Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH, INSURANCE, & ENVIRONMENT

Date:02/26/2015
ATTENDANCE
Time:01:32 PM to 05:37 PM
Brown
X
Esgar
X
Place:HCR 0107
Humphrey
*
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
*
Ryden
X
Ginal
X
McCann
X
X = Present, E = Excused, A = Absent, * = Present after roll call
Bills Addressed: Action Taken:
HB15-1211
SB15-052
HB15-1191
HB15-1143		Amended, Referred to Appropriations
Postponed Indefinitely
Amended, Referred to the Committee of the Whole
Amended, Referred to Finance


01:33 PM -- HB 15-1211

Representative Young presented House Bill 15-1211. The bill makes several changes to the licensing of durable medical equipment (DME) suppliers. Specifically, the bill modifies the definition of "DME supplier" to cover persons and entities who bill or plan to bill the federal Medicare program for certain products listed by the Center for Medicare and Medicaid Services in competitive bidding categories for the DME, prosthetics, orthotics, and supplies. It also exempts from the definition of DME supplier persons and entities who:

• provide products through the Medicare national mail order program;
• are Colorado pharmacies with a current pharmacy accreditation exemption to supply DME through Medicare; and
• are a medical practitioner providing DME to his or her own patients as part of the practitioner's own services.

The bill also removes the physical location requirement for DME suppliers to be licensed in Colorado. Instead, an applicant may be licensed if they attest that they are capable of selling or servicing all products that the supplier sells in the state on a 24-hour-per-day, 7-day-per-week basis.


01:41 PM

 Representative Young distributed a fact sheet (Attachment A) and amendments L.008 and L.009 (Attachments B and C). Representative Young clarified that amendment L.007 referenced in the fact sheet is actually amendment L.009. Representative Young answered questions about the proposed amendments and the potential increase in FTE, as indicated in the fiscal note.

150226 AttachA.pdf150226 AttachA.pdf150226 AttachB.pdf150226 AttachB.pdf150226 AttachC.pdf150226 AttachC.pdf

01:45 PM -- Kristen Forrestal, Office of Legislative Legal Services, answered a question about amendment L.009.

01:46 PM

Representative Young answered questions about DME.

01:48 PM -- Doug Coleman, Colorado Association for Medical Equipment Services, testified in support of the bill. He discussed House Bill 14-1369, concerning required licensure for durable medical equipment suppliers, and the Medicare competitive bidding program. Mr. Coleman discussed the hardship for consumers and discharge planners finding DME. Mr. Coleman answered questions about the allowable distance from Colorado DME suppliers can be located. Representative Young discussed the issues that arise when out-of-state suppliers are awarded the Medicare DME contracts. Mr. Coleman answered questions about the licensing requirements for DME suppliers. The committee dialogued with Mr. Coleman about the distance from Colorado that licensed DME suppliers can be located.

02:00 PM -- Brad Young, Rx Plus Pharmacies, testified in support of the bill. He discussed the impact that House Bill 14-1369 had on pharmacies.

02:03 PM

Representative Young discussed amendment L.008. The committee recessed.


02:07 PM

The committee came back to order. Representative Young further discussed amendment L.008.
BILL:HB15-1211
TIME: 02:08:26 PM
MOVED:McCann
MOTION:Adopt amendment L.008 (Attachment B). The motion passed without objection.
SECONDED:Ginal
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


02:08 PM

Representative Young explained amendment L.009. Representative Young and Representative Brown dialogued about the amendment and the Medicare competitive bidding program.
BILL:HB15-1211
TIME: 02:12:08 PM
MOVED:Landgraf
MOTION:Adopt amendment L.009 (Attachment C). The motion passed without objection.
SECONDED:Ginal
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

BILL:HB15-1211
TIME: 02:14:08 PM
MOVED:McCann
MOTION:Refer House Bill 15-1211, as amended, to the Committee on Appropriations. The motion passed on a vote of 13-0.
SECONDED:Ginal
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

02:15 PM -- SB 15-052

Representative Keyser presented Senate Bill 15-052. The bill requires that the Legislative Health Benefit Exchange Implementation Review Committee approve all bonuses for employees of the state's health benefit exchange (Connect for Health Colorado). Approval must be given in advance of the employee receiving the bonus.

02:18 PM

Representative Keyser answered questions about the exchange's employees and whether other quasi-governmental agencies require the same type of oversight as outlined in the bill. The committee dialogued with Representative Keyser about the Senate amendments to the bill, the Legislative Health Benefit Exchange Implementation Review Committee, and Connect for Health Colorado. Representative Keyser answered questions about the bonuses given to the exchange's employees and the fiscal note.

02:39 PM

The committee continued to dialogue with Representative Keyser about the bill.

