House Committee on Health and Human Services (01/26/2009)

Final
STAFF SUMMARY OF MEETING

HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

Date:	01/26/2009	ATTENDANCE

Time:	01:33 PM to 07:35 PM	Acree	X
		Gerou	X
Place:	LSB A	Green	X
		Kefalas	X
This Meeting was called to order by		Kerr J.	X
	Representative Riesberg	McGihon	X
		Nikkel	X
This Report was prepared by		Primavera	X
	Kelly Stapleton	Swalm	X
		Gagliardi	X
		Riesberg	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
HB09-1032 HB09-1007 HB09-1116 HB09-1056 HB09-1047 HB09-1020		Postponed Indefinitely Referred to the Committee of the Whole Amended, Referred to the Committee of the Whole Referred to the Committee of the Whole Amended, Referred to Appropriations Referred to Appropriations

01:34 PM -- House Bill 09-1032

Representative Liston presented House Bill 09-1032 which directs a pharmacist to require a photo identification from a person seeking to fill a prescription for a schedule I and II controlled substance. Representative Liston provided several statistics regarding the number of individuals abusing prescription medications. He spoke to amendment L.005 which exempts mail-order pharmacy deliveries or pharmacies that deliver directly to a nursing home (Attachment A). Representative Liston also spoke to amendment L.002 (Attachment B).

01:42 PM

Sheryle Hutter, Colorado Cross Disability Coalition and the Colorado Disability Council, testified in opposition to the bill. She stated that she has great concerns with this bill for the disability population. Ms. Hutter stated that this bill will put an additional burden on this population and it is not in the best interest of the population. Committee members has several questions of the witness. Ms. Hutter stated that it can be difficult for members of this population to obtain a driver's license or some other kind government identification.

01:52 PM

Mary Pat Aardrup, Senior Vice President, National Pain Foundation, testified in opposition to the bill. Ms. Aardrup stated that she appreciates the intent of the bill to reduce the abuse of prescription medications. She stated that if a person is required to show proof of identification, a person waiting to mug someone for their pain medication would be tipped off that the person was filling a prescription for pain medication, as other medications do not require proof of identification. Ms. Aardrup stated that she is concerned about the unintended consequences of this bill.

02:01 PM

Faith Gross, the Legal Center for People with Disabilities and Older People, testified in opposition to the bill. Ms. Gross stated that she has helped the disabled and elderly prepare for the recent elections. She stated that in that process, there were several individuals that did not have identification. She stated she was concerned over the impact on this population that are consumers of schedule I and II controlled substances. Representative Gerou made a comment that identification is probably going to be required at some point in the future. Representative McGihon asked the witness to comment on the fact that the bill requires that a "government issued identification" is required versus a different type of identification. Ms. Gross agreed stated that was a great concern to her. She stated she would be more amenable to the bill if a state-funded program could cover the cost of obtaining an identification.

02:08 PM

Julie Gonzales, Policy Coordinator, Colorado Immigrant Rights Coalition (CIRC), testified in opposition to the bill. She stated she is concerned about the unintended consequences of the bill. Ms. Gonzales concurred with Ms. Gross with regard to obtaining a government-issued identification. She pointed out that many low-income and people of color may be disenfranchised by this bill. Ms. Gonzales also pointed out the financial hardship that the bill will put on several individuals.

02:12 PM

Cathy Hazouri, Executive Director, American Civil Liberties Union (ACLU), testified in opposition to the bill. Ms. Hazouri stated that several witnesses have testified to the hardship that obtaining a government-issued identification poses. She stated that although many people feel it is a simple process to get a birth certificate which is what is required to get a government-issued identification, it can very difficult. Ms. Hazouri reiterated that this bill will disenfranchise individuals with disabilities. Ms. Hazouri commented that it took her three months to get a new driver's license and she pointed out that she is a lawyer and knows how the system works. She pointed out that the bill does not get at reducing drug abuse.

02:27 PM

Chris Howes, Colorado Retail Council, provided information to the committee that most of their members participate in the Colorado Prescription Drug Monitoring program. He stated they are in opposition to the bill without amendments. He responded to committee members questions regarding how well pharmacists are trained to verify identification. Mr. Howes noted that pharmacist must also take into consideration the length of time it takes to fill a prescription, and if the bill passes, the length of time it would take to fill a prescription and verify an client's identification.

