House Committee on Health, Insurance, & Environment (02/20/2014)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH, INSURANCE, & ENVIRONMENT

Date:	02/20/2014	ATTENDANCE

Time:	01:37 PM to 06:41 PM	Fields	X
		Ginal	X
Place:	HCR 0107	Humphrey	X
		Joshi	E
This Meeting was called to order by		Landgraf	X
	Representative McCann	McNulty	X
		Primavera	X
This Report was prepared by		Singer	X
	Amanda King	Swalm	*
		Schafer	X
		McCann	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB14-1263 HB14-1213 HB14-1263 HB14-1209 HB14-1186		Amended, Referred to Finance Amended, Referred to Appropriations Amended, Referred to Finance Amended, Referred to Appropriations Amended, Referred to the Committee of the Whole

01:38 PM -- HB14-1263

Representatives McCann and Gerou presented House Bill 14-1263. The bill prohibits anyone from giving, selling, distributing, or offering for sale cigarettes or tobacco products to anyone who is under 21 years of age. The bill prohibits anyone who is under 21 years of age from purchasing or possessing cigarettes or tobacco products. The bill makes an exception for anyone who was born on or before June 30, 1996.

01:50 PM

Representatives McCann and Gerou discussed the bill's fiscal note. They responded to questions about whether other states have passed similar legislation, whether there is any specific reason to raise the age to 21 rather than another age, and whether the bill will effect the sale of all tobacco products. They continued to respond to questions from the committee about the bill.

02:06 PM -- Dr. Karen Wilson, representing Children's Hospital Colorado, testified in support of the bill. She discussed her patients' whose parents smoke, brain development, and the effects of second-hand smoke exposure. She relayed statistics about sudden infant death syndrome. Dr. Wilson responded to questions about whether there is something significant about raising the age for tobacco purchases to 21 years of age.

02:13 PM -- James Boles, representing himself, testified in support of the bill. He discussed his experience with smoking in the military.

02:20 PM

Representative Schafer laid over House Bill 14-1263 until after House Bill 14-1213.

02:20 PM -- HB14-1213

Representative Kraft-Tharp presented House Bill 14-1213. The bill requires a pharmacy benefit manager (PBM) to include the basis for determining maximum allowable cost pricing in each contract between PBMs and a pharmacy, update the pricing information at least every seven days, and maintain a procedure to eliminate products from the list of drugs subject to maximum allowable cost pricing. In order for a prescription drug to be placed on the maximum allowable cost list, the bill requires the PBM to ensure that the drug meets specific requirements. The bill requires each contract between a PBM and a pharmacy to include a process to appeal, investigate, and resolve disputes regarding maximum allowable cost pricing.

02:26 PM

Representative Kraft-Tharp responded to questions about the stakeholders who were involved in the bill drafting and how timely manner will be calculated.

02:28 PM -- Michelle Mack, representing Express Scripts, testified in a neutral capacity. She discussed maximum allowable cost pricing. Ms. Mack responded to questions about whether patient cost increases could result from enacting the bill, which prescription drugs can be listed on maximum allowable cost pricing lists, and the reasons why drug prices fluctuate. She responded to questions about the maximum allowable cost pricing lists and drug purchasing procedures. Representative Kraft-Tharp discussed a fact sheet about the bill that was distributed prior to the committee meeting. Ms. Mack responded to additional questions from the committee.

02:39 PM -- Brad Young, representing Rx Plus Pharmacies, testified in support of the bill. He discussed drug pricing and the reasons why the bill is needed. Mr. Young responded to questions about how enacting the bill could impact patients. Representative Kraft-Tharp responded to questions about the bill's fiscal note.

02:46 PM -- Bill Zepernick, representing Legislative Council Staff, responded to questions about the bill's fiscal note.

02:49 PM -- Val Kalnins, representing the Colorado Pharmacists Society, came to the table to respond to questions. He discussed the drug rating system, the reference in the bill to the orange book, and the reasons for appeal.

02:52 PM

Representative Kraft-Tharp discussed Amendment L.002 (Attachment A).

140220AttachA.pdf


BILL:	HB14-1213
TIME:	02:53:57 PM
MOVED:	Fields
MOTION:	Adopt amendment L.002 (Attachment A). The motion passed without objection.
SECONDED:	Primavera
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi	Excused
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann

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

02:54 PM

Representatives Swalm and Kraft-Tharp discussed the bill and the bill's fiscal note.


