2018 General Assembly focuses on substance use, other health care issues
by Susan Koontz, JD, General Counsel, Senior Director of Government Relations
Featured in the March/April 2018 Colorado Medicine.
As we approach the halfway point of the Colorado General Assembly’s 2018 Regular Session, the Colorado Medical Society is tracking more than 20 bills related to the interests of Colorado physicians and their patients. The lobby team expects many more bills to be introduced before the end of session – including legislation relating to out-of-network providers, physical therapists, acupuncturists and medical marijuana.
With staff support, the CMS Council on Legislation (COL) reviews each relevant bill to understand its intent, 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 as we look toward the second half of the session. Six bills currently under consideration come from the work of the bipartisan Opioid and Other Substance Use Disorders Interim Study Committee, which conducted business during summer 2017.
Supported by COL
SB18-022 Clinical Practice for Opioid Prescribing
This bill would limit an initial prescription to seven days for patients who have not had an opioid in 12 months, with the option to allow for one seven-day refill. This limit would apply to the prescribing practices of physicians, physician assistants, podiatrists, dentists, advance practice nurses, optometrists and veterinarians.
The bill allows for certain exceptions to the seven-day prescription, to be determined at the prescriber’s discretion. Those include chronic pain that:
- Lasts longer than 90 days or past the time of normal healing, or to a patient following transfer of care from another provider who prescribed an opioid;
- Is the result of underlying conditions or diseases;
- Is the result of cancer;
- Is a part of palliative or hospice care and is focused on improving quality of life;
- Is the result of surgery where, due to the nature of the procedure, post-surgical pain is expected to last more than 14 days.
The bill also makes exceptions for patients undergoing medication-assisted treatment and those who are prescribed an abuse deterrent drug.
Senators Irene Aguilar and Jack Tate have been diligent sponsors for this bill and COL supports their hard work. The bill passed unanimously through the Senate Health and Human Services Committee after testimony by CMS physicians and is assigned to the House Health, Insurance and Environment committee.
SB18-024 Expand Access Behavioral Health Care Providers
Another piece of legislation to come out of the interim study committee, this bill creates two programs for substance use providers, specifically licensed addiction counselors (LAC) and certified addiction counselors (CAC).
The first program is a scholarship for the continued education of already-practicing CACs. The second is a new category of loan repayment for behavioral health providers with addiction-specific education and training who commit two years of service to an area labeled as having a behavioral health care provider shortage. An amended version of the bill was referred to the Committee on Appropriations.
SB18-040 Substance Use Disorder Harm Reduction
This bill aims to address and manage overdose and the spread of disease related to substance use as an intermediate step in the opioid crisis as treatment and demand concerns are in the process of being addressed. Specifically, it would pave the way for establishing clean needle exchanges and overdose prevention sites. CMS physicians testified on behalf of the bill; however, it died in committee on Feb. 14.
HB18-1003 Opioid Misuse Prevention
CMS is closely following the progress of this bill aimed at maintaining the momentum created by the interim study committee. The committee would evaluate current data, statistics, policy, education and other relevant information to determine the most effective response to Colorado’s opioid crisis.
The bill is assigned to the House committee on Public Health Care and Human Services and is scheduled for hearing March 13.
HB18-1012 Vision Care Plans Carriers Eye Care Providers
This bill prohibits a carrier or entity that offers a vision care plan from requiring an eye care provider with whom the carrier contracts to provide services or materials to a covered individual at a fee set by the carrier. The only exceptions to this are if the services or materials are fully covered by the carrier or entity and if they then reimburse the eye care provider a reasonable amount. The bill also prohibits requiring an eye care provider to participate in any of the carrier’s other vision plans as a condition of participating in one vision plan.
The bill passed its third reading in the House on Feb. 15 and is assigned to the Senate committee on Health and Human Services.
HB18-1006 Infant Newborn Screening
This bill would update the current timeline for newborn hearing screenings and require the results be included in electronic medical records. It also requires proper follow-up services be provided for at-risk infants or those that were not screened. The program would be paid for partially by a fee increase and partially by the establishment of the newborn hearing screening cash fund. The bill passed out of committee with amendments and is awaiting a hearing with the Committee on Appropriations.
HB18-1211 Controlling Medicaid Fraud
Created with input from CMS and its lobbyists, this piece of legislation would establish the Medicaid fraud control unit to investigate and prosecute Medicaid fraud and waste, as well as patient abuse, neglect and exploitation. The bill also creates offenses related to Medicaid fraud. The bill has a March 15 hearing with the Judiciary Committee.
HB18-1207 Hospital Financial Transparency
Pending a hearing with the Health, Insurance and Environment Committee, this bill aims to monitor hospital expenditure and uncompensated costs. It requires general hospitals in the state to provide the Department of Health Care Policy and Financing with information regarding costs submitted for Medicaid and Medicare services, annual audits, staffing, and centralized data of hospital utilization and finance.
This report would be public information, accessible by the governor, committees of the general assembly, and on the department’s website. This bill will be heard March 8 by the House Health, Insurance and Environment Committee.
HB18-1094 Children and Youth Mental Health Treatment
Under current law, the Child Mental Health Treatment Act provides children and youth access to mental health services. This bill aims to indefinitely extend and streamline the program. The House committee on Public Health Care and Human Services referred an amended bill to Appropriations.
HB18-1182 Statewide System for Advance Directives
This bill would create a statewide electronic system for uploading and accessing advance directives. The system will be paid for by grants, donations, and gifts. The hearing for this bill is scheduled for March 15 with the House Health, Insurance, and Environment Committee.
SB-146 FSED Required Consumer Notices
This bill requires an FSED to provide multiple written and verbal disclosures to individuals regarding the facility’s affiliations, insurance partners, average costs for common services and the individual’s rights.
