The act expands the 'Colorado Cottage Foods Act' (CCFA) by allowing for the sale of homemade foods that require refrigeration and foods that include meat and meat products. A producer of a food (producer) that requires time and temperature control must take a food safety course that includes food handling training concerning time and temperature control and acquire and maintain proof of course completion.

     A producer selling products that require time and temperature control for safety may sell one type of such food product, with the ability to offer up to 5 variations of that one type of food product. The producer must specify the individual food products that require time and temperature control for safety and provide a list of such food products to the department of public health and environment (department) or a county, district, or regional health agency (public health agency) upon request.

     A producer selling products under the CCFA is required to register with the department before selling. The department must issue a registration number to each producer and maintain an electronic registry of producers. A producer may earn up to $150,000 of net revenues under the CCFA each calendar year, increased from $10,000 . The department is required to adjust this cap annually for inflation.

     The act authorizes a public health agency that inspects or investigates homemade food products produced pursuant to the CCFA to impose a fine for a violation of the requirements of the CCFA and to recover the cost of the inspection or investigation. If a public health agency determines that, on 3 separate occasions within 12 months, a producer has misbranded food that requires time and temperature control for safety or failed to comply with requirements related to food that requires time and temperature control for safety, the producer shall not sell foods that require time and temperature control.

     The act creates the cottage foods cash fund (cash fund) and transfers $300,000 into the cash fund ($200,000 from the medication administration cash fund and $100,000 from the assisted living residence cash fund). The act also appropriates $119,354 to the department to implement the act.


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

     The act prohibits sterilization of a person with an intellectual and developmental disability without the person's informed consent if the person has decision-making capacity. The act prohibits sterilization of a person with an intellectual and developmental disability without the person's informed consent if the person does not have decision-making capacity, except in accordance with processes in existing law that allow another person with legal authority to make medical decisions for the person to consent on the person's behalf.

     The act repeals provisions that:

• Explain what happens when there is a disagreement about whether an adult with an intellectual and developmental disability is capable of consenting to sterilization;
• Set forth a process for a person to petition a court for, and a court to order, sterilization of a person with an intellectual and developmental disability who either cannot consent or is a minor; and
• Require all records, hearings, and proceedings related to a decision to sterilize a person with an intellectual and developmental disability to remain confidential.(Note: This summary applies to this bill as enacted.)

     The act authorizes an occupational therapist to perform dry needling on and after September 1, 2027, if the occupational therapist:

• Has the knowledge, skill, ability, and documented competency to perform the act;
• Has successfully completed a dry needling course of study that meets supervisorial, educational, and clinical prerequisites to be established by rule; and
• Obtains a written informed consent from each patient for dry needling, including information concerning the potential benefits and risks of dry needling and a statement that the occupational therapist performing dry needling is not an acupuncturist.

     The act requires the director of the division of professions and occupations within the department of regulatory agencies to adopt rules to implement the authorization for an occupational therapist to perform dry needling. At a minimum, the rules must establish requirements for dry needling performed by an occupational therapist that are equivalent to the requirements in rules adopted by the state physical therapy board for dry needling performed by a physical therapist.


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

The bill creates the "Prescription Drug Optimized Sourcing Transparency and Integrity Act" to prohibit a pharmacy benefit manager (PBM) or a health-care consultant from knowingly making or disseminating false or misleading statements or claims to a self-insured employer or policyholder about the legality or safety of a lawful prescription drug optimized sourcing program established by a pharmacy stewardship program.

Upon written request by a self-insured employer, a PBM or health-care consultant is required to provide certain cost information for each prescription drug dispensed under the health benefit plan.

The prohibition and information-sharing provisions of the bill do not restrict or limit the rights of a self-insured employer to purchase prescription drugs through and contract for a lawful prescription drug optimized sourcing program. The bill also recognizes that a pharmacy stewardship program is an effective cost-containment tool and is authorized when implemented in compliance with federal law and with the bill.

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

     The act defines 'first responder' to include:

• A peace officer;

• A firefighter;
• A volunteer firefighter;
• An emergency medical service provider; or
• A mental health professional who responds in a professional capacity to a justifiable medical emergency.

     Existing law requires the emergency medical and trauma services advisory council (council) to review and approve new rules and modifications to rules prior to the adoption of such rules or modifications by the state board of health. The act requires the council to make recommendations for, instead of approve, rules and modifications to rules concerning emergency medical and trauma services prior to the adoption of such rules or modifications by the state board of health.

     Beginning January 1, 2027, the act requires the department of health care policy and financing (state department) to reimburse the following entities under the 'Colorado Medical Assistance Act':

• An ambulance service for ground transportation by an ambulance or other vehicle to a hospital or other destination as deemed appropriate by the ambulance service's medical director;
• An ambulance service for treatment on the scene of a medical emergency, which treatment does not result in ground transportation; and
• A qualified provider, an ambulance service, or an agency for evaluation by telemedicine of a person being treated by an ambulance service or an agency for the purpose of preventing the need to transport the person to a hospital.
  
  (Note: This summary applies to this bill as enacted.)

     The act imposes requirements regarding a contract or agreement between an insurance carrier (carrier) and a third party concerning access to dental care services, including:

• Prohibiting a carrier from entering into a third-party network lease agreement to provide access to dental care services or contractually agreed-upon discounts provided by a dental provider who is contracted as a participating provider (provider) with the carrier, unless the provider gives affirmative consent to allow the third party to access the provider's dental care services and contractually agreed-upon discounts;
• Prohibiting a carrier from canceling or entering into a contract with a provider on the grounds that the provider refuses to allow access by a third party to the dental care services and contractually agreed-upon discounts provided by the provider; and
• If a provider allows a third party to access the provider's dental care services and contractually agreed-upon discounts through a contract between a carrier and a third party, requiring the carrier to comply with specified obligations.

     The act creates exemptions from the prohibitions on specified contract provisions in contracts between carriers and dental providers, including if:

• A provider network contract for dental services is provided to beneficiaries of programs for medical assistance sponsored by the state of Colorado; or
• Access to a provider network contract is granted to a dental carrier or an entity operating in accordance with the same brand licensee program as the contracting entity, and a list of the carriers or entities with the same brand licensee program as the contracting entity is made available to a provider on the contracting entity's website.
  
  (Note: This summary applies to this bill as enacted.)

The bill codifies an individual's right to own, possess, and use a firearm to the maximum extent permissible by the state and federal constitutions.

Extreme risk protection orders and temporary extreme risk protection orders are repealed.

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

     The act increases funding for county child abuse prevention services and programs by changing the source of reimbursement money transmitted to the Colorado child abuse prevention trust fund (trust fund) from money received for all prevention services and programs identified in the federal Title IV-E clearinghouse (prevention services clearinghouse) to money received by the Colorado department of early childhood and identified in the prevention services clearinghouse.

     The act continues the trust fund and Colorado child abuse prevention board indefinitely.

     For the 2026-27 state fiscal year, the general assembly anticipates that the department of human services will receive $150,000 in federal funds to implement the act.


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

     The act requires a minor who is under 18 years old to have written permission of the minor's parent or legal guardian to obtain an instruction permit to drive a motorcycle. The act does not apply to emancipated minors.


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

The bill requires each interscholastic or intramural athletic team or sport that is sponsored by a school or athletic association (team or sport) to expressly designate the team's or sport's participants as either biological male, men, or boys; biological female, women, or girls; or coeducational or mixed.

The bill prohibits a team or sport that is designated for females, women, or girls from being open for participation by a male student or male participant. The bill prohibits a team or sport that is designated for males, men, or boys from being open for participation by a female student or female participant unless there is no female team offered or available for the sport for female students or female participants.

The bill prohibits a state agency, entity, licensing or accrediting organization, or athletic association from entertaining a complaint, opening an investigation, or taking any other adverse action against a school for maintaining a separate team or sport for female students or female participants.

If the commissioner of education (commissioner) determines that a public school or institution of higher education has refused to comply with the provisions of the bill, the commissioner shall notify the public school or institution of the noncompliance and allow the public school or institution a reasonable amount of time to comply. If the public school or institution is still not in compliance and has not made a good-faith attempt to comply, the commissioner is permitted to take appropriate remedial action within the commissioner's authority.

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

The bill requires a pregnant person's health-care provider to offer a pregnant person the option to fill out a "Do Not Abort" form that expresses the person's wishes to not receive an abortion in the event the person is incapacitated or incapable of communicating. If the pregnant person fills out a "Do Not Abort" form, the health-care provider shall input the form into the pregnant person's medical record.
(Note: This summary applies to this bill as introduced.)

The bill prohibits a person, health-care provider, or mental health professional from knowingly performing surgery on, or prescribing, administering, or providing hormones or puberty blockers to, a minor for the purpose of altering the minor's biological sex characteristics, or providing mental health therapy, counseling, or referrals that promote or affirm a minor's belief that the minor was born in the wrong body or that the minor needs medical intervention to address distress related to the minor's biological sex (prohibited interventions).

The bill prohibits the state from investigating or penalizing a minor's parent, or terminating the parent's rights, for refusing to consent to a prohibited intervention for the minor. A public school, health-care provider, or a governmental entity is prohibited from withholding information from a minor's parent regarding the minor's express desire to transition the minor's biological sex.

The bill prohibits state or federal funding, medicaid reimbursement, and health insurance coverage from being used to pay for a prohibited intervention. A person who, as a minor, was subjected to a prohibited intervention may bring a civil action within 20 years after attaining the age of 18 years against the person, health-care provider, or mental health professional who performed or provided the prohibited intervention.

The bill requires a regulator to revoke a health-care provider's or mental health professional's license for performing or providing a prohibited intervention. A person who knowingly performs or provides a prohibited intervention commits a class 5 felony, and the court is required to sentence the person to the maximum term of imprisonment and impose the maximum fine.

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

The bill prohibits a public health facility from denying, restricting, or conditioning the granting, use, or exercise of full medical staff privileges to a certified nurse midwife or a certified midwife (licensee) engaged in independent practice within their scope of practice solely on the basis of their licensure. If granted, privileges extended to a licensee must include admitting and discharge privileges, be consistent with those of other medical staff, and permit a licensee to exercise the same voting rights as other members of the medical staff.
(Note: This summary applies to this bill as introduced.)

The bill prohibits the department of health care policy and financing (department) from denying a medicaid member (member) the ability to purchase primary care services or enter into a direct primary care agreement. A member who purchases direct primary care services from a direct primary health-care provider or enters into a direct primary care agreement must sign a document acknowledging that the direct primary health-care provider is enrolled in the Colorado medical assistance program only as an ordering, prescribing, and referring provider; that the direct primary health-care provider does not accept medicaid payments for the services rendered; that the member cannot submit a claim for medicaid reimbursement for the services rendered by the direct primary health-care provider; and that the member retains the right to receive primary care services from a primary care provider who is enrolled in the Colorado medical assistance program.(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

     The act requires a law enforcement entity that receives a report alleging an offense involving sexual assault or abuse of a child to conduct a minimal facts interview and record certain information, including the child's name, the alleged offender's name, and a summary of the alleged incident. After receiving the report, a law enforcement entity must notify a child advocacy center within the judicial district where the alleged crime occurred, or another appropriate child advocacy center, within one week after taking the report. The law enforcement entity is required to collaborate with the child advocacy center in requesting a forensic interview for the alleged child victim if the law enforcement entity deems a forensic interview is necessary and appropriate.

     The act changes the definition of a child witness for purposes of testifying using closed-circuit television from a person who is 12 years old or younger, to a person who is younger than 18 years old. The act requires a judge to make findings on the record regarding a witness who is a child or a person who has an intellectual and developmental disability, specifically, if the witness will suffer serious emotional distress or trauma from courtroom testimony when the defendant is present.


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

If a pregnant person presents to a health-care facility requesting an abortion, the bill requires the person's health-care provider, if willing, or another willing health-care provider to discuss, at least 24 hours before the abortion procedure, certain information related to adoption as a pregnancy outcome option, unless the person declines the discussion.

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

     The act establishes information disclosure requirements for a licensed facility that offers on-site and residential services for individuals with dementia and dementia-related conditions, including Alzheimer's disease ('dementia care facility' or 'facility').

     The act requires the department of public health and environment (department), in consultation with the state long-term care ombudsman or the ombudsman's designee, to create a dementia care services information form (form) by July 1, 2027. The form must include certain specified fields for the disclosure of information regarding a dementia care facility's dementia care services, including the facility's:

• Dementia training requirements for staff that are in addition to statutory training requirements;
• Guidelines for using restraints;
• Security features and procedures for addressing the needs of residents with dementia; and
• Criteria and processes to determine placement, transfer, or discharge of residents living with dementia.

     The department may review and update the form to ensure that it facilitates the disclosure of the required information. After creating or updating the form, the department must provide the form to every dementia care facility in the state.

     A dementia care facility must complete the form with responsive, accurate, and complete information regarding the facility's dementia care services. Beginning October 1, 2027, every dementia care facility shall:

• Provide its completed form to every individual who contacts the facility seeking dementia care services;
• Review and update the form when the facility's information changes to ensure the information on the form is current, complete, and correct;
• Publish the facility's current completed form on the facility's website; and
• Maintain on the facility's premises and have available for inspection a copy of the facility's current completed form, and produce the form upon request by the department during a survey or inspection of the facility.

