HEALTHY AND WELL KIDS IN IOWA (HAWK-I)
January 28, 2000
Eldon Huston, Chair
Terri Vaughan, Vice Chair (absent)
Susan Voss (for Terri Vaughan)
Ted Stilwill (absent)
Brenda Oas (for Ted Stilwill)
Stephen Gleason, D.O. (absent)
Mary Weaver (for Stephen Gleason)
LEGISLATIVE BOARD MEMBERS
Senator Johnie Hammond (absent)
Senator Mary Kramer (absent)
Representative Brad Hansen (absent)
Representative Robert Osterhaus
DEPARTMENT OF HUMAN SERVICES
ATTORNEY GENERAL'S OFFICE
Visiting Nurse Services
Eligibility Services, Inc.
Iowa Department of Public Health
Div. of Community Action Agencies
Senate Democratic Staff
House Democratic Staff
Iowa Community Action Assoc.
Jack Hatch and Associates
Wellmark Blue Cross Blue Shield
Iowa Dental Association
WELCOME AND INTRODUCTIONS
Eldon Huston, Chair, called the meeting to order on January 28, 2000, at 9:10 a.m. at the Utilities Board, 350 Maple St., Conference Room 4, with 23 people present.
Introductions were made.
ANNOUNCEMENTS AND ROLL CALL
Anita Smith took roll call.
Huston stated to the audience that if anyone wants to comment during the public
comment period to send him a note indicating their name and the nature of the
APPROVAL OF THE DECEMBER 15, 1999, MEETING MINUTES
Eldon Huston asked for approval of the minutes of the December 15, 1999, Board meeting. One correction and one addition was made to the minutes.
The minutes were approved as amended by Dave Krutzfeldt and seconded by Nancy Mounts. Unanimous approval was made by Eldon Huston, Nancy Mounts, Dave Krutzfeldt, Susie Poulton, Susan Voss, and Brenda Oas.
It was determined that the letter from Visiting Nurses had been discussed at the last meeting and no further action was required.
A copy of Peter Roberts December 28, 1999, letter to Dr. Peter Wallace was reviewed. In the letter, Mr. Roberts offered to meet with Dr. Wallace to discuss Johnson County physician participation in Wellmark's Unity Choice Plan.
Susie Poulton reported that the Children With Special Health Care Needs Committee met in January to look at and focus on goals. The committee is looking at quality review standards of care for HAWK-I special needs children. There are no national standards and the number of children in HAWK-I with special needs has not been fully determined yet. The committee discussed the possibility of a wrap-around package, but the committee needs clarification if this money would come from administration or benefits?
Ms. Poulton reported that some children might need more physical therapy visits, for example, than most providers’ plans will allow. Ms. Poulton added that we need to allow some sort of wrap around plan for those children who need care that is more specialized. Ms. Poulton stated that many of our plans including managed care plans limit the number of visits and inquired if there was a way to develop some type of wrap around plan?
Ms. Mounts asked if the funds had to come out of administrative funds or if there was another source that could be used?
Ms Poulton responded that Dr. Lobas was informed that it would have to come out of administrative funds.
Ms. Smith stated that was one of the items of comment for the proposed federal regulations. Ms. Smith informed the Board that the regulation read as follows:
“If the state offers a limited package of services to address special needs that is not part of the comprehensive coverage requirement, state expenditures for the limited package would be subject to the 10% limit on federally matchable expenditures for items other than comprehensive coverage package under Section 210582 of the Act.”
Ms. Smith summarized by saying that if you have add-on benefits for any special needs requirements, the cost of those add-on benefits would have to come out of the Department’s 10% administrative dollars.
Mr. Huston stated that the Board decided to do a study and report on special health care needs but has not decided what avenues to take. Mr. Huston asked for Representative Osterhaus' comments on the subject.
Representative Osterhaus suggested that the Board indicate to either the Governor's office or to the Legislative leadership to endorse the current report. Representative Osterhaus asked for Ms. Smith's suggestions.
