House Committee on Health and Environment (03/13/2012)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH AND ENVIRONMENT

Date:	03/13/2012	ATTENDANCE

Time:	10:11 AM to 07:18 PM	Bradford	X
		Brown	X
Place:	LSB A	Fields	X
		Joshi	X
This Meeting was called to order by		Kefalas	X
	Representative Summers	Kerr J.	X
		Massey	X
This Report was prepared by		McCann	X
	Elizabeth Burger	Peniston	X
		Schafer S.	X
		Young	X
		Acree	*
		Summers	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Presentation on the Colorado Indigent Care Program Presentation on CoverColorado SB12-077 SB12-099 HB12-1294		Witness Testimony and/or Committee Discussion Only Witness Testimony and/or Committee Discussion Only Referred to the Committee of the Whole Referred to the Committee of the Whole Amended, Laid Over

10:12 AM -- Presentation on the Colorado Indigent Care Program

Representative Summers called the committee to order and reviewed changes to the committee's calendar. John Bartholomew, Budget Director for the Department of Health Care Policy and Financing, and Nancy Dolson, Safety Net Programs Manager for the Department of Health Care Policy and Financing, introduced themselves and began their presentation on the Colorado Indigent Care Program (CICP). Mr. Bartholomew reviewed the CICP's annual report (Attachment A). A copy of the presentation was also distributed to the committee (Attachment B).

10:17 AM

Ms. Dolson explained that the CICP is not a health insurance program, but rather a financing method for health care services. She described how the program is administered, stating that the program is essentially managed by providers. Providers screen patients for eligibility for Medicaid or the Children's Basic Health Plan, and if the clients are not eligible for those programs, they are screened for CICP eligibility. She described the program's copayments, which are based on client income levels and explained the services that are available through the program. She responded to questions from Representative Summers regarding how providers determine eligibility for the program and from Representative Massey regarding payments to hospitals and other providers through the program. She stated that in FY 2010-11, hospitals were reimbursed approximately 58 percent of costs and clinics were reimbursed about 62 percent of costs. Ms. Dolson further responded to questions from Representative Peniston regarding the differences in reimbursement payments to hospitals and clinics.

10:24 AM

Ms. Dolson listed various types of providers who participate in the CICP, including hospitals and clinics, and described the support the department offers to providers. In FY 2010-11, hospitals received $295.8 million and clinics received $29.8 million in funding through the CICP. Mr. Bartholomew and Ms. Dolson reviewed the financing of the department's safety net programs, noting that the CICP is only one of several safety net programs administered by the department. She noted that safety net funding has increased in recent years even though the department has not received additional General Funds for this purpose. Overall, General Funds accounts for about 2 percent of safety net funding. Other sources of funds include federal funds, provider fees, the tobacco tax, and certified public expenditures. Other safety net programs administered by the department include the Old Age Pension Health and Medical Care Program, the School Health Services Program, the Primary Care Fund, the Nursing Facility Provider Fee, and the Hospital Provider Fee.

10:30 AM

Ms. Dolson responded to questions from Representative McCann regarding the programs that receive General Funds and whether ambulatory surgical centers may participate in the CICP program. Ms. Dolson responded to questions from Representative Joshi regarding the affect of the federal health care legislation on the CICP program. She noted that the department is currently engaged in stakeholder discussions regarding whether there will continue to be a need for the program when the federal health care legislation is fully implemented.

10:35 AM -- Presentation on CoverColorado

Suzanne Bragg-Gamble, Executive Director, CoverColorado, introduced herself and distributed a handout regarding the CoverColorado program to the committee (Attachment C). Ms. Bragg-Gamble explained that under current law, the individual health insurance market is permitted to deny coverage to individuals with preexisting health care issues, and CoverColorado provides insurance to those individuals who are denied coverage. She stated that state law requires insurers to notify individuals about CoverColorado when denying individual coverage. She explained that CoverColorado premiums are, by law, higher than those in the standard insurance marketplace. Ms. Bragg-Gamble stated that CoverColorado provides comprehensive coverage, and that individuals insured under CoverColorado have a $1 million cap on claims. She described the plans that are offered through CoverColorado.

