House Committee on Health, Insurance, & Environment (04/30/2015)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH, INSURANCE, & ENVIRONMENT

Date:	04/30/2015	ATTENDANCE

Time:	01:33 PM to 04:55 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:
SB15-228 HB15-1389		Referred to Appropriations Referred to Appropriations

01:33 PM -- SB 15-228

Representative Rankin presented Senate Bill 15-228. The bill establishes a process for the Department of Health Care Policy and Financing to uniformly review Medicaid provider rates. It requires the department to set up a review cycle so that each provider rate is reviewed at least once every five years. More frequent reviews may be conducted at the request of the Joint Budget Committee (JBC) or the Medicaid Provider Rate Review Advisory Committee (advisory committee) established under the bill. The review schedule must be in place by September 1, 2015.

Beginning November 1, 2016, and on or before November 1 of each year thereafter, the department is required to provide a report to the JBC, advisory committee, and other stakeholders comparing Medicaid rates to available benchmarks, including Medicare rates and usual and customary rates paid by private parties. Beginning May 1, 2016, and on or before each May 1 thereafter, the department must also report on whether payments are sufficient to allow for provider retention and client access. Following the report, a period of review and public meetings are required in order to solicit feedback and comments on the report. The department and the Office of State Planning and Budgeting are required to examine the report and develop budget recommendations, which the department must submit to the JBC and advisory committee by November 1 of each year.

01:38 PM -- Eric Kurtz, JBC Staff, answered questions about Medicaid rates.

01:40 PM

Representative Rankin answered questions about the bill and the bill's fiscal note. The committee discussed the advisory task force established by the bill with Representative Rankin and Mr. Kurtz. Committee discussion with Representative Rankin about the bill ensued.

01:53 PM

Mr. Kurtz responded to a question about whether other states have a similar process as the one outlined in the bill. In response to a question, Mr. Kurtz discussed federal requirements for establishing Medicaid rates. Representative Rankin responded to questions from the committee about the bill.

02:02 PM

Mr. Kurtz answered questions about how the Medicaid provider rate increases will be financed.

02:04 PM -- Charlie Sheffield, Emergency Medical Services (EMS) Association of Colorado, testified in support of the bill. He discussed how inadequate Medicaid provider rates impact EMS agencies.

02:07 PM

Representative Rankin made closing remarks about the bill. Committee members commented on the bill.


BILL:	SB15-228
TIME:	02:11:03 PM
MOVED:	Landgraf
MOTION:	Refer Senate Bill 15-228 to the Committee on Appropriations. The motion passed on a vote of 11-2.
SECONDED:	Lontine
		VOTE
	Brown	Yes
	Esgar	Yes
	Humphrey	No
	Joshi	Yes
	Klingenschmitt	No
	Landgraf	Yes
	Lontine	Yes
	Mitsch Bush	Yes
	Primavera	Yes
	Ransom	Yes
	Ryden	Yes
	Ginal	Yes
	McCann	Yes

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

02:12 PM

The committee recessed.

02:19 PM -- HB 15-1389

The committee came back to order. Speaker Hullinghorst and Representative Court presented House Bill 15-1389. The bill creates a Health Care Affordability Enterprise (enterprise) within the Department of Health Care Policy and Financing (HCPF). Beginning in FY 2016-17, the enterprise is responsible for the collection of a new hospital provider fee that replaces the hospital provider fee assessed under current law, and for the administration of the hospital provider fee program created pursuant to House Bill 09-1239. The bill abolishes the Hospital Provider Fee Oversight and Advisory Board, which currently administers the hospital provider fee, and the board's functions are transferred to a new board in the enterprise.

The Health Care Affordability Enterprise is designated as an enterprise under the Taxpayer's Bill of Rights (TABOR) and has the authority to issue revenue bonds. Hospital provider fee revenue collected by the enterprise is not subject to the state's TABOR limit. The bill clarifies that termination of the HCPF's authority to assess and collect the hospital provider fee, and creation of a new enterprise to assess and collect a new hospital provider fee, does not require or authorize a downward adjustment to the TABOR limit.

02:27 PM

The bill sponsors answered questions from committee members about the hospital provider fee, the bill, whether other states have established similar enterprises, and the state's ability to receive federal funds via the hospital provider fee.

02:45 PM -- Henry Sobanet, Office of State Planning and Budgeting, testified in support of the bill. He provided a handout diagraming the hospital provider fee, severance tax, and other TABOR revenue and Referendum C (Attachment A). He discussed the TABOR limit and constitutional constraints on the state's budget. Mr. Sobanet answered questions from committee members about the amount of money received via the hospital provider fee, TABOR, and the uses for the hospital provider fee. Committee discussion with Mr. Sobanet about the hospital provider fee, other states that have established hospital provider fees, and the creation of state enterprises ensued.

