House Committee on Health and Human Services (02/18/2010)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	02/18/2010	ATTENDANCE

Time:	01:34 PM to 05:40 PM	Acree	X
		Apuan	X
Place:	LSB A	Gerou	*
		Kefalas	X
This Meeting was called to order by		Kerr J.	X
	Representative Riesberg	Primavera	X
		Roberts	*
This Report was prepared by		Swalm	*
	Kelly Stapleton	Tyler	X
		Gagliardi	X
		Riesberg	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB10-1255 HB10-1229 HB10-1032 HB10-1213 HB10-1258 HB10-1179		Referred to the Committee of the Whole Amended, Referred to the Committee of the Whole Amended, Referred to Appropriations Amended, Referred to the Committee of the Whole Postponed Indefinitely Amended, Referred to Appropriations

01:34 PM -- House Bill 10-1255

Representatives Kefalas and Acree presented House Bill 10-1255 which continues the Colorado Commission for the Deaf and Hard of Hearing until 2015. A handout in support of the bill was distributed to the committee (Attachment A).

01:36 PM -- Art Zamora, Colorado Senior Lobby, spoke in support of the bill.

01:37 PM -- Cliff Moers, Chair, Colorado Commission for the Deaf and Hard of Hearing, spoke in support of the bill. Mr. Moers explained the functions of the commission.

01:38 PM -- Cheri Davis, Colorado Commission for the Deaf and Hard of Hearing, spoke in support of the bill. She stated she administers the auxiliary services for the commission which provides CART services for deaf and hard of hearing individuals in the judicial system. She explained that CART services or computer-assisted real time technology provides translation services for the deaf and hard of hearing.

01:41 PM -- Mary McGhee, Director, Division of Boards and Commissions, Department of Human Services, testified in support of the bill.


BILL:	HB10-1255
TIME:	01:43:08 PM
MOVED:	Acree
MOTION:	Moved to refer House Bill 10-1255 to the Committee of the Whole. The motion passed on a 10-0 roll call vote.
SECONDED:	Swalm
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	Yes
	Roberts	Excused
	Swalm	Yes
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes
Final YES: 10 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS

01:44 PM -- House Bill 10-1229

Representative Pace presented House Bill 10-1229 which requires all verbal medical orders in hospitals to be authenticated by a physician or another individual who has authority. All verbal orders must be authenticated within 48 hours, unless they have been verified through a read-back process. The bill specifies that orders verified through a read-back process must be authenticated within 30 days. Representative Pace stated that initially he had concern that the bill may jeopardize patient safety, but was assured that the bill does not put patients at risk. He stated that there is a process in place to authenticate a verbal order, however the 48-hour time period requirement is administratively burdensome.

01:52 PM -- Dr. Steven Nafziger, ParkView Medical Center and Judy Sikes, ParkView Medical Center, spoke in support of the bill. Ms. Sikes described the verbal authentication process and the read-back process. Ms. Sikes stated that during an audit of the verbal authentication process, three verbal orders were not authenticated within 48-hours, as is required. She stated that ParkView Medical Center had 1.8 million orders in one month's time, and of those, 131,000 were verbal orders. She indicated that none of the verbal orders were incorrect and that is primarily due to the read-back process. She stated that authenticating verbal orders within 48 hours creates a lot of administrative burden. She stated that the medical center would prefer to spend the time with their patients.

02:03 PM -- Janet Stephens, Colorado Hospital Association, spoke in support of the bill and distributed a handout in support of the bill to the committee (Attachment B). She explained that the 48 hour time period is the standard that the hospital shoots for.

02:05 PM -- Dr. Nafziger returned to the table and stated that he has conversed with several physicians across the state regarding this issue. He stated that the verbal authentication requirement does not increase patient safety. He spoke to the time period after a medical order is given, stating that 48 hours or 30 days is not what is important, the actual accuracy of taking down the verbal medical order is the important piece which is addressed with the read-back process. He described the verbal order process and read-back process.

02:12 PM -- Dr. Mark Laitos, Colorado Medical Society, spoke in support of the bill. He spoke to the importance of the accuracy of the order, rather than the time period required to authenticate that order.

