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S_JUD_2019A 04/15/2019 01:32:58 PM Committee Summary

PUBLIC
STAFF SUMMARY OF MEETING
SENATE COMMITTEE ON JUDICIARY
Date 04/15/2019
Attendance
Cooke X
Gardner *
Rodriguez X
Gonzales *
Lee X
X = Present, E = Excused, A = Absent, * = Present after roll call
Time 01:32:58 PM to 07:17:19 PM
Place SCR 352
This Meeting was called to order by Senator Lee
This Report was prepared by Juliann Jenson
Hearing Items Action Taken
HB19-1219 Referred to the Committee of the Whole - Consent Calendar
HB19-1174 Amended, referred to Senate Finance

HB19-1219 - Referred to the Committee of the Whole - Consent Calendar


01:33:10 PM  

Senator Lee called the meeting to order. 

Senator Crowder, sponsor, explained HB 19-1219, concerning modernization of the permanency hearing statutes. 

01:34:55 PM  

Gretchen Russo, representing the Colorado Department of Human Services, spoke in support of the bill.  She discussed how permanency placements for children is an integral part of child welfare system.

Jennifer Mullenbach, representing Jefferson County, testified in support of the bill. She discussed her work on this issue. 

01:38:14 PM  

Cara Nord, representing the Office of the Child's Representative, spoke in support of the bill.  She discussed reunification efforts and the bill. 

01:39:27 PM  

Ruchi Kapoor, representing the Office of Respondent Parents' Counsel, spoke in support of the bill.  She discussed kinship placements and other priorities.



01:42:35 PM
Motion Refer House Bill 19-1219 to the Committee of the Whole and with a recommendation that it be placed on the consent calendar.
Moved Gonzales
Seconded
Cooke Yes
Gardner Yes
Rodriguez Yes
Gonzales Yes
Lee Yes
Final YES: 5   NO: 0   EXC: 0   ABS:  0   FINAL ACTION:  PASS



HB19-1174 - Amended, referred to Senate Finance

01:42:42 PM  

Senators Gardner and Pettersen, co-prime sponsors, explained HB19-1174, concerning out-of-network health care services provided to covered persons, and, in connection therewith, making an appropriation. 

The senators explained how the bill will protect consumers and reduce health care costs.  Senator Gardner specified the groups impacted by the bill and the purpose of setting a benchmark for out-of-network services. 

 

 

01:58:27 PM  

Senator Gardner briefly discussed and distributed the following amendments:  L. 040 (Attachment A); L. 053 (Attachment B);  L. 044 (Attachment C); L. 046 (Attachment D); L. 055 (Attachment E); and L.056 (Attachment F). 

02:05:29 PM  

Adela Flores-Brennan, representing the Colorado Consumer Health Initiative, testified in support of the bill. She discussed surprise and balance billing and consumers who find themselves in the middle of insurance carriers and providers.  She distributed two handouts in support of the measure, one which explained cost drivers and the other outlined consumer stories (Attachment G and H). 

02:11:18 PM  

Charles Woodard, representing himself and his son, spoke in support of the measure.  He discussed balance billing problems after his son received emergency services at an in-network hospital with out-of-network providers.   

02:18:45 PM  

Dr. David Downs, representing the Colorado Medical Society, spoke in opposition to the bill.  He supported the part of the bill that removes patients from the middle of disputes between providers and carriers but otherwise expressed concerns about marketplace disruptions.  He stressed that Colorado emergency room physicians are the lowest paid in the country and did not support reimbursement rates decreasing any further.

 

02:23:41 PM  

Dr. Peter Ricci, representing the Colorado Medical Society, testified in opposition to the bill. He expressed concerns that it penalizes physicians.  He suggested that an amendment should be added to ensure that health plans don't have unilateral authority in these matters. 

 

 

02:27:04 PM  

Dr. David Dungan, representing the Colorado Radiology Society, spoke in opposition to the bill.  He noted concerns about unintended consequences and reimbursement rates that are not competitive on a national level.  He also worried the bill would impact the ability to recruit doctors to the state. 

 

02:30:48 PM  

Dr. Donald Stader, representing the Colorado chapter of the American College of Emergency Physicians, testified in opposition to the bill.  He suggested a different benchmark from the one outlined in the bill that doesn't punish providers.  He emphasized that emergency room doctors in Colorado are the lowest compensated in the country.

Discussion followed about insurance carriers, terminating doctors from health plan networks, and relationships between health plans and hospitals.   

 

 

02:45:05 PM  

Further discussion ensued about recruiting physicians in rural areas, free-standing emergency rooms, and a level playing field between insurance carriers and physicians. 

