House Committee on Business Affairs and Labor (04/29/2009)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON BUSINESS AFFAIRS AND LABOR

Date:	04/29/2009	ATTENDANCE

Time:	11:25 AM to 07:08 PM	Balmer	X
		Bradford	X
Place:	HCR 0112	Gagliardi	X
		Liston	X
This Meeting was called to order by		Priola	X
	Representative Rice	Ryden	X
		Scanlan	*
This Report was prepared by		Soper	X
	Kelly Stapleton	Stephens	X
		Casso	X
		Rice	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
SB09-255 SB09-247 SB09-244		Amended, Referred to the Committee of the Whole Amended, Referred to Appropriations Amended, Referred to the Committee of the Whole

11:27 AM -- Senate Bill 09-244

Representative Primavera presented Senate Bill 09-244, which requires all health insurance policies which are subject to state regulation to provide coverage to assess, diagnose, and treat autism spectrum disorder (ASD). The bill includes a definition of terms including ASD, applied behavior analysis, autism service providers, and treatment plan. Representative Stephens pointed out that Medicaid and the Children's Basic Health Plan (CHP+) are not required under the bill to provide coverage. Representative Primavera responded that Medicaid provides services to children with autism under the Home- and Community-Based Autism waiver. Representative Primavera provided data regarding how much premiums have increased in other states where a similar bill passed. The committee discussed the fiscal note dated April 28, 2009.

Several handouts were provided to the committee including:

a fact sheet from the sponsor of the bill in support of the bill (Attachment A);

written testimony in support of the bill from Adrienne Paradis (Attachment B);

written testimony in support of the bill from Lu Etta Loeber (Attachment C);

a statement from the Colorado Department of Education in support of the bill (Attachment D);

a fact sheet in support of the bill from the Autism Society of Colorado (Attachment E);

excerpts from the Mandate Commission Report on Senate Bill 09-244 (Attachment F); and

a summary of changes to health insurance law and costs for Colorado employers from 1998-2009 (Attachment G).

11:41 AM -- Dr. Helena Huckabee, Emerge, P.C., spoke in support of the bill. Dr. Huckabee stated that she is a clinical psychologist and a mother of a child with autism. Dr. Huckabee provided her written testimony and an article titled "The Lifetime Distribution of the Incremental Societal Costs of Autism" to the committee (Attachments H and I). Dr. Huckabee spoke to the services she provides to children with autism. Members of the committee asked the witness questions.

12:03 PM -- Dr. David Hatfield, representing himself, spoke in favor of the bill. Dr. Hatfield provided a written handout to the committee which included a definition of applied behavior analysis (ABA) (Attachment J). Dr. Hatfield stated that as a clinical psychologist and board certified behavior analyst, that he believes ABA is a legitimate intervention technique that can significantly improve the core symptoms for individuals with ASD. He stated that ABA is a stand alone practice, not grouped with educational or medical treatments for autism. He stated that one of the arguments against ABA is that it is an educational practice and that health insurance carriers should not be responsible to pay for an educational practice. Dr. Hatfield spoke about other states that have implemented similar policies.

12:17 PM -- Betty Lehman, Executive Director, Autism Society of Colorado, testified in support of the bill. She spoke to the services offered though Medicaid, specifically referencing the children's extensive support and the children with autism waivers. She stated that there are approximately 75 children on the Children with Autism waiver. Ms. Lehman stated that autism is 90 percent treatable. She stated that the Commission on Mandated Health Insurance provided a report which stated that the Division of Insurance calculated that if the bill were to pass, there would be an increase to premiums of approximately $4.12 monthly or about $49 annually. She spoke to the benefits of treatment which cannot be calculated in a fiscal note. Ms. Lehman stated that for every $1 spent on early intervention services, it saves $12. Ms. Lehman stated that she does not believe any other significant health illness like autism is excluded from coverage.

