Senate Committee on Health and Human Services (02/12/2009)

Final
STAFF SUMMARY OF MEETING

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	02/12/2009	ATTENDANCE

Time:	01:34 PM to 07:36 PM	Carroll M.	X
		Lundberg	*
Place:	SCR 356	Mitchell	*
		Morse	X
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:
SB09-144 SB09-056 SB09-153 SB09-167 SB09-134 SB09-012 SB09-129 SB09-132		Amended, Referred to Appropriations Amended, Referred to Appropriations Postponed Indefinitely Amended, Referred to Appropriations Postponed Indefinitely Amended, Referred to the Committee of the Whole Amended, Referred to the Committee of the Whole Amended, Referred to Appropriations

01:35 PM -- Senate Bill 09-144

Senator Boyd announced that she would limit testimony in order to keep the committee's hearing within the time allotted. Senator Kester introduced Senate Bill 09-144. The bill addresses technical issues within the Colorado Commission for the Deaf and Hard of Hearing and adds additional duties that are directly related to the existing statutory mandates of the commission. A fact sheet concerning the bill was distributed to the committee (Attachment A).

01:39 PM -- Cliff Moers, Director of the Commission for the Deaf and Hard of Hearing, testified that the bill involves a small amount of money but will have a huge impact on the deaf and hard of hearing community. He described the provisions of the bill. Specifically, the bill changes the title of the director of the commission, and clarifies the definition of the state court system to ensure that it is clear that the commission's legal auxiliary services' obligations are limited to courts within the state judicial branch. In addition, the bill updates the statutory language of the commission's telecommunications equipment distribution program. He explained why the statutory language should be updated, stating that the change will allow deaf and hard of hearing individuals to access up-to-date technology. In addition, the bill authorizes the commission's Legal Auxiliary Services program to coordinate scheduling of auxiliary services, including interpreting and real-time captioning, for the state court system. The bill creates a system navigator/technical assistance specialist under the commission to assist deaf and hard of hearing citizens who are attempting to access government system. He gave an example of a situation in which a navigator could assist individuals who are deaf and hard of hearing. Finally, the bill creates a grant program to provide grants to meet the needs of the deaf and hard of hearing community.

01:47 PM -- Joe Benedetto, Colorado Commission for the Deaf and Hard Hearing, testified that the bill will support the deaf community.

01:49 PM -- Cheri Davis, Colorado Commission for the Deaf and Hard of Hearing, testified regarding the changes made to the Legal Auxiliary Services program. She stated that the needs of deaf and hard of hearing citizens in the court system are different than those of hearing citizens. She stated allowing the commission to schedule auxiliary services for the court will create efficiencies. She responded to questions from Senator Carroll regarding how the Legal Auxiliary Services program will coordinate the services for the court system.

01:54 PM -- Emy Lopez, Judicial Department, testified in support of the bill, specifically as it relates to the scheduling of interpreters for the court system. She stated that there are a number of instances that lead her to believe that the scheduling of interpreters would better be handled through a centralized system. She stated that such a system would reduce the burden on judicial staff, and ensure that the needs of deaf and hard of hearing citizens are met.

01:56 PM -- Ami Garry, Dove Advocacy Services, testified that prior to the creation of the commission, the courts were often not equipped to address the needs of deaf and hard of hearing citizens in the judicial system. She stated that the commission is a great resource for individuals who have questions about services for deaf and hard of hearing citizens.

02:00 PM -- Ray Kilthau, representing himself, testified that there has been a lot of work on the provisions of the bill and that the bill is a big step forward.

02:00 PM -- Karen Keil, representing herself, testified regarding her experiences being called for jury duty as an individual who is hard of hearing. She testified regarding the importance of adequate accommodations for individuals in the court system. She spoke in favor of the bill's provisions regarding the system navigator, stating such a position will go a long way to meet the needs of deaf and hard of hearing individuals.

02:06 PM -- Carrie Ann Lucas, Colorado Cross Disability Coalition, testified in support of the bill. She testified regarding the portion of the bill that creates a system navigator, and spoke to how the navigator could help avoid conflicts of interest and difficulties in scheduling interpreters in the court system.

02:10 PM -- Devorah Kappers, representing ADAPT and Disability Center for Independent Living, testified in support of the bill.

