Senate Committee on Health and Human Services (02/04/2009)

Final
STAFF SUMMARY OF MEETING

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	02/04/2009	ATTENDANCE

Time:	11:04 AM to 01:33 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:
SB09-073 SB09-061		Postponed Indefinitely Witness Testimony and/or Committee Discussion Only

11:05 AM -- Senate Bill 09-073

Senator Renfroe introduced Senate Bill 09-073. The bill permits a family child care home that accepts children for less than 24-hour care to be exempt from licensing if the home receives one or more related children from up to 2 families, and if parental consent is received from the families. Senator Renfroe explained the circumstances that led him to introduce the bill. He stated that child care provided in a family home can often be less expensive than care provided in a center.

11:11 AM -- Rosemarie Allen, testified in opposition to the bill. She stated the bill will allow a provider to care for children from two separate families with no consideration of the total number of children being served. She stated the bill could allow large numbers of children to be served in unregulated homes. She stated that nationally, several deaths have occurred in unlicensed homes, which has led to legislation in other states restricting unlicensed child care facilities. She stated that, currently, licensed family child care homes can only serve up to six children, plus two school-aged children, with a maximum of two children under the age of two. She stated that strong licensing programs reduce childhood risks and that the bill poses a risk to the health and safety of Colorado's children. She responded to questions from Senator Lundberg regarding her examples of incidents that occurred in unlicensed child care homes, the costs associated with licensure, and whether laws concerning child abuse apply to unlicensed providers. Ms. Allen responded to questions from Senator Newell regarding the costs associated child care licensure. Senator Renfroe discussed the requirements of licensure, and its ancillary costs.

11:30 AM -- Cathy Moyer, Colorado Association for Family Child Care, testified in opposition to the bill, stating the bill is not in the best interests of the safety of children. She stated that the bill does not cap the total number of children who could be served in one unlicensed home. She stated that she disagreed with assertions that unlicensed child care costs less than licensed child care.

11:33 AM -- Marilyn Dean, Colorado Association for Family Child Care, testified that parents appreciate it when providers are licensed. She responded to questions from Senator Lundberg regarding at what point family child care providers need to be licensed. She responded to additional questions from Senator Lundberg regarding the differences between babysitting and regular child care. Ms. Moyer noted that the license is required when the care is provided for profit on a regular and consistent basis.

11:38 AM -- Gladys Wilson, Qualistar Early Learning, testified that the bill could cause more challenges for families, and that the bill could cause unintended consequences by not limiting the total number of children who could be served in an unlicensed home. She stated that unlicensed child care providers are not checked and are not subject to investigations by the Department of Human Services.

11:41 AM -- Sheryl Hutter, representing herself, testified regarding her experiences with unlicensed child care. She questioned whether a provider could adequately care for a large number of children. Senator Mitchell commented on the feasibility of large families receiving care from the same unlicensed child care provider.

11:45 AM -- John Paul Bianchi, Colorado Children's Campaign, testified that there is a need to increase child care capacity, but that there is chance that the bill's approach will compromise child safety. He stated the bill permits parents to essentially waive certain rules that exist for the safety of children and that shouldn't be permitted. He stated that South Dakota is the only state that permits an exempt child care provider to provide care for more than 6 children, and that state caps the number of children in care at 12. He responded to questions from Senator Lundberg. Senator Renfroe clarified that an exempt family child care provider must obtain background checks if he or she participates in the Colorado Child Care Assistance Program (CCAP). He responded to questions from Senator Newell regarding child to child care provider ratios in Colorado and nationally.

11:56 AM -- Devorah Kappers, representing herself, testified regarding her concerns with the safety of children in unlicensed care.

11:58 AM -- Pat Ratliff, Colorado Counties Inc., testified that her organization is neutral on the bill. She asked the committee to consider adding a cap on the total number of children who could be in care with an unlicensed provider. She noted that the bill does not contain a definition of "family," and stated that this lack of definition could increase the number of children in care. She stated the bill potentially could increase incidents of risk for children. Ms. Ratliff responded to questions from Senator Lundberg, stating that her organization is not opposed to the bill, but that the bill should perhaps be amended to limit the number of children in care.

12:07 PM

Senator Renfroe gave concluding remarks regarding the bill. Senator Newell asked if Senator Renfroe would be open to amendment the bill to limit the number of children in care. Senator Renfroe responded that he is opposed to the cap proposed by some parties, which was 4 children. Various members commented on the bill.


BILL:	SB09-073
TIME:	12:12:39 PM
MOVED:	Schultheis
MOTION:	Refer Senate Bill 09-073 to the Committee of the Whole. 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:	SB09-073
TIME:	12:14:37 PM
MOVED:	Tochtrop
MOTION:	Reverse the previous roll call vote and postpone indefinitely Senate Bill 09-073. The motion passed without objection.
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

12:16 PM -- Senate Bill 09-061

Senator Carroll introduced Senate Bill 09-061. The bill specifies that, for the purposes of workers' compensation, property and casualty, and health insurance, any internal review of claims, independent medical examination, or utilization review must be conducted by a Colorado-licensed health care professional who is in good standing and has appropriate expertise to review the claim. Amendment L.006 (Attachment A) was distributed to the committee. Senator Carroll responded to questions from Senator Schultheis regarding the bill's fiscal note and its potential to increase insurance costs. She further responded to questions from Senator Mitchell.

