House Committee on Public Health Care & Human Services (02/19/2013)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON PUBLIC HEALTH CARE & HUMAN SERVICES

Date:	02/19/2013	ATTENDANCE

Time:	02:00 PM to 04:53 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	X
		Tyler	*
		Wilson	X
		Young	X
		Primavera	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB13-1152 HB13-1175 HB13-1209 HB13-1221 HB13-1068 HB13-1196		Referred to Appropriations Postponed Indefinitely Amended, Referred to the Committee of the Whole Amended, Referred to the Committee of the Whole Amended, Referred to the Committee of the Whole Amended, Referred to Appropriations

02:00 PM -- House Bill 13-1152

Representatives Gerou and Levy introduce House Bill 13-1152. The bill reduces the General Fund portion of the per diem rate paid to nursing facilities commencing in FY 2013-14 and continuing in each fiscal year thereafter. Representative Levy explained that similar reductions have been enacted each year in recent years as part of the budget balancing actions of the General Assembly, and the bill makes these reductions permanent. Representative Gerou explained that nursing facilities support the legislation. Representative Levy responded to questions from Representative Joshi regarding the bill's effect on the state's ability to draw down federal funds.

02:05 PM -- Josh Winkler, representing himself, testified in support of the bill but stated that he wished there was more parity in funding for nursing facilities and home- and community-based services (HCBS). He stated that nursing facilities have received rate increases in recent years, while the funding for HCBS services has been flat. He stated that the bill begins the process of addressing a larger problem. Representative Levy and Representative Gerou responded to Mr. Winkler's testimony. Mr. Winkler responded to questions from the committee regarding the difference in the cost of nursing facilities and HCBS services.


BILL:	HB13-1152
TIME:	02:13:51 PM
MOVED:	Young
MOTION:	Refer House Bill 13-1152 to the Committee on Appropriations. The motion passed on a vote of 13-0.
SECONDED:	Schafer
		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

02:15 PM -- House Bill 13-1175

Representative DelGrosso introduced House Bill 13-1175. The bill prohibits the state from participating in the Medicaid expansion under the federal Affordable Care Act until the General Fund appropriation to higher education is at least $747 million, which is approximately the General Fund appropriation to the Department of Higher Education in FY 2007-08. He discussed the cuts in funding to higher education in recent years and distributed a summary of the FY 2007-08 and FY 2008-09 and the FY 2011-12 and FY 2012-13 appropriations for higher education (Attachments A and B). He responded to questions from the committee regarding whether the bill is pitting Medicaid funding against higher education, and the federal match for Medicaid. Representative DelGrosso discussed the high cost of higher education, and stated that it is important to address those costs before expanding other state programs.

130219 AttachA.pdf

130219 AttachB.pdf

02:40 PM -- Gabriel Davison, representing himself, testified in opposition to the bill. He stated that the bill could prevent the Medicaid expansion from ever going into effect, and discussed Colorado's tax rates. He responded to questions from the committee regarding his testimony, stating that it seems random to target Medicaid especially since there is no cost to the state to expand Medicaid under the Affordable Care Act. He noted that the bill will not address the real problem, which is the rising cost of higher education. He further addressed the costs of higher education, stating that costs will continue to increase regardless of whether the bill passes.

03:04 PM -- Matthew Valeta, Colorado Consumer Health Initiative, testified in opposition to the bill. He stated that the bill creates a false choice between funding health care and funding higher education. He stated that lawmakers should focus on the state's underlying budget issues. He responded to questions from members of the committee stating that it was plausible that Colorado wouldn't have to expend any state money on the expansion. He further responded to questions regarding whether the state could opt out of the Medicaid expansion in the future and the costs of uncompensated care.

03:11 PM -- George Lyford, Colorado Center on Law and Policy, testified in opposition to the bill. He stated that the bill significantly impacts the state's ability to expand the Medicaid program, ties the hands of the legislature by limiting the ways the Medicaid program expansion could be funded, and pits education against health care, which is not good for the state.

03:15 PM

Representative DelGrosso gave concluding remarks regarding the bill. Members of the committee commented on the bill.


