2017 Legislative Report Table of Contents

Introduction...... 1

Preventing Devastating Cuts to Hospitals and the Colorado State Budget...... 2

Maintaining Coverage and Access to Care...... 6

Increasing Health System Transparency and Addressing Cost of Care...... 8

Improving the Health and Safety of Hospital Employees and Those We Serve...... 10

Strengthening Colorado’s Behavioral Health System.....12

Conclusion...... 13

2017 CHA Bill Summary...... 14

Use this to identify the bill number for BILL the legislation being discussed. Additional details on the bills are available in the CHA Bill Summary (page 14). Introduction

Dear Health Care Leader,

Following the 2016 election, the makeup of the 71st Colorado General Assembly remained markedly similar to the past two legislative sessions – Republicans continued to control the Senate, and Democrats maintained the majority in the House of Representatives. While Colorado retained its split-party control, the nation witnessed sweeping changes at the federal level. With the profile of the state legislature seemingly unchanged, and so much unexpected uncertainty surrounding the federal health care landscape, it was difficult to predict which health care issues – if any – would find a successful path through the General Assembly. As bills progressed, however, it became clear that once-rigid political dynamics were shifting, and both sides of the aisle demonstrated a greater willingness to compromise on challenging matters facing Colorado.

Many contentious issues were successfully resolved and sent to the Governor this year. Among the greatest achievements were an end to the four-year stalemate over construction defects and the passage of the bill creating the Hospital Provider Fee (HPF) enterprise, which also included much-needed funding for transportation and education. Most Coloradans – including some legislative leaders – had predicted the HPF enterprise to be an impossible feat, but on the last day of the legislative session, a bipartisan compromise worth an annual $2.9 billion passed its final vote. This compromise, a bill coined, “Concerning the Sustainability of Rural Colorado,” touched on several key priorities set out by the legislature. Most importantly to Colorado hospitals, this bipartisan compromise served as the vehicle to safeguard HPF funding from state budget cuts – the Association’s top legislative priority for the past three years.

While establishing the HPF enterprise was the focal point of the Association’s efforts at the legislature, CHA was ultimately able to successfully tackle every issue on its legislative agenda. Overall, CHA actively monitored, engaged in, amended, opposed or supported 90 bills crossing five themes:

• Preventing devastating cuts to hospitals and the Colorado state budget • Maintaining coverage and access to care • Increasing health system transparency and addressing cost of care • Improving the health and safety of hospital employees and those we serve • Strengthening Colorado’s behavioral health system

As each legislative session comes to an end, there are always issues that are poised to resurface in future sessions. Hospitals and health systems should be prepared to work with legislators and stakeholders to find meaningful solutions to the growth of freestanding emergency departments, health care transparency and unaffordability of health insurance in rural areas of the state. Collectively, CHA and its members must continue to work together in a shared commitment to improving health care in Colorado.

Sincerely,

Steven J. Summer PRESIDENT AND CEO COLORADO HOSPITAL ASSOCIATION

2017 Legislative Report 1 Preventing Devastating Cuts to Hospitals and the Colorado State Budget As with the prior two years, CHA began The centerpiece of the legislation is the transition of the the legislative session focused on efforts to HPF into an enterprise, which will be called the Colorado convert the Hospital Provider Fee (HPF) to Healthcare Affordability and Sustainability Enterprise an enterprise, thus negating potential cuts to (CHASE). To hospitals, it will function similarly to the hospitals. As part of Governor Hickenlooper’s current HPF program; however, beginning July 1, 2017, it budget request for the 2017-18 state fiscal will become a distinct government-owned business entity year, he proposed a $195 million cut to the within the Department of Health Care Policy and Financing revenue collected by the HPF to balance (HCPF). Its creation means that CHASE revenue will not the budget. Following the March Revenue count against the constitutionally mandated revenue cap and Economic Forecast, the legislature’s Joint Budget and will not be subject to potential cuts by the JBC to Committee (JBC) faced an even larger deficit and was balance the budget. forced to increase the cut to $264 million – $528 million when the federal match is included – in the formal budget The bill also included some modest reforms to Colorado’s legislation, the “long bill” (Senate Bill (SB) 17-254). As Medicaid program. HCPF, in partnership with CHA, will approved by the JBC, the budget also included a develop a hospital payment reform program in line with complementary bill, SB 17-256, that made a temporary the federal Delivery System Reform Incentive Payments change to statute to ensure the cuts to the HPF came Program (DSRIP), which will be implemented in October from hospitals and did not force a rollback of Medicaid 2019. In addition, upon the passage of federal authorizing expansion. Although CHA formally opposed this bill, it passed legislation, the state will implement the Advancing Care and was signed into law. Fortunately, the cuts and the for Exceptional (ACE) Kids Act, a care coordination program effects of SB 17-256 were eliminated by the subsequent for children with medically complex conditions. Finally, passage of SB 17-267. existing co-pays will increase for Medicaid clients in two categories: outpatient services and prescription drugs. SB 17-267 was the most significant achievement of this legislative session – not only for CHA, but for the General Passage of SB 17-267 was a mammoth effort that required Assembly and the entire state. Sponsored by Republicans the partnership of hundreds of organizations not only in – Senate President Pro Tem Jerry Sonnenberg (R-Sterling) health care, but also in transportation, K-12 and higher and Rep. Jon Becker (R-Fort Morgan) – and Democrats – education, government and business, among others. The Senate Minority Leader Lucia Guzman (D-Denver) and House Association is grateful for partners across the political Majority Leader KC Becker (D-Boulder), the legislation has spectrum that contributed to the success of this effort. been heralded as the “compromise of the decade,” and its annual value to the state is nearly $2.9 billion.

2 2017 Legislative Report 1 Grand Compromise Worth $2.9 Billion to Colorado Each Year • Reverses $528 Million Cut to Hospitals: Moves the Hospital Provider $ Fee to an enterprise and reduces TABOR cap by $200 million; makes 1 Senior Homestead Property Tax Exemption refund mechanism when TABOR refund is triggered. • Reforms Medicaid: 3% maximum admin fee for enterprise; requires Medicaid reforms: Delivery System Reform Incentive Payment Program and the ACE Kids Act; targeted copay increases for Medicaid patients (outpatient and pharmacy only). • Funds Infrastructure & Reduces Government Spending: $1.8 billion for transportation projects (25% for rural, 10% for transit); $120 million for capital construction; each state agency must submit a plan for a 2% budget reduction. • Expands Business Tax Credit: For small businesses, valued at $21 million, by increasing the retail marijuana tax. • Provides $30 Million for Schools: Rural schools only in Year 1, subsequent years to all schools.

Who Does the HPF Help?

Vulnerable Coloradans

RURAL HOSPITAL DAY

Although there were a variety of measures in the bill, the effort to pass SB 17-267 was spearheaded by CHA and its member hospitals and health systems. Many of the Association’s members visited the Capitol for Protect Rural Hospitals Day on March 8, during which Sen. Sonnenberg announced his intent to run legislation addressing the HPF.

AND reduces the cost of private insurance for Colorado individuals and businesses

2017 Legislative Report 3

e Report e 2017 Legislativ 2017 4

2016 to 2017 to 2016

For more information, contact Aly Schmidt, 970.214.4231 or [email protected] or 970.214.4231 Schmidt, Aly contact information, more For For more information, contact Aly Schmidt, 970.214.4231 or [email protected] or 970.214.4231 Schmidt, Aly contact information, more For

reimbursement from from reimbursement

living facility living

in HPF net net HPF in

assisted assisted change

10-bed

31 %

skilled nursing facility nursing skilled

in annual payroll annual in

long-term long-term

9 million 9

35-bed

2017 $ More than than More

33% Medicaid Medicaid 33%

and

38% Medicare 38%

in the community the in

2016

employers employers Patient population is is population Patient

top three top

Medicare 17

One of the of One

State Budget Cuts: Budget State +

Impact of Proposed Proposed of Impact

Medicaid 51

$40 million in annual payroll annual in million $40

% Other Services: Other

the San Luis Valley with more than than more with Valley Luis San the

$4 million $4

Patient Population is: Population Patient One of the largest employers in in employers largest the of One

Employees 190

600+ Employees 600+

– –

would be a a be would $4 million loss million $4

Proposed Hospital Provider Fee Fee Provider Hospital Proposed

cut cut

– KONNIE MARTIN, CEO, SAN LUIS VALLEY HEALTH VALLEY LUIS SAN CEO, MARTIN, KONNIE –

employees, and jeopardize southern Colorado’s overall regional health care system.” system.” care health regional overall Colorado’s southern jeopardize and employees,

would would immediately threaten our ability to provide services, provide to ability our threaten immediately

“For a hospital like ours, that operates on a a on operates that ours, like hospital a “For

negatively impact our our impact negatively

lean budget, lean

the proposed provider fee reduction reduction fee provider proposed the

San Luis Valley Regional Medical Center Medical Regional Valley Luis San

Conejos County Hospital County Conejos

hospice care hospice

Home health and and health Home

Cardiac Rehab Cardiac

Occupational Therapy Occupational

Physical and and Physical and Burlington and Radiology

of I-70 corridor between Denver Denver between corridor I-70 of

Behavioral health Behavioral Laboratory

Only hospital along the 160 miles miles 160 the along hospital Only

Conejos County Hospital County Conejos Level IV Trauma Center Trauma IV Level

Hospital Services: Hospital

Regional Medical Center Medical Regional

San Luis Valley Valley Luis San Lincoln County Lincoln

Hugo, Colorado in in Colorado Hugo,

Access Hospital Access

located throughout the Valley the throughout located

15-bed Critical Critical 15-bed

2 hospitals 2

For more information, contact Aly Schmidt, 970.214.4231 or [email protected] or 970.214.4231 Schmidt, Aly contact information, more For responsible for for responsible 450 births per year per births 450 and

5 clinics 5

Lincoln Community Hospital Community Lincoln

San Luis Valley Health: Health: Valley Luis San service in the Valley, Valley, the in service

CASE STUDY: STUDY: CASE

Providing the the Providing

only Labor & Delivery & Labor only

continued

CASE STUDY: STUDY: CASE

San Luis Valley Health Valley Luis San

889,000 Colorado Hospitals: Economic Impact Impact Economic Hospitals: Colorado

Jobs Jobs

continued SOURCE:

Colorado Office of Economic Development and International Trade International and Development Economic of Office Colorado

• One rural physician’s employment creates approximately approximately creates employment physician’s rural One • in secondary revenue secondary in

in rural Colorado rural in

• Health care is one of the the of one is care Health •

Rural Spotlight Rural

200 200

For more information, contact Aly Schmidt, 970.214.4231 or [email protected] or 970.214.4231 Schmidt, Aly contact information, more For

Mt. San Rafael Rafael San Mt.

top 3 industries 3 top Southeast

650

300 800 million 446

Valley Health Health Valley

1 Spanish Peaks Regional Regional Peaks Spanish 1

1 Mercy Regional Mercy

San Luis Luis San

300 400 $

Memorial

Regional 143 4

6 1

Southwest Arkansas Valley Valley Arkansas

200 Rio Grande Grande Rio

1,300

Corwin Corwin

390 million 390

9 Medical Group Group Medical

Prowers Prowers

St. Mary Mary St.