BILL:	HB14-1213
TIME:	02:56:05 PM
MOVED:	McCann
MOTION:	Refer House Bill 14-1213, as amended, to the Committee on Appropriations. The motion passed on a vote of 9-0, with two members excused.
SECONDED:	Schafer
		VOTE
	Fields	Yes
	Ginal	Yes
	Humphrey	Yes
	Joshi	Excused
	Landgraf	Excused
	McNulty	Yes
	Primavera	Yes
	Singer	Yes
	Swalm	Yes
	Schafer	Yes
	McCann	Yes

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

02:57 PM

The committee took a brief recess.

03:06 PM -- HB14-1263

The committee came back to order and resumed testimony on House Bill 14-1263.

03:07 PM -- Jodi Radke, representing the Campaign for Tobacco-Free Kids, testified in support of the bill. She discussed making the allowable age to use various substances consistent and the 1964 Surgeon General's Report on Smoking and Health.

03:11 PM -- Anita Roberts, representing the March of Dimes and the Association of Women's Health, Obstetric, and Neonatal Nurses, testified in support of the bill and provided a handout (Attachment B). She discussed the risks of smoking while pregnant and statistics about teenage smoking.

140220AttachB.pdf

03:14 PM -- Dr. Arnold Levinson, representing himself, testified in support of the bill. He relayed statistics about smoking and the decrease in revenues that may result from the bill.

03:17 PM -- Dr. Bill Burman, representing the Colorado Association of Local Public Health Officials and Denver Health, testified in support of the bill. He stated that, in Denver, tobacco exposure is a major contributor to five of the ten leading causes of death. He discussed tobacco addiction and the benefits of the bill.

03:20 PM -- Abrian Sabo, representing herself, testified in a neutral capacity. She discussed tobacco use by teenagers.

03:22 PM -- Rebecca Kissinger, representing herself, testified in a neutral capacity. She discussed that 18-year-olds are tried as adults for crimes. She responded to questions about whether increasing the purchasing age for tobacco would deter teenagers from smoking.

03:25 PM

Ms. Sabo responded to questions about whether a fine would deter teens from using tobacco products and teenage use of alcohol. Ms. Kissinger and Ms. Sabo responded to questions about teenage tobacco use and the major public health concerns for teenagers.

03:34 PM -- Brandon Gelatt, representing himself, testified in support of the bill. He discussed the peer pressure on teenagers to start smoking.

03:37 PM -- Helen Orozco, representing herself, testified in support of the bill. She discussed the use of electronic cigarettes and chewing tobacco by teenagers.

03:38 PM -- Daniela Miramontes, representing herself, testified in support of the bill. She discussed teenage tobacco use in her high school.

03:41 PM -- Summer Joseph, representing herself, testified in support of the bill. She discussed her friends' and family's use of tobacco.

03:43 PM -- Hudson Turner, representing himself, testified in support of the bill. He discussed his neighbor who smoked.

03:45 PM

Ms. Orozco and Mr. Gelatt responded to a question about the prevalence of electronic cigarette and chewing tobacco use by teenagers. Ms. Miramontes responded to questions about why teenagers decide to smoke and how many students in her high school would support the bill. Mr. Turner said that teenagers may not consider the consequences of smoking.

03:50 PM -- Cindy Liverance, representing the American Lung Association of Colorado, testified in support of the bill. She stated that the current starting age for smoking in Colorado is 12 years old. Ms. Liverance discussed brain development, a volunteer of her organization that started smoking at age 13, and a 2012 Surgeon General's report.

03:53 PM -- Bruce Dalton, representing the Colorado Lung Health Connection, testified in support of the bill. He discussed his experience with smoking.

03:57 PM -- Bob Doyle, representing the Colorado Tobacco Education and Prevention Alliance, testified in support of the bill. He discussed the costs related to smoking and statements from the Department of Defense concerning tobacco use. He responded to questions about whether other states have enacted similar legislation and whether there will be efforts in the future to further raise the purchasing age for tobacco.

04:01 PM -- Patrick Maroney, representing the Colorado Department of Revenue's Liquor and Tobacco Enforcement Division, came to the table to respond to questions about the enforcement of the bill.

