House Committee on Health, Insurance & Environment (02/14/2013)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH, INSURANCE & ENVIRONMENT

Date:	02/14/2013	ATTENDANCE

Time:	01:35 PM to 07:41 PM	Conti	X
		Fields	*
Place:	HCR 0107	Ginal	X
		Humphrey	X
This Meeting was called to order by		Joshi	X
	Representative Schafer	Primavera	X
		Stephens	*
This Report was prepared by		Swalm	X
	Amanda King	Young	X
		Schafer	X
		McCann	*
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB13-1155 HB13-1158 HB13-1111		Referred to Appropriations Amended, Referred to the Committee of the Whole Amended, Referred to Finance

01:36 PM -- House Bill 13-1155

Representative Gerou presented House Bill 13-1155, concerning revision of the condition precedent upon which the transfer authorized by House Bill 12-1268 are contingent. The bill makes the interdepartmental transfer of staff responsibilities for the life safety code inspections of health facilities contained in House Bill 12-1268 contingent upon approval from the Secretary of the federal Department of Health and Human Services. Staff will be transferred from the Department of Public Health and Environment to the Department of Public Safety. Specifically, the bill indicates that the Department of Public Safety requested and received approval from the federal Department of Health and Human Services to transfer life safety code inspection responsibilities from the Department of Public Health and Environment to the Department of Public Safety and amends the effective date requirements for House Bill 12-1268 to require the Department of Public Safety to notify the Revisor of Statutes that the federal Department of Health and Human Services approved the request to transfer inspection functions.

01:40 PM -- Paul Cooke, Division of Fire Prevention and Control within the Department of Public Safety, testified in support of the bill. Mr. Cooke discussed the documents in the packet of information he provided to the committee (Attachment A).

130214 AttachA.pdf

01:46 PM -- Nancy McDonald, Department of Public Health and Environment, testified in support of the bill. Ms. McDonald responded to questions from Representative Primavera about plan review fees and licensing fees.

01:51 PM -- Ginny Brown, Colorado Hospital Association, testified in support of the bill. She expressed concerns about the lack of response from the Department of Public Health and Environment about certain financial information.

01:53 PM

Representative Gerou provided concluding remarks on the bill.


BILL:	HB13-1155
TIME:	01:56:18 PM
MOVED:	Primavera
MOTION:	Refer House Bill 13-1155 to the Committee on Appropriations. The motion passed on a vote of 10-0, with one member excused.
SECONDED:	Ginal
		VOTE
	Conti	Yes
	Fields	Yes
	Ginal	Yes
	Humphrey	Yes
	Joshi	Yes
	Primavera	Yes
	Stephens	Yes
	Swalm	Yes
	Young	Yes
	Schafer	Yes
	McCann	Excused

Final YES: 10 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS

01:57 PM

The committee took a brief recess.

02:05 PM -- House Bill 13-1158

The committee came back to order. Representative Hamner presented House Bill 13-1158, concerning the Cottage Foods Act. The bill amends the Colorado Cottage Foods Act to exempt home kitchen food producers from regulation under the Farm Products Act. This bill allows egg producers to sell up to 250 dozen whole eggs per month without holding a dealer's license. Finally, the bill clarifies that, rather than being certified in safe food handling and processing, home kitchen food producers must take a food safety and sanitation course provided by a third party, comparable to and including classes given by the Colorado State University Extension Service, or a state, county, or district public health agency. Producers must maintain a status of good standing in accordance with the course requirements, including attending additional classes if necessary. Representative Hamner provided a handout about House Bill 13-1158 to the committee (Attachment B).

130214 AttachB.pdf

02:09 PM -- Monica Wiitanen, representing herself, testified in support of the bill. She listed the organizations she is affiliated with that are supporting the bill. She described her experience as a home kitchen food producer. Ms. Wiitanen responded to questions from the committee about the required classes for home kitchen food producers.

02:16 PM -- Ed Bowditch, Rocky Mountain Farmers Union, testified in support of the bill.

02:18 PM -- Nicholas Colglazier, Colorado Farm Bureau, testified in support of the bill.

02:19 PM

Representative Hamner explained amendment L.002 (Attachment C). Chuck Brackney, Office of Legislative Legal Services, came to the table to respond to questions from the committee about amendment L.002. Representative Hamner made concluding remarks about the bill.

