Senate Committee on Health and Human Services (04/16/2009)

Final
STAFF SUMMARY OF MEETING

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	04/16/2009	ATTENDANCE

Time:	01:36 PM to 07:55 PM	Carroll M.	X
		Lundberg	X
Place:	SCR 356	Mitchell	X
		Morse	E
This Meeting was called to order by		Newell	X
	Senator Boyd	Schultheis	X
		Tochtrop	X
This Report was prepared by		Boyd	X
	Elizabeth Burger
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Conf 09-Pinnacol Assurance Board of Directors Conf 09-Children's Trust Fund Board HB09-1022 HB09-1175 HB09-1204		Favorably Refer to the Full Senate Favorably Refer to the Full Senate Referred to Appropriations Witness Testimony and/or Committee Discussion Only Amended, Referred to Appropriations

01:38 PM

Paul Pettinger and Robert John "R.J." Jolly, Governor's appointees to the Pinnacol Assurance Board of Directors, discussed their backgrounds and interest in serving on the board. Copies of their appointment letters and resumes were distributed to the committee (Attachment A). The appointees responded to questions from the committee regarding the fiduciary duties of the board, whether Pinnacol has an obligation to help support the state's General Fund, Pinnacol's budget surplus, benefits for injured workers, the reasons for the accumulation of Pinnacol's surplus, the steps Pinnacol is taking to reduce the surplus, protections for injured workers in Colorado, customer service surveys of injured workers, the expansion of Pinnacol into other lines of insurance, whether the state has any interest in Pinnacol's reserves, the role of the State Auditor with regarding to Pinnacol, a possible sale of Pinnacol, and bonuses for employees of Pinnacol.

(Attachment A can be viewed at State Archives)


BILL:	Conf 09-Pinnacol Assurance Board of Directors
TIME:	02:45:40 PM
MOVED:	Tochtrop
MOTION:	Refer the appointments of Paul Pettinger and Robert John "R.J." Jolly to the Pinnacol Assurance Board of Directors to the full Senate. The motion passed on a 7-0 roll call vote, with one member excused.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Excused
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

Final YES: 7 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS

02:48 PM

Frances Cosby and Lori Moriarty, Governor's appointees to the Colorado Children's Trust Fund Board, discussed their backgrounds and interest in serving on the board. Copies of their appointment letters and resumes were distributed to the committee (Attachment B). Various committee members commented on the appointments.

(Attachment B can be viewed at State Archives)


BILL:	Conf 09-Children's Trust Fund Board
TIME:	02:55:43 PM
MOVED:	Tochtrop
MOTION:	Refer the appointments of Frances Cosby and Lori Moriarty to the Children's Trust Fund Board to the full Senate. The motion passed on a 7-0 roll call vote, with one member excused.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Excused
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

Final YES: 7 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS

02:56 PM -- House Bill 09-1022

Senator Boyd introduced House Bill 09-1022. The bill creates a Recidivism Reduction Grant Program within the Division of Criminal Justice. The grant program is to provide three-year implementation grants for programs to reduce recidivism of individuals with mental illness who have been involved in the criminal justice system. A county government or a group of counties is eligible to apply.

03:00 PM -- Harriet Hall, representing the Task Force for the Continuing Examination of the Treatment of Persons with Mental Illness who are Involved in the Criminal Justice System, stated that the bill is intended to support programs that are establishing recidivism reduction efforts.


BILL:	HB09-1022
TIME:	03:07:52 PM
MOVED:	Boyd
MOTION:	Refer House Bill 09-1022 to the Committee on Appropriations. The motion passed on a 4-3 roll call vote, with one member excused.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	No
	Mitchell	No
	Morse	Excused
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Final YES: 4 NO: 3 EXC: 1 ABS: 0 FINAL ACTION: PASS

03:11 PM -- House Bill 09-1175

Senator Williams introduced House Bill 09-1175. The bill concerns the regulation of naturopathic doctors. A packet of information concerning the bill was distributed to the committee (Attachment C). Senator Williams described the bill's provisions. Specifically, the bill creates a registration program for naturopathic doctors in the Division of Registrations at the Department of Regulatory Agencies. Applicants who complete an approved naturopathic medical program and pass a competency test can be registered.