 

02:56:31 PM  

Dr. James Denton, representing himself as a trauma and acute care surgeon, spoke in opposition to the bill.  He explained that doctors have no control over the patients they see.  

03:01:29 PM  

Sallie Clark, representing herself as a general surgeon, testified in opposition to the bill. She emphasized that the patient should not be in the middle, but there needs to be a clearer relationship between the physician and insurance carrier. 

03:04:06 PM  

Steve Quach, representing himself as a physician, spoke in opposition to the bill. He expressed concerns that insurance carriers will cancel contracts with such low benchmarks and no means to negotiate.   

03:09:44 PM  

George Hertner, representing Emergency Medical Specialists, testified against the bill.  He worried that emergency physicians will leave the state if the bill's reimbursement provisions pass. 

03:14:42 PM  

Rebecca Kornas, representing US Acute Care Physicians, testified in opposition to the measure.  She reported that the state cannot afford to lose doctors. 

Discussion followed about contracts with insurers and business versus medical decisions. 

03:24:11 PM  

Stephanie Wachman, representing herself, spoke in support of the bill. She relayed a personal experience with her son who received disparate bills from three different providers for the same service.  She supported putting an end to surprise medical billing. 

03:29:23 PM  

Nikki Studer Briggs, representing herself, testified in favor of the bill. She relayed a personal experience with an emergency appendectomy that was out-of-network and the lawsuits and financial strain thereafter.  

Michael Conway, State Insurance Commissioner in the Department of Regulatory Agencies, testified in support of the bill.  He discussed what the bill accomplishes and how surprise bills drive up insurance costs.  He answered questions about the Affordable Care Act, Medicaid, Medicare, and insurance carriers. 

 

03:47:52 PM  

Bill Lindsay, representing himself as an employee benefit consultant, spoke in support of the bill. He discussed insurance and reimbursement rates.

03:50:53 PM  

Robert Smith, representing the Colorado Business Group on Health, testified in favor of the bill. He discussed price controls. 

Discussion followed about consequences of setting the benchmark too high or too low. 

 

04:03:06 PM  

Further discussion ensued about emergency treatment, arbitration, and other options for recourse.

04:06:27 PM  

Jennifer Mello, representing Centura Health, testified in support of the bill.

Tom Donohue, representing SCL Health, testified in favor of the bill.  He discussed definitions of emergency services.

 

 

04:11:00 PM  

Brad Neidermyer, representing the Colorado State Association of Health Underwriters, testified in support of the bill. He discussed surprise billings and situations in which they occur. 

04:16:14 PM  

Jeanette Hensley, representing the Colorado Senior Lobby, spoke in support of the bill. She discussed an injury that occurred years ago in which she is still paying for out-of-network services. 

04:19:56 PM  

The committee discussed emergency physician rates and insurance carriers. 

04:26:16 PM  

Dr. Ira Chang, representing Blue Sky Neurology Colorado, spoke in opposition to the bill.  She discussed rate caps and negotiation tools. 

Dr. Mark Kozlowski, representing himself as an emergency room physician, testified in support of the bill if amended to adjust the benchmark to a higher reimbursement rate for physicians.  He discussed disparities in wealth and insurance carriers. 

04:35:36 PM  

Dr. John McLaughlin, representing himself as an independent physician practicing family medicine, spoke in opposition to the bill.  He discussed his work with the under served community. 

04:39:48 PM  

Dr. David Friedenson, representing himself as an emergency room physician, spoke in opposition to the bill as written.  He noted that he would support it with an amendment to adjust the benchmark.  He discussed insurance carriers cancelling contracts because of low reimbursement rates. 

Discussion ensued about reimbursements for specialists, contracts between physicians and insurers, and high deductibles. 

 

04:58:13 PM  

Hunter Railey, representing the Small Business Majority, testified in support of HB 19-1174. He discussed the cost-saving elements of the bill.

05:02:56 PM  

Sara Allen, representing Kaiser Permanente, testified in support of the bill. She discussed large bills levied for out-of-network health care, and noted the effect of this practice on health care costs overall.

05:05:05 PM  

Michelle Kohera, representing Kaiser Permanente, testified in support of the bill. She discussed the damage that a select number of specialty doctors are causing to the health care system.

05:08:23 PM  

Nicholas Colglazier, representing the Colorado Competitive Council, testified in support of the bill. Discussion ensued regarding the requirement that certain out-of-network costs be paid, with no recourse.

05:15:32 PM  

Dr. Sean Bryant, representing himself, spoke in opposition to the bill. He discussed how the bill punishes those who are playing by the rules. 

05:21:06 PM  

Dr. Jamie Dhaliwal, representing himself as an ER physician, spoke in opposition to the bill. He discussed the complexity of submitting claims to insurance.  He stressed that doctors do not have a choice in who they treat. 

