For health coverage plans issued or renewed on or after January 1, 2024, the act requires a health insurance carrier (carrier) that provides coverage for prescription auto-injectors (injectors) to cap the total amount that a covered person is required to pay for injectors at an amount not to exceed $60 for a 2-pack of the injectors. The act allows coverage for injectors to be offered through a high deductible plan that qualifies for a health savings account, and a carrier may apply deductible amounts if the coverage is not considered by the United States department of the treasury to be preventive or to have an acceptable deductible amount.

Effective January 1, 2024, the act creates an epinephrine auto-injector affordability program (program) to provide low-cost injectors to eligible individuals. By January 1, 2024, each manufacturer must establish procedures and make injectors available as prescribed in the act to eligible individuals who hold a valid prescription for injectors.

The act establishes eligibility requirements that residents of Colorado must meet in order to be eligible for the program.

The act requires the division of insurance in the department of regulatory agencies (division) to create an application for the program for use by an individual seeking injectors through the program and requires the division and the department of health care policy and financing to make the application available on their websites and to promote the availability of the program.

A pharmacy that dispenses injectors is authorized to collect a copayment not to exceed $60 from the individual to cover the pharmacy's costs of processing and dispensing a 2-pack of injectors.

A manufacturer of injectors:

• Is required to make injectors available to individuals through the program;
• May be required to reimburse the dispensing pharmacy in an amount that the pharmacy paid for the number of injectors dispensed through the program or send the pharmacy a replacement supply of the same number of injectors;
• Is required to develop a process for a pharmacy to submit electronic reimbursement claims.

If a manufacturer fails to comply with the requirements of the act, the manufacturer engages in a deceptive trade practice and is subject to a $10,000 fine for each month of noncompliance.

The act appropriates $58,291 from the division of insurance cash fund to the department of regulatory agencies for use by the division of insurance to implement the act.

APPROVED by Governor June 7, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

The bill prohibits:

• Requiring a COVID-19 vaccine for a minor in Colorado;
• Administering a COVID-19 vaccine to a child without the informed consent of the child's parent or legal guardian;
• Administering a COVID-19 vaccine to an emancipated minor without the informed consent of the emancipated minor;
• A school from dismissing, suspending, refusing admission, or refusing to permit participation in an extracurricular activity to a student who has claimed a COVID-19 immunization exemption;
• A public or private entity from discriminating against a minor participating in a nonpublic home-based educational program based on whether the minor received the COVID-19 vaccine;
• A public entity from levying a fee, fine, or tax, or a private entity from levying a fine or fee, on a minor or their parent or legal guardian based on whether the minor received the COVID-19 vaccine; or
• A public or private entity from discriminating against a minor based on whether the minor received a COVID-19 vaccine.

The bill allows an aggrieved person to file a civil action and waives sovereign immunity if the violator is a public entity.

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

Fiscal Note

The act requires 1 of the 7 members of the state board of psychologist examiners (board) to be a prescribing psychologist.

The act allows a licensed psychologist to prescribe and administer psychotropic medications if the licensed psychologist holds a prescription certificate issued by the board.

A licensed psychologist may apply to the board for a prescription certificate and must include in the application satisfactory evidence that the applicant:

• Has completed a doctoral program in psychology;
• Has completed a master of science in a clinical psychopharmacological program with specified areas of core instruction;
• Has passed the psychopharmacology examination for psychologists;
• Has completed a supervised and relevant clinical experience approved by the board;
• Has successfully undergone a process of independent peer review; and
• Maintains the required malpractice insurance.

A licensed psychologist with a prescription certificate (prescribing psychologist) is authorized to prescribe and administer psychotropic medications if the prescribing psychologist:

• Maintains the required malpractice insurance;
• Completes at least 40 hours of continuing education every 2 years; and
• Maintains a collaborative relationship with the health-care provider who oversees the client's general medical care.

The board is authorized to promulgate rules to:

• Implement procedures for obtaining a prescription certificate; and
• Establish grounds for denial, suspension, and revocation of the certificates.

The Colorado medical board is required to review complaints regarding violations of the act and make recommendations to the board regarding disciplinary action.

The act requires a prescribing psychologist to disclose to each patient that the psychologist is not a licensed physician.

The act requires a prescribing psychologist to file with the board all individual federal drug enforcement administration registrations and numbers. The board and the Colorado medical board are required to maintain current records of every psychologist with prescriptive authority, including registrations and numbers.

The department of regulatory agencies (department) is required to annually collect information regarding prescribing psychologists, to compile the information, and to share the information with the office in the department responsible for conducting sunset reviews for inclusion in each scheduled sunset review concerning the regulation of mental health professionals.

APPROVED by Governor March 3, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The bill requires all individual and group health benefit plans to provide coverage for biomarker testing if the testing is supported by medical and scientific evidence. Biomarker testing is defined as an analysis of a patient's tissue, blood, or other biospecimen for the presence of an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention.

The bill requires the commissioner of insurance to implement biomarker testing coverage for all individual and group health benefit plans issued or renewed on or after January 1, 2025.

Biomarker testing is subject to the health benefit plan's annual deductibles, copayment, or coinsurance but is not subject to any annual or lifetime maximum benefit limit.

If a carrier requires prior authorization for biomarker testing, the bill requires the carrier to use an expedited prior authorization process.

Subject to federal authorization and federal financial participation, beginning July 1, 2024, the bill includes coverage for biomarker testing as part of the state medical assistance program if the testing is supported by medical and scientific evidence.

Under the state medical assistance program, the bill requires an expedited utilization review and prior authorization process, as well as an appeal process if biomarker testing is denied.

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

Fiscal Note

Effective January 1, 2025, with respect to step-therapy protocols (protocols) for health insurance, section 1 of the act defines "serious mental illness" and prohibits the protocols from requiring a person to try more than one prescription drug prior to receiving coverage for the drug prescribed by the person's health-care provider. If certain conditions are met and attested to by the person's health-care provider, the carrier, private utilization review organization, or pharmacy benefit manager must cover the drug prescribed by the person's health-care provider without requiring compliance with protocols.

Section 2 of the act defines "serious mental illness" for purposes of the "Colorado Medical Assistance Act" in the same manner as the term is defined for commercial health insurance. The act requires the medical services board to require a review for coverage of a new drug approved by the federal food and drug administration for a serious mental illness within 90 days after the drug is approved.

The act appropriates $53,117 to the department of health care policy and financing (department) from the general fund for use by the executive director's office to implement the act, with the assumption that the department will receive an equal amount of federal funds to implement the act.