12:22 PM -- Jill Tappert, representing herself and her family, testified in support of the bill and distributed a copy of her testimony to the committee (Attachment B). She described her family's experience going through an appeals process with an insurance company. She stated that if the bill had been the law at the time of her appeal, her lawsuit could have been avoided or the process could have at least been more efficient.

12:27 PM -- Dr. John Sbarbaro, University of Colorado and University Physicians Inc., testified in support of the bill, and in support of the provisions of Amendment L.006. He described the purpose of utilization review and how those decisions interact with medical care that is ordered by a physician. Dr. Sbarbaro described the use of medical literature in making decisions authorizing patient care. He stated that increases in health insurance premiums can only be controlled through utilization control techniques. He stated that physicians in other states should be permitted to make utilization review decisions if a Colorado-licensed physician is not available. He stated that procedures that lead to the denial of care are often fair.

12:35 PM -- Dr. Patrick Ray, Colorado Chiropractic Association, testified in support of the bill. He stated that utilization reviews are often conducted by people without appropriate expertise. He spoke to the time he spends writing to insurance companies trying to obtain care for his patients. He stated that lack of appropriate review by insurance companies can cause delays in care for the patient, which increases the need for health care services. Senator Mitchell commented on the bill's potential to increase insurance costs. Dr. Ray responded, stating that the bill allows for a dialogue between people of similar training regarding appropriate care. Senator Carroll commented on the administrative costs associated with the health insurance process, and stated that the bill will help prevent the escalation of certain appeals.

12:47 PM -- Emmy Conroy, representing herself, testified regarding her experiences attempting to receive approval for coverage of her child's care from her insurance company.

12:52 PM -- Christy Blakely, Family Voices, testified that Family Voices has a staff member to assist with denials of health insurance claims. She stated in her experience, claims are denied by individuals without specific expertise in the area of the claim. She stated that individuals reviewing insurance appeals should have the proper expertise.

12:56 PM -- Jacquelyn Kilmer, Colorado AIDS project and Colorado Organizations Responding to AIDS, spoke in support of the bill, and testified that denials of care can result in the loss of care that is critical to survival. She stated the bill provides common sense standards for the insurance appeals process. She stated the bill will increase the efficiency of the claim review process and ensure its integrity.

12:58 PM -- Betty Lehman, Colorado Division of Insurance Consumer Council, testified regarding her experience with the insurance appeals process. She stated that claims related to her son's care were not reviewed by doctors. She stated that it is a reasonable expectation of insured individuals that individuals with appropriate experience will review claims.

01:01 PM -- Heidi Loeffel, paralegal, testified that her law firm often represents consumers in claims against insurance companies. She gave examples of claims that have been denied by insurance companies. She stated that if insurance companies employ appropriate personnel to review claims, many appeals could be avoided.

01:05 PM -- Michael Rosenberg, Colorado Trial Lawyers Association, testified in support of the bill. He stated the bill is a matter of basic fairness. He stated that the expectation is that if treatment is denied, the person authorizing the denial has experience with that treatment.

01:08 PM -- Sheryle Hutter, Colorado Cross Disability Coalition, testified in support of the bill and regarding her experience with insurers denying claims. She stated requiring a Colorado-licensed doctor to make decisions will help level the playing field.

01:11 PM -- Robert Ferm, American Insurance Association, testified that the bill also impacts workers' compensation and property and casualty insurers, as well as health insurers. He stated that utilization review organizations are contracted with insurance companies, and that insurance companies are responsible for acts that are improper of utilization review organizations. He stated that utilization review organization are regulated, but indirectly. He stated that amendment L.006 attempts to address the issues raised by the bill regarding medical decision making. He stated that parties are continuing to work on the bill. He gave an example of unintended consequences that could be caused by the bill.

01:17 PM -- Steve Fitzsimmons, Anthem Blue Cross and Blue Shield, testified regarding his concerns with the bill, in its current form. He stated that the bill could have an impact on the regulatory framework of review of claims and appeals. He described the federal and state regulations that apply to claims review and appeals of denials. He stated that the regulations establish specific timelines and consistent procedures for claims review. He described the notice provisions that apply when claims are denied and the current regulations related to appeals of denials. He described the portion of the bill that requires a reviewing physician to consult with a peer, requesting that portion of the bill be modified, as the reviewing physician already must be a peer to the physician who originally ordered the treatment. He stated that the bill changes current procedures for second level appeals, stating that a panel is currently allowed to oversee the appeals and asked that the bill be modified to allow this to continue to occur. He testified that the bill's requirements related to review by physicians in similar specialties jeopardizes the plans' ability to meet claim review deadlines.

01:25 PM -- Jerry McElroy, Kaiser Permanente, testified regarding his concerns with the bill, and stated that his organization would like to pursue amendments to the bill. He stated that a number of claims are denied because coverage for the benefit is not provided through the insurance contract, and it wouldn't matter if the claim was reviewed by a member of a similar specialty, the claim would likely be denied because the person's plan doesn't provide coverage for the disputed benefit. He discussed the necessity of training for individuals who review insurance claims.

01:29 PM

Senator Boyd announced that the bill be laid over and that it considered for action only at a later date. She invited witnesses in favor of the bill who didn't get a chance to testify to state their support for the bill briefly. Tom Russell, representing Health Care for All Colorado, Devorah Kappers, representing ADAPT and Colorado Cross Disability Coalition, Dr. Irene Aguilar, representing herself, Dede dePercin, representing Colorado Consumer Health Initiative, and Paula Rhodes, representing herself, voiced their support for the bill. The bill was laid over and the committee recessed.