Senate Health & Welfare Committee

 

2003 Minutes

 

January 8, 2003
January 9, 2003
January 10, 2003
January 14, 2003
January 15, 2003
January 16, 2003
January 17, 2003
January 21, 2003
January 22, 2003
January 23, 2003
January 24, 2003
January 28, 2003
January 29, 2003
January 30, 2003
January 31, 2003

February 3, 2003
February 4, 2003
February 5, 2003
February 6, 2003
February 7, 2003
February 10, 2003
February 11, 2003
February 12, 2003
February 13, 2003
February 14, 2003
February 18, 2003
February 19, 2003
February 20, 2003
February 21, 2003
February 25, 2003
February 26, 2003
February 27, 2003
February 28, 2003

March 4, 2003
March 5, 2003
March 6, 2003
March 7, 2003
March 11-12, 2003
March 13, 2003
March 14, 2003
March 17, 2003
March 19, 2003
March 20, 2003
March 21, 2003
March 24, 2003
March 25, 2003
March 26, 2003
March 27, 2003
March 28, 2003

April 1, 2003
April 2, 2003
April 3, 2003
April 4, 2003
April 7, 2003
April 8, 2003
April 9, 2003
April 10, 2003
April 11, 2003
April 17, 2003
April 29, 2003

July 7 & 8, 2003

DATE: Wednesday
TIME: January 8, 2003
PLACE: Room 437
MEMBERS: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/EXCUSED: None
GUESTS: See attached sign-in sheets
Chairman Brandt called the first meeting of the Health and Welfare committee to order and explained the purpose of this two-day educational meeting is to familiarize committee members about the programs and services provided by the Idaho Department of Health and Welfare (IDHW).

The Idaho Department of Health and Welfare (IDHW) Director Karl Kurtz introduced his management staff, Deputy Director Joseph Brunson, Deputy Director Joyce McRobert, Deputy Director Gary Broker, Division of Health Administrator Richard Schultz, Division of Welfare Administrator Scott Cunningham, Division of Family and Community Services (FACS) Administrator Kenneth Deibert, and Division of Medicaid Deputy Administrator Kathleen Allyn. Other management staff introduced included Region I Director Michelle Britton from Coeur d'Alene, Region IV Director Randy Woods from Boise, Region VII Director Joan Gridney from Idaho Falls, and Acting Administrator Division of Medicaid Randy May.

Director Kurtz distributed a chart outlining the overall IDHW statistics, and the 2003 appropriations. The Department serves a total of 338,926 Idaho residents.

  1. General Funds - $359.6 million
  2. Total IDHW funds $1.2 billion
  3. Year 2003 authorized full-time staff positions of 2,999
  4. Appropriation by Divisions: Medicaid 70.5 percent, Welfare 10.1 percent, Councils 0.3 percent, Indirect Support 2.6 percent, Health 4.3 percent, and Family and Community Services 12.2 percent.


  1. Medicaid's spending by program - Basic Medicaid is 97.5 percent, CHIP (Children's Health Insurance Program) 2.2 percent, Facility Standards 0.3 percent and has 196 positions. The Medicaid expenditure categories are benefits at 95.7 percent, operating 2.9 percent, and personnel 1.4 percent. Medicaid has 196 full-time staff positions.


  2. FACS (Family and Community Services) spending by program - Child Welfare 28.6 percent, state hospitals 28.4 percent, Children's Mental Health 8.8 percent, Adult Mental Health 12.6 percent, Substance Abuse 9.2 percent, Developmental Disabilities 12.4, FACS expenditure categories are personnel 56.1 percent, benefits 26.9 percent, and operating 17.0 percent. FACS has 1,683 full-time staff positions.


  3. Welfare's spending by program - eligibility 28.7 percent, community action 12.9 percent, child care 29.7 percent, cash payment 12.3 percent, and child support 16.4 percent. Welfare expenditure categories include benefits of 58.3 percent, personnel 23.6 percent, and operating 18.1 percent. This division has 657full-time staff positions.


  4. Public Health's spending by program - women, infants and children 34.1 percent, environmental health 2.3 percent, emergency medical services (EMS) 6.8 percent, immunization 8.9 percent, health promotion 9.7 percent, labs 10.0 percent, vital stats 11.3 percent, and physical health 16.9 percent. This division has 178 full-time staff positions.
HEALTH Division of Health Administrator Richard Schultz explained the division consists of 35 very distinct programs, and provides an array of services ranging from immunizations to food safety and emergency medical services to testing for communicable diseases. He outlined the organizational chart of the Division of Health which includes bureaus of Clinical and Preventive Services, Health Promotion, Environmental Health and Safety, Health Policy, Vital Statistics, Medical Services, State Laboratories, the Office of Epidemiology and the Office of Rural Health and Primary Care.

Senator Stegner asked Mr. Schultz to explain what children are served by the programs, who is eligible for services, who is targeted for services, and what is the focus of programs. Mr. Schultz explained that each program has different eligibility criteria. He briefly outlined the following programs.

Children's Special Health Program - Any child in the state can access the program. The program contracts for clinics around the state that are staffed by physician specialists, who diagnose and provide consultation for children with special health needs, such as cardiac, neurologic, orthopedic, craniofacial, cleft lip and palate, and cystic fibrosis. The program assists in paying, on a sliding fee scale, for treatment of uninsured children with these diagnoses. If a child is insured, the insurance company is billed. This program is not a benefit's program. This is a public health program and serves about 2,400 children each year.

Immunization - This program provides about 500,000 doses of childhood vaccine for all children in the state. No eligibility is required for immunizations. Vaccines are provided free to physicians throughout the state. More than 700 physicians in Idaho administer the vaccine. The program tracks adverse reactions (about 0.1 percent), the immunization rate at two years of age (75 percent), and schools' entry (95 percent), monitors physicians' use of the vaccine to assure quality and efficiency, and promotes vaccination of children.

Newborn Screening/Genetics Clinics - Every child in Idaho is required to have newborn screening on birth. This program provides physicians with access to laboratory analysis of blood samples collected on all newborns (about 21,000/year) for metabolic abnormalities. If diagnosed early and with proper intervention, the impact the abnormalities have on decreased mental capacity or potential death can be averted.

There are no geneticists in the state, the program contracts with geneticists from the medical schools in surrounding states to staff clinics in Idaho, where they provide consultative services to patients referred from physicians throughout the state. Approximately 210 families, to individuals are seen annually. The cost for newborn screening previously had been paid by the State, but is now paid by the parents.

Reproductive Health - This is a program that provides services to mostly low-income women. Payments are based on a sliding fee scale. The majority of services provided through the Bureau of Clinical Preventive Services are contracted through the District Health Departments, so the site for the delivery of services is at the local Health District clinic. The District Health Departments provide family planning services to women throughout Idaho. The program serves approximately 30,000 women per year, the majority of whom are low incomes.

STD/AIDS - No eligibility requirement for services. The program contracts with District Health Departments to hold clinics for the diagnosis and treatment of people with sexually transmitted diseases (STD's) and their partners. Additionally, the clinics provide diagnostic services for human immunodeficiency viruses (HIV) and acquired immunodeficiency syndrome (AIDS), approximately 30 new HIV/year and 25 new AIDS/year. If a HIV-positive patient is less than 300 percent of the poverty level, they may qualify for the federal-funded AIDS Drug Assistance Program, (approximately 90 patients). The drugs are meant to reduce the patient's viral load, making them less infectious and maintaining their health status longer.

Women, Infants and Children (WIC) - This is the largest program within the division, both monetarily and in the number of people served. The program contracts with District Health Departments and some tribes to provide clinical assessment of the nutritional status of pregnant or breast-feeding women and children under the age of five (5) years, who are below 185 percent of the poverty level. If the patient is found to be nutritionally compromised, prescription food checks (worth approximately $38/monthly) are provided for specific food items to meet the nutritional risk. Approximately 33,000 patients are served annually.

Bureau of Health Promotion - This is a non clinical bureau and the majority of programs in the bureau are population-based health promotion programs. The Bureau provides preventive health programs and services to local Health Departments, schools, businesses, hospitals and other community-based organizations to improve the health of Idahoans. The Bureau has programs in adolescent pregnancy prevention, arthritis, asthma, breast and cervical cancer early detection, injury prevention, oral health and tobacco prevention and control, diabetes control, and rape prevention and education.

Bureau of Environmental Health and Safety - Provides environmental health education, food protection, indoor environment and worker health and safety services. The Bureau works closely with the Department of Environmental Quality, and with the seven District Health Departments in Idaho.

The focus is on providing the public with information on how to reduce their risk of harm from exposure to various environmental contaminants. The work is done primarily at sites that are or being considered as potential Superfund sites (lead at Bunker Hill and the Coeur d'Alene Basin, selenium around Soda Springs, arsenic at Blackbird Mine, (approximately 10 sites around the state are actively being worked). Health consultations are also provided to communities that request assistance in evaluating health concerns surrounding an environmental contaminant, such as cancer concerns at Oldtown. Fish advisories are issued when contaminants in fish reach levels of concern, most recently mercury at Brownlee, C.J. Strike, and Salmon Falls Creek reservoirs, and selenium in East Mill Creek.

Bureau of Health Policy and Vital Statistics - This group converts health data into information. It is responsible for producing the annual vital statistics report for Idaho, which contains all the information on births, deaths, and divorces in Idaho. It also performs surveys of the population to determine health risks, such as the Behavior Risk Factor Survey (BRFS), and the Pregnancy Risk Assessment Tracking Survey. The surveys provide the most time-sensitive information on which to develop or revise health program efforts. The survey data reflect changing attitudes and, more important, behaviors, which are good predictors of mortality. This group identifies our health problems and how too most effectively address them.

Emergency Medical Services (EMS) - This program is responsible for identifying emergency medical system weaknesses and developing proposals to improve its performance. Two of the most recent initiatives have focused on improving training and guidelines for treating children and development of a Trauma Registry that, when implemented, will link pre-hospital with hospital emergency room data to assess the quality of patient care in both settings. The program is also responsible for staffing the State Child Mortality Review Committee, which is responsible for reviewing all child deaths occurring in the state to determine if there are system changes that should be made to reduce childhood deaths.

The EMS program is also responsible for the licensure of all EMS units in Idaho (approximately 200) and certification of EMS personnel, approximately 4,500 staffs, 68 percent of whom are volunteers.

The EMS is responsible for the Communications Center which operates 24 hours a day, 365 days a year. It dispatches rural EMS units without 911 systems and air ambulances, offers flight-following monitor flight progress; provides communication links between any EMS unit and the hospital to which they're transporting a patient.

The EMS program administers grants to primarily rural EMS units, EMS consultants, and provide local units with information and assistance in maintaining viable EMS services.

Public Health Laboratory - Laboratory sites are located in Coeur d'Alene, Pocatello, and Boise. This group performs analysis of environmental samples (about 12,000 yearly), primarily for the Department of Environmental Quality. They are responsible for licensing all clinical laboratories in Idaho (approximately 800) and inspecting all clinical X-ray equipment in the state, approximately 1,250 sites.

The Microbiology Laboratory receives about 16,000 samples annually from Idaho clinical laboratories to confirm test results, and from District Health Department clinics and disease investigations. It also performs other tests such as tuberculosis and environmental specimens for biological agents.

The Virology/Serology Laboratory deals with some of the nastiest critters - viruses. It is the only lab in Idaho that tests for rabies, about 20 exposures yearly. This group would more than likely be the lab to identify smallpox, if it is introduced in Idaho.

The Microbiology and the Virology/Serology labs receive samples from hospital and physician laboratories for confirmation. Both laboratories are key labs in investigating disease outbreaks.

Office of Epidemiology - This office is the focal point for medical consultation regarding communicable diseases. It is also the coordination point with District Health Departments for investigation of and development of strategies to interrupt disease transmission throughout Idaho.

Office of Rural Health and Primary Care - This office provides consultation to rural communities on ways to improve or maintain access to health care locally. The office administers the $250,000 Rural Access Grant program as well as other federal grant programs to improve rural hospital viability, such as the Critical Access Hospital Program.

Mr. Schultz briefly discussed two proposed pieces of legislation. One pertains to the authority to quarantine and isolation of individuals with infectious disease. The second relates to housekeeping issues created when the Division of Environmental Quality (DEQ) was separated from IDHW. The enforcement authorities were transferred to DEQ; therefore, the food enforcement statutes were also transferred, and those statutes need to be under the public health laws.

WELFARE Division of Welfare Administrator Scott Cunningham explained what services are provided and that most people served are low-income and those in crisis situations, to help them become and remain self-reliant members of Idaho. The population served are mostly at about 100 to 200 percent of the poverty level. The federal government sets the standards for poverty and that standard is incorporated within the rules of Health and Welfare. As time allows later in the legislative session, Mr. Cunningham stated he would like to have his staff meet with the committee to present a more detailed description about each Welfare program and eligibility requirements.

The Division administers various self-reliant programs such as child support collections, Food Stamps, child care and cash assistance, while requiring people to strive to become employed and self-reliant. Other programs include food commodities, energy assistance, telephone assistance, weatherization assistance and other services funded through the federal Community Services Block Grant Program. The Division reviews the needs of individuals and families, designing and integrating health care, child support services, temporary cash support and employment training.

The total number of applications for services during fiscal year 2002 was more than 154,000. The Division has 657 authorized full-time positions of which 525 are self-reliant employees. The balance of positions are located in the Central office or other statewide sites. We have found about a 60 percent increase in the application for services, which is about 58,000 more applications for services over the last five (5) years.

Mr. Cunningham explained TAFI (Temporary Assistance for Families in Idaho). TAFI provides cash assistance to needy families with children. The Department partners with families, community programs, employers, and other agencies such as the Department of Labor, Vocation Rehabilitation, area learning centers for adults, to help participants obtain jobs and achieve self-reliance. There is a 24-month lifetime limit for adults to receive cash assistance. To receive TAFI, most adult participants must seek education, training or employment opportunities. People leaving TAFI often continue receiving benefits in other programs such as Food Stamps, Medicaid and child care. The average number of participants who received TAFI in year 2002 was approximately 2,300, and about $5.3 million was paid in benefits.

Aid to the Aged, Blind and Disabled (AABD) - AABD provides cash assistance to certain low-income participants who are blind, disabled or age 65 or older. In SFY 2002, a monthly average of about 11,000 people received cash payments under this program. This program connects with Medicaid for a more comprehensive service.

Another direct benefit program is the Food Stamp Program. This program helps low-income families maintain good health and nutrition. This is a federally funded, mandated program managed by the State. Idaho determines the eligibility for families to receive the benefits. The average number of families in Idaho in SFY 2002 who received food stamps is about 67,000 with a cost of about $58 million.

Idaho Child Care Program (ICCP) - This is another benefit program. ICCP subsidizes child care costs for low-income families while parents work or attend educational or training programs. ICCP helps families become self-reliant and gainfully employed. In SFY 2002, we served more than 10,000 children per month with a total cost of about $27.7 million.

Benefit Delivery - Benefit delivery in the self-reliance program has undergone significant change in recent years. Beginning in 1998, the Electronic Benefit Transfer (EBT) System was implemented statewide to increase efficiency and reduce the cost of benefit payments for the self-reliance program. The Department implemented the Quest card to be used for payments of Child Support, Food Stamps, TAFI, and AABD. Payments are made electronically.

Self-Reliance - Employment-related Services - The Department provides employment-related services to qualified individuals. Adult participants in the TAFI Program and certain adults in the Food Stamp program are required to take part in these employment services to receive benefits. The Department contracts with agencies and vendors to help families search for, gain and keep employment.

The Food Stamp Program includes the Job Search and Assistance Program (JSAP) which was expanded throughout the state in 1998, part of the Welfare Reform Act. The goal is to provide Food Stamp recipients with employment tools, which they can use to become self-reliant. JSAP can help in a job search and referrals, unpaid work-experience opportunities, job skills training and education. Last year, approximately 5,900 food stamp participants received assistance from JSAP.

Child Support Services - The Idaho Child Support Program (ICSP) promotes physical and economic health of families by ensuring parents are financially responsible for their children. The program helps locate non-custodial (absent) parents and enforces their obligations to provide financial and medical support for their children.

In SFY 2002, Child Support Services administered a monthly average of 76,425 non-county child support cases, collecting and distributing more than $102.4 million. Services include establishing paternity, locating non-custodial parents, establishing court orders for child support, and collecting and distributing child support payments through the Electronic Payment System (EPS).

In 1999, the federal government determined all child support cases should be administered by a single agency in each state. Health and Welfare was chosen by the State Legislature to assume this responsibility. The Department had handled most child support cases in the state and now has assumed collection and distribution of more than 16,000 additional child support cases that were previously administered by county courts. In SFY 2002, the Department administered more than 92,000 child support cases, and collected $140.3 million. ICSP uses a variety of methods to enforce child support orders. The primary tool for enforcing payments is wage withholding. Other tools include new hire reporting through electronic data matching, license suspension, and direct collection methods. In SFY 2002, there were 1,120 licenses suspended, but very few professional licenses have been suspended. Most license suspensions are driver license.

Self-Reliance: Community Services - The Division of Welfare administers federal grant programs to improve living conditions for low-income households and encourage self-reliance. These programs are available to qualifying communities and residents.

Community Services Block Grant - The federal anti poverty block grant is distributed throughout all 44 counties of Idaho by Community Action Agencies and the Idaho Migrant Council. The goals are to revitalize low-income communities, reduce poverty and empower families and individuals to become self-reliant. The grants can be used to provide emergency and supportive services, employment readiness, food, housing, and transportation assistance. A total of $3.1 million was distributed during SFY 2002, serving more than 19,200 people quarterly.

Emergency Food Assistance Program (TEFAP) - The TEFAP distributes USDA purchased commodities through Community Action Agencies to help supplement the diets of Idaho's low-income population. Commodities valued at $1.7 million were distributed in SFY 2002 to an average of 31,000 households per quarter. Cost of administering the program was $222,241. The administrative portion of this program is 98 percent federally funded.

Community Food and Nutrition Program - This program provides education about food distribution and nutrition through Community Action Agencies and the Idaho Migrant Council to low-income people. The program helps coordinate private and public food assistance programs to better serve low-income populations. Funding comes through the Community Service Block Grant and totaled $17,402 in SFY 2002.

Low-Income Home Energy Assistance Program - This program helps Idaho's low-income population pay a portion of their home heating cost and provides energy conservation education through Community Action Agencies. Payment is made to heating suppliers and vendors. A federal grant from the U.S. Department of Health and Human Services funds this program, spending $12.3 million and serving more than 29,000 Idaho households in SFY 2002.

Telephone Service Assistance Program - This is a small program costing $342,163 in benefits in SFY 2002 while helping more than 32,000 households. The program provides assistance with telephone installation, and/or monthly service to low-income residents. Benefits are provided by the telephone companies through charges included on their customers' phone bills.

Weatherization Assistance Program - Reimburses community action and nonprofit agencies that install energy conservation measures for low-income people, particularly the elderly, disabled and families with small children. This federally funded program served more than 1,400 households, spending $1.8 million in SFY 2002.

Mr. Cunningham discussed the faith-based initiatives generated by President Bush. The goal is to help more faith and community-based organizations to learn how to partner in community-based services. The Department sees this as a wonderful opportunity to establish partnerships within communities, and to work and establish a richer network of services. Religious organizations must serve all individuals, and federal funds cannot be used for religious activities.

Healthy Families in Nampa Collation - This is a partnership in cooperation with Region X (Seattle) Administration of Family and Children Services. It is a group of people who have gotten together who want to do something to help support healthy marriages and responsible fatherhood. They have applied for a grant and, if approved, they will provide services such as marriage counseling, skill development, parenting skills training, to help parents in Nampa. The application has been submitted.

Senator Darrington asked about the error-rate for Idaho, and how is the Department currently doing with its error rate. Mr. Cunningham stated the Department continues to receive incentive awards from the federal government in the TAFI program for performance. Idaho's participation rate is very good. During the last two years, Idaho has dropped a percentage point in the Food Stamp error rate. Idaho is at or below national norms on error rates. This is considered an indicator of how well the Department's staffs are doing their jobs.

FACS Division of Family and Community Services Administrator Kenneth Deibert presented an overview of the vital role the Division plays in the development, provision and monitoring of social and behavioral health services to the citizens of Idaho. We are fortunate in Idaho to have 1600 competent and dedicated employees in this division, who each day strive to provide for the needs of some of the most vulnerable of Idaho's citizens, our children, families, and neighbors impacted by abuse, mental illness, disabilities or substance abuse.

Within the Department, FACS is designated as the lead agency for the operation of the system of care for adult and children's mental health, adult and children's developmental disabilities services, infant and toddler program, substance abuse, child welfare, which includes child protection, adoption and foster care. The Division is also responsible for the operations of the State's three hospitals. Idaho State School and Hospital in Nampa provides intensive residential services for persons with severe developmental disabilities. State Hospital South in Blackfoot provides inpatient and skilled nursing services to adults and adolescents with serious and persistent mental illness. State Hospital North in Orofino provides intensive inpatient treatment to adults also affected by serious and persistent mental illness.

In SFY 2002, more than 100,000 citizens had some contact with the various services and programs offered by the division. That is approximately a 9 percent increase in the number of individuals who accessed our services and programs compared to SFY 2001. Our current budget for SFY 2003 is about $148 million which is $11 million less than the appropriation we received in SFY 2002. The Division has eliminated 69 positions during the past 18 months. Staffing reductions occurred primarily through the elimination of administrative staff and positions that supported Regional Mental Health Authority and disability services. Staff reductions occurred in all programs except Child Protective Services.

We have been faced with many difficult decisions related to how best to manage the reductions in funding, decisions we have had to make. Balancing resources with needs is a constant challenge. As we considered how best to manage our current resources, we based our decisions on the following priorities:

  1. We worked to avoid major impacts in the programs that the Department has statutory responsibility to provide.
  2. We made every effort to avoid staffing and service reductions that would impact community, staff and consumer safety.
  3. We were mindful of the need to provide federally required maintenance of effort funding for our mental health, substance abuse, and infant and toddler programs. Had we not maintained a federally prescribed level of state participation in these programs, we would have risked losing significant amounts of federal funding.


As we approached the decision-making process over the past 18 months to address the required holdbacks in State General Funds, careful consideration of the entire continuum of services that the Division is responsible for was made prior to reaching the final budget reductions. No one likes to see reductions in services for the people we serve. The staffs of this Division are committed to working with you and the people whom we serve to find the best solutions to the challenging task of balancing resources and needs.

Since this presentation is intended to provide an orientation of the work of the Division, I will give you a brief description of each of the programs we manage.

Idaho CareLine - This is a bilingual, toll-free telephone information and referral service (1-800-926-2588). This past year, CareLine has joined forces with private nonprofit groups to expand information and referral services across the state, and to include health and human service programs' information in addition to the IDHW information. In SFY 2002, more than 38,000 calls for information about health and human service providers in the State were received.

Children and Family Services - This is one of the most significant programs managed by the Division. This program is responsible for child protection service, foster care, adoption, children's mental health, Indian child welfare, and licensing of children's residential treatment facilities.

Staff who work in the child protective services are responsible for screening and assess each report or referral of child abuse or neglect that is brought to our attention. Our Child Protection Services focuses on safety, permanence, and the well-being of children. We work cooperatively with the police, prosecutors and the courts to address the safety needs of children who are abused or neglected. In 2002, we had 783 substantiated cases of abuse and neglected in Idaho.

One common misconception about the Department's role in Child Protective Services, our staff do not remove children who are abused or neglected from their parents. A child can only be removed from their parents by the action of law enforcement or a judge once the child is determined to be in imminent danger, and cannot be safely cared for within the current family structure. When this determination is made, our staff are then responsible for providing a safe and nurturing environment for the child to live, until they can safely be reunited with their family, or in some cases adopted by other caring families.

Foster Care Program - The cornerstone of our child's welfare system is the Foster Care Program. Foster families provide for a supportive temporary home for children placed in state custody, Last year we placed 2,260 children in foster care in Idaho. In most cases we are successful in reuniting the children with their natural families. For those children where this is not possible, we seek to find adoptive families. In FY 2002, 92 children found new families to care for them through our adoption programs.

Children's Mental Health Program - Children who experience serious emotional disturbances can receive services through this program. Services are provided through a system of public and private partnerships that offer outpatient, inpatient and residential care. The state has been working to develop a broad system of care to meet the needs of children and their families with serious emotional disorders based upon a monitored agreement with the federal courts. The state entered into this agreement as a result of a suit filed against Idaho known as the Jeff D. case. The Idaho Council on Children's Mental Health, which is a partnership of the Governor's office, Legislature, Department of Health and Welfare, Department of Education, Department of Juvenile Corrections, concerned citizens, providers, and advocates, is leading the effort to assure the state's compliance with the court settlement.

This past fiscal year, we were able to provide assessments for 3,766 children, which is almost 1,200 more than the previous fiscal year, and to provide outpatient treatment to more than 9,000 children, either through the resources of departmental staff or through contracts with private providers. Staffs provide crisis services, assessments, service authorization, provider enrollment, training, and quality assurance. Approximately 85 percent of the children who qualify for children's mental health services are eligible for Medicaid reimbursed services.

Another vital service provided by the Division is our programs for adults who are mentally ill. Our services are focused primarily on providing care to people with serious and persistent mental illness such as schizophrenia or major depression. Services include crisis response, evaluation, case management, treatment, including psychiatric evaluations, medication management and counseling. We also provide court-related support services and placement coordination with the hospital or residential care as required. Staff of the seven regional mental health programs, act as the regional mental health authorities to evaluate, determine eligibility and authorize care for individuals eligible for Medicaid-funded psychosocial rehabilitation services.

The majority of treatment services for Medicaid eligible clients is provided through a network of private providers. Individuals, who meet the program eligibility requirements but lack the financial resources to purchase services or to receive them through the Medicaid program, receive their care directly from our staff. In SFY 2002, more than 6,000 individuals received services from our mental health programs. This is about an 8 percent increase from SFY 2001. Since July 2001, our staffing in the regional mental health programs has decreased by 23 staffs. We have accomplished cost savings by reducing administrative staff and shifting the assessment functions of the regional mental health authority to the private sector. These changes have not been accomplished without creating additional challenges for a program that has been ranked 47th lowest in per capita funding in the United States. We have less staff to respond to crisis calls, work with courts, support resource development and to manage and evaluate program effectiveness.

Substance Abuse - This is a unique program within the Division given all of the treatment services for this clients' population is contracted out to private providers. The 6.5 divisional staffs who work in this program area are responsible for the overall management of prevention services, program planning, staff development, contract management and DUI evaluator licensing and program evaluation. We work closely with providers, concerned citizens, law enforcement, courts and advocates to set priorities for treatment and prevention activities in each of the seven regions.

We contract with all of the State universities and colleges to provide certified alcohol and drug counselor training. We also partner with the Supreme Court to fund many of the drug court programs currently operating throughout Idaho. Through our collaborative efforts with the courts, schools, Department of Correction, Juvenile Corrections and our communities, we feel that a system of care based on best practice models is being established in Idaho. In SFY 2002, we served 6,153 clients by this program. This is an 8 percent increase in utilization over the previous fiscal year.

Substance abuse staffs in partnership with the Idaho State Police also have the lead agency responsibility for the Tobacco Project. This program is designed to reduce the sale of tobacco to minors by education of merchants, retail permitting and inspections. The State's rate of tobacco sales to minors is 12 percent lower than when the program began in 1999.

Developmental Disabilities (DD) - This program provides services to people who are developmentally disabled. These programs are designed to provide care and support of individuals and their families with developmental disabilities. The programs are designed to provide services for infants to the elderly. The major components of the developmental disabilities services are family support, which is designed to help families maintain children and adults in their homes rather than in institutions.

Idaho Infant Toddler Program - This program serves children from birth to age three (3), coordinates early intervention and treatment services for children and their families. The Division partners with families to plan and provide comprehensive services including speech, occupational, developmental, medical and social work services to enhance each child's developmental potential. We served 2,424 children, and a 4 percent increase from last year.

Because of the increase in the number of children and families served and the reductions in funds, we have needed to reduce the level of services provided to many of the families involved in this program.

As the lead agency for the developmental disabilities services, the Division provides intake, eligibility determination, service authorization, provider enrollment, training and quality assurance functions for both the children and adult developmental disabilities program. Regional offices contract with private providers for therapy, housing, employment and personal assistance services as well as case management activities. Of the adults receiving services through the DD program, 93 percent of them qualify for the Medicaid program. We determined 79 percent of the children and 63 percent of the individuals served in the Infant and Toddler Program are eligible to receive Medicaid-funded services through Medicaid reimbursement. We have 11,857 people or 8.8 percent more individuals with developmental disabilities received services funded by the Medicaid program this past fiscal year than in FY 2001.

Even with the growth in people served, state staff available to screen, assess, determine eligibility, treat and manage care has decreased by 17 staffs or 9 percent less staff than in FY 2001. Along with the three institutions that were mentioned earlier, these are the programs and services that the Division of Family and Community Services functions as the lead agency.

As the lead agency for these programs, we are responsible for assuring a system of care is available to individuals and their families who meet service and financial eligibility criteria. A system of care provides both for clinical services and program management.

Mr. Deibert had previously distributed a chart listing the 19 core services provided or contracted out, listing key functions that must be in place to assure the efficient operation of the various programs and services that the Division manages. The list identifies the types of direct service functions that need to be provided to deliver treatment for individuals or families. The Division is not only responsible for assuring that the care is available when and how it is needed, they are also charged with the responsibility to provide oversight of the various management and support functions the staff must perform to assure compliance with numerous state and federal statues and regulations. They also enroll and license providers, provide training and technical assistance and quality assurance reviews for hundreds of private providers in each of the program areas.

He explained the Division interacts with 80-plus Councils, Advisory Boards, Interagency Committees, Consumer and Advocacy Groups to gain input on current service systems performance and the development of services to meet additional needs. The responsibilities are numerous. The work that we perform is complex and challenging. The individuals that we serve have multiple and complex needs that we strive to find effective interventions that will assist them in developing life skills so they may function as independently as possible.

As we look to the future, the work of the Division must be focused on providing leadership for the development and implementation of a sustainable and integrated service delivery system. We must support models of care that reflect best practice and rules that foster responsibility and effective use of resources. Most important, we must assure through our system of care, the safety of our most vulnerable citizens, the children, the mentally ill and the developmentally disabled. We will need to continue to foster more partnerships with public and private organizations. As our population grows in Idaho, we can anticipate continued growth in the demand for services. We have many challenges, but we can also point to many positive outcomes.

Several questions were asked by committee members such as what is the current poverty level (for a family of one, 100 percent of the poverty level is $8,800, and a family of two would be $11,940); what is a STD/HIV "viral load"; staff locations and sites; a client's eligibility requirements for services; school age children in public and home schools requirements for TAFI; possible community program reductions; problems for clients whose income is just over the limits and unable to qualify for assistance; fraud; child protection requirements; TAFI and Food Stamps; status of the back-to-work program after five years; community-based partnerships, and the effects of budget and staff reductions.

As time allows, the committee would like for administrators to return later during the legislative session and discuss health issues such as Smallpox, community action agencies, and programs. An updated version of the IDHW's acronyms was requested and will be sent to committee members.

Senator Compton asked about the FACS child protective followup system or a check and balance system, to ensure a case such as what happened recently in the state of New Jersey cannot happen in Idaho. [The case touched off a furor over New Jersey's child welfare system, which had investigated complaints about the family but closed the case last year. The caseworker was suspended after the supervisor in charge of the case was put on leave.] Does Mr. Deibert have a high level of comfort that children signed-off on are not in harms way?

Mr. Deibert reported he is very confident that assessments done when a child 's case is assigned, it is correct. The Division each month randomly selects at least ten (10) percent of child protective cases managed by FACS, and conducts a complete risk assessment to ensure the assessment completed is the correct assessment and appropriate for the needs of the child. The Quality Protective Services conducts a followup and quality assurance assessment ensures the New Jersey situation does not happen in Idaho. In June 2003, FACS will involved in a Family and Children review which is a federal review conducted in every state in the United States. The federal government will review six criteria of performance. At this time, Idaho is in compliance with three (3) of the criteria and is close to being in compliance with the others. No state in the U.S. has passed the federal review. Of the 32 states reviewed so far, none have passed the review. Idaho has improvements to make in the system, and plans to have a will not pass, but we intend to have a comprehensive plan that will address those issues.

Senator Ingram asked about the number of cases investigated for abuse or neglect, and the number of cases investigated by a fraud investigator. [The information about the number of cases investigated by a fraud investigator will be sent to him by the IDHW.]

Senator Burkett asked about the FACS criteria for placing children with extended family members as opposed to non family members and how that is determined, and if the criteria or protocol is different in drug related child protective cases as opposed to child sexual abuse cases. Does it take a period of time to qualify an extended family member for the child to be placed with them?

Mr. Deibert explained the application process to become a foster home. A review of the family home and criminal history background checks must be conducted prior to placing a child in a home. The same certification process is used to certify family or non-family foster homes. The priority preference for placing children who come into the custody of IDHW, is to place the child in an extended family member's home, if at all possible. If an extended family related home is unavailable, the child will be place in a certified foster home. A risk assessment must be conducted. There is a specific process that must be followed.

Senator Darrington asked who makes the immediate decision about the placing of a child. Is it a decision of law enforcement or the Department of Health and Welfare? If it is a department decision, why can't a child be placed with a family member who knows and has a relationship with the child, as this would cause less stress and trauma in the life of the child. He prefers a child be placed with a family member, particularly with a grandparent, rather than foster care. Mr. Deibert explained, when a child is declared in imminent danger by law enforcement, and they contact child protection, our normal response, in the vast majority of cases, is to place the child outside the family environment until a risk assessment is completed, review the circumstances of the abuse or neglected complaint, and evaluate the support system that the child might have available. (NOTE: Refer to minutes, Thursday, January 16, 2003, page 4, motion)

Senator Ingram expressed his concerns about the placement of children. If the Department must go through the evaluation process prior to a placement, why is the court system requiring an outside evaluation? Why can't FACS use the same evaluation report done by the courts? Mr. Deibert reported the Department very seldom is involved in custody issues such as in a divorce or family separation. Courts often order an assessment of a parent or family environment to make a determination for the placement of a child as a result of the divorce. That is not a role for the Department's child protection unit.

Senator Compton and Senator Ingram asked about fiscal reductions and the effect on programs. What program had the greatest impact? Director Kurtz reported the 3.5 percent October 2002 reduction had more impact on clients than any of the other holdbacks. The last budget reduction caused some personnel reductions. Reductions to programs discussed included the adult dental program in Medicaid and case management.
Chairman As time allows later in the session, the committee will invite administrators to return, and to present additional information pertaining to services and the populations served.
ADJOURN: Meeting adjourned at 10:23 a.m.




DATE: Thursday, January 9, 2003
TIME: 8:30 A.M.
PLACE: Room 437
MEMBERS: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/EXCUSED: None
GUESTS: See attached sign-in sheet
Chairman Brandt opened the meeting, and explained this is a continuation of the educational process presented by the Department of Health and Welfare.

Department of Health and Welfare Director Karl Kurtz outlined the presentation for today.

ITSD Information and Technology Services (ITSD) Division Administrator Charles Wright discussed this division's functions. The ITSD provides support to the Department's programs to ensure effective service delivery and efficient use of automated system resources. ITSD is responsible for the design, development, opperation, maintenance and ongoing enhancement of flexible automated information systems. The Division provides technical assistance for acquisition of hardware and software products, along with handling the Department's computer hardware and software problems.

The Division is comprised of two organizational units, Information Services, and Technology Services. These two units provide program support, administration, customer services issues; and internet and intranet application development, mainframe support, wide and local area network support, operations, resource security and database and warehousing support.

He explained e-government is becoming an increasingly important component in the Department's efforts to improve customer services and save money through more efficient and creative use of computer technology. ITSD provides the technical support for the coordination and leverage of resources, skills, knowledge and methodologies for these key electronic government projects.

MEDICAID The Division of Medicaid Deputy Administrator Kathleen Allyn explained

the Division of Medicaid administers the state's Medicaid program. This includes developing and implementing program policy consistent with federal requirements, managing the quality and utilization of services, and overseeing the payment process for services. As the prior presentations indicated, a few of these functions are shared with other Divisions. The Division of Welfare works with the Division of Medicaid in developing eligibility policy but Division of Welfare staff in the field make most of the Medicaid financial eligibility determinations. The Division of Family and Community Services (or FACS) works with Medicaid to develop policy for services for people with mental retardation or developmental disabilities and, to a limited extent, is a direct care provider of some Medicaid services, for example, at Idaho State School and Hospital.

Within the Division of Medicaid, we also carry out the statutory state licensing of health care facilities through the Bureau of Facility Standards. This entails initial and periodic inspections of any state-licensed facility, whether or not it cares for Medicaid clients, as well as investigations of complaints about the facilities. Such facilities include hospitals, nursing homes, intermediate care facilities for persons with mental retardation, residential or assisted living facilities, and ambulatory surgical centers.

In addition, the federal government contracts with the Department for the Bureau of Facility Standards to certify health care facilities as Medicare providers. Because the Medicare certification process requires inspections similar to those needed for state licensure, the Department is able to combine these activities to prevent duplication of effort and obtain federal matching funds for these activities.

Because of the complexity of the Medicaid program and its significance to the state budget, I plan to spend the remainder of my time discussing the Medicaid program and how it works.

Historical overview and purpose of medicaid

The enactment of Social Security in 1934 with its focus on health care services for mothers and children started a national debate about the need for some form of health insurance to provide protection against unpredictable and potentially catastrophic medical costs. That debate ultimately led Congress in 1965 to enact the Medicare and Medicaid programs as Title XVIII and Title XIX, respectively, of the Social Security Act.

Medicare or Title XVIII was established to cover the specific medical care needs of the elderly and is available to most people over age 65 regardless of income. Coverage was added in 1973 for certain disabled persons and certain persons with kidney disease. Medicare is administered by the federal government.

Medicaid or Title XIX is the nation's health insurance program for many low-income Americans. Medicaid is a jointly-funded federal/state entitlement program, administered by the states, that pays for medical assistance for certain individuals and families with low incomes and resources.

In Medicaid, each state, within federal guidelines, (1) establishes eligibility standards; (2) determines the type, amount, duration, and scope of services; (3) sets the rate of payment for services; and (4) administers the state's program. Medicaid policies for eligibility, services, and payment are complex and vary considerably, even among states of similar size or geographic proximity.

In Idaho, we have a fairly basic program. There currently is, on average, about 150,000 people on Medicaid, which includes about 105,000 children. The state has chosen not to cover all of the groups or services that would be matched by federal dollars. Even so, Idaho is projected to spend about $849 million on Medicaid in fiscal year 2003 -- about $234 million of that in state general funds.

In some ways, Medicaid fills a role that private insurance can't. Most people who use Medicaid can't afford private insurance or need services that are not available from private insurers such as services for persons with developmental disabilities or traumatic brain injury. Even, coverage of mental illness by the private sector is only minimal.

The Department of Health and Welfare provides few direct healthcare services; there is already a private healthcare system in place to do that. Through Medicaid, we support the existing health care structure ­ the physicians, nurses, hospitals, and nursing homes -- critical to maintaining a healthy population. In fact, Idaho Medicaid pays more in benefits in Idaho than Blue Cross and Blue Shield combined. The $849 million that Medicaid spends goes directly or indirectly into the private sector, creating a viable health care industry that serves all the citizens of Idaho.

Because of the escalating costs of the program, Medicaid has intensified its focus on the development of quality improvement processes and care management tools that can create a healthier public and result in a more efficient use of tax dollars.

Who gets medicaid? In order to participate in the Medicaid program, states are required to provide Medicaid coverage for certain groups of individuals who receive federally assisted income-maintenance payments, as well as for related groups not receiving cash payments. These mandatory Medicaid "categorically needy" eligibility groups basically fall into three low-income groups: parents and children, the elderly, persons with disabilities.

Parents and children - Historically, most women and children were eligible for Medicaid because they were eligible for cash assistance through the Aid to Families with Dependent Children (AFDC) program. The repeal of the AFDC program by the 1996 welfare reform law broke the automatic link between cash assistance and Medicaid. Even so, similar poverty guidelines are used to identify low income families with children who must be covered by Medicaid. Also, pregnant women and children in families with incomes below 134 percent of the federal poverty limit (2002: $24,000 for family of 4) must be covered.

Elderly - Now you might think that Medicare (the federal program for the elderly) would take care of most health care costs of the poor elderly. However, Medicare primarily covers hospital and physician care. It does not cover most nursing home or other long term care costs or most outpatient prescription drugs. But Medicaid pays for these and other services not covered by Medicare when someone is covered by both Medicare and Medicaid.

Whether or not they have Medicare, many elderly people must be covered by Medicaid because they receive cash assistance through the Supplemental Security Income (SSI) program ­ basically they are poor. Others have too much income to qualify for SSI but "spend down" to mandatory Medicaid eligibility by incurring high medical or long-term care expenses ­ in other words, they become poor.

Disabled - Many people with disabilities also must be covered by Medicaid because they receive cash assistance through the SSI program or because they incur large medical expenses and meet their "spend down" obligation.

Optional categories that Idaho has chosen to cover consist primarily of low income children, persons with disabilities, or the elderly.

Note that it is not enough just to be poor to qualify for Medicaid; an individual must also fit into a covered eligibility category (e.g., pregnant woman, child, etc.). Many people with low incomes, including childless couples and single, childless adults who are not aged or disabled cannot receive Medicaid even though they are poor.

Additionally, in 1997, Congress enacted Title XXI of the Social Security Act which allowed states to provide health insurance for children in families with incomes over the Medicaid eligibility level. This is the State Children's Health Insurance Program or S-CHIP. Rather than developing a separate insurance program for CHIP kids, Idaho insures them through the Medicaid program. Children from families with household incomes from 134 percent to 150 percent of the federal poverty limit (2002: $24,000 to $27,000, family of 4) qualify for S-CHIP. At the end of state fiscal year 2002, there were over 12,000 children enrolled in S-CHIP.

WHAT DOES MEDICAID COVER? - By choosing to participate in Medicaid, Idaho must cover a minimum set of benefits. These federally mandated benefits include:

hospital care (inpatient and outpatient)

nursing home care

physician services

laboratory and x-ray services

Idaho has also chosen the option of covering additional services and receiving federal matching funds for those services. These optional services include:

prescription drugs

home- and community-based services

Services for people with developmental disabilities

Mental health services

States have discretion to vary the amount, duration, or scope of the services that they cover, including the mandatory services, but in all cases the service must be "sufficient in amount, duration, and scope to reasonably achieve its purpose."

PAYMENT FOR MEDICAID - Medicaid pays medical care providers directly for services provided to Medicaid clients. The payment rates must be sufficient to allow Medicaid recipients to receive services comparable to services available to the general population in that area. Providers participating in Medicaid must accept Medicaid payment rates as payment in full.

The Federal Government pays a share of the medical assistance expenditures under each State's Medicaid program. That share, known as the Federal Medical Assistance Percentage (FMAP), is determined annually by a formula that compares the State's average per capita income with the national income average. States with higher per capita income are reimbursed a smaller share of their costs. Idaho receives about a 70 percent federal/ 30 percent state match. For S-CHIP the federal match rate is higher, with 80 percent of the program paid for with federal dollars and 20 percent with state general funds.

The Federal Government also shares in each State's expenditures for the administration of the Medicaid program. Most administrative costs are matched at 50 percent, although higher percentages are paid for certain activities and functions, such as development of mechanized claims processing systems.

MEDICAID TRENDS - Over the years Medicaid eligibility has been expanded beyond its original ties with eligibility for cash programs.

Federal legislation in the late 1980s mandated Medicaid coverage to an expanded number of low-income pregnant women, poor children, and to some Medicare beneficiaries who are not eligible for any cash assistance program. Other federal legislative requirements have increased the scope of the program to the point that about 45 percent of the Idaho Medicaid budget goes toward meeting federal mandates.

In addition to federal mandates, Idaho has enacted certain mandates into law. These state mandated Medicaid services include prescription drugs, developmental disability services, breast and cervical cancer treatment, and adult vision and hearing. Approximately 43 percent of the Idaho Medicaid budget is governed by state law. In all, 88 percent of the Idaho Medicaid budget is driven by either federal or state law.

In most years since their inception, state Medicaid programs have had very rapid growth in expenditures. In Idaho, this rapid growth in Medicaid expenditures as been due primarily to the following factors:

The increase in size of the Medicaid-covered populations as a result of federal and state mandates, population growth, and economic recession.

The expanded coverage and utilization of services.

The increase in the number of people requiring acute and/or long-term health care services.

The results of technological advances to keep a greater number of critically ill or severely injured persons alive.

The increase in payment rates to providers of health care services, when compared to general inflation.

As with all health insurance programs, most Medicaid recipients require relatively small average expenditures per person each year, and a relatively small proportion incurs very large costs. In Idaho, the aged and people, including children, with disabilities make up 23 percent of the Medicaid population but account for approximately 70 percent of the costs. By comparison, children without disabilities, including S-CHIP kids, make up 67 percent of the insured population but 22 percent of the costs.

MANAGING THE COST OF MEDICAID - Even in good economic times, budgeting for Medicaid is difficult. Because Medicaid is an entitlement program, the state is required to pay for all medically necessary covered services that are provided to persons enrolled in the program.

There are three basic ways to affect the amount spent in Medicaid:

By the number of people on the program;

By the number and duration of covered services; and

By the amount paid for services.

A fourth tool -- managing health care services to eliminate unnecessary or ineffective care ­ can achieve some dramatic cost avoidances in the short term by providing cost and utilization controls that have been missing. Once these management tools are place, however, further cost control from care management is achieved in the long term through better care and the management of chronic illnesses.

As you are aware, the Governor implemented several holdbacks to help keep the state budget in line. The Department has seen four budget cuts since 2001. In Medicaid alone, this has meant $115 million in cost avoidance.

These reductions were met by tightening administrative spending, taking advantage of federal matching dollars where possible, and using care management tools. In the end, that was still not enough and Idaho Medicaid had to reduce services for some clients and reimbursement to some providers to be able to reach the $115 million target we needed to hit by the end of state fiscal year 2003.

The Medicaid program is now undertaking more intensive review of programs and services primarily focused on the high cost areas of the program. The top six spending areas in the program are hospitals, nursing facilities, prescription drugs, developmental disability services, physician services, and mental health services.

Medicaid is working to increase enrollment in Healthy Connections ­ a program that links Medicaid clients with primary care providers who manage their care. Through this program, Medicaid avoids spending about $31 per month for each Healthy Connections enrollee. The target is to enroll 68 percent of Medicaid clients in Healthy Connections by the end of state fiscal year 2003 and, so far, the Department is ahead of schedule to reach that target. Through Healthy Connections, Medicaid also can implement disease management programs for clients with chronic diseases like diabetes and asthma. Such programs will improve the health of these clients and slow the growth of Medicaid expenses.

Management steps are being developed for the prescription drug program that could reduce the Medicaid pharmacy budget by $42 million. There steps include denying early refill of prescriptions, requiring prior approval of certain therapeutic drug classes, reviewing high prescription volume clients, and implementation of a preferred drug list

In addition, the Medicaid program has developed lower cost alternatives to institutional care such as nursing home care or intermediate care facilities for persons with mental retardation. Known as home and community based services waivers (or HCBS waivers), these four programs allow eligible elderly and disabled individuals to receive the services they need without having to be placed in an institution. The costs for supplying the waiver services must be no greater than the cost of the institution and, in fact, average significantly less than the cost of institutional care.

The current economy brings the sustainability of Medicaid's present scope into question and has prompted considerable debate about the future design of the program. The economic predictions for fiscal year 2004 show the need to maintain the current reductions and find more ways of managing costs. However, unless current projected revenues increase, the state may also need to make significant reductions in the people or services that are covered or the amount that is paid for services.

SUMMARY - As the Governor and Department work with the Legislature to define the future of Idaho Medicaid, it is important to keep the following in mind:

As the National Conference of State Legislatures puts it: "There are no easy answers to the problem of health care financing for the poor. Every proposed solution raises difficult issues of fairness, equity, access, and quality of care. No answer to the question of Medicaid cost containment is free of controversy and political risk."

Other considerations --

For every state dollar taken out of Idaho Medicaid, the state loses an additional $2.3 dollars in federal funds.

The Idaho Medicaid program channels a significant amount of money into the overall health care infrastructure. Significant reductions in the Medicaid program can adversely affect the entire state health care delivery system.

Preventive medicine, including care and disease state management, is a proven way of controlling health care costs. Studies confirm that early intervention and prevention programs are more effective in avoiding health care costs than waiting for people to become more ill and consequently, more costly to treat.

We look forward to working with you in determining the future direction of this most important program.

WRAP-UP Director Kurtz briefly outlined the relationship between the District Health Departments and the Department of Health and Welfare, and budgets. There is a good relationship, but primarily a vendor-type contractor and partnership system.

He discussed the budget recommends submitted to the Governor for the 2004 budget. He will have three (3) supplement requests, but none for Medicaid. The requested supplements will total approximately $3 million.

The Governor has not approved the budget for SFY 2004.

The Department has reduced spending about $140 million during the past holdbacks. Cumulatively, about 168 positions were eliminated. The majority of the Department's money, about 80 percent, goes to benefits for programs such as child care, Medicaid, but some reductions in programs has been necessary due to budget holdbacks.

Director Kurtz expressed concerns to be consider, such as future long-term care budget impacts, baby-boomers' impact on the Medicaid program and the funds needed to support Medicaid. As nursing home expenditures increase, (currently we provide about 70 - 75 percent of all funding for nursing homes in Idaho, how can we manage this need? As the population ages, and the successes in extending the life expectancy, (historically those expenses fall to Medicaid) how are we going to sustain the Medicaid Program? Medical and insurance costs are increasing about 8 to 12 percent, how can this be sustained with the State's revenue system?

ADJOURN: Meeting adjourned at 10:25 a.m.




DATE: Friday, January 10, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/EXCUSED: None
GUESTS: See attached sign-in sheet
Environmental

Quality

Department of Environmental Quality (DEQ) Director Steve Allred informed the committee about performance budgeting and measurements and accountability of control of the budget and resources. He outlined some of the successes and also upcoming challenges.

  1. The Air Quality Permitting Program completed the issuing of Title V operating permits; eliminated permits to construct application backlog, and Office of Performance Evaluation review.
  2. TMDLs completed on schedule and settled the lawsuit.
  3. Improved water quality in Cascade Reservoir and Middle Snake River.
  4. Moving forward on Pit 9 at INEEL - retrieval of buried plutonium-contaminated waste.
  5. Coeur d'Alene Basin Environmental Improvement Project Commission - local control over superfund implementation.
  6. Air Quality Consent Order with Monsanto - good for environment, industry, and economy.
  7. Development of environmental priorities for the Amalgamated Sugar facilities - good for environment, the company and the economy.
  8. Grants and Loans - aid economy while meeting infrastructure needs.


Mr. Allred described some of the challenges for the Department in fiscal year 2004. Such as:

  1. Relations with EPA - maintaining state decision making.
  2. Air quality in the Treasure Valley - ozone and PM.
  3. Smoke management.
  4. NPDES program for customers.
  5. Groundwater - nitrate priority areas
  6. Increasing public challenges to permit issuance.
  7. Drinking water - aiding small water systems meet new federal standards.
  1. Maintain matching funds for federal grants - Water Pollution Control Account.


Grants and Loans - There have been 63 grants for water and wastewater improvements made primarily to Idaho rural communities and totaling approximately $1 million. These grants are used to plan and design facilities to improve drinking water and wastewater systems that serve the citizens of Idaho. Grants allow communities to utilize scarce resources on other community needs and prevent the need for raising additional revenue to cover costs.

Loans totaling $49,600,000 have been made in Idaho to 14 communities to construct needed improvements in water and wastewater systems. This also brings needed resources into the community and aid in their financial stability. Funds have increased economic activities in communities as well as provided the infrastructure for continued economic growth.

Water Pollution Control Fund Statute - The ratio for every $1 Idaho spends brings in $5 in federal funds. The Drinking Water Loan Account is $51,830,000, Wastewater Loan Account is $131,854,000, totaling $183,684,000 for loans.

Remediation Reductions - As a result of past budget cuts, DEQ suspended remediation work on the former MK-Rail site in Boise, and the PCE contaminated site in Garden City. We eliminated work on all above ground storage tank sites except for emergencies which resulted in a 25 percent reduction in the amount of time spent on AST sites. DEQ postponed a planned $50,000 contract to evaluate the use of logyard residual materials in mine remediation in the Coeur d'Alene Basin for two years. Additional remediation projects were also delayed.

DEQ has eliminated the AST budget. In cases where we had to respond to AST emergencies (such as ASTs which caused the flash fire in Malad), we sought outside assistance, e.g., EPA did initial site characterization under emergency response), but we still needed to pay for time DEQ staff put into responding to emergencies which in many cases is significant. That time is charged to regions' general remediation budget, and decreases the time and money available to work on other state remediation projects.

Lawsuits - Mr. Alfred discussed contested cases initiated before the Board of Environmental Quality, and not administrative enforcement or other administrative actions. A total of 34 lawsuits was handled during the past year. These included active cases, some of which are still ongoing. DEQ had 19 contested cases in the last year, and some are still ongoing.

Committee members asked numerous questions related to federal mandated rules, Superfund and lead testing sites, nitrate areas, public health and DEQ, air and water quality monitoring, solid waste, dropping water levels in wells, projected population growth and vehicle emissions, slash and field water burning, vehicle emissions in the Treasure Valley, federal funds for roads, DEQ website, committee members requesting to be added to DEQ mail lists for minutes from board and committee meetings, and rural communities' needs.
ADJOURN: Meeting adjourned 10:24 a.m.




DATE: Tuesday, January 14, 2003
TIME: 8:30 A.M.
PLACE: Room 437
MEMBERS: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/EXCUSED: None
GUESTS: See attached sign-in sheet
Vice Chairman Compton conducted the meeting.
IDAPA

19.0101.0201

Board of Dentistry Executive Director Michael Sheeley presented IDAPA 19.0101.0201, a pending fee rule. The purpose of the rule is to require CPR certification for initial licensure and renewal for dentists, dental specialists and dental hygienists; to make mandatory and increase the administrative fee for anesthesia permit applications, renewals and reinstatements to $300 based upon the recognition that the Board of Dentistry's administrative costs in connection with a permit renewal or reinstatement are identical in amount to the costs incurred in connection with an initial application. An anesthesia permit is valid for a period of five (5) years and may be renewed for additional five (5) year periods.

The two anesthesia permits available are the General Anesthesia/Deep Sedation permit and the Conscious Sedation permit. The administration of general anesthesia/deep sedation entails putting a patient in an induced state of unconsciousness or depressed consciousness in order to provide treatment. The administration of conscious sedation entails putting a patient in a minimally depressed state of consciousness in order to provide treatment.

There are currently 63 anesthesia permit holders in Idaho. Of that number, 36 are conscious sedation permits and 27 are general anesthesia/deep sedation permits. On average, there are approximately five (5) new applications for an anesthesia permit each calendar year.

MOTION Senator Ingram moved to approve IDAPA 19. 0101.0201. Seconded by Senator Bailey. Motion carried by voice vote.
Board of Nursing Executive Director Sandra Evans, MAEd., RN., presented the following IDAPA rules for the Board of Nursing.
IDAPA

23.0101.0201

House Bill 393, established an emeritus status license for nurses who have retired from active practice, but who wish to continue to use the protected titles of licensed practical nurse, registered nurse, certified nurse midwife, clinical nurse specialist, nurse practitioner and registered nurse anesthetist. This rule, Section 900.04 and 05 and 901.06, establish a fee of $25 for initial application for the emeritus license, a fee of $20 for biennial renewal of the license, and a fee of $35 for late renewal or reinstatement of a lapsed emeritus license.
MOTION: Senator Ingram moved to approve IDAPA 23.0101.0201. Seconded by Senator Brandt. Motion carried by voice vote.
IDAPA

23.0101.0202

IDAPA 23.0101.0202, a pending rule, is the result of the final year of a five-year effort to review and revise the full docket of administrative rules of the Board of Nursing. These changes will clarify the practice of registered and licensed practical nurses, to delete unnecessary detail in defining practice and to reformat the order of practice definitions from the broadest, which is that of the registered nurse, to that of licensed practical nurses, and finally to that of unlicenced assistive personnel. Hearings were held in Coeur d'Alene, Lewiston, Boise, Idaho Falls, Pocatello and Twin Falls. Most comments supported the changes, indicating that changes would result in clearer direction for nurses practicing in Idaho. The changes also clarify requirements for educational programs preparing unlicenced assistive personnel as well as licensed practical and professional nurses. Proposed changes will allow schools accredited by U.S. Department of Education recognized organizations to offer nurse aide training in the state, a change responsive to the current shortage of health care providers.
MOTION: Senator Darrington moved to approved IDAPA 23.0101.0202. Seconded by Senator Ingram. Motion carried by voice vote.
Board of Medicine The Board of Medicine Executive Director Nancy Kerr testified the Idaho State Board of Medicine does not oppose the rules as presented by the Idaho State Board of Nursing, and recognizing that there remains in Idaho Code 54-1402 a statutory requirement for physician supervision of advanced practice nurses, the Board continues to work with the Board of Nursing through the Advanced Practice Nursing Advisory Committee.

The Board of Medicine wishes to express to the Legislature its concern with an expanding scope of practice for health care providers.

The issues addressed by the committee members regarding gaps in health care providers availability are at the heart of the concerns of the Board, that scopes of practice are sometimes expanded in an attempt to fill gaps beyond the usual scope of practice of the profession.

The Board of Medicine wishes to make the Legislature aware of its concerns of expanding scope of practice and offers no opposition to the rules presented by the Board of Nursing.

ADJOURN The meeting adjourned at 9:55 a.m.




DATE: Wednesday, January 15, 2003
TIME: 8:30 A.M.
PLACE: Room 437
MEMBERS: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/EXCUSED: None
GUESTS: See attached sign-in sheet
Vice Chairman Compton conducted the meeting.
PHARMACY Board of Pharmacy Executive Director Richard Markuson, R. Ph., presented rules for the Board of Pharmacy.
IDAPA

27.0101.0201

IDAPA 27.0101.0201, a temporary and proposed fee rule. The current rule treats "preparations containing ephedrine or salts of ephedrine," as prescription drugs. The proposed rule sets out specific criteria for ephedrine products that can be sold without prescription. These criteria include maximum dosage requirements, label disclosures and warnings.
MOTION Senator Darrington moved to approve IDAPA 27.0101.0201. Seconded by Senator Stegner. Motion carried by voice vote.
IDAPA

27.0101.0202

IDAPA 27.0101.0202, a proposed rule, provides needed change to adapt to the legislation that eliminated the duplicate prescription blanks for Schedule II controlled substance drugs, which contain notice of the former seven-day requirement. The change will also clarify that the time restriction applies only to Schedule II controlled substances, a distinction which was lost when the rules were renumbered. Most Schedule II prescriptions are filled in a very short time. The thirty-day change will allow for the few exceptions when patients are not in the immediate need of the prescription, e.g., methyphenidate, Dexedrine or completing a similar prescription before filling the new one.
MOTION Senator Brandt moved to approve IDAPA 27.0101.0202. Seconded by Senator Stegner. Motion carried by voice vote.
IDAPA

27.0101.0203

IDAPA 27.0101.0203, a proposed rule, clarifies that students enrolled in pharmacy technician training courses and volunteers at hospital pharmacies may register as pharmacy technicians and be authorized to act as pharmacy technicians even though they are not formally employed by the pharmacy. The proposed rule changes the definition of a pharmacy technician to one who is employed or otherwise authorized to participate in preparing, compounding, distributing, or dispensing of medications at a pharmacy.
MOTION Senator Stegner moved to approved IDAPA 27.0101.0203. Seconded by Senator Bailey. Motion carried by voice vote.
IDAPA

27.0101.0204

IDAPA 27.01101.0204, a proposed rule, formalizes what has previously been an informal practice of allowing a carryover of continuing education credits earned in June, but not necessary for meeting the prior reporting period's education requirements. The proposed rule allows continuing education units earned during June of any given licensing period to be carried over into the next licensing period to the extent the pharmacist's total hours for the given licensing period exceed that required by the rules.
MOTION Senator Sweet moved to approve IDAPA 27.0101.0204. Seconded by Senator Darrington. Motion carried by voice vote.
IDAPA

27.0101.0205

IDAPA 27.0101.0205, a temporary rule with immediate effect, is necessary to comply with deadlines set out in Senate Bill 1417 of the 2002 legislative session, which voided prior rules relating to controlled substance prescriptions effective June 30, 2002. The Board of Pharmacy is engaged in, and will continue, the process of negotiated rulemaking for promulgation of a permanent rule for review by the 2004 Legislature. Part of the negotiated rulemaking process will include an analysis of the efficacy of this temporary rule, after a period of time has elapsed with the rule in effect, and the possibility of revisions to the temporary rule, through the negotiated rulemaking process, to improve its functionality.
MOTION Senator Darrington moved to approve IDAPA 27.0101.0205. Seconded by Senator Sweet. Motion carried by voice vote.
OCCUPATIONAL LICENSES Bureau of Occupational Licenses Bureau Chief Rayola Jacobsen presented the following rules for the Bureau of Occupational Licenses.
IDAPA

24.0301.0201

IDAPA 24.0301.0201, a pending rule, will change the expiration date and reinstatement of licenses for Chiropractic Physicians to be in accordance with Section 67-2614, Idaho Code, and establish the requirement for licenses canceled more than five (5) years to be in accordance with the section.
MOTION Senator Brandt moved to approve IDAPA 24.0301.0201. Seconded by Senator Bailey. Motion carried by voice vote.
IDAPA

24.0501.0201

IDAPA 24.0501.0201, a pending rule, effective March 19, 2002, Chapter 24, Title 54, Idaho Code, Environmental Health Specialists laws were repealed. Therefore, this chapter of rules is being repealed.
MOTION Senator Darrington moved to approve IDAPA 24.0501.0201. Seconded by Senator Brandt. Motion carried by voice vote.
IDAPA

24.0901.0201

IDAPA 24.0901.0201, a pending rule, relating to examiners of nursing

SENATE HEALTH AND WELFARE

Wednesday, January 15, 2003 - Minutes - Page 2 home administrators. This rule deletes the reference under nursing home administrator-in-training requirement to the facility administrator not being the preceptor.

MOTION Senator Brandt moved to approve IDAPA 24.0901.0201. Seconded by Senator Bailey. Motion carried by voice vote.
IDAPA

24.1101.0201

IDAPA 24.1101.0201, a pending rule relating to podiatry, updates the Incorporation by Reference section to reflect current publication date; deletes the reference to the annual renewal date; changes passing grade on examination to 70 percent; and changes the standards of ethical practice to be the same as the American Podiatric Medical Association's Code of Ethics.
MOTION Senator Sweet moved to approve IDAPA 24.1101.0201. Seconded by Senator Brandt. Motion carried by voice vote.
IDAPA

24.1201.0201

IDAPA 24.1201.0201, a pending rule related to psychologist examiners. The rule adds that the reexamination fee shall be those charged by the national examining entity plus $25 processing fee and changing reciprocity fee to endorsement fee.

Roger Hales, attorney for the Bureau of Occupational Licenses, testified about the fee requirement of IDAPA 24.1201.0201.

MOTION Senator Brandt moved to approve IDAPA 24.1201.0201. Seconded by Senator Kennedy. Motion carried by voice vote.
IDAPA

24.1201.0202

IDAPA 24.1201.0202, a pending rule related to psychologist examiners, allows a one-year carryover of continuing education hours; deletes unnecessary record keeping requirements; requires the training facility to be on site and of adequate size; clarifies the definition of a professional psychology program.
MOTION Senator Brandt moved to approve IDAPA 24.1201.0202. Seconded by Senator Bailey. Motion carried by voice vote.
IDAPA

24.1401.0201

IDAPA 24.1401.0201, a pending rule related to social work examiners. The rule adds Bureau contact information; deletes obsolete social work classifications and establishes current classifications and definitions to be in compliance with current law changes; adds the board/bureau contract is to include investigative, legal and fiscal responsibilities; clarifies reimbursement expenses for board members; deletes that expired licenses will cancel on July 1; updates the classifications under fees to reflect those in the current law change; changes board meeting dates to be at least three (3) times each year and at such other times each year and at such other times and places as deemed by the board; clarifies endorsement requirements; changes application deadline date to be at least 10 days prior to the next board meeting; and clarifies continuing education requirements.

Gregory Dickerson, a licensed Master Social Worker in Idaho President

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Wednesday, January 15, 2003 - Minutes - Page 3

of the Mental Health Provider Association, testified in opposition to IDAPA 24.1401.0201.

Bill Benkula, a licensed social worker, presented testimony in opposition to IDAPA 24.1401.0201.

Roger Hales, attorney for the Bureau of Occupational Licenses, requested the Senate Health and Welfare Committee to hold IDAPA 24.1401.0201to allow additional time in order to resolve issues pertaining to the rule changes.

After a lengthy discussion and review of IDAPA 24.1401.0201, and at the request of the Bureau of Occupational License, Vice Chairman Compton determined to hold IDAPA 24.1401.0201, relating to social workers, until a meeting can be held to try and resolve the issues presented in opposition to the rule changes.

IDAPA

24.1501.0201

IDAPA 24.1501.0201, a pending fee rule relating to professional counselors and marriage and family therapists. The statute authorizing this fee is Section 67-5226(2), Idaho Code. This rule establishes the fee for Marriage and Family Therapist Intern registrations to be $25. This rule adds an Incorporation by Reference for supervisors; adds postgraduate supervision requirement to be effective July 1, 2004; establishes counselor supervisor requirements; establishes acceptable supervised experience for a Clinical Professional Counselor, Pastoral Counselor and Marriage and Family Therapists; adds effective July 1, 2002 continuing education rules for Pastoral Counselor, Clinical Professional Counselor and Marriage and Family Therapists and incorporates all under rule; delete rules for conditional counseling license and establishes requirements for registered interns.
MOTION Senator Brandt moved to approve IDAPA 24.1501.0201. Seconded by Senator Bailey. Motion carried by voice vote.
IDAPA

24.1601.0201

IDAPA 24.1601.0201, a pending fee rule, relates to denturity. This rule inserts rules for Administrative Appeals, Incorporation by Reference; adds Bureau contact information; adds Public Records Section; adds Bureau definition; adds the board may meet and have examinations at such other times as determined by the Board; establishes the examination shall include a theory examination; establishes grading and reexamination requirements; establishes the reexamination fee shall be the same as the original examination fee. The fee reference is found in Section 250.
MOTION Senator Darrington moved to approve IDAPA 24.1601.0201. Seconded by Senator Stegner. Motion carried by voice vote.
IDAPA

24.1701.0201

IDAPA 24.1701.0201, a pending rule relating to acupuncture. The rule inserts Rules for Incorporation by Reference; adds Bureau contact information; adds Public Records section; defines the Bureau; updates

the qualification for licensure to be that they have received certification





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Wednesday, January 15, 2003 - Minutes - Page 4

from NCAAOM (National Certification for Acupuncture and Oriental Medicine); changes renewal of license to be in accordance with Section 67-2614, Idaho Code; establishes continuing education requirements; and establishes waiver of continuing education requirements for an inactive license.

MOTION Senator Ingram moved to approve IDAPA 24.1701.0201. Seconded by Senator Sweet. Motion carried by voice vote.
IDAPA

24.1901.0201 and IDAPA

24.1901.0202

IDAPA 24.1901.0201, a pending fee rule relating to residential care

facility administrators. The rule further defines courses approved for continuing education; changes the requirement for renewal of a license to be in accordance with Section 67-2614, Idaho Code; increases the license application fee with Section 67-2614, Idaho Code; increases the license application fee to $50 and deletes reference to recertification in annual renewal fee.

IDAPA 24.1901.0202, a pending rule, relating to residential care facility administrators. This rule establishes that an applicant for examination shall be required to register with and pay the examination fee to NAB; deletes contents of examination; establishes passing score to be determined by NAB; deletes requirement for retakes; adds approved courses of study for licensure.

The NAB (National Association of Board of Examiners of Long Term Care Administrators) provides all testing services to this Board. This rule establishes the testing provisions.

MOTION Senator Kennedy moved to approve IDAPA 24.1901.0202. Seconded by Senator Brandt. Motion carried by voice vote.
Adjourn Meeting adjourned at 10:30 a.m.