12:28 PM -- Gregory Goodman, parent of a child with autism, spoke in support of the bill. Mr. Goodman provided his written testimony to the committee (Attachment K). Mr. Goodman highlighted the handout which describes changes to health insurance coverage. He stated that the chart demonstrates that health insurance premiums have not increased when an additional health insurance mandate was implemented. He stated that health insurance mandates do not increase costs to premiums.

12:34 PM -- Dr. Deb Efird, American Academy of Pediatrics, practicing at the Children's Hospital, spoke in favor of the bill. She stated that she has a child with autism. She spoke to how much her child's condition improved after receiving applied behavior analysis treatment.

12:39 PM -- Heidi Loeffel, paralegal from Ewing and Ewing, PC, testified that the law firm she works for recently worked on a case in which a child with autism was denied coverage because the child received ABA therapy. She stated that the case involved Kaiser Permanente. Ms. Loeffel stated that the claim of denial was based on the fact that ABA is not a medically recognized treatment. Ms. Loeffel provided paperwork regarding the lawsuit (Attachment L).

12:43 PM -- Julie Cook, board member of the Alpine Autism Center and a parent of a child with autism, spoke in support of the bill. She stated that she is a small business owner and pays approximately $1,000 for her and her husband's health insurance premiums. She stated that her insurance does not cover ABA therapy, which her daughter receives about once a week. Ms. Cook stated that the treatment of cancer is on the same level as the treatment of autism. She stated that a health insurance carrier could not deny the treatment of cancer, and asked why it would then be able to deny treatment of autism.

12:50 PM -- Jill Tappert, parent of a child with autism, stated that she recently won an arbitration case against Anthem BlueCross BlueShield to cover ABA therapy. She stated that the judge in the case ruled that ABA therapy was considered medically necessary and not experimental, and that it is the standard of care in treating autism. Ms. Tappert provided her written testimony to the committee (Attachment M). She spoke to how much her child has improved since implementing ABA autism treatment.

01:07 PM -- The written testimony from Phillip Strain was provided to the committee (Attachment N).

01:08 PM -- Sarony Young, Family Voices Colorado, stated that Family Voices helps individuals file appeals of claims for the coverage for ABA therapy that are denied. She testified in support of the bill.

01:13 PM -- Sharlene Yabe, Colorado State Association of Health Underwriters, spoke in opposition to the bill. Ms. Yabe stated that the bill will add to the already high costs of premiums. She stated that the underwriters set criteria with regard to what types of illnesses to cover. She stated that the bill will not increase access to health care, will not decrease the cost of premiums, and will likely drive out healthy individuals who will not pay any more money for increased premiums. She urged the committee to wait until national reform has been put in place before passing another health insurance mandate. Representative Bradford asked why the insurance industry has not been more proactive in dealing with this issue considering other states have passed mandates to cover the treatment of autism. Ms. Yabe stated that the insurance industry has been active, but was not asked to the table for discussions regarding this particular bill.

01:28 PM -- Mark Mannino, parent of a child with autism, spoke in favor of the bill. Mr. Mannino described the improvement his child achieved after receiving ABA therapy. His written testimony was provided to the committee (Attachment O).

01:31 PM

Senate Bill 09-244 was taken off the table.

01:33 PM -- Senate Bill 09-255

Senate Bill 09-255 was put back on the table. For witness testimony, see the committee summary from April 27, 2009. Representative A. Kerr stated that he will be offering amendment L.004 which will address the committee's concern aired in witness testimony (Attachment P). Representative A. Kerr explained the effect of the amendment on the bill.


