Bill Tracker

Current law requires the prescription drug monitoring program
(program) to track all controlled substances prescribed in Colorado. The
bill expands the program, effective February 1, 2023, to track all
prescription drugs prescribed in this state. The bill extends the repeal of
the program until September 1, 2028.

The bill prohibits a health benefit plan that provides coverage for
cancer treatment from applying a higher standard of clinical evidence for
coverage of proton beam therapy than the health benefit plan applies for
other radiation therapy treatment.

The bill permits the majority of the governing body of any county
or municipality by adoption of a resolution, ordinance, law, or rule to
abrogate all or any portion of a disaster emergency order applying to the

county or municipality that has been issued by the governor under the
governor's emergency management powers when the disaster emergency
lasts longer than 30 days. Upon the enactment by the governing body of
such a resolution, ordinance, law, or rule the order, or any portion of the
order, has no legal force and effect within, as applicable, the municipality
or within the unincorporated portions of the county where the resolution,
ordinance, law, or rule has been approved by the governing body of a
county.
The bill prohibits the state and any state department, institution, or
agency from taking any action against a county or municipality, including
without limitation any action resulting in denial of a monetary payment
or the provision of any other form of financial assistance in retaliation for
action by the governing body of the county or municipality to abrogate the
governor's order.
The bill requires the governing body of the county or municipality
to notify the governor and any affected state departments, institutions, or
agencies of the adoption of such resolution, ordinance, law, or rule.

The bill specifies that a health order issued by a county, district, or
municipal public health agency, public health director, or board of health
takes effect within the territory of a county, city and county, or
municipality, unless the governing body of the county, city and county,
or municipality rejects the order by a majority vote.

The bill also allows the governing body of a county, city and
county, or municipality to modify a health order issued by a county,
district, or municipal public health agency, public health director, or
board of health.

Under current law, a physician is required to conduct an in-person
physical examination of a person prior to certifying that the person would
benefit from medical marijuana. The bill permits a physician to treat,
counsel, and conduct appropriate personal physical examinations, in
person or remotely via telephone or video conference, to establish a bona
fide physician-patient relationship with a patient seeking a medical
marijuana card.
Under current law, retail marijuana stores are prohibited from
selling retail marijuana and retail marijuana products online and to a
person not physically present in the retail marijuana store's licensed
premises. The bill repeals this prohibition.

The bill adds a requirement, as part of mandatory health insurance
coverage of preventive health care services, that health plans cover an
annual mental health wellness examination of up to 60 minutes that is
performed by a qualified mental health care provider. The coverage must:
  • Be comparable to the coverage of a physical examination;

  • Comply with the requirements of federal mental health
parity laws; and
  • Not require any deductibles, copayments, or coinsurance
for the mental health wellness examination.
The coverage applies to plans issued on or after January 1, 2022.

The bill establishes immunity from civil liability for entities for
any act or omission that results in exposure, loss, damage, injury, or death
arising out of COVID-19 if the entity attempts in good faith to comply
with applicable public health guidelines.
The bill is repealed 2 years after the date the governor terminates
the state of disaster emergency declared on March 11, 2020.

The bill extends the duration of a state of disaster emergency

declared by the governor from 30 to 60 days, but prohibits the governor
from renewing a state of disaster emergency declared beyond 60 days.
Instead, the bill authorizes the general assembly, upon the written request
of the governor and by adopting a joint resolution, to extend the state of
disaster emergency for up to 60 additional days. The general assembly
may continue, at the written request of the governor and by adopting a
joint resolution for each extension, to extend a state of disaster emergency
for periods of up to 60 days for as long as it deems it necessary to do so.
If the general assembly is not scheduled to convene in a regular session
when a state of disaster emergency will end as required by the bill, the
governor or a two-thirds majority of the members of each house of the
general assembly, in accordance with applicable state constitutional
provisions, may call the general assembly into an extraordinary session
to consider extending the state of disaster emergency.

