Final
STAFF SUMMARY OF MEETING

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:02/08/2006
ATTENDANCE
Time:09:35 AM to 12:26 PM
Johnson
X
Mitchell
*
Place:SCR 352
Sandoval
X
Shaffer
X
This Meeting was called to order by
Traylor
X
Senator Hagedorn
Hanna
X
Hagedorn
X
This Report was prepared by
Elizabeth Burger
X = Present, E = Excused, A = Absent, * = Present after roll call
Bills Addressed: Action Taken:
SB06-101
SB06-112
SB06-087
SB06-131		Postponed Indefinitely
Amended, Referred to the Committee of the Whole
Amended, Referred to the Committee of the Whole
Amended, Referred to Appropriations

09:36 AM -- Senate Bill 06-101

Senator Teck introduced Senate Bill 06-101, which specifies that a Colorado resident shall not receive publicly-funded treatment services for tobacco-related cancer. Persons can receive a percentage of treatment depending on the year in which the person began smoking or using tobacco products. He stated that many years have passed since the surgeon general's warning about smoking, and if people choose to smoke in spite of the dangers, the state should not pay for the consequences of the person's conscious decision to smoke. He said that the legislature needs to have a discussion of how limited health dollars will be spent. Senator Teck responded to questions from Senator Sandoval regarding if the bill addresses other behaviors that are unhealthy, stating that publicly-funded health care cannot be all things to all people. Senator Hanna asked whether denying public-funding for care will shift the costs of the treatment to hospital emergency rooms. The committee discussed the complexity in determining which illnesses would be subject to the provisions of the bill.

09:52 AM -- Pat Ratliff, Colorado Counties Inc., testified in opposition to the bill. She stated that the private insurance industry often follows governmental health programs, and as a result of the bill, insurance companies might choose to drop coverage for smoking-related illnesses, marginalizing care for smokers.


09:54 AM

Senator Teck gave concluding remarks regarding the bill. Various members of the committee commented on the bill.
BILL:SB06-101
TIME: 10:00:32 AM
MOVED:Hagedorn
MOTION:Refer Senate Bill 06-101 to the Committee on Appropriations. The motion failed 1-6.
SECONDED:
VOTE
Johnson
Yes
Mitchell
No
Sandoval
No
Shaffer
No
Traylor
No
Hanna
No
Hagedorn
No
Not Final YES: 1 NO: 6 EXC: 0 ABS: 0 FINAL ACTION: FAIL
BILL:SB06-101
TIME: 10:01:07 AM
MOVED:Hanna
MOTION:Reverse the previous roll call vote and postpone indefinitely Senate Bill 06-101. The motion passed 6-1.
SECONDED:
VOTE
Johnson
No
Mitchell
Yes
Sandoval
Yes
Shaffer
Yes
Traylor
Yes
Hanna
Yes
Hagedorn
Yes
Final YES: 6 NO: 1 EXC: 0 ABS: 0 FINAL ACTION: PASS



10:03 AM -- Senate Bill 06-112

Senator Teck introduced Senate Bill 06-112 and distributed amendment L.001 to the committee (Attachment A). He spoke to amendment L.001, stating that as amended, the bill requires that if a person has a health policy in place and files a claim within six months of the service, the person is entitled to coverage for coverage of the claim as specified by the policy. Senator Teck responded to questions from the committee regarding amendment L.001 and the coverage of in-network and out-of-network claims under the bill.

10:06 AM -- Janet Stephens, Colorado Health and Hospital Association, testified regarding amendment L.001 (Attachment A). Senator Mitchell asked why the claim must be made in six months if the service was a covered benefit under the policy. Senator Teck stated that a six-month time period was an adequate time frame for policy holders to file claims.

10:09 AM -- Michael Huotari, Colorado Association of Health Plans, testified in support of amendment L.001 (Attachment A) and responded to questions from Senator Mitchell regarding timely filing of claims.


