Subject to federal authorization and federal financial participation, on or after July 1, 2024, medicaid reimbursement is available for therapy using equine movement when provided by a physical therapist, an occupational therapist, or a speech-language pathologist.

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

Current law requires a legislative committee of reference to hold a hearing on whether to continue or terminate the existence of each division, board, agency, or advisory committee that is subject to sunset review. The bill reestablishes the committee for sunrise and sunset review (committee) and requires this committee to hold the hearings instead.

The committee consists of 6 legislators, appointed as follows:

• 2 members appointed by the speaker of the house of representatives;
• 2 members appointed by the senate president;
• One member appointed by the house of representatives minority leader; and
• One member appointed by the senate minority leader.

The committee is also responsible for:

• Reviewing proposals to regulate a new professional or occupational group; and
• Reviewing each bill introduced during the legislative session that creates a new advisory committee, which includes committees, boards, and commissions.
  (Note: This summary applies to this bill as introduced.)

The act requires the director of the division of professions and occupations (director) in the department of regulatory agencies to complete, on or before June 1, 2023, an audit of the regulated professions and occupations and the regulation of various professions and occupations by regulators of a specific profession or occupation (regulator) to determine what barriers exist for licensing, certification, and registration of individuals with criminal history records and, on or before July 1, 2023, to report the findings to the general assembly.

The act limits the authority of a regulator to deny a license, certification, or registration based on an applicant's criminal history record on by requiring the hearing and mediation process established in current law. A regulator is required to document the grounds for the denial of the license, certification, or registration in writing to the applicant.

The act clarifies that a regulator may grant a conditional license, certification, or registration to an applicant with a criminal history record consistent with the process established in current law.

The director is required to compile de-identified information regarding the reasons why a license, certification, or registration was denied and make this information available to the public on the division's website.

The act requires state and local agencies responsible for issuing occupational or professional credentials (occupational agency), before making a final determination that an applicant's criminal conviction disqualifies the applicant from receiving a license, certification, permit, or registration, to provide a written notice to the applicant specifying the reason for the disqualification and the right of the applicant to submit additional evidence for the occupational agency to consider before making a final determination. A final determination to disqualify an applicant based on a criminal conviction must be issued in writing and include notice of the applicant's right to appeal the determination and the earliest date on which the applicant may reapply.

The act appropriates $11,036 from the division of professions and occupations cash fund to the department of regulatory agencies for use by the division of professions and occupations.

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

For income tax years beginning on or after January 1, 2023, but before January 1, 2030, the bill creates an income tax credit (tax credit) for any employer that:

• Creates a clean commuting plan to implement strategies to increase the use of alternative transportation options and reduce the number of measurable vehicle miles driven by its employees in single-occupancy vehicles when commuting to and from their work site (clean commuting plan) for the purpose of reducing automobile-related air pollution, traffic congestion, and transportation costs, particularly for essential workers and workers earning under $40,000 per year;
• Conducts an employer commuter survey to determine how its employees commute to and from their work site; and
• Offers 2 or more alternative transportation options to some or all of its employees in furtherance of the employer's clean commuting plan.

The amount of the tax credit is 50% of the amount spent by the employer to provide alternative transportation options to some or all of its employees.

In addition, the bill requires the executive director of the department of transportation (director), in coordination with the Colorado energy office and metropolitan planning organizations, to create an annual commuter survey for employers to use to determine how their employees commute to and from their work site. The director and the Colorado energy office are required to determine the content of the commuter survey and the form and manner in which the commuter survey will be completed and returned to the department of transportation.

Beginning in specified calendar years, in an effort to reduce the number of employees who commute to and from their work site in a single-occupancy vehicle, employers with over 100 employees are required to:

• Annually conduct a commuter survey of its employees and submit the completed commuter surveys to the department of transportation by April 30 of the year in which the survey was conducted;
• Offer its employees qualified transportation fringe benefits allowed pursuant to federal law;
• Offer its employees commuter choice information in electronic or hard copy format and update the information every 6 months; and
• Offer a cash allowance in lieu of a parking space under certain circumstances.