     The act requires the department to issue a citation to a facility that fails to maintain on its premises and have available for inspection its completed form or that fails to produce the form upon request by the department during a survey or inspection.

     The department may adopt rules, as necessary, to implement the act's requirements concerning the form; except that the rules adopted by the department must not exceed applicable national standards. The department may use money from the assisted living residence improvement cash fund for the purposes of creating the form and adopting related rules.


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

The bill requires all health benefit plans in the state and the medicaid program to provide coverage for hormone replacement therapy, as prescribed by licensed physicians, for women who are experiencing menopause or perimenopause.

Coverage for hormone replacement therapy will be implemented for all large employer health benefit plans issued or renewed in this state on or after January 1, 2027. Coverage for hormone replacement therapy will be implemented for all individual and small group health benefit plans issued or renewed in this state on or after January 1, 2028, as long as the state is not required to defray the cost of the coverage of the hormone replacement therapy.

The state medicaid program is required to provide hormone replacement therapy beginning on July 1, 2027.

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

     The act repeals the requirement for coroners, or other officials performing like functions, to report to the department of transportation (department) deaths resulting from traffic accidents on a monthly basis. The act requires coroners, or other officials performing like functions, to report all available toxicology results to the department for each deceased party who has died as a result of a motor vehicle crash. The report must be submitted by the final business day of each quarter of the calendar year.

     If a participant in a crash dies within 30 days as a result of a crash, the act requires the law enforcement officer who was notified of, or investigated, the crash to submit an amended report to the department within five days after receiving a notification of the death.


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

The bill requires that a cause of action for an intentional or negligent act for an injury as a result of a youth gender transition procedure by a provider must be brought before the youth reaches 38 years old.

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

     Beginning on July 1, 2027 January 1, 2028 , the bill requires a building with an indoor restroom that is open to the public, including to customers or public visitors, and that does not include private offices or workspaces that are but that is not in a private office or workspace that is generally not open to customers or public visitors (restroom accessible to the public), to have safe, sanitary, and convenient baby diaper changing tables (baby diaper changing station) as follows:

• At least one baby diaper changing station in each gender-specific one restroom designated for each gender on each floor;
• At least one baby diaper changing station in a non-gendered single-stall restroom on each floor; or
• At least one baby diaper changing station in a non-gendered multi-stall restroom on each floor.

     The owner or manager of a building with a restroom accessible to the public is required to ensure that each baby diaper changing station is cleaned with the same frequency as the restroom in which it is located and maintained, repaired, and replaced as necessary to ensure safety and ease of use.

      Beginning on July 1, 2027, for each restroom accessible to the public with a baby diaper changing station, the owner or manager of a building is required to display:

• A pictogram, void of gender, at or near the restroom accessible to the public that indicates the presence of a baby diaper changing station; and
• Signage, at or near the entrance to the building, indicating the location of each restroom accessible to the public and each baby diaper changing station in the building.

     Providing a baby diaper changing station in a restroom accessible to the public and providing the corresponding signage is not required if: a local building permitting entity or building inspector determines that

• The installation of a baby diaper changing station in a restroom accessible to the public would result in a failure to comply with applicable building standards governing the right of access for individuals with disabilities or the 'Americans with Disabilities Act of 1990' , or if the building is a certified historic structure;
• The building is owned or managed by a state department or state agency, state institution of higher education, a county, a city and county, or a municipality;
• The building is owned by an employer with 25 or fewer employees that generates no more than $3.5 million in annual gross income and the building has an occupancy of fewer than 25 people; or
• A portion of the building is occupied by a business that does not admit individuals who are under 21 years old, but only with respect to that portion of the building.

(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.)

     On and after July 1, 2027, a manufacturer of a hair relaxer product or a hairpiece product (covered hair product) is prohibited from selling or distributing a covered hair product in the state that contains an intentionally added carcinogen or reproductive toxicant unless the covered hair product has a warning label that notifies the consumer that the covered hair product contains an intentionally added carcinogen or reproductive toxicant, which warning label must comply with certain requirements depending on whether the covered hair product contains an intentionally added carcinogen, an intentionally added reproductive toxicant, or both (warning label requirement).

     The warning label requirement does not apply to a covered hair product that is sold or distributed to a commercial entity for professional use. On and after July 1, 2028, the attorney general may adopt rules updating the warning label requirement. A violation of the warning label requirement constitutes a deceptive trade practice.


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

     On and after January 1, 2027, when determining coverage for health-care services, the act requires entities that use an artificial intelligence system (AI system) for the purpose of conducting utilization review of health-care services, including health insurance companies (carriers), pharmacy benefit managers, private utilization review organizations, behavioral health administrative services organizations, and managed care entities (entities), ensure that the AI system complies with certain requirements specified in the act. Specifically, an entity shall ensure that the AI system:

• Makes determinations based on medical or clinical history, the patient's individual clinical circumstances, and other relevant clinical factors specified in the act, with denial of coverage reviewed by a licensed clinician or physician or other competent regulated professional who is competent to evaluate the specific clinical issues and review the health benefit plan's terms of coverage (competent regulated professional);
• Does not base its determination solely on group data without reference to the individual's data;
• Is not used in any way that discriminates against individuals in violation of other state or federal laws and is fairly and equitably applied, including in accordance with regulations and guidance issued by the federal department of health and human services; and
• Is periodically reviewed to ensure the AI systems outcomes are accurate and reliable and that an individual's health data is not used beyond its intended or stated purpose.

     Entities that use AI systems shall disclose to the division of insurance, the department of human services, or the department of health care policy and financing, as applicable, the utilization review functions for which the AI system will be used and the points in the utilization review process when it will be used, the process for human oversight of adverse coverage determinations, and the process for maintaining audit information to ensure that the use of the AI system complies with the requirements in the act.

     The AI system may be used to assist in utilization review, including expedited approvals. A carrier's denial of coverage for a service based in whole or in part on medical necessity shall not be issued solely on the output of an AI system without human review by a licensed clinician or physician or other competent regulated professional.

     Further, the act prohibits a carrier and a payer of services under the 'Colorado Medical Assistance Act' and the 'Children's Basic Health Plan Act' from paying for psychotherapy services that are provided directly to a client and that are conducted by an AI system.


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

     The act establishes civil immunity for a board member, staff member, or volunteer of a child advocacy center that arises from the performance of the board member's, staff member's, or volunteer's duties if the board member's, staff member's, or volunteer's acts are in good faith.

     The act allows certain entities to share information under certain circumstances that is relevant to the protection of a child that is the subject of a child maltreatment case.


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

     The act requires an entity that requires an individual to provide a social security number for a background check for a non-employment-based educational opportunity to accept an individual's taxpayer identification number in lieu of a social security number, including in clinical educational experiences for health-related academic programs, subject to certain exceptions.

     A licensed or certified hospital or covered school, or a state institution of higher education or local district college that offers a non-employment-based educational opportunity that involves work with a vulnerable population, shall accept either an applicant's taxpayer identification number or a fingerprint-based background check in lieu of a social security number.

     An applicant for a non-employment-based educational opportunity that involves work with a vulnerable population at a licensed or certified hospital or covered school, or a state institution of higher education or local district college, is permitted to have their fingerprints taken by a local law enforcement agency or an entity approved by the Colorado bureau of investigation for taking fingerprints for the purpose of a background check. A licensed or certified hospital or covered school, or state institution of higher education or local district college, must determine who pays the fee for the fingerprint-based background check.

     The attorney general is authorized to bring a civil action to enforce the provisions of the act. An entity that violates this act is subject to a civil penalty of $2,000 for the first violation and $5,000 for each subsequent violation.


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

Under the bill, a "covered business" is defined as a sole proprietorship, a partnership, a limited liability company, a corporation, an association, or another legal entity, or an affiliate of such a legal entity, that:

• Conducts business in the state and generates a majority of its annual revenue from online services;

• Makes available online gaming services, products, or features that are reasonably likely to be accessed by a user who is a minor or who the covered business labels as a minor (covered minor);

• Collects users' personal data or has users' personal data collected on its behalf by a processor; and

• Solely or jointly with others determines the purposes and means of the processing of users' personal data.

The bill states that a covered business that processes the personal data of a covered minor owes a minimum duty of care to the covered minor. The bill also requires a covered business to:

• Configure default privacy settings provided to a covered minor to the highest level of privacy and to include certain default settings;

• Provide a prominent, accessible, and responsive tool to allow a covered minor to request that the covered minor's account be unpublished or deleted and, if the business receives such a request, to honor it within 15 days; and

• Immediately delete all data that relates to the determination of a user's age after it is determined that the user is a covered minor.

The bill prohibits a covered business from:

• Providing a covered minor with a single setting that makes all of the default privacy settings less protective at once;

• Requesting or prompting a covered minor to make their privacy settings less protective;

• Collecting, selling, sharing, or retaining personal data of a covered minor that is not necessary to provide an online gaming service, product, or feature with which the covered minor is actively and knowingly engaged;

• Using previously collected personal data of a covered minor for any purpose other than a purpose for which the personal data was collected;

• Permitting an individual to monitor the online activity of a covered minor or to track the location of the covered minor without providing a conspicuous signal to the covered minor when the covered minor is being monitored or tracked;

• Using the personal data of a covered minor to select, recommend, or prioritize media for the covered minor unless the covered minor makes certain requests or takes certain actions warranting such conduct by the covered business; or

• Sending push notifications to a covered minor between 12 midnight and 6 a.m.

The bill imposes additional specific requirements and prohibitions for a covered business that collects users' personal data for the purpose of conducting age assurance.

The bill requires a covered business to ensure that the purchase price for an online gaming service, product, or feature that is made available through the covered business's online gaming service, product, or feature and that is reasonably likely to be accessed by a covered minor is listed in United States dollars at the point of sale.

A covered business shall impose and collect a fee on each add-on transaction that is conducted by a covered minor through the covered business's online gaming service, product, or feature. The amount of the fee is 5% of the amount of the transaction. Money collected as such fees is credited to the state public school fund.

The bill requires a social media platform to provide certain information on its website or mobile application concerning privacy policies and the use of algorithms. A social media platform is prohibited from using an algorithmic recommendation system to sell or otherwise distribute an illicit substance to a covered minor.

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

     The act requires that school districts test the vision of students in pre-kindergarten, in addition to testing the vision of students in kindergarten and the first, second, third, fifth, seventh, and ninth grades.

     The act updates terminology by replacing the word 'sight' with the word 'vision'.


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

     The act prohibits individuals lawfully permitted to provide psychotherapy services in the state (regulated professionals) from allowing an artificial intelligence system (AI system) to interact with clients in any form of therapeutic communication without synchronous, real-time interaction between the regulated professional, the AI system, and the client, or generate therapeutic recommendations or treatment plans without review and approval by the regulated professional.

     Except for educational, administrative, simulation, or training purposes or as part of a research program, a regulated professional shall not use an AI system to provide, direct, or guide psychotherapy, clinical intervention, counseling, diagnosis, treatment planning, or other activity that constitutes the practice of psychotherapy with an individual or group unless the use satisfies the conditions specified in the act. At initial client contact, a regulated professional shall inform clients of the prohibitions regarding use of AI systems in the practice of psychotherapy. Regulated professionals may be disciplined by the appropriate licensing board in the department of regulatory agencies for violations of this act.

     The act allows regulated professionals to use an AI system to assist in providing administrative support or supplementary support, as these terms are defined in the act, for psychotherapy services if the regulated professional maintains responsibility for reviewing any outputs of the AI system used to provide administrative support or supplementary support. If a client's therapeutic session will be recorded or transcribed through the use of an AI system, the regulated professional must disclose in advance the use of an AI system and the purposes for its use, and obtain written, informed consent from the client.

     The act does not prohibit a regulated professional from using an AI system within accredited or approved educational, instructional, or professional training programs, so long as the AI system is used solely for educational, administrative, simulation, or training purposes and is not deployed, marketed, or represented as a tool for use with clients, patients, or the public. Further, a regulated professional may be involved in the development, testing, or evaluation of an AI system solely for research purposes under the oversight of a federally registered institutional review board, so long as the AI system is not offered to consumers or used outside of the research setting.

     The act does not apply to regulated professionals who use or recommend the use of technology in the state that does not diagnose or treat mental health disorders, clearly discloses that the technology is not a substitute for clinical care, and:

• Provides self-help, therapeutic homework, coaching, patient navigation, guided meditation, journaling, or other tools specified in the act; or
• Is regulated by the federal food and drug administration.

     Except as provided in the act, the act also makes it an unfair or deceptive trade practice under the 'Colorado Consumer Protection Act' for an individual, corporation, or entity (person) to use any term, letter, or phrase in the use of an AI system in a manner that:

• Indicates or implies that the AI system's outputs are provided by, endorsed by, or equivalent to services provided by a regulated professional;
• Represents that the AI system provides psychotherapy services; or
• Represents that a user's data is confidential in a manner that would lead a reasonable user to believe that the privacy of their data is protected in a manner similar to therapist-client confidentiality.

     The act does not impose liability on a regulated professional for defects in or failures of an AI system that are attributable to the developer or deployer of the AI system.