10:12 AM

Senator Teck gave concluding remarks regarding the bill.
BILL:SB06-112
TIME: 10:13:19 AM
MOVED:Mitchell
MOTION:Amend prepared amendment L.001 (Attachment A), line 8, strike "SIX" and substitute "TWELVE". The motion passed without objection.
SECONDED:
VOTE
Johnson
Mitchell
Sandoval
Shaffer
Traylor
Hanna
Hagedorn
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:SB06-112
TIME: 10:14:06 AM
MOVED:Mitchell
MOTION:Adopt prepared amendment L.001 (Attachment A), as amended. The motion passed without objection.
SECONDED:
VOTE
Johnson
Mitchell
Sandoval
Shaffer
Traylor
Hanna
Hagedorn
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:SB06-112
TIME: 10:14:14 AM
MOVED:Mitchell
MOTION:Refer Senate Bill 06-112, as amended, to the Committee on the Whole. The motion passed 4-2-1.
SECONDED:
VOTE
Johnson
Excused
Mitchell
Yes
Sandoval
Yes
Shaffer
Yes
Traylor
No
Hanna
Yes
Hagedorn
No
Final YES: 4 NO: 2 EXC: 1 ABS: 0 FINAL ACTION: PASS


10:16 AM

The committee recessed briefly.
10:26 AM -- Senate Bill 06-087

The committee reconvened. Senator Jones introduced Senate Bill 06-087. He explained that, under current law, occurrences of certain diseases are required to be reported to the state Department of Public Health and Environment. Under Senate Bill 06-087, the fact that a report might be made to the department must be disclosed to a patient prior to obtaining any specimen or sample from the patient. He distributed amendments L.001, L.002, L.003, and L.004 to the committee (Attachments B through E).

10:27 AM -- Becky Fuller, citizen, testified in support of the bill and regarding her personal experiences with having a child's health condition reported to the department without her knowledge. She explained that current law requires certain diseases to be reported to the department, but that there is no requirement that the patient be notified that the information is going to be reported. She stated that it is the state's responsibility to ensure that citizens are informed about the current reporting requirements. Ms. Fuller responded to questions from Senator Mitchell regarding the department's response to Ms. Fuller's concerns. Senator Traylor stated that physicians do not always know what conditions will be reported to the state and that it is important to remember that the department collects the information to monitor disease outbreaks. Ms. Fuller stressed that she was not asking for the reporting to stop, only that the patient be informed when a report is made. The committee further discussed reporting and health confidentiality requirements.

10:43 AM -- Pat Steadman, Colorado Organizations Responding to Aids, testified in support of the concept of the bill. He testified in support of L.001 (Attachment B), which adds the notification requirements to statutes that address reports of AIDS and HIV-related conditions. He responded to questions from Senator Hagedorn regarding occurrences of diseases that must be reported to the Centers for Disease Control and Prevention.

10:47 AM -- Pat Ratliff, Colorado Counties Inc., stated her concern that the notice requirements under the bill would having a chilling effect on the diagnosis and reporting of diseases. Senator Mitchell commented on the reporting requirements.

10:52 AM -- Todd Saliman, Colorado Hospital Association, testified regarding amendments L.003 and L.004 (Attachments D and E). He responded to questions from Senator Hagedorn regarding how consent is obtained from a patient when the patient is not conscious. Senators Traylor and Mitchell responded to Senator Hagedorn's questions, stating that current law provides that unconscious patients give implied consent to treatment. Senator Traylor clarified that Senate Bill 06-087 only requires a patient be informed about the report, not to consent to the report. Mr. Saliman responded to questions from Senator Shaffer regarding the effect of amendment L.004 (Attachment D). Senator Mitchell asked if Mr. Saliman would accept an amendment to line 2 of amendment L.004 (Attachment E) striking "consistent" and substituting "recurring". Mr. Saliman stated that he would not object to such an amendment.