APPROVED by Governor June 6, 2023

PORTIONS EFFECTIVE August 7, 2023

PORTIONS EFFECTIVE January 1, 2025

NOTE: This act was passed without a safety clause.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act requires the department of health care policy and financing (state department) review and determine if an exception to step therapy is granted if the prescribing provider submits a prior authorization request with justification and supporting clinical documentation for treatment of a serious or complex medical condition. The act requires the state department to provide a response to a prior authorization request for a step-therapy exception within 24 hours after receipt of the request.

If a prior authorization request for a step-therapy exception is incomplete or if additional clinically relevant information is required, the act requires the state department to notify the prescribing provider within 24 hours after the submission of the request. If the state department does not receive a response within 72 hours after the state department's request for additional information, the prior authorization is denied. If the prior authorization request is denied, the act requires the state department to inform the recipient in writing that the recipient has a right to appeal the determination.

The act requires the state department to authorize coverage for the prescription drug prescribed by the recipient's prescribing provider if the prior authorization request for a step-therapy exception request is granted.

The act requires the state department to make the prior authorization requirements for coverage of prescription drugs and a description of the step-therapy exemption process available on the state department's website.

The act appropriates $56,250 to the state department from the general fund.

APPROVED by Governor May 1, 2023

EFFECTIVE May 1, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

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

The act requires an outlet dispensing prescription drugs through a system to:

• Register the system with the state board of pharmacy (board);
• Require a pharmacist to perform all clinical services as part of the dispensing process;
• Ensure that the system clearly displays the system's registration number and contact information;
• Locate each system at the same location as the outlet unless other criteria is met;
• Ensure confidentiality of health information; and
• Ensure that the system is accessible to persons with disabilities.

An outlet may operate a system in the same or different location than the outlet if it is:

• Under the supervision and control of the outlet;
• Installed in a place and manner where it cannot be removed or accessed without authorization; and
• Located in a secure location.

The act also requires each outlet operating a system:

• To develop, implement, and maintain written policies and procedures to ensure the proper, safe, and secure functioning of the system;
• Inside the premises of a retail business to only operate during the hours that the outlet is closed; and
• To make all transaction information readily available for review and inspection by the board.

APPROVED by Governor May 1, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

For a contract between a pharmacy benefit manager (PBM) or a health insurance carrier (carrier) and a certificate holder or policyholder, the act requires that the amount charged by the PBM or carrier to the certificate holder or policyholder for a prescription drug be equal to or less than the amount paid by the PBM or carrier to the contracted pharmacy for the drug.

For group health benefit plans in effect during the 2025 calendar year and each calendar year thereafter, the act creates transparency requirements for PBMs and carriers regarding prescription drug benefits and grants audit authority to the commissioner of insurance (commissioner) for fully insured plans to ensure compliance with the requirements.

The commissioner is authorized to promulgate rules to implement the act.

A violation of the requirements of the act is a deceptive trade practice in the business of insurance, with regard to fully insured plans.

For contracts between a PBM and the department of health care policy and financing (state department) or one of its affiliated managed care organizations offering a prescription benefit plan that is issued on or after January 1, 2025, the act requires the amount charged by the PBM to the state department or managed care organization for a prescription drug dispensed to an enrollee in the Colorado medical assistance program to be equal to or less than the amount paid by the PBM to a pharmacy for the prescription drug dispensed to the enrollee. The act directs the medical services board to adopt rules to implement and ensure compliance with this requirement.

APPROVED by Governor May 10, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The bill requires the Colorado school of public health to analyze model legislation for implementing a publicly financed and privately delivered universal health-care payment system for Colorado that directly compensates providers. The Colorado school of public health must submit a report detailing its findings from the analysis to the general assembly by December 1, 2023. October 1, 2024.

The bill also creates the statewide health-care analysis task force consisting of members appointed by the general assembly and the governor, as well as executive directors of specified state departments, the commissioner of insurance, and the chief executive officer of the Colorado health benefit exchange or any designees of the executive directors, the commissioner, and the chief executive officer. The task force is created for the purpose of advising the Colorado school of public health during the analysis.

The bill also exempts the analysis conducted by the Colorado school of public health from a financial aid funding requirement.

(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.)

Fiscal Note

On and after July 1, 2024, the act prohibits a health-care provider (provider), which is an individual provider or a health facility, or a health system, which is a corporation or organization that owns, contains, or operates 3 or more hospitals, from charging, billing, or collecting a facility fee directly from a patient that is not covered by the patient's insurance for mandatory coverage for preventive health-care services that are provided in an outpatient setting. The act defines "facility fee" as any fee that a hospital or health system charges or bills for outpatient services that is intended to compensate the hospital or health system for its operational expenses and that is separate and distinct from a professional fee charged or billed by a provider for professional medical services. The limitation on charging, billing, or collecting a facility fee does not apply to a critical access hospital, a sole community hospital in a rural or frontier area, a community clinic affiliated with a sole community hospital in a rural or frontier area, or a hospital established by the Denver health and hospital authority.

The act:

• Requires a provider that charges a facility fee to provide notice to a patient that the provider charges the fee and to use a standardized bill that includes itemized charges identifying the facility fee, as well as other information;
• Requires a health facility that is newly affiliated with or owned by a hospital or health system on or after July 1, 2024, to provide written notice to patients of the health facility during the previous 12 months concerning the change in ownership and that the health facility may now charge a facility fee, and prohibits the collection of a facility fee until at least 30 days after the notice is sent; and
• Makes it a deceptive trade practice to charge, bill, or collect a facility fee when doing so is prohibited.

The act creates a steering committee (steering committee) in the department of health care policy and financing (department) to facilitate the development of a preliminary report by August 1, 2024, and a final report by October 1, 2024, detailing the impact of outpatient facility fees on the Colorado health-care system, including the impact on consumers, employers, and providers.

The steering committee consists of 7 members appointed by the governor with relevant expertise in health-care billing and payment policy, including, among others, members representing consumers, payers, and providers. The act lists specific data and information to be collected, identified, evaluated, and analyzed, including:

• Data from:
• The all-payer health-claims database;
• Hospital and health systems;
• The department, the division of insurance, and commercial payers; and
• Independent health-care providers that are not affiliated with or owned by a hospital or health system evaluated in the report;
• The impact of facility fees and payer coverage policies on the Colorado healthcare affordability and sustainability enterprise, the medicaid expansion, uncompensated care, and undercompensated care;
• The impact of facility fees on access to care, integrated care systems, health equity, and the health-care workforce; and
• A description of the way in which providers may be paid or reimbursed by payers for outpatient health-care services.

To the extent feasible, data must be sourced from 2014 through 2022, as determined by the steering committee and any third-party contractors, and disaggregated, as described in the act. The steering committee shall seek to exhaust existing data sources before making additional requests and shall minimize the number of data requests.

