The act creates the health-care services reserve corps task force (task force) in the department of public health and environment. The purpose of the task force is to evaluate and make recommendations on the creation of a health-care services reserve corps program (program), in which medical professionals could cross-train to be able to serve the state in an emergency or disaster and receive a benefit for their service.

The task force consists of at least 10 and no more than 11 members. The task force is required to consider and make findings and recommendations on issues including:

• The types of medical professionals who could participate in a health-care services reserve corps program, including how to ensure an appropriate cross section of providers;
• The types of emergencies and disasters for which the program could prepare and provide assistance, and whether the program could be deployed out of state;
• Any legal or regulatory obstacles to creating such a program;
• Liability protections for professionals and facilities participating in the program;
• Whether the program could be streamlined or integrated with existing programs or procedures;
• The types and hours of training that would be required;
• How to ensure the program and cross-training are accessible to rural medical professionals;
• The costs associated with the program;
• Issues related to insurance coverage and reimbursement;
• Consumer protections for patients being treated by the program;
• How the health-care services reserve corps would be deployed; and
• The type of benefit that could be offered and the amount, terms of, and funding for the benefit that participants would receive.

The task force is required to consult with medical and nursing schools in making recommendations related to the cross-training elements of the program and with additional stakeholders as necessary to address additional questions, including disaster response experts, affected state agencies, and entities with experience in medical malpractice insurance. The task force is authorized to consult with additional stakeholders with expertise in identifying the physical and mental health needs of Coloradans or in coordinating emergency response at the local, state, or federal level to identify additional questions for future consideration by the program. The task force is authorized to contract with an outside consultant to assist the task force in completing its work.

The task force is required to submit a report with its findings and recommendations to the house public health care and human services committee and the senate health and human services committee by December 1, 2023. The task force is required to meet at least once every 2 months. Task force members serve without compensation and are not eligible for reimbursement for expenses. The act is repealed effective September 1, 2024.

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

Current law requires the prescription drug monitoring program (program) to track all controlled substances prescribed in Colorado. The act requires the state board of pharmacy (board) to determine if the program should track all prescription drugs prescribed in this state. If the board determines that all drugs should be tracked, the act requires the board to promulgate rules to include all prescription drugs in the program. If the board determines that one or more drugs should not be tracked through the program, the act requires the board to publicly note the justification for the exclusions.

$61,118 is appropriated from the prescription drug monitoring fund to the department of regulatory agencies for use by the division of professions and occupations to implement the act.

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

The act adds a requirement, as part of mandatory health insurance coverage of preventive health care services, that health plans cover an annual mental health wellness examination of up to 60 minutes that is performed by a qualified mental health care provider. The coverage must:

• Be comparable to the coverage of a physical examination;
• Comply with the requirements of federal mental health parity laws; and
• Not require any deductibles, copayments, or coinsurance for the mental health wellness examination.

The coverage applies to large employer plans issued or renewed on or after January 1, 2022, and to individual and small group plans issued or renewed on or after January 1, 2023, if the commissioner of insurance determines, and the United States department of health and human services confirms or fails to timely respond to a request for confirmation, that the coverage for an annual mental health wellness examination does not require state defrayal pursuant to the federal "Patient Protection and Affordable Care Act". Additionally, the division of insurance (division) is directed to conduct an actuarial study to determine the effect of the coverage on insurance premiums.

The act appropriates $26,353 to the division to conduct reviews of health plans to ensure compliance with the coverage required by the bill.

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

The bill requires that firearms be responsibly and securely stored when they are not in use to prevent access by unsupervised juveniles and other unauthorized users. The bill creates the offense of unlawful storage of a firearm if a person stores a firearm in a manner that the person knows, or should know:

• That a juvenile can gain access to the firearm without the permission of the juvenile's parent or guardian; or
• A resident of the premises is ineligible to possess a firearm under state or federal law.

Unlawful storage of a firearm is a class 2 misdemeanor.

The bill requires licensed gun dealers to provide with each firearm, at the time of a firearm sale or transfer, a locking device capable of securing the firearm. Transferring a firearm without a locking device is an unclassified misdemeanor punishable by a maximum $500 fine.

The bill requires the state court administrator to annually report to the general assembly about the number of charges related to unsafe firearms storage and the disposition of those charges.

The bill requires the office of suicide prevention within the department of public health and environment (department) to include on its website, and in materials provided to firearms-related businesses and health care providers, information about the offense of unlawful storage of a firearm, penalties for providing a handgun to a juvenile or allowing a juvenile to possess a firearm, and the requirement that gun dealers provide a locking device with each firearm transferred. Subject to available money, the department is required to develop and implement a firearms safe storage education campaign to educate the public about the safe storage of firearms, and state requirements related to firearms safety and storage, and information about voluntary temporary firearms storage programs .

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

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

The act makes it unlawful for a person to make available on the internet the personal information of a public health worker if the dissemination of the personal information poses an imminent and serious threat to the public health worker's safety or the safety of the public health worker's family. "Public health worker" is defined in the act to include contractors or employees of contractors of the department of public health and environment or of county or district public health agencies, who are engaged in public health duties, and members of county or district boards of health, other than elected county commissioners. A violation of this law is a class 1 misdemeanor.

