House Committee on Public Health Care & Human Services (04/15/2014)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON PUBLIC HEALTH CARE & HUMAN SERVICES

Date:	04/15/2014	ATTENDANCE

Time:	01:31 PM to 05:37 PM	Conti	X
		Everett	X
Place:	HCR 0107	Ginal	X
		Joshi	X
This Meeting was called to order by		Landgraf	E
	Representative Primavera	McCann	X
		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:
HB14-1360 HB14-1358 HB14-1357 HB14-1368 HB14-1362		Amended, Referred to Finance Referred to Appropriations Amended, Referred to Appropriations Referred to Appropriations Referred to the Committee of the Whole

01:33 PM -- HB14-1368

Representatives May and Gerou introduced House Bill 14-1368. The bill establishes a plan and appropriates funds to transfer youths who are 18 to 20 years of age and who have intellectual and developmental disabilities (IDD) into adult services under Medicaid home- and community-based services (HCBS) in the Department of Health Care Policy and Financing. Representative May provided background information on the bill and discussed how the youth affected by the bill currently receive services through the child welfare system. The bill sets forth criteria for transition planning and instructs the State Board of Human Services and the Medical Services Board to promulgate any rules necessary to guide the transition. Representative May responded to questions from the committee regarding the appropriations required by the bill.

01:39 PM -- Jodi Walters, Imagine!, Alliance, and Foster Care Adoption Agencies of Colorado, testified in support of the bill. She stated that there is a lack of trained providers to serve children with IDD in the child welfare system, and that many of the children with IDD currently served in the child welfare system shouldn't have been there in the first place. She stated that the goal is to eventually move the entire population of children with IDD from the child welfare system.

01:42 PM -- Marijo Rymer, Arc of Colorado, testified in support of the bill. She spoke regarding the bill's provisions that allow for flexibility regarding the transition of youth from the child welfare system to adult HCBS services. She spoke regarding the practice in which a family with a child with IDD must relinquish the child to the child welfare system in order for the child to receive services.

01:46 PM -- Emily Blanford, Department of Health Care Policy and Financing, testified in support of the bill. She spoke regarding the process the department used to identify the individuals with IDD who are in the child welfare system.

01:48 PM -- Andrew Johnson, Department of Human Services, responded to questions from the committee regarding how many children aged 18 to 20 with IDD are in the child welfare system.

01:51 PM

Representative May gave concluding remarks regarding the bill.


BILL:	HB14-1368
TIME:	01:51:52 PM
MOVED:	Young
MOTION:	Refer House Bill 14-1368 to the Committee on Appropriations. The motion passed on a vote of 12-0, with one member excused.
SECONDED:	Singer
		VOTE
	Conti	Yes
	Everett	Yes
	Ginal	Yes
	Joshi	Yes
	Landgraf	Excused
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Yes
	Tyler	Yes
	Wilson	Yes
	Young	Yes
	Primavera	Yes

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

01:54 PM -- HB14-1360

Representative Young introduced House Bill 14-1360. The bill implements the recommendations of the Sunset Review of the Licensing of Home Care Agencies, which the committee considered on April 1, 2014. Representative Young described the provisions of the bill and distributed amendments L.001, L.002, and L.003 (Attachments A through C). The bill continues the regulation of home care agencies and home care placement agencies until September 1, 2019, and:

clarifies that owners, managers, and administrators must obtain a criminal history record check when applying for a home care agency license or a home care placement agency (placement agency) registration;
identifies a list of convictions that will disqualify an applicant from employment at a home care agency or placement agency;
directs the State Board of Health to set fees for the direct and indirect costs of the department's oversight of placement agencies, and to promulgate rules for agencies to consider in determining disqualifying crimes for providers and rules regarding placement agency record retention and inspection;
authorizes the Department of Public Health and Environment (CDPHE) to inspect home care placement agencies and to remove home care placement agencies from the registry for noncompliance; and
excludes programs of all-inclusive care for the elderly (PACE) regulated by the Department of Health Care Policy and Financing (HCPF) from the definition of home care agencies, but requires the CDPHE to coordinate with HCPF regarding the regulation of PACE providers.

14HsePHS0415AttachA.pdf

14HsePHS0415AttachB.pdf

14HsePHS0415AttachC.pdf

02:06 PM -- Randy Kirkendall, CDPHE, testified in support of the bill, but noted that the department wants to continue to refine some portions of the bill.

