Senate Committee on Health and Human Services (02/05/2009)

Final
STAFF SUMMARY OF MEETING

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	02/05/2009	ATTENDANCE

Time:	01:33 PM to 04:11 PM	Carroll M.	*
		Lundberg	X
Place:	SCR 356	Mitchell	X
		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:
SB09-030 SB09-009 SB09-103 SB09-100		Referred to the Committee of the Whole Postponed Indefinitely Amended, Referred to Appropriations Referred to the Committee of the Whole

01:33 PM -- Senate Bill 09-030

Senator Keller introduced Senate Bill 09-030. The bill concerns the Child Mental Health Treatment Act. A fact sheet concerning the bill was distributed to the committee (Attachment A). Senator Keller explained the provisions of the Child Mental Health Treatment Act which allows families to access residential treatment services for their child without requiring that the children be declared dependent or neglected. The bill extends the repeal of the act to July 1, 2019, and clarifies certain reporting requirements. Senator Keller responded to questions from Senator Lundberg regarding the funding for the act.

01:39 PM -- Bill Bane, Colorado Department of Human Services, described the Child Mental Health Treatment Act, stating that prior to the act, families could usually access residential treatment services for their children only through a dependency and neglect action. He described how services are accessed through the provisions of the act, depending upon whether or not the child is Medicaid-eligible. Services are also paid through private insurance, parental payments, and Supplemental Security Income payments. He stated that if a child is requesting residential care under the act and the request is denied, the family may appeal the decision, both at the provider level and at that department level. He stated that Senate Bill 07-230 improved the program by allowing children to receive intensive services pursuant to the act while remaining in their family home.

01:46 PM -- Todd Marendino, Colorado Department of Human Services, described the bill's requirement for Behavioral Health Organizations serving children receiving Medicaid to report certain information to the Department of Health Care Policy and Financing, which must forward the information to the Department of Human Services. Senator Keller responded to questions from Senator Schultheis regarding whether children who qualify for services pursuant to the act are Medicaid-eligible. Senator Keller explained that the bill is not expanding the program, but rather continuing it for 10 more years.

01:51 PM -- Margie Grimsley, Federation of Families for Children's Mental Health - Colorado Chapter, stated that residential care is sometimes required for severely mentally ill children. She stated services through the act were not available, services would be still be provided, but through the child welfare system or the juvenile justice system. She emphasized that children served under the act have a very high need for services. She responded to questions from Senator Newell regarding whether there is a waiting list for the program.

01:57 PM -- Amanda Callahan, Mental Health America of Colorado, stated the organization has helped families access services through the act.

01:59 PM -- Marlene Fish, National Alliance on Mental Illness, testified regarding her family's experiences with mental illness.

02:01 PM -- Dr. Skip Barber, Colorado Association of Family and Children's Agencies, testified regarding the services provided through the act. He stated that the acuity of the children served through the act's provisions is high, and that a number of families have benefitted from the program. He stated that the program is family-friendly. Dr. Barber responded to questions from Senator Schultheis regarding community-based care for children.

02:09 PM -- Sheryle Hutter, Colorado Cross Disability Coalition, testified in support of the bill.

02:10 PM

Senator Keller gave concluding remarks regarding the bill.


BILL:	SB09-030
TIME:	02:10:29 PM
MOVED:	Boyd
MOTION:	Refer Senate Bill 09-030 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	Yes
	Morse	Excused
	Newell	Yes
	Schultheis	Yes
	Tochtrop	Yes
	Boyd	Yes

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

02:12 PM -- Senate Bill 09-009

Senator Boyd introduced Senate Bill 09-009. The bill adds adult dental services to the optional services provided under the Medicaid program, and as a benefit available to pregnant women in the Children's Basic Health Plan. A handout regarding the program was distributed to the committee (Attachment B). Senator Boyd noted that due to the fiscal condition of the state, the bill would likely not go forward, but that it was still important to discuss the need for appropriate oral health care.

02:14 PM -- Karen Cody Carlson, Dental Aid and Oral Health Awareness Colorado!, testified that there is a close connection between oral health and systemic health. She said that promotion of oral health can improve health outcomes for individuals with chronic illnesses, such as diabetes, and may improve pregnancy outcomes. She discussed the limitation of dental services in the Medicaid program currently.

