House Health & Human Services [May 05, 2026 - Upon Adjournment]

Okay, the Health and Human Services Committee will come to order. Mr. Chudun, please call the roll.

Here. Bradley. Ecke. English.

Here. Hamrick.

Here. Cormac.

Here. Stewart.

Here. Leader.

Here. Okay. Thank you, everyone, for joining us here today. I'm sorry we're a little bit behind. We will have two minutes for testimony today and ten-minute panels. And we have our first bill sponsors here for Senate Bill 66, after they take their photo.

bill, and I'll turn it over to Rep Soper. Representative Soper. Thank you, Madam Chair and members of the committee, and thank you also to my co-prime sponsor here. Members, you've probably heard a lot about this bill. There's certainly been a lot of things said one way or another, and I do want to lay on the record, first and foremost, that this is not a big pharma bill. It really is ensuring that the ingredients that's in pharmaceuticals are a pharmaceutical grade, that when someone markets that it's a fantastic weight loss drug, that it's using vetted ingredients that were not putting Coloradans in harm's way because they heard something on TV in an online ad. They found a way to buy what is a similar drug that you would need a prescription for from a Colorado doctor, from an online doctor, and get it instead. I do want to highlight why we need to address this issue. It won't be this year, but it needs to be done. For someone like Jimmy Wilson, a woman in Kentucky who injected only four doses of the GLP-1 receptor antagonist and ended up in the emergency room having surgery, fighting for her life, in need of a liver transplant. Only four doses, that's all. Or a family in Texas who filed a wrongful death lawsuit last month, two siblings who lost their mother because she trusted a product that was marketed to her as legitimate, safe, equivalent to the real thing. However, none of that was true, and she's gone. To Coloradans who've called poison control centers at a rate of 1,500% higher than before these products flooded the market. I want to just say that again. 1,500% higher than before the GLP-1 products flooded the market. These are not statistics. These are neighbors of ours here in Colorado, our friends, our constituents. This bill is also about the researchers at the Anschutz Medical Center right here in Colorado who are researching the next stage of pharmaceuticals and of treatment for patients. And just several weeks ago, released a report documenting the egregious safety failures in many of these products. It's not theoretical failures. It's well-documented, tested, measured findings by a university right here in Colorado. And to doctors who've warned their patients to educate them on the issue, such as a CU health expert on endocrinology, diabetes, and metabolism, Dr. Cecilia Wong, who continues to warn patients about the effects of compounded versions of these drugs These specialists have taken time to educate their patients to share what they are seeing on the front lines only to watch it play out over and over again. Because people do make decisions based on economics with the idea that it must be safe because it's being advertised. And everyone would like to lose a few more pounds, that's for sure. I want to be clear, this is not a partisan issue. This exact same version of this bill passed unanimously in Indiana and is on the verge of unanimously passing in California. No one would mistake in Indiana for being liberal or California for being conservative. Instead, it's quite the opposite. Patients deserve to know what are in the pharmaceuticals that they're putting into their body and that they do meet the level of FDA-approved that they believe they are. This is as bad as, quite frankly, the fentanyl crisis, where if we turn a blind eye, the problem only gets worse. Colorado has spent years building a reputation as a leader on patient safety. We've been proud of that. We've campaigned on it. And today we have the opportunity to add another chapter to that record. unfortunately we'll be asking to PI the bill and I do find it deeply disappointing while I won't be coming back to the legislature next year I see many faces who will be returning and I do want to tell this panel remember this issue and to take it up because while the lobby has certainly poisoned the well pun intended we have to be able to protect Coloradans and to give them transparency and notice of the fact that just because someone advertises on TV or online and they call it an equivalent and they say it's safety making wildly speculative claims that have not been vetted that have proven to send people to the hospital or worse yet kill them because everyone wants to look their best. And certainly we're in a phase where the GLP-1 is kind of by the miracle drug on weight loss. And so I just want to tell this panel, don't let this issue be killed by the lobby. Take up this mantle next year. Thank you, sponsors.

Seconded by Representative Frey.

Representative Zabaron.

Redfield.

Bradley. Yes. English is excused. Frey.

Hamrick.

Hanson.

McCormick.

Wrighton.

Stewart.

Wook.

Peter.

Madam Chair. Yes. That bill is postponed indefinitely. Thank you, sponsors. Appreciate your time. Okay. Moving on to Senate Bill 162. Okay, sponsors, who would like to start? Representative Hamrick. Oops, sorry. Picture. Picture. Oh. Well, it's her camera. Representative Hamrick.

They vote on Senate Bill 26162. Representative Hartzell.

Thank you, sponsors. Questions from the committee? Representative McCormick.

off? Representative Hartzell. Thank you, Madam Chair, and thanks for the question. So the physicians, I mean, the short answer is yes. It's a two-way. If you're a patient and you're working with your doctor saying, I want to sign up. I want to have all my records released immediately, whatever they are, you will go through that. When you're right on the amendments they did in the Senate, it was because in the rural hospitals, everyone was looking at what we can't modify and kind of go back and forth. So then it has to become that conversation between the patient and the doc. And we're like, okay, that's fine. Let's just do that. One would assume, and this kind of goes into a little bit of responsibility, if you want your records released and you don't want any delay, just tell the doc, I don't need a phone call. Just release everything immediately. But if you're the person that says, I want to talk to you, I'd like to have a phone call, then tell your doctor that, and they will implement either way that it goes. Representative Johnson.

Representative Hurtek. Thank you, Madam Chair, and thank you, Rep. So CMS will be up here to testify, but very similar to what was just asked. Again, the conversations between you, the patient, and the provider kind of saying, hey, this is how I would like to have my information passed to me. Either I want it immediately or I want what we're doing is allowing 72 hours because that's currently it doesn't exist. And under the CARES Act, everything is fed immediately. That's why the other states have passed this. but CMS if you want to talk to the doctor they can go through the exact procedures of how that would happen on a portal and that exact mechanics for it

and opt out of that three-day waiting? Representative Hartzell. Yes. One more. Thank you. I would love to work on that amendment with you. I know

Representative Hatton. Thanks, Madam Chair. I guess I didn't communicate correctly. My opening statement, I said, that the intent here Once again you the patient If you want that then by all means do that For the people that don then all we doing is allowing them that 72 hours If there's something specific language that needs to be put in there that meets how you see that, that's fine. Understand the intent is to give the patient maximum dignity, either get it when they want it at 2 a.m. in the morning or wait until they talk to the doctor. Either way, we're good with that.

Thank you, Madam Chair. So the feds passed an act that makes all medical providers have to give test results immediately, correct? And so are providers in trouble if they don't do that?

Thank you, Madam Chair. Great question. So, A, if you look at the amendment, can we get into the amendment? Sure, yeah. So the amendment that got passed around to you, if you go down to, because, yes, that question's coming, so it's specified, so they're indemnified. You got it, go. Yeah, I can just go over the amendment if you'd like.

Representative Hartzell. Thanks, Commissioner. Yes, on line 35. So that's where that specifically states that, because that was a question that was brought up. Again, that was never our intent in the other states. This has been model legislation that the AMAs used, so that's what we copied in. But, yes, to answer your question, Rep. Bradley, that's exactly on line 35, paragraph C. that is to indemnify them so that doesn't happen.