03:23 PM -- Dave and Laura Flanagan, representing themselves, testified regarding their son's death and his treatment by a naturopathic doctor. Ms. Flanagan testified in support of the bill, stating that there is a need to regulate this area of medicine, and that the bill will guarantee that naturopathic doctors have the proper education. Mr. Flanagan stated that the harm that naturopathic doctors can cause is real. Mr. and Mrs. Flanagan responded to questions from Senator Mitchell.

03:33 PM -- Mark Slavsky, representing Wheat Ridge Police Department, testified that during the investigation of the naturopathic doctor who treated Mr. and Mrs. Flanagan's son, he discovered that many individuals where holding themselves out as naturopathic doctors and was surprised to learn that the profession is not regulated. Mr. Slavsky stated that many agencies refused to investigate the doctor, and that there are others who are causing harm due to the lack of regulation.

03:36 PM -- George Brauchler, prosecutor, testified regarding the prosecution of the case of the naturopathic doctor who treated the Flanagan's son. He stated that people should have the information to make an informed choice.

03:40 PM -- Kirsten West, representing Susan West R.N., read the testimony of Susan West. Susan West's testimony related to the importance of the licensure and regulation of naturopathic medicine. Kirsten West stated that she is entering a residency program for naturopathy and that she doesn't believe she will be able to legally practice in Colorado without a license.

03:44 PM -- Dr. Mark Cooper, representing the Colorado Association of Naturopathic Physicians, testified that he has been prosecuted for being a naturopathic doctor and that he received his training through accredited educational programs. He testified in support of the bill, stating it is overdue, and that nobody who is properly trained will be put out of work by the bill.

03:48 PM -- Dr. Charley Cropley, representing the Colorado Association of Naturopathic Physicians, testified that current laws make him a criminal for practicing naturopathic medicine. He responded to questions from Senator Newell regarding the harm that regulating naturopathic doctors may cause to other persons practicing naturopathic medicine. Dr. Cooper responded to additional questions from Senator Lundberg regarding how the bill affects individuals who give advice related to naturopathic medicine, but are not naturopathic doctors. Senator Williams also commented on how the bill affects individuals who have not competed a naturopathic educational program.

04:11 PM -- Dr. Steve Rissman, representing the Colorado Association of Naturopathic Doctors, testified regarding his practice as a naturopathic doctor. He said there is precedence for regulating other health professions in Colorado.

04:15 PM -- Dr. Mark Laitos, Colorado Medical Society and Colorado Academy of Family Physicians, testified in support of the bill. He stated that because the practice of naturopathy is not regulated in Colorado, patients may be exposed to dangerous treatments. He stated that patients do not have significant recourse against substandard care provided by individuals who practice naturopathic medicine.

04:18 PM -- Audress Johnson, consumer of naturopathic medicine, testified regarding her experiences researching naturopathic doctors. She stated that the Department of Regulatory Agencies currently cannot take action against naturopathic physicians if there is a problem with their treatment.

04:21 PM -- Phyllis Hunt, consumer of naturopathic medicine, testified that the health care system needs the expertise of naturopathic doctors, but that consumers need the same transparency as is provided when they receive care from other health care practitioners.

04:24 PM -- Frances Wolpo, representing her granddaughter, testified regarding her granddaughter's training as a naturopathic doctor. She stated that 15 states license naturopathic doctors.

04:27 PM -- Heather Isely, Executive Vice President of Vitamin Cottage Natural Food Markets Inc., provided background on Vitamin Cottage. She stated the bill will enhance the community and provide greater consumer protection. She stated the bill will not limit the use of dietary supplements and alternative therapies.

04:30 PM -- Sharon Rouse, parent of naturopathic doctor, described her daughter's naturopathic practice. She testified that her daughter works with physicians in providing care.

04:33 PM -- Bernie Roland, parent of a student of naturopathic medicine, described his daughter's training as a naturopathic doctor. He discussed why he believes training programs for naturopathic physicians are currently limited.

04:37 PM -- Dr. Kelly Parcell, representing herself and the Colorado Association of Naturopathic Doctors, testified that she holds her primary license in Washington, but practices in Colorado, although she cannot be licensed in the state. She explained that she cannot be covered by malpractice insurance in Colorado. She stated that the bill is not meant to regulate alternative therapies, only naturopathic doctors.

