House Health & Human Services [Mar 11, 2026]

Representative Zabaron.

Radfield.

Here.

Bradfield is here.

English.

Frey.

Hamrick.

Johnson.

Luck.

McCormick.

Raiden.

Stewart.

Leader.

Madam Chair.

Okay. Welcome, everyone. We're off to a fun start this late afternoon. We are going to hear the following bills in this order, 1019 with the representatives that are here now, and then 1116, 1260, 1092, 1235, and 1214. witnesses will have two minutes and ten minute panels and with that we'll turn it over to

Just for you all, over the last couple of years, Representative Leder has talked to me about this task force and asked me for continued support of it. And I'm not sure if many of you know why or know my story with this issue. My mom moved to Boulder, Colorado around 2005 and 2006. But it wasn't until 2009 that she got some very important information. Until then, she had visited her doctors regularly in Mississippi. And upon finally having a physician in Colorado, they did one screening and determined that she needed a new kidney. And so when I think about what this bill means as a matter of actual life or death, I think about a very real reality in that if she didn't have doctors who cared enough to look into things a little bit more or to do particular blood work, she may not still be with me now. I was not able to give her one of my kidneys, and one of my first cousins is her donor. But the conversation we had as a family was about why is it that her physicians in Mississippi didn't care to screen for kidney illness and kidney disease. And because of this state, which even though we hadn't passed this bill yet, the caliber of doctor that she had decided to do that, and they saw that her creatinine levels were exceptionally impacted and that she moved into the transplant list. I, unfortunately, was taking a law school final during that surgery. But, again, that surgery was in 2009, and my mother is still here with us today. And so I want to turn to you all to a few phrases or sentences in the legislative deck and a few sentences from the task force report. In the legislative deck, it does say starting on lines 14, and we're looking at a strike below as well, so I do want to acknowledge that. But there is language there that talks about the number of individuals who have chronic kidney disease is disproportionately higher in minority communities. Unfortunately, the African American community has a higher representation of those who have diabetes along with hypertension. Those are the diseases that deeply impact the kidney. I would also say in reading from the task force's final recommendations, it says in light of the data presented, it is evident that the state of Colorado has the opportunity to make strategic investments in early screening and interventions for chronic kidney disease, potentially yielding significant savings in the long run. And some of those savings go from spending a fraction of a dollar on a pill. I don't know if I'm allowed to say things, but a lot of us are familiar with a certain diabetes pill, right? To having to spend, you know what I mean?

I'm allowed to say it.

This is a majority.

okay but and we think about how much that costs compared to the cost of dialysis or the cost of a transplant and the medication that you need after a transplant that is anti-rejection medication for the rest of your life and so when we think about the communities that are impacting and the low cost of prevention versus dealing with the high cost later as you heard from our co we do believe that it is a strategic advancement and therefore want to label this as preventative care And so with that, members, thank you for listening to us, listening to our stories. It's an honor to be here, and we will yield for questions.

Thank you, Madam Chair, and thank you to the bill sponsors. I guess my question would be, why not allow the insurance carriers to tailor the specific population in different regions versus just, I'm not a big mandator. I don't like that word. So why not maybe permissive or allow them to tailor it towards the populations that maybe need it more than other populations?

Additional questions from the committee? Okay. Seeing none, we'll move on to our witness testimony. Thank you, sponsors. Okay. Let's bring up Kelly Strother, Lance Thorne, Christy Kibler. Kibler, sorry. and then we have two remote Seth Levy and Amber Wall and then we have two folks from DOI for questions only if we could have Deb Judy and Tara Smith come forward as well we can maybe pull a chair up if we needed an additional one do we need to move Perfect. Well, thank you so much. Wonderful. Why don't we start from my left to right? If you could introduce yourself, the organization that you represent. I know you both are here for questions only, so that's all you need to do. And then if the rest of the witnesses have two minutes, please proceed.

If we could just have it on the mic, sorry. The tiny little, perfect.

Okay.

It looked like it was on.

I'm Tara Smith. I'm with the Colorado Division of Insurance.

Thank you. Please proceed. A tiny little button by the plug. Nice. We're on. Okay.

Thank you so much for your testimony. Please proceed.

Thank you so much. Please proceed.

Thank you so much for your testimony. Really appreciate it. We'll move online to Dr. Levy.

We can.

thousands of lives throughout our state. Thank you so much for your testimony. We'll move on to our final witness, Amber Wall.

We can.

And questions from the committee. Representative Hamrick.

Okay, so picking up. And yet when cost sharing stands between a patient and preventive screening, people skip it. We see this in our community every day. The patients most at risk for kidney disease, those living with diabetes, hypertension, or family history, or communities of color who face disproportionately higher rates of kidney failure, then must absorb an unexpected medical bill. This bill would eliminate that barrier entirely. This bill aligns Colorado with evidence-based preventive care guidelines that ensures that doing the right thing for your health doesn't come at a financial penalty. It is a targeted, meaningful intervention that will save lives and reduce downstream costs across our health system. On behalf of patients, families, and communities we serve, the National Kennedy Foundation of Colorado urges a yes vote on House Bill 26-10-19. We are grateful to the bill's sponsor for their leadership, and we are happy to serve as a resource to this community and to the committee. Thank you.

Thank you. Thank you for your testimony. Any additional questions from the committee?

Dr. Levy. Yeah, thank you for the opportunity to speak on this. So we have done some of these outreach campaigns. I'm also a member of the board of the National Kidney Foundation, and we've done some public health screenings. The problem with that is the scale is small, although the targeted audience is very worthy because these are often, I mean everybody worthy but these are often under or uninsured patients who are minority status who are both less likely to get the care and also have a higher genetic risk So it absolutely a valid effort The challenge is that the scale is small And the reason that we are advocates of this bill is because even in the healthcare provider's office, where they may probably be aware of the situation, they have a lot of other requirements. You know, there's a lot to consider when you have to evaluate a patient in 15, 20 minutes who has multiple chronic diseases. Part of the benefit of this bill is it makes it easier for them to offer it, both by not having the financial barrier and then also as a recommendative service. We know from other health conditions that these do improve quantity and quality of lives. For example, colonoscopies, mammograms. These are fairly advanced tests that we do recommend to screen for cancers. and they do save lives, far fewer lives than those that are lost to kidney disease, however. Doctors are also encouraged to ask about smoking, vaccinations. You know, there's a number of things that they're encouraged to do. So these just get done more. Even though we have very diligent, very intelligent people in our health care force, they're quite busy. And so if this goes under the radar because the patients won't ask about it, they often won't have symptoms. they won't get diagnosed until later. And so the whole effort to move this upstream is to make it easier on patients, easier on healthcare providers, which by the way, will save millions of dollars for the healthcare system and everyone benefits. We're making it easier. We're removing barriers, which will lead to more action taken, which means more patients screened at an earlier stage where they're treating themselves or they're being treated with partnership from the healthcare provider, which is far more effective. Sorry, continue. I just wanted the benefit I wanted to mention as we've discussed that the cost of the screening is just a few dollars versus the many tens or hundreds of thousands of dollars of treating the advanced disease. So the tests will more than pay for themselves. But there's one additional benefit to our society, which is that, you know, as a kidney doctor, I've been treating these patients for almost 20 years. And what I see with someone who has mild kidney disease is they come in the office every few months, maybe once a year, and then they go. They're well. They're going to take their kids to school. They're going to work. They're contributing to society in a way that the advanced disease patients do not. These patients that I see in the dialysis unit, they need a lot of help. They have typically very little energy. Some of them are doing pretty well. Many of them are just kind of getting by. They drain a lot of resource. They end up in a hospital. They get various procedures. They often have to have transportation from their other family members or from a hired service. It's a lot of resource and there's not being much put back in. So the other benefit of keeping patients healthy by screening and treating earlier is that these are patients who do go to work. They pay taxes. They're contributing to society. You know, there are untold benefits to everyone, whether you have kidney disease or not, by addressing this underrecognized disease and helping to treat it earlier.