10:38 AM

Ms. Bragg-Gamble described the funding mechanism for CoverColorado, which is as follows: member premiums (50%), an assessment charged to insurance carriers (25%), and funding from the Unclaimed Property Trust Fund (25%). She noted that member claims in 2012 are projected at $140 million. She discussed the future of CoverColorado in light of the federal health care legislation and the creation of a state health insurance exchange. She stated that the carriers in the exchange will be required to issue individual health plans in the exchange in 2014, and if insurers must take all applicants, there will be no need for CoverColorado. She stated that if the federal law is repealed or is extensively changed, and insurers are still permitted to deny coverage, there could still be a need for CoverColorado, at which time the funding mechanism for CoverColorado would have to be revised. She stated that in 2013, representatives of CoverColorado will likely approach the legislature with legislation to either wind down the affairs of CoverColorado or to revise the funding mechanism for the program so that it can be sustainable in the future.

10:42 AM

Ms. Bragg-Gamble responded to questions from Representative Kefalas regarding a task force that was created in 2008 to make recommendations regarding the funding of CoverColorado. Ms. Bragg-Gamble explained that the task force recommended that the program enact measures to reduce the costs of care, namely by reducing provider payment rates. Ms. Bragg-Gamble discussed the implementation of legislation that reduced provider payment rates. She further responded to questions from Representative Summers regarding the premiums paid by CoverColorado participants, stating that the rates are required to be 100 to 150 percent of commercial rates, and from Representative Young regarding coverage for autism treatment through CoverColorado.

10:50 AM

Ms. Bragg-Gamble reviewed the differences between CoverColorado and Getting Us Covered, which is Colorado's high-risk insurance pool that was created by the passage of the federal health care legislation. She explained that to be eligible for coverage through Getting Us Covered, individuals must have been uninsured for at least six months. She discussed the differences between the clientele served in CoverColorado and Getting Us Covered. She noted that there are about 1,200 people enrolled in Getting Us Covered, and in 2014, those individuals will be served through the state health insurance exchange. She responded to questions from Representative Summers regarding how the premiums in Getting Us Covered are determined, and she noted that the premiums in the program must be the same as in the commercial market. Ms. Bragg-Gamble noted that individuals in the Getting Us Covered program have generally not had health insurance coverage for some time and thus have many unmet health needs. Ms. Bragg-Gamble responded to questions from Representative McCann regarding how an eligible person would choose between enrolling in CoverColorado and Getting Us Covered, and from Representative Summers regarding federal moneys available to fund the Getting Us Covered program.

11:01 AM

In response to a question from Representative Schafer, Ms. Bragg-Gamble described the administration of the CoverColorado and Getting Us Covered programs. Representative Summers gave concluding remarks.

11:04 AM

The committee recessed.

01:33 PM -- Senate Bill 12-077

The committee reconvened, and Representative Summers made announcements related to the committee's schedule. Representative Sonnenberg introduced Senate Bill 12-077, which amends statutory provisions pertaining to the Department of Public Health and Environment's regulation of yellow grease to provide for the regulation of yellow grease only if it is intercepted by a grease trap or interceptor. Under the bill, yellow grease will be regulated in circumstances where it is also trap grease. Current law defines yellow grease as use cooking oil, spent shortenings, or any other inedible kitchen grease or waste vegetable oil produced by restaurant and food facilities.

01:37 PM -- Carly Dollar, Colorado Association of Commerce and Industry, testified in support of the bill. She noted that if the bill passes, there will still be regulations concerning grease in place.

01:38 PM -- James Peyrouse, Aspen Oil, testified in support of the bill and stated it will help maintain small businesses in Colorado.

01:39 PM -- Kurt Lange, Sustainable Oil Service, testified in support of the bill, and discussed the fees that could be incurred by some businesses if recently adopted regulations regarding yellow grease are not revised.