8 $ 2

2,500

6 cut from Colorado’s economy Colorado’s from cut 300

Parkview

Heart of the Rockies the of Heart

= cuts HPF in

1 Impact of proposed state budget cuts: budget state proposed of Impact

400 St. Thomas More More Thomas St. 70

5 2,600 500

Memorial

300

St. Francis St. Keefe

100 St. Vincent General General Vincent St.

10 Memorial 2

Penrose-

4,200 Montrose Montrose

Gunnison Valley Gunnison

13 1

120

Health System Health

120

500

2 Memorial Memorial

County Memorial County

Delta County Memorial County Delta

$11.05 billion $11.05 Kit Carson Carson Kit

Hospital & Nursing Home Nursing & Hospital

Lincoln Community Community Lincoln 4

Labor Income: Labor

2,000

St. Mary’s St. 1 7,100

Impact on Total on Impact

Health 5

600

10,300 HealthONE HealthONE 1,000 Centura Centura

1 1

Community

Valley View Valley 3 360

7,700

SCL SCL Colorado Plains Colorado 2

150

10 East Morgan County Morgan East

370

4,100

Sterling Regional Sterling 2

& McKee & billion

layoffs their community their 5.72 billion 5.72

Banner: NCMC NCMC Banner:

$ 1 reductions or or reductions

employer in in employer

community to consider staff staff consider to

5,300

are top 1-3 1-3 top are 600

Payroll:

services to their their to services

1 90

will be forced forced be will

Poudre Valley Valley Poudre

90 Yampa Valley Yampa will reduce reduce will

% 28.9

% $

Hospital Community Impact Community Hospital 11

#1 Job Creator Job #1

KEY: Region , Regional Rank, Hospital Name, Number of Employees of Number Name, Hospital Rank, Regional , Region

Economic Impact Economic

Impact: (See top employer rankings by OEDIT regions below) regions OEDIT by rankings employer top (See

for Coloradans for

care recruiting care Regions a Hospital is Ranked the the Ranked is Hospital a Regions Economic

(non-clinical), specialty medical medical specialty (non-clinical),

11 of 14 of 11

In In

highly skilled jobs skilled highly

Hiring restrictions restrictions Hiring

in Colorado in

new clinics on hold on clinics new

Colorado Hospitals: Hospitals: Colorado

higher paying, paying, higher Reduced services, services, Reduced 183,961 jobs 183,961

and generate generate and Hospitals provide provide Hospitals

health care sector care health 75,500 Coloradans 75,500

in Colorado is in the the in is Colorado in

Hospitals employ more than than more employ Hospitals

1 in 16 jobs 16 in 1

Urban hospitals would be affected: be would hospitals Urban

Archuleta Montezuma

La Plata La Conejos

Costilla

Las Animas Las

Rio Grande Rio

Baca

Dolores Dolores Alamosa

Juan

Mineral

Top Employers Top San Huerfano

San Miguel Miguel San

Hinsdale

Otero

Saguache Saguache Ouray

Bent Custer

Montrose

Prowers

Pueblo

Fremont Crowley

Gunnison

Kiowa

Hospitals are are Hospitals Chaﬀee Delta

Lincoln Mesa El Paso El

Teller

Cheyenne

Park Lake

Pitkin Pitkin

Douglas Garﬁeld

Elbert

Kit Carson Kit

Eagle Jeﬀerson

Summit

Clear Creek Clear

Arapahoe Arapahoe

Rio Blanco Rio

Gilpin

Denver Denver

Adams

Washington

Grand

Boulder Yuma

Broomﬁeld

Routt

Morgan

Moﬀat

Jackson

Larimer

Weld

Phillips Logan

no hospital would grow by by grow would hospital no

Sedgwick

50% Number of counties with with counties of Number

hospitals hospitals

528 million 528

$ Budget bill would cut cut would bill Budget Hospitals

Cuts Close Close Cuts

some of which are shown here. shown are which of some

rural hospitals, and the consequences of the budget cuts in the form of fact sheets and case studies, studies, case and sheets fact of form the in cuts budget the of consequences the and hospitals, rural CHA provided a significant amount of educational material to legislators about hospitals generally, generally, hospitals about legislators to material educational of amount significant a provided CHA

Report Legislative 2017 5

For more information, contact Aly Schmidt, 970.214.4231 or [email protected] or 970.214.4231 Schmidt, Aly contact information, more For

Medicare

| | %

Medicaid 20

% BREAK EVEN BREAK

Patient Population is: Population Patient

of Denver Health’s patients Health’s Denver of

Since 2013, Medicaid covers Medicaid 2013, Since in 2017-18 in $

$1 million $1

Proposed cuts equal about about equal cuts Proposed

$ in area in

cancer care cancer

and

in the state for 2017-18 for state the in

advanced imaging imaging advanced

HOSPITAL

obstetrics, obstetrics,

Provider Fee cut Fee Provider

7,000 employees 7,000 with with

MEMORIAL

COUNTY Only provider of provider Only Largest Hospital Hospital Largest

One of Denver’s largest employers employers largest Denver’s of One DELTA

CEO,

CLECKLER,

JASON – –

wisely set aside, but it will be very difficult to survive beyond one year of cuts.” cuts.” of year one beyond survive to difficult very be will it but aside, set wisely

“It is not likely that we will close in one year due to the amount of reserves we have have we reserves of amount the to due year one in close will we that likely not is “It

– ROBIN WITTENSTEIN, CEO, DENVER HEALTH DENVER CEO, WITTENSTEIN, ROBIN –

our patients with nowhere else to go.” go.” to else nowhere with patients our

Denver Health to reduce essential services, leaving leaving services, essential reduce to Health Denver

“Cuts to the Hospital Provider Fee will force force will Fee Provider Hospital the to “Cuts

school-based health centers health school-based

Denver Health’s 17 17 Health’s Denver

receive free health care at at care health free receive

in annual payroll annual in Denver Public Schools students students Schools Public Denver

31 million 31

Colorado Rural Health Center – 2017 Snapshot of Rural Health in Colorado in Health Rural of Snapshot 2017 – Center Health Rural Colorado

HCPF HPF Oversight and Advisory Board – 2016 Annual Report Annual 2016 – Board Advisory and Oversight HPF HCPF

615 employees 615 SOURCES:

5 hours from Denver from hours 5

Delta County with with County Delta

survival rate survival

Grand Junction and 100,000+ calls 100,000+

in 2015 in

Largest employer in in employer Largest

......

98%

trauma trauma a has ......

Nearly an hour from from hour an Nearly

......

system answered answered system

......

Level I Trauma Center Center Trauma I Level

......

emergency response response emergency

care

preventive and

exchange (172,000 enrollees). (172,000 exchange + Denver Health’s Health’s Denver

Denver’s 911 medical medical 911 Denver’s

services.

are ...... took effect, suggesting that more

...... insurance health the and coverage) for eligible newly

911 . . . . .

...... 8% over the past three years since Medicaid expansion Medicaid since years three past the over 8%

seeking primary . . . . . (350,000 expansion Medicaid HPF, the through care to Hospital in America in Hospital

- Emergency Department visits have declined by nearly by declined have visits Department Emergency - patient visits in 2016 2016 in visits patient annually admissions

• • Colorado was successful in improving coverage and access access and coverage improving in successful was Colorado

Named a Top 20 Rural Rural 20 Top a Named

597,350 25,000 providing providing than more

care when they need it. it. need they when care

• • People living with disabilities | Seniors, including those also eligible for Medicare for eligible also those including Seniors, | disabilities with living People 9 525-bed When people have coverage, they are more likely to get get to likely more are they coverage, have people When

family health centers, centers, health family with hospital

through the pre-ACA expansion and the ACA Medicaid expansion. Medicaid ACA the and expansion pre-ACA the through

rural hospital rural

Children | Pregnant women | Low-income adults Low-income | women Pregnant | Children Who Does Medicaid Serve: Serve: Medicaid Does Who

49-bed

The HPF supports Medicaid coverage for for coverage Medicaid supports HPF The 480,000 Coloradans, 480,000

Denver Health is the safety net hospital for the city and county of Denver of county and city the for hospital net safety the is Health Denver

Delta County Memorial Hospital Memorial County Delta

(27.8 )

(43.5

)

Archuleta

to invest facilities and services

(35.1

) %

Conejos % (56.1

)

Montezuma CASE STUDY: STUDY: CASE (35.1

) %

% Costilla

improve local access. When Medicaid reimbursement increases, these hospitals hospitals these increases, reimbursement Medicaid When

Baca 20% – 29% – 20%

continued (20.6 n )

50% – 59% – 50%

% (38.8

)

Budget cuts put patients at risk at patients put cuts Budget CASE STUDY: STUDY: CASE

(42.4

) La Plata La

Las Animas Las 10% – 19% – 10%

Rio Grande Rio n

40% – 49% – 40%

(44.4 ) n

Alamosa

2009 – pre-HPF – 2009 (25.4

) 0% – 9% – 0%

(21.8

)

% Dolores (27.5 Dolores centers and labs. and centers

30% – 39% – 30%

% )

(44.0

n ) Juan

2015 – post-HPF – 2015 Mineral

Huerfano San San

care facilities and building their own imaging imaging own their building and facilities care

(43.0 ) cost of care of cost

Otero

(19.8

Colorado Hospitals: Access to Care Care to Access Hospitals: Colorado )

San Miguel (16.4 Miguel San

(43.5

)

(31.9

)

offering hospice, nursing homes and/or long-term long-term and/or homes nursing hospice, offering

per $1 per

% % Hinsdale

Prowers

(20.4%) Bent (17.8 )

Saguache (44.1 Saguache

) Ouray

Colorado’s Hospitals and Medicaid Medicaid and Hospitals Colorado’s Custer cost of care of cost

continued %

.54

(41.3 )

for their community by employing physicians, physicians, employing by community their for

% $

(31.2

Pueblo

)

areas of the state. the of areas

per $1 per %

(26.7

)

Montrose

Rural hospitals tend to build a continuum of care care of continuum a build to tend hospitals Rural

Crowley

rate .75

(28.3 )

than residents in other other in residents than

(27.5 %

) $

Fremont %

Kiowa

(21.5 )

% cantly higher higher cantly f signi

at a a at

(20.5 $ )

Chaﬀee

(32.8

) Gunnison (24.6

)

