March 24, 2026 · Health & Human Services · 41,127 words · 21 speakers · 206 segments
Okay, the Health and Human Services Committee will come to order. Mr. Shadum, please call the roll.
Representative Zabuton. Present. Bradfield. Here. Bradley. Here. English. Excuse. Gray. Here. Amrick. Excuse. Johnson. Excuse. McCormick. Here. Wrighton. Here. Stewart. Here. Wook. Excuse. Leader. Present. Madam Chair. Here.
Okay, welcome everyone. We are going to move a little bit out of order than what was announced. We're going to start with House Bill 1325, then 1327, and then 1092, and then maybe slot in the Sunset Division of Professions and Occupations when we can. So we are two minutes for witnesses today and 10-minute panels, and it looks like we already have our prompt sponsors. Amazing.
If you want to go ahead and tell us about your bill, Minority Leader Caldwell. Thank you, Madam Chair and members. Representative Foray and I are introducing legislation that directly confronts one of Colorado's most pressing crises. the intertwined epidemics of opioid use disorder, treatment-resistant mental health conditions, and trauma, especially among our veterans. Colorado is facing a severe and worsening mental health crisis. Existing treatments too often fall short of delivering long-term remission and recovery. That is why we must responsibly explore innovative, evidence-based options and why this bill creates the Ibogaine Research Pilot Program. Let me first explain what ibogaine is and why it matters. Ibogaine is a naturally occurring psychoactive alkaloid derived from the root bark of the Tabernanth iboga plant, traditionally used in Central African healing practices. Modern research shows that a single medically supervised dose can interrupt opioid dependence and dramatically reduce relapse risk. Clinical studies report on an 80 to 97% success rate in preventing relapse with withdrawal symptoms eliminated in just 24 to 72 hours compared to weeks or months of traditional rehab. Improve PTSD, depression, and anxiety by helping repair damaged neural pathways and giving patients new perspectives on their trauma. support neurological recovery. Most notably, a 2024 Stanford study published in Nature Medicine found significant improvements in functioning, PTSD, depression, and anxiety among veterans with traumatic brain injury after ibogaine therapy. Because ibogaine remains a Schedule I substance under federal law, U.S. research has been severely limited. This bill changes that for Colorado by creating a tightly regulated, medically supervised research pathway. Here's exactly what HB 26-1325 does. It establishes the Ibogaine research pilot program inside the Behavioral Health Administration. It authorizes up to five pilot sites across the state to conduct rigorous institutional review board approved research under full medical oversight including prescreening continuous monitoring and adverse event reporting It requires the BHA to form a review committee to select sites based on scientific merit safety protocols, and community benefit. It directs the BHA and pilot sites to pursue federal authorization, including FDA investigational new drug, also known as IND, applications, and potential federal research program status under 21 U.S.C. 872. It creates a dedicated cash fund and grant program so the state can accept public and private gifts, grants and donations, ensuring research does not solely rely on general fund dollars. It mandates a benefits-sharing plan with indigenous communities that have stewarded the iboga plant for centuries. It brings expertise from the Natural Medicine Advisory Board in a future rulemaking and adds targeted safety guard rails for when and if Ibogaine care is ever expanded beyond the pilot. The bill also makes two modest technical improvements to our existing natural medicine framework. It equalizes expertise requirements across all 15 members of the advisory board and clarifies facilitator liability protections. It also gives the apartment of revenue clear authority to set differentiated licensing fees to prioritize pilot site applications. Members, this is not about rushing a new treatment to market. This is about responsible, science-driven exploration of one of the most promising therapies emerging anywhere in the world. Every day we delay, more Coloradans lose their lives to overdose, more veterans struggle in silence, and more families bear the cost of inadequate care. I respectfully ask for your support for HB 26-1325 so that Colorado can lead safely, ethically, and with rigorous oversight in giving hope to those who have run out of options. Members, you probably have by now some amendments. We have five amendments with an amendments explainer. We'll also have DOR, BHA here as well. If you have some specific questions, I think we're going to do the amendments at the end, But I'm happy to go through it when we get there on what the amendments actually do.
Thank you. Representative Frey.
Thank you, Madam Chair. Great to be in front of the committee again. This is my final bill day, so you're welcome. The one thing I wanted just to note and piggyback, he did a really good job explaining what this bill does. One of the reasons that I decided to join this bipartisan effort is because earlier, before a session started, Rep. Caldwell and I were down in Colorado Springs at the Student Veterans of America National Conference, and they had two leaders come join some of the veteran-electeds for dinner, and they both were researching natural medicine. And that, to me, really stood out. Historically, when we were suffering from our own internal struggles, we often just medicated by drinking. That was the millennial generation way of coping. And one of the things I had noticed by talking to some of these student veteran leaders was that they were interested in different types of therapy. The traditional therapy approaches were not working, and they wanted to explore others. And so when we started exploring natural medicine last year, and then again this year, this is a bill that I thought would be a responsible way to explore a different type of therapy that our veteran community, especially our younger veteran community, is asking for. So I wanted to come jump on and support this just from a veteran perspective lens. So thank you for listening and I hope to have your yes vote.
Minority Leader Caldwell.
Thank you, Madam Chair. And to my co sponsor point I spoken directly with several veterans who have actually gotten this treatment So currently because it is Schedule 1 people have to travel down to Mexico and get this treatment There's actually a great documentary on it on Netflix called End Waves and War that really kind of outlines it and follows a group of Navy SEALs. I've spoken with a Navy SEAL who lives here in Colorado and who is an elected official. And he wanted to be here today, and I don't believe he was able to make it. But he talked about his experience with his Navy SEAL friends going down and getting this treatment and how kind of impactful it was to him. I also spoke with someone whose sister was addicted to heroin for 20 years, went to Mexico, did the Ibogaine treatment, and has been clean ever since. And it's been a couple years since then. So heroin for 20 years, one Ibogaine treatment, and has been clean for a couple years now. There may be some experts here that can talk about all the details and how it actually works in the brain. I've got some things on here, some notes, if you were to ask that question. But I don't view this as – I can imagine some people view this as, oh, this is a drug legalization thing. It's not that. We decriminalized Ibogaine. The voters did in 2022. too. But right now, we just don't have any guardrails, any safety measures around it. And we have a very unique opportunity here to actually explore it and see how it works. I'm very much of the kind of all of the above approach, serving in the military for 10 years and serving in Afghanistan. And with most of the people I served with, have deployed, like my co-prime said earlier, some people self-medicate with alcohol. Some people use pharmaceuticals. Some people use marijuana. Some people go to a counselor. Personally, as a Christian, I recommend going to church and starting there. But not everything works for everybody. And so what this looks like from my research on it is a very promising new potential treatment for those with opioid addictions and PTSD. Thank you.
Thank you, sponsors. Questions from the committee?
Representative Bradley. Thank you, Madam Chair, and thank you both for your service. I get where you guys are coming from. I obviously want to help veterans. I have a problem with there's not been any high-quality random control trial evidence that clearly shows whether this works better than placebo or standard treatment for addictions. So there's no science. There's no large systematic review studies. But what we do know is that 50% of people that do this can have a QT interval, which is a heart rhythm problem, in a dangerous range, 50%. And that can affect, could last more than 24 hours. So I guess my question in a fiscal crisis, why are we doing this versus just maybe letting some more trials
come out, letting some more information come out before we spend $700,000 in two years on something that we had talked about the state of Texas is putting $50 million into. Minority Leader Caldwell.
Thank you, Madam Chair, and thank you, Representative Bradley. So there has been quite a number of studies. I have a list here. Frontiers in Pharmacology 2018 concluded that it significantly reduces opioid withdrawal symptoms and cravings. Journal of Substance Abuse Treatment 2018 sustained reductions in opioid use post American Journal of Drug and Alcohol Abuse 2017 reductions in opioid use plus improved psychological outcomes And then the Stanford study from 2024 that showed improvements in PTSD depression anxiety To your point I think that the important part of this program here is what you raised about the potential medical issues. So there's a story if you Google 2021 Broomfield, Colorado, Ibogaine, it can have serious potential consequences because it is a very long and intense treatment session. And so that's why we want this program because this program lays out the medical requirements and medically clearing people before they use this treatment and then also requiring that they have medical professionals continuously uninterrupted monitoring the people with the treatment. And so that is my fear is because of that. But getting medically cleared before using Ibogaine, which in 2021, a person, a Coloradan didn't do that. And was it from my understanding of the story was it was administered by a friend. And that person unfortunately passed away at their home where they were going through this experience. And so what I want is if people want to get this treatment. Instead of going down to Mexico, we've decriminalized it here and do it under the supervision of medical professionals who can sit there and monitor them. And the important thing is clearing them ahead of time before they even do this. Because if you watch a documentary, like I said, there's a great one on Netflix. It's an experience. It's a very long experience. I mean, 10 plus hours. And so it's important that we have the medical professionals there keeping oversight
over it. Thank you. Just wanted to recognize that Representative Johnson joined us and Representative Bradley. I'm sorry, and Representative Luke. Thank you, Madam Chair. So let's see you have
these pilot studies to go through and they say this is safe under the guise of the medical
community, but the FDA still not approved it. What happens then? Sorry, Minority Leader Caldwell.
Thank you, Madam Chair, and thank you again, Representative Bradley. So the process, the way that I understand it, and there may be some witnesses that can speak better to it, is we will have to apply to the federal government to get one of these IND waivers, which usually sets a timeline, like two to three years. This is how long your waiver is for, so this is how long you can do the actual research studies on it. There will also be an amendment coming forward that allows us to share information with other states who may be doing this and other groups to see if our results line up with their results, if they're maybe doing something differently. So – and I kind of forgot what the question was originally, but I think what would happen is after this pilot research study gets done, we complete it within the waiver. I imagine if we need a little bit longer, they could submit a waiver. I think your question, if I'm not mistaken, is about the Schedule 1. It's still being Schedule 1. That's a good lawyer question. If it's still decriminalized here and we find that the pilot study comes back and it's positive, but it's still Schedule 1, I can tell you that – I don't know if it's this article I have here. The federal administration has been talking for the last year about looking to move it from a Schedule I, but it's kind of based on states like what we're doing right here. The federal government wants states to do these studies. to give the feedback before they move it from a Schedule I, and that's why they're offering that waiver. And so Texas and Arizona are two states that I'm aware of who have started doing studies like that. But I think the moving it from Schedule I is going to be dependent on what the feedback from the states are.
Additional questions? Okay. No additional questions from the committee. Thank you, sponsors. we'll bring up the witnesses. And I got your... So we'll start with Nicholas McClellan, Kevin Johnson, Sally Roberts, and Cindy Brown. Okay. We'll start from my left to my right. If you can state your name, the organization you represent, and you have two minutes. And then there's a tiny little button right by the plug that you should push it until it turns green, if that's okay. It's green right now. Oh, you're great. Go right ahead. All right.
My name is Cindy Brown, and I'm here representing myself. Hello, committee members. Thank you for having me. I want to share how Ibogaine has changed my life 180 degrees. I have struggled with anxiety, depression, suicidal ideation, childhood trauma, emotional, physical, sexual, PTSD, and insomnia, to name a few. I know I'm not the only one that can relate to my story of trauma. I am a retired first responder serving over 23 plus years. Once I retired, I thought life was going to get great. No, it got worse. I went to outpatient therapy at the Meadows in Denver with only a little help. I went to the Stella Mental Health Center in Denver for a stellar ganglior block, which only reduced the mind chatter slightly. I then discovered Ibogaine, did research, and reached out to a clinic in Mexico. I'd never done psychedelics before, but at that point, I was losing all hope. I was referred to the Casey Scudin 343 Fund, which helped cover the costs, did pre- and post-integration for my journey. Even though I was skeptical, I kept hearing all these amazing stories that I was not alone and that they could definitely help me out with Ibogaine. When I was on Ibogaine, I was able to see and come to terms with many things. I was able to see that I was numbing things out instead of facing them. I would have never been able to go into this deep insight no matter how many pills, no matter how much drugs, alcohol, or coaching I did. Ibogaine was able to show me things in a new light and provide me ways to face it with a new lens than when the situation first occurred. I know Ibogaine was able to change things in my brain waves by activating the cerebrum, producing neuroplasticity. I know it changed my whole body, no longer having blood pressure, right eye twitching, restless leg syndrome, sleep depression, insomnia, you name it. After Ibogaine, I had no use of any medications that the doctors had to give to me, and including no more alcohol or drugs whatsoever to suffer. I do not want anyone on this planet to suffer anymore and end up like my brother did, losing hope and commit suicide. Thank you.
So do you want to just finish your sentence?
Yeah. I know many Colorado residents are suffering in silence and have tried everything with little to no help. I want them to be happy. Smile each day and know that there is hope. Please committee let help the people in Colorado and make this happen and save lives Thank you so much for your testimony Please proceed So there a tiny little button right by the plug
I think you're good. Yeah. Thank you, Madam Chair and committee members. My name is Kevin Johnson. I'm a Pueblo native, born and raised, East High School graduate, 1991. I joined the Army and spent 1991 to 1999 in the infantry and psychological operations. I wound up in St. Louis and got out of the Army and became a police officer. 9-11 happened two years after I became a police officer and I went back in the service as a psychological operations specialist. I deployed to Iraq in 2004 and 2005. I was not wounded, but I was injured in Iraq. I suffered from PTSD but didn't know it at the time. I got out of the Army in 2005 when we got home and went back to the police department. I was diagnosed with PTSD by the VA in 2006, and I had to leave the police department in 2007 due to PTSD and the injuries I received in combat. I found my calling as a cemetery director with the National Cemetery Administration shortly after that, and I managed cemeteries in Kansas, Nebraska, and Missouri prior to coming to Colorado as the assistant and director of Fort Logan National Cemetery, where I buried over 4,000 veterans a year. Many of them were suicide victims. That job was cool until 2018 when we opened Pikes Peak National Cemetery, and I was tasked with disinterring veterans from Fort Logan to be transferred to Pikes Peak for their final resting place. I disinterred personally over 200 veterans and their family members, and that's when my health started to crash. It brought back Iraq, stuff that I had suppressed with alcohol and work. You know, work was my drug. Alcohol was the thing that fueled it. I started bleeding from my intestines. I lost 95 pounds in less than a month. I was treated for Crohn's disease, IBS, IBD, polyps. None of that worked. A buddy of mine from Iraq called me up and said, hey, what about Mexico? Let's go try the Ibogaine. I went to Mexico. I did Ibogaine, and the chronic pain was gone. I wasn't cured of the gut problems, but the chronic pain was gone. and I was able to concentrate on everything that I needed to to heal myself.
Thank you so much for your testimony. Please proceed.
Thank you, Madam Chair. Members of the committee, I appreciate your time here, and this is an honor. My name is Nicholas McClellan. I am a co-founder of Colorado for Ibogaine. I'm a left-line Colorado resident, Cherry Creek, 1998, and someone who cares deeply about the state and the people in it. I am here today to speak from personal experience in support of creating a safe, medically responsible pathway for Ibogaine in Colorado. For me, this issue is personal. I have struggled with addiction and PTSD. I've seen countless friends suffer these same ailments, and most of them aren't here today to speak. I know firsthand what it means to search for healing and to confront the limits of the options available. That is what led me to Ibogaine. When I first learned about Ibogaine, I heard it could help relieve addiction, PTSD, and promote neuroplasticity in the brain. I was immediately interested, but I also learned that I could stress the cardiac system, so I took that seriously. I looked for proper care in Colorado, and although it's been decriminalized here, there is no treatment that truly exists in a safe, medically supported environment here in Colorado. Therefore, I went to Mexico for treatment. My experience with Ibogaine was one of the most significant healing experiences of my whole entire life For me it felt like a reset of my complete nervous system in real time It felt like a real interruption in destructive patterns and genuine opportunity to reflect and begin rebuilding in a deeper way. What came through most powerfully to me was a core message that Ibogaine is here to help people heal. That does not mean Ibogaine should be approached casually. It carries real risks and demands real seriousness. That is exactly why thoughtful legislation matters. People are already seeking Ibogaine. The real question is whether people will continue to pursue in unregulated settings without clear standards or protections, or will you build a system grounded in safety, screening, medical accountability, and proper aftercare. I'm here today because I believe Ibogaine can save lives. I urge you to support the safe and medically credible pathway for Ibogaine because it is about healing. Thank you.
Thank you so much for your testimony. With that, we'll move online to Ms. Roberts. If you can come off mute, say your name, your organization, and you have two minutes.
Hello, Madam Chair. My name is Sally Roberts. I am representing myself, Americans for Ibogaine, and the Veterans Mental Health Leadership Coalition. I have been a resident of Colorado Springs since 2003 when I first got residency at the Olympic Training Center. I have two resumes. One, I'm a two-time world bronze medalist in women's wrestling. I'm a combat veteran from special operations. I wrestled for the Army's world-class athlete program, and I've gone on to become an entrepreneur and drive my own business. My second resume is that I've had multiple concussions, a TBI, I've had traumatic brain injuries, and I also have PTSD. And it's important for me to share that my PTSD is not a result of representing America as an athlete. That was a joy. It was not a result of me serving in the military. That was an honor and a privilege of a lifetime. My PTSD is a result of when I was five years old, my family was living in Aurora, Colorado. I was playing outside of our apartment complex. I got abducted from the playground. I was raped and my body was left in a broiler room. And when I got pulled out of the broiler room, my mother at the time was told by the police detectives that I was not going to remember the incident and that I wouldn't need therapy. And that put me on a collision course with either going to be juvenile detention or thank God I found the sport of wrestling that has really helped me. In 2003, I was working in Washington, D.C., and I was really by all mark and measure living a fabulous life. But something wasn't right with inside of me, and I didn't know how to reconcile it, and I couldn't get it out. I had gone to the VA to see if they could give me support and assistance. I had been given a tremendous amount of pharmaceuticals to help me with this unknown injury that I couldn't describe. And it was finally when my therapist suggested I might go down to Mexico and try Ibogaine. at my most vulnerable and certainly at my most mentally weak. I did, in fact, go down to Mexico and I sat with the medicine. And when I went into that medicine, I was a broken human being that was really without love. And I didn't know who I was. And when I came out, I realized that that plant medicine, it didn't give me my life back. It gave me the opportunity to live a life that I never had that was filled truly with love. Thank you. So thank you for supporting this.
Thank you so much for your testimony. With that, we'll turn it over to the committee for questions. Representative Wook.
Thank you Madam Chair Sir I wasn sure if you had anything else to add I just wanted to ask you if you had something else to add or if you finished up Thank you sir
I would just like to add that...
Mr. Johnson?
Yes.
Okay, great.
I'm sorry, Kevin Johnson.
Please proceed.
Yeah. I would just like to add that Ibogaine should be available for everybody that needs it. It saved my life. I went to Mexico four months ago for this treatment. I weighed 159 pounds, and I was barely able to make the trip. I wouldn't be sitting here before you today without Ibogaine and that treatment. Thank you.
Representative Bradley?
Thank you, and thank you all for your testimony. We appreciate your vulnerability. Have any of you, did any of you try ketamine before Ibogaine?
I mean, I had a problem with the ketamine, so that's probably the reason I went. But I was abusing it, yeah.
Representative Bradley. And then second question, did any of you that have done the Abigain, because the largest study on Abigain says 50% will have heart problems, a QT interval problem, did any of you experience that?
No. I'd had a heart attack prior. Mr. Johnson, go ahead. I'd had a heart attack prior to going to Mexico, so it was a major concern for me. It's the care that is provided. It's the pre-evaluation that you have to do with your personal doctor. And then it's the constant monitoring of the physicians, the medics, and the nurses.
while you're in their care. Can I answer you about ketamine, ma'am? Ms. Brown.
When I went to the Steller Mental Health Clinic in Denver, they evaluated me and determined that ketamine would be useless for me to even try. After my exam, they said my case was so severe that the only benefit they could help me was to do the cellular ganglion blocks where they inject a medicine in your carotid artery to reset your nervous system. And they said that was the only thing that would work. Ketamine, they said, would be a waste of time and all the other modalities that they had at the facility.
Representative Bradley. Thank you. And thank you for answering that. So, Mr. Johnson, do you feel like that that study was flawed because there wasn't good health care preventatively taking people subjectively and objectively through an exam to make sure they were aware of if there might have been heart conditions underlying and then the treatment to make sure they were supervising through the entire plan like the broomfield man his friend that gave it to him left and went to go grab lunch and then came back and he was dead so your experiences if you're in a medical facility that they're trained to watch for this and to prevent it from happening
Mr. Johnson, sorry.
Thank you.
Yes, ma'am. That was my concern, was my heart attack. And that was the protocol that they put in place prior to me ever even being accepted into the program. I had to provide blood work. I had to provide EKGs, ECGs. I had to provide a medical history for them. It was that environment. When I got there, the first thing we did was a medical evaluation by doctors and nurses. We were on heart monitors the entire time we were in Ibogaine. I can't speak to this study. I can't. I'm not that kind of a human. I'm not a scientist. I'm not a doctor. But for me, it was the security of knowing that there were medical professionals there to take care of me. The only problem was I had to go to Mexico for it.
Can I also add to that?
Ms. Brown? As a former national certified paramedic in I can honestly say the only reason I even agreed to do the Ibogaine at the clinic in Mexico was because of how thorough they made me do an EKG before, blood work. They did all these tests. As soon as we got there, they rechecked our blood work. They did an EKG again on site. They made sure we completely had all the fluids, all the IV was prepared just in case there was an issue. We were already preset and we were monitored 24 hours when we were in that room. There was my group. There was six of us. They had eight doctors, eight nurses. And then there was three doctors that watched us at the clinic that I attended. And they watched us for the whole time with us hooked up to a heart monitor. And I felt extremely safe. And that is one of the reasons that I went was because of the strict protocol. because as being a paramedic, I know that it's very, if you don't do stuff by the order, people die.
Just wanted to know that Rep. English and Rep. McCormick have joined us, and then Representative Bradfield, you had a question?
Thank you, Madam Chair, and thank you to all of you who are here today. When you went to Mexico, how many treatments did you have with this medication?
Mr. Johnson? One. I had one, and I would like to add.
Sorry. I just need to introduce you for the record so that people listening know who's speaking. So I apologize. Go ahead.
