House Committee on Health, Insurance & Environment (05/02/2013)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH, INSURANCE & ENVIRONMENT

Date:	05/02/2013	ATTENDANCE

Time:	01:33 PM to 04:43 PM	Conti	X
		Fields	*
Place:	HCR 0107	Ginal	X
		Humphrey	X
This Meeting was called to order by		Joshi	X
	Representative McCann	Primavera	X
		Stephens	X
This Report was prepared by		Swalm	*
	Amanda King	Young	X
		Schafer	X
		McCann	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
SB13-277 SB13-225 SB13-215		Referred to Appropriations Referred to Appropriations Witness Testimony and/or Committee Discussion Only

01:34 PM -- Senate Bill 13-277

Representative Ginal presented Senate Bill 13-277 concerning the development of a prior authorization process to be used in obtaining prior approval from carriers for coverage of drug benefits. The bill requires the Commissioner of Insurance in the Department of Regulatory Agencies to develop by July 31, 2014, by rule, a uniform prior authorization process for insurance carriers to submit and receive requests for prior coverage approval of a drug benefit. Prior authorization is an extra step that some insurance carriers require before deciding to approve coverage of a patient's medicine. Under the prior authorization process to be developed by the commissioner, insurance carriers and pharmacy benefit management firms will be required to:

make the process available electronically, but must not require the prescribing provider to submit a prior authorization request electronically;
make certain items accessible in a centralized location on the their web sites;
use evidence-based guidelines, when possible, when making prior authorization determinations;
include certain information in its prior approval notification; and
inform a prescribing provider that the covered person has a right to appeal the denial of a prior approval request.

The bill requires the commissioner to appoint a working group within 30 days of the bill's effective date for purposed of assisting in the development of the prior authorization process. The work group's recommendations must be made not later than six months after the date on which membership appointments are made. As part of the rule promulgation, the commissioner is required to develop a standardized prior authorization form that is not to exceed two pages in length. The commissioner is required to take into consideration existing forms, including those established by the federal Centers for Medicare and Medicaid Services and the Department of Health Care Policy and Financing.

Carriers are required to begin using the prior authorization process on January 1, 2015. A request for prior authorization is deemed granted if a carrier fails to use the prior authorization process or fails to respond within two business days to any request submitted electronically, subject to certain conditions. The deadline for nonurgent requests is three business days. Urgent requests must be responded to within one business day. Once approved, a prior authorization is valid for at least 180 from the date of approval.

Representative Ginal provided several handouts to the committee (Attachments A through E).

130502 AttachE.pdf

01:39 PM -- Dr. Jan Kief, Colorado Medical Society, testified in support of the bill. She discussed the issues with the current prior authorization process. Dr. Kief responded to questions about why standardization of the prior authorization process has not happened before.

01:43 PM -- Dr. Alvin Otsuka, Rocky Mountain Cancer Center, testified in support of the bill. He discussed the costs of the current prior authorization process, the current practice of following nationally published guidelines for cancer treatments, and how the standardization of the prior authorization process will help reduce medical care costs.

01:46 PM -- Marcus Garcia, Rocky Mountain Cancer Center, testified in support of the bill. He discussed the prior authorization process and delays in care due to waiting for insurance authorizations. Mr. Garcia responded to questions about the prior authorization forms.

01:50 PM

Representative Joshi discussed his experience with the prior authorization process.


BILL:	SB13-277
TIME:	01:50:08 PM
MOVED:	Ginal
MOTION:	Refer Senate Bill 13-277 to the Committee on Appropriations. The motion passed on a vote of 11-0.
SECONDED:	Schafer
		VOTE
	Conti	Yes
	Fields	Yes
	Ginal	Yes
	Humphrey	Yes
	Joshi	Yes
	Primavera	Yes
	Stephens	Yes
	Swalm	Yes
	Young	Yes
	Schafer	Yes
	McCann	Yes

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

01:52 PM -- Senate Bill 13-225

Representative Ginal and Representative Primavera presented Senate Bill 13-225 concerning the development of a system to improve quality of care to patients suffering specified acute incidents. The bill creates the STEMI Task Force and the Stroke Advisory Board in the Department of Public Health and Environment.

The STEMI Task Force will consist of 15 members appointed by the Governor. The task force is required to study and make recommendations for developing a statewide plan to improve quality of care to STEMI heart attack patients, including:

the creation of a state database or registry consisting of data on STEMI care that mirrors data hospitals submit to nationally recognized organizations;
developing access to aggregated STEMI data;
a plan that encourages hospitals to coordinate services for the referral of patients requiring STEMI care; and
criteria used by nationally recognized bodies for designating a hospital in STEMI care, and whether such designation is appropriate or needed in Colorado.

