Bill Tracker

Effective January 1, 2024, the bill creates an epinephrine
auto-injector affordability program (program) to provide low-cost
epinephrine auto-injectors to individuals who:
  • Are residents of this state;
  • Are not enrolled in the state medicaid program or the
federal medicare program;
  • Have a prescription for an epinephrine auto-injector; and
  • Are not enrolled in prescription drug coverage that limits
the total amount of cost sharing that the enrollee is required
to pay for an epinephrine auto-injector.
The bill requires the division of insurance in the department of
regulatory agencies (division) to create an application for the program and
requires the division and the department of health care policy and
financing to make the application available on their websites and to
promote the availability of the program.
The bill requires a carrier that provides coverage for prescription
epinephrine auto-injectors to cap the total amount that a covered person
is required to pay for all covered prescription epinephrine auto-injectors
at an amount not to exceed $60 for a 2-pack of epinephrine auto-injectors.
A pharmacy that dispenses epinephrine auto-injectors is authorized
to collect a copayment not to exceed $60 from the individual to cover the
pharmacy's costs of processing and dispensing a 2-pack of epinephrine
auto-injectors.
A manufacturer of epinephrine auto-injectors:
  • Is required to make epinephrine auto-injectors available to
individuals through the program; and
  • May be required to reimburse the dispensing pharmacy an
amount that covers the difference between the pharmacy's
wholesale acquisition cost for the number of epinephrine
auto-injectors dispensed through the program and the
amount the recipients of the epinephrine auto-injectors paid
for the same number of epinephrine auto-injectors or send
the pharmacy a replacement supply of the same number of
epinephrine auto-injectors.
If a manufacturer fails to comply with the requirements of the bill,
the manufacturer may be subject to a fine.

The bill creates the sixth through twelfth grade mental health
assessment program (program) administered by the department of public
health and environment (department).
The bill allows any public school that serves any of grades 6
through 12 to participate in the program and requires a public school that
wants to participate in the program to notify the department.
The bill requires participating schools to provide written notice to
the parents of students within the first 2 weeks of the start of the school
year in order to allow parents to opt their child out of participating in the
mental health assessment.
The bill specifies that a student 12 years of age or older may
consent to participate in the mental health assessment even if the student's
parent opts out.
Mental health assessments must be conducted in participating
schools by a qualified provider. The bill requires the department to select
a qualified provider to administer the mental health assessment and
establishes requirements that the qualified provider must meet.
The bill requires a qualified provider to notify the student's parent
under certain circumstances, if the qualified provider finds that additional
treatment is needed after reviewing the student's mental health assessment
results.
The bill authorizes the department to promulgate rules as necessary
to implement and administer the program.

The bill prohibits:
  • Requiring a COVID-19 vaccine for a minor in Colorado;
  • Administering a COVID-19 vaccine to a child without the
informed consent of the child's parent or legal guardian;
  • Administering a COVID-19 vaccine to an emancipated
minor without the informed consent of the emancipated
minor;
  • A school from dismissing, suspending, refusing admission,
or refusing to permit participation in an extracurricular
activity to a student who has claimed a COVID-19
immunization exemption;
  • A public or private entity from discriminating against a
minor participating in a nonpublic home-based educational
program based on whether the minor received the
COVID-19 vaccine;
  • A public entity from levying a fee, fine, or tax, or a private
entity from levying a fine or fee, on a minor or their parent
or legal guardian based on whether the minor received the
COVID-19 vaccine; or
  • A public or private entity from discriminating against a
minor based on whether the minor received a COVID-19
vaccine.
The bill allows an aggrieved person to file a civil action and
waives sovereign immunity if the violator is a public entity.

The bill prohibits a supplemental health-care staffing agency
(staffing agency) from including in a contract or agreement with a
health-care worker, nursing care facility, or assisted living residence a
provision for liquidated damages, employment fees, or other
compensation to be paid to the staffing agency if the nursing care facility
or assisted living residence hires the health-care worker as a permanent
employee either prior to or after the termination of the contract or
agreement.
A staffing agency that violates the prohibition commits a civil
infraction and is subject to a monetary penalty. Further, for repeated or
willful violations, the executive director of the department of labor and
employment may impose monetary or administrative penalties against the
staffing agency.

Under current law, every health-care provider is required to report
specified information about an individual known to the provider to have
a diagnosis of or a positive test for a sexually transmitted infection to the
department of public health and environment or a local public health
agency. The bill exempts mental health professionals from this reporting
requirement.

The bill updates information associated with Prader-Willi
syndrome to conform to current laws and regulations.

Effective January 1, 2024, the bill:
  • Reduces the individual and marriage and family therapy
practice requirement for licensure as a marriage and family
therapist from at least 2 years of post-master's or one year
of postdoctoral practice to at least one year of post-master's
or one year of postdoctoral practice; and
  • Reduces the post-degree clinical supervised practice period
required for an applicant for licensure as a licensed
professional counselor from at least 2 years of post-master's
practice or one year of postdoctoral supervised clinical
practice to at least one year of post-master's or
post-doctoral supervised clinical practice.

The bill adds 2 members to the state board of psychologist
examiners (board) and requires 2 of the 9 members of the board to be
prescribing psychologists.
The bill allows a licensed psychologist to prescribe and administer
psychotropic medications if the licensed psychologist holds a conditional
prescription certificate or a prescription certificate issued by the board.
A licensed psychologist may apply to the board for a conditional
prescription certificate and must include in the application satisfactory
evidence that the applicant has met specific educational, supervisory, and
clinical requirements. The board is required to issue a conditional
prescription certificate to the licensed psychologist if the board
determines the applicant has met the requirements. The licensed
psychologist with a conditional prescription certificate may only
administer and prescribe psychotropic medications under the supervision
of a licensed physician or advanced practice registered nurse and must
maintain a collaborative relationship with the patient's health-care
provider.
A licensed psychologist who holds a conditional prescription
certificate for 2 years and who meets the specified requirements may
apply for and receive a prescription certificate (prescribing psychologist).
A licensed psychologist with a prescription certificate may prescribe
psychotropic medication to a person if the licensed psychologist:
  • Holds a current license in good standing;
  • Maintains the required malpractice insurance; and
  • Annually completes at least 20 hours of continuing
education.
The board is authorized to promulgate rules to:
  • Implement procedures for obtaining a conditional
prescription certificate and a prescription certificate; and
  • Establish grounds for denial, suspension, and revocation of
the certificates.
The bill requires a prescribing psychologist and a licensed
psychologist with a conditional prescription certificate to file with the
board all individual federal drug enforcement administration registrations
and numbers. The board and the Colorado medical board are required to
maintain current records of every psychologist with prescriptive authority,
including registrations and numbers.
The department of regulatory agencies (department) is required to
annually collect information regarding prescribing psychologists and
licensed psychologists with conditional prescription certificates, to
compile the information, and to share the information with the office in
the department responsible for conducting sunset reviews for inclusion in
each scheduled sunset review concerning the regulation of mental health
professionals.

The bill prohibits a licensed physician; licensed medical resident,
intern, or fellow; licensed professional nurse; advanced practice
registered nurse; registered direct-entry midwife; or medical, nursing, or
direct-entry midwife student or trainee (licensee, student, or trainee) from
performing, and prohibits a licensed health-care facility from permitting
a licensee, student, or trainee to perform, an intimate examination on a
sedated or unconscious patient unless the patient has given specific
informed consent to an intimate examination. Additionally, a student or
trainee may perform an intimate examination on a sedated or unconscious
patient for educational or training purposes only if:
  • The examination is related to the planned procedure to be
performed on the patient;
  • The patient recognizes the student or trainee as part of the
patient's care team; and
  • The student or trainee is under the direct supervision of the
supervising licensee.
The bill outlines the requirements for obtaining the patient's
informed consent. Failure to comply with the requirements of the bill, or
retaliating against a person who complains about a violation of the bill,
constitutes unprofessional conduct, is grounds for discipline, and subjects
the licensee, student, or trainee to discipline by the regulator that regulates
the particular health-care profession. A licensed health-care facility that
fails to comply with the requirements of the bill is subject to sanctions
imposed by the department of public health and environment.
Additionally, liability limitations otherwise applicable to
health-care professionals and institutions under current law do not apply
to a licensee that performs, or a licensed health-care facility that permits
a licensee to perform, an intimate examination on a sedated or
unconscious patient in violation of the requirements of the bill.

The bill requires a health-care provider who performs an abortion
of an unborn child who is 20-weeks gestational age or more to administer
a painkiller to the child prior to the abortion. The bill makes exceptions
to this requirement in specific circumstances.

The bill requires all individual and group health benefit plans to
provide coverage for biomarker testing if the testing is supported by
medical and scientific evidence. Biomarker testing is defined as an
analysis of a patient's tissue, blood, or other biospecimen for the presence
of an indicator of normal biological processes, pathogenic processes, or
pharmacologic responses to a specific therapeutic intervention.
The bill requires the commissioner of insurance to implement
biomarker testing coverage for all individual and group health benefit
plans issued or renewed on or after January 1, 2025.
Biomarker testing is subject to the health benefit plan's annual
deductibles, copayment, or coinsurance but is not subject to any annual
or lifetime maximum benefit limit.
If a carrier requires prior authorization for biomarker testing, the
bill requires the carrier to use an expedited prior authorization process.
Subject to federal authorization and federal financial participation,
beginning July 1, 2024, the bill includes coverage for biomarker testing
as part of the state medical assistance program if the testing is supported
by medical and scientific evidence.
Under the state medical assistance program, the bill requires an
expedited utilization review and prior authorization process, as well as an
appeal process if biomarker testing is denied.

