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Hick Calls for Budget Changes, LARC Funding Bill Faces Long Odds

Hick Calls for Budget Changes, LARC Funding Bill Faces Long Odds

Governor John Hickenlooper outlined his five-point plan to address what he calls Colorado’s budget “contradictions” in an April 16 letter to lawmakers. The governor’s proposal lays out options to free up more state money for areas such as education and transportation, including reclassifying the Hospital Provider Fee.

But it didn’t meet with universal approval, especially coming just weeks before the end of the legislative session. Sen. Pat Steadman (D) dismissed it as a “Hail Mary.”

The Denver Post’s editorial board responded more favorably, saying that action is needed and the governor deserves “credit for trying.” With limited time remaining in the session, however, it seems unlikely the governor’s plan will result in immediate changes.

While the governor advocates for full TABOR rebates for taxpayers in fiscal years 2014-15 and 2015-16, he believes that the refund mechanism should be addressed after that. Of special interest: he wants to grant the Hospital Provider Fee enterprise status. For an explanation or refresher on that topic, see Joe’s blog on the “magic” of converting the provider fee to an enterprise fund. However, the apparently simple process may be more difficult to accomplish than it seems.

In health care legislation news: the much-watched House Bill 1194, which would allocate $5 million in state funding to continue a long-acting reversible contraception (LARC) program for low-income women, seems poised to fail. The bill, championed by Rep. Don Coram (R), passed the House by a vote of 37-26 but was assigned by Senate President Bill Cadman (R) to the Committee on State, Veterans and Military Affairs – traditionally viewed as the “kill committee.”

It’s unlikely HB 1194 will pass the five-member group at its April 29 scheduled hearing. State funding for LARC could also have been granted through an amendment to the budget bill, which was added during budget discussions but did not make the final cut. If the bill somehow does manage to pass, it would be the only notably controversial health care bill to make it through this session.

Similarly, Rep. Dianne Primavera (D) saw her House Bill 1083, which originally sought to make rehabilitation services more affordable by prohibiting their classification as “specialty services,” quickly pass its first chamber after a long-delayed vote in the House Health, Insurance and Environment Committee. But Speaker Cadman then assigned it to the same Senate committee, State, Veterans and Military Affairs.

The copayment for a rehabilitation visit – including physical therapy, occupational therapy, and chiropractic services – would have been limited to half of what an insurance company pays the provider for the visit. However, the bill was amended to instead require a study on patient cost-sharing for rehab services by the Colorado Commission on Affordable Health Care, with a report due by November 1, 2015. It remains to be seen if the weakened version of the bill can pass State Affairs; a hearing date has not been set.

After months of lead-up, an anticipated bill to provide a universal health care system for all Coloradans fell short before it could begin. The legislation, drafted by Rep. Joann Ginal (D) and Sen. Irene Aguilar (D), will not be introduced this session. The group created to support the effort reported that House Speaker Dickey Lee Hullinghorst (D) has decided not to allow its introduction.

Instead, advocates will continue their work to get a citizens’ initiative on the November 2016 ballot. CHI will continue to monitor the issue and the voter campaign, to be called ColoradoCareYES.

Meanwhile, Sen. David Balmer (R) surprised many with his Senate Bill 274, which would reinstate a sales tax exemption for soft drinks sold in Colorado. The exemption was removed in 2010 to discourage soda purchases, but Balmer’s bill argues that “singling out soft drinks” when most food and drinks are exempt from state sales tax is “arbitrary and unfair.” It has been assigned to the Senate Finance and Appropriations Committees.

House Bill 1367, introduced by the Joint Budget Committee along with the Speaker of the House and Senate President, refers a ballot issue to voters in November asking their permission (again) for the state to keep retail marijuana tax revenue. If the ballot measure is defeated, the bill lays out how the money will be spent. The bill passed the Appropriations Committee and needs a final affirmative vote on the House floor to pass the chamber. For a helpful explanation of retail marijuana policy and the tax issue in Colorado, check out CHI’s newest report – released, appropriately, on 4/20.

Senate Bill 259, introduced by Sen. Aguilar, sought to protect consumers from some out-of-network charges, but it went down on a party-line vote in the Senate Business, Labor and Technology Committee. Consumers, insurers and advocacy groups spoke in favor of the bill, which Aguilar branded as “Know Before you Owe,” while physician and hospital groups opposed it. Physicians believe that they already lack bargaining power when up against insurers and said this bill would remove more of their limited agency.

During the bill’s hearing, several changes were suggested that ultimately made the legislation more about the need for transparency so consumers wouldn’t be shocked by high price tags. While several opponents agreed with the need for better information disclosure, they said they could not support the bill as written. The committee’s five Republican members voted to kill it after several hours of testimony.

Senate Bill 197, though, fared much better. The bill, which would expand the abilities of advanced practice nurses (APNs) by making it easier for them to write prescriptions, passed the House without any amendments and is ready to be signed by the governor. It continues a streak of success for health professional scope-of-practice bills, which have appealed to legislators from both sides of the aisle. SB197 allows APNs to write prescriptions after 1,000 practice hours (down from 3,600 hours) as long as they have at least three years of clinical experience.

A quick roundup of other bill developments:

In the Senate, the Health and Human Services Committee passed five bills we’re watching. House Bill 1242, requiring patients to have the opportunity to designate a caregiver during their first day in the hospital, passed the committee 5-0 and then easily passed the full Senate. It is heading to the governor for signature. Senate Bill 256, concerning the Colorado Health Insurance Exchange Oversight Committee, passed Health and Human Services, the Appropriations Committee and then the full Senate. The House Health, Insurance and Environment Committee sent the bill forward on a unanimous vote to the Legislative Council Committee, where it now stands. Senate Health and Human Services also voted 5-0 in favor of House Bill 1232, which would expand the availability of emergency epinephrine auto-injectors. The bill goes next to Appropriations.

The committee voted unanimously to pass House Bill 1186, which would expand the age limit for autistic children to receive health care services and remove the set cap on annual per-child spending. The bill then passed Senate Appropriations and is awaiting its final vote on the Senate floor. House Bill 1097 passed Health and Human Services 4-1, but was then voted down (3-2) in State, Veterans and Military Affairs. The bill would have revived a commission on fetal alcohol spectrum disorders under the Department of Human Services.

In the House, the two health committees sent several bills forward. House Bill 1297, which aims to prohibit insurance carriers from limiting the fees that optometrists may charge or requiring optometrists to participate in specific plans or networks, passed the House Health, Insurance and Environment Committee on a vote of 7-6. The bill’s next reading on the House floor has been postponed until May 11, after the end of the session – meaning that it will not move forward. The same committee approved House Bill 1318, which would create a single Medicaid waiver for home- and community-based services for adults with intellectual and developmental disabilities, on a margin of 10-3. The bill subsequently passed the Appropriations Committee and is waiting for third reading on the House floor.

The House Public Health Care and Human Services Committee gave the nod (11-2) to House Bill 1226, a bill that is of great interest to the public health community. It seeks to increase funding for inspections of retail food establishments and reduce the payment burden on county governments and local public health agencies (LPHAs). Currently, the LPHAs must contribute food inspection funding out of their limited budgets because the annual licensing fees paid by restaurants are not adequate to foot the bill. HB 1226 later passed House Finance and is ready for a floor vote.

Governor Hickenlooper has signed several more bills into law as the end of the session nears. They include Senate Bill 15 (requiring benefit parity for autism services), House Bill 1067 (requiring continuing professional development for licensed psychologists) and House Bill 1164 (allowing women who are breast-feeding to postpone jury duty).