These are all of the healthcare bills proposed in the 2019 session. Each bill has its own bill number, please use your browser search feature to find the bill you are interested in. Return to the Colorado home page to pick a different bill category.

None of the text is the opinion of Engage. Each bill's description, arguments for, and arguments against are our best effort at describing what each bill does, arguments for, and arguments against the bill. The long description is hidden by design, you can click on it to expand it if you want to read more detail about the bill. If you believe we are missing something, please contact us with your suggestion. Some of these bills have the notation that they have been sent to the chamber's "kill" committee. This means that the leadership has decided to send the bill to the State committee even though it does not belong there based on its subject matter. This committee, in both chambers, is stacked with members from "safe" districts and the idea is to kill the bill without forcing any less safe members to take a hard vote. It is possible for a bill to survive the kill committee, but it is very rare.

Prime sponsors are given after each bill, with Senate sponsors in () and House sponsors in []. They are color-coded by party.

Some bills will have text highlighted in pink or highlighted in orange. Pink highlights mean House amendments to the original bill; orange mean Senate amendments. The bill will say under the header if it has been amended.

Each bill has been given a "magnitude" category: Major, Medium, Minor, and Technical. This is a combination of the change the bill would create and the "controversy" level of the bill. Some minor bills that are extending current programs would be major changes if they were introducing something new, but the entire goal here is to allow you to better curate your time. Something uncontroversial likely to pass nearly unanimously that continues a past program may not be worth your time (and please remember, you can still read all of the minor bills!). Technical bills are here to round out the list. They are non-substantive changes.

House

Click on the House bill title to jump to its section:

MAJOR

HB19-1004: Proposal for Affordable Health Coverage Option PASSED AMENDED
HB19-1103: Protect Human Life at Conception KILLED IN HOUSE COMMITTEE
HB19-1168: State Innovation Waiver Reinsurance Program PASSED AMENDED
HB19-1174: Out-of-Network Health Care Services PASSED AMENDED
HB19-1193: Behavioral Health Supports for High-Risk Families PASSED
HB19-1216: Reduce Insulin Prices PASSED AMENDED

MEDIUM

HB19-1001: Hospital Transparency Measures to Analyze Efficacy SIGNED AMENDED
HB19-1010: Freestanding Emergency Departments Licensure PASSED
HB19-1019: Psychotherapists Continuing Competency Requirements KILLED ON HOUSE FLOOR
HB19-1038: Dental Services for Pregnant Women on Children's Basic Health Plan Plus SIGNED INTO LAW
HB19-1041: Require Surgical Smoke Protection Policies SIGNED INTO LAW
HB19-1077: Pharmacist Dispense Drug Without Prescription in Emergency SIGNED INTO LAW AMENDED
HB19-1095: Physician Assistants Supervision and Liability PASSED AMENDED
HB19-1120: Youth Mental Health Education and Suicide Prevention PASSED AMENDED
HB19-1131: Prescription Drug Cost Education PASSED AMENDED
HB19-1145: Primary Residence Exempt Liens for Medical Debt KILLED BY BILL SPONSORS
HB19-1154: Patient Choice of Pharmacy KILLED IN HOUSE COMMITTEE
HB19-1160: Mental Health Facility Pilot Program PASSED AMENDED
HB19-1176: Health Care Cost Savings Act of 2019 PASSED AMENDED
HB19-1211: Prior Authorization Requirements Health Care Service PASSED AMENDED
HB19-1233: Investments in Primary Care to Reduce Health Costs PASSED AMENDED
HB19-1237: Licensing Behavioral Health Entities PASSED AMENDED
HB19-1241: University of Colorado Training and Scholarships Rural Physicians KILLED ON HOUSE CALENDAR
HB19-1242: Board of Pharmacy Regulate Pharmacy Technicians PASSED AMENDED
HB19-1269: Mental Health Parity Insurance Medicaid PASSED AMENDED
HB19-1287: Treatment for Opioid & Substance Use Disorders PASSED AMENDED
HB19-1296: Prescription Drug Cost Reduction Measures KILLED ON HOUSE CALENDAR
HB19-1312: School Immunization Requirements KILLED ON SENATE CALENDAR

MINOR

HB19-1009: Substance Use Disorders Recovery PASSED AMENDED
HB19-1027: Clean Syringe Exchange Environmental Impact Report KILLED IN HOUSE COMMITTEE
HB19-1031: Child Patient More Than One Primary Caregiver PASSED AMENDED
HB19-1044: Advance Behavioral Health Orders Treatment SIGNED INTO LAW AMENDED
HB19-1065: Public Hospital Boards of Trustees SIGNED INTO LAW
HB19-1083: Athletic Trainers License SIGNED INTO LAW
HB19-1088 Modify Income Tax Credit Health Care Preceptors PASSED AMENDED
HB19-1105: Nurse Practitioner Workers' Compensation SIGNED INTO LAW
HB19-1109: Convalescent Centers as Pharmacies SIGNED INTO LAW
HB19-1122: Colorado Department of Public Health and Environment Maternal Mortality Review Committee PASSED AMENDED
HB19-1125: Mental Health Professional Access to Dismissed Complaint KILLED BY HOUSE COMMITTEE
HB19-1147: Revise Traumatic Brain Injury Program PASSED
HB19-1150: Recreate Consumer Insurance Council SIGNED INTO LAW
HB19-1169: Mental Health Involuntary Transportation Holds KILLED BY BILL SPONSORS
HB19-1183: Automated External Defibrillators in Public Places PASSED AMENDED
HB19-1208: Physical Therapists Youth Athletes Head Trauma SIGNED INTO LAW AMENDED
HB19-1253: Living Organ Donor Insurance PASSED AMENDED
HB19-1285: Denver Health Managed Care Organization Contracts with the Department of Health Care Policy and Financing PASSED
HB19-1301: Health Insurance for Breast Imaging PASSED AMENDED
HB19-1302: Cancer Treatment and License Plate Surcharge PASSED AMENDED
HB19-1320: Hospital Community Benefit Accountability PASSED AMENDED
HB19-1326: Rates for Senior Low-Income Dental Program PASSED

TECHNICAL

HB19-1070 Colorado Department of Public Health and Environment Cancer Drug Testing SIGNED INTO LAW

Senate

Click on the Senate bill title to jump to its section:

MAJOR

SB19-005: Import Prescription Drugs From Canada PASSED AMENDED
SB19-134: Out-of-Network Health Care Disclosures and Charges KILLED IN SENATE COMMITTEE

MEDIUM

SB19-001: Expand Medication-Assisted Treatment Pilot Program PASSED
SB19-008: Substance Use Disorder Treatment in Criminal Justice System PASSED AMENDED
SB19-010: Professional Behavioral Health Services for Schools PASSED
SB19-065: Peer Assistance Emergency Medical Service Provider PASSED AMENDED
SB19-079: Electronic Prescribing Controlled Substances SIGNED INTO LAW AMENDED
SB19-098: Cost-Based Reimbursement for Rural Hospitals KILLED BY BILL SPONSOR
SB19-110: Licensing Regulation Ambulatory Surgical Centers KILLED IN SENATE COMMITTEE
SB19-195: Child and Youth Behavioral Health System Enhancements PASSED AMENDED
SB19-222: Individuals at Risk of Institutionalization PASSED AMENDED
SB19-227: Harm Reduction Substance Use Disorders PASSED AMENDED
SB19-228: Prevention of Opioid and Other Substance Use PASSED AMENDED
SB19-238: Improve Wages and Accountability Home Care Workers PASSED AMENDED

MINOR

SB19-004: Address High-Cost Health Insurance Pilot Program PASSED HEAVILY AMENDED
SB19-015: Create Statewide Health Care Review Committee PASSED
SB19-041: Health Insurance Contract Carrier and Policyholder SIGNED INTO LAW AMENDED
SB19-052: Emergency Medical Service Provider Scope of Practice SIGNED INTO LAW AMENDED
SB19-073: Statewide System of Advance Medical Directives PASSED
SB19-133: Require License Practice Genetic Counseling PASSED AMENDED
SB19-145: Sunset Continue Dialysis Clinic and Technician Regulation PASSED
SB19-146: Sunset Home Care Agencies PASSED AMENDED
SB19-153: Sunset Podiatry Board PASSED AMENDED
SB19-154: Sunset License Regulate Psychiatric Technicians PASSED
SB19-164: Sunset In-Home Support Services Program PASSED AMENDED
SB19-193: Sunset Continue Colorado Medical Practice Act PASSED AMENDED
SB19-197: Continue Complementary or Alternative Medicine Program PASSED
SB19-219: Sunset Continue Licensing of Controlled Substances PASSED AMENDED
SB19-234: Sunset Professional Review Committees PASSED
SB19-242: Emergency Medical Service Providers Licensing PASSED

TECHNICAL

SB19-021: Board of Health Approval for Legal Services SIGNED INTO LAW
SB19-044: Colorado Department of Public Health and Environment Emergency Medical and Trauma Care System SIGNED INTO LAW
SB19-080: Colorado Department of Public Health and Environment Emergency Epidemic Preparedness SIGNED INTO LAW
SB19-081: Repeal Cancer Drug Repository Act SIGNED INTO LAW
SB19-082: Repeal Board of Health Authority over Colorado Department of Public Health and Environment Funds SIGNED INTO LAW

HB19-1001 Hospital Transparency Measures to Analyze Efficacy (Moreno, Rankin) [Kennedy]

AMENDED: Minor

SIGNED

Short Description:

Requires the department of health care policy and financing to prepare an annual report detailing uncompensated hospital costs and expenditures information by payer group.

Long description:

Requires the department of health care policy and financing to prepare an annual report detailing uncompensated hospital costs and expenditures information by payer group. Information includes: cost reports submitted to Medicare and Medicaid, audited financial statements, total unreimbursed care, gross patient revenue, property, plant and equipment and accumulated depreciation, operating expenses, staffing information, number of beds, number of inpatient surgeries, number of births, number of admissions from emergency department, other gross charges categorized by primary care provider. Information that is not publicly available is protected as trade secrets and will not be disseminated publicly. All hospitals included in the report have a minimum of 15 days to review the report and submit any clarifications or corrections. Some hospitals may be exempted by the state. These include: psychiatric hospitals, general hospitals certified as long-term care facilities, critical access hospitals that are licensed as general hospitals, and in-patient rehabilitation facilities.


Arguments For:

Getting a handle on our health care costs involves understanding where those costs are coming from, and one of the biggest cost centers is hospitals. Colorado hospitals are among the most profitable in the nation, the Denver Post recently reported that their prices have increased by 76% during a seven-year period. Clearly healthcare in hospitals is not an area where we want to encourage extreme profitability. This will allow us to have a better idea of not only what the landscape looks like, but if any changes are having an effect as we go forward.

Arguments Against:

This is too big an ask for hospitals, opening up their books for the government to examine and publicly parade around. If we allow hospitals to be a for-profit enterprise, then we have to accept that they are going to try to be profitable. A profitable hospital is one that can take chances on new expensive treatment options and provide the best care.

How Should Your Representatives Vote on HB19-1001

HB19-1004 Proposal for Affordable Health Coverage Option (Donovan) [Roberts, Catlin]

AMENDED: Minor

PASSED

Short Description:

Requires the state department of health care policy to develop a plan to implement a state public option for health care coverage and submit it to the general assembly. Plan must be done by 2020 session.

Requires the state department of health care policy to develop a plan to implement a state public option for health care coverage and submit it to the general assembly. Plan must be done by 2020 session. Department must consider provider rates necessary to provide quality health care delivery, eligibility criteria for individuals and small businesses, impact on state budget, impact on stability of individual and small group markets as well as Colorado exchange and other existing health programs, determine if plan should be part of exchange, determine what type of plan it should be (managed care, fee for service, fully at risk, accountable care collaboration, or combination), funding options including federal funds, need for federal waivers, and identify expected premium costs.


Arguments For:

Multiple regions in Colorado still struggle to obtain affordable, useful insurance. The useful clause there is important, low-cost mostly useless insurance doesn’t do anymore much good and is the system we had before the Affordable Care Act when bankruptcy from health care costs was considered a normal thing in this country. 14 counties have access to only one insurer through the state’s exchange. The federal government doesn’t seem like it is going to do anything to address this, so it is up to us. We therefore need to explore the feasibility of a public option and figure out exactly how it could work to deliver decreased premium costs to Coloradans, increase competition among insurers, and most importantly get more Coloradans insured which will lower health care costs for everyone by getting younger and healthier people into the system, increasing preventative medical care, and decreasing costly emergency room visits.

Arguments Against:

Getting costs down by getting more free market innovation into the space is the right way to go, not more government involvement. There is a reason why there are few insurers who want to provide coverage in these counties and that is because of the high cost of delivering health care in these areas. Thanks to the Affordable Care Act, these insurers cannot offer lower cost plans that do not cover as much, so everyone is stuck with high priced plans. Moving these individuals onto the state dollar won’t lower the cost of health care, it will just change who is paying for it to the taxpayers of the state of Colorado. While it is true that the bill does not implement anything on its own, it is going to be either a waste of time or the first step toward a road where our budget is choked by paying for increasingly large amounts of people’s health care.

How Should Your Representatives Vote on HB19-1004

HB19-1009 Substance Use Disorders Recovery (Priola) [Kennedy, Singer]

From the Opioid and Other Substance Use Disorders Study Committee

AMENDED: Minor

PASSED

Short Description:

Expands a currently existing housing voucher program to include those with substance use disorder, requires each recovery residence in the state to be licensed, and creates a recovery fund for money the state receives as settlement or damages from opioid-related litigation.

Long Description:

Takes the existing housing voucher program that assists those with a mental health disorder, or co-occurring behavioral health disorder transitioning from department of corrections or youth corrections and expands it. Adds substance use disorder as a qualifier and adds transitioning from mental health institute as well as someone who is homeless or in an unstable living environment and transitioning from residential treatment program. Adds $4.3 million dollars to fund this expansion. Requires recovery residence (which does not include private homes in which a related family member is required to receive services) to be licensed by the state. Creates a recovery fund with a defined governing board to manage any money the state receives as settlement or damages form opioid-related litigation.

Arguments For:

Part of breaking the cycle of substance use disorder is stable housing. Obviously substance use disorder should be included along with other mental and behavioral health issues as a qualifier for this program. Expanding it beyond just those transitioning for prisons to include residential treatment programs also makes sense. This is a very dangerous time for those with substance use disorders, when they are first on their own again and we need to make sure that they are in a stable environment to have the best chance at ongoing recovery. The basics are the same: help get stable housing for those who are the edge and need help.

Arguments Against:

This program is designed to help those with mental and behavioral health problems transition out of corrections. The more you move away from a program’s intention, the less likely it is to be effective. A program to help those with substance use disorder transition out of residential treatment is too different to be folded in here.

We should not tie the hands of future legislators by dictating where any potential opioid litigation funds go. We should trust that they will be put to good (and varied) uses when the time comes.

This program should not exist in the first place. Tax dollars should not be spent on helping people who have made their own bad choices in life obtain housing.

How Should Your Representatives Vote on HB19-1009

HB19-1010 Freestanding Emergency Departments Licensure [Mullica, Landgraf]

AMENDED: Technical

PASSED

Short Description:

Creates a new license specifically for freestanding emergency departments.

Long Description:

Creates a new license specifically for freestanding emergency departments. The bill leaves the details of the license up to the state board of health except for a requirement that each individual seeking treatment at the freestanding ER receive a medical screening and a prohibition against delaying the screening to inquire about the individual’s ability to pay or insurance status. Allows the department of public health to issue waivers for licensed community clinics or clinics that serves an underserved population in the state.

Arguments For:

Colorado is one of the top three states in the nation for the number of FSEDs in the state. They need their own licensure and we need to make sure that individuals who seek treatment are at least screened for emergency health needs before worrying about payment. Vesting the board of health with the actual construction, rather than using legislative fiat, also makes it more likely to be successful. Trust the experts.

Arguments Against:

Free-standing ERs can be suitably licensed under existing licensure options and don’t need their own special license.

The legislature needs to tackle the problems of free-standing ERs when it comes to price gauging or unnecessarily sending people to full emergency rooms. Any licensure of these facilities needs to address the problems people have with them, not leave it all up to the board of health.

How Should Your Representatives Vote on HB19-1010

HB19-1019 Psychotherapists Continuing Competency Requirements [Coleman]

AMENDED: Significant

KILLED ON HOUSE FLOOR

Short Description:

Establishes continuing professional competency requirements for registered psychotherapists, which mirror the requirements for social workers, marriage and family therapists, licensed professional counselors, and addiction counselors.Requires the state to set rules for minimum professional standards for becoming a registered psychotherapist and a continuing professional competency program for registered psychotherapists.

Long Description:

Establishes continuing professional competency requirements for registered psychotherapists, which mirror the requirements for social workers, marriage and family therapists, licensed professional counselors, and addiction counselors. These are set by the board of registered psychotherapists and must include, at a minimum: a self-assessment of the knowledge and skills of a registered psychotherapist, development, execution, and documentation of a learning plan based on the self-assessment, and periodic demonstration of knowledge and skills through documentation of activities necessary to ensure at least minimal ability to safely practice psychotherapy.n/a

Arguments For:

Currently registered psychotherapists are virtually unregulated, with anyone able to register and set out a shingle as a private practitioner. This will protect the public and ensure that anyone who uses the title registered psychotherapist has met some minimal requirements while stopping short of requiring licensure.

Arguments Against:

Most jobs in the field require some sort of licensure, so this will not affect the work agencies around the state are doing. Registered psychotherapists provide a useful service below the level of licensure and making them more like licensed therapists may close down this niche. The public and the market can sort out the charlatans from those who know what they are doing.

This may confuse some consumers who think that a registered psychotherapist is on a similar level as a licensed psychologist or social worker. People who are struggling with mental health issues may not be able to suss out that a registered psychotherapist doesn't have the training of a licensed professional. There is no baseline competency in this field, so it is impossible to have continuing education requirements.

How Should Your Representatives Vote on HB19-1019

HB19-1027 Clean Syringe Exchange Environmental Impact Report [Beckman]

KILLED IN HOUSE COMMITTEE

Short Description:

Requires any agency or nonprofit organization operating a clean syringe exchange program to submit an annual environmental impact mitigation plan to its county or district board of health.

Long Description:

Requires any agency or nonprofit organization operating a clean syringe exchange program to submit an annual environmental impact mitigation plan to its county or district board of health. The plan must include the number of syringes received and given, the plan to minimize the number of syringes near the exchange location that have not been disposed of safely, and the plan to minimize the environmental impact of any unsafe or improper syringe disposal.


Arguments For:

If we are going to have clean syringe exchange programs, we need to make sure that the collateral impacts to the communities around the exchange sites are minimized. These communities are not choosing to be hosts to the sites and any organization or agency that is intruding must make sure that they both actively seek to minimize the number of improperly disposed of syringes and the impact of any that slip through the cracks.

Arguments Against:

This is an unreasonable request to make of these facilities, to have some sort of control over the areas around them.

How Should Your Representatives Vote on HB19-1027

HB19-1031 Child Patient More Than One Primary Caregiver [Gray]

AMENDED: Technical

PASSED

Short Description:

Medical marijuana patients are limited to having one primary caregiver at a time. This bill makes an exception for minors and allows each parent or guardian to serve as a primary caregiver.

Long Description: n/a

Arguments For:

Both parents need to be able to make medical decisions for their child, sometimes one parent will be unavailable. This bill simply extends this common practice to medical marijuana.

Arguments Against:

Medical marijuana is far from a run of the mill treatment and in the case of a disagreement, one parent might have gotten marijuana to the child before the other can object through the legal avenues available in cases of parental disagreement.

How Should Your Representatives Vote on HB19-1031

HB19-1038 Dental Services for Pregnant Women on Children's Basic Health Plan Plus (Ginal, Story) [Duran, Lontine]

AMENDED: Technical

SIGNED INTO LAW

Short Description:

Requires dental services to be included for all pregnant women in the state’s child plan plus program (for children under 18 of families who earn too much to qualify for Medicaid but not enough to pay for private insurance as well as pregnant women 19 or over in the same situation). Previously was children only.

Long Description: n/a

Arguments For:

Nearly 900 women in this program do not have coverage for dental services. About 25% of pregnant women in Colorado overall lacked dental insurance in 2016. Pregnancy increases the risk of a number of oral health conditions and periodontal disease in pregnant women has been linked to adverse birth outcomes such as pre-term birth and low newborn birth weights. The bacteria associated with poor oral health can also pass from mother to child with the potential to cause dental caries in infancy and early childhood.

