Revenue Forecasts, Macbeth and the Weekly Bill Recap

This just in. The newest state revenue forecasts released Friday morning contain some sobering economic projections, news that may impact the contentious debate this session over the Hospital Provider Fee.

Legislative Council estimates that General Fund revenues are down $27 million from projections for the current fiscal year and $90 million for next year.

The governor’s forecast from the Office of State Planning & Budgeting lowered its current year projections by 0.5 percent from its December 2015 forecast and lowered its projections for Fiscal Year 2016-17 by 0.8 percent. Those percentages may seem small, but they represent shortfalls of $51 million and $88 million, respectively.

The reasons for the lower estimates? The contraction in the oil and gas sector; low commodity prices and a strong dollar that are hurting the agriculture, natural resources and manufacturing sectors; an anemic stock market; and global pressures on corporate profits.

The six-member Joint Budget Committee (JBC) had been holding its collective breath for the forecasts, which reveal how close – or not – it has come to balancing the budget based on decisions it has made so far during the department figure-setting process. After hearing the estimates, Sen. Pat Steadman (D), a JBC member, wrote on Twitter that the atmosphere during the revenue forecast was “very Macbeth-ish.” He added: “Next week will not be fun.”

Legislative Council economists said that the lower projections mean that there most likely won’t be a TABOR refund for tax year 2016 because state revenue will fall short of the cap that would trigger it. There’s been much debate about whether to exempt the Hospital Provider Fee from TABOR to avoid taxpayer refunds. (Read this explanation by my CHI colleague Joe Hanel.)

This could lessen the Provider Fee debate for the remainder of this session. Check back next week as CHI delves deeper into the implications of the forecasts. Unless the JBC’s efforts to reconcile decisions with today’s numbers become particularly messy, the budget is scheduled to be introduced in the House on Monday, March 28.

Now, back to bills. Registering surgical technicians — a subject that has been top-of-mind in Colorado with the news that a surgical technologist accused of stealing narcotics had been fired by four hospitals in other states — received the go-ahead from a House committee this week.

The House Health, Insurance, and Environment Committee passed House Bill 1160, which would continue the requirement – otherwise set to end – that surgical technicians and assistants must register with the state’s Department of Regulatory Agencies (DORA). The vote was 10-3, with three of the committee’s Republicans siding with all seven Democrats to advance it.

The bill comes on the heels of the indictment of the Swedish Medical Center technician with a history of drug theft who exposed Denver-area patients to blood borne illnesses through dirty needles. Another Colorado technician infected dozens of people with hepatitis C in 2009, also through needle use.

Regulation of various health care professionals has become a popular topic of discussion this session, and so far it’s drawn a fair amount of bipartisan agreement.

HB 1160 is stronger than originally written: In addition to continuing registration with DORA, it would direct the state to run criminal background checks on all surgical technicians and assistants seeking new registration or reinstatement of a registration that has expired.

The bill’s first hearing made it clear that while some Republicans support the measure, others think the bill goes too far and would prefer to let the current regulation rules sunset. Rep. Steve Humphrey (R), who opposed it, said that he "consider[s] it to be blacklisting” of certain professionals and duplicative of hospitals’ existing screening processes.

The legislation should clear the House comfortably, but its fate in the Republican-led Senate will be less clear.

As usual, we have a recap of other recent health-related votes for you, starting with votes from the House floor.

Two bills passed the chamber unanimously and are on to Governor Hickenlooper for a signature. Senate Bill 127 would repeal a 2010 law that established the Medical Clean Claims Task Force. SB 94 is designed to give rural counties more control over their district public health agencies.

HB 1210 passed its final House reading by a 35-29 margin. The bill would prohibit mental health providers from practicing conversion therapy, which is designed to change sexual orientation, with anyone under 18. Before the vote, Rep. Dominick Moreno (D), one of the legislature’s openly gay members, shared that he himself had sought help via counseling when he was wrestling with his sexual orientation.

Moreno was angry that during the bill’s hearing, “we heard people in committee — not witnesses, but colleagues in this chamber — compare being gay to alcoholism and drug addiction.” He called the comparisons hurtful. For the second year in a row, Rep. Dan Thurlow was the only House Republican to join with Democrats in supporting the bill.

Two bills continue to have their first House floor vote delayed. HB 1164, which would put the state health department in charge of reviewing requests for student immunization exemptions, rather than students’ schools, was scheduled for second reading this week but is postponed until at least next Monday. Tensions around this bill are high and it has already drawn many hours of testimony. HB 1101 will also be heard Monday at the earliest. It would allow doctors to make decisions for a patient with no criminal liability if no one can be found to represent the patient.

Other bills had committee hearings.

Last Friday, the House Public Health Care & Human Services Committee passed two bills with bipartisan agreement.

• HB 1277 passed 11-2 and goes next to House Appropriations. The bill which would extend the required notice period that the Department of Health Care Policy and Financing (HCPF) must give Medicaid enrollees about changes or cancellations to their benefits, and give enrollees more time to appeal these decisions.
• HB 1321 advanced by a 10-3 margin and will be heard next in House Finance. It would direct HCPF to implement a Medicaid “buy-in” program for Coloradans who qualify for home- and community-based services but whose income is above the Medicaid eligibility threshold.

The Senate Health & Human Services Committee showed plenty of agreement yesterday, voting unanimously to kill one bill and pass another.

• SB 139 died in the committee. It would have required the Colorado Commission on Affordable Health Care to explore a change from reimbursing rural hospitals based on a fee-for-service model to a total-cost-of-care model. All committee members present agreed to table the bill.
• HB 1103 had the opposite fate, passing 5-0. The bill proposes clarifying rules about licensing for mental health professionals, including social workers. Due to the committee’s bipartisan agreement, HB 1103 will be placed on the Senate’s consent calendar for its next vote.

The Senate State, Veterans And Military Affairs Committee voted 3-2 to kill SB 152, which sought to require clinics and hospitals to provide notice to people about upcoming services not covered in-network under their insurance plan. This had been the only bill so far to deal with the issue of out-of-network costs and services.

The House State, Veterans and Military Affairs Committee voted 5-4 to kill HB 1221, which would have boosted Medicaid provider rates by reallocating funds used by the state government for lobbying, conferences and membership in professional organizations.

In addition to HB 1160, mentioned in the introduction, the House Health, Insurance, and Environment Committee approved HB 1294 on a party-line vote, with Democrats in favor. The margin was 7-5, with one Republican member excused. The bill, which would greatly increase the number of contraceptive options that insurers have to cover, drew testimony from advocacy groups and women who shared stories of why broader contraceptive access is important to them. It was opposed by insurance industry representatives and questioned by Republicans who felt it would go too far and cost businesses money. HB 1294 will be heard next on the House floor.

The House Finance Committee gave an enthusiastic thumbs-up to the amended HB 1142, advancing the bill on an 8-0 vote. It would create a tax credit benefiting uncompensated preceptors who train students to become rural primary care providers. It goes next to House Appropriations, its third committee.

The House Judiciary Committee showed a similar level of agreement, voting 11-0 to pass HB 1278, which would allow courts to require anyone on probation to participate in a residential drug treatment program, not just those sentenced for drug-related offenses. The bill is on to the House floor.

We’ll be focused on these upcoming votes:

On Tuesday (March 22), the House Public Health Care and Human Services Committee will consider two bills.

• HB 1326 would ease access to physical rehabilitation services by preventing insurance companies from imposing inconsistent standards or unreasonable delays on patients for rehab appointments.
• HB 1322 would require insurance plans to reimburse providers for prescribing multi-month supplies of contraceptive pills. Patients are allowed an initial three-month supply and subsequent 12-month supplies. 

Wednesday (March 23), the Senate Health & Human Services Committee will vote on SB 147, which already had testimony. The bill would make Colorado the first state to implement an ambitious prevention model with the goal of reducing suicides to zero. Colorado ranks seventh nationally in suicide deaths.

And there is lots going on next Thursday (March 24). Bills we’re tracking are up in four committees, underlining the fact that health-related issues touch diverse areas such as finance, education and the judicial system.

• The Senate Health and Human Services Committee will hear SB 158, a new bill that seeks to clarify the tasks that a physician’s assistant is allowed to perform with oversight from a supervising doctor. The allowed tasks include working for licensed podiatrists, issuing immunization certificates and medical exemptions, and writing most prescriptions without an accompanying seal from the supervising physician. The bill has bipartisan sponsors in senators Kevin Lundberg (R) and Dianne Primavera (D).
• House Judiciary will hear HB 1320, which would extend the power of the Department of Regulatory Agencies to take disciplinary action, including filing criminal charges, against massage therapists who exhibit illegal behavior from fraudulent practice to indecent exposure.
• House Finance will consider HB 1047, which would create an agreement to expedite licensure for doctors from other states.
• House Health, Insurance and Environment will hear HB 1336, which would direct the Division of Insurance to study the idea of doing away with the state’s geographical ratings, which determine how much insurance costs for Coloradans in different parts of the state.

We continue to find new bills to watch. Many new proposals were introduced this week, and unless otherwise noted, they carry bipartisan support:

• SB 161 reinstates oversight of athletic trainers by DORA. The legislature failed to continue DORA’s regulatory authority over trainers in the 2015 session, and this bill hopes to reestablish it.
• HB 1360 also deals with DORA regulation, this time of direct-entry midwives, who enter the field by apprenticing with practicing midwives rather than training formally through an accredited program. (The latter are known as certified nurse-midwives). The bill would continue the department’s oversight of midwives and make recommended changes to their allowed scope of practice, such as authorizing them to give stiches and local anesthetics for basic procedures. It would also convene a working group to report on ways to minimize risks in midwifery practices.
• SB 162 would put more responsibility on Medicaid enrollees to seek out providers designated to serve Medicaid patients. Currently, enrollees are not responsible for covering any costs for services (as long as the services are approved by Medicaid) regardless of the provider they use, including providers who do not accept reimbursement through the program. This bill would open Medicaid enrollees up to cost-sharing for appointments with non-Medicaid providers.
• HB 1370 proposes broadly increasing regulation of retailers that sell tobacco or nicotine products in Colorado. It would require retailers to register with the Liquor Enforcement Division, increase penalties for selling illegal tobacco products and for selling to minors, and provide more funding for tobacco education programs.
• HB 1361 would broaden patient choice for where to fill prescriptions. The bill aims to prohibit insurers from limiting consumers’ options to choose their pharmacy and from assessing extra fees on consumers based on which pharmacy they elect to use. A similar bill (SB 15-123) failed last year.
• HB 1374 is a long-awaited bill to require pricing disclosure at freestanding emergency rooms. It would require these ERs to inform non-emergency patients in writing that their ER costs a comparable amount to a hospital emergency visit, that the visit may not be covered in-network by their insurance plan, and that patients may be better off visiting a primary care doctor instead. Unlike the bills above, HB 1374 does not have the benefit of bipartisan support. Rep. Lois Landgraf (R), who had planned to sponsor the bill, withdrew her name after a lengthy negotiation process over its content. That leaves only Democrats as sponsors.
• HB 1380 would direct HCPF to add coverage for in-home support services for qualified Medicaid enrollees who suffer from a major mental illness or brain injury. The lone sponsor is Rep. Dave Young (D), who is also sponsoring HB 1321 with the goal of expanding Medicaid services.

In addition, this week saw new bills to aid consumers with the purchase of hearing aids (HB 1366), specify how credit is awarded for licensed psychologists’ professional development work (HB 1379), require health plans to pay for annual breast cancer screenings (HB 1381), and guarantee insurance coverage for a range of severe protein-related allergies and gastrointestinal tract conditions (HB 1387).

And to end on a tasty note: Colorado’s farmers and ranchers were celebrated at Ag Day at the Capitol this week. If you were willing to brave the crowds – or were smart and arrived early – you were treated to delectable sliders, waffles topped with lamb, strawberries and cream, and more. Let’s just say that we were willing.