S.B. 288 Medicaid Provider Amendments: transcript

Thank you Chair. Let me as a segue into this piece of legislation. Let me, let me make, make a few, uh, 50,000 foot level statements first, um, is there is a need, need for some, for some certainty in, in our providers of social services. And the opportunity that is before us is to look at a way that we can create to ensure that in, in doing and in seeking for that certainty you need, I think to answer appropriately to those that we have been charged with, uh, caring for the resources, the precious resources we're given, is you need to make sure that who's receiving the resources is, is, uh, meeting a, a level of, of service and quality of service, that that is important. Number one, you have to have a funding source to do it. Number two, and there needs to be, from my perspective in this space, an opportunity rather than to, in some major, have a rotational cycle of picking those that are able to have the resources. And there's not enough to go around seeking to, to lift all in an incremental way, step by step, that, uh, makes this, this area and this safety net more effective and, and compassionate and, and, and, uh, data intentionally driven. And with that, I'm gonna turn the time to my copilot here to, uh, talk about some of the details and come back to me. Thank you.

Good afternoon, Mr. Chair, members of the committee, Lincoln Insurance with Lincoln Hill Partners, uh, here to help Senator Stratton with this, uh, presentation. Uh, a little bit of history on this legislation. So we actually, uh, started this effort last year with Senator Owens, who had a bill file that, uh, came before the legislature to look at doing a 2% rate adjustment for providers ongoing. Uh, during those con conversations, both with the House and the Senate, there was some concern, um, from folks that by just simply doing a 2% rate increase for providers across the board in the Medicaid space, it was going to commit the legislature long term to a funding paradigm, uh, that didn't give them flexibility as they looked at individual budget years. Uh, so we went back to the draft, uh, kind of the drawing board this year, and working with Senator Stratton in his role as the Chair of Social Services Appropriations Committee. And to try to come up with a new mechanism where we could still, uh, increase provider rates for individuals who provide Medicaid services, but give flexibility to the legislature on an annual basis on how we're going to do that. And so the bill that's in front of you today does a couple of things. One, it, uh, looks at the a CA expansion savings account. This is an account that was created when we expanded Medicaid here in Utah. What we essentially do is through some taxes on hospital services, we fund an account that is essentially a rainy day for the Medicaid program. Uh, that account sits at just under $400 million within that account. Um, that the money is invested through the PTIF, which is the Public Treasurer's Investment Fund, and earns approximately 15 to $18 million a year worth of interest. Uh, recognizing the concerns that I think came from some that we didn't want to dip into the principle of that fund and financial responsibility around the Medicaid program and the expansion population. In particular, what we have suggested in this legislation is that we simply capture the interest earnings on an annual basis. That would be a decision made by the legislature annually. And with that interest earnings, whatever that number is to be, we can reinvest those interest earnings back into provider rates. So these are the individuals that are actually providing the Medicaid services. So with this bill, we are not looking at lowering the expansion savings account. We are not looking at a long-term commitment, per se, of the legislature, but an annual evaluation as to whether or not they want to use interest earnings off of this account to reinvest back into the program through provider payments. I think it's also helpful to point out that this is not expanding Medicaid. Further, this is simply investing in the programs that we've already committed to here in the state of Utah, and making sure that we have adequate pay for those providers that are providing those services. Uh, as we've been working with the various stakeholders, uh, there are several provider groups that have not seen increases. Some have been five, seven years since they've seen a rate increase in what they're being paid to provide Medicaid services. If you look at just the cost of inflation, which is hovering right around 3% over those five years, they've compounding have lost about 20% of pay by simply not receiving a provider rate increase. And so this is an attempt to really give the legislature some flexibility, a new revenue tool without dipping into the general fund to invest in the Medicaid program. Uh, there are a couple other elements of the bill that I'll quickly touch on. Uh, one of the concerns that I think we've heard, um, throughout the healthcare system is coordination of care. So there are some, uh, language in this, uh, legislation as well that requires the department lose some of these dollars to coordinate care, uh, between the various providers, both on the social network side as well as on the physical health side. And then lastly, looks at some contract change modification language. What that language really does is say, Hey, department of Health, if you're gonna be changing contracts for providers, you have to provide notice to those providers of any contract changes that would have a discernible increase in the cost associated with those program changes. And with that, Mr. Chair, I'm happy to answer any questions and we'll turn it back over to Senator Stratton.