DATE: Thursday, January 16, 2003
TIME: 8:30 am
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
MEMBERS ABSENT/EXCUSED: None
Vice Chairman Compton conducted the meeting.
Office on Aging Idaho Commission on Aging (ICOA) Program Operations Unit Manager Sarah Scott presented the IDAPA rules for the Commission. The Commission's administrator Lois Bauer was also present.
IDAPA

15.0101.0201

IDAPA 15.0101.0201, a pending rule, relating to senior services, makes technical corrections; amends references to the UAI provisions to provide that the assessment instrument utilized by the Area Agencies on Aging will be such assessment instrument that may from time to time be approved by the ICOAA, and amends reference to the completion of client assessments to clarify that Case Management shall perform such assessments.
MOTION Senator Kennedy moved to approve IDAPA 15.0101.0201, except for Section 025.03, Fees and Client Contributions. [Determining Income For this purpose, income means gross household income from all sources, less the cost of medical insurance and expenditures for non-covered medical services and prescription drugs. Payments the client receives from owned property currently being leased shall be counted as income after expenses are deducted if paid by the client, i.e., insurance, taxes, water, sewer, and trash collection. In determining income for respite clients, income means the gross income of the client as specified above but shall not include the income of any other person(s) who reside in the household.]

Seconded by Senator Bailey. Motion carried by voice vote.

IDAPA

15.0102.0201

IDAPA 15.0102.0201, a pending rule, relating to adult protection. The rule changes include adding an additional definition, revising the investigative requirements to provide that adult protection workers immediately forward reports to the Department of Health and Welfare which are to be initially reported to the Department pursuant to Idaho Code Section 39-5303 and revising the duty of adult protection workers requiring them to make referral to Law Enforcement in substantiated cases involving serious injury or serious imposition of rights.
MOTION Senator Bailey moved to approve IDAPA 15.0102.0201. Second by Senator Brandt. After discussion, Senator Kennedy voted Nay.

Motion carried by voice vote.

Discussions about IDAPA 15.0102.0201included areas pertaining to adult protection cases, closure of cases and followup of those closures, reviewing cases, adult abuse or neglect and body bruising on clients, investigating cases not referred to Law Enforcement, mandates and requirements, household incomes and sliding fee scale, person(s) unable to provide care for themself, guardianship of adult, lack of support staff, and case management. The ICOA does not determine cases by gross income.

IDAPA

15.0121.0201

IDAPA 15.0121.0201, a pending rule, relating to the Older Americans Act Services. The rule changes revise the Information and Assistance services provisions to provide that Area Agencies on Aging rather than service providers shall maintain records required by the ICOA regarding information and assistance services in their area. The rule deletes unnecessary reference to the Older Americans Act.
MOTION Senator Sweet move to approve IDAPA 15.0121.0201. Seconded by Senator Brandt. Motion carried by voice vote.
Board of Nursing Board of Medicine Executive Director Nancy Kerr presented six (6) IDAPA rules for the Board of Medicine.
IDAPA

22.0101.0101

IDAPA 22.0101.0201, a pending rule, relates to the licensure to practice medicine and surgery and osteopathic medicine and surgery. The rule is needed to meet Federal deadline requirements for fingerprints and to address shortage of qualified physicians, especially in rural Idaho. The rule was extended as a temporary rule during the 2002 legislative session and is now presented as a final rule of the agency. The rule provides required language to meet Federal guidelines for the Federal Bureau of Investigation fingerprint screening. These changes were required to be made before the May 2002 federal deadline. All physician applicants submit fingerprints for screening.

The rule provides an opportunity for physicians who have graduated from an unapproved medical school, but have demonstrated competency through board certification, education evaluation, and postgraduate training in the U.S. or Canada the opportunity to work in Idaho and fill urgent physician vacancies in rural areas of the state. Applicants, legislators on the behalf of applicants, hospitals and health care agencies have supplicated the Board in the past to make the rules for foreign graduates more flexible and allow them to employ these otherwise qualified individuals.

MOTION Senator Brandt moved to approve IDAPA 22.0101.0101. Seconded by Senator Kennedy Motion carried by voice vote.
IDAPA

22.0101.0201

IDAPA 22.0101.0201, a pending rule, relates to the licensure to practice medicine and surgery and osteopathic medicine and surgery. The rule defines the requirement for continuing education for physicians, specify the number of hours of education required in a two (2) year license cycle, identify acceptable alternatives to continuing education and define the method of reporting continuing education. This rule would require an individual licensed to practice medicine and surgery or osteopathic medicine or surgery in Idaho to complete not less than 40 hours of practice relevant, Category 1, CME every two (2) years.

MOTION Senator Bailey moved to approve IDAPA 22.0101.0201. Seconded by Senator Kennedy. Motion carried by voice vote.
IDAPA

22.0103.0201

IDAPA 22.0103.0201, a proposed rule, relates to licensure of physician assistants. The Board of Medicine requested that the Legislature reject this rule. The Board of Medicine will clarify and return an improved set of rules for Physician Assistants for consideration during the 2004 legislative session.
MOTION Senator Kennedy moved to reject IDAPA 22.0103.0201 at the request of the Board of Medicine. Seconded by Senator Bailey. Motion carried by voice vote.
IDAPA

22.0105.0201

IDAPA 22.0105.0201, a pending rule, relating to registration of physical therapists and physical therapist assistants. The purpose for the rule changes are minor housekeeping and clarification changes to correct the term of office of the chairman of the Physical Therapy Advisory Committee, provide clarification regarding applicants who fail the licensing examination, clarification of applicants who apply for licensure by endorsement, and clarifies the requirements for reinstating an expired license.
MOTION Senator Sweet moved to approve IDAPA 22.0105.0201. Seconded by Senator Brandt. Motion carried by voice vote.
IDAPA

22.0109.0201

IDAPA 22. 0109.0201, a pending fee rule. The purpose of the rule change is to clarify licensure requirements, fees for reinstatement, to allow the Board to collect costs for extraordinary expenses related to license application, to add to the text the Code of Ethics to correctly identify the education-accrediting agency for the profession.

The changes in the text of the pending rule that differ from the proposed rule are: to remove the Code of Ethics as incorporated by reference and add it as Appendix A; to add text to accurately identify the Accreditation Council for Occupational Therapy Education as the American Occupational Therapy Association's Accreditation Council for Occupational Therapy Education pursuant to a comment made by the American Occupational Therapy Association; to add the specific date for qualification for licensur by endorsement as noted by a comment by an Occupational Therapy Licensure Board member; and to add text to require in rule that an applicant must report any licenses issued as well as any denied.

MOTION Senator Bailey moved to approve IDAPA 22.0109.0201. Seconded by Senator Brandt. Motion carried by voice vote.
IDAPA

22.0113.0201

IDAPA 22.0113.0201, a pending fee rule, relates to the licensure of dietitians. The purpose of the rule is to update the scope of practice of the dietitians in Idaho by clarifying the process and licensure fees for converting an inactive license to an active license. It will also require current certification by the Commission on Dietetic Registration for license renewal. The rule change does not impose any new or additional fee. The new language is to clarify the process and the fees for converting an inactive license to an active license.
MOTION Senator Kennedy moved to approve IDAPA 22.0113.0201. Seconded by Senator Bailey. Motion carried by voice vote.
MOTION Senator Darrington moved to approve the committee's minutes for Wednesday, January 8, 2003 with an exception to the comments by Ken Deibert, administrator of the Division of Family and Community Services, page 16, reference a child in imminent. Seconded by Senator Compton. Motion carried by voice vote.
ADJOURN Meeting adjourned at 10:00 a.m.




DATE: Friday, January 17, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
MEMBERS ABSENT/

EXCUSED:

None
Vice Chairman Compton conducted the meeting.
DEQ DEPARTMENT OF ENVIRONMENTAL QUALITY (DEQ) RULES. With the permission of Vice Chairman Compton, IDAPA 58.0105.0201 was presented out of numerical order.
IDAPA

58.0105.0201

IDAPA 58.0105.0201, a pending rule, relates to hazardous waste in Idaho, was presented by Regulations and Policy Coordinator John Brueck. Idaho's Rules and Standards for Hazardous Waste are updated annually to maintain consistency with the U.S. Environmental Protection Agency's federal regulations implementing the Resource Conservation and Recovery Act (RCRA) as directed by the Idaho Hazardous Waste Management Act (HWMA). This rulemaking updates Idaho's rules so that they are consistent with revisions to the federal RCRA regulations as of July 1, 2002. Additional changes include a clarification to the definition of Subsection 003.04, a technical correction to Section 005 due to a corresponding federal regulatory revision, and a grammatical correction to the title of Section 900. No public comments were received. The rule changes will allow Idaho to maintain primacy over the hazardous waste program.
MOTION Senator Darrington moved to approve IDAPA 58.0105.0201. Seconded by Senator Baliey. Motion carried by voice vote.
IDAPA

58.0101.0201

IDAPA 58.01010201, a pending rule, was presented by the Division of Air Quality Administrator Kate Kelly. The purpose of this rulemaking is to revise the open burning rule. The open burning rule is intended to set general parameters under which open burning can and cannot occur in Idaho with a goal toward protecting human health and the environment from air pollutants in smoke. Most critically, the proposed changes will remedy inconsistencies with other local, state and federal rules, regulations and laws, and remove awkward or ambiguous phasing. Also, burn periods for prescribed fires, additional prohibitions, and reasonable precautions are proposed. The proposed rule adds reference to the Smoke Management and Crop Residue Disposal Act.

After a lengthy discussion and review of IDAPA 58.0101.0201, it was determined to hold IDAPA 58.0101.0201, for further review and can be rescheduled at a later date.

IDAPA

58.0101.0202

IDAPA 58.0101.0202, a pending rule, relates to air quality in Idaho. was presented by Kate Kelly. The purpose of the rule is to clarify several areas of the air quality stationary source program. The Department held negotiated rulemaking meetings with representatives of the regulated community to hear concerns and receive their comments. The Department received written comments from the regulated community and made appropriate revisions to the rule.

The air quality rules establish requirements for three (3) types of air quality permits: permits to construct for new or modified sources, Tier II operating permits, and Tier I operating permits for major sources regulated by Title V of the Clean Air Act. The rule proposes revision to several specific provisions, i.e., the update of the citations to the federal regulations incorporated by reference; adjustment of the permit to construct application requirements for toxic air pollutants to ensure consideration of the cumulative effect of multiple air pollution sources and incremental increases in emissions; removal of the grain-loading standard; correction to a cross-reference section number regarding the pre-permit to construct process; revision of time frames for filing appeals to make them consistent with provisions of the Rules of Administrative Procedure before the Board of Environmental Quality; clarification of Tier I permit application submission by owners or operators of deferred Tier I sources; clarification of current policies used in interpreting and applying the rules for Tier I operating permit insignificant activities; clarification of the process for handling the expiration and renewal of Tier operating permits; correction of errors in spelling and capitalization in the toxic air pollutant increment tables and updating of compound values; and, addition of new abbreviations.

MOTION Senator Bailey moved to approve IDAPA 58.0101.0202. Seconded by Senator Ingram. Motion carried by voice vote.
IDAPA

58.0101.0203

IDAPA 58.0101.0203, a pending fee rule, relates to air pollution in Idaho and presented by Kate Kelly. The rule change is a revision to the Title V fee and registration provisions. The Idaho Department of Environmental Quality has obtained authorization from the U.S. Environmental Protection Agency to implement a Tier quality operating permit program under Title V of the federal Clean Air Act. The federal Clean Air Act mandates that the full cost of administration and implementation of the Tier I permit program be funded by a fee imposed on the facilities regulated under the program. The DEQ is authorized by state statute to impose such a fee and to require facilities to register their air pollution activities. The rule will revise the existing structure for annual registration of Tier I sources, and the annual assessment and payment of Tier I fees. The current structure is not self-supporting and adoption of a rule increasing the amount of fees paid by the regulated sources will ensure sufficient funding and continued compliance with federal requirements.

The proposed fee structure continues to use a combination of service- and emissions-based calculations to allow for an equitable allocation of fee payments among the facilities and to comply with a requirement of state statute that the fee has an incentive for emissions reductions. To better interface with the availability of information and state fiscal year cycles, it is proposed that the dates for submission of registration information and fee payments be changed. Removal of provisions imposing radionuclide emissions registration and fee and fee payments be changed. Removal of provisions imposing radionuclide emissions registration and fee requirements on the U.S. Department of Energy facilities is also proposed. The rule contains language stating when and if deferred sources are required to submit a Tier I permit application, the DEQ will reconsider the registration and fee requirements to determine whether an alternative basis to regulate those types of sources should be developed.

IACA Richard Rush, Vice President for Natural Resources, Idaho Association of Commerce and Industry, reported this rule (IDAPA 58.0101.0203) had extensive review and negations by industry and DEQ. IACA is not recommending the rules be rejected. He discussed the relationship of industry and the Department of Environmental Quality, and reported companies, both large and small, are impacted by the Title V air pollution rules. As time allows later during the 2003 legislative session, the committee chairman will invite Mr. Rush to return and present a more detail report about concerns pertaining to industry and environment.
MOTION Senator Kennedy moved to approve IDAPA 58.0101.0203. Seconded by Senator Stegner. Motion carried by voice vote with 1 Nay vote by Senator Ingram .
Senator Brandt notified the committee that IDAPA 58.0103.0201, relating to Individual/Subsurface Sewage Disposal, will be transferred from the Senate Resources and Environment Committee to Health and Welfare.
ADJOURN Meeting adjourned at 10:25 a.m.




DATE: Tuesday, January 21, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
GUESTS See attached sign-in sheet
Vice Chairman Compton chaired the meeting.
MINUTES Senator Bailey moved to approve the committee minutes for Thursday, January 9; Friday, January 10; Tuesday, January 14; Wednesday, January 15, and Thursday, January 16, 2003. Seconded by Senator Sweet, and motion was carried by voice vote.
DEQ Department of Environmental Quality (DEQ) Administrative Rules Review
IDAPA

58. 0103.0201

IDAPA 58.0103.0201, a pending rule, relating to Individual/Subsurface Sewage Disposal, was presented by Barry Burnell, Waster Water Program Coordinator for the Department of Environmental Quality.

The Department of Environmental Quality (DEQ) is evaluating the various conditions and circumstances that are used for making determinations of when public or central wastewater treatment facilities are reasonably accessible to undeveloped property. DEQ conducts reviews of proposed subdivisions at the request of city and county governmental agencies.

The purpose of this rule making is to provide greater detail to DEQ and the Health Districts in making decisions as to when central wastewater treatment facilities are reasonably accessible for new development and for issuing subsurface sewage disposal permits. The rule is needed to protect public health from ground water degradation due to nitrate contributions from septic systems in areas where subdivisions may be better served by central wastewater facilities. The rule establishes the conditions in which septic systems are an acceptable alternative to central wastewater treatment facilities.

The rule revises the list of systems installed by complex septic system installers; deletes the exemption from licensure requirement for public works' contractors and specified that homeowners and residents may install their own systems; revises the separation distance to surface waters by adding additional categories for watertight pipe (irrigation) and tiled ditches; and adopts additional siting criteria.

The rule allows local jurisdictions to adopt rules, standards, or ordinances that are more stringent than these rules. The rule title is changed from Individual/Subsurface Sewage Disposal rules to Individual/Subsurface Sewage Treatment and Distribution rules. The rule also sets down the procedures to revoke permits and to issue failing permits.

DEQ received public comments concerning the proposed rule and has revised the initial proposal as allowed under Section 67-5227, Idaho Code.

If the rule is adopted, the DEQ will have specific factors to evaluate when determining if a property has reasonable access to a central wastewater treatment facility. The factors to use in determining when a permit should or should not be issued are clearly identified. The rule provides consistency, certainty and specificity as to when property is considered to have reasonable access to a central wastewater treatment facility, thus minimizing the director's discretionary authority.

John Eaton, a representative for the Building Contractors Association of Idaho, testified in opposition IDAPA 58.0103.0201.

He reported the Idaho Building Contractors Association (IBCA) opposes passage of the DEQ proposed rule increasing regulations on septic tank installation in Idaho. If passed, the rule would significantly limit construction practices throughout the state, and would have an adverse effect on the cost of affordable housing. Although IBCA was not originally included as one of the organizations invited to participate in the negotiated rule making process with DEQ, we did attempt to work with DEQ throughout the fall of 2002 to develop language to address the Department's stated concerns. Unfortunately, we were not able to negotiate any change in language on several key provisions, and some new provisions were added that increased the stringency of the proposed rule. A major concern is the rule does not include a grandfather clause.

Dave Mabe, administrator, State Water Quality Division, DEQ, explained how the DEQ pursued IDAPA 58.0103.0201. In summary, he believes that generally this is a good set of guidelines for the director to consider as he looks at whether or not something should be hooked up to a septic system. If the Senate Health and Welfare Committee decides to not put this rule in place at this time, Mr. Mabe requested the committee help DEQ discern, in that process, what is the legislative intent, and how does the committee want the DEQ to act differently in the next proposal they bring to the committee next year?

After a lengthy review and discussion of IDAPA 58.0103.0201, the following action was taken.

MOTION Senator Brandt moved to reject IDAPA 58.0103.0201, and the Senate Health and Welfare Committee will draft guidelines pertaining to the management of non municipal solid waste for the Department of Environmental Quality. Motion seconded by both Senator Ingram and Senator Sweet. Discussion: Senator Brandt will designate whom he will have work on drafting of the guidelines. The draft guidelines will be reviewed by the committee members for a final review, prior to submitting the guidelines to the Department of Environmental Quality. Motion was carried by a voice vote.
IDAPA

58.0106.0201 and 58.0106.0202

IDAPA.58.0106.0201, a pending fee rule, relating to solid waste management, was presented by Dean Ehler, Solid Waste Coordinator for the Department of Environmental Quality. The U.S. Environmental Protection Agency (EPA) explains the federal role in the regulation of non municipal solid waste. Subtitle D of the federal Solid Waste Act establishes a framework for federal, state, and local government cooperation in controlling the management of nonhazardous solid waste. The federal role in this arrangement is to establish the overall regulatory direction, by providing minimum nationwide standards for protecting human health and the environment, and to provide technical assistance to States for planning and developing their own environmentally sound waste management practices. The actual planning and direct implementation of solid waste programs under subtitle D, however, remain largely State and local functions, and the act authorizes States to devise programs to deal with State-specific conditions and needs.

Mr. Ehler explained the rule was reviewed by the Environmental Common Sense Committee, and the State Board of Environmental Quality. Negotiated rule making was held.

IDAPA 58.0106.0202 repeals the previous solid waste management rules (chapter repeal), and rewritten as IDAPA 58.0106.0201.

Richard Rush, Vice President of the Idaho Commerce and Industry Association (IACA), testified and recommended approval of IDAPA 58.0106.0202.

At the discretion of Vice Chairman Compton, IDAPA 58.0106.0201 and 58.0106.0202 will be held in Committee and will be rescheduled later, this postponement is to allow committee members additional time to review this rule making docket.

IDAPA

58.0108.0102

IDAPA 58.0108.0102, a pending rule, relating to public drinking water, was presented by Tom John, Microbial Rules Analyst for the Department of Environmental Quality. He explained the standards have not been revisited since the mid-1980's. Advancing technologies and new national regulations have combined to make some portions of the rules increasingly dated and, in some instances, overly restrictive. This rule making is to update obsolete provisions, add flexibility where possible and appropriate, and clarify certain language that has presented interpretive difficulties in the past.

Additionally, a number of housekeeping changes are included in this rule. The engineering standards apply to newly designed public water systems and to significant modifications proposed for existing public water systems. As such, they affect consulting engineers, developers of new systems, and owners of new and existing systems. The housekeeping changes are for the benefit of all users of the rules and also serve to meet standards established by the Legislature and the Department of Administration.

The engineering standards for design, construction, and operation of public water systems regulate activities that are not regulated by the federal government. These standards were promulgated to fulfill the requirements, Idaho Code 39-118,and predate the Safe Drinking Water Act.

Negotiated rule making was held and groups involved included the Idaho Rural Water Association, Idaho Ground Water Users Association, JUB Engineering, Carollo Engineering, American Water Works Association, Idaho Professional Geologists, Idaho Department of Water Resources, DEQ Water Quality Engineers, Cities of American Falls, Blackfoot, and Lewiston.

If adopted, the regulated community will benefit from rules that reflect current industry standards and are generally easier to use. Certain practices that have proven to be ineffective will be eliminated.

MOTION Senator Brandt moved to accept IDAPA 58.0108.0102. Motion was Seconded by Senator Sweet. Motion carried by voice vote.
IDAPA 58.0108.0201 IDAPA 58.00108.0201, a pending rule, was presented by Tom John of the DEQ Water Quality Program. The U.S. Environmental Protection Agency (EPA) promulgated the Filter Backwash Recycling Rule and the Long Term 1 Enhanced Surface Water Treatment Rule. These are national primary drinking water regulations. As a State that has primacy for administering the Safe Drinking Water Act, Idaho must adopt these rules within two years of promulgation.

Filter Backwash Recycling Rule - requires public water systems that use surface water or ground water under the direct influence of surface water to notify the State if they recycle and waste fluids from their treatment process. Systems must provide the State with descriptions of their recycling practices and identify the point at which these recycled streams enter the treatment train.

Long Term 1 Enhanced Surface Water Treatment Rule - requires public water systems that use surface water or ground water under the direct influence of surface water and serve less than 10,000 persons to meet tighter standards for turbidity, to monitor individual filter bed turbidity continuously, and to undertake corrective actions if turbidity excursions occur. Systems must prepare a disinfection profile of their treatment plant unless they can demonstrate to the State that they have disinfection by-product levels that are less than 80 percent of the maximum contaminant levels set forth in the Stage 1 Disinfection By-products Rule.

DEQ received no public comments. If adopted, this rule will maintain Idaho's primacy agreement for administration of the Safe Drinking Water Act.

MOTION Senator Brandt moved to accept IDAPA 58.0108.0201. Motion was Seconded by Senator Bailey. Motion was carried by voice vote.
IDAPA

16.0505.0201 and

58.0114.0201

IDAPA 16.0505.0201 and 58.0114.0201, pending fee rule, relating to fees for health and environmental operating permits, was presented by Barry Burnell, Waste Water Program Coordinator for DEQ. The Department of Health and Welfare rule chapter IDAPA 16.05.05, rules governing fees for Health and Environmental Operating Permits, Licenses and Inspection Services, contains sections imposing environmental fees which are no longer flexible enough to meet the needs of the different health districts. This rule making deletes from the Health and Welfare rule chapter the sections relating to the imposition of environmental fees, parcel surveys and sanitary restriction administration, and transfers those sections to a new DEQ rule chapter (58.01.14). Language has been added to Section 100, Environmental Fees, giving health districts the necessary flexibility.

This rule making allows local government and the health districts to adopt equivalent or more stringent fees to cover the services provided. Some units of local government have adopted environmental fee ordinances and some health districts have revised fee rules that were adopted under their boards' rule making authority. The environmental fee structure needs to be flexible, across the state, to reflect the costs of providing environmental services rather than using a flat fee. Some health district environmental service costs are greater than other districts and the fees need to be reflective of the costs so that services can continue to be provided to the public. The districts with higher costs need the flexibility to revise fee structures to cover costs of providing services. DEQ received no public comments.

MOTION Senator Bailey moved to accept IDAPA 58.0114.0201 and 16.0505.0201. Motion was Seconded by Senator Kennedy. Motion was carried by voice vote.
ADJOURN The meeting adjourned at 10:15 a.m.




DATE: Wednesday, January 22, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
MEMBERS ABSENT Senator Dick Compton
GUESTS See attached sign-in sheet
The meeting was conducted by Chairman Brandt.
IDAPA Process Karen Gustafson, coordinator for the Office of Administrative Rules, presented a brief outline about the rule numbering and docketing system. Administrative rules are produced by state agencies and published in the Idaho Administrative Code and Idaho Administrative Bulletin, are organized and tracked by a numbering system. Each individual rule has a set of numbers that identify the agency, division, program, and chapter.
IDAPA

16.0205.0201

IDAPA 16.0205.0201, a pending rule, relating to human immunodeficiency virus (HIV) related services, was presented by Russell Duke, bureau chief, Bureau of Clinical and Preventive Services, Division of Health in the Department of Health and Welfare. The rule provides new chapter guides for the planning and disbursement of funds to provide HIV related services to eligible individuals for the federal Ryan White Care Act and the state supported AIDS Drug Assistance Program (ADAP). Changes are being made to Section 200.06 to require a mental health diagnosis in order for the participant to qualify for mental health services. A new Subsection 200.08 has been added for psychosocial support services in response to public comments received. This added subsection renumbered the subsections in the proposed text. Section 230 was amended to provide participants access to medications approved by the Food and Drug Administration for HIV treatment.

Mr. Duke discussed the eligibility requirements to obtain services, the 200 percent poverty level, substance abuse, and the Ryan White Care Act.

MOTION Senator Ingram moved to accept IDAPA 16.0205.0201. Motion was Seconded by Senator Bailey. Discussion: How are funds for the HIV related services distributed, how grants are administrated, and the Ryan White Care Act. Motion was carried by voice vote.
IDAPA

16.0210-0201

IDAPA 16.0210.0201, a pending rule, relating to Idaho reportable diseases, was presented by Richard Schultz, administrator, Division of Health. Idaho reportable diseases are regulated under these rules. Definition sections were updated to define "a waterborne outbreak," and delete definition of "week." Five (5) conditions detectable by newborn screening were added to the reportable disease list, as were three (3) infectious diseases. Reporting time frames were also updated.

Isolation - The separation of infected persons, persons who may have been exposed to a highly contagious infectious agent, or of persons suspected to be infected, from other persons to such places, under such conditions, and for such time as will prevent transmission of the infectious agent. The place of isolation shall be designated by the Department or the District Board of Health.

MOTION Senator Ingram moved to approve IDAPA 16.0210.0201. Motion was Seconded by Senator Kennedy. Motion was carried by voice vote.
IDAPA

16.0212.0201 and

16.0212.0202

IDAPA 16.0212.0202, a pending rule, relating to procedures and testing on newborn infants, was presented by Russell Duke, bureau chief, Bureau of Clinical and Preventive Services, Division of Health.

This rule rewrites the entire chapter of rules governing procedures and testing to be performed on newborn infants. The testing of newborn infants for phenylketonuria and other preventable diseases and the instillation of an opthalmic preparation in the eyes of the newborn to prevent Opthalmia Neonatorum. The rules specify the time and manner of testing as directed in Section 39-909, Idaho Code.

Negotiated rule making was held and groups involved included the Idaho Hospital Association, Idaho Perinatal Project, Division of Medicaid, Idaho Medical Association, and Idaho Chapter of the March of Dimes. The Department of Health and Welfare is directed by Idaho Statute to prescribe what tests shall be made for preventable diseases and the time and manner of such testing.

There were 20,000 registered births in Idaho last year. A test kit, covering the newborn testing costs the parent(s) $18.00.

Senator Burkett requested a copy of the old rule to be repealed. No copy was available; therefore, at the discretion of Chairman Brandt the rules will be held until Wednesday, January 23, 2003, so a review of the chapter proposed to be repealed is available.

IDAPA

16.0000.0201

IDAPA 16.0000.0201, a pending rule, relating to House Bill 406 passed by the 2002 Legislature amending the Social Work Licensing Act, was presented by Ray Millar, an alternative care Coordinator for Medicaid's Bureau of Benefits and Reimbursement Policy. The rule changes will not negatively impact service recipients, service providers, or the Department of Health and Welfare.

During 2002, the Legislature passed HB 406 and signed into law amending Title 54, Chapter 32, of the Social Work Licensing Act to change the titles and designations of social workers. To make rules consistent with the new professional titles adopted in law. The rule changes the titles of Certified Social Worker, Certified Social Worker-Private Practice to Licensed Master's Social Worker, Licensed Clinical Social Worker, and Licensed Clinical Professional Counselor respectively. The impact of the rules is that providers and consumers will see a non substantive name change in three professional titles.

MOTION Senator Burkett moved to approve 16.0000.0201. Motion was Seconded by Senator Ingram. Motion to approve was carried by voice vote.
IDAPA

16.0307.0101

IDAPA 16.0307.0101, a pending rule, relating to compliance with the HCBS Waiver for the aged and disabled and changes that have been made in the federal regulations governing home health agencies, was presented by Debby Ransom, bureau chief of the Bureau of Facility Standards, Division of Medicaid.

These rules were developed to bring time lines for completion of plans of care into congruence with federal requirements and to refine the definition of a home health agency. The change in time lines reflects a change in federal requirements from 62 to 60 days. Another change was initiated in partnership with the Idaho Association of Home Health Agencies. The definition clarifies who must be licensed as a home health agency. To be a licensed home health agency, the agency must be primarily engaged in providing skilled nursing and at least one other health care service (home health aide, physical therapy, occupational therapy, speech therapy, nutritional services, respiratory therapy) in a patient's home.

MOTION Senator Bailey moved to accept IDAPA 16.0307.0101. Motion was Seconded by Senator Darrington. Motion was carried by voice vote with one (1) Nay vote made by Senator Burkett.
ADJOURN Meeting adjourned at 10:12 a.m.




DATE: Thursday, January 23, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
MEMBERS ABSENT None
GUESTS See attached sign-in sheet
The meeting was conducted by Vice Chairman Compton.
Department of Health and Welfare - Rules Review
IDAPA

16.0212.0201 and

16.0212.0202

IDAPA 16.0212.0201 and 16.0212.0202, these two rules, relating to procedures to be performed on newborn infants, were presented on Wednesday, January 22, 2002 and held at the discretion of the Chair to be continued today. Russell Duke, bureau chief, Bureau of Clinical and Preventive Services, Division of Health, provided a copy, as requested by the committee on January 22, 2003, of the previous chapter that is to be repealed, IDAPA 16.0212.0201. IDAPA 16.0212.0202 is a rewrite of the entire chapter.
MOTION Senator Brandt moved to approve IDAPA 16.0212.0201. Motion was Seconded by Senator Bailey. Motion to approve was carried by voice vote.
MOTION Senator Brandt moved to approve IDAPA 16.0212.0202. Motion was Seconded by Senator Bailey. Motion to approve was carried by voice vote.
IDAPA

16.0309.0201

IDAPA 16.0309.0201, a pending rule, relates to residential and assisted living or certified family homes, Level I, II, or III care payment, was presented by Leslie Clement, bureau chief, Medicaid Benefits and Reimbursement Policy.

This pending rule affects the way some payments are processed for care received in residential care facilities and certified family homes. Cash payments were previously paid to residents through the Division of Welfare. Because of legislation in 2001, SCR 110, Medicaid now pays providers directly. Generally, this change in payment methodology created an opportunity to leverage Medicaid funds and improve the reimbursement for personal care services. The net savings to the state general fund in 2002 was approximately $1 million. For the most part, the change was invisible to the recipient.

The Division of Medicaid successfully negotiated reimbursement rates with industry representatives in 2001. These rules were presented as temporary rules during last legislative session and were approved by both Houses. The resulting change has been in effect since January 2002. The only barrier in implementation was the unwillingness of several facilities to enroll as Medicaid providers. The Department decided to allow recipients in these non-Medicaid facilities to remain in these homes and continue to receive cash payments rather than force residents from these homes. The Department continues to work with these providers to encourage Medicaid provider enrollment. For the majority of the stakeholders, this rule change was welcome and positive reflecting the right price for the right care.

MOTION Senator Sweet moved to approve IDAPA 16.0309.0201. Motion was Seconded by Senator Kennedy. Motion to approve was carried by voice vote.
IDAPA

16.0309.0202

IDAPA 16.0309.0202, a pending rule, relating to transportation reimbursement, was presented by Sharon Duncan, bureau chief, Medicaid Operations. This rule was implemented as a part of the Division's cost containment plan for the Governor's one (1) percent holdback in FY2002.

Provider rates for commercial, non commercial, and individual transportation providers will be reimbursed on a per mile basis, at a rate established by the Department after a study of costs has been conducted. These studies will be conducted no less than every three (3) years.

Meal reimbursement for Medicaid clients will also be reimbursed at a rate established by the Department. The Department has implemented rate changes for transportation providers effective January 1, 2002, in response to the budget holdback. For FY2002, the savings reached was $910,000, and the estimated savings for FY2003 is $3.7 million.

There were three (3) positive comments received.

MOTION Senator Stegner moved to approve IDAPA 16.0309.0202. Motion was Seconded by Senator Kennedy. Motion to approve was carried by voice vote.
IDAPA

16.0309.0204

IDAPA 16.0309.0204, a pending rule, relating to medical support costs from absent parents who have been court ordered to pay medical support for his/her child, was presented by Larry Tisdale, program supervisor, Third Party Recovery, Division of Medicaid.

This rule change would allow the Division of Medicaid to pursue medical support costs from absent parents who have been court ordered to pay medical support for his/her child. The text of the pending rule has been amended in accordance with Section 67-5227, Idaho Code.

MOTION Senator Darrington moved to approve IDAPA 16.0309.0204. Motion was Seconded by Senator Bailey. Motion to approve was carried by voice vote.
IDAPA

16.0309.0206

IDAPA 16.0309.0206, a pending rule, relating to Medicaid reimbursement methodology for claims also covered by Medicare Part B, was presented by Lloyd Forbes, manager, State Plan and Waivers Section of the Bureau of Benefits and Reimbursement Policy, Division of Medicaid.

This rule involves changes to the way the Medicaid program pays for Medicare Part B crossover claims. This rule was developed to reduce Medicaid expenditures to meet the funds available following the budget shortfall, and to provide services at the right price. No hearings were held, and three (3) comments were received during the comment period. Two (2) comments were positive and one (1) negative.

Before this rule change, Medicaid automatically paid the total amount of the Medicare Part B coinsurance and deductible amount on all Medicare and Medicaid, which "crossed over" to Medicaid. Following this change, Medicaid will cover the difference between the Medicare payment amount and either the Medicare allowable amount, or the medicaid-allowed amount for the service, whichever is less. As Medicaid generally pays less than Medicare, the amount paid is generally reduced, resulting in savings to the Medicaid program. These rules specifically address physicians, hospital outpatient, and ambulance providers. However, other Part B service providers such as durable medical equipment, physical therapy, psychology and other medical service providers are also impacted. This change in payment methodology is projected to save $2.3 million during the current fiscal year.

MOTION Senator Bailey moved to approve IDAPA 16.0309.0206. Motion was Seconded by Senator Brandt. Motion to approve was carried by voice vote.
IDAPA

16.0309.0207

IDAPA 16.0309.0207, a temporary and proposed rule, relating to independent personal care providers, was also present by Lloyd Forbes.

No public hearings were held, and two (2) comments were received, both were positive. Before this rule change, individuals were paid for residential habilitation services in the home of the participant under both of the Department's Developmental Disability waivers. Because this arrangement was allowed, the Department was found to be responsible for the withholding of FICA, FUTA, and SUTA payments. As pointed out by the Legislative Auditors, this practice was time consuming and costly to the Department. In addition, the Department was considered to be the Common Law employer of such individuals, creating a potential liability risk.

All other independent providers such as Personal Care Service and Aged and Disabled Waiver providers have been required to be employees of an agency for some time. This rule change treats all providers of similar services consistently by the Department. These rules also clarify that RESHAB providers who provide services in their own homes as Certified Family Homes must be affiliated with an RESHAB Agency for training and oversight.

MOTION Senator Kennedy moved to approve IDAPA 16.0309.0207. Motion was Seconded by Senator Stegner. Motion to approve was carried by voice vote.
IDAPA

16.0309.0208

IDAPA 16.0309.0208, a pending rule, relating to the method of reimbursement used to pay for services in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), was also presented by Lloyd Forbes, manager, State Plan and Waivers Section, Division of Medicaid.

This change is required by a change in federal law. These are negotiated rules, no public hearings were held, and during the comment period two (2) comments were received, both positive.

Section 702 of the Benefits Improvement and Protection Act (BIPA) of year 2000 required that states pay encounter rates to FQHCs and RHCs using a prospective payment system with a federally specified base year, and then inflating their payments using a national index.

Previously, providers were paid on a retrospective, cost settlement basis. These rules were negotiated with the affected industries. They clarify the types of encounters which can be reimbursed by Medicaid, including the addition of a dental encounter for FQHCs. The description of what service constitutes an encounter is updated to conform the federal requirements and actual industry practice.

MOTION Senator Bailey moved to approve IDAPA 16.0309.0208. Motion was Seconded by Senator Darrington. Motion to approve was carried by voice vote.
The following dockets were presented out of numerical order with the approval of Vice Chairman Compton.
IDAPA

16.0309.0210

IDAPA 16.0309.0210, a pending rule, relating to nursing visits (A*D), and clarifies how a personal need allowance is determined, was presented by Lloyd Forbes, manager, State Plan and Waivers Section of the Bureau of Benefits and Reimbursement Policy of Medicaid.

This rule primarily deals with clarifying the language and consistently using the term "participant" throughout the affected sections of rule. In these sections, Medicaid currently refers to the same person as a client, patient, and eligible individual. No public hearings were held. Three (3) positive comments were received during the comment period.

In Section 146, which covers Personal Care Services, the requirements for a supervising RN (registered nurse) visit at least every 90 days was eliminated, and it is left up to the participant and the Department's Nurse Reviewer to determine the frequency of the RN visits, or if any such visits are necessary for the particular individual.

Change in Section 149 which covers "client contribution for waiver services" essentially condenses a page of verbiage on how to calculate the participant's personal needs allowance into a single chart. This is designed to make this section of rule much more understandable for both the Department and the public. Except for the addition of how an over or underpayment is handled in Subsection .11, no actual change in current practice is made based on this clarification.

MOTION Senator Bailey moved to approve IDAPA 16.0309.0210. Motion was Seconded by Senator Brandt. Motion to approve was carried by voice vote.
IDAPA

16.0309.0212

IDAPA 16.0309.0212, a temporary and proposed rule, relating to traumatic brain injury waiver rules, was presented by Lloyd Forbes, manager, State Plan and Waivers Section, Bureau of Benefits and Reimbursement Policy of Medicaid.

The rule changes are basically technical in nature and clarify provider qualifications, and updates terminology to make these rules more consistent with the terminology found in the Department's other Home and Community-based waivers. The term "participant" is used throughout to identify a person using services to standardize the language. Diagnosis codes for "concussion" and "intercranial injury of other and unspecified nature" are added to the list of qualifying diagnoses. The term "Individual support plan" is replaced by the term "Plan of Care."

No hearings were held about this rule, and two (2) positive comments were received.

MOTION Senator Brandt moved to approve IDAPA 16.0309.0212. Motion was Seconded by Senator Stegner. Motion to approve was carried by voice vote.
IDAPA

16.0309.0211

IDAPA 16.0309.0211, a pending rule, relating to intensive behavioral intervention (IBI) services delivered by a school district or a developmental disabilities agency, was presented by Leslie Clement, bureau chief, Medicaid Benefits and Reimbursement Policy.

The purpose of these rules is to establish clear standards for professionals rendering Medicaid services. These rules refer to Developmental Disability Agency rules found in IDAPA 16.0411.0201 that specifies the details of these requirements.

This pending rule points to the requirements in the Developmental Disability Agency rules that clarify the professional requirements for individuals providing intensive behavioral intervention to children in children, ages 0-21 years old that has self-injurious, aggressive or severely maladaptive behavior and severe deficits in areas of verbal and nonverbal communication. These services require prior authorization, periodic and annual review. Provider qualifications include specific degree requirements and experience. The existing rules allowed for various interpretation and these pending rules help clarify professional experience, educational, and training requirements.

Negotiated rule making was not formally conducted. However, notification was sent to affected stakeholders with a draft copy of these rules asking for input. Three (3) hearings were held to provide an opportunity for individuals to testify. Twenty-seven comments were received, most opposed the original proposed language. However, individuals expressed the need to ensure that quality services are provided by competent professionals. Although amendments were made to the original rules, the department maintains that these rules sufficiently define the qualifications necessary to assure its recipients are receiving the appropriate care. Legislative Services reviewed these rules and had no substantive or procedural concerns.

MOTION Senator Stegner moved to approve IDAPA 16.0309.0211. Motion was Seconded by Senator Brandt. Motion to approve was carried by voice vote.
ADJOURN Meeting adjourned at 10:07 a.m.




DATE: Friday, January 24, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, and Kennedy
MEMBERS ABSENT: Senator Brandt
GUESTS See attached sign-in sheets
Vice Chairman Compton conducted the meeting.
MINUTES Senator Bailey moved to approve the minutes of Friday, January 17, 2003. Motion was seconded by Senator Stegner. Motion to approve carried by voice vote.
Department of Health and Welfare - Division of Medicaid Rules
IDAPA

16.0309.0215

IDAPA 16.0309.0215, a temporary rule, relating to Targeted Services (TSC) caseload limit requirements, was presented by Leslie Clement, bureau chief, Medicaid Benefits and Reimbursement Policy. These rule changes allow Medicaid to provide clients with the right care for the right price.

These temporary rules relax some of the provider requirements for targeted service coordinators and targeted case managers because of reduced reimbursement and benefit limitations. The Governor asked the Division of Medicaid, like other state agencies, to reduce its expenditures by 3.5 percent. Medicaid reviewed various benefit reduction options. There are three (3) primary ways to reduce expenditures beyond improving management techniques. These include:

  1. Changing Medicaid eligibility to make it more difficult to qualify for benefits;
  2. Reducing or eliminating optional benefits, and
  3. Reducing provider reimbursement.


Additionally, Medicaid is limited in its ability to reduce or cut certain services that are federally mandated. Ms. Clement distributed a chart pertaining to the service category and explained which service is required by federal or state mandates or by rule, and if a rate-set is a federal mandate, state mandate, or a rule. (Attachment #1)

Medicaid attempted to minimize the impact on recipients by reducing reimbursement and limiting benefits, rather than eliminating services.

The services identified in this rule docket are case management services for developmentally disabled and mentally ill Medicaid recipients. The services are brokerage services in which case managers help direct individuals to resources. These are not diagnostic or treatment services. These changes do not affect any other developmental disability or mental health services that Medicaid recipients are currently receiving or may need in the future.

For disabled individuals, crisis case management services continue to be available through Medicaid. For mentally ill individuals, crisis hours are contained in the new four-hour per month limitation. Individuals who need additional crisis case management may access these services through psychosocial rehabilitation and mental health clinics. Additionally, the department's regional mental health program is also available any time of day to provide help during crisis.

As of December 2002, there were 64 providers actively providing mental health case management services to 1,800 Medicaid recipients. In fiscal year 2002, Medicaid spent approximately $6.0 million for this service.

Fifty-six (56) providers actively providing targeted service coordination for approximately 1,900 developmentally delayed adults. Medicaid spent approximately $3.5 million for targeted service coordination for these recipients.

There were 66 active providers rendering target service coordination to 2,200 Medicaid children. Medicaid's 2002 cost for this service totaled $3.9 million.

The budget hold back, based on the limit on available case management hours and the projected reduction in targeted service coordination, is projected to save $2.2 million in 2003.

While Medicaid has attempted to minimize the effects of these reductions on recipients and providers, it acknowledges that there will be some individuals whose needs are not met, and providers who will be unable to provide the same level of care. Medicaid staff has been meeting with providers to work through these issues.

The Department of Health and Welfare (DHW) received 289 requests for hearings. Nine written comments were received, seven of these were negative - with most expressing concerns that the reductions will result in higher costs resulting from emergency and hospital care that could have been avoided through case management. The DHW will hold two hearings early this year to give individuals the opportunity to testify.

The Committee heard testimony from the following people who opposed IDAPA 16.0309.0215. Four (4) other persons gave a precise indication of opposing IDAPAa 16.0309.0215. (Attached sign-in sheets)

Maureen McDonald testified in opposition of IDAPA 16.0309.0215.

Diane Strunk testified in opposition of IDAPA 16.0309.0215.

Steve Hansen testified and provided written comments in opposition of IDAPA 16.0309.0215. In summary, he recommended that these temporary rules, (IDAPA 16.0309.0215) be adopted only with strong language from this committee, and the Legislature as a whole, that requires the Department of Health and Welfare continue to aggressively negotiate and implement rules which:

  1. Will relieve the providers of case management and service coordination from professional liabilities which may be directly associated with these rules, as they relate to the areas of client abandonment.


  1. Prohibits the Department from using inconsistent and arbitrary interpretations which might be hidden in provider agreements or regional guidelines which are not specifically defined in rule in the future.


  1. Ensures that the Department's expectations of service coordinators are reflected in both rule and practice in order to ensure that such expectations match the recent cut in reimbursement for the service.


  1. Ensures that a single person be identified at the state level by the Department who can determine equity in the regional interpretation and implementation of any rules relating to service coordination for adults with developmental disabilities or EPSDT service coordination, and have the authority to give direction as needed.


  1. Ensures that when the idea of offering cost of living adjustments to Health and Welfare employees in the future, such as consideration is accompanied by the Department's good faith review of similar adjustments for those providers who are in the trenches, doing the work that the taxpayer intends their tax dollars to support.


  1. Ensures that the additional rule recommendations which are being developed in the current case management work group be adopted in the form of new temporary proposed rules no later than April 1, 2003, with necessary revisions being made throughout this year, and complete the promulgation process before the next legislative session. The department should agree to assist in travel costs associated with current members of that workgroup being able to participate in that process.


Laura Scuri testified in opposition to IDAPA 16.0309.0215.

Debbie Johnson provided written comments and is strongly opposed to these rules. In summary she wrote, "as families we are the gatekeepers of these services. We know the ones that work and the ones that don't. We can also help you identify areas in which to examine and the ones that need praise. The current rules, with the exception of the payment portion works well. For many Idaho families TSC/CM services are their lifelines."

Karen Canfield of Boise, opposed IDAPA 16.0309.0215. In summary, she wrote "Medicaid is a complex challenge, but it seems that the cuts could be made in a more equitable fashion say...2.5 percent across the board, rather than taking it all away from disabled adults and children, that have lost so much already in the way of benefits the last several years."

Penney Friedlander of Coeur d'Alene, wrote opposing any budget cuts. The Trinity Group Homes, Inc., in Coeur d'Alene, is a nonprofit agency providing a supportive group home environment to adults who have been diagnosed with major mental illnesses. " We have experienced a direct loss of service providers in Coeur d'Alene due to an inability for the providers to cover costs. The situation is dire. We implore you to analyze the effects of budgetary changes in determining whether costs will be reduced. Consider the larger picture."

Bob Madderra submitted written comments in opposition to the rules. He wrote "the already limited amount of four hours costs the state of Idaho more money due to the alternative when crisis situations occur. Persons with mental illnesses need differing amounts of targeted case management. Limiting it to four hours is unreasonable, and there needs to be more flexibility for cases that need additional attention."

After reviewing the rule, and with specific attention to areas on pages 49, 55 and 61 of IDAPA 16.0309.0215, and listening to testimonies, Senator Kennedy explained that it appears to him in our discussion of who is taking comparative hits as a result in the reductions of service, he has to think that the group taking the biggest hit are the recipients in the mental health situation who are not even being represented before the committee today.

At the discretion of Vice Chairman Compton, an additional review of IDAPA 16.0309.0215 will be scheduled at a later date in order to allow committee members additional time to consider the rule prior to making a decision.

IDAPA

16.0310.0202

IDAPA 16.0310.0202, a pending rule, relating to legislative intent language that capped rates, was also presented by Leslie Clement. The purpose of this docket is to support the Department of Health and Welfare's commitment to providing access to the right care for the right price.

This rule removes Idaho legislative intent language that capped intermediate care facility rates from July 1, 2000 through June 30, 2002. The changes also allow the existing rate methodology which relies on the prospective payment system to be restored beginning July 1, 2002.

Intermediate care facilities provide services to mentally retarded individuals. These individuals typically have higher level of care needs and are unable to function effectively in the community. Sixty-four (64) intermediate care facilities in Idaho serve approximately 470 individuals. The cost of providing care in fiscal year 2002 totaled $34.5 million. By lifting these caps, the total annual cost to Medicaid is estimated at $35.5 million in fiscal year 2003, and $36.2 million in fiscal year 2004. This reflects an average annual increase of approximately 2.3 percent.

Medicaid has been routinely meeting with industry representatives to ensure requirements are reasonable, costs are managed and care is safely and effectively rendered. Intermediate care facility providers perform a valued service to Medicaid recipients whose needs are uniquely served by this industry.

MOTION Senator Darrington moved to approve IDAPA 16.0310.0202. Motion was seconded by Senator Sweet, and mMotion to approve was carried by voice vote.
IDAPA

16.0310.0203

IDAPA 16.0310.0203, a temporary rule, relating to reimbursement settlements, was presented by Leslie Clement from the Division of Medicaid. The purpose of these rules is to meet budget hold back directives while continuing to meet the department's commitment to provide access to the right care for the right price. The Governor directed state agencies to reduce state general fund expenditures by 3.5 percent. The 3.5 percent reduction in hospital reimbursement, as reflected in these rules, is anticipated to save approximately $2.5 million in Medicaid's state fiscal year 2003 budget.

Hospital services represent the largest Medicaid expenditure category, followed by nursing home and pharmacy services. Medicaid payments for hospitals during state fiscal year 2002 were made in four general categories:

  1. inpatient hospital services totaled approximately $104 million
  2. outpatient hospital services totaled $35 million
  3. hospitals also received $10.3 million in a disproportionate share (DSH), and
  4. another $10.4 million in federal upper payment limit (FUPL).


The DSH and FUPL payments are based on Medicaid inpatient utilization rates.

The first two payment categories are based on hospital claims submitted to Medicaid. Hospitals receive interim payments based on a percent of charges, and are later subject to a cost settlement process managed by Medicaid's contractor auditor, Myers & Stauffer.

All hospitals received prior notice of the 3.5 percent reduction in their interim payments, and the related change that will occur during the cost settlement process.

Steve Millard, president of the Idaho Hospital Association(IHA) testified and the Association does not oppose the rules. He recommended the committee approve the rules.

MOTION Senator Kennedy moved to approve IDAPA 16.0310.0203. Motion was seconded by Senator Burkett, and motion to approve was carried by voice vote.
CHAIRMAN Due to lack of time, Vice Chairman Compton determined other rule dockets on the agenda, scheduled for presentation, would be rescheduled.
ADJOURN Meeting adjourned at 10:30 a.m.




DATE: Tuesday, January 28, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Sweet, Bailey, Burkett, Kennedy
ABSENT and

EXCUSED:

Senator Stegner
The meeting was conducted by Vice Chairman Compton
Division of Medicaid - Rule Presentations
IDAPA

16.0309.0215

IDAPA 16.0309.0215, a temporary rule, was first presented on ????, 2003, by Leslie Clement, bureau chief of Medicaid Benefits and Reimbursement Policy, Division of Medicaid. At that time, the Committee held this temporary rule for further review.

The purpose of this docket is to meet budget holdback directives while continuing to meet the Department of Health and Welfare's commitment to providing access to the right care for the right price.

These rules relax some of the provider requirements for targeted service coordinators and targeted case managers because of reduced reimbursement and benefit limitations.

Several persons sent letters or provided a precise indication or testimony in opposition to IDAPA 16.0309.0215.

The Committee held a lengthy discussion about the ongoing debate about the reduction of case management hours (20 hrs to 4hrs) per month, what is federal or state mandated services, safety value, emergency hours, general and federal funds and mandates, and asked those in opposition to IDAPA 16.0309.0215 what suggestions could be offered to the Department of Health and Welfare to provide budget cuts to programs, and increase in taxes to avoid and afford programs.

A Medicaid status report for January 2003, a budget snapshot, was reviewed. The Department of Health and Welfare has seen four budget cuts since 2001. In Medicaid, this has meant $115 million in cost avoidance. Medicaid is projected to spend about $849 million in fiscal year 2003 - about $234 of that in state general funds. There are three basic ways to affect the amount spent in Medicaid. They are:

1. By the number of people on the program;

2. By the number and duration of covered services; and

3. By the amount paid for services.

A fourth tool-managing health care services to eliminate unnecessary or

ineffective care - can achieve some dramatic cost avoidances in the short term by providing cost and utilization controls that have been missing.

Cost containment initiatives during the past fiscal year included:

1. Changing the discount for pharmacy reimbursement from A WP -11

percent to 12 percent,

2. Requiring prior authorization on brand name prescriptions,

3. Restricting early prescription refills,

4. Including the Children's Health Insurance Plan in the drug rebate

program,

5. Changing the initial hospital length of a stay from 4 days to 3 days,

6. Creating a standardized reimbursement method for transportation

services,

7. Requiring prior authorization for durable medical equipment,

8. Changing the reimbursement methodology for Medicare crossover

claims,

9. Limiting adult dental benefits to emergency services,

10. Applying the Medicare rates to selected Medicaid services,

11. Increases Healthy Connections enrollment,

12. Reducing reimbursement rates for case management services for

DD,

13. Limiting case management hours for MI,

14. Reducing hospital reimbursement,

15. Requiring prior authorization for select classifications of medications.

  1. Medicaid absorbed about 2.6 percent of a holdback beginning in November 2002. This was originally 3.5 percent, but the Governor asked the Division to hold off its planned implementation of waiver cutbacks.
  2. State General Fund still needs to find approximately $160 million to address revenue shortfalls.
  3. For every state dollar taken out of Idaho Medicaid, the state loses an additional $2.3 dollars in federal funds.


Committee members discussed the problems that the Department of Health and Welfare must face during this tight budget situation. A way of controlling expenditures, maintaining personnel to perform services, and when rules are mandated by federal or state determination. Senator Darrington pointed out that Line 18 of the following chart would explain this program. Senator Darrington encouraged committee members to use the chart to help determine if a program is mandated and service is required.

At the discretion of Vice Chairman Compton, no decision will be made at this time regarding IDAPA 16.0309.0215.

IDAPA

16.0311.0301

IDAPA 0311.0301, a temporary rule that sets a cap on beds in community intermediate care facilities (ICF/MR) for persons with mental retardation at 486 beds. This docket was presented by Kathleen Allyn, deputy administrator of the Division of Medicaid and she explained the purpose of this rule is to put a temporary cap on expansion of this service as a cost control measure. The Department of Health and Welfare is requesting this rule be extended for one (1) year.

This bed cap was first set in 2000 in intent language attached to the appropriation for medical assistance. This temporary rule was promulgated at that time to implement the legislative intent language. The bed cap language was repeated in the appropriation for 2001 and the Department requested a year's extension of this rule. Although the bed cap language was not repeated in the 2002 appropriation bill, the Department requested and received an extension of the bed cap for another year.

The Department consulted with the Idaho Association of Community Options and Resources, the ICF/MR association, and there is no objection to this request from the association. The Department is aware of no concerns from any other group.

Committee members requested Medicaid to provide data about persons place out-of-state and if, at the time of that placement, Idaho had empty beds.

MOTION A motion was made by Senator Brandt to approve IDAPA 16.0311.0301. Motion was seconded by Senator Bailey, and motion was carried by a voice vote.
IDAPA

16.0314.0201

IDAPA 16.0314.0201, a pending rule, relating to minimum standards for hospitals in Idaho, was presented by Debby Ransom, bureau chief of the Bureau of Facility Standards, Division of Medicaid.

This rule change was initiated in partnership with the Idaho Hospital Association. This change updates the rules to the current standard of practice and reflects federal guidelines and standards. The Joint Commission on Accreditation for Healthcare Organizations holds hospitals to state rules and requirements. The current rule requires a history and physical examination to be performed within 72 hours of admission. This rule change allows physicians to complete a history and physical exam up to sever (7) days prior to a planned admission and shortens the completion time to 48 hours for all other patients except emergency admissions.

MOTION A motion was made by Senator Bailey to adopt IDAPA 16.0314.0201. Motion was seconded by Senator Brandt, and motion was carried by a voice vote.
IDAPA

16.0319.0101

IDAPA 16.0319.0101, a pending rule, relating to certified family homes, was also presented by Debby Ransom, bureau chief of the Bureau of Facility Standards, Medicaid.

Ms. Ransom reported that during the 2000 legislative session, the Board and Care Act and the Residential Care Act for the Elderly was amended to allow a provider to make application to care for up to four (4) residents in a certified family home. These rules were developed with input from providers, advocates, and consumers through public meetings and members of the Board and Care Council and the Residential Care for the Elderly.

These rules will assist in ensuring residents receive the right care, in the right setting with the right outcomes in the most cost efficient manner.

MOTION A motion was made by Senator Darrington to adopt IDAPA 16.0319.0101. Motion was seconded by Senator Sweet , and motion was carried by a voice vote.
IDAPA

16.0319.0102

IDAPA 16.0319.0102, a pending rule, relating to certified family homes and emergency transportation for violent residents, was presented by Debby Ransom, Division of Medicaid, bureau chief of the Bureau of Facility Standards.

This rule was developed in response to a recommendation by the Board and Care Council for the Elderly and the Residential Care Council. This rule requires a CHF to arrange for emergency transportation of residents with medical and/or behavioral emergencies. Providers are not equipped or trained to provide this type of service. This rule change will help ensure residents who have emergent needs are met.

MOTION A motion was made by Senator Bailey to approve IDAPA 16.0319.0102. Motion was seconded by Senator Kennedy, and motion was carried by a voice vote.
IDAPA

16.0322.0101

IDAPA 16.0322.0101, a pending rule, relating to residential care facilities and assisted living in Idaho, was also presented by Debby Ransom, bureau chief, Bureau of Facility Standards, Medicaid.

This rule was developed in response to a recommendation by the Board and Care Council for the Elderly and the Residential Care Council. This rule requires a Residential or Assisted Living Facilities to arrange for emergency transportation of residents with medical and/or behavioral emergencies. Providers are not equipped or trained to provide this type of service. This rule change will help ensure residents who have emergent needs are met.

MOTION A motion was made by Senator Burkett to adopt IDAPA 16.0322.0101. Motion was seconded by Senator Brandt, and motion was carried by a voice vote.
IDAPA

16.0322.0201

IDAPA 16.0322.0201, a pending rule, relating to residential care facilities and assisted living in Idaho, statutory changes, was presented by bureau chief, Bureau of Facility Standards, Debby Ransom.

These rule changes were made to align the rules with statutory changes made by Senate Bill 1365 to the Board and Care Act and the Resident Care Act for the Elderly during the 55th session of the 2000 Legislature.

These rules correct the name of Residential OR Assisted Living Facilities, add a new definition, an authorized provider to recognize nurse practitioners and clinical nurse specialists licensed by the Board of Nursing and physician assistants. Changes reflect current standards and name changes of the National Boards or Councils.

Ensures all residents, not just the elderly, are to be informed of their right to develop advanced directives; modifies and ensures rules referring to administrators qualifications are consistent with the Department of Health and Welfare's rules governing criminal history clearance.

MOTION A motion was made by Senator Bailey to approve IDAPA 16.0322.0201. Motion was seconded by Senator Kennedy, and motion was carried by a voice vote.
ADJOURN There being no further business to discuss, the meeting adjourned at 10:00 a.m.


DATE: Wednesday, January 29, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Sweet, Bailey, Burkett, Kennedy
ABSENT/

EXCUSED:

Senator Stegner
The meeting was conducted by Vice Chairman Compton.
MINUTES Senator Ingram moved to approve the minutes of Tuesday, January 21, 2003. Senator Brandt seconded the motion. The motion was carried by voice vote.
REGION X

SEATTLE WA

The Department of Health and Human Services (HHS) Regional Director Carolyn Oakley from Seattle, Washington, presented an update about the national status of HHS.

She explained one of Secretary Thompson's goals is a healthy America. He launched his comprehensive initiative on disease prevention in a National Press Club speech April 30, outlining steps that individuals can take on their own for good health.

  1. A new Web site "HealthierUS.gov" has been created.
  2. Physical activity - outlined the special benefits of physical activity and moderate exercise for older Americans. Center for Disease Control (CDC) launched a $190 million multicultural media campaign in July aimed at promoting a healthier lifestyle for young people.
  3. Healthy diet - A report was released in June showing that overweight and obesity cost America $117 billion annually and accounts for at least 14 percent of deaths in the U.S., or some 300,000 premature deaths each year. Nearly one-third (1/3) of U.S. adults now classify as obese, and obesity among young people is growing rapidly.
  4. In October, $100 million was made available to tribal organizations for prevention and treatment of diabetes among American Indians and Alaska Natives. On average, American Indians and Alaska Natives are 2.6 times more likely to have diabetes than non-Hispanic whites of similar age.
  5. HIV/AIDS - In addition to efforts to improve health for all Americans through healthy diet and exercise, HHS maintained and expanded its efforts to prevent HIV/AIDS and support treatment, both domestically and internationally. Total HHS spending on HIV/AIDS increased from $11.4 billion in FY2001 to $12.1 billion in FY2002, with a further increase of almost $1 billion proposed in the President's budget for FY2003. HHS' contribution to the global effort against HIV/AIDS increased from $276 million in FY2001 to $486 million in FY2002.


  6. Bioterrorism preparedness - America ended the year 2002 much better prepared to confront terrorism. Under HHS Secretary Tommy G. Thompson's leadership, the department led the nation's efforts to be ready in particular for possible incidents of bioterror. HHS' budget for bioterrorism increased tenfold, from $305 million for FY2001 to $2.98 billion in FY2002. Of the budget increase, more than $1 billion was provided to states and major cities to support increased preparedness by hospitals and public health systems. The objective is local preparedness, with national resources ready to be deployed immediately whenever and wherever needed.


  7. Smallpox and other vaccines - HHS took steps to provide enough smallpox vaccine to be able to vaccinate every American, in the possible event of a release of this disease. In December, President Bush announced a careful policy of voluntary vaccination for front-line health care and emergency personnel, to ensure effective response if the disease were released. Vaccination of others is not recommended at this time, in the absence of an emergency. In addition, production of the current anthrax vaccine was resumed, and research into improved vaccines for anthrax and other diseases was accelerated.


  8. Disease surveillance and communications - In order to detect any possible release of disease agents by terrorists, the nation's disease surveillance system is being expanded, with spending increased from $67 million in FY2001 to $940 million in FY2002. This expansion will also help to quickly identify outbreaks of naturally-occurring diseases. The nation's network of public health laboratories is being expanded.


  9. Teen smoking - Results from the "Monitoring the Future" survey for 2002, showed a significant decrease in smoking by teens, accelerating a trend that began after teen smoking reached a high point in 1996. This year's survey also showed that teen alcohol consumption was down, as was teens' use of illicit drugs.

  1. In 2002, HHS approved waiver and plan amendments for state SCHIP and Medicaid programs that expanded access to health coverage to more than 600,000 additional Americans. These changes provided additional services to more than one (1) million other beneficiaries. Since the start of the Bush Administration, HHS has approved waivers and plan amendments that expand access to coverage to nearly 1.8 million Americans and improved benefits for more than five (5) million other Americans.


Other areas briefly discussed were a one-page list of acronyms used by HHS, delay and lengthy of time to process Waiver requests (goal is a 90-day turnaround), and promoting seniors' access to prescription drugs.

IDAPA

58.0101.0201

IDAPA 58.0101.0201, a pending rule, relating to air quality in Idaho and clarifying open burning, was previously presented by Kate Kelly from the Department of Environmental Quality. At that time, at the discretion of the Chairman, the rule was held in the committee for further review.

After review, the Committee addressed concerns and questions about several sections in IDAPA 58.0101.0201, including Section 603.01(e) the burning of plastics, i.e., plastic bailing twine; Section 603.01(g) burning petroleum products; Section 603.01(h) burning lumber treated with preservatives; Section 611.02 on-site wastes burning, and Section 611.03 daylight burning only. Also of concern is the enforcement procedure, and keeping the old rule in place while rejecting this new proposal.

MOTION A motion was made by Senator Darrington to reject IDAPA 58.0101.0201. Motion was seconded by Senator Ingram.

Discussion: After discussion to reject part or all of IDAPA 58.0101.0201, it was determined the complete new rule would be rejected. The Department of Environmental Quality can bring a new docket to the committee next year.

Motion to reject IDAPA 58.0101.0201 was approved by voice vote.

IDAPA

58.0106.0201 and

58.0106.0202

IDAPA 58.0106.0201 and 58.0106.0202, rules relating to solid waste management to repeal and rewrite regulations of non-municipal wastes, was previously presented to the Committee by Dean Ehlert from the Department of Environmental Quality. At that time, at the discretion of the Chairman, the rule was held in Committee for further review.
MOTION A motion was made by Senator Ingram that IDAPA 58.0106.0201 and 58.0106.0202 be approved. Motion was seconded by Senator Bailey. Motion was approved by voice vote.
IDAPA

16.0309.0217

IDAPA 16.0309.0217, a temporary rule, relating to allowing penalties for late submission of a review document - outpatient procedures. The rule has a technical update replacing the term "peer review organization" with the new term "quality improvement organization," in compliance with the change in the code of federal regulations.

Other changes in the rule relate to the assessment of late penalties. At the current time, the Department of Health and Welfare is allowed to assess a penalty to providers for submitting a late review to our contracted quality improvement organization. This rule would allow a penalty to be assessed by the Department for internal reviews. This would ensure that all procedures are submitted in a timely manner for review in order to support public health and safety.

MOTION A motion was made by Senator Bailey to accept IDAPA 16.0309.0217. Motion was seconded by Senator Kennedy. Motion was approved by voice vote.
IDAPA

16.0309.0218

IDAPA 16.0309.0218, a temporary rule, relating to Clozapine care coordinators, was presented by Lloyd Forbes from the Division of Medicaid.

This docket addresses the right service for the right price and eliminates Medicaid payment for the entry of laboratory results into the Clozapine National Registry for participants who require this medication for the treatment of their mental illness.

In October 2001, the Department of Health and Welfare (DHW) reduced its payment for this service from $29.07 to $5 in order too more accurately reflect the complexity of the service and bring our payment into line with what other states were paying. Further, DHW's research found that Utah, Wyoming, Montana, and Nevada were not paying for this service at all under their Medicaid programs. During SFY 2002, Medicaid paid $39,143 for this service. In light of the state's financial picture, continued payment by Idaho Medicaid could not be justified.

MOTION A motion was made by Senator Ingram to approve IDAPA 16.0309.0218. Motion was seconded by Senator Brandt. Motion was approved by voice vote.
IDAPA

16.0309.0301

IDAPA 16.0309.0301, a temporary rule, relating to reimbursement for out-of-state nursing home placements for care when services are not available in Idaho, was presented by Lloyd Forbes from the Division of Medicaid.

Medicaid payment for out-of-state nursing home care is very limited and generally is only allowed if the care the person needs are not available in an Idaho facility. Because of the complexity of the current acuity-based reimbursement for instate nursing homes, the Department of Health and Welfare has elected to pay out-of-state facilities the same rate as they receive from the Medicaid program in their home state. This simplified their billing and claim submission and is the method previously and currently used by the department.

MOTION A motion was made by Senator Ingram to approve IDAPA 16.0309.0301. Motion was seconded by Senator Brandt. Motion was carried by voice vote.
IDAPA

16.0310.0201

IDAPA 16.0310.0201, a temporary rule, relating to the methods used for reimbursements, was presented by Lloyd Forbes from the Division of Medicaid.

This docket is a companion to IDAPA 16.0309.0208 and describes the method to pay federally qualified health centers and rural health clinics based on a federally required prospective payment system. These rules delete the previous reimbursement system and replace it with a reference to the method specified in the Federal Law.

This change was negotiated with the affected industries before the rules were promulgated. No public hearings were held and two (2) positive comments were received.

MOTION A motion was made by Senator Kennedy. Motion was seconded by Senator Brandt. Motion was approved by voice vote.
IDAPA

16.0310.0204

IDAPA 16.0310.0204, a temporary rule, relating to supplies of ICF/MR facilities, was also presented by Lloyd Forbes from the Division of Medicaid.

This rule change removes wheelchairs from the content of care for Intermediate Care Facilities for the Mentally Retarded. This rule change was negotiated between the Department of Health and Welfare and the ICF/MR industry.

This change has three positive effects:

  1. It eliminates the cash flow problem experiences by small ICF/MR facilities when a participant requires a highly specialized and expensive wheelchair.
  2. As the Medicaid program pays for such chairs on a fee schedule rather than billed charges, the cost is less to the Medicaid program.
  3. The participant is more readily accepted for admission into the small facilities and keeps the wheelchair, no matter if he moves between facilities and into a community placement.
MOTION A motion was made by Senator Brandt to approve IDAPA 16.0310.0204. Motion was seconded by Senator Bailey. Motion to approve was carried by voice vote.
IDAPA

16.0310.0301

IDAPA 16.0310.0301, a temporary rule, relating to reimbursement for out-of-state nursing home placements when services are not available in Idaho, was presented by Lloyd Forbes, manager of the State Plan and Waivers section of the Bureau of Benefits and Reimbursement Policy Unit, Division of Medicaid. This rule addresses the right service to the right person at the right location.

