EXCUSED:

Regarding length of meetings, the Chairman remarked that last year, time
was taken to educate new members and was a necessary factor that
resulted in some very long meetings. This year the Chairman will be taking
less committee time for education though he is sensitive to the fact that
educating the members on issues that come before the committee will at
times be necessary. The Chairman stated that in an effort to reduce their
length, if a meeting has not ended by 5:30 p.m., he will let the committee
decide whether or not they wish to continue further or adjourn to a later
time. He stated that the issues before the committee do not seem to be as
numerous or as difficult this year. The Chairman then opened up the
meeting for discussion and questions from the members.

Some of the members commented on the length of time allowed for
testimony. The Chairman shared that he believes those who come before
the committee ­ particularly citizens wanting to testify – should be able to
take the time that they need to make their point, but he will always
consider requests from members to establish a time limit. He suggested
that the members be sensitive to the fact that it is difficult for the public to
take time to appear at meetings and they are often very intimidated by the
process and the members. If no time limit has been imposed, it will be up
to each member to speak up if they feel one is needed.

Representative Henbest brought before the committee the consideration
of scheduling informational meetings, whether the best time would be
before or after the regular meetings or at another time altogether. She
shared the concern of having individuals who take time away from work,
especially professionals, who attend a meeting pertaining to a particular
legislation and that legislation ends up being carried over to the next day
due to lack of time. The Chairman asked that when members know that
people with difficult schedules will be appearing to testify on a bill that they
please bring this kind of situation to his attention so that he will have an
opportunity to plan ahead and schedule accordingly.

The Chairman urged the members to take the responsibility to be
knowledgeable regarding parliamentary procedure. He reminded the
members that the proper working of every legislative body, whether the full
House or its Committees, requires the proper use of parliamentary
procedure. It is each member’s responsibility to make sure they are
knowledgeable regarding that procedure and also willing to use it to make
their voice heard. He asked that any time a member has a question
regarding the procedure, even if this occurs during a vote, that he/she
bring it to the attention of the Chair immediately, allowing the Chair to
make proper rulings at the time and assist in education or explanation.

The Chairman opened for discussion and welcomed questions from the
committee. After time for discussion, the Chairman requested of the
committee that whenever they have questions or concerns that they
“speak up” and bring the issues at hand to his attention so that he can
take steps to assist in a resolution.

The Chairman addressed the committee regarding the challenge before
them concerning the growing health care crisis. The increases in the cost
of health care cannot be sustained and more and more people are faced
with going without health insurance.

Chairman Sali referred to a conference that had been sponsored by the
Idaho Assisted Living Association. Speaker Newt Gingrich had been
featured and had discussed many of the points raised in his book Saving
Lives, Saving Money. The members were urged to read the book and
contemplate Speaker Gingrich’s points and suggestions. Chairman Sali
remarked that he had concluded, following the conference, that health
care as it is known in the United States will not exist in ten years because
the increases in costs cannot be sustained and because the growth in the
long-term care population will cause further increases, resulting in greater
overall consumption of health care and also resulting in a provider
shortage.

He pointed out that each member has been elected to lead in this area
and he encouraged each member to rise to the challenge that lies ahead
and participate in every way possible. He commented that this committee
shares a great responsibility in the future outcome for healthcare for the
state of Idaho.

Representative Garrett commented that she is serving on the Healthcare
Task Force. She asked that the Chairman seek to have more committee
members appointed to that task force as she believes there is a greater
opportunity for improvement and change if the group has a stronger voice.
Chairman Sali asked Representative Garrett to approach the Speaker
with her request. He will be happy to join her.

The Chairman will be dividing the Rules into two groups. Rules that
appear to be more complicated or controversial will be heard in front of the
full committee. The sub-committee will be assigned the remainder. He
appointed Representative Garrett to chair the sub-committee.
Representative Kulczyk, Representative Mitchell and Vice-Chairman
Block will also serve on the sub-committee. Other members are
encouraged to attend the sub-committee as time allows. The committee
will report back to the full committee. Chairman Sali asked the members
to advise him if they hear of any rule dockets that may require the time of
the full committee.

There being no further business brought before the committee, Chairman
Sali adjourned the meeting at 2:20 P.M.

EXCUSED:

Dr. Erik Olsen, a member of AARP Board of Directors, gave a brief
presentation on the Medicare prescription drug bill that was passed last
year. He stated that the passage of this bill has created opportunities and
challenges for AARP, its members and volunteers, but they believe this
has opened a new era of opportunity for Medicare beneficiaries throughout
the country. Dr. Olsen elaborated on the following points: The $400
billion benefit is to be spent in the following areas — those at the lowest
end of the income scale, those with very high drug costs, employers who
might be forced to drop retiree coverage, and a basic benefit applying to
everyone. A drug discount card will be available this year which will allow
about a 15 percent savings off the retail price of prescription drugs. He
summarized by saying that AARP thinks this benefit was well worth
supporting and their goal is to make prescription drugs more affordable for
seniors and they will continue to strive for this goal. (See attached for
more detail of his presentation). Chairman Sali invited questions from the
committee.

Crisis case management means “linking, coordinating, and advocacy” and
does not include crisis counseling, transportation, or skills building
provided through other channels. These rules require providers to
document crisis services and submit written justification when crisis hours
fall into the more restrictive category. This docket lengthens the interval
for service plan reviews from 120 days to 180 days. It also allows licensed
clinical professional counselors without private practice licensors and
marriage and family therapists to provide case management services.

By Unanimous Consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0309-0215.

With the allocation of about $148,000, the Department increased on-going
case management hours (those not requiring meeting “crisis” criteria) from
four to five hours per month. This current benefit package allows for five
hours of on-going case management, three hours of crisis case
management that doesn’t require prior authorization, and four hours of
crisis case management that requires justification and prior approval.

By Unanimous Consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0309-0306.

Mr. Rogers asked for the permission to give the Committee a brief
summary on the remaining dockets since they are all related, and then
address each docket separately. There was no objection.

He explained that the purpose of these rules is to promote a sustainable,
integrated health care system that ensures adults with developmental
disabilities receive the right outcomes by accessing the care, in the right
place, at the right price.

Managing care improves the quality of care, controls growth in costs and
promotes consumer satisfaction through an objective assessment process
that focuses on the individuals’ needs.

The primary elements of these rules include: the use of an Independent
Assessment Provider; Improved Quality Assurance and Quality
Improvement; increased participant choice and engagement in the
development and delivery of their services.

Chairman Sali clarified to the Committee that the Behavioral Health Care
Management program as it is now called, was formerly known as the
Utilization Management Program. The House Committee had urged last
year that the Utilization Management program be postponed until
projected savings could be more clearly identified. Funding was not
explicitly provided by appropriation, but rather was to come from projected
savings. Last year the Committee had serious concerns regarding those
projections. At the urging of the Senate Health and Welfare Committee,
Utilization Management was implicitly approved by JFAC with approval of
the Department’s appropriation and the program is now in place.

If requested services fall outside the individualized participant budget, it
can be referred to a Department care manger for additional evaluation,
review and approval as appropriate. Medicaid funded services will not be
reimbursed unless authorized by the Department.

The new chapter also outlines quality assurance and quality improvement
activities. The development of these measures will be critical as Idaho
moves toward greater self-determination for participants and the service
system is transformed into a more consumer-directed model.

During discussion of this rule, Chairman Sali put the Committee at ease.

Chairman Sali called the meeting to order at 2:50 P.M. Representative McGeachin distributed a copy of a Consumer Budget Distribution report
that she received from a constituent. This report reflects the Level of
Support linked to SIB-R scores with their corresponding budget ranges
(See attached). Questions and discussion followed relating to this report.

Committee discussion continued with the following points covered:
concern regarding budget distributions to participants based on the level of
need, the need to better monitor funds that are allotted to participants,
criteria used for assessing qualifications of independent assessment
providers, the extent the SIB-R is used as an assessment tool.

In response to questions from members, Mr Rogers commented that the
Department has worked diligently to match the participants’ needs with the
level of support received. Reports from the recent Pilot Project have been
an effective tool in monitoring the level of support compared with the level
of need. The Department tries to determine on an individual-by-individual
basis whether or not these services parallel with what was intended. He
said he would be happy to provide additional information regarding budget
distributions and any other information the Committee would desire.

Committee discussion and questions followed. One of the main concerns
from the Committee was the language as it is currently written in Section
143.06.b.iii of the Rules Governing Medical Assistance Program is not
clear.

Jim Baugh, executive director of CO-AD (Comprehensive Advocacy,
Inc.), addressed the Committee with his concern with the interpretation of
the language to be a factor in determining eligibility versus a factor for
establishing a budget for care management. He is concerned the
participants’ eligibility would be more restrictive.

After further discussion the Committee agreed with Chairman Sali’s
proposal that the Department write a letter stating that the intent of the
changes made in this section would not affect eligibility criteria for
participants. Kathleen Allyn, deputy administrator for the Division of
Medicaid agreed to prepare the letter with an explanation that would serve
as a record, to be given to the Committee at the January 22, 2004
meeting. The letter is attached to these minutes.

Bill Benkula, president of the Idaho Association of Developmental
Disability Agencies presented his testimony regarding Docket 16-0313-0301. His agency continues to support the concept of utilization
management plan, however they maintain that it can be done more cost
effectively by professionals in the field performing the assessment process
in collaboration with the Health and Welfare personnel who authorize
services. The $2 Million expense of an independent assessment provider
is unnecessary.

Mr. Benkula remarked that the Care Management program shifts the
service authorization process from physicians to the Department and its
contracted Independent Assessment Provider. He also stated that under
the current program, the client’s access to appropriate services and
supports will change from choices, flexibility, and self-direction to simply
eligibility and the resulting program cost. Appropriate therapeutic services
and the quality of services available to the clients will be severely
challenged under this new system. He is concerned as the rules are
presently written, that too much weight is given to the SIB-R as the unit for
measuring the participant’s need with the level of support they should
receive. He gives the Department credit for their efforts in trying to come
up with a workable, effective system.

Kelly Hall, an owner and plan developer with Dunstan Hall & Associates,
addressed the Committee. She explained that the support plans they
implement are based on projected use. They may have a client who was
budgeted for a certain amount for services in a given year, but due to
vacation, illness, etc., not all of the services were used. Consequently the
budget for the next year may be less. This situation makes it very difficult
in making their projections.

Committee discussion followed with reservations regarding accepting
either of the two dockets before them, Docket 16-0313-0301 and Docket
16-0309-0307.

Chairman Sali asked if it would be the pleasure of the Committee to
withhold action on Docket 16-0313-0301 subject to the call of the Chair.
There was no objection.