Nicholas McClellan here. But I had one treatment, and I was hooked up to magnesium the whole time, which protects your heart. That's one of the best protocols we have. You're also doing electrolytes, potassium. So your heart's in good condition throughout the experience. And I hope that's part of the protocols moving forward here.
And Ms. Roberts, you had your hand up as well. Yes. When I went to the clinic in Mexico, I was there for seven days, completely monitored. And the facility is very much mimicked and mirrored that of the Olympic Training Center, where you had every access and resource on site to ensure that every step of the way you were going to be safe, you're going to be protected. And most importantly for me, coming from the athlete perspective, safeguarding. I wanted to know that in my most vulnerable time of need, they were truly going to take care of me from all facets, from all angles.
Additional questions from the committee? Okay, thank you all so much for participating today. We appreciate you being here. We'll bring up our second panel, Mr. Philip Wolfe, Dr. Sue Sisley, Dr. Fernando Rivas, and Ms. Claire Dernst. Okay, with that, we'll start in person. If you could introduce yourself, the organization you represent, and you have two minutes.
It's already on. Oh, there you go. Hi, my name is Philip Wolfe, and I'm representing myself today. I have experience of 17 years with plant medicines in the legal space. I've also built a health care clinic in Haiti, which really drives my perspective of why I'm showing up here today. I really want to commend the sponsors of this bill for the aspects of reciprocity that they have included in this bill. Putting reciprocity into this bill is going to allow Colorado to stand head and shoulders above any other state that doing this type of research because it a whole approach system that will provide reciprocity back to Gabon where all of this technology, all this healing that we are having the opportunity to tap into comes from, specifically Bawiti people who have stewarded this cultural medicine. And the reason that reciprocity is going to make us the best in the world outside of a whole system approach is because that's going to help us create relationships with people in Gabon where there's going to be an opportunity to tap into thousands of years of observational science to assist us because the act of reciprocity is going to help us create relationship. And within that culture, which is so important to honor, we need to make sure that we have a broad scope of the different people who we are interacting with in Gabon to make sure we are going to provide these reciprocal services in the best way possible. And again, that's going to put Colorado head and above everybody else, which I'm very excited about. And within that, there's also opportunities for funding mechanisms outside of psychedelics to be a part of this. Because what we're going to do with biopiracy, what we're going to do with some of the, essentially, the stewarding of around reciprocity, around implementation, around potentially Nagoya protocol, around the protection of these ecosystems and the preservation of iboga is going to allow a broader net to potentially bring in funding in here to the state of Colorado.
Thank you so much for your testimony. We'll move online to Fernando Rivas, if you could introduce yourself, the organization you represent, and you have two
minutes. Thank you, Madam Chair. Good afternoon. My name is Fernando Rivas, and I'm an emergency physician based in Cancun. Although I am the chief medical officer for Transcend Clinic in Mexico, I am here on behalf of myself. I practiced as an ER doctor and professor for about 15 years before transitioning into addiction medicine and the clinical use of ibogaine. I chose to go into emergency medicine because of its immediate impact. In the ER, you see the direct results of your actions. You stabilize, you intervene, you essentially save lives in real time. And I found exactly that same satisfaction in treating patients with ibogaine. Four years ago, I joined a clinic using ibogaine to treat addiction. Within two weeks, I saw outcomes that changed my understanding of what is possible in medicine. This led me to make the decision to dedicate my career to this work. Eventually, that drive evolved to include a commitment to make the world a better place, not just by delivering Ibogaine to one patient at a time, but to do it in a larger scale by promoting research and education, developing innovative protocols around it, and voicing an opinion before clinicians, academics, politicians, and other relevant stakeholders. As physicians, we are trained to diagnose, to treat, and when possible, to cure. But over time, I have come to understand that this framework can be incomplete. The first principle of medicine is not simply to cure, it is to alleviate human suffering. Even when cure is not possible, relief still must be. In my professional experience, the degree to which I'm going to alleviate suffering surpasses anything I have encountered before. I have seen patients who struggle with severe substance use for years, even decades, experience a level of interruption in their addiction that allows them, often for the first time, to meaningfully engage in recovery. I have seen patients with severe PTSD experience near immediate lasting relief from debilitating symptoms that had burdened them for years and failed to respond to prior interventions Ibogaine is a clinical intervention grounded in science that requires proper screening medical supervision and follow care Under these conditions it represents a promising and urgently needed tool. The state of Colorado has an opportunity to lead with a science-driven, compassionate approach to substance use and mental health that would allow for patients to access this treatment while at the same time generating scientific knowledge crucial to the widespread adoption of ibogaine as a treatment form. I would be more than happy to answer questions.
Thank you so much. We'll move to Claire Durst.
Madam Chair, members of the committee, thank you for the opportunity to speak today. My name is Claire Durst. I'm a trauma nurse, a TBI survivor, and someone who spent nearly two decades on the front lines of emergency and addiction medicine, including serving as medical director of operations at an ibogaine clinic in Mexico. I'm here representing Americans for Ibogaine. You'll never be the same. That's what I was told after I suffered a traumatic brain injury at the start of my military career. I was a trauma nurse with over a decade in emergency medicine trained to save lives, but suddenly I couldn't save my own. For six years, I lived disabled. I followed every medical protocol, every medication, every therapy, every procedure. I became dependent on sedatives and benzodiazepines just to function, and still I did not improve. Within months, my providers stopped searching for answers. My doctors quit on me. The system I devoted my life to didn't believe in my own recovery. So I kept searching across multiple states, across countries, and eventually I found Ibogaine. I've seen war. I've seen suicide. I've seen addiction devastate even the strongest among us. And I've never seen a treatment that works as effectively as Ibogaine. Clinically, it does something profound. It interrupts compulsive behavior, quiets the brain's default patterns, and operates and opens a window of neuroplasticity, allowing patients to confront and process deep-rooted trauma. Because addiction is not often about the substance, it's about the pain beneath it. Traditional rehab often cannot access this pain because the mind is still defending it. Ibogaine temporarily disarms those defenses. It allows patients to see the root of their suffering clearly and begin to heal it. and the results can be life-changing. But in the U.S., Ibogaine remains illegal, forcing Americans to seek treatment abroad, often without regulations. But we have the power to change that. We already know how to do this safely with proper medical and psychiatric screening, cardiac monitoring, continuous clinical oversight, and structured aftercare, just like we do in the hospitals with other high-risk medical treatments every single day. Yes, there are risks, but medicine manages risk. We do it with chemotherapy. We do it with surgery. We can do it here with Ibogaine too. I stand before you not as just a clinician, but as someone who's actually lived this. Ibogaine did not cure me, but it gave me my life back. We're ready to study it, to regulate it, and deliver it
safely. And I urge you to open the door to real recovery. Thank you so much for your testimony.
We'll move on to Dr. Sisley. Yep. Hi, chair members of the committee. My name is Sue Sisley. I'm a physician and a clinical researcher, and I serve as principal investigator of the nonprofit Scottsdale Research Institute Foundation, where we conduct FDA-controlled trials looking at Schedule I substances. I'm here in support of House Bill 26-13-25. From a research perspective, ibogaine is certainly one of the most promising investigational compounds for opioid use disorder and several other important illnesses There already a meaningful body of observational research and international clinical experience suggesting that ibogaine can significantly reduce withdrawal symptoms it can interrupt patterns of dependence, and it can support a really sustained remission in many patients. There's also emerging evidence of the benefits with PTSD, TBI, other things that people have have brought up earlier. At the same time, we do need more rigorous, controlled research in the U.S. to fully understand the safety profile, to optimize the future treatment protocols, and generate objective data required for a broader medical application or adoption later. So this bill seems like a practical and responsible step forward. It creates a framework for a compliant and well-regulated research program that builds on what we already know about ibogaine, but it also helps answer a lot of the questions that, the critical questions that still remain. So I know of a few Colorado researchers who are interested in establishing a clinical research site in Colorado, and I'm happy to mentor them through that regulatory process. Doing Schedule 1 research is not easy, and we're excited about the multi-state collaboration that is part of this, that this bill would enable. So I guess we're all working internationally. Our group is working internationally as well to issue a memo of understanding of the country of Gabon and to try to study iboga.
Thank you so much for your testimony. With that, we'll turn it over to the committee for questions. Vice Chair Leader.
Thank you, Madam Chair. This is for any of the doctors that want to take the question.
How long do you assess the patient before you administer the Ibogaine?
Dr. Rivas?
Thank you for the question. Patients must reach clinical stability, and that has different meaning depending on the nature of the patient. A typical opioid-dependent patient reaches stability in their detox process around day five. Over the first few days of their stay at the clinic, they receive a thorough assessment, and the final clearance is given by an in-house cardiologist. Patients undergo ECG, cardiac echocardiogram, or ultrasound of the heart, as well as laboratory investigations and any other investigations that may be relevant to ascertaining the safety of delivering ibogaine for each specific patient. but it would be a several day period over which patients are assessed.
Representative Bradley.
Thank you, Madam Chair. I have a couple of questions to Dr. Is it Rivas?
Yes.
I'm a medical professional.
You're a medical professional.
We know that the gold standard for medicine is random control trials, meaning that subject A may or may not get Ibogaine, subject B may or may not get it, and then you can subjectively and objectively make assessments versus just subjective, oh, I feel better. kind of thing. So I'm asking you because I can't find any research that has a random control trial
for this medicine. Dr. Rivas. There are no randomized control trials for ibogaine treatment. The only reports that we have are a series of cases and that is part of the reason why we have such an opportunity to actually implement and deploy the badly needed trials to understand what patients benefit, the safety profile of the treatment is and its efficacy as well. You are correct. There are no
randomized control trials at present. Representative Patrick. Thank you. So right now it's subjective reporting. I have another question. I'd like to understand the long-term outcome and follow-up, meaning how long you've actually followed patients. What is the longest amount of time? how many patients stayed in the follow-up, and what were your relapse outcomes? Because it looks like it's about a 50% relapse associated with Abagaine. Who would like to answer that? One of the doctors? Dr. Rivas?
Sure. Thank you. The reported rates of success, and success is broadly defined as staying away from the problem substance at one year, range between 40 and 75 percent. These reports have been out for both stimulants and opioid use. However, it can be very challenging to structure follow-up for patients. The information that has been published in the case series supports a 45 to 75 percent success rate, which is significantly better than most current forms of treatment presently available anywhere in the world.
Representative Bradley. Thank you, and thank you for that. And how many people were in that 40% to 75% one-year follow-up?
Dr. Rivas. I would have to go through the study again to make sure how many individuals were, but there were smaller than 50 patients each report.
Additional questions from the committee? Okay, seeing none, thank you so much for your participation. We appreciate you being here today. Okay, we'll move on to our third panel. Ms. Nicole Martin, Erica Gannett, Joshua Capel. And then let's also call up, we have two folks here for questions only, Allison Robinette and Dominique Mendiola. Are they online? Oh, in person. Hello there. Thank you. Okay, we'll start from my right to my left. If you can introduce yourself, the organization you represent, and you have two minutes.
Good afternoon, Madam Chair and members of the committee. My name is Erica Gannett, and I serve as the Legislative Affairs Officer for the Behavioral Health Administration. I'm here to testify today in support of House Bill 26-1325. You'll hear today, or you've heard already, from experts and individuals who've witnessed and even experienced firsthand the life-saving impacts of this medicine. So I'll keep my remarks focused on the BHA's role in the bill. The bill, in establishing the Ibogaine Research Pilot Program in the BHA, creates a program in which the BHA will approve up to five pilot sites who intend to pursue federal authorization to perform clinical research on the safety and effectiveness of Ibogaine to treat behavioral health disorders. Broadly, BHA will act as a convener and a partner in this process, supporting pilot sites to advance their research efforts. This includes establishing and facilitating the pilot site review committee providing support and technical assistance to pilot sites as they apply for new or expanded INDs exploring additional research authorizations and facilitating partnerships with federal agencies to advance Colorado's research efforts related to the safety and effectiveness of Ibogaine, monitoring for the availability of grant funding aligned with pilot efforts in order to expand research, including opportunities such as state, federal, or private grants. We've all seen the devastating impacts that opioid use and severe mental health disorders have on people we love in our communities. And while many successful treatment approaches do exist, for those who do not receive benefit from these treatments, Ibogaine may be a life-saving option, and BHA is excited to partner to expand these research efforts into this treatment. We urge your support of this bill. Thank you.
Thank you so much. Please proceed.
Can you hear me? We can. Hi, my name is Nicole Martin. I'm here today representing myself, but I'm actually on an advisory board with the Douglas County Opioid Abatement Council. I'm an advisory board member, excuse me, under Commissioner Abe Layton, and I was also appointed as the Douglas County Opioid Abatement Council's liaison for Ibogaine Research, and I've been doing that for a year. I'm here today with somebody with lived experience for chronic pain. I have not experienced Ibogaine myself, but I am excited about what it could bring to the table. One thing that, if I were to leave you with anything today, it would be that opioid use disorder is a brain injury. We talk about TBIs and why Ibogaine does treat vets so well with that. What we don't talk about is that when you use opioids, it's not that you're not managing it correctly, but very quickly what happens is your brain stops making serotonin and it stops making dopamine very quickly if you have to start taking opioids. And many people have to do that every day for all sorts of injuries. I've had to do that myself. I also have an adult daughter who has been experiencing medical issues as well, and she's had to take those. So what ends up happening then is for your brain to start kicking that back in, you have to stop opioids altogether for 18 months before your brain will start to make those happy, your serotonin and your dopamine again. the opportunity in itself if if as you go and I have been through through rehab for dependency because of me having multiple surgeries and trying to get off myself and then I kept ending up in the hospital I'm so appreciative for the current model I would just ask that we add another tool to the toolbox and make Ibogaine available where we do not have to travel to Mexico thank you
so much thank you so much for your testimony please proceed
Thank you, Madam Chair, members of the committee. My name is Joshua Kappel. I'm an attorney licensed here in Colorado. I'm one of the founders of the law firm Vicente LLP. I was one of the drafters of the Natural Medicine Health Act. I represent the Healing Advocacy Fund, who is in support of this bill, and also Colorado for Ibogaine, who I'm here on behalf of today. So thank you. Colorado for Ibogaine is made up of patients, philanthropists, advocates, operators who are trying to create access to this tool of care here in Colorado. And this bill is really important for three main reasons One it necessary to move this forward today We see thousands of people last year a thousand people probably five people today in Colorado will die of overdose. And they need more effective tools. And we see the same every day with veterans committing suicide. And it's just, we have to do something about that. And this bill is a necessary piece and I've been in care with this research is a necessary tool to move this forward. It's also a really smart bill. You know, this bill is a two-tiered approach, you know, where it first moves forward with, you know, supporting BHA and creating a research program, working with the federal government with very clear safeguards, while also giving time for the state under the Natural Medicine Health Act to develop a safe program for Ibogaine care and allowing, you know, both the regulatory agencies involved in that process and the advisory board to really look at and dive into what does continuous medical monitoring look like? What sort of screenings are necessary? And so this approach, this two-tiered approach of research and then a slow rollout of creating a system of providing care is really smart. And finally, it's responsible. You know, it's this measured approach, as I mentioned, but also it's culturally responsible. And we've heard from others where there's measures in the bill that allow for reciprocity with indigenous groups who have worked with Iboga for centuries, if not longer than that. And so not only is this bill necessary, it's smart, but also responsible. So thank you very much for your support.
Thank you so much for your testimony. And if you could introduce, you both are here for questions only, right? If you could just introduce yourself to the organization for the record.
Thank you so much, Madam Chair. My name is Allison Robinette. I serve as the Director of Policy and Regulatory Affairs for the Department of Revenue Natural Medicine Division.
Good afternoon, Madam Chair, members of the committee. My name is Dominique Comendiola, and I serve as the Senior Director for the Colorado Department of Revenues, both our Marijuana Enforcement Division and our Natural Medicine Division.
Thank you so much. Questions from the committee.
Representative Bradley. Thank you, Ms. Gannett. You know we're in a budget crisis. Where is $700,000 coming from?
Thank you for the question. Representative Bradley, I can speak to the BHA's portion of the fiscal note, which reflects about $150,000 in its first year, and then I think $154,000 in out years. That funding is reflective of one FTE and then additional funds to contract with specialists who have expertise in the administration of Ibogaine, FDA, IND processes, etc. It's a very small investment to make in advancing these research efforts in Colorado. As you noted earlier, $50 million has been invested into clinical research into Ibogaine in Texas. And while we don't have those funds at our fingertips, this is a small investment that we can make in order to advance these efforts, specifically here in Colorado.
Representative Brevin? Thank you. Same question for the lawyer. Americans for Abigain, are they going to grant fund this? I mean, I'm trying to figure out where this money is coming from. Are we just kicking this can down the road so that in appropriations this bill dies? I'm trying to figure out where this money is coming from.
Mr. Capel? Yeah, I don't represent Americans for Ibogaine, but with Colorado's for Ibogaine, we are looking at different philanthropic solutions both for the BHA side and also for the full regulatory program And I not in a know to opine on the specifics of you know Colorado budget But you know it is something where there is a lot of support to move this forward because of its efficacy. And, you know, and I hope when we think about the cost of what opiate use addiction costs this state every year, and we look at this as a substitute treatment that's actually a lot cheaper. I mean, you know, you're talking about the latest numbers I saw was like about $63,000 per person who has opioid use disorder on like relying on like state funding, you know, and that's over their lifetime. So if you could do a treatment that reduces those numbers, like over the long run, it's actually very fiscally responsible, but I don't know the
ins and outs of the state budget. Representative Bradley. Thank you. And I appreciate you said, listen, I am not for opioid use. Trust me. I'm not, I love natural medicine. I love a lot of natural medicine, especially during COVID. That being said, thank you for that. You talked about efficacy. There's no random control trials on this drug, which is the gold standard for medicine. So that's my hesitancy as a healthcare provider. I get where we're coming from. I want veterans to be treated. I want them to be taken care of, but there's no real long-term follow-up. There's no efficacy because there's no random control trials. And what I don't want
to see are patients not being safeguarded. That is my goal. Mr. Capel. Yeah. One of the fundamental issues around this with randomized controlled studies is that the impact of Ibogaine is so life-changing that they haven't been able to find a placebo that actually works. And so this is a a common issue when you look at this field of medicine around randomized controlled studies.
Additional questions from the committee? Okay, seeing none, thank you all so much for your participation. We appreciate you being here today. Let's bring up our final folks, Mr. Lundy Ramos and Mr. Henry Berkowitz. And then if there's anybody else online or in person that would like to come forward and testify. Is it just the one individual? Okay. Okay. We'll move to Mr. Lundy Ramos. If you could state your name, the organization you represent, and you have two minutes.
Thank you, Madam Chair and members of the committee. My name is Lundy Ramos and I represent myself. I was appointed by Governor Polis in 2023 to the Natural Medicine Advisory Board as a representative for the mental health providers and mental health equity. I am also a licensed professional counselor and the founder and CEO of the largest outpatient therapy nonprofit in Colorado serving uninsured populations. I also served as chairperson of the Natural Medicine Advisory Board for over two years. I'm not speaking on behalf of the board, but I give you that context. I'm speaking from direct service. From that vantage point, I have significant concerns with this bill as written. Colorado has already built a structurally sound framework for natural medicines under SB 23290, and this bill departs from that structure. First, separating Ibogaine from the existing framework moves it away from established expert oversight to BHA without institutional knowledge. If Ibogaine requires greater caution, and I believe it does, That is an argument for stronger integration, not less. Second, the bill allows for a cash fund without clearly defining donor transparency or limits influence. That raises concerns about public accountability and private influence. Third, changes to the board composition and removal authority create the potential, whether intended or not, to replace independent expertise with more aligned perspectives. Fourth, limiting provider liability to cases of intentional misconduct or gross negligence creates a higher barrier to accountability and weakens patient protections. Finally, on Ibogaine sourcing and benefit sharing, the advisory board engaged in months of deliberation with international experts advising the prior and informed consent from the collective voices of Gabonese First Nation stakeholders as essential. This bill does not reflect those recommendations. Additionally, those collective voices are not present in this room today and that absence that absence matters
thank you so much appreciate it thank you so much for your testimony questions for this witness seeing none thank you so much for your participation we appreciate you being here today okay um with that the witness testimony is closed sponsors would you like to come back up I hear you have a few amendments
Yes Representative Frey would you like to move your first amendment
Sure you want me to make the motion and then you explain it
Representative Frey Thank you I move L001 to House Bill 1325 Second
Representative Johnson Second
Minority Leader Caldwell Thank you, Madam Chair. Members, I just want to apologize up front. I try to give as many people as I could a heads up that there were going to be some amendments coming. The lawyers are going to lawyer. But I will say they worked very hard on it, and I'm just giving them a hard time. So I've got a short explanation here. So for L001, so we'd heard some questions about the fiscal note. So what this essentially is going to do is bring it down to where it's just the one FTE. So it's the $150,000. If you're looking at the original fiscal note, it's got a few different numbers on there, 327. then it'll be roughly $150,000 for the one FTE. And as far as I think Representative Bradley, you had some questions about the funding thing. So I will say that talking with the governor actually multiple times on this, I feel like this is kind of, I don't want to say it's a priority without him actually saying it's a priority, but he has been seemed very invested in this to make this work. And I know he has requested that the $150,000 be set aside for that. And so that's obviously going to have to be a decision between JBC appropriations and all of that. So it is not the 300-something that we'd seen in the original fiscal null. And L-001 is going to do that. And it adds requirements for the BHA in overseeing the Ibogaine pilot program and then liability for a physician or medical professional administering Ibogaine. I did catch that one of the last witness there had some concerns there but if you if you read into the bill it's kind of standard like gross negligence is obviously not acceptable but also as we've discussed over and over today kind of throughout the testimony that you know there are risks to it there always going to be risks when you when you getting a treatment especially one like this And so you know things can happen And unless the physicians are being grossly negligent or doing something improper, not following proper medical procedures or protocols, you know, that's where your liability comes in. Any questions on this amendment?
any objections to this amendment okay seeing none l001 passes okay next amendment representative
frey thank you madam chair i move l002 to house bill 1325 representative johnson second keeps feeding you um would you representative frey would you like to explain the amendment
thank you madam chair since my bill sponsor took too long to talk about the other amendment i'll
go a little bit faster for you the um number the number two is the indigenous benefits sharing agreement. So this strengthens the relationship with the indigenous people to share data, potential funding. This is what one of the people that testified talked about in terms of making sure the people of Gabon are aware and in the conversations. Any questions? Oh, Minority Leader Caldwell. I'm just joking. Any questions on this amendment? Any objections to this amendment? Okay, seeing
none. L002 passes.
