House Committee on Health, Insurance, & Environment (03/12/2015)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH, INSURANCE, & ENVIRONMENT

Date:	03/12/2015	ATTENDANCE

Time:	01:30 PM to 04:46 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	*
		Ransom	X
		Ryden	*
		Ginal	X
		McCann	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB15-1151 HB15-1238		Postponed Indefinitely Amended, Referred to Finance

01:31 PM -- HB 15-1151

Representative Rankin presented House Bill 15-1151. The bill, which was recommended by the Joint Budget Committee, specifies that, as of July 1, 2015, payments to Medicaid providers be at least 60 percent of the rate for the equivalent service under Medicare. If there is no equivalent Medicare rate, the payment should be at least 60 percent of the average fair market rate. Representative Rankin requested that the bill be postponed indefinitely because another bill will be coming forth to address the issue.

01:37 PM

Representative Young discussed postponing the bill indefinitely. Representative McCann made comments about the need to address the Medicaid provider reimbursement rates (provider rates). Representative Young and Representative Rankin commented on addressing provider rates and involving stakeholders in the rate setting process.

01:42 PM -- Tim Dienst, Emergency Medical Services (EMS) Association of Colorado, testified in support of the bill. He provided two handouts (Attachments A and B) to the committee. He stated that the bill will provide relief to EMS providers. He asked to be involved in the drafting of the new bill.

150312 AttachA.pdf

150312 AttachB.pdf

01:44 PM -- Chief Ray Jennings, EMS Association of Colorado, testified in support of the bill. He discussed the financial impacts that provider rates have on EMS providers. Chief Jennings answered questions about why the provider rates for EMS providers are so low. In response to a question, he discussed how the cost to operate an EMS agency has increased over time. Committee members dialogued with Chief Jennings about the costs of operating an EMS agency.

01:55 PM -- Tim Dorn, American Medical Response Ambulance Co., testified in support of the bill. He discussed the cost of readiness for ambulances and indexing off of Medicare provider rates for Medicaid reimbursement rates.

02:01 PM -- Chief Ira "Jerry" Rhodes, International Association of Fire Chiefs, testified in support of the bill. He discussed how agencies adjust to lost income and volunteer agencies. Chief Rhodes answered questions about how changes to automobile insurance statutes impacted payments received by EMS agencies.


BILL:	HB15-1151
TIME:	02:09:36 PM
MOVED:	McCann
MOTION:	Postpone House Bill 15-1151 indefinitely. 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

02:11 PM -- HB 15-1238

Representative Buck presented House Bill 15-1238. The bill creates a state income tax credit for a physician volunteer, also known as a preceptor, who provides personal instruction, training, and supervision to a graduate medical student enrolled at a Colorado higher education institution. To qualify, the preceptorship must be undertaken in a health shortage area, as designated by the U.S. Department of Health and Human Services.

The preceptor may earn $1,000 for each preceptorship provided during the tax year. Preceptors with at least 10 percent of their patients receiving Medicaid may receive $1,500 for each preceptorship. The credit is capped at $5,000 per tax year and any unused credits may be carried forward for five income tax years. The bill requires the qualified preceptor to obtain a certificate from the Colorado Area Health Education Center Program, a program under the University of Colorado Anschutz Medical Campus, certifying that he or she has satisfied the requirements for the credit. The credit is available for tax years 2015 through 2021.

Representative Buck answered questions about the bill. She provided the committee with two handouts (Attachments C and D).

150312 AttachC.pdf

150312 AttachD.pdf

02:25 PM -- Louis Pino, Legislative Council Staff, answered questions about the fiscal note. Representative Buck referenced a possible amendment that will affect the fiscal note. The committee dialogued about the bill and fiscal note.

02:27 PM -- Dr. Rick Budensiek, Colorado Academy of Family Physicians, testified in support of the bill. He discussed preceptorships. He addressed the fiscal note. Dr. Budensiek answered questions about health professional shortage areas. The committee dialogued with Representative Buck about the tax credit the bill would provide. Dr. Budensiek answered questions about preceptorships. Representative Joshi shared his experience being a preceptor. Committee discussion about the bill ensued.

02:43 PM -- Monica Mika, Centennial Area Health Education Center, testified in support of the bill. She relayed information about counties that lack health care providers. She referenced the handout (Attachment E) she provided to the committee.

150312 AttachE.pdf

02:50 PM -- Dr. Mark Deutchman, Colorado Area Health Education Center Program and University of Colorado School of Medicine, testified in support of the bill. He outlined the provisions of the bill.

02:54 PM

Dr. Deutchman and Ms. Mika answered questions about whether mental health providers are included under the bill. Dr. Deutchman answered questions about the tax credit and health professional shortage areas. Ms. Mika answered questions about the types of health care professionals that are covered under the bill. The witnesses continued to respond to questions from the committee about the bill, preceptorships, and health professional shortage areas.