This docket addresses the payment of out-of-state nursing home care, and is the companion of IDAPA 16.0309.0301. No hearings were held, and two (2) positive comments were received during the comment period.

This rule allows the Department of Health and Welfare to reimburse out-of-state nursing homes using the rate being paid by the Medicaid jurisdiction in which the facility is located. Technical changes are also made to update manual section references and other editorial changes. In addition, this docket adds a section on incorporation by reference and incorporates 42 CFR Part 447, and the Medicare Provider Reimbursement Manual into these rules.

MOTION A motion was made by Senator Ingram to approve IDAPA 16.0310.0301. Motion was seconded by Senator Brandt. Motion was carried by voice vote.
ADJOURN There being no further business, the meeting adjourned at 9:35 a.m.




DATE: Thursday, January 30, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Sweet, Bailey, Burkett, Kennedy
ABSENT/

EXCUSED:

Senator Stegner
Department of Health and Welfare - Rules Review -

The following ten (10) IDAPA rules were presented by Phil Gordon from the Division of Welfare.

IDAPA

16.0301.0201

IDAPA 16.0301.0201, a temporary rule, relating Medicaid for Families and Children in Idaho (TAFI). He explained that TAFI provides cash assistance to needy families and children. When the TAFI grant increased last year, some families had the potential of losing their Medicaid coverage. This rule ensures that those families can continue to receive Medicaid while receiving TAFI benefits.

This rule assists families who go off cash assistance due to work, to continue receiving Medicaid for six (6) months with up to an additional six (6) months, if the participant remains employed. These changes will help transition these individuals to work and move families off welfare.

This rule also adds back rules that specify those items that are not counted in determining income available to the participant, as prescribed by federal regulations-income exclusions. Some of those are:

  1. Commodities and Food Stamps
  2. Housing subsidies, and
  3. Income tax refunds.
MOTION Senator Kennedy moved to approve IDAPA 16.0301.0201. Motion was seconded by Senator Bailey. Motion to approve was carried by voice vote.
IDAPA

16.0304.0103

IDAPA 16.0304.0103, a pending rule, relates to Food Stamps (FS), net monthly income limits. This docket puts into rule the annual FS "cost of living" increases to income limits and benefit amount for 2001.

Food Stamp families will receive an increase in their benefits ranging from $5 to $30 depending on the size of the family. For example, a household of one (1) will increase from $130 to $135 per month, and a household of four (4) will increase from $434 to $452.

These changes are superceded by IDAPA 16.0304.0202 - increase for 2002. This rule corrects the language that aligns with federal policy related to aged and disabled individuals who cannot buy and prepare their own meals separately from others in the home.

The Department of Health and Welfare has been applying the correct policy and the automated system is correctly calculating benefits, but now the Department is correcting the rule site.

MOTION Motion was made by Senator Brandt to approve IDAPA 16.0304.0103. Motion was seconded by Senator Bailey. Motion to approve was carried by voice vote.
IDAPA

16.0304.0201

IDAPA 16.0304.0201, a pending rule, revises and clarifies policy regarding the Food Stamp work programs. For example,

  1. Who must register for work.
  2. What costs can or cannot be paid for work program funds (in particular, supportive services.
  3. When to apply penalties for individuals quitting a job or reducing their work hours.
  4. How they can re-establish eligibility.


Next, the rule lengthens FS eligibility for some households, able bodied adults without dependents (ABAWDS) in high unemployment areas beyond the three (3) month limits. A relatively small number of individuals are impacted, i.e., depressed economic areas. For example, northern Idaho, determined by the Department of Labor and listed in rule, Individuals still must comply with the work plan.

The Department of Health and Welfare put into the rule some language that expands work services to a larger FS population. Again, this enables the Department to move more individuals into employment and off public assistance.

MOTION Motion was made by Senator Bailey to approve IDAPA 16.0304.0201. Motion was seconded by Senator Brandt. Motion to approve was carried by voice vote.
IDAPA

16.0304.0202

IDAPA 16.0304.0202, a temporary rule, relating to Food Stamp requirements that legal and qualified immigrants receiving disability benefits who are legally present in the U.S. as of August 22, 1996 for FS eligibility.

This puts into rule the annual federally mandated FS "cost of living" increases for 2002. This increases income limits, standard utility allowance, and the FS allotment amount. Per federal regulation, this increased the asset limit for disabled individuals from $2000 to $3000. The Department of Health and Welfare now considers asset limits the same for both elderly and disabled. By federal requirement, the Department added a rule that increased the standard deduction for larger families: households size of four (4) or less is $134, households of size of five (5) is $147, and a household of size six (6) or more is $168.

Now lawful non citizens, who are blind or disabled, can receive Food Stamps. This is a policy and rules change based on federal regulations.

  1. 25,000 families on FS - a very small number who would now be able to receive FS under this change.
  2. The benefits would be 100 percent federally funded.
  3. Increased workloads would be managed.
MOTION Motion was made by Senator Kennedy to approve IDAPA 16.0304.0202. Motion was seconded by Senator Ingram. Motion to approve was carried by voice vote.
IDAPA

16.0305.0201

IDAPA 16.0305.0201, a pending rule, relating to the Aged, Blind and Disabled (AABD) residents, whose care will be paid for by Medicaid Personal Care Services.

This rule impacts some elderly or disabled individuals living in a homelike setting. They can have their care paid for with federally matched dollars, instead of 100 percent general funds. This nets the State a substantial general fund cost savings.

  1. Homelike setting - certified family homes, in someone's home (lives with family).
  2. Developmentally disabled adults - residential and assisted living-group home (businesses) that serve disabled and elderly. Lower level of care is required.
  3. About 350 individuals - putting individuals on the State Plan PCS (personal care service) Medicaid coverage.
  4. Saves $700,000 - instead of costing $1 million a year in state general funds, it now costs $300,000 in general funds.


This rule also allows providers to be paid directly for services.

MOTION Motion was made by Senator Kennedy to approve IDAPA 16.0305.0201. Motion was seconded by Senator Brandt. Motion to approve was carried by voice vote.
IDAPA

16.0305.0202

IDAPA 16.0305.0202, a pending rule, relating to Aid to the Aged, Blind and Disabled, does three (3) things.

  1. Tightens the rule regarding asset transfers - clarifies what transfers are allowable and what transfers are not. Penalties apply to nursing home and Home and community based services (HCBS) clients.
  2. Unless a transfer meets the exception requirement, it is presumed (rebuttable presumption) the transfer was made for the purpose of qualifying for Medicaid.
  3. This rule will clarify policy and reduce confusion regarding these transfers.


This rule also increases personal needs' allowance for veterans in nursing home. Allows veterans in nursing homes to retain an additional $50 of their income, for personal needs for a total of $90 for incidentals such as shaving needs. This affects approximately 120 veterans in nursing homes. This rule will have a minimal increase to the general fund cost.

The rule clarifies "end of treatment" for breast and cervical cancer patients. This is to ensure that the Division of Medicaid and the Division of Welfare are defining the end of treatment the same.

MOTION Motion was made by Senator Burkett to approve IDAPA 16.0305.0202, with a rejection of Section 831.01, Rebuttable Presumption.

Discussion:

  1. Senator Burkett asked Phil Gordon is presumption rebuttable or not? Mr. Gordon responded "yes" the presumption is rebuttable. It would be the responsibility of the individual who had the assets to prove that they did not make the transfer for the purpose of making themself eligible for Medicaid or in making that transfer, the amount would still be eligible as the value of that asset.


  2. Senator Darrington understands that rebuttable presumption is a federal requirement in numerous programs - Medicaid and non-Medicaid. We have to have rebuttable presumption in programs by federal law. Mr. Gordon has the same understanding as Senator Darrington.

  1. Senator Burkett stated he thinks it is important that if we change the rules that presumption is rebuttable by individuals or clients, so he moved that the language be changed back on page 121. Karen Gustafson, the rule coordinator for Administrative Rules, explained the Committee could approve or reject the docket, they could reject a subsection without rejecting the complete docket, the underlined text would be returned and the strikeout section would go away.


MOTION was repeated by Senator Burkett - Motion to approve IDAPA 16.0305.0202 with a rejection of the change in .01 on page 121, regards to the language "Rebuttable Presumption."

Point of Clarification: Senator Kennedy asked Senator Burkett if he meant Section 831.01, on page 121 of the rule. He answered "yes."

Motion was seconded by Senator Kennedy.

Roll Call Vote:

Senator Sweet voted No Senator Burkett voted Aye

Senator Ingram voted Aye Senator Bailey voted Aye

Senator Kennedy voted Aye Senator Brandt voted Aye

Senator Compton voted Aye Senator Darrington voted No

Motion received six (6) Ayes and two (2) No (Nays)

IDAPA

16.0305.0203

IDAPA 16.0305.0203, a temporary rule, relating to Aid to the Aged, Blind and Disabled (AABD).

This rule provides an easier application and benefit renewal process for elderly and disabled individuals by allowing and encouraging telephone interviews, instead of those individuals having to go to the Welfare office. This reduces a hardship for these individuals, and streamlines the eligibility process.

Amended Section 05.05.106.03.c is incorrect and has been removed from the rule. Legal aliens entitled to benefits if blind or disabled, are eligible under a different rule - Section 03.05.106.01.b.

The rule eliminates a Medicaid eligible group who's federal funding ended December 31, 2002. It was a program that helped defray a small portion of their Medicare premium (SLMB 3). The Department ended the program because the federal funding ended.

This rule clarifies and aligns eligibility rules between programs, in an effort to simplify those rules. Qualified Medicare beneficiary (QMB), specified low-income Medicare beneficiary (SLIMBL), and the aid to the aged, blind and disabled (AABD), now consider income and resources (related to exclusion and disregards) the same. This will remove ambiguity that will help the Department operate the program more efficiently. An example or definition of Room and Board is "lives with."

MOTION A motion was made by Senator Brandt to approve IDAPA 16.0308.0201. Motion was seconded by Senator Ingram. Motion to approve was carried by voice vote.
IDAPA

16.0308.0201

IDAPA 16.0308.0201, a pending rule, relating to temporary assistance for families in Idaho (TAFI), will increase the maximum TAFI benefit amount from $293 to $309 per month, as approved by the Legislature in 2002.

It will add back into rule a policy, inadvertently omitted, that requires parents who receive TAFI cash payments to assign legal rights to any Child Support payments to the State (up to the grant amount). This is not a new policy, just correcting a rule site.

MOTION A motion was made by Senator Brandt to approve IDAPA 16.0308.0201. Motion was seconded by Senator Ingram. Motion to approve was carried by voice vote.
IDAPA

16.0414.0301

IDAPA 16.0414.0301, a temporary rule, relating to low income home energy assistance (LIHEAP). This places in rule the formula (methodology) for calculating energy assistance benefits. The specific benefit calculations will be placed in the Intake Manual after finding out the annual funding level from the federal government. That manual is updated annually, and is located on the web site.

This rule eliminates the need to update the rules every year, and will save the cost associated with the rulemaking process.

MOTION A motion was made by Senator Ingram to approve IDAPA 16.0414.0301. Motion was seconded by Senator Kennedy. Motion to approve was carried by voice vote.
IDAPA

16.0612.0101

IDAPA 16.0612.0101, a pending rule, relating to the Idaho Child Care program has three (3) significant rule changes.

The Department of Health and Welfare (DHW) will have a rule (recommended by the Child Care Oversight Committee) that requires a child care agreement between the provider and the Department,

  1. This will clarify responsibilities (providers and department),
  2. Enhance accountability, and
  3. Strengthen the DHW's ability to recoup misspent dollars.


Extends minimum health and safety guidelines to all Idaho Child Care Program (ICCP) providers, including family and relative providers.

Removes the exemption for specific relative providers.

Health and safety guidelines:

  1. Must sign self-declaration that no conviction for specific crimes.
  2. Agree to health and safety inspection.
  3. Maintain a current CPR/First Aid certification.


The third change specifies that Child Care payments will be made directly to the providers.

MOTION: A motion was made by Senator Bailey to approve IDAPA 16.0612.0101. Motion was seconded by Senator Burkett. Motion to approve was carried by voice vote.
DISCUSSION: Upcoming meetings; rescheduling targeted case management rule; Section 67-5280, Idaho Code, relating to Legislative review of rules; policy of leadership is to not amend a rule, the Attorney General ruling advises against any committee's making amendments to a rule, statute and/or legislative intent language.
ADJOURN There being no further business to discuss, the meeting adjourned at 10:00 a.m.




DATE: Friday, January 31, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/

EXCUSED:

None
Vice Chairman Compton conducted the meeting.
Department of Health and Welfare - Rules Review
IDAPA

16.0411.0201

IDAPA 16.0411.0201, a pending rule, relating to intensive behavioral intervention certified providers who deliver services through a Developmental Disabilities agency, was presented by Mary Jones, acting bureau chief of the Bureau of Developmental Disabilities.

The purpose of this docket is to establish clear standards for professionals rendering Medicaid services. This pending rule clarifies the requirements in the Developmental Disability Agency rules regarding the professional requirements for individuals providing intensive behavioral intervention to children in developmental disability agencies and in schools. Intensive behavioral intervention is only available to children, ages 0-21 years old that has self-injurious, aggressive or severely maladaptive behavior and severe deficits in areas of verbal and nonverbal communication. These services require prior authorization, periodic, and annual review. Provider qualifications include specific degree requirements and experience. There has been a lack of clarity in certifying intensive behavior intervention professionals as the current rule allows individuals with "related degrees" to be considered and this lead to confusion and an interest in incorporating all standards in rule rather than leaving them subject to interpretation. The rule includes a provision to grandfather currently certified professionals who continue to provide intensive behavioral intervention services.

Three hearings were held to provide an opportunity for individuals to testify. Twenty-seven (27) comments were received. Most articulated strong opposition to the original proposed language, but there were multiple comments that also indicated a value for high standards and the need for quality through competence. Amendments were made in response to these concerns. At this time, Ms. Jones is unaware of outstanding opposition to the rule language.

Work has begun to improve the training to develop provider competency and demonstrations of competencies. This change to the training system is supported through the University of Idaho Center on Disabilities and Human Development as well as an advisory group made up of providers and family members.

MOTION: A motion was made by Senator Ingram to approve IDAPA 16.0411.0201. Motion was seconded by Senator Kennedy. Motion was carried by voice vote.
IDAPA

16.0504.0101

IDAPA 16.0504.0101, a pending rule, relating to domestic violence grant funding, was presented by Celia Heady, from the Idaho Council on Domestic Violence and Victim Assistance Program, formerly titled Idaho Council on Domestic Violence.

Domestic Violence program standards provide guidelines for existing programs and direction for communities that are developing new programs. The Standards Committee has acknowledged that Idaho has reached a level of service provisions that requires development of a formal process to more effectively ensure program accountability and assure victims are treated fairly, professionally, and given the help needed. A minimum quality of services for battered victims and their children should be assured.

Idaho Courts must use only treatment programs that are approved by the Idaho Council on Domestic Violence and Victim Assistance (ICVVA), Idaho Code 18-918. A current list of approved programs is available at www.state.id.us/crimevictim. Where batterers' treatment is ordered by a court, it is now recognized that this treatment should be provided only by those who have an understanding of the complex nature of domestic violence and who meet the standards developed by the ICDVVA and experts in the field of batterers' treatment. In order to be effective, treatment programs for domestic violence perpetrators must meet these standards, and should be closely monitored by representatives of the criminal justice system, members of the community and victim service programs.

The last update of the rules of the council was in 1990. Recent legislative changes to Chapter 52 of the Idaho Code need to be incorporated into the rules as well as updating existing rules. The rule change will incorporate the name change and additional assigned responsibilities of the Council as enacted by the Legislature. Other changes include updating the formatting of the chapter.

MOTION A motion was made by Senator Kennedy to approve IDAPA 16.504.0101. Motion was seconded by Senator Burkett. Motion to approve carried by voice vote.
IDAPA

16.0506.0201

IDAPA 16.0506.0201, a pending rule, relating to a fee for a mandatory criminal history check, was presented by Sue Altman, from the Department of Health and Welfare.

The Department began requiring criminal history background checks for potential foster parents in the mid-1980's. Most of the background checks performed by the Department are required by the Federal Child Protection Act of 1994, which mandates background checks for those individuals providing services to children and vulnerable adults. At the inception of the background process, the Department was charging just the passthrough amount for the background check and has continued this practice to the present. The current passthrough cost and the current background check fee is $34, $24 for the FBI and $10 for the Bureau of Criminal Identification (BCI). Since the start of this process, the Department has fully absorbed their share of the cost of completing the background check. Due to current financial difficulties, the Department has determined a need to increase the background check fee to begin to cover some of the agency's cost of completing the background check. The Department has in the past several years experienced a substantial increase in the number of background checks performed. The Department has not been in a position to increase staff to handle the increased volume of required background check. The upgraded Criminal History automated system as well as streamlining the complete process, and allow the Department to continue to handle the volume without adding staff.

The text of this pending rule has been amended in accordance with Section 67-5227, Idaho Code.

MOTION A motion was made by Senator Bailey to approve IDAPA 16.0506.0201. Motion was seconded by Senator Brandt. Motion to approve carried by voice vote.
IDAPA

16.0601.0101

IDAPA 16.0601.0101, a pending rule, relates to state statutory and federal regulatory changes, was presented by Chuck Halligan, bureau chief for Children and Family Services with the Department of Health and Welfare. This docket had no hearings and three (3) positive comments.

These rules are the result of state and federal changes. In 2001, the Legislature passed two bills that are reflected in these rules. One is the Safe Haven Act, which allows a parent to be exempt from being placed on the child abuse registry if they follow the procedures of abandoning and infant within 30 days of birth.

The other piece of legislation is subsidized guardianship. This process provides support for children and their legal guardian when adoption is not an option for that foster child. The subsidized guardianship parallels the same process that already exists for subsidized adoptions. These guardianships are for foster children whose parental rights have been terminated and adoption has been fully explored, but ruled out for the child.

A recent review of our Federal Title IV-E plan led to several corrections in the rules. Section 403, Section 426, and Section 900 reflect the changes necessary for IV-E compliance. Briefly Title IV-E refers to Section IV-E of the Federal Social Security Act which provides financial assistance to states for foster care and adoption assistance to eligible children in the state's custody.

Other federal changes now require the Department to report on children adopted from foreign countries that are placed in the Department's care. Section 923 sets forth these requirements.

These rules also defined parent and changes were made but not published to consistently reflect the use of the word parent throughout the text. Descriptive summary summarizes the changes.

MOTION A motion was made by Senator Brandt to adopt IDAPA 16.0601.0101. Motion was seconded by Senator Bailey. Motion to adopt was carried by voice vote.
IDAPA

16.0601.0201

IDAPA 16.0601.0201, a pending rule, relating to child protection reports, substantiated and unsubstantiated, was also presented by Chuck Halligan from the Department of Health and Welfare.

This rule deals with dispositioning child abuse and neglect referrals. Department social workers follow a standardized assessment protocol when there are allegations of child abuse or neglect. The primary concern during the assessment is the safety and well being of the child. Once the assessment has been completed a disposition is documented. An individual who has abused or neglected a child is placed on the department's central registry. A central registry of persons who have abused or neglected children is essential for the continuing protection of our children should that individual become a day care provider, foster parent, or adoptive parent. The central registry is part of the required background check for certain employment or activities involving children or vulnerable adults. The registry is not open to the public.

These rules propose changing from five (5) dispositional codes to two (2). Having two dispositional codes will result in greater inter-rater reliability, reflect more accurately the actual incidents of child abuse and neglect in the state and more importantly helps protect children from individuals that should be on the central registry.

Section 560.01(a) adds the words "family services" to clarify that the incident has to be witnessed by a Department of Health and Welfare worker. Sections 561 and 563 just reorganize the existing language. Persons placed on the central registry have the right to appeal that decision and have their name removed from the registry as stated in Section 561.

MOTION A motion was made by Senator Kennedy to approve IDAPA 16.0601.0201. Motion was seconded by Senator Darrington. Motion to approve carried by voice vote.
IDAPA

16.0601.0301

IDAPA 16.0601.0301, a temporary rule, relating to the term "legal parent" was presented by Chuck Halligan, bureau chief for Children and Family Services, Department of Health and Welfare.

The Department made some changes to the word parent in a previous docket through an omnibus clerical correction. Upon further review, the department needed to add better language around the word parent. The term Certified Adoption Professional was added in place of the term qualified individual. Sections 889 through 895 incorporates the change in the term as well as reorganizes the existing sections. Section 890.04 provides the standard appeal process for Certified Adoption Professionals should they be decertified by the Department of Health and Welfare.

MOTION A motion was made by Senator Bailey to adopt IDAPA 16.0601.0301. Motion was seconded by Senator Brandt. Motion to adopt carried by voice vote.
IDAPA

16.0602.0201

IDAPA 16.0602.0201, a pending rule, relating to placement of children in therapeutic outdoor camps not previously covered under the child care licensing rules, was presented by Jim Puett, Licensing Program Specialist for the Department of Health and Welfare.

In 2002, the Senate and House unanimously approved the revisions to the Child Care Licensing Act, giving the Department the authority to oversee children's therapeutic outdoor programs in Idaho. The Department believed this was a very strong endorsement of the project and for the protection of children in out-of-home care who receive services in therapeutic outdoor programs.

The change in the statute was the result of a three-year project to update all of the child care licensing standards, and to include therapeutic outdoor programs. During that process, committees consisting of child care providers, consultants, department representatives and consumers, worked extensively in the development of the rules.

Public hearings were held in Coeur d'Alene and Boise. The only comment received was from a neighborhood association in north Idaho who supports the proposed rules. During the presentation in 2002 for the statute change, representatives from the three (3) outdoor programs in Idaho testified before the Legislature in support of the proposed legislation.

In this time of serious budget constraints, the Department must consider the cost of services provided, including those associated with child care licensing. Currently, there are three (3) programs that have submitted applications and are in the process of being licensed. The Department does not anticipate a significant increase in that number. The cost of including outdoor programs to the licensing responsibility of the Department was debated extensively last year, and an estimated cost breakdown was submitted to the House. Because of the limited number of programs in Idaho, and some of them being associated with currently licensed residential programs, the Department believes it can absorb the additional workload with the current staff. Costs associated with the licensure of the outdoor programs consist primarily of per diem and travel. The estimated annual cost is approximately $2,400.

The Department is looking at the possibility of developing a schedule of licensing fees for residential child care facilities, children's agencies and children's outdoor therapeutic programs. This was discussed with all of the workgroups during the rule revision process, and the majority supported a fee schedule, as long as it was fair. There lies part of the challenge. The Department must look at the size of the programs, services offered, for profit vs. not for profit, in determining if fees are appropriate and if so, in what amount.

The Department is currently surveying surrounding states and continuing to communicate with members of the workgroups on this issue.

MOTION A motion was made by Senator Stegner to approve IDAPA 16.0602.0201. Motion was seconded by Senator Ingram. Motion to approve carried by voice vote.
IDAPA

16.0603.0301

IDAPA 16.0603.0301, a temporary rule, relating to standards for Outpatient Drug Court, was presented by Pharis Stanger, program manager, Substance Abuse for the Department of Health and Welfare.

This tevide. We focused reductions in staffing and services to areas where impact on community, staff, and client safety would be avoided.

The FACS reduction plan took into careful consideration the need to achieve required levels for general fund maintenance of effort for mental health, substance abuse, and infant and toddler programs, to avoid reductions in federal dollars. We are seriously close in all of these programs to having state general funding levels that are below the target maintenance of effort levels required by the federal government, for continuation of funding through Block Grant appropriations. Depending upon the program, our match rate ranges from a high of 80 percent to a low of 50 percent. Most of the remaining state general funds appropriated to FACS are heavily leveraged against federal dollars.

The hold back strategy, as it relates to the reductions in sheltered workshops funding, meets the priorities that were established in the budgeting process. The Department fully recognizes the reductions the workshops are being asked to make have impacted the consumers they serve, and have reduced the funds that are available for them to conduct their business operations. But looking at the overall perspective of the impact, and of the alternatives that we faced when developing our plan, there were no-good options, only options that provided varying degrees of disadvantage.

Mr. Deibert discussed the proposal of diverting $443,400 from the Division of Medicaid budget to the FACS budget to fund sheltered workshops. He outlined the process he would use for determining those funds. If he could do as he wanted with those monies ($443,400), he would find ways to leverage those dollars to maximize the overall impact on the service delivery system for social and behavioral services.

If the $443,400 is returned solely to the workshop program, it will not generate any additional federal match funds that could be used to provide services to the citizens of Idaho. It would benefit only those clients, who receive vocational services through the sheltered workshop program, and the community supported employment.

Last week, the Department received notification from the federal government about our allotment for the substance abuse block grant. We anticipated we would receive between $200,000 to $300,000 in additional federal monies, but the notification indicated we would receive $30,000 in additional federal funding for substance abuse services. In that program, we have a 9 percent increase in the rate of utilization. Substance abuse is one of the most significant and perplexing problems we face in Idaho.

He emphasized the Department looked at the overall perspective for services we provide, or asked to provide by constituents. We have greater priorities, at this time, for our social and behavioral services. We have greater opportunities to maximize the availability of funding by a different utilization of savings that have been identified through the Medicaid Program for the $443,000, and requested the committee members to look at the overall perspective of the service delivery system, and the needs that we have in social behavioral services.

He explained these are challenging times for everyone, but funding the sheltered workshops with Medicaid savings is going in the wrong direction.

Jeff Crumrine, executive director of the Magic Valley Rehabilitation Services in Twin Falls, testified in support of restoring the $443,400 to the sheltered workshops. He presented an analysis about funding sources of operating revenue for the Idaho Association of Community Rehabilitation Programs for FY2003, that being:

  1. Total projected operating budgets - $22,490,851.
  2. Projected revenues from provision of Health and Welfare vocational services (work services and community supported employment) - $3,114,450.
  3. Projected revenues from provision of Idaho Division of Vocational Rehabilitation Services (fees for various vocational services) - $997,488.
  4. Projected revenues from provision of Health and Welfare Medicaid Services (not vocational services) - $6,872,248.
  5. Projected revenues from industrial activities, fund raising and other sources (no fees for vocational services) - $11,506, 665.


He reported, "for every $2.60 made available by the state of Idaho as Health and Welfare and Idaho Division of Vocational Rehabilitation fees for vocational services, the eleven organizations that are members of the Idaho Association of Community Rehabilitation Programs generate $7.40."

M.C. Niland, president of the Western Idaho Training Company in Caldwell and a representative for the Workshop Association, testified in support of restoring $443,400 to the shelter workshop program. She emphasized the effects upon those individuals served by the sheltered workshops. Changes in an individual's work program or living standards can evoke a strong mental or emotional response, or even a violent response, from those affected individuals. She requested the committee seek the necessary $443,400 funding for sheltered workshops.

The committee held a lengthy and detailed discussion related to the matter at hand, diverting $443,400 from the Department of Health and Welfare's Division of Medicaid, and restoring the $443,400 to the Department's Division of Family and Community Services for sheltered workshop services.
MOTION Senator Compton explained the sheltered workshop program is a very important program and he supports it throughly, but realizing the impact on other funds, at this time, to reinstate the $443,400 without additional appropriations to the Department of Health and Welfare would be very difficult. If we have the wisdom to appropriate additional money, then the sheltered workshops should be one of the first priorities added to the list.

A motion was made by Senator Compton to ask in the committee's letter to the Joint Finance-Appropriations Committee (JFAC) to fund an additional $443,400 to the Department of Health and Welfare appropriations, and direct the transfer of these additional funds to the sheltered workshop program.

Motion was seconded by Senator Ingram.

DISCUSSION:

  1. Original intent language showed a Medicaid savings of $923,700 from which JFAC was going to state that $443,400 of the savings would be diverted to the sheltered workshop program. That cannot possibly happen as the state would lose $1.3 million in matching dollars, then we would not have the $923,700 in Medicaid savings.
  2. Ensure JFAC understands the germane committee is asking for an additional funding of $443,400 for the sheltered workshop program, not diverting the funds from Medicaid.
  3. The additional funds would be state general revenues of $443,400 and will have noting to do with the Medicaid funds.
  4. Frustration of the Department of Health and Welfare and providers, and lack of funds for needy programs.
  5. The Department of Health and Welfare should have presented a priority list to the committee, at the beginning of the session, and explained why and how the Department use to determined program cuts. The committee should have been fully informed about the options the Department used to cut programs, and those they did not choose to cut.
  6. If no additional funds become available, revisit the workshop program issue.
  7. Prioritization of programs.


Senator Bailey called for the question.

The beforehand motion was carried by a voice vote of 5 Ayes and 2 Nays.

Senator Stegner voted No. Senator Brandt voted No.

ADJOURNED Due to business being conducted on the Senate Floor, the adult dental discussion will be rescheduled for Monday, April 7, at 8:00 a.m. The meeting adjourned at 9:07 a.m.




DATE: Monday, February 3, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/

EXCUSED:

None
IDAPA

16.0309.0214

IDAPA 16.0309.0214, a temporary rule, relating to changes to the prescription drug rules, was presented by Leslie Clement, bureau chief of Medicaid Benefits & Reimbursement Policy, Division of Medicaid.

Ms. Clement presented a brief overview of the temporary rule docket 16-0309-0214. These rules define Medicaid pharmacy management practices.

The purpose of these temporary rules is to support the Department of Health and Welfare's cost containment efforts by providing access to the right care for the right price.

Idaho paid $114 million for Medicaid prescription drug benefits in fiscal year 2002. Nationally, drug costs have been the fastest growing component of Medicaid expenditures, growing at an annual rate of 20 percent, compared to overall Medicaid expenditure growth of 9 percent.

Prescription drugs are the third most expensive Medicaid benefit following nursing home care and hospital services, and account for 14 percent of the Medicaid budget.

To slow this growth, Idaho ­ like other states are pursuing a variety of cost containment methods including reducing payment rates, requiring generic substitution, and requiring prior authorization of drugs.

Medicaid's existing prescription drug rules do not include the necessary management tools to control spending. The current rules list the specific names of excluded drugs that must be prior authorized by the department.

The number of new brand name drugs and classes of drugs that continuously become available, make it impossible to continue listing each specific drug in rule.

These temporary rules allow Medicaid to review brand name prescription drugs for medical necessity when there may be a less expensive and equally effective drug available.

The concept of "medical necessity" is built into all that Medicaid does in the healthcare field. The state plan, as well as federal rules and state statutes mandates a strict adherence to medical necessity criteria in all areas.

Coupled with medical necessity in the state plan and federal requirements is the principle of "least costly." This rule clearly defines both aspects of this requirement. Medicaid must be able to assure both elements.

These rules describe when a prescription is considered medically necessary, and clarify coverage and limitations.

Additionally, by identifying categories of drugs that must be prior authorized rather than identifying each specific drug, the department does not need to update rules every time a new drug is introduced by the pharmaceutical industry.

Further, under the existing rules, early refills of prescription drugs have been identified as an unnecessary and costly practice that needs to be controlled to reduce unnecessary Medicaid spending.

These temporary rules allow Medicaid to require that 75 percent of the previous prescription has been utilized before Medicaid will pay for a refill. Most private health insurers use 90 percent.

The Department's efforts to address the escalating pharmacy costs intensified in January 2002. Medicaid began implementing a prior authorization process for all drugs exceeding average prescription utilization. On average, 45,000 Medicaid clients receive approximately four prescriptions per month.

After an analysis of the medications it prior authorized, and the resources required to support this initiative, Medicaid determined that a more focused management approach would be more effective than prior authorizing all medications based solely on volume. In addition to reviewing use of prescriptions in amounts exceeding the FDA and currently accepted guidelines, Medicaid identified three therapeutic drug classes for review.

This management review focused on prescription antihistamines, antacids, and antidepressants that were not only prescribed more frequently than other medications, but were also available at varying prices.

Significant costs have been avoided each month since this management review process was implemented in May 2002

Additionally, these rules allow for generic substitution where possible. Medicaid acknowledges that in certain areas ­ especially mental health and other neurological conditions that it is prudent to use brand names as opposed too generic. Medicaid currently functions in this manner.

In addition, therapeutic substitution allows for evaluation within a drug classification to determine clinical efficacy and equivalence, thus allowing price competition to occur based on good science.

The combined effect of these management review approaches, and the 75 percent refill limit, helped to avoid an estimated $4.2 million in pharmacy costs.

These temporary rules became effective in late May. Medicaid's state plan amendment, incorporating the medical necessity definition and clarifying prior authorization requirements was approved by the Centers for Medicare & Medicaid in November 2002.

This rule docket was published in the December Administrative Bulletin. Negotiated rulemaking was not formally conducted because of the mandatory reduction in Medicaid spending, however the Department of Health and Welfare has continuously met with various stakeholders to obtain input.

Two positive comments and thirty-one requests for a hearing were received by the department.

A hearing will be conducted on February 20, 2003 in Boise.

Of those requesting this hearing, 61 percent were received from out-of-state pharmaceutical companies.

Local requests came from advocacy groups and a Boise law firm. Advocacy groups are particularly concerned with maintaining consumer access to newer medications.

These rules will not create a formulary that excludes certain drugs.

These rules will allow Medicaid to make decisions based on good scientific evidence that are already standard practice in commercial health insurance plans.

Medicaid will encourage the utilization of effective medications at the best price, but if a physician provides the evidence that an individual requires a more expensive drug, that drug will be authorized.

The purpose of this rule docket is not about limiting access ­ it is about appropriate access.

Without these rules, the department's ability to manage pharmaceutical costs will be severely restricted.

Medicaid's current budget is based on the expectation that it will be able to continue to manage drug utilization, and slow the rise in our prescription drug costs.

Senator Kennedy discussed a Mountain Home constituent who reported he had surgery and was given a generic pain killer by his doctor. The constituent had a serious reaction to the generic drug. The doctor faxed Medicaid for permission to prescribe the non-generic pain killer, and was denied the right to do that. The question is - in the event someone cannot take the generic substitute recommended by the department, is there a policy that says a patient will go without any medication?

Ms. Clement stated, "No." She will get all the fact pertaining to this case and respond to the question as soon as possible. Senator Brandt explained he had previously contacted the Department of Health and Welfare, and a response should be forthcoming today.

Cynthia Swanson from the National Alliance for the Mentally Ill, testified in opposition to IDAPA 16.0309.0214. She reported the national, state, and local affiliations oppose any restrictions on medications used to treat mentally ill patients.

Jack Lewis, a registered pharmacist in Idaho since 1977, testified in support of the Medicaid rules. Three (3) topics discussed included prior authorization, the 75 percent refill rule, and generic vs brand drugs.

Jim Alexander, a pharmacist in Idaho for 30 years, testified in support of the Medicaid rules. He believes Medicaid is doing the thing right by using generic drugs whenever possible to control the cost of drugs.

Dr. Jim Scheel, a physician in Idaho and a lobbyist for the Idaho Medical Association, testified in opposition to the rules. He has concerns about the 75 percent refill mandate and certain disease classifications such as asthma. He wants physicians to have authority and flexibility to prescribe a drug. The Association realizes the concerns about the increases in pharmaceutical costs, and applauds the Department's efforts in trying to get a handle on the problem. He has concerns about the implementation of the rules.

Thomas Young, MD, for the Division of Medicaid, addressed committee members' questions and concerns pertaining to physicians' flexibility to prescribe drugs; the 72-hour rule to obtain prior authorization and a 24- hour, or less, turnaround time for prior authorization; Medicaid's automated system for prior authorization; some $4.2 million savings in the 2003 Medicaid budget and projected higher savings in the 2004 budget year; quality improvement and studies pertaining to outcomes and recovery times; cross reference of drugs; 156,000 Medicaid patients; children are exempted from the prior authorization rule, and in his opinion, as a practicing physician, Medicaid's effort to control pharmaceutical costs is the right thing to do.

William Roden, representing the Prarmaceutical Research and Manufacturers of America (PhRMA) provided a lengthy testimony in opposition to major portions of IDAPA 16.0309.0214. He testified that on behalf of PhRMA, but more importantly, on behalf of the patients who need the medicines we produce, and the doctors who prescribe them, we believe the temporary rule, as written, is neither in the best interest of constituents who need medicines, nor in the long-term best interest of the health and of the state. There are many issues involved with this rule. He stated his testimony merely touched the surface. Formularies, prior authorization for prescribing practices, preferred drug lists that are dependent for their success in forcing additional rebates by the drug companies, are all issues that should be explored. The one premise they all have common is that "cost" is the determining factor - not the patient or the doctor. He reported this rule has no safeguards for the patient or the doctor. The Department will be the prescriber - the medical practitioner, and it will be based primarily on economic considerations, no the needs of the patient. Mr. Roden requested the temporary rule not go forward, let the Department do its work on the proposed rule, letting it adopt recommendations based on the hearings.

Two persons, who did not testify, but did provided a precise indication in opposition to IDAPA 16.0309.0214, is also noted. (See attached sign-in sheets).

Department of Health and Welfare Deputy Director Joyce McRoberts addressed the questions of Senator Kennedy about a Mountain Home constituent (page 4 of the minutes). She stated the Department had not received a statement from the doctor; therefore, no further action was taken.

Mr. McRoberts distributed a handout explaining changes to the prescription drug rules being made to allow better management of Medicaid spending and to make it easier for clients and providers to understand the Medicaid prescription drug program. The four (4) page handouts are attached. (See attachment # 1)

A discussion and review of numerous sections, subsections, and clarifications of sections, publication and retroactive dates of this rule, was held.

At the discretion of Chairman Brandt, IDAPA 16.0309.0214 will be held in Committee and rescheduled for Tuesday, February 4, 2003, for a final review. This action will allow committee members additional time to review the prescription drug rules.

MOTION At the discretion of Chairman Brandt, this rule docket will be held in Committee and a final review is scheduled for Tuesday, February 4, 2003.
Adjourn There being no further business, the meeting adjourned at 10:25 a.m.




DATE: Tuesday, February 4, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/

EXCUSED:

None
Vice Chairman Compton conducted the meeting.
IDAPA

16.0309.0214

IDAPA 16.0309.0214, a temporary rule, relating to changes to the prescription drug rules are being made to allow better management of the Medicaid spending and to make it easier for clients and providers to understand the Medicaid prescription drug program, was previously presented by Leslie Clement. This rule making was first presented on February 3 and 4, 2003. At that time, the Chairman determined to hold IDAPA 16.0309.0214 to allow committee members additional time to review the rule changes. The hearing today is for the Committee's final review and decision. No additional testimonies were give today.
MOTION A motion was made by Senator Stegner to support IDAPA 16.0309.0214. Motion was seconded by Senator Brandt.

Discussion:

  1. Several committee members reported they have problems with the rule;
  2. One area of concern is, but not limited to, the medical insurance industry;
  3. A physician knows best what a patient's medical needs are;
  4. Concept of the rule will save state many dollars;
  5. Changes will require close monitoring
  6. Changes to Sections 805 and 812.03 reviewed;
  7. Management care;
  8. Will rule return during the 2004 legislative session as a proposed rule;
  9. Dramatic fiscal savings during the past six (6) months,
  10. The language in the rule.




A roll call vote was requested and granted by the Chairman.

Roll Call Vote:

Senator Ingram voted No Senator Burkett voted Yes

Senator Sweet voted No Senator Stegner voted Yes

Senator Darrington voted Yes Senator Compton voted Yes

Senator Brandt voted Yes Senator Kennedy voted No

Senator Bailey voted No

The motion carried 5 Yes and 4 No.

IDAPA

16.0309.0215

IDAPA 16.0309.0215, a temporary rule, relating to reimbursement targeted services, was previously presented by Leslie Clement from the Division of Medicaid. This rule making was first presented on January 24 and 28, 2003. At that time, the Chairman determined to hold IDAPA 16.0309.0215 to allow committee members additional time to review the rule changes. The hearing today is for the Committee's final review and decision.

As a result of the reduction in reimbursement for Targeted Service Coordination (TSC), the rule changes removed all caseload limit requirements, and removed the requirement for availability of a care coordinator on a twenty-four (24) hour basis. As a result of the reduction in the ESC (Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Service Coordinator reimbursement, the rule changes remove all caseload limit requirements, and remove the requirement for availability of a care coordinator on a twenty-four (24) basis.

The rule changes will also reduce ongoing Targeted Case Management (TCM) for the mentally ill from unlimited hours to a maximum of four (4) hours per month, remove all caseload limit requirements, remove the requirement for availability of a case manager on a twenty-four (24) hour basis, and specify that crisis assistance will no longer be a required core element of targeted case management. Also, hours available for initial evaluation and service planning were reduced from eight (8) hours to six (6) hours.

Senator Brandt explained he had met with Department of Health and Welfare Director Karl Kurtz, some TSC providers, and others, to try and resolve the issue of the reduction in hours. The Department showed a willingness to work with providers and try to reach a consensus before the Legislature's seine die. He read into the minutes a letter he received from Director Karl Kurtz. (Attachment #1)

Director Kurtz stated in his letter: "As a follow up to our conversation on January 28, 2003, I would like to state that the Department of Health and Welfare shares your committee's concern regarding the 4-hour limit for targeted case management for persons with mental illness. I agree it is important the Department work with providers to develop an agreed upon methodology for crisis case management hours.

Since the Department shares your concern about situations where there is an emergency, we have and will continue to work with the providers in modifying those rules for emergency situations prior to the adjournment of the 2003 legislative session, so the new rules will go into effect in April or at adjournment.

We hope this action addresses the committee's concerns about Docket No.16-0309-0215."

Committee members expressed concerns with IDAPA 16.0309.0215. After a lengthy review of these rules and specific problem areas within the rules on pages 51, 52, 58, and 61, the following action was taken.

MOTION A motion was made by Senator Darrington to adopt IDAPA 16.0309.0215 as published. Motion was seconded by Senator Stegner.

Discussion:

  1. The rule does not have broad acceptance statewide
  2. Face-to-face monthly meetings;
  3. The promise of the Department of Health and Welfare;
  4. The definition of a case manager's functions and responsibilities,
  5. Crisis situations.
MOTION A substitute motion was made by Senator Kennedy to approve IDAPA 16.0309.0215 on the expressed condition to reject Sections 118.02(d)(i) printed on page 51 of the rule, Section 118.03(b) printed on page 52 of the rule, Section 480.03 printed on page 58 of the rule, and Section 483.12 printed on page 61 of the rule.

The substitute motion was seconded by Senator Ingram.

Roll Call Vote on the substitute motion:

Senator Ingram voted Yes Senator Burkett voted Yes

Senator Sweet voted No Senator Stegner voted No

Senator Darrington voted No Senator Compton voted No

Senator Brandt voted No Senator Kennedy voted Yes

Senator Bailey voted No



The substitute motion failed with 6 No and 3 Yes.

Roll Call Vote on the original motion:

Senator Ingram voted No Senator Burkett voted No

Senator Sweet voted Yes Senator Stegner voted Yes

Senator Darrington voted Yes Senator Compton voted Yes

Senator Brandt voted Yes Senator Kennedy voted No

Senator Bailey voted Yes

The motion carried with 6 Yes and 3 No.

Senator Brandt encouraged everyone to work together to develop rules to help Idahoans in need. He looks forward to working with all the parties involved.

ADJOURN There being no further business to conduct, the meeting adjourned at 9:33 a.m.




DATE: Wednesday, February 5, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/

EXCUSED:

None
GUESTS: See attached sign-in sheets
Vice Chairman Compton conducted the meeting.
IDAPA

24.1401.0201

IDAPA 24.1401.0201, a pending rule related to social work examiners, was previously presented on January 15, 2003, by Rayola Jacobsen, bureau chief, Bureau of Occupational Licenses. At that time, she requested this rule making be held in Committee for a period of time.

Ms. Jacobsen reported that opposition to IDAPA 24.1401.0201at the January 15, meeting had been negotiated and issues were resolved.

On January 15, Craig Dickerson had testified opposing this rule making, but testified today he is now in favor of the rule.

MOTION A motion was made by Senator Kennedy to approve IDAPA 24.1401.0201. Motion was seconded by Senator Brandt. Motion to approve was carried by voice vote.
IDAPA

16.0309.0213

IDAPA 16.0309.0213, a temporary rule, relating to payment for abortions, was presented by Division of Medicaid Deputy Administrator Kathleen Allyn. This rule implements a statutory change and subsequent court ruling on state-funded abortions.

In 2001, the Legislature amended Idaho law to remove a requirement that the state pay for abortions to save the health of the mother. Implementation was delayed until July 1, 2002, because of a court suit challenging the legality of the amended statute.

The court upheld the amendment. At the time, the court ruled that the state law requirement to have two physicians certify the necessity of an abortion violated federal law and could not be enforced by the state. The court's decision was effective July 1, 2002.

The temporary rule implements both the statutory amendment and court decision by:

  1. Removing state payment for abortions to save the health of the mother.
  2. Changing the two physician certification requirement to certification by one physician.


An identical proposed rule was published at the same time as this temporary rule. Unfortunately, the comment period expired after the date for submitting rules to be reviewed this session, however, the pending rule will be presented during the 2004 legislative session.

MOTION A motion was made by Senator Brandt to approve IDAPA 16.0309.0213. Motion was seconded by Senator Kennedy. Motion to approve was carried by voice vote.
IDAPA

16.0309.0216

IDAPA 16.0309,0216, a temporary and proposed rule, relating to dental services for adults, was presented by Lloyd Forbes, manager, State Plan and Waivers Section of the Bureau of Benefits and Reimbursement Policy of Medicaid.

The Department of Health and Welfare is requesting that the Committee extend this temporary and proposed rule. These rules are required to comply with legislative intent language in the Department's appropriation bill, and essentially limit adult dental procedures to emergency situations.

Retta Green from the Idaho Community Action Association (ICAN), testified in opposition to IDAPA 16.0309.0216.

J. L. Byington testified in opposition to IDAPA 16.0309.0216, and requested that dental services be restored.

Ronald Matthews from the Idaho Community Action Association, testified in opposition to IDAPA 16.0309.0216.

Jessica Fry testified and explained the difficulties in finding dentist and doctors willing to take Medicaid clients. She did not indicate support or opposition to IDAPA 16.0309.0216.

Committee members reviewed several sections of IDAPA 16.0309.0216, and asked many questions about the rules. The Committee also reviewed numerous pages of the rule such as pages 68, 70, 71, and 72. Other areas discussed included the following:

  1. Emergencies and who would deem a case as an emergency. A dentist determines a case as an "emergency";
  2. If a dentist deemed a case as an "emergency" would services be provided? Ms. Allyn answer "yes";
  3. Dental services for clients more than age 21;
  4. Pregnant women and children (PWC);
  5. Reimbursement rates;
  6. Rule changes will address the Governor's concerns.


A lengthy discussion was also held by the committee members about the Joint Finance Appropriations Committee's (JFAC) directions given to the Department of Health and Welfare to "not cover adult dental" except for an emergency, and the responsibilities of germane committees, and the setting of policies.

At the discretion of Vice Chairman Compton, no decision will be made at this time for IDAPA 16.0309.0216. The rule will be held while the chairman reviews concerns and issues with the House Health and Welfare Committee's chairman.

RS12308 Michael Sheeley, executive director, Board of Dentistry, explained the purpose of RS12308 is to bring the Board of Dentistry's examination statutes into step with actual practice. That is accomplished by specifically stating that the Board of Dentistry may accept the examination results of regional and national testing organizations for licensing purposes and that those regional and national testing organizations will establish the passing standards for the examinations they administer.

This legislative change is necessitated by the following:

1. Antiquated Requirements in the Existing Statute - The existing language of Idaho Code 54-918 requires the Board of Dentistry or its agent to conduct written and clinical examinations in dentistry and hygiene in order to ascertain the fitness and qualifications of applicants for licensure in Idaho. That requirement does not change in the proposed legislation. Traditionally, the Board has conducted the written examination through an agent, the American Dental Association. That will not change in the proposed legislation. At one time the Board conducted its own clinical examination and graded the examination in accordance with the mandate of the existing statute (passing grade of 70 percent for each section of an examination with a general average passing grade of 75 percent). Due to increasing numbers of applicants and a lack of appropriate testing facilities as well as trained, independent examiners, in the mid-1980's the Board discontinued conducting the clinical examination and joined with a number of other states to participate in a regional testing organization to conduct the clinical examination. That regional testing organization is referred to as the Western Regional Examining Board (WREB). For purposes of the clinical examination requirement, the Board of Dentistry accepts the results of the WREB examination and, since 2001, also accepts the results of the Central Regional Dental Testing Service (CRDTS). Those testing organizations conduct examinations at dental and dental hygiene schools using trained and calibrated examiners. It will greatly simplify the Board of Dentistry's application of the examination statute if the language is clarified to specifically state that the regional or national testing organizations shall establish the examination's passing grade standard or level of competency.

2. Recent District Court Decision - An applicant for licensure who received a general average passing grade of 74 percent (as opposed to the 75 percent required by the existing statute and the testing entity) on an examination required by the Board of Dentistry brought legal action requesting that the district court direct the Board of Dentistry to issue the applicant a license. The district court found in favor of the applicant and directed the Board to grant the license. The district court determined that the board of Dentistry was required to average the scores of all the examinations conducted, both written and clinical, in order to arrive at a general average passing grade. The Board has traditionally relied upon the literal language of the statute to require that an applicant score at least 70 percent on each section of an individual examination, with the general average grade for each individual examination to be at least 75 percent. Given the disparate nature of the written and clinical examinations, The Board has never favored or adopted the averaging approach identified by the district court in the legal proceeding. Recognizing that the existing language of the examination statute was somewhat imprecise, the Board of Dentistry preferred to revise the language of the statute rather than appeal the adverse district court decision.

The proposed changes to the Board of Dentistry's examination statute does not place any additional costs or examination requirements upon an applicant for licensure. Nor will the proposed legislation cause any additional fiscal impact upon the Board of Dentistry. The examinations currently required of an applicant by the Board of Dentistry will not change. The Board's ability to administer the examination requirements of the Idaho Dental Practice Act will be greatly enhanced by the proposed legislation.

MOTION A motion was made by Senator Darrington to send RS12308 to print. Motion was seconded by Senator Sweet. Motion was carried by voice vote.
RS12386 Decker Sanders, a program specialist within the Department of Health and Welfare, presented RS12386.

This legislation addresses concerns with the inspection of retail tobacco outlets by an adult enforcement officer with the assistance of a minor at locations often called "age restricted."

Under, Idaho Code Title 39 Chapter 57 Section 04 it is unlawful, ". . . to sell or distribute or offer tobacco products for sale or distribution at retail or to possess tobacco products with the intention of selling at retail without having first obtained a tobacco permit from the department . . . " The permit is provided free of charge. Section 10 paragraph 3 requires "The Department shall conduct at least one (1) random, unannounced inspection per year, with the assistance of a minor, at all locations where tobacco products are sold or distributed at retail to ensure compliance with this chapter." This places the Department in the position of conducting a compliance inspection with the assistance of a minor at all permitted locations including bars and adult entertainment establishments which have "age restrictions" imposed upon them in other statutes. The Department has been assured of the legality of conducting compliance checks with the assistance of a minor in such establishments.



The safety of inspectors, both adult and minor, is a primary concern during all inspection operations. Program policy allows inspectors to not conduct an inspection if either the adult or minor is uncertain or uncomfortable with attempting an inspection at any given location. The level of concern is significantly higher at locations where alcohol is the predominate product served or consumed and at adult entertainment locations.

RS12386 addresses these concerns by first adding a definition for a "minor exempt permit" in Section 02, found in lines 20 through 25 in this legislation. The definition calls out requirements that businesses applying for this permit have at least 55 percent of their total revenues result from the sale of alcoholic beverages for consumption on-site or identified with adult oriented entertainment.

RS 12386 also amends Section 10 to indicate that the Department of Health and Welfare will conduct inspections for minor exempt businesses without the assistance of a minor at locations with a minor exempt permit, and with the assistance of a minor at all other permitted locations.

Businesses receiving a minor exempt permit would be exempt from the random and unannounced inspections with the assistance of a minor routinely conducted by the Department of Health and Welfare. These businesses would be subject to a random and unannounced inspection by an adult inspection officer for all aspects of compliance with Title 39 Chapter 57 except an attempt to purchase tobacco products by a minor.

Businesses with a minor exempt permit, under this amendment, may be subject to an inspection with the assistance of a minor as part of the investigation of a written complaint of such a business selling tobacco products to minors.

The changes proposed in RS 12386 decreases the potential for the compromise of the safety of an inspecting team or minor assisting with compliance inspections, while keeping all permit holders subject to random and unannounced inspections for compliance with Title 39 Chapter 57.

Inspections based upon the investigation of a written complaint and enforcement actions by law enforcement agencies are not effected by this change.

MOTION A motion was made by Senator Brandt to send RS12386 to print. Motion was seconded by Senator Darrington. Motion was carried by voice vote.
ADJOURN There being no further business to conduct, the meeting adjourned at 10:00 a.m.




DATE: Thursday, February 6, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/

EXCUSED:

None
RS 12835 Senator Burkett presented this proposed legislation, RS12835. This bill provides authority to the Department of Health and Welfare to allow outreach, including media, for the Children's Health Insurance Program (CHIP). Legislative intent language in the 2001 Health and Welfare appropriation law restricted CHIP outreach to the minimum required by federal law. The Department of Health and Welfare requires authority to reinstate the previous CHIP outreach program. This bill specifically restates the original intent of the Legislature to allow funds for outreach as long as CHIP funding does not exceed the current funding cap.

There is no fiscal impact to the General Fund. Total funds expended on CHIP are currently governed by a cap of $3.8 million. This legislation allows for outreach from current budgeted funds as long as total expenditures do not exceed the mandated cap.

MOTION A motion was made by Senator Bailey to send RS12835 to print. Motion was seconded by Senator Kennedy, and was carried by a voice vote.
RS12689C1 Terri Meyer, from the Department of Health and Welfare, presented RS12689C1. The federal law requires that the state of Idaho begin using the National Medical Support Notice (NMSN) by October 1, 2001, or the first legislative session after October 1, 2001. The NMSN is a standardized federal form that will provide information and a standardized procedure to employers and administrators of group health plans in obtaining medical support for Idaho's children.

Idaho Code 32-1214 is substantially impacted by the changes needed to implement the National Medical Support Notice. This section will be rewritten to bring Idaho Code into compliance with the requirements of the NMSN process. This will include an outline of the procedures notifying employers and group health plan administrators of their duties and obligations that are required by the NMSN.

Fiscal Impact - The first year the estimated cost is $60,400 and $45,400 thereafter.

MOTION A motion was made by Senator Darrington to send RS12689C1 to print. Motion was seconded by Senator Ingram, and was carried by a voice vote.
RS 12320 Russell Duke, from the Department of Health and Welfare, presented RS12320. When those sections of the Idaho Code relating to the Department of Health and Welfare were separated from those provisions relating to the Idaho Department of Environmental Quality, the enforcement provisions of the Food Establishment Act were not adjusted accordingly. This legislation corrects the references to statutory enforcement provisions in the food establishment act to reflect current enforcement statutes applicable to the Department of Health and Welfare. There is no fiscal impact to the General Fund.
MOTION A motion was made by Senator Burkett to send RS12320 to print. Motion was seconded by Senator Bailey, and was carried by a voice vote.
RS 12322C1 Christine Hahn, M.D., from the Department of Health and Welfare, presented RS12322C1. While long believed to be an inherent power of the Department of Health and Welfare, as successor to the department of public health, there are no specific statutory provisions authorizing the imposition of quarantine and isolation. Such powers are historically recognized as necessary to prevent the spread of infectious or communicable diseases. In recognition of the need to be prepared to deal with the threats of drug resistant and emerging diseases and the threat of chemical or biological terrorism, this bill clarified the authority of the director of the Department of Health and Welfare to impose isolation and quarantine orders. It also provides for the possibility of immediate judicial review of such orders as a safeguard to those who may be affected by such orders.
MOTION A motion was made by Senator Ingram to send RS12322C1 to print. Motion was seconded by Senator Compton, and was carried by a voice vote.
RS 12387 Jerry Anderson, from the Department of Health and Welfare, presented RS 12387. Currently the professional disciplines to be a Designated Examiner are not consistent within Idaho Code 16-2403 and 66-329.

Idaho Code 16-317 allows the Department to designate "other mental health professionals" to be examiners besides those included in statute, but Idaho Code 66-317 restricts the qualifications to designated professional disciplines.

To make the codes consistent, the definition of "Designated Examiner" in Idaho Code 16-243(4) is struck and moved to Idaho Code 66-317. In Idaho Code 66-317 language is added that the designated examiner by "qualified by training and experience in the diagnosis and treatment of mental or mentally related illnesses or conditions." Specific references to degrees are struck from Idaho Code 66-317. Those qualifications will be created in the Department's rules.

The language struck in Idaho Code 66-329(d) again removes specific reference to degrees, but does not take away from the original intent of the law that "at least one (1) designated examiner shall be a psychiatrist, licensed physician or licensed psychologist."

These changes will create consistency between Idaho Code 16-2403, 66-317 and 66-329, and enable the Department of Health and Welfare to create rules to govern the appointment of examiners for adults as well as for children.

MOTION A motion was made by Senator Darrington to send RS12387 to print. Motion was seconded by Senator Burkett, and was carried by a voice vote.
RS 12752 Molly Creswell, from Givens Pursley LLP, presented RS 12752. The Idaho State Board of Medicine has suggested that some sleep disorder clinic or laboratory personnel (polysomnographers) have been practicing respiratory therapy without a license. The purpose of this legislation is to provide for the issuance of limited permits to some polysomnographers allowing them to continue to perform their limited scope of duties in the field of respiratory therapy without becoming licensed as full-fledged respiratory therapists. The legislation provides qualifications for permits, including educational requirements, and places polysomnographers under the direction of the respiratory therapy licensure board, a board under the direction of the Idaho State Board of Medicine. There is no fiscal on the General Fund.
MOTION A motion was made by Senator Compton to send RS 12752 to print. Motion was seconded by Senator Kennedy, and was carried by a voice vote.
DISCUSSION Senator Burkett expressed a concern about written comments from constituents about a rule or issue and not being made a part of the Committee's official records, and recorded in the minutes. He believes written comments received from constituents, and presented during the Committee's public meetings and submitted by a committee member should be included as a part of the official record and be included in the Committee's minutes.

After discussion, the Chairman agreed that written comments from constituents discussed or submitted during a public committee meeting can be indicated within the minutes. The Chairman generally responds in writing to constituents' written comments. [After final approval, the Committee's public meeting minutes are posted on the Internet.]



Senator Burkett previously expressed a concern pertaining to IDAPA 16.0309.0215, targeted case management services, presented on January 24, 2003, by Leslie Clement from the Division of Medicaid. Upon clarification with Ms. Clement, her statement shown in the minutes of January 24, 2003, is correct; therefore, the January 24, 2003 minutes will not be amended in that portion of her testimony.

The committee's secretary was directed by the Chairman to change the minutes of January 24, 2003, to reflect written comments submitted by a committee member.

ADJOURN There being no further business to conduct, the meeting adjourned at 9:00 a.m.




DATE: Friday, February 7, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/

EXCUSED:

None
Gubernatorial Reappointment Gubernatorial Reappointment to the Idaho State Board of Health and Welfare:

Quane Kenyon of Boise, was reappointed by Governor Dirk Kempthorne for a term of four (4) years, commencing January 7, 2003 and expiring January 7, 2007. He is a retired professional journalist. His civic and community activities have included serving on the Idaho State Board of Health and Welfare since July 1999, serving on the State University Centennial Task Force, and co-chair of the State Affairs Committee. He is also a former president of the Idaho Press Club. His political affiliation is Republican.

Gubernatorial

Reappointment

Gubernatorial Reappointment to the Idaho State Board of Health and Welfare:

Richard T. Roeberg M.D., of Caldwell, was reappointed by Governor Dirk Kempthorne for a term of four (4) years, commencing January 7, 2003 and expiring on January 7, 2007. Dr. Roeberg is a retired physician. His civic and community activities have included serving on the Idaho State Board of Health and Welfare since July 1999, serving on the Southwest District Medical Society, Idaho Medical Association, American College of OB-GYN, University of Idaho Alumni Association Board of Directors, University of Idaho Foundation, and as a member of the Rotary International and a member of the Caldwell Rotary Club. His political affiliation is Independent.

Gubernatorial Appointment Gubernatorial Appointment to the Idaho State Board of Health and Welfare:

Jack T. Riggs, M.D., of Coeur d'Alene, was appointed by Governor Dirk Kempthorne for a term of four (4) years, commencing January 7, 2003 and expiring on January 7, 2007. Dr. Riggs served as Idaho's 38th Lieutenant Governor, and was elected to the Executive Committee, National Conference of Lt. Governors. He is a former member of the Idaho State Senate.

Dr. Riggs currently serves on as Chair, Idaho Bio-Security Council; Chair, Idaho Council on Children's Mental Health; executive committee member of the National Lieutenant Governor's Association; the council of State Government (CSG), National Executive Committee; CSG National Health Trends Tracking Team, and co-chair, CSG National Health Capacity Task Force.

MOTION A motion was made by Senator Compton to approve confirmation of Quane Kenyon, Richard T. Roeberg, and Jack T. Riggs to the Idaho State Board of Health and Welfare. Senator Ingram seconded the motion, and was carried by voice vote.

Floor sponsors are: Senator Compton for Jack T. Riggs, Senator Burkett for Quane Kenyon, and Senator Kennedy for Richard Roeberg.

IDAPA

16.0309.0216

IDAPA 16.0309.0216, was previously presented by Lloyd Forbes, from the Division of Medicaid, on February 5, 2003. At that time, at the discretion of the Chair, no decision was made for IDAPA 16.0309.0216 in order to allow additional time for the committee members to address concerns and issues pertaining to this rule making.

The Department of Health and Welfare requested this temporary and proposed rule be extended. These rules are required to comply with legislative intent language in the Department's appropriation bill, and essentially limits adult dental procedures to emergency situations.

Committee members discussed many concerns and issues pertinent to adult dental care and the Joint Finance Appropriations Committee's (JFAC) legislative intent language. No additional public testimony was heard today on IDAPA 16.0309.0216.

MOTION A motion was made by Senator Stegner to reject IDAPA 16.0309.0216. Motion was seconded by Senator Kennedy.

Discussion:

  1. Rejection of the rule is putting the Department of Health and Welfare(DHW) into a difficult position;
  2. Authorities of Joint Finance Appropriation Committee (JFAC) and germane committees;
  3. Addressing the reality of JFAC actions, this being the first opportunity this Committee has had to become involved in this action;
  4. Policies of Health and Welfare should be set by the Senate Health and Welfare Committee (germane committee);
  5. Financial causes that determined JFAC's action;
  6. A possible budget item in the current DHW budget expenditures for about $1.8 million to purchase 79 new automobiles at an average cost of $23,000 per automobile - almost the exact amount of money required for the DHW to fund this $8.4 million project on dental care of adults once it reached the federal match;
  1. It was suggested that this Committee send a message, to all affected state agencies, that we deem it more important to take care of the health of Idahoans than it is to, in a tight economic year, purchase 79 new automobiles;
  2. Modification of the rule and the expansion of emergency services;
  3. Reinstate emergency services;
  4. Dentists making the decisions of "emergency situation" and will that cause a significant increase in the number of people obtaining services without increasing the overall cost of the Medicaid program;
  5. Legislative intent language;
  6. Optional programs and federal program mandates;
  7. Priority issues being preventive medical care;
  8. Erosion of powers of germane committees through legislative intent language of the budget committee;


Roll Call Vote to reject IDAPA 16.0309.0216:

Senator Ingram voted Yes Senator Burkett voted Yes

Senator Sweet voted Yes Senator Stegner voted Yes

Senator Darrington voted Yes Senator Compton voted Yes

Senator Brandt voted Yes Senator Kennedy voted Yes

Senator Bailey voted Yes

The motion to reject IDAPA 16.0309.0216 was carried unanimously by a voice vote. IDAPA 16.0309.0216 failed.

After the above action, committee members further discussed the following issues:

  1. Support of professional and dedicated employees of the Department of Health and Welfare;
  2. Authority of JFAC vs. authority of each committee
  3. This committee sets policy and JFAC must set budget;
  4. How immensely interrelated are committees' setting policy, and when a policy is set it is expected to either raise revenue to meet that policy, or to find revenue by realigning current resources meet that policy.
  5. Appreciation to Scott H. Kido, DMD, for his letter and concerns regarding preventive and restorative dental care for adult Medicaid recipients.
  6. Committee members' were encouraged to attend the Board of Health and Welfare meetings and expand their knowledge about the department and its rules. [The 2003 Board meetings are January 27, April 25, June 20, and November 6 and 7, 2003]
  7. Draft a letter to DHW outlining the wishes and suggestions of the committee.
BUDGET: A briefing pertinent to the appropriations and expenditures of the Department of Health and Welfare was presented by representatives from the Department of Health and Welfare, the Division of Financial Management, and the Legislative Services Office.

Mond Warren, bureau chief, Bureau of Fraud and Abuse Investigations, presented an update about the Department's fraud and abuse investigations. The Department's Fraud and Abuse Program consists of the fraud investigation unit and the surveillance and utilization review (SUR) unit. The SUR investigates fraud and abuse within the Medicaid program by monitoring and reviewing provider billing practices, and reviewing provider records of support services billed to the program. The SUR Unit staff works closely with the Medicaid staff to ensure there are proper controls in the Medicaid claims processing system. They work with Medicaid policy staff when policy or guidelines are identified that should be revised or strengthened.

Medicaid investigations are initiated through complaints from providers and clients, referrals from agencies, and through proactive targeting or reviews of claims to identify improper billing. Once investigated, issues may be resolved through provider education or policy revision, recovery of funds from the provider, civil monetary penalties imposed, provider agreement termination or program exclusion, or a referral for prosecution.

The fraud unit investigates department-wide allegations of fraud to include Medicaid providers, Welfare programs and contractors. The Unit also conducts internal investigations.

Fraud investigators are stationed statewide to respond to any investigation, working with other state and federal agencies to investigate and prosecute providers and clients identified as defrauding Medicaid or Welfare programs.

A fraud and abuse chart outlining Medicaid penalties collected, Medicaid cost avoidance, Medicaid dollars collected, identified Medicaid fraud, and identified Welfare fraud cases was reviewed. (Attachment #1)

Mr. Warren informed the Committee the lack of staff impacts the amount of dollars the Bureau of Fraud and Abuse units collected. Additional investigators would increase the ability to respond more quickly and identify and collect more resources. The Bureau currently has 35 pending cases of which 10 are investigations of providers, and 25 are client investigations.

MINUTES A motion was made by Senator Burkett to approve the minutes of January 24, 2003 as written after the written comments from constituents have been included in the minutes with the constituent's name, date of correspondence, and subject matter, being included in the minutes. Senator Compton seconded the motion, and motion to approve was carried by a voice vote.
ADJOURN Due to committee members' appearance requirement to be on the Senate Floor, the Chairman announced the budget presentations scheduled, but not heard, will be rescheduled. The meeting adjourned at 10:30 a.m.




DATE: Monday, February 10, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/

EXCUSED:

None
RS 12918C1 Idaho Hospital Association President Steven A. Millard presented RS 12918C1. He explained health care organizations maintain a formal peer review process in order to reduce the occurrence of illness and death, and to enforce and improve standards of medical practice. This process enables research, discipline, and medical study. Records used in peer review are confidential and privileged, and are not subject to subpoena or discovery proceedings, as set forth in Idaho Code 39-1392.

This legislation serves to clearly define key terminology, to include: "peer review," "peer review records," and "[atient care records." It also delineates the circumstances upon which records lawfully may be released by the health care organization that owns them; and it clarifies immunity from civil liability. Further, a new section fully delineates the health care organizations' reporting obligations to the state board of medicine and details the sanctions and content of mandatory reports. In addition, the measure clarifies that no physician or surgeon shall be required to report information known, learned or discovered as a result of access to peer review records or participation in peer review. There is no fiscal impact on the state General Fund.

MOTION A motion was made by Senator Darrington to send RS12918C1 to print. Motion was seconded by Senator Stegner, and was carried by a voice vote.
ADJOURNMENT The meeting adjourned at 8:55 a.m.