04:41 PM -- Dr. Nancy Rao, representing the Colorado Association of Naturopathic Doctors, offered to answer committee questions. Ms. Parcell responded to a question from Senator Newell regarding insurance reimbursement.

04:43 PM -- Hillary Roland, representing herself, testified in support of the bill. She talked about the education that is required to become a naturopathic doctor and other states that license naturopathic doctors. Ms. Roland addressed an earlier question regarding the differences between naturopathic doctors and medical doctors.

04:50 PM -- Kelsey Asplin, representing herself, testified that she takes the same prerequisites in preparation for her training in naturopathic medicine as students who attend traditional medical schools. She asked the committee to support the bill.

04:52 PM -- Jean Rashkin, representing herself, testified regarding her experience seeking information about naturopathic doctors.

04:54 PM -- Rose McCool, representing the Department of Regulatory Agencies, testified in support of the bill. She discussed the 2005 and 2008 sunrise reviews of the regulation of naturopathic doctors. She stated that the reports found that there was sufficient harm to the public by unregulated naturopathic physicians to warrant regulation. She clarified the number of alternative health care providers who are not regulated in Colorado. She stated the bill affects less than 100 providers who meet the bill's requirements. Ms. McCool stated that the bill is aimed at regulating doctors and health care providers who diagnose ailments. Ms. McCool responded to questions from Senator Lundberg regarding naturopathic medicine and naturopathic diagnoses. She responded to questions from Senator Carroll regarding how the bill may affect the practice of individuals who practice alternative therapies, but who do not hold themselves out as naturopathic doctors. She clarified that if a person calls him or herself a naturopathic doctor and has not attended an accredited school, it is currently a violation of the consumer protection act.

05:19 PM -- Larry Sarner, representing Quackwatch, distributed a handout in opposition to the bill (Attachment D). He stated that the bill regulates a profession that does not exist. He stated that naturopathic training schools are not the equivalent of medical schools. He responded to proponents' assertions that the bill will increase the supply of low cost medical care. He responded to questions from Senator Mitchell regarding the position of the Colorado Medical Society on the bill.

05:26 PM -- Dr. Mark Johnson, representing himself, discussed the terms "doctors" and "physicians." He stated that the bill represents a war between two factions of naturopathic doctors, and that both groups have been practicing unregulated for the last 25 years. He discussed the difficulty in determining what activities are naturopathic. He discussed the schools that train naturopathic doctors and their accreditation by the U.S. Department of Education. He responded to questions from Senator Mitchell regarding the position of the Colorado Medical Society on the bill. He responded to questions from Senator Carroll regarding whether consumers will be better off if the profession remains totally unregulated. He further responded to questions from Senator Newell.

05:47 PM -- Boyd Landry, representing the Coalition for Natural Health, distributed a handout in opposition to the bill (Attachment E). He addressed the comments of previous witnesses regarding the effect of the bill on individuals who practice naturopathic medicine. He stated that the bill is an attempt to protect the income streams of the schools of naturopathic medicine and is not a guarantee of safety. He responded to questions from Senator Carroll regarding the effect of the bill on holistic practitioners. Senator Newell and Mr. Landry dialogued regarding the bill.

06:03 PM -- Joanie Coffey, Colorado Coalition for Natural Health, testified regarding her naturopathy practice and training.

06:06 PM -- Sheryl Strom, Colorado Coalition for Natural Health, testified in opposition to the bill. She described her naturopathic training and education.

06:09 PM -- Robert Schulman, Colorado Coalition for Natural Health, read testimony in opposition to the bill. Ms. Coffey responded to questions from Senator Newell regarding whether alternative health providers are currently practicing illegally.

06:20 PM -- Dr. Cynthia Timberman, naturopathic doctor, testified regarding her training and experience as a naturopathic doctor. She testified in opposition to the bill.

06:23 PM -- Linda Rosa, National Council Against Health Fraud, testified in opposition to the bill. She stated that it is a myth that there is a large demand for naturopathic services.

06:27 PM -- Patrician Danzing, naturopathic doctor, testified regarding her education as a naturopathic doctor and testified in opposition to the bill. Ms. Timberman responded to questions from the committee regarding malpractice insurance and whether health insurance pays for her services.

06:31 PM -- Tammy Still, consumer of naturopathic services, testified regarding her experience receiving treatment from a naturopathic doctor.

