2012 Legislative Wrap-up

Lawmakers prescribe antidotes to health care bureaucracy

The Colorado Statesman

Gov. John Hickenlooper signed more than a dozen bills this year addressing health concerns in Colorado.

House Bill 1281, sponsored by Reps. Dave Young, D-Greeley, and Cheri Gerou, R-Evergreen, and Sens. Pat Steadman, D-Denver, and Ellen Roberts, R-Durango, authorizes a pilot project with the goal of reforming how the state pays for Medicaid services. The legislation was considered a centerpiece of health-related legislative actions for both parties. It was signed on June 4.

The law aims to shift the state away from fee-for-service Medicaid programs towards outcomes-oriented payment systems. Lawmakers believe the current system relies too heavily on volume, rather than providing incentives for quality.

Accountable Care Collaborative (ACC) contractors may submit proposals for payment reform pilot projects that include global payments, risk adjustment, risk sharing and aligned payment incentives such as gainsharing, to name a few. The ACC was launched in 2011 as a new Medicaid program to improve health and reduce costs. The Department of Health Care Policy and Financing will select the pilot projects by July 2013, and the projects will run for two to three years.

The bill comes as Medicaid enrollment is reaching unsustainable levels in Colorado, with 615,000-plus enrollees, accounting for about 25 percent of the state’s general fund. Enrollment is only expected to continue to increase.

“Entitlement spending is out of control,” said Gerou. “While we’re still waiting for Democrats to join us in broad based entitlement reform, modest proposals like this program will maintain our focus on reducing costs and eliminating waste.”

While Gerou took a jab at Democrats in her statement, HB 1281 was actually the brainchild of House Democratic leadership and Young. Republicans signed on as co-sponsors after Young had already begun working on the bill.

“Anything we do to try to improve outcomes and contain costs goes beyond modest,” Young said of Gerou’s statement.

The bill was an ambitious undertaking for Young in his first year at the legislature, but he was able to rally a broad coalition of stakeholders, including medical providers, insurance companies, hospitals and consumer groups.

“It was fairly ambitious, but I appreciated the confidence that minority leadership had in me…” said Young.
“My hope for the future is that we actually learn from the pilot projects what payment systems are going to work to improve Medicaid, and maybe equally as reliable, which payment systems may not work, and then we can build from that to really help get better health outcomes for people on Medicaid,” he added. “We want people to feel more satisfied with their health care, and that we are also able to contain costs in Medicaid at the same time.”

Lawmakers also addressed plans to extend the ACC to Coloradans who are eligible for Medicare and Medicaid — known as “dual eligibles” — who often require costly care, including long-term services.

Under the ACC model, patients are assigned to a so-called “medical home,” which serves as the patient’s primary care facility, including a team of clinicians. The goal is to coordinate care to save money and improve quality. The program is divided into seven Regional Care Collaborative Organizations (RCCOs), which manage the program by region across the state.

Senate Bill 23, sponsored by Sen. Betty Boyd, D-Lakewood, and Reps. Ken Summers, R-Lakewood, and Andy Kerr, D-Lakewood, requires case managers and state agencies to work with dual eligible clients to provide information about the state’s Program of All-Inclusive Care for the Elderly (PACE), which serves as an already existent integrated model of care for dual eligible enrollees. The law was signed on April 12.

Senate Bill 127, sponsored by Sen. Linda Newell, D-Littleton, and Summers, permits Long-Term Services and Supports (LTSS) providers to contract with RCCOs as medical homes, or to provide some of the services provided by RCCOs under the ACC model. The bill was signed on April 23.

And Senate Bill 128, sponsored by Roberts and Summers, creates a Medicaid three-year pilot program that aims to move dual eligibles from nursing homes to alternative care facilities in their communities. The bill was signed on June 8.

Hospital legislation to streamline services

Lawmakers also sent to the governor several bills that take aim at reforming and streamlining hospital services with the goal of reducing costs for the state and for patients.

House Bill 1268, sponsored by Rep. Cindy Acree, R-Aurora, and Sen. Evie Hudak, D-Westminster, transfers the in-spections of health care facilities for building and fire safety standards from the Colorado Department of Public Health and Environment to the Colorado Department of Public Safety, which already per-forms similar reviews for public schools. The measure was signed on May 29.

“Without a single oversight agency, navigating the multiple levels of inspection that take place at the federal, state and local levels for health care entities becomes a confusing and disorienting process,” said Acree. “With this law, we’re helping these businesses save time and money by creating clear and consistent requirements within Colorado.”