Ms. Smith replied that benefits of any kind should not come out of administrative dollars. Ms. Smith stated that benefits are still benefits regardless if you have an add-on package or special need or whatever. Ms. Smith reminded the Board that the Department did comment on this issue in the proposed regulations. The only other alternative is to make the HAWK-I benefit package so rich that it will take care of the special needs kids but that would probably make the cost higher for everybody.
Ms. Mounts asked the Board if we couldn't do better for substance abuse and behavior issues than just a benchmark if it is good for the children?
Ms. Smith replied that we could cost out the current benefit package and enrich it to include special needs.
Mr. Huston stated that special needs have never been addressed under standard insurance packages.
Ms. Smith inquired if Ms. Mounts was suggesting the Board increase the limits for behavioral health and substance abuse under the current policy? Ms. Mounts added that the Board could also increase the limits for diabetes management and other special health care needs. Ms. Mounts' question was are we just going to do the minimum, or are we really going to make a difference?
Ms. Poulton made the point that we do not know if these special need children's needs are being met or not through the regular plan.
Representative Osterhaus commented that when we get into the degree of disadvantage that a child has within the HAWK-I population, we need to adopt a definition of "medically necessary" that applies to substance abuse, behavioral health, physical ailments, and the like so that we can attain the assistance of the plan providers.
Mr. Huston stated that for purposes of discussion, we would need to separate substance abuse from behavioral health issues. Mr. Huston stated that "special needs" relate to the handicapped and exceptional children. Mr. Huston explained that presently, the Board is trying to give the special needs committee some guidance through addressing the report on children with special needs and will discuss substance abuse at a different time.
Ms. Poulton reported on behalf of the special needs committee that they would like to develop a proposal for a demonstration project within a certain part of the state in developing the medical home model to a certain group of children with special health care needs. If this information could be gathered, we would know what this population looks like after applying ideal standards of care to meet their needs. Ms. Poulton suggested the Board request Dr. Lobas's assistance in looking at that population within HAWK-I and determining if their current needs are being met or not.
Representative Osterhaus agreed with Ms. Poulton's concept of moving toward a pilot project to collect some data, which would give us more information on these special needs children.
Ms. Smith stated that a pilot project could be funded out of HAWK-I administrative dollars and they would be matchable dollars. Ms. Smith suggested that we look not exclusively in Iowa but also outside Iowa at another state that is currently supporting a special needs program.
Ms. Smith reported that Connecticut has three programs:
1) Husky A = Medicaid 2) Husky B =CHIP 3) Husky C= Special Needs
Ms. Smith has spoken with the program director who has expressed surprise regarding how few of Connecticut's children have come forward to participate in their Husky C program for special needs. It was found that those children are having their needs being served elsewhere, leaving few to come forward for enrollment into their Husky C program. Ms. Smith suggested that we might be able to attain some good data from them because their program is designed a lot like ours with Medicaid expansion and a separate add-on program plus the special needs program.
Representative Osterhaus stated, it has been determined that Iowa has a population of 200 to 400 children, labeled profoundly disadvantaged, and is not known how many of these would be categorized as special needs children.
Ms. Poulton stated that the Children With Special Health Care Needs Committee could look into the aforementioned "demonstration project" and bring a proposal to the Board for discussion and review.
Ms. Smith reminded the Board that the children would have to be HAWK-I eligible kids (targeted low income & uninsured) in order to fund this special project out of HAWK-I funds.
Ms. Mounts asked if the funds had to come out of HAWK-I administrative dollars? Ms. Smith replied that we could check with Connecticut and see where they are getting the funding.
Ms. Oas commented that the Board could look at those children that are at risk for out-of-home placement, and their family is concerned with their ability to continue care.
Mr. Krutzfeldt asked Ms. Smith to clarify what she said earlier when talking about administrative matchable dollars. Ms. Smith clarified that the Department receives a 75% federal match for all of its HAWK-I dollars, whether administrative or benefit.
Representative Osterhaus suggested private foundation support to fund the special needs committee's pilot program.
Ms. Smith stated that there are rules for the source of funds that the state uses to draw down federally matching dollars. No matter where the funds come from, it would have to be acceptable to HCFA.
(Mary Weaver entered the meeting at this time.)
