House Committee on Public Health Care & Human Services (03/18/2014)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON PUBLIC HEALTH CARE & HUMAN SERVICES

Date:	03/18/2014	ATTENDANCE

Time:	01:33 PM to 06:22 PM	Conti	*
		Everett	X
Place:	HCR 0107	Ginal	X
		Joshi	X
This Meeting was called to order by		Landgraf	X
	Representative Primavera	McCann	*
		Schafer	*
This Report was prepared by		Singer	X
	Elizabeth Burger	Stephens	X
		Tyler	X
		Wilson	X
		Young	X
		Primavera	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
SB14-018 HB14-1317 HB14-1211		Amended, Referred to the Committee of the Whole Amended, Referred to Appropriations Amended, Referred to Appropriations

01:33 PM -- SB14-018

Represenative Hamner and Representative Young discussed Senate Bill 14-018. The bill expands the current prohibition on providing or selling cigarettes or tobacco products to persons under the age of 18 to include all nicotine products. The committee previously considered witness testimony on the bill on March 11, 2014. Representative Hamner explained and distributed amendment L.005 (Attachment A).

14HsePHS0318AttachA.pdf


BILL:	SB14-018
TIME:	01:35:13 PM
MOVED:	Young
MOTION:	Adopt amendment L.005 (Attachment A). The motion passed without objection.
SECONDED:	Singer
		VOTE
	Conti
	Everett
	Ginal
	Joshi
	Landgraf
	McCann	Excused
	Schafer	Excused
	Singer
	Stephens
	Tyler
	Wilson
	Young
	Primavera

YES: 0 NO: 0 EXC: 2 ABS: 0 FINAL ACTION: Pass Without Objection

01:37 PM

The committee recessed briefly.

01:44 PM

The committee reconvened.


BILL:	SB14-018
TIME:	01:44:12 PM
MOVED:	Young
MOTION:	Refer Senate Bill 14-018, as amended, to the Committee of the Whole. The motion passed on a vote of 7-6.
SECONDED:	Singer
		VOTE
	Conti	No
	Everett	No
	Ginal	Yes
	Joshi	No
	Landgraf	No
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	No
	Tyler	Yes
	Wilson	No
	Young	Yes
	Primavera	Yes

YES: 7 NO: 6 EXC: 0 ABS: 0 FINAL ACTION: PASS

01:45 PM -- HB14-1317

Representative Duran introduced House Bill 14-1317 and distributed amendment L.001 (Attachment B). The bill makes a variety of changes to the Colorado Child Care Assistance Program (CCCAP). Specifically, the bill requires: the Department of Human Services (DHS) to set provider rates for each county at a level adequate to ensure access for CCCAP families that is equal to that of non-CCCAP families; the DHS to increase provider rates for infant and toddler care so that the rates are at least equal to the 75th percentile of each county's local market rate by July 1, 2016; counties to reimburse providers for up to five days per month for child absences and holidays; counties to maintain a current and accurate waiting list of parents who have inquired about enrollment in the CCCAP; that the co-payment amount for families on CCCAP with incomes below 100 percent of the federal poverty level (FPL) be limited to no more than one percent of the family's gross monthly income, and increasing the co-payments as the family's income increases; and that the activities in which a parent is participating in order to be eligible for CCCAP be expanded to include enrollment in a post-secondary education program or workforce training program. Representative Duran responded to questions from the committee regarding the reimbursements that are provided under the CCCAP to child care providers for child absences and holidays, the length of time allotted under the CCCAP for job-search activities, and the educational activity eligibility category created by the bill. Representative Duran discussed a 2008 audit of the CCCAP, and the importance of enacting consistent eligibility standards for the program.

14HsePHS0318AttachB.pdf

02:10 PM -- Bill Zepernick, Legislative Council Staff, came to the table to respond to committee questions regarding the bill's fiscal note specifically related to the eligibility categories for the CCCAP program. Representative Landgraf asked how this bill relates to House Bill 14-1052, which concerns tax credits for child care expenses.

02:16 PM

Representative Duran responded to questions from the committee regarding whether the bill obligates counties to pay for additional CCCAP slots.

02:19 PM -- Charlotte Brantley, Clayton Early Learning, gave an overview of the relationship between welfare reform and child care assistance programs. She discussed administrative issues with the CCCAP that created difficulty for providers and families and contributed to the "churn" effect, in which children rotate in and out of child care. She stated that state support for the CCCAP has declined over time while more families are in need of the services. She stated that the bill addresses a number of issues with the program while allowing the same number of children to be served. She responded to questions from the committee regarding the "churn" effect and further discussed how the bill addresses the "cliff" effect, in which a family's income increases to the point where they are no longer eligible for assistance, but the family can not afford child care without a subsidy. Ms. Brantley responded to questions from the committee about whether the bill addresses the hours of operation for child care providers, thus allowing parents to accept more job opportunities.

