Susan Koontz, JD, CMS General Counsel
2015 General Assembly tackling multiple health care issues
The 2015 Regular Session of the Colorado General Assembly has reached the halfway point and committees have had packed hearing schedules as deadlines approach for bills to either be passed out of committee or postponed indefinitely. The Colorado Medical Society lobby team is tracking more than 35 bills this session to ensure legislation benefits physicians professionally and helps improve the health and wellness of Colorado patients. They expect many more bills to be introduced before the end of the session – including bills concerning the scope of practice of advanced practice nurses, naturopaths and acupuncturists.
With staff support, the CMS Council on Legislation (COL) reviews each bill to understand its intent, its possible outcomes and the political landscape to collectively determine how and at what level CMS should engage. Below are a handful of bills of particular interest to CMS members and supporters.
Supported by Council on Legislation
HB15-1029: Health Care Delivery Via Telehealth Statewide
Under current law, health benefit plans issued, amended or renewed in Colorado cannot require in-person health care delivery for a person covered under the plan who resides in a county having 150,000 or fewer residents if the care can be appropriately delivered through telemedicine and the county has the necessary technology for care delivery via telemedicine.
Starting Jan. 1, 2016 the bill removes the population restrictions and precludes a health benefit plan from requiring in-person care delivery regardless of geographic location of the health care provider. By removing the limitation of a population of 150,000 or fewer residents for telehealth, this bill will allow more Coloradans timely access to high-quality primary and specialty care, regardless of where they reside in the state. The bill also reimburses the treating provider for a telehealth encounter on the same basis as in-person care.
Representatives Perry Buck, R-Windsor, and Joann Ginal, D-Fort Collins, have worked diligently on this bill, which the COL voted to strongly support. The bill passed unanimously in the House and passed the Senate and is presently headed to the Governor for his signature. For more on this bill and the promise of telehealth, read the cover story on page 8.
SB15-057: Clean Claims Task Force Reporting
Under current law, the Colorado Medical Clean Claims Task Force (CCCTF) is required to report to the executive director of the Department of Health Care Policy and Financing; the Health and Human Services Committee of the Senate; and the Health, Insurance and Environment Committee and Public Health Care and Human Services Committee of the House of Representatives. This bill directs that the reports be submitted instead to the commissioner of insurance and to the Business, Labor and Technology Committee of the Senate and the Business, Labor, Economic and Workforce Development Committee of the House of Representatives, since those committees will be addressing how the standardized claim edits are to be maintained after the task force is sunset. The bill passed out of the Senate and House and is presently headed to the Governor for his signature.
HB15-1036: Warn Pregnant Women Medical Marijuana Dangers
The bill is sponsored by Rep. Jack Tate, R-Centennial, whose wife is an OB/GYN, and seeks to warn women of the effects on the fetus caused by smoking or ingesting marijuana while pregnant. HB15-1036 requires the Department of Revenue to promulgate rules requiring that a licensed medical marijuana center display in a conspicuous location a sign that warns pregnant women about the dangers to fetuses. This bill was postponed indefinitely on Feb. 3, 2015.
HB15-1147: Require License to Practice Genetic Counseling
This bill enacts the Genetic Counselor Licensure Act, whereby on and after June 1, 2016, a person cannot practice genetic counseling without being licensed by the director of the Division of Professions and Occupations in the Department of Regulatory Agencies. CMS Past President Jan Kief, MD, spoke in favor of this bill at a recent COL meeting. In addition, Kief testified on Feb. 19, 2015 before the House Health, Insurance and Environment Committee. The bill passed that committee and subsequently the House Finance Committee and was referred to Appropriations on March 5, 2015.
HB15-1194: Authorize General Fund Dollars for LARC Services
Starting in 2008 the CDPHE received a multi-year grant to conduct an expanded family planning program, which focuses on access to long-acting reversible contraception, known as LARC, to low-income women in Colorado. This bill requires the CDPHE to continue the expanded program and appropriate $5 million from the state general fund to CDPHE to provide LARC services in the 2015-16 fiscal year. The bill was referred to Appropriations by the House Public Health Care and Human Services Committee.
SB15-053: Dispense Supply Emergency Drugs for Overdose Victims
Under current law, physicians, physician assistants, pharmacists and advanced practice nurses with prescriptive authority are not subject to civil or criminal liability or professional discipline when they prescribe or dispense an opiate antagonist in a good-faith effort to assist a person who is experiencing an opiate-related overdose event or to assist a friend, family member or other person who is able to provide assistance to a person who may experience an opiate-related overdose event.
This bill expands the ability to prescribe to an employee or volunteer of a harm reduction organization or a first responder. First responders and harm reduction employees and volunteers acting in good faith would also be immune from professional discipline. The bill passed the Senate and passed its third reading in the House.
Opposed by Council on Legislation
HB 15-1066: Repeal Health Benefit Exchange
The bill sought the repeal of the Colorado Health Benefit Exchange Act, enacted in 2010. The act allows each state to establish a health benefit exchange option through state law or opt to participate in a national exchange. This bill was postponed indefinitely on Jan. 29, 2015.
SB 15-074 Transparency in Health Care Prices Act
This bill would create the Transparency in Health Care Prices Act, requiring health care professionals to make available to the public, either electronically or on its website, the following:
- Prices they assess for at least the 15 most common health care services, if applicable, they provide.
- The 50 most-used diagnosis-related group codes or other codes they use for billing in-patient health care services.
- The 25 most-used outpatient CPT or health care services procedure codes used for filing.
Neither a health care facility nor a health care professional is required to report its direct pay prices to any agency for review, filing or any other purpose, nor will there be any disciplinary action against a physician for failing to participate in this reporting.
The COL voted to amend physicians out of this bill or oppose the bill. The bill passed the Senate with amendments and is currently assigned to the House State, Veterans and Military Affairs Committee.
Other bills of interest
HB15-1135: Terminally Ill Individuals End-of-Life Decisions
This bill, known as the Colorado Death with Dignity Act, sought to authorize an individual with a terminal illness to request, and the individual’s attending physician to prescribe to the individual for self-administration by ingestion, life-ending medication intended to hasten the individual’s death.
The bill elicited very strong opinions on both sides of the argument. It was heard in Committee on Feb. 6, 2015. On that day hundreds of people listened to testimony and waited to testify at the Capitol where, after 11 hours, the bill was defeated by a vote of 9-4 and postponed indefinitely. CMS expects this bill will come back in upcoming sessions or possibly on initiative.
HB15-1151: Floor for Medicaid Provider Rates
Current law authorizes the Medical Services Board by rule to establish payment rates for services under Medicaid. On and after July 1, 2015, the State Department rules promulgated for the payment of providers must provide that payment rates for services are not less than 60 percent of the rate for the equivalent service under Medicare, or if there is no equivalent Medicare rate, the average fair market rate for the service.
The COL is monitoring this bill to see how the Joint Budget Committee addresses this issue.
The Colorado Medical Society continually demonstrates influence at the Capitol thanks to strong lobbying efforts and through the engagement and involvement of dedicated physicians on the Council on Legislation. Active involvement in advocacy is crucial to Colorado physicians and patients, and CMS encourages anyone interested to get involved. Go to www.cms.org/advocacy for more information.