Meeting Minutes Wednesday, March 16, 2016 Approved April 20, 2016 Call to Order The Colorado Board of Health held a public meeting on Wednesday, March 16, 2016, in the Sabin-Cleere Conference Room, Bldg. A, 1st Floor at 4300 Cherry Creek Drive South, Denver, CO 80246. The meeting was called to order at approximately 10:05 a.m. Members Present Christopher Stanley, M.D., Board Vice-President, District 1; Janelle Orsborn, District 2; Jill Hunsaker-Ryan, County Commissioner, District 3; Tony Cappello, PhD, Board President, District 4; Matt VanAuken, District 5; Joan Sowinski, District 6; Rick Brown, District 7; Nadeen Ibrahim, At-Large; Ray Estacio, M.D., At-Large, and; Larry Wolk, M.D., MSPH, Executive Director and Chief Medical Officer, CDPHE. Staff Present Deborah Nelson, Board Administrator; Jamie L. Thornton, Program Assistant, and; Jennifer Weaver, First Assistant Attorney General. Review of the minutes from the February 17, 2016 board meeting The board unanimously approved the meeting minutes as written. Public comments for matters not on the agenda The public did not offer any comments. Board comments for matters not on the agenda Board members did not offer any comments. Request for Appointment of State Registrar of Vital Records Kirk Bol, Center for Health and Environmental Data, presented the recommendation to appoint Alain Alexander Quintana as the State Registrar of Vital Records. Mr. Quintana served as the local registrar for Adams, Arapahoe and Douglas counties for the last three years. He has knowledge of and experience with implementing Colorado vital records policies and has participated in Colorado’s efforts to implement and improve our electronic vital records systems, including the Electronic Death Reporting System (EDRS). Mr. Quintana provided an overview of his background, accomplishments and goals. The board unanimously approved the appointment of Mr. Quintana as the State Registrar. Motion: Dr. Cappello; second: Ms. Orsborn. Rule-making Hearings 6 CCR 1011-1, Standards for Hospitals and Health Facilities Ch. 26, Home Care Agencies The board convened a rulemaking hearing in order to receive public testimony and consider revisions to 6 CCR 1011-1, Standards for Hospitals and Health Facilities Ch. 26, Home Care Agencies. Randy Kuykendall and Laurie Schoder, Health Facilities and Emergency Medical Services Division presented the proposed amendments. Mr. VanAuken disclosed that he works for a Community Centered Board that serves individuals and families of these agencies; however, he does not believe there is a conflict of interest. The board agreed there was no conflict of interest and Mr. VanAuken participated in the hearing. The proposed amendments are required in order to comply with House Bill 14-1360, which directed the Departments of Public Health and Environment (department) and Health Care Policy and Financing (HCPF) to form a workgroup and develop a plan to identify gaps and conflicts in each agency’s regulation of home care providers. The workgroup compared department and HCPF requirements in the following areas of home care agency services: client rights, personal care definitions, specific care situations, supervision requirements, training requirements and various policies and procedures. The majority of the gaps and conflicts identified by the workgroup can be