DATE: Tuesday, February 11, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Stegner, Sweet, Bailey, Burkett, Kennedy
MEMBERS ABSENT/

EXCUSED:

Senator Ingram
HJM 1 HJM 1 was presented by Representative Mike P. Mitchell from the House of Representatives.
This is a Memorial to Idaho's Congressional Delegation urging their support of equalizing Medicare payments to physicians and other healthcare providers in Idaho and other less populous, rural states by the removal of geographic practice cost indices that are currently part of the Medicare payment formula. These indices result in much higher reimbursements for physicians and healthcare providers in large, urban areas for the same services.
This disparity is inherently unfair and is having a negative impact on the Medicare patient's access to care in rural states. S2873 removes the geographic practice cost index. There is no fiscal impact on the General Fund.
MOTION A motion was made by Senator Compton to send HJM to the Floor with a Do Pass recommendation. Motion was seconded by Stegner. Motion was approved by voice vote. Senator Burkett will sponsor HJM 1.
HCR 1 HCR 8, concerning the impacts of obesity on the citizens of Idaho and declaring January through March as Obesity Awareness months, was presented by Representative Margaret Henbest from the House of Representatives.
The purpose of this resolution is to declare the months that the Legislature is in session Obesity Awareness Months and to urge communities, businesses and schools to develop an awareness of the causes, symptoms and long-term consequences of this condition and how it can be prevented. There is no cost to the General Fund.
MOTION A motion was made by Senator Stegner to adopt HCR 8. Motion was seconded by Senator Kennedy. Motion was carried by voice vote. Senator Burkett will sponsor HJM 8.
DFM BRIEFING Judie Wright from the Division of Financial Management (DFM) presented an overview of the division's budget process concerning the Department of Health and Welfare. Ms. Wright reported the relationship between DFM and the Department of Health and Welfare (DHW) is very good. She has always found the DHW to be very cooperative.
Ms. Wright described the budget cycle, a budget request process, maintenance of current operations, and enhancement requests. (See Attachment #1)
Legislative Services Office Richard (Dick) Burns from the Legislative Services Office (LSO) outlined the organizational structure of the Department of Health and Welfare. He informed the committee members about the Fiscal Year 2003 General Fund appropriations, dedicated funds, and federal funds and how the funds are distributed. He also discussed a comparison chart of the General Fund and Medicaid, and the full-time positions (FTP) of the Department of Health and Welfare from 1994 to a projected FTP in 2004. A more detailed data report can be obtained from Attachment #2.
Department of Health and Welfare Department of Health and Welfare Deputy Director Gary Broker briefed the committee members about the appropriations received by the department. The budget appropriations are dispersed to divisions within the department. I.e., Medicaid, Family and Community Services, Welfare, Health, and indirect support program. His briefing included a discussion about the Fiscal Year 2003 appropriations, expenditure categories, personnel distribution, and the department's perspective full-time positions. The Department of Health and Welfare employs 2,921.91 full- time staff positions. A more detailed budget data report can be obtained from Attachment #3.
Mr. Broker also referred committee members to the department's Facts/ Figures/Trends publication for 2002-2003. It gives a good picture of the budgets and how funds are spent.
ADJOURN Due to committee members' being called to the Floor, Don Berg will be rescheduled at a later time. The meeting adjourned at 10:40 a.m.




DATE: Wednesday, February 12, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Stegner, Sweet, Bailey, Kennedy
MEMBERS ABSENT/

EXCUSED:

Senators Ingram and Burkett
S 1067 This legislation, S1067, was presented by Decker Sanders, a program specialist with the Department of Health and Welfare. The legislation will amend Title 39 Chapter 57 Idaho Code, Prevention of Minors' Access To Tobacco Products

S1067 addresses concerns with the inspection of retail tobacco outlets by an adult enforcement officer with the assistance of a minor at locations often called "age restricted." Under, Idaho Code Title 39 Chapter 57 Section 04 it is unlawful, "...to sell or distribute or offer tobacco products for sale or distribution at retail or to possess tobacco products with the intention of selling at retail without having first obtained a tobacco permit from the department..." The permit is provided free of charge. Section 10 paragraph 3 requires "The Department shall conduct at least one (1) random, unannounced inspection per year, with the assistance of a minor, at all locations where tobacco products are sold or distributed at retail to ensure compliance with this chapter." This places the Department in the position of conducting a compliance inspection with the assistance of a minor at all permitted locations including bars and adult entertainment establishments which have "age restrictions" imposed upon them in other statutes. The Department has been assured of the legality of conducting compliance checks with the assistance of a minor in such establishments.

The safety of inspectors, both adult and minor, is a primary concern during all inspection operations. Program policy allows inspectors to not conduct an inspection if either the adult or minor is uncertain or uncomfortable with attempting an inspection at any given location. The level of concern is significantly higher at locations where alcohol is the predominated product served or consumed and at adult entertainment locations.

S1067 addresses these concerns by first adding a definition for a "minor exempt permit" in Section 02, found on page one, lines 20 through 25 in the bill. The definition calls out requirements that businesses applying for this permit have at least 55% of their total revenues result from the sale of alcoholic beverages for consumption on site or identified with adult oriented entertainment.

S1067 also amends Section 10 to indicate that the Department will conduct inspections for minor exempt businesses without the assistance of a minor at locations with a minor exempt permit and with the assistance of a minor at all other permitted locations.

Businesses receiving a minor exempt permit would be exempt from the random and unannounced inspections with the assistance of a minor routinely conducted by the Department. These businesses would be subject to a random and unannounced inspection by an adult inspection officer for all aspects of compliance with Title 39 Chapter 57 except an attempt to purchase tobacco products by a minor.

Businesses with a minor exempt permit under this amendment may be subject to an inspection with the assistance of a minor as part of the investigation of a written complaint of such a business selling tobacco products to minors.

The changes proposed in S1067 decreases the potential for the compromise of the safety of an inspecting team or minor assisting with compliance inspections while keeping all permit holders subject to random and unannounced inspections for compliance with Title 39 Chapter 57.

Inspections based upon the investigation of a written complaint and enforcement actions by law enforcement agencies are not effected by this change.

MOTION A motion was made by Senator Kennedy to send S1067 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Darrington. Motion was carried by voice vote, and Senator Kennedy agreed to sponsor S1067.
S 1068 This legislation, S1068, was presented by Michael Sheely, director of the Board of Dentistry. The purpose of this proposed legislation is to revise the Board of Dentistry's examination statutes to clarify their operation and make them consistent with the actual practice and requirements of the Board of Dentistry's ability to conduct qualifying examinations and establish passing standards for the examinations it conducts.

In addition, the proposed revision authorizes and specifies that the Board of Dentistry can require and accept the results of examinations conducted by approved regional and national examining organizations. The proposed legislation also specified that an applicant seeking reinstatement of a lapsed license may be required to successfully complete such examinations in the Board of Dentistry's discretion as will adequately test the applicant's competency.

MOTION A motion was made by Senator Compton to send S1068 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Stegner. Motion was carried by voice vote, and Senator Sweet will sponsor.
S 1073 This legislation, S1073, was presented by Terri Meyer, chief of the Bureau of Child Support Operations in the Division of Welfare within the Department of Health and Welfare.

The proposed legislation is directly in support of the mission of the Department of Health and Welfare, getting children enrolled in private health insurance. Child Support, and the nationwide Child Support program, has a vitally important role because we work on behalf of children who grow up in divorced, never married, or separated families. For these children, the risk of not having health care coverage is great.

Ms. Meyer discussed how these children get covered by private health insurance when parents have it available. The Department has not always done this, but in 1998, welfare reform required every child support order to include provisions for medical support. Since 1998, every child support agency in the nation has been working with thousands of employers and health plan administrators to meet this demand. It is a confusing process, leaving employers and plan administrators overwhelmed, and some children without health insurance coverage.

Immediately after the requirement was implemented, employers and plan administrators began to pressure Congress for uniform policies and strategies to make the system easier and more cost effective.

Congress responded by establishing the Medical Child Support Working Group. This group had 30 members who represented the legitimate competing concerns of employers, small businesses, the health insurance industry, and the government. The group was tasked with "improving the health of our nation's children."

The Congressional work group relied heavily on the experiences of employers and Plan Administrators as they identified the barriers and proposed solutions to enrolling children in their parent's private health insurance, and the proposed legislation represents Idaho's desire to adopt the nationally standardized tools and procedures set forth by the Congressional work group, led by employers and Plan Administrators.

Ms. Meyer talked about requiring the use of standard documents and procedures. It is important to know that these documents and procedures were designed by and for employers and Plan Administrators.

The Department's emphasis is on supporting employers and Plan Administrators because of the vitally important role they play in getting child support dollars, and medical coverage, to families who need these things.

Last year, Idaho's child support program administered more than 76,000 cases, and collected and distributed more than $100 million. Every dollar we collect, and every health insurance policy we establish for a child, rests primarily with employers and Plan Administrators.

Getting and keeping health care coverage for children -- as we are currently doing it -- is complicated and resource intensive for everyone involved. There are no consistent procedures to follow, and this is frustrating, especially for families. The goal of this legislation is very simply "Better health for Idaho's children."

This legislation will help us accomplish that goal by:

1. Eliminating barriers to enrollment and coverage in either parent's private health insurance

2. Ensuring that coverage is obtained in the easiest, most cost effective manner possible for both parents.

On a local level, The Bureau of Child Support has been working with the Department of Insurance and the local chapters of the American Payroll Association, who represent approximately 2000 employers in four states.

We will continue to work closely with them and develop the supports they say they need in order to make this easier:

1. Website -- with a simple orientation, directions, and frequently asked questions (FAQs).

2. 1-800 number

We know our ability to improve in this area means supporting them.

This legislation repeals the current code sections in child support and insurance law, and replaces them with the following:

Section 2 -- Purpose. The State of Idaho has an interest in ensuring children receive health insurance benefits through private means when available.

Section 3 -- Definitions section.

(5) Medical Child Support Order -- This definition has been broadened to include what is now called a Qualified Medical Support Order (QMSO).

--Large self-insured employers like Micron and Albertsons currently require families to go through a second, completely separate court process to establish a qualified medical support order (QMSO).

--This is an expensive, cumbersome process for families.

--This legislation establishes a single process for everyone.

(7) Obligor ­ Parent ordered to carry health insurance ("obligated parent.")

(8) Party -- This term is used when the child is not in the custody of either parent, but IS in the custody of other family members, friends, or is in the custody of the state Foster Care or Department of Juvenile Corrections.



Section 4 -- A large section with nine (9) parts:

Sets forth the standardized requirements and procedures to be used.

Paragraph 1 Establishes one process for establishing a medical support order and does away with the QMSO process.

Paragraph 2 Establishes the National Medical Support Notice (NMSO) as the document that will be used by Child Support agencies, employers and health plan administrators to gather and communicate required information.

1. The state will issue the NMSN for all new child support cases and transmit the document to the obligated parent's employer.

2. Upon receipt of the Notice, the employer is required to review and act on it within 20 business days.

--The Notice will inform the employer of the type of coverage required and the terms of the coverage.

--The Notice includes a response form that will allow employers to notify the child support agency of any reason it cannot provide coverage according to the terms of the order.

--If the employer can provide coverage, they forward the Notice to their insurance plan administrator

3. The plan administrator has 40 days to complete their part of the Notice and return it to the child support agency.

--Their part of the Notice requires information about whether coverage will be provided and when, and a description of the coverage.

4. Procedures for making a plan choice when more than one plan is available:

(1) If the obligated parent has already chosen a plan, the child is enrolled in the same plan.

(2) If the obligated parent has not chosen a plan, the plan administrator will work with the Department or the other parent to choose a plan.

(3) If the other parent is not available to make the choice, the Department will choose the least expensive benefit plan available for the child.

5. The procedures for employers for withholding child support and medical insurance premiums from the obligated parent's income.

--In some cases, the amount of the obligated parent's child support payment, combined with the cost of medical insurance, will exceed 50% of their income. In these cases, the order for medical support will not be enforced.

6. Requires the plan administrator or employer to provide everything necessary to use the insurance benefit to either the Department or the other parent.

7. Requires that insurers not hold state agencies such as Medicaid to different standards for payment of claims.

--Ensuring Medicaid is the payor of last resort.

8. Allows claims to be submitted without the obligated parent's approval.

9. Forbids insurers from considering Medicaid eligibility for children who are eligible for private insurance coverage.

--Ensuring Medicaid is the payor of last resort.

Section 5 -- Lists for employers and plan administrators the exceptions to immediate enrollment:

1. Employer does not offer insurance

2. The obligated parent does not qualify for insurance

3. The obligated parent is no longer employed

4. The obligated parent is a new employee on probation. In these cases, the child will be enrolled when insurance becomes available.

Section 6 -- Makes it clear that a child shall not be denied enrollment in medical insurance because:

1. They were born out of wedlock

2. They are not claimed as a dependent on the obligated parent's federal income tax return

3. They do not live with the obligated parent -- or in the insurer's service area

4. There is no current open enrollment season.

Section 7 -- Requires that all support orders and divorce decrees issued after July 1, 2003 include notice to obligated parents that they must proceed to enroll the child in a health insurance plan, and that failure to do so will result in the Department or the other parent working directly with the employer to enroll the child.

Section 8 ­ Gives the Department the authority to promulgate rules to support the implementation and day-to-day business governed by these new laws. Also provides the obligated parent a way to protest the NMSO (mistake of fact).

Section 9 -- Safety net providing a way to start the process over again.

--This would apply to existing cases where medical support is not being provided as ordered, and to

--Any new cases where insurance has now become available.

--The process starts by notifying the obligated parent, giving them 20 days to apply for health insurance coverage for the child.

--If they fail to follow through, this allows the Department or the other parent to work directly with the employer to establish coverage.

Section 10 -- Prohibits employers from dis-enrolling or eliminating coverage, with these exceptions:

--The obligated parent is no longer required to carry the health insurance

--The child has been enrolled in another plan

--The employer has eliminated family health coverage for all its employees

--The obligated parent is no longer employed

Section 11 -- Requires that the employer notify the Department or the other parent within 20 days when coverage is no longer available.

Section 12 -- Provides a penalty of $300 that may be imposed on employers or health plan administrators if they fail to process the NMSN as required.

Sections 13 through 15 -- Housekeeping, and clean up all cross references.

This legislation simplifies the efforts required of employers and plan administrators -- in ways designed and proposed by them. And because this will improve the health of Idaho's children by making it easier to access private health care coverage.

MOTION A motion was made by Senator Compton to send S1073 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Stegner. Motion was carried by voice vote. Senator Bailey voted No. Senator Compton agreed to sponsor S1073.
S 1074 This legislation, S1074, was presented by Richard Schultz, administrator of the Division of Health, Department of Health and Welfare.

He explained when sections of the Idaho Code relating to the Department of Health and Welfare were separated from those provisions relating to the Idaho Department of Environmental Quality, the enforcement provisions of the Food Establishment Act were not adjusted accordingly. This bill corrects the references to reflect current enforcement statutes applicable to the Department of Health and Welfare.

MOTION A motion was made by Senator Stegner to send S1074 to the Floor and Consent Calendar. Motion was seconded by Senator Bailey. Motion was carried by voice vote.
ADJOURN There being no further business to discuss, the meeting adjourned at 9:12 a.m.




DATE: Thursday, February 13, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
ABSENT/

EXCUSED:

MINUTES A motion was made by Senator Bailey to approve the minutes of February 12, 2003, as written. Motion was seconded by Senator Kennedy, and was carried by a voice vote.
S 1075 Christine Hahn, the state epidemiologist, presented SB 1075. She explained this legislation tries to accomplish the following things:

  1. Clarifies the authority of the director of Health and Welfare to impose isolation and quarantine.
  2. Clarifies the difference between the two authorities.
  3. Establishes a system for a person upon whom isolation or quarantine is imposed, to seek relief through the courts.


This legislation defines isolation as separation of infected persons from others to prevent spread of an infectious agent; quarantine is defined as restriction to or from a place or premises where an infectious agent or hazardous material exists, and provides the authority to impose isolation and quarantine is explicitly stated. Also, the wording allows judicial review of any order of isolation or quarantine.

Diseases which may require isolation include measles, tuberculosis, pneumonic plague, and smallpox. Some other conditions which may require isolation include persons exposed to infectious agents such as anthrax-laden powders, or persons exposed to smallpox.

During the past six (6) years, the health department has not issued an order of quarantine, which would limit the movement of persons into or out of a given locations, such as a building. This authority would be used only if a health risk were determined to occur at a site and it was necessary to do so, such as occurred in Washington DC, last year at the Hart Senate Building during the anthrax attacks.

A number of questions pertaining to "authority" and statute was discussed.

MOTION A motion was made by Senator Burkett to send SB1075 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Stegner, and motion was carried by a voice vote. Senator Bailey was assigned as sponsor of SB1075.
S 1076 Jerry Anderson, from the Department of Health and Welfare, presented SB1076. He reported that currently the professional disciplines to be a Designated Examiner are not consistent within Idaho Code 16-2403, 66-317, and 66-329. Idaho Code 16-2403 allows the Department of Health and Welfare to designate "other mental health professionals" to be examiners besides those included in statute, but Idaho Code 66-317 restricts the qualifications to designated professional disciplines.

These changes will create consistency between Idaho Code 16-2403, 66-317, and 66-329 and enable the Department of Health and Welfare to create rules to govern the appointment of examiners for adults as well as for children.

This legislation and the definition of a "designated examiner" was difficult to understand as written.

MOTION A motion was made by Senator Stegner to send SB1076 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Darrington.

Roll Call Vote on motion to Do Pass:

Senator Ingram voted Yes Senator Burkett voted No

Senator Sweet voted No Senator Stegner voted Yes

Senator Darrington voted Yes Senator Compton voted No

Senator Brandt voted Yes Senator Kennedy voted No

Senator Bailey voted No

The motion totaled 5 No and 4 Yes. Motion failed.

Discussion Committee members briefly discussed clients who have a terminal illness and who are "just: over the maximum limit to receive assistance from Medicaid and Welfare, those clients who fall "through the cracks" and yet need assistance. The need for a waiver for certain cases in this type of situation.

Senator Kennedy read Idaho Code 39-416 - Rules adopted by district board - Procedure.

(1) The district board by the affirmative vote of a majority of its members may adopt, amend or rescind rules and standards as it deems necessary to carry out the purposes and provisions of this act.

(2) Every rule or standard adopted, amended, or rescinded by the district board shall be done in a manner conforming to the provisions of Chapter 52, Title 67, Idaho Code.

(3) At the same time that proposed rules and standards are transmitted to the director of legislative services, they shall be submitted for review and comment to the state board of health and welfare, and to the board of county commissioners of each county within the public health district's jurisdiction. The state board of health and welfare shall, within seventy-five (75) days of receipt of a district board's proposed rules, disapprove of the adoption of the rules if, on the advice of the attorney general, such rules would be in conflict with state laws or rules. The state board of health and welfare shall immediately advise the district board as to the reason for the disapproval.





DATE: Friday, February 14, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, and Kennedy
MEMBERS ABSENT/

EXCUSED:

Senator Burkett
GUESTS: See attached sign-in sheets
JUVENILE

CORRECTIONS

The Idaho Department of Juvenile Corrections (IDJC) Director Brent D. Reinke presented a legislative update.

The Idaho Juvenile Justice Commission is an advisory group appointed by the Governor to provide citizen input into the state's juvenile justice policy decisions. The Commission consists of 21 members including a host of multidisciplinary professionals and youth from across the state. The Commission is given the responsibility of distributing up to 250 different grants totaling $2.5 million each fiscal year to local communities throughout Idaho. Outcome-based grant distribution encompasses the entire continuum of care-from prevention to aftercare.

Mr. Reinke presented information pertinent to the Idaho juvenile offender system, such as:

  1. Probation, education, detention, etc.;
  2. Functional Family Therapy Program (FFT);
  3. Performance-based standards;
  4. Length of custody (LOC);
  5. Custody Review Board;
  6. FY2003 original appropriations and FY2002 average cost-per day for education, administration, food services, medical services, maintenance, laundry and clothing, and janitorial services. In FY2002, the total average cost-per day was $169.81;
  7. Composition of Custody population, 88 percent male and 12 percent females. And 22 percent of Juveniles have serious emotional disturbance (SED) difficulties
  8. A general flow chart of Idaho's juvenile justice process;
  9. 6,500 youth are on county probation and for every 10 juveniles committed to IDJC five (5) will commit no further acts of crime and two (2) will be adjudicated of a new misdemeanor or felony (reintegrating into the local juvenile justice system), two (2) will descend to the Idaho Department of Corrections (IDOC), and one (1) will be recommitted to the Idaho Department of Juvenile Corrections.


One of the measures of the Department's success is reducing the juveniles' length of custody in the Department, FY2002 8,000 juveniles in custody, and currently in FY2003 the number is 6,500. The Department recently reported that 55 percent of the juveniles committed to the Department's custody, substance abuse is noted as a primary, secondary or tertiary behavioral problem. Recognizing this as a serious issue, the Department has taken steps to increase the amount of treatment services that are offered to these juveniles in both state and contract facilities.

Another measure of success is the regionalization of services effort. This undertaking is of significant importance to the communities and families of the juveniles in the Department's custody, As more services are regionalized, it increases the opportunity to successfully transition the juvenile back into the community.

Dr. Ryan Hulbert discussed the Idaho Council on Children's Mental Health's (ICCMH) community report card published December 2002. This report card provides an overview of children's mental health services provided through the Department of Health and Welfare, Department of Juvenile Corrections, and the State Department of Education. The services provided are targeted toward children with a serious emotional disturbance and their families. The ultimate goal of the services is to provide the child and family with the services and supports necessary to maximize the family's ability to provide care for their child at home.

The Department of Health and Welfare (DHW) provides services to children with serious emotional disturbance and their families through voluntary agreements with the parents. Children must meet be diagnosed with an emotional disorder and a substantial impairment of functioning in major life activities. In FY 2002 (July 1, 2001 - June 30, 2002) the following children's mental health services were provided to children and families by DHW:

  1. 4,273 families contacted Children and Family Services;
  2. 1,802 children received comprehensive mental health assessments;
  3. 2,282 children and families were provided case management;
  4. 42 children were placed in therapeutic foster homes at a cost of $216,510;
  5. 1,059 children accessed Department-funded day treatment;
  6. 149 families accessed family support services at a total cost of $22,791;
  7. 888 Children were placed in hospitals for psychiatric care at a total cost of $6,716,839;
  8. 9,085 children accessed outpatient care at a cost of $18,651,865;
  9. 120 children accessed residential care through the children's mental health program;
  10. 53 children accessed respite care at a cost of $21,825;
  11. CAFAS (Child and Adolescent Functional Assessment Scale) - The CAFAS is a standardized nationally recognized instrument that measures a child's functioning in a variety of life domains. The range of scores is 0-240. Children at entry into Department services had an average score on the CAFAS of 107. Children at discharge from Department services had an average score of 62.
  12. Family satisfaction surveys - Families receiving children's mental health services from the Department are provided an opportunity every 120 days to anonymously report their impressions of the services provided. Results of the surveys indicate that 93.1 percent rate accesses to services positively, 97.3 percent rate appropriateness of services positively, 97.2 percent rate effectiveness positively, and 93.8 percent rate parental involvement positively.


The Department of Juvenile Corrections (IDJC) serves youth committed to it under the Juvenile Corrections Act, for the care, control and competency development of adjudicated juvenile offenders. The IDJC has a legal mandate to provide reasonable medical care, including mental health care, to all juveniles in its custody who have those needs. The Department is further identifying juveniles in custody who meet the Department of Health and Welfare's definition of having a serious emotional disturbance. Juveniles with serious emotional disturbances constitute only a portion of those in custody who needs mental health care, but they are the most seriously ill and most likely to need community-based services upon their return home.

The IDJC is now tracking the following indicators to better identify the juveniles in the state's custody who are defined as seriously emotionally disturbed (SED).

  1. 114 youths identified as SED, August 2002;
  2. Average CAFAS score upon initial assessment was 129;
  3. 29 youth received a comprehensive assessment by DHW either prior or at the time of commitment to IDJC;
  4. 10 youth were staffed by a local council in an effort to provide a comprehensive community-based plan;
  5. 20 youth were determined eligible for public mental health services after discharge from IDJC custody;
  6. State Department of Education, through local school districts, ensures that eligible students, age 3-21, are provided with appropriate and individualized education under the Individuals with Disabilities Education Act (IDEA). Students must meet the eligibility requirements for emotional disturbance under IDEA;
  7. 935 students identified as ED, 3.21 percent of the total special education population, an increase from 2.59 percent in 1999-2000.


The IDJC, in coordination with the Police Officer Standards and Training Academy under guidance from the Juvenile Training Council, has established two (2) academic courses leading to certification, according to a legislative mandate, all county probation officers and detention officers must be certified by October 1, 2004. Currently, detention officer and probation officer courses have successfully graduated a total of approximately 150 students from a diverse cross section of all Idaho counties.

The IDJC has three (3) regions, Region 1 Districts 1 and 2 in Lewiston; Region 2 Districts 3, 4, and 5 in Nampa, and Region 3 Districts 6 and 7 located at St. Anthony, Idaho. Regionalization provides benefits to Idaho citizens by keeping juveniles closer to their home communities and families, increasing the juvenile's accountability to the victim, and increasing the opportunity to successfully transition the juvenile back to the family and community.

MEDICAID Chairman Brandt requested Division of Medicaid Deputy Administrator Kathleen Allyn to inform the Committee about Medicaid adult dental coverage options. The Committee previously heard a presentation about IDAPA 16.0309.020216 pertaining to adult dental coverages.

Ms. Allyn reported currently the Medicaid program provides only emergency services to the adult population. The program also provides some limited coverage of other services dignity of the client. Both the House and Senate Health and Welfare Committees have expressed concern that the current program does not address the needs of the most vulnerable clients within the Medicaid population. At the request of the Senate and House Health and Welfare Committees, The Department of Health and Welfare examined some options that were proposed during the hearings on these rules.

The three (3) options for consideration are:

Option 1 - The Idaho State Dental Association, in a letter from Dr. Scott Kido, provided several suggestions to redesign the adult dental program. The proposal would result in reducing service options to include preventive and limited restorative services focused primarily on the most vulnerable clients. The proposal also includes an increase in dental fees to improve access to services. Implementation of the proposal will require restoration of the balance of the $7.1 million in SFY2003 and $8.4 million reduction in SFY2004.

Option 2 - This option would be budget neutral and provide the basic preventive and restorative services to the most vulnerable developmentally and physically disabled in the Medicaid program as well as continuing emergency services to all adults. Those emergency services would include care to adults with tooth and gum conditions at high risk for periodontal infection likely to lead to bacteremia or other serious health concerns, as requested by the House Health and Welfare Committee, provided these services are limited to the most serious conditions. Budget neutrality would be accomplished by a reduction in nonessential services in the children's dental program in the area of orthodonture. In consultation with the dental community, the requirements for orthodonture will be restructured which will allow approximately $600,000 to be shifted to coverage of the most vulnerable adults to provide the limited preventive and to coverage of the most vulnerable adults to provide the limited preventive and restorative program. This would allow preventive and restorative coverage to approximately 3,500 individuals.

Option 3 - The third option is to maintain the current adult emergency dental service program.

Scott H. Kido, a representative of the Idaho State Dental Association (ISDA), testified and presented written comments.

Dr. Kido explained the ISDA believes an adult Medicaid dental care benefit program should be restored, and the ISDA does not support reinstating the program as it was before it was eliminated. That program, while well intended and through no fault of the Department of Health and Welfare, was flawed, wasteful, caused significant economic and ethical challenges to the providing dentists, and did little to encourage personal responsibility for the recipient's own oral health.

At a subcommittee meeting last week, he reported he observed several very separate issues.

a) Provide preventive dental care to the physically and mentally handicapped. This issue is ISDA's highest priority. There are many handicapped citizens that simply are not capable of taking care of themselves. Unchecked and untreated dental disease can become a life threatening problem in these individuals. Treating these patients after their dental problems become so severe is practically inhumane. It also proves to be extremely expensive to the state. Expensive root canals, crowns, bridges, etc., should not be part of a preventive dental plan.

b) Allow individuals with high risk health problems, i.e., artificial heart valves, diabetes, medicated for seizure disorders, cancer patients that have received radiation treatment to the jaws, organ transplant recipients, etc. While this group suffers from serious medical problems, they probably are not in the same situation as the mentally and physically handicapped. Most of these individuals are capable of independent living and can assume sone responsibility for their own oral health. The fact that these people cannot afford their dental care seems to be the issue. People with these conditions need a consistent level of dental care to protect them from serious complications.

c) Reducing the use of hospital emergency rooms to treat dental problems. Often someone covered by Medicaid will seek hospital emergency room care for help with a dental problem. Typically it is a dental problem that has been neglected for a long time and now has developed into an emergency situation. The difficulty Medicaid patients have accessing not only private dental offices, but also community health center dental clinics are very well documented. Usually the emergency room does not actually fix the problem, but will treat the symptoms with pain medicine and antibiotics.

Unfortunately, helping the issues (a) and (b) will not affect issue (c). The mentally and physically handicapped and the seriously ill are not the ones predominately using the hospital emergency rooms to treat dental problems. . . not yet anyway. Unless a preventive dental program isn't made available to them soon, I'm afraid we will see a rise in their usage of hospital emergency rooms too.

To address the problem, we need to study the old Medicaid dental program. Instead of devoting resources to adequately fund programs focused on preventing dental disease before it starts, (dental disease is almost entirely preventable) the state had been attempting to pay to fix every cavity in every tooth in every Medicaid recipient in Idaho, with few limits to what that care was. All dental insurance companies in Idaho have a maximum annual benefit cap, except Medicaid. How could the state possible afford to pay for such a high level of dental care, for the segment of our population that has 80 percent of all the state's dental disease? Of course, it couldn't, and the results are what we are dealing with today.

What Idaho needs is a complete overhaul of the Medicaid system. Develop a system that promotes prevention and instills an attitude of personal responsibility for one's oral health, Utilize all of the highly trained dental professionals in the state. Limit the care provided to preventive and limited restorative procedures, and pay a higher fee for the limited procedures. If a patient wants a higher level of care than what the state can afford, let them pay for it themselves. Most dentists would be willing to offer significant discounts to these people (especially if they are fairly compensated for the other covered procedures), yet the patients would still have a personal investment in their own oral health. ISDA stands ready to advise and help implement such a program.

Until this happens, the cycle will continue where the poor have bad teeth and poor oral hygiene, where dentists are fed up with Medicaid and drop out. We think you can work with the Division of Medicaid to implement covering these people. Whether it takes modifying the legislative intent of the rule cutting adult Medicaid coverage, or expanding the term emergency dental services only.

Dr. Kido explained he wants to offer help at a common sense, practical approach to Medicaid dental coverage. We have lost the focus on fixing the immediate issue...which is, what to do now? Kathleen Allyn has worked very hard at coming up with a politically, realistic approach that will get us by until we have time to really fine tune reform.

Dental care for the disadvantaged is such an important issue to me, my passion sometimes leads me into conflicts with people I regard with deep respect. I understand the realities of this budget year that makes implementing a plan such as what I outlined quite difficult, if not impossible, in the short term. I cannot walk away from what I think is the right thing to do, and I cannot turn my back on a population that desperately needs dental care . . . but I believe it would be best in the long term if ISDA and the Medicaid department work together for a common goal.

If we simply restore the old program, it will be very difficult to cut it back later. It would be much better to add preventive and limited restorative to an emergency only program. So if we can't implement option 1 now, I would support finishing out the year with option 2 and then working out option 1 later. But option 1 won't happen later without clear directives from the legislators.

Option 2 has some weaknesses, but they can be worked out as long as we know the intent of the legislators. I'm assuming option 2 would include the preventive/limited restorative codes ISDA suggested in option 1, only that the coverage would be limited to the most helpless and needy.

Again, I offer my experience and knowledge of dental matters in anyway that will be of help to you and the State.

ADJOURNMENT There being no further business to conduct, the meeting adjourned at 10:15 a.m.




DATE: Tuesday, February 18, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
MEMBERS ABSENT/

EXCUSED:

None
MINUTES: A motion was made by Senator Kennedy to approve the minutes of February 13, 2003 as written. The motion was seconded by Senator Bailey, and motion was carried by a voice vote.
WITCO

PRESENTATION

Mary Carol Niland, president and executive officer of the Western Idaho Training Co. (WITCO) in Caldwell, Idaho, explained WITCO provides services for adults and children with disabilities who live in Canyon, Owyhee, Gem, Payette, Ada, Elmore, and Washington counties in Idaho and eastern Oregon. The community rehabilitation programs (CRP) are unique in that they are the oldest providers of community-based services for adults with disabilities in Idaho. Most were incorporated in the early 1970's with the assistance of the Idaho Division of Vocational Rehabilitation and the Department of Health and Welfare. Additionally, these are all private not for profit service providers.

All of these CRPs were originally incorporated to provide employment services, including competitive placement in jobs in private industry, as well as work services (work in center-based sheltered environments). Over time, most members have added other services, which may include developmental therapies, residential care, case management or other programs. However, our primary focus remains work and employment. Our belief is that all people, regardless of disability, should be afforded the opportunity to work and become a contributing member of society. We view this as both a right and a responsibility.

In about 1996, the Department of Health and Welfare made major changes in the disability service system. Vocational contracts were eliminated and an hourly fee for service was instituted. The provider network was expanded from 13 providers to more than 30 providers, and the system was expanded to include for profit providers. The ideas behind these changes were to expand consumer choice of services and providers and to create competition, which would drive rates down. Choice was indeed expanded, but rates did not go down. Additionally, with few exceptions the "not for profit" providers stopped providing services above the amount the state had available to pay. Consequently, between the implementation of these changes and this fiscal year, before the holdbacks, the waiting list for vocational services grew to 190 individuals. The holdback has led to this list now exceeding 600 individuals. The list contains names of people who currently receive no vocational services as well as those who wish to have services increased or reinstated to the level they were before the holdback.

All individuals, even those who contact us directly, must be referred to the Idaho Division of Vocational Rehabilitation (IDVR). IDVR completes or orders a vocational assessment or evaluation, and based on that information as well as interviews with the consumer and those of importance in that consumer's life, determines the type and amount of service appropriate for the individual. When vocational rehabilitation maintains a case, services are funded through a combination of 80 percent federal and 20 percent state dollars. Although many states use Medicaid dollars to fund vocational services, Idaho does not. In Idaho the funding is 67 percent general fund and the remainder is Social Services Block Grant (SSBG) money and TANF (Temporary Assistance for Needy Families) dollars the state moved to the SSBG.

IACRP members work with businesses and industries throughout Idaho, and those businesses either employ people we train, or they contract with us for work. The work is provided by the individuals with disabilities we serve who all earn real wages. The wages our consumers earn offset the cost of state provided services and SSI (Social Security Insurance) payments.

Despite what we consider being the best possible return on tax payer dollars, when the Governor ordered a 3.5 percent reduction in general funds, the Department of Health and Welfare cut the general funds appropriated for vocational services by 27.5 percent. The huge cuts are also destabilizing the vocational system. Statewide there are staff layoffs.

We ask you to support us in our efforts to reduce the amount of our FY2003 budget cut and support intent on the FY2004 budget.

A fact sheet about the appropriations impacts on the Idaho Association of Community Rehabilitation Programs was reviewed. (Attachment #1)

The Department of Health and Welfare Deputy Director Joyce McRoberts testified and disagreed with the 27.5 percent budget cut to the vocational rehabilitation programs. She explained the Department reviewed the budget as a whole, and made the least budget cuts where it would affect services to clients.

The Committee agreed to request the Division of Family and Community Services Administrator Kenneth Deibert to meet with them and explain the process used in determining program cuts, and the fairness of those programs' reductions.

IDAPA 16.0309.0216 Division of Medicaid Deputy Administrator Kathleen Allyn met with the Committee again to discuss options pertaining to IDAPA 16.0309.0216. At a previous meeting, three (3) options were discussed pertinent to preventive and restorative services to meet the needs of the most vulnerable Medicaid adult dental clients. The three (3) options were again reviewed.

She discussed the testimony of February 14, 2003, presented by Scott Kido, president of the Idaho Dental Association. Dr. Kido's plan for co-pay and limitations (caps) are issues to consider later, but are not feasible at this time and not included in the current Medicaid appropriations.

A lengthy discussion about the 2002 JFAC legislative intent language was held.

MOTION A motion was made by Senator Stegner that the committee formerly recommends to the Joint Finance Appropriation Committee, through the supplemental appropriation process, to modify the legislative intent language to reflect the Senate Health and Welfare Committee's desires for Option #2. The motion was seconded by Senator Compton, and motion was approved by a voice vote.

[Option #2 - This option would be budget neutral and provide the basic preventive and restorative services to the most vulnerable developmentally and physically disabled in the Medicaid program as well as continuing emergency services to all adults. Those emergency services would include care to adults with tooth and gum conditions at high risk for periodontal infection likely to lead to bacteremia or other serious health concerns, as requested by the House Health and Welfare Committee, provided these services are limited to the most serious conditions. Budget neutrality would be accomplished by a reduction in nonessential services in the children's dental program in the area of orthodonture. In consultation with the dental community, the requirements for orthodonture will be restructured which will allow approximately $600,000 to be shifted to coverage of the most vulnerable adults to provide the limited preventive and restorative program. This would allow preventive and restorative coverage to approximately 3,500 individuals.]

ADJOURN There being no further business to discuss, the meeting adjourned at 10:20 a.m.




DATE: Wednesday, February 19, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Sweet, Bailey, Burkett, and Kennedy
MEMBERS ABSENT/

EXCUSED:

Senators Ingram and Stegner
Gubernatorial

Appointment

Gubernatorial Appointment of Jacki Rolph of Idaho Falls, Idaho, to the Commission for the Blind and Visually Impaired.
Jackie Rolph was appointed by Governor Dirk Kempthorn for a term commencing July 26, 2002 and expiring July 1, 2005. She explained her goals and desires to serve the blind and visually impaired population. She was born in Bonneville County and lived all life in Idaho Falls. She is self-employed, married 31 years, and has one child. She is not a member of the National Federation of the Blind. Her civic and community activities have been with the INEEL in eastern Idaho.
MOTION A motion was made by Senator Darrington to recommend the appointment of Jacki Rolph to the Commission for the Blind and Visually Impaired. Motion was seconded by Senator Sweet, and motion was carried by voice vote.
IDAPA

27.0101.0201

IDAPA 27.0101.0201 a temporary and proposed fee rule, relating to the rules of the Board of Pharmacy, was presented by Richard Markuson.

He explained a memorandum from Kent E. Nelson, deputy attorney general for the Contracts and Administrative Law Division, that the House Health and Welfare Committee raised issues regarding the registration fee under Docket No. 27.0101.0201. In light of the House committee's concerns, the Board of Pharmacy wishes to revise the rule to reduce the proposed registration fee to $100 and to clarify that the product may be registered either by the manufacturer or by a wholesaler or other entity in the sales chain. This change will allow wholesalers or other entities to have a product registered in Idaho even if the manufacturer is not particularly interested in doing so.

The mechanism for accomplishing this revision would be for the Legislature to reject Docket 27.0101.0201 with the understanding that the Board will enact the new rule as a temporary and proposed rule. The changes in the new rule are in Subsection xi. No further action is required by the Senate Health and Welfare Committee.

IDAPA

58.0101.0201

IDAPA 58.0101.0201, a pending rule relating to the control of air pollution in Idaho, was previously rejected by the Committee. This rule making revises the open burning rules.

The Department of Environmental Quality Director C. Stephen Allred explained this pending rule, IDAPA 58.0101.0201, is needed to update the state implementation plan that the Environmental Protection Agency (EPA) must approve for Idaho to have a delegated program under the federal Clean Air Act. Without that update, the federally enforceable rules are inconsistent with Idaho current law, and could be enforced through the federal courts by third parties.

MOTION A motion was made by Senator Brandt to approve IDAPA 58.0101.0201, with the rejection of Subjection 605, Subsection 608, Subsection 611 and Subsection 614. Motion was seconded by Senator Darrington, and motion was carried by a voice vote.
ADJOURNMENT The meeting adjourned at 10:15 a.m.




DATE: Thursday, February 20, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Sweet, Bailey, Burkett, Kennedy
MEMBERS ABSENT/

EXCUSED:

Senator Stegner
GUESTS: See attached sign-in sheets
S 1067 S1067, relating to enforcement actions of tobacco permittees, and amending Sections 39-5702 and 39-5710, Idaho Code, was presented by Decker Sanders, a program specialist within the Department of Health and Welfare.

A proposed amendment to SB1067 is Section 2, page 2 of the printed bill, line 23, following "minor" insert: If it is otherwise lawful for the minor to be on the premises of the permittee." was reviewed.

The proposed changes consist of the addition of a "minor exempt" tobacco retail permit, and language to allow the conduct of tobacco permit inspections without the assistance of a minor for all businesses holding a "minor exempt" tobacco retail sales permit. Businesses self-identify for the "minor exempt" tobacco retail sales permit by certifying that at least 55 percent of their revenues come from the sale of alcohol for consumption on site, or adult oriented entertainment. Businesses provided a "minor exempt" tobacco retail sales permit are routinely inspected by an adult inspector for all random and unannounced inspections during the year, and are subject to the same level of investigation as all other permit holders for written complaints.

Any minor entering a tobacco specialty store is not subject to being cited for a violation of Idaho law, in the same way as when entering a bar. Idaho Code makes it clear that a minor entering a bar is subject to a misdemeanor. Idaho law does not make it a misdemeanor for a minor to enter a tobacco specialty shop. More correctly, it is a violation of Idaho Code 39-5706(4) as it relates to self-service displays for businesses to allow minors into the store.

Idaho Code 39-5706 requires vendor assisted sales, and makes sales from self-service displays illegal. Stores gain an "exemption" allowing the use of self-service displays if their total merchandise is comprised of at least 75 percent tobacco products, and minors are not allowed in the store. The store must post notice that minors are not allowed in the store on all entrance doors. Owners of businesses, with at least 75 percent of their merchandise in tobacco products, have an option to not allow minors into their businesses in exchange for having self-service displays in their stores. "Exempt" business owners that allow minors to enter or remain an "exempt" tobacco store violated Idaho Code 39-5706(4). The compliance inspection expectation is that the minor would be refused entrance at such locations.

Idaho Code, Section 5706 Vendor Assisted Sales (1):

  1. It shall be unlawful to sell or distribute tobacco products by any means other than vendor assisted sales, where the customer has no access to the product except through the assistance of the seller.
  2. On and after January 1, 2000, it shall be unlawful to sell or distribute tobacco products from a vending machine. From January 1, 1999, to December 31, 1999, vending machines shall be located in a place not accessible to persons under the age of nineteen (19) years.
  3. It shall be unlawful to sell or distribute tobacco products from self-service displays.
  4. Stores with tobacco products comprising at least 75 percent of total merchandise are exempt from requiring vendor assisted sales, if minors are not allowed in the store and such prohibition is posted clearly on all entrance doors.


  1. Minors assisting with inspections do not violate Title 39 Chapter 57. This protection is found in Idaho Code 39-5703(2) and is applicable only when conducting compliance inspections.


Idaho Code, Section 5703 Possession, Distribution or Use by a Minor:

(1) It shall be unlawful for a minor to possess, receive, purchase, sell, distribute, use, or consume tobacco products or to attempt any of the foregoing.

(2) It shall be unlawful for a minor to provide false identification, or make any false statement regarding their age in an attempt to obtain tobacco products.

  1. A minor who is assisting with a random unannounced inspection in accordance with this chapter, shall not be in violation of this chapter.


  2. A minor may possess, but not sell or distribute tobacco products in the course of employment, for duties such as stocking shelves or carrying purchases to customers' vehicles.


  3. Penalties for violations by a minor. A violation of this chapter by a minor shall constitute a misdemeanor and shall be punishable by imprisonment in any appropriate facility not exceeding six (6) months, a fine not exceeding $300, or both such fine and imprisonment. The court may, in addition to the penalties provided herein, require the minor and the minor's parents or legal guardian to attend tobacco awareness programs or to perform community service in programs related to tobacco awareness.
MOTION A motion was made by Senator Kennedy to send S1067 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Darrington, and motion carried by a voice vote. Senator Sweet voted No.
Department of Environmental Quality Director Steven Allred introduced the Idaho Board of Environmental Quality members, and explained the necessity of having a board, and the board's specific functions.
Gubernatorial Reappointment Gubernatorial Reappointment of Marguerite McLaughlin of Orofino, Idaho, to the Board of Environmental Quality.

Marguerite McLaughlin was appointed to the Board of Environmental Quality July 1, 2002, by Governor Dirk Kempthorn. The Governor has reappointed her for a term commencing July 1, 2002 and expiring July 1, 2006. She served nine (9) terms as an Idaho State Senator for District 7. She also served two (2) terms as an Idaho State Representative for District 7.

Other civic experiences include serving as the Democratic caucus chair, assistant Democratic Leader and Democratic Leader; co-chair for the Joint Legislative Oversight Committee, served on the Finance, Transportation, Commerce and Human Resources, Resources and Environment, Local Government and Taxation, Education, and State Affairs committees. She has served on many interim committees, councils, and task forces including the Western States Legislative Forestry Task Force, Legislative Council, Legislative Council on River Governance, Change in Employee Compensation, Electric Utility Restructure, Health Insurance Premium Task Force, Idaho Housing Board, Endowment Fund and Restructure Task Force, and Health Insurance Premium Task Force. She was appointed by Governor Phil Batt to serve on the Workforce Training Council, Medicaid Reform Task Force, and the State Insurance Fund Commission.

She was recently appointed by Governor Kempthorne to serve on the reorganization of the Department of Lands. She also serves on the Clearwater Valley Hospital Board; Board of Trustees; Joint School District 171; past president of the Orofino Celebrations; Orofino Chamber of Commerce; past president, VFW Auxiliary to Post 3296; president, North Idaho Deanery; Council of Catholic Women, and PEO Sisterhood, an educational and charitable organization. Her political affiliation is Democrat.

MOTION A motion was made by Senator Compton to approve the reappointment of Marguerite McLaughlin to the Board of Environmental Quality. Motion was seconded by Senator Ingram, and motion carried by voice vote.
Gubernatorial Reappointment Gubernatorial Reappointment of Donald J. Chisholm of Rupert, Idaho, to the Board of Environmental Quality .

Donald J. Chisholm was appointed to the Board of Environmental Quality July 1, 2000, by Governor Dirk Kempthorn. The Governor has reappointed him for a four (4) year term commencing July 1, 2002 and expiring July 1, 2006.

He is an attorney, in private practice since 1967, a general practitioner in solo law practice. Practice includes representation of small businesses, real estate, estate planning and probate, municipal law, civil litigation (including domestic relations) and occasional representations of criminal defendants. His bar admissions include the Idaho Supreme Court and United States District Court, United States Court of Appeals (9th Circuit), United States Supreme Court, and the United States Tax Court.

Other professional activities include former president, Fifth District Bar Association; a former member of the Appellate Rules Committee of the Idaho Supreme Court; a former member of the Idaho State Bar Disciplinary Committee; former panelist, Idaho State Bar Association Bar Exam Preparation Committee, and former member of American Arbitration Association Panel of arbitrators for the Northwest Region.

Other community and public service include: member and former president of the Rupert Rotary Club; former director and past president of Rupert Country Club; former director and past president of Magic Valley Regional Rehabilitation Services; former legal counsel to Magic Valley Rehabilitation Services; former board member and past president of the school board of St. Nicholas School; board member and president of St. Nicholas School Endowment Foundation; helped establish public mental health services in Minidoka County; published articles advocating consolidation of county and municipal entities and utilities in Mini-Cassia area; co-plaintiff and plaintiff's counsel in successful litigation to sever unlawful financial relationship between Cassia County and Intermountain Health Care; appointed to the Idaho Board of Health and Welfare by Governor Dirk Kempthorne, July 1999, for a term ending January 2001; and appointed to the Idaho Board of Environmental Quality by Governor Kempthorne in June 2000 and served as Chairman of the DEQ board, July 2000 to July 2002. His political affiliation is Republican.

MOTION A motion was made by Senator Darrington to confirm the appointment of Donald Chisholm to the Board of Environmental Quality. Motion was seconded by Senator Kennedy, and motion was carried by voice vote.
APPROVAL The Senate Resources and Environmental Committee Chairman Senator Laird Noh, testified he supports the reappointment of both Marguerite McLaughlin and Donald Chisholm to the Board of Environmental Quality.
Department of Environmental Quality Department of Environmental Quality (DEQ) Director Steven Allred discussed the procedures for underground storage in Idaho, and promulgation of rules. He explained it takes approximately one (1) year to process a rule. Numerous areas discussed involved:

  1. Communications and process for DEQ rules;
  2. Common Sense Committee;
  3. Intervene between Idaho and Environmental Protection Agency;
  4. Compliance and enforcement, reasonable approach;
  5. Lack of representation from North Idaho.


Greg Nelson, a representative for the Idaho Farm Bureau Federation, testified he does not disagree with the negotiation rule making process, it is a good process. He discussed several issues he has with the Department of Environmental Quality (DEQ). One such issues is pertained to a 8-9,000 head dairy. When a siting committee has a DEQ representative with them, and the siting committee signs-off, then the DEQ staff goes before the county commission and spends-off a bunch of considerations they say the siting committee did not take care of, and then the dairy does not get approved, and a whole bunch of new science get woven into the issue. In this case the issue was ammonia, yet DEQ had sign-off on the Garnet Energy Plant being built, that the ammonia they would create would be no problem to the air, yet the dairy was going to cause considerable ammonia emissions.

Senator Ingram asked about vehicle emission testing in Kuna. Mr. Gannon believes vehicle emission testing for air quality should remain a volunteer program. He also expressed his concerns with tort reforms ; pressurized water system requirements, Indian Creek, pollution of air quality requirements, and problems with implementation and working with some DEQ rules. He wants DEQ to use a "common sense" approach to individual case.

Dick Rush, Vice President of the Idaho Association of Commerce and Industry (IACA), testified he believes this type of general discussion, at a legislative level, is very important. IACA represents most of the manufacturing industry in Idaho. He believes Idaho does need an effective inspection agency. IACA did not oppose the DEQ regulations proposed this year, and believes very strongly in the negotiated rule process. Some concerns of IACA include non municipal solid waste and the areas not strongly regulated; streamlining the permit process; air quality regulations; water quality regulations, and primacy rules. He stated IACA did not oppose any of the DEQ rules this year. He explained House Bill 150, called the Good Science bill, is important to good science peer review data.

ADJOURNMENT There being no further business to conduct, the meeting adjourned at 10:20 a.m.




DATE: Friday, February 21, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Burkett, and Kennedy
MEMBERS ABSENT/

EXCUSED:

Senator Bailey
GUESTS: See attached sign-in sheets
FACS/DHW The Division of Family and Community Services Administrator Ken Deibert presented a briefing to answer questions about the Department of Health and Welfare's 2003 budget reductions for shelter workshops. He reported he understood that M. C. Niland, a representative for the Workshop Association presented earlier this week, and indicated that their Association felt the cuts made to workshops were excessive, and they are requesting those cuts be reinstated, and the Division of Family and Community Services make additional reductions in other program areas.

I would like to present briefly the Department's perspective on this subject. I want you to know that none of the recommendations for budget hold backs made, in FY 02 or FY03, have been easy decisions on the part of the Department. These have been very difficult decisions because we recognize that each one of the reductions had impacts on individual lives, whether they were employees of the State or consumers of our services. We did not make cuts to programs because we do not value the service, or lack compassion for the people served. We reached our decisions after careful consideration of many factors.

Let me state briefly, some of the priorities upon which the Department based its decision-making. First and foremost, we wanted to avoid reductions in programs that the Department has statutory responsibility to provide. We focused our reductions in staffing and services to areas where impact on community, staff, and client safety would be avoided. Our reduction plan took into careful consideration the need to achieve required levels for general fund maintenance of effort for our mental health, substance abuse, and infant and toddler programs to avoid reduction in federal dollars. We are seriously close in all of these programs to having state general funding levels that are below the target maintenance of effort levels required by the Federal Government for continuation of funding through Block Grant appropriations.

Lastly, if our budget reduction strategies would impact consumers, we wanted to make sure there were service options available either through the Department, or other community or private sector service delivery systems. I believe that our hold back strategy, as it relates to the reductions in sheltered workshops funding, meets the priorities that were established in our budgeting process.

I would like to discuss with you a handout that you have before you that lists the general fund reductions the Division of Family and Community Services has had to make during FY02 and FY03. I believe it is extremely important that as we consider any of the budget reductions for any programs that they are made in the context of the overall reductions the Division has had to incur over the last two fiscal years.

As you can see from a review of the data for FY2002 and 2003, the funding reductions for workshops are certainly not disproportionate to other programs within the Division, as has been suggested by the Association. Certainly, a state general fund reduction of 41 percent in child protection and children's mental health, in my view, is substantially greater than the reductions for the workshops.

One last point about our budget reduction strategy that I would like to point out to you is our effort to leverage, as much as possible, Federal dollars. Of the $11million dollars that the Division has lost in funding, just more than $800,000 was lost in Federal dollars. We have made every effort in our strategies to maximize the level of federal funding, to offset the total impact of budget reductions on the consumers that we serve within the Division. I believe we have been quite successful in achieving that outcome.

In the materials presented to you by the Association, it was suggested that $657,264 should be returned to the sheltered workshops appropriation, and that the Division should take an equal amount of reductions in general fund support for other services that are the responsibility of the Division. Before considering that option, I feel it is my responsibility to inform you of some of the potential consequences of that action.

It is extremely important for you to understand that at this point, most of the remaining state general funds that we have appropriated to this Division are heavily leveraged against federal dollars. Depending upon the program, our match rate ranges from a high of 80 percent to a low of 50 percent. If we were required to make these reductions, The Department would be forced to look at elimination of between 29 and 47 positions in our children's mental health, adult mental health, or child protective services, in order to generate $657,264 in general fund savings. These positions fill critical roles providing services to the chronically mentally ill, who lack resources to purchase services from private providers, or through Medicaid-funded programs. If we look at just mental health services, each clinician carries a caseload of approximately 40 individuals on an ongoing basis. If we were to lose that number of positions, between 1,200 and 1,900 individuals would be left without a therapist to provide them with the necessary treatment and care to address their serious mental conditions. It would potentially place us in further jeopardy in our efforts to comply with the federal Jeff D. lawsuit and it would most likely place an additional burden on our local communities and counties to provide care to these individuals.

If we were required to make this level of reduction, we would not be able to hold harmless the staffing levels in our child protective program, as we have been able to achieve throughout past reductions. Any reduction in this program which continues to see dramatic increases in the number of reports of abuse, neglect and mistreatment and a 53 percent increase in substantiated cases of abuse, neglect, and mistreatment, between FY2002 and 2003 would have, in my view, unacceptable consequences for the safety and well being of our children.

I fully recognize that the reductions the workshops are being asked to make have impacted the consumers they serve, and have reduced the funds that are available for them to conduct their business operations. I believe when you look at the overall perspective of the impact of the alternatives that we faced when developing our plan, you can see there were no good options, but only options that provided varying degrees of disadvantage.

Committee members held a lengthy, and detailed review of two (2) charts. One pertained to the community supported employment sheltered workshop data appropriations for FY 2001, 2002, 2003, and 2004. The second chart pertained to the general fund appropriation for FY 2002-2003 and the program share of the general fund reduction in dollars and percentages. (Attachments' #1 and #2).

Committee members also asked questions about, but not limited to, the following issues:

  1. What programs were not required to have a budget reduction?
  2. Base appropriations;
  3. Federal requirements and program mandates;
  4. Substance abuse program reduction;
  5. Total amounts of funds available to workshops, other funding resources, what other options available for workshops;
  6. Evaluations, referrals, and backlog for clients to get into a workshop;
  7. Limited employment for workshop clients;
  8. Plans for an additional hold back in FY2004;
  9. Services provided, transportation and rate of payment, duplication in service areas;
  10. FTE (full-time employees) FTP (full-time positions), and number of staff reductions in each program, how many staff reductions were administrative management staff, and how many management positions were eliminated the past year;
  11. Available funding through federal grants;
  12. Reduction of mental health therapists;
  13. Consolidate administrative manager positions such as combine mental health and developmental disabilities program mangers;
  14. Fairness in reductions in workshops and programs;
  1. Idaho Code 39-4601requirements, and
  2. Cost savings.


Jeff Crumrine, from the Magic Valley Rehabilitation Service, and M.C. Niland, a representative of the Workshop Association, testified and requested the Department of Health and Welfare restore the $657,000 budget cut to the shelter workshops.

ADJOURNMENT There being no further business to discuss, the meeting adjourned at 10:30 a.m.




DATE: Tuesday, February 25, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, and Kennedy
MEMBERS ABSENT/

EXCUSED:

Senator Burkett
GUESTS See attached sign-in sheet
MINUTES: A motion was made by Senator Bailey to approved the minutes of January 31, February 4, February 5, February 6, February 18 and February 19, 2003, as written. Motion was seconded by Senator Compton, and motion to approve was carried by a voice vote.
HCR 16 Senator Brandt presented HCR 16, stating findings of the Legislature and rejecting certain rules of the Department of Environmental Quality relating to individual/subsurface sewage disposal are not consistent with legislative intent and should be rejected. The effect of this resolution, if adopted by both houses, would be to prevent the agency rules from going into effect. There is no fiscal impact to the General fund.
MOTION A motion was made by Senator Darrington to approve HCR 16. Motion was seconded by Senator Kennedy, and motion was carried by a voice vote.
SB 1120 This legislation, SB1120, was presented by the Department of Health and Welfare, Division of Health Administrator Richard Schultz. This legislation removes the sanitary supervision of barber shops, hairdressing parlors, retail cosmetics' dealers, public bathrooms and public bathing places from the jurisdiction of the director of the Department of Health and Welfare; repeals Chapter 20, Title 39, Idaho Code. There is no fiscal impact on the General or dedicated funds.
MOTION A motion was made by Senator Compton to send SB1120 to the Floor with a Do Pass recommendation. Motion was seconded by Bailey, and motion was approved by a voice vote. Senator Brandt will sponsor SB1120.
SB 1102 The Idaho Hospital Association President Steven A. Millard presented SB1102. This legislation relates to hospital licenses and inspection and amends Section 39-1329a, Section 39-1392c, Section 39-1392d, and repeals Section 39-1393, Idaho Code. It also amends Chapter 13,Title 39, Idaho Code, but the addition of a new Section 39-1393 Idaho Code, to provide for notification of professional review action imposed upon a physician. Amends Section 54-1818, Idaho Code, to provide a correct code reference and to provide that no physician or surgeon shall report certain information relating to peer review records and to provide that health care organizations shall not be relieved of certain notification obligations.

Health care organizations maintain a formal peer review process in order to reduce the occurrence of illness and death and to enforce and improve standards of medical practice. This process enables research, discipline, and medical study. Records used in peer review are confidential and privileged and are not subject to subpoena or discovery proceedings, as set forth in Idaho Code 39-1392.

This legislation serves to clearly define key terminology, to include: "peer review," "peer review records," and "patient care records." It also delineates the circumstances upon which records lawfully may be released by the health care organization that owns them. It clarifies immunity from civil liability. Further, a new section fully delineates the health care organizations' reporting obligations to the state board of medicine and details the sanctions and content of mandatory reports. In addition, the measure clarifies that no physician or surgeon shall be required to report information known, learned or discovered as a result of access to peer review records or participate in peer review.

This legislation will have no fiscal impact of the state general fund.

An amendment to SB1102 was discussed pertaining to Section 6 "On page 6 of the printed bill, in line 10, delete "may" and insert: "shall"; and delete lines 21 and 22 and insert: "or authorized by it."

A detailed review was made to SB1102 and some specific areas discussed, but not limited to, are:

  1. Definition of a "peer review" (Page 2, line 20 of SB1102);
  2. Internal reviews controlled by the hospital, and external reviews by independent parties;
  3. Quality assurance of peer review;
  4. Records confidential and privileged, protection of records;
  5. What triggers a peer review;
  6. Discoverable data in records;
  7. Reportable issues about quality of patient care;
  8. What actions required to be reported to the Board of Medicine;
  9. Voluntary or involuntary revocation - who would make that determination;
  10. Patient quality care and safety;
  11. If the Board of Medicine takes an action, when is that information made public? If no action is taken then no public notice is made.


The Board of Medicine Executive Director Nancy Kerr testified to support of SB1102. The Idaho Medical Association CEO Robert Seehusen testified to support of SB1102.

MOTION A motion was made by Senator Darrington to send SB1102 to the 14th Order for amendment. Motion was seconded by Senator Ingram, and motion was carried by a voice vote.
ADJOURNMENT There being no further business to conduct, the meeting adjourned at 10:05 a.m.




DATE: Wednesday, February 26, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Sweet, Bailey, and Kennedy
MEMBERS ABSENT/

EXCUSED:

Senators Stegner and Burkett
GUESTS: See attached sign-in sheet
MINUTES: Senator Kennedy moved to approve the committee's minutes for Friday, February 21, 2003, with an exception to page 2, paragraph ??, line ??, change the wording "just more than $800,000 ??? loss in federal funds to read "just over $800,000 loss in federal funds." Also, add the time the meeting adjourned on page 4. Motion was seconded by Senator Sweet, and motion was carried by voice vote.
VACCINATION LIBERATION The Vaccination Liberation, Idaho Chapter, President Ingri Cassel of Coeur d'Alene testified to amend Idaho's existing voluntary vaccination law. She reported the current law has been misinterpreted by two attorneys claiming that our law only applies to school children. The law also requires that before a vaccine is administered in this state, the person is to be told the risks associated with the procedure. It appears that most people are unaware of the law leading to many cases of people being coerced or intimidated into receiving one or more vaccines against their will. The group's website is http://www.vaclib.org.

Ms. Cassel explained she will leave a video titled Vaccines: What CDC Documents And Science Reveals by Sherri J. Tenpenny, D.O., and a packet of information about Vaccination Liberation, will be left in the Committee's office for review by committee members during this legislative session. Some items for review, but not limited to the following:

  1. Vaccination Liberation - Idaho Chapter - The right to know, the freedom to abstain;
  2. A list of books, videos and audiotapes available through Vaccination Liberation; Vaccination Liberation's lending library;
  3. Basic facts to know about vaccinations;
  4. Facts about Hepatitis B - the disease and the vaccine;
  5. Measles, mumps and rubella - the disease and vaccine;
  6. Facts about influenza;
  7. Want a smallpox shot? It could KILL you;
  8. Smallpox pandemic planned-are you ready;
  9. Vaccination exemption pursuant to Idaho Code 39-4804;
  10. Vaccination workshop, February 23, 2002;
  11. Vaccination - dispelling the myths;
  12. Vaccines - new plague for a new era;
  13. Antibody theory;
  14. How do the vaccines work;
  15. Shaken baby syndrome - the vaccination link, and shaken baby impact syndrome, flawed concepts and misdiagnoses based on a review of 28 cases;
  16. Disease - scary-go-round;
  17. Why the compulsory vaccination laws must be repealed;
  18. Neurosurgical focus by Joseph H. Piatt, Jr., M.D.
  19. Hydrocephalus in infants and children;
  20. Recombivax HB - Hepatitis B vaccine;
  21. Retrospective review - case of Damian Kershner, following jury trial of Michael Shutz;
  22. Pertussis - North Idaho outbreak 1997, an epidemiological report and case study;
  23. What is coming through that needle - the problem of pathogenic vaccine contamination, and
  24. Testimony by Jerri Johnson, Health and Human Services Policy Committee.


Angie Vasques, director of the South Idaho Chapter of Vaccination Information and Liberation, Burley, Idaho, testified that Idaho's vaccination law needs to be revised. As with any law, there should be penalties for breaking the law. If I leave this hearing today and get caught speeding or running a red light, I am fined and I pay the ticket. There is no physical evidence that I was caught speeding other than the officer witnesses me do the crime. There is no other evidence except for his word against mine, but I still have to pay the price for the crime I did of breaking the law.

We have testimonies of healthcare workers and other breaking the law by not following Idaho Code 39-4804. When they do not tell parents that vaccines are voluntary in this state, and even more, not telling parents what adverse reactions can occur after their child receives a vaccine before vaccinating them, then they should pay a fine.

In summary, Ms. Vasquez, testified I was once a parent who believed in vaccines completely. I was never told of the dangers of vaccines. From the beginning of my school years, I read in books, was told by doctors, even watched in cartoons how important getting shots were to be healthy and protect us from dangerous diseases. Never once was I told there might be a possible negative side effect. As I grew up and had my own children, I never thought twice whether or not to vaccinate my children. There was never a discussion about the issue. Whenever I got the reminder in the mail, "It's time for your child's shots" I immediately scheduled an appointment to have them vaccinated, believing it was important to keep them healthy.

Today, my daughter is just a statistic for having a vaccine reaction. She is dead because I was never told there was even a possibility of an adverse reaction to her shots. Doctors only tole me of the "benefits" but never the dangers.

When registering your child for school, you are not told of exemptions to required vaccines. One family in Benewah County is home schooling their child as they did not want to risk an adverse vaccine reaction. They wanted their child to attend public school and were astounded when they learned a year later that other children attended school without having vaccines.

People who enjoy working with food, taking care of the elderly or sick patients, and make that their careers in life are denied employment or terminated from their jobs for refusing a Hepatitis A or B shot.

Idaho Code Chapter 39 Section 4804 needs to be clarified. Informed consent is not really happening before a shot is administered in this state. The medical procedure known as vaccination is not emergency medicine and carries the risk of permanent disability or death. It is imperative that before parents submit themselves or their children to such a procedure, they are told it is voluntary in Idaho as well as the very real dangers involved. There also needs to be a penalty for those who violate the law. Everyone who requests vaccination records for school or daycare entry, or for government programs such as WIC or Medicaid, needs to follow the law and tell their clients that vaccines are voluntary in Idaho. Also, employers should not be imposing a risky, unnecessary medical procedure on their employees as a requirement for employment.

Christy Shult testified briefly and provided written testimony on behalf of her son Michael Shutz as well as Joshua King, Ricky McCusker, and all other who have been falsely accused and convicted of violent child abuse, with the most common offense defined as Shaken Baby Syndrome. She explained she is personally familiar with the details. The discovery of these cases holds compelling evidence supporting the innocence of each. Yet all three (3) are imprisoned with sentences ranging from four (4) years fixed, with six (6) years indeterminate, fifteen (15) years fixed, with life indeterminate, and three (3) years fixed, with six (6) years indeterminate, (the consolation for taking the plea bargain), respectively. This is unconscionable injustice, and must be viewed as such by all who become aware.

The inconsideration of the accused begins in the hospitals, where it has become obvious that the allegation of child abuse is taking precedence and substitution of screening tests to determine the possibility of a chronic condition or other malady. Such as the child my son was accused of harming. One doctor, of the many attending, discovered the child had Hydrocephalus that had gone undiagnosed despite accelerated head growth that had been taking place since birth. A chronic condition, with suspicions of the Hep.B vaccination the child received within a day of birth having caused. However, regardless of the cause, the diagnosis remained as Shaken Baby Syndrome, and the significance of the Hydrocephalus was negated at the trial, as was a massive recurrent hemorrhage following the four (4) month immunizations of the child.

There are tactics used by Health and Welfare workers and others threatening the mothers' of the alleged victims with loss of custody to the State if they do not cooperate with the implication of their boyfriend or husband as the perpetrator. Subtle hints of this were brought out during testimony at my son's trials, as well as references in the discovery.

I do not discount that child abuse exists. However, there are highly credentialed, experienced experts who believe the Shaken Baby Syndrome diagnosis to be seriously flawed. And that innocent people are being accused and convicted is a criminal act in itself. If we do not make a move in an honest and positive directions, we are failing the very innocents we claim to protect.

H 22 Bureau of Occupational License Chief Rayola Jacobsen presented HB 22, relating to barbers and amending Sections 54-504, 54-507, 54-513, and 54-518, Idaho Code.

Section 54-504. The barber board will expand exemption to include all licensed nurses, persons practicing in their own homes on family members without compensation, and to allow services for those unable by ill health, medical confinement or involuntary incarceration to go to the barber shop.

This legislation would require barber schools or colleges approved by the board to deliver to the board a $20,000 bond.

Section 54-513 deals with location and performance of services, changing the term registered to license, and adding the term barber-stylist.

Section 54-518 strikes language dealing with temporary permit fees. There will be no impact on General or Dedicated funds.

MOTION A motion was made by Senator Compton to send HB22 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Ingram, and motion was carried by a voice vote. Senator Brandt assigned to sponsor HB22 on the Floor.
H 23 Bureau of Occupational License Chief Rayola Jacobsen presented HB 23, relating to cosmeticians and amending Section 54-804, Idaho Code, to revise exemptions and make technical corrections.