Chairman Sali asked if it would be the pleasure of the Committee to
withhold action on Docket 16-0309-0307 subject to the call of the Chair.
There was no objection.

By Unanimous Consent, the Committees’s report will reflect there was no
basis found upon which to reject Docket 16-0323-0301.

By Unanimous Consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0411-0301.

for Residential Habilitation Agencies with the new chapter.

By Unanimous Consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0417-0301.

EXCUSED:

The Chairman presented to the Committee the official letter from the
Department, previously requested by the Committee at the January 20th
meeting regarding the criteria of eligibility determination. The letter will
serve as record of clarification of the changes made in Docket 16-0309-0307, Section 143.06.b.iii of the Rules Governing Medical Assistance
Program. (The letter is attached.)

The Chairman explained to the Committee that on the Internet, a list of all
of the rules for the Health and Welfare Committee for this current year
were attached to the minutes from the January 14, 2004 meeting as an
Exhibit A. This attachment includes the web address for anyone who is
interested in seeking further information about a specific rule/rules. The
Chairman asked for consent for the Exhibit to be attached to those
minutes on the Internet, though they had already been approved by the
Committee. There was no objection.

The Chairman asked that those who wish to testify please be considerate
of the Committee by not duplicating testimony that has already been
heard.

rule changes was twofold: a) There was a need to reflect changes in
provider and department responsibilities as a result of staff reductions in
the Regional Mental Health Authority; and b) There was a need to clarify
service expectations and provide service definitions in response to health
& safety concerns, particularly for services provided in Partial Care
settings.

The first part of the docket identifies changes to the Pycho-Social
Rehabilitation (PSR) rules, reflecting the reduction in Regional Mental
Health staffing and resulting changes in roles and responsibilities of
Private PSR providers. The functions of assessment and service planning
have been transferred to the private PSR providers.

PSR Provider Agency personnel coming into direct contact with
participants must comply with existing statutes governing criminal history
check requirements; and, PSR agencies provide 24-hour crisis response
services for their participants or make contractual arrangements for the
provision of those services.

The changes to the mental health clinic rules and related partial care rules
were made primarily due to safety issues. Prior to these rules, “partial
care”, a –Mental Health Clinic Service– could be applied to a number of
programs. Some, including babysitting, television watching, and/or boot
camp type services. For lack of clearly articulating service expectations,
many of the safety issues have arisen in this setting.

This rule does not introduce any new federal or state requirements for
clinic except for the inclusion of building standards, which were added as
a direct result of documented cases of child endangerment due to
substandard buildings that were being used as clinics.

Ms. Clement further explained that there were a number of concerns
expressed by providers and other stakeholders after three separate public
hearings were conducted regarding the changes made in the Mental
Health Clinic section which includes Partial Care. The Department staff
have been drafting amendments that attempt to clarify requirements,
however, they have not been finalized. A meeting of interested
stakeholders will take place on February 5, 2004.

She concluded the presentation by stating that the Department is
committed to continued negotiations with stakeholders in order to produce
resulting rules that will be in compliance with applicable state and federal
laws, protect the health & safety of the recipients, be cost effective, and
will recognize resource limitations.

The Department requests that the Committee extend these temporary
rules with the Department’s assurance they will continue to work with
stakeholders on amendments that will address areas of concern.

Kelly Keele, social worker with the Mental Health Providers Association
of Idaho addressed the Committee. He briefly touched on the following
three issues: The definition of Partial Care needs to be more clearly
defined. For example, in one part of the rules the term socialization is
included for one of the services and in another area it is excluded. The
changes to the building standards are good changes and are supported
by those he represents. He proposes the current 56 hours of treatment
required per week is not necessary and should be lowered to 36 hours
per week.

April Crandall, president of Mental Health (MH) Provider’s Association of
Idaho addressed the Committee. She acknowledged that the Department
met with the Mental Health Provider Association and she complimented
them on their commitment and willingness to continue to have open,
monthly meetings with concerned groups and to continue to work on
amendments. The MH Provider’s Association recommends that this
proposed temporary rule be extended with the expectation they will be
amended following further negotiation.

Steve Myers M.D., a pediatrician in Idaho Falls spoke passionately to the
Committee regarding the need for change within Partial Care services
program. He shared several concerns that he has with PSR. Children
are in partial care programs for years without parent interventions in
place; lack of qualified PSR oversight and assessment after working with
a client for over a year; utilizing programs that are not designed to treat
the severity of the problems of children; lack of communication with the
doctor who is designated the “Team Leader”.

He further explained that policy and procedures should not be created
from the top down, but from the bottom up. Those responsible need to be
able to explain why outcome goals are not being met. He stated that the
system is fragmented.

He recommends the following; develop a state oversight system to review
treatment plans and account for outcomes not being met; make parent
participation a MUST and give parents mental health access services if
needed; provide day care if needed but do not squander limited partial
care resources for day care activities.

Tammie Bradley, a social worker from Blackfoot, Idaho, addressed the
Committee. She stated that she is in favor of the proposed rules but
believes that several changes need to occur within the scope of the
language in order for mental health services to be effective.

Matthew Smith, program director Mental Health Clinic in Idaho Falls
addressed the Committee. He stated that this is generally a good rule,
but changes still need to be made. He recommends that there be
additional stringent outcome and accountability measures for private
providers. This will allow the state to expend its resources more
effectively. He also recommends that a licensure system be set up for
partial care programs.

Ms. Clement was asked to yield to the Committee’s question regarding
the issue of allowing paraprofessionals to perform therapeutic services,
even with the recommended professional supervision. The Department is
not in favor of taking this approach. They believe it loosens the
qualifications. The Department’s philosophy has been to increase the
qualifications and standards.

Committee discussion continued regarding options of acting on this rule.

Michelle McMullen from the Office of Administrative Rules yielded to
questions and explained that a temporary rule cannot be amended. The
Committee can find no reason to reject the rule, or the Committee can
reject the rule, but the Committee cannot make changes to the text of the
rule. If a temporary rule is held, the Committee should act on it before the
end of the legislative session.

Discussion continued on the Motions before them.

After discussion, Representative Mitchell withdrew his SUBSTITUTE
MOTION.

The Therapeutics Committee and the Medicaid Pharmacy work together.
The Committee makes recommendations to the Department regarding the
Enhanced Prior Authorization Program.

Additionally, in an effort to obtain the right price for medications paid for
by Idaho Medicaid, this rule adds guidelines for a supplemental rebate
program which allows the Department to purchase prescription drugs in a
cost-effective manner. Supplemental rebates will be received in addition
to rebates Medicaid currently receives. Supplemental rebates allow for
price competition to occur after a thorough scientific (evidence-based)
review.

John Santa, M.D., Assistant professor, Oregon Health and Sciences
University who supports the Evidence-Based approach addressed the
Committee about the Drug Effectiveness Review Project in Oregon (see
attached materials). This project provides Idaho and other participating
organizations with the most current, comprehensive, rigorous review of
evidence regarding the comparative effectiveness and safety of selected
prescription drugs. It does so in a way that is independent, scientific, and
objective enabling local decision makers to evaluate all of their decision
options.

This project is a collaboration of private and public purchasers, like Idaho,
who think it best to do this information gathering step together. Each
participant, including Idaho, has a vote in selecting the drugs to be
reviewed and identifying the key questions regarding these drugs. The
project will be guided throughout by local decision makers with input from
stakeholders in their state or organization.

The Center for Evidence-based Policy (described in the attached
materials) provides support to the project by facilitating the collaboration,
including contracting with Evidence-based practice centers to review and
report on the drugs and key questions identified. He shared an example
in support of this process regarding the effectiveness of different drugs
(see ACP Journal Club, Jan. ’04 attached).

Dr. Santa provided a more detailed paper summarizing the key elements
of systematic reviews (see attached). He invited questions from the
Committee.

Ted Epperle, M.D., physician and physicians’ trainer, addressed the
Committee in support of the rule. Dr. Epperle believes that this program is
cost-effective and provides a mechanism to insure safety and
effectiveness for patients. He explained that the program is data-driven,
evidence-based, and chooses the best practice. This is a system that
educates and also provides feedback for physicians. He said that this
does not take away from the primacy of the doctor/patient relationship. If
the decision by the Department is not in agreement with the patient or
doctor, then they have the option of choosing another alternative at their
cost. He invited questions from the Committee.

Jim Alexander, pharmacist, spoke in support of this rule. He explained
that this program is cost-effective because it creates the opportunity to
derive information from scientific data instead of relying on advertisers
and prescription drug salesmen. He invited questions from the
Committee.

Bill Roden, representing PHRMA –the trade association for research
based pharmaceutical companies in the U.S. addressed the Committee.

He explained that since last year, the Department has made significant
strides to open the process of communication for all stakeholders,
particularly through the efforts of the new Medicaid director, David
Rogers. He confirmed that the industry still believes that the Department
is headed in the wrong direction through the implementation of a Prior
Authorization system linked to Supplemental Rebates. He does
appreciate that there has been a significant improvement in
communication through the efforts of Mr. Rogers.

Mr. Roden summarized the problems as follows: a) there is no statutory
authority for implementation of supplemental rebate programs in Idaho;

b) cost effectiveness of such a program may not be great, because the
rebates will offset against state expenditures, with a resulting loss of
federal funds since the rebates will not qualify for federal fund match;

c) the rule authorizes the Department to utilize the services of a third party
to negotiate supplemental rebates. The designated third party is also a
commercial provider of health insurance containing drug benefits. He
believes this is a conflict of interest; d) Because of the definition of
“therapeutic interchangeability” in another portion of the rule, cost is not a
factor that can be considered by the P&T Committee in making its
recommendations to the Department for PDL purposes. He said that
PHRMA believes that any rule that allows the Department rather than the
prescribing physician to make the final decision as to the medication to be
prescribed is not in the best interests of the patient. He invited questions
from the Committee.

Rick Sutton, pharmacist for Shopko, Boise, addressed the Committee in
support of the rule and stated that he always has been in support of the
Prior Authorization program. He explained the process undertaken
during Pharmacy & Therapeutic Committee meetings is extensive and
thorough. The members are comprised of physicians, professionals,
pharmaceutical representation and the public. He shared that the Smart
System (computer program/Medicaid) is very effective in retrieving
necessary patient information for the pharmacists and provides data in
seconds. He invited questions from the Committee.

Clyde Dailey, State director for AARP of Idaho spoke on behalf of AARP.
He briefly stated that AARP endorses the invaluable work the P&T
Committee has accomplished and feels the promise of future work of the
P&T Committee can only strengthen the analysis of the drugs in the
market place.