02:45 PM -- Sharon O'Hara, Connect for Health Colorado, testified in opposition of the bill. She discussed the nonprofit status of the exchange and the Internal Revenue Services Form 990 that the exchange files. Ms. O'Hara answered questions about the employee bonuses given by the exchange to date and the number of employees the bill would impact. The committee dialogued with Ms. O'Hara about the Legislative Health Benefit Exchange Implementation Review Committee and Connect for Health Colorado.


03:04 PM

Ms. O'Hara answered questions about the possible impact the bill could have on recruiting new employees. Committee discussion with Ms. O'Hara about Connect for Health Colorado ensued.

03:11 PM

Representative Klingenschmitt explained amendment L.003 (Attachment D). The committee discussed the amendment.

150226 AttachD.pdf150226 AttachD.pdf

03:14 PM

The committee recessed.

03:20 PM

The committee came back to order.
BILL:SB15-052
TIME: 03:20:38 PM
MOVED:Klingenschmitt
MOTION:Adopt amendment L.003 (Attachment D). The motion failed on a vote of 6-7.
SECONDED:Brown
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


03:21 PM

Committee members commented on the bill and Connect for Health Colorado. Representative Keyser made concluding remarks. Committee members dialogued with Representative Keyser about the bill and Connect for Health Colorado.
BILL:SB15-052
TIME: 03:34:13 PM
MOVED:Landgraf
MOTION:Refer Senate Bill 15-052 to the Committee of the Whole. The motion failed on a vote of 6-7.
SECONDED:Brown
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:SB15-052
TIME: 03:36:53 PM
MOVED:Ginal
MOTION:Postpone Senate Bill 15-052 indefinitely. The motion passed on a vote of 7-6.
SECONDED:Primavera
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

03:38 PM

The committee recessed.

03:50 PM -- HB 15-1191

The committee came back to order. Representative McCann opened public testimony on House Bill 15-1191, concerning the addition of dentists to the "Physician Designation Disclosure Act." The Physician Designation Disclosure Act, created by Senate Bill 08-138, established minimum requirements a health care entity must meet when developing a designation for a physician.

03:51 PM -- Dr. Gary Field, Colorado Dental Association, testified in support of the bill. He discussed the importance of dental care and outlined aspects of designation programs.

03:57 PM

Representative Petterson presented House Bill 15-1191. The bill adds dentists to the Physician Designation Disclosure Act that was created by Senate Bill 08-138, and changes the name of the act to the "Health Care Provider Designation Disclosure Act." Under this bill, the standards and requirements for health care entities that assign designations to physicians based on performance assessments also apply to dentists.


Designations are based on claims data, practice criteria, or guidelines, and may be used in advertising by the health care provider to inform patients. Upon request of the designated dentist or the Division of Insurance within the Department of Regulatory Agencies, a health care entity is required to disclose the process and data used in creating a designation, and dentists may appeal a designation, during which time it cannot be used. The bill also allows a dentist to take civil action against a health care entity. A health care entity violating the act commits an unfair or deceptive practice in the business of insurance. Representative Petterson answered questions about the bill.

04:04 PM -- Jennifer Goodrum, Colorado Dental Association, testified in support of the bill. She discussed why only dentists are being added to the Physician Designation Disclosure Act and a potential amendment. Ms. Goodrum responded to questions about the bill from the committee.

04:09 PM -- Christy Chase, Office Legislative Legal Services, responded to a question about health care entity as the term is used in the bill.

04:11 PM

Representative Petterson explained amendment L.002 (Attachment E). Ms. Chase answered questions about the amendment.

150226 AttachE.pdf150226 AttachE.pdf
BILL:HB15-1191
TIME: 04:12:06 PM
MOVED:McCann
MOTION:Adopt amendment L.002 (Attachment E). 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


04:13 PM

Representative Petterson made concluding remarks about the bill.
BILL:HB15-1191
TIME: 04:13:43 PM
MOVED:Ginal
MOTION:Refer House Bill 15-1191, as amended, to the Committee of the Whole. The motion passed on a vote of 13-0.
SECONDED:Joshi
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

04:14 PM -- HB 15-1143

Representative Conti presented House Bill 15-1143, concerning a tax incentive for home health care. Representative Conti explained that she would be offering amendment L.001 (Attachment F), which is a strike-below amendment. With strike below amendment L.001, the bill provides a state income tax credit of up to $3,000 per year for out-of pocket costs for durable medical equipment (DME), telehealth equipment, home modifications, or home health care services incurred by a taxpayer who is 75 years of age or older.

150226 AttachF.pdf150226 AttachF.pdf

To claim the credit, the qualifying senior must obtain a credit certificate from an approved medical provider and include it with his or her tax return.

