With certain exceptions, for health benefit plans that are issued or renewed on or after January 1, 2027, the bill requires a health-care insurance carrier (carrier) to include a primary care provider as a participating provider in all networks, including narrow networks and all tiers of tiered networks, of the carrier's health benefit plan if the primary care provider is:

• Licensed to practice in Colorado;
• Certified or accredited by a national association for the certification or accreditation of primary care providers;
• Enrolled in an alternative payment model; and
• Credentialed by federal law to receive reimbursement for the provision of care to patients receiving benefits from medicaid.

On or before December 31, 2025, the commissioner of insurance must promulgate rules to implement the bill, including rules:

• Establishing criteria and a process for determining whether a primary care provider meets the criteria; and
• Establishing a schedule for contracted reimbursements issued to primary care providers who participate in a health benefit plan.

The division of insurance must contract with an actuary to determine a minimum reimbursement schedule for alternative payment models. The schedule:

• Must ensure that primary care providers are reimbursed at rates that are at least equal to the reimbursement rates established in law for purposes of the Colorado standardized health benefit plan;
• Must include adjustments for regional cost of living variations; and
• May include incentives for integration of behavioral health-care services and comprehensive care coordination services.

If a carrier and a primary care provider do not negotiate and agree to terms of reimbursement, the carrier must compensate the primary care provider in accordance with the schedule for contracted reimbursements established by rule. If a primary care provider employed by a medical group or hospital system leaves the medical group or hospital system to establish an independent practice, the primary care provider may communicate with patients about continuing to see them in the new practice. Under current law, any covenant not to compete provision of an employment, partnership, or corporate agreement between physicians that restricts the right of a physician to practice medicine upon termination of the agreement is void; except that all other provisions of the agreement, including provisions that require the payment of damages in an amount that is reasonably related to the injury suffered by reason of termination of the agreement, are enforceable. Provisions of a covenant not to compete that require the payment of damages upon termination of the agreement may include damages related to competition. The bill:

• Establishes exceptions to the general prohibition on covenant not to compete provisions;
• Broadens the scope of the prohibition to apply to any agreement rather than applying only to employment, partnership, and corporate agreements between physicians;
• Narrows the existing exception to the prohibition to apply only to provisions that require the payment of damages in an amount that is reasonably related to the injury suffered due to a breach, rather than a termination, of the agreement; and
• Prohibits including in an agreement any of several provisions that require payment of certain types of damages.

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

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

The bill establishes that evidence that a person has engaged in an unfair or deceptive trade practice constitutes a significant impact to the public.

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

The act repeals the following infrequently used tax expenditures:

• The catastrophic health insurance income tax deduction (sections 2 and 3 of the act);
• The non-resident disaster relief worker income tax subtraction (sections 4, 5, and 6);
• The medical savings account income tax deduction (sections 7, 8, 9, and 10);
• The childcare facility investment income tax credit (section 11);
• The school to career expenses income tax credit (section 12);
• The Colorado works program employer income tax credit (section 13);
• The income tax credit for purchase of uniquely valuable motor vehicle registration numbers (section 14);
• The low-emitting vehicles and commercial vehicles used in interstate commerce sales and use tax exemptions (sections 15, 16, 17, and 18);
• The biotechnology sales and use tax refund (sections 19 and 20);
• The rural broadband equipment sales and use tax refund (section 21);
• The first time home buyer savings account income tax deduction (sections 22, 23, 24, and 25);
• The aircraft gasoline and special fuel tax exemption (section 26); and
• The cigarette and tobacco bad debt tax credit for cigarette and tobacco wholesalers, distributors, and retailers that write off bad cigarette and tobacco tax debts (sections 27 and 28).

The act also modifies several tax expenditures as follows:

• Section 29 of the act eliminates the requirement that the executive director of the department of revenue present the tax profile and expenditure report to the finance committees of the house of representatives and the senate;
• Section 30 clarifies that the purpose of the college tuition program income tax deduction is to create additional incentives for saving for college tuition not already created by other state or federal law and allows the wildfire mitigation deduction for tax years commencing before January 1, 2025, rather than for tax years commencing before January 1, 2026;
• Section 31 increases the maximum amount of a health-care preceptor income tax credit from $1,000 to $2,000, allows for a maximum of 3 credits per income tax year, and increases the maximum aggregate amount of the credit awarded to any one taxpayer from $1,000 to $6,000 for any income tax year;
• Section 32 changes the maximum amount a taxpayer may claim for the wildfire hazard mitigation income tax credit to $1,000 per income tax year for income tax years commencing on or after January 1, 2025, but prior to January 1, 2028.
• Section 33 requires a local government and a nonprofit to file an informational tax return as prescribed by the executive director of the department of revenue (informational tax return) rather than a corporate tax return when claiming an alternative transportation options income tax credit;
• Section 34 requires a local government and a nonprofit to file an informational tax return when claiming a conservation easement income tax credit;
• Section 35 requires a local government and a nonprofit to file an informational tax return when claiming an income tax credit for environmental remediation of contaminated land;
• On and after January 1, 2025, sections 36 and 37 exempt from sales and use tax the sale, storage, usage, or consumption of a modular home or any closed panel system utilized in construction of a factory-built residential structure;
• Section 38 states that the purpose of the renewable energy source sales and use tax exemption is to create additional incentives for developing renewable energy projects not already created by other state or federal law;
• Section 39 repeals detailed required reporting for enterprise zone tax credits;
• Section 40 extends the employer alternative transportation for employees tax credit until January 1, 2027; and
• Section 41 makes the income tax credit for employer expenditures for alternative transportation options for employees available through the 2026 income tax year, rather then through 2024 income tax year.

