House Committee on Health, Insurance, & Environment (02/05/2015)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH, INSURANCE, & ENVIRONMENT

Date:	02/05/2015	ATTENDANCE

Time:	01:35 PM to 07:22 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:
HB15-1083 HB15-1075		Witness Testimony and/or Committee Discussion Only Amended, Referred to the Committee of the Whole

01:36 PM -- HB 15-1083

Representative Primavera presented House Bill 15-1083. The bill prohibits insurance companies from classifying office visits for physical rehabilitation services provided by a physical therapist, occupational therapist, or chiropractor as a specialty service. In addition, the copayment cannot be more than 50 percent of the payment amount that the provider is paid by the insurance carrier for the visit. A handout on the bill was distributed to the committee (Attachment A).

150205 AttachA.pdf

01:44 PM

Representative Primavera responded to questions about House Bill 14-1108, concerning limits on copayments made by a covered person for physical rehabilitation services, that was vetoed by the Governor; House Bill 15-1083; and whether a definition of a speciality service exists in state law.

01:53 PM -- Dr. Audrey Waldron, American Physical Therapy Association, testified in support of the bill. She provided a copy of her testimony to the committee (Attachment B). Dr. Waldron answered questions about how the payment process would changed by the bill. The committee dialogued with Dr. Waldron about payments for physical therapy. She responded to a question about the organizations that opposed House Bill 14-1108.

150205 AttachB.pdf

02:08 PM -- Dr. Terry Gebhardt, American Physical Therapy Association, testified in support of the bill. He outlined elements of physical therapy and how it can prevent the need for other more expensive and more invasive procedures. In response to a question, Dr. Gebhardt referenced a handout (Attachment C) that was provided to the committee. He answered questions about payments, billing, and costs for physical therapy.

150205 AttachC.pdf

02:18 PM -- Ben Myerhoff, representing himself, testified in support of the bill. He discussed his experience needing extensive physical therapy and occupational therapy after a spinal cord injury and how the current payment system may prevent care.

02:22 PM -- Dr. James Farrell, Colorado Chiropractic Association, testified in support of the bill. He reviewed the billing statements for physical rehabilitation services that he provided to the committee (Attachment D). Dr. Farrell responded to questions about the billing statements he provided to committee, Medicare and Medicaid reimbursement rates, and payments for chiropractic services.

150205 AttachD.pdf

02:36 PM -- Pam DiPasquale, Occupational Therapy Association of Colorado, testified in support of the bill. She described the types of patients who seek occupational therapy. She outlined the possible secondary complications that can occur in patients in need of occupational therapy. Ms. DiPasquale responded to questions about the average number of occupational therapy visits a patient may require, the use of billing codes for occupational therapy, and the rate setting process for occupational therapy services.

02:46 PM -- Stefan Van Duursen, American Physical Therapy Association, testified in support of the bill. He provided a copy of his testimony to the committee (Attachment E). Mr. Van Duursen answered questions about the handout he provided and about copayments, self-pay rates, and reimbursement rates for physical therapy.

150205 AttachE.pdf

03:04 PM

The committee dialogued with Mr. Van Duursen about health care costs in the United States and Europe.

03:07 PM -- Sherry Jones-Meador, representing herself, testified in support of the bill. She discussed her increasing copayments for specialists and her need for physical therapy.

03:11 PM -- Sara Orrange, Colorado Association of Health Plans, testified in opposition to the bill. She discussed the administrative burden for insurance carriers created by the cost sharing outlined in the bill. Ms. Orrange expressed her organization's concerns about the reclassification of rehabilitation services. She stated that a patient should never overpay for services.

03:15 PM -- Virginia Morrison Love, America's Health Insurance Plans, testified in opposition to the bill. She discussed health insurance premiums and copayments. Ms. Morrison Love stated that the bill would result in a co-insurance for certain rehabilitation services. She referenced the rehabilitation services and insurance plans that would not be covered by the bill. She discussed the benefits to a patient for utilizing insurance to pay for rehabilitation services rather than self paying.

