HOUSE FINANCE COMMITTEE February 3, 2020 1:34 p.m. 1:34:52 PM CALL TO ORDER Co-Chair Foster called the House Finance Committee meeting to order at 1:34 p.m. MEMBERS PRESENT Representative Neal Foster, Co-Chair Representative Jennifer Johnston, Co-Chair Representative Dan Ortiz, Vice-Chair Representative Ben Carpenter Representative Andy Josephson Representative Gary Knopp Representative Bart LeBon Representative Kelly Merrick Representative Colleen Sullivan-Leonard Representative Cathy Tilton Representative Adam Wool MEMBERS ABSENT None ALSO PRESENT Adam Crum, Commissioner, Department of Health and Social Services; Sana Efird, Assistant Commissioner, Department of Health and Social Services; Albert Wall, Deputy Commissioner, Medicare and Health Care Policy, Department of Health and Social Services; Gennifer Moreau-Johnson, Acting Director, Division of Behavioral Health, Department of Health and Social Services; Renee Gayhart, Health Care Services Director, Department of Health and Social Services. SUMMARY HB 205 APPROP: OPERATING BUDGET/LOANS/FUNDS HB 205 was HEARD and HELD in committee for further consideration. HB 206 APPROP: MENTAL HEALTH BUDGET HB 206 was HEARD and HELD in committee for further consideration. FY 21 BUDGET OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES AND MEDICAID PRESENTATION: MEDICAID BUDGET UPDATE Co-Chair Foster reviewed the agenda for the day. HOUSE BILL NO. 205 "An Act making appropriations for the operating and loan program expenses of state government and for certain programs; capitalizing funds; making appropriations under art. IX, sec. 17(c), Constitution of the State of Alaska, from the constitutional budget reserve fund; and providing for an effective date." HOUSE BILL NO. 206 "An Act making appropriations for the operating and capital expenses of the state's integrated comprehensive mental health program; and providing for an effective date." 1:36:02 PM ^FY 21 BUDGET OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES AND MEDICAID Co-Chair Foster invited testifiers from the Department of Health and Social Services (DHSS). 1:36:36 PM ADAM CRUM, COMMISSIONER, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, (DHSS) introduced himself. 1:37:03 PM SANA EFIRD, ASSISTANT COMMISSIONER, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, introduced the budget overview presentation for the Department of Health and Social Services and Medicaid (copy on file). She began with slide 2 which depicted the total budget comparison between FY 19 to FY 21. The comparison of 2 years showed a small reduction in the budget across the 2 years. She highlighted that in looking at the bar graph looking at the federal authority equaled 60 percent. Vice-Chair Ortiz wondered whether the comparison between FY 19 and FY 21 referred to the actuals and not the budget. Ms. Efird responded that the comparison was to the management plan, which was the passed FY 19 budget with the department's adjustments. She remarked that there were some minor changes to the budget within the management plan. Vice-Chair Ortiz asked if supplementals were included form FY 19. Ms. Efird responded that FY reflected supplemental numbers. Ms. Efird continued to slide 3 showing a comparison between FY 20 to FY 21 operating budget. She highlighted an increase of $133.747 million, which was a 13.8 difference in the UGF. Ms. Efird turned to slide 4 which showed a breakdown of the changes to the FY 21 operating budget. 1:40:58 PM Ms. Efird turned to slide 5 which reflected the FY 21 fund source breakdown by funding source. She indicated the slide also showed a breakdown of formula programs and non-formula programs. The department's formula driven programs made up 75 percent of the state's DHSS budget. Co-Chair Foster remarked that the grand total was $3.4 billion, and he assumed that the total was prior to the duplicate removal Ms. Efird responded in the affirmative. She explained that it was meant to show that the Office of Management and Budget (OMB) was attempting to show that some funds were budgeted for various aspects, agencies, and departments in the state. Ms. Efird turned to slide 6 which showed the budget for the Alaska Pioneer Homes Program. She explained the fund source changes and budget changes: ? Add Authority for Alaska Pioneer Homes Payment Assistance $5,000.0 UGF. ? Reduce Authority to Align with Anticipated Revenue and Expenditures. ($2,592.2) DGF, ($7,407.8) Other. 