Ms. Mounts asked if the Board ever received a report from the Clinical Advisory Committee on substance abuse that was requested at the November Board meeting.
Ms. Ruggle answered Ms. Mounts that the Clinical Advisory Committee is meeting next week to discuss substance abuse and behavioral health.
§ Mr. Mosley reported that on a daily basis the application count has been averaging 75 to 80 per day, which is up substantially. Monthly enrollment for CHIP and HAWK-I combined, as of the end of December, is at 22% of the combined total (10% = HAWK-I and 12% = Medicaid expansion).
§ Mr. Mosley reported that in regard to the local outreach committees, most of them are bringing part-time and/or full-time help on board to do the outreach work for them. Mr. Mosley stated that as a result, the Department is receiving requests from around the state for training programs for these newer outreach workers. Mr. Mosley stated that the Department might want to start either a statewide or regional outreach training program and added, most of the people that he has talked with would prefer a regional outreach training program. Although, Wellmark Blue Cross Blue Shield is interested in a statewide outreach training program with a "best practices session" calling on the local outreach committees to take part in the session.
§ Mr. Huston inquired if Polk County was up and running yet regarding their outreach plan? Mr. Mosley replied that Outreach Coordinator, Becky Miles-Polka, has assigned someone to help put the program together. Mr. Mosley stated that Polk County is currently doing a credible job in terms of applications received.
§ Mr. Mosley reported that the Department has made requests to Anderson Erickson Dairy and Roberts Dairy that they put a marketing photo on their milk cartons. Mr. Mosley stated that a new program has begun to take outreach into the Hispanic community statewide.
§ Ms. Mounts asked if Mr. Mosley had talked to Wells Blue Bunny. He replied that he had not spoken to them.
§ Mr. Mosley spoke with the Vice President of Marketing at HyVee about placing some of our advertising on their grocery sacks. HyVee's view on the subject was that 55,000 HAWK-I kids is such a marginal number and did not think that it would be beneficial. Mr. Mosley reported that a request has been made to Jesse Rasmussen to cosign a letter to HyVee expressing the importance of the program to HAWK-I and even though the population is small in number, it is still a very important program in Iowa.
§ Mr. Mosley attended a meeting with the Iowa/Nebraska Primary Care Association. Mr. Mosley stated that the association received a federal grant to conduct outreach and will be working with the public health clinics statewide. Mr. Mosley said that the Department would be continuing to work with the association in areas of assisting them in developing an outreach program and in designing marketing materials etc.
§ Mr. Mosley also met with the Department of Public Health who had a meeting with the School Nurses Association. A statewide training session for school nurses is being planned for April 13th.
Ms. Weaver referred to a piece of correspondence in her packet that stated the Department of Public Health is requesting $100,000 from the General Fund. Ms. Weaver wanted to clarify to the Board that the Department of Public Health did not make a request for funds through the Department of Human Rights. A discussion occurred about exactly where the request originated and for what reason.
Representative Osterhaus commented that he believed the Community Action Agency made the request to the Health and Human Rights budget-sub committee, for $100,000 from the general fund for HAWK-I outreach.
Mr. Huston asked Representative Osterhaus if he thought that the issue should have been discussed with the HAWK-I Board before it was presented.
Representative Osterhaus replied that he did not know the specifics, this was something that had just happened in the last day or two, although the Community Action Association did make a presentation to the Health and Human Rights Committee for the aforementioned purpose.
Mr. Huston suggested inviting someone from the Community Action Association to speak to the HAWK-I Board to clarify the issue.
Ms. Smith reported that in receiving additional correspondence, it appears as if there was some discussion about taking the funds out of the HAWK-I trust fund.
Ms. Weaver asked if there was anyone in the audience from the Community Action Association?
Ms. Dreibelbis was not sure about the specifics, but stated that Mr. Bill Brand, of the Community Action Association, would be in attendance at the meeting soon and would be able to clarify the request and answer any questions that the Board may have.
Ms. Weaver stated that she has been helping the public health agencies at the local level to work with the outreach program, and inquired of Mr. Mosley about the status on the counties that have not as yet submitted an outreach plan? Mr. Mosley answered that most of the counties have a plan, although, about 14 counties have not yet submitted their plans for funding.
