Final
STAFF SUMMARY OF MEETING

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:03/19/2009
ATTENDANCE
Time:01:36 PM to 06:31 PM
Carroll M.
X
Lundberg
X
Place:SCR 356
Mitchell
X
Morse
X
This Meeting was called to order by
Newell
X
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:
SB09-244
HB09-1252
SB09-245
Amended, Referred to Appropriations
Referred to Appropriations
Amended, Referred to Appropriations


01:40 PM -- Senate Bill 09-244


Senator Shaffer introduced Senate Bill 09-244. The bill requires all health insurance policies that are subject to state regulation to provide coverage for the assessment, diagnosis, and treatment of autism spectrum disorders (ASD). He distributed amendment L.005 (Attachment A) and an unofficial preamended version of the bill including the amendment (Attachment B). He explained that he has been working closely with the health insurance plans on the bill and has made changes to the bill in response to the health plans' concerns. Senator Shaffer discussed the bill's fiscal note. Senator Shaffer responded to questions from Senator Boyd regarding removal of the term "medically necessary" from the bill. He responded to additional questions from Senator Newell regarding insurance coverage for autism in other states, the cost of the coverage, how the bill will change current insurance coverage for autism, and costs to state social services system if autism treatment is not obtained early in life.

09SenateHHS0319AttachA.pdf 09SenateHHS0319AttachB.pdf

02:02 PM -- Ben Price, representing the Colorado Association of Health Plans, testified in opposition to the bill. He stated that successful treatment for autism can be elusive. He discussed his concerns with the bill, including concerns relating to the credentialing and qualifications of providers of autism treatment services. He stated that the bill warrants more discussion with all of the involved parties. Mr. Price responded to questions from the committee regarding health insurance data and the time necessary for the health plans to review the bill.










02:16 PM -- Tony Gagliardi, representing the National Federation of Independent Business, testified that health insurance is a great concern of his members. He stated that small businesses are often caught in the middle of discussions on mandated coverages for health insurance. He stated his hope was that the parties could reach an agreement on the bill's provisions. He stated his opposition to the bill. He responded to questions for Senator Tochtrop regarding data on health insurance coverage offered by small business. Mr. Gagliardi clarified that the bill would not apply to all health insurance plans.

02:25 PM -- Jandel Allen-Davis, representing Kaiser Permanente, described Kaiser Permanente's approach to treating children with autism. She stated that Kaiser Permanente cannot support the bill and outlined the organization's reason for opposing the bill. She discussed applied behavioral analysis, stating that the medical literature has not shown it to be more effective than other treatments for autism. She distributed a handout concerning applied behavioral analysis (Attachment C). She responded to questions from Senator Mitchell regarding the data on applied behavioral analysis therapy.

09SenateHHS0319AttachC.pdf

02:37 PM -- Susan Cox, representing Kaiser Permanente, responded to questions from Senator Carroll regarding the treatments for autism that are currently covered by Kaiser Permanente. Senator Shaffer discussed the changes made to the bill by amendment L.005. Dr. Allen-Davis responded to questions from Senator Carroll regarding autism treatment requirements in other states and from Senator Boyd regarding delegation of medical services. Ms. Cox discussed the potential cost increases to Kaiser Permanente as a result of the bill, and the resulting cost increases to state employee's health insurance coverage. She distributed a handout related to autism legislation in other states, and estimates of the cost increases of that legislation (Attachment D). She listed states that have considered, but not passed, similar legislation. She further noted that the bill does not apply to employers who self-insure their plans. She responded to questions from Senator Carroll regarding whether the cost estimates attributed to the legislation include estimates for the costs of the services that are currently being provided by Kaiser Permanente. She committed to continuing to work on the bill over the summer.

09SenateHHS0319AttachD.pdf

03:05 PM -- Ed Steinberg, Assistant Commissioner for the Colorado Department of Education, testified in support of the bill. He stated that the department believes the bill is a great benefit to students and adults with ASD. He responded to questions from Senator Lundberg regarding whether or not the State Board of Education supports the bill, stating that the board has not yet taken a position on the bill.