Further, a public health worker meeting certain requirements specified in statute may submit a written request to a state or local government official to remove personal information from public records that are available on the internet.

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

The act requires members of a county board of health or a district board of health and members of the state board of health, on and after January 1, 2022, to attend both annual public health training provided by the department of public health and environment and developed by the department of public health and environment along with the Colorado school of public health and annual public health training developed and provided by the department of public health and environment and the director of the office of emergency management concerning the role of a board of health in preparing for, responding to, and recovering from an emergency disaster.

The act also requires the department of public health and environment, on and after January 1, 2022, to develop guidance on recruiting persons to serve on county and district boards of health and to provide this guidance to any board of county commissioners, county board of health, or district board of health that requests it.

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

The act amends the definition of "telemedicine" in the "Colorado Medical Practice Act" to state that the term means the delivery of medical services through technologies that are used in a manner that is compliant with the federal "Health Insurance Portability and Accountability Act of 1996", including information, electronic, and communication technologies, remote monitoring technologies, and store-and-forward transfers, to facilitate the assessment, diagnosis, consultation, or treatment of a patient while the patient is located at an originating site and the person who provides the service is located at a distant site. The act amends and preserves the existing statutory definition of "telemedicine" for purposes of the "Colorado Medical Assistance Act".

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

Beginning June 1, 2022, a health-care facility shall screen each uninsured patient for eligibility for public health insurance programs, discounted care through the Colorado indigent care program (CICP), and discounted care as described in the act. Health-care facilities shall use a single uniform application developed by the department of health care policy and financing (department) when screening a patient. If a health-care facility determines a patient is ineligible for discounted care, the facility shall provide the patient notice of the determination and an opportunity for the patient to appeal the determination.

Beginning June 1, 2022, for emergency and other non-CICP health-care services provided to patients qualified for public health insurance or discounted care, a health-care facility and licensed health-care professional shall limit the amounts charged to not more than the discounted rate established by the department; collect amounts charged in monthly installments such that a patient is not paying more than 4% of the patient's monthly household income on a bill from a health-care facility and not paying more than 2% of the patient's monthly household income on a bill from each licensed health-care professional; and after a cumulative 36 months of payments, consider the patient's bill paid in full and permanently cease any and all collection activities on any balance that remains unpaid.

Beginning June 1, 2022, a health-care facility shall make information about patient's rights and the uniform application for discounted care available to the public and to each patient.

Beginning June 1, 2023, and each June 1 thereafter, each health-care facility shall report to the department data that the department determines is necessary to evaluate compliance across patient groups based on race, ethnicity, age, and primary language spoken with the required screening, discounted care, payment plan, and collections practices.

No later than April 1, 2022, the department shall develop a written explanation of a patient's rights, make the explanation available to the public and each patient, and establish a process for patients to submit a complaint relating to noncompliance with the requirements. The department shall periodically review health-care facilities and licensed health-care professionals (hospital providers) to ensure compliance, and the department shall notify the hospital provider if the hospital provider is not in compliance that the hospital provider has 90 days to file a corrective action plan with the department. A hospital provider may request up to 120 days to submit a corrective action plan. The department may require a hospital provider that is not in compliance to develop and operate under a corrective action plan until the department determines the hospital provider is in compliance. The act implements fines for hospital providers if the department determines the hospital provider's noncompliance is knowing or willful.

Beginning June 1, 2022, the act imposes requirements on hospital providers before assigning or selling patient debt to a medical creditor or before pursuing any permissible extraordinary collection action and imposes fines for any hospital provider that fails to comply with the requirements.

Beginning June 1, 2022, a medical creditor shall not use impermissible extraordinary collection actions to collect debts owed for hospital services. A medical creditor may engage in permissible extraordinary collection actions 182 days after the patient receives hospital services. At least 30 days before taking any permissible extraordinary collection action, a medical creditor shall notify the patient of potential collection actions and shall include with the notice a statement that explains the availability of discounted care for qualified individuals and how to apply for such care. If a patient is later found eligible for discounted care, the medical creditor shall reverse any permissible extraordinary collection actions.

Beginning June 1, 2022, a medical creditor shall not sell a medical debt to another party unless, prior to the sale, the medical debt seller has entered into a legally binding written agreement with the medical debt buyer in which certain terms are agreed to. The medical debt seller shall indemnify the medical debt buyer for any amount paid for a debt that is returned to or recalled by the medical debt seller.

Beginning June 1, 2022, the department shall promulgate rules prohibiting hospitals from considering assets when determining whether a patient meets the specified percentage of the federal poverty level for CICP and ensuring the method used to determine whether a patient meets the specified percent is uniform across hospitals.

The act appropriates $219,295 to the department of health care policy and financing to implement the act.

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

Current law requires the public utilities commission (commission) to oversee the safety and oversight of medicaid nonmedical and nonemergency medical transportation services (transportation services). The act eliminates the commission's responsibility to oversee the safety and oversight of the transportation services.

