What physicians need to know as the Colorado General Assembly adjourns
by Emily Bishop, CMS Director of Government Affairs
Featured in the May-June-July 2022 Colorado Medicine Colorado Medicine.
The Colorado General Assembly adjourned on May 11, concluding a legislative session defined by contradictions. The House of Medicine faced intense scope of practice battles, while simultaneously enjoying broad collaboration to find solutions for Colorado’s health care workforce. The Colorado Medical Society also engaged on important issues like prior authorization reform and mental and public health this session.
CMS’s positions on legislation are determined by the Council of Legislation, a diverse group of physicians who consider bill language, potential impact to physicians and their patients, CMS policy, and the political landscape to reach positions and allocate resources.
“The Council on Legislation has an impactful role during the legislative session,” says COL Chair Kim Warner, MD. “Diverse physician voices by specialty and geographic location are invaluable to the workings and success of the Council. The power of COL lies in the grassroot physician involvement at every stage of the political-advocacy process.”
The following is a snapshot of some of this session’s key issues.
Legislators acknowledge physician-led, team-based care, reject PA bid for independent practice second year in a row.
A perennial issue, CMS closely analyzes any attempt to expand non-physicians' scope of practice to defend quality patient care and stand up for physicians and their practices.
CMS secured a key victory in defeating HB22-1095, which sought to drastically expand the scope of practice of physician assistants (PAs) and strike all physician supervision from statute. Proponents argued the bill would improve rural access and allow PAs to work at the top of their training. CMS, member physicians and House of Medicine lobbyists argued the move would fragment health care delivery.
“Since the beginning of this debate, CMS and our House of Medicine partners worked tirelessly to convey the importance of PAs in the physician-led health care team,” said CMS President Mark B. Johnson, MD, MPH. “Expanding their scope of practice to be completely independent of physicians is not in line with PA training or the needs of Colorado patients.” Dr. Johnson lauded the defeat of HB22-1095 as a win for patient safety and the preservation of the team-based approach to care.
CMS and House of Medicine partners suffered a loss on HB22-1233, the optometrist sunset. Despite best efforts, the bill is expected to pass and will allow optometrists to perform injections around the eye and some surgeries.
HB22-1384 was a late-in-the-game play by naturopathic doctors to expand their formulary beyond the nonprescription, biologics medicine class to which they’re currently limited. However, through great House of Medicine collaboration, specifically between the Colorado Academy of Family Physicians, Colorado Chapter of the American Academy of Pediatrics and CMS, the bill was postponed indefinitely to allow for a robust stakeholder process in the coming interim.
Health care workforce solutions enjoy broad support.
CMS supports physicians in all stages of your career, and initiatives to build the workforce for the future. A number of bills aimed at recruitment and retention of health care providers in Colorado, especially for those in underserved communities, passed this session. Read more in the cover story on page 6.
SB22-172 will expand the University of Colorado School of Medicine’s successful rural track training program to other institutions and health care professionals across the state. CMS joined a group of health care organizations in supporting SB22-226, which focuses on the resilience and retention of our state's health care workforce. HB22-1005 expands Colorado’s rural preceptor tax credit program while SB22-200 establishes a grant program for rural hospitals. HB22-1050 establishes an innovative program for international medical graduates interested in completing their medical degrees in Colorado.
Prior authorization “gold card” program and payment reform bills; legislators moved by patient stories.
One of CMS’s highest priorities this session was expanding on our work to streamline and codify the prior authorization process for the sake of practices and patients. CMS has heard loud and clear from physicians and patients about the hassle and cost to patients of prior authorization. You can read one of these patient stories on page 24. The legislature ran out of time to approve a prior authorization "gold card" program for providers who demonstrate safe and consistent practices through their prior authorization approval percentages. However, work will continue to reduce cost and administrative burdens for patients and physicians alike.
Primary care physicians currently using or considering integrated care models will be able to apply for a grant from the program established by HB22-1302. Watch for further information when those funds become available. This precedent-setting bill is one of the ways Colorado is on the cutting edge of payment reform. While CMS secured important protections for physicians in the bill, there is still important work to be done to ensure APMs work well for physicians and patients. Expect to hear from us in the coming months about how you can be involved with the implementation process.
Mental and public health access see boost for second year in a row because of the COVID-19 pandemic.
The legislature continued last year’s efforts to increase access to mental and behavioral health. HB22-1278 established the behavioral health administration and tasked it with creating a coordinated, cohesive, and effective behavioral health system in Colorado. Several bills also addressed mental health services in the criminal justice system, including SB22-196, SB22-021 and HB22-1256.
Once again, CMS opposed anti-vaccination legislation such as HB22-1200 and SB22-053, which sought to limit a hospital or facility’s ability to prohibit visitations to reduce the risk of disease transmission.
CMS supported HB22-1267, which emphasizes the importance of equipping physicians and other health care providers with culturally relevant training. The bill establishes a grant to fund a program that would be available statewide. Finally, CMS supported HB22-1064, a bill that aimed to ban flavored tobacco and regulate synthetic nicotine products. While CMS and our partners knew this bill would be a difficult fight, it was important to show a united front of concerned physicians and health care providers. Stronger regulation of the tobacco industry is a long game and CMS remains committed to protecting consumers.
CMS member surveys consistently show advocacy is the No. 1 priority of Colorado physicians and CMS is honored to be your voice at the Capitol. Grassroots engagement is critical to our continued successes on health care issues. Watch for updates in our Policy Pulse e-newsletter and invitations to interview candidates before the November election. We always welcome your involvement and feedback; email firstname.lastname@example.org.