Representative Frey. Thank you, Madam Chair. I move L003 to 1325. Second. Vice Chair, leader, seconds.
Representative Frey. Thank you, Madam Chair. This one requires
rules to be adopted concerning the administration of Ibane. We ask for a yes vote. Any questions on this amendment? Any objections to this amendment? Okay, with that, L003 passes.
Representative Frey. Thank you, Madam Chair. I move L003
4 to 1325. Second. Vice Chair Leader seconds. Representative Frey. Thank you, Madam Chair. This sets requirements for the state licensing authority regarding the inclusion of Ibogaine and funding for new natural medicines. We ask for a yes vote. Any questions on this amendment? Any objections to this amendment?
Okay, with that, L004 passes.
Representative Frey. Thank you, Madam Chair. Last but not least, I move L005 to House Bill 13. Second. Representative Johnson seconds.
Thank you, Madam Chair. This will
adjust the liability for facilitators, as we had mentioned. This changes the priority of applications to the state licensing authority and requires a licensee seeking to cultivate, manufacture, test, or dispense or administer Ibogaine to consult with indigenous communities to establish a benefit sharing plan. Any questions on this amendment? Any objections to this amendment?
Okay, seeing none, L005 passes. Sponsors, would you like to wrap up? Oh, wait, I'm sorry. Committee, are there any additional amendments? Sponsors, no? No. Okay, with that, the amendment phase is closed. Sorry, I got ahead of myself. Sponsors, would you like to wrap up?
Minority Leader Caldwell. Thank you, Madam Chair, and thank you, members of the committee. If I can turn your attention to the Netflix documentary, it's only an hour and a half long. We're going to use that for closing. Only kidding, though. So I think everybody's heard here the potential here, and I appreciate the back and forth and the conversations as far as studies. This is what we want to do, right? We want to kind of lead the way on this and see what our results are compared with other states. and hopefully provide that research that eventually leads this Ibogaine to no longer being a Schedule 1 if the results lead that way When I was walking into committee, I just purely coincidentally ran into a friend from the Common Sense Institute, and he said, hey, did you see the study we released last week? And here's what the study said. It said Colorado is one of five states, one of only five states with increased fentanyl use. Overdose deaths in Colorado increased 17% since December 2024, while the national trend is going down 21%. So Colorado has increased 17%. Nationally, the trend is down 21%. And Ibogaine is one of those treatments that I believe can make that difference. and get people back onto the right path. I want to leave you, and the last thing I'll say, because my co-prime's getting fidgety over here, I read a quote by Governor Rick Perry, and former Texas governor, I think it reached out to some of you on the committee, and I thought this was very eye-opening, and this really shows you have a Democrat governor here in Colorado, you have the former governor of Texas, a Republican, and this quote from Governor Perry, is this. I traveled to see Abagene clinics in Mexico myself. I met the doctors and researchers. I listened to the patients. I studied the clinical data. I don't care if you're a Republican or a Democrat. Every one of us knows someone who's struggling, whether with addiction, trauma, or mental health. This is the cause I will dedicate the rest of my life to fighting for because too many lives hang in the balance to do anything else. I really appreciate all the engagement and all the questions and would ask for your support.
Representative Frey. Thank you, Madam Chair. I echo what my co-prime has shared and I just want to note that we know when the governor says that, oh, I want to set aside money, that it's not always guaranteed. We hear that and we've been hearing that a lot. We are going to proactively look for gifts, grants, and donations to help fund this because we are in a budget crisis this year and I understand the concerns around wanting to fund a pilot program in a budget crisis year. So that is something we are going to proactively be looking to do. So I just wanted to put that in your ear as well, if there were concerns in that. And I ask for a yes vote.
Representative Freywood, would you like to move your bill?
Yes.
The finance committee? On appropriations.
Appropriations? Yes. Thank you. I move House Bill 1325 as amended to appropriations.
Second. Representative Barone, I think, got the second on that one. Okay. closing comments from the committee.
Representative Johnson. Thank you, Madam Chair. Thank you, sponsors, for bringing this. And thank you, ML, for being willing to continue talking on some of the funding, but for veterans, for first responders, I will be excited yesterday.
Representative Bradley. Thank you, Madam Chair, and thank you to the bill sponsors and everyone that came to testify. I ask a lot of questions because I need to try to figure out where my stance is going to be. I take a lot of notes I know it gets annoying sometimes. I appreciate the priority for veterans. I appreciate the priority for people that conventional medicine just doesn't work for. I agree. I think we're in an opioid crisis. I think there's been too much prescribing of opioids and too many side effects, and I always looking for alternatives to those things especially with natural medicine my concern is the trials right is that we just hearing subjectively that these people get better and there's not been the gold standard. And then I hear you say, but Brandy or Representative Bradley, we need those pilot programs to move towards that. So I'm very torn. I told you coming in when we talked offline, I did not know how I was going to vote on this because I see where you guys are coming from, and I understand it, And that's why I ask so many questions. I need to talk to you probably more. We need a no today. But look forward to alternatives for our veterans
and want to talk a little bit more offline so I can get to a comfortable position on seconds. Thank you. Representative Fryden. Thank you, Madam Chair. I'm happy to support this today. I work in this space, and there is a shortage of medication-assisted therapies. So really excited that we can start looking at some other avenues to truly provide some relief, especially interested not just on the ramifications for PTSD and addiction, but also for chronic pain. That also is a huge deficit that we have, and we know contributes to the fentanyl crisis and opioid issues that we have. So thanks for bringing this. Representative Bradfield. Thank you, Madam Chair, and thank you so much for bringing this bill, and thank you to all the people who spent time with us this afternoon to tell us about their experiences. I'm pleased to vote yes. Vice Chair Leader. Thank you Madam Chair I had no idea what Ibogaine was before I won't say names came to me, brought me his piece of paper and I'm like what? and I'm out there, he's explaining it to me and then I did some more research and I go I'm going to listen to the testimony but thank you for bringing this because I know we had already passed it when we did the mushroom bill it was already passed so it's kind of out there as a wild west here at least I think this kind of brings in some type of guardrails on it and looks at different ways to do this. And I'm all about getting rid of fentanyl and the opioid addiction and helping our veterans. So I will be at yesterday. So thank you. Thank you, sponsors, for bringing this today. And also just wanted to say thank you to all the folks who brought their lived experience and shared those personal stories. Those were really powerful. So with that, Mr. Shadun, could you please call the roll? Representatives of Iran? C. Redfield? Yes. Bradley? Respectfully now. English? Yes. Frey. Yes. Amrick. Yes. Johnson. Yes. McCormick. Yes. Ryden. Yes. Stewart. Yes. Wook. Yes. Leader. Yes. Madam Chair. Yes. The bill passes 12 to 1. You're on your way to Committee on Appropriations. Okay. We are going to move on to get back on track with the order here, Bill 1324. Of course, yeah. Thank you. Thank you. Okay. Our next bill will be House Bill 1324. We would like to start. Representative McCormick. Thank you, Madam Chair. This is the sunset of the divisions of professions and occupations that we introduced a few weeks ago. As you might recall, that we had amendments upon introduction. we will be bringing an amendment today as well just to forewarn you it's getting passed out and this division is houses many of the administrative support to the boards and programs that regulate over 60 professions and occupations and all different types of businesses and if you had gotten the booklet you will have seen all of the i know there's no visuals but i'm just letting you know, all of the professions and occupations are listed in the back of the booklet that this important division has oversight over. And the importance of this division is to protect the public to make sure that these regulated individuals and businesses do meet certain basic requirements while striving to maintain a fair and competitive marketplace. place. So just as an overview, in fiscal year 23-24, this division regulated a total of 336,000 plus individuals and businesses. And these professions and occupations either have a director in the division or they have a governing board. So many of you are familiar with a lot of the medical professions that have governing boards, but some of these are actually director model programs that do not have boards. So this review, this is a division that doesn't come up for repeal because it's important that it keeps going, but it does come up for review every 10 years to make sure that any updates or changes that are needed do come before this body. and we went through quite a few of the recommendations as you recall we did delete amend out edited out a couple of the recommendations that you heard about upon introduction and the bill before you now is that bill and i'll turn it over to my co-prime to kind of go over what those recommendations are how they're reflected in the bill before you representative Thank you Madam Vice Chair And also just wanted to thank the prime of the bill Representative McCormack for her work on this As she mentioned this makes several changes to the Division of Profession and Occupations and talked about some of the changes we made before introduction I'll just briefly go over the sections of the bill now. Sections one and two allow a regulator to delegate authority for the administrative tasks authorized by statute or other tasks specifically authorized to the policy of a border commission to a designee at the regulator's discretion. And then Section 3 changes the amount of time a licensee, certificate holder, or a registrant who receives a letter of admonition has to request a hearing to within 25 days after the date of issuance. Really riveting stuff here. Of the letter of admonition rather than the 20-day after receipt of the letter. And then Section 3 through 22 clarify that the regulator may provide communications to licensees through email. Section 23 raises the amount of the excise tax on renewal fees from $1 to $2. We'll talk a little bit more about that during the amendment phase. And the money goes to a legal defense account created within the Division of Professions and Occupations cash fund. Dora is here to answer any technical questions, and we hope you will vote yes today. Thank you. Committee, do we have any questions? Representative Bradley. I mean, don't sound so excited. Thank you, Madam Chair. Thank you, Bill Sponsors. I just have a couple of questions as far as definitions. On page two, what is a fixed and certain standard? Are there examples of that? And how do we define exercise significant judgment or discretion? I'd like to take that. Dora? Okay. That's fine. Okay. Representative Gilchrist. Sorry, Madam, thank you, Madam Vice Chair, and thank you, Representative Bradley, for the question. I think we'd like to defer that to Dora to answer the question. Representative Bradley. Thank you, and this might be another Dora question, so just let me know. Just accountability on making sure that the administrative tasks are not like complicated decisions. Who is responsible for that accountability and transparency? Because we all know bad actors, right, that will say that something complicated is an administrative task. So just looks like Representative McCurney. I'm on it. Thank you, Madam Chair. And Representative Bradley, that was one of my questions as well. And going back to the review on pages 35 and 36, it does go into a little bit more detail about how if those tasks have been delegated to another board member or the director to complete, it's not the end of that decision. That decision has to come back to the board and be ratified. So it really is a way for a kind of a safety net if something needs to move quickly or some decision needs to be made in the protection of consumer protection, it can be done, but it has to come back in front of the board and they have to vote to approve that. Thank you. Committee, any further questions? Okay, with that we'll move on to the witness phase. And go ahead and come up, as I call your name, Dr. Catherine Plummer, Sarah Werner, and some of these are online. Saul Larson, I'm just going to bring them all up, Brian Tobias, Shahib Singh and if I mispronounce your name please let me know and John Conklin Okay we going to start with the people in front Let start with Dr Catherine Plummer Hi. Please state your name, who you represent, and you have three minutes. Great. Thank you, Madam Chair and members of the committee. Thank you for the opportunity to testify today. My name is Dr. Catherine Plummer, and I am speaking on behalf of the Colorado Academy of Family Physicians in support of House Bill 26-1324. We also support the amendment being brought forward by the sponsors in the committee today. We want to thank the bill sponsors, Representative McCormick and Gilchrist and the Department of Regulatory Agencies for their thoughtful collaboration and stakeholder engagement throughout the process. We want to specifically highlight the importance of the peer-to-peer program continuing to be contracted by the Colorado Medical Board, Ensuring this program remains under contract with the Medical Board preserves its credibility, effectiveness, and trust among physicians. This program is meant to be for providers, by providers, and we support it being selected by providers as well. We appreciate the amendment being considered today, which we believe will improve the bill and reflect continued collaboration. L.001 will change the Licensed Defense Fund excise tax to a fee that will ensure license funds remain sustainable while only having to pay one more dollar. For these reasons, the Colorado Academy of Family Physicians respectfully urges the committee to support House Bill 26-1324. Thank you for your time and consideration. Thank you. And I know the rest are for questions only, but please have you state your name. who you represent. So we'll go to Sarah Werner. Good afternoon, Madam Chair, members of the committee. My name is Sarah Werner. I'm the Deputy Division Director for Policy and Communications within the Division of Professions and Occupations, and I am here to help with any questions. Thank you. And we'll go online to Sal Larson. Please state your name and who you represent, and I understand you're here for questions only, but please introduce yourself. Thank you, Madam Chair, members of the committee. My name is Saul Larson. I'm with the Colorado Office of Policy Research and Regulatory Reform within DORA. And we obviously conducted the Sunset Review, and I'm just here for questions only. Next, Brian Tobias. Thank you, Madam Chair. I'm Brian Tobias. I'm the director of the Colorado Office of Policy Research and Regulatory Reform. Here to answer questions. Thank you. And Shab Singh, please correct me. Thank you, Madam Chair. Sahih Singh, also an analyst at the Colorado Office of Policy, Research, and Regulatory Reform. Here for questions only. And next we'll go to John Conklin. Thank you, Madam Chair and members of the committee. My name is John Conklin. I'm outside counsel to the Colorado Medical Society. I'm happy to address any questions, including Rep. Bradley's question from earlier. Thank you. Thank you. And with that, committee, do we have any questions? Rep. Bradley. Thank you. I'm just glad somebody pays attention to me, so thank you, Mr. Conklin. Yes, if you could answer that question, then I have one more for you. Thank you so much. And, Rep. Bradley, could you please repeat the question so everybody can hear? Yes. Mr. Conklin, could you give me examples of what fixed and certain standard is and how we exercise significant judgment or discretion, please? Go ahead, please. Thank you, Madam Chair. Thank you, Rep. Bradley, for the question. So the Medical Society has some concern over that language and the delegation of any disciplinary action by any of the regulatory boards to non members for exactly that reason because those standards are not defined in Colorado law And so we could have a lot of variability in terms of both what boards, individual boards do in terms of setting standards and also certainly situations that don't fit within guidelines or standards that may be promulgated by the medical board, for example. So I think the intent is that the board could set some kind of criteria that if it's met, then the delegee could take certain action, which we do not believe should include the ability to impose any type of discipline. Thank you, Representative Bradley. Thank you. Thank you for that, Mr. Coughlin. And so do you feel like this should be amended so that boards can set that criteria for definitions versus like a one size fits all? Mr. Conklin? Thank you, Madam Chair. Thank you, Rep. Bradley, for the follow-up question. So the way this is written currently would allow the board to set that criteria or those standards, but it would be different within each board. We just don't believe that the board should be able to delegate the statutory and function of imposing discipline when that impacts the constitutional license of a licensee. So I think an amendment would be indicated to take care of that particular concern. Thank you. Further questions? One more question, please. Thank you. To the doctor that came to testify, do you believe that this bill adds any more state oversight to your licensed profession versus the board having your oversight? Dr. Catherine Plumer. Oh, sorry. Thanks. As a resident, I would have to defer that back to Dora. Okay. Who would like to take that? There's a lot. rock, paper, scissors. Anybody up there would like to online? Go ahead. Let's try for Brian Tobias. Do you want that? I didn't see your hand. Go ahead. Sorry, we're going to defer to the person in the room. Sarah Werner. Thank you, Madam Chair, Representative Bradley. This does not change oversight of the medical profession, so the medical profession is still within the medical board, which has full oversight. Anyone online want to expand that? All right. Thank you. Committee, do we have any further questions for this panel and for this testimony? All right. Anyone else would like to come up and testify who has not signed up that's online or in the audience? Seeing none, witness testimony is over. Bill sponsors. Now, the big question. Do we have any amendments? Representative McCormick. Yes, we do have an amendment for today. And just for the committee's information, we are willing to continue to talk to the folks around the issue in question here to make sure, because it's important to me as well, to make sure that boards do have the disciplinary authority that they have had to date to make sure that that's clear. I think it's really a matter of the wording that we have, and we're going to continue to work on that. And we had heard about this issue even before today, but thought it was important to make sure we can work that out to make sure we get the wording right. So I move L-001 to House Bill 1324. Second. Thank you. Okay. Committee members. I can tell you about it. Would you like to explain that? Well, I was going to see if they had any questions or if they approved, but go ahead. Thank you, Madam Chair. I just thought I'd tell you what L-001 does first. And in this amendment, a couple different things. The bulk of the amendment has to do with a bill that passed back in 2024, House Bill 24-13-29, which inadvertently struck some language that allowed licensing by endorsement for professional engineers, land surveyor interns, and professional land surveyors. And that language was not supposed to have been back then. So this adds it back in because these are professions that are under the division of professions and occupations, and many of those professionals have asked us to put the language back in. So that's that part. The other part has to do with, I think it was recommendation five in the report that speaks to the Legal Defense Fund. This fund was actually set up back in 1987. I want to give you a little history here, where DORA categorized this legal defense assessment as a surcharge established by rule within DORA. And this fund was set up to help the division have a mechanism and a fund to be able to defend professions as needed. And, for instance, back in fiscal year 23-24, the legal expenses for the division were around $5.2 million. As you can see, previously this fund was only $1 per professional license, and we're asking to have that fund go up to $2 because the dollar is not covering the expense. But back in 1987, they called this an excise tax on the fees well before Tabor, and it has ever since then acted like a fee and not a tax. And so this amendment actually will update that language to be in line with all these other fees that we see that go to a specific purpose to have this legal defense fund do what it's supposed to do. Otherwise, if we don't do that, this will create increased amounts of licensing fees that every professional would need to pay. And just with the economy of scale, this $1 increase in this fee will really help cover all the professions. Otherwise all the professions will have their license fees go up by potentially tens or hundreds of dollars So I wanted you all to have that background on that and understand the reasoning for calling this an additional fee on their license Thank you Any other discussion? Okay, are there any questions regarding the amendment? Any objections to the amendment? Seeing none, L001 is adopted. Do we have any other amendments? Committee, do we have any amendments? All right. Seeing none, the amendment phase is closed. Okay. Committee, would you bill sponsors like to wrap up? Any other comments? Rep. Gilchrist. Thank you, Madam Chair. I look forward, hopefully, that you all vote yes today. Also really appreciate the discussion, Representative Bradley, about the task portion of the bill. And we, as Rep. McCormick mentioned, are committed to continuing conversations and appreciate that flag. And obviously very important to move this bill forward to make sure that we can regulate the Division of Professions and Occupations and make sure that our amazing professionals around the state have the right regulations. So I hope you will vote yes today. Thank you, Representative McCormick. Thank you, Madam Chair. I agree. This is a very important division that I have depended on the whole time I've lived in Colorado, and I know a lot of other professions do as well, and we want to make sure that they are doing what we need them to do for not only the consumer protection part of this, but to make sure that our professions are held to the high standard that they are. And I move House Bill 26-13-24 as amended to the Committee of the Whole for the favorable recommendation. Second. Okay. Committee, do we have any final comments? Representative Bevin. Thank you, Madam Chair, and thank you both bill sponsors for bringing this forward. Sunsets, I don't think people understand how complicated these are to put into bill format, and I appreciate you, Rep McCormick, because although we don't see eye to eye on a lot of things, we typically have the same kind of questions regarding bills. I generally just make it principle to make sure the bill is in good format if I vote in favor of it. I appreciate it. I think that you guys will do your due diligence to make this language cleared up and clarify that. I'll be a no today just for principal, but on the floor for seconds, I'm sure we can get to a good spot. So thank you. Thank you. Committee, any further questions? Do you have a question? I've seen you getting ready. Okay. I would just like to say I would do want to see you continue on with the conversation with Mr. Conklin's concerns over it, especially when it comes to discipline. that's huge for me because of where I come from it's all about making sure the workers are in discipline and everything is done fairly and properly but I will be a yes today okay with that Mr. Shadoon you take the roll Senator Zabron no Radfield no for today English yes Hamrick Johnson Haas McCormick Yes. Wrighton. Yes. Stewart. Yes. Wook. No. Representative Johnson. No for today. Leader. Yes Madam Chair Yes That bill passes 9 to 4 You are on your way to the committee As amended you are on your way to the committee of the whole Thank you. Okay, as we shuffle things around, we're going to start on House Bill 1327. You tell me when you're ready, Representative Frey. Oh, she's ready. Representative Frey. Thank you, Madam Chair. the long-awaited bill that I've been working on. I know you all are probably tired of hearing about it and being lobbied on it, so I will do my best to summarize it for you. Over the interim, after special session, I started looking at some of the data in HICPUF around spending utilization in HICPUF. I spent about eight months studying this national and state data to try to figure out a better way to address the growing use of Medicaid members that are working part-time in these large companies. So the trends were pretty clear that there is a growing movement towards more of a part-time workforce in which these employees can utilize our Medicaid system program to get health care rather than through their employee-sponsored health care. We have seen through some of this data the retail big box stores, the private companies having large numbers of employees on Medicaid. That's not to say that some of the other industries don't have Medicaid within their employee ranks, but there is a trend in the industries around the retail associations that have more utilization than some of the others. So what we did here was I pretty much brought a brain trust together over the past eight months with the governor's office, the departments, the AG's office, CCLP, the law centers, the Colorado Fiscal Institute, Bell, provider associations, anyone I could think of, including the business lobby. And I think that's important to note because while I know that we are going to have opposition to this bill in the business industry, I really wanted to hammer home that I have spent many months trying to find a good, compromised, fair bill. I know they won't get to yes, but I feel like this approach is fair to the best that we can do within the legal capacity and with Tabor. That said, after the bill was published, we had a lot of feedback from a lot of different places, and we incorporated that into that big bill amendment, sorry, the big amendment that was circulated on Monday for you all. And that should help get and address some of the concerns that were brought up from some of the advocates. So I can talk about that in the amendment phase. With that, I know I've talked a lot with you about this bill, And so I will open up for questions, comments, concerns. Questions from the committee. Representative Bradley. Thank you, Madam Chair. And thank you, Rep. Ray, for bringing this bill. I guess my first question would be how you're going around the enterprise and how it violates the Taxpayer Bill of Rights. And then just questions about ERISA and all of the different lawsuits that have ruled in favor of ERISA Thanks Representative Frey Thank you Madam Chair And I appreciate your perspective on TABOR and your concern around that One the amendment will bring a part of that amendment will remove the cash fund overflow. So it will only be a standalone enterprise. So that was one of the concerns in the sense of we're kind of going around the 100 million enterprise cap. So that was eliminated. And so it will just be that one enterprise to hopefully address some of the concerns around that money. I understand it's not going to get you to a happy place in the sense of Tabor, and I honor and respect that, but we did hear the concern around that overflow, and that was pulled out. In terms of ERISA, over the course of, I'd say, six, five or six months, I have worked with HICPF, DOR, DOI, AG's office, GOV's office, CFI, CCLP, Bell policy, as many as I could think of to make sure that this policy was as legally sound as I could. And collectively, we think this is a legally sound approach. That can be debated. It can be debated in courts. It can be debated with lawyers. I'm sure you're going to hear that as the main concern. This has been through several iterations of what works best for what we're trying to tackle. And we believe that this will be able to stand in court. So there are different variables and approaches around ERISA and ERISA law. I am not a lawyer or an ERISA lawyer, so I'll give that disclosure. But the subject matter experts collectively have worked together to try to make it as legally sound as possible. Representative Bradley. Thank you. And thank you, Rep. Vare. We talk offline a lot, and I appreciate your stakeholding. I think that you do a good job. I was always wondering where the 2300 came from and how employers are going to identify this. And I think a big pause for me is the disabled community, now that my son is a part of it, is he goes into Walmart or Amazon disabled. Why would they hire him? This seems like a true disservice to the disability community, and that gives me grave concern. Representative Frey. Thank you, Madam Chair. This is specifically targeted to income-eligible Medicaid. So when a Medicaid member is applying at HICPF, and HICPF is here to testify if you want to get more in the weeds with them, but they submit they're either income or disabled eligible, both. So the idea here is that we are targeting the income-qualified Medicaid, so the truly lowest of income, not disabled. They are not part of that metric. The stores would never know who is on Medicaid and who isn't. So if this entire health committee is working for Target or Amazon, half of you might be on Medicaid, half of you might be on your VA health insurance, half might be on your spouse insurance. You're all part-time. There's no way for them to deduce, to know who specifically is on Medicaid. That Medicaid member is reporting to their case manager, to HICPF, their income eligibility, their employer, all of their information. So there is no information that goes back to the employer. Representative Badley, did you have an additional? No. Okay. We got one there. Representative McCormick. Thank you, Madam Chair. Thank you, Rep. Furet. I wanted to just ask about all workers working 20 or more hours each week or 80 or more hours each month, learning that there's different thresholds for part-time, to hear a little bit more about how you came up with that number, And then also learning that, for instance, Target has already set their part-time hours for when they go ahead and offer health care at 25. So curious to know if these numbers that are in the bill are negotiable to really go after a different subset if necessary. And just tell us a little bit more about how you came up with 20 hours. Representative Frey. Thank you, Madam Chair. Thank you for the question. 