02:11 PM -- Mary McGhee, Colorado Department of Human Services, testified regarding the source of funding for the bill's provisions, which is the Disabled Telephone Users Fund. She specified that the commission receives money both from the General Fund and the Disabled Telephone Users Fund. She explained that the bill's services would be funded by an increase in the Disabled Telephone Users Fee, which is a monthly fee charged on residential telephone lines in Colorado. Senator Mitchell commented on the funding source for the bill, stating his belief that the bill essentially increases taxes, and asked if the Attorney General had provided an opinion regarding whether there was a Taxpayer's Bill of Rights (TABOR) issue with the fee increase. Ms. McGhee responded that the Public Utilities Commission (PUC) has the authority to raise and lower the fee, and noted that the PUC has lowered the assessment in the past. Senator Morse commented on the differences between fees and taxes, and Ms. McGhee discussed some of the services that are funded with the fee. Ms. McGee responded to questions from Senator Schultheis regarding the fiscal note of the bill. She responded to additional questions from Senator Tochtrop regarding whether the fee is assessed only against land lines, responding that it is. Senator Kester asked whether there was a TABOR issue when the fee was lowered in past years. The committee discussed TABOR and the authority of the General Assembly to implement and increase fees.

02:30 PM

Senator Kester gave concluding remarks regarding the bill. Amendment L.001 (Attachment B) was distributed to the committee. The amendment makes a technical correction to the wording of the bill.


BILL:	SB09-144
TIME:	02:30:33 PM
MOVED:	Tochtrop
MOTION:	Adopt prepared amendment L.001 (Attachment B). The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

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


BILL:	SB09-144
TIME:	02:31:49 PM
MOVED:	Tochtrop
MOTION:	Refer Senate Bill 09-144, as amended, to the Committee on Appropriations. The motion passed on a 5-3 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	No
	Mitchell	No
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Final YES: 5 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS

02:38 PM -- Senate Bill 09-056

Senator Kester introduced Senate Bill 09-056. A packet of information (Attachment C) and two handouts concerning the bill (Attachments D and E) were distributed to the committee. Senator Kester explained that the bill allows the Executive Director of the Department of Human Services to transfer title to the Trinidad State Nursing Home. He stated that, in today's economy, the state cannot afford the upkeep on the facility. In the process of transferring the property, the Executive Director must encourage and entertain bids that include an assurance of continuity of care for residents and an employee retention plan. Senator Kester responded to questions from Senator Schultheis regarding whether a private entity could run the home more efficiently.

02:47 PM -- Bill Hanna, Colorado Department of Human Services, testified that the bill is really a fiscal issue. He stated that the home has been incurring an operating loss for some time. He explained that the home is an enterprise, as are the state veterans nursing homes. Because all of the homes are funded from the same fund, in essence, the veterans nursing homes are subsidizing the Trinidad home. Mr. Hanna explained that the process for moving forward with the bill has involved community input. He discussed the bill's title, explaining that it is a broad title to allow for all necessary changes, and to allow flexibility for what is best for the local community. He clarified that the Trinidad home is not a veteran's nursing home. Senator Tochtrop expressed concern about what would happen to the current residents of the home if the Trinidad home were to close due to its financial situation. Mr. Hanna responded to questions from Senator Carroll regarding why the issues with the home were not raised earlier, stating that perhaps they should have been, but with the change of administrations, they were not.

03:03 PM -- Viki Manley, Colorado Department of Human Services, spoke regarding the financial situation of the Trinidad home, explaining that 85 to 90 percent of the funding for the home is through Medicaid dollars. She responded to a question from Senator Carroll regarding the Medicaid rate paid to the Trinidad home. She described some of the factors driving increases in operating costs for the home and explained that the home is not able to access capital moneys, unlike the veterans homes. Ms. Manley responded to questions from Senator Carroll regarding what other options other than a sale have been considered for the Trinidad home to address the operating loss. Ms. Manley and Mr. Hanna responded to questions from Senator Lundberg regarding how bids will be assessed to determine the bidder that would maintain the best quality of care for the residents. Senator Newell asked why the staffing or management of the facility can't be contracted to an outside entity. Ms. Manley responded that the state constitution does not permit jobs that are filled by state employees currently to be replaced with private contractors. She discussed the costs of hiring a contractor to implement changes at the Fitzsimmons Veterans Nursing Home, noting that it cost over $1 million.

03:18 PM

Ms. Manley responded to additional questions from Senator Newell regarding whether or not the facility could do more to increase the patient census to a point at which the facility could financially break even. Ms. Manley further responded to questions from Senator Carroll regarding what factors are driving the losses at the facility, stating the last time the facility had the appropriate number of patients to break even was 2001. Maintenance costs and staffing costs are also driving some of the increased costs for the facility. Mr. Hanna said that local involvement and private expertise could be joined to help broker a solution to the problem, but that maybe the state isn't the best entity to manage the facility.