Arguments Against:

This program is designed to provide a floor for pregnant women and children, not to accommodate every potential health issue in pregnancy. The program now only covers children’s dental care and that is how it should stay.

How Should Your Representatives Vote on HB19-1038

HB19-1041 Require Surgical Smoke Protection Policies (Rodriguez) [Buckner]

SIGNED INTO LAW

Short Description:

Requires hospitals with surgical services to adopt a policy to prevent human exposure to surgical smoke (gas byproduct of energy-generating surgical devices). Also requires state department of health to create rules for surgical smoke.

Long Description: n/a

Arguments For:

Surgical smoke contains toxic chemicals including 16 that are listed as priority pollutants by the EPA and carcinogens. We need to make sure anyone in an operating room in protected. There’s absolutely no question that the smoke is irritating and can cause short-term illness (like nausea) and there is a debate over whether it causes much more serious long-term health risks with more study needed. Rather than waiting and continuing to expose people to what is at a minimum a nasty work environment and possibly much more, this bill acts now to protect the public.

Arguments Against:

The science here is early and still somewhat controversial. A review conducted by the British government found most published research on the topic was poor quality and larger longitudinal studies of OR nurses compares to other nurses have found no increased rates of cancer. Equipping all devices in operating rooms to capture the smoke will be very costly and we need a stronger foundation of evidence before taking a drastic step.

How Should Your Representatives Vote on HB19-1041

HB19-1044 Advance Behavioral Health Orders Treatment (Todd, Coram) [Kraft-Tharp, Landgraf]

AMENDED: Moderate

SIGNED INTO LAW

Short Description:

Allows for the creation of advance medical directives around behavioral health, which are treated in a similar manner to advanced directives around medical treatment. Orders are valid for two years and them must be renewed.

Long Description:

Allows for the creation of advance medical directives around behavioral health. These directives can mean the provision, withholding, or withdrawal of any behavioral health examination, service, procedure, or medication. The order must include identifying information, the adult’s instructions concerning treatment and secondary treatment, medication (including primary and alternative instructions), and instructions on appointing or not appointing an agent to act on their behalf. If they appoint an agent, the order must include the agent’s contact information and the scope of the agent’s authority to make decisions. Emergency medical personnel can ignore the order if they believe it will cause substantial harm to the adult. In this case they must make a good faith effort to consult with the adult's agent and propose an alternative form of treatment. The order also does not exempt the adult from an involuntary procedure of commitment pursuant to state law. Orders are valid for two years and them must be renewed.

Arguments For:

Adults with behavioral health disorders are in need of a consistent method for identifying and communicating critical behavioral health treatment history, decisions, and preferences that each sector of the health care community will recognize and follow. This will create better care for these individuals if they find themselves in a crisis and are unable to accurately convey their behavioral health treatment needs.

Arguments Against:

These directives can be created with no input from any medical personnel of any kind. This goes beyond life support and other such issues and into treatment and medicine preferences which are the arena of trained doctors. While most of these directives will no doubt be fashioned appropriately by an adult not in crisis who understands fully their treatment needs, the bill makes no provision to ensure this reality and it remains possible that some will be crafted by adults who are not in control of their behavioral health disorder and are not recording the treatment and medicine that will best help them in a crisis. This remains true with the substantial harm exemption. Mental health treatment and especially drugs are extremely complicated and the interactions can vary widely from person to person. It may not be apparent that something will cause substantial harm before it is administered. Because behavioral health disorders are different from end of life scenarios in how they can possibly impact others, we cannot allow this blank check with no medical oversight.

How Should Your Representatives Vote on HB19-1044

HB19-1065 Public Hospital Boards of Trustees (Rankin) [Soper]

SIGNED INTO LAW

Short Description:

Removes requirement that not more than 4 of 7 trustees of a public hospital board of trustees may be residents of the town or city where the hospital is located and creates exemption to the law that hospital boards require board of county commissioner approval to lease real and personal property. The exemption applies only for hospitals that have declared themselves enterprises.

Long Description: n/a

Arguments For:

When a county hospital decides to lease an MRI machine, right now they need the approval of county commissioners. If a hospital is run as an enterprise, the enterprise has financial oversight not the county, but they still have to ask the county for permission right now, so this change will help things work more easily. On the living requirements, it is an undue hindrance to force this many trustees into the town or city in a rural area of the state where you might have a hard time filling the board without reaching into the county.

Arguments Against:

While it might make sense to let enterprise boards worry about leasing an MRI machine, it might also make sense for the county board to be involved in leasing a building. This bill would remove that oversight over larger transactions.

How Should Your Representatives Vote on HB19-1065

HB19-1070 Colorado Department of Public Health and Environment Cancer Drug Testing (Tate) [Arndt] TECHNICAL BILL

From the Statutory Revision Committee

SIGNED INTO LAW

Short Description:

Repeals unnecessary language requiring department of public health and environment to test substances for cancer treatment.

Long Description: n/a

HB19-1077 Pharmacist Dispense Drug Without Prescription in Emergency (Tate, Pettersen) [Roberts]

AMENDED: Moderate

SIGNED INTO LAW

Short Description:

Allows a pharmacist to dispense an emergency supply of a chronic, non-opioid or similar controlled substance, maintenance drug to a patient without a prescription under certain conditions.

Long Description:

Allows a pharmacist to dispense an emergency supply of a chronic, non-opioid or similar controlled substance, maintenance drug to a patient without a prescription if the pharmacist is unable to obtain authorization to refill the prescription from a health care provider, has a record of the prescription in the patient’s name or withholding the drug will endanger the health of the patient in the pharmacist’s opinion, the amount dispensed will not exceed the amount of the most recent prescription, the pharmacist has not dispensed an emergency supply to the same patient in the previous year, and the prescriber of the drug has not indicated that no emergency refills are authorized.


Arguments For:

This is a narrowly constructed exception to the need for a prescription. It excludes opioids and similar addictive drugs, it requires the pharmacist to try to obtain an actual prescription and adhere to some basic checks and balances to prevent abuses. And it solves a problem: for some these drugs are a life and death matter and we cannot let an emergency situation fall through the cracks because of bureaucratic snafus. The bill is informally called Kevin's Law because it is named after Kevin, a type 1 diabetic who did not have access to emergency medication and died.

Arguments Against:

Any drug that requires a prescription requires it for a reason. Because we don’t want people taking it without the informed consent of a medical professional who has access to the entire medical picture of the patient. No offense to pharmacists, but they are not doctors and do not have a patient’s medical history. There may be other prescriptions the individual is taking the pharmacist is unaware of. And so if the pharmacist cannot get a health care provider to provide a prescription, there is probably a good reason. The bill also does not require pharmacists to check the state’s prescription drug monitoring program or make any new additions to that program for this distribution without a prescription. Just because the patient hasn’t sought the drug from this particular pharmacist without a prescription doesn’t mean they haven’t tried it with others.

How Should Your Representatives Vote on HB19-1077

HB19-1083 Athletic Trainers License (Williams, Cooke) [Hooton, Van Winkle]

AMENDED: Technical

SIGNED INTO LAW

Short Description:

Colorado trainers are currently classified as registered. This bill changes that status to licensure status, which grants them the ability to port their liability insurance across state lines.

Long Description: n/a

Arguments For:

Recent federal law change has clarified that the liability insurance follows the trainer, not the employer of the trainer. So this change allows our trainers to practice their profession in other states in case of malpractice incidents, as well as participate in interstate compacts. This does not at all change how trainers practice in state or their requirements for licensure. Everything else stays the same, just the trainers are more able to travel with their teams and give medical care without worry of lawsuits. This is a much cleaner way to help our trainers without messing around with liability laws. There is also an interstate compact that the national group of trainers is working on and Colorado trainers will need to be licensed in order to participate. 46 other states classify trainers as licensed, we should join them.

Arguments Against:

There are other ways to do this, make the liability insurance portable for trainers without having to change the registration status. Licensure should mean something beyond registration. There will be no board, no licensing fees, etc. People see licensed and think that means some form of extra knowledge. This bill forces no such extra knowledge on these trainers. Nothing will change, except the insurance question. The state division of regulatory agencies, which manages these things, is also not quite so sure that this is required to allow trainers to operate in other states. The interstate compact does not exist right now, if it ever does we can worry about it then.

How Should Your Representatives Vote on HB19-1083

HB19-1088 Modify Income Tax Credit Health Care Preceptors (Donovan) [Buck]

AMENDED: Technical

PASSED

Short Description:

Extends the income tax credit for health care preceptors in health professional shortage areas (an uncompensated mentor to eligible graduate students earning their professional degrees) to 2025 (set to expire in 2020) and clarifies that the four week minimum requirement refers to business days.

Long Description: n/a

Arguments For:

Finding professional training and instruction in rural areas of the state can be difficult, which is why this tax credit was created in 2016. It remains limited to 200 people per year.

Arguments Against:

Only 74 people claimed this credit in 2017. We should give it more time before making it permanent to make sure it is working.

How Should Your Representatives Vote on HB19-1088

HB19-1095 Physician Assistants Supervision and Liability (Fields) [Cutter, Landgraf]

AMENDED: Moderate

PASSED

Short Description:

Redefines the cut-off point for “new” and “experienced” physician assistants, which greatly changes the supervision required, from 1 year to 3 years. Also requires a practice agreement for experienced physician assistants. RemovesChanges the requirement that physicians have no more than 4 maximum number of physician assistants a physician to can supervise at a time from 4 to 8. To supervise more than 4 physician assistants at one time the licensed physician must directly assume the responsibility, it cannot just be assigned. Also adds two physician assistants to the state’s medical board and requires that one of the four members of the licensing committee be a physician’s assistant.

Long Description:

Redefines the cut-off point for “new” and “experienced” physician assistants from 1 year to 3 years. Does not change any of the hourly supervision requirements for new and experienced physician assistants. New physician assistants are required to be supervised for their first 160 hours by a physician who works at the same physical location, with 25% of those hours coming from the primary supervising physician. After the 160 hours are done the supervisor must complete an initial performance assessment and a supervisory plan (also not new). Experienced physician assistants do not require supervision but this bill adds the requirement of a practice agreement which sets out protocols for consultation.


Arguments For:

These supervisory requirements were drastically lowered last year by the regulatory agency in an attempt to make the state more physician assistant friendly (previous regulations of 1000 supervisory hours and first 500 charts reviewed were among the most draconian in the country), but in the process we’ve gone too far in the other direction. One year is not sufficient experience to consider a physician assistant experienced, as the law stands now after one year a physician assistant requires no supervision at all when starting a new job in the same field. Three years is enough time to have seen and done enough to be considered experienced enough to be entrusted with patient care by a new doctor who does not know the physician assistant’s work. The requirement to have no more than 4 assistants to supervise was a relic of the old regime when supervision was much more taxing and so can be safely removed. The fact that the physician assistant rules were unchanged for 35 years until last year shows that we need more physician assistant presence on the board and licensing committee.

Arguments Against:

The guidelines that the state changed to are not too permissive, compared to other states we are just fine. Physician assistants are a critical tool in bringing down health care costs as we transition more and more to a model where licensed physicians, whose time is extremely expensive, do not have to make every last decision when it comes to medical care. This is a proven model and physician assistants go through their own specialty schooling and testing before they see patients, and then those first 160 hours are supervised. Needed that supervision again, after a year of work in the field, is not only not necessary, it’s wasteful of the physician’s time and hostile to the physician assistant. We need more physician assistants in the state and this bill is a step in the wrong direction.

How Should Your Representatives Vote on HB19-1095

HB19-1103 Protect Human Life at Conception [Humphrey, Saine]

KILLED IN HOUSE COMMITTEE

Short Description:

Prohibits abortion except in cases of protecting the mother’s health. Makes it a class 1 felony for the doctor, no punishment for the mother.

Long Description: n/a

Arguments For:

Abortion is a nice way of saying killing an unborn fetus. Whether or not a fetus could live outside the womb is not really the issue, the issue is that the act kills it and ends a human life before it has even begun. In cases where the health of another human, the mother, is threatened, then of course the mother’s health must be protected. The constitutionality of abortion may change with the new composition of the Supreme Court, which is what decides what is or is not constitutional in our country.

Arguments Against:

This is the most deeply personal medical choice for any woman, and to be clear, it is a personal medical choice. Women have the right to make their own decisions about their bodies. A fetus is not a baby, there is a reason why we have separate terms for the two. Abortion is legal in this country (another issue with this bill, it is unconstitutional, full-stop) because we recognize that up to a certain point, a fetus is not a baby and moreover could not be a baby if outside of the mother’s body. We also know, for a fact, from our history that criminalizing abortion doesn’t end the practice, it merely moves it into the shadows and alleys where it becomes less safe. We also know that numerous anti-abortion advocates have been caught recommending abortions in cases where they personally would be affected, so the morality of the anti-choice movement seems to be at times situational. Finally, this contains no exception for rape or incest, forcing a woman to carry her abuser’s baby to full term and delivery.

How Should Your Representatives Vote on HB19-1103

HB19-1105 Nurse Practitioner Workers' Compensation (Marble, Winter) [Mullica, Saine]

AMENDED: Minor

SIGNED INTO LAW

Short Description:

Allows advance practice nurses with prescriptive authority to obtain level I accreditation for workers’ compensation. Level I allows the accreditation holder to provide primary care to the injured worker who loses more than three days from work.

Long Description: n/a

Arguments For:

Advance practice nurses who can prescribe mediation are more than able to provide this kind of care. A key component of lowering medical costs across our system is utilizing less expensive advance practice nurses where possible instead of very expensive physicians. Note that this accreditation is not automatically granted, it is a certificate that must be earned.

Arguments Against:

When it comes to the tricky area of workers’ compensation treatment we should stick with physicians.

How Should Your Representatives Vote on HB19-1105

HB19-1109 Convalescent Centers as Pharmacies (Pettersen, Tate) [Hooton, Larson]

AMENDED: Technical

SIGNED INTO LAW

Short Description:

Permits convalescent centers and hospices to operate a pharmacy.

Long Description: n/a

Arguments For:

Given the nature of convalescent centers and hospices, it makes sense to not force people to outside of the building to obtain prescription medication. Both are perfectly suited to the security requirements of prescription medication and have trained staff on-hand to assist. One of the ways we can lower our overall medical system costs is to avoid readmitting people into hospitals from convalescent centers. And a trained pharmacist on-site working with the staff can help.

Arguments Against: n/a

How Should Your Representatives Vote on HB19-1109

HB19-1120 Youth Mental Health Education and Suicide Prevention (Fenberg) [Michaelson Jenet, Roberts]

AMENDED: Moderate

PASSED

Short Description:

Lowers the age of consent for psychotherapy services from 15 to 12, except for a minor seeking inpatient services in which case it stays at 15. The provider of therapy services is encouraged to obtain the consent of the minor to speak to the minor’s parent or legal guardian. The provider is allowed to inform the parents of treatment if the provider feels the minor cannot manage their own care or treatment or if the minor is at imminent risk of harming themselves. The provider must document their reason for not notifying parent or legal guardian and also document any attempts to notify. The department of health is also required to create and maintain a mental health education and literacy resource bank, available to the public for free. Mandates the state board of education adopt standards that identify the knowledge and skills a K-12 teacher should acquire related to mental health, including suicide prevention.

Long Description:

Lowers the age of consent for psychotherapy services from 15 to 12, except for a minor seeking inpatient services in which case it stays at 15. The provider of therapy services is encouraged to obtain the consent of the minor to speak to the minor’s parent or legal guardian. The provider is allowed to inform the parents of treatment if the provider feels the minor cannot manage their own care or treatment or if the minor is at imminent risk of harming themselves. The provider must document their reason for not notifying parent or legal guardian and also document any attempts to notify. The department of health is also required to create and maintain, in consultation with the office of suicide prevention and the state youth advisory council, a mental health education and literacy resource bank, containing evidence-based, research-based, and promising program materials and curricula pertaining to mental health, available to the public for free. The bank must be youth-friendly, culturally sensitive, and available in both English and Spanish. Mandates the state board of education adopt standards that identify the knowledge and skills a K-12 teacher should acquire related to mental health, including suicide prevention.


Arguments For:

Suicide is the leading cause of death for Colorado youth between the ages of 10 and 14 and the state has the 10th highest suicide rate in the nation. The ability for a teen to seek mental health guidance without a parent’s permission could be the critical difference for a child who is unable to talk to his or her parents, for instance in a case where a gay or lesbian 12 year-old cannot come out to their parents and needs help. Lives are literally on the line. Unfortunately we cannot always choose who a teen will or will not feel comfortable opening up to, so it is critical that the training that can save lives is spread as broadly as possible which includes teachers. Finally, a centralized repository of knowledge can help ensure that best practices reach as widely as possible.

Arguments Against:

Lowering the age of consent may prevent parents and caregivers from being involved in treatment, which would decrease the effectiveness of the treatment. If a school-based person or therapist is having a hard time getting consent for treatment from a parent that is a neglect issue and is probably indicative of other more significant problems in their child’s life.

How Should Your Representatives Vote on HB19-1120

HB19-1122 Colorado Department of Public Health and Environment Maternal Mortality Review Committee (Gardner, Fields) [Buckner, Landgraf]

AMENDED: Minor

PASSED

Short Description:

Creates a maternal mortality review committee, which reviews maternal deaths, identifies the causes, and develops recommendations to prevent future deaths. The state’s chief medical officer is delegated to appoint the committee, but given guidelines to follow to make it representative of the state and medical specializations.

Long Description: n/a

Arguments For:

Colorado’s maternal mortality rate nearly doubled between 2008 and 2013 and 80% are considered preventable. This is absolutely unacceptable. The department of public health as a committee of volunteers reviewing deaths since 1993 but their capacity is limited by lack of protection, funding, and authority. 41 other states and the District of Columbia have similar committees. It’s past time for Colorado to join them. We can of course still institute best practices from other states in the meantime, but the laws and regulations of every state are unique and thus the problems and solutions can be too.

Arguments Against:

Instead of forming our own committee, Colorado should look to these other states and implement the best practices they have uncovered. Every state is certainly unique, but Colorado is not such a special flower that we cannot learn from other states with similar populations and geography. Waiting to review deaths will result in more deaths while we uncover the way forward.

How Should Your Representatives Vote on HB19-1122

HB19-1125 Mental Health Professional Access to Dismissed Complaint [Melton]

AMENDED: Minor

KILLED BY HOUSE COMMITTEE

Short Description:

Currently, when a complaint against a mental health professional is dismissed, information contained in the files of the regulatory board is exempt from disclosure under public records law. This bill allows the mental health professional who was the subject of the complaint to access this information but the name of the respondent’s clients or other recipients of service and any other information that would identify an individual, including any potential witnesses, must be redacted.

Long Description: n/a

Arguments For:

This gives mental health professionals greater insight into why a complaint was brought against them without betraying the identity of the complainant and creating a chilling effect on complaints.

Arguments Against:

The mental health professional may be able to figure out who the complainant is from the details of the complaint, unless the entire thing is redacted and then there’s no point to the bill. This could led to retaliation from the mental health provider. Particularly in the field of mental health, that is a concern too big to allow.

How Should Your Representatives Vote on HB19-1125

HB19-1131 Prescription Drug Cost Education (Winter) [Jaquez Lewis]

AMENDED: Significant

PASSED

Short Description:

Requires prescription drug wholesalers and their sales agents to provide the wholesale drug price in writing whenever they share information about the drug are attempting to sell the drug and to provide educational materials about the cost of at least three other prescription generic drugs in the same therapeutic class..

Long Description: n/a

Arguments For:

Prescription drug costs are skyrocketing in this country and a prime driver of our overall increasing healthcare costs. This bill is all about sunshine and it is very simple: no hiding your price, or the price of you competitors, when you try to sell your drug to doctors and pharmacies. In an ideal world, of course, these doctors and pharmacists would be perfect consumers who researched all of their options and were well aware of all of the pricing. But that is not our world and is this too important to the citizens of this state.

Arguments Against:

This could be a crippling mandate for any business. Imagine, anytime you discuss the drug with anyone go on a sales call, you have to provide them the price in writing and you have to tell them all of your competitors prices too, which of course means that not only do you have to know all of this information at all times, you have to constantly print new materials whenever new prices (yours or someone else’s) pop-up. It is virtually unheard of to force a business to provide its competitors’ prices when selling its goods (some businesses of course do this voluntarily). And they are not selling to some clueless consumer who we cannot expect to be an expert. This is wholesale, so we are talking about doctors and pharmacists. This is their job and we should expect them to be informed purchasers and prescribers. This bill has been declawed and now does not provide the vital information about potential alternatives and their prices. It will not do enough to lower our prices.