03:07 PM -- Perry Pearce, representing the Colorado Competitive Council, testified in opposition to the bill and distributed a copy of his testimony to the committee (Attachment E). Mr. Pearce testified that while his organization is sympathetic to the families struggling with autism, it believes the increased cost of the coverage will lead to more employers dropping health insurance for their employees. He stated that health care costs need to be controlled, and that the bill is a step in the wrong direction. Mr. Pearce responded to questions from Senator Newell regarding costs to employers and employees associated with caring for family members with autism.

09SenateHHS0319AttachE.pdf





03:18 PM --
Dr. Phil Strain, representing himself, distributed a copy of his testimony to the committee (Attachment F). He discussed the effects of autism and stated that the lifetime cost of care for each individual with autism ranges from $2 to $4 million. He discussed applied behavioral analysis as a treatment for autism. He gave estimates of cost savings that could accrue through the services provided by the bill. He responded to questions from Senator Newell regarding "medical" and "behavioral" services for autism and certified treatment providers, and from Senator Mitchell regarding studies of the efficacy of applied behavioral analysis.

09SenateHHS0319AttachF.pdf

03:39 PM --
Dr. Stephen Block, Executive Director of Denver Options, testified that the bill will both help children and support the business community. He stated that there is no way to avoid the costs associated with autism. He responded to previous witnesses' comments related to the therapies that could be provided as a result of the bill. He stated that it is clear that providing early intervention services to children with autism avoids long-term costs.

03:49 PM --
Dr. Cordelia Robinson, Director of JFK Partners at the University of Colorado School of Medicine, read the testimony of a colleague, Dr. Ann Reynolds, in support of the bill (Attachment G).

09SenateHHS0319AttachG.pdf

03:52 PM --
Greg Goodman, representing himself, referenced a packet of information in support of the bill that was distributed to the committee (Attachment H). He stated that the data shows that it is hard to determine a correlation between mandates and health insurance premium cost increases.

(Attachment H can be viewed at State Archives)

04:03 PM --
Tasha Aper, representing herself, distributed a copy of her testimony to the committee (Attachment I). Senator Tochtrop distributed information on Colorado's health insurance mandates (Attachment J). Ms. Aper discussed the benefits of early and intensive applied behavioral analysis therapy.

09SenateHHS0319AttachI.pdf 09SenateHHS0319AttachJ.pdf

04:06 PM --
Jill Tappert, representing herself, testified in support of the bill and distributed a copy of her testimony to the committee (Attachment K). She discussed the services her daughter receives to address her autism, including applied behavioral analysis therapy. She discussed the cost of obtaining treatment for her daughter.

09SenateHHS0319AttachK.pdf








04:17 PM --
Dr. David Hatfield, representing himself, distributed a copy of his testimony to the committee (Attachment L). He described applied behavioral analysis therapy and the manifestations of the disease. He discussed the qualifications of individuals who provide applied behavioral analysis therapy. He stated that there is already a national model for certification, and that certifying behavioral analysts is more appropriate than setting up a licensing structure for these individuals.

09SenateHHS0319AttachL.pdf

04:30 PM --
Angela West, representing herself, testified in support of the bill and described her family's experience with autism.

04:31 PM --
Jeff Johnson, representing himself, testified in support of the bill and distributed a handout in support of the bill (Attachment M).

09SenateHHS0319AttachM.pdf

04:33 PM --
Carol Meredith, representing herself, testified in support of the bill and distributed a handout of her testimony (Attachment N).

09SenateHHS0319AttachN.pdf

04:35 PM --
Mark Mannino, representing himself, testified in support of the bill.

04:38 PM --
Betty Lehman, representing the Colorado Autism Society, responded to previous committee questions regarding what is considered "medically necessary." She discussed the cost of the coverage and the need for treatment services for individuals with autism.