03:21 PM -- Jeff Jerebker, Pinon Management, testified that Pinon Management is a consultant to the state and veterans nursing homes. He stated that there are many advantages that the private sector could offer to address the situation. He stated a private enterprise could access capital and would be unencumbered from state personnel and procurement procedures. He stated a Medicaid operation can be successful, but the operation must be very efficient. He stated a private provider could provide the same level of services, but because they don't have to follow all of the state procedures, a private enterprise could operate on a narrower margin. He responded to questions from Senator Carroll regarding the particular state rules that, if waived, might decrease costs or inefficiencies for the facility. Mr. Jerebker stated that the break even point would be lower for a private facility and that the capital improvements that a private entity would bring would allow the facility to create a niche in the community. The committee discussed the Medicaid reimbursement system for nursing facilities, and how the facility's management by a private entity may affect its Medicaid rate.

03:31 PM -- Steve Simonson, Director, Trinidad-Las Animas County Economic Development Inc., testified regarding the economic impact of the Trinidad State Nursing Home in the Trinidad area. He stated that there are few opportunities for state employees at the nursing home to transfer to other state jobs. He stated that the problem is not new, and the home has been losing money for some time. He suggested that the committee look at authorizing a long-term feasibility study to explore nontraditional methods to maintain the nursing home. He stated his concern that resident care may be compromised if the facility is closed.

03:40 PM -- Jim Vigil, Las Animas County Commissioner, noted his belief that it was important to keep the facility open. Senator Carroll asked if he believed all of the options for the facility have been explored. Senator Kester reminded the committee that the bill gives the Department of Human Services options with regard to the facility, but doesn't set any time frames for the situation to be resolved.

03:44 PM -- Jesse Manzanares, President, Health Services District and City of Trinidad, testified regarding the health service district that was approved by Las Animas County voters in 2008. He stated that it is likely that the voters of the district will be asked to help fund services and capital improvements at the facility in the future through a tax increase. He described the changes he would like in the bill including that an entity outside of the Department of Human Services should make the determination as to whether or not the facility should be transferred, that the authority to transfer should not be limited to a sale of the facility, but should include a possibility that the facility could be gifted to an entity such as the health district, and that specific assurances should be made that the facility will remain open.

03:49 PM -- Ralph Bozella, Colorado Board of Veterans Affairs, testified that the current funding system for the facility means that Veterans Administration (VA) moneys are essentially supporting losses at the Trinidad home, and that the VA may eventually question the use of the funds in this way. He testified that there is concern about what will happen to the residents and the employees of the facility, but that the bill provides assurances that the facility will remain a nursing home.

03:52 PM -- George Thomas, United Veterans Committee of Colorado.expressed concern over the funding for the Trinidad facility and how its operating losses may affect the veterans nursing homes.

03:52 PM -- Virginia Bedford, Board of Commissioners for the State and Veterans Nursing Homes, stated that closing the home is not an option, and that the main option should be to try and sell the facility so that it can continue to serve patients. She stated she believed that the property could bring a viable sale on the private market. She testified in support of the bill, on her behalf. She responded to questions from Senator Carroll regarding whether all of the options for disbursement of the property have been explored.

03:56 PM -- Sheila Hicks, Colorado Cross Disability Coalition, testified regarding her concern that the residents will be displaced from the facility.

03:57 PM

Amendment L.001 (Attachment F) was distributed to the committee. The amendment specifies that the Department of Human Services must work in consultation with the Board of County Commissioners for Las Animas County in the process of transferring title to the Trinidad facility.


BILL:	SB09-056
TIME:	03:58:00 PM
MOVED:	Tochtrop
MOTION:	Adopt prepared amendment L.001 (Attachment F). The amendment passed on a 7-1 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Not Final YES: 7 NO: 1 EXC: 0 ABS: 0 FINAL ACTION: PASS

04:00 PM

Senator Tochtrop moved a conceptual amendment to require that, prior to the transfer of title to the Trinidad State Nursing Home, an independent feasibility study of alternatives concerning the operation of the home be conducted. The committee discussed the potential cost of a feasibility study and what entity should conduct the feasibility study. The committee discussed including a requirement that no state moneys be used for the cost of the study and that the study should be funded through gifts, grants, and donations.