The act requires the department of health care policy and financing (department) to oversee the safety and oversight of the transportation services. If a provider of transportation services already complies with the transportation safety standards established by another state department which meet or exceed the rules and processes established by the department, demonstrating such compliance to the department is sufficient to verify compliance with the requirements of the act. The act also requires the department to collaborate with stakeholders, including but not limited to disability and member advocates, PACE providers, transportation brokers, and transportation providers, to establish rules and processes for the safety and oversight of transportation services.

For the 2021-22 state fiscal year, the general fund appropriation made in the annual general appropriation act to the department for transfer to the department of regulatory agencies for regulation of medicaid transportation is decreased by $66,003. The same amount is appropriated from the general fund to the department for medical and long-term care services for medicaid-eligible individuals.

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

The act requires the commissioner of insurance (commissioner) in the department of regulatory agencies to establish a standardized health benefit plan by rule on or before January 1, 2022, to be offered by health insurance carriers (carriers) in the individual and small group markets. The standardized plan must:

• Offer health-care coverage at the bronze, silver, and gold levels of coverage;
• Include pediatric and other essential health benefits;
• Be offered through the Colorado health benefit exchange and in the individual market;
• Have a standardized benefit design that is created through a stakeholder engagement process, has a defined benefit design and cost sharing that improves access and affordability, and is designed to improve racial health equity and decrease racial health disparities;
• Provide by, among other measures, providing first-dollar, predictable coverage for certain high value services;
• Be actuarially sound and allow carriers to meet financial requirements;
• Comply with state and federal law; and
• Have a provider network (network) that is culturally responsive and reflects the diversity of its enrollees and be no more narrow than the most restrictive nonstandardized plan offered by the carrier.

Each carrier must:

• Include, as part of its network access plan for the standardized plan, a description of its efforts to construct diverse, culturally responsive networks;
• Include a majority of the essential community providers in the service area in its network; and
• Allow consumers to easily compare the standardized health benefit plans offered by each carrier.

Additionally, the act requires the commissioner to:

• Promulgate rules regarding network adequacy;
• Contract with an independent third party to conduct an analysis of the implementation of the standardized health benefit plan and the related requirements; and
• Collaborate with the health benefit exchange to conduct a consumer survey.

Beginning January 1, 2023, and each year thereafter, the act requires carriers that offer:

• An individual health benefit plan in Colorado to offer the standardized health benefit plan in the individual market in each county where the carrier offers an individual plan; and
• A small group health benefit plan in Colorado to offer the standardized health benefit plan in the small group market in each county where the carrier offers a small group plan.

In the individual market and in the small group market, each carrier shall offer a standardized health benefit plan premium that:

• For 2023, is at least 5% less than the premium rate for health benefit plans offered by that carrier in the 2021 calendar year, as adjusted for medical inflation;
• For 2024, is at least 10% less than the premium rate for health benefit plans offered by that carrier in the 2021 calendar year, as adjusted for medical inflation;
• For 2025, is at least 15% less than the premium rate for health benefit plans offered by that carrier in the 2021 calendar year, as adjusted for medical inflation;
• For 2026 and each year thereafter, is increased above the premium in the previous year by no more than medical inflation, relative to the previous year.

The act also requires each carrier to file its premium rates for the standardized health benefit plan with the commissioner. If a carrier or health-care provider anticipates that a carrier will be unable to meet network adequacy standards or the premium rate requirements due to a reimbursement rate dispute, the carrier or the health-care provider may initiate nonbinding arbitration prior to filing rates for the standardized health benefit plan. If a carrier cannot meet the premium rate requirements, the carrier must notify the commissioner of the reasons. The division shall hold a public hearing concerning network adequacy and premium rates. Based on evidence at the hearing, the commissioner may establish carrier reimbursement rates for hospitals and health-care providers and require the hospitals and health-care providers to accept patients and the established reimbursement rates. The act establishes limits on the reimbursement rates that may be set.

The act creates an advisory board, with members appointed by the governor, to implement the standardized health benefit plan. The advisory board is charged with considering recommendations to streamline prior authorization and utilization management processes, recommend ways to keep health-care services in communities where patients live, and to consider alternative payment models.

The commissioner may apply to the secretary of the United States department of health and human services for a state innovation waiver to capture savings as a result of the implementation of the standardized health benefit plan. Upon approval of the waiver, the commissioner is authorized to use any federal money for the implementation of the bill and for the Colorado health insurance affordability enterprise.

The act requires the commissioner to:

• Contract with an independent third party to prepare reports regarding the implementation of the bill;
• Monitor whether there is an adequate number of health-care providers in the carriers' standardized health benefit plan network and the percentage of premiums attributable to health-care providers in the network;
• Contract with an independent third-party organization to evaluate how to phase in a hospital's reimbursement rate methodology;
• Report various findings during the hearings conducted pursuant to the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act"; and
• Disapprove of a rate filing submitted by a carrier if the rate filing reflects a cost shift between the standardized health benefit plan and the health benefit plan for which rate approval is being sought.

