House Committee on Health, Insurance, & Environment (02/19/2015)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH, INSURANCE, & ENVIRONMENT

Date:	02/19/2015	ATTENDANCE

Time:	01:34 PM to 06:52 PM	Brown	X
		Esgar	X
Place:	HCR 0107	Humphrey	X
		Joshi	X
This Meeting was called to order by		Klingenschmitt	X
	Representative McCann	Landgraf	X
		Lontine	X
This Report was prepared by		Mitsch Bush	X
	Amanda King	Primavera	X
		Ransom	X
		Ryden	X
		Ginal	X
		McCann	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB15-1145 HB15-1147 HB15-1163		Referred to the Committee of the Whole Amended, Referred to Finance Postponed Indefinitely

01:35 PM -- HB 15-1145

Representative McCann allowed several students who were shadowing the members to introduce themselves. Representative Rankin presented House Bill 15-1145. The bill outlines numerous updates to Colorado's radiation control statute as required by the federal Nuclear Regulatory Commission (NRC) to maintain Colorado's delegated authority through the State Radiation Control Act. The bill implements several recommendations from the 2014 NRC audit report, including, but not limited to:

• modifying, adding, and repealing certain definitions;
• requiring the NRC to approve any state groundwater remediation standards differing from federal standards;
• increasing financial warranty requirements;
• repealing the State Board of Health's ability to issue provisional licenses;
• clarifying that an administrative law judge in the Department of Personnel and Administration may approve a radioactive material license; and
• repealing outdated provisions related to the federal Uranium Mill Tailings Radiation Control Act of 1978.

The bill also repeals the statutory authority of the Department of Public Health and Environment to acquire former uranium processing sites through eminent domain.

01:40 PM -- Jennifer Opila, Department of Public Health and Environment, testified in support of the bill. Representative McCann referenced a memorandum that was provided to the committee members prior to the meeting. Ms. Opila reviewed the provisions of the bill. Ms. Opila answered questions about radium-226 and the groundwater standards referenced in the bill. She responded to questions about the memorandum and the provision of the bill concerning eminent domain. Committee members dialogued with Ms. Opila about the bill and radioactive materials.


BILL:	HB15-1145
TIME:	01:51:57 PM
MOVED:	Landgraf
MOTION:	Refer House Bill 15-1145 to the Committee of the Whole. The motion passed on a vote of 13-0.
SECONDED:	Mitsch Bush
		VOTE
	Brown	Yes
	Esgar	Yes
	Humphrey	Yes
	Joshi	Yes
	Klingenschmitt	Yes
	Landgraf	Yes
	Lontine	Yes
	Mitsch Bush	Yes
	Primavera	Yes
	Ransom	Yes
	Ryden	Yes
	Ginal	Yes
	McCann	Yes

Final YES: 13 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

01:53 PM -- HB 15-1147

Representative Ginal presented House Bill 15-1147. The bill creates a licensure program for genetic counselors in the Division of Professions and Occupations in the Department of Regulatory Agencies. Under the bill, genetic counselors in Colorado must be licensed by June 1, 2016. The bill sets forth the requirements for genetic counselors seeking licensure, including the requirements that applicants be certified as a genetic counselor or medical geneticist by certain national organizations, unless the applicant meets the criteria for a provisional license while obtaining the national certification.

The bill also sets forth application and renewal processes, scope of practice for genetic counselors, rulemaking authority, disciplinary procedures, and other provisions related to the establishment of the licensure program. Only licensed individuals may use the title of "genetic counselor" and other related titles. The licensure program is repealed on September 1, 2020, following a sunset review.

01:59 PM

Representative Ginal answered questions about why regulation of genetic counselors is needed. An informational packet was distributed to the committee (Attachment A).

150219 AttachA.pdf

02:01 PM -- Carol Walton, Colorado Genetic Counselors Network, testified in support of the bill. She outlined the education requirements for genetic counselors and the practice of genetic counseling. Ms. Walton referenced other states that have enacted laws regulating genetic counselors.

02:07 PM -- Mary Freivogal, Colorado Genetic Counselors Network, testified in support of the bill. She discussed overtreatment, undertreatment, and financial harm related to genetic counseling. Ms. Freivogal discussed genetic counseling for cancer.

02:12 PM -- Lisa Ku, Colorado Genetic Counselor Network, testified in support of the bill. She referenced letters of support in the informational packet.

02:16 PM

Ms. Freivogal answered questions about what services genetic counselors provide and genetic testing laboratories. Ms. Walton answered questions about the types of samples taken for genetic testing. In response to a question, Ms. Walton discussed the genetic counseling program at the University of Colorado. Ms. Walton, Ms. Ku, and Ms. Freivogal answered questions about insurance coverage for genetic testing and counseling. The committee dialogued with the witnesses about genetic counseling.

02:42 PM

In response to questions, Ms. Freivogal and Ms. Walton discussed continuing education for genetic counselors. Ms. Walton answered questions about the licensure requirements in the bill and certification of genetic counselors. Ms. Walton further discussed the training for genetic counselors.

