House Committee on Health, Insurance, & Environment (04/02/2015)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH, INSURANCE, & ENVIRONMENT

Date:	04/02/2015	ATTENDANCE

Time:	01:36 PM to 06:52 PM	Brown	X
		Esgar	*
Place:	HCR 0112	Humphrey	X
		Joshi	X
This Meeting was called to order by		Landgraf	X
	Representative McCann	Lontine	X
		Mitsch Bush	X
This Report was prepared by		Primavera	X
	Amanda King	Ransom	X
		Ryden	*
		Sias	X
		Ginal	X
		McCann	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB15-1297 SB15-197 HB15-1309 HB15-1297		Witness Testimony and/or Committee Discussion Only Referred to the Committee of the Whole Amended, Referred to Finance Witness Testimony and/or Committee Discussion Only

01:37 PM -- HB 15-1297

Representative McCann explained the agenda for the meeting. She stated that the committee would hear testimony from Robert Holden, National Association of Vision Care Plans, on House Bill 15-1297, concerning unfair business practices within vision insurance plans, which the committee heard testimony on at its March 31, 2015, meeting. She said that after Mr. Holden's testimony the bill would be laid over until later in the meeting for additional testimony and action.

01:38 PM -- Robert Holden, National Association of Vision Care Plans, testified in opposition to the bill. He discussed the benefits that vision plans provide. He referenced the essential health benefits that require pediatric vision services under the federal Patient Protection and Affordable Care Act. He discussed the prices and discounts for eyeglasses. Mr. Holden shared his concerns about the bill. Mr. Holden answered questions about vision plans, credentialing requirements for optometrists, and the requirement for optometrists to use certain out-of-state laboratories for eyeglasses.

02:01 PM

The committee members continued to dialogue with Mr. Holden about vision plans, why optometrists would choose to contract with a vision plan, and the bill. Mr. Holden responded to questions about similar legislation introduced and enacted in other states.

02:20 PM

Discussion between the committee members and Mr. Holden ensued.

02:33 PM

Representative McCann laid the bill over until later in the meeting.

02:33 PM -- SB 15-197

Representative Willet and Representative Fields presented Senate Bill 15-197. The bill makes several changes regarding the prescriptive authority of advanced practice nurses (APNs). Specifically, the bill:

• eliminates the 1,800 hours of preceptorship required for an APN to achieve provisional prescriptive authority and instead allows an APN to gain provisional prescriptive authority upon graduation and passage of the certification examination;
• reduces the hours of the prescribing mentorship required for an APN to gain full prescriptive authority from 1,800 hours to 1,000 hours;
• allows an APN to complete a prescribing mentorship under the supervision of an APN with full prescriptive authority in his or her same area of practice;
• allows an APN to communicate with his or her mentor remotely in real time, although email is excluded from the allowable forms of communication; and
• specifies that provisional prescriptive authority expires after three years if a mentorship is not completed.

The bill sponsors showed a video of a news story concerning APNs.

02:43 PM -- Dr. Jana Faragher, representing herself, testified remotely in support of the bill. She discussed being a nurse practitioner in a rural community. Dr. Faragher answered questions about her education, her practice, the bill, and her ability to obtain prescriptive authority.

02:54 PM -- Barbara Kelley, Department of Regulatory Agencies, testified in support of the bill. She discussed the Nurse Physician Advisory Task Force for Colorado Healthcare (NPATCH) review of the current requirements for APNs to obtain prescriptive authority. Director Kelley answered questions about the current requirements for an APN to obtain full prescriptive authority.

03:00 PM -- Douglas Warnecke, NPATCH, testified in support of the bill. He discussed the process utilized in preparing the NPATCH's Final Report and Recommendations on the Requirements for Advanced Practice Registered Nurses Seeking Prescriptive Authority dated November 10, 2014.

03:01 PM -- Dr. Sue Townsend, NPATCH, testified in support of the bill. She discussed how the current requirements for APNs to obtain prescriptive authority were established and how the proposed requirements in bill were determined.

