AdvocacyDenver’s Health Care Advocacy Program is offering a FREE Health Matters class from February through May, 1x a week (up to 2 hours) to community based day programs. Health Matters is an evidence based curriculum for persons with Intellectual and/or Developmental Disabilities (I/DD). The program focuses on becoming physically active, making health food choices, and maintaining a healthy lifestyle. The program offers community activities that will include visiting a local gym, picking out healthy snacks at a grocery store, attending health expos, and making healthy meal choices at a restaurant, etc. What better way to start out a healthy and happy 2017?

Health Matters is partnering with the Dahlia Center, 3401 Eudora St., classes will begin at the Dahlia Center from 10a-12pm, exact dates are negotiable dependent on the need.

If you are interested in participating, please contact Mary Sims, Wellness Educator:
303-974-2535
msims@advocacydenver.org

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Educational Advocacy is Passion for Disability Law Executive

Mary Anne Harvey began her career as a teacher in a Wyoming child care center. That work experience introduced her to children with disabilities and spawned an advocacy passion that has never left her. In the 1970’s, she began her work at what was formerly called ‘The Legal Center for People With Disabilities and Older People.’ At that time, the organization was tasked with implementing changes in the law governing special education.

Now Executive Director of Disability Law Colorado, Mary Anne says although the organization’s name has changed, its mission and its advocacy issues have not. In an interview with Catherine Strode, she says protecting children with disabilities in the educational system remains one of its ongoing advocacy efforts.

Catherine Strode is Advocacy Denver’s Communications and Policy Specialist.  She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.

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Jeannie Ritter: ‘Early Intervention Key To Children’s Mental Health’

Colorado’s former First Lady Jeannie Ritter says more children are being expelled from preschool settings than high schools in the state.  This comes as advocates report seeing more significant behaviors in younger children. In the second of a two-part interview, Jeannie Ritter tells AD Policy Outreach Specialist Catherine Strode that training and early intervention may hold the key to turning around this trend.

How can we decrease the number of preschool expulsions in Colorado?

“I took a call just this morning from a public school teacher exactly on this topic.  This is really a crisis. We don’t have the training we need to support these young kids and these families in our classroom. We want to do parental education and make sure parents have some good strategies in place when challenging behaviors come along. The preschool doesn’t have the tools to deal with challenging behavior and so these young kids are expelled. That, in itself, starts this spiral. Young moms need this kind of support so they can go to work. They might choose places that don’t provide the expertise they need around some of these challenging behaviors that are exhibited by their young kids. We have a missed opportunity for parents to be engaged in learning tools to deal with that.  Help us get the message out to a broader community, to: educators, other service providers, policy makers. We want to pull some focus into these earlier interventions because the return, the chance of better outcomes, is much more enhanced if we can intervene earlier in the lives of people.”    

Why are we seeing significant behaviors in younger children?

 “We know that moms are entering the work force earlier. Before, maybe there was caregiver at home. We have a lot of movement in our nation and you find families out here, and their relatives live in Chicago.  The natural supports aren’t there. There are challenges around keeping a household running in a healthy way when we have existing behavioral health issues or challenges around finances. We’re constantly trying to look at maternity leave. This is not just a luxury.  This is actually part of the continuum which enhances or stacks the odds for healthy beginnings for moms and infants.  Then we have all the other supports: that kids have access to the right foods, access  to emotional supports in their communities. That all contributes to healthier outcomes, to kids that are ready to learn, feel safe in a learning environment and aren’t having to be hypervigilant because of what might be going on in the community. We don’t just take on one system. The win is when we coordinate those systems.”

What kinds of interventions are needed?

“One of the big challenges is advocating for infant mental health.  People have a hard time understanding how infants and frankly, in utero fetuses, are impacted by toxic stress, violence, and  anxiety that young moms have.  When I’m talking about infant mental health and working with young moms, we can take an opportunity to give parents tools for creating a predictable environment that children know is safe and enhances a child’s well-being.  The sooner we can begin to work with maternal mental health and postpartum (mental health), that’s when we get our best outcomes. That’s the best investment we can be making: supporting young families in what they need to feel better about what they do as a family.  Maybe even these parents might not feel safe in their environment. Are we talking about food and security?  Are we talking about not having access to being outside where we know that walking, feeling connected to a neighborhood, might not be a possibility if the neighborhood is not safe? How do we begin to engage people at that level and get all the systems in play that can impact those things?

