Senate Committee on Health and Human Services (03/05/2009)

Final
STAFF SUMMARY OF MEETING

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	03/05/2009	ATTENDANCE

Time:	04:18 PM to 07:42 PM	Carroll M.	X
		Lundberg	X
Place:	SCR 356	Mitchell	*
		Morse	X
This Meeting was called to order by		Newell	*
	Senator Boyd	Schultheis	X
		Tochtrop	X
This Report was prepared by		Boyd	X
	Elizabeth Burger
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Conf 09-Colorado Commission on the Aging HB09-1223 SB09-239 HB09-1188 HB09-1059		Favorably Refer to the Full Senate Referred to the Committee of the Whole Amended, Laid Over Referred to Appropriations Referred to the Committee of the Whole

04:19 PM -- Confirmations of Members of the Colorado Commission on the Aging

Alice Langley, governor's appointee to the Colorado Commission on the Aging, described her background and interest in serving on the commission. Copies of her appointment letter and resume were distributed to the committee (Attachment A). She stated that she can be a resource on senior issues. Various committee members commented on her appointment.

(Attachment A can be viewed at State Archives)


BILL:	Conf 09-Colorado Commission on the Aging
TIME:	04:25:12 PM
MOVED:	Tochtrop
MOTION:	Refer the appointment of Alice Langley to the Colorado Commission on the Aging to the full Senate with a favorable recommendation. The motion passed on an 8-0 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

Final YES: 8 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

04:26 PM -- House Bill 09-1223

Senator Tapia introduced House Bill 09-1223. The bill extends the deadline for expending moneys for the Colorado Benefits Management System from the Health Care Supplemental Appropriations and Overexpenditures Account of the Tobacco Litigation Settlement Cash Fund for one year. He explained that the deadline was extended last year, and it should have been extended for two years. He stated that the money has already been appropriated, but it hasn't been spent. Senator Tapia responded to questions from Senator Mitchell regarding why the funding was not used to help balance the budget.


BILL:	HB09-1223
TIME:	04:33:04 PM
MOVED:	Boyd
MOTION:	Refer House Bill 09-1223 to the Committee of the Whole with a recommendation that it be placed on the consent calendar. The motion passed on a 8-0 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

Final YES: 8 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

04:33 PM -- Senate Bill 09-239

Senator Tochtrop introduced Senate Bill 09-239. Amendments L.001, L.003, L.005, L.006, L.009 (Attachments B through F), were distributed to the committee. A letter concerning the bill was also distributed to the committee (Attachment G). The bill implements the recommendations of the Department of Regulatory Agencies (DORA) contained in its sunset review of the Nurse Practice Act. The committee previously held a hearing on the sunset report and its recommendations on Thursday, February 19. Senator Morse suggested that the committee limit its discussion to amendments L.005 and L.006, which both concern a definition of advanced practice nursing, stating that there was likely to be committee agreement on amendment L.001, which addresses the prescriptive authority of advanced practice nurses, and other issues raised in the sunset report. Senator Tochtrop stated that nurses do not have a problem defining advanced practice nursing for the statutes, but that they strongly believe that nurses should be developing the definition. The committee discussed the amendments.

04:45 PM -- Dr. Lynn Parry, representing the Colorado Medical Society (CMS), testified regarding amendments addressing "delegated medical functions". She testified that amendment L.005 does not restrict access to providers, limit competition, or limit choice of providers. She stated that legal liability in situations in which physicians and advanced practice nurses are sharing care needs to be clarified. She responded to questions from Senator Carroll regarding the differences between the two amendments. She responded to questions from Senator Mitchell regarding delegated medical functions. Senator Morse and Dr. Parry further discussed the definition of advanced practice nursing in the amendments and issues related to delegated medical functions. Senator Tochtrop commented on amendment L.001, which concerns prescriptive authority for advanced practice nurses. She responded to questions from Senator Newell regarding the legal liability in situations involving delegated medical functions. Senator Carroll asked for clarification regarding language concerning delegated medical functions that was included in a definition of licensed practical nursing within the bill.

05:11 PM -- Dr. Luke Casias, representing the Colorado Academy of Family Physicians and Colorado Medical Society, testified regarding amendment L.005. He gave examples of situations in which physicians would delegate medical functions to advanced practice nurses. He responded to questions from Senator Morse regarding why it was important to define advanced practice nursing to include delegated medical functions, and Dr. Casias stated that as advanced practice nurses gain more experience and training, the lines between medical and nursing care can become blurred.