04:44 PM

Senator Boyd closed witness testimony. Individuals who signed up in support of the bill but who did not get a chance to testify included: Cami Learned, Lu Etta Loeber, Janice Panting, Erin Genullis, Adrienne Paradis (a copy of her testimony is included as Attachment O), Shelly Roney, Tom Tolt (a copy of his testimony is included as Attachment P), Emmy Conroy (a copy of her testimony is included as Attachment Q), John Sandoval, Angelique Layton (a copy of her testimony is included as Attachment R), Helena Huckabee (a copy of her testimony is included as Attachment S), Karen Brass, Monica Britton (a copy of her testimony is included as Attachment T), Rebecca Betancourt (a copy of her testimony is included as Attachment U), and Ken Gordon. Senator Shaffer gave concluding remarks regarding the bill. Senator Mitchell distributed a copy of amendment L.003 (Attachment V). The amendment specifies that the Medicaid program must cover the same services authorized by the bill in its Home- and Community-Based Services for Children with Autism waiver program.

09SenateHHS0319AttachO.pdf 09SenateHHS0319AttachP.pdf

09SenateHHS0319AttachQ.pdf 09SenateHHS0319AttachR.pdf

09SenateHHS0319AttachS.pdf 09SenateHHS0319AttachT.pdf

09SenateHHS0319AttachU.pdf 09SenateHHS0319AttachV.pdf

BILL:SB09-244
TIME: 04:47:17 PM
MOVED:Tochtrop
MOTION:Adopt prepared amendment L.005 (Attachment A). The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Lundberg
Mitchell
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection





BILL:SB09-244
TIME: 04:48:35 PM
MOVED:Mitchell
MOTION:Adopt prepared amendment L.003 (Attachment V). The motion passed on a 6-2 roll call vote.
SECONDED:
VOTE
Carroll M.
No
Lundberg
Yes
Mitchell
Yes
Morse
Yes
Newell
Yes
Schultheis
Yes
Tochtrop
No
Boyd
Yes
Not Final YES: 6 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS
BILL:SB09-244
TIME: 04:56:35 PM
MOVED:Schultheis
MOTION:Adopt a conceptual amendment to strike the bill's provisions and add the bill's topic as an item of study for the Health Care Task Force during the 2009 interim. The motion failed on a 3-5 roll call vote.
SECONDED:
VOTE
Carroll M.
No
Lundberg
Yes
Mitchell
Yes
Morse
No
Newell
No
Schultheis
Yes
Tochtrop
No
Boyd
No
Not Final YES: 3 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: FAIL











BILL:SB09-244
TIME: 05:06:20 PM
MOVED:Tochtrop
MOTION:Refer Senate Bill 09-244, as amended, to the Committee on Appropriations. The motion passed on a 5-3 roll call vote.
SECONDED:
VOTE
Carroll M.
Yes
Lundberg
No
Mitchell
No
Morse
Yes
Newell
Yes
Schultheis
No
Tochtrop
Yes
Boyd
Yes
Final YES: 5 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS


05:10 PM

The committee recessed briefly.


05:13 PM -- House Bill 09-1252

The committee reconvened. Senator Isgar introduced House Bill 09-1252. The bill authorizes the San Luis Valley County Commissioners Association to create a Local Access to Health Care Pilot Program to provide access to health care services to individuals employed by employers in the San Luis Valley. Legislation was passed in 2007 that created a similar program in Pueblo County.

05:17 PM --
Holly Hanson, Chief Executive Officer of Health Access Pueblo, described the Local Access to Health Care Pilot Program in Pueblo County. She stated the program has been enrolling individuals for 6 months and that some of the initial results are very favorable. She responded to questions from Senator Boyd and Senator Carroll regarding the enrollment in the program and the period of time for which the program is authorized. She responded to additional questions regarding the cost to individuals for participating in the program and how the program is funded. Ms. Hanson further responded to questions from the committee regarding the benefits offered through the program, the co-pays for services, and whether dependents can be covered under the program. Senator Isgar responded to questions from Senator Newell regarding the bill's reporting requirements.













