Bill Tracker

Effective January 1, 2024, the bill creates an epinephrine
auto-injector affordability program (program) to provide low-cost
epinephrine auto-injectors to individuals who:
  • Are residents of this state;
  • Are not enrolled in the state medicaid program or the
federal medicare program;
  • Have a prescription for an epinephrine auto-injector; and
  • Are not enrolled in prescription drug coverage that limits
the total amount of cost sharing that the enrollee is required
to pay for an epinephrine auto-injector.
The bill requires the division of insurance in the department of
regulatory agencies (division) to create an application for the program and
requires the division and the department of health care policy and
financing to make the application available on their websites and to
promote the availability of the program.
The bill requires a carrier that provides coverage for prescription
epinephrine auto-injectors to cap the total amount that a covered person
is required to pay for all covered prescription epinephrine auto-injectors
at an amount not to exceed $60 for a 2-pack of epinephrine auto-injectors.
A pharmacy that dispenses epinephrine auto-injectors is authorized
to collect a copayment not to exceed $60 from the individual to cover the
pharmacy's costs of processing and dispensing a 2-pack of epinephrine
auto-injectors.
A manufacturer of epinephrine auto-injectors:
  • Is required to make epinephrine auto-injectors available to
individuals through the program; and
  • May be required to reimburse the dispensing pharmacy an
amount that covers the difference between the pharmacy's
wholesale acquisition cost for the number of epinephrine
auto-injectors dispensed through the program and the
amount the recipients of the epinephrine auto-injectors paid
for the same number of epinephrine auto-injectors or send
the pharmacy a replacement supply of the same number of
epinephrine auto-injectors.
If a manufacturer fails to comply with the requirements of the bill,
the manufacturer may be subject to a fine.

The bill prohibits:
  • Requiring a COVID-19 vaccine for a minor in Colorado;
  • Administering a COVID-19 vaccine to a child without the
informed consent of the child's parent or legal guardian;
  • Administering a COVID-19 vaccine to an emancipated
minor without the informed consent of the emancipated
minor;
  • A school from dismissing, suspending, refusing admission,
or refusing to permit participation in an extracurricular
activity to a student who has claimed a COVID-19
immunization exemption;
  • A public or private entity from discriminating against a
minor participating in a nonpublic home-based educational
program based on whether the minor received the
COVID-19 vaccine;
  • A public entity from levying a fee, fine, or tax, or a private
entity from levying a fine or fee, on a minor or their parent
or legal guardian based on whether the minor received the
COVID-19 vaccine; or
  • A public or private entity from discriminating against a
minor based on whether the minor received a COVID-19
vaccine.
The bill allows an aggrieved person to file a civil action and
waives sovereign immunity if the violator is a public entity.

The bill prohibits a supplemental health-care staffing agency
(staffing agency) from including in a contract or agreement with a
health-care worker, nursing care facility, or assisted living residence a
provision for liquidated damages, employment fees, or other
compensation to be paid to the staffing agency if the nursing care facility
or assisted living residence hires the health-care worker as a permanent
employee either prior to or after the termination of the contract or
agreement.
A staffing agency that violates the prohibition commits a civil
infraction and is subject to a monetary penalty. Further, for repeated or
willful violations, the executive director of the department of labor and
employment may impose monetary or administrative penalties against the
staffing agency.

The bill adds 2 members to the state board of psychologist
examiners (board) and requires 2 of the 9 members of the board to be
prescribing psychologists.
The bill allows a licensed psychologist to prescribe and administer
psychotropic medications if the licensed psychologist holds a conditional
prescription certificate or a prescription certificate issued by the board.
A licensed psychologist may apply to the board for a conditional
prescription certificate and must include in the application satisfactory
evidence that the applicant has met specific educational, supervisory, and
clinical requirements. The board is required to issue a conditional
prescription certificate to the licensed psychologist if the board
determines the applicant has met the requirements. The licensed
psychologist with a conditional prescription certificate may only
administer and prescribe psychotropic medications under the supervision
of a licensed physician or advanced practice registered nurse and must
maintain a collaborative relationship with the patient's health-care
provider.
A licensed psychologist who holds a conditional prescription
certificate for 2 years and who meets the specified requirements may
apply for and receive a prescription certificate (prescribing psychologist).
A licensed psychologist with a prescription certificate may prescribe
psychotropic medication to a person if the licensed psychologist:
  • Holds a current license in good standing;
  • Maintains the required malpractice insurance; and
  • Annually completes at least 20 hours of continuing
education.
The board is authorized to promulgate rules to:
  • Implement procedures for obtaining a conditional
prescription certificate and a prescription certificate; and
  • Establish grounds for denial, suspension, and revocation of
the certificates.
The bill requires a prescribing psychologist and a licensed
psychologist with a conditional prescription certificate to file with the
board all individual federal drug enforcement administration registrations
and numbers. The board and the Colorado medical board are required to
maintain current records of every psychologist with prescriptive authority,
including registrations and numbers.
The department of regulatory agencies (department) is required to
annually collect information regarding prescribing psychologists and
licensed psychologists with conditional prescription certificates, to
compile the information, and to share the information with the office in
the department responsible for conducting sunset reviews for inclusion in
each scheduled sunset review concerning the regulation of mental health
professionals.

Section 1 of the bill increases the limit on medical impairment
benefits based on mental impairment from 12 weeks to 36 weeks.
Section 2 removes language authorizing an employee to petition
the division of workers' compensation in the department of labor and
employment (division) prior to receiving a replacement of any artificial
member, glasses, hearing aid, brace, or other external prosthetic device,
including dentures.
Section 3 allows an employee to request a hearing when the
employee's temporary total disability benefits end based on an attending
physician's written release to return to regular employment.
Section 4 specifies that when a physician recommends medical
benefits after maximum medical improvement, the benefits admitted by
the insurer or self-insured employer are not limited to any specific
medical treatment.
Current law requires an insurance carrier to provide an
independent medical examiner and all other parties a complete copy of all
medical records in its possession pertaining to an injury. Section 5 limits
the medical records required to be provided to records relevant to the
injury. Section 5 also specifies how the division is required to determine
the amount and allocation of costs to be paid by the parties for an
independent medical examination.
Section 6 allows a prehearing administrative law judge to issue
interlocutory orders resolving disputes regarding the content and format
of the independent medical examiner's medical record packet, indigency
status, and the allocation of independent medical examiner costs.
Current law states that a contingent attorney fee exceeding 20% of
the amount of contested benefits is presumed to be unreasonable. Section
7 increases the amount to 25%.

The bill prohibits a licensed physician; licensed medical resident,
intern, or fellow; licensed professional nurse; advanced practice
registered nurse; registered direct-entry midwife; or medical, nursing, or
direct-entry midwife student or trainee (licensee, student, or trainee) from
performing, and prohibits a licensed health-care facility from permitting
a licensee, student, or trainee to perform, an intimate examination on a
sedated or unconscious patient unless the patient has given specific
informed consent to an intimate examination. Additionally, a student or
trainee may perform an intimate examination on a sedated or unconscious
patient for educational or training purposes only if:
  • The examination is related to the planned procedure to be
performed on the patient;
  • The patient recognizes the student or trainee as part of the
patient's care team; and
  • The student or trainee is under the direct supervision of the
supervising licensee.
The bill outlines the requirements for obtaining the patient's
informed consent. Failure to comply with the requirements of the bill, or
retaliating against a person who complains about a violation of the bill,
constitutes unprofessional conduct, is grounds for discipline, and subjects
the licensee, student, or trainee to discipline by the regulator that regulates
the particular health-care profession. A licensed health-care facility that
fails to comply with the requirements of the bill is subject to sanctions
imposed by the department of public health and environment.
Additionally, liability limitations otherwise applicable to
health-care professionals and institutions under current law do not apply
to a licensee that performs, or a licensed health-care facility that permits
a licensee to perform, an intimate examination on a sedated or
unconscious patient in violation of the requirements of the bill.