02:38 PM -- Kathryn Hammerbeck, Early Childhood Education Association, testified that she struggles to provide quality and affordable child care to her clients and that CCCAP rates are insufficient to meet her expenses. She stated that providers must seek other sources of funding, including increases in rates to private pay clients, to make up the difference between the cost of care and CCCAP payments. She discussed the decline in the participation of providers in the CCCAP in recent years.

02:41 PM -- Elyse Adlen, Florence Crittenton, discussed the importance of a high school degree for a parent's economic success and described the services provided by the Florence Crittenton school.

02:43 PM -- RB Fast, Montessori Academy of Colorado and Colorado Montessori Association, testified that the members of her association were overwhelmingly in favor of CCCAP reform. She stated that many schools previously accepted CCCAP but no longer participate primarily due to inadequate reimbursement rates and payments for closure days. Ms. Hammerbeck and Ms. Fast responded to questions from the committee regarding reimbursement for school closures.

02:55 PM -- Gladys Wilson, Qualistar Colorado, testified regarding the importance of quality in early childhood programs. She stated that knowing their child is in a high-quality child care program allows parents to continue employment.

03:01 PM -- Jennifer Landrum, Denver Preschool Program, described the Denver Preschool Program and explained that the program provides larger subsidies to families who enroll in programs with higher quality ratings. Ms. Wilson responded to questions from the committee.

03:10 PM -- Chaer Robert, Colorado Center on Law and Policy, discussed the costs of child care in counties represented by the various members of the committee and the amount a family must earn to become self-sufficient.

03:15 PM -- Bridget Kaminetsky, Colorado 9-to-5, testified in support of the bill.

03:18 PM -- Nicole Zayhowski, representing herself, testified regarding her participation in the CCCAP program and the administrative difficulties she experienced. She explained that she is facing the cliff effect, and she responded to questions from the committee. Ms. Kaminetsky responded to questions from the committee regarding the administrative burden on CCCAP participants.

03:25 PM -- Rich Jones, The Bell Policy Center, distributed a handout to the committee (Attachment C) and testified in support of the bill. He discussed how the bill will help mitigate the cliff effect. He responded to questions from the committee regarding income a family of three must earn to be self sufficient.

14HsePHS0318AttachC.pdf

03:35 PM -- Molly Yost, Clayton Early Learning, testified regarding the burdensome administrative processes that keep families from full participation in the CCCAP. She highlighted the portions of the bill which will help to address the churn effect.

03:39 PM -- Nancy Sharpe, Colorado Counties Inc., explained that previous testimony asserted that counties could use CCCAP money to bolster county reserves and that this testimony was incorrect. She spoke to the counties' concerns with the bill and asked that the committee support amendment L.001 (Attachment B) and continue additional discussions on future amendments to the bill. She stated that counties oppose the provisions of the bill that require the State Board of Human Services to set provider reimbursement rates, stating that removing the discretion of counties to set rates removes a tool that the counties have to ensure that the maximum number of families can be served within program allocations. She spoke regarding the bill's provisions requiring the county to ensure that the provider rates are sufficient to ensure that CCCAP families have the same access to services as families not enrolled in CCCAP. She further testified in opposition to the bill's provisions requiring the establishment of a waitlist for services.

03:45 PM -- Donna Rohde, Colorado Human Services Directors Association, testified regarding the importance of maintaining county flexibility in administering the CCCAP. She spoke in opposition to the bill's language, as introduced, that would require provider rates to be at least 75 percent of the market rate in each county. She spoke regarding the current practice of incorporating payments for holidays and vacation days into the reimbursement rate. She further addressed the bill's provisions reducing the number of paystubs that a family must provide to qualify for the program.

03:53 PM -- Lorraine Archuleta, Boulder County Housing and Human Services, stated that counties support increased funding for the program but have concerns with the bill. She spoke in support of including funding to fix the program's eligibility determination and payment system, the Child Care Automated Tracking System (CHATS). She stated that the bill's provisions limiting parental payments to 1 percent of income will in essence create a new cliff effect. Ms. Sharpe responded to questions from the committee. Ms. Archuleta testified that CHATS does not currently allow for data to be collected regarding the churn effect. She further discussed the bill's provisions limiting the number of paystubs that must be provided to determine eligibility. The committee discussed CHATS. Ms. Sharpe responded to questions from the committee, and Ms. Rohde responded to questions about funding reductions.

04:19 PM -- Bill Jaeger, Colorado Children's Campaign, testified in support of the bill. He discussed the rules for the job search eligibility category and stated the average length of a job search is 14 weeks. He stated that nothing in the bill creates a mandate or entitlement and discussed the copayment cap. Mr. Jaeger discussed the fiscal impact of moving CCCAP rates to at least 75 percent of the counties' market rates for child care. He responded to questions from the committee regarding county child care allocations and the process that occurs when a county overspends its allocation. Mr. Jaeger further addressed questions from the committee regarding amendment L.001 and how it will reduce the bill's fiscal note. He continued to respond to committee questions regarding the tiered reimbursement rates for providers.


