House Committee on Health and Human Services (02/02/2009)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	02/02/2009	ATTENDANCE

Time:	01:30 PM to 05:30 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	X
		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:
HB09-1059 HB09-1119 HB09-1103 HB09-1084		Amended, Referred to the Committee of the Whole Witness Testimony and/or Committee Discussion Only Amended, Referred to the Committee of the Whole Witness Testimony and/or Committee Discussion Only

01:30 PM -- House Bill 09-1059

Representative Primavera presented House Bill 09-1059 which mandates that state regulated health insurance plans cover routine patient care for policyholders and their dependents participating in clinical trials. Representative Primavera described the specifics of the bill. Representative Primavera spoke to prepared amendment L.001 (Attachment A).

01:36 PM -- Paul Wisor, Rocky Mountain Multiple Sclerosis Center, testified in support of the bill. Mr. Wisor explained the bill. He stated that some people are deterred from participating in clinical trials because their routine care is not necessarily covered by their insurance. He stated that the bill is modeled off of Medicare. He stated that 23 states have already passed a similar law. He addressed the fiscal note which states that there is a potential cost of $154,000 to the state. Mr. Wisor stated that he disagrees with the fiscal note analysis and that the number is difficult to arrive at. He stated that the bill is intended to save the state money. Mr. Wisor explained how amendment L.001 fits into the bill (Attachment A).

01:43 PM -- Dr. Timothy Vollmer, Medical Director, Rocky Mountain Multiple Sclerosis Society, testified in support of the bill. Dr. Vollmer spoke to the cost savings aspect of the bill.

01:50 PM

Two handouts, one from the National Multiple Sclerosis Society - Colorado Chapter and another from the Chronic Care Collaborative, were provided to the committee in support of the bill
(Attachments B and C respectively).

01:51 PM -- Carol Sjerven, certified registered nurse, Veeda Oncology, testified in support of the bill. Ms. Sjerven read out loud to the committee several documents that are provided to cancer patients when considering participating in a trial study. She stated she would inform her patients not mention to an insurance company that they were participating in a study as the standard of care costs may not be covered, or at the minimum, would spark a debate with the insurance company with regard to paying for basic care. She spoke to the need for patients to participate in clinical trials, yet there is not much support for clients to do this for fear of losing their coverage. She stated that the bill does not require the insurance company to pay for anything outside of standard of care costs.

01:59 PM -- Jacquelyn Kilmer, Vice-President, Board of Directors, Colorado AIDS Project, testified in support of the bill. She stated that the individuals she represents have benefited for many years from clinical trials and the use of experimental drugs. She stated that the bill is fair and balanced, it does not ask insurance companies to do anything outside of what they should be providing according to contracts.

02:01 PM -- Susan Cox, Betsy Nugent, and Dr. Richard Veintimilla, Kaiser Permanente, testified in support of the bill. Ms. Cox stated that Ms. Nugent and Dr. Veintimilla run their clinical trials department. Ms. Cox stated that with the amendments, Kaiser Permanents supports the bill.

02:08 PM -- Ben Price, Colorado Association of Health Plans, testified in support of the bill with amendments. He stated that with amendments the bill follows the national Medicare model.

02:12 PM

Representative Riesberg stated that the bill has been sent to the Health Care Mandate Commission. He explained that the committee does not expect to hear back from the commission as the commission currently has four vacancies. He stated that there may be a report provided to the Senate Health and Human Services committee, if the bill moves forward.

02:12 PM -- Dana Dzwonkowski, American Cancer Society and Center Action Network, testified in support of the bill.


BILL:	HB09-1059
TIME:	02:17:30 PM
MOVED:	Primavera
MOTION:	Moved to adopt prepared amendment L.001 (Attachment A). The motion passed without objection.
SECONDED:	Gagliardi
		VOTE
	Acree
	Gerou
	Green
	Kefalas
	Kerr J.
	McGihon
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	HB09-1059
TIME:	02:18:30 PM
MOVED:	Primavera
MOTION:	Moved to refer House Bill 09-1059 to the Committee of the Whole. The motion passed on a 10-0 roll call vote.
SECONDED:	Acree
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	Excused
	Kefalas	Yes
	Kerr J.	Yes
	McGihon	Yes
	Nikkel	Yes
	Primavera	Yes
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	Yes

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

02:20 PM -- House Bill 09-1119

Representative Vigil presented House Bill 09-1119 which will raise revenue to help cities and counties provide substance abuse programs to rural communities. He stated that the program is intended to be self-funded with minimal start up costs. He stated that the bill creates the Rural Alcohol and Substance Abuse Grant Program in the Department of Human Services, Division of Alcohol and Drug Abuse. He stated that the bill provides grants to any entity that provides youth with alcohol and substance abuse treatment or services in rural areas. The committee asked several questions of the sponsor regarding the funding mechanism of the bill.