02:16 PM -- Charlie Hebeler, Colorado Nurses Association, spoke in support of the bill and and distributed a handout in support of the bill (Attachment C).


BILL:	HB10-1229
TIME:	02:22:24 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt prepared amendment L.003 (Attachment D). The motion passed without objection.
SECONDED:	Kerr J.
		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:	HB10-1229
TIME:	02:24:59 PM
MOVED:	Kefalas
MOTION:	Moved to refer House Bill 10-1229, as amended, to the Committee of the Whole. The motion passed on a 10-0 roll call vote.
SECONDED:	Kerr J.
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	Yes
	Roberts	Excused
	Swalm	Yes
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes
Final YES: 10 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS

02:26 PM -- House Bill 10-1032

Representative Frangas presented House Bill 10-1032. He described the bill as it came out of the interim Health Care Task Force. He stated that he would like to offer a strike below amendment to the bill L.002 (Attachment E). He stated that the strike below amendment would require the Department of Human Services to survey available resources to determine what services may be available to address persons in mental health or substance abuse crisis. Committee members discussed the bill's fiscal note.

02:43 PM -- Stephen Kopanos, Mental Health America - Colorado, testified in support of the bill. He relayed a personal story concerning a mental health episode he had and stated that episode is one of the reasons why he supports the bill. He stated that Colorado is in need of crisis stabilization services. He stated that when an individual drinks something that is potentially poisonous, he or she can call poison control and get answers. He explained that no similar service exists for individuals in a mental health crisis. He stated that is it important to have a call center for reasons he previously mentioned. Committee members and the witness discussed the benefit of the state surveying its resources. Members discussed the current protocol regarding what happens when an individual has a medical crisis.

03:02 PM -- Wayne Maxwell, Executive Director, North Range Behavioral Health Center, testified in support of the bill with the adoption of amendment L.002 (Attachment E). He stated that the bill offers an opportunity for the various stakeholders to come together. He stated that merely having a coordinated response system cannot do much if the resources to help an individual are not available. He stated that he supports a regional support system rather than a statewide system as different parts of the state have different needs.

03:11 PM -- Larry Krause, concerned citizen, spoke in support of the bill. He stated that he was diverted from a hospital with a psychological unit when he was in crisis. He stated that he was arrested and now has a felony on his record. He stated that it is important to address the issue of mental illness in the community.

03:13 PM -- Chris Habgood, Division of Behavioral Health, Department of Human Services, spoke in support of services for mental health and substance abuse. He stated that he has not reviewed the strike below amendment, but supports the original bill. He commented on the need for mental health services. He described several different plans that different states use for their behavioral health needs.

03:25 PM -- Amanda Smith, We Can!, spoke in support of the bill. She stated her organization represents individuals who use mental health and behavioral health services. She stated that the need for a coordinated crisis system is crucial. She stated that the emergency room is not the ideal place for an individual who is experiencing a crisis.

03:39 PM

Representative Frangas provided concluding remarks to the bill.


BILL:	HB10-1032
TIME:	03:42:05 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt prepared amendment L.002 (Attachment E). The motion passed without objection.
SECONDED:	Apuan
		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:	HB10-1032
TIME:	03:43:21 PM
MOVED:	Gagliardi
MOTION:	Moved to refer House Bill 10-1032, as amended, to the Committee on Appropriations. The motion passed on a 11-0 roll call vote.
SECONDED:	Apuan
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	Yes
	Roberts	Yes
	Swalm	Yes
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes
Final YES: 11 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

03:53 PM

The committee took a brief recess.

04:00 PM -- House Bill 10-1213

Representative Acree presented House Bill 10-1213 which removes the statutory requirement that an individual eligible for services under a home- and community-based services waiver have an individualized plan established while on the waiting list for services. The bill also removes the statutory requirement for individuals who are on the waiting list for services to have an annual review of their individualized plans.