How Should Your Representatives Vote on HB19-1131

HB19-1145 Primary Residence Exempt Liens for Medical Debt [Tipper, Jaquez Lewis]

KILLED BY BILL SPONSOR

Short Description:

Prohibits the placing of a lien on someone’s primary residence for a medical debt.

Long Description: n/a

Arguments For:

This is sadly a common practice. One Colorado company, collecting for a small group of surgeons, has placed more than 170 liens on Denver-area homes since the start of 2017. Liens have been placed on the homes of patients who have received care in at least eight Denver-area hospitals. This is happening to people with insurance, without insurance, it is still a problem in Colorado, with almost 750,000 Coloradans reporting struggling to pay medical bills in 2017, and until we get medical debt under control, no one should lose their house over it.

Arguments Against:

While it always sad when someone falls into such steep debt that they cannot pay the money they owe, the fact is that the money is owed and the creditor has to be able to get it back. Excluded medical debt will not just vanish into thin air, it will come out of the pocket of everyone who is paying their medical bills in the form of increased cost. In addition, the spotlight on liens on homes was brought about by an unrelated problem: out-of-network surgeons who don’t actually work at a hospital levying huge bills on unsuspecting patients. That is an entirely separate problem and should be solved at its core, not by fixing the after-effects.

How Should Your Representatives Vote on HB19-1145

HB19-1147 Revise Traumatic Brain Injury Program (Lee) [Snyder]

PASSED

Short Description:

Updates the state’s brain injury program, designed to improve the lives of Coloradans who have suffered severe brain injuries, by removing the word “trauma” and “traumatic” from the program, redefining qualifying injuries, and increasing the traffic ticket penalties that fund the program.

Long Description: n/a

Arguments For:

The old definition was far too narrow and required partial or total disability without much further elucidation. The new one is broader, in removing trauma and in not caring about how the injury was sustained so long as it was post-birth and non-hereditary. It also allows for a wider range of impairments. Updating the traffic ticket penalties is just keeping up with inflation. They have not been adjusted in a while.

Arguments Against: n/a

How Should Your Representatives Vote on HB19-1147

HB19-1150 Recreate Consumer Insurance Council (Danielson) [Titone]

AMENDED: Technical

SIGNED INTO LAW

Short Description:

Recreates the Consumer Insurance Council, which existed from 2008 to 2018 but was sunsetted last year when a bill extending the council failed in a Senate committee. The council is an advisory body to the commissioner of insurance and can submit recommendations to the commissioner.

Long Description:

Recreates the Consumer Insurance Council, which existed from 2008 to 2018 but was sunsetted last year when a bill extending the council failed in a Senate committee. The council is an advisory body to the commissioner of insurance and can submit recommendations to the commissioner. Changes to the council from its previous setup include: no ability to issue consumer’s choice awards to health insurers, membership of the council directed to be more representative of the entire state and consumers not engaged in the insurance industry can sit on the council, members to be reimbursed for expenses, and the authorization to submit recommendations the commissioner already discussed.


Arguments For:

Insurance is one of the most critical issues to a lot of Coloradans and having a council dedicated to it under the commissioner is a helpful way of bringing these issues to forefront. The council’s meetings are open to the public and directed to be held around the state. It never should have been allowed to expire last year and now we can fix that.

Arguments Against:

This was sunsetted on the recommendation of the department of regulatory agencies, which reviews all upcoming sunsets, because it found that the council had not made many recommendations in the 18 month time period it was studied (amongst other issues). Legislators agreed last year in a bipartisan manner: this council didn’t do enough when it existed to warrant it continuing. What was true last year is still true this year.

How Should Your Representatives Vote on HB19-1150

HB19-1154 Patient Choice of Pharmacy (Danielson, Coram) [Catlin, Mullica]

KILLED IN HOUSE COMMITTEE

Short Description:

Prohibits health insurance carriers that offer prescription drug coverage from restricting the ability of the covered individual to use the pharmacy or pharmacist of their choice, impose any fees or cost-sharing requirements for selecting a particular pharmacy, imposing any other conditions on this, or denying a pharmacy or pharmacist the right to participate in any network contracts if the they agree to the network conditions. All of these requirements do not apply to pharmacies that are owned by the health insurance carrier or those in managed care programs and do require the pharmacy or pharmacist to have agreed to the contract terms of the carrier.

Long Description: n/a

Arguments For:

People should have the right to choose the pharmacy of their choice and not be boxed by any side deals or other inducements insurance carriers have with pharmacies. It is not only a matter of convenience it is also a matter of competition in an increasingly consolidating pharmacy/healthcare industry where patients are forced to use mail-order drugs. The bill makes the reasonable exemption for plans where the entire point is that everything is done in concert under one system (managed care) or where the carrier and pharmacy are owned by the same entity. A version of the bill already exists in 27 other states and is not causing problems there.

Arguments Against:

This is an unreasonable restriction on the ability for insurance carriers and pharmacies to work together to provide the best benefits to consumers. We always jump to negative conclusions about such things, but carriers may know from experience in working in the field that some pharmacies are simply better (either service or cost or both) or that mail order drugs are the best way to serve customers at the lowest price. This bill makes it impossible for carriers to prioritize these pharmacies or methods to the consumer and may raise prices since carriers cannot give lower prices for online or mail order pharmacies. That version of this bill is unique, it does not exist in other states.

How Should Your Representatives Vote on HB19-1154

HB19-1160 Mental Health Facility Pilot Program (Gardner) [Landgraf, Singer]

AMENDED: Significant

PASSED

Short Description:

Creates a pilot program for a new type of license for behavioral health facilities to provide residential care, treatment, and services to people with both either a behavioral health diagnosis and a physical health diagnosis.

Long Description:

Creates a 3 year pilot program for a new type of license for behavioral health facilities to provide residential care, treatment, and services to people with both either a behavioral health diagnosis and a physical health diagnosis. To be eligible for this license, facilities must be able to serve people with both physical and behavioral health diagnosis; offer secure staff environments; have the capability to provide integrated services with community medical and behavioral health providers; have sufficient staffing levels of licensed nurses, nursing assistants, and occupational and recreational professionals; have a partnership with either an acute care hospital or psychiatric hospital and with a skilled nursing facility; in a community that the resources to support engagement to move an individual to less restrictive environments as they progress; and is able to contribute 1/3 of the increased costs of the pilot program and has an identified source for the other 2/3. Two facilities will be picked for the program.


Arguments For:

There are people with significant physical or mental health needs who often get care in expensive acute care facilities, often at the expense of state taxpayers. In addition, this kind of facility is often not the best place for an individual to progress toward reintegrating into the community and transitioning to living on their own. This bill aims to test out facilities that can both treat these patients at a lower expense level and better prepare them to live on their own.

Arguments Against:

This is a heavy ask for these facilities, to in effect eat 1/3 of the increased costs of this program and find someone else to eat the other 2/3. Of course we want to save the state money, but perhaps this goes too far by trying offload too much of the cost away from the state.

How Should Your Representatives Vote on HB19-1160

HB19-1168 State Innovation Waiver Reinsurance Program (Donovan, Rankin) [McCluskie, Rich]

AMENDED: Very Significant

PASSED

Short Description:

Authorizes the state insurance commissioner to apply to the federal department of health and human services for authorization to use federal funds for a state reinsurance program to assist health insurers in paying high-cost insurance claims. Paid for by hospital costs that go over "attachment" point defined by state. Paid for by fees assessed on hospitals to meet claim reduction cost targets. Paid for by taking $15 million in year one, $40 million in year two, and then an unspecified amount of funds all taken from HB1245, which took sales tax processing rebates away from companies and was putting all of the money toward affordable housing. Additional fees will come from hospitals, but maximum of around $30 million per year.

Long Description:

Authorizes the state insurance commissioner to apply to the federal department of health and human services for authorization to use federal funds for a state reinsurance program to assist health insurers in paying high-cost insurance claims. The program is exempt from TABOR limits on revenues and can only be adopted if the federal government approves.  The program is designed to reimburse insurers to achieve a 30-35% reduction in claims costs in geographic regions in the state where average premiums are highest, a reduction of 20-25% in geographic regions where average premiums are higher, and a 15-20% reduction in claims costs in the rest of the state. The program is to be funded by federal funds made available from the premium reduction the program will create and savings from lowered costs in the state’s healthcare system. It uses a fee schedule created by the state that is required to take into consideration remote facilities whose ability to operate may be harmed and thus may need exemptions from the fee schedule. Hospitals that are not exempt and go over the fee schedule send those overcharges to the reinsurance fund. by a special fee assessed on hospitals. The fee amount is to be determined by commissioner of insurance to meet claim reduction goals but cannot exceed $150 million per year or $500 million over five years. No hospital system may be responsible for more than 25% of the total collected. Commissioner is to determine exemptions and must consider following factors: hospitals with less than 50 beds; in extreme rural areas; hospital affiliated with network of hospitals; hospital with negative net income; if hospital is critical access; if hospital has high amount of uncompensated care; if hospital has high number of Medicaid or Medicare patients. Paid for by taking $15 million in year one, $40 million in year two, and then an unspecified amount of funds all taken from HB1245, which took sales tax processing rebates away from companies and was putting all of the money toward affordable housing. Additional fees will come from hospitals, but maximum of around $30 million per year.


Arguments For:

The federal reinsurance program that was part of the Affordable Care Act died in Washington in 2017. It is a standard part of large federal health programs to help keep premiums affordable. Part of the ACA also prohibits insurance companies from using less than 80% of the premiums paid (or 85% for large group policies) on medical costs. So any additional money going to the insurance companies here is doing one thing: keeping premium costs down. The federal government was estimated to pay $3.3 billion in this program in 2016. Alaska, Oregon and Minnesota have already successfully obtained waivers to continue state versions of the program. We have discovered recently that hospitals in the state are raking in profits. It seems only fair that the biggest driver of our health costs contributes to lowering premiums. The unclaimed property fund should provide a strong base to fund this program, buttressed by fees assessed on the biggest drivers of health care costs in the state: hospitals. We cannot take more out of the hospitals due to federal law.

Arguments Against:

We don’t need more insurance company bailouts, they are already highly profitable middlemen sucking money out of our health care system. If premiums are too high, we should be attacking them by addressing insurance company practices, not simply handing the companies more money so they will lower the premiums. The bill also believes these extra costs (hundreds of millions of dollars) will be paid for in part by less spending by the state from savings in the health care system. There is no guarantee that will materialize and if it doesn't, we will be on the hook. In addition, this bill requires a fee schedule that may squeeze hospitals and cause havoc in our system. Price fixing doesn't belong in our healthcare system.So much for putting millions into affordable housing, and this is a very thin and potentially unsustainable branch to put this program on. The unclaimed property fund and the cap on the limits of fees placed on hospitals could put us on the hook for a ton of money from the general fund to keep this program going.

How Should Your Representatives Vote on HB19-1168

HB19-1169 Mental Health Involuntary Transportation Holds (Cooke) [Arndt]

KILLED BY BILL SPONSORS

Short Description:

Clarifies that a person being transported to a treatment facility by an intervening professional worried about physical or psychiatric harm to the person or others remains in an involuntary hold until they are evaluated.

Long Description: n/a

Arguments For:

Closes a loophole in the law whereby the hold expired when the person was delivered to the facility. Obviously we need to do the evaluation first.

Arguments Against:

Keeping someone in a facility against their will is serious business and if they were transported there by someone concerned about their welfare, that may not rise to the level of holding them against their will if the individual decides they want to leave.

How Should Your Representatives Vote on HB19-1169

HB19-1174 Out-of-Network Health Care Services (Gardner, Pettersen) [Esgar, Catlin]

AMENDED: Moderate

PASSED

Short Description:

Establishes that people who receive emergency care at an out-of-network facility or any care at an in-network facility from an out-of-network provider, are not responsible for any additional costs due to the care being out-of-network. Individuals will still be responsible for any relevant in-network copays, deductibles, and co-insurance. The out-of-network facility or provider is to bill the insurance carrier directly, at rates established by the bill. Any accidental overbilling is to be reimbursed to the individual within 60 days that the overpayment was reported. Failure to do so starts earning a 10% annual interest penalty. Bill also directs commissioner of insurance and other state agencies to create rules for disclosure of out-of-network care to consumers.

Long Description:

Establishes that people who receive emergency care at an out-of-network facility or any care at an in-network facility from an out-of-network provider, are not responsible for any additional costs due to the care being out-of-network. Individuals will still be responsible for any relevant in-network copays, deductibles, and co-insurance. The out-of-network facility or provider is to bill the insurance carrier directly. The rate is the greater of: 105% of the carrier’s average in-network rate for the service in the same geographic area, 125% of the Medicare reimbursement rate, or 100% of the median in-network reimbursement for all of the same service provided in the previous year. The carrier and out-of-network provider are free to negotiate a different rate. Denver Health facilities have different rates: greater of carrier's in-network median rate of reimbursement, 200% of the Medicare reimbursement, or median rate of reimbursement for all of the same service. Insurers can appeal to an arbiter, and both parties submit their belief on the payment amount. Arbiter picks one, loser pays cost of arbitration. Any accidental overbilling is to be reimbursed to the individual within 60 days that the overpayment was reported. Failure to do so starts earning a 10% annual interest penalty. Bill also directs commissioner of insurance and other state agencies to create rules for disclosure of out-of-network care to consumers.


Arguments For:

Surprise! medical billing needs to be thing of the past. We cannot ask people to pick and choose between in- and out-of-network facilities in an emergency, and we are seeing far too many examples of people having a procedure done in-network who were completely unaware that the actual doctor was out-of-network and then get hit with a medical bill in the tens of thousands of dollars. These out-of-network doctors then get their collections agencies to go after people’s assets for repayment. One Colorado company, collecting for a small group of surgeons, has placed more than 170 liens on Denver-area homes since the start of 2017. Liens have been placed on the homes of patients who have received care in at least eight Denver-area hospitals. The system this bill creates allows everyone to know what they are getting into beforehand, doctors understand what sort of compensation they will be receiving, insurers know that they may be on the hook for out-of-network care in these circumstances, and most importantly, consumers know exactly what they will be paying.

Arguments Against:

More transparency is always a good thing, people should know if they are going to be utilizing an out-of-network service and, if possible, have the opportunity to switch to in-network. In emergencies this can be more difficult but it is not impossible in many cases. It absolutely should be possible in the case of non-emergency care. This bill does not allow for an informed choice by a patient: if they know they are trying to get out-of-network care when an in-network option is available at the same facility, that provider should not be penalized. The patient made an informed choice.

We should not be fixing health care prices. This could be devastating to out-of-network doctors, who rely on the fees that they charge in order to practice. If they are too restricted, they may not agree to perform services at all on people who are out-of-network, which could cause problems for patients receiving quality care. As for emergency services, the added costs to our insurance providers aren’t going to be eaten by them. They will be passed on to the rest of us in the form of higher premiums.

How Should Your Representatives Vote on HB19-1174

HB19-1176 Health Care Cost Savings Act of 2019 (Foote) [Sirota, Jaquez Lewis]

AMENDED: Moderate

PASSED

Goal: To study four different methods of health care delivery to see if we can lower costs for Coloradans.

Short Description:

Creates a health care cost analysis task force that is to select an analyst to do an in-depth cost and financing analysis of our current health care system, a public option system, a multi-payer universal health care system where the government pays some of the insurance cost and a direct compensation from the government system that excludes private insurance completely.

Long Description:

Creates a health care cost analysis task force that is to select an analyst to do an in-depth cost and financing analysis of our current health care system, a public option system, a multi-payer universal health care system where the government pays some of the insurance cost, and a direct compensation from the government system that excludes private insurance completely.

The task force is composed of 8 legislators chosen equally by both parties, 9 people appointed by the governor, the three executive directors of state agencies related to health care.

The analyst must consult with licensed medical professionals and other health care providers, mental health providers and advocates, health care education organizations, people with disabilities and their advocates, patient advocates, representatives of underserved and rural populations, faith-based organizations, and employees and employer organizations.

For each alternative the analyst must consider: 1st, 2nd, 5th, and 10th year costs; compensation for health care providers that will attract and keep necessary health care workers; benefits for Coloradans living out-of-state; number of under and uninsured and at-risk individuals; health expenditures by payer; out-of-pocket costs for patients; Medicare and Medicaid services; women’s health services; vision, hearing, and dental; access to primary care in rural and underserved areas; behavioral, mental health, and substance use disorder coverage; and the collateral costs to society. These are defined as: cost of emergency care and other alternatives to primary care or preventative medicine; effects on jobs and employment for those with chronic conditions; cost of medical bankruptcy and severe financial hardship due to medical costs; any other collateral costs.

Analyst must consider at least four funding options for each alternative: general fund; federal waivers; progressive income taxes; payroll taxes split between employee and employer; other taxes; premiums based on income.


Arguments For:

There are approximately 350,000 Coloradans without health insurance and 850,000 who have insurance with nearly unaffordable out-of-pocket expenses. Coloradans still go bankrupt every year from medical bills, and there is still no end in sight. Costs continue to rise, rural areas of the state continue to have it the worst, and we still are messing around at the edges, hoping the federal government or something else will bail us out. We need to explore our own options and find out if there is one that will lower costs for all Coloradans while continuing to provide quality medical care. In short, we need data and that is what this bill will provide.

Arguments Against:

This is a waste of time. We know the answers, because this is one of the most studied area in the entire country. Other states have explored each of these alternatives and other states have found, without exception, that is not possible to have a system of insurance and medical care that is completely different from the system in the rest of the United States and is not underwritten to a large degree by the federal government. TABOR prevents the state from any progressive taxation and puts an upper bound on the amount of revenue the state can collect, so there is no point in looking at solutions involving taxation that falls under the purview of TABOR unless those provisions are removed from the state constitution.

This bill stacks the deck in favor of left-wing solutions to our health care problems. Each of the alternatives to our present system involves more government involvement. If we are going to examine our options, at least one should be less government involvement and more freedom in the health care marketplace.

How Should Your Representatives Vote on HB19-1176

HB19-1183 Automated External Defibrillators in Public Places [Roberts]

AMENDED: Minor

PASSED

Goal: To increase the number of automated external defibrillators in public places.

Short Description:

Encourages any public school or any public place (holds more than 100 people and public invited or permitted) to place functional automated external defibrillators in sufficient numbers to ensure reasonable availability in an emergency.

  • Funds $75,000 to go to a nonprofit to acquire and place them.
  • Encourages public schools to accept gifts, grants, and donations to achieve this.
  • Holds anyone who is not primarily in the health care provider industry harmless from civil damages from using or not using the machine in an emergency unless they were negligent or willfull and wanton.

Long Description: n/a

Arguments For:

We all know that every second is critical when someone is having a heart attack and not having to wait for trained personnel can save lives. You don’t need to be trained in CPR in order to use these devices, which greatly increases the chances of any person successfully helping someone in need.

Arguments Against:

First, we don’t need to place life and death burdens on people who are not trained for them. Obviously they won’t be sued, but the mental toll of trying and failing to save someone’s life is not an easy burden to bear.

This bill does not go far enough to achieve its goal. A very small amount of money and some encouragement aren’t going to cut it.

How Should Your Representatives Vote on HB19-1183

HB19-1193 Behavioral Health Supports for High-risk Families (Garcia) [Herod, Pelton]

PASSED

Goal: To provide more support for pregnant and recently pregnant women who need substance use disorder treatment, including trying to keep families together as much as possible.

Description:

  • Adds women who are less than one year removed from giving birth, defined as parenting women, to multiple programs that assist pregnant women who are in need of substance use disorder treatment.
  • Encourages providers and the state to identify these women and refer them to approved treatment facilities as well try to reduce the likelihood of out-of-home placement of children.
  • Authorizes use of state money for residential substance use disorder treatment for pregnant and parenting women until this becomes covered by Medicaid and authorizes state to try to seek federal changes to permit this authorization.
  • Creates a high-risk families cash fund to provide services to high-risk parents and children with behavioral health disorders. Fund money is to be used to contract with providers to increase treatment capacity or to provide substance use disorder services to families.
  • Creates a child care services pilot program to increase child care services available for pregnant or parenting women seeking or participating in substance use disorder treatment. $500,000 is appropriated annually through 2021-22 fiscal year for the program.
  • Bans the use of information relating to substance use disorder in criminal proceedings that is obtained as part of proving postpartum care up to one year postpartum or disclosed while women are seeking or participating in substance use disorder treatment. This ban already exists for pregnant women’s pregnancy or prenatal care.

