House Committee on Health and Human Services (03/30/2009)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	03/30/2009	ATTENDANCE

Time:	01:31 PM to 07:03 PM	Acree	X
		Gerou	*
Place:	LSB A	Green	*
		Kagan	X
This Meeting was called to order by		Kefalas	X
	Representative Riesberg	Kerr J.	X
		Nikkel	X
This Report was prepared by		Primavera	*
	Kelly Stapleton	Swalm	X
		Gagliardi	X
		Riesberg	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
SB09-138 SB09-061		- -

01:32 PM -- Representative Riesberg called the meeting to order. He stated that Senate Bill 09-103 would not be heard in committee and was laid over to Monday, April 6, 2009.

01:32 PM -- Senate Bill 09-138

Representative Gagliardi presented Senate Bill 09-138 which implements the recommendations from the Department of Regulatory Agencies' sunset review of the regulation of certified nurse aides (CNAs). The bill continues the program through September 1, 2020, and makes the following changes:

changes the composition of the advisory committee which assists the State Board of Nursing on matters relating to CNAs, and allows advisory committee members to receive per diem for their services;
eliminates the Medication Administration Advisory Committee;
specifies that records of disciplinary actions must be open to public inspection, and clarifies grounds for discipline regarding drug use;
repeals requirements from statute regarding a CNA's authority to administer medications, and, instead, allows the board to promulgate rules in this area;
authorizes the board to require CNA training programs to include up to 25 percent more hours than the federal minimum requirements;
specifies that the four months that a CNA may work without certification must be consecutive; and
removes the prohibition on a registered nurse from delegating the authority to select medications.

01:41 PM -- Brian Tobias, Department of Regulatory Agencies, testified in support of the bill. Mr. Tobias stated that the bill reflects the department's recommendations as stated in the sunset review. Mr. Tobias responded to committee questions.

01:46 PM -- Susan Miller, Health Care Director, Division of Registrations, Department of Regulatory Agencies, spoke in support of the bill. Ms. Miller responded to committee questions. Ms. Miller spoke to the $3.00 fee increase in response to Representative Kerr's question. There was discussion regarding the fee increase.


BILL:	SB09-138
TIME:	02:00:39 PM
MOVED:	Gagliardi
MOTION:	Moved to refer Senate Bill 09-138 to the Committee on Appropriations. The motion passed on a 11-0 roll call
SECONDED:	Green
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	Yes
	Kagan	Yes
	Kefalas	Yes
	Kerr J.	Yes
	Nikkel	Yes
	Primavera	Yes
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 11 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS

02:02 PM -- The committee took a brief recess.

02:14 PM -- Senate Bill 09-061

The committee reconvened. Representative Primavera presented Senate Bill 09-061, which requires any internal review of claims, independent medical examination, or utilization review to be conducted by a Colorado-licensed health care professional. Representative Primavera stated that the health care professional who is conducting the review must be in good standing and have appropriate expertise in the same or similar specialty as would typically manage the case being reviewed. Several handouts were provided to the committee including a fact sheet on the bill, a letter in support of the bill from Jill Tappert, a letter in support of the bill from Jon Dukeman, and a chart comparing the requirements under the bill for independent medical examinations (IMEs), utilization reviews, and initial claim reviews (Attachments A, B, C, and D respectively). Representative Primavera spoke to amendments L.014, L.015, and L.016 (Attachments E, F, and G respectively). Representative Primavera responded to committee questions.

02:34 PM -- Patrick Boyle, Property Casualty Insurers Association of America, spoke in opposition to the bill. Mr. Boyle stated that he does not see a need for the bill with regard to property and casualty insurance. He stated that the bill fixes a problem that does not exist. He also stated that the bill requires a physician to sign off on any coverage decision, which will increase the cost of insurance. Mr. Boyle responded to committee questions.

02:46 PM -- James Hall, Regional Vice-president, State Relations, American Council of Life Insurers, spoke in opposition to the bill. He stated that the bill was amended in the Senate to include disability insurance. He provided a handout in opposition to the bill (Attachment H). He described the difference between disability income insurance and coverage for the diagnosis and treatment of medical conditions.