03:12 PM

Committee discussion with Dr. Deutchman about preceptorships and attracting health care providers to rural areas ensued.

03:17 PM -- Rhonda Squires, University of Northern Colorado, testified in support of the bill. She relayed information about preceptorships for nurse practitioner students. In response to a question, Ms. Squires discussed the additional time commitment preceptorships create for preceptors. Ms. Squires answered questions about advanced practice registered nurses. Committee discussion with Ms. Squires about preceptorships continued.

03:32 PM -- Dr. Kim Marvel, Commission on Family Medicine and Colorado Association of Family Medicine Residencies, testified in support of the bill. He discussed community preceptors. Dr. Marvel referenced the Family Medicine Residency Education in Colorado report (Attachment F). He discussed the training requirements for medical students versus residents, family medicine residencies, and rural training tracks. Dr. Marvel answered questions about the bill, the likelihood of medical students moving to rural areas after training there, and preceptorships. Committee members dialogued with Dr. Marvel about the connection of preceptors to the University of Colorado School of Medicine.

150312 AttachF.pdf

03:45 PM

Representative Buck answered questions about the health care providers that are covered under the bill.

03:48 PM -- Sally Henry, representing Colorado Area Health Education Center Program, testified on the bill. She discussed the complexities of education requirements for health care professionals. She referenced the Area Health Education Center Program in Georgia. She discussed the shortages of preceptors in Colorado and the value of rural rotations. Ms. Henry answered questions about Colorado Area Health Education Center Program and the facility appointment requirement provision of the bill.

04:01 PM

Representative Buck discussed amendment L.003 (Attachment G). The committee discussed severing the amendment. Dr. Marvel returned to table to answer questions about the mental health training model. Representative McCann decided not to sever the amendment.

150312 AttachG.pdf


BILL:	HB15-1238
TIME:	04:09:56 PM
MOVED:	McCann
MOTION:	Adopt amendment L.003 (Attachment G). The motion passed on a vote of 10-3.
SECONDED:	Primavera
		VOTE
	Brown	Yes
	Esgar	No
	Humphrey	Yes
	Joshi	Yes
	Klingenschmitt	Yes
	Landgraf	Yes
	Lontine	Yes
	Mitsch Bush	Yes
	Primavera	No
	Ransom	Yes
	Ryden	No
	Ginal	Yes
	McCann	Yes

YES: 10 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS

04:12 PM

Representative Primavera discussed amendment L.002 (Attachment H). Committee discussion about the amendment ensued. Ms. Henry returned to the table to address questions about the different levels of training for nurses. Representative Buck commented on amendment L.002. Representative Klingenschmitt discussed offering a substitute conceptual amendment. Representative McCann denied the request to offer a conceptual amendment. Committee discussion about amendment L.002 continued. Ms. Henry answered questions about the professions involved with Colorado Area Health Education Center Program. Representative Buck answered questions about the bill. Representative Primavera answered questions about amendment L.002. Representative Mitsch Bush and Representative Buck commented on the intent of the bill.

150312 AttachH.pdf


BILL:	HB15-1238
TIME:	04:30:23 PM
MOVED:	Primavera
MOTION:	Adopt amendment L.002 (Attachment H). The motion failed on a vote of 6-7.
SECONDED:	Ryden
		VOTE
	Brown	No
	Esgar	Yes
	Humphrey	No
	Joshi	No
	Klingenschmitt	No
	Landgraf	Yes
	Lontine	Yes
	Mitsch Bush	No
	Primavera	Yes
	Ransom	No
	Ryden	Yes
	Ginal	Yes
	McCann	No

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

04:31 PM

Representative McCann discussed a conceptual amendment to correct the name of the Colorado Area Health Education Center Program in the bill. Ms. Henry discussed the correct name for the Colorado Area Health Education Center Program. The committee members discussed the conceptual amendment.


BILL:	HB15-1238
TIME:	04:32:15 PM
MOVED:	McCann
MOTION:	Adopt a conceptual amendment to add "center" after "health education" and strike "CAHEP" and substitute "CAHEC program" throughout the bill. The motion passed without objection.
SECONDED:	Esgar
		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

04:37 PM

Representative Buck made concluding remarks. Committee members commented on the bill. Representative Klingenschmitt read a statement from Dr. Dave Richman, President of the El Paso County Medical Society. Committee discussion ensued.


BILL:	HB15-1238
TIME:	04:45:41 PM
MOVED:	Ginal
MOTION:	Refer House Bill 15-1238, as amended, to the Committee on Finance. The motion passed on a vote of 10-3.
SECONDED:	Joshi
		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

04:46 PM

The committee adjourned.