(26.0

% )

Delta Medicaid Reimbursement Medicaid

Lincoln %

(25.5

) Rural residents use Medicaid Medicaid use residents Rural

El Paso El

(23.2

)

(30.0 Cheyenne )

Teller %

Mesa

Lake (25.6 Lake )

(19.3 % )

Park Pitkin (8.9 Pitkin

) (8.1

)

% %

(12.5 Douglas ) (25.2

)

Elbert Kit Carson Kit

(17.5 ) Garﬁeld (24.3 Garﬁeld

) % Critical Access and Rural Hospitals

(14.1 % Jeﬀerson

(13.9 )

Summit

(18.3

)

accept Medicaid clients. Medicaid accept

Eagle 43 Trauma Centers Trauma 43 Arapahoe (22.3 Arapahoe

Medicaid coverage than urban areas urban than coverage Medicaid Clear Creek Clear )

108 hospitals hospitals 108

(18.5

) (18.5

)

at at % (29.8

) (23.8

(30.2

) )

Rural communities have more more have communities Rural

Gilpin Rio Blanco Rio

% 28

% %

(26.5

) Adams Washington

Denver Denver

Yuma

(16.2

All of Colorado’s Colorado’s of All )

(15.6 (11.0 21

) )

% % Boulder

Broomﬁeld

Grand % RURAL

(16.3

)

239,942

(30.1 % )

Routt %

Emergency Department visits Department Emergency URBAN Morgan

(29.8 )

(24.1

)

Moﬀat % (19.3

)

Jackson

(25.0 )

hospital

(24.1 )

% Larimer 6,535

% Weld

babies delivered babies

Phillips

(22.2 )

(30.4

)

Logan NO is only only is

% one

hospital

32,318 Sedgwick

inpatient discharges

counties,

have counties

there

Critical Access and Rural Hospitals: Hospitals: Rural and Access Critical

Colorado Colorado

only 75 cents for every dollar. dollar. every for cents 75 only

Patient care in 2015 by by 2015 in care Patient 28

In In

Medicaid services they provide – – provide they services Medicaid

More than than More 2/5 are children are

receive full reimbursement for the the for reimbursement full receive

75 of Colorado hospitals could be detrimental to the health of Coloradans of health the to detrimental be could hospitals Colorado of

improved, hospitals still don’t don’t still hospitals improved,

MEDICAID

People seek care in their home community, and jeopardizing the future future the jeopardizing and community, home their in care seek People

While Medicaid reimbursement has has reimbursement Medicaid While

33 percent percent 33

went to hospitals. hospitals. to went

$ in Rural Colorado Rural in

1.3 million 1.3

Coloradans Coloradans

2015-16 2015-16

is enrolled in Medicaid – that is about about is that – Medicaid in enrolled is

Total Medicaid expenditures expenditures Medicaid Total 1/4

of the Colorado population population Colorado the of

Access to Care to Access

Medicaid is a critical revenue source for Colorado’s hospitals Colorado’s for source revenue critical a is Medicaid

way to reverse these cuts these reverse to way

Colorado Hospitals: Hospitals: Colorado Passing SB 267 is the only only the is 267 SB Passing

& Medicaid &

Yuma District Hospital District Yuma

Colorado’s Hospitals Hospitals Colorado’s Director of Quality and Regulatory Affairs Regulatory and Quality of Director

Bev Sanburg RN Sanburg Bev

Bev

This is the face of your decision. your of face the is This

imagine not having those 17 days or not comforting her as she died. died. she as her comforting not or days 17 those having not imagine

died alone in the back of an ambulance with no hope of survival is unthinkable. I can’t can’t I unthinkable. is survival of hope no with ambulance an of back the in alone died

Mallory would not have survived a half hour transport to another hospital, let alone alone let hospital, another to transport hour half a survived have not would Mallory

died. Were it not for our hospital, Mallory would have died in the back of an ambulance. ambulance. an of back the in died have would Mallory hospital, our for not it Were died. For more information, contact Aly Schmidt, 970.214.4231 or [email protected] or 970.214.4231 Schmidt, Aly contact information, more For

were blessed to have 17 days to say goodbye and she had her family with her when she she when her with family her had she and goodbye say to days 17 have to blessed were

disaster response disaster

Health Hospital. Mallory died 17 days later from Sepsis. Although Mallory died, we we died, Mallory Although Sepsis. from later days 17 died Mallory Hospital. Health

nurses and athletic trainers; supports community’s community’s supports trainers; athletic and nurses

Hospital provides medical care, such as school school as such care, medical provides Hospital • • as flown to Denver Denver to flown as w and treatment lifesaving received she where Hospital District

SCHOOL

temperature. Mallory was discovered hours later and transported by EMS to Yuma Yuma to EMS by transported and later hours discovered was Mallory temperature.

– SUPERINTENDENT OF A NORTHEASTERN COLORADO SCHOOL DISTRICT SCHOOL COLORADO NORTHEASTERN A OF SUPERINTENDENT –

local hospital and medical partners to help with health in our schools every day!” every schools our in health with help to partners medical and hospital local accident on a rural county road and pinned from the waist down in sub-freezing sub-freezing in down waist the from pinned and road county rural a on accident

worry about having a school in a community with no health care. We rely on our our on rely We care. health no with community a in school a having about worry

February 18, 2002, my 15 year old daughter, Mallory Funaro, was in a rollover rollover a in was Funaro, Mallory daughter, old year 15 my 2002, 18, February Always says yes when a cancer patient needs meal help meal needs patient cancer a when yes says Always • •

“I not only worry about contact sports and pole vault with no medical care nearby, I I nearby, care medical no with vault pole and sports contact about worry only not “I

Knitting group makes welcome blanket for all new babies new all for blanket welcome makes group Knitting • •

– HEAD FOOTBALL COACH FOR EASTERN COLORADO HIGH SCHOOL HIGH COLORADO EASTERN FOR COACH FOOTBALL HEAD – heart attack heart

understand the necessity of rural hospitals and will see the humanity of their decision. their of humanity the see will and hospitals rural of necessity the understand

Grateful when the medics saved the organist during a a during organist the saved medics the when Grateful loans and bonds and loans • •

each sideline. That’s how seriously immediate medical care is viewed!” viewed!” is care medical immediate seriously how That’s sideline. each

FAMILY AND FRIENDS AND FAMILY

accounts, as well as hospital hospital as well as accounts, I am sharing my daughter’s personal story in hopes that lawmakers will will lawmakers that hopes in story personal daughter’s my sharing am I

Holds hospital and employee employee and hospital Holds medical care nearby. Watch an NFL game and you’ll see several physicians on on physicians several see you’ll and game NFL an Watch nearby. care medical • •

BANK “I can’t imagine coaching a game, in a contact sport like football, without without football, like sport contact a in game, a coaching imagine can’t “I

Dear Legislators, Legislators, Dear

community

Provides care for for care Provides • •

care.” of level comparable next the to far so is it considering impact negative very and shops in town in shops and

Staff lives, works works lives, Staff “The loss of medical services would immediately isolate our community and have a a have and community our isolate immediately would services medical of loss “The • •

Top employer Top year one

– RURAL HOSPITAL CEO HOSPITAL RURAL – • •

– ATHLETIC DIRECTOR AT SOUTHERN COLORADO HIGH SCHOOL HIGH COLORADO SOUTHERN AT DIRECTOR ATHLETIC –

HOSPITAL

sponsored by hospital by sponsored services stemming from our hospital due to budget cuts.” cuts.” budget to due hospital our from stemming services

80% of Colorado hospitals will receive cuts receive will hospitals Colorado of 80%

Colorado hospitals in hospitals Colorado Safe playground playground Safe • •

offerings, if we were to ever lose our local hospital and/or a high level of of level high a and/or hospital local our lose ever to were we if offerings,

PARK Urban and rural hospitals will be affected – – affected be will hospitals rural and Urban Dollars cut from from cut Dollars

“It would obviously be quite concerning, for reasons way beyond school sports sports school beyond way reasons for concerning, quite be obviously would “It Billion Billion

Half Half

community

the in care health isn’t

May relocate if there there if relocate May

• •

insurance for workers for insurance

if there were no medical care nearby? nearby? care medical no were there if SHOP PET

Provides health health Provides • •

Can you imagine letting your child play contact sports sports contact play child your letting imagine you Can BUSINESS

Consequences

injuries

medical care for onsite onsite for care medical

Grateful for quick quick for Grateful • •

Sells food to the hospital the to food Sells Cuts Have Have Cuts •

FARM

Hospitals are a Key Piece in the Community Puzzle Community the in Piece Key a are Hospitals

Impact

Community Community Letting a hospital in rural Colorado close has far greater consequences than you may realize. may you than consequences greater far has close Colorado rural in hospital a Letting

What’s at Risk at What’s

Colorado Hospitals: Hospitals: Colorado

CASE STUDY: STUDY: CASE

School Sports and Local Hospitals Local and Sports School

Colorado Hospitals: Community Impact Impact Community Hospitals: Colorado continued

e Report e 2017 Legislativ 2017 6

ect, suggesting that more are seeking primary care and preventive services. services. preventive and care primary seeking are more that suggesting ect, eff

took expansion Medicaid since years three past the over 8% nearly by declined have visits Department ency Emerg -

e coverage, they are more likely to get care when they need it. it. need they when care get to likely more are they coverage, e hav people When •

ate now stands at only 6.7 percent. 6.7 only at stands now ate r uninsured

Colorado has been successful in dramatically improving health insurance coverage and access to care – the state’s state’s the – care to access and coverage insurance health improving dramatically in successful been has Colorado •

480,000 THE HPF SUPPORTS MEDICAID COVERAGE FOR FOR COVERAGE MEDICAID SUPPORTS HPF THE COLORADANS

the study is to help prepare Colorado as much as possible for forthcoming federal health care changes. care health federal forthcoming for possible as much as Colorado prepare help to is study the

reinsurance program in Colorado to help lower premiums and improve health carriers’ risk pools. The impetus of of impetus The pools. risk carriers’ health improve and premiums lower help to Colorado in program reinsurance

the last week of session and heavily amended in the Senate, authorizes the DOI to study the feasibility of creating a a creating of feasibility the study to DOI the authorizes Senate, the in amended heavily and session of week last the

state’s health insurance exchange, Connect for Health Colorado, in 2018. Another bill (SB 17-300), introduced introduced 17-300), (SB bill Another 2018. in Colorado, Health for Connect exchange, insurance health state’s

defeat a piece of legislation introduced the first week of session (SB 17-003) that would have repealed the the repealed have would that 17-003) (SB session of week first the introduced legislation of piece a defeat

Several bills were introduced in response to the uncertainty of health care policy at the federal level. CHA helped helped CHA level. federal the at policy care health of uncertainty the to response in introduced were bills Several