2:31 PM -- Michael Seaman, Crossroads, testified in support of the bill. Mr. Seaman spoke to the lack of resources for substance abuse issues in rural communities. He stated that a detoxification program saved his life.

02:40 PM -- Amanda Bowsher, Crossroads, testified in support of the bill. Ms. Bowsher recounted her personal story and how it lead her to Crossroads. Ms. Bowsher stated that detoxification is instrumental in helping individuals get to recovery.

02:58 PM -- Dustin Kelver, Crossroads, testified in support of the bill. He stated he is a volunteer at Crossroads and speaks with addicts. He recounted his personal story to the committee. He stated that during his detoxification, the people treated him like a human being and that was very important to him in his recovery process.
03:03 PM -- Mark Randall, Colorado District Attorney's Council, testified in support of the bill. He stated that district attorneys are always looking for a beneficial drug treatment program. He emphasized the need for services in rural communities. He stated the bill sets up a fund so that rural communities may use that money to fund programs.

03:11 PM -- Bill Hanna, Department of Human Services, stated that the department is supportive of the goals of the program. He stated that he wanted to work on an amendment so that the administrative aspect could be worked out. He stated that the department would like to work with the sponsor of the bill on amendments.

03:14 PM Representative Vigil stated that he would like to work with the department on amendments. The bill was laid over to February 5, 2009.

03:22 PM -- House Bill 09-1103

Representative Riesberg presented House Bill 09-1103 which authorizes the Department of Health Care Policy and Financing (DHCPF) to seek federal approval to allow people who are in need of long-term care to be presumptively eligible for Medicaid, including home- and community-based programs. Representative Riesberg explained the circumstances in which an individual might need to be eligible for long-term care immediately. He stated that the state would have paid their respective amounts if an individual is rejected on Medicaid. He stated that the bill will help Colorado provide a higher quality of life and save the state money. Two handouts, one from the National Multiple Sclerosis Society - Colorado Chapter, and one from the Chronic Care Collaborative, were provided to the committee
(Attachments D and E respectively).

03:31 PM -- Julie Reiskin, Colorado Cross Disability Coalition, testified in support of the bill. She responded to a committee question regarding why this had not been implemented sooner. Ms. Reiskin provided a handout in support of the bill to the committee (Attachment F).

03:38 PM -- Vennita Jenkins, Administrator, Colorado Association of Homes and Services for the Aging (CAHSA), testified in support of the bill. Ms. Jenkins stated that prior bills (House Bill 08-1374) have directed some group to study presumptive eligibility. She stated that one of the recommendations was presumptive eligibility for long-term care.

03:40 PM -- Susan Langley, Colorado Center for Hospice and Palliative Care, testified in support of the bill. She stated that she helps her clients fill out the necessary paperwork to be approved under Medicaid. She spoke to the 90 day time frame that Medicaid requires for approval saying that sometimes it is too long, as the person may have expired by that time. She encouraged the committee to pass the bill.

03:42 PM -- Donna Roberts, Colorado Center for Hospice and Palliative Care, testified in support of the bill. She explained the process of how a person may be approved under Medicaid. She pointed out the cost savings to the state by implementing the bill.

03:46 PM -- Barbara Prehmus, Long-term Benefits Division Director, Department of Health Care Policy and Financing (DHCPF), and Chris Underwood, Division Director, State Programs and Federal Financing, DHCPF, testified in support of the bill. Ms. Prehmus spoke to the length of time it takes to become approved for Medicaid. She stated that at times the length it takes to get approved, the person may become more ill than if they had been presumptively eligible, which ends up costing the state more money.