The amount of the credit is based on the taxpayer's federal taxable income and a percentage of the out-pocket costs incurred by the qualified senior. The amount of the credit is determined as follows:

• for single income tax filers with a federal taxable income between $0 and $25,000, taxpayers may claim 70 percent of the out-of-pocket costs incurred by the qualifying senior;
• for single income tax filers with a federal taxable income between $25,001 and $45,000, taxpayers may claim 35 percent of the out-of-pocket costs;



• for joint income tax filers with a federal taxable income between $0 and $50,000, taxpayers may claim 70 percent of the out-of-pocket costs incurred by the qualifying senior; and
• for joint income tax filers with a federal taxable income between $50,001 and $90,000, taxpayers may claim 35 percent of the out-of-pocket costs.

The tax credit is capped at $3,000 per income tax year and is nonrefundable. The taxpayer may carry forward any unused credits for up to three years. The taxpayer agrees to allow the Department of Revenue to review all necessary records related to the income tax credit under this bill.

The credit will be available for tax years 2015 through 2017.

Representative Conti answered questions about the bill and proposed amendment. The committee discussed the bill's fiscal note.

04:25 PM -- John Baumgarten, Virtual Care Works, spoke in support of the bill and discussed the provisions of amendment L.001 related to telehealth equipment. He responded to questions from the committee regarding telehealth equipment, and whether Medicare or Medicaid covers the equipment.

04:32 PM -- Ed Shackelford, Colorado Senior Lobby, testified in support of the bill. He discussed the cost effectiveness of the bill and the technology that can be installed in a home to improve home care. Representative Conti answered questions about expanding the bill to include additional technology.

04:37 PM -- John Vecchiarelli, Department of Revenue, made himself available for questions. He answered questions about expanding the list of accepted home improvements and DME. Mr. Vecchiarelli and Representative Conti responded to questions about the list of approved home care agencies required by amendment L.001. Mr. Vecchiarelli answered questions about the ownership requirements of the home to which improvements are being made. Representative Conti answered questions about what home modifications would be eligible for the tax credit. The committee dialogued with Representative Conti about the proposed amendment. Mr. Vecchiarelli answered questions about the percentage of the costs incurred that would be allowable for the tax credit as outlined by amendment L.001.

04:47 PM -- Vickie Agler, Colorado Association for Medical Equipment Services, testified in support of the bill. She discussed the definition of DME. Ms. Agler answered questions about the existing sales tax exemption for DME.

04:49 PM -- Amy Downs, Colorado Health Institute, testified in a neutral capacity. She read from the fact sheet she provided (Attachment G). Ms. Downs answered questions about the potential costs and savings the bill could provide. Representative Conti answered questions about whether assisted living facilities would be covered by the bill or only private residences.

150226 AttachG.pdf150226 AttachG.pdf

04:58 PM -- Lorin Chevalier, Home Care Association, testified in support of the bill. He discussed how the bill addresses the needs of Colorado's senior population. He listed the types of services seniors may need that are not covered by Medicare.

05:04 PM -- Diana Protopapa, Alzheimer's Association, testified in support of the bill.


05:05 PM -- Betsy Murray, Accessible Systems, testified in support of the bill. She discussed the home modifications listed under the proposed amendment.

05:06 PM -- Ellen Caruso, Home Care Agencies, testified in support of the bill. She discussed Medicare coverage of home health care and telehealth.

05:09 PM

Louis Pino, Legislative Council Staff, answered questions about the fiscal note.

05:16 PM

Esther van Mourik, Office of Legislative Legal Services, answered questions about the effective date of the bill. Mr. Pino answered additional questions about the fiscal note.

05:23 PM

Mr. Vecchiarelli returned to the witness table to answer questions about the additional FTE needed to implement the bill. Committee members commented on the bill and amendment L.001.
BILL:HB15-1143
TIME: 05:32:46 PM
MOVED:McCann
MOTION:Adopt amendment L.001 (Attachment F). The motion passed without objection.
SECONDED:Ginal
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


05:34 PM

Representative Conti made concluding remarks about the bill.
BILL:HB15-1143
TIME: 05:36:22 PM
MOVED:Ginal
MOTION:Refer House Bill 15-1143, as amended, to the Committee on Finance. The motion passed on a vote of 10-3.
SECONDED:Primavera
VOTE
Brown
Yes
Esgar
Yes
Humphrey
No
Joshi
Yes
Klingenschmitt
Yes
Landgraf
No
Lontine
Yes
Mitsch Bush
Yes
Primavera
Yes
Ransom
No
Ryden
Yes
Ginal
Yes
McCann
Yes
Final YES: 10 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS

05:37 PM

The committee adjourned.