H_HI_2021A 04/21/2021 01:31:04 PM Committee Summary PUBLICSTAFF SUMMARY OF MEETINGHOUSE COMMITTEE ON HEALTH & INSURANCE Date 04/21/2021 Attendance Baisley X Hanks X Jackson X Kennedy * McCormick X Mullica X Ortiz X Pelton X Soper X Titone X Van Beber X Caraveo X Lontine X Time 01:31:04 PM to 08:02:38 PM Place HCR 0112 This Meeting was called to order by Lontine This Report was prepared by Julia Group Hearing Items Action Taken hHB21-1198 Amended, referred to House Appropriations hHB21-1172 Postponed Indefinitely hHB21-1237 Amended, referred to the Committee of the Whole hHB21-1256 Referred to the Committee of the Whole HB21-1198 - Amended, referred to House Appropriations Attachment Tag File Name Attachment A http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/D851BC44C9EB...$File/21HouseHealth0421AttachA.pdf?OpenElement 21HouseHealth0421AttachA.pdf Attachment B http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/1633502A3903...$File/21HouseHealth0421AttachB.pdf?OpenElement 21HouseHealth0421AttachB.pdf Attachment C http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/843DFA914E88...$File/21HouseHealth0421AttachC.pdf?OpenElement 21HouseHealth0421AttachC.pdf Attachment D http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/D68954D2C6D2...$File/21HouseHealth0421AttachD.pdf?OpenElement 21HouseHealth0421AttachD.pdf Attachment E http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/82B78E357D0E...$File/21HouseHealth0421AttachE.pdf?OpenElement 21HouseHealth0421AttachE.pdf Attachment F http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/4FF39EABC82B...$File/21HouseHealth0421AttachF.pdf?OpenElement 21HouseHealth0421AttachF.pdf 01:31:21 PM Representative Jodeh, bill sponsor, introduced HB21-1198. The bill repeals, reenacts, and expands hospital requirements around providing discount care to uninsured patients (discount program) and moves regulatory authority over the program from the Colorado Department of Public Health and Environment (CDPHE) to the Department of Health Care Policy and Financing (HCPF). Changes to the program include: Applying regulations to health care facilities, instead of just hospitals; requiring HCPF to develop a standard application for health care facilities to screen uninsured patients for eligibility for public health insurance programs, the Colorado Indigent Care Program (CICP), or discounted care; creating an appeals process if a patient is found to be ineligible; limiting the amount a health care facility can charge for eligible patients for emergency and other non-CICP services to 80 percent of the Medicare rate, instead of the lowest negotiated rate from a private health plan; limiting collection amounts to monthly payments of no more than 5.0 percent of the patientâs monthly household income; considering a patientâs bill paid in full after 36 months of payments; requiring health care facilities to post information on patientâs rights under the discount program, as developed by HCPF; requiring health care facilities to collect and report certain information to HCPF to determine compliance across demographics; requiring HCPF to periodically review health care facilities to ensure compliance; and requiring HCPF to promulgate rules prohibiting hospitals from considering assets when determining if a patientâs income eligibility and to ensure the method used to determine eligibility is uniform across hospitals. By April 1, 2022, the State Board of Health in the CDPHE must promulgate rules to implement the program and HCPF must develop information on patientâs rights, establish a process for patients to appeal a determination of ineligibility, and begin to periodically review health-care facilities for compliance. By June 1, 2023, and each June 1 after, each health care facility must collect and report data to HCPF on compliance. Collection of medical debt. The bill updates regulations around the collection of medical debt. Specifically, before a health care facility can assign or sell patient debt to a collection agency or before pursing permissible extraordinary collection action the facility must: screen the patient for eligibility for programs listed above; provide discounted care or offer a payment plan that does not exceed 5.0 percent of the patientâs monthly household income, and provide an explanation of the services and fees being billed. A health care facility that does not follow these steps is liable to the patient for damages, as specified in the bill. A medical creditor or medical debt collector cannot engage in any permissible extraordinary collection actions until 180 days after the first bill for a medical debt is sent. In addition, 30 days before taking an action, a creditor must provide the patient with a notice developed by HCPF. If a creditor fails to follow these steps, the creditor must reverse any collection actions. Representative Jodeh distributed a handout to the committee (Attachment A). 