| Members Present: Sen. Allen M. Christensen, Chair Rep. James A. Dunnigan, Chair Sen. Gene Davis Sen. Brian Zehnder Rep. Brad M. Daw Rep. Marie H. Poulson Rep. Edward H. Redd | Members Absent: Sen. Peter C. Knudson Rep. Rebecca Chavez-Houck Rep. Francis D. Gibson Rep. Michael S. Kennedy Staff Present: Mr. Mark D. Andrews, Policy Analyst Mr. Daniel M. Cheung, Associate General Counsel Ms. Andrea Crabb, Administrative Assistant |
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Note: A copy of related materials and an audio recording of the
meeting can be found at www.le.utah.gov.
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| Chair Dunnigan called the meeting to order at 1:18 p.m. |
| 1. Committee Business |
| MOTION: Sen. Christensen moved to approve the minutes of the September 28 and October 25, 2018, meetings. The motion passed with a vote of 6-0-5. | |||
| Yeas - 6 | Nays-0 | Abs-5 | |
| Sen. A. Christensen Rep. B. Daw Rep. J. Dunnigan Rep. M. Poulson Rep. E. Redd Sen. B. Zehnder | Rep. R. Chavez-Houck Sen. G. Davis Rep. F. Gibson Rep. M. Kennedy Sen. P. Knudson |
| 2. Medicaid - Recent and Potential Changes |
| Mr. Nate Checketts, Deputy Director, Utah Department of Health, described how the Medicaid eligibility expansion approved by voters on November 6 will affect existing Medicaid programs and the Children's Health Insurance Program. He also highlighted related issues that may need to be addressed by the Legislature. |
| Ms. Emma Chacon, Operations Director, Division of Health Care Financing, Utah Department of Health, reported that recent federal legislation will allow states, by waiver, to enroll incarcerated individuals in Medicaid 30 days prior to their release. She highlighted the need for for funding to create a database that tracks when people enter and exit the corrections system. |
| 3. Balance Billing |
| Chair Dunnigan described the concept of balance billing. |
| Mr. Mark D. Andrews, Policy Analyst, Office of Legislative Research and General Counsel, reviewed the methodology used by insurers under the federal Affordable Care Act to pay for emergency services provided by out-of-network providers. |
| Mr. Brandon Orton described his experience with balance billing. |
| Mr. Mike Lyons related his experience with balance billing. |
| Mr. Scott Olsen related his experience with balance billing. |
| Ms. Collette Bakko related her experience with balance billing. |
| Ms. Lucy Fawcett related her experience with balance billing. |
| Ms. Lisa Ray related her experience with balance billing. |
| Ms. Amanda Sagez related her experience with balance billing. |
| Ms. Rashelle Wilson related her experience with balance billing. |
| Mr. Kirk Stueber related his experience with balance billing. |
| Mr. Luke Rowley related his experience with balance billing. |
| Mr. Brandon Streator related his experience with balance billing. |
| Mr. Gabe Atilla related his experience with balance billing. |
| Mr. Eric Hales, Vice President for Network Management, Regence BlueCross BlueShield of Utah, said that Regence is currently negotiating an out-of-network agreement with Intermountain Healthcare and called upon IHC to stop balance billing Regence enrollees. He reviewed the causes of the balance billing problem and indicated the Legislature should prevent balance billing in all out-of-network situations and require all hospitals to accept an insurer's median hospital contract rate. |
| Mr. Alan Dayton, Intermountain Healthcare, indicated that IHC has out-of-network agreements with all insurers except Regence BlueCross BlueShield of Utah and that IHC is close to developing such an agreement with Regence. |
| Mr. Kelly Atkinson, Utah Health Insurance Association, distributed a handout, "Surprise! It's Your Out-of-Network Bill," reviewed the insurance industry's attempt to address the balance billing issue over the past several years, said that no Utahn in an emergency situation should be balance billed, and called for transparency and for disclosure of balance bills when they occur. |
| Mr. Steve Nielsen, Utah Association of Health Underwriters, urged the Legislature to continue working on the balance billing issue until is is resolved. |
| Mr. Mark Brinton, General Counsel and Director of Government Affairs, Utah Medical Association, noted that legislative proposals to address balance billing also affect physicians. He said the association does not, and will not, defend outrageous bills by any provider, but noted that physician bills are rarely the problem. He also said that insurance should provide adequate coverage with adequate networks. |
| Dr. Smitha Warrier, anesthesiologist at the University of Utah School of Medicine and President, Utah Society of Anesthesiologists, said that all should come to the table to resolve the balance billing issue. |
| Mr. Travis Slade, Vice President, Utah Society of Anesthesiologists, expressed a willingness to work with Rep. Dunnigan to find a solution to the balance billing issue. He indicated that network adequacy is a related problem. |
| Mr. Dave Gessel, Utah Hospital Association, reviewed balance billing solutions adopted by other states and said the association's government relations committee will have more in-depth discussion on the issue. He noted that the vast majority of hospitals in the state have solved the balance billing issue contractually. |
| Mr. David Maybe, Chair of the Utah Chapter of the American College of Emergency Physicians, expressed the college's willingness to work with others to find a solution to the balance billing problem. |
