House Committee on Public Health Care & Human Services (04/23/2013)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON PUBLIC HEALTH CARE & HUMAN SERVICES

Date:	04/23/2013	ATTENDANCE

Time:	01:35 PM to 06:35 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
	Dave DeNovellis	Stephens	*
		Tyler	X
		Wilson	X
		Young	X
		Primavera	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB13-1309 HB13-1314 SB13-047 SB13-200 HJR13-1023 SB13-205 HJR13-1028		Amended, Referred to Appropriations Amended, Referred to the Committee of the Whole Amended, Referred to Appropriations Referred to Appropriations Amended, Referred to the Committee of the Whole Referred to Finance Amended, Referred to Legislative Council

01:35 PM -- House Bill 13-1309

Representative Primavera, sponsor, presented House Bill 13-1309 concerning health insurance coverage for preventive breast imaging. A mammogram is one type of breast imaging used for screening and diagnostic purposes and is a mandatory coverage provision for insurance policies regulated by state law. For individuals with at least one risk factor for breast cancer, this bill expands insurance coverage to include all types of breast imaging. The applicable risk factors include:

• having a family history of breast cancer;
• being 40 or older;
• presenting with symptoms; or
• having a genetic predisposition to breast cancer.

Under the bill, insurance coverage for breast imaging is not subject to policy deductibles, co-payments, or coinsurance. Under current law, if a policy issued in another state (home state) covers mammography, all complaints on that policy are under the jurisdiction of the home state. This bill changes that exception to require policies written in another state to have comparable coverage for breast imaging for complaints to fall under the jurisdiction of the home state.

Representative Primavera discussed her experience as a breast cancer survivor and the various types of breast imaging. She distributed amendment L.003 to the committee (Attachment A).

130423 AttachA.pdf

01:46 PM

Representative Primavera responded to questions from the committee regarding the effect of the bill on health insurance premiums and genetic predispositions toward breast cancer. She distributed a letter of support from the Colorado Radiological Society (Attachment B).

130423 AttachB.pdf

01:48 PM -- Marc Reece, representing the Colorado Association of Health Plans, testified against the bill. He stated that many health plans do currently cover breast imaging. Mr. Reece discussed cost-sharing and federal health care reform.

02:03 PM

Mr. Reece responded to questions from the committee regarding health insurance premiums under the Affordable Care Act. Representative Primavera commented on cost-sharing in health insurance.

02:13 PM

Mr. Reece responded to questions from the committee regarding reimbursement ratios to providers for breast imaging, colonoscopies, and other cancer screenings.

02:20 PM -- Dr. Jerome Schroeder, representing breast imaging radiologists testified in support of the bill. He discussed breast cancer survival rates and the different types of breast screenings.

02:29 PM -- Travis Berry, representing Colorado Competitive Council, testified against the bill. He stated that insurance mandates tend to raise health insurance premiums. Mr. Berry responded to questions from the committee regarding how the bill would affect the state health benefit exchange. Representative Primavera responded to questions from the committee regarding utilization rates and stated that the amendment addresses medically necessary testing.

02:36 PM

Mr. Reece returned to the table and responded to questions from the committee regarding actuarial analysis of the bill's effect on state employee health plans.

02:41 PM -- Joanne Vermeulen, representing Susan G. Komen for the Cure, testified in support of the bill. She distributed a letter about cancer treatment costs to the committee (Attachment C). Ms. Vermeulen responded to questions from the committee regarding insurance premiums and deductibles.

130423 AttachC.pdf

02:50 PM -- R.J. Ours, representing the American Cancer Society and the Cancer Action Network, testified in support of the bill.

02:53 PM -- Kathleen Cady, representing Susan G. Komen for the Cure, testified in support of the bill.

02:55 PM -- Nicole Davis, representing herself as a breast cancer survivor, testified in support of the bill. She described her experience with breast cancer, misdiagnoses, and the multiple screenings she went through.

03:02 PM

Representative Primavera concluded her presentation on House Bill 13-1309. She described amendment L.003. The committee discussed the amendment and the cost of the screenings to private insurers.