01:48:56 PM The bill sponsor responded to questions from the committee. 01:49:32 PM Allison Neswood, Colorado Center on Law and Policy, testified in support of the bill. Mr. Daniel Vedra, representing himself, testified in support of the bill. Mrs. Nancy Dolson, Department of Health Care Policy and Financing, testified in support of the bill. The witnesses responded to questions from the committee. 02:04:14 PM Joshua Ewing, Colorado Hospital Association, testified to amend the bill. Ms. Jackie Zheleznyak, Denver Health, testified to amend the bill. Dr. Karen Foster, Colorado Dental Association, testified to amend the bill. Dr. Steven Nelson, Colorado Dental Association, testified to amend the bill. The panel of witnesses responded to questions from the committee. 02:33:24 PM Alex Witteveld, Colorado Legal Services, testified in support of the bill. Regina Stjernholm, representing herself, testified in support of the bill. 02:41:13 PM Jill Schneider, Clinica Colorado, testified in support of the bill. Mr. Kerry Gleason, representing himself, testified in support of the bill. Ms. Leslie Kalechman, AARP Colorado, testified in support of the bill. Ms. Elissa Jane Mastel, representing herself, testified in support of the bill. Perla Rodriguez, Center for Health Progress, testified in support of the bill. Adela Flores-Brennan, Colorado Consumer Health Initiative, testified in support of the bill and distributed a handout to the committee (Attachment B). The witnesses responded to questions from the committee. 03:06:31 PM Ms. Neswood responded to questions from the committee. Submitted written testimony can be found in Attachment F. 03:09:14 PM Representative Jodeh introduced and explained amendments L.002 (Attachment C), L.001 (Attachment D), and L.004 (Attachment E). 03:12:35 PM Motion Adopt amendment L.002 (Attachment C) Moved Caraveo Seconded Kennedy Baisley Hanks Jackson Kennedy McCormick Mullica Ortiz Pelton Soper Titone Van Beber Caraveo Lontine YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection 03:13:45 PM Motion Adopt amendment L.001 (Attachment D) Moved Caraveo Seconded Kennedy Baisley Hanks Jackson Kennedy McCormick Mullica Ortiz Pelton Soper Titone Van Beber Caraveo Lontine YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection 03:14:26 PM Motion Adopt amendment L.004 (Attachment E) Moved Caraveo Seconded Titone Baisley Hanks Jackson Kennedy McCormick Mullica Ortiz Pelton Soper Titone Van Beber Caraveo Lontine YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection 03:14:45 PM Representative Jodeh provided closing comments on the bill. 03:16:53 PM Committee members made closing comments on the bill. 03:18:15 PM Motion Refer House Bill 21-1198, as amended, to the Committee on Appropriations. Moved Caraveo Seconded Ortiz Baisley No Hanks No Jackson Yes Kennedy Yes McCormick Yes Mullica Yes Ortiz Yes Pelton No Soper No Titone Yes Van Beber No Caraveo Yes Lontine Yes Final YES: 8 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: PASS HB21-1172 - Postponed Indefinitely Attachment Tag File Name Attachment G http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/97382CFFD2D3...$File/21HouseHealth0421AttachG.pdf?OpenElement 21HouseHealth0421AttachG.pdf 03:21:06 PM Representative Geitner, bill sponsor, presented HB21-1172. The bill requires health care facilities, including hospitals, nursing care facilities and assisted living residences, to allow their patients and residents to have at least one visitor of their choosing. The bill also requires these health care facilities to have written policies and procedures concerning visitation, including any restrictions or limitations that are placed on visitation and the reasons for these restrictions or limitations. The bill prohibits health care facilities from disallowing visitation if the sole reason is to reduce the risk of transmission of a pandemic disease, but allows health care facilities to impose requirements and limitations on visitors to reduce the risk of transmission of a pandemic disease as follows: during a period of heightened pandemic disease transmission risk, health care facilities may designate entry points, deny visitors with known symptoms of the pandemic disease, require visitors to wear face coverings or other protective equipment, and require them to sign a waiver acknowledging the risks of visitation; during a period of known community transmission of a pandemic disease, health care facilities may require all visitors to be screened for symptoms of the disease before visitation, and deny entrance to any visitor who has symptoms of the disease; and during widespread community transmission of the disease, facilities may limit visitation to essential caregivers or for compassionate care visits from a friend or family member to alleviate physical or emotional distress. 