The department of public health and environment, upon notice from the commissioner, may fine or suspend or impose conditions on a hospital that refuses to participate in the standardized health benefit plan.

The act creates the office of the insurance ombudsman in the department of health care policy and financing to act as an advocate for consumer interests in matters related to access to and affordability of the standardized health benefit plan.

To implement this act:

• $1,409,637 is appropriated to the department of regulatory agencies for use by the division of insurance and the executive director's office, $212,680 of which is reappropriated to the department of law for the provision of legal services; and
• $78,993 is appropriated to the department of health care policy and financing.
  (Note: This summary applies to this bill as enacted.)

Current law states that in-person contact between a health-care provider or mental health-care provider and a patient is not required under the state's medicaid program for services delivered through telemedicine that are otherwise eligible for reimbursement under medicaid. The act requires the department of health care policy and financing to promulgate rules specifically relating to entities that deliver health-care or mental health-care services exclusively or predominately through telemedicine.

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

The act requires a health benefit plan issued or renewed on or after January 1, 2023, to provide a cost-sharing benefit for nonpharmacological treatment where an opioid might be prescribed. The required cost-sharing benefit must include a cost-sharing amount not to exceed the cost-sharing amount for a primary care visit for nonpreventive services, at least 6 physical therapy visits, 6 occupational therapy visits, 6 chiropractic visits, and 6 acupuncture visits per year. The division of insurance (division) is required to submit to the federal department of human services a determination as to whether the cost-sharing benefit is in addition to an essential benefit and subject to defrayal by the state pursuant to federal law and a request for confirmation of the determination. The division is required to implement the benefit only if the benefit does not constitute an additional benefit that requires a defrayal.

The act requires an insurance carrier (carrier) that provides prescription drug benefits to provide coverage, beginning January 1, 2023, for at least one atypical opioid that is approved by the federal food and drug administration (FDA) for the treatment of acute or chronic pain, which coverage must be at the lowest cost-sharing tier of the carrier's formulary with no requirement for step therapy or prior authorization. Additionally, a carrier cannot require step therapy for any additional FDA-approved atypical opioids.

The act precludes a carrier that has a contract with a physical therapist, occupational therapist, chiropractor, or acupuncturist from:

• Prohibiting the physical therapist, occupational therapist, chiropractor, or acupuncturist from, or penalizing the physical therapist, occupational therapist, chiropractor, or acupuncturist for, providing a covered person information on the amount of the covered person's financial responsibility for the covered person's physical therapy, occupational therapy, chiropractic services, or acupuncture services; or
• Requiring the physical therapist, occupational therapist, chiropractor, or acupuncturist to charge a covered person an amount or collect a copayment from a covered person that exceeds the total charges submitted to the carrier by the physical therapist, occupational therapist, chiropractor, or acupuncturist.

The commissioner of insurance is required to take action against a carrier that the commissioner determines is not complying with these prohibitions.

Current law limits specified prescribers from prescribing more than a 7-day supply of an opioid to a patient who has not obtained an opioid prescription from that prescriber within the previous 12 months unless certain conditions apply. This prescribing limitation is set to repeal on September 1, 2021.The act continues the prescribing limitation indefinitely.

The also requires the applicable board for each prescriber to promulgate rules that limit the supply of a benzodiazepine, which is a sedative commonly prescribed for anxiety and as a sleep aid, that a prescriber may prescribe to a patient who has not had a prescription for a benzodiazepine in the last 12 months, except for benzodiazepines prescribed to treat specific disorders or conditions.

The act continues indefinitely the requirement that a health-care provider query the prescription drug monitoring program (program) before prescribing an opioid, including a benzodiazepine, and changes current law to require the query on every prescription fill, not just the second fill. This section also requires a practitioner to query the program before prescribing a benzodiazepine unless it is to treat a specific disorder or condition.

In addition to current law allowing medical examiners and coroners to query the program when conducting an autopsy, section 16 allows medical examiners and coroners to query the program when conducting a death investigation.

The act also authorizes the state board of pharmacy to provide a means of sharing prescription information from the program with the health information organization network in order to work collaboratively with statewide health information exchanges designated by the department of health care policy and financing.

The act requires the center for research into substance use disorder prevention, treatment, and recovery support strategies to include in its continuing education activities the best practices for prescribing benzodiazepines and the potential harm of inappropriately limiting prescriptions to chronic pain patients and makes an appropriation for this purpose.

The act directs the office of behavioral health in the department of human services to convene a collaborative with institutions of higher education, nonprofit agencies, and state agencies for the purpose of gathering feedback from local public health agencies, institutions of higher education, nonprofit agencies, and state agencies concerning evidence-based prevention practices.

$382,908 is appropriated to the department of human services for use by the office of behavioral health. $13,000 is appropriated to the department of regulatory agencies for use by the division of insurance. $215,207 is appropriated to the department of regulatory agencies.