03:04 PM

Mr. Warnecke answered questions about the bill. In response to a question, Mr. Warnecke and Dr. Townsend discussed the difficulties of finding preceptors in rural areas. Dr. Townsend and Mr. Warnecke answered questions about the Senate amendments to the bill.

03:10 PM -- Dr. Amy Silva-Smith, representing the University of Colorado system, testified in support of the bill. She discussed the educational process for nurses to become APNs and the access to care that APNs provide.

03:16 PM -- Dr. Margaret Hughes, AARP, testified in support of the bill. She discussed the shortage of primary care practitioners and the current requirements for APNs to obtain full prescriptive authority.

03:21 PM -- Aubrey Hill, Colorado Coalition for the Medically Underserved, testified in support of the bill. She discussed the limited access to health care in certain parts of Colorado.

03:24 PM -- Dr. Barry Martin, Colorado Community Health Network, testified in support of the bill. He discussed his experience working with APNs. Representative Fields discussed Dr. Martin's work in Aurora.

03:28 PM -- Dr. Mary Ciambelli, Colorado Nurses Association, testified in support of the bill. She discussed how the bill will help remove barriers for APNs from obtaining prescriptive authority. Dr. Ciambelli answered questions about how the bill will help increase the health care workforce in Colorado.

03:33 PM -- Jacob Weinstein, representing himself, testified in support of the bill. He discussed his educational and professional experience. He shared his personal experience of not being able to find employment without prescriptive authority and how he cannot obtain prescriptive authority without employment. He discussed the other states that allow independent prescriptive authority for APNs.

03:38 PM -- Molly Harris, representing herself, testified in support of the bill. She discussed her educational and professional experience in nursing. She discussed the primary care providers shortage and the difficulties for APNs to find employment in Colorado. She referenced a 2010 Colorado Health Institute study focusing on APNs.

03:43 PM -- Lee Anne Merrifield, Colorado Behavioral Healthcare Council, testified in support of the bill. She relayed statistics about providing care to people with mental health needs. She stated that APNs are leaving the state or not coming to Colorado due to the current requirements.

03:47 PM -- Charlotte Yanakopolous-Veath, Colorado Behavioral Healthcare Council, testified in support of the bill. She discussed the costs to health care organizations caused by the current 3,600 hour requirement for an APN to obtain full prescriptive authority. She discussed the health care workforce shortage.

03:52 PM -- Beccy Finn, representing herself, testified in support of the bill. She stated the bill does not change the scope of practice for APNs. She shared her professional and educational experience as a nurse working to obtaining her APN degree.

03:56 PM -- Heather Dunham, representing herself, testified in support of the bill.

03:57 PM -- Melissa Bosworth, Colorado Rural Health Center, testified in support of the bill. She provided two handouts (Attachments A and B) to the committee members. She discussed the Colorado Provider Recruitment Program, which focuses on expanding the primary care workforce throughout Colorado's rural communities, and shared statistics about rural health care providers.

150402 AttachA.pdf

150402 AttachB.pdf

04:00 PM -- Kelly Gallegos, San Luis Valley Health, testified in support of the bill. She discussed the difficulties in recruiting APNs due to the current prescriptive authority requirements.

04:03 PM -- Denise Clark, Mt. San Rafael Hospital, testified in support of the bill. She discussed how the bill will allow APNs to mentor APNs. She relayed health statistics about Las Animas County. She discussed APNs leaving the state after receiving their education and training in Colorado. Representative Joshi discussed being a preceptor.

04:09 PM -- Deanna Tolman, ClinicNet, testified in support of the bill. She shared her experience operating a health clinic. Ms. Tolman answered questions about the training for nurses related to prescribing authority.

04:14 PM -- Gail Finley, Colorado Hospital Association, testified in support of the bill.

04:15 PM -- Candace Deyerling, representing herself, testified in support of the bill.

04:16 PM -- Dr. Shawn Elliott, representing herself, testified in support of the bill. She explained that she works as a part-time pediatric nurse practitioner in Alamosa, averaging eight hours a week. She noted that at this rate, it would take her seven years to obtain prescriptive authority under the current statutes.

