April 29, 2026 · Health & Human Services · 10,187 words · 10 speakers · 107 segments
Excuse. English. Excuse. Fray. Excuse.
Hamrick. Here.
Johnson. Here.
McCormick. Here.
Raiden. Excuse.
Stewart. Here.
Wook. Here.
Leader.
I know she's on her way. Excuse.
Madam Chair.
There she is. Here. There she is. Here.
And Representative Bradley is here. And Representative Leeder is here.
Thank you.
All right. We have our bill sponsors ready to present House Bill 1425. Who would like to begin? Representative Brown.
Thank you, Madam Chair. And thank you, committee, for your attention today. Today we present House Bill 1425, which is a bill that is ultimately about helping Colorado to keep pace with the growing demand for behavioral health services in Colorado, while still making sure that our systems reflect today's realities. Applied behavioral analysis or ABA therapy plays a critical role in supporting individuals, especially children with autism and other developmental needs. As our families rely on these services, I should say as more families are relying upon these services, it becomes even more important that the state has clear and consistent standards in place to ensure quality and accountability across the board. Right now, the ABA landscape is uneven. Families navigate a complex system without clear guidance on what high-quality care should look like, and providers are often operating without fully standardized expectations. This bill works to address that gap, modernizing the oversight of this particular provider type, clarifying requirements and aligning Colorado's approach with current best practices in behavioral health. We're not here to create unnecessary barriers. We are here to create consistency so that families can trust the care that their loved ones are receiving no matter where they go. And I think we've all probably read some of the challenging allegations of some bad actors in this particular space. And we're here, again, to protect kids who need these services and make sure that these services continue to be able to be provided. it's important to emphasize that this bill is mindful of the provider community I want to first of all thank my co-prime sponsor for her work on this bill she has pulled together an amazing stakeholder process over the past six, eight, I don't even know how long many months and has done yeoman's work pulling people together trying to deal with the concerns of a variety of different stakeholders, the provider communities, but also the departments and others. And so, you know, I think that is worth mentioning, that there could not possibly have been a better stakeholder bill than this one that we are considering today. It's important to emphasize that because of all that stake holding, this bill is very mindful of the provider community. We already facing workforce challenges in behavioral health and the intent here is not to make that worse Instead we aiming to clarify the structure so providers know what expected of them can deliver care and that they have a more consistent regulatory framework that supports providers but also protects kids, reduces ambiguity, and creates a more stable and trustworthy system overall. So with that, I will be happy to turn it over to my co-prime sponsor again and thank her for all of her work, and thank you all for your attention.
Representative Gilchrist.
Thank you, Madam Chair, and thank you to my co-prime sponsor. And I just want to start from the beginning where all of us had experienced outreach from families what seems like many, many years ago, but was I think this summer. Families reaching out saying we're worried about access to services, to ABA services and support for our autistic children. And so Representative Brown and I and others on the committee immediately dug into it and wrote a letter to HICPUF and wondering about what's happening. And so from there, we spent that in-between time from those emails to now trying to figure out how we ensure that we have regulation in the space that keeps kids safe and the balance of ensuring that we have access for these families. And we've seen a dramatic increase in diagnosis of autism, which is really important and good. That means kids get the right supports. And so there's been an increase in need for these ABA services. And so this bill works to strike that balance. So as we went through that process and engaging with HICPF and CDHS and others, and then with providers. And then also, you know, reading as my co-prime mentioned, some of the fraud allegations and the maltreatment allegations that were out there, that this was something that had to happen and had to happen now. And so what you see before you today is both a professional licensure and a facility licensure for ABA providers and a facility licensure for ABA clinics. And this professional licensure is something providers have been asking for for years. And so it comes in, brings us up to speed with other states. Lots of other states have professional licensure for ABA providers. So that is critically important. And then facility licensure, because we really want to make sure these facilities are safe for kids. That if there is an allegation of abuse or maltreatment, that the department can go and evaluate and then take action. That is incredibly important. And so we believe the combination of those two things gets us to a really good place in the state to make sure that we have access for these kids and that that access and those support services are safe. I have mentioned this before, but my middle child was diagnosed with autism. When she was, we explored this path of ABA and came into contact with a lot of these providers. And so this is near and dear to my heart to get this right. It has kept me up at night many, many nights. to get to this point. And I think you'll hear from agencies about the process and their position on each of these pieces of the bill. And then also you'll hear from providers who we have engaged with from the very beginning. Not all providers are the same. And so we've also tried to strike that balance of how do we make sure everyone comes into compliance we all working from the same level but that we acknowledge that there are small providers and then there are large providers There are providers that are nationwide and then there are providers that have one ABA clinic. So, yes, that is where we are. I look forward to any questions you have and urge a yes vote today.
Thank you both very much. I wanted to report that Representative English, Representative Frey, and Representative Ryden have joined us. Any questions for our bill sponsors from committee? All right. I'm not seeing any, so we'll move on to witness testimony. We have approximately 11, 16.
Some of them are doubles.
There are. So I will start with a panel of folks from our state agencies so that we can get any questions answered for them straight away. So if you're in the room or online, listen for your name. Mr. Tom Miller, Logan Ellett, Adela Flores Brennan, and Mr. Sam Delp. I think it's here from Dora for questions only. And I think that's all the agency people that I have. so we will allow three minutes for each person to testify and 10-minute panels for any questions so who would like to begin go ahead and make sure your mic mic is on you'll have three minutes
introduce yourself and tell us who you represent thank you very much good afternoon madam chair and members of the committee my name is tom miller i am the director of the office of children Aging and Community Service at the Colorado Department of Human Services. We appreciate all the hard work that has gone into House Bill 26-14-25 and are very supportive of the facility licensure language contained within. This effort is a priority for the office and the department as our primary mission is the safety of children and youth and this bill directly addresses that mission. I am joined by Logan Ellett, Provider Development Manager for the Department's testimony.
