Legislative preview

Wednesday, January 01, 2014 11:17 AM

Colorado legislators share what to expect in 2014

Susan Koontz, JD, CMS General Counsel

The second regular session of the 69th Colorado General Assembly convened Jan. 8, 2014, and with its convening comes opportunities to advance the priorities of Colorado physicians and their patients.

“Very big picture, we’re looking at things we can do to strengthen Colorado’s economy,” said Senate President Morgan Carroll (D-Aurora). “We’re interested in looking at education and affordability, things like that. In health care there are some big-ticket items worth emphasizing.” Lawmakers will continue to fine-tune the Medicaid expansion and rollout of the Affordable Care Act in Colorado but without making large-scale changes because “the dust hasn’t settled yet,” she said.

Sen. Irene Aguilar (D-Denver), chair of the Senate Health and Human Services Committee, said not to expect hot-button issues to be raised this session including any changes to tort laws. “[Medical liability] tends to be a very polarizing issue between Democrats and Republicans. And I think we’d like to show the kind of unity that people aren’t seeing in Washington so we’ll be avoiding things that are too controversial,” she said.

Budget
The Colorado Department of Health Care Policy and Financing will make several budget requests important to physicians including a rate increase to all eligible Medicaid providers and an additional targeted rate increase to allow the department to rebalance certain rates to create incentives for outcomes. The targeted rate allocation would be set through stakeholder input.

Within a few days of the start of the session, the Joint Budget Committee passed a 3 percent increase out of committee. “Members of the JBC know that physicians lose money on every Medicaid patient,” said Rep. Cheri Gerou (R-Evergreen). “Our recent unanimous vote to increase rates to 3 percent across the board was an attempt to close the gap between Medicaid and Medicare reimbursement rates.”

Additionally, HCPF will request funding to assist Medicaid providers with adopting electronic health record systems and connecting to Colorado’s health information technology network. The department will work to build interfaces and an electronic infrastructure to allow data from Medicaid beneficiaries to be aggregated and exchanged between EHR systems, the department’s claims system and other Medicaid-related systems in the state.

Another HCPF budget request would allow the department to explore telemedicine technology to facilitate the exchange of patient information between primary care physicians and specialist physicians without the need for an in-person patient visit, much like Project ECHO in New Mexico, said Katherine Blair, senior health policy advisor to Gov. John Hickenlooper. This technology will allow for increased access to care for patients in rural areas and reduce unnecessary utilization of specialty care by allowing specialists to virtually screen clients.

The JBC will continue to look at cost drivers in health care and solicit recommendations for controlling costs. “Especially at the legislature, we’re always looking for ways to make sure we’re using our dollars wisely and that’s going to be an ongoing conversation for years to come,” said JBC chair Rep. Crisanta Duran (D- Denver).

She said they’re also looking for feedback on what more legislators can do to provide incentives to specialists to encourage more to see low-income patients. “I think that’s something many of us are very interested in. It will be a good conversation for years to come as well, and we appreciate all of the feedback that CMS has given us throughout the years.”

Prescription drug abuse
A top initiative of the governor’s office over the past year has been to reduce the abuse of prescription drugs. Blair said the administration will work with legislators to make changes to the Prescription Drug Monitoring Program to bring it up to speed with national best practices. The draft legislation will likely involve expanding delegated authority to other medical professionals and a requirement for all prescribers to register with the PDMP. “It’s not mandatory usage but we’re trying to encourage more doctors to get involved in checking that database before they write prescriptions for certain drugs,” said Rep. Beth McCann (D-Denver), chair of the House Health, Insurance and Environment Committee.

Additionally, the administration is working on another bill, spearheaded by the Colorado Department of Public Health and Environment, related to the disposal of prescription drugs.

Health care costs
One of Aguilar’s goals for the session is to look at the drivers of health care costs that aren’t providing value and to have a serious conversation, as a state, about how to control costs. “Whenever you try to talk about controlling costs in health care it needs to include focusing on supporting providers, especially primary care providers, with the help they need to manage patients and keep them healthy.”