The bill requires a health-care provider who performs an abortion
of an unborn child who is 20-weeks gestational age or more to administer
a painkiller to the child prior to the abortion. The bill makes exceptions
to this requirement in specific circumstances.

The bill:
  • Requires a contract between a health insurance carrier
(carrier) and a licensed health-care provider (provider) for
the provision of health-care services to covered persons
under a health coverage plan issued by the carrier (contract)
to offer at least one method of payment to the provider for
which there is not an associated fee; and
  • Prohibits the contract from restricting the form or method
of payment the carrier uses to make payments to the
provider so that the only acceptable payment method is a
credit card payment.
If a carrier initiates a payment to a provider using, or changes the
payment method to, electronic funds transfer payments, including virtual
credit card payments, the bill requires the carrier to:
  • Notify the provider of any fees associated with the
particular payment method;
  • Advise the provider of the available payment methods and
include instructions on how to select an alternative
available method; and
  • With each payment, remit an explanation of benefits.
The bill prohibits a carrier from charging a fee for a change in the
payment method to a specified electronic transaction and allows a
provider's billing service to charge a fee under certain circumstances.
The bill makes it an unfair method of competition and unfair or
deceptive act or practice in the business of insurance if a carrier violates
or fails to comply with the requirements of the contract limitations and
requirements.

The bill defines a person to include an unborn child at all stages
of gestation, from fertilization to natural death, as it relates to a private
right of action and current homicide and assault provisions.
The bill declares that any existing state law relating to prenatal
homicide or assault or regulating abortion or abortion facilities is
superseded to the extent it conflicts or is inconsistent with the provisions
of the bill.
The bill authorizes the state to disregard any federal court decision
that purports to enjoin or void this requirement and subjects a Colorado
judge to impeachment or removal if the judge purports to enjoin, stay,
overrule, or void the requirement.

Section 1 of the bill defines medical debt as any obligation or
alleged obligation of a consumer to pay any amount whatsoever arising
from the receipt of health-care goods or services.
Current law prohibits a consumer reporting agency from making
any consumer report containing any of certain items of information.
However, this prohibition does not apply to:
  • A credit transaction involving, or that may reasonably be
expected to involve, a principal amount of $150,000 or
more; or
  • The underwriting of life insurance involving, or that may
reasonably be expected to involve, a face amount of
$150,000 or more.
Section 2 eliminates both of these exceptions to the prohibition
and substitutes a new exception, which applies to a credit transaction
involving, or that may reasonably be expected to involve, a principal
amount that exceeds the national conforming loan limit value determined
annually by the federal housing finance agency. Section 2 also prohibits
a consumer reporting agency from making any consumer report
containing any information concerning medical debt.
Section 3 prohibits a debt collector or collection agency, when
attempting to collect medical debt or to obtain information about a
consumer in relation to an attempt to collect medical debt from:
  • Making a false or misleading representation that the
medical debt will be included in a consumer report or
factored into a consumer's credit score; or
  • Failing to disclose that the medical debt will not be
included in a consumer report and therefore not factored
into a consumer's credit score.
The bill makes exceptions to these prohibitions when the
information is used in connection with a credit transaction involving, or
that may reasonably be expected to involve, a principal amount that
exceeds the national conforming loan limit value determined annually by
the federal housing finance agency.

For the purposes of health insurance coverage for a prosthetic
device (device), the bill requires a health insurance carrier to provide
coverage for an additional device for a covered person under 26 years of
age if the covered person's treating physician determines that the
additional device is necessary for the covered person to engage in
physical and recreational activity and to maximize the covered person's
upper limb functions.

The bill creates the Abortion Pill Reversal Information Act (act).
The act requires a physician or other qualified medical professional to
provide state-prepared information concerning abortion pill reversal,
including a telephone number and website address where a pregnant
woman can seek resources to obtain abortion pill reversal, to any woman
seeking an abortion through the use of an abortion-inducing drug. The
physician or other qualified medical professional must provide the
information at least 24 hours before the physician prescribes or
administers the abortion-inducing drug or induces the abortion.
The department of public health and environment is required to
maintain the state-prepared information on its public-facing website.
The act makes it a deceptive trade practice to fail to provide the
required information concerning abortion pill reversal. The act also
includes civil penalties and professional discipline for failure to comply
with the requirements in the act and allows the general assembly to
appoint members to intervene in any lawsuit challenging the
constitutionality of the act.

Under current law, the knowing possession of any material,
compound, mixture, or preparation that weighs more than one gram and
not more than 4 grams and contains any quantity of fentanyl, carfentanil,
benzimidazole opiate, or an analog thereof, is a level 4 drug felony;
except that, if a defendant shows supporting evidence to establish that the
defendant made a reasonable mistake of fact and did not know that the
controlled substance contained fentanyl, carfentanil, benzimidazole
opiate, or an analog thereof, the matter must be submitted to the finder of
fact in the form of interrogatory included in the verdict form. If the finder
of fact determines the defendant made a reasonable mistake of fact, the
defendant commits a level 1 drug misdemeanor. The bill eliminates this
provision. Under current law, the knowing possession of any material,
compound, mixture, or preparation that weighs not more than one gram
and contains any quantity of fentanyl, carfentanil, benzimidazole opiate,
or an analog thereof, is a level 1 drug misdemeanor; except that a fourth
or subsequent offense is a level 4 drug felony. The bill eliminates the
requirement that the possession must be knowing.
The bill creates the opioid antagonist fund in the department of
education to bulk purchase and distribute opioid antagonists to eligible
schools. For the 2023-24 state fiscal year, the general assembly
appropriates $2 million to the fund from the general fund.
The bill extends civil and criminal immunity to the department of
education, or a person acting on behalf of the department, for acting in
good faith to furnish an opioid antagonist to an eligible school.
The bill requires every agency that employs a peace officer to
submit an annual report to the department of public health and
environment (department) concerning every incident in which a peace
officer administered an opioid antagonist to an individual. Using that
information the department creates a consolidated report and provides it
to the house of representatives judiciary and public and behavioral health
and human services committees and the senate judiciary and health and
human services committees.