Great. Go ahead, Ms. Ellett.
Thank you, and good afternoon, Madam Chair, members of the committee. My name is Logan Ellett. I'm the Provider Development Manager for the Division of Child Welfare at the Colorado Department of Human Services, the licensure of 24-hour child care facilities, day treatment centers, child placement agencies, and potentially soon-to-be ABA clinics as a part of my unit's responsibility as the provider regulatory body at CDHS. This proposal, as it relates to the clinic licensure component, would add a new license type of applied behavior analysis clinic within Title 26 and provide statutory authority to CDHS to license, monitor, and oversee the day-to-day operations to ensure child safety in what we estimate to be about 410 to 500 unlicensed ABA clinics operating across Colorado today. This proposal is also a request for funding for staff who would be responsible for the licensing and monitoring of the ABA clinics. To date, there are only two states that currently oversee ABA facility licensure, with three other states working toward ABA clinic licensure. Colorado would be the fourth state to work toward ABA clinic licensure. These clinics serve children ages 18 months old up to 21 years of age and typically children with autism spectrum disorder or who have intellectual and developmental disabilities To date the department has received 35 separate complaints on 15 different unlicensed ABA clinics that we have been unable to investigate due to not having the statutory authority to license or oversee the clinics These complaints range from children being served raw chicken to pertussis outbreaks to restraint to physical abuse, medication overdose, and registered sex offenders on staff at the facility. As a result, CDHS has only been able to refer these complainants to law enforcement, the Child Protection Hotline, Disability Law Colorado, or the Child Protection Ombudsman's Office, none of which have the ability to oversee facility operations. Facility licensure is critical to ensure child safety and proper oversight of the clinics, their operations, and the safety of the staff. We appreciate working with stakeholders and providers to get to a solution that finds an appropriate balance between child safety and access to these needed services. Without clear statutory authority to license ABA clinics and a regulatory framework for the licensing and monitoring staff. The department anticipates continued abuse and neglect to complaint allegations and an inability to ensure child safety in these clinics statewide. This puts children and staff in the clinics at risk and does not provide consumer protection to parents and guardians who are relying on these needed services for their children. Thank you, and we're happy to answer questions.
Thank you for your testimony. We'll go online to Ms. Sedella Flores-Brennan. Go ahead and introduce yourself, and you'll have three minutes.
Thank you, Madam Chair. Good evening, everyone and members of the committee. My name is Adela Flores Brennan. I'm the Medicaid Director at the Department of Healthcare Policy and Financing, and we are testifying tonight in an amend position and respectfully request amendments to Section 6 of the bill, and I'll get into that in a little bit. ABA therapies and Medicaid have been one of our fastest growing benefits. We're serving currently over 8,000 Medicaid members, but at a cost of $287 million per year. With the increasing numbers of autism diagnoses, it's important that we are able to ensure the availability of these services for children, both now and in the future. And ensuring access also means that it is important for us to maintain the safety and integrity of the benefit. On the whole, we think this is important legislation that helps to ensure the highest level of integrity, safety, and quality for children seeking ABA services. And again, as I noted earlier, there is one piece that's a major concern for HICPF. Section 6 of this bill creates a grace period and requires HICPF to reimburse for services provided by a behavioral technician prior to them being credentialed in up to 60 days. The minimum requirement for registered behavioral technician credentialing includes a high school diploma, 40 hours of training, a supervised competency assessment, and passage of a national exam. Section 6 asks the state to put Medicaid dollars on the line before any of that is verifiably complete. At a time when we are being asked to make reductions to the Medicaid budget, This does not seem fiscally prudent, and it also means that we have minimally trained and uncertified individuals providing services to vulnerable children. This has also been an area of significant growth. The behavioral technicians over the past couple of years, the past couple of fiscal years, specifically has grown 23 percent. So it is a rapidly growing area of this benefit. But the members receiving these services are children with autism spectrum disorder and related conditions. And we believe that authorizing payment for uncredentialed staff who may have no formal training or relevant education is inconsistent and creates a safety gap that... we are looking for you to close. Please also consider that Title X, which regulates commercial plans in Colorado, does require that ABA services be delivered by credentialed providers. So, making sure that we have credentialed providers in Medicaid would be consistent with Title X as well. HICPF supports a regulated, well-trained ABA workforce, and we're supportive of the licensure framework that the bill establishes. We're just looking for those changes to Section 6, and I'm happy to take questions. Thank you very much.
Thank you for your testimony. And I know we have Dr. Sam Delp online. If you could go ahead and introduce yourself. I know you're here for questions only.
Yes, thank you, Madam Chair. My name is Sam Delp. I'm here with the Division of Professions and Occupations at DORA. We're pleased to have worked with the sponsors on the individual licensing components of this bill, and I'm here for any questions.
Thank you very much. Committee members, do we have any questions for this group of witnesses? Representative Johnson.
Thank you, Madam Chair. My question is to the two liaisons with CDHS. I'm seeing you're in an amend, but I didn't catch what you're amending in your opening statement. Can you kind of flush out what it is you're looking to amend? Ms. Allett. Thank you, Madam Chair, and thank you, Representative, for the question. We are in a happy amend position in collaboration with HICPF as well as DORA to amend their section of the bill. We believe that the section related to facility licensure does not require amendments at this time, but would support HICPF in their request for an amendment.