     Further, under conditions specified in the act, nothing in the act prohibits a person from developing, testing, or evaluating an AI system solely for research purposes or using an AI system in educational, instructional, or training programs. In addition, it is not an unfair or deceptive trade practice for a person to use a technology that does not diagnose or treat mental health disorders, clearly discloses that the technology is not a substitute for clinical care, and:

• Provides self-help, therapeutic homework, coaching, patient navigation, guided meditation, journaling, or other tools specified in the act; or
• Is regulated by the federal food and drug administration.
  
  (Note: This summary applies to this bill as enacted.)

The bill requires that if a statewide high school activities association (association) requires a physical examination and written clearance from a health-care provider before a student may play or participate in a supervised team athletic activity, the association shall permit a licensed physical therapist to provide the physical examination and written clearance for the student to play or participate.(Note: This summary applies to this bill as introduced.)

     On or before December 1, 2026, and annually thereafter, the act requires each transportation broker that administers nonemergency medical transportation to medicaid members to submit certain information to the department of health care policy and financing (state department) regarding transportation providers that the transportation broker contracts with. Beginning January 1, 2027, the state department is required to include this information in its annual 'SMART Act' presentation.

     The act changes the term 'qualified alien' to 'qualified noncitizen' to align with federal requirements.

     If the state department plans to implement, apply, or enforce new multiple procedure payment reductions for outpatient therapy services, the act requires the state department to provide notice to the impacted providers of the changes at least 6 months prior to implementing the changes and to hold at least one stakeholder meeting to discuss the payment reductions.

     The act requires the state department to reimburse a provider who is licensed and authorized to prescribe, dispense, compound, or administer medication-assisted treatment in a jail setting.

     The act requires the medical services board to adopt rules before January 1, 2027, to comply with federal community engagement requirements and requires the state department make available on its website data on the community engagement requirements and their impact on medical assistance enrollment.

     The act requires the state department to collect direct care service cost to administrative cost ratio information from home- and community-based service provider agencies and submit a report to the general assembly detailing the information collected.

     The act repeals the state medical assistance and services advisory council.


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

     The act declares emergency medical services as an essential service in the state and an integral part of the state's health-care infrastructure.

      The act also declares that emergency medical service providers, whether responding on duty or as a volunteer and regardless of location, provide essential services when providing emergency ambulance services and nonemergency ambulance services.

     The act also updates certain definitions related to emergency medical services, including the addition of a definition of 'out-of-hospital services', which term is defined to mean the furnishing of necessary health-care goods and services outside of a hospital setting but does not include prehospital setting transports.

     The act clarifies that an off-duty emergency medical service provider is not obligated to respond to the scene of a medical emergency or provide emergency medical services.


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

     In current law concerning contracts with health-care providers, an entity wishing to make a material change to such a contract must provide written notice of the change to the health-care provider (provider) at least 90 days before the effective date of the change. The bill adds language requiring a person to give such written notice two separate times by standard electronic means and, if the provider has not affirmatively responded, a third time by registered mail and by email or personal service to the health-care provider or administrator who signed the contract. and The bill adds a reference to this language in the area of the Colorado Revised Statutes concerning health-care insurance carriers.

(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 requires the department of public health and environment (department) to annually license, and to establish and enforce standards for the operation of, facilities that are not currently required to be licensed by the department and that perform medical or surgical induced abortions during the second or third trimester of pregnancy.

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

     The act provides that, if the action is undertaken in accordance with applicable federal and state law:

• A licensed person may compound a drug or device in the state;
• A state-licensed pharmacy or a distribution facility registered with the federal food and drug administration (licensed 503B outsourcing facility) may supply a compounded drug or device to a licensed health-care provider, pharmacy, facility, or organization; and
• A licensed health-care provider, pharmacy, facility, or organization may obtain, dispense, or administer a compounded drug or device supplied by a state-licensed pharmacy or a licensed 503B outsourcing facility.

     In addition, the act prohibits the state board of pharmacy from adopting rules that are more restrictive than federal or state law regarding the compounding of drugs or devices by licensed 503B outsourcing facilities.

     Current law exempts drugs that are intended solely for investigational use by experts qualified by scientific training and experience and that are plainly labeled for investigational use only from the sales and delivery prohibition for new drugs. The act also exempts from the prohibition:

• Drugs that are reviewed by an institutional review board and plainly labeled for investigational use only; and
• Compounded drugs and devices if the compounding of the drug or device is undertaken in accordance with applicable federal and state law.
  
  (Note: This summary applies to this bill as enacted.)

     The act defines a 'conversational artificial intelligence service' as an artificial intelligence system that is accessible to the general public and that primarily simulates human conversation and interaction through adaptive textual, visual, or aural communications.

     Effective January 1, 2027, the act creates requirements and prohibitions for a person, partnership, corporation, or entity that develops and makes publicly available a conversational artificial intelligence service or offers a conversational artificial intelligence service to a consumer (operator).

     An operator is required to use commercially reasonable methods or generally accepted methods to estimate the age of a consumer who has or opens an account or profile to use a conversational artificial intelligence service (account holder) and the age of other users of a conversational artificial intelligence service. If an operator knows that an account holder or user is a minor, an operator is:

• Required to provide certain disclosures;
• Prohibited from providing the minor account holder or minor user with points or rewards to encourage engagement with the conversational artificial intelligence service;
• Required to institute technically feasible measures to prevent the conversational artificial intelligence service from producing explicit sexual conduct, intimate digital depictions, or statements that simulate emotional dependence;
• Required to implement a protocol for a conversational artificial intelligence service to stop engaging in response to a user prompt regarding sexual conduct with a minor; and
• Required to provide tools for the minor account holder or minor user or a parent or guardian of the minor account holder or minor user to manage the minor account holder's or minor user's privacy and account settings.

     The act also requires an operator to provide a disclosure to a user that a conversational artificial intelligence service is artificial intelligence, implement a protocol for user prompts regarding suicidal ideation or self-harm, and annually report to the attorney general's office information regarding the protocol the operator is implementing. The act prohibits an operator from stating that any output data provided by a conversational artificial intelligence service is provided by, endorsed by, or equivalent to services provided by certain licensed or certified professionals.

     The act clarifies that nothing in the act limits an individual's ability to access certain information and resources pursuant to the state constitution, requires an operator to disclose confidential information, or authorizes content moderation practices inconsistent with the United States constitution.


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

The bill adds to the list of impermissible collection actions that a medical creditor is prohibited from using when collecting on a medical debt. Current law requires a medical creditor to comply with certain conditions and notify a patient with medical debt 30 days before taking any permissible extraordinary collection actions. In addition to providing notice before taking any permissible extraordinary collection actions, the bill requires a medical creditor to notify a patient 30 days before collecting, transferring, selling, or assigning a medical debt, and to verify the patient has been screened for public health insurance programs and discounted care. The bill requires a medical creditor to offer a reasonable payment plan to each patient with medical debt. If the medical creditor violates the requirements for selling, transferring, or assigning medical debt, or undertaking collection activities, the patient is entitled to damages in the amount of $3,000 or actual damages, whichever is greater.(Note: This summary applies to this bill as introduced.)

     The act requires a court to sentence a defendant convicted of second degree assault by strangulation in an enhanced range as a crime of violence subject to mandatory incarceration if the defendant has previously been convicted of second degree assault by strangulation. A previous conviction must be set forth in the complaint, indictment, or information for the present act.


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

     The act:

• Continues the functions of the Colorado medical board (board) for 9 years until September 1, 2035, pursuant to the provisions of the sunset law;
• Exempts from the practice of medicine for which a license is required an individual who is facilitating natural medicine services within the scope of a natural medicine facilitator license;
• Changes the license renewal period for a distinguished foreign teaching physician and for a temporary distinguished foreign teaching physician from annual renewal to a renewal period determined by the board, so long as the physician is still serving on the academic staff of a medical school;
• Authorizes the president of the board to serve as a full member of the board's licensing panel for licensing panel meetings; and
• Authorizes the board, on and after January 1, 2027, to issue an administrative license to a physician who engages in the teaching or instruction of a medical student, resident, or fellow that does not involve direct patient care, including teaching or instruction activities such as curriculum management; mentorship; participation in team-based discussions; evaluation of diagnostic decision-making, clinical reasoning, or patient prioritization; providing feedback; or providing certain services that are purely administrative in nature, such as research design and analysis and other roles that require a medical license, but that do not involve treating patients or prescribing medication. A physician with an administrative license is required to have medical liability insurance and is exempted from continuing medical education requirements.
  
  (Note: This summary applies to this bill as enacted.)

     The act defines school zones as all roadways within at least 1,000 feet of a school property boundary, except state highways unless they are designated as part of a school zone with the written approval of the Colorado department of transportation, and including school zones established before August 12, 2026, that are 200 feet or more from a school property boundary. A school zone must have appropriate signs posted indicating it is a school zone and that the penalties and surcharges within the school zone will be doubled.

     The act allows a local government that has jurisdiction over a school zone to reduce the size of a school zone after first holding a public hearing, but the act does not allow a school zone to be reduced to less than 200 feet from a school property boundary. Additionally, the act does not prohibit local governments from expanding school zones to beyond 1,000 feet from a school property boundary.

     The act limits requirements the state, a county, a city and county, or a municipality must complete regarding placing and using an automated vehicle identification system along a safe route to school.

     The act allows a local government to designate a portion of a roadway immediately adjacent to a school property boundary as a school street and requires the local government to post signs indicating it is a school street if the local government has jurisdiction to do so. The local government may close a school street to traffic. If there is traffic on the school street, the maximum speed limit is 10 miles per hour and vehicles must yield the right-of-way to pedestrians, bicyclists, or micromobility users. The local government may suspend additional traffic provisions on the school street that endanger pedestrians, bicyclists, or micromobility users.


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

     The act implements recommendations of the department of regulatory agencies' (department) sunset review and report on the division of professions and occupations in the department.

     Sections 1 and 2 of the act allow a regulator to delegate authority for administrative tasks authorized by statute or other tasks specifically authorized through the policy of a board or commission to a designee at the regulator's discretion.

     Section 3 changes the amount of time a licensee, certificate holder, or registrant (licensee) who receives a letter of admonition has to request a hearing to within 25 days after the date of issuance of the letter of admonition, rather than within 20 days after receipt of the letter.

     Sections 3 through 22 clarify that a regulator may provide communications to licensees through email.

     In current law, the executive director of the department collects an excise tax of $1 upon the payment of fees for the renewal of a license, registration, or certificate. Section 23 changes the term used to refer to this payment from an 'excise tax' to an 'additional fee'.

     Sections 25 through 30 restore provisions repealed in 2024 by House Bill 24-1329 concerning the continuation of the state board of licensure for architects, professional engineers, and professional land surveyors, regarding enrollment by endorsement for engineer-interns and land surveyor-interns and licensure by endorsement for professional engineers and professional land surveyors.


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

     The act establishes the ibogaine research pilot program (pilot program) in the behavioral health administration (BHA) to research the safety and effectiveness of using ibogaine to treat mental health conditions and substance use disorders. The act requires the BHA to establish a committee to review pilot program site applications and make recommendations to the BHA on which applicants to accept. The BHA may select up to 5 ibogaine pilot sites. The act allows the BHA to seek, accept, and expend gifts, grants, and donations and establishes the ibogaine research pilot program cash fund. The pilot program is contingent on the BHA receiving sufficient gifts, grants, and donations to administer the pilot program and award grants to the selected ibogaine pilot sites to help with financing needs.

     Under current law, the division of natural medicine advisory board consists of 15 voting members, 8 of whom must have general expertise and experience related to natural medicine and 7 of whom must have specialized expertise and experience in various areas of natural medicine. The act amends the expertise and experience requirements to apply equally to all 15 voting members.

     The act adds that a facilitator of natural medicine services is not liable for a physical or psychological injury that a participant may experience as a result of the facilitator's performance or supervision of the natural medicine services that a participant receives, unless the injury is the result of the facilitator's intentional misconduct, gross negligence, or a deviation from the recognized standard of care.

     The act authorizes the state licensing authority for natural medicine or natural medicine product (state licensing authority) to adopt rules related to the administration, manufacturing, and use of ibogaine.

     The act sets requirements for how the state licensing authority must prioritize reviewing applications for licensure to facilitate natural medicine services and allows the state licensing authority to set different licensing fees depending on the type of natural medicine the applicant is seeking licensure for.

     The act allows the state licensing authority to accept gifts, grants, and donations from public or private sources and requires gifts, grants, or donations received to be deposited in the regulated natural medicine division cash fund.

     The act requires the BHA to work to secure federal research and development funding available through the advanced research projects agency for health within the federal department of health and human services, or other available funding, in order to advance research on the use of ibogaine for the treatment of serious mental illness.

     The act updates the powers and duties of the director of the division of professions and occupations to include adopting rules that guide the use and administration of ibogaine.

     A licensee seeking to cultivate, manufacture, dispense, or administer ibogaine shall, in consultation with Indigenous communities, establish a benefit-sharing plan that directly benefits those Indigenous communities.