Section 54-804 allows to strike language designating levels of nursing experience, adding barber-styling as a designation and allow cosmetologists to provide services for those unable to go to a cosmetological establishment. There will be no impact on General or Dedicated funds.

MOTION A motion was made by Senator Sweet to send HB23 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Ingram, and motion was carried by voice vote. Senator Compton assigned to sponsor HB23 on the Floor.
H 24 Bureau of Occupational License Chief Rayola Jacobsen presented HB 24, relating to counselors and therapists, and amending Section 54-3407, Idaho Code, to expand the permissible disciplinary actions of the Board of Counselors and Marriage and Family Therapists to include the refusal to issue or renew a license upon specified grounds, and amends Section 54-3411, Idaho Code, to provide for a maximum fee of $25 for the original registration of interns.

There is an anticipated income to the dedicated fund for the Bureau of Occupational Licenses of approximately $550 per year.

MOTION A motion was made by Senator Kennedy to send HB24 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Compton, and motion was carried by a voice vote. Senator Kennedy assigned to sponsor HB24 on the Floor.
H 25 Roger Hale, an attorney for the Bureau of Occupational License, presented HB25, relating to nursing home administrators, and amends existing law to provide for the endorsement of licenses for nursing home administrators based upon the submission of evidence that the applicant meets qualifications as established by rule of the Board of Nursing Home Administrators.

Section 54-1609. Endorsement of Licenses: The board, in its discretion, and otherwise subject to the provisions of this act, and the rules of the board promulgated thereunder prescribing the qualifications for a nursing home administrator license, may endorse a nursing home administrator license issued by the proper authorities of any other state upon payment of a fee and upon submission of evidence satisfactory to the board that the applicant meets those qualifications established by the rules of the board.

Robert Vande Merwe, executive director of the Idaho Health Care Association, testified to support HB25.

MOTION A motion was made by Senator Darrington to send HB25 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Compton, and motion was carried by a voice vote. Senator Darrington assigned to sponsor HB25 on the Floor.
ADJOURNMENT There being no further business to conduct, the meeting adjourned at 9:55 a.m.




DATE: Thursday, February 27, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Sweet, Bailey, and Kennedy
MEMBERS ABSENT/

EXCUSED:

Senators Burkett and Stegner
GUESTS: See attached sign-in sheet
H 19 HB 19, relating to the Board of Psychologist Examiners, and amending Section 54-2307, Idaho Code, to clarify requirements for fee payments, was presented by Bureau of Occupational Licenses Bureau Chief Rayola Jacobsen,

This legislation amends existing law relating to the Board of Psychologist Examiners to clarify the requirements for fee payments. This bill also clarifies the manner of payment, which is directly to the National Examination Entity, as fees are now submitted directly to this entity and not the Bureau of Occupational Licenses. Additionally, the language in this legislation clarifies a processing fee of $25 that is charged by the Bureau of Occupational Licenses. This is not a new fee, and has been approved by the legislative body in law and rule.

MOTION A motion was made by Senator Sweet to send HB19 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Ingram, and motion was carried by a voice vote.
H 20 HB 20, amends existing law to remove barber shops, hair dressing parlors, and retail cosmetic shops from the jurisdiction of the director of the Department of Health and Welfare and from a certificate of compliance requirements, was also presented by Rayola Jacobsen. The original law was passed in 1913, and amended in 1974 with the creation of the Bureau of Occupational Licenses, which is when the jurisdiction for barber shops, hair dressing parlors, and retail cosmetic shops was removed from the jurisdiction of the director of the Department of Health and Welfare, and placed with the Bureau of Occupational Licenses.

This bill, HB 20, strikes outdated language from the Health and Welfare statute, Chapter 20 Title 39, dealing with the inspection of Barber Shops, and Cosmetology establishments. This legislation is presented to strike language that should have been changed in 1974.

SB 1120 will strike the remainder of the outdated language from this chapter. There is no impact on the General or dedicated funds.

MOTION A motion was made by Senator Sweet to send HB20 to the Floor with A Do Pass recommendation. Motion was seconded by Senator Ingram, and motion was carried by a voice vote.
H 21 Rayola Jacobsen, from the Bureau of Occupational Licences presented HB 21. This legislation relates to the Board of Podiatry, and amends existing law, Section 54-606, Idaho Code, to provide that the examination fee shall not exceed $600, to delete language referencing fees of a National Examining Entity, and to make technical corrections, and amends Section 54-613, Idaho Code to delete a reference to examination fees. Section 54-606, strikes reference to a National Examination Entity, and set a cap on the examination fee.

There will be no impact on General funds. There will be no fiscal impact on Dedicated funds until rules are promulgated. The additional amount that would be realized at that time, if the entire fee cap was requested, would be an approximate increase of $1200 per year. This fee will allow the Board to recover development costs, and cover administrative costs.

MOTION A motion was made by Senator Kennedy to approve HB21, with a Do Pass recommendation. Motion was seconded by Senator Bailey, and motion was carried by a voice vote. Senator Kennedy was assigned as sponsor.
MOTION A motion was made by Senator Darrington to send HB 19 and HB 20 to the Consent Calendar. Motion was seconded by Senator Sweet, and motion was carried by a voice vote.
JFAC Chairman Brandt explained a meeting he had with a co-chair of the Joint Finance-Appropriations Committee (JFAC) concerning issues that JFAC has with the Department of Health and Welfare. One issue dealt with the number of employee layoffs, because of the holdbacks, by the department. The Chair informed the committee members that Friday the Department of Health and Welfare would present an in-depth explanation about how many FTPs (full-time positions) were eliminated, how many staffs were actually placed on layoff, bumping privileges, and how many of the full-time positions (FTP) that were eliminated were actually vacant FTPs for the past two (2) years. The Chair explained the department had the appropriations to fill those vacant positions; therefore, they believed they could count those positions in the layoff.

The Committee will try to clarify some of the JFAC issues, and try to make suggestions as to where budget cuts could be made. The committee is not interested in trying to micro manage the Department of Health and Welfare, but try to be of assistance to both the JFAC and the department.

The Committee discussed obtaining a copy of the Department of Administration's annual Vacant Position Report for state agencies, to see if the report would provide additional information that would be helpful to the Joint Finance-Appropriations Committee.

Other items briefly discussed included the cost-savings bonus program, zero-based balancing, travel budget savings, accounting validation, enhancements, and performance levels set for departmental programs.

ADJOURNMENT There was no further business to conduct; therefore, the meeting adjourned at 9:30 a.m.




DATE: Friday, February 28, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Stegner, Sweet, Bailey, Burkett, Kennedy
MEMBERS ABSENT/

EXCUSED:

Senators Darrington and Ingram
GUESTS: See sign-in sheet
HEALTH & WELFARE Department of Health and Welfare Deputy Director Joyce McRoberts introduced Deputy Director Gary Broker Gary Broker, Division of Welfare Administrator Scott Cunningham, Division of Family and Community Services Administrator Kenneth Deibert, Division of Medicaid Acting Administrator Randy May, and Bureau of Health Policy and Vital Statistics Bureau Chief Jane Smith.

The department has planned an extensive educational briefing about issues that have come before the Senate Health and Welfare Committee. The meeting will also be heard during the week of March 4 - 7, 2003. Items planned for discussion today include the FTP (full-time position) authority for Fiscal Year 2002, and FTPs eliminated due to the 2002-2003 budget holdbacks, and net loss of personnel funding.

Two (2) charts were distributed giving a precise listing of positions eliminated, both for administrative and direct service positions. The FTP changes are listed by appropriation authorization, the staff positions for Indirect Support Services such as the Division of Family and Community Services, Management Services, Human Resources, Information Technology, and the director's office. The Division of Medicaid, Health, and Welfare were also discussed. A detailed review of the charts was held. (See attachments #1 and #2)

Numerous areas were reviewed and discussed, pertinent to the concerns about, but not limited to, the following:

  1. Service delivery that will affect clients;
  2. Additional staff layoffs and the impacts on programs;
  3. Staff layoffs with bumping privileges and retention points;
  4. The importance of the employees' three-step recognition awards program;
  5. The risk of losing federal program funding;
  6. Child protection workers (the department has not, at this time, reduced the number of assigned staff for child protection, but with additional budget reductions child protection workers will need to be considered;
  7. Monitoring 149 federal grants within the department;
  8. Communications - keeping communications opened as community liaisons and with line-staff;
  9. Impact on direct support services and providers;
  10. Possible consolidation of some staff positions and program impacts;
  11. Allowing flexibility of certain program staff within the seven (7) department's regions;
  12. Substance abuse, mental health, developmental disabilities programs;
  13. Timeliness of payments for expenditures, and quality of payments, Self-reliance Program and Welfare-to-Work Program.


The Department receives five (5) appropriations bills, each with a dedicated number of authorized full-time staff positions.

ADJOURNMENT Chairman Brandt explained the committee must report to the Floor; therefore, the department's presentations scheduled from the Division of Medicaid and the Division of Health, will be scheduled for the following week. The meeting adjourned at 10:25 a.m.




DATE: Tuesday, March 4, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Sweet, Bailey, Burkett, Kennedy
MEMBERS ABSENT/

EXCUSED:

Senator Stegner
MINUTES: A motion was made by Senator Kennedy to approve the committee's minutes for Wednesday, February 26, 2003, with the exception of a topographical correction on page 4, line 1, change the wording trail to trial. Motion was seconded by Senator Compton, and motion was carried by a voice vote.
GUESTS: See an attached sign-in sheet
SCR 107 There was a brief discussion about SCR107, stating findings of the Legislature and rejecting a certain pending rule, IDAPA 15.0101.0201 of the Idaho Commission on Aging, relating to the Sensor Services Program. The rule was approved by the committee on January 16, 2003, with the exception of Section 025.03, fees and client contributions, determining the gross income for the household from all sources. (Refer to the committee's minutes, Thursday, January 16, 3003)
S 1128 SB1128 was presented by the Division of Family and Community Services Administrator Kenneth Deibert. He explained that currently in Idaho Code there are two sections that address what the process is for establishing a designated examiner for adult mental health and children's mental health cases. Designated examiners are individuals who do an examination of persons when petitioned for a commitment because of mental illness. Examiners present their findings to the court, and the court makes the determination whether or not the individual is committable under Idaho Code.

This legislation relates to the qualifications of a designated examiner for purposes of adult and children's mental health services, amends Section 16-2403, Idaho Code, to further define terms of becoming a designated examiner, adding language to strengthen the qualifications to become an examiner making it consistent with the designated examiner definition in Section 66-317, Idaho Code. SB1128 further amends Section 66-317, Idaho Code, to define terms making it consistence with the designated examiner's definition found in the children's mental health services, Section 16-2403, Idaho Code.

This legislation will enable the director of the Department of Health and Welfare to promulgate rules to appoint other mental health professionals for adults, as current Idaho Code allows for children.

This bill, making the definitions for who can qualify as a designated examiner for adult and children's cases to include "other mental health professionals" will provide the Department of Health and Welfare additional qualified professionals to conduct designated examinations. This is particularly important in rural areas of the state, where access to mental health professionals is limited. There is no fiscal impact to these changes.

The Senate Health and Welfare Committee previously reviewed legislation, SB1076, and made recommendations for changes to the bill. SB1128 is a new legislation and incorporates the committee's suggested changes to SB1076.

MOTION A motion was made by Senator Compton to send SB1128 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Sweet.

Discussion:

  1. Previous hearing of SB1076 was reviewed;
  2. A review of Section 66-329(d), page 4, lines 46-51;
  3. The qualifications of a social worker;
  4. The need to have a medical examination by a person with the proper qualifications.


The motion made beforehand by Senator Compton, and seconded by Senator Sweet, was approved by a voice vote. Senator Bailey voted No. Senator Compton was assigned as sponsor of SB1128.

HEALTH AND WELFARE The Department of Health and Welfare Deputy Director Gary Broker, Division of Medicaid Acting Administrator Randy May, and the Division of Health Administrator Richard Schultz presented an educational briefing about Idaho's Medicaid and Health programs.

Gary Broker presented three (3) charts pertinent to the briefing today. The charts outlined programs' FY2003 FTP (full-time positions) authority for the Divisions of Health and Medicaid. (Attachment #1)

The second chart was previously presented with a typographical error, and now has the correct date of 03/03/2003. (Attachment #2)

The third chart is a summary of position changes due to the 2002-2003 budget holdbacks for the Department of Health and Welfare. Mr. Broker explained the full-time position authority for fiscal year 2002, original appropriation, was 3,092.01 positions. The current full-time position authority is 2,021.91, a reduction in full-time position authority of 170.10 positions. This chart also provides a summary of holdback position changes, by appropriation, for indirect support. (Attachment #3)

The Division of Medicaid Acting Administrator Randy May explained that Medicaid is, in essence, a health plan. In fact, it is the largest health plan in Idaho. This year, Medicaid will serve approximately 152,000 clients, and pay out about $850 million, in benefits, to more than 15,000 Medicaid providers throughout the state.

Medicaid's overhead operating and personnel costs are the smallest of all other health plans in Idaho. Medicaid's operating cost is 2.9 percent and personnel cost is 1.4 percent, a total of 4.3 percent. The national trend is between 12 and 15 percent. He stated that Medicaid is a very large, very complex, health plan.

Mr. May discussed efforts to try and control the growth of Medicaid costs. He outlined three (3) approaches that can affect Medicaid costs.

  1. Reduce the number of people served, by tightening eligibility requirements and removing services to people.
  2. Reduce the amount or scope of services.
  3. Reduce the reimbursement rates. The Medicaid dental reimbursement rate is currently so low, that dentists do not want to treat Medicaid clients.


He outlined Utilization Management - a tool used for encouraging and getting people to use the appropriate type and the appropriate amount of services. Case in point, utilization of emergency rooms (ER) - last year Medicaid spent about $6.6 million on emergency room treatments, at an average cost of $106 per ER visit, not including doctor and laboratory fees. The top five (5) reasons people visited an emergency room was for earache, upper respiratory problems, unspecified stomach complaints, fever, or sore throat.

Several other Medicaid areas were discussed, such as:

  1. Utilization Management Program (UMP) - This program has been very successful, and is important to reducing the cost of Medicaid.
  2. Co-pay, even a $3 to $5 co-pay on emergency room treatments, and certain areas where a co-pay cannot be required.
  3. Federal mandated limits on co-pay requirements.
  4. Requesting a waiver to some of the federal mandates.
  5. Developing standards for visits to emergency rooms, and reducing the number of ER visits.
  6. Employees - location of employees statewide, and the addition of 24 FTP to Medicaid.
  7. Economy - lower economy drives up the demand for Medicaid services, increases growth and effects on Medicaid's costs.
  8. Private employers providing health care insurance plans.
  9. Upcoming long-term health care needs and growth in service demands.
  10. Medicare does not pay for prescriptions, and Medicaid does.
  11. Poverty levels - 133 percent base.
HEALTH Division of Health Administrator Richard Schultz explained the division's funding is mostly from federal funds, only 13 percent of Health's revenue comes from the General Fund, and the majority of that is in vaccine and for the state's laboratories. Personnel holdbacks did not affect the division as greatly as it did other divisions. The vast majority of personnel assigned to the Division of Health are paid 100 percent by federal funds.

He reported that 95 staffs are involved in direct services. The vast majority of those staffs are involved in the process of vital statistics, such as providing services to people wanting their birth certificates or a death certificate, etc.

The Emergency Medical Services (EMS), employs about 20 staffs. They support a statewide communication center, provide technical assistance, monitor grants to community EMS units, and evaluate EMS system performance. Emergency Medical Services supports a statewide system that responds to critical illness and injury situations. Those services include ambulance licensing, and certifying EMS personnel. About 60 percent of the EMS ambulances are operated by volunteers.

Mr. Schultz outlined the responsibilities and functions of the 153 staffs assigned within the division, such as:

  1. The state's vaccine program for children.
  2. The newborn screening and clinic services.
  3. The workers' health and work site safety unit.
  4. Health Promotions - preventive health programs and services to local Health Departments, schools, businesses, hospitals, and community-based organizations.
  5. Management of grants.
  6. Laboratories and services provided.
  7. There are 35 different programs in the division, and three (3) are federally funded.


He encouraged committee members to visit the EMS communication center located in Meridian, and also to tour the local state laboratory.

Senator Darrington recommended having the Bureau of Emergency Services Bureau Chief Dia Ganor come and explained the EMS services. He also encouraged members, as time allows, to visit the communication center. Mr. Schultz reported he is willing to arrange a field trip at the convenience of the committee members.

HB 113 Senator Brandt asked if HB113 will impact EMS? Mr. Schultz responded he does not believe the legislation will have an impact on the EMS services. [HB113 relates to clarifying that it is the county sheriff who is responsible for search and rescue operations within a county; clarifies that there can be only one person charged with the responsibility for a search and rescue operation and one person in charge of obtaining and maintaining resources for search and rescue operations.]
MANAGEMENT SERVICES Deputy Director Gary Broker provided a step-by-step review of attachments 1, 2, and 3, and FTP authority included in the Department of Health and Welfare's five (5) appropriation bills. Another area discussed included the systems maintained by the Information Technology Services Division (ITSD). He reported, on page 109 of the Department of Health and Welfare's Facts/Figures/Trends 2002-2003 publication, is a list of each division and the automated systems used, the purpose and the number of software programs in the ITSD system. For example, Welfare's Eligibility Programs Integrated Computer System (EPICS) is about 17 years old, and supports 20 welfare programs including cash assistance, food stamps, and medical assistance. [A copy of the Department of Health and Welfare's Facts/Figures/Trends 2002-2003 publication is maintained in the committee's office during the legislative session.]
ADJOURNMENT Due to time for the committee members to convene on the Senate Floor, the meeting adjourned at 10:00 a.m.




DATE: Wednesday, March 5, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Sweet, Bailey, Burkett, and Kennedy
MEMBERS ABSENT/

EXCUSED:

Senator Stegner
MINUTES: A motion was made by Senator Bailey to approve the committee's minutes for Friday, February 14, 2003. Motion was seconded by Senator Compton, and motion was carried by a voice vote.

A motion was made by Senator Sweet to approve the committee's minutes of Tuesday, February 25, 2003. Motion was seconded by Senator Bailey, and motion was carried by a voice vote.

GUESTS: Senator Marti Calabretta and Representative Jim Clark. See attached sign-in sheet.
DEPARTMENT OF HEALTH & WELFARE The Department of Health and Welfare continued with the educational briefings that began on Friday, February 28, a five (5) day presentation about programs and personnel.

The Division of Welfare Administrator Scott Cunningham presented an educational program update regarding the position changes in the statewide Self Reliance programs, due to the 2002-2003 holdbacks. He explained the programs that are administered and the services that are delivered through the Self Reliance program. He also explained the Welfare-to-Work Program.

We provide for the following benefit programs: Temporary Assistance for Families in Idaho (TAFI), Aid to the Aged, Blind and Disabled (AABD), Food Stamps and the Idaho Child Care Program (ICCP).

In addition to the benefit services I described, we also provide the full range of child support services, including: collections, paternity establishment and support order establishment.

Finally, the statewide Self Reliance program administers a series of community service programs, including: Community Service Block Grant (CSBG), Community Food and Nutrition Program, Low Income Energy Assistance, Telephone Assistance Program and Weatherization Assistance.

I would direct you to the section of your handout entitled "Division of Welfare Positions." I would like you to keep in mind that at the same time we were making decisions about how to address the budget holdbacks, we were also engaged in a realignment whereby the direct administration of the programs was being transferred from the regions to the divisions. So, while we were addressing the holdbacks, we were also guided by our transition plan which required us to develop consistent program services statewide and look for program efficiencies throughout all our programs.

The first position action taken was to reduce the number of fraud and collection positions by four (4) full-time Positions (FTP). The program had seven (7) positions, but we felt that with new technology, and streamlined fraud referral procedures, we could handle the work with three (3) investigators; one located in North Idaho, one in the Treasure Valley and one in Eastern Idaho that could also serve the Twin Falls area.

The second position action we took was to eliminate 3.8 Community Resource Development positions, and assigned those duties to the regional Self Support Managers.

The third action we took was to reduce the number of statewide trainers by nine (9) positions. Prior to this reduction, there were 25 trainers statewide.

The fourth action we took was to complete the transfer of all employment-related services to existing TAFI employment services contractors for a reduction of 13.8 FTP. The contractors utilized are both government and non-government organizations. This action created no new expense to the State.

The fifth and sixth actions we took involved streamlining the central office administration by: regionalizing the Food Stamp Quality Control (FSQC) which eliminated 11.5 central office positions. In the old system, the central office staff provided all quality control checks which involved traveling statewide in order to ensure compliance with the United States Department of Agriculture, Food and Nutrition Service agency. I also eliminated two (2) positions in my office, and have spread that work out to remaining staff.

When the second 3.5 percent holdback was announced, we were still in the process of transitioning the administration of the Self Reliance programs to the Division, and we were still committed to finding efficiencies and promoting consistency. The first thing we did was to eliminate 12 vacant, but funded positions.

Next, we analyzed where we might be able to improve processes or serve outlying offices and achieve savings. We decided to move staff out of four (4) field offices, eliminate the positions and have other field offices provide services to those affected individuals and families. We have the technology and capacity to serve people via the telephone, voice response units and to a limited degree -- e-mail.

Montpelier and Malad are now being served out of the Preston office, Bellevue is now being served out of the Jerome office, and Homedale is now being served out of our Nampa and Caldwell offices.

Finally, and probably the most difficult decision to make was to eliminate seven (7) regional self reliance manager positions, and their support staff. Prior to making this decision, we had an opportunity to run a pilot project in Region 7 with an existing child support supervisor and an existing benefit supervisor, that proved to be highly successful. Our current structure has each region following this successful pilot with each acting area supervisor reporting directly to either the benefits or child support bureau chief.

I would now direct your attention to the chart entitled "DHW Central Office Positions" and the column entitled Division of Welfare. I must tell you that the majority of our staff in the central office have multiple duties so some of these FTP numbers are expressed as the equivalent of an FTP, but it may be four (4) staffs who perform the work at a .25 FTP level.

The first group of staff consists of 8 FTP - bureau chiefs and supervisors who respond to new state and federal laws and regulations, and develop policy to support the numerous changes that govern our work.

As you can see, the bulk of the staff, 28 FTP, in the division performs policy implementation work. This includes: rule writing, policy development for field staff, help desks, liaison with federal and other state agencies, and automation/business requirements.

We have two (2) staff who direct the statewide quality control and audit activities for all of our programs (Medicaid and Food Stamps have a very specific federal requirement about quality control and audit functions).

As you can well imagine, with the span of programs in the Division of Welfare, we have some very heavy federal reporting requirements on program outputs and persons served. That requires the equivalent of four (4) FTP's worth of time. In the same vein, virtually every program we administer has a federal requirement to maintain and submit an annual State plan. This requires the equivalent of four (4) FTP on an annual basis.

We have three (3) staff who are engaged in business improvement projects. Those projects are: simplified notices, child care, and performance management/ balanced score card. We also have one (1) staff person who is working on developing a new system called A-Med.

The FTP listed as executive administration is my position. I am ultimately responsible to the director for all aspects of the Self Reliance Program: audits, budget management, program performance, personnel and member of Executive Leadership Team.

The last FTP is a legal support position for the deputy attorney general's staff who is housed in our child support unit.

Mr. Cunningham's handout, referred to previously, about the enhanced work services contracts - Welfare-to-Work - Self Reliance Program included the following information.

Philosophy:

  • Work Services is the heart of Idaho Welfare Reform
  • At-risk citizens are moved from Welfare dependent programs toward economic independence through employment
  • The "Work First" process has revitalized human service efforts to move participants from welfare, from poverty, from dependence and onto a path toward self sufficiency
  • Work First Model -
    • Get a job, any job
    • Keep a job
    • Get a better job


History:

  • From Family Support Act of 1980s ~JOBS/JSAP (Job Search Assistance Program), programs to current Welfare Reform TANF program since 1997.
  • Current program has fewer exemptions from work requirements. In addition to job-ready individuals, EWS (enhanced work services) serves those TAFI individuals with physical and mental disabilities, limited education/literacy, transportation issues, Substance Abuse, etc. (Limited exemptions from participation are for rare childcare issues).

  • Target Populations:


    • TAFI and Food Stamp recipients who the Department has a rule obligation to provide work services for.
    • Are required to perform significant work activities in order to receive benefits from the department.
    • TAFl participants are required to participate 30 hr/week (42 USC 607)
    • Federal FS participation requirements are much lower than TAFI requirements (7CFR 273.7) however contractors make every effort to engage these participants at 30 hrs/week as well.


  • The federal government has placed hard to meet specific countable* activities on this population that Idaho must meet. (TAFI: 50 percent of population must meet a countable activity requirement of 30 hrs/wk, 90 percent of 2-parent TAFI families must pass this requirement).


  • These mandatory participation and activity rates have been met statewide over the past several years, in a large part by contracting these services out to competitive bidders who have performed or been replaced since 1997.

  • Since 1997, Idaho has achieved incentive payments from the Feds for excellent job placement and retention results.


*Countable activities have been defined by the Federal Government and exclude many of the activities our hard-to-serve participants need to engage in order to later successfully gain employment. For example, Drug and Alcohol or Mental Health counseling is not considered a "countable activity." Contractors have successfully juggled to Federal requirements with the needs of the participants to create win-win situations.

Current Efforts:

  • New work services contracts were awarded commencing April 1, 2002 from a competitive RFP (request for proposal) process.


  • Seven (7) contracts throughout state with four (4) different contractors: two (2) for-profit companies, one (1) nonprofit company, and one (1) state agency.


  • Current contractors:


    • Provide consistent services to participants statewide
    • Have achieved cost savings to the Department through competitive bid process and successful negotiations
    • Include formal performance requirements, with financial consequences for poor performance
    • Successfully put this T and B money into the business community.


Services Provided:

  • Assessment of current situation
  • Job Readiness Services
  • Case Management
  • Post Employment/Transitional services
  • Supportive Services such as transportation dollars, tools, clothing for employment or other goods and services needed to secure or maintain employment.


Services are Based on Work First Model: Put participant into a job first with their existing assets and skills, and then work on keeping that job. Finally, efforts into enhancing employment status are offered to participants previously placed in employment.

Funding:

  • T&B (trustee and benefit) dollars used. TANF Funding is 100 percent federal funds, JSAP (Job Search Assistance Program) funding is an average of 50 percent federal funds and 50 percent general funds.

_____________________________________________________________________

Contracted Services Supportive Services
For participants
Total
TANF $5,387,000 $953,000 $6,340,000
JSAP $ 445,200 $116,100 561,300
TOTAL $5,832,000 $1,069,100 $6,901,300

_______________________________________________________________________

  • Of this nearly $7 million budget, only $338,700 comes from the state General Fund.


  • With reduced DHW staffing, the work services workload was moved to contractors to provide work services.


Results:

  • April I - December 31, 2002:


    • 6582 non-duplicated participants served
    • Of these, 1469 have been placed in jobs
    • Average job placement: 32 hours/week, $7.15/hr
    • These results have been achieved at an average cost of $443.07 per participant for Contracted Services and $81.33 for supportive services per participant.


Savings:

  • Total spent July - December 2002 = $3,277,069, reflects an estimated savings of $400,000 due to performance based service delivery.


  • Additionally, these savings have enabled the Department to offer contracted enhanced work services for non-custodial parents. Goal - obtain employment and pay child support. The model is based upon earlier Idaho NCP (non custodial parent) projects in northern and south eastern Idaho which demonstrated a 75 percent increase in Child Support payments after 90 days post-service, and 34 percent increase in the amount of payment after mediation services. These services are expected to commence by April 1, 2003 (therefore no outcome data is currently available).


Monitoring:

  • All seven contracts have been closely monitored.
  • July - December 2002 Results:
    • 991 formal case reviews completed statewide
    • Requirement = 90 percent or better standard for accuracy and timeliness in service delivery.
    • Cumulative average for ALL contractors during this time period is 94.46 percent.
MEDICAID Division of Medicaid Acting Administrator Randy May outlined Medicaid's programs, explaining those things we have the ability to change and those that cannot be changed due to mandates, as shown on a chart, Attachment #1.

This chart outlines the Medical Assistance Program expenditures by service category, in millions of dollars. The chart was previously review on January 28, 2003, and is included as a part of those minutes on the Internet. The chart lists services required by the federal government, by state government, and services required by rule.

The committee members discussed Idaho's Medicaid mandates as shown in the Department of Health and Welfare's Facts/Figures/Trends 2002-2003 publication, page 16. Idaho's Medicaid program provides coverage of health care services which are required by the federal government, Idaho Code or Idaho Rules. The list of SFY2002 mandated expenditures by federal, state, and rules cost a total of $776.6 million, as listed below:

MEDICAID MANDATES - FEDERAL (in millions):

1. Hospital Related Services $149.2 Includes services for Inpatient/Outpatient Hospital - $139.1

Hospital DSH (Disproportionate Share Hospital) - $10.1

2. Nursing Home Care $117.2

Includes services for Nursing Facility

3. Physician and Clinic Services $56.5

Includes services for:

Rural Health Clinic - $4.2

Federally Qualified Health Center - $1.7

Indian Health Services $1.6

Physician Services - $1.6

4. Medical Transportation $11.7

Includes services for Medical Transportation

5. Lab and X-ray Services $7.7

Includes services for Laboratory/Radiology Services

6. EPSDT Services $3.8

Includes services for Early Periodic Screening and

Diagnostic Testing

7. Family Planning $1.7

Includes services for Family Planning

8. Hospice Benefits $0.6

Includes services for Hospice Benefits



MEDICAID MANDATES - IDAHO CODE (in millions)

1. Prescribed Drugs $114.2

Includes services for Prescribed Drugs

2. Waivers and Personal Care Services $92.7

Includes services for:

Aged/Disabled - Waiver - $46.3

Personal Care Service Plan - $14.9

Idaho State School & Hospital /State Hospital South and

Developmentally Disabled Waiver - $30.8

Traumatic Brain Injury Waiver - $0.7

3. DD/MH Care $34.6

Includes services for:

Targeted Case Management - $13.5

Development Disability Center - $31.8

Inpatient Mental Health - $9.1

4. ICF/MR Care $34.6

Includes services for Intermediate Care Facility for

the Mentally Retarded

5. Dental $20.4

Includes services for Dental Services

6. DME/Medical Supplies $8.7

Includes services for:

Durable Medical Equipment - $8.5

Medical Supplies - $0.2

7. Other Practitioners $8.7

Includes services for Other Practitioners

8. School District Services $2.3

Includes services for School District Services

9. Outpatient Rehab $1.1

Includes services for Outpatient Rehabilitation

10. District Health $0.1

Includes services for District Health

11. Nurse's Aide Training $0.1

Includes services for Nurse's Aide Training



MEDICAID MANDATES - IDAHO RULES (in millions):

1. Mental Health $36.7

Includes services for Mental Health

2. Child Health Program (Title XXI) $16.7

Includes services for Child Health Program (Title XXI)

3. Medicare Parts A & B $14.6

Includes services for Medicare Part A & B

4. Home Health Services $6.9

Includes services for Home Health Services

5 Ambulatory Surgical Centers $4.8

Includes services for Ambulatory Surgical Centers

6. Physical Therapy $4.0

Includes services for Physical Therapy

7. Institutional MH Diseases/SHS $3.0

Includes services for Institutional Mental Disease/SHS

8. Healthy Connections $2.0

Includes services for Healthy Connections

9. Group Health Plan Payments $1.6

Includes services for Group Health Plan Payments

10. Breast and Cervical Cancer $0.5

Includes services for BCC

11. DUR/Other $0.2

Includes services for Drug Utilization Review

Total expenditures for programs - $776.6

Other Medicaid issues reviewed and discussed included the following:

  1. Medicare Part A and B payments, and why beneficial to Medicaid clients to receive Medicare insurance;
  2. W-2 expenditure category when discontinued;
  3. Disposing of assets to "spend-down" to become Medicaid eligible, and the process to recoup those costs;
  4. Physicians and dentist discontinuing treatments for Medicaid clients due to low reimbursement rates;
  5. Idaho ranks #49 of the states in number of Medicaid programs offered;
  6. Match funds - Federal 70 percent and state 30 percent;
  7. Cost of nursing home beds;
  8. Most expensive Medicaid services are hospital related services, nursing home care, and prescription drugs.
Deputy Director Gary Broker presented two (2) charts outlining programs in the Department of Health and Welfare that operate solely with General Fund dollars. He explained the charts, Attachments #2 and #3.

  1. Eliminating any one of these programs presents specific problems. Eliminating them all would not meet the savings target for the current fiscal year. Eliminating them all also falls short of all 2003 and 2004 targets. Mr. Broker explained staff bumping privileges. (Attachment #2)


  2. Attachment #3 - is a list of Medicaid programs - If the Legislature cut 360 staff, eliminated all general fund-only programs and eliminated the operating expenses identified, legislators would remain well short of all four savings targets. To reach the savings targets, they would be forced to eliminate a significant number of Medicaid optional services.


3. What program, if eliminated, would not impact federal funds? (See attachments #2 and #3)

The committee members held a lengthy review of the charts presented, and discussed reductions of staff and effects on programs, increased co-pay for child care, closure of some state institutions and where patients could be placed, eliminating the Katie Becket services, and increasing eligibility requirements.

ADJOURNMENT Due to committee members' appearance required on the Senate Floor, the meeting adjourned at 10:13 a.m.




DATE: Thursday, March 6, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
MEMBERS ABSENT/

EXCUSED:

None
GUESTS: See the attached sign-in sheet
HEALTH AND WELFARE The Department of Health and Welfare continued with the educational briefing that began on Friday, February 28, 2003. Today, the committee reviewed legislative intent language prepared by Representative Lee Gagner, and also from the Department of Health and Welfare.

Representative Gagner's intent language is as follows:

Section 3. The Legislature has concerns relative to the degree of reductions to specific program budgets in the recent 3.5 percent holdback, and as a result, the House Medicaid Task Force met with providers of services and the Department of Health and Welfare personnel and identified short-term savings of $1,123,700 annualized.

It is the intent of the Legislature that a pro-rated amount equal to $230,900 be restored to three budgets; $71,600 to Targeted Case Management and Services Coordination; $48,500 to Residential Habilitation Services; and $110,800 to Sheltered Workshops.

It was recommended that Representative Gagner be invited to meet with the committee and discuss his legislative intent language.

The Department of Health and Welfare's legislative intent report is as follows:

There is hereby reappropriated to the Department of Health and Welfare any unexpended and unencumbered balances of the Cooperative Welfare Fund for fiscal year 2003, to be used for nonrecurring expenditures only for the period July 1, 2003 through June 30, 2004. The reapporpriation shall be computed by the Department of Health and Welfare from available moneys.

This section allows the Department to efficiently spend out appropriation balances, without requiring processing of encumbrance transactions. This also provides incentive for the Department to operate economically at year end to preserve funds for spending the next year. Historically, the Department does not receive any appropriation for capital outlay or minor (under $30,000) facility maintenance projects, and must use carryover funds for these items. If reappropriation authority is not provided for, the Department would be required to encumber fund balances to preserve spending authority. This would require additional staff to account for these encumbrances.

Notwithstanding the provisions of Section 67-3516(2), Idaho Code, the Department of Health and Welfare is hereby authorized to expend all receipts collected as noncognizable funds for the period July 1, 2003 through June 30, 2004.

This section allows the Department to maximize funding available from receipts collected, without requesting supplemental spending authority. Many times the Department is able to collect additional funds to support programs that are not anticipated at the time the budget is requested. For example, the Department was able to pay an additional $10 million dollars to inpatient hospital facilities which utilized match from these facilities and federal funds (no state funds were needed). Any receipt collected from federally funded programs must be spent on that program, or the federal share must be returned to the grantor agency.

It is legislative intent that the appropriation of moneys from the Cancer Control Fund specifically supersedes the provisions of Section 57-1702, Idaho Code.

This section allows the Department to spend appropriated personnel funds from the Cancer Control Funds. Idaho Code 57-1702 does not provide for using these funds for personnel. The Department is able to more economically provide services using state staff than under contract.

The Department spends $50,000 for personnel costs to coordinate contracts, and provide technical assistance to health districts on the programs. There is $237,500 used for contracts in tobacco risk awareness contracts with health districts, tribes, and physician groups. This is used as match for federal grants in this area. There is an additional $85,800 used for contracts with the health districts in the breast and cervical cancer program. Total in governor's recommendation is $401,700, however, historically the account has not generated over $375,000 in income. Any unencumbered balance at year end reverts to the General Fund.

As appropriated, the state controller shall make transfers of the General Fund to the Cooperative Welfare Fund, periodically, as requested by the director of the Department of Health and Welfare, and approved by the Board of Examiners.

This section allows the Department to operate more efficiently, and reduces the number of transactions required to conduct business. Since most of the Department's programs involve the use of federal funds, either directly or indirectly, most payments are funded from federal and state dollars. If the cooperative welfare fund and the related general fund transfer were not available, each payment would have to be split between federal and state funds. Since the exact federal/state share is not known until after cost allocation is run on a monthly basis, an adjustment would be required to change the federal/state share to the actual amounts. This would require additional staff and computer resources to maintain.

The Department must have adequate cash on deposit in the state controller's and state treasurer's accounts before warrants are written. However, federal funds cannot be requested from the federal treasury until they are actually used to cover redemption of warrants. Because of this, the Department must have access to state funds to cover the delay from the time warrants are issued, until they are redeemed and the federal funds can be deposited. For example, on a weekly Medicaid payroll the 70 percent federal share must be drawn as follows:

Business days after warrant is issued
until federal funds are drawn
% available to draw

Day of issue
1 day after issue
2 days after issue
3 days after issue
4 days after issue
5 days after issue
6 days after issue
7 days after issue
8 days after issue
9 days after issue
10 days after issue

0
0
52.3%
2.1%
9.3%
14.8%
10.9%
4.4%
2.3%
1.1%
2.8%

Other items briefly discussed included the following:
  1. Responsibilities of germane committees;
  2. JFAC (Joint Finance-Appropriations Committee) responsibilities;
  3. Request JFAC to let a germane committee know in advance of any proposed legislative intent pertaining to appropriations;
  4. Have authors, or others, meet with germane committees to discuss legislative intent language;
  5. Germane committee take an active role in preparing intent language for allocations of funds;
  6. Impacts of legislative intent language on agencies;
  7. Working in cooperation with JFAC and ensuring legislative intent language incorporates the germane committees' policies to agencies.
ADJOURNMENT There being no further business, the meeting adjourned at 9:50 a.m.




DATE: Friday, March 7, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, and Kennedy
MEMBERS ABSENT/

EXCUSED:

Vice Chairman Compton
GUESTS: Representative Jim Clark, and see the attached sign-in sheet
MINUTES: A motion was made by Senator Kennedy to approve the committee's minutes for Thursday, February 27, 2003, as written. Motion was seconded by Senator Bailey, and motion was carried by a voice vote.
A motion was made by Senator Bailey to approve the committee's minutes for Thursday, January 30, 2003, as written. Motion was seconded by Senator Kennedy, and motion was carried by a voice vote.
A motion was made by Senator Sweet to approve the committee's minutes for Thursday, February 20, 2003, as written. Motion was seconded by Senator Kennedy, and motion was carried by a voice vote.
DEPARTMENT OF HEALTH AND WELFARE The Department of Health and Welfare (DHW) continued the educational briefings presented February 28, and during the week of March 4 - 7, 2003.

The department has presented a five (5) day educational briefing about issues that have come before the Senate Health and Welfare Committee concerning staff reductions and programs.

Today, Deputy Director Gary Broker presented a summary pertaining to the department's SFY2004 General Fund appropriations, and the overall reduction appropriation by an additional $454,800 in the FY2003 appropriations. He outlined possible strategies to achieve the new appropriation savings for the FY 2003 appropriations. (Attachments #1 and #2)

The committee held an in-depth review of the proposed FY2004 chart. Areas discussed included the Indirect Supports, and numerous other areas pertinent to the concerns about, but not limited to, the following:

  1. Service delivery that will affect clients;
  2. Additional staff layoffs and how that will impact programs;
  3. Staff bumping privileges and retention points;
  4. The importance of the employees' recognition award program;
  5. The risk of losing federal program funding;
  6. Child protection workers (the department has not, at this time, reduced the number of assigned staff for child protection, but with additional budget reductions then child protection workers will need to be considered;
  7. Monitoring 149 federal grants within the department;
  8. Communications - keeping communications opened as community liaisons and with line-staff;
  9. Impact on direct support services and providers;
  10. Consolidation of staff positions;
  11. Allowing flexibility within seven regions;
  12. Substance abuse, mental health, developmental disabilities program;
  13. Payment of expenditures and quality of payments, and the
  14. Self-reliance Program and Welfare-to-Work Program.


The Department receives five (5) appropriations bills, each with a certain number of authorized full-time staff positions.

April Crandell, LSW, from Idaho Falls, a representative of the Mental Health Providers Association of Idaho and Administrative Quality Assurance Public Relations, distributed a four (4) page handout pertinent to cost for mental health assessments, the service plan, and reviews for adult mental health including psychosocial rehab, targeted case management, and clinic assessment. She described her plan to deliver mental health services in a more efficient manner. She explained the total cost per consumer is $1,330.16 or a total cost of $2,660,320 for 2,000 consumers.

Ms. Crandell presented a mental health consumer pathway of services, such as doing one assessment for the three (3) mental health services, creating a savings of all most one-half (½) the cost for the assessment process currently used by the Department of Health and Welfare. She explained her proposal would save funds, but would still provide consumers with the right amount of services, at the right time. She briefed the committee about all four (4) pages of her handout. (Attachment #3)

Chairman Brandt explained Ms. Crandell's proposal deals with the Department of Health and Welfare's Utilization Management Program (UMP). He asked the Division of Medicaid Acting Administrator Randy May if the department is reviewing the proposal presented by Ms. Crandell. Mr. May reported the department is aware of this proposal, and is reviewing it. Senator Brandt explained the proposal being presented by Ms. Candall is related to the UMP process used by the Department of Health and Welfare. This is an area that will come before the committee soon be reviewing.

Senator Darrington informed the committee it has been the goal and objective of this committee for years, not just in regards to mental health assessments but also drug and alcohol evaluations, that treatments are not to be provided by the same people, are even the same company, who does the assessment of clients. The committee determined the best process is to have treatments provided by someone other than the assessor. Ms. Crandell was asked, if her proposal provided for treatments to be done by the same agency, or the same person(s), who does the assessment? She answered, yes, and disagreed with the process the department uses. She gave an example of a person going to one doctor for assessment, and then go to another doctor for treatment. She does not believe this is the best management practice to follow, and it is more expensive to use the current process. She believes the one assessment process provides cost savings.

The committee must report to the Senate Floor; therefore, the meeting adjourned at 10:25 a.m.




DATE: Tuesday & Wednesday, March 11 & 12, 2003
TIME: 8:30 a.m.
PLACE: Room 437
MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, and Burkett
MEMBERS ABSENT/

EXCUSED:

Senator Kennedy was absent and excused on Wednesday, March 12, 2003
GUESTS: See the attached sign-in sheets.
MINUTES: A motion was made by Senator Bailey to approve the committee's minutes of Thursday, March 6, 2003, with a typographical correction on page 3. Motion was seconded by Senator Compton, and motion was carried by a voice vote.

A motion was made by Senator Sweet to approve the committee's minutes of Friday, February 28, 2003. Motion was seconded by Senator Bailey, and motion was carried by a voice vote.

HB 150 HB 150 was first presented on Tuesday, March 11, and continued on Wednesday, March 12, 2003.

HB150 was presented by Richard R. Rush, vice president of Natural Resources, Idaho Association of Commerce and Industry (IACI), an organization representing approximately 300 industry companies.

This legislation, HB150, clarifies the intent of Section 107D, Chapter 39, Idaho Code, related to certain rule making requirements by the Idaho Department of Environmental Quality (DEQ). The bill, H150, requires that the department utilize the best available science and apply well established risk assessment methods when passing rules that are more stringent or broader in scope than federal rules. The bill places in state law the existing requirements imposed on the United States Environmental Protection Agency (EPA), under the federal law when EPA passes rules.

The bill will amend existing law to provide that the DEQ shall utilize the best available data, which has been subject to peer reviewed science and supporting studies when proposing rules; and to provide for additional material in the notice of rulemaking when a rule proposes a standard necessary to protect human health and the environment.

Mr. Rush requested the committee consider an amendment to HB150, Section 1. The changes he requested are as follows:

ON PAGE 2: Page 2, of the printed bill, on line 8, and delete "Any rule" and delete lines 9 through 12, of HB150. Attachment #1

Mr. Rush requested the committee pass HB150, with the amendment to Section 1, page 2.

C. Stephen Allred, director of the Department of Environmental Quality (DEQ), informed the committee that the Department of Environmental Quality will follow whatever direction is set-forth by the Legislature. The department is not for or against the Bill. What he hopes to do is clearly identify how the DEQ would administer this Bill, if it is passed, and if it is the decision of this Committee that DEQ is to follow that structure in preparing rules. He restated that DEQ will follow the Legislature's directions.

Mr. Allred proposed an amendment to simplify this Bill, and presented a draft amendment to HB150. Attachment #3 The amendment reads:

ON PAGE 1:

(2) Insert "more stringent than federal law after rule in line 24, and deleting subject to this section, lines 24 and 25.

(3) Insert "more stringent than federal law" after rule in line 27, and deleting subject to this section, line 27; and insert "numerical" between the word "a" and "standard" on line 27.

ON PAGE 2:

(4) Insert "including a numerical standard" after "board" on line 9.

Mr. Allred discussed a chart outlining the current rule making process that the DEQ must follow. To promulgate a rule to be published in the Administrative Bulletin, submitting the rule to the Legislature, and for the rule to become a pending rule for final approval, requires about 390 days. DEQ does use the negotiated rule making process. In order to process rules for approval or denial by EPA, (Environmental Protection Agency) currently requires about 570 days.

He explained the rule making process after HB150 will require about 1,290 days, before obtaining EPA approval or denial. If HB150 is approved, it will increase costs and assessments to promulgate rules.

(Attachment #2)

Clive J. Strong, a Deputy Attorney General and Chief of the Natural Resources Division, provided the following attorney general analysis, dated March 11, 2003, of House Bill 150, upon the February 21, 2003, request of Mr. Allred for an opinion of House Bill 150. The opinion was reviewed and discussed by the committee members.

  1. QUESTIONS PRESENTED


A. What Department of Environmental Quality (DEQ) rules or programs would be subject to the requirements of House Bill 150? In answering this question, please identify those existing rules, the amendment of which, would be subject to the requirements of this Bill, and those existing programs and authorities under which DEQ may propose a new rule that would be subject to the requirements of this Bill.

B. What is a "standard" as used in paragraph (3) of House Bill 150?

C. For those programs or rules subject to House Bill 150, what actions or studies would DEQ and the Board of Environmental Quality (the Board) be required to undertake to ensure compliance with the requirements of House Bill 150?

II. CONCLUSIONS

A. House Bill 150 applies to rules formulated and recommended by the Director of DEQ to the Board, which are broader in scope or more stringent than federal law or regulations, or propose to regulate an activity not regulated by the federal government. Whether a proposed rule is subject to the requirements of House Bill 150 will depend upon an examination of the particular rule and the federal law or regulation involved. There are, however, some general guidelines that can be used to determine when House Bill 150 would apply. First, House Bill 150 would only apply when DEQ is authorized to adopt rules that are broader in scope or more stringent than federal law or regulations or proposes to regulate an activity not regulated by the federal government. With respect to certain programs, DEQ is prohibited from adopting rules that are more stringent or broader in scope than federal law, and so House Bill 150 would not apply to rules adopted for these programs. Second, for a rule to be broader in scope than a federal law or regulation, the proposed state rule would have to apply to the same subject matter covered by a federal law or regulation and regulate some aspect of the subject matter not covered by the federal law or regulation. Third, for a proposed state rule to be more stringent than federal law or regulation, the proposed state rule would have to address an activity that is already subject to a specific federal law or regulation, and the state rule would have to impose restrictions upon that activity beyond those found in the federal law or regulation. Fourth, a proposed state rule regulates an activity not regulated by the federal government only when there is no federal counterpart that addresses the activity regulated by the proposed state rule, either by establishing federal standards, or providing for establishment of standards by state agencies.

In short, House Bill 150 would apply to every standard-setting rule promulgated by DEQ other than (1) a rule identical to an existing federal standard, or (2) a rule promulgated within the limits and authority set for the state program under federal law.

B. A "standard" as used in House Bill 150 most likely means a requirement, criterion or other measure against which the correctness or appropriateness of specified actions, practices or procedures may be determined. Such a standard is subject to House Bill 150 if it is necessary to protect human health and the environment and is broader in scope or more stringent than federal law or regulation or proposes to regulate an activity not regulated by the federal government.

C. For those rules subject to the Bill, House Bill 150 provides two separate requirements: (1) the agency must "utilize the best available data which has been subject to peer reviewed science and supporting studies"; and (2) for those rules that propose a standard necessary to protect human health and the environment, the agency must include in the notice for proposed rulemaking and rulemaking record the results of a risk assessment that identifies each population or receptor, the expected risk or estimate of risk, the uncertainty involved, and any studies that support, are directly relevant to or fail to support any estimate of public health or environmental effects. House Bill 150 does not define the terms "best available data" or "peer reviewed science." The language, however, is modeled after the federal Safe Drinking Water Act; therefore, guidance relating to implementing the Safe Drinking Water Act is instructive in determining what actions are necessary to meet the requirements of the Bill. The federal guidance suggests that DEQ will be required to conduct detailed, lengthy assessments in order to meet the requirements of House Bill 150.

III. ANALYSIS

House Bill 150 proposes to amend Idaho Code § 39-107D that deals with rules adopted by DEQ. The language proposed to be added to § 39-107D reads as follows:

    (2) In proposing any rule or portions of any rule subject to this section, the department shall utilize the best available data which has been subject to peer-reviewed science and supporting studies.

    (3) Any proposed rule subject to this section which proposes a standard necessary to protect human health and the environment shall also include in the notice of proposed rulemaking and rulemaking record requirements under chapter 52, title 67, Idaho Code, the following additional information:

      (a) Identification of each population or receptor addressed by an estimate of public health effects or environmental effects; and

      (b) Identification of the expected risk or central estimate of risk for the specific population or receptor; and

      (c) Identification of each appropriate upper bound or lower bound estimate of risk; and

      (d) Identification of each significant uncertainty identified in the process of the assessment of public health effects or environmental effects and any studies that would assist in resolving the uncertainty; and

      (e) Identification of studies known to the department that support, are directly relevant to or fail to support any estimate of public health effects or environmental effects and the methodology used to reconcile inconsistencies in the data.

A. What DEQ rules or programs would be subject to the requirements of House Bill 150?

House Bill 150 would amend Idaho Code § 39-107D. The Bill provides certain new requirements for "any rule subject to this section." Under House Bill 150, a rule subject to § 39-107D is a rule "formulated and recommended by the department to the board which is broader in scope or more stringent than federal law or regulations, or proposes to regulate an activity not regulated by the federal government." Therefore, there are three different types of rules that could trigger the requirements of House Bill 150:

    (1) rules that are broader in scope than federal law or regulation;

    (2) rules that are more stringent than federal laws or regulations;

    or

    (3) rules that propose to regulate an activity not regulated by the federal government.



1. Broader in Scope

Statutory interpretation begins with the words of the statute, giving language its plain, obvious and rational meaning. Atkinson v. State, 131 Idaho 222, 953 P.2d 662 (1998); State v. Johnson, 131 Idaho 808, 964 P.2d 675 (1998). While House Bill 150 does not define "broader in scope," the plain and ordinary meaning of the Bill suggests there is a three-step analysis for determining whether a proposed state rule is broader in scope than federal law or regulation:

    (1) Is there a federal law or regulation that addresses the same subject matter addressed by the proposed state rule?

    (2) What is the scope of that federal law or regulation?

    (3) Is the proposed rule broader in scope than the federal law or regulation?

"Scope" is defined in Webster's Dictionary as "extent of treatment, activity, or influence." Webster's New Collegiate Dictionary. Therefore, in order to be broader in scope than federal law or regulation, the proposed rule must address matters extending beyond the limits or extent of the federal treatment of the same subject matter. This interpretation is supported by a review of cases in which the courts have used the phrase "broader in scope" when comparing statutes. For example, the court in People v. General Motors Corporation, 51 Cal.Rptr.2d 651 (1996), compared California's Porter-Cologne Act to the federal permitting program under the Clean Water Act (CWA). The court found the state law was broader in scope because it regulated discharges to ground water as well as surface water and discharges of wastes in addition to the discharge of pollutants regulated by the federal scheme. Similarly, the Idaho Supreme Court in State v. Boyle, 67 Idaho 512, 186 P.2d 859 (1947), stated the following when comparing two laws regulating the sale of liquor: "The 1939 Act is much broader in scope, and has to do with the control, regulation, manufacture, sale and dispensation of liquors in general, while the 1947 Act relates only to retail sale by the drink under license and local option." 67 Idaho at 523. In each of these cases, two laws regulated the same general subject matter, but one was viewed as being broader in scope because it regulated some aspect of the subject matter not regulated by the other law.

In sum, House Bill 150 will apply when there is a federal law or regulation that addresses the same subject matter as the proposed state rule, and the state rule regulates some aspect of the subject matter not regulated by the federal law or regulation.

2. More Stringent

House Bill 150 also applies to proposed rules that are more stringent than federal law or regulation. Similar to the analysis regarding the term "broader in scope," the plain language of the Bill indicates two questions must be answered:

(1) Is there a federal law or regulation that addresses the same issue addressed in the proposed state rule?

(2) Is the proposed state rule more stringent than the federal law or regulation?

The first question to be addressed is whether there is a federal law or regulation that addresses the identical issue as the proposed rule. Unlike the analysis of "broader in scope," it is not enough that the federal law generally addresses the subject matter; the federal government must have directly spoken on the precise issue addressed by the proposed state rule. Any other interpretation would, in part, render this language superfluous. If the stringency language were read to apply when the federal government addresses a general subject area but does not regulate the specific activity in question, then the stringency language would duplicate the "broader in scope" restriction. Statutes should be construed to avoid superfluous language. Petersen v. Franklin County, 130 Idaho 176, 938 P.2d 1214 (1997). Therefore, for a state law to be more stringent, there must be an affirmative regulatory act by the federal government to which the proposed state law can be compared.

This conclusion is supported by judicial construction of a similar Missouri statute in Farmer v. Simmerman, 51 S.W.3d 64 (2001). In Farmer, the court reviewed a statute that prohibited the state from adopting standards any stricter than those required under the provisions of the federal Clean Air Act. The plaintiffs argued that the state was prohibited from adopting standards for odorous emissions because EPA had chosen not to regulate odors under the Clean Air Act. The court determined that the prohibition in the statute only applied when the federal government has directly spoken on the precise issue of odors and odorous emissions through an affirmative regulation, and, therefore, since there was no EPA standard, the state was not prohibited from adopting the odor standards. 51 S.W.3d at 79.

The court in Old Ben Coal Company v. Department of Mines and Minerals, 562 N.E.2d 1202 (1990), reached a similar conclusion with respect to an Illinois statute that prohibited state rules more stringent than those required to meet the Federal Surface Mining Control and Reclamation Act. The court reviewed state rules challenged under this Illinois statute and held that when federal law gives the state discretion to adopt regulations not specified by the federal act, there is no comparable federal requirement and the stringency limitation does not apply.

Based on the foregoing, House Bill 150 applies when there is a federal law or regulation that addresses the precise issue addressed by the state rule, and the proposed rule is more stringent than the federal law or regulation.

3. Regulating an activity not regulated by the federal government.

House Bill 150 also would apply to any rule that proposes to regulate an activity not regulated by the federal government. Reading this language, with the other trigger language reviewed above, indicates that a proposed rule regulates an activity not regulated by the federal government when there is no federal counterpart to the proposed state rule

4. Specific DEQ rules that may be subject to House Bill150.

You requested this office to identify those existing rules that would, if amended, be subject to the requirements of House Bill 150. You also requested us to identify those existing programs and authorities under which DEQ may propose a new rule that would be subject to the requirements of this Bill. Whether a particular proposed rule is subject to House Bill 150 would require a searching comparison of the particular rule and the corresponding federal law or regulation, if any. Therefore, it is impracticable to identify future rules that would be covered by this Bill. Moreover, since the operative language in the Bill is undefined and general in nature and there is very little case law to use as guidance, it is very difficult to predict the application of House Bill 150 to any specific set of existing rules. Some general comments regarding the application of House Bill 150 to existing DEQ programs and rules, however, can be made and may be helpful in reviewing future rulemaking for compliance with this proposed law.

With respect to certain issues and programs, the Idaho Code prohibits DEQ from adopting rules that are broader in scope or more stringent than federal law or regulations. These limits on DEQ rulemaking typically occur when there is a detailed state statutory scheme coupled with detailed federal law or regulations. For example, Idaho Code § 39-4404 states the following with respect to the state hazardous management program:

CONSISTENCY WITH FEDERAL LAW. The legislature intends that the state of Idaho enact and carry out a hazardous waste program that will enable the state to assume primacy over hazardous waste control from the federal government. The legislature finds that the RCRA, as amended, 42 U.S.C. § 6901 et seq., and federal regulations adopted pursuant thereto, establish complex and detailed provisions for regulation of those who generate, transport, treat, store, and dispose of hazardous wastes. The legislature cannot conveniently or advantageously set forth in this chapter all the requirements of all of the regulations, which have been or will be established under RCRA. However, by the provisions of this chapter, the legislature desires to avoid the existence of duplicative, overlapping or conflicting state and federal regulatory systems. Therefore, the board is directed to promulgate rules, which are consistent with RCRA and the federal regulations adopted by the administrator of the United States environmental protection agency to implement RCRA . . . . The board may not promulgate any rule that would impose conditions or requirements more stringent or broader in scope than RCRA and the RCRA regulations of the environmental protection agency.

Idaho Code § 39-4404.

Other sections of the Idaho Code containing similar limitations on DEQ rulemaking are: Idaho Code §§ 39-105(3)(g);39-118B;39-3601;39-6205;39-7210 and 39-7404.

Since House Bill 150 only applies when a rule is broader in scope or more stringent than federal law or regulation or proposes to regulate an activity not regulated by the federal government, House Bill 150 would not apply to any rules adopted under the authority of those Idaho Code sections that prohibit DEQ from adopting rules more stringent or broader in scope than existing federal statutes and regulations.

Many of the existing DEQ rules implement programs established by federal environmental law that provide authority directly to the states. In addition, federal environmental laws often reserve broad authority to states to impose more stringent requirements or requirements that are broader in scope than the federal law. This federal/state scheme has several implications relating to the application of House Bill 150. First, when federal law provides authority to the state to develop rules to implement an environmental program, and there are no comparable federal rules, the state rules will generally not be considered more stringent, because there is no federal counterpart to which the state rule can be compared. Likewise, if the state rules fit within the limits of the program and authority set for the state under federal law, the state rule will probably not be considered broader in scope than the federal law. For example, the CWA provides primary authority to the states to develop water quality standards. Natural Resources Defense Council v. EPA, 16 F.3d 1395 (4th Cir. 1993); PUD No. 1 of Jefferson County v. Washington Department of Ecology, 511 U.S. § 700, 114 S. Ct. 1900 (1994). Water quality standards include designations of the uses of the waters of the state and criteria sufficient to protect the designated uses. 40 C.F.R. 131.6. The federal government does not promulgate water quality standards unless it finds that the state standards do not meet certain minimum requirements. 33 U.S.C. § 1313 (c); 40 C.F.R. 131. The federal government provides states with guidance regarding water quality standards, but states are free to use other criteria. 33 U.S.C. § 1314(a); 40 C.F.R 131.11(b). The CWA also broadly reserves to states the authority to adopt or enforce any standard or limitation respecting discharges of pollutants or respecting control or abatement of pollution, but limits this reservation by precluding the adoption or enforcement of certain effluent limitations if they are less stringent than those in effect under the CWA. 33 U.S.C. § 1370.

DEQ is the agency responsible for developing CWA water quality standards for Idaho. Idaho Code § 39-3601 et seq. Idaho Code provides that the water quality rules adopted by DEQ should not impose requirements beyond those of the federal CWA. Idaho Code § 39-3601. This language could be read to limit DEQ from developing rules broader in scope or more stringent than the CWA.

Since there generally are no federal water quality standards, a state proposed water quality standard would probably not be considered more stringent than federal law or regulation. Likewise, the lack of specific federal water quality standards does not necessarily require the conclusion that state water quality standards "regulate an activity not regulated by the federal government." The CWA does "regulate" water quality by providing the authority and framework for the state water quality standards and, therefore, a proposed state water quality standard may not be considered to regulate an activity not regulated by the federal government. Proposed water quality standards could, however, be broader in scope than federal law or regulation if they went beyond the bounds of the water quality standards program established under the CWA. This could happen, for example, if DEQ attempted to regulate surface waters not included within the definition of waters of the U.S. regulated by the CWA.

Other DEQ programs will be affected by House Bill 150. DEQ currently has rules that regulate activities for which there is no federal counterpart. These include, but may not be limited to, the Ground Water Quality Rule, IDAPA 58.01.11; Individual/Subsurface Sewage Disposal Rules, IDAPA 58.01.03; Wastewater-Land Application Permit Rules, IDAPA 58.01.17; Rules Governing the Cleaning of Septic Tanks, IDAPA 58.01.15; and Rules for Ore Processing by Cyanidation, IDAPA 58.01.13. Amendments to any of these rules could potentially be subject to House Bill 150.

B. What is a "standard" as used in paragraph (3) of House Bill 150?

Paragraph 3 of House Bill 150 reads, in part, as follows:

Any proposed rule subject to this section which proposes a standard necessary to protect human health and the environment shall also include in the notice of proposed rulemaking and rulemaking record requirements under chapter 52, title 67, Idaho Code, the following additional information . . . .

Paragraph 3 imposes additional requirements on DEQ with respect to "any proposed rule subject to this section which proposes a standard necessary to protect human health and the environment." The additional requirements, therefore, apply with respect to a standard that is (1) broader in scope or more stringent than federal law or regulations or regulate an activity not regulated by the federal government, and (2) is necessary to protect human health and the environment.

1. What is a standard?

The first step in determining the applicability of paragraph 3 is to define what a "standard" means. While this word is not defined in the Bill or DEQ rules, the Idaho Administrative Procedure Act (APA) defines "standard" as "a manual, guideline, criterion, specification, requirement, measurement or other authoritative principle providing a model or pattern in comparison with which the correctness or appropriateness of specified actions, practices or procedures may be determined." Idaho Code § 67-5201(21). This defined term is then used in Idaho Code § 67-5229, which provides that an agency may incorporate by reference into an agency rule certain standards adopted by other agencies or entities. See 2000 Idaho Session Laws, ch. 203, p.510 (indicating that the definition of "standard" was added to clarify the applicability of section 5229).

Using the APA definition as a guide to the meaning of House Bill 150 appears appropriate since the APA defines those standards that may be incorporated into agency rules, and House Bill 150 addresses rules that include a standard. Using the APA definition, House Bill 150 is applicable to any DEQ rule that sets a requirement, criterion or other measure against which the correctness or appropriateness of specified actions, practices or procedures may be determined. This would extend to a very broad range of DEQ rules, including the numeric criteria set forth in the state water quality standards (IDAPA 58.01.02.210 through 252, and more general narrative standards, such as the narrative criteria in the water quality standards (IDAPA 58.01.02.200).

2. What is a standard that is necessary to protect human health and the environment?

In order for House Bill 150 to apply the rule must not only set forth a standard, but it also must be a standard necessary to protect human health and the environment. DEQ was created to protect human health and the environment. Idaho Code § 39-102A. The agency was given rulemaking authority that, consistent with its mission, is broadly limited to rules to prevent, control or abate environmental pollution or degradation and risks to public health. Idaho Code §§ 39-105 and 39-107(7). Given DEQ's mission and its rulemaking authority, it is likely that most of the rules DEQ proposes would be considered rules to protect human health and the environment.

3. Standards that are broader in scope or more stringent than federal law or regulations or propose to regulate an activity not regulated by the federal government.

Finally, the standard proposed must be broader in scope or more stringent than federal law or regulations or propose to regulate an activity not regulated by the federal government. As discussed above, it is difficult to predict what future rules might fit this definition. At the least, however, there are a number of existing DEQ rules that regulate activities not regulated by the federal government, and the amendment of any of these rules to propose a standard would be subject to House Bill 150.

C. For those rules subject to House Bill 150, what actions or studies would DEQ and the Board of Environmental Quality be required to undertake to ensure compliance with the requirements of House Bill 150?

House Bill 150 provides two separate requirements for rules: (1) the agency must "utilize the best available data which has been subject to peer reviewed science and supporting studies";and (2) for those rules that propose a standard necessary to protect human health and the environment, the agency must include in the notice for proposed rulemaking and rulemaking record the results of a risk assessment, including the identification of each population or receptor, the expected risk or central estimate of risk, significant uncertainties, and studies that support, are directly relevant to or fail to support any estimate of public health or environmental effects.

House Bill 150 does not define many of the critical terms used in this section of the Bill. For example, there is no definition of "best available data" or "peer reviewed science" or "supporting studies." There is also nothing to suggest how the agency is to "utilize" this information when it develops a rule. Without this information, it is difficult to determine the extent of the burden placed on the agency by House Bill 150.

The language in paragraphs 2 and 3 of the Bill, however, appears to be patterned after language found in the federal Safe Drinking Water Act (SDWA). The SDWA provides that whenever the federal EPA develops national primary drinking water regulations, it must meet the following requirements:

    (A) Use of science in decision making

    In carrying out this section, and, to the degree that an Agency action is based on science, the Administrator shall use--

    (i) the best available, peer-reviewed science and supporting studies conducted in accordance with sound and objective scientific practices; and

    (ii) data collected by accepted methods or best available methods (if the reliability of the method and the nature of the decision justifies use of the data).

    (B) Public information

    In carrying out this section, the Administrator shall ensure that the presentation of information on public health effects is comprehensive, informative, and understandable. The Administrator shall, in a document made available to the public in support of a regulation promulgated under this section, specify, to the extent practicable­

    (i) each population addressed by any estimate of public health effects;

    (ii) the expected risk or central estimate of risk for the specific populations;

    (iii) each appropriate upper-bound or lower-bound estimate of risk;

    (iv) each significant uncertainty identified in the process of the assessment of public health effects and studies that would assist in resolving the uncertainty; and

    (v) peer-reviewed studies known to the Administrator that support, are directly relevant to, or fail to support any estimate of public health effects and the methodology used to reconcile inconsistencies in the scientific data.

42 U.S.C.A. § 300g-1(b)(3).

In order to implement the requirements in the SDWA, and also to adapt these principles to other EPA programs, EPA has developed extensive guidelines. These include, but are not limited to, Guidelines for Ensuring and Maximizing the Quality, Objectivity, Utility and Integrity for Information Disseminated by the Environmental Protection Agency (December 2002): Peer Review and Peer Involvement at the U.S. EPA (June 1994); Peer Review Handbook, 2nd Edition, U.S. EPA, Science Policy Council (December 2000); EPA Guidelines for Ecological Risk Assessment (1998); Guidelines For Exposure Assessment (1992); Guidelines For Neurotoxicity Risk Assessment (1998); Guidelines for Reproductive Toxicity Risk Assessment (1996). These guidance documents, and a review of SDWA regulations that have been developed pursuant to this language, may provide the agency information to help it in attempting to meet the requirements of House Bill 150. It is impossible to summarize in this opinion all the information developed by EPA in these guidance documents relating to risk assessments, use of scientific data and peer reviews. The guidance documents suggest, however, that meeting the requirements of House Bill 150 may involve lengthy, detailed scientific analysis by DEQ.

Tim Teater testified and presented written comments in opposition to HB150. He testified as a private citizen, not as an employee of the Department of Environmental Quality. He outlined HB150, an act relating to administrative rules of the Department and Board of Environmental Quality; amending section 39-107d, Idaho Code, to provide that the Department of Environmental Quality shall utilize the best available data which has been subject to peer reviewed science and supporting studies when proposing rules, and to provide for additional material in the notice of rulemaking when a rule proposes a standard necessary to protect human health and the environment.