COLORADO’S RESPONSE TO THE AMERICAN HEALTH CARE ACT OF 2017 2017 OF ACT CARE HEALTH AMERICAN THE TO RESPONSE COLORADO’S

one 28 NO 17 Colorado counties, there is only only is there counties, Colorado In hospital have counties Colorado hospital

has not been effective in the past. past. the in effective been not has

by insurers to adhere to evidence-based standards. standards. evidence-based to adhere to insurers by recommended by the patient’s health care provider – if it it if – provider care health patient’s the by recommended

second (SB 17-151) would have required provider credentialing credentialing provider required have would 17-151) (SB second patients to try lower-cost drugs prior to covering a drug drug a covering to prior drugs lower-cost try to patients

provider complaints and notify providers of the results. The The results. the of providers notify and complaints provider requiring “step-therapy” – a common practice requiring requiring practice common a – “step-therapy” requiring

(SB 17-133) would have required the DOI to investigate investigate to DOI the required have would 17-133) (SB 17-203) prohibits insurance carriers from from carriers insurance prohibits 17-203)

Insurance (DOI) but were ultimately killed. The first first The killed. ultimately were but (DOI) Insurance provided in the community. The third bill (SB (SB bill third The community. the in provided

additional oversight of health insurers by the Division of of Division the by insurers health of oversight additional allows Medicaid home health services to be be to services health home Medicaid allows

with a government agency. Two other bills would have created created have would bills other Two agency. government a with technologies. The second bill (SB 17-091) 17-091) (SB bill second The technologies.

with public officials about policy issues or files a complaint complaint a files or issues policy about officials public with requiring providers to use proprietary proprietary use to providers requiring

from punishing a provider who communicates communicates who provider a punishing from telehealth law, prohibiting carriers from from carriers prohibiting law, telehealth

bill (HB 17-1173) prohibiting health insurers insurers health prohibiting 17-1173) (HB bill (HB) 17-1094) modifies Colorado’s existing existing Colorado’s modifies 17-1094) (HB)

Association supports. CHA monitored another another monitored CHA supports. Association for Coloradans. The first bill (House Bill Bill (House bill first The Coloradans. for

Network Adequacy model law, which the the which law, model Adequacy Network home health and prescription drug coverage coverage drug prescription and health home

National Association of Insurance Commissioners’ Commissioners’ Insurance of Association National CHA helped enact three bills designed to expand telehealth, telehealth, expand to designed bills three enact helped CHA

This new law closely mirrors language in the the in language mirrors closely law new This Expanding Health Care Access and Coverage and Access Care Health Expanding

makes the information more widely available. available. widely more information the makes

providers in tiered-network contracts and and contracts tiered-network in providers were successful in maintaining coverage and access to care. care. to access and coverage maintaining in successful were

requiring standards for selecting and tiering tiering and selecting for standards requiring Washington, D.C., CHA and other health care advocates advocates care health other and CHA D.C., Washington,

helped enact a piece of legislation (SB 17-088) 17-088) (SB legislation of piece a enact helped of discussions to repeal the Affordable Care Act (ACA) in in (ACA) Act Care Affordable the repeal to discussions of

business practices of health insurers. CHA CHA insurers. health of practices business Coloradans’ access to health care. In part, due to the slowing slowing the to due part, In care. health to access Coloradans’

Several bills introduced aimed to modify the the modify to aimed introduced bills Several at the Capitol, and there was a renewed vigor to protect protect to vigor renewed a was there and Capitol, the at

of Health Insurance Health of

health care at the federal level cast a shadow on debate debate on shadow a cast level federal the at care health

Increased Regulatory Oversight Oversight Regulatory Increased During the 2017 legislative session, the uncertainty of of uncertainty the session, legislative 2017 the During Maintaining Coverage and Access to Care to Access and Coverage Maintaining Improving Colorado’s Medicaid Program Efforts to Increase Consumers’ Colorado’s Medicaid program was a focal Health Care Choices point of many bills this year. One notable This year, several bills were introduced to bill (HB 17-1353) advanced by HCPF creates provide consumers greater flexibility in a statutory framework for the Accountable receiving health care services. One bill Care Collaborative (ACC) – the foundation (HB 17-1115), enacted with support from for Medicaid reform in Colorado. Following the addition CHA, creates parameters for direct primary of an amendment ensuring HCPF did not gain additional care agreements – an emerging health care statutory authority, CHA supported the bill. The ACC has delivery model where providers and patients been an important step for Colorado Medicaid and codifying agree on periodic fees in exchange for primary care services. the work of this program will help ensure its future. Another bill (HB 17-1247), known as “any willing provider,” would have allowed greater patient access to a health care The legislature also supported significant provider of their choosing, even if that provider was not efforts to tackle fraud and improve client “in network” with their insurer. A similar piece of legislation communications in the Medicaid program. was introduced in 2016, which CHA successfully amended One bill (HB 17-1139) aimed to improve to exempt inpatient hospital pharmacy services, and this HCPF’s fraud-prevention initiatives and year’s bill included the same exemption. However, the bill protect clients from improper billing. The faced significant opposition from insurance carriers and bill allows HCPF to penalize providers that ultimately failed. improperly bill or seek collection from a Medicaid client. CHA successfully negotiated an amendment that ensures providers are not liable if they make a good faith effort to correct the billing error. Finally, an interim committee recommended a package of bills to improve HCPF’s communications with clients and improve legal protections when a client appeals a reduction in benefits or a termination of benefits. (HB 17-1126, HB 17-1143, HB 17-1129 and SB 17-121).

1/4 of the Colorado population is enrolled in Medicaid – that is about 1.3 million Coloradans

More than 2/5 are children All of Colorado’s hospitals accept Medicaid clients

2017 Legislative Report 7

e Report e 2017 Legislativ 2017

of Colorado hospitals are rural are hospitals Colorado of

minimum for sustainability) for minimum

operating below a 4 percent margin (less than industry industry than (less margin percent 4 a below operating

4 1 (12 percent in urban areas) urban in percent (12 /

17 In 2015, nearly of Colorado’s rural hospitals were were hospitals rural Colorado’s of nearly 2015, In

of rural population is over the age of 65 65 of age the over is population rural of

rural to an urban hospital urban an to rural

102 miles 102 rural or County with Extreme Access Consideration Access Extreme with County or rural

is the average distance from a from distance average the is 3/4

of the state’s 64 counties are considered micro, micro, considered are counties 64 state’s the of

clinic or Federally Qualified Health Center Health Qualified Federally or clinic

16 17

counties have no hospital, and two have no hospital, hospital, no have two and hospital, no have counties communities rural in lives population state’s the of

HEALTH CARE IN RURAL COLORADO COLORADO RURAL IN CARE HEALTH

areas to also offer catastrophic plans to eligible individuals. individuals. eligible to plans catastrophic offer also to areas

would have required health insurers operating in certain certain in operating insurers health required have would

principles. principles. Another bill (SB 17-104), unrelated to the Governor’s agenda, agenda, Governor’s the to unrelated 17-104), (SB bill Another

bill because it aligns with the Association’s transparency transparency Association’s the with aligns it because bill state to provide insurance in certain areas of the state. state. the of areas certain in insurance provide to state

protect patient confidentiality. CHA actively supported this this supported actively CHA confidentiality. patient protect would have required health insurers that contract with the the with contract that insurers health required have would

successful in securing an amendment this year that helps helps that year this amendment an securing in successful on rural communities in Colorado. The third (HB 17-1286) 17-1286) (HB third The Colorado. in communities rural on

CHA worked to amend similar legislation in 2015 and was was and 2015 in legislation similar amend to worked CHA some, many organizations felt it could have an adverse impact impact adverse an have could it felt organizations many some,

their 15 most common health care services provided. provided. services care health common most 15 their While this legislation may have lowered insurance costs for for costs insurance lowered have may legislation this While

non-facility providers will be required to post prices for for prices post to required be will providers non-facility insurance plan offered to State of Colorado employees. employees. Colorado of State to offered plan insurance

common outpatient services, while physicians and other other and physicians while services, outpatient common such as counties and municipalities, to opt-in to the health health the to opt-in to municipalities, and counties as such

prices for the 50 most common inpatient and 25 most most 25 and inpatient common most 50 the for prices (HB 17-1237) would have enabled local government entities, entities, government local enabled have would 17-1237) (HB

Starting in 2018, health facilities will be required to post post to required be will facilities health 2018, in Starting on health insurance premiums. The second second The premiums. insurance health on

regulated providers to post “self-pay” prices. prices. “self-pay” post to providers regulated who spend more than 15 percent of their income income their of percent 15 than more spend who

(SB 17-065). The legislation requires all all requires legislation The 17-065). (SB proposed a short-term subsidy for individuals individuals for subsidy short-term a proposed

care price transparency for consumers consumers for transparency price care were ultimately successful. The first (HB 17-1235) 17-1235) (HB first The successful. ultimately were

legislature this year that increases health health increases that year this legislature forth by the Governor’s Office, none of which which of none Office, Governor’s the by forth

CHA supported the only bill passed by the the by passed bill only the supported CHA Association monitored bills that were brought brought were that bills monitored Association

force did not result in legislation, but the the but legislation, in result not did force

Senate committee. committee. Senate the state. Most of the solutions from the task task the from solutions the of Most state. the

monitored this bill, which failed on a party-line vote in a a in vote party-line a on failed which bill, this monitored high cost of health insurance in rural areas of of areas rural in insurance health of cost high

which would then be aggregated in an annual report. CHA CHA report. annual an in aggregated be then would which developed recommendations to address the the address to recommendations developed

submit information on pharmaceutical costs to the DOI, DOI, the to costs pharmaceutical on information submit task force convened by the Lt. Gov., which which Gov., Lt. the by convened force task

bill (HB 17-1318) would have required health insurers to to insurers health required have would 17-1318) (HB bill Over the interim, CHA participated in a a in participated CHA interim, the Over

information for every hospital. Another Another hospital. every for information Rising Rural Health Insurance Premiums Premiums Insurance Health Rural Rising

report to the legislature detailing financial financial detailing legislature the to report

have been required to issue an annual annual an issue to required been have insurers, pharmaceutical companies and hospitals. and companies pharmaceutical insurers,

HCPF. Using this information, HCPF would would HCPF information, this Using HCPF. by introducing a package of six bills targeting health health targeting bills six of package a introducing by

Reports and audited financial statements to to statements financial audited and Reports Governor Donna Lynne played a key role in these debates debates these in role key a played Lynne Donna Governor

requiring hospitals to submit Medicare Cost Cost Medicare submit to hospitals requiring Coloradans from rising health care costs. Lieutenant Lieutenant costs. care health rising from Coloradans

