House Committee on Public Health Care & Human Services (02/12/2013)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON PUBLIC HEALTH CARE & HUMAN SERVICES

Date:	02/12/2013	ATTENDANCE

Time:	01:31 PM to 04:07 PM	Conti	*
		Everett	X
Place:	HCR 0107	Joshi	X
		Landgraf	X
This Meeting was called to order by		May	X
	Representative Primavera	McCann	*
		Schafer	X
This Report was prepared by		Singer	*
	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:
HB13-1185 HB13-1199 HB13-1171		Referred to the Committee of the Whole Amended, Referred to the Committee of the Whole Amended, Referred to Appropriations

01:32 PM -- House Bill 13-1185

Representatives Gerou and Duran introduced House Bill 13-1185. The bill repeals the statutory section in current law that specifies a schedule for transfers from the Operational Account of the Severance Tax Trust Fund that are made to three separate low-income energy assistance cash funds. Future transfers to each fund will be made three times a year, ensuring that any proportional reductions that occur are born equally by each fund. The bill also allows the State Treasurer to equalize distributions in FY 2012-13. Representative Gerou explained that the goal of the bill is to equalize cuts to the programs, if necessary, rather than having one program take a disproportionate hit. Representative Duran responded to questions and explained that current law creates three separate funds for energy-related assistance. Representative Gerou further discussed the programs that receive the funding. A handout was distributed to the committee (Attachment A).

130212 AttachA.pdf

01:38 PM -- Jennifer Gremmert, Energy Outreach Colorado, testified in support of the bill. She explained how the funds received by Energy Outreach Colorado and the other programs are distributed. She responded to questions from the committee regarding the income eligibility criteria for the program.


BILL:	HB13-1185
TIME:	01:41:59 PM
MOVED:	Landgraf
MOTION:	Refer House Bill 13-1185 to the Committee of the Whole. The motion passed on a vote of 11-0, with one member excused and one member absent.
SECONDED:	May
		VOTE
	Conti	Yes
	Everett	Yes
	Joshi	Yes
	Landgraf	Yes
	May	Yes
	McCann	Excused
	Schafer	Yes
	Singer	Yes
	Stephens	Absent
	Tyler	Yes
	Wilson	Yes
	Young	Yes
	Primavera	Yes

Final YES: 11 NO: 0 EXC: 1 ABS: 1 FINAL ACTION: PASS

01:43 PM -- House Bill 13-1199

Representative Pettersen introduced House Bill 13-1199 and distributed amendment L.001 (Attachment B). The bill clarifies what types of continuing care retirement communities are exempt from paying the nursing home provider fee and clarifies the authority of the Department of Health Care Policy and Financing to collect the fee and the timing of the fee collection.

130212 AttachB.pdf

01:45 PM -- MaryKathryn Hurd, Department of Health Care Policy and Financing, testified that the bill is clarifying statute. She stated that the bill doesn't affect any current continuing care retirement community. She explained that the bill also modifies reporting requirements related to data collection for nursing facilities and noted that the bill changes the reporting requirement from an annual to a monthly report.

01:47 PM -- Nancy Dolson, Department of Health Care Policy and Financing, offered to respond to committee questions. Ms. Hurd described amendment L.001 (Attachment B). Ms. Dolson responded to questions from the committee regarding the collection of the nursing facility provider fee.

01:52 PM

Representative Pettersen explained amendment L.001 (Attachment B).


BILL:	HB13-1199
TIME:	01:53:00 PM
MOVED:	Young
MOTION:	Adopt amendment L.001 (Attachment B). The motion passed without objection.
SECONDED:	Schafer
		VOTE
	Conti
	Everett
	Joshi
	Landgraf
	May
	McCann	Excused
	Schafer
	Singer
	Stephens
	Tyler
	Wilson
	Young
	Primavera

YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	HB13-1199
TIME:	01:53:19 PM
MOVED:	Schafer
MOTION:	Refer House Bill 13-1199, as amended, to the Committee of the Whole. The motion passed on a vote of 9-3, with one member excused.
SECONDED:	Tyler
		VOTE
	Conti	Yes
	Everett	No
	Joshi	No
	Landgraf	Yes
	May	Yes
	McCann	Excused
	Schafer	Yes
	Singer	Yes
	Stephens	No
	Tyler	Yes
	Wilson	Yes
	Young	Yes
	Primavera	Yes

Final YES: 9 NO: 3 EXC: 1 ABS: 0 FINAL ACTION: PASS

02:01 PM -- House Bill 13-1171

Representative Primavera introduced House Bill 13-1171. The bill requires the State Board of Education, in consultation with the Department of Public Health and Environment, to adopt rules by December 31, 2013, for treatment plans for the management of students with life-threatening allergies. The plans must include education and training for personnel designated to manage students with life-threatening allergies, including school nurses; standards for training programs that must be completed by designated personnel in order to administer an epinephrine auto-injector (epi-pen); procedures for responding to students' life-threatening allergic reactions; a process for developing individualized health care and allergy action plans for students known to have life-threatening allergies; protocols to prevent students' exposure to allergens; and incident reporting protocols. The bill also allows, but does not require, public and nonpublic schools to adopt policies that authorize designated personnel, in accordance with standard protocol, to administer an epi-pen to a student who is believed to be experiencing anaphylaxis. School governing bodies are authorized to enter into agreements with manufacturers of epinephrine auto-injectors or third-party suppliers in order to obtain the injectors at fair market or reduced prices.