To implement the act, for the 2023-24 state fiscal year, the act:

• Increases general fund appropriations to the department in the 2023 long bill by $18,326 for personal services and $337 for operating expenses;
• Decreases anticipated federal funds received by the department by $18,663; and
• Appropriates $516,950 from the general fund to the department for general professional services and special projects.

APPROVED by Governor May 30, 2023

EFFECTIVE May 30, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act requires the department of public health and environment (department), by August 1, 2024, and in consultation with stakeholders, to identify reproductive health-care services, LGBTQ health-care services, and end-of-life health-care services (identified health-care services) that, for nonmedical reasons, are not generally available at a specified health-care facility (covered entity) or that are subject to significant restriction at a covered entity. The department shall develop a simple service availability form (form) to be filled out by each covered entity for the purpose of conveying to patients and to the public information about identified health-care services that are subject to denial of care at the covered entity.

The act defines:

• "Covered entity" as a hospital, community clinic, maternity hospital, freestanding emergency department, or rehabilitation hospital, but "covered entity" does not include a health-care professional or a hospital, community clinic, or other facility owned or operated by the state;
• "Denial of care", in part, as refusal to provide health-care services for nonmedical reasons;
• "Nonmedical reasons", in part, as nonclinical criteria, rules, or policies that restrict health-care professionals at a covered entity from providing health-care services that the health-care professional is authorized to provide and that the covered is licensed to provide; and
• Reproductive health-care services, LGBTQ health-care services, and end-of-life health-care services.

The act includes requirements for the content and format of the form and requires each covered entity to submit a completed form to the department and to update the form within 30-days after a change in the availability of the identified health-care services. Beginning on or before October 1, 2024, the department shall maintain on its public-facing website a list of covered entities and the form for the covered entity. The department shall review and update the service availability form at least biennially in consultation with stakeholders.

A covered entity shall provide patients with the current service availability form during scheduling for identified health-care services and at the time federal privacy laws are provided to patients before health-care services are initiated, and shall maintain a record of the patient's receipt of the form. A covered entity that fails to comply with the act is subject to a fine not exceeding $1,000 for each day the covered entity is in violation of the act.

The state board of health shall adopt rules to implement the act.

For the 2023-24 state fiscal year, the act appropriates $64,627 from the general fund to the department for use by the health facilities and emergency medical services division to implement the act.

APPROVED by Governor May 10, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act makes changes to the "Colorado Standardized Health Benefit Plan Act" to require the Colorado health benefit exchange (exchange), in collaboration with the commissioner of insurance (commissioner), and after a stakeholder engagement process with consumers, producers, and insurance carriers (carriers), to develop a format for displaying the standardized health benefit plans (standardized plans) on the exchange.

The act requires carriers to file with the commissioner insurance rates for the standardized plans that comply with the premium rates specified in law for the standardized plans. The act allows the commissioner to establish uniform limits on carriers' administrative costs and profits for standardized plans.

Under the act, if a carrier is unable to offer the standardized plan at the required premium rates:

• The carrier must provide relevant information concerning the steps the carrier will take to meet the requirements, along with supporting documentation; and
• The division of insurance may hold a public hearing, pursuant to notice by the commissioner and in a manner specified by rules promulgated by the commissioner, prior to the approval of the carrier's final rates.

APPROVED by Governor May 10, 2023

EFFECTIVE May 10, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

In 2021, the general assembly enacted Senate Bill 21-175, concerning the Colorado prescription drug affordability review board, which created the prescription drug affordability review board (board) in the division of insurance (division) and an affordability review process whereby the board may review costs associated with, and establish upper payment limits for, certain prescription drugs. The 2023 act makes certain changes concerning the board.

Section 1 clarifies which actions taken by the board are "board activities", as this term is used elsewhere. Section 2 states that staff members and contractors of the division must disclose any conflict of interest related to a prescription drug for which the board is conducting an affordability review or establishing an upper payment limit. Such a disclosure remains confidential if it relates to a personal association. The board, upon review of a disclosure, may direct the staff member or contractor of the division to recuse themselves.

Section 3 allows the chair of the board to cancel or postpone a board meeting for good cause. Section 4 makes certain changes to the procedure by which the board identifies prescription drugs that may be subjected to an affordability review, which changes take effect January 1, 2025, and requires the board to report on its public web page certain information regarding its considerations.

Under current law, the board may not establish an upper payment limit for more than 12 prescription drugs per calendar year for 3 years, beginning April 1, 2022. Section 5 lets the board establish an upper payment limit for up to 18 prescription drugs per calendar year if the board determines that there is a need and has sufficient staff support.

Section 6 establishes that an upper payment limit for a prescription drug is not a final agency action that is subject to judicial review until the board promulgates a rule establishing the upper payment limit. Sections 6 and 7 remove certain language concerning a process for appealing decisions of the board.

Sections 8 and 9 extend the repeal and associated sunset review of the board from September 1, 2026, to September 1, 2031.

Section 10 establishes that a denial of a request for benefits for a prescription drug that is unavailable in the state because a manufacturer has withdrawn the prescription drug from sale or distribution within the state is an "adverse determination" for which an individual may request an independent external review.

APPROVED by Governor May 10, 2023

PORTIONS EFFECTIVE August 7, 2023

PORTIONS EFFECTIVE January 1, 2025

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die; except that, section 4 of the act takes effect January 1, 2025.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

Current law requires the department of health care policy and financing (state department) to annually prepare a written hospital expenditure report. The act changes the name of the report to the hospital transparency report (transparency report).

The act adds specified information that each hospital shall report to the state department for the transparency report.

No later than July 1, 2024, the act requires each hospital to provide specified information to the state department for previous fiscal years.

The act authorizes the state department to impose certain enforcement mechanisms against a hospital that does not provide all of the information required to be reported to the state department.

Current law requires the state department to submit the transparency report to the house of representatives public and behavioral health and human services committee. The act requires the transparency report to also be submitted to the house of representatives health and insurance committee.

The act requires the state department to report on the transparency report during the state department's "SMART Act" hearing.

Beginning July 1, 2024, the act requires any patient bill to follow industry standard billing practices, including, at a minimum, the date of service, the patient's name, the provider's name, a description of the services provided, and the charges for each service.

The act appropriates $75,167 to the state department from the healthcare affordability and sustainability cash fund to implement the act. It is anticipated that the state department will receive an additional $75,165 in federal funds for the implementation of the act.