Be It Enacted by the Legislature of the State of Idaho:

SECTION 1. That Section 39-107D, Idaho Code, be, and the same is hereby amended to read as follows:

39-107D. RULES OF DEPARTMENT OR BOARD. (1) The Legislature directs that any rule formulated and recommended by the department to the board which is broader in scope or more stringent than federal law or regulations, or proposes to regulate an activity not regulated by the federal government, is subject to the following additional requirements: the notice of proposed rulemaking and rulemaking record requirements under Chapter 52, title 67, Idaho Code, must clearly specify that the proposed rule, or portions of the proposed rule are broader in scope or more stringent than federal law or regulations, or regulate an activity not regulated by the federal government, and which portions of the proposed rule are broader in scope or more stringent than federal law or regulations, or regulate an activity not regulated by federal government.

This provision, as it requires notification, may not be overly problematic depending on interpretation. However, the new language "or proposes to regulate an activity not regulated by the federal government" seems directed at or will at least have a significant negative impact on many rules and programs designed to protect the public health, such as the Toxic Air Pollutant and state water programs. This is of significant concern, because toxic and hazardous air (and water) pollination has been shown to be a significant health problem nationally and locally, and one that Idaho must continue to address. It must be understood that the Clean Air Act, the Clean Water Act and other similar federal statutes and EPA regulations are aimed at problems of a national or regional nature, and were never intended to substitute for state and local specific environmental protection rules.

(2) In proposing any rule or portions of any rule subject to this section, the department shall utilize the best available data which has been subject to peer reviewed science and supporting studies.

This section fails to define "peer reviewed science," standard or supporting studies. For instance is that science that is published in a journal such as Science, or the Journal of Agromedicine? Or will studies have to be published in a specifically refereed journal? Are supporting studies those studies that specifically support the study in question or studies that generally support the conclusions of the study in question? Will DEQ's consultation with our own consulting toxicologist or with the Department of Agriculture's or Division of Health's Toxicologist be invalidated unless that consultation is publish for peer review?

Are the following acceptable "peer reviewed science?

Technical Basis for a Total Reduced Sulfur Ambient Air Quality Standard by the Nebraska DEQ.

Health Effects of Reduced Sulfur Gases, a document from the National Council of the Paper Industry for Air and Stream Improvement (NCASI)

Toxicological Profile for Hydrogen Sulfide by the Agency for Toxic Substances and Disease Registry (ATSDR)

Publishing, even in a "peer reviewed' Journal, does not automatically confer validity. There are legitimate disagreements among scientists and risk assessors. There is often significant uncertainty in the best data. This section of the bill essentially requires the legislature to be the arbiter of what science is "acceptable." Regulatory scientists and risk assessors, operate in an environment of uncertainty and must arrive at conclusions using multiple lines of enquiry and evidence, and must be given the authority and flexibility to make decisions about the appropriateness of scientific information for regulatory decision making. It is unreasonable to substitute one-size fits all legislation for established scientific and administrative decision making processes.

Additionally, the existence of uncertainty and data gaps, while justifying a call for further research, does not necessarily justify delay in regulation when there is general agreement that a need exists I.E. "paralysis by analyses." For instance, it is not necessary to understand the caliber, bullet weight, velocity, trajectory and potential neighborhood victims of a bullet before one passes rules outlawing shooting off a gun in the backyard.

(3) Any proposed rule subject to this section which proposes a standard necessary to protect human health and the environment shall also include in the notice of proposed rulemaking and rulemaking record requirements under chapter 52, title 67, Idaho Code, the following additional information:

A. Identification of each population or receptor addressed by an estimate of public health effects or environmental effects; and

B. Identification of the expected risk or central estimate of risk for the specific population or receptor; and

C. Identification of each appropriate upper bound or lower bound estimate of risk; and

D. Identification of each significant uncertainty identified in process of the assessment of public health effects or environmental effects and any studies that would assist in resolving the uncertainty; and

E. Identification of studies known to the department that support, are directly relevant to or fail to support any estimate of public health effects or environmental effects and the methodology used to reconcile inconsistencies in the data.

These provisions may seem reasonable on their face and are, in general, part of what DEQ considers when evaluating the need for a rule or rule change. However, the imposition of this NEPA-like (National Environmental Protection Act) provision goes too far. A few potential problems are listed below:

  • If a new toxic chemical compound comes into use in Idaho, does A, above, require that DEQ identify all populations that may potentially be exposed to this new compound before we can set a regulatory level and does that regulatory level need to be published and peer reviewed before DEQ can implement it?
  • Regarding B above how will risk, which is usually applied to the risk of excess cancers over time, be applied to the emissions of acutely toxic non-carcinogenic compounds?
  • Regarding C above, of what value is the development of a lower bound risk estimate if the upper bound risk estimate is not high enough to be of concern? The added language addressing characterization of uncertainty and upper, lower and central tendency suggests that the legislative intent is that rules are to be based on probabilistic risk assessment. This will add complexity to the process without clarifying how this will result I better rules.
  • D and E above essentially cover much of the same ground. Uncertainty is a fact of life when developing any health based regulatory standard. There is uncertainty in going from in vitro and animal studies to human application. There is uncertainty in applying occupational studies to non-occupational populations. There is uncertainty in all epidemiological health effect studies. DEQ has no difficulty in acknowledging the fact of uncertainty but to provide a discussion and quantification and qualification of the uncertainty in each data point or aspect of risk assessment is unreasonable and probably not possible.


  • Another unintended consequence of the bill may be to create problems in State Implementation Plans (SIP) developed pursuant to EPA requirements. For instance if we are required to develop a rule because of a nonattainment situation or as the result of a court decision, how will this bill affect that effort? Will DEQ have to wait until all the data and science used is published and peer reviewed before passing a required rule? SIPs have stringent time frames and if DEQ must await publication and peer review, the agency will miss required deadlines potentially bringing on significant penalties to the state such as withholding highway funds and/or two to one offsets in emissions in the state.


  • (4) Any rule promulgated or adopted by the board which is broader in scope or more stringent than federal law or regulations, or which regulates an activity not regulated by the federal government, submitted to the standing committee of the legislature pursuant to section 67-5291, Idaho Code, shall include a notice by the board identifying the portions of the adopted that are broader in scope or more stringent than federal law or rules, which regulate an activity not regulated by the federal government.

    (5) Any rule adopted by the board subject to subsection (3) of this section and submitted to the standing committee of the legislature pursuant to section 67-5291, Idaho Code, shall include the information referenced in subsection (3) of this section.

    Nothing provided herein is intended to alter the scope or effect of sections 39-105(3)(g)(v), 39-118B, 39-3601, 39-4404, 39-6205, 39-7210 and 39-7404, Idaho Code, or any other provision of state law which limits or prohibits agency action or rulemaking that is broader in scope or more stringent than federal law or regulations.

    Statement of Purpose / Fiscal Impact

    The bill clarifies the intent of Section 107D, Chapter 39, Idaho Code, related to certain rule making requirements by the Idaho Department of Environmental Quality (DEQ). The bill requires that the department utilize the best available science and apply well established risk assessment methods when passing rules that are more stringent or broader in scope than federal rules. The bill places in state law the existing requirements imposed on the United States Environmental Protection Agency (EPA) under the federal law when EPA passes rules.

    The stated purpose of this bill is to require that DEQ use the "best available science." However, we already do that! While purposeful or not, this bill will make it much more difficult for DEQ to make necessary and relevant rules for situations not covered by EPA regulations. As noted above, the Clean Air Act, the Clean Water Act and other similar federal statutes and EPA regulations are aimed at problems of a national or regional nature and were never intended to substitute for state and local specific environmental protection rules. This is a critical fact in this matter. The more impediments there are to reasonable public health and environmental rulemaking, the less able DEQ is able to properly and effectively respond to emerging environmental hazards.

    This bill will make it more difficult for DEQ to comply with state policy on Environmental Protection as elucidated in Idaho Code 39-102 which states in part "It is recognized by the legislature that the protection of the environment and the promotion of personal health are vital concerns and are therefor of great importance to the future welfare of this state."

    FISCAL IMPACT: There is no fiscal impact to the general fund. The bill requires only that the department base rules and standards on sound data and that they disclose that data. Department funds may be required if additional studies are needed to substantiate new rules.

    Finally, it is not accurate to say there will be no fiscal impact to the general fund. The NEPA-like requirements of this bill will add substantially to the expense and difficulty of rulemaking for DEQ. I hope in consideration of this bill you will consider not only the vested economic interests of those proposing it, but also the right of the people to the protection of their health and environment as already acknowledged by this legislature.

    Dr. Greg Nelson, a representative of the Idaho Farm Bureau Federation (IFBF), testified they (IFBF) supports HB150 with the proposed amendment presented by Mr. Rush. Good peer science, in my training and in my background, unless it is peer reviewed it cannot be reproduced.

    John Eaton, a representative of the Building Contractors Association of Southwestern Idaho, testified in support of HB150. He discussed that regulating our members will increase the cost of housing in the state by a substantial amount. It may cost them more to use better science, but it cost our members significant dollars, in the tens of millions of dollars, so we should be able to rely on the fact that the science they are using to impose those regulations on our industry is valid and good science.

    Rob Sterling, an environmental engineer at Micron, testified in support of HB150.

    Joan Cloonan, a member of the Board of Environmental Quality and a member of IACI, testified but did not indicate support or opposition to HB150. She expressed her greatest concern with working with this legislation are in Section 2 and 3 and will require detailed studies. We do need to use the best available science. She discussed how the board reviewed DEQ rules and issues. The board's decisions are subject to challenge, if needed. She outlined the process of the DEQ's negotiated rule making, and how the board works with rule making.

    Don Munkers, executive director of the Idaho Rural Water Association, testified and submitted written comments in support of HB150. He reported this non profit organization represents water and wastewater systems throughout Idaho. While working with then Senator Kempthorne and his staff on the reauthorization of the Safe Drinking Water Act (SDWA), one of the key issues was to readdress the use of sound scientific data with peer review to assess the need and scope of rules promulgated by the administering agency (U.S.EPA). Prior to the passing of that legislation on August 6, 1996, water systems in Idaho were forced to look for arbitrarily selected contaminants that EPA was mandated to come up with that had no scientific basis nor peer review.

    If this new sound science process was acceptable to the drafter of the SDWA and the affected industry supported it, I believe it would follow that it is a worthy concept at the state level and indeed it is one that our industry supports.

    I suspect that one could make a good case that if the IDEQ (Idaho Department of Environmental Quality) is the primacy agency for the administration of the SDWA, and that this sound science peer review language is in the Act, if they indeed promulgate rules addressing aspects of the Act. In other cases, HB150 states that if the rule is more stringent or if the feds do not have a rule then HB150 will be followed. Again our industry supports that understanding and agrees with HB150. The language in HB150 comes directly from the SDWA as amended in 1996, and is now followed by all federal agencies. How can we not consider the use of this language and the use of sound scientific date to develop rules in Idaho?

    The SDWA specifically states that the federal government understands that the states play a critical role in the implementation of drinking water programs and need increases in funding to accomplish this. That is why the federal government allocated its monetary contributions to the state which could be used to development of rules that are based on sound scientific data with adequate peer review. Rules based on sound and objective science and benefit - cost analysis are important analytical tools for improving the efficiency and effectiveness of regulations to protect human health. By doing this, by adopting HB150 we can target environmental problems of greatest public health concerns. The IRWA urges you to send this bill, HB150, to the amending order.

    Norm Semanko, executive director of the Idaho Water Users Association, testified in support of HB150. He discussed the importance of peer review to water users of the state as is sound science. He also discussed a peer review study conducted by Karl Dreher and a professor at the University of Washington and others. He explained the impact ten (10) years ago regarding an additional million acre feet of water, and because of current peer review science that concern is being resolved. If the peer review science had been conducted in 1975, it would have saved water users and the state literally thousands of dollars. He stated he has not had time to fully review the opinion provided by the attorney general, and believes it provides a mechanism, or path, for the department to implement legislation, if it is enacted. There are some conclusions in the attorney general's opinion that are perhaps a little constrictive, in terms of when the bill may or may not apply. Mr. Semanko believes that pages 7 and 8, regarding water quality standards, need to be looked at on a case by case basis.

    Lynn Tuminaga, a consultant for the Idaho Ground Water Association, the Idaho Farm Bureau Federation, the Idaho Irrigation Pumpers Association, and the North Snake Ground Water District, testified in support of HB150. As the federal Safe Drinking Water Act is implemented more and more, and more testing for different substances and organic compounds are conducted there, is a concern, especially from agriculture, as the state goes to a more stricter level, it will add cost to agriculture and the people who use the ground water. We want to be sure that information is based on good, sound science.

    Jane Gorsuch, a representative of the Associated Logging Contractors and the Intermountain Forest Association, testified in support of HB150. She stated, we believe HB150 is a step in the right direction. It is important that Department of Environmental Quality utilize the best available scientific data and by going the step of peer review data, and get the information out to the public, in a public debate, and can comment back on and review that work. By the use of the best available science, you can have improved regulations coming from the Department of Environmental Quality Ms. Gorsuch requested that HB150, as amended, be approved by the committee.

    There were five (5) people who did not testify, but gave a precise indication in support of HB150. (See sign-in sheets)

    Donald J. Chisholm, an attorney in Burley, and a member of the Board of Environmental Quality, submitted written comments dated March 6, 2003, referencing HB150, and opposing HB150. His comments are as follows:

    I understand your committee is going to discuss House Bill 150 early next week. I cannot attend the hearing, but I would like to share some thoughts with the committee as well as the sponsors of this legislation and other interested parties by including these comments in the record.

    I served on the Board of Health & Welfare for a year before the Board of Environmental Quality was created. I have served two and one-half years on the Board of Environmental Quality. Idaho has made significant progress in developing an effective agency to handle environmental affairs. Adoption of House Bill 150 would be detrimental to Idaho.

    Industry and agricultural have a love-hate relationship with the Department of Environmental Quality. They love DEQ when they perceive that it shields them from some of the burdens of federal environmental regulations and the harshness of EPA enforcement actions.

    Federal regulations can be unnecessarily restrictive in some geographic areas, because EPA uses a one size fits all approach to regulation. The other side of the coin, however, is that EPA can under regulate some activities, due to economic constraints, bureaucratic inertia or lack of interest in local issues.

    Supporters of House Bill 150 want to create certainty that they will never be subjected to environmental regulations which are more stringent than federal regulations. Although the concept of stringency is already contained in Idaho law, House Bill 150 would require that the department undertake such an expensive and time consuming analysis of proposed regulations that DEQ could not fulfill its mission of protecting human health and the environment.

    Idaho's Board of Environmental Quality is made up of people who understand the needs of agriculture and industry in Idaho. They also understand the importance of protecting human health and the environment. Any regulations which are proposed by the agency or other interested parties must be approved by the Board of DEQ before they become effective. Then they are subject to legislative review. In all cases, the proposed regulations have been the subject of public hearings. In most cases they have also been the subject of negotiated rule making.

    If someone's rights are violated by DEQ regulations, the regulations are still subject to review by the courts. At some point it is necessary to say enough is enough.

    It has been my observation that industry and agriculture are often their own worst enemies. They complain about the expense of the State's environmental program, but they propose legislation such as House Bill 150 which would increase the cost of operating the department while reducing its effectiveness.

    Industry and government would have saved billions of dollars and thousands of lives if effective environmental regulation had prevented the damage caused by lead, PCB's, and asbestos. Industry and agriculture need to be part of the solution instead of proposing obstructionist legislation. I urge the committee to reject House Bill 150.

    Nick Purdy, of the Picabo Livestock Company in Picabo, Idaho, submitted written comments in opposition to HB150. His written statement, in summary, follows:

    Our Ranch is one of the older members of IACI and our major stockholder, Bud Purdy, served as IACI's President in 1982. I have a lot of respect for the members and the association of IACI, and I think they do an effective job protecting the interests of industry in Idaho.

    However, I am concerned by IACI's support of House Bill 150. I understand how frustrated anyone in business is with the endless environmental rules and regulations that are created by the regulators. But industry is very fortunate in Idaho to have a local DEQ Board that stands between industry and the federal EPA. I set on the State DEQ Board and I am amazed at the influence that IACI has with the State DEQ staff and the State DEQ Board. For two years I have seen the DEQ go to extreme lengths to satisfy the wishes of IACI.

    Last week before the Senate Health and Welfare Committee, I was distressed to hear Dick Rush's tepid analysis of the working relationship between IACI and the DEQ staff and the Board. Craig Nelson of the Idaho Farm Bureau was equally unflattering, but the Idaho Farm Bureau has not woke up yet and smelled the manure. He was criticizing the DEQ for their input to the Canyon County Commissioners on the installation of an 8000 head dairy and on the DEQ's opinion on the impact it would have on air quality in the valley. The dairies and the Farm Bureau have been their own worst enemies because they have not been proactive like IACI on environmental issues.

    It was ironic that later on the same day that Dick and Craig were blasting the DEQ, the Board toured one of the Valley's biggest air quality permittees, the Nampa Amalgamated Sugar Company. The environmental managers at Amalgamated were very complimentary of the Staff of the DEQ for the fine working relationship they had and the exceptional job the staff did on the approval of the air quality permits for the company. Their main suggestion was that all air quality permits are combined into one permit along with the permit to construct. This is an announced goal of the DEQ's Director, Steve Allred. If House Bill 150 were passed it would make this new rule almost impossible because of the requirements of the new bill.

    I know there would be a lot of self satisfaction by industry to put more requirements on the DEQ Staff to slow down the enactment of environmental rules and regulations and to make sure better "science" is used. However, the results will be increased bureaucratic time spent on approvals and increased paperwork for industry to complete and more data to be collected. The rules that industry brings forward for speedy approval will become tangled up in the requirements of this bill and approvals will be harder and longer in coming. Costs will rise and the State, and ultimately industry, will have to pay for them.

    House Bill 150 has good intentions but it will place an unacceptable burden on the DEQ and ultimately on industry. Industry would be better served to make sure that the DEQ Board is a friend and a supporter of industry because they are the people who make the rules not the DEQ Staff. The request for good "science" can be made to the Board from IACI and other groups like the Farm Bureau without further increasing the bureaucratic process of rule making.

    The committee members held a lengthy review about HB150. Discussions included many issues and concerns pertaining to HB150, such as, but not limited to, the following items:

    • Federal peer review studies and processes;
    • The process of negotiated rule making currently utilized by the Department of Environmental Quality;
    • The length of time and cost to promulgate rules, and if industry disagrees with the current DEQ negotiation process;
    • Federal stringency and importance of maintaining primacy;
    • Time lines for emergency rules to be promulgated in crisis situations;
    • Difference in Subparagraph A and B
    • Future Environmental Protection Agency rules;
    • Health, safety and environment for the public;
    • Broader of scope issues;
    • Rules can be more stringent than federal rules, but rules cannot be less stringent than federal guidelines;
    • Quality Assurance Program;
    • Communications between industry and DEQ, and the hope the parties can meet and reach a consensus about HB150;
    • Federal guidelines on peer review is very extensive.
    MOTION A motion was made by Senator Darrington to send HB150 to the amending order. Motion was seconded by Senator Bailey, and a roll call vote was taken. Senator Stegner and Senator Kennedy were absent and excused at the time of the vote.

    Senator Ingram voted Yes Senator Darrington voted Yes
    Senator Burkett voted Yes Senator Compton voted Yes
    Senator Sweet voted Yes Senator Bailey voted Yes

    The motion was carried unanimously.

    ADJOURNED The meeting adjourned on March 11, 2003 at 9:50 a.m. and at 9:28 a.m. on March 12, 2003.




    DATE: Thursday, March 13, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
    MEMBERS ABSENT/

    EXCUSED:

    None
    GUESTS: See attached sign-in sheet
    MINUTES: A motion was made by Senator Sweet to approve the committee's minutes for Tuesday, March 4, 2003. Motion was seconded by Senator Compton, and motion was carried by a voice vote.
    HB 12 This legislation, HB12, was presented by Nancy Kerr, executive director of the Board of Medicine. This bill relates to the licensure by the Board of Medicine, and amends Section 54-1810 and Section 54-1811, Idaho Code, to require that applicants for licensure by written examination to practice medicine and surgery or osteopathic medicine and surgery shall include fingerprint-based criminal history checks, declaring an emergency and providing retroactive application.

    The purpose of this legislation is to amend existing law to add language to comply with the Federal Bureau of Investigation (FBI) requirement, Pub. L. 92-544, that Idaho's state statute establishing guidelines for issuance of a license must, in itself, require fingerprinting and authorize the licensing agency to exchange fingerprint data with the FBI to allow access to criminal history record information maintained by the FBI. According to the Department of Justice, agency rules or regulations do not comply with this requirement.

    There is no fiscal impact to the General Fund. The fiscal impact to the Board of Medicine's dedicated fund is an ongoing cost of approximately $9,000 annually for the processing of fingerprints for an average of 220 physician applicants.

    MOTION A motion was made by Senator Bailey to send HB12 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Kennedy, and motion was carried by a voice vote. The sponsor will be Senator Bailey.
    HB 26 This bill, HB26, was presented by Dr. Michael Graham, from the Commission for the Blind and Visually Impaired. HB26 relates to the Commission for the Blind and Visually Impaired, and amends Section 67-5402, Idaho Code, to revise the definition of "blind" or "visually impaired" and provide a definition of "functionally blind."

    This legislation is necessary to remove from Idaho Code, Section 67-5402(2) the requirement of a medically documented opinion in determining whether an individual is functionally blind. The Idaho Commission for the Blind and Visually Impaired believes that a medical opinion should only be one of the factors used in determine whether an individual is functionally blind and this amendment would allow Commission counselors the ability to consider additional factors in making a final decision as to whether an individual is functionally blind.

    There is no fiscal impact to the state of Idaho.

    MOTION A motion was made by Senator Ingram to send HB26 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Compton, and was carried by a voice vote. The sponsor will be Senator Ingram.
    HCR 25 HCR 25, stating the findings of the Legislature and rejecting certain rules of the Department of Environmental Quality relating to the control of air pollution in Idaho, was presented by Chairman Brandt.

    The effect of this resolution, if adopted by both Houses, would be to prevent the agency rules from going into effect.

    The committee heard IDAPA 58.0101.0201, and rejected Section 605, Section 608, Section 611, and Section 614, of the rule.

    MOTION A motion was made by Senator Compton to send HCR25 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Stegner, and motion was carried by a voice vote. The sponsor will be Senator Brandt.
    A brief discussion was held pertaining to legislative intent language prepared by the Joint Finance-Appropriations Committee, effecting the programs and staff of the Department of Health and Welfare. The germane committee has not been involved in drafting the legislative intent language, and has concerns about the impacts on the department's ability to deliver services to Idahoans, and maintain policies set-forth by the Senate Health and Welfare Committee.
    ADJOURNED The meeting adjourned at 8:55 a.m.




    DATE: Friday, March 14, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:

    None
    GUESTS: Representative Frances Field from District 23. See the attached sign-in sheet
    HB 237 HB237, relating to controlled substances and the Idaho Board of Pharmacy, was presented by the State Board of Pharmacy Executive Director Richard Markuson, R.Ph.

    This legislation is necessary to adjust the schedule of controlled substances in Idaho to match schedule adjustments by the federal Drug Enforcement Administration. This proposed legislation moves the substance Buprenorphine from Schedule V (Idaho Code 37-2713 (b) (1) to Schedule III, revises Schedule I to allow specific products containing gamma hydroxybutyric acid, including its salts, isomers, and salts of isomers, for which an application is approved under Section 505 of the Federal Food, Drug, and Cosmetic Act, and provides for penalties for using or being under the influence of any drug product containing gamma hydroxybutyric acid, including its salts, isomers, and salts of isomers, including unauthorized use of such a product for which an application is approved under Section 505 of the Federal Food, Drug, and Cosmetic Act.

    This bill amends Sections 37-2705, 37-2709, 37-2713, 37-2732C, and 37-2705, Idaho Code. There is no fiscal impact to the General Fund.

    MOTION A motion was made by Senator Compton to send HB237 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Stegner, and motion was carried by a voice vote. Senator Burkett will sponsor HB237.
    HB 203 HB203, relating to the practice of nursing, and amending Section 54-1401, Idaho Code, to clarify the prohibition against individuals representing themselves to the public as nurses unless they are licensed as provided by law, was presented by Representative Margaret Henbest.

    The purpose of this legislation is to preserve the title of nurse. The title of "nurse" may only be used by a dully licensed person. There is no fiscal impact to the General Fund.

    The Board of Nursing Executive Director Sandra Evans testified in support of HB203.

    The usage of the term or using the word "nurse" and if it is, or is not, a criminal offense was discussed, including Sections 54-1401(1) and 54-1401(2) of the bill.

    MOTION A motion was made by Senator Compton to send HB203 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Stegner, and motion was carried by a voice vote. Senator Compton will sponsor HB203.
    HB 213 HB213, relating to sterilization, was presented by Representative Margaret Henbest and James R. Baugh the executive director of the Comprehensive Advocacy (CO-AD).

    This bill is designed to rewrite the portion of Idaho Code regarding involuntary sterilization for people with developmental disabilities. The current statute has been found unconstitutional by Idaho District Courts. This Bill will require courts to use criteria which meets constitutional standards for substantive and procedural due process. It also establishes a uniform procedure for the evaluation of the capacity of a person to give informed consent. For people who lack such capacity, this bill will give them an opportunity to access information about the procedure, it's risks and benefits, and to express their preferences. This bill would also give physicians and health care workers a clear legal authority for such procedures, and protection from liability when they perform a surgery that meets the guidelines of the statute.

    Mr. Baugh explained this bill was drafted by Comprehensive Advocacy, Inc., attorneys who are familiar with the sterilization process, and are concerned with the rights of people with disabilities. They studied court decisions and state statutes to ensure that the legislation would meet constitutional standards. The draft bill was reviewed by the Idaho Medical Association, the legislative committee for Idaho judges, the Department of Health and Welfare, the Idaho Attorney General's Office, The Idaho Council on Developmental Disabilities, the Co-Ad Board of Directors, the State Independent Living Council, and the disability related organizations. No objections to the legislation were submitted.

    There is no fiscal impact to the General Fund.

    MOTION A motion was made by Senator Kennedy to send HB213 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Burkett.

    Discussion:

    1. Independent living clients who do not have a legal guardian;
    2. People functionally incapable of giving informed assent;
    3. Difference of mentally ill and mentally retardation;
    4. Sterilization as part of emergency medical treatment, and
    5. Section 39-3914, Immunity, physicians going the judicial route if there is any question whatsoever about the client, and
    6. A trailer bill that requires the courts to report procedures.

    The beforehand motion was carried by a voice vote. Senator Burkett will sponsor HB213.

    HB 238aa HB238aa (amended in the House), relating to the unlawful practice of dentistry, and amending Section 54-905, Idaho Code, to provide for civil penalties for the unlawful practice of dentistry, and to provide a formula for assessing the penalties and to provide the civil penalties will be remitted to the General Fund, was presented by Skip Smyser, a representative for the Idaho Dental Association.

    There are those that have come into the state of Idaho and held themselves out as qualified licensed dentists, who were not. This legislation would provide for a civil penalty that would eliminate the financial incentive in practicing dentistry without a license in the state of Idaho. This legislation could result in a small gain to the General Fund.

    MOTION A motion was made by Senator Kennedy to send HB238aa to the Floor with a Do Pass recommendation. Motion seconded by Senator Ingram, and the motion was carried by a voice vote. Senator Kennedy will sponsor HB238aa.
    ADJOURNMENT The meeting adjourned at 9:24 a.m.




    DATE: Monday, March 17, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Sweet, Bailey, Burkett, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:

    Senator Stegner
    GUESTS: Representative Lee Gagner and Representative Bill Sali. See attached sign-in sheets.
    LEGISLATIVE INTENT LANGUAGE Representative Lee Gagner presented an overview pertaining to the legislative intent language for year 2004, for the Department of Health and Welfare (DHW). He outlined items he wanted to discuss today including Medicaid's Utilization Management Program (UMP), what it is and isn't.

    Today, he wanted to provide a quick look at Medicaid, at the growth of Medicaid, where it is growing and where it is not. He listed several aspects pertinent to Medicaid such as:

    1. Is Medicaid costs out of control?
    2. How far are costs out of control?
    3. Are costs out of control just because of so many people?
    4. Are costs out of control because of productivity?
    5. Are costs out of control because there is abuse in the system?


    He explained we have been discussing utilization management for about three (3) years, and, basically it has been held in JFAC (Joint Finance-Appropriations Committee) for the past two-years because of concerns of providers and others. He wanted to discuss, basically, utilization management concepts, and how it relates to developmental disabilities.

    Representative Gagner presented several items for review pertaining to Medicaid. (Attachments' #1 - 11)

    1. Medicaid's funding history from 1983 to year 2003, a General Fund comparison of Medicaid to the State budget (Associated Taxpayer Meeting report prepared by Randy Nelson);
    2. Medicaid expenditures and projections for FY1994 - FY2006; *
    3. Idaho's Medicaid Program, comparisons with other states; *
    4. Table - Opportunities Identified in Medicaid Evaluation; *
    5. The percent of Idaho's population on Medicaid was generally the same as peer states in 1998; *
    6. In 1998, elderly and disabled populations in Idaho's Medicaid Program were somewhat similar to its peer states; *
    7. Idaho spent less on vendor payments per recipient in 1998; *
    8. Peer states' spending on recipients with disabilities has increased at faster rates than in Idaho; *
    9. Annual per person cost - institutions vs. waivers; *
    10. Individual served through private DD agencies and annual expenditures (Facts/Figures/Trends 2002-2003 a Health & Welfare publication);
    11. A Utilization Management Plan Comparison chart (prepared by Julie Fodor, University of Idaho);
    12. Pages from the Lewin Group report of November 2000, *
    13. Medicaid's responses to coalition for long-term solutions proposals, dtd February 25, 2003.

    * The Lewin Group of Falls Church, Virginia, and Sjoberg Evashenk Consulting of Sacramento, California, prepared studies pertinent to Idaho's Medicaid Program: The Department of Health and Welfare Has Many Opportunities for Cost Savings, November 2000, and an addendum, Idaho's Medicaid Program: Comparisons With Other States, January 2001.

    Representative Gagner explained HCR 21 would soon be coming to the committee for review. HCR21, regarding the use of utilization management of Medicaid services to persons with developmental disabilities, and directing the adoption of the most cost-effective program with features specified, is not being presented today.

    He explained a draft of the FY2004 legislative intent language sections for the Department of Health and Welfare. He stated Sections 2 thru 6 are not controversial. Today, he is presenting Sections 7 and 8 of the intent language.

    Section 7, "It is the intent of the Idaho Legislature that the Department of Health and Welfare implement a case management software program, but not enter into a utilization management, Independent Assessment Provider (IAP) contract for fiscal year 2004."

    He explained HCR 21spells out the use of an alternate model that deals with a full prior authorization by the Department's staff within the regions. Representative Gagner emphasized the importance that the software communication program move ahead. He outlined HCR 21 (not being presented today) and stated HCR 21 spells out the use of an alternate model that deals with a full, prior authorization.

    Section 8 "The Legislature has concerns relative to the degree of reductions to specific program budgets as a result of holdbacks and current funding levels. As a result, the House of Representatives Medicaid Task Force met with providers of services along with personnel from the Department of Health and Welfare, and identified General Fund Medicaid savings of $923,700. Of this amount, it is the intent of the Idaho Legislature that $286,300 be redirected to targeted case management for the mentally ill and targeted service coordination for the developmentally disabled, $194,000 be used to restore a portion of the residential habilitation affiliation fee, and that $443,400 be diverted to the Division of Family and Community Services for sheltered workshop services."

    Representative Gagner explained Section 8 of the intent language deals with some cuts taken from last year's budget, dealing with the developmental disabilities and mental health areas. It was found those budgets for targeted case services, residential habilitation facilities, and sheltered workshops were cut between 30 percent and 50 percent. He reported meetings were held with the Department of Health and Welfare and providers, and they discussed major issues. A chart, dated February 25, 2003, titled Division of Medicaid additional responses to coalition for long-term solutions proposals, showing an estimated $1,123,700 annual cost avoidance, was reviewed. (Attachment #10)

    Representative Bill Sali, House Health and Welfare Committee Chairman, presented Section 9.

    Section 9, "It is the intent of the Idaho Legislature that, notwithstanding Section 56-209d(4)(C), Idaho Code, adult dental services covered by the state's Title XIX Medicaid program shall be limited to emergency services and, for high risk adults, preventive and restorative services consistent with the direction of the House and Senate Health and Welfare Committees."

    He explained Section 9 deals with adult dental services. The intent language is also needed to fix problems with the FY2003 budget. Questions were asked about the necessity of having this intent language if the problem was cleared by a rule change for FY2004. Representative Sali explained the intent language has effective law. Representative Gagner explained the intent language is needed for budget perspective, to show the intent to fix the FY2003 budget.

    Also, other items discussed were salary savings and capitol outlays. Representative Sali reported whenever the Department of Health of Welfare has vacant staff positions, and leaves those positions vacant, they have a salary savings, accountability is needed for those salary savings; accountability is also needed for expenditures for operating expenses and capital outlays; the possibility of including a capital outlay item for each agency's budget for cars, etc.; carryover authority for budgets; the importance of tracking budget spending by each agency, and that is the intent of this language.

    MOTION Due to business to be conducted on the Senate Floor, the meeting adjourned at 9:25 a.m.




    DATE: Wednesday, March 19, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:

    Senator Brandt
    Vice Chairman Compton conducted the meeting.
    MINUTES: A motion was made by Senator Kennedy to approve the committee's minutes of Tuesday, March 5, 2003, as written. Motion was seconded by Senator Sweet, and motion carried by a voice vote.

    A motion was made by Senator Bailey to approve the committee's minutes of Friday, March 7, 2003, as written. Motion was seconded by Senator Darrington, and motion was carried by a voice vote.

    HB 15 HB15, relating to residential care facility administrators, amends existing law to provide several revisions, i.e., terminology; adoption of a code of ethics, qualifications for licensure, the issuance of licenses and license renewal and reinstatement, and revises board disciplinary actions. This Bill amends Sections 54-4201, 54-4206, 54-4208, 54-4209, 67-2614, 54-4210, 54-4211, and 54-4213, Idaho Code.

    This legislation was presented by the Bureau of Occupational Licenses Bureau Chief Rayola Jacobsen, who explained this Bill is largely designed to correct the name of the Board under the Act. In the 2000 legislative session, the Department of Health and Welfare inadvertently changed the name of the Board from the Residential Care Facility Administrators to the Residential or Assisted Living Facility Administrators. This legislation will return the name of the Board of the Residential Care Facility Administrators, while only changing the statutes that address this Board. This Bill will save the Board approximately $3,000 that would be required to change all of the Board's documents.

    The Bill still meets the Department of Health and Welfare's desired intent by including the term assisted living in the definition of a facility in the Act. The Department is in support of HB15. This legislation also cleans up some archaic language in the Act. The only substantive changes to the Act are:

    a. Providing the Board power to adopt a code of ethics;

    b. Establishing for license renewal by birth date rather than on July 1st

    c. Limiting temporary permits to practice to three (3) month rather than six (6) months, and requiring that the applicant be otherwise qualified for a license except for having taken the examination.

    MOTION A motion was made by Senator Sweet to send HB15 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Ingram, and motion was carried by a voice vote. Senator Sweet will sponsor HB15.
    HCR 13aa HCR 13, stating findings of the Legislature and directing the Idaho Council on Developmental Disabilities, in collaboration with the Department of health and Welfare and other stakeholders, to convene a Task Force to develop a waiver for a self-directed service delivery system for Idahoans with developmental disabilities and requiring a report, was presented by the Idaho Council on Developmental Disabilities Executive Director Marilyn Sword.

    This resolution directs the Council to convene a Task Force to develop a Medicaid model waiver that would permit up to 200 adults with developmental disabilities to choose a different way of receiving services. The services would be based on need as determined by a consumer-centered plan and would cost no more, on average, than the services for these 200 people cost now. Implementation of this model requires the Department of Health and Welfare to submit a waiver application to the federal Centers on Medicaid and Medicare.

    The meeting and technical assistance costs to support this group will be paid by the Council with allocated federal funds. There will be no fiscal impact to the state in FY2004.

    Ms. Sword presented a letter from the Department of Health and Welfare, Division of Medicaid Interim Administrator Randy May, and Division of Family and Community Services Administrator Ken Deibert, in support of the Council's efforts. (Attachment #1)

    She also presented a letter of support from Julie Fodor, Ph.D., director for the Center on Disabilities and Human Development at the University of Idaho. (Attachment #2)

    A letter of support to HCR13 from the Idaho People First organization was also presented. Attachment #3)

    A letter of support for HCR13 from Dale J. Hasenoehrl, M.Ed.,CRC, a retired program manager for the Department of Health and Welfare's Developmental Disability and Adult Mental Health Programs in Region II, Lewiston, was submitted. (Attachment #4)

    There was a discussion about the process of amending House Concurrent Resolution 13.

    Kristyn Herbert testified in support of HCR13 via a taped recording.

    Noll Garcia testified in support of HCR13.

    There was no testimony provided in opposition to HCR13.

    MOTION A motion was made by Senator Darrington to send HCR13 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Sweet, and motion was carried by a voice vote. Senator Bailey will sponsor HCR13.
    HB 199aa HB199aa, relating to an athletic trainer's licensure, and amending existing law to further govern the duties of the Board of Athletic Trainers and the Board of Medicine to license athletic trainers, determines qualifications and enforce the requirements of practice, was presented by Ron Williams, attorney-at-law and a representative for the Idaho Athletic Trainers.

    In 1989 the Legislature determined that only "registered athletic trainers" could practice athletic training in Idaho. To be a registered athletic trainer under current law, a person had to either be an existing (grandfathered) athletic trainer or meet the following requirements: (i) be a college graduate, (ii) meet specific requirements of the Board of Athletic Trainers, (iii) submit an application, (iv) pass a board approved test, and (v) pay a fee.

    This legislation will limit the practice of athletic training to only qualified individuals, and in order to protect athletes from having someone without proper training or experience assist them concerning an athletic injury. This Bill contains much more specific definitions of an "athletic," and "athletic injury" and what the practice of "athletic training" means. The Board of Medicine drafted many of these key definitions, with substantial and considered impute from other health provider organizations. The Board of Medicine also drafted extensive provisions dealing with how the practice of athletic training can only occur under the watchful eye of a directing physician, and only as allowed within a new scop of practice section. The Board of Medicine approved a provision prohibiting athletic trainers from operating an independent practice, thus ensuring that athletic training only and continually occur under the watchful eye of a directing physician.

    Administratively, this legislation also streamlines and simplifies the licensing requirement for athletic trainers meeting the statutory qualifications. Idaho athletic trainers now must take a national certification examination approved by the Board of Medicine, rather than a separate examination administered by the Board of Athletic Trainers. Educational standards are also raised from simply having a college degree, to having a four-year degree that meets the minimum athletic training curriculum established by the Board of Medicine.

    There is no fiscal impact on the General or Dedicated Funds.

    Tom Koto, an athletic trainer and a representative for the Idaho Athletic Association, testified in support of HB199aa. He gave a brief outline about the history of athletic trainers since the 1989 statutes. He agrees that the legal language pertaining to athletic trainers needs to be updated and expanded in detail.

    The Board of Medicine Executive Director Nancy Kerr, testified in support of HB199aa. She responded to an earlier question about the scope of practice, as defined in Idaho Code 54-703, which allows chiropractic physicians to diagnose, examine, etc., but treatment is defined as the application of chiropractic principles of adjustment, manipulation and massage. Acute injury cannot be treated by such applications, i.e., fracture or asthma. The scope of practice as defined in HB199 would be null and void as it would allow the athletic trainer to practice at a level higher than "directing physician" (if chiropractor) assessing and treating medical conditions beyond the application of adjustment, manipulation, and massage. The Act written with the concept of supervising MD, and would need to be rewritten to address the chiropractic MD.

    Linda Hammann, a physical therapist and a athletic trainer, testified in support of HB199. She outlined the difference in being a physical therapist and an athletic trainer. A physical therapist has more background in disease and disease process, rehabilitation, and have a different scope of practice. She believes this Bill adequately supports the practice of the athletic trainer.

    Dr. Steven Newman, a sports medicine physician, testified in support of HB199. He responded to a question about having a problem with chiropractic physicians being involved in the process. He has no problems, and remains neutral, but considers this an issue between the Board of Medicine and the chiropractic association.

    Brad Hoaglun, a representative for the Idaho Association of Chiropractic Association, testified in support of HB199, as amended in the House, but he proposed an additional amendment for the Senate to consider. He explained the proposed amendments to the HB199aa are:

    Page 2, line 9 following "registered with the board" add "or a designated Idaho licensed chiropractic physician."

    Page 2, line 24 following "registered with the board" add "or a designated Idaho licensed chiropractic physician."

    Page 2, line 43 and 44 following "registered with the board" add "or a designated Idaho licensed chiropractic physician."



    Under the current system, athletic trainers are able to work under the direction of a chiropractic physician. HB199aa changes the registration of Athletic Trainers to licensure, and in the legislation it allows athletic trainers to work for a licensed Idaho physician who is registered with the Board of Medicine. Chiropractic physicians are licensed Idaho physicians, but they are licensed under their own board, the Board of Chiropractic Physicians. Adding this amendment would allow a licensed athletic trainer, if this Bill is passed and signed into law, to be able to continue to work for chiropractic physicians.

    The safety of the public is not compromised in any way by this amendment. If disciplinary measures were needed for an athletic trainer, they would go before the Board of Medicine. If the chiropractic physician needs to be investigated that would be conducted by the Board of Chiropractic Physicians. This amendment allows chiropractic physicians to hire skilled assistants like athletic trainers to provide quality services to their patients.

    Jeremy Pisca, an attorney and representative for the Idaho Association of Chiropractic Physicians, testified in support of the proposed Senate amendment to HB199aa. He explained that currently an athletic trainer cannot practice independently, they can only practice under the supervision of a licensed Idaho physician, or they can practice with a team or educational institution to provide on-field services. The proposed amendment by the chiropractors would allow those chiropractors to be a directing physician.

    Dr. Jim Kranz, chairman of the Idaho Association of Chiropractic Physicians, Inc., testified in support of the proposed Senate amendments to HB199aa. He reported the Chiropractic Physicians Association request the Committee to allow continued participation by chiropractic physicians as designated physicians for an athletic trainer. The Association believes this is a reasonable and legitimate request that will enhance patient care for Idahoans.

    He reported there were several issues raised where I need to respond. The first is the insinuation that somehow chiropractic physicians are not qualified to provide oversight of an athletic trainer. State law says that the practice of chiropractic means to "investigate, examine, and diagnose for any human disease, ailment, injury, infirmity, deformity, or other condition"; Idaho Code 54-703(1)(a). The educational requirements to become a chiropractic physician gives us the ability to diagnose, and Idaho law recognizes that fact.

    Athletic trainers are ancillary personnel, like a physical therapist or an x-ray technician. That means, a patient must first see a medical doctor or chiropractic physician to be referred to an athletic trainer. The doctor or chiropractic physician is responsible for the direction of the athletic trainer.

    Regarding the issue of duality, I think it is clear that this is not an issue. The Board of Medicine licenses athletic trainers, and any disciplinary action needed would be referred to the Board of Medicine. Problems with a chiropractor would be referred to the Board of Chiropractic Physicians.

    Both the Board of Medicine and Board of Chiropractic Physicians are in place to protect "the public health, safety and welfare in the state of Idaho by the licensure and regulation of . . ." If you review Idaho Code, Sections 54-702 and 54-1802, you will see that the above language is identical for both boards. They each have the responsibility to oversee their respective professions, and to take action when necessary.

    The health, safety and welfare of citizens in Idaho are in good hands with chiropractors as the designated physician for athletic trainers. If you review the Scope of Practice found in Section 54-3903 of HB199, you will find that there is a good fit between a chiropractic physician and an athletic trainer who choose to work in that type of setting.

    Chiropractic physicians have a vast knowledge of the musculoskeletal system of the body, and any athletic trainer working under their supervision will greatly enhance their knowledge and ability as an athletic trainer. For chiropractors, the ability to hire and utilize the knowledge and skills of athletic trainers in their practice means quality care for their patients.

    With the problems of rising costs and shortages of medical care facing the population, the state should be encouraging the integration of care for individuals, not excluding qualified physicians from utilizing the best personnel available.

    Dr. Jim Hollingsworth, a representative for the Board of Chiropractic Physicians, testified about HB199, and explained they are not asking for anything new - just keep the current system, as it is. He states that if an athletic trainer made a mistake, in their own purpose, they would be reported to the Board of Medicine by the chiropractor. If a chiropractor did something wrong, and told the athletic trainer to do something inappropriate, the chiropractor would bear the penalty with the Idaho Board of Chiropractic Licensing. The athletic trainer would be reported to the Board of Medicine.

    Robert Seehusen, chief executive office of the Idaho Medical Association briefly testified and stated the Association had planned to be neutral about HB199, but they do have concerns about the amendment, and they do oppose the proposed Senate amendment. He reported "medical supervision" goes beyond just sport injury. The chiropractor is trained and educated in a very limited area, and the scope of practice in Idaho is pretty well defined, and not an issue here. The supervision is there to look at things above and beyond just sport injuries. He restated they oppose the amendment being considered, but is neutral on the Bill.

    A lengthy review about HB199aa, and the proposed amendments by the chiropractic physicians, was held. Items discussed included, but not limited to the following:

    1. Scope of practice and liability;
    2. Nationally recognized credentialing agency;
    3. Registration and licensure;
    4. Allowing athletic trainers to move from state to state;
    5. Referring a patient to a chiropractor;
    6. Internal reviews of physicians and chiropractors;
    7. All physicians do not have hospital privileges;
    8. When an athletic trainer would report an injury to a supervisor;
    9. Shortages in rural areas of medical care providers.


    In response to questions about future sport legislation, Tom Koto stated. "One of the strongest oppositions early on, in 1988 and 1989, was actually the schools. School administrators, school boards, and so on, as they were fearful that we, as an association, once we passed our initial bill, would come back around and introduce legislation that would require schools to hire athletic trainers, certified athletic trainers who were registered. We made a promise to the school administrators at that time, we would not do that, and we have held true to that promise, as we will. What we have noticed is that schools, as they are able to and as they see fit, will hire certified or registered athletic trainers when they can. We have not pressured the schools to do that, and we have no intention of doing that."

    Several questions were asked pertaining to registration vs. licensure, such as, how will licensure improve health and safety beyond registration?

    Two specific questions were asked, and anyone present at the meeting who had testified or not, or was an athletic trainer, was encouraged to answer. The questions are:

    1) If the present registration act was changed today, and we increased the qualifications for registration, how are we better improving the health and safety of those you work with today, by making you licensed?

    2) How will licensure enhance the safety and health of clients?

    Mr. Koto responded that the challenge they have met, is that by the registration definition that it is just a registry, either voluntary or mandatory, and that is the way it is perceived, not only here but also across the nation.

    Mr. Williams explained that if we hold Idaho out, and as others look at Idaho as only a registration state, rather than a licensure state, it will tell those who cannot get licensed in another state to come to Idaho, as it only requires registration to work.

    Senator Darrington explained that the difference between registration and licensure is extremely important, and a very substantial change in the nature of the law. Soon, will personal trainers and others working in the health and safety areas, also need to be licensed? After a brief discussion, Senator Darrington explained we are only discussing those who are working in areas dealing with health and safety.

    ADJOURNMENT Due to the late hour, Senator Kennedy moved the committee recess as they are due to attend to business on the Senate Floor. It was agreed, and the hearing for HB199aa would continue on Thursday, March 20 at 8:30 a.m. The meeting adjourned at 10:02 a.m.




    DATE: Thursday, March 20, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Vice Chairman Compton, Senators Darrington, Ingram, Sweet, Bailey, Burkett, Kennedy
    MEMBERS ABSENT/

    EXCUSED:

    Senators Brandt and Stegner
    GUESTS: See the attached sign-in sheets
    Vice Chairman Compton conducted the meeting
    HB 199aa This legislation, HB199aa, relating to athletic trainers, was first discussed on Wednesday, March 19, 2003, and rescheduled for additional testimony. The Bill was presented by Ron Williams, a representative for the Idaho Athletic Trainers. When the committee adjourned on March 18, they were in the process of dealing with a specific issue, "how will licensure enhance the safety and health of Idahoans?"

    Mr. Williams presented comments about HB199aa. In 1989, the Legislature enacted the Athletic Trainers Practice Act to require that only "registered athletic trainers" could practice athletic training in Idaho. Today, we are revising that practice act in order to recognize a higher educational standard for athletic trainers, and to better define the scope of practice of athletic trainers. Furthermore, we are defining in much greater detail the control over the practice of athletic training by licensed Idaho physicians. The former law simply said athletic trainers practiced under a directing physician. H199aa comprehensively defines the specific direction a physician must give to the practicing athletic trainer, while also holding that physician accountable.

    H199 also contains much more specific definitions of an "athletic," an "athletic injury" and what the practice of "athletic training" means. These definitions were originally drafted by the Board of Medicine, and now have the concurrence of the Idaho Physical Therapy Association.

    House amendments ensure that coaches and volunteers assisting athletic events, or good Samaritans rendering aid at an athletic event, are not illegally practicing athletic training, so long as such persons do not hold themselves out as athletic trainers. Senate amendments provide that a directing physician can be either medical or a chiropractic physicians.

    Administratively, H199 streamlines and simplifies the licensing requirements for athletic trainers by allowing them to take national certification examination approved by the Board of Medicine, rather than a separate examination administered by the Board of Athletic Trainers.

    In response to the questions asked by Senator Darrington yesterday, (March 19) Mr. Williams submitted written comments and explained these items. (Attachment #1)

    1. Definition of licenses taken from Idaho Code, Administrative Procedures Act, Section 67-5201.


    2. Definition of licensure from Legal Opinion of National Registry of Emergency Medical Technicians.


    3. Registration.


    4. Examples of other health professions licensed under Title 54, Idaho code.


    Ron Pfeiffer, a professor at Boise State University (BSU), and for 17 years was the director of the Athletic Training Educational Program at BSU, a current member of the Idaho Athletic Association, and as the chairman of the athletic trainers that serve the Idaho Board of Medicine, testified in support of HB199. He outlined how licensure relates to education, and what it would do for the citizens of Idaho. As he understands, what we are trying to do is move from the bill brought into law in 1989, the first practice act for athletic trainers in Idaho, which is a bill that requires registration. That bill has served us well, and the citizens of Idaho benefitted from having that in statute in Idaho, but he thinks it's time to move to the next level which is licensing, which does provide a standardization and a scope of practice within which we can work, which again, of course, like other allied health professions assures the public that when someone holds himself or herself out as an athletic trainer, they have met some standard. In this case, monitored by the Board of Medicine. Mr. Pfeiffer referred to Section 54-3903, Idaho Code, Scope of Practice.

    One thing he really likes about HB199 is it has written into it a specific set of educational criteria, and anyone who wants to be licensed in the state would have to meet those criteria in order to be considered for licensure. And those criteria would be, they would have to be a graduate of an accredited athletic training educational program, either with a bachelor's or a master level degree. In order to be in an accredited athletic training program, you have to meet criteria set forth by the National Athletic Trainers Association, as well as with the Board of Athletic Trainers Association. In short, standardized education ensures that these students would be graduated, and then ask to be licensed.

    A question was asked about Section 3906, education requirements, and would it not be possible, under the current registration system, to upgrade the education licensure requirements? Mr. Pfeiffer stated he supposed it would be possible, but he is not an expert on how to do bills. When they asked legal councils of their professional association, almost a year ago, they strongly recommended we move this Act to the next level.

    Nancy Kerr, executive director of the Idaho Board of Medicine, testified to clarify the issue of an athletic trainer working under a chiropractic physician. She reported, a trainer cannot provide treatment, where under the direction of a medical physician, treatment could be provided. A chiropractic physician can diagnose and examine, but treatment is defined only as the application of chiropractic principles such as adjustment, manipulation and massage. Therefore, athletic trainers working under a chiropractic physician would only be allowed to apply chiropractic principals to those injured.

    Dr. James Hollingsworth, a practicing chiropractic physician, testified in support of the proposed Senate amendments to HB199. He explained that chiropractic physicians would like to have the right, as they have always had for all these years, to employ or utilize athletic trainers in the expertise of his/her field. The chiropractic physicians want to retain the right to ask an athletic trainer, would you like to work under my license, and would you be willing to see my patients?

    Committee members asked numerous questions, and held a lengthy review concerning HB199aa, and the proposed amendments by the Idaho Association of Chiropractic Physicians, and the discussion also included future legislation and criteria for licensure in Idaho.

    MOTION A motion was made by Senator Kennedy to send HB199aa to the Floor, 14th Order, with recommendations that the Bill be amended to authorize chiropractic physicians to serve as "directing physician" under Section 54-3902(3) line 9, following "registered with the board" add "or a designated Idaho licensed chiropractic physician"; and Section 54-3902(7) line 24, following "registered with the board" add "or a designated Idaho licensed chiropractic physician"; and Section 54-3903, lines 43 and 44, following "registered with the board" add "or a designated Idaho licensed chiropractic physician."

    The motion was seconded by Senator Sweet, and motion was carried by a voice vote. Senator Darrington voted No. Senator Kennedy will sponsor HB199aa.

    Senators Brandt and Stegner were absent and excused.

    SB 1165 SB1165, relating to the practice of respiratory therapy, and amending Sections 54-4303, 54-4304(a), and 54-4313, Idaho Code, was presented by Molly Creswell, a representative for the Idaho Sleep Disorder Association.

    She explained S1165 is a replacement bill for S1077. After printing SB1077, we learned of some concerns from the Board of Medicine and the Respiratory Therapy Board. We believe SB1165 represents consensus legislation by the associations and boards associated with polysomnography.

    The Idaho Sleep Disorders Association has approximately 55 members in Idaho, and these members are known professionally as polysomnographers or sleep techs. They work in sleep centers or laboratories performing sleep studies on patients who experience sleep apnea or other sleep disorders. They administer machines that monitor sleeping patients to assist in the assessment and diagnosis of sleep disorders.

    Earlier this year the Idaho Board of Medicine suggested those sleep techs, who administer oxygen as a part of these sleep studies, are practicing respirator therapy without a license. A quote from the Board of Medicine's website: "The Respiratory Therapy Board has reviewed multiple concerns regarding the use of CPAP (continuous positive airway pressure) in sleep labs across the state. CPAP falls within the statutory definition of the practice of respiratory therapy and the concern of the Respiratory Therapy Board has been the health and safety of the public receiving services from non regulated sleep lab technicians."

    We are here to address only that part of the polysomnography profession that overlaps with respiratory therapy. Members of the Idaho Sleep Disorders Association met with the Board of Medicine to address the issue and the Board requested that the sleep techs bring legislation to bring themselves under the authority of the Board of Respiratory Therapy, which is a paraprofessional board under the Board of Medicine.

    We developed this legislation, SB1165, with the goal of allowing these sleep techs to continue to perform their jobs. This is a limited permit under the Board of Respiratory Therapy. We worked with the respiratory therapists to ensure that the scope of practice is sufficiently narrow so that sleep techs can perform only those respiratory care related duties necessary for their work in sleep centers.

    Most sleep centers or laboratories are within hospitals, and the Idaho Hospital Association supports this legislation. Members of the Idaho Society for Respiratory Care has assisted in the drafting of the legislation. The Idaho State Board of Medicine and the Respiratory Therapy Board also assisted in the drafting of SB1165. The Idaho Medical Association has reviewed the legislation and is neutral.

    This bill comes under the existing Respiratory Care Act. It adds polysomnography related definitions to the definition section of the respiratory care act. It provides a definition of "Polysomnography," which is basically the overall process of analyzing, monitoring and recording data during sleep cycles to assist in the assessment of sleep-related disorders. It also provides a definition of polysomnography related respiratory care services which are the functions of polysomnography. Basically, there are three limited areas of regulation under this definition: the use of oxygen, the noninvasive ventilatory assistance of spontaneously breathing patients and CPR if necessary. All hospital personnel are required to have CPR training, and the maintenance of nasal and oral airways that do no extend into the trachea. All of these functions are ordered by a physican and performed under the direction of medical director. There are also definitions for the different levels of sleep techs, and a definition for a sleep disorder center or laboratory.

    The qualifications to be a practicing polysomnographer are:

    1. An applicant must be no less than 18 years of age.


    2. Certification of completion/graduation from approved Respiratory Therapy curriculum/program.


    3. NBRC certification/registration.


    4. A completed application is required on forms provided by the Board.


    5. The Board may, at its discretion, require the applicant to appear for a personal interview.


    6. Applications must be legible.


    This bill also makes a change to the respiratory therapy licensure board. It is a three (3) member board, and it remains as such. The makeup of the board changes so that one member of the board will hold both a respiratory therapy license and a permit as a registered polysomnographic technologist.

    Diana Lincoln-Haye, a practicing polysomnographer for the past ten years in Twin Falls, testified in support of SB1165. She explained sleep disorder treatments. Polysomnographers also treat children with sleep disorders. All referrals to a sleep disorder clinic are made by a medical physician, and very extensive, evaluation studies are required.

    MOTION A motion was made by Senator Bailey to send SB1165 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Kennedy, and motion was carried by a voice vote. Senator Brandt will sponsor SB1165.
    ADJOURNMENT The meeting adjourned at 9:43 a.m.




    DATE: Friday, March 21, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Bailey, Burkett, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:

    Senator Sweet
    MINUTES: A motion was made by Senator Bailey to approve the committee's minutes for Thursday, March 13, 2003, as written. Motion was seconded by Senator Compton, and motion was carried by a voice vote.
    GUESTS: Representative Mike Mitchell, and see attached sign-in sheet
    KENNEDY'S REPORT Senator Kennedy briefly updated committee members about his meeting with the House Health and Welfare Committee to explain the rejection by the Senate Committee of two (2) rules. One rule from the Commission on Aging and determining income for fees and client contributions, HCR28; the second rule rejection was from the Department of Health and Welfare pertaining to rebuttal presumption for aid to the aged, blind, and disabled, SCR108. He reported the House Committee voted to hold both HCR28 and SCR108 in the committee; therefore, the rules will stand as adopted.
    HEALTH AND WELFARE Alisa Axtman from the Division of Medicaid presented a summary of the Developmental Disabilities/Mental Health (DD/MH) Service Delivery Project pilot. She presented a brief report about the history of the developmental disabilities and mental health service delivery project pilot.

    The DD/MH project was initiated in response to escalating Medicaid costs associated with developmental disability and mental health services. In April 2000, the Joint Finance-Appropriations Committee appropriated $600,000 to the Office of Performance Evaluations (OPE) to examine Idaho's Medicaid Program. The OPE contracted with The Lewin Group to provide an independent study of the state's management, oversight, and administration of Idaho's Medicaid program. The resulting report is commonly referred to as "The Lewin Report."

    The report concludes ". . .better utilization management techniques over mental health, developmental disability, nursing facilities and inpatient services will result in more consistent and effective services."

    The Lewin Report has a number of important recommendations and offers valuable insight regarding mental health and developmental disability programs in Idaho. Ms. Axtman emphasized one particular recommendation that was extremely important to the Pilot from the November 2000 Lewin Report, page 57. . . "When private providers fulfill all the roles, including facilitating an individual's intake assessment, establishing service plans, and delivering treatment-as we addressed earlier in this chapter-not only are Idaho's rules violated, but it creates a potential weakness in the process. Strong control precesses suggest that persons assisting in the intake, assessment, and service planning should be independent of those having a financial interest in the delivery of services." This is an important recommendation because it stresses the need to keep a separation between providing a service and assessing the need for that service. The Department developed the role of the Independent Assessment Provider (IAP) in an effort to correct this weakness.

    The DD/MH Service Delivery Project developed a pilot at the request of the 2001 Legislature following the Lewin Report. The intent language in 2001 guided the Department to ". . .continue designing a regional comprehensive utilization management plan that rectifies current weaknesses without giving up the strengths inherent in the system as outlined in the Lewin Group Report." The intent also guided the Department to continue work with the already established Quality Improvement Council and its subcommittees.

    The project established the Independent Assessment Provider through a contract with the University of Idaho in Moscow. The Independent Assessment Provider was contracted to provide assessment, eligibility, and plan authorization.

    The project piloted consumer-centered concepts such as person-centered planning, plan developers and consumer budgets. These provided opportunities for consumers to choose who would help them write their plan. Consumers also made decisions regarding the services that they would receive.

    The DD/MH Project pilot began in Region 2, in Lewiston, on October 1, 2001. The kickoff was preceded by an extensive training effort for department staff, consumers and service providers in the region. The goals of the pilot included slowing the growth in expenditures, testing the processes in the business model and continuing to provide good customer service.

    During the pilot, the Department tested a consumer-centered pathway from application to service delivery. Applicants had assessments completed by the IAP to determine eligibility and identify service needs. Assessments included a functional assessment, medical social evaluation, medical care evaluation, and a review of previous service utilization, The IAP met face to face with consumers and their plan developers to discuss assessed needs and service options, and to finalize a consumer budget based on the consumer's entire assessment. The Department used the score on the functional part of the assessment, the SIB-R, as a starting point to identify an appropriate budget. SIB-R is standardized and provides the assessor with details relative to the consumer's ability to independently complete every day tasks. During the pilot, the IAP's job was to help consumers find alternatives to services they found intrusive or restrictive.

    One of the goals of the project is to slow the growth rate of Medicaid expenditures. The pilot demonstrated success with this goal for adult consumers with developmental disabilities.

    The pilot authorized plans for 114 consumers. There were 64 consumers in the pilot who had four (4) years of continuous service history. Total authorized cost was $2.3 million, with a growth rate of 6 percent, compared to growth rates of 41 percent, 38 percent and 25 percent during previous years for these 64 consumers. The authorized service plans in the sample had a total of $2.3 million in expenditures. Using the authorized expenditures, 64 consumers in our sample had a growth rate of 6 percent from their previous year's expenditures. This is a significant decrease from growth rates in previous years.

    Prior to the pilot, the project entered into a contract with an independent research firm who conducted a satisfaction survey among pilot participants.

    1. 69 percent of consumers said the service plan was fair.
    2. 76 percent of consumers said service plan staff provided quality service.
    3. 78 percent of consumers said they are satisfied with freedom to choose services.


    Ms. Axtman explained what we learned with the pilot. The IAP was critical to the success of the pilot. In order to duplicate the pilot cost containment, an IAP must be included in the business model. The utilization management business model is effective.

    The Governor's 2020 Task Force recommends implementation of the utilization management business plan for people with developmental disabilities and mental illness. (Attachment #1)

    A summary of the Department of Health and Welfare's Utilization Management Plan was reviewed. This summary outlined why should the Department implement the pilot plan statewide, how much will it cost to implement the pilot plan statewide, and how much cost can Medicaid avoid if the pilot plan is implemented statewide. The Department's plan is endorsed by the Governor, as well as the Governor's Blue Ribbon Task Force. (Attachment #2)

    A discussion was held about the Department's IAP, why some people are critical or have objections to utilization management, the need to ensure a monitoring system and ability to cancel a contract, SIB-R measurement tool, and the length of time required for the state to develop an independent IAP network provider assessment.

    Discussion also included how the intent language impacts the Department's ability to implement this project statewide. Ms. Axtman was asked if the major stumbling block the Department has in implementing this program statewide, the potential legislative intent language from JFAC. Ms. Axtman report the intent language is not just a major stumbling block, it is "the" only one.

    MOTION A motion was made by Senator Stegner that this committee sends a strong letter to JFAC, stating this germane committee has determined that the Department of Health and Welfare should enter into the Utilization Management Project statewide. Motion was seconded by Senator Bailey. After a brief discussion, the motion was carried by a voice vote.
    The Division of Medicaid Interim Administrator Randy May presented the Department's assessment to the legislative intent language in Sections 7, 8 and 9.

    Section 7: "It is the intent of the Idaho Legislature that the Department of Health and Welfare implement a case management software program, but not enter into a utilization management, Independent Assessment Provider (IAP) contract for fiscal year 2004." He explained the Department does not support the legislative intent language that precludes them from entering into an IAP contract. The IAP contract is essential to the care management plan of utilization management.

    Section 8: The Legislature has concerns relative to the degree of reductions to specific program budgets as a result of holdbacks and current funding levels. As a result, the House of Representatives Medicaid Task Force met with providers of services along with personnel from the Department of Health and Welfare, and identified General Fund Medicaid savings of $923,700. Of this amount, it is the intent of the Idaho Legislature that $286,300 be redirected to targeted case management for the mentally ill and targeted service coordination for the developmentally disabled, $194,000 be used to restore a portion of the residential habilitation affiliation fee, and that $443,400 be diverted to the Division of Family and Community Services for sheltered workshop services."

    Mr. May explained he divided Section 8 into four (4) areas, A - D.

    Section 8(a): Relates to target service coordination (TSC), and directs the Department to restore funding of $286,300 that was pulled back due to the 3.5 percent holdback. He discussed TSC responsibilities such as developing an individual support plan for developmental disabled clients, service coordination/linking, client monitoring, and follow-up.

    The Department does not support the intent language for restoring this funding.

    Section 8(b): Relates to targeted case management (TCM), and directs the Department to restore funding, part of the $286,300 listed in Section 8a. TCM responsibilities include developing an individual care plan for mental health clients, providing service coordination and linking but no direct client treatments, provide client monitoring, and adjustment of service mix. Prior to December 2002, there were no limitations in TCM hours at $39.76 per client per hour, but the Department found widespread over-utilization, abuse, and fraud in this area. After December 2002, limitations of four (4) hours per client per month at $39.76 per hour regular, and a four (4) hours per client per month at $39.76 for crisis services (as needed by client). The Department will conduct retrospective audits. Additional crisis hours are available, if needed, with a prior authorization required. This will provide a net savings of $900,000 General Fund money to the SFY2004.

    The Department does not agree with restoring funding.

    A letter from the director of the Department of Health and Welfare, dated March 17, 2003, was discussed. (Attachment #3)

    A brief discussion about the type of fraud charges against providers was held. Mr. May stated the Fraud Unit bills Medicaid for services, and at this time, he is uncertain of the number of cases currently being investigated. He agreed to send a report about Medicaid fraud cases to committee members.

    Section 8(c): Relates to residential habilitation affiliation, and directs the Department to restore funding of $194.000. Res-Hab agency responsibilities include developing client's res-hab implementation plan (6 hours annually), provide training to res-hab providers, (8 hours annually), provider client monitoring (1 visit per quarter minimum), and resources for res-hab providers, as needed. Prior to December 2002, the Department paid $13.07 per client per day amounting to $397.55 per client per month, and at a quarterly pro-rata activity level (6-8 hours per quarter) it cost $149.08 per hour. After December 2002, the Department pays $198.93 per client per month with a quarterly pro-rata activity level (6-8 hour per quarter) costing $74.60 per hour. The net savings to the SFY 2004 budget impact is $730,000.

    The Department does not agree with restoring funding.

    Section 8(d): Relates to sheltered workshops ". . .that $443,000 be diverted to the Division of Family and Community Services for sheltered workshop services."

    The Department loses of $1.03 million in federal matching funds; therefore, the Department does not agree with the diversion of the funds.

    Section 9: "It is the intent of the Idaho Legislature that, notwithstanding Section 56-209d(4)(C), Idaho Code, adult dental services covered by the state's Title XIX Medicaid program shall be limited to emergency services and, for high risk adults, preventive and restorative services consistent with the direction of the House and Senate Health and Welfare Committees."

    Mr. May reported the Department does not agree. This intent language is not needed.

    Dick Burns, a budget analyst from the Legislative Services Office, informed the committee that in relations to earlier discussions, part of the Department's 2004 budget there will be a supplemental appropriation and it will be an emergency clause, and the emergency clause will refer back to that section of adult dental.

    This germane committee has not discussed adult dental intent language for the 2004 budget, just for the FY2003 budget. The committee will continue a discussion pertinent to the adult dental program and the 2004 intent language on Monday, March 24, 2003.

    The Department of Health and Welfare Deputy Director Gary Broker, briefly explained Section 10.

    Section 10: "It is the intent of the Idaho Legislature that all Title X funds available to the Department of Health and Welfare and all funds representing state match for Title X funds shall be provided to Idaho's seven public health districts by contract."

    Mr. Broker explained Title X is a family planning grant of $1.5 which is funded by 90 percent federal funds. He reported this intent literally eliminates the grant for family planning. The Department is the agency that can apply for the federal grant. Section 10 will be discussed again on March 24, 2003.

    MOTION The meeting adjourned at 9:53 a.m.