1:44:38 PM Representative Wool noted the addition of $5 million to the Pioneer Homes in UGF. He wondered how there was also a net reduction to the Pioneer homes of $4 million. Ms. Efird replied that the previous year's Pioneer Homes budget had a different component budget structure. She noted that historically there was one component budgeted with all the Pioneer Homes, and a smaller component for the administrative cost. She remarked that OMB, in the year prior, had inserted a new budget structure that accounted for payment assistance. Therefore, all the money that was collected was coming into the Pioneer Homes budget as general funds in the "Payment Assistance Component." She stated that the fund was only used as residents came into the home with their income eligibility portion met. She stated that once that resident was eligible for assistance, the Payment Assistance Component was billed to meet the needs monthly for each resident that needed help in making their payments to stay in the home. She noted that in the previous year there was some duplication of how the funding source should show up in the Pioneer Homes component, so the current budget was meant to ensure that there was an exact payment assistance UGF number as it is billed as interagency receipts or other funds. She restated that the piece was a technical "shoring up" of how those sources were coming in. She stressed that it was a true $5 million increase to meet the needs of the Pioneer Homes residents. 1:47:21 PM Representative Wool asked if the resident would experience the effects of an increase or a decrease in the budget. Ms. Efird replied that the budget was based on a projection provided by the Pioneer Homes to meet the needs of the residents. She noted that the reduction in "other funds" referred to payment assistance amount. She noted that there was also a request for a decrement in the DGF funds, and those funds were private pay. She stressed that the Pioneer Homes budget was always based on a projection, while not knowing the exact number of patients that might need payment assistance. Representative Wool felt that there could be an accurate expectation of additional fees paid privately, because of the rate increase. Ms. Efird would follow up with the committee. She noted that the funding sources for the FY 20 budget was not accurate, because of all of the attempts to make adjustments and changes. She thought there were some unintentionally double-counted items. Vice-Chair Ortiz requested to see the information Ms. Efird was going to provide. He wondered whether the $5 million increase was a recalculation of how much would be needed after the increase went into effect. 1:52:08 PM Commissioner Crum believed the number of residents that left the Pioneer Home as a result of the fee increase was about 16 people. He remarked that there was an increase of individual payments of almost $7 million, which was a new aspect to the budget. He explained that the $5 million would help provide the flexibility during the resident turnover. Vice-Chair Ortiz remarked that the year prior had a presenter that made the projection that while the impact of the proposed rate increase might show that the state would save money, there would really cause a shift of the population to see a higher percentage of the population being unable to have the resources pay on their own, so they would require state assistance to make up for the change in population. Commissioner Crum reported that the number of dollars increased coming through the door in the year prior, but noted the uniqueness of the turnover rate. 1:55:10 PM Vice-Chair Ortiz asked for clarification in wording. Commissioner Crum restated that there was a state saving increase. Vice-Chair Ortiz queried the exact amount of state savings. Ms. Efird replied that the Pioneer Homes was still down approximately $2 million in UGF, but agreed to go over the specific numbers throughout the previous years. Representative Josephson asked where to look for the additional fees. Ms. Efird clarified that there was a technical issue the department was attempting to correct. Ms. Efird continued to slide 7 reflecting the Alaska Psychiatric Institute (API) budget. The change to the budget was to attempt to fill all beds at API: ? Add Authority to Achieve Full Capacity at the Alaska Psychiatric Institute. $2,529.2 UGF, $6,837.2 Other. Representative Wool wondered whether the department was receiving Medicaid payments prior to the waiver. He asked whether residents of API were eligible for Medicaid. Ms. Efird responded in the affirmative. She furthered that it would now be covered under the 1115 waiver. Representative Wool asked about the $2.6 million was for expanding the number of beds. He asked if the department still had the resources to increase the number of beds without the 1115 waiver. Ms. Efird replied that the increment was intended to provide the resources to meet the staffing requirements needed for the additional 80 beds. She stressed that the slide reflected how the department would capture the funding for the increment. 1:59:46 PM Ms. Efird advanced to slide 8 showing the budget for the Division of Behavioral Health. She pointed out the fund source change from UGF to the MET fund: ? In FY2021 a Fund Change from UGF ($11,400.0) to MET Fund (DGF) $11,400.0. Co-Chair Johnston commented that there had been discussions in the subcommittee about the sustainability, and was interested in what was "really sustainable" year over year for the Marijuana Fund. Ms. Efird commented that the department would continue to monitor the issue and would look more closely at the fund to make sure sustainable dollars were available. 