BILL:	HB09-1103
TIME:	03:57:20 PM
MOVED:	Riesberg
MOTION:	Moved to adopt prepared amendment L.001 (Attachment G). The motion passed without objection.
SECONDED:	Nikkel
		VOTE
	Acree
	Gerou
	Green
	Kefalas
	Kerr J.
	McGihon
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	HB09-1103
TIME:	03:58:23 PM
MOVED:	Riesberg
MOTION:	Moved to refer House Bill 09-1103 to the Committee of the Whole. The motion passed on a 10-0 roll call vote.
SECONDED:	Kefalas
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	Excused
	Kefalas	Yes
	Kerr J.	Yes
	McGihon	Yes
	Nikkel	Yes
	Primavera	Yes
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	Yes

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

03:59 PM -- House Bill 09-1084

Representative Gagliardi presented House Bill 09-1084 concerning the procedures for audits of Medicaid providers.

04:04 PM -- Dr. Gordon Rheaume, representing himself, testified in support of the bill. Dr. Rheaume spoke to the process of auditing. He said that when he was audited he was asked to provide over 400 pages of information from over six years. He stated that the process was extremely cumbersome, lasted over 18 months, and cost him approximately $30,000. He provided two handouts to the committee illustrating his costs (Attachments H and I respectively). He stated that he does not think an audit should punish the doctor or cost them their livelihood.

04:15 PM -- Brad Young, RxPlus Pharmacies, testified in support of the bill. He stated that Val Kalnins, Colorado Pharmacist Society and Colorado Pharmacists are in support of the bill as well. He spoke to the complexity of audit reporting and said the bill may simplify some of the processes.

04:19 PM -- Gary Cummins, Colorado Dental Association, testified in support of the bill. Mr. Cummins stated that there are less than 400 dentists providing services to Medicaid clients. He stated that one of the concerns about becoming a provider is the auditing process.

04:25 PM -- Dr. David Griffin, podiatrist representing himself, testified in support of the bill. He spoke to the complexities of the auditing process. Dr. Griffin provided correspondence between himself and the Medicaid Audit Committee (Attachment J). He stated that he had been threatened by the Attorney General's to settle his case otherwise every piece of paper in his office would be requested and audited (Attachment J).

04:32 PM -- Tom Murphy, A Step Ahead Foot and Ankle Center, testified in support of the bill. He concurred with previous testimony and stated that several thousand pages of documentation was required for his Medicaid audit. He stated that it was a significantly large cost to his business.

04:35 PM -- James Dill, All Colorado Podiatry Group, testified in support of the bill. He recounted his audit experience. He stated it was extremely strenuous to track down documents from six years prior. He mentioned that the company that is hired to do the audit works on a contingency fee. He spoke to how his company provide services to Medicaid clients and how it has become extremely difficult to continue serving these clients. Dr. Dill provided his written testimony to the committee (Attachment K).

04:39 PM -- June Laird, attorney who represents licensed doctors in an appeal process for Medicaid audits, testified in support of the bill. She stated that the audit is extremely inconsistent.

04:47 PM -- Corky Kyle, Executive Director, Colorado Podiatrist Medical Society (CPMS), testified in support of the bill.

04:52 PM -- Jim Driscoll, Colorado Hospital Association, testified in support of the bill with amendments. He stated that on page 4, line 24, that the stricken language regarding the January 1, 2009 date pertaining to the status report should be put back in the bill. He stated there is a need to build something in the system that allows mistakes to be caught sooner rather than later.

04:57 PM -- Amy Larsen, Office of Legislative Council, fiscal analyst, explained the fiscal note. She pointed out that the bill limits the provider audits to three years, and record requests to 15 days per month in any given year. She stated that currently, a Medicaid audit can request records from an unlimited amount of time. Representative Kerr wanted to know how much was saved through Medicaid audits for the purpose of reviewing if audits are an effective tool. Ms. Larsen stated she would try to get that information for him. Committee members asked several questions of Ms. Larsen.

05:08 PM -- Jennifer Evans, Deputy Director, Financing, Department of Health Care Policy and Financing, stated that the department has some concerns with the bill, but are hoping to make some progress. She mentioned they are significant requirements that the department must meet in order to comply with program integrity from the federal Centers for Medicare and Medicaid. Members asked several questions of the witness. She spoke to the concern that the number of days that may be audited is limited to fifteen noting that some entities bill once a month. She stated that 15 days is not a statistically significant number to procure information regarding the provider.
05:27 PM
Representative Gagliardi stated she would like to work with the department on the bill. The bill was laid over to Thursday, February 5, 2009. The committee adjourned.