House Committee on Health, Insurance, & Environment (02/17/2015)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH, INSURANCE, & ENVIRONMENT

Date:	02/17/2015	ATTENDANCE

Time:	10:48 AM to 01:20 PM	Brown	X
		Esgar	X
Place:	HCR 0107	Humphrey	X
		Joshi	X
This Meeting was called to order by		Klingenschmitt	X
	Representative McCann	Landgraf	*
		Lontine	*
This Report was prepared by		Mitsch Bush	X
	Kori Donaldson	Primavera	X
		Ransom	*
		Ryden	X
		Ginal	X
		McCann	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB15-1186 HB15-1182		Referred to Appropriations Amended, Referred to the Committee of the Whole

10:49 AM -- HB 15-1186

The committee was called to order. A quorum was present. Representative Dave Young, prime sponsor, presented House Bill 15-1186, which is recommended by the Joint Budget Committee. The bill expands eligibility for the Autism Waiver Program by increasing the age limit from six years of age to eight years of age. If a child enrolls prior to his or her eight birthday, he or she is eligible to receive services for a total of three full years. The bill removes the existing per child spending cap of $25,000 per year and instead directs the Medical Services Board in the Department of Health Care Policy and Financing to set the per child spending cap each year based on available appropriations. Representative Young distributed a summary of the bill, prepared by Joint Budget Committee (JBC) staff (Attachment A).

150217 AttachA.pdf

He responded to questions from the committee about the anticipated cost of the bill. In response to a question about whether all children with an autism diagnosis are eligible to qualify for an autism waiver, Representative Young said any child that meets the statutory definition of autism qualifies for the autism waiver. He also responded to a question about whether the members of the JBC unanimously support the bill.

11:01 AM -- Ms. Marijo Rymer, representing the ARC of Colorado, testified in support of the bill. Ms. Rymer described the limitations associated with the number of children that may qualify for the autism waiver under current law and the need to expand eligibility to more children. She responded to a question from the committee about the additional number of children that may qualify for an autism waiver if the bill is adopted. She also responded to questions about the efficacy of available programs for qualifying children and the types of services available to children after they age out of the program.

11:10 AM -- Dr. Corry Robinson Rosenberg, representing the University of Colorado School of Medicine, testified in support of the bill. Dr. Robinson Rosenberg discussed early intervention research related to children with autism. She addressed questions from the committee about how parents can be involved in the treatment and instruction of autistic children. Dr. Robinson Rosenberg discussed possible factors associated with the occurrence of autism, including a genetic predisposition and environmental conditions. Discussion ensued on this topic.

11:23 AM

Dr. Robinson Rosenberg addressed a question about whether treatments will differ for older children that may be enrolled in the program if the bill is adopted. Discussion returned to possible factors associated with the occurrence of autism.

11:26 AM

Representative Young stated that the Autism Society is supportive of the bill.

11:27 AM -- Ms. Jill Pidcock, representing herself as a parent of an autistic child and as a board member of the ARC of Colorado, testified in support of the bill. She described her experience as the parent of an autistic child. Her child was wait-listed and never qualified for the autism waiver. Ms. Pidcock also described a day in the life of her autistic child.

11:37 AM -- Mr. Josh Rael, Director of Alliance, testified in support of the bill. Mr. Rael provided a copy of his testimony (Attachment B).

150217 AttachB.pdf

11:39 AM -- Mr. Ken Winn, representing Firefly Autism, testified in support of the bill. Mr. Winn spoke about the effectiveness of behavioral treatments for individuals with autism. He also spoke about ways to decrease costs associated with treatments for people with autism.

11:45 AM -- Ms. Carol Meredith, representing herself as the parent of an autistic child and the ARC of Arapahoe and Douglas Counties,, testified in support of the bill. She explained that it is important to provide behavioral treatments to young children with autism, rather than wait until children are older. She stated that the services that were made available to her adult son during his school career were not sufficient and that he would have benefited from early intervention and additional behavioral treatments. Ms. Meredith responded to questions from the committee about whether she would have benefitted from training as the parent of an autistic child.

11:52 AM -- Mr. David Bolin, Executive Director of Accent on Independence, testified in support of the bill. He responded to a question from the committee about how his organization is funded.

11:55 AM

Representative Young made some closing remarks about the bill. Various members of the committee commented on the merits of the bill.


