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

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	03/05/2009	ATTENDANCE

Time:	04:13 PM to 07:28 PM	Acree	X
		Gerou	X
Place:	LSB A	Green	X
		Kefalas	X
This Meeting was called to order by		Kerr J.	X
	Representative Riesberg	McGihon	E
		Nikkel	X
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:
SB09-132 HB09-1278		Witness Testimony and/or Committee Discussion Only Postponed Indefinitely

04:14 PM -- Senate Bill 09-132

Representative Kerr presented Senate Bill 09-132 which repeals and re-enacts the Colorado Cares Rx Program. The Department of Health Care Policy and Financing is required to research and make information available to the public about discount prescription drug programs including ways to obtain lower-cost prescription drugs and contact information for programs.

04:20 PM -- Kelly Fritz, American Association of Retired Persons (AARP), stated that they have concerns about the bill. She stated that Senate Bill 07-001, the authorizing legislation for the Colorado Cares Rx program, was not implemented as intended. She stated that the introduced version of Senate Bill 09-132 repealed the program completely. She stated that the reengrossed bill keeps the program alive, but only as an educational tool for discount drug cards which are supported by the pharmacies. Ms. Fritz said one of their concerns is that Wal-Mart of Target could change the Preferred Drug List (PDL) program at any time. She also stated that the state did not enter into a multi-purchasing pool which in her opinion hurt the program.

04:27 PM -- Brad Young, RxPlus Pharmacies, expressed his concern with the bill. He stated that the retail pharmacists had some concern that they would have to bear the brunt of the 'discount' provided to consumers. He provided a printout of a website called Pharmacy Checkers.com and the and the Department of Health Care Policy and Financing's website reference to "Prescription Drug Discount Resources" (Attachments A and B respectively). After checking the department's website describing the prescription drug discount resources, he stated there is no link to independent pharmacies and that one links is to a website called Pharmacy Checkers. He stated that Pharmacy Checkers is an on-line pharmacy for the purpose of importing drugs. He stated that in all cases importation of drugs through an on-line pharmacy is illegal under federal law. He stated he has some concerns with the state's website leading individuals to a website that supports illegal activities.

04:40 PM -- Paula Rhoads, traumatic brain injury patient, asked how the program was advertised. She showed the committee several of her own prescriptions and asked if the committee could determine which were on the Wal-Mart preferred drug list. She stated that without her medications she would likely be in prison. She stated that if the program provides medications to low-income individuals, she supports the program.

04:46 PM -- Chris Underwood, Director, State Programs and Federal Financing Division, Department of Health Care Policy and Financing, and Kerri Coffey, Pharmacy Program Administrator, Department of Health Care Policy and Financing, spoke to the implementation of the Colorado Cares Rx Program. Ms. Coffey provided a historical timeline of the implementation of the program. She stated that the original implementation plan included using the Colorado Benefits Management System to verify eligibility for enrollment into the program. She stated that during the process, the department incurred several cost and time issues. She stated that since the program was to be self-funded, the department had to look to other avenues to implement the program. Ms. Coffey stated that since the department was not the direct purchaser or payer of the drugs, it would not be able to negotiate discounted prescription drugs prices. She stated that the department would have had to contract with each individual pharmacy to negotiate and receive a discount on prescription drugs. Ms. Coffey stated that the department decided that the most cost-effective and time-efficient way to create the program would be to use a company with an existing preferred drug list program. She stated that the department entered into a one-year trial no-cost agreement with Express Scripts. Ms. Coffey stated that the one-year agreement has expired and Express Scripts has indicated they do not want to continue the partnership with the department. She stated the department has found no other programs or ideas that would be practical to implement. She suggested other ways in which the department could provide information to the state regarding low-cost prescription drug coverage. She acknowledged that the bill was not implemented as many had expected.

04:51 PM -- Responding to Representative Green's question regarding why the department did not enter into a multi-purchasing pool, Ms. Coffey stated that the department did not find it would receive discounted prices for prescription drugs if it entered into a multi-purchasing pool. She stated that in order to enter into multi-purchasing agreements it required funding, and given that the program is self-funded, it was not a viable option. Mr. Underwood explained how a multi-purchasing pool operates. He stated that there is no evidence that shows a multi-purchasing pool provides cheaper drugs. Mr. Underwood explained that the Maine Rx program, which was referred to in Ms. Fritz's testimony as a successful state run preferred drug list program, used state dollars to fund the program. He stated that Colorado does not have the General Funds dollars, as Maine did, to fund the program.

