kevin questioned the number of people dropped due to failure to pay premiums.  Ellen addressed the OMAP statistics.  Jennie said she would like OHP Central to track re-enrollments by outreach code.

Kevin questioned if limited OHP hospital benefit and differential of OHP Standard and average number of which has a appropriation for the coming year, why are people dropping off OHP besides because of premiums.  Members of the EAC offered a number of reasons, including limited benefits, moving, etc.  Kevin said he would like to project the number from the 6-month wait period of 58,737 eligibles.  He questioned if the State has a plan for every enrollment up to 85,000, and the enrollment does not reach this level, can the money be used to provide more services. 

Ellen asked Nancy R. for the number of people dropped monthly.  She also addressed sponsorship organizations for premium support. Kevin suggested they think about what to fund and not have money left over.  Rhonda stressed the need to ensure premiums and co-pays are not increased.  Ellen questioned the archaic computer system.  Linda H. suggested the State look at contracting with Earhart to do applications.  Nancy H. suggesting looking at what other states are doing, and use their ideas.  Michele said she has contacts from the national CKF conference who have Internet applications.  She’ll ask Carolyn Ross to look into it.

c.       Coordination – Linda H. addressed concerns relative to whole families being dropped from OHP.  Nancy R. asked her to send her the information to correct this situation.  In response to item #1, Nancy R. said they will include a statement on the Form 57B (disqualification form) referencing the fact that children remain eligible for coverage.  This will be done before the October mailing (Oct. 15-17). Ellen asked if advocated could review prior to printing.

Ellen said FHIAP has been doing some aggressive outreach since February.  They sent out 2,000 outreach pieces to businesses with 100+ employees, 2,300 to businesses with 50-99 employees, 4,600 to businesses with 25-49 employees, and XXXXX to businesses with less than 24 employees.  She shared her concern that nowhere in the materials was SCHIP referred to.  She addressed the lack of coordination between programs, and the yellow sheet with wrong numbers.

Jenny questioned who sends information to managed care organizations.  Nancy H. said materials are sent by request only.  Ellen suggested it would be easier to have local coalitions distribute brochures.

d.       Premiums – Ellen addressed #3 about hearings, asking what the wait period is for a hearing.  Donna explained it takes 45 days or less.  Michele said they have approximately 30 hearings per month regarding no exceptions; actually, 90 hearing per month take place for other reasons, however, benefits continue through the hearing period.  Ellen shared her concerns about premiums not being received.  Nancy R. said Earhart goes to the post office every morning and are very diligent, adding the post office needs to be held accountable. 

Laura addressed what Washington has been doing relative to sponsorship organizations.  Native American organizations have been paying premiums.  The sponsorship program when through the Legislature to ensure its integrity and legislation passed to allow for community sponsorship organizations closely related to providers.  In clinics, they must offer choices of all managed care organizations upon enrollment.

Nancy R. said OMAP is trying to work it out so sponsorship organizations can pay premiums for OHP clients, however the Attorney General has concerns regarding anti-kickback rulings.  She explained if a clinic receives federal dollars and offsets, they cannot sponsor premium payments.  She said some able created a 501 (c)(3) with equal access, adding the downside is designated funds.  Ellen pointed out Multnomah County is still sponsoring premiums payments.  Nancy R. said the AG does not look favorably on this.  Marcy clarified they don’t pay premiums up front, but look at clients paying in arrears.  They are paying for clients already being seen at their clinic.

Laura said Yakima Valley Farmworkers Clinic has a separate entity, Mount Adams, a brother organization, that pays premiums.  They share the same staff and computers, offering assistance through the Mount Adams Foundation, and the clinics offer community health plan and all others to choose from.  Ellen pointed out the problem is people come in at the last minute for premium assistance.  Laura suggested people could donate through OHAP to assist with premiums payments.  Linda C. said it’s hard to do in her three-county area, however, churches are willing to assist.  Rhonda said Progressive Options received a large grant from the Confederated Tribes of Siletz Indians to pay premiums and co-pays.

Ellen asked Nancy R. if they can accept credit cards.  Nancy R. said the electronic fund transfers (EFT) was a disaster, but organizations can do it.  Ellen suggested including a list of organizations able to assist with premium payments with the premium notices.  Nancy R. said this would require stuffers and stoppage of action.  LoriAnn suggested it’s EAC’s job to get the information out to the consumers.  Laura added it would be more effective to get information out through community non-profits.  Ellen said with a sponsorship organization, the Helpline can assist.  She asked if clinics could pay via a sponsorship organization.  Nancy R. said it has to be less than 50,000/year as a safe harbor.

III.            Outreach for Uninsured Children:  Jennie pointed out the greatest number of covered children are between the ages of six and 12.  There is a significant number of eligibles between the ages of one and five, 13-18.  She added there will be an outreach meeting, hosted by OPCA , in Roseburg on October 3, handing out information.

IV.              MEDS – The New Medically Needy Program – Nancy H. said the Legislature felt passionate about replacing the medically needy program.  They started with $21 million, ending up with $18 million to implement.  $3 million is committed to HIV & transplant meds.  Currently, they have two weeks to design the program.  The legislative intent was to include co-payments and co-insurance.  She attended a meeting of advocates on Monday, and they suggested stair-stepping co-insurance since out-of-pocket is tied to this.  She added Representative Bates, Connie Seeley and Mike VanAtta met last Wednesday and decided to cap assets at $2,000 and not grand father over 133% FPL.  The program will be tailored to special needs and will involve benefits for prescription drugs only.

Nancy H. explained HIV/AIDS will have a restrictive formulary, not including pain medications.  She added the average prescription costs $63.00 per person per month.  Jennie pointed out that as of January 1, 2002, the state reduced hospitalization benefits.  Nancy H. said the providers are pulling together.  Ellen told the EAC the State has asked stakeholders to come to the MEDS meetings.

V.        CKF National Conference – LoriAnn gave a brief update on the CKF national conference attended by Michele Wallace, Linda Carter, Elizabeth Ledman and Kristina Hamm from Outside Inn, and herself.  She addressed one workshop presented by Cheryl Camillo  of CMS, covering simplification strategies for child and adult programs.  She handed out the Powerpoint information from the workshop.

                        Michele addressed the Supporting Families workshops she attended with LoriAnn.  She explained Oregon was one of the states chosen for this unique program, which will involve strong networking with fellow states in addressing various methods of simplification and coordination at the state level.  She will be talking with Lynn Read about pursuing this program before the State CKF commits to its participation.

VI.       Other Business:

a.       Ballot Measure – Ellen handed out the ballot measure  on HB 2152 as presented by the Secretary of State’s office.

b.       Statesman-Journal – Ellen informed the EAC the Statesman Journal is looking for stories about OHP consumers and the impact of changes.

IV.            Announcements & Adjournment: 

            A.            Next meeting:  October 28, 9:30-11:30 p.m., OHAC.

            B.            Adjournment:  11:30 a.m.

Handouts:

OMAP Medically Eligibles Data (September 2003)

COER Request List to Lynn Read

CMS Simplification Strategies Powerpoint                  

Tax Increase Ballot Measure

OPCA OEW Meeting Notice

August 26, 2003 EAC Meeting Minutes

OHAC Handout on Legislative Actions

Memo from Jean Thorne (9/19/03)

Engrossed HB 2152

EACMtg092303.doc

Recorded by LoriAnn Sheridan, OHAP