HOUSE Amended 2nd Reading April 6, 2009First Regular Session Sixty-seventh General Assembly STATE OF COLORADO ENGROSSED This Version Includes All Amendments Adopted on Second Reading in the House of Introduction LLS NO. 09-0413.02 Kristen Forrestal HOUSE BILL 09-1273 HOUSE SPONSORSHIP Kefalas, Green, Frangas, Court, Fischer, Hullinghorst, Labuda, Levy, Miklosi, Pace, Vigil, Apuan, McCann, Ryden, Schafer S., McGihon SENATE SPONSORSHIP Foster, Bacon, Carroll M. House Committees Senate Committees Business Affairs and Labor Appropriations A BILL FOR AN ACT Concerning the creation of a health care authority to develop a health care system that shall be the administrator for health care services in Colorado. Bill Summary (Note: This summary applies to this bill as introduced and does not necessarily reflect any amendments that may be subsequently adopted.) Creates the Colorado health care authority (authority) as a body corporate and political subdivision of the state. Establishes the mission of the authority, which is to create a health care system in Colorado that is the administrator and payer for health care services. Requires the authority to create a system to recommend to the general assembly that provides comprehensive medical benefits to Coloradans. Requires the appointment of a board of directors (board) to create and develop the health care system. In creating and developing the system, requires the board to consider specific requirements and analyses. Specifies comprehensive medical benefits to be included in the system. Establishes a fund consisting of any general fund moneys appropriated by the general assembly. Requires the executive director of the board to seek all necessary waivers, exemptions, and agreements from the federal government to ensure consistent levels of funding if the system is implemented by bill of the general assembly. Prohibits the implementation of the creation and development of the system if the board does not raise sufficient gifts, grants, and donations by July 1, 2011, to fund its activities. Prohibits the implementation of the system until all necessary waivers, exemptions, and agreements are in place; the board certifies that the board has received sufficient funding; and the general assembly acts by bill to implement the system. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. Title 25.5, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW ARTICLE to read: ARTICLE 9 Colorado Guaranteed Health Care Act 25.5-9-101. Short title. This article shall be known and may be cited as the "Colorado Guaranteed Health Care Act". 25.5-9-102. Legislative declaration. (1) The general assembly finds, determines, and declares that: (a) Colorado confronts urgent and interconnected challenges to provide affordable quality health care for its citizens; (b) Health care is unavailable or unaffordable to an increasing number of Coloradans; (c) All Coloradans pay for the uninsured as health insurance premiums increase to cover the cost for those who cannot pay; (d) Extending health care to all Coloradans will eliminate the burden of uncompensated care, reduce costs, improve the health of Coloradans, and establish the principle of universal health care coverage; (e) The fundamental participant in health care transactions is the individual and the fundamental relationship is between the individual and his or her health care provider; (f) Health care services should be provided to an individual with limited and efficient outside intervention and maximum transparency; (g) The increasing costs to businesses of providing employee health care coverage are not economically sustainable under the current health care system unless an affordable solution is found for all Coloradans; and (h) There should be no required connection between health care and employment; (i) An effective means to address the problems of access, cost, and quality is a comprehensive health care system that guarantees coverage that is primarily publicly funded and privately delivered with individual choice of provider and services. 25.5-9-103. Definitions. As used in this article, unless the context otherwise requires: (1) "Authority" means the Colorado health care authority created in section 25.5-9-104. (2) "Board" means the board of directors of the authority. (3) "Executive director" means the executive director of the authority. (4) "Medical home" means an appropriately qualified medical specialty, developmental, therapeutic, or mental health care practice that verifiably ensures continuous, accessible, and comprehensive access to a coordination of community-based medical care, mental health care, oral health care, and related services for the consumer. A medical home shall ensure, at a minimum, the following: (a) Health maintenance and preventative care; (b) Anticipatory guidance and health education; (c) Acute and chronic illness care; (d) Coordination of medications, specialists, and therapies; and (e) Provider participation in hospital care. (5) "System" means the health care system created by the authority. 25.5-9-104. Colorado health care authority. (1) There is hereby created the Colorado health care authority, that shall be a body corporate and a political subdivision of the state, that shall not be an agency of state government, and that shall not be subject to administrative direction or control by any department, commission, board, bureau, or agency of the state. (2) The authority and its corporate existence shall continue until terminated by law; except that no such law shall take effect if the authority has notes or other obligations outstanding unless adequate provision has been made for the payment thereof. 25.5-9-105. Mission of the authority - create health care system. The mission of the authority shall be to create a health care system in Colorado that shall be the benefits administrator and payer for health care services as defined by the authority. The authority shall create a system to recommend to the general assembly that provides comprehensive medical benefits to all eligible participants in Colorado. 