Representative Garrett addressed the Committee with her remarks
regarding this rule. She believes that the P&T Committee is appropriate
for the purpose of obtaining and reviewing the best possible evidence and
making sound, clinical decisions about the effectiveness of medications
for patients. She stated she still has concerns on Evidence-Based
research for very new drugs. She also stated that this is a very new
process but believes that this is what needs to happen to move to the next
level.

Rep. Garrett distributed a copy of letter dated January 8, 2004,
addressed to Governor Kempthorne from Karl Kurtz, Director, Health and
Welfare, which provides an update on the Medicaid Enhanced Prior
Authorization Program for prescription medications (see attachment a);
Also attached is memo dated January 22, 2004, from Jeanne
Goodenough, Chief, Human Resources, Office of the Attorney General to
the Department of Health and Welfare (see attachment b); Also attached
is a chart illustrating the route that a pharmaceutical drug takes from the
initial response of the pharmacy through approval/disapproval and on to
the patient (see attachment c).

Committee discussion followed.

Chairman Sali suggested the Committee could vote to approve Docket
16-0309-0303 and allow the process to continue to improve the program.
The Committee continued with discussion.

By Unanimous Consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0309-0303.

By Unanimous Consent, the Committee’s report will reflect there was no
basis to object Docket 16-0501-0301.

By Unanimous Consent, the Committee’s report will reflect there was no
basis found upon which to object Docket 16-0501-0302.

EXCUSED:

There was discussion on the minutes. The Chairman put the Committee
at ease.

Chairman Sali announced that due to computer difficulties, the prepared
minutes were not correct and corrected minutes for meetings of January
20, and 22 will be brought before the Committee for approval at the next
meeting on January 28.

Roger Hales, attorney for the Bureau of Occupational Licenses, stated
that the intent of this bill is to give a good representation by having a
public member and the legislation is not an effort to broaden the
spectrum of input.

Chairman Sali asked for unanimous consent to return RS 13468C1 to
the sponsor for further clarification. There was no objection.

Mr. Markuson responded to a question from the Committee regarding
filing prescriptions electronically. He said that there are electronic
systems already in place in some health care facilities. Chairman Sali
asked that he share with the Pharmacy Board the interest this Committee
has in establishing electronic prescription filing process.

By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 27-0101-0205.

By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 27-0101-0302.

Michelle Glascow, Director of the Idaho Assisted Living Association,
spoke in support of this rule. She explained work is being done with the
help of the Department, in developing a reimbursement plan which will
provide the incentive for participation that will allow dollars to be returned
to the state.

By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 27-0101-0303.

By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 27-0101-0304.

Within the first section, Idaho Medicaid has used the same
reimbursement methodology as Medicare for Ambulatory Surgical
Center. Medicare has recently changed their methodology for
reimbursing these facilities and this change is not compatible with Idaho
Medicaid’s automated system. The Department will continue to use the
historic reimbursement methodology instead of the new Medicare
methodology.

The second section of the rule deals with Personal Care Services.
Section 146 of the Medical Assistance rules, was deleted completely and
the entire section was reorganized and rewritten in plain language based
on ongoing input of staff and providers. In response to public comment a
new subsection was added to permit agencies to use a software system
allowing personal assistants to register their start and stop times and
maintain a list of services they provide by placing a telephone call to the
agency system from the participant’s home. This does not replace the
documentation requirements of these rules. Mr. Leary asked the
Committee to adopt this pending rule as final.

By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0309-0309.

Geni Weppner, Program Manager for the Division of Welfare yielded to
a question from Rep. Martinez who asked her about a constituent’s
concern regarding late payments made by the Department to providers
of the Idaho Child Care Program. Mrs. Weppner responded by stating
that the Department has acknowledged that there is a problem.

By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0612-0301.

She further explained that 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, and she is not aware of concerns from any other group.

By unanimous consent, the Committee’s report will reflect there was
no basis found upon which to reject Docket 16-0311-0101.

EXCUSED:

The Chairman reminded the Committee that three sets of minutes were
before them for approval. The minutes were for the meetings of January
20, 22 and 26.

Rep. Henbest questioned testimony as it was recorded for Dr. Meyer in
the minutes prepared for January 22nd. Rep. Garrett requested that the
letter to Governor Dirk Kempthorne from Health and Welfare Department
Director, Karl Kurtz, supporting Docket 16-0309-0303 (establishing P&T
committees) be entered in the minutes as an attachment. She also
asked that hand-outs she had prepared for the prior authorization
process be attached as well.

Rep. Martinez inquired about the meeting of the Psycho-Social Rehab
work group that the Department is planning to hold on February 5, 2004
in reference to Docket 16-0309-0311. Chairman Sali asked Kathleen
Allyn, Administrator, Medicaid Division, if she would ask Leslie Clement
to send a letter indicating the groups who do attend that meeting. She
agreed.

Programs provided by CAPs include: employment preparation and
dispatch, education assistance, child care, emergency food, senior
independence and support, clothing, home weatherization, affordable
housing, health care access, and much more. The existence of local
boards allows CAP’s to identify and develop programs to address the
needs of the low income in each community. It also allows them to
respond quickly to abrupt changes in those needs.

Community Action also mobilizes its partnerships into increased funding
for its programs. For every one Community Service Block Grant dollar,
another $7 are mobilized in monetary and in-kind resources through
private and public resources. Total state Community Service Block
Grant monies total $3.3 Million.

Jim Baugh, Executive Director of Co-Ad, Inc, responded to a question
from the Committee regarding how his agency was funded.

Vice Chairman Block yielded the gavel to Chairman Sali.

By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 22-0103-0301.

Ms. Kerr explained that the purpose of the rule is for the following: a.) to
update the rules for supervising physicians as required by changes to the
PA rules and to add the requirement for directing physicians as required
by the changes to athletic trainer’s act and rules. b.) to provide for
patient safety by limiting the numbers of physician extenders that a
physician may safely supervise and provide for required review of
education, training, and experience of each physician assistant assigned;
c.) to define the fee range for the registration of directing physicians; d.)
to clarify the responsibility of supervising and directing physicians, direct
complaints to the appropriate licensing board and limit scope of practice
to that of supervising physicians.

By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 22-0104-0301.

The purpose of this rule is to update the rules for athletic trainers to
reflect changes of House Bill No. 199 from the 2003 session. The rule
provides for a more formal relationship with the directing physician to be
defined by the Athletics Trainers’ service plan and protocol. It also
defines the duties and responsibilities of the directing physician, clarifies
the licensing types, allows for two-year renewal, and clarifies the renewal
process including continuing education requirements. This rule clarifies
appointment and responsibilities of the Board of athletic trainers, and
designates that a contact person for the Board of chiropractic physicians
be assigned; and clarifies the complaint process as it relates to the
directing physician and the athletic trainer.

By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 22-0110-0301.

Ms. Kerr further explained the purpose of the rules as follows: a.) to
update the rules for respiratory therapists to reflect changes of Senate
Bill No. 1165 from the 2003 session; b.) to provide addition of
polysomnographer permit types and related terminology definitions; c.)
to permit requirements and grounds for discipline for permitted
polysomnographers; d.) to clarify appointment and responsibilities for the
Board of respiratory therapists; e.) to provide for two-year licensure
renewal process; f.) to provide a uniform ground for refusal to issue or
renew a license or permit and suspension and revocation of license or
permit.

By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 22-0111-0301.

Ms. Allyn explained that 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 and 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 (effective July 1, 2002).

Ms. Allyn further explained that this 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 requirements to certification by one physician. Questions
from the Committee followed.

By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0309-0213.

Mr. Shultz listed the ten substantive changes in the proposed new Idaho
Food Code and how they are distinguished from the existing Unicode.
He responded to Chairman Sali’s request that he would provide this
same list to the Committee. (See Attachment B).

Mr. Shultz further explained that Senate Bill 1215 has passed the
Senate House and Welfare Committee which exempts jails and
correctional facilities from the food rules. The Idaho Assisted Living
Association has expressed concern over certain aspects of the rules.

Questions and discussion followed. Among some of the points of
concern shared was the requirement placed on churches, bed and
breakfasts, mom and pop grocery stores, and day care facilities.

Patrick Guzzle yielded to the Committee for clarification of how these
particular facilities will be affected.

A member from the Committee questioned the language under Section
001, .04, f. Title, Scope and Applicability, pg. 27 regarding the usage
of the words or/no. The Committee and Department believed it
reasonable to assume that the error in the wording was a typographical
error.

Chairman Sali yielded to Dennis Stevenson, Administrator, Office of
Rules Administration for his opinion of how to correct the typographical
error. After further discussion, Mr. Stevenson stated that he would
research proper procedures for this kind of correction and report back to
the Committee.

Michelle Glascow, Executive Director Idaho Assisted Living Association,
addressed the Committee. She stated that the Idaho Assisted Living
Association would like to express its concerns with the replacement of
the Idaho Unicode with the FDA 2001 Food Safety Code. She explained
that as with the correctional facilities, through an oversight, her industry
was not involved in the development and they are scrambling to come to
an agreement with Health and Welfare on ways to adapt these rules to
the Assisted Living Industry needs.

She further explained that smaller assisted living residences have unique
needs compared to larger industry food entities with large kitchens, chefs
and dieticians on staff. She said that they are convinced that they need
more time and she and her association are concerned that during the
interim, facilities may be exposed to unfair survey deficiencies, unfair
suspensions and litigation because of the facilities’ inability to meet the
requirement of this rule that really do not apply easily to some assisted
living providers. (Please see Attachment C for more detail of testimony).

Committee discussion followed. One of the main points of discussion
was the consideration of holding this rule until some of the problem
issues can be worked out.

Mr. Shultz yielded to this question by saying that since the Senate
approved this rule and if the House were to hold it until next year, then
those groups that have already gone forward with the program will be put
in jeopardy. He answered a question by saying that this rule will go into
effect upon adjournment of this legislative session.

Michael Kane, attorney, representing the County Sheriffs Association,
addressed the Committee regarding the concerns he has pertaining to
this rule. He commented that in order to meet the requirements, most
food groups will have the financial burden of increasing staff, and that the
added cost of these changes will be too burdensome on the correctional
institutions and the agency he represents. He explained that there is
legislation coming forth that will exempt the county jails as well as the
Department of Corrections and Juvenile Corrections. He does not
oppose this rule, as long as the forth coming legislation is passed.

Mr. Kane yielded to a question from Rep. Kulczyk by saying that the
county jails are overseen by the Health Districts.