BILL:	HB13-1309
TIME:	03:02:39 PM
MOVED:	Primavera
MOTION:	Adopt amendment L.003 (Attachment A). The motion passed without objection.
SECONDED:	McCann
		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:	HB13-1309
TIME:	03:03:42 PM
MOVED:	Primavera
MOTION:	Refer House Bill 13-1309, as amended, to the Committee on Appropriations. 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

03:16 PM -- House Bill 13-1314

Representatives Levy and Gerou, co-prime sponsors, presented House Bill 13-1314 concerning the transfer of the administration of long-term services for persons with intellectual and developmental disabilities to the Department of Health Care Policy and Financing. Recommended by the Joint Budget Committee, this bill creates the Office of Community Living within the Department of Health Care Policy and Financing (HCPF) on July 1, 2013. On March 1, 2014, multiple programs (including all related powers, duties, and functions) serving persons with intellectual and developmental disabilities within the Department of Human Services (DHS) are transferred to HCPF by a type 2 transfer, including:

three Home-and Community-Based Services (HCBS) Medicaid waiver programs, including Adult Comprehensive Services, Children's Extensive Services, and Supported Living Services;

targeted case management services for the transferring HCBS waiver programs; and

family support services.

Representative Gerou distributed amendment L.001 to the committee (Attachment D). Representative Levy responded to questions from the committee regarding whether certain Medicaid waivers would be transferred under the bill.

130423 AttachD.pdf

03:30 PM

Megan Davisson, Joint Budget Committee Staff, came to the table to respond to questions regarding the creation new Medicaid waivers.

03:32 PM -- Suzanne Brennan and Lorez Meinhold, representing HCPF, and Joscelyn Gay, representing DHS, testified in support of the bill. They responded to questions from the committee regarding new and existing Medicaid waivers, the pediatric assessment tool, and the collaboration between the departments.

03:48 PM

Ms. Brennan, Ms. Meinhold, and Ms. Gay responded to questions from the committee regarding community centered boards, the estimated transfer timelines, and anticipated administrative and policy changes.

03:52 PM -- David Ervin, representing Alliance, the Resource Exchange, and the State Board of Human Services, testified in support the bill.

03:57 PM -- MariJo Rymer, representing the Arc of Colorado, testified in support of the bill.

04:00 PM

Mr. Ervin and Ms. Rymer responded to questions from the committee regarding how the bill will affect the number of people on the waiver waiting lists and potential Medicaid savings to the state.

04:09 PM

Representatives Levy and Gerou concluded their presentation on House Bill 13-1314 and described amendment L.001.


BILL:	HB13-1314
TIME:	04:09:32 PM
MOVED:	Young
MOTION:	Adopt amendment L.001 (Attachment D). 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:	HB13-1314
TIME:	04:15:19 PM
MOVED:	Young
MOTION:	Refer House Bill 13-1314, as amended, to the Committee of the Whole. The motion passed on a vote of 13-0.
SECONDED:	Landgraf
		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

04:22 PM -- Senate Bill 13-047

The committee recessed.

04:30 PM

The committee reconvened.

Representative Fields, sponsor, presented Senate Bill 13-047 concerning protections for youth in foster care against identity theft. The bill clarifies the role of counties and the Department of Human Services in obtaining and remediating inaccuracies in credit reports for youths in foster care, and makes the following changes:

expands the credit report requirement to youths in the custody of the Division of Youth Corrections and state mental hospitals;

requires all youths in such placements who are age 16 and older to receive credit report assistance, rather than only youths between the ages of 16 and 18; and

clarifies that credit reports must be obtained annually.

Representative Fields distributed to the committee a fact sheet in support from the Office of the Child's Representative (Attachment E) and amendment L.002 (Attachment F).

130423 AttachE.pdf

130423 AttachF.pdf

04:31 PM -- Dorothy Macias, representing the Colorado Office of the Child's Representative, testified in support of the bill and discussed the prevalence of identity theft among youth in foster care.

04:36 PM

Representative Fields concluded her presentation on Senate Bill 13-047 and described amendment L.002.


