House Committee on Health and Human Services (04/23/2009)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	04/23/2009	ATTENDANCE

Time:	02:33 PM to 06:50 PM	Acree	X
		Gerou	X
Place:	LSB A	Green	X
		Kagan	X
This Meeting was called to order by		Kefalas	X
	Representative Riesberg	Kerr J.	X
		Nikkel	*
This Report was prepared by		Primavera	X
	Kelly Stapleton	Swalm	X
		Gagliardi	X
		Riesberg	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB09-1364 HB09-1353 SB09-239		Referred to the Committee of the Whole Referred to Appropriations Amended, Referred to Appropriations

02:34 PM -- House Bill 09-1364

Representative Riesberg presented the House Bill 09-1364. He described the composition and charge of the Health Care Task Force. He explained that members may serve no more than two consecutive terms and that one term is the equivalent to one year. Representative Riesberg stated that a majority of the members currently appointed to the task force cannot be reappointed because they have served two terms. He stated that House Bill 09-1364 increases the term of office for members of the task force from one year to two years.


BILL:	HB09-1364
TIME:	02:36:39 PM
MOVED:	Riesberg
MOTION:	Moved to refer House Bill 09-1364 to the Committee of the Whole. The motion passed on a 10-0 roll call vote.
SECONDED:	Kefalas
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	Yes
	Kagan	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Nikkel	Excused
	Primavera	Yes
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 10 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS

02:37 PM -- House Bill 09-1353

Representative Miklosi presented House Bill 09-1353, which, subject to sufficient appropriations and the receipt of federal financial participation, authorizes the Department of Health Care Policy and Financing to provide benefits under Medicaid and the Children's Basic Health Plan (CHP+) to pregnant women and children who are legal immigrants prior to the five-year waiting period following their date of entry into the United States. Representative Gerou stated that she was under the impression that, during the last economic downturn, the General Assembly cut off funding for any programs to legal immigrants. She asked the sponsor if he knew when funding for legal immigrants was reinstated. Representative Miklosi stated that he would defer to one of the witnesses. Committee members asked how many legal immigrants would be eligible for the program, if there are U.S. citizens who are currently not covered by the program, and how many legal immigrants use hospitals for their primary care needs.

02:52 PM -- Becky Updike, representing Tennyson Center for Children, Every Child Matters, and the Colorado Council of Churches, spoke in favor of the bill. She stated that access to health care is a moral imperative. She stated that 80 percent of brain development happens in the first four years of life and getting proper health care during this time is vital for healthy development. She stated that when kids are not healthy, they cannot excel.

02:55 PM -- Robert Semro, Colorado Consumer Health Institute, spoke in favor of the bill. He provided data regarding why it is important to provide access to health care for children.

02:57 PM -- Adela Flores-Brennan, Colorado Center on Law and Policy, testified in support of the bill. She stated that one of the core objectives of the center is to provide access to health care for low-income families. She stated that the inequity not to allow legal immigrants access to health care ensures that legal immigrant children go without proper care. She stated that five years is too long to wait to access health care.

03:01 PM -- Tara Trujillo, Healthy Families Director, Colorado Children's Campaign, testified in support of the bill. She spoke to the Cover All Kids by 2010 initiative. She stated the initiative is a coalition of approximately 50 groups that work to provide access and coverage for all children in Colorado. She spoke to the five-year waiting provision which was removed with the federal reauthorization of the State's Children Health Insurance Plan (SCHIP). She spoke to the cost-effectiveness of providing care to children and pregnant women. Committee members asked Ms. Trujillo to expand on the financing mechanisms of the CHP+.

03:09 PM -- Dr. Sandeep Wadhwa, Chief Medical Officer, Department of Health Care Policy Financing, spoke in favor of the bill. He explained the impetus for the bill which was the federal reauthorization of the SCHIP program. He spoke specifically to the removal of the five-year waiting period provision. He stated that the department would have to request an appropriation in FY 2010-11 in order to implement the bill in the Medicaid program. He stated that the bill allows the department to get the necessary administrative requests in order prior to funding becoming available. Ginny Brown, Legislative Liaison, Department of Health Care Policy, responded to Representative Kefalas' question regarding the cost of the bill with regard to the Colorado Benefits Management System (CBMS). She stated that John Bartholowmew could respond to that question.

03:19 PM -- Amy Larsen, Fiscal Analyst, Colorado Legislative Council, responded to committee questions regarding the fiscal note.

03:29 PM -- John Bartholowmew, Budget Division, Department of Health Care Policy and Financing, responded to committee questions regarding the fiscal note.


BILL:	HB09-1353
TIME:	03:37:54 PM
MOVED:	Kefalas
MOTION:	Moved to refer House Bill 09-1353 to the Committee on Appropriations. The motion passed on an 8-2 roll call vote.
SECONDED:	Gagliardi
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	Yes
	Kagan	Yes
	Kefalas	Yes
	Kerr J.	Excused
	Nikkel	No
	Primavera	Yes
	Swalm	No
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 8 NO: 2 EXC: 1 ABS: 0 FINAL ACTION: PASS

03:40 PM -- Senate Bill 09-239

Representative Riesberg presented Senate Bill 09-239, which implements the recommendations of the Department of Regulatory Agencies (DORA) sunset review of the state Board of Nursing and continues the function of the board until July 1, 2020. Representative Riesberg provided a handout which outlines the bill (Attachment A). He spoke to amendment L.018, which addresses Recommendation 6 concerning the board's fining authority (Attachment B).