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

Under existing federal law, a licensed gun dealer may transfer a firearm to another person prior to receiving the results of a required background check if 3 days have elapsed since the dealer initiated the background check; state law does not generally require a background check prior to a transfer by a licensed gun dealer. The bill establishes a state requirement for a licensed gun dealer to obtain approval for a firearms transfer from the Colorado bureau of investigation (bureau) prior to transferring a firearm.

The bill prohibits the bureau from approving the transfer of a firearm to a person who was convicted of specified misdemeanor offenses. The bill also prohibits the bureau from approving a firearms transfer until the bureau determines that its background investigation is complete and that the transfer would not violate federal prohibitions on firearms possession or result in a violation of state law.

Under existing law, a person who has been denied a firearms transfer following a background check can appeal the denial. The bureau is required to review background check records that prompted the denial and render a final administrative decision regarding the denial within 30 days. The bill establishes a 60-day deadline for the bureau to conduct the review and render a final administrative decision.

A person may be denied a firearms transfer if there has not been a final disposition in criminal proceedings for certain offenses for which the prospective transferee, if convicted, would be prohibited from purchasing, receiving, or possessing a firearm. Under existing law, the inability of the bureau to obtain the final disposition of a case that is no longer pending cannot constitute the basis for the continued denial of the transfer. The bill removes this restriction and permits continued denial of the transfer when the bureau is unable to obtain the final disposition of a case that is no longer pending.

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

The act establishes the office of gun violence prevention (office) within the department of public health and environment to coordinate and promote effective efforts to reduce gun violence. The office is required to conduct public awareness campaigns to educate the general public about state and federal laws and existing resources relating to gun violence prevention.

Subject to available money, the office may establish and administer a grant program to award grants to organizations to conduct community-based gun violence intervention initiatives that are primarily focused on interrupting cycles of gun violence, trauma, and retaliation that are evidence-informed and have demonstrated promise at reducing gun violence without contributing to mass incarceration.

The office is required to create and maintain a resource bank as a repository for data, research, and statistical information regarding gun violence in Colorado. The office must collaborate with researchers to improve data collection in Colorado and use existing available research to enhance evidence-based gun violence prevention tools and resources available to Colorado communities.

The office is required to issue a report to the general assembly every 5 years summarizing gun violence prevention measures adopted by local jurisdictions. This reporting requirement is contingent upon Senate Bill 21-256 being enacted and becoming law.

The act appropriates $3,000,000 to the department of public health and environment for program costs related to family and community health for the office of gun violence prevention.

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

Current law establishes a $100 cap on a person's 30-day supply of prescription insulin. The act clarifies that this cap is for the person's entire insulin supply, regardless of the number of prescriptions the person may have.

Beginning January 1, 2022, the act also:

• Requires pharmacists to provide eligible individuals with access to one emergency prescription insulin supply within a 12-month period at a cost not to exceed $35 for a 30-day supply; and
• Creates the insulin affordability program through which pharmacists provide eligible individuals with prescription insulin for 12 months at a cost not to exceed $50 for a 30-day supply.

A pharmacist that dispenses prescription insulin through the emergency supply or the insulin affordability program may seek reimbursement for the cost of the insulin from the insulin manufacturer.

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

The act requires the department of health care policy and financing to administer a reproductive health care program (program) that provides contraceptive methods and counseling services to participants. The program must offer each participant at least a one-year supply of the requested contraceptive method or an alternative contraceptive method and not impose cost-sharing requirements.

Beginning in fiscal year 2023-24, the department shall analyze and report the cost-effectiveness of the program to the public during its annual SMART act hearing.

The act appropriates $4,125,347 from the general fund to the department of health care policy and financing to implement the act.

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

The act expands certain preventive health-care services to include counseling, prevention, and screening for a sexually transmitted infection (STI). The act adds contraception as a mandatory health benefit.

Current law requires a health-care provider or facility to perform a diagnostic exam for an STI and subsequently treat the STI at the request of a minor patient. The act allows a health-care provider to administer, dispense, or prescribe preventive measures or medications where applicable. The consent of a parent is not a prerequisite for a minor to receive preventive care, but a health-care provider shall counsel the minor on the importance of bringing the minor's parent or legal guardian into the minor's confidence regarding the services.

Current law requires the executive director of the department of health care policy and financing to authorize reimbursement for medical or diagnostic services provided by a certified family planning clinic. The act removes the requirement that services be provided by a certified family planning clinic and authorizes reimbursement for family planning services and family-planning-related services provided by any licensed health-care provider.

The act appropriates $90,547 to the department of health care policy and financing and $13,353 and provides 0.2 FTE to the department of regulatory agencies for use by the division of insurance to implement the act.

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

The act requires that, prior to initiating a review or audit of a medicaid provider's records, the reviewer or auditor, or a qualified agent contracted with the department of health care policy and financing (state department) shall confirm the provider's contact information with the provider. After confirming the provider's contact information, the reviewer or auditor, or qualified agent, shall notify the provider of additional information concerning the review or audit.

Current law requires the reviewer or auditor, prior to initiating the review or audit, to deliver to the provider not less than 10 business days prior to the commencement of the audit a written request describing in detail such records and offering the provider the option of providing either a reproduction of such records or inspection at the provider's site. The act requires the written request to be provided through both e-mail and certified mail.