Representative Harte. Thank you, Madam Chair. And thanks again for the clarification. So, yeah, in 2016 when the feds passed the 21st Century Cares Act, it was designed so you could get that information immediately. Nothing is held back. with the advent of electronic records and everything, that technology made it basically at a fingertip. You log into your portal 2 a 2 p doesn matter It all right there What they also allowed in there was states to say oh hey maybe we want to make some exceptions They wrote that allocation in the federal requirement saying states, if you want to do something different, then you can do that, which is why the AMA, along with several other states like we're talking about, you've got Texas, Kentucky, California, Pennsylvania, and there are several others. They've already passed laws like this. It's all model legislation. They're doing the same thing because patients across the country are saying, yeah, I still want, I love my portal, but on some of these issues, I want to talk to a doctor first. I want to know what's going on. I'm going to have questions. And so they put in that exception that you could write that into state law to do that. And then still, like we put in this amendment, indemnify so the provider is not held liable for anything.

Representative Hartzell. Thanks, my sir. Yes, ma'am. I mean, yeah, 72 hours is the max. That's it. 72 hours is released no matter what.

and I tend to agree with Representative Johnson on lines 30 and 31 of your, page one of your amendment, it does go into how if you're using an electronic medical record system, that the health care provider will utilize this option in the patient portal to delay the release. But those last two lines does say can opt out of this. they can be released immediately if the healthcare provider authorizes the immediate release of the sensitive test results. So it does seem to take away that ability for me as a patient to just say, I don't ever want a 72-hour delay. I don't even care what it is. I'm like, I want it immediately. I know some doctors don't like that, but I love the fact that that is available to me. So it is not 100% clear that the patient still has that ability to just kind of like not opt into this

by all means too easy representative johnson thank you um sponsors thank you for being willing to do that amendment um i guess my question looking at this bill is and i i appreciate that we do have that opt out of that three-day safety. I'm just wondering why are we making people now have to opt out at that three-day hold to get their information as opposed to either people not going on the portal if they don't want to see it until the doctor calls or asking instead for someone to say I want a blanket hold on my information until my doctor calls instead of making patients have to go and say I'll go through this extra paperwork to get my information. I'm just curious why we didn't

Okay, additional questions from the committee, and we are joined by Representative English. Okay, with that, we'll move on to witness testimony. Thank you, sponsors. Okay, can we bring up Aaron Leibovitz, Robert Glassmeyer, Michael Boone, Mary Toth? And then I think we'll add the... Yeah, okay, great. Is that... Is everyone online? Let's add the men folks too. Mary Toth and Kelly Herbsaker. I'm sorry, did I... And Audrey Wright, Rich Loy. Okay. Thank you so much for joining. We'll start with the folks online. Let's start with Mr. Boone. You can come off mute. Introduce yourself and you have two minutes.

much for your testimony. We'll move on to Erin Leibovitz. Hi. Thank you. My name is Erin Leibovitz.

driving myself home alone while Baltimore was in crisis during the Freddie Gray protests. A doctor's phone call was not a safe harbor. It was the moment I received life-changing news in one of the least safe circumstances imaginable. In the cancer community, we have a term for the period surrounding a scan. scan, scansiety. I live with neuroendocrine cancer, a rare disease, and I get scans every six months. A 72-hour delay is not just an administrative pause. It's a three-day of state-mandated scansiety with no guarantee of support at the end of it. Patients who want to wait for their doctor already can. They can choose not to open the portal, but patients who need immediate access should not lose that choice because the state assumes we can't handle information about our own bodies. If this bill moves forward, I ask at minimum an amendment exempting patients with an existing confirmed diagnosis. Please do not legislate for an ideal system that does not exist. Please don't turn dysfunction into law. Thank you. Thank you so much for your testimony. We'll move on to Robert Glassmeyer. Hello, good afternoon. Can you hear me? Yes, we can. If you want to introduce yourself and the organization you represent, and you have two minutes. Great. Thank you. Madam Chair, members of the committee, my name is Robert Glassmeyer, and I'm here in opposition to Senate Bill 26-162. I'm a testicular cancer patient in remission. I am currently under active surveillance for reoccurrence. I depend on timely access to my lab, radiology, and pathology reports to manage my care. I also pay for these tests, treatments, and services. As written, this bill would delay my access to reports for 72 hours, 72 excruciating hours. While I rely on my oncologist for medical judgment and treatment decisions, I am knowledgeable about my own body and medical history. I would feel more comfortable with this bill if it allowed patients to opt out of immediate access rather than requiring them to opt in. And of course, they have that option now. Simply don't read the report. I can imagine waiting an additional three days to see that radiology report or driving the 80 miles to my oncology office while wondering what those results might show Having immediate access allows me to prepare so I can bring my wife ask informed questions, and walk into that appointment with a little bit of a clear head so that I can ask those questions. I can't imagine in March of 2025, if I was informed by my oncologist of that reoccurrence, I would have had to drive 80 miles home alone without my wife. I shouldn't need my oncologist permission to access my own health information. I should be able to direct the facility performing my imaging to release those results to me without delay. Madam Chair and members of the committee, I respectfully urge you to oppose Senate Bill 26162 as written or support amendments that guarantee patient directed timely access to their own results. Thank you. Thank you so much for your testimony. We'll move on to Mary Topp. You are on mute. Thank you. Madam Chair and distinguished members of the committee, thank you for the opportunity today to speak with you. I'm also and I am opposed to Senate Bill 26162. And I'm just going to outline briefly the reasons why. First of all, you only address cancer patients. And I'm not sure if the Senate thinks that it's only cancer patients that have the inability to regulate their emotions and have the cognitive maybe inability to see their test results. What about patients who have other life-threatening diseases such as MS, ALS, Alzheimer's, the list goes on? The fact that this bill only targets cancer patients is upsetting. The other thing is that I know it was spoken about earlier that the doctors have to call within 72 hours. That's actually a delay. That's a delay for a cancer patient. When you are diagnosed with cancer, a doctor calls you pretty immediately. So this actually gives permission to delay the process even more, and there's already so much anxiety. I just want this committee to know, please know that under no circumstances is a patient not aware of the test that they received. And this could be a possibility when you're going for that kind of diagnostic testing. You know what that possibility is. And for patients like myself that like to read it, the results, It gives us time to be able to ask the doctor. I also want to let you know, I don't think that the Senate considered, I'm a state employee. I'm not representing any state agency. But as of June 1st, I can't carry a cell phone in my facility. I've worked for another department where there was no cell phones allowed. And in some industries in the private sector, you cannot have your phone. So whether a patient chooses to opt in or out of this new legislation, if you don't have your cell phone around or available, that is problematic. But the other issue is as well is that my provider is outside of the UC Health system. So my PCP is out and my providers are at UC Health. And so to assume that a provider all of a sudden can hurry up and have that request in that you want your results, it's just easier for the patient to opt out. Thank you for your time. Thank you so much for your testimony. We move on to amend Aubrey Ray Good afternoon Madam Chair and members of the committee Thank you for the opportunity to testify today My name is Audrey Reich-Loy, Director of Programs at San Luis Valley Health, the regional health care system for the San Luis Valley. I'm here on behalf of the Colorado Health Hospital Association to testify in support of the amendment being offered today. I first want to thank the bill sponsors for their collaboration and thoughtful engagement with hospitals and providers across Colorado. Most of us in this room have experienced either firsthand or in support of a loved one, the agonizing anticipation of a critical test result and how difficult and isolating that can be. And therefore, we honor the intent of this bill to ensure that patients receive sensitive and life-altering information in a way that allows for appropriate clinical context, communication, and support. Many providers deliver this kind of news with compassion and care today. The amendment that will be offered recognizes the variation in electronic health record systems hospitals use and the role those systems play in making this bill workable. Electronic health record capability and cost vary widely, especially for hospitals with limited financial resources. The amendment gives runway to set up appropriate systems, acknowledges existing EHR functionality, and clarifies vendor responsibility. These changes reflect today's operational and technical realities. This flexibility is especially important for rural hospitals like mine, which operate with limited financial and IT capacity and rely heavily on vendor timelines and pricing, often resulting in additional manual strain on providers. compliance on existing system capabilities recognize those constraints and allow hospitals to adopt this policy reasonably as technology evolves. As this bill moves toward implementation, continued collaboration is needed to support patients without unintended impacts on access or health outcomes. We appreciate the sponsor's partnership to identify a patient-centered solution that protects both the patient's rights to direct access to their health information and the comfort of receiving test results within the context of the physician-patient relationship. Thank you. Thank you so much for your testimony. We'll move to in-person. I'd also like to call up Jason Hopfer, who's also in an amended position. Would you like to come forward? Oh, well, he is coming up. Ms. Herb Zager, if you'd like to go ahead. Great, thank you. Good afternoon, Chair and Committee members. Thanks for the opportunity to testify today. My name is Kelly Erbsager with the Colorado Rural Health Center, speaking in a men position on Senate Bill 162. I want to start by thanking the bill sponsors for meeting with rural health care providers to ensure that we can make this work in rural health care settings. So whether in an urban or rural health care setting, all electronic medical records platforms do not work the same, they don't cost the same, and they're not updated the same way. For the specific needs of this bill, some of our members shared that their EMRs are all or nothing, meaning their EMR requires either all tests to be released upon completion or all the test results to be held. So in order for hospitals to be in compliance with the requirements of this bill, it would require manually going into a patient's portal and holding certain test results. With already limited lab and admin staff, this is difficult, and even the best resource hospitals mistakes happen. So in order to streamline the process and make EMR and make the EMR automatically hold certain tests back. In many cases, it would require what's called a custom build from an EMR company. Tammy Dunker from Rangeley District Hospital shared with me that for their EMR, custom $20,000 to $50,000 for hospitals, and if interfaces or consultants are needed, it would come up with additional costs on top of that. For a small clinic with maybe one to three providers, the cost could be anywhere from $5,000 to $15,000 or more. So the choice here for many rural hospitals is either an administrative cost or a financial one, neither of which our rural hospitals have much capacity to spend. The amendment being brought forth today will equip hospitals with the tools they need to meet the requirements of the bill and provide compassionate consideration for patients with cancer. Once again, a huge thank you to the bill sponsors for listening to our rural hospitals and advocating for their sustainability. I'll ask for the committee to please support the amendment today. Thanks for your time. Thank you so much. Mr. Hoffman. Madam Chair, members of the committee, my name is Jason Hoffman. We're here on behalf of the Colorado Hospital Association. In hearing some of the questions on the amendment, I want to just come up and be clear about what our intent was. And I think Kelly has already kind of described some of the issues, particularly with our rural hospitals, in compliance with the version that passed the Senate. Now, given the lateness of the time that we've had in the legislature, in the movement of this bill, we were working with the Senate sponsors and then the House sponsors to try to address the practical issues that we see with the required notice provisions that were in the Senate version of the bill. our intent as i think as you hear from kelly is that we want to we have systems certain systems in certain hospitals allow for a patient to toggle whether they today whether they want to have an immediate notification or have it to be delayed not all hospitals have that system you know so in trying to figure out how we address the ability the availability of that if you were just look at the 002 subsection b only if the electronic health record system or patient portal provides an option to delay. I think we probably, given what we're hearing today, need to be clearer as to the patient's ability to make that determination. I definitely hear that there's some concern there that that is not accurate. Our goal is to make sure that patients have the choice one way or the other to do that based on what the intent of the bill sponsors were. Whether this amendment does completely that, I hear what the committee is saying. However, I want to be clear Whereas the intent we have is to try to match what the sponsors have asked for, which is the ability for patients to say, I want to hear from a doctor first, versus I want to just see my results when I get them. We have some capability to do that today, but not universal. So we're trying to find a way to cover both scenarios in a way in which the patient has the ability to make that choice. Thank you. Witnesses, questions from the committee.

