Senate Committee on Health and Human Services (03/04/2009)

Final
STAFF SUMMARY OF MEETING

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	03/04/2009	ATTENDANCE

Time:	11:13 AM to 12:42 PM	Carroll M.	X
		Lundberg	X
Place:	SCR 354	Mitchell	*
		Morse	X
This Meeting was called to order by		Newell	X
	Senator Boyd	Schultheis	*
		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:
HB09-1056 HB09-1103		Amended, Referred to Finance Amended, Referred to the Committee of the Whole

11:14 AM -- House Bill 09-1056

Senator Kopp introduced House Bill 09-1056. The bill makes changes to the enforcement procedures of the Department of Public Health and Environment (DPHE) related to solid waste disposal. The bill specifies that DPHE is not required to conduct a hearing before issuing a compliance order, but a person who receives a compliance order may request a hearing through the Office of Administrative Courts within the Department of Personnel and Administration. In addition, the bill authorizes a compliance order to include an administrative or civil penalty, allows an administrative law judge (ALJ) to grant a motion to stay any portion of a compliance order pending the outcome of a hearing, and allows an ALJ to request an interpretive rule from the Solid and Hazardous Waste Commission. Senator Kopp distributed Amendment L.001 (Attachment A).

11:19 AM -- Martha Rudolph, Department of Public Health and Environment, testified in support of the bill and the amendment. She stated that the enforcement procedures for the solid waste program are inconsistent with other environmental programs overseen by the department. She described the bill's provisions, including the provision that raises the maximum penalty for violations from $2,000 to $10,000 a day. She stated that the cost of compliance in some cases can be greater than the maximum penalty that may be assessed, and that means that some violators may choose to pay the penalty rather than to comply with the law. Senator Kopp discussed his reasons for carrying the bill. Ms. Rudolph responded to questions from Senator Carroll regarding compliance orders and whether there is due process prior to the assessment of a fine.

11:29 AM -- Joe Schieffelin, Department of Public Health and Environment, responded to questions from Senator Carroll regarding compliance orders and whether or not fines are assessed without an opportunity for hearing. He stated that the department is permitted to assess the fee without a hearing, but that in order to enforce an order with fines, a hearing is necessary. The committee, Mr. Schieffelin, and Ms. Rudolph discussed whether there was appropriate due process prior to the assessment of fines. Senator Schultheis asked for clarification of what are considered to be "egregious" violations. Mr. Schieffelin responded, and described provisions of the department's penalty manual used in determining the level of violations.

11:43 AM

In response to a question from Senator Newell regarding whether the fines and penalties are credited to the General Fund or to the county or municipality, Mr. Schieffelin clarified that the bill's fines are credited to the General Fund, but that municipalities are also allowed to assess fines. Senator Tochtrop clarified that two sets of fines could not be assessed, but the department or entity with oversight would be the entity to assess and collect the fine.

11:47 AM -- Donnah Moody, Colorado Association of Commerce and Industry, testified that the association has a neutral position on the bill, and that amendment L.001 addresses the association's concerns with the appropriate appeal procedures.

11:48 AM -- Charles Bayley, Waste Management, testified regarding the bill. He responded to questions from Senator Mitchell regarding whether the inspections, in his view, are intended to correct deficiencies or are punitive. Mr. Bailey responded that his company has had positive interactions with the Department of Public Health and Environment.

11:52 AM

Senator Kopp gave concluding remarks regarding the bill. He explained amendment L.001 (Attachment A). The amendment outlines the factors an ALJ must consider when making a determination on a motion to request an interpretive rule.


BILL:	HB09-1056
TIME:	11:54:24 AM
MOVED:	Boyd
MOTION:	Adopt prepared amendment L.001 (Attachment A). 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:	HB09-1056
TIME:	11:54:32 AM
MOVED:	Boyd
MOTION:	Refer House Bill 09-1056, as amended, to the Committee on Finance. 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

11:56 AM -- House Bill 09-1103

Senator Newell introduced House Bill 09-1103. The bill authorizes the Department of Health Care Policy and Financing to seek federal approval to allow an applicant who meets certain requirements to be presumptively eligible for Medicaid long-term care services. Senator Newell described her reasons for bringing the bill, stating that Colorado is a national leader in promoting home- and community-based services. She stated the bill will help to reduce costs for the state by reducing client moves between long-term care facilities, ensuring that a client's health needs do not escalate because care is delayed during the eligibility determination period, and allowing clients to receive home- and community-based services instead of nursing home services if that level of care is appropriate. Senator Tochtrop commented on the level of care provided by nursing homes.