Pending the adoption of an amendment regarding the requirement to provide a post-emergency screening disclosure that may lead to complications with insurance providers, COL originally voted to oppose this bill. However, upon the adoption of the desired amendment, COL reconsidered and now supports it.
Opposed by COL
HB18-1068 Eliminate Registered in Naturopathic Doctor Title
Under current law, a naturopathic doctor (ND) may use “registered” in their title, or the initials R.N.D. This bill would remove that distinction under pretext of eliminating public confusion surrounding the title and its distinction from other professions.
CMS opposes the licensing of NDs and supports enforcing the Medical Practice Act, which, among other things, prohibits the use of the term physician by any person other than an MD or DO. This bill died on Feb. 26.
SB18-115 Apply Stark Laws to Medical Referrals Outside Medicaid
Current law prohibits medical providers who receive Medicaid reimbursement to refer patients to entities owned by that provider or an immediate family member. This bill would extend that prohibition to all health care providers.
CMS strongly opposes any legislation that would make it more difficult to provide quality patient care and limit the abilities of health care providers. The potential negative outcomes of this bill far outweigh the positives. This bill died after its hearing with the Senate State, Veterans, and Military Affairs Committee on Feb. 14.
HB18-1112 Pharmacist Health Services Coverage
This bill would allow carriers to compensate pharmacists for health care services they preform in health professional shortage areas. The compensation would be comparable to that received by a physician. The bill passed the House on its final reading and is awaiting assignment in the Senate.
Other bills of interest
HB18-1007 Substance Use Disorder Payment and Coverage
Another bill to come out of the interim study committee, this would prohibit plans from penalizing physicians for having bad pain scores and prohibit the requirement that a covered person or Medicaid recipient undergo step therapy.
It would require commercial health plans and Medicaid to cover certain medicines, standardize requirements for medication assisted treatment, and would authorize pharmacists to inject naltrexone. A hearing with the Public Health Care and Human Services Committee is scheduled for March 13. CMS is monitoring the bill.
SB18-050 Freestanding Emergency Department as Safe Haven (monitor)
The purpose of this bill is to expand Colorado’s Safe Haven laws by including, in addition to firefighters and hospital staff, all staff of free-standing emergency department (FSED) facilities, allowing them to take physical custody of infants younger that 72 hours old if voluntarily surrendered by the parents. The bill is awaiting the governor’s signature after passing both the Senate and House.
SB18-065 Add HMOs Life and Health Insurance Protection Assistance (monitor)
This bill amends the Life and Health Insurance Protection Association Act by including HMOs in these associations and requiring HMOs contribute to the fund for the purpose of defraying the costs of a health insurer insolvency. CMS took a monitor position on the bill but it died in committee Feb. 5.
HB18-1097 Patient Choice of Pharmacy (Neutral)
CMS has taken a neutral position on this bill that would prohibit insurance carriers that cover pharmaceutical services from limiting or restricting an individual’s ability to select a pharmacy or pharmacist of their choice. Similar legislation was also introduced last year but failed. CMS was neutral on that as well. This year’s bill passed the House on third reading.
HB18-1118 Create Health Care Legislative Review Committee
The committee that this bill looks to create would be responsible for studying health care issues affecting Colorado residents. It would consist of members from the House and Senate committees on health and human services and would be able to recommend up to five bills a year.
An amended version of the bill was referred to Appropriations by the House Health, Insurance and Environment Committee. CMS is monitoring the bill.
HB18-1136 Substance Use Disorder Treatment
The most recent bill to come out of the Interim Study Committee on Opioid and other Substance Abuse Disorders, this bill would add substance use disorder services to the Colorado medical assistance program. If this goes into effect and Colorado receives the necessary federal approval, money would be allocated from the marijuana tax cash fund to assist individuals not otherwise covered by insurance.
CMS has taken a monitor position on this bill. The hearing with the Public Health Care and Human Services Committee is scheduled for March 13.
HB18-1114 Require Genetic Counsel License
This bill would require genetic counselors to be licensed by the director of the division of professions and occupations in the department of regulatory agencies.
CMS supported a similar bill in 2015. Pending an amendment clarifying the language in the bill, COL has taken a position of conditional support pending that amendment. The hearing for the bill is March 8.
HB18-1212 FSED Licensure
This bill would create a new license for health facilities that offer emergency care. The license breaks facilities into two categories: those that are hospital affiliated and those that are independent. Health facilities with FSEDs are subject to facility fees.
The hearing for the bill is scheduled for March 15 with the House Health, Insurance and Environment Committee. CMS is currently monitoring the bill.
HB18-1155 Sunset Continue Physical Therapy Board Functions
This bill would extend current licensure until 2027 and allow PTs to make physical-therapy-related diagnoses, extend scope of practice to include supervising unlicensed PTs, allow PT assistants to preform wound debridement, and add a PT assistant to the physical therapy board.
Physical therapists are also trying to add a provision to allow them to perform dry needling. The hearing is scheduled for March 5 with the House Finance Committee. CMS is monitoring.
HB18-1179 Prohibit Price Gouging on Prescription Drugs
This bill would prohibit price gouging on sales of essential generic and off-patent drugs and make that practice a deceptive trade act under the Colorado Consumer Protections Act.
Any price gouging would need to be reported to the attorney general, who is authorized to seek subpoenas and file lawsuits.
A hearing with the House Committee on Health, Insurance and Environment is pending. CMS has taken a monitor position on this bill.
CMS continually demonstrates influence at the Capitol thanks to strong lobbying efforts and through the engagement and involvement of dedicated physicians on COL. 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.