05:13 PM

Mr. Underwood responded to committee questions regarding the implementation of the program and how the funds that were appropriated to the program were used. Mr. Underwood stated that the program was marketed, but that the department was behind the private market in launching the program. He stated that private companies such as, King Soopers, Safeway, Wal-Mart, and Target, provided discount drugs through a preferred drug list program prior to the department launching its program. He stated that he does not know if the department could administer a program that is cheaper, if not comparable, to the private market's programs for low-cost drugs. Mr. Underwood stated his main concern at this point is that the department is not in compliance with the law and that is the main focus of Senate Bill 09-132, to bring the department into compliance.

05:22 PM

The was pulled off the table and will be heard for action only on Monday, March 9, 2009.

05:24 PM -- House Bill 09-1278

Representative Frangas presented House Bill 09-1278. He stated that he had several amendments to the bill and would explain the bill as amended.

He stated that Sections 1 and 2 allow the Department of Health Care Policy and Financing to increase the federal poverty level for persons eligible for the Children's Basic Health Plan to the maximum permitted under federal law. He stated that two amendments will be offered in for these sections, amendment L.003 and L.004 (Attachment D and E).

He stated that Section 3 establishes a state navigator for the Medicare Prescription Drug program. He stated he will offer no amendments to the section.
He stated Sections 4 through 10 address improving the Colorado Cares Rx Program. He stated that no amendment will be offered to this section.
He stated Section 11, which would require the state department to pay reasonable attorney fees regarding appeals, will be struck with the adoption of amendment L.007 (Attachment H).
He stated that Sections 12 through 14 address chronic disease. He stated he will not offer any amendments to these sections.
He stated that Section 15 will be struck with the adoption of amendment L.005 (Attachment F).

He stated that Sections 16 through 20 addressed home care placement agencies. He stated that these sections will be struck with amendment L.002 which establishes a task force to study licensure of home care placement agencies (Attachment C).
Representative Frangas stated that amendment L.006 adds Section 22 which allows, rather than requires, recipients to obtain maintenance medications through mail order (Attachment G).

05:54 PM -- Mark Simon spoke in support of the bill. He stated that one of the recommendations from the Blue Ribbon Commission on Health Care Reform was to increase eligibility for the state's Children's Basic Health Plan (CHP+). He stated there is a need for a Medicare navigator because the program is very complicated. He stated that providing health care to the unemployed is crucial.

06:03 PM -- Adam Eichberg, Colorado Department of Public Health and Environment (DPHE), spoke specifically to Sections 16 through 21 of the bill. He stated that last year, Senate Bill 08-153 established protocol for licensing of home care agencies. He stated that the act required home care agencies to register with the department, perform a criminal history record check of new employees. The act also requires home care placement agencies to perform a criminal history check for persons seeking placement. Mr. Eichberg stated that the department has several concerns with amendment L.002 because as the amendment would establish a task force to study home care agencies, the amendment does not include the DPHE as a member on the task force (Attachment C). He also stated the department has concerns with how the department will administer the task force within its current budget.

06:15 PM -- Eileen Doherty, Colorado Genealogical Society, spoke in support of Section 3 of the bill which establishes the Medicare Navigator position to aid individuals working in the Medicare Prescription Drug program. She spoke to the need to regulate home care placement agencies.

06:20 PM -- Cheryl Ternes, Arapahoe County and Colorado Social Services Directors Association, spoke in favor of the bill with the adoption of amendments L.003 and L.004 (Attachments D and E). She stated that the amendments require sufficient funding to counties to fund the CHP+ program at the levels specified in the bill.

06:25 PM -- Karen Moorehead, Elderlink Companion Care Inc., spoke in support of amendment L.002 which establishes a task force to study the licensure of home care agencies (Attachment C). She spoke for the need to license home care agencies.

06:28 PM -- Rita Lynne, All Generation Home Care, spoke in favor of amendment L.002 which establishes a task force to study home care agency licensure (Attachment C). She concurred with Mr. Moorehead's testimony. She stated that there is a need for licensure. She stated that other states have effectively licensed home care agencies. She stated that the task force could study these states and provide best practices to the state of Colorado.

06:40 PM -- Jonelle Leinbach, Adeste In-Home Care, spoke in favor of amendment L.002 which establishes a task force to study home care placement agencies (Attachment C).

06:45 PM -- Fran Coleman, Home Care Placement Agencies, for questions only. She provided testimony on behalf of Arthur Powers who supports the bill with regard to licensing home care placement agencies.

06:50 PM -- Susan Cox, Kaiser Permenente, spoke in favor of amendment L.006 which addresses Medicaid mail-order.