03:33:28 PM The bill sponsor responded to questions from the committee. 04:04:58 PM Representative Lontine proceeded with witness testimony. 04:05:22 PM Ms. Judith Burke, Colorado Nurses Association, testified in opposition to the bill. Arlene Miles, Colorado Health Care Association, testified to amend the bill. Joshua Ewing, Colorado Hospital Association, testified to amend the bill. Mr. Ewing responded to questions. 04:33:32 PM Andrea Waitley, representing herself, testified in support of the bill. Stephen Reiter, the NEVER Alone Project, testified in support of the bill. The panel responded to questions from the committee. 04:43:53 PM Mr. Todd Workman, representing himself, testified in support of the bill. Jennifer Crow, representing herself, testified in support of the bill. Ms. Kelly Huenink, representing herself, testified in support of the bill. 04:55:39 PM Mrs. Brandee Gillham, representing herself, testified in support of the bill. Mr. Roy Gillham, representing himself, testified in support of the bill. Mr. Matt Gillham, representing himself, testified in support of the bill. The witnesses responded to questions from the committee. 05:18:53 PM Mr. Jake Gillham, representing himself, testified in support of the bill. Mrs. Nita Gillham, representing herself, testified in support of the bill. 05:28:24 PM Ms. Huenink responded to questions from the committee. 05:29:01 PM Mr. Daniel Gillham, representing himself, testified in support of the bill. Mrs. Sarah Gillham, representing herself, testified in support of the bill. The witnesses responded to questions from the committee. Submitted written testimony can be found in Attachment G. 05:38:38 PM Representative Geitner provided closing comments on the bill. 05:49:41 PM Committee members made closing comments on the bill. 06:00:11 PM Committee comments on the bill continued. 06:18:45 PM Motion Refer House Bill 21-1172 to the Committee on Appropriations. Moved Baisley Seconded Van Beber Baisley Yes Hanks Yes Jackson No Kennedy No McCormick No Mullica No Ortiz No Pelton Yes Soper Yes Titone No Van Beber Yes Caraveo No Lontine No YES: 5 NO: 8 EXC: 0 ABS: 0 FINAL ACTION: FAIL 06:19:04 PM Motion Postpone House Bill 21-1172 indefinitely using a reversal of the previous roll call. There was no objection to the use of the reverse roll call, therefore, the bill was postponed indefinitely. Moved Kennedy Seconded Caraveo Baisley No Hanks No Jackson Yes Kennedy Yes McCormick Yes Mullica Yes Ortiz Yes Pelton No Soper No Titone Yes Van Beber No Caraveo Yes Lontine Yes Final YES: 8 NO: 5 EXC: 0 ABS: 0 FINAL ACTION: PASS HB21-1237 - Amended, referred to the Committee of the Whole Attachment Tag File Name Attachment H http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/83F340ED42A6...$File/21HouseHealth0421AttachH.pdf?OpenElement 21HouseHealth0421AttachH.pdf Attachment I http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/23FB970558D2...$File/21HouseHealth0421AttachI.pdf?OpenElement 21HouseHealth0421AttachI.pdf Attachment J http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/2F8926628B14...$File/21HouseHealth0421AttachJ.pdf?OpenElement 21HouseHealth0421AttachJ.pdf 06:19:20 PM The committee took a brief recess. 06:30:40 PM Representative Lontine, bill co-sponsor, presented HB21-1237. The bill directs the Department of Personnel and Administration (DPA) to enter into a contract with a pharmacy benefit manager (PBM) for the administration of state employee health insurance through a reverse-auction process prescribed by the bill, and then use that platform to audit claims. State employee insurance offered through Kaiser Permanente is exempt from this requirement. It creates avenues for other public and private health insurance plans to participate jointly with the state. Technology platform. By November 1, 2021, DPA must obtain a technology platform, and associated services from the platform operator, capable of conducting a reverse-auction for a PBM. The platform must be equipped with certain automation and price comparison capabilities specified in the bill. In addition, the platform must be able to perform automated line-by-line review of all invoiced PBM drug claims to identify any deviations from the terms of the PBM contract. DPA may perform a market check during the term of the PBM contract to evaluate the incumbent PBMâs drug pricing for continuing competitiveness. Fee. The platform, operator services, claim review, and market checks will be paid for by a per-prescription fee paid by the winning PBM directly to the platform operator. Joint participation. Any other self-funded public sector health plan may use the processes and procedures established in the bill individually, collectively, or as a joint purchasing group with a state employee health insurance plan. After completion of the first PBM reverse auction, self-funded private sector health plans with substantial participation by Colorado employees may also participate in a joint purchasing pool with state employees for subsequent PBM reverse auctions. Any health plans participating in a purchasing pool retain autonomy over their drug formularies and benefit designs. She distributed a handout to the committee (Attachment H). 