BILL:	HB15-1186
TIME:	11:58:56 AM
MOVED:	Landgraf
MOTION:	Refer House Bill 15-1186 to the Committee on Appropriations. The motion passed on a vote of 11-2.
SECONDED:	Ginal
		VOTE
	Brown	Yes
	Esgar	Yes
	Humphrey	No
	Joshi	Yes
	Klingenschmitt	Yes
	Landgraf	Yes
	Lontine	Yes
	Mitsch Bush	Yes
	Primavera	Yes
	Ransom	No
	Ryden	Yes
	Ginal	Yes
	McCann	Yes

Final YES: 11 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS

12:00 PM -- HB 15-1182

Representatives Lois Landgraf and Susan Lontine, co-prime sponsors, presented House Bill 15-1182, which allows certified nurse aides (CNAs) who are deemed competent by a registered nurse to perform the following tasks:

digital stimulation, insertion of a suppository, or the use of an enema to stimulate a bowel movement;
certain tube-based feedings; and
placement of pre-sorted medication in a patient's mouth if the medication has been boxed or packaged by a registered nurse or pharmacist.

Representative Landgraf shared her experience as the parent of a disabled child and discussed the need for the bill. Committee members received a letter from the Colorado Nurses Association in support of the bill (Attachment C). Representative Landgraf addressed a question about how CNAs will be trained to perform the tasks allowed under the bill.

150217 AttachC.pdf

12:14 PM -- Mr. David Bolin, Executive Director of Accent on Independence, testified in support of the bill. Mr. Bolin said many of his clients would benefit from the bill. He also addressed an earlier question from the committee about why CNAs are not currently permitted to perform the tasks allowed under the bill. Mr. Bolin discussed the intimate nature of the services performed by nurses and CNAs. He also expressed his opinion that the bill will result in cost savings because it costs less to use a certified nurse aide than a registered nurse. Mr. Bolin addressed questions from the committee about who would be held accountable if a certified nurse aide did not properly perform one of the tasks allowed under the bill. Discussion ensued on this topic. Mr. Bolin discussed similarities between home health aides and certified nurse aides.

12:34 PM

Mr. Bolin addressed a question about whether and how the scope of duties for nurses and certified nurse aides needs to be spelled out in law.

12:38 PM -- Ms. Ronne Hines, representing the Department of Regulatory Affairs, testified in support of the bill. She addressed an earlier question about whether and how the scope of duties for nurses and certified nurse aides needs to be spelled out in law. She also responded to a question about why certain recent changes were made to the scope of the practice for CNAS. Discussion returned to the question of what duties for registered nurses and certified nurse aides should be outlined in statute.

12:44 PM -- Ms. Kristen Forrestal, representing the Office of Legislative Legal Services, came to the table to address a question about how the scope of duties for registered nurses and certified nurse aides is outlined in law. She addressed a comment from the committee about the difference between the definition and use of the term "competence" and the term "delegation" in the bill and in current law. Discussion ensued on this topic.

12:52 PM -- Mr. Ryan Zeiger, representing Personal Assistance Services of Colorado and Colorado Long Term Assistance Providers, testified in support of the bill. He spoke to the need for clear direction about what tasks CNAs are permitted to perform. He also discussed his training as a certified nurse aide. He responded to a question about his experience as a certified nurse aide. He also discussed about how a registered nurse supervises a certified nurse aide when certain tasks are delegated to the certified nurse aide.

01:02 PM -- Mr. Ed Neyra, representing himself, testified in support of the bill. He spoke about his experience utilizing home health services.

01:05 PM -- Ms. Carol Meredith, representing the ARC of Arapahoe and Douglas Counties, testified in support of the bill. She responded to comments from the committee about the regulation of home health care providers.

01:10 PM

Representative Landgraf distributed Amendment L.001 (Attachment D).

150217 AttachD.pdf


BILL:	HB15-1182
TIME:	01:12:10 PM
MOVED:	Landgraf
MOTION:	Adopt Amendment L.001 (Attachment D). The motion passed without objection.
SECONDED:	Primavera
		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

01:13 PM

Members of the committee commented on the merits of the bill.


BILL:	HB15-1182
TIME:	01:18:30 PM
MOVED:	Landgraf
MOTION:	Refer House Bill 15-1182, as amended, to the Committee of the Whole. The motion passed on a vote of 12-1.
SECONDED:	Landgraf
		VOTE
	Brown	Yes
	Esgar	No
	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: 12 NO: 1 EXC: 0 ABS: 0 FINAL ACTION: PASS

01:20 PM

The meeting adjourned.