25.5-9-106. Creation of system - required elements of system. (1) The board shall create and design the health care system for Colorado in collaboration with parties that may be affected by the design and implementation of the system. In creating and designing the system, the board shall not be limited in making recommendations regarding the elements of the system, but shall at least make recommendations concerning the following elements: (a) The membership of a board of directors to govern the authority once the system is established; (b) The establishment, as part of the plan for the system, of regional systems to administer and pay for comprehensive medical benefits coverage for all eligible participants based on patient need and without delay or discrimination; (c) The impact of incorporating the medical portions of state liability insurance, workers' compensation insurance, and automobile insurance into the system through an analysis completed by the board; (d) Appropriate and cost-effective benefit design and eligibility requirements, standards and qualifications for health care providers, provider rates, and any other provisions the board finds necessary to carry out the mission and purposes of this article; (e) The current use of public moneys spent on health care in Colorado and how the funding sources may be streamlined and used in a more efficient and cost-effective manner; (f) The creation, as part of the plan for the system, of the allowance for participants to choose a licensed personal physician or licensed advanced practice nurse to manage and coordinate the continual care of the participant and serve as the participant's medical home; (g) A plan for the short- and long-term health care needs of the participants; (h) The development of information technology specifications for: (I) Clearly defined standards for a confidential, electronic patient records system and electronic personal health records to maintain accurate patient records and to simplify the billing process, thereby reducing medical errors and administrative costs; (II) An automated method for claims processing, billing, and payment; and; (III) Provisions for statewide and regional collection and analysis of clinical data including utilization, quality measures, outcomes, and errors; (i) Establishing mechanisms for the use of clinical data collected under subparagraph (III) of paragraph (h) of this subsection (1) to establish standards for best practices through the application of evidence-based medicine; (j) Improving the health of Coloradans with community health initiatives; the support of innovative, efficient, and coordinated care; wellness education; and end-of-life education; (k) Establishing a central purchasing authority responsible for negotiating favorable prices for prescription drugs and durable medical equipment where appropriate; (l) Including health care coverage for all medically necessary oral health care, mental health care, and substance abuse treatment on the same basis as the coverage for other conditions; (m) Developing a transition plan for retraining and job placement that considers extended unemployment benefits for those whose jobs have been impacted by the implementation of the system; (n) Providing support for health care provider education and training that effectively addresses primary care, nursing, and other provider shortages primarily in rural and underserved areas of the state; (o) Establishing a system for filing and arbitrating all grievances regarding delay, denial, or modification of health care services; (p) Creating a Colorado health care quality and dispute resolution system to measure quality, investigate reports of poor quality, and develop an efficient and fair dispute resolution system; (q) Collaborating with local governments, special districts, critical access hospitals, private sector foundations, and representatives of special populations to address special health care needs and establish education and outreach programs, research studies, grants, and financial incentives to meet the health care needs of localities and special populations; (r) Recommending a financing system to carry out the mission of the authority and the purposes of this article. In its analysis, the board shall consider: (I) Collecting fees or premiums from all residents of Colorado who are eligible to participate in the system; (II) Determining the fee or premium structure and approval process, including a means-based fee or premium that ensures all income earners and employers are contributing an amount that is affordable, fair, and consistent with current funding sources for health care in Colorado; (III) Coordinating with existing, ongoing funding sources from federal and state programs; (IV) Being consistent with state and federal requirements governing financial contributions for persons eligible for public programs; and (V) Complying with federal requirements. (s) An analysis of how to finance and address health care services for visitors, nonresident students, refugees, and other ineligible persons in Colorado. (2) In addition to the duties described in subsection (1) of this section, the board may address other issues and implement other measures as necessary to create the system. (3) The system shall not be implemented unless the requirements of section 25.5-9-111 (3) are met. (4) The board shall ensure that the health benefit plan offered pursuant to the system does not cause harm to persons eligible for benefits pursuant to the "Colorado Medical Assistance Act", articles 4, 5, and 6 of this title. 25.5-9-107. Board of directors. (1) The authority shall be governed by a board of directors, consisting of twenty-three members, who shall be appointed as follows: (a) The president of the senate shall appoint the following members: (I) One licensed primary care physician; (II) One licensed dentist; (III) One health care consumer; (IV) One representative of organized labor; and (V) One representative of a federally qualified health care center. (b) The minority leader of the senate shall appoint the following members: (I) One licensed physician with experience in public health or epidemiology; (II) One licensed pharmacist; (III) One health care consumer who is either a member of the disabled community or is a care giver of members of the disabled community; (IV) One representative of small businesses; (V) One representative of hospitals. (c) The speaker of the house of representatives shall appoint the following members: (I) One licensed mental health care provider; (II) One licensed professional nurse; (III) One health care consumer who is at least sixty-five years of age and has served as an advocate for senior citizens; (IV) One representative of large businesses; and (V) One representative of the insurance industry. (d) The