House Bill 1294, sponsored by Rep. Larry Liston, R-Colorado Springs, and Sen. Lois Tochtrop, D-Thornton, also aims to lessen regulatory burdens on hospitals by reducing duplication and unnecessary government oversight and regulation. The bill was signed on June 4.

And Senate Bill 134, sponsored by Sen. Irene Aguilar, D-Denver, and Acree, requires hospitals to provide information on charity and discount programs available to uninsured patients at the time the patient is receiving care. Hospitals must screen uninsured patients for financial assistance eligibility when possible and limit fees to the lowest negotiated rate from a private health plan. The law also prohibits hospitals from charging a patient more than the cost of care and requires hospitals to work on a payment plan with patients. The bill was signed on May 7 and takes effect on Aug. 8.

“There are many avenues open to needy patients in Colorado that help make health care more affordable,” said Acree. “This measure will raise the public’s awareness of available health care payment options.

“One of the largest obstacles to affordable health care is simply not knowing what options are out there,” added Acree. “This is a practical approach to solving that problem and expanding health care coverage in Colorado.”

Efficiencies lead to lower costs to taxpayers, businesses

The legislature spent much of its time on health care issues trying to streamline services and create efficiencies to lower costs to taxpayers and businesses.

House Bill 1041, sponsored by Rep. Jeanne Labuda, D-Denver, and Sen. Lucia Guzman, D-Denver, creates an electronic death registration system so that coroners and others responsible for reporting deaths can do so electronically. Lawmakers hope the measure will allow for better records and reporting of death data, thereby streamlining the process. The bill was signed on June 6.

House Bill 1054, sponsored by Rep. Rhonda Fields, D-Aurora, and Boyd, aims to simplify the Department of Health Care Policy and Financing process for authorizing health care providers by reducing the number of contracts required to participate in health-related entitlement pro-grams. The bill was signed on March 15.

House Bill 1058, sponsored by Rep. Janak Joshi, R-Colorado Springs, and Sen. Jeanne Nicholson, D-Black Hawk, transfers the responsibility to treat newborns with eye drops containing antibiotics to prevent the spread of gonorrhea from the Colorado Department of Public Health and Environment to the health care provider delivering the child. The bill was signed on March 24.

House Bill 1339, sponsored by Rep. Jon Becker, R-Fort Morgan, and Sen. Kent Lambert, R-Colorado Springs, appropriates $23 million to improve the Colorado Benefits Management System, the state’s computer system for Medicaid and other entitlement programs. The system has been plagued with troubles for years, including failing a federal audit last year that could result in Colorado losing federal support. The bill was signed on May 3.

Senate Bill 37, sponsored by Sen. Steve King, R-Grand Junction, and Young, allows for the electronic transfer of prescriptions for controlled substances. Pharmacies are currently prohibited from dispensing controlled substances without a written prescription. SB 37 reverses that law. The bill was signed on March 22.

Finally, House Bill 1052, sponsored by Rep. Summers, and Sens. Boyd and Roberts, requires the Department of Regulatory Agencies to implement a system to collect health care work force data from health professionals who are eligible for the Colorado Health Service Corps, a program for doctors serving in high-demand areas in exchange for student loan repayment. The data will be used to plan for future health care workforce needs. The bill was signed on May 29.

Redirecting resources to improve health care

Hickenlooper also signed several bills that redirect the state’s resources to save money and improve health care.

House Bill 1100, sponsored by Summers and Aguilar, deals with redirecting resources from criminal prosecution to develop long-term solutions for substance abuse. The bill prohibits information about illegal drug use obtained through a pregnancy test to be used criminally against a pregnant woman. The bill allows pregnant women to enter treatment for substance abuse without being prosecuted for using illegal drugs. The bill was signed on March 9.

Aguilar says the goal is to encourage providers to screen more pregnant women and to reassure women that information discovered will not lead to criminal consequences.

“Pregnancy can dramatically increase the effectiveness of treatment interventions since the woman tends to be highly motivated to protect her unborn child,” Aguilar said during debate of the bill. “We need to increase the screening and identification of substance use during this time to protect children in Colorado.”

Senate Bill 161, sponsored by Nicholson and Rep. Laura Bradford, R-Colbran, also addresses medical resources concerning the criminal justice system, allowing correctional facilities to return certain unused medication, medical devices and medical supplies to be re-dispensed to another patient. The bill was signed on May 24.