The act requires the state department to ensure providers understand the relationship between the state department and the qualified agent and how to contact the qualified agent prior to a qualified agent commencing any review or audit.

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

The act requires the department of health care policy and financing to seek federal authorization through an amendment to the state medical assistance plan to provide family planning services to individuals who are not pregnant and whose income does not exceed the state's current effective income level for pregnant women under the children's basic health plan.

The act appropriates $272,956 to the department of health care policy and financing for use by the executive director's office and $565,614 to the office of the governor for use by the office of information technology to implement this act.

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

The act creates the diaper distribution program (program) in the department of human services (department) to provide diapering essentials to eligible individuals. The department shall solicit interest and cost distribution proposals from diaper distribution centers to administer the program for not more than twelve months after which the department shall commence a selection process that complies with the state procurement code. Diapering essentials must be made available to all parents, guardians, or family members of a child who wears diapers and resides in Colorado.

The act allows the department to contract with a third party vendor to solicit, vet, award, and monitor food pantry assistance grants.

The act appropriates $2,000,000 from the general fund to the department of human services for use by the office of self sufficiency to implement the diaper distribution program and $5,000,000 from the economic recovery and relief cash fund to the department of human services for use by the office of self sufficiency for the food pantry assistance grant program.

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

An individual who owns a firearm must report the loss or theft of that firearm to a law enforcement agency within 5 days after discovering that the firearm was lost or stolen. A first offense for failure to make such a report is a civil infraction punishable by a $25 fine, and a second or subsequent offense is a misdemeanor punishable by a maximum $500 fine. The 5-day reporting requirement does not apply to a licensed gun dealer.

Another person who is a member of the owner's family or who resides with the owner may report the lost or stolen firearm. If the other person reports the loss or theft of the firearm, the owner is not required to make a report. A report by another person is not an acknowledgment of firearm ownership.

A person who reports a lost or stolen firearm is immune from criminal prosecution for an offense pursuant to state law related to the storage of firearms.

The act requires a law enforcement agency that receives a report of a lost or stolen firearm to enter information about the lost or stolen firearm into the Colorado bureau of investigation crime information center database.

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

The act:

• Prohibits an agricultural employer from retaliating against any person, including an agricultural employee who is asserting protected rights, and allows an aggrieved person to assert a claim in district court or with the division of labor standards and statistics (division) in the department of labor and employment for alleged retaliation;
• Removes the exemption of agricultural employers and employees from the Colorado "Labor Peace Act" and authorizes agricultural employees to organize and join labor unions; engage in protected, concerted activity; and engage in collective bargaining;
• Removes the exemption of agricultural labor from state and local minimum wage laws;
• Establishes a separate minimum wage for agricultural employees engaged in the range production of livestock on the open range;
• Requires the director of the division to promulgate rules to establish the overtime pay of agricultural employees, to implement procedures concerning retaliation claims, to ensure access to key service providers, and for overwork protections for agricultural workers;
• Grants agricultural employees meal breaks and rest periods throughout each work period, consistent with protections for other employees;
• Requires agricultural employers to provide agricultural employees with access and transportation to key service providers;
• Authorizes agricultural employees to have visitors at employer-provided housing without interference from other persons;
• Requires agricultural employers to provide overwork and health protections to agricultural employees;
• Prohibits the use of the short-handled for agricultural labor except in specific circumstances;
• During a public health emergency, requires an agricultural employer to provide extra protections and increased safety precautions for agricultural employees;
• Creates rights, remedies, and enforcement actions for aggrieved agricultural employees, whistleblowers, and key service providers; and
• Creates the agricultural work advisory committee to study and analyze agricultural wages and working conditions.

$474,657 is appropriated from the employment support fund to the department of labor and employment to implement the act, of which amount $38, 282 is reappropriated to the department of law to provide legal services to the department of labor and employment. Additionally, $193,882 is appropriated from the general fund to the department of agriculture for use by the plant industry division to implement the act.

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

The act continues the prescription drug monitoring program (program) indefinitely.

Additionally, the act:

• Authorizes the state board of pharmacy (board) to promulgate rules that identify a list of prescription drugs that are not currently listed as controlled substances and require such drugs to be tracked through the program;
• Authorizes each coroner to authorize deputy coroners to access the program;
• Authorizes the board to create a data retention schedule for information obtained and stored by the program;
• Eliminates the requirements that the board seek gifts, grants, and donations in order to maintain the program and report annually to committees of reference of the general assembly on the gifts, grants, and donations; and
• Makes a technical change to remove a reference to the department of health care policy and financing from the statute as that department does not have access to the program.
  (Note: This summary applies to this bill as enacted.)

Current law allows specific entities to purchase opiate antagonists through the opiate antagonist bulk purchase fund (fund) and also allows specific entities to receive opiate antagonists pursuant to standing orders and protocols. The act aligns these sections of law so that:

• A unit of local government may purchase opiate antagonists through the fund pursuant to a standing order and protocol; and
• A harm reduction organization, law enforcement agency, or first responder to which opiate antagonists have been prescribed or dispensed through a standing order and protocol may purchase the opiate antagonists through the fund.
  (Note: This summary applies to this bill as enacted.)