     The act:

• Updates definition of 'administration session' to include the use of regulated natural medicine and regulated natural medicine product that the participant purchases to consume during the administration session;
• Prohibits a person from advertising bona fide harm reduction services or bona fide support services offered for remuneration, advertising natural medicine or natural medicine products, or using harm reduction services or support services to conduct sales of natural medicine;
• Clarifies that the state licensing authority is not required to conduct routine, periodic, or pre-operational inspections as a condition of licensure unless expressly required;
• Requires state licensing authority to adopt rules regarding licensing privileges and restrictions of a limited regulated natural medicine sales license and eligibility requirements for an applicant to obtain a limited regulated natural medicine sales license;
• Allows the state licensing authority to adopt rules regarding the application procedures and license requirement for a healing center to operate a temporary premises; and requirements for cultivation, manufacture, testing, or dispensing of ibogaine;
• Allows the department of public health and environment to issue a temporary premises permit to a licensed natural medicine healing center if certain conditions are met and allows a healing center to apply for a temporary premises permit;
• Prohibits a healing center licensee from selling regulated natural medicine or regulated natural medicine product unless a co-located limited regulated natural medicine sales licensee conducts the transaction in accordance with certain requirements; and
• Allows the director of the natural medicine division to issue an order to cease and desist if the director determines that a person is acting or has acted without a license to operate a natural medicine business or to own, grow, harvest, transfer, manufacture, supervise, provide, or administer natural medicine.
  
  (Note: This summary applies to this bill as enacted.)

     The bill creates the large employer health-care support enterprise (enterprise) to impose, assess, and collect the large employer health-care support fee (enterprise fee) in the amount of $2,300 for each supported worker for the calendar year in an amount determined by the enterprise board (enterprise board) that reflects the costs of the services provided by the enterprise . A worker who is receiving medical assistance benefits under the state medical assistance program, except for a worker eligible for medical assistance benefits based on disability, is a supported worker (supported worker).

     An employer is subject to the enterprise fee if the employer is a large employer, which is defined in the bill as an employer that has 500 or more supported workers (large employer). An employer is exempted from paying the enterprise fee if the employer:

• Provides affordable health coverage to all workers working 20 or more hours per week or 80 or more hours per month;
• Is a franchisee of the employer;
• Is a nonprofit employer;
• Is a public employer; or
• Has a collective bargaining agreement with its employees that includes health-care coverage.

     The business purpose s of the enterprise are to use enterprise fee revenue to help large employers retain supported workers who are not provided employer-sponsored affordable health coverage by using enterprise fee revenue to:

• Help finance the costs for medical assistance benefits for large employers' supported workers ; and
• Provide reimbursement grants to large employers for some or all of an employer's costs incurred for allowing a worker to buy into an employer-sponsored health benefit plan, should the employer choose to participate in the worker buy-in program created in the bill.

This These business service s reduce s lost productivity due to worker illness and training costs to replace workers who may otherwise seek employment that provides affordable health coverage.

     Starting with a review of the 2027 calendar year, the department of health care policy and financing (HCPF) every employer that employed 500 or more workers in the state shall prepare an annual employer report on or before January 31, 2028, and on or before the same date each year thereafter, that includes information about the employer's employees, including the employee's name, date of birth, hours worked, and dates of employment for the preceding calendar year. An employer may seek an exemption from the requirement to file the annual employer report by demonstrating that it provides affordable health coverage to all workers working 20 or more hours per week or 80 or more hours per month. Upon receipt of the annual employer report, the enterprise shall determine whether an employer is a large employer and shall issue a report by March of the following same calendar year that identifies large employers by their number of supported workers for the preceding calendar year and impose the enterprise fee on each large employer . An employer may contest the employer's identification as a large employer. Once identified, a large employer shall either pay the enterprise fee for each of the large employer's supported workers or demonstrate that it provides will offer affordable health coverage to all workers working 20 or more hours per week or 80 or more hours per month. The enterprise may adjust the amount of the enterprise fee to reflect the cost of the services, for inflation, or for other reasons. A large employer commits a petty offense and is subject to a civil penalty for

      The enterprise shall contract with the department of revenue to collect and enforce the payment of the enterprise fee on behalf of the enterprise, including the failure to provide information necessary to calculate the enterprise fee or to either timely pay the enterprise fee or demonstrate that the large employer offers affordable health coverage as specified in the bill. The department of revenue may collect interest and penalties and institute collection actions on behalf of the enterprise.

     Enterprise revenue is used to support the pay for payment of medical assistance benefits for working-age adults under the state medical assistance program, and to increase reimbursement rates for ensure access to health-care providers providing medical assistance program services, to ensure worker access to medical services and to pay for large employer reimbursement grants under the worker buy-in program for large employers that pay the enterprise fee.

     The enterprise is governed by the enterprise board, and the enterprise board shall report annually to the general assembly on the enterprise revenue and the enterprise's use of the enterprise revenue in support of large employers.

     If the enterprise determines that the enterprise to would receive more than $100 million dollars in its first 5 fiscal years, the state treasurer shall credit the additional fee revenue to the large employer fee cash fund created in the state treasury for administration by HCPF, and that fee revenue is subject to the state fiscal year spending limit imposed by section 20 of article X of the state constitution and the excess revenues cap. The money in the large employer fee cash fund shall be used by HCPF to pay for costs for medical assistance benefits to support large employers' supported workers enterprise shall reduce the amount of the enterprise fee.

(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 act requires an institution of higher education (institution) that operates a student health center to provide abortion medication to all students enrolled at the institution.

     The act requires an institution that has an on-site prescription drug outlet or other outlet to maintain a stock of and provide access to abortion medication to students enrolled at the institution.

     The act requires an institution that does not have an on-site prescription drug outlet or other outlet to either submit a prescription for abortion medication to an off-campus prescription drug outlet or other outlet or dispense abortion medication through the institution's student health center if permitted by the student health center's licensure.

     The act prohibits an institution from knowingly providing personally identifiable information contained in a student's patient records, billing records, or precise location data related to accessing abortion medication in response to a request from another state seeking to impose liability for accessing abortion medication.

     An institution is not required to provide access to or stock abortion medication if doing so would jeopardize an institution's federal grant participation, require the institution to deviate from generally accepted billing practices, modify the generally accepted standards of medical practice, or conflict with the institution's sincerely held religious beliefs or practices.


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

     If certain conditions are met, the act requires health benefit plans that provide hospital, surgical, or medical expense insurance to provide reimbursement for health-care services provided by a pharmacist that are within the pharmacist's scope of practice without entering into a collaborative pharmacy practice agreement. Similarly, under the medical assistance program (medicaid), the act authorizes reimbursement for services that are within a pharmacist's scope of practice and not duplicative of other pharmacist services or programs reimbursed by medicaid.

     Further, solely on the basis of the type of license or certification, a health benefit plan or health insurance company (carrier) shall not discriminate against a pharmacist who is acting within the scope of the pharmacist's license or certification under state law, with respect to participation, referral, reimbursement of covered services, or indemnification, or prohibit a pharmacist from membership in a provider network; except that, in selecting pharmacist providers, the act does not:

• Prohibit a health benefit plan or carrier from including providers in its provider network only to the extent necessary to meet the needs of the plan or from limiting referrals or establishing quality control measures;
• Require a health benefit plan or carrier to contract with any provider willing to abide by the terms and conditions for participation established by the health benefit plan or carrier; or
• Require coverage for any health-care service that is not otherwise covered.

     The act makes changes to the definitions in the pharmacy practice statutes to include a definition for 'final product verification'. For drug, device, or product orders that are not for controlled substances, final product verification may be delegated by a supervising pharmacist to a certified pharmacy technician or pharmacy intern. A pharmacy or other outlet shall have a continuous quality assessment system in place to periodically verify the accuracy of the final drug, device, or product and must create a plan for final product verification, including how pharmacists' hours will be maintained to provide direct patient care. The state board of pharmacy is required to adopt rules relating to final product verification no later than December 31, 2026.

     Under current law, a pharmacist may administer certain tests to patients who are 12 years old or older for certain conditions and prescribe drugs to treat the tested conditions. The act adds to the definition of the 'practice of pharmacy' independent prescriptive authority for drugs that are not controlled substances, drug categories, or devices that are prescribed to patients who are 5 years old or older but under 12 years old for conditions that do not require a new diagnosis, that are minor and self-limiting, or that have a test that guides diagnosis and are not medications that may only be prescribed pursuant to a certified education program and a limited distribution network. If a pharmacist tests or treats any patient who is under 18 years old, the act requires a pharmacist to notify the patient's primary care provider consistent with health-care privacy laws or, if the patient does not have or disclose a primary care provider, refer the patient to a primary care provider for further care.


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

     The act continues the functions of the Colorado podiatry board (board) for 9 years until September 1, 2035, pursuant to provisions of the sunset law.

     The act requires a licensed podiatrist (licensee) to develop a written plan to ensure the security of patient medical records, including the proper storage and disposal of records, the disposition of medical records in the event the licensee dies, retires, or otherwise ceases to practice, and the method by which a patient may access or obtain records if such events occur. A licensee shall attest to compliance with the requirement upon initial licensure and upon renewal of the license. A licensee who fails to comply with the requirements of the act is subject to discipline by the board.


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

     Beginning on or before July 1, 2028, the act extends certain application, accounting, and notice provisions already in place for federal survivor benefits awarded to a child or youth who is in foster care (child or youth) to federal supplemental security income benefits (SSI), which are monthly payments awarded to a child or youth with a disability and limited resources. The act adds requirements for a county department of human or social services (county department) to follow specified procedures for identifying a child or youth with a disability who may qualify for SSI and for documenting the disability. If the county department determines that a child or youth may be eligible to receive SSI, the county department is required to initiate the application process within 45 days after receiving certain information. If a child or youth is receiving SSI, the county department must document how the money is spent in the state's child welfare case management system.

     If legal custody of a child or youth receiving SSI or federal survivor benefits is transferring from a county department to another individual, the act requires the county department to reassess the designation of the representative payee or fiduciary receiving and managing federal benefits on behalf of the child or youth. The reassessment must be performed in consultation with interested parties and in compliance with federal requirements.


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

     The act limits the benefits pregnant women and children with a certain family household income and citizen or immigration status are eligible for under the state medical assistance program and the medical assistance program.

     Eligible pregnant women and children are subject to the following limitations on benefits:

• Beginning July 1, 2026, there is an annual cap on dental services in the amount of $1,100;
• Beginning January 1, 2027, behavioral health services offered must be provided on a fee-for-service basis only;
• Beginning January 1, 2027, services offered through the accountable care collaborative are no longer covered; and
• Beginning January 1, 2027, managed care services through the medical assistance program are no longer covered.

     Beginning January 1, 2027, children under 19 years old whose family household income does not exceed 260% of the federal poverty line, adjusted for family size, and who are not eligible for the medical assistance program due to their immigration status, are not eligible for home- and community-based services, community first choice, long-term home health, private duty nursing, hospice care, and nursing home care unless those children already receive those services on or before December 31, 2026.

     Beginning January 1, 2027, the act caps enrollment of children in the state medical assistance program at 25,000 children if either enrollment exceeds 25,000 or the expenditures for a fiscal quarter exceeds one-quarter of the appropriation for state medical assistance plus 5% to account for seasonality fluctuations. If one of the conditions is met, the enrollment cap begins on the first day of the month following 60 days after the department of health care policy and financing (state department) determines that the condition was met.

     The act repeals provisions requiring the state department to develop an outreach and enrollment strategy for enrolling eligible groups into new coverage options and repeals the state children's basic health plan.

     The act appropriates $3,378,166 from the general fund to the state department to implement the act and reduces appropriations to the state department by $14,202,723 if certain conditions are met.


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

     The act caps at $400 the amount that a health-care entity or health-care provider may charge for a record request made by a patient's attorney or the attorney of the patient's personal representative pursuant to an authorization in compliance with the federal 'Health Insurance Portability and Accountability Act of 1996', a valid subpoena, or a valid court order, if the requested record exceeds 664 pages. The health-care entity or health-care provider may charge a reasonable fee above the cap if the record request requires the health-care facility or health-care provider to segregate, withhold, or redact protected health information in order to comply with applicable law or the scope or limitations of the authorization in compliance with the federal 'Health Insurance Portability and Accountability Act of 1996', a valid subpoena, or a valid court order.

     Beginning January 1, 2028, and every even-numbered year thereafter, the act requires the $400 limit to be adjusted for inflation.

     The act requires the requested medical records to be delivered in electronic format if the requestor requests electronic format, the original records are stored in electronic format, and the records are readily producible in electronic format.

     The act requires the health-care facility or health-care provider to provide the requestor with an invoice for the records provided in response to the record request within 30 days of receiving the request, and the health-care facility or health-care provider must provide the records upon payment of the invoice.

     If the health-care facility or health-care provider is unable to comply with the request for records within 30 days after the request, the health-care facility or health-care provider must send written notice of a 30-day extension to the requestor. The health-care facility or health-care provider must provide the records to the requestor at no cost if the records were not provided within 30 days or without written notice of an extension, unless the delay is due to a force majeure event. In the case of a force majeure event, the health-care facility or health-care provider must provide written notice to the requestor within 5 business days of becoming aware of the force majeure event. The 30-day time frame to respond to a request for records commences upon resolution of the force majeure event.


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

     The act requires each covered social media platform (covered platform) to impose a fee on each add-on transaction that occurs on the covered platform. The act creates the youth mental health services access enterprise in the behavioral health administration (BHA) to use the fee revenue to operate and fund programs that provide youth mental health services. The youth mental health services access enterprise constitutes an enterprise for purposes of section 20 of article X of the state constitution.