Rep. Kulczyk commented that he does not think that the same rules
should apply to restaurants and public food service establishments as

apply to nursing homes and jails.

Chairman Sali expressed his concern regarding staffing issues, the
fiscal impact to the Medicaid budget as well as private business.

Rep. Garrett recommended that a task force be put together for further
discussion and return to the full Committee with a recommendation of
how to proceed.

Chairman Sali directed Vice Chairman Block to chair a subcommittee
regarding this Docket 16-0219-0302. Rep. Nielsen, Rep. McGeachin,
Rep. Kulczyk, and Rep. Henbest will serve on that subcommittee.

EXCUSED:

15-0120-0301

Ms. Sarah Scott spoke to the Committee regarding this rule. She stated
that this rule has only one change. These rules apply to agencies, not
contractors. Area agencies will follow the Federal rules. The intent is to
clean up the rules, get rid of excess and avoid duplication of The Older
Americans Act. The rules have been reorganized to read more clearly.
There will be more choices and flexibility for consumers.

16-0322-0301

16-0309-0308

16-0305-0203

Ms. Terry Meyer, Deputy Administrator, Division of Welfare, spoke to the
Committee regarding this rule. This rule serves a fragile population, those
over 65, blind or disabled. The change makes it physically easier to apply
for the program. The requirements go from a face to face interview to a
telephone interview. This also clarifies dates, and income guidelines to
be internally consistent. The cost saving is $45,000.00 a year.

16-0305-0301

Ms. Terri Meyer spoke to the Committee regarding this rule. The
language in this rule has been updated due to Welfare Reform mandates.
All recipients must meet the established requirements. This aligns
citizenship requirements with federal regulations. There is an estimated
30 people affected with a saving of $160,000.00 a year.

16-0305-0302

Ms. Terri Meyer spoke to the Committee regarding this rule. This rule
accomplishes safeguards and supports for Social Security Number
verification. This can be done when the person is there. This closes a
loophole and allows the Department to consider real estate holdings in
determining benefits. Rule clarifies services offered to ages 15-19. There
is no fiscal impact and adds no new participants.

Mr. W. Corey Cartwright, Deputy Attorney General, spoke regarding
section 841. This has technical corrections only- no real changes. There
is no intent to change the meaning.

16-0308-0301

Ms. Terri Meyer spoke to the Committee regarding this rule. This rule
aligns citizenship requirements with federal regulations for assistance.
This rule will affect two people and cost $7,500.00 annually. The funds
come from the Federal government.

16-0308-0302

Ms. Terri Meyer spoke to the Committee regarding this rule. This rule
aligns social security numbers with federal regulations. This allows for
SSN verification to be done on line.

16-0320-0301

Ms. Terry Meyer spoke to the Committee regarding this rule. This rule is
required by the Federal Government and meets the Federal standards.
The Department is required to correct errors. No fiscal impact.

16-0414-0301

Ms. Terri Meyer spoke to the Committee regarding this rule. This rule
helps low income families pay their utility bills. There are approximately
30,000 people with an average income of $11,000.00 a year in the
program. Variables to program moved from rules to procedures. No
fiscal impact.

16-0309-0212

Ms. Leslie Clement spoke to the Committee regarding this rule. The
purpose of this rule is to update the terminology used to describe the
department’s Traumatic Brain Injury Waiver program in order to improve
understanding and clearly describe services. These are technical
changes and do not introduce any new services.

16-0309-0217

Ms. Leslie Clement spoke to the Committee regarding this rule. This rule
updates terminology regarding the department’s peer review organization
and provides for the consistent application of penalties for late submission
of a review docket. The clarification was made to ensure that all
procedures are submitted in a timely manner for medical necessity review
to protect the public health and safety.

16-0309-0218

Ms. Leslie Clement spoke to the Committee regarding this rule. This rule
removes an extra Medicaid payment for sending information to a national
registry. It removes the Medicaid payment for the entry of laboratory
results into the Clozapine National Registry for participants who require
Clozapine to treat mental illness. In October 2001, the department
reduced its payment for this service from $29.07 to $5.00 to bring
payment into line with what other states were paying. After additional
research they found that Utah, Wyoming, Montana, and Nevada were not
paying for his service at all under their Medicaid programs. Last year,
Idaho Medicaid followed suit and elected not to continue the $5.00
administrative processing payment. This is consistent with other
reimbursement policies which do not establish an additional
reimbursement rate for administrative activities.

16-0309-0301

Ms. Leslie Clement spoke to the Committee regarding this rule. This rule
describes the payment methodology used to reimburse out-of-state
nursing homes for care provided to Medicaid eligible persons. Medicaid
payment for out of state nursing home care is very limited and generally is
only allowed if the care the person needs is not available in an Idaho
facility. Because of the complexity of the current acuity based
reimbursement for in-state nursing homes, the department has elected to
pay out of state facilities the same rate as they receive from the Medicaid
program in their home state. This simplifies their billing and claim
submission process.

16-0309-0304

Ms. Leslie Clement spoke to the Committee regarding this rule. This rule
restores routine and preventive coverage for adults effective July 1, 2003.
Medicaid was able to restore these benefits as a result of a special
appropriation at the conclusion of last year’s legislative session. This rule
also includes technical changes that reflect new HIPAA coding
requirements. Access to dental care has improved, but there are still
issues. The Board of Dentistry will pursue legislation to improve services
regarding Dental Hygienists.

16-0309-0310

Ms. Leslie Clement spoke to the Committee regarding this rule. The
purpose of this rule change is to reduce the administrative barriers that
have created reluctance among school districts to become Medicaid
providers. Over the past year, department staff has been working in
collaboration with the department of education and school representatives
to streamline procedures that will improve access to care for Medicaid
eligible children. By encouraging increased school participation in
Medicaid, more children may be served in a familiar environment with
services coordinated and managed under a single roof. There are
already positive affects of this rule change. In January 2003, there were
just 44 school districts enrolled as Medicaid providers. By June 2003, this
number increased to 71 districts. The number of eligible children
receiving service also jumped during this time frame, up from 3,300 to
6,400.

School district providers are unique in that they fund the Medicaid state
match – there are no costs to the state Medicaid program when services
are billed by a school-based provider. This is an attractive service
arrangement that the department wants to further develop and support.
The department has begun working with some private providers and
school district representatives to develop protocols and templates for
coordinating services. Private providers can play a key role by providing
an additional resource during the school hours. Children can be better
served by having most of their needed services provided during the day
rather than after a long school day. Schools are encouraged to contract
with providers and bill Medicaid for all services whether provided directly
or through a contract. Many school districts have already established this
arrangement in their communities. The department will continue to work
with schools and private providers to support the cost-effective
collaborative effort to providing services to school aged children.

16-0309-0305

Mr. Paul Leary, Program Manager, Division of Medicaid, spoke to the
Committee regarding this rule. The Uniform Assessment Instrument is
the tool used by the Department to assess whether or not a participant
requires Nursing Facility level of care. The scoring system for the Uniform
Assessment Instrument was quantified for scoring levels of care for
supervision. The rules are being amended to reflect current practice and
to assure services on the UAI are consistent.

16-0317-0301

Ms. Pamela Mason, spoke to the Committee regarding this rule. This
rule is a total rewrite of the current four sections. It combines all four sets
of rules into one chapter. It is more consistent and understandable to
providers. Many interested groups provided input.

Mr. Ken Mordan, Rules Specialist, stated that they will be putting forth
dockets to remove these four sets of rules next Legislative session.

Ms. Kelly Hall, Dunstan, Hall & Assoc., objected to these changes. Their
firm provides service coordination for disabled people. She had two
issues: The 30 day time line is too rigid with all that needs to be done; 60
days would be more realistic, and there is no reimbursement for time
spent developing plans for the participants.

16-0309-0214

EXCUSED:

16-0601-0301

Mr. Ken Deibert, Division Administrator for Family and Community
Services with the Dept. of Health & Welfare, spoke to the Committee
regarding this rule. The intent of this rule will make it more consistent and
understandable, in particular by adding clarification around the word
“parent” and the word “certified adoption professional.” The term “certified
adoption professional” was added and clarifications of the sections related
to that term were edited.

16-0601-0401

Mr. Ken Deibert spoke to the Committee regarding this rule. This rule is
to increase the rate that foster parents are reimbursed for the care they
provide to the state’s most vulnerable children. Although financial
incentives are not the most important factor in recruiting and retaining
foster parents, and Idaho’s rates are still below the national average,
efforts to increase the reimbursement rates are appreciated by Idaho’s
foster parents.

16-0614-0201

Ms. Terry Pappin, Program Specialist, Division of Family and Community
Services, Dept. of Health & Welfare spoke to the Committee regarding
this rule. The first change in this rule is to require permittees to pay
outstanding fines prior to the renewal of their annual permit. The state
Auditor’s Office recommended this change be made to improve the rate
and timeliness of fine payments. The change has increased permittee
awareness of the law and the need to comply with the law. In addition,
one technical and several insignificant word changes were also made to
the rule. The technical change moved the date on which the number of
permittees is established. This is used in the formula determining the
number of inspections to be conducted during the following calendar year.
Word changes were made to conform with the Department of Health and
Welfare’s “plain-speaking” rules.

19-0101-0301

Mr. Mike Sheeley, Executive Director, Idaho State Board of Dentistry
spoke to the Committee regarding this rule. These rules are intended to
incorporate the American Dental Association’s Principles of Ethics, Code
of Professional Conduct and Advisory Opinions (Principles of Ethics) by
reference into the Idaho Board of Dentistry’s professional standards. The
ADA’s Principles of Ethics address such areas of dental practice as
patient self determination, patient confidentiality, standards of care and
dentist veracity. The ADA’s Principles of Ethics are currently applicable to
all Idaho dentists who are members of the Idaho State Dental Association
or the American Dental Association. A violation of the Idaho Board of
Dentistry’s professional standards can result in disciplinary action against
a dental licensee.

This rule will also specify those dental specialities which are recognized
and licensed by the Idaho Board of Dentistry. The Idaho Board of
Dentistry currently licenses six dental specialities and the Board members
determined that those specialities should be expressly identified in the
administrative rules.

This rule will also define advertising terms and delineate what conduct
constitutes false, misleading or deceptive advertising. Enforcement of the
advertising provisions in the Idaho Dental Practice Act requires the Idaho
Board of Dentistry to specify those matters that constitute impermissible
advertising conduct.

24-0601-0301

Ms. Rayola Jacobsen, Bureau Chief, Bureau of Occupational Licenses,
Dept. of Health & Welfare spoke to the Committee regarding this rule.