Additional Details:

  • The state may continue to use state funds for residential treatment if the parenting woman qualifies as indigent but is not eligible for services under Medicaid. These facilities must allow a woman to begin treatment without providing up-to-date medical records for her child. These must be provided within 30 days.
  • The high-risk families cash fund keeps its unexpended money at the end of a fiscal year.
  • Child care service program grants are to be allocated as follows:
    • Enhance existing child care resource and referral programs in one rural and one urban site for pregnant and parenting women seeking or participating in substance use disorder treatment.
    • A regional mobile child care model to serve young children of parenting women in substance use disorder treatment. This must be a public-private partnership.
    • Increase the capacity of the existing child care resource and referral program’s centralized call center to serve pregnant and parenting women seeking or participating in substance use disorder treatment


Arguments For:

Our current paradigm of supporting women around childbirth and substance use disorder fails by stopping at birth. Substance use disorder treatment that supports the family as a unit has been proven to be effective in maintaining drug abstinence and child well-being. But there are few intensive treatment options that allow children to remain in their mother’s care. One such program in the state has a waiting list of 8-12 weeks. In all, only 3.3% of outpatient substance use disorder treatment facilities in the state provide childcare. The period right after birth is a critical time: the overdose risk is highest at 7-12 months postpartum and overdose is one of three leading causes of maternal mortality in the state. We therefore need to do better in constructing treatment capacity that both addresses postpartum women and keeps families together to the extent possible. That is what this bill does, both by simply adding one year postpartum women to a list of services already provided to pregnant women and by multiple approaches to keep babies with their mothers while the mother seeks treatment. It is more than one life on the line here.

Arguments Against:

We’re flushing a lot of money and resources down the drain of drug addicts who can’t get their lives together. While it is undeniably tragic, there are plenty of life choices people make that are tragic that do not get millions of dollars of state resources thrown at them. And yes, we have innocents here, the children. Some families should not be together, at least while the mother is getting her act straight. If the mother can successfully kick her addiction, then we can think about putting the family back together.

How Should Your Representatives Vote on HB19-1193

HB19-1208 Physical Therapists Youth Athletes Head Trauma (Fields, Gardner) [Singer, Landgraf]

AMENDED: Moderate

SIGNED INTO LAW

Goal: To allow licensed physical therapists to clear youth athletes for return to team activities after a suspected concussion.

Description:

Adds licensed physical therapists who have training in neurology or concussion evaluation and management to the list of medical personnel who can clear a youth athlete for return to team activities after a suspected concussion.

Additional Information: n/a

Arguments For:

Licensed physical therapists are just as likely (if not more likely) to be trained in concussion management as a regular doctor. Doctors receive enormous general training, but many have no specialized knowledge of concussions and the brain. We already aren’t requiring kids to go to neurological specialists, so we should not pretend that right now kids are always seeing someone who has expertise in the brain. It is appropriate that they be added to this list and 25 other states have already done so.

Arguments Against:

Concussions are extremely tricky, as many things with the brain are, and it is too much to ask of physical therapists, who do not have the extensive medical training that doctors do, to make these calls. This is particularly true to the extreme seriousness of concussions, the greatly increased danger to an individual while they are still recovering from a concussion, and the likelihood of greater future trauma. Current law is also setup to be hard on purpose: the delay required in seeing a doctor can be a delay that helps keep a kid out of danger for a longer period of time.

How Should Your Representatives Vote on HB19-1208

HB19-1211 Prior Authorization Requirements Health Care Service (Williams) [Michaelson Jenet]

AMENDED: Moderate

PASSED

Goal: To clarify and lessen the usage of prior authorization for medical procedures by insurance companies.

Description:

Requires insurance carriers to publish and update their prior authorization requirements and restrictions, use clinically-based criteria that are aligned with other quality initiatives of the carrier to evaluate requests, comply with the short deadlines established in the bill to make a ruling on a prior authorization request, limit the use of prior authorization to providers who care patterns differ significantly from their peers, and exempt from prior authorization any provider with an over 80% approval rate over the previous year. Nonprofit HMOs that provide the majority of care through a single medical group (like Kaiser) are exempt.

Additional Information:

Any changes in prior authorization procedures or requirements require notification to all providers. Insurance carriers must post their prior authorization stats on their website (does not have to be publicly facing). The deadlines for decisions are as follows: two five business days for normal care with two additional days if the provider asks for additional information from the provider, one calendar business day (but no more than 72 hours) for urgent care with one additional calendar day for additional information, and 60 minutes for immediate evaluation or stabilization services required after emergency services. Emergency services are entirely exempt, they cannot have prior authorization at all. If the carrier misses the deadline, the request is automatically approved. If the provider misses their deadline to give more information, it is automatically denied. Prior authorization approvals are good for 180 days.


Arguments For:

The provider-patient relationship should not be broken by insurance companies denying services they don’t want to pay for. While prior authorization programs are a good way to keep costs down by leveraging the wisdom of the crowd, they also can easily get out of control and turn into a simple mechanism for insurance companies to cut corners. This bill makes sure that any prior authorization program is clear with clear deadlines (for obvious reasons) and that it only applies to providers who truly need someone looking over their shoulder.

Arguments Against:

This cuts against the prevailing trend in healthcare that part of the reason for our skyrocketing costs are the expense of medical procedures themselves and that a good way to get a better handle on these costs is to remove the deification of doctors. Insurance companies are prohibited by law from spending less than 80% of the premiums they collect on reimbursement and if they don’t hit the 80% target they have to reimburse all of their premium holders. So they are not incentivized to cut their reimbursements down. We understand better now that individual doctors may indeed be doing the wrong, costly, thing simply because the doctor doesn’t know any better. Of course the system needs to be clear and responsive, but a doctor that is failing to provide the most efficient care 2 times out of 10 is a doctor that is contributing to our systematic problems.

How Should Your Representatives Vote on HB19-1211

HB19-1216 Reduce Insulin Prices (Donovan, Priola) [Roberts]

AMENDED: Moderate

PASSED

Goal: To reduce the price of insulin to consumers in Colorado.

Description:

Requires insurance carriers to pass on any rebates they receive for insulin from prescription drug companies to consumers who have cost-sharing for insulin as follows: either 51% of all rebates or an amount that ensures the covered person’s cost-sharing will not exceed 125% of the carrier’s cost for the drug. The total cost of insulin to the consumer must not exceed $100 for a month’s supply. Requires state to investigate insulin pricing to determine if additional protections are needed.

Additional Information:

The investigation is given carte blanche to look into every step of the insulin supply chain, with the exception that proprietary information or trade secrets are protected. It must issue a report in 2020 with a summary of insulin prices and variables that contribute to pricing of various health care plans along with recommendations to lower costs for Coloradans.


Arguments For:

Nearly 300,000 Colorado adults are diagnosed diabetics and it is estimated that another 110,000 are undiagnosed but live with the disease. The annual medical cost related to diabetes in Colorado is $4 billion, 18% of which is prescription drugs. Insulin prices rose by 45% between 2014 and 2017. And not surprisingly, 25% of type I diabetics have reported underuse of insulin due to its cost. This is a life-saving (and not at all new) drug, it should be impossible in the richest nation on Earth that it is out-of-reach for some Coloradans. While we investigate and find deeper solutions, we need to make sure that people can get their insulin now, which is what the cap and the rebate sharing in this bill accomplishes.

Arguments Against:

This is price-fixing, which is something we should not do in America. Drug companies have to spend enormous sums on medical research, much of which doesn’t end up going anywhere, and thus need to be able to set the price of their medications where they see fit. Insurance companies have to rely on what drug companies are charging, they cannot operate at razor-thin, or perhaps, negative margins if the $100 monthly requirement cannot be met with mere rebate sharing.

How Should Your Representatives Vote on HB19-1216

HB19-1233 Investments in Primary Care to Reduce Health Costs (Ginal, Moreno) [Froelich, Caraveo]

AMENDED: Minor

PASSED

Goal: To find ways to reduce health care costs in primary care through models of payment other than fee-for-service.

Description: Creates a primary care payment reform collaborative to consult with state departments that deal with insurance in order to analyze current methods of primary care reimbursement to determine what practices direct more resources and investments toward innovation and care improvement and what barriers exist to adopting alternative payment methods to fee-for-service.  The collaborative is tasked with creating recommendations that will increase the use of other methods. Report due each October.

Additional Information:

The collaborative is tasked with examining the all-payers claims database to analyze the percentage of expenses in primary care that come from health insurers and state Medicaid/Medicare. Recommendations should increase investment in advanced primary care without increasing costs to consumers or raising total health care costs, align primary care reimbursement by all consumers of primary care, reduce health disparities, and share best practices. Collaborative to be made up of: providers (including primary care), consumers, employers, insurers, Medicaid/Medicare, primary care office in department of public health, executive director of department of health care policy and financing, and experts in health insurance actuarial analysis.


Arguments For:

The fee-for-service model does not work very well. We know this from years of research and moving toward fees for outcomes is a core part of most attempts to lower health care costs. Much of this effort has focused on hospitals, but primary care is where some of the biggest savings can be realized because it is where problems get found early, before they develop into even more difficult issues that cost much more money to resolve.

Arguments Against:

This bill stacks the deck by presuming that in the primary care setting, fee-for-service is a bad system and therefore the collaborative must look to alternatives. The prime flaw in fee-for-service is that it incentivizes doing work rather than incentivizing helping the patient. But this is more of a hospital problem, primary care providers are the patient’s doctor, the one they trust and go to first. They retain patients and get referrals by being a good doctor, so they already have the incentive to get the best outcome. Drastically changing the way they get paid for their work may cause them to refuse to even see higher-risk patients who by definition are more likely to end up with a worse outcome regardless of medical treatment.

How Should Your Representatives Vote on HB19-1233

HB19-1237 Licensing Behavioral Health Entities [Cutter]

AMENDED: Minor

PASSED

Goal: To create a unified behavioral health license for entities that provide behavioral health services.

Description:

Creates a behavioral health license and requires all behavioral health entities currently licensed under either the department of public health and environment or the department of human services to transition to this new license by 2022. Bill creates an advisory committee to aid the transition and minimum rules to be created for the new license (full rules to be created by state board of health).

Additional Information:

  • Entities that must use this new license include: acute treatment units, alcohol or substance use disorder treatment facilities, community mental health center, community mental health clinic, or a crisis stabilization unit licensed as community clinic. Does not include residential child care facilities or services provided by a licensed mental health care professional under their practice at their own premises.
  • Minimum rules include:
    • Consumer assessment, care coordination, patient rights, and consumer notice requirements
    • Administrative and operational standards for governance, consumer records and record retention, personnel admission and discharge criteria, policies and procedures, and quality management
    • Physical plant standards including infection control
    • Occurrence reporting requirements
    • Service specific standards for each of the formerly distinct groups
      • Acute treatment units
      • Community mental health center
      • Community mental health clinic
      • Crisis stabilization unit
      • Walk-in centers that meet licensing requirements
    • Mandatory inspections
      • Written correction plans for violations
      • Enforcement remedies
    • Factors to consider for past criminal history relating to employment (criminal background check required for all employees; fingerprint-based check for owners and managers)
  • Bill lays out provisional 90-day licensure procedure
  • Fees to be determined by state board
  • Advisory board to consist of: Executive directors of departments of public health and environment and department of human services and department of health care policy and financing and department of public safety; one member representing crisis stabilization or acute care units; one member representing community health centers; one member representing a non-community health mental health provider; one representing a substance use disorder treatment service; one representing a substance use disorder withdrawal treatment service; one representing a substance use disorder treatment service that did not previously have to be licensed; one member representing behavioral health consumers; one member representing family members of people with behavioral health disorders; one member from an advocacy organization that represents behavioral health consumers.


Arguments For:

Having a single license and rule structure may make it easier for integrated treatment across a spectrum of care: from crisis stabilization to ongoing care. It also may make innovation in the market easier since we would only have one set of licensure rules to examine and tweak. This single licensure source may also make it easier to achieve more parity in funding for behavioral health since payment sources only have to account for one license type.

Arguments Against:

This may just be a difficult and costly reorganization that doesn’t net any benefit once we are through it. Since the single license will have to have sub-categories to account for the differences in the various fields being brought together, the end result may be that we have just about the same setup as right now except that instead of technically having distinct licenses all of the entities have technically the same overall license. There may also be out-of-state funding problems for the underlying entities, since funding is frequently dependent on having a particular type of license.

How Should Your Representatives Vote on HB19-1237

HB19-1241 University of Colorado Training and Scholarships Rural Physicians (Ginal, Hisey) [Buentello, Wilson]

KILLED ON HOUSE CALENDAR

Goal: To increase number of physicians in rural areas of the state.

Description:

Requires the University of Colorado’s school of medicine to offer scholarships to all students with demonstrated financial needs in its rural track who have committed in writing to living and serving as generalist physicians in rural or frontier shortage area for at least four years after residency, subject to available appropriations. Each scholarship must be at least $10,000 per year. School must also pay housing expenses for the students while they are located in the rural areas. Entities in rural or frontier areas may also award scholarships to students committed to serving in the area. Students who get these scholarships get priority for school scholarships if there are more students than scholarships available.

Additional Information:

A student who violates the four-year pledge must return all of their scholarship money. These scholarships do not affect the student’s eligibility for the Colorado Health Service Corps.


Arguments For:

47 of Colorado’s 64 counties are either rural or frontier. Many of them have been designated as primary care health professional shortage areas by the Colorado Rural Health Center. 20% of the state’s population lives in these counties, but only 9% of the state’s physicians practice there. We desperately need more trained physicians who are willing to live and work in these more remote areas. This bill provides an avenue by leveraging the state’s only public medical school and its existing rural medicine track. This track already produces physicians who live and work in rural and frontier areas at a much higher rate than the rest of the medical school. So providing a very significant carrot of at least $40,000 in scholarships should drive more students into this track and into practicing medicine for at least four years in this community (average debt of a CU med school grad is $224,000).

Arguments Against:

Nothing keeps the student in the rural or frontier area after four years and we simply be setting a constant transitory system where we still have shortages but they are more variable: some areas get relief for four years only to then lose their doctor and be out in the cold again. Except that we will have spent probably at least $50,000 (when you consider housing expenses) on each of these students. And this is money that our state institutions are really struggling to obtain, since the state legislature has not come close to restoring the dramatically slashed higher education budget. More state tuition hikes could be in the offing.

No one is forced to live in a rural or frontier area. Part of the decision to live there is to deal with the lack of infrastructure and amenities these areas have. There is only so much money we can throw at this problem, people have to accept responsibility for their living decisions.

How Should Your Representatives Vote on HB19-1241

HB19-1242 Board of Pharmacy Regulate Pharmacy Technicians (Winter, Tate) [Jackson, Jaquez Lewis]

AMENDED: Minor

PASSED

Goal: To regulate pharmacy technicians and provide continuing education requirements.

Description:

Requires all pharmacy technicians to obtain certification for the state board of pharmacy by June 15, 2020. Applicants must provide proof of certification by a board-approved, nationally recognized organization that certifies pharmacy techs and must provide proof of fingerprint based criminal history check or submit to one. Board may allow up 18 month provisional certification to obtain national certification. To renew, pharmacy tech must satisfy continuing education requirements of the national certification organization. Bill also makes pharmacy techs subject to discipline by the board for unprofessional conduct. Replaces one non-pharmacist member of the board with a certified pharmacy tech.

Additional Information:

Bill keeps limitation on number of pharmacy techs and interns a pharmacist can supervise at 6, but requires that if the pharmacist is supervising more than 3, the majority must be certified techs. Places all of this regulation under the same sunset review process as the pharmacy board in general. Board is tasked with determining application and renewal fees. Board can extend provisional certification beyond 18 months if the applicant demonstrates: negative effects on access to care in applicant’s community, financial hardship, or health circumstances.


Arguments For:

Colorado is currently one of only five states that doesn’t require pharmacy techs to be certified or registered. Right now you can work in a pharmacy, filling prescriptions, without any required training or background check. Almost 77% of medication filling mistakes were made by pharmacy techs and 52% of the time the patient took the medication. This also allows us to track technicians so they cannot bounce from location to location without detection of their previous malfeasance. It also may make it less likely for theft by techs.

Arguments Against:

Errors are on the pharmacist, who is supposed to oversee the technicians and the prescriptions they fill (not to mention that since there are more pharmacy techs you would expect them to making more errors). Requiring this certification and oversight may make it harder for pharmacies to hire techs since the job requirements will be higher. The industry should be policing itself here, with its own certificates and its own requirements.

How Should Your Representatives Vote on HB19-1242

HB19-1253 Living Organ Donor Insurance [Landgraf, Buckner]

AMENDED: Minor

PASSED

Goal: To ensure organ donors are not discriminated against by insurance companies.

Description:

Prohibits life insurance, disability insurance, and long-term care insurance companies from precluding someone from donating all or a part of an organ as a condition of insurance or from using someone's status as a living organ donor to determine premium rates . Also forbids discriminating in the offering, issuance, cancellation, amount of coverage, price, or any other condition of a policy based on living organ donor status unless it is based on sound additional actuarial principles related to other factors or actual reasonably anticipated expense.

Additional Information:

Also requires state to develop provide educational materials that it has for the public on benefits of live organ donation and the effects on insurance.


Arguments For:

There is no data that shows that being a living organ donor reduces life expectancy or prevents donors from living full, healthy lives. Live organ donation is an incredibly important tool for those with kidney, liver, lung, and other potentially deadly health issues that we can address and allow both donor and recipient to live full lives. So we should not have artificial barriers in the way in the form of insurance companies discouraging the practice.

Arguments Against:

A live organ donor is someone who is by definition making themselves less whole and thus perhaps more of a risk for these insurance companies for becoming seriously ill or dying early. There is currently no systematic nationwide data on the health risks to donating part of or an entire organ. What we do know from limited information is that the risk is higher for kidney failure, for instance (which makes sense, you’re down to just one) and we know that liver donation is more dangerous than kidney donation. Not to mention any surgery is a risk.

How Should Your Representatives Vote on HB19-1253

HB19-1269 Mental Health Parity Insurance Medicaid (Ginal) [Cutter, Sullivan]

AMENDED: Minor

PASSED

Goal: To increase parity between mental health and physical health for insurance companies and Medicaid as is already required by law.

Description:

Requires the following of insurance companies:

  • Adherence to mandatory insurance coverage for behavioral, mental health, and substance use disorder and inclusion of prevention, screening, and treatment for these disorders as required by federal law
  • Requires coverage services to continue while a claim is under review
  • Adherence to federal regulations on treatment limitations and precludes carriers from applying any limitations to behavioral, mental health, and substance use disorder benefits that do not apply to medical or surgical benefits
  • Requires an adequate network of providers and procedures for authorizing treatment by non-participating providers when a participating provider is unavailable
  • Modifies definitions of behavioral, mental health, and substance use disorders to include more up-to-date diagnostic categories and screenings to reflect current national recommendations
  • Requires commissioner of insurance to disallow rate increases for failure to demonstrate compliance with federal parity laws
  • Requires any denial of benefits to include information about federal parity law protections, how to contact various state actors for potential violations of this law, and right to request medical necessity criteria
  • By 2020 requires any plan that offers free annual physical to also offer free annual mental health checkup
  • By 2020 requires any plan that offers prescription drugs benefits for substance use disorder treatment to include any FDA approved medication without authorization or step therapy requirements, place all of these drugs on the lowest pricing tier, and forbids these plans from excluding court-ordered medication
  • Requires carriers to submit an annual report showing they are complying with parity laws to commissioner of insurance

For Medicaid:

  • Requires state to ensure compliance with federal parity laws
  • Requires managed care entities to provide adequate network of services and prohibits these entities from denying services on basis that the diagnosis was not primary
  • Requires these entities to make network plans public, examine parity complaints, and provide information on how to contact them regarding possible parity violations
  • Requires these entities to submit data to the department on service utilization, denial rates, and provider directories
  • Requires state to submit annual parity report to general assembly
  • By 2020 requires any entity that offers prescription drugs benefits for substance use disorder treatment to include any FDA approved medication without authorization or step therapy requirements, place all of these drugs on the lowest pricing tier, and forbids these plans from excluding court-ordered medication

Additional Information:

  • Definition modifications includes diagnostic categories listed in the mental disorders section of the International Statistical Classification of Diseases and Related Health Problems, the Diagnostic and Statistical Manual of Mental Disorders, or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood.
  • Network adequacy includes ability to get treatment within seven calendar days after initial visit for medically necessary treatment and therapeutically appropriate intervals for other treatment.
  • Non-participating treatment providers forced into action by unavailability of participating providers must result in same charges to covered individual.
  • Unhealthy alcohol use screening, depression screening, and perinatal maternal counseling must all be covered under preventative services.
  • Insurance company proof of compliance must include data demonstrating compliance and description of process used to develop or select criteria for benefits for both behavioral, mental, and substance use disorders and medical and surgical benefits. Must also have an analysis defending their selections as being equivalent in both areas.
  • Managed care entities must report utilization broken out into: housing instability, limited English proficiency, race, and LGBTQ status. These entities must submit the same analysis as insurance companies in proving their adherence to parity requirements.