What is the future ‘face’ of behavioral health?

“Technology is going to have a real impact: telehealth. I don’t mean just for rural communities.  I mean for people who are isolated, homebound, or it’s just too much for them to get across town.  Can we enhance telehealth in a way that people get services on their handheld?  MHCD is working on these telehealth strategies.   Now you can do this on your own monitor at home. The screen can be split into three compartments: a family member, your psychiatrist or primary care provider, and everybody’s talking.  This concept of integrated care, that is where there’s real hope.Your primary care doctor makes sure there’s a behaviorist on site. We’re in over 60 sites across the city in primary care settings. We can make sure folks get access if they’re not coming through our traditional doors. That’s the new face of mental health.”

Second of A Two-Part Interview 

Missed the First Part?  Click here for Jeannie Ritter’s Discussion of the Importance of Early Childhood Intervention

Catherine Strode is Advocacy Denver’s Communications and Policy Specialist.  She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.

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Former First Lady Jeannie Ritter Embraces Mental Health Advocacy

Colorado’s former First Lady, Jeanne Ritter, is actively involved in efforts to improve behavioral health services in the state. As Mental Health Ambassador for the Mental Health Center of Denver, she establishes alliances within the mental health community and works to reduce duplication of efforts. Mental Health is an issue she passionately adopted as First Lady. In this two-part interview with Policy Outreach Specialist Catherine Strode, she says her passion for the issue has undergone change.

From where do you draw your passion for mental health advocacy?

“I used to answer that question by stating that I have an older sister that has a bipolar diagnosis and from the impact that had on our family. Now, I have changed that answer to include all of us. It’s not really about one person in my family having a mental health issue. It’s about everyone in my world (family members, neighbors, coworkers), all of us including myself where behavioral health intersects in our lives. Anxiety, substance use, depression, as well as other severe diagnoses. We all move in a world where that is our community and that’s where the passion comes from.”

As Mental Health Ambassador, what movement are you seeing in the field?

“There are so many efforts going on in terms of behavioral health. I get to participate in a lot of conversations and, hopefully, move work forward. I have a really great 30,000 foot view to see what the efforts are going on out there. Where could we link efforts and really expand? I work across the spectrum on everything from early childhood, infant mental health, all the way to initiatives that have to do with chronically homeless folks that need supports and housing. I say, ‘all roads lead to mental health.’ Regardless of what outcome you’re working towards, whether it’s obesity, grade level reading, employment, or cardiac efforts, people are beginning to realize you can’t get there without walking through the doors of a behavioral health conversation. Everybody’s on board. It’s an integrated approach. It’s an inclusive approach. It’s an all person approach. We no longer look at mental health as this stand alone; we see it as a component to the overall health and well-being of a person.”

 Have recent violent societal events changed the dialogue among mental health professionals?

“The dialogue is always in the keeping of what we always say which is, ‘let’s make sure we have trauma informed services.’ We try to be a resource to the community. I have a colleague that works at CDPHE (Colorado Department of Public Health and Environment) and he made sure I knew there are supports for the trauma reporters are experiencing even in the reporting of these events. The key word here would be trauma. We know that trauma exists and we know what the byproducts of trauma are. How do we get earlier interventions in place and get folks to realize, whether they’ve been witnesses, part of the community, or working in any setting, it impacts all of us? It is not something we’re crafting. It’s absolutely real. What do we have as things that can help us build our own resiliency? What are the mechanisms we can call upon for our own calming so we build this collective, protective shield around us? What do we have in place to help us be protective in the future? A lot of us hope to cultivate those practices within the community where people are calling upon natural supports, building on natural supports, learning how to be a support to one another. Learning how we harness those tools to mitigate negative impacts and build that protective shield. Especially with children. Our children are exposed. It’s on the radio, it’s on the TV.”

What is the Mental Health Center of Denver doing to support children’s mental health?