APPROVED by Governor June 4, 2024

EFFECTIVE August 7, 2024
(Note: This summary applies to this bill as enacted.)

The act excludes injuries involving the possession of drugs or drug paraphernalia from a physician's mandatory reporting requirements. The act also adds an exemption to the prohibition on possessing drug paraphernalia for possession of drug paraphernalia that a person received from an approved syringe exchange program or a program carried out by a harm reduction organization while the person was participating in the program.

With respect to opioid antagonists, the act:

• Clarifies that the civil and criminal immunity that protects a person who acts in good faith to furnish or administer an opioid antagonist also protects a person who distributes the opioid antagonist;
• Specifies that the mere presence of an opioid antagonist is insufficient to establish probable cause to perform a warrantless search or seizure; and
• Updates the term "opiate antagonist" to "opioid antagonist" in current law.

The act specifies that money appropriated to the department of public health and environment to purchase non-laboratory synthetic opioid detection tests may also be used to purchase other drug testing equipment.

The act authorizes an organization operating a clean syringe exchange program to:

• Purchase and distribute other supplies and tools intended to reduce health risks associated with the use of drugs, including smoking materials; and
• Provide drug testing services through the program.

APPROVED by Governor June 6, 2024

EFFECTIVE June 6, 2024
(Note: This summary applies to this bill as enacted.)

Colorado Youth Advisory Council Review Committee. The bill requires the department of public health and environment (department) to conduct or cause to be conducted a gender-affirming health-care provider study (study). The study must determine:

• The number of gender-affirming health-care providers and facilities in each region, without disclosing identities of providers;
• The resources available to gender-affirming health-care providers and facilities in the state;
• Threats to gender-affirming health-care providers;
• The number of patients seeking gender-affirming health-care services in each region, including the ratio of patients to providers in each region, without disclosing identities of patients or providers;
• The types of gender-affirming health-care services that patients seek;
• The prevalence and impact of nonprescribed treatments; and
• The availability of insurance coverage for different types of treatment.

The bill requires the department and any third party that the department contracts with to conduct the study to seek input from specified persons. The department is required to submit a report on or before December 31, 2026, including its findings and recommendations, to specified committees of the general assembly.

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

The act prohibits an insurance carrier that provides coverage for a drug used to treat a substance use disorder under a health benefit plan from requiring prior authorization for the drug based solely on the dosage amount.

The act requires an insurance carrier to reimburse a licensed pharmacist prescribing or administering medication-assisted treatment (MAT) pursuant to a collaborative pharmacy practice agreement (collaborative agreement) at a rate equal to the reimbursement rate for other health-care providers. The act amends the practice of pharmacy to include prescriptive authority for any FDA-approved product indicated for opioid use disorder in accordance with federal law, if authorized through a collaborative agreement. The act requires the state board of pharmacy, the Colorado medical board, and the state board of nursing to develop a protocol for pharmacists to prescribe, dispense, and administer certain FDA-approved products for MAT. The act requires reimbursement to pharmacies of an enhanced dispensing fee for administering injectable antagonist medication for MAT that aligns with the administration fee paid to a provider in a clinical setting. The act requires the medical assistance program to reimburse a pharmacist prescribing or administering medications for opioid use disorder pursuant to a collaborative agreement at a rate equal to the reimbursement rate for other providers.

The act authorizes licensed clinical social workers, marriage and family therapists, and licensed professional counselors (professionals) within their scope of practice to provide clinical supervision to individuals seeking certification as addiction technicians and addiction specialists, and directs the state board of addiction counselors and the state board of human services, as applicable, to adopt rules relating to clinical supervision by these professionals. Further, a licensed addiction counselor is authorized to provide clinical supervision to individuals seeking licensure as marriage and family therapists or professional counselors if the licensed addiction counselor has met the education requirements for those professions, or the equivalent, as determined by the respective boards regulating those professions.

The act expands the medication-assisted treatment expansion pilot program to include grants to provide training and ongoing support to pharmacies and pharmacists who are authorized to prescribe, dispense, and administer MAT pursuant to a collaborative agreement or drug therapy protocol to assist individuals with a substance use disorder.

The act requires the department of health care policy and financing (HCPF) to seek federal authorization to provide MAT, case management services, and a 30-day supply of prescription medication to medicaid members upon release from jail or a juvenile institutional facility.

The act adds substance use disorder treatment to the list of health-care or mental health-care services that are required to be reimbursed at the same rate for telemedicine as a comparable in-person service.

The act requires HCPF to seek federal authorization to provide partial hospitalization for substance use disorder treatment with full federal financial participation.

The act requires each managed care entity (MCE) that provides prescription drug benefits or methadone administration for the treatment of substance use disorders to:

• Set the reimbursement rate for take-home methadone treatment and office-administered methadone treatment at the same rate; and
• Not impose any prior authorization requirements on any prescription medication approved by the FDA for the treatment of substance use disorders, regardless of the dosage amount.

The act requires the behavioral health administration (BHA) to collect data from each withdrawal management facility on the total number of individuals who were denied admittance or treatment for withdrawal management and the reason for the denial and to review and approve any admission criteria established by a withdrawal management facility.