     The act defines a 'covered platform' as a sole proprietorship, a partnership, a limited liability company, a corporation, an association, or another legal entity, or an affiliate thereof, that:

• Conducts business in this state;
• Generates revenue directly from add-on transactions conducted in an online gaming service, product, or feature;
• Generates a majority of its annual revenue from online gaming services, products, or features;
• Publishes one or more online gaming services, products, or features that are reasonably likely to be accessed by a youth;
• Collects users' personal data or has users' personal data collected on its behalf; and
• Determines the purposes and means of the processing of users' personal data.

     The act defines an 'add-on transaction' as a transaction through which a player or participant in a video game accessed via an online gaming service, product, or feature acquires:

• An item or ability that provides the player or participant an advantage over other players or participants of the video game; or
• A feature that alters or enhances the video game as accessed by the online gaming service, product, or feature.

     The act creates the youth mental health services access enterprise fund, consisting of money credited to the fund as fee revenue, any money received from the issuance of revenue bonds, and any other money that the general assembly may appropriate or transfer to the youth mental health services access enterprise fund. Money in the youth mental health services access enterprise fund is continuously appropriated to the youth mental health services access enterprise.

     After deducting its administrative expenses, the youth mental health services access enterprise is required to allocate the remaining fee revenue credited to the fund as follows:

• 40% to operate and fund the youth mental health peer navigator grant program, which program is created in the act;
• 35% to operate and fund the crisis resolution team program, which program is created in the act; and
• 25%, beginning January 1, 2028, to operate the existing youth mental health services program.

     The initial amount of the fee is 5% of the amount of the add-on transaction. On and after October 1, 2027, the youth mental health services access enterprise may adjust the amount of the fee.

     The act creates the youth mental health peer navigator grant program to award grants to entities that recruit and train young adults to provide prevention services, peer support, and system navigation to youth in schools or community-based settings.

     The act creates the crisis resolution team program to provide community-based de-escalation and stabilization services to youth who are experiencing high-acuity behavioral health crises and to their caregivers.

     Under current law, the BHA operates the youth mental health services program to facilitate access to mental health services, including substance use disorder services, for youth in response to mental health needs identified in an initial mental health screening through the program's web-based portal. The youth mental health services program reimburses providers for up to 3 mental health sessions with a youth. The act directs the youth mental health services access enterprise, rather than the BHA, to operate and fund the youth mental health services program beginning January 1, 2028. The act also allows the youth mental health services access enterprise to reimburse a provider for up to 6 mental health sessions with a youth.

     The act creates the youth programming and protections enterprise to:

• Award grants through the existing out-of-school time program grant program; and
• Support the department of education's enforcement of educational rights on behalf of children.

     The youth programming and protections enterprise constitutes an enterprise for purposes of section 20 of article X of the state constitution.

     The act creates the youth programming and protections enterprise fund. In each state fiscal year, after the state treasurer has credited $8 million to the youth mental health services access enterprise fund, the state treasurer must credit any other money received as fees to the youth programming and protections enterprise fund.

     Under current law, the department of education administers the out-of-school time program grant program and the state board of education awards grants from the program, subject to available appropriations. The act directs the department of education to consult with the youth programming and protections enterprise in administering the out-of-school time program grant program, and the act directs the youth programming and protections enterprise to award grants from the program in consultation with the state board of education. The act also requires the out-of-school time program grant program to provide programming and services that support the mental health and well-being of children and youth.

     The act requires a covered platform to ensure that the purchase price for an online gaming service, product, or feature that is reasonably likely to be accessed by a minor to be listed in United States dollars at the point of sale.

     For the 2026-27 state fiscal year, the act appropriates:

• $294,984 to the department of revenue from the general fund;
• $26,500 to the department of law from reappropriated funds;
• $145,750 to the department of law from the youth mental services access enterprise fund created in the act; and
• $79,500 to the department of law from the youth programming and protections enterprise fund created in the act.
  
  (Note: This summary applies to this bill as enacted.)

     Under existing law, an individual licensed, certified, registered, or enrolled in good standing to practice a particular profession or occupation in another state or United States territory or through the federal government is eligible to apply for and receive a license, certification, registration, or enrollment in that profession or occupation in Colorado (accreditation) if the individual meets specific criteria. The act adds an individual licensed, certified, registered, or enrolled in good standing to practice a particular profession or occupation in another country to those individuals eligible for accreditation if the individual meets specific criteria.


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

     The act repeals the health-care delivery system reform incentive payments program in the Colorado healthcare affordability and sustainability enterprise (enterprise) and creates the hospital quality incentive program (incentive program) to use enterprise hospital provider fee revenue to make additional payments to hospitals that meet performance metrics in delivering safer and more effective care that improves patient outcomes and reduces preventable utilization to reduce health-care costs. Prior to implementing the program, the enterprise board shall approve the percentage of hospitals' reimbursement in the incentive program and the incentive program structure, performance measures, and scoring methodology. Once the incentive program is implemented, the total amount of payments made under the incentive program must not exceed 9% of the total reimbursements made to hospitals in the previous state fiscal year.


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

     The act adds a co-responder who is part of a co-responder community response to the list of community members who may petition the court for an extreme risk protection order. Health-care facilities, behavioral health treatment facilities, school districts, the state charter school institute, K-12 charter schools, private schools, and institutions of higher education are established as institutional petitioners that may petition a court for an extreme risk protection order.


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

     The act requires a health insurance carrier that provides prescription drug benefits to require that:

• The utilization review requirements, including prior authorization and step therapy, for a non-opioid drug prescribed and approved by the federal food and drug administration (FDA) for the treatment or management of chronic or acute pain (non-opioid pain management drug) are no more restrictive than the least restrictive utilization review requirements for opioid drugs prescribed for the treatment or management of chronic or acute pain; and
• The cost-sharing, copayment, or deductible for a non-opioid pain management drug is not greater than the cost-sharing, copayment, or deductible for an opioid drug prescribed for the treatment or management of chronic or acute pain.

     The act requires each individual and small group health benefit plan issued or renewed on or after January 1, 2027, and each large employer health benefit plan issued or renewed on and after January 1, 2028, to ensure there is at least one non-opioid pain management drug available as a clinically appropriate alternative for an opioid pain management drug. If the division of insurance determines that coverage for a non-opioid pain management drug offered by individual and small group health benefit plans requires state defrayal of the cost of coverage, the requirement to make a non-opioid pain management drug available is inoperative.

     The state employee health benefit plan is excluded from the requirements of the act.

     The act appropriates $15,415 to the department of regulatory agencies for use by the division of insurance to implement the act.


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

     The act permits a health facility to allow patients who are terminally ill and who are registered in the state's medical marijuana program to use medical marijuana within the health facility, subject to certain parameters. The act requires a health facility that allows such use to document the patient's medical marijuana program registration and medical marijuana usage in the patient's medical records and develop guidelines for and impose restrictions on the possession, usage, storage, and administration of medical marijuana to ensure the safety of others, safe facility operations, and compliance with other laws. A health facility is not required to handle medical marijuana for a patient.

     The act prohibits the department of public health and environment (department) from requiring compliance with the act as a condition for a health facility to obtain or renew a license or certification that it is required to carry to operate as a health facility. Additionally, the act prohibits the department from requiring compliance if compliance would result in a violation of state law, a loss of federal funding, noncompliance with the federal medicare or medicaid programs, or noncompliance with accreditation or licensing requirements. Lastly, the act allows a health facility to suspend compliance with the act's provisions in the event that, and only as long as, a listed federal entity takes an action that requires the health facility to suspend its compliance with the act.


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

The bill establishes the adult mental health services program (program) to facilitate access for adults to mental health services, including substance use disorder services, and to respond to identified mental health needs. The program reimburses providers for up to 6 mental health sessions with an adult and may provide additional reimbursement, subject to available money. The adult mental health program enterprise (enterprise), created in the bill, creates, operates, and funds the program. The enterprise is required to enter into an agreement with a vendor to create or use an existing website or web-based application as a portal that is available to adults and providers to facilitate the program. The department of human services is required to annually report to the general assembly about the program.

The bill establishes the internet-enabled mental health access grant program (grant program) to award grants to entities that use the internet to facilitate mental health services. The enterprise administers the grant program. The enterprise shall annually report to the health and human services committees of the house of representatives and the senate about the grant program.

The bill creates the mental health services enterprise as a government-owned business within the behavioral health administration for the business purpose of imposing and collecting a surcharge on internet service account holders in Colorado and to use the surcharge revenue to create, operate, and fund the adult mental health services program and internet-enabled mental health access grant program. Each internet service provider shall collect from its account holders located in Colorado the mental health services access surcharge and remit the surcharge to the enterprise.

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

     The act:

• Increases the statewide base per pupil funding for the 2026-27 budget year by $208.60 to account for inflation;
• Sets a new statewide base per pupil funding amount for the 2026-27 budget year at $8,900.40; and
• Sets the total program funding for the 2026-27 budget year at $10,178,856,871.

     Under current law, there are 2 total program formulas that are used to determine a school district's total program, commonly referred to as the old formula and the new formula.

     A school district's funded pupil count is a figure that is used as a part of determining a school district's total program. Under the new formula, for the 2026-27 budget year and each budget year thereafter, a school district's funded pupil count is calculated by determining the greater of the school district's pupil enrollment for the applicable budget year or the average of the district's pupil enrollment for the applicable budget year and the immediately preceding 2 budget years.

     However, the act requires that when specified conditions are met, a school district's funded pupil count is the school district's online pupil enrollment for the budget year, plus the school district's supplemental kindergarten enrollment for the budget year, plus the school district's extended high school pupil enrollment for the budget year, plus the greater of:

• The school district's pupil enrollment for the budget year;
• An amount equal to 50% of the school district's pupil enrollment for the budget year, plus an amount equal to 30% of the school district's pupil enrollment for the preceding budget year, plus an amount equal to 20% of the school district's pupil enrollment for the budget year that is 2 years preceding the budget year; or
• An amount equal to 97% of the school district's pupil enrollment for the preceding budget year.

     A school district's cost of living factor is a figure that is used as a part of determining a school district's total program. Under the old formula and the new formula, the act requires the cost of living factor that was used for the 2025-26 budget year to apply in the 2026-27 budget year.

     Under current law, for the 2026-27 budget year, a district's total program is the greater of:

• The district's total program amount for the 2024-25 budget year; or
• The amount calculated for the 2025-26 budget year under the old formula plus an amount equal to 30% of the difference between the amounts calculated between the old formula and the new formula.

     The act clarifies that for the 2026-27 budget year, if the calculation under the new formula is less than the calculation under the old formula, then that district's total program for the 2025-26 budget year is the greater of:

• The district's total program amount for the 2024-25 budget year under the old formula; or
• The amount calculated for the 2026-27 budget year under the old formula.

     The act permits a school transformation grant recipient that is implementing a priority improvement or turnaround plan to use the grant award to plan for and implement rigorous redesign strategies.

     The act changes the provisions that determine the amounts of total program that school districts and the state charter school institute distribute to their charter schools. Related to the changes of these provisions, the act repeals at-risk supplemental aid for charter schools.

     The act exempts from a future repeal the general assembly's legislative declaration that using state education fund money for maintaining a website that explains major categories in the chart of accounts for local education providers is a permissible use of state education fund money.

     The act repeals the scheduled repeal of, resulting in a continuation of, a statute that authorizes contingency reserve fund payments to be used for rural or small rural school districts if an unusual financial burden would be caused by the withholding of local property taxes due to a delay in filing the audit report due to extraordinary problems that could not have been reasonably foreseen or prevented by the rural or small rural school district. The act adds an assistant superintendent, a vice principal, and an assistant principal to the list of eligible school employees who may receive a salary without a reduction in public employees' retirement association (PERA) benefits if the service retiree meets specified conditions.

     The act permits a local education provider to request that the department of education approve the local education provider's use of pencil and paper to complete any or every portion of a state assessment for grades 3 or 4 and requires that the local education provider be responsible for costs owed to the vendor that are associated with the administration of the assessment using pencil and paper.

     The act authorizes the state board of education to adopt rules that are necessary to determine the district of residence of a child with a disability for a circumstance that is not described under law.

     The act repeals the requirement that $500,000 be distributed to administrative units that enroll children with disabilities and instead requires that $1 million be distributed to fund reimbursements for administrative units that pay tuition or education expenses that ensure a free appropriate public education for a student in out-of-home placement who has an individualized education program.

     The act requires the department of education to engage stakeholders concerning public placements in facility schools and on the issue of whether to make recommendations concerning such placements to the state board of education regarding rules or to the general assembly regarding statutes.

     Under current law, each participating school food authority that satisfies certain requirements is eligible to receive a local food purchasing grant and an amount to increase wages or stipends for individuals employed to prepare and serve school meals. The act clarifies that a charter school that operates under a participating school food authority is eligible for the awards.

     The act:

• Prohibits a board of cooperative services (BOCES) from acting as a statewide authorizer of programs or schools; and
• Limits a BOCES to operating a school or program outside the geographic boundaries of its school district members, unless specified conditions are satisfied.