“We have a robust infant mental health program here, as well as early childhood. Beginning with what they call the ‘DYAD”. It’s working with the two: the caregiver and the infant. Restoring that protective shield, or creating it if it never existed, for the mom. Some folks, due to trauma in their earlier lives, maybe they have behavioral health challenges, maybe they live in unsafe environments, that is not always in place. There’s a lot of tension. We know infants feed off of that tension. That starts this negative spiral. We don’t have to wait until there’s a full blown crisis. When we can work with our primary care doctors, our delivery doctors, we might know she’s going to have some challenges. Let’s put these supports in place. Let’s stack the odds for a healthy caregiver infant relationship. If we need to, we keep that going where families may have experienced trauma or witnessed violence. Little children that have witnessed, and sometimes not even witnessed but they were in their crib, are absolutely impacted by the trauma that happened in that household. Capturing and intervening with those families – that’s all very exciting.”

First of A Two-Part Interview Series

Next Issue: Jeannie Ritter Discusses Importance of Early Childhood Intervention

Catherine Strode is Advocacy Denver’s Communications and Policy Specialist.  She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.

The post Former First Lady Jeannie Ritter Embraces Mental Health Advocacy [Part 1] appeared first on AdvocacyDenver.

Join ADVOCACYDENVER at the Denver Broncos’ FREE Health and Wellness EXPO over Labor Day Weekend! Saturday and Sunday, September 5-6, 9am to 3pm at Sports Authority Field at Mile High Stadium.

ADVOCACY DENVER Joins the Denver Broncos to Support Health EXPO An interview with Dennis Moore by Catherine Strode ADVOCACYDENVER will be participating in the Denver Broncos’ premiere Health and Wellness EXPO over Labor Day Weekend. The EXPO is a first for the Broncos, who are pairing up with UCHealth, to impact the health and well-being of their fans statewide. It began with the recent renaming of their Training Center and is extending to a long-term health campaign. The EXPO, held at Sports Authority Field, will feature free medical screenings provided by UCHealth. ADVOCACYDENVER’s booth will feature: demonstrations of modified exercise, healthy snacks, and exercise videos. In an interview with Catherine Strode, Broncos Vice President of Sales and Marketing Dennis Moore says the EXPO is only the beginning of many future Broncos’ large scale health events. How was the vision of this partnership created? “The vision of it goes back quite a ways in terms of the Broncos’ internal conversations.  We’ve been working down this path around what role can we play in the health and wellness of our fans? Obviously, we’re a football team so that effort can only go so far. Who we partner with in the health care space is a critical component in us making a positive impact in health and wellness.  We’ve articulated our vision. What we want to accomplish is, at some point in the future, being able to say we have the healthiest fan base in the NFL.  That’s a big goal but we felt great synergy with the leadership team at UCHealth and how they want to take a leadership stance in health and wellness.  By combining what the Broncos’ brand and our fan base bring, with their expertise in health and wellness, we had a partnership that can start to look pretty special in what we do and how we go about starting to make a positive impact for our fans and anybody who lives in Colorado.” Are you using the renaming of the training facility to launch the health and wellness campaign? “The renaming of our training center to ‘UCHealth Training Center’ is very much a symbolic part of a partnership that has many tentacles beyond the naming rights of our training center.  That is obviously the one that we led with because it’s going to get the most publicity. That is a significant asset for bringing attention to UCHealth and to our partnership but that is not the ‘meat of the bone’, if you will. That is the public dynamic to it. The majority of the health and wellness work, and how we’re going to partner on a lot of these initiatives, is going to be done through events. We’re going to be doing health and wellness digital challenges where we will be asking our fans to sign up and do daily activities to earn points and compete against each other in health and wellness challenges. Although the facility and the naming rights brings the most significance in terms of awareness to UCHealth, that is just the tip of the iceberg in terms of the programming and activations we’ll be doing with UCHealth.” Is the health and wellness campaign focusing on one specific physical condition? “With all of the service lines that UCHealth supports, it would be unfair to rule anything out at this point because we’re so new into the partnership. Their organization is learning a lot about us and what are passion points for the Broncos’ organization in terms of those issues. We would like to get involved in: Breast Cancer awareness, or Alzheimer’s, or domestic violence.  I think all of those things, even football specific – concussion awareness – and what that means to the vitality of football, are on the table.  As we get this partnership off the ground, it is less about one particular issue. More than anything right now, it’s how do our two organizations start to make a wide canvas across our state and bring more awareness to overall health and wellness platforms.  How do we get somebody who is making unhealthy decisions get off the couch and start leading an active lifestyle? How do we get families to start paying attention to healthier recipes?  How do we start to institute some workout programs and allow our fans to compete against each other?  How do we create an impact that is year-round and not singularly focused on one event but really is tailored to create an impact throughout the course of the year? We are bringing our players, our cheerleaders, our dieticians, our athletic trainers, to the table where people are paying attention because it’s the right talent delivering the right content.” Who are you targeting in this health and wellness campaign? “It is not focused on 53 players but focused on our millions of fans.  If we can enable 500 fans to get screened, that ordinarily would not get screened, that’s what the partnership is all about:  early detection and wellness exercises. It is providing access and motivation and education to our entire fan base. It’s designed to get the messaging out to as many of our fans as possible, whether they’re in our seats, or whether they never come to our games. The focus is how do we touch as many people as possible.”

