House Committee on Health, Insurance, & Environment (04/24/2014)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH, INSURANCE, & ENVIRONMENT

Date:	04/24/2014	ATTENDANCE

Time:	02:01 PM to 06:46 PM	Fields	*
		Ginal	X
Place:	HCR 0107	Humphrey	X
		Joshi	X
This Meeting was called to order by		Landgraf	X
	Representative McCann	McNulty	*
		Primavera	X
This Report was prepared by		Singer	*
	Amanda King	Swalm	X
		Schafer	X
		McCann	*
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
SB14-088 HB14-1386 SB14-173		Amended, Referred to Legislative Council Referred to the Committee of the Whole Referred to the Committee of the Whole

02:01 PM -- SB 14-088

Representative Kraft-Tharp presented Senate Bill 14-088. The bill creates a Suicide Prevention Commission (commission) to provide leadership and craft data-driven, evidence-based, and clinically informed recommendations on suicide prevention in Colorado. The commission is required to make recommendations to the governor's office, the Office of Suicide Prevention within the Department of Public Health and Environment (DPHE), and the General Assembly.

Within 60 days of the bill's effective date, the Executive Director of the DPHE will appoint no more than 25 members to the commission. The bill specifies the various sectors and professional backgrounds to be represented on the commission. Commission members will not be compensated for their time but may seek travel reimbursement. The DPHE will provide administrative support for the commission and will include its recommendations in an annual report submitted to the General Assembly.

Under the bill, the DPHE may accept gifts, grants, and donations from public and private entities to help finance the direct and indirect costs of the commission. All funds will be transferred to the Suicide Prevention Coordination Cash Fund. The commission is repealed on September 1, 2024.

02:05 PM -- Susan Marine, representing the Suicide Prevention Coalition of Colorado, testified in support of the bill. She discussed her personal losses to suicide and her organization. She stated that the bill creates a public-private partnership and will increase public awareness about suicide. She discussed the diversity of the commission's membership. Ms. Marine responded to questions about the Office of Suicide Prevention, Colorado's suicide rates, and the commission.

02:15 PM -- Jarrod Hindman, representing the DPHE, testified in support of the bill. He discussed the Office of Suicide Prevention. Mr. Hindman responded to questions about how the commission will interact with the Office of Suicide Prevention. Representative Kraft-Tharp stated the bill establishes a public-private partnership.

Mr. Hindman and Representative Kraft-Tharp responded to questions about the commission members. Mr. Hindman responded to questions about whether the model outlined in the bill has worked in other states. He discussed the 2012 National Strategy for Suicide Prevention and Colorado's suicide rates. Mr. Hindman responded to questions about whether demographic data of suicide victims is tracked, the suicide rate for seniors, and the grants provided by the Office of Suicide Prevention. Representative Kraft-Tharp further discussed the commission membership. Mr. Hindman responded to questions about the difference between the commission and the existing Suicide Prevention Coalition of Colorado, whether there will be a duplication of efforts to address suicide, and whether there are existing best practice models for suicide prevention.

02:39 PM

Mr. Hindman responded to questions about the bill's fiscal note. Representative Kraft-Tharp discussed Oregon's requirement for suicide prevention training for certain professionals. Mr. Hindman stated the commission would not be directly providing services in response to a question. Mr. Hindman responded to questions about how the commission would work with existing community suicide prevention organizations. Representative Kraft-Tharp responded to questions about the bill's fiscal note and the additional FTE created by the bill. Mr. Hindman responded to questions about the staff of the Office of Suicide Prevention and whether the bill will decentralize suicide prevention efforts. He responded to questions about the role of the commission, how the commission will be different from existing suicide prevention entities, how often the commission will meet, and the staffing for the commission.

02:50 PM -- Dr. Barbara Becker, representing Arapahoe/Douglas Mental Health Network, testified in support of the bill. She discussed how the commission will help address mental health needs in the state, community mental health centers, and the need for organized, data-driven, concentrated efforts.

02:55 PM -- Dr. Michael Allen, representing the Colorado Psychiatric Society and the Colorado Trust's Convening for Colorado Grant Program, testified in support of the bill. He discussed suicide-related statistics, why he believes government should be involved in suicide prevention efforts, and the role of the commission. Dr. Allen responded to questions about potential funding for the commission from private sources and the representatives on the commission. The committee continued to dialogue with Dr. Allen about suicide.