Representative Hamrick, did you have your hand up?
Thanks, Madam Chair. This is for the HICPA representative. It's about the 60-day grace period. Once the person gets the license, is there some kind of retroactive reimbursement?
Ms. Flores-Brennan.
We could take that under consideration. There is not currently a retroactive reimbursement in place. That is something that we would need to look into.
Representative Bradley.
Thank you, Madam Chair. To Ms. Ellett, only two other states have done this. Why?
Ms. Ellett.
Thank you, Representative, for the question. In our conversations with a handful of other states over the last six months, we are all identifying that this is a newer issue coming to the department in terms of regulating the clinics. As was mentioned in the beginning of the hearing, professionals associated with ABA therapy, they're board-certified behavior analysts, registered behavior technicians, they've had professional licensure in 39 or 40 states at this point. But in terms of facility or clinic licensure, that is something that is newer across the United States and an issue that a handful of states have approached thus far. And I have those states here. It was Pennsylvania and Arkansas who are currently overseeing ABA facility clinic licensure and operations and three others that are working toward that.
Representative Bradley.
Thank you, and thank you for that. In the two states that require the licensure, are you seeing complaints being resolved? Are you seeing fewer complaints? I was trying to write down how many complaints that you had had. And are you seeing maybe less fraud? because in the state we had what million in fraud with ABA fraud racking up So I want to know that increasing licensure in the state is going to cut down on fraud and make it safer
Ms. Allett.
Thank you, Madam Chair, and thank you, Representative, for the question. Well, we did have 35 separate complaints that we have not been able to adjust or resolve yet that have been submitted to the department. in conversation with those other states over the last six months or so. We didn't dig into the specifics on whether or not they have been receiving complaints and resolving those complaints. These were higher level conversations around what does their statutory language, regulatory structure look like? How would we work to mimic that if it's working within their state, just to kind of get some information from other states who are operating in a way that we hope to be potentially. And to speak to your question around mitigating things like fraud, licensure actually can mitigate a handful of the findings from that HHS audit, that $77.8 million. It mitigates things such as ensuring that there are clear background checks before staff are hired into facilities. That is a responsibility of members of my team. It mitigates things like ensuring there's a comprehensive assessment that is completed prior to a treatment plan being implemented, as well as ongoing checks of that specific treatment plan based on the needs of the youth in that program. There are dozens of other components that licensure helps to mitigate, but it would absolutely help to cut down on some of that fraud. Representative Hamrick.
Thanks, Madam Chair. This is for DHS.
the bill authorizes you all DHS to set standards for the restraint of children in the clinics and I'm not sure where you are in the process or talking about it but just wondering if it will be more or less restrictive than the current protections in public schools. Ms. Allen. Thank you Madam Chair and thank you Representative for the question
I'd have to brush up on the current regulations for public schools as you know my purview is very much specific to the licensing act and licensed facilities and agencies but at this time As of last July 1st, 2025, we did update all of the restraint and seclusion regulations in 12 CCR 2509-8, Section 7.71453 through 549. And I know that because that's my job is to write these rules. So we updated them to be in alignment with what is in the protection of persons from restraint statutes in 2620, 2620, as well as federal requirements for restraint and seclusion, everything from documentation to debriefing and training for staff. So there currently will be a review of those regulations to ensure that they are in compliance with state and federal law for restraint.
I have a question about, for you, Ms. Allett, these clinics or facilities that you're looking to stand up licensure for, how long will that take and what is going to happen in the meantime for some kind of interim oversight or regulation or licensing process to reassure the public that your eyes are already on these clinics? Ms. Allitt.
Thank you, Madam Chair. I think that is the elephant in the room a lot of the time. Right now, we are aware of around 410 to up to 500 clinics, and it is never the department's intention to shut down any of these providers. We want to work in collaboration with them because the licensure process can be cumbersome. I have seen it take 90 days. I have seen it take six months to a year. A lot of it is dependent upon the provider's ability, willingness to come into compliance with some of the regulations. That being said because regulations for a brand new license type takes some time to come and be promulgated by our State Board of Human Services Our current process is the same as it has always been So if we are aware of a facility that may be operating without a license that does require licensure, if we receive a complaint, an allegation of abuse and or neglect that our team needs to investigate, we have statutory authority and requirements to do that under 26.6.918. and we would investigate those complaints and have discussions with the provider as to if they meet a licensure definition in Title 26 under the Licensing Act and move through that process of licensure. What that looks like once we have identified that they meet licensed criteria is we have conversations with the provider and in statute right now there are allowances for a provisional license for up to six months for that initial period. All that we would require to get that provisional license, to then continue toward full licensure to an ABA clinic license or day treatment, which is what we are doing right now, is we would make sure that that facility has proper fire inspection approval, health inspection approval, zoning, and background checks cleared for their staff. Through that six-month period, we work on reviewing policies and procedures. We do lots of walkthroughs of their physical space, ensuring safety for the youth and staff, and then we work up to that full licensure. So during that time, the provider can continue to operate, and we have actually worked through that in the past few years with a handful of providers we have brought into compliance and licensure in this way.
Thank you. We probably have time for one more question. Does somebody else? Representative Bradfield, did you have your hand up?
You asked most of my question. Thank you.