Well, thank you Chair. I, I, we could go to the specific language in the bill, but I think we've got a good overview at 50,000 and then 10,000 feet. So let's, let's, uh, turn it to the committee.

Thank you, Mr. Chair. Committee members. My name is James Whipple. I'm the current president of ux, which is a local association of providers, um, supporting individuals with intellectual and developmental disabilities. We actually represent about 70% of the individuals receiving these services, uh, throughout the state. And we're here to urge you to push this forward, um, and support this. Um, the reason being is it's critical to the stability of our workforce. Let me explain that to you really quick. Um, as was just said, we receive, there's a cadence of us receiving increases somewhere between three to five years. The problem specifically for us with that is that we solely rely on the funding and the revenue, um, that comes, um, from the legislature through the waivers that are managed by DSPD and all, you know, um, those waivers are a mix of, uh, federal and state funding. But when we don't get money, um, through the waivers and funding, what it ends up doing is making it really hard for us to be able to pass along any increases to our employees. So our amazing workforce, our direct support professionals that are out there doing this amazing work day in and day out, they as well are going two, three years, um, without any increases. And you can imagine in the current market we're battling with, um, fast food and other industries. We're getting amazing people in the door. It's really hard to keep them if we can't give them any sort of increase. Um, the last thing that I'll leave you with is that, um, we have, um, understood that, uh, we just basically, uh, had an independent rate study done. Uh, that rate study showed that our service industry for people with disabilities is 24% underfunded. I believe if we'd have done something like this maybe a decade ago, uh, we wouldn't find ourselves in this situation. Um, and I feel like it's the right thing to do now, and we're grateful for your support with this bill.

Thank you. Thank you. Please come forward. Thank you, Mr. Chair. My name is Cory Holdaway. I am representing the Utah, uh, home Health and Hospice Association. And we are grateful to the Senator for, uh, the concept of this bill. We think it's a creative solution, uh, or potential solution to some challenges that we did have been dealing with for a number of years. Um, home care services is the least expensive service that, uh, can be provided and often the most, uh, desirable service that families want to have. Um, we are losing providers, uh, because of the, uh, the reimbursement rate for Medicaid. Um, this is a, uh, a way to address that and in a meaningful way. And when I talk about home care services, I'm talking about personal care, uh, nurses. I'm talking about PRI or private duty nurses. I'm talking about personal care, uh, services that are being provided as well as a number of others. Um, this, uh, this bill could help with, uh, keeping those industries solvent. Um, just as an example, we've lost a number of providers, uh, over the course of the last few years and, and continue to lose providers because they can't stay in business with the, uh, the current reimbursement rates. So, um, we think this is a, uh, a potential solution to that. Uh, we also, uh, would just ask that, uh, as the quality measures for, uh, that the department is going to be asked to put together on this, that we be included in, in those measures, uh, we, uh, uh, are anxious to, to be a participant in that. And, uh, again, thank the senator for this. Thanks.

Hi. Thank you to the chair and the committee, um, for the time today. Uh, Allison Spengler, Utah Healthcare Association. We support this bill and would urge your support as well. I echo what the other two, um, gentlemen of said. Uh, the Medicaid rates are, um, wholly inadequate at this point, and having some predictability, um, of rate increases every year along with the, the value-based system, um, we feel is a really good solution. And, uh, especially at a time when the aging population is growing, it would, um, really allow us to continue to continue to remain viable and serve, um, those seniors in the state of Utah. Thank you.

Yes. Uh, th this is a few tweaks that, that make it a better bill. Appreciate the consideration.

Thank you. I think we've had a good discussion. We're going in a, a real positive direction. It'll be help, help, uh, the tide to come in and lift all that are in this space. Thank you.

I am, I'm right here, but I'm headed up shortly.

Yes. So moved. So the motion for this to pass out favorably the minutes or approve the minutes of February 12th and February 18th.

Thank you Mr. President. There's also an amendment on in my name that I, I want to amend it as well if I may please. Okay. We, I'm looking for the amendment. I am not sure I see the amendment. Is the amendment on? There we go. We got it. Okay. Amendment's online.