03:20 PM

Ms. Morrison Love and Ms. Orrange answered question about patients choosing to opt-out of physical therapy and the different types of copayments for certain services. Ms. Morrison Love answered questions about preventative care and why there are different copayments for rehabilitation services and primary care. The committee dialogued with Ms. Morrison Love and Ms. Orrange about health insurance copayments, health insurance plans, and the classification of rehabilitation services by health insurance carriers.

03:31 PM -- Dan O'Connell, Colorado Association of Commerce and Industry, testified in opposition to the bill. He discussed his organization's concerns about the cost sharing outlined in the bill. In response to a question, Mr. O'Connell discussed how the bill would limit the ability of health insurance carriers to recover costs associated with certain services. He answered questions about primary care providers. Mr. O'Connell referenced the Colorado Commission on Affordable Health Care in response to a question about addressing health care costs.

03:44 PM -- Christina Johnson, Colorado Cross-Disability Coalition and Atlantis Community, Inc., testified in support of the bill. She discussed her need for physical therapy after a severe car accident.

03:46 PM -- Mizraim Cordero, Colorado Competitive Council, testified in opposition to the bill. He discussed how the bill could increase health care costs. He referenced the Governor's veto of House Bill 14-1108 during his testimony.

03:49 PM -- Representative Ken Summers, representing himself, testified in support of the bill. He discussed access to and equity in health care for consumers. He shared his personal story about needing rehabilitative services.

03:58 PM

The bill was laid over at the request of the sponsor. The committee took a brief recess.

04:08 PM -- HB 15-1075

The committee came back to order. Representative Ginal presented House Bill 15-1075. The bill allows registered naturopathic doctors to treat children under two years of age if certain conditions are met. The conditions outlined in the bill are the same as those under current law for naturopathic doctors who treat children between the ages of two and eight. Specifically, in order to treat a child under the age of two, the bill requires naturopathic doctors to:

• provide the child's parent with the current recommended immunization schedule for children;
• complete 3 hours per year in education or training in pediatrics in any year that he or she treats children under the age of two;
• require the child's parent to sign an informed consent form prior to providing services; and
• refer a child to a licensed physician at his or her first visit if the child does not have a pediatric health care provider.

The informed consent form must inform the parent about the naturopathic doctor's registration under the Naturopathic Doctor Act, state that he or she is not a licensed physician, recommend that the child maintain a relationship with a licensed physician, and request permission to collaborate with the child's pediatric health care provider. An informational packet was distributed to the committee (Attachment F).

150205 AttachF.pdf

04:16 PM

Representative Ginal responded to questions about the continuing medical education requirements for naturopathic doctors outlined in the bill. She distributed amendment L.001 (Attachment G). She responded to questions about the medical liability insurance requirements for naturopathic doctors. The committee dialogued with Representative Ginal about the bill.

150205 AttachG.pdf

04:23 PM -- Dr. Mark Cooper, Colorado Association of Naturopathic Doctors, spoke in favor of the bill. He discussed the current training requirements for naturopathic doctors. Dr. Cooper answered questions from the committee regarding the scope of practice and regulation of naturopathic doctors. He discussed the importance of referrals and the types of treatments he can provide to patients. Dr. Cooper answered questions from the committee regarding immunization of infants and the training requirements outlined in amendment L.001. He spoke on insurance reimbursements related to naturopathic doctors.

04:35 PM

Representative Ginal spoke on other states that have licensed or registered naturopathic doctors. Dr. Cooper answered questions about naturopathic doctors in Montana. The committee dialogued with Dr. Cooper about vaccination rates in states that license naturopathic doctors. Dr. Cooper answered questions about over-the-counter supplements and herbal treatments. He provided a handout to the committee (Attachment H).