Ms. Smith informed the Board that the Department made packets containing several of the outreach plans and that there were a few remaining for Board members upon request. The plans were brought to the meeting and can be distributed after the meeting is over.
Ms. Smith informed the Board that the Department sent out a mailing this week to approximately 2,000 families that were previously denied HAWK-I eligibility due to excess income. Ms. Smith stated that mailing labels were obtained from ESI, and the Department included a letter to the parents along with a new application and income guidelines making them aware that they may now be HAWK-I eligible. The Department placed a special stamp (a star or rose) on the application form which will be used for tracking the number of applications filed specific to this effort.
Ms. Smith referred to a newsletter that she put together for the purpose of sharing information with all of the outreach coordinators. Ms. Smith stated that the newsletter talks about the 20% earned income deduction and the fact that some state employees may now qualify for HAWK-I. Ms. Smith reported that HCFA has released information that those state employees who are not eligible for health care coverage as a state employee can participate in the HAWK-I program. Ms. Smith said that this might impact graduate students who are working for the universities, intermittent, temporary, or seasonal workers that are not eligible for state employee benefits.
Ms. Smith also noted in the newsletter was information on the depreciation of capital assets, cost-sharing for Native Americans, and an update on the John Deere Health Plan participation. The newsletter also addresses questions such as, is it OK to pay premiums ahead, and informs that the Department has provided copies of the community outreach plans. The newsletter was sent out along with a list of all of the outreach coordinators throughout the state, a supply of inserts for all of the brochures, and copies of the outreach plans for each of the coordinators. Ms. Smith stated that future editions of the newsletter would sent out on an as-needed basis according to the necessity to share new information and updates about the HAWK-I program.
Ms. Weaver asked if that at some point will the Medicaid and HAWK-I applications be alike so that when someone wants services, they will be able to complete one application, and depending on what the application says, they will be routed to the correct place.
Ms. Smith replied that is how it is now and that a HAWK-I application is also a Medicaid application. Ms. Smith said that the steps that the Department has not taken as of yet are that it only has “one” application. Ms. Smith described her own views of how to come up with only “one” public services application. Ms. Smith listed as an example, the basic 1040 income tax form. There is one main form with separate schedules (i.e. Schedule A, Schedule C, Schedule E) each of which applies to that exclusive individual’s needs. Ms. Smith said that there could also be a basic public services application that asks questions that all programs need to know (i.e. name, address, SS#, income, family size). Additional forms would ask questions relating to a specific program that would apply only to that individual’s current needs.
Ms. Weaver inquired if there was a way the Board could implement a timeline for this universal application process?
Ms. Smith replied that it could be done, although, it would take a lot of cooperation from several state agencies and departments that are in addition to the Department of Human Services. Ms. Smith stated that it might even take some legislative action to bring it about.
Representative Osterhaus commented that he would work with Ed Conlow and Steve Conway to research the concept of having a universal application process for all state programs realizing that Medicaid has to meet certain federal guidelines.
(Bill Brand entered the meeting at this time.)
Mr. Huston welcomed Mr. Bill Brand, Administrator for the Division of Community Action Agencies, Department of Human Rights, to the meeting. Mr. Huston proceeded to explain to Mr. Brand, that the Board received an inquiry from Deb Anderson, of the Legislative Fiscal Bureau, about a request for $100,000 from the general fund for HAWK-I outreach. Mr. Huston asked Mr. Brand if he could clarify, for the Board, what the request was and where the funds would be coming from?