02:17 PM -- Dr. Mark Deutchman, University of Colorado School of Medicine and School of Dentistry, testified regarding the importance of the link between oral health and systemic health care. He discussed the relationship between oral health care and the treatment of diabetes. He testified there is a link between the oral health of parents and children. Senator Schultheis commented on the cost of including dental benefits in the Medicaid program.

02:23 PM -- Dr. John McFarland, Salud Family Health Centers and Colorado Community Health Network, testified regarding the number of people who receive dental services through community health centers. He testified regarding the importance of preventative dental care, and noted that fluoridating water has saved billions of dollars in dental costs. He discussed the effects of dental care on the treatment of individuals of diabetes. He stated that providing oral health benefits for a pregnant woman is important because providing care at that point can assist in preventing oral decay in the child.

02:32 PM -- Dr. Bruce Madison, Colorado Medical Society and Health Advocates Alliance, testified in support of the bill. He discussed the relationship between oral health and systemic health. He discussed studies that have found that oral health is an important part of general health. He stated that poor oral health can have negative social effects. He stated that early treatment of oral disease reduces costs.

02:36 PM -- Dr. Sandeep Wadhwa, Chief Medical Officer, Colorado Department of Health Care Policy and Financing, stated that there is a false dichotomy between oral health and physical health. He stated the department understands the financial reality of the state, and this is probably not the time for the bill, but that not having an oral health benefit in the Medicaid is a big hole in the program's offerings.

02:39 PM -- Sheryle Hutter, Colorado Cross Disability Coalition, testified that disabled individuals are often on medications that damage teeth, and urged the committee to ensure that disabled adults will be considered for a dental benefit in Medicaid in the future.

02:40 PM

Debra Kolp, Colorado Alliance for Retired Americans, Charlie Hebeler, Colorado Dental Association, Dr. Kelly Dawson, Colorado Academy of Family Physicians, and Lawrence Krause, representing himself, voiced their support for the bill.


BILL:	SB09-009
TIME:	02:41:39 PM
MOVED:	Boyd
MOTION:	Lay over Senate Bill 09-009 until May 7, 2009. The effect of the motion is to postpone indefinitely Senate Bill 09-009. The motion passed on a 6-2 roll call vote.
SECONDED:
		VOTE
	Carroll M.	Yes
	Lundberg	Yes
	Mitchell	Yes
	Morse	No
	Newell	Yes
	Schultheis	Yes
	Tochtrop	No
	Boyd	Yes

Final YES: 6 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS

02:43 PM -- Senate Bill 09-103

Senator Carroll introduced Senate Bill 09-103. The bill defines as an unfair claim settlement practice and a deceptive act or practice in the business of insurance the practice of providing any pay, salary, reward, bonus, promotion, or other financial incentive to any person involved in the review of a claim for benefits or to person performing utilization review in connection with the denial of a claim. She stated that there is nothing in the bill that prevents the denial of insurance claims. She stated that other states have expressly prohibited providing financial incentives for the denial of claims. She responded to questions from Senator Mitchell regarding the number of states that have prohibited the practice in statute, responding that 16 states have expressly prohibited the practice, and that every state that has heard litigation on the issue has ruled that it is an unfair business practice. She responded to additional questions from Senator Mitchell regarding whether Colorado's courts would rule similarly, responding that they have, but that codifying the practice in statute will ensure that the Division of Insurance has authority over the complaints. Amendment L.005 was distributed to the committee (Attachment C). She responded to additional questions regarding incidents in which insurers rewarded employees for denying claims, giving an example of a case in which the practice occurred. Senator Carroll responded to questions from Senator Schultheis regarding whether states with similar statutes have experienced an increase in premiums. Senator Carroll further elaborated on why the practice should be consider an unfair practice or deceptive act. Senator Carroll emphasized that she is not aware of any insurance companies currently engaged in the practice.

03:06 PM -- Mike Hodges, Colorado Trial Lawyers Association, testified in support of the bill. He stated the bill will provide a deterrent effect. He responded to questions from Senator Mitchell.

03:14 PM -- Craig Ewing, representing himself, testified that insurance should be there when people need help, and that creating incentives for insurance company employees to deny claims is inappropriate. He responded to a question from Senator Mitchell regarding cases in which companies were sued for providing incentives to deny claims.

03:19 PM -- Sheryl Hutter, Colorado Cross Disability Coalition, testified in support of the bill. She stated the bill will help protect consumers. She stated that she has had personal experience with the activities the bill is seeking to prohibit.