Current law does not expressly recognize domestic abuse as a form
of child abuse or neglect. The bill adds domestic abuse, when a child's
parent, legal guardian, or custodian exposes a child to their perpetration

of domestic abuse, to the definition of child abuse or neglect.
Under current law, child welfare caseworkers do not have
established training policies or assessment procedures to identify and
assess situations when a child's parent, legal guardian, or custodian
exposes a child to their perpetration of domestic abuse. The bill requires
the department of human services to promulgate rules to implement
assessment policies, procedures, and training for child welfare
caseworkers to recognize and assess situations when a child's parent, legal
guardian, or custodian exposes a child to their perpetration of domestic
abuse.

The bill establishes requirements for health benefit plans related

to health-care services provided by physician assistants and
reimbursement for such services.
The bill also modifies the relationship between a physician
assistant and a physician by removing the supervision requirement and
replacing it with a requirement that a physician assistant collaborate with
a physician. Formal collaboration with a physician is required only for a
physician assistant with fewer than 5,760 hours of practice experience or
who is beginning practice in a new specialty.

For the purposes of the Colorado Medical Practice Act, the bill
amends the definition of telemedicine to state that the term means the
delivery of medical services through HIPAA-compliant
telecommunications systems, including information, electronic, and
communication technologies, remote monitoring technologies, and
store-and-forward transfers, to facilitate the assessment, diagnosis,

consultation, or treatment of a patient while the patient is located at an
originating site and the physician, anesthesiologist assistant, or physician
assistant is located at a distant site.

No later than June 1, 2022, a health-care facility shall screen each
uninsured patient for eligibility for public health insurance programs,

discounted care through the Colorado indigent care program (CICP), and
discounted care as described in the bill. Health-care facilities shall use a
single uniform application developed by the department of health care
policy and financing (department) when screening a patient. If a
health-care facility determines a patient is ineligible for discounted care,
the facility shall provide the patient notice of the determination and an
opportunity for the patient to appeal the determination.
For emergency and other non-CICP health-care services provided
to qualified patients, a health-care facility and licensed health-care
professional shall limit the amounts charged to not more than 80% of the
medicare rate if the patient is uninsured; collect amounts charged in
monthly installments such that a patient is not paying more than 5% of the
patient's household income; and after a cumulative 36 months of
payments, consider the patient's bill paid in full and permanently cease
any and all collection activities on any balance that remains unpaid.
A health-care facility shall make information about patient's rights
and the uniform application for discounted care available to the public
and to each patient.
Beginning June 1, 2023, and each June 1 thereafter, each
health-care facility shall collect and report to the department data that the
department determines is necessary to evaluate compliance across patient
groups based on race, ethnicity, and primary language spoken with the
required screening, discounted care, payment plan, and collections
practices.
No later than April 1, 2022, the department shall develop a written
explanation of a patient's rights, make the explanation available to the
public and each patient, and establish a process for patients to submit a
complaint relating to noncompliance with the requirements. The
department shall periodically review health-care facilities and licensed
health-care professionals (hospital providers) to ensure compliance, and
the department shall notify the hospital provider if the hospital provider
is not in compliance that the hospital provider has 90 days to file a
corrective action plan with the department. A hospital provider may
request up to 120 days to submit a corrective action plan. The department
may require a hospital provider that is not in compliance to develop and
operate under a corrective action plan until the department determines the
hospital provider is in compliance. The bill implements fines for hospital
providers if the department determines the hospital provider's
noncompliance is knowing or willful.
The bill imposes requirements on hospital providers before
assigning or selling patient debt to a medical creditor or before pursuing
any permissible extraordinary collection action and imposes fines for any
hospital provider that fails to comply with the requirements.
The bill prohibits a medical creditor from using impermissible
extraordinary collection action to collect debts owed for health-care
services provided by a hospital provider. A medical creditor may engage
in permissible extraordinary collection actions 180 days after the first bill
for a medical debt is sent to the patient. At least 30 days before taking any
permissible extraordinary collection action, a medical creditor shall
provide the patient with a notice about the discounted care policy, the
permissible extraordinary collection actions that will be initiated, and a
deadline after which such permissible extraordinary collection actions
will be initiated. If a patient is later found eligible for discounted care, the
medical creditor shall reverse any permissible extraordinary collection
actions.