Thank you, Madam Chair.

Dr. Alibi? Yes, thank you for that clarification. So that's why we want the screening to be covered at no cost to the patient, because the barrier is the financial barrier. Even though the test only costs a few dollars, sometimes the bill that the patient will receive could be several hundred dollars. And although under the Affordable Care Act, all people are granted access to certain preventative services, including annual screening visits with their doctor, that doesn't necessarily cover labs. And so the doctor may ask screening questions, and if it's not a colonoscopy, they may not recommend it. If it's not a mammogram, they may not recommend it. The patient may not want it if they have cost sensitivity. And then what happens is eventually it gets picked up far later when they land in the ER and they've got some advanced disease. What we're promoting is an office visit outpatient and auditory well patients getting screened where their doctor, their healthcare provider can say, hey, by the way, this won't cost you anything. Most people would probably consent to that. And not all of them will be positive, but the ones who will wouldn't have known it in most other cases. And now they have the opportunity to intervene when they're still otherwise a fairly stable well patient.

Ms. Judy, Ms. Smith? Ms. Judy. Thank you, Madam Chair. I think somebody could opt out of a test if they didn't want to take a test and it should not show up on their coverage. They shouldn't be paying for it.

Ms. Judy? Thank you, Madam Chair. Thank you, Representative. I don't think the legislation includes a specific age that it starts, is my recollection of the bill as it's written.

My name is Judy. Coverage? Madam Chair, thank you, Representative. So, carriers are required to cover, I'm going to talk about major medical plans, essential what we call qualified health benefit plans. They are required to cover 10 essential health benefits. That includes lab tests, ambulatory, you know, hospital services, mental and behavioral health visits there 10 of them I can think of them all off the top of my head Then we are also required to cover certain preventative services This is not considered a preventative service at the moment Those are dictated by three national organizations. My understanding is the U.S. Preventative Services Task Force, which helps set our preventative services guidelines, is currently reviewing whether to cover kidney screening, but it is not. So what we require of carriers is that they cover those essential health benefits, they cover all those preventative services that are required by the Affordable Care Act. We did conduct a study, the representative asked for an analysis. We do believe that in many cases carriers are already covering these services, but not necessarily for screening of an asymptomatic person.

Good afternoon, Chair and members of the committee. My name is Dr. Jessie Shea. I use she, her pronouns, and I'm the Executive Director of Chronically Informed, a nonprofit that supports patients with chronic health conditions as they navigate the medical system. I am a doctor of social work with an expertise on the experience patients have who live with chronic illness. And most importantly, I am a patient who lives with a number of chronic medical conditions myself. One of the chronic conditions I live with is kidney disease. I'm here today to testify in support of House Bill 26-1019. For years, I was lucky enough to receive kidney screenings because I was on medication that indicated the tests were necessary. After being on that medication for more than 25 years, my creatinine went up dramatically, suggesting I had developed issues with my kidney function. My doctor then referred me to a nephrologist who confirmed that I do, in fact, have kidney disease. If I had not been receiving regular kidney screenings, I would not have been diagnosed in time to actively treat the condition and improve my health. I am now being treated for my kidney disease with one pill a day, not dialysis. The kidney screenings I received prevented more invasive treatment and made it so I can take less medication than if I had been diagnosed after the kidney disease had progressed. By passing this law, you will be making life-changing and sometimes life-saving screenings available to patients who might not be able to access it otherwise. This inexpensive, simple test will help patients get the care they need sooner and prevent what could be a death sentence for some. Living with chronic kidney disease can be difficult, but what makes it more difficult is not catching it in time to prevent serious kidney damage. With routine screenings, patients can end up like me, someone who takes a tiny pill once a day and has a future that will likely never include dialysis or kidney surgery. Everyone deserves the access to quality health care that I have been so lucky to have. Please support this bill. You can save lives. Thank you for your time.

Vice Chair Leader would you like to move your amendment Yes It a strike below You all should have got it the other day And it L I move to House Bill 1019.

Please explain the amendment. Thank you.

Okay. Any questions on the amendment? Seeing none, any objections?

Mr. Shadun, can you please call the roll? Representative Verón?

Bradfield?

Bradley?

English?

Frey?

No.

Wrighton? Yes.

Leader. Yes. Madam Chair. Yes.

AML Bacon sorry members thank you so much for hearing the stories today and thank you to the witnesses who came to share their experiences as well I do want to thank you also for voting for the strike below had the strike below not been passed you would be voting on a bill that includes a little bit more by way of the screening and the tests along with some things that we have heard in regards to coverage for, you know, the high deductible plans and the HSAs, those would not have been included in the bill. So the vote for the strike below, we bring to you a leaner bill that has been stake held in regards to an understanding, a better understanding of what could be included in the screening, including the two types of tests that you heard and where this coverage could extend to. Just for a little bit of history, you know, five years ago, we also had conversations about preventative care. And there we included things like osteoporosis and breast cancer screening. And what we do know is as we move things along with our understanding of our health conditions, we do understand that preventative care is exactly what the name suggests. It does not only save people their lives it saves businesses costs it saves the state costs with our coverage And again when we talk about right now what the medication can be as you even heard from our witnesses, to treat things like diabetes and hypertension, given how low that cost is due to medical advances, we believe, and along with the task force, believes that this is a sound investment. The task force even goes so much as to say that, you know, we implore you to not think of this as a cost. We implore you to think of this as a strategic investment and that we do know that this illness can be cut early. And also in regards to what we heard from the physicians, you know, thank you for the questions. If it is not considered preventative care, then it doesn't have the coverage as it is. And so even though community outreach may occur, people will still have to pay for the screening. And that's, again, why we're having it declared as preventative, so that it could be covered by insurance policies, so that down the line, it will not only save dollars, but it will save lives. And so for many people who have talked to us about ROI and return on investment, we believe that this coverage is a sound one. And so while I can appreciate the concerns around a mandate, I will say that over time, when all of us have come to a conclusion in regards to not only how many lives or money it will save us, that's what should be matched by a mandate, because it is a statement to say that we find this to be preventative when we find it to be life-saving. And so again, this is not the only time we have talked about illnesses in our coverage. Again, five years ago, we included postnatal depression because we find the same types of benefits by way of cost-benefit analysis. And so with that, members, we have an opportunity to do something here to bring more people into the fold of something that is treatable, something that can occur even though it hits communities, certain communities at a disproportionately high rate, it doesn't mean it doesn't hit all communities. And if we have an opportunity as a state to say that we care and we now know this is studied for the outcomes, then we should do that. And so with that, members, I do encourage an aye vote. And again, I look forward to any continued conversations and discussions. but let's make a decision that can help a lot of good people today. Thank you.

And thanks to everybody who came up here and testified. This has been a long time working on this bill, and I appreciate their time and the wait. I mean, this is 130, but, you know, things happen. That's the way we bake the stuff here. So early screening prevents late diagnosis, particularly for high-risk populations. You've heard it. With hypertension, diabetes, it enables timely medical intervention before kidney disease progresses to costly advanced stages. The bill will also reduce the overall financial burden on patients, insurance plans, and state health care plans through cost-effective preventative care, as is in the actuary study. This is personal for me. My brother was a transplant receiver. unfortunately he's since passed but it wasn't because of the kidney he had a great kidney and it was still working strong so just like your Annual exam, this is straightforward, preventative care. The Affordable Care Act requires coverage for cancer screenings, heart disease screenings, and diabetes screenings. He was a diabetic since he was 17. I didn't want to age limit on it. I have friends that have kids that are seven. Kidney disease is the ninth leading cause of death globally. Early detection works, and it saves money and lives. With that, I ask for an aye vote.