The bill requires that any private sector employer that wishes to claim the tax credit participate in the employer commuter survey and submit the results of the survey to the department by April 30 of the year in which the survey is conducted, even if the employer's participation in the commuter survey is not otherwise required.

For the 2023-24 state fiscal year, and for each state fiscal year thereafter through the 2029-30 state fiscal year, of the money allocated to the transportation commission for state multimodal projects from the multimodal transportation and mitigation options fund, the transportation commission is required to allocate $250,000 to each of the transportation management associations and transportation management organizations operating in a nonattainment area for the purposes of assisting employers in creating a clean commuting plan and complying with the requirements of the bill.

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

The bill prohibits an employer from taking adverse action against an employee, including an applicant for employment, who engages in the use of:

• Medical marijuana on the premises of the employer during working hours; or
• Retail or medical marijuana off the premises of the employer during nonworking hours.

An employer is permitted to impose restrictions on employee use of medical or retail marijuana under specified circumstances.

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

The bill grants a supervising health-care provider or health-care facility the authority to identify and select a temporary proxy decision-maker (temporary proxy) to make emergency medical treatment decisions for an adult patient who has been determined, by the patient's attending physician, to lack decisional capacity to make informed consent to or refusal of medical treatments. The temporary proxy is to be utilized only in emergency circumstances when an otherwise legally authorized proxy decision-maker cannot be located. The bill outlines guidelines for selecting the temporary proxy and when the authority of the temporary proxy terminates.
(Note: This summary applies to this bill as introduced.)

The act implements the recommendations of the department of regulatory agencies (department), as specified in the department's sunset review of the "Speech-language Pathology Practice Act", as follows:

• Continues the practice act for 11 years, until September 1, 2033;
• Allows the director of the division of professions and occupations in the department to extend a provisional certification beyond 24 months; and
• Specifies that insurance fraud and abuse are grounds for discipline.
  (Note: This summary applies to this bill as enacted.)

The act implements the recommendations of the department of regulatory agencies' (department) sunset review and report on the licensing of massage therapists by:

• Continuing the licensing requirements for 9 years, until September 1, 2031;
• Granting sole discretion to the director of the division of professions and occupations to approve the licensure examination for massage therapists by repealing the reference to national licensure examinations as an option for massage therapist applicants to take in lieu of another examination approved by the director; and
• Adding, as grounds for disciplining a massage therapist, engaging in fraud, misrepresentation, deception, or cheating in taking or furnishing the results of a required examination or having the person's score on the examination invalidated by the testing provider because the person was determined to have cheated or engaged in fraud, misrepresentation, or deception in taking the examination.
  (Note: This summary applies to this bill as enacted.)

The act creates the mandatory reporter task force (task force). The purpose of the task force is to analyze best practices and recommend changes to training requirements and reporting procedures for people required by law to report child abuse or neglect.

The task force shall analyze issues, including, but not limited to:

• The effectiveness of mandatory reporting and its relationship with systemic issues, including the disproportionate impact of mandatory reporting on under-resourced communities, communities of color, and persons with disabilities;
• The definition of "immediately" and how reporting time frames affect mandatory reporters from different professions;
• Reporting time frames for mandatory reporters who are creating a safety plan for victims of domestic violence, sexual assault, or stalking to ensure the safety of the victim and the victim's family members while creating the safety plan;
• Medical child abuse and the process to report medical child abuse;
• Whether mandatory reporters should report incidents observed outside of a mandatory reporter's professional capacity;
• A reporting process for 2 or more mandatory reporters to report child abuse or neglect when they have joint knowledge or joint reasonable cause to make a report of child abuse or neglect;
• Whether institutions that employ mandatory reporters may develop procedures to assist mandatory reporters in meeting reporting requirements; and
• The benefits of an electronic reporting platform for the state.

The task force is required to analyze national best practices and consult with additional stakeholders as necessary to finalize its findings and recommendations. The task force may propose clarifications to the law to help implement its recommendations. The task force operates for 2 years. The task force shall submit a final report on its findings and recommendations on January 1, 2025, to the house of representatives public and behavioral health and human services committee and the senate health and human services committee, or their successor committees; the governor; and the department of human services.

