Senate Healthcare and Medical Liability Reform and House Health and Human Services COR AHCCCS, Board of Optometry

Senator John Nelson

Representative Matt Heinz

Co-Chairman Barto announced that the Committee will begin with an audit and presentation on optometry by Senate staff.

Sunset Audit of the Arizona State Board of Optometry

Marianne Yamnik, Senate Research Analyst, informed the Members that the primary purpose of the Arizona State Board of Optometry (Board) is to protect the health, safety and welfare of Arizona citizens by regulating and achieving the highest standards in the optometry profession. She advised that the powers and duties of the Board include the following:

· Evaluating applications and issuing licenses

· Administering examinations

· Determining education requirements including continuing education programs

· Investigating and resolving complaints against licensees

· Regulating out-of-state contact lens dispensers

Ms. Yamnik stated that the membership of the Board consists of seven Governor-appointed members: five of whom are licensees engaged in the profession of optometry in Arizona for at least three years immediately before the appointment, one public member and one physician licensed as a medical doctor (MD) or doctor of osteopathy (DO). The Board Members serve four-year terms and cannot serve more than two complete consecutive terms.

Ms. Yamnik advised that the Board's budget consists of revenues from applications, licensing and renewal fees. The Board deposits 10 percent of the revenues collected into the General Fund and retains 90 percent for operating expenses. She informed that the amount appropriated in fiscal year 2013 is just under $200,000 and the Board has two full-time equivalent (FTE) positions. Board members are eligible to receive compensation in the amount of $30 for each day engaged in service for the Board.

Margaret Whelan, Executive Director, Arizona State Board of Optometry, testified in support of the ten-year continuation of the Arizona State Board of Optometry (Board) and provided a brief history.

Don Isaacson, Aging Services of Arizona and Arizona Optometric Association, in favor of the continuation of the Arizona State Board of Optometry (Board), provided a letter of support to the Members (Attachment 1) and expressed concern with regard to the composition of the Board. He advised that Arizona is the only state in the country that continues to require one of the Board members to be an osteopathic physician (DO) or a medical doctor (MD) and none of the other independent health care professional regulatory boards in Arizona contain a statutory requirement to have an MD or DO as a member of their respective boards. Mr. Isaacson stated that the requirement should be changed and that a public member should be appointed instead.

Representative Ash questioned the difference between an ophthalmologist and an optometrist and asked if there is a crossover of the two professions. Mr. Isaacson related that there is an overlap between the two professions when it comes to infections such as conjunctivitis, but an optometrist deals with the health of the eye and the surrounding tissue while an ophthalmologist treats injuries and performs surgery on the eye.

Co-Chairman Barto stated that her office received numerous accolades on the Board's performance and commended them.

Co-Chairman Carter announced the names of those who signed up in support of the continuation of the Arizona Board of Optometry but did not speak:

Tim McAuliffe, Doctor, representing self

Steven Burns, Doctor, representing self

Annette Hanian, Doctor, Arizona Optometric Association

Larry Holle, Doctor, representing self

Gail Bass-Descheid, Doctor, representing self

Stuart Greenberg, Doctor, representing self

Gary Greene, Doctor, representing self

Doyle Holle, Doctor, representing self

Tami Lang, Doctor, representing self

James Abbott, Doctor, representing self

Joel Ackerman, Doctor, representing self

Marla Husz, Doctor, representing self

Bart Pemberton, Doctor, representing self

Monica Diamos, Doctor, representing self

Patrick Barry, Doctor, representing self

Roger Juarez, Doctor, representing self

Gilbert Wong, Optometrist, Former President, Arizona Optometric Association

Frank Akers II, Optometrist, President-Elect, Arizona Optometric Association

Kelsey Lundy, R & R Partners, Midwestern University and UnitedHealthcare of Arizona

Caroline Griego, Optometrist, representing self

Jonathan Bundy, Doctor, representing self

Brian Mach, President, Arizona State Board of Optometry

Todd Smith, Doctor of Optometry, representing self

Jan McVey, Doctor, Past Member, Arizona Board of Optometry, representing self

Lilien Vogl, Doctor, Secretary Treasurer, Arizona Optometric Association

Don Jarnagin, Doctor, representing self

Co-Chairman Carter moved that the Arizona State Board of Optometry receive a ten-year continuation. The motion carried by a unanimous voice vote.

Sunset Audit of the Arizona Health Care Cost Containment System

Dot Reinhard, Performance Audit Manager, Arizona Office of the Auditor General, supplied the Members with a handout outlining the Arizona Health Care Cost Containment System (AHCCCS) performance audits and sunset review (Attachment 2) and provided information on the following topics:

· Coordination of Benefits - Report 12-01

· Medicaid Eligibility Determination - Report 12-02

· Medicaid Fraud and Abuse Prevention, Detection, Investigation and Recovery Processes - Report 12-06

· Sunset Factor Analysis - Report 12-07

In response to Senator Aboud's question, Ms. Reinhard informed Members that AHCCCS is the payor of last resort for covered medical services and the main focus is on cost avoidance which involves identifying other responsible parties to pay for all or part of an AHCCCS members' medical costs before claims are paid.