03:22 PM -- Ben Price, Colorado Association of Health Plans, testified that the association has not taken a position on the bill. He noted that members of the association had initial concerns with the clarity of the bill's language, but not its intent. He stated that Senator Carroll has worked with the association on amendment L.005, and the amendment will make the bill's language more clear. He stated he believed the practice is not occurring in Colorado today.

03:23 PM -- Robert Ferm, American Insurance Association, stated that it is inappropriate to provide incentives to deny claims, and stated that the bill includes specific language prohibiting the practice. He stated the language in amendment L.005 has been reviewed and the industry is growing more comfortable that the bill will not interfere with legitimate practices of insurance companies. He stated that he believes that current law already prohibits the practice, but that the bill's language is more specific. He responded to questions from Senator Schultheis regarding whether there will be an increase in legal costs as a result of the bill.

03:30 PM -- Cindy Compton, Land Title Association of Colorado, testified in opposition to the bill in its current form. She stated that the practice that is prohibited by the bill is already prohibited by current law. She responded to questions from Senator Mitchell regarding incidents in which claims may be properly denied.

03:34 PM -- Art Karsteedt, American Family, testified regarding the case referenced by Senator Carroll as an example in which a company was sued for providing incentives related to claim denial.

03:35 PM -- Dan O'Neil, Pinnacol Insurance, testified that the bill's provisions are already in current law. He spoke to language he would like to see included in Amendment L.005.

03:37 PM

Senator Carroll gave concluding remarks regarding the bill.


BILL:	SB09-103
TIME:	03:39:20 PM
MOVED:	Carroll M.
MOTION:	Adopt prepared amendment L.005 (Attachment C). 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:	SB09-103
TIME:	03:40:44 PM
MOVED:	Carroll M.
MOTION:	Refer Senate Bill 09-103, 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

03:41 PM -- Senate Bill 09-100

Senator Newell introduced Senate Bill 09-100. The bill amends the definition of a "noncustodial parent" for purposes of employment assistance provided through the Temporary Assistance to Needy Families (TANF) program. The bill's change will permit a noncustodial parent to receive employment assistance under the Colorado Works Program even though his or her child is not receiving assistance under the Colorado Works Program. She emphasized that the bill only applies to job training and placement services, and will not permit the parent to receive cash assistance. She stated that the bill will help assist parents who wish to pay their child support, but who have barriers to employment. The services will be paid for out of county TANF reserves.

03:45 PM -- Susan Beckman, chair of the Arapahoe County Board of County Commissioners, stated that child support helps families become self-sufficient. She stated the bill will allow the parents to pay their child support, and it will help prevent the family from ending up on the TANF program. She responded to questions from Senator Boyd regarding any possible unintended consequences for other aspects of the TANF program as a result of the bill. Ms. Beckman noted that the bill will not take any services or funding away from the custodial parent.

03:50 PM -- Cheryl Ternes, Arapahoe County, described the county's Parents to Work Program. She distributed letters of support for the program and a pamphlet describing the program (Attachments D and E). She stated the program has also helped to decrease custody issues and increase payment of child support. She stated that the program benefits children and parents.

03:54 PM -- Pauline Burton, Colorado Department of Human Services, testified in support of the bill. She stated that providing individuals the necessary employment support to allow them to pay child support leads to good outcomes for families. She stated that the bill is good public policy. She responded to questions from Senator Boyd about possible ramifications of the bill on other portions of the TANF program.

03:56 PM -- Pat Ratliff, Colorado Counties Inc., testified that employment program is currently only available to families whose children are enrolled in TANF, and that the bill will allow counties to serve parents who are at risk of needing TANF services. She stated that the bill is permissive for counties, and has no fiscal impact. Senator Schultheis asked what the current level of El Paso county's reserves is, and Ms. Ratliff responded that the reserves only accrue if the county is able to come up with an appropriate matching amount. She stated that El Paso is having trouble paying their match. She further responded to a question from Senator Schultheis regarding county TANF reserves, noting that legislation passed in the previous session recoups some of counties' unspent reserves. Various members of the committee commented on the TANF program.

04:07 PM

Senator Newell gave concluding remarks regarding the bill.


BILL:	SB09-100
TIME:	04:09:47 PM
MOVED:	Newell
MOTION:	Refer Senate Bill 09-100 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

04:11 PM

The committee recessed.