This rule adds required sections; clarifies application fees and license
fees currently being assessed; clarifies continuing education requirements
and amends sound field testing requirements. All license renewals are for
12 months and will be due on the applicant’s birthday. There will be
random audits for continuing education requirements.

24-1001-0301

Ms. Rayola Jacobsen spoke to the Committee regarding this rule. This
rule is to clarify required examination and acceptable requirements, and
clarify the continuing education requirements and the record keeping
required for continuing education. In 1986 the National Board of
Optometry established standards for all states for the “Treatment and
Management of Ocular Disease Examination.” For those licensed in
another state before that time, they must submit documentation that they
have the education, training and exam for therapeutic privileges in that
other state.

24-1201-0301

Ms. Rayola Jacobsen spoke to the Committee regarding this rule. This
rule changes the date on articles incorporated by reference; corrects e-mail addresses; clarifies application procedure; amends exam section to
comply with national testing; amends service extender section to clarify
documentation required and amends educational curriculum
requirements. The way the tests are scored has been changed. A
passing score on the test shall be a raw score of 140 or for examinations
after April 1, 2001 a scaled score of 500 for liscensure.

241401-0301

Mr. Roger Hales, Attorney, Idaho Bureau of Occupational License, spoke
to the Committee regarding this rule. This rule adds definition for
psychotherapy, clarifies practice of social work at each level, clarifies
examination procedure and endorsement requirements, amends
continuing education in cases involving illness, clarifies continuing
education ethics requirement, allows continuing education from social
services agencies, and defines competent practice for social workers.
The rule also includes the definition for supportive counseling. Revisions
were made in practice of social work; the word endorsement was added
to section 350 ; and competent practice for social workers is defined.

Ms. Linda Burch, President, National Association of Social Workers,
State of Idaho spoke in support of this rule.

Mr. Ray Millar, Central Office Program Manager, Adult Mental Health,
Division of Family and Community Services, Department of Health and
Welfare spoke to the Committee regarding this rule. He supports the
Board’s continuing efforts to improve the standard of practice for social
workers and asked the Committee to approve the rules.

Mr. Robert Payne, Chairman, Idaho Board of Social Work Examiners
stated that nothing proposed runs counter to the rules. He recommended
adoption.

Mr. Greg Dickerson, Mental Health Providers Association of Idaho,
stated that he fully supports this rule.

24-1501-0301

Ms. Rayola Jacobsen spoke to the Committee regarding this rule. This
rule makes provision for supervision guidelines and definitions for both
counselors and marriage and family therapists; deletes grandfather
provision as the grandfather period has passed; requires ethics as part of
continuing education. Items in the rule have been renumbered.

24-1701-0301

Ms. Rayola Jacobsen spoke to the Committee regarding this rule. This
rule corrects the Board address and changes the effective date for
continuing education requirements for renewal.

24-1901-0301

Ms. Rayola Jacobsen spoke to the Committee regarding this rule. This
rule incorporates by reference the American College of Health Care
Administrators (ACHCA) Code of Ethics; adds facility language to conform
with Idaho Code; strikes temporary permit, as law does not allow for
extension or emergency permits; adds violation of Code of Ethics as
discipline.

16-0310-0203

Ms. Sheila Pugatch, Senior Financial Specialist, Division of Medicaid
spoke to the Committee regarding this rule. This rule addresses hospital
reimbursement. As a result of the Governor’s 3.5% hold back, the
Department is paying hospitals 3.5% less each month.

16-0310-0204

Ms. Sheila Pugatch, spoke to the Committee regarding this rule. This
rule changes how Medicaid pays for wheelchairs for residents of
Intermediate Care Facilities for the Mentally Retarded, also known as
ICFs. Under these rules, Medicaid directly pays Durable Medical
Equipment Supplies instead of paying the ICFs. This change has three
positive affects. It eliminates the cash flow problem experienced by small
ICF’s when a resident requires a highly specialized and expensive
wheelchair. Since Medicaid purchases wheelchairs directly from the
suppliers, costs are reduced because Medicaid reimbursement is less
than the retail prices that ICFs pay. The participant is more readily
accepted for admission into the small facilities and keeps the wheelchair,
no matter if he moves between facilities or into a community placement.

16-0310-0301

Ms. Sheila Pugatch spoke to the Committee regarding this rule. This
rule explains that out-of-state nursing homes are reimbursed using the
same rate they receive from the Medicaid program in their home state.
Other minor clarifying language has been added to improve
understanding of this reimbursement section. In addition, this rule
incorporates Title 42 of the Code of Federal Regulations, Part 447,
entitled “Payment for Services,” and the Medicare Provider
Reimbursement Manual into these rules.

16-0310-0302

Ms. Sheila Pugatch spoke to the Committee regarding this rule. This
rule changes how monthly Medicaid payments are paid to hospitals in
order to lessen the effect of overpayments and under payments. The
change will improve the accuracy of payments during the course of the
year rather than waiting until cost settlement which often occurs two years
after the interim payments are made. The change will improve cash flow
for the Department. The change only affects those hospitals where
payments vary by more than $100,000.00 on their most recent cost
report. No hospital receives a 100% reimbursement. Hospitals under 40
beds receive 96.5% maximum reimbursement.

16-0310-0303

Ms. Sheila Pugatch spoke to the Committee regarding this rule. This
rule clarifies four sections in Chapter 16.03.10. The first section clarifies
the occupancy adjustment factor. The clarification is to specify that the
property rental rates are not included in the total property costs for the
occupancy level calculation. The second section clarifies the extension of
the effective date for a special rate. The third section clarifies that all
financial reports are subject to audit. The last section clarifies the process
regarding amending Disproportionate Share Hospital surveys, otherwise
known as DSH.

16-0603-0301

Mr. Pharis Stanger, Substance Abuse Program Manager, Department of
Health and Welfare, Division of Family and Community Services spoke to
the Committee regarding this rule. This rule standardizes treatment for
Drug Court participants. The new language corresponds with other drug
treatment programs. This rule was approved as temporary one year ago.

16-0613-0301

Ms. Mardell Nelson, Program Manager, Division of Family and
Community Services, Department of Health and Welfare spoke to the
Committee regarding this rule. This rule repeals the entire chapter.

16-0613-0302

Ms. Mardell Nelson spoke to the Committee regarding this rule. This
rule standardized the use of Emergency Assistance funds to help families
address any immediate crises that puts children at risk. The rules will
allow direct service providers in all Department programs, not just
licensed social workers in Children and Family Services, to authorize
these one-time funds on behalf of families. This expedites the
responsiveness of the Department to resolve the families’ emergency
conditions, precisely when timeliness is critical to child safety and well-being. These rules also specify the types of Emergency Assistance
services that are to be available statewide. This clarification assures that
children at risk and their families receive individualized services, based on
their presenting needs and it assures that this array of emergency
services are consistently available, regardless of where the family lives in
the state. These rules comply with Welfare Reform Legislation.

RULE: 16-0322-0301

RULE: 16-0309-0308

RULE: 16-0317-0301

RULE: 16-0309-0214

Additionally: on one rule from the January 26, 2004 meeting, the
Committee found to have no reason to reject section 214 of the rule, but
the Committee urged that sections 346-349 be rejected.

RULE: 16-0301-0302

Chairman Garrett agreed to talk to Chairman Sali.

Chairman Garrett thanked the Committee members for their hard work
on this Subcommittee.

EXCUSED:

Chairman Sali announced to the Committee that he has been asked by
the Joint Finance Appropriations Committee (JFAC) to give a presentation
on February 11, 2004 at 9:45 A.M. JFAC would like to hear
recommendations for this year. He asked that if any member has any
concerns (programs, spending, other issues) they would like included in
the presentation, please bring them to his attention so that they can be
discussed in the full Committee before next week’s appointment on the
11th.

Rep. Garrett suggested that Karl Kurtz, Director of the Health and
Welfare Department be invited to present an overview of their budget to
the Committee. The secretary will arrange scheduling.

Rep. Mitchell shared that there are some excellent printed materials
available regarding JFAC budget information. The secretary will arrange
to make these available.

Chairman Sali shared with the Committee that guardianship issues have
been contentious over the years and he feels that the time is appropriate
to address these issues. He asked for members who would desire to be
on the Committee. Rep. Eberle, Rep. Block, and Rep. Kulczyk
volunteered to serve. Chairman Sali will chair. Rep. Henbest will report
back with a member who will serve on this committee.

Mr. Hardenbrook explained that their goal is to make Nampa a
community where families thrive; their objectives are to help children by
strengthening marriages and parents by increasing knowledge and skills
as parents. He further explained their “Bottom-Line” objectives are: a. to
reduce the number of divorces by 25%; b. to reduce the number of out-of-wedlock pregnancies and births by 30%; c. to provide all that marriages
performed by Healthy Families-Nampa coalition members will include
professional premarital instruction. A film was shown which is available to
the public.

Father Doug Yarbrough,

Rector of Grace Episcopal Church in Nampa, addressed the Committee
by giving an account of the events and accomplishments of the coalition
in 2003-2004.

Keith Fletcher, member of Church of Jesus Christ of Latter Day Saints,
addressed the Committee by giving a summary of the reasons why they
are using this faith-based approach to address this prevailing crisis in our
country. He shared that the family is the basic unit of all society and
healthy families lead to strong societies. Without the family, man and
society will fail. They believe that using a faith-based approach brings a
philosophy of love and hope which builds stability in people’s lives.

Terry Smith, Executive Director, distributed to the members a handout
with facts and data relating to the presentation.

Mr. Hardenbrook responded to a question of the Committee by
answering that the federal government is very supportive of this program
and has set very few limitations on this endeavor.

Rep. Garrett commented that the Subcommittee concluded that the way
Section 214 has been re-written allows for electronic verification which is
more efficient in qualifying applicants and ascertaining necessary
information.

Dennis Stevenson yielded to the Committee by confirming that Section
214 of the rule will be approved if Sections 346-349 are rejected.

EXCUSED:

The Chairman announced to the Committee that the purpose of the
Subcommittee meeting is to obtain additional testimony on the rule
Dockets 16-0219-0302 and 16-0219-0301. She explained that their job is
to acquire research. She directed the members specifically to the Health
and Welfare rule book, Tab 6, Text Tab 1 and 2, page 25 under the
descriptive summary wherein lies the text of the food safety rules.

The members were given a handout listing six areas of research to be
assigned to the Subcommittee. The six areas are:

1. The circumstances that prompted the promulgation of the rule
dockets.

2. A complete account of the facilities, organizations, businesses
or other entities affected by the rules contained in the dockets.