Come meet the Broncos and the Broncos Cheerleaders! EVENT INFO: Saturday, September 5 and Sunday, September 6 9:00 am to 3:00 pm Sports Authority Field at Mile High Stadium FREE TO THE PUBLIC Get more info here! AdvocacyDenver’s Health Care Advocacy Program will have a booth at the EXPO. Stop by for some fun activities! Healthy Snack Buffet Adaptive Exercises Health and Wellness Jeopardy

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Colorado’s Insurance Commissioner, Marguerite Salazar, wants state residents to know where they can go for greater understanding of the benefits offered in insurance policies, and, where to file complaints when they are not satisfied with an insurance company’s practices.  She says the Division of Insurance relies on consumers to know when something within an insurance company isn’t working for the consumer’s benefit.In this interview with Advocacy Denver’s Policy Outreach Specialist Catherine Strode, Commissioner Salazar also discussed the future of Colorado’s Health Exchange, predicting more financial viability in the years ahead.

What are your thoughts on the Exchange’s past and future performance? “I am on the Board and bring the perspective from the Division of Insurance, which is to help the Exchange in making sure that all regulations are followed, plans they are selling are viable, and they have met all the requirements.  My first thought about the Exchange, as I look across the country, is that this is a very strong Exchange.  We’ve got lots of plans to sell; we’ve got more than any other Exchange in the country. But what has happened is, because it’s a new business, we really don’t know how to capitalize it in the best way we could.  The Board was trying to be very conservative in looking at the fees and the assessments they were charging.  But because it has been so successful (there are so many people who have enrolled) the costs for the call centers has really gone up.  With that comes a need for more money to pay for bigger call centers and more help.  I think we were underfunded. The Board did pass an increase in the assessment to three and a half per cent. I know that some of the staff doesn’t believe that is enough.  However, that’s what the Board approved. I am very hopeful this is going to be enough.  We will watch them closely, from our perspective, to make sure they are collecting what they should, doing everything from a regulatory standpoint that they should.  We have not seen any gaping holes, or any big problems.   With strong stewardship, and we think see that with Kevin Patterson coming on board, I think their future looks good.” What signs do you see that health care reform is working? “We see that millions of people now have health insurance who before couldn’t afford it, or, wouldn’t be allowed to be on a plan because they had a pre-existing condition.  I see people every day talking about the fact that just being able to go to a doctor for preventative care has meant so much for them.  People who used to wait until they were really sick and ended up in the emergency room with a huge bill don’t have to worry about that anymore.  I also hear great stories about people who have had to change insurance because their insurance plan didn’t include a certain hospital or a doctor. They were able to drop the current plan and go to the plan that more met their needs because it happened in the enrollment period.  That could never have happened before.  To me, that is the biggest sign that consumers are getting served.” What steps is the Division taking to ensure narrow networks aren’t cutting high needs individuals out of services? “We measure and look at network adequacy with all the plans.  We have been doing some network adequacy studies to make sure there are the proper hospitals, specialists, primary care doctors, ancillary services available to people who buy certain plans.  We’re really watching that closely. Our biggest challenge is to make sure each plan has a sufficient network that includes all the needs that are out there for the benefits that they are going to sell. Who they sell it to is something we don’t get into.  When people file complaints to say, ‘I can’t get into a certain specialist,’ or, ‘these things aren’t made available,’ we do investigations to make sure the plan is providing what the consumer has purchased.” Is there an issue of insurance companies not paying for out-of-network services? “That is a big issue. I have heard about that more from carriers than I have from individuals. Colorado has a law that says individuals cannot be billed for services that were rendered when the provider wasn’t a participating provider.  