02:08 PM -- Suzanne Brennen, HCPF, explained the process of licensing Medicaid providers and how the HCPF works with CDPHE regarding licensing of home care providers. She noted that HCPF relies on CDPHE's licensure process and described the different roles of the departments in the licensing process. Representative Stephens commented on the FTE increase required by the bill. Mr. Kirkendall responded to questions from the committee regarding the composition of the work group created by L.001.

02:18 PM

Representative Young commented on the bill and noted that the Community Living Advisory Group is also looking at issues of duplication in the licensing of home care providers by the DPHE and HCPF. Mr. Kirkendall walked the committee through the provisions of L.001. He explained that amendment requires the State Board of Health to develop a methodology for establishing differentiating fees for licensure of community centered boards and service agencies, suspends temporarily from July 1, 2014 to July 1, 2016 the relicensure surveys for CCBs and service agencies that have been certified or recertified by HCPF within the last 12 months, and ensures that new agencies seeking licensure will continued to be surveyed.

Mr. Kirkendall explained the provisions of amendment L.003, which provides that the DPHE shall not assess fees between July 1, 2014, and July 1, 2016, for a new or renewal home care agency license issued to a community centered board or service agency, and provides that the department's costs for the licensing process will instead be paid from the Intellectual and Developmental Disabilities Services Cash Fund. Mr. Kirkendall noted that the CDPHE will continue to investigate occurrences and complaints, even during the period of time when the survey process is suspended.

Amendment L.001 also establishes a work group to review the developmental disability (DD) services rules and to identify gaps or conflicts between the license requirements of CDPHE and those required of providers within the HCBS Medicaid waiver system. The work group must submit its recommendations by September 1, 2015, and the departments must adopt rules to resolve the conflicts and gaps identified by July 1, 2016. Finally, amendment L.001 requires the HCPF and CDPHE to report to the committees as part of the SMART Government Act their progress in analyzing and developing a plan to resolve conflicts and gaps in the requirements that apply to home care agencies.

02:32 PM -- Dave DeNovellis, Legislative Council Staff, responded to questions from the committee regarding the bill's fiscal note.

02:36 PM -- Marijo Rymer, Arc of Colorado, discussed the issues that were raised by DD service providers regarding the home care licensure process. She asked that the work group created by amendment L.001 be small, and that the proposed rule changes that emerge from the work group have the support of stakeholders before going before the State Board of Human Services and the State Board of Health. She stated that it is important to ensure that there are providers who can serve the DD population. She responded to questions from the committee.

02:46 PM -- Edie Busam, Home Care Association of America, addressed amendment L.002, which relates to home care placement agencies. Specifically, the amendment requires registration of home care placement agencies and requires agencies to obtain and maintain general liability insurance coverage for the agency and the providers the agency employs. Ms. Busam discussed issues related to fingerprint checks of various managers and employees of home care agencies. She responded to questions from the committee regarding home care placement agencies.

02:56 PM -- David Ervin, The Resource Exchange and Alliance, testified in support of amendment L.001 and discussed the regulation of service providers in the DD community. He discussed the need to reduce duplication in the licensing of service providers in order to create more capacity in the DD service provider pool. He responded to questions from the committee regarding his organization's support for amendments L.001 and L.003.

03:07 PM -- Ellen Caruso, Home Care Association of Colorado, testified regarding the services provided by the members of her organization. She testified in support of amendments L.001 and L.002. She discussed the licensing fees and the history of how the licensing fees were determined.

03:12 PM -- Sonya Newmann, Centura Health, testified regarding the process of developing amendments to the bill to address the unique situations of the DD community and providers of PACE services, and stated that there needs to be consistent regulation of all home care providers. Ms. Caruso addressed statutory language that allows for different licensing requirements for various types of skilled home health and personal care services, including differentiating requirements for providers that are substantially funded through Medicare and Medicaid reimbursement.