130214 AttachC.pdf


BILL:	HB13-1158
TIME:	02:20:23 PM
MOVED:	Swalm
MOTION:	Adopt amendment L.002 (Attachment C). The motion passed without objection, with one member excused.
SECONDED:	Conti
		VOTE
	Conti
	Fields
	Ginal
	Humphrey
	Joshi
	Primavera
	Stephens
	Swalm
	Young
	Schafer
	McCann	Excused

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

02:21 PM

The committee took a brief recess.

02:26 PM

The committee came back to order.


BILL:	HB13-1158
TIME:	02:27:24 PM
MOVED:	Young
MOTION:	Refer House Bill 13-1158, as amended, to the Committee of the Whole. The motion passed on a vote of 11-0.
SECONDED:	Swalm
		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

02:33 PM -- House Bill 13-1111

Representative Ginal presented House Bill 13-1111, concerning the regulation of naturopathic doctors. The bill creates a licensing program for naturopathic doctors in the Division of Professions and Occupations in the Department of Regulatory Agencies and creates the seven-member Board of Naturopathic Medicine to regulate naturopathic doctor practice. Beginning January 1, 2014, only individuals properly licensed may use the title "naturopathic doctor" or otherwise represent themselves as such. The licensing program is repealed September 1, 2019, following a sunset review. Amendments L.003, L.004, L.005, and L.007 (Attachments D to G) were distributed to the committee. Amendment L.003 is a strike-below amendment. Representative Ginal referenced a packet of information that was distributed to the committee prior to the meeting (Attachment H). She provided copies of several naturopathic doctor certificates (Attachments I to R) and a naturopathic medical education comparative curricula document (Attachment S). Representative Ginal discussed issues concerning medical malpractice as it relates to naturopathic doctors and the education of naturopathic doctors.

130214 AttachO.pdf

130214 AttachS.pdf

02:44 PM

Christy Chase, Office of Legislative Legal Services, explained amendments L.003, L.004, L.005, and L.007. Ms. Chase responded to questions from the committee about the amendments.

02:57 PM -- Dr. Denise Clark, Colorado Association of Naturopathic Doctors, testified in support of the bill. She discussed the changes that potential amendments would make to the bill.

03:02 PM -- Dr. Julie Barter, Colorado Association of Naturopathic Doctors, testified in support of the bill. She read from several letters from medical doctors and doctors of osteopathic medicine in support of the bill. Dr. Barter discussed her experience treating a patient after the patient was treated by a naturopathic doctor who would not of meet the criteria outlined in the bill.

03:09 PM -- Dr. Steve Rissman, Colorado Association of Naturopathic Doctors, testified in support of the bill. He discussed the accreditation process for naturopathic medical programs and the education of naturopathic doctors.

03:17 PM

Dr. Rissman responded to a question from Representative Primavera about the schools offering naturopathic medical programs. Dr. Clark responded to questions from the committee about malpractice insurance and the scope of practice of naturopathic doctors. Dr. Barter responded to questions about the stakeholders involved in drafting the bill. Representative Ginal commented on the titles being used by naturopathic practitioners. Dr. Rissman responded to questions from the committee about naturopathic doctor working relationship with medical physicians.

03:25 PM -- Dr. Roann Rouse, Colorado Association of Naturopathic Doctors, testified in support of the bill. She described her experience practicing as a naturopathic doctor. Dr. Rouse responded to questions from the committee about the reimbursements she receives for her services, how she notifies her patients about her qualifications, and how the bill could create clarity about naturopathic doctors. Dr. Rouse continued to respond to questions from the committee. Dr. Clark returned to the table to respond to questions about how Affordable Care Act effects naturopathic doctors. Dr. Rouse and Dr. Clark continued to respond to questions from the committee.

03:52 PM -- Dino Ioannides, Department of Regulatory Agencies, testified on the bill. Mr. Ioannides discussed the difference between licensure and registration for professions. Mr. Ioannides responded to questions from the committee about whether a sunrise report would be warranted and the impact of the potential amendments on the fiscal note.

04:00 PM -- Robert Goodman, Institute of BioEnergetic Medicine School of Acupuncture, testified against the bill. He expressed concerns about the confusion the bill may create. Mr. Goodman responded to questions from the committee about the licenses he holds and malpractice insurance.