BILL:	SB09-255
TIME:	01:39:34 PM
MOVED:	Liston
MOTION:	Moved to adopt prepared amendment L.004 (Attachment P). The motion passed without objection.
SECONDED:	Priola
		VOTE
	Balmer
	Bradford
	Gagliardi
	Liston
	Priola
	Ryden
	Scanlan
	Soper
	Stephens
	Casso
	Rice

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


BILL:	SB09-255
TIME:	01:41:37 PM
MOVED:	Balmer
MOTION:	Moved to refer Senate Bill 09-255, as amended, to the Committee of the Whole. The motion passed on a 8-3 roll call vote.
SECONDED:	Liston
		VOTE
	Balmer	Yes
	Bradford	Yes
	Gagliardi	No
	Liston	Yes
	Priola	Yes
	Ryden	No
	Scanlan	Yes
	Soper	No
	Stephens	Yes
	Casso	Yes
	Rice	Yes

Final YES: 8 NO: 3 EXC: 0 ABS: 0 FINAL ACTION: PASS

01:46 PM -- Senate Bill 09-247

Representative Pace presented Senate Bill 09-247, which expands the availability of unemployment insurance compensation benefits to certain unemployed individuals and enables the state to receive and expend funds from the federal "American Recovery and Reinvestment Act of 2009." Eligibility for benefits is expanded to include individuals who leave a job for certain compelling family reasons including:

to accompany a spouse whose employment location has changed;
to care for a family member who is ill or disabled; and
domestic abuse.

Representative Pace stated that expanded benefits are to be charged to the Unemployment Insurance (UI) Trust Fund and will not affect an employer's premium. Members asked questions of the sponsor regarding accepting federal dollars for the expansion of the UI benefits.

01:59 PM -- Kathy White, Project Director, Fiscal Policy Institute, spoke in favor of the bill. Ms. White spoke to the specifics in the bill. She stated that the funds will be available this year. Ms. White provided a handout to the committee which provides a description of the bill (Attachment Q).

02:05 PM

Amendment L.005 was provided to the committee (Attachment R). The bill was taken off the table. The committee recessed.

04:15 PM -- Senate Bill 09-247

Senate Bill 09-247 was put back on the table and the committee reconvened with witness testimony.

04:18 PM -- Tony Gagliardi, National Federation of Independent Business (NFBI), spoke in favor of the bill.

04:20 PM -- Alice Johnson, Department of Labor and Employment, spoke in favor of the bill.

04:20 PM -- Rich Jones, The Bell Policy Center, testified in support of the bill. Mr. Jones provided a handout to the committee (Attachment S).

04:21 PM -- Jeff Clayton, Colorado Department of Labor and Employment, spoke against amendment L.006 (Attachment T). He provided a packet of information to the committee (Attachment U).

04:23 PM

Representative Pace spoke to amendment L.005 (Attachment R). He provided concluding remarks to the bill.


BILL:	SB09-247
TIME:	04:23:44 PM
MOVED:	Soper
MOTION:	Moved to adopt prepared amendment L.005 (Attachment R). The motion passed without objection.
SECONDED:	Gagliardi
		VOTE
	Balmer
	Bradford
	Gagliardi
	Liston
	Priola
	Ryden
	Scanlan
	Soper
	Stephens
	Casso
	Rice

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


BILL:	SB09-247
TIME:	04:25:37 PM
MOVED:	Gagliardi
MOTION:	Moved to refer Senate Bill 09-247, as amended, to the Committee on Appropriations. The motion passed on a 7-4 roll call vote.
SECONDED:	Casso
		VOTE
	Balmer	No
	Bradford	No
	Gagliardi	Yes
	Liston	No
	Priola	No
	Ryden	Yes
	Scanlan	Yes
	Soper	Yes
	Stephens	Yes
	Casso	Yes
	Rice	Yes

Final YES: 7 NO: 4 EXC: 0 ABS: 0 FINAL ACTION: PASS

04:27 PM -- Senate Bill 09-244

Senate Bill 09-244 was put back on the table and witness testimony reconvened.

04:30 PM -- Daniel West, representing himself, spoke in support of the bill. Mr. West provided his written testimony to the committee (Attachment V).

04:37 PM -- Travis Berry, Colorado Competitive Council (C3), spoke in opposition to the bill. He stated that his heart goes out to the families who have children with autism. He spoke to the exclusions in the bill for state employees and self-funded health insurance plans. He stated that many large companies are self-funded. He said that he would caution the committee against creating unrealistic expectations. Committee members asked questions of the witness. Mr. Berry spoke to the how the bill may affect businesses. He stated that it is irresponsible in these economic times to place the burden solely on business who provide health insurance.

