House Committee on Health and Human Services (02/11/2010)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	02/11/2010	ATTENDANCE

Time:	01:32 PM to 06:43 PM	Acree	*
		Apuan	*
Place:	LSB A	Gerou	X
		Kefalas	X
This Meeting was called to order by		Kerr J.	*
	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:
HB10-1031 HB10-1160 HB10-1022 HB10-1029 HB10-1179 HB10-1050		Postponed Indefinitely Amended, Referred to the Committee of the Whole Amended, Referred to Appropriations Amended, Referred to the Committee of the Whole Witness Testimony and/or Committee Discussion Only Amended, Referred to the Committee of the Whole

01:33 PM -- House Bill 10-1031

Representative McCann presented House Bill 10-1031 which was recommended by the interim Health Care Task Force. She stated that the bill requires the Department of Health Care Policy and Financing to put out an request for proposals (RFP) to administer dental services under Medicaid. She explained that Medicaid provides dental services in cases of emergency situations for eligible adults and children. She referred to a handout in support of the bill (Attachment A). She spoke to the fiscal note and stated that the state will accrue a savings at some point down the road.

01:42 PM -- Dr. Jeff Hurst, Colorado Dental Association, spoke in support of the bill. Dr. Hurst provided a packet of information to the committee (Attachment B). He spoke to the reimbursement methods for dental services in the state. He stated that the state is not a good administrator of the dental services program. He spoke to the number of dental providers who have left the program.

01:58 PM -- Katie Jacobson, Colorado Community Health Network (CCHN), spoke in support of the bill. She stated that CCHN operates approximately 37 health centers across Colorado which provide dental services. She stated that the health centers have seen approximately 8,000 dental patients.

02:03 PM -- Karen Cody Carlson, Dental Aid, spoke in support of the bill. She stated that she is also the Co-chair of Oral Health Awareness Colorado. She concurred with Dr. Hurst's testimony that the money spent to contract with an third party administrator will quickly be recovered due to the savings from the program.

02:09 PM -- Lawless Barrientos, Government Affairs, Comfort Dental, and Dr. Roy Martin, Comfort Dental, spoke in support of the bill. Dr. Martin stated that he owns a private Comfort Dental office which does not accept Medicaid. He stated that they previously accepted Medicaid until about two years ago. He stated that the bill would ease the administrative burden on dental providers.

02:12 PM -- Sue Hayes, Children's North Surgery Center, described her experience in working at an ambulatory surgical center. She stated that the Children's North Surgery Center is a partner of the Children's Hospital which is in opposition to the bill. She stated that the surgery center is concerned with the provision in the bill that requires pre-authorization of any dental surgeries. Ms. Hayes stated that this requirement would create a massive backlog of paperwork.

02:19 PM -- Todd Cruse, Senior Vice President, Forba, spoke in opposition to the bill. He stated that Forba is the largest provider of dental services for Medicaid participants. He stated that Forba is located in several states and he is privy to the various methodologies that each state uses to administer dental services. He stated that contracting with an outside administrator to provide dental services will not save the state money. Responding to Representative Swalm's question, he stated that Colorado is one of the easiest states to work with. He responded to Representative Primavera's question about the recent lawsuit that was settled regarding Small Smiles. Mr. Cruse stated that Small Smiles settled the federal lawsuit and agreed to have additional internal auditing of the company.

02:31 PM -- Marcy Bonnett, Department of Health Care Policy and Financing (DHCPF) and Margaret Mohan, Director, Benefit Management Section, DHCPF, responded to committee questions. A handout was distributed to the committee (Attachment C).

02:39 PM

Representative McCann spoke to the amendments L.001, L.002, and L.003 (Attachments D, E, and F respectively).


BILL:	HB10-1031
TIME:	02:40:40 PM
MOVED:	Kefalas
MOTION:	Moved to adopt prepared amendment L.001 (Attachment D). The motion passed without objection.
SECONDED:	Tyler
		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:	HB10-1031
TIME:	02:42:51 PM
MOVED:	Tyler
MOTION:	Moved to adopt prepared amendment L.002 (Attachment E). 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:	HB10-1031
TIME:	02:43:28 PM
MOVED:	Apuan
MOTION:	Moved to adopt prepared amendment L.003 (Attachment F). 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

02:44 PM

Representative McCann provided concluding remarks to the bill.