05:25:46 PM  

Dr. Cassie Reynolds, representing herself as a trauma surgeon, spoke in opposition to the bill. She discussed actual costs of services as opposed to rates. 

05:39:27 PM  

Dr. Cassie Reynolds, representing herself as a trauma surgeon, spoke in opposition to the bill. She discussed actual costs of services as opposed to rates. 

05:44:12 PM  

Dr. Nathan Lamborn, representing himself as an anesthesiologist, testified in opposition to the bill.  He discussed health insurance companies, patients, and the billing process. 

 

05:49:39 PM  

Dr. Matt Maloney,  representing the US Anesthesia Partners, spoke in opposition to the bill. He discussed unintended consequences such as the ability to retain and recruit anesthesiologists. 

05:57:38 PM  

Dr. Jack Betts, representing the US Anesthesia Partners, spoke in opposition to the bill.  He discussed the scope of insurance networks.

Dr. Randall Clark, representing himself as an anesthesiologist, spoke in opposition to the bill.  He raised concerns that the bill removes incentives for health plans to negotiate fair terms. 

06:09:18 PM  

Dr. Anna Weyand, representing the Colorado Society of Anesthesiologists, spoke in opposition to the bill. She discussed arbitration and the proposed reimbursement benchmarks in the bill.    The committee asked questions and discussed how anesthesiologists are reimbursed. 

 

06:15:10 PM  

Dr. Stephen Altmin, representing himself as an emergency room physician, spoke in opposition to the bill. He discussed recruiting and access to care concerns. 

06:19:59 PM  

Paul Webster, representing Assured Neuro Monitoring, spoke in opposition to the bill. He discussed balance billing and warned that capping reimbursement will result in decreased neuro monitoring.

06:26:45 PM  

Bethany Pray, representing the Colorado Center on Law and Policy, spoke in support of the bill. She discussed how provider consolidation has resulted in higher prices. She addressed statements by previous witnesses about providers fleeing the state if the bill is enacted.  She answered questions from the committee about lower paid providers.

06:37:04 PM  

Kim Bimestefer, representing the Department of Health Care Policy & Financing, testified in support of the bill. She emphasized the important of aligning systems. 

06:52:21 PM  

Marc Reece, representing the Colorado Association of Health Plans, spoke in favor of the bill.  He discussed the impact of the bill, rates, billing, network adequacy, and fundamental market dynamics.  



06:52:35 PM
Motion Adopt amendment L.040
Moved Gardner
Seconded
Cooke
Gardner
Rodriguez
Gonzales
Lee
YES: 0   NO: 0   EXC: 0   ABS:  0   FINAL ACTION:  Pass Without Objection


07:06:51 PM
Motion Adopt amendment L.053
Moved Gardner
Seconded
Cooke
Gardner
Rodriguez
Gonzales
Lee
YES: 0   NO: 0   EXC: 0   ABS:  0   FINAL ACTION:  Pass Without Objection


07:07:57 PM
Motion Adopt amendment L.044
Moved Gardner
Seconded
Cooke
Gardner
Rodriguez
Gonzales
Lee
YES: 0   NO: 0   EXC: 0   ABS:  0   FINAL ACTION:  Pass Without Objection


07:08:35 PM
Motion Adopt amendment L.046
Moved Gardner
Seconded
Cooke
Gardner
Rodriguez
Gonzales
Lee
YES: 0   NO: 0   EXC: 0   ABS:  0   FINAL ACTION:  Pass Without Objection


07:10:21 PM
Motion Adopt amendment L.055
Moved Gardner
Seconded
Cooke
Gardner
Rodriguez
Gonzales
Lee
YES: 0   NO: 0   EXC: 0   ABS:  0   FINAL ACTION:  Pass Without Objection


07:11:56 PM
Motion Adopt amendment L.056
Moved Gardner
Seconded
Cooke
Gardner
Rodriguez
Gonzales
Lee
YES: 0   NO: 0   EXC: 0   ABS:  0   FINAL ACTION:  Pass Without Objection
07:11:57 PM  

Senator Pettersen made closing remarks and explained how the bill provides checks and balances for consumers in Colorado.

 

Senator Gardner made closing remarks and explained that the bill eliminates surprise billing.  He acknowledged the challenge of finding an appropriate benchmark. 



07:17:02 PM
Motion Refer House Bill 19-1174, as amended, to the Committee on Finance.
Moved Gardner
Seconded
Cooke No
Gardner Yes
Rodriguez Yes
Gonzales Yes
Lee Yes
Final YES: 4   NO: 1   EXC: 0   ABS:  0   FINAL ACTION:  PASS


07:17:19 PM   The committee adjourned.