04:48 PM -- Tony Gagliardi, National Federation of Independent Business (NFIB), spoke in opposition to the bill. He stated that it was a difficult position to be in opposition to the bill. He provided information regarding NFIB's membership, which he said has been increasingly shrinking given the current state of the economy. He stated that each additional health insurance mandate on small group policies increases premiums by approximately 35 percent. He stated that businesses that offer quality benefits packages are competitive and aim to keep qualified employees, but at some point, a small business owner simply cannot afford to continue to pay the increased costs of premiums. He spoke to the mandated coverage placed on businesses. He spoke to the increasing price of premiums for small group policies. He stated that the bill creates two classes of children. He stated that the there is a significant cost shift to small business. He stated that any type of treatment covered should be evidence-based.

05:03 PM -- Donnah Moody, Colorado Association of Commerce and Industry (CACI), spoke in opposition to the bill. She spoke specifically to ABA therapy and the costs of that treatment. She asked the committee to refer to the fiscal note when Medicaid and the Children's Basic Health Plan were included. She stated that the fiscal note was approximately $80 million. She stated that the bill creates a niche specific to autism, and that it opens the door to dismantling the health insurance industry.

05:10 PM -- Ben Price, Colorado Association of Health Plans, spoke in opposition to the bill. Two handouts were provided to the committee, the 2009 State Autism Mandate Bills Cost Estimates and a copy of the draft of the working principles provided to the Autism Society of Colorado (Attachments W and X). Mr. Price stated that the 2009 State Autism Mandate chart compares bills in other states to Colorado, and the actual cost of premiums. He concurred with Mr. Gagliardi's testimony regarding the cost shift onto small businesses. He also spoke to the ABA therapy model and whether it is an educational technique or a medical treatment. Mr. Price also stated that the bill is fairly broad regarding how it defines autism treatment providers.

05:27 PM -- Linda Daniel, Rocky Mountain Health Plans, testified in opposition to the bill. She stated that it is difficult to oppose the bill. She stated that remaining fiscally responsible may not be realistic if the bill is passed. She concurred with Ms. Moody's testimony regarding carving out a specific niche for a particular group of individuals with a specific illness. She stated that the bill will raise premiums. She stated that their plans may have to decrease coverage in other areas to cover the costs associated with this bill. She also stated that she is not sure if there are enough qualified providers to serve all the children with autism.

05:34 PM -- Susan Cox, Kaiser Permanente, testified in opposition to the bill. She provided 3 handouts, an article titled "Autism Overview: What We Know," another article from the American Academy of Pediatrics titled "Management of Children with Autism Spectrum Disorders," and a handout from the National Institute of Mental Health regarding modalities of ASD (Attachments Y, Z, and AA respectively). She pointed out the handout from the National Institute of Mental Health states that there is no single best treatment for children with ASD. She stated that Kaiser supports evidence-based treatments. She stated that bills in other states which have mandated significantly less in coverage have been postponed indefinitely. Ms. Cox stated that the bill is too specific regarding the treatment of autism. She stated that it is not fair to place the majority of the burden on private health insurance policy holders. She stated that there is a difference of opinion on the best modality for the treatment of ASD. Ms. Cox stated that Kaiser has not had sufficient time to review several amendments and their effects. She stated that the cost to Kaiser would be approximately 15 percent of their mental health budget in order to care for less than 1/1000 of the population served.

05:51 PM -- Dr. Jean Milofsky, Chair of Psychiatry Department, Kaiser Permanente, described how Kaiser Permanente treats children with autism. She spoke to the need to have control over a treatment plan. Committee members asked questions of the witness.

06:10 PM

At the request of Representative Gagliardi, Mr. Price from the Colorado Association of Health Plans provided a copy of the numbers he referenced in his testimony (Attachment BB). The committee took a brief recess.

06:34 PM

The committee reconvened. The committee discussed several amendments.