BILL:	HB13-1175
TIME:	03:25:14 PM
MOVED:	Landgraf
MOTION:	Refer House Bill 13-1175 to the Committee on Appropriations. The motion failed on a vote of 6-7.
SECONDED:	Joshi
		VOTE
	Conti	Yes
	Everett	Yes
	Joshi	Yes
	Landgraf	Yes
	May	No
	McCann	No
	Schafer	No
	Singer	No
	Stephens	Yes
	Tyler	No
	Wilson	Yes
	Young	No
	Primavera	No

YES: 6 NO: 7 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	HB13-1175
TIME:	03:25:58 PM
MOVED:	Young
MOTION:	Postpone House Bill 13-1175 indefinitely. The motion passed on a vote of 7-6.
SECONDED:	Schafer
		VOTE
	Conti	No
	Everett	No
	Joshi	No
	Landgraf	No
	May	Yes
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	No
	Tyler	Yes
	Wilson	No
	Young	Yes
	Primavera	Yes

Final YES: 7 NO: 6 EXC: 0 ABS: 0 FINAL ACTION: PASS

03:26 PM -- House Bill 13-1209

Representative May introduced House Bill 13-1209. The bill makes changes to the requirements and calculation of child support payments. She responded to questions from the committee and distributed amendment L.001 (Attachment C).

130219 AttachC.pdf

03:30 PM -- Robert Kurtz, Department of Human Services, testified in support of the bill and offered to answer committee questions.

03:30 PM -- Gina Weitzenkoin, representing herself, testified in support of the bill, stating the bill addresses a number of issues. She explained the child support guidelines have not been updated in many years, and that the bill increases the upper limit of monthly payments from $20,000 to $30,0000 and clarifies when certain types of income are to be included in child support calculations. She responded to questions from the committee regarding the imputation of income of parents who are voluntarily unemployed.


BILL:	HB13-1209
TIME:	03:35:44 PM
MOVED:	May
MOTION:	Adopt amendment L.001 (Attachment C). 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


BILL:	HB13-1209
TIME:	03:37:20 PM
MOVED:	May
MOTION:	Refer House Bill 13-1209, as amended, to the Committee of the Whole. The motion passed on a vote of 13-0.
SECONDED:	Schafer
		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

03:38 PM -- House Bill 13-1221

Representative May introduced House Bill 13-1221. The bill set standards for pharmacy audits by pharmacy benefit managers, insurance carriers, and auditing entities acting on their behalf. She distributed amendment L.003 (Attachment D).

130219 AttachD.pdf

03:41 PM -- Brad Young Rx Plus Pharmacies, offered to respond to committee questions.

03:42 PM -- Patrick Boyle, Express Scripts, testified in support of the bill and offered to respond to committee questions.


BILL:	HB13-1221
TIME:	03:43:33 PM
MOVED:	May
MOTION:	Adopt amendment L.003 (Attachment D). The motion passed without objection.
SECONDED:	Schafer
		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

03:46 PM

The committee recessed briefly.

03:50 PM

The committee reconvened.


BILL:	HB13-1221
TIME:	03:50:20 PM
MOVED:	May
MOTION:	Refer House Bill 13-1221, 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

03:52 PM -- House Bill 13-1068

Representative Young introduced House Bill 13-1068. The bill aligns state law concerning the inspection of Medicaid providers with federal law. Under current state law, the state is required to provide a minimum of 10 days of advance notice of a pending review or audit. Federal law requires that Medicaid providers allow the state to conduct on-site inspections, unannounced and without advance notice, for audit or review reasons or to otherwise ensure compliance with state and federal law. Representative Young distributed and discussed amendment L.001 (Attachment E), a strike-below amendment to the bill. The amendment specifies that the Department of Health Care Policy and Financing must conduct pre-enrollment and post-enrollment site visits of providers who are designated as moderate or high categorical risks to the Medicaid program. The department may waive the visits if the visits are conducted by Medicare or other federally designated entities. Under the amendment, a provider in the Medicaid program must permit the Centers for Medicare and Medicaid Services or its agent and the Department of Health Care Policy and Financing to conduct unannounced, on-site inspections of any and all provider locations.

130219 AttachE.pdf

03:58 PM -- Edie Busam, Colorado Association of Medical Equipment Suppliers, testified in support of the bill, as amended by L.001 (Attachment E). She explained that the auditing process of medical providers can be burdensome.

