House Committee on Health and Environment (02/14/2012)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH AND ENVIRONMENT

Date:	02/14/2012	ATTENDANCE

Time:	11:40 AM to 03:45 PM	Bradford	E
		Brown	X
Place:	LSB A	Fields	E*
		Joshi	X
This Meeting was called to order by		Kefalas	X
	Representative Summers	Kerr J.	X
		Massey	X
This Report was prepared by		McCann	E*
	Amanda King	Peniston	X
		Schafer S.	E*
		Young	X
		Acree	E*
		Summers	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
CO Ambulatory Surgery Center Assoc HB12-1276 HB12-1097		Witness Testimony and/or Committee Discussion Only Amended, Referred to the Committee of the Whole Amended, Referred to the Committee of the Whole

11:41 AM -- CO Ambulatory Surgery Center Assoc

Dan Connolly, Ross Alexander, and Rosalie Einspahr, Colorado Ambulatory Surgery Center Association, introduced themselves. The committee was provided an informational packet (Attachment A). Mr. Connolly stated that there are over 100 ambulatory surgery centers operating in Colorado. Mr. Connolly explained the types of services that are provided at the ambulatory surgery centers and some of the differences between ambulatory surgery centers and hospitals, including the costs differences. Mr. Connolly discussed the Medicaid reimbursement rate for ambulatory surgery centers and how ambulatory surgery centers could be utilized for cost-containment for Medicaid.

11:50 AM

Ms. Einspahr discussed the Medicaid pilot project to increase the utilization of ambulatory surgery centers for Medicaid, which increased the Medicaid rate paid on certain procedures. Ms. Einspahr, Mr. Alexander, and Mr. Connolly responded to questions about how cost savings are achieved if reimbursement rates are raised for ambulatory surgery centers and why ambulatory surgery centers are not used more often for Medicaid cases.

12:01 PM

Chris Skagan, Colorado Ambulatory Surgery Center Association, explained how the cost savings would occur even if reimbursement rates are increased. Mr. Alexander responded to questions about the different types of ownership arrangements that exist for ambulatory surgery centers. Mr. Alexander and Ms. Einspahr responded to questions about the costs and Medicaid reimbursement rates for certain procedures in hospitals.

12:07 PM

Mr. Alexander discussed the Colorado Ambulatory Surgery Center Association wish list, which includes increasing input and involvement, decreasing regulation, increasing understanding of the differences between ambulatory surgery centers and hospitals, and decreasing the gap in payment rates for ambulatory surgery centers and hospitals.

12:10 PM

Mr. Alexander, Mr. Connolly, and Ms. Einspahr responded to questions about the relationship ambulatory surgery centers have with private insurance companies, whether a federal Medicaid block grant would allow more flexibility for ambulatory surgery center reimbursement rates, whether the ambulatory surgery centers have involvement with the all-payer claims database, the regulations related to physician ownership of ambulatory surgery centers, and whether the ambulatory surgery centers will be providing services under the Colorado Health Benefit Exchange.

12:19 PM

The committee recessed.

01:35 PM -- House Bill 12-1276

Representative Duran presented House Bill 12-1276, concerning child care licensure waivers for materials related to a child care center's curriculum. The bill allows child care centers regulated by the Department of Human Services to apply for waivers to use certain materials in conjunction with their curricula. Child care centers are required to adopt policies concerning parental notification about the potential safety risks of those materials and the training of staff in the use of the materials. The bill requires the Department of Human Services to promulgate rules for the waiver process. The bill allows child care centers to appeal waiver denials and sets forth other requirements on the Department of Human Services concerning inspections, time frame for appeals, and publishing negative licensing actions concerning the waivers created by the bill.

01:39 PM -- Julie Krow, Department of Human Services, stated that the department is monitoring the bill and is looking to bring in national experts to review how the department approves waivers. She said the department wants to work with child care providers.