The bill requires the department of health care policy and
financing (state department) to grant an exception to step therapy if the
prescribing provider submits a prior authorization request with
justification and supporting clinical documentation for treatment of a
serious or complex medical condition. The bill requires the state
department to provide a response to a prior authorization request for a
step-therapy exception within 24 hours after receipt of the request.
If a prior authorization request for a step-therapy exception is
incomplete or if additional clinically relevant information is required, the
bill requires the state department to notify the prescribing provider within
24 hours after the submission of the request. If the state department does
not receive a response within 72 hours after the state department's request
for additional information, the prior authorization is denied. If the prior
authorization request is denied, the bill requires the state department to
inform the recipient in writing that the recipient has a right to appeal the
determination.
If the state department does not make a determination regarding
the step-therapy exception request, respond to the appeal of the denial of
the request, or request additional clinically relevant information, the
step-therapy exception request or the appeal of the denial is deemed
granted. The bill requires the state department to authorize coverage for
the prescription drug prescribed by the recipient's prescribing provider if
the prior authorization request for a step-therapy exception request is
granted.
The bill requires the state department to make the prior
authorization requirements for coverage of prescription drugs and a
description of the step-therapy exemption process available on the state
department's website and provide to the recipient, upon written request,
all specific clinical review criteria and other clinical information relating
to a recipient's particular condition or disease.

The bill authorizes a prescription drug outlet to operate an
automated pharmacy dispensing system for the purpose of dispensing
prescription medications, other than controlled substances, to patients.

The bill specifies that a city may authorize the operation of an
overdose prevention center within the city's jurisdiction for the purpose
of saving the lives of persons at risk of preventable overdoses.

The bill requires the Colorado school of public health to analyze
model legislation for implementing a publicly financed and privately
delivered universal health-care payment system for Colorado that directly
compensates providers. The Colorado school of public health must submit
a report detailing its findings from the analysis to the general assembly by
December 1, 2023.
The bill also creates the statewide health-care analysis task force
consisting of members appointed by the general assembly and the
governor, as well as executive directors of specified state departments,
the commissioner of insurance, and the chief executive officer of the
Colorado health benefit exchange or any designees of the executive
directors, the commissioner, and the chief executive officer. The task
force is created for the purpose of advising the Colorado school of public
health during the analysis.

The bill defines health-care provider as a person that is licensed
or otherwise authorized in this state to furnish a health-care service,
which includes a hospital and other providers and health facilities.
The bill prohibits a health-care provider (provider) affiliated with
or owned by a hospital or health system from charging a facility fee for
health-care services furnished by the provider for:
  • Outpatient services provided at an off-campus location or
through telehealth; or
  • Certain outpatient, diagnostic, or imaging services
identified by the medical services board as services that
may be provided safely, reliably, and effectively in
nonhospital settings.
The bill:
  • Requires a provider that charges a facility fee to provide
notice to a patient that the provider charges the fee and to
use a standardized bill that includes itemized charges
identifying the facility fee, as well as other information;
  • Requires the administrator of the all-payer health claims
database to prepare an annual report of the number and
amount of facility fees by payer, codes with the highest
total paid amounts and highest volume, and other
information; and
  • Makes it a deceptive trade practice to charge, bill, or collect
a facility fee when doing so is prohibited.

The bill requires the department of public health and environment
(department) to identify health-care services that are or may be subject to
a denial of care in this state and to develop a simple service availability
form to be filled out by a covered entity for the purpose of conveying to
patients and to the public information about health-care services that, for
nonmedical reasons, are not generally available at the covered entity or
that are subject to significant restriction at the covered entity.
The bill defines:
  • Covered entity as a hospital, community clinic, maternity
hospital, freestanding emergency department, or
rehabilitation hospital;
  • Denial of care, in part, as refusal to provide health-care
services for nonmedical reasons; and
  • Nonmedical reasons, in part, as nonclinical criteria, rules,
or policies that restrict health-care professionals and
covered entities from providing health-care services that
the professionals or facilities are authorized or licensed to
provide.
The bill includes requirements for the content and format of the
service availability form and requires the department to publish and
maintain on its public-facing website a list of covered entities and the
service availability form for the covered entity.
The bill authorizes the department to update the service availability
form at least biennially. The executive director of the department shall
adopt rules to implement the requirements in the bill and investigate
complaints and assess fines against covered entities that fail to comply
with the requirements in the bill.
The department shall implement a public awareness program that
includes how denial of care may negatively impact health-care access and
quality of care, how denial of care may be avoided, and the impacts of
denial of care on vulnerable people and communities.
A covered entity shall provide patients with the current service
availability form as part of the informed consent process prior to initiating
a health-care service and shall maintain a record of the patient's receipt
of the form. The covered entity shall encourage health-care professionals
with privileges at the covered entity to share the covered entity's service
availability form with a patient when a health-care service is scheduled
at the covered entity.

The bill makes changes to the Colorado Standardized Health
Benefit Plan Act to:
  • Require the Colorado health benefit exchange (exchange),
with the consent of the commissioner of insurance
(commissioner), to develop a format for displaying the
standardized plans on the exchange;
  • Grant the commissioner 120 days to review the rate filings
for standardized plans instead of the current 60 days;
  • Require a carrier to notify the commissioner of the steps
the carrier will take to meet premium rate requirements if
the carrier is unable to offer a standardized plan;
  • Make changes to the requirements for public hearings held
by the commissioner for carriers who are unable to offer
the standardized plan; and
  • Specify that decisions of the commissioner are final agency
actions subject to judicial review in the court of appeals.

In 2021, the general assembly enacted SB 21-175, which created
the prescription drug affordability board (board) in the division of
insurance (division) and an affordability review process whereby the
board may review costs associated with, and establish upper payment
limits for, certain prescription drugs. The bill makes certain changes
concerning the board.
Section 1 defines board activity, and section 2 states that only
board members, and not staff members or contractors of the division, are
required to recuse themselves from any board activity or vote where they
have a conflict of interest.
Section 3 allows the chair of the board to cancel or postpone a
board meeting for good cause.
Section 4 makes certain changes to the procedure by which the
board identifies prescription drugs that may be subjected to an
affordability review. Section 4 also requires the board to report on its
public web page certain information regarding its considerations.
Section 5 removes language prohibiting the board from
establishing an upper payment limit for more than 12 prescription drugs
within a specified period.
Section 6 establishes that an upper payment limit for a prescription
drug is not a final agency action that is subject to judicial review until the
board promulgates a rule establishing the upper payment limit.
Sections 6 and 7 remove certain language describing an appeals
process for appealing decisions of the board.
Sections 8 and 9 extend the repeal and associated sunset review
of the board from September 1, 2026, to September 1, 2031.
Section 10 establishes that a denial of a request for benefits for a
prescription drug that is unavailable in the state because a manufacturer
has withdrawn the prescription drug from sale or distribution within the
state is an adverse determination for which an individual may request
an independent external review.

Current law requires the department of health care policy and
financing (state department) to annually prepare a written hospital
expenditure report. The bill changes the name of the report to the hospital
transparency report (transparency report).
The bill adds specified information that each hospital shall report
to the state department for the transparency report.
No later than July 1, 2024, the bill requires each hospital to
provide specified information to the state department for previous fiscal
years.
The bill authorizes the state department to impose certain
enforcement mechanisms against a hospital that does not provide all of
the information required to be reported to the state department.
Beginning July 1, 2024, the bill requires any patient bill to include
a clear, plain language description of the services the patient is being
billed for and a statement that the patient has a right to receive a detailed
explanation of the services charged and who to contact to receive such
information.