I move House Bill 1019 as amended to the Committee of the Whole.

Thank you so much, Rep. Leader and Rep. Bacon, for bringing this really important bill and the people that testified, especially the young man. And Sheila, you're talking about people as young as seven if they're diagnosed early. So thank you for bringing this and the awareness of kidney issues, and I'll be an enthusiastic guest.

Representative Zabaron.

Bradfield.

Bradley.

English.

Ray.

Hamrick.

Johnson.

Luck.

Formick.

Wrighton.

Stewart.

Leader.

Madam Chair.

Thanks, Representative Ryden. Tell us about your bill.

Hi, everybody. So many of you know I have been really working to try to understand our crisis response system, especially when it comes to psychiatric crisis. We've been trying to unpack this. I thought we were going to address one lever with 11-16 that we proposed. Those were in the first couple sections of the bill. I am learning some new things as a newish legislature, legislator, and the surprise of costs that sometimes happen when we have these ideas. And so you're seeing the amendment that we have, which really is going to strike most of this bill. I spoke with some of you already about this. I emailed you essentially the amendment to strike the bulk of it. and then you also have a revised fiscal note as well that is kind of why we're striking most of it but really what is left is still good things the two components left is really going to make life easier for healthcare providers and it's going to allow for a little bit faster access to mental health treatment in the outpatient space so the section 5 of the bill It going to provide some clarity to our hospitals and you hear from them a little bit on why they need that clarity But when a 72-hour hold is issued, that is, again, someone is in psychiatric crisis, they're brought to a walk-in center or they're brought to a hospital, and then they're further evaluated, those three days, those 72 hours expire. In current statute, after that expires, the hospital is required per current law to follow up with them within at least 48 hours. That has provided a little bit of confusion to some of the folks in that community. And again, you'll hear the specifics of that. So what we're looking to do with this part of the bell is just expand that to 72 hours for the follow-up call to happen. And within that timeframe, I'm going to be very specific about what that is to help with with some of the lack of clarity that some of the folks in the hospitals are experiencing. The last part, Section 6, this is just permission to the Behavioral Health Administration to accept local inspection of outpatient providers. And it kind of clarifies that if you're doing telehealth, you don't need to have an inspection. So again, just trying to, I think we've been looking for ways to figure out what are the barriers to people accessing care and for brick and mortar clinics, you know, to get up and running again, especially post-COVID. We've had a lot of people wanting to return to in-person. And this is one of those hurdles is having to wait for a state inspection. So it doesn't make it seems like that's a bit of a redundancy. So can we cut some of that redundancy by just making a clearance statute that that can be accepted by the Behavioral Health Administration? So with that, again, the goal really of this bill originally was to look at improving the crisis response system. We can't do all that right now. I'm going to keep working on it. But for now, we at least can do these two things that you see in that amendment. And with that, I can turn it over to my colleague.

Thank you, Madam Chair.

Thank you, sponsors.

Representative Fryden. thank you for the question yes I think that was part of the impetus for this as we were hearing that it is a little challenging to follow through on these things and I have concerns about this part of the bill as written which was put in a statute several years ago And as I investigating more of what happens to our folks in psychiatric crisis and the follow care I do wonder about some of the stuff that's actually happening. I'm going to continue to look into that. I wouldn't say it's an unfunded mandate. I think they have been doing it, and they've been doing it the best they can, because we know that's what health care providers do. They do the best they can often with what they have to work with. but the reason was is we've got to give a little bit more space and capacity in order to do that I've worked in psych hospitals on the weekends as like as needed and it's chaos and you know you are just trying to do everything you can following the law as best you can that's also why you'll notice there's that exclusion excluding weekends and holidays to also give a little bit of additional space and breath and flexibility to the health care providers who truly and that's mostly the nurses and social workers who are doing, and maybe some of the case managers if they have case management on the weekends, which often they don't. So it does sometimes fall in the nurses to do some of these follow-ups. I hope that answers your question. Additional questions from the committee.

Madam Chair. So in talking, I think when we spoke, and tell me if I was wrong, first of all, I'm sorry you had to amend this like this. It's heartbreaking when you worked so hard on something. So thank you for being open to listening to people bringing this forward. I know that that's frustrating. You were just clarifying because the at least 48 hours was very confusing for a lot of people. So putting into statute the 72 hours after discharge is clearing up that kind of ambiguous statute, correct?

confusion. Additional questions from the committee? Okay, seeing none, we'll move on to the witness testimony. Thank you, sponsors. We're going to go ahead and call up Aubrey Shomo, Ryan Templeton, Kristen Hartman, Alicia Bunch, and Frank Cornelia. While we're bringing up folks online, if you want to go ahead and get started, Mr. Templeton, introduce yourself, the organization that you represent, and you have two minutes.

Thank you so much for your testimony.

Perfect. I will move to online. Kristen Hartman, please.

Thank you so much for your testimony. We'll move on to Alicia Bunch.

Thank you for your testimony. We'll move on to Frank Cornelia.

Thank you so much for your testimony. We'll move on to Aubrey Shomo.

to a day in court. Thank you for your testimony. Thank you for your testimony. That currently have no other option. Thank you for your testimony. We need to move on. Questions from the committee? No questions from the committee. Okay, thank you so much for participating. We appreciate you being here today. Is there anyone else in the audience or online that would like to testify? With that, the witness phase is closed. Sponsors,

Representative Wright.

Please describe the amendment.

Thank you, Madam Chair. I'll just say I'm going to keep working on it. There's so much to do, and as I look more and more at the statute and try to reach out to the different folks who are impacted by it, I'm seeing more and more in the confusion in the way our statute is written. I don't think that's okay. You heard a little bit about that. It's complicated. It's hard for – I'm an educated individual. I have a lot of different license in this space, and I still have to read some of these statues five, six times to understand what they are. How are we expecting consumers to be able to understand this well, let alone other providers and things like that. So I'm committed to working on this so you will see more from me and perhaps Representative Gonzalez on this in the future. Representative Gonzalez. Thank you, Madam Chair, and I'll keep it short, but again, I just need this to add clarity for some of the providers of what they need, a step in the right direction, and as my co-prime said, there is much work to be done, and I look forward to the discussions and state calling that will ensue afterwards to make sure we get this in place. And in the budget, hopefully next year we will have it in a better condition where we can have more leverage and more services and options and resources provided to us to help get us there, especially with parity. That's so important to our providers in the health care industry. Overall, go to Bill. Vote yes.

Thank you, Madam Chair. I move House Bill 1116 to the Committee of the Whole as amended with a favorable recommendation.

Additional comments from the committee?

Representative Bradfield. Thank you, Madam Chair. This bill has, my goodness, it has certainly changed from the first one you and I had talked about. I know that you'll come back with more next time, and I look forward to seeing that. I am a yes for today. I feel like you have taken the step in the right direction for this, and to have statute be so confusing that people don't know what to do is something that we need to take care of. Thank you.

Okay. Representative Luck. Thank you Madam Chair I too want to add in that I think what you are trying to accomplish is noble and made nobler still by the challenge of it all As someone who walked with a family member throughout different crises like this and realizing how confused the situation is and how seemingly unaccessible, I appreciate your desire long-term to try and create something that is more holistic and sensible and not made piecemeal, but actually made with design from the beginning. And so I just want to encourage you in that, because I know that operating in any of these kind of spaces is especially difficult with all of the different voices, and so I don't want you to be discouraged in this process. I want you to know that we think that it is important work you're doing, and we thank you for it.