04:06 PM -- Mary Szarmach, representing Smoker Friendly and Gasamat, testified in opposition to the bill. She discussed allowing adults to make decisions for themselves, statistics related tobacco taxes, and legislation funded by tobacco tax revenues. Ms. Szarmach relayed several statistics about tobacco consumers and revenues in response to a question. She responded to questions about the legislation funded by tobacco tax revenues, retailer compliance with age restrictions for tobacco purchases, the products carried in her retail stores, and the cost of a package of cigarettes.

04:21 PM -- Grier Baily, representing the Colorado Wyoming Petroleum Marketers Association, testified in opposition to the bill. He discussed the possible impact on border communities, advertising efforts against smoking, and allowing 18 to 20 year olds to make choices.

04:27 PM -- Chris Howes, representing the Colorado Retail Council, testified in a neutral capacity. He discussed phasing in the bill and the possible confusion that phasing in could cause for retailers. Representatives Gerou and McCann responded to questions about phasing in the bill.

04:34 PM -- Mary Lou Chapman, representing the Rocky Mountain Food Industry Association, testified in opposition of the bill. She discussed her organization's concerns about the bill, the impact phased in implementation of the bill would have on retail clerks, and Senate Bill 14-018, which prohibits nicotine product distribution to minors.

04:38 PM -- Brian Soule, representing himself, testified in opposition to the bill. He discussed his military experience.

04:41 PM

The committee discussed phasing in the bill with the bill sponsors. Representatives McCann and Gerou responded to questions about Senate Bill 14-018. Kristen Forrestal, representing the Office of Legislative Legal Services, came to the table to respond to questions about Senate Bill 14-018.


BILL:	HB14-1263
TIME:	04:49:25 PM
MOVED:	McCann
MOTION:	Amend printed bill, strike "June 30," and substitute "December 31," throughout the bill, and page 6, line 13, strike "July 1, 2014." and substitute "January 1, 2015.". The motion passed without objection.
SECONDED:	McNulty
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi	Excused
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann

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

04:50 PM

Representative Gerou discussed the Tobacco Master Settlement Agreement and provided concluding remarks on the bill. Representative McCann made concluding remarks on the bill. Committee discussion ensued.


BILL:	HB14-1263
TIME:	05:05:39 PM
MOVED:	McCann
MOTION:	Refer House Bill 14-1263, as amended, to the Committee on Finance. The motion passed on a vote of 6-4, with one member excused.
SECONDED:	Ginal
		VOTE
	Fields	Yes
	Ginal	Yes
	Humphrey	No
	Joshi	Excused
	Landgraf	No
	McNulty	No
	Primavera	Yes
	Singer	Yes
	Swalm	No
	Schafer	Yes
	McCann	Yes

Final YES: 6 NO: 4 EXC: 1 ABS: 0 FINAL ACTION: PASS

05:07 PM

The committee took a brief recess.

05:18 PM -- HB14-1209

Representative McCann called the committee back to order. Representative Stephens presented House Bill 14-1209. The bill creates the Marijuana Diversion Grant Program to be administered by the State Controller in the Department of Personnel and Administration. The General Assembly is authorized to appropriate funds in the Marijuana Cash Fund to the grant program when the fund has a surplus. The appropriation for the grant fund is limited to $1 million in FY 2014-15 and FY 2015-16. The grant program will provide grants to the Colorado State Patrol and other state law enforcement agencies in states that share a border with Colorado to assist in efforts to prevent the diversion of retail marijuana outside Colorado. The bill creates a grant review committee, and requires the State Controller to develop a grant application that must include certain elements. Grant applications must be submitted by August 1 of any year that the General Assembly appropriates grant money. The grant review committee will review and award grants based on need and effectiveness with priority given to an application from the Colorado State Patrol. Representative Stephens provided four handouts to the committee (Attachments C through F).

140220AttachC.pdf

140220AttachD.pdf

140220AttachE.pdf

140220AttachF.pdf

05:22 PM

Representative Stephens responded to questions about providing funds to other states. Representative Stephens discussed Amendment L.004 (Attachment G). The committee discussed Amendment L.004 and the bill. Representative Stephens responded to questions about the governor's proposal for the marijuana tax revenue.

140220AttachG.pdf


BILL:	HB14-1209
TIME:	05:34:39 PM
MOVED:	McNulty
MOTION:	Adopt amendment L.004 (Attachment G). The motion passed without objection.
SECONDED:	Landgraf
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi	Excused
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann

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

05:35 PM

Representative Stephens and the committee discussed Amendment L.005 (Attachment H).

