The act clarifies that the health benefits coverage for the prevention of, screening for, and treatment of behavioral, mental health, and substance use disorders must be no less extensive than the coverage provided for any physical illness. The act requires that every health benefit plan provide coverage for medically necessary treatment of covered behavioral, mental health, and substance use disorder benefits, consistent with specified criteria.

The act also specifies criteria to be used for conducting utilization review, service intensity, and the level of care for covered persons. In addition, the act prohibits:

• A health benefit plan from limiting coverage for chronic behavioral, mental health, or substance use disorders to short-term symptom reduction; and
• A health insurance carrier from reversing or altering a determination of medical necessity except in the case of fraud.

The act requires carriers that provide benefits for mental health conditions or substance use disorders to offer meaningful benefits for mental health conditions and substance use disorders. The act describes how to determine whether the benefits provided are meaningful benefits.

The commissioner of insurance is authorized to adopt rules to:

• Establish carrier utilization review compliance;
• Specify data testing requirements for plan design and application of parity compliance;
• Set standard definition for coverage requirements;
• Establish timelines for carriers to provide comparative analysis information to the division of insurance; and
• Establish time periods for visits with a provider for treatment of a behavioral, mental health, or substance use disorder after an initial visit with a provider.
  (Note: This summary applies to this bill as enacted.)

The act authorizes an occupational therapist to directly recommend or prescribe durable medical equipment to a patient without requesting the prescription from a licensed physician and requires that the occupational therapist consult with the patient concerning payment options.

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

The act directs the Colorado disability opportunity office to develop a comprehensive community integration plan (plan) for implementing its obligation to provide qualified individuals with disabilities with opportunities to live, work, and be served in the least restrictive settings possible. The act requires the plan to include specified elements and that the plan must be reviewed and updated every 3 years.

The act establishes that public and governmental entities (entities) shall administer services, programs, and activities in the most integrated setting that is appropriate to the needs of individuals with disabilities. The act establishes when entities are required to provide home- and community-based services (services) to qualified individuals with disabilities.

If an entity cuts services, the act requires the entity to assess whether the service cut increases the risk of institutionalization for qualified individuals with a disability receiving services. An entity is not required to comply with the provisions of the act if it can establish that doing so would require a fundamental alteration of its program. The act does not create a new private right of action for entities that fail to comply with it and does not create a standard different than federal law.

The bill appropriates $658,410 from the disability support fund to the department of labor and employment for the Colorado disability opportunity office to implement the act.

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

The act requires an individual who is licensed to practice medicine or licensed to practice as an advanced practice registered nurse to make certain disclosures to patients if the individual delegates medical-aesthetic services to an individual who is not a licensed health-care provider.

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

The act amends various statutes governing the operations of the department of public health and environment (department) regarding disease control. Specifically, sections 1 through 9 of the act:

• Repeal the governor's expert emergency epidemic response committee (GEEERC);
• Direct the state board of health to review and amend, as necessary, the department's emergency response and recovery plan every 3 years; and
• Require the executive director of the department or, if the executive director is not the chief medical officer, the chief medical officer to convene a group of subject matter experts to develop crisis standards of care to be used in responding to a public health emergency.

Sections 10 through 18 modify school immunization provisions as follows to:

• Allow the records of a physician assistant to be used to create an official certificate of immunization for a student;
• Extend the period within which a student whose certificate of immunization is not up to date to comply with immunization requirements to attend school from 14 days after notice of noncompliance is received to 30 days after receipt of the noncompliance notice;
• Extend from February 15 to April 15 the deadline for a school to distribute the annual letter to parents specifying the school's aggregate immunization rates and the immunization requirements applicable for the next school year;
• Direct the state board of health, in adopting rules establishing immunization requirements, to take into consideration, as appropriate and in addition to the recommendations of the advisory committee on immunization practices, the recommendations of the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Physicians;
• For purposes of out-of-state campers attending a licensed children's residential camp, allow the camp to maintain an out-of-state immunization record for an out-of-state camper, rather than the state's official certificate of immunization;
• Remove gendered pronouns and replace them with gender-neutral language; and
• Repeal the requirement for schools to notify the department and the local public health agency when a student is suspended or expelled from school for noncompliance with immunization requirements.

Section 19 extends from July 15 to September 15 the date by which the department is required to submit to the general assembly an annual report summarizing health-care-associated infections data received from health facilities in the state.