Okay. Anyone else? All right. Seeing no further questions, Thank you all very much for your time and testimony today. We'll move on to the next panel of folks. There might be some in the room and online, so I'm going to call them all. Ms. Hillary Jorgensen, Ian Goldstein, Barb Dwyer, Brock Lee. All those folks might be in the room. Maybe not. Mr. Sean Davis, Dr. Paul Bauman, Megan Lovelace, Will Martin, and Ken Wynn. Is there anyone else in the room that wanted to testify on this bill for against or amend? Come forward. All right. Well, we'll start with you, Ms. Jorgensen, since you're here. Go ahead with your testimony. You have three minutes.
Thank you, and good evening, Madam Chair and committee. My name is Hillary Jorgensen. I am one of the co-executive directors at the Colorado Cross Disability Coalition. We are a statewide advocacy organization for people with other different kinds of disabilities. That's the cross in our name. We are here receiving a strong support of this bill. So we had a family report to us several months ago who believed that their child was being mistreated in one of these facilities. And when our staff looked into filing complaints, they were extremely alarmed to discover that neither the providers in these facilities nor the facilities themselves were licensed And because of that there essentially was no statutory legal oversight for these facilities and these providers, which is alarming on any level, and it's particularly concerning when you consider that many of the kids being treated by these providers and in these facilities are not able to verbally communicate, and 18% of them are three years of age and under. And so, you know, talking about protecting kids and the youngest kids and kids who may not always be able to tell their families when something is wrong. I want to be clear that we believe that the vast majority of these providers and these facilities are providing good care, but it's really imperative that we license professionals doing this work and facilities doing this work so that the state can have a website into health and safety, including medications like food. Seclusion and restraint is one that's really important to us. And I just really appreciate the sponsors and the state polling that has been done. I think we have a few more conversations to have, But I really appreciate the statement and the conversations that have happened. And we really, really believe that it is imperative that we pass this bill this year so that we ensure that kids undergoing this kind of treatment have all the same protections and oversight that children in child care facilities also have. So thank you. Please vote yes. Happy to answer.
any questions. Thank you for your testimony. We'll go online. Do we have Ian Goldstein?
Yes. Can you all hear me okay? Yes, we can. Go ahead with your testimony. You have three minutes. Great. My name is Dr. Ian Goldstein. I am a physician by background, no longer in practice. I'm the founder of SOAR Autism Center. We're a network of multidisciplinary autism clinics across the state of Colorado. I'm also the dad of a child with autism, and I speak from both of those perspectives today. Overall, we are generally very supportive of this bill, and we think it is a positive step for care quality for autism in the state of Colorado. We do believe there are a couple areas that could use some refinement, and so that puts us in an amend position for the bill. In terms of our support, I want to thank the committee, and in particular the sponsors and Representative Gilchrist, for your collective work on this bill. We do believe it is a meaningful step to improve care quality in the state of Colorado for children with autism. There are many ways that we believe this bill does this. First, from a professional licensure perspective, this is something providers have been looking for for many years. I think it's 39 or 40 states in the United States have professional licensure for BCBAs or behavior analysts. Colorado does not. this is a very, very good step to ensure that the professionals who oversee care for kids with special needs have the right standards and background to provide great care in our state. Second, we are very supportive of the RBT requirement. The RBT requirement is something that we already do for the vast, vast majority of our staff, and this brings it, into statute and also provides a reasonable 60-day grace period to recognize the unique workforce constraints that ABA providers experience. Finally, we are supportive of some aspects of the facility licensure to help cover any outstanding gaps not covered by the professional licensure segment. So, you know, overall, we believe we should be setting expectations high for providers. When we do that, we can provide great care for kids. And we do think that this bill takes meaningful steps in that direction, and we appreciate your work to bring it forward. We do have two areas of concern that we're looking to be refined. We've shared some additional comments offline on both of these. The first is clarifying the intermediate period on facility licensure. So as written, the bill, I believe, gets until 2029 to promulgate the rules and having more clarity both for the providers and the state of how the next two to three years will be handled until those rules are in place. And then second is refining some of the language in the facility licensure section related to childcare. Though we do serve children, we are not childcare centers. We are healthcare centers providing medically necessary therapy. And so we're really looking to ensure that the language reflects the unique healthcare that we provide. Meaning with Colorado Medicaid, we are not allowed to provide childcare. We're denied for childcare and custodial care and making sure that the regulations are consistent with the healthcare framework that we operate in. We have several specific recommendations in that that we will share offline. Overall, thank you for your time today. Thank you for your work on this bill and look forward to seeing the progress moving forward.
Thank you for your testimony. We'll go next to Mr. Sean Davis. Go ahead and introduce yourself and you'll have three minutes.
Thank you. I'm Sean Davis and I'm the father of a 16-year-old son with autism who was nonverbal, who also spent nine years in ABA, both in a facility and also in home. Madam Chair and members of the committee, thank you for the opportunity to testify today. Raising a child with autism is one of the greatest blessings of my life. It is filled with love, joy, courage, and moments that mean everything. It is also hard in ways that many people never fully see. Many families live with sleepless nights, communication barriers, meltdowns born from frustration, school struggles, therapy schedules, insurance fights, financial stress, and the constant fear of what happens to our child when we are no longer here. We carry all of that because we love our children beyond words. When families seek ABA services, they are often not coming from a place of convenience. They are coming tired. They are coming worried. They are coming after months or years of trying to help their child. They are coming with hope in one hand and then fear in the other. They are trusting strangers with the person they love the most in the world. In my case, my son is nonverbal, and if something happens to him, he has absolutely no way to tell me what's going on. There are parents all across Colorado who hand their children to providers every day, knowing their child may not be able to describe mistreatment, fear, neglect, or harm. We are asked to trust completely and to hope the system is worthy of that trust. That is why this bill matters so deeply. House Bill 1425 creates common sense protections. Licensing for professionals providing the ABA services criminal background checks standards for ethics and competence accountability when misconduct occurs These are not burdens These are protections The bill tells families Colorado sees you Colorado understands the trust you are being asked to place in the system. Colorado believes your children deserve safeguards. Good providers should welcome this bill because it lifts up quality care and protects the integrity of their profession. Today, you have the power to give families a little more peace of mind, a little more trust, a little more protection for children who may not always be able to protect themselves. So I ask you to please vote yes on House Bill 1425. Thank you. And I'm happy to answer any questions you may have.