04:20 PM -- Lauren Larson, Department of Regulatory Agencies, testified in support of the bill. She discussed the data in the handout comparing disciplinary actions in other states against APNs with independent prescriptive authority (Attachment C).

150402 AttachC.pdf

04:22 PM

Representative Fields described the process leading to the bill. Committee members commented on the bill.


BILL:	SB15-197
TIME:	04:28:13 PM
MOVED:	Landgraf
MOTION:	Refer Senate Bill 15-197 to the Committee of the Whole. The motion passed on a vote of 13-0.
SECONDED:	Sias
		VOTE
	Brown	Yes
	Esgar	Yes
	Humphrey	Yes
	Joshi	Yes
	Landgraf	Yes
	Lontine	Yes
	Mitsch Bush	Yes
	Primavera	Yes
	Ransom	Yes
	Ryden	Yes
	Sias	Yes
	Ginal	Yes
	McCann	Yes

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

04:29 PM

The committee recessed.

04:35 PM -- HB 15-1309

The committee came back to order. Representative Ginal presented House Bill 15-1309. The bill allows dental hygienists to receive a permit from the Colorado Dental Board to perform interim therapeutic restorations. In order to receive a permit, a dental hygienist must:

• hold a license in good standing to practice dental hygiene;
• carry professional liability insurance;
• complete required training; and
• complete a board-approved course concerning interim therapeutic restorations.

Under the bill, the Department of Regulatory Agencies must establish an advisory committee to develop standards for interim therapeutic restorations. The bill specifies the membership of the committee and requires the committee to submit its recommendations to the Dental Board within 120 days of the bill taking effect.

The bill places various restrictions on dental hygienists performing interim therapeutic restorations, including prohibiting the use of local anesthesia and requiring that a dentist first provide the diagnosis, treatment plan, and instruction for the dental hygienist to perform the restoration. The bill allows dentists to supervise and order interim therapeutic restorations by dental hygienists via telehealth and outlines rules for such remote consultations. Medicaid and the Children's Basic Health Plan may reimburse dentists for services provide via telehealth relating to interim therapeutic restorations.

04:39 PM -- Dr. Jeff Kohl, Colorado Dental Association, testified in support of the bill. He discussed increasing access to dental care and outlined the barriers to dental care. He explained interim therapeutic restorations. Dr. Kohl answered questions about interim therapeutic restorations and the telehealth provision of the bill.

04:52 PM -- Deb Astroth, Colorado Dental Hygienists' Association, testified on the bill. She stated that the bill was a collaborative effort. She discussed how the bill will broaden the reach of dental professionals in rural parts of the state.

04:54 PM -- Linda Reiner, Caring for Colorado, testified on the bill. She provided information on establishing a virtual dental home pilot program in Colorado. She shared statistics about school-based sealant programs.

04:58 PM -- Deborah Foote, Oral Health Colorado, testified in support of the bill. She provided a handout (Attachment D) to the committee members. She listed the entities that are supporting the legislation.

150402 AttachD.pdf

05:00 PM -- Bill Heller, Department of Health Care Policy and Financing, testified in support of the bill. He discussed the Medicaid dental program and how the bill will be beneficial to several populations.

05:05 PM

Representative Ginal explained L.001 (Attachment E). The committee discussed the fiscal note.

150402 AttachE.pdf


BILL:	HB15-1309
TIME:	05:05:42 PM
MOVED:	Ginal
MOTION:	Adopt amendment L.001 (Attachment E). The motion passed without objection.
SECONDED:	McCann
		VOTE
	Brown
	Esgar
	Humphrey
	Joshi
	Landgraf
	Lontine
	Mitsch Bush
	Primavera
	Ransom
	Ryden
	Sias
	Ginal
	McCann

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

05:07 PM

Representative Ginal made closing remarks about the bill.