02:32 PM

Detective Rhonda Yohn, Metro Vice, Narcotics and Intelligence Division, Colorado Springs Police Department, testified in support of the bill. Detective Yohn provided her written testimony and a fact sheet to the committee (Attachment C). Detective Yohn described several ways individuals obtain prescription drugs illegally. She stated that these individuals are not picked up by the prescription monitoring system because they are not required to show an identification. Representative McGihon noted that one of the amendments removes the record keeping aspect of the bill. There was some discussion with committee members regarding the effect of not having record keeping aspect to the bill. Detective Yohn responded to Representative Kefalas' question stating that several states such as Wyoming, Florida, New York, and Ohio have passed a similar law to House Bill 09-1032, but could not speak to the results as they are fairly new laws.

02:44 PM

Byron K. Bruce, Drug Enforcement Administration, testified in support of the bill. Mr. Bruce stated that he works in the Tactical Diversion Squad which was established to combat the problem of pharmaceuticals being sold into the community. He spoke to how individuals obtain illegal prescriptions. He stated that without identification, most people can obtain multiple prescriptions.

02:56 PM

Detective Dale Wallis, Denver Police Department and the Drug Enforcement Agency, testified in support of the bill. Detective Wallis stated that one pill of oxcycotton on the street goes for about $80. He reiterated and concurred with Detective Bruce's comments.

03:12 PM

Richard Sruka, pharmacist, testified in support of the bill. He stated that he is not necessarily trained in verifying identification. He stated that many individuals are getting smarter at requesting fraudulent prescriptions. He pointed out that at-risk individuals typically use the same pharmacists and the pharmacists know them. He stated those individuals are not the problem.

03:19 PM

Dr. Val Kalnins, Executive Director, Colorado Pharmacists Society, testified in support of the bill with amendments. Mr. Kalnins acknowledged that mandating pharmacists to verify photo identification for prescriptions for controlled substances could be overly burdensome for pharmacists.

03:21 PM

Peg Ackerman, Legislative Liaison, County Sheriff's of Colorado, testified in support of the bill. She stated that at the recent county sheriff stakeholder meeting, that the sheriff's voted unanimously for the bill.

03:22 PM

Susan Cox, Kaiser Permanente, testified in support of the bill. She reiterated support of the bill with amendments. She stated that Kaiser requires identification from their clients, but she also pointed out that Kaiser is a closed system, meaning that it only serves its members.

03:25 PM

Brad Young, RxPlus Pharmacies, testified in support of the bill. He reiterated and concurred with Dr. Kalnins testimony and stated they support the bill with amendments.

03:31 PM

Representative Liston responded to questions from the committee. He stated that individuals who were purchasing prescriptions and disbursing those prescriptions are breaking the law and could face a felony charge. He stated that by requiring individuals to show identification, the impact of facing a felony becomes more real. He stated that he does not think it is overly burdensome to require individuals to show identification. He stated that by requiring individuals to show proof of identification will not eradicate the problem, but will at least address the problem.


BILL:	HB09-1032
TIME:	03:35:50 PM
MOVED:	Kerr J.
MOTION:	Moved to adopt prepared amendment L.002 (Attachment B). Representative Liston explained the amendment. The motion passed without objection.
SECONDED:	Gerou
		VOTE
	Acree
	Gerou
	Green
	Kefalas
	Kerr J.
	McGihon
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	HB09-1032
TIME:	03:39:41 PM
MOVED:	Kerr J.
MOTION:	Moved to adopt prepared amendment L.005 (Attachment A). Representative Liston explained the amendment. Representative Riesberg expressed some concern that controlled substances may still be delivered by pharmacists and received without showing identification under this bill. The motion passed without objection.
SECONDED:	Gerou
		VOTE
	Acree
	Gerou
	Green
	Kefalas
	Kerr J.
	McGihon
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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

03:46 PM

Representative Liston provided a wrap-up to the bill. He stated that the pharmacists have testified in support of the bill. He stated that individuals must show identification to obtain alcohol and that controlled substances are much more dangerous to society. He concluded by saying that by requiring individuals to show a photo identification will reduce fraudulent prescription filling.


BILL:	HB09-1032
TIME:	03:50:07 PM
MOVED:	Kerr J.
MOTION:	Moved to refer House Bill 09-1032 to the Committee of the Whole. The motion failed on a 5-6 roll call vote.
SECONDED:	Swalm
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	No
	Kefalas	No
	Kerr J.	Yes
	McGihon	No
	Nikkel	Yes
	Primavera	No
	Swalm	Yes
	Gagliardi	No
	Riesberg	No

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


BILL:	HB09-1032
TIME:	03:54:13 PM
MOVED:	McGihon
MOTION:	Moved to postpone House Bill 09-1032 indefinitely. The motion passed on a 6-5 roll call vote.
SECONDED:	Gagliardi
		VOTE
	Acree	No
	Gerou	No
	Green	Yes
	Kefalas	Yes
	Kerr J.	No
	McGihon	Yes
	Nikkel	No
	Primavera	Yes
	Swalm	No
	Gagliardi	Yes
	Riesberg	Yes

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

03:55 PM

The committee took a brief recess.