Thank you. One of the questions that I had for you two is that hospitals aren't making the change in electronic health care records systems. It would be the vendor itself. And the argument is that you're saying that they cannot afford to do a $20,000 to $50,000 system change to accommodate for that option to see the results or not. Is that correct? Ms. Rubezsega?

And so just to follow up, in those conversations with the vendors, they're saying that's going to be a $20,000 to $50,000 change to make that custom change. Ms. Zerbazegra. Madam Chair, Representative Furet.

Oh, you were off mute and now you're on mute. Sorry. Thank you. So sorry. Yeah, I would. Yeah. I just wanted to. Yeah. In either case, I don't think in either exception that the patient has any ability to make that choice. But was your question is I think that the other I think your question was speaking to those who want to opt out. And the Journal of Medicine already did a long, extensive study with over 8,000 patients in 2023, that 96% of patients, even when they have non-normal results, want the results immediately. This legislation for 4% of population that can already opt out, I don't think we need to stay involved. Representative Johnson.

Well, I'm a respiratory therapist, so I don't deal a lot with telling delivering results to patients. But even with HIPAA, I cannot go into my own chart and see these things. I have to rely on the patient portal to get my own results. So for this delay to happen, it can actually, for instance, in my case, with them having not called me for two days, I happen to have been able to get an appointment when they had a cancellation. So sometimes it can take weeks before you can get into a specialist. So that is going to result in a delay of care. The earlier you know and the earlier you can get a chance of getting an appointment, the better off you are, especially with some of these aggressive cancers. Mine was somewhat aggressive. When it reoccurred, it had grown back quite quickly and was already back into the lymph nodes again. So I see this as a danger to patient health, really. And Mr. Glassman, I think you came off mute on the last question. Just wanted to make sure I didn't cut you off there. Thank you, Madam Chair. That was simply to reply to Representative Bradley's comment. Did you want to reply? Yes, please. I respectfully would ask, I would respectfully ask the state to stay out of my medical health records. And quite honestly, if we have to rely on a hospital to try to develop a system or a vendor to try to develop a system, it's going to get messed up down the line. I think the simple answer is patients that don't want to see their their medical chart, their their portal, they can simply just opt out by not looking at it. Thank you. And Mr. Boone, you had your hand up? Yeah, the other thing I wanted to ask about too is what about these hospital systems that are in multi states? How much is that going to cost these hospital systems because their EHR isn't going to be just for Colorado, they're going to have to make those changes in other states as well. And so that's going to actually cost quite a bit more money than what it would if it's just a handful of hospitals here in this state. Representative Johnson.