04:03 PM -- Sheryle Hutter, Colorado Cross Disability Coalition, spoke in support of the intent of the bill, but stated that her organization needs clarifying language to alleviate their concerns. She stated their concern is the removal of the 30-day deadline in establishing an individualized plan (IP). She stated that without a deadline, the organization is concerned that an IP would not get developed. She spoke in support of amendment L.004 (Attachment F).

04:08 PM -- Marijo Rymer, Executive Director, The Arc of Colorado, spoke in support of the bill.

04:10 PM -- Aileen McGinley, Advocacy Denver, spoke in support of the bill as amended. She referred to a handout from the Legal Center for People with Disabilities and Older People in support of the bill (Attachment G).

04:12 PM -- John Miles, Department of Human Services, spoke in support of the bill as amended. A handout in support of the bill as amended was distributed to the committee (Attachment H). He spoke to a study the department commissioned to evaluate which case management functions were statutorily required and funded, and which were not. He stated that the removal of the statutory requirement to develop an IP for individual on a waiting list would enable a community centered board to focus their available staff time on other areas of need, such as navigation of support services.


BILL:	HB10-1213
TIME:	04:26:38 PM
MOVED:	Acree
MOTION:	Moved to adopt prepared amendment L.004 (Attachment F). The motion passed without objection.
SECONDED:	Gerou
		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:	HB10-1213
TIME:	04:28:32 PM
MOVED:	Acree
MOTION:	Moved to refer House Bill 10-1213, as amended, to the Committee of the Whole. The motion passed on a 11-0 roll call vote.
SECONDED:	Roberts
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	Yes
	Roberts	Yes
	Swalm	Yes
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes
Final YES: 11 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

04:29 PM -- House Bill 10-1258

Representative Acree presented House Bill 10-1258 which allows insurance carriers to offer premium discounts to covered persons who comply with a treatment plan prescribed by a health care provider to manage a chronic health condition. She spoke to amendment L.001, and a memorandum concerning the fiscal note (Attachment I). She stated the amendment would remove the fiscal impact of the bill.

04:32 PM -- Jean Nofles, AARP, spoke in opposition to the bill. She stated that AARP has concerns with how the bill would treat privacy issues between a patient and a doctor. She spoke to how the bill may adversely affect the elderly.

04:38 PM -- Stephen Kopanos, Mental Health America - Colorado, spoke in opposition to the bill.

04:38 PM -- Dr. Bruce Madison, Colorado Medical Society, spoke in opposition to the bill. He concurred with Ms. Nofles' comments regarding privacy issues.

04:42 PM -- Elisabeth Arenales, Center on Law and Policy, stated her concerns about the bill and concurred with Dr. Madison's testimony regarding the privacy issues.

04:44 PM -- Kelly Shanahan, Colorado Consumer Health Initiative (CCHI), spoke in opposition to the bill. She stated that CCHI supports encouraging individuals to be proactive in treating their chronic health issues. She stated there are many factors that affect outcomes of one's health. She further indicated that compliance with a treatment plan depends on several factors such as education level, transportation, and affordability of a prescribed treatment plan. She stated that linking compliance to a reduction in health insurance premiums may not have the desired outcomes. The committee discussed how to encourage individuals to live healthier lifestyles.

04:58 PM

Representative Acree provided concluding remarks.


BILL:	HB10-1258
TIME:	05:04:05 PM
MOVED:	Acree
MOTION:	Moved to adopt prepared amendment L.001 (Attachment I). The motion passed without objection.
SECONDED:	Kerr J.
		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:	HB10-1258
TIME:	05:08:14 PM
MOVED:	Acree
MOTION:	Moved to adopt prepared amendment L.002 (Attachment J). The motion passed on a 10-1 roll call vote.
SECONDED:	Kerr J.
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	No
	Kerr J.	Yes
	Primavera	Yes
	Roberts	Yes
	Swalm	Yes
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes
Not Final YES: 10 NO: 1 EXC: 0 ABS: 0 FINAL ACTION: PASS