Under current law, pharmacy benefit managers (PBMs) are
required to perform certain acts and are prohibited from engaging in
certain acts. Specifically, PBMs are prohibited from:
  • Requiring patients to obtain their prescription drugs
through mail order;
  • Charging pharmacies fees to adjudicate claims;
  • Requiring pharmacies to obtain accreditations or
certifications that are different than what the PBM requires
of its affiliated pharmacies;
  • Retroactively reducing a payment made to a pharmacy on
a drug claim after the point of sale or reimbursing a
pharmacy in an amount that is less than the amount
reimbursed to its own affiliated pharmacy for the same
pharmacy service;
  • Modifying the prescription drug formulary under a health
benefit plan during the plan year;
  • With regard to audits, using specified techniques in
calculating a recoupment or penalty, subjecting a pharmacy
to recoupment when a clerical error is discovered, and
requiring pharmacies to be audited more than once a year;
  • Prohibiting a pharmacy or pharmacist from, or penalizing
a pharmacy or pharmacist for, providing information to
patients about more affordable, therapeutically equivalent
alternatives to a prescribed drug; or
  • Requiring a pharmacy or pharmacist to charge or collect a
copayment from an insured patient that exceeds the total
charge submitted by the pharmacy for the prescription
drug.
Additionally, PBMs are required to:
  • Provide pharmacies 7 days' written notice before an audit,
conduct an audit by or in consultation with a pharmacist,
allow the pharmacy to supplement claims documentation,
and establish an appeals process;
  • Provide an insured individual, the insured's health-care
provider, or a third party acting on behalf of the insured or
provider with up-to-date and real-time cost, benefit, and
coverage information under the terms of the insured's
health benefit plan; and
  • Provide contracted pharmacies with the list of sources the
PBM used in determining maximum allowable cost pricing,
update the information every 7 days, allow pharmacies the
ability to readily review the information, follow specified
requirements when placing a drug on the maximum
allowable cost list, and establish an appeals process to
resolve disputes.
The bill specifies that the commissioner of insurance
(commissioner) has the power to enforce these prohibitions and
requirements and impose penalties on PBMs for failing to comply with
these prohibitions and requirements.
Additionally, the bill requires:
  • PBMs to register with and pay a registration fee to the
commissioner; and
  • Health insurers to pay a fee when filing with the
commissioner their list of PBMs they use for prescription
drug benefits administration.
The fees imposed under the bill are to be used to fund the costs of
the division of insurance in enforcing requirements and prohibitions on
PBMs.

The bill makes changes to the hospital community benefit and
imposes certain requirements on the public presentation of each hospital's
community implementation plan. The bill requires each hospital to:
  • Solicit feedback from the community during each annual
presentation of its proposed community benefit
implementation plan for the following year;
  • Submit a report that details who attended the public
meeting, the topics discussed at the meeting, and any
decisions made as a result of the discussion;
  • Make the report available to the public; and
  • Complete a community benefit implementation plan that
addresses the needs described in the reporting hospital's
community health needs assessment and includes an
explanation of the community served by the hospital.
The bill requires the state board to promulgate rules governing the
accessibility standards for the public meetings and to implement best
practices to ensure public engagement from a diverse range of
populations.
The bill requires the department of health care policy and
financing (state department) to:
  • Include in its annual report a summary of the estimated
federal and state tax exemptions made by each hospital;
  • Establish a minimum annual community investment target
based on certain calculation standards; and
  • Set requirements for compliance, and allows the state
department to take remedial action if a hospital fails to
comply with the hospital community benefit requirements.

The bill specifies that a Colorado-licensed, -certified, or
-registered health-care professional may render care via telehealth to
patients or clients located in another state if the professional is authorized
to practice the profession in the other state pursuant to an interstate
compact or other grant of authority from the other state.

The bill requires the department of health care policy and
financing to analyze how directed payment authority can be used as part
of a comprehensive plan to facilitate an adequate network of services for
children and youth by requiring each managed care entity to pay no less
than state department-established fee schedule rates for services needed
to promote clinical stabilization.
No later than July 1, 2023, the bill requires the department of
human services (CDHS) to form a working group to make
recommendations about developing an incentive funding pool pilot
program to incentivize residential treatment providers to accept and treat
children and youth who have high-acuity behavioral health needs to
appropriate treatment and placement.
The bill requires the behavioral health administration (BHA) to
develop a framework to measure and assess how the behavioral health
system for children and youth is functioning, which framework must
include measures of accountability for children and youth who are
boarding or in extended stay.
Beginning September 1, 2023, and each quarter thereafter until
October 1, 2024, the bill requires each hospital to report de-identified
information to the BHA on the total number of children and youth
patients who were boarding or had extended stay in the previous quarter;
if known, how many children and youth who were boarding or had
extended stay and were in county custody at the time; and, for patients
who were discharged during the quarter, where the patients were
discharged to.
Beginning September 1, 2023, and each quarter thereafter until
October 1, 2024, the bill requires CDHS to report de-identified
information to the BHA on the total number of children and youth in the
custody of, or who had involvement with, a county department of human
or social services who spent time at least overnight in a hotel or a county
department office as a stopgap setting or remained in detention when the
child or youth could have been released but no placement was available.
No later than September 1, 2023, and each quarter thereafter until
October 1, 2024, the bill requires the BHA to report aggregated and
de-identified information submitted to the BHA to the BHA advisory
council and to the child and youth mental health service standards
advisory board.
The bill requires CDHS to develop a plan for whenever a
residential treatment facility for children and youth closes or has a
substantial change in operation to support children and youth treatment
capacity elsewhere in a manner that most appropriately serves the
behavioral health needs of the child or youth.

The bill creates a nonprofit unincorporated legal entity, the fair
access to insurance requirements plan association (association), to help
persons who are unable to find coverage in the voluntary market obtain
property insurance coverage for their real property.
The association must:
  • Establish, offer, and maintain a property insurance policy
that satisfies the requirements specified in the bill;
  • Establish a reinsurance association; and
  • Assess and share among member insurers all expenses,
income, and losses based on each member insurer's written
premium in the state.
The association is managed by a board of directors consisting of
9 members appointed by the governor. The board is required to administer
the fair access to insurance requirements plan (FAIR plan).
The FAIR plan must include rates that:
  • Are not excessive, inadequate, or unfairly discriminatory;
  • Are actuarially sound so that revenue generated from
premiums is adequate to pay for expected losses, expenses,
and taxes and the cost of reinsurance; and
  • Reflect the investment income of the FAIR plan.
The plan of operation for the FAIR plan may include provisions
establishing maximum limits of liability, reasonable underwriting
standards for determining the insurability of a risk, and commissions to
be paid to the licensed producers that offer the FAIR plan.
The commissioner of insurance may suspend or revoke the
certificate of authority to transact insurance business in this state of any
member insurer that fails to timely pay a fee or to comply with the plan
of operation for the FAIR plan.