Arguments For:

The law is not being followed. It really is as simple as that. Despite federal requirements that mental health be treated the same as physical health, insurance companies and Medicaid are not doing so. Insurance companies in Colorado pay mental health doctors 30 percent less than they pay other medical professionals, and consumers have to pay for out-of-network care seven times more often than they do for other medical care. Determining what is “medically necessary” in mental health is more loosely defined than in the rest of medicine, so this bill hones on that area to force insurers and Medicaid providers to prove they aren’t shortchanging mental health. Chronic conditions can frequently be treated differently: physical conditions get care for a lifetime while mental conditions are supposed to be “solved” within a period of time. And our definitions are behind the times, currently ADD and Tourettes are not included in parity laws. Again, the laws already exist. It’s time to make sure they are being followed.

Arguments Against:

There is a shortage of mental health professionals in the state, and only a portion of them contract with insurance companies because they can make more money accepting direct payment from patients. In Colorado, we have two retiring psychiatrists for every one that is entering the field. So while this bill is well-intentioned, it is setting out some mandates that insurers will find very difficult to meet in terms of network adequacy. It also is just not easy to determine parity in two such radically different fields. Medical necessity is a slippery term and the mountain of work this bill dumps on insurers to prove they are walking the walk is going to increase overhead which may increase premiums. Insurers may also turn extremely conservative in terms of trying to meet these requirements which would lead to increased payouts which is going to also raise premiums.

How Should Your Representatives Vote on HB19-1269

HB19-1285 Denver Health Managed Care Organization Contracts with the Department of Health Care Policy and Financing (Fields) [Lontine]

PASSED

Goal: Allow Denver Health to enter into a contract with the state directly, removing the middle man.

Description:

Requires Denver Health to enter into a Medicaid contract directly with the state and no longer use an intermediary managed care organization.

Additional Information: n/a

Arguments For:

This is an unanticipated consequence of our current newish system, where the managed care organization currently in the middle between Denver Health and the state is basically doing the exact same work Denver Health is already doing in its reports. It is not necessary to have this middleman and the bill removes it.

Arguments Against: n/a

How Should Your Representatives Vote on HB19-1285

HB19-1287 Treatment For Opioid & Substance Use Disorders (Priola, Pettersen) [Esgar, Wilson]

AMENDED: Minor

PASSED

Short Description:

Creates a capacity tracking system for behavioral health facilities as well as a grant program to build capacity in underserved communities and a care coordination system to assist individuals in receiving substance use disorder treatment.

Long Description:

Component 1: Creates a web-based tracking system that can be accessed by health care professionals, law enforcement, court personnel, and the public. It must coordinate with the already existing telephone crisis service. It requires capacity updates from providers at least once a day, unless the provider is a residential facility with unchanged capacity. Any facility that provide evaluation and treatment to individuals held under an emergency commitment, inpatient training facilities, residential treatment facilities, medical detoxification facilities, and opioid treatment programs and medically or clinically managed withdrawal facilities must participate. Other facilities may participate with permission of state. Tracking system includes basic facility information, including admission and exclusion criteria.

Component 2: Creates a care coordination system to help people who want inpatient or residential treatment for substance use disorder or want treatment for an affected family member or friend. System must include independent screening of the individual using recognized criteria to determine care required and identification of viable options and services available in the state. Must be available 24-7 and online, by phone, or in person. These services will be contracted out to providers who meet criteria. Providers must provide detailed information about their interaction with the public under the system to the state.

Component 3: Creates a $5 million grant program to increase substance use disorder treatment capacity and services in rural and frontier communities. Grant program overseen by committee consisting of members appointed by county commissioners of these communities, managed service organizations of these communities, and the state’s department of health and human services.


Arguments For:

The opioid crisis continues in this state and this country and this bill tackles the problem of meeting capacity to the challenge. First, we need to make sure we are fully utilizing what we have, which is what components 1 and 2 does by creating a way to know exactly what capacity exists in the system at any given time and giving the public a resource to find and use that capacity. We also need more capacity, in particular in rural areas, which is what section 3 does.

Arguments Against:

We’re flushing a lot of money and resources down the drain of drug addicts who can’t get their lives together. While it is undeniably tragic, there are plenty of life choices people make that are tragic that do not get millions of dollars of state resources thrown at them. Cycling people continuously through treatment isn’t the answer, stopping people from getting hooked in the first place is. Sadly our resources are better used in different places once they are this far down the path.

Our rural areas need more than a small grant in this crisis. The bill doesn’t go far enough to address the needs of rural Colorado.

How Should Your Representatives Vote on HB19-1287

HB19-1296 Prescription Drug Cost Reduction Measures (Ginal, Donovan) [Jackson, Jaquez Lewis]

AMENDED: Minor

KILLED ON HOUSE CALENDAR

Goal: To greatly increase transparency around prescription drug pricing and interactions among insurers, pharmacy benefit management firms, and pharmacies. Also to ensure insurance companies are appropriately pricing their cost-sharing for prescription drugs with customers.

Description:

Numerous disclosure requirements for insurers and prescription drug manufacturers. Insurers must:

  • Submit to state each year information on their top prescription drug payouts each year, by several different sorting categories and information about rebates received from drug manufacturers
  • A list of all pharmacy benefit management (PBM) firms the insurers contract with
  • Specific information on rebates and administrative fees about drugs that trigger a price report to the state under this bill (more below)

Drug manufacturers must:

  • Notify state, state Medicaid, insurers, and PBMs when the manufacturer increases the price of certain prescription drugs by more than specified percentage amounts or introduces a new specialty drug onto the market. This disclosure must include information about if the drug has changed.
  • Notify the state, for every drug the manufacturer was required to notify about in previous section, numerous pricing, sales, and profit information about the drug and a detailed explanation for the increase

Non-profits in this area must annually report any thing of value worth $1,000 or more received by the organization from a drug manufacturer, PBM, or insurer and the percentage of the company’s gross income attributable. All of this information, minus proprietary information, is to be posted on the state website. The data is to be analyzed and reported on each year. Bill also prohibits PBMs from retroactively reducing payments on a proper claim submitted by a pharmacy. Insurers must reduce the cost of drugs covered individuals must pay by greater of 51% of average aggregate rebates received by insurer for all drugs or amount that ensures cost sharing will not exceed 125% of carrier’s cost.

Additional Information:

Insurers annual information includes:

  • 25 most frequently paid for drugs
  • 25 most costly drugs paid for
  • 25 drugs that accounted for the highest increase in total spending compared to previous year
  • 25 most frequently paid outpatient drugs where the insurer received a rebate or anything else that reduced cost to insurer

Violating these requirements results in a fine of up to $10,000 per day.

Triggering the price increase notification requires a drug with a price of more than $100 if the increase the increase is 10% or more from previous year or 16% or more over previous two years or if the drug is an essential drug (from World Health Organization list of essential medicines) and increase was either of the two already stated increases or 20% or more over previous 36 months. The notice to everyone must be at least 30 days prior to increase and requires:

  • Date of increase, current price, and future price
  • Statement of if the drug has been improved necessitating the increase and if so, how

The more detailed report due to the state on a drug that triggers this disclosure occurs quarterly. Information provided includes:

  • Name and price of the drug and increase in percentage terms over previous year
  • How long the drug has been on the market, its introductory price and the net yearly increase of the drug in previous five years
  • Description of the specific financial and non-financial factors leading to the increase
  • For brand names under patent, all relevant patents and their status (including expiration date); for generics, year of FDA approval
  • Name of any generic version available on market
  • Whether drug is deemed an innovator, multiple source, noninnovator multiple source, or single source drug by FDA
  • Description of change, if any, that necessitated increase
  • Total gross revenues from sales of drug in state in previous calendar year
  • Direct costs incurred by manufacturer for the drug in research and development, manufacturing, marketing, distribution, and ongoing safety and effectiveness research
  • Profit from the drug in previous year
  • 10 highest prices paid outside the US for the drug in previous year
  • If the drug was purchased within previous five years, price of drug at acquisition and in year after acquisition; name of company it was acquired from, date of acquisition, and purchase price
  • Any other information the manufacturer deems relevant to decision to increase price

For specialty drugs, information required is: description of marketing and pricing plans used in Colorado; estimated number of patients in state that might be prescribed the drug; whether the drug was granted breakthrough therapy designation or priority review by FDA; date and price of acquisition if the drug was acquired from other manufacturer.

Non-profits qualify for the disclosure requirements if they have annual budget of more than $50,000, advocate on behalf of patients on pharmaceutical issues, and have received an item of value worth $1,000 or more from a manufacturer, PBM, or insurer in previous year.


Arguments For:

While we all know the general gist of prescription drug pricing issues (and the few extremely notable cases that have received large amounts of public attention), what we do not know are the deep details. This bill is all about those details and about transparency. We need to know what drugs insurers are paying out the most for. We need to know about big price increases and we need the justification for them and the details that will help us understand if price gouging is going on. And we need transparency around the interactions between the entities that determine what we pay for these drugs to ensure no one is pocketing profits in the middle at the expense of people who need these drugs to survive. And that, ultimately, is what this is about. Many prescription drugs are life or death for the people who need them. And yet increasing numbers of Americans are forgoing these medications because they cannot afford them, insulin being perhaps the most prominent example. The bill does not stop manufacturers from pricing their drugs or PBMs or insurers from getting rebates or non-profits from getting things of value. It just makes sure we all know the score.

Arguments Against:

This is a deeply intrusive move into the inner workings of prescription drug companies, who are required to essentially turn over reams of profit data for many drugs which the state is then going to turn around and publish. It may erode the ability of these companies to compete with each other and it may erode their ability to conduct the incredibly expensive research required to find new life-saving drugs. It is also an administrative burden on insurers, who have to turn over all of this annual information to the state, and an intrusion into their business in the form of price-fixing on cost sharing amounts. We are raising the cost of doing business for all of these entities that touch prescription drugs and they are likely to try to pass those increases on to us.

Data is fine, but action is better. The bill goes out of its way to note that it does not prevent drug companies from doing anything they like (within legal boundaries) when it comes to pricing. And it does not. We already know public shame doesn’t do anything, just look at the current state of things where we are very much aware of the dramatic price increases in the industry.

How Should Your Representatives Vote on HB19-1296

HB19-1301 Health Insurance for Breast Imaging (Williams) [Michaelson Jenet, Buckner]

AMENDED: Minor

PASSED

Goal: To allow more modalities than mammographies for the required annual breast cancer screening covered by insurance.

Description:

Requires the annual coverage for one breast cancer screening study and subsequent breast imaging to use the noninvasive imaging modality appropriate for each individual, as determined by individual’s health care provider based on guidelines from American College of Radiology.

Additional Information: n/a

Arguments For:

Frequently additional exams are needed to make an accurate diagnosis. It makes sense that rather than dictate that the exam must be a mammogram, we use the noninvasive imaging that is appropriate for the patient, whatever that may be.

Arguments Against: n/a

How Should Your Representatives Vote on HB19-1301

HB19-1302 Cancer Treatment and License Plate Surcharge (Winter) [Michaelson Jenet, Buckner]

AMENDED: Significant

PASSED

Goal: To continue the breast and cervical cancer prevention and treatment program and create a new fund to provide treatment those who do not have insurance.

Description:

Extends the breast and cervical cancer prevention and treatment program through 2029. Creates a new fund to provide treatment to those with breast or cervical cancer who do not have insurance. Directs department of public health to create rules to administer fund. Increases one of the $25 fees for the purchase, replacement, or renewal of the breast cancer awareness license plate to $30 and credits $10 to the new uninsured treatment fund, leaving $20 for the prevention and treatment fund. This is until July 2021, when the distribution reverts to $25 for the prevention and treatment fund and the added $5 goes to the uninsured fund.

Additional Information: n/a

Arguments For:

This program will expire in July if it is not extended and over a hundred Coloradans would lose access to their treatment. It is extremely successful and important and should be extended. In addition, we should be looking to augment cancer treatment for the uninsured, who will quite literally die if they do not get adequate treatment in a timely manner. For the more cold-blooded among us, that will also probably end up costing us more money in end-of-life treatment.

Arguments Against:

Adding this new program and taking money away from the highly successful existing one is the wrong way to go about this.

HB19-1312 School Immunization Requirements (Gonzales, Priola) [Mullica]

AMENDED: Minor

KILLED ON SENATE CALENDAR

Goal: To increase Colorado’s immunization rate by making it harder to claim an exemption.

Description:

Requires state to develop rules on medical exemptions from immunizations and required immunization guidelines based on practices recommended by Centers for Disease Control. State is allowed to add additional immunization requirements and must develop the required immunization schedule for kids. State also must create educational materials regarding immunizations for health care professionals to use with parents. Must develop standardized form for claiming medical exemption and a form for claiming a personal or religious exemption. The medical exemption form must be signed by a medical professional. The medical form is submitted directly to the school. The personal/religious objection form goes to the department of public health for the county, district, or municipality, when then gives a certified exemption certificate for the parent to give to the school. Requires the medical professional to submit the immunization exemption to the state tracking system (but parents can opt out). Requires state to submit personal/religious exemption to state tracking system (but parents can opt out).

Additional Information:

There is no sanction for non-compliance by a medical professional with submission to the tracking system.


Arguments For:

Each year in the United States, immunizations save 33,000 lives, prevent 14 million disease cases, and save $9.9 billion in direct health care costs. But Colorado is the worst state in the country for immunization rates, and is only one of 17 states to even allow a personal belief exemption. In 2017, 23,228 children attended Colorado schools without 20 protection from one or more immunizations. And guess what? 9,424 Colorado children, a majority of them under the age of four, were hospitalized or went to an emergency department to be treated for disease that was preventable by an immunization, resulting in $55.5 million in charges. In 2016, two measles outbreaks cost the state $68,192 just to investigate and prevent spread of the disease.  Immunizations are one of the great health achievements of all-time and we are throwing it all away. Diseases that were eradicated are making comebacks, and this is just an issue of money. Some people cannot receive immunizations for medical reasons or are too young. These people are being put at-risk of harm or death by the careless actions of those who have bought into the paranoid conspiracy theories about immunization. So we have to make it harder to claim an exemption (right now no standardized form is required, you just tell the school) and do a better job of educating parents about the risk/benefit analysis of immunizations. This bill does that while maintaining the ability for parents to make their own decisions about the health of their children.

Arguments Against:

Take the entire “For” argument and stop right after conspiracy theories. Then feel free to add, “And this bill does nothing to solve the problem.” People who are opposed to immunizations are just confused or wishy-washy, they are virulently opposed and will happily jump through a few additional hoops that do nothing but slightly slow them down. We need to remove the personal exemption entirely. As was already written, this is about public health and safety of all of us and that is where the ability for a parent to make decisions about their child ends. We force children to be schooled. We don’t let children work below a certain age. So we already have some restrictions for parents. And a bedrock belief in our society is that your personal freedoms end at the point where you can harm someone else. That is absolutely true for parents that choose to not vaccinate their children. It needs to end.

These additional steps are an infringement on the right of parents to protect their children from what the parents feel is a harmful practice. Even pro-vaccine people admit that there are risks. There is no risk of getting autism from a vaccine but there are other risks including bad reactions to the vaccine. There is no liability for medical professionals administering them and extremely limited liability for pharmaceutical companies so families have no recourse if something goes wrong.

How Should Your Representatives Vote on HB19-1312

HB19-1320 Hospital Community Benefit Accountability [Kennedy, Lontine]

AMENDED: Moderate

PASSED

Goal: To increase reporting by hospitals around unreimbursed community benefit activities.

Description:

Creates a community accountability board in each state health care region. This board is to assist each non-profit hospital is to create an assessment, plan, and report for unreimbursed community benefit activities. These are unreimbursed goods, services, and resources provided by the hospital to its community to address community-identified health needs. For-profit hospitals are encouraged, but not required, to do the same. Each hospital is to conduct a public meeting with stakeholders to determine community needs.

Additional Information:

Community benefits are categorized as free or discounted health care services, programs that address health behaviors or risks, programs that address the social determinants of health, and such other categories as may be defined by the state board.

  • Health care services, which included unreimbursed portions of charity care, funding or in-kind contributions that support physical, oral, or behavioral health services provided by other organizations in the community; research and residency training that address community-identified health needs; and unreimbursed care transition services and support for people with disabilities.
  • Programs designed to address individual health behaviors or risk factors, including addiction prevention and treatment programs, suicide prevention programs, programs to prevent tobacco use, and nutrition education programs.
  • Programs that specifically address underlying social determinants of health, including funding or in-kind support of job training programs; early childhood and elementary, middle, junior high, and high school education; programs that increase access to nutritious food and safe and affordable housing; and community-building activities that affect health in the community.
  • Programs intended to achieve objectives of the state department’s hospital transformation program, relating to value-based care.

Psychiatric hospitals, general and long-term care hospitals, inpatient rehab facilities, and critical access hospitals are excluded. The assessment, plan, and report must be done every three years. Report must include total cash value of each activity done and its percentage of total hospital revenue, total cash value of each federal, state, and local tax exemption, and evaluation of implementation plan for previous year.

Each board is to be 15 members, all of whom must reside or work in the region full-time, and include: Public meeting should include:

  • A local public health official
  • Person representing the state department, one for the department of public health and environment, and one for the department of human services
  • Person representing statewide organization of chambers of commerce
  • Person with professional experience with economic development
  • Person who represents a statewide organization of health care consumers or local organization of health care consumers
  • Person who represents a statewide organization of education executives
  • Person who represents a statewide organization of county commissioners
  • Person who represents the regional accountable entity
  • Person who represents a statewide organization of community health centers, a local community health center, or a certified rural health clinic or primary care clinic in the county
  • Person who represents state commission on higher education
  • people who live in the region and are not medical professionals or hospital employees


Arguments For:

Hospitals represent both a major cost center in our health care system and a major opportunity for community-based interventions. Given the massive amount of money in our hospitals, including some eye-popping price increases in recent years, we need to ensure that our hospitals are serving the truly needy populations in our state, particularly for hospitals that have designated themselves as non-profits.

Arguments Against:

The likely largest source of lack of activity the bill is seeking to identify is for-profit hospitals, but this is optional for them. And on the whole, this bill is asking if hospitals are in essence doing a whole host of things that aren’t strictly speaking in their purview. There are educational things, primary care things, and really state-responsible things that we shouldn’t be “asking” our hospitals to do.

How Should Your Representatives Vote on HB19-1320

HB19-1326 Rates for Senior Low-Income Dental Program (Zenzinger, Rankin) [Esgar, Hansen]

PASSED

Goal: Allow state dental health care program for low-income seniors to serve more seniors.

Description:

The state dental health program is for seniors 60 and over, at or below 250% of federal poverty level and do not have any Medicaid or dental coverage. Currently its reimbursement rates cannot be less than they were when the program began a few years ago. This bill changes this to allow the advisory committee to this program and the state medical board to set rates no lower than the Medicaid fee-for-service rate.

Additional Information: n/a

Arguments For:

This bill would allow the program to serve an additional 600-700 more seniors each year, because right now it runs out of funds before it can serve everyone, resulting in a wait list. The seniors on this list obviously don’t have many good options: Medicare doesn’t cover this, they are low-income and have difficulty affording it on their own, and of course they have dental needs that can increase as they age. Allowing the board to lower the fees to match Medicaid (so not stiffing any providers) will allow more seniors to get the care that they need.

Arguments Against:

Rather than sticking the providers with this bill (and some may opt-out of providing this service if they have to take Medicaid rates) we should simply provide more funding to the program so we can cover everyone. We spend $2.9 million right now annually to serve just under 3,000 seniors. Just a tick more should get us all the way there.

How Should Your Representatives Vote on HB19-1326

SB19-001 Expand Medication-Assisted Treatment Pilot Program (Garcia)

AMENDED: Technical

PASSED

Short Description:

Expands an opioid medication-assisted treatment pilot program begun in 2017 in Pueblo and Routt counties to the entire San Louis Valley and up to two additional counties. Also increases funding from $500,000 to $5 million and extends program by two years.

Long Description:

Expands an opioid medication-assisted treatment pilot program begun in 2017 in Pueblo and Routt counties to the entire San Louis Valley and up to two additional counties. This program provides grants to community agencies, office-based practices, behavioral health organizations, and substance abuse treatment organizations. Also increases annual funding from $500,000 to $5 million and extends program by two years (was due to expire in 2020). Takes management of the program from the University of Colorado college of nursing and gives it to the University of Colorado center for research into substance use disorder prevention, treatment, and recovery support strategies. Adds representation from San Luis Valley and any additional counties to advisory board.