Mr. Brand reported that in the community action agencies’ budget request to Governor Vilsack this past fall was a request for a state match, in addition to federal dollars, that has to do with a community services block grant program. Mr. Brand proceeded to explain that as a component in their request is a federal funding block grant that provides core funding for community action programs in the state of Iowa. Mr. Brand stated that the block grant was designed to promote an entire variety of programs related to self-sufficiency for low-income individuals in the state. Some of these programs would include health care, nutrition, education, and employment related things asking for self-sufficiency. Mr. Brand reported that in asking for state support for that federal block grant, they included in their efforts a component to do outreach for HAWK-I. Mr. Brand said that the Governor then asked him for clarification on the community action agencies’ plans for support of the HAWK-I program. Mr. Brand detailed for the Governor the kinds of things that he has spoken to the HAWK-I Board about in the past in terms of what community action can and is doing in the way of outreach for HAWK-I. Mr. Brand clarified to the Governor that those kinds of things could be done in a more focused comprehensive manner and hopefully learn some lessons about how to do outreach more effectively. Mr. Brand informed the Governor that if the agency could attain the support, they would do some private projects along the line. Mr. Brand reported that the Governor included that request when he made his recommendations to the Legislature in December.
Ms. Voss inquired if the entire $100,000 was specifically for HAWK-I? Mr. Brand stated yes.
Mr. Huston asked Mr. Brand how to coordinate that with the function of the HAWK-I Board?
Mr. Brand replied that in his understanding, the Governor is asking for that money to come out of the state general fund.
Ms. Smith relayed to Mr. Brand the question that the Human Rights Appropriation Sub-Committee had asked was whether the initiative could be funded through the HAWK-I trust fund rather than from the general fund, and how would it apply to HAWK-I’s 10% administrative cap? Ms. Smith stated to Mr. Brand that the Human Rights Sub-Committee was clearly asking HAWK-I to fund the community action agencies’ request.
Mr. Brand reported that he attended a Human Rights Sub-Committee meeting yesterday in which they had a similar discussion about some of those same questions. Mr. Brand said they were discussing options for funding, and he would not be surprised if they came to the Department to discuss some way that the Department could help make this work.
Mr. Huston inquired of Mr. Brand how to coordinate HAWK-I with what Mr. Brand is doing so that the Legislators are sure that we are working together in the request?
Mr. Brand replied that the Board could formally endorse the Department of Human Rights' request for support to do HAWK-I outreach. Mr. Brand stated in terms of the general concept of stepping up our efforts at outreach, he would sincerely appreciate a discussion from the Board along with its support. Mr. Brand stated that in terms of how to coordinate our efforts, he would suggest the necessity of a conversation with the Legislative staff.
Ms. Mounts commented to Mr. Brand that we always welcome any support for outreach, although, we have to keep in mind that there are several other things that will be coming out of administrative dollars.
Mr. Brand replied that they are looking at this simply as a request to the Governor for general fund dollars that would supplement what the Department is already doing for HAWK-I outreach.
Mr. Huston inquired if Representative Robert Osterhaus would like to meet with Mr. Brand and Anita Smith for a discussion of the issue at hand and then report back to the Board with comments and suggestions on how to proceed. All three named above agreed to a meeting.
(Dr. Peter Damiano entered the meeting at this time.)
Ms. Smith commented on the "application count" discussed previously by Mr. Mosley. In the past, about 40-50 percent of the applications were being referred to Medicaid. Ms. Smith reported that in the last three weeks, that number has dropped significantly to 27%. Ms. Smith stated that hopefully, this may mean that people are understanding better whether they are to apply for HAWK-I or for Medicaid with the initial application rather than just applying to HAWK-I and waiting to be referred to Medicaid.
Ms. Smith announced that Mr. Willie Mosley, HAWK-I Outreach Coordinator, has tendered his resignation and his last day is February 4, 2000.
Wellmark has agreed to investigate the possibility of providing both financial and in-kind resources to assist in HAWK-I outreach. This includes engaging the other participating health plans as well. The Department will continue discussions with Wellmark and update the Board.