20 hours seemed like the fair middle ground. We know that 30 hours is when federally it kicks in. 25 is, to your point, where Target has started offering health insurance. In my conversations with businesses, I had offered, hey, if you bring it down to 25, we can adjust this bill. We can change this bill. there has been a series of options that I have given to the business lobby to find a way forward and there is no interest in finding that way forward and I understand why they don't want to move this forward and I respect that I feel and I think others in this building feel that we can't continue to operate in this way so I am certainly open for other options that will get us to change the dependency that we're seeing on this Medicaid program. And then just one last part on the $2,300. I know I didn't answer that, Rep. Bradley. It was that $2,300 is half the cost of the average Medicaid member per year. So it's about $4,600 per year per member to be on Medicaid. So I thought a fair approach would be to ask for half of that while we cover the other half. Additional questions from the committee? Okay, seeing none, we'll move on to the witness phase. Oh, she has a great... Okay, we'll bring up our first panel, Lindsay Compton, George Marlin, Casey Barrett, Amanda Boone, and Bridget Dandaroff. Anyone in person today? Oh, great. No problem. Take your time. Why don't we get started with the folks online? Lindsay Compton, could you take yourself off mute, introduce yourself and the agency or organization that you represent? You have two minutes. Thank you very much, Madam Chair. My name is Lindsay Compton. I'm a general dentist, and I own and operate my own practice in Arvada, Colorado. I am speaking in favor of House Bill 1327. I want to thank Representatives Ferre and Millica for bringing up this very important issue. As a business owner and employer, and yet also a provider, I see tremendous value in this bill. Every day I see the discrepancy in coverage between private pay or employee-sponsored dental plans versus state-sponsored or Medicaid dental plans. With the exception of one year, reimbursements continue to decrease and my patients struggle to get the care that they need. The more and more lives that are added to this already stretched Medicaid program, the less and less patients actually receive in care. Further every year fewer and fewer of my colleagues and providers sign up to be providers in this population This is definitely a strained system As an employer I see value in offering meaningful benefits to my employees By forcing employees to be on state programs and not providing meaningful benefits, you're not making Coloradans healthier. You're actually choosing corporate profits over Coloradans' meaningful care. So I do urge you to choose Coloradans and not corporate profits. Thank you. Thank you for your testimony. We'll move on to Amanda Boone. Hello, good afternoon, and thank you so much for letting us speak today and having the time to go over this important legislation. I am the co-founder of a grassroots organization called TF United, and I represent rare disease patients and patients with cystic fibrosis. We are dedicated to improving access to medications and therapies for individuals with rare diseases, and we are in support of HB 26, 1327. Many of the patients we serve in Colorado are living with disabilities, and we rely on Medicaid. Many of our patients are also children. Given the current state budget deficit and ongoing cuts to Medicaid, this issue has become increasingly urgent. We have already been seeing cuts to Medicaid for the past couple of years, not just right now. And we're honestly terrified of what's to come in the trends that are deeply disturbing from the federal and state budget cuts. We have participated in public comment in the past couple of years and actually talked to many of you up at the Capitol regarding joint budget committee meetings. And we have consistently asked an urge to protect Medicaid. We appreciate Senator Mullica and Representative Paray putting together this creative solution, and we also wanted to commend the ingenuity of addressing this challenge. HB 1327 is a timely and balanced solution, and it encourages large employers to either provide affordable health insurance or contribute to the cost of care their workers receive through Medicaid. We believe it is a practical and reasonable approach to protecting Medicaid funding, and we believe that it will stabilize coverage, protect vulnerable populations, and support the health care system during a period of constrained public resources. Thank you for hearing me say, and I hope that you go yes. Thank you for your testimony. We'll move on to George Marlin. Thank you. Good afternoon, Chair and members of the committee. My name is George Marlin, a Clear Creek County Commissioner, speaking on behalf of counties and commissioners acting together, as well as my constituents who cannot afford the healthcare system we have today, let alone the one we will have when the impacts of H.R.1, Medicaid changes, Obamacare divestment, and reduced reimbursement rates are fully realized. CCAT, made up of urban and rural counties that collectively govern more than half the state's population, supports this bill as a crucial step in rebuilding our health care system after these attacks from the Trump administration and Congress, as well as a response to increased Medicaid expenses at the state level. CCAT has a long history of engagement in health care policy, including the 2019 reinsurance program and the public option. This is because counties sit at the center of the complex impacts of a failing medical system. As employers who do pay health insurance, our employees are strained under the cost growth that far exceeds growth caps. As case managers for people who seek Medicaid, often while employed, we see the impact when doctors begin to refuse new Medicaid patients. We are preparing furiously in collaboration with the state for a new red tape reality in which a mistake on someone paperwork can render them ineligible Counties also manage public health departments and EMS where we do our best to serve people who cannot afford any other option than seeking a public health nurse or emergency health care. Some of our members have even stood up hospitals in rural areas where only county support can guarantee any medical access at all. Counties have this constant feed of information from so many aspects of our healthcare systems. All of them are currently flashing red. We support this bill as the only solution that can give our healthcare system a chance on a timeline that can make a difference in the lives of our constituents and our employees. Thank you for your time. Please vote yes. And I welcome any questions. Thank you so much for your testimony. We'll move on to Bridget Dardawa-Sarrett. Hi, my name is Bridget Dardawa-Sarrett, and I am with Advocates for Compassionate Therapy Now and the Colorado Rare Disease Coalition, we wholeheartedly support this bill. When speaking with my constituents in my community about this bill, I was horrified to realize that Walmart actually uses Medicaid paperwork, the application process as part of their onboarding. And here we are facing cuts with HCBS, massive cuts that threaten to put our community of severely disabled intellectually and developmentally disabled adults into homelessness or a place where they are losing services. I'm going to strongly urge this committee to vote yes on this bill because Medicaid right now is not sustainable as it is. We cannot afford to be subsidizing billion-dollar multinational corporations instead of subsidizing home and community-based services. I'm asking you to please don't send a message that billion-dollar multinational corporations are more important than the severely disabled Coloradans who utilize Medicaid every day. Thank you, and please vote yes on this bill. Thank you. We'll move in person. If you could introduce yourself, the organization you represent, and you have two minutes. And if you can just push the button. Wonderful. Yeah, that went pretty good. You're all good. Thank you. Thank you, Madam Chair and members of the committee. My name is Casey Barrett. This is my daughter, Olivia. I'm a single father and caregiver to her. She receives services through Medicaid waivers and requires near continuous care. I am here in support of HB 26-1327 because strengthening Medicaid funding and supporting providers is critical for families like mine. As you all are aware, obviously, if you were living under a rock, you wouldn't know, but the state is facing a significant budget deficit. And the Joint Budget Committee has been very clear about how difficult the decisions ahead will be. That makes it even more important to look at where funding can be responsibly generated to protect essential services. This bill recognizes that Medicaid is currently absorbing costs that, in many cases, are being shifted from large employers onto the state. Addressing that helps stabilize the system without cutting care. For families like mine, the challenge is not just funding. It's whether authorized care can actually be delivered in a workforce that does not currently exist. when care breaks down at home the result is often hospitalization or higher cost care which ultimately increases pressure on medicaid system supporting medicaid means not only funding it but ensuring that care can be delivered safely and consistently thank you for your time And I representing myself Thank you so much for your testimony today Questions from the committee Representative Bradley. Thank you, Mr. Bearer. You and I connected via email not too long ago about HICPAF's SMART Act hearing presentation. My question for you is Medicaid was never intended to be entitlement. It was meant to be a swing, not a hammock. And it was supposed to go to the disabled, the elderly, poor, and pregnant women. But we have expanded that net, and now we're in a financial crisis. So for me, it's based on policy not to put the responsibility on big business in the state of Colorado since we're the sixth most regulated state. So I was wondering if you would talk a little bit more about policy decisions that have affected your ability to get those services. Mr. Barrett. Thank you, Madam Chair. And thank you, Rep. Bradley, for that question. Yeah, the expansion has definitely changed a lot. I think we've seen after COVID, there was very little oversight on a lot of different aspects of Medicaid. We saw a lot of agencies that were essentially committing fraud in a sense. Representative Taggart said it the other day in the JBC meeting about how a family walked up to him and showed him an email that he'd received from an agency that said, we can get you $100,000 to take care of your kid without ever evaluating their kid. And obviously, I believe that those things have definitely caused a lot of our problems on that. I think that there can be a lot of policy for more oversight in HickPuff and the agencies and the people within the Medicaid system. as far as the big business is concerned I think that it's just I think the bill is a good idea because we aren't finding other ideas I think Rep Frey had said it I think everybody is probably open to any kind of ideas I met with Rep Brown a couple months ago when he was doing a town hall at a coffee shop and he was very adamant about the fact that we are looking everywhere you all are looking everywhere for alternatives and I think that because we have found one I think it's a good idea to move forward because we don't currently have anything to sustain what is happening. And if we go forward with all the cuts that are happening, it's going to destabilize a lot of the system. Additional, Representative Bradley, a follow-up? No, just a different question to Dr. Compton. You're a small business owner, so I guess my question would be, why do you feel like businesses need to pay for this? if we were asking you to pay for your employees, would you be willing to do that? Ms. Compton. So your question was if I'd be willing to pay for a health plan for my employees? Representative Bradley says yes. Yes, absolutely. 100%. I've actually even put in place QSERAs. I've done everything I can. I've done reimbursements, if their spouse's health plan doesn't cover everything, because I care that they get meaningful benefits and they get the care that they can provide and that it's the highest quality of care. Representative Beth. Thank you, Madam Chair, and thank you for that answer, but you weren't mandated to do it, correct? You did it out of the kindness of your heart. No, there is no mandate because I only have three employees, and I am just a small business employer in Arvada, but I want my employees to have a good quality of life. Representative Bradfield. Thank you, Madam Chair. The question is for you. How has the HICPA if a restriction on home care affected you and your family? Mr. Barrett. Thank you, Madam Chair, and thank you, Representative Bradfield. Currently, we haven't seen a lot of those changes, but the ones that are being proposed and have passed so far would be detrimental. We're looking at, you know, with the 56-hour cap that's being proposed, that would cut my personal income in half. right now her older brother is my extra caregiver he's 20 and he's in his second year of college so at some point he will be leaving and if that cap was to go into place I would need to find two extra caregivers to come into my home and take care of her so that is just one of the many propositions that are being put forward right now I know the age-based calculator has got a lot of the people up in arms about that. But for me, I'm not as concerned because I'm a very small minority where my daughter is almost 24-7 care. The other part of the 56-hour CAF right now is that the exception process is abysmal, to be honest with you. Right now, it's meant to be only temporary. and the description was you can have an exemption if you are remedying the exemption. And when it comes to kiddos like my daughter, and this applies to the adult side as well, she's not going to get better. There's no remedy for her. So the fact that as a single parent, I can't give that care for her beyond that 56 hours is, it feels really dumb. and that other caregivers who might have two members in their household that they can care for can still get maxed out at 112 hours because they can give 56 to each one of them. But I'm still limited to just 56 with her. It doesn't make sense to me in a lot of aspects because of the way it's financially put out there. And it shouldn't really matter who's taking care of her as long as she's being taken care of. And I feel like the parent should have the or the guardian or whomever is in charge of that care should be should be able to make that choice and shouldn't have to bring in extra caregivers that. Quite frankly, I don't know. Additional questions in the committee. OK, seeing none. Thank you all so much for testifying today and thank you for being in person. Thank you. Appreciate it. OK, with that, we'll move on to our next panel. Can we bring up Parker White, Katie Wolf, Megan Dollar, Trey Rogers? Looks like Parker White's on here twice. Anybody on the line? Oh, here it comes. She's probably upstairs. Okay, we'll start from my left to my right. If you can introduce yourself, the organization you represent, and you have two minutes. It's actually right next to the plug. There it is. There you go. Thank you. Madam Chair, committee members, my name is Trey Rogers. I'm here on behalf of the Colorado Retail Council. I'm a lawyer with the Rhett Kornfeld Law Firm here in Denver. I've been in private practice in Colorado for 29 years with the exception of the three and a half years that I served as Governor Ritter chief legal counsel When I worked for the governor and since I was involved in drafting legislation and defending state statutes that others alleged violated Tabor In every one of those cases, I was for the state and defended those statutes. That's why it's a little strange that I'm here today testifying against 1327 and testifying to you that it violates Tabor and is preempted by ERISA. I do so because if this bill passes and if the courts strike it down, that will strike a blow to the General Assembly's ability to use enterprises and fund enterprises to deal with some of our fiscal problems. With that, I want to get into the reasons that I think the bill violates ERISA and TABOR. First, with regard to ERISA, 1327 is intended to force large employers to provide health care to employees, part-time employees, or face paying a penalty to the state. Other jurisdictions have enacted similar legislation. The courts have looked at this issue, and they have found that bills like this violate ERISA. most prominently is a Fourth Circuit case in which a Maryland law required either the payment of health care benefits at 8% of the employee's salary or paying a fee to the state. And when the Fourth Circuit looked at that case, they said, look, that's not a meaningful choice for an employer. What this bill really does is forces the employer to provide health care benefits, and that violates herissa. That is inconsistent with herissa, and that's preempted by federal law. If you pass this bill, the result undoubtedly will be that our courts will strike it down as preempted by federal law. Let me move on to Tabor. The bill violates Tabor in three ways. First, this bill does not provide for a fee. It provides for a tax. The reason we know that is that the fee would be used to pay for Medicaid expenses, and that is a general fund obligation in Colorado. I see I'm out of time, happy to answer questions. There are a couple of other reasons that I think the bill violates Tabor. Thanks. Thank you so much for your testimony. Please proceed. Thank you, Madam Chair and members of the committee. My name is Katie Wolf, and I'm here on behalf of the Colorado Retail Council in opposition to House Bill 1327. The Colorado Retail Council represent retailers across the state, including grocery stores, pharmacies, convenience stores, online retailers, and nationally and locally owned businesses that serve millions of Colorado consumers every day. Medicaid costs are rising, and the state faces a real funding gap, but HB 1327 doesn't solve that problem. It shifts the cost of a public policy choice onto a handful of private employers while exempting everyone else. Publications across the state have also been consistently covering the program's mismanagement. This bill doesn't ask large employers to contribute to Medicaid. It's a penalty tax that asks them to subsidize the cost of coverage. They have no role in designing. The exemptions make the inequity impossible to defend. A corporate retailer pays a fee. A franchise operator running 20 locations across the Denver metro area, same workforce, same wage structure, potentially more Medicaid-enrolled workers pays nothing. At least one Colorado-founded company is on the target list. The corporate franchise down the street is not. We're not drawing lines based on behavior or ability to pay. We're drawing lines based on corporate structure and politics, and we're putting yet another burden on business. The revenue of this bill claims to raise is roughly $85 million per year. According to the latest fiscal note, Colorado's Medicaid shortfalls measured in billions. This is not a solution. It's a band-aid that doesn't fix the systematic problems. One other consideration is that employers cannot and should not ask workers whether they are on Medicaid. Medicaid forms include only an optional employment question that is updated when workers change jobs you are proposing to levy a financial penalty on companies based on things they cannot see cannot verify and cannot contest until after the bill arise. This raises due process concerns and creates administrative burdens without clear accountability. Washington state introduced this bill this year and dropped it. Oregon had a bill and they turned it into a study and it effectively died on the calendar. Maryland had a similar version of this bill. It was overturned by the courts. No state has enacted anything at this scale, not that it's lack of ambition it's because every state has looked at it closely and found the same problems we are raising today the retail council is not here to simply say no give us a real seat at the table and we'll continue to help address the problem thank you thank you so much for your testimony please proceed thank you madam chair members of the committee my name is megan dollar i'm here on behalf of the colorado chamber of commerce um we are in opposition to house bill 26 13 27 we represent thousands of businesses of all sizes across the state as well as over 80 local chambers of commerce. Our opposed position was taken by our Labor and Employment Council made up of experts in this issue area. Feeing, or in this case, taxing Colorado businesses is not the way to solve Colorado's budget crisis or the problems with Medicaid like fraud and mismanagement. HB 1327 would add between $15 million and $100 million annually in new cost to businesses in Colorado. That means higher prices for families, fewer investments, and in many cases, business closures or relocation out of Colorado. I am not being hyperbolic here. We have data on this. Companies are already leaving the state, even without Colorado being the only state in the nation with a fee or tax for employers to pay for Medicaid. Perhaps most importantly, HB 1327 is likely illegal and unworkable. Federal law strictly governs Medicaid funding, and this proposal raises serious concerns under federal preemption and ERISA. And you've certainly heard about that already. It also asks employers to track information they cannot legally access, such as Medicaid status tied to private household and health data. Colorado needs real solutions, not policies that cost jobs, raise prices, and create legal uncertainty here in Colorado for businesses. Thank you so much. Please proceed. Thank you, Madam Chair, members of the committee. My name is Parker White, and I represent the Colorado Competitive Council and the Denver Metro Chamber of Commerce. I am here today in opposition to House Bill 26-13-27. First, I want to thank Representative Foray for sincere outreach throughout this process. Our primary concern with this bill is that its definitions are simply too broad and too unclear. As written, the bill does not adequately protect employers from decisions that are ultimately made by employees themselves. For example, if an employee chooses to opt out of employer-sponsored health care coverage, even when that coverage is offered, the employer could still be exposed to consequences under this framework. That creates a level of uncertainty that businesses can't reasonably plan around. The bill also lacks clear definitions of who is covered and what compliance actually looks like. It does not clearly define what types of employees are included, the extent to which employers would be responsible for contractors, how, excuse me, employers would be responsible for contractors, how coverage standards would be applied across different employment structures, or what constitutes adequate coverage. And stepping back, it's important to recognize that employers and employees are already major, excuse me, employers are already major contributors to Colorado's health care system. The majority of Coloradans receive coverage through employer-sponsored plans, and businesses help fund programs like the health insurance affordability enterprise, while also paying taxes that support Medicaid. Asking employers to take on additional undefined responsibilities without clear standards adds to growing concerns about Colorado economic competitiveness As you heard throughout this session and even on this panel Colorado 46th in the nation this year for employment growth Policies that drive up costs for employers are policies that mean less jobs, less raises, and lower benefits packages for Colorado's workers. We appreciate Representative Frey's engagement on this, but C3 and the Denver Metro Chamber must remain opposed. We remain committed to working as thoughtful partners to develop solutions that expand health care access throughout the state, while providing the clarity and fairness that employers need to operate with confidence. Unfortunately, House Bill 26-13-27 is not that solution. Thank you. Thank you so much for your testimony. Representative Brun. Thank you, Madam Chair. So TABOR is very important in my district. So, Mr. Rogers, can you continue on your points of TABOR? Mr. Rogers. Thank you, Representative. So I covered the first way in which the bill would violate TABOR, and that is because the bill raises revenue to cover a general fund obligation, that is Medicaid, it is a tax, not a fee. The second reason it violates TABOR is that there must be, to have an enterprise, to have a government-owned business, there has to be a nexus between the payer of the fee and the benefit received. So, for instance, when I buy a hunting or fishing license, that money goes to enhance hunting and fishing in Colorado. So that's the kind of nexus that the courts are looking for. Or when I pay my faster registration fee, that goes to build safer bridges in Colorado, which I then get to use. That nexus is absent here. The employer pays the fee, but that fee doesn't go to provide health care to that employer or the employer's employees. It goes again to a general fund obligation that helps defray the cost of Medicaid for everyone covered by Medicaid on the income basis in Colorado. And the third reason is a government-owned business, an enterprise, typically enters into kind of an arm's length or typically a voluntary transaction. Not always voluntary. but this bill imposes the fee. And not only that, but the bill would make it a petty offense to fail to comply with the provisions of the bill. So it's not, this isn't an arm's length business transaction. This is a coercive bill that requires the payment under penalty of a violation of law. And so that's, that is more like the taxing power that the state has and less like the, the transaction that an enterprise can enter into with, with a citizen in the case of faster safety, or in the case of a hunting or fishing license. Representative Badfield. Thank you, Madam Chair. And this question is for Mr. Rogers. You mentioned the Fourth Circuit Court. Does that apply to Colorado, or where is that relevant? Thank you, Representative. Mr. Rogers. Colorado is not within the Fourth Circuit. We're within the Tenth Circuit. but the Fourth Circuit and the Tenth Circuit are appellate courts in the federal system. Those are one level below the United States Supreme Court. The Tenth Circuit, neither the Tenth Circuit nor that I could find any district court within the Tenth Circuit, has considered a case like this. And so the courts would, Colorado District Court or the Tenth Circuit, would look for authority from other appellate courts. In this case, the Fourth Circuit is that I could find the only federal appellate court that has dealt with an issue like this one. There are some similar cases, but the most on point is this Fourth Circuit case. So it would be very good, but not binding authority on our cards. Thank you. Representative McCormick. Thank you. Thank you, Madam Chair. My question is also for Mr. Rogers. I was listening to you talk about the fee being a tax, but it was my understanding that if an employer pays this fee into the enterprise, it's not going into the general fund directly to pay Medicaid, the whole services. It's going to be allocated after the decision of the board that's set up to oversee this fund to go directly to Medicaid providers out there in the field so that in a way it seems to be tied to the fact that the employer pays the fee in defense of this person getting health care and that money goes directly to providers that are providing health care. Granted, we're not going to know exactly which individuals are getting what, but again, I can argue that it seems to act more like a fee and that there is a direct nexus there. So I wanted you to just go into that a little bit further. Mr. Rogers. Thank you, Representative. So you're right that it doesn't go into the general fund, But in Colorado, Medicaid is largely a general fund obligation. And so whether the money is going to – I mean, all Medicaid dollars go to providers, essentially. And so when that money is collected from employers and then it is used to satisfy the state's obligations to provide Medicaid, it's essentially taking on a general fund obligation. Even though it doesn't pass through the general fund, it passes through an enterprise, it's still a general fund obligation. And again, it's not benefiting that employer who has paid the fee. It's benefiting the state and the state taxpayers generally who would otherwise be on the hook for covering those Medicaid expenses. Representative Bradley. Thank you. The other questions were asked, so I'm going to aim mine at the chamber. I just looked up last year 12,000 jobs moved out of Colorado. The net migration has dropped over 50% in the last decade. 