2:02:06 PM Representative Josephson commented that the reduction in the Behavioral Health portion of the budget still allowed for providers to submit claims through the agency. He wondered whether the 1115 waiver would show up in the Supplemental Budget. Ms. Efird did not completely understand Representative Josephson's question. Representative Josephson clarified that the need would be comparable in FY 19. The legislature had recently underfunded in anticipation of waiver approval for services. Ms. Efird clarified that the waiver services funding had been approved. Representative Josephson wondered whether have of the waiver program was still "pending." Ms. Efird responded, "That is correct." She deferred to Mr. Wall. 2:04:46 PM ALBERT WALL, DEPUTY COMMISSIONER, MEDICARE AND HEALTH CARE POLICY, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, shared that the services provided under the 1115 waiver for the substance use disorder services were already online. Those services were being rolled out a little bit at a time. He explained that the old way of billing under Medicaid was still available, so there were two different forms to bill under Medicaid. He explained that the reduction in grants was the first phase, and the second phase was anticipated for the following fiscal year. 2:06:09 PM GENNIFER MOREAU-JOHNSON, ACTING DIRECTOR, DIVISION OF BEHAVIORAL HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, explained the sequence of milestones to help to clarify the intent and process. She recalled that in FY 16, there was a bill that allowed for the application of the grant decrement. The decrement was implemented ahead of the 1115 waiver demonstration project. She furthered that in November of 2018, the department received approval from the federal government for the substance use disorder component, which added twelve new services to be covered by Medicaid. She remarked that it was in addition to regular Medicaid. Mr. Wall explained the reason why the 1115 waiver was divided into the two portions. 2:10:38 PM Representative Wool wondered whether the API residents would be double billed for the resident fee and the substance abuse assistance fee. Mr. Wall responded that API was only doing the inpatient psychiatric component, and not the substance abuse component. Representative Wool referred to an increase in the "other" portion of the budget. Mr. Wall further clarified that there was a shift in the Medicaid expenditure in API in the coming years. Commissioner Crum added that there was an anticipation of receiving the IMB exclusion to bill against the behavioral health portion, which would allow for the increase in revenue for the incoming dollars. Representative Wool asked that with the increase in revenues, the state would be able to expand the number of beds. Mr. Wall noted that the problem did not have to do with additional beds, rather it had to do with staffing requirements. Ms. Efird reviewed slide 9 having to do with the Office of Children's Services: ? Staff Retention and Wellness Initiatives $1,500.0 Federal. ? Title IV-E Reimbursement for Legal Representation for Parents $1,200.0 Federal. 2:14:47 PM Vice-Chair Ortiz noted that the Office of Children's Services Division generated the most questions from his constituents. There were complaints that the division could not meet the demands of services properly. Commissioner Crum responded that a GAP analysis study would be release in the following month. He hoped community outreach would increase and allow for the department to focus on the issue. Ms. Efird advanced to the Health Care Services Division on slide 10. The department felt the position should fall within the Office of the Governor rather that the Health Care Services Division: ? Transfer Office of Rate Review to Commissioner's Office Ms. Efird advanced to slide 11 and showed the budget breakdown for the Division of Juvenile Justice. Co-Chair Foster asked about the $2 million cut to the Nome Youth Facility. He noted that the slide showed an increase in funding for juvenile justice, and aske for further information. Ms. Efird replied that the reduction occurred from FY 19 to FY 20. She noted that the major adjustments were salary and technical adjustments in the budget. Co-Chair Foster noted there had been cuts to travel. He asked her to speak to transportation costs. He was concerned that the cuts offset increments. 2:20:24 PM Commissioner Crum responded that the staff had been maintained at the Nome Facility for probation services, and maintaining a facility for other kids until their transfer. He stressed that many items, like Zoom, provided the ability for distant access to keep some of the costs down. He stressed that there were some discussions about the best use for that facility for public use. Co-Chair Foster asked if the commissioner had kept track of the process. He wanted to know the detail on the Nome Facility periodically. Ms. Efird would provide the information to the committee. Ms. Efird turned to slide 12 regarding the Division of Public Assistance: ? Restore Adult Public Assistance Maintenance of Effort Methodology $7,471.2 UGF. ? Transfer Parents as Teachers Program from the Department of Education and Early