BILL:	HB14-1360
TIME:	03:19:36 PM
MOVED:	Young
MOTION:	Adopt amendment L.002 (Attachment B). The motion passed without objection.
SECONDED:	Ginal
		VOTE
	Conti
	Everett
	Ginal
	Joshi
	Landgraf	Excused
	McCann
	Schafer
	Singer
	Stephens
	Tyler
	Wilson
	Young
	Primavera

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


BILL:	HB14-1360
TIME:	03:20:18 PM
MOVED:	Young
MOTION:	Adopt amendment L.003 (Attachment C). The motion passed without objection.
SECONDED:	Stephens
		VOTE
	Conti
	Everett
	Ginal
	Joshi
	Landgraf	Excused
	McCann
	Schafer
	Singer
	Stephens
	Tyler
	Wilson
	Young
	Primavera

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


BILL:	HB14-1360
TIME:	03:22:07 PM
MOVED:	Young
MOTION:	Adopt amendment L.001 (Attachment A). The motion passed without objection.
SECONDED:	Tyler
		VOTE
	Conti
	Everett
	Ginal
	Joshi
	Landgraf	Excused
	McCann
	Schafer
	Singer
	Stephens
	Tyler
	Wilson
	Young
	Primavera

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


BILL:	HB14-1360
TIME:	03:22:25 PM
MOVED:	Young
MOTION:	Refer House Bill 14-1360, as amended, to the Committee on Finance. The motion passed on a vote of 11-1, with one member excused.
SECONDED:	McCann
		VOTE
	Conti	Yes
	Everett	No
	Ginal	Yes
	Joshi	Yes
	Landgraf	Excused
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Yes
	Tyler	Yes
	Wilson	Yes
	Young	Yes
	Primavera	Yes

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

03:35 PM -- HB14-1358

Representative Young explained House Bill 14-1358, which implements the recommendations of the Sunset Review of In Home Support Services (IHSS). The committee previously considered the sunset review on April 1, 2014. Changes under the bill include extending HCBS waiver programs through September 1, 2019, and adding clients served through the Spinal Cord Injury Waiver Pilot Program as eligible for IHSS. Representative Joshi commented on the bill.

03:37 PM -- David Bolin, CLASP - an organization of service providers, testified in support of the bill and stated that IHSS provides an important option for individuals. He said that making clients served through the Spinal Cord Injury Waiver Pilot Program eligible for IHSS is an important issue.

03:39 PM -- Todd Slechta, People Care Health Services and Home Care Association of Colorado, testified that clients in rural areas are very dependent on the IHSS program and spoke in support of the bill.


BILL:	HB14-1358
TIME:	03:44:13 PM
MOVED:	Joshi
MOTION:	Refer House Bill 14-1358 to the Committee on Appropriations. The motion passed on a vote of 10-1, with one member excused.
SECONDED:	Young
		VOTE
	Conti	Excused
	Everett	No
	Ginal	Yes
	Joshi	Yes
	Landgraf	Excused
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Yes
	Tyler	Yes
	Wilson	Yes
	Young	Yes
	Primavera	Yes

Final YES: 10 NO: 1 EXC: 2 ABS: 0 FINAL ACTION: PASS

03:46 PM -- HB14-1357

Representative Young introduced House Bill 14-1357 and distributed amendment L.001 (Attachment D). The bill makes changes to the IHSS program, including allowing IHSS to be provided in the home or community, adding a spouse as an eligible family member who may act as an attendant providing IHSS services, clarifying that the eligible client is responsible for directing the provision of IHSS, giving an eligible client or his or her representative the ability to determine the amount of nurse oversight needed, allowing family members to be reimburse for providing IHSS, and expanding IHSS to persons receiving services through the Spinal Cord Injury Waiver Pilot Program. He responded to questions from the committee regarding the bill's fiscal note.

14HsePHS0415AttachD.pdf

03:54 PM -- Kevin Smith, representing himself, testified in support of the bill and regarding his experience receiving services through the IHSS program. He testified regarding his desire to participate in the Spinal Cord Injury Waiver Pilot Program.

04:00 PM -- David Bolin, CLASP - an organization of service providers and Accent on Independence, explained that the Consumer Directed Attendant Support Program in Medicaid has been expanded to be offered through all of the Medicaid HCBS waivers, and he's seeking a similar expansion of IHSS. He discussed the bill's fiscal note. He explained that currently individuals can receive home health services from a spouse and be reimbursed, but spouses cannot provide personal care services. Mr. Bolin explained that the current prohibition on spouses providing personal care services is restrictive and removing the prohibition will help with provider shortages in rural areas of the state. He gave examples of how individuals have utilized IHSS. He spoke in support of the bill and responded to questions from the committee.

04:12 PM -- Linda Skaflen, Arc of Adams County, testified in support of the bill and stated that individuals should have options and choices regarding their long-term care services. She stated that IHSS is not a program, but rather a care delivery model. She explained that the services that are provided through IHSS are carefully monitored, and highlighted the importance of allowing spouses to provide care to IHSS participants and allowing IHSS services to be provided in the community.