Tom Betlach, Director, Arizona Health Care Cost Containment System (AHCCCS), provided the Members with two handouts of the PowerPoint presentation detailing the response to the Arizona Office of the Auditor General's findings and the route AHCCCS is taking to implement all of the recommendations (Attachments 3 and 4). Mr. Betlach discussed the following subject matter:

· AHCCCS establishment and integrity

· Arizona Long Term Care System (ALTCS)

· KidsCare Program

· Federal Healthcare Reform Legislation

· Medicare Program

· Medicaid Program

· Arizona Managed Care Program

· Home and Community Based Care

· AHCCCS overview

Spending
Staffing
Reductions
Population
Budget requests
Capitation trends
National performance
Coordination of benefits
Fraud prevention
Long-term strategy
Payment reform
Fiscal recoveries
Goals
Impact of eliminating the program

In response to Members questions, Mr. Betlach informed Members that AHCCCS had an incorrect eligibility determination rate of 1 percent for the acute and long-term care programs while the national average error rate for Medicaid programs is 6.7 percent. He went on to state that AHCCCS is striving to improve the determination rate.

Discussion ensued relating to the program's performance, integrity and future.

Representative Carl Seel, testified as neutral on the continuation of the Arizona Health Care Cost Containment System (AHCCCS) and provided Members with supporting documents of his plan for recovery (Attachment 5). He stated satisfaction with the Auditor General's report but stressed that continued cost saving measures are necessary. Representative Seel went on to explain numerous areas for improvement such as checking death and felony records and the use of public transportation instead of taxi cabs.

Deb Gullett, Executive Director, Arizona Association of Health Plans (AzAHP), testified in favor of the continuation of the Arizona Health Care Cost Containment System (AHCCCS). Ms. Gullett related AzAHP is the private half of the public-private partnership model that makes the AHCCCS program one of the most successful managed care programs in the United States and submitted a letter to the record explaining the process (Attachment 6). She advised that the purpose of the audit was to ensure AHCCCS was fulfilling its mission of serving the state's Medicaid agency and the Arizona Office of the Auditor General concluded that AHCCCS completed all of its statutory requirements.

Co-Chairman Carter announced the names of those who signed up in support of the continuation of the Arizona Health Care Cost Containment System (AHCCCS) but did not speak:

Gibson McKay, University of Arizona Health Network

Steven Moortel, Tucson Medical Center

Gregory Harris, Lobbyist, Health Management Systems

Kelsey Lundy, R & R Partners, Midwestern University, United Healthcare of Arizona

Genevra Richardson, President, GovGroup LLC, Arizona Physicians IPA

Jeff Gray, Legislative Liaison, Arizona Pharmacy Alliance, March of Dimes Arizona Chapter Jim Norton, President, Arizona Chamber of Commerce and Industry

Brian Hummell, Arizona Director Government Relations, American Cancer Society Cancer Action Network

Kathleen Pagels, Executive Director, Arizona Health Care Association

Kathryn Busby, Health Net, Inc.

Helena Whitney, Director, Government Relations, UA Health Network

Heather Bernacki, Government Relations Associate, John C. Lincoln Health Network/Arizona Physical Therapy Association

James Stover, CEO, University of Arizona Health Plans

Ryan Harper, Triadvocates, LLC, Abrazo Health Care, Vanguard Health Systems

Karen Mlawsky, CEO, University of Arizona Medical Center

Debbie Johnston, Vice President Advocacy, Arizona Hospital and Healthcare Association

Warren Whitney, Deputy Secretary of State, Maricopa Integrated Health System

Tara Plese, Arizona Association of Community Health Centers

Betsey Bayless, Former Secretary of State, Maricopa Integrated Health Systems

Michael Fronske, Director of Governmental Affairs, Maricopa Integrated Health Systems

Annie Mooney, Director of Public Affairs, Phoenix Children's Hospital

Eddie Sissons, Executive Director, Arizona Foundation for Behavioral Health

Michelle Bolton, Vice President of Public Affairs, Greater Phoenix Chamber of Commerce

Nicole Olmstead, Government Relations Director, American Heart Association

Jennifer Bonnett, The Arizona Public Health Association

Misty Hansen, University of Arizona Medical Center

Bryan Milward, Government Relations Specialist, University of Arizona Health Network

Brandy Petrone, Dignity Health

Emily Jenkins, President/CEO, Arizona Council of Human Service Providers

Jason Bezozo, Senior Program Director, Government Relations, Banner Health

Michael Haener, Centene Corporation

Christian Stumpf, Regional Director of Government Relations, American Lung Association in Arizona

Tara Plese submitted letters of support for the record (Attachment 7).

Co-Chairman Carter moved that the Arizona Health Care Cost Containment System receive a ten-year continuation. The motion carried by a unanimous voice vote.

Without objection, the meeting adjourned at 12:38 p.m.

__________________________________________

Abby Selvey, Committee Secretary

December 3, 2012

(Original minutes, attachments and audio on file in the Office of the Chief Clerk; video archives available at http://www.azleg.gov)

---------- DOCUMENT FOOTER ---------

SENATE HMLR AND HOUSE HHS COMMITTEE OF REFERENCE

November 13, 2012

---------- DOCUMENT FOOTER ---------

Senator Nancy Barto, Co-Chairman	Representative Heather Carter, Co-Chairman
Senator Paula Aboud	Representative Cecil Ash
Senator Linda Lopez	Representative Kate Brophy McGee
Senator Rick Murphy	Representative Katie Hobbs

Members Present

Members Absent