Mr. Hopper. Madam Chair, Representative Johnson, I'll do my best. I guess the first thing I'd say is if you have a portal based on a Colorado hospital, you're going to get the results from Colorado, whether you live in Wyoming or Nebraska. The other answer to that, I think, to the gentleman's assertion about other states is what we've seen in Texas, for example, who has adopted a bill like this, it doesn't have any patient choice. It's a mandate on the hospitals, which is something that we had concerns with when this bill was introduced in the Senate. And that's not the direction this bill is going. But you know we are Texas If we have members who have hospitals in Texas they are having to comply in a wholly different way of their hospitals there uh it not i wouldn say it necessarily consistent but and i wouldn i wouldn necessarily agree that we have to change them across the board right for for the for our colorado operations you all have different requirements and criteria for hospitals for all sorts of things compared to other states okay any additional questions for

Thank you so much, panelists, for your time and for sharing your stories of navigating this complex system. Okay. We will call up our last two witnesses, Dr. Brigitte Robinson, Dr. Colleen Murphy. I get what you're saying, darling. I want it, but I'm tempted, but yet I don't need it. Then they devastate themselves because they can't handle it. And it goes the cookie line here. Oh, okay. Yeah, Emma Hudson. Is the other person not online? No? Okay. Okay. Why don't we start with Dr. Robinson? and if you could state your name, the organization you represent, and you have two minutes. It's the tiny little gray button by the plug. Okay. That's different than our boardroom. Madam Chair and members of the committee, thanks for the opportunity to be here today. I'm Brigitte Robinson. I'm the Colorado Medical Society president, and I represent more than 6,500 physicians across our state. I'm here to express our support for Senate Bill 162, and I want to thank Representatives Hamrick and Harlsberg for championing this important patient protection. This bill is about one thing, making sure that when a patient receives news that may change their life, they don't receive it alone. The 21st Century Cures Act was passed with genuine good intent to empower patients with access to their own health information. Colorado physicians supported that goal, but the act's immediate release requirements have required an unintended consequence that we see playing out in our clinics and hospitals every day. A patient picks up their phone, opens their portal, reads their pathology or radiology report with words like suspicious mass or consistent with malignancy before a physician has had any opportunity to call them to provide context or even just to be present for that moment. That's not how a potential cancer diagnosis should reach a patient, and it doesn't have to be this way. Senate Bill 26162 creates a brief three business day window, which is time for the ordering physician to review sensitive results and reach out to the patient before the results appear in their portal. And that conversation matters enormously. It's the difference between a patient's in fear over the result they don't yet understand, and a patient who hears the difficult news with their doctor beside them, ready to answer questions, explain the next steps, and to provide the support that medicine is meant to offer. We understand that questions have been raised about the ability for some of the EMRs to operationalize the bill, especially in rural hospitals around the state. That's worth discussing and resolving. What matters most, however, is that This bill works for patients and for their physicians who serve them. And given the forthcoming amendment we have seen, we think that the outcome is achievable. So we urge this committee to support Senate Bill 26162. Thank you very much. Thank you so much for your testimony, Ms. Hudson. It's a little plug, but oh, I can't talk. There you go. I usually have clients doing this. All right. My name is Emma Hudson. I am part of the contract lobby team for the Colorado Oncology Society, and I'm here today testifying you're left with me because the oncologists are off saving lives like Dr. Robinson does a lot. So I will be reading the testimony today of Dr. Marie Wood. Mr. Chair and members of the committee, my name is Dr. Marie Wood, and I am here on behalf of the Colorado Oncology Society. We are asking you to support SB 162 regarding sensitive test results in healthcare. I went to medical school and did my fellowship at the University of Colorado. I then stayed on staff at Denver Health until moving to the University of Vermont in 1997. I recently returned to the University of Colorado in 2022. I'm an academic oncologist with expertise in breast cancer and genetics and focused my research in the area of screening and prevention. I became an oncologist to be able to help people with or at risk for cancer. It has been a privilege over my career to walk this adventure with so many. As an oncologist, I know how important it is to both patients and physicians that they be able to discuss results of sensitive tests together, especially when the information in those tests can be so potentially life-altering. Patients can often receive tests from scans before we have had a chance to review and discuss them with our patient. Receiving a notification that results are in your portal late at night or on the weekend or a holiday can easily lead to a Google or chat GBT search that suggests metastatic disease. But when we review the scans, the findings can be dismissed. Sometimes the scans could suggest progression of disease only because it was not compared to the most recent scan in the record, where in reality there was no progression in the chronological scans. I have also had many patients told they have metastatic disease on a scan, but it was really a benign process. I deal with these issues on a weekly basis. For example, I have a patient who had a history of cancer many years prior and developed a cough. She had a CAT scan which showed some enlarged lymph nodes. The scan was read as likely metastatic breast cancer, which did not make sense to me given how low risk of recurrence and the unusual pattern of adenopathy. In fact, a biopsy revealed sarcoid and not metastatic cancer. I have another patient who at her diagnosis underwent a staging evaluation with a CAT scan that showed an abnormality in her kidney, which was read as, quote, cannot rule out metastatic disease. metastasis from breast cancer to the kidney are exceedingly uncommon. And in fact, further evaluation revealed this to be a benign mass, nearly done. You can imagine that for patients to read these reports prior to being able to talk with the ordering provider is anxiety provoking anxiety, which could have been completely avoided by delaying the results directly to the patient, um as soon as they ready Having the release um would be better uh as designed by SB 162 and we would appreciate your support of this bill The amendment is fine with the Colorado Oncology Society and we maintain a support position Thank you for your testimony. Questions from the committee? Okay, seeing none, thank you so much for your participation. We appreciate you being here. Okay, is there anyone online or in person who would like to provide testimony today? Okay, seeing none, the witness phase is closed. Okay, at the request of the sponsors, we're going to lay over Senate Bill 162. Until, I'm sorry. No. Yeah. Okay, we're going to move on to our next bill, Senate Bill 17. We might need to get our sponsors. Yeah. The Health and Human Services Committee will go into a brief recess. Don't go far. Thank you. Thank you. Thank you Thank you. Thank you. The Health and Human Services Committee will come back to order. Welcome, sponsors. Tell us about your bill. Who would like to go first?