Representatives, we're on. Yes.

Bradley. Yes.

Frey. Yes.

Johnson. Pass.

McCormick. Yes.

Stewart. Excuse.

Leader. Yes.

Passes. 12 to 0 with one excuse.

Thank you, Madam Chair. Good afternoon, committee. I want to just give a special shout out. It's great to see Representative Luck on this committee. and Representative Bradley. It's always great to see Rep Bradley. And Rep Barone. And Rep Johnson, although she's not here, and especially Rep Bradfield. Okay.

To the bill. And I'd love to see my colleagues on this side of the aisle, too.

Members of committee, Madam Chair, Representative Wilford and I are pleased to be with you this afternoon and to tell you more about House Bill 1260, why it's needed to ensure Colorado families and their kids continue to have access to quality, affordable child care through the Colorado Child Care Assistance Program, also known as CCAP. Easy access to affordable childcare is a foundational block of building Colorado's future. I hear this regularly from my constituents and I'm sure the same is for each of you. No matter which part of the state you represent, parents are running small businesses, they're working 9 to 5, 9 to 8, 10 to 4, managing overnight shifts and running between multiple part-time positions and they all need childcare. Affordable child care strengthens Colorado's economy by supporting families of all kinds to remind the workforce and providing children with the experiences they need for healthy development. But the rising cost of child care remains one of the biggest challenges that Colorado families are facing. According to a poll commissioned by Healthier Colorado last year, 72% of Coloradans think the cost of child care is unaffordable. Moreover, 65% said they do not have access to quality, affordable child care in their communities. Those numbers reflect what we all know is true. This is an issue that transcends politics. Regardless of where you live or how you vote, we need to get more parents connected to affordable, reliable, quality child care. House Bill 1260 helps bring us closer to that goal. House Bill 1260 allows Colorado Department of Early Childhood to remain flexible to the state's current budget reality and build towards a long-term funding solution for CCAP. The bill extends the implementation date of four provisions that we passed in House Bill 1223 that support child care providers and improve access to affordable quality care from August 1, 2026 to August 1, 2028. These provisions are, one, paying rates based on enrollment instead of attendance, compensating providers prospectively instead of through retroactive reimbursements, using grants or contracts to better serve certain populations, and ensuring that families spend no more than 7% of their income on child care. The bill in its current form also clarifies that no more than 5% of the funding allocated to counties for child care may be used for administrative costs. However, we have received feedback from the department and many county representatives that this may cause unintended consequences, so we'll be bringing an amendment forward later in the hearing changing this to a reporting requirement. CCAP is a proven economic tool to ensure child care isn't yet another hardship for parents. Historic underinvestments in the program, coupled with rising child care costs driven by overdue provider pay increases, quality improvements, inflation, workforce challenges, and the goal of providing CCAP families with equitable access to child care comparable to the private pay market are placing the program under significant budget pressure. That is why we need you to support House Bill 1260 today. Data from Ready Nation, an initiative by the Institute for Child Success, shows that failing to adequately support our already fragile child care infrastructure has caused growing economic harm to employers, workers, and taxpayers. And without action, we do ongoing harm to Colorado's economy. Without a strong and stable system of child care, our families cannot support themselves and our workforce cannot meet the needs of our business. And finally, research has shown time and time again that connecting kids to high-quality child care has lasting benefits that follow them into adulthood. Numerous studies show that children who enter care programs earlier and for longer demonstrate stronger academic performance, language skills, social-emotional intelligence, and health outcomes when compared to kids who do not attend child care programs. Before handing things over to Ruck Wilford, I want to share my own experiences with the child care field. Some of you may know that my job outside the Capitol is leading the Colorado Statewide Parent Coalition, a nonprofit organization that supports informal child care providers. The family members, friends, and neighbors who take care of our kids while their parents are at work. And I seen firsthand how the lives of both children and parents are transformed when they are connected to quality dependable child care and how integral our society child care providers truly are Thank you for your time, and I'll hand it over to my co-prime.

Thank you very much, Madam Chair. And thank you, Representative Garcia. It's an honor to sponsor this bill with you. As legislators and for many of us as parents, we experience this reality daily. Child care affords us the opportunity to come to the Capitol and do work that we believe in on behalf of our communities. Members, this bill is so important. For all of the reasons that Representative Garcia talked about and for all the reasons I want to share with you now, for me, this bill is about economic stability for families, healthy development for young children, supporting our child care providers across the state, and ultimately building stronger supportive communities. Working Colorado families are the backbone of our economy and this would not be possible without a stable affordable system of child care providers that parents can count on. Unfortunately for too many families in all of our districts the high costs of child care are forcing families to live under constant financial strain. This means families are forgoing medical care, cutting back on groceries, not enrolling their kids in enrichment opportunities like sports or summer camp, or not making utility payments on time. When parents cannot access dependable, affordable child care, it impacts their work. Many parents have stated that they've had to cut back hours on work, use sick time, left a job, or even put off getting a new job due to the lack of child care. Let's be clear, though. CCAP is not a handout program. It's a lifeline for thousands of parents who are trying to go to work, continue their education, and further their skills to improve the lives and futures of their kids. CCAP helps families achieve more economic stability, all while giving kids who come from low-income households a chance to access quality care so their futures are as bright as their peers who come from higher-income families. When families do well, our communities thrive and our state prospers. This goes to show why House Bill 1260 is needed now. We can't afford any more disruptions to the program that have had a ripple effect on our economy and our community's well-being. Parents deserve every chance to succeed in the workforce, go to school to advance their career, or look for a job while also having the peace of mind of having access to affordable child care. We cannot afford continued disruptions to CCAP, which is why I urge you to support House Bill 1260. All kids deserve the best shot they can get in life, and that starts with early access to child care. The better foundation our kids get when they're young, the better off we will all be in the future. Thank you for your consideration.

Representative Luck. Thank you, Madam Chair. And ladies, forgive me because I am new to this committee and didn't get a chance to thoroughly review this before, but your effective date, you have a safety clause, but your effective date is August 1st, 2026 and all of these other changes. And I just want to make sure that there's nothing that people would have to prepare in advance such that the changes in here would not actually be handling that.

Thank you very much for the question, Representative. The reason why we have a safety clause is because particularly the section that requires the co the 7 co we delaying that because it actually does go into effect If we don delay it it goes into effect this August and it will cost the state money that we don have And so that is why we do need to have the safety clause in there so it goes into effect right away and gets pushed out. And really quick, the other parts of this bill, there hasn't actually been movement towards the implementation of these other provisions. There's nothing that the providers have to take back, if that makes sense.

Representative Garcia. So this original effective date that we're striking, August 1, 2026, is what was written into House Bill 24, 1223 that set the implementation of these provisions that they have to start on August 1 of 2026. So, the Department of Early Childhood submitted a waiver to our federal administration and received the waiver was granted that allows them two additional years before they have to actually start implementing these. And so the reason essentially that we are moving this implementation date to August 1, 2028 is to match that waiver on the first three provisions. And then also the copay provision is also just for the sake of the funds and to match this new model of best practices for early childhood. I don't believe that we would have any sort of influx by having this implementation of shifting the dates, challenging the actual implementation of when these policies should take effect.

Representative Wilford.

Additional questions from the committee?