BILL:	SB09-056
TIME:	04:00:07 PM
MOVED:	Tochtrop
MOTION:	Adopt a conceptual amendment to require that an outside, independent feasibility study of alternatives concerning the operations of the Trinidad State Nursing Home be conducted prior to the transfer of title to the facility. The study is to be conducted only if sufficient gifts, grants, and donations are received to fund the costs of the study. The motion passed on a 5-3 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	No
	Mitchell	No
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Not Final YES: 5 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS


BILL:	SB09-056
TIME:	04:06:08 PM
MOVED:	Tochtrop
MOTION:	Refer Senate Bill 09-056, as amended, to the Committee on Appropriations. The motion passed on an 8-0 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

Final YES: 8 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

04:10 PM -- Senate Bill 09-153

Senator Penry introduced Senate Bill 09-153. The bill requires the Department of Public Health and Environment to conduct an analysis of the newborn screening program. He explained that Department of Public Health and Environment has agreed to address the issues raised by the bill without legislation.


BILL:	SB09-153
TIME:	04:12:25 PM
MOVED:	Mitchell
MOTION:	Lay over Senate Bill 09-153 until December 3, 2009. The effect of the motion is to postpone indefinitely Senate Bill 09-153. The motion passed on a 7-0 roll call vote, with one member excused.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Excused
	Boyd	Yes

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

04:14 PM -- Senate Bill 09-167

Senator Boyd introduced Senate Bill 09-167. The bill implements the recommendations of the Department of Regulatory Agencies (DORA) sunset review regarding the State Board of Chiropractor Examiners. Specifically, the bill continues the board until July 1, 2020, and makes other changes related to malpractice insurance requirements, grounds for discipline, and scope of practice for chiropractors. In addition, the bill creates a process through which a chiropractor can register with the board to perform chiropractic on dogs and horses. Three amendments were distributed to the committee L.001, L.002, and L.003 (Attachments G, H, and I). Amendment L.001 limits to five the number of unlicensed chiropractic assistants that may be supervised by a chiropractor. Amendment L.002 allows an applicant who lawfully practices chiropractic in another state to be granted a temporary license. Amendment L.003 removes the provisions of the bill concerning animal chiropractic.

04:18 PM -- Leo Boyle, Colorado Association of Acupuncturists and Colorado Veterinary Medical Association, testified in support of the bill.

04:19 PM -- Reiner Kremer, representing himself, testified in favor of the portion of the bill that increases the malpractice requirements for chiropractors. He testified in support of the bill. In response to a question from Senator Boyd, Mr. Kremer commented on amendment L.003, stating he would be opposed to striking the provisions of the bill concerning animal chiropractic.

04:22 PM -- Steve Schuster, Colorado Chiropractic Association, testified in support of the bill and in favor of amendments L.001 and L.002. He testified that he would not support amendment L.003. He responded to questions from Senator Schultheis regarding amendment L.001 and whether it was necessary to set a limit on the number of unlicensed persons that a chiropractor may supervise. Mr. Schuster responded to questions from Senator Newell regarding amendment L.002 and its provisions regarding temporary chiropractor licenses, stating the amendment will not unduly limit the practices of chiropractors who travel in the state for certain events. Mr. Schuster responded to questions from Senator Mitchell regarding the bill's provisions concerning animal chiropractic, and whether there should be protections for consumers of chiropractic services who have allergies to animals.

04:28 PM -- Mr. Boyle returned to the table to voice his opposition to amendment L.003.

04:31 PM

Senator Morse distributed amendment L.004 (Attachment J) which excludes colonic irrigation therapy from the definition of "chiropractic." Senator Carroll explained why the amendment was being offered, noting that the committee had discussed the issue when it considered the sunset review, but an amendment that was offered during the sunset review applied the exclusion only to the portions of the bill concerning animal chiropractic.

04:33 PM -- Dr. Kremer returned to the table to respond to questions regarding amendment L.004. He stated that chiropractors are the only group that are specifically prohibited from performing colonic irrigation. He stated it is a restraint of trade to prohibit chiropractors from performing colonic irrigation when others can. Dr. Kremer responded to a question from Senator Tochtrop regarding whether the practice of colonic irrigation was part of the training curriculum for chiropractors, responding that it may be for some programs.

04:35 PM -- Diana Protopapa, Colorado Medical Society, testified in support of amendment L.004. She responded to a question from Senator Mitchell, stating that she believe that the practice should be prohibited for chiropractors.