BILL:	SB12-077
TIME:	01:42:42 PM
MOVED:	Massey
MOTION:	Refer Senate Bill 12-077 to the Committee of the Whole. The motion passed on a vote of 12-0, with one member excused.
SECONDED:	Kerr J.
		VOTE
	Bradford	Yes
	Brown	Yes
	Fields	Yes
	Joshi	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Massey	Yes
	McCann	Excused
	Peniston	Yes
	Schafer S.	Yes
	Young	Yes
	Acree	Yes
	Summers	Yes

Final YES: 12 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS

01:43 PM -- Senate Bill 12-099

Representative Todd introduced Senate Bill 12-099. The bill expands the population that may be served in the Ridge View Youth Services Center to include youth who are in the temporary custody of county departments of social services. Under current law, Ridge View serves youth who are in the custody of the Department of Human Services in the Division of Youth Corrections. Ridge View is owned by the State of Colorado and operated by a private contractor. She responded to questions from the committee regarding the capacity and occupancy of Ridge View, stating that the capacity is 500 and currently 250 beds are occupied.

01:53 PM -- Kim Dvorchak, Colorado Juvenile Defender Coalition, testified in opposition to the bill. She stated that Ridge View is a commitment facility for juvenile delinquents. She stated that the state's efforts should be focused on reducing the use of out-of-home placements and congregate beds, but the bill's goal is to make additional beds available for out-of-home placements. She stated the type of program that is in place at Ridge View is not recommended for children in the child welfare system and that Ridge View is not an appropriate placement for dependent and neglected children. She responded to questions from the committee regarding the segregation of the youth corrections and child welfare populations at Ridge View and co-mingling of these populations at other facilities.

02:04 PM -- John Riley, Colorado Criminal Justice Reform Coalition, distributed a handout to the committee (Attachment D). He stated that there is no evidence that placement in juvenile correctional facilities is rehabilitative for children and can, in fact, make children's outcomes worse. He discussed the placement of children of color, and discussed the mental health and behavioral issues that abused and neglected children may have. He stated that money should be placed in to education rather than punishment. He responded to committee questions regarding the types of offenses that children who are housed in the Ridge View facility may have committed.

02:15 PM -- Bonnie Saltzman, Colorado Bar Association, testified in opposition to the bill. She stated the association would support the bill if it were amended to require a hearing before the placement of children who are dependent and neglected in the facility. She stated that the facility does not serve children who are low risk and discussed the recidivism rates for children who were placed in Ridge View. She stated that abused and neglected children are not delinquents and should not be placed in the facility. She responded to committee questions regarding whether there should be judicial oversight over all out-of-home placements, and the safeguards such oversight would provide.

02:28 PM -- Ellen Toomey Hale, Colorado Criminal Justice Reform Coalition, stated that research shows that even low-risk adjudicated children should not be placed in secure facilities, much less abused and neglected children. She questioned why there is objection to limiting the placement of children in Ridge View to adjudicated youth and to requiring judicial oversight for the placements. She stated that county departments of social services want full discretion, but not allowing judicial oversight over placements at Ridge View could take away the due process rights of children. She responded to questions from the committee regarding the availability of out-of-home placements for youth, stating that family reunification should be the goal.

02:35 PM -- Carla Bennett, League of Women Voters, testified in opposition to the bill as currently written, and stated her opposition to placing youth who have not been adjudicated delinquent in a secure facility. She stated her concern that placing dependent and neglected youth in Ridge View will send the message that they are somehow responsible for their problems. She responded to questions regarding the layout of the Ridge View facility.

02:43 PM -- Linda Weinerman, Office of the Child's Representative, testified in opposition to the bill and distributed a handout to the committee (Attachment E). She stated that Ridge View is a correctional facility for high-risk offenders, and questioned whether it is appropriate to send abused and neglected children to a correctional facility. She stated that children who go to the facility are at risk for victimization or becoming delinquents themselves.