01:42 PM -- Jennifer Landrum, Colorado Children's Campaign, testified in support for the bill. Ms. Landrum discussed the current appeal and waiver process for child care centers and how House Bill 12-1276 could strengthen and improve the process and the licensing system. Ms. Landrum responded to questions about the regulation of child care programs. Kathryn Hammerbeck, Early Childhood Education Association, testified in support for the bill. Ms. Hammerbeck explained the need for a more formalized process for the appeal and waiver process. Ms. Hammerbeck explained elements of the bill, including parental notification, staff training requirements, and time frames for waivers. Ms. Hammerbeck provided the committee a handout (Attachment B).

01:50 PM -- Rebecca Fast, Montessori Academy of Colorado, testified in support for the bill. She provided the committee an information packet (Attachment C). Ms. Fast discussed the initial licensing process for her child care center and her experience receiving citations from the Department of Human Services. Ms. Fast responded to questions about the number of incidents caused by glass or chokables. Linda Gottschalk, Gateway Montessori School, testified in support for the bill. Ms. Gottschalk discussed her experience of applying for waivers for her child care center. Dorothy Thompson, Montessori Education Center of the Rockies, testified in support for the bill. Ms. Thomspon described some of the techniques used at Montessori programs that could be deemed a choking or cutting hazard. Ms. Thompson responded to questions about the number of safety incidents that have occurred in Colorado and how glass objects are used in the classrooms. Ms. Thompson provided the committee a handout (Attachment D). Representative Duran stated that the bill is directing the Department of Human Services to consider parental notification and the instruction of educators when issuing or denying a waiver.

02:12 PM -- Christine Lowry, Forest Park Montessori, testified in support for the bill. She discussed the federal regulations related to warning labels and that education materials were removed from the banned substances list. Janice Kruse, Montessori School of Lakewood, testified in support for the bill and discussed the impact of the Department of Human Services' regulations on small businesses that operate Montessori programs. Ms. Kruse responded to questions about the enrollment at her school. Kerry Merkel, Blue Mountain Montessori, testified in support for the bill. Ms. Merkel shared testimony from a discussion she had with her students about the Department of Human Services' regulations. Ms. Merkel provided a handout to the committee (Attachment E). Representative Duran stated she has recently learned that Department of Human Services will not be revoking all of the waivers.

02:23 PM -- Dr. Martha Urioste, representing herself, testified in support for the bill. Dr. Urioste described her experience in bringing Montessori programs to Denver Public Schools. Denise Glenn, representing herself, testified in support for the bill and described her experience as a parent whose child attended a Montessori program. Chris Corton, representing himself, testified in support for the bill and discussed the regulation of educational settings. Mr. Corton discussed his experience as a parent of child who attends a Montessori program.

02:34 PM -- Tracy Bernett, representing herself, testified in support for the bill and discussed her experience as a parent whose children attended Montessori programs. Allana Farley, representing herself, testified in support for the bill and discussed her experience as a parent whose child attends a Montessori program. Kathy Frank, representing herself, testified in support for the bill and discussed her experience as a parent whose child attends a Montessori program. Ms. Frank described the unique needs of her child who was sexually abused by other students in a previous educational setting and the need for proper supervision in child care centers.

02:44 PM -- Elisa Foster, representing herself, testified in support for the bill and discussed her experience as a parent whose children attended a Montessori program.

02:48 PM

Written testimony from Babbette Norton, representing herself, was submitted into the record (Attachment F).

02:49 PM

Ms. Krow returned to the table to responded to questions from the committee regarding about the number of fatalities due to choking that occurred child care centers, the federal requirements for labeling of choking hazards, whether the Department of Human Services trains staff in different educational curriculum, and the availability of data related to choking incidents.

02:53 PM

Representative Duran presented amendment L.003 (Attachment G), which expands the representation included on the appeals panel.


BILL:	HB12-1276
TIME:	02:55:13 PM
MOVED:	Massey
MOTION:	Moved amendment L.003 (Attachment G). The motion passed without objection.
SECONDED:	Kefalas
		VOTE
	Bradford	Excused
	Brown
	Fields
	Joshi
	Kefalas
	Kerr J.
	Massey
	McCann
	Peniston
	Schafer S.
	Young
	Acree
	Summers

YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection

02:56 PM

Representative Duran provided closing comments on the bill. The committee dialogued about the bill.