Joint Budget Committee. The bill makes the following changes
to the reviews and audits of the payments by the department of health care
policy and financing (department) to providers:
  • The department shall review and audit underpayments and
overpayments to providers;
  • If the department determines that an overpayment occurred
because services could have been provided at a lower cost
setting, the overpayment is the difference between the
amount paid and the amount due if the services had been
provided under other circumstances;
  • Any overpayment review evaluating medical necessity
must be conducted by a Colorado physician relying only on
the information available at the time of treatment;
  • The department shall not declare the existence of an
overpayment until providers have exhausted all
administrative and judicial remedies;
  • If the department determines that there has been an
underpayment, the department shall pay the provider the
amount due because of the underpayment, plus interest;
  • Reimbursement for covered services, including amounts
collected for an overpayment, must be in an amount
adequate to ensure access to care;
  • Audits and reviews must not occur more than 3 years after
the date the claim was filed;
  • Notices of adverse action that fail to comply with
department rules are void;
  • In an appeal of a determination of overpayment or
underpayment, an administrative law judge's ruling must be
published on the department's website and other
administrative law judges may rely on previous rulings as
precedent;
  • The department shall annually identify billing errors
common across multiple providers to enable providers to
correct the errors;
  • The department may contract with a qualified agent to
review or audit payments to providers for both
overpayments and underpayments and must protect against
conflicts of interest;
  • In any contingency-based contract for review or audit of
payments, the compensation must not exceed 12.5% of the
amount of overpayments collected and the amount due
because of underpayments determined;
  • At least quarterly, the department shall publish on its
website an audit activity report detailing current and
recently completed audits and reviews and summaries of
the findings of such audits and reviews and a copy of the
contracts, scopes of work, and information regarding
supervision of contractor deliverables for audits and
reviews;
  • The department shall create a provider advisory group to
advise the department on issues that providers have
concerning the audits and reviews; and
  • The department shall contract for an independent review of
reviews and audits conducted from the 2018-19 to the
2022-23 state fiscal years for compliance with coding
practice standards and state law.

The bill creates the task force on the rights of Coloradans with
disabilities (task force) in the Colorado civil rights commission. The task
force shall create a minimum of 4 subcommittees to study and make
recommendations on specific issues related to persons with disabilities:
  • The rewrite subcommittee, which must study and make
recommendations concerning the various issues related to
the rewrite and modernization of the Colorado Revised
Statutes concerning civil rights of persons with disabilities;
  • The outdoors subcommittee, which must study and make
recommendations related to the basic accessibility of
outdoor spaces for persons with disabilities;
  • The housing subcommittee, which must study and make
recommendations related to the affordability, accessibility,
and attainability of housing for persons with disabilities;
and
  • The government subcommittee, which must focus on basic
physical and programmatic accessibility within state and
local government.
Minimum mandatory membership and reporting requirements are
outlined for the task force and each subcommittee. The task force shall
produce a final report, including recommendations, to submit the
governor and general assembly on or before January 30, 2025.

Joint Budget Committee. The bill requires the department of
health care policy and financing (state department) to conduct a study to
determine the feasibility of extending continuous eligibility medical
coverage for eligible children and adults.
The state department is required to submit a report detailing its
findings and recommendations from the feasibility study to the joint
budget committee of the senate and house of representatives, the
governor, and to the house of representatives public and behavioral health
and human services committee and the senate health and human services
committee, or any successor committees, by January 1, 2026.
The state department is required to prepare documents seeking
federal authorization to provide continuous eligibility medical coverage
to eligible adults and children and include the completed federal
authorization documents with its report submitted to the joint budget
committee of the senate and house of representatives, the governor, and
to the house of representatives public and behavioral health and human
services committee and the senate health and human services committee,
or any successor committees.
No later than April 1, 2024, the state department is required to seek
federal authorization to extend continuous eligibility coverage for
children less than 3 years of age, including children who would be
eligible for medical assistance coverage but are not because of their
immigration status, and to extend eligibility coverage for 12 months for
adults who have been released from a Colorado department of corrections
facility, regardless of a change in income.
The bill makes an appropriation.

The bill amends the priority of distribution of insurance claims
paid from an insurer's estate in the event of the insurer's liquidation to
include in the class 1 distribution priority payments that an impaired or
insolvent insurer owes to the risk adjustment program that are necessary
to prevent another insurer from becoming impaired or insolvent. This
prioritization adjustment repeals on July 1, 2026.
The bill also amends the Life and Health Insurance Protection
Association Act (act) as follows:
  • Adds health maintenance organizations (HMOs) as
members of the association and subjects HMOs to
assessments from the association;
  • Allocates responsibility for long-term care insurance
assessments between health insurance and life insurance
association members; and
  • Specifies that the act does not provide coverage to a person
that acquires rights to receive, or to a payee or beneficiary
that transfers its rights in, a structured settlement factoring
transaction, as defined in federal law, regardless of when
the transaction occurred.

The bill authorizes the department of health care policy and
financing (state department) to seek federal authorization from the centers
for medicare and medicaid services to provide medicaid reimbursement
for community health worker services.
The bill requires the state department to hold at least 4 public
stakeholder meetings to solicit input on considerations to include in the
state department's request for federal authorization.
The bill grants the state department the authority to promulgate
rules necessary to facilitate reimbursement for community health worker
services.
The bill requires that on or before January 31, 2026, the state
department include a report on how community health workers are being
utilized through medicaid in its presentation to the joint budget committee
of the general assembly and in its presentation at the State Measurement
for Accountable, Responsive, and Transparent (SMART) Government
Act hearing.

The bill prohibits a prescriber from issuing to a patient a
prescription for an opioid that will be dispensed or administered outside
of a health-care facility or the prescriber's practice location if the amount
of the opioid exceeds 90 morphine milligram equivalents per day, unless
the patient suffers from intractable pain.

The bill creates the Colorado multidisciplinary health-care
provider access training program (program) to improve the health care of
medically complex, costly, compromised, and vulnerable older
Coloradans. The university of Colorado Anschutz medical campus shall
develop, implement, and administer the program. The program may be
offered to Colorado institutions of higher education with clinical health
professions graduate degree programs. The program coordinates and
expands geriatric training opportunities for clinical health professions
graduate students (students) enrolled in participating Colorado institutions
of higher education (participating institutions) across Colorado studying
to become advanced practice providers; dentists; nurses; occupational
therapists; pharmacists; physicians, including medical doctors and doctors
of osteopathy; physical therapists; psychologists; social workers; and
speech-language therapists. Students who successfully complete the
program are awarded certificates and issued letters authorizing those
students to become trainers for the program in clinics across the state.
The bill creates the Colorado multidisciplinary health-care
provider access training program advisory committee (committee) to
ensure that the training for the program is consistent and collaborative
across the fields of study. The committee is required to:
  • Appoint a program chair;
  • Set the program's standards for training and delivery of
multidisciplinary medical care to medically complex,
costly, compromised, and vulnerable older Coloradans;
  • Establish requirements for the program;
  • Identify and invite institutions of higher education that
offer appropriate clinical health professions graduate
degree programs to become participating institutions;
  • Collaborate with participating institutions of higher
education across Colorado to enhance recruitment of
students to enter a field specific to geriatrics and select
students with an interest in geriatric care to participate in
the program;
  • Assist with updating the program's curricula;
  • Analyze data collected by the program;
  • Build a multidisciplinary network of trained geriatric
clinicians to collaborate and provide opportunities for
clinicians to work together to better understand the roles of
each health-care discipline in urban, rural, and underserved
communities when caring for older Coloradans;
  • Improve placement of students in experiential clinical
training opportunities, prioritizing rural and underserved
communities;
  • Coordinate with graduates of the program to become
geriatric trainers for future students; and
  • Increase the number of clinical training sites across
Colorado, specifically in rural and underserved
communities.