BILL:	HB10-1031
TIME:	02:45:36 PM
MOVED:	Apuan
MOTION:	Moved to refer House Bill 10-1031, as amended, to the Committee on Appropriations. The motion failed on a 3-8 roll call vote.
SECONDED:	Kefalas
		VOTE
	Acree	No
	Apuan	Yes
	Gerou	No
	Kefalas	No
	Kerr J.	No
	Primavera	Yes
	Roberts	No
	Swalm	No
	Tyler	Yes
	Gagliardi	No
	Riesberg	No

Not Final YES: 3 NO: 8 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	HB10-1031
TIME:	02:51:30 PM
MOVED:	Kerr J.
MOTION:	Moved to postpone House Bill 10-1031 indefinitely. The motion passed on a 7-4 roll call vote.
SECONDED:	Acree
		VOTE
	Acree	Yes
	Apuan	No
	Gerou	Yes
	Kefalas	No
	Kerr J.	Yes
	Primavera	No
	Roberts	Yes
	Swalm	Yes
	Tyler	No
	Gagliardi	Yes
	Riesberg	Yes

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

02:53 PM -- House Bill 10-1160

For witness testimony, see the committee summary from February 11, 2010. Representative Riesberg explained to the committee that the sponsors of the bill requested that a motion to reconsider amendment L.001 be offered.


BILL:	HB10-1160
TIME:	02:54:04 PM
MOVED:	Gerou
MOTION:	Moved to reconsider the adoption of amendment L.001 (Attachment G). The motion passed on a 11-0 roll call vote.
SECONDED:	Acree
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	Yes
	Roberts	Yes
	Swalm	Yes
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes

Not Final YES: 11 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS


BILL:	HB10-1160
TIME:	02:55:28 PM
MOVED:	Gerou
MOTION:	Moved to adopt amendment L.001 (Attachment G). The motion failed on a 0-11 roll call vote.
SECONDED:	Roberts
		VOTE
	Acree	No
	Apuan	No
	Gerou	No
	Kefalas	No
	Kerr J.	No
	Primavera	No
	Roberts	No
	Swalm	No
	Tyler	No
	Gagliardi	No
	Riesberg	No

Not Final YES: 0 NO: 11 EXC: 0 ABS: 0 FINAL ACTION: FAIL

03:02 PM

Representative Rice spoke to the preamended version of the bill (Attachment H). A handout in support of the bill from National Jewish Health was distributed to the committee (Attachment I). The committee discussed the amendment with the sponsor. Committee members expressed concern that the amendment made the administration of a wellness program more complicated. Representative Rice stated that the amendment clarifies the definition of 'health outcomes.'


BILL:	HB10-1160
TIME:	03:19:47 PM
MOVED:	Roberts
MOTION:	Moved to adopt prepared amendment L.003 (Attachment J). The motion passed on a 8-3 roll call vote.
SECONDED:	Swalm
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	No
	Kerr J.	Yes
	Primavera	No
	Roberts	Yes
	Swalm	Yes
	Tyler	Yes
	Gagliardi	No
	Riesberg	Yes

Not Final YES: 8 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS


BILL:	HB10-1160
TIME:	03:20:55 PM
MOVED:	Roberts
MOTION:	Moved to refer House Bill 10-1160, as amended, to the Committee of the Whole. The motion passed on a 6-5 roll call vote.
SECONDED:	Gerou
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	No
	Kerr J.	Yes
	Primavera	No
	Roberts	Yes
	Swalm	Yes
	Tyler	No
	Gagliardi	No
	Riesberg	No

Final YES: 6 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: PASS

03:22 PM

The committee took a brief recess.

03:28 PM -- House Bill 10-1022

The committee reconvened. Representatives Summers and Gagliardi presented House Bill 10-1022 which was recommended by the interim Economic Opportunity Poverty Reduction Task Force. The bill changes the name of the food stamp program to the Supplemental Nutrition Assistance Program (SNAP), changes the eligibility criteria for food assistance by removing the asset test and increasing the gross household income to 200 percent of the federal poverty level (FPL), and creates an outreach plan to promote awareness and access to the program. Representative Summers described the bill and the need to expand the food assistance program. Representative Summers explained that several amendments would be offered in order to reduce the fiscal note.

03:42 PM -- Pat Ratliff, Colorado Counties Inc (CCI), stated that CCI has not had the opportunity to review the bill and take a position. She stated that CCI has two concerns with the bill as introduced. She stated that part of the bill's funding comes from the Department of Defense, approximately $4 million. She stated that this is one time funding. Another concern Ms. Ratliff expressed was that permanently changing the eligibility criteria for the SNAP will probably require Colorado Benefit Management System (CBMS) changes which will certainly drive a higher fiscal note. Committee members discussed the cost of making changes to the CBMS.