3. A complete account of the difference between the standards in
existing rules and those contained in these dockets.

4. An accurate estimate of the fiscal impact to governments as
well as the financial impacts to private businesses.

5. The training available to those whom the rules impact to assist
them with compliance.

6. Issues that may arise with the transition from the old standards
to the new rules.

Chairman Block assigned Rep. Henbest to research areas No’s. 1, 5, 6;
Rep. Nielsen to research area No. 2; Rep. McGeachin to research area
No. 3; Rep. Kulczyk to research area No. 4.

Chairman Block asked the Committee to report their findings at the next
Subcommittee meeting Upon Adjournment of the full Committee meeting,
February 4.

The Chairman made the following announcements:

• Time Line for the Subcommittee work is two weeks or nine
  working days.
• The hearing date is tentatively scheduled for Thursday, February
  12.
• The date to report Subcommittee findings to the full Committee is
  Monday, February 16.

Rep. Henbest commented by making a suggestion that some of the
burden of finding a resolution be placed on those representing the
assisted living associations. Chairman Block asked the Committee to
please include the assisted living associations in their area of research.

Chairman Block stated that the scope of this effort is to find additional
information about the these two dockets concerning food safety rules.

EXCUSED:

Chairman Sali announced that his presentation originally scheduled
February 11 to JFAC has been postponed for a couple of weeks at his
request. He explained that he wanted the Committee to have more time
to gather information and discuss issues to be included in the
presentation.

Some of the concerns considered were: constituents as well as
colleagues are putting pressure on members about how programs can be
cut; cutting the budget in areas without cutting programs and/or affecting
the efficiency of the program; losing the federal match by cutting
programs; shifting the cost to counties if programs are cut; reviewing
possible cuts in the administrative areas without cutting services.

On pages 2 and 3, Mr. Burns further explained the changes in authorized
position levels in the Department for the period 2003 and 2004, noting
that the Governor had authorized 77 additional staff above what had been
authorized by the Legislature.

Mr. Burns then turned to page 4 and walked the Committee through
changes in funding for the Medicaid budget from 2003 through 2006. He
noted a structural deficit of some $50 million that occurred during 2003
that continues to this day. Mr. Burns further noted that increased drug
rebates, third-party recoveries, audit settlements, and enhanced federal
match were the only reasons keeping the Department from requesting a
supplemental appropriation to deal with this shortfall. Instead, he
indicated the real impact will be felt in fiscal year 2006, where he
estimates that about $55 million in new state dollars will be needed to
maintain current levels of services.

Turning to page 6, Mr. Burns informed the Committee that the Legislature
had implemented a series of cost reduction initiatives to help reign in the
spiraling costs of Medicaid during fiscal years 2002 and 2003. He
reported however, that only 82% percent of the savings expected from
these cost saving measures had been realized to date.

In addition, Mr. Burns also noted, in referring to page 7 of the handout,
that federal mandates, or requirements, were not the driving force behind
these escalating costs. He pointed out that the cost of federally required
services went from 75% of the total in 1993 down to 44% in 2003.
Conversely, the cost of optional services climbed from 25% in 1993 up to
56% of the total in 2003.

Mr. Burns then briefly reviewed page 8 of his presentation that showed
those services required by the federal government, those enacted into law
at the state level, and those put into place through administrative rule.
Page 9 was a similar report that was sorted by type of service from high to
low, where he indicated the top five categories of expense were in
inpatient hospital, prescription drugs, nursing home care, waivered
services, and mental health.

Finally, Mr. Burns turned to page 10 of his handout reviewing for the
committee the 2003 federal poverty guidelines as published in the Federal
Register, February 2003. He indicated that individuals making up to
100% of the federal poverty level typically qualified for Medicaid, those
earning between 100% to 133% qualified under the Pregnant Women and
Children’s Program (PWC), those earning between 133% to 150%
qualified for the Children’s Health Insurance Program (CHIP), and those
earning between 150% up to 185% of federal poverty would qualify for
services under the newly expanded CHIP B/ Idaho Acces program. Mr.
Burns invited questions from the Committee.

Chairman Sali asked David Rogers, Department administrator to yield,
who explained that currently there is not a concrete system in place that
will measure performance. He explained that the Department needs to
review the process of determining the standard of rate increases for
providers who deserve to be compensated for their quality of service.

Chairman Sali asked if Mr. Rogers would provide a letter from the
Department indicating how the Department would provide a process for
such review of rates.

Rep. Garrett commented that she believes a mechanism is needed that
would allow providers the opportunity to setup a procedure for regular,
consistent dialogue with the Department.

EXCUSED:

She explained that the purpose of the meeting was to hear reports from
members on their research to-date.

Rep. Nielsen reported on Area #2 (complete account of the facilities,
organizations, businesses or other entities affected by the rules contained
in the dockets). He reported that he had acquired a list of all of the
facilities that are affected by these rule changes (see attached).

Rep. McGeachin reported in Area #3 (complete account of the difference
between the standards in existing rules and those contained in these
dockets). She reported that she had acquired information from the
Department which compares the provisions in the current code with the
proposed code. She reported she had learned that the a primary focus
has to do with food temperature. She also reported that the Department
is considering exempting assisted living facilities under ten beds.

Rep. Kulczyk reported on Area #4 (an accurate estimate of the fiscal
impact to governments as well as the financial impacts to private
business). He reported that he had spoken with the correctional
institutions who have expressed that in order to meet the requirements of
the new food code, an additional three full-time employees would have to
be hired. He reported that restaurants and nursing homes are not
affected by this, consequently, the issue is narrowing down to facilities of
eight beds and under. He noted that our own kitchen for the House of
Representatives would not be in compliance.

Rep. Henbest reported on Area #5 (training available to those whom the
rules impact to assist them with compliance). She reported that she has
acquired information explaining training options. She commented that
she believes them to be reasonable (see attached).

Rep. Henbest reported on Area #6 (issues that may arise with the
transition from the old standards to the new rules). She reported on three
concerns: (1) storage of refrigerated medications in food establishments;
(2) additional expense if additional manpower is necessary; (3) Definition
of critical violation that was changed within the code (see attached).

Chairman Block thanked the Committee for their work and announced
there would be another meeting to finalize their findings.

EXCUSED:

Rep. Sali pointed out the language Line 17, Section 1 suggesting that the
word “of” be stricken and the words “regarding the identity of the person”
be inserted for more clarity. The Committee was in agreement.

Mr. Leary explained that a provider had expressed concern during the
Subcommittee meeting with Section 400 with regard to the 30 day time
limit stated. The Department agreed that 60 days is more appropriate
especially for the DD population. He stated that the Department proposes
to promulgate a new docket that addresses this concern of time limit for
service plan development as soon as possible.

Chairman Sali requested that Mr. Leary provide a letter to the Committee
indicating intent by the Department. He agreed. Rep. Nielsen requested
that there be a specific time frame included. Mr. Leary agreed to have the
letter state that the Department will propose to have a temporary rule in
place by the end of this session.

The report to the Speaker will reflect that the Committee found no basis
upon which to reject Docket 16-0317-0301.

Michelle Glasgow spoke in opposition to this rule change. She shared
that assisted living facilities receive many of their patients’ medications in
bulk from other entities such as the Railroad Retirement Fund, Veterans
Administration, insurance companies, family, etc., who will bear the cost
as a result of this rule. She also shared her concern for error if nurses are
not allowed to repackage medications and this process is left for the non-licensed care givers. There were questions and discussion by the
Committee.

Ms. Ransom answered a question by giving the two options of packaging
that are eligible for return which are the “true unit dose” and the ‘blister’ or
‘bubble’ pack.

Another concern considered was the increase in cost for the facility due to
removing the ability of nurses and allowing only pharmacists to fill Medi-sets.

Chairman Sali asked the Committee to consider the options for accepting
or rejecting this rule. He commented that the Department is concerned
about errors if the Medi-sets are packaged by nurses, and the Facility is
concerned about errors if they are not allowed to package Medi-sets.

EXCUSED:

Chairman Sali addressed the Committee regarding SCR 120 concurrent
resolution. There was discussion of whether to bring the resolution back
to Committee or let it remain on the Floor Calendar. Several members
expressed their desire to first and foremost serve the people in need.
However, at the same time look for efficiencies in the health care system.

Mr. Buckland replied to a question by a Committee member by saying
that there would be a $400,000 fiscal impact. Committee questions and
discussion followed, the majority of the questions were regarding the
impact of the cost of the program to the general fund.

Steven Rodoletz, E.D., Idaho Benefits Planning Assistance and
Outreach Program addressed the Committee in support of this program.
He stated that the Medicaid Buy-In Program puts the monies back into
Idaho and lets people work without penalizing them. The program allows
Idahoans with disabilities to become more independent.

Chairman Sali asked Jenie Sue Weppner, Department of Health and
Welfare, to yield to questions from the Committee regarding the cash
assistance services. Rep. Kulczyk withdrew the Substitute Motion.

Rep. McGeachin believes this bill will save the tax payers of Idaho a
substantial amount of money in the Medicaid budget. She explained that
both RS 13879 and RS 13895 go hand in hand. RS 13895 compliments
RS 13879 and RS 13879 must be past before RS 13895 can go into
effect. She further explained that the memorial will be sent to the U.S.
Congress as a statement of support from the State of Idaho and will align
with the long term care initiative Senator Larry Craig is introducing and
Governor Kempthorne’s long term care initiative with the National
Governors’ Association. She explained that long term care services
(personal care homes, assisted living facilities, nursing homes) cost

$143 million annually, $43.7 million is the state’s share. This bill would
provide people with an incentive to acquire private long term health care
insurance.

EXCUSED:

16-0219-0302

• Monday, February 16 – hearing date on the Docket.





• Wednesday, February 18 – Subcommittee members to make
  research report to the Subcommittee and give written report to
  Committee Chair, providing both hard copy and disk, listing
  research results including information gained at hearing.
  Subcommittee will debate and vote on their recommendation to
  the full Committee.





• Friday, February 20 – Subcommittee recommendation report to full
  Committee.

ADJOURN:

EXCUSED:

Ryan Hulbert, PhD of Clinical Services, addressed the Committee. He
noted on page 4 of the handout the average age of juvenile offenders is
15.7 years old. He further noted in the handout on page 5 the 48.9%
figure representing the area of Significant Aftercare Challenges. He
demonstrated three approaches used in the aftercare program by using a
stool with three legs as a model. The first step is the protection of the
community. The goal is for the offender to be less likely to use drugs. The
second approach is competency development where the goal is to
educate the offender on healthy kinds of behavior. The third is an
accountability factor, where the offender takes part in paying restitution to
the victim. (See attached handout.)