The bill:
  • Requires a contract between a health insurance carrier
(carrier) and a licensed health-care provider (provider) for
the provision of health-care services to covered persons
under a health coverage plan issued by the carrier (contract)
to offer at least one method of payment to the provider for
which there is not an associated fee; and
  • Prohibits the contract from restricting the form or method
of payment the carrier uses to make payments to the
provider so that the only acceptable payment method is a
credit card payment.
If a carrier initiates a payment to a provider using, or changes the
payment method to, electronic funds transfer payments, including virtual
credit card payments, the bill requires the carrier to:
  • Notify the provider of any fees associated with the
particular payment method;
  • Advise the provider of the available payment methods and
include instructions on how to select an alternative
available method; and
  • With each payment, remit an explanation of benefits.
The bill prohibits a carrier from charging a fee for a change in the
payment method to a specified electronic transaction and allows a
provider's billing service to charge a fee under certain circumstances.
The bill makes it an unfair method of competition and unfair or
deceptive act or practice in the business of insurance if a carrier violates
or fails to comply with the requirements of the contract limitations and
requirements.

The bill defines a person to include an unborn child at all stages
of gestation, from fertilization to natural death, as it relates to a private
right of action and current homicide and assault provisions.
The bill declares that any existing state law relating to prenatal
homicide or assault or regulating abortion or abortion facilities is
superseded to the extent it conflicts or is inconsistent with the provisions
of the bill.
The bill authorizes the state to disregard any federal court decision
that purports to enjoin or void this requirement and subjects a Colorado
judge to impeachment or removal if the judge purports to enjoin, stay,
overrule, or void the requirement.

Section 1 of the bill defines medical debt as any obligation or
alleged obligation of a consumer to pay any amount whatsoever arising
from the receipt of health-care goods or services.
Current law prohibits a consumer reporting agency from making
any consumer report containing any of certain items of information.
However, this prohibition does not apply to:
  • A credit transaction involving, or that may reasonably be
expected to involve, a principal amount of $150,000 or
more; or
  • The underwriting of life insurance involving, or that may
reasonably be expected to involve, a face amount of
$150,000 or more.
Section 2 eliminates both of these exceptions to the prohibition
and substitutes a new exception, which applies to a credit transaction
involving, or that may reasonably be expected to involve, a principal
amount that exceeds the national conforming loan limit value determined
annually by the federal housing finance agency. Section 2 also prohibits
a consumer reporting agency from making any consumer report
containing any information concerning medical debt.
Section 3 prohibits a debt collector or collection agency, when
attempting to collect medical debt or to obtain information about a
consumer in relation to an attempt to collect medical debt from:
  • Making a false or misleading representation that the
medical debt will be included in a consumer report or
factored into a consumer's credit score; or
  • Failing to disclose that the medical debt will not be
included in a consumer report and therefore not factored
into a consumer's credit score.
The bill makes exceptions to these prohibitions when the
information is used in connection with a credit transaction involving, or
that may reasonably be expected to involve, a principal amount that
exceeds the national conforming loan limit value determined annually by
the federal housing finance agency.

With respect to step-therapy protocols (protocols) for health
insurance, the bill defines serious mental illness and prohibits the
protocols from requiring a person to try more than one prescription drug
prior to receiving coverage for the drug recommended by the person's
health-care provider. If certain conditions are met and attested to by the
person's health-care provider, the carrier, private utilization review
organization, or pharmacy benefit manager must cover the drug
recommended by the person's health-care provider.
The bill defines serious mental illness for purposes of the
Colorado Medical Assistance Act in the same manner as the term is
defined for commercial health insurance. The bill requires the medical
services board to require a review for coverage of a new drug approved
by the federal food and drug administration for a serious mental illness
within 90 days after the drug is approved.

Current law requires reports of known or suspected child abuse or
neglect to include the source of the report and the name, address, and
occupation of the person making the report whenever possible. The bill
requires a report of this information in all circumstances.

The bill creates the Abortion Pill Reversal Information Act (act).
The act requires a physician or other qualified medical professional to
provide state-prepared information concerning abortion pill reversal,
including a telephone number and website address where a pregnant
woman can seek resources to obtain abortion pill reversal, to any woman
seeking an abortion through the use of an abortion-inducing drug. The
physician or other qualified medical professional must provide the
information at least 24 hours before the physician prescribes or
administers the abortion-inducing drug or induces the abortion.
The department of public health and environment is required to
maintain the state-prepared information on its public-facing website.
The act makes it a deceptive trade practice to fail to provide the
required information concerning abortion pill reversal. The act also
includes civil penalties and professional discipline for failure to comply
with the requirements in the act and allows the general assembly to
appoint members to intervene in any lawsuit challenging the
constitutionality of the act.

The bill requires the state department of human services (state
department) to contract with an independent third party to conduct a
feasibility study to determine the feasibility of creating a system to
support individuals with serious mental illness through a collaboration
between Colorado's behavioral health and judicial systems.
The bill requires the state department to work with the behavioral
health administration, department of local affairs, department of public
safety, department of health care policy and financing, judicial
department, and other state agencies to determine the eligibility
requirements and application process for selecting the independent third
party.
The bill requires the state department to submit a report detailing
the findings and recommendations from the feasibility study to the
general assembly, the governor's office, and impacted state agencies by
December 31, 2023.

Under current law, the knowing possession of any material,
compound, mixture, or preparation that weighs more than one gram and
not more than 4 grams and contains any quantity of fentanyl, carfentanil,
benzimidazole opiate, or an analog thereof, is a level 4 drug felony;
except that, if a defendant shows supporting evidence to establish that the
defendant made a reasonable mistake of fact and did not know that the
controlled substance contained fentanyl, carfentanil, benzimidazole
opiate, or an analog thereof, the matter must be submitted to the finder of
fact in the form of interrogatory included in the verdict form. If the finder
of fact determines the defendant made a reasonable mistake of fact, the
defendant commits a level 1 drug misdemeanor. The bill eliminates this
provision. Under current law, the knowing possession of any material,
compound, mixture, or preparation that weighs not more than one gram
and contains any quantity of fentanyl, carfentanil, benzimidazole opiate,
or an analog thereof, is a level 1 drug misdemeanor; except that a fourth
or subsequent offense is a level 4 drug felony. The bill eliminates the
requirement that the possession must be knowing.
The bill creates the opioid antagonist fund in the department of
education to bulk purchase and distribute opioid antagonists to eligible
schools. For the 2023-24 state fiscal year, the general assembly
appropriates $2 million to the fund from the general fund.
The bill extends civil and criminal immunity to the department of
education, or a person acting on behalf of the department, for acting in
good faith to furnish an opioid antagonist to an eligible school.
The bill requires every agency that employs a peace officer to
submit an annual report to the department of public health and
environment (department) concerning every incident in which a peace
officer administered an opioid antagonist to an individual. Using that
information the department creates a consolidated report and provides it
to the house of representatives judiciary and public and behavioral health
and human services committees and the senate judiciary and health and
human services committees.

Under current law, a person is immune from arrest and prosecution
of certain criminal offenses if the person reports an overdose to an
emergency responder and satisfies additional requirements related to the
reporting. The bill extends that immunity from arrest and prosecution to
the following criminal offenses:
  • Unlawful possession of a controlled substance if the
material, compound, mixture, or preparation contains
fentanyl, carfentanil, benzimidazole opiate, or an analog
thereof; and
  • Unlawful distribution or transfer of the controlled
substance for the purpose of consuming all of the
controlled substance with another person at a time
substantially contemporaneous with the transfer, if the
distribution or transfer involves certain controlled
substances.
The bill creates an affirmative defense to the prosecution for
unlawful distribution, manufacturing, dispensing, or sale of a material,
compound, mixture, or preparation that weighs not more than 4 grams and
contains any amount of certain controlled substances if the person reports
an overdose to an emergency responder and satisfies additional
requirements related to the reporting.

The bill requires the department of health care policy and
financing (state department) to grant an exception to step therapy if the
prescribing provider submits a prior authorization request with
justification and supporting clinical documentation for treatment of a
serious or complex medical condition. The bill requires the state
department to provide a response to a prior authorization request for a
step-therapy exception within 24 hours after receipt of the request.
If a prior authorization request for a step-therapy exception is
incomplete or if additional clinically relevant information is required, the
bill requires the state department to notify the prescribing provider within
24 hours after the submission of the request. If the state department does
not receive a response within 72 hours after the state department's request
for additional information, the prior authorization is denied. If the prior
authorization request is denied, the bill requires the state department to
inform the recipient in writing that the recipient has a right to appeal the
determination.
If the state department does not make a determination regarding
the step-therapy exception request, respond to the appeal of the denial of
the request, or request additional clinically relevant information, the
step-therapy exception request or the appeal of the denial is deemed
granted. The bill requires the state department to authorize coverage for
the prescription drug prescribed by the recipient's prescribing provider if
the prior authorization request for a step-therapy exception request is
granted.
The bill requires the state department to make the prior
authorization requirements for coverage of prescription drugs and a
description of the step-therapy exemption process available on the state
department's website and provide to the recipient, upon written request,
all specific clinical review criteria and other clinical information relating
to a recipient's particular condition or disease.