The bill requires the commissioner of insurance (commissioner)
in the department of regulatory agencies to establish a standardized health
benefit plan (standardized plan) by rule to be offered by health insurance
carriers (carriers) in the individual and small group markets. The
standardized plan must:
  • Offer health-care coverage at the bronze, silver, and gold

levels;
  • Be offered through the Colorado health benefit exchange;
  • Be a standardized benefit design created through a
stakeholder engagement process;
  • Provide first-dollar, predictable coverage for certain high
value services; and
  • Comply with state and federal law.
Beginning January 1, 2023, and each year thereafter, the bill
encourages carriers that offer:
  • An individual health benefit plan in Colorado to offer the
standardized plan in the individual market; and
  • A small group health benefit plan in Colorado to offer the
standardized plan in the small group market.
For 2023, each carrier shall set a goal of offering a standardized
plan premium that is at least 10% less than the premium rate for health
benefit plans offered by that carrier in the 2021 calendar year in the
individual and small group market. For 2024, each carrier shall set a goal
of offering a standardized plan premium that is at least 20% less than the
premium rate for health benefit plans offered by that carrier in the 2021
calendar year in the individual and small group market. For 2025 and
each year thereafter, carriers are encouraged to limit annual premium rate
increases for the standardized plan to no more than the consumer price
index plus one percent, relative to the previous year.
The Colorado option authority (authority) is created for the
purpose of operating as a carrier to offer the standardized plan as the
Colorado option if the carriers do not meet the established premium rate
goals. The authority shall operate as a nonprofit, unincorporated public
entity. The authority is required to implement a provider fee schedule as
established by the commissioner in consultation with the executive
director of the department of health care policy and financing.
Health-care providers and health facilities are required to accept
consumers who are enrolled in any health benefit plan offered by the
authority.
The bill creates an advisory committee to make recommendations
to the authority concerning the development, implementation, and
operation of the authority.
The commissioner is required to apply to the secretary of the
United States department of health and human services for a waiver and
include a request for a pass-through of federal funding to capture savings
as a result of the implementation of the standardized plan. The
commissioner is required to disapprove of a rate filing submitted by a
carrier if the rate filing reflects a cost shift between the standardized plan
and the health benefit plan for which rate approval is being sought.
The bill makes the failure to accept consumers who are covered
through the Colorado option or the balance billing of a patient in violation
of this bill grounds for discipline under specified practice acts.
The bill repeals the authority and its functions if the United States
congress establishes a national public option program that meets or
exceeds the premium rate goals set forth in and health-care coverage
pursuant to this bill.

The bill exempts a business from a public health agency order or
executive order requiring businesses to close if:
  • The products sold or services offered by the business are
also available at a business that has not been required by
the applicable order to cease or limit operations and the
open business is operating at a physical location in the

geographical area that is subject to the order; and
  • The business that is required by the applicable order to
limit or cease operations complies with any safety
precautions that the order requires of businesses that are
permitted to continue operations.

The bill creates the reproductive health care program that provides
contraceptive methods and counseling services to participants.

The bill authorizes a pharmacist to prescribe an opiate antagonist.

The bill requires a pharmacist who dispenses an opioid to an
individual to inform the individual of the potential dangers of a high dose
of opioid and offer to prescribe the individual an opiate antagonist if:
  • In the pharmacist's professional judgment, the individual
would benefit from the information;
  • The individual has a history of prior opioid overdose or
substance use disorder;
  • The individual is, at the same time, prescribed a
benzodiazepine, a sedative hypnotic drug, carisoprodol,
tramadol, or gabapentin; or
  • The opioid prescription being dispensed is at or in excess
of 90 morphine milligram equivalent.

The bill codifies a number of preventive health care services
currently required to be covered by health insurance carriers pursuant to

the federal Patient Protection and Affordable Care Act and adds them
to the current list of services required to be covered by Colorado health
insurance carriers, which services are not subject to policy deductibles,
copayments, or coinsurance. The bill expands certain preventive health
care services to include osteoporosis screening; urinary incontinence
screening; and counseling, prevention, screening, and treatment of a
sexually transmitted infection (STI).
Current law requires a health care provider or facility to perform
a diagnostic exam for an STI and subsequently treat the STI at the request
of a minor patient. The bill allows a health care provider to administer,
dispense, or prescribe preventive measures or medications where
applicable. The consent of a parent is not a prerequisite for a minor to
receive preventive care, but a health care provider shall counsel the minor
on the importance of bringing the minor's parent or legal guardian into the
minor's confidence regarding the services.
Current law requires the executive director of the department of
health care policy and financing to authorize reimbursement for medical
or diagnostic services provided by a certified family planning clinic. The
bill removes the requirement that services be provided by a certified
family planning clinic and authorizes reimbursement for family planning
services and family-planning-related services provided by any licensed
health care provider.