The term STEMI is defined as ST-elevation myocardial infarction, a severe heart attack caused by a prolonged period of blocked blood supply that affects a large area of the heart.

The Stroke Advisory Board is comprised of 18 members appointed by the Governor. The purpose of the advisory board is to evaluate potential strategies for stroke prevention and treatment and develop a statewide plan to improve quality of care for stroke patients. The advisory board is to explore:

creation of a database or registry consisting of data on stroke care that mirrors the data hospitals submit to nationally recognized organizations;
access to aggregated stroke data;
currently available stroke treatments and the development of ways to improve stroke prevention and treatment;
a plan for hospitals to coordinate services for the referral of patients requiring stroke care in the state; and
criteria used by nationally recognized bodies for designating a hospital in stroke care, and whether such designation is appropriate or needed in Colorado.

The task force and advisory board have certain reporting requirements. The bill provides for a process for the Department of Public Health and Environment to make information publicly available about a hospital's accreditation, certification, or designation in stroke or STEMI care from a nationally recognized accrediting body.

Representative Ginal provided two handouts (Attachments F and G) to the committee.

130502 AttachF.pdf

130502 AttachG.pdf

01:56 PM -- Dr. Dave Ross, Colorado Chapter of the American College of Emergency Physicians, American College of Cardiology, and Colorado Medical Society, testified in opposition to the bill. He discussed the need to address the issues through professional research rather than legislation and the possibility of increased health care costs. He discussed the task force and the voluntary reporting of national certification included in the bill. Dr. Ross responded to questions about the certification process, how it is decided where a patient will be transported, and the costs related to the certification. The committee discussed whether the bill creates a database.

02:18 PM

Dr. Ross continued to respond to questions about how the bill could increase costs for hospitals, marketing efforts by hospitals, and whether hospitals would be pressured to seek certain certifications.

02:23 PM

Doug Dunsavage, American Heart Association, testified in support of the bill. He discussed various national certifications and accreditations. Mr. Dunsavage responded to questions about how the designations would be publicized, the costs related to hospital accreditations and certifications, and the impact of the bill on rural hospitals.

02:37 PM -- Dr. Jeb Burchenal, South Denver Cardiology, testified in support of the bill. He discussed the lack of uniformity in STEMI and stroke care and the level of rigor for various national certifications. Dr. Burchenal discussed the All-Payer Claims Database and rural hospitals.

02:46 PM -- Janet Stephens, Colorado Hospital Association, testified in support of the bill. She discussed the task forces created by the bill. Ms. Stephens responded to a question from Representative Stephens about the cost of the joint commission accreditation process.

02:51 PM -- Mary Ann Orr, representing herself, testified in support of the bill. She discussed her experience having a stroke. Ms. Orr responded to a question about how a statewide plan could have helped her while she was experiencing a stroke.

02:59 PM

The committee dialogued about the bill.


BILL:	SB13-225
TIME:	03:01:14 PM
MOVED:	Primavera
MOTION:	Refer Senate Bill 13-225 to the Committee on Appropriations. The motion passed on a vote of 6-5.
SECONDED:	Ginal
		VOTE
	Conti	No
	Fields	Yes
	Ginal	Yes
	Humphrey	No
	Joshi	No
	Primavera	Yes
	Stephens	No
	Swalm	No
	Young	Yes
	Schafer	Yes
	McCann	Yes

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

03:02 PM

The committee took a brief recess.

03:08 PM -- Senate Bill 13-215

The committee came back to order.

Representative Ginal presented Senate Bill 13-215 concerning alternative health care practitioners. The bill places certain requirements and restrictions on practitioners of complementary and alternative health care services who are not otherwise licensed or regulated by the state as a health care professional. Specifically, the bill requires practitioners of complementary and alternative health care services to provide a written disclosure to clients that states certain information about the practitioner. The bill outlines services and practices that may not be performed by practitioners of complementary and alternative health care services, as well as procedures that may be provided with certain training. In addition, persons who are not allowed to engage in complementary and alternative health care services are specified. Failure to provide the required disclosure or performing prohibited services constitutes a deceptive trade practice under the Colorado Consumer Protection Act. The bill also specifically exempts complementary and alternative health care services from the definition of "practice of medicine" if the services are provided in compliance with the bill.

03:12 PM -- Joanie Coffey, Colorado Coalition for Natural Health, testified in support of the bill. She discussed the need for legitimization and protection of natural health professionals.

03:15 PM -- Larry Sarner, Colorado Citizens for Science and Medicine, testified against the bill. He discussed the unlicensed practice of medicine.

03:17 PM -- Linda Rosa, representing herself, testified against the bill. She discussed similar legislation in Minnesota and the treatments that would be allowed under the bill.