04:05 PM -- House Bill 09-1007

Representative Frangas presented House Bill 09-1007 which requires a representative from the field of domestic violence to be a part of a local inter-agency oversight group within the Collaborative Management Program, a multi-agency group that provides services to children and families. The new representative would be available to provide guidance to identify the cause and action necessary to decrease the recurrent number of child abuse and neglect reports involving domestic violence. Representative Frangas stated the bill carries no fiscal note as well. Representative Frangas provided a handout in support of the bill to the committee (Attachment D).

04:11 PM -- Pat Ratliff, Colorado Counties, Inc., testified in support of the bill. She stated that this model works very well.

04:13 PM -- George Kennedy, Deputy Director, Office of Child Youth and Families, Department of Human Services, testified in support of the bill. Mr. Kennedy spoke to the Child Welfare Action Committee, which is an Executive Order issued by Governor Ritter regarding improving the child welfare system. He stated that the interim report from the action committee recommended adding a domestic violence representative to the Collaborate Management Program.

04:16 PM

Sheryle Hutter, Equal Justice Foundation, testified in opposition to the bill. She stated there are sometimes false allegations made in domestic violence cases. She stated she is concerned that information shared through the inter-agency task force could be damaging and further false information. She stated she does not necessarily disagree with having someone involved, but she is concerned about the sharing of information. Representative Riesberg stated that the task force already exists and that the bill would simple change the membership make-up.

04:23 PM

Representative Frangas provided a wrap-up to the bill.


BILL:	HB09-1007
TIME:	04:24:19 PM
MOVED:	Kefalas
MOTION:	Moved to refer House Bill 09-1007 to the Committee of the Whole. The motion passed on a 11-0 roll call vote.
SECONDED:	Gagliardi
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	Yes
	Kefalas	Yes
	Kerr J.	Yes
	McGihon	Yes
	Nikkel	Yes
	Primavera	Yes
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	Yes

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

04:25 PM -- House Bill 09-1116

Representative Frangas presented House Bill 09-1116 which will remove a statutory ban on using General Funds for the Children's Dental Assistance Program. Representative Frangas addressed whether this bill requires the General Assembly to provide General Fund dollars to the program. He then outlined several issues with regard to a lack of dental hygiene for children. He also spoke to the current financing of the program. Representative Frangas spoke to amendment L.001 which would allow the Department of Human Services to request an appropriation from the General Fund that is equal to the reduction of a funding request for another program within the department (Attachment E).

04:34 PM -- Dr. Ned Calonge, Chief Medical Officer, Colorado Department of Public Health and Environment, testified in support of the bill. He spoke to the need for oral health and its connection to overall health. He stated that at this time, it is clearly not an option to use General Fund dollars for the program. Dr. Calonge stated that the department is in support of amendment L.001 (Attachment E). He stated that if a General Fund appropriation were to be made, that federal dollars would be used to expand the program. There was some discussion about whether allowing the Children's Dental Assistance Program to receive General Fund dollars that the General Assembly would be required, in the future, to make an appropriation for the program. Dr. Calonge clarified that the bill does not require an appropriation, but allows General Fund dollars to be used for the program.

04:56 PM -- Deborah Colburn, Executive Director, Oral Health Awareness Colorado, testified in support of the bill. She pointed out that Medicaid providers have been very difficult to keep and maintain in the program. She stated that one of the greatest barriers is getting kids to a primary care provider. She also commented that the program is cost effective and actually goes down with the more kids enrolled in the program. Ms. Colburn also provided some statistics of those who benefit most from oral health services.

04:59 PM -- Julie Collett, Executive Director, Kids In Need of Dentistry, testified in support of the bill.

05:01 PM -- Charlie Hebeler, Colorado Dental Association, testified in support of the bill.

05:02 PM -- Pat Ratliff, Colorado Counties, Inc. testified in support of the bill.

05:04 PM -- Tara Trujillo, Colorado Children's Campaign, testified in support of the bill.

05:05 PM

Representative Frangas provided a brief wrap-up on the bill. He stressed that the bill does not require an appropriation, but allows for General Funds to be used for the program, when and if funds become available in future years.