04:04 PM -- Robert Clark, Institute of BioEnergetic Medicine School, testified against the bill. He discussed patient safety. Dr. Clark responded to questions from Representative Conti.

04:12 PM -- Carol Cochrane, representing herself, testified against the bill.

04:19 PM -- Zach Zaslow, Children's Hospital Colorado, testified in a neutral capacity on the bill. He said his concerns are addressed by proposed amendments L.003 and L.004. Mr. Zaslow responded to a question from Representative Conti.

04:21 PM -- Dr. Mark Johnson, Colorado Medical Society and Institute for Science in Medicine, testified against the bill. He discussed the concerns of the Colorado Medical Society about the director model for registration, the advisory council created by amendment L.003, disclosure requirements, and some of the definitions used in the bill. He encourage a sunrise review for naturopathic practitioners. Dr. Johnson responded to questions from the committee. The committee continued to dialogue with Dr. Johnson.

04:36 PM -- Dr. Denise Clark returned to the table to respond to Dr. Johnson's testimony. Dr. Johnson continued to respond to committee questions about naturopathic practitioners and stakeholder involvement in the drafting of the bill. Dr. Johnson discussed homeopathy practices.

04:56 PM -- Donna Walter, Colorado Concerned Naturopaths, testified against the bill. Ms. Walter discussed medical malpractice, health savings accounts, and the lack of a grandfather clause in the bill for existing naturopathic practitioners. Ms. Walter responded to questions from the committee.

05:01 PM

Dr. Rouse returned to the table to discuss malpractice insurance with the committee.

05:04 PM -- Ben Lipman, representing himself, testified against the bill.

05:08 PM -- Larry Sarner, Colorado Citizens for Science in Medicine, testified against the bill. He discussed the practice of medicine versus naturopathy.

05:11 PM -- Darrell Kutchin, representing himself, testified against the bill. He discussed concepts of the healing process. Mr. Kutchin responded to questions from the committee about the American Naturopathic Certification Board and whether the bill would limit his practice.

05:18 PM -- Linda Rosa, Institute for Science in Medicine, testified against the bill. She discussed a book by Joseph Pizzorno of Bastyr University and naturopathic views of childhood vaccinations. Ms. Rosa responded to questions from Representative Young about the Institute for Science in Medicine. She provided a handout to the committee (Attachment T).

130214 AttachT.pdf

05:24 PM -- Maureen Maker, Colorado Citizens for Science in Medicine, testified against the bill. She discussed potential exploitation of cancer patients.

05:28 PM -- Janice Kerschner and Nate Gorman, Colorado Sunshine Health Freedom Foundation, testified against the bill. Mr. Gorman distributed a portion of the 2008 Sunrise Review: Naturopathic Physicians (Attachment U). Ms. Kerschner and Mr. Gorman responded to questions from the committee about the Colorado Sunshine Health Freedom Foundation and potential amendments to the bill.

130214 AttachU.pdf

05:40 PM -- Kimberly Sharples and Sheryl Strom, Colorado Coalition for Natural Health, testified against the bill. Ms. Sharples and Ms. Strom responded to questions from the committee about the Colorado Coalition for Natural Health and whether natural health practitioners are practicing illegally.

05:52 PM -- Paul Bloede, representing himself, testified against the bill. He discussed the lack of protection in the bill for Reiki Masters and other natural health practitioners. Mr. Bloede responded to a question from Representative Young about Reiki.

05:57 PM -- Dr. William Blanchet, representing himself, testified in support of the bill. He discussed consumer protection and treatment for heart disease by naturopathic practitioners.

06:01 PM -- James Knight, representing himself, testified in support of the bill. He discussed his experience being treated by a naturopathic doctor. Mr. Knight responded to a question from Representative Stephens about the disclosures provided by his naturopathic doctor.

06:03 PM -- Dr. Gretchen Frey, representing herself, testified in support of the bill. She discussed the collaborative relationships she has with naturopathic doctors. Dr. Fry responded to a question from the committee about her involvement with the Colorado Medical Society and licensure versus registration for naturopathic doctors.

06:08 PM -- Chris Amenson, representing himself, testified in support of the bill. He discussed his experience with both medical and naturopathic doctors.

06:12 PM -- Barbara Metcalf, representing herself, testified in support of the bill. She discussed her experience researching various medical providers.