04:39 PM -- Terry Snyder, Colorado Chiropractic Association, testified regarding the portion of the bill that addresses animal chiropractic. He stated that there are currently no regulations concerning animal chiropractic, but that the Board of Chiropractic Association will engage in rule making on the issue in order to ensure that consumers are protected.

04:41 PM -- Michael Nehring, representing himself, testified regarding his concerns regarding the portion of the bill that permits animal chiropractic. He stated that such chiropractors should be required to post signs stating that they are an animal treating chiropractic, and that, if chiropractors are permitted to treat animals, certain public protections should be put in place.

04:46 PM

Senator Boyd gave concluding remarks regarding the bill.


BILL:	SB09-167
TIME:	04:46:27 PM
MOVED:	Boyd
MOTION:	Adopt prepared amendment L.001(Attachment G). The motion passed on a 6-2 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Yes
	Newell	No
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Not Final YES: 6 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS


BILL:	SB09-167
TIME:	04:47:07 PM
MOVED:	Boyd
MOTION:	Adopt prepared amendment L.002 (Attachment H). The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

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


BILL:	SB09-167
TIME:	04:47:33 PM
MOVED:	Schultheis
MOTION:	Adopt prepared amendment L.003 (Attachment I). The motion failed on a 2-6 roll call vote.
SECONDED:
		VOTE
	Carroll M.	No
	Lundberg	Yes
	Mitchell	No
	Morse	No
	Newell	No
	Schultheis	Yes
	Tochtrop	No
	Boyd	No

Not Final YES: 2 NO: 6 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	SB09-167
TIME:	04:49:44 PM
MOVED:	Carroll M.
MOTION:	Adopt prepared amendment L.004 (Attachment J). The motion passed on a 5-3 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	No
	Mitchell	Yes
	Morse	Yes
	Newell	No
	Schultheis	Yes
	Tochtrop	No
	Boyd	Yes

Not Final YES: 5 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS


BILL:	SB09-167
TIME:	04:53:53 PM
MOVED:	Boyd
MOTION:	Refer Senate Bill 09-167, as amended, to the Committee on Appropriations. The motion passed on a 7-1 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

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

04:55 PM -- Senate Bill 09-134

Senator Renfroe introduced Senate Bill 09-134. The bill allows a community residential home that provides services to people with developmental disabilities to be licensed as multiple community residential homes for the purposes of applying for and receiving federal and state benefits. Two letters of support were distributed to the committee (Attachments K and L). Senator Renfroe described the circumstances that led him to introduce the bill, explaining that there is a facility in his district that serves individuals with individuals with developmental disabilities, and that the facility was reclassified from a group home to an assisted living facility in the previous year. This reclassification affected the resident's ability to qualify for food stamps. He explained that he couldn't change the facility's eligibility for food stamps as that program is a federal program, but he was attempting to reclassify the facility's regulatory status so that it could again qualify for food stamps. He stated that concerns had been raised regarding the bill and whether or not the bill promotes the use of institutions for individuals with developmental disabilities. Senator Carroll asked why, if the goal of the bill was to allow residents of the facility to receive food stamps, the bill changes licensing and other provisions. He responded to questions from Senator Boyd regarding the involvement of the residents of the facility in his district in the community.

05:02 PM -- John Miles, Department of Human Services, raised concerns regarding the bill. He stated that the bill creates unintended consequences, and that the bill does not limit the total number of buildings within the same compound that could be licensed. Mr. Miles stated it would be hard to meet federal Medicaid waiver requirements regarding inclusion for individuals within the community when the bill concerns the use of "compounds" and congregate settings. Mr. Miles stated that a large number of individuals who are living in a congregate setting could create a risk for the community. Mr. Miles explained that about 90 percent of funding for services for individuals with developmental disabilities is through Medicaid waivers. He stated that the bill is inconsistent with other provisions of statute concerning services for persons with developmental disabilities. He responded to questions from Senator Schultheis regarding whether the issues with the bill could be addressed given more time. Senator Newell asked if there were other ways that the food stamp issue could be addressed, and Mr. Miles responded that if the facility used funding sources other than federal Medicaid money, it may be possible. Senator Morse spoke regarding the interconnected nature of statutes governing services for people with developmental disabilities.