06:33:23 PM Representative Rich, bill co-sponsor, continued introducing the bill. 06:35:57 PM The sponsors responded to questions from the committee. 06:38:57 PM The testimony of Mr. Drew Cline, Josiah Bartlett Center for Public Policy, was read into the record. The testimony was in a neutral position on the bill. 06:42:34 PM Mr. Ky Davis, RxPlus Pharmacies, testified to amend the bill. 06:46:15 PM Mrs. Hilary Glasgow, Colorado WINS, testified in support of the bill. 06:50:37 PM The sponsors responded to questions from the committee. 06:54:31 PM Mr. Dudley Burdge, Communications Workers of America/New Jersey State Health Benefits Commission, testified in support of the bill. 07:00:24 PM Mr. Mark Blum, America's Agenda, answered committee questions. 07:10:46 PM The sponsors responded to questions from the committee. 07:11:42 PM Mr. Blum and Mr. Burdge continued to respond to committee questions. Submitted written testimony can be found in Attachment I. 07:15:23 PM Representative Rich introduced amendment L.006 (Attachment J). 07:16:45 PM Committee members made comments on amendment L.006. 07:18:51 PM Motion Adopt amendment L.006 (Attachment J) Moved Lontine Seconded Kennedy Baisley Hanks Jackson Kennedy McCormick Mullica Ortiz Pelton Soper Titone Van Beber Lontine Caraveo YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection 07:19:13 PM The bill sponsors made closing comments on the bill. 07:22:21 PM Committee members made closing comments on the bill. 07:24:47 PM Motion Refer House Bill 21-1237, as amended, to the Committee of the Whole. Moved Lontine Seconded Ortiz Baisley Yes Hanks No Jackson Yes Kennedy Yes McCormick Yes Mullica Yes Ortiz Yes Pelton Yes Soper No Titone Yes Van Beber Yes Lontine Yes Caraveo Yes Final YES: 11 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS HB21-1256 - Referred to the Committee of the Whole Attachment Tag File Name Attachment K http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/ECDE267D1A67...$File/21HouseHealth0421AttachK.pdf?OpenElement 21HouseHealth0421AttachK.pdf Attachment L http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/75500D1338C7...$File/21HouseHealth0421AttachL.pdf?OpenElement 21HouseHealth0421AttachL.pdf Attachment M http://www2.leg.state.co.us/CLICS/CLICS2021A/commsumm.nsf/0/0E88F6C03D2D...$File/21HouseHealth0421AttachM.pdf?OpenElement 21HouseHealth0421AttachM.pdf 07:24:54 PM The committee took a brief recess. 07:25:16 PM Representative Lontine, bill sponsor, introduced HB21-1256. The bill directs the Department of Health Care Policy and Financing, which administers the stateâs Medicaid program, to promulgate rules specifically relating to health care providers that deliver health care or mental health services exclusively or primarily through telemedicine. She distributed a packet of info to the committee (Attachment K). 07:32:57 PM Ms. Aubrey Hill, Colorado Association for School-Based Health Care, testified in support of the bill. Dr. Deborah Archer, American Academy of Pediatrics - Colorado, testified in support of the bill. Ms. Phyllis Albritton, Colorado Safety Net Collaborative, testified in support of the bill. Commissioner Wendy Buxton-Andrade, Prowers County, testified in support of the bill. 07:46:28 PM Jackie Zheleznyak, Denver Health, testified in support of the bill. Dr. Tracy Johnson, Department of Health Care Policy and Financing, testified in support of the bill. The witnesses responded to questions from the committee. Submitted written testimony can be found in Attachment L. 07:55:12 PM Representative Soper introduced and described amendment L.001 (Attachment M). 07:57:02 PM Motion Adopt amendment L.001 (Attachment M) Moved Soper Seconded Baisley Baisley Yes Hanks Yes Jackson No Kennedy No McCormick No Mullica No Ortiz No Pelton Yes Soper Yes Titone No Van Beber Yes Lontine No Caraveo No YES: 5 NO: 8 EXC: 0 ABS: 0 FINAL ACTION: FAIL 07:57:17 PM Representative Lontine provided closing comments on the bill. 07:59:34 PM Committee members provided closing comments on the bill. 08:02:30 PM Motion Refer House Bill 21-1256 to the Committee of the Whole. Moved Lontine Seconded Mullica Baisley No Hanks Yes Jackson Yes Kennedy Yes McCormick Yes Mullica Yes Ortiz Yes Pelton Yes Soper No Titone Yes Van Beber Yes Lontine Yes Caraveo Yes Final YES: 11 NO: 2 EXC: 0 ABS: 0 FINAL ACTION: PASS 08:02:38 PM The committee adjourned.