BILL:	SB13-047
TIME:	04:36:18 PM
MOVED:	Young
MOTION:	Adopt amendment L.002 (Attachment F). 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


BILL:	SB13-047
TIME:	04:36:49 PM
MOVED:	Young
MOTION:	Refer Senate Bill 13-047, as amended, to the Committee on Appropriations. The motion passed on a vote of 12-0.
SECONDED:	Singer
		VOTE
	Conti	Yes
	Everett	Yes
	Joshi	Yes
	Landgraf	Yes
	May	Yes
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Excused
	Tyler	Yes
	Wilson	Yes
	Young	Yes
	Primavera	Yes

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

04:40 PM -- Senate Bill 13-200

Speaker Ferrandino, sponsor, presented Senate Bill 13-200, concerning an increase in the income eligibility for the Medicaid program. This bill expands Medicaid eligibility from 100 percent of the federal poverty level (FPL) to 133 percent for parents and caretaker relatives with dependent children (parents) and adults without dependent children (AWDC). It also allows the state's share of costs for these eligibility groups, up to 133 percent of FPL, to be paid with Hospital Provider Fee Cash Fund moneys.

The bill also repeals provisions of current law that allow the state to reduce, by rule, eligibility or benefits for optional groups in the Medicaid or Children's Health Plan Plus (CHP+) programs if there are insufficient hospital provider fee cash funds and matching federal funds. Under current law, for parents, reductions are permitted for those with incomes of between 61 percent and 100 percent of FPL, and for AWDC, the state may reduce or eliminate the eligibility group entirely.

In 2010, the federal government adopted the Patient Protection and Affordable Care Act (ACA), which sets forth a number of requirements that affect Medicaid. Among its many provisions and beginning in 2014, ACA requires states to increase the upper income limit or expand eligibility for Medicaid to 133 percent of FPL or $14,856 for an individual and $30,657 for a family of four in 2013. For the first three years, the federal government will pay the cost of expanding eligibility. Beginning in FY 2016-17, the federal government will reduce its share gradually until, in 2020, it covers 90 percent of expansion costs. Colorado's Medicaid program has several eligibility groups; the children and pregnant women groups already use the 133 percent of FPL limit.

House Bill 09-1293 authorized the state to collect hospital provider fees (cash funds), in part, to increase Medicaid eligibility for certain "optional groups." This includes expanding coverage for parents from the existing 60 percent to 100 percent of FPL and, to the extent money is available, providing coverage to AWDC with incomes of up to 100 percent of FPL. Hospital provider fee revenue is also currently used to:

provide expanded eligibility in the CHP+ program from 205 percent of FPL to 250 percent of FPL;

provide a Medicaid buy-in program for disabled adults and children from families with incomes of up to 450 percent of FPL, which is in the process of being implemented;

provide reimbursements to hospitals as provider payments and quality incentive payments;

increase safety-net provider payments under the Colorado Indigent Care Program to 100 percent of costs; and

pay administrative costs.

Under current law, hospital provider fee revenue may also be used to provide 12 months of continuous eligibility for children in Medicaid, which has not yet been implemented. The Department of Health Care Policy and Financing (HCPF) has only partially implemented the expansion of Medicaid authorized in current law under HB09-1293. Parents are currently funded at 100 percent FPL. For AWDC, as of January 1, 2013, HCPF has expanded enrollment to 10 percent of FPL, and enrollment is capped at 10,000 individuals. Beginning in April 2013, HCPF plans to enroll 3,000 persons from the AWDC waitlist and, as funding permits, enroll 1,250 persons each subsequent month through September 2013.

In 2012, the United States Supreme Court ruled that states must be able to choose whether to participate in the Medicaid expansion under ACA. The federal Centers for Medicare and Medicaid Services has provided guidance to states that newly eligible groups enrolled after March 2010, when ACA became law, are also eligible for the enhanced federal matching funds. However, to take advantage of these funds for these existing groups, states must agree to fully implement expansion of Medicaid eligibility to 133 percent of FPL. This ruling allows the state to finish implementing Medicaid expansions for AWDC to 100 percent of FPL with federal funding if it chooses to expand eligibility for both parents and AWDC from between 101 percent and 133 percent of FPL. If this occurs, the state will be able to refinance costs for parents with incomes between 61 percent and 100 percent of FPL and all of the currently enrolled AWDC clients because these groups are considered to be "newly eligible" and were enrolled after ACA took effect.