CHILDREN WITH SPECIAL HEALTH CARE NEEDS ADVISORY COMMITTEE UPDATE
Dr. Peter Damiano, of the Clinical Advisory Committee, reported on the second survey and presented the results of the baseline survey of one child in the household. Dr. Damiano stated that this report differs from the previous report in that it includes the next four months of data collection. Dr. Damiano reported that there were no significant differences in the two surveys of more than a percent or two. The only difference was that people seemed to be delayed in their care more so this survey than after the initial survey report. Dr. Damiano referred to Page 27 of the report regarding an error on the initial survey report. The question asks if there were any other children in the household with emotional or behavioral problems. It was over reported in the first survey at 26%. The actual figure is 7%. Dr. Damiano stated one reason that they only survey one child in the household is that the answers of the parent related to different children in the family were often linked because of their experience. Dr. Damiano stated that the committee feels it is cleaner from an analytical perspective. The second reason is that the committee felt that their response rate would be much higher than if you asked one parent the same questions about two, three, or four of their children that are in the program. Dr. Damiano said this could overwhelm the parent and lessen their response rate as a result.
Dr. Damiano informed the Board that we are coming up on the 1-year anniversary of the HAWK-I program and they will be doing the follow-up survey for those respondents that took part in the initial survey. These same questions will be asked for follow-up except asked in terms of the HAWK-I program so that comparisons can be made with access and functional health status issues. Dr. Damiano reported that the survey response rate is 73%. Dr. Damiano said in order to avoid overburdening the respondents, a comfortable number of questions must be agreed upon.
Dr. Damiano stated that when the committee did a Medicaid survey, they added a blank page in the back of the survey for a "comments" page and would we like to do that with the HAWK-I survey?
Ms. Smith replied that we could receive a lot of insight with the comment page.
Ms. Smith informed the Board that she received a call from the Governor's office requesting the name of a family who had received HAWK-I. The purpose was to ascertain the financial and emotional impact HAWK-I had on the family. The family expressed to Ms. Smith how much the HAWK-I program meant to them and that their son would not have been able to receive a hearing operation if it weren't for HAWK-I. Prior to HAWK-I enrollment, he had a 50% hearing loss. Now his hearing has been restored fully.
Mr. Huston asked the Board to give their thoughts on the follow-up survey to Anita Smith so that she can communicate them to Dr. Damiano.
Representative Robert Osterhaus reported that there were no new updates outside of the $100,000 budget request discussed earlier in the meeting.
Ms. Smith referred the Board to the document entitled:
HAWK-I Budget Update
January 27, 2000
$11,047,000 Department's Budget
5,051,979 Appropriation Bill
$ 5,995,000 Deficit*
* $5.1 million estimated trust fund balance after FY '2000 (this assumes that no trust fund dollars are used to pay for administrative costs that exceed the 10% cap.)
$ 1,614,596 Tobacco Bill
Ms. Smith reported that the Department's budget for the HAWK-I program that went to the Governor was $11,047,000. Ms. Smith stated when the appropriation bill came back, the budget figure had been reduced to $5,051,979. Thus reducing the budget request by almost six million dollars. Ms. Smith reported that based on the current enrollment projections, the Department believes funding will be sufficient because it is estimated that there will be a $5.1 million dollar balance in the trust fund.
Ms. Smith reported that we will have to pay for the deficit with the trust fund money. Ms. Smith stated the trust fund estimate does not include any additional administrative costs that might be included because of the new procurement process. Ms. Smith added that the Department might have to go into the trust fund if the 10% administrative limit is exceeded to pay for those expenditures.
Ms. Smith also informed the Board that the tobacco bill includes $1.6 million dollars for the HAWK-I expansion, continuous eligibility, presumptive eligibility, and some other things.
Ms. Smith reported that the HAWK-I "clean-up bill" was reviewed yesterday, and the changes that were requested by the Board were put into the bill.
Update on Enrollment
Ms. Smith stated the Department had projected an 18.4% cumulative growth rate for the months up to November, but is actually seeing a 13.2% growth rate. Ms. Smith reported that the growth rate in the HAWK-I program is at 80% of projection for this time period.
For the month of December, the number one reason for denial of a HAWK-I application is the same as the previous month (people are applying to HAWK-I when they are Medicaid eligible). Ms. Smith reported that the following two reasons for denial have reversed order from last month. The number two reason for denial is that the application was referred to Medicaid but did not follow through with the process or were noncompliant in some way. The number three reason for denial is that the family is over the income limits.