02:46 PM -- Dorothy Macias, Office of the Child's Representative, discussed the potential emotional impact of housing abused and neglected children at Ridge View. Ms. Weinerman responded to questions from Representative Summers regarding the role of the Office of Child's Representative in cases involving out-of-home placements for children, stating that the office serves as a check and balance on county departments of social services. Ms. Weinerman said that counties are bound by bureaucracy and financial constraints, while the office represents the best interests of child. Ms. Weinerman stated the office frequently contests placements of children and stated that she would support the bill if it were amended to provide judicial oversight over the placements at Ridge View. Ms. Weinerman and Ms. Macias responded to questions from the committee regarding recidivism of youth offenders.

02:59 PM -- Lacey Berumen, Family Advocate - National Alliance of Mental Illness, testified in opposition to the bill and regarding emergency placements for dependent and neglected youth.

03:02 PM -- Alison Bettenberg, Bettenberg, Sharshel, and Maguire, LLC, discussed her experience as an attorney for dependent and neglected youth. She stated that Ridge View could be an appropriate placement for some children who are dependent and neglected, but it is only appropriate for a small number of children. She stated that commingling of delinquent and dependent and neglected youth in other facilities does occur, but the commingling occurs in treatment facilities and the children who are housed in the facilities have similar issues. She stated that Ridge View is not a clinical model designed to treat children, and discussed how placing children in Ridge View may affect the goals of reunifying children and families. She spoke in support of adding a judicial review component to the bill. She responded to questions from Representative Summers regarding the information that is available to attorneys and county departments of human services regarding dependent and neglected youth.

03:15 PM -- Lynn Johnson, Executive Director, Jefferson County Department of Human Services, stated that the department is in support of increasing the available placement options for children. She stated the department supports reducing congregate care placements, and stated the department's goal is to allow emancipating youth to avoid adult correctional systems. She discussed the evolution of the academic model for youth corrections, and described the experiences of youth who have been through the Ridge View program.

03:22 PM -- Mary Berg, Deputy Director, Jefferson County Department of Human Services, clarified that a youth has to be in the custody of the Department of Human Services before a placement is made and thus children in emergency placements could not be placed at Ridge View. She testified that youth can be determined to be dependent or neglected if they are abused or if they are out of the control of their parents, and stated that the child welfare population includes both of these types of children. She stated that the goal of the bill is to add an additional placement option for counties and described the other facilities that commingle the delinquent and child welfare populations.

03:24 PM -- Barb Weinstein, Jefferson County Department of Human Services, described the county process of placing children in out-of-home placements. She reiterated that the bill allows, but does not require, Ridge View to be a placement for counties. Ms. Johnson responded to questions from the committee regarding data on children who are in the youth corrections and child welfare systems who are commingled in facilities. Ms. Berg clarified that the department does not support the proposed amendment that would add judicial oversight to the process.

03:31 PM -- Julie Krow, Colorado Department of Human Services, discussed the use of congregate placements, and testified that the department supports efforts to reduce the need for such placements, but that there continues to be a need for some out-of-home placement options. She stated the bill offers another option for counties, and clarified that placement decisions are made as part of a team. She stated that the department has a good relationship with the Right of Passage program, which is the contractor for the Ridge View facility, and spoke regarding the programs offered at Ridge View, including academic and athletic programs. She noted that many state facilities accept children in both the child welfare and youth corrections systems. She responded to questions from the committee regarding whether the department would support an amendment to add additional judicial oversight to the process of placing children at Ridge View, stating that the department does not believe that the amendment is necessary. Ms. Krow discussed the types of children that may be referred to Ridge View, but noted that a clinical assessment is necessary to make the appropriate placement.

03:48 PM -- Cheryl Ternes, Director, Arapahoe County Department of Human Services, spoke in support of the bill.

03:49 PM -- Angela Lytle, Arapahoe County, testified that counties are required to explore lower levels of placement before children are placed in residential facilities. She stated that Arapahoe County would be pleased to contract with Ridge View to place a limited number of children.

03:53 PM -- Michael Valentine, Deputy County Attorney, Arapahoe County, described his experience prosecuting dependency and neglect and delinquency cases. He reiterated that there are specific criteria for out-of-home placements, and stated that the court listens to children's caseworkers and guardians ad litem in making the placements, and if there is objection to the placements by any of the parties, a hearing is required. He stated that the proposed amendment will create a hearing requirement for only one of 30 similar facilities in the state. Mr. Valentine responded to questions from Representative Kefalas regarding the proposed amendment to add judicial oversight, stating that the proposed amendment would be redundant to processes that already exist that allow for review of out-of-home placements.