CHA successfully defeated a bill (HB 17-1236) 17-1236) (HB bill a defeated successfully CHA

how to increase health system transparency and protect protect and transparency system health increase to how

Health Price Transparency Price Health The legislature spent significant time this year discussing discussing year this time significant spent legislature The

and Addressing Cost of Care of Cost Addressing and Increasing Health System Transparency Transparency System Health Increasing

Report Legislative 2017 9

. . www.WhereforCare.org at

social media posts and more. More information is available available is information More more. and posts media social

address concerns heard during this legislative session. session. legislative this during heard concerns address

campaign resources, such as posters, the family care plan, plan, care family the posters, as such resources, campaign

improve health system transparency and affordability and and affordability and transparency system health improve

Hospital partners are also encouraged to use a variety of of variety a use to encouraged also are partners Hospital

and consumers. The Association has already begun work to to work begun already has Association The consumers. and

area and the launch of the “Where for Care” website. website. Care” for “Where the of launch the and area

commitment by all providers, public and private payers payers private and public providers, all by commitment

media (e.g., billboards, bus shelters) in the Denver metro metro Denver the in shelters) bus billboards, (e.g., media

consumers to make informed choices and reflect a mutual mutual a reflect and choices informed make to consumers

care. The first stage of the campaign featured outdoor outdoor featured campaign the of stage first The care. transparency efforts that enhance the ability of patients and and patients of ability the enhance that efforts transparency

primary and urgent care from more-expensive emergency emergency more-expensive from care urgent and primary central issue for policymakers. CHA will continue to support support to continue will CHA policymakers. for issue central

engage in this issue in the coming months as it will remain a a remain will it as months coming the in issue this in engage with resources to help them differentiate less-expensive less-expensive differentiate them help to resources with

2017, hospitals and health systems should be prepared to to prepared be should systems health and hospitals 2017,

coverage. This campaign aims to provide consumers consumers provide to aims campaign This coverage.

While most transparency-related legislation did not pass in in pass not did legislation transparency-related most While

shaped by their health condition and their insurance insurance their and condition health their by shaped

time – and understanding how that decision should be be should decision that how understanding and – time

their doctors. their

level of medical care, in the right setting and at the right right the at and setting right the in care, medical of level

raise awareness and inform patients’ conversations with with conversations patients’ inform and awareness raise

educate Colorado consumers about accessing the right right the accessing about consumers Colorado educate breast tissue. Proponents of the bill hope the notice will will notice the hope bill the of Proponents tissue. breast

CHA developed a targeted media campaign designed to to designed campaign media targeted a developed CHA notice when an individual’s results indicate they have dense dense have they indicate results individual’s an when notice

bill (SB 17-142) requiring mammography reports to include include to reports mammography requiring 17-142) (SB bill

EDUCATION CAMPAIGN CAMPAIGN EDUCATION

carriers were split on the issue. The legislature did pass a a pass did legislature The issue. the on split were carriers

“WHERE FOR CARE” CONSUMER CONSUMER CARE” FOR “WHERE

of the system. Unfortunately, consumers, providers and and providers consumers, Unfortunately, system. the of

mutual responsibilities and accountability for all pieces pieces all for accountability and responsibilities mutual

facilities. CHA supported this bill, as it reflected reflected it as bill, this supported CHA facilities.

out-of-network provider services at in-network in-network at services provider out-of-network

procedures when paying claims for for claims paying when procedures

required health insurers to follow certain certain follow to insurers health required

this session. The legislation would have have would legislation The session. this

providers (SB 17-206) failed for the third time time third the for failed 17-206) (SB providers

A consumer notice bill for out-of-network out-of-network for bill notice consumer A

legislation ultimately failed. failed. ultimately legislation

(CDPHE). Despite efforts to work with the sponsors, the the sponsors, the with work to efforts Despite (CDPHE).

Colorado Department of Public Health and Environment Environment and Health Public of Department Colorado

be licensed under a newly created license type from the the from type license created newly a under licensed be

conditions. The bill would have also required FSEDs to to FSEDs required also have would bill The conditions.

bill patients at the lower urgent care rate for non-emergent non-emergent for rate care urgent lower the at patients bill

requirements for FSEDs, including a mandate that FSEDs FSEDs that mandate a including FSEDs, for requirements

the Association could not support. The bill set several new new several set bill The support. not could Association the

legislation was introduced that included provisions that that provisions included that introduced was legislation

and although the group did not come to consensus, consensus, to come not did group the although and

met during 2016 to discuss potential FSED legislation, legislation, FSED potential discuss to 2016 during met

emergency departments (FSEDs). A stakeholder group group stakeholder A (FSEDs). departments emergency

a bill (SB 17-064) addressing freestanding freestanding addressing 17-064) (SB bill a

of the health care system. Most notable was was notable Most system. care health the of

informing consumers about the complexities complexities the about consumers informing

and providers to play a stronger role in in role stronger a play to providers and

The legislature saw several bills urging payers payers urging bills several saw legislature The Notice to Consumers to Notice Improving the Health and Safety of Hospital Employees and Those We Serve Each year there are a handful of bills introduced impacting While the bill concerning background checks how hospitals care for patients. Most notably this year were on licensees failed, another major piece bills aimed at protecting patients from malicious health care of legislation (HB 17-1284) addressing a professionals. Legislators also focused on improving various similar issue made it to the Governor’s desk. aspects of clinical care, such as domestic violence reporting, Starting in 2019, health care facilities serving heart attack care and end-of-life treatment. CHA worked at-risk adults will be required to request a Colorado Adult throughout the session to mitigate any unintended Protective Services (CAPS) check prior to hiring direct care consequences these measures could have on patient care employees. CHA participated in the Task Group that the and operations. heard the evidence and developed the recommendations that ultimately became the legislation. CHA consistently Addressing Safety Concerns in opposed the inclusion of general hospitals in a mandatory Health Care Settings CAPS check because these harms only rarely occur in Over the past few years, high-profile media hospital settings. Despite the Association’s objections, the reports in Colorado have illuminated bill passed in the final days of the legislative session, and inconsistent practices in the health care field CHA is now preparing to engage in the rulemaking process. for conducting employee background checks. This issue rose to the top of legislators’ A bill that CHA monitored and ultimately agendas this session, and CHA actively engaged in three passed (HB 17-1165) modifies the disciplinary bills seeking to better protect patients and employees in procedures for health care professionals health care settings. The first measure (HB 17-1121) would licensed by DORA. Specifically, it will require have allowed the Department of Regulatory Agencies improvements in DORA’s internal processes (DORA) to conduct background checks on certain health based on provider complaints made by patients. care professionals and align Colorado’s statutes with the most recent national Nurse Licensure Compact language. While CHA supports statewide background checks and the enhanced compact, CHA opposed the bill because it would have created duplicative background checks and allowed DORA to fine employers for failing to comply. While the bill was ultimately defeated, the Association expects a narrower piece of legislation addressing the enhanced Nurse Licensure Compact to be introduced in 2018.

Hospitals employ more than Hospitals provide 1 in 16 jobs 75,500 Coloradans higher paying, in Colorado is in the and generate 183,961 highly skilled jobs health care sector jobs in Colorado for Coloradans

10 2017 Legislative Report Improving Clinical Care and Quality Addressing Employer Issues This year, the General Assembly enacted CHA actively engaged in two key employer several measures to improve clinical practices bills introduced this year. First, CHA worked and outcomes. First, CHA actively engaged in closely with COPIC to defeat a bill (HB 17-1254) a bill (HB 17-1322) that creates an exception that would have removed the cap on non- to domestic violence reporting where a economic damages (i.e., those for pain and health care professional, under a number of enumerated suffering) that may be awarded for the wrongful conditions, may choose not to report an incident. death of a child. CHA strongly opposed this bill because it could have destabilized the medical liability CHA also helped pass a bill (HB 17-1087) environment. CHA monitored a second successful bill that creates a pilot program to provide legal (HB 17-1229) that expands workers’ compensation for guardianship services for incapacitated and mental impairment claims for law enforcement and first indigent adults. Another bill (HB 17-1246) responders to include post-traumatic stress disorder (PTSD) supported by CHA and advanced by the – an issue that has been in front of the legislature in American Heart Association, implements several previous sessions. recommendations of the STEMI Task Force, in which CHA and member hospitals participated. There were five bills, which were introduced In addition, (SB 17-268) a bill allowing a and failed in 2016 and were reintroduced pharmacist to supervise up to six pharmacy and failed again in 2017, addressing various technicians successfully passed. Another bill employer-related issues. These bills sought to (HB 17-1368) that was supported by CHA and allow employees to leave work to attend their failed would have modified Colorado’s End of Life Options child’s academic activities (HB 17-1001); Act. This measure sought to clarify the death certificate create a retirement plan for employees not process for a medical aid-in-dying patients and will likely covered by an employer’s plan (HB 17-1290); return next year. create a family and medical leave insurance program (HB 17-1307); reduce the regulatory burden on small businesses (SB 17-276); and prohibit employers from stating in an Hospital application that a person with a criminal Colorado Opioid Innovation and history may not apply (HB 17-1305). Safety Pilot Improvement Network (HIIN)

Colorado Hospitals’ Commitment to

Quality Patient Family Just Culture and Patient Advisory Safety Councils (PFAC)

Antimicrobial (antibiotic) Stewardship

2017 Legislative Report 11

e Report e 2017 Legislativ 2017

and initial results in a statewide Colorado Opioid Safety Collaborative Summit in the fall of 2017. of fall the in Summit Collaborative Safety Opioid Colorado statewide a in results initial and

reduce the use of opioids in Colorado emergency departments. The pilot sites will share both experiences experiences both share will sites pilot The departments. emergency Colorado in opioids of use the reduce

CHA member hospitals to implement the new Colorado Emergency Physicians ED Opioid Guidelines to to Guidelines Opioid ED Physicians Emergency Colorado new the implement to hospitals member CHA

CHA and its partners formed the Colorado Opioid Safety Collaborative and began a pilot in May of 2017 with eight eight with 2017 of May in pilot a began and Collaborative Safety Opioid Colorado the formed partners its and CHA

CHA EMERGENCY DEPARTMENT OPIOID SAFETY PILOT SAFETY OPIOID DEPARTMENT EMERGENCY CHA

enforcement officials. officials. enforcement

behavioral health needs. needs. health behavioral to provide onsite response and counseling services to law law to services counseling and response onsite provide to

can appropriately respond to individual and community community and individual to respond appropriately can agencies to adopt a policy for mental health professionals professionals health mental for policy a adopt to agencies

to ensure Colorado has functional systems of care that that care of systems functional has Colorado ensure to with support from CHA that encourages law enforcement enforcement law encourages that CHA from support with

CHA will closely monitor the implementation of these bills bills these of implementation the monitor closely will CHA for mental illness. A final bill (HB 17-1215) was enacted enacted was 17-1215) (HB bill final A illness. mental for

purchasing plans for medications prescribed prescribed medications for plans purchasing