Section 1 of the bill:
  • Removes the knowingly or recklessly mental state from the
general unfair or deceptive trade practice provision
concerning an unfair, unconscionable, deceptive,
deliberately misleading, false, or fraudulent act or practice;
  • Establishes as a deceptive trade practice the act of
including in a contract offered to or entered into with a
consumer a term that is substantially unconscionable or
void as against public policy;
  • Establishes that evidence that a person has engaged in an
unfair or deceptive trade practice constitutes a significant
impact to the public; and
  • Amends the definition of recklessly with regard to unfair
or deceptive trade practices to mean without regard to
consequences or to the rights, interests, or safety of others.
Under current law, a person commits an unfair and unconscionable
act or practice if the person engages in price gouging with regard to the
sale or provision of certain goods or services during, and for a certain
period after, a declared emergency disaster (disaster period). Section 2
extends the disaster period from 180 days after the first declaration of the
disaster to 180 days after the final declaration concerning the disaster
expires.
Section 3 repeals and reenacts the Colorado Antitrust Act of
1992 as the Colorado State Antitrust Act of 2023 (act) and:
  • Establishes that the facilitation or aiding and abetting of
another person's violation of the act is itself a violation of
the act;
  • Authorizes the attorney general (AG) to request discovery
from any person that the AG believes may in the future
engage in, or has information related to, a violation of the
act;
  • Authorizes the AG to deem investigatory or intelligence
records related to the act available for public inspection,
but allows the AG to issue public statements or warnings
regarding conduct forming the basis of the investigatory or
intelligence records without waiving the AG's authority not
to deem the records available for public inspection;
  • Authorizes a court, upon request of the AG, to compensate
a person that has been injured from a violation of the act as
part of a civil action that the AG brings on behalf of the
person;
  • Increases the maximum civil penalty that a court may
award for a violation of the act from $250,000 to
$1,000,000 per violation; and
  • With regard to the statute of limitations for commencing a
civil action under the act:
  • Clarifies that a cause of action accrues on the date
of the last in a series of acts or practices that, in the
aggregate, constitute a violation of the act;
  • Tolls the statute of limitations for any civil action
pertaining to an alleged violation of the act during
the pendency of a federal proceeding regarding the
conduct forming the basis of the alleged violation of
the act; and
  • Exempts the AG from the statute of limitations.

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

For group benefit plan contracts between a pharmacy benefit
manager (PBM) or a health insurance carrier (carrier) and an employer,
certificate holder, or policyholder, the bill requires that the amount
charged by the PBM or carrier to the employer, certificate holder, or
policyholder for a prescription drug be equal to or less than the amount
paid by the PBM or carrier to the contracted pharmacy for the drug.
The bill creates transparency requirements for PBMs and carriers
regarding prescription drug benefits and grants audit authority to the
department of health care policy and financing for self-funded plans and
to the commissioner of insurance for fully insured plans, on request of the
office of the attorney general, to ensure compliance with the
requirements.
A violation of the requirements of the bill is a deceptive trade
practice under the Colorado Consumer Protection Act, with regard to
self-funded plans, and a deceptive trade practice in the business of
insurance, with regard to fully insured plans.

The bill specifies that a city may authorize the operation of an
overdose prevention center within the city's jurisdiction for the purpose
of saving the lives of persons at risk of preventable overdoses.

The bill requires the Colorado school of public health to analyze
model legislation for implementing a publicly financed and privately
delivered universal health-care payment system for Colorado that directly
compensates providers. The Colorado school of public health must submit
a report detailing its findings from the analysis to the general assembly by
December 1, 2023.
The bill also creates the statewide health-care analysis task force
consisting of members appointed by the general assembly and the
governor, as well as executive directors of specified state departments,
the commissioner of insurance, and the chief executive officer of the
Colorado health benefit exchange or any designees of the executive
directors, the commissioner, and the chief executive officer. The task
force is created for the purpose of advising the Colorado school of public
health during the analysis.

The bill requires the Colorado department of public health and
environment (department) to distribute stop the bleed training materials
and bleed control kits to K-12 schools that opt into receiving them. The
bill also requires the department, in collaboration with the American
college of surgeons' committee on trauma, to report the number of schools
that opt in, the number of people who have been trained in stop the bleed
procedures in schools, the total number of stop the bleed control kits sent
to schools, and the total cost of the program for each school year.

The bill defines health-care provider as a person that is licensed
or otherwise authorized in this state to furnish a health-care service,
which includes a hospital and other providers and health facilities.
The bill prohibits a health-care provider (provider) affiliated with
or owned by a hospital or health system from charging a facility fee for
health-care services furnished by the provider for:
  • Outpatient services provided at an off-campus location or
through telehealth; or
  • Certain outpatient, diagnostic, or imaging services
identified by the medical services board as services that
may be provided safely, reliably, and effectively in
nonhospital settings.
The bill:
  • Requires a provider that charges a facility fee to provide
notice to a patient that the provider charges the fee and to
use a standardized bill that includes itemized charges
identifying the facility fee, as well as other information;
  • Requires the administrator of the all-payer health claims
database to prepare an annual report of the number and
amount of facility fees by payer, codes with the highest
total paid amounts and highest volume, and other
information; and
  • Makes it a deceptive trade practice to charge, bill, or collect
a facility fee when doing so is prohibited.

The bill requires the department of public health and environment
(department) to identify health-care services that are or may be subject to
a denial of care in this state and to develop a simple service availability
form to be filled out by a covered entity for the purpose of conveying to
patients and to the public information about health-care services that, for
nonmedical reasons, are not generally available at the covered entity or
that are subject to significant restriction at the covered entity.
The bill defines:
  • Covered entity as a hospital, community clinic, maternity
hospital, freestanding emergency department, or
rehabilitation hospital;
  • Denial of care, in part, as refusal to provide health-care
services for nonmedical reasons; and
  • Nonmedical reasons, in part, as nonclinical criteria, rules,
or policies that restrict health-care professionals and
covered entities from providing health-care services that
the professionals or facilities are authorized or licensed to
provide.
The bill includes requirements for the content and format of the
service availability form and requires the department to publish and
maintain on its public-facing website a list of covered entities and the
service availability form for the covered entity.
The bill authorizes the department to update the service availability
form at least biennially. The executive director of the department shall
adopt rules to implement the requirements in the bill and investigate
complaints and assess fines against covered entities that fail to comply
with the requirements in the bill.
The department shall implement a public awareness program that
includes how denial of care may negatively impact health-care access and
quality of care, how denial of care may be avoided, and the impacts of
denial of care on vulnerable people and communities.
A covered entity shall provide patients with the current service
availability form as part of the informed consent process prior to initiating
a health-care service and shall maintain a record of the patient's receipt
of the form. The covered entity shall encourage health-care professionals
with privileges at the covered entity to share the covered entity's service
availability form with a patient when a health-care service is scheduled
at the covered entity.

The bill makes changes to the Colorado Standardized Health
Benefit Plan Act to:
  • Require the Colorado health benefit exchange (exchange),
with the consent of the commissioner of insurance
(commissioner), to develop a format for displaying the
standardized plans on the exchange;
  • Grant the commissioner 120 days to review the rate filings
for standardized plans instead of the current 60 days;
  • Require a carrier to notify the commissioner of the steps
the carrier will take to meet premium rate requirements if
the carrier is unable to offer a standardized plan;
  • Make changes to the requirements for public hearings held
by the commissioner for carriers who are unable to offer
the standardized plan; and
  • Specify that decisions of the commissioner are final agency
actions subject to judicial review in the court of appeals.

In 2021, the general assembly enacted SB 21-175, which created
the prescription drug affordability board (board) in the division of
insurance (division) and an affordability review process whereby the
board may review costs associated with, and establish upper payment
limits for, certain prescription drugs. The bill makes certain changes
concerning the board.
Section 1 defines board activity, and section 2 states that only
board members, and not staff members or contractors of the division, are
required to recuse themselves from any board activity or vote where they
have a conflict of interest.
Section 3 allows the chair of the board to cancel or postpone a
board meeting for good cause.
Section 4 makes certain changes to the procedure by which the
board identifies prescription drugs that may be subjected to an
affordability review. Section 4 also requires the board to report on its
public web page certain information regarding its considerations.
Section 5 removes language prohibiting the board from
establishing an upper payment limit for more than 12 prescription drugs
within a specified period.
Section 6 establishes that an upper payment limit for a prescription
drug is not a final agency action that is subject to judicial review until the
board promulgates a rule establishing the upper payment limit.
Sections 6 and 7 remove certain language describing an appeals
process for appealing decisions of the board.
Sections 8 and 9 extend the repeal and associated sunset review
of the board from September 1, 2026, to September 1, 2031.
Section 10 establishes that a denial of a request for benefits for a
prescription drug that is unavailable in the state because a manufacturer
has withdrawn the prescription drug from sale or distribution within the
state is an adverse determination for which an individual may request
an independent external review.

Current law requires the department of health care policy and
financing (state department) to annually prepare a written hospital
expenditure report. The bill changes the name of the report to the hospital
transparency report (transparency report).
The bill adds specified information that each hospital shall report
to the state department for the transparency report.
No later than July 1, 2024, the bill requires each hospital to
provide specified information to the state department for previous fiscal
years.
The bill authorizes the state department to impose certain
enforcement mechanisms against a hospital that does not provide all of
the information required to be reported to the state department.
Beginning July 1, 2024, the bill requires any patient bill to include
a clear, plain language description of the services the patient is being
billed for and a statement that the patient has a right to receive a detailed
explanation of the services charged and who to contact to receive such
information.