Along those lines, Aguilar is studying urban free-standing emergency rooms without hospital affiliation, which have no obligation to see Medicaid, Medicare or the uninsured; this is another example, she said, of a facility that may add cost but not value to the health care system.

Colorado has had an ongoing interest in transparency, and in collecting as much data as possible to help us make informed choices, Carroll said. “We’re trying to get more data about health care delivery systems overall, whether it’s on the insurance side or the provider side, what we can learn from pharmaceutical cost drivers or the hospital system.”

Medical training
Aguilar is also looking into whether it would be possible for Colorado to use Medicaid GME funding to start a rural residency program focused on primary care in the San Luis Valley – where roughly one-quarter of residents were Medicaid-eligible even before the expansion. “Ideally I’d like it to be an outpatient-based residency program to reflect the wave of the future,” she said. She’s working with the Commission on Family Medicine to analyze need and feasibility.

Sen. Larry Crowder (R-Alamosa) supports this action. “Due to the vast geographic area in southern Colorado, I would support a bill to increase medical residencies in this area.”

And Rep. Clarice Navarro (R-Pueblo) said, “In order to keep these rural communities alive and thriving it is important that there is a variety of medical resources and/or residency programs available to meet their needs.” 

Wellness
Rep. Dianna Primavera (D-Boulder), chair of the House Public Health Care and Human Services Committee, is focused on working with the governor on his goal to make Colorado the healthiest state in the nation. This includes a bipartisan bill that she and two other representatives hope to sponsor on childhood obesity. “Even though Colorado has always been considered one of the leanest states, we’re losing our battle with childhood obesity,” and that drives many costs to society, she said.

Mental health
Primavera said the legislature is also beginning to see the importance of integrating behavioral health and physical health. “We’re hoping to get a crisis line put together, [with] more mental health navigators and regional crisis centers,” she said. “I just think we’re putting a bigger emphasis on mental health, which is very important in light of a lot of the violence we’ve seen in society.”

“Every time we’re looking at health care access issues, we’re explicitly looking at mental health services as well,” Carroll said. “Both last year and this year we’ll continue to see public financial support within the budget to try and improve our mental health services.”

Many are also looking at mental health in the corrections system. McCann is working on legislation to combine procedures for involuntary commitment for drug abuse and alcohol abuse, and is working on another bill to assist law enforcement when they take a person in for a mental health hold. This bill would allow an officer to direct an offender to treatment rather than jail, but it would also alert law enforcement when the person has been released from treatment so officials can decide how to proceed with the case.

Immunization
Building on work from the previous session, Aguilar is studying personal belief exemptions that allow individuals to opt out of immunizations, and the effect of the exemptions on public health. Colorado ranks high in the number of families who opt out of immunizations and a coalition suspects some opt out of immunizations for ease rather than by informed decision.

Potential legislation would ensure people are adequately informed of the risks. “We want to be sure that people aren’t just doing it for convenience and have the ability to be given information about what the potential health consequences are of their decision,” Aguilar said. “We wouldn’t in any way get rid of people’s right to deny it.”

Importance of involvement
Carroll encouraged all Coloradans to make their voices heard, even when they are part of a group like the Colorado Medical Society that has a lobbying presence at the Capitol. “There’s really nothing ever quite as effective as individuals getting engaged, getting to know their legislators, showing up at town hall meetings, showing up to testify when you can, submitting written testimony when you can.”

“Physicians matter when they come to the Capitol,” said Rep. Amy Stephens (R- El Paso). “I have watched physicians single-handedly change the course of a bill because of their testimony in opposition or support of the bill. Physicians need to be involved.”

Carroll said the legislature needs physicians to share their unique expertise and educate lawmakers. “There’s a very valuable role of education to help us make better policy. The more people who are involved with real-world experiences that weigh in and participate in shaping public policy, the better the public policy is in the end.”