12,000 jobs is equivalent to about $720 million to $900 million a year in lost economy. Total economic loss is $1.1 billion to $1.8 billion per year. Lost tax revenue is $60 million to $120 million per year. So I wanted you to talk about that, but I also wanted you to talk about if businesses don't leave, it just means they're going to raise prices to consumers. And for people who are barely struggling, especially in underserved areas, who can barely afford their groceries at stores like Walmart and stuff, They're just going to raise their prices. And to be quite honest, what I would do if I was a retailer is I just wouldn't offer part-time positions anymore. Ms. Dollar. Thank you, Madam Chair. Thank you, Representative Bradley, for the question. You know, look, I can't speculate on what exactly each individual company is going to do if this bill is passed. But what I can speculate on is what we know, which is exactly what you said, Representative. We are very low when it comes to – or excuse me, very high when it comes to the cost of business in Colorado compared to other states. We're in the top 10 in how expensive we are. Certainly 47th with cost of living generally compared to other states as well. And we know that based on laws that have already passed that companies are leaving Colorado and that is affecting jobs per what you referenced. So that would be my answer to the question but I happy to perhaps get more specifics if it helpful after this Representative Bradley Thank you I like you to speak on the fact that if businesses don leave what they will do and I think the retail council can say it too when theft goes up in our state, then consumers pay the consequences of said theft because the retailers have to adjust their loss in profit. So what does that mean for all the consumers in our districts? Ms. Wolfe. so i think that thank you representative and thank you madam chair and representative bradley for the question i think that what we see then is increase in prices because there is time spent from employees having to report those crimes um and there are you know additional costs with making up for that loss and then you know that reduces the number of available jobs additional questions from the committee Vice Chair Leader Thank you Madam Chair So I believe And this could probably be for Mr. Rogers But anybody can take it I believe Vermont has this Same type of bill that they've had it for over A decade Has anyone successfully challenged that law Mr. Rogers Thank you Representative for the question Not that I'm aware of I did a pretty deep dive on where this issue has been litigated And I did not see any litigation in Vermont So maybe I ought to call some buddies up there and see if they want to take that on. Not yet, though. Thanks. It's been a decade. Thank you. Additional questions from the committee? Okay. Seeing none, thank you so much for your participation today. We appreciate it. Okay. We'll move on to our next panel. Ms. Adele Flores-Brennan Josh Penns Christina Mantley and Alicia Folsom and then I think we have one more Christina, oh I'm sorry, never mind I called her, we're good oh nobody's here we'll wait for folks to get online okay well um we're bringing those folks up um we could start with uh ms flores brennan if you could introduce yourself the organization you represent and you have two minutes Thank you, Madam Chair and members of the committee. My name is Adela Flores Brennan. I am the Medicaid Director at the Department of Healthcare Policy and Financing. I'm here on behalf of the department to support House Bill 26-13-27 with amendments. Colorado's Medicaid program covers more than one in four Coloradans. It's a significant share of those enrollees who are working adults, people employed full-time or part-time by large employers, who do not offer affordable health coverage. Research from the Kaiser Family Foundation consistently shows that low-wage workers at large employers are among the most likely to rely on public coverage, not because they are outside of the workforce, but because their employment does not come with health benefits. This bill recognizes that reality and creates a mechanism for large employers to share the cost of coverage their workers depend on, and HICPF does support that principle. This is not a novel approach. Several states have explored employer contribution models as a tool for Medicaid sustainability, and the policy rationale is sound. When large employers benefit from a publicly subsidized healthy workforce a cost structure is a reasonable and fair response to that dynamic At a time when Colorado faces significant Medicaid budget pressures this bill represents a meaningful step toward putting the program on a more sustainable footing. HICPF has been closely collaborating with the bill's sponsors and the governor's office throughout this bill's development. We are actively working on amendments to address two implementation areas that need to be resolved. First, we seek changes to ensure the new enterprise is structured within HICPF appropriately. And then second, we seek amendments to ensure that HICPF and the enterprise are armed with the right data to conduct the analysis completely in a way that gives the enterprise the information it needs to accurately identify large employers and calculate supported workers. HICPF supports the direction of this bill, and we look forward to its passage with amendments, and I thank you. Thank you for your testimony. We'll move on to Christina Manthe. Thank you, Madam Chairman. My name is Christina Manthe, and I'm a volunteer lobbyist with the League of Women Voters of Colorado. I am here to support House Bill 26-1327 on behalf of the League. For 106 years, the League of Women Voters, as a nonpartisan organization, has encouraged informed and active participation in government and influences public policy through education and advocacy. The League believes that a basic level of quality health care at an affordable price should be available to all U.S. citizens. The League supports social and economic incentives that encourage the development of cost-effective ways of delivering and paying for health care. In this country, we have chosen to have health care provided through our employers. While this is not a league goal, it is the system in place. This system allows employers to establish criteria for benefit eligibility. Large employers manipulate their employees' hours so that employees are ineligible for the benefits, particularly health care. These employees are now forced into public assistance for health care and become a social societal burden. Under the present law, there is no consequence to the employers for these actions. The harm to the public health care system is significant because of the volume of employees involved. House Bill 26-1327 attempts to address the burden placed on society. Large employers will be required to make payments to an enterprise fund to lower the state burden of providing health care for employees who work at least 20 hours a week. The League of Women Voters supports House Bill 26-1327 for its innovative way to encourage the provision of health care to workers. We urge you to vote yes on House Bill 26-1327. Thank you so much for your testimony. We'll move on to Josh Pence. Thank you, Madam Chair, members of the committee. I'm Josh Pence, Director of Tax Policy for the Department of Revenue, and I'm here to answer any of the committee's questions. Thank you so much. questions for this panel? Okay. Seeing no additional questions, thank you so much for your testimony. We appreciate you being here today. Is there anyone in the room or online that would like to testify that has not already come up? Okay. With that, witness testimony is closed. Representative Frey. Thank you, Madam Chair. I do have one amendment, and I move L001 to House Bill 1327. Second. By chair leader seconds. Representative Frey, would you like to describe your amendment? Sure. So this amendment tackled a couple of issues. Not issues but concerns and this is from a variety of people So one of them it adjusts languages for data sharing adjusts language to ensure funds are more targeted to the large employers as you heard in the opposition It removes independent contractors. It requires employers to give data to the enterprise so they can help with comparison on some of the behavioral trends so people wouldn't all switch to 1099 workers or subcontracted workers. and then it also removes the overflow process of the extra funds collected and I ask for a yes vote. Any questions on this amendment? Any objections to this amendment? Okay, with that, L001 passes. Representative Frey, any additional amendments? No. Any amendments from the committee? Seeing none, the amendment phase is closed. Representative Frey, would you like to wrap up? Thank you, Madam Chair. I appreciate everyone that came to testify. I appreciate the opposition being cordial in the way that they were presenting as well. It's a little sad to hear them wanting to get to yes, but then not working throughout those months to get to a better place with me. So I hope that moving forward we can pass this and continue to have conversations to get to a better spot. And I'm happy to continue to talk with you all. I urge your support. This is a new approach, a new way to tackle an issue, and I think we're on the right track, and I know that there are some tweaks, but I hope we can continue to have those conversations and build it out to be a stronger bill as it moves forward. Thank you, Representative Frey. Would you like to move your bill to your Committee on Finance? Thank you. I move House Bill 26-13-27 as amended to the Committee on Finance. Second. Vice Chair Leader seconds. Additional closing comments from the committee. Representative McCormick. Thank you, Madam Chair. Thank you, Representative Foray. I just want to have this bill move forward today because I appreciate your innovative approach and I think this is an important conversation to have. It draws attention to a problem. Not sure if this is exactly the right way to solve it, but again, I applaud you for all of your effort and all of your work, and I just like the thinking outside the box. So I appreciate you. Additional closing comments from the committee. Vice Chair Leader. Is she going to have me? I don't think so. Do you have a comment? Oh, Representative Bradley. Thank you Madam Chair She likes me, she does Thank you for bringing this bill forward I appreciate you do stay cold And I enjoy sitting in front of you so we can talk through all of these things Back and forth and I appreciate what you are trying to do For the people of Colorado, I do, I think your heart is pure And genuine on the policies we're both trying to bring forward I don't believe it should come at the expense to businesses. And so you and I have already talked. I'm not going to go over what I feel that this is violating Tabor and this is going to be a legal issue. And I'm worried that our state will be sued because of it. We've already had those conversations. So today I'll be a no. Thank you. Vice Chair Leader. Thank you, Madam Chair. I want to thank you for bringing this bill. I think this is something I've thought of for a very long time. in regards to why this isn't done. It hasn't been done sooner when they sit there. And I know people who work at the big box stores, and this is exactly what they do. They do give them stuff that says, here's how you can go on Medicaid at the expense of our tax dollars. I think they need to pay their fair share. They make billions and billions of dollars. I think the explanation they gave about the Tabor and the enterprise, I think that's a stretch. So that's, in my opinion, I fought against Tabor in, I think it was 1992. So I believe that's a stretch. I think this is a great bill, and I know how you have worked diligently and so hard all summer long. I'm a sponsor, a co-prime priority introduction, and I will definitely be a yes. And thank you for all of the testimony here and for coming here to support the bill. Thank you. Representative Batfield. Thank you, Madam Chair. And Representative Ferreira, I too want to thank you for the hours and hours of work on this bill. it shows your stake holding and careful thought about everything. However, it's an enterprise, just like you said, and so I will be a respectful no. Thank you. Representative Johnson. Thank you, Madam Chair. No, and thank you for your passion behind the sponsor. I do want to just make it for the record that our great colleague is on his way less than two minutes away who does want to vote I also want to make the notes on this when we're looking I appreciate your ongoing conversations on this that we've talked about in the interim ongoing you brought this long bill a long amendment process forth I understand this is a very hard thing to do I know when we were we had a question on the committee about Let me pull it up. So I'm trying to see where. But we had, you know, questions if this is legal to put extra fees. How do you regulate, you know, who has Medicaid, who doesn't? Looking, you know, the question that was mentioned on Vermont requiring large employers to pay a fee for each of the large employers' employees on Medicaid. The answer is, Remark does not require large employers to pay a fee for each of their employees enrolled in Medicaid. The state has a health care fund contribution, HCFCA, that applies to employers with more than four full-time equivalent FTE employees who lack qualifying health coverage. This assessment is based on the number of hours worked by FTE, uncovered employees, and does not apply to employees enrolled in Medicaid or health insurance purchased through the state's exchange. employers must contribute toward the cost of the coverage, but they are not penalized for not providing group health insurance. And so when we heard that mentioned, I just wanted to clear that aspect up. And I will be a respectful now. Thank you, Representative Frey, for bringing the bill. Really appreciate your efforts in this process in bringing business to the table. I also really appreciated the discussion around the legality of the proposed bill. Also, you know, I think, as you just mentioned in some of your descriptions about the amendments, I also appreciated the focus on trying to find ways that there aren't unintended consequences, and that your commitment to continue to work, to tweak things to get the best possible policy. So really appreciate your work on this. And with that we will Mr Shudun could you please call the roll Representative what on Respectful no Redfield No Bradley No English Yes. Frey? Yes. Hamrick? Yes. Johnson? No. McCormick? Yes. Bryden? Yes. Stewart? Yes. Wook? Very respectfully, no. Leader? Absolutely, yes. Madam Chair? Yes. The bill passes 8 to 5. You're on your way to the Committee on Finance. Okay, we will move on to House Bill 1092. Sponsors. Thanks for hanging with us. Okay, well, she's waiting to do that. Thank you. Thank you. Okay, Representative Luck, we're ready for you. Thank you. Thank you Representative Luck Representative Wilford Thank you very much, Madam Chair. Good afternoon, Health and Human Services Committee. I am honored to be bringing House Bill 1092 with my colleague today. This is, it's funny sometimes how bills work in this building, and you find colleagues that are diametrically opposed on so many issues find common ground on other issues. And I'm delighted that this bill in particular was one of those one of those happy happenstances, circumstances, whatever. But I want to start off with introducing this bill by telling you all, oh, after I take my picture. Thank you. Okay, now for real. But I want to start off by telling you all a little bit about my best friend. She started her career as a newspaper photographer. And she spent years telling other people's stories. And after she had her first child, she became a birth photographer. And after witnessing so many births over and over again, she saw something that changed her. She saw how much the experience of a person who was birthing depended upon who was in the room, who knew you, who understood your preferences, who could advocate for you when things didn't go to plan. So she became a midwife. When I was pregnant with my daughter, she was my doula, and honestly, it made all the difference. Before I ever stepped into a delivery room, we had already talked through my preferences, my fears, what I wanted, if things changed. She knows me. She had been part of my pregnancy from the very beginning, and when things got intense, I didn't have to explain myself. I had someone there who could help navigate my options in real time. That experience, that continuity of care is exactly what this bill is about. Because right now that continuity can disappear the moment someone needs a higher level of care. If a person plans a birth in the community and then needs pain management or a higher level of care, they're transferred to a hospital where their provider may or may not allow them to continue to receiving care or consultation with their original provider, who could be a midwife. Not because midwives aren't qualified, not because they're not trained, because they are. They are also licensed healthcare professionals, but because they couldn't get a physician to sign a piece of paper. That is the system that we have today, a system where private physicians can effectively decide who is allowed to practice in the hospital, even when that provider meets every credentialing and competency standard. Members, that's not safety. That is gatekeeping. And it has very real consequences. It means that patients are handed off to someone they've never met in the most vulnerable moments of their lives. It means care gets fragmented when coordination matters the most. And in rural communities it means fewer options entirely This bill simply requires and I should back up and say we have worked very hard to hear from stakeholders to take their feedback and to integrate it as much as possible into our bill. There were amendments that were offered that would entirely gut our bill, or that would basically put the existing practice that many hospitals use into statute. And we felt like that would set our bill back and set the relationship with OBGYNs and midwives backwards. And so we did not take those amendments. But we did decide to move forward with three amendments, which I'll let my co-prime walk through in just a moment in order to be collaborative and to find a path forward. And this bill simply requires public hospitals that offer obstetric services to have a fair and transparent process for midwives to apply for privileges based on their credentials. That's it. Hospitals still get to decide who gets privileges. they can still enforce their standards and nothing about scope of practice changes. But we remove a barrier that has nothing to do with competency and everything to do about control. So with that, I will say thank you in advance for your questions, for your willingness to consider this legislation, and for hopefully voting yes at the conclusion of this presentation. Representative Luck. Thank you, Madam Chair, and thank you, Committee. I'd ask that the Committee do me a favor and set aside everything you've heard about this bill, because there's been a lot of confusion about what this bill is designed to do and what it actually does. And so I want you to hear from us what we are trying to accomplish. There are amendments that, in essence, rewrite the substantive part of the bill to reframe what we are trying to accomplish. Words are tricky things. And what one person means with a set of words, another person receives as the exact opposite. And I think that took place with respect to this bill. When we first sat down with stakeholders, they were saying, but this is going to allow a midwife to come to the hospital door and demand to serve their patient in one of the beds. We don't even know who those midwives are. We don't know anything about them. And I think both Rep. Wilford and I looked around the table and were a bit perplexed because that wasn't in any way what we had envisioned with this policy. It was never about giving a random midwife the opportunity to come to the hospital door and demand to treat their patient in a room. It was never about that. What it is about is allowing for midwives to access hospital privileges in a way similar to obstetricians and gynecologists. Already under law, midwives have the authority to ask for admitting privileges. That's already been... Is everything okay? Okay. Okay. They already have the authority to ask for admitting privileges. We're not giving that to them. They can already pursue that from hospitals. They also can already practice independently. They already have that right as well. And so they have at law these rights to be able to come into the hospital and treat their patients. Those conversations have already taken place in this building. What they find, though, is that when they try to exercise those rights, barriers are put up against them, not because of competency, not because of legitimate reasons that the hospital has in their view, but simply as protectionist barriers, as a discrimination against their license type. Because they chose the route of midwife and not the route of an OB, they are seen as not capable of then operating in that space. Now it's curious because some places like Denver Health don't see it that way at all. They actually have a model where they have a department of OBs and a department of midwives. And women who are seeking care from their facility can access either based off of their own personal preference, the preference of the woman. Do they support an OB model or do they support a midwife model? And the midwives at Denver Health are not required to be under the authority of the OB department. They operate as practitioners, wholly independent, like the law allows them to do. And at that point where their scope of practice is reaching its end, they can transfer that care over to the OB. We think that's a beautiful model, and we just believe that public hospitals should provide some mechanism to create that within their own facilities. You will note that this bill requires three prongs to be met for a hospital to be subject to this. First of all, they have to be a public health facility. It's not a private health facility. That decision was made for a couple of reasons. One, as the drafter of this bill, I cannot support the idea of it applying to private hospitals because of my own political understandings of the rights of association for the government to step in. That's my own quirk, so to speak. Two, because as a government entity, you do have a higher responsibility under law to provide certain services and rights. So as a government entity, you are considered a state actor. And as a state actor, you cannot infringe upon associational rights. And in Colorado, because Colorado has acknowledged a fundamental right to reproductive health care. If you look in the statutes, you will note that section 256403 says that every individual has a fundamental right to make decisions about that individual's reproductive health care, and that a pregnant individual has a fundamental right to continue a pregnancy and give birth and to make decisions about how to exercise that right. That particular right, the right of reproductive health care, is defined in statute under 25.64024 to mean health care and other medical services related to the reproductive processes, functions, and systems at all stages of life. It includes but is not limited to prenatal postnatal and delivery care Further under that same section 256 a public entity which is what these hospitals are shall not it very clear shall not deny restrict interfere with or discriminate against an individual's fundamental right to give birth in the regulation or provision of benefits, facilities, services, or information. That means that a woman in Colorado who makes the choice to have delivery care from a midwife cannot be barred by a public entity simply because she chose a midwife, meaning there has to be some mechanism by which that public facility, if it allows for OBs to have the ability to give care in their facility, also has to have some mechanism by which midwives can also give that care. That is consistent with this particular set of statute. These public entities do have a higher standard. They have a higher standard in the same way that we treat public schools and other public facilities. We hold them to a higher standard we expect more from them because they are public institutions. And so we are asking that they be public. The second prong is that they have to have a delivery and labor or labor and childbirth services. They have to offer labor. Let me just get it right. Labor and childbirth services. So first prong, they have to be public health facility, not private, public. Second, that facility has to offer labor and childbirth services. And third, they have to have admitting privileges. That means that all three of those things have to exist before they would be subject to this. Public hospital that has labor and childbirth facilities or services and that also allows for people to seek admitting privileges from them. If any of those things are not in existence, this bill does not apply to them. So you will note that there are a couple of hospitals and hospital systems that are in oppose, but they are private hospitals. They are not covered under this particular bill. Secondly, there are some who may object to this, but they don't have labor and delivery services as part of their practices. And third, there are some who don't allow for admitting privileges at all. So there are public health facilities that do do labor and delivery, but they don't allow for any sort of admitting privileges. Denver Health is an example of that. They are an employee-based model, and so they do not allow for outside doctors to apply to be able to admit. So it doesn't apply to them. Similarly, UC system, they have one hospital, as I understand it, that is a public hospital, that's university hospital, and because they are a faculty model, they also do not have admitting privileges, so it does not apply to them. So in essence, all we are saying is that these types of facilities need to have some process by which they can genuinely access the ability of being able to provide in these facilities. There cannot be unnecessary burdens or barriers put up against them being able to access that space. What is unnecessary doesn include things like malpractice If someone is shown to be negligent in their care the hospital doesn have to allow for them If someone is being doesn't have the credentials, the proper credentials, doesn't have to allow for them. All we're saying is that you cannot unnecessarily put up restrictions to keep midwives from actually effectuating the rights that they have and thereby minimizing the ability of women to choose the care provider and care type that they desire in this most intimate of settings. We have an amendment to clearly say that. I believe they've all been passed out. That's Amendment L002. We also have an amendment L-001 that strikes the legislative declaration. There is a lot of feelings in this space related to the relational dynamics in a general sense between OBs and midwives. and we couldn't come to a place of agreement with the different interested parties. And so we're just striking that so that we don't have any of that framing listed out. And then third, we have L003 that ensures the necessary amounts of liability coverage to bring some of the hospitals, to alleviate some of the concerns related to some of the liability pieces. I will also note that when we remove these kinds of barriers, we are not just removing them for these midwives. more importantly we are removing them for the women seeking the care of a midwife and I think it's important that you keep that in mind that there are those who desire that particular care instead of OB care the state has said they're both valid forms of care that can practice in hospitals and so we just want to make sure that that's actually something they can do and I will Allow the midwives, who I believe are scheduled to testify, to explain some of the barriers that they have experienced as they have sought access to the hospitals. Thank you, sponsors. Questions from the committee? Representative Bradley.