The act appropriates $97,500 from the general fund to the judicial department for use by the office of the child protection ombudsman for program costs.

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

The act makes changes to the acupuncturists' practice act, including the changes recommended by the department of regulatory agencies' (department) sunset review and report on the licensing of acupuncturists, by:

• Continuing the licensing requirements for 11 years, until September 1, 2033;
• Authorizing the director of the division of professions and occupations (director) in the department to impose administrative fines as a disciplinary action;
• Requiring final actions of the director to be appealed directly to the court of appeals;
• Modernizing the definition of "acupuncturist" so that it includes only persons licensed under the acupuncturists' practice act and modernizing the titles and designations protected for use by licensed acupuncturists;
• Authorizing an acupuncturist to supervise unlicensed acupuncture aides in the performance of specific tasks as determined by rule of the director and directing the director to adopt rules specifying the tasks that may be performed by acupuncture aides, the training and supervision required, and the number of acupuncture aides that an acupuncturist may supervise;
• Replacing the term "oriental", in references to the methods and concepts of acupuncture, with more modern terminology;
• Requiring each acupuncturist to devise a plan for the safe storage, security, and disposal of patient records;
• Requiring each applicant for acupuncturist licensure to pass an examination approved by the director;
• Repealing the reference to the specific national organization that establishes standards for auricular acudetox training and allowing the director to designate a national organization;
• Making it a unlawful act for a person to use the term "medical acupuncturist" or other similar term unless the person is practicing in accordance with medical practice act;
• Updating the grounds for discipline of an acupuncturist relating to the use or abuse of alcohol, habit-forming drugs, and controlled substances to align with other regulated professions;
• Adding as a grounds for discipline the failure to respond to a complaint filed against the acupuncturist in an honest, responsive, and timely manner; and
• Authorizing the director to adopt rules to establish the appropriate use of telehealth to provide acupuncture services.
  (Note: This summary applies to this bill as enacted.)

The act amends the "Workers' Compensation Act of Colorado" by:

• Creating a process for a claimant to receive advance payment for mileage expenses for travel that is reasonably necessary and related to obtaining compensable treatment, supplies, or services and that requires round-trip travel greater than 100 miles;
• Specifying how to determine the benefit amount for medical impairment when the amount payable using the schedule of injuries would exceed the amount payable for nonscheduled injuries;
• Increasing the maximum benefit payable for funeral and burial expenses;
• Requiring reporting by employers to the division of workers' compensation (division) in the department of labor and employment of active medical treatments necessary to cure and relieve an injury lasting for a period of more than 180 calendar days after the date of the injury; and
• Repealing the special funds board and moving the duties of the board to the director of the division.
  (Note: This summary applies to this bill as enacted.)

The act clarifies provisions in the "Workers' Compensation Act of Colorado" (workers' compensation act) relating to the release and disclosure of mental health records pertaining to an injured employee making a claim under the workers' compensation act (claimant).

The act:

• Defines "mental health records" psychological or psychiatric tests, including neuropsychological testing; other records prepared by or for a mental health provider; independent medical examination records, audio recordings, and reports that address psychological or psychiatric issues; division independent medical evaluation records and reports that address psychological or psychiatric issues; and records relating to the evaluation, diagnosis, or treatment of a substance use or abuse disorder;
• Requires a mental health provider to provide an insurer or employer, if self-insured, with mental health records, as necessary for payment, adjustment, and adjudication of claims involving psychological or psychiatric issues; to the employer, as necessary, to enable to employer to comply with applicable state and federal laws, rules, and regulations; and to the referring physician and any other relevant treating or evaluating providers;
• Prohibits the disclosure of mental health records to any person who is not reasonably necessary for the medical evaluation, adjustment, or adjudication of claims involving psychological or psychiatric issues, unless otherwise directed by order of the director of the division of workers' compensation (director) or an administrative law judge;
• Permits an insurer to release information from a claimant's mental health records to the claimant's employer concerning work restrictions and information necessary for the adjustment or adjudication of the claim, but prohibits the disclosure of the claimant's actual mental health records to third parties that do not need the information; and
• For a self-insured employer:
• Requires the employer to keep a claimant's mental health records separate from personnel files;
• Limits disclosure of the claimant's mental health records to a supervisor or manager to only information from the mental health records pertaining to work restrictions placed on the claimant; and
• Prohibits disclosure of the claimant's mental health records to any third party and redisclosure by the third party to any person who is not directly involved in adjusting or adjudicating claims involving psychological or psychiatric issues, unless the disclosure is otherwise ordered by the director or an administrative law judge.