03:45 PM -- Dr. Mary Ciambelli, Colorado Society of Clinical Specialists and Psychiatric Nursing, spoke to the reengrossed bill. She stated that she supports the bill, but would like to see the language on pages 38, Section 33 of the bill, amended. She stated that this section addresses the issue of whether to allow advanced practice nurses (APNs) the authority to involuntarily commit individuals to alcohol and drug treatment programs.

03:49 PM -- Fran Ricker, Executive Director, Colorado Nurses Association, spoke in support of the bill, with the exception of Section 33 of the reengrossed bill. She reiterated Dr. Ciambelli's testimony that APNs have a tremendous amount of education and are qualified and competent to address issues surrounding drug and alcohol abuse.

03:58 PM -- The committee recessed.

05:32 PM -- The committee reconvened, and continued with witness testimony.

05:32 PM -- Cheryl Blankemeier, Colorado Association of Nurse Anesthetists, spoke in support of the bill. She spoke to the responsibilities of the Board of Nursing.

05:35 PM -- Edie Sonn, Colorado Medical Society (CMS), spoke in support of the reengrossed bill as it came out of the Senate. She spoke to the collaboration between the Colorado Medical Society and the Colorado Nurses Association regarding the definition of advanced practice nurses and their scope of authority. She spoke to Section 33, the involuntary commitment piece of the bill, stating that it was added in the Senate. She stated that CMS is in support of that language.

05:41 PM -- Susan Miller, Director Health Care Section, Department of Regulatory Agencies, responded to committee questions.

05:43 PM -- Dr. Charles Smith, Deputy Director, Division of Behavioral Health, Department of Human Services, spoke to Section 33, the involuntary commitment piece of the legislation. Dr. Smith stated that the division is in support of the language currently in the bill. He stated that there are no other states that allow APNs to involuntarily commit individuals to a drug or alcohol program. He described the process in which a person is involuntarily committed to a drug and alcohol treatment program. Dr. Smith described what happened during the 2008 legislative session when APNs were given the authority to involuntarily commit individuals to drug and alcohol treatment stating that it was put into law with House Bill 08-1167. He stated that an amendment was put on the bill on second reading and the department was unaware of it until it became law. He stated that the department and the APNs worked with the Governor to delay implementation of the authority until July 2009. He responded to Representative Gagliardi's question regarding the department's assurance that when the department sits down to evaluate this issue, all pertinent stakeholders will be invited to the discussion.

06:01 PM -- Tay Kopanos, Colorado Nurses Association (CNA) and the Denver Nurse-Midwives, spoke to the collaboration in drafting the bill. She spoke to the DORA sunset review report. She spoke to Section 33 which allows APNs to sign documents related to the involuntary commitment of substance and alcohol abusers. She stated that there is a need in the community for APNs to be able to sign these commitment forms. She spoke to the educational factors the APN's acquire throughout their training and education. Ms. Kopanos spoke to the APNs prescriptive authority. She stated that CNA is concerned with Page 32, lines 26 and 27 and Page 33, lines 1 and 2 of the reengrossed bill. She stated that the DORA Working Group, which reviewed the legislation for the Nurse Practice Act before it was introduced, did not approve this section. She stated that rule making should be separate between the Board of Nursing and the Board of Medicine. She stated that these lines in the bill may allow joint rule making which the CNA is opposed to. She clarified for the committee that she is in support of the bill without the language in Section 33. She spoke briefly about Senate Bill 09-007 which would have required the Division of Behavioral Health to review whether APNs may have the authority to involuntarily commit an individual for a drug or alcohol treatment program. Ms. Kopanos responded to committee questions.

06:20 PM

Representative Riesberg responded to committee questions that were asked during testimony. He clarified that APNs do not have the authority to involuntarily commit individuals with alcohol and substance abuse problems. He stated that implementation regarding that piece of House Bill 08-1061 was delayed until July 2009. He provided data regarding how many involuntary commitments have occurred across the state. He spoke to the involuntary commitment issue within the bill. Representative Riesberg provided concluding remarks to the bill.


BILL:	SB09-239
TIME:	06:37:42 PM
MOVED:	Riesberg
MOTION:	Moved to adopt prepared amendment L.018 (Attachment B). Representative Riesberg explained the amendment. The motion passed without objection.
SECONDED:	Kefalas
		VOTE
	Acree
	Gerou
	Green
	Kagan
	Kefalas
	Kerr J.
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	SB09-239
TIME:	06:39:32 PM
MOVED:	Riesberg
MOTION:	Moved to adopt prepared amendment L.019 (Attachment C). Representative Riesberg explained the amendment. The motion passed without objection.
SECONDED:	Kefalas
		VOTE
	Acree
	Gerou
	Green
	Kagan
	Kefalas
	Kerr J.
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	SB09-239
TIME:	06:42:33 PM
MOVED:	Riesberg
MOTION:	Moved to refer Senate Bill 09-239, as amended, to the Committee on Appropriations. The motion passed on a 9-0 roll call vote.
SECONDED:	Kefalas
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	Excused
	Kagan	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Nikkel	Yes
	Primavera	Excused
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 9 NO: 0 EXC: 2 ABS: 0 FINAL ACTION: PASS

06:45 PM

The committee adjourned.