02:51 PM -- Dr. Tim Benke, Children's Hospital Colorado, testified in support of the bill. He discussed Rett syndrome and the importance of genetic counseling. Dr. Benke answered questions about the hiring process for genetic counselors and when a physician may utilize a genetic counselor.

02:59 PM -- Dr. Catherine Klein, representing herself, testified in support of the bill. She discussed the evolution of genetic testing, the various testing options, and the possible misinterpretation of test results.

03:05 PM -- Lauren Larson, Department of Regulatory Agencies, testified in opposition to the bill. She referenced the department's sunrise review of genetic counseling. She discussed the costs related to the bill. Ms. Larson discussed Colorado's sunrise process.

03:10 PM -- Saul Larsen, Department of Regulatory Agencies, made himself available to the committee for questions about the sunrise reviews the department has conducted on genetic counselors.

03:10 PM

Ms. Larson answered questions about fiscal impact of the bill. Mr. Larsen and Ms. Larson answered questions about possible harm to the public by genetic counselors and the licensing of professions in Colorado.

03:26 PM -- Melinda Dodge, representing herself, testified in support of the bill. She discussed her daughter's diagnosis of 22q deletion syndrome.

03:33 PM -- Noelle Johnson, representing herself, testified in support of the bill. She discussed her experience with genetic counseling for cancer.

03:36 PM -- Sarah Hunt, representing herself, testified in support of the bill. She discussed her experience with genetic counseling for dwarfism.

03:41 PM

Ms. Dodge answered questions about her ability to access genetic counseling and 22q deletion syndrome. Ms. Hunt answered questions about whether the bill could impact access to genetic counseling.

03:45 PM

Ms. Walton returned to the table to respond to questions about genetic testing of newborns and discussed the newborn screening panel testing program. Ms. Ku answered questions about cases of misdiagnosis by genetic counselors. Ms. Walton answered questions about the impact of licensure of genetic counselors in other states.

03:58 PM -- Scott Horak, representing himself, testified on the bill. He stated he is for genetic testing post-natal, but opposed to it prenatal.

04:05 PM -- Dr. Jan Kief, Colorado Medical Society, testified in support of the bill. She discussed her experience with genetic counselors and how licensing genetic counselors will improve access to this service. She referenced genetic testing costs.

04:13 PM

Tom Morris, Office of Legislative Legal Services, explained amendment L.002 (Attachment B).

150219 AttachB.pdf


BILL:	HB15-1147
TIME:	04:13:32 PM
MOVED:	Ginal
MOTION:	Adopt amendment L.002 (Attachment B). The motion passed without objection.
SECONDED:	McCann
		VOTE
	Brown
	Esgar
	Humphrey
	Joshi
	Klingenschmitt
	Landgraf
	Lontine
	Mitsch Bush
	Primavera
	Ransom
	Ryden
	Ginal
	McCann

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

04:14 PM

The committee discussed the bill. Representative Ginal made closing remarks on the bill.


BILL:	HB15-1147
TIME:	04:23:04 PM
MOVED:	Ginal
MOTION:	Refer House Bill 15-1147, as amended, to the Committee on Finance. The motion passed on a vote of 7-6.
SECONDED:	Esgar
		VOTE
	Brown	No
	Esgar	Yes
	Humphrey	No
	Joshi	No
	Klingenschmitt	No
	Landgraf	No
	Lontine	Yes
	Mitsch Bush	Yes
	Primavera	Yes
	Ransom	No
	Ryden	Yes
	Ginal	Yes
	McCann	Yes

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

04:24 PM -- HB 15-1163

The committee recessed.

04:32 PM

The committee came back to order. Representative Klingenschmitt presented House Bill 15-1163. Conditional upon a repeal of all or part of the federal Patient Protection and Affordable Care Act (PPACA), the bill automatically repeals the corresponding provisions in state law enacted by House Bill 13-1266 to align state health insurance laws with the requirements of the PPACA. The Commissioner of Insurance is required to notify the Revisor of Statutes if federal action is taken to repeal all or part of the PPACA in order to trigger the repeal of the various provisions in House Bill 13-1266.

The provisions of House Bill 13-1266 that are subject to repeal under the bill include:

• the mandatory issuance and renewal of health insurance policies;
• the prohibition against exclusions for pre-existing conditions;
• the requirement that health insurance plans cover children of policyholders up to age 26;

• the requirement that health insurance plans cover certain essential health benefits at various coverage levels;
• the open and special enrollment periods to purchase insurance in the individual and small group markets and required grace periods in which insured individuals may pay premiums;
• the prohibition against discrimination with respect to participation under an insurance plan by any provider acting within the scope of his or her license;
• fair market practices;
• the requirement that continuing coverage be offered to employees who are no longer employed by an employer; and
• procedures for the denial of benefits and internal reviews.

The bill maintains the existing requirements for maternity and contraception coverage and specifies that the mandated contraception coverage only applies to contraception that does not destroy an embryo. Also, the bill places a 20 percent cap on wellness coverage incentives, which can be adjusted in rule under current law.