     The act permits a local education provider to offer one or more part-time programs for homeschool students if specified conditions are satisfied.

     The act requires an authorizer contracting with an education management provider to maintain appropriate independence from, and oversight of, the education management provider. The act prohibits a school district from creating a contract school that is a full-time complete educational program offered exclusively by a private entity pursuant to a contract with the public entity.

     The act appropriates:

• $3,755,558 to the department of education from the state education fund for the state share of districts' total program;
• $313,395 to the department of education from the state education fund for management and administration for information technology services and for use by school district operations for administration related to public school finance; and
• $3,385,203 to the department of education from the state education fund for school district operations for costs associated with holding charter schools harmless for changes in the distribution of total program funding.

     The act adjusts the 2026-27 long bill by decreasing:

• $8,502,195 from the appropriation from the state education fund to the department of education for the state share of districts' total program funding; and
• $3,504,995 from the appropriation from the state education fund to the department of education for use by school district operations for at-risk supplemental aid.
  
  (Note: This summary applies to this bill as enacted.)

The bill creates an income tax credit for a resident individual's contributions to a health savings account that supports a high deductible health plan, as defined pursuant to federal law (credit). The credit is an amount equal to 25% of the amount of the contribution, limited to:

• $500 for a single filer;
• $1,000 for joint filers; and
• $1,500 for contributions to a family health plan.

The credit is available beginning January 1, 2027, through December 31, 2032.

If the credit exceeds the income taxes due on the resident individual's income, the amount of the credit not used to offset income taxes is not carried forward as tax credits against the resident individual's subsequent years' income tax liability and is not refunded to the individual.

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

     The act exempts from schedule I a prescription drug product containing a schedule I controlled substance (product) if the product is:

• Approved for prescription use by the United States food and drug administration;
• Designated or rescheduled by the United States drug enforcement agency (DEA);
• Dispensed by a pharmacy or prescription drug outlet, or administered by an authorized practitioner; and
• Possessed by a person who is authorized to possess a controlled substance.

     The exemption applies upon the DEA's designation or rescheduling.

     The act requires that the product be controlled in Colorado in the same manner as the product is controlled by the DEA and state law.

     The act clarifies that its provisions do not apply to or affect the regulation of or lawful actions or conduct concerning natural medicine, natural medicine product, marijuana, or marijuana concentrate.


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

     The act amends the law and adds new provisions to law relating to access to vaccines as follows:

     For the cervical cancer vaccine: (Sections 3 and 14)

• Updates insurance coverage statutes to refer to the vaccine as the human papillomavirus vaccine, rather than the cervical cancer vaccine;
• Recognizes coverage for both women and men;
• Authorizes the commissioner of insurance to adopt coverage rules for the vaccine if the advisory committee on immunization practices to the centers for disease control in the federal department of health and human services (ACIP) no longer recommends the vaccine; and
• Updates language in the cervical cancer immunization program to define the cervical cancer vaccine as the human papillomavirus vaccine and to refer in the program to underinsured minors, rather than just uninsured female minors, since both male and female minors receive the vaccine;

     Under Colorado law, a naturopathic doctor must provide a parent or legal guardian with a copy of the most recent schedule of immunizations recommended by the ACIP. The act removes references to ACIP and requires a naturopathic doctor to refer patients to a schedule of immunizations established by rule of the state board of health (board of health) (Sections 4 and 5);

     The act authorizes pharmacists to exercise independent prescriptive authority for vaccines and requires the state board of pharmacy to review and repeal record-keeping rules for vaccines (Sections 6 and 7);

     In the context of vaccines required for school entry, updates vaccine-related liability limitation provisions to limit liability for injuries if the vaccine was administered to a child of any age according to the schedule of immunizations established by the board of health or to ACIP's schedule referenced in Colorado law (Section 8);

     The act also does the following:

• Directs the board of health, in adopting rules addressing which vaccines are to be administered to infants, to consider the recommendations of ACIP, as well as the recommendations of the American Academy of Pediatrics and other similar entities (Section 9);
• Removes the prohibition on the use of state money for infant immunization programs if the state does not receive federal money for the infant immunization programs, and requires any additional general fund money for the programs to be appropriated through the annual state budget process or emergency supplemental process (Section 10);
• For claims brought on or before January 30, 2029, adds pharmacies, manufacturers, and wholesalers to liability limitation provisions for hospitals, clinics, and other providers relating to the handling, storage, and distribution of vaccines for infants. Manufacturer and wholesaler liability limitation provisions are removed from the law for claims brought on or after January 31, 2029 (Section 11).
• Authorizes the department of public health and environment to consider vaccines adopted by the board of health by rule, recommendations of the American Academy of Pediatrics and other similar entities, in addition to ACIP, in recommending the purchase of vaccines, sending notifications concerning overdue vaccines and vaccine-preventable disease outbreaks, and when considering equivalent vaccines (Section 12).

     The act creates the 'Adult Immunization Act' (act), which applies to individuals at least eighteen years old. A person that administers a vaccine or other immunizing agent to an adult is not liable for civil damages for injury or death of an adult caused by a vaccine or immunizing agent if:

• The vaccine or immunizing agent was administered according to the schedule of immunizations establish by the board of health by rule, after considering recommendations from ACIP, the American Academy of Pediatrics, and other similar entities;
• There were no medical contraindications; and
• The vaccine or immunizing agent was administered in accordance with generally accepted clinical methods.

     For claims brought on or before January 30, 2029, against a hospital, clinic, pharmacy, manufacturer, wholesaler, or provider arising from injuries resulting from the handling, storage, or distribution of vaccines, there is no liability unless the injuries are the result of the negligent failure of an employee of the hospital, clinic, pharmacy, or manufacturer, wholesaler, or provider to conform to recognized standards to protect public health. Manufacturer and wholesaler liability protections are removed from the law for claims brought on or after January 31, 2029 (Section 15).

     The act authorizes the department of health care policy and financing to purchase for the children's basic health plan vaccines that are recommended by the American Academy of Pediatrics and other similar entities, in addition to those recommended by ACIP (Section 16).


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

Section 1 of the bill amends and relocates the current requirements for notification to the attorney general regarding certain mergers, acquisitions, or transfers of securities or assets. Current law prohibits the attorney general from charging a party to a merger a fee connected with filing of the merger or a fee for providing additional information regarding the merger. The bill allows the attorney general to charge each filing party a reasonable fee, not to exceed $5,000. Section 1 also requires that the parties to a merger, acquisition, or contracting affiliation of one or more health-care entities (material change transaction) comply with specified notice requirements at least 60 days before the closing of the material change transaction. If the material change transaction requires the filing of a premerger notification with the federal trade commission or the United States department of justice pursuant to the federal "Hart-Scott-Rodino Antitrust Improvements Act of 1976", the parties shall also submit notice to the attorney general. If the terms of the material change transaction are altered following the submission of the written notice to the attorney general, the parties must provide notice to the attorney general of the alteration.

The attorney general may deem information and materials provided in compliance with the notice requirements as public records subject to disclosure under the "Colorado Open Records Act".

Section 1 also prohibits a material change transaction if the material change transaction may substantially lessen competition or tend to create a monopoly or may harm consumer welfare. A party to a material change transaction shall not close the material change transaction until specified conditions are met. Sections 3 through 9 amend the current requirements for transactions that involve licensed hospitals and are subject to notice requirements to the attorney general (covered transactions) by:

• Including in the definition of a "covered transaction" a transaction that would result in the sale, transfer, lease, exchange, or other disposition of the management, control, or operations of a hospital;
• Requiring parties to a covered transaction to include, in the notice to the attorney general of the transaction, a statement describing the charitable missions of each nonprofit entity entering into the covered transaction and the services provided by each nonprofit entity in furtherance of the nonprofit entity's charitable purposes and charitable missions;
• Specifying that if a covered transaction will not result in a material change in the charitable purposes, charitable missions, or services provided in furtherance of the charitable purposes or missions of a nonprofit entity entering into the covered transaction, and will not result in a termination of the attorney general's jurisdiction over the charitable assets due to a transfer of a material amount of those assets outside of the state of Colorado, the parties may proceed with the covered transaction without additional review by the attorney general. The attorney general may perform specified actions to review, and use specified criteria to determine, whether the covered transaction will result in a material change.
• Authorizing the attorney general to exercise their common law authority to assess and review or challenge a covered transaction that will result in a material change in the charitable purposes, charitable missions, or services provided in furtherance of the charitable purposes or missions of a nonprofit entity entering into the covered transaction or will result in a termination of the attorney general's jurisdiction over the charitable assets due to a transfer of a material amount of those assets outside of the state of Colorado;
• Adding specified information to the notice requirements for covered transactions in which the parties involved in the transaction are all for-profit entities; and
• Creating notice requirements for and attorney general review of covered transactions involving a for-profit hospital and a nonprofit entity.

     Section 20 of article X of the state constitution (the Taxpayer's Bill of Rights or TABOR) defines 'fiscal year spending' as excluding 'collections for another government' and 'damage awards'. Although TABOR does not define either 'collections for another government' or 'damage awards', the TABOR implementing statutes define both terms. The act clarifies both of these definitions for state fiscal years commencing on or after July 1, 2025.

     The act clarifies that 'collections for another government', as used for the purpose of determining whether specific money received by the state is subject to the TABOR limitation on state fiscal year spending, includes:

• Revenue from the excise tax and sales and use tax on gasoline used as fuel for the propulsion of specified aircraft that is collected by the state and distributed to governmental or airport entities operating a federal aviation administration-designated public use airport; and
• Revenue from fees that are collected by the department of public safety for the purpose of criminal history record checks and that is transmitted to the federal bureau of investigation for a required federal component of such criminal history record checks.

     The act also clarifies that 'damage award', as used for the purpose of determining whether specific money received by the state is subject to the TABOR limitation on state fiscal year spending, includes money from certain sources that is deposited in the crime victim compensation fund of each judicial district.

     The act specifies that for fiscal years commencing on or after July 1, 2026, the general assembly shall appropriate money to the district attorney in each judicial district in an amount equal to 20% of the total amount of money in the fund in that judicial district for administrative costs and to the court executive in each judicial district in an amount equal to 2.5% of the total amount of money in the fund in that judicial district for administrative costs.

     For the 2026-27 state fiscal year, the act appropriates $2,250,000 from the general fund to the judicial department for use by state courts administration for victim's compensation administration.


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

     The act requires a child care center to disclose the following information in its policies and procedures to the parents or guardians of children being served at the child care center:

• A statement that child care center workers are mandatory reporters of child abuse or neglect under state law; and
• For a child care center that utilizes video recording equipment, a disclosure of the presence of video recording equipment and the child care center's policies and procedures regarding the use of the video recording equipment and the generated video footage.
  
  (Note: This summary applies to this bill as enacted.)

     The act requires an operating system provider that operates a publicly available internet website, software application, online service, or platform that distributes and facilitates, on a commercial basis, the download of applications from third-party developers to users of devices (covered application store) or makes a covered application store available preinstalled on an operating system to:

• Provide an accessible interface at account setup that requires an account holder to indicate the birth date, age, or age bracket of the user of that device in order to provide a signal regarding the user's age (age signal) to applications available in the covered application store;
• Provide application developers with a reasonably consistent, real-time application programming interface to request and receive an age signal; and
• Send only the minimum amount of information necessary to comply with the act. An operating system provider or covered application store shall not share an age signal with a third party for a purpose not required by the act.

     The act requires a consumer software application that is accessed through a covered application store and that may be run or directed by a user on a device (covered application) to request an age signal with respect to a particular user when the covered application is initially launched or when a user first creates an account. A covered application that receives an age signal is deemed to have knowledge of the age range of the user to whom that age signal pertains across all platforms of the application and points of access of the application. However, if a developer has clear and convincing information that a user's age is different than the age indicated by an age signal, the developer shall use that information as the primary indicator of the user's age range.

     A developer shall ensure that a covered application that receives an age signal does not:

• Request more information concerning a user from an operating system provider or a covered application store than is necessary to comply with the act; or
• Communicate an age signal to a third party for a purpose not required by the act.

     With respect to a device for which account setup was completed before July 1, 2028, the act requires an operating system provider to provide, before January 1, 2029, an accessible interface that allows an account holder to indicate the birth date or age of the user of that device for the purpose of providing an age signal regarding the user's age-bracket data to covered applications available in the operating system provider's covered application store. If a covered application last updated on or after July 1, 2027, was downloaded to a device before July 1, 2028, and the covered application has not requested an age signal with respect to the user of the device on which the covered application was downloaded, the covered application must request an age signal from the covered application store from which the covered application was downloaded with respect to that user before January 1, 2029.

     A person that violates the act must pay a civil penalty of not more than $2,500 for each minor affected by each negligent violation or not more than $7,500 for each minor affected by each intentional violation. The penalty is assessed and recovered in a civil action brought by the attorney general. An operating system provider or covered application store that makes a good faith effort to comply with the act is not liable for an erroneous age signal or for conduct by a covered application that receives an age signal.


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

     The act requires coaches of youth athletic activities to complete a biennial mental health education course. The required mental health education course must address a coach's impact on the mental health of a youth athlete, a wellness framework for youth athletes, mental health disorders, trauma, substance abuse, and suicide prevention. The act requires a coach of a youth athlete, or other designated personnel, to advise the parent or guardian of the youth athlete to seek a medical evaluation from a licensed health-care provider for appropriate medical and behavioral health guidance if the youth athlete is removed from play for a suspected concussion.