Representative Garcia. What I will first say about the fraud and I know that we'll have representation from CDET who can also talk about that but what I will say is that Colorado's monitoring of how the funds are spent actually goes above and beyond the requirements of the federal government. We collect more information than we are required to do so as a state And so I think that that's intentional to make sure that we are good stewards of the money that taxpayers trust us with. As far as how can CCAP serve as a support system, when families have CCAP, they also have either a work or a study requirement. And so they have to be working or they have to be studying or they have to be undergoing treatment of some sort so that they can get back into society. And that is essentially this is a step for families to be able to get that job, to be able to show that they can get that promotion, to be able to continue to climb out of poverty. if we what we have seen with the freezes across the across the state with ccap is families are having to make really difficult decisions when they're not benefiting from ccap on or is one of the one of the parents if they're in a two-parent household having to quit their job are they having to pull their kids out of the center that they've had their kid in for the last two or three years and so there's a lot of um a lot of heartache and challenges that families have to overcome when ccap is not available.

Oh, sorry, Representative Frey. Thank you. In your fiscal or in your fact sheet, you said that you're removing a provision with your amendment around the 5% administrative. Do you know what the average administrative cost typically is for child care providers? If we're trying to cap it at 5, is there data that you found out about it being 10, 15, 20.

Any additional questions? Okay. Thank you, sponsors. We'll move to witness testimony. Let's see. We're going to bring up Sarah Dawson, Christina Walker, Pamela Harris, and Alethea Gomez. Okay, we'll start from my left to the right. If you can introduce yourself, the organization you represent, and you have two minutes. And the button is right next to the plug. It's a tiny little gray button. There you go. Great. Good afternoon, Madam Chair and members of the committee.

We'll move on to Ms. Dawson. Thank you, Madam Chair, and thank you, members of the committee.

members of the committee. My name is Christina Walker. I'm the Senior Director of Policy at

Thank you for your testimony. We'll move online to Alathena Gomez.

Thank you so much for your testimony. Questions for this panel? Representative Bradley.

Ms. Harris.

Additional questions for the panel? Representative Bradley.

Ms. Harris.

Representative Bradley. Thank you. Thank you for those clarifying answers. To the department, do you feel like the reporting requirements are enough? I get that some counties have to spend 40,000, or sorry, 40% of the money allocated to counties. Others can do 5%, but the ones that are frivolously spending are reporting requirements enough?

Thank you Madam Chair and thank you Representative Bradley for the question The department is in support of the reporting requirements and are happy to see the amendment come forward

I move L-0... Where did it go? I filed it. L-001 to House Bill 1260.

Representative Johnson, second.

Yes, I would be happy to. Thank you, Madam Chair. All right, so in Amendment L-001, Lines 1 through 2, it strikes the requirement the funding is allocated by the state's allocation committee to each county.

I'm going to stop reading this thing. It basically strikes the 5% requirement to each county and instead says that counties have to report how much of their administrative costs are and how they're spending those administrative costs. And this directly comes from conversations that we've had with counties, including Representative Garcia and I's county ourselves, So it responsive to that And then secondly that it That it Wonderful Any questions about the amendment

Thank you, Madam Chair, members of the committee. Thank you to all of the groups that we were working with to get this through, to the department, to everyone who's engaged in this bill. I know that one of the sentiments that I have is that this is not actually a bill that I would like to be bringing. I don't want to bring a bill that delays implementation of best practice. Unfortunately, because of our situation, because of our structural deficit, we have to. because what we don't want is to plunge us further into a space where we're not going to be able to make these policies sustainable. So it is, to be honest, it is with reluctance that I ask you all to please vote yes on 1260 so that we can keep these best practices in statute and implement them later.

Thank you very much, Madam Chair and committee, for your attention. I share Representative Garcia's perspective and sentiments around the bill. In fact, she came to me earlier in the session and was like, we have to do this thing. We have to delay the implementation. I was like, no, I don't actually want to do that. But the reality is if we don't pass this bill, then the August deadline stays in place, which means that we'll be able to serve fewer families with the existing requirements. And so that's ultimately one of the many reasons that we're pushing them out. I think this is a reasonable and responsible approach, and very much ask for your yes vote tonight.

I move House Bill 261260 as amended to the Committee on Appropriations.

Representative Johnson seconds.

Representative Verón.

Bradfield.

Bradley.

English. Excuse. Frey. Representative Frey. Excuse. Hamrick. Regrabble, yes. Johnson. Yes. Luck. Yes. McCormick. Yes.

on appropriations. Thanks for visiting today. The Health and Human Services Committee will go into a brief recess. Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. The Health and Human Services Committee will come back to order. Okay. A quick announcement. We are going to lay over House Bill 26-12-60, updates to child... Oh, I'm sorry. House Bill 261092, Licensed Midwife Public Health Facility Privileges to a Later Date. Okay. Do I need to bang? Okay. With that, we will move on to House Bill 261235. Representative Array. It's true. The health committee will go into a brief recess. The health committee will come back to order. Representative Ray, would you like to come to the front and present your bill?

Representative Furray.

Thank you. Questions for the sponsor. Representative McCormick.

some of the JVC members, I had flagged that this is a theme that I'm seeing in some of the constituent outreach and emails. They agreed that they saw that too, but they didn't have data to say, are the overhead costs actually 40 to 60 percent? Is that reasonable? I asked HICPF, do you have that data? They didn't have data to really showcase that ratio of direct care costs and overhead administrative costs. If we are able to have that one-time collection, we can see what the trends are. Is it across the agency sectors that we have 40 or 60 percent overhead costs or not? And that helps us to, one, talk to the constituents and say, no, this is actually not the case. Or, yes, this is the case. We should explore it more and have conversations of why there's overhead. In conversations in stakeholder with the agencies, they report that there is a lot of administrative burden and regulation that is causing and driving some of that overhead costs. And I had shared that maybe that's something we need to do next session is cut some of those overly burdensome regulations that are driving up costs. So this data will help further that conversation for the providers as well as ourselves. Additional questions for McBitty.

Got your paper? Yeah. All right. Thank you, Madam Chair. Thank you, Rep. Farre. Just some questions from, there's some home health care providers, some on the Western Open have a few questions, so I'm just going to ask the questions just to get some clarification. And I believe it's on Amendment 3. First of all, how do HCBS providers currently track their financial data in the cost categories required by this bill?

Representative Frey. Thank you, Madam Chair. I believe these metrics are able to be tracked and reported as they're common metrics, so things like workforce compensation, overtime, payroll taxes, bonuses, incentive payments. This feels like common payroll and accounting data and metrics that you can pull. in conversation with the agencies they had shared, you know, this will be really hard to do. I've reached out to the chamber, talked with them. I've reached out to some businesses and asked kind of those concerns. That being said, if there are specific data points that are just too far, we can have that conversation and strike some of those. But at this time, in the compromise, this feels like a fair amount of reporting.

Great. And then another question, what would it cost agencies to rebuild their accounting systems to comply?

Representative Frey. The amendment that we have brought I think it a L004 maybe it was the long one it changes it from annual reporting to that one reporting So there shouldn be a need to rebuild accounting systems But again, in my conversations with business and chambers asking around payroll and accounting and data points that I specifically shared with them, they felt that there wouldn't be a need for accounting changes. So I could see that being a concern in terms of staff time, but I don't think technical system changes would be necessary.

Thank you. Has the department conducted any analysis of the administrative burden this reporting requirement will impose on providers?

Thank you, Madam Chair. In terms of administrative burden, we did discuss that, and that is why we brought that amendment to change from annual reporting to a one-time reporting. Additionally, we had the threshold of if you are an agency serving 30 or more, you need to report. We tripled that number to make that a little bit of a carve-out for the smaller agencies that are already a bit underwater. And so now it's over 100 members. That, to me, felt like a fair compromise from an annual reporting to one time and then tripling that threshold.