12:01 PM -- Barbara Prehmus, Department of Health Care Policy and Financing, testified in support of the bill. She described the eligibility requirements for Medicaid-funded long-term care services. She stated that the financial review of eligibility is a major obstacle in the eligibility determinations. Ms. Prehmus explained that the bill will permit the department to seek federal approval to determine a person presumptively eligible for long-term care services.

12:05 PM -- Chris Underwood, Department of Health Care Policy and Financing, testified regarding the process of obtaining federal approval to implement presumptive eligibility for long-term care services. He described the differences in the cost of home- and community-based services and nursing home services. He stated that a pilot program on long-term care presumptive eligibility found that there was about a 1 percent error rate in presumptive eligibility determinations. He stated that the department is not estimating the cost savings associated with presumptive eligibility now, but that the bill is meant to start a conversation with the federal government about seeking approval to implement presumptive eligibility. Mr. Underwood responded to questions from Senator Mitchell regarding delays in eligibility determinations for long-term care. Ms. Prehmus responded to questions from Senator Schultheis regarding the delays in gathering appropriate income documentation, stating sometimes individuals in need of long-term care do not have family members to assist them in gathering the appropriate documents.

12:17 PM

Mr. Underwood responded to questions from Senator Lundberg regarding the anticipated costs of a presumptive eligibility system, and whether changes to the Colorado Benefits Management System will be required. Senator Carroll noted that the bill was authorizing the department to ask the federal government for permission to implement the bill, and that the implementation of the program may drive costs in the future.

12:21 PM -- Pat Ratliff, Colorado Counties Inc., testified in support of the bill. She noted that when an individual enters long-term care in a nursing home, Medicaid will pay retroactively. She discussed a potential amendment to the bill to specify that counties are not responsible for any sanctions that may be assessed if a person is later determined to be ineligible for the program.

12:24 PM -- Julie Reiskin, Colorado Cross Disability Coalition, testified in support of the bill and distributed a handout (Attachment B). She gave an example of one of her clients who could benefit from presumptive eligibility for long-term care. She responded to questions from Senator Schultheis regarding how presumptive eligibility will allow clients to gather the necessary documentation to comply with the eligibility requirements of the program.

12:30 PM -- Susan Langley, Denver Hospice, testified that navigating the Medicaid system can be exhausting, especially for individuals who are need of hospice services. She stated that many individuals do not have the luxury of time it takes to gather the necessary eligibility documentation. She stated that there are times when the hospice is not reimbursed for services because the eligibility process is not finished by the time the person dies.

12:34 PM -- Robert Semro, Colorado Consumer Health Initiative, testified in support of the bill. He testified that the need for long-term care services can be immediate. He stated that immediate access to long-term care services can make a measurable difference in a person's quality of life and health, and delays in care can increase costs if a person's health care needs increase while care is delayed.

12:37 PM

Senator Newell gave concluding remarks regarding the bill.


BILL:	HB09-1103
TIME:	12:37:46 PM
MOVED:	Newell
MOTION:	Strike the Effective Date Clause of the bill and replace it with a Safety Clause. 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:	HB09-1103
TIME:	12:38:30 PM
MOVED:	Newell
MOTION:	Page 3, after line 1, insert the following "If it is determined that a recipient was not eligible for medical benefits after the recipient had been determined to be eligible based upon presumptive eligibility, the state department shall not pursue recovery from a county department for the cost of medical services provided to the recipient, and the county department shall not be responsible for any federal error rate sanctions resulting from such determination." The motion passed on a 6-2 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	No
	Mitchell	Yes
	Morse	Yes
	Newell	Yes
	Schultheis	No
	Tochtrop	Yes
	Boyd	Yes

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


BILL:	HB09-1103
TIME:	12:40:04 PM
MOVED:	Newell
MOTION:	Refer House Bill 09-1103, as amended, to the Committee of the Whole. 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

12:41 PM

The committee recessed.