What happens is, the carriers end up having to pay that bill.   The Division doesn’t get into contracting between the carriers and the providers. We don’t have any legislative authority.  One of the things that could happen would be out of the Cost Commission;  someone might run a bill to give the Division, or somebody, more authority to look at those contracts.  There really isn’t any law stopping people from whether they want a contract or not, especially in rural areas.” Can you give us any insight into rising pharmaceutical costs? “I can’t speak specifically about a particular insurance company, but I do know that pharmaceutical costs are going up.  We’re seeing it with all the specialty drugs available. The cost is real expensive, not only for the patient, but for the carrier as well.  One in particular happens to be the drugs people use for Hepatitis C.  I think there are only two drugs in that category. The companies can charge whatever they want.  We have a specialty drug working group which includes PHARMA, carriers, consumers, just to talk about what we could do.  It’s really disappointing when people do finally get insurance and then find out the drug costs can be three or four thousand dollars out of the pocket the first month.  It’s almost like the second tier of health reform we need to get into. It comes down to the marketing power the carrier has with the pharmaceutical companies, what the patients need, and what they are able to afford.”

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Senate Bill 60, sponsored by State Senator Ellen Roberts, and passed with nearly unanimous bipartisan support, will put some teeth into the prosecution of Medicaid fraud across the state.  Currently, the Attorney General’s office prosecutes provider fraud.  But recipient fraud is handled through the counties, who often lack the personnel to conduct the investigative process.

In an interview with Catherine Strode, Coordinator of the Health Care Advocacy Program, State Senator Roberts said the bill’s main intent is to create a stronger system of tracking Medicaid fraud carried out by both health care providers and benefit recipients.

Why is this bill good for the state of Colorado?

“Because it will give us good information. Currently we don’t have any streamlined system to inform the legislature as to how much it’s occurring, who’s doing it, provider versus recipient. I think we have people out there saying one thing or another as if there’s strong data to back up their claims. When I went after getting that strong data, I couldn’t locate it.”

How will it be implemented?

“Medicaid fraud is handled in two different ways in Colorado.  Grantee or recipient fraud is handled through the counties.  The Departments of Human Services at the county level, when they see something that they’re concerned about, are to investigate it.  If it rises to the level of abuse, then they are to turn it over to District Attorneys to prosecute the case.  If it’s provider fraud, a physician or a hospital, then the Attorney General’s office is supposed to investigate and prosecute.  So we have a split system which is why we don’t know at the State Legislature who’s doing what.  How much Medicaid fraud is occurring? What’s being pursued? What I have heard from folks is there’s wild speculation both in terms of who’s doing it, how much money is involved, and how many people who actually deserve Medicaid benefits are being deprived because money is being filtered off the system by those who aren’t entitled to it.”

Are there statistics on Medicaid fraud in Colorado?

“No. That’s the point.  There are some people who say it’s rampant.  And yet last fall when I was trying to get a handle on this, nobody could give me accurate numbers. HCPF has data for what they cover but it’s not the state agency’s responsibility to pursue it on the recipient side. The Attorney General’s office has a Medicaid fraud control unit which has several million dollars a year that they recover.  But that is only providers, not recipient fraud.  What happens at the county level, because often the dollars involved are much smaller, there’s not really a strong pursuit of going after Medicaid fraud because it takes more time and personnel  than they think they will actually recover.  The way the statute currently reads is that even if a county were to recover Medicaid fraud proceeds, they have to turn it over to the state (the state being Health Care Policy and Financing) so there’s no incentive for the counties to really pursue it because they have to help pay for the District Attorney to actually prosecute.  If they recover any money, they don’t even get the cost of prosecution.”

