Bill Summary for Bill Number SB10-002

Date: 05/03/2010

Final
BILL SUMMARY for SB10-002

HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

Votes: View-->	Action Taken:
Moved to adopt prepared amendment L.016 (Attachmen Moved to adopt prepared amendment L.019 (Attachmen Moved to adopt prepared amendment L.020 (Attachmen Moved to refer Senate Bill 10-002, as amended, to	Pass Without Objection Pass Without Objection TIE PASS

01:34 PM -- Senate Bill 10-002

Representative Primavera and Representative Looper presented Senate Bill 10-194. Representative Primavera stated that the bill was recommended by the Interim Committee on the Developmental Disability Wait List. The reengrossed bill includes a number of provisions regarding the denial of benefits by health coverage plans and recoveries in the state's Medicaid program. The bill requires the Department of Health Care Policy and Financing (DHCPF) to do the following:

• provide clients in the Medicaid program with information concerning their right to appeal denials of benefits by third parties;
• act as the client's designated representative for purposes of appealing a denial of benefits by a health insurance company paid by Medicaid, by virtue of the client signing the application for Medicaid and thereby designating the department as such;
• require the county department or other entity designated to accept medical benefits applications to enter third party information into the Colorado Benefits Managements System (CBMS); and
• examine the feasibility of developing an additional process to identify reasons for denial of benefits which should be considered for an appeal, and to prioritize appeal of denials based upon such reasons.

Representative Looper spoke to the bill's revised fiscal note dated May 2, 2010. She clarified that under the bill, the DHCPF is not required to appeal every denial of benefits. Several amendments were provided to the committee, including amendments L.016, L.019, and L.020 (Attachments A, B, and C respectively). Representative Looper described amendment L.020.

01:56 PM -- Betty Lehman, representing herself, testified in support of the bill. Ms. Lehman provided her written testimony to the committee (Attachment D). She relayed a story about her son who was dually insured with private insurance and Medicaid. She stated that she would struggle to get her son's medical expenses covered under private insurance. She suggested that many times the medical expenses should have been paid by private insurance, but were not. She explained that since Medicaid is the payor of last resort, the bill allows the DHCPF to recover funds from third party payors. She spoke to how the department is often not aware of a third party payor. She stated that one provision of the bill requires the county departments to enter third party information into the Colorado Benefits Management System so that Medicaid can be aware of another payor. Ms. Lehman commented that she believes that the amount of funds due by third party payors is much higher than the bill's fiscal note indicates. Representative Kerr asked why the department does not already go after third party payors. Ms. Lehman stated that they do, but often times the department is unaware that there is a third party payor.

02:26 PM -- Ken Gordon, representing himself, spoke in support of the bill. Mr. Gordon described how the bill would work and provided background regarding the impetus for the bill. He suggested that there are a significant number of individuals with private insurance whose private insurance does not cover their medical expenses and the state picks up the tab.

02:36 PM -- Craig Ewing, an attorney who deals with health insurance denial appeals, testified in support of the bill. He provided a copy of his testimony to the committee (Attachment E). He stated there is no incentive for providers to go after the 'correct' payor because Medicaid typically pays the claim. He stated that he has collected thousands of dollars for his clients.

02:48 PM -- Christine Russell, Family Advocate for Professional Pediatric Home Care, spoke in support of the bill. A copy of her written testimony was distributed to the committee (Attachment F). She described reasons why an insurance benefit would be denied. She stated that it is not the responsibility of the state to go after every benefit denial. She spoke to the effort it takes to overturn a health insurance benefit denial.

02:58 PM -- Ginny Brown, Legislative Liaison, and Robert Douglas, Legal Division, Department of Health Care Policy and Financing, came to the table to respond to committee questions. Ms. Brown stated that the department has been involved in the bill's evolution since the interim committee. She explained that if a insurance company is not paying its share of a health insurance claim, that constitutes fraud. She explained that there are additional avenues to address health insurance carriers not paying their portion of a claim within existing statute. Mr. Douglas explained the third party payor recovery process. In responding to Representative Roberts' question, Mr. Douglas stated that the department current investigates third party payors and that the department has no backlog of investigations. Mr. Douglas responded to several committee questions regarding how much money is recovered, how much money may be recovered, and the ability of the department to collect money.

03:20 PM

Committee members discussed the amount of money that could potentially be recovered if the bill were to pass.

03:33 PM

Representative Looper responded to committee questions. She stated that the intent of the bill is to collect moneys that should have been paid by private insurance. She suggested that a sunset provision be added to the bill so that the state may evaluate the effectiveness of the program.


BILL:	SB10-002
TIME:	03:37:42 PM
MOVED:	Primavera
MOTION:	Moved to adopt prepared amendment L.019 (Attachment B). Representative Looper stated that the amendment narrows the scope of the bill and addresses the concerns that the DHCPF expressed. The amendment clarifies that the department is not required to appeal every benefit denied. The motion passed without objection.
SECONDED:	Gagliardi
		VOTE
	Acree
	Apuan
	Gerou
	Kefalas
	Kerr J.
	Primavera
	Roberts
	Swalm	Excused
	Tyler
	Gagliardi
	Riesberg

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


BILL:	SB10-002
TIME:	03:40:06 PM
MOVED:	Primavera
MOTION:	Moved to adopt prepared amendment L.020 (Attachment C). The motion was withdrawn.
SECONDED:	Gagliardi
		VOTE
	Acree
	Apuan
	Gerou
	Kefalas
	Kerr J.
	Primavera
	Roberts
	Swalm
	Tyler
	Gagliardi
	Riesberg

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Withdrawn


BILL:	SB10-002
TIME:	03:44:48 PM
MOVED:	Primavera
MOTION:	Moved to adopt prepared amendment L.016 (Attachment A). The motion passed without objection.
SECONDED:	Gagliardi
		VOTE
	Acree
	Apuan
	Gerou
	Kefalas
	Kerr J.
	Primavera
	Roberts
	Swalm
	Tyler
	Gagliardi
	Riesberg

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


BILL:	SB10-002
TIME:	03:47:18 PM
MOVED:	Primavera
MOTION:	Moved to refer Senate Bill 10-002, as amended, to the Committee on Appropriations. The motion passed on a 7-4 roll call vote.
SECONDED:	Gagliardi
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	No
	Kefalas	Yes
	Kerr J.	No
	Primavera	Yes
	Roberts	No
	Swalm	No
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 7 NO: 4 EXC: 0 ABS: 0 FINAL ACTION: PASS