Ms. Smith reported on the "How You Heard of Us" report, explaining that ESI can track information from the application regarding the source from which the applicant has heard of the HAWK-I program. Either the applicant can fill in the how they heard of the program on the application, or the source itself can prestamp the applications to ensure they will be counted in the referrals.
Ms. Smith reported on the "HAWK-I Disenroll By County" report. Ms. Smith noted that of the 31 children that disenrolled, one-half of them aged out (turned 19), 8 children became eligible for Medicaid, and 3 children's premiums were not paid. Ms. Smith reported that all of the Department's preliminary information shows that people are paying their HAWK-I premiums and even paying several months ahead.
Ms. Smith reported on the DHS Medical Assistance CHIP Budget - Fiscal Year 2000 report. Ms. Smith stated that she talked to Dean Wheeler in DHS - Fiscal and asked why our administrative expenditures were so low. Mr. Wheeler explained that the Department is earning interest on the HAWK-I trust fund, and this interest is being applied to administrative costs. Ms. Smith requested that Mr. Wheeler put the trust fund interest of $53,785 on the report so that we could get a better picture of administrative expenditures. Ms. Smith clarified that the $53,785 is state money but is being used to draw down federal match.
Ms. Smith reported on the $500,000,000 "delinking fund." Ms. Smith stated she will be attending a meeting on this and reporting back to the Board. Ms. Smith stated that Iowa's share of the money was $4.7 million, which had to be spent by the sunset date of December 31, 1999. Ms. Smith reported that the sunset has been repealed and the Department will be discussing whether the can be used on outreach or if it will have to be focused elsewhere.
Comments on Proposed federal CHIP Regulations
Ms. Smith reported that the Department has sent in comments on the proposed CHIP regulations. A copy of the comments was provided to the Board.
The comments around the definition of a targeted low-income child, utilization of the federal vaccine program, employer buy-in, and funding of special health care needs were discussed.
Update on RFP Process
Ms. Smith reported on the RFP process and said that essentially, the Department is requesting the same services as it did in the last RFP except that several more detailed reports have been requested that will be helpful to the outreach workers. The reports will be broken down into zip codes. Ms. Smith said that the Department is requesting that the contractor provide space for up to 10 co-located income maintenance workers, the development of an electronic application, and the acceptance of premium payments through automatic bank account withdrawal.
Ms. Smith reported that the bidders' conference was well attended with several questions asked. Ms. Smith stated that the Department had asked potential bidders to submit questions and to-date have received around 400 questions. Ms. Smith stated that the Department would provide written responses to the questions by Monday, January 31, 2000.
Ms. Smith stated that one company indicated they would not bid because the implementation period was too short. Ms. Smith added that in reviewing the questions, there were several that indicated the 60-day transition period was too short. Ms. Smith reminded the Board that in the current contract with ESI is the ability to extend that contract one month, but the Department must inform ESI of the extension by March 1st. Ms. Smith asked if the Board shouldn't consider the option to extend ESI's contract for the additional month. One consideration is that even if the successful bidder is able to meet the 60-day time frame, Ms. Smith is concerned about the availability of staff resources to work with the successful contractor on the implementation. (i.e. meetings, approval of forms, answering questions, etc.)
Ms. Smith stated that the current ESI contract terminates April 30, 2000. If the contract is extended, the contract would terminate May 31, 2000, which means that the successful bidder would have until June 1, 2000, to be up and running.
A MOTION was made by Nancy Mounts and SECONDED by David Krutzfeldt to extend ESI's contract to May 31, 2000. The MOTION was unanimously carried by Eldon Huston, Nancy Mounts, David Krutzfeldt, Mary Weaver, Brenda Oas, and Susie Poulton.
Executive Order Number Eight
Ms. Smith reported that according to Executive Order Number Eight, the state must review their administrative Rules and decide if they are going to rewrite them or not. Ms. Smith stated that the intent is to reopen the policy debate on all of the Department's administrative Rules. Ms. Smith stated that each agency has to prepare a plan describing the method of how they are going to conduct the review. Additionally, each agency has to prepare a list that identifies the constituents that might want to be a part of the review process and a plan on how they are going to prepare comments. Ms. Smith questioned the Board on who they wanted the Department to include on the list of people who may want to review the HAWK-I rules. Ms. Smith stated that comments would be due November 1, 2000. The comments will be reviewed and brought to the Board. It is anticipated that any rule changes would be effective July 1, 2000.