    DATE: Monday, March 24, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
    MEMBERS ABSENT/

    EXCUSED:



    None
    GUESTS: Representative Mike Mitchell, and see the attached sign-in sheets
    MINUTES: A motion was made by Senator Bailey to approve the committee's minutes for Tuesday and Wednesday, March 11 and 12, 2003, as written. Motion was seconded by Senator Ingram, and motion was carried by a voice vote.
    LEGISLATIVE INTENT This meeting is a continuation of reviewing the legislative intent language from the JFAC (Joint Finance-Appropriations Committee) for the FY2004 budget for the Department of Health and Welfare.
    The Department of Health and Welfare Deputy Director Gary Broker presented the Department's understanding of the FY2004 intent sections, historically included in the Department's appropriation bills. The Department of Health and Welfare has five (5) appropriation bills.

    Section 8: "The Legislature has concerns relative to the degree of reductions to specific program budgets as a result of holdbacks and current funding levels. As a result, the House of Representatives Medicaid Task Force met with providers of services along with personnel from the Department of Health and Welfare, and identified General Fund Medicaid savings of $923,700. Of this amount, it is the intent of the Idaho Legislature that $286,300 be redirected to targeted case management for the mentally ill and targeted service coordination for the developmentally disabled, $194,000 be used to restore a portion of the residential habilitation affiliation fee, and that $443,400 be diverted to the Division of Family and Community Services for sheltered workshop services."

    Mr. Broker reported, essentially what the intent language says is that the savings identified in the Medicaid program be used for three (3) purposes. Items one (1) and two (2) involve partially restoring services that were part of the cut back. The targeted case management and residential habilitation affiliation fee, those would be partially restored, and those expenses would be Medicaid matching funds. The $443,400 is to be diverted to the Division of Family and Community Services (FACS) for the sheltered workshop services. The funds would be diverted from Medicaid to FACS for sheltered workshops at a loss of federal funds, approximately $900,000, and then it would be 100 percent state funds for workshops.

    The Division of Medicaid Interim Administrator Randy May responded to questions previously asked about Medicaid's fraud investigations. He reported that since May 2001, there have been 25 Medicaid fraud cases investigated, and 16 of those cases have been resolved. The 16 cases involved more than $78,000. There are nine (9) remaining cases opened involving approximately $900,000. Last week, there were two (2) new indictments issued for claims submitted in excess of $100,000. The U.S. Attorney's office was involved because of federal funds. At times, when the U.S. Attorney is involved, the Department does not know the case status for a few days. Most Medicaid fraud cases are a combination of Medicaid and Medicare funds, and the current cases being investigated are all vendors. Fraud cases may be found when case files are matched vs. billing records received.

    Mr. May continued the discussion pertaining to the JFAC legislative intent language.

    Section 8: Mr. May divided this section into four (4) areas, A thru D. Basically, this section says that the projected savings in 2004. By changing the way Medicare party crossover claims are done, and the way we handle durable medical equipment purchases, there could be about $927,000 in General Funds as projected to be saved. The intent language specifically shifts those funds into four (4) areas in Section 8.

    1. 8a - Target service coordination (TSC) for developmental disabled - recommends shifting $286,300. TSC responsibilities such as developing an individual support plan for developmental disabled clients, service coordination/linking, client monitoring, and follow-up. Prior to December 2002, this was allowed 3.5 hours per client per month at $39.40 per hour or $137.90 per client per month. After December 2002, this was reduced one (1) hour for a total of $98.50 per client per month, with a projected savings of $353,800.


    2. 8b - Target service case management for mental health clients - recommends shifting $286,300 for TSC and TCM, but does not provide a formula for distributing those funds. TCM responsibilities include developing an individual care plan for mental health clients, providing service coordination and linking but no direct client treatments, provide client monitoring, and adjustment of service mix. This service was reduced by one (1) hour, and additional hours are available for crisis, if needed with a prior authorization. This is projected for a net savings of $900,000 in General Fund money to the SFY2004.


    3. 8c - Residential habilitation affiliation fee - directs the Department to restore funding of $194.000. Res-Hab agency responsibilities include developing clients' res-hab implementation plan (6 hours annually), provide training to res-hab providers, (8 hours annually), provider client monitoring (1 visit per quarter minimum), and resources for res-hab providers, as needed. Prior to December 2002, the Department paid $13.07 per client per day amounting to $397.55 per client per month, and at a quarterly pro-rata activity level (6-8 hours per quarter) it cost $149.08 per hour. After December 2002, the Department pays $198.93 per client per month with a quarterly pro-rata activity level (6-8 hours per quarter) costing $74.60 per hour. The net savings to the SFY 2004 budget impact is $730,000.


    4. 8d - Relates to sheltered workshops ". . .that $443,000 be diverted to the Division of Family and Community Services (FACS) for sheltered workshop services." The Department does not support this section, primarily due to the loss of $1.03 million in federal matching funds, once those funds are transferred from Medicaid. He explained that Medicaid does not operate sheltered workshops, but if these funds ($443,000) are withdrawn from the Medicaid budget and transferred to FACS for their sheltered workshops, then the federal funds are lost to the Medicaid program.


    Deputy Director Gary Broker outlined the process of transferring Medicaid dollars into FACS for a non Medicaid service will create a loss of about $1.5 total funds. He explained the sheltered workshops in FY2003 spent about $3.3 million on services, which is after the cuts. With the proposal now, without the transfer of funds, they will have about $3.3 million in FY2004. The $443,000 will bring them back to the funding level in FY2002. In FY2002, they spent about $3.9 million. They have gone all of FY2003 at the level proposed for FY2004. The workshops in FY2002 served about 625 clients, in FY2003 they served about 660 clients, and in FY2004 they will serve about 625 clients. This is without the intent language.

    He explained that the sheltered workshop program is not only funded just by the state appropriations. They are also a Medicaid provider, and bill for services for Medicaid. They get about $26 - $28 million from that revenue source.

    Other items discussed included the merit of workshops vs. loss of federal matching funds, other resources of funding for sheltered workshops, the Department's funding for sheltered workshops has increased annually, and with no additional cuts in FY2004 budget - funding is the same as FY2003 budget, when cuts were made for workshops.

    The Department has analyzed all the different budget cuts, and believes that to provide the services needed for the number of people requiring services, and the budget constraints, sheltered workshops were cut back. Now with the legislative effort to move $443,000 from Medicaid, that would cost the state an additional $1.03 million in match funds. The Department does not believe that is a wise move in transferring funds.

    If the Legislature finds $443,000 in General Funds and adds that into the effort, the Department has no objection. The problem will arise if the $443,000 is diverted from the Medicaid funds, and Idaho loses an additional $1.03 million in matching funds, that is a poor use of money.

    Given the condition of the Medicaid Program, with a growth of 15 percent in Medicaid, which has been reduced to about 6 percent growth, that is far better than the national figure.

    Mr. Broker informed the committee that if the Department received an additional $400,00 in General Fund, with no strings attached, they would go through the same process as when they were notified of the budget cuts, to try to determine how to get the most services to the most needy people for that dollar expenditure.

    A discussion about several issues pertinent to the Medicaid budget was held, such as: increased growth in the need for Medicaid services as unemployment occurs; what other resources of non-Medicaid funding are available for sheltered workshops; if there are cost savings that produce more funds will those funds go into restoring services for the developmental disabled. Without a FY2004 budget, the Department is unable to project any areas of savings.

    Senator Brandt explained he is drafting a letter to the Joint Finance-Appropriations Committee (JFAC) regarding Section 7 of the legislative intent language for the Department's FY2004 budget. The Committee regards Section 8 as micro-management.

    Senator Ingram expressed his concerns about the Department's projected savings. He believes that Representative Gagner is on the right tract about micro-managing the Department of Health and Welfare. He expressed his concerns about the funding for sheltered workshops, targeted case management, residential habilitation, and the number of individuals affected by the cutbacks, without any restoring of funds to the programs. He explained that he would feel better about Representative Gagner's program if we could get rid of Utilization Management in Section 7, as we know there is money that we could make up in the utilization management program. He explained that Representative Gagner does not want to do Section 7, or any of the other plans. Senator Ingram stated he believes that would be a mistake, and we should encourage the Department of Health and Welfare to go full bore into these areas, and start seeing where we could find people to do it.

    Senator Brandt explained that previously the committee had reached a consensus to send a letter to JFAC that we do not support this intent language. Should the letter also include an aye or nay to Section 8?

    Senator Stegner recommended the committee oppose Section 8. He has more trust in the Department to determine the value of those things, than he does in others. He understands the importance of the concerns voiced by providers, but wants to give the Department the benefit of the doubt in being able to analyze the value of the money spent - across the entire board. When the Department tells us that the targeted case management program can take these cuts, and justify based on the prior delivery of services from those organizations, and given the current economic climate and consideration, he supports the Department. He believes they have a very dependable analysis that is unbiased in the terms of value. Senator Stegner opposes all of Section 8 of the intent language.

    MOTION A motion was made by Senator Kennedy that the Chairman, in his letter to JFAC, states (1) That the committee is opposed to any micro-management of the potential $923,700 in savings that could result in Medicaid. (2) That they cannot recommend that the $443,400 be diverted to a non-Medicaid function because the entire $923,700 would disappear, and that we; therefore, allow the Department to allocate any savings they have as a result of the reductions, to any Medicaid function they deem more appropriate, rather than having micro-management from the JFAC

    Motion was seconded by Senator Stegner.

    Discussion:

    Senator Burkett explained the importance to recognize the Department has moved from the original four (4) hour limitations established with the original holdbacks. It is important to recognize we have made some progress for those providers. The Department has amended rules and will allow an additional four (4) hours of crisis case management. He is disappointed we have not heard from providers as to their satisfaction of the rules. The committee heard their evidence, and showed concern, and the Department has responded. He supports the motion. (Attachment #1)

    Senator Compton supports the motion. He has heard from individual providers, and they believe the response from the Department is in the right direction. If they cannot move forward and live with the Department's response, they will return next year.

    Senator Sweet opposes the motion. He listed three (3) areas of concern:

    1) We would not manage the budget based on matching funds only as the number one (1) criteria. That is a poor way to measure the merits of any program.

    1. If unable to obtain matching funds for sheltered workshops, why not take the entire budget for sheltered workshops and put it into the Medicaid program, and then leverage it out.


    2. What were the actual priorities of the Department?


    A roll call vote was requested for the above motion.
    Senator Ingram voted No Senator Burkett voted Yes
    Senator Sweet voted No Senator Stegner voted Yes
    Senator Darrington voted Yes Senator Brandt voted Yes
    Senator Kennedy voted Yes Senator Bailey voted Yes
    Senator Compton vote Yes


    The beforehand motion was carried by a roll call vote.

    ADJOURNMENT The meeting adjourned at 9:14 a.m.




    DATE: Tuesday, March 25, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
    MEMBERS ABSENT/

    EXCUSED:

    None
    GUESTS: See an attached sign-in sheet
    HCR 17 HCR 17, relating to the destruction of unopened and unused drugs and directing the Board of Pharmacy and the Department of Health and Welfare to develop necessary, statutory and rule changes to allow return and use, was presented by Michelle Glasgow, a representative for the Idaho Assisted Living Association.

    This legislation proposes to curtail the wasteful practice of destroying unused and unopened medications by allowing assisted living facilities to return medications just as hospitals and nursing homes presently do. This will help reduce costs of healthcare, especially as it relates to prescription medications for the elderly and disabled.

    Ms. Glasgow reported that approximately $3 million to $4 million in drugs are destroyed annually in assisted living facilities. Approximately $1.7 million are purchased with Medicaid dollars. In addition to saving state Medicaid and general funds. Savings to those people in assisted living facilities, who pay for their own medications, this will allow them to avoid "spending down" their own assets, delaying or possibly eliminating their need for Medicaid assistance in the future.

    She explained the purpose of the Bill is to allow unused, unopened medications from Idaho's assisted living facilities to be returned to the dispensing pharmacy for credit, regardless if the payer is private or Medicaid. Less than 10 percent of destroyed medications are controlled substances. Approximately 35 percent to 55 percent of medications being destroyed are purchased with Medicaid dollars.

    Handouts about the cost-savings to Idaho through the return and reuse of medications, the cost of destroyed medications in Idaho assisted living facilities in 2003, and a cost comparative chart of Medicaid dollars vs. private pay was also submitted. (Attachments #1 - 3)

    Written comments were submitted from Robert F. Spiel, president of PharmEase, an independent pharmacy in southern Idaho, in support of HCR17. In summary, he supports ending the waste providing there is adequate financial compensation for accepting the return drugs and if the system is not cumbersome. He asked the committee to evaluate this Bill because we serve more than 80 assisted living facilities in the Treasure Valley, Magic Valley and Idaho Falls.

    When assessing this proposed legislation, someone suggested requiring the use of seven-day blister packs as another potential solution. He opposes the use of seven-day blister packages. The weekly blister packs would be extremely cost prohibitive; essentially, the pharmacists and pharmacy technicians would be spending four (4) times the labor for filling and checking prescriptions. In his Boise pharmacy alone, it would cost an extra $50,000 per month in labor costs - a 50 percent increase. Instead of lowering the cost of health care, such a program would increase the cost of health care.



    Kathleen Allyn, deputy administrator for the Division of Medicaid, was asked for her comments about how this process would work. She briefly commented about the details of how she believed this process would be done. She reported discussions about this process have been ongoing for sometime and several important areas need to be considered, such as: How much imposition will this be on smaller facilities? How comfortable will a pharmacist be with returned medications? She believes there are a number of issues that still need to be worked out.

    Richard Markuson, R.Ph., executive director of the Idaho State Board of Pharmacy, testified about the concerns of the Board of Pharmacy with HCR17. He stated in the beginning, HCR17 sounded fairly simple, but it is not as simple as it has been previously stated. HCR17 is specifically directed to assisted living facilities.

    The Board of Pharmacy is very concerned about the integrity of these returned products. The Board wants to be assured, and so do the pharmacists, that these products, when they are returned, have that integrity, and have been kept in conditions that do not affect the product.

    Some residents go on home visits and take their medications with them, which comprises the integrity of the products. There are approximately 300 of these facilities in Idaho, and the Board of Pharmacy does not register or inspect these facilities. The Board has no oversight, at all, of these assisted living facilities. Medicaid does inspect assisted living facilities, but, currently, Medicaid does not have enough personnel to inspect all the facilities very often. Generally, inspections are two (2) to three (3) years behind schedule.

    Mr. Markuson, again, expressed the concerns of the Board of Pharmacy regarding the oversight, integrity of handling and monitoring the products, the safety of the returned medications, and the cost and staff to inspect these facilities. He stated the Board of Pharmacy, as well as Medicaid, does not have enough staff to inspect facilities, and to ensure the integrity of medications.

    He explained that rules are currently in place for long-term care facilities, such as nursing homes. * Medications belong to a resident, and if he or she is moved to a different facility, the medications should go with that person to the new facility. He reemphasized the importance of determining who will have oversight, who will be responsible for the costs involved, who will provide the integrity and oversight of the returned medications, and ensure HCR17 is cost-effective and will provide a savings for private pay as well as for Medicaid.

    * The requirement for nursing homes to return drugs is found at IDAPA 16.03.09.817.07.

    07. Return of Drugs. Drugs dispensed in unit dose packaging as defined by IDAPA 27.01.01, "Rules of the Idaho State Board of Pharmacy," Subsection 156.05, shall be returned to the dispensing pharmacy when the client no longer uses the medication as follows: (3-15-02)

    a. A pharmacy provider using unit dose packaging must comply with IDAPA 27.01.01, "Rules of the Idaho State Board of Pharmacy," Subsection 156.05. (3-15-02)

    b. A licensed skilled nursing care facility must return unused drugs dispensed in unit dose packaging to the pharmacy provider that dispensed the medication. (3-15-02)

    c. The pharmacy provider that receives the returned drugs must credit the Department the amount billed for the cost of the drug less the dispensing fee.

    MOTION A motion was made by Senator Sweet to send HCR17 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Burkett, and motion was carried by a voice vote. Senator Sweet will sponsor HCR17.
    ADJOURNMENT The meeting adjourned at 9:07 a.m.




    DATE: Wednesday, March 26, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Sweet, Bailey, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:



    Senators Stegner and Burkett,
    GUESTS: See the attached sign-in sheets
    HB 160aa HB160aa, relating to the termination of parental rights, and amending Section 16-2005, Idaho Code, to revise conditions under which the court may terminate parental rights, was presented by Kelly Buckland, director of the Idaho Independent Living Association. This Bill was amended in the House, on page 1 of the printed bill, line 24, deletes "unable failing" and insert: "unable"; and in line 26, delete "a failure" and insert: "inability."

    He presented a brief history of this legislation. In early 1999, the Idaho State Independent Living Council established the Committee for Fathers and Mothers Independently Living with their Youth (FAMILY). The committee was created to remove from current law any inappropriate disability language, builds into current law protections against discriminatory actions because of a parent's disability in child custody legal proceedings, and create an evaluation system that is consistent and takes into consideration the use of adaptive equipment and supportive services.

    The committee for FAMILY includes state legislators, an attorney with family law expertise representing the Idaho Bar Association, state Family and Children's Services officials, the director of the Protection and Advocacy System, representatives of disability advocacy groups, and members of the Grandparents as Parents and Idaho Parents Unlimited. Since 1999, the FAMILY committee has met 12 times to review and revise laws pertaining to child protection and termination of parental rights.

    Legislation was introduced and passed in the 2002 Idaho State Legislature that amended the law regarding termination of parental rights for parents with disabilities. This proposed legislation will amend language that was not amended during the last legislative session. There is no fiscal impact to the General Fund.

    Jim Baugh, CO-AD, Inc., testified in support of HB160aa and HB167. He explained the parental rights of parents with disabilities. He discussed the proposed legislation, HB160, and the difference between unable and failing, and inability.

    Mike Keithly, chairman of the State Independent Living Council, testified in support of HB160aa and HB167. He explained the goal of the SILC is to remove discriminatory language and to secure the rights of parents with a disability to keep their children in their family and within their home and community. A basic right that we as humans all hold dear, but sadly for some a right that is denied them solely because they have a disability.

    The language and intent of HB160 and HB167 will allow parents with a disability the opportunity to prove themselves to be effective, worthy parents. We also believe that this language protects the health and welfare of the children who may be caught up in this situation. He emphasized that those of us who have worked on this language have always placed the best interests of the child at the forefront of our efforts. We fully realize that there will be cases where circumstances are such that the child must be removed for their safety. We have worked very hard to craft language that protects children, respect the rights of a parent with a disability, takes into consideration the needs of the Department of Health and Welfare, and satisfies the concerns raised by county prosecutors. We have, successfully I believe, gained the support of all those agencies entrusted with the health and welfare of Idaho's children.

    In closing, he asked each member to put themselves in the shoes of a parent with a disability, who is about to have their child removed from their care, simply because of discriminating language, lack of services or a judicial system that sometimes harbors a bias. He stated, "I can only think of a few situations where a parent's pain and despair may be greater." He asked for a favorable vote for HB160 and HB167.

    Marty Duran, legislative council for the American Civil Liberties Union of Idaho, a statewide organization representing approximately 1,300 members and supporters, testified in support of HB160 and HB167.

    Marilyn Sword, executive director of the Idaho Council on Developmental Disabilities, testified in support of HB160 and HB167.

    Robert L. Aldridge, Attorney-at-Law, who has worked for the past 14 years bringing legislation based primarily on guardianship issues, testified in support of HB160. He believes that in all these areas, there should be a level playing field, and this particular bill (HB160) does. If problems do arise, they can be dealt with. He explained his primary testimony deals with HB167.

    Roger Howard, from the Living Independence Network Corp., (LINC) testified supports HB160.

    Brenda Korewa, an advocate for Parents with Disabilities, supports HB160 and HB167.

    MOTION A motion was made by Senator Kennedy to send HB160 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Ingram, and motion was carried by a voice vote. Senator Ingram will sponsor HB160aa.
    HB 167 HB167 was also presented by Kelly Buckland, chairman of the State Independent Living Council, and explained this legislation, relating to the Child Protective Act, is the last item of legislation being submitted on behalf of parents with disabilities. This Bill was amended in the House, and he described each change, that being on page 1, line 33; page 4, line 12; page 6, line 8; page 7, line 1 through 23, and a correction to the title on page 1, line 3.

    Families in which one or both parents have a disability face significant barriers as they attempt to raise their children. These barriers include, attitudinal barriers, lack of information about parenting adaptations, lack of funding for adaptive technology, exclusion from public policy considerations, and lack of disability expertise in service systems.

    Idaho child protection laws, as currently written, reflect the historical bias against parents with disabilities and present an unrealistic view of the disability community by their constant referral to having a disability imply that parents with disabilities are incapable of properly caring for their children. It is seldom a person's disability that inhibits a persons' capacity to provide a stable and loving home for children. Rather, it is a lack of disability related supports for a parent with a disability that results in an unstable home environment.

    Many parents with significant disabilities provide excellent care and stable homes for their children with the assistance of family, friends and neighbors. Factors that should be considered in child protection cases include abuse, neglect, abandonment, etc., regardless of whether the parent has a disability. This legislation removes from current law any inappropriate disability language, and builds into current law protections against discriminatory actions because of a parent's disability in child protection legal proceedings.

    Based on information provided by Through the Looking Glass, a National Resource Center for Parents with Disabilities, there are more than 8.1 million U.S. families, or 10.9 percent of families with children, in which one or both parents have a disability. Based on these figures, the proposed legislation will have a positive impact on an estimated 14,750 Idaho families.

    There will be no fiscal impact on the General Fund.

    Cameron Ball, a minor with a parent with disabilities, explained his mother, regardless of her disabilities, has provided adequate and loving care for him and his sister. He requested committee members look at all the resources available to help a disabled parent. He supports HB160aa and HB167.

    Bobby Ball, director of the Task Force on the Americans with Disabilities Act (ADA), supports HB160aa and HB167.

    Robert L. Aldridge, Attorney-at-Law, testified in support of HB160aa and HB167. He believes the legislation is very important in the continuing efforts to make Idaho Code a level playing field and fundamental processing rights. He believes there are additional steps needing to be taken, and there are still responsibilities the state has, in dealing with persons with disabilities.

    Mr. Aldridge agreed that, in the future, language and structural changes will need to be done legislatively, i.e., supportive services and adaptive equipment needs.

    A general question and answer period was held pertinent to the language, and definitions of adaptive equipment found in several sections, of the proposed legislation.

    Roger Howard, executive director of the Living Independence Network Corp., (LINC), an organization who provides services to people with disabilities by people with disabilities. He supports HB167.

    Ronald Suler, director of the Idaho Assistive Technology Project at the University of Idaho, and father of a son with cerebral palsy, testified in support of HB167. His testimony focused on the promise of assistive technology devices and services for supporting parents with disabilities. Assistive technology includes such things as reachers, adaptive silverware, computer hardware and software, recreation technology, communication systems, and thousands of other commercially available devices. In fact, there are more than 20,000 devices currently in the marketplace designed to help persons with disabilities.

    If Idahoans' with disabilities are provided with the tools they need, they can be successful in school, at work and are better prepared to live in their communities. This is especially true for parents with disabilities. Parents with disabilities can successfully maintain their families if they are provided with the tools they need. (Attachment #1)

    In year 2000, the Idaho Department of Health and Welfare funded the Parent Support Project. The 12-month pilot project had the goal of helping parents with disabilities to maintain their families through the provision of assistive technology devices and related services. The Parent Support Project was part of the efforts of the committee for FAMILY, to address the unique needs of parents with disabilities living in Idaho.

    Parent with disabilities typically use adaptive devices for bathing, dressing, lifting, carrying, diapering, feeding, and transporting their children. Adaptive devices are also used for helping with homework, child-proofing kitchens and bathrooms, and to help perform household chores.

    The Parent Support Project received 187 applications and subsequently provided adaptive devices to a total of 163 families. Approximately $950,000 was spent on adaptive technology for these families - an average of $5,828 per family. There was an average of 2.5 children per household. The most commonly purchased devices included mobility equipment such as adaptive strollers and specialized children's car seats. Other types of devices provided to parents included adaptive baby cribs and minor home modifications. The results of the Parent Support Project underscore the tremendous potential of adaptive technology for helping parents with disabilities to maintain their families.

    He explained he does not believe that the strength of a family can be accurately evaluated unless parents have the tools that will allow them to interact with their children in order to develop a healthy and normal relationship. Passing HB167 will signify that Idaho supports a parent with disabilities.

    Written comments were presented by Mr. Buckland and prepared by Patricia Tobias, administrative director of the state of Idaho Supreme Court, who clarified that while the Judiciary does not take a position either in support or opposition to HB167, she did compare the changes proposed by the Children in Foster Care Committee and find that these suggested changes have been incorporated into HB167. She also reported, I would note one additional point raised by the Chair of the Children in Foster Care Committee, the Honorable Bryan Murray, Magistrate Judge, Pocatello. In 16-1602(24)(b) a list of causes for the failure of a parent or guardian to discharge their responsibilities, i.e., incarceration, hospitalization, or other physical or mental incapacity, has been stricken in favor of any failure on account of which the child lacks parental care.

    The Chair wants to be sure that the striking of these enumerated causes does not foreclose their consideration as a basis for determining that a parent is "failing" to care for the child.

    Written comments were also presented by Mr. Buckland and prepared by Sharon Ullman of Boise. Ms. Ullman believes that the changes proposed in HB160 and HB167 are centuries overdue. The concept of forcibly taking a child away from his/her parent solely on the basis of that parent having a disability sounds more like something out of the Stone Age that the Age of Modern Technology in which we live today.

    Many disabilities do not affect a parent's capacity to love and nurture his/her child. Forcibly terminating the parent/child relationship, however, could have long-lasting and emotionally costly consequences for both parent and child. To have laws on the books that allow the severing of ties between parent and child for no reason other than the parent's disability, without taking into consideration and providing for the use of available adaptive equipment and support services, is just plain wrong.

    Although HB167 indicates that there will be a cost to Idaho's taxpayers in order to provide for implementation, including the costs of staff training and adaptive equipment, I would also argue that on a long-term basis, this bill actually makes financial sense. Surely it is more cost-effective to leave a child in the home of a disabled parent and provide adaptive equipment and support services that it is to remove the child from the home and have to provide full support for that child.

    MOTION A motion was made by Senator Compton to send HB167 to the Floor with a Do Pass recommendation. Motion was seconded by Senator Ingram, and motion was carried by a voice vote. Senator Kennedy will sponsor of HB167.
    ADJOURNMENT The meeting adjourned at 9:37 a.m.




    DATE: March 27, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
    MEMBERS ABSENT/

    EXCUSED:

    None
    GUESTS: Jon Sandoval, Chief of Staff Department of Environmental Quality; Jason Jedry, Analyst Department of Environmental Quality; Rayola Jacobsen, Bureau of Occupational Licenses; Roger Halts, Attorney Idaho Bureau of Occupational Licenses; Brad Hoaglun, Idaho Association Chiropractic Physicians; Maggie Mahoney, Idaho Association of Counties; Jeremy Pisca, Idaho Physical Therapy Association; Pam Eaton, Idaho Retailers Association; Victoria Paulson, Idaho Medical Association; Senator Clint Stennett; Senator Hal Bunderson
    CONVENED: Chairman Brandt convened the meeting at 8:37 a.m.
    H 17a Relating to Chiropractic physicians; amending Section 54-705, Idaho Code, to clarify an exemption; amending Section 54-708, 54-709, 54-710, 54-711, Idaho Code, to change the language dealing with renewal fees and to increase the cap for renewal and examination fees from $100 to $150. Rayola Jacobsen, Bureau Chief of Bureau of Occupational Licenses was given the Floor to present H 17a, as amended, to the Committee. The legislation clarifies exemptions and to revise licensing and temporary permit fees. H 17a clarifies exemptions by stating the exemptions rather than by referencing them. Previous exemptions in this act include exemptions by reference from Title 54, Chapter 18, which is the portion of Idaho Code regarding physicians and surgeons. The change will occur in the chiropractic physicians exemption by deleting the section which allows unlicenced persons to practice chiropractics as a guide for undefined religious beliefs. The Board of Chiropractic physicians while charged with the responsibility for protection of the health, safety and welfare of the public and the regulations for licensing of this profession are seeking this solution to solve an ongoing situation. The situation is that of an unlicenced chiropractic individual who is practicing chiropractic manipulation and is doing so by saying that it is his religious belief to do so. The local prosecutor will not bring him to trial due to many complaints because of the religious exemption.

    The second part of the proposal raises a cap for license fees from $100 to $150 dollars. The fees are presently at the top of the cap. Prior to a future fee increase a rule must be presented to the legislature and be approved. In the event the Board may need to raise fees in the future, this increase in the cap would allow the Board to present such a rule and realize the benefit in a shorter time frame.

    The third part of the proposal raises the cap for license fees for temporary permits from $50 to $100. These fees are also at the top of the cap and prior to any future increase it must be presented to the legislature in rule form and be confirmed.

    Discussion Discussion between Committee members and Ms. Jacobsen included:

    Do the amendments just deal with military medical officers?

    Ms. Jacobsen stated the amendments spell out the exemptions and she read the entire list.

    Why did the Bureau leave out the religious exemption?

    Ms. Jacobsen commented on a case concerning an individual who is practicing chiropractic manipulation without being licensed, the Bureau has received many complaints about this individual.

    Did the exemption of Section 54-1804 deal exclusively with chiropractors?

    Ms. Jacobsen stated the bill was originally written to include by reference certain portions of the exemption presently stated in the Physicians and Surgeons part of the code, the bill was amended to state the exemptions so that they are clearly shown.

    Is Section 54-1804 the exemption portion of the Physicians and Surgeons' licensure statute?

    Ms. Jacobsen stated this was correct.

    Is the new language in subparagraph g through k the same exceptions that appeared in Section 54-1804 of the Code?

    Roger Hells, attorney representing the Bureau of Occupational Licenses, stated that the language is from the Physicians and Surgeons Act.

    Because of the exemption under the medical statute, doesn't this just allow the individual to call himself a doctor and continue to practice spinal manipulation?

    Mr. Hells stated that he is confident that the medical board would not allow this.

    What is the reason for the increase in fees?

    Ms. Jacobsen stated that the Board suffered a lawsuit that depleted reserve funds, and they are concerned about the size of the funds. This legislation doesn't raise the fees. It raises the cap. Before the fees can be raised, the Board must appear before the Committee and receive permission.

    Testimony Brad Hoaglun, representing the Idaho Association of Chiropractic Physicians, was given the floor to testify on H 17a. Mr. Hoaglun supported the legislation, and spoke on the need to replenish the fund to reduce the time it would take should the Board need to raise the fees. He stated that the only change made to exemptions is to take out the religious exemption, it's not known of any religion that uses spinal manipulation as a practice ritual, so he feels the legislation is a good move and will allow legal action to be taken on someone who shouldn't be working on people in Idaho.
    MOTION A motion was made by Senator Compton to send H 17 as amended to the Floor with a do pass recommendation. A second was made by Senator Stegner. The motion carried by a voice vote. The sponsor will be Senator Ingram.
    H 198 Relating to Waste Tire Disposal; the proposed changes to the Waste Tire Act strengthen the ability of State, Counties, and Cities to regulate storage and disposal sites. Senator Bunderson presented H 198 to the Committee. Senator Bunderson stated the background of the legislation and commented on the great work done by Jon Sandoval, Bureau Chief of Department of Environmental Quality (DEQ). Senator Bunderson stated there was a task force formed of stakeholders to evaluate how to solve the problem of the accumulation of tires: tire dealers, health districts, counties, and tire recylers. This meeting took place over the summer and in conclusion of the meeting everyone agreed to the legislation. There were no objections. However, in the House of Representatives the Cities voiced their concern over the legislation in regards to language. They reached a consensus, it fixes most of the problems prospectively from reoccurring, and it provides options for Counties who are overcome with some of the problems they have today, the historical problems.

    Senator Bunderson turned the floor over to Senator Stennett. He thanked the committee for last year's work on this issue. He stated the legislation is much different from what he presented last year. Senator Stennett stated this bill does not do anything for the existing tires that are there, except allow them to be landfilled. He commented on the Shoshone and Lincoln County problem where the County was left with the responsibility. He stated that although the legislation is different from what he expected, with the House amendments, he thinks the Senate should look at it.

    Senator Compton asked for clarification on what the legislation does, and for a summary of the legislation.

    Jon Sandoval, Bureau Chief of DEQ, reported on H 198. He stated the issue has been a problem since 1991 and that Idaho generates approximately one million waste tires each year. Mr. Sandoval described the history of the Waste Tire Law. He stated the changes in the Idaho Waste Tire Law strengthen the ability of the state, counties and cities to regulate storage and disposal sites in their jurisdictions. Waste tire storage sites will maintain a $2.50 per tire financial assurance in the form of a cash bond in favor of the county, city or State where the facility is sited. This is not a $2.50 fee, this is a cash bond payable to the county or city in case whoever manages the storage site should go under. The other important change to the Idaho Waste Tire Law as amended will allow for the land filling of tires as long as the tires are reduced by 65% (chipped, shredded or quartered). He stated the concerns raised in the House of Representatives was by the Cities. The Cities don't issue conditional use permits they may issue written authorizations, but they do not permit those kinds of facilities. In the legislation the facility in Lincoln County was given a two-year window, so the operator of that facility could continue to clean up the waste tire pile. Mr. Sandoval stated there is a good management system in Idaho, with the exception being in southwestern Idaho, where the critical problem exists. This legislation, with amendments, is a good fix on a short-term and long-term solution for waste tire management.

    Senator Ingram asked about the cycle, the money trail of consumers. Mr. Sandoval stated when consumers buy tires from a dealer, the dealer tags on $2.00 per tire disposal fee, the dealer pays this fee to a hauler (to a storage site, cement kiln, an out of state processor, retreader). When the hauler takes the tire to an end use, the responsibility is with a hauler/processor to make sure the tire moves from a storage site to whatever the end use of the tire. The cost of moving the tire from the retailer to the end use comes from the $2.00 fee. In a storage site, if that operator of facility exceeds the limit of waste, the County can act on the cash bonding requirement, to make sure there are adequate funds. The hauler/processor that goes out of business, or takes the money and leaves a million tires sitting, with the financials assurance provisions in this proposed amendment, the bonding will provide adequate funds for the clean up so the costs aren't passed on to the community. In amending this it permits those storage sites to establish a cash bond of $2.50 to protect the city and the county in the event that the storage facility goes out of operation.

    Senator Brandt asked if it was up to the tire dealer to dispose of the tire. Mr. Sandoval stated this was correct.

    Senator Bailey asked if this bill will restrict the amount of tires that a dairyman can put on his manure pile? The Agriculture exemption of waste tire, in the legislation it reads . . . the total number of waste tires shall not exceed fifteen hundred, if in violation it is $500 per tire. Mr. Sandoval stated this was correct. He stated the importance of the language "knowingly."

    Senator Brandt asked about the individual with twenty tires stacked beside his shop, is he going to be fined. Mr. Sandoval stated no, they are concerned with those piles of fifteen hundred tires or more.

    Ingram asked what assurance there is that the tire will end up at its final end use location. Mr. Sandoval stated that the goal in amending the Idaho Waste Tire law was to look at the disposal sites and what ultimately happens to that waster tire, storage sites and providing enough flexibility to local jurisdiction, and site these facilities and manage them, and close the loop on haulers/processors, having the opportunity to enforce and to ensure that waste tires go from a retail operator to a designated end use.

    Senator Compton asked if Counties can charge their own fee. Mr. Sandoval stated this is a local option that they can exercise on their own. He mentioned that waste tires (chipped, shredded) are a good source, supply, as cover material than other costly alternatives.

    Senator Bailey asked about the exception of the waste tire storage site in the magic valley (page 2 of amendment, line 13 financial assurance, (i) line 31), what makes them special? Mr. Sandoval stated this makes the facility in Lincoln County special, by allowing them two years to attempt to clear two million waste tires. Senator Stennett updated the Committee on the status of this facility. He stated the intent will keep the previous owner active in clearing the pile, if the owner is forced to come up with the $2.50 bond, he will walk out.

    Senator Sweet questioned whether the legislation was good public policy. He stated that it would be better public policy to start everyone off in 2005, and not let this magic valley exemption be the only one for 2005. Mr. Sandoval stated the amendment of the Idaho Waste Tire Law provides flexibility and accountability of local government to mange storage sites and the disposal of waste tires. This takes the State out of the way, and allows for local government to manage these and to come up with a long-term solution. Senator Stennett stated the exemption is for this storage site only.

    Senator Sweet asked how many other storage sites are in the state? Mr. Sandoval stated to his knowledge there is only one storage site.

    Senator Kennedy stated that in keeping in mind the definition of a waste tire storage site, how many non permitted waste tire storage sites are in Idaho? Mr. Sandoval stated he was aware of one in Tuttle, and reported on the use of those tires.

    Senator Darrington voiced his concern for the Agriculture community with a dairy limit of fifteen hundred tires. He stated that $500 is a steep penalty for a silage pit. He remarked on Idaho Code 6503 old code, and new code 6504 on landfill. He asked if the landfills are going to have to comply with a different regulation under the new section? He also stated concern about the language regarding the scientific test. Mr. Sandoval stated the importance of the word "knowingly" in the fifteen hundred tire limit. He stated that landfills are covered under federal regulations and those conditions still apply. DEQ tried to provide more discretion to those that manage landfills in Idaho to look at ways of using waste tires in daily operations. And try to reduce the ways the department needs to have to approve new technologies to demonstrate that waste tire products have a more efficient use.

    Senator Darrington asked if everything that is in 6503, in 2a, 2b, 3a and 3b, are now covered by Rule? Mr. Sandoval stated he is talking about the 65% reduction of whole tires, and by including this in Statute, it avoids going to the rule making, it still provides enough flexibility to the operators of landfills to manage them. Senator Darrington states he likes the rule making process better than putting it in Statute because then it lets the legislature have the last say. Once its put in Statute it isn't changed very easy or very fast. It is very specific in this Statute, and someone is going to have to apply some scientific test to this because this is not a guideline. It is very specific within the Code and he objects to that. Mr. Sandoval stated that by inserting this into code, it tells how to effectively manage and get the reduction at the local level.

    Senator Stennett made the comment that most tires in the silage pits will be half tires.

    Senator Kennedy asked why about section 6503 . . . "would be subject to a civil penalty of not more than $500 per violation," what is the discretion in that? Mr. Sandoval stated the discretion is for a case by case basis. DEQ has tried to make enough grey areas to allow for flexibility and for DEQ to take those individual situations into account as they come up. Senator Kennedy followed up by asking what the difference is in the section 6502, other than the change to the magic valley exemption? The reference to a conditional use permit (cup), the language change is throughout, talking about permit or other written authorizations by city or county government. This is the major change to section 6502.

    Senator Sweet asked about page one, line 30 "existing waste tire storage site" and what it covers. Mr. Sandoval read the definition and stated it's about an existing facility that is storing tires prior to recycling, reusing or final disposal by July 1, 2003. Senator Sweet states this language is broad "any property" is vague. Mr. Sandoval replied the subject is any storage site that is permitted by a county or city jurisdiction to operate a waste tire storage site. This language refers to a very specific property and a very specific operation.

    Maggie Mahoney, Idaho Association of Counties, was given the floor to testify on H 198. In regards to definition 13, "store" or "storage" there is a two hundred tire requirement. So that individual who has 50 or 100 tires is not a concern.

    Senator Sweet asked if any farmer with 200 tires or more would then be a waste tire disposal site? Ms. Mahoney stated that there is a separate exemption for farmers and agricultural use (page 2, line 45).

    Testimony Maggie Mahoney, IAC, supports H 198. She stated that the legislation has gone through a very thorough negotiation process. IAC believes all concerns were addressed by those impacted by the legislation. The ability to landfill is of specific importance to counties. Currently they are not land filling. The financial bonding assurance is also very important to the counties, to prevent future problems.

    Senator Bunderson closed the discussion with comments that the legislation is not any easy fix.

    MOTION A motion was made by Senator Darrington and seconded by Senator Compton that H 198 be sent to the Senate with a do pass recommendation. Senators Brandt, Compton, Darrington, Ingram, Stegner, Burkett and Kennedy voted aye. Senators Sweet and Bailey voted nay. The motion carried by a voice vote. Senator Stennett will sponsor the bill. Senator Bunderson will cosponsor the bill.
    ADJOURNED Chairman Brandt adjourned the meeting at 10:00 a.m.




    DATE: March 28, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Bailey, Stegner, Sweet, Burkett
    MEMBERS ABSENT/

    EXCUSED:

    Senators Ingram and Kennedy
    GUESTS: Jeff Crumrine, Idaho Association of Community Rehabilitation Programs; Randy May, Idaho Department of Health & Welfare (IDHW); Ken Korczyk, IACRP/Tesh Inc.; Gary & Susan McMullen; Kathleen Allyn, IDHW; Riley Cutler, Idaho Department of Health & Welfare; Scott Kido, Idaho State Dental Association; M.C. Niland, WITCO; Jerry Davis, Idaho State Dental Association; Lee Finn, Idaho Women's Network; Sue Reents, IPCA; Joyce McRoberts, IDHW; Dan Goodwin; Steve Westerberg, IPA; Bev Balt, IDHW; Karen Gustafson, Administrative Rules; Dwight Whittaker, Development Work Shop Inc.
    CONVENED: Chairman Brandt convened the meeting at 8:40 a.m.
    MINUTES: The motion was made to by Senator Darrington and seconded by Senator Compton to approve the minutes of March 19th and 20th as written. The motion carried by a voice vote.
    Briefing on Idaho Association of Community Rehabilitation Programs Jeff Crumrine, is the Executive Director of Magic Valley Rehabilitation Services (MVRS) as well as a representative of the Idaho Association of Community Rehabilitation Programs. Mr. Crumrine was given the floor to present his testimony regarding the funding of the rehabilitation programs in the Magic Valley area. He stated he previously testified before the committee to ask the members to support the restoration of a portion of the Idaho Department of Health & Welfare (IDHW) FY03 hold back of general funds for sheltered workshop programs. He IDHW response to the Governor's 3.5% hold back of general funds was a 27.5% hold back ($753,000) of general funds or 18.4% of the total FY03 appropriation for sheltered workshop services. Mr. Crumrine stated it is his understanding that the Committee has voted to send a letter to the Joint Finance-Appropriations Committee (JFAC) not supporting legislative intent to restore a portion of the hold back as part of the FY04 base. He stated that for 30 years the legislature, by its actions, has consistently said that people who are developmentally disabled and mentally ill should have an opportunity to work and to be contributing members of society. Because of that continued commitment, Idaho's nonprofit rehabilitation providers have requested your support for inclusion of legislative intent in the Department's FY04 appropriation. The intent would restore a portion of the reduction for FY03 and put $443,400 of the $753,000 general fund reduction back into the FY04 base. Even with the requested restoration, the FY04 appropriation would be a 11.32% general fund reduction ($309,600) and an overall reduction of 7.57% from the original FY03 appropriation. He stated he had committee members express concerns that restoration of the $443,400 in general funds would result in the loss of more than $1,000,000 in Medicaid funds. His understanding of the $443,400 and other general funds included in the intent being proposed by Representative Gagner is that the funds are coming from general fund savings identified by a House Medicaid Task Force. He stated it is confusing to him how general funds that have been saved would result in Medicaid funds being lost. If general funds are saved, not spent, then Medicaid funds should also be saved, not spent. Unless the IDHW has used the general fund savings to match other Medicaid expenditures, the general funds should be available and the Medicaid funds should be neither expended nor lost. This is the exact explanation he received from Representative Gagner. Mr. Crumrine stated if it is the position of the Committee and the Legislature that the IDHW should not be given direction through legislative intent, programs that literally have assisted thousands of severely disabled persons to work and to learn the skills to be employed in the community will cease to exist. He voiced his hope that the Committee would agree that it the best interest of people of Idaho for the Legislature to give IDHW direction through legislative intent. He also hoped the Committee would reconsider its previous decision not to support legislative intent that would restore $443,400 of the general funds reduced through FY03 hold back. A copy of Mr. Crumrine's testimony is on file in the Health & Welfare Committee secretary's office.

    Discussion between Committee members and Mr. Crumrine included:

    Is the funding for the programs done only through federal & state money, or are there any provisions for family members to assist in paying for the services? Mr. Crumrine stated the average age of those in the program is 40 years old, so maybe one-third have living parents. He also stated the source of revenues: of the million-dollar operation, 70% are fees for services provided by IDHW, Division of Vocational Rehabilitation, 25% is industrial division activity; and four out of the remaining 5% are miscellaneous fundraising funds.

    Senator Darrington asked about the private funding contributions, haven't they been declining? Mr. Crumrine stated that probably as a percent of the daily operating budget they have, but not as a dollar amount. Because the programs have expanded to provide the developmental services that are Medicaid funded. He stated that revenue of $225,000 out of one million dollars comes from industrial. Fundraising has grown a little, but so has the number of nonprofit organizations in the community.

    Senator Compton asked about the three recommendations: zero funding, 27.5% hold back, or a figure in between the two. He asked if Mr. Crumrine's programs were funded 100% through the General fund with no money from Medicaid. Mr. Crumrine stated that in the total amount of funds originally appropriated for FY03 $4, 088,300 appropriations, of that amount $1, 353,000 was a social service block grant (federal funds), so roughly 30% federal funds. Senator Compton asked why he needs the money so individuals can go back to work? Mr. Crumrine stated he had to lay off staff because he doesn't have the staff to supervise the number of people in the work programs.

    Senator Compton asked if there was a prejudicial attitude with IDHW that might be discriminated against. Mr. Crumrine stated the history of recommendations of zero funds by IDHW over the last 30 years. He stated that IDHW believes other programs are more important than his.

    Senator Sweet asked about the 135 individuals out of 477 that are eligible for other programs. Mr. Crumrine stated it is not a matter of who qualifies for the other programs, its people that want to work, they choose to participate.

    Continued discussion between Committee members and Mr. Crumrine included:

    -The other programs available for the individuals besides his program;

    -Is there a point when clients are kicked loose of the program;

    -The business partners in the community and their use of the program;

    -If the state spends $3 on Mr. Crumrine's program, does it receive $10 effectiveness just like Medicaid does.

    The Floor was turned over to Randy May, IDHW, for questions. The Committee discussed:

    -The shift of Medicaid dollars and the potential loss of one million dollars in matching funds;

    -Why this program was cut 27.5%;

    -Where is the supposed $923,000 savings;

    -If there was more money would IDHW fund $443,000 for this group;

    -Is IDHW saying when it looks at all things, this program is getting $4 million and that because it is not Medicaid money its not shared money, its more subject to being cut because of the mathematics that if we cut the Medicaid program, we lose additional federal dollars, and the priority by IDHW of the return for the money invested?

    Discussion relating to Medicaid dental coverage for adults Chairman Brandt expressed his apology to those who wished to testify on Adult dental. He moved the Committee into discussion on the Adult dental issue and where the Committee wants to go with the 2004 budget. He stated the Committee came to a decision in regards to the 2003 budget, and some members believed that budget would continue on into 2004. However, some members wanted to go into what could be some possibilities for 2004. Chairman Brandt asked if Senator Stegner wanted to hear from any specific individual.

    Senator Stegner asked for a brief description of the handout and what is suggested by the handout. A copy is on file in the Health & Welfare Committee secretary's office.

    Senator Stegner thought the Committee was not happy with no adult dental program. The function of the Committee is to make a recommendation. He hoped for if not a dollar statement, a policy statement, to come out of the Committee about what it feels the direction of the state should be. This is his objective and hopes that at some point it would dovetail with the IDHW.

    Randy May, Idaho Department of Health & Welfare (IDHW) was given the Floor to present the information covered on the handout. The first slide stated with a $180,000 shift of General Fund from children's orthodontics to adult services the Medicaid Adult Dental would continue emergency services to all adults, and will provide basic preventive and restorative services to "high risk" adults. On the second slide an additional $750,000 in the General Fund for fiscal year 2004 would be needed in addition to the $180,000 shift from ortho to adult services would continue emergency services, and provide limited preventive and restorative services to all Medicaid adult clients. He reported that when the Rules were rejected this session, the intent of last year dies with it on June 30; when this occurs, the full dental program will reappear with no funds to cover it. IDHW needs something. IDHW has intent to promulgate a temporary rule in January of the next session, to what the dental benefit will be described in that rule.

    Discussion between Committee members included:

    -Those individuals defined as high-risk adults and the ability to treat those individuals;

    -Would a high-risk patient receive a root-canal under slide one provisions;

    -Will the shift in funding from children's orthodontics eliminate any orthodontics for children in Idaho;

    -Is anything cosmetic allowed in this orthodontics program;

    -In regards to the well-known denture case, the services would only be available under the enhancement (slide two);

    -The additional $750,000 be coupled with federal matching funds of three times this amount, but this still included the $180,000 shift, it does not restore that amount;

    -Because of budget restraints isn't it pointless to consider the $750,000; recommendation of the Dental program co-pay plan for fiscal year 2004;

    -the good attempt by IDHW to find middle ground to provide some preventive dental care;

    -Those individuals who are just out of the qualifying range yet are still underprivileged.

    Testimony Dr. Scott Kido, member of the State Dental Association, is supportive of the Enhancement (slide two).
    ADJOURNMENT Chairman Brandt adjourned the meeting at 9:50 a.m.




    DATE: Tuesday. April 1, 2003
    TIME: 8:00 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Bailey, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:

    Senator Sweet was absent and excused. Senator Burkett was absent and excused, and Acting Senator Barbara Roberts (appointed on March 31, 2003) was present on his behalf.
    Chairman Brandt opened the meeting at 8:13 a.m.
    A motion was made by Senator Stegner that the Senate Health and Welfare Committee move into an Executive Session, according to Section 67-2345(d), Idaho Code. Motion was seconded by Senator Ingram. A roll call vote was requested to move into an Executive Session.

    Senator Ingram voted Yes Senator Stegner voted Yes.
    Senator Darrington voted Yes Senator Compton voted Yes.

    Senator Brandt voted Yes

    Senator Kennedy voted Yes

    Senator Bailey voted Yes

    Senator Sweet and Senator Burkett were absent and excused.

    The beforehand motion was carried by a voice vote.

    ADJOURNMENT No other business was conducted, the meeting adjourned at 8:53 a.m.




    DATE: Wednesday, April 2, 2003
    TIME: 8:00 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Senators Darrington, Ingram, Stegner, Bailey, Burkett, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:

    Senator Compton and Senator Sweet
    GUESTS: Representative Mike Mitchell, and see the attached sigh-in sheet
    MINUTES: A motion was made by Senator Bailey that the committee's minutes for Monday, March 17, 2003, be approved. Motion was seconded by Senator Ingram, and motion was carried by a voice vote.

    A motion was made by Senator Kennedy that the Committee's minutes of Friday, March 21, 2003, be approved. Motion was seconded by Senator Bailey, and motion was carried by a voice vote.

    HCR 29 HCR29, relating to findings of the Legislature and encouraging the Idaho Council on Developmental Disabilities, in collaboration with the Department of Health and Welfare and other stakeholders, in convening a task force to develop a waiver for a self-directed service delivery system for Idahoans with developmental disabilities, was presented by Marilyn Sword, executive director of the Idaho Council on Developmental Disabilities.

    This resolution encourages the Council on Developmental Disabilities to convene a task force to develop a Medicaid model waiver that would permit up to 200 adults with developmental disabilities to choose a different way of receiving services. The services would be based on need as determined by a consumer-centered plan and would cost no more, on average, than the present costs for these 200 people. Implementation of this model will require the Department of Health and Welfare to submit a waiver application to the federal Centers on Medicaid and Medicare. Individuals currently receiving services as well as any individuals determined eligible would be offered the option of receiving services and supports under this waiver.

    This waiver will be developed by a group of individuals convened by the Council on Developmental Disabilities. The meeting and technical assistance costs to support this group will be paid by the Council with allocated federal funds. There will be no fiscal impact to the state General Fund in FY2004.

    MOTION A motion was made by Senator Ingram that HCR29 be sent to the Floor with a Do Pass recommendation. Motion was seconded by Senator Bailey, and motion was carried by a voice vote. Senator Bailey will sponsor HCR29.
    HEALTH AND WELFARE Chairman Brandt explained Title X of the JFAC legislative intent would be discussed on Tuesday, April 8, 2003. Today, the committee will review the Department of Health and Welfare budget summary, per the Governor's adjusted recommendation for FY2004. The Department supports the Governor's budget plan.

    The Department of Health and Welfare Deputy Director Gary Broker presented a chart outlining the Department's budget perspective for year 2004 total request of $1.3 billion. Caseloads are currently operating with an 8 percent to 10 percent increase. This budget is based on little or no caseload growth.

    He distributed a two-page budget outline and explained "maintenance of effort" levels. One decision unit, foster care, has a 4 percent rate increase. He provided a line-by-line review of the budget summary. (Attachment #1)

    Mr. Broker explained the JFAC (Joint Finance-Appropriations Committee) passed two supplement bills for the Department. Those two supplemental bills totaled $6.4 million.

    Other items discussed included: very little flexibility in federal programs; electronic systems, reduction in full-time positions, replacement of capital outlay items, personnel costs and medical insurance increases; adult dental preventive services, need for sheltered workshops, the germane committee responsibilities and directions, placing caps on services, and reimbursement rates.

    ADJOURNMENT Due to business to be conducted on the Senate Floor, the committee adjourned at 9:02 a.m.




    DATE: Thursday, April 3, 2003
    TIME: 8:00 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, Kennedy
    MEMBERS ABSENT/

    EXCUSED:



    None
    GUESTS: See the attached sign-in sheet
    MINUTES: A motion was made by Senator Darrington, that the minutes of Tuesday, April 1, 2003, which was the morning the committee held an executive session, is an absolute accurate reflection of the proceedings of that morning, be approved as written. Motion was seconded by Senator Compton, and motion was carried by a voice vote.
    A motion was made by Senator Bailey to approve the committee's minutes of Monday, March 24, 2003, as written. Motion was seconded by Senator Ingram, and motion was carried by a voice vote.
    A motion was made by Senator Sweet to approve the committee's minutes for Friday, March 14, 2003; Thursday, March 27, 2003; and Friday, March 28, 2003, as written. Motion was seconded by Senator Kennedy, and motion was carried by a voice vote.
    HEALTH AND WELFARE Chairman Brandt explained the meeting today is a continuation of the discussion of the Department of Health and Welfare FY2004 appropriations. The committee will not discuss intent language today, but will review the Governor's suggested appropriations, and will concentrate mainly on what dollar number this committee want to suggest to JFAC (Joint Finance-Appropriations Committee) for the total appropriations to the Department of Health and Welfare for FY2004.

    The Governor suggested appropriations of $378,195,600 million. We have a program maintenance appropriation of $376,051,400 million, or we have the JFAC recommendations of $370,693,500 million.

    A review and outline of how JFAC determines motions and intent language was held.

    Senator Stegner recommended the committee send a letter to the co-chairs of JFAC asking them to take into consideration, and hopefully respect, the wishes of the germane committee. The germane committee cannot write intent language, all the germane committee can do is to make recommendations to JFAC. The official process for each member would be their individual vote on the Floor.

    Senator Kennedy agreed with Senator Stegner's suggestion. He explained, Health and Welfare will review the appropriations' bills and do whatever the JFAC intent language says to do. The germane committee needs to convince JFAC. He recommended the committee request a brief hearing with JFAC, and try to convince them to change the intent language.

    Senator Burkett discussed other avenues that can be taken this year, i.e., pass legislation, pass resolutions, we can write a letter to JFAC and try to convince them what to do, and once the bill comes out on the Floor we can amend the bill, we can have a committee amendment prepared to take out some intent language on the Floor. The question is, if the committee is prepared to take other avenues this year.

    Senator Darrington explained that in all the years he has been a legislator, an appropriation bill has never been amended on the Floor. He has never liked very much intent language, but he is reconsidering the sheltered workshops appropriations, and he supports adult dental preventative care, too. The cuts to the sheltered workshops impacts lives of those most needy.

    Senator Stegner understands the committee is going to address workshops, possible case management, and adult dental, soon. And Title X will be addressed early next week; therefore, our purpose today is to try to think in terms of the total base number, with additions to follow.

    Senator Stegner reported we have the March 20, 2003, FY2004 budget that shows an FY2004 Program Maintenance of General Funds of $376,051,400 million, that varies from the Governor's appropriations in only a couple of areas. One, Inflationary Adjustment is slightly less; two, the Replacement Items were removed, and three, the Non Standard Adjustments are reduced. That makes up the total difference of nearly $2 million.

    Senator Stegner stated he planned to make a motion that the committee recommends the FY2004 Program Maintenance of $376,051,400, with additional enhancements that may be considered by the committee.

    MOTION A motion was made by Senator Stegner that this committee recommends by letter to JFAC, to appropriate General Funds for FY2004 appropriations of $376,051,400 million to the Department of Health and Welfare. Motion was seconded by Senator Bailey.

    DISCUSSION:

    During this budget review, Department of Health and Welfare Deputy Director Joyce McRoberts reminded the germane committee that the Department does support the Governor's recommendations.

    The committee will also inform JFAC, in the letter, that the committee does support Section 3 of the legislative intent, and consider this section a very good management tool for the Department of Health and Welfare.

    Senator Ingram recommended the funding for sheltered workshops, adult dental, and Title X planned parenthood be reinstated in the budget.

    Chairman Brandt explained that if the sheltered workshops and adult dental are to be reinstated, those functions are not included in the $376,051,400 million budget. If the committee decides to do that, they will need to suggest to JFAC that the JFAC appropriate additional funds to increase the $376,051,400 million to the Department to take care of those issues. The JFAC should not expect the Department of Health and Welfare to pull those additional funding from internal programs.

    A lengthy discussion was held about several items such as, unfunded vacant full-time positions and the need to have some vacant positions to fully operate a large agency; salary savings; asking additional funding from JFAC for sheltered workshops and additional resources of funding for workshops, possible additional income from an increase in the sales tax.

    Senator Sweet stated he is hopeful the economy will improve, but he is concerned the federal level will be tightened, and we cannot depend on federal funds to solve state problems. He does not believe in FY2004 we will have the projected additional revenues needed. He does not believe we should judge programs by matching federal funds, and if he could, he would shift funds to the sheltered workshops. He believes the sheltered workshops were given a larger budget cut than was their fair share.

    Senator Bailey called for the question.

    Chairman Brandt explained this is an informal vote in regards to where we are going, and explained this is a vote supporting the motion for the $376,051,400 appropriations.

    The motion was carried by a voice vote. Senator Sweet voted No. Senator Ingram voted No.

    ADJOURNMENT The meeting adjourned at 8:55 a.m.




    DATE: Friday, April 4, 2003
    TIME: 8:00 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:



    None
    GUESTS: See the attached sigh-in sheets
    MINUTES: A motion was made by Senator Kennedy to approve the committee's minutes for Tuesday, March 25, 2003, as written. Motion was seconded by Senator Bailey, and motion was carried by a voice vote.
    AGENDA: Chairman Brandt explained the two issues before the committee for today are the adult dental services and the sheltered workshops.
    SHELTERED WORKSHOPS The Department of Health and Welfare, Division of Family and Community Services (FACS) Administrator Kenneth Deibert, explained the Department's position related to sheltered workshops, and the budget reduction plans that were implemented this past year as part of the Governor's 3.5 percent holdbacks.

    He explained he previously provided testimony about the prioritization decision-making processes used by FACS in determining reductions in programs. [February 21, 2003]

    He reported, we wanted to avoid reductions in programs that the Department has statutory responsibility to provide. We focused reductions in staffing and services to areas where impact on community, staff, and client safety would be avoided.

    The FACS reduction plan took into careful consideration the need to achieve required levels for general fund maintenance of effort for mental health, substance abuse, and infant and toddler programs, to avoid reductions in federal dollars. We are seriously close in all of these programs to having state general funding levels that are below the target maintenance of effort levels required by the federal government, for continuation of funding through Block Grant appropriations. Depending upon the program, our match rate ranges from a high of 80 percent to a low of 50 percent. Most of the remaining state general funds appropriated to FACS are heavily leveraged against federal dollars.

    The hold back strategy, as it relates to the reductions in sheltered workshops funding, meets the priorities that were established in the budgeting process. The Department fully recognizes the reductions the workshops are being asked to make have impacted the consumers they serve, and have reduced the funds that are available for them to conduct their business operations. But looking at the overall perspective of the impact, and of the alternatives that we faced when developing our plan, there were no-good options, only options that provided varying degrees of disadvantage.

    Mr. Deibert discussed the proposal of diverting $443,400 from the Division of Medicaid budget to the FACS budget to fund sheltered workshops. He outlined the process he would use for determining those funds. If he could do as he wanted with those monies ($443,400), he would find ways to leverage those dollars to maximize the overall impact on the service delivery system for social and behavioral services.

    If the $443,400 is returned solely to the workshop program, it will not generate any additional federal match funds that could be used to provide services to the citizens of Idaho. It would benefit only those clients, who receive vocational services through the sheltered workshop program, and the community supported employment.

    Last week, the Department received notification from the federal government about our allotment for the substance abuse block grant. We anticipated we would receive between $200,000 to $300,000 in additional federal monies, but the notification indicated we would receive $30,000 in additional federal funding for substance abuse services. In that program, we have a 9 percent increase in the rate of utilization. Substance abuse is one of the most significant and perplexing problems we face in Idaho.

    He emphasized the Department looked at the overall perspective for services we provide, or asked to provide by constituents. We have greater priorities, at this time, for our social and behavioral services. We have greater opportunities to maximize the availability of funding by a different utilization of savings that have been identified through the Medicaid Program for the $443,000, and requested the committee members to look at the overall perspective of the service delivery system, and the needs that we have in social behavioral services.

    He explained these are challenging times for everyone, but funding the sheltered workshops with Medicaid savings is going in the wrong direction.

    Jeff Crumrine, executive director of the Magic Valley Rehabilitation Services in Twin Falls, testified in support of restoring the $443,400 to the sheltered workshops. He presented an analysis about funding sources of operating revenue for the Idaho Association of Community Rehabilitation Programs for FY2003, that being:

    1. Total projected operating budgets - $22,490,851.
    2. Projected revenues from provision of Health and Welfare vocational services (work services and community supported employment) - $3,114,450.
    3. Projected revenues from provision of Idaho Division of Vocational Rehabilitation Services (fees for various vocational services) - $997,488.
    4. Projected revenues from provision of Health and Welfare Medicaid Services (not vocational services) - $6,872,248.
    5. Projected revenues from industrial activities, fund raising and other sources (no fees for vocational services) - $11,506, 665.


    He reported, "for every $2.60 made available by the state of Idaho as Health and Welfare and Idaho Division of Vocational Rehabilitation fees for vocational services, the eleven organizations that are members of the Idaho Association of Community Rehabilitation Programs generate $7.40."

    M.C. Niland, president of the Western Idaho Training Company in Caldwell and a representative for the Workshop Association, testified in support of restoring $443,400 to the shelter workshop program. She emphasized the effects upon those individuals served by the sheltered workshops. Changes in an individual's work program or living standards can evoke a strong mental or emotional response, or even a violent response, from those affected individuals. She requested the committee seek the necessary $443,400 funding for sheltered workshops.

    The committee held a lengthy and detailed discussion related to the matter at hand, diverting $443,400 from the Department of Health and Welfare's Division of Medicaid, and restoring the $443,400 to the Department's Division of Family and Community Services for sheltered workshop services.
    MOTION Senator Compton explained the sheltered workshop program is a very important program and he supports it throughly, but realizing the impact on other funds, at this time, to reinstate the $443,400 without additional appropriations to the Department of Health and Welfare would be very difficult. If we have the wisdom to appropriate additional money, then the sheltered workshops should be one of the first priorities added to the list.

    A motion was made by Senator Compton to ask in the committee's letter to the Joint Finance-Appropriations Committee (JFAC) to fund an additional $443,400 to the Department of Health and Welfare appropriations, and direct the transfer of these additional funds to the sheltered workshop program.

    Motion was seconded by Senator Ingram.

    DISCUSSION:

    1. Original intent language showed a Medicaid savings of $923,700 from which JFAC was going to state that $443,400 of the savings would be diverted to the sheltered workshop program. That cannot possibly happen as the state would lose $1.3 million in matching dollars, then we would not have the $923,700 in Medicaid savings.
    2. Ensure JFAC understands the germane committee is asking for an additional funding of $443,400 for the sheltered workshop program, not diverting the funds from Medicaid.
    3. The additional funds would be state general revenues of $443,400 and will have noting to do with the Medicaid funds.
    4. Frustration of the Department of Health and Welfare and providers, and lack of funds for needy programs.
    5. The Department of Health and Welfare should have presented a priority list to the committee, at the beginning of the session, and explained why and how the Department use to determined program cuts. The committee should have been fully informed about the options the Department used to cut programs, and those they did not choose to cut.
    6. If no additional funds become available, revisit the workshop program issue.
    7. Prioritization of programs.


    Senator Bailey called for the question.

    The beforehand motion was carried by a voice vote of 5 Ayes and 2 Nays.

    Senator Stegner voted No. Senator Brandt voted No.

    ADJOURNED Due to business being conducted on the Senate Floor, the adult dental discussion will be rescheduled for Monday, April 7, at 8:00 a.m. The meeting adjourned at 9:07 a.m.




    DATE: Monday, April 7, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:



    Senator Burkett
    GUESTS: See the attached sign-in sheets
    Chairman Brandt opened the meeting, and explained today the committee would discuss the Adult Dental Program.
    ADULT DENTAL Karren McWilliams, from the Idaho Community Action Network (ICAN), testified in support of restoring the Medicaid Adult Dental Program. She stated there are many elder people depending on dental services for their health, and health can be damaged when you do not have teeth to chew your food properly.

    Emile Jones, form ICAN, testified in support of restoring the Medicaid Adult Dental Program. She explained she is a disabled person who is in need of obtaining dentures, hoping it will improve her health. Adult dental services is needed, especially for seniors and people with disabilities.

    J. L. Byington, from ICAN, testified in support of restoring the Medicaid Adult Dental Program. She reported she has a disabled daughter and lack of dental care is causing her health problems. There are other adults who need this program, such as the disabled and the aged. The adult dental services are very much needed.

    Senator Stegner explained the committee has been discussing this topic for a number of weeks, dealing with it first in rule. Because of the legislative intent language from JFAC (Joint Finance-Appropriations Committee) intent language from a year ago.

    The committee has discussed a modified program, not a reinstatement of the program, but are asking JFAC for $750,000 in new money. This is not intended as a shift of funds, but additional funds.

    MOTION A motion was made by Senator Stegner that this germane committee includes in its letter to JFAC a recommendation that we have reviewed this issue at length, and we encourage them to fund in new appropriations $750,000 for a basic adult dental plan outlined by Department of Health and Welfare in its handout, and to include a copy of the handout with the JFAC letter. (Attachment #1)

    Motion was seconded by Senator Ingram.

    DISCUSSION:

    Senator Kennedy discussed the handout titled Medicaid Dental Consultants Recommendations for a Revised Adult Dental Care Program, dated March 2003, and asked if this the plan we will be voting for in the motion made by Senator Stegner. The answer was "yes."

    The Division of Medicaid Interim Administrator Randy May explained that this Plan would provide specific limitation and exclusions of services. On Page 2, of the Plan, is a listing of services offered to adults.

    Senator Stegner explained to the people in the audience this germane committee does not make appropriations, we make recommendations to JFAC that we consider adult dental services to be a priority item, and should be included in the current appropriation bills.

    Senator Brandt asked, "where do we prioritize this - over or under the Sheltered workshops?"

    A general discussion was held about prioritization of funding requests to JFAC; the funds requested in additional revenues, and the requested $600,000 in funds to be shifted from the Medicaid children's orthodontics program.

    A call was made for a vote on the beforehand motion. The motion was carried by a voice vote.

    MOTION A motion was made by Senator Kennedy that in the letter to be sent to JFAC that this germane committee sets the priority of adult dental ahead of the sheltered workshop program. Motion was seconded by Senator Ingram.

    DISCUSSION:

    Senator Stegner supports prioritizing the adult dental program, and encourage JFAC to consider our request.

    Senator Compton listed subjects the committee has discussed:

    1. We have been somewhat critical about micro managing the Department of Health and Welfare.


    2. The Department will make good decisions on the Medicaid funds available to them, and how to maximize those monies.


    3. The Department understands the direction and the will of the Senate Health and Welfare Committee; therefore, a motion to prioritize is not necessary.


    Senator Kennedy believes it is highly appropriate that the germane committee makes its recommendation to JFAC, which of these two programs we feel should be funded first.

    Senator Brandt called for a vote on the motion to prioritize adult dental ahead of the sheltered workshops. The motion was carried by a voice vote.