Thank you, Madam Chair. Ladies, welcome to the turf war we call medicine. It's been acupuncturists versus chiros, chiros versus PTs. There's never going to be enough patients to go around, and the patients end up falling through the cracks. I've never been on a bill that would not allow safeguarding. And personally, I've never used a midwife. I've only used OBs, but plenty of my friends have done it and had access. Now, that being said, I live five minutes away from five different hospitals, ten minutes away from five different hospitals. So my question for you, the people in the opposition clearly don't understand this bill either, which is mind-blowing to me. Two questions. How many hospitals would this affect? and what would this do for people in rural Colorado who don't have access? We know during the first trimester of care, how would this help rural Colorado in their quest for access the desperate needed access for prenatal, natal and postnatal care?
I got that Representative LaForge Thank you very much Madam Chair and thank you Representative Bradley for the question Officially we believe that there are roughly a handful of hospitals that this would impact I think initially we believed that there were four, although we're continuing to hear from some rural areas that they may qualify as well. And then in terms of your question regarding how this might impact outcomes for birthing people in rural areas, I think the reality is, you know, for so many folks that are living in rural areas, you know, they experience a higher lack of care and access to care than other people, obviously, that live in populated areas. areas. And so I think, you know, when you have access to a midwife that is either willing to travel to you or you're traveling to see them, I think that that ensures that, you know, people just simply have access to care. And I think that that's vitally important. I believe, and Rep Luck, you can help correct me, but I believe we have a statute that says that, that essentially says that if you're a practicing midwife that you have to be X number of miles close to a hospital in order to operate. And I don't have that exact number off the top of my head. But I think, you know, typically midwives are seeing patients that are low risk pregnancies. And in the event that something goes sideways, they always make a medical transfer. That's, you know, that is just standard practice. If, you know, if a situation is escalating, that either puts, you know, the baby's life in jeopardy or potentially the mother's life in jeopardy, they always do make that transfer. So for folks that are living in rural areas, you know, having midwives that are, are one, able to accept clients and two, able to, you know, continue that continuity of care and follow their patient into a hospital, I mean, I think it just expands options for people across the board, and that's a positive thing, especially in rural areas. Representative McCoy. Thank you, Madam Chair, and thank you for the explanation about being public, having a birthing center, allowing admitting privileges from outside. so I'm trying to do my best to google away here but do you have a list of what hospitals this actually would apply to that we could see representative luck thank you madam chair and thank you for the question we've actually been working on that for months now trying to find that information and you would not believe how convoluted this space is we've even gone to the degree of asking CDPHE for information about it. And nobody actually knows, which is interesting because for instance, for instance, Montrose County Hospital is a county hospital by incorporation, but they have signed a 99 year lease with a private facility that actually runs their hospital. And so the Colorado Supreme Court has said that they're this interesting creation that really is more private, but they're not, even though they're created public, that they don't have to respond to like core requests and do things that are public. And so there's all sorts of these little tweaks, but from what we gather, it's really a handful and we don't, we haven't been given even the names of it. We're just being told it's a handful of places like Gunnison. So, and we've called around, just so you know, we've called the different hospital and said, hey, do you have this, do you have that, do you allow for this? And we just have a growing list of confusion related to that. Representative McCoy. Thank you. Just follow up. Thank you for that. So that brings up a concern is we have a solution to something, but we don't know exactly where it would even apply and what communities would that help. So I think that's a really important piece of information to have is if this goes into law, where is it applicable? Representative Wilford, did you have a follow-up? Yeah, I wanted to offer Representative McCormick that if it was helpful, we would be more than happy to share the information that we received from CDPHE so that you're able to see some of the confusion and some of the frustration on our end. Personally, I think this is something that CDPHE should be able to answer given their jurisdiction over licensing facilities. So, you know, my belief is that, you know, should this bill move forward and is signed into law, that CDPHE would have a responsibility to determine exactly who it would apply to. Representative Luck. Thank you, Madam Chair. And I'll also just say, you know, this bill would be a lot simpler if I wasn't on it, because it could easily apply to all hospitals that take Medicaid or Medicare or however it generally is written in these statutes. But as I said, because of my political ideology and beliefs about the government infringing upon private actors and determining their contractual terms, I have to limit it to the public hospitals because that's consistent with the commitments I've made to my constituents. And so I think that even if it benefits one community or a handful of communities that midwives would be able to access those facilities, that that is worth doing. I'll also note that when I was pregnant, I actually moved in with friends in a separate place about an hour away in order to access midwife care because there wasn't any in my community. And so I do know that there is a growing population of women who want that particular kind of care, that if it does exist in different places in our state and they can access it, that they would probably be like me and go to that. I'll say in my own birthing classes that I took with the midwives facility that I was at, there were people from other farther afield places as well who were coming to this spot because they were so enamored with that particular model of labor and delivery. Representative Hammer. Thank you, Madam Chair. Thank you, sponsors, for bringing the bill. You mentioned that midwives would get full medical staff privileges. Can you go over what that entails when you get full medical staff privileges? Representative Locke. Thank you, Madam Chair, and thank you for that question. So if you will pull out the Amendment 2, number 2, you will note that it strikes on Line 3, Page 3, Line 7 through 21, which is the section of the introduced bill that speaks to what you're speaking to. Our new language does not actually require that same thing. Instead it just requires that the health facility maintain a process through which these midwives may apply for admitting privileges It not requiring the full staff privileges that were contemplated under the introduced bill I actually have a follow question on that and then a few others So walk me through the process of if a midwife is granted the privileges that you are outlining, your amended version, what does that look like for them in the hospital? Representative Luck. Thank you, Madam Chair. I think that I would love for one of the witnesses to answer that because she's going to be able to do it more detailed than I will. If you have, I think it would be better if she answered that. Her name is Jolene. And so if you would ask that question to her, she's going to do a much better job than me of outlining all of those specific questions. Sure. Happy to ask that. I think my biggest concern, I know we've discussed this, but just what happens when there's a difference of opinion for a patient and what does that look like for if there is a person who is not employed or credentialed with the hospital and is entering into that hospital and providing care. Representative Block. Thank you, Madam Chair, for that clarification. That helps me to better answer your question. So it's important to know that these folks would be quote unquote credentialed in the sense that the hospital would have the opportunity to give their stamp of approval that these folks work in their facilities, right? In the same way that an OB can work there that has an outside practice. I mean, if you think of it this way, you have Sally and Jane. Sally is an OB. Jane is a midwife. Sally goes to this public health facility and says, I have this private clinic and office in our town. I'd love if my patients need it to be able to admit them and continue caring for them in your hospital. What do I need to do? If Jane goes and asks that same question, all we're saying is that there needs to be some way for both of them to genuinely be able to provide that care once they're in that facility. So there is oversight. There is credentialing, so to speak, right? It's not just anybody gets the opportunity to do this simply because they're a midwife. Once they're in that space, it operates really in the same way that we see operating now with respect to OBs. So when you, for instance, have an OB who the patient wants an epidural, the OB doesn't do that. The OB calls the anesthesiologist, the anesthesiologist comes in and provides that particular service. There is a working together of those providers and practitioners to the degree that is necessary for their scope of practice. The anesthesiologist departs and the OB resumes care. It's very similar. If you come into a situation where the midwife is now starting to bump up against her scope of practice, as I understand it, the midwife has a responsibility to then pass that patient off to the OB, right? And so there shouldn't be these points of conflict in my understanding. Again, I would direct you to some of the witnesses who have in other places received admitting privileges in other states and what have you to better clarify. But my understanding is there shouldn't be that kind of situation where they're going to be at odds. Thank you for that clarification. I appreciate that And so if I understanding the amendment two um correctly that it is or maybe just the bill as amended by two um that are requiring the hospitals that meet those three criteria that you mentioned to allow for credentialing of a midwife. So to go through that process, they're not just allowing entry, but they are requiring credentialing of midwives. Okay. Both sponsors are nodding. Okay. Thank you. That's helpful. I do think having an understanding, I am still unclear on which hospitals are under this requirement and appreciate that that is something you're working on as well. It is my understanding that UC Health and the University Hospital, which was my original understanding of this bill, it was UC Health, the university under UC Health's purview and Denver Health that were impacted by this bill. I understand that UC Health does have credentialing privileges and falls under those three criteria. You said something differently. So just wondering if there's anything that you'd like to expand on that front. Representative Locke. Thank you, Madam Chair. So it's our understanding that the university hospital has a faculty system. So not strictly speaking, administering, admitting privileges, but that it's a faculty. You have to be part of the faculty in order to work in that hospital. And it's our understanding as well that they have a framework or a mechanism by which midwives can become faculty. And so for us, that means that that care is then open in both the OB sense and the midwife sense at that particular facility. So it's not our intention to touch what they already have in place. Okay. Thank you for that. And then my final question is on the, I know we're not in the amendment phase, but you brought them up, so I just thought it would be helpful to keep talking. So on the malpractice piece, the L003, do you have any, is there any information on how that would impact cost to hospitals if they have to have this particular type of malpractice insurance to cover those folks that are now going through the credentialing process? Representative Wolfe. Thank you very much, Madam Chair. Amendment 3 specifically speaks to the malpractice liability insurance that's required for a midwife in the event that they have admitting privileges. And so what we're doing specifically is increasing that from the statutorily required $500,000 per incident and $1.5 million in aggregate to $1 million per incident and $3 million in aggregate. And from conversations that we've had with midwives, this is pretty standard across the board anyway, and most folks carry that level already. Well, thank you so much for that clarification. I appreciate that. Okay, any additional questions for the committee? Okay, thank you, sponsors. We'll bring up our first panel of witnesses. We'd love to hear opposed first and then support. Thank you. Okay. Let's bring up Essie Yerda, Kelly Erb Zager, and Dr. Kim Warner, and then any other folks in the room or online that are in an opposed position. Okay We start from my left to my right If you can introduce yourself the organization you represent and you have two minutes Great Thank you Madam Chair and committee members Thank you for the opportunity to
speak today. My name is Kelly Urbzager and I serve as the Director of Policy and Advocacy at the Colorado Rural Health Center. CRHC serves as Colorado's nonprofit, nonpartisan State Office of Rural Health and Rural Health Association. We support the hospitals and clinics in Colorado's rural and frontier counties, I'm here today respectfully speaking in opposition to 1092. I want to start by acknowledging the significant disparities in maternity care access in Colorado's rural communities and assure the bill sponsors and all of you committee members that we share in the overall goal of increasing access to safe, reliable access to OB for all Colorado moms and babies. Unfortunately, this bill may threaten some of the access it seeks to create. So when a rural hospital struggles financially, OB services are often one of the first service lines to be eliminated. Only 17 of the 43 rural hospitals in Colorado have a hospital OB department. Low Medicaid reimbursement rates, which are about half the rate of private insurers on average, and high staffing and insurance costs are significant barriers to keeping OB units open in rural, which is why we must do all we can to maintain the already fragile access to maternity care in rural Colorado. Rural Colorado hospitals express multiple concerns with this bill. At a high level, members are concerned with legislating clinical decision-making and forcing facilities to forego internal credentialing processes centered around patient safety. The bill may conflict with maternity care quality initiatives that all rural hospitals with an OB unit are currently engaged in. There's also significant liability concerns. Colorado's rural hospitals support midwives as part of a team-based OB care in rural Colorado when it's safe for mom and baby and appropriate for the rural hospital providing care. But as Colorado's rural health care providers face ongoing sustainability concerns that may present barriers to rural OB access, we respectfully ask that you remove at least one potential barrier by voting no on House Bill 1092. Thank you.
Thank you for your testimony. Please proceed.
Thank you. Good afternoon, Madam Chair and members of the committee. My name is Issa Yerdau with the Colorado Hospital Association, and I'm here to respectfully oppose House Bill 261092. Colorado hospitals are committed to improving access to safe, high-quality maternity care, and we value the important roles midwives play on collaborative care teams across the state. We have been working with the bill's sponsors to share our concerns and appreciate those conversations. We look forward to continuing to work together on solutions that expand access while preserving patient safety. Our concern with this bill is not about midwives themselves. it is about preserving hospitals' ability to make clinical governance decisions that ensure safe, high-quality care. Hospitals rely on medical staff bylaws and credentialing processes to verify training, competency, and how providers are integrated into care, care teams based on hospitals' resources and staffing model. HB 26-1092 would override those established processes. The bill also limits a hospital's ability to require reasonable conditions on privileges, including collaborative agreements. These agreements are often misunderstood. They are not about supervision or requiring midwives to seek permission to provide care. Certified nurse midwives are independent, licensed providers. In hospital-based programs, collaborative agreements are intended to define a consultative and collegial relationship. They outline clear expectations for communication, consultation, and escalation of care when clinical situations exceed a midwife's scope or when complications arise. These agreements preserve the midwife's independent clinical judgment while ensuring there's a clear tested pathway to involve and upset when needed. This clarity is especially important in obstetric care where patients' conditions can change quickly. For many hospitals, particularly rural facilities, defined escalation pathways are essential to patient safety. Colorado hospitals support collaborative maternity care and expanded access. However, hospitals misretain the ability to define these pathways through credentialing and clinical governance. This bill limits that ability. For these reasons, we respectfully ask the committee to vote no on House Bill 26-1092. Thank you for the opportunity to testify.
Thank you for your testimony. We'll move on to Dr. Warner.
Great. Hi. Good afternoon, Madam Chair, members of the committee. My name is Dr. Kim Warner. I am a practicing OB-GYN for 27 years. I'm past president of the Colorado section of the American College of OBGYN. I'm an immediate past president of the Colorado Medical Society, and I've served on several credentialing committees. I'm here on behalf of ACOG and Colorado Medical Society to speak in opposition to 1092. Physicians routinely collaborate with midwives. We love it. In fact, collaborative models between physicians and credentialed midwives can provide excellent outcomes for many patients. However, collaboration must occur within a system that protects maternal and newborn safety. Hospital credentialing exists for one simple reason, patient safety. It ensures every provider practicing within a hospital has met the facility's standards for training, competency, emergency management, and accountability. When clinicians are credentialed, the hospital can verify qualifications, review outcomes, require continuing education, and ensure that providers follow the same clinical protocols designed to protect mothers and babies. Allowing providers to practice in hospital without credentialing bypasses these safeguards. Obstetrics is an area where emergencies can arise suddenly. I've done this without warning. Conditions like postpartum hemorrhage, shoulder dystocia, fetal distress, emergency cesarean delivery require rapid coordinated responses from a fully integrated medical team. These are the times when seconds matter in your care of moms and babies. Ultimately, credentialing is not about limiting access or professional autonomy. It's about ensuring that every clinician practicing in the hospital meets the same safety standards and participates fully in coordinated care. For the safety of mothers and babies, it's critical anyone providing care within a hospital be properly credentialed. I respectfully request you vote no on House Bill 1092, and I'm happy to answer any questions, particularly about credentialing, transfer of care. And we're willing to work with the sponsors continuing forward with this.
Thank you for your testimony. Questions for this panel? Representative Hamrick. Yeah, Dr. Warner, you mentioned how you work routinely with midwives. Can you explain some of those situations?
Dr. Warner. Yes. Yes, thank you, Madam Chair. Well, we work collaboratively with them in the hospital, and I am now an OB-GYN hospitalist, but I have been a general OB-GYN, and I worked with midwives in the offices. but this really particularly refers to in the hospital for this patient safety piece. In the hospital, we work in a collaborative model where the nurse midwife takes entire care of the patient, and if there is no issues going forward, that remains the same. If there is an issue, I am aware of it before the proverbial cred hits the fan, and we can manage the patient in a much safer environment.
Representative Hamrick. Thank you. So the nurse midwife is right there by your side in the hospital working with the patient?
Dr Warner Yes Yes Thank you Madam Chair The nurse midwife actually has complete autonomy with the patient And if they I am aware that the patient is there and if they need me I step in
Representative Stewart. Thank you, Madam Chair. My question is for Ms. Herb Zager. Thank you for being here. You know, in the opening, we had heard the sponsors talk about access to care, which is a big proponent of you and I have had lots of conversations about that. And we know that birthing is a life-changing experience for so many reasons and very scary at times too. So I was wondering if the rural health centers could speak to your concerns on the bill as amended and really, I guess, the access that the sponsors are talking about. Is there a way that we can thread the needle here? That was not a very good question. I'm sorry.
Ms. Herbzinger. Thank you, Madam Chair. Thank you, Representative Stewart. And I'll start by saying it was a good question, and we are more than willing to continue to work with the sponsors on finding a solution that works for everyone. Midwives provide amazing care for many rural deliveries, but rural hospitals have low birth volumes and really limited resources. So when complications arise, integrated team-based care where everyone is on the same page is incredibly important for both mom and baby. And sometimes that team-based care does include midwives, like San Luis Valley Health and Alamosa. But they do so in partnership with the care team. And it depends on the needs of the community and the capacity of the hospital. So to bring midwives into some rural hospital care settings, there are specialized local credentialing processes that are designed for their specific community needs, namely a collaborative agreement. That being said, I also think that there's something we've said about the bill infringing on local control over rural hospitals operations and staffing and really legislating their clinical practice in these really critical times in limited resource areas. Thank you.
Representative Bradley.
Thank you, Madam Chair. I'm wondering if you're not reading the amendments. The bill does not change the credentialing that the hospital has put in place. The bill does not say, okay, hospitals, here's your credentialing for OBs. Now here's your credentialing for midwives. It is up to the hospital to credential both. So I'm just wondering if you're not understanding and digesting the bill or you're reading into something that the bill does not do in what I'm reading. What I'm reading is if hospitals allow OBGYNs to credential through their hospital, then they must have a process for that credentialing for midwives. They're not saying, here is your process, one size fits all, to credential midwives.
Ms. Would either of you or any who would like to adapt to Warren? I've sat on credentialing committees for years and years, And we do have obviously separate scopes for privileges. So the credentialing is the overarching umbrella. And we give privileges for a general surgeon versus an obstetrician versus an anesthesiologist versus a midwife. So we do have different scopes of practices and they're very transparent. Follow up, Representative Bradley.
Okay I going to use my inside voice Dr Warner thank you for that But this bill is not saying that the hospitals have to credential a certain way It still allowing the hospitals to have their own credentialing plan
Dr. Warren. Thank you, Madam Chair. That is correct. They all have their own credentialing plan, and it is set through a credentialing committee.
Ms. Yudera.
Thank you, Madam Chair. Yeah, so I think where we have some challenges with the current, the bill and potentially some of the amendments, we're working through those amendments. We appreciate some of the amendments that have already been made, and I think they have been said by the sponsors already. I think where we're currently stuck is at the collaborative agreements portion of the bill, and that's what we're trying to make sure that we all have an equal-footed understanding of what does a collaborative agreement mean. So the bill right now, to our understanding, is saying that there should not be collaborative agreements when it comes to credentialing and privileging midwives.
One more. Representative Bradley.
Thank you. Dr. Warner, you said something that stuck out to me. As a mom to someone who's had a stillbirth, I certainly understand the complexities, and I was under OB care. You talk about when the certifiable poop hits the fan, but midwives come to hospitals when there is a high-risk situation, and you've never treated those patients before. So explain the difference to me.
Dr. Warner. Thank you, Madam Chair. I'm not sure I understand your question.