APPROVED by Governor June 2, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

Under current law, pharmacy benefit managers (PBMs) are required to perform certain acts and are prohibited from engaging in certain acts. Specifically, PBMs are prohibited from:

• Requiring patients to obtain their prescription drugs through mail order;
• Charging pharmacies fees to adjudicate claims;
• Requiring pharmacies to obtain accreditations or certifications that are different than what the PBM requires of its affiliated pharmacies;
• Retroactively reducing a payment made to a pharmacy on a drug claim after the point of sale or reimbursing a pharmacy in an amount that is less than the amount reimbursed to its own affiliated pharmacy for the same pharmacy service;
• Modifying the prescription drug formulary under a health benefit plan during the plan year;
• With regard to audits, using specified techniques in calculating a recoupment or penalty, subjecting a pharmacy to recoupment when a clerical error is discovered, and requiring pharmacies to be audited more than once a year;
• Prohibiting a pharmacy or pharmacist from, or penalizing a pharmacy or pharmacist for, providing information to patients about more affordable, therapeutically equivalent alternatives to a prescribed drug; or
• Requiring a pharmacy or pharmacist to charge or collect a copayment from an insured patient that exceeds the total charge submitted by the pharmacy for the prescription drug.

Additionally, PBMs are required to:

• Provide pharmacies 7 days' written notice before an audit, conduct an audit by or in consultation with a pharmacist, allow the pharmacy to supplement claims documentation, and establish an appeals process;
• Provide an insured individual, the insured's health-care provider, or a third party acting on behalf of the insured or provider with up-to-date and real-time cost, benefit, and coverage information under the terms of the insured's health benefit plan; and
• Provide contracted pharmacies with the list of sources the PBM used in determining maximum allowable cost pricing, update the information every 7 days, allow pharmacies the ability to readily review the information, follow specified requirements when placing a drug on the maximum allowable cost list, and establish an appeals process to resolve disputes.

The act specifies that the commissioner of insurance (commissioner) has the power to enforce these prohibitions and requirements and impose penalties on PBMs for failing to comply with these prohibitions and requirements. The commissioner is also authorized to adopt rules as necessary to implement and enforce these prohibitions and requirements.

Additionally, the act requires PBMs to register with and pay a registration fee to the commissioner and authorizes the commissioner to deny, suspend, revoke, or refuse to issue, continue, or renew a PBM registration or to issue a cease-and-desist order if the commissioner finds that a PBM has engaged in specified activities, including violating an insurance law.

The PBM registration fees imposed under the act are to be used to fund the costs of the division of insurance in enforcing requirements and prohibitions on PBMs.

The act appropriates $206,647 from the division of insurance cash fund to the department of regulatory agencies for use by the division of insurance for personal services and operating expenses related to implementing the act.

APPROVED by Governor May 10, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

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

Fiscal Note

The act requires the department of health care policy and financing (department) to:

• At least quarterly, publish on its website an audit activity report detailing current and recently completed recovery audits and summaries of the findings of recovery audits;
• When the department enters into a new contract for recovery audits, post on its website a copy of the contract, scope of work, and information regarding supervision of contractor deliverables for such audits;
• At least quarterly, conduct trainings for providers and hold stakeholder meetings; and
• Create a provider advisory group to advise the department on issues that providers have concerning the recovery audits.

The act requires the office of the state auditor to:

• During the 2023-24 state fiscal year, contract for an independent review of the department's recovery audit contractor program for compliance with requirements of the federal recovery audit contractor's program, coding practice standards, and state law; and
• Contract with an entity to assess federal flexibilities to improve the recovery audit contractors program and assist the department in pursuing those flexibilities.

The act appropriates from the general fund $39,287 to the department and $850,000 to the legislative department for use by the office of the state auditor.

APPROVED by Governor June 1, 2023

EFFECTIVE June 1, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act authorizes the department of health care policy and financing (state department) to seek federal authorization from the centers for medicare and medicaid services to provide medicaid reimbursement for community health worker services.

The act requires the state department to hold at least 4 public stakeholder meetings to solicit input on considerations to include in the state department's request for federal authorization.

The act grants the state department the authority to promulgate rules regarding the voluntary competency-based community health worker registry.

The act requires that on or before January 31, 2026, the state department include a report on how community health workers are being utilized through medicaid in its presentation to the joint budget committee of the general assembly and in its presentation at the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act" hearing.

For the 2023-24 state fiscal year, the act appropriates $40,717 from the general fund to the state department to be used by the executive director's office as follows:

• $36,842 for personal services; and
• $3,875 for operating expenses.

For the 2023-24 state fiscal year, the act anticipates the state department will receive $40,717 in federal funds to be used as follows:

• $36,842 for personal services; and
• $3,875 for operating expenses.

For the 2023-24 state fiscal year, the act appropriates $169,973 to the department of public health and environment to be used by chronic disease prevention programs in the prevention services division for the community health workers initiative.

APPROVED by Governor May 10, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

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

Fiscal Note

The act creates the Colorado multidisciplinary health-care provider access training program (program) to improve the health care of medically complex, costly, compromised, and vulnerable older Coloradans. The university of Colorado Anschutz medical campus shall develop, implement, and administer the program. The program may be offered to Colorado institutions of higher education with clinical health professions graduate degree programs. The program coordinates and expands geriatric training opportunities for clinical health professions graduate students (students) enrolled in participating Colorado institutions of higher education (participating institutions) across Colorado studying to become advanced practice providers; dentists; nurses; occupational therapists; pharmacists; physicians, including medical doctors and doctors of osteopathy; physical therapists; psychologists; social workers; and speech-language therapists. Students who successfully complete the program are awarded certificates and issued letters authorizing those students to become trainers for the program in clinics across the state.

The act creates the Colorado multidisciplinary health-care provider access training program advisory committee (committee) to ensure that the training for the program is consistent and collaborative across the fields of study. The committee is required to:

• Appoint a program chair;
• Set the program's standards for training and delivery of multidisciplinary medical care to medically complex, costly, compromised, and vulnerable older Coloradans;
• Establish requirements for the program;
• Identify and invite institutions of higher education that offer appropriate clinical health professions graduate degree programs to become participating institutions;
• Collaborate with participating institutions across Colorado to enhance recruitment of students to enter a field specific to geriatrics and select students with an interest in geriatric care to participate in the program;
• Assist with updating the program's curricula;
• Analyze data collected by the program;
• Build a multidisciplinary network of trained geriatric clinicians to collaborate and provide opportunities for clinicians to work together to better understand the roles of each health-care discipline in urban, rural, and underserved communities when caring for older Coloradans;
• Improve placement of students in experiential clinical training opportunities, prioritizing rural and underserved communities;
• Coordinate with graduates of the program to become geriatric trainers for future students; and
• Increase the number of clinical training sites across Colorado, specifically in rural and underserved communities.