BILL:	HB12-1276
TIME:	02:59:09 PM
MOVED:	Acree
MOTION:	Moved to refer House Bill 12-1276, as amended, to the Committee of the Whole. The motion passed on a vote of 12-0.
SECONDED:	Kefalas
		VOTE
	Bradford	Excused
	Brown	Yes
	Fields	Yes
	Joshi	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Massey	Yes
	McCann	Yes
	Peniston	Yes
	Schafer S.	Yes
	Young	Yes
	Acree	Yes
	Summers	Yes

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

02:59 PM

The committee took a brief recess.

03:05 PM -- House Bill 12-1097

The committee came back to order.

Representative Summers presented House Bill 12-1097, concerning civil penalties for retail food establishments. The bill specifies that the Department of Public Health and Environment, or a county or district board of health, may initiate license suspension or revocation proceedings against a retail food establishment only after the imposition of penalties proscribed in section 25-4-1611, C.R.S. He provided history on the current statutes related to the regulation of retail food establishments, the need to clarify existing statutes, and the impact on small businesses that are required to close for a violation.

03:14 PM -- Don Jacobsson, representing a private unnamed client, testified in support for the bill. He explained the litigation that his client is currently involved in under existing statutes and the need to add certainty and clarity to the process.

03:17 PM -- Pete Meersman, Colorado Restaurant Association, testified in support for the bill. He discussed the current system for retail food establishments related to the civil penalty process and the need for the bill to address a loophole in the existing statutes related to civil penalty process. He discussed the need to add a definition of an imminent health hazard to the bill. He discussed making a change to the statute concerning changing the time frame for allowable number of civil penalties from a calendar year to a twelve-month period. Mr. Meersman responded to a question about what a reasonable time to comply would mean.

03:24 PM -- Tom Butts, Colorado Association of Local Public Health Officials, stated the organization is neutral on the bill. He discussed the need to address additional issues to clarify and streamline the inspection process, including some that were identified in a state audit. Mr. Butts responded to questions about outstanding audit issues, the percentage of food establishments that have actions taken against them annually, how the inspection process occurs and how the process would be changed by House Bill 12-1097. Mr. Butts provided the committee an excerpt from the Consumer Protection Division of the Department of Public Health and Environment Performance Audit from May 2003 (Attachment H).

03:33 PM -- Christie O'Donnell, Colorado Hotel Association, testified in support for the bill.

03:34 PM

Representative Summers discussed the bill, specifically the need to bring clarity to the current process and to assist businesses.

03:37 PM -- Mary Lou Chapman, Rocky Mountain Food Industry Association, testified in support for the bill and stated that grocery stores are included under the retail food establishment regulations.

03:39 PM

Representative Summers explained L.002 (Attachment I), which adds a definition of imminent health hazard to the bill. The committee and Representative Summers dialogued about a potential amendment that was not offered including addressing certain penalties in statute.


BILL:	HB12-1097
TIME:	03:39:16 PM
MOVED:	Summers
MOTION:	Moved amendment L.002 (Attachment I). The motion passed without objection.
SECONDED:	Brown
		VOTE
	Bradford	Excused
	Brown
	Fields
	Joshi
	Kefalas
	Kerr J.
	Massey
	McCann
	Peniston
	Schafer S.
	Young
	Acree
	Summers

YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	HB12-1097
TIME:	03:43:36 PM
MOVED:	Summers
MOTION:	Moved amendment L.003 (Attachment J). The motion passed without objection.
SECONDED:	Kerr J.
		VOTE
	Bradford	Excused
	Brown
	Fields
	Joshi
	Kefalas
	Kerr J.
	Massey
	McCann
	Peniston
	Schafer S.
	Young
	Acree
	Summers

YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection

03:44 PM

Representative Summers provided closing remarks on the bill.


BILL:	HB12-1097
TIME:	03:44:57 PM
MOVED:	Kefalas
MOTION:	Moved to refer House Bill 12-1097, as amended, to the Committee of the Whole. The motion passed on a vote of 11-0.
SECONDED:	Schafer S.
		VOTE
	Bradford	Excused
	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

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

03:45 PM

The committee adjourned.