Bill Summary for Bill Number SB09-056

Date: 02/12/2009

Final
BILL SUMMARY for SB09-056

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Votes: View-->	Action Taken:
Adopt a conceptual amendment to require that an ou Adopt prepared amendment L.001 (Attachment F). Th Refer Senate Bill 09-056, as amended, to the Commi	PASS PASS 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