Representative Klingenschmitt provided two handouts (Attachments C and D). He discussed the information provided in the handouts and expressed concern about unintended consequences of the PPACA. Committee members discussed insurance policy cancellations and insurance coverage for preexisting conditions with Representative Klingenschmitt.

150219 AttachC.pdf

150219 AttachD.pdf

04:44 PM

Committee discussion with Representative Klingenschmitt continued regarding specific provisions of the bill and the bill's contingent nature. Committee dialogued about the PPACA ensued.

05:03 PM -- Tony Gagliardi, National Federation of Independent Business, testified in support of the bill. He discussed his organization's position on the PPACA and its impact on small business. Mr. Gagliardi discussed his organization's position on the establishment of Colorado's health exchange. Mr. Gagliardi answered questions about health care reform, health insurance coverage for preexisting conditions, and the contingent nature of the bill.

05:18 PM -- A.W. Schnellbacher, Jr., AARP Colorado, testified in opposition to the bill. He discussed the implementation of Medicare and polling data on the PPACA. Mr. Schnellbacher relayed information about health care reform efforts in Colorado. Mr. Schnellbacher answered questions about whether AARP sells health insurance and the federal funding for the PPACA.

05:33 PM -- Scott Rankin, representing himself, testified in support of the bill. He discussed health insurance policy cancelation notices and funding for Colorado's health exchange and Medicaid expansion. Mr. Rankin answered questions about direct-pay physicians and the health insurance market prior to the enactment of the PPACA. The committee dialogued with Mr. Rankin about rescission of health insurance plans prior to enactment of the PPACA.

05:49 PM -- Amber Burkhart, Colorado Consumer Health Initiative, testified in opposition to the bill. She read from the handout she provided to the committee (Attachment E).

150219 AttachE.pdf

05:53 PM -- Allison Neswood, Colorado Center on Law and Policy, testified in opposition to the bill. She discussed health care and health insurance prior to the enactment of the PPACA. Ms. Neswood talked about the bill's contingent nature. Ms. Neswood answered questions about whether people were denied health care prior to the enactment of the PPACA.

06:00 PM -- Michael Schlierf, representing himself, testified on the bill. He discussed the cancellation of his health insurance policy and how he believes the PPACA limits consumer choice. Mr. Schlierf answered questions about his out-of-pocket costs for health care under his previous health insurance plan.

06:04 PM -- Michael Lott-Manier, Mental Health America of Colorado, testified in opposition to the bill. He conveyed information about the Blue Ribbon Commission for Health Care Reform, other health initiatives in Colorado, and House Bill 13-1266. Mr. Lott-Manier discussed mental health parity. Mr. Lott-Manier dialogued with the committee about the PPACA, as well as catastrophic insurance coverage.

06:19 PM -- Peg Brown, Division of Insurance in the Department of Regulatory Agencies, testified on the bill in a neutral capacity. She outlined the history of the provisions in the bill. Ms. Brown answered questions about House Bill 13-1266, health insurance cancellation notices, and Colorado's health insurance market. Ms. Brown dialogued with the committee about the PPACA and House Bill 13-1266. Ms. Brown distributed a handout (Attachment F).

150219 AttachF.pdf

06:36 PM

Representative Landgraf discussed amendment L.001 (Attachment G).

150219 AttachG.pdf


BILL:	HB15-1163
TIME:	06:37:14 PM
MOVED:	Landgraf
MOTION:	Adopt amendment L.001 (Attachment G). The motion passed without objection.
SECONDED:	Brown
		VOTE
	Brown
	Esgar
	Humphrey
	Joshi
	Klingenschmitt
	Landgraf
	Lontine
	Mitsch Bush
	Primavera
	Ransom
	Ryden
	Ginal
	McCann

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

06:37 PM

Representative Klingenschmitt made closing remarks about the bill. He referenced a letter from Don Rogers (Attachment H). Committee members commented on the bill.

150219 AttachH.pdf


BILL:	HB15-1163
TIME:	06:49:55 PM
MOVED:	Klingenschmitt
MOTION:	Refer House Bill 15-1163, as amended, to the Committee of the Whole. The motion failed on a vote of 6-7.
SECONDED:	Joshi
		VOTE
	Brown	Yes
	Esgar	No
	Humphrey	Yes
	Joshi	Yes
	Klingenschmitt	Yes
	Landgraf	Yes
	Lontine	No
	Mitsch Bush	No
	Primavera	No
	Ransom	Yes
	Ryden	No
	Ginal	No
	McCann	No

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


BILL:	HB15-1163
TIME:	06:51:15 PM
MOVED:	Ginal
MOTION:	Postpone House Bill 15-1163 indefinitely. The motion passed on a vote of 7-6.
SECONDED:	Esgar
		VOTE
	Brown	No
	Esgar	Yes
	Humphrey	No
	Joshi	No
	Klingenschmitt	No
	Landgraf	No
	Lontine	Yes
	Mitsch Bush	Yes
	Primavera	Yes
	Ransom	No
	Ryden	Yes
	Ginal	Yes
	McCann	Yes

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

06:52 PM

The committee adjourned.