BILL:	HB10-1258
TIME:	05:11:05 PM
MOVED:	Acree
MOTION:	Moved to adopt prepared amendment L.003 (Attachment K). The motion failed on a 3-8 roll call vote.
SECONDED:	Gerou
		VOTE
	Acree	Yes
	Apuan	No
	Gerou	Yes
	Kefalas	No
	Kerr J.	Yes
	Primavera	No
	Roberts	No
	Swalm	No
	Tyler	No
	Gagliardi	No
	Riesberg	No
Not Final YES: 3 NO: 8 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	HB10-1258
TIME:	05:16:01 PM
MOVED:	Acree
MOTION:	Moved to refer House Bill 10-1258, as amended, to the Committee on Finance. The motion failed on a 4-7 roll call vote.
SECONDED:	Roberts
		VOTE
	Acree	Yes
	Apuan	No
	Gerou	Yes
	Kefalas	No
	Kerr J.	Yes
	Primavera	No
	Roberts	Yes
	Swalm	No
	Tyler	No
	Gagliardi	No
	Riesberg	No
Not Final YES: 4 NO: 7 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	HB10-1258
TIME:	05:23:22 PM
MOVED:	Gagliardi
MOTION:	Moved to postpone House Bill 10-1258 indefinitely. The motion passed on a 7-4 roll call vote.
SECONDED:	Primavera
		VOTE
	Acree	No
	Apuan	Yes
	Gerou	No
	Kefalas	Yes
	Kerr J.	No
	Primavera	Yes
	Roberts	No
	Swalm	Yes
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes
Final YES: 7 NO: 4 EXC: 0 ABS: 0 FINAL ACTION: PASS

05:24 PM -- House Bill 10-1179

House Bill 10-1179 was put back on the table. For witness testimony, see the committee summary for February 11, 2010. Representative Acree explained several amendments to the committee and their effect on the bill. She stated that amendment L.001 would still be offered and has not changed (Attachment L). She stated that amendment L.002 would be offered to address the Colorado Medical Society's concerns brought up in testimony (Attachment M). Representative Acree explained amendment L.003, which requires the department to submit a report to the General Assembly regarding ways to increase provider reimbursement rates rather than develop a strategic plan to increase provider reimbursement rates (Attachment N).


BILL:	HB10-1179
TIME:	05:27:06 PM
MOVED:	Acree
MOTION:	Moved to adopt prepared amendment L.001 (Attachment L). The motion failed on a 5-6 roll call vote.
SECONDED:	Roberts
		VOTE
	Acree	Yes
	Apuan	No
	Gerou	Yes
	Kefalas	No
	Kerr J.	Yes
	Primavera	No
	Roberts	Yes
	Swalm	Yes
	Tyler	No
	Gagliardi	No
	Riesberg	No
Not Final YES: 5 NO: 6 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	HB10-1179
TIME:	05:33:01 PM
MOVED:	Acree
MOTION:	Moved to adopt prepared amendment L.002 (Attachment M). The motion passed without objection.
SECONDED:	Gerou
		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:	HB10-1179
TIME:	05:34:05 PM
MOVED:	Acree
MOTION:	Moved to adopt prepared amendment L.003 (Attachment N). The motion passed on a 6-5 roll call vote.
SECONDED:	Roberts
		VOTE
	Acree	Yes
	Apuan	No
	Gerou	Yes
	Kefalas	No
	Kerr J.	Yes
	Primavera	No
	Roberts	Yes
	Swalm	Yes
	Tyler	Yes
	Gagliardi	No
	Riesberg	No
Not Final YES: 6 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: PASS


BILL:	HB10-1179
TIME:	05:38:40 PM
MOVED:	Acree
MOTION:	Moved to refer House Bill 10-1179, as amended, to the Committee on Appropriations. The motion passed on a 6-5 roll call vote.
SECONDED:	Roberts
		VOTE
	Acree	Yes
	Apuan	No
	Gerou	Yes
	Kefalas	No
	Kerr J.	Yes
	Primavera	No
	Roberts	Yes
	Swalm	Yes
	Tyler	Yes
	Gagliardi	No
	Riesberg	No
Final YES: 6 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: PASS

05:40 PM

The committee adjourned.