And last one. Colorado already collects. Sorry, Representative Hamrick, not McCormick. I apologize.

Colorado already collects caregiver wage data through the base wage reporting system. What is a new financial reporting system? Why is it necessary?

Thank you. Appreciate the interrogation. I think these are actually really good questions. And I'm also very excited that people care enough about this bill because it's very nerdy for me, but I love it. Base wage is reporting. What we are looking for is the difference. So this is not the same reporting system and metrics. This is saying what is the cost difference here? And that's kind of the fundamental change here.

I actually have just a follow-up to the base wage. So you're saying that the direct care worker base wage is different than what you're asking for. There's not duplication, and it's actually what you're looking for. you're looking for that additional information. Representative Frey.

the overhead administrative costs that we really want to dig into so we can get that comparison. So that's kind of the build upon the base wage. Thank you. And then what is sort of, we've been hearing that this is sort of proprietary information. What is sort of your response to that. Thank you. That was flagged. And I don't know if that's true or not, but I respect that. And so part of L-004 amendment takes out the public facing information. HICPF is not going to be putting that on their website. This is for internal legislative information. Hopefully that helps tackle the issue. And I had just shared with that with the lobby that that was kind of a last minute ad, just, you know, if that is a concern, I don't know legal proprietary knowledge, so I just wanted to be safe and pulled that out. Thank you. Yes.

Thank you very much, Madam Chair, members of the committee. Thank you for the opportunity to testify today. My name is Kristen Bates. I'm the Deputy Medicaid Director at the Department of Healthcare Policy and Financing, and I'm here on behalf of the department to testify in an amend position for this bill. This bill contains several provisions that HICPF has brought to sponsor as a part of our legislative agenda for the year. That includes Sections 4, 5, and 7. Those reflect our HICPF priorities, and we're very grateful to the sponsors for carrying them. Section 4 supports more streamlined rate review. For the rates that are subject to federally mandated reviews, Section 5 makes necessary amendments and adjustments to allow additional provider types to be able to be paid for Medicaid-assisted treatment in jails. This supports the department's 1115 waiver, improves access to care, and helps counties with reimbursement for inmate health services. Section 7 puts us all in compliance with federal rules around our advisory committee. to be clear, the committee is not going away. It will continue to run as usual. And then we wanted to flag the two areas of amendments. Section 2 is where HICPF appreciates the amendments in Section 2. The revised language removes the outright prohibition on these multiple procedure payment reductions and compounding billing methodology restriction, which created some direct conflicts with our Medicaid policy and specifically that outpatient hospital methodology. In their place, the amendment requires HICPUFs to still provide advance notice to impact providers, allow a minimum of six months before implementing any multiple procedure payment reduction for outpatient services, and we believe that's the approach to balance provider predictability, which is very important, as well as the department's need to manage costs. And then with Section 6, HICPUF is supportive of Section 6 as amended, moving it from medical loss ratio to direct care service cost ratio. So part of this is that the term is from health insurance and it just didn't translate cleanly to the home and community-based services space. This also makes it, as Representative said, a one-time data collection instead of ongoing, limits reporting to agencies serving more than 100 Medicaid members, and requires aggregate rather than individual agency reporting.

Hello, members of the committee. Eliza Schultz. Today I am representing the Home Care and Hospice Association of Colorado, and we are opposed to the bill. I know there's a lot of good stuff in here. We are going to specifically talk about Section 6, which is the Home and Community-Based Services one. I first want to thank the sponsor for continuing dialogue and working with us. I do think that we can get there. I don't think we're there yet. So a couple of things. As one of the witnesses mentioned earlier, medical loss ratio was the terminology used. That's not appropriate for HCBS. It just doesn't fit. However, this section is still in the managed care section of statute. And so none of the definitions for home and community services actually translate over into this section, which causes a lot of confusion about what providers and services are in and what providers and services are out. so we also want to just highlight that there is base wage reporting for home and community services There also a number of other questions If you go to base wage reporting HICPUF you can pull up a report that talks about insurance that is offered to employees and all sorts of other things And it is an ongoing thing. I think there's three years of reporting on that website already, so you can see trends. That's one of the, I think, shortcomings of this section is that it is one time. It will be administratively burdened. And then what do we do from there? Because we aren't quite sure what services are included, it could be adult day. It could be consumer directed. It could be traditional agency model. It could be IDD. And comparing those across for what their admin or cost or spend is, they're all so different care delivery models. I think it's just a little too broad. and would like to see that narrowed a little bit more. For home care, we only employ W-2 workers. It's against federal law for us to do 1099 workers. So the cost of employing workers, there is a cost associated with that. Thank you.

Thank you, Madam Chair. Good evening to members of the committee. My name is Ellen Jensby. I'm the Public Policy Director for Alliance, whose membership includes service providers for people with intellectual and developmental disabilities. Today, I'll focus on Section 6. While Amendment 3 is a significant improvement, we still have concerns and recommend additional adjustments. First, discussions about administrative costs often suggest that only direct care expenses are desirable while administrative costs are wasteful. In reality, delivering high-quality HCBS requires extensive training, compliance, and oversight. These administrative functions support safety, quality, and accountability and directly affect the people served. Second, these discussions often assume that providers are responsible for low wages without acknowledging that Medicaid rates have not kept pace with inflation and rising costs for many years. Third, increasing regulatory and reporting requirements are themselves a major driver of administrative costs. New reporting requirements like those proposed here add administrative burden while reinforcing the narrative that administrative spending is problematic. We also have questions about what this section is intended to measure. If, as the sponsor mentioned, the goal is to understand the percentage retained by agencies in contractor arrangements, the bill will not capture that information. It also fails to capture program costs outside of compensation, and for agencies with mixed revenue sources, isolating Medicaid-only costs and wages would significantly burden them. Colorado already has strong wage protections when combined with workforce competition, these policies ensure that the vast majority of reimbursement goes to direct services. For example, when considering Denver rates and minimum wage plus associated payroll taxes, at least 73% and 77% of every dollar paid for personal care and homemaker, respectively, goes to the caregiver today. Finally, this reporting will not offer a clear and comparable picture across providers. Administrative ratios vary widely depending on service mix, frequency, agency size, and other factors. In closing, we are concerned about the precedent of adding administrative burdens when rates are expected to be cut. If the bill moves forward today, we'll work with the sponsors to address our concerns. Thank you. Thank you for

questions only. No problem. Can you just introduce yourself and the agency that you represent? Bye. Yeah, absolutely. My name is Raina Henry. I'm a hospital and specialty care section manager for the Department of Health Care Policy and Financing. And I have some background here in the medical procedure payment reduction area, so I'm here to answer questions if necessary.

Thanks, Madam Chair. I have two sort of question points. First, Ms. Schultz, go ahead and finish your comments.

Thank you, Madam Chair. Thank you, Representative Hamrick. I think there are a lot of things in home care to deliver quality care. And the patient is first and foremost in that discussion. So I want to just list a couple of things that are not included in the contemplation of overhead. And we've had these conversations that overhead implies bad. But there are a lot of reasons why an agency might have high overhead. and that might be better quality care. So a couple of, I have made a list of things that just came to mind that are not covered in here is unemployment insurance, because remember all of our workers are W-2, workers' comp, liability insurance, criminal background checks, adult protective services checks, workstation fees. Home care can't be outside of a certain radius to provide care to their clients. So you have to have a workstation within so many miles of every house. You have to have your gerographic service area assurance. So you have to duplicate everything for backup care because you can't have someone in their home go without. It's not like an inpatient setting where you have a floor and you have staff and you can kind of triage. You have to make sure that that person goes to your home. So we really have to duplicate almost every service. We have really strict timelines in our rules about record retention and production. We have to provide the state any records they request within 30 minutes. That's in our rules. We have to provide the patient any records they request within two hours, so that's a violation of our license. We also have to do in-person supervisory visits every 90 days. Sometimes those can be done via telehealth, but typically not. And so that supervision of those direct care workers is a cost, and it is hard to reflect these quality measures in a report that is designed to say, what is the worker taking home in wages and everything else? Thank you, Madam Chair.