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Meeting Minutes Wednesday, March 16, 2016 Approved April 20, 2016 resolved through departmental guidance or HCPF rule changes. The proposed changes address the remainder of the gaps and conflicts. The proposed changes clarify when licensing requirements need to be met, update the requirements to align with HCPF services, update terminology and provide accurate cross-references to assist readers of the rule. Ms. Ibrahim pointed out a typo on page eight, line fourteen and she suggested that the words “and/or” be added between the words “shaving and washing”. After a brief discussion the board and staff agreed that the change would not impact the intent of the regulation and that the proposed language be added. No oral testimony was offered during the hearing. The board unanimously adopted the rule with the proposed amendment to page eight, line fourteen, along with the statement of basis and purpose, specific statutory authority and the regulatory analysis. Motion: Commissioner Hunsaker-Ryan; second: Dr. Stanley. 6 CCR 1011-1, Standards for Hospitals and Health Facilities Ch. 5, Long Term Care Facilities, and Ch. 2, General Licensure Standards The board convened a rulemaking hearing in order to receive public testimony and consider revisions to 6 CCR 1011-1, Standards for Hospitals and Health Facilities Ch. 5, Long Term Care Facilities, and Ch. 2, General Licensure Standards. Randy Kuykendall and Laurie Schoder, Health Facilities and Emergency Medical Services Division presented the proposed amendments. The proposed amendments strike the current chapter in its entirety and replaces it with a new version that has been reorganized and renumbered, and changes the title of Chapter 5 from “Long Term Care Facilities” to “Nursing Care Facilities” to align with the department’s statutory authority. The proposed changes address at-risk elder abuse reporting, expands the medical services language to include non-physician practitioners, updates staff qualifications, updates the medication donation language to align with House Bill 15-1039, incorporates standards to ensure health information security and aligns with current technology, provides person-first language throughout the rule, and address requirements related to petitioning the court when a resident lacks decisional capacity and has no designated representative. The division met with stakeholders over the course of fourteen months to discuss revisions to Chapter 5. All stakeholder meetings were open to the public and routinely included the state long-term care ombudsman, a nursing care facility resident, members of the Colorado Medical Directors Association, owners and administrators of licensed nursing care facilities, and representatives of the Colorado Health Care Association, Leading Age Colorado, the Legal Center and the Colorado Hospital Association. To align with the Department of Regulatory Agencies, the department highlighted that the rulemaking packet included a June 1, 2016 effective date; this was a change since the request for rulemaking presentation. Mr. Kuykendall and Ms. Schoder responded to questions regarding HB 15-1039 (concerning medication donation), administrator requirements, staff identification, the scope of practitioner, exceptions for religious beliefs, and fees. No oral testimony was offered during the hearing. Mr. VanAuken commended staff for their work and stakeholder process. The board unanimously adopted the rule along with the statement of basis and purpose, specific statutory authority and the regulatory analysis. Motion: Ms. Orsborn; second: Dr. Cappello. 6 CCR 1015-7, Loan Repayment Program for Dental Professionals The board convened a rulemaking hearing in order to receive public testimony and consider revisions to 6 CCR 1015-7, Loan Repayment Program for Dental Professionals. Stephen Holloway, Prevention Services Division presented the proposed amendments. The Dental Loan Repayment Program was authorized by the Colorado General Assembly in 2001; its purpose is to offer an incentive for dental professionals, particularly those in private practice, and to provide services to underserved populations. Both dentists and dental hygienists are eligible

