House Committee on Public Health Care & Human Services (04/09/2013)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON PUBLIC HEALTH CARE & HUMAN SERVICES

Date:	04/09/2013	ATTENDANCE

Time:	01:34 PM to 05:50 PM	Conti	X
		Everett	X
Place:	HCR 0107	Joshi	X
		Landgraf	*
This Meeting was called to order by		May	X
	Representative Primavera	McCann	X
		Schafer	X
This Report was prepared by		Singer	X
	Elizabeth Burger	Stephens	*
		Tyler	X
		Wilson	X
		Young	X
		Primavera	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB13-1281 SB13-137 HB13-1271 SB13-180		Referred to the Committee of the Whole Amended, Referred to the Committee of the Whole Amended, Referred to Appropriations Referred to Finance

01:35 PM -- House Bill 13-1281

Representative Primavera announced that House Bill 13-1291 would be laid over until a future meeting of the committee. Representative Gerou introduced House Bill 13-1281. The bill concerns appropriations for the Medicaid Management Information System (MMIS) and specifically allows the Department of Health Care Policy and Financing to retain any unspent or unencumbered General Fund appropriations for the MMIS at the end of a fiscal year. She responded to questions from the committee regarding how money much could potentially be rolled forward and the amount that is annually appropriated for the MMIS.

01:43 PM -- MaryKathyrn Hurd, Department of Health Care Policy and Financing, testified in support of the bill. She explained that if MMIS system changes can't be completed in a particular fiscal year, work often stops until a supplemental appropriation can be approved. She responded to questions from the committee regarding whether changes to the MMIS system are overseen by the Governor's Office of Information Technology.


BILL:	HB13-1281
TIME:	01:46:15 PM
MOVED:	Young
MOTION:	Refer House Bill 13-1281 to the Committee of the Whole. The motion passed on a vote of 12-0, with one member excused.
SECONDED:	Singer
		VOTE
	Conti	Excused
	Everett	Yes
	Joshi	Yes
	Landgraf	Yes
	May	Yes
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Yes
	Tyler	Yes
	Wilson	Yes
	Young	Yes
	Primavera	Yes

Final YES: 12 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS

01:48 PM -- Senate Bill 13-137

Representative Navarro introduced Senate Bill 13-137. The bill directs the Department of Health Care Policy and Financing to issue a request for information (RFI) by September 30, 2013, regarding the use of predictive analytics technologies in Medicaid. She responded to questions from the committee regarding how the bill's provisions relate to existing Medicaid fraud statutes and distributed a handout to the committee regarding Medicaid fraud and abuse (Attachment A). She continued to respond to questions from the committee regarding amendments made to the bill in the Senate, and the RFI process. She further addressed questions from the committee regarding whether there is Medicaid fraud that is not being addressed by current fraud and abuse prevention statutes, specific provisions of the bill addressing waste, and the bill's language regarding delaying the payment of claims until the claims are determined to be valid. Representative Joshi clarified that the bill concerns the issuance of an RFI and not the specific provisions of the fraud and abuse system that may be implemented as a result of the RFIs that are received. The committee discussed whether the Office of Information Technology should be involved in the RFI process.

130409 AttachA.pdf

02:09 PM -- Chris Underwood, Department of Health Care Policy and Financing, testified in support of the bill, explaining that the bill was amended in the Senate to change the provisions of the bill to require the issuance of an RFI. He stated that the RFI is a first step in gathering additional information about the potential return on investment for a data analytics system and determining whether such a system would save enough money to cover its costs. He noted that the point of such a system is to stop fraudulent claims at the point of payment so the department doesn't have to recover fraudulent payments after the fact. He stated that protections for providers need to be built into the system, and discussed the timeline on which Medicaid payments are currently paid. He stated the RFI will help determine how to ensure that claims are reviewed before they are paid, but are still paid in a timely manner. He gave examples of the types of fraud and abuse that a data analytics system could potentially address and noted that the General Assembly would have to approve funding for a data analytics system prior to the department's use of such a system. He responded to questions from the committee regarding the potential cost savings of the implementation of a data analytics system, the other states that are developing similar systems, and the interaction of the bill with the Medicaid False Claims Act. He additionally responded to questions from the committee regarding acts that constitute Medicaid fraud, waste, and abuse, and whether the department is currently employing data analytics in its billing systems.

02:32 PM

The committee discussed whether the bill should be amended to include a safety clause.

02:33 PM

Brita Darling, Office of Legislative Legal Services, responded to questions from the committee regarding the bill's effective date clause.