150430 AttachA.pdf

03:03 PM

Mr. Sobenet answered questions about whether other state enterprises receive federal funds, the handout he provided, and Referendum C.

03:05 PM -- Thad Tecza, representing himself, testified in opposition to the bill. He expressed his concerns about the bill and discussed TABOR. Mr. Tecza answered questions about the bill, TABOR, and his testimony.

03:15 PM -- Tony Milo, Colorado Contractor Association, testified in support of the bill. He listed the other organization from the construction industry he was representing. He discussed how the bill will benefit the state's transportation system, capital construction, and taxpayers. Mr. Milo answered questions his organization's position on the bill.

03:21 PM -- Jane Urschel, Colorado Association of School Boards, Colorado Education Association, and Colorado Association of School Executives, testified in support of the bill. She discussed how the bill could increase funding for schools. Ms. Urschel answered questions about whether public schools have previously received enterprise funds. Representative Court answered questions about how funding for public schools could increase if the bill was enacted.

03:25 PM -- Todd Saliman, University of Colorado System, testified in support of the bill. He discussed previous decreases in higher education funding. In response to a question, Mr. Saliman discussed how higher education institutions could benefit from the enactment of the bill. Mr. Saliman answered questions about the bill's fiscal note and funding sources for higher education.

03:36 PM

Committee discussion about the bill ensued. The committee members continued to dialogue with Mr. Saliman about the bill and state funding for higher education.

03:42 PM -- Kachina Weaver, Colorado Department of Higher Education, testified in support of the bill.

03:44 PM -- Elisabeth Arenales, Colorado Center on Law and Policy, testified in support of the bill. She discussed the establishment of the hospital provider fee in 2009 and the possible establishment of an enterprise to manage the funds collected by the hospital provider fee. She referenced the Medicaid Buy-in Program.

03:47 PM -- Carol Hedges, Colorado Fiscal Institute, testified in support of the bill. She distributed a written statement of support for the bill from the Bell Policy Center (Attachment B). She discussed how the state constitution permits the creation of enterprises to allow for flexibility.

150430 AttachB.pdf

03:49 PM -- Cody Belzley, Colorado Children's Campaign, testified in support of the bill.

03:49 PM

Ms. Arenales answered a question about Medicaid expansion. Ms. Hedges answered a question about estimated TABOR refund amounts. Ms. Arenales provided additional comments about Medicaid expansion.

03:52 PM

Representative Court shared information about the average estimated TABOR refund.

03:53 PM -- Steven Summer, Colorado Hospital Association, testified in support of the bill. He discussed increased health insurance coverage, the Blue Ribbon Commission for Health Care Reform created by Senate Bill 06-208, and the hospital provider fee. He outlined the provisions of the bill.

03:57 PM -- Todd Oberheu, Spanish Peaks Regional Health Center, testified in support of the bill. He discussed primary health care in rural Colorado.

03:58 PM -- Jeff Thompson, University of Colorado Health, testified in support of the bill.

03:58 PM -- Robert Vasil, Health One, testified in support of the bill.

03:58 PM -- Jackie Zheleznyak, Denver Health, testified in support of the bill.

03:58 PM -- Zach Zaslow, Children's Hospital Colorado, testified in support of the bill.

03:59 PM -- Sara Orrange, Colorado Association of Health Plans, testified in support of the bill.

03:59 PM

Mr. Oberheu and Mr. Summer answered questions about how hospitals benefit from the hospital provider fee. Mr. Vasil answered questions about how the hospital provider fee transactions work. Mr. Vasil answered questions about whether the bill will change how the hospital provider fee operates.

04:08 PM -- Tamra Ward, Colorado Concern, testified in support of the bill. She discussed the TABOR revenue limit and creating an enterprise for the hospital provider fee.

04:10 PM -- Kelly Brough, Denver Metro Chamber of Commerce, testified in support of the bill.

04:10 PM -- Miz Cordero, Colorado Competitive Council, testified in support of the bill.

04:11 PM -- Sandra Solin, North Colorado Legislative Alliance, testified in support of the bill.

04:11 PM

Ms. Brough answered questions from the committee.

04:16 PM -- Greg Sobetski, Legislative Council Staff, answered questions about the bill's fiscal note and the hospital provider fee.

04:36 PM

Representative Joshi discussed a potential amendment to the bill.

04:37 PM

Representative Court made concluding remarks about the bill. Committee members commented on the bill.

04:42 PM

Speaker Hullinghorst made concluding remarks about the bill. Committee discussion about the bill ensued.


BILL:	HB15-1389
TIME:	04:54:47 PM
MOVED:	McCann
MOTION:	Refer House Bill 15-1389 to the Committee on Appropriations. The motion passed on a vote of 7-6.
SECONDED:	Ginal
		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

04:55 PM

The committee adjourned.