05:13 PM

Senator Boyd drew the committee's attention to a letter of opposition for the bill (Attachment M). Senator Renfroe responded to questions from Senator Schultheis regarding Mr. Miles' testimony. Senator Renfroe stated that he thought the state would be better if it chose not to accept federal money for services for individuals with developmental disabilities because of the complex requirements associated with the funding. Various committee members commented on the bill.


BILL:	SB09-134
TIME:	05:20:52 PM
MOVED:	Schultheis
MOTION:	Refer Senate Bill 09-134 to the Committee of the Whole. The motion failed on a 2-5 roll call vote, with one member excused.
SECONDED:
		VOTE
	Carroll M.	No
	Lundberg	Yes
	Mitchell	Excused
	Morse	No
	Newell	No
	Schultheis	Yes
	Tochtrop	No
	Boyd	No

Not Final YES: 2 NO: 5 EXC: 1 ABS: 0 FINAL ACTION: FAIL


BILL:	SB09-134
TIME:	05:21:44 PM
MOVED:	Tochtrop
MOTION:	Reverse the previous roll call vote and postpone indefinitely Senate Bill 09-134. The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell	Excused
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

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

05:22 PM -- Senate Bill 09-012

Senator Morse introduced Senate Bill 09-012. Senate Bill 09-012 authorizes the creation of professional review committees to review and investigate the quality and appropriateness of patient care provided by, and the professional conduct of, health care providers in specified health care professions. He distributed amendments L.001 and L.002 (Attachments N and O). Amendment L.001 strikes everything below the enacting clause of the bill. The amendment limits the scope of the bill to paramedics that are part of the trauma care system. Currently, only hospital-based paramedics are permitted to engage in peer review activities. He explained why he was seeking to limit the scope of the bill. Senator Morse further explained the provisions of amendment L.001. He stated that there is reluctance to create quality management programs to review instances of inappropriate care because there is fear that the processes could be used as part of a lawsuit. He explained Amendment L.002 clarifies language in Amendment L.001 that concerns corrections of errors in medical records that are discovered during quality management functions. Senator Schultheis asked for clarification regarding the portion of the bill that requires that the medical record be corrected. Senator Morse further elaborated on certain circumstances in which the medical record would be corrected.

05:33 PM -- Dr. David Ross, Penrose Hospital, testified regarding the bill. He stated that emergency medical services (EMS) providers often care for very vulnerable patients, and while EMS providers to limit medical errors, some errors still do occur. He stated that peer review activities that review instances of medical errors or inappropriate procedures may help preemptively improve patient care. He stated that quality improvement in EMS is a big issue of discussion statewide. He gave examples of other states that have implemented similar provisions.

05:39 PM -- Randy Kuykendall, Colorado Department of Public Health and Environment, testified that the department is neutral on the bill, but has been involved with the drafting of the bill. He stated that the bill will include the EMS community in quality improvement activities that already occur within the trauma system. He stated that trauma centers are already required to have quality improvement programs, and it seemed to make good sense to provide peer review protections to EMS providers through that framework. He stated that the bill will not increase the workload of the department with regard to the review of trauma facilities.


BILL:	SB09-012
TIME:	05:42:25 PM
MOVED:	Morse
MOTION:	Adopt prepared amendment L.001 (Attachment N). The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

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


BILL:	SB09-012
TIME:	05:42:41 PM
MOVED:	Morse
MOTION:	Adopt prepared amendment L.002 (Attachment O). The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

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


BILL:	SB09-012
TIME:	05:43:28 PM
MOVED:	Morse
MOTION:	Refer Senate Bill 09-012, as amended, to Committee of the Whole. The motion passed on a 7-0 roll call vote, with one member excused.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Excused
	Morse	Yes
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

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

05:44 PM -- Senate Bill 09-129

Senator Tochtrop introduced Senate Bill 09-129. The bill adds duties to the list of what constitutes the practice of unsupervised and supervised dental hygiene, and clarifies the tasks that are authorized to be performed by dental assistants or dental hygienists. She distributed amendment L.006 (Attachment P). Two handouts were distributed to the committee (Attachments Q and R).

05:48 PM -- Dr. Jeanne Salcetti, Colorado Dental Association, testified that the Colorado Dental Association has worked collaboratively with the Colorado Dental Hygienists Association regarding the bill. She testified that the dental association has a concern with the term "dental hygiene diagnosis" contained in the bill. She read a letter concerning the difference between dental hygiene diagnosis and dental diagnosis. Dr. Salcetti stated that there is concern with the term "diagnosis" and that the dental association feels that it is more appropriate to use the term "assessment."