Amendment was, uh, uh, clarification requested by the agency when there is a change in the contract terms, uh, either in the amount that's funded or by agreement, it, it allows that, uh, to, to work together to change a contract. Otherwise, it creates stability within, within the agreements. As we're moving forward with that, I'll yield the

Thank you. Uh, working in this, the, this space, one of the challenges we face with our, our limited budget is it's hard to, to lift everyone incrementally. And what we've found is oftentimes in, in this social service space, we'll give a lift to one area and then go several years. And we'll give this here and there to others and, and, and there's this, uh, challenging impact that creates instability and lack of certainty. And what this bill does, it puts together, it charges the department, the agency with coming up with some quality control measures. And those are, are, are articulated in, uh, uh, line 64, uh, through about, on, on, in that section specific, uh, quality measurements that the, those that are the providers of our, of our Medicaid services that are non-state employees, employees can then work towards. And it creates an incentive opportunity and a, uh, an opportunity to have an incentive payment each year. This will, what it will do is it'll stabilize the, the, the work and effort of, of the Social Service appropriations committee in that allowing when we, we get to a point, there's, we, if we can identify some resources, those resources been, would be split evenly among those have gone through the quality control and lift all together incrementally rather than a, a, a shot of adrenaline one year. And then, then we're, we're not doing anything for several years. In addition, this, this legislation designates specific funding from this year of, I'll get to you. Okay. 1,000,925 approx 1.9 million to private duty nursing home health rate increase of 1.9 H-C-S-B-H-C-B-S, new choice waiver of 2 million. Personal care rate increase 2 million DSPD rate increase of 4 million, foster care provider rate increase of 2 million, and nursing home rate increase of 2 million. And then leaves, uh, some funds within. Those are the approximate numbers. The intent then leaves funds ongoing with the social service to use in addition to any other funds that can be identified on an annual basis to, uh, put towards the opportunity to have the incentive payment. With that Mr. P, I'll be glad to yield.

President, uh, sponsor yield. Senator Stratton, will you yield?

Just a quick question. I was noticing it's got a big fiscal note. Is that, is that one that's, uh, that you know of that has been funded or,

Thank you. Yes. Sorry. Yes, Mr. President, that was included in our, in our base budget or not our base budget, our building blocks.

Thank you. Appreciate the discussion and the opportunity to present this. I wanna thank the stakeholders and, and those, and this, this is a really a, a a a positive consensus bill currently to move forward allows some sustainability and certainty and a path forward for those heroes in our society, helping those are in greatest need. And, uh, with that I'll waive and under suspension the rules move that, uh, fifth substitute Senate bill 2 88 as amended be passed.

Thank you, Mr. President. Having voted on prevailing side, I move that we recall SB three oh four for the consideration.

Thank you. The, uh, the motion is to reconsider actions on Senate bill three oh first substitute Senate Bill 3 0 4. The reason is we changed the effective date that has to be done in a substitute bill. So we're gonna circle the bill. I'll, I'll call the bill, we'll circle it and then wait for the substitute to catch up with it. So placing it now on the top of the second reading calendar, I think that's where it came from.

Thank you. Present motion to encircle Senate bill 2 63 Senate bill 2 62. We have a motion to encircle Senate bill 2 62. 2 62. Law enforcement usage of unmarked vehicles. All in favor say aye. Aye. Any opposed?

circled matter. Leading clerk. Its substitute Senate bill 2 88 Medicaid provider amendments by Senator Stratton. This bill did not receive a standing committee hearing. The house sponsors representative Stevie Liston.

Uh, thank you Mr. Speaker Prote. Motion to circle,

Uh, just trying to resolve, uh, one question and looking at a possible amendment. Thank you.