Legislative Oversight Committee Concerning the Treatment
of Persons with Behavioral Health Disorders in the Criminal and
Juvenile Justice Systems. The bill prohibits the department of health
care policy and financing from imposing prior authorization, step therapy,
and fail first requirements for medicaid coverage of a prescription drug,
as indicated on federally approved labels, to treat serious mental health
disorders.

The bill authorizes a physician, a physician assistant, and an
advanced practice registered nurse (prescriber) to prescribe and
administer a drug approved by the federal food and drug administration
for an off-label use if:
  • The off-label use of the drug for the indication has
longstanding, common use;
  • There is medical evidence to support the off-label use and
no known evidence contraindicating such off-label use; and
  • The prescriber has provided the patient or a minor patient's
parent or guardian with an informed consent form, and the
patient or parent or guardian has signed the form.
The bill applies the same standard of care for the off-label use of
the drug as for the on-label use of the drug.
The bill clarifies that a pharmacist who fills a prescription for
off-label use is not subject to discipline by the state board of pharmacy.

Current law allows the residents of any county to present their
board of county commissioners with a petition asking that a public
hospital board of trustees (hospital board) be appointed and that an annual
tax be levied for the establishment and maintenance of a public hospital
in the county. The board of county commissioners may create, by
resolution, a hospital board to levy the tax and may appropriate money to
the hospital board for purchasing or building a hospital and for
maintaining the hospital. The bill makes the following changes regarding
hospital boards:
  • Currently, if a hospital board acquires real property, title to
the real property must be in the name of the county. The
bill authorizes real property to be in the name of either the
county or the hospital.
  • A hospital board has the authority to borrow money and
incur indebtedness. The bill clarifies that any indebtedness
incurred by a hospital board is an obligation of the hospital
board and not an obligation of the board of county
commissioners.
  • Currently, a hospital board must have the approval of the
board of county commissioners before incurring
indebtedness. The bill specifies that a hospital board needs
the approval of the board of county commissioners before
incurring indebtedness only if the repayment of the
indebtedness is dependent on tax money received for
hospital purposes from the board of county commissioners.
  • The bill allows a hospital board to offer to the general
public products and services of any health care
organization, association, partnership, or corporation to the
extent that the products and services are consistent with the
powers and duties of a county public hospital; and
  • Each year, the board of county commissioners may
appropriate not more than 5% of its general fund for the
improvement or enlargement of any public hospital
established in the county. The bill removes the annual 5%
limit on appropriations from a county's general fund and
also allows such money to be used for the operation of a
public hospital.

Current law allows a physician to submit documentation to the
department of public health and environment (department) stating that a
patient has a debilitating medical condition or disabling medical condition
and may benefit from the use of medical marijuana. The bill clarifies that
the physician is submitting a recommendation to the department rather
than a certification or authorization.
The bill removes the following requirements for a physician's
recommendation to the department:
  • The physician's federal drug enforcement agency number;
  • The maximum THC potency level of the medical marijuana
product;
  • The recommended medical marijuana product;
  • The patient's daily authorized quantity of the medical
marijuana product; and
  • Directions for use of the medical marijuana product.
The bill allows a physician to establish a bonafide
physician-patient relationship remotely via video or telephone conference
if the patient is:
  • 21 years of age or older;
  • Under 18 years of age; or
  • 18 years of age or older but under 21 years of age and the
patient received a medical marijuana recommendation prior
to 18 years of age.
The bill clarifies that a patient must only present a uniform
certification form completed by a recommending physician to a medical
marijuana store if the patient seeks to purchase more than the statutorily
allowed limit of medical marijuana products.
Current law limits the amount of medical marijuana concentrate
that a patient may purchase in a single day to 8 grams. The bill increases
that limitation to 40 grams, but limits the total amount that a patient can
purchase in a 30-day period to the equivalent of 8 grams per day. Current
law limits the combined amount of medical marijuana products that a
patient may purchase in a single day to 20,000 milligrams. The bill adds
an exception to that limitation for nonedible, nonpsychoactive medical
marijuana products.
Current law limits the amount of medical marijuana concentrate
that a patient 18 years of age or older but under 21 years of age may
purchase in a single day to 2 grams. The bill allows a patient that is 18
years of age or older but under 21 years of age and had a registry
identification card issued by the department prior to 18 years of age to
purchase in a single day up to 8 grams of medical marijuana concentrate.
The bill clarifies that when a physician issues a uniform
certification form to a patient 18 years of age or older, the physician may
consider whether the patient had a registry identification card issued by
the department prior to 18 years of age as a factor in recommending that
the patient be allowed to purchase more than the statutorily allowed
quantities of medical marijuana products.
The bill allows a retail marijuana store to sell retail marijuana
products to patients at the statutorily allowed limit for medical marijuana
products and registered primary caregivers 21 years of age or older who
present a registry identification card issued by the department. The bill
also allows a registered primary caregiver to purchase retail marijuana
products for a patient who is under 21 years of age at the applicable
statutorily allowed limit for medical marijuana products for patients under
21 years of age.

The bill modifies the relationship between a physician assistant
and a physician or podiatrist by removing the requirement that a physician
assistant be supervised by a physician or podiatrist. Instead, a physician
assistant must enter into a collaborative agreement with an employer,
physician, or podiatrist.
The collaborative agreement must include:
  • The physician assistant's name, license number, and
primary location of practice;
  • The signature of the physician assistant and the person with
whom the physician assistant has entered into the
collaborative agreement;
  • A general description of the physician assistant's process
for collaboration;
  • A description of the performance evaluation process, which
may be completed by the physician assistant's employer in
accordance with a performance evaluation and review
process established by the employer; and
  • Any additional requirements specific to the physician
assistant's practice required by the employer, physician, or
podiatrist entering into the collaborative agreement,
including additional levels of oversight, limitations on
autonomous judgment, and the designation of a primary
contact for collaboration.
For a physician assistant with fewer than 3,000 practice hours, the
collaborative agreement must also:
  • Require that collaboration during the first 160 practice
hours be completed in person or through technology;
  • Incorporate elements defining the expected nature of
collaboration; and
  • Require a performance evaluation and discussion of the
performance evaluation with the physician assistant.
The bill also requires physician assistants who have been
practicing for less than 3 years to satisfy certain financial responsibility
requirements from which such physician assistants are exempt under
current law.

The bill:
  • Caps the rate of interest on medical debt at 3% per annum;
  • Defines medical debt, for purposes of a statutory cap on
interest rates and fair debt collection practices, to include
debt arising from the receipt of health-care services or
medical products or devices;
  • Requires a debt collector or collection agency collecting on
a medical debt to provide to the consumer, upon the
consumer's written or oral request, an itemized statement
concerning the debt and allows the consumer to dispute the
validity of the debt after receipt of the itemized statement;
  • Establishes requirements relating to payment plans for
medical debt, including written documentation of the
payment plan between the consumer and the creditor, debt
collector, or debt collection agency; notice to the consumer
if the payment plan will be accelerated or declared in
default or inoperative due to nonpayment; and the
opportunity to renegotiate the payment plan;
  • Prohibits collection on the debt during any appeal
proceedings and prohibits reporting the debt to a consumer
reporting agency until a certain amount of time after the
payment plan becomes inoperative;
  • Requires a debt collector or collection agency that files a
legal action to collect medical debt to include an
itemization of the charges and, prior to the entry of a
default judgment against the creditor, provide evidence of
the debt;
  • Makes it a deceptive trade practice to violate provisions
relating to billing practices, surprise billing, and balance
billing laws; and
  • Requires a health-care provider or health-care facility to
provide, upon request of a prospective patient, an estimate
of the total cost of a health-care service (service) to a
person who intends to self-pay for the service (self-pay
estimate). The bill includes requirements for the self-pay
estimate and caps the amount by which the final, total cost
of the service may exceed the self-pay estimate, with
exceptions for emergency or unforeseen, medically
necessary services required during the service. The bill
makes it a deceptive trade practice to violate provisions
relating to the self-pay estimate.