Representative Primavera discussed anaphylaxis and how an epi-pen works. She stated that the bill doesn't require that schools have epi-pens, but allows public and nonpublic schools to adopt policies that authorize designated personnel to administer an epi-pen to a student who is believed to be experiencing anaphylaxis. She discussed the bill's fiscal note. Representative Primavera responded to questions from the committee regarding the training required by bill, the cost of the epi-pens to schools, the shelf life of the epi-pens, and the bill's fiscal note.

02:17 PM -- Kirk Mlinek, Legislative Council Staff, responded to committee questions regarding the bill's fiscal note.

02:19 PM -- Teresa Ross, Colorado Association of School Nurses, testified in opposition to the bill. She discussed the portions of the bill the association does support, stating that the bill provides an opportunity for schools to have a stock of epi-pens and allows the school nurse to administer an epi-pen to students having an anaphylaxis incident. She stated that the association is troubled by the fact that, under the bill, nonmedical personnel could make a determination that a student is suffering anaphylaxis. The committee discussed whether a nurse should make the determination of whether an epi-pen should be administered. Ms. Ross stated that school personnel should call 911 rather than allowing unlicensed personnel to administer the epi-pen, and she described the negative outcomes that can occur if an epi-pen is administered to a student who is not actually in an anaphylactic state. Ms. Ross discussed the burden that would be placed on school nurses to train other school personnel to administer epi-pens.

02:41 PM -- Dr. Haidi Demain, representing herself, described her daughter's food allergies. She discussed the prevalence of food allergies in children and that one in four students who may need epinephrine do not have an existing prescription for the drug. She stated that there are no known reasons to withhold epinephrin in cases of anaphylaxis and that the training requirements of the bill will provide confidence to school employees to administer epinephrine in emergency situations. She responded to questions from the committee regarding the side effects of administering epinephrine to a person who is not in an anaphylactic state.

02:54 PM -- Bruce Lott, Mylan Inc., discussed the number of children with food allergies and legislation in other states regarding epinephrine auto injectors. He responded to questions from the committee regarding the epi-pen.

03:03 PM -- Christianna Fogler, representing herself as a school principal, testified regarding an allergy incident in her school. She spoke in support of permitting school personnel to respond in such situations.

03:09 PM -- Katie Pritchard, representing herself, discussed students who have died from anaphylaxis. She described her daughter's food allergies, and noted that her daughter's school personnel are trained to address anaphylaxis.

03:13 PM -- McKinzie Ham, representing herself, discussed her food allergies and stated that it is difficult for her to self-administer her epi-pen, so she supports allowing others to do so if necessary.

03:15 PM -- Katie Martin, representing herself, introduced her children and discussed her daughter's allergies. She noted that a number of children have food allergies that they do not know about.

03:20 PM -- Alessandro Chiastra, representing himself, testified regarding his food allergies. He stated the slightest exposure to his allergens could cause anaphylactic shock. He described the incidents of allergic reactions he has experienced and responded to questions from the committee.

03:28 PM -- Julie Rugg, representing herself, discussed her experiences as an allergy and asthma nurse. She stated that the prevalence of food allergies is on the rise. She stated that from the onset of a reaction to an allergen, anaphylaxis can occur within seconds and that delayed administration of epinephrine causes more problems than unnecessary dosing. She stated that a diagnosis is not required to administer epinephrine and compared the administration of epi-pens by lay people to the administration of CPR, the use of automatic external defibrillators, and the use of the Heimlich Maneuver.

03:36 PM -- Lorrie Ham, representing herself, testified regarding her daughter's food allergies and asthma. She stated that having epi-pens available in schools would provide peace of mind for parents.

03:38 PM -- Dr. David Fleischer, representing himself, testified regarding his research regarding food allergies at National Jewish. He stated that epinephrine is safe and the side effects are minimal. He reiterated that it is better to give the epi-pen than to not give it, and early administration of epinephrine leads to better outcomes. He stated that all school personnel should be trained to administer an epi-pen. He responded to questions from the committee regarding whether National Jewish can be involved in providing the training required by the bill and the bill's fiscal note.

03:49 PM -- Kathy Rienert, representing herself as a school nurse, testified in support of having a supply of epinephrine in schools and the administration of the epinephrine by nurses. She stated that the bill is unrealistic in its training requirements.

03:53 PM

Representative Primavera described amendment L.002 (Attachment C).

130212 AttachC.pdf


BILL:	HB13-1171
TIME:	03:53:33 PM
MOVED:	Primavera
MOTION:	Adopt amendment L.002 (Attachment C). The motion passed without objection.
SECONDED:	Schafer
		VOTE
	Conti
	Everett
	Joshi
	Landgraf
	May
	McCann	Excused
	Schafer
	Singer
	Stephens
	Tyler
	Wilson
	Young
	Primavera

YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection

03:55 PM

The committee recessed.

04:02 PM

The committee reconvened.


BILL:	HB13-1171
TIME:	04:04:35 PM
MOVED:	Primavera
MOTION:	Refer House Bill 13-1171, as amended, to the Committee on Appropriations. The motion passed on a vote of 11-2.
SECONDED:	Singer
		VOTE
	Conti	Yes
	Everett	No
	Joshi	No
	Landgraf	Yes
	May	Yes
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Yes
	Tyler	Yes
	Wilson	Yes
	Young	Yes
	Primavera	Yes

Final YES: 11 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS

04:07 PM

The committee adjourned.