Substance Use Disorder this summer. this Disorder Use Substance to set rules and develop formularies and and formularies develop and rules set to

also convene an Interim Study Committee on Opioids and and Opioids on Committee Study Interim an convene also bill requires the Office of Behavioral Health Health Behavioral of Office the requires bill

to the passage of these three bills, the legislature will will legislature the bills, three these of passage the to transferring between state facilities. The The facilities. state between transferring

University of Colorado Health Sciences Center. In addition addition In Center. Sciences Health Colorado of University for individuals with behavioral health needs needs health behavioral with individuals for

and addiction prevention strategies and treatment at the the at treatment and strategies prevention addiction and 17-019) creating medication consistency consistency medication creating 17-019)

17-193) creates a research center for substance abuse abuse substance for center research a creates 17-193) CHA also engaged in a successful bill (SB (SB bill successful a in engaged also CHA

medications to treat substance abuse. A final bill (SB (SB bill final A abuse. substance treat to medications

which will provide training for providers on prescription prescription on providers for training provide will which and CHA supported the legislation. the supported CHA and

pilot program in Pueblo and Routt counties, counties, Routt and Pueblo in program pilot between state and federal law, it is a significant improvement, improvement, significant a is it law, federal and state between

creates a medication-assisted treatment treatment medication-assisted a creates rooms. While this does not fully resolve EMTALA conflicts conflicts EMTALA resolve fully not does this While rooms.

under Medicaid. The second (SB 17-074) 17-074) (SB second The Medicaid. under amendments allowing individuals to be taken to emergency emergency to taken be to individuals allowing amendments

substance use disorder treatment as a benefit benefit a as treatment disorder use substance CHA worked extensively with proponents to achieve to proponents with extensively worked CHA

study on providing residential and inpatient inpatient and residential providing on study response within the crisis mental health system statewide. statewide. system health mental crisis the within response

CHA requires HCPF to prepare a feasibility feasibility a prepare to HCPF requires CHA provides $7 million to improve capacity, capabilities and and capabilities capacity, improve to million $7 provides

enacted (HB 17-1351) with support from from support with 17-1351) (HB enacted health services from being held in a jail. The bill also also bill The jail. a in held being from services health

study substance abuse in Colorado. A bill bill A Colorado. in abuse substance study prohibits individuals in need of crisis mental mental crisis of need in individuals prohibits

Three bills passed this session that will help help will that session this passed bills Three health crisis response system. Foremost, it it Foremost, system. response crisis health

changes to the state’s coordinated behavioral behavioral coordinated state’s the to changes

by the patient or prescribing provider. provider. prescribing or patient the by enacted this year (SB 17-207) makes several several makes 17-207) (SB year this enacted

dispense the drug in smaller increments when requested requested when increments smaller in drug the dispense The most robust behavioral health bill bill health behavioral robust most The

a pharmacist filling a prescription for a Schedule II opioid to to opioid II Schedule a for prescription a filling pharmacist a Expanding Mental Health Coverage & Services & Coverage Health Mental Expanding

(HB 17-1350) that subsequently failed would have allowed allowed have would failed subsequently that 17-1350) (HB

PDMP access for HCPF (HB 17-1351). Another bill bill Another 17-1351). (HB HCPF for access PDMP especially focused on opioid abuse. opioid on focused especially

veterinarians. Separate legislation also added added also legislation Separate veterinarians. several efforts to address substance use disorders, disorders, use substance address to efforts several

the PDMP for health professionals, including including professionals, health for PDMP the were introduced. Additionally, the legislature endorsed endorsed legislature the Additionally, introduced. were

successfully passed and increases access to to access increases and passed successfully discussions, several bills addressing current system failings failings system current addressing bills several discussions,

dispensed to patients. One bill (SB 17-146) 17-146) (SB bill One patients. to dispensed Criminal and Juvenile Justice. As a result of the interim interim the of result a As Justice. Juvenile and Criminal

information about controlled substances substances controlled about information Health Holds Task Force and the Colorado Commission on on Commission Colorado the and Force Task Holds Health

(PDMP), a secure online database that stores stores that database online secure a (PDMP), consensus-based responses to the issue – the Mental Mental the – issue the to responses consensus-based

the Prescription Drug Monitoring Program Program Monitoring Drug Prescription the Two parallel task forces met during 2016 to develop develop to 2016 during met forces task parallel Two

legislature led efforts to expand access to to access expand to efforts led legislature the 2016 session addressing crisis mental health services. services. health mental crisis addressing session 2016 the

misuse and abuse of prescription drugs, the the drugs, prescription of abuse and misuse Governor’s action to veto a bill CHA spearheaded during during spearheaded CHA bill a veto to action Governor’s

In response to Colorado’s high rate of of rate high Colorado’s to response In Assembly this year. This comes in response to the the to response in comes This year. this Assembly

Substance Use Challenges Use Substance

top priority for both Gov. Hickenlooper and the General General the and Hickenlooper Gov. both for priority top

Efforts to Address Colorado’s Colorado’s Address to Efforts Improving Colorado’s behavioral health system was a a was system health behavioral Colorado’s Improving Strengthening Colorado’s Behavioral Health System Health Behavioral Colorado’s Strengthening Conclusion

CHA achieved great success on behalf of its member hospitals and health systems in 2017. While celebrating this year’s accomplishments, the Association will continue to look to the future and forecast new opportunities and threats. With each election cycle, new faces join the legislature, bringing new ideas and priorities. The challenges Colorado faces will continue to evolve. In the midst of these continual changes, CHA will advocate tirelessly to ensure the blue “H” is able to retain its core purpose: directing individuals in crisis to care and being ever-present as a comforting reminder that access to health care is within reach. This iconic blue “H” symbolizes the steadfast commitment of Colorado hospitals and health systems to ensure that where you live does not determine if you live.

2017 Legislative Report 13 2017 CHA Bill Summary

Final Status & Bill # Sponsors Bill Summary Position Implementation Date

HB 17-1001 This bill reinstated the Parental Involvement Act of Employee Leave Attend Rep. Buckner (D) 2009, allowing employees to take leave from work Monitor Failed Child’s Academic Activities Sen. Kerr (D) to attend their child’s academic activities.

HB 17-1010 The bill makes clarifications concerning the practice Passed Rep. Ginal (D) of dental hygiene with laser and emergency drug Governor Signed Dental Practice Act and Sen. Crowder (D) administration and oversight by the Colorado Dental Monitor Implementation Date: Dental Hygiene Board. Aug. 9, 2017 HB 17-1011 Passed The bill requires mental health professionals to Statute of Limitation Rep. Melton (D) Governor Signed Discipline Mental Health Sen. Tate (R) notify former clients that records may not be Monitor Implementation Date: Professional maintained after seven years. July 1, 2018 Passed HB 17-1021 The bill requires the Division of Labor in CDLE to Rep. Danielson (D) Governor Signed Wage Theft Transparency Sen. Cooke (R) treat certain violations of wage law as public records Monitor Implementation Date: Act available upon request. April 13, 2017

HB 17-1027 Rep. J. Becker (R) Passed Rep. Buckner (D) The bill continues the Emily Maureen Ellen Keyes Governor Signed Remove Fund Repeal & Sen. Gardner (R) Organ and Tissue Donation Awareness Fund Support Implementation Date: Clarify Organ Donor Process Sen. Garcia (D) indefinitely. Sept. 15, 2017

HB 17-1032 The bill removes the requirement that evidentiary Passed Rep. Arndt (D) privilege only applies to communications occurring Governor Signed First Responder Peer Support Sen. Cooke (R) in an individual support meeting during the court Monitor Implementation Date: Testimony Privilege process for first responder team members. March 16, 2017

HB 17-1057 Rep. Liston (R) Passed Rep. Winter (D) This bill states that the Governor shall enter into an Governor Signed Interstate Physical Therapy Sen. Gardner (R) Interstate Physical Therapy Licensure Compact to Monitor Implementation Date: Licensure Compact Sen. Kerr (D) improve access to physical therapy. Aug. 9, 2017

HB 17-1060 Passed Reporting Requirements Rep. Thurlow (R) This bill both repeals some reporting requirements Governor Signed by Health Care Policy Sen. Tate (R) and continues other HCPF reporting requirements. Monitor Implementation Date: & Financing to General March 1, 2017 Assembly HB 17-1080 Rep. Young (D) Requirements Durable The bill clarified and modified the licensing Failed Medical Equipment Sen. Sonnenberg (R) requirements for DME suppliers. Monitor Suppliers Sen. Crowder (R)

HB 17-1085 The bill required all abortion clinics in the state to Women’s Health Rep. Neville (R) be licensed by the Attorney General who would Monitor Failed Protection Act then inspect them annually.

HB 17-1086 Rep. Everett (R) This bill required a physician to give information Abortion Pill Reversal Rep. Nordberg (R) to a woman on the possibility of an abortion pill Monitor Failed Information Act Sen. Marble (R) reversal.

HB 17-1087 The bill creates a pilot program in the Judicial Passed Rep. Young (D) Department to provide legal guardianship services Governor Signed Office of Public Guardianship Sen. Lundberg (R) for incapacitated and indigent adults in certain Support Implementation Date: Pilot Program judicial districts. June 5, 2017

HB 17-1094 Rep. Buck (R) Passed Rep. Valdez (D) The bill makes clarifications and modifications to the Governor Signed Telehealth Coverage Under Sen. Crowder (R) existing requirement that health benefit plans cover Support Implementation Date: Health Benefit Plans Sen. Donovan (D) telehealth services. March 16, 2017

HB 17-1108 Rep. Humphrey (R) Protect Human Life at Rep. Ransom (R) The bill prohibited physicians from performing Monitor Failed Conception Sen. Neville (R) abortions except in certain instances.

14 2017 Legislative Report 2017 CHA Bill Summary

Final Status & Bill # Sponsors Bill Summary Position Implementation Date

HB 17-1112 The bill provided immunity from civil penalties for Immunity Unauthorized Rep. Van Winkle (R) individuals who make voluntary disclosures of the Monitor Failed Practice of Profession unauthorized practice of their profession.

HB 17-1115 Rep. Buck (R) Passed Rep. Ginal (D) The bill establishes definitions and legal parameters Governor Signed Direct Primary Health Support Implementation Date: Sen. Kefalas (D) for direct primary health care agreements. Care Services Sen. Tate (R) Aug. 9, 2017

HB 17-1121 The bill required health care professionals to submit Rep. Buckner (D) to a criminal history record check. It repealed and Oppose Failed Patient Safety Act Sen. Todd (D) replaced the “Nurse Licensure Compact Act.”

