2015 end-of-session legislative recap
Susan Koontz, JD, CMS General Counsel
The Colorado Medical Society advocates for Colorado physicians and their patients in a tough legislative environment. In the 2015 regular session of the Colorado General Assembly, legislators addressed telehealth, clean claims, out-of network provider rates, scope of practice, women’s and children’s health issues, transparency in health care prices and Medicaid, among many other issues.
CMS lobbied for or against more than 50 bills to ensure legislation benefits physicians professionally and helps improve the health and wellness of Colorado patients. The CMS Council on Legislation (COL) and its policy and public affairs professionals reviewed each bill to understand its intent, its possible outcomes and the political landscape to collectively determine how and at what level CMS should engage. Demonstrating that organized medicine in Colorado is not an oxymoron, CMS, state and component medical societies united on numerous bills to enhance impact and assure positive outcomes. The accomplishments of the session can be divided into six categories, as follows.
SB 15-259: Out-of-Network Health Care Provider Charges
CMS worked diligently and tirelessly alongside various component societies, stakeholders and lobbyists, to oppose this bill with the common goal of creating an interim study, which had been agreed to by the Colorado Association of Health Plans (CAHP) and CMS. The bill was heard on April 20 before the Senate Business, Labor and Technology Committee. On that day, CMS President Tamaan Osbourne-Roberts, MD, along with CMS physician members Ron Lepoff, MD, David Markenson, MD, Ron Pelton, MD, PhD, David Friedenson, MD, Eric Olsen, MD, John C. Kefer, MD, F. Brent Keeler, MD, Peter Ricci, MD, James Regan, MD, and J.T. Boyd, MD, and practice managers Melissa McCormick and Jennifer Souders, testified in opposition to this bill. See the cover story on page 8 for more details. The bill was killed at that hearing by a vote of 5 (Republicans) - 4 (Democrats).
SB 15-057: Clean Claims Task Force Reporting
The CMS-supported Medical Clean Claims Task Force continues to work toward development of a standardized set of claim edits. The creation of a uniform set of claim edits and payment rules enable claims to be filed with any payer using one uniform set of transparent rules. This bill continues this work and was signed into law by Gov. John Hickenlooper on March 18.
SB 15-074: Transparency in Health Care Prices Act
CMS lobbied in opposition of this bill, which would have required all physicians to provide a list of estimated charges upon patient request. CMS supports transparency in health care billing; however, this bill would have created unnecessary administrative burdens on physicians. The bill was heard before the House State, Veterans and Military Affairs Committee on March 18. On that day, F. Brent Keeler, MD, and Murray Willis, MD, testified in opposition to the bill. The bill was killed by a vote of 6 (Democrats) - 5 (Republicans). CMS has agreed to work with the bill sponsor Sen. Tim Neville (R-Littleton) over the interim, to address his concerns about transparency and physician charges.
HB 15-1029: Health Care Delivery Via Telehealth Statewide
We are pleased to report that the governor signed the telehealth bill on March 20. This bill was initiated by the CMS House of Delegates and CMS Past President John Bender, MD. Passage of this legislation removes the population limitation of 150,000 or fewer residents for telehealth regardless of where a person resides in our state and will now ensure that more Coloradans are afforded timely access to high-quality primary and specialty health care. This law also requires health plans to reimburse physicians the same amount for a telehealth encounter as a physical encounter.
HB 15-1281: Newborn Heart Defect Screening Pulse Oximetry
This bill would require that all newborns born in a birthing center that is located at an elevation below 7,000 feet be screened for congenital health defects using pulse oximetry prior to the infant leaving the health facility. Pulse oximetry is a noninvasive test that estimates the percentage of hemoglobin in blood that is saturated with oxygen and, when performed on newborns in delivery centers, is effective at detecting critical, life-threatening congenital heart defects that might otherwise go undetected using current screening methods. It is believed that many newborn lives may be saved by the use of the screening required by this bill.
COL voted to support this bill, which passed through both the House and the Senate.
SB 15-071: Pharmacist Substitute Interchangeable Biological
CMS supported this legislation, which allows a pharmacist to substitute a biological product if the FDA has determined that the biological product is therapeutically equivalent with the prescribed biological product and if the physician has not indicated that the prescription must be dispensed as written. The governor signed SB 15-071 into law on April 3.
SB 15-228: Medicaid Provider Rate Review
This bill establishes a process enabling the Department of Health Care Policy and Financing to review provider fee rates under the Colorado Medical Assistance Act. The bill will create a Medicaid Provider Rate Review Advisory Committee consisting of 24 members who will serve without compensation and reimbursement for expenses. The president of the Senate, speaker of the House of Representatives and minority leaders of the Senate and House will appoint these members. There will be three physicians on this committee: CMS will recommend one specialist to be appointed by the House speaker, a statewide association for primary care physicians will recommend another physician member, and the third physician member of facility-based physicians (which includes anesthesiologists, emergency room physicians, neonatologists, pathologists and radiologists) will be appointed by the House minority leader. The long bill will include a 0.5 percent across-the-board increase in all Medicaid reimbursement rates with a few providers excluded. The bill passed through both the House and the Senate.
Scope of practice
HB 15-1075: Registered Naturopathic Doctor Treating Children
Under current law, registered NDs have been prohibited from treating a child who is under 2 years of age. This bill permits NDs to do so when they have met the following requirements: provided the child’s parents the current recommended immunization schedule for children; successfully completed five hours per year of education or practicum training solely related to pediatrics; obtained a signed informed consent from the child’s parents; has, on the first visit, referred a child who does not have a relationship with a pediatric health care provider to a licensed physician who treats pediatric patients for a wellness evaluation; and has complied with director rules pertaining to training, referral and communication requirements.