Thank you for your testimony. Next, we'll go to Dr. Paul Bauman. Go ahead when you're ready. You have three minutes.
Good afternoon, Madam Chair and members of the committee. Thank you for the opportunity to speak to you in support of House Bill 26-14-25. My name is Paul Bauman, and I'm here today representing Advocacy Denver, Denver's chapter of the ARC. Advocacy Denver promotes and protects the human rights of people with disabilities and actively supports the full inclusion and participation in the community through their lifetimes. Every child who needs access to ABA therapy needs access to ABA therapy that meets high standards of quality, period. Unfortunately, at Advocacy Denver, we know that this is not always what children receive from their ABA providers. House Bill 261425 provides an important step in ensuring that ABA therapy provided to children truly serves them and their needs, rather than the needs of providers, clinics, and corporate owners. Advocacy Denver supports HB 261425 because it provides a regulatory structure similar to structures used for other comparable services for other groups of marginalized children. This structure, a licensing board that largely consists of professionals in the field, the licensing of practitioners and clinics, is sensible and is shown to be navigable for many groups of professionals. This is doable in our estimation. Regulation of ABA services through the licensing of providers and clinics would allow families to have their complaints heard and addressed when necessary. It would allow the state to hold providers accountable for providing services paid for by public Medicaid funds. It would allow private insurance companies to be sure that their policyholders are receiving the level of therapeutic services they deserve, and would allow the field of ABA through a licensing board to set meaningful and enforceable standards for credentialing and practice. In addition to my professional 30-plus career in teaching and education and disability policy, my best, most important job is as a parent to my two children, Brooks, 13, and Cora, age 9. They are amazing human beings, and they teach my husband and I something new every day. I know as a parent how consequential high-quality ABA therapy can be for a child who needs it. Brooks was diagnosed with autism at age three and also has severe ADHD, has epilepsy, and several other conditions that resulted from in utero exposure to alcohol. Since his autism diagnosis, Brooks has received applied behavior analysis therapy at various times. He currently has an amazing BCBA who understands adolescence with autism and provides some high therapy in home and in clinic and thank you Colorado in school Shout out to Megan and Brooks' team at Cherry Creek Schools for fostering this really important relationship between therapists and school. That's why I'm here today. In closing, I ask for your support of HB 26-14-25, and thank you for your time. I'd be happy to answer any questions you may have.
Thank you for your testimony. And next up, we have Will Martin. Go ahead when you're ready. You'll have three minutes.
Hi, everyone. My name is Will Martin, and I've been a board-certified behavior analyst for the last 12 years, and I'm here speaking on behalf of the Colorado Association for Behavior Analysis, which I'll refer to as COABA moving forward. At COABA, I serve as a board member and the chair of the Public Policy Committee. Since its inception, COABA has been committed to high standards and meaningful regulation for behavior analysts to ensure that individuals and families which we serve receive the highest quality care. I'm here to voice COABA's strong support for this bill, and we're particularly grateful for Representative Gilchrist and Representative Brown for sponsoring this bill and taking a thoughtful approach to balancing access, sustainability, and safety. This bill creates both professional licensing for ABA providers, which is something COABA has advocated for for many years, as well as licenses specifically for ABA clinics, which are substantively different from both day treatment centers and child care centers. As you've heard from other speakers, there are currently 39 states that license behavior analysts, and this bill would ensure that Colorado is in line with the best practices across the nation, and it also gives meaningful regulatory oversight to the state. We're also supportive of facility licensure, although we do have some additional feedback to ensure that we have the correct classification for the unique medical services that behavior analysts provide in the state. Specifically, we want to ensure that facilities in which we provide services are classified correctly as medical clinics rather than child care facilities. Being classified as a child care facility has many knockoff impacts, and our position remains that our unique service model requires its own classification and its own rules. We look forward to working with the legislature around these changes as the bill moves forward. I'd also like to comment briefly on the RBT training period that's sometimes called a grace period. There are many other states who have their Medicaid programs allow for 90-day or greater training periods. There are also many commercial insurance providers that allow for these training periods in place. The intention for COABA is not that untrained technicians are working with children, rather that we recognize that a technician must engage with three to four different groups or bodies in order to actually pass the RBT exam, which is administered at a Pearson testing center, is a multiple choice exam, and in which no content is based on child safety or welfare. Instead, we'd like to give people the time to move through that process at a reasonable pace and ensure providers are investing in training early so that they can cover some non-RBT certification areas like child safety, welfare, and at my organization, we also have people engage with Colorado Shines to ensure that they know their obligations as mandated reporters. So I'd ask you to support a reasonable training period to make sure providers aren't pressured to cut corners and that we establish meaningful training standards in that process. Thank you very much for your time, and I'd be glad to answer any questions. Thank you very much,