The act authorizes the director to promulgate rules necessary for the implementation of the act.

The act requires a person providing mental health services under the workers' compensation act to be a licensed mental health provider.

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

The act requires the division of insurance (division), on or before November 1, 2022, to retain by contract one or more entities that have experience in actuarial reviews, health-care policy, and health equity (contractors) for the purpose of performing actuarial reviews of legislative proposals that may impose a new health benefit coverage mandate on health benefit plans or reduce or eliminate coverage mandated under health benefit plans. The contractors, under the direction of the division, shall conduct an actuarial review of up to 6 such legislative proposals for each regular legislative session as follows:

• Up to 2 members of the majority party of the house of representatives may submit a request for an actuarial review;
• One member of the minority party of the house of representatives may submit up to one request for an actuarial review;
• Up to two members of the majority party of the senate may submit a request for an actuarial review; and
• One member of the minority party of the senate may submit up to one request for an actuarial review.

Each actuarial review performed by the contractors must consider the predicted effects of the legislative proposal during the 5 and 10 years immediately following the effective date of the proposed legislation, or during another time period following the effective date if such consideration is more actuarially feasible, including specifically described considerations.

A request for an actuarial review and the final report resulting from such a request must be treated as confidential except by the member of the general assembly who made the request until the legislative proposal that is the subject of the actuarial review is introduced in the regular legislative session following the submission of the request for the actuarial review or, if no such legislative proposal is introduced, until after the end of the legislative session following the submission of the request.

The division may not engage any contractor to perform an actuarial review unless the division determines that there are adequate resources available within existing appropriations to compensate the contractor for the actuarial review.

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 include a statement that a report has been prepared by the contractors for the legislative proposal and an indication of how the report may be obtained in its entirety.

The act is repealed, effective November 1, 2027.

For the 2022-23 state fiscal year, the act appropriates $100,000 from the division of insurance cash fund to the department of regulatory agencies for use by the division of insurance as follows:

• $50,000 for personal services; and
• $50,000 for operating expenses.
  (Note: This summary applies to this bill as enacted.)

The act requires the administrator (administrator) of the all-payer health claims database (database) to create a tool to facilitate the review of certain health claims reimbursement data that are included in the database. The tool must include 2018 health claims reimbursement data as the first year of available data.

The act includes minimum requirements for the design of the tool, including how the information will be displayed and searchable by users of the tool.

The act requires the administrator, subject to available appropriations, to update the tool at least annually.

For the 2022-23 state fiscal year, to implement the act, the act appropriates $155,250 from the general fund to the department of health care policy and financing for use by the executive director's office for the database.

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

The act directs the agency that regulates an occupation to dismiss an anonymous complaint that is lodged against the holder of an occupational license, certification, or registration if the complaint is based on words said or actions taken while engaged in official duties as:

• An elected official of Colorado or a political subdivision of Colorado; or
• A member of a board or commission of Colorado or a political subdivision of Colorado.

If the same type of complaint is submitted, but not anonymously, the agency is authorized to dismiss the complaint. The subject of the complaint need not respond or provide evidence for the complaint to be dismissed.

An exception is made for words said to or actions committed for a specific person when the license, certificate, or registration holder is speaking or acting as a member of the regulated occupation.

