First Regular Session Sixty-eighth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 11-0647.01 Brita Darling HOUSE BILL 11-1171 HOUSE SPONSORSHIP Ferrandino, Becker, Gerou SENATE SPONSORSHIP Steadman, Hodge, Lambert House Committees Senate Committees Health and Environment Legislative Council A BILL FOR AN ACT Concerning a committee to study dedicated sources of revenue in the state constitution related to health care. Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://www.leg.state.co.us/billsummaries.) Certain provisions of the state constitution that are enumerated in the bill dedicate moneys from specific revenue sources to support specific health care programs or uses. Due to the passage of the "Health Care Affordability Act of 2009" and the federal "Patient Protection and Affordable Care Act", and related federal laws and regulations, the dedication of certain moneys in the state constitution may be inefficient or obsolete. Further, the state economic downturn and the desirability of drawing federal matching dollars may warrant revisions to the constitutional requirements relating to certain sources of revenue. The bill creates a 15-member study committee consisting of 6 legislators, the governor, or his designee, and nonlegislative members who shall be appointed by the senate president, the speaker of the house of representatives, and the governor, and shall include members representing various stakeholder groups. The study committee shall meet no more than 3 times during the legislative interim and shall consider the following issues: What changes, if any, may be proposed to section 21 (5) (a), (5) (b), and (5) (e) of article X of the state constitution due to the passage of state and federal health care reform; What changes, if any, may be proposed to section 21 (5) (b) of article X of the state constitution to ensure that revenues collected pursuant to that section are eligible for federal matching dollars; What changes, if any, may be proposed to section 7 (b) of article XXIV of the state constitution that would allow the general assembly to appropriate moneys placed in the stabilization fund created in that section; and What changes, if any, may be proposed to section 7 (c) of article XXIV of the state constitution due to the passage of certain state and federal health care reform laws. The study committee shall be limited to consideration of the issues specified in the bill and any issues necessarily related to the study of those issues. The legislative and nonlegislative members of the study committee shall serve without compensation or reimbursement for expenses. On or before November 30, 2011, the study committee shall submit written recommendations to the joint budget committee, the health and human services committee of the senate, the health and environment committee of the house of representatives, and the governor. The provisions of the bill repeal, effective July 1, 2012. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. Article 2 of title 2, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW PART to read: PART 17 STUDY COMMITTEE CONCERNING CONSTITUTIONAL PROVISIONS RELATING TO CERTAIN HEALTH CARE PROGRAMS 2-2-1701. Legislative declaration. (1) The general assembly finds and declares that: (a) The state constitution and authorizing statutes dedicate the following revenues to health care programs: (I) Pursuant to section 21 (5) (a) of article X of the state constitution, approximately seventy million dollars for increasing enrollment in the children's basic health plan above the average enrollment in state fiscal year 2004, adding parents of enrolled children, and expanding eligibility for low-income adults and children who receive medical care pursuant to the children's basic health plan or the "Colorado Medical Assistance Act", articles 4 to 6 of title 25.5, C.R.S.; (II) Pursuant to section 21 (5) (b) of article X of the state constitution, approximately twenty-five million dollars to fund comprehensive primary care for providers that are community health centers or where at least fifty percent of the provider's clients are uninsured or medically indigent persons; (III) Pursuant to section 21 (5) (e) of article X of the state constitution, approximately two million five hundred thousand dollars to the old age pension fund for health related purposes; (IV) Pursuant to section 7 (b) of article XXIV of the state constitution, five million dollars for the old age pension stabilization fund; and (V) Pursuant to section 7 (c) of article XXIV of the state constitution, ten million dollars to provide health care for persons who qualify to receive an old age pension. (b) In many cases, the dedicated source of revenue created in the state constitution is insufficient to fund the medical costs of the populations assigned to the dedicated revenue without either substantially reducing reimbursement rates paid to providers or without future subsidies from the general fund or another state revenue source. For example, dedicated revenues for the health care expansion fund, created pursuant to section 24-22-117 (2) (a) (I), C.R.S., are insufficient to pay the costs of the three stated purposes of the fund. (c) In other cases, the dedicated source of revenue created in the state constitution may no longer be necessary. For example, the "Health Care Affordability Act of 2009", section 25.5-5-201 (1) (p) (I), C.R.S., expanded medicaid coverage to include adults without a dependent child with an income at or below one hundred percent of the federal poverty level. Due to this expansion of medicaid eligibility, the majority of clients receiving medical services pursuant to the old age pension health and medical care program, created pursuant to section 25.5-2-101, C.R.S., will be eligible to receive medicaid coverage. The resulting movement of clients away from the old age pension health and medical care program should reduce the need for a dedicated source of revenue created in the state constitution for these medical services. Additionally, children and pregnant women who receive coverage under the children's basic health plan may eventually receive coverage through a federal health care exchange program. If this occurs, the constitutional requirement in section 21 (5) (a) of article X of the state constitution to maintain enrollment in the children's basic health plan at levels higher than the 2004 enrollment level may be obsolete. (d) Furthermore, during the last two fiscal years, the general assembly has passed an emergency resolution, authorized pursuant to the state constitution, transferring moneys from a dedicated source of revenue created in the state constitution to the Colorado health care services fund, created pursuant to section 25.5-3-112 (1) (a), C.R.S., so that these moneys could be distributed to providers in a way that draws a federal match through the medicaid program. With an amendment to certain provisions in the state constitution, it may be possible to use these moneys to consistently