| MOTION: Sen. Davis moved that the Task Force go on record as supporting Rep. Dunnigan's efforts to address balance billing and that this issue be brought to a conclusion during the 2019 Annual General Session of the Legislature. The motion passed with a vote of 7-0-4. | |||
| Yeas - 7 | Nays-0 | Abs-4 | |
| Sen. A. Christensen Sen. G. Davis Rep. B. Daw Rep. J. Dunnigan Rep. M. Poulson Rep. E. Redd Sen. B. Zehnder | Rep. R. Chavez-Houck Rep. F. Gibson Rep. M. Kennedy Sen. P. Knudson |
| 4. Availability of Social Workers for Behavioral Healthcare |
| Mr. Travis Wood, representing the Utah Chapter of the National Association of Social Workers, the Utah Association of Counties' local mental health authorities, and the Utah Association of Addiction Treatment Providers indicated that current waiting lists for providers are attributable to a lack of providers rather than a lack of funding. |
| Ms. Emily Bleyl, social worker, introduced Ms. Jenna Christensen. |
| Ms. Jenna Christensen, Vice President of the Utah Chapter of the National Association of Social Workers, Associate Director of the Utah Area Health Education Center, and former employee of the Utah Medical Education Council where she published the state's first mental health workforce report in 2016, addressed the state's behavioral healthcare workforce capacity. |
| Mr. Adam Cohen, Chief Executive Officer, Odyssey House of Utah, and President of the Utah Association of Addiction Treatment Providers, distributed a handout, "Utah Association of Addiction Treatment Providers (UAATP) Behavioral Health Workforce Information Sheet," described the workforce shortage experienced by behavioral healthcare providers, and recommended solutions to the workforce shortage. |
| Mr. Jake Shoff, CEO, The Phoenix Recovery and Counseling Centers, and Vice President, Utah Association of Addiction Treatment Providers, explained why substance use disorder treatment providers have problems billing for services provided by substance use disorder counselors. |
| Ms. Becky Brown, Valley Behavioral Health, indicated that her organization is seeing a critical need for behavioral healthcare workers and pressure to pay available workers more. |
| Ms. Bleyl, addressed scope of supervision. She indicated that having someone other than a licensed clinical social worker supervise certified social workers may create issues, although there may be room for negotiation to address underserved areas. She and Mr. Wood also addressed the availability of slots for social work students at institutions of higher education. |
| Mr. Richard Nance, Utah Association of Counties' Utah Behavioral Healthcare Committee, indicated the state could look at the use of group supervision and eliminating the minimum monthly face-to-face contact between a supervisor and a clinician delivering services via telehealth. He recommended increasing the capacity of institutions of higher education to train social workers and indicated there is a need for various types of social workers, not just individuals with a masters of social work degree. |
| Dr. Scott Whittle, Medical Director, SelectHealth, spoke in support of increasing the number of social workers, particularly social workers who understand how to work with emergency departments, primary care physicians, and specialists. He indicated that using social workers who meet a provider's needs and are able to bill using "9- codes" would be easier than trying to get insurers to pay certain social workers using "H- codes." He indicated that increasing the trainee to supervisor ratio to six is probably not unreasonable; however the ratio should be adjusted to account for the nature of the supervisory relationship --- whether the supervisor is a sole provider or operating within a system that provides training. He also indicated that options presented to the task force should be combined with other strategies to address underserved populations, including those in metropolitan areas. |
| 5. New Guidance on Section 1332 Waivers |
| Mr. Andrews summarized recent federal guidance reinterpreting the four statutory guardrails used to evaluate a state's application for a Section 1332 State Innovation Waiver under the federal Affordable Care Act. He also highlighted three new Section 1332 options recently announced by the federal government. |
| Commissioner Todd Kiser, Utah Insurance Department, expressed appreciation to the task force for addressing balance billing and introduced Mr. Jaakob Sundberg. |
| Mr. Jaakob Sundberg, Health Actuary, Utah Insurance Department, indicated the department has federal funding it received earlier this year to evaluate, but not to implement, Section 1332 waiver options. He said that except for reinsurance, the earliest any of the options outlined by the federal government could be implemented is 2021 and that they would require a lot of work. He recommended the state look carefully at whether it would receive federal funding under a waiver for enrollment that exceeds current enrollment in the federal health insurance exchange. He also recommended the state determine the impact of the voter-approved Medicaid expansion on the calculation of federal pass-through funding under a waiver. And, he noted that prospects for approval of a waiver could change following the presidential election in 2020. |
| 6. Adjourn |
| MOTION: Sen. Davis moved to adjourn. The motion passed with a vote of 7-0-4. | |||
| Yeas - 7 | Nays-0 | Abs-4 | |
| Sen. A. Christensen Sen. G. Davis Rep. B. Daw Rep. J. Dunnigan Rep. M. Poulson Rep. E. Redd Sen. B. Zehnder | Rep. R. Chavez-Houck Rep. F. Gibson Rep. M. Kennedy Sen. P. Knudson |
| Chair Dunnigan adjourned the meeting at 4:09 p.m. |