Bill Summary for Bill Number HB12-1294

Date: 03/13/2012

Final
BILL SUMMARY for HB12-1294

HOUSE COMMITTEE ON HEALTH AND ENVIRONMENT

Votes: View-->	Action Taken:
Adopt prepared amendment L.009 (Attachment I). The Adopt prepared amendment L.010 (Attachment J). The Adopt prepared amendment L.011 (Attachment K). The Adopt prepared amendment L.013 (Attachment L). The Adopt prepared amendment L.014 (Attachment M). The Adopt prepared amendment L.015 (Attachment N). The Adopt prepared amendment L.016 (Attachment O). The	Pass Without Objection Pass Without Objection Pass Without Objection Pass Without Objection Pass Without Objection Pass Without Objection

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 action.

07:18 PM

The committee adjourned.