Speaker Ferrandino responded to questions from the committee regarding the hospital provider fee, the decision to expand the program legislatively rather than by executive order, the potential fiscal impact of the bill, and the number of Medicaid providers needed to serve the expanded population.

05:04 PM -- Cody Belzley, representing the Colorado Children's Campaign, testified in support of the bill. She read testimony from Tish Barber, a mother from Montrose, who was unable to attend the committee hearing. Ms. Belzley responded to questions about the number of people who would be covered by the expansion.

05:08 PM -- Moe Keller, representing Mental Health America Colorado, testified in support of the bill. She discussed the cost of emergency room care to the states and private insurance.

05:14 PM -- John Gardner, representing the Yuma District Hospital, testified in support of the bill. He discussed how uninsured care creates bad debt for hospitals, and that preventative care leads to less emergency room care. He responded to questions from the committee regarding uninsured care debt collection, the hospital provider fee, and Medicaid referrals.

05:22 PM -- Steven Summer, representing the Colorado Hospital Association, testified in support of the bill. He responded to questions from the committee about whether it was possible to raise the hospital provider fee rather than expanding Medicaid.

05:27 PM -- Travis Berry, representing the Colorado Competitive Council, testified in support of the bill. He stated that the cost of uninsured care is currently borne through private health insurance premiums and the expansion makes this cost-sharing transparent.

05:30 PM -- Marc Reece, representing the Colorado Association of Health Plans, testified in support of the bill. He stated that the bill addresses the health care system as a whole.

05:32 PM -- Patrick Boyle, representing the Colorado Group Insurance Association, testified in support of the bill.

05:33 PM -- Dr. Jeff Sankoff, representing himself as an emergency room doctor, testified in support of the bill. He stated that the Colorado Medical Society and the Colorado Association of Family Physicians supports the bill. A letter of support from the Bell Policy Center was distributed to the committee (Attachment G).

130423 AttachG.pdf

05:35 PM

Speaker Ferrandino concluded his presentation on Senate Bill 13-200. He responded to committee questions regarding various studies on Medicaid expansion, Colorado's return on investment of federal tax dollars, and the estimated number of jobs that may be created due to the expansion.


BILL:	SB13-200
TIME:	05:35:54 PM
MOVED:	Young
MOTION:	Refer Senate Bill 13-200 to the Committee on Appropriations. 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

05:46 PM -- House Joint Resolution 13-1023

Representatives Gardner and Young, co-prime sponsors, presented House Joint Resolution 13-1023 concerning the guiding principles for redesigning Colorado's long-term care services and supports system. The resolution states that it is in the best interests of the state of Colorado and the General Assembly that a redesign of the long-term services and supports system be based on person-centered and self-direction values and principles.

Representatives Gardener and Young distributed to the committee and discussed amendments L.001 and L.002 (Attachments H and I).

130423 AttachH.pdf

130423 AttachI.pdf


BILL:	HJR13-1023
TIME:	05:56:27 PM
MOVED:	Young
MOTION:	Adopt amendment L.001 (Attachment H). 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


BILL:	HJR13-1023
TIME:	05:56:56 PM
MOVED:	Young
MOTION:	Adopt amendment L.002 (Attachment I). 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


BILL:	HJR13-1023
TIME:	05:59:08 PM
MOVED:	Young
MOTION:	Refer House Joint Resolution 13-1023, 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

06:01 PM -- Senate Bill 13-205

Representatives Gardner and Young, co-prime sponsors, presented Senate Bill 13-205 concerning revisions to the Colorado Medicaid False Claims Act to comply with federal law. This bill makes a number of technical changes to align the Colorado Medicaid False Claims Act with the federal False Claims Act in order to qualify for an additional share of state recoveries for false or fraudulent Medicaid claims. Among these changes, the bill requires that civil penalties be calculated in accordance with federal law and increases the range for penalties to between $5,500 and $11,000 from the current levels of between $5,000 and $10,000. Depending on the facts of the case, the bill also provides for variable time frames in the statute of limitations for a plaintiff who believes he or she was retaliated against following a qui tam (whistleblower) action. Under the bill, a private action for retaliation may not be brought more than three years after the date when the retaliation occurred.