COL supported this bill, which passed through both the House and the Senate and was signed by the governor on March 26.
HB 15-1182: Scope of Practice Certified Nurse Aides
Prior to the introduction of this legislation, certified nurse aides (CNAs) had been performing certain tasks. However, due to the rescission of policy guidelines, the filing of this legislation was necessitated. HB 15-1182 allows a CNA to perform the following tasks: digital stimulation, insertion of a suppository or the use of an enema, or any other medically acceptable procedure to stimulate a bowel movement; G-tube and J-tube feedings; and placement in a client’s mouth of presorted medication that has been boxed or packaged by a registered nurse, a licensed practical nurse or a pharmacist. (C.R.S. § 12-38.1-108.5 added.)
COL voted to support this bill, which passed through both the House and the Senate. The measure became law on March 31.
HB 15-1352: Naturopathic Doctor Formulary Changes
The COL scope of practice workgroup along with the NDs worked together on the draft bill for more than a year. The bill, similar to the Direct Entry Midwife statute, allows NDs to obtain and administer (not prescribe) medications from registered or licensed wholesalers, manufacturers or prescription drug outlets, including providing the medication; obtaining and administering saline, sterile water, topical antiseptics and local anesthetics, including those with epinephrine, in connection with minor office procedures; obtaining and administering oxygen in emergency situations; prescribing and administering vitamins B6 and B12; obtaining, administering or dispensing FDA-regulated substances that do not require a prescription to be dispensed; and obtaining and administering vaccines, in accordance with the ACIP guidelines, for patients who are at least 18 years of age.
The bill passed through both the House and Senate without amendment.
HB 15-1360: Acupuncturists Practice Injection Therapy
Since 1999 acupuncturists have engaged in injection therapy under a policy adopted by the Colorado Office of Acupuncture and Licensure. Due to change in the pharmacy laws, acupuncturists are unable to obtain substances for injection therapy. This bill provides statutory authority for the acupuncturists to obtain these substances. Injection therapy is defined as the injection of sterile herbs, vitamins, minerals, homeopathic substances or other similar substances into acupuncture points by means of hypodermic needles. The bill also requires acupuncturists to obtain substances for injection therapy from a registered prescription drug outlet, registered manufacturer or registered wholesaler. The CMS Scope of Practice Workgroup held a series of meetings with acupuncturists with regard to the draft bill. The COL voted to support this legislation and the bill passed through the House and Senate without amendment.
SB 15-053: Dispense Supply Emergency Drugs for Overdose Victims
COL voted to support this bill, which passed the Legislature and was signed on April 6 by Gov. Hickenlooper. It expands the ability of an employee or volunteer of a harm reduction organization or a first responder to prescribe opiate antagonist under protocols.
SB 15-197: APN Prescriptive Authority
Current law requires an APN to complete 1,800 hours of prescribing in a preceptorship and to complete 1,800 hours of prescribing in a mentorship in order to achieve full prescriptive authority. This bill reduces the requirement to 1,000 practice hours in order to achieve full prescriptive authority. In addition, the bill requires a licensed physician or an APN who has full prescriptive authority to mentor an APN. Upon completion of the mentorship requirement, an APN with provisional prescriptive authority must develop an articulated plan for safe prescribing that documents how the APN intends to maintain ongoing collaboration with physicians and other health care professionals in connection with the APN’s practice of prescribing medication within his or her role and population focus.
The bill passed through both the Senate and the House and was sent to the governor for signature.
A bad idea killed
SB 15-275: Protections Information Provided to General Assembly
This bill would have allowed any state employee to disclose to any member of the general assembly (House or Senate) confidential, privileged or private information, including protected health information and professional review records. The legislator could use the protected information in open hearings. The bill would have precluded the state agency from sanctioning the employee for disclosing the confidential, privileged or private information, even if the employee knows that the information is confidential, and even if the employee is making a false representation or providing a falsified document.
CMS lobbied against this bill. SB 15-275 was killed on the Senate floor during second reading.
SB 15-285: A Woman’s Right to Accurate Healthcare Information
This bill sought to provide transparency to women who may be considering the termination of a pregnancy. SB 15-285 would have required that a physician provide full disclosure to a pregnant woman, which included providing the current ultrasound of the unborn child and all medical information, including the viability of the pregnancy, gestational age of the unborn child, description of the development of the unborn child as well as discussing the physical and psychological risks associated with termination of the pregnancy. It also required that a woman submitting to an abortion provide voluntary and informed consent to an abortion. SB 15-285 would have created a civil right of action for noncompliance with the bill’s requirements, making a physician’s noncompliance with the requirements a crime. The bill was killed in the Senate Health and Human Services Committee by a vote of 3-2.
HB 15-1041 Protect Human Life at Conception
The bill sought to prohibit abortion, making a violation a Class 3 felony. Exceptions to the prohibition were: a licensed physician performing a medical procedure intended to prevent the death of a pregnant mother; the physician making reasonable medical efforts to preserve both the life of the mother and the life of the unborn child in a manner consistent with conventional medical practice; a licensed physician rendering treatment to the mother resulting in the accidental or unintentional injury or death to the unborn child. CMS opposed the bill. HB 15-1041 was defeated in the House Judiciary Committee.
HB 15-1112: Born Alive Infant Protection Act
The bill sought to prohibit a person from denying or depriving an infant of nourishment with the intent to cause or allow the death of the infant for any reason. CMS opposed the bill. HB 15-1112 did not make it out of the House Committee on Public Health Care and Human Services.