BILL:	HB15-1309
TIME:	05:08:56 PM
MOVED:	Ginal
MOTION:	Refer House Bill 15-1309, as amended, to the Committee on Finance. The motion passed on a vote of 13-0.
SECONDED:	McCann
		VOTE
	Brown	Yes
	Esgar	Yes
	Humphrey	Yes
	Joshi	Yes
	Landgraf	Yes
	Lontine	Yes
	Mitsch Bush	Yes
	Primavera	Yes
	Ransom	Yes
	Ryden	Yes
	Sias	Yes
	Ginal	Yes
	McCann	Yes

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

05:10 PM

The committee recessed.

05:15 PM -- HB 15-1297

The committee came back to order and resumed hearing testimony on House Bill 15-1297, concerning unfair business practices within vision insurance plans.

05:16 PM -- Ben Price and Sara Orrange, Colorado Association of Health Plans, testified in opposition to the bill. Mr. Price summarized his testimony from the March 31, 2015, committee meeting. Mr. Price answered questions about vision insurance. Ms. Orrange answered questions about health insurance plans' ability to contract with optometrists. Mr. Price answered questions about health insurance plans and vision care plans. Representative Mitsch Bush referenced list of vision care plans (Attachment F) that was provided by the National Association of Vision Care Plans. The committee continued to dialogue with Mr. Price about vision care plans, health insurance plans, and credentialing requirements.

150402 AttachF.pdf

05:30 PM -- Dan O'Connell, Colorado Association of Commerce and Industry, testified in opposition to the bill. He discussed the ongoing discussion to develop amendments. He outlined his organization's concerns about the bill. Mr. O'Connell answered questions about the members of his organization and his organization's position on the bill. In response to a question, he discussed cost-shifting. Committee discussion with Mr. O'Connell ensued.

05:52 PM

Mr. O'Connell reiterated his desire to allow additional time for the interested parties to work to address their concerns with the legislation.

05:54 PM -- Dr. Mitchell Munson, representing himself, testified in support of the bill. He provided a handout (Attachment G) to the committee that outlines the reimbursement rates for optometrists under various vision care plans. Dr. Munson discussed legislation in other states and credentialing requirements under health insurance plans. He explained non-covered materials and the required discounts. He discussed retinal scans. Dr. Munson explained situations in which medical insurance would be billed for vision exams. He expressed why legislation is necessary to address the concerns of the optometrists related to vision care plans. Dr. Munson answered questions about the contract negotiations between vision care plans and optometrists.

150402 AttachG.pdf

06:06 PM

Committee discussion with Dr. Munson ensued.

06:11 PM

In response to a question, Kevin Paul, Colorado Optometric Association, came to the table to discuss anti-trust laws.

06:13 PM

Dr. Munson answered questions about vision care plans and non-covered services. He discussed Medicare reimbursement rates. Dr. Munson continued to respond to questions from the committee.

06:22 PM -- Virginia Morrison Love, America's Health Insurance Plans, testified in opposition to the bill. She discussed the market share that various vision care plans have in Colorado. She outlined her concerns about the bill. Ms. Morrison Love answered questions about the bill and vision care plans.

06:33 PM -- Kevin Paul, Colorado Optometric Association, testified in support of the bill. He outlined the provisions of the bill, requirements of vision care plans, and anti-trust issues. Mr. Paul answered question about the use of the term "credentialing" in the bill and the unfair or deceptive acts or practices statute.

06:44 PM -- Kathi Williams, Colorado Optometric Association, testified in support of the bill. She discussed cost shifting related to vision care. She discussed how House Bill 15-1297 compares to legislation in other states. She discussed meeting with Division of Insurance in the Department of Regulatory Agencies and Attorney General's Office about vision care plans. She referenced a handout that outlines the difference between general health insurance and vision care plans (Attachment H).

150402 AttachH.pdf

06:50 PM

Representative McCann discussed laying over the bill with the sponsors to allow time for the stakeholders to meet on the bill. Representative McCann laid the bill over the bill to a future date to be determined

06:52 PM

The committee adjourned.