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

     The bill establishes regulations for the sale, transfer, or distribution of compounded weight-loss medication, which custom-made medications that, is defined in the bill as a drug that is:

•      Created by combining, mixing, or altering other drugs or drug substances;

       

•      Intended to be used by humans for obesity or weight management and contains an active ingredient that is named in a drug approved by the federal food and drug administration (FDA); and

       

•      A glucagon-like peptide-1 receptor agonist drug, known as a 'GLP-1' drug.

Unlike mass-produced medications, a compound weight-loss medication is not subject to approval by the federal food and drug administration (FDA). A person may not sell, transfer, or distribute a compounded weight-loss medication unless the person confirms that the medication: FDA.

• Is made from bulk drug substances and drugs that are approved by the FDA when such approval is required;
• Was manufactured in compliance with FDA processes;
• Contains bulk drug substances that are pharmaceutical grade and are accompanied by a certificate of analysis containing information that is material to the safety and efficacy of the bulk drug substances;
• Was manufactured at a facility that is registered with the FDA and passed an FDA inspection within the previous 2 years; and
• Is verified for purity and accurate dosage.

      Labels for compounded weight-loss medications must list all active and inactive ingredients, the quantity of those ingredients, and the ingredients' country of origin. There must also be a warning on the label stating that the compounded weight-loss medication has not been FDA-approved, has inadequate evidence of safety or efficacy, and has known and unknown side effects. A person must also provide certain disclosures to a patient when prescribing compounded weight-loss medications.

      The bill prohibits the use of false or misleading claims, including unsubstantiated claims, when advertising or promoting compounded weight-loss medications.

      A person that sells, transfers, or distributes compounded weight-lost medication must keep records related to the compounded weight-loss medication for at least 2 years after the date of expiration of the compounded weight-loss medication and make those records available for inspection by the state board of pharmacy.

      The state board of pharmacy may issue fines of up to $1,000 per dose of compounded weight-loss medications that are sold or distributed in violation of the bill and may revoke a pharmacy or business license for violations.

      The attorney general has authority to enforce this bill as a deceptive trade practice under the 'Colorado Consumer Protection Act'.

      The bill establishes that a person engages in a deceptive trade practice when the person :

• Makes a false or misleading claim about a compounded weight-loss medication when advertising or promoting the medication;
• Distributes a compounded weight-loss medication when not legally authorized to distribute or transfer the drug used in the compounded weight-loss medication;
• Makes a materially false or misleading representation that the compounded weight-loss medication is approved by the FDA when the medication is not approved by the FDA; or
• Makes a materially false, misleading, or unverified claim regarding the efficacy, safety, performance, outcomes, or benefits of the compounded weight-loss medication.

      The attorney general has exclusive authority to enforce the bill as a deceptive trade practice under the 'Colorado Consumer Protection Act'. There is no private right of action for a violation of the bill, and the provisions of the bill may only be enforced by the attorney general.

     The bill does not apply to certain facilities or in certain circumstances, including:

• The administration of a compounded weight-loss medication by a practitioner at certain hospitals, clinics, and other health facilities licensed by the department of public health and environment;
• Long term care facilities;
• Assisted living residences;
• Home care agencies;
• The program of all-inclusive care for the elderly or PACE program;
• Adult day care facilities; or
• The compounding of drugs for animal use.

(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 allows a court to order additional parenting time to a parent or legal custodian who was wrongfully denied court-ordered parenting time if the denial resulted from an investigation by a law enforcement agency, child welfare agency, or county department of human or social services and the investigation did not result in a substantial finding of abuse or neglect.

The additional parenting time ordered by a court must be of the same type and duration as the parenting time that was wrongfully denied; may include weekend, holiday, or vacation periods; and must be exercised by the parent or legal custodian no later than 2 years after the date the court finds that parenting time was wrongfully denied.

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

     The act requires that, beginning July 1, 2027, a death certification professional ensure that they are aware of the most recent epilepsy-related death certification recommendations from a nationally recognized and reputable organization. On or before June 1, 2027, the department of public health and environment (department) must electronically notify all registered medical certifier users of the Colorado vital events system of this requirement.

     If a death certification professional determines that the cause of an individual's death is consistent with known or suspected sudden unexpected death in epilepsy, the act requires the professional to ensure that the individual's death certificate identifies epilepsy as a contributing cause or a suspected cause of death.

     The act allows the department to provide online guidelines for clinicians and medical certifiers for death certificates regarding epilepsy-related deaths, including sudden unexpected death in epilepsy.


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

     The act creates the cradle to career grant program (grant program) in the department of human services (CDHS) to provide grants to a local government, local education provider, state institution of higher education, Indian tribe or tribal organization, or community-based nonprofit or not-for-profit organization (eligible entity) to promote coordinated community-based supports and services that open opportunities for economic mobility from poverty. The grant program must connect children and youth with high-quality educational and extracurricular programming and families with key health and social services in order to improve prenatal and early childhood outcomes, student achievement, workforce readiness, and wealth-building opportunities.

     The act creates the cradle to career advisory council (council) to approve or disapprove CDHS's potential grant recipients and to collaborate with CDHS to develop grant program guidelines and criteria for awarding grants. Council members must be Colorado residents and must not provide financial support for the grant program.

     To receive a grant, an eligible entity must submit an application that includes an economic mobility needs assessment and a comprehensive proposal to address the needs within its designated service area. The application must identify prospective community partners and subcontractors. The act caps the amount that CDHS may award in connection with a single grant application at 49% of available grant program money.

     A grant recipient must comply with various health and safety, financial responsibility, and anti-discrimination safeguards. Each grant recipient must annually report to CDHS addressing the recipient's progress using a set of performance indicators to assess the economic mobility outcomes and impacts associated with the grant award. CDHS must make a related report to the health and human services committees of the general assembly and the governor each year.

     CDHS may seek, accept, and expend gifts, grants, and donations for grant-program-related purposes. If CDHS does not receive $900,000 for those purposes on or before December 31, 2028, the grant program is repealed. The general assembly shall not appropriate general fund dollars for grant program operations.


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

     The act requires a licensee, nurse, or certified midwife who performs a medical forensic examination to inform the victim-survivor about how to determine when the testing related to the examination is complete and how to obtain the results and records.

     The act subjects a cause of action against a person arising from any protected statement by a victim-survivor to a special motion to dismiss unless the court determines that the plaintiff has established that there is a reasonable likelihood that the plaintiff will prevail on the claim.

     The act makes a predispute arbitration agreement and predispute joint-action waiver void and unenforceable upon request of an individual who alleges conduct that results in a sexual harassment dispute or a sexual misconduct dispute or upon request of a named representative of a joint action, class action, or collective action that results in a sexual harassment dispute or a sexual misconduct dispute.

     The act requires a judge to allow a forensic scientist to testify remotely in a criminal proceeding if a party requests and both parties consent to the remote testimony.

     The act authorizes the court to order that the testimony of a victim-survivor of domestic violence, unlawful sexual behavior, stalking, human trafficking for involuntary servitude, or human trafficking for sexual servitude be taken in a room other than the courtroom and be televised by closed-circuit television in the courtroom under certain circumstances.

     The act requires peace officer annual in-service training programs to include a 2-hour training to improve a peace officer's understanding of the impact of trauma on victim-survivors of crimes and the optimal way for a peace officer to respond to victim-survivors who are experiencing trauma and includes trauma-informed investigation and response training as a permissible use of peace officer training and support fund money.

     The act renames the Colorado sexual assault forensic medical evidence review board as the Colorado sexual assault response review board and adds 4 members to the board.


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

Under current law, any material, compound, mixture, or preparation that is a controlled substance analog that is substantially similar to the chemical structure of a controlled substance in schedule II (analog to a schedule II controlled substance) is treated as a controlled substance in schedule II.

The bill authorizes the governor to temporarily classify a material, compound, mixture, or preparation as an analog to a schedule II controlled substance, subject to conditions.

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

The bill requires a youth sports organization and local government that provides youth athletic activities (youth sports organization) to have at least one adult who possesses a current first aid, CPR, and AED certification present at each youth athletic activity.

Current law requires all youth sports organization coaches who work directly with youth members to obtain a criminal history record check (background check) prior to employment. The bill requires chaperones who accompany the youth sports organization on a trip that includes one or more overnight stays to pass a background check. The bill requires a coach or chaperone who lived outside the U.S. for more than 180 days since the coach's or chaperone's last background check to also obtain an international background check. The act creates a cause of action for failing to conduct a background check.

Current law prohibits a youth sports organization from hiring a person to be a coach if the person has been convicted of certain crimes. The bill adds crimes of violence and other violent crimes to the list of disqualifying offenses.

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

     Current law requires a recovery residence operated in Colorado to be certified by a third-party certifying body, unless the recovery residence has been operating in Colorado for 30 or more years as of May 23, 2019.

     Beginning July 1, 2027, the act requires a recovery residence to obtain a license from the behavioral health administration (BHA). The act sets forth application procedures and rules for minimum standards of operating a recovery residence. A recovery residence must report specified occurrences to the BHA, including occurrences that result in the death of or specified injury to a resident, involve abuse and neglect of a resident, involve misappropriation of a resident's property, or in which a resident's drugs are diverted for use by another person. Recovery residence licensing is subject to sunset review prior to its repeal in 2033.


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

With regard to the family and medical leave insurance (FAMLI) program, the bill:

• Defines a neonatal intensive care unit (NICU) for the duration extension that applies to a covered individual who has a child receiving care in a NICU; and
• Extends the duration of paid FAMLI leave for claims arising on or after January 1, 2027, up to an additional 2 weeks, following the death of a family member for whom a covered individual cared for while using such leave.(Note: This summary applies to this bill as introduced.)

The bill makes it an unfair or deceptive trade practice under the "Colorado Consumer Protection Act" for a facility or medical practice providing cosmetic, aesthetic, wellness, longevity, or lifestyle treatments involving the administration or use of prescription drugs, including injectable and sterile drug products (medical spa), to:

• Acquire or receive a prescription drug from a person not legally authorized to distribute or transfer the prescription drug;
• Fail to store, handle, prepare, or administer a prescription drug in accordance with manufacturer requirements, applicable federal and state law, or generally accepted standards of medical practice;
• Permit an individual to prescribe or administer prescription drugs outside the scope of the individual's state-issued credential;
• Fail to maintain reasonable safeguards to prevent contamination, diversion, theft, or misuse of prescription drugs;
• Represent that a prescription drug is safe or effective in a manner inconsistent with federal law or federal food and drug administration-approved labeling; has sponsorship, approval, characteristics, ingredients, uses, or benefits that it does not have; or is approved by the federal food and drug administration when it is not;
• Fail to designate a licensed health-care provider with prescriptive authority to provide clinical oversight of prescription drugs used at the medical spa; or
• Fail to create, maintain, or produce to the attorney general or a district attorney records of serious adverse events involving patients.

The attorney general or a district attorney may enforce a violation of a prohibited action specified in the bill. The attorney general may adopt rules to implement the bill.

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

     Section 2 of the act prohibits a person that is licensed by the Colorado limited gaming control commission (commission) to operate an internet sports betting operation (internet sports betting operator) from:

• Accepting more than 6 separate deposits from an individual in a gaming day; or
• Initiating or sending mobile device push notifications or text messages to account holders in the state soliciting bets or deposits.

     Section 3:

• Prohibits a sports betting operation or its marketing affiliate from targeting, or creating advertising content that is clearly meant for, persons under 21 years old or from advertising on media for which the majority of the demographic audience is reasonably expected to be under 21 years old; and
• Requires an internet sports betting operator, on an annual basis, to provide to the division of gaming in the department of revenue (division) data and metrics related to the operator's sports betting operation for the preceding calendar year. The division must compile the data into a public report every 3 years starting on January 1, 2029.

     Section 4 prohibits an internet sports betting operator from accepting deposits using a credit card in connection with the acceptance of a sports bet (prohibition). A violation of the prohibition constitutes a class 2 misdemeanor.

     Section 5 allows the commission to assess a maximum penalty of $25,000 against a violator of the prohibition.

     Section 6 requires that the amount of money annually transferred from the sports betting fund (fund) to the water plan implementation cash fund is no less than the amount transferred to the water plan implementation cash fund in the previous state fiscal year.

     $124,623 is appropriated from the legal services cash fund to the department of law to provide legal services to the department of revenue in implementing the act. The appropriation is from revenue received from the department of revenue that is continuously appropriated to the department of revenue from the fund.


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

     The act requires the secretary of state to refer a ballot issue at the November 2026 general election to seek voter approval for the state, beginning in the 2026-27 state fiscal year, to retain and spend an amount of state revenue equal to the amount of state public K-12 education funding in excess of the limitation on state fiscal year spending and to increase state public K-12 education funding by up to 2% per year for 10 years.

     The act directs legislative council staff to determine the amount of state public K-12 education funding and describes how legislative council staff will make that determination.