04:02 PM -- Ginny Brown, Colorado Hospital Association, testified in support of the bill as amended by L.001.

04:02 PM -- Chris McGowne, Colorado Medical Society, testified in support of the bill as amended by L.001.

04:03 PM -- Jeremy Schupbach, Alliance, testified in support of the bill.

04:04 PM -- Brad Young, Rx Plus Pharmacies, testified regarding the process of drafting amendment L.001 and testified in support of the bill and the amendment.

04:07 PM -- MaryKathryn Hurd, Department of Health Care Policy and Financing, testified in support of amendment L.001.

04:08 PM -- Chris Underwood, Department of Health Care Policy and Financing, responded to questions from the committee regarding amendment L.001, pre- and post-enrollment site visits, the risk categories of Medicaid providers, and how the amendment affects current law's requirements for a 10-day notice period for unannounced on-site visits. He noted that the bill will bring Colorado in compliance with federal law.


BILL:	HB13-1068
TIME:	04:16:11 PM
MOVED:	Young
MOTION:	Adopt amendment L.001 (Attachment E). The motion passed without objection.
SECONDED:	Stephens
		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


BILL:	HB13-1068
TIME:	04:17:15 PM
MOVED:	Young
MOTION:	Refer House Bill 13-1068, as amended, to the Committee of the Whole. The motion passed on a vote of 13-0.
SECONDED:	Schafer
		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

04:18 PM -- House Bill 13-1196

Representative Stephens introduced House Bill 13-1196. The bill requires the Department of Health Care Policy and Financing to report on efforts by the regional care collaborative organizations (RCCOs) to contain costs and reduce waste in the Medicaid program. She distributed amendment L.001 (Attachment F), which is a strike-below amendment to the bill, and amendment L.002 (Attachment G), an amendment to L.001. Amendment L.001 requires the Department of Health Care Policy and Financing, as part of its annual report pursuant to the SMART Government Act, to report on: the specific efforts within the accountable care collaboratives (ACCs) to identify and implement best practices relating to cost containment, any statutes or policies or procedures that prevent the RCCOs from realizing efficiencies and reducing waste within the Medicaid system, and any other efforts by RCCOs or the state department to ensure that those who provide care for Medicaid clients are aware of and actively participate in reducing waste within the Medicaid system.

130219 AttachF.pdf

130219 AttachG.pdf

04:27 PM -- Julie Mowry, Rocky Mountain Health Plans, testified regarding the bill and amendments L.001 and L.002.

04:27 PM -- Kerry White, Legislative Council Staff, came to the table to discuss the fiscal impact of amendment L.001. She stated that the amendment will reduce the FTE costs associated with the bill and may reduce the department's contracting costs. Ms. White responded to questions from the committee regarding the bill's original fiscal note.

04:32 PM -- Kathryn Jantz, Colorado Department of Health Care Policy and Financing, offered to answer technical questions.

04:32 PM -- MaryKathryn Hurd, Department of Health Care Policy and Financing, testified that the department is neutral on the bill. Ms. Jantz stated that to report robust data regarding the RCCOs, the department may need to contract for additional data analysis. She responded to questions from the committee regarding amendment L.001's requirements for data reporting and analysis. Ms. Jantz discussed the amendment's requirements for information that will be provided as part of the department's SMART Government Act hearing.

04:40 PM -- Gretchen McGinnis, Colorado Access, testified that there is a lot of value in the RCCO program, but that the data that is available to RCCOs and providers is not currently available in real time. She discussed local initiatives that allow providers to share data amongst themselves.


BILL:	HB13-1196
TIME:	04:49:55 PM
MOVED:	Stephens
MOTION:	Adopt amendment L.002 (Attachment G). 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


BILL:	HB13-1196
TIME:	04:50:57 PM
MOVED:	Stephens
MOTION:	Adopt amendment L.001 (Attachment F). The motion passed without objection.
SECONDED:	May
		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


BILL:	HB13-1196
TIME:	04:52:21 PM
MOVED:	Stephens
MOTION:	Refer House Bill 13-1196, as amended, to the Committee on Appropriations. 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

04:53 PM

The committee adjourned.