Arguments For:

This bill takes the program that has worked well in part of the state and brings it to other parts that need help. Pueblo and Routt both vastly increased the number of people who received medication-assisted treatment, from 99 in 2017 to 626 in 2018. The San Luis Valley has some of the highest opioid overdose rates in the state and would greatly benefit from being added to the program. Many other counties also lack available and qualified medication-assisted treatment options.

Arguments Against:

If the program is so successful, we should not be capping it. Open it up to any county in the state that can demonstrate the need for it and open the coffers more to fund whatever is needed.

We don’t yet have the data from 2018 to know if these programs are actually helping lower overdose fatalities in Pueblo and Routt counties. We should have a better idea if they are actually working to achieve this goal before expanding them.

How Should Your Representatives Vote on SB19-001

SB19-004 Address High-Cost Health Insurance Pilot Program (Donovan) [Roberts]

AMENDED: Very Significant

PASSED

Short Description:

Tells the state’s personnel director to explore the feasibility of developing a one-year pilot program to allow individuals in specific parts of Eagle and Garfield counties who earn between 400 and 500% of the federal poverty line to participate in the group medical insurance plans offered to state employees. If the plan is determined to be feasible, the director must implement it. Also alters state health care cooperatives to make it possible for division of insurance to work with large group, small group, and individuals to band together to increase their bargaining power to get better rates from both providers and insurers.

Long Description:

Tells the state’s personnel director to explore the feasibility of developing a one-year pilot program to allow individuals in specific parts of Eagle and Garfield counties who earn between 400 and 500% of the federal poverty line (and are thus ineligible for federal subsidies under the Affordable Care Act) to participate in the group medical insurance plans offered to state employees. Program is capped at 100 individuals. Director must find out how the state can enroll non-employees, if a third-party is required, the effect on premiums for both the existing plans and individuals eligible for the pilot program, and any other costs to the state. If the plan is determined to be feasible, the director must implement it. Also alters state health care cooperatives to make it possible for division of insurance to work with large group, small group, and individuals to band together to increase their bargaining power to get better rates from both providers and insurers.

Arguments For:

Many Coloradans in rural areas fall into a trap of earning too much to be eligible for federal insurance subsidies under the ACA but not enough to really afford their pricey insurance (in some cases more than 20% of the annual income). They then do not purchase insurance, because they cannot afford it, which makes all of the problems of few carriers, few plans, and high costs in these rural areas worse. Getting these individuals into affordable insurance plans will benefit everyone, as the more people we can get affordably insured the lower the premiums and health care costs for the entire state (due to more young and healthy individuals in the pool, more preventative medicine, and fewer ER visits). Larger risk pools are the best way to provide insurance to these people and this bill takes extra care to make sure this can work for the state by first requiring a feasibility study and then starting with a small pilot program. Getting people cheap insurance that doesn’t really cover anything when you actually need it is the mess we had before the Affordable Care Act and won’t solve any problems.

Arguments Against:

The feasibility study could be a fig leaf, as the bill doesn’t define what is and isn’t feasible at all and definitions will definitely vary. State employees may see their insurance premiums worsened by adding these people who live in high health care cost regions and that may still be deemed feasible. People in the situation this bill identifies should be free to purchase cheaper insurance that wouldn’t be as comprehensive as what they are currently required to purchase but would still provide some coverage.

Trying to stick more and more fingers into the flooding dike of private insurance is worse than a waste of time, it diverts us from the real solutions we need to pursue of removing the private market entirely from health insurance. We need single payer health care, not more bandages to keep private insurers (who provide state employees with their coverage) in the game.

How Should Your Representatives Vote on SB19-004

SB19-005 Import Prescription Drugs From Canada (Rodriguez, Ginal) [Jaquez Lewis]

AMENDED: Moderate

PASSED

Short Description:

Creates a program by which the department of health can import prescription pharmaceuticals from Canada. The program must ensure drug safety and cost savings for Coloradans and must be approved by the federal department of health and human services.

Long Description:

Creates a program by which the department of health can import prescription pharmaceuticals from Canada. Human medicine only. The program must ensure drug safety and cost savings for Coloradans and must be approved by the federal department of health and human services. Must select qualified Canadian suppliers that are licensed and regulated under Canadian law. Must sample imported products for purity, chemical composition, and potency, including statistically valid sample of each batch for first importation and statistically valid sample of shipment for subsequent ones. Must ensure that all imported products are significantly less costly than their U.S. equivalents. Must ensure that no drugs are distributed, dispensed, or sold outside Colorado. Must ensure that carriers are both paying the proper amounts for the drugs and charging the proper copays to consumers. Must set a maximum profit margin for wholesalers, distributors, and pharmacies that participate. Must exclude generic products if their importation would violate US patent law. Must determine a method to cover administrative costs which may include a fee on each product sold. No infused, intravenously injected, or drugs that are inhaled during surgery. Importers must track date received, quantity, point of origin and destination, and price paid. Canadian exporter must track original source of drug (including manufacturer), date manufactured, location of manufacture, date shipped, quantity shipped, and lot and batch numbers. Vendors must have a surety bond of at least $25,000.

Arguments For:

U.S. consumers pay some of the highest prescription drug costs in the world, as high as twice as Canadians for patented drugs and 20% more for generics. They also in some cases are skyrocketing, as in the well-known example of insulin. Canada has a system to license and monitor drugs that is equivalent to our FDA, obviously works well for Canadians, and the US and Canada have a memorandum of understanding on pharmaceutical regulation cooperation since 1973. The bill includes sufficient protections to make sure that the drugs are safe and effective and that no new cottage industry is created to grossly profit from the situation. Vermont has already passed a similar law and is waiting for federal approval. This is literally a matter of life and death for many people, who sometimes have to choose between medication and other basics like clothing and food. We need to provide our citizens some other way to get the life-saving medicine they need.

Arguments Against:

The FDA opposes this for safety concerns. Canada may have its own version but it is not the same as our FDA and the Canadian government does not inspect or take responsibility for the legitimacy of prescription medicines shipped to the U.S. We should not rely on a vague sampling process to keep our citizens safe. Importation also greatly increases the risk of counterfeiting, particularly with Internet pharmacies, and the burden of investigating this will fall on ill-prepared state governments. The state’s ability to construct some sort of monitoring system to ensure safety may either not exist or be extremely expensive. This bill will also damage American pharmaceutical companies which employ thousands of American workers.

The Trump administration is never going to approve this bill, Vermont’s from last year is still waiting and no one expects it to be approved. So in the end it won’t change anything.

How Should Your Representatives Vote on SB19-005

SB19-008 Substance Use Disorder Treatment in Criminal Justice System (Moreno, Priola) [Kennedy, Singer]

AMENDED: Moderate

PASSED

From the Opioid and Other Substance Use Disorders Study Committee

Short Description:

Creates a study to find alternatives to criminal charges for those with substance use disorders arrested for drug offenses as well as best practices for investigating criminal opioid distribution and a process for automatically sealing criminal records for drug offenses. Also makes the current sealing process easier for those with level 4 drug felonies (lowest level) or a lower level of crime. Requires department of corrections to allow medication-assisted treatment to people who were receiving treatment in a local jail previously. Also requires jails that receive funding through behavioral  health services program to allow medication-assisted treatment and authorizes state to ask for Federal Medicaid funding for substance use disorder treatment in jails. Also increases diversion pilot program funding. Creates a harm reduction grant program for increased training and usage of harm reduction treatments in the criminal justice system.

Long Description:

Creates a study to find alternatives to criminal charges for those with substance use disorders arrested for drug offenses as well as best practices for investigating criminal opioid distribution and a process for automatically sealing criminal records for drug offenses. Also makes the current sealing process easier for those with level 4 drug felonies (lowest level) or a lower level of crime. This allows convicts to petition to have their records sealed three or more years after the final disposition of their case or their release from supervision as long as they have not been charged or convicted of a criminal offense in those three years. The court first reviews the petition, then if it decides it is acceptable, sets a hearing.

Requires department of corrections to allow medication-assisted treatment to people who were receiving treatment in a local jail previously. Allows department to enter into partnerships with private organizations to assist in development and administration of this treatment. Also requires jails that receive funding through behavioral health services program to allow medication-assisted treatment and again allows for private partnerships to administer. Authorizes state to ask for Federal Medicaid funding for substance use disorder treatment in jails (must include medication-assisted treatment and withdrawal management programs).

Also increases diversion pilot program funding, growing from 4 to 10 sites for a law enforcement led diversion pilot and 8 to 12 sites for a co-responder pilot that utilizes a law enforcement/behavioral health specialist team to de-escalate situations that have historically resulted in arrest.

Creates a harm reduction grant program for increased training and usage of harm reduction treatments in the criminal justice system. Allowed grant uses include: trainings, including how to administer naloxone; purchasing and providing sterile equipment and syringe disposal equipment; providing direct services to those in danger of coming into the system, including treatment at all levels; outreach and engagement to those in danger of coming into the system; facilitating communication, training, and technical assistance among law enforcement, public health agencies, and community-based harm reduction agencies; coordinating local efforts for co-responder and diversion programs; and auricular acudetox training and services.


Arguments For:

This bill takes direct aim at one of the links in the addiction chain, prisoners who aren’t able to get the treatment they need. First, we need to do a better job of keeping some non-violent people out of prison period, which is the point of diversion programs and other alternatives including de-escalation. Second we need to do a better job of getting treatment to those in jail, so they can break their addiction. Finally, we need to provide a better path for those who have kicked their addiction to fully re-enter society without their past dragging them down. We cannot punish our way out of drug abuse and addiction, we’ve basically tried that for years and gotten nowhere.

Arguments Against:

This bill sets us further down the path of trying to find ways to not punish people for their behavior. Increasing the number of get out of jail free cards isn’t going to deter people from committing crimes. As for kicking addictions, our prisoners are already not being supplied with drugs, so they are detoxing without medication assistance or withdrawal treatment. It’s on the individual to make the best of their opportunity to clean after that. Sealing records makes it harder for potential employers and landlords to find out the information they want to know about someone’s past. If the individual in question can convince everyone that they have truly turned their lives around great, but the employer or landlord should be able to decide for themselves, not have the information withheld.

How Should Your Representatives Vote on SB19-008

SB19-010 Professional Behavioral Health Services for Schools (Fields) [McLachlan, Valdez]

AMENDED: Significant

PASSED

Short Description:

Allows schools to use the existing behavioral health care professional matching grant program, designed for schools to bolster their behavioral health care services, for a wider array of mental and behavioral health issues as well as access community partners for matching funds and services. Appropriates an extra $3 million from the marijuana cash fund to help fund the extension.

Long Description:

Allows schools to use the existing behavioral health care professional matching grant program, designed for schools to bolster their behavioral health care services, for a wider array of mental and behavioral health issues as well as access community partners for matching funds and services. The program currently focuses almost exclusively on substance abuse, but the bill would broaden that out to any behavioral health issues and solutions. Appropriates an extra $3 million from the marijuana cash fund to help fund the extension


Arguments For:

Student mental and behavioral health issues go far beyond substance abuse. Colorado has one of the higher teen suicide rates in the U.S. and it is absolutely appropriate to use this program more broadly to address the mental well-being of more students. It also makes sense to involve more community organizations to help.

Arguments Against:

This program is designed for substance-abuse issues, not for broader mental health. Stretching a program beyond its initial conception can have unintended consequences.

How Should Your Representatives Vote on SB19-010

SB19-015 Create Statewide Health Care Review Committee (Ginal) [Beckman]

AMENDED: Technical

PASSED

Short Description:

Recreates the former health care task force, renamed the statewide health care review committee, to study health care issues during both the regular session and interim period. Membership consists of respective health care committees in the House and Senate.

Long Description: n/a

Arguments For:

True in-depth study is frequently needed for the legislature to get its arms around complicated problems and there are few problems as complicated as our health care system. Review committees like this do an excellent job of bringing multiple stakeholder groups together and coming up with solutions to problems.

Arguments Against: n/a

How Should Your Representatives Vote on SB19-015

SB19-021 Board of Health Approval for Legal Services (Moreno) [McKean] TECHNICAL BILL

From the Statutory Revision Committee

SIGNED INTO LAW

Short Description:

Removes requirements that state board of health approve retention of counsel when department of public health and environment seeks to bring legal action and that an agency acquire approval of state board of health before retaining counsel to defend itself.

Long Description: n/a

SB19-041 Health Insurance Contract Carrier and Policyholder (Smallwood) [Kraft-Tharp]

AMENDED: Minor

SIGNED INTO LAW

Short Description:

Currently policyholders must pay premiums for individuals under their plan through the date that the policyholder informs the insurance carrier that the individual is no longer eligible. This bill would make the policyholder liable only until the individual is no longer eligible as long as the carrier is notified within 10 business days of ineligibility so long as the employee left without notice or was terminated immediately.

Long Description: n/a

Arguments For:

If an individual leaves unexpectedly it’s tough for a business to get the notification through to the insurance carrier right away. The business should have some leeway to inform the insurance carrier without losing money on the premium for an employee that isn’t eligible anymore.

Arguments Against:

This is a pretty small amount of money (one person’s premium over 10 days) to create this structure for.

How Should Your Representatives Vote on SB19-041

SB19-044 Colorado Department of Public Health and Environment Emergency Medical and Trauma Care System (Zenzinger) [Hooton]

From the Statutory Revision Committee

SIGNED INTO LAW

Short Description:

Repeals obsolete language requiring department of public health to implement a statewide emergency medical and trauma care system by July 1, 1997, and requiring coordination with counties in their own regional systems.

Long Description: n/a

SB19-052 Emergency Medical Service Provider Scope of Practice (Garcia) [Mullica]

AMENDED: Moderate

SIGNED INTO LAW

Short Description:

Expands Emergency Medical Services providers scope of practice by allowing them to practice under the direction of an advanced practice nurse or physician assistant. Also authorizes state board of health to create rules to expand EMS scope of practice as it sees fit. Clarifies that emergency medical services providers can practice within their scope of duties in a clinical setting under supervision. Clarifies that physician assistants or nurse practitioners can delegate tasks to emergency medical providers in a clinical setting outside the EMS scope of practice.

Long Description: n/a

Arguments For:

Advanced practice nurses and physician assistants receive massive amounts of training. We use them all over the medical field to supplement physicians and they are more than qualified to supervise trained EMS personnel. Expanding the supervisor field will help EMS organizations by not requiring them to pay a full-blown physician, which will help us all by making EMS services less expensive. This allows for greater multi-disciplinary teams to operate and for greater innovation in the health care profession. The EMS industry is different today, many providers work in different environments, and we should not tie EMS care in a clinical setting to a set relationship with one supervising physician in one hospital. Given our shortage of medical personnel around the state, we should be utilizing our EMS workers in more settings than just ambulances.

Arguments Against:

This does not differentiate at all between various levels of EMS providers, which can vary quite a bit in terms of education requirements from an EMT (over a hundred hours) to a paramedic (over a thousand). We should not have a less qualified and trained individual, like an advanced nurse or physician assistant, supervising another less trained and qualified individual like an EMT. There is no guarantee that EMS providers will pass on any savings from less expensive supervision options. They may very well just pocket it as profit.

How Should Your Representatives Vote on SB19-052

SB19-065 Peer Assistance Emergency Medical Service Provider (Garcia)

AMENDED: Minor

PASSED

Short Description:

Creates a peer health assistance program for emergency medical service providers funded through fees collected from initial or renewal of certification as an EMS provider. State board of health to select one or more providers to administer the program.

Long Description:

Creates a peer health assistance program for emergency medical service providers funded through fees collected from initial or renewal of certification as an EMS provider. State board of health to select one or more providers to administer the program. Program will provide for education and offer assistance of EMS personnel for the recognition and prevention of physical, emotional, and psychological problems. Also help refer for treatment, monitor status of those referred, and provide counseling and support.


Arguments For:

This is one of the highest stress fields in the country. The extraordinary stress combined with constant tragedy makes for a toxic stew. A recent study of Canadian EMS personnel found nearly ½ exhibited clinically significant symptom clusters for psychological problems, with much higher rates of PTSD, depression, and panic disorder than the general population. A national survey of US personnel found 58% of respondents unhappy with their mental health services, with many unhappy with being sent to non-trauma trained counselors. The program this bill creates would be driven solely by EMS needs and funded by EMS providers themselves.

Arguments Against:

EMS providers should not have to foot the bill for their mental well-being, given that their job is a critical public service. The state, on behalf of the taxpayers EMS providers serve, should fund this program.

With the skyrocketing costs of health care, we do not need to add yet more costs for operators in the field (or for the state if you went that payment route) to get passed on to consumers. The stigma around mental illness is just as responsible for the problems in this field and money won’t solve that. EMS providers are able to seek mental health treatment under their health insurance and should do so.

How Should Your Representatives Vote on SB19-065

SB19-073 Statewide System of Advance Medical Directives (Ginal) [Landgraf]

AMENDED: Moderate

PASSED

Short Description:

Directs the department of health to create an electronic system that allows medical professionals and individuals to upload and access advanced directives for medical treatment (or non-treatment). Requires a written signature from the individual for a medical professional to upload into the system.

Long Description: n/a

Arguments For:

A paper system is an obvious problem in this area, where the whole point of an advanced directive is to enable an individual to make their wishes known when their medical condition makes it impossible for them to do so in the moment.

Arguments Against:

Electronic systems are more vulnerable to hacking and literal life and death decisions shouldn’t be exposed in this manner.

How Should Your Representatives Vote on SB19-073

SB19-079 Electronic Prescribing Controlled Substances (Todd, Priola) [Esgar, Landgraf]

AMENDED: Moderate

SIGNED INTO LAW

Short Description:

Requires controlled substance prescriptions to be electronically transmitted to a pharmacy, with a few exceptions. Pharmacists do not have to verify the validity of exceptions for non-electronic prescriptions.

Long Description:

Requires controlled substance prescriptions to be electronically transmitted to a pharmacy, with a few exceptions. These are: technical failure at time of prescription; out-of-state dispensation; prescribing doctor is dispensing the controlled substance; prescription includes one or more elements that are not supported by the most recent version of the national council for prescription drug programs SCRIPT standard; FDA requirements mandate non-electronic transmission; prescription is not specific to a patient; prescription is for a substance under a research protocol; doctor writes 24 or fewer prescriptions a year; doctor is prescribing substance to be administered in medical facility; doctor determines patient would be unable to obtain the controlled substance in a timely manner and the delay would adversely affect the patient; doctor applies for and is granted an economic hardship waiver (not to exceed one year). Pharmacists do not have to verify the validity of exceptions for non-electronic prescriptions. Requirement goes into effect July 1, 2021. Doctors in rural areas or in single practice have until July 1, 2023 to comply.


Arguments For:

Part of getting a handle on our opioid epidemic is attacking prescriptions, which is generally the gateway into the addiction (not to mention all the rest of the prescription drug abuse that occurs in the state). We have the technology to make the much more secure and harder to forge electronic submission mandatory rather than optional. This bill does precisely that. It also should vastly reduce the chance for errors based on the notoriously poor handwriting of prescribers.

Arguments Against:

Allowing pharmacists to fill a written prescription without verification of the exception claimed does remove a large administrative roadblock for pharmacists and prescribers offices but unfortunately undercuts the purpose behind the bill. People scamming prescriptions may find ways around this by utilizing the exceptions.  It’s also a big burden on offices that haven’t transitioned yet to an electronic system, they’ll have a few years to do so under the bill’s terms but they’re going to have to eat whatever the associated costs are themselves.

How Should Your Representatives Vote on SB19-079

SB19-080 Colorado Department of Public Health and Environment Emergency Epidemic Preparedness (Zenzinger) [Arndt] TECHNICAL BILL

SIGNED INTO LAW

From the Statutory Review Committee

Short Description:

Removes obsolete language from the list of health care facilities required to be prepared for a disaster epidemic

Long Description: n/a

SB19-081 Repeal Cancer Drug Repository Act (Zenzinger) [Hooton] TECHNICAL BILL

From the Statutory Review Committee

SIGNED INTO LAW

Short Description:

Repeals the obsolete cancer drug repository act.

Long Description: n/a

SB19-082 Repeal Board of Health Authority over Colorado Department of Public Health and Environment Funds (Moreno) [McKean]

From the Statutory Review Committee

SIGNED INTO LAW

Short Description:

Repeals authority the state board of health actually does not have to accept, use, and administer money in some cases.