150205 AttachH.pdf

04:44 PM -- Ronne Hines, Department of Regulatory Agencies, stated that the department is neutral on the bill. She responded to questions about the complaints the department has received about naturopathic doctors and the continuing education requirements outlined in the bill. Ms. Hines responded to questions about investigations of herbal supplements.

04:48 PM -- Dr. Jody Shevins, Colorado Association of Naturopathic Doctors, testified in support of the bill. She discussed her experience becoming a naturopathic doctor, the recent measles outbreak and vaccinations, and collaborating with medical physicians.

04:55 PM

Representative Ginal relayed statistics on vaccinations rates in other states and Colorado.

04:56 PM -- Larry Sarner, Advocates for Children in Therapy, testified in opposition to the bill. He discussed his organization that was formed after the death of a child receiving attachment therapy. He discussed vaccination rates of children treated by naturopathic doctors. Mr. Sarner answered questions about the treatment he referenced during his testimony.

05:03 PM -- Maureen Maker, Colorado Citizens for Science in Medicine, testified in opposition to the bill. She discussed vaccination rates of children treated by naturopathic doctors and the role of the Department of Regulatory Agencies in regulating naturopathic doctors. Ms. Maker responded to question about vaccination practices of naturopathic doctors and the requirements of the bill related to the immunization schedule. The committee continued to dialogue with Ms. Maker about the treatment of children by naturopathic doctors and childhood immunizations.

05:16 PM -- Linda Rosa, Institute for Science in Medicine, testified in opposition to the bill. She discussed naturopathic doctors' practices concerning immunizations and treating children. Ms. Rosa responded to questions about naturopathic doctors treatments for children.

05:28 PM -- Dr. Christina Suh, Children's Hospital Colorado, testified in opposition to the bill. She provided a handout to the committee (Attachment I). She discussed her concerns about naturopathic doctors treating infants and toddlers. Dr. Suh responded to questions about parents who prefer to have their children treated by naturopathic doctors. She responded to questions about the continuing medical education requirements for pediatricians, potential amendments to the bill, and whether she would refer a parent of a young child to a naturopathic doctor. She responded to questions about residency requirement for various medical professionals and whether those professionals are banned from seeing patients under two years of age. Dr. Suh responded to questions about the position of the Colorado Medical Society on the bill.

150205 AttachI.pdf

05:44 PM

Representative Ginal discussed the ability of chiropractors to treat children under two years old. Dr. Suh discussed one of her infant patients who was seen by a chiropractor and had negative results.

05:47 PM -- Alan Lewis, representing himself, testified in support of the bill. He discussed his daughter's personal experience with a pediatrician that resulted in needing to be admitted to the intensive care unit.

05:51 PM -- Janet Opila-Lehman, Colorado Association of Naturopathic Doctors, testified in support of the bill. She discussed vaccinations for children and the training of naturopathic doctors in infant nutritional care. She stated that naturopathic doctors provide safety net care for children whose families refuse to see pediatricians. Ms. Opila-Lehman responded to questions about possibly increasing the continuing medical education requirements in the bill.

05:56 PM -- Donna Walter, Colorado Association of Naturopathic Medicine, testified on the bill. She discussed House Bill 13-1111, concerning the regulation of naturopathic doctors, and Senate Bill 13-215, concerning alternative health care practitioners, that were enacted in 2013. She discussed allowing alternative health practitioners the ability to treat children under two years of age. Ms. Walter answered questions about her educational background and her credentials in naturopathy. She responded to questions about whether the bill provides more or less parental choice.

06:10 PM -- Nate Gorman, Sunshine Health Freedom Foundation, testified on the bill in a neutral capacity. He discussed Senate Bill 13-215 and the prohibition of alternative health practitioners from treating children under two years of age.