and we go to Ken Wynn When you ready you have three minutes Go right ahead Thank you so much Thank you to the chair Thank you to the members of the committee I so appreciate the work that has been done by the sponsors
My name is Ken Wynn. I'm the CEO and founder of Advanced Behavioral Resources. I'm former president of the Colorado Association for Behavior Analysis and Four Corners Association for Behavior Analysis. I'm the current president of the Rocky Mountain Association for Behavior Analysis, and I am a licensed behavior analyst in Texas. I've been certified as a behavior analyst since 1989 and have seen the exponential growth of behavior analysts as a profession. I fully support this bill. We are one of only 10 states without licensure, and it is time that we do. Colorado should be leading the country. There has been untold harm by practitioners who call themselves by any number of names, ABA therapist, ABA practitioner, behavior therapist, behavior specialist, and the list goes on. As long as they do not call themselves by the terms that are restricted by the BACB, such as Behavior Analysts, BCBA, BCBAD, or BCABA, or RBT, there is no oversight for them in their practice legally. While we have a code of ethics and the BACB can discipline certificates and only certificates that violate the code, they don't have any procedures to enforce the code by regulating the practice. taken only by enforcing the reporting of the violations of our code. There are currently 17, 1,775 BCBAs, 55 doctoral-level BCBAs, 55 BCABAs, and 7,445 RBTs. And the field continues to grow, especially in the field of autism spectrum disorder, which is where ABA is the treatment of choice. I noticed in the fiscal note that there's a projected revenue for the 27-28 with a little over a million dollars in revenue, and I think that's conservative. If you do the numbers, you should actually be generating revenue for the state. So this is a way that the state can generate revenue by licensing behavior analysts. Here's the reasons we need to for licensure. One is to protect the consumer. Two is to protect the practitioner and establish our profession in state law. And the third is to protect the practice for our scope of practice, because right now there only is the restriction of the title. This will restrict the title and the practice. It would regulate our profession, enforce ethical standards with the weight of law that it currently doesn't have. Currently, we only have certification in Colorado and only restricts the title only. I do have a little bit of concerns about how the licensing board, it will be set up and who will be on it. We've done this in other states
and it has been messed up in other states. So I would look to get guidance from the BACB and the Association for Professional Behavioral Analysis, APBA. I appreciate the time and thank you. If you're interested, there's a wonderful article by Dorsey et al. in 2009 in Behavior Analysis and Practice that demonstrates the value of having licensure. And I'd answer any questions that you have.
Thank you for your testimony. All right, committee, these are our folks. Representative Johnson.
Thank you, Madam Chair. And I have two questions. The first, just because you just recently talked, Mr. Wynn, you mentioned a revenue drive for state licensure. What's your opinion if we would follow national certification? That way we're streamlining it across the board, especially for our communities that sit on a state border. because we're surrounded so then they can be able to practice in both states for children who might be traveling both ways. Mr. Nguyen? I fully support that. Thank you so much for the question.
I fully support that. I work in multiple states. Like I said, I'm licensed in Texas as well as being nationally certified. So I think that's the right way to go. I would learn from some of the mistakes other states have made, such as there were some things done in North Carolina and Arizona that I think we can learn from. The good news is that we have a model licensing act that the Association for the Professional Behavior Analysis has online, and I would recommend they have great resources. So this is an easy lift.
Representative Johnson, follow up? Yeah. Also for Mr. Winn and maybe Mr. Martin, because I still haven't had time to reach out to my seven counties with how fast this is moving. have you heard from any small or rural practices on how this could with this extra regulation might actually put more burden on them now looking at a fee and other areas i know we're strapped for resources and so i just don't want to see anything that limits that even further do you see any concerns or have you talked with any rural folks mr win i have i have and i'll let will speak
because will can speak for coaba that that would be that would be the avenue that i think we would make this easier for them is through an organization like the Colorado Association for Behavioral Analysis, and they do a lot of outreach for these rural communities. So as I said, I'm licensed in Texas, and they do that all over Texas. So I think this has been well-covered territory, but I think the utilization of an organization like Coaba would help mitigate some of the challenges in those rural communities.
Mr. Martin, would you like to add?
Yes, if you don't mind, just to build on what Ken is saying, I think that's why we're so adamant about the importance of the regulation being specific to this unique service model and not being a blanket child care or day treatment license. Because in rural communities in particular, there's not enough real estate for some of those requirements that are currently in regulation for every ABA center to meet those. It's also why we think having a reasonable grace period or training period is meaningful for RBTs, because oftentimes people on the Western Slope or other parts of our state live three to four hours from a testing center, and it is quite a burden to get there to meet those standards. And so we see it as a delicate balance, but overall feel like it is valuable to have this regulation to protect consumers and raise the standards in our field, but agree that it has to be done so thoughtfully so it does not limit access to families, particularly in rural communities who need care. So I think it is a balancing act, and I feel like Representative Brown and Gilchrist have done a nice job of hearing from stakeholders and feel that some of the provisions I mentioned do safeguard against that, but it is a balance for sure.
Representative Bradley.