HB 17-1122 The bill required the state to issue new birth Rep. Esgar (D) certificates to any person born in Colorado whose Failed Gender Identification on Sen. Moreno (D) gender is different from the gender denoted on that Monitor Birth Certificates person’s birth certificate.

HB 17-1126 The bill requires administrative law judges to Passed Rep. Danielson (D) review the legality of Medicaid notices of action Governor Signed Medicaid Appeal Review Rep. Michaelson-Jenet (D) when a client appeals a reduction in benefits or a Monitor Implementation Date: Legal Notice Requirements Sen. Crowder (R) termination of benefits. Jan. 1, 2018

HB 17-1129 The bill clarified the continuation of benefits Technical Issues Filing Rep. Danielson (D) without an affirmative request by a client who is Support Failed Medicaid Appeals Sen. Crowder (R) appealing a termination or reduction in benefits.

HB 17-1139 Rep. Landgraf (R) The bill maintains legal protections for consumers Passed Medicaid Provider Rep. Michaelson-Jenet (D) against balance billing while giving the state Governor Signed Compliance Billing Safety Sen. Kefalas (D) flexibility in addressing providers that break the law Neutral Implementation Date: Rules Sen. Martinez-Humenik (R) without diminishing provider networks. April 6, 2017

HB 17-1143 Passed Rep. Landgraf (R) The bill requires the state auditor to conduct an Governor Signed Audits of Medicaid Client Sen. Crowder (R) audit of client correspondence with Medicaid Monitor Implementation Date: Correspondence regarding an individual’s eligibility. Aug. 9, 2017 HB 17-1165 Passed Department of Regulatory Rep. Lebsock (D) This bill modifies the disciplinary procedures for Governor Signed Agencies Boards Disciplinary Sen. Aguilar (D) six health care boards for health care professionals Monitor Implementation Date: Action Resolution Process with prescriptive authority within DORA. June 6, 2017

HB 17-1173 The bill expands protections for health care Passed Rep. Hansen (D) providers in contracts with health insurance carriers Governor Signed Health Care Providers and Sen. Neville (R) by prohibiting the carrier from taking adverse Monitor Implementation Date: Carriers Contracts actions against the provider in certain situations. April 6, 2017 HB 17-1187 Change Excess State Rep. Thurlow (R) This bill referred a proposition to voters to change Failed Revenues Cap Growth Sen. Crowder (R) the Referendum C cap formula. Support Factor

HB 17-1215 Passed Rep. Coleman The bill creates a grant program to support local Governor Signed Mental Health Support for Sen. Kagan (D) governments that provide mental health counseling Support Implementation Date: Peace Officers Sen. Gardner (R) to peace officers. Aug. 9, 2017

HB 17-1224 Passed Rep. Kraft-Tharp (D) The bill amends the pharmacy practice law to make Governor Signed Misbranded Adulterated Sen. Gardner (R) it unlawful to possess, administer or sell a drug or Monitor Implementation Date: Counterfeit Drugs Penalty device that is adulterated or misbranded. Aug. 9, 2017

HB 17-1229 Rep. Singer (D) Passed Rep. J. Becker (R) The bill adds the definitions “psychologically Governor Signed Workers’ Compensation Sen. Cooke (R) traumatic event” and “serious bodily injury” to the Monitor Implementation Date: for Mental Impairment Sen. Todd (D) workers’ compensation statutes. July 1, 2018 Rep. Mitsch-Bush (D) HB 17-1235 Rep. Hamner (D) The bill proposed financial relief for individuals Financial Relief Defray Sen. Coram (R) and families who spend more than 15% of their Monitor Failed Individual Health Plan Cost Sen. Crowder (R) household income on health insurance premiums.

2017 Legislative Report 15 2017 CHA Bill Summary

Final Status & Bill # Sponsors Bill Summary Position Implementation Date

HB 17-1236 Rep. Kennedy (D) Health Care Policy and Fi- The bill required hospitals to submit certain financial Failed nancing Annual Report on Sen. Coram (R) records to HCPF to develop an annual report. Oppose Hospital Expenditures Sen. Smallwood (R) HB 17-1237 Rep. Hamner (D) This bill enabled local government entities such as State Employee Group Failed Benefit Plans for Local Sen. Coram (R) counties and municipalities to opt in to the state Monitor Government Sen. Crowder (R) employees’ health benefit plans. HB 17-1240 The bill relocates the statutes on Uniform Passed Relocate Title 12 Colorado Rep. Wist (R) Emergency Volunteer Health Practitioners Act and Governor Signed Department of Public Sen. Cooke (R) the Cancer Cure Control Program from Title 12 to Monitor Implementation Date: Health and Environment Title 25, C.R.S. Aug. 9, 2017

HB 17-1246 Passed ST-elevation Myocardial Rep. Kraft-Tharp (D) The bill implements several recommendations of Governor Signed Infarction Task Force Sen. Tate (R) the STEMI Task Force regarding mandatory and Support Implementation Date: Recommendations Heart Sen. Garcia (D) voluntary data reporting. May 18, 2017 Attack Care HB 17-1247 Rep. Danielson (D) The bill allowed a patient to select a provider of his Patient Choice Health Care Rep. J. Becker (R) or her choice if the selected provider agreed to the Monitor Failed Provider Sen. Sonnenberg (R) terms of the contracted health benefit plan. HB 17-1254 Rep. K. Becker (D) The bill removed the cap on damages for Noneconomic Damages Failed Cap Wrongful Death of Rep. Salazar (D) noneconomic loss that may be awarded for the Oppose Child Sen. Kagan (D) wrongful death of a minor child.

HB 17-1269 Rep. Danielson (D) Passed Rep. Nordberg (R) The bill provides wage transparency protections Governor Signed Repeal Prohibition of to all employees in the state by removing certain Monitor Implementation Date: Sen. Martinez-Humenik (R) Wage Sharing Information Sen. Donovan (D) exemptions. Aug. 9, 2017 Passed HB 17-1284 Governor Signed Data System Check for Rep. Lontine (R) The bill requires certain employers at facilities that Implementation Date: Employees Serving At-risk Sen. Gardner (R) serve at-risk adults to request a CAPS check prior to Oppose Jan. 1, 2019 Adults Sen. Aguilar (D) hiring direct care employees. *Rulemaking likely to occur in 2017-18

HB 17-1286 The bill required health insurance carriers that Rep. Esgar (D) contract with the state to provide group benefit Failed State Employee Health Sen. Crowder (R) plans to state employees aimed at expanding Monitor Carrier Requirements consumer options.

HB 17-1290 Rep. Buckner (D) The bill created the Colorado Secure Savings Plan Rep. Pettersen (D) to enable employees not covered by an employer’s Failed Colorado Secure Savings Sen. Todd (D) retirement plan to have payroll deductions go into Monitor Plan Sen. Donovan (D) an IRA. HB 17-1305 Rep. Melton (D) This bill prohibited an employer from stating in a Limits on Job Applicant Rep. Foote (D) job application or description that a person with a Monitor Failed Criminal History Inquiries Sen. Guzman (D) criminal history may not apply. HB 17-1307 Rep. Winter (D) The bill created the Division of Family and Medical Family and Medical Leave Failed Insurance Program Wage Sen. Moreno (D) Leave Insurance (FAMLI) as an enterprise to provide Monitor Replacement Sen. Fields (D) wage-replacement benefits to eligible employees. HB 17-1318 Rep. Ginal (D) The bill required health insurers to submit Division of Insurance Failed Annual Report Sen. Kefalas (D) information to DOI on the cost of pharmaceuticals Monitor Pharmaceutical Costs Data Sen. Coram (R) covered under individual and group plans.

HB 17-1320 Rep. Michaelson-Jenet (D) The bill lowered the age of consent for a minor to Age of Consent Outpatient Rep. Landgraf (R) obtain outpatient psychotherapy services without Monitor Failed Sen. Fenberg (D) Psychotherapy for Minors Sen. Coram (R) parental consent.

HB 17-1322 Passed Rep. Esgar (D) This bill creates an exception to domestic violence Governor Signed Domestic Violence Reports Rep. Landgraf (R) reporting for physicians, physician assistants and Monitor Implementation Date: by Medical Professionals Sen. Donovan (D) anesthesiologist assistants. Aug. 9, 2017

16 2017 Legislative Report 2017 CHA Bill Summary

Final Status & Bill # Sponsors Bill Summary Position Implementation Date

HB 17-1350 Rep. Pettersen (D) Rep. Liston (R) The bill allowed pharmacists to partially fill opioid Failed Pharmacist Partial Fill Sen. Smallwood (R) prescriptions. Monitor Opioid Prescription Sen. Jahn (D)

HB 17-1351 The bill requires HCPF to prepare a report for the Passed Rep. Pettersen (D) legislature on the feasibility of providing residential Governor Signed Study Inpatient Substance Sen. Jahn (D) Support Implementation Date: and inpatient substance use disorder treatment as Use Disorder Treatment Sen. Crowder (R) part of the Medicaid program. June 2, 2017

HB 17-1353 Passed Rep. Young (D) The bill codifies the implementation of the ACC Governor Signed Implement Medicaid Delivery Sen. Lundberg (R) 2.0. It authorizes HCPF to implement performance- Support Implementation Date: & Payment Initiatives based payments. May 23, 2017

HB 17-1368 The bill removed the requirement that an attending Rep. Ginal (D) physician or hospice medical director sign the death Failed End-of-Life Death Sen. Court (D) certificate of an individual who used an aid-in-dying Support Certificate Signature medication.

HB 17-1371 The bill allows hospitals and other entities Passed Rep. Lee (D) to distribute compounded and prepackaged Governor Signed Distribution of Medications Sen. Cooke (R) medications to pharmacies and to other outlets Monitor Implementation Date: to Certain Outlets under common ownership. June 2, 2017

SB 17-003 Repeal Colorado Health Sen. Smallwood (R) The bill repealed the state’s health insurance Oppose Failed Benefit Exchange Rep. Neville (R) exchange “Connect for Health Colorado.”

SB 17-004 Access to Providers for Sen. Tate (R) The bill allowed providers who are not enrolled with Monitor Failed Medicaid Recipients Rep. Wist (R) Medicaid to bill Medicaid clients directly.

SB 17-017 Passed Sen. Aguilar (D) The bill expands the statutory right for a patient to Governor Signed Allow Medical Marijuana Rep. Singer (D) use medical marijuana to include stress disorders Monitor Implementation Date: Use for Stress Disorders or PTSD. June 5, 2017

SB 17-019 The bill requires the Office of Behavioral Health Passed Sen. Martinez Humenik (R) to develop formularies and purchasing plans for Governor Signed Medication Mental Illness Rep. Singer (D) medications prescribed for mental illness in the Neutral Implementation Date: in Justice Systems justice system. Aug. 9, 2017 SB 17-022 The bill required the Department of Local Affairs to Rural Economic Failed Advancement of Rep. Donovan (D) award grants to assist rural communities that have Monitor Colorado Towns experienced a negative economic event. SB 17-032 The bill changed the current process for law Prescription Drug Failed Monitoring Program Sen. Merrifield (D) enforcement officials and state regulatory boards Monitor Access when trying to gain access to the PDMP.