Development for Better Alignment $474.7 UGF. Representative Knopp asked for a brief synopsis of the Adult Public Assistance maintenance effort. He also requested the eligibility requirements for some of the public assistance programs. Ms. Efird replied that the Adult Public Assistance Program was required as a match for the Medicaid program. She explained that the payments went to age-blind and disabled people. The eligibility requirements included income calculations related to who received the payments. She furthered that there was a spending requirement called a "maintenance of effort" on the program as a match for the Medicaid program. The two ways the state calculated their total maintenance of effort: 1) reverting to the payments from 1983 with cost of living increases, which was proposed in the original FY 20 budget; and 2) to maintain current total expenditures of the process of payments. She explained that the department estimated that the state could save some funding in the current fiscal year, but was more than the governor had in the original proposal, therefore there was a reverting to the current proposal. Commissioner Crum furthered that the Division of Public Assistance administered eligibility and the intake for all assistance programs. Ms. Efird continued to slide 13, which compared the FY 20 and FY 21 budgets: SB93 Increase SDPR for SHARP II Vice-Chair Ortiz asked Ms. Efird to elaborate on the motivation for the governor's particular change. Commissioner Crum responded that the program had historically been under the Department of Education and Early Development. In the last couple of years the Division of Public Health had been assigned that program. Vice-Chair Ortiz would have more questions at the subcommittee meeting. 2:29:28 PM Ms. Efird discussed the Senior Disabilities Services Budget. She expressed disappointment in the budget, because the department had asked for an increase in the increment of federal funds for the Preschool Development Grant, which was phase 2. she stated that the Senior Disabilities Services put in the application of the portion of the grant. Vice-Chair Ortiz returned to the topic of the $7 million the state would not be receiving. He asked if the grant had been in existence but would no longer be available. Ms. Efird explained that the grant was developed by the federal government to address preschool development. She explained that states were asked to apply, so the state applied through the Department of Education and Early Development (DEED). The stated received that portion of the grant. Vice-Chair Ortiz interjected a question. He wondered what happened to that portion of the grant. Commissioner Crum responded that the grant was identified by the Alaska Early Development Coordinating Council. He explained that the initial phase of the grant was for strategy, and did a very good job with all the stakeholders. Ms. Efird added that only the states that received the first piece were asked to request the second phase request. Ms. Efird reviewed slide 14 showing the Senior Disabilities Services: ? Children and Families Preschool Development Grant (Grant was not awarded to division and authority will be adjusted.) $7,000.0 Federal. ? Electronic Visit Verification System Maintenance and Operation $412.5 Federal and $137.5 UGF. 2:34:38 PM Vice-Chair Ortiz asked about slide 14, and wondered about day rehab services within the Senior and Disability Services. Commissioner Crum replied in the affirmative. Vice-Chair Ortiz noted concern about the adjustment to the program over several years, particularly in rural communities that did not have alternatives. He asked for more information on that issue. Commissioner Crum admitted it was an ongoing issue. He was aware of a definition rewrite. There had been a significant amount of input from the community. He suggested the conversation was constant. Vice-Chair Ortiz asked if it was safe to say over the last several years there had been a significant reduction in services. Commissioner Crum could follow-up with more information. Vice-Chair Ortiz would like to further address the area of concern. Ms. Efird continued to the last budgeted appropriation was the Medicaid Services Appropriation. She reported an increased request. Representative Josephson commented in the prior March and April he became knowledgeable enough to be dangerous. He noted a hearing with Mr. Teal at which time he declared that the governor could put any plan forward . He wondered about the administration's reform, and asked Ms. Efird to provide a sense of the administration's position. Commissioner Crum indicated the question would get addressed the following Medicaid presentation. Co-Chair Johnston asked the commissioner to provide further detail about the 4 additional staff positions as noted on slide 15. Commissioner Crum explained that he had asked for feedback from division directors who all provided feedback that Medicaid typically overshadowed the divisions. He noted a new position included a tribal liaison. Co-Chair Johnston noted the department was adding a deputy commissioner position, and wondered what other positions would be added. Ms. Efird responded that department would be adding a deputy commissioner, a special assistant, and two project coordinators. Representative Wool wondered whether the four positions would require the two records of funding be a total of $630,000. Ms. Efird replied in the affirmative. She explained that it was based on the public assistance cost allocation plan, where there was a cost-out of the federal portion. ^MEDICAID BUDGET UPDATE 2:44:50 PM RENEE GAYHART, HEALTH CARE SERVICES DIRECTOR, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, introduced herself. 