05:25 PM -- Sue Townsend, representing the American Academy of Pediatrics, described how she develops medical care plans that are implemented by advanced practice nurses. A handout regarding independent prescriptive authority for advanced practices nurses was distributed to the committee (Attachment H). She stated that amendment L.005 is an attempt to define the interface between the functions of doctors and nurses. She responded to questions from Senator Tochtrop regarding articulated plans for advanced practice nurses with prescriptive authority.

05:30 PM -- Kari Hershey, representing the Colorado Medical Society, testified in support of amendment L.005. She stated that advanced practice nurses working in integrated care settings perform delegated medical functions. She stated that even if the acts are performed by nurses, physicians retain legal liability for the acts by operation of law. She stated that a definition of advanced practice nursing that does not include delegated medical functions could confuse patients and that amendment L.005 does not impede an advanced practice nurse from performing independent nursing functions. Ms. Hershey responded to previous questions from Senator Carroll regarding language in the bill that includes delegated medical functions in a definition of practical nursing. Ms. Hershey clarified that the articulated plans outlined in amendment L.001 only apply to advanced practice nurses with prescribing authority, and the issue with delegated medical functions involves both advanced practice nurses with and without prescribing authority. She discussed her concerns with amendment L.006. She responded to questions from Senator Newell regarding CMS's reasons for supporting a definition of advance practice nursing that includes delegated medical functions. Senator Newell asked if the relationship between advanced practice nurses and doctors would be changed by adopting an amendment that defines advanced practice nursing to include delegated medical functions.

05:45 PM -- Tay Kopanos, representing the Colorado Nurses Association, testified that the nurses are open to defining advanced practice nursing, but that the definition should come from the nursing community. She stated that the language in amendment L.005 limits and constrains the practice of advanced practice nursing. She stated that the practice of advanced practice nursing is independent and that advanced practice nurses do not practice under delegated medical authority. She stated that any definition of advanced practice nursing needs to be fluid and flexible. She responded to question from Senator Carroll regarding what the harm was in including delegated medical functions in the definition of advanced practice nursing. She stated that advanced practice nursing is an autonomous profession, and when an advanced practice nurse chooses to perform a delegated medical function, he or she is no longer practicing under his or her authority as an advanced practice nurse; he or she is practicing under his or her authority as a professional nurse.

06:04 PM -- Linda Pearson, representing the Colorado Nurses Association, described data concerning malpractice actions involving nurse practitioners and physicians. She responded to questions from Senator Newell regarding whether advanced practice nurses who are exercising a function at the request of a physician are performing functions as a professional nurse or as an advanced practice nurse. Senator Mitchell asked for clarification about the boundaries of advanced practice nurses' scope of practice. Ms. Pearson stated that it was essential for nurses to define nursing and physicians to define medicine. Senator Lundberg asked if the nursing scope of practice was self-regulating.

06:20 PM -- Linda Siderius, representing the Colorado Nurses Association, stated that there are independent and dependent pieces to nursing. She stated that even in an dependent situation, a professional nurse is independently obligated to execute the duties within his or her scope of practice. She stated that there is an exemption within the Medical Practice Act for the practice of nursing. Ms. Siderius responded to questions from Senator Schultheis regarding how conflicts between advance practice nurses and physicians are resolved. Senator Carroll asked if there would be any benefit to defining "advanced practice nurse" separately from "advanced practice nursing." Ms. Kopanos discussed the qualifications for advance practice nurses. The committee discussed whether there would be any benefit in defining the terms separately. Ms. Siderius responded to committee questions regarding the boundaries of advanced practice nursing scope of practice and the liability of nurses.

06:42 PM -- Marion Thornton, President of the Colorado Society of Advanced Practice Nurses, testified that including delegated medical authority in the definition of advanced practice nursing will limited advanced practice nurses' scope of practice.

06:43 PM -- Lieutenant Colonel Larry Shovelton, representing the Colorado Association of Nurse Anesthetists, stated that whether an act is nursing or medicine is defined by the person who performs the act. He stated that he supported L.006 because nurses do not perform medical functions.

06:47 PM -- Doug Warnecke, representing the Colorado Association of Nurse Anesthetists, testified that doctors and advanced practice nurses have overlapping scopes of care. He stated that any restrictions on the scope of care for advanced practice nurses is bad for Colorado.

06:50 PM

Various individuals who were not able to testify indicated their support for amendment L.006.

06:52 PM -- Charlie Hebeler, representing the Colorado Nurses Association, testified regarding amendment L.001 (Attachment B).


BILL:	SB09-239
TIME:	06:53:16 PM
MOVED:	Tochtrop
MOTION:	Adopt prepared amendment L.001 (Attachment B). The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell	Excused
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

06:55 PM

The bill was laid over for further action at the next meeting of the Senate Health and Human Services Committee.