BILL:	HB14-1317
TIME:	04:50:54 PM
MOVED:	Young
MOTION:	Adopt amendment L.001 (Attachment B). The motion passed without objection.
SECONDED:	Schafer
		VOTE
	Conti
	Everett
	Ginal
	Joshi
	Landgraf
	McCann
	Schafer
	Singer
	Stephens
	Tyler
	Wilson
	Young
	Primavera

YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION:

04:52 PM

Representative Duran gave concluding remarks regarding the bill. Various committee members commented on the bill.


BILL:	HB14-1317
TIME:	05:00:27 PM
MOVED:	Young
MOTION:	Refer House Bill 14-1317, as amended, to the Committee on Appropriations. The motion passed on a vote of 8-5.
SECONDED:	Tyler
		VOTE
	Conti	No
	Everett	No
	Ginal	Yes
	Joshi	No
	Landgraf	No
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Yes
	Tyler	Yes
	Wilson	No
	Young	Yes
	Primavera	Yes

FINAL YES: 8 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: PASS

05:01 PM

The committee recessed briefly.

05:05 PM -- HB14-1211

The committee reconvened. Representative Young introduced House Bill 14-1211. As introduced, the bill requires the Department of Health Care Policy and Financing to recognize complex rehabilitation technology (CRT) as a unique category of services under Medicaid. He distributed and explained amendment L.003, which is a strike-below amendment to the bill (Attachment D). The amendment defines CRT as individually configured wheelchair systems that are configured for individuals to meet their specific and unique medical, physical, and functional needs, are primarily used to serve a medical purpose, and require services provided by a qualified CRT provider to ensure appropriate design, configuration, and use. The amendment specifies the requirements for qualified CRT professionals and suppliers, and requires the Department of Health Care Policy and Financing to provide a separate recognition within the state's Medicaid program for CRT. Representative Young responded to questions from the committee regarding amendment L.003 (Attachment D).

14HsePHS0318AttachD.pdf

05:12 PM -- Patrick Mahncke, Colorado Association of Medical Equipment Services, testified regarding the importance of CRT to his client and discussed how such equipment allows clients to work and live in their homes. He stated that the bill preserves access to the equipment and provides safeguards. He stated that the bill preserves the current Medicaid benefit, and noted that many medical equipment providers have gone out of business in recent years. Mr. Mahncke responded to questions from the committee regarding the necessity of the bill, the number of medical equipment providers in the state, the amendment's requirements to provide service and repair of CRT, reimbursement of CRT by Medicaid and Medicare, the determination of adequate pricing of equipment, and Medicare rules changes.

05:34 PM -- MaryKathryn Hurd, Department of Health Care Policy and Financing, testified that the department is neutral on the bill. She noted that the bill codifies the current practice of the department regarding CRT. She clarified that many of the changes in the industry are being driven by Medicare regulations.

05:38 PM -- Alex Stephens, Department of Health Care Policy and Financing, responded to questions from the committee regarding whether individuals can be dually enrolled in Medicare and Medicaid. Ms. Hurd responded to questions from the committee regarding the length of time the department has to approve or deny claims.

05:45 PM

Mr. Mahncke responded to questions from the committee regarding what provisions of the bill are driving costs. Representative Young responded to questions from the committee regarding the bill's legislative declaration and fiscal note.

05:49 PM -- Priscilla Carlson, Colorado Cross-Disability Coalition, discussed the importance of CRT to individuals with disabilities. She stated that it is important to ensure that individuals have access to the equipment without undue delay.

05:56 PM -- Janice Hinds, Occupational Therapy Association of Colorado, testified in support of the bill with amendment L.003 (Attachment D).

05:58 PM -- Julie Reiskin, Colorado Cross Disability Coalition, responded to questions from the committee regarding Medicare and Medicaid rules for CRT and whether private insurance plans cover CRT.

06:09 PM -- Chris Hinds, representing himself, described his experience as a client eligible for Medicaid and Medicare, and his experience receiving CRT.

06:14 PM -- Mark Simon, representing himself, responded to previous committee questions regarding reimbursement rates for CRT and requirements for timely repairs of CRT. He responded to questions from the committee regarding the health care systems in other countries.


BILL:	HB14-1211
TIME:	06:18:45 PM
MOVED:	Young
MOTION:	Adopt amendment L.003 (Attachment D). The motion passed without objection.
SECONDED:	Singer
		VOTE
	Conti
	Everett
	Ginal
	Joshi
	Landgraf
	McCann
	Schafer
	Singer
	Stephens
	Tyler
	Wilson
	Young
	Primavera

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

06:19 PM

Representative Young gave concluding remarks regarding the bill.


BILL:	HB14-1211
TIME:	06:20:06 PM
MOVED:	Young
MOTION:	Refer House Bill 14-1211, as amended, to the Committee on Appropriations. The motion passed on a vote of 12-1.
SECONDED:	Ginal
		VOTE
	Conti	Yes
	Everett	No
	Ginal	Yes
	Joshi	Yes
	Landgraf	Yes
	McCann	Yes
	Schafer	Yes
	Singer	Yes
	Stephens	Yes
	Tyler	Yes
	Wilson	Yes
	Young	Yes
	Primavera	Yes

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

06:22 PM

The committee adjourned.