Joint Budget Committee. The bill extends the deadline from
January 1, 2023, to October 1, 2023, for when the department of public
health and environment (department) must contract with an independent
entity to conduct a study concerning House Bill 22-1326.
The bill extends the authority for the department to use the
appropriation received in the 2022-23 state fiscal year to pay for the
independent study through the 2024-25 state fiscal year.

The bill allows a health-care provider to prescribe, dispense, or
administer a schedule II, III, IV, or V controlled substance (drug) to a
patient in the course of treatment for a diagnosed condition that causes
chronic pain. The bill also clarifies that the prescribing health-care
provider is not subject to disciplinary action by the appropriate regulator
for prescribing a dosage of a drug that is equal to or more than a
morphine milligram equivalent dosage recommendation or threshold
specified in state or federal opioid prescribing guidelines or policies.
The bill prohibits a health-care provider from refusing to accept or
continue to treat a patient solely on the basis of the dosage of a drug the
patient requires for the treatment of chronic pain. A health-care provider
is also prohibited from tapering a needed dosage solely to meet a
predetermined dosage recommendation.
The bill also prohibits a pharmacist, health insurance carrier, or
pharmacy benefit manager from refusing to fill or approve the coverage
for a drug solely on the basis of the dosage requirement of a patient.

The bill:
  • Authorizes a pharmacist to delegate to a pharmacy
technician any task within the practice of pharmacy for
which the pharmacy technician has been specifically
trained, except for patient counseling, drug regimen review,
and clinical conflict resolution;
  • Removes the statutory supervision ratio for pharmacists
supervising pharmacy technicians when the pharmacy is
not a public-facing pharmacy and is acting as an agent of
an originating pharmacy to fill or refill a prescription; and
  • Authorizes reimbursement under the medical assistance
program for dispensing or administering vaccines to
children under 19 years of age.

Joint Budget Committee. Current law requires the department of
health care policy and financing (department) to submit a written report
to the joint budget committee concerning the review process for medicaid
provider rates on or before November 1, 2025, and each November
thereafter. The bill changes the date of the first written report to
November 1, 2023.

The bill requires hospitals to make public a list of all standard
charges for all hospital items and services provided to patients. The
standard charges include the gross billed charge, the payer-specific
negotiated charge, the minimum and maximum negotiated charges, and
the discounted cash price. The bill also requires each hospital to maintain
and make public a list of at least 300 shoppable services provided by the
hospital or, if the hospital does not provide 300 shoppable services, all of
the hospital's shoppable services. Each hospital is required to report its
updated lists to the department of health care policy and financing (state
department).
The bill requires the state department to monitor hospital
compliance with the price transparency requirements. If the state
department determines that a hospital is not in compliance, the state
department is required to issue a written notice to the hospital and require
the hospital to submit a corrective action plan.
The bill repeals sections of statute regarding hospital price
transparency and debt collection that are currently under the
administration and authority of the department of public health and
environment and relocates these sections so that hospital price
transparency and debt collection are under the state department.
The bill makes a violation of the hospital transparency
requirements outlined in the bill a deceptive trade practice under the
Colorado Consumer Protection Act.

The bill protects an individual applying for licensure, certification,
or registration in a profession or occupation in Colorado (applicant), as
well as a professional who is currently licensed, certified, or registered in
a profession or occupation in Colorado (licensee), from having the
license, certification, or registration denied to the applicant, or from
discipline being imposed against the licensee, based solely on:
  • A civil or criminal judgment against the applicant or
licensee regarding the consumption, possession,
cultivation, or processing of marijuana, if the underlying
actions were lawful and consistent with professional
conduct and standards of care within Colorado and did not
otherwise violate Colorado law; or
  • Previous professional disciplinary action concerning an
applicant's or a licensee's professional licensure in this or
any other state or U.S. territory, if the professional
disciplinary action was based solely on the applicant's or
licensee's consumption, possession, cultivation, or
processing of marijuana and the applicant or licensee did
not otherwise violate Colorado law.

Current law requires the manufacturer of cosmetic products,
dietary supplements, food products, and food additives, including hemp
products, to be registered with the department of public health and
environment (department).
The bill creates a new framework for the department to regulate
and register hemp products and certain intoxicating hemp products and
for the marijuana enforcement division in the department of revenue
(division) to regulate intoxicating products or potentially intoxicating
compounds that are or may be cannabinoids. This regulation includes:
  • The power to promulgate rules authorizing or prohibiting
chemical modification, conversion, or synthetic derivation
to create certain types of intoxicating cannabinoids;
  • Labeling and advertising requirements;
  • Production and testing requirements; and
  • Inspection, record-keeping, and tracking requirements.
Hemp- and marijuana-derived compounds and cannabinoids are
classified into three classifications:
  • Nonintoxicating cannabinoids;
  • Potentially intoxicating compounds; and
  • Intoxicating cannabinoids.
Nonintoxicating cannabinoids that are derived from hemp may be
produced, distributed, or sold as a hemp product. With the exception of
products manufactured or produced for export, which are referred to as
safe harbor hemp products, products containing potentially intoxicating
compounds and intoxicating cannabinoids must only be produced,
distributed, or sold by a person licensed by the division to produce,
distribute, or sell the compound or cannabinoid as a product.
The bill clarifies that:
  • Nonintoxicating cannabinoids, potentially intoxicating
compounds, and intoxicating cannabinoids are marijuana
or marijuana products for the purposes of the retail
marijuana sales tax; and
  • A person must be licensed to manufacture potentially
intoxicating compounds or intoxicating cannabinoids.
The bill prohibits the following acts:
  • Manufacturing, selling, or delivering products that contain
intoxicating cannabinoids in excess of limits established by
rule;
  • Manufacturing a product containing hemp that is not a
cosmetic, a dietary supplement, a food, a food additive, or
an herb; or
  • Manufacturing, producing, selling, distributing, or holding
for sale or distribution a safe harbor hemp product without
registering with the department.
The penalty for a violation is up to $10,000. The bill specifies
factors to consider in determining the amount of the penalty.
The bill requires the executive director of the department of
revenue to analyze the feasibility of establishing a standing committee to
evaluate cannabinoids and cannabis-derived products for the purpose of
determining and making recommendations regarding their safety profiles
and potential for intoxication. The department of revenue may engage
experts to do this analysis.