04:17 PM -- Todd Slechta, Home Care Association of Colorado, testified that his organization initially had concerns with the bill and spoke in support of amendment L.001 (Attachment D).

04:19 PM

Representative Young commented on the bill's fiscal note.

04:19 PM -- Josh Block, Department of Health Care Policy and Financing, discussed the revised information that the department has submitted regarding the fiscal note and the expected reduction in the bill's fiscal note. He explained that the bill's General Fund impact, as revised, will total around $400,000. He responded to questions from the committee.

04:22 PM -- Ryan Zeiger, CLASP - an organization of service providers, testified that HCPF has worked with stakeholders regarding the bill's fiscal note and discussed the specific assumptions contained in the department's fiscal analysis.


BILL:	HB14-1357
TIME:	04:25:18 PM
MOVED:	Young
MOTION:	Adopt amendment L.001 (Attachment D). The motion passed without objection.
SECONDED:	Singer
		VOTE
	Conti
	Everett
	Ginal
	Joshi
	Landgraf	Excused
	McCann
	Schafer
	Singer
	Stephens
	Tyler
	Wilson
	Young
	Primavera

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


BILL:	HB14-1357
TIME:	04:26:46 PM
MOVED:	Young
MOTION:	Refer House Bill 14-1357, as amended, to the Committee on Appropriations. The motion passed on a vote of 9-3, with one excused.
SECONDED:	Schafer
		VOTE
	Conti	Yes
	Everett	No
	Ginal	Yes
	Joshi	No
	Landgraf	Excused
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Yes
	Tyler	Yes
	Wilson	No
	Young	Yes
	Primavera	Yes

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

04:34 PM -- HB14-1362

Representative Moreno introduced House Bill 14-1362. The bill adds great-grandparents to the statutory provisions governing the visitation rights of grandparents and disputes concerning grandparent visitation.

04:38 PM -- Guillermo Serna, representing himself, testified in support of the bill and regarding his and his wife's experience raising their great-grandson and subsequent custody decisions regarding his great-grandson's care. He read the testimony of Mr. Jordan Fox in support of the bill.

04:51 PM -- Raquel Serna, representing herself, testified in support of the bill and regarding her personal experience raising her great-grandson.

04:56 PM -- Melinda Flores, representing herself, testified regarding her parents' experience raising their great-grandson and the subsequent custody decisions regarding the great-grandson's care. She spoke in support of the bill. Ms. Serna further commented on the bill.

05:01 PM -- Javier Serna, representing himself, testified in support of his grandparents' fight for visitation with their great-grandson and spoke in support of the bill.

05:05 PM -- Dorothy Macias, Office of the Child's Representative, responded to questions from the committee regarding the bill. She stated that expanded opportunities for visits with family members is good for children. She explained that a 2013 case ruled that the current grandparent visitation law did not encompass great-grandparents and this bill would align statute with the practice of allowing visitation with great-grandparents. She responded to questions from the committee regarding the opposition of the Colorado Bar Association to the bill and case law regarding grandparent visitation rights. Representative Moreno responded to questions from the committee regarding statutes governing the placement of children with great-grandparents.

05:19 PM -- Michael Valdez, Colorado Bar Association, testified regarding the association's objection to the bill and the association's preference that the bill's language be placed in Title 14, C.R.S., which governs child custody and domestic matters, rather than in Title 19, C.R.S., which concerns dependency and neglect of children. Representative Moreno commented on the process of drafting the bill. Mr. Valdez responded to questions from the committee.

05:25 PM -- Brita Darling, Office of Legislative Legal Services, came to the table to address committee questions regarding the drafting of the bill. She responded to questions from the committee regarding the placement of the grandparent visitation statute in Title 19, C.R.S., and whether statutes regarding the placement of children outside of the home could be amended to include great-grandparents.


BILL:	HB14-1362
TIME:	05:34:05 PM
MOVED:	Singer
MOTION:	Refer House Bill 14-1362 to the Committee of the Whole. The motion passed on a vote of 12-0, with one member excused.
SECONDED:	Everett
		VOTE
	Conti	Yes
	Everett	Yes
	Ginal	Yes
	Joshi	Yes
	Landgraf	Excused
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Yes
	Tyler	Yes
	Wilson	Yes
	Young	Yes
	Primavera	Yes

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

05:37 PM

The committee adjourned.