The Board suggested that Ms. Smith go back through the HAWK-I Board meeting guest lists and send notice to those individuals.
Ms. Mary O'Brien reported that the Polk County outreach committee has met twice, is diligently working on their outreach plan, and will have it submitted soon.
ADMINISTRATOR'S REPORT CONTINUED
Ms. Goldman reported on the Draft Report of the HCFA Site Visit. Ms. Goldman stated that HCFA routinely does site visits and visited Iowa on September 2nd & 3rd of 1999. Ms. Goldman reported that we were in high standing with "best practices" and the fact that we had held the outreach conference. Ms. Goldman stated that HCFA was pleased with the Blue Cross Blue Shield and Iowa Health Solutions benefits packages. Ms. Goldman said that HCFA did site visits to doctor's offices and had good things to say about the visit regarding their excellent forms and being tuned into preventive medicine. Ms. Goldman reported that HCFA was very impressed with the HAWK-I program and the fact that the Department was able to negotiate with health plans in different parts of the state and get a statewide program going. Ms. Goldman stated that comments back to HCFA have to be in by February 23, 2000.
Mr. Huston commented that it would be good for those legislators on the sub-committee dealing with the HAWK-I program to have a copy of the report. Mr. Huston stated that the report is very complimentary to the HAWK-I program.
Update on John Deere Contract
Ms. Smith reported that some John Deere counties will be up in March and the remainder will be in April.
Contracts Up for Renewal
Ms Smith reported on the contracts and their renewal dates as follows:
§ Health Plan Contracts June 30, 2000
§ University of Iowa June 30, 2000
§ Actuarial Contract June 30, 2000
RULES FOR ADOPTION
Ms. Smith reported that the rules for adoption were submitted to the Legislative Rules Committee and were passed. The two rules were as follows:
§ Depreciation of Capital Assets
§ Cost Sharing for Native American Indians
Mr. Huston entertained a motion to adopt the above mentioned rules.
A MOTION was made by David Krutzfeldt and SECONDED by Nancy Mounts to adopt the two above mentioned rules. The MOTION was unanimously carried by Eldon Huston, Nancy Mounts, David Krutzfeldt, Mary Weaver, Brenda Oas, and Susie Poulton.
Ms. Smith brought an issue to the Board for consideration regarding the 12 months of eligibility granted to children approved for HAWK-I. The legislation currently states that children are granted 12 months of eligibility when approved for HAWK-I. However, when an additional child enters the home, the question is whether to give that child 12 months of eligibility or just the months remaining in the original 12-month period. The issue is problematic in that if each child gets 12 months of eligibility, some children will stay on HAWK-I when the 12-month review is done while others may be ineligible or referred to Medicaid.
Ms. Smith suggested that the language be changed to state "up to 12-months of eligibility" so that the family can be reviewed as a unit. Ms. Smith stated that the extra child scenario would have his eligibility period coincide with the family's 12-month period.
A MOTION was made by Nancy Mounts and SECONDED by Susie Poulton to pursue a legislative language change that states "up to 12-months of eligibility." The MOTION was unanimously carried by Eldon Huston, Nancy Mounts, David Krutzfeldt, Mary Weaver, Brenda Oas, and Susie Poulton.
CREDITABLE COVERAGE UNDER HIPAA
Ms. Smith reported in order for HAWK-I to be credible coverage in the individual insurance market, it must be subject to Iowa's individual health insurance reform law which is a separate law.
The Board decided that it would contact Ms. Terri Vaughan for clarification and urgency.
Chair, Eldon Huston, will be out of town during the next meeting, and Vice-Chair Terri Vaughan will preside at the next meeting.
The meeting was adjourned at 1:00 p.m.
Date - February 21, 2000
Place- Botanical Center, Oak Room
Des Moines, Iowa
Time- 12:30 p.m. – 4:30 p.m.
Respectfully submitted by: