Senate Assignment Will be Key for Change in Provider Fee

This week’s big news: The proposal to change the Hospital Provider Fee to an enterprise fund has passed the House. But its future depends on which Senate committee gets to hear it first. That will be determined by Senate President Bill Cadman (R), who has opposed converting the fee. More on that shortly.

This gray, rainy and snowy week has us dreaming of summer, but a lot still has to happen at the Capitol before we can focus on pool time and popsicles. Almost as exciting as warm weather treats? A proposal to bring a presidential primary back to Colorado. Since many people ran into crowds at caucus sites in March, the idea of a primary has been front-of-mind for some legislators. Reps. Dominick Moreno (D) and Tim Dore (R) introduced House Bill 1454 this week to do just that. Their bill would also add participation options for unaffiliated voters.

And in the legislative circle of life, other bills died. House Bill 1164 on vaccinations didn’t fail by a vote; rather, it experienced death by delay, as it was laid over until after the final day of the session. The controversial bill involved a tense debate about vaccination exemptions and the state’s role in the process.

HB 1164 had proposed to shift the responsibility for reviewing student immunization exemption requests from students’ schools to the Department of Public Health and Environment (CDPHE). Decisions would be logged in a statewide immunization tracking system. But among several amendments to the bill, a change to a single word sunk much of the support from proponents: Legislators changed the word “exclude” to “include” on page eight, which made the tracking system opt-in instead of opt-out.

Between this shift and the continued politics around vaccines, which are easier to get out of in Colorado than in most states, stakeholders agreed the bill had reached the end of the line. We’re guessing this isn’t the last we’ll hear of this issue.

Now, to your weekly top eight.

Here are five health policy votes we watched closely this week – led, of course, by the Provider Fee.

House Bill 1420

• What the bill proposes: HB 1420 would repeal the Hospital Provider Fee and replace it with an identical program — categorized as an enterprise fund — not subject to the limit set by the state’s Taxpayer’s Bill of Rights (TABOR). Other state enterprise funds include the lottery, state parks and public colleges. If passed, it would also restore the $73 million in cuts to the Provider Fee in the upcoming fiscal year, which were made to avoid TABOR refunds. The bill is known as the “Colorado Health Care Affordability and Sustainability Enterprise Act” — CHASE for short. It is sponsored by Speaker of the House Dickey Lee Hullinghorst (D) and Sen. Larry Crowder (R).
• What happened: The bill passed the House by a vote of 39-26. Five Republicans joined all of the Democrats in voting to remove the Provider Fee from beneath the TABOR limit.
• Why we chose it: This proposal was introduced a month ago and made it through House Appropriations the next day, but Speaker Hullinghorst held back on next steps until yesterday as she and others worked behind the scenes to gain support. Republican Reps. J. Paul Brown and Dan Thurlow vocally threw their support behind the bill leading up to the vote and offered to serve as co-sponsors. During the floor debate, Hullinghorst spoke passionately about the need for the bill, insisting that “if you drive on roads, send your children to public schools, need health care or hope to keep state colleges and universities affordable, you and each of your constituents are touched by this bill.” She called HB 1420’s group of backers “one of the largest and most diverse coalitions” that she had ever witnessed. House Minority Leader Brian DelGrosso (R) was just as passionately opposed. Referencing the legislative debate over the creation of the Hospital Provider Fee in 2009, he said he believed the 21 House co-sponsors had made a “conscious decision” — not a mistake — not to make it an enterprise fund. “Members,” he insisted, “it is not a glitch” — a reference to the “Fix the Glitch” tagline favored by bill supporters. DelGrosso also argued that HB 1420 is taking money away, in the form of voided tax refunds, from each legislator’s constituents. Despite these objections, the bill advanced with support from all of the Democrats and a handful of Republicans. Thurlow, who represents Grand Junction, said he supported what he viewed as a simple decision because “our constituents want us to do our job and not pass the buck.” The big question now: What Senate Committee will be assigned to hear HB 1420? Thanks to Crowder’s sponsorship, this bill has enough support to pass the Senate if it is allowed to get to the floor. We should know soon.