The act states that the department of health care policy and financing (department) may expand the Canadian prescription drug importation program (program) to allow a manufacturer, wholesale distributor, or pharmacy from a nation other than Canada to export prescription drugs into the state under the program if certain conditions are met. If, upon the satisfaction of these conditions, the department decides to expand the program, the executive director of the department shall notify the president of the senate, the speaker of the house of representatives, and specified legislative committees of the department's intent to do so.

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

The act requires that when a physician applies to be credentialed as a participating physician in a health insurance carrier's (carrier's) provider network, the carrier must conclude the process of credentialing the applicant within 60 calendar days after the carrier receives the applicant's completed application. A carrier must provide each applicant written or electronic notice of the outcome of the applicant's credentialing within 10 calendar days after the conclusion of the credentialing process.

Within 7 calendar days after a carrier receives an application, the carrier must provide the applicant a receipt. If a carrier receives an application but fails to provide the applicant a receipt within 7 calendar days, the carrier shall consider the applicant a participating physician, effective no later than 53 calendar days following the carrier's receipt of the application.

A carrier may not deny a claim for a medically necessary covered service provided to a covered person if the service:

• Is a covered benefit under the covered person's health coverage plan; and
• Is provided by a participating physician who is in the provider network for the carrier's health coverage plan and has concluded the carrier's credentialing process.

A carrier may not require a participating physician to submit an application or participate in a contracting process in order to be recredentialed.

With certain exceptions, a carrier must allow a participating physician to remain credentialed and include the participating physician in the carrier's provider network unless the carrier discovers information indicating that the participating physician no longer satisfies the carrier's guidelines for participation.

The commissioner of insurance is required to enforce the new requirements. A carrier that fails to comply with the act or with any rules adopted pursuant to the act is subject to such civil penalties as the commissioner may order.

To implement the act, for the 2021-22 state fiscal year, the act appropriates $52,505 to the department of regulatory agencies from the division of insurance cash fund. Of this amount, $21,268 is reappropriated to the department of law for legal services.

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

The act requires each dental plan issued, amended, or renewed in this state to cover services offered to a covered person through telehealth. The act also requires the state's medical assistance program to reimburse providers for dental care services provided through telehealth.

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

The act modifies the Colorado health service corps program administered by the primary care office (office) in the department of public health and environment, which program includes a loan repayment program, to allow geriatric advanced practice providers, defined as advanced practice registered nurses and physician assistants with geriatric training or experience, to participate in the loan repayment program on the condition of committing to provide geriatric care to older adults in health professional shortage areas for a specified period.

For the 2021-22 state fiscal year, the act appropriates $400,000 from the general fund to the Colorado health service corps fund for use by the office to help repay loans for geriatric advanced practice providers.

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

The act creates the Colorado prescription drug affordability review board (board) in the division of insurance (division) in the department of regulatory agencies as an independent unit of state government, requires the board to perform affordability reviews of prescription drugs, and authorizes the board to establish upper payment limits for prescription drugs the board determines are unaffordable for Colorado consumers. The board is also required to promulgate rules as necessary for its purposes.

The board shall determine by rule the methodology for establishing an upper payment limit for a prescription drug. An upper payment limit applies to all purchases of and payer reimbursements for the prescription drug dispensed or administered to individuals in the state in person, by mail, or by other means. Any savings generated for a health benefit plan as a result of an upper payment limit established by the board must be used by the carrier that issued the health benefit plan to reduce costs to consumers, prioritizing the reduction of out-of-pocket costs for prescription drugs.

On and after January 1, 2022, the act prohibits, with certain exceptions, any purchase or payer reimbursement for a prescription drug at an amount that exceeds the upper payment limit established by the board for that prescription drug.

A person aggrieved by a decision of the board may appeal the decision within 60 days. The board shall consider the appeal and issue a final decision concerning the appeal within 60 days after the board receives the appeal. Final board decisions are subject to judicial review.

Any prescription drug manufacturer (manufacturer) that intends to withdraw from sale or distribution within the state a prescription drug for which the board has established an upper payment limit must notify, at least 180 days before the withdrawal:

• The commissioner;
• The attorney general; and
• Each entity in the state with which the manufacturer has contracted for the sale or distribution of the prescription drug.

The commissioner may impose a penalty of up to $500,000 on a manufacturer that fails to comply with the notice requirement. The board is directed to adopt rules regarding notice to consumers of a manufacturer's intent to withdraw a prescription drug from sale or distribution in the state.

Beginning in the 2022 calendar year, for all prescription drugs dispensed at a pharmacy and paid for by a carrier during the immediately preceding calendar year, the act requires each carrier and each pharmacy benefit management firm acting on behalf of a carrier to report certain information to the all-payer health claims database.

The act creates the Colorado prescription drug affordability advisory council to provide stakeholder input to the board.