    Senator Darrington voted No. Senator Compton voted No.

    ADJOURNMENT The meeting adjourned at 8:25 a.m.




    DATE: Tuesday, April 8, 2003
    TIME: 8:00 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Senators Darrington, Ingram, Sweet, Bailey, Burkett, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:



    Senator Stegner and Senator Compton
    MINUTES: A motion was made by Senator Kennedy to approve the committee's minutes for Wednesday, April 2, 2003, as written. Motion was seconded by Senator Sweet, and motion was carried by a voice vote.
    GUESTS: Representative Bill Sali, and see the attached sign-in sheets
    Chairman Brandt opened the meeting and explained we are meeting in regards to Title X funds, relating to Planned Parenthood of Idaho. He must limit the time for testimonies; therefore, he will allow two people (one pro and one con) each five (5) minutes. Otherwise, testimonies' both pro and con will be limited to three (3) minutes each.
    TITLE X FUNDS AND PLANNED PARENTHOOD OF IDAHO: Representative Sali explained the legislative intent language to retain all Title X (Title 10) funding for the state's seven (7) public health districts. He had asked the Department of Health and Welfare, "what the ramifications would be if the Title X monies, currently being used for Planned Parenthood, were eliminated." He also asked for a list of services provided by Planned Parenthood of Idaho (PPI) and the Central District Health Department.

    The Department reported that under current contracts, both Planned Parenthood of Idaho and the Central District Health Department provide the same services. The Department's response, to the question about the ramifications if the current contract funds were transferred from Planned Parenthood of Idaho to the Central District Health, "could District Health serve the Planned Parenthood clients?" The answer is yes.

    Bureau of Clinical and Preventive Services Bureau Chief Russell Duke, from the Department of Health and Welfare, reported the following information to Representative Sali.

    Both agencies provide comparable services that are consistent with the Title X requirements for federal funding. Both agencies are funded to provide access to complete medical examinations and contraceptive supplies, and priority is given to low income, uninsured women.

    The federal Title X program guidelines are comprehensive and stipulate the methods for project planning, evaluation, financial management, personnel, training of staff, reporting requirements, review of educational materials, and community participation. Required services include the following: patient education, counseling, informed consent, personal and family medical and social history, comprehensive physical examination and clinical procedures as indicated, laboratory testing, and follow-up and referrals.

    The program guideline for Project Grants for Family Planning Services provides definitions, and a complete list of all the required services.

    Question: If funds were transferred from Planned Parenthood to Central District Health Department, would the Health Department have the capability of serving the Planned Parenthood clients?

    Mr. Duke reported he talked with Central District Health Director Kathy Holley, and with the fund transfer they would have the ability to serve the Planned Parenthood of Idaho clients.

    Representative Sali explained that each District Health Department receives Title X funds. Idaho has legislation restricting abortions; he emphasized that Planned Parenthood of Idaho clearly has the right to operate, but with private funds. He believes it is inappropriate for the State to be involved in a contract with such a highly controversial issue. Idaho Chooses Life Alliance is a private corporation, Right to Life of Idaho is also a private corporation, and both are on the opposite side of Planned Parenthood.

    In an area that involves this much contention is it proper for the state of Idaho to be involved that closely with a private corporation? Just as Right to Life Idaho and Idaho Chooses Life raise all of its private funding, for all its activities; therefore, it is appropriate for Planned Parenthood to do the same. With budget cuts to the District Health Departments, returning this funding to them would help offset those budget cuts. Representative Sali stated he opposes any state funding for a private organization, such as Planned Parenthood, with Title X funds.

    The committee members asked many questions pertaining to Title X funds, and Planned Parenthood of Idaho. Some areas discussed, but not limited to, are as follows:

    1. The parental consent legislation. Does Planned Parenthood actually suggests they should have the right to be involved with decisions made by a teenage girl, even ahead of the rights of the girl's parents?
    2. Legislation and lobbying efforts of Planned Parenthood of Idaho.
    3. State funds and private money supporting Planned Parenthood.
    4. Number of times Planned Parenthood has filed suit on behalf of a teenage girl in Idaho.
    5. Number of states that do have Planned Parenthood.
    6. Do other states give Title X funds to Planned Parenthood?


    Representative Sali explained his understanding of parental rights, and the constitutional rights of a teenager, in the area of abortion. There is a case currently in the 9th Circuit Courts regarding parental rights. Planned Parenthood has taken the position that their counseling of teenage girls, cannot be infringed upon by the rights of the parent(s).

    Ellie Merrick, director of Public Affairs at Planned Parenthood of Idaho, testified in support of Planned Parenthood of Idaho receiving Title X funding.

    In summary, she reported Planned Parenthood of Idaho's mission is to reduce unintended pregnancies in Idaho through the provision of reproductive health and family planning services. Through these services, each and every day PPI insures that all Idahoans have access to services that enable them to plan their families.

    Planned Parenthood of Idaho is a full-service family planning healthcare center serving more than 12,000 patients annually in its Boise and Twin Falls healthcare centers, and providing comprehensive, medically accurate sexuality education.

    Our healthcare centers offer the following list of comprehensive reproductive healthcare services: initial and annual gynecological examinations, pap tests, screening for cervical cancer and breast cancer, birth control supplies, pregnancy testing, HIV testing and counseling, emergency contraception, and sexually transmitted infection testing and treatment.

    PPI is a not-for-profit organization with an annual operating budget for FY2003 of $1.3 million. PPI's two (2) healthcare centers provide 70 percent of the revenue stream, and 10 percent is derived from Federal Title X funding, and 20 percent from private foundations, grants, corporate contributions, and individual contributions.

    She stated, first and foremost, "let me clarify that Planned Parenthood of Idaho receives NO state money for family planning services." We receive $136,800 per year in federal Title X dollars, administered by the Department of Health and Welfare for direct family planning services. Title X funds can be used ONLY for family planning and reproductive health care services for Idahoans. Congress has determined what Title X money can be used for, as written in statutes and program regulations.

    Statutes and regulations are very precise as to what services must be provided and which services, such as abortion, are prohibited. Planned Parenthood of Idaho cannot, and does not, use any Title X money for abortion related services.

    PPI is one of the largest and most respected family planning providers in the state, and has been a part of Idaho's Title X Family Planning Project for 30 years.

    Last fiscal year, PPI served 7,293 clients in the Boise healthcare center. Six months into FY2003, PPI has served 4,000 clients, which is a dramatic increase over this same period last year.

    Ms. Merrick disagreed that Planned Parenthood's family planning services are a duplication of services, already available through the District Health Departments. For years, we have worked in concert with the District Health Department in offering services at times when the Health Departments are not open.

    It is also not a reasonable nor sound assumption to make that more than 7,000 women and men will be automatically be referred to, and absorbed into, the public health system for a reimbursement of $136,800 (PPI's Title X funds). The public health departments would be unable, by their own admission, to serve the same amount of clients for the money that PPI receives from the Title X program.

    She explained about the devastating ramifications defunding Planned Parenthood will have, not only on the Title X program statewide, but for the thousands of Idaho women and men this project serves. And defunding PPI will not, in any way, work toward the prevention of unintended pregnancies and the reduction of abortion rates.

    David Snyder, pastor of the Life Christian Fellowship, testified opposing Planned Parenthood of Idaho. He distributed two handouts: a publication, Child Predators, by Mark Crutcher, "exposing the partnership between Planned Parenthood, the National Abortion Federation, and men who sexually abuse underage girls," and a publication by Judie Brown, President of the American Life League, Inc., titled Condoms and AIDS Fact Sheet. [Items are on file in the Senate Health and Welfare Committee office.]

    In summary, he testified government exists to protect the rights and freedoms of those it serves. Therefore, the function of government, while it may be many other things, is moral in nature. Because government's function is moral, it has an obligation to promote righteousness and advance the well-being of its citizens.

    Righteousness, not license, produces freedom. Modern ideologies tout the supposed freedoms of immorality, but in truth, immorality has produced the bondage of unwanted pregnancy, STDs, AIDS, suicide, and a whole host of other societal-ills. The greater a society's commitment to what is morally upright thought, the greater freedom that society will inherit. While the state Senate cannot force its citizens to embrace morality, it can ensure laws and policies are moral. In doing so, it advances the cause of true freedom.

    Even more, the well-being of citizens must be the heart of government policy. Not only must laws and policies be moral to secure freedom, they must be moral because it secures our well-being. That which is most moral, safeguards the blessing of goodness. For these reasons, it is the responsibility of government to protect its citizens from policies that destroy and damage those it serves. To continue disbursing tax money to Planned Parenthood clearly contradicts the purpose of government to secure freedom and promote the well-being of Idahoans. Consider some facts:

    1. Planned Parenthood is an avid proponent of the safe-sex message, deceiving the public that condoms provide reasonable protection against pregnancy and STDs. Not only is the message deceptive, but the consequences for our young men and women are increasing rates, not decreasing rates, of unwanted pregnancy, STDs. AIDS, HPV and cervical cancer, and obvious emotional and relational devastation.


    2. Planned parenthood is a proponent of homosexuality, communicating to those who hear its message, that homosexuality is normal and healthy. While I do not believe any person, whether homosexual or not, should be the object of prejudice or hatred, the homosexual lifestyle--includes significantly higher rates of suicide, murder, and drug addiction--is devastating to a person's emotional and physical well-being.


    3. Planned Parenthood almost certainly protects child molesters from exposure and prosecution. Many of the young women who receive birth control or abortion counseling are minors, some of whom are engaged in sexual activity with adult men. And yet, as an agency, Planned Parenthood does virtually nothing to expose and report these men, and probably even knowingly harbors them.


    With these things in mind, how can we continue to funnel tax dollars to an organization that promotes this agenda, the end result being increased immorality, emotional devastations to individuals and society, and apparent illegal protection of child molesters. Since righteousness and morality secure freedom and well-being, it is societal and cultural suicide to continue giving money to an organization whose practices foster physical, emotional, and financial bondage and destruction.

    Pastor Snyder asked the committee to seriously consider changing the intent language so funds are directed for family planning through the Central Health District.

    Allen Marsh, from Nampa, testified in opposition to Title X funds being used for Planned Parenthood. He reported, in summary, statutory rape is a crime, but Planned Parenthood consistently treats adult-child intercourse as though it were nothing more than "consensual" sex.

    Last year, Life Dynamics Incorporated of Denton, Texas, recorded more than 800 calls made to Planned Parenthood facilities across America. The female caller portrayed a 13-year-old girl who was pregnant by an adult, and wanted an abortion in order to hide the illegal sexual relationship from her parents and the authorities.

    On the tapes, many of the Planned Parenthood workers told the caller that the situation was unlawful, and that they were legally mandated to report it to the state. Even after acknowledging this, more than 91 percent of the 800 facilities contacted, including Idaho, agreed to conceal it. When completed, the investigation documented a massive nationwide cover-up of child sexual abuse, with Idaho results being virtually identical. Representatives answering these calls were routinely willing to instruct an underage sexual assault victim to lie outright, or in some way hide the truth in order to get around the law.

    Mr. Marsh reported that Mark Crutcher, president of Life Dynamics, said, "The tapes from our investigation clearly prove that these people are running a pedophile protection racket . . . Family planning clinics are little . . . more than corporate accomplices for sexual predators who target children. "

    He also noted that this cover-up is part of an epidemic of older men sexually preying on underage girls. He said, "The most reliable current data shows that among girls 15 or younger who get pregnant, between 60 and 80 percent are impregnated by adults, and now we know who's making big money off the cover-up."

    These tapes prove that it is the policy and practice of Planned Parenthood not to comply with the law. The website at lifedynamics.com

    provides the details of this investigation.

    In California, the abortion providers asked the state attorney general whether they could be exempt from the law. A Dallas, Texas, TV station ran a three-day expose of their study of Planned Parenthood facilities in their area. And Life Dynamics reports that many states are taking action against Planned Parenthood.

    The Idaho attorney general's office and Boise police have declined to investigate Idaho's Planned Parenthood. One media source has indicated interest in this, but nothing has been accomplished yet. Until a local investigation is made, Planned Parenthood of Idaho can claim innocence, but Life Dynamics told that their responses were essentially part of the 91 percent.

    In closing, Mr. Marsh stated, in this time of budget crunch (state employees had no pay raises for two years), do you want to give government money to this private enterprise that protects criminals? Do you want to give this organization access to our schools to promote condom use, and birth control methods which do not protect against lethal STDs which are rampant among our youth? Logically, morally, financially, and health-wise, state funding to Planned Parenthood should stop.

    Judith Murray, executive director of the Idaho Nursing Association, testified in support of Planned Parenthood. She reported Planned Parenthood follows rules the same as the health district. Preventive pregnancies avoid abortions. She supports PPI receiving Title X funds.
    Marilyn Scott, director, Pregnancy Crisis Center in Twin Falls, testified in opposition of funds going to Planned Parenthood of Idaho. Her clinic is private funded. She expressed her concerns with the budget cuts going across the board in the state of Idaho, including our schools and other educational areas.
    Lee Flinn, executive director of the Idaho Women's Network - an organization comprised of 1,000 individual members and 25 organizations. She testified, "I am here today to testify in opposition to the Title X Intent Language."

    This intent language is unnecessary, and it is nothing more than a back door approach by a few, to strip federal Title X funding from Planned Parenthood of Idaho.

    I agree with others who have testified regarding the effectiveness of the Title X Program, and the benefits of family planning. I want to underscore that family planning services are basic reproductive health care and, therefore, necessary health care for women and men. Birth control, screening for breast and cervical cancer, blood pressure testing, and screening and treatments for sexually transmitted diseases, are essential to both women and men.

    Research (Guttmacher Institute) shows that the typical American woman wants-and has-two children. She, therefore, spends roughly three decades trying to avoid becoming pregnant. Because of this reality, family planning IS fundamental health care for women. The Title X Program serves low-income and working poor people in Idaho and in the nation.

    This intent language is simply bad policy:

    • It is fiscally irresponsible, as is seeking to remove funding from Planned Parenthood of Idaho, a very successful public-private partnership that has received Title X funds for 30 years.
    • This intent language would likely have a negative impact on working poor people in Idaho, as it would jeopardize access to reproductive health care for 7,000 women and men. Currently, Planned Parenthood is the largest provider in the Title X program in Idaho, and their numbers are steadily increasing due to their own outreach efforts and specialized service. (Advertising, extended evening and weekend hours to accommodate working people)


    • This intent language seeks to "solve" a problem that does not exist. As you heard, Planned Parenthood of Idaho serves thousands of patients per year. Good policy should address a real problem experienced by people in our state, this intent language does not. If enacted, it would jerk the rug from under 7,000 people (mostly women) who currently have access to excellent low cost or free reproductive health care through Planned Parenthood. Again, I want to emphasize that this would hurt low-income and working poor people. This policy change would not affect those who have private insurance.


    In closing, I want to say that removing federal funds from Planned Parenthood would jeopardize essential health care for thousands of women in Idaho. Some have said that this is a way to channel more money to the seven (7) health districts in Idaho. That may sound good, but no one can say for sure if the health districts could absorb an additional 7,000 patients if Planned Parenthood were to lose Title X funding. Because of this uncertainty, and because reproductive health care is essential for women, and often their only access to health care, I urge you to oppose this intent language before you.

    Harmony Barnes, who reported she is a parent with personal experience dealing with the services of Planned Parenthood of Idaho. She testified in opposition to funding the Planned Parenthood program. She presented a very passionate and provocative testimony pertinent to a personal involvement with Planned Parenthood of Idaho. She urged the committee to not give funds, or support, to Planned Parenthood of Idaho. She emphasized the importance of giving Title X money to agencies that will do good work, and not finance abortions for teenage children, as does the Planned Parenthood of Idaho.

    Chairman Brandt explained that due to business to be conducted on the Senate Floor, this hearing would be continued tomorrow (April 9, 2003).

    Bryan Fischer, senior pastor, Community Church of the Valley and also works with the Pastors Policy Council, an informal coalition of pastors which exists to give a voice to local clergy on matters of public policy, provided written comments as time did not allow his personal testimony. He previously served a term as the chaplain of the Idaho Senate.

    In summary his written comments are - I am here to urge you to recommend that Title X funding be redirected from Planned Parenthood to local district health centers. Planned Parenthood sends a "safe sex" message to our teens, the message that is responsible for a dramatic increase in teenage sexual experimentation, a dramatic increase in teenage pregnancy, the alarming spread of sexually transmitted diseases, and a dramatic increase in the number of abortions performed on teenagers.

    In addition, Planned Parenthood systematically undermines parental authority by continually cutting parents out of the decision making loop. We've already heard of Planned Parenthood's efforts to assist teenage girls in getting abortions without the consent let alone the knowledge of their parents. In my pastoral counseling practice, I recently ministered to a family whose 16-year-old daughter had been provided with birth control by Planned Parenthood entirely without her parents' knowledge or permission.

    I've printed out four pages from Planned Parenthood's site for teenage sexual advice. The first page contains a list of questions Planned Parenthood answers on this website on the subject of sex. The second page contains a list of the questions the website answers on the subject of masturbation. The third page is the website's answer to one of the questions concerning masturbation. And the fourth page contains Planned Parenthood's answer to the question, "Is it normal for two girls to 'do stuff' together?" Planned Parenthood's answer is that this is "totally normal." In fact, it says this twice.

    The question I would pose to you is a simple one: Is this the organization you want to officially represent the state of Idaho in giving sex education to our teens? Is this truly, as the top of page claims, "Sexuality and relationship info you can trust?" I believe the answer to these questions is "No," and so I ask you to recommend that Title X funding be redirected from Planned Parenthood to local health districts. (Attachment #1).

    ADJOURNMENT The meeting adjourned 8:56 a.m.




    DATE: Wednesday, April 9, 2003
    TIME: 8:00 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:



    None
    GUESTS: See the attached sign-in sheets
    MINUTES: A motion was made by Senator Bailey to approve the minutes of Thursday, April 3, 2003, as written. Motion was seconded by Senator Kennedy, and motion was carried by a voice vote.
    Chairman Brandt opened the meeting to discuss the recommendations made by the Governor's Idaho 2020 Blue Ribbon Task Force for a low interest loan program for the purchase of assistive technology in Idaho.
    2020 BLUE RIBBON TASK FORCE Ronald Seiler, director of the Idaho Assistive Technology Project, Center on Disabilities and Human Development, at the University of Idaho, explained Governor Kempthorne's Blue Ribbon task Force approved a recommendation to establish a low interest loan program for assistive technology on April 4, 2003.

    Assistive technology loan programs (alternative financing programs) provide low interest loans to individuals with disabilities and their families for the purchase of assistive technology. The Task Force unanimously passed this recommendation for three reasons:

    1. It takes advantage of the federal assistance that President Bush and Congress have recently made available to the states.
    2. Assistive technology loan programs hold tremendous potential for lessening the burden of state government.
    3. Assistive technology increases the independence and productivity of older persons and individuals with disabilities.


    He explained why he thinks the Legislature should follow the lead of the Task Force and provide support for this program, even in these hard economic times.

    During his first month in office, the President unveiled his New Freedom Initiative to Congress and the American public. This is the President's blueprint for Americans with disabilities:

    1. A cornerstone of the New Freedom Initiative is the increased reliance on assistive technology.
    2. Assistive technology includes such items as adaptive computers, wheelchairs, communication technologies, reachers, grab bars, and thousands of other commercially available devices.
    3. In FY2002-2003 federal budget, the President requested, and the U.S. Congress appropriated, $37 million to help states establish alternative financing (loan) programs which allow people with disabilities to obtain affordable financing for assistive technology.
    4. The federal assistance is authorized under Title III of the Assistive Technology Act of 1998.
    5. The President states, "State Tech Act projects could work with other lending entities to establish low-interest loans for the purchase of AT."


    The Idaho Assistive Technology Project, which is funded under Title I of the Assistive Technology Act of 1998, is the "State Tech Act" project for Idaho. This one-time increase in federal assistance is a golden opportunity to establish a loan program in Idaho. Idaho is eligible for funding in the millions of dollars, depending upon the size of the match provided by the state. However, the state is required to provide a 25 percent match in order to be eligible for the federal assistance.

    Mr. Seiler outlined the Assistive Technology Loan Program and stated the program can lessen the burden of state government:

    1. Providing low interest loans for assistive technology holds the promise of significantly lessening the burden of state agencies, in particular, in Medicaid, vocational rehabilitation, and special education programs.
    2. Assistive technology loan programs allow persons with disabilities and older persons to be less dependent on entitlement programs, and can help them to avoid entering publicly-funded institutions.
    3. In a recent federally-funded study, 200 elders were each provided with $2,600 worth of assistive technology, which resulted in a saving of $17,438 in health care costs of each elder in just 18 months, (Mann, 2000).
    4. Assistive technology can reduce the need for delivered meals and homemaker services. When determining the return-on-investment for the city of Chicago, the cost of the service savings was compared to the cost of the assistive technology equipment. For the 45 clients that had been able to reduce or eliminate the need for services, the city would realize a total savings of $867,531, and the return -0n-investment in assistive technology would be 20 to 1, (Hedman, 1996).
    5. According to the Office of Technology Assessment, "assistive device can delay or prevent institutionalization, resulting in enormous personal and financial savings."


    Mr. Seiler also explained how these loan programs work. Individuals with disabilities of all ages and income levels and their families are eligible for loans. Assistive technology loan programs directly benefit adults with disabilities and their families, students with disabilities and their parents, family care givers, older persons with functional impairments and their families, and direct care providers.

    The loans are very similar to car loans, in that, they are real loans that must be re-payed to the bank. The bank will loan its own money. However, there are some critical differences. Loans are offered with a very low interest rate, which lowers the monthly payments. The other difference is what happens when someone has no credit history, or they have poor credit that is due to their disability.

    In these cases, we would provide either a loan guarantee or principle buy-down arrangement. For instance, if someone wanted to borrow $3,000 to purchase a computer, and they would otherwise not be eligible for a loan because of their poor credit history, this program would provide a full or partial guarantee for the loan, assuming they can demonstrate the ability to repay the loan. This guarantee makes the banks more comfortable making loans to people with disabilities. In Idaho, this program will be operated by the Idaho Assistive Technology Project collaboration with the Idaho Community Foundation, Zions First National Bank, and Key Bank of Idaho.

    In order to create a stable funding base for the loan program, the state and federal shares would need to total about $2 million. This would require a state match of $500,000, which would make Idaho eligible for $1.5 million in federal match funds. The Idaho Assistive Technology Project at the University of Idaho has already prepared the grant application, and is prepared to submit it to the U.S. Department of Education, National Institute on Disability Rehabilitation and Research as soon as the match is secured. Proposals are due in early summer. The Legislature would only need to authorize spending during the 2003 session. No funds would actually be appropriated until Idaho is selected to receive the grant. The money would not be appropriated if Idaho was not selected to receive the federal grant.

    Written comments were submitted by the Idaho 2020 Blue Ribbon Task Force. The Task Force has officially endorsed the attachment recommendation to establish a permanent low interest loan program for the purchase of assistive technology in Idaho. We urge the Governor and the Idaho Legislature to consider implementation of this important program as soon as possible. (Attachment #1)

    Mr. Seiler, distributed a fact sheet, dated March 12, 2003, relating to the background on loan programs, alternative Financing Program for Assistive Technology. (Attachment #2)

    Kelly Buckland, director of the Idaho State Independent Living Council, testified in support of the Assistive Technology Low Interest Loan Program. He emphasized JFAC does not need to spend the $500,000 this year, but is needed for signature authority. He encouraged the committee to support the recommendations of the Task Force.

    The committee members held a lengthy discussion about the problems already facing the JFAC (Joint Finance-Appropriations Committee) to finance other programs recommended by this committee, and should the committee included in the letter of recommendations for JFAC to also consider funding $500,000 for this program. The committee previously determined to request funding from JFAC for the adult dental program and the sheltered workshop program.

    MOTION A motion was made by Senator Kennedy to request JFAC to meet with Ron Seiler and hear the program, and if JFAC feels it would be appropriate to take whatever action it deemed necessary to authorize the application for the federal grant this year. The motion is to recommend the JFAC to authorize the filing application for the grant.

    The motion died for lack of a second.

    MOTION A substitution motion was made by Senator Compton to endorse this program, it is a great idea, but do not endorse funding for the program this year 2004 budget.

    The motion died for lack of a second.

    MOTION An alternative motion was made by Senator Burkett that we endorse this concept so he can go and talk to JFAC, and this committee should focus on that. It is a good program, something the state should be going forward with, we should give it our endorsement and leave it up to JFAC to make a recommending on the funding issue.

    The motion died for lack of a second.

    MOTION A motion was made by Senator Stegner that this committee acknowledge this is an intriguing program, and encourage them to come back next year. Motion was seconded by Senator Compton, and was carried by a voice vote.
    PLANNED PARENTHOOD OF IDAHO Chairman Brandt announced the committee was required to report to the Senate Floor; therefore, the continued hearing scheduled for Planned Parenthood of Idaho would be rescheduled for the next business day.
    ADJOURNMENT The meeting adjourned at 9:00 a.m.




    DATE: Thursday, April 10, 2003
    TIME: 8:00 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, Burkett, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:



    None
    GUESTS: See the attached sign-in sheet
    MINUTES: A motion was made by Senator Sweet to approve the committee's minutes for Friday, April 4, 2003, as written. Motion was seconded by Senator Kennedy, and motion was carried by a voice vote.
    PLANNED PARENTHOOD OF IDAHO Chairman Brandt explained the committee held a discussion relating to the Title X funding. It is the call of the Chair there will be no additional testimonies today, and he will entertain a motion and discussion. [Previous hearing held Tuesday, April 8, 2003.]

    Several items and written comments were submitted to the committee.

    Tammy Seydel's written comments reported about her post on an abortion message board and its responses.

    1. What happens when a woman is raped? Whoever said life is easy? I am the product of a rape. I thank my mother for not sucking me into a jar all torn in pieces. My mother told me, "Tammy, I just thought I got the better end of the deal, I got you." I guess you just make something good out of bad. Two wrongs don't make a right. Have you ever done any research on post abortion problems . . . there are many, many articles on the net. I encourage you to put your compassion where your mouth is and volunteer at a crisis pregnancy center. Life is life and should be protected. God help us if we stand by here and do nothing to save these tortured little ones. Abortion is euphemism for killing babies.


    2. What happens when a woman is raped? Right on! My father was the product of rape and also had to grow up in a small southern town with everyone knowing he was "illegitimate." He went on to become a (minor) war hero in the defense of his country, a successful businessman, a respected public servant, and about the best dad any boy ever had! He loved to play cards and he always told me, "It isn't really the cards you're dealt that matters, it's the way you play your hand." That was about the best advice I ever got.


    3. I cried for one month before I decided to end it. Your story is much like mine. It has been 11 years for me, and the pain never goes away. Feel free to email me, you and I could use a shoulder in these times that you and I often visit when no one else understands, or wants to. I have used my experience to help others and in turn it has helped me also.


    4. I cried for one month before I decided to end it. I know the hurt you feel. It has been 32 years, and I still mourn my baby everyday. I know that God has forgiven me just as he has forgiven you, and that he has our babies with him. I am sure that someday we will be with them and, hopefully, they will understand why we did what we did. You are right, and we need to educate young women not only on how to prevent pregnancy, but how to deal with it if it does happen. They need to learn that abortion is NOT an easy out . . . it is the wrong way out. Abortion rights people don't want these girls to know about the scars that they will carry emotionally - forever. God bless you, and keep you safe.


    A chart was presented by the Department of Health and Welfare in response to questions from the committee on April 8, 2003. The chart outlines the reproductive health program clients served and budgets of the Central District Health and the Planned Parenthood of Idaho. The chart also has a listing of the total number of clients and budgets for the seven health districts. (Attachment #2)

    Two handouts were presented (no name given) pertaining to three questions: "What if your girlfriend is pregnant? Abstinence-Is it right for you? And, What are you learning in sex ed? (Attachment #3)

    Another handout titled, Idaho Reproductive Health Program, and a map listing the locations of the 44 Public Health District and the two Planned Parenthood Clinics. (Attachment #4)

    A handout titled, Idaho Reproductive Health Program, Title X and Family Planning, was received. (Attachment #5)

    A discussion was held by the committee members. Items discussed included, but not limited to the following:

    1. The total budget for Planned Parenthood of Idaho is more than a million dollars. We have cut the Central District Health Department's budget 8 or 9 percent for this year. If we are willing to do that, we need to be very careful of any monies we would distribute outside of those agencies, because of the fact we cut the health districts significantly. It would be more proper to take any funding and spread it out amongst those health districts, and perhaps lessen the impact of those cuts for this year.


    2. Budgets and mandated funding, and the complicated process to determine budgets.
    MOTION: A motion was made by Senator Compton to not recommend language in the letter to JFAC in opposition. Motion was seconded by Senator Ingram.
    MOTION: A substitute motion was made by Senator Sweet that in the interest of funding our Central District Health Departments that we include the intent language in the JFAC appropriation bill. Motion was seconded by Senator Darrington.
    MOTION An alternative motion was made by Senator Stegner to include in the letter as a recommendation to JFAC that they maintain Title X funding for Planned Parenthood of Idaho. Motion was seconded by Senator Kennedy.

    DISCUSSION:

    Planned Parenthood of Idaho has received federal funding for their programs for about 30 years. They are following the laws of the state of Idaho in connection of the counseling they do. One of the incidents we heard about on Monday or Tuesday, about the one child who received an abortion, a consent for that was granted pursuant to a statute enacted by this Legislature which directed the manner by which this consent had to be obtained. And that legislation was indeed sponsored on the Floor of the House by Representative Bill Sali. Everything was followed in accordance with that statute, and I do not think that should be used as an excuse to cut the federal funding for Planned Parenthood. I think they have done a good job, and are only asking for $136,000 and could have filed independently of the Department of Health and Welfare and obtained a grant on their on behalf, but instead they have been working with the Department of Health and Welfare, and I believe they are entitled to continue the funding.

    We all know this is federal funds; there are no general funds in the state of Idaho being asked for. It has been historically handled this way, and there is no need to change. The House will probably offer an alternative view. It is important for the committee to balance that view in our letter to JFAC. The committee needs to keep in mind they do not get to decide this issue, but JFAC will decide the issue. This germane committee has spent some time on this issue, and our opinion will differ from the House. Hopefully, the JFAC will see a balance in the view point from the various bodies of the Legislature.

    Discussion about a letter dated February 3, 2003, from the Idaho Department of Health and Welfare, to a question addressed by Representative Sali, and the letter of response inquiring about duplicating services between Central District Health and Planned Parenthood was read. (Attachment #1). This senator cannot understand why we are cutting a state agency to fund a private agency, to say the least. It is controversial. We are taking money from the Central District Health to fund a private agency. That is bad public policy.

    Other concerns discussed by the committee included, but not limited to, the following.

    1. This is a classic issue involving the philosophical differences of the senators, and our recommendation to JFAC will reflect that, because the two of us who differ on this issue will not convince each other of our differences.


    2. There is no Planned Parenthood in the district; therefore, this is not a personal issue. It is reported that Planned Parenthood is doing a good job.


    3. Would moving the $136,000 out of Planned Parenthood put them out of business? This senator does not believe moving the money to the Central District Health would put Planned Parenthood out of business. They would still be there, and still able to do perform their services. There is no Planned Parenthood in this senator's district; therefore, people have to go to the public health district facility. This senator does not believe any decision the committee makes, will make a difference to JFAC.


    A brief discussion was also held about the importance of the committee informing the JFAC of the committee's recommendations for programs, otherwise, the JFAC will assume the germane committee does not oppose the legislative intent language.

    Senator Stegner restated his alternative motion.

    Roll call vote:

    Senator Ingram voted yes.
    Senator Burkett voted yes.
    Senator Sweet voted no.
    Senator Stegner voted yes.
    Senator Darrington voted No.
    Senator Compton voted yes.
    Senator Brandt voted No.
    Senator Kennedy voted yes.
    Senator Bailey voted No.

    Motion carried with 5 Yes and 4 No.

    ADJOURNMENT The meeting adjourned at 8:26 a.m.




    DATE: Friday, April 11, 2003
    TIME: 8:00 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Stegner, Bailey, Burkett, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:

    Senator Ingram and Senator Sweet
    MINUTES: A motion was made by Senator Bailey to approve the committee's minutes for Monday, April 7, 2003, as written. Motion was seconded by Senator Kennedy, and motion was carried by a voice vote.
    GUESTS: Roy Eiguren, Steve Allred, Suzanne Schaefer, and David Mabe.
    HB 394 HB394, relating to environmental quality, and amending Chapter 1, Title 39, Idaho Code, by the addition of a new Section 39-116A, to provide for compliance agreement schedules, and declaring an emergency, was presented by Roy Eiguren.

    The purpose of this bill is to provide the legal authority to the Idaho Department of Environmental Quality (IDEQ) to voluntarily enter into agreements with persons and organizations it regulates to implement multi-year environmental compliance schedules in situations where the person or organization is already in compliance with applicable federal and state environmental laws and rules, but desires to take additional actions to improve environmental quality.

    Current law limits the authority of the Department to enter into compliance schedules or consent orders only if a person or organization is not in compliance with such laws and rules.

    This legislation was developed by the Amalgamated Sugar Company in conjunction with the Idaho Department of Environmental Quality. It is designed to help allow Amalgamated to invest $20 million in new environmental control equipment during the next 10 years at its three sugar beet factories in Idaho - one in Nampa, one at Twin Falls, and one near Rupert. The new statutory provision contained in HB394 can be used by any person or company subject to DEQ.

    Idaho law currently does not provide for DEQ to enter into voluntary compliance schedules or agreements with companies that it regulates. Currently, Idaho law only provides that DEQ may require or mandate that companies it regulates enter two types of binding agreements. The first is a Consent Order, and the second is a Compliance Schedule. Both a Consent Order and a Compliance Schedule are available only when a company has violated an environmental law or rule. If a regulated company wants to enter into an agreement with DEQ for the purpose of implementing a long-term environmental compliance program, DEQ under current law doesn't have the authority to enter into such an agreement.

    This legislation resolves that problem by expanding Idaho Code Section 39-116 by adding a new section "A" outlining the specific powers of parties. This new section expressly provides for a "compliance agreement" . . . An agreement is defined by Black's Law Dictionary as "a manifestation of mutual assent on the part of two or more persons as to the substance of a contract." Accordingly, DEQ cannot force a regulated company into entering a compliance agreement. Rather, it is totally voluntary on the part of the company.

    The reasons that a compliance agreement is a good concept are:

    1. IDEQ is subject to an enforceable agreement with the company. Accordingly, if a IDEQ employee gets the "good idea" to impose a new requirement, the company has a process under the agreement to resolve this issue.


    2. The agreement is enforceable and, therefore, in effect, a contract. This is a good provision as it provides certainty.


    3. The statute expressly recognized that IDEQ may prioritize environmental problems. This is the first express statutory recognition of prioritization, as usually an agency simply states, "comply now." The recognition of prioritization is in and of itself a reason to enact this legislation.


    4. IDEQ may consider financial capability and "other factors" in entering into the schedule. This is an incredibility good provision as it allows the agency to recognize the reality of a company's ability to finance environmental improvements and work with the company to develop a long-term schedule to finance and install pollution control technologies.


    Mr. Eiguren distributed copies of Idaho Code Section 39-108(iv) relating to Consent Order. He also presented a copy of Idaho Code Section 39-116 relating to Compliance Schedules. A third handout pertaining to the Amalgamated Sugar Company's Consent Order with the Idaho Department of Environmental Quality, dated March 27, 2003, was reviewed. (Attachment s #1, #2, and #3)

    There is no fiscal impact to the General Fund.

    The Department of Environmental Quality Director Steve Allred testified in support of HB394, and explained the benefits to the state and industry with the passage of HB394. Three other states have enacted this type of legislation, Wisconsin, Michigan, and one other.

    MOTION: A motion was made by Senator Kennedy to send HB394 to the Floor with a Do Pass recommendation. Motion was seconded by both Senators Darrington and Compton, and motion was carried by a voice vote.

    Senator Kennedy will sponsor HB394.

    ADJOURNMENT The meeting adjourned at 9:00 a.m.




    DATE: Thursday, April 17, 2003
    TIME: 8:00 a.m.
    PLACE: Department of Health and Welfare, 450 West State Street, Boise, ID.
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Bailey, and Burkett
    MEMBERS ABSENT/

    EXCUSED:

    Senators Stegner, Sweet, and Kennedy
    This brief meeting was called by Chairman Brandt to have committee members tour the Department of Health and Welfare, located in the Pete T. Cenarrusa Building, 450 West State Street, in Boise.

    Prior to the tour, the committee briefly discussed the committee's draft letter to the Joint Finance-Appropriations Committee (JFAC) for the FY2004 appropriations for the Department of Health and Welfare. The draft letter will soon be completed, and each committee member will be given a copy of the final draft prior to delivery to the JFAC.

    MINUTES: A motion was made by Senator Bailey to approve the committee's minutes for Tuesday, April 8; Wednesday, April 9; and Thursday, April 10, 2003, as written. Motion was seconded by Senator Ingram, and motion was carried by a voice vote.
    MINUTES: A motion was made by Senator Compton to approve the committee's minutes for Wednesday, March 26, and Friday, April 11, 2003, as written. Motion was seconded by Senator Ingram, and motion was carried by a voice vote.
    ADJOURNMENT The business meeting adjourned at 8:37 a.m.




    DATE: Tuesday, April 29, 2003
    TIME: 8:30 a.m.
    PLACE: Room 437
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Bailey, Burkett, and Kennedy
    MEMBERS ABSENT/

    EXCUSED:



    Senators Stegner and Sweet
    MINUTES: There were no minutes to approve today.
    Chairman Brandt convened the meeting to consider two gubernatorial appointments.
    Gubernatorial Appointment Gubernatorial appointment of Craig D. Harlen to the Idaho Board of Environmental Quality.
    Department of Environmental Quality Director Steve Allred introduced Craig D. Harlen as the newly appointed member to the Idaho Board of Environmental Quality. Mr. Allred also presented a synopsis of the duties and responsibilities of the Idaho Board of Environmental Quality, and its board members.

    Craig D. Harlen, from Pocatello, was appointed by Governor Kempthorne as a member to the Idaho Board of Environmental Quality for a term commencing April 11, 2003, and expiring July 1, 2003, to complete the unexpired term of former board member Marti Calabretta. Governor Kempthorne also appointed Mr. Harlen to serve a four-year term commencing July 1, 2003 and expiring July 1, 2007.

    Mr. Harlen has a Bachelor of Science Chemical Engineering degree from Montana State University. He is currently self-employed as a consultant. He has an extensive business background dealing with cash management, strategic planning, staff management, contract negotiations and finance, and mining and manufacturing fertilizer operations in Idaho, California, Wyoming, and Manitoba.

    From 1976 to 1995, he worked for Nu-West Industries, Inc., located in Soda Springs, Idaho, and was president and CEO for the last nine years of that time.

    From 1996 to 1998, he was vice president of Mining and Manufacturing for J. R. Simplot Company Minerals and Chemicals. He was responsible for mining and manufacturing operations for all J.R. Simplot Company fertilizer operations in Idaho, California, Wyoming, and Manitoba.

    During 1971 to 1976, Mr. Harlen was engineer and chief chemist and plant superintendent for Kaiser Cement & Gypsum in Montana, California, and Texas.

    Other professional activities include: Outside director, Centennial Resources in Louisville, Kentucky; director, Caribou Memorial Hospital; pesident, Harlen Management Consulting (1998 to present); and president of the Idaho Mining Association. In 1998, he was president of the Bannock Development Corporation, and also served as director of the Natural Heritage Foundation, Idaho State University Museum Natural History.

    Mr. Harlen received the OSHA Star Award (twice) for safe man hours at the Soda Springs facility; Outstanding Achievement Award, and the National Safety Council Merit Award. His political affiliation is Democrat.

    MOTION: A motion was made by Senator Kennedy that the committee approve the gubernatorial appointment of Craig D. Harlen as a member of the Idaho Board of Environmental Quality, to fulfill the unexpired term of Marti Calabretta, expiring July 1, 2003, and an additional four (4) year term commencing on July 1, 2003 and to expire July 1, 2007. Motion was seconded by Senator Ingram, and the motion was carried by a voice vote. Senator Burkett will sponsor Mr. Harlen.
    Gubernatorial appointment of Stephen C. Weeg to the State Board of Health and Welfare.
    Department of Health and Welfare Director Karl Kurtz introduced Stephen C. Weeg, and then explained the duties and responsibility of the State Board of Health and Welfare.

    Stephen C. Weeg, from Pocatello, was appointed by Governor Kempthorne as a member to the State Board of Health and Welfare for a term commencing April 11, 2003, and expiring January 7, 2007.

    Mr. Weeg has an extensive background in health care. His professional goal is to improve the capacity of health systems to meet the health needs of our citizens, with a focus on rural and behavioral healthcare.

    He is the current executive director of Telehealth Idaho at the Idaho State University in Pocatello. He is responsible for planning and implementation of an Office for the Advancement of Telehealth grant, to expand Telehealth services in Idaho, to improve access to health care, and to develop and sustain rural healthcare professionals. He is responsible for the development of partnerships with community and statewide healthcare organizations.

    During July 1999 to December 2001, he was a partner of Catalyst Associates, LLC. The partnership was formed to increase and enhance the provision of management consulting services to public, proprietary, and not for profit organizations. Services provided to hospitals and human service agencies have included: proposal development, strategic planning, project monitoring and technical assistance to the Idaho Department of Health and Welfare on the design and implementation of the Idaho Children's Health Insurance Program (CHIP), and support and planning to the Idaho Hospital Association through the Critical Access Hospital grant.

    His professional affiliations include the American College of Healthcare Executives, Idaho Hospital Association, Idaho Rural Health Association, Idaho Mediation Association, and the American Telemedicine Association. His political affiliation is Demoncrat.

    Several other professional positions previously held by Mr. Weeg include:

    1. Executive director, Alcohol Rehabilitation Center of Southeast Idaho;
    2. Acting administrator, EPICS project manager for the Division of Welfare, Idaho Department of Health and Welfare;
    3. Regional director, Region VI in Pocatello, Idaho Department of Health and Welfare;
    4. Administrative director, State Hospital South in Blackfoot Idaho;
    5. Vice president of Development CM Healthcare Services;
    6. Director of operations, Western Division Magnolia Health Systems;
    7. Interim director, Behavioral Health Services, Saint Alphonsus Regional Medical Center, and,
    8. Principal, SCW Consulting Services.

    There was a general discussion about the need and the possibility of increasing the powers and authorities of the State Board of Health and Welfare; the importance of maintaining a substance abuse treatment program in Idaho; reduction in appropriations and the requirement to support sheltered workshops, the Department of Health and Welfare's Utilization Management Program, the growth in Medicaid programs, and increased healthcare costs to provide services.

    MOTION: A motion was made by Senator Darrington that the Health and Welfare Committee recommend the confirmation of Stephen C. Weeg to the State Board of Health and Welfare. Motion was seconded by Senator Bailey, and the motion was carried by a voice vote. Senator Kennedy will sponsor Mr. Weeg.
    ADJOURNMENT There being no other business to conduct, the meeting adjourned at 9:40 a.m. Further meetings will be at the call of the Chair.




    DATE: Monday and Tuesday, July 7 and 8, 2003
    TIME: 9:00 a.m.
    PLACE: Idaho Department of Health and Welfare, 450 West State Street, Boise
    MEMBERS PRESENT: Chairman Brandt, Vice Chairman Compton, Senators Darrington, Ingram, Stegner, Sweet, Bailey, and Kennedy
    MEMBERS ABSENT: Senator Burkett absent on July 7 & 8, 2003. Senators Darrington and Sweet absent on July 8, 2003.
    GUESTS: House Health and Welfare Committee members: Chairman William Sali, Representatives Sharon Block, Bob Ring, Kathie Garrett, Peter Nielsen, Mike Mitchell, Janice McGreachin, and Henry Kulczyk.

    Governor's Office - Michael Bogert and David Lehman

    Idaho Department of Health and Welfare - Karl Kurtz, Joe Brunson, Joyce McRoberts, William Walker, Jodi Carpenter, Dick Humiston, Scott Cunningham, Randy May, Charlie Wright, Bev Lynn, Ken Deibert, Shirley Alexander, Richard Schultz, Christine Hahn, Michelle Britton, Alisa Axtman, Al Drennen, and Diana Jansen.

    Idaho Board of Health and Welfare - Chairman Quane Kenyon

    Idaho Board of Environmental Quality - Chairman Paul Agidius, Joan Cloonan, and Randy MacMillian.

    Department of Environmental Quality - Director Steve Allred, Jon Sandvol, Debra Cline, and Jess Byrne.

    Co-Ad, Inc.- Corinne Wolfe

    WELCOME Chairman Brandt and Idaho Department of Health and Welfare (IDHW) Director Karl Kurtz welcomed the attendees, and outlined the items for discussion. Chairman Brandt explained the Senate Health and Welfare Committee planned a two-day informational interim meeting and had invited the members of the House Health and Welfare Committee to participate.
    EXECUTIVE SESSION MOTION A motion was made by Senator Compton, pursuant to Senate Rule 20(E) and Idaho Code, Section 67-2345(f), that the Senate Health and Welfare Committee resolve into an Executive Session for the purpose of considering and advising legal counsel on pending litigation relating to the Jeff D. matter.

    The motion was seconded by Senator Sweet. A roll call vote was requested to move into an Executive Session.

    Aye: Senators Brandt, Compton, Darrington, Ingram, Stegner, Sweet, and Bailey.

    Nay: Senator Kennedy - he explained his objection and plans to introduce legislation in 2004 pertaining to Senate Rule 20(E).

    The motion to enter into an Executive Session carried - 7 Ayes, 1 Nay, and 1 absent (Senator Burkett)

    The purpose of the Executive Session was explained. [Litigation actions prohibit the release of confidential information as a part of the mediation process. A current opinion of the Attorney General has been obtained by the Senate leadership, confirming the legality of the Executive Session to be conducted by the Committee.]

    Michael Bogert, Deputy Attorney General for the Governor's Office; Jodi Carpenter, Deputy Attorney General for the Department of Health and Welfare; and David Lehman, Policy Advisor for the Governor's Office, presented a background history and an update about Jeff D. litigation.

    It was further explained, the reason for the need to maintain the confidentiality of mediated actions. The Executive Session updated legislative members about the Jeff D. litigation and talk solely about the litigation in itself, the strategy around the litigation, and the path forward for the state of Idaho.

    EXECUTIVE SESSION MOTION A motion was made by Senator Compton that the Senate Health and Welfare Committee adjourn the Executive Session. Motion was seconded by Senator Bailey. A roll call vote was requested.

    Aye: Senators Brandt, Compton, Darrington, Ingram, Stegner, Sweet, Bailey, and Kennedy. 1 absent (Senator Burkett).

    Nay: None

    The motion to adjourn the Executive Session carried - 7 Ayes - 1 absent.

    Board and Department of Environmental Quality (DEQ) The Department of Environmental Quality (DEQ) Director Steve Allred and members of the Board of Environmental Quality presented a brief background history of the Board of Environmental Quality, and its responsibilities.
    The seven (7) members of the DEQ Board are appointed by the Governor, and confirmed by the Senate. Board members serve at the pleasure of the Governor, and terms are four (4) years. The Board operates in conjunction with the Department and is composed in a fashion that assures appropriate geographic and political representation of the state of Idaho. The existence of the Board provides the public with one more vehicle/opportunity to participate and be involved in the process. Several public meetings are held throughout Idaho each year; at which time the Board conducts its official business and functions, i.e., rule making and contested cases.

    The Board is an advisory body for the DEQ. The Board may adopt, amend or repeal the rules, codes, and standards of the DEQ that are necessary and feasible to carry out its purposes and provisions of the Environmental Protection and Health Act, and to enforce the laws of Idaho. Rules adopted by the Board have the force of law, but are subject to legislative review.

    Anyone aggrieved by the action or inaction of the DEQ may request a hearing by the Board or a board-designated hearing officer. Likewise, Board determinations may be petitioned for judicial review. All rule making proceedings and hearings of the Board are governed by Title 67, Chapter 52, Idaho Code.

    The DEQ, with assistance from the attorney general's office, is responsible for drafting rules for consideration by the Board. Two basic types of rules - proposed and temporary may be presented to the Board for adoption, according to Title 67, Chapter 52, Idaho Code.

    A general discussion was held regarding improving communications between DEQ, the Board, and the Legislature; the DEQ budget; DEQ's rule making process, and new rules likely to be reviewed during the 2004 legislative session pertaining to air and water quality, hazardous waste, drinking water, and contested case rules. [For more information about DEQ's rule making activities and programs, visit DEQ's web site at www.state.id.us/deq or contact Paula Gradwohl at 208.373.0418.]

    Idaho Deparment of Health and Welfare (IDHW) IDHW Director Karl Kurtz and the Division of Financial Management Acting Administrator Richard Humiston explained the General Fund reversion for fiscal year 2003, i.e., personnel savings across all programs from delayed filling of positions and the elimination of 100 vacant unfunded positions; replacement vehicle purchases were delayed; automation of the eligibility process for the Medicaid program being delayed, and direct assistance cash payments for disabled clients were replaced by services in the Medicaid program under waivers where they receive federal participation.
    Federal Medical Assistance Percentage (FMAP) for fiscal year 2003 and 2004 was discussed. Every state's FMAP increased 2.95 percent, and the state is held harmless for any decrease in the current FMAP rate for one (1) federal year. In Idaho, currently appropriated General Funds will generate almost $30 million in additional federal support over the five-quarter period. The increased FMAP is a one-time funding and will require a fund shift in FY2005 of about $24 million in General Fund, unless surplus funds are available to a carryover.
    The IDHW's actual budget status for FY2003 was $1,249,046,300 and the grand total for FY2004 is $1,346,448,800 - an 8 percent change. The FY2003 personnel savings reverted to the General Fund. Increased health insurance and anticipated savings from staff reductions are reflected in the FY2004 budgets. The FY2004 Medicaid operating increase reflects costs of implementing care management activities implemented as part of cost savings in holdback plans. The FY2004 capital outlay will be funded with carryover, transfers, and federal fund increases. Fewer personnel and operating dollars are available to support increased caseloads, and this increases the risk of the IDHW to continue to deliver services accurately and timely. [A chart listing the DHW's personnel, operating, capital outlay, trustee and benefits totals for FY2003 and FY2004 will be maintained in the Committee's Senate office until the end of the 2004 legislative session.]
    WELFARE Division of Welfare Administrator Scott Cunningham outlined the rising caseloads, workloads, and error rates; the dependence on new automation, and charitable choice. Charts outlining the Self-Reliance Benefits and Child Support caseloads, Idaho's Child Care Program (ICCP, Temporary Aid for Families in Idaho (TAFI), Medicaid and Food Stamps were reviewed.

    • Since July 2000, monthly active caseloads increased 42.9%
    • Since SFY2001, an annual average of self-reliance applications increased by 17%
    • Since July 2000, the average monthly denial rate for Benefit applications is 42.8%
    • TAFI - monthly active caseloads increased 39.2%
    • TAFI - monthly applications processed increased 69.5%
    • Since July 2000, monthly active Medicaid eligibles increased 43.3%
    • Since SFY2001, annual average Medicaid applications increased 13.4%
    • Since July 2000, monthly active Food Stamp caseloads increased 48.8%
    • Since SFY2001, annual average Food Stamp applications increased 18.6%
    • Since SFY2001, annual average ICCP (Idaho Child Care Program) applications increased 13%
    • Since July 2000, monthly Child Support caseloads increased 20.2%


    Other facts:

    • National characteristics - about 17.3 million people living in 7.5 million households received food stamps in the United States each month in FY2001.
    • Many food stamp recipients work, but have little income.
    • The Food Stamp Program is the first line of defense against hunger, and continues to play a critical role in facilitating the transition from welfare to work.
    • Idaho's payment error rate is projected to move from 9.04% in 2002 to 11 percent in 2003 and 13% in year 2004, which would result in a significant financial penalty. Efforts are currently underway to use as many as 40 temporary staff to reduce 2004's projected error rate.
    • Food stamps are one of the most policy proscriptive and labor intensive benefit eligibility programs IDHW operates.
    • Idaho's Food Stamp caseload has increased by almost 50%. Idaho's caseload is larger than at any other time in the state's history.
    • Staff resources have decreased by 22% from year 2000 to 2003.
    • Technology improvements along with streamlined processes and policy must be implemented to manage the increasing workload with decreasing staff resources - creating fewer staff intensive processes such as contracts and automatic eligibility using intelligent software programs.


    Mr. Cunningham also discussed a Presidential Executive Order - the Charitable Choice Rule. Faith-based organizations can now compete with other organizations and businesses to provide program services within six federal departments: Health and Human Services, Housing and Urban Development (HUD), Justice, Education, Labor, and Agriculture.

    • States must now consider faith-based social service providers when working to procure critical services for people in need.
    • Faith-based providers stand on equal footing with other providers when State contracts are being evaluated.
    • Faith-based service providers must serve all eligible persons without discrimination.
    • Participants and recipients cannot be forced to take part in activities such as worship, scripture study or prayer.
    • No one can be excluded from benefits on the basis of religion.
    • If a participant objects to a faith-based organization's services, the State must provide an alternative source or method for services.
    • Healthy Families - Nampa: establish a community environment that coordinates and delivers faith-based and community initiatives in support of healthy marriages and responsible fatherhood; increase the financial well-being of children; create a community coalition, anchored by faith-based community involvement, to initiate and implement a community marriage policy and process to support healthy martial relationship and responsible fatherhood; establish community norms that support families and responsible parenting.


    [Charts pertinent to the Division of Welfare's presentation will be maintained in the Committee's Senate office until the end of the 2004 legislative session.]

    Medicaid The Division of Medicaid's Acting Administrator Randy May presented a synopsis about the Medicaid SFY2003 budget, Medicaid receipts, the holdback restorations, Healthy Connections, pharmacy and enhanced prior authorization, and the CHIP (Children's Health Insurance Program) access card.
    Medicaid SFY 2003 Budget
    Original Estimate Appropriation Actual

    Receipts
    State
    Federal
    Totals

    $37,880,200
    261,426,705
    638,802,995
    $938,109,900
    $35,806,800
    228,785,400
    556,188,500
    $820,780,700
    $66,870,800
    226,449,200
    576,238,800
    $869,558,800


    SFY2004 legislative action's updates include:

    • Residential Habilitation Agency fees' $657,800 (raised per client daily rate from $6.54 to $7.96)
    • Targeted Case Management for clients with developmentally disabilities $327,900 (raised hours per client per month from 2.5 to 2.75)
    • Targeted Case Management for mental health clients $499,900 (raised hours per client per month from 4 to 5 and additional crisis hours available as needed)
    • Expanded adult dental benefit $3,180,000 (funding includes $600,000 transferred from children's orthodontics plus $2,580,000 directed funds
    • Service expansion includes continuing emergency services, provides limited preventive and restorative services to all Medicaid adult clients
    • Sheltered Workshops - transferred $443,400 from Medicaid to the Division of Family and Community Services to fund partial restoration of sheltered workshops.


    Mr. May explained enrollment for the Healthy Connection Program continues to increase. He briefly outlined the Enhanced Prior Authorization Program, the P&T Committee (Pharmacy and Therapeutics), and Drug Utilization Review Board (DUR).

    The SmartPA was also discussed. This is an automated pharmacy prior authorization software package that implements clinical rules. SmartPA is to be implemented with HIPAA (Health Insurance Portability and Accountability Act) release in December 2003. The IDHW is currently on track to implement the project.

    CHIP Access Card Mr. May also explained the objective of the CHIP access card is to expand health care coverage to a greater segment of the population (150% to 185% of the federal poverty level). Medicaid's Deputy Administrator Kathleen Allyn is the project sponsor. This project involves the High Risk Reinsurance Pool Board, the Department of Health and Welfare, and other external partners. [For additional data pertinent to the CHIP Access Card project contact the Division of Medicaid.
    Technology Information and Technology Division Administrator Charlie Wright presented a slide show about the new Common Directory (CD) software, and how it improves the application process. The CD project is a database of pertinent information about clients regardless of what services they may be receiving. Currently, a client who is receiving benefits from food stamps, child support, and child care, is entered in three different computer systems managed by the IDHW. The CD project links the IDHW's computer systems together by entering each client in a directory that has their name, birth date, gender, Social Security data, and client's identification numbers. In all, seven department computer systems are linked together through the Common Directory. A process is identified to alert an employee when information about a particular client should be protected or handled with caution.

    The Common Directory project paves the way for better customer service. The CD links Welfare computer systems for child support, child care and self-reliance programs to other divisions' programs. The CD will inform the IDHW of people who may be receiving more than one service, and will allow the IDHW to see a complete picture of all the services an individual receives, and coordinate with other programs.

    [Charts pertinent to the Common Directory Project will be maintained in the Committee's Senate office until the end of the 2004 legislative session.]

    Family and Community Services (FACS) The Division of Family and Community Services Administrator Kenneth Deibert and Child Welfare Program Manager Shirley Alexander outlined child welfare, foster families, the child and family services review, the federal proposal - Title IV-E Foster Care Reform, substance abuse, and children's mental health caseloads.

    Idaho Child Welfare Background:

    • Total number of children placed in Idaho foster care increased from 2,008 children in year 2000, to 2,260 in year 2002. A 12% increase.
    • Daily censuses of children in foster care increased from 896 children in 1996 to 1,215 in year 2002. A 38% increase.
    • The number of social workers in IDHW shows a 4% decrease. Social workers are carrying higher caseloads.
    • Federal government recommends a social worker perform no more than 12 risk assessments per month. In 11 of the IDHW offices, workers perform more. In the Caldwell office, social workers are averaging 19 risk assessments per month.


    Foster Families:

    Idaho has a very active role recruiting foster parents. In year 2000, IDHW had 854 foster parents and in year 2002, had 1,120 foster parents - a 31% increase. Idaho still has a need for Hispanic and Native American foster families. The IDHW is placing more emphasis on training for foster parents, and retaining current foster parents.

    Child and Family Services Review:

    The federal government review is a comprehensive assessment of child welfare services that examine the child welfare system each state has developed to provide safety, permanency and well-being of children and families. The review examines the soundness of the infrastructure of the system. The goal of the review is to help a state improve their child welfare services, and achieve improved overall outcomes for children and families.

    The review evaluates recurrence of maltreatment, foster care re-entries, incidences of child abuse and/or neglect in foster care, stability of foster care placement, length of time to achieve reunification, and length of time to achieve adoption.

    The review also evaluates factors such as responsiveness to the community, the statewide information system, foster and adoptive parent licensing, recruitment and retention, case review system, quality assurance system, service array and resource development, and staff and provider training.

    In years 2001 and 2002, 32 states were surveyed; none of the 32 passed the review. In 2003, six (6) states have been surveyed. The IDHW does not expect Idaho to pass the review. Most states that have completed the review are allocating additional manpower and resources to ensure they meet their Program Improvement Plan goals.

    • Idaho has a good system for screening prospective foster and adoptive parents to protect children if they require an out-of-home placement. Consequently, Idaho also has a low abuse rate for children in foster care.
    • IDHW has a good computer data system in place to track children.
    • IDHW has a good relationship with other agencies, and the courts, to provide services to children and families.
    • Statistically, IDHW reunites 88% of foster children with their families within a year.
    • IDHW needs to provide comprehensive services to foster children and families, and develop additional services in rural areas so if a child in foster care is reunited with their family, the child does not suffer repeated abuse or neglect.
    • Improve training programs for new caseworkers.


    Idaho's final review report has not been received.

    Title IV-E Foster Care Reform:

    The Bush Administration and Health and Human Services Secretary Tommy Thompson, are proposing a "Child Welfare Reform Option." This proposal will make dramatic changes to the funding structure of Title IV-E foster care for Idaho. Under the proposal each state would have an option to receive a fixed, predetermined allocation or block grant, of Title IV-E foster care maintenance payments, administrative costs and training funds. States could use the funds for any child in the child welfare system, regardless of income. Based on current eligibility, approximately 60% of all children in Idaho are supported with federal funds. A state choosing the option would have to maintain the same level of state funds now used to draw down federal Title IV-E foster care funds.

    This proposal breaks the links between federal funding based upon an open-ended entitlement funding formula, and transforms it into a fixed amount of funds no longer driven by need or number of eligible children. Freezing federal foster care funds, along with the current funding levels would mean that at least 70% of federal spending for child welfare would be frozen through 2008. The Administration's foster care proposal is cost neutral, setting a 5-year cap on spending. The proposal does not recognize the need for any new resources of potential expansion in the number of children enrolled in foster care services.

    Substance Abuse Admitted for Treatment:

    A chart outlining substance abuse treatment cases from FY2000 to FY2003 was reviewed. In FY2000, 4,372 adults received treatment and a projected FY2003 caseload is 4,357. In FY2000, 829 adolescents received treatment, and the FY2003 projected caseload is 968. Budget uncertainty impacts the program.

    Children's Mental Health Caseload:

    An increase in new Children's Mental Health (CMH) referrals have occurred because of the increased efforts of the IDHW and community partners to inform and educate families of available services. During FY2003, the IDHW reduced Children's Mental Health staff by 14.5 FTEs (full-time employees), which necessitated a change in the system to avoid a reduction in services. The reduction in the number of assessments completed by Children's Mental Health authority in FY2003 is a result of the reduction in staff, which then allowed private providers to complete assessments for Medicaid-eligible children.

    • FY2002, CMH had 4,273 new referrals.
    • FY2003, CMH had 5,335 new referrals.
    • FY2003, 69 youth received inpatient services at State Hospital South (SHS).
    • FY2002, 56 youths received inpatient services at SHS.
    • Adults Mental Health statewide caseload in FY2002 was 9,199 and in FY2003 the total caseload was 9,833.
    Health The Division of Health Administrator Richard Schultz and Epidemiologist Dr. Christine Hahn presented a status report pertaining to immunization screening, bioterrorism and block grant, SARS, West Nile, Smallpox, and Monkeypox.

    Immunization Screening:

    Immunizations are required in Idaho for access to school and childcare facilities as defined by Idaho Code 39-4801. Immunization status is also part of the eligibility screening for limited department programs. An exemption statute, 39-4802, Idaho Code, also exists. The exemption allows a parent or guardian to refuse immunizations for themselves or their children for medical, religious, or philosophical reasons. The healthcare community advocates for the immunization of children.

    In accordance with medical standards recognized by the Board of Medicine, and the immunization recommendations available from the IDHW's Bureau of Clinical and Preventive Services, within fourteen (14) days of a child's initial attendance to any licensed day care facility in Idaho, immunizations are required and must be administered, appropriate for age, to children four (4) months of age and older:

    • DTP or DtaP (Diphtheria, Tetanus and Pertussis)
    • Polio
    • MMR (Measles, Mumps, and Rubella)
    • Hib (Haemophilus Influenza Type B)
    • Hepatitis B


    All children are required to have certain vaccinations before entering school or child care. A medical exemption requires a signed statement from a licensed physician that the child has a medical condition preventing him or her from receiving any or all of the required vaccinations. This must be presented to school authorities at registration. A religious or philosophical exemption requires the parent or guardian to complete an official exemption form, which is contained on the back of the Idaho School Health form and Daycare form.

    Bioterrorism:

    Last year, Idaho received a $7 million federal grant for bioterrorism preparedness associated with public health, and a $700,000 federal grant for hospital preparedness.

    Areas of preparedness include the capacity of the public health system - what can we do, how much and how fast; legal authorities - statutory

    authorities; knowledge of staff to respond appropriately; epidemiology and public health response plans; mass vaccination plans; capacity enhancements - staffing and mutual aid agreements; passage of Senate

    Bill1075 - quarantine and isolation authority; update reportable disease rules; coordination of services; training; disease control measures for

    specific organisms; forensic epidemiology and laboratory analytical methods for new emerging diseases; and emergency medical communication systems.

    Hospital Preparedness:

    Assess hospital capacity, developed hospital-specific response plans, and developed regionalized hospital response plans to cope with a surge of 500 patients.

    Other areas discussed included:

    • Capacity to respond to chemical exposures,
    • Enhanced training and equipment
    • Current infrastructures,
    • Improve ability to respond to disease outbreaks and other public health threats,
    • Contract with district health to coordinate continued development of public health and hospital response at local levels,
    • 42 new FTEs hired in public health districts.
    SARS Mr. Schultz discussed how Idaho's public health system is preparing for SARS. Outbreak plans are in place at district and state health departments, a "health alert" has been issued to primary care physicians alerting them how to notify authorities of possible cases, what testing is available, and the authority for isolation and quarantine.
    Smallpox He explained the current situation in Idaho for Smallpox vaccination. As of June 9, 2003, Idaho's last vial of vaccine expired, and no additional vaccine is available at this time. The Institute of Medicine and the Advisory Committee on Immunization Practices, both urge caution in proceeding with further vaccination.
    West Nile Virus West Nile Virus (WNV) is a mosquito-borne virus that can cause serious illness. WNV is relatively new to North America and has spread rapidly across the United States since its discovery in New York in 1999. People and animals catch WNV from infected mosquitoes. There is no vaccine for people. Most people bitten by an infected mosquito do not become ill, although some may experience a mild fever, headaches and body aches. As of June 30, 2003, no case of WNV was known in Idaho.

    There are approximately 13 active mosquito abatement districts statewide. Mosquito control is a key to disease control, and control is a local effort.

    Monkeypox Monkeypox is a rare viral illness normally found in central and west Africa. The disease was discovered in 1958, and affects many mammals including man, rats and squirrels. It causes rash illness similar to smallpox, and the smallpox vaccine is effective against monkeypox. The
    disease entered the United States with infected Gambian rats from Africa in early 2003. The first illness in people and exotic pets was detected in May 2003. Interstate movement, sales, and importation of exotic pocket pets (prairie dogs, certain squirrels, and certain rats) were banned by the FDA (Federal Drug Administration) and the CDC (Center for Disease Control) of June 11, 2003. To date, no monkeypox cases in people or animals exist in Idaho. There are ongoing health education efforts in Idaho.
    A brief discussion was held pertaining to other health issues such as: status of venereal diseases in Idaho; the role of the public health district offices to notify public; prevention and treatment of venereal diseases and risk behavior. Idaho's diabetes management program was also discussed.
    IDHW Regions The IDHW's Region I Director Michelle Britton outlined the roles and responsibilities of the seven (7) regional directors who represent the Department's Director Karl Kurtz. Regional directors provide leadership in their communities to bring individuals, businesses and others together to develop partnerships, relationships and resources for a sustainable and integrated health and human service system to promote a healthier Idaho at less cost.

    The regional directors' jobs are tied directly to the IDHW strategic plan. She explained the goals, objectives and tasks target dates of the strategic plan.

    Care Management Alisa Axtman, from the Division of Medicaid, presented an outline about Medicaid's Adult Developmental Disability Care Management Program. She discussed a client's care management process such as the enrollment, assessment, budget plan, plan development, review and approval plan, prior authorize services, delivery of services, and quality assurance.

    She explained the background of the program and the escalating costs for Medicaid developmental disabilities (DD) services, and the success of the pilot project in Region II. The Department's staff has been trained and will provide training to external stakeholders including providers, contractors, and consumers.

    Also discussed was the Independent Assessment Provider (IAP) to complete assessments and review and authorize a client's service plan. Idaho's state colleges and universities can fulfill the role of the IAP with

    a high degree of quality. Six schools have also expressed an interest in an IAP contract.

    The IDHW is currently working with a vendor to develop automation solutions for multiple programs including Adult DD Care Management. Efficiencies from automation will enable IDHW staff and providers to focus more on quality improvement.

    All Idaho adults receiving Medicaid funded developmental disability services will have a care management plan developed by January 2005.

    Any Door Initiative

    The Any Door Initiative is the next phase in IDHW's realignment and consolidation plan. It evolved from Goal five (5) of the IDHW's Strategic Plan ". . . . align structures, people and technology, while improving communication and customer service. . . ."

    The goal is that any door should be the right door for people to get the information and services they need. Integrating services will lead to better outcomes for clients and families and provide more effective and efficient services. It means a focus on prevention, identifying needs early to lead to a shorter stay in the system, and fewer people returning after they leave. It means healthier people, stronger families, and safer children.

    The Any Door system design will be complete in the fall of 2003, and the prototype will be tested from January through September 2004. Part of designing this new system will include identifying the skill sets needed to support integrated service delivery. The organizational structure of the Idaho Department of Health and Welfare will change. The design will allow IDHW to continue to provide good service to Idahoans.

    Adjourn There being no further business to discuss, the committee adjourned at 3:50 p.m.