Colorado Medical Society navigates tricky session to advocate on behalf of physicians and patients

The final gavel has dropped and another whirlwind legislative session has ended. Colorado Medical Society presents our sine die report, briefly summarizing our work leading up to and through the 2023 Colorado General Assembly. Your CMS advocacy team, along with physician leaders and friends in the House of Medicine, touched many bills that affect your patients, practice and profession. We took positions on 36 bills, worked with elected officials to revise language before bills were introduced, ensured amendment language was added to bills in-process, and provided testimony in many hearings.

Several key health care themes emerged this session, including:

Who should be doing what (HB23-1071: Licensed Psychologist Prescriptive Authority, HB23-1077: Informed Consent to Intimate Patient Examinations, HB23-1295: Audits of Department of Health Care Policy and Financing Payments to Providers, SB23-083 Physician Assistant Collaboration Requirements, SB23-167: Board of Nursing Regulate Certified Midwives, SB23-170: Extreme Risk Protection Order Petitions, SB23-188: Protections for Accessing Reproductive Health Care, SB23-189: Increasing Access to Reproductive Health Care, SB23-190: Deceptive Trade Practice Pregnancy-related Service);

Affordability and transparency (HB23-1002: Epinephrine Auto-Injectors, HB23-1201: Prescription Drug Benefits Contract Term Requirements, HB23-1215: Limits on Hospital Facility Fees, HB23-1225: Extend and Modify Prescription Drug Affordability Board, SB23-195: Calculation of Contributions to Meet Cost Sharing); and

Increased coverage (HB23-1130: Drug Coverage for Serious Mental Illness, HB23-1136: Prosthetic Devices for Recreational Activity, SB23-033: Medicaid Preauthorization Exemption, SB23-144: Prescription Drugs for Chronic Pain).

Below are some key bills for medicine

Prior authorization reform – CMS, in collaboration with our allies, worked for months with friend of medicine Rep. Shannon Bird on a bill that we hoped would address our core priorities of preventing disruptions in approved care, providing alternatives or exemptions to prior authorization, and improving transparency to prevent confusion and waste. Time and other unrelated priorities worked against us and it was decided not to advance the bill this session. It is important to note that another bill that we supported (SB23-033) did pass to prohibit prior authorization, step therapy and fail-first requirements in Medicaid for prescriptions to treat serious mental health disorders. We remain committed to removing unnecessary prior authorization burdens and will pursue all advocacy options to achieve reform including potential legislation in the 2024 session.

Physician assistant scope of practice (SB23-083) – SB23-083 changed the supervisory relationship between physicians and physician assistants to a collaborative agreement. Amendments were added to the bill to ensure that agreements are only made between PAs and physicians or groups actively practicing in Colorado. The amendments also ensure that PAs provide care within their education, experience and competency levels, and maintain a supervisory relationship with physicians at level I and II trauma centers. Sen. Kyle Mullica and other legislative champions for medicine were key to securing these amendments to protect Colorado patients.

Psychologist prescriptive authority (SB23-1071) – Colorado’s ongoing mental health crisis drove momentum for the passage of this bill that enables prescriptive authority for psychotropic medications for specially trained psychologists. Intense lobbying, a united House of Medicine, and more great help by legislative leaders secured critical amendments to increase the level of training, requiring further education to treat pregnant people, geriatric and pediatric (only with parental consent) populations, and requiring physician oversight and collaboration.

Consumer protection standards (HB23-1192)  – This bill would have destabilized the liability climate and increased more inappropriate lawsuits by lowering the standard for how consumer protection claims are filed. It would have created incredible exposure for physicians and how they engage with patients because of the threat of treble damages and attorney fees. CMS actively opposed this bill and achieved victory after leaders like Sen. Dylan Roberts helped to remove the key, problematic section of the bill.