The act requires each MCE to disclose the aggregated average and lowest rates of reimbursement for a set of behavioral health services determined by HCPF and authorizes behavioral health providers to disclose reimbursement rates paid by an MCE to the behavioral health provider.

Beginning in the 2024-25 state fiscal year, the act appropriates $150,000 from the general fund to the Colorado child abuse prevention trust fund (trust fund) for programs to reduce the occurrence of prenatal substance exposure. For the 2024-25 and 2025-26 state fiscal years, the act also annually appropriates $50,000 from the general fund to the trust fund to convene a stakeholder group to identify strategies to increase access to child care for families seeking substance use disorder treatment and recovery services.

The act requires the BHA to contract with an independent third-party entity to provide services and supports to behavioral health providers seeking to become a behavioral health safety net provider with the goal of the provider becoming self-sustaining.

The act creates the contingency management grant program in the BHA to provide grants to substance use disorder treatment programs that implement a contingency management program for individuals with a stimulant use disorder.

The act authorizes the BHA to apply for federal funding for fetal alcohol spectrum disorder programs and to receive and disburse federal funds to public and private nonprofit organizations.

The act extends the opioid and other substance use disorders study committee until September 1, 2026.

The act appropriates money to implement the act.

APPROVED by Governor June 6, 2024

PORTIONS EFFECTIVE August 7, 2024

PORTIONS EFFECTIVE July 1, 2025
(Note: This summary applies to this bill as enacted.)

The bill requires the Colorado school of public health to analyze draft model legislation for implementing a single-payer, nonprofit, 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 to the general assembly by October 1, 2025 December 31, 2025 .

The bill also creates the statewide health-care analysis advisory task force collaborative ("analysis collaborative") consisting of 21 members appointed 20 members invited by the general assembly and the governor executive director of the department of health care policy and financing, four members of the general assembly appointed by the president of the senate, minority leader of the senate, speaker of the house of representatives, and the minority leader of the house of representatives , 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 advisory task force analysis collaborative is created for the purpose of advising the Colorado school of public health during the analysis.

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

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

The bill creates the "Abortion Pill Reversal Information Act" (act). The act requires a physician or other qualified medical professional assisting a physician 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.

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

The act requires a pharmacy, on and after July 1, 2025, to provide an individual who has difficulty seeing or reading standard printed labels on prescription drug containers with access to the prescription drug label information by:

• Including an electronic label affixed to the prescription drug container that transmits the prescription drug's label information, directions, and written instructions to an individual's external accessible device, including an individual's compatible prescription drug reader;
• Providing a prescription drug reader at no cost to the individual;
• Providing a prescription drug label in braille or large print; or
• Providing the individual with a method recommended by the United States access board.

A pharmacy has 28 days to provide such access if a patient requests a method of access the pharmacy has not yet been asked by any other patient to provide. A pharmacy must make reasonable efforts to inform the public that prescription drug label information is available in accessible formats.

The act creates the prescription accessibility grant program in the department of public health and environment to provide hardship grants to pharmacies for the purchase of equipment used to create accessible prescription labels.

APPROVED by Governor June 3, 2024

EFFECTIVE August 7, 2024
(Note: This summary applies to this bill as enacted.)

With regard to prior authorization requirements imposed by carriers, private utilization review organizations (organizations), and pharmacy benefit managers (PBMs) for certain health-care services and prescription drug benefits covered under a health benefit plan, the act requires carriers, organizations, and PBMs, as applicable, to adopt a program, in consultation with participating providers, to eliminate or substantially modify prior authorization requirements in a manner that removes administrative burdens on qualified providers and their patients with regard to certain health-care services, prescription drugs, or related benefits based on specified criteria. Additionally, a carrier or organization is prohibited from denying a claim for a health-care procedure a provider provides, in addition or related to an approved surgical procedure, under specified circumstances or from denying an initially approved surgical procedure on the basis that the provider provided an additional or a related health-care procedure.

Starting January 1, 2027, if a provider submits a prior authorization request through an electronic interface or secure electronic transmission system used by the carrier, organization, or PBM, as applicable, the carrier, organization, or PBM to which the request was submitted is required to accept and respond to the request through its interface or electronic transmission system.

A carrier or PBM is prohibited from imposing prior authorization requirements more than once every 3 years for a chronic maintenance drug approved by the federal food and drug administration that the carrier or PBM has previously approved for a person covered under the carrier's or PBM's health benefit plan, except under specified conditions.

The act extends the duration of an approved prior authorization for a health-care service or prescription drug benefit from 180 days to a calendar year.

Carriers are required to post, on their public-facing websites, specified information regarding:

• The number of prior authorization requests that are approved, denied, and appealed;
• The number of prior authorization exemptions from or alternatives to prior authorization requirements provided pursuant to a program developed and offered by the carrier, an organization, or a PBM; and
• The prior authorization requirements as applied to prescription drug formularies for each health benefit plan the carrier or PBM offers.

The act appropriates $36,514 from the division of insurance cash fund to the department of regulatory agencies for use by the division of insurance to implement the act.

APPROVED by Governor June 3, 2024

EFFECTIVE August 7, 2024
(Note: This summary applies to this bill as enacted.)

The act establishes a continuing medical education requirement (CME) for physicians licensed in this state.

