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.”