Regulatory Audit Contractors (RAC) audits (HB23-1295) – In the months preceding this legislative session CMS heard from numerous practices facing inappropriate audits seeking to recoup “overpayments.” CMS engaged with the Colorado Department of Health Care Policy and Financing (HCPF), which manages Health First Colorado (Medicaid), to pause the latest series of audits due to flawed logic and inappropriate processes that require an extraordinary amount of time for physicians and practice staff to defend. As more questions arose, the legislature became involved and this bill aims to enhance transparency to the RAC process. Strong legislative leadership by the Joint Budget Committee – Vice Chair Rep. Shannon Bird, Chair Sen. Rachel Zenzinger, Rep. Rod Bockenfeld, Sen. Jeff Bridges, Sen. Barbara Kirkmeyer and Rep. Emily Sirota – coupled with support by the House of Medicine and the Colorado Hospital Association helped to pass HB23-1295 that funds a rigorous and detailed audit of the Medicaid RAC program with results to be reported back to the legislature for future policy action.

Prescription drugs for chronic pain (SB23-144) – This bill fixes a flaw in the response to the ongoing opioid epidemic, which has negatively impacted patients and their families coping with chronic pain. The policy response, though well-intentioned, has imposed unhelpful care restrictions. CMS supported this bill, which enables health care providers to prescribe medications for chronic pain treatment safely and effectively, without the fear of regulatory discipline. We collaborated with Sen. Joann Ginal and patients to strengthen physician-patient relationships and eliminate care mandates, particularly those based on arbitrary pain management standards.

Copay calculator (SB23-195) – We supported this bill to prohibit co-pay accumulator programs by health plans so patients can receive payment assistance to help pay for their medications. Heartbreaking patient testimony that highlighted the need for lifesaving medications propelled the passage of this bill. CMS continues to support efforts to lower prescription drug costs for Coloradans.

Virtual credit cards (HB23-1116) – We supported this bill that protects physicians from unnecessary processing fees when being reimbursed for billed claims. Sponsored by Rep. Anthony Hartsook, the bill prohibits health plans from charging fees when they pay providers for covered services or limiting how reimbursement is made to just credit card methods.

Timely certified death certificates (SB23-020) – This bill was prompted by families unable to obtain timely death certificates for their loved ones due to a lack of physician certification. Initially focused on enforcement, CMS highlighted system and process issues that can legitimately cause delays in certification. Thanks to the leadership of Sen. James Coleman, amendments to the bill extended the timeframe for processing requests from 48 to 72 hours, upon receipt of the request, clarified which physician is responsible for certification, and limited Colorado Medical Board enforcement actions to cases of willful or repeated failure without reasonable cause.

Closing thoughts

The 2023 legislature tackled a number of hot topics including property taxes, housing and land use, a tight state budget, TABOR rebates, guns, and abortion. Before the session started health care was not supposed to be one of the marquee issues, but once things got rolling the continued importance of health policy rose to the forefront of the 74th General Assembly.

While every session lasts for 120 days, managing the legislative calendar became more of a feat this year. Of the 617 bills introduced, 486 passed. Within the current legislative environment, close to 80% of the bills pass, showing the importance of getting the best amendments CMS can negotiate. The Democrats with super-majority status in the House and just shy of super majority in the Senate had a list of priorities to get through. Republicans in the minority were sometimes left with using delay tactics to get their voices heard. Disagreements between and within the political parties meant that of the 131 bills that failed many were due to lack of funding or the clock running out (e.g. a single-payer study bill, HB23-1209, died on the calendar). There were also contentious moments as rarely utilized power to cut off debate was wielded.

The strength of Colorado Medical Society advocacy lies with members like you who engage in the work at the Capitol to influence legislation in a skillful and respectful way. CMS hopes all physicians will continue to remain engaged with us in advocacy. Sharing with your elected representatives how a bill will affect your practice and patients often makes the difference between passing a good bill, amending a bill with promise, or defeating a bad bill.

Categories: Communications, Colorado Medicine, Legislative Updates, Resources, Initiatives, Prior Authorization, Scope of practice, Liability caps, Advocacy, Patient Safety and Professional Accountability