Are you saying that because I've never seen a patient, I don't have a relationship with them and thus provide lower quality care? One final follow-up. Representative Bradley. I'm just clarifying. It's not a follow-up. I'm asking, you were talking about established patient care. I'm saying that there are midwives that have home births that have to come to the hospital in a high-risk situation. Those are patients you've never treated either. Dr. Warner. Thank you, Madam Chair. That is correct. Actually, as an OBGYN hospitalist, I've not met many of the patients because I only work in a hospital, but I do all of the high risk. I do all of the sort of backup emergency care. And what we do is we create incredible relationships with patients, just as your nurse midwife would do. And that is part of what our skill is. Representative Hamrick. Thank you, Madam Chair. Dr. Warren, you mentioned how you work with midwives. There's like a partnership with a care team. How would this bill change that relationship? Dr. Warren. Thank you, Madam Chair. So we absolutely require a collaborative agreement with nurse midwives that does not dictate how they care for a patient, although that is in their credentialing and privileging. But when they need my help, I am already involved and know about the patient. If there's not a collaborative agreement, then you're setting up two standards of care, two tiers of safety for patients, private versus public, midwife versus obstetrician. And we have to have that partnership. Representative Hamrick. Representative Hamrick. So this bill would weaken that collaborative agreement, that collaborative care? Dr. Warner. Thank you, Madam Chair. If it not required to have a collaborative agreement if the midwife just needs credentialing and does not have to have a collaborative agreement yes absolutely patience will suffer Representative Wright. Thank you. I'm trying to wrap my head around what I'm hearing. So I want to make sure I get this right on the collaborative agreement. So you are interpreting the bill and the amendments thus far presented as saying that you don't need a collaborative process, that it would go through credentialing process why can't the credentialing process include what is would be in a collaborative agreement who like you're down i gotta write that you're down thank you madam chair thank you so much so it is our understanding in speaking with our hospitals exactly as you said representative that part of that privileging process which also as the physician mentioned credentialing privileging we're kind of using those words interchangeably, right? But that is the process where the hospitals goes through to make sure that the provider has a good track record and they're able to provide the care that they're being hired to. So that's the credentialing privileging process. Within that process, the midwives are asked to get into a collaborative agreement with the physicians so that everybody kind of understands the escalation process. So if you're being hired to work at a hospital, you are filling, you are signing that collaborative agreement as part of your privileging process. And so if we are taking that off the table as part of this bill, that's what we're saying, that's going to be problematic for the hospitals because we need to make sure that there's an escalation pathway established. Representative English. Thank you. Does the hospital require other collaborative agreements for other physicians? Who would like to? Dr. Warner. If that's for me, we don't have, thank you, Madam Chair, we don't have collaborative agreements for physicians. We have collaborative agreements for non-physicians, so physicians assistants, nurse practitioners, CRNAs. So all of them have collaborative agreements. Representative Johnson. Thank you, Madam Chair. Thank you so much for being here. And this is a question, I guess, for rural health or either with the collaborative agreements because of escalation. I'd assume that's a lot like when you change ambulance services, that because you have different protocol, you need to make sure everyone knows what to do, when, if. Am I understanding that correctly? That's correct. Thank you, Madam Chair. You're down. Okay. I just have one follow-up to the question I asked the sponsors earlier about the list of hospitals that would be impacted. Since you're representing the hospital association, do you have a sense of which hospitals would be impacted? by this legislation? Thank you, Madam Chair. Yes, we do have a list. And we use the HICPF's Chase report to draw the list because, as they said, it can be a little bit hard to understand who's public versus private. And so we have a list. It would impact 10 hospitals. Okay. Thank you for that answer. Okay. Our time is left for this panel. Appreciate all the questions. Thank you for your participation today. With that, we'll bring up our folks in support. Okay. We'll bring up Katie Viglotti, Vicky Ariati, Jeannie Rush, Teresa Hubbard. Donna Labelle, and Amy Persons-Birch. Okay, well, we're bringing up folks online. If you could state your name, the organization you represent, and you have two minutes. And it's that tiny little button right by the plug. What am I pressing? Oh, you're on green. Never mind. You're good to go. Oh, okay. Well, hi, guys. My name is Katie Vigliotti. I personally have never had a midwife, but I have plenty of friends and family that have used midwives. I have a good friend who I was speaking with yesterday, and this is why I decided to come here to testify, to tell her story. She couldn't be here today. So I have a good friend who was supposed to have her baby and deliver with her midwife, the type of person who plans everything down to a T, had a very close relationship with that midwife. Unfortunately, ended up in a situation where she had to have an emergency C-section, and her midwife could no longer be there with her, taking care of her at the hospital and following through with her plan. she described it as extremely traumatic and that she would have liked if there was an opportunity for if that midwife could have been credentialed and be there at the hospital with her that that would have been a possibility that there were the barriers that were in place that prevented her from having her involvement with her at that time really just in conclusion I just want to say that I do support House Bill 1092 and it's nice seeing both sides working together on a bill like this, and I really hope to see it move forward. Thank you. Thank you so much for your testimony. We'll move online to Jeannie Rush. Okay, kids, let's do this. In 2021, midwives attended 12% of the births in the United States, US GAO source. As of 2025, there are about 17,000 midwives in practice in the U.S., and they provide care during pregnancy, birth, and many attend births in hospitals and other centers. I mean, they can't do any worse than all the dirty clinics that are doing, you know, you know what. To be clear, in Colorado, we have the right of choice that goes for medication, my body, my everything. I think this is a good bill because you do have standards you've required. The state does have laws to authorize this. Now, let me remind everyone here that these privileges can't hurt when you're in the hospital. I had two babies and I had to have the Rogan shot, you know, so you wouldn't have a blue baby. And I had a midwife for both of my babies. And that was in like 50 years ago or something in the clinics in certain places, second and third trimester. They are butchering women without any standards. And that's in this state, too, by the way, if it's not in the hospital. So I had I want to say a couple of things. If you don't remember that you've passed bills to take care of dogs and wolves and cats in the last few weeks, but we're not taking care of women. And we should have the absolute right to have a midwife attend with us, especially when they're willing to honor everything that the hospital asks. But then they're there unless they need the doctor, which in my case, I needed the shot. I think that this state has just gone too far in overreach. And we, the people, need to have these rights. If we're free of choice, we should do this. So I hoping that you will definitely pass this bill and honor we the women Thank you so much for your testimony We move on to Amy Persons Thank you, committee members. Amy Birch, Alpazzo County. I represent myself and I ask you to pass HB 25-1092. Mother has the right to choose the best option of assistance for her child's birth. I'm personally grateful to my creator that I hired an independent assistant to encourage me at the hospital during our birth, somebody who was respected by hospital staff working closely with the RN. I was blessed with the best of both approaches, the RNs and the doula and or midwife, whatever you decide. Hospitals and birthing centers can benefit by including this expertise wholeheartedly. We live in a state that protects the authority of the mother to birth her child as she sees fit. Let's widen the authority of the consumer, protecting her choice to work with whom she chooses to work with. The mother may choose where, how, and with whom she will experience the birthing process. And just since I have a little bit of time left, let me clarify. I fully intended to have my baby at home, but because of heart complications, the obstetrician said, yeah, have the baby at the hospital. So I did. So it was the best of both worlds when I found Laurel and her name is Laura Lee Kipp. And she's a wonderful doula in town. I birthed eight children herself. She wasn't one of these experts, but she really knew all about the birthing process. in her experience. And it was just wonderful to have a friend to work with us and not just be stuck in the circle of professionalism, so to speak. And I understand the other side of what they're saying too, but let's work in collaboration. Thank you. Please pass this Bill 1092. Thank you for your testimony. We'll move on to Donna LaBelle. I'm Chair Gilchrist and committee members. My name is Donna LaBelle and I represent myself. I testify in many bills because I care about Colorado and usually I have to do research and look up definitions to understand the bill. But this time I can say that my testimony will be more anecdotal. Before the word was automatically connected with autism, spectrum meant the whole gamut from one end to the other. And in this wide array of your constituents, there is an extremely special group of parents, ones who believe that sunshine, fresh air, playing outside, and a good night's sleep are some of the best medicines. Way back in the day, I was a crunchy mom, long before that was even a term. but I did not start out that way so sadly my first birth was an emergency cesarean because I had toxemia and preeclampsia. The second and third births were automatic c-sections with general anesthesia. My fourth pregnancy however my doctor who was a man at that time I still believed that you trusted and never questioned anything your doctor told you but this doctor had a question for me. Would you like to have a VBAC? What is a VBAC? A vaginal birth after cesarean. Wow, really? I didn't know there was such a thing, and absolutely I would. Even with all the monitors and being on my back with a sleeping husband in the chair beside me no epidural and no drugs of any kind it was the most glorious experience To get up and walk away from the delivery table was like a miracle to me My other births five other births and 20 grandkids and four great grandkids births each is their own unique special story In America, we are now realizing the importance, the value of healthy births. So, committee members, I ask you to vote yes on this important bill. And I thank Representative Luck for bringing it forward. And for once I could say I'll be happy to answer any questions and actually tie it into midwives. Thank you. Thank you for your testimony. We'll move on to Vicki Ariati. Hi, my name is Vicki Ariati, and I'm in favor of this bill. And I live in the Denver area. I had my third child at home with a lay midwife. She was not licensed. She was not credentialed. But she knew what she was doing because the first two births that I had at the hospital were bad enough to where I didn't want to ever have a baby in the hospital again. It was the most beautiful experience that I had experienced. And I was right there at home with my my two older children. I bonded with this baby differently than I did with my first two. Although I love all three of my kids, I since had twins after that. But there was something special about being totally in control of who was at my birth, where I was, my choices, my body, my choice, my life. And it was a beautiful experience. I wouldn't trade that for anything. I support this bill because I know there are women who most likely may go to home births because they can't get a midwife into a hospital in that situation. I have friends who did have the opportunity to have a midwife in a hospital setting next door to the hospital in a separate room. one needed help and the other one didn't and it was a beautiful experience for them so I think that we should be able to have the right to choose for ourselves how we want to have our babies where we want to have them and who we want with our babe with us while we're having our babies I did not like the cold environment of the hospital even when I was witnessing my grandkids birth it was cold bright lights baby screaming to me that was more abuse than anything thank you thank you for your testimony any questions from the committee okay seeing none thank you all so much for your testimony we appreciate you being here today move on to our last I'm sorry any questions from the committee sorry Thank you for being here today. We appreciate your participation. Okay, we will move on to our next panel, our final panel, Jolene Hammond, Aaron Metzke, Nancy Eason, Justina Nazario. And then is there anyone else in the room or online that would like to testify? Are you? Oh, yeah, no problem. Take your time. Okay. Okay Okay Okay Okay Okay Okay Okay Okay Okay it looks like we just have Jolene Hammond If you'd like to come off mute, say your name and your organization, and you have two minutes. Hi, thank you, Chair and members of the committee. My name is Jolene Hammond. I'm a nurse midwife practicing in Colorado. I've been attending birth since 2007 in hospitals, homes, and birth centers. I'm representing myself. With this bill, midwives must still meet all standard privileging and credentialing requirements that all providers have to meet. Colorado law already recognizes midwives as independent practitioners. We safely manage 85% of pregnancies and births and are well-trained to identify when care outside our scope is needed. We deeply value our physician colleagues and our work as part of the maternity care team. No other maternity care specialty has to have a supervisory or written collaborative agreement to practice in hospitals. Family medicine physicians providing obstetric care, for example, are not required to have these agreements, even though they need to consult surgical colleagues similarly to midwives. Just like all physicians have guidelines for practice within the hospital and are expected to collaborate, we can do so without a document giving us permission to practice. If competence is a standard, midwives should be evaluated like any other clinician. Practices like mine are forced to consider paying physicians for a required signature just to care for our own patients. That's a barrier, and it's fragile. If an agreement is withdrawn, an entire practice can shut down overnight, leaving patients without care. This matters because 38% of our counties are maternity care deserts, higher than the national average. One in five cannot access first trimester care, and the OBGYN shortage is worsening. We cannot address maternal mortality, rural gaps, or racial disparities if we limit qualified providers like midwives only to areas where OBGYNs practice. States with stronger midwife integration in hospitals like Oregon have far fewer maternity care deserts, 8% to our 38%. This bill does not expand scope. It simply ensures public hospital policies align with existing Colorado law and expands access to care. I strongly urge a yes vote. Thank you for your time. Thank you so much for your testimony. We'll move on to Justina Nazario. Thank you, Madam Chair and members of the committee. My name is Justina Nazario, and I'm a certified professional midwife, CPM, licensed in the state of Colorado. I hold a bachelor's of science, and I've dedicated my career to providing safe, evidence-based, family-centered care for two and a half years in Colorado. I'm writing in support of House Bill 26-1092 on behalf of myself and Elephant Circle, where I serve as a statewide operations coordinator. Continuity of care is directly linked to improved maternal and neonatal outcomes. When a patient's trusted provider can remain involved throughout pregnancy, labor, birth, and postpartum care, including during hospital admission when necessary, it reduces fragmentation, enhances communication, and supports safer decision making. This bill protects this continuity by prohibiting discrimination based on licensure. At the same time, I would respectfully highlight the important omission that certified professional midwives, though licensed and regulated in Colorado, are not included in this bill's definition of licensee. This exclusion represents a barrier to full integration of all qualified midwives and reflects an ongoing bias between provider types. CPMs are providers that are nationally certified and licensed and regulated in the state of Colorado. Many of us, including myself, hold an advanced academic degree in midwifery, and our exclusion from hospital privileging conversations limits the state's ability to fully integrate maternity care providers and strengthen collaborative systems. We support the intent and direction of House Bill 26-1092, and I hope this legislation will open the door to future collaboration so that all licensed providers and midwives in Colorado may be recognized for their training and permitted to practice within their scope in hospital settings under appropriate supervision and privileging structures. I urge you to support this bill and continue working towards a more collaborative and inclusive maternity care system in Colorado. Thank you so much for your commitment to Colorado families. Thank you for your testimony. We will move on to Erin Metzke. Madam Chair, members of the committee, thank you for the opportunity to speak. My name is Erin Meshke. I live in Boulder and represent myself. Midwives played an essential role throughout most of history until the rise of obstetric medicine in the 1800s. By the early 1900s, male doctors attended approximately half of births despite having little training in obstetrics, but midwives continued to attend births in rural America and black midwives attended up to 75% of births in the South until the 1940s. Sadly, by 1910, pressure moved toward hospital deliveries and the abolition of midwifery. Thankfully, there was a resurgence of midwives in the 60s and 70s as women reclaimed natural childbirth with Ina Mae Gaskin at the forefront of this movement. If you haven't seen her books or documentaries highlighting her midwifery center in Tennessee, she is an absolute inspiration and treasure. A national scoping study review showed that midwife-led models were linked to a decrease in cesarean deliveries and interventions like epidurals or forceps and higher rates of satisfaction with their childbirth experience, which impacts both mothers and babies. When midwives have gone through all necessary training and testing, they are sometimes more qualified than their obstetrics counterparts for labor and delivery. Outcomes show that 66% of midwives achieved a normal vaginal birth compared to 39.5% of the general population, and only 16.8% of midwives had patients who ended up with a cesarean birth instead of more than double that rate in the general population, which is well above the considered acceptable levels of C-sections, which is 10 to 15%. Even CU Anschutz agrees that integrating midwifery can lower cesarean rates. Midwives are an important option for some mothers, so I ask for your yes vote on HB 261092 to support healthy deliveries and better outcomes for mothers and babies by including midwives. Thank you. Thank you so much for your testimony. Moving on to Nancy Eason. Thank you, Madam Chair. My name is Nancy Eason. I represent myself. I was pleased to learn about this bill this morning just in time to testify in favor of it. I'm happy to say that Colorado already has a good law for lay midwives and home birthing, something from which I benefited greatly 30 years ago when my kids were born at home, my choice, and more recently, the births of some of my grandchildren. So given that excellent law for home birth attendants, it only makes sense to ensure that women desiring to give birth in a medical setting should have access to the birth attendants of their choice and that these attendants would have equal privileges to anyone certified to work in that setting. This bill just makes sense to me. As an informal birthing coach, I've been privileged in the past to attend a number of my friends' hospital births where I saw how important the birth attendant is The certified midwives and nurse midwives did an excellent job spending more time with their clients than the OBGYNs did With the births attended by certified midwives and nurse midwives the mothers were more likely to have a successful natural birth which is what they had hoped for However, my only objection to the bill is that, and this might be the first time I've disagreed with Representative Luck, I wish it affected more hospitals. And I hope that in time that will become the case. we need to encourage hospitals to work with these midwives and it'll serve our our clients their clients it'll serve medical costs in colorado i think by bringing them down because of their excellent care um so i hope we can expand that and uh i ask that you would vote yes on on this bill thank you thank you for your testimony uh and finally we'll move on to theresa Hubbard. Thank you, Madam Chair, for allowing me the opportunity to speak today. My name is Teresa Hubbard, and I'm here on behalf of myself in support of House Bill 26-1092. This bill addresses a health care problem in Colorado. Even though certified nurses, nurse midwives, and certified midwives are fully licensed and authorized to practice independently in some hospitals, they are still denied full medical staff privileges simply because of their title. That doesn't just affect providers, it affects patients. When a pregnant woman chooses a midwife, that relationship is built over months through prenatal care, education, and trust. That provider knows their patient's history, understands their risk, and is often the first to recognize when something isn't right. But right now, that continuity of care can be broken the moment a patient enters a hospital. And when that happens, it can lead to delays, miscommunication, and unnecessary complications at one of the most critical moments for both mother and baby. House Bill 261092 fixes this by ensuring that qualified midwives cannot be denied full privileges solely based on licensure. It allows them to admit their patients, manage their care, and discharge them, just like the other medical staff working within their scope. This is not about expanding scope of practice, it's about removing barriers that don't belong in a system focused on patient safety. This is a nonpartisan issue. We all want the same outcome, healthy moms, healthy babies, and safe deliveries. This bill supports that by improving access to care, strengthening continuity, and respecting the role of qualified providers. This is a common sense solution that aligns policy with practice and puts patients first. I respectfully urge you to vote yes on House Bill 26-1092. Thank you so much for your testimony. I have questions from the committee. Representative Bradley. Thank you, Madam Chair. Excuse me. I think that we're very confused with the words collaborative agreement. If one of the midwives could step in and sum it up for us, that would be amazing. Ms. Hammond? If I may. So written collaborative agreements is something that has a long history among advanced practice nurses, which all certified nurse midwives and certified midwives are, including the history of being eliminated by Colorado law in 2010, except for within the walls of hospitals at Colorado since then. Written collaborative agreements generally are written as the privileging and credentialing, essentially. Essentially, they aren't needed because of privileging and credentialing. Privileging and credentialing already tells us within the walls of a hospital what protocols midwives and other providers are to follow and how collaboration should look and what scope should look like within the walls of that hospital If that answers the question. Additional questions. Representative Hamrick. Thank you Madam Chair. This is for the midwives, Ms. Hammond and the midwife from Elephant Circle. First, and I know the midwife from Elephant Circle already said this and I kind of missed some of it, so could you just go over the different types of licensed midwives? I would like to answer that. Ms. Hammond. Ms. Nazario? Yes, I can answer that. So within this bill, the two provider types that are outlined are CNMs, which are certified nurse midwives, and CMs, which are certified midwives. I was raising the fact that certified professional midwives that are also licensed and regulated in our state are not included in this bill. So we have those three midwifery types in our state in Colorado. Additional questions from the committee. Representative Hamer. Thank you, Madam Chair. Just to be clear, midwives are already allowed to practice in the hospital, but they have to be either in sort of a collaborative group or with the supervisor? Who would like to answer that? Ms. Hamer. Thank you, Madam Chair. So, yes, midwives are already allowed to practice within hospitals. I have been one of them. But in order to do so, we have to have a supervisory or written collaborative agreement, which, again, was eliminated in Colorado law in 2010, except within the walls of a hospital. And I am actually one of them who, once my employment ended with the position that I had a supervisory agreement with, my privilege has ended. Representative Beth. Thank you. So what is the problem with a collaborative agreement? I think that that's what we're trying to understand, why the amendment says not require supervisory or collaborative agreement. That's what we're trying to get the basis of. Ms. Hammond. Thank you, Madam Chair. So a written collaborative agreement is essentially a piece of paper that gives permission to practice that no other type of provider has to have. Whereas protocols within the hospital setting could be in place that outline how someone practices in general without having a piece of paper that gives permission for that provider to practice. If that answers. Representative Bradley. Thank you. I think that answered. So a collaborative agreement is a piece of paper versus a protocol that you are supposed to follow, which is more safeguarding for patient safety. Ms. Hammond. Correct. Representative Wright. Thanks, Madam Chair. A clarifying question on that one, because that was a great question. So would it also be saying then that you have to, as the midwife, you would have to have a personal or professional relationship with an individual physician to engage in that collaborative agreement with them? And that one of the challenges Ms Hammett Thank you Madam Chair Yes that is one of the challenges is independent midwifery has been recognized in the state of Colorado for decades but except for within the walls of a hospital Additional questions from the committee. Where we have to have a specific relationship. Sorry to interrupt you there. Thank you. Okay. seeing no additional questions thank you so much for participating in the testimony today with that the witness phase is closed sponsors would you like to join us again we hear you have some amendments would someone like to move L001 representative Bradley I move L-001 to House Bill 1092. Second. Seconded by Representative Foray. Representative Buck, would you like to explain L-001? Yes, and if I may, Madam Chair, also say that while we have three amendments today, we are willing and ready to continue working with all of these guys to find that proper threading of the needle. The first amendment, as I mentioned in the opening, just strikes the legislative declaration. Because as I mentioned, there are different perspectives about the problem at bar and the relationship that is why midwives are being kept from this space. And so we don't want to fight that fight. That's not what the purpose of this is. Our desire is just to be able to gain greater access for women to the providers of their choice in a hospital setting. And so we are just asking to strike that so that there is no contention around it. Any questions about this amendment? Any objections to this amendment? Okay, with that, L001 passes. Would someone like to move L002?
Move L002 to House Bill 1092.
Representative Bradley moves. Is there a second? Representative Frey seconds. Representative Luck, could you describe the amendment?
Yes, thank you, Madam Chair. the bulk of this bill, where the confusion stemmed from, where a lot of the consternation came from, is between lines 7 and 21 of the introduced version. This amendment strikes those lines, rewrites what we were trying to accomplish. In essence, we're trying to eliminate the barriers that are being put up. I want to say in my own words why we are opposed to the idea of a collaborative agreement. We are not in any way opposed to facilitating communication and care between the different providers within a hospital. That already takes place physician to physician. When a pregnant woman needs the care of a urologist or an anesthesiologist, there are already mechanisms by which those doctors interact with each other. Those mechanisms do not require the OB to get permission from an anesthesiologist to be in the hospital. However, under a collaborative agreement, what is happening is these independent practitioners, which Colorado law has said are just as qualified to be in that space as an OB within their scope of practice. These collaborative agreements require the midwife to get permission from OBs in order to be in the hospital. They have to sign these particular agreements. And if they cannot get an OB to sign off, they can't access. If the OB that signed off leaves, as was stated by Ms. Hammond, their entire privileges also evaporate. And all of the patients that thought that if something went awry, they would be able to access the hospital with their midwives now no longer have that protection. All we're saying is that those kinds of barriers that are set up from the experience of our midwives, their perspective is that they're set up to keep them from being able to access it, that they be removed in government-run hospitals, that we utilize similar protocols that are already in existence, physician to physician, and we treat these midwives as the independent professionals that the state law has said that they are. And so that is why we have written this the way that it is. The hospitals continue to be able to have the credentialing process that they want. If they think that a certain number of degrees are necessary or a certain number of observations are necessary or certain whatever is necessary, and those are held as necessary in that space so long as they're not requiring, so long as they have a process that midwives can access their hospital and that process does not require an OB to sign off on their presence there, we're good to go. They have complete discretion as to what that credentialing system looks like. So we ask for an aye vote.