05:39 PM --
Gwen Heller, representing San Luis Valley Regional Medical Center, stated that the region has experienced a growth in the number of uninsured individuals. She stated that there are some of the aspects of the Pueblo pilot program that appeal to interested persons in the San Luis Valley. She discussed the benefits of the pilot for the San Luis Valley. She responded to questions from Senator Boyd regarding whether it is premature to expand the pilot to other areas of the state prior to knowing the outcomes of the pilot in Pueblo. She responded to questions from Senator Boyd regarding the interaction between this bill and House Bill 09-1143, which allows health maintenance organizations to offer limited health benefit plans in rural areas. The committee discussed whether the plan authorized by House Bill 09-1143 would influence the program authorized under this bill, and the reporting requirements for each program.

06:07 PM --
Robert Hagedorn, Rio Grande County Commissioner, stated that the bill will help create a healthier population within Rio Grande County. He said the bill will help the hospitals in the area to obtain reimbursements for services and will help reduce the need for charity care.

06:12 PM --
Crestina Martinez, Costilla County Commissioner, described the San Luis Valley and the types of businesses that could benefit from the program. She emphasized that the supporters were not seeking state funding, just authorization to implement the program. She noted that the San Luis Valley County Commissioners Association supports the bill.

06:16 PM --
John Sandoval, Conejos County Commissioner, testified that the bill will benefit residents in the San Luis Valley.

06:17 PM --
Pat Ratliff, representing Colorado Counties Inc., testified in support of the bill.


06:18 PM

Senator Isgar gave concluding remarks regarding the bill.
BILL:HB09-1252
TIME: 06:19:06 PM
MOVED:Tochtrop
MOTION:Refer House Bill 09-1252 to the Committee on Appropriations. The motion passed on a 5-1 roll call vote, with 2 members excused.
SECONDED:
VOTE
Carroll M.
Excused
Lundberg
Yes
Mitchell
Excused
Morse
Yes
Newell
Yes
Schultheis
Yes
Tochtrop
Yes
Boyd
No
Final YES: 5 NO: 1 EXC: 2 ABS: 0 FINAL ACTION: PASS






06:21 PM -- Senate Bill 09-245

Senator Sandoval introduced Senate Bill 09-245. The bill amends portions of the Colorado Children's Code to comply with the federal "Fostering Connections to Success and Increasing Adoptions Act of 2008." Specifically, the bill establishes a kinship guardianship assistance program. A handout concerning the federal law was distributed to the committee (Attachment W).

09SenateHHS0319AttachW.pdf

06:25 PM --
Dannie Goff, representing Bridging the Gap, testified regarding his experiences in foster care. He stated that the bill will assist foster parents and relatives to care for children in foster care.


06:27 PM

Senator Sandoval gave concluding remarks regarding the bill. She distributed amendment L.001 (Attachment X).


09SenateHHS0319AttachX.pdf
BILL:SB09-245
TIME: 06:29:15 PM
MOVED:Tochtrop
MOTION:Adopt prepared amendment L.001 (Attachment X). The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Lundberg
Mitchell
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection










BILL:SB09-245
TIME: 06:30:23 PM
MOVED:Tochtrop
MOTION:Refer to Senate Bill 09-245, as amended, to the Committee on Appropriations. The motion passed on a 6-0 roll call vote, with 2 members excused.
SECONDED:
VOTE
Carroll M.
Excused
Lundberg
Yes
Mitchell
Excused
Morse
Yes
Newell
Yes
Schultheis
Yes
Tochtrop
Yes
Boyd
Yes
Final YES: 6 NO: 0 EXC: 2 ABS: 0 FINAL ACTION: PASS


06:31 PM

The committee recessed.