The act requires a representative of the program to submit a report on July 1, 2025, and no later than July 1 each year thereafter, summarizing program data to the health and human services committee of the senate and the health and insurance committee of the house of representatives, or their successor committees. The report must include the following:

• The number of students participating in the program;
• The number of students who successfully complete the program;
• The subsequent locations and job placements of program graduates;
• The number of program graduates who become trainers; and
• The description of facilities where program graduates become trainers.

The act appropriates $784,269 to the department of higher education from the general fund.

APPROVED by Governor June 5, 2023

EFFECTIVE June 5, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

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

Fiscal Note

The bill authorizes a physician, a physician assistant, and an advanced practice registered nurse licensed health-care professional who is authorized to prescribe drugs (prescriber) to prescribe and administer a drug approved by the federal food and drug administration (FDA) for an off-label use. if:

• The off-label use of the drug for the indication has longstanding, common use;
• There is medical evidence to support the off-label use and no known evidence contraindicating such off-label use; and
• The prescriber has provided the patient or a minor patient's parent or guardian with an informed consent form, and the patient or parent or guardian has signed the form.

The bill applies the same standard of care for the off-label use of the drug as for the on-label use of the drug.

The bill clarifies that:

• The prescription and administration of an FDA-approved drug for an off-label use is not, by itself, a grounds for discipline; and
• A pharmacist who fills a prescription for off-label use is not subject to discipline by the state board of pharmacy.

(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.)

Fiscal Note

Current law allows a physician to submit documentation to the department of public health and environment (department) stating that a patient has a debilitating medical condition or disabling medical condition and may benefit from the use of medical marijuana. The bill clarifies that the physician is submitting a recommendation to the department rather than a certification or authorization.

The bill removes the following requirements for a physician's recommendation to the department:

• The physician's federal drug enforcement agency number;
• The maximum THC potency level of the medical marijuana product;
• The recommended medical marijuana product;
• The patient's daily authorized quantity of the medical marijuana product; and
• Directions for use of the medical marijuana product.

The bill allows a physician to establish a bonafide physician-patient relationship remotely via video or telephone conference if the patient is:

• 21 years of age or older;
• Under 18 years of age; or
• 18 years of age or older but under 21 years of age and the patient received a medical marijuana recommendation prior to 18 years of age.

The bill clarifies that a patient must only present a uniform certification form completed by a recommending physician to a medical marijuana store if the patient seeks to purchase more than the statutorily allowed limit of medical marijuana products.

Current law limits the amount of medical marijuana concentrate that a patient may purchase in a single day to 8 grams. The bill increases that limitation to 40 grams, but limits the total amount that a patient can purchase in a 30-day period to the equivalent of 8 grams per day. Current law limits the combined amount of medical marijuana products that a patient may purchase in a single day to 20,000 milligrams. The bill adds an exception to that limitation for nonedible, nonpsychoactive medical marijuana products.

Current law limits the amount of medical marijuana concentrate that a patient 18 years of age or older but under 21 years of age may purchase in a single day to 2 grams. The bill allows a patient that is 18 years of age or older but under 21 years of age and had a registry identification card issued by the department prior to 18 years of age to purchase in a single day up to 8 grams of medical marijuana concentrate.

The bill clarifies that when a physician issues a uniform certification form to a patient 18 years of age or older, the physician may consider whether the patient had a registry identification card issued by the department prior to 18 years of age as a factor in recommending that the patient be allowed to purchase more than the statutorily allowed quantities of medical marijuana products.

The bill allows a retail marijuana store to sell retail marijuana products to patients at the statutorily allowed limit for medical marijuana products and registered primary caregivers 21 years of age or older who present a registry identification card issued by the department. The bill also allows a registered primary caregiver to purchase retail marijuana products for a patient who is under 21 years of age at the applicable statutorily allowed limit for medical marijuana products for patients under 21 years of age.

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

Fiscal Note

The act modifies the relationship between a physician assistant and a physician or podiatrist by removing the requirement that a physician assistant be supervised by a physician or podiatrist except in certain circumstances. Instead, a physician assistant must enter into a collaborative agreement with a physician or podiatrist or physician group. The physician or podiatrist must be licensed in good standing in Colorado and be actively practicing with a regular and reliable physical presence in the state.

The collaborative agreement must include:

• The physician assistant's name, license number, and primary location of practice;
• The signature of the physician assistant and the physician or physician group with whom the physician assistant has entered into the collaborative agreement;
• A description of the physician assistant's process for collaboration;
• A description of the performance evaluation process, which may be completed by the physician assistant's employer in accordance with a performance evaluation and review process established by the employer; and
• Any additional requirements specific to the physician assistant's practice required by the physician or physician group entering into the collaborative agreement, including additional levels of oversight, limitations on autonomous judgment, and the designation of a primary contact for collaboration.

For a physician assistant with fewer than 5,000 practice hours, or a physician assistant changing practice areas with fewer than 3,000 practice hours in the new practice area, the collaborative agreement is a supervisory agreement that must include required elements and must also:

• Require that collaboration during the first 160 practice hours be completed in person or through technology, as permitted by the physician or physician group with whom the physician assistant is collaborating;
• Incorporate elements defining the expected nature of collaboration; and
• Require a performance evaluation and discussion of the performance evaluation with the physician assistant.

For a physician assistant entering into a collaborative agreement with a physician or physician group in the emergency department of a hospital with a level I or level II trauma center, the collaborative agreement remains a supervisory agreement and continues indefinitely.

For a physician assistant changing practice areas to practice in an emergency department of a hospital that is not a level I or level II trauma center, the supervising physician or physician group may increase the number of hours for which the collaborative agreement is a supervisory agreement.

The act also eliminates the 3-year time limit for physician assistants to satisfy certain financial responsibility requirements from which such physician assistants are exempt under current law.

APPROVED by Governor April 26, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act allows a health-care provider to prescribe, dispense, or administer a schedule II, III, IV, or V controlled substance (drug) to a patient in the course of treatment for a diagnosed condition that causes chronic pain. The act also clarifies that the prescribing health-care provider is not subject to disciplinary action by the appropriate regulator for prescribing a dosage of a drug that is equal to or more than a morphine milligram equivalent dosage recommendation or threshold specified in state or federal opioid prescribing guidelines or policies.

The act prevents a health-care provider from being required to taper a patient's medication dosage solely to meet a predetermined dosage recommendation or threshold if the patient is stable, compliant with treatment, and not experiencing serious harm.

The act also prohibits a pharmacy, health insurance carrier, or pharmacy benefit manager from having a policy in place that requires a pharmacist to refuse to fill a prescription for an opiate issued by a health-care provider solely because the prescription is for an opiate or because the prescription order exceeds a predetermined morphine milligram equivalent dosage recommendation or threshold.