03:52 PM -- Pauline Burton, Colorado Department of Human Services, spoke in support of the bill. Ms. Burton described the SNAP. She stated that Colorado's population is one of the fastest growing in the nation. She also commented that the number of individuals that counties are serving who are eligible for SNAP is increasing at a very high rate. She described the process an individuals goes through to determine eligibility for SNAP. Ms. Burton responded to questions from Representative Kefalas.

04:05 PM -- Rich Mauro, Denver Regional Council of Governments and the Senior Lobby, spoke in support of the bill. He spoke in support of the awareness and outreach efforts that are crucial in getting information out to individuals who are in need of food assistance.

04:08 PM -- Sandra Stenmark, Kaiser Permanente, spoke in support of the bill. She spoke to the consequences of inadequate nutrition in children.

04:13 PM -- Tara Trujillo, Colorado Children's Campaign, spoke in support of the bill. She provided statistics regarding how many children go without food. She stated that the United States Department of Agriculture (USDA) reported that approximately 22 percent of children are food insecure, meaning that they go without two or more meals a day. Ms. Trujillo spoke to the paradox of keeping the asset test in determining eligibility for food assistance programs. She stated that the bill is a comprehensive strategy that enables individuals to move out of poverty.

04:18 PM -- Leona Martens, Weld Food Bank, spoke in support of the bill. She stated that the food bank has served an increase of 300 individuals a month since the recession began. She spoke to the large increase in families seeking food assistance. She stated that the bill enables a partnership between the government and the community to address food shortages. She stated that she supports the new model of partnership between the government and community organizations.

04:26 PM -- Kathy Underhill, Coalition to End Hunger, spoke in support of the bill. She stated that the bill is a systemic solution to a systemic problem. She stated that the strategies listed in the bill are recommended by the USDA and are considered best practices. She spoke to private funding that has been collected to be used towards an educational outreach program for the SNAP.


BILL:	HB10-1022
TIME:	04:33:41 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt amendment L.001 (Attachment K). The amendment removes the provision to rebrand the food assistance program to the Supplemental Assistance Nutritional Program (SNAP). 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:	HB10-1022
TIME:	04:34:53 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt prepared amendment L.002 (Attachment L). The amendment removes the certification period which is intended to remove some of the CBMS changes that may be required. 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:	HB10-1022
TIME:	04:39:51 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt prepared L.003 (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:	HB10-1022
TIME:	04:41:12 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt prepared amendment L.004 (Attachment N). The amendment removes the provision in the bill that increases the federal poverty level for eligibility for food stamps. The motion passed without objection.
SECONDED:
		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:	HB10-1022
TIME:	04:42:03 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt prepared amendment L.005 (Attachment O). 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:	HB10-1022
TIME:	04:43:29 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt prepared amendment L.006 (Attachment P). 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:	HB10-1022
TIME:	04:44:06 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt prepared amendment L.008 (Attachment Q). The amendment allows the department, pursuant to federal authorization, to eliminate the asset test for eligibility for food assistance benefits. 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: Passed Without Objection


BILL:	HB10-1022
TIME:	04:52:14 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt prepared amendment L.009 (Attachment R). 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

04:58 PM

Representative Gagliardi spoke to the fiscal note. She indicated that a new fiscal note would be prepared for the Committee on Appropriations.


BILL:	HB10-1022
TIME:	05:04:26 PM
MOVED:	Gagliardi
MOTION:	Moved to refer House Bill 10-1022, as amended, to the Committee on Appropriations. The motion passed on a 10-0 roll call vote.
SECONDED:	Kefalas
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	Yes
	Roberts	Yes
	Swalm	Yes
	Tyler	Excused
	Gagliardi	Yes
	Riesberg	Yes

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

House Bill 10-1050 was laid over to the end of the calendar.

05:13 PM -- House Bill 10-1029

Representative Acree, sponsor of House Bill 10-1029, introduced the bill which was recommended by the interim committee on the Developmental Disability Waiting List. Representative Acree spoke to changes in the bill that would occur with the adoption of amendment L.003 (Attachment S). She stated that the bill directs the Department of Health Care Policy and Financing to work with one or more nonprofit organizations to develop a list of approved vendors who are willing to sell durable medical equipment and medical supplies at discounted prices to persons who have applied for, but are not yet receiving, benefits under Medicaid.