2:45:39 PM ADAM CRUM, COMMISSIONER, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, began the Medicaid budget overview with slide 20: 5 percent Provider Rate Reduction for Medicaid services Representative Josephson wondered whether the commissioner was saying that the cuts from FY 20 was a restoration of the cuts from FY 20. Commissioner Crum responded replied that a portion of the cuts had been restored from FY 20. Representative Sullivan-Leonard referred back to slide 16 and asked if the supplemental funding was included in that request. She also asked for explanation of the increase of the $127 million for the difference between FY 20 and FY 21. Commissioner Crum responded that the likely supplemental request of the $120 million range would be read the following day. Co-Chair Foster thought the supplemental would be out in the current day. 2:49:01 PM Commissioner Crum explained that the system was shocked in the year prior. He stated that there was an increment request to bring stability to the system, so there was not a large supplemental request. He explained that it was an item was meant to move forward with a larger increment for stability to the Medicaid program. Representative Sullivan-Leonard clarified that $127 million for the governor's increase, and there would be a separate increase for the supplemental. Ms. Efird responded that the FY 20 numbers did not include a supplemental, but there would be a request coming out soon. Co-Chair Foster noted that the base would increase after the supplemental was released. Ms. Efird noted the supplemental amounts were not included. 2:51:46 PM Co-Chair Johnston could see the confusion because in the previous year there was a promise that there would not be a supplemental. She also asked about a date for the supplemental. Ms. Efird responded that the department was working on the numbers and the timing for additional funds. Co-Chair Johnston stressed that there were some concerns because private sector businesses had incurred costs. Commissioner Crum continued to discuss slide 20. He reported that the previous year had drastic measures and cuts, and some were successful and some were not. Commissioner Crum moved on to discuss the hospital diagnostic related groups as seen on slide 21: Hospital Diagnostic Related Groups (DRGs) Commissioner Crum moved to slide 22 regarding the long-term care rate reduction. The department could only provide a rate reduction of 3 percent. 2:56:12 PM Representative Josephson asked how the flat rate versus actual cost rate affected providers. Ms. Gayhart responded that no providers had disenrolled, but many years had a flat rate. Representative Josephson suggested the previous system was generous. Commissioner Crum agreed, and explained that the Medicare program also paid for the service. Representative Wool asked whether a flat rate would be more in line with a fee per service. Commissioner Crum replied that it was a flat rate basis. Commissioner Crum spoke about the pharmacy adjustment listed on slide 24. He mentioned that the department was working closely with the Department of Corrections (DOC). He indicated it was an internal alignment. Co-Chair Johnston asked if there was an alignment with the Department of Administration (DOA). Commissioner Crum responded in the affirmative, and there were discussions with the Division of Retirement and Benefits; and discussions with the Division of Insurance. He explained that Washington was able to receive a waiver for the pharmaceutical purchasing, which allowed for some larger purchasing and bulk power. He stressed that the department was able to achieve a long list of items to pursue. Ms. Gayhart spoke to slide 25 dealing with the limited physical therapy, occupational therapy, and speech therapy. 3:01:12 PM Ms. Gayhart explained that the Expanded Care Management Program was the attempt to be the "friendlier face of Medicaid." She explained that there was a desire to assist Medicaid recipients by being more thoughtful in their use of services. She explained that the program tied the recipient to one primary care provider and one pharmacy for all of their needs. She stated that regulations took longer than anticipated for the program, so they did not meet the number of desired recipients. Commissioner Crum moved to slide 27 having to do with implementing a nurse hotline. Commissioner Crum explained that the timely filling allowance reduction, shown on slide 28, would not save money. Ms. Gayhart continued to slide 29 to discuss streamlining costs of care collections. A savings would be seen in FY 21. Commissioner Crum moved to slide 30. He stated that it was more affordable for the department to pay the premium to keep a person on Medicaid, than it was for the department to lose that person due to the high cost of the premium. 