Thank you, Madam Chair. For Mr. Martin, I know that HICPF had come and wanted an amendment. They said Section 6, but I believe they were talking about Section 5. I was wondering if you could talk a little bit more. I think I found what they were talking about where they were discussing, I believe, page 27, line 16, where they say under a behavior technician is not certified at the time of services for services provided during a temporary period of not less than 60 days while the behavior technician is pursuing the certification. Would this be likened to a student who is going through maybe a physical therapy degree, but they're still a student and they are doing an internship, but they're not getting paid for services rendered Would you be getting paid for services or are you just working while you pursuing the certification Walk me through that That was for Mr Martin Yeah go ahead Mr Martin Yes, thank you. So I think it would be more similar to other medical technician roles, such as a mammographer technician, a pharmacy technician, a dialysis technician, etc., where where our technicians are typically entry-level providers, and we typically train them ourselves because there's not a pool of people who have this training. And so the training, as Adela from the department mentioned, is not like getting a degree or an advanced degree. It is a meetable bar for people who are not going back to school. However, all providers typically train their own staff in house, and it does take some time to do that. And also, the registered behavior technician credential is not about, doesn't really have a lot of components that are specific to child welfare, child safety, and some of those things that I know are concerns for this group. And so, oftentimes, like the organization that I work for, we greatly exceed the minimum training and provide six weeks of training for these folks. However, in order to actually become an RBT or get your certification as a registered behavior technician, you have to go to a testing center that is administered by Pearson and sit for a written exam. And so in order to do that, you have to submit an application, find an appointment, drive there. There's a lot of other steps to get there. So what we're suggesting with that part of the bill is that we can have some minimum training standards, and we would be happy to include those in the bill, particularly around child welfare and safety, but give people time to actually achieve the certification component, which does require these extra steps, and not have children waiting who need care, who can't access it because someone didn't sit for an exam. Rather, we create a reasonable baseline set of expectations, compel providers to meet those, and then give flexibility for some of those final steps.
Mr. Nguyen, did you want to add something to that answer?
I did. I forgot to mention that. I fully support that grace period. I'm a provider. I've been a provider for years. And I think what Will said is well said. It would be an undue burden on providers not to have that grace period. You want these providers to have specific training in situ. And so this, I love the fact that Will called it a training period. That's exactly what it is. And many other providers do that. So that's what this would be. It would allow them to modulate their training to the circumstances, the setting, as Will said, child care, child welfare, and other settings. So it's not just ABA clinics. They're applicable to a bunch of different areas. And so this allows us to do that on-the-job training. The thing I would be mostly concerned about is network adequacy. We already have more RBTs than we need. They have zero, any RBT can get trained and immediately start working. They have zero unemployment. So we're all scrambling to get RBTs. Adding more burdensome to make that happen is just going to delay people getting the needed services that are life-changing for them.
Any further questions for this panel of witnesses? All right, seeing none, thank you all very much for your time and testimony today. and we did have last call for anyone that wanted to testify on 1425. Seeing no further folks, that ends our witness testimony phase and we will call our bill sponsors back. Representative Gilchrist, do you have any amendments We do not Committee any amendments for 1425 Alright seeing none that ends the amendment phase Representative Gilchrist just talks slow
Thank you, Madam Chair. Thank you, Committee, for engaging and the great questions that were asked today. I just wanted to kind of outline some things. So first of all, you heard from both agency and providers that there are a few things that they want adjusted. We are in the process of working on that. So both with that, what the providers mentioned about the child care discrepancies, we're working on clarifying that. We particularly looked at a standalone facility licensure because of that, because ABA is so unique and not trying to fit it into an existing licensure process. it's also important to note that that will take some time to stand up that facility licensure but in the meantime CDHS will continue to work through clinics to get them licensed in the current structure in the day treatment process and then obviously everything will transition to the standalone facility licensure as soon as that is stood up but we felt like that was really important to have that unique licensure for these ABA clinics. I also wanted to talk just briefly about the 60-day window that you heard from both HICPF and from providers that both it's important and also that it needs to be adjusted. I am hopeful that we can come up with a compromise much like what we have done with the rest of the bill. I think the balance there is how do we make sure that folks who are in the position to do that work as an RBT, have that time to be trained, but also that folks who are taking care of vulnerable children are supervised and are in a situation where they are equipped and are providing safe care for these kids. So we are working on that compromise, and we'll bring amendments to hopefully address all of those issues. I also just wanted to thank the stakeholders, many of the folks in the provider community and the agencies have been on hours and hours and hours long calls going word by word of this 50-page bill to make sure we get it right. And I think also appreciated the questions about what we've seen professional licensure in other states, but we haven't seen facility licensure in only two states. I think the important note there is that like this is a growing issue and a needed one and so I think it's really our opportunity in Colorado to lead and that's why I've taken we've worked so hard to get this right because we do want this to be a model for the rest of the country and so with that I I'm grateful for your engagement today and we ask for a yes vote to to keep kids safe make this really important needed change and support the families and children who need these supports.
Representative Brown.
Thank you, Madam Chair, and also thank you to my co-prime sponsor for her words. I think what I would just like to emphasize is that this is clearly a delicate balance between making sure that we have, you know, the appropriate safeguards and regulations in place that are going to protect kids and make sure that families know that they're getting a high level and a high quality of care and making sure that we are fighting fraud abuse neglect in these environments So what I think we have come up with here in this bill is the right balance between this tension between access and regulation. It is clear that we need to do better by these kids. It is also clear that we need to make sure that we are providing access for families and kids who need these services so desperately. So I hope that you, as you're thinking about this and you're voting, I hope you'll think about just all of the thoughtfulness that we have approached this with in terms of making that balance and making sure that we are striking the right balance in this particular bill. And I appreciate your support and ask for an aye vote.
Representative Gilchrist, would you like to move your bill?
Yes, thank you, Madam Chair. I move House Bill 26, 14, 25 to the Committee on Finance as a favorable recommendation.
Second.
All right.