Under current law, pharmacy benefit managers (PBMs) are
required to perform certain acts and are prohibited from engaging in
certain acts. Specifically, PBMs are prohibited from:
  • Requiring patients to obtain their prescription drugs
through mail order;
  • Charging pharmacies fees to adjudicate claims;
  • Requiring pharmacies to obtain accreditations or
certifications that are different than what the PBM requires
of its affiliated pharmacies;
  • Retroactively reducing a payment made to a pharmacy on
a drug claim after the point of sale or reimbursing a
pharmacy in an amount that is less than the amount
reimbursed to its own affiliated pharmacy for the same
pharmacy service;
  • Modifying the prescription drug formulary under a health
benefit plan during the plan year;
  • With regard to audits, using specified techniques in
calculating a recoupment or penalty, subjecting a pharmacy
to recoupment when a clerical error is discovered, and
requiring pharmacies to be audited more than once a year;
  • Prohibiting a pharmacy or pharmacist from, or penalizing
a pharmacy or pharmacist for, providing information to
patients about more affordable, therapeutically equivalent
alternatives to a prescribed drug; or
  • Requiring a pharmacy or pharmacist to charge or collect a
copayment from an insured patient that exceeds the total
charge submitted by the pharmacy for the prescription
drug.
Additionally, PBMs are required to:
  • Provide pharmacies 7 days' written notice before an audit,
conduct an audit by or in consultation with a pharmacist,
allow the pharmacy to supplement claims documentation,
and establish an appeals process;
  • Provide an insured individual, the insured's health-care
provider, or a third party acting on behalf of the insured or
provider with up-to-date and real-time cost, benefit, and
coverage information under the terms of the insured's
health benefit plan; and
  • Provide contracted pharmacies with the list of sources the
PBM used in determining maximum allowable cost pricing,
update the information every 7 days, allow pharmacies the
ability to readily review the information, follow specified
requirements when placing a drug on the maximum
allowable cost list, and establish an appeals process to
resolve disputes.
The bill specifies that the commissioner of insurance
(commissioner) has the power to enforce these prohibitions and
requirements and impose penalties on PBMs for failing to comply with
these prohibitions and requirements.
Additionally, the bill requires:
  • PBMs to register with and pay a registration fee to the
commissioner; and
  • Health insurers to pay a fee when filing with the
commissioner their list of PBMs they use for prescription
drug benefits administration.
The fees imposed under the bill are to be used to fund the costs of
the division of insurance in enforcing requirements and prohibitions on
PBMs.

The bill makes changes to the hospital community benefit and
imposes certain requirements on the public presentation of each hospital's
community implementation plan. The bill requires each hospital to:
  • Solicit feedback from the community during each annual
presentation of its proposed community benefit
implementation plan for the following year;
  • Submit a report that details who attended the public
meeting, the topics discussed at the meeting, and any
decisions made as a result of the discussion;
  • Make the report available to the public; and
  • Complete a community benefit implementation plan that
addresses the needs described in the reporting hospital's
community health needs assessment and includes an
explanation of the community served by the hospital.
The bill requires the state board to promulgate rules governing the
accessibility standards for the public meetings and to implement best
practices to ensure public engagement from a diverse range of
populations.
The bill requires the department of health care policy and
financing (state department) to:
  • Include in its annual report a summary of the estimated
federal and state tax exemptions made by each hospital;
  • Establish a minimum annual community investment target
based on certain calculation standards; and
  • Set requirements for compliance, and allows the state
department to take remedial action if a hospital fails to
comply with the hospital community benefit requirements.

The bill moves the regional health connector program (program)
from the university of Colorado school of medicine to the prevention
services division (division) in the department of public health and
environment. The bill requires the division to contract with a third-party
entity to coordinate and oversee the program. The contracted entity is
required to distribute money to each locally based host organization,
which hires and supports a regional health connector to engage in
program activities.

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

The bill requires the department of health care policy and
financing to analyze how directed payment authority can be used as part
of a comprehensive plan to facilitate an adequate network of services for
children and youth by requiring each managed care entity to pay no less
than state department-established fee schedule rates for services needed
to promote clinical stabilization.
No later than July 1, 2023, the bill requires the department of
human services (CDHS) to form a working group to make
recommendations about developing an incentive funding pool pilot
program to incentivize residential treatment providers to accept and treat
children and youth who have high-acuity behavioral health needs to
appropriate treatment and placement.
The bill requires the behavioral health administration (BHA) to
develop a framework to measure and assess how the behavioral health
system for children and youth is functioning, which framework must
include measures of accountability for children and youth who are
boarding or in extended stay.
Beginning September 1, 2023, and each quarter thereafter until
October 1, 2024, the bill requires each hospital to report de-identified
information to the BHA on the total number of children and youth
patients who were boarding or had extended stay in the previous quarter;
if known, how many children and youth who were boarding or had
extended stay and were in county custody at the time; and, for patients
who were discharged during the quarter, where the patients were
discharged to.
Beginning September 1, 2023, and each quarter thereafter until
October 1, 2024, the bill requires CDHS to report de-identified
information to the BHA on the total number of children and youth in the
custody of, or who had involvement with, a county department of human
or social services who spent time at least overnight in a hotel or a county
department office as a stopgap setting or remained in detention when the
child or youth could have been released but no placement was available.
No later than September 1, 2023, and each quarter thereafter until
October 1, 2024, the bill requires the BHA to report aggregated and
de-identified information submitted to the BHA to the BHA advisory
council and to the child and youth mental health service standards
advisory board.
The bill requires CDHS to develop a plan for whenever a
residential treatment facility for children and youth closes or has a
substantial change in operation to support children and youth treatment
capacity elsewhere in a manner that most appropriately serves the
behavioral health needs of the child or youth.

The bill creates a nonprofit unincorporated legal entity, the fair
access to insurance requirements plan association (association), to help
persons who are unable to find coverage in the voluntary market obtain
property insurance coverage for their real property.
The association must:
  • Establish, offer, and maintain a property insurance policy
that satisfies the requirements specified in the bill;
  • Establish a reinsurance association; and
  • Assess and share among member insurers all expenses,
income, and losses based on each member insurer's written
premium in the state.
The association is managed by a board of directors consisting of
9 members appointed by the governor. The board is required to administer
the fair access to insurance requirements plan (FAIR plan).
The FAIR plan must include rates that:
  • Are not excessive, inadequate, or unfairly discriminatory;
  • Are actuarially sound so that revenue generated from
premiums is adequate to pay for expected losses, expenses,
and taxes and the cost of reinsurance; and
  • Reflect the investment income of the FAIR plan.
The plan of operation for the FAIR plan may include provisions
establishing maximum limits of liability, reasonable underwriting
standards for determining the insurability of a risk, and commissions to
be paid to the licensed producers that offer the FAIR plan.
The commissioner of insurance may suspend or revoke the
certificate of authority to transact insurance business in this state of any
member insurer that fails to timely pay a fee or to comply with the plan
of operation for the FAIR plan.

Joint Budget Committee. The bill makes the following changes
to the reviews and audits of the payments by the department of health care
policy and financing (department) to providers:
  • The department shall review and audit underpayments and
overpayments to providers;
  • If the department determines that an overpayment occurred
because services could have been provided at a lower cost
setting, the overpayment is the difference between the
amount paid and the amount due if the services had been
provided under other circumstances;
  • Any overpayment review evaluating medical necessity
must be conducted by a Colorado physician relying only on
the information available at the time of treatment;
  • The department shall not declare the existence of an
overpayment until providers have exhausted all
administrative and judicial remedies;
  • If the department determines that there has been an
underpayment, the department shall pay the provider the
amount due because of the underpayment, plus interest;
  • Reimbursement for covered services, including amounts
collected for an overpayment, must be in an amount
adequate to ensure access to care;
  • Audits and reviews must not occur more than 3 years after
the date the claim was filed;
  • Notices of adverse action that fail to comply with
department rules are void;
  • In an appeal of a determination of overpayment or
underpayment, an administrative law judge's ruling must be
published on the department's website and other
administrative law judges may rely on previous rulings as
precedent;
  • The department shall annually identify billing errors
common across multiple providers to enable providers to
correct the errors;
  • The department may contract with a qualified agent to
review or audit payments to providers for both
overpayments and underpayments and must protect against
conflicts of interest;
  • In any contingency-based contract for review or audit of
payments, the compensation must not exceed 12.5% of the
amount of overpayments collected and the amount due
because of underpayments determined;
  • At least quarterly, the department shall publish on its
website an audit activity report detailing current and
recently completed audits and reviews and summaries of
the findings of such audits and reviews and a copy of the
contracts, scopes of work, and information regarding
supervision of contractor deliverables for audits and
reviews;
  • The department shall create a provider advisory group to
advise the department on issues that providers have
concerning the audits and reviews; and
  • The department shall contract for an independent review of
reviews and audits conducted from the 2018-19 to the
2022-23 state fiscal years for compliance with coding
practice standards and state law.

Joint Budget Committee. The bill requires the department of
health care policy and financing (state department) to conduct a study to
determine the feasibility of extending continuous eligibility medical
coverage for eligible children and adults.
The state department is required to submit a report detailing its
findings and recommendations from the feasibility study to the joint
budget committee of the senate and house of representatives, the
governor, and to the house of representatives public and behavioral health
and human services committee and the senate health and human services
committee, or any successor committees, by January 1, 2026.
The state department is required to prepare documents seeking
federal authorization to provide continuous eligibility medical coverage
to eligible adults and children and include the completed federal
authorization documents with its report submitted to the joint budget
committee of the senate and house of representatives, the governor, and
to the house of representatives public and behavioral health and human
services committee and the senate health and human services committee,
or any successor committees.
No later than April 1, 2024, the state department is required to seek
federal authorization to extend continuous eligibility coverage for
children less than 3 years of age, including children who would be
eligible for medical assistance coverage but are not because of their
immigration status, and to extend eligibility coverage for 12 months for
adults who have been released from a Colorado department of corrections
facility, regardless of a change in income.
The bill makes an appropriation.