3:05:19 PM Ms. Gayhart reported that the state was on target for a savings of $20 million. She scrolled through slides 32-34 and noted that after FY 17 and FY 18 there was a $20 million savings. They were fairly aggressive targets. Representative Josephson asked about tribal reclaiming. He wondered if the issue was simply that formerly Alaska Natives were having some of their services billed through Medicaid at 50 to 60 percent, but were now billed at 100 percent and saving through the general fund. Ms. Gayhart responded that they were prior period adjustments. She explained that the claims were paid at whatever percentage they would be paid. She stated that currently a Native Alaskan who received services at a tribal health organization would receive 100 percent. She explained that if they received the service at a non-tribal site, the payment would be a match of the eligibility of that individual. Commissioner Crum discussed transportation efficiencies on slide 36. She reported that the dollars had been absorbed in reclaiming efforts by tribal organizations. 3:10:45 PM Co-Chair Johnston warned of the 'One-Liners." She thought adjustments had been made to the transportation. She thought the Tribal Health Organizations deserved kudos. Commissioner Crum spoke of the electronic visit verification program as noted on slide 37. Commissioner Crum moved to slide 38 which discussed the transitional services to 1915(k). Commissioner Crum reviewed slide 39, to discuss the Adult Preventative Dental costs. Co-Chair Johnston had concerns about how the Adult Preventative Dental program would roll out. She wondered whether there would be a "bump" in the supplemental, because of the removal of the program in the year prior. Commissioner Crum responded in the affirmative. Co-Chair Johnston asked if it cost the state more money. Commissioner Crum replied in the affirmative. Commissioner Crum turned to slide 40, which discussed Transitional Behavioral Health Grants. Commissioner Crum looked at slide 41, which discussed the 1115 Behavioral Health Waiver: ? Substance Misuse Disorder Treatment Component ? Approved in November 2018 ? Became effective January 1, 2019 ? Behavioral Health Component Approved September 2019 ? Will be implemented by June 30, 2020 ? Administrative Services Organization ? Contracted with Optum Health in November 2019 ? Goes live on February 1, 2020 Commissioner Crum continued to the bar chart on slide 42 showing Medicaid enrollment and spending in Alaska. 3:16:23 PM Co-Chair Johnston asked if she was seeing that Alaska was spending less for more people. Commissioner Crum moved to slide 43 to answer Co-Chair Johnston's question. Co-Chair Johnston wondered whether there were projections noting the formula change. Commissioner Crum replied in the affirmative. He stressed that the formula change provided a long-term forecast. He stressed that the curve was bent slightly from the year prior. Co-Chair Johnston thought all members had received the MESA Report. Representative Josephson asked about the growth in the green bar. He wondered if it represented the increasing percent over 90 percent. Commissioner Crum responded that it was the actual expansion group. Representative Josephson wondered about a cost to the state. Ms. Efird responded that she could provide the information to the committee. Representative Josephson asked for a dollar figure. Ms. Efird replied that she would provide the exact numbers. Representative Josephson asked the administration's position on the amendments. 3:20:15 PM Commissioner Crum responded that some of the items were put forward due to regulation change. Representative Wool referred to the chart on slide 43 regarding the Medicaid expansion numbers. Commissioner Crum referred back to slide 42 that reflected population and dollar amounts. Representative Wool surmised that the two graphs were tracking exactly proportionately. He stated that the increase in the total Medicaid spending, including expansion, was many times less than the federal total dollars. Commissioner Crum replied in the affirmative. 3:23:55 PM Co-Chair Johnston wondered whether the department was aware of the projected dates in which the state would run out of Medicaid funding. Commissioner Crum turned to the final slide which address the 3-year vision of DHSS: DHSS Mission To promote and protect the health and well-being of Alaskans. Health and Social Services ? Systems Alignment and Change ? Focus on IT Systems ? Emergency Readiness and Response ? Behavioral Health Continuum of Care HB 205 was HEARD and HELD in committee for further consideration. HB 206 was HEARD and HELD in committee for further consideration. Co-Chair Foster reviewed the agenda for the following day. ADJOURNMENT 3:32:59 PM The meeting was adjourned at 3:32 p.m.