Joint Budget Committee. The bill requires the department of
health care policy and financing (department) to seek federal
authorization through an amendment to the state medical assistance plan
to implement the community first choice option.
The bill requires the state plan amendment to include personal care
services, homemaker services, health maintenance activities, personal
emergency response system and other emergency back-up services, and
voluntary training on how to select, manage, and dismiss an attendant.
The bill authorizes the department to provide permissible services
and supports that are linked to an assessed need or goal in an individual's
person-centered service plan, including transition costs and expenditures
relating to increasing an individual's independence or reducing reliance
on human assistance.
To be eligible for the community first choice option, an individual
must:
  • Be eligible for the state medical assistance program;
  • Be in an eligibility group under the state medical assistance
program that includes nursing facility services, or if in an
eligibility group that does not include nursing facility
services, have an income that is at or below 150% of the
federal poverty level; or
  • Receive an annual determination that in the absence of
home- and community-based attendant services and
supports, the individual would require the level of care
furnished in certain care settings.
The bill makes conforming amendments to remove the services
provided through the community first choice option from other long-term
care waiver programs.

The bill amends the regulatory framework for natural medicine and
natural medicine product.
The bill requires the director of the division of professions and
occupations to:
  • Regulate facilitators and the practice of regulation,
including issuing licenses for facilitators;
  • Promulgate rules necessary for the regulation of facilitators
and the practice of facilitation; and
  • Perform duties necessary for the implementation and
administration of the Natural Medicine Health Act of
2022, including investigatory and disciplinary authority.
The bill creates the natural medicine advisory board (board). The
board's duties include examining issues related to natural medicine and
natural medicine product, and making recommendations to the director
of the division of professions and occupations and the executive director
of the state licensing authority.
The bill creates within the department of revenue the division of
natural medicine for the purpose of regulating and licensing the
cultivation, manufacturing, testing, storage, distribution, transport,
transfer, and dispensation of natural medicine or natural medicine product
between natural medicine licensees. The bill requires the division of
natural medicine to:
  • Regulate natural medicine, natural medicine product, and
natural medicine businesses, including healing centers,
cultivators, manufacturers, and testers, and issue licenses
for such businesses;
  • Promulgate rules necessary for the regulation of natural
medicine, natural medicine product, and natural medicine
businesses; and
  • Perform duties necessary for the regulation of natural
medicine, natural medicine product, and natural medicine
businesses, including investigatory and disciplinary
authority.
The bill requires the department of revenue to coordinate with the
department of public health and environment concerning testing standards
of regulated natural medicine and natural medicine product.
The bill requires a sunset review for the articles governing the
department of regulatory affairs and the department of revenue in the
regulation of natural medicine, natural medicine product, facilitators, and
natural medicine businesses.
The bill states that:
  • A person who is under 21 years of age who knowingly
possesses or consumes natural medicine or natural
medicine product commits a drug petty offense and is
subject to a fine of not more than $100 or not more than 4
hours of substance use education or counseling; except that
a second or subsequent offense is subject to a fine of not
more than $100, not more than 4 hours of substance use
education or counseling, and not more than 24 hours of
useful public service;
  • A person who openly and publicly consumes natural
medicine or natural medicine product commits a drug petty
offense and is subject to a fine of not more than $100 and
not more than 24 hours of useful public service;
  • A person who cultivates natural medicine shall do so on the
person's private property, subject to area and physical
security requirements. A person who violates this provision
commits a drug petty offense and is subject to a fine of not
more than $1,000.
  • A person who is not licensed to manufacture natural
medicine product and who knowingly manufactures natural
medicine product using an inherently hazardous substance
commits a level 2 drug felony;
  • Unless expressly limited, a person who for the purpose of
personal use and without remuneration, possesses,
consumes, shares, cultivates, or manufactures natural
medicine or natural medicine product, does not violate state
or local law, except that nothing permits a person to
distribute natural medicine or natural medicine product to
a person for certain unlawful purposes;
  • A peace officer is prohibited from arresting, and a district
attorney is prohibited from charging or prosecuting, a
person for a criminal offense under part 4 of article 18 of
title 18 involving natural medicine or natural medicine
product, unless expressly provided by the bill;
  • A lawful action related to natural medicine or natural
medicine product must not be the sole reason to subject a
person to a civil penalty, deny a right or privilege, or seize
assets;
  • A lawful action related to natural medicine or natural
medicine product must not be used as the sole factor in a
probable cause or reasonable suspicion determination of
any criminal offense; except that an action may be used in
such determination if the original stop or search was lawful
and other factors are present to support a probable cause or
reasonable suspicion determination of any criminal offense;
  • The fact that a person is entitled to consume natural
medicine or natural medicine product does not constitute a
defense against any charge for violation of an offense
related to operation of a vehicle, aircraft, boat, machinery,
or other device;
  • A local jurisdiction is prohibited from adopting, enacting,
or enforcing a conflicting law;
  • A person or entity who occupies, owns, or controls a
property may prohibit or otherwise regulate the cultivation
or manufacture of natural medicine or natural medicine
product on or in that property.
The bill states that an act involving natural medicine or natural
medicine product that is performed by a person:
  • Does not solely constitute child abuse or neglect, or
grounds for restricting or prohibiting family time;
  • Does not solely constitute grounds for denying health
insurance coverage;
  • Does not solely constitute grounds for discrimination for
organ donation; and
  • Must not be considered for public assistance benefits
eligibility, unless required by federal law.
The bill makes a person eligible to file a motion to have conviction
records related to natural medicine or natural medicine product sealed
immediately after the later date of final disposition or release from
supervision.
Under federal law, certain expenses are disallowed under section
280E of the internal revenue code. Under state law, the state income tax
code permits taxpayers who are licensed under the Colorado Marijuana
Code to subtract expenses that are disallowed by section 280E of the
internal revenue code. The bill expands this permission to taxpayers who
are licensed under the Colorado Natural Medicine Code.

The bill permits a hospital that has fewer than 50 beds and is a
county public hospital, a hospital formed by a health service district, or
a hospital affiliated with either such hospital (hospital) to enter into
collaborative agreements to engage in activities that may be characterized
as anticompetitive or result in displacement of competition, such as
agreements to provide ancillary or specialty services, joint purchasing,
shared services, consulting, and collaboration efforts with payers.
The bill exempts collaborating hospitals from state antitrust laws
and provides immunity from federal antitrust laws under the state action
doctrine for approved collaborative activity.
Prior to entering into a collaborative agreement, the hospitals must
submit the proposed collaborative agreement (proposal) to the department
of health care policy and financing (department) and to the attorney
general. If the department determines that the collaborative agreement
will result in cost savings or other efficiencies that will improve or
expand the delivery of health-care services in rural and frontier
communities, the department must refer the proposal to the attorney
general.
The attorney general must review each proposal that is referred by
the department and determine, within a specified time, that the benefits
are not outweighed by any anticompetitive harm that may result from the
agreement. The department or the attorney general may request additional
information concerning a proposal within 60 days after its original
submission. If additional information is requested, the department and
attorney general have an additional 45 days to review the proposal.
If the department and the attorney general make a favorable
determination, the proposal is approved and the hospitals may enter into
a collaborative agreement. If neither the department nor the attorney
general respond within the time frames set forth in the bill, the
collaborative proposal is deemed approved.
The department or the attorney general may review a collaborative
agreement annually to ensure the outcomes related to the collaborative
agreement are consistent with statute.