SB 17-033 Passed Sen. Aguilar (D) The bill allows a professional nurse to delegate Governor Signed Delegate Dispensing Over- Rep. Lawrence (R) dispensing authority of an OTC drug for a minor Monitor Implementation Date: the-counter Medications with signed parental consent. Aug. 9, 2017

SB 17-040 Passed Sen. Kefalas (D) The bill modifies the Colorado Open Records Act Governor Signed Public Access to Rep. Pabon (D) (CORA) with respect to digital or electronic records. Monitor Implementation Date: Government Files Aug. 9, 2017 SB 17-056 Reporting Requirements Passed by Colorado Department Sen. Kerr (D) The bill continues reporting requirements by CDPHE Governor Signed of Public Health and Rep. Arndt (D) to the Governor, the General Assembly and other Monitor Implementation Date: Environment to General agencies on specified reports and repeals others. Feb. 1, 2018 Assembly

2017 Legislative Report 17 2017 CHA Bill Summary

Final Status & Bill # Sponsors Bill Summary Position Implementation Date

SB 17-057 The bill created the Colorado Healthcare Colorado Healthcare Failed Affordability & Sen. Guzman (D) Affordability and Sustainability Enterprise within Support Sustainability Enterprise HCPF, replacing the current Hospital Provider Fee.

SB 17-064 The bill required freestanding emergency License Freestanding Sen. Kefalas (D) departments to be licensed under a newly created Monitor Failed Emergency Departments Rep. Lontine (D) license type from CDPHE.

SB 17-065 Passed Sen. Lundberg (R) The bill requires certain health care facilities to post Governor Signed Transparency in Direct Pay Rep. Lontine (D) “self-pay” health care prices on a website or to Support Implementation Date: Health Care Prices provide to a patient upon request. Jan. 1, 2018

SB 17-074 The bill establishes the medication-assisted Passed Sen. Garcia (D) treatment pilot program in Pueblo and Routt Governor Signed Create Medication-assisted Rep. Esgar (D) Counties to address the growing opioid addiction Monitor Implementation Date: Treatment Pilot Program problem. May 22, 2017 Passed SB 17-083 Sen. Kagan (D) The bill provides for the continuation of certain Governor Signed Rule Review Bill Rep. Foote (D) state agencies’ rules and regulations and the Monitor Implementation Date: expiration of others. April 28, 2017

SB 17-084 Sen. Jahn (D) The bill prohibited a health insurer in the individual and small group markets from excluding drug Failed Coverage for Drugs in a Rep. Esgar (D) coverage if the drug was initially covered on Monitor Health Coverage Plan Rep. Singer (D) enrollment.

SB 17-088 Sen. Holbert (R) Passed Sen. Williams (D) The bill makes changes to the selection and Governor Signed Participating Provider Rep. Van Winkle (R) deselection process between insurers and providers. Support Implementation Date: Network Selection Criteria Rep. Hooton (D) Jan. 1, 2018 SB 17-091 The bill removes the requirement that home health Passed Allow Medicaid Home Sen. Moreno (D) services under Medicaid be provided in a client’s Governor Signed Health Services in Sen. Crowder (R) home and allows them to be provided in the Support Implementation Date: Community Rep. Ginal (D) community. June 5, 2017

SB 17-104 The bill required carriers to offer a catastrophic plan Catastrophic Plans in Sen. Donovan (D) to any eligible individual if the individual was in a Monitor Failed Geographic Rating Areas certain geographic area of the state.

SB 17-106 Passed Sen. Coram (R) The bill continues the registration of Naturopathic Governor Signed Sunset Registration of Sen. Aguilar (D) doctors which was set to expire and implements Monitor Implementation Date: Naturopathic Doctors Rep. Singer (D) recommendations of the Sunset review by DORA. Aug. 9, 2017

SB 17-121 Sen. Lundberg (R) Passed Sen. Crowder (R) This bill requires HCPF to engage in an ongoing Governor Signed Improve Medicaid Client Rep. Landgraf (R) process to improve Medicaid client correspondence. Support Implementation Date: Correspondence Rep. Danielson (D) Aug. 9, 2017 SB 17-133 This bill required the Insurance Commissioner Insurance Commissioner Sen. Tate (R) Failed Investigation of Provider Rep. Young (D) to investigate certain complaints against health Monitor Complaints insurance carriers filed by health care providers.

SB 17-137 Passed Sen. Todd (D) The bill continues the Colorado Health Service Corps Governor Signed Sunset Health Service Sen. Merrifield (D) Advisory Council indefinitely. Monitor Implementation Date: Corps Advisory Council Rep. Jackson (D) April 18, 2017

SB 17-142 Passed Rep. Williams (D) The bill requires that a mammography report Governor Signed Breast Density Notification Rep. Danielson (D) include a specified notice when the patient’s Monitor Implementation Date: Required mammogram indicates dense breast tissue. Oct. 1, 2017

SB 17-146 Passed Sen. Jahn (D) The bill increases health professionals access to the Governor Signed Access to Prescription Rep. Ginal (D) PDMP database. It also adds veterinarians to obtain Monitor Implementation Date: Drug Monitoring Program access. April 6, 2017

18 2017 Legislative Report 2017 CHA Bill Summary

Final Status & Bill # Sponsors Bill Summary Position Implementation Date

SB 17-151 The bill required health insurance carriers that Consumer Access to Sen. Crowder (R) conduct credentialing of providers to adhere to Monitor Failed Health Care Rep. Ginal (D) evidence-based standards and other requirements. SB 17-181 The bill allowed the presentation of collateral-source Collateral-Source Rule Sen. Gardner (R) evidence unless a plaintiff agreed to a reduced jury Monitor Failed Evidence of Insurance Rep. Willett (R) award. SB 17-189 Passed Consumer Options in Sen. Cooke (R) The bill eliminates the requirement that a law Governor Signed Fingerprint Background Rep. Foote (D) enforcement agency be the only entity authorized Monitor Implementation Date: Checks to take fingerprints for background checks. Aug. 9, 2017

SB 17-193 Sen. Jahn (D) This bill creates a research center for substance Passed Sen. Lundberg (R) abuse and addiction prevention strategies and Governor Signed Research Center Prevention Rep. Rankin (R) treatment, at the University of Colorado Health Monitor Implementation Date: Substance Abuse Addiction Rep. Pettersen (D) Sciences Center. May 18, 2017

SB 17-203 The bill prohibits carriers from requiring covered Passed Sen. Todd (D) persons to undergo step therapy if the covered Governor Signed Prohibit Carrier from Rep. Kennedy (D) person has already tried step therapy under a Support Implementation Date: Requiring Alternative Drug Rep. Covarrubias (R) current or previous health benefit plan. Sept. 1, 2017

SB 17-206 This bill required state-regulated health insurers Sen. Gardner (R) to follow certain procedures when paying claims Failed Out-of-network Providers Rep. Singer (D) for out-of-network provider services at in-network Support Payments Patient Notice facilities.

SB 17-207 Passed Sen. Cooke (R) The bill removes the use of jails for 72-hour mental Governor Signed Strengthen Colorado Sen. Kagan (D) health holds and clarifies state law for hospitals Support Implementation Date: Behavioral Health Crisis Rep. Sias (R) to allow individuals to be taken to an emergency Aug. 9, 2017 System Rep. Salazar (D) department. & May 1, 2018 SB 17-223 Passed Relocate Dead Human Sen. Gardner (R) This bill relocates the Revised Uniform Anatomical Governor Signed Bodies Title 12 Rep. Herod (D) Gift Act from Title 12 to Title 15 of the C.R.S. Monitor Implementation Date: Recodification Aug. 9, 2017

SB 17-249 Passed Sen. Smallwood (R) The bill continues the DOI until 2030 and Governor Signed Sunset Division of Sen. Williams (D) implements recommendations from the 2016 Monitor Implementation Date: Insurance Rep. Ginal (D) DORA report. June 1, 2017

SB 17-254 Passed Sen. Lambert (R) The bill appropriates all state money for the Governor Signed 2017-18 Long Rep. Hamner (D) 2017-18 fiscal year. Monitor Implementation Date: Appropriations Bill July 1, 2017

SB 17-256 Passed Sen. Lambert (R) The bill effectuates the $264 million cut to hospitals Governor Signed Hospital Reimbursement Rep. Hamner (D) from the provider fee to balance the state budget. Oppose Implementation Date: Rates Repealed by SB 17-267

SB 17-267 Sen. Guzman (D) The bill creates a Colorado Healthcare Affordability Passed Sen. Sonnenberg (R) and Sustainability Enterprise within HCPF, replacing Governor Signed Sustainability of Rural Rep. J. Becker (R) the current hospital provider fee, in addition to Support Implementation Date: Colorado Rep. K. Becker (D) other provisions to aid rural Colorado. July 1, 2017

SB 17-268 Sen. Kerr (D) The bill allows a pharmacist to supervise up to six Passed Sen. Smallwood (R) pharmacy technicians. If three or more technicians Governor Signed Pharmacy Technician Rep. Ginal (D) are on duty, the majority must have certain Monitor Implementation Date: Supervision Ratio Rep. Ransom (R) qualifications. Aug. 9, 2017

SB 17-276 The bill required the state to give a small business Sen. Neville (R) notice in writing and steps to take when the Failed Alleviate Fiscal Impact Rep. Neville (R) business committed a first-time minor violation of Monitor State Rules Small Business administration rules.

2017 Legislative Report 19 2017 CHA Bill Summary

Final Status & Bill # Sponsors Bill Summary Position Implementation Date

SB 17-284 Sen. Lundberg (R) The bill created the “Women’s Reproductive A Woman’s Right to Sen. Marble (R) Failed Accurate Health Care Rep. Ransom (R) Information Guarantee for Health and Transparency Monitor Information Rep. Saine (R) Act” specifying terms for abortion in Colorado.

SB 17-295 Passed Sen. Lundberg (R) The bill requires HCPF to consolidate reports on Governor Signed Revise Medicaid Fraud Rep. Young (D) Medicaid client and provider fraud into one report. Monitor Implementation Date: Reporting Aug. 9, 2017

SB 17-300 Passed Sen. Lambert (R) The bill requires the Commissioner of Insurance to Governor Signed High-risk Health Care Rep. Kennedy (D) study methods of providing health care coverage to Monitor Implementation Date: Coverage Program high-risk individuals. Aug. 9, 2017

20 2017 Legislative Report

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