140220AttachH.pdf

05:40 PM

Michael Dohr, representing the Office of Legislative Legal Services, came to the table to respond to questions about the Correctional Treatment Cash Fund. Representative Stephens discussed recovery programs.

05:44 PM

Representative Stephens responded to questions about Amendment L.005 and the youth risk behavior survey.


BILL:	HB14-1209
TIME:	05:52:23 PM
MOVED:	Swalm
MOTION:	Adopt amendment L.005 (Attachment H). The motion passed without objection.
SECONDED:	McNulty
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi	Excused
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann

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

05:53 PM

The committee discussed the bill.


BILL:	HB14-1209
TIME:	05:59:02 PM
MOVED:	McNulty
MOTION:	Refer House Bill 14-1209, as amended, to the Committee on Appropriations. The motion passed on a vote of 7-3, with one member excused.
SECONDED:	Swalm
		VOTE
	Fields	No
	Ginal	Yes
	Humphrey	Yes
	Joshi	Excused
	Landgraf	Yes
	McNulty	Yes
	Primavera	Yes
	Singer	No
	Swalm	Yes
	Schafer	Yes
	McCann	No

Final YES: 7 NO: 3 EXC: 1 ABS: 0 FINAL ACTION: PASS

06:00 PM -- HB14-1186

Representative Shafer presented House Bill 14-1186 and discussed Amendment L.001 (Attachment I). The bill concerns the release of medical records to a person other than the patient and allows the setting of reasonable fees to be paid for the release of medical records.

140220AttachI.pdf

06:05 PM

Representative Schafer distributed Amendments L.001 and L.002 (Attachment J). Representative McCann distributed a letter of support from Mark Simon (Attachment K).

140220AttachJ.pdf

140220AttachK.pdf

06:08 PM -- Kyle Probst, representing Healthport Technologies, testified in support of the bill. He discussed the review that occurs under the federal Health Insurance Portability and Accountability Act of 1996 when a medical record is requested by a third party. Mr. Probst discussed Amendment L.001. Mr. Probst responded to questions about whether third parties need a subpoena to obtain health records, whether patients have to pay for their own records, and whether state agencies have to pay for health records. He continued to respond to questions about Amendment L.001, the releasing of medical records, and the security of electronic medical records.

06:25 PM -- Regina Tironi, representing MRO Corporation, testified in support of the bill. She discussed the process for releasing a medical record to a third party.

06:29 PM -- Ryan Biehle, representing the Colorado Consumer Health Initiative, testified in a neutral capacity. He stated that the amendments address many of his organization's concerns. He suggested adding a timeframe to the provision allowing one free copy for eligibility determination for disability benefits. Mr. Biehle discussed clarifying the provision concerning the exchange of records between health care providers for continuing medical care. He stated his organization still has concerns about adjusting the fees based on the consumer price index.

06:34 PM -- Pat Boyle, representing COPIC, testified in a neutral capacity. He stated his organization supports the bill with the amendments. Mr. Boyle discussed the stakeholders involved in the drafting of the bill and his organization's interest in the legislation.


BILL:	HB14-1186
TIME:	06:36:50 PM
MOVED:	Schafer
MOTION:	Adopt amendment L.001 (Attachment I). The motion passed without objection.
SECONDED:	Singer
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi	Excused
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann

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

06:37 PM

Representative Schafer discussed Amendment L.002.


BILL:	HB14-1186
TIME:	06:37:24 PM
MOVED:	Schafer
MOTION:	Adopt amendment L.002 (Attachment J). The motion passed without objection.
SECONDED:	Singer
		VOTE
	Fields
	Ginal
	Humphrey
	Joshi	Excused
	Landgraf
	McNulty
	Primavera
	Singer
	Swalm
	Schafer
	McCann

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

06:38 PM

The committee discussed the bill.


BILL:	HB14-1186
TIME:	06:39:34 PM
MOVED:	Schafer
MOTION:	Refer House Bill 14-1186, as amended, to the Committee of the Whole. The motion passed on a vote of 10-0, with one member excused.
SECONDED:	Swalm
		VOTE
	Fields	Yes
	Ginal	Yes
	Humphrey	Yes
	Joshi	Excused
	Landgraf	Yes
	McNulty	Yes
	Primavera	Yes
	Singer	Yes
	Swalm	Yes
	Schafer	Yes
	McCann	Yes

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

06:41 PM

The committee adjourned.