The act also prohibits a health-care practice or clinic from having a policy in place that requires a health-care provider to refuse to prescribe, administer, or dispense a prescription for an opiate solely because the prescription order exceeds a predetermined morphine milligram equivalent dosage recommendation or threshold.

APPROVED by Governor May 4, 2023

EFFECTIVE May 4, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act:

• Amends the practice of a pharmacy technician to include performing point-of-care testing and patient care technical tasks as specifically trained for and delegated by a supervising pharmacist;
• Requires the majority of pharmacy technicians to be fully certified by the state board of pharmacy when 3 or more pharmacy technicians are on duty; and
• Changes the supervision ratio for pharmacists to include supervising up to 8, rather than only 6, pharmacy technicians when the pharmacy, other than a pharmacy located in a hospital, is a central fill pharmacy that is not a public-facing pharmacy and is acting as an agent of an originating pharmacy to fill or refill a prescription.

The act authorizes reimbursement under the medical assistance program for dispensing or administering vaccines to children under 19 years of age. To be eligible to receive reimbursement, the pharmacy or pharmacist must be enrolled in good standing with the federal centers for disease control and prevention vaccines for children program administered by the department of public health and environment (department). Until the department determines a framework for participation by pharmacies or pharmacists, the department is not required to enroll pharmacies receiving reimbursement for the administration of vaccines through the medical assistance program as vaccines for children providers.

APPROVED by Governor May 4, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act lists the minimum factors to be considered when determining medical necessity or appropriate level of care for an individual with an eating disorder. The act prohibits certain health benefit plans or the state medical assistance program from utilizing the body mass index, ideal body weight, or any other standard requiring an achieved weight when determining medical necessity criteria or appropriate level of care for an individual with a diagnosed eating disorder. The prohibition does not apply when determining medical necessity or the appropriate level of care for an individual diagnosed with anorexia nervosa, restricting subtype or binge-eating/purging subtype; however, body mass index, ideal body weight, or any other standard requiring an achieved body weight must not be the determining factor when assessing medical necessity or the appropriate level of care for an individual diagnosed with anorexia nervosa, restricting subtype or binge-eating/purging subtype.

The act states a retail establishment engages in a deceptive trade practice if the retail establishment sells, transfers, or otherwise furnishes over-the-counter diet pills to any individual under 18 years of age.

APPROVED by Governor May 30, 2023

PORTIONS EFFECTIVE May 30, 2023

PORTIONS EFFECTIVE January 1, 2024

PORTIONS EFFECTIVE July 1, 2024
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act requires contracts between insurers or other persons and health-care providers regarding the delivery of health-care services to include a provision that prohibits the following actions if the actions are based solely on the health-care provider's provision of, or assistance in the provision of, reproductive health care or gender-affirming health-care services (legally protected health-care activity) in this state, so long as the care provided did not violate Colorado law:

• A medical malpractice insurer from refusing to issue, canceling or terminating, refusing to renew, or imposing any sanctions, fines, penalties, or rate increases for a medical malpractice policy (section 2);
• A health insurer from taking an adverse action against a health-care provider, including refusing to pay for a provided health-care service (section 3);
• A health insurer from refusing to credential a physician as a network provider or terminating a physician's status as a network provider (section 4); or
• A person or entity from terminating a health-care contract with a health-care provider, unless the person or entity is a religious organization and legally protected health-care activities conflict with the religious organization's bona fide religious beliefs and practices (section 25).

Section 5 of the act protects an individual applying for licensure, certification, or registration in a health-care-related profession or occupation in Colorado (applicant), as well as a health-care professional currently licensed, certified, or registered in Colorado (licensee), from having the license, certification, or registration denied or discipline imposed against the licensee based solely on:

• The applicant's or licensee's provision of, or assistance in the provision of, a legally protected health-care activity in this state or another state or United States territory, so long as the care provided was consistent with generally accepted standards of practice under Colorado law and did not otherwise violate Colorado law;
• A civil or criminal judgment or a professional disciplinary action arising from the provision of, or assistance in the provision of, a legally protected health-care activity in this state or another state or United States territory, so long as the care provided was consistent with generally accepted standards of practice under Colorado law and did not otherwise violate Colorado law;
• The applicant's or licensee's own personal effort to seek or engage in a legally protected health-care activity; or
• A civil or criminal judgment against the applicant or licensee arising from the individual's own personal legally protected health-care activity in this state or another state or United States territory.

Section 6 of the act prohibits a court, judicial officer, court employee, or attorney from issuing a subpoena in connection with a proceeding in another state concerning an individual who accesses a legally protected health-care activity in Colorado or an individual who performs, assists, or aids in the performance of a legally protected health-care activity in Colorado.

Section 7 of the act prohibits the state from applying another state's law to a case or controversy heard in Colorado state court or giving any force or effect to any judgment issued without personal jurisdiction or due process or to any judgment that is penal in nature pursuant to another state's law if the other state's law authorizes a person to bring a civil action against another person or entity for engaging or attempting to engage in a legally protected health-care activity.

If a medical malpractice action is brought in this state against a health-care provider regulated in this state or another state, section 8 of the act prohibits a court or arbitrator from allowing evidence or witness testimony relating to professional discipline or criminal or civil charges in this state or another state concerning the provision of, or assistance in the provision of, a legally protected health-care activity, so long as the care provided did not violate Colorado law.

Section 9 of the act prohibits a peace officer from knowingly arresting or participating in the arrest of any person who engages in a legally protected health-care activity, unless the acts forming the basis for the arrest constitute a criminal offense in Colorado or violate Colorado law.

Section 10 of the act prohibits the issuance of a search warrant to search for and seize any property that relates to an investigation into a legally protected health-care activity.

Section 11 of the act prohibits a judge from issuing a summons in a case when a prosecution is pending, or when a grand jury investigation has started or is about to start, for a criminal violation of another state's law involving the provision or receipt of or assistance with accessing a legally protected health-care activity that is legal in Colorado, unless the acts forming the basis of the prosecution or investigation would also constitute a criminal offense in Colorado.

Section 12 of the act prohibits the issuance of an ex parte order for wiretapping or eavesdropping to obtain any wire, oral, or electronic communication that relates to an investigation into a legally protected health-care activity.

Current law allows for the extradition of a person who committed an act in this state that intentionally results in a crime in the state whose executive authority is making the demand, even though the accused was not in the demanding state at the time of the commission of the crime. Section 13 of the act requires the acts for which extradition is sought to be punishable by the laws of this state if the acts occurred in this state and prohibits the governor from surrendering a person charged in another state as a result of the person engaging in a legally protected health-care activity, unless the executive authority of the demanding state alleges in writing that the accused was physically present in the demanding state at the time of the commission of the alleged offense.

