From the Capitol – February 2022

Physician Assistance Proposal
The bill (HB1095) will go to the House Health & Insurance on February 23. Please watch for updates via EngagED. CO ACEP opposes the bill in its current form. HB22-1095 severs the team-based approach to emergency medicine. This year’s version of the bill decreases the number of hours of collaboration (no supervision) to 3,000 hours. Upon completion of the 3,000 hours, the PA no longer requires any formal relationship with a physician. Further, the bill allows a facility or employer to require a physician to “collaborate” with a PA for those first 3,000 hours as a conditional of the physician’s employment.

27-65 Legislation
Mental Health Colorado (MHCO) is an organization that advocates for individuals and families living with mental health disorders. Colorado Revised Statute number 27-65 refers to emergency mental health holds and certifications. MHCO is seeking to amend that statute. Your CO ACEP leadership has been working with MHCO to ensure that you, as EM physicians, can provide the best care for your patients. We have made significant progress in addressing emergency mental health 72-hour holds in the ED, yet we continue to advocate for subsequent 72-hour holds when a patient remains gravely disabled or a harm to themselves or others and no in-patient bed can be located. The bill draft contemplates a lengthy and very detailed discharge summary. We are meeting with the legislative sponsors of the bill to discuss that summary and the appropriateness of discharging a patient with medications to act as a bridge until the patient can receive follow up care. This bill will likely be introduced later this month.

Out-of-Network
The Colorado Division of Insurance (DOI) is working with Representative Esgar (D-Pueblo) towards the introduction of a bill seeking to align the current Colorado out-of-network (OON) legislation with the federal No Surprises Act (NSA). CO ACEP is participating with the DOI on stakeholder meetings related to the alignment bill. A key element in the NSA legislation that has been missing in the Colorado OON statute is the ability to batch claims when forced to go to arbitration. We will be working to add this to the Colorado OON statute, but anticipate a fight with the health plans over that issue. This alignment bill too is expected to be introduced later this month.

Workforce
As expected, workforce issues are shaping up to be hot topic in this session. CO ACEP has been part of a coalition of health and health care stakeholders including CMS, CAFP, CHA, CNA, CRHC, CCHN, CALPHO, CPharmS and the coalition has developed a set of draft short, medium and long-term policy recommendations. Along the way, Reps. Mullica and Lontine, as well as the Polis Administration, have been kept apprised of this work as plans to bundle many of these recommendations into legislation are taking shape.

Highlights from the bundle include:
• Building out data sets and analyses to help pinpoint what is and isn’t working to address health workforce shortage needs.
• Creating a Health Worker Wellness program and other peer support programs
• Enhancing recruitment and retention efforts for various professions through tax credits, grants, loan repayment and hero pay

Leadership changes in Colorado
Senate Democrats selected Senator Steve Fenberg (D-Boulder) to serve as the chamber’s new President for the balance of this session. Fenberg had been serving as the Senate Majority Leader, the No. 2 (and most believe, more powerful) position in leadership. Fenberg was elected president unanimously, without a formal vote, of his 20-member caucus, and was the only candidate nominated.

Fenberg’s selection still must be approved by the full Senate. He replaces outgoing President Leroy Garcia, a Pueblo Democrat who is leaving the legislature on February 23 to take a Biden administration appointment at the Pentagon. A vacancy committee will appoint Garcia’s replacement for his Pueblo senate seat.

Senator Dominick Moreno (D-Commerce City) will become Majority Leader, leaving his position as Vice Chair of the legislature’s Joint Budget Committee. And proving once again that there is karma, Senator Rachel Zenzinger (Arvada) was appointed to fill Moreno’s seat on the powerful budget committee (Zenzinger you will recall was unceremoniously removed from the JBC in 2020 when Chris Hansen moved from the House to Senate to fill the seat vacated by Lois Court. Zenzinger had won a difficult election and has been stewing about her treatment by leadership ever since). Fenberg will appoint a replacement for Zenzinger chair of the Senate Education Committee.

These musical chairs have reportedly generated tension in the Senate Democratic caucus. Garcia was not a hands-on President, but would often mediate inter-party squabbles. The election of Fenberg will definitely move the Senate even further to the left. Among other things, this will make Governor Polis’ job more difficult, since he will have few tools to prevent politically-difficult progressive legislation from reaching his desk during this election year.