04:06 PM -- Kent Moe, Director of Program Development for Right of Passage, Ridge View Academy, discussed the history of Ridge View Academy. He stated that the facility was designed to have an open campus and described the layout of the facility. He stated that the facility is a good placement option for children who are out of the control of their parents and at risk for future involvement with the juvenile delinquency system. He testified that Arapahoe County Sheriff Grayson Robinson is in support of the bill and distributed a letter of support from Sheriff Robinson (Attachment F).

04:20 PM -- Steven Gibson, Ridge View Academy, testified regarding his experiences during his placement at Ridge View.

04:22 PM -- Cody Chiarelli, Ridge View Academy, testified regarding his experiences during his placement at Ridge View and regarding the benefits of the Ridge View program.

04:28 PM -- Judy Jackson, representing herself, testified regarding her experience with her great-nephew's placement at Ridge View, and the benefits of the Ridge View program for her great-nephew.

04:35 PM -- Skip Barber, Colorado Association of Children and Families Agencies, testified in support of the bill. He discussed the availability of out-of-home placements, and stated the bill is not about creating more capacity for out-of-home placements, but rather about allowing access to Ridge View's unique program. He described the process of providing services to children in the child welfare system, and stated that children are only placed in residential care when their particular needs required that level of care.

04:39 PM -- Lauren Davey, Right of Passage and the Betty Marler Youth Services Center, testified regarding her experience being placed in a program operated by Right of Passage and described the benefits of the program.

04:43 PM -- Witnesses who were signed up in support of the bill identified their support for the bill. The witnesses included Bill Wood, representing Ridge View, Patricia Harper, representing the Ridge View school board, Robert Sutherland, representing the Community Advisory Board, Evy Schott, representing Right of Passage, and Dan Makelky, representing Douglas County.

04:44 PM -- Pat Ratliff, Colorado Counties Inc., testified that a majority of counties support the bill.

04:47 PM

Representative Kefalas distributed amendment L.006 (Attachment G). The amendment creates a process for judicial review of youth placements in the Ridge View facility.


BILL:	SB12-099
TIME:	04:47:41 PM
MOVED:	Kefalas
MOTION:	Adopt prepared amendment L.006 (Attachment G). The motion failed on a vote of 4-7, with two members excused.
SECONDED:	Bradford
		VOTE
	Bradford	Yes
	Brown	No
	Fields	Yes
	Joshi	Excused
	Kefalas	Yes
	Kerr J.	No
	Massey	No
	McCann	Excused
	Peniston	No
	Schafer S.	No
	Young	Yes
	Acree	No
	Summers	No

YES: 4 NO: 7 EXC: 2 ABS: 0 FINAL ACTION: FAIL

4:52 PM

Representative Kefalas distributed amendment L.007 (Attachment H) to the committee. The committee discussed the amendment, which requires an annual report on the number of, and outcomes for, juveniles who are placed in the Ridge View facility. The committee discussed whether the requirements of the amendment should apply to other facilities.


BILL:	SB12-099
TIME:	04:54:49 PM
MOVED:	Kefalas
MOTION:	Adopt prepared amendment L.007 (Attachment H). The motion failed on a vote of 4-7, with two members excused.
SECONDED:	Bradford
		VOTE
	Bradford	Yes
	Brown	No
	Fields	Yes
	Joshi	Excused
	Kefalas	Yes
	Kerr J.	No
	Massey	No
	McCann	Excused
	Peniston	No
	Schafer S.	No
	Young	Yes
	Acree	No
	Summers	No

YES: 4 NO: 7 EXC: 2 ABS: 0 FINAL ACTION: FAIL

5:03 PM

Representative Fields discussed a conceptual amendment to add statutory criteria regarding the placements that are made to Ridge View. Representative Todd discussed the existing criteria used by the counties in making out-of-home placements. The conceptual amendment was not offered.