Section 14 of the act requires a correctional facility or private contract prison incarcerating a person who is capable of pregnancy to, regardless of the person's ability to pay, ensure access to abortions by providing a pregnant person with information about abortion providers; referrals to community-based providers of abortions; referrals to community-based organizations that help people pay for abortions; and transportation to access an abortion; and ensure access to miscarriage management, including medication.

Section 15 of the act adds a reproductive health-care services worker to the list of protected persons whose personal information may be withheld from the internet if the protected person believes dissemination of such information poses an imminent and serious threat to the protected person or the safety of the protected person's immediate family.

Section 16 of the act prohibits the prosecution or investigation of a licensed health-care provider if the health-care provider prescribes an abortifacient to a patient and the patient ingests the abortifacient in another state so long as the abortifacient is prescribed or administered consistent with accepted standards of practice under Colorado law and does not violate Colorado law.

Section 17 through section 20 of the act adds a protected health-care worker to the list of persons authorized to participate in the address confidentiality program.

Section 21 of the act authorizes the attorney general to independently initiate and bring a civil and criminal action to enforce the "Reproductive Health Equity Act".

Section 22 of the act prohibits a state agency from providing any information or using any government resources in furtherance of any out-of-state investigation or proceeding seeking to impose civil or criminal liability or professional sanction upon a person or entity for engaging in a legally protected health-care activity.

Section 23 of the act prohibits a public entity from:

• Restricting any natural or legal person in performing, or prohibit any natural or legal person from providing, reproductive health care through the imposition of licensing, permitting, certification, or similar legislative or regulatory requirements that apply solely to providers of reproductive health care; or
• Prosecuting or otherwise criminally sanctioning any natural or legal person for providing, assisting in the provision of, arranging for, or otherwise assisting a person in accessing reproductive health care performed within the scope of applicable professional licensure and certification requirements.

Section 24 of the act states the venue to enforce an action to under the provisions of the "Reproductive Health Equity Act" is in the Denver district court.

Section 26 and 27 of the act require every local government that has adopted or adopts a zoning ordinance to recognize the provision of outpatient reproductive health care as a permitted use in any zone in which the provision of general outpatient health care is recognized as a permitted use.

APPROVED by Governor April 14, 2023

EFFECTIVE April 14, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act changes the term "HIV infection prevention drug", as used in the Colorado Revised Statutes, to "HIV prevention drug". The act specifies that, for health benefit plans issued or renewed on or after January 1, 2025, if counseling, prevention, and screening for a sexually transmitted infection (STI) are covered services, the health benefit plan must provide coverage without cost sharing, regardless of the covered person's gender, and the coverage must include HIV prevention drugs and the services necessary for initiation and continued use of an HIV prevention drug consistent with federal guidelines.

The act prohibits, before July 1, 2027, a health insurance carrier from requiring a covered person to undergo step therapy or to receive prior authorization before a health-care provider may prescribe or dispense a medication for the treatment of HIV that is included on the insurance carrier's prescription drug formulary as of March 1, 2023. The act requires the division of insurance to contract for a study, which includes consultation with the HIV community, to consider the predicted costs and health impacts of removing step therapy and prior authorization before a health-care provider may prescribe or dispense HIV treatment drugs and to provide the study to the general assembly by October 1, 2026. The act specifies the requirements and time frames for health insurance carriers for certain prior authorization requests related to HIV prescription drug coverage.

Regarding the state medical assistance program, the act prohibits the department of health care policy and financing (state department), before July 1, 2027, from using prior authorization or step therapy requirements for prescription drugs prescribed for the treatment or prevention of HIV, except for utilization review that is necessary for patient safety or for ensuring the prescribed use is for a medically accepted indication.

For health benefit plans issued or renewed on or after January 1, 2025, if sterilization services are a covered service, a health benefit plan must provide the coverage regardless of the covered person's sex or gender and without deductibles, copayments, coinsurance, annual or lifetime maximum benefits, or other cost sharing; except that this provision does not apply to a high deductible health benefit plan until the deductible has been met, unless allowed pursuant to federal law.

The act requires mandatory preventive health-care services coverage for health benefit plans to include, in addition to the A and B recommendations of the United States preventive services task force, the recommendations of the advisory committee on immunization practices to the centers for disease control and prevention in the federal department of health and human services (HHS) and the women's, infants', children's, and adolescents' preventive services guidelines of the health resources and services administration in the HHS.

The act requires large employer health benefit plans issued or renewed on and after January 1, 2025, to provide coverage for the total cost of abortion care without policy deductibles, copayments, or coinsurance. Individual and small group health benefit plans must provide this coverage if the HHS confirms the state's determination that the coverage is not subject to state defrayal pursuant to federal law. The provisions relating to abortion care do not apply to a high deductible health benefit plan until the deductible has been met, unless allowed pursuant to federal law. Employers are exempted from providing coverage if providing coverage conflicts with the employer's sincerely held religious beliefs or the employer is a public entity prohibited by section 50 of article V of the state constitution from using public funds to pay for induced abortions.

With the minor's consent, a health-care provider acting within the scope of the health-care provider's license, certificate, or registration, may furnish contraceptive procedures, supplies, or information to a minor without notification to or the consent of the minor's parent or parents, legal guardian, or any other person having custody of or decision-making responsibility for the minor.

The act expands the reproductive health-care program administered by the state department to include additional family planning services and family-planning-related services.

The act requires the department of public health and environment (department) to convene a family planning access collaborative, on or before September 1, 2023, to advise the department in identifying access gaps that contribute to Coloradans lacking family planning access. The department shall publish its recommendations on or before December 15, 2023.

To implement the act, for the 2023-24 state fiscal year the act appropriates:

• $200,000 to the department of public health and environment from the general fund for the family planning access collaborative and corresponding report;
• $67,627 and 0.5 FTE to the department of regulatory agencies from the division of insurance cash fund; and
• $23,263 and .1 FTE to the department of law from reappropriated funds received from the department of regulatory agencies for legal services.

APPROVED by Governor April 14, 2023

EFFECTIVE April 14, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act makes it a deceptive trade practice for a person to make or disseminate to the public any advertisement that indicates that the person provides abortions, emergency contraceptives, or referrals for abortions or emergency contraceptives when the person knows or reasonably should have known that the person does not provide those specific services.