To meet the CME requirement, a physician must complete 30 credit hours of CME (CME credit hours) in the 24 months preceding the renewal, reinstatement, or reactivation of the physician's medical license in topics selected by the physician and also in topics specified in the act. The act specifies the type and sponsors of programs or activities that qualify for CME credit hours. The board, at its discretion, may initiate a stakeholder process to consider requiring CME credit hours in a certain topic and shall initiate a stakeholder process for the board to consider requiring specific credit hours relating to health disparities and outcomes data, reproductive, sexual, and gender-based health care, and explicit and implicit bias.

To verify compliance with the CME requirement, the physician shall affirm on the license renewal form submitted to the board that the physician has complied with the CME requirement. The board is also authorized to audit up to 5% of physician renewals annually, chosen at random with an oversampling of nonboard-certified physicians, and to require that the physician submit proof of the CME programs completed and the CME credit hours awarded. A physician's failure to comply with the CME requirement or to submit proof to the board during a board audit, without reasonable cause, constitutes unprofessional conduct. If the physician fails to comply with the CME requirement, the physician's license is inactive until reinstated by the board.

The board may adopt rules to implement the CME requirement.

The director of the division of professions and occupations in the department of regulatory agencies shall increase existing fees on physician licensure renewals to cover any additional costs associated with implementing the CME requirement.

APPROVED by Governor June 4, 2024

EFFECTIVE August 7, 2024
(Note: This summary applies to this bill as enacted.)

The bill imposes a set of duties on the Denver airport authority (authority) by established times for accessibility-related functions at Denver international airport. The authority is encouraged to monitor the completion and ongoing upkeep of the duties and functions.

The division of aeronautics (division) is authorized to issue fines for noncompliance of the duties and functions to any entity in violation (entity). For a first offense, the entity has 30 days to remedy the noncompliance. If not remedied within 30 days, the division is authorized to fine the entity an amount not to exceed $3,500. For each subsequent offense, the division shall fine the entity an amount not to exceed $7,000 per offense.

An individual alleging damages resulting from a violation by an entity may bring a civil suit and may seek a court order requiring compliance and any other remedy the court determines necessary.

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

The bill clarifies that the naturopathic doctor formulary (formulary) may include prescription classes of medicines and adds certain medicines to the formulary, including all legend drugs and, for a naturopathic doctor with a federal drug enforcement administration registration, all drugs listed on schedules III through V under the "Uniform Controlled Substances Act of 2013", except for benzodiazepines, opioids, and opioid derivatives . Before obtaining, dispensing, administering, injecting, ordering, or prescribing any of the medicines or devices on the formulary, a naturopathic doctor who is currently registered with the department of regulatory agencies must show proof of completion of 10 hours of pharmacological continuing education pertinent to or reflective of the naturopathic formulary. The bill prohibits a naturopathic doctor from prescribing any medicine or device to an individual under 18 years of age, or ketamine to an individual of any age, unless recommended by the naturopathic doctor advisory committee and approved by the director. Beginning September 1, 2024, the bill requires an individual applying for registration as a naturopathic doctor to pass a pharmacology examination administered by the North American Board of Naturopathic Examiners or a nationally recognized, director-approved successor entity. For the renewal of a naturopathic doctor registration on or after June 1, 2025, the bill requires a naturopathic doctor to complete 12 hours per year of education in pharmacology.

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

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

The bill defines the term "assault weapon" and prohibits a person from manufacturing, importing, purchasing, selling, offering to sell, or transferring ownership of an assault weapon. The bill further prohibits a person from possessing a rapid-fire trigger activator. A person in violation of the prohibitions will be assessed a first-time penalty of $250,000 and $500,000 for each subsequent violation. The bill prohibits the sale or transfer by an individual on or after July 1, 2024, to anyone within the state, except to:

• An heir by bequest or intestate succession; or
• A licensed gun or firearms dealer, who shall render the weapon inoperable within ninety days of the transfer.

An individual or entity that does not have a permit to sell firearms but sells or attempts to make a private sale of an assault weapon or rapid-fire trigger activator in violation of the requirements of the bill on or after July 1, 2025, shall be assessed a civil penalty in the amount of $750. A licensed gun dealer, licensed firearms dealer, gun show vendor, or other person who has a permit to sell firearms who sells or attempts to sell an assault weapon or rapid-fire trigger activator in violation of the requirements of the bill on or after July 1, 2025, shall be reported to the department of revenue. The department of revenue shall take appropriate actions as required by law. A licensed gun dealer, licensed firearms dealer, gun show vendor, or other person who has a permit to sell firearms who purchases an assault weapon or rapid-fire trigger activator from a manufacturer of assault weapons that operates in Colorado shall be reported to the department of revenue. The department of revenue shall take appropriate actions as required by law.

The prohibition does not apply to:

• A member of the United States armed forces, a peace officer, or other government officer or agent, to the extent that the person is otherwise authorized to acquire or possess an assault weapon and does so while acting within the scope of the person's duties; A person who is an active member of the United States armed forces while on duty and serving in conformance with the policies of the United States armed forces;
• The manufacture, sale, or transfer of an assault weapon or rapid-fire trigger activators by a licensed firearms manufacturer to any branch of the United States armed forces, or to an entity that employs peace officers, for use by that entity or its employees a peace officer or to an entity that employs peace officers;
• The manufacture, sale, or transfer of an assault weapon by a licensed firearms manufacturer to any branch of the Unites States armed forces;
• The transfer of an assault weapon to a licensed firearms dealer or gunsmith for the purposes of maintenance, repair, or modification, and the subsequent return of the assault weapon to the lawful owner;
• Any federal, state, or local historical society, museum, or institutional collection that is open to the public, provided that the assault weapon is securely housed and unloaded;
• A forensic laboratory, or any authorized agent or employee of the laboratory, for use exclusively in the course and scope of authorized activities;
• An entity that operates an armored vehicle business and an authorized employee of the entity while in the course and scope of employment;
• A licensed gun dealer who has remaining inventory of assault weapons as of August 1, 2024, and sells or transfers the remaining inventory only to a non-Colorado resident and the sale or transfer takes place out of state; or
• A peace officer.