Thank you very much, Madam Chair. Thank you, Representative Hamrick. Really, I think what we've heard very clearly from JBC is right now our Medicaid budget needs to be very closely watched. We need as much information as possible to make data-driven decisions. We need to understand where our Medicaid dollars are going. This is the main conversation we're having with our federal partners, with our state partners, with our community partners on both sides of the aisle. I think that we heard a lot of questions about how do we know when Medicaid dollars are going out the door How do we know where they going and who are they going to and what are they for So I think that this is part of a lot of our transparency efforts where we're trying to make sure we have information and data that helps us make better decisions and also monitor where there are potential changes that need to be made.

Yes, thank you for the question, Madam Chair. So there's a lot of ways that we set rates in Medicaid. One of them is through our IMPRAC committee, which is the Medicaid provider rates and review advisory committee. My apologies. Thank you so much, Liza. So, yes, there are public ways that we do this. We also have a lot of rules from CMS on how we have to set rates. So rate setting is not just the choice of every Medicaid agency and the providers. it's a mix of information that you get from the way that other people are paying actuarial independent actuaries also give us information so there's a lot of ways that we get information from the public but we have to balance that with other factual data a lot of it also is connected to Medicare rates as well. Representative Johnson

Thank you Madam Chair, thank you Representative Johnson Unfortunately, I'm not prepared on the process to share that information. I just didn't have it prepared. We are happy to follow up with you. So Rain and our friends who are listening, please make sure that we follow up with Representative Johnson on where we are in the NEMT process and the needs of our urban and rural partners.

Ms. Holtz. Thank you, Madam Chair. Thank you so much for the question. Based on what I've heard from my folks is the way the amendment is constructed would be really difficult for reporting. We don't track the actual funds, how they come in associated with this. and you heard from a witness today that someone with a mixed payer model, we don't say that Eliza Home Care Agency is being reimbursed for care for Ms. Bates, and therefore the worker for Ms. Bates gets a portion of that reimbursement. And so some of this would be really difficult for us to tease out. And I think a question for you all as policymakers is, is the juice worth the squeeze for a one-time report that doesn't reflect, in our point of view, a lot of what goes into providing quality care and then also the administrative cost of doing the actual reporting Representative Brown Thank you for that answer

Thank you, Madam Chair. I think that's a great question. So because of the way it's constructed under the managed care, it's unclear. there were some conversations about it would be the base wage reporting entities. And I went to HICPF's website, and this is the list. It's adult day, alternative care facilities, community connector, consumer-directed attendant support services, foster care home, which is the children's habilitative residential program waiver, group home habilitation, group residential support services, homemaker, homemaker enhanced, host home, in-home support services, individual resident support services, job coaching, job development, mental health, transitional living homes, mentorship, pediatric, personal care, personal care, pre-vocational services, respite, specialized habilitation, supportive community connections, and supportive living programs. So I think it, again, I think it's very broad right now, and I think it would be difficult to compare these programs because the delivery model is so different if someone is going to a facility or it's residential versus in-community. And I think it would be probably a good step to narrow it to what exactly are we trying to target.

Thank you, Madam Chair. Thank you, Representative Bradley. I think that the way that you find out if somebody has committed fraud is that you look at everybody. You can't know if somebody's committed fraud until you investigate them and review their information. So there's no way. For those who have a past of committing fraud, absolutely we can keep looking at that. State monitors are looking at that. Our federal partners are looking at that. But we have to continue to monitor these providers to make sure that there aren't others. So I think that that's important to recognize that that's what oversight entails.

Ms. Bape. Thank you. representative, Madam Chair. Representative, yeah, we absolutely have reporting requirements, but we also need additional. We definitely need additional. And I'd be happy to follow up if you have additional specific questions on that.

Representative Foray, would you like to move your amendment? Yes. I move L001 to House Bill 1235 Second Representative Hamrick seconds

This one talks about changing the requirement that there cannot be any new multiple provider rate changes across the board to allowing the change for six months heads up. So that was something that HICPF had asked for, to be federally and state compliant. So my ask is for yes.

Representative Bradley. Thank you, Madam Chair. Can you explain it like I'm five? Sure.

Additional questions on this amendment? Any objections to this amendment? Seeing none, amendment L001 passes. Okay, any additional amendments? Two more.

Thank you.

Would anyone second? Second. I'm sorry.

Because I'm not there. Go ahead and explain your amendment.

Any questions on this amendment? Seeing none. Any objections? Seeing none. Okay, with that, L002 passes.

I know, we really do.

Senator Ryden, seconds.

Thank you, Madam Chair.

Four.

L-004. She said three.

sorry what hold on one second so so we're going to just pause for a second does everyone in the committee have okay we do not have copies for everyone so hold on one second are you sure it should stapled in your packet. I think it's just missing from a packet. Hold on one second. We are looking at L004.

Okay. And No, I need to do Okay, let's redo. Okay, so

Motion withdrawn. Thank you.

and that should be in your packets.

Questions on this amendment? Representative McCormick.

Representative Frank. Thank you for that clarification. Yes, because I changed that one part of removing the website, the amendment stays the same as L003, as L004, just removing that website public-facing data. I wanted to make sure that that was addressed as it was flagged as a concern, and I wanted to honor that. So yes, the fiscal note is brought down to zero because it is a one-time reporting rather than an annual one.

section six so i appreciate that you're willing to keep working on it additional question oh representative yes thank you i hear the concerns i think some of them are fair and i would love to to see if we can get to that middle ground. There are great things in this bill. This is one that we're trying to get to the right middle ground. If that doesn't come to fruition, it's okay if we take that out. That's the beauty of compromising stakeholder. I would love to get to yes, because I think it's important. And I think that JBC and just as legislators, we should know that. But also, I understand that we have to find a balance. So I hear them, and I hope we can get to a good spot, but I also understand if that's something that we need to take away.

objects. Mr. Shadun, could you please call the roll?

No. Bradley? No. English?

Emmerich. Yes. Johnson. No. Luck. No. McCormick. Yes.

The amendment passes 7 to 5 with one excuse.

Any additional amendments from the committee?

Representative Frey, would you like to wrap up?

Would you like to move your bill?

Representative Ryden, second.

Representative Barone.

Representative Batfield. Thank you, Madam Chair. I'm not going to say the words, but I echo Representative Verón. Thank you.

Additional comment, Representative Wrighton. Thank you, Madam Chair. Thank you, Representative Foray, for tackling this, for being kind of nerdy about it. I really appreciate that diligence and all that hard work and the relationships that you carry. And I echo my colleagues over there just respecting the process. It's very thorough. And I really appreciate what you're doing with the runway piece on that six months. I think that is something really necessary for our providers. So thanks for tackling that. Representative Hamrick. I appreciate all the stakeholding that you've done and know that you will continue. Home health care workers still have issues. but I know that you're going to reach out and try to figure out that. So I'm yes for today.

Thank you, Representative Frey, for your work on this bill. I think, you know, just appreciate your due diligence. I also appreciate what you're trying to do with the Section 6 and how important it is to get that clarity in information. And also, it sounds like there's more work to be done that you obviously are very committed to.

No.

No.

Foray?

Hamrick?

Johnson?

Luck?

McCormick?

Wrighton?