03:21 PM -- Maureen Maker, Colorado Citizens for Science in Medicine, testified against the bill. She discussed heat treatments. Ms. Maker responded to questions about consumers making informed decisions and whether she has received treatment from alternative health care providers.

03:26 PM -- Dr. Mark Johnson, representing himself, testified against the bill. He provided a written copy of his testimony (Attachment H). He discussed the impact the bill would have on public health related to immunizations and the lack of safeguards for unsafe practices in the bill. Dr. Johnson responded to questions about the immunization statistics he discussed during his testimony, the regulation of alternative health care providers, and whether any county health departments have taken positions on the bill.

130502 AttachH.pdf

03:33 PM -- Donna Walter, representing herself, testified on the bill. She stated that she has concerns, but is neither for or against the bill. She discussed the vagueness and confusion the bill may create.

03:35 PM -- Alan Lewis, Vitamin Cottage, testified in support of the bill. He discussed natural health practices and referenced a potential amendment. Mr. Lewis responded to questions about whether there would be an impact on his business if the bill is not enacted.

03:38 PM -- Pati Thomas, representing herself, testified in support of the bill, but not any potential amendments. She discussed her practice as a certified nutritionist. Ms. Thomas responded to questions about whether she requires her patients to have a pediatrician, the professional relationship she has with pediatricians, and the education required for nutritionists.

03:46 PM -- Theresa Wrangham, representing herself, testified in support of the bill. She discussed her family's utilization of alternative health care providers and pediatricians.

03:48 PM -- Peggy Gates, representing herself, testified in support of the bill. She discussed being a student of complimentary nutrition therapy and expressed her concerns about a potential amendment.

03:50 PM -- Tony Brown, representing himself, testified in support of the bill. He discussed his experience with a naturopathic practitioner.

03:51 PM -- Pat Taggart, representing herself, testified in support of the bill. She discussed being a homeopathic practitioner and expressed her concerns about a potential amendment.

03:54 PM -- Sue Boorn, representing herself, testified in support of the bill. She discussed being an alternative health care consumer and homeopathic practitioner. Ms. Boorn responded to a question about the education required to become a homeopathic practitioner.

03:58 PM

Ms. Taggart responded to a question about the interaction between homeopathic remedies and prescription drugs. Ms. Boorn and Ms. Taggart responded to questions about whether they carry malpractice insurance, whether they advise about vaccinations, and the conditions they treat for patients under two years of age. Representative Stephens discussed her experience with alternative health care practitioners. Ms. Taggart and Ms. Boorn continued to respond to questions about immunizations and the practice of homeopathy.

04:11 PM -- Kimberly Sharples, Colorado Coalition for Natural Health, testified in support of the bill. She stated the need to allow for the legal practice of alternative care providers and to provide consumer protection. She discussed parental responsibility related to the use of pediatricians and other health care providers, the utilization of alternative health care providers, and her experience with a natural health practitioner.

04:14 PM -- Dr. Jasper Hillhouse, Children's Hospital Colorado and American Academy of Pediatrics, testified in a neutral capacity. He discussed the need for an amendment to address the care of children by alternative health care providers.

04:17 PM -- Zach Zaslow, Children's Hospital Colorado, testified on the bill. He discussed the need for the adoption of potential amendments related to the care of children by alternative health care providers.

04:19 PM

Dr. Hillhouse responded to questions regarding his concerns about the bill related to the care of children by alternative health care providers.

04:22 PM -- Kate Pfeiffer, Nutrition Inc., testified in support of the bill, but against potential amendments. She discussed her company and the services she provides to her clients concerning wellness and nutrition. Ms. Pfeiffer responded to questions about the impact a potential amendment would have on nutritionists.

04:27 PM -- Bethany Braunstein, Colorado Academy of Nutrition and Dietetics, testified in support of the bill if a potential amendment is adopted. She discussed the education and practice of registered dietitians and a potential amendment.

04:30 PM -- Regina Topelson, Colorado Academy of Nutrition and Dietetics, testified in support of the bill if a potential amendment is adopted. She discussed her experience as a registered dietitian. She responded to questions about possible drug and food interactions.

04:33 PM -- Lucinda Simpson, representing herself, testified in support of the bill. She discussed colonic treatments.

04:36 PM -- Janice Kerschner, Colorado Sunshine Health Freedom, testified in support of the bill. She discussed consumer protection, the need for access to natural health care, and the economic impact of alternative health care providers.

04:40 PM

Representative McCann explained what the Department of Regulatory Agencies is in response to a question from the member of the audience.

04:41 PM -- Dino Ioannides, Department of Regulatory Agencies, came to the table to respond to questions about the bill. He stated that the Attorney General's office would enforce the bill.

04:43 PM

Representative McCann laid the bill over for amendments and final action to a later date. The committee adjourned.