Section 20 repeals the requirement for certain health-care providers to offer a hepatitis C screening test to individuals born between 1945 and 1965 and instead directs the state board of health to adopt standards, consistent with recommendations from the federal centers for disease control and prevention, for hepatitis C screening tests.

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

The bill modifies the address confidentiality program (program), which is intended to protect the confidentiality of the actual address of a relocated protected health-care worker or a relocated victim of domestic violence, a sexual offense, human trafficking, or stalking. The modifications to the program are:

• Expanding the requirement to use a substitute address for a program participant from applying only to government agencies to applying to private entities, upon request of the program participant;
• Removing work and school addresses from the definition of actual address, such that an actual address only covers a residential address;
• Allowing a program participant to apply with their actual address and either a telephone number or an email address, rather than requiring a telephone number;
• Clarifying that entities and agencies must use a substitute address in the place of the name of a school or employer or for a program participant's home-based business, if requested;
• Increasing the court fine applied to convictions for certain offenses, which is used to fund the program, from $28 to $33 and expanding this fine by applying it to convictions for sexual assault and municipal offenses for domestic violence, stalking, sexual assault, and human trafficking;
• Creating a process to allow program participants to shield real property records from public inspection; and
• Allowing a criminal justice official or government agency that has requested and been approved for expedited disclosure of a program participant's actual address to share the actual address with a law enforcement agency for the purpose of conducting a welfare check.

The bill also makes technical and conforming amendments.

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

The act requires a board of county commissioners, a governing body of a municipality, or a regional building department operating through an intergovernmental agreement with a board of county commissioners or governing body of a municipality that adopts or substantially amends a building code or updates a building code with a succeeding version of the international building code to ensure that the building code meets or exceeds the accessibility standards in the International Building Code, and the adopted accessibility standards cannot provide less protection than what is required by the federal "Americans with Disabilities Act of 1990". However, this requirement does not apply when energy-efficient building codes are adopted, nor does it apply to one- and 2-family dwellings and townhomes that comply with either the International Residential Code or a local building code whose accessibility standards are equivalent to the standards in the International Residential Code.

The act requires the division of fire prevention and control within the department of public safety to ensure that, when certain building codes pertaining to public school and health facilities are substantially amended, the codes meet or exceed accessibility standards in the International Building Code.

The act also requires the state housing board to ensure that, when the uniform construction and maintenance standards for hotels, motels, and multiple dwellings in jurisdictions with no local building code are substantially amended, the standards meet or exceed the accessibility standards in the International Building Code. The act also requires the state housing board to ensure that, when the recommendations for uniform housing standards and building codes to the general assembly and local governments are substantially amended, the codes meet or exceed the accessibility standards in the International Building Code.

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

The act makes it legal to prescribe, dispense, distribute, possess, use, and market in Colorado a prescription medicine that contains crystalline polymorph psilocybin upon the medicine's approval by the United States food and drug administration.

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

Under current law, a medical malpractice insurer (insurer) is prohibited from increasing premiums for, refusing to issue, canceling, terminating, or refusing to renew a medical malpractice insurance policy (prohibited actions). The bill permits an insurer to take prohibited actions against an applicant or named insured, including an individual health-care professional or business, or against a health-care facility, such as a hospital or clinic, that allows the use of facilities, equipment, or supplies for, or provides, prescribes, orders, or performs, gender-affirming health-care services for an individual who is a minor under 18 years of age.

The bill also prohibits an insurer from accepting state money for the payment of premiums if the malpractice policy covers actions relating to providing gender-affirming health-care services to minors.

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

For a minor who is 15 years of age or younger, current law authorizes electroconvulsive treatment (ECT) to be performed if certain conditions are met, including that ECT is medically necessary to treat life-threatening malignant catatonia. The act removes this condition.

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

In current law, a "qualified individual" is authorized to determine the cause of death of an individual and complete the medical certification for a certificate of death. The act defines the term "qualified individual" to include a physician, a physician assistant, an advanced practice registered nurse, or the chief medical officer of the institution in which the death occurred.

The act requires that qualified individuals register to use the electronic death registration system used by the department of public health and environment (department) and the state registrar prior to signing a death certificate.

Physician assistants and advanced practice registered nurses are required to review training materials regarding signing a death certificate provided by the department before the first time they sign a death certificate.

For the 2025-26 state fiscal year, $25,000 is appropriated to the department from the vital statistics records cash fund for use by the center for health and environmental data to implement the act.