Stewart?

Leader?

Madam Chair? Yes. Passes 7 to 5 with one excuse. You're on your way to the committee of the whole. Really, guys? The Health and Human Services Committee will go into a brief recess, but please stay very close. I didn't know if that was going to pass. Thank you. Thank you. Thank you Thank you. Thank you. The Health and Human Services Committee will come back to order. Hi, sponsors. Hello. And THLG.

Representative English? Would you like to tell us about your bill?

What if you explain the bill, and we'll see if we can get this taken care of?

Substance use disorder is a serious public challenge facing communities across Colorado, but is also a treatable medical condition, and our policies must reflect the best medical knowledge available today. House Bill 2612-14, which is a sunset substance abuse treatment program licensing programs to... Sorry, House Bill 2612-14 ensures that Colorado continues to maintain the licensing and oversight system that allows treatment programs to safely provide medically managed care to people struggling with addiction. Without this legislation, the state framework that licenses facilities administering controlled medications for treatment would sunset in 2026, creating uncertainty for providers and patients alike. This bill responsibly continues that system through 2041. And I know that may seem way off, but this is definitely an issue that needs to be cared for in a way that we can ensure that people get the help that they need. And number one, it protects access to evidence-based treatment. The facilities regulated under this act provide critical treatment services for individuals living with substance use disorders. Many patients rely on medically supervised care that may include FDA-approved medications combined with behavioral health support. These programs help stabilize individuals, reduce harmful substance use, and support long-term recovery. By continuing the Colorado Licensing of Controlled Substance Act, this bill ensures that patients can continue accessing medically managed treatment in safe licensed environments. Number two, it aligns Colorado law with modern clinical standards. The amendment improves the bill by aligning statutory language, the amendment that's going to come, with current treatment standards used by clinicians and regulators. The updated terminology reflects the broader concept of medically managed treatment, which captures the full continuum of care that individuals may receive during recovery. This includes care designed to stabilize physical and psychiatric symptoms, manage addiction-related conditions, and support individuals as they work toward sustained recovery. Aligning Colorado statute with modern clinical terminology ensures that state law reflects real-world treatment practices and nationally recognized standards of care. Number three, it strengthens oversight and patient safety. State licensing requirements are not simply administrative. They provide critical safeguards for patients. Through the licensing process the state ensures that facilities administering controlled medications for treatment meet professional standards maintain proper record keeping follow safety protocols provide care through qualified medical professionals Maintaining this oversight protects both patients and the integrity of Colorado's behavioral health system. Number four, it supports Colorado's behavioral health infrastructure. This bill ensures that the Colorado Behavioral Health Administration can continue overseeing treatment programs and maintaining a central registry that supports accountability and coordination. Colorado has invested heavily in building a modern behavioral health system. Continuing this licensing framework ensures that those investments remain stable, coordinated, and effective. It also reduces barrier to care. A key component of this legislation ensures that treatment programs have clear policies for verifying identity while still allowing individuals who may lack traditional identification, including people experiencing homelessness, to access care. Self-duse use disorder often intersects with housing instability, poverty, and systemic barriers to health care. Policies that allow treatment providers to responsibly verify identity while maintaining access to care help ensure that people are not turned away when they are seeking help. Equity and public health. From a public health perspective, expanding access to medically managed treatment is critical. Communities across Colorado, especially low-income communities and communities of color, have been disproportionately impacted by addiction, overdose, and barriers to care. Policies that maintain strong treatment systems help move us toward a health care-centered approach to addiction that prioritize recovery, stability, and dignity. And with that, I'll turn it over to my co-prime, Rep. Jackson.

Thank you, Madam Chair. Good evening, committee. Before coming to the legislature, I served as the COO of the Naloxone Project, where I worked directly with communities across Colorado responding to the overdose crisis. And through that work, I saw firsthand that naloxone is only the first step in saving a life. Reversal is not recovery. The real goal is making sure that once someone survives an overdose, that they have a pathway to treatment, stability, and long-term recovery. And those treatment programs must be safe, effective, and accountable. That's exactly what this licensing framework helps ensure. Colorado has made significant investments in addressing the overdose crisis through expansion of Loxone access, strengthening harm reduction, and improving recovery supports. But those efforts only work if our treatment infrastructure is strong and well regulated. This bill ensures we continue to maintain the regulatory structure necessary to support that system. And I would urge a yes vote.

Representative Johnson. Thank you, Madam Chair. And it's just been a few weeks since we heard this in the drafting process, so I was just wondering if you can explain why it's 2041 so far out as opposed to putting the sunset closer.

Representative?

How many patients are actually not getting access to opioids, which are a chronic medication? As we address one issue, I feel like we're opening another issue up. And so I just didn't know if you've heard of this, what the data is. I just want to make sure we're supporting all.

Additional questions from the committee? Seeing none, we can move on to the witness testimony. We have one witness, Mr. Ryan Mueller, if you could come forward.

If you can introduce yourself and the agency you represent, and you have two minutes.

So questions for the panelists.

Mr. Mueller.

Additional questions from the committee.

Mr. Mueller.

Additional questions from the committee? Okay, seeing none, thank you.

Would you like to ask an additional question?

Mr. Mueller.

I'm referring to, yes, page 7, line 10 all the way to line 15.

Oh, sorry, Madam Chair. Thank you. Sorry for the clarification need, but this is intended, I believe, to be for an opioid treatment program, but I'm happy to bring this back to the Behavioral Health Administration and talk it through to make sure we're not excluding potentially other substance use disorder treatments.

How about, would you like to try to answer the question and then if we have additional questions maybe we could.

Mr. Mueller.

Wonderful. Any additional questions?

Thank you so much for your testimony. We appreciate it. Is there anyone else in the audience or online that would like to testify? Seeing none, the witness phase is closed.

Sponsors. Do you have amendments today?

Sorry, Representative Jackson.

Any amendments from the committee? No amendments from the committee. Seeing none, the amendment phase is closed. Sponsors, would you like to wrap up?

Thank you. Thank you. Representative English, would you like to move the bill?

Second.

Sorry.

No problem.

Second.

Advice Chair Leaders.

Representative Bradley. Thank you, Madam Chair. I just got a text from someone in BHA, but I'm not seeing the section that shows the substance use disorder has been moved, so I'm concerned about this part of the bill. Okay, so I'll be a no today until we figure this out. Thank you. Additional

Bradfield. Dang it.

Additional comments from the committee?

Rep Johnson. Thank you, Madam Chair. Would love to continue the dialogue. I'm worried about how far the sunset goes out. I'm worried about the unintended consequences on our patients, as I mentioned, as we push so forward one way. what is the message the other way? I'm also confused now. Like our colleague, it says substance abuse treatment program, but now we're saying it only focuses on opioids, but the way it was presented in committee was for substance. And so I would love just to talk offline before seconds so we can see where we're going, because I know we all want the same goal. I just want to make sure that we're getting it for all the patients at the table in Colorado, and I appreciate your work on this, but I will be a respectful now.

Thank you. So I also just wanted to recognize Mr. President visiting the House.

Good to have you here. Thank you sponsors for bringing the bill and appreciate your patience with BHA as they have amendments but it sounds like they'll bring them on second so I think looking forward to seeing those it sounds like there's some more discussion to be had which I know you will have so appreciate you both of your work on this and I'll be a yes today. With that Mr.

Representative Zabaron? No.

Respectfully no.

English.

Frey.

Hamrick.

Johnson.

Luck.

McCormick.

Biden.

Stewart.

Leader.

Madam Chair.

Passes 8 to 5. You're on your way to the Committee on Appropriations. And with that, the Health and Human Services Committee is adjourned.