The bill amends the priority of distribution of insurance claims
paid from an insurer's estate in the event of the insurer's liquidation to
include in the class 1 distribution priority payments that an impaired or
insolvent insurer owes to the risk adjustment program that are necessary
to prevent another insurer from becoming impaired or insolvent. This
prioritization adjustment repeals on July 1, 2026.
The bill also amends the Life and Health Insurance Protection
Association Act (act) as follows:
  • Adds health maintenance organizations (HMOs) as
members of the association and subjects HMOs to
assessments from the association;
  • Allocates responsibility for long-term care insurance
assessments between health insurance and life insurance
association members; and
  • Specifies that the act does not provide coverage to a person
that acquires rights to receive, or to a payee or beneficiary
that transfers its rights in, a structured settlement factoring
transaction, as defined in federal law, regardless of when
the transaction occurred.

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

Current law requires a certificate of death for every death that
occurs in Colorado to be filed with the state registrar within 5 days after
the death occurs. The funeral director is responsible for filing the death
certificate and must obtain the medical certification necessary to complete
the portion of the certificate pertaining to the cause of death from a
qualified individual. Physicians must complete, sign, and return to the
funeral director all medical certification within 48 hours after a death
occurs. If an inquiry is required to be made to a coroner, the coroner must
determine the cause of death and complete and sign the medical
certification within 48 hours after taking charge of the case. If the cause
of death cannot be determined within 48 hours after a death, the medical
certification must be completed as provided by rule.
The bill changes the time frame required to file a certificate of
death with the state registrar from 5 days to 48 hours with limited
exceptions. It also imposes a requirement that a funeral director file the
certificate within 48 hours if they are able to obtain the medical
certification from a qualified individual within those 48 hours. The bill
requires that a qualified individual complete the medical certification
within 36 hours after the death has occurred unless an inquiry is required
to be made to a coroner. The coroner shall determine the cause of death
and complete the medical certification within 48 hours after taking charge
of the case unless in good faith, the coroner determines that additional
time is needed, in which case, the coroner must determine the cause of
death and complete the medical certification as soon as practicable.
Section 2 of the bill requires the department of public health and
environment, upon request, to provide a certified death certificate to an
applicant having a direct and tangible interest in the certified copy of the
record of death within 24 hours.

The bill encourages each public school in the state to provide
instruction on cardiopulmonary resuscitation and the use of an automated
external defibrillator to students in grades 9 through 12. The bill requires
the instruction to meet certain requirements.
The bill requires the instruction of cardiopulmonary resuscitation
and the use of an automated external defibrillator to be included in the
curriculum for a high school that participates in the Colorado
comprehensive health education program.

The bill creates the Colorado multidisciplinary health-care
provider access training program (program) to improve the health care of
medically complex, costly, compromised, and vulnerable older
Coloradans. The university of Colorado Anschutz medical campus shall
develop, implement, and administer the program. The program may be
offered to Colorado institutions of higher education with clinical health
professions graduate degree programs. The program coordinates and
expands geriatric training opportunities for clinical health professions
graduate students (students) enrolled in participating Colorado institutions
of higher education (participating institutions) across Colorado studying
to become advanced practice providers; dentists; nurses; occupational
therapists; pharmacists; physicians, including medical doctors and doctors
of osteopathy; physical therapists; psychologists; social workers; and
speech-language therapists. Students who successfully complete the
program are awarded certificates and issued letters authorizing those
students to become trainers for the program in clinics across the state.
The bill creates the Colorado multidisciplinary health-care
provider access training program advisory committee (committee) to
ensure that the training for the program is consistent and collaborative
across the fields of study. The committee is required to:
  • Appoint a program chair;
  • Set the program's standards for training and delivery of
multidisciplinary medical care to medically complex,
costly, compromised, and vulnerable older Coloradans;
  • Establish requirements for the program;
  • Identify and invite institutions of higher education that
offer appropriate clinical health professions graduate
degree programs to become participating institutions;
  • Collaborate with participating institutions of higher
education across Colorado to enhance recruitment of
students to enter a field specific to geriatrics and select
students with an interest in geriatric care to participate in
the program;
  • Assist with updating the program's curricula;
  • Analyze data collected by the program;
  • Build a multidisciplinary network of trained geriatric
clinicians to collaborate and provide opportunities for
clinicians to work together to better understand the roles of
each health-care discipline in urban, rural, and underserved
communities when caring for older Coloradans;
  • Improve placement of students in experiential clinical
training opportunities, prioritizing rural and underserved
communities;
  • Coordinate with graduates of the program to become
geriatric trainers for future students; and
  • Increase the number of clinical training sites across
Colorado, specifically in rural and underserved
communities.

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

The bill authorizes a physician, a physician assistant, and an
advanced practice registered nurse (prescriber) to prescribe and
administer a drug approved by the federal food and drug administration
for an off-label use if:
  • The off-label use of the drug for the indication has
longstanding, common use;
  • There is medical evidence to support the off-label use and
no known evidence contraindicating such off-label use; and
  • The prescriber has provided the patient or a minor patient's
parent or guardian with an informed consent form, and the
patient or parent or guardian has signed the form.
The bill applies the same standard of care for the off-label use of
the drug as for the on-label use of the drug.
The bill clarifies that a pharmacist who fills a prescription for
off-label use is not subject to discipline by the state board of pharmacy.

Current law allows the residents of any county to present their
board of county commissioners with a petition asking that a public
hospital board of trustees (hospital board) be appointed and that an annual
tax be levied for the establishment and maintenance of a public hospital
in the county. The board of county commissioners may create, by
resolution, a hospital board to levy the tax and may appropriate money to
the hospital board for purchasing or building a hospital and for
maintaining the hospital. The bill makes the following changes regarding
hospital boards:
  • Currently, if a hospital board acquires real property, title to
the real property must be in the name of the county. The
bill authorizes real property to be in the name of either the
county or the hospital.
  • A hospital board has the authority to borrow money and
incur indebtedness. The bill clarifies that any indebtedness
incurred by a hospital board is an obligation of the hospital
board and not an obligation of the board of county
commissioners.
  • Currently, a hospital board must have the approval of the
board of county commissioners before incurring
indebtedness. The bill specifies that a hospital board needs
the approval of the board of county commissioners before
incurring indebtedness only if the repayment of the
indebtedness is dependent on tax money received for
hospital purposes from the board of county commissioners.
  • The bill allows a hospital board to offer to the general
public products and services of any health care
organization, association, partnership, or corporation to the
extent that the products and services are consistent with the
powers and duties of a county public hospital; and
  • Each year, the board of county commissioners may
appropriate not more than 5% of its general fund for the
improvement or enlargement of any public hospital
established in the county. The bill removes the annual 5%
limit on appropriations from a county's general fund and
also allows such money to be used for the operation of a
public hospital.

Current law allows a physician to submit documentation to the
department of public health and environment (department) stating that a
patient has a debilitating medical condition or disabling medical condition
and may benefit from the use of medical marijuana. The bill clarifies that
the physician is submitting a recommendation to the department rather
than a certification or authorization.
The bill removes the following requirements for a physician's
recommendation to the department:
  • The physician's federal drug enforcement agency number;
  • The maximum THC potency level of the medical marijuana
product;
  • The recommended medical marijuana product;
  • The patient's daily authorized quantity of the medical
marijuana product; and
  • Directions for use of the medical marijuana product.
The bill allows a physician to establish a bonafide
physician-patient relationship remotely via video or telephone conference
if the patient is:
  • 21 years of age or older;
  • Under 18 years of age; or
  • 18 years of age or older but under 21 years of age and the
patient received a medical marijuana recommendation prior
to 18 years of age.
The bill clarifies that a patient must only present a uniform
certification form completed by a recommending physician to a medical
marijuana store if the patient seeks to purchase more than the statutorily
allowed limit of medical marijuana products.
Current law limits the amount of medical marijuana concentrate
that a patient may purchase in a single day to 8 grams. The bill increases
that limitation to 40 grams, but limits the total amount that a patient can
purchase in a 30-day period to the equivalent of 8 grams per day. Current
law limits the combined amount of medical marijuana products that a
patient may purchase in a single day to 20,000 milligrams. The bill adds
an exception to that limitation for nonedible, nonpsychoactive medical
marijuana products.
Current law limits the amount of medical marijuana concentrate
that a patient 18 years of age or older but under 21 years of age may
purchase in a single day to 2 grams. The bill allows a patient that is 18
years of age or older but under 21 years of age and had a registry
identification card issued by the department prior to 18 years of age to
purchase in a single day up to 8 grams of medical marijuana concentrate.
The bill clarifies that when a physician issues a uniform
certification form to a patient 18 years of age or older, the physician may
consider whether the patient had a registry identification card issued by
the department prior to 18 years of age as a factor in recommending that
the patient be allowed to purchase more than the statutorily allowed
quantities of medical marijuana products.
The bill allows a retail marijuana store to sell retail marijuana
products to patients at the statutorily allowed limit for medical marijuana
products and registered primary caregivers 21 years of age or older who
present a registry identification card issued by the department. The bill
also allows a registered primary caregiver to purchase retail marijuana
products for a patient who is under 21 years of age at the applicable
statutorily allowed limit for medical marijuana products for patients under
21 years of age.

