House Committee on Health, Insurance, & Environment (04/29/2014)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH, INSURANCE, & ENVIRONMENT

Date:	04/29/2014	ATTENDANCE

Time:	10:59 AM to 01:02 PM	Fields	*
		Ginal	*
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
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
SB14-162 SB14-187		Referred to the Committee of the Whole Referred to Appropriations

10:59 AM -- SB14-162

Representative Mitsch Bush presented Senate Bill 14-162. The bill specifics the mandatory components of quality management programs for emergency medical services (EMS) organizations electing to evaluate the effectiveness of prehospital emergency services. Under the bill, each quality management program must use certain criteria in its evaluation. Quality management programs must include quality assurance and risk management components and peer reviews of providers, among other functions.

A quality management program under the bill does not include a review or assessment of the licensing, use, or maintenance of vehicles used by an EMS. The bill does not alter the medical practice licensing producers undertaken by the Division of Professions and Occupations in the Department of Regulatory Agencies.

11:04 AM

Representative Mitsch Bush responded to questions about quality management programs. Prior to the meeting, Representative Mitsch Bush distributed a fact sheet about Senate Bill 14-162 to the committee (Attachment A).

140429 Attach A.pdf

11:06 AM -- Zane Laubhan, representing himself, testified in support of the bill. He discussed and distributed a handout about Carol J. Shanaberger (Attachment B).

140429Attach B.pdf

11:09 AM -- Dr. Jeff Beckman, representing himself, testified in support of the bill. He stated that the goals of the bills are to enhance and augment the existing quality management programs, to maintain a high level of EMS provider and paramedic performance, and to enhance and maintain patient safety. Dr. Beckman discussed the organizations that support the bill and quality management programs. He responded to questions about whether best practices will be shared, whether legislation or changes in scope of practices might come from the bill, and the impact of transport times and initial care. Dr. Beckman responded to questions about how the program will recognize differences between rural and urban areas.

11:20 AM

Representative Mitsch Bush read a letter from the North Routt Fire Protection District. Dr. Beckman responded to questions about existing peer review of quality management programs, the information that would be shared under the bill, and how malpractice issues are currently handled when EMS providers are involved. He responded to questions about who will collect data and perform the other tasks outlined in the bill. Dr. Beckman stated that the information would be de-identified. He responded to questions about the costs of the bill to local entities.

11:28 AM -- Dr. Jean Martin, representing COPIC Insurance Company, testified in support of the bill. She stated that the bill is modeled after current statutes concerning hospital quality management programs. She stated the bill provides the following legal protections: confidentiality, privilege, and immunity. She stated that bill does not remove liability for negligent acts by an EMS provider. Dr. Martin responded to questions about whether quality management review teams would report situations that warrant disciplinary action and whether certain records would remain confidential.

11:35 AM -- Will Dunn, representing the Eagle County Paramedic Services, testified in support of the bill. He stated that paramedics are an extension of the emergency departments and intensive care units, but they do not share the same privileges as physicians. He responded to questions about his testimony.

11:38 AM

Representative McCann referenced a letter that was distributed to the committee from Dr. William L. Hall (Attachment C). Representative Mitsch Bush discussed the letter from Dr. Hall and made concluding remarks about the bill.

140429Attach C.pdf


BILL:	SB14-162
TIME:	11:42:03 AM
MOVED:	Fields
MOTION:	Refer Senate Bill 14-162 to the Committee of the Whole. The motion passed on a vote of 11-0.
SECONDED:	Swalm
		VOTE
	Fields	Yes
	Ginal	Yes
	Humphrey	Yes
	Joshi	Yes
	Landgraf	Yes
	McNulty	Yes
	Primavera	Yes
	Singer	Yes
	Swalm	Yes
	Schafer	Yes
	McCann	Yes

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

11:43 AM -- SB14-187

Representative Stephens and Representative Schafer presented Senate Bill 14-187. The bill establishes the Colorado Commission on Affordable Health Care (commission). The commission will study the drivers of health care costs and evidence-based cost containment strategies, and make recommendations for action. The commission will use state data to conduct empirical analysis of health care utilization in the state. The commission will have 12 voting members, representing various public and private sector health care experts and five nonvoting members from state government. Under the bill, the commission will review previous reports and studies, including the report from the former Blue Ribbon Commission for Health Care Reform. The commission will also create small advisory committees to study specific areas, and coordinate with other Colorado entities studying health care costs as appropriate.

The commission must provide two annual reports to the General Assembly in FY 2014-15 and FY 2015-16 and a final report by June 30, 2016. Legislative committees and the Governor will consider the commission's recommendations for future legislation and regulatory action. The bill creates the Colorado Commission on Affordable Care Cash Fund within the Department of Public Health and Environment and appropriates $400,000 to the fund in FY 2014-15. The commission is repealed on July 1, 2017.

11:51 AM

Representative Stephens responded to questions about the bill's fiscal note. She stated that the commission is modeled after the Commission on Criminal and Juvenile Justice. Representative Stephens responded to questions about what will result from the commission. Representative Schafer discussed the various entities working on health issues as a result of the Blue Ribbon Commission for Health Care Reform, also known as the 208 Commission, and stated the bill will allow a coordinated effort between these entities on affordable health care.