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

For ground ambulance services (ambulance services), the act:

• Allows a political subdivision or an ambulance service providing ambulance services on behalf of the political subdivision to submit to the division of insurance (division) the established rates for the ambulance services, if the rates meet specified conditions;
• Requires the division to publish reimbursement rates on the division's public-facing website;
• Establishes reimbursement rates for ambulance services that are out of network; and
• Prohibits an out-of-network ambulance service from billing an individual covered under a health insurance coverage plan (covered person) any outstanding balance for a covered service not paid for by an insurance carrier, except for any coinsurance, deductible, or copayment amount required to be paid by the covered person. If a covered person makes a payment for an out-of-network ambulance service, the payment must be applied to the covered person's in-network deductibles and in-network out-of-pocket maximum amounts.

For the 2025-26 state fiscal year, $38,149 is appropriated from the division of insurance cash fund to the department of regulatory agencies for use by the division to implement the act.

VETOED by Governor 5/29/2025
(Note: This summary applies to this bill as enacted.)

Beginning January 1, 2027, the act:

• Allows a pharmacy benefit manager (PBM) to earn income derived from the assessment of a flat-dollar service fee for the provision of a prescription drug;
• Prohibits a PBM from earning income based on the price or cost of a prescription drug;
• Prohibits a PBM from designing a formulary to favor a certain branded pharmaceutical or biologic;
• Requires a PBM to be reimbursed by a health benefit plan for lowering the plan's prescription drug spending over a given period of time and for the direct services the PBM provides to the plan;
• Sets the amount that a PBM shall reimburse an unaffiliated pharmacy or a PBM-affiliated retail, mail order, or specialty pharmacy for a prescription drug; and
• Requires a contract between a PBM and a health benefit plan to contain a provision where the PBM discloses prescription drug cost information to the health benefit plan and a provision authorizing the health benefit plan to execute an audit to validate compliance with the contract.
  (Note: This summary applies to this bill as enacted.)

The act authorizes the department of health care policy and financing (department) to seek federal authorization to determine a member's eligibility for reenrollment without checking federally approved electronic data sources or requesting additional information if the member's income consists solely of social security income or another source of stable income or assets or if the member's income or assets have not changed since the initial verification during the application process.

The act requires the department to modify the questions asked by medical professionals when verifying a member's need for long-term services and supports and allows a treating licensed medical professional who has a bona fide physician-patient relationship with a member to sign the documentation necessary to verify a member's need for long-term services and supports.

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

The bill sets the reimbursement rates that a health insurance carrier (carrier) may reimburse a health-care provider (provider) for covered services for the state employee group benefit plans (state group benefit plans) and for small employer group benefit plans (small group plans).

The bill prohibits a provider that is subject to the reimbursement limitations from billing or collecting payment from a person covered under a state group benefit plan or small group plan for any outstanding balance for covered services that is not reimbursed by the carrier, except for the applicable in-network coinsurance, copayment, or deductible amounts.

The bill requires a carrier to provide cost and quality of care information to the commissioner of insurance (commissioner) in the case of small group plans and to the director of the department of personnel (director) in the case of state group benefit plans, at the request of the commissioner or director, as applicable, and prohibits a carrier from entering into an agreement with a provider or third party that would restrict the carrier from providing the information.

By September 1, 2027, and by September 1 each year thereafter, the director is required to provide a report to the governor's office, the state treasurer's office, and the joint budget committee that states the amount of calculated savings in general fund expenditures (calculated savings), if any, for health plan reimbursement for the prior fiscal year as a result of the reimbursement limits for state group benefit plans. The director is also required to include in the report the cost to the department in determining the calculated savings. By September 15, 2027, and by September 15 each year thereafter, of the money from the calculated savings, the state treasurer is required to transfer an amount equal to the department's costs in determining the calculated savings to the group benefit plans expenditure savings cash fund (expenditure savings cash fund), which is created in the bill, and specified percentages of the calculated savings from the general fund to the primary care fund and to the expenditure savings cash fund.

The bill also requires the executive director of the department of health care policy and financing (state department) to conduct a study, in collaboration with specified state agencies, to determine the feasibility of establishing a similar reimbursement limit for group benefit plans offered to school district, higher education, and local government employees. The executive director is required to complete the study and report the findings to the general assembly on or before January 1, 2028. The bill allocates $500,000 from the calculated savings to a health care reimbursement feasibility study cash fund created in the bill and authorizes the state department to use the money to conduct the study.