     The act creates a positive factor to increase state public K-12 education funding. The amount of the positive factor compounds annually for 10 years. The positive factor for the 2026-27 budget year is 2% of the program foundation calculated for the 2025-26 budget year. For the 2027-28 through 2034-35 budget years, it is the sum of 2% of the prior year's program foundation plus the prior year's positive factor. For the 2035-36 budget year and beyond, it is the sum of 2% of the 2034-35 program foundation plus the 2034-35 positive factor.

     A district's share of the positive factor is calculated proportionally based on the district's total program under the new school finance formula relative to the statewide total program.

     A district may only use its positive factor funding for increasing teacher pay, improving teacher retention, lowering class sizes, and increasing access to career and technical courses.

     For the 2026-27 state fiscal year, the children's account consists of an amount of money equal to the amount of state revenues that the state retains for a given fiscal year pursuant to voter approval of the act. For state fiscal years commencing on or after July 1, 2027, the account consists of that same amount minus an amount equal to the total dollar amount of warrants issued by the state treasurer to reimburse local governments for property tax exemptions. Money in the account must first be spent to pay districts their positive factor, then any remaining funds are appropriated for disability services and school services and to increase annual contact hours, and finally to programs prioritizing child care and full-day preschool.

     The act directs the state auditor to conduct and publish a report on excess state revenues for each state fiscal year that the state retains and spends state revenues in excess of the limitation on state fiscal year spending. That report must include descriptions of:

• The amount of state revenues that the state retained and spent that would otherwise have been in excess of the limitation on state fiscal year spending; and
• How the state expended the state revenues that the state retained and spent that would otherwise have been in excess of the limitation on state fiscal year spending.

     Beginning August 1, 2027, the act requires each local education provider to post, online for free public access in a format that can be downloaded and sorted, its actual expenditures of any positive factor received.

     Lastly, the act updates provisions regarding the expanded earned income tax credit, the family affordability tax credit, and the affordable housing financing fund to ensure that voter approval of the act does not adversely impact those programs.


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

     Section 2 of the act repeals a requirement that health-care profession regulators adopt rules that require each licensed health-care provider, as a condition of renewing, reactivating, or reinstating a license, to complete up to 4 credit hours of training per licensing cycle in order to demonstrate competency regarding topics related to prescribing drugs and treatment.

     Section 3 authorizes the Colorado dental board to adopt rules that require every dentist, dental therapist, and dental hygienist, as a condition of renewing, reactivating, or reinstating a license, to complete up to 4 credit hours of training per licensing cycle regarding topics related to prescribing drugs and treatment.

     Section 4 requires a licensed veterinarian to complete at least 1 hour of training per renewal period regarding topics related to prescribing drugs and treatment.

     Section 5 changes the frequency at which specific health-care facilities are required to apply for a license issued by the department of public health and environment from annually to every 2 years.

     Under current law, a health-care facility is required to screen each uninsured patient for eligibility for public health insurance programs and discounted care (screening) utilizing a single uniform application developed by the department of health care policy and financing (state department). Sections 6 through 11 change this requirement by:

• Changing the method used to conduct the screening from a uniform application to use of a third-party resource, such as a major credit bureau, or use of a uniform screening questionnaire (questionnaire) developed by the state department;
• Allowing a health-care facility the option of screening a patient for eligibility for the health-care facility's financial assistance program;
• Requiring a health-care facility to provide specified notifications upon completion of the screening;
• Creating an application for discounted care (application) for use by a health-care facility upon completion of the screening through which additional information is requested from a patient to determine whether the patient qualifies or is likely to qualify for public health-care coverage or discounted care;
• Requiring a health-care facility to provide specified notice and appeal rights to a patient upon completion and review of the application; and
• Requiring the state department to adopt rules regarding the questionnaire and application.

     Section 11 also narrows state department review requirements of health-care facilities' and licensed health-care professionals' billing for patients who are indigent. The act prohibits the state department from making changes to regulatory documents or imposing new requirements unless the changes or new requirements are adopted by rule by specified dates and are subject to stakeholder engagement.

     Section 12 requires the state department to establish by rule the content and format of the information each hospital must provide to the state department for a hospital transparency report at least 30 days prior to the hospital's fiscal year. The act changes the deadline for a hospital to submit to the state department an annual audited financial statement from 120 days to 150 days after the end of the hospital's fiscal year. Current law requires that each hospital has a minimum of 15 days to review the hospital transparency report; the act specifies that the review period is 15 business days and requires that a statewide hospital association must also have a minimum of 15 business days to review the report.


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

     The bill states that the Colorado prescription drug affordability review board has no authority to perform an affordability review of, or to establish an upper payment limit for, a prescription drug that is:

• Designated as a drug for a rare disease or condition by the food and drug administration (FDA) of the federal department of health and human services; or
• A licensed biological product that is derived from human whole blood or plasma as indicated on product labeling approved by the FDA.
  
  (Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

     To qualify for an initial special services license as a school counselor, an applicant must hold a master's degree or higher from an accredited institution of higher education. The degree must be in school counseling and require completion of at least 48 graduate semester credit hours.


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

     Beginning July 1, 2027, the bill prohibits the immediate release of a patient's sensitive test results to the patient's electronic health record or through a patient portal. Instead, the bill requires that sensitive test results, once they are finalized, not be released as part of the patient's electronic health record or through a patient portal for 3 business days.

     The bill establishes 2 exceptions one exception to this requirement: Sensitive test results may be immediately released as part of the patient's electronic health record or through a patient portal immediately and without delay if the patient's health-care provider authorizes immediate release of the results or if the patient requests to receive the sensitive test results of a particular test without delay the sensitive test results to be released before the end of the three 3-business-day period .

     The bill defines 'sensitive test results' as:

• A pathology or radiology report that is ordered for the purpose of diagnosing or monitoring a patient for cancer; or
• Test results that may reveal a genetic marker that relates to a cancer condition.

     The bill specifies that a custodian of person that administers and controls a patient's electronic health record that contains sensitive test results is responsible for implementing the requirements of the bill. The bill states that compliance with the requirements of the bill is not information blocking under the federal '21st Century Cures Act'. A person that fails to comply with the requirements of the bill is not subject to civil, criminal, or administrative liability or professional disciplinary action.

(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.)

     Beginning on January 1, 2028, a health insurance carrier (carrier) of an individual or group health benefit plan in Colorado (plan) shall, when calculating a covered person's contribution to an out-of-pocket maximum or cost-sharing requirement under the plan, account for and credit to the covered person's contribution an out-of-pocket expense that the covered person incurs by purchasing a prescription drug directly from a pharmacy or direct-to-consumer platform (contribution credit). The carrier shall apply the contribution credit to the out-of-pocket maximum or cost-sharing requirement that is applicable in the plan year in which the out-of-pocket expense was incurred.

     To receive a contribution credit, a covered person must provide to the carrier proof of payment for a direct purchase of a prescription drug, such as an itemized receipt or pharmacy record, within 90 days after making the purchase (proof of payment). The carrier may request additional information or documentation if the proof of payment is insufficient or incomplete.

     The carrier shall not apply a contribution credit in the following circumstances:

• For an amount of a covered person's out-of-pocket expense incurred by the direct purchase of a prescription drug that is greater than the amount the covered person would have incurred if they had obtained the same prescription drug in the same plan year from an in-network pharmacy and pursuant to the terms of their plan;
• If the covered person does not provide proof of payment;
• If the covered person incurred the out-of-pocket expense by purchasing a prescription drug that is not covered under the formulary of the covered person's plan, unless the carrier grants an exception; or
• If the covered person does not comply with the carrier's utilization management processes, including prior authorization and step therapy protocols required under the covered person's plan.
  
  (Note: This summary applies to this bill as enacted.)

     The act:

• Authorizes the health insurance affordability enterprise (enterprise), on or after January 1, 2027, to issue revenue bonds of up to $100 million to fund enterprise programs, secured by the enterprise's revenues, and require the enterprise to pay bond obligations before allocating revenues for enterprise programs;
• Allows the enterprise to invest specified money in the health insurance affordability cash fund (cash fund) without regard to otherwise applicable requirements for such investments and to contract with private professional fund managers to advise on investment strategies;
• Modifies the allocation of enterprise revenue among authorized purposes and allows the enterprise to reallocate unexpended amounts for specified purposes;
• Directs the enterprise to require qualified individuals who are enrolled in state-subsidized individual health coverage plans eligible for subsidies from the enterprise to pay premiums established in rules adopted by the commissioner, in consultation with the health insurance affordability board (board);
• Requires the enterprise to adjust the statewide average premium reduction under the reinsurance program to 18% and to reduce the amount of bonds issued to account for the reduced costs for the reinsurance program;
• Directs the board, in recommending parameters for implementing subsidies for state-subsidized individual health coverage plans, to recommend coverage that prioritizes enrollment stability and customer predictability; when seeking input on its recommendations regarding plans, coverage, and the number of eligible slots, to enable feedback in at least English and Spanish and in other languages upon request; and to indicate how it incorporated such feedback into its final recommendations;
• Directs the enterprise to conduct or contract a third party to conduct a study to evaluate the feasibility of restructuring the enterprise programs to increase health insurance affordability and maximize enrollment in health insurance plans;
• Requires the enterprise to submit 3 written reports and make one in-person presentation to the joint budget committee each year regarding the status of the cash fund and, as part of its in-person presentation in January 2027, to provide an analysis of the effects of changing the statewide average premium reduction under the reinsurance program to 15% and of creating a tiered, income-based, structure for premium assistance for individuals who purchase insurance on the Colorado health benefit exchange (exchange);
• Repeals the tax credit for contributions to the exchange and replaces it with a tax credit for contributions to the enterprise; and
• Directs the state treasurer to transfer $40 million from the marijuana tax cash fund to the cash fund by June 30, 2026, reduces to $60 million the designation of money in the marijuana tax cash fund as the state emergency reserve for the 2025-26 and 2026-27 state fiscal years, and increases by $40 million the value of the capitol annex building for purposes of the state emergency reserve for the 2025-26 and 2026-27 state fiscal years.
  
  (Note: This summary applies to this bill as enacted.)

     Current law prohibits a principal from discriminating, taking adverse action, or retaliating against a worker who, in good faith, raises a reasonable concern about workplace violations of government health or safety rules.

     The bill adds the university of Colorado hospital authority and the Denver health and hospital authority to the definition of 'principal'. The bill further clarifies that any action or potential action arising under the law regarding worker rights related to health and safety is not subject to the limitations, notice requirements, procedural requirements, or liability restrictions set forth in the 'Colorado Governmental Immunity Act'.

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

     The act creates the commission on medicaid (commission) to develop recommendations regarding implementation of new federal medicaid policy changes that go into effect in 2026, 2027, and 2028 and to support Coloradans impacted by those policy changes.

     The commission is required to:

• Convene at least 6 times but no more than 12 times between May 14, 2026 and December 11, 2026;
• Invite relevant state agency representatives and medicaid stakeholders to present and provide feedback on commission recommendations; and
• Contract with a technical advisor to assist the commission in writing and submitting a report to the general assembly and the governor documenting the commission's process and any recommendations by December 11, 2026.

     The act appropriates $500,000 to the legislative department from the general fund to implement the act.


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

     In 2024, the general assembly enacted Senate Bill 24-205, which created consumer protections in interactions with artificial intelligence systems. The act repeals and reenacts those provisions with new requirements regarding the use of automated decision-making technology in consequential decisions.

     The act defines an 'automated decision-making technology' (ADMT) as a technology that processes personal data and uses computation to generate output, including predictions, recommendations, classifications, rankings, scores, or other information that is used to make, guide, or assist a decision, judgment, or determination concerning an individual. The act defines a 'consequential decision' as a decision that relates to an individual's access to, eligibility for, or compensation related to education, employment, housing, financial or lending services, insurance, health-care services, or essential government services and public benefits.

     The act requires the developer of an ADMT (developer) that is used to materially influence a consequential decision (covered ADMT), starting January 1, 2027, to provide a deployer of a covered ADMT (deployer) with technical documentation describing the covered ADMT's intended uses, categories of training data, known limitations, and instructions for appropriate use and human review. Developers must notify deployers of material updates or modifications to the covered ADMT. Both developers and deployers are required to retain records necessary to demonstrate compliance with the act for at least 3 years.

     The act establishes consumer notice requirements, mandating that deployers provide clear and conspicuous notice to consumers at the point of interaction with a covered ADMT. A deployer is required to provide a consumer with a plain language description of a covered ADMT's role within 30 days after the covered ADMT makes a consequential decision that results in an adverse outcome for the consumer. The attorney general must adopt rules to clarify these post-adverse outcome disclosure requirements by January 1, 2027.

     Consumers have the right to request personal data and correction of factually incorrect personal data used by a covered ADMT. The act also grants consumers the right to request meaningful human review and reconsideration following a covered ADMT making a consequential decision resulting in an adverse outcome.

     The attorney general is directed to enforce the act through the 'Colorado Consumer Protection Act', and a violation of the act is deemed a deceptive trade practice. Before initiating an action before January 1, 2030, the attorney general must provide the developer or deployer with a 60-day notice and opportunity to cure the alleged violation, if a cure is deemed possible. The act does not create a new private right of action but establishes how fault is allocated between developers and deployers in civil actions alleging unlawful discrimination under existing law.

     Specified entities are exempted from the requirements of the act to the extent the entities comply with other legal obligations.


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