12:00 PM -- Deb Judy, representing the Colorado Consumer Health Initiative, testified in support of the bill. She discussed the lack of access to affordable health care and referenced the 2012 Colorado Health Care Cost Report.

12:02 PM -- Elisabeth Arenales, representing the Colorado Center on Law and Policy, testified in support of the bill. She discussed other states that have established health cost commissions and the need for a focused effort on cost drivers. She responded to questions about whether someone from the Colorado Health Benefit Exchange should be on the commission.

12:07 PM -- Cindy Sovine-Miller, representing the Colorado Association of Commerce and Industry, testified in support of the bill. She discussed the bill's requirement for evidence-based analysis of the major cost drivers in health care and what happens when employers discontinue health insurance coverage.

12:10 PM -- Alfred Gilchrist, representing the Colorado Medical Society, testified in support of the bill. He discussed the information packet he distributed to the committee (Attachment D).

140429Attach D.pdf

12:12 PM -- Patrick Boyle, representing the Colorado Group Insurance Association and the Colorado Competitive Council, testified in support of the bill. He discussed the importance of studying increasing health care costs.

12:14 PM -- Virginia Morrison Love, representing America's Health Insurance Plans, testified in support of the bill. She stated that health costs drive insurance premiums. She provided two handouts to the committee (Attachments E and F).

140429Attach E.pdf

140429Attach F.pdf

12:16 PM

Mr. Boyle stated that he did not want to anticipate what the results of the commission might be in response to a question. Representative Schafer stated legislation may result from the study.

12:20 PM -- Sara Smith, representing Health One Hospital Systems, testified in support of the bill. She shared examples of what can be achieved when experts work together to pursue health strategies.

12:23 PM -- Dr. Jandel Allen-Davis, representing Kaiser Permanente, testified in support of the bill. She discussed addressing health care costs, developing best practices for care delivery, addressing racial and ethnic disparities, and understanding the state's fiscal challenges.

12:26 PM -- Shalini Wittstruck representing Anthem Blue Cross Blue Shield, testified in support of the bill. She stated that health care costs continue to increase and that Colorado is one of the most expensive markets.

12:27 PM -- Mike Huotari, representing Rocky Mountain Health Plans, testified in support of the bill. He distributed a letter of support from Club 20 (Attachment G).

140429Attach G.pdf

12:29 PM -- Marc Reece, representing the Colorado Association of Health Plans, testified in support of the bill. He discussed the composition of the commission.

12:31 PM

Dr. Allen-Davis responded to questions about how the commission will address racial disparities related to health care.

12:33 PM -- Tony Gagliardi, representing the National Federation of Independent Business, testified in support of the bill. He stated that public policy focuses on premiums, but not on what drives premiums. He responded to questions about the potential outcomes of the commission.

12:39 PM

Representative McCann discussed amendment L.019 (Attachment H). Representative Fields commented on food deserts. Representative Fields discussed amendment L.020 (Attachment I). Representatives Schafer and Stephens commented on amendment L.020. The committee discussed the bill, the composition of the commission, and the amendments with the bill sponsors.

140429Attach H.pdf

140429Attach I.pdf


BILL:	SB14-187
TIME:	12:52:30 PM
MOVED:	McCann
MOTION:	Adopt amendment L.019 (Attachment H). The motion failed on a vote of 4-7.
SECONDED:	Schafer
		VOTE
	Fields	Yes
	Ginal	No
	Humphrey	No
	Joshi	No
	Landgraf	No
	McNulty	No
	Primavera	Yes
	Singer	No
	Swalm	No
	Schafer	Yes
	McCann	Yes

YES: 4 NO: 7 EXC: 0 ABS: 0 FINAL ACTION: FAIL

12:53 PM

The committee discussed amendment L.020.


BILL:	SB14-187
TIME:	12:56:33 PM
MOVED:	Fields
MOTION:	Adopt amendment L.020 (Attachment I). The motion failed on a vote of 5-6. The motion failed on a vote of 5-6.
SECONDED:	McCann
		VOTE
	Fields	Yes
	Ginal	No
	Humphrey	No
	Joshi	No
	Landgraf	No
	McNulty	No
	Primavera	Yes
	Singer	Yes
	Swalm	No
	Schafer	Yes
	McCann	Yes
YES: 5 NO: 6 EXC: 0 ABS: 0 FINAL ACTION: FAIL

12:57 PM

The committee discussed the bill.


BILL:	SB14-187
TIME:	01:01:47 PM
MOVED:	Schafer
MOTION:	Refer Senate Bill 14-187 to the Committee on Appropriations. The motion passed on a vote of 9-2.
SECONDED:	McCann
		VOTE
	Fields	Yes
	Ginal	Yes
	Humphrey	No
	Joshi	No
	Landgraf	Yes
	McNulty	Yes
	Primavera	Yes
	Singer	Yes
	Swalm	Yes
	Schafer	Yes
	McCann	Yes
Final YES: 9 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS

01:02 PM

The committee adjourned.