transparency with physicians specifically the bill has planned share with the physicians the information needed so that the physician knows whether they should access the card or do I process or challenge the federal reimbursement at the federal level, I do want to note that not all plans are regulated by the state of Colorado and are out-of-network statute. Many plans are regulated by federal statutes and are subject to the federal No Surprise Act. And when patients' plans are regulated by Colorado statutes, the plan must share the methodology and data used by the plan to come to the reimbursement amount. This bill does not change the statutory definement reimbursement formula, nor does it remove the compromise any patient protections. To date there's no known opposition to the bill. Senate Bill 17 is a critical common-sense measure that increases efficiency and ensures both physicians and patients are protected when emergency or unexpected out of network care is required. Our physicians care for all our patients with without regard to their ability to pay. Those patients expect that their health insurance benefits will reimburse their physician. Senate Bill 17 ensures those physicians are reimbursed appropriately and if they are not, they have an efficient, accessible process to resolve any discrepancies. Thank you, sponsors. Questions from the committee? Representative Bradley. Thank you. I just was wondering if you had, I know you've been working on this, so if you have any data about how many unresolved disputes we have, how many unpaid claims to small providers and data for resolution timelines. How long are we talking about for these claims to be paid, and how many claims are still out there, and what's the average, if there's a $500 claim, how much is it costing these providers? Representative Stewart. Thank you, Madam Chair. Thank you for the question. I'm probably going to defer the timelines to some folks coming behind me. I will say that when we had these conversations last year on the previous iteration of this legislation, there was some discrepancy about the data and the data set was kind of lacking. And one big thing we really wanted to do and couldn't because it costs money is actually start to collect a lot more data to at least prove that this was indeed a problem at the very, very least. And we weren't able to do that last year, unfortunately. But yes, hold that for folks behind me. Additional questions? Okay, seeing none, thank you sponsors. We'll bring up the witnesses. We just have one panel. We'll have Isabella Cruz, Dr. Jacob Alholtz, Dr. Dhaliwal, both Dr. Dhaliwals. I don't think we usually have both of them. Okay, we'll start with in person from my left to my right. If you want to introduce yourself, the organization you represent, and you have two minutes. Thank you, Madam Chair, and the other members of this committee, and those present for the indulgence of your time. My name is Jacob Altman. I'm an emergency physician here in Denver as well as a toxicologist, providing care both locally and across the state in these capacities. I am here representing the Colorado chapter of the American College of Emergency Physicians, expressing our support and appreciation for this bill. We are really excited to see the first steps towards codifying the processes with which we can ensure our out-of-network billing is not an increasingly unfair process with inadequate compensation. When I have patients that are presenting to my emergency room, they are not concerned with who their insurance carrier is, and that is an ideal situation. However, now the burden of arbitration has moved to the providers and their systems. This process is fraught with uneven burdens, and as the Senate amendments have pointed out, this process has disadvantaged smaller groups. This process will need much attention in the long run, but we are excited that this bill should come law. Some of the information and financial disparity when moving through this process could be mitigated. Ensuring enforcement of these kinds of payments, and in addition, ensuring that these payments are not unfairly minimal, can ensure that the health care system will continue to be able to provide care. Because ultimately, that's what I care about. I was born and raised in Aurora and went to undergrad here at CU Denver. I also live walking distance from this building. I'm currently an ER physician across the Denver metro area within Denver Health and within the UC Health System, and I am honored to be able to help and provide care for the community that raised me and made me who I am today. This will help me continue to do that. Once again, we thank you for your time, and we at Colorado ASAP stand ready in case there are any questions or needs for our perspective. Thank you. Thank you for your testimony. Please proceed. A little plug. Yes. Thank you. Good afternoon, Madam Chair, members of the committee. My name is Isabel Cruz and I'm the Policy and Advocacy Director for the Colorado Consumer Health Initiative. I'm happy to join today to express our support for SB17. We're grateful to the sponsors and lead proponents for coming to the table to find a compromise to codify DOI's processes and authority to resolve disputes related to out-of-network payments and care. Since our surprise out-of-network billing law was passed in 2019, CCHI has been dedicated to protecting consumers by preserving the carefully crafted payment rate and dispute mechanisms that balance the needs of providers and insurers while keeping patient costs in check. This has led us to fiercely oppose any efforts to upend this balance through opening up a slippery slope of arbitration and batching exceptions that would increase costs for consumers, as many of you heard about last year. As promised to this committee last year, we came to the table to better understand and address the concerns of the provider groups to find an alternative to the costly arbitration process. SB 17 represents a step to clarify and codify pathways that providers can use to resolve disputes and leverage the authority of the insurance commissioner to ensure existing standards are followed and enforced. We recognize from the consumer perspective that unjustified downcoding or underpayment have the most risk for independent practices and smaller providers who have less ability to fight claims and take on financial risk with underpayments, which could contribute to practice closures and pressures to merge that may harm access to patient care. We hope you will support this bill to preserve patient protections and clarify pathways for resolving disputes with our out-of-network framework. Thank you. Thank you so much for your testimony. Dr. Dhaliwal. Thank you, Madam Chairwoman. My name is Jamie Dahlia. I'm an emergency physician in Denver, but I practice in multiple counties throughout the state. I'm testifying on behalf of Colorado ASAP in favor of this bill. I first want to thank the bill sponsors who have worked for multiple years now to get this bill over the line. As you've heard, our arbitration process for out-of-network claims is financially not viable for physicians, positions, particularly small groups to utilize. And so this bill looks to clarify and codify the existing DOI process for complaints regarding of network payments to providers and specifically improves transparency around when a plan is governed by the state DOI and when it is under a federal statute Furthermore it allows for more transparency in the calculation of the median in rate which is something that is statutory required as part of the payments to out-of-network physicians. We're very excited about this bill. It will play a small role in helping maintain viability of particularly rural emergency physician practices, as well as other MTALA-based rural physicians. So I ask the committee to support this field. Thank you. Thank you for your testimony. Any questions from the committee? Representative Bradley. Thank you, Madam Chair, to the doctor in front of us here. Can you walk us through numbers so we can visualize what you're going through? You bill this, the claim is this, arbitration costs you this, so we can get a number game. I might actually defer to Dr. Dhaliwal if he has this because he actually is in a role that is more appropriate for answering that. I am currently across larger systems. Dr. Dhaliwal. Yeah, so in our current process, let's say that a physician group in the Western Slope is systematically underpaid $5, $10 per claim for emergency medicine. Our claims average around $200 to $400 per claim, but that $10, which is about 5% per claim, is significant to their practice, the viability of their practice. They have to recruit and retain physicians, maintain medical legal protections, and also support the administrative functions of their groups. Those $5 to $10 disagreements add up over time. And so in our current arbitration process, which this bill does not alter, you would have to pay an arbitrator, which amounts to, on average, around $450. So if you imagine you arbitrate 30 claims, you get $10 more per claim, but then you lose an arbitration hearing. That single arbitration hearing, which is baseball arbitration, you have to pay the $450, which means it wipes out anything for the original 40 claims that you were trying to get additional payment on. That's where the arbitration process hasn't worked. This bill simply codifies our existing complaint process with the DOI and further allows them some more enforcement authority to compel insurers to pay the statutory required rates, which are either it's the greater of 110 percent of the carrier's in-network rate or the 60th percentile of that geographic area's all-payer claims database payment amount for that particular CPT code. So a lot of technical jargon. Basically, it costs a lot of money to do arbitration claim by claim. We're going to kind of our folks at CCHI were concerned about arbitration batching leading to increased costs. So we've said, OK, we'll leave that alone. But why don't we make the DOI process kind of hardened and allow some more enforcement there? OK, additional questions from the committee. Seeing none. Thank you so much for your testimony. Appreciate you being here today. OK, is there anybody else in person or online who would like to testify? Seeing none, the witness phase is closed. Sponsors. Do you have any amendments? No amendments. Any amendments from the committee? Okay. Seeing none, the amendment phase is closed. Sponsors, would you like to wrap up? Representative Stewart. Thank you, Madam Chair. Thank you again, committee. And I just want to express my extreme gratitude to our extraordinary Senate sponsors as well as the folks from the emergency room physicians CCHI and the DOI for coming together on what felt like a monstrously impossible task last year to the bill that you are seeing today So just want to express my gratitude and my deep hope that we are going to be able to support our physicians as they continue to carry the burden of supporting so many folks in our communities across Colorado and would encourage us to continue to take data to Rep Bradley's point to ensure that the intent of the legislation and what we're hoping to do and the problem we hope it solves actually does. Representative Gonzalez. Thank you, Madam Chair. Thank you, Committee. And you know, you're hearing from some of the experts here about why this bill is so important. As you all know, health care is a very complex issue that has multiple mechanisms that are involved. And any type of relief, however big or small, we can do to provide to our providers and people who are impacted by health care, I think, is something that we can do and lead the way here in the state of Colorado. And I want to commend my co-prime because it's something that she's been passionate about and been working on for years, and I'm happy to join her on it. And she's leading the charge to make sure that we not only protect providers, but also the people to get the care that they need. And while this may seem like a simple fix, this is something that goes a long way for our providers and for ultimately making sure that we have a better health care system in Colorado and making sure that the providers have a voice, especially when it comes to these types of litigation. So I encourage an eye vote. Good bill. Thank you. Vice Chair Leader, would you like to move the bill? Yes, I move Senate Bill 26017 to the Committee of the Whole. Seconded by Representative Furet. Any closing comments from the committee? Representative Bradley. Thank you, Madam Chair. To the bill sponsors, congrats. And it's hard to bring people like that to the table and all get them to agree. any relief we can provide to providers in the state is tremendously appreciated, especially when we continue to cut their rates. They have families they have lives, too. They need to keep the lights on in their homes as well. So big congratulations for you getting this through. Additional comments? Thank you, sponsors. This was such a battle last year and so appreciate it. It's so wonderful when you have everyone come together. So thank you for your hard work on this really important issue. With that, Mr. Chidun, can you please call the roll? Representative Zabron. Yes. Bradfield. Yes. Yes. Bradley. Bradley. Yes. Not bad. Yes. I was just so excited. English. Yes. Frey. Yes. Hamrick. Yes. Johnson. Yes. McCormick. Yes. Bryden. Yes. Stewart. Yes. Wook. Yes. Peter. Yes. Madam Chair. Yes. That passed unanimously. You're on your way