The prohibition does not apply to the transportation of assault weapons through the state by a person who is not otherwise prohibited by state or federal law from transporting, shipping, or receiving a firearm. A person is entitled to transport an assault weapon for any lawful purpose from any place where the person may lawfully possess and carry the assault weapon to any other place where the person may lawfully possess and carry the assault weapon, provided the transportation is in accordance with federal law.

(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 directs the department of health care policy and financing (state department) to conduct a feasibility study (study) to explore seeking federal authorization to provide nutrition, housing, and tenant supportive services that address medicaid members' health-related social needs (HRSN). The state department shall report the study's findings to the joint budget committee on or before November 10, 2024. The study and report must address integrating HRSN services with existing nutrition-related, housing-related, and tenant supportive services.

The act requires the state department to seek federal authorization to provide HRSN services no later than July 1, 2025, if seeking federal authorization would be budget neutral to the general fund.

The act appropriates $222,920 from the general fund to the state department for use by the executive director's office (office). From this appropriation, the office may use $67,070 for personal services, $3,975 for operating expenses, and $151,875 for general professional services and special projects. The act anticipates that the state department will receive $222,919 in federal funds for the act's implementation.

APPROVED by Governor June 3, 2024

EFFECTIVE June 3, 2024
(Note: This summary applies to this bill as enacted.)

The act creates the school-based mental health support program (program) in the behavioral health administration (BHA) to provide high-quality training, resources, and implementation and sustainment support for the existing public school educator workforce to provide evidence-based mental health services to students through a contract with an external provider. The program emphasizes supporting schools in rural areas and schools with students who do not have equitable access to mental health care.

No later than January 1, 2025, the act requires the BHA to contract with an external provider to implement the program no later than the start of the 2025-26 school year.

The act requires the BHA to collaborate with the external provider to determine the cost of implementing the program in at least 400 public schools by the start of the 2027-28 school year.

For the 2024-25 state fiscal year, $2,500,000 is appropriated from the general fund to the department of human services for use by the BHA to administer the program. The BHA may use up to $100,000 of the funds to select the external provider.

APPROVED by Governor April 18, 2024

EFFECTIVE April 18, 2024
(Note: This summary applies to this bill as enacted.)

The act makes it a deceptive trade practice under the "Colorado Consumer Protection Act" for a manufacturer of insulin to fail to comply with the manufacturer requirements under the insulin affordability program and for the emergency supply of prescription insulin. The act also authorizes the attorney general to enforce the epinephrine auto-injector affordability program (epinephrine program).

For the insulin affordability program, the state board of pharmacy (board), rather than the division of insurance (division) and the department of health care policy and financing (department), shall develop an application form for the insulin affordability program, make the application form available on the board's website, provide the application form to pharmacies and health-care providers and others, and promote the availability of the program to Coloradans.

For the emergency supply of prescription insulin, the board, rather than the division and the department, shall develop an application form for individuals seeking an emergency supply of prescription insulin, make the application form available to the public, and promote the availability of the emergency supply of prescription insulin to Coloradans.

The act also changes the amount of a fine for a manufacturer's failure to comply with the requirements of the insulin affordability program or with the requirements for the emergency supply of prescription insulin, or for failure to comply with the epinephrine program, to the amount and frequency of the fine that is permitted under the "Colorado Consumer Protection Act".

For the epinephrine program, the act requires all manufacturers subject to the epinephrine program to participate in the epinephrine program. The board shall develop a program application form and make the form available to individuals, pharmacies, health-care providers, and health facilities through the board's website, with each manufacturer required to link to the epinephrine program on the manufacturer's website. The board shall also provide information to pharmacies about the epinephrine program that includes a quick response (QR) code to allow individuals to access the epinephrine program's application online, including how to submit the application, and information necessary for a dispensing pharmacy to successfully submit an electronic claim for reimbursement of the cost to dispense an epinephrine auto-injector to an individual, above any required cost sharing by the individual.

APPROVED by Governor June 3, 2024

EFFECTIVE June 3, 2024
(Note: This summary applies to this bill as enacted.)

Effective January 1, 2025, the act repeals the existing statutory requirement to test a person who is pregnant for syphilis at the person's first professional visit with a health-care provider or during the first trimester of pregnancy.

The act requires each health-care provider to take a blood sample from each pregnant person under their care and submit the sample to a laboratory for HIV testing and, if a pregnant person declines to be tested, to document in the person's medical record the refusal to be tested.

The act requires the state board of health (board), on or before January 1, 2025, to promulgate rules concerning prenatal testing standards for syphilis, including the frequency of testing. At least once every 3 years, the department of public health and environment (department) is required to review the board's rules for alignment with national prenatal testing recommendations for sexually transmitted infections and the department's infection control duties.

For statistical purposes, the department is required to make de-identified case rate data for syphilis available to county and district public health agencies, which data must remain confidential.

APPROVED by Governor June 5, 2024

EFFECTIVE June 5, 2024
(Note: This summary applies to this bill as enacted.)