05:52 PM -- Dr. Dave Lurye, Colorado Dental Association, testified regarding his experience working with dental hygienists to address their scope of practice. He addressed the portion of the bill that allows dental hygienists to make study casts. He stated his concerns regarding the term "diagnosis" in the bill. He responded to questions from Senator Schultheis.

06:07 PM -- Dr. Jeff Hurst, Colorado Dental Association, testified regarding his concerns that the patient will be given incorrect information if a dental hygienist is allowed to diagnose the patient without the involvement of a dentist.

06:08 PM -- Mark Patterson, Colorado Dental Hygienists Association, offered to answer questions regarding the training and education for dental hygienists. He discussed the ways in which he believes that dental hygienists make diagnoses. He stated that a change has been proposed that will remove the word "diagnosis" from the American Dental Association accreditation standards for dental hygiene education programs. He testified that he expects the change to be opposed by dental hygiene associations. He responded to a questions from Senator Carroll regarding the difference between a "dental hygiene diagnosis" and a "dental diagnosis." Mr. Patterson said that dental hygienists only engage in the activities that are permitted by their scope of practice under Colorado law.

06:16 PM -- Jackie Alexander, Colorado Dental Hygienists Association, discussed the term "dental hygiene diagnosis" and read the definition of "dental hygiene diagnosis" from various dental hygiene textbooks. She stated that registered dental hygienists are trained to make these diagnoses but that current law restricts identification of some diseases. She stated that the bill will aid in the education of dental patients.

06:21 PM -- Claire Silk, Colorado Dental Hygienists Association, testified that allowing dental hygienists to make dental hygiene diagnoses will encourage patients to see a dentist for further treatment in a timely manner. She responded to questions from Senator Morse regarding whether the term "dental hygiene diagnosis" should remain in the bill. Mr. Patterson further commented on the term "dental hygiene diagnosis," noting that other health care providers are allowed to make diagnoses within the scope of their practice. The committee discussed adding a definition for the term "dental hygiene diagnosis" to the bill.

06:31 PM

Senator Tochtrop gave concluding remarks regarding the bill. She stated that the bill will provide access to dental care. She explained the provisions of amendment L.006 (Attachment P). The amendment makes various changes including adding certain requirements related to unsupervised dental hygiene practices, and requiring certain dental hygienists to carry professional liability insurance.


BILL:	SB09-129
TIME:	06:32:44 PM
MOVED:	Tochtrop
MOTION:	Adopt prepared amendment L.006 (Attachment P). The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

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

06:36 PM

Senator Morse distributed amendment L.005 (Attachment S). The amendment removes the term "dental hygiene diagnosis" from the bill. The committee discussed whether a definition of the term "dental hygiene diagnosis" should be included in the bill.


BILL:	SB09-129
TIME:	06:36:08 PM
MOVED:	Morse
MOTION:	Adopt prepared amendment L.005 (Attachment S). The motion was withdrawn.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Withdrawn


BILL:	SB09-129
TIME:	06:38:05 PM
MOVED:	Tochtrop
MOTION:	Refer Senate Bill 09-129, as amended, to the Committee of the Whole. The motion passed on a 7-0 roll call vote, with one member excused.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Excused
	Morse	Yes
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

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

06:40 PM -- Senate Bill 09-132

Senator Boyd introduced Senate Bill 09-132. The bill repeals the Colorado Cares Rx Act and requires the Department of Health Care Policy and Financing to make information about lower-cost generic or discounted prescription drugs available to the public. She explained the evolution and intent of the Colorado Cares Rx Program, and stated that the program only serves 40 people currently. She stated that the program has a lot of associated employes, and that it hasn't experienced the enrollment that was anticipated when legislation creating the program was passed in 2005. She distributed amendment L.001 (Attachment T). The amendment retains the Colorado Cares Rx Act, but amends the requirements of the act, specifying that in addition to providing public information about lower cost prescription drugs, the department must research cost-effective programs or mechanisms by which low-income, uninsured persons may purchase lower-cost prescription drugs. The department must report annually to the Health and Human Services Committee regarding the bill's provisions. Senator Boyd responded to questions from Senator Lundberg regarding a portion of the legislative declaration contained in the Colorado Cares Rx Act and Senator Carroll regarding whether the bill removes the statutory authority for the Colorado Cares Rx program from the statutes. Senator Boyd stated that the statutory authorization for the program would be kept, but the program rules would be struck.