03:10 PM

Representative Kraft-Tharp explained amendment L.007 (Attachment A).

140424 AttachA.pdf


BILL:	SB14-088
TIME:	03:11:46 PM
MOVED:	Schafer
MOTION:	Adopt amendment L.007 (Attachment A). The motion passed without objection.
SECONDED:	Singer
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann

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

03:12 PM

Representative Kraft-Tharp explained amendment L.010 (Attachment B). She responded to questions about amendment L.010. Kristen Forrestal, Office of Legislative Legal Services, responded to questions about amendment L.010. The committee discussed amendment L.010 and the appointments to the commission.

140424 AttachB.pdf


BILL:	SB14-088
TIME:	03:19:59 PM
MOVED:	McNulty
MOTION:	Amend prepared amendment L.010, page 1, line 2, after "SENATE" insert "AND THE SPEAKER OF THE HOUSE OF REPRESENTATIVES SHALL JOINTLY" and after "MEMBER" insert "OF THE GENERAL ASSEMBLY". The motion passed without objection.
SECONDED:	McCann
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann

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


BILL:	SB14-088
TIME:	03:20:31 PM
MOVED:	Schafer
MOTION:	Adopt amendment L.010 (Attachment B), as amended. The motion passed without objection.
SECONDED:	Singer
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann
YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

03:20 PM

Representative McCann discussed changing the reference to co-chairpersons to executive director on page 5, line 12, of the reengrossed bill.


BILL:	SB14-088
TIME:	03:21:34 PM
MOVED:	McCann
MOTION:	Amend the reengrossed bill, page 5, line 12, strike "CO-CHAIRPERSONS" and substitute "EXECUTIVE DIRECTOR". The motion passed without objection.
SECONDED:	McNulty
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann
YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

03:20 PM

Representative McNulty and Representative Fields discussed cyber bullying. Representative Kraft-Tharp discussed amending the bill to include a representative from the school safety resource center with experience in cyber bullying. The committee discussed the representatives on the commission.


BILL:	SB14-088
TIME:	03:27:19 PM
MOVED:	McNulty
MOTION:	Amend the reengrossed bill, page 5, before line 9, insert "A REPRESENTATIVE FROM THE SCHOOL SAFETY RESOURCE CENTER WITH EXPERIENCE IN BULLYING, INCLUDING CYBER BULLYING; AND" and adjust the number of the commission members as appropriate. The motion passed without objection.
SECONDED:	Landgraf
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann

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

03:32 PM

Representative McNulty discussed amendment L.011 (Attachment C). The committee discussed amendment L.011.

140424 AttachC.pdf


BILL:	SB14-088
TIME:	03:33:07 PM
MOVED:	McNulty
MOTION:	Amend prepared amendment L.011, page 1, after line 4, insert "Renumber succeeding subparagraphs accordingly.". The motion passed without objection.
SECONDED:	Landgraf
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann

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

03:32 PM

The committee discussed amendment L.011 with Representative Kraft-Tharp. Representative Kraft-Tharp responded to questions about the length of the commission members' terms.


BILL:	SB14-088
TIME:	03:34:18 PM
MOVED:	McNulty
MOTION:	Adopt amendment L.011 (Attachment C), as amended. The motion passed without objection.
SECONDED:	Landgraf
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann

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

03:36 PM

Representative Fields explained amendment L.009 (Attachment D).

140424 AttachD.pdf


BILL:	SB14-088
TIME:	03:36:42 PM
MOVED:	Fields
MOTION:	Adopt amendment L.009 (Attachment D). The motion passed without objection.
SECONDED:	Schafer
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann

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

03:37 PM

The committee discussed the bill. Representative Kraft-Tharp made concluding remarks about the bill.


BILL:	SB14-088
TIME:	03:41:31 PM
MOVED:	Schafer
MOTION:	Refer Senate Bill 14-088, as amended, to the Legislative Council Committee. The motion passed on a vote of 8-3.
SECONDED:	Fields
		VOTE
	Fields	Yes
	Ginal	Yes
	Humphrey	No
	Joshi	No
	Landgraf	Yes
	McNulty	Yes
	Primavera	Yes
	Singer	Yes
	Swalm	No
	Schafer	Yes
	McCann	Yes

Final YES: 8 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS

03:42 PM

The committee took a brief recess.