06:16 PM -- Zach Zaslow, Children's Hospital Colorado, testified in opposition to the bill. He discussed the ability of certain health care providers to treat children aged zero to two years old. He stated support of a potential amendment to require a referral by a physician prior to a naturopathic doctor treating a child under two years of age. Mr. Zaslow responded to questions about how likely a physician would be to refer a patient to a naturopathic doctor.

06:23 PM -- Dr. Caitlin O'Connor, Colorado Association of Naturopathic Doctors, testified in support of the bill. She discussed consumer choice, consumer safety, and collaboration. She relayed information about other states that license naturopathic doctors. Dr. O'Connor referenced a letter in the informational packet provided to the committee (Attachment F). In response to questions, Dr. O'Connor discussed the types of treatments and herbs that might be prescribed for infants and young children by a naturopathic doctor, if it was permitted. Dr. O'Connor answered questions about the malpractice insurance requirements for naturopathic doctors and the collaborative relationships between physicians and naturopathic doctors. In response to a question, she discussed the scope of practice of naturopathic doctors.

06:42 PM

Representative Ginal answered questions about amendment L.001. The committee discussed the amendment.


BILL:	HB15-1075
TIME:	06:43:48 PM
MOVED:	Ginal
MOTION:	Adopt amendment L.001 (Attachment G). The motion passed without objection.
SECONDED:	Ransom
		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

06:45 PM

Representative Ryden explained amendment L.002 (Attachment J) and referenced a letter from the American Academy of Pediatricians that was in the informational packet (Attachment F) that was distributed to the committee. Representative Ginal commented on the amendment. Committee discussion about the amendment ensued. Christy Chase, Office of Legislative Legal Services, responded to questions about the Michael Skolnik Medical Transparency Act and amendment L.002.

150205 AttachJ.pdf


BILL:	HB15-1075
TIME:	07:02:56 PM
MOVED:	Ryden
MOTION:	Adopt amendment L.002 (Attachment J). The motion failed on a vote of 5-8.
SECONDED:	Primavera
		VOTE
	Brown	No
	Esgar	No
	Humphrey	No
	Joshi	Yes
	Klingenschmitt	No
	Landgraf	No
	Lontine	Yes
	Mitsch Bush	Yes
	Primavera	Yes
	Ransom	No
	Ryden	Yes
	Ginal	No
	McCann	No

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

07:05 PM

Representative Joshi explained amendment L.003 (Attachment K). Committee discussion about the amendment ensued. Representative Ginal commented on the amendment.

150205 AttachK.pdf


BILL:	HB15-1075
TIME:	07:12:01 PM
MOVED:	Joshi
MOTION:	Adopt amendment L.003 (Attachment K). The motion failed on a vote of 6-7.
SECONDED:	Landgraf
		VOTE
	Brown	No
	Esgar	Yes
	Humphrey	No
	Joshi	Yes
	Klingenschmitt	No
	Landgraf	Yes
	Lontine	Yes
	Mitsch Bush	Yes
	Primavera	No
	Ransom	No
	Ryden	Yes
	Ginal	No
	McCann	No

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

07:15 PM

Representative Ginal made closing remarks about the bill and answered questions about the bill.


BILL:	HB15-1075
TIME:	07:18:56 PM
MOVED:	Ginal
MOTION:	Refer House Bill 15-1075, as amended, to the Committee of the Whole. The motion passed on a vote of 9-4.
SECONDED:	McCann
		VOTE
	Brown	Yes
	Esgar	Yes
	Humphrey	Yes
	Joshi	No
	Klingenschmitt	Yes
	Landgraf	Yes
	Lontine	No
	Mitsch Bush	No
	Primavera	Yes
	Ransom	Yes
	Ryden	No
	Ginal	Yes
	McCann	Yes

Final YES: 9 NO: 4 EXC: 0 ABS: 0 FINAL ACTION: PASS

07:20 PM

Representative Primavera, on behalf of Representative McCann, announced that the committee would not meet on Tuesday, February 10. The committee adjourned.