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Meeting Minutes Wednesday, March 16, 2016 Approved April 20, 2016 to participate in the program. The proposed changes are largely technical. The changes remove obsolete and unnecessary terms, align the rule with current practice, specify the program’s loan repayment priorities, specify the application and reporting requirements and correct typographical errors. These changes are recommended to improve the clarity of the rule, remove unnecessary language, and create symmetry with the Colorado Health Service Corps. Mr. Holloway responded to board questions regarding definition of “significant level”, average payouts, and the possibility of extending funding for participants. Dr. Cappello highlighted the importance of the program for rural Colorado communities. No oral testimony was offered during the hearing. The board unanimously adopted the rule along with the statement of basis and purpose, specific statutory authority and the regulatory analysis. Motion: Ms. Sowinski; second: Mr. Brown. 6 CCR 1016-3, International Medical Graduates Seeking State Support of an Immigration Petition: Eligibility, Application Process, Fees and Selection Procedures The board convened a rulemaking hearing in order to receive public testimony and consider revisions to 6 CCR 1016-3, International Medical Graduates Seeking State Support of an Immigration Petition: Eligibility, Application Process, Fees and Selection Procedures. Stephen Holloway, Prevention Services Division presented the proposed amendments. The program facilitates the placement of non U.S. resident physicians in underserved areas of the state for the purpose of increasing access to primary and specialty medical services. The proposed changes simplify and clarify language which governs the programs placing foreign trained physicians in Colorado. The amendments refine program definitions, update statutory reference, remove unnecessary requirements, simplify instructions to applicants regarding the review process, and modify the pre-requisites for applications to better align with federal partners and employer activities. Mr. Holloway responded to questions regarding charitable care policy for the uninsured and the sliding fee scale requirement. Commissioner HunsakerRyan remarked that the program is vital to serve the uninsured. No oral testimony was offered during the hearing. The board unanimously adopted the rule along with the statement of basis and purpose, specific statutory authority and the regulatory analysis. Motion: Dr. Cappello; second: Ms. Orsborn. Preventive Health and Health Services (PHHS) Block Grant State Plan Dr. Wolk sought a moment of privilege to recognize Leslie Akin for all of her efforts to shepherd the department through the accreditation process at the outset of Ms. Akin’s presentation. Ms. Akin, Office of Planning, Partnerships and Improvement reviewed the PHHS Block Grant recommendations for fiscal year 2016. The board appreciated that the department did not take full advantage of the ten percent allowance for administrative costs and this made more dollars available for program efforts. The board and the department discussed a number of topics including that: the additional funding for health equity; these health equity activities are distinguishable from those occurring under the Health Disparities Grants Program; there is no decrease in funds being distributed to local public health agencies, rather, the department has created efficiency within its own staff allocations; the additional funding for suicide prevention will include firearm safety education and outreach, and a pilot program on Colorado’s Western slope; the $10,000 decrease to the worksite wellness program was based upon a decrease in the requested amount from the program; the board supports worksite wellness having metrics that track outcomes so the effort is data driven and can be replicated by other organizations; there are shared risk and protective factors across suicide prevention, sexual assault prevention and bullying prevention, and; the Help Me Grow effort, which partners several state agencies with the Mile High United Way,

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Meeting Minutes Wednesday, March 16, 2016 Approved April 20, 2016 moves beyond information and outreach to improving accessibility to services for youth and families through navigation and follow-up efforts. Dr. Stanley discussed the process and evaluation that occurred to develop the funding recommendations the board was seeing today was sound and he appreciated the overall balancing of the funds across these efforts. Dr. Cappello, Ms. Ibrahim, and Dr. Estacio shared their enthusiasm for the projects being proposed; they appreciated the optimism seen across the funding recommendations. No oral testimony was offered during the hearing. The board, as the advisory board for the Preventive Health and Health Services Block Grant, moved to approve the federal fiscal year 2016 funding recommendations from the department in the amount not to exceed $1,880,810 to fund the activities identified in the funding recommendation memo dated March 16, 2016. Award amounts to specific grantees may be adjusted by the department; however, the total for all projects will not exceed $1,880,810. Motion: Dr. Cappello; second: Ms. Sowinski. Request for Rule-making Hearings 6 CCR 1009-2, Infant Immunization and Immunization of Students Attending School Lynn Trefren, Disease Control and Environmental Epidemiology Division asked the board to set a rulemaking hearing to consider amendments to 6 CCR 1009-2, Infant Immunization and Immunization of Students Attending School. Colorado requires all students to be immunized per the vaccine schedule established by Colorado Board of Health (BOH) rule 6 CCR 1009-2. The purpose of the immunization requirements is to protect students, staff, and the visiting public against vaccine-preventable diseases within schools. The proposed rule clarifies that the requirements apply at school entry for students entering kindergarten and sixth grade; this clarification assists schools and school nurses with implementing the requirements. In addition to addressing this request from school stakeholders, these proposed amendments incorporate the 2016 ACIP recommended vaccine schedules, clarify when non-medical exemptions expire, and clarify which schools must send statistical data to the department. In response to board questions, staff explained the difference between the three exemptions, Colorado’s immunization and exemption rates, how Colorado compares to other states, publishing data for parents and interested stakeholders, and HB 16-1164 (transferring the requirement to gather and maintain exemption documentation from schools to the department). Ms. Sowinski suggested changing line 42, page 7 to read “This exception will expire each year on the last official day of the school year”. Mr. Brown recommended adding “prior to” in front of “kindergarten entry” at line 152 page 10.By unanimous consent, the board scheduled a public rulemaking hearing to consider the proposed amendments to 6 CCR 1009-2, Infant Immunization and Immunization of Students Attending School. The rulemaking hearing is tentatively scheduled for May 18, 2016. Dr. Cappello will chair. Colorado HIV and AIDS Prevention Grant Program Progress Report Bob Bongiovanni, Maria Jackson and Daniel Shodell, Disease Control and Environmental Epidemiology Division, provided an overview of the Colorado HIV and AIDS Prevention Grant Program. Mr. Bongiovanni discussed programmatic objectives, grantee performance, and program challenges and accomplishments. Mr. Bongiovanni discussed that the department did not receive any bids to the Request for Proposal that would have enable the program to serve the remaining 17 rural counties that are not included any of the existing projects; the department will release the RFP again. The department responded to questions regarding preexposure and post-exposure prophylaxis, HIV incidence, demographics and trends, needle use, methamphetamine use, the increasing need for mental health supports, Colorado’s linkage to care model is replicated by other states, insurance coverage and other funding streams to support medication distribution, developing medication distribution models that protect rural