Dr. Weed concludes that the emergence of abstinence education is
becoming more evident as a primary factor in risk prevention. He cited a
study conducted in Virginia where the Department of Health developed
and piloted an abstinence education strategy. The purpose was to
determine the impact of an abstinence education program on teenage
sexual initiation over a one year period and to understand how this impact
occurred. The conclusion to the study was that an abstinence education
program could influence students to abstain from sexual intercourse in
significantly greater numbers than their counterparts who did not receive
this education. The presentation was followed with questions and
discussion from the Committee. (See attached handouts for greater detail
of the presentation.”)

February 10.

Keith Holloway, CEO Western Health Care Corporation, addressed the
Committee in opposition of this bill. He explained that the bill is not
needed because the licensure act duplicates criteria to screen nursing
aides that is already in place. He explained that the nursing home industry
is the second most regulated industry in America. The process of
certification of nursing assistants is done on a regular basis and includes
reviewing qualifications, checking references and background checks. He
explained that he takes exception to the affect on the fiscal impact.

Rick Holloway, President, Western Health Care Corporation addressed
the committee in opposition of this bill. He expressed his concern with the
words currently written in the language: “engages in the practice of
nursing.” He further expressed that this language is extremely vague as it
is written.

Chairman Sali put the Committee at ease.

Robert VandeMeure, addressed the Committee in opposition of this bill.
He stated that he has problems with the language of the bill as it is
currently written. Federal law states that family members and volunteers
can help with feeding patients, but their own employees cannot assist in
feeding patients. He further explained the concern he has for the
shortage of nursing aides. They rely on family members because there is
not an adequate supply of nursing assistants.

EXCUSED:

Chairman Sali asked the Committee to review the minutes of February
12, 2004.

Chairman Sali explained that noting the unanimous consent request was
not required because the ruling from the Chair had been that those who
had signed up to testify would be recognized to offer testimony only on
the changes that Rep. Henbest had suggested for the RS. Chairman
Sali also explained that the specific language that Rep. Henbest wanted
to include would have to be spelled out for the Substitute Motion.

Rep. Henbest withdrew the Substitute Motion.

Rayola Jacobsen, Occupational License Bureau, addressed the
Committee supporting the bill by stating that it deletes pastoral counselors
from licensure. A pastoral counselor may still practice pastoral
counseling, however, he/she may no longer retain the word “licensed”
within the scope of a title. Ms. Jacobsen in response to a Committee
member’s question stated that a person could apply for a license in
another category as long as they have met all of the licensure
requirements including required education, examinations, etc.

Bill Sutherland, President of Idaho Assisted Living, commented that this
bill will more clearly identify the criteria for determining the appropriate
number of additional staff that would be necessary.

clients. He asked the question: How can we set a staffing guideline that
can only apply to a portion of the residents? He commented that the UAI
was originally set as a reimbursement tool not a staffing tool.

Mr. Shadduck continued by stating that the term “Negotiated” needs to
be put back into the equation. The Regional Medicaid Unit (RMU)
typically does not want to negotiate the rate and thus the provider is left
with a resident with inadequate reimbursement. He also stated he would
like the consideration of retroactive reimbursement back to date of
request.

.
Debbie Ransom, yielded to a Committee member’s question by
explaining how the two survey groups interface with each other. She
explained that a random sampling is taken of individuals in the residence
and in turn are then included in the overall evaluation of the facility.

Rep. Block withdrew the original Motion commenting that she thinks
more time for discussion needs to take place. The Substitute Motion
then became the Main Motion.

Bill Sutherland addressed the Committee in support of this legislation.
He stated that he thinks this method would make the process much
easier, more efficient, and less costly. He also added the efficiency of the
survey process by encouraging other providers to adopt this system
would be increased as well.

The issue of the secured password was considered by the Committee.
Mr. Sutherland explained that the method of tracing a signature through a
secured log-in password is a far more secure and reliable means than
trying to trace a written signature.

David Rogers, Medicaid Division of Department of Health and Welfare,
addressed the Committee. He stated that the Department has taken the
position that a system that would support electronic signatures is not in
place and not possible to implement at this time.

Some of the following points considered were: the potential cost to the
general fund, other agencies in the state using this kind of system, time-line required for the Department to have electronic technology in place.
This legislation requires the Department to have eight criteria in place by
July 1, 2004.

HB 628 TO GENERAL ORDERS PASSED.

Voting Nay – Representatives Kulczyk, McGeachin, Nielsen

Voting Aye – Representatives Block, Eberle, Garrett,

Ring, Henbest, Martinez, Mitchell

EXCUSED:

16-0209-0302

16-0209-0301

Mike Kane, Attorney representing Idaho Sheriff’s Association, spoke in
support of the bill. He explained that the county jails (total of 42) in the
state of Idaho will have to add additional staff to meet the requirements
set out in this rule, which will be an additional cost of approximately
$75,000 to $100,000 per jail.

Lisa Wright, Corporate Manager for Jack in the Box restaurants,
addressed the Committee in support of the bill. She explained they are
already in compliance and have food supervisors in place during all shifts.
She stated that the acceptance of these rules would align Idaho with the
majority of states that have adopted the federal food code.

Michelle Glasgow, Director Assisted Living Facilities, addressed the
Committee in opposition of these rules. She expressed her concern of
the additional cost to facilities of 15 beds or less.
Another concern she expressed is the lack of clarity in the extensive
descriptive information contained within the scope of the 15 questions,
and critical violations.

Eric Mundell, surveyor for the Department of Health and Welfare,
addressed the Committee. He stated that he is in favor of adopting the
food code in its entirety. He also stated that the only change to the code
is the new requirement of a training course in food handling and
recognition of temperature of food. Committee discussion and questions
followed.

Some of the considerations were: why some entities are exempt and
others are not; critical violations are not easily identified; lack of
clarification of the “person in charge” and their responsibilities.

Dick Schultz yielded to a question explaining the report ability of food
borne disease.

Dick Schultz yielded to a question explaining that the District Health
Department will perform the enforcement of these rules.

Dick Schultz yielded to a question by explaining the following three
categories of compliance: (1) Avoid critical violation; (2) Take the
accredited course; (3) Be able to answer the fifteen questions relating to
food handling, temperature of food, etc. A facility will be in compliance if
they meet any one of the three categories.

Kathy Holley, Director Central District Health Department, yielded to a
question by stating that no additional cost is expected.

Tom Turco, Director Environmental Health-Central District Health
Department, addressed the Committee in support of this rule. He
explained that presently there are about 2200 licensed food
establishments that they will be regulating under these new rules. He
believes that these rules represent the best science and knowledge
concerning assuring that the Committees’ constituents receive safe food.

(See attachment for further detail of testimony.)

Dick Schultz yielded to a question by Chairman Block by agreeing to
provide her with information regarding where the exemptions are listed in
the federal code.

EXCUSED:

Chairman Sali asked if the Committee would like to reconsider the action
taken on HB 628, which had been to send the bill to general orders.
There was Committee discussion.

At the request of Chairman Sali HB 628 will be returned to the
Committee for further discussion.

16-0309-0308

He explained the following changes/amendments to clarify and restructure
the rules: In the changes the Department has clarified their ability to
access and copy records of services provided to Medicaid clients. He
stated that these changes do not add authority but clarify existing
authority and practices. Changes have been made to clarify the
Department’s ability to deny payments or suspend provider agreements
for failing to provide access to records. This language is consistent with
federal regulations and clarifies existing authority. Changes have been
made to clarify and standardize the appeal process for Department
actions. The Department is attempting to consolidate rules, and appeals
are defined in the Rules Governing Contested Case Proceedings.
Clarifications have been made on Department actions to mirror the federal
regulations when suspending payments to providers for fraud which
makes the Department more accountable.

Mr. Warren stated that after publication, the Department did not receive
any public comment or opposition to the pending rules. He further stated
that he had presented these rules to the Senate Committee a few weeks
ago and heard opposition/testimony from two groups. One did not oppose
the rules, however, opposed the organizational structure of the fraud unit.
He explained that he has met with the second group, the Mental Health
Providers Association who understand the need to address fraud and
abuse in order to stop those providers who will drain program resources,
and cast distrust on their profession and the services they perform. He
stated he has committed to the association to further define the process
for decision making when suspending payments to providers. With this
commitment, the association has agreed to support these rules to allow
the Department to stop unnecessary waste and abuse, provided sections
210 is restored. The Senate Committee approved the amendments as
final except for section 204 and 210 which they recommended be restored
and not changed. This would provide in rule, a hearing within 30 days for
an immediate action, and would give the Department a mechanism to
refer issues to a committee to review. Mr. Warren noted in a handout
provided to the Committee a pie chart illustrating eight levels of case
resolutions of provider investigations from 2001 to 2003 (See attachment
for further testimony and handout).

Mr. Warren yielded to the various concerns raised by the Committee
regarding the language used in Section 202.01 pertaining to the
Department’s ability to access records. He explained that this section
describes documentation of services as “Documentation to support claims
for services includes, but is not limited to, medical records, treatment
plans, medical necessity justification, assessments…..”

Mr. Warren yielded to questions regarding the intent and the potentially
broad language as to what documentation a provider was required to
provide the Department access to since this rule indicates “to include, but
not limited to”. He explained that this rule identifies the documentation
that is required by rule, statue, or contract, and each program may have
different types of documentation requirements such as pharmacy, durable
medical equipment, nursing services. The intent of this rule is not to list
all of the documentation.

Rep. Sali asked Mr. Warren if he would provide a letter verifying that the
intent of this rule was not to list the documentation but require providers to
maintain documentation which is already required by rule, statute or
contract for the individual program under which the provider provides
services. He agreed to provide such a letter.

Kathleen Allyn, Medicaid, Health and Welfare Department answered a
question regarding the appeal process for providers under investigation.
She explained three categories of action the department can take when
dealing with fraud and abuse issues: (1) Administrative (suspension of
payments, pending investigation, opinion of hearing officer etc.); (2)
Education (opinion of Director); (3) Criminal (grand jury indictments, state
or federal court, prosecutor).

Jeff Hough stated his concerns regarding suspension of payments for
providers while undergoing investigations without an automatic stay on
appeal. It will put providers out of business whether they have committed
fraud or not.

Mr. Warren yielded to Chairman Sali by explaining that the intention of
the Department is to suspend the payments and stop the money from
being disbursed.

Chairman Sali stated to the Committee that the Senate has provided a
concurrent resolution rejecting Sections 204 and 210. He stated that the
Committee will take up that concurrent resolution.