06:48 PM -- Ginny Brown, Colorado Department of Health Care Policy and Financing, testified that the department attempted to implement the program as specified in statute, but that the department is now asking that the program be modified. She stated that the department would like to provide resources to the public regarding discount drugs, and would like the authority to explore other options related to a discount drug program. She stated that the department found that there was not a market for the program authorized by statute.

06:50 PM -- Kerri Coffey, Colorado Department of Health Care Policy and Financing, testified regarding the steps the department took to attempt to implement the program. She described the provisions of the program that currently exist in statute. She testified that the department attempted to negotiate prices for drugs, but because there was not an identified population who would participate in the program, negotiations on the drug prices were not successful. She explained that there were several existing mechanisms to allow individuals to purchase drugs at a discounted prices, and that it was determined that the most efficient way to implement the program would be to contract with an existing company. She stated that the current company who is contracted to implement the program does not wish to continue as the contractor for the program. She stated that the department has determined that the best way to go forward is to make information available to the public concerning low-cost prescription drug programs. She responded to questions from Senator Schultheis regarding how the information will be disseminated to the public.

07:02 PM -- Kelli Fritts, AARP, testified regarding concerns with Senate Bill 09-132. She stated that Colorado Cares Rx Program has never been implemented as originally envisioned. She stated that the Maine Rx Program allows consumers to purchase drugs at prices that are negotiated through the use of a preferred drug list and a multistate purchasing agreement. She stated that a good discount drug program in Colorado is needed, and she would like that program to be modeled on the Maine Rx Program. Two handouts were distributed to the committee (Attachments U and V).

(Attachment V can be viewed at State Archives)

07:05 PM -- Greg Glischinski, AARP, offered to answer committee questions. Ms. Fritz responded to questions from Senator Carroll regarding why Colorado didn't implement a program similar to Maine's. Mr. Glischinski spoke to how an internet website promoting certain discount programs may be viewed by the public.

07:08 PM -- Brad Young, Rx Plus Pharmacies, testified regarding the implementation of the Colorado Cares Rx Program, stating that his organization was upset with the implementation of the program through a mail order discount drug company. He stated that changes need to be made to the current program.

07:18 PM -- Chris Underwood, Colorado Department of Health Care Policy and Financing, discussed reasons why the Colorado Cares Rx Program could not be implemented in a manner similar to the program in Maine. He responded to questions from Senator Carroll regarding why the department was unable to identify the specific population that would benefit from the program. He stated that the prescription drug market changed during the implementation of the Colorado Cares Rx program, creating other options for consumers to access discounted drugs. He responded to questions from Senator Newell regarding the bill's provisions and whether the program should be repealed.

07:26 PM

Senator Boyd gave concluding remarks regarding the bill.


BILL:	SB09-132
TIME:	07:27:42 PM
MOVED:	Lundberg
MOTION:	Amend prepared amendment L.001 (Attachment T), page 1, strike lines 19 and 20; page 2, strike lines 1 through 3 and substitute the same language in strike-type. The amendment strikes paragraph (d) from the current statutory legislative declaration for the Colorado Cares Rx Program. The amendment passed on a 4-3 roll call vote, with one member excused.
SECONDED:
		VOTE
	Carroll M.	No
	Lundberg	Yes
	Mitchell	Excused
	Morse	Yes
	Newell	Yes
	Schultheis	Yes
	Tochtrop	No
	Boyd	No

Not Final YES: 4 NO: 3 EXC: 1 ABS: 0 FINAL ACTION: PASS


BILL:	SB09-132
TIME:	07:31:45 PM
MOVED:	Boyd
MOTION:	Adopt prepared amendment L.001, as amended. The motion passed on a 5-2 roll call vote, with one member excused.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	No
	Mitchell	Excused
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

Not Final YES: 5 NO: 2 EXC: 1 ABS: 0 FINAL ACTION: PASS


BILL:	SB09-132
TIME:	07:33:06 PM
MOVED:	Boyd
MOTION:	Page 1, line 104, strike "repealing" and substitute "modifying". The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell	Excused
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

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


BILL:	SB09-132
TIME:	07:33:41 PM
MOVED:	Boyd
MOTION:	Refer Senate Bill 09-132, as amended, to the Committee on Appropriations. The motion passed on a 6-1 roll call vote, with one member excused.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	No
	Mitchell	Excused
	Morse	Yes
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

Final YES: 6 NO: 1 EXC: 1 ABS: 0 FINAL ACTION: PASS

07:36 PM

Adjourn.