BILL:	SB13-137
TIME:	02:34:29 PM
MOVED:	Young
MOTION:	Strike the bill's effective date clause and substitute a safety clause. The motion passed without objection.
SECONDED:	Singer
		VOTE
	Conti
	Everett
	Joshi
	Landgraf
	May
	McCann
	Schafer
	Singer
	Stephens
	Tyler
	Wilson
	Young
	Primavera

YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

02:34 PM

Representative Navarro gave concluding remarks regarding the bill.


BILL:	SB13-137
TIME:	02:35:55 PM
MOVED:	Landgraf
MOTION:	Refer Senate Bill 13-137, as amended, to the Committee of the Whole. The motion passed on a vote of 13-0.
SECONDED:	Young
		VOTE
	Conti	Yes
	Everett	Yes
	Joshi	Yes
	Landgraf	Yes
	May	Yes
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Yes
	Tyler	Yes
	Wilson	Yes
	Young	Yes
	Primavera	Yes

Final YES: 13 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

02:36 PM -- House Bill 13-1271

Representative Singer and Representative May introduced House Bill 13-1271. The bill requires the Department of Human Services to establish a steering committee to develop an implementation plan for a statewide child abuse reporting hotline. The steering committee must include state, local, and stakeholder representatives, and is required to submit its recommendations to the Executive Director of the department and the State Board of Human Services by July 1, 2014. The hotline is required to be operational and publicized statewide no later than January 1, 2015. The bill specifies that the hotline is required to operate 24 hours a day, 7 days a week.

02:43 PM

Representative May stated that the bill recognizes differences between county operations. She noted that very small counties can struggle to provide 24-hour services, and the bill allows counties to work with each other to provide response services. Representative Singer responded to questions from the committee regarding why the 911 system isn't the appropriate system to respond to reports of child abuse and neglect, and how people will become aware of the hotline number. The committee discussed the costs of marketing the hotline and whether there is an off-the-shelf system that could work in Colorado that would reduce the costs of the bill. Representative Singer responded to questions from the committee regarding false reports of child abuse and neglect and incidents that may be reported to the hotline that do not rise to the level of child abuse. The committee further discussed the bill's requirements regarding training and whether the training would be conducted through the Child Welfare Training Academy. Representative May addressed questions regarding the membership of the steering committee, and

clarified that the bill creates another option for people to report child abuse and neglect. Representative Singer noted that the bill isn't prescriptive and creates a rule promulgation process to determine the parameters of the hotline. The committee discussed the relationship between the hotline and 911 and potential liability issues if reports made to the hotline aren't properly reported to counties for investigation.

03:16 PM

Committee discussion continued regarding the process of screening reports of child abuse and neglect and the bill's fiscal note. The committee discussed the steering committee's role in determining the structure of the hotline. Committee discussion continued on whether the existing 911 system should be utilized for purposes of the bill.

03:41 PM -- Reggie Bicha, Executive Director of the Department of Human Services, testified regarding Governor Hickenlooper's child welfare plan, which he noted included a proposal for a statewide child abuse and neglect reporting hotline. He stated that the bill authorizes the Department of Human Services to establish a statewide portal to allow members of the public to report child abuse and neglect and noted that the hotline will be supported with additional services for families and training for workers who take the hotline calls. He described the steering committee created by the bill. He responded to questions from the committee regarding whether the hotline created by the bill is duplicating the existing 911 system, the bill's fiscal note, the potential FTE impact of the bill, and the Department of Human Services' current year budget request.

04:00 PM

Bill Zepernick, Legislative Council Staff, came to the table to respond to the questions from the committee regarding the bill's fiscal note. He noted that the Joint Budget Committee had set aside $200,000 in FY 2013-14 for costs related to a consultant for the hotline and described the information technology costs of the bill in FY 2013-14. He further clarified the bill's estimated costs in FY 2014-15 and 2015-16.

04:04 PM

Mr. Bicha responded to questions from the committee regarding the possible structure of the hotline. He further responded to questions regarding the impetus for the bill.

04:11 PM -- Commissioner Cindy Domenico, Boulder County Commissioner and Chair of the Health and Human Services Steering Committee for Colorado Counties Inc. (CCI), stated that the bill is a result of collaboration between the counties and the bill sponsors. She stated that counties are doing a good job in child welfare, and the current system is not confusing; however, the bill creates another option for people to call to report abuse and neglect.

04:14 PM -- Commissioner Nancy Sharpe, Arapahoe County Commissioner and representing CCI, testified that counties support giving people another option to report abuse and stated that the bill may make it easier for people to report abuse and neglect. She stated that the counties are very interested in monitoring the outcomes for the hotline and assessing whether the hotline improves the system. Commissioner Domenico noted that the counties support a direct routing option and do not support a loss of county control over the assessment of hotline calls. Commissioner Domenico responded to questions from Representative Tyler regarding the support of counties for the bill, and she reiterated the counties' support for a routing system that appropriately routes calls in a timely manner.