Long Description: n/a

SB19-098 Cost-Based Reimbursement for Rural Hospitals (Crowder)

KILLED BY BILL SPONSOR

Short Description:

Requires the state to reimburse rural critical access hospitals and sole community hospitals for outpatient services at 100% of actual cost for Medicaid clients. Currently critical access hospitals get 100% cost reimbursement from Medicare (federally managed) but are treated like all other hospitals in the state for Medicaid.

Long Description:

Requires the state to reimburse rural critical access hospitals and sole community hospitals for outpatient services at 100% of actual cost for Medicaid clients. Currently critical access hospitals get 100% cost reimbursement from Medicare (federally managed) but are treated like all other hospitals in the state for Medicaid. Critical Access Hospital is a designation given to eligible rural hospitals by the Centers for Medicare and Medicaid Services. Eligible hospitals must meet the following conditions to obtain designation: Have 25 or fewer acute care inpatient beds; be located more than 35 miles from another hospital (exceptions may apply); maintain an annual average length of stay of 96 hours or less for acute care patients; and provide 24/7 emergency care services.


Arguments For:

Congress created the Critical Access Hospital designation in 1997 in response to a string of rural hospital closures during the 1980s and early 1990s. They are by definition lone treatment oases in a hospital desert and are critical to providing health care to the regions they support. But because they serve such remote areas, they do not have the volume and variety of cases that other hospitals do and they therefore struggle with more traditional reimbursement schemes, particularly those based on outcomes and quality of care. One bad outcome can destroy a critical access hospital’s stats, where it might be a blip in an urban center. These hospitals also do not have access to the private payer revenue that helps more urban centers.

Arguments Against:

One of the things we have recognized in healthcare is that paying for what doctors and hospitals do results in a lot waste in the system. Providers are free to run any test or do any procedure and not worry at all about the cost (or if there is a less expensive way to do the same test or procedure) because they know they will get reimbursed for it. That is why there has been a large-scale shift toward paying for outcomes: provide the best care possible and you will be rewarded, regardless of how you did it. Creating exceptions to this model creates multiple points of potential cost overruns. Instead of a blank check, we need a nuanced approach that both takes into account these facilities unique situations and our need to keep medical costs down everywhere.

How Should Your Representatives Vote on SB19-098

SB19-110 Licensing Regulation Ambulatory Surgical Centers (Crowder) [Pelton]

KILLED IN SENATE COMMITTEE

Short Description:

Directs the department of public health and environment to license certain freestanding and office-based facilities performing outpatient procedures and adopt rules governing their operation.

Long Description: n/a

Arguments For:

Currently some places that perform outpatient procedures like liposuction and radiation treatments are not regulated to the same extent as facilities within a hospital or in some cases, not at all. A medical procedure is a medical procedure, we need a regulatory structure governing it to protect Coloradans both in terms of safety and in terms of cost.

Arguments Against:

These small facilities are nothing like hospitals and don’t need a host of new regulations dumped on them. They are of course, medical facilities, so the basics that go along with that are already present.

How Should Your Representatives Vote on SB19-110

SB19-133 Require License Practice Genetic Counseling (Ginal, Todd) [Michaelson Jenet]

AMENDED: Minor

PASSED

Short Description:

Creates a licensure requirement and structure for genetic counseling requiring an appropriate genetic counseling degree and national certification, with a few small exceptions. Also requires counselors to carry insurance and abide by mandatory disclosures of past activity required by the Michael Skolnik Medical Transparency Act.

Long Description:

Creates a licensure requirement and structure for genetic counseling requiring an appropriate genetic counseling degree and national certification, with a few small exceptions. Renewals require 30 hours of continuing education approved by national genetic counseling society. Also requires counselors to carry insurance and abide by mandatory disclosures of past activity required by the Michael Skolnik Medical Transparency Act.


Arguments For:

Genetic counseling is a medical field and we regulate medical fields for obvious reasons. This bill treats genetic counseling like any other medical field in the state. Licensure would also allow genetic counselors to get credentialed which would allow them to bill for their services and help grow the field. It also gives a place to adjudicate complaints, without licensure there is no place to complain. Right now anyone can call themselves a genetic counselor and give critical life and death healthcare advice to a patient. The idea that because this very new and emerging field doesn't have enough complaints yet, so we should wait until someone gets terrible genetic counseling advice and dies or suffers severe health problems is not how Colorado should operate. This is an incredibly complex and rapidly evolving field. We cannot afford to treat it lightly.

Arguments Against:

Requiring a license for this emerging field may stifle innovation and keep some people out. The boom in the industry may push us to a place where we actually have a shortage of genetic counselors. The state department of regulator agencies has not found a large level of consumer complaints in this field and does not think it warrants licensure. Genetic counselors have several nationwide certification boards that can provide the proof of knowledge and credentials we need.

How Should Your Representatives Vote on SB19-133

SB19-134 Out-of-Network Health Care Disclosures and Charges (Fields, Tate) [Soper]

KILLED IN SENATE COMMITTEE

Short Description:

Establishes that people who receive emergency care at an out-of-network facility are not responsible for any additional costs due to the care being out-of-network. The out-of-network facility or provider is to bill the insurance carrier directly, at rates established by the bill. People who receive non-emergency care at an in-network facility are required to have full disclosure from the facility of anyone who may be treating them that is out-of-network. The facility must give the patient the ability to choose an in-network provider, if available. If there is no in-network provider available, then the out-of-network provider is to bill the insurance carrier directly, at rates established by the bill. In both cases Individuals will still be responsible for any relevant in-network copays, deductibles, co-insurance, or unanticipated out-of-network services in the plan. If the out-of-network provider does not know the insurance status of the patient, they can bill the patient directly but only with full disclosure that they may be entitled to protection from out-of-network providers. Out-of-network providers can take insurers to arbitration with the state commissioner of insurance if they do not feel they were adequately compensated.

Long Description:

Establishes that people who receive emergency care at an out-of-network facility are not responsible for any additional costs due to the care being out-of-network. The out-of-network facility or provider is to bill the insurance carrier directly. The rate is the greater of: the carrier’s average in-network rate for the service in the same geographic area, 125% of the Medicare reimbursement rate, or 100% of the average in-network reimbursement for all of the same service provided in the previous year. People who receive non-emergency care at an in-network facility are required to have full disclosure from the facility of anyone who may be treating them that is out-of-network. The facility must give the patient the ability to choose an in-network provider, if available. If there is no in-network provider available, then the out-of-network provider is to bill the insurance carrier directly. The rate is the lesser of the actual billed rate or the minimum benefit standard. This is the greater of 150% of the 75th percentile of in-network reimbursements or the average of the same service in the same geographic area. For rural areas, these numbers change to 200% of the highest in-network amount or 200% of the average of the same service in the same geographic area. In all cases Individuals will still be responsible for any relevant in-network copays, deductibles, co-insurance, or unanticipated out-of-network services in the plan. If the out-of-network provider does not know the insurance status of the patient, they can bill the patient directly but only with full disclosure that they may be entitled to protection from out-of-network providers.

Out-of-network providers can take insurers to arbitration with the state commissioner of insurance if they do not feel they were adequately compensated. This can be for: not properly recognizing the provider’s training, education, and expertise; nature of services provided; available capacity of the provider’s practice; provider’s usual charge for services; circumstances and complexities of the case; and other relevant factors. Commissioner must set standard rules for arbitration, including forms, and a pool of arbitrators.


Arguments For:

Surprise! medical billing needs to be thing of the past. We cannot ask people to pick and choose between in- and out-of-network facilities in an emergency, and we are seeing far too many examples of people having a procedure done in-network who were completely unaware that the actual doctor was out-of-network and then get hit with a medical bill in the tens of thousands of dollars. These out-of-network doctors then get their collections agencies to go after people’s assets for repayment. One Colorado company, collecting for a small group of surgeons, has placed more than 170 liens on Denver-area homes since the start of 2017. Liens have been placed on the homes of patients who have received care in at least eight Denver-area hospitals. The system this bill creates allows everyone to know what they are getting into beforehand, doctors understand what sort of compensation they will be receiving, insurers know that they may be on the hook for out-of-network care in these circumstances, and most importantly, consumers know exactly what they will be paying. But it does this while balancing the need for providers to earn their living: by creating a separate rural standard and by ensuring that provider rates are high enough when we have out-of-network providers at an in-network facility. The system also allows an avenue for disputes.

Arguments Against:

This bill still leans too far in the direction of providers, who are getting paid too much on these scales in comparison to an in-network procedure. That cost does go the insurance company, but they aren’t going to eat it, they are going to pass it on to the rest of us in the form of higher premiums. In addition, the bill opens the door for endless arbitration. Of course every doctor thinks they are a special wallflower who deserves to be paid more than their peers. Insurers are on the hook for ½ of the cost unless the provider is such a serial arbiter that the commissioner of insurance notices and forces them to pay the entire cost. That’s more expense that is going to be passed on to consumers.

We should not be fixing health care prices. This could be devastating to out-of-network doctors, who rely on the fees that they charge in order to practice. If they are too restricted, they may not agree to perform services at all on people who are out-of-network, which could cause problems for patients receiving quality care, rather than having to endlessly go to arbitration and end up being the hook for all of the arbitration costs. As for emergency services, the added costs to our insurance providers aren’t going to be eaten by them. They will be passed on to the rest of us in the form of higher premiums.

How Should Your Representatives Vote on SB19-134

SB19-145 Sunset Continue Dialysis Clinic and Technician Regulation (Todd) [A. Valdez]

PASSED

Goal: To extend regulation of dialysis clinics and technicians.

Description:

Extends the regulation of dialysis clinics and technicians through 2026. Deletes some obsolete language in the statutes.

Additional Information: n/a

Arguments For:

The state department of regulatory agencies recommended that these regulations be extended indefinitely in their sunset review. From their report: “As the front-line providers of care in dialysis clinics, hemodialysis technicians must possess the proper education and training to safely perform routine dialysis tasks and to know when to alert the supervising nurse or physician to any concerning changes in a patient’s condition. Therefore, regulation is justified.” The changed federal regulatory environment referenced in Arguments Against happened in 2008, so it is not new and multiple sunset reviews have occurred in the time period since.

Arguments Against:

The same sunset report notes that “The regulatory environment has changed, however, since the General Assembly first imposed regulation on hemodialysis technicians. The federal Centers for Medicare and Medicaid Services now requires hemodialysis technicians to be certified. Now that there are explicit federal standards in place, the utility of continuing to subject Colorado’s hemodialysis technician statutes to sunset review is unclear.” Explicit federal standards means we don’t need additional state hoops. Time to let this one go.

How Should Your Representatives Vote on SB19-145

SB19-146 Sunset Home Care Agencies (Pettersen) [Kennedy]

AMENDED: Minor

PASSED

Goal: To continue regulation of home care agencies and implement suggestions of department of regulatory agencies.

Description:

Extends the regulation of home care agencies and placement agencies through 2028. Also repeals the $10,000 civil fine limit and moves any fine money collected to the general fund. Requires home care advisory council to include representatives of placement agencies.

Additional Information: n/a

Arguments For:

From the department of regulatory agencies sunset review report: “Home care agencies provide both skilled and personal care services to consumers, while placement agencies provide referrals to independent contractors to provide healthcare services to consumers. The Division protects the public from home care agencies and placement agencies that jeopardize their clients’ health… Therefore, the General Assembly should continue the regulation of home care and placement agencies for 11 years, until 2030.” On civil fines: Civil fines are an important regulatory tool to ensure compliance with existing requirements in the statute or applicable rules. Limiting the amount of fines on a licensee or registrant may compromise consumer protection. For example, if a home care agency reaches its civil fine limit, it may choose to relax regulatory standards because it cannot be fined any more money in a calendar year.”

Arguments Against:

The bill should have kept the removal of the fine limitation. From the sunset report: "Civil fines are an important regulatory tool to ensure compliance with existing requirements in the statute or applicable rules. Limiting the amount of fines on a licensee or registrant may compromise consumer protection. For example, if a home care agency reaches its civil fine limit, it may choose to relax regulatory standards because it cannot be fined any more money in a calendar year.”

How Should Your Representatives Vote on SB19-146

SB19-153 Sunset Podiatry Board (Fields) [Kipp]

AMENDED: Minor

PASSED

Goal: To continue the regulation of podiatrists and implement the suggestions of the department of regulatory agencies’ sunset review report.

Description:

Continues the regulation of podiatrists through 2026. Requires a podiatrist to notify the board of a physical illness, physical condition, or behavioral or mental health disorder that affects the podiatrist's ability to practice and allows the podiatrist and the board to enter into a confidential agreement to limit the podiatrist's practice based on the illness, condition, or disorder. Specifies that an examination approved by the board is required for initial licensure. Eliminates requirement that letters of admonition by board be sent by certified mail.

Additional Information: n/a

Arguments For:

From the department of regulatory agencies’ sunset review report: “Podiatrists perform medical and surgical treatments on the human foot and ankle, and podiatric treatment performed by an unqualified or incompetent practitioner could result in serious harm to a patient, including deformity, chronic pain and amputation of a toe, foot or lower leg. Considering the potential for harm, regulation of the profession is necessary, and the General Assembly should continue the Podiatry Board for seven years, until 2026.” As for the big change, the examination, this was part of the requirements for licensure but was inadvertently removed in 2010. This is a common practice for medical licensure (and podiatry licensure in other states).

Arguments Against:

We seem to be doing just fine without the examination in the law, even if its removal was inadvertent. That is perhaps because the podiatry board does require passage of an examination by its own rules. Let’s keep the board in charge of this, rather than dictate by legislative decree.

How Should Your Representatives Vote on SB19-153

SB19-154 Sunset License Regulate Psychiatric Technicians (Court) [Sirota]

PASSED

Goal: To continue the regulation of psychiatric technicians and implement the suggestions of the department of regulatory agencies’ sunset review report.

Description:

Continues the regulation of psychiatric technicians through 2034. Changes “accredited” to “approved” as description of education programs approved (but not accredited) by the board. Clarifies that discipline related to alcohol or substance abuse is for excessive or habitual use. Eliminates as grounds for discipline having a physical or developmental disability and instead subjects an individual for discipline for failing to warn the board of the disability or act within the confines of practicing safely with the disability. Allows the board to enter confidential agreements with individuals with these disabilities surrounding their limitations. Removes terms “willfully” and “negligently” from grounds for discipline. Eliminates requirement that letters of admonition by board be sent by certified mail.

Additional Information: n/a

Arguments For:

From the department of regulatory agencies’ sunset review report: “Without LPTs, the Colorado Mental Health Institute and the regional centers that serve people with intellectual and developmental disabilities would struggle to provide services to their patients, which would put the patients’ health and safety at risk. Therefore, the General Assembly should continue the licensing and regulation of LPTs for 15 years, until 2034.”

Arguments Against: n/a

How Should Your Representatives Vote on SB19-154

SB19-164 Sunset In-Home Support Services Program (Todd, Crowder) [Mullica]

AMENDED: Moderate

PASSED

Goal: To continue the in-home support services program and implement the recommendations of the department of regulatory agencies’ sunset review report.

Description:

Extends the in-home support services program, which allows Medicaid beneficiaries to continue to live in their communities and avoid placement in institutional care, through 2026 2028. Also makes some technical changes.

Additional Information: n/a

Arguments For:

From the department of regulatory agencies sunset review report: “IHSS offers a unique combination of independence and institutional support. It allows participants the freedom to direct their own care, while having an IHSS-certified agency on hand to provide administrative assistance and resources, including 24-hour backup attendants. Among stakeholders interviewed for this review, there is strong, often passionate, support for IHSS. Not only is IHSS well-received and increasingly popular, it is also cost-effective. HCPF data demonstrate that long-term care services provided via IHSS cost on average 30 percent less than those delivered via nursing facilities.”

Arguments Against: n/a

SB19-193 Sunset Continue Colorado Medical Practice Act (Ginal, Lee)

AMENDED: Minor

PASSED

Goal: To continue licensing medical professionals under the Colorado Medical Practice act and implement some of the suggestions of the state department of regulatory agencies’ sunset review report.

Description:

Extends the Colorado Medical Practice act through 2026. Eliminates restriction on number of days a physician may practice in a calendar year with a pro bono license. Removes requirement letters of admonishment be sent by certified mail.

Additional Information: n/a

Arguments For:

From the state department of regulatory agencies’ sunset review report: “Medical or surgical treatment performed by an unqualified or incompetent medical provider could result in serious harm to a patient, including disability and death. Considering the potential for harm, regulation is necessary to ensure competent and qualified practitioners. Therefore, the General Assembly should continue the Board for seven years, until 2026.”

Arguments Against: n/a

How Should Your Representatives Vote on SB19-193

SB19-195 Child and Youth Behavioral Health System Enhancements (Fields, Gardner) [Kraft-Tharp, Landgraf]

AMENDED: Completely. Brand new bill

PASSED

Goal: To create a permanent structure in the government to improve Colorado’s youth behavioral health system. To improve quality of behavioral health care through increased wrap-around services, standardized tools, and a statewide referral program.

Description:

Creates the office of children and youth behavioral health policy coordination in the governor’s office, as well as a commission and an advisory council in that office. Commission is to provide leadership and coordinate efforts among state agencies and departments to improve the child and youth behavioral health system in Colorado, in particular it is tasked with implementing wraparound services for children and youth at risk of out-of-home placement. Council is designed to be a larger, advisory body. Entire structure is set for sunset review in 2024 2025. Directs state to ask federal government for Medicaid waiver to implement wrap-around services for behavioral health care. If waiver granted, requires managed care entities to implement wrap-around services. State may use targeting criteria to ramp up to 100% usage. Requires state to create standardized screening and assessment tools in one year for use by state and primary care providers. Must also create a plan for establishing a single state-wide referral and entry point for children and youth in one year. Within two years state must recommend pilot program to integrate funding across the state to serve children and youth.

Additional Information:

Exact duties of the commission are:

  • Provide leadership to increase and enhance efficient and effective youth and child behavioral health services
  • Coordinate among state agencies and departments to increase public awareness and understanding
  • Recommend policies to remove barriers to cooperation among communities, state departments, and other political state entities
  • Monitor network adequacy
  • Compile and disseminate best practices
  • Recommend funds in each department that can be used for collaborative delivery systems
  • Recommend performance measures for each department, office, and county represented on commission.

For wrap-around services, commission is tasked with:

  • Recommending a single assessment tool to all affected departments
  • Recommending standardized screening tools for primary care providers that can be used statewide and culture-wide
  • Design and recommend a delivery pilot system that addresses challenges of fragmentation and duplication of health services

Commission also tasked with:

  • Recommending a process to create a single statewide referral and entry point for children and youth
  • Ensuring proper training on all of these creations and recommendations
  • Mental health care professional workforce development and retention
  • Behavioral health training for educators in local schools
  • Residential child care facility closures
  • Data and transparency requirements
  • Quality improvement initiatives
  • Transition into adult systems
  • Screenings and referrals in middle and high school
  • Children in juvenile justice system
  • Meeting needs of those with co-occurring diagnoses

Commission is composed of 15 voting members:

  • Executive directors of departments of health care policy and financing, human services, public health and environment, and public safety
  • Attorney General
  • Commissioners of department of education, and of insurance
  • Ombudsman for behavioral health care access and the one for child protection
  • Director of office of children and youth behavioral health care policy coordination (this bill’s creation)
  • Representative of statewide association of counties appointed by governor
  • One member each appointed by four majority and minority leaders in assembly
  • Designees are not permitted except in extenuating circumstances

Council is 25 members and composition is as follows (appointed by governor):

  • County commissioner Two county representatives, one from an urban county and one from a rural county.
  • Representative of police department or sheriff’s office
  • Director of county department of human or social services
  • Representative of local collaborative management program
  • Representative of community mental health center serving children and youth
  • Representative of substance use disorder treatment provider serving children and youth
  • Mental health professional or psychiatrist with clinical experience working with children and youth
  • Primary care provider with experience working with children and youth
  • Individual representing a family-run organization whose explicit purpose to serving families of children and youth with behavioral health disorders
  • Individual from organization representing children and youth with co-occurring disorders
  • Representative of school districts
  • Mental health professional with clinical experience with children under age of 5
  • Representative of Colorado commission on criminal and juvenile justice
  • Representative of state suicide prevention commission
  • Representative of residential child care facility
  • Representative of court-appointed special advocates for children
  • Representative of organization that addresses child maltreatment
  • Representative of a district attorney’s office
  • Representative of a general hospital
  • Administrator of a managed care entity
  • Administrator of the behavioral health crisis response system
  • Three members who are children or youth representing children or youth with behavioral health disorders

Wrap-around care means a high-fidelity, individualized, family-centered, strengths-based, and intensive care planning and management process.