That's been moved and seconded. Committee, any closing remarks? Representative Bradley.
Thank you, Madam Chair, and thank you to the bill sponsors. The problem with end-of-session rate is a 52-page bill that comes late at night, last night, that doesn't allow us to stake hold. It doesn't allow us to go to the lobby corps. It doesn't allow us to go look at fiscal notes. it doesn't allow the representative to talk to seven different counties. And so that for us is hard. It's disappointing. I haven't been able to talk to rural Douglas County, suburban Douglas County. I know where your heart is. I would agree that everyone on this committee wants to protect children. We want to fight fraud and abuse and neglect. We want to increase access. But for us, mandates and new regulations can hurt rural Colorado pretty significantly. It can hurt providers that are barely operating above the red line. To be quite honest with you, I don't even know what all 52 pages say in it. I've gotten to page 27. I don't know. I need to get on board with HICPF and find out if we're paying for people not being certified and what does that mean if they don't get certified and we've already paid for them to provide services and they don't get certified. What type of fraud is that? I appreciate you guys bringing it forward, but this is a state expenditure of $2.2 million. And, you know, I wouldn't put that cost on protecting children's, you know, heads with the fraud that's in this program, but I haven't even had time to digest it. I appreciate you bringing it forward, but I just feel like we have to be able to stay cold in our districts, too.
Representative Johnson.
Thank you, Madam Chair. Thank you, sponsors, for bringing this. And not to repeat, but to echo what our colleague just said. I remember working on this, helping lead one of those efforts with APA last year and being all on board and being told we're going to do something. And then I hadn't heard anything after December. I didn't know if we were going to do anything until yesterday and seeing this. So it's really disheartening to realize this has been heavily stakeholder. It has been worked through JBC, looking at who co-sponsored, looking at this. Would I love to see a different process, maybe being introduced so it could be open to stakeholder. Held it to do long bill. I get the financial piece and then continuing. I've only made it to page 10, so not quite to page 27. Trying to talk with all my folks. I'm scrambling right now in committee trying to reach out to my people in rural areas and my biggest concern is adding more regulations. It's actually going to decrease what we have out there and we're barely holding on as it is. I'm happy, though, we will have the weekend coming forth, hopefully, depending on how fast this thing moves, to actually get back out to my community, talk about these, get Colorado to look at it, because it's only been open for 24 hours. I will be a respectful note today, because I need to figure all this out. It feels a little behind. I do love the momentum of last year, though. I was so happy to be on board with both of you leading those letters. So it's just very sad, also, just to point the elephant in the room. I see two Democrats, and then the first co-sponsors are Democrats. I would love to see the collaboration with across the state, across everyone, because this is huge for everybody. My mom's specialty in special education is autism. I've grown up, when she's going to conferences, hearing about these things, some of my best friends being some of the students and growing up. And so I'm excited now. It's an open stakeholding. I really want to work with you. I loved the idea of maybe doing an amendment, like talking with the stakeholders, that we recognize national certification as a primary qualification. and saying if we can't move that into this as well, we'd love to talk about amendment phases and as we move forward now together and open stakeholding. And I appreciate all the work you're doing. I feel like we just need a loop in a few more people and a little more time, which I know we don't have. We have less than 13 14 days but really do want to get to a yes on this I see the efforts and I be respectful now but really do want to now work together Representative Hamrick
Thank you, Madam Chair.
I really appreciate the testimony today, the practitioners, the parents, the state agencies, the community advocates. It's really hard to get all of them on the same page for something that is so good. I very much support the licensing of clinics and providers and setting up mechanisms for that. appreciate the bipartisan sponsors in both the House and the Senate and their commitment to continue stakeholding this bill. And I've heard great things about your stakeholding abilities. And so
I'll be a yes today. Representative Ryden.
Thank you, Madam Chair. Yeah, I hear some of those concerns. And I know it is at the end of the session. And so it is hard to think about who in my district do I need to talk to. I know you've probably talked to a lot of those individuals, or at least the representatives. I know that's been happening for a while. And I know you will keep at it the next 14 days. And so I look forward to what comes out of that and happy to express my support for today and see where this lands and hopefully we can at least get something. And if not and you can get into a workable place and we can get other colleagues on board as well then I really hope it something we can address next year Representative Bradfield Thank you Madam Chair
I want to thank you for bringing this forward.
I must echo what Representative Bradley and Johnson both said. I, too, if I can't be on board 100%, I know that I need to step back and see why not. and that's where I am. I too need to talk to the people in my county about their feelings on this bill and where they want to be. And so just because I'm a no today doesn't mean that's a no all the way through. I just need to do some more homework.
Thank you.
Thank you both. I know I've been hearing about this since last summer. It wasn't years ago. It was months ago. and have been very interested to see this come forward, especially actually hearing from Ms. Jorgensen and the number of times where they've had to refer folks out there in the wind or to law enforcement or whatever concerns me deeply and that it is almost past time that we did something like this and that the fact that the professionals themselves are asking to be regulated is a key point for me as well So thank you for your work on this. I'm happy to support today and going forward.
And Mr. Shudun, please call the roll. Representative Zabarone?
No for today. Redfield? No. Respect. Respectfully, no. Bradley. No. English. Yes, for today. Frey. Yes. Hamrick.
Yes.
Johnson.
Respectfully, no.
McCormick.
Yes.
Dryden.
Yes.
Stewart.
Yes.
Wook.
No.
Leader. Yes. Madam Chair.
Yes. And that passes 8 to 5. You're on your way to finance. And with that, our business is done. We are adjourned. Thank you.