Drs. Neal O’Connor (left) and Ramnik Dhaliwal (right) testify before the House Health & Insurance Committee on HB22-1284 which brought parts of Colorado’s Out-of-Network statute into alignment with the federal No Surprises Act.
The second session of the seventy-third General Assembly adjourned just before midnight on Wednesday, May 11th. During this 2022 120-day legislative session there were 657 bills introduced. Needless to say, it was a busy year as CO ACEP identified 65 of those bills as being important to emergency medicine. While many of the bills we have been involved with are settled, either already signed by the Governor or postponed indefinitely (killed), as of the writing of this update, 377 bills are on the Governor’s desk awaiting his action. The Governor has 30 days to sign, veto or allow a bill to become law without his signature. Please check the CO ACEP website mid-June for a final report.
Legislative proposals of high priority to CO ACEP this session included (in numerical order):
HB22-1095 – Physician Assistant Collaborative Requirements
The proposal, very similar to last year’s proposal, would have remove formal supervision of physicians assistants by physicians. In lieu of “supervision”, the PAs were asking for “collaboration” for the first 3,000 hours for a newly licensed PA or 2,000 hours for a PA changing specialties. Upon completion of those required hours, the PA would not be required to have any collaborative plan with a physician. Initially the bill would have also allowed an employer to require a physician to collaborate with a PA as a condition of the physician’s employment. With opposition from CO ACEP and other physician advocacy groups, HB22-1095 failed to pass. COACEP, in an effort to support our PA colleagues and try to address the underserved areas of Colorado, will be creating a PA/Rural Access Task Force led by Dr. Jamie Dhaliwal. The goal is to make a recommendation to the 2023 legislature as they take up this issue again. If you have an interest in participating on this task force, please contact Suzanne.
HB22-1240 – Mandatory Reporters
Following a well-publicized, heartbreaking case of medical child abuse, the Office of the Child Protection Ombudsman of Colorado took up an overhaul of the mandatory reporter statutes. Initially, the bill would have required on-going CME as to the requirements of a mandatory reporter tied to a physician’s license or renewal, mandatory reporters would have been responsible for reporting outside of their professional capacity and made EM physicians direct reporters no longer able to delegate a report be filed among other concerns. CO ACEP worked very diligently over months of negotiations to address these issues as well as others. The bill was ultimately converted into a study of the current mandatory reporter statutes and the task force created in the bill will study the above issues along with many other and make a recommendation on these policy issues back to the legislature. CO ACEP will work to get an EM physician appointed to this task force and will provide the EM perspective on this very important subject.
HB22-1256 – Modifications to Civil Involuntary Commitment Statute
Mental health advocates have expressed concerns about the emergency mental health hold process. This bill was an attempt to rectify what these advocates saw as holes or problems in the current 27-65 statue. After endless hours of debate, negotiations and education about how the M-1 process is applied in the ED setting, we were ultimately able to get to a good place with this piece of legislation. As originally contemplated the bill would have required all ED to go through the designation process and become “designated mental health care facilities” and would have inadvertently put steps and “patient rights” in place which could have placed patients suffering an emergency mental health crisis, ED staff and other patients at risk. Your CO ACEP leadership was relentless in ensuring CO ACEP members are able to provide the best care for all patients in the ED.
HB22-1284 – Health Insurance Surprise Billing Protections
Colorado’s out-of-network statute predates the federal No Surprises Act (NSA). With the passage of the NSA it became necessary to make alignments to Colorado’s law. This piece of legislation provided CO ACEP the opportunity to educate the legislature about the need for batching of claims for the purpose of arbitration as is allowed for in the NSA. Numerous lawsuits remain unsettled surrounding the NSA reimbursement methodology at the federal level. We were successful in starting the conversation and will be working with key legislators over the interim to amend Colorado’s statute such that challenging the reimbursement of an out-of-network a reality for physicians.
HB22-1326 – Fentanyl Accounting and Prevention
Addressing the fentanyl crisis was one of the most hotly debated bills of the session. Harm reduction advocates seeking to get people suffering with SUD into treatment were at odds with law enforcement and families of those who have lost loved ones to accidental fentanyl overdoses who were seeking to get fentanyl off the streets. Neither side was granted their full wish list, but the legislators reached a compromise on the bill, and it is on its way to the Governor. CO ACEP was able to add two amendments to the bill that will promote the ability of EM physicians to discharge patients at risk of overdose with take home opioid antagonists. The amendments remove the current storage, labeling and record keeping requirements hurdles as well as require Medicaid to reimburse for the dispensed antagonists.
SB22-068 – Provider Tool to View All-payer Claims Database
The Colorado All-payers Claims Database (APCD) plays a role in most reimbursement decisions made by third party payers as well as being one of the benchmarks for out-of-network reimbursement. Because the data in the APCD has such a large impact on EM physician reimbursement, CO ACEP partnered with other physician advocacy groups to ensure the data in the database is available to physicians. Prior to this legislation, a physician wanting access to this data had to purchase each dataset. The costs of the data were often cost prohibitive. This bill creates a provider tool whereby any physician can access three years of data at no cost. The APCD will now provide 2018 reimbursement data (pre-COVID and pre-out-of-network) as well as the data for the two preceding years. For example, once the bill is enacted later this year, you will have access to a report showing 2018, 2020 and 2021 reimbursement data. Next year the report will disclose 2018, 2021 and 2022 data.
In addition to the bills noted above, numerous bills touched on the workforce issues across Colorado. A few of those bills which passed include the extension of the Rural Health-care Preceptor Tax Credit (HB22-1005), a Hospital Nurse Staffing Standards bill (HB22-1401), a new Rural Provider Stimulus Grant Program (SB22-200) and Programs to Support Health-care Workforce (SB22-226). Each of these bills increase either access to appropriately educated and trained health care providers or dedicates resources so that the workforce can be bolstered.
Again, a full and final list of the bills CO ACEP identified as being of importance to CO ACEP’s members will be up on the CO ACEP website after the Governor’s statutory 30-days to take action. Please visit coacep.org for legislative and other information.
With the 2022 session coming to an end, we now shift our focus to the upcoming elections and preparing for the 2023 session. It is never too early to start. Prior to the closing gavel, CO ACEP was already aware of the return of the PA bill, the report of the mandatory reporter task force and the discussion of the out-of-network batching issue in 2023.
Elections have consequences. To that end, CO ACEP has a Small Donor Committee (a form of a political action committee) so that we can support candidates that share our mission of promoting the interests and values of emergency physicians and their patients. In Colorado, Small Donor Committees (SDC’s) are unique in that they may not accept contributions of more than $50 per person per calendar year. By limiting the amount that can be contributed to the SDC, the SDC can make larger expenditures to candidates. If you agree that the legislative proposals listed above are important to your practice, please consider making a small contribution ($50 or less) to the ACEP, Colorado Chapter SDC. Your money stays local and helps your Colorado emergency medicine advocacy organization support legislators friendly to emergency medicine and its goals. Contributions can be made here.