to the Committee of the Whole. Okay, next we are on to Senate Bill 138. Okay, Representative Stewart. Thank you, Madam Chair and members of the committee. Every Colorado family deserves a fair, dignified, and accessible path to financial assistance when receiving health care, but right now the system we built to deliver on that promise is getting in the way of its goal. Senate Bill 138 opens up avenues for hospitals to make the eligibility determination process more efficient without compromising the standards that get people the support they need to fund their care. The timing of this legislation matters. The passage of HR1 at the federal level is likely to increase the number of uninsured and underinsured Coloradans. More families will be walking into hospitals and clinics without coverage, and more of them will need to navigate the process for discounted care We need that process to work but our current system requires patients to complete a uniform application even when a facility already has the data it needs to make a determination quickly. It does not give patients clear and timely notice of their rights or the outcome of their screening, slowing their access to support. The current system also creates issues for hospitals, because the State Department changes what is required of the hospitals through policy manuals that are not subject to public rule and does not formally include stakeholders in the process. The result is a system that creates barriers for the very families it was designed to protect and uncertainty for the providers doing the work of serving them. 138 streamlines a financial assistance screening process while strengthening the protections patients are entitled to. Healthcare facilities will be permitted to use third-party data resources as well as uniform screening questionnaire developed by HICPF to conduct screenings, getting patients faster answers without requiring the documentation they may not have when a full application is unnecessary. Facilities will also have the option to screen patients for their own financial assistant programs at the same time, which often provide broader eligibility than public programs alone. Clear notice and appeal rates are also required at every step. On the back end, HECPF will be required to adopt any new program requirements through formal rulemaking with stakeholder engagement so hospitals know what rules are and have a voice in shaping them. This bill does not reduce patient protections. It strengthens the pathway to them. Every patient retains the right to appeal. Every determination requires notice. What changes is that the process takes full advantage of the information the hospitals have access to to make timely determinations for the patients that support they need faster. I urge you to support 138. Thank you. Questions from the committee? Okay, seeing none, we'll bring up the witnesses. Amend and then support. Okay, great. We'll bring up our folks in amend, Isabelle Cruz, Joshua Block, and Bethany Prey. Okay, we'll start from my right to my left. If you can introduce yourself to the organization you represent, you have two minutes. The button is right by the plug. There you go. Thank you, Madam Chair. My name is Josh Block. I am the Chief Financial Officer of the Department of Healthcare Policy and Financing. The department is here in an amended position on Senate Bill 26138. Specifically, the amendments that were adopted in the Senate, along with the committee amendments before you today, have resolved most of the department's concerns. However, we do believe a refinement remains, and we do think that changes are still necessary to ensure that the program can operate as intended. The concern relates to the rulemaking for the program. Representative Stewart just mentioned some of those things. As it's written, however, the bill creates serious technical problems by forcing virtually all program guidance to be put into rule. Specifically, it's the language on page 19, starting at line 11, and as drafted, the bill requires the department to issue every operational change to the discounted care program, including manual updates, application revisions, clarifying instructions, and even sub-regulatory issuances through full rulemaking. You can see the problem here. By definition, sub-regulatory guidance is supposed to be something that is not in rule. We agree with the general intent of this provision. The program guidance should not change with a high frequency. providers should have an opportunity to review professionals and there must be oversight conducted via some type of mechanism. In this case, the amendment that we're seeking maintains the annual cadence that the bill establishes for most operational changes, including the screening questionnaire, the application, new program criteria, so hospitals continue to receive a single consolidated update on a predictable timeline. It directs the oversight. The amendment we're seeking would direct the oversight to the proper place, which is the statutorily created hospital discounted care advisory board, not the medical services board, without changing the core concepts or creating complex requirements to establish standard program guidance inside of regulation. Significant program changes would still be limited to a once a year process. Without this amendment, however, the department's ability to operate the program and ensure that it is working for the patients who need it would be severely diminished. We think this is fundamentally a technical issue, but it is a necessary one. We're happy to, or we think it's a necessary one to ensure the program can continue to run smoothly. We stand ready to continue working with the sponsors and the proponents and this committee to make sure that we get this bill across the finish line. Thank you very much. Happy to answer any questions. Thank you. Ms. Cruz, welcome back. Hello again. Good afternoon. Madam Chair, members of the committee, Isabel Cruz, still with Colorado Consumer Health Initiative. We are here today in an amended position on SB 138. We would really like to express our immense gratitude to the sponsors and the proponents for their communication and continued work on amendments thus far. While the amendments in the Senate were an improvement, we are still working in good faith to hone additional amendments to ensure opioid training requirements are adequate and that we get the details right for patients and providers on making changes to hospital discounted care. We share the bill's goal of streamlining processes so patients can more easily understand what they qualify for and access care. Our consumer assistance program navigators work with Coloradans across the state as they navigate layers of administrative burden, just even to get in contact with the correct department to start the process for HGC or ask questions about any determination or information they've been given. To better balance patients' needs with the administrative efficiencies the proponents are looking for, we've requested the following amendments and hope you will support us in addressing them. First, on screening and eligibility, we are grateful that the bill as amended reflects shared goals between patients and the sponsors and proponents to lower rather than raise barriers for eligible patients to understand what they qualify for. In order to ensure transparency in the screening process, however, we are requesting that the results of the screening, whether that is income or the percentage of the federal poverty level, are included on the notice. Sharing this information will help ensure patients can easily correct any mistakes from these third-party screening tools, which are well known to be less accurate for families whose income may put them just at or above the eligibility threshold for HDC. Second, on third-party screening tools, we are supportive of using these as an option, but we maintain that patients must be informed and provide consent. We originally asked for a clear regulatory process to vet and approve these. We recognize that this is likely to be addressed in the recently introduced AI bill, but we also, not knowing how that bill is going to go, ask that hospitals disclose to the HICPAF what tools they are using so the public can be informed. Finally, we remain concerned about removing opioid prescribing training requirements and are open to continued conversation on how to reduce these requirements rather than completely eliminate them. We respectfully ask for your support in continuing to refine the bill, and thank you for your time. Thank you. Ms. Prey. Thank you, Madam Chair and members of the committee. I'm Bethany Prey, Chief Legal and Policy Officer at the Colorado Center on Law and Policy, and I'm testifying today in an amend position on Senate Bill 138. CCLP is a nonpartisan statewide anti-poverty organization. We share the proponents goals of reducing administrative burdens for the healthcare industry and we also recognize there is an important balance we need to strike There are reporting requirements or training requirements created by this legislature that may add burdens but if the training saves the lives of Coloradans or a reporting requirement prevents financial disaster, those burdens are appropriate and worthwhile. This bill is amended and the Senate has come a long way, thanks to collaboration with our hospital partners. So I'm going to basically say ditto to CCHI's amendment requests regarding the tools that hospitals use and regarding the notice components that patients are entitled to so that they know whether or not they need to appeal. We don't want people to appeal unnecessarily or to miss the opportunity. We also incidentally agree with the annual cadence of the major changes, as Mr. Block was referring to, for HICPF, but allowing those to go through non-regulatory processes because that would be overwhelming, honestly, to have that all go through rule. We appreciate the Hospital Association and other proponents entertaining these requests and for the teamwork getting the bill to this point. Thank you. Thank you so much for your testimony. Okay. We've got everybody for some reason. I thought there was someone online. Questions for this panel? Okay. Seeing none, thank you so much for your participation. We appreciate it. Okay, anybody online or in person that would like to testify? Oh, I'm sorry. Moved too quickly. I apologize. We have plenty. It's the end of session. I apologize. Don't panic. Okay, let's start with Paul Horang, Kelly Herb Zager, Matt Buckner, Dr. Robinson. I apologize. And then the three folks remote, Cassandra Garza, Ellen Stern, and Joe Fine. Hi, everyone. Okay, we'll start from my left to my right. If you could introduce yourself, the organization you represent, and you have two minutes. It's that tiny little button by the plug. I muted it. Good afternoon, Chair and members of the committee. I'm Paul Horang, and I'm Director of Government Relations for HCA Health 1. Here to encourage you to vote yes for Senate Bill 26-138. Health 1 serves the highest volume of Medicaid and uninsured patients in Metro Denver, and every day our providers demonstrate our commitment to serving anyone who needs care. At its core, the hospital discounted care program is about access. This bill builds on that theme, making sure patients can get the care that they need without unnecessary administrative hurdles standing in the way. Every day, hospitals work with patients who are navigating not only health challenges but also financial uncertainty. When the process to determine eligibility for discounted care is overly complex, it can create confusion and encourage patients to delay care. This bill takes meaningful steps to simplify that process, Allowing hospitals to use third-party mechanisms to quickly determine whether a patient is eligible for a discount will strengthen the HDC program by helping hospitals get patients' discounts quicker and avoid mandated follow-up phone calls and letters that frustrate patients and providers. These provisions mean quicker determinations, clearer communication, and ultimately faster access to needed services. These changes don't reduce accountability, they improve it. A more efficient system is easier for patients to understand and easier for providers to administer consistently. It helps ensure that those who qualify for discounted care actually receive it without unnecessary delays or barriers It a practical patient improvement It supports hospitals in delivering compassionate care while also recognizing the real challenges patients face when navigating the healthcare system I'd like to thank HICPF, CCHI, and CCLP for working with us to get this bill right, and we believe it will make a meaningful difference for patients across Colorado. Thanks. Please proceed. Good afternoon, Madam Chair and members of the committee. My name is Matt Buechner, and I'm here representing the Colorado Hospital Association and the more than 100 hospital members across the state in support of SB 26138. Late last year, members of the Colorado Hospital Association came together to identify opportunities to strengthen administrative processes and programs that hospitals participate in, particularly healthcare facility licensure, hospital financial transparency reporting, and the hospital discounted care program. We are excited that this opportunity to work with bill sponsors and other stakeholders came forward on this bill. Over the past few months, we have been working with hospitals to draft technical changes that