03:52 PM -- HB 14-1386

Representative McCann called the committee back to order. Representative Kraft-Tharp and Representative Gardner presented House Bill 14-1386. The bill modifies the definitions of "gravely disabled" and "danger to self or others" and removes the requirement that danger to self or others be imminent. Representative Kraft-Tharp discussed a handout about the bill (Attachment E). Representative Kraft-Tharp responded to questions about Section 2 of the bill.

140424 AttachE.pdf

04:04 PM -- Dr. Patrick Fox, representing Office of Behavioral Health in the Department of Human Services, testified in support of the bill. He discussed the definitions in the civil commitment statutes concerning danger to self or others and gravely disabled. He discussed the terms "danger" versus "imminent danger" concerning civil commitments. Dr. Fox responded to questions about how long a civil commitment would last, how many people with mental illness participated in the 2013 Civil Commitment Task Force, and the impact of not enacting House Bill 14-1386. Representative Gardner dialogued with Dr. Fox as to whether additional civil commitments will occur with the passage of House Bill 14-1386 and how the civil commitment definitions are applied. Dr. Fox responded to questions about task force's work on the definitions, the lack of consistent interpretations of the term "imminent" between jurisdictions, and what definitions other states use related to civil commitments. Representative Kraft-Tharp described an incident with a former client.

04:22 PM -- Aubrey Ellen Shomo, representing herself, testified against the bill. She discussed the removal of the word "imminent" from term "imminent danger" and the proposed definition of "gravely disabled." She discussed the 2013 Civil Commitment Task Force and suggested establishing another task force. Ms. Shomo responded to questions about whether she participated on the 2013 Civil Commitment Task Force. She discussed her experience with emergency procedures and responded to questions about the use of police force in certain circumstances. Representative Kraft-Tharp and Ms. Shomo discussed the Behavioral Health Transformation Council.

04:33 PM -- Renee Ryan, representing herself, testified against the bill. She discussed her experience working at the Colorado Mental Health Institute at Fort Logan and her concerns about expanding the definitions concerning civil commitments. She stated it is dangerous to marginalize a population. Ms. Ryan responded to questions about whether the bill clarifies or expands the definitions. She stated that she does not believe that there is a problem with the current definitions, but that there is a problem with that lack of services and the lack of oversight.

04:46 PM -- Mark Ivandick, representing The Legal Center for People with Disabilities, testified against the bill. He discussed the Protection and Advocacy for Individuals with Mental Illness Program. Mr. Ivandick discussed emergency holds, his participation in the 2013 Civil Commitment Task Force, and his objections to changing the definition of "danger to self or others." He discussed civil commitments and the 2013 Civil Commitment Task Force Report. He stated that the task force did not make a recommendation about deleting the word "imminent" from Section 27-65-105, C.R.S. Representative Kraft-Tharp asked Mr. Ivandick to send her the information he discussed concerning the 9th Circuit Court of Appeals. Mr. Ivandick responded to questions about situations in which someone may be placed on an emergency hold, the task force's recommendations, and whether the bill was constitutional. Mr. Ivandick and Representative McCann discussed the bill. Representative Kraft-Tharp mentioned Utah's enactment of the Susan Gall Involuntary Commitment Amendments.

05:14 PM -- Nita Bradford, representing herself, testified on the bill. She expressed her concerns about the confusion the bill may create for families, law enforcement, and mental health professionals. Ms. Bradford and Representative McCann discussed the language in the bill and when certain provisions would go into effect. She discussed the use of the term "appears" in the bill and her other concerns about the bill. Representative Primavera stated that a fact sheet was distributed prior to the meeting stating that National Alliance on Mental Illness Colorado supports the bill.

05:24 PM -- Valerie Schlecht, representing herself, testified in support of the bill. She discussed her experience being placed on an emergency hold in another state and the definition of "gravely disabled."