The board must submit an annual report to the governor and to subject matter committees of the general assembly summarizing the activities of the board during the preceding calendar year, and the chair of the board must present to those committees information concerning any prescription drug for which the board established an upper payment limit during the preceding calendar year. Upon approval of a majority of the committee members, any member of the committees may pursue legislation to discontinue the upper payment limit for a particular prescription drug, and the legislation does not count against the limit on the number of bills the member may introduce in a regular legislative session.

The board and its functions are repealed, effective September 1, 2026, following a sunset review by the department of regulatory agencies.

For the 2021-2022 state fiscal year, the act appropriates $730,711 from the division of insurance cash fund to the department of regulatory agencies. Of this amount, $325,297 is appropriated for use by the division for personal services, $22,650 is appropriated for use by the division for operating expenses, and $382,824 is appropriated for the purchase of legal services, which amount is reappropriated to the department of law for providing legal services.

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

The act renames the existing "health disparities grant program" as the "health disparities and community grant program" (program) and expands the program to authorize the office of health equity (office) to:

• Award grants from money currently transferred from the prevention, early detection, and treatment fund to the health disparities grant program fund (fund) for the purpose of positively affecting social determinants of health to reduce the risk of future disease and exacerbating health disparities in underrepresented populations; and
• Award grants from any additional money appropriated by the general assembly to the fund to community organizations to reduce health disparities in underrepresented communities through policy and systems changes regarding the social determinants of health.

On or before July 1, 2022, and continuing every 2 years thereafter, the department of public health and environment (department), in collaboration with the health equity commission and other stakeholders, is required to conduct an assessment and publish a report concerning health disparities and inequities that includes an assessment of the impact of social determinants of health on health disparities and inequities and recommended strategies to begin to address such inequities.

Within 6 months after the publication of the department's first report, the governor is required to convene the health equity commission to develop an equity strategic plan and to ensure that there is coordination in equity-related work across state agencies to address the social determinants of health. Additional state agencies are added to and required to participate on the commission and are required to develop an equity strategic plan in the agency's respective area.

$4,872,818 is appropriated to the department for use by the office of health equity to implement the act. Of the total amount appropriated, $4,821,035 is from the general fund and $51,783 is from the health disparities grant program fund.

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

The act requires:

• A carrier offering a health benefit plan in the state, and the department of health care policy and financing when administering the "Colorado Medical Assistance Act", to reimburse health-care providers that provide health-care services related to labor and delivery in a manner that:
• Promotes high-quality, cost-effective, and evidence-based care;
• Promotes high-value, evidence-based payment models; and
• Prevents risk in subsequent pregnancies;
• Each health-care provider licensed by the state who regularly provides health-care services related to labor and delivery to:
• Be able to identify when to transmit and receive patient information and transfer and receive patients, across the facility's levels of care; and
• Coordinate with other providers to effectuate services across the facility's levels of care in a way that prevents patients losing access to care;
• The birth certificate worksheet form to include a place to report where the pregnant person intended to give birth at the onset of the person's labor;
• The department of public health and environment to engage in a stakeholder process to:
• Make recommendations to improve the collection and public reporting of maternal health data from various entities; and
• Study the use of research evidence in policies related to the perinatal period in Colorado; and
• The department of health care policy and financing, no later than July 1, 2022, to seek an amendment to the state medical assistance plan to provide 12 months of postpartum medical benefits to persons who qualified for benefits while pregnant.

To implement the act, the act appropriates:

• $77,993 from the general fund to the department of health care policy and financing based on the assumption that the department will receive $481,379 in federal funds, and the act reappropriates the anticipated $481,379 of federal funds; and
• $82,243 from the general fund to the department of public health and environment for use by the prevention services division.
  (Note: This summary applies to this bill as enacted.)

For each of the 2021-22, 2022-23, and 2023-24 state fiscal years, the act requires the general assembly to appropriate $21,090,149 to the department of public health and environment as follows:

• $10,000,000 for distributions to local public health agencies; and
• $11,090,149 for disease control and public health response.

The appropriation for the 2021-22 fiscal year is from the economic recovery and relief cash fund, which is comprised of money received by the state pursuant to the federal "American Rescue Plan Act of 2021". The appropriations for the 2022-23 and 2023-24 fiscal years will be from the general fund.

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

The act declares that the regulation of firearms is a matter of state and local concern. A local government is permitted to enact an ordinance, regulation, or other law governing or prohibiting the sale, purchase, transfer, or possession of a firearm, ammunition, or firearm component or accessory. The ordinance, regulation, or law may not be less restrictive than state law. The local law may only impose a criminal penalty for a violation upon a person who knew or reasonably should have known that the person's conduct was prohibited.

The act permits a local government, including a special district, and the governing board of an institution of higher education to enact an ordinance, resolution, rule, or other regulation that prohibits a permittee from carrying a concealed handgun in a building or specific area within the local government's or governing board's jurisdiction, or for a special district, in a building or specific area under the direct control or management of the district. A local law may only impose a civil penalty for a violation, and the maximum fine that may be imposed for a first offense is $50.

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