The bill modifies the relationship between a physician assistant
and a physician or podiatrist by removing the requirement that a physician
assistant be supervised by a physician or podiatrist. Instead, a physician
assistant must enter into a collaborative agreement with an employer,
physician, or podiatrist.
The collaborative agreement must include:
  • The physician assistant's name, license number, and
primary location of practice;
  • The signature of the physician assistant and the person with
whom the physician assistant has entered into the
collaborative agreement;
  • A general description of the physician assistant's process
for collaboration;
  • A description of the performance evaluation process, which
may be completed by the physician assistant's employer in
accordance with a performance evaluation and review
process established by the employer; and
  • Any additional requirements specific to the physician
assistant's practice required by the employer, physician, or
podiatrist entering into the collaborative agreement,
including additional levels of oversight, limitations on
autonomous judgment, and the designation of a primary
contact for collaboration.
For a physician assistant with fewer than 3,000 practice hours, the
collaborative agreement must also:
  • Require that collaboration during the first 160 practice
hours be completed in person or through technology;
  • Incorporate elements defining the expected nature of
collaboration; and
  • Require a performance evaluation and discussion of the
performance evaluation with the physician assistant.
The bill also requires physician assistants who have been
practicing for less than 3 years to satisfy certain financial responsibility
requirements from which such physician assistants are exempt under
current law.

The bill requires the department of health care policy and
financing (state department) to create a limited risk factors that influence
health benefit (benefit) for medicaid recipients under 21 years of age who
experience a qualifying risk factor that influences health.
The bill requires the benefit to include access to certain behavioral
health services.
The bill requires the state department to implement the benefit no
later than July 1, 2024.

The bill:
  • Caps the rate of interest on medical debt at 3% per annum;
  • Defines medical debt, for purposes of a statutory cap on
interest rates and fair debt collection practices, to include
debt arising from the receipt of health-care services or
medical products or devices;
  • Requires a debt collector or collection agency collecting on
a medical debt to provide to the consumer, upon the
consumer's written or oral request, an itemized statement
concerning the debt and allows the consumer to dispute the
validity of the debt after receipt of the itemized statement;
  • Establishes requirements relating to payment plans for
medical debt, including written documentation of the
payment plan between the consumer and the creditor, debt
collector, or debt collection agency; notice to the consumer
if the payment plan will be accelerated or declared in
default or inoperative due to nonpayment; and the
opportunity to renegotiate the payment plan;
  • Prohibits collection on the debt during any appeal
proceedings and prohibits reporting the debt to a consumer
reporting agency until a certain amount of time after the
payment plan becomes inoperative;
  • Requires a debt collector or collection agency that files a
legal action to collect medical debt to include an
itemization of the charges and, prior to the entry of a
default judgment against the creditor, provide evidence of
the debt;
  • Makes it a deceptive trade practice to violate provisions
relating to billing practices, surprise billing, and balance
billing laws; and
  • Requires a health-care provider or health-care facility to
provide, upon request of a prospective patient, an estimate
of the total cost of a health-care service (service) to a
person who intends to self-pay for the service (self-pay
estimate). The bill includes requirements for the self-pay
estimate and caps the amount by which the final, total cost
of the service may exceed the self-pay estimate, with
exceptions for emergency or unforeseen, medically
necessary services required during the service. The bill
makes it a deceptive trade practice to violate provisions
relating to the self-pay estimate.

The National Labor Relations Act does not apply to federal,
state, or local governments and the Colorado Labor Peace Act excludes
governmental entities, with an exception for mass transportation systems,
leaving public employees without the protection afforded by these labor
laws. The bill grants certain public employees, including individuals
employed by counties, municipalities, fire authorities, school districts,
public colleges and universities, library districts, special districts, public
defender's offices, the university of Colorado hospital authority, the
Denver health and hospital authority, the general assembly, and a board
of cooperative services, the right to:
  • Discuss or express views regarding public employee
representation or workplace issues;
  • Engage in protected, concerted activity for the purpose of
mutual aid or protection;
  • Fully participate in the political process while off duty and
not in uniform, including speaking with members of the
public employer's governing body on terms and conditions
of employment and any matter of public concern and
engaging in other political activities in the same manner as
other citizens of Colorado without discrimination,
intimidation, or retaliation; and
  • Organize, form, join, or assist an employee organization or
refrain from organizing, forming, joining, or assisting an
employee organization.
The bill also prohibits certain public employers from
discriminating against, coercing, intimidating, interfering with, or
imposing reprisals against a public employee for engaging in any of the
rights granted.
The Colorado department of labor and employment (department)
is charged with enforcing any alleged violation of these rights and is
granted rule-making authority. A party may appeal the department's final
decision to the Colorado court of appeals. The bill requires the court of
appeals to give deference to the department.

Joint Budget Committee. The bill extends the deadline from
January 1, 2023, to October 1, 2023, for when the department of public
health and environment (department) must contract with an independent
entity to conduct a study concerning House Bill 22-1326.
The bill extends the authority for the department to use the
appropriation received in the 2022-23 state fiscal year to pay for the
independent study through the 2024-25 state fiscal year.

The bill allows a health-care provider to prescribe, dispense, or
administer a schedule II, III, IV, or V controlled substance (drug) to a
patient in the course of treatment for a diagnosed condition that causes
chronic pain. The bill also clarifies that the prescribing health-care
provider is not subject to disciplinary action by the appropriate regulator
for prescribing a dosage of a drug that is equal to or more than a
morphine milligram equivalent dosage recommendation or threshold
specified in state or federal opioid prescribing guidelines or policies.
The bill prohibits a health-care provider from refusing to accept or
continue to treat a patient solely on the basis of the dosage of a drug the
patient requires for the treatment of chronic pain. A health-care provider
is also prohibited from tapering a needed dosage solely to meet a
predetermined dosage recommendation.
The bill also prohibits a pharmacist, health insurance carrier, or
pharmacy benefit manager from refusing to fill or approve the coverage
for a drug solely on the basis of the dosage requirement of a patient.

The bill:
  • Authorizes a pharmacist to delegate to a pharmacy
technician any task within the practice of pharmacy for
which the pharmacy technician has been specifically
trained, except for patient counseling, drug regimen review,
and clinical conflict resolution;
  • Removes the statutory supervision ratio for pharmacists
supervising pharmacy technicians when the pharmacy is
not a public-facing pharmacy and is acting as an agent of
an originating pharmacy to fill or refill a prescription; and
  • Authorizes reimbursement under the medical assistance
program for dispensing or administering vaccines to
children under 19 years of age.

Starting July 1, 2024, the bill authorizes individuals who have a
midwife certification from the American Midwifery Certification Board,
pay the required fee, and submit to a criminal history record check to
obtain a license from the state board of nursing (board) to practice as a
certified midwife in the state. A certified midwife licensed by the board
may apply for and obtain provisional and full prescriptive authority upon
satisfying the requirements specified in the bill. Certified midwives are
subject to regulation by the board to the same extent that the board
regulates the practice of nursing, including grounds for discipline and
disciplinary actions.

The bill repeals and reenacts the statutory article related to extreme
risk protection orders.
Under current law a family or household member and a law
enforcement officer or agency can petition for an extreme risk protection
order. The bill expands the list of who can petition for an extreme risk
protection order to include licensed medical care providers, licensed
mental health-care providers, licensed educators, and district attorneys.
The bill requires the office of gun violence prevention to expend
funds annually on a public education campaign regarding the availability
of, and the process for requesting, an extreme risk protection order.

The bill requires the department of health care policy and
financing (state department) to provide certain behavioral health services
for medicaid recipients who are under 21 years of age.
The bill requires the state department to begin to provide the
services no later than July 1, 2024.