Listen, Uh, thank you Mr. Speaker. Uh, just to give a little background, uh, for, uh, the importance of this bill, uh, driving or driving home last night from the Capitol. I was listening to a story on the radio, uh, that, uh, department of Health and Human Services just yesterday had shut down, uh, a Medicaid, uh, provider that provides services to, uh, adults, uh, with special needs after a, a very difficult situation. Um, not saying this bill could have prevented the tragedy that that was tied to, but, uh, we've gone six years without increasing provider rates, uh, for a number of key Medicaid funded, uh, positions. For instance, uh, DSPD, division of service with people with disabilities uh, they have not get, got a funding increase. I've, I've heard anecdotally that you can, uh, go get a job, uh, you know, flipping burgers or cleaning toilets, which was my, my first job out of high school. Uh, very honorable. Nothing against that, but, uh, doesn't pay super well. But to deal with people, um, to work with people that have special needs requires special individuals also, and their pay has been, uh, severely lagging compared to other comparable market rate positions. So, uh, this bill, uh, allows the Department of Health and Human Services to establish quality measures, uh, for certain Medicaid providers performance, uh, and, uh, covers a number of categories, uh, that allows them to be part of the provider quality program. It's not a requirement that they participate in this program, but if they do, they would have to meet, uh, certain metrics. It's an opt in program. Uh, this covers, uh, different Medicaid funding positions from DSPD to hospice nurses, uh, personal care assistants that, uh, help people with daily living, foster care providers, uh, and nursing homes. And, uh, I think those are kind of the main categories. So, uh, this is a, a bill that's been been funded, uh, prioritized by the committee, and I think it's critical that if we're offering services to some of our most vulnerable, that we are able to follow that up with quality individuals that are fairly compensated. And this bill, well, it doesn't fill the whole gap, takes us, uh, in, in a, in a very important step forward. Thank you, Mr. Speaker.

Thank you Mr. Speaker. Motion to adopt amendment two in my name.

Yeah. Um, I really appreciate what the good sponsors on this bill are doing. Um, we know from history that we really do need to increase those provider rates. However, there have been some concerns expressed around the quality control measures. This just says after the department makes those rules, that they will be reviewed by our rules Review and oversight committee. And it also adds some language that says there will be a report back to the Social Services Interim committee, um, on how those funds were actually used. So whether it goes directly to provider rates, how much of it stalls at administration? We know the purpose of this is to push this all down to the providers, and this is just a way to ensure that that happens.

Thank you, Mr. Speaker. That is a, a very friendly amendment and I've been working with the good representative from Utah County on it.

I'll waive. Okay. We'll go ahead and place the motion.

Thank you, Mr. Speaker. I just would like to rise in support of this bill. Um, in social services, we have a trouble just keeping up with inflation. Some of the, some of the things in social services do get inflationary adjustments. We pay our, our ACOs, um, our large organizations that manage Medicaid services for them, we pay them a statutory increase every year. Um, state employees at least get consideration for an inflationary adjustment every year. They don't get it every year, but it gets considered. But in social services, we have a large number of services that just go out through contractors. The people who provide the services are not state employees. Um, these are foster families, regular foster families. These are fo Proctor families who get specialized training to take care of difficult people. These are our support coordinators for DSPD services. These are the providers of DSPD services. And so what tends to happen is we just drift out of line with inflation for some number of years until the program gets in crisis, and then we're trying to figure out something to catch back up. Um, the, the, a big portion of what this is is just to give some inflation type adjustments to many of the programs that we provide that have gone several years without them. And this will be, uh, an important step to keep them doing the services that we hope that they do.

Thank you, Mr. Speaker. I just wanna rise in support of this bill as well. I know this is gonna help all the good work that has been done in Social Services Appropriations Committee, and I think it's a really great bill. Thank you.

Thank you, Mr. Speaker. I'd also like to just rise in support. There's been a lot of discussions about where this bill ended and appreciate the good sponsor from Salt Lake County. This bill is good because the funds go directly to the providers who are taking care of the most vulnerable of our population. Uh, these are people who are our seniors, those who are receiving DSPD services and also our foster care children. And so I'm in, in support of this and ask for your support colleagues.

Thank you, Mr. Speaker. I rise in support as well. This is good for, uh, nursing homes in rural Utah. Commend the sponsor for listening. Thank you.

Uh, thank you. I'll just, uh, quickly say thank you to the committee and all the other people who've worked on this bill to, uh, get it to the point that it's at. Thank you, Mr. Speaker.

Thank you Mr. President. Motion to Concur.

Bet. Uh, we just added, uh, something that's very important on this. Uh, there's, this is a big funding, uh, bill and we added that, that, that those receiving the funds would come back to the Social Service Appropriations Committee and report on how the money was used.