draw federal matching dollars. The general assembly should determine if these moneys would be better allocated to the health care expansion fund, created pursuant to section 24-22-117 (2) (a) (I), C.R.S., or to pay a portion of the state match for medicaid expansions that will occur if the federal "Patient Protection and Affordable Care Act", Pub.L. 111-148, is implemented and substantially reduces the number of uninsured persons in the state. (2) It is therefore the intent of the general assembly to establish an interim study committee to review the impact that state and national health care reforms have or will have on the health care programs that receive dedicated funding through the state constitution. Once the study committee has ascertained the impact of the state and national health care reforms on the health care programs that receive dedicated funding through the state constitution, the study committee shall make recommendations to the general assembly regarding any changes to state constitutional provisions that would make more appropriate or efficient use of the dedicated sources of revenue for the health care programs created in the state constitution. 2-2-1702. Study committee concerning constitutional provisions - creation - membership - duties - report. (1) There is hereby created a study committee concerning state constitutional provisions relating to certain health care programs, referred to in this part 17 as the "study committee", which shall meet in the legislative interim after the first regular session of the sixty-eighth general assembly to study state constitutional provisions relating to certain health care programs. (2) (a) The study committee shall consist of fifteen members appointed as follows: (I) Two members of the senate appointed by the president of the senate and consisting of one member serving on the joint budget committee and one member serving on the health and human services committee of the senate, or any successor committee; (II) Two members of the house of representatives appointed by the speaker of the house of representatives and consisting of one member serving on the joint budget committee and one member serving on the health and environment committee of the house of representatives, or any successor committee; (III) One member of the senate appointed by the minority leader of the senate and serving on the health and human services committee of the senate, or any successor committee; (IV) One member of the house of representatives appointed by the minority leader of the house of representatives and serving on the health and environment committee of the house of representatives, or any successor committee; (V) Two nonlegislative members appointed by the president of the senate, as follows: (A) One member representing individuals who receive medical services as part of their eligibility for an old age pension; and (B) One member representing hospital providers who received moneys in the 2009-10 fiscal year from the primary care fund created in section 24-22-117 (2) (b), C.R.S.; (VI) Two nonlegislative members appointed by the speaker of the house of representatives, as follows: (A) One member representing clinic providers who received moneys in the 2009-10 fiscal year from the primary care fund created in section 24-22-117 (2) (b), C.R.S.; and (B) One member representing the coalition in support of the initiative that enacted section 21 of article X of the state constitution; (VII) The governor, or his or her designee; and (VIII) Four members appointed by the governor, as follows: (A) One member representing the department of health care policy and financing; (B) One member representing the department of human services; and (C) Two members with experience relating to public health programs, state and national health care reform legislation, or health care financing. (b) All appointments to the study committee shall be made by June 15, 2011. (c) The members of the study committee shall elect a chair of the study committee from among the members of the general assembly appointed to the study committee. (3) (a) The study committee shall consider and may seek public input concerning the following issues: (I) What changes, if any, may be proposed to the revenues appropriated pursuant to section 21 (5) (a), (5) (b), and (5) (e) of article X of the state constitution, due to the passage of the "Health Care Affordability Act of 2009", section 25.5-4-402.3, C.R.S., and the federal "Patient Protection and Affordable Care Act", Pub.L. 111-148, and related federal law or regulations; (II) What changes, if any, may be proposed to section 21 (5) (b) of article X of the state constitution to ensure that revenues collected pursuant to said section would be eligible for a federal match either through provisions of Title XIX or XXI of the social security act or through the provisions of the federal "Patient Protection and Affordable Care Act", Pub.L. 111-148, and related federal law or regulations; (III) What changes, if any, may be proposed that would allow the general assembly to appropriate moneys placed in the stabilization fund pursuant section 7 (b) of article XXIV of the state constitution; and (IV) What changes, if any, may be proposed to the provisions of section 7 (c) of article XXIV of the state constitution due to the passage of the "Health Care Affordability Act of 2009", section 25.5-4-402.3, C.R.S., and the federal "Patient Protection and Affordable Care Act", Pub.L. 111-148, and related federal law or regulations. (b) The study committee shall be limited to the consideration of the issues specified in paragraph (a) of this subsection (3) and any issues that the study committee determines are necessarily related to those issues. (4) The study committee shall meet no more than three times during the 2011 interim. (5) (a) Legislative members of the study committee shall serve without compensation and without reimbursement of expenses. (b) Nonlegislative members of the study committee shall serve without compensation and without reimbursement for expenses. (6) The legislative council staff, the office of legislative legal services staff, and the joint budget committee staff shall be available to assist the study committee in carrying out its duties and shall do so within existing appropriations. (7) On or before November 30, 2011, the study committee shall submit written recommendations to the joint budget committee, the health and human services committee of the senate and the health and environment committee of the house of representatives, or any successor committees, and the governor concerning the issues considered by the study committee pursuant to subsection (3) of this section. The recommendations may include a proposed draft of a concurrent resolution for introduction during the second regular session of the sixty-eighth general assembly. 2-2-1703. Repeal of part. This part 17 is repealed, effective July 1, 2012. 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.