Legislature Addresses Access to Care
Rural Colorado is short on health care providers. Just ask CHI’s newest research analyst Eli Boone, who grew up in Rifle, Colorado.
In fact, nearly every county in the state is a federally designated Health Provider Shortage Area (see map below). This means residents may have trouble getting care, either due to geographic isolation or the cost of care. According to the 2017 Colorado Health Access Survey, 17.7 percent of Coloradans said they were unable to get an appointment at the doctor’s office as soon as they thought one was needed. And some parts of Colorado face especially acute shortages of health care professionals.
Several bills introduced in this legislative session aim to improve access, including some that would expand the list of procedures and practices certain health care workers can perform under their license. I’ve been watching these bills closely during the session. Here’s an update on where they stand.
Senate Bill 27 was the first bill passed by the legislature this session. The speed was necessary to meet a January 19 deadline to make Colorado nurses eligible to participate in a 27-state licensure compact without having to deal with extra red tape. This bill, which was signed by the governor, allows nurses to practice in any of the 27 states without needing a state-specific license. It also maintains licenses for 86,000 nurses who would have otherwise had to reapply. By enabling nurses from any of the 27 states to practice in-person or via conference call or computer link, Colorado hopes to reduce its nursing shortage.
Similar to a 2015 bill that expanded the scope of practice of registered dental hygienists, House Bill 1045 would allow hygienists to apply silver diamine fluoride under the supervision of a dentist. Silver diamine fluoride is a restorative measure that temporarily reduces sensitivity in decaying teeth. Dentists would be able to oversee this procedure via telehealth technology. The SMILES Dental Project®, implemented by the Caring for Colorado Foundation, has been using the 2015 expanded scope of practice to provide care to underserved areas of the state. HB 1045 would add another tool to dental hygienists’ toolbelts. Read more about the SMILES program here.
SB 20, which was sent to the governor on March 12, expands the list of mental health professionals approved to provide auricular acudetox. Registered psychotherapists are now included. This procedure uses acupuncture around the ear to alleviate the symptoms of withdrawal from substance use. While evidence is mixed on the efficacy of the procedure, many patients and providers believe that having more treatment options is beneficial.
Unsurprisingly, the physician shortage hits rural areas harder than urban areas. Some doctors don’t want to practice in small town Colorado, and existing providers are often stretched thin. HB 1112 aims to ease the burden on rural physicians by requiring insurance companies to cover certain health care services provided by pharmacists, as long as the services are delivered in a health provider shortage area and the insurer covers the same services when they’re provided by a physician or advanced practice nurse. Licensed pharmacists can provide screening and treatment for many conditions and chronic diseases. HB 1112 would ensure that these allowed treatments would be covered by insurance.
In Colorado, contracts between a physician and their practice group may include a provision known as a noncompete clause. Typically, it prohibits physicians from taking patients from the group if they leave the group or facility. Critics say a noncompete clause can limit access to care, particularly for patients with unique conditions for which there might only be a few specialty physicians. SB 82 provides an exemption from the noncompete clause, allowing specialists who leave a practice group to continue treating patients with rare disorders.
SB 24 would expand the Colorado Health Service Corps to include behavioral health specialists like counselors, clinical social workers, psychologists and nurses. This program provides loan forgiveness and other incentives to health providers who practice in a provider shortage area for a designated length of time. The measure aims to encourage specialists to move to rural areas with the greatest need. This bill would tap $2.5 million from the marijuana tax cash fund to help provide loan repayments. Read more about the legislature’s various efforts to provide more resources for behavioral health and substance use treatment here.
Finally, the failed SB 81 would have changed the certification requirements for emergency medical service (EMS) personnel to a licensure program. This would have created more thorough screening and increased transparency of EMS personnel. SB 81, backed by the EMS Association of Colorado, died in the Senate Committee on Business, Labor, and Technology on January 24 by a vote of 4-3.
CHI will continue to follow these bills as they make their way through the legislature and, if successful, into practice around the state.
Find Ian Pelto on Twitter: @CHI_Pelto
Want more information about health and health policy in Colorado? Subscribe to our newsletter or find CHI on Facebook and Twitter
Related Research and Blogs: