Opioid and Other Substance Use Disorders Interim Study Committee. Section 1 of the bill establishes in statute the opioid and other substance use disorders study committee, consisting of 5 senators and 5 representatives from the general assembly, to:

• Study data and statistics on the scope of the substance use disorder problem in Colorado;
• Study current prevention, intervention, harm reduction, treatment, and recovery resources available to Coloradans, as well as public and private insurance coverage and other sources of support for treatment and recovery resources;
• Review the availability of medication-assisted treatment and the ability of pharmacists to prescribe those medications;
• Examine measures that other states and countries use to address substance use disorders;
• Identify the gaps in prevention, intervention, harm reduction, treatment, and recovery resources available to Coloradans and hurdles to accessing those resources; and
• Identify possible legislative options to address gaps and hurdles to accessing prevention, intervention, harm reduction, treatment, and recovery resources.

The committee is authorized to meet 6 times in a calendar year and may report up to 6 legislative measures to the legislative council, which bills are exempt from bill limitations and introduction deadlines. The committee is repealed on July 1, 2020.

Section 2 requires the governor to direct the Colorado consortium for prescription drug abuse prevention to:

• Create a process to develop a plan that addresses the full continuum of recovery services;
• Develop a definition for recovery residences and recommend whether the residences should be licensed; and
• Report recommendations to the general assembly.

Section 3 specifies school-based health care centers may apply for grants from the school-based health center grant program to expand behavioral health services to include treatment for opioid and other substance use disorders and requires the department of public health and environment to prioritize funding to the centers that serve communities with high-risk factors.

Section 4 directs the department of health care policy and financing, starting July 1, 2018, to award grants to organizations to operate a substance abuse screening, brief intervention, and referral program.

Section 5 creates the Charlie Hughes and Nathan Gauna opioid prevention pilot program in the Tony Grampsas youth services program for preventing opioid use among the youth population and supporting youth whose family members experience addiction. The Tony Grampsas youth services board shall oversee a grant process for the pilot program using specific criteria. The Tony Grampsas youth services program shall award the grants on or before October 1, 2018. The bill creates a fund for the direct and indirect costs associated with the program. The department of human services is required to work with the grant recipients and submit a report to the general assembly on or before January 1, 2021, regarding the progress of the grant recipients.

Section 6 directs the center for research into substance use disorder prevention, treatment, and recovery to develop and implement continuing medical education activities to help prescribers of pain medication to safely and effectively manage patients with chronic pain, and when appropriate, prescribe opioids. Sections 3 through 6 also direct the general assembly to appropriate money to implement those sections.

Section 7 appropriates:

• $675,00 to the department of health care policy and financing from the marijuana tax cash fund to implement the bill;
• $750,000 to the department of higher education from the marijuana tax cash fund for research purposes;
• $1,500,000 to the youth opioid and substance use prevention fund from the marijuana tax cash fund;
• $500,000 to the department of human services from reappropriated funds for use by the division of child welfare;
• $90,928 to the department of humans services from the marijuana tax cash fund for use by the division of child welfare;
• $39,249 to the legislative department from the general fund; and
• $775,00 to the department of public health and environment from the marijuana tax cash fund for use by the prevention services division.
  (Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

Opioid and Other Substance Use Disorders Interim Study Committee. The bill requires all individual and group health benefit plans to provide coverage without prior authorization for a five-day supply of at least one of the federal food and drug administration-approved drugs for the treatment of opioid dependence for a first request within a 12-month period.

The bill prohibits carriers from taking adverse action against a provider or from providing financial incentives or disincentives to a provider based solely on a patient satisfaction survey relating to the patient's satisfaction with pain treatment.

The bill clarifies that an 'urgent prior authorization request' to a carrier includes a request for authorization of medication-assisted treatment for substance use disorders.

The bill permits a pharmacy that has entered into a collaborative pharmacy practice agreement with one or more physicians to administer injectable antagonist medication for substance use disorders and receive an enhanced dispensing fee for the administration.

The bill requires the Colorado medical assistance program to authorize reimbursement for at least one federal food and drug administration-approved ready-to-use opioid overdose reversal drug without prior authorization.

The bill permits a pharmacy that has entered into a collaborative pharmacy practice agreement with one or more physicians to administer injectable opioid antagonist medication for substance use disorders and receive an enhanced dispensing fee under the Colorado medical assistance program for the administration.

The bill requires the department of health care policy and financing and the office of behavioral health in the department of human services to establish rules that standardize utilization management authority timelines for the nonpharmaceutical components of medication-assisted treatment for substance use disorders.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill creates the 'Diabetes Drug Pricing Transparency Act of 2018'. The state board of health is responsible for implementing the act. Drug manufacturers, pharmacy benefit managers, insurers, and pharmacies must submit annual reports to the state board regarding prescription insulin drugs used to treat diabetes. The state board analyzes the submitted information and publishes a report. The state board may impose penalties on drug manufacturers or pharmacy benefit managers who do not comply with reporting requirements. Nonprofit organizations advocating for patients with diabetes or funding diabetes medical research that receive contributions from certain diabetes drug manufacturers must annually report those contributions.

$287,602 is appropriated from the general fund to the department of public health and environment to implement the act. $10,656 of this amount is reappropriated to the department of law for legal services to the department of public health and environment.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill requires the department of public health and environment to provide individualized patient information from the department's EMS agency patient care database to health information organization networks for any use allowed under the federal 'Health Insurance Portability and Accountability Act of 1996' (HIPAA). By contract with health information organization networks, the department must control access to patient information and limit the use of patient information to only those purposes allowed under HIPAA.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill requires a health benefit plan to provide coverage for health care services provided by a pharmacist if:

• The services are provided within a health professional shortage area; and
• The health benefit plan provides coverage for the same services provided by a licensed physician or advanced practice nurse.
  (Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill recreates the former health care task force, renamed as the statewide health care review committee, to study health care issues that affect Colorado residents throughout the state. The committee consists of the members of the house of representatives committees on health, insurance, and environment and on public health care and human services and the senate committee on health and human services. The committee is permitted to meet up to 2 times during the interim between legislative sessions, including 2 field trips.

For the 2018-19 fiscal year, the bill appropriates $23,951 from the general fund to the legislative department to implement the bill.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill extends the advanced industries export acceleration program that is currently managed by the office of economic development.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

Sunset Process - House Public Health Care and Human Services Committee. The bill implements the recommendations of the department of regulatory agencies in its sunset review and report concerning the 'Physical Therapy Practice Act' as follows:

• Extends the licensing of physical therapists and the certification of physical therapist assistants until 2024 ( sections 1 through 3 );
• Clarifies that a physical therapist may make physical therapy diagnoses ( sections 5 and 7 );
• Allows a physical therapist to perform dry needling if the physical therapist has the knowledge, skill, ability, and competency to perform the act and has completed a dry needling course and obtains informed consent from the patient. The bill also allows the department to promulgate rules to establish requirements for dry needling ( section 8 );
• Clarifies that a physical therapist's scope of practice includes the direct supervision of unlicensed physical therapists ( section 9 );
• Requires that physical therapy professional development activities must be measured by a contact-hour-to-credit-hour ratio ( section 10 ); and
• Adds as grounds for disciplinary action the failure to supervise physical therapist assistants; and the failure to report an adverse action, the surrender of a license, or other discipline taken in another jurisdiction ( section 11 ).

In addition, the bill:

• Allows a physical therapist assistant to perform noninvasive wound debridement under the supervision of a physical therapist ( sections 13 and 15 );
• Repeals some elements of the continuing professional competency program for physical therapists ( section 13 ) and subjects physical therapist assistants to a continuing professional competency program ( section 14 );
• Replaces a physical therapist member of the physical therapy board with a physical therapist assistant member ( section 6 ); and
• Removes physical therapists practicing in Colorado pursuant to the 'Interstate Physical Therapy Licensure Compact Act' from the 'Michael Skolnik Medical Transparency Act of 2010' ( section 16 ).
  (Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill:

• Prohibits a pharmaceutical manufacturer or wholesaler from price gouging on sales of essential off-patent or generic drugs;
• Makes the practice of price gouging a deceptive trade practice under the 'Colorado Consumer Protection Act'; and
• Requires the state board of pharmacy and the executive director of the department of health care policy and financing to report suspected price gouging to the attorney general. The attorney general is authorized to seek subpoenas and file lawsuits with the appropriate district courts.
  (Note: This summary applies to this bill as introduced.)

Fiscal Note

Not more than 30 days after receiving at least $750,000 in gifts, grants, and donations for the purpose of creating and administering a statewide electronic system (system) that allows medical professionals and individuals to upload and access advance directives, the department of public health and environment shall create such a system. 'Advance directive' means:

• A declaration as to medical treatment;
• A medical durable power of attorney;
• A directive relating to cardiopulmonary resuscitation;
• A medical orders for scope of treatment form;
• A designated beneficiary agreement; or
• Any legal form of these types that has been properly executed in another state in accordance with the laws of that state.

The department shall contract with one or more health information organization networks for the administration and maintenance of the system during the next year. On or before November 1, 2018, the department shall promulgate rules to administer the system.

The system is repealed, effective September 1, 2028. Prior to such repeal, the department of regulatory agencies shall perform a sunset review of the system.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

Current law requires state agencies to give a licensee:

• Notice of facts or conduct that may warrant revocation, suspension, annulment, limitation, or modification of a license;
• An opportunity to submit written data, views, and arguments with respect to the facts or conduct; and
• A reasonable opportunity to comply with all lawful requirements except for a willful violation or violation that is a danger to public health and safety.

When a matter pertains to an individual who is licensed to practice an occupation, if mediation is ordered, section 2 of the bill requires a state agency to do the following upon the motion of the agency or licensee after the licensee receives the notice of hearing:

• To include a person who has authority to make prehearing decisions concerning disposition of the issue in settlement and mediation meetings and communications with the licensee; and
• To include a public or private mediator???at the expense of the licensee when the mediator is privately retained???upon the licensee's request.

Administrative law judges are instructed to make themselves available for mediation, without cost, if feasible. Procedures are set for mediation. If mediation fails, the agency may continue to seek discipline upon instituting a disciplinary hearing against a licensee. The office of administrative courts and the division of professions and occupations in the department of regulatory agencies are required to report to specified legislative committees certain information about hearings, mediations, and proceedings held between July 2019 and July 2021.

Section 3 of the bill clarifies that a court may overturn discipline for a failure to follow the requirements of current law or to submit to mediation.

$125,356 is appropriated to the department of regulatory agencies from the division of professions and occupations cash fund to implement the bill. From that appropriation $19,917 is appropriated to the department of personnel for use by the office of administrative courts and $64,575 is appropriated to the department of law.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill enacts the 'Colorado Prescription Drug Price Transparency Act of 2018', which requires:

• Health insurers, starting in 2021, to submit to the commissioner of insurance (commissioner), as part of the health care cost reporting requirement, information regarding prescription drugs covered under their health insurance plans that were dispensed in the preceding calendar year;
• Prescription drug manufacturers to notify state purchasers, health insurers, and pharmacy benefit management firms when the manufacturer, on or after July 1, 2020, increases the price of certain prescription drugs by more than 10% or introduces a new specialty drug in the commercial market; and
• Prescription drug manufacturers, within 15 days after the end of each calendar quarter that starts on or after July 1, 2020, to provide specified information to the commissioner regarding the drugs about which manufacturers are required to notify purchasers of a drug price increase or new specialty drug on the market.

The commissioner is required to post the information received from prescription drug manufacturers on the division of insurance website. Additionally, the commissioner, or a disinterested third-party contractor, is to analyze the data submitted by health insurers and prescription drug manufacturers and other relevant information to determine the effect of prescription drug costs on health insurance premiums. The commissioner is to publish a report each year, submit the report to specified legislative committees, and present the report during annual 'State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act' hearings. The commissioner is authorized to adopt rules as necessary to implement the requirements of the act.

A prescription drug manufacturer that fails to notify purchasers or fails to report required data to the commissioner is subject to discipline by the state board of pharmacy, including a penalty of $1,000 per day for each day the manufacturer fails to comply with the notice or reporting requirements. The commissioner is to report manufacturer violations to the state board of pharmacy.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill adds autism spectrum disorders to the list of disabling medical conditions that authorize a person to use medical marijuana for his or her condition.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

Under current law, health insurers are permitted to consider the geographic location of the policyholder when establishing health insurance rates for individual and group insurance plans.

For an individual health plan issued, amended, or renewed on or after January 1, 2019, the bill prohibits a health insurer from considering the geographic location of the policyholder when establishing rates for the plan, thereby creating a single geographic rating area consisting of the entire state for purposes of all individual health benefit plans.
(Note: This summary applies to this bill as introduced.)

Fiscal Note

The bill clarifies that a licensed and qualified pharmacist may serve as a practitioner and prescribe over-the-counter medication under the 'Colorado Medical Assistance Act' and a statewide drug therapy protocol pursuant to a collaborative pharmacy practice agreement.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

Joint Budget Committee. The bill authorizes the general assembly to appropriate general fund money to the department of health care policy and financing (department) to pay for expenses related to the all-payer health claims database (database).

The bill also establishes a grant program to assist nonprofit organizations and governmental entities, other than the department, in accessing the database to conduct research. The bill authorizes the advisory committee to oversee the database, review grant applications, and recommend to the department which grant applications to fund and the amount of each grant. The department is authorized to develop and review grant applications and determine which grant applications to fund and the amount of each grant. The medical services board is authorized to adopt rules governing the grant program.

The bill appropriates money to the department to pay for the database and the grant program.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill imposes requirements on health care facilities, health care providers, pharmacies, and health insurers, starting January 1, 2019, to disclose information about health care charges. Specifically, section 2 of the bill enacts the 'Comprehensive Health Care Billing Transparency Act' (act), which requires health care facilities, including hospitals, ambulatory surgical centers, community clinics, and physician practice groups, to:

• Publish their fee schedules or other lists of charges the facilities bill for specific health care services before applying any discounts, rebates, or other charge adjustment mechanisms;
• Include in every bill sent to a patient an itemized detail of each health care service provided, the charge for the service, how any payment or adjustment by the patient's health insurer was applied to each line item in the bill, and, for hospitals, the amount of the healthcare affordability and sustainability fee the hospital is charged; and
• In situations where an individual provides health insurance information to the facility or a provider in a facility setting, disclose whether the facility or provider participates in the individual's health insurance plan; whether the services the facility or provider will render will be covered as an in-network or out-of-network benefit; and whether the individual will receive a service from an out-of-network provider at an in-network facility.

For an individual health care provider who provides health care services at a health care facility, has a separate fee schedule for the services the provider delivers in the facility setting, and whose fees for those services are not included in the facility's published fee schedule, the provider must provide a fee schedule to the facility for posting on the facility's website.

Section 2 also prohibits a facility or provider from billing a patient or third-party payer an amount in excess of the lower of any established self-pay rate or the lowest rate negotiated with or reimbursed by any third-party payer, including the federal centers for medicare and medicaid services in the United States department of health and human services, for the particular health care services rendered to the patient if the facility or provider has failed to publish or provide its fee schedule.

Additionally, section 2 requires a pharmacy to publish a list of its retail drug prices, which is a list of the charges the pharmacy charges to an insured or uninsured person for prescription drugs it administers or dispenses, before any rebates, discounts, or other price adjustment mechanisms are applied. Section 4 specifies that failure to comply with the requirements to publish retail drug prices constitutes grounds for the state board of pharmacy to discipline a pharmacist.

Health insurers, facilities, and providers are prohibited from including any provision in a contract between the parties issued, amended, or renewed on or after January 1, 2019, that restricts the ability of a provider, facility, or health insurer to provide patients with the charge information required to be published. Section 2 also directs the state board of pharmacy to adopt rules necessary to implement the provisions of the act that are applicable to pharmacies and the executive director of the department of public health and environment to adopt any other rules necessary to implement and administer the act.

Section 3 requires health insurers to publish information about contract terms, cost-sharing arrangements, and prescription drug prices. The commissioner of insurance is directed to adopt rules to implement and administer these requirements and is authorized to use enforcement powers under current law to enforce the requirements on health insurers.
(Note: This summary applies to this bill as introduced.)

Fiscal Note

The bill establishes a primary care payment reform collaborative in the primary care office in the department of public health and environment. To facilitate the collaborative's work, the administrator of the all-payer health claims database is to report data on primary care spending by private health insurers, insurers providing state employee health benefit plans, and the department of health care policy and financing under the state medicaid program and the children's basic health plan.
(Note: This summary applies to this bill as introduced.)

Fiscal Note

The bill prohibits a health insurance carrier from excluding or limiting a drug under a health benefit plan and from moving the drug to a disadvantaged tier in the plan formulary if the drug was covered at the time the covered person enrolled in the plan. A carrier may not increase the amount that a covered person pays for a copayment, coinsurance, or deductible or set limits while the covered person is covered by the health benefit plan for drugs that were covered when the person became covered under the plan.

If a carrier uses a tiered plan, the carrier may not move a drug to a disadvantaged tier under specified circumstances.

A carrier may limit coverage for a drug or biosimilar product if a provider prescribes a generic drug or biosimilar product to treat the covered person's medical condition instead of the originally-prescribed drug and the covered person agrees.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

The bill requires the department of health care policy and financing and the division of insurance in the department of regulatory agencies (departments) to conduct a study and to prepare and submit a report to certain committees of the general assembly concerning the costs, benefits, and feasibility of implementing a medicaid buy-in option, a public-private partnership option, or a community- or regionally based option for health care coverage.

The report must contain a detailed analysis of the advantages and disadvantages of each option and must identify the most feasible option based on objectives and criteria described in the bill.

In conducting the study, the departments shall engage in a stakeholder process that includes public and private health insurance experts, consumers, consumer advocates, providers, and carriers.

The bill includes an appropriation.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill authorizes the commissioner of insurance to apply to the secretary of the United States department of health and human services for a state innovation waiver, for federal funding, or both to allow the state to implement and operate a reinsurance program to assist health insurers in paying high-cost insurance claims. The state cannot implement the program absent waiver or funding approval from the secretary. The program is established as an enterprise for purposes of section 20 of article X of the state constitution. The division of insurance is to include an update regarding the program in its annual SMART Act report, and the program is subject to sunset review and repeal in 5 years.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill requires hospitals with surgical services and ambulatory surgical centers to adopt a policy to prevent human exposure to surgical smoke. Surgical smoke is a gaseous byproduct produced by energy-generating surgical medical devices. On or before March 1, 2019, the Colorado department of public health and environment shall promulgate rules regarding requirements for surgical smoke evacuation policies. A policy adopted in accordance with the bill applies to surgical procedures performed on or after July 1, 2019.
(Note: This summary applies to this bill as introduced.)

Fiscal Note

Opioid and Other Substance Use Disorders Interim Study Committee. The bill restricts the number of opioid pills that a health care practitioner, including physicians, physician assistants, advanced practice nurses, dentists, optometrists, podiatrists, and veterinarians, may prescribe for an initial prescription to a seven-day supply and allows each health care practitioner to exercise discretion to include a second fill for a seven-day supply, unless, in the judgment of the practitioner, the patient:

• Has chronic pain that typically lasts longer than 90 days or past the time of normal healing, as determined by the podiatrist, or following transfer of care from another podiatrist who prescribed an opioid to the patient;
• Has been diagnosed with cancer and is experiencing cancer-related pain; or
• Is experiencing post-surgical pain that, because of the nature of the procedure, is expected to last more than 14 days.

Additionally, an advanced practice nurse may prescribe a refill if the patient is undergoing palliative or hospice care. The restrictions repeal on September 1, 2021.

Current law allows health care practitioners and other individuals to query the prescription drug monitoring program (program). The bill requires health care practitioners to indicate his or her specialty or practice area upon the initial query and to query the program prior to prescribing the second fill for an opioid unless the person receiving the prescription meets certain requirements.

The bill requires the department of public health and environment to report to the general assembly its findings from studies regarding the prescription drug monitoring program conducted pursuant to a federal grant program.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill allows a pharmaceutical manufacturer or its representative to promote the off-label use of a prescription drug, biological product, or device approved by the United States food and drug administration.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

Opioid and Other Substance Use Disorders Interim Study Committee. The bill modifies the Colorado health service corps program administered by the primary care office in the department of public health and environment as follows:

• For purposes of determining areas in the state in which there is a shortage of health care professionals and behavioral health care providers to meet the needs of the community, allows the primary care office, under guidance adopted by the state board of health, to develop and administer state health professional shortage areas using state-specific methodologies;
• Allows behavioral health care providers, which include licensed and certified addiction counselors, licensed professional counselors, licensed clinical social workers, licensed marriage and family therapists, licensed psychologists, licensed physician assistants with specific training in substance use disorders, advanced practice nurses, and physicians certified or trained in addiction medicine, pain management, or psychiatry, and candidates for licensure as an addiction counselor, professional counselor, clinical social worker, marriage and family therapist, or psychologist, to participate in the loan repayment program on the condition of committing to provide behavioral health care services in health professional shortage areas for a specified period;
• Directs the advisory council to prioritize loan repayment and scholarships for those behavioral health care providers, candidates for licensure, or addiction counselors who provide behavioral health care services in nonprofit or public employer settings but permits consideration of applicants practicing in a private setting that serves underserved populations;
• Establishes a scholarship program to help defray the education and training costs associated with obtaining certification as an addiction counselor or with progressing to a higher level of certification;
• Adds 2 members to the advisory council that reviews program applications, which members include a representative of an organization representing substance use disorder treatment providers and a licensed or certified addiction counselor who has experience in rural health, safety net clinics, or health equity;
• Modifies program reporting requirements and requires annual reporting that coincides with required SMART Act reporting by the department; and
• Requires the general assembly to annually appropriate $2.5 million from the marijuana tax cash fund to the primary care office to provide loan repayment for behavioral health care providers and candidates for licensure participating in the Colorado health service corps and to award scholarships to addiction counselors participating in the scholarship program.

The bill appropriates $2.5 million from the marijuana tax cash fund to the department of public health and environment for use by the primary care office in the prevention services division to implement the bill.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

Opioid and Other Substance Use Disorders Interim Study Committee. The bill:

• Specifies that hospitals may be used as clean syringe exchange sites ( section 1 );
• Provides civil immunity for participants of a clean syringe exchange program ( section 1 );
• Creates a supervised injection facility pilot program in the city and county of Denver and provides civil and criminal immunity for the approved supervised injection facility ( sections 2 through 4 );
• Allows school districts and nonpublic schools to develop a policy by which schools are allowed to obtain a supply of opiate antagonists and school employees are trained to administer opiate antagonists to individuals at risk of experiencing a drug overdose ( sections 5 through 11 ); and
• Requires the commission on criminal and juvenile justice to study certain topics related to sentencing for opioid-related offenses ( section 12 ).
  (Note: This summary applies to this bill as introduced.)

Fiscal Note

An agreement among physicians may contain a covenant not to compete, under which a physician who leaves the group practice may be compelled to pay damages if he or she solicits patients who are former or prospective patients of the group practice. The bill makes an exception in the case of patients with a rare disorder, as determined in accordance with nationally recognized criteria, who would otherwise not have ready access to a physician with the necessary expertise to treat the disorder.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill formally establishes in statute the circle program, a 90-day inpatient treatment program for persons with co-occurring mental health and substance use disorders.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

Current law requires health insurance carriers to report to the division of insurance a list of average reimbursement rates for the average inpatient day or the average reimbursement rate for the 25 most common inpatient procedures. The bill repeals this requirement.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill requires the commissioner of insurance to conduct an actuarial analysis to determine if the sale of catastrophic health plans to Colorado residents 30 years of age and older and not meeting a hardship requirement would result in a reduction in advanced premium tax credits received by Colorado residents or increase the average premiums of individual health plans. If the actuarial analysis demonstrates that there would not be a reduction in advanced premiums tax credits or an increase in average premiums of individual health plans, the commissioner shall apply to the secretary of the United States department of health and human services for a 5-year waiver of the federal law restricting catastrophic health plans offered through the Colorado health benefit exchange. The waiver, if approved, would permit the offering of catastrophic health plans to any individual residing in Colorado rather than only individuals under the age of 30 or meeting a hardship requirement. Catastrophic health plans under the waiver must only be sold through the health benefit exchange and would not be eligible for advanced premium tax credits. If the waiver is denied, the statutory section is repealed.

The bill appropriates $9,200 to the department of regulatory agencies for use by the division of insurance for personal services.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill allows an insurance producer or broker advising a client on individual health benefit plans to charge the client a fee if the producer or broker does not receive a commission related to the individual health benefit plan selected by the client and if the producer or broker discloses in writing the fee to the client. The commissioner of insurance shall promulgate rules regarding how the producer or broker must provide the fee disclosure.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill:

• Prohibits a pharmaceutical manufacturer or wholesaler from price gouging on sales of essential off-patent or generic drugs;
• Makes the practice of price gouging a deceptive trade practice under the 'Colorado Consumer Protection Act'; and
• Requires the state board of pharmacy and the executive director of the department of health care policy and financing to report suspected price gouging to the attorney general. The attorney general is authorized to seek subpoenas and file lawsuits with the appropriate district courts.
  (Note: This summary applies to this bill as introduced.)

Fiscal Note

The bill requires hospitals, other than critical access hospitals, that are exempt from state or local taxes to report information about the tax benefits they receive and the community benefits they provide. The bill creates a hospital community benefits advisory council within the department of health care policy and financing to accept and analyze hospital reports. The executive director of the department is required to adopt rules, in consultation with the advisory council, specifying when hospitals are to submit the reports, the form and manner of reporting the required data, the categories of community benefits they provide and the services that constitute a community benefit, and related matters.

Upon analyzing hospital data, the advisory council is to:

• Make recommendations to the executive director regarding any modifications needed to the hospital reporting requirements as specified in rules; and
• Provide annual reports to specified legislative committees regarding the hospital data and any legislative recommendations.

The advisory council and hospital reporting requirements are subject to sunset review in 2021, with repeal of the advisory council and hospital reporting requirements scheduled for September 1, 2022.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

The bill requires extended-release opioid antagonists for use in medication-assisted treatment to be included as a pharmacy benefit under the medical assistance program.

The bill permits a pharmacist who has entered into a collaborative pharmacy practice agreement with one or more prescribers to administer injectable medication-assisted treatment for substance use disorders and receive an enhanced dispensing fee under the Colorado medical assistance program for the administration.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

The bill directs the department of health care policy and financing (department) to prepare and submit a waiver to the federal government requesting authority to implement certain self-sufficiency provisions as part of the Colorado medical assistance program (medicaid). The bill:

• Requires able-bodied adults as a condition of eligibility for medicaid to become employed, actively seek employment, attend job or vocational training, or volunteer at a nonprofit organization; except that this requirement does not apply to certain persons specified in the bill;
• Requires able-bodied adults to verify income monthly for determination of eligibility;
• Authorizes the department to prohibit enrollment in medicaid if a person fails to report a change in family income or makes a false statement regarding compliance with the work requirement;
• Establishes a lifetime limit on medicaid benefits of 5 years, and includes persons excepted from the limit; and
• Authorizes the department to impose copayments to deter the use of emergency departments and ambulance services for nonemergency services and nonemergency transportation.

The bill requires the department to report to the general assembly regarding the preparation, submission, approval, implementation, and outcome of the self-sufficiency waiver provisions.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

Current law requires the department of regulatory agencies (department) to analyze whether to begin or continue the regulation of a profession or occupation based on several factors. The bill elaborates on these factors and requires the department to find present, significant, and substantiated harm to consumers before recommending regulation. The bill further requires the department to recommend only the least restrictive regulation necessary to address the harm.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

Under current law, when a health care provider who is not under a contract with a health insurer, and is therefore an out-of-network provider, renders health care services to a person covered under a health benefit plan at a facility that is part of the provider network under the plan (in-network facility), the health insurer is required to cover the services of the out-of-network provider at the in-network benefit level and at no greater cost to the covered person than if the services were provided by an in-network provider.

The bill specifies that the in-network benefit level also applies to emergency services provided to a covered person by an out-of-network provider or at an out-of-network facility.

The bill also requires health care facilities, providers, and health insurers to provide disclosures to consumers about the potential effects of receiving nonemergency services from an out-of-network provider or emergency services at an out-of-network facility. The commissioner of insurance, the director of the division of professions and occupations, and the state board of health are directed to adopt rules detailing the disclosure requirements imposed on carriers, providers, and health facilities.

Additionally, if a covered person receives nonemergency services provided by an out-of-network provider at an in-network facility or emergency services provided by an out-of-network provider or at an out-of-network facility and pays the out-of-network provider or facility an amount in excess of the required cost-sharing amount, the out-of-network provider or facility must refund the overpayment and must pay interest on the overpayment if the provider or facility fails to timely refund the overpayment.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

Joint Budget Committee. The bill directs the department of health care policy and financing (department) to provide information to providers participating in the accountable care collaborative regarding:

• Cost and quality of medical services provided by hospitals and other medicaid providers; and
• Cost and quality of available pharmaceuticals prescribed by medicaid providers.

The department may make the same information available to other medicaid providers.

The department shall automatically review claims to identify and correct improper coding prior to payment and may obtain commercial technology to conduct the reviews.

The department is authorized to pursue cost-control strategies, value-based payments, and other approaches to reduce the rate of expenditure growth in the medicaid program. The department shall allow recipients, providers, and stakeholders an opportunity to comment and shall report to the joint budget committee prior to implementing any strategies or measures. The department is required to contract for an independent evaluation of any measures pursued and to provide reports to the joint budget committee on the evaluations.

Subject to federal approval, the department is also directed to design and implement an evidence-based hospital review program to ensure that utilization of hospital services is based on a recipient's need for care. Prior to implementing any changes, the department shall allow recipients, providers, and stakeholders an opportunity to comment and shall report to the joint budget committee. The department shall also report to the joint budget committee on the estimated savings from the changes.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill creates the crisis and suicide prevention training grant program (grant program) in the department of public health and environment (department). The purpose of the grant program is to provide financial assistance to schools in providing crisis and suicide prevention training to schools, with priority given to those schools that have previously not received such training. The grant program may authorize up to $400,000 in grants per year in varying amounts. The office of suicide prevention and the school safety resource center shall work collaboratively with the department to develop guidelines and criteria for the grant program. Grant recipients are required to report on their activities using grant money.

The crisis and suicide prevention training grant program fund is created and authorized to accept appropriations from the general assembly, as well as gifts, grants, and donations.

The bill makes conforming amendments that authorize the existing office of suicide prevention in statute.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note