11:01 AM

Witness testimony was closed and Senator Jones asked the committee to support the bill.
BILL:SB06-087
TIME: 11:01:51 AM
MOVED:Shaffer
MOTION:Adopt prepared amendment L.001 (Attachment B). The motion passed without objection.
SECONDED:
VOTE
Johnson
Mitchell
Sandoval
Shaffer
Traylor
Hanna
Hagedorn
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:SB06-087
TIME: 11:04:55 AM
MOVED:Shaffer
MOTION:Adopt prepared amendment L.002 (Attachment C). The motion passed without objection.
SECONDED:
VOTE
Johnson
Mitchell
Excused
Sandoval
Shaffer
Traylor
Hanna
Hagedorn
Not Final YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:SB06-087
TIME: 11:05:13 AM
MOVED:Shaffer
MOTION:Adopt prepared amendment L.003 (Attachment D). The motion passed without objection.
SECONDED:
VOTE
Johnson
Mitchell
Excused
Sandoval
Shaffer
Traylor
Hanna
Hagedorn
Not Final YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:SB06-087
TIME: 11:05:28 AM
MOVED:Mitchell
MOTION:Amend prepared amendment L.004 (Attachment E), line 2, strike "CONSISTENT" and substitute "RECURRING". The motion was adopted without objection.
SECONDED:
VOTE
Johnson
Mitchell
Sandoval
Shaffer
Traylor
Hanna
Hagedorn
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:SB06-087
TIME: 11:05:57 AM
MOVED:Shaffer
MOTION:Adopt prepared amendment L.004 (Attachment E), as amended. The motion passed without objection.
SECONDED:
VOTE
Johnson
Mitchell
Sandoval
Shaffer
Traylor
Hanna
Hagedorn
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:SB06-087
TIME: 11:06:50 AM
MOVED:Shaffer
MOTION:Refer Senate Bill 06-087, as amended, to the Committee of the Whole. The motion passed 6-0-1.
SECONDED:
VOTE
Johnson
Excused
Mitchell
Yes
Sandoval
Yes
Shaffer
Yes
Traylor
Yes
Hanna
Yes
Hagedorn
Yes
Final YES: 6 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS



11:11 AM -- Senate Bill 06-131

Senator Tochtrop introduced Senate Bill 06-131. Senate Bill 06-131 requires the Department of Health Care Policy and Financing to conduct a feasibility study for a new reimbursement system for Class I nursing facilities based on a pricing model, requires that each class I reimbursement facility's reimbursement rate must be at least 85 percent of the statewide average for FY 2006-07, and limits a provider's reimbursement rate to 10 percent increase over the current rate. Additionally, the bill removes the 8 percent limit on health care services costs for class I and class V nursing facilities. Senator Tochtrop explained that nursing homes are not receiving a Medicaid payment rate that covers their costs. Although some facilities can cost-shift the difference between the Medicaid rate and costs onto private pay patients, some nursing homes cannot do this, and are in danger of closing as a result. She described problems that may occur if rural nursing homes do not receive adequate reimbursement and have to close. Senator Tochtrop responded to questions from the committee regarding whether the study is necessary in light of Senate Bill 05-173 which created a committee to study and recommend comprehensive long-term care system reforms. Two amendments, L.002 and L.003, were distributed to the committee (Attachments F and G).

11:23 AM -- Janet Snipes, Holly Heights Nursing Home, responded to questions raised by the committee regarding the Senate Bill 05-173 committee, stating that the committee has not explored nursing home reimbursement methodology. She stated that Senate Bill 06-131 will begin a needed discussion of nursing home reimbursement rates. Ms. Snipes responded to a question from the committee why the Senate Bill 05-173 committee can't study nursing home reimbursement. She further responded to questions regarding the portions of bill that increase Medicaid nursing home reimbursement rates before the study is completed, stating that certain nursing homes cannot continue under the current nursing reimbursement rates and will have to close before the study is completed unless they receive some stop-gap funding. Senator Mitchell commented on Referendum C and the prioritization of funding needs within the state. Senator Tochtrop stated that nursing homes are in crisis and that there is a great need for increased funding.