BILL:	SB09-244
TIME:	06:42:12 PM
MOVED:	Stephens
MOTION:	Moved to adopt prepared amendment L.020 (Attachment CC). Representative Primavera asked the committee to strike line 5 of the amendment. Amendment L.020 puts back in the coverage for state employees. Representative Stephens withdrew her motion. Representative Liston withdrew his second.
SECONDED:	Liston
		VOTE
	Balmer
	Bradford
	Gagliardi
	Liston
	Priola
	Ryden
	Scanlan
	Soper
	Stephens
	Casso
	Rice

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


BILL:	SB09-244
TIME:	06:48:17 PM
MOVED:	Gagliardi
MOTION:	Moved to adopt Section A of amendment L.020 (Attachment CC). Section A of amendment L.020 includes lines 1 through 4. The motion passed on a 6-5 roll call vote.
SECONDED:	Casso
		VOTE
	Balmer	No
	Bradford	No
	Gagliardi	Yes
	Liston	No
	Priola	No
	Ryden	Yes
	Scanlan	Yes
	Soper	Yes
	Stephens	No
	Casso	Yes
	Rice	Yes

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


BILL:	SB09-244
TIME:	06:50:16 PM
MOVED:	Balmer
MOTION:	Moved to adopt prepared amendment L.024 (Attachment DD). The sponsor explained the amendment. Debbie Haskin, Office of Legislative Legal Services, provided an explanation of the amendment. The motion passed without objection.
SECONDED:	Priola
		VOTE
	Balmer
	Bradford
	Gagliardi
	Liston
	Priola
	Ryden
	Scanlan
	Soper
	Stephens
	Casso
	Rice

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


BILL:	SB09-244
TIME:	06:51:21 PM
MOVED:	Soper
MOTION:	Moved to adopt prepared amendment L.025 (Attachment EE). The sponsor explained the amendment. The motion passed without objection.
SECONDED:	Gagliardi
		VOTE
	Balmer
	Bradford
	Gagliardi
	Liston
	Priola
	Ryden
	Scanlan
	Soper
	Stephens
	Casso
	Rice

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


BILL:	SB09-244
TIME:	06:55:25 PM
MOVED:	Priola
MOTION:	Moved to adopt prepared amendment L.030 (Attachment FF). The motion passed without objection.
SECONDED:	Stephens
		VOTE
	Balmer
	Bradford
	Gagliardi
	Liston
	Priola
	Ryden
	Scanlan
	Soper
	Stephens
	Casso
	Rice

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


BILL:	SB09-244
TIME:	06:56:54 PM
MOVED:	Stephens
MOTION:	Moved to adopt prepared amendment L.031 (Attachment GG). The amendment changes the benefit caps for coverage. The motion passed on a 10-1 roll call vote.
SECONDED:	Balmer
		VOTE
	Balmer	Yes
	Bradford	Yes
	Gagliardi	Yes
	Liston	No
	Priola	Yes
	Ryden	Yes
	Scanlan	Yes
	Soper	Yes
	Stephens	Yes
	Casso	Yes
	Rice	Yes

Not Final YES: 10 NO: 1 EXC: 0 ABS: 0 FINAL ACTION: PASS

07:02 PM

Representative Primavera provided a wrap-up to the bill. She stated that the state, the education system, the federal government, and the military pay their share to treat children with autism. She stated that it is now time for insurance companies to step up and cover their share.


BILL:	SB09-244
TIME:	07:05:25 PM
MOVED:	Gagliardi
MOTION:	Moved to refer Senate Bill 09-244, as amended, to the Committee of the Whole. The motion passed on a 9-2 roll call vote.
SECONDED:	Stephens
		VOTE
	Balmer	Yes
	Bradford	No
	Gagliardi	Yes
	Liston	No
	Priola	Yes
	Ryden	Yes
	Scanlan	Yes
	Soper	Yes
	Stephens	Yes
	Casso	Yes
	Rice	Yes

Final YES: 9 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS

07:07 PM

The committee adjourned.