By Unanimous Consent the report to the Speaker will reflect that the
Committee found no basis upon which to reject Docket No. 16-0309-0308
with the exception of Section 204 and Section 210.

16-0309-0214

Ms. Kittridge yielded to a question by explaining that technology is in
place and advancing the Smart PA program and the Physician Dial Up
Box is very successful and useful in providing information to physicians.

By Unanimous Consent, the report to the Speaker will reflect that the
Committee found no basis upon which to reject Docket 16-0309-0214.

and

HB 658

Rep. McGeachin explained that Senator Craig’s bill to amend the portion
of the Social Security Act which will allow all of the states to participate in
the partnership care program has been introduced and will be heard by
Congress this year. (See attached handouts: The Robert Wood Johnson
Foundation “Partnership for Long-Term Care; National Association of
Health Underwriters in support of this bill).

Rep. McGeachin yielded to a question by explaining that the policies do
have to conform to state approved policies.

Rep. Henbest recommended that the Statement of Purpose (SOP) be
rewritten before it is placed on the Third Reading Calendar. Rep. Garrett
asked Rep. McGeachin if she would work with the Department to arrive
at an agreement on the fiscal impact for the SOP. She agreed.

Chairman Sali called the meeting to order at 5:40 P.M.

An advisory committee to the board of nursing is made up of physicians,
advanced nurses and pharmacists, a balanced committee of peers that
regulate advanced practice nursing. She explained that this bill removes
physician supervision requirements applicable to nurse midwives, clinical
nurse specialists, nurse practitioners, and registered nurse anesthetists.
Currently there are only six states that still require supervision by
physicians. This legislation aligns Idaho more closely with other states. A
handout from Dr. Neeraj Soni, a supervising physician in support of bill
was distributed to the Committee (see attached handout).

Rep. Henbest explained that she has met with Idaho Medical Association
resulting in an understanding that this legislation would be more
acceptable if there was reference to a collaboration relationship and peer
review process included in the language, which would provide additional
assurance that nurse practitioners were functioning in a safe manor. She
proposed an amendment to HB 659 reflecting the concerns brought up by
the Medical Association. The amendment inserts collaboration language,
returns original language for nurse anesthetists, and provides for peer
review process. Committee questions and discussion followed.

Rep. Nielsen withdrew the Substitute Motion.

Myrna Olson, Idaho Nurses Association, yielded to a question by stating
that Blue Cross will reimburse moneys directly to Nurse Practitioners if
physician supervision is removed from the equation. This will save her
patients and Blue Cross money.

Rep. Garrett also provided a letter to Chairman Sali regarding the need to
have the Department report on the total cost of the Prescription Drug
Management as well as savings actually experienced from that initiative.
Chairman Sali will include that information in the presentation. (See
attached letter.)

EXCUSED:

• (1) To accept both dockets
• (2) Reject both dockets – a concurrent resolution to be sent
  through both Houses would be required; a portion of the rules as
  they exist may be rejected.
• (3) Reject the first docket and plan to amend S 1215 to exempt
  other entities, including public schools, assisted living facilities,
  veterans, administrations, churches, soup kitchens, etc.

EXCUSED:

The Vice Chairman announced that the minutes of February 18 had not
been reviewed and would be approved at the next meeting on February
24. She asked the Committee to review minutes of February 16.

16-0309-0311

Ms. Clement further explained that the rule changes relate to two distinct
mental health benefits: 1) Psycho-Social Rehabilitation (PSR) and 2)
Mental Health Clinic services. The first part of the docket identifies
changes to the PSR services, reflecting the reduction in Regional Mental
Health staffing and the resulting changes in the roles and responsibilities
of private PSR providers. The functions of assessment and service
planning have been transferred to the private PSR providers.
Additionally, these rules incorporate service definitions, clarify provider
qualifications, and spell out service expectations. Significant clarifications
include the requirements that: PSR Provider Agency personnel coming
into direct contact with participants must follow the criminal history check
process identified in existing rules and, PSR agencies provide 24-hour
crisis response services for their participants or make contractual
arrangements for the provision of those services.

Ms. Clement explained that the changes to the mental health clinic rules
and related partial care rules were made primarily due to safety issues.
Over the past year, the department was alerted to situations where
individuals appeared to be at risk when receiving care under this benefit.
Without these rules, there is limited ability to stop providers from providing
poor quality services. This rule docket does not introduce any new
federal or state requirements for clinics except for the inclusion of building
standards, which were added as a direct result of documented cases of
child endangerment due to substandard buildings that were being used as
clinics.

Ms. Clement explained that since her previous testimony before this
Committee, the Senate Health & Welfare committee was provided an
update on our work group’s progress and voted to extend these
temporary rules. On February 5 including members of the MH Provider’s
Association, individual provider representatives, advocates, consumers
and department representatives sat down to review these rules and
discuss the primary areas of concern. She explained that all groups were
able to come to agreement on many issues. She explained that although
the work group met for almost five hours, all the rule changes were not
addressed. There were assignments made that included researching
utilization of partial care and clarifying rule promulgation procedures and
schedules. The work group has scheduled its next meeting for early
March and anticipates that amendments can successfully be completed
for publication. This is just the first step in the work group’s long term
commitment to addressing mental health system issues. The group will
be developing recommendations for outcome measurements in addition
to reviewing different approaches in service delivery.

Laura Scurri, Vice President, Mental Health Provider’s Association
addressed the Committee thanking them for participating in the
promulgation of these rules. The negotiation has been very positive. She
explained that their mutual goal is to provide quality of services in a cost-effective manner.

Vice Chairman Block noted a letter from April Crandall, President of
Mental Health Provider’s Association regarding this docket and
agreements made with the Department of Health and Welfare in reference
to these rules and the mental health system. (See attached copy of
letter.)

By Unanimous Consent, the report to the Speaker will reflect that the
Committee found no basis upon which to reject Docket 16-0309-0311.

Michael McGrane, RN, MSN, Director of Air St. Luke’s Hospital
addressed the Committee. He explained that 70% of Idaho’s emergency
medical services are provided by volunteer basis life support personnel,
the majority residing in Idaho’s rural and frontier areas with remote access
to emergency services. EMS services in Idaho depend upon air medical
services to provide advanced life support backup, additional personnel
and equipment, rapid patient transport, and allows the local EMS service
to remain available. He explained that there are mechanisms already in
place to address concerns with air medical services or utilization by EMS
personnel by medical directors. (See attachment for further detail of
testimony and handout entitled, “Recommended Elements of a Pre
hospital Air Medical Dispatch Protocol”).

Jim Alter, Department of Health and Welfare, EMS Bureau, addressed
the Committee. He explained that the EMS focuses on the care of
patients at emergency scenes and transportation to the hospital. The
EMS Bureau provides both reasonable regulation and support of local
EMS agencies throughout Idaho. He believes that the most pressing
problem in the EMS system in Idaho is getting rural EMS providers to
make appropriate choices about when to call for a helicopter for their
most severe patients, but acknowledged that many agencies do make
good decisions regarding patient transportation. He further explained that
this legislation will create an organized method to set criteria through
negotiated rule making which will allow the air medical services, local
EMS agencies, hospitals and physician communities throughout the state
to craft a common standard of care about patient transportation from
emergency scenes. (See attached testimony.)

Roy Eiguren, attorney representing St. Al’s Hospital Regional Medical
Center, addressed the Committee. He noted a letter from Stanley Rose,
director of St. Al’s Life Flight program in support of establishing criteria for
the use of air medical resources by EMS personnel. Mr. Eiguren

explained that the director of Life Flight has indicated at times there is
utter chaos and confusion at emergency scenes particularly in rural areas,
when determining the appropriate situations for dispatching air ambulance
services

Ms. Evans yielded to the following concerns:
(1) The Board of nursing anticipates that applicants will be required to
submit their fingerprints to the FBI, which in turn reports to the Board. The
Board, after all facts, application, etc. have been reviewed decide whether
the applicant would pose a risk to the public. The cost will be included in
clerical costs of receiving, reviewing and compiling information, as well as
investigating information or to impose disciplinary action. The licensure
fee will not increase.
(2) Fingerprints are taken at the time of examination and then again at
licensure and the two sets are compared, this also applies to those
applicants applying from other states, providing a safeguard.
(3) The Board will look at first time/repeat offense, pattern of behavior,
recent offense or long history honesty and integrity in answering
questions truthfully.
(4) An additional two full-time employees are necessary to provide for
program operation and for administrative costs.

Mr. Rogers explained that the state is acting to restrain Medicaid
expenditures in the categories of eligibility, benefits, provider payments
and to improve program management. He further explained that the
Department’s Enhanced Prior Authorization Program (EPAP) for
pharmacy benefits is an effort to manage care delivered to Medicaid
participants and Care Management for adults with developmental
disabilities is an effort to more effectively manage the growth of Medicaid
expenditures. The Department has made great efforts to enroll almost
80% of Medicaid participant’s in Healthy Connections, which provides
participants with a medical home. The Department is working on
development and implementation of new programs in the areas of
Disease Management and Long Term Care. (See attached copy of
presentation for references and further detail).

EXCUSED:

16-0313-0301

16-0309-0307

16-0313-0301 and 16-0309-0307 had been held in Committee for further
review and are related to the Care Management Program. He distributed
a copy of a letter, dated February 23, 2004, from the Department,
including handouts, regarding questions and concerns that had been
raised in the Department’s previous presentation of these rules. He
referred to the letter and briefly touched on the following items addressed
in the letter: (1) Number of Independent Assessment Providers (IAP) and
caseload size; (2) IAP Qualifications (12 of the 17 or 70%) have masters
degrees); (3) Individualized Budget Ranges; (4) Guardianship and
Consumer Training issues posed by Kelly Hall of Dunstan Hall &
Associates; and IAP Training, Plan Development, and Region II Reports,
concerns posed by Bill Benkula, Delta Developmental Services. (See
letter and attached charts).

HB 657 IN COMMITTEE TO A TIME CERTAIN PASSED.

Voting Nay – Representatives Block, Kulczyk

Voting Aye – Representatives Garrett, Ring, McGeachin, Nielsen, Henbest, Martinez, Mitchell

The Chairman called the meeting to order at 5:15 P.M.

Some of the considerations from the Committee were the time-line of this
project, the estimated cost, number of participants who would qualify,
some type of reporting procedure put in place.

(1) Participation in the pilot program shall be limited to 100 clients;

(2) The length of the pilot program shall be limited to three (3) years;

(3) Participation shall be limited to clients with a Body Mass Index over
25; and

(4) The Department shall report annually to the Senate and House
Health and Welfare Committees concerning the progress of all
programs initiated under the waiver.”