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

With regard to health-care services, section 1 of starting January 1, 2024, the bill requires a health insurance carrier (carrier) or private utilization review organization (organization) , as applicable, to offer a qualified provider with at least a 95% approval rate of prior authorization requests over the prior 12 months an alternative to prior authorization requirements, including an exemption from the requirements or incentive awards or other innovative programs to reward provider compliance designed by the carrier or organization that reduce patient wait times or administrative burdens to receiving the requested health-care service . To be a "qualified provider", a provider must:

• Be, and have been continuously for at least the immediately preceding 12 months, a participating provider; and
• Have, over the immediately preceding 12 months: At least a 95% approval rate on prior authorization requests submitted for the same health-care service; and submitted at least 24 prior authorization requests for the same health-care service.

A carrier or organization is required to inform a provider of the provider's status as a qualified provider and, at least annually, to reevaluate whether a provider satisfies the requirements of a qualified provider.With regard to drug benefits, section 2 requires a carrier or pharmacy benefit management firm, as applicable, to offer the same types of alternatives to prior authorization requirements to a provider who has at least a 95% approval rate of prior authorization requests over the prior 12 months.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)

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

The bill creates the Colorado multidisciplinary geriatric provider pipeline program (program) in the university of Colorado Anschutz medical campus. The program coordinates and expands geriatric training opportunities for clinical graduate students enrolled in participating institutions of higher education who study in the health-care fields of medicine, medicine with a focus on training to be a physician assistant, dentistry, pharmacy, nursing, psychology, and social work.

The bill creates the geriatric training executive advisory committee (committee) to ensure that the training for the program is consistent and collaborative across the health-care fields of study. The committee is required to:

• Set the program's standards for training and delivery of medical care to the most frail and medically complex, costly, and compromised older Coloradans;
• Collaborate with participating institutions of higher education across Colorado to select clinical graduate students who have an interest in geriatric care to participate in the program;
• Analyze data collected by the program;
• Build relationships, collaborate, and create a multidisciplinary team that provides opportunities for clinicians to work together in teams to better understand the roles of each discipline and better place clinical graduate students for experiential training opportunities; and
• Coordinate with graduates of the program for opportunities to become trainers to future clinical graduate students once practicing in the graduate's field of study.
  (Note: This summary applies to this bill as introduced.)

The act requires supplemental health-care staffing agencies (staffing agencies) to complete initial and annual certification with the division of unemployment insurance in the department of labor and employment (department) prior to operating the staffing agency. A staffing agency that fails to comply with the certification requirements commits a civil infraction and may be assessed fines by the department. On or before September 1 of each year, the department of public health and environment and the department of health care policy and financing shall provide the department with a list of all known names of and the contact information for staffing agencies operating in the state.

No later than October 1, 2022, each staffing agency shall begin maintaining detailed data necessary for required reporting to the department that includes, in part:

• A detailed listing of the average amount charged during each quarter of the reporting period to a health-care facility for each category of health-care worker providing services to the health-care facility; and
• A detailed listing of the average amount paid during each quarter of the reporting period to health-care workers for their services for each category of health-care worker providing services.

Commencing April 30, 2023, each staffing agency shall submit biannual reports to the department with the required data. The act includes fines for staffing agencies that submit late or noncompliant biannual reports.

The department shall provide copies of the staffing agencies' biannual reports to the department of public health and environment and to the department of health care policy and financing for purposes of analyzing the information provided by the staffing agencies and determining the need for regulation of staffing agencies.

For the 2022-23 state fiscal year:

• $427,591 is appropriated from the general fund to the department of labor and employment for use by the division of labor standards and statistics to implement the act. The appropriation is based on an assumption that the division will require an additional 2.0 FTE;
• $39,358 is appropriated to the department of public health and environment for use by the health facilities and emergency medical services division for administration and operations and to purchase information technology services. The appropriation is based on an assumption that the division will require an additional 0.3 FTE.
• $15,545 is appropriated to the office of the governor for use by the office of information technology to provide information technology services to the department of public health and environment. This appropriation is from reappropriated funds received from the department of public health and environment.
  (Note: This summary applies to this bill as enacted.)