A health-care provider engages in unprofessional conduct or is subject to discipline in this state if the health-care provider provides, prescribes, administers, or attempts medication abortion reversal in this state, unless the Colorado medical board, the state board of pharmacy, and the state board of nursing, in consultation with each other, each have in effect rules finding that it is a generally accepted standard of practice to engage in medication abortion reversal. The specified boards shall promulgate applicable rules no later than October 1, 2023, in consultation with each other, concerning whether engaging in medication abortion reversal is a generally accepted standard of practice.

APPROVED by Governor April 14, 2023

EFFECTIVE April 14, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

For health benefit plans issued or renewed on or after January 1, 2025, the act requires a health insurer or pharmacy benefit manager to include in the calculation of a covered person's contributions toward cost-sharing requirements, including any annual limitation on a covered person's out-of-pocket costs, any payments made by or on behalf of the covered person for a prescription drug if:

• The prescription drug does not have a generic equivalent or, for a biological product, a biosimilar drug or interchangeable biological product; or
• The prescription drug has a generic equivalent, a biosimilar drug, or an interchangeable biological product, but the covered person is using the brand-name drug after obtaining prior authorization, complying with a step-therapy protocol, or otherwise receiving approval from the carrier or pharmacy benefit manager if those utilization management processes are not otherwise prohibited by law.

The commissioner of insurance is authorized to adopt rules necessary to implement the act. The act applies to health benefit plans issued or renewed on or after January 1, 2025.

APPROVED by Governor June 5, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act removes the requirement that medicaid recipients pay a copayment for pharmacy and outpatient services.

$1,886,150 is appropriated to the department of health care policy and financing (department), consisting of $1,439,499 from the general fund and $446,651 from the healthcare affordability and sustainability fee cash fund, for medical and long-term care services for medicaid-eligible individuals. It is anticipated that the department will receive $5,459,357 in federal funds to implement this act.

APPROVED by Governor April 20, 2023

EFFECTIVE April 20, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

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

APPROVED by Governor April 17, 2023

EFFECTIVE April 17, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act requires hospitals to make public and post each hospital's medicare reimbursement rates.

The act:

• Requires the department of health care policy and financing (state department) to conduct a performance assessment for each hospital to determine the hospital's adherence to federal transparency rules and publish the results on its website;
• Repeals sections of statute regarding hospital price transparency and debt collection that are currently under the administration and authority of the department of public health and environment and relocates these sections so that hospital price transparency and debt collection provisions are under the administration and authority of the state department; and
• Makes a violation of the hospital transparency requirements outlined in the act a deceptive trade practice under the "Colorado Consumer Protection Act".

APPROVED by Governor June 2, 2023

EFFECTIVE June 2, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act allows a physician, a physician assistant, an advanced practice registered nurse, or any other person who is authorized by law to administer a vaccine (practitioner) to ask an individual who seeks to receive a publicly funded vaccine to present proof of health insurance or other form of identification, but a practitioner is prohibited from conditioning the receipt of the vaccine on the individual's presentation of the documentation or ability to pay an administration fee. The act requires practitioners to post a notice and provide to individuals seeking a publicly funded vaccine a disclosure statement indicating that the publicly funded vaccine will be provided regardless of the individual's presentation of the requested documentation or ability to pay an administration fee.

The act allows an independent pharmacy to condition receipt of a publicly funded vaccine on an individual's ability to pay for the administration of the vaccine but limits the amount an independent pharmacy may charge.

The act prohibits a practitioner from charging an individual for the cost of a vaccine that is paid for by the federal, the state, or a local government but permits a practitioner to charge and seek payment from an insurer or the vaccine recipient or, if applicable, from a federal or state source, for the cost of administering the vaccine.

APPROVED by Governor May 10, 2023

EFFECTIVE May 10, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act protects an individual applying for licensure, certification, or registration in a profession or occupation in Colorado (applicant), as well as a professional who is currently licensed, certified, or registered in a profession or occupation in Colorado (licensee), from having the license, certification, or registration denied to the applicant, or from discipline being imposed against the licensee, based solely on:

• A civil or criminal judgment against the applicant or licensee regarding the consumption, possession, cultivation, or processing of marijuana, if the underlying actions were lawful and consistent with professional conduct and standards of care within Colorado and did not otherwise violate Colorado law; or
• Previous professional disciplinary action concerning an applicant's or a licensee's professional licensure in this or any other state or United States territory, if the professional disciplinary action was based solely on the applicant's or licensee's consumption, possession, cultivation, or processing of marijuana and the applicant or licensee did not otherwise violate Colorado law.

APPROVED by Governor May 24, 2023

EFFECTIVE May 24, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act requires a carrier that offers a health benefit plan (carrier) or a pharmacy benefit management firm that administers or manages contraception coverage under a health benefit plan (PBM) to provide coverage for, and reimburse a prescribing provider or in-network dispensing entity for, the single dispensing or furnishing of contraception intended to last the covered person for a duration of 12 months, as permitted by the covered person's prescription, dispensed or furnished at one time, unless requested otherwise by the covered person.

A carrier or PBM is subject to certain requirements, as applicable, including:

• Allowing coverage of continuous use of contraception, as determined by the prescribing provider;
• A prohibition against implementing utilization management practices that prevent the dispensing of a 12-months' duration of contraception;
• Allowing for alternate prescribed contraception, if medically necessary; and
• Providing coverage for over-the-counter contraception without a prescription and without prior authorization, step therapy, utilization management, or cost sharing.

The act requires carriers to report annually to the division of insurance in the department of regulatory agencies concerning contraception coverage and requires PBM's to provide information to carriers for purposes of this reporting. The act authorizes the commissioner of insurance to promulgate rules regarding the coverage.

APPROVED by Governor May 30, 2023

EFFECTIVE August 7, 2023

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

The act requires each institution of higher education (institution) to acquire and stock a supply of epinephrine auto-injectors. The act encourages each institution to place epinephrine auto-injectors in sufficient quantities in emergency public access stations to ensure reasonable availability to a person perceived to be experiencing anaphylaxis.

The act encourages the person, immediately after using an epinephrine auto-injector, to make a 911 emergency call.

The act encourages an institution to accept a donation of a supply of epinephrine auto-injectors that meets standards established by the federal food and drug administration, and to accept gifts, grants, and donations, including in-kind donations, designated for obtaining a supply of epinephrine auto-injectors.

The act requires each institution to adopt a policy concerning the placement of epinephrine auto-injectors that focuses on areas where students gather in the largest volumes, including in dormitories and dining halls.

The act provides immunity for any person who acts reasonably and in good faith to furnish or administer an epinephrine auto-injector to an individual the person reasonably believes is experiencing anaphylaxis.

APPROVED by Governor June 6, 2023

EFFECTIVE June 6, 2023
(Note: This summary applies to this bill as enacted.)

Fiscal Note