The bill requires contracts between insurers or other persons and
health-care providers regarding the delivery of health-care services to
include a provision that prohibits the following actions if the actions are
based solely on the health-care provider's provision of, or assistance in the
provision of, reproductive health care or gender-affirming health-care
services (legally protected health-care activity) in this state, so long as the
care provided did not violate Colorado law:
  • A medical malpractice insurer from refusing to issue,
canceling or terminating, refusing to renew, or imposing
any sanctions, fines, penalties, or rate increases for a
medical malpractice policy (section 2);
  • A health insurer from taking an adverse action against a
health-care provider, including refusing to pay for a
provided health-care service, terminating or refusing to
renew a contract with the health-care provider, or imposing
other penalties on the health-care provider (section 3);
  • A health insurer from refusing to credential a physician as
a network provider or terminating a physician's status as a
network provider (section 4); or
  • A person or entity from terminating a health-care contract
with a health-care provider (section 25).
Section 5 protects an individual applying for licensure,
certification, or registration in a health-care-related profession or
occupation in Colorado (applicant), as well as a health-care professional
currently licensed, certified, or registered in Colorado (licensee), from
having the license, certification, or registration denied or discipline
imposed against the licensee based solely on:
  • The applicant's or licensee's provision of, or assistance in
the provision of, a legally protected health-care activity in
this state or another state or United States territory, so long
as the care provided was consistent with generally accepted
standards of practice under Colorado law and did not
otherwise violate Colorado law;
  • A civil or criminal judgment or a professional disciplinary
action arising from the provision of, or assistance in the
provision of, a legally protected health-care activity in this
state or another state or United States territory, so long as
the care provided was consistent with generally accepted
standards of practice under Colorado law and did not
otherwise violate Colorado law;
  • The applicant's or licensee's own personal effort to seek or
engage in a legally protected health-care activity; or
  • A civil or criminal judgment against the applicant or
licensee arising from the individual's own personal legally
protected health-care activity in this state or another state
or United States territory.
Section 6 prohibits a court, judicial officer, court employee, or
attorney from issuing a subpoena in connection with a proceeding in
another state concerning an individual who accesses a legally protected
health-care activity in Colorado or an individual who performs, assists,
or aids in the performance of a legally protected health-care activity in
Colorado.
Section 7 prohibits the state from applying another state's law to
a case or controversy heard in Colorado state court or giving any force or
effect to any judgment issued without personal jurisdiction or due process
or to any judgment that is penal in nature pursuant to another state's law
if the other state's law authorizes a person to bring a civil action against
another person or entity for engaging or attempting to engage in a legally
protected health-care activity.
If a medical malpractice action is brought in this state against a
health-care provider regulated in this state or another state, section 8
prohibits a court or arbitrator from allowing evidence or witness
testimony relating to professional discipline or criminal or civil charges
in this state or another state concerning the provision of, or assistance in
the provision of, a legally protected health-care activity, so long as the
care provided did not violate Colorado law.
Section 9 prohibits a peace officer from knowingly arresting or
participating in the arrest of any person who engages in a legally
protected health-care activity, unless the acts forming the basis for the
arrest constitute a criminal offense in Colorado or violate Colorado law.
Section 10 prohibits the issuance of a search warrant to search for
and seize any property that relates to an investigation into a legally
protected health-care activity.
Section 11 prohibits a judge from issuing a summons in a case
when a prosecution is pending, or when a grand jury investigation has
started or is about to start, for a criminal violation of another state's law
involving the provision or receipt of or assistance with accessing a legally
protected health-care activity that is legal in Colorado, unless the acts
forming the basis of the prosecution or investigation would also constitute
a criminal offense in Colorado.
Section 12 prohibits the issuance of an ex parte order for
wiretapping or eavesdropping to obtain any wire, oral, or electronic
communication that relates to an investigation into a legally protected
health-care activity.
Current law allows for the extradition of a person who committed
an act in this state that intentionally results in a crime in the state whose
executive authority is making the demand, even though the accused was
not in the demanding state at the time of the commission of the crime.
Section 13 requires the acts for which extradition is sought to be
punishable by the laws of this state if the acts occurred in this state and
prohibits the governor from surrendering a person charged in another
state as a result of the person engaging in a legally protected health-care
activity, unless the executive authority of the demanding state alleges in
writing that the accused was physically present in the demanding state at
the time of the commission of the alleged offense.
Section 14 requires a correctional facility or private contract
prison incarcerating a person who is capable of pregnancy to, regardless
of the person's ability to pay, ensure access to abortions by providing a
pregnant person with information about abortion providers; referrals to
community-based providers of abortions; referrals to community-based
organizations that help people pay for abortions; and transportation to
access an abortion; and ensure access to miscarriage management,
including medication.
Section 15 adds a reproductive health-care services worker to the
list of protected persons whose personal information may be withheld
from the internet if the protected person believes dissemination of such
information poses an imminent and serious threat to the protected person
or the safety of the protected person's immediate family.
Section 16 prohibits the prosecution or investigation of a licensed
health-care provider if the health-care provider prescribes an abortifacient
to a patient and the patient ingests the abortifacient in another state so
long as the abortifacient is prescribed or administered consistent with
accepted standards of practice under Colorado law and does not violate
Colorado law.
Section 17 through section 20 adds a protected health-care
worker to the list of persons authorized to participate in the address
confidentiality program.
Section 21 authorizes the attorney general to independently initiate
and bring a civil and criminal action to enforce the Reproductive Health
Equity Act.
Section 22 prohibits a state agency from providing any
information or using any government resources in furtherance of any
out-of-state investigation or proceeding seeking to impose civil or
criminal liability or professional sanction upon a person or entity for
engaging in a legally protected health-care activity.
Section 23 prohibits a public entity from:
  • Denying, restricting, or interfering with, through any
efforts, including licensing or zoning restrictions, any
person's or business entity's ability to provide reproductive
health care; or
  • Interfering with, discriminating against, or penalizing,
through any civil or criminal laws, any person or business
entity for assisting, aiding, or treating an individual for
reproductive health care; or
  • Prohibiting or restricting, through any civil or criminal
laws, including the establishment or expansion of a private
right of action, any person or business entity from assisting,
aiding, or treating an individual for reproductive health
care.
Section 24 authorizes an action to enforce the provisions of the
Reproductive Health Equity Act to be commenced by a person or
business entity with standing in Denver district court.

The bill makes it a deceptive trade practice for a person to make
or disseminate to the public any advertisement that indicates, directly or
indirectly, that the person provides abortions, emergency contraceptives,
or referrals for abortions or emergency contraceptives when the person
knows or reasonably should have known that the person does not provide
those specific services.
A health-care provider engages in unprofessional conduct or is
subject to discipline in this state if the health-care provider provides,
prescribes, administers, or attempts medication abortion reversal in this
state.

The bill requires a health insurer or pharmacy benefit manager to
include in the calculation of a covered person's contributions toward
cost-sharing requirements, including any annual limitation on a covered
person's out-of-pocket costs, any payments made by or on behalf of the
covered person.

Joint Budget Committee. The bill removes the requirement that
medicaid recipients pay a copayment for pharmacy and outpatient
services. The bill makes an appropriation.

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

The bill requires hospitals to make public a list of all standard
charges for all hospital items and services provided to patients. The
standard charges include the gross billed charge, the payer-specific
negotiated charge, the minimum and maximum negotiated charges, and
the discounted cash price. The bill also requires each hospital to maintain
and make public a list of at least 300 shoppable services provided by the
hospital or, if the hospital does not provide 300 shoppable services, all of
the hospital's shoppable services. Each hospital is required to report its
updated lists to the department of health care policy and financing (state
department).
The bill requires the state department to monitor hospital
compliance with the price transparency requirements. If the state
department determines that a hospital is not in compliance, the state
department is required to issue a written notice to the hospital and require
the hospital to submit a corrective action plan.
The bill repeals sections of statute regarding hospital price
transparency and debt collection that are currently under the
administration and authority of the department of public health and
environment and relocates these sections so that hospital price
transparency and debt collection are under the state department.
The bill makes a violation of the hospital transparency
requirements outlined in the bill a deceptive trade practice under the
Colorado Consumer Protection Act.

The bill protects an individual applying for licensure, certification,
or registration in a profession or occupation in Colorado (applicant), as
well as a professional who is currently licensed, certified, or registered in
a profession or occupation in Colorado (licensee), from having the
license, certification, or registration denied to the applicant, or from
discipline being imposed against the licensee, based solely on:
  • A civil or criminal judgment against the applicant or
licensee regarding the consumption, possession,
cultivation, or processing of marijuana, if the underlying
actions were lawful and consistent with professional
conduct and standards of care within Colorado and did not
otherwise violate Colorado law; or
  • Previous professional disciplinary action concerning an
applicant's or a licensee's professional licensure in this or
any other state or U.S. territory, if the professional
disciplinary action was based solely on the applicant's or
licensee's consumption, possession, cultivation, or
processing of marijuana and the applicant or licensee did
not otherwise violate Colorado law.

Current law requires the manufacturer of cosmetic products,
dietary supplements, food products, and food additives, including hemp
products, to be registered with the department of public health and
environment (department).
The bill creates a new framework for the department to regulate
and register hemp products and certain intoxicating hemp products and
for the marijuana enforcement division in the department of revenue
(division) to regulate intoxicating products or potentially intoxicating
compounds that are or may be cannabinoids. This regulation includes:
  • The power to promulgate rules authorizing or prohibiting
chemical modification, conversion, or synthetic derivation
to create certain types of intoxicating cannabinoids;
  • Labeling and advertising requirements;
  • Production and testing requirements; and
  • Inspection, record-keeping, and tracking requirements.
Hemp- and marijuana-derived compounds and cannabinoids are
classified into three classifications:
  • Nonintoxicating cannabinoids;
  • Potentially intoxicating compounds; and
  • Intoxicating cannabinoids.
Nonintoxicating cannabinoids that are derived from hemp may be
produced, distributed, or sold as a hemp product. With the exception of
products manufactured or produced for export, which are referred to as
safe harbor hemp products, products containing potentially intoxicating
compounds and intoxicating cannabinoids must only be produced,
distributed, or sold by a person licensed by the division to produce,
distribute, or sell the compound or cannabinoid as a product.
The bill clarifies that:
  • Nonintoxicating cannabinoids, potentially intoxicating
compounds, and intoxicating cannabinoids are marijuana
or marijuana products for the purposes of the retail
marijuana sales tax; and
  • A person must be licensed to manufacture potentially
intoxicating compounds or intoxicating cannabinoids.
The bill prohibits the following acts:
  • Manufacturing, selling, or delivering products that contain
intoxicating cannabinoids in excess of limits established by
rule;
  • Manufacturing a product containing hemp that is not a
cosmetic, a dietary supplement, a food, a food additive, or
an herb; or
  • Manufacturing, producing, selling, distributing, or holding
for sale or distribution a safe harbor hemp product without
registering with the department.
The penalty for a violation is up to $10,000. The bill specifies
factors to consider in determining the amount of the penalty.
The bill requires the executive director of the department of
revenue to analyze the feasibility of establishing a standing committee to
evaluate cannabinoids and cannabis-derived products for the purpose of
determining and making recommendations regarding their safety profiles
and potential for intoxication. The department of revenue may engage
experts to do this analysis.