07:01 PM -- House Bill 09-1188

Senator Carroll introduced House Bill 09-1188. She stated that the bill is a clean-up bill for the Michael Skolnik Medical Transparency Act. The Michael Skolnik Medical Transparency Act requires licensed medical providers to disclose certain information to the State Board of Medical Examiners whenever they renew their license. The board then makes the information available to the public. She described the bill's provisions. Specifically, the bill clarifies the information that physicians must disclose, and specifies that physicians are not required to report precautionary or administrative suspensions of medical staff membership or clinical privileges, or medical malpractice judgments that occurred prior to January 1, 1988. She stated that she has worked with various stakeholders on the bill.

07:04 PM -- Dr. Ben Vernon, representing the Colorado Medical Society, testified in support of the bill. He testified regarding the need for transparency of information about physicians. He stated that some of the original bill's requirements did not aid in the goals of the bill. He spoke to the efforts of Patty Skolnik to increase transparency of information. He asked the committee to support the bill.


BILL:	HB09-1188
TIME:	07:08:22 PM
MOVED:	Carroll M.
MOTION:	Refer House Bill 09-1188 to the Committee on Appropriations. The motion passed on a 7-0 roll call vote, with one member excused.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Excused
	Morse	Yes
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

Final YES: 7 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS

07:09 PM -- House Bill 09-1059

Senator Carroll introduced House Bill 09-1059. The bill concerns health care coverage for individuals who are participating in clinical trials. She stated that the bill will put everybody on the same page regarding whether a person participating in a clinical trial is covered by health insurance for the routine care they otherwise would have received if they weren't participating in the trial. She responded to Senator Schultheis regarding the cost of participating in clinical trials and whether the cost is covered by the trial sponsor. Senator Newell commented on the bill's requirement that a doctor sign off on a patient's participation in a clinical trial. Senator Carroll responded to questions from Senator Lundberg regarding whether the bill's provisions had been adopted in other states, noting that the bill's provisions were based on federal legislation.

07:17 PM -- Carol Sjerven, representing the Oncology Nursing Society and Veeda Oncology, described the process of enrolling a patient in a clinical trial. She stated that patients have declined to participate in clinical trials due to their fear that insurance won't cover some expenses. She described her experience seeking standard of care treatment on behalf of patients who were also enrolled in clinical trials. She stated that the bill does not require health insurers to cover anything investigational and merely ensures that the patient would receive the services that they would be entitled to if they were not participating in the trial.

07:25 PM -- Dana Dzwonkowski, representing the American Cancer Society and Cancer Action Network, responded to Senator Lundberg's questions regarding other states that have similar laws.

07:25 PM -- Jacquelyn Kilmer, representing Colorado Organizations Responding to Aids and the Colorado Aids Project, testified in support of the bill.

07:26 PM -- Elizabeth Nugent, representing Kaiser Permanente, testified in support of the bill.

07:26 PM -- Paul Wisor, representing the Rocky Mountain Multiple Sclerosis Center, testified in support of the bill

07:26 PM -- Dr. Rafael Veintimilla, representing Kaiser Permanente, testified in support of the bill.

07:27 PM -- Jerry McElroy, representing Kaiser Permanente, testified in support of the bill. He responded to questions from Senator Lundberg regarding the bill's effect on Kaiser Permanente and other insurance companies. Senator Carroll and Senator Lundberg discussed the fiscal note of the bill. Mr. Wisor discussed whether or not there would be an increase in costs to insurance companies for providing the care. He stated that some studies have found that costs increased, while others have found cost savings. He further responded to questions from Senator Lundberg regarding the potential cost of the bill's provisions for insurance companies, stating that a study in Maryland showed that there were no increased costs. Mr. Wisor, Dr. Veintimilla, and Ms. Dzwonkowski discussed the number of patients that could be affected by the bill. Ms. Nugent responded to committee questions regarding whether Kaiser Permanente has experienced an increase in costs as a result of their program to allow patients to participate in clinical trials.

07:37 PM

Senator Carroll gave concluding remarks regarding the bill. She testified that the insurance industry has reviewed the bill. She stated that the bill is important for research.


BILL:	HB09-1059
TIME:	07:38:40 PM
MOVED:	Carroll M.
MOTION:	Refer House Bill 09-1059 to the Committee of the Whole. The motion passed on a 5-2 roll call vote, with one member excused.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	No
	Mitchell	Excused
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Final YES: 5 NO: 2 EXC: 1 ABS: 0 FINAL ACTION: PASS

07:41 PM

The committee recessed.