04:23 PM -- Angela Lytle, Division Manager for Child Protection Services in Arapahoe County, came to the table to address committee questions regarding the differences between the proposed hotline and a 911 system. She noted that the hotline is meant to primarily address calls that are not immediate emergencies.

04:30 PM -- Sarah Ehrlich, Denver Human Services, testified in support of the bill. She stated the hotline would create awareness about child abuse and that April is Child Abuse Prevention Month. She responded to questions about the hotline system and the interplay between the 911 and 311 systems with child welfare reporting.

04:36 PM -- Roberta Long-Twyman, League of Women Voters, testified in support of the bill.

04:38 PM

Representative Primavera distributed amendment L.001 (Attachment B).

130409 AttachB.pdf


BILL:	HB13-1271
TIME:	04:39:15 PM
MOVED:	Primavera
MOTION:	Adopt amendment L.001 (Attachment B). The motion passed without objection.
SECONDED:	Young
		VOTE
	Conti
	Everett
	Joshi
	Landgraf
	May
	McCann
	Schafer
	Singer
	Stephens
	Tyler
	Wilson
	Young
	Primavera

YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

04:39 PM

The committee discussed potential amendments to the bill. Representative Singer and Representative May gave concluding remarks regarding the bill and members of the committee discussed their positions on the bill.


BILL:	HB13-1271
TIME:	04:52:45 PM
MOVED:	Singer
MOTION:	Refer House Bill 13-1271, as amended, to the Committee on Appropriations. The motion passed on a vote of 8-5.
SECONDED:	May
		VOTE
	Conti	No
	Everett	No
	Joshi	No
	Landgraf	Yes
	May	Yes
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	No
	Tyler	Yes
	Wilson	No
	Young	Yes
	Primavera	Yes

Final YES: 8 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: PASS

04:53 PM -- Senate Bill 13-180

Representative Singer introduced Senate Bill 13-180. The bill continues the regulation of occupational therapists in the Department of Regulatory Agencies until September 1, 2018. Under current law, both occupational therapists (OTs) and OT assistants are required to be registered. The bill changes the requirement to licensure.

04:57 PM -- Ben Meyerhoff, representing himself, testified in support of the bill and spoke regarding his spine injury and the impact of OTs on his recovery and quality of life. He stated that it doesn't make sense to him that Colorado could be the one of the few states that allow OTs to be unlicensed. He responded to questions from the committee regarding the differences between OTs and physical therapists.

05:03 PM -- Rosalie Lewin, representing herself, testified regarding her practice as an OT treating hand injuries. She responded to questions from the committee regarding whether OTs practice under a doctor's supervision and whether or not OTs have difficulty receiving reimbursement from insurance companies.

05:11 PM -- Amy Solomon, representing herself, testified in support of the licensure of OTs and described the education requirements for practicing as an OT. She spoke regarding her practice as an OT and the potential for harm to patients if OTs are not licensed. She stated the bill will protect the public by creating a mechanism to follow up on OTs who are not providing appropriate care. A letter of support for the bill was distributed to the committee (Attachment C).

130409 AttachC.pdf

05:18 PM -- Nathan Colburn, representing himself, described his business providing accessibility equipment and discussed his relationship with OTs. He noted that OTs can prescribe medical equipment under the Medicare program.

05:23 PM -- Pamela DiPasquale-Lehnerz, representing herself, distributed a letter of support for the bill (Attachment D).

130409 AttachD.pdf

05:25 PM -- Janice Hinds, representing herself, responded to questions from the committee regarding the practice of occupational therapy. Ms. DiPasquale-Lehnerz provided additional information on the practice settings for OTs and the reasons why the profession is seeking licensure.

05:32 PM -- Deann Conroy, Department of Regulatory Agencies, responded to questions from the committee regarding the department's recommendations in its 2012 sunset review of OTs. She described the sunset review process, and explained the reasons why, in her view, there was limited data regarding complaints against OTs. She further responded to questions from the committee regarding registration fees and confidential agreements for OTs to limit their practice. She further addressed questions from the committee regarding the proposed licensing fees under the bill. The committee continued to discuss the bill's fiscal note.

05:48 PM

Representative Singer gave concluding remarks regarding the bill.


BILL:	SB13-180
TIME:	05:49:22 PM
MOVED:	Singer
MOTION:	Refer Senate Bill 13-180 to the Committee on Finance. The motion passed on a vote of 9-4.
SECONDED:	Everett
		VOTE
	Conti	Yes
	Everett	No
	Joshi	No
	Landgraf	No
	May	Yes
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Yes
	Tyler	Yes
	Wilson	No
	Young	Yes
	Primavera	Yes

Final YES: 9 NO: 4 EXC: 0 ABS: 0 FINAL ACTION: PASS

05:50 PM

The committee adjourned.