06:58 PM -- Ginny Brown, Legislative Liaison, Department of Health Care Policy and Financing, stated she could not speak to the bill as amended, as she has only seen the introduced version. She provided information to the committee regarding what the department currently offers to address some of the concerns Representative Frangas presented in the bill.

07:02 PM -- Bill Zepernick, fiscal note analyst, Office of Legislative Council, spoke to the conditional state expenditures regarding optional Medicaid coverage.

07:07 PM


BILL:	HB09-1278
TIME:	07:09:02 PM
MOVED:	Primavera
MOTION:	Moved to adopt prepared amendment L.003 (Attachment D). The motion failed on a 4-6 roll call vote.
SECONDED:	Gerou
		VOTE
	Acree	Yes
	Gerou	No
	Green	Yes
	Kefalas	No
	Kerr J.	No
	McGihon	Excused
	Nikkel	No
	Primavera	Yes
	Swalm	No
	Gagliardi	No
	Riesberg	Yes

Not Final YES: 4 NO: 6 EXC: 1 ABS: 0 FINAL ACTION: FAIL


BILL:	HB09-1278
TIME:	07:10:15 PM
MOVED:	Primavera
MOTION:	Moved to adopt prepared amendment L.004 (Attachment E). The motion failed on a 4-6 roll call vote.
SECONDED:	Green
		VOTE
	Acree	Yes
	Gerou	No
	Green	Yes
	Kefalas	No
	Kerr J.	No
	McGihon	Excused
	Nikkel	No
	Primavera	Yes
	Swalm	No
	Gagliardi	No
	Riesberg	Yes

Not Final YES: 4 NO: 6 EXC: 1 ABS: 0 FINAL ACTION: FAIL


BILL:	HB09-1278
TIME:	07:11:52 PM
MOVED:	Primavera
MOTION:	Moved to adopt prepared amendment L.007 (Attachment H). The motion failed on a 4-6 roll call vote.
SECONDED:	Gagliardi
		VOTE
	Acree	No
	Gerou	No
	Green	No
	Kefalas	Yes
	Kerr J.	No
	McGihon	Excused
	Nikkel	No
	Primavera	Yes
	Swalm	No
	Gagliardi	Yes
	Riesberg	Yes

Not Final YES: 4 NO: 6 EXC: 1 ABS: 0 FINAL ACTION: FAIL


BILL:	HB09-1278
TIME:	07:12:50 PM
MOVED:	Green
MOTION:	Moved to adopt prepared amendment L.005 (Attachment F). The motion passed without objection.
SECONDED:	Primavera
		VOTE
	Acree
	Gerou
	Green
	Kefalas
	Kerr J.
	McGihon	Excused
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

Not Final YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	HB09-1278
TIME:	07:13:22 PM
MOVED:	Kefalas
MOTION:	Moved to adopt prepared amendment L.002 (Attachment C). The motion passed without objection.
SECONDED:	Green
		VOTE
	Acree
	Gerou
	Green
	Kefalas
	Kerr J.
	McGihon	Excused
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

Not Final YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	HB09-1278
TIME:	07:14:09 PM
MOVED:	Kefalas
MOTION:	Moved to adopt prepared amendment L.006 (Attachment G). The motion passed without objection.
SECONDED:	Swalm
		VOTE
	Acree
	Gerou
	Green
	Kefalas
	Kerr J.
	McGihon	Excused
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

Not Final YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection

07:15 PM

Representative Frangas provided a wrap-up to the bill. He stated that he is amenable to add the Department of Public Health and Environment as a member on the task force to study the licensure of home care agencies.


BILL:	HB09-1278
TIME:	07:19:26 PM
MOVED:	Green
MOTION:	Moved to refer amended House Bill 09-1278 to the Committee on Appropriations. The motion failed on a vote of 3-7.
SECONDED:	Kefalas
		VOTE
	Acree	No
	Gerou	No
	Green	Yes
	Kefalas	No
	Kerr J.	No
	McGihon	Excused
	Nikkel	No
	Primavera	Yes
	Swalm	No
	Gagliardi	No
	Riesberg	Yes

Not Final YES: 3 NO: 7 EXC: 1 ABS: 0 FINAL ACTION: FAIL


BILL:	HB09-1278
TIME:	07:26:23 PM
MOVED:	Swalm
MOTION:	Moved to postpone House Bill 09-1278 indefinitely. The motion passed on a 7-3 roll call vote.
SECONDED:	Kerr J.
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	No
	Kefalas	No
	Kerr J.	Yes
	McGihon	Excused
	Nikkel	Yes
	Primavera	No
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 7 NO: 3 EXC: 1 ABS: 0 FINAL ACTION: PASS

07:28 PM

The committee adjourned.