we hope will make processes more streamlined, efficient, and better for hospitals and the patients they serve. In addition, we have been meeting with other interested stakeholder groups and regulatory agencies, reviewing their feedback and incorporating it into our proposals when it aligns with the intent of the bill and strengthens the processes and programs addressed in this bill. We hope to continue working with these stakeholders as the legislative process continues to ensure the bill is as strong as it can be, while ensuring these processes are predictable and efficient for hospitals so they can help patients receive the care they need and the discounts they're entitled to. You'll hear testimony from hospitals today who can speak directly to the real world impact of these practical changes to hospitals and patients that they serve. By reducing redundant paperwork, aligning eligibility standards, and streamlining verification requirements, the bill allows hospitals to focus more on patients and less on administrative tasks. By allowing a hospital discounted care program screening alone to qualify a patient to access a discount, we believe this bill will strengthen the program, make it easier to access discounts, and solidify the legacy of the work done to establish the program. By providing a modest extension to the hospital financial transparency reporting submission requirement, this bill will better align with hospital financial audit processes. And by moving to biennial health facility licensure, CDPHE has expressed that they can better stagger the roughly 2,600 health facility license applications and renewals they currently approve each year and focus on the other important work that they do. Thank you for your time and consideration of this bill. We'd love for you to vote yes. Thank you so much. Please proceed. Welcome back. Thank you so much. Good afternoon, Chair and Committee members. Thanks for the opportunity to testify today. Kelly Erbzager with the Colorado World Health Center here in support of Senate Bill 138. This bill will alleviate some administrative burden at a time when Colorado's rural hospitals are bracing for intensifying financial strain in the face of reimbursement cuts and the impacts of H.R. 1. Rising labor costs, supply expenses, and workforce shortages have only added to that strain. And as a result, 20 of Colorado's 43 rural hospitals are operating with negative profit margins. But this issue is bigger than just hospital margins. Rural hospitals and clinics are often one of the top employers in a rural community and are essential to the economic viability of rural Colorado. In response to these increasingly impossible circumstances, Colorado's rural hospitals are constantly searching for ways to reduce costs and keep their doors open so they can continue to provide essential services like emergency care, OB and maternity care, and behavioral health. We believe this bill provides valuable tools for rural hospitals to streamline workflows and reduce regulatory burden. First a move to biennial health facility licensure will help ease the regulatory burden on rural hospitals and we encourage lawmakers to look for additional opportunities for similar systems change Additionally we hope that streamlining the HGC program will make it easier to administer and help patients who need help paying their hospital bills get the support they need The current systems for administering HGC can be complex fragmented and administratively burdensome, both for patients trying to navigate eligibility and for hospitals already stretched thin. This is especially critical for rural patients who are more likely to be uninsured or underinsured. By simplifying eligibility pathways and reducing administrative duplication, this bill can help ensure that patients receive timely financial assistance while allowing hospitals to focus their limited resources on delivering care rather than managing paperwork. Senate Bill 138 recognizes that improving access to discounted care isn't just about policy. It's about making systems. The systems work better for the people and providers who rely on it every day. I urge you to support this effort to strengthen rural health access and sustainability. Thank you. Thank you so much. Please proceed and welcome back. Thanks. Good afternoon, Madam Chair and the members of the committee. I'm still Brigitte Robinson, and I still practice general surgery, and I'm the current president of the Colorado Medical Society. The CMS supports Senate Bill 26138. My testimony today is just focused on Section 2 of the bill, which repeals the state's mandated opioid prescribing CME requirement as a condition of license renewal. There's three reasons. The first, physicians are already doing this work. The Federal Mate Act effect of June 2023 requires every DEA-registered prescriber to complete eight hours of opioid and SUD training as a condition of their federal prescribing license. That's four times what the state mandate requires. The state requirement is redundant. Second, the data on what has changed prescribing in Colorado couldn't be more clear. According to the IQVIA data published by the AMA this year, Colorado opioid prescriptions fell 46% between 2012 and 2020 before there was a mandate. That number has changed to 54% fewer prescriptions through 2024, and the dosage strength is down nearly 70%. Physician-driven prescribing restraint has done enormous work, and Colorado physicians remain vigilant. The deaths that persist today are largely driven by illicit opioids, not prescription opioids. Third, this is an administrative burden with no measurable return. Academic medicine found that physicians spending more time on administrative duties reported lower career satisfaction, higher burnout, and were more likely to reduce their patient load. Nearly half physicians nationally report burnout symptoms with administrative tasks consistently among the top drivers. Colorado's new 30-hour CME requirement under HB 24-1153 already provides meaningful continuing education directed at physicians' specialties and patients. Checking to the bill is a modest, targeted step towards giving Colorado physicians back the time they need to focus on patients. We urge your support for Senate Bill 26-138. I'm happy to answer any questions. Thank you so much. We'll move online to Ms. Stern. Good afternoon, Madam Chair, members of the committee. I'm Ellen Stern, Director of Government Affairs for Children's Hospital Colorado. Sorry, I couldn't be there in person. We are very grateful for Rep Stewart's leadership on this and support the bill. At Children's, we're the largest pediatric health care provider in the state. Roughly half of our patients rely on Medicaid, and many of our patients have complex social and health care needs. For us as a safety net hospital, financial stability is not an abstract policy. It's directly connected to our ability to sustain care for the children and communities that depend on us. Over the past several years, the state's developed a process to understand hospital finances through required reporting to Colorado Medicaid annually and on a quarterly basis, which brings additional administration. demands. Financial transparency reporting really illustrates the different realities across hospitals and should help all of you as policymakers to better understand the financial health of hospitals and the fact that most Colorado hospitals are currently operating on thin or negative margins while still delivering essential services to our communities. In this bill, we really support the updates to ensure more reasonable timelines so that hospitals have sufficient time to review materials so that we have actually 15 business days to look at all of the data aggregated by HICPAF for accuracy. Extending the hospital financial transparency year-end reporting is also critical from 120 current days to 150 days, which better aligns state transparency requirements with existing provider obligations, including completion of our annual audits, debt covenant calculations, cost reporting, and regulatory filings. For many hospitals, audited financial statements and those compliance analyses are finalized near after the 120 day mark. So that compresses our timelines. We really appreciate the work of the stakeholders on this and just would ask for your yes vote. Thank you so much. Thank you so much. We'll move on to Cassandra Garza. Good afternoon, Madam Chair and members of the committee. My name is Cassandra Garza and I'm the director of regulatory advocacy with Advent Health. I'm here today in support of Senate Bill 138. This bill represents a practical step towards improving our licensure framework by transitioning licensure with CDPHE from an annual to a biannual cycle. It streamlines processes and reduces redundancy. Today, hospitals and other licensed facilities are required to complete the full licensure renewal process every year. This process is comprehensive and resource intensive, requiring significant administrative effort from facility staff, as well as review and processing time from CDPHE. While oversight and accountability are critically important, the annual cycle does not provide additional safety or quality benefits proportional to the significant administrative burden it creates. Senate Bill 138 strikes an appropriate balance. Moving to a biannual renewal, Timeline maintains strong regulatory oversight while reducing unnecessary administrative workload on both the facilities and the department. This change allows facilities to redirect staff time and resources away from duplicative paperwork and towards what matters most, delivering high-quality care to patients and supporting their workforce. and the resource. Importantly, this change also benefits CDPHE. By reducing the volume of routine renewals CDPHE can better focus its resource on higher value activities such as inspections compliance and patient safety where oversight has the greatest effect We also want to express our appreciation to CDPHE for their collaboration on this proposal Their partnership has been instrumental in ensuring that this policy change maintains appropriate oversight while improving efficiency for everyone involved. For these reasons, we respectfully urge your support of Senate Bill 138 as a measured approach to reducing administrative burden while preserving strong patient protection. Thank you for your time and consideration. Okay, we'll move on to Mr. Thine. Thank you. Good afternoon, Madam Chair, members of the committee. Thanks for the opportunity to testify today, and thank you, Representative Stewart, for bringing this bill forward. My name is Joe Thine, and I'm the CEO at Southwest Health System in Cortez, Colorado, and I'm here in support of Senate Bill 26-138. and to underscore the importance of thoughtful regulatory relief at a time when hospitals are being asked to do more with less. Rural hospitals across the state operate on extremely thin margins and, as many have noted, often on negative operating margins. We are often the only source of care within many miles, providing both emergency services, primary care, and increasingly complex services to aging and medically vulnerable populations. At the same time, we face persistent workforce shortages, rising supply and labor costs, and declining reimbursement rates. In this environment, every administrative requirement carries a real cost, one that ultimately affects our ability to deliver care. Senate Bill 138 represents a practical, measured step towards aligning regulatory expectations with our operating realities. In particular, I'd like to highlight two provisions that are meaningful for rural providers. First, as others have noted, the bill's allowance for a biennial licensure offers a sensible adjustment to current processes. This renewal requires significant staff time and administrative coordination and takes resources that could otherwise be directed towards other important administrative work and patient care away. Second, the bill's provision related to the hospital-discounted care screening and application processes provide important changes. Rural hospitals are deeply committed to ensuring access for patients regardless of their ability to pay. However, rigid follow-up requirements when a hospital can easily determine through a screening process that a patient is eligible for HDC or a very own charity care program can create barriers for both patients needing assistance and for the staff working to connect them with the resources. Streamlining these processes will help ensure that financial assistance is accessible efficient and responsive to the realities where patients often don respond to some of the follow communications Additionally requiring the state agency to conduct changes to the HTC application and program requirements in a predictable manner with stakeholder feedback is essential for effective implementation when we're working with a lean operation. Taken together, these provisions reflect an important shift forward towards a culture of focusing our limited resources on patient care. Thank you. Thank you very much for the opportunity to testify today. Thank you so much. Questions for this panel? Did I miss anyone? No. Okay. Seeing none, thank you all so much for your participation. We appreciate it. Okay. Now we have gotten through all the witnesses. Is there anyone else in person or online who would like to testify today. Okay, seeing none, the witness phase is closed. Representative Stewart, do you have amendments?