05:27 PM -- Michael Lott-Manier, representing Mental Health America of Colorado, testified in support of the bill. He discussed updating the definitions concerning civil commitments and the history of changes to the mental health system in Colorado. He stated that involuntary civil commitments and emergency holds should be used as a measure of last resort. He discussed that the number of civil commitments did not dramatically increase in other states that clarified their statutes concerning emergency holds. He discussed the reasons why the bill is necessary and the error contained House Bill 13-1296. Mr. Lott-Manier responded to questions about waiting until next session to enact legislation concerning the definitions regarding civil commitments.

05:45 PM

Representative Kraft-Tharp read a statement of support from Lacey Berumen who was unable to stay to testify on the bill.

05:48 PM

Representative Singer commented on the bill. Representative Gardner and Representative Kraft-Tharp provided concluding remarks on the bill.


BILL:	HB14-1386
TIME:	05:56:26 PM
MOVED:	Singer
MOTION:	Refer House Bill 14-1386 to the Committee of the Whole. The motion passed on a vote of 9-2.
SECONDED:	Schafer
		VOTE
	Fields	Yes
	Ginal	Yes
	Humphrey	No
	Joshi	Yes
	Landgraf	Yes
	McNulty	Yes
	Primavera	No
	Singer	Yes
	Swalm	Yes
	Schafer	Yes
	McCann	Yes

Final YES: 9 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS

05:57 PM -- SB 14-173

Representative McNulty and Representative Singer presented Senate Bill 14-173. The bill recommends, but does not require, that all primary health care providers offer a Hepatitis C test to patients born between 1945 and 1965. If a test is offered and results in a positive finding, the provider may offer follow-up health care or a referral for such follow-up care. The Department of Public Health and Environment (DPHE) must promulgate rules to ensure that providers offer tests in a culturally appropriate manner. Representative Singer responded to a question about why this specific population is more at risk of having Hepatitis C.

06:01 PM -- Jolene McKenna, representing the Hep C Connection, testified in support of the bill. She discussed her personal experience with Hepatitis C and liver cirrhosis. She stated the reasons why people need to get tested for Hepatitis C. Ms. McKenna responded to questions about the potential impact of the bill.

06:08 PM -- Amy E. Warner, representing DPHE, testified in support of the bill. She stated that the bill is consistent with national recommendations from the Centers for Disease Control and Prevention and other entities. Ms. Warner relayed statistics about Hepatitis C. She discussed the previous lack of a Hepatitis C test, the lack of implementation of the national recommendations, and the DPHE's efforts to address Hepatitis C education, screenings, and training. She discussed why the bill is needed. Ms. Warner responded to questions about the screenings performed by DPHE. Representative McNulty responded to questions about the cost to consumers and health insurers for the Hepatitis C testing. Ms. Warner responded to a question about the size of the targeted population. She stated that the cost for the rapid test is $20.

06:17 PM -- Nancy Steinfurth, representing Hep C Connection, testified in support of the bill. She discussed why baby boomers need to be tested for Hepatitis C. She stated that the test that is covered under the federal Affordable Care Act. Ms. Steinfurth shared the story of a Vietnam veteran who had Hepatitis C. She relayed data concerning Hepatitis C treatment costs. She discussed why a bill, rather than a resolution, is needed and the continuing medical education that her organization is helping to develop. Ms. Steinfurth responded to questions about the treatment costs. She dialogued with the committee about the populations that are at risk of having Hepatitis C.

06:34 PM -- Marc Reece, representing Colorado Association of Health Plans, testified in a neutral capacity. He said that the screening should not have any impact on health insurance premiums, but that the state needs to have a plan for dealing with the cost of Hepatitis C treatments. He discussed Hepatitis C treatments and screenings. Mr. Reece dialogued with the committee about Hepatitis C screenings, diagnostic tests, and treatment costs.

06:45 PM

Representative Singer and Representative Landgraf made comments on the bill.


BILL:	SB14-173
TIME:	06:45:14 PM
MOVED:	Singer
MOTION:	Refer Senate Bill 14-173 to the Committee of the Whole. The motion passed on a vote of 10-1.
SECONDED:	McNulty
		VOTE
	Fields	Yes
	Ginal	Yes
	Humphrey	Yes
	Joshi	No
	Landgraf	Yes
	McNulty	Yes
	Primavera	Yes
	Singer	Yes
	Swalm	Yes
	Schafer	Yes
	McCann	Yes

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

06:46 PM

The committee adjourned.