House Bill 1450

• What the bill proposes: This is a new bill, introduced since our last blog. HB 1450 was drafted as a replacement for HB 1421 to clarify how funds freed up from the potential conversion of the Hospital Provider Fee to an enterprise would be spent. It prioritizes schools, roads and repaying the state severance tax fund for the next five years. Passage of HB 1450 is contingent on the success of HB 1420. It is sponsored by Hullinghorst.
• What happened: The bill passed the House 43-22. Four more Republicans joined the five who voted in favor of HB 1420.
• Why we chose it: This bill is closely linked to HB 1420, but is important because Democrats hope it is a more appealing spending plan than their first attempt. HB 1450 had an equally long House floor debate on Thursday. The bill saw many amendments, especially from Brown and Rep. Janak Joshi (R). Rep. Bob Rankin (R), a member of the Joint Budget Committee (JBC), called attention to what he called “the elephant in the room”: the rising expenditures for Medicaid, which he said is the cause behind many of the state’s budget pressures. A Rankin amendment to take a closer look at growing Medicaid spending was supported by Hullinghorst. The additional Republican votes on HB 1450 presumably came from representatives who oppose the Provider Fee move, but would prefer to have the spending priorities in place if it passes.

House Bill 1101

• What the bill proposes: HB 1101 would allow doctors to make medical decisions for incapacitated patients if no family or close friends can be located. The bill is meant to improve outcomes — or at least options — for patients. It was amended so that a patient’s attending physician can’t be the decision-maker, and doctors would have to consult with a medical ethics committee before taking action. The bill’s sponsor, Rep. Dave Young (D), pointed to an “inspiring group of concerned, individual citizens” who convinced him of the need for this bill. It is also sponsored by Sen. Kevin Lundberg (R).
• What happened: The bill passed its third and final reading in the Senate by a 33-1 margin. It’s on its way to the governor for a signature, which will make it a law.
• Why we chose it: Some days it seemed that this bill was never going to reach the finish line. It required most of the session, as well as numerous amendments, to get there. The final form of HB 1101 represents an impressive set of compromises that made an emotionally charged issue with many considerations into something that members of both parties could agree on. It’s a refreshing example of patience and bipartisan teamwork.

Senate Bill 6

• What the bill proposes: SB 6 would require Connect for Health Colorado, the state-based health insurance marketplace, to provide information about insurance brokers to consumers. In addition to necessitating an explanation of the difference between navigators and brokers — especially the fact that navigators can offer assistance but not advice — the bill would require the marketplace to offer to transfer non-Medicaid-eligible consumers to a licensed broker for help enrolling in a plan. To work with Connect for Health Colorado, brokers must be authorized and licensed by the marketplace. It is sponsored by Sen. Beth Martinez Humenik (R) and Rep. Lang Sias (R).
• What happened: The bill passed the House State, Veterans and Military Affairs Committee 9-0 and then passed the full House 63-2. It’s ready for the governor’s signature.
• Why we chose it: This was one of the only proposals to come out of the Health Insurance Exchange Oversight Committee before the start of the session. With six Republicans and no Democrats as sponsors, SB 6 seemed a partisan bill doomed to fail in the House. At first, it seemed like it wouldn’t even make it through a Republican-controlled committee. Senate Health and Human Services actually failed to advance the bill back in January, but didn’t officially kill it. After some discussion and reworking, the committee revived it and passed it 3-2. Thanks to amendments that backed off the requirement for a new system at Connect for Health Colorado – the final bill simply calls for a new “protocol” – and other changes, SB 6 managed to gain unanimous approval from the House’s designated “kill committee.” It’s definitely not what we would have expected a few months ago. Here’s to another example of D’s and R’s working together.