BILL:	SB12-099
TIME:	05:08:49 PM
MOVED:	Summers
MOTION:	Refer Senate Bill 12-099 to the Committee of the Whole. The motion passed on a vote of 8-3, with two members excused.
SECONDED:	Brown
		VOTE
	Bradford	Yes
	Brown	Yes
	Fields	No
	Joshi	Excused
	Kefalas	No
	Kerr J.	Yes
	Massey	Yes
	McCann	Excused
	Peniston	Yes
	Schafer S.	Yes
	Young	No
	Acree	Yes
	Summers	Yes

Final YES: 8 NO: 3 EXC: 2 ABS: 0 FINAL ACTION: PASS

05:10 PM

The committee took a brief recess.

05:19 PM -- House Bill 12-1294

The committee reconvened. Representative Liston introduced House Bill 12-1294. Under current law, the Department of Public Health and Environment (DPHE) licenses and establishes and enforces standards for the operation of health facilities in the state. Both DPHE and the Department of Human Services (DHS) jointly regulate community residential homes for persons with developmental disabilities. As amended by the House Economic and Business Development Committee, the bill eliminates DPHE's authority to license and develop standards for the operation of community residential homes and establishes that authority in the DHS. In addition, the bill modifies DPHE's authority concerning the licensing of health facilities. The bill:

requires DPHE to establish a schedule for extended survey cycles, or an abbreviated, periodic inspection system for health facilities that have been licensed for at least three years and that have not been the subject of any enforcement activity or complaints within the past three years;
prohibits DPHE from imposing construction standards that are more stringent than, or that do not comply with, applicable national, state, and local building and fire codes when considering a license application or renewal;
places limits on DPHE's authority in determining an applicant's fitness to conduct and maintain a health facility;
establishes criteria for deeming that licensing requirements have been satisfied;

requires DPHE only to regulate Program for All-inclusive Care for the Elderly (PACE) organizations in a manner consistent with federal regulations and regulations found in current three-way agreements;
permits the State Board of Health to increase fees upon recommendation of the Health Care Industry Facility Advisory Council, with increases not to exceed inflation;
clarifies that home care placement agencies are not licensed or certified by DPHE and subjects facilities that make such a claim to a civil penalty.

He distributed amendments L.009, L.010, L.011, L.013, L.014, L.015 and L.016 (Attachments I through O). A summary of the amendments was also distributed to the committee (Attachment P).

Representative Liston discussed the process that led to the introduction of the bill. He stated that the bill will bring efficiencies to the DPHE, and that many health care-related organizations have been working in collaboration with the department on the bill.

05:38 PM -- Joni Reynolds, DPHE, testified that the department has not taken an official position on the bill, and thanked the health care stakeholders who have been working with the department on the bill. She identified four issues on which the department and stakeholders have not been able to gain consensus. She spoke regarding the bill's provisions regarding life safety code, stating that the bill's provisions are similar to provisions in House Bill 12-1268 to which the department is opposed. She noted that the department and stakeholders have not discussed the issues related to the life safety code provisions. She spoke regarding the bill's provisions transferring the inspections of community residential homes for persons with developmental disabilities to the DHS. Ms. Reynolds discussed the bill's provisions establishing an advisory council, and the department's desire that the council be streamlined. Finally, she addressed issues related to "deemed status" in which facilities that are subject to national accreditation standards will be deemed to have met certain state licensing requirements, and stated that the stakeholders and department have worked on a compromise on that issue. Representative Summers and Representative Liston responded to questions from Representative Fields regarding consumer representation on the advisory council. Ms. Reynolds addressed questions from the committee regarding the transfer of surveys of community residential homes to the DHS.