06:15 PM -- Rob Cagen, representing himself, testified in the support of the bill. He discussed practicing as naturopathic doctor in Arizona and his decision to cease practicing when he moved to Colorado. Mr. Cagen responded to questions from Representative McCann about the licensing process in Arizona.

06:20 PM -- Dr. Lorraine Caron, representing Colorado Association of Naturopathic Doctors, testified in support of the bill. She discussed why naturopathic doctors do not become physician's assistants or medical doctors and why many naturopathic doctors reference being primary care providers on their websites.

06:23 PM -- Michael Mastrodonato, representing himself, testified in support of the bill. Mr. Mastrodonato responded to questions from the committee about his experience with naturopathic and medical doctors. Representative Ginal responded to questions from Representative Swalm about whether naturopathic practitioners are currently practicing illegally.

06:31 PM -- Dr. Mary Rondeau, Colorado Association of Naturopathic Doctors, testified in support of the bill. She discussed the integrated clinic where she practices and read from a letter from a physician with whom she works.

06:34 PM -- Dr. Rhonda Marcus, Colorado Association of Naturopathic Doctors, testified in support of the bill. She read a letter from one of her patients.

06:37 PM -- Donnah Moody, Colorado Coalition for Natural Health, testified against the bill. Ms. Moody responded to questions from Representative Schafer about how to address the right to practice for various natural health practitioners. Representative Ginal responded to questions from the committee about the communication with various stakeholders about the potential amendments. The committee continued to dialogue with Ms. Moody and Representative Ginal about how the concerns expressed by the opponents could be addressed, issues concerning the right to practice of various natural health practitioners, and the possible impact of potential amendments to the bill.

06:52 PM -- Mary Amenson, representing herself, testified in support of the bill. She discussed her experience with medical and naturopathic providers.

06:56 PM -- Dr. Mark Carney, Colorado Association of Naturopathic Doctors, testified in support of the bill. He discussed doctors of osteopathic medicine, the use of evidence-based medicine, and regulation of natural health practitioners in other states. Dr. Carney responded to questions from the committee about his education.

07:03 PM

The committee took a brief recess.

07:19 PM

The committee came back to order. Christy Chase, Office of Legislative Legal Services, explained amendment L.005 (Attachment F).


BILL:	HB13-1111
TIME:	07:21:08 PM
MOVED:	Ginal
MOTION:	Adopt amendment L.005 (Attachment F). The motion passed without objection.
SECONDED:	Schafer
		VOTE
	Conti
	Fields
	Ginal
	Humphrey
	Joshi
	Primavera
	Stephens
	Swalm
	Young
	Schafer
	McCann

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

07:21 PM

Ms. Chase explained amendment L.004 (Attachment E).


BILL:	HB13-1111
TIME:	07:22:01 PM
MOVED:	Ginal
MOTION:	Adopt amendment L.004 (Attachment E). The motion passed without objection.
SECONDED:	Young
		VOTE
	Conti
	Fields
	Ginal
	Humphrey
	Joshi
	Primavera
	Stephens
	Swalm
	Young
	Schafer
	McCann

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

07:22 PM

Representative Ginal provided concluding remarks on the bill. The committee continued to discuss the bill.


BILL:	HB13-1111
TIME:	07:37:49 PM
MOVED:	Ginal
MOTION:	Adopt amendment L.003 (Attachment D), as amended. The motion passed on a vote of 8-3.
SECONDED:	Young
		VOTE
	Conti	Yes
	Fields	Yes
	Ginal	Yes
	Humphrey	No
	Joshi	No
	Primavera	Yes
	Stephens	Yes
	Swalm	No
	Young	Yes
	Schafer	Yes
	McCann	Yes
YES: 8 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS


BILL:	HB13-1111
TIME:	07:38:27 PM
MOVED:	Ginal
MOTION:	Refer House Bill 13-1111, as amended, to the Committee on Finance. The motion passed on a vote of 8-3.
SECONDED:	Young
		VOTE
	Conti	Yes
	Fields	Yes
	Ginal	Yes
	Humphrey	No
	Joshi	No
	Primavera	Yes
	Stephens	Yes
	Swalm	No
	Young	Yes
	Schafer	Yes
	McCann	Yes
Final YES: 8 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS

07:41 PM

The committee adjourned.