minority leader of the house of representatives shall appoint the following members: (I) One representative who is an actuary and who has experience with the insurance industry; (II) One representative of ambulatory surgical centers; (III) One representative of an integrated health care delivery system; (IV) One representative of rural communities who is familiar with consumer health care issues; and (V) One advanced practice nurse. (e) The governor shall appoint the following members: (I) One representative who has expertise in hospital and physician costs, billing, and fees; (II) One consumer; and (III) One representative from the long-term care industry. (2) Each member shall serve a term of four years; except that eleven of the members shall serve an initial term of two years. Each member of the board shall hold office for such member's term and until a successor is appointed and qualified. Any member shall be eligible for reappointment, but members shall not be eligible to serve more than two consecutive full terms. (3) In making appointments to the board, the appointing authorities shall make good faith efforts to assure that their appointments reflect, to the greatest extent possible, the social, demographic, and geographic diversity of the state. The appropriate appointing authority shall fill any vacancy on the board within thirty days after the vacancy occurs. (4) No part of the revenues or assets of the authority shall inure to the benefit of, or be distributed to, its board or officers or any other private person or entity; except that the authority may make reasonable payments for expenses incurred on its behalf relating to any of its lawful purposes, including for the provision of health care services; and the authority is authorized and empowered to pay reasonable compensation for services rendered to or for its benefit relating to any of its lawful purposes, including payment to each member for each meeting attended. (5) Any member of the board who has an immediate personal or financial interest in any matter before the board shall disclose the fact to the board and shall not vote upon the matter. (6) The board may employ an executive director of the authority, a chief financial officer, a chief medical officer, a patient advocate, a patient safety officer, a provider advocate, and any other officers the board finds necessary to create and develop the system. (7) The board may enter into such contracts as are necessary or proper to carry out the provisions and purposes of this article, including contracts with appropriate administrative staff, consultants, and legal counsel. No contract entered into pursuant to this subsection (7) shall be subject to article 103 of title 24, C.R.S. (8) The board may appoint appropriate legal, actuarial, and other committees as necessary to provide technical assistance and other expertise and experience in the development of the system. (9) On or before February 1 of each year, the board shall report to the health and human services committees of the senate and the house of representatives or their successor committees and the governor regarding the progress of the system, any recommended legislative changes, and the future goals and priorities of the authority. 25.5-9-108. Required covered benefits. )1( Covered comprehensive medical benefits under the system plan shall include: )a( Primary and preventive care; )b( Inpatient care; )c( Outpatient care; )d( Emergency care; )e( Prescription drugs; )f( Durable medical equipment; )g( Long-term care, including community-based and consumer-directed services; )h( Mental health services; )i( Dental services; )j( Substance abuse treatment; )k( Chiropractic services; )l( Reproductive health care services; )m( Occupational and physical therapy services; )n( Vision care and correction; and )o( Hearing services and hearing aids. )2( The plan for the system shall include comprehensive medical benefits coverage for all eligible participants in Colorado that shall be coordinated with other public health efforts and may be coordinated with public health officials, agencies, and organizations. 25.5-9-109. Gifts, grants, and donations - federal grant moneys. The board is authorized to seek gifts, grants, and donations and federal grant moneys for the purposes of implementing this article. Moneys received by the board shall be transferred directly to the authority for the purposes of this article. No moneys from the general fund shall be used for the implementation of this article. 25.5-9-110. Duty to seek waivers, exemptions, and agreements. The executive director shall seek input from and collaborate with the department of health care policy and financing to seek all necessary waivers, exemptions, and agreements from the federal government so that all current levels of funding from the federal government to the state, counties, or local governments for the provision and payment of health care services may be appropriated to the authority once the system is implemented by bill of the general assembly. 25.5-9-111. Requirements for implementation of the system - repeal. (1) Sections 25.5-9-101, 25.5-9-102, 25.5-9-103, 25.5-9-104, 25.5-9-105, 25.5-9-107, 25.5-9-109, and this section shall take effect upon the enactment of this article. (2) Sections 25.5-9-106, 25.5-9-108, and 25.5-9-110 shall not take effect until the board identifies and guarantees that sufficient gifts, grants, and donations have been received to plan and develop the system in accordance with said sections. Upon identification and guarantee that the board has received sufficient moneys to implement said sections, the board shall notify the revisor of statutes, in writing, of the effective date of said sections. If sufficient gifts, grants, and donations are not identified and guaranteed on or before July 1, 2011, said sections shall not take effect, and this article is repealed, effective July 1, 2011. (3) If sections 25.5-9-106, 25.5-9-108, and 25.5-9-110 are implemented and the plan for the system is developed and created, the system shall not be implemented until: (a) All necessary waivers, exemptions, and agreements are in place to effectively implement the system; and (b) The general assembly approves the implementation of the system by bill. SECTION 2. Safety clause. The general assembly hereby finds, determines, and declares that this act is necessary for the immediate preservation of the public peace, health, and safety.