The temporary youth mental health services program (program), commonly known as "I Matter", is scheduled to repeal on June 30, 2024. The act continues the program until June 30, 2034.

Under existing law, the selection of a vendor to create or use an existing online portal to facilitate the program (program vendor) is exempt from the requirements of the state's procurement code. The act repeals the exemption.

Existing law requires the state department of human services to report to the general assembly about the program twice each year. The act requires one annual report, due June 30 of each year.

The act requires the program vendor to annually deliver to the BHA information and data about the program and requires the BHA to conduct surveys of providers who participate in the program.

The act appropriates $5 million from the general fund to the BHA for the program.

APPROVED by Governor June 4, 2024

EFFECTIVE June 4, 2024
(Note: This summary applies to this bill as enacted.)

The bill allows a board of county commissioners to adopt an ordinance or resolution to:

• Regulate the distribution of cigarettes, tobacco products, or nicotine products; and
• Prohibit the distribution or retail sale of cigarettes, tobacco products, or nicotine products, including prohibiting the sale of any or all flavored cigarettes, flavored tobacco products, or flavored nicotine products.

(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.)

For purposes of the school-based health center grant program (grant program), the act expands the definition of a school-based health center and the purposes of the grant program to authorize grants for evidence-informed, school-linked health-care services. Services may include primary health-care, behavioral health-care, oral health-care, and preventive health-care services for students and youth (school-linked health-care services).

School-linked health-care services may be delivered through telehealth, mobile services, and referrals for health-care services at a clinic near school grounds.

Subject to available appropriations, the act authorizes grant money to be directed to evidence-informed, school-linked health-care services models to expand access to school-based health care, unless the prevention services division in the department of public health and environment determines that adequate proposals have not been submitted for the grant cycle.

The act also requires the department of health care policy and financing to create a service-location identifier for claims for services provided at school-based health centers or through school-linked health-care services.

APPROVED by Governor June 5, 2024

EFFECTIVE August 7, 2024
(Note: This summary applies to this bill as enacted.)

The act:

• Exempts veterinarians from complying with specific aspects of the prescription drug use monitoring program (program) that are specific to prescriptions for human patients;
• Allows the medical director of a medical practice or hospital, including a nurse medical director, to appoint designees to query the program on behalf of a practitioner in the medical practice or hospital setting;
• Allows the department of health care policy and financing (department) to access the program, consistent with federal data privacy requirements, for purposes of care coordination, utilization review, and federally required reporting relating to recipients of certain benefits; and
• Updates current language in the laws relating to the program by using more modern terminology.

A county or district public health agency may establish a multidisciplinary and multiagency overdose fatality review team (local team). The act prescribes membership requirements, purposes, and duties for local teams, including a duty to report annually to the county or district public health agency served by the local team. The act requires certain entities, upon receiving a written request of the chair of a local team, to provide the local team with information and records regarding a person whose death or near death is being reviewed by the local team. Unless the chair of the local team grants an extension of time, the entity must provide the local team the requested information and records within 10 business days after receipt of the request. A person or entity that receives a records request from a local team may charge the local team a reasonable fee for the service of duplicating any records requested.

A person or entity, including a local or state agency, that provides information or records to a local team is not subject to civil or criminal liability or any professional disciplinary action pursuant to state law as a result of providing the information or record.

Upon request of a local team, a person who is not a member of a local team may attend and participate in a meeting at which a local team reviews confidential information and considers a plan, an intervention, or other course of conduct based on that review. The act requires each person at a local team meeting to sign a confidentiality form before reviewing information and records received by the local team. Local team meetings in which confidential information is discussed are exempt from the open meetings provisions of the "Colorado Sunshine Act of 1972".

A local team shall maintain the confidentiality of information provided to the local team as required by state and federal law, and information and records acquired or created by a local team are not subject to inspection pursuant to the "Colorado Open Records Act". Local team members and a person who presents or provides information to a local team may not be questioned in any civil or criminal proceeding or disciplinary action regarding the information presented or provided. Law enforcement may not use information from any overdose fatality review for any law enforcement purpose.

The department is required to publish guidance for providers concerning reimbursement for all variations of screening, brief intervention, and referral to treatment interventions.

The act requires the existing substance use screening, brief intervention, and referral to treatment grant program in the department to require implementation of:

• A statewide adolescent substance use screening, brief intervention, and referral practice that includes training and technical assistance for appropriate professionals in Colorado schools, with the purpose of identifying students who would benefit from screening, brief intervention, and potential referral to resources, including treatment; and
• A statewide substance use screening, brief intervention, and referral practice that includes training and technical assistance for pediatricians and professionals in pediatric settings, with the purpose of identifying adolescent patients who would benefit from screening, brief intervention, and potential referral to resources, including treatment.

Current law authorizes the center for research into substance use disorder prevention, treatment, and recovery support strategies (center) to conduct a statewide perinatal substance use data linkage project (data linkage project) that uses ongoing collection, analysis, interpretation, and dissemination of data for the planning, implementation, and evaluation of public health actions to improve outcomes for families impacted by substance use during pregnancy. The act:

• Requires the center to conduct the data linkage project;
• Requires the data linkage project to utilize data from additional state and federal programs; and
• Expands the data linkage project to examine the education of pregnant and postpartum women with substance use disorders.