11:34 AM -- Laura Landwirth, Colorado Association of Homes and Services for the Aging, distributed a handout to the committee (Attachment H). She testified that her organization has neither supports nor opposes the proposal. She stated that under a pricing model of nursing home reimbursement, one price is paid to everyone, but not everyone has the same needs. She stated that the increase in class I facilities reimbursement rates and removal of the 8 percent limit on health care services costs are premature and advance a change in the current system that is not yet determined to be needed. She further questioned why the study is needed given that the Senate Bill 05-173 study is currently underway. She testified regarding her concerns that a pricing systems promote less staffing and a lower quality of care.

11:39 AM -- Jeff Jerebker, Pinon Management, testified in support of the bill. He stated that the status quo of nursing facility reimbursement is faulty and there is a need to study options for changing the system. He stated that the state's goal is to move persons who require less care into home- and community-based services, and, as a result, nursing homes are left with higher needs patients. Nursing homes need reimbursement that reflects the increased costs of serving higher-needs patients. He spoke to the revenue that nursing homes will lose if the 8 percent cap is not lifted.

11:44 AM -- Joyce Hamiston, Valley Inn, testified regarding reimbursement received by rural, for-profit nursing homes. She testified that private pay patients can make up some of the difference between the Medicaid reimbursement and costs, but if the private pay rates increase too much, the private pay patients become Medicaid patients faster. She testified that the study of a new reimbursement system is necessary, but that certain nursing home providers need help now or they will close. She responded to questions from the committee regarding whether a pricing model will affect the quality of care in the nursing homes she manages.

11:53 AM -- Mike McCarty, Colorado Cross Disability Association, testified in support of the study on nursing homes reimbursement methodology. He stated that nursing homes receive lopsided pay compared to home- and community-based providers.

11:54 AM -- Arlene Miles, Colorado Health Care Association, testified that nursing homes are currently paid under a cost-based system, and, with the exception of community health clinics, are the only Medicaid providers that are paid under a cost-based, rather than fee-based, system. Adopting a pricing model will allow the state to determine a rate to pay nursing homes and require that nursing homes deliver services within that rate. She discussed quality nursing facility care, stating that staffing isn't the only element that leads to quality care. She testified that the reimbursement system has not been studied in 30 years, and the study is necessary to determine whether to change the provider payment methodology. She responded to questions from the committee regarding whether the Department of Health Care Policy and Financing supports the bill. She spoke to the fiscal note for the bill.

12:06 PM -- Rhonda Bentz, Colorado Department of Health Care Policy and Financing, testified that the Department is fine with the bill but is working on concerns with the fiscal note.


12:07 PM

Senator Hagedorn closed public testimony and moved amendment L.002 (Attachment F). He explained that the amendment adds a pay-for-performance system as an additional reimbursement methodology to be studied under the provisions of the bill. Additionally, the amendment suspends the 8 percent cap on health care service costs for FY 2006-07 only. He responded to questions from the committee concerning the amendment.
BILL:SB06-131
TIME: 12:23:17 PM
MOVED:Hagedorn
MOTION:Adopt prepared amendment L.002 (Attachment F). The motion passed 5-2.
SECONDED:
VOTE
Johnson
Yes
Mitchell
No
Sandoval
Yes
Shaffer
No
Traylor
Yes
Hanna
Yes
Hagedorn
Yes
Not Final YES: 5 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS
BILL:SB06-131
TIME: 12:24:14 PM
MOVED:Hagedorn
MOTION:Adopt prepared amendment L.003 (Attachment G). The motion passed without objection.
SECONDED:
VOTE
Johnson
Mitchell
Sandoval
Shaffer
Traylor
Hanna
Hagedorn
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection
BILL:SB06-131
TIME: 12:25:37 PM
MOVED:Hagedorn
MOTION:Refer Senate Bill 06-131, as amended, to the Committee on Appropriations. The motion passed 6-1.
SECONDED:
VOTE
Johnson
No
Mitchell
Yes
Sandoval
Yes
Shaffer
Yes
Traylor
Yes
Hanna
Yes
Hagedorn
Yes
Final YES: 6 NO: 1 EXC: 0 ABS: 0 FINAL ACTION: PASS


12:26 PM

The committee recessed.