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Meeting Minutes Wednesday, March 16, 2016 Approved April 20, 2016 citizen’s privacy, and the provider community embracing technology and the new outreach efforts. Reports Legislative Report Ms. McGowan updated the board regarding Joint Budget Committee activities, department budget priorities and department legislative initiatives. She discussed figure setting as it pertains to clean air, recycling, the clean water program, the immunization program, oil and gas health risk assessment, and the Trusted Adult campaign. Ms. McGowan mentioned the Healthy Equity on the Hill event and acknowledged board members who attended. There are numerous bills and discussion concerning immunizations, retail food, the Clean Power Plan, marijuana edibles, and pesticide use for marijuana. Dr. Wolk and the board discussed the board providing a letter for support to the general assembly as it related to marijuana proficiency testing, immunization policy, accreditation and overall department performance. Executive Director Report Dr. Wolk updated the board on: the Zika virus, states providing the EPA lead and copper level information following what transpired in Flint, Michigan, the non-harmful levels of Perfluorinated compounds (PFCs) in Security, Widefield and Fountain, Colorado, continued increased enrollment (now at 11.7%) in the Diabetes Prevention Program, child care centers and health care providers participating in “I am Learning, I am Moving” obesity prevention training, potential additional federal funding for the department’s substantive abuse and mental health efforts, and the department’s accreditation as well as the El Paso county and Mesa County accreditations. Attorney General’s Report Ms. Weaver stated that there were no updates. Administrative Updates Ms. Nelson indicated that the department is reviewing the letter submitted by Rep. Lee and the board will receive a copy of the response. The public comments submitted by Colorado Student Government Coalition have been sent to the Disease Control Environmental Epidemiology Division and they will incorporate this feedback as they assess the merits of requiring meningococcal vaccine. Ms. Nelson reminded the board that the April meeting would be at the department and the May meeting will be in Weld County. Members are welcome to carpool but we will not have a van service. Jamie will provide members the address. The TriAgency Board meeting with the Medical Services Board and State Board of Human Services will be on June 10, 2016, downtown. In addition, Ms. Nelson indicated that the Board will have its meeting in October 19, 2016 and inviting the Air Quality Control Commission to the board’s meeting. Board Member Reports of Committee Activities Mr. Brown remarked that he appreciates the department’s ability to get additional spending authority for the Cancer, Cardiovascular and Chronic Pulmonary Disease Grant Program and he let the board know the RFA has been released.

The meeting adjourned at approximately 12:57 p.m.

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Meeting Minutes Wednesday, March 16, 2016 Approved April 20, 2016 NOTE: There were no board elections during the March meeting even though it was listed on the agenda. Additionally, a Legislative Report was provided during the March meeting even though it was not listed on the March agenda.

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