House Bill 1401

• What the bill proposes: HB 1401 would increase the licensing fees for retail food establishments. To start, businesses smaller than 15,000 square feet will pay between $195 and $375 annually, based on whether they serve pre-packaged or freshly prepared food. Bigger stores and restaurants will pay up to $715. The larger fees would be phased in over the next three years, and exemptions from paying them would be limited. HB 1410 also directs CDPHE to come up with a system to clearly share the results of food inspections with the public. It’s not all bad news for retailers, though: The bill decreases the maximum suspension for violations from six months to only one month, except in cases of an “imminent health hazard,” and bars restaurants from being scored on a letter, number or symbol-based system (so no more A through F grades, for example).
• What happened: The bill passed the Senate Business, Labor and Technology Committee 6-3 and then passed the full Senate 23-11 without a clear partisan split. As with the two prior bills, it’s on to Governor Hickenlooper.
• Why we chose it: A similar idea (HB 15-1226) was floated last year, but met with a lot of resistance and was ultimately converted into a stakeholder group. This year, proponents can celebrate a tangible change in policy — even though they had to make some major concessions along the way. While many were disappointed when the 2015 bill was reduced to a task force, it turned out to be a good move. The stakeholder group had time to plan and negotiate outside of the politically charged atmosphere of the legislative session and draft a detailed bill. HB 1401 still underwent amendments and compromises, especially regarding the more vague scoring system, which led to a fight from Weld County Commissioners and resulted in senators from both parties opposing it. But it’s a step forward. You can read more about some of the proposed changes from Food Safety News here and about Weld County’s opposition from The Greeley Tribune here.

The Senate Appropriations Committee has its hands full today: it will consider 26 bills. I hope its members brought coffee. Three votes that you may be interested in next week:

House Bill 1361

• What the bill proposes: 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.
• Who will be voting: The five members of the Senate Finance Committee.
• Why we chose it: A similar bill (SB 15-123) failed last year, but HB 1361 has already passed the Senate State, Veterans and Military Affairs Committee and the full House. Sponsors can see the light at the end of the tunnel. Increasing choice for patients in health care is always a popular topic, but big pharmacies and insurers have balked at similar proposals. Groups including Express Scripts and the Colorado Association of Health Plans have testified in opposition to this bill, while small facilities, such as Star Drug, Harris Pharmacy and the Kiowa Health Mart, have spoken up in support. The bill has drawn an interesting mix of both bipartisan support and opposition. Read more about the debate over this issue from The Colorado Independent here.

House Bill 1436

• What the bill proposes: HB 1436 is the latest attempt to regulate the appearance of edible marijuana. The bill would ban pot products shaped like a human, animal or fruit.
• Who will be voting: The nine members of the Senate Business, Labor and Technology Committee.
• Why we chose it: We’ll admit it — we chuckled when we read the description of this bill. But rules around the packaging and labeling of marijuana edibles are no laughing matter, and it’s an issue the legislature has struggled with over the past couple of sessions. We’ve lost count of the number of marijuana-related bills that have been introduced this session, and they’ve had mixed results. HB 1436 should be in good shape since it’s already passed the House 50-14. But you can bet marijuana retailers around the state are groaning about how to redesign many of their products. It seems legislators don’t care, if that change can keep edibles out of the hands of kids. The threat of kids eating pot products that resemble candy is frequently talked about, but it’s unclear how often it actually happens. Read more about this bill from The Pueblo Chieftain here.

Senate Bill 120

• What the bill proposes: SB 120 would require the Department of Health Care Policy and Financing (HCPF) to develop an explanation of benefits and accompanying educational materials for Medicaid enrollees. The bill includes an appropriation of nearly $40,000 to cover the changes next fiscal year.
• Who will be voting: The 13 members of the House Public Health Care and Human Services Committee.
• Why we chose it: The hope behind this bill is that it would make it easier to find and report administrative errors and fraudulent claims, and it gained the support of 34 of the 35 senators. SB 120 is one of many 2016 bills attempting to change or improve the Medicaid program. While more controversial Medicaid bills have failed, it seems likely that this one will coast through.

In addition to HB 1450, we saw two new bills of note this week.

• Senate Bill 199 would require that the monthly capitated rate for programs of all-inclusive care for the elderly (PACE) be included on contracts between PACE providers and HCPF. A capitation model involves paying a fixed amount of money per patient for care over a specific period of time. The bill states that the PACE rate must be less than what would have been paid through Medicaid for a non-PACE patient. SB 199 also creates an ombudsman to work with patients and investigate PACE-related complaints.
• Senate Bill 202 comes from the six members of the JBC. It proposes about $6 million in funding for substance use disorder services, which would be assessed and delivered through Colorado’s existing regional managed service organizations (MSO). Substance use treatment resources would be analyzed for adolescents, young adults, pregnant and postpartum women and other adults in need of services. Funds for the MSOs would come from the state’s marijuana tax cash fund.