05:38 PM -- Julia Martinez, DHS, testified regarding the bill and in opposition to the provisions of the bill transferring the licensing of community residential homes to the DHS from the DPHE. She stated it is critical that the DPHE maintain licensing authority over the homes, and stated that DPHE is the federally approved licensing authority for such homes. She stated that the bill puts DHS in the position of having to create a licensing structure that parallels DPHE's current structure, and that current DHS employees do not have the necessary expertise to conduct licensing surveys. She stated that the bill will fragment the licensing system, and that if community residential homes are exempted from DPHE licensing, other health agencies will ask to be exempted from DPHE licensing in the future. She stated it is important to maintain a neutral and highly skilled state licensing agency. She questioned whether it was appropriate for DHS to inspect community residential homes, and stated the department's commitment to continue to work on streamlining the current licensing process.

05:45 PM -- Shari Repinski, DHS, responded to questions regarding federal requirements related to the licensing and inspection of health care facilities. She described community residential homes and the residents served by the homes. She described the inspection that the DHS conducts of community residential homes, noting that the DHS' inspections are primarily focused on programs offered by the homes, and acknowledged that there could be overlap between the inspections conducted by DHS and DPHE. She stated that the departments have worked to reduce the overlap in inspection requirements. She responded to questions from the committee regarding whether the inspection processes of the departments could be further coordinated.

05:56 PM -- Shannon Gimbel, Denver Regional Council of Governments (DRCOG) - State Long-term Care Ombudsman Program, testified that she believes that some of the amendments will address DRCOG's concerns with the bill. She discussed DRCOG's concerns with the bill, specifically related to deemed status. She discussed the potential for small violations to show an ongoing pattern of harm, and the importance of tracking violations over time.

06:03 PM -- Edie Busam, Colorado Center for Hospice and Palliative Care, National Private Duty Association, and Professional Pediatric Home Care, spoke regarding the stakeholder process in developing the bill and the ongoing discussions regarding the bill. She stated that there is a lot of duplication in the inspection and licensing of health care facilities.

06:08 PM -- Ellen Caruso, Home Care Association of Colorado and the Colorado Center for Hospice and Palliative Care, testified in support of the bill and spoke to the coalition process in developing the bill. She discussed the bill's provisions related to performance incentives and testified that the process is currently working well for home care providers.

06:09 PM -- Fofi Mendez, Leading Age Colorado, testified regarding discussions with DPHE about how the number of surveys for health care facilities that are good performers and have had good surveys three years in a row can be reduced.

06:13 PM

Ms. Busam responded to questions from the committee regarding the bill's fiscal note.

06:16 PM -- Roger Jensen, Alliance, testified that one of the consistent complaints of staff in community residential homes for individuals with developmental disabilities is the duplication of regulation and between the DPHE, DHS, and local fire departments. He discussed the staff time that is devoted to responding to surveys and the need to streamline the process. He stated that only duplicative requirements will be eliminated and that the facilities will still be regulated. He discussed the bill's fiscal note.

06:23 PM -- Kirk Mlinek, Legislative Council Staff, came to the table to respond to committee questions regarding the bill's fiscal note. He discussed the bill's inclusion of a "No Appropriation" clause, and described the costs that are driven by the bill. Mr. Mlinek discussed the issues related to the federal waiver which requires that community residential homes for persons with developmental disabilities serving between four and eight clients be licensed by the DPHE.

06:32 PM -- Christy Chase, Office of Legislative Legal Services, discussed the bill's "No Appropriation" clause. She noted that the clause was included in the introduced version of the bill, and explained that the bill's costs will be evaluated by House Appropriations Committee. She responded to questions from the committee regarding licensing fees and the bill's costs.

06:37 PM

Mr. Mlinek responded to questions from the committee regarding the bill's costs related to rulemaking and stakeholder outreach. He responded to questions from the committee regarding the potential reduction of costs in the future and whether the fiscal note was affected by the federal waiver that requires DPHE to license community residential homes for persons with developmental disabilities.

06:44 PM -- Arlene Miles, Colorado Health Care Association, testified regarding the bill's fiscal note. She discussed the potential of the DPHE to redistribute the money saved by reducing the number of surveys of health care facilities to cover the costs of the bill's new requirements. She stated the goal of the bill is to make the licensing process more efficient and to limit licensing fee increases while still maintaining consumer safety.