Under current law, as enacted in Senate Bill 10-167, anyone who knowingly submits a false Medicaid claim or intends to defraud the state or a political subdivision is liable for up to three times the amount of damages, the costs of civil action, and a civil penalty of between $5,000 and $10,000. Persons who are ineligible to receive state funds and report receiving such funds to the Attorney General within 30 days may be liable for two times the amount of damages and no civil penalty, provided certain conditions are met.

Because most costs for Medicaid are split equally between the state and the federal government, state recoveries for false or fraudulent claims are also split. The federal Deficit Reduction Act (DRA) allows a state to retain an additional 10 percent of the recoveries if the state's law is at least as effective as federal law in rewarding and facilitating whistleblower actions. If the Colorado Medicaid False Claim Act were in compliance with federal standards, the state would receive 60 percent of most recoveries, rather than the current 50 percent.

The DRA charges the Inspector General's Office of the federal Department of Health and Human Services (HHS) with determining whether a state's law meets federal standards. Following the enactment of SB10-167, the state requested approval from HHS. In two separate letters to the state, HHS cited nine areas of Colorado's law as being noncompliant with federal standards. This bill seeks to address those concerns in order to obtain HHS approval.

06:07 PM -- George A. Codding, Colorado Office of the Attorney General, testified in support of the bill. He discussed the 2010 False Claims Act and noted that the revisions in the bill are necessary to be in compliance with federal standards. He responded to questions regarding federal whistleblower laws and the estimated recoveries.

06:14 PM -- Keith Cross, representing the Colorado Trial Lawyers Association, testified in support of the bill. He discussed recent Medicaid false claims cases and the amount of damages the state would have received had it been in compliance with federal standards.

06:21 PM

Representatives Gardener and Young concluded their presentation on Senate Bill 13-205.


BILL:	SB13-205
TIME:	06:22:00 PM
MOVED:	Young
MOTION:	Refer Senate Bill 13-205 to the Committee on Finance. The motion passed on a vote of 13-0.
SECONDED:	McCann
		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

06:24 PM -- House Joint Resolution 13-1028

Representatives Young and May, co-prime sponsors, presented House Joint Resolution 13-1028 concerning the creation of an interim committee to study the system of long-term services. This joint resolution creates a legislative interim committee to address long-term care and support services, to review that topic, and potentially propose bills. The Long-Term Services Interim Committee may solicit and accept reports from the Colorado Living Advisory Group, along with public testimony, to consider regulatory and statutory changes on the issue of redesigning the state's system of long-term care and support services in the state. The committee consists of 8 members of the General Assembly, 4 from each chamber, who must be selected within 45 days after the effective date of this resolution. The committee is authorized to meet no more than 6 times during the legislative interim in October.

06:33 PM

Representatives May and Young concluded their presentation on House Joint Resolution 13-1028. Representative Young distributed and described amendment L.001 (Attachment J).

130423 AttachJ.pdf


BILL:	HJR13-1028
TIME:	06:33:06 PM
MOVED:	Young
MOTION:	Adopt amendment L.001 (Attachment J). 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


BILL:	HJR13-1028
TIME:	06:33:51 PM
MOVED:	Young
MOTION:	Refer House Joint Resolution 13-1028, as amended, to the Legislative Council Committee. The motion passed on a vote of 12-0 with one member excused.
SECONDED:	May
		VOTE
	Conti	Yes
	Everett	Yes
	Joshi	Yes
	Landgraf	Yes
	May	Yes
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Excused
	Tyler	Yes
	Wilson	Yes
	Young	Yes
	Primavera	Yes

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

06:35 PM

The committee adjourned.