02:57 PM -- Robert Ferm representing American Insurance Association, Aetna, Humana, and Cigna, spoke in opposition to the bill. Mr. Ferm stated that the bill confuses decisions that health care providers make versus decisions that insurance companies make. He discussed the difference between "medically necessary" and benefit determination. He stated physicians make decisions about what is medically necessary and lawyers make decisions about contract provisions. He stated that the bill requires a physician to be registered in Colorado in order to perform a utilization review, for example. He stated that this requirement will deter physicians from participating in the process. He stated that the administrative expenses would be a prohibitive barrier to bring in new carriers and could deter current smaller carriers from remaining in the state. He stated that the bill mixes decisions regarding medical necessity, utilization review, and requirements under a specified contract. Mr. Ferm stated that he is concerned about the unintended consequences.

03:23 PM -- Ben Price, Executive Director, Colorado Association of Health Plans, spoke in opposition to the bill. Mr. Price concurred with previous testimony.

03:25 PM -- Jerry McElroy, Kaiser Permanente, spoke in opposition to the bill. Mr. McElroy explained Kaiser Permanente's process for utilization review and independent medical review. He stated that the process works well. He stated that the bill will increase premium costs. Representative Kagan asked Mr. McElroy to comment on the data that 48 percent of first time appeals are overturned. Mr. McElroy stated that the percentage is not representative of poor reviews by insurance companies, but rather it shows that insurance companies are more understanding of first level review requests. He stated that the bill will create a situation where physicians do not want to sit on a panel for insurance reviews because it may open them up to greater liability.

03:42 PM -- Brandon La Salle, Government Affairs, American Family Insurance, spoke in opposition to the bill. He spoke to the unintended consequences that could result if the bill were to become law.

03:47 PM -- Christian Rataj, National Association of Mutual Insurance, spoke in opposition to the bill. He stated that the bill asks physicians to consider and interpret contracts. He commented that the bill aims to fix a problem that has yet to be identified.

03:54 PM -- Bob Epstein, President, Senior Lobby, spoke in support of the bill.

03:59 PM -- Michael Springfield, Colorado Chiropractors Association, spoke in support of the bill. He stated that he is comfortable having another chiropractor review his work. He stated that it seems more practical that another chiropractor would review his work versus a pediatrician, for example. Representative Acree stated that the IME and the utilization review should be separated in the bill. She stated she has some concerns with physicians making decisions regarding contract requirements.

04:12 PM -- Sheryle Hutter, Colorado Cross Disability Coalition, spoke in support of the bill.

04:15 PM -- Heidi Loeffel, paralegal, spoke in support of the bill. She stated that qualified medical professionals should be making decisions that relate to health care, not lawyers.

04:24 PM -- Michael Braden, chiropractor, spoke in support of the bill. He spoke to the need for a medical professional in the same discipline to make decisions regarding utilization and independent medical examinations. He stated that the people making decisions regarding a patient's direction of care should have expertise in the field in which a patient has been denied coverage. He stated that as a health care provider, communicating with a person who is making decisions about his patients care who lives in Colorado, is easier and better.

04:34 PM -- Dr. William Miller, Rehabilitation Services, spoke in support of the bill. He emphasized the need for a medical practitioner who has similar expertise to review claims of persons who have been denied coverage. Dr. Miller responded to committee questions. He spoke to aspects of the bill that would encourage dialogue between providers and insurance companies. He stated that as a physician, it would be nice to know why the insurance company denied a particular claim. He stated that physicians also advocate for their patients and dialogue could improve care to clients.

05:04 PM -- Betty Lehman, representing herself and providing the testimony of Jill Tappert, described her experience appealing insurance company decisions regarding her son's care (Attachment B). She stated that she used to write appeals for children with autism spectrum disorder. She stated that in many circumstances the appeal was overturned. She emphasized that the bill is not frivolous and that people are seriously affected by claims denial. Ms. Lehman responded to committee questions.

05:31 PM -- Jon Dukeman, patient who has been denied medications by an insurance company, spoke in support of the bill. Mr. Dukeman read his testimony to the committee (Attachment C).

05:38 PM -- Dr. Greg Denzel, Greeley Quick Care, spoke in support of the bill. Dr. Denzel concurred with Dr. Miller's testimony. He stated when a claim is reviewed, it should be by a physician with a similar expertise. He stated that it is important to have accountability.