For the 2024-25 state fiscal year, the act appropriates:

• $75,000 from the general fund to the executive director of the department for general professional services and special projects; this appropriation is based on the assumption that the department will receive $75,000 in federal funds for these services; and
• $250,000 from the general fund to the department of higher education for use by the Colorado commission on higher education and higher education special purpose programs.

APPROVED by Governor June 6, 2024

EFFECTIVE June 6, 2024
(Note: This summary applies to this bill as enacted.)

The act establishes the Black Coloradan racial equity commission (commission) in the legislative department to conduct a study to determine, and make recommendations related to, any historical and ongoing effects of slavery and subsequent systemic racism on Black Coloradans that may be attributed to Colorado state practices, systems, and policies. The study includes historical research conducted by the state historical society (society), commonly known as history Colorado, and an economic analysis conducted by a third party.

The society may enter into an agreement with a third-party entity to conduct all or parts of the historical research. The society shall conduct at least 2 community engagement sessions for members of the public to provide input to the society. The society shall provide the commission with quarterly updates about the status of its research. The society is required to submit a report to the commission with the results of its research and any recommendations.

The commission shall enter into an agreement with a third party to conduct an economic analysis of the financial impact of systemic racism on historically impacted Black Coloradans utilizing the findings of the society's historical research. The third party shall deliver the results of its economic analysis to the commission.

At the conclusion of the study, the commission shall submit a report to the general assembly and the governor about the study and make the report available on a publicly accessible webpage of the general assembly's website. The report must include a description of the study's goals, the results of the historical research and economic analysis, and the commission's recommendations. After the commission submits the report, the commission shall work with any parties necessary to implement the recommendations in the report.

The study is contingent upon the commission receiving $785,000 of gifts, grants, or donations for the purpose of conducting the study. The act creates the Black Coloradan racial equity study cash fund to accept the gifts, grants, or donations received for the study. The money in the cash fund is continuously appropriated to legislative council for use by the commission and to the society for conducting the historical research.

APPROVED by Governor June 4, 2024

EFFECTIVE August 7, 2024
(Note: This summary applies to this bill as enacted.)

The bill requires all private insurance companies to provide coverage for the treatment of the chronic disease of obesity and the treatment of pre-diabetes, including coverage for intensive behavioral or lifestyle therapy, bariatric surgery, and FDA-approved anti-obesity medication.

No later than January 2025 The bill requires the department of health care policy and financing (department) to seek federal authorization to provide treatment for the chronic disease of obesity and the treatment of pre-diabetes. Within existing appropriations and upon receiving federal authorization, the department is required to notify medicaid members in writing about the availability of the treatment.

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

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

The bill states that the Colorado prescription drug affordability review board has no authority to perform an affordability review of, or to establish an upper payment limit for, any prescription drug that is designated as a drug for a rare disease or condition by the federal food and drug administration.

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

The act allows an enrollee in the state medicaid program or with a private health insurance carrier whose coverage has been terminated or not renewed to receive continued care with the enrollee's same health-care provider or health-care facility under the enrollee's new health benefit plan at the in-network level under the enrollee's new health benefit plan for specified time periods if certain conditions exist.

APPROVED by Governor April 4, 2024

EFFECTIVE January 1, 2025
(Note: This summary applies to this bill as enacted.)

Existing law limits the amount recoverable for noneconomic damages in medical malpractice actions to $300,000. Beginning January 1, 2025, the bill incrementally increases the noneconomic damages limitation to $500,000 over the course of 5 years.

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

The act allows a health-care provider (applicant) who possesses a license, certificate, registration, or other approval as a health-care provider in another state (out-of-state credential) to provide health-care services through telehealth to patients located in Colorado if the applicant registers with the regulator that regulates the health-care services the applicant will provide (regulator). An applicant is eligible for registration if:

• The applicant submits an application in a manner prescribed by the division of professions and occupations (division) in the department of regulatory agencies (department) and pays the applicable fee;
• The applicant possesses an out-of-state credential issued by a governmental authority in another state, the District of Columbia, or a possession or territory of the United States that is active and unencumbered, that has educational and supervisory standards equivalent to or exceeding the educational and supervisory standards required for the equivalent credential in this state or the interstate compacft license for the applicable credential type, and that entitles the applicant to perform health-care services that are substantially similar to health-care services that may be performed by a licensee, certificate holder, or registrant in this state;
• The applicant designates an agent upon whom service of process may be made in Colorado;
• The applicant has not been subject to any disciplinary action relating to the applicant's out-of-state credential during the 5-year period immediately preceding the submission of the applicant's application that has resulted in the applicant's out-of-state credential being limited, suspended, or revoked, unless the disciplinary action pertains to an action, behavior, or treatment permitted under Colorado law; and
• The applicant demonstrates passage of a jurisprudence examination administered by the division if passage of a jurisprudence examination is required for substantially similar credentialing in this state.

An applicant who has been registered to provide health-care services through telehealth to patients located in Colorado (registered provider) shall:

• Provide health-care services in compliance with the professional practice standards for health-care services in this state;
• In the event of an emergency situation, make a good faith effort to contact and coordinate with emergency services located near the originating site, or facilitate contact with the appropriate local mental and behavioral health services, and remain on a synchronous connection with the patient, if the emergency arises during a synchronous connection, until emergency services have reached the originating site or the situation is resolved in the registered provider's clinical judgment;
• Maintain a written emergency protocol that is appropriate to the applicable standard of care for Colorado;
• Notify the applicable regulator of restrictions placed on the registered provider's out-of-state credential in any state or jurisdiction or of any disciplinary action taken or pending against the registered provider in any state or jurisdiction;
• Maintain and have in effect a form of financial responsibility that covers services provided to patients in this state as required by the applicable regulator;
• Disclose to the patient that the registered provider does not have a physical location in Colorado and disclose the location of the registered provider; and
• Not open an office in this state and shall not provide in-person health-care services to patients located in this state unless the health-care provider obtains the license, certification, or registration that the applicable regulator requires for the performance of the relevant health-care services in this state.