Arguments For:

In 2017 suicide was the leading cause of death for children and youth ages 10-24 in Colorado. We have one of the higher suicide rates in the nation. Childhood and adolescence are critical periods of risk for the onset of a behavioral health disorder. Nationally, half of all lifetime cases of mental illness begin by the age of 14 and three-quarters begin by the age of 24. Children and youth may be exposed to trauma, maltreatment, and other adverse childhood experiences that may be risk factors for behavioral health diagnoses in adolescence and adulthood, and there is a need to strengthen the protective factors for child and youth health and safety because children and youth have unique physical and behavioral health needs. Additionally, many children and youth are left undiagnosed and untreated because they have not been exposed to adverse childhood experiences or do not show outward signs that would identity the child or youth as at risk. We need better statewide coordination in this effort, both to align efforts in the same direction and also to do a more efficient job of utilizing the resources we have. This bill creates a powerful office with a powerful commission with real teeth with specific goals to achieve and a wide mandate to do even more. You are not going to get anywhere without getting the people with the real power in the system involved, and that is exactly what this bill does.

Arguments Against:

We know what the main problem is, and it isn’t departments not coordinating with each or not having the exactly correct screening or assessment tools. It’s resources. We do not have enough resources at just about every level of behavioral health care in this state. We don’t pay providers well enough, we don’t have enough mental health resources in schools, we don’t have enough system capacity, and we don’t have anywhere near the level of parity we need with the rest of the health care system. Instead of being treated like the life or death necessity that it is, behavioral health is treated like a nice add-on, good to have but maybe something we can’t afford for everyone. And a commission or council or government office may not have any sort of lasting impact unless we truly devote more resources to the entire system. So while it may seem that this bill won’t do any harm, in fact it may delay further the hard decisions we have to make as a society about allocating our resources and may hold out false hope of solutions that don’t involve more money.

This committee and council structure may be too large and unwieldy to achieve the results we are looking for. By including everyone, you risk bogging down everything. Each member has their own turf and their stakes to protect, and when the goal is to break down barriers and increase collaboration, sometimes outsiders with the authority to tell people what they need to do work better than getting everyone in the same room and hoping they can come to an agreement.

How Should Your Representatives Vote on SB19-195

SB19-197 Continue Complementary or Alternative Medicine Program (Zenzinger) [Kennedy]

AMENDED: Technical

PASSED

Goal: To continue the state’s complimentary or alternative medicine pilot program for spinal cord injuries through 2025.

Description:

Extends the state’s complimentary or alternative medicine pilot program for spinal cord injuries, set to expire next year, through 2025.

Additional Information: n/a

Arguments For:

This program allows people with spinal cord injuries to receive complimentary (not free, but additional) or alternative medicine for their injuries. These treatments provide additional benefits to the injured and help keep our Medicaid costs down, as well as preventing people from searching for alternative methods to manage pain, like opioids or other drugs. People in the program have reported higher quality of life from these treatments.

Arguments Against:

This program needs some expansion. People who do not have spinal cord injuries cannot qualify, this leaves out people with genetic disorders. People who benefit from medical malpractice lawsuits and are on Medicare cannot benefit from the waiver either.

How Should Your Representatives Vote on SB19-197

SB19-219 Sunset Continue Licensing of Controlled Substances (Pettersen) [Gonzales-Gutierrez]

AMENDED: Minor

PASSED

Goal: To continue the licensing of controlled substances act and implement the recommendations of the department of regulatory agencies’ sunset review report.

Description:

Continues the licensing of controlled substances act through 2026. Requires department of human services to develop and implement a formal, simple, accurate, and objective system to track and categorize complaints and disciplinary actions. Directs department of human services to develop a secure online central registry for licensees to submit information.

Additional Information: n/a

Arguments For:

From the sunset review report: “The Act is the law which authorizes the licensing and regulation of the facilities that treat addiction with controlled substances. Opioid medication-assisted treatment (OMAT) programs typically use methadone, buprenorphine, and naltrexone, all of which are controlled substances, in treatment. The main regulatory focus of the Act is making certain that diversion of the controlled substances used in treatment does not occur. The existence of OMAT programs is an important tool for public protection as is the regulation of such facilities to prevent drug diversion. However, because conditions around such issues are dynamic and constantly changing, the General Assembly should continue the Act for only seven years, until 2026.” As for the central registry, “There have been multiple problems with the antiquated system employed by OBH. The criteria that direct sunset analysis asks analysis to consider if an agency’s operations are impeded by current procedures and practices, and whether duties are performed efficiently and effectively.”

Arguments Against: n/a

How Should Your Representatives Vote on SB19-219

SB19-222 Individuals at Risk of Institutionalization (Lee, Story) [Esgar, Landgraf]

AMENDED: Minor

PASSED

Goal: To have the state develop and then execute plans to prevent Medicaid recipients with severe behavioral health disorders from being involved with the criminal justice system and to create a behavioral health safety net system to provide better treatment for these people statewide.

Description:

Requires state to develop incentives for behavioral health providers to accept Medicaid recipients with severe behavioral health problems and determine if we need to seek a federal waiver to implement in-patient stays past 15 days and if not, develop an alternative plan. Requires access to inpatient civil beds to be based on need of individual and not geographic location, current health provider, or payer type. Creates a community behavioral health safety net system, which requires state to determine what a high-intensity behavioral health treatment program looks like, what an adequate network of these programs looks like, and what existing options we have. Then develop a plan to increase the number of programs to ensure adequate access statewide. Finally the state must, with the help of an advisory body the bill creates, develop a safety net system for individuals with severe behavioral health problems that will provide treatment regardless of the individual.

Additional Information:

Incentives for providers may include:

  • Higher reimbursement rates
  • Quality payments to regional accountable entities for expanded networks
  • Establishing performance measures and performance improvement plans for network expansion
  • Transportation solutions for Medicaid recipients to attend appointments
  • Outreach to Medicaid recipients to ensure they are engaged in needed services

High-intensity behavioral health treatment program must at minimum include:

  • Program with evidence of effectiveness at engaging and treating individuals with severe behavioral health disorders
  • Program that conducts extensive outreach to high-risk populations that are known and unknown to current health systems
  • Availability for individuals under civil commitment and those involved with or at-risk of involvement with the criminal justice system, including individuals with co-occurring mental health and substance use disorders.

Implementation plan for adequate network of high-intensity behavioral health treatment programs must include:

  • Funding or legislative appropriations required
  • Costs associated with creating a program
  • Potential cost-sharing opportunities with municipalities and counties
  • Recommendations on local zoning barriers, transportation, housing, and workforce
  • How plan will cover entire state

Advisory body is not specifically defined, but should include relevant state departments, representatives from law enforcement, consumers, and advocates. Voting members cannot include behavioral health providers with a potential financial stake in the outcome.

Safety net proposal must include, at minimum:

  • What behavioral health services each community must have in each region of the state
  • An adequate funding model that does not supplant existing funding
  • Recommendations to address barriers, including licensing, housing, transportation, and workforce
  • Criteria for when needs of an individual referred to safety net provider exceeds ability of the provider

Safety net system must consider community mental health centers, managed service organizations, contractors for the state behavioral health crisis response system, and other behavioral community providers as key elements in the system and at minimum:

  • Not refuse treatment based on ability to pay or type of insurance coverage, clinical acuity, readiness to transition out of state or private mental health institutes due to no longer requiring in-patient care, involvement in criminal or juvenile justice or child welfare systems, co-occurring disorders or disabilities, or displays of or history of aggressive behavior
  • Proactive engagement of hard-to-serve individuals with care management and care coordination
  • Promote competency in de-escalation techniques
  • Achieve timely access to treatment including both high-intensity and community-based treatment
  • Require robust collaboration with all law enforcement jurisdictions and counties
  • Triage care for those who need it outside the scope of the system
  • Promote patient-centered care and cultural awareness
  • Update information about available treatment options and outcomes as requested by state
  • Utilize evidence-based or evidence-informed programming


Arguments For:

Colorado has experienced a dramatic increase in the number of individuals with severe behavioral health disorders who are arrested and incarcerated, often for low-level crimes, and whose competency to assist in their own defense is questioned. To date, Colorado has not consistently evaluated or treated such individuals in a timely and clinically appropriate manner, resulting in lawsuits and millions of state taxpayers' dollars unnecessarily spent. In addition, the last thing people with high-intensity behavioral health problems who have committed low-level crimes need is prison, they need treatment. This will also save the state money in our corrections division. All Coloradans should have access to a high-quality behavioral health system that serves individuals regardless of payer type or acuity level and that has a full continuum of behavioral health treatment services, and all of that is what this bill sets to out to do. Not by dictating a program from on high, but by requiring the people who can create such a program to get together and tell us what they need to make it a reality.

Arguments Against:

This bill dances all around the problem without attacking it squarely, which is funding. We don’t have adequate behavioral health care in this state because we don’t fund it and we don’t force insurance companies to treat it equally to physical health. So we don’t have enough providers, we don’t have enough high quality workers, and thus we have loads of people who fall through the cracks. So we have an entire set of things the state must do in this bill, but anything that requires money is put-off to another bill for another day.

How Should Your Representatives Vote on SB19-222

SB19-227 Harm Reduction Substance Use Disorders (Pettersen, Gonzales) [Kennedy, Herod]

AMENDED: Moderate

PASSED

Short Description:

Allows schools to develop policy that authorizes them to obtain opiate antagonists (drugs that can stop opioid overdoses) and train employees to administer them to individuals at risk of an overdose. Also specifies that hospitals may be used as a clean syringe site and expands household medication take-back program to include needles and syringes. Requires state to make mobile response units available for purpose of providing medication assisted treatment in jails. Requires anyone making an external automated defibrillator available to also make an opiate antagonist available. Creates a Naloxone (opiate antagonist) bulk purchase fund that eligible entities can purchase from. Prohibits state from penalizing a facility that starts medication-assisted treatment with an individual who does not have identification. Individual has 6 weeks to provide required documentation to continue treatment.

Long Description:

Allow school governing bodies to create policies that allow schools to acquire opiate antagonists and have them available in the school to be administered by an employee or agent of the school that has received appropriate training. Exempts employees or agents of the school acting in accordance with policy from prosecution. Expands the clean syringe exchange program to include licensed or certified hospitals and expands household medication take-back program to include needles, syringes, and other devices used to inject medication. Requires state to make mobile response units available for purpose of providing medication assisted treatment in jails. Requires anyone (with exception of schools) that makes an external automated defibrillator available to also make an opiate antagonist available. They are eligible to purchase Naloxone (opiate antagonist) from the state. Anyone acting in good faith who uses the antagonist is exempt from prosecution. Creates a Naloxone bulk purchase fund, which is funded by purchases from eligible entities, gifts, and donations and any general fund money appropriate (none is in the bill). State can contract with a provider to acquire the Naloxone and create the rules regarding pricing.


Arguments For:

This is literally a bill about savings lives. Properly administered opiate antagonists can save someone at risk of an overdose but the time frame for such an act is short. A school that has to call in emergency help from the outside might be too late to save a student. Jails are another high-risk area where additional state help is welcome. Where we have public defibrillators to save lives we should also have antagonists to save lives. Getting dirty injection devices out of commission perfectly meets the ideals of the drug takeback program. Since we need all of this Naloxone, why not leverage the state to buy in mass bulk to take advantage of bulk discounts and then allow facilities to buy at that same lower cost from the state?

Arguments Against:

This creates too many winners and losers in the Naloxone market by making the state in essence a price controller for qualified entities. We don’t do state controlled medicine in Colorado for other things, we should not for Naloxone.

We shouldn’t be asking people in schools and even on the streets to take the burden of trying to successfully administer a drug to save someone from an overdose.

Syringe exchange programs are just encouragement for people with drug problems. We should be focusing on getting them off drugs, not giving them clean needles.

How Should Your Representatives Vote on SB19-227

SB19-228 Prevention of Opioid and Other Substance Use (Winter, Moreno) [Buentello, Singer]

AMENDED: Moderate

PASSED

Short Description:

This bill has 9 components. Component 1 requires certain health care providers who write prescriptions to complete substance use disorder training to renew their license. Component 2 prohibits doctors or physician’s assistants from accepting any direct or indirect benefits for prescribing a certain medication. Component 3 requires opioids for outpatient use to have a warning label. Component 4 expands access to the prescription drug monitoring program (used to catch drug seekers) to medical examiners. Component 5 gives $5 $3 million of general fund money to address opioid and other substance abuse priorities. Component 6 gives the legislature a better idea of how much federal money is available/being used for HIV and hepatitis testing and makes sure primary care providers are aware of eligibility requirements. Component 7 creates two grant programs to focus on at-risk youth and their families who have not been successful in seeking aid and creates more state positions to help local communities acquire grants. Component 8 creates and funds a public awareness campaign around safe use, storage and disposal of opioids and availability of antagonist drugs. Component 9 creates pilot programs for detection and intervention for substance use disorder in prenatal and postpartum care.

Long Description:

Component 1: Requires podiatrists, dentists, advanced practice nurses, optometrists, and veterinarians to complete substance abuse disorder training to renew their license.

Component 2: Prohibits doctors or physician’s assistants from accepting any direct or indirect benefits for prescribing a certain medication. Specifies that any benefits offered regardless of doctor or physician assistant activity do not apply.

Component 3: Requires any prescribed prescription drug for outpatient use that contains opioids to have the following warning label: CAUTION: OPIOID. RISK OF OVERDOSE AND ADDICTION                                                                                                                             Component 4: Allows medical examiners, if they are investigating a death with suspicious, unnatural or unusual circumstances, to access the dead individual’s information in the state’s prescription drug monitoring program.

Component 5: Grants $5 $3 million of general fund money for addressing opioid and substance use disorders through public health interventions and to work with community partners, including local governments.

Component 6: Requires the state to submit amount of federal funds it is receiving or eligible to receive for HIV and hepatitis testing and the number of people currently and anticipated being tested.  Also requires the state to prepare materials describing eligibility standards for these tests to be distributed to primary care providers throughout the state.

Component 7: Creates two grant programs to create pilot programs with the goal of preventing youth opioid use and supporting youth with family addiction problems. Gives $6 million of general fund money to fund the programs.

Component 8: Requires the state center combating substance use disorders to create a public awareness campaign around safe use, storage and disposal of opioids and availability of antagonist drugs (also gives annual $750k to fund the program from the Marijuana tax fund). Campaign and funding go away in 2024. The center must also hire additional staff to help local communities acquire grants.

Component 9: Creates multiple pilot programs to address substance use disorder detection and treatment referral (frequently called SBIRT interventions) in prenatal and postpartum care. One program is under the state center combating substance use disorders, which is first required to a statewide assessment to get the most accurate lay of the land, and is in five counties (Alamosa, Boulder, Denver, El Paso, and Pueblo). The state is designated to work with the College of Nursing at the University of Colorado. This program is given $228,000 from the Marijuana cash fund. The College of Nursing is also given another pilot in the same counties to provide training and technical assistance to health care providers. This program is given $172,000 from the Marijuana cash fund. Finally, a pilot is created to integrate substance use disorder and medication assisted treatment with obstetric and gynecological care for three larger facilities and six clinics. Facilities and clinics will apply for grants under the pilot. The bill directs the assembly to give money to the office of behavioral health to run the program but does not specify an amount.


Arguments For:

While complicated, in essence this bill is about attacking opioid abuse at several critical areas: expanding the numbers of providers who are required to get training (since drug seekers always find the weaknesses in a system), expanding access to the state’s prescription drug monitoring program, increasing public awareness through both media and a simple warning label, and providing more resources for at-risk youth and women in the process of having a child. The number of newborns affected by opioid exposure increased 83% from 2010 to 2015 and accidental drug overdose was the leading cause of death among postpartum women from 2004 to 2012. Pilot programs are used here because we are doing something new and when we do something new it is always best to do it small and in multiple different ways at first to figure out what is going to be most effective before potentially wasting millions of dollars (and perhaps some lives) on statewide solutions that may not be the right ones.

Arguments Against:

This bill needs more muscle behind its goals, while the Legislative Staff is assuming everything gets fully funded (with over $2 million in general fund and marijuana cash fund money that is not specifically mentioned by the bill), there are no guarantees.

Pilot programs are nice, but move too slowly. Because this is a crisis, we need to be willing to do some things wrong while moving faster to bring a broader impact across the state.

This bill adds a lot of unnecessary red tape to the state’s bureaucracy: prescribers that barely interact with people getting opioids, more cumbersome rules for doctors around what they are allowed to accept from drug companies, nanny state labeling requirements, and wasting medical examiner’s time by playing detective instead of using the body they have in front of them.

How Should Your Representatives Vote on SB19-228

SB19-234 Sunset Professional Review Committees (Rodriguez, Foote) [Weissman]

PASSED

Goal: To continue the professional review committee and implement the recommendations of the state department of regulatory agencies’ sunset review report.

Description:

Continues the professional review committee through 2030. Clarifies that data and which governing board reported it may be known to the staff of the division of professions and occupations. Require governing boards to update their basic information annually. Establishes a process to remove a board from the registry.

Additional Information: n/a

Arguments For:

From the department of regulatory agencies’ sunset review report: “The Act is necessary to protect the public because it provides health-care facilities and other entities the ability to review the conduct of practitioners. Without its protections, colleagues would be less likely to report substandard or inappropriate conduct, and they may also be unwilling to share information during a review in case the information they provide is used in a lawsuit. In order to ensure the open and honest discussions necessary to improve patient care in health-care facilities and other professional review entities, the Act should be continued.” For the governing boards, that information can get out-of-date within a few years but right now boards are required to keep it updated after initial registration. There is also no mechanism for the division to remove a board from its registry even if the board no longer exists.

Arguments Against: n/a

How Should Your Representatives Vote on SB19-234

SB19-238 Improve Wages and Accountability Home Care Workers (Danielson, Moreno) [Kennedy, Duran]

AMENDED: Significant

PASSED

Goal: To increase the wages of home care workers while also increasing accountability and training.

Description:

Requires home care service agencies to pay at least $12.41 per hour minimum wage 77% of funds received from the Colorado Medical Assistance Act to non-administrative personnel wages. Directs state to seek an 8.1% increase in federal reimbursement rate. Agencies to pay 100% of any increases to employees providing the services in first year and 85% in next year. Requires each agency to annually submit proof of wage payment as well as full contact information for each non-administrative employee along with their most recent date of completion of training or skills validation. Department is to make report public, but can redact employee information under certain circumstances. Requires state to establish a process for enforcing initial and ongoing training requirements. Creates a stakeholder group to review training standards, how to enforce them, and if any standards are required.

Additional Information:

To redact employee information one of the following conditions must be demonstrated:

  • Victim of domestic violence, sexual assault, or crime of violence
  • Subject of protection order issued by court against another individual
  • Under extraordinary personal circumstances that require an exception to the disclosure requirement

State to do random inspections of books to look for violations of wage rules. Violators are required to pay remaining amount owed and may be subject to penalty from the state of up to $1,000 per employee.

Arguments For:

There are thousands of Coloradans who depend on assistance of home care workers to maintain their independence and live in their homes. But we have a shortage of workers right now, and the state population is set to age further in the coming years, which will lead to more need for home care workers. So we need to further incentivize this job by increasing wages, which too often right now are minimum wage. Think about that: one of the most trusted fields in our state, the care of an elderly or disabled loved one in their home, are paid poverty wages. This bill ensures that agencies employers aren’t taking more than their fair share of the proceeds any rate increases go directly these workers. It also creates a group to review existing training standards, how to enforce them, and if there are new standards that need to be adopted.

Arguments Against:

This is a massive intrusion into the operating of these businesses, by requiring them to spend a specific amount on salaries. And these agencies need to sink money into structural development and expansion as well as salaries and forcing these agencies into spending these amounts in specific ways may be counterproductive in growing the industry. Also, home health care workers probably won’t want their personal information splashed on a public website.

The revised bill doesn’t go far enough, the new minimum salary is barely above minimum wage and not indexed to any future minimum wage increases.

SB19-242 Emergency Medical Service Providers Licensing (Garcia)

PASSED

Goal: To allow EMS personnel to get licensure if they want to.

Description:

Allows certified EMS personnel to apply for licensure from the department of public health and environment based on demonstration of achievement of a four-year bachelor’s degree program from an accredited college or university.

Additional Information: n/a

Arguments For:

This serves two purposes. First it allows EMS personnel who have achieved their degree, which should increase their professional opportunities and compensation. Second, it helps increase the professionalism of the field by encouraging EMS to achieve their degree, which will improve the quality of care that all Coloradans receive. This will not affect the scope of practice of EMS workers.

Arguments Against:

The bill doesn’t specify what types of four-year degrees are required and could result in the rule making process coming up with degrees that don’t fit.