The bill requires that, prior to initiating a review or audit of a
medicaid provider, a reviewer or auditor shall confirm receipt of the
written request to perform the audit or review.

Under current law, school districts must permit primary caregivers
to possess and administer cannabis-based medicine on school grounds
and school principals are given the discretion to permit the storage,
possession, and administration of cannabis-based medicine on school
grounds by school personnel. The bill removes the discretion from the

school principals and requires school boards to implement policies
allowing for the storage, possession, and administration of
cannabis-based medicine by school personnel. The bill allows school
personnel to volunteer to possess, administer, or assist in administration
of cannabis-based medicine and protects those who do from retaliation.
The bill imposes a duty on school principals to create a written treatment
plan for the administration of cannabis-based medicine and on school
boards to adopt policies regarding actual administration.
The bill provides disciplinary protection to nurses who administer
cannabis-based medicine to students at school. The bill requires schools
to treat cannabis-based medicine recommendations like prescriptions.

Colorado courts follow the common law rule that, generally, only
a parent or guardian has the right to claim pre-majority economic
damages of a minor for which another person is liable. The bill abolishes
the common law rule and permits a minor to bring a claim to recover
damages for the minor's pre-majority economic loss. A minor or a parent
may not be awarded damages for any economic loss that have been

awarded to another person.
Under existing law, the statute of limitations for civil claims
against health care institutions and health care professionals is 2 years,
with certain exceptions. The exceptions to the 2-year limitation include
claims brought by or on behalf of a minor who is under 8 years old and
claims brought by or on behalf of a person under disability. The bill
makes any exemption to the 2-year limitation that would apply to a
minor's claim also apply to a claim brought by a person entitled or
required to bring a claim to recover damages for a minor's pre-majority
economic loss.

An entity is not liable for any damages that result from exposure,
loss, damage, injury, or death arising out of COVID-19 unless:
  • A claimant proves by clear and convincing evidence that
the exposure, loss, damage, injury, or death was caused by
the entity's failure to comply with public health guidelines;
or

  • The exposure, loss, damage, injury, or death was caused by
gross negligence or a willful and wanton act or omission of
the entity.
The bill is repealed 2 years after the date the governor terminates
the state of disaster emergency declared on March 11, 2020.

The bill requires the division of insurance (division) to retain a
contractor on or before November 1, 2021, for the purpose of performing
actuarial reviews of proposed legislation that may impose a new health
benefit mandate on health benefit plans. The contractor, under the
direction of the division, shall conduct an actuarial review of up to 5

legislative proposals for each regular legislative session, each at the
request of a member of the general assembly. Each actuarial review
performed by the contractor must consider the predicted effects of the
legislative proposal during the 5 years immediately following the
effective date of the proposed legislation, including specifically described
considerations.
In preparing a fiscal note for any legislative proposal that may
impose a new health benefit mandate on health benefit plans, the
legislative service agency charged with preparing the fiscal note shall
either:
  • Include in the fiscal note information that is produced by
the contractor in review of the legislative proposal; or
  • If no information is produced by the contractor in review of
the legislative proposal, indicate such fact in the fiscal note.

Current law appropriates $5 million annually from the tobacco tax
cash fund to the department of public health and environment
(department) for breast and cervical cancer screenings. The bill expands

the use of the funds for additional cancer screenings. The bill changes the
name of the breast cancer screening fund to the cancer screening fund and
authorizes the money in the fund to be used for breast and cervical cancer
screenings, colorectal cancer screenings, and screenings for additional
screenable cancers.
The bill changes the makeup of the existing advisory board from
persons interested in health care and the promotion of breast cancer
screenings to include persons who are interested in health care and the
promotion of services for other screenable cancers. When making
recommendations to the executive director of the department concerning
cancer screening services, the bill requires the advisory board to allocate,
at a minimum, $2.5 million annually for breast and cervical cancer
screenings, $1 million annually for colorectal cancer screenings, and, if
feasible, money for screenings for additional screenable cancers.

Sunset Process - Senate Health and Human Services
Committee. The bill implements the recommendations of the department

of regulatory agencies in its sunset review and report on the surgical
assistants and surgical technologists registration program. Specifically:
  • Sections 1 and 2 of the bill continue the surgical assistant
and surgical technologist registration program for 7 years,
until 2028.
  • Section 3 requires a surgical assistant or surgical
technologist whose registration is revoked or who has
surrendered a registration in lieu of disciplinary action to
wait 2 years before reapplying for registration and
authorizes the director of the division of professions and
occupations within the department of regulatory agencies
(director) to issue letters of admonition and confidential
letters of concern to surgical assistants and surgical
technologists.
  • Section 4 clarifies that a registrant may be disciplined for
failing to notify the director of the limitations created by an
illness or other health condition, act within such
limitations, or act within the limitations imposed under a
confidential agreement with the director to limit practice.
Section 4 also adds the following as grounds for discipline:
  • Habitual or excessive use of alcohol, a
habit-forming drug, or a controlled substance;
  • Failing to notify the director of any disciplinary
action;
  • Failing to respond in a materially responsive and
timely manner to a complaint;
  • Practicing outside the scope of the practice of a
surgical assistant or surgical technologist; and
  • Failing to satisfy generally accepted standards of
practice as a surgical assistant or surgical
technologist.
  • Sections 5 and 6 allow the director to enter into
confidential agreements with surgical assistants or surgical
technologists to limit practice based on an illness or other
health condition that affects the ability to safely practice the
profession.

Sunset Process - Senate Health and Human Services
Committee. The bill implements the recommendation of the department

of regulatory agencies' sunset review and report concerning the Michael
Skolnik Medical Transparency Act of 2010 to continue the act for 7
years, until 2028.

Sunset Process - Senate Health and Human Services
Committee. The bill implements the recommendations of the department

of regulatory agencies' 2020 sunset review and report by:
  • Continuing the prescription drug monitoring program
(program) until September 1, 2028 (sections 4 and 5 of the
bill);
  • Authorizing the state board of pharmacy (board) to
promulgate rules that identify a list of prescription drugs
that are not currently listed as controlled substances and
require such drugs to be tracked through the program
(section 2);
  • Authorizing each coroner to authorize deputy coroners to
access the program (section 2);
  • Authorizing the board to create a data retention schedule
for information obtained and stored by the program
(section 2);
  • Requiring the board to report its efforts to seek outside
funding for the program during the State Measurement for
Accountable, Responsive, and Transparent (SMART)
Government Act hearings (section 3); and
  • Making a technical change to remove a reference to the
department of health care policy and financing from the
statute as that department does not have access to the
program (section 2).

Sunset Process - Senate Health and Human Services
Committee. The bill implements the recommendations of the department

of regulatory agencies' sunset review and report on the registration of
direct-entry midwives by:
  • Continuing the registration requirements for 7 years, until
September 1, 2028 (sections 1 and 2 of the bill);
  • Authorizing direct-entry midwives to administer group B
streptococcus (GBS) prophylaxis (section 5);
  • Adding licensed birth centers to the locations where a
direct-entry midwife may practice (section 3); and
  • Requiring the director of the division of professions and
occupations to develop policies regarding direct-entry
midwives in training (section 6).
The bill also:
  • Specifies that a direct-entry midwife who is granted
additional authority is not required to apply for renewal of
that authority or pay any renewal fees for the authority
(section 5); and
  • Removes the requirement that a direct-entry midwife report
certain data at the time of registration renewal (section 4).

In 2019, the Colorado general assembly enacted, and the governor
subsequently signed into law, the Canadian prescription drug importation

program (program) in the department of health care policy and financing
(department). The bill states that the department may expand the program
to allow a manufacturer, wholesale distributor, or pharmacy from a nation
other than Canada to export prescription drugs into the state under the
program if certain conditions are met.
If, upon the satisfaction of these conditions, the department
decides to expand the program, the executive director of the department
shall notify the president of the senate, the speaker of the house of
representatives, and specified legislative committees, of the department's
intent to do so. The executive director shall provide the notice at least 30
days before the program is expanded, and the notice may include any
recommendations of the department for legislation to amend the program
to reflect its expansion.

The bill requires that when a physician applies to be credentialed
as a participating physician in a health insurance carrier's (carrier's)
provider network, the carrier must conclude the process of credentialing
the applicant within 60 calendar days after the carrier receives the
applicant's completed application. A carrier must provide each applicant
written or electronic notice of the outcome of the applicant's credentialing

within 10 calendar days after the conclusion of the credentialing process.
Within 7 calendar days after a carrier receives an application, the
carrier must provide the applicant a receipt. If a carrier receives an
application but fails to provide the applicant a receipt within 7 calendar
days, the carrier shall consider the applicant a participating physician,
effective no later than 53 calendar days following the carrier's receipt of
the application.
A carrier may not deny a claim for a medically necessary covered
service provided to a covered person if the service:
  • Is a covered benefit under the covered person's health
coverage plan; and
  • Is provided by a participating physician who is in the
provider network for the carrier's health coverage plan and
has concluded the carrier's credentialing process.
A carrier may not require a participating physician to submit an
application or participate in a contracting process in order to be
recredentialed.
A carrier must allow a participating physician to remain
credentialed and include the participating physician in the carrier's
provider network unless the carrier discovers information indicating that
the participating physician no longer satisfies the carrier's guidelines for
participation.
The commissioner of insurance is required to enforce the new
requirements. A carrier that fails to comply with the bill or with any rules
adopted pursuant to the bill is subject to such civil penalties as the
commissioner may order.

The bill authorizes the director of the division of professions and
occupations or the applicable regulatory board in the department of
regulatory agencies (regulator) to suspend or waive statutes or rules
governing a health care profession or occupation over which a regulator
has authority during a disaster emergency declared by the governor. The

suspension or waiver of a statute or rule is limited to those in which strict
compliance would prevent, hinder, or delay necessary action in coping
with or responding to the disaster emergency and may not suspend,
waive, or modify any supervisory requirements.
The bill allows a regulator to promulgate emergency rules
commensurate with the nature of the disaster emergency and within the
limits of the declaration and the applicable practice act for a health care
profession or occupation. The emergency rules automatically expire 60
days after the termination of the declared disaster emergency.

The bill requires the division of homeland security and emergency
management in the department of public safety (division), on or before
January 1, 2022, to implement a pilot grant program (program) to help

finance the use of nurse intake of 911 calls, which involves nurses
assisting with 911 dispatch for the purpose of diverting nonurgent 911
calls to medical care that does not require ambulance service or treatment
in an emergency room. The division, after reviewing applications, shall
designate 4 public safety answering points to participate in the program,
one of which is located in a county with 60,000 or more residents and 3
of which are located in a county or counties with fewer than 60,000
residents. To participate in the program, the designated public safety
answering points must each enter into a contract with an entity that can
provide nurses who are trained and equipped to provide nurse intake of
911 calls.
On or before June 1, 2023, the division shall report to the judiciary
committees in the senate and the house of representatives or their
successor committees on the program.

The bill renames the existing health disparities grant program to
the health disparities and community grant program (program) and
expands the program to authorize the office of health equity (office) to:
  • Award grants from money currently transferred from the
prevention, early detection, and treatment fund to the health
disparities grant program fund (fund) for the purpose of

positively affecting social determinants of health to reduce
the risk of future disease and exacerbating health
disparities in underrepresented populations; and
  • Award grants from any additional money appropriated by
the general assembly to the fund to community
organizations to reduce health disparities in
underrepresented communities through policy and systems
changes regarding the social determinants of health.
On or before January 1, 2022, and continuing every 2 years
thereafter, the office is required to issue a report concerning health
disparities in Colorado by race and ethnicity that includes an assessment
of the impact of social determinants of health on health disparities and
recommended strategies to begin to address such inequities with the
collaboration of the health equity commission and other stakeholders.
On or before July 1, 2022, the office is required to facilitate a state
agency work group to develop an equity strategic plan. Specific state
agencies are required to participate in the state agency work group to
ensure coordination in equity-related work across state agencies to
address social determinants of health in each agency's respective area.
The bill adds additional state agency executive directors to the
health equity commission.