06:33 PM -- Ann Johnson, representing herself, testified regarding her concern that the bill will put her health foods store out of business.

06:36 PM -- Suzanne Weber, naturopathic practitioner, testified in opposition to the bill. Ms. Still further commented on the bill.

06:41 PM -- Eugene Robinson, representing himself, testified that the bill will affect his practice as a massage therapist.

06:44 PM -- Kimberly Matteo, representing Nature Sunshine products and herself, testified in opposition to the bill. She distributed a packet of information in opposition to the bill (Attachment F).

(Attachment F can be viewed at State Archives)

06:47 PM -- Diana Jackson, representing herself, testified in opposition to the bill.

06:50 PM

Senator Boyd announced that the bill would be laid over for action until next Wednesday, April 22. Senator Williams gave concluding remarks regarding the bill. Senator Williams distributed amendment L.033 (Attachment G), and discussed the definition of naturopathic medicine. The bill was laid over.

06:59 PM -- House Bill 09-1204

Senator Boyd introduced House Bill 09-1204. The bill expands the required coverage for preventive health care services provided under individual and small group health insurance policies according to recommendations by the U.S. Preventive Services Task Force. She outlined the specific services required to be covered by the bill and distributed a letter of support for the bill (Attachment H) and two amendments, L.005 and L.006 (Attachments I and J). She testified that the mandated services required by the bill are the services that have been found to have a large impact on preventing the morbidity of patients. She responded to questions from Senator Tochtrop regarding whether the bill requires coverage of prostate cancer screening. She responded to questions from Senator Lundberg regard whether the bill will increase health insurance costs.

07:10 PM -- Vanessa Hanneman, representing the Colorado Association of Health Plans, testified in support of the bill. She testified that coverage for preventive services should be in coordination with the U.S. Preventive Services Task Force. She stated that prevention does cost money, but that it is a long-term investment. She distributed a booklet entitled "Colorado Health Plan and Hospital Quality Report - A State of Quality" to the committee (Attachment K).

(Attachment K can be viewed at State Archives)

07:13 PM -- Cindy Palmer, representing San Luis Valley HMO, testified in support of the bill and addressed the bill's fiscal note. She stated that the recommendations contained in the bill were driven by groups who study recommended preventive services and their potential cost savings. Ms. Palmer responded to comments from Senator Schultheis regarding the bill's potential for cost savings. Ms. Palmer responded to additional questions from Senator Lundberg regarding whether the bill increases insurance costs.

07:30 PM -- Susan Cox, representing Kaiser Permanente, testified that Kaiser is comfortable with the bill. She testified that preventive services cost money, but that Kaiser provides preventive services because they catch diseases early, and provide an opportunity for a patient to be cured. Ms. Cox responded to questions from Senator Lundberg regarding the bill's potential to increase health insurance costs. She responded to additional questions from Senator Newell. Ms. Cox further responded to questions from Senator Lundberg regarding cost savings associated with preventive health services.

07:47 PM -- Cindy Palmer, representing San Luis Valley HMO, returned to the table to respond to the questions regarding the services listed in the bill and how services are added to the list of required coverage. She responded to additional questions from Senator Schultheis regarding amendments to the bill made in the House of Representatives.

07:51 PM

Senator Boyd gave concluding remarks regarding the bill.


BILL:	HB09-1204
TIME:	07:51:30 PM
MOVED:	Boyd
MOTION:	Adopt prepared amendment L.005 (Attachment I). The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse	Excused
	Newell
	Schultheis
	Tochtrop
	Boyd

Not Final YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	HB09-1204
TIME:	07:52:40 PM
MOVED:	Boyd
MOTION:	Adopt prepared amendment L.006 (Attachment J). The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse	Excused
	Newell
	Schultheis
	Tochtrop
	Boyd

Not Final YES: 0 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: Pass Without Objection


BILL:	HB09-1204
TIME:	07:53:03 PM
MOVED:	Boyd
MOTION:	Refer House Bill 09-1204, as amended, to the Committee on Appropriations. The motion passed on a 3-2 roll call vote, with 3 members excused.
SECONDED:
		VOTE
	Carroll M.	Excused
	Lundberg	No
	Mitchell	Excused
	Morse	Excused
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

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

07:54 PM

The committee recessed.