What is the effect you want the implementation of this bill to have?

“With the huge increase in Medicaid eligibility, the system is going to be overwhelmed for awhile, as we have more and more people enrolled both because we at the legislature expanded eligibility but also depending on what’s happening at the federal level.  So I just want to make sure that those entitled to receive Medicaid benefits actually get them. That we don’t have a siphoning off of state money to people who aren’t entitled, or are  abusing the system, whether they be providers or recipients of the benefits. There’s so much money at stake in Colorado’s Medicaid budget.  That’s why I think we need to get to the bottom of this.”

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House Minority Leader Mark Ferrandino rates the passage of bills that have supported small businesses as the most significant ‘hallmark’ action of the Democratic caucus during the 2012 legislative session.  Bills which have been proposed by the Democratic caucus to support job growth, but have failed, he rates as his greatest disappointment.

In an interview with Catherine Strode, Coordinator of the Health Care Advocacy Program, Minority Leader Ferrandino discussed his personal accomplishments and goals of the 2012 session.  What does he consider as his greatest personal accomplishment of the session: state personnel reform. What is his greatest goal: passage of a bill to support Civil Unions.

What do you view as your greatest success of the 2012 session?
 
“You know getting a budget to pass 64 to 1 is a huge success for both parties.  I think that’s a significant success.  I think sticking on the message of jobs and the economy and the bills that we’ve pushed forward to help small businesses, to help entrepreneurs, really has been a strong hallmark of the Democratic caucus in the House.  Some of those bills are still alive, some of them have passed and become law, and we’re still working with Republicans to try and find common ground on those.  On a personal issue, I’ve worked hard on the personnel reform that the governor was pushing.  That’s the bill that I’ve spent hours negotiating with both state workers and department heads to try and come to a good balance.  I think we have that balance and it passed the House unanimously and just passed the Senate unanimously and it’s coming back to the House for consideration.  I think that will be a significant piece of legislation.  You know one thing that I’m just, personally, very hopeful for,  it’s still in the process but, is civil unions.  It’s going to be an uphill battle but if we can get that passed – that will be a significant victory for Colorado.”

And what’s your greatest disappointment so far?
 
“I think a lot of the jobs agenda that we’ve been pushing.  Some of the things like (Representative) Max Tyler’s investment in small business development centers.  (Representative) Dave Young’s tech transfer incentives, (Representative) John Kefalas’ angel investors.  All those don’t seem as of right now that they’ll be moving forward and those are good, smart job creations with proven incentives, and investments.  And, so unfortunately, we weren’t able to find bipartisan support for some of those.  Maybe it will change in the next couple of weeks because some of them are still alive. I think some of my disappointment has been around places where we all agree we need to focus on job creation but we weren’t able to come together – Democrats and Republicans – to compromise and find the right vehicle to get those smart investments done for our economy and investments.  And, so unfortunately, we weren’t able to find bipartisan support for some of those.  Maybe it will change in the next couple of weeks because some of them are still alive. I think some of my disappointment has been around places where we all agree we need to focus on job creation but we weren’t able to come together – Democrats and Republicans – to compromise and find the right vehicle to get those smart investments done for our economy.”

What do you think are the most significant pieces of health care legislation to come out of the 2012 session?

“Representative Young and now Representative Gerou have a bill, 1281 on Medicaid Payment reform, which I’ve been involved with, on a pilot program and then opening it up to looking at global payment methods, and paying for performance, and outcomes versus fee for service.  It could have a significant change in the way we deal with health care in the public sector.  So I think that’s the most significant.  I think that it has a very good chance of becoming law this year.  Outside of that, I think the budget is always a significant health care bill because it deals with a lot of the funding for health care. Not having to cut provider rates at all this year, helping to put some more money into DD slots, some of those things I think were good in health care.”

And what is your opinion of the health care Long Term Services Relocation bill being proposed?