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

The act authorizes the director (director) of the division of professions and occupations in the department of regulatory agencies (division) to license dietitians and nutritionists if they meet the requirements specified by the act and the rules adopted by the director pursuant to the act. On and after September 1, 2026, an individual is prohibited from engaging in or offering to provide medical nutrition therapy unless the individual is licensed by the director.

The act creates the dietetics and nutrition advisory committee in the division, which is responsible for advising the director in the regulation of medical nutrition therapy and the implementation of the act.

An individual who desires to practice as a dietitian must file with the director:

• An application for a license;
• Proof of completion of educational requirements and supervised practice experience; and
• Proof of compliance with examination requirements or proof of holding a valid, current registration with the Commission on Dietetic Registration.

An individual who desires to practice as a nutritionist must file with the director:

• An application for a license;
• Proof of completion of educational requirements and supervised practice experience; and
• Proof of compliance with examination requirements.

Until September 1, 2028, the director may waive the examination requirement and may grant a nutritionist license to an applicant who meets specified criteria.

The director may deny or refuse to renew a license, suspend or revoke a license, or impose probationary conditions on a license. The director may also issue warnings to or seek injunctive relief against a licensee or applicant for licensure who has engaged in specified grounds for discipline or unprofessional conduct.

The director may issue a provisional license to practice as a dietitian or a nutritionist upon the filing of an application with the appropriate fees, submission of evidence of successful completion of the educational and supervised practice requirements, and submission of evidence that the individual has applied to take the required licensing examination.

The act exempts specified individuals from the licensing requirements established by the act.

An individual who practices or offers or attempts to practice as a dietitian or nutritionist without being licensed pursuant to the act and who is not exempted from licensure commits a class 2 misdemeanor.

The director shall adopt rules as necessary to implement the act.

The act is scheduled for repeal on September 1, 2035. Before the repeal, the functions of the director in regulating dietitians and nutritionists are scheduled for review in accordance with the sunset law.

For the 2025-26 state fiscal year, the act appropriates $100,584 from the division of professions and occupations cash fund to the department of regulatory agencies to implement the act.

VETOED by Governor 5/23/2025
(Note: This summary applies to this bill as enacted.)

The act requires the office of gun violence prevention (office) in the department of public health and environment (department) to post the office's gun violence prevention materials (materials) in an accessible manner on the office's website for school districts, boards of cooperative services, district charter schools, institute charter schools, and the Colorado school for the deaf and the blind (local education providers) to access and distribute to parents, guardians, and legal custodians of elementary or secondary school students.

The act requires each local education provider to:

• Provide the materials in a written or electronic format to students' parents, guardians, and legal custodians at the beginning of each school year; and
• Post the materials or a link to the materials on the local education provider's website.

Beginning in January 2026, and in January every year thereafter, the department shall include in its "SMART Act" hearing information concerning the materials.

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

The act allows, but does not require, an eligible patient to request from a manufacturer the manufacturer's individualized investigational drug, biological product, or device, which is a drug, biological product, or device that is unique and produced exclusively for use by an individual patient based on the patient's own genetic profile. The manufacturer must be operating within an institution that operates under federal rules for the protection of human subjects.

An eligible patient is an individual who has:

• A life-threatening or severely debilitating illness, as attested to by the patient's treating physician;
• Considered all other treatment options currently approved by the United States food and drug administration;
• Received a recommendation from the patient's treating physician;
• Given written, informed consent for the use of the individualized investigational drug, biological product, or device; and
• Documentation from the treating physician that the individual meets the definition of "eligible patient".

The act authorizes, but does not require, a manufacturer to make the individualized investigational drug, biological product, or device available to an eligible patient at no charge, but the manufacturer may require payment to cover the cost.

If any harm is caused to the eligible patient resulting from the use of the individualized investigational drug, biological product, or device, a private right of action cannot be brought against the manufacturer or against any other individual or entity involved in the care of the eligible patient with regard to the eligible patient's use of the individualized investigational drug, biological product, or device, so long as the manufacturer, individual, or entity complied with the law and exercised reasonable care.

The act prohibits disciplinary action against a health-care provider's license based on the health-care provider's recommendations regarding the use of the individualized investigational drug, biological product, or device.