05:15 PM -- Fofi Mendez, representing Family Voices, testified in support of the bill. She explained the importance for families to have access to discounted medical supplies as they wait for Medicaid funding. She also spoke on behalf of the Colorado Association for Medical Equipment Services (CAMES). A handout in support of the bill was distributed to the committee (Attachment S).


BILL:	HB10-1029
TIME:	05:18:49 PM
MOVED:	Acree
MOTION:	Moved prepared amendment L.003 (Attachment T). 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:	HB10-1029
TIME:	05:20:48 PM
MOVED:	Acree
MOTION:	Moved to refer House Bill 10-1029, as amended, 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	Yes
	Swalm	Yes
	Tyler	Excused
	Gagliardi	Yes
	Riesberg	Yes

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

05:24 PM -- House Bill 10-1179

Representative Acree, sponsor of House Bill 10-1179, concerning increasing the availability of primary health care services in underserved areas of the state, presented the bill to the committee. She handed out a packet to the committee members, which included a map of the federal designated shortage areas, a brief article regarding the shortage of primary care providers in rural communities, and amendment L.001 (Attachments U, V, and W respectively). Representative Acree stated that the bill removes the $35,000 per year cap on loan repayment awards under the State Health Care Professional Loan Repayment Program. There was discussion among the committee that the bill makes the similar changes that House Bill 10-1138 does to the loan repayment program. The bill also requires the Department of Health Care Policy and Financing to develop a five-year strategic plan for increasing provider reimbursement rates statewide for primary care providers.

05:48 PM -- Rochelle Cohen, Health Care for All Colorado, stated that in theory the organization supports the bill. She stated they support the idea of encouraging residents to go into primary care.

05:51 PM -- Clint Cresawn, Colorado STRIDES, spoke in support of the bill. He described the shortage of physicians in rural communities. Mr. Cresawn stated his support for amendment L.001 (Attachment W). The committee discussed the addition of a primary care provider to become a non-voting member on the Small Business Council.

06:00 PM -- Edie Sonn, Colorado Medical Society (CMS), stated that CMS supports the concept of the bill of increasing primary care physicians in underserved areas. She stated that CMS has an issue with the provision in the bill that encourages physicians to make donations or investments to establish primary care practices. Ms. Sonn stated that is a prohibited activity.

06:08 PM -- Jesi Dobosz, Department of Public Health and Environment, responded to questions from Representative Primavera regarding the repayment loan program.

06:10 PM

House Bill 10-1179 was laid over.

06:11 PM -- House Bill 10-1050

Representative Tyler presented House Bill 10-1050. He stated that the he intends to offer amendment L.001 which is a strike below amendment (Attachment X). The amendment authorizes an entity that facilitates the exchange of health information to promote confidential exchange of forms containing an individual's advanced directives for medical treatment. He stated that the Department of Public Health and Environment is required to maintain a link on the department's website with a copy of any relevant forms. Committee members discussed their concerns around privacy issues with regard to the bill.

06:27 PM -- Susan Fox, private citizen, spoke in support of the bill. She stated she is an attorney. She stated that many of her clients have asked her if there is any way to have their advanced care directives available in a way that they do not have to keep producing the similar document to various physicians, or in cases when the patient become disabled or cannot speak for themselves due to a disability.


BILL:	HB10-1050
TIME:	06:37:46 PM
MOVED:	Tyler
MOTION:	Moved to adopt prepared amendment L.001 (Attachment X). The motion passed on a 9-2 roll call vote.
SECONDED:	Roberts
		VOTE
	Acree	Yes
	Apuan	Yes
	Gerou	No
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	No
	Roberts	Yes
	Swalm	Yes
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes

Not Final YES: 9 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS


BILL:	HB10-1050
TIME:	06:38:16 PM
MOVED:	Tyler
MOTION:	Moved to refer House Bill 10-1050, as amended, to the Committee of the Whole. The motion passed on a 7-4 roll call vote.
SECONDED:	Gagliardi
		VOTE
	Acree	No
	Apuan	Yes
	Gerou	No
	Kefalas	Yes
	Kerr J.	Yes
	Primavera	No
	Roberts	Yes
	Swalm	No
	Tyler	Yes
	Gagliardi	Yes
	Riesberg	Yes

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

06:39 PM

Representative Riesberg spoke to the Joint Budget Committee hearing scheduled for Monday, February 15, 2010. The committee adjourned.