Go ahead.

Second. Seconded by Representative Hamrick. Would you like to describe the amendment?

Representative Stewart.

Okay. Any questions on this amendment? Okay. Any objections to this amendment? Okay. Seeing none, L012 passes. Additional amendments.

Representative Stewart. Yeah, thank you, Madam Chair. So this makes other technical changes,

Any objections to this amendment? Okay seeing none L013 passes Any additional amendments No Madam Chair but I did want to say that we are continuing to work with the stakeholders that came forward to testify on an amendment for the floor so we hear everyone loud and clear Okay, any additional amendments from the committee? Okay, seeing none, the amendment phase is closed. Representative Stewart would you like to move your bill and wrap up

Second Representative Hamrick second Representative Stewart

Additional comments from the committee? Representative McCormick. Thank you, Madam Chair. And thank you, Representative Stewart, and also to your Senate sponsors for paying attention to the dentists and the veterinarians who were scooped up in this bill, probably inadvertently, but the fact that you all listened to the amendments that we needed was very important to me. So thank you. Additional comments from the committee. Representative Johnson.

Additional comments from the committee? Okay. Seeing none, Mr. Shadun, will you please call the roll?

Bill passes 9 to 4 You're on the way to Committee of the Whole Okay, with that, the Health and Human Services Committee is adjourned