Any questions on this amendment, Representative Bradley?
Thank you, Madam Chair. So what you're saying in this is there's still a protocol to follow, there's still credentialing to follow, they just don't have to get the permission. But this is not some backdoor way for a midwife to have a high-risk pregnancy, complicated pregnancy, for them to be responsible. You're not providing cover or a way for them to fraudulently practice outside their scope.
Representative Wilford.
Thank you, Madam Chair. Yes, that's correct, Representative Bradley. Hospitals still get to decide who gets privileges. They still get to define their process, enforce their standards. Nothing about this changes scope of practice either.
Additional questions? Representative McCormick.
Thank you, Madam Chair. Just because this came up about the certified professional midwives, where do they stand in all of this?
Representative Wilford.
Thank you, Madam Chair. Certified professional midwives are not included in this bill because they have different levels of expertise, and so we're specifically focused on certified nurse midwives as well as certified midwives, and those are individuals who have a master's degree. And so we're specifically looking at the higher level of credentialed midwives in this bill.
Representative Block.
And thank you, Madam Chair. And to just add on to that, the reason largely is because of the fact that already at law, these two classes of midwives have admitting privileges and they have independent practice authority. So these two classes already have been determined to have the skill set necessary to work in the hospital and to work independently.
I just have a quick follow-up question. So I think if I missed, maybe I misunderstood the midwife that was speaking earlier, Ms. Hammond, and Representative Luck, I think you just referenced it. But so with this amendment, that if there is a relationship with a doctor, the midwife could through this process as amended that would allow for the midwife to participate or to treat a patient in a hospital
Representative Black.
I'm not wholly sure what you're asking, but should I just state again what we're trying to do? So I heard, and maybe I heard incorrectly, but from both the midwife and then I think from you, Representative Lux,
so I just want to clarify that if this bill passes with this amendment, that a midwife could treat a patient in a hospital if they had a relationship through this amended version. through a hospital, that it would not be through the credentialing process in the hospital.
Representative Block. Thank you, Madam Chair. No, that's not true. So the midwife would have to go through the credentialing process, whatever that process is that the hospital establishes. Under this bill, the hospital has to ensure two things. One, there has to be a process for midwives to credential, right? So if you have an OB credentialing process, you also have to have a midwife credentialing process. If you don't have an OB credentialing process, you don't have to have a midwife credentialing process. So there is a credentialing requirement. The second thing that this amendment does and that the bill would then do is say the credentialing process cannot require that the midwife get permission from an OB in order to operate there. Because an OB doesn't have to get permission from an anesthesiologist who would give an epidur to operate there. The midwife shouldn't also have to get permission from the OB to operate in that space. That is not the same thing as saying that that's a lot of double negatives. So those are the two things it does. What it does not do is prohibit the hospital from creating protocols for escalation, right protocols for how do you handle xyz when your patient becomes in a in a difficult situation the hospital still has the ability to do that all the hospital cannot do is require that the ob give permission um be that the the ob be the gatekeeper right because ob's aren't often interested in opening the gate to their competition to the midwives and so it's nearly impossible for a midwife to be able to access admitting privileges. So in, in plain, like in discriminatory language, right, it's in writing, not discriminatory, because there seem to be these mechanisms to allow for it. But in practice, it ends up discriminating against midwives because they cannot satisfy the term to get an OB to sign off on them being at the hospital.
Thank you so much for that clarification. I'm just sorry, one more follow up that that was super helpful. So in the scenario you just described, if a hospital does not have an escalation plan, what happens when a midwife is then treating a patient in the hospital and the OB and the midwife do not agree on treatment? Representative Locke. Thank you, Madam Chair. So
So the hospital can have a set of protocols that answer that question in light of whatever their needs are in that hospital and all of the considerations in that hospital right Perhaps you in a setting where there only one OB and then a general emergency surgeon. And so during these hours, this is the process for escalation because the OB is there, but then during these other hours, the general surgeon is there. And so this is the process. The hospitals can do all of that and figure out all of that in the same way that they do today when you have a patient who needs to be treated by four different specialists, right? Hospitals manage those kinds of dynamics every day. What happens when the urologist disagrees with the oncologist, right? What do they do then? There are already mechanisms in the hospitals that determine those questions, and we are not precluding that. In fact, we are incentivizing them to do that. All we're saying is that you cannot require a midwife to get permission from an OB, which is what these collaborative agreements are, in order to
access the facilities to provide services to their patients. Thank you for that. Representative
Burrung. Thank you, Madam Chair. So my understanding of collaborative agreements, I'm sorry, English is my second language.
It's not contagious.
It's not contagious. Is that the collaborative agreements is to ensure there's a certain protocol so when the midwife comes to a point where it's outside of her scope of work, they're all on the same page of what's the next step after that. That's my understanding of collaborative agreements. Everybody that is a non-physician goes under a collaborative agreement, so they're all on the same page. But to compare a midwife to an OB, an OB needs an education of a bachelor's degree, four years medical school, and four years hospital residency. Their focus is high-risk pregnancy, surgical intervention like C-sections, and complex labor complications. Now, midwife education is a bachelor's degree in nursing, RN, followed by a master's or doctoral degree from an accredited midwife program. Focus is low-risk pregnancy, holistic care, and normal childbirth with minimal intervention. I just, to put somebody that is a non-physician in a point where you must not require supervisory collaborative agreement, And I don't think it's fair to do that for somebody that might be out of their scope of work if something goes wrong all of a sudden.
Representative Buck.
Thank you, Madam Chair, and thank you for sort of addressing the elephant in the room, Representative Barone. I appreciate it. I have a collaborative agreement right here, and it requires the supervisory element that you're pointing to. And a lot of this goes back to what Representative Bradley had mentioned at the beginning of a turf war. The state of Colorado has already answered the question that you're posing. They have already said that those particular qualifications of a midwife satisfy the requirements necessary to practice in a hospital. They've already said that midwives can be independent practitioners who have admitting privileges. There are those in the medical community who, as lawyers, which I am one, take this view that those with lesser qualifications are somehow incompetent or lesser. And we don subscribe to that same idea Colorado has already said these folks are highly trained highly qualified and can operate in a hospital situation within their scope of practice The hospitals, largely through the OBs, are putting up barriers to that because they don't like it. And what I'm saying, and what Representative Wilford is saying, is that for public hospitals that are government-run, they don't have the right to put up those barriers. They don't have the right under law, not only because these midwives are already qualified in this way, but also because the fundamental right to reproductive health care that exists in Colorado precludes them from being able to do that. Because as I read at the beginning, a public entity cannot interfere with that right through its facilities and services, which is what they are doing today. And so while you may disagree with whether or not they should have independent practice authority and whether they should have admitting privileges, that's not the question before you today. Those decisions have already been made, and they already have been answered yes. The question is, do we continue to allow barriers to exist that preclude them from being able to access those hospitals and facilities in contravention of these multiple areas of law and in detriment to the patients that they serve?
Representative McQuarrick. Okay. Additional questions on this amendment? Any objections to this amendment? Okay, with that, L002 passes. Would someone like to move L003?
I move L003 to House Bill 1092.
Segundo.
Representative Frey, seconds. Sponsors, would you like to describe the amendment?
Representative Wilford. Yes, number one, do not bring this to state affairs, whatever that just happened. Number two, this amendment is one that we worked closely with a stakeholder on to move them to neutral. And as I mentioned earlier, changes the required level of malpractice insurance from $500,000 per incident to $1,000.
Wouldn't that be nice?
$1 million per incident with up to $3 million in aggregate insurance annually. and this is specifically just for midwives who are practicing and have privileges at a hospital but are not employed by the hospital. So would ask for a yes vote.
Any questions on this amendment? Any objections on this amendment? Okay, but that LJ3 passes. Okay, sponsors. Oh, I'm sorry. Do you have any additional amendments? No. Okay, any additional amendments from the committee? Seeing none. Amendments phase is closed. Sponsors, would you like to wrap up?
Representative Wilford. Thank you very much, members, for this robust discussion. There have been a lot of questions. It seems like a lot of confusion, which is why I'm glad that we've been able to have this conversation because I think over the last week or two, there's been a lot of activity, we'll say, trying to influence members to vote a particular way. And I'm glad that we were able to get very clear about what this bill is seeking to do. And that is, we are trying to make sure that a private physician collaboration agreement is not in place for people who are fully qualified and could go through a credentialing process and receive privileges. The barrier has nothing to do with competency. It is ultimately about control. I have to admit I was a little troubled and disappointed by some of the testimony by individuals who were opposed to the bill, alleging that if midwives were to obtain admitting privileges, that that would lead to less than satisfactory patient care. That was disappointing and I think is connected, unfortunately, to the turf war that we see, unfortunately, between midwives and OBGYNs. I think that midwives are phenomenal health care providers that exercise their scope of practice and, you know, really do add to our continuum of care in Colorado and across the nation. I also just wanted to say on the record that I did reach out to the hospital association and to rural providers in particular to try and learn about what it is that they would need in order to move this bill forward. And I never got an answer. I asked them specifically if a hospital can require a physician to sign a collaborative agreement before a midwife can obtain privileges, what happens in communities where physicians simply refuse to sign those agreements? because that scenario in itself negatively impacts patient care and negatively impacts a continuity of care, and that is ultimately what we are trying to do with this bill. We have been very open to amendments. We will continue to be open to amendments and making sure that this is the best policy, but really don't believe that inhibiting midwives and creating additional unnecessary barriers is the right choice for Colorado. So I would ask for your aye vote.
Representative Luck. Thank you, Madam Chair, and thank you, committee. One of the things that we haven't covered today is the why for me. In 2023, I got pregnant during session and found out that I was pregnant during session and then proceeded to lose the child during session. The experience was very traumatic and built on other experiences that I've had with the institutional medical world. later on in that year, I got pregnant again. And my husband was not at all open to my original desire to pursue midwife care because of what had happened and the complications with our first child. And so it took me a little bit of time to convince him that the midwife model was the better model for me. Not necessarily because it was a better model, but because when I walked into an OB's clinic, my heart rate went up and my blood pressure went up every time. I was not comfortable in that space. I was not comfortable with the sterility that faced me. I was not comfortable with any of the dynamics that are just part and parcel of OBGYN care. And so we moved to a midwife a birth center model And I relaxed I felt much more excited about the whole process I felt much more heard When I would go to appointments I was able to relax and just enjoy that moment of whatever was taking place. I learned all sorts of things, like the fact that if you allow for the placenta to stay connected to the child, that it adds nutrients and it adds blood back into the child. And there's there's all these benefits to it if you if instead of whisking the child away to be cleaned up and you know fixed in the in the medical realm that is a hospital environment and you just instead put that child skin to skin that again there are all sorts of benefits to both mother and child and breastfeeding etc etc etc and I was delighted I was delighted with what I was learning about this model. I was delighted with the care. I was delighted with my particular team. Fast forward to January of 2024, I find myself 40 plus hours into active labor without any sort of pain relief. I don't know for those who have given birth whether you remember what it was like to be in laboring pain and not have any sort of relief. But I reached my breaking point and said, I really need an epidural, right? There was nothing wrong with the child. There was nothing wrong with me except for my stamina had given way. That's a long time, right? And so we went to the hospital. It was an icy evening. And I just remember sort of being scooted in because of all of the ice, not wanting to fall. And my midwife had to leave me at the hospital door. I was not even seated in a bed when the OB came in and demanded that I prepare for a C-section. And I said, oh, hold on. Wait, pause. What? No, no, no, no. That's not me. You got the wrong chart because I'm only here for an epidural. and from that moment the hostility pursued or ensued i got an epidural and the midwife came back or sorry the the ob came back my midwife is now gone the ob comes back and says okay we're we're gonna need to give you a c-section and i said i'm not here for a c-section and some of the comments that she made during this interaction told me that she was very irritated that i had chose in the midwife model instead of the OB model. And she continued to push. And I said, well, okay, is there anything wrong with the baby? No. All right. So then what is wrong with just setting some benchmarks? How about if in an hour X hasn't happened, we regroup on this question? Okay, fine. Well, an hour passed and the benchmark was met and she seemed very disappointed. In fact, she was very flustered. The next benchmark was set and met. The hostility continued to increase. We continued forward. Nothing was wrong with the child. Nothing was wrong with me, but it was about shift change time. And she walked into my room and said, you have three options You have your epidural so you can leave Your baby can die even though there was no indication that anything was wrong or you can have a C I said no. I said, it is my understanding that the baby is visible enough to where you can use suction. I'd like you to use suction. And she agreed to three rounds of suction and proceeded to do only one. And when I spoke to a doctor afterwards about the experience, because I had enough feeling with epidural because I was blessed in that way to still feel some things, and I explained the sensation, he said she didn't suction properly. It is my strong belief that I could have given natural birth to that child, but because the OB model treats birth more like a medical event than a natural process, which is why they have high interventions and more costs, and because shift was coming to an end, she wanted that C-section to happen. As a result, I ended up having a C-section. A C-section where, despite her promise to allow my husband into the room before it happened so he could be there the whole time, he wasn't there until after my child was already delivered and on the table, placenta cut, and all of the things that we had decided, gone. I was not able to hold that child in those first moments and have that golden hour with him on my breast. and that impacted a whole range of things. Those decisions, that care impacted a whole range of things that even impact us too today. Just different complications and consequences that this body and the rest of the world don't need to know about. If my midwife had been allowed to continue care with me, it would have been a different experience. All I needed was an anesthesiologist to give me an epidural. I didn't need any other interventions. I didn't need any other OB-specific treatment. I didn't need her scope of practice. The midwife would have been wholly capable to deliver my son in the way that I had dreamed about for months. But I was deprived of that opportunity, in part because hospitals put up these barriers. barriers that they cannot point us to reasonable ways that they can't resolve we're not against patient safety we are for women to be able to have the choice in that most intimate of moments the provider that they feel most comfortable with and that will best honor their particular situation So that's why I'm bringing this bill. I'm also bringing it because my doula was there, which is interesting that a doula could be there too. She said, I've never seen someone so gracious under such a situation and in such pain. In the recovery room next to mine was a teenage girl. She had no family with her. She's completely alone. The event was traumatizing to me and I stood my ground through many of the situations How many more women who don have the skill set that I have developed in this building and other places are pressured to do things that traumatize them and their children for life? And so I'm here not only for my story, but for that teenage girl in the room next to me. because I just think that if you're going to be more comfortable with a midwife, that in government-run hospitals, you should have the right to have that care. So I ask for your aye vote.
Thank you, sponsors.
Vice Chair Leader, would you like to move the bill to the Committee of the Whole? I move House Bill 261092 to the Committee of the Whole.
As amended.
As amended.
Representative Frey, second.
Closing comments from the committee.
Representative Stewart. Thank you, Madam Chair, and thank you, bill sponsors. We've had some conversations, and I know where your heart is, and Representative Luck, thank you for sharing your story. I can imagine and I can picture because I was in a similar situation, and I'm very moved and I appreciate you sharing. And, you know, expanding access to health care is certainly something that I work on every day in this building, or at least try to. So I really do appreciate you bringing this forward in this discussion. I am stuck on the collaborative agreement. It's sticking with me quite a bit. Um, and I, I'll be a respectful no today, but it's not because I, I don't support the work that you're, you're trying to accomplish. And I hope we can continue to have conversations about expanding this care. And I just, I really appreciate you both.
Thank you.
Representative McCormick. Thank you, Madam Chair. Thank you for sharing your story. And I'm sorry that you had such a not good experience, to put it mildly, and that it stuck with you and it will stick with you. That is hard to hear, and I'm sure it was really hard to go through. I heard from the Elephant Circle person. She even said that she spoke of appropriate supervision and collaboration for midwives. So I'm also confused about what she said. I wrote it down right after she said it. And then the amendment language that forbids that to happen. And I think there may be others here, too, that we're not really clear on exactly what the credentialing process would cover versus what this forbidding a collaborative agreement would be. Also, I'm unclear on which hospitals in our state this would apply to and how they would go forward. How many people would we be opening up access to? I completely support midwives and love that they exist. I think that when you share the Denver Health model, yes, why can't we all have that model where they have departments for each and there is that choice? Yeah. Two will be a respectful no today and appreciate having this conversation.
It's opened up a lot more questions, actually, in my head.
Representative Bradley. Thank you, Madam Chair. Thank you, Rep. Locke, for sharing your story. Anyone that loses a child is not for the faint of heart, that's for sure. I guess I'm confused as to the question still surrounding the collaborative agreement. We heard it's just a piece of paper versus a protocol to follow. So hospitals are not going to credential midwives and then allow safe or unsafe standards to occur, especially one of the highest malpractice issues in medicine. They are going to ensure that if they credential, I mean, Denver Health credentials. Denver Health has two different models, and they probably deliver more babies in our state than I would say any other hospital. So if they can allow it and there's no malpractice and midwives are stepping over their scope of practice, then we know it's not happening because they're responsible for tons of babies being born. There's a credentialing process that you're not asking the hospitals to do. The hospitals come up with that game plan. The hospitals put it into place. The hospitals put the protocol to follow. It's not the Rep Luck and Rep Wilford, we're going to create the credentialing process like happens in this building with mandates all the time. Midwives are allowed to deliver in the state regardless. There's a midwife model at Denver Health because they believe that is a safe practice. And so I hear rural deserts and barriers to care, but then we're not going to vote on this bill and allow for those barriers to care to be brought down. And so I'm left scratching my head a little bit. Sometimes I wonder if the difference in costs for a vaginal delivery or, excuse me, a C-section and for OBs to charge is way more than midwives to charge. And I wonder if that's why some of the lobbyists came out to oppose your bill. This is a turf war. I've been in medicine for 26 years. It's been a turf war for that long. Chiropractors telling PTs we can't manipulate, we're going to kill patients, we can't dry needle, we're going to puncture a lung. That does not happen What happens when PTs are allowed to do those things is that access for care increases and your patients actually get the care that they deserve and need I would never be on a bill or vote in favor of a bill that would remove safeguarding for patients. This is a terrafore, plain and simple, and patients are going to pay the consequences of it. I will be a strong no.
Yes, thank you.
Representative Hamrick. Thank you, Madam Chair, and thank you so much for bringing the bill. I learned a lot today, and I'm really sorry, Rep Black, about that situation and wish it had been different. So from those who testified today, I learned that currently midwives are active in the hospitals, ensuring continuity of care, which is really, really great. I do, though, worry about the dissolution or the weakening of the current care team, of which the med wives seem to be a part of by prohibiting the requirement of supervisory or collaborative agreements. So I worry about the risks to the patient, and I'll be a respectful note today, but I appreciate you bringing the bill.
Vice Chair Leader.
Thank you, Madam Chair. I come in here, didn't know how I was going to vote. I've looked at this and looked at this, and I've learned a lot. the collaborative agreement is a hang-up. The insurance piece of it, as I spoke with Wilford about, I want to see the equal insurance. I think your amendment, though, addresses some of it, not all of it. But what I also hear is that you are willing to continue having more discussion in regards to this. And I know exactly what you're talking about in regards to the situation that you were in, and I'm so sorry for that. So I'll be respectful yes today, as long as you can continue to work on with that, because I didn't know how I was going to vote. I told Rep Wilford that I'm not sure how I'm voting for this. I'm going to listen to the testimony. So thank you, and thank you for everybody who came in here and testified.
Representative Fred.
Thank you, Madam Chair. And I echo that as well. Representative Luck, you went through something very traumatic. and clearly you are a good advocate for yourself because you've learned those skills and everybody is able to do that and I applaud you for being able to move through that. I did promise you that I would listen today and I did my best to truly try to understand what I was hearing and give it my full attention So I did do that I still heard a lot of conflicting testimony of what is in current practice and still confusion I'm just not ultimately convinced. So I will be a no, but a very respectful no. And I do think there are those barriers around this. And I would be really interested in those 10 hospitals that maybe we can identify or could be identified. and engaging each of them individually and to understand more about is the collaborative agreement the source spot or is there something else that is preventing continuity of care among midwives and the physicians who are treating them in the hospital. And I'm also really curious why your doctor didn't have those relationships with some of the hospitals to help provide that for their patients. So those are some of the questions that I was going through my head. Thank you, sponsors, so much for bringing this bill today, and thanks for the tremendous efforts to work with different stakeholders to get here. I think I said this, Representative Luck, when we first started talking about this, but I worked on a year-long project on midwifery internationally, And the data is so clear that midwives make a tremendous impact on the health and safety of women and their children and babies. And so I think I'm in complete agreement about that fact. And I think it's incredibly important that we promote that practice in every way we possibly can in the state of Colorado and across the world because of the impact they have during birth and after and before. And so I also think, you know, I think I was delighted to hear in this process about hospitals like Denver Health who are doing this collaboratively with midwives and that there are examples to point to and that we can continue to build that out in our system. And I think that's incredibly important. I also think that the folks who came and testified in opposition or the folks that are asking questions I think it really important to make sure that that doesn mean that we against midwifery or the practice of midwives or the tremendous impact they bring And I think that that important to to make sure that we not you know questioning someone intention I think that important to make sure that we not questioning someone intention I think again as we heard from others on the committee that there just still questions And so I, in particular, the clarity around the list of hospitals, I think, would be really helpful to understand which hospitals would be impacted by this and how. and then kind of further defining what the collaborative agreement looks like, just so that we can make sure that there are those expansion of a system like what we heard from Denver Health in hospitals, that, again, where midwives are able to work collaboratively with the hospital staff and that we're not putting anyone at a liability risk and also making sure that we're keeping moms and babies safe. So I really, really appreciate this. I appreciate your story, sharing such an intimate and difficult story too and turning that into something that could change other people's experiences. So I really, really appreciate that and hope that whatever happens today, that these conversations continue. So thank you for bringing the bill today.
With that, Mr. Shudun, can you please call the roll?
Representative Frey? Yes. Leader? Yes. Madam Chair? No.
The bill fails on the count of four to nine. I make a motion to P.I. the bill in the reverse order of the roll call vote. Second by Representative Frey. Any objections? Seeing none, the bill is postponed indefinitely. With that, the Health and Human Services Committee is adjourned.