Legislative Update

Tuesday, July 01, 2014 12:20 PM

Susan Koontz, JD, CMS General Counsel

CMS celebrates successful legislative session

The Colorado Medical Society advocates for Colorado physicians and their patients in a challenging legislative environment. Despite strongly held beliefs among the elected officials, partisan control of both chambers is thinly held resulting in a raft of bipartisan legislation from the state budget to policy. In this environment, unique among most state legislatures, legislators addressed scope of practice issues, provider reimbursement rates, the rising costs of health care, clean claims, the growing problem of prescription drug abuse, children’s health issues, and many others.

CMS lobbied for or against more than 40 bills to ensure legislation benefited physicians professionally and helps improve the health and wellness of Colorado patients. The CMS Council on Legislation (COL), along with their policy and public affairs professionals, reviewed each bill to understand its intent, its possible outcomes and the political landscape to collectively determine how and at what level CMS should engage. Demonstrating that organized medicine in Colorado is not an oxymoron, CMS, component medical societies, and state specialty societies united on numerous bills to enhance impact and assure positive outcomes.

The accomplishments of the session can be divided into six categories:

Liability

CMS participated vigorously in the 2012 election cycle by making preservation of Colorado’s stable liability climate a priority. Despite Democratic control of both chambers and the governorship, which had the potential to favor traction by the trial lawyers, the legislature preserved the liability climate and there was no erosion to professional review – the two highest priorities based on CMS member polling.

Maintaining these priorities is a direct result of physician member contributions to the Colorado Medical Political Action Committee (COMPAC) and the Small Donor Committee. The interview and endorsement process enabled by your contributions builds strong legislative relationships and drives commitments from legislators on these top issues.

Physician payment

For the second year in a row, legislators approved an across-the-board increase in Medicaid payment, with 1.5 percent last year and 2 percent this year and an additional 0.5 percent increase to conduct pilot projects on specialty access. This pattern demonstrates a commitment by Gov. John Hickenlooper and his administration to ensure good access to health care for this population.

Additionally, the legislature maintained Medicaid pay parity with Medicare for primary care through 2015 at a time when the federal government discontinued this increase. The Hickenlooper Administration, backed strongly by primary care and CMS advocates, is directly responsible for extending the payment increase and preserving primary care access.

CMS advanced the process for standardization of claims edits. We strongly supported SB14-159: Extending the Clean Claims Taskforce, which allows for an extension of the work of the Colorado Clean Claims Task Force so the group can work to implement reforms nationally. The development of uniform edits for commercial payers has the potential to save $80 to $100 million per year in Colorado alone. The bill was signed into law on May 29.

Prescription drug abuse

This is an emotionally charged issue and could have potentially sparked a backlash against physicians, but CMS worked to support two bills to reduce opioid misuse and abuse while not adding substantial burden to physician practices. The new CMS Committee on Prescription Drug Abuse reviewed all bills in detail and provided CMS decision-makers with subject matter expert advice.

HB14-1283: Modify Prescription Drug Monitoring Program, signed into law on May 21, makes modifications to the electronic prescription drug monitoring program (PDMP), including the ability for physicians to designate up to three people to access the PDMP on their behalf. The bill mandates registration of physicians to the system but it does not mandate use or education. CMS registered strong support for this bill throughout the legislative process while also being involved with the Colorado State Board of Pharmacy to update the PDMP to make it more user-friendly.

HB14-1207: Household Medication Take-back Program, also signed into law on May 21, creates a permanent infrastructure that allows individuals to dispose of unused medications at approved collection sites, and for carriers to transport unused medications from approved collection sites to disposal locations.

Health care cost

SB14-187: Colorado Commission Affordable Health Care, signed into law on May 29, creates a 12-member commission to undertake a comprehensive, evidence-based analysis of the principal cost drivers in health care in Colorado and the effectiveness of strategies for controlling health care expenditures. The commission will include representatives from across the state, appointed on a bipartisan basis by the governor and legislative leadership. CMS recommended five physician nominees for service on the commission. CMS member Jeff Cain, MD, was appointed. The commission is required to make recommendations to the legislature for each of the following three years.

The Colorado Center on Law and Policy incubated this legislation. Virtually every stakeholder was lined up to testify in support of the bill, including the business community, health plans and providers. Our support positions CMS well as the commission is established to bring ideas to the table about quality, cost containment and access.

Bad ideas killed at our urging

CMS was instrumental in killing HB14-1068: Physician Report Driving Condition, which would have required a physician to report a patient to the state for any condition that could compromise his or her ability to drive a vehicle – “loss, interruption or lapse of consciousness or motor function” – imposing both criminal and civil penalties for failure to report. It also would have removed physician immunity for reporting to the DMV thereby exposing physicians to additional liability by third parties.

CMS president-elect Tamaan Osbourne- Roberts, MD, and COMPAC Chair Dave Ross, DO, testified against the bill, explaining the potential consequence that patients would avoid medical treatment and evaluations and physicians would face criminal harassment or prosecution if a patient, regardless of ability, were involved in a traffic accident.

CMS also opposed SB14-32: Alternative Health Care Providers Treat Children, which would have repealed the restrictions on alternative health care providers to treat children of any age. After a tough fight, CMS and its specialty allies prevailed and the bill was killed in the House Health, Insurance and Environment Committee.

CMS opposed SB14-128: Modify Naturopathic Doctor Act, which would have allowed a naturopathic doctor (ND) who does not satisfy the education and examination requirements determined last year by HB13-1111 but who holds an active certification in good standing from the American Naturopathic Medical Certification Board to obtain a state-issued ND registration. The bill was killed in the Senate Health and Human Services Committee.

CMS was instrumental in killing HB14- 1364: Treatment of PTSD with Medical Marijuana, which would have added post-traumatic stress disorder to the list of conditions that could be treated with medical marijuana.

A bill that would have decreased the hours for prescriptive authority of advanced practice nurses was proposed but not introduced. In the interim we have pledged to work with other health care providers on prescriptive authority, anesthesia and tele health.

Other significant legislation

SB14-016: CDPHE Regulate Freestanding Emergency Centers would have permitted the Colorado Department of Public Health and Environment (CDHPE) to issue a community clinic license to a community clinic that provides emergency care if it is located more than 25 miles from a hospital in the state. Two years after the effective date of the bill, all other freestanding emergency rooms would have been required to be owned and operated by a licensed or certified hospital. CMS supported the bill but it was viewed as anticompetitive by conservatives on both sides of the aisle and did not pass.

As originally drafted, HB14-1288: Student Immunizations Prior to School Attendance would have put into place modest educational requirements for parents who were considering use of the “personal belief exemption” for opting out of immunizing their children. Unfortunately, the bill was amended to remove the educational requirements to only require schools to report vaccination rates. The governor signed the bill into law on May 21. The CMS lobbying team anticipates that the fight for stricter educational requirements around an increasing vaccine opt-out rate will continue into next session and beyond.

HB14-1108: Copayments for Physical Rehabilitation Services would have prohibited a carrier from charging a covered person a copayment for physical rehabilitation services that is more than the copayment charged for a visit to a primary care physician. The bill required a carrier to clearly state the availability, including limitations, conditions, and exclusions, of physical rehabilitation services under its plan. This bill could not be killed in the statehouse and the governor vetoed it.

SB14-155: Medical Marijuana Health Effects Grants Program will create a sub account in the CDPHE medical marijuana cash fund that will provide funding for medical marijuana health research. The governor signed it on May 21.

We want to thank the members of the Council on Legislation for their hard work and congratulate all CMS members for an exceptional session.