05:41 PM -- Ronald Calvert, representing himself, spoke in support of the bill. He provided his personal story to the committee about having his insurance claim denied by an insurance company. He stated he has been in litigation for over 12 years and the case is still not resolved. He stated that if the bill improves the process for just one person, it is worth it. He encouraged the committee to pass the bill.

05:49 PM -- Bob Summers, Director, Division of Workers' Compensation, Colorado Department of Labor and Employment, spoke in support of amendment L.014 (Attachment E).

05:53 PM -- Susan Miller, Division of Registrations, Department of Regulatory Agencies, spoke in support of the bill with the adoption of amendment L.015 (Attachment F). She stated that the amendment clarifies that the state in which the medical board issues the opinion with regard to a denial has regulatory authority over the denial.

06:07 PM

Representative Primavera read testimony from Patty Skolnik.

06:07 PM

Christy Chase, Office of Legal Services, explained amendments L.014, L.015, L.016, and L.017 to the committee (Attachments E, F, G, and I). Ms. Chase referred to the comparison chart to explain the amendments (Attachment D).

06:28 PM

Representative Primavera responded to committee questions. Representative Primavera spoke to the increase in costs of health insurance premiums over a period of approximately ten years. She stated that data shows that there is not a correlation between the increase of health care premiums and the increase of health insurance mandates. She stated that there is a need to have accountability with regard to insurance denials. Representative Primavera stated that through testimony, a problem has come to light and the bill provides a solution to the issues raised in testimony.


BILL:	SB09-061
TIME:	06:37:55 PM
MOVED:	Primavera
MOTION:	Moved to adopt prepared amendment L.014 (Attachment E). The motion passed without objection.
SECONDED:	Green
		VOTE
	Acree
	Gerou
	Green
	Kagan
	Kefalas
	Kerr J.
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	SB09-061
TIME:	06:38:39 PM
MOVED:	Primavera
MOTION:	Moved to adopt prepared amendment L.015 (Attachment F). The motion passed without objection.
SECONDED:	Green
		VOTE
	Acree
	Gerou
	Green
	Kagan
	Kefalas
	Kerr J.
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	SB09-061
TIME:	06:40:37 PM
MOVED:	Primavera
MOTION:	Moved to adopt prepared amendment L.017 (Attachment I). Ms. Chase explained amendment L.017. The motion passed without objection.
SECONDED:	Green
		VOTE
	Acree
	Gerou
	Green
	Kagan
	Kefalas
	Kerr J.
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	SB09-061
TIME:	06:51:24 PM
MOVED:	Primavera
MOTION:	Moved to adopt prepared amendment L.016 (Attachment G). The motion passed without objection.
SECONDED:	Gagliardi
		VOTE
	Acree
	Gerou
	Green
	Kagan
	Kefalas
	Kerr J.
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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

06:52 PM

Representative Primavera provided concluding remarks to the bill.


BILL:	SB09-061
TIME:	06:53:49 PM
MOVED:	Primavera
MOTION:	Moved to refer Senate Bill 09-061, as amended, to the Committee of the Whole. Substitute motion to refer Senate Bill 09-061 to the Committee on Appropriations. See vote sheet below. The motion to refer Senate Bill 09-061 to the Committee of the Whole passed on a 6-5 roll call vote.
SECONDED:	Green
		VOTE
	Acree	Yes
	Gerou	No
	Green	Yes
	Kagan	Yes
	Kefalas	Yes
	Kerr J.	No
	Nikkel	No
	Primavera	Yes
	Swalm	No
	Gagliardi	Yes
	Riesberg	No

Final YES: 6 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: PASS


BILL:	SB09-061
TIME:	06:55:25 PM
MOVED:	Swalm
MOTION:	Substitute motion to refer Senate Bill 09-061, as amended, to the Committee on Appropriations. The motion failed on a 5-6 roll call vote.
SECONDED:	Gerou
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	No
	Kagan	No
	Kefalas	No
	Kerr J.	Yes
	Nikkel	Yes
	Primavera	No
	Swalm	Yes
	Gagliardi	No
	Riesberg	No

Not Final YES: 5 NO: 6 EXC: 0 ABS: 0 FINAL ACTION: FAIL

07:03 PM

The committee adjourned.