BILL:	HB09-1116
TIME:	05:07:18 PM
MOVED:	McGihon
MOTION:	Moved to adopt prepared amendment L.001 (Attachment E). The motion passed without objection.
SECONDED:	Gagliardi
		VOTE
	Acree
	Gerou
	Green
	Kefalas
	Kerr J.
	McGihon
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	HB09-1116
TIME:	05:07:38 PM
MOVED:	McGihon
MOTION:	Moved to refer House Bill 09-1116 to the Committee of the Whole. The motion passed on a 10-0 roll call vote.
SECONDED:	Acree
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	Excused
	Kefalas	Yes
	Kerr J.	Yes
	McGihon	Yes
	Nikkel	Yes
	Primavera	Yes
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 10 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS

05:10 PM -- House Bill 09-1056

Representative McCann presented House Bill 09-1056 which will increase the fines for the penalty for illegally disposing of solid waste. She stated that the bill proposes increasing the fine from $2,000 a day to $10,000 a day. The bill 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 specifies factors for the ALJ to consider. Representative McCann stated that additional time will allow the ALJ to provide resolution to the query.

05:17 PM -- Martha Rudolf, Director of Environmental Program, and Joe Schieffelin, Program Manager, Hazardous Waste Manager Program, Department of Public Health and Environment, testified in support of the bill. Ms. Rudolf stated that the bill 'levels' the playing field by increasing the penalty fee. She noted that the fine is significantly less than any of the other type of environmental violation. She stated that it will be less costly to have administrative authority involved in the resolution process, whereas as the law stands now, violators go before a district court which is significantly more costly. Mr. Schieffelin provided a definition of solid waste for the committee. Representative Acree asked if the department could explain the appeal process. Mr. Schieffelin stated that the bill does not change the appeal process.

05:28 PM

Donnah Moody, Director of Government Affairs, Colorado Association of Commerce and Industry (CACI), testified in support of the bill.


BILL:	HB09-1056
TIME:	05:32:16 PM
MOVED:	Gagliardi
MOTION:	Moved to refer House Bill 09-1056 to the Committee of the Whole. The motion passed on a 10-0 roll call vote.
SECONDED:	McGihon
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	Excused
	Kefalas	Yes
	Kerr J.	Yes
	McGihon	Yes
	Nikkel	Yes
	Primavera	Yes
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 10 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS

05:34 PM -- House Bill 09-1047

Representative Todd presented House Bill 09-1047 which would establish a pilot program allowing Medicaid clients with spinal cord injuries who are eligible for Home- and Community-based Services (HCBS) to receive complementary or alternative therapies. Representative Todd stated that the bill was passed last year, but was vetoed by the Governor because the cost of the waiver could not be funded. She stated that the bill is similar to last year's bill, but that the HCBS waiver could be covered by private funding or donations. Representative Todd stated that ideally funds would come from the state, but stated that she is working on getting a foundation to contribute funds. Committee members asked several questions to the sponsor.

05:52 PM -- Arthur Guerrero, Vietnam veteran, testified in support of the bill. Mr. Guerrero stated that he's been supporting alternative therapies for over forty years. He spoke to the lack of blood circulation that causes serious problems for individuals living in spinal cord injuries. He stated that he goes to massage therapy which helps considerably with blood circulation. He stated it is a lot less expensive to treat spinal cord injuries through alternative therapies versus being treated at the emergency room.

06:01 PM -- Chanda Hinton, self, testified in support of the bill. Ms. Hinton stated she was shot in the neck when she was nine years old. She stated that she sat in a wheel chair without any use of alternative therapies until she was 21. She stated that she was admitted into the hospital weighting 59 pounds. At that time, she stated she was introduced to alternative therapies and it saved her life. She stated that the Chain the Pain Foundation has stated they would partner with the state in order to help get the pilot program off the ground. She also stated that a pilot program in Florida has been operating for some time and they are planning on implementing it as a waiver based program.

06:11 PM -- Leo Boyle, Colorado Acupuncture Association, testified in support of the bill.

06:16 PM

Representative Todd provided a wrap-up to the bill. She pointed to the Veterans Administration, who has implemented alternative therapies into its program, as proof that alternative therapies are viable and efficient.


