H_HI_2021A 04/21/2021 01:31:04 PM Committee Summary

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 patient’s
  monthly household income;
• considering a
  patient’s bill paid in full after  36 months of payments;
• requiring health
  care facilities to post information on patient’s 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 patient’s 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 patient’s 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 patient’s 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).

The bill sponsor responded to questions from the committee.

Ms. Neswood responded
to questions from the committee.



Submitted written
testimony can be found in Attachment F.

Representative Jodeh provided closing comments on the bill.

Committee members made closing comments on the bill.

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.

The bill sponsor responded to questions from the committee.

Representative Lontine proceeded with witness testimony.

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.

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.

Mr. Jake Gillham, representing himself, testified in support of the bill. Mrs. Nita Gillham, representing herself, testified in support of the bill.

Ms. Huenink responded to questions from the committee.

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.

Representative Geitner provided closing comments on the bill.

Committee members made closing comments on the bill.

Committee comments on the bill continued.

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 PBM’s 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).

Representative Rich, bill co-sponsor, continued introducing the bill.

The sponsors responded to questions from the committee.

The sponsors responded to questions from the committee.

Mr. Blum and Mr.
Burdge continued to respond to committee questions.



Submitted written
testimony can be found in Attachment I.

The bill sponsors made closing comments on the bill.

Committee members made closing comments on the bill.

Representative Lontine provided closing comments on the bill.

Committee members provided closing comments on the bill.