“When I was on the budget committee, I spent a lot of time raising concerns about how the Department of Human Services was managing the finances of the DD line items. And so I was pushing for people to look at should we move this to HCPF – given that a lot of the funding comes from HCPF because it goes through Medicaid.  HCPF is a Department that’s much better at handling money – they’re kind of like an insurance company – where the Human Services is more of a service provider.  So it might make sense to move more of the controls and financing to HCPF. That being said, there a lot of concerns that have been raised– what is this going to do to people with developmental disabilities? Are we going to make sure at the end of the day we’re not harming that population?  And that’s the biggest key.  I don’t think anyone wants to have a negative impact on that population. So we have to be very careful and diligent.  The question is – is this the right way to do it? My hope is that they do it in a deliberate, systematic way that builds upon community input to try and do it. And if it moves forward – keep an open door through the process – to make sure that community concerns are addressed as both the bill moves forward and if the bill passes – then as the transition actually happens.”

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State Senator Linda Newell is sponsoring Senate Bill 127, ‘Medicaid Health Homes Long-term Care Providers.’  The bill creates a provision for long-term care services to be included in Medicaid health homes for those individuals who are “Dual Eligibles” – or – eligible for both Medicare and Medicaid benefits.  It ensures that these services will be included in the Accountable Care Collaboratives established under the guidelines of state health care delivery reform.

To ensure passage of the bill, State Senator Newell brought together a wide range of stakeholders including representatives of: senior organizations, hospital associations, assisted living facilities, and insurance plans.  She told Catherine Strode, Program and Outreach Coordinator of the Health Care Advocacy Program, that negotiations over the final version of the bill resembled ‘turf wars.’    

Senator Newell, please explain the intent of the bill and who brought it.

“The intent of SB 127 is to make sure that those who are dually eligible do not fall through the cracks and that they  are allowed to get every service they possibly can being dually eligible.  So we first worked with Leading Age Colorado on it, and then after that, the Colorado Health Care Association and the Center for Assisted Living. They came on board.  Then the Behavioral Health Care Council came on board. And then AARP came on board and total long term care. Those are the major stakeholders. We also included Rocky Mountain Health Plans, United Healthcare, all of the major health care plans that cover this population. With all of this health care reform, we want to make sure that as they’re developing these Accountable Care Collaboratives and the Regional Care Organizations, they remember the long term care dually eligible.  We wanted to make sure that as the Department of Health Care Policy and Finance is putting their rules together, that they are providing coordinated care.  We want to make sure that the mental health or behavioral health care needs are met, not only the chronic condition. The integration of the care was really critical.   To me that’s one of the most important parts of this bill – that it does promote that integrated care model.”

How would the bill be implemented?  

“It’s very general and broad on purpose.  So that as HCPF is putting their definitions together, it is allowing for all of these long term care providers to be at the table. Nobody is left out.  It’s more of one of those bills that lays the foundation prior to the action. It’s putting into statute, and directing HCPF, to include the providers of long term care and services as part of their health home when they’re putting together their programs.”

What were the stakeholders’ concerns about SB 127?

“HCPF said they would be promulgating the rules around it but the stakeholders thought we needed to direct them to do it now because we don’t know what it might look like as they go about it.  We had to work with the insurance plans to make sure that we came up with all of the language that they felt was broad enough but wasn’t restricting.  On the other hand, one of the concerns was we didn’t want anything in statute with a definition that would give preference to any one kind of long term care provider or an  insurance plan.  So we wanted to make sure we were on equal footing.  Once we came up with the language for that, – we did get it passed unanimously.”

What did you learn in promoting this bill?

“Like anything else in this building, it’s sad to see so much energy on turf wars as opposed to care for long term.  The concern was “We don’t want them to have preference in the statute.” What makes me sad sometimes is – where’s the patient in all of this?  They’re all so worried about their own political stature or their piece of the pie. The patient gets lost, I think, sometimes.  For me, as someone who has worked closely with people who are dual eligible, it’s just wrong. These are our most vulnerable and we should be looking out for the patient.  The good news is we did all get to the table and we all did come up with something that was equitable.”

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