BILL:	HB09-1047
TIME:	06:18:53 PM
MOVED:	Kefalas
MOTION:	Moved to adopt prepared amendment L.001 (Attachment F). The motion passed without objection.
SECONDED:	Primavera
		VOTE
	Acree
	Gerou
	Green
	Kefalas
	Kerr J.
	McGihon
	Nikkel
	Primavera
	Swalm
	Gagliardi
	Riesberg

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


BILL:	HB09-1047
TIME:	06:22:26 PM
MOVED:	Kefalas
MOTION:	Moved to refer House Bill 09-1047 to the Committee on Appropriations. Representative Todd clarified that any state match would come from gifts, grants, and donations. She further noted that if no gifts, grants, or donations are received that the pilot program would not go forward. The motion passed on a 10-0 roll call vote.
SECONDED:	McGihon
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	Excused
	Kefalas	Yes
	Kerr J.	Yes
	McGihon	Yes
	Nikkel	Yes
	Primavera	Yes
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	Yes

Final YES: 10 NO: 0 EXC: 1 ABS: 0 FINAL ACTION: PASS

06:28 PM -- House Bill 09-1020

Representative Riesberg provided a handout to the committee for the committee's Health Care Resource Notebook that is a list of acronyms provided by Aponte and Busam (Attachment G).

06:32 PM

Representative Acree presented House Bill 09-1020 which directs the Department of Health Care Policy and Financing (DHCPF) to establish a process for reenrollment in Medicaid and the Children's Basic Health Plan both over the phone and the internet. Representative Acree stated that she is well aware of the financial situation in Colorado. She stated that the funds allocated in the fiscal note have already been appropriated to this project. She spoke to the benefits of implementing this process.

06:39 PM

Representative Riesberg stated that the department has no position on the bill, however the money that was appropriated for this process is part of what the department is planning on proposing as a budget cut. There was some discussion among the committee members regarding the fiscal note and the potential funding of the process. Representative Acree reiterated the benefits of the process and stated she was unaware that the department was planning on cutting the money from their portion of the budget. There was some discussion about the Colorado Benefits Management System (CBMS). Representative Riesberg stated that he has heard from several counties that are not on board with this process as of right now.

06:48 PM

Representative Riesberg noted that the debate is not centered around the benefits of eligibility modernization, but rather the fiscal situation. Representative McGihon asked if anyone could speak to the economic stimulus package with regard to Medicaid funding.

06:50 PM -- Tara Trujillo, Colorado Children's Campaign, testified in support of the bill. Ms. Trujillo explained the difference between the department's project and this bill. Ms. Trujillo spoke to the on-line eligibility piece which is about reenrollment. She noted that the General Assembly passed a bill last session which allows the DHCPF to verify a candidate's eligibility status. Ms. Trujillo stated that money was appropriated to fund this project, but that it is taking longer to organize the project. She noted that through the economic stimulus package a great deal of money was allocated for health information technology.

06:59 PM -- Deborah Colburn, Executive Director, Colorado Coalition of the Medically Underserved, testified in support of the bill. She stated that the state needs to keep moving forward and that modernization eligibility is extremely important. She provided a handout to the committee (Attachment H).

07:01 PM -- Stephanie Benintendi, Director, The Children's Hospital, testified in support of the bill. She stated her office helps individuals enroll in Medicaid and that this bill will help cut the amount of administrative cost in half.

07:05 PM -- Marijo Rymer, The Arc of Colorado, testified in support of the bill. She encouraged the committee to pass the bill out of committee until more information can be learned about the economic stimulus package.

07:14 PM

Jean Nofles, member of AARP, written comments were provided to the committee (Attachment I).

07:15 PM -- Toni Panetta, NARAL Pro-Choice Colorado, testified in support of the bill.

07:22 PM

Representative Acree provided a wrap-up to the bill. She asked the committee to pass the bill forward and allow time for the details of the federal stimulus package to emerge.


BILL:	HB09-1020
TIME:	07:27:25 PM
MOVED:	Acree
MOTION:	Moved to refer House Bill 09-1020 to the Committee on Appropriations. Several members expressed their concern with the fiscal note, but stated that they would like some time to review what may happen with the economic stimulus package. Other members expressed concern over spending more money on CBMS which has not shown to be effective. Representative Primavera stated she is very concerned that the DHCPF nor any county representative was available to communicate to the committee their position on the bill. She stated that they may be impacted the most by this bill. The motion passed on a 8-2 roll call vote.
SECONDED:	McGihon
		VOTE
	Acree	Yes
	Gerou	Yes
	Green	Excused
	Kefalas	Yes
	Kerr J.	Yes
	McGihon	Yes
	Nikkel	Yes
	Primavera	No
	Swalm	Yes
	Gagliardi	Yes
	Riesberg	No

Final YES: 8 NO: 2 EXC: 1 ABS: 0 FINAL ACTION: PASS

07:34 PM

The committee adjourned.