The bill requires a carrier that offers a health benefit plan or a
pharmacy benefit management firm that administers or manages
contraception coverage under a health benefit plan to provide coverage
for, and reimburse a prescribing provider or in-network dispensing entity
for, the single dispensing or furnishing of an amount of contraception
intended to last for 12 months' duration, as permitted by the covered
person's prescription.
Further, under the bill, a carrier offering a health benefit plan or a
pharmacy benefit management firm acting on behalf of a carrier is subject
to certain requirements, as applicable, including:
  • Allowing coverage of continuous use of contraception, as
determined by the prescribing provider;
  • Prohibiting utilization management practices that prevent
the dispensing of a 12-months' duration of contraception;
  • Allowing for alternate prescribed contraception, if
medically necessary; and
  • Providing coverage for over-the-counter contraception
without a prescription and without prior authorization, step
therapy, utilization management, or cost sharing.
The bill also requires carriers to report annually to the division of
insurance in the department of regulatory agencies concerning
contraception coverage and authorizes the commissioner of insurance to
promulgate rules regarding the coverage.

Not later than September 1, 2023, the bill requires the department
of health care policy and financing (state department) to initiate a
stakeholder process to promote the expansion and utilization of doula
services for pregnant and postpartum medicaid recipients (recipients).
The bill requires the state department to work with a maternity
advisory committee to create a report detailing the findings and
recommendations from the stakeholder process and submit the report to
the general assembly during the state department's SMART Act
hearing.
Not later than July 1, 2024, the bill requires the state department
to seek federal authorization for medicaid providers to provide doula
services for pregnant and postpartum people.
The bill creates a doula scholarship program to provide financial
support to eligible individuals to pursue doula training and certification.
To be eligible for a scholarship, individuals must agree to enroll as a
doula provider and provide doula services to recipients.
The bill requires the division of insurance (division) to contract
with an independent entity to study the potential health-care costs and
benefits of providing coverage for doula services in health benefit plans.
The bill requires the division to submit a report to the general assembly
during the state department's SMART Act hearing detailing the results
and recommendations from the study during the state fiscal year 2024-25.

Joint Budget Committee. The bill requires the department of
health care policy and financing (department) to seek federal
authorization through an amendment to the state medical assistance plan
to implement the community first choice option.
The bill requires the state plan amendment to include personal care
services, homemaker services, health maintenance activities, personal
emergency response system and other emergency back-up services, and
voluntary training on how to select, manage, and dismiss an attendant.
The bill authorizes the department to provide permissible services
and supports that are linked to an assessed need or goal in an individual's
person-centered service plan, including transition costs and expenditures
relating to increasing an individual's independence or reducing reliance
on human assistance.
To be eligible for the community first choice option, an individual
must:
  • Be eligible for the state medical assistance program;
  • Be in an eligibility group under the state medical assistance
program that includes nursing facility services, or if in an
eligibility group that does not include nursing facility
services, have an income that is at or below 150% of the
federal poverty level; or
  • Receive an annual determination that in the absence of
home- and community-based attendant services and
supports, the individual would require the level of care
furnished in certain care settings.
The bill makes conforming amendments to remove the services
provided through the community first choice option from other long-term
care waiver programs.

The bill amends the regulatory framework for natural medicine and
natural medicine product.
The bill requires the director of the division of professions and
occupations to:
  • Regulate facilitators and the practice of regulation,
including issuing licenses for facilitators;
  • Promulgate rules necessary for the regulation of facilitators
and the practice of facilitation; and
  • Perform duties necessary for the implementation and
administration of the Natural Medicine Health Act of
2022, including investigatory and disciplinary authority.
The bill creates the natural medicine advisory board (board). The
board's duties include examining issues related to natural medicine and
natural medicine product, and making recommendations to the director
of the division of professions and occupations and the executive director
of the state licensing authority.
The bill creates within the department of revenue the division of
natural medicine for the purpose of regulating and licensing the
cultivation, manufacturing, testing, storage, distribution, transport,
transfer, and dispensation of natural medicine or natural medicine product
between natural medicine licensees. The bill requires the division of
natural medicine to:
  • Regulate natural medicine, natural medicine product, and
natural medicine businesses, including healing centers,
cultivators, manufacturers, and testers, and issue licenses
for such businesses;
  • Promulgate rules necessary for the regulation of natural
medicine, natural medicine product, and natural medicine
businesses; and
  • Perform duties necessary for the regulation of natural
medicine, natural medicine product, and natural medicine
businesses, including investigatory and disciplinary
authority.
The bill requires the department of revenue to coordinate with the
department of public health and environment concerning testing standards
of regulated natural medicine and natural medicine product.
The bill requires a sunset review for the articles governing the
department of regulatory affairs and the department of revenue in the
regulation of natural medicine, natural medicine product, facilitators, and
natural medicine businesses.
The bill states that:
  • A person who is under 21 years of age who knowingly
possesses or consumes natural medicine or natural
medicine product commits a drug petty offense and is
subject to a fine of not more than $100 or not more than 4
hours of substance use education or counseling; except that
a second or subsequent offense is subject to a fine of not
more than $100, not more than 4 hours of substance use
education or counseling, and not more than 24 hours of
useful public service;
  • A person who openly and publicly consumes natural
medicine or natural medicine product commits a drug petty
offense and is subject to a fine of not more than $100 and
not more than 24 hours of useful public service;
  • A person who cultivates natural medicine shall do so on the
person's private property, subject to area and physical
security requirements. A person who violates this provision
commits a drug petty offense and is subject to a fine of not
more than $1,000.
  • A person who is not licensed to manufacture natural
medicine product and who knowingly manufactures natural
medicine product using an inherently hazardous substance
commits a level 2 drug felony;
  • Unless expressly limited, a person who for the purpose of
personal use and without remuneration, possesses,
consumes, shares, cultivates, or manufactures natural
medicine or natural medicine product, does not violate state
or local law, except that nothing permits a person to
distribute natural medicine or natural medicine product to
a person for certain unlawful purposes;
  • A peace officer is prohibited from arresting, and a district
attorney is prohibited from charging or prosecuting, a
person for a criminal offense under part 4 of article 18 of
title 18 involving natural medicine or natural medicine
product, unless expressly provided by the bill;
  • A lawful action related to natural medicine or natural
medicine product must not be the sole reason to subject a
person to a civil penalty, deny a right or privilege, or seize
assets;
  • A lawful action related to natural medicine or natural
medicine product must not be used as the sole factor in a
probable cause or reasonable suspicion determination of
any criminal offense; except that an action may be used in
such determination if the original stop or search was lawful
and other factors are present to support a probable cause or
reasonable suspicion determination of any criminal offense;
  • The fact that a person is entitled to consume natural
medicine or natural medicine product does not constitute a
defense against any charge for violation of an offense
related to operation of a vehicle, aircraft, boat, machinery,
or other device;
  • A local jurisdiction is prohibited from adopting, enacting,
or enforcing a conflicting law;
  • A person or entity who occupies, owns, or controls a
property may prohibit or otherwise regulate the cultivation
or manufacture of natural medicine or natural medicine
product on or in that property.
The bill states that an act involving natural medicine or natural
medicine product that is performed by a person:
  • Does not solely constitute child abuse or neglect, or
grounds for restricting or prohibiting family time;
  • Does not solely constitute grounds for denying health
insurance coverage;
  • Does not solely constitute grounds for discrimination for
organ donation; and
  • Must not be considered for public assistance benefits
eligibility, unless required by federal law.
The bill makes a person eligible to file a motion to have conviction
records related to natural medicine or natural medicine product sealed
immediately after the later date of final disposition or release from
supervision.
Under federal law, certain expenses are disallowed under section
280E of the internal revenue code. Under state law, the state income tax
code permits taxpayers who are licensed under the Colorado Marijuana
Code to subtract expenses that are disallowed by section 280E of the
internal revenue code. The bill expands this permission to taxpayers who
are licensed under the Colorado Natural Medicine Code.

The bill permits a hospital that has fewer than 50 beds and is a
county public hospital, a hospital formed by a health service district, or
a hospital affiliated with either such hospital (hospital) to enter into
collaborative agreements to engage in activities that may be characterized
as anticompetitive or result in displacement of competition, such as
agreements to provide ancillary or specialty services, joint purchasing,
shared services, consulting, and collaboration efforts with payers.
The bill exempts collaborating hospitals from state antitrust laws
and provides immunity from federal antitrust laws under the state action
doctrine for approved collaborative activity.
Prior to entering into a collaborative agreement, the hospitals must
submit the proposed collaborative agreement (proposal) to the department
of health care policy and financing (department) and to the attorney
general. If the department determines that the collaborative agreement
will result in cost savings or other efficiencies that will improve or
expand the delivery of health-care services in rural and frontier
communities, the department must refer the proposal to the attorney
general.
The attorney general must review each proposal that is referred by
the department and determine, within a specified time, that the benefits
are not outweighed by any anticompetitive harm that may result from the
agreement. The department or the attorney general may request additional
information concerning a proposal within 60 days after its original
submission. If additional information is requested, the department and
attorney general have an additional 45 days to review the proposal.
If the department and the attorney general make a favorable
determination, the proposal is approved and the hospitals may enter into
a collaborative agreement. If neither the department nor the attorney
general respond within the time frames set forth in the bill, the
collaborative proposal is deemed approved.
The department or the attorney general may review a collaborative
agreement annually to ensure the outcomes related to the collaborative
agreement are consistent with statute.