06:54 PM -- Gail Finley, Colorado Hospital Association, testified in support of the bill. She discussed the accreditation process for health care facilities and the process of licensing ambulatory surgical centers. She discussed the bill's definition of "community clinic." She stated that the coalition is still discussing the definition with the DPHE and stated that she was hopeful that the bill would resolve issues related to the definition.

06:58 PM -- Beverly Dalan, Total Long Term Care, described the Program of All Inclusive Care for the Elderly (PACE) and the process of regulating PACE programs. She stated that the bill eliminates duplicative requirements for PACE programs.

07:00 PM -- Kim Hendren, Total Long Term Care, gave examples of the duplicative requirements to which PACE programs are subject. Ms. Dalan stated that the bill will preserve public safety while eliminating unnecessary regulation.

07:05 PM

Representative Summers stated that the committee would consider amendments and lay the bill over for final action until a future meeting of the committee.


BILL:	HB12-1294
TIME:	07:06:07 PM
MOVED:	Summers
MOTION:	Adopt prepared amendment L.009 (Attachment I). The motion passed without objection.
SECONDED:	Kerr J.
		VOTE
	Bradford
	Brown
	Fields
	Joshi
	Kefalas
	Kerr J.
	Massey
	McCann
	Peniston
	Schafer S.
	Young
	Acree
	Summers

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


BILL:	HB12-1294
TIME:	07:07:08 PM
MOVED:	Summers
MOTION:	Adopt prepared amendment L.010 (Attachment J). The motion passed without objection.
SECONDED:	Kerr J.
		VOTE
	Bradford
	Brown
	Fields
	Joshi
	Kefalas
	Kerr J.
	Massey
	McCann
	Peniston
	Schafer S.
	Young
	Acree
	Summers

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

07:08 PM

Ms. Miles returned to the table to explain amendment L.011 (Attachment K).


BILL:	HB12-1294
TIME:	07:08:19 PM
MOVED:	Summers
MOTION:	Adopt prepared amendment L.011 (Attachment K). The motion passed without objection.
SECONDED:	Kerr J.
		VOTE
	Bradford
	Brown
	Fields
	Joshi
	Kefalas
	Kerr J.
	Massey
	McCann
	Peniston
	Schafer S.
	Young
	Acree
	Summers

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


BILL:	HB12-1294
TIME:	07:11:05 PM
MOVED:	Summers
MOTION:	Adopt prepared amendment L.013 (Attachment L). The motion passed without objection.
SECONDED:	Kerr J.
		VOTE
	Bradford
	Brown
	Fields
	Joshi
	Kefalas
	Kerr J.
	Massey
	McCann
	Peniston
	Schafer S.
	Young
	Acree
	Summers

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

07:11 PM

Ms. Miles responded to questions from the committee regarding the advisory council created by the bill.


BILL:	HB12-1294
TIME:	07:11:49 PM
MOVED:	Summers
MOTION:	Adopt prepared amendment L.014 (Attachment M). The motion passed without objection.
SECONDED:	Kerr J.
		VOTE
	Bradford
	Brown
	Fields
	Joshi
	Kefalas
	Kerr J.
	Massey
	McCann
	Peniston
	Schafer S.
	Young
	Acree
	Summers

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


BILL:	HB12-1294
TIME:	07:15:03 PM
MOVED:	Summers
MOTION:	Adopt prepared amendment L.015 (Attachment N). The motion was withdrawn.
SECONDED:	Kerr J.
		VOTE
	Bradford
	Brown
	Fields
	Joshi
	Kefalas
	Kerr J.
	Massey
	McCann
	Peniston
	Schafer S.
	Young
	Acree
	Summers

YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION:


BILL:	HB12-1294
TIME:	07:15:42 PM
MOVED:	Summers
MOTION:	Adopt prepared amendment L.016 (Attachment O). The motion passed without objection.
SECONDED:	Kerr J.
		VOTE
	Bradford
	Brown
	Fields
	Joshi
	Kefalas
	Kerr J.
	Massey
	McCann
	Peniston
	Schafer S.
	Young
	Acree
	Summers

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

07:16 PM

The bill was laid over for final action.

07:18 PM

The committee adjourned.