The act also allows the division or the regulator to take disciplinary action against a registered provider under specified conditions. The department may notify other states in which the registered provider is licensed, registered, or certified to practice of any disciplinary actions taken against the registered provider in this state.

A registered provider is prohibited from prescribing a controlled substance.

APPROVED by Governor June 7, 2024

EFFECTIVE June 7, 2024
(Note: This summary applies to this bill as enacted.)

Beginning July 1, 2025, the act requires the department of health care policy and financing (state department) to provide reimbursement to certain medicaid members (member) for the use of telehealth remote monitoring for outpatient services. The department shall initiate a stakeholder process to determine the billing structure prior to providing reimbursement.

The act creates the telehealth remote monitoring grant program to provide grants to outpatient health-care facilities located in a designated rural county or designated provider shortage area to assist with the costs of providing telehealth remote monitoring for outpatient clinical services. The state department may award up to five grants worth $100,000 each.

Beginning November 1, 2025, the act requires the state department to provide coverage for continuous glucose monitors to medicaid medical and pharmacy benefit members.

For the 2024-25 state fiscal year, the act appropriates $34,128 to the department of health care policy and financing to implement this act.

APPROVED by Governor May 29, 2024

EFFECTIVE August 7, 2024
(Note: This summary applies to this bill as enacted.)

The act requires health benefit plans to provide coverage for doula services in the same scope and duration of coverage for doula services that will be included in the department of health care policy and financing's request for federal authorization of doula services (request) under the "Colorado Medical Assistance Act" (medical assistance program). Doulas providing services must meet the same qualifications for and submit to the same regulation as individuals providing doula services as recommended under the medical assistance program.

Coverage for doula services will be implemented for large employer health benefit plans issued or renewed in this state on and after July 1, 2025, or 12 months after submission of the request, whichever is later. For small group and individual plans, doula services will be implemented if the division of insurance and the federal department of health and human services determine that the benefit does not require state defrayal of the cost of the benefit or the division of insurance determines defrayal is not required and the federal department fails to respond to the division's request for confirmation of the determination within 365 days after the request is made.

The act authorizes the department of public health and environment (department) to partner with the designated state perinatal care quality collaborative (perinatal quality collaborative) to track the statewide implementation of the recommendations of the Colorado maternal mortality review committee, implement perinatal health quality improvement programs with hospitals that provide labor and delivery or neonatal care services (hospital) to improve infant and maternal health outcomes, and address disparate care outcomes among certain populations and of those living in frontier areas of the state.

No later than July 1, 2025, and no later than July 1 each year thereafter, the act requires hospitals to submit specified data to the perinatal quality collaborative concerning disparities in perinatal health care and health-care outcomes and beginning December 15, 2025, to annually participate in at least one maternal or infant health quality improvement initiative (initiative), as determined by the hospitals. The act authorizes financial support for hospitals in rural and frontier areas of the state, hospitals that serve a higher number of medical assistance patients or uninsured patients, and hospitals with lower-acuity maternal or neonatal levels of care.

The act requires the department to contract with the perinatal quality collaborative to issue an annual report, no later than July 1, 2026, and no later than July 1 each year thereafter, on clinical quality improvements in maternal and infant health outcomes and related data, as well as other information that can be shared with hospitals and health facilities, policymakers, and others and posted on the internet. The act includes protections for the confidentiality of certain data collected or shared under the act.

No later than July 1, 2025, the act requires the medical services board to promulgate rules to include coverage under the medical assistance program of over-the-counter choline dietary supplements for pregnant people and to seek federal approval for the coverage if necessary.

For the 2024-25 state fiscal year, $1,328,652 is appropriated from the general fund to the department, for use by the prevention services division, with the assumption that the division will require 0.9 FTE, to implement the act.

APPROVED by Governor June 5, 2024

EFFECTIVE June 5, 2024
(Note: This summary applies to this bill as enacted.)

The act authorizes the department of higher education to enter into a limited purpose fee-for-service contract with the board of regents of the university of Colorado for allocation to programs or institutions of higher education to expand an existing rural track program. If an allocation is made to a program or institution to expand an existing rural track program, the department of higher education shall utilize a formula developed and revised annually by the rural program office, in collaboration with the institutions, that is based on data that documents the program's or institution's fulfillment of certain requirements. The act requires the rural program office to submit a report to the general assembly each year that includes the allocation formula developed by the rural program office.

The act creates the rural hospital cash fund and on July 1, 2024, requires the state treasurer to transfer $1,742,029 from the general fund to the rural hospital cash fund for the purpose of distributing money in equal amounts to rural hospitals.

For the 2024-25 state fiscal year, the act appropriates $866,667 from the general fund to the department of higher education for the college opportunity fund program to be used for limited purpose fee-for-service contracts with institutions of higher education.

APPROVED by Governor June 6, 2024

EFFECTIVE June 6, 2024
(Note: This summary applies to this bill as enacted.)