The act does not affect a health-care insurer's obligation under current law relating to coverage for an insured's participation in a clinical trial.

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

The act authorizes the department of health care policy and financing (HCPF) to seek and accept gifts from private or public sources for the primary care fund.

The act authorizes a federally qualified health center (FQHC) to establish a separate subsidiary company for the purpose of providing fee-for-service services outside of the FQHC's standard cost report if the subsidiary is providing fee-for-service services that have historically been provided and reimbursed on a fee-for-service basis and if HCPF determines that the subsidiary's reimbursements would be budget neutral. Upon receiving any necessary federal authorization, HCPF is required to reimburse a subsidiary of an FQHC on a fee-for-service basis for services that are eligible for fee-for-service reimbursement. A subsidiary that receives reimbursement is authorized to pass through money received from the reimbursement directly to the FQHC operating as the subsidiary's parent corporation. Services reimbursed to an FQHC's subsidiary are excluded from the FQHC's cost report. The act requires HCPF to exclude all costs associated with a subsidiary company from the calculation of a FQHC's reimbursement rates and requires a FQHC that establishes a separate subsidiary company to include the costs associated with the subsidiary in its cost report that is necessary to calculate reimbursement rates.

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

Beginning in 2026, the bill authorizes an increase to the health insurance affordability fee assessed and collected from insurance carriers (carriers) by up to one percentage point to implement and administer the health insurance affordability enterprise (HIAE). The bill includes objectives for the commissioner of insurance (commissioner) to consider in determining whether to increase the HIAE fee, including, in part, maintaining HIAE programs to achieve a premium reduction in the reinsurance program and to provide subsidies for individuals with low income who purchase insurance on the Colorado health benefit exchange. The commissioner shall notify carriers of the amount of the HIAE fee for the upcoming calendar year.

The bill changes the allocation of the HIAE fee assessed for 2026, dedicating up to 40% each to state-subsidized individual health coverage plans purchased by qualified individuals and to the reinsurance program cash fund, with the remaining revenue allocated for other purposes specified in the bill, including new and emerging health insurance affordability initiatives.

The bill authorizes the enterprise to seek, accept, and expend gifts, grants, or donations for the purposes of the HIAE.

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

Health benefit insurance plans (health benefit plans) include coverage for gender-affirming health care as part of individual and group health benefit plans. "Gender-affirming health care" is defined in the act as supplies, care, and services of a medical, behavioral health, mental health, psychiatric, habilitative, surgical, therapeutic, diagnostic, preventive, rehabilitative, or supportive nature relating to the treatment of gender dysphoria (gender-affirming health care). The act codifies gender-affirming health care treatments in statute and prohibits a health benefit plan from denying or limiting medically necessary gender-affirming health care, as determined and prescribed by a physical or behavioral health-care provider.

The act authorizes the health insurance affordability board to seek, accept, and expend gifts, grants, or donations and to use those gifts, grants, or donations to cover abortion costs and to ensure access to legally protected health-care activity.

The act exempts prescriptions for testosterone from the tracking requirements of the prescription drug use monitoring program and blocks archived records concerning testosterone use from view.

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

The act defines a "specified semiautomatic firearm" as a semiautomatic rifle or semiautomatic shotgun with a detachable magazine or a gas-operated semiautomatic handgun with a detachable magazine. The act excludes certain types of firearms and specified models of firearms from the definition of "specified semiautomatic firearm".

The act prohibits knowingly manufacturing, distributing, transferring, selling, or purchasing a specified semiautomatic firearm on or after August 1, 2026; except that a person may transfer a specified semiautomatic firearm to an individual residing in another state or a federally licensed firearm dealer. The act exempts certain manufacture, transfers, sales, and purchases from the prohibition, including specified transactions involving law enforcement agencies and peace officers, the department of corrections, armored vehicle businesses, military forces, gunsmiths, educational programs, and historical societies and museums; transfers that occur by operation of law or because of the death of a person; and conduct involving firearms for use solely as a prop for a film. Additionally, the prohibition does not apply to the transfer or sale of a specified semiautomatic firearm to, and receipt or purchase of a specified semiautomatic firearm by, a person who:

• Completed a hunter education course certified by the division of parks and wildlife (division) and, within 5 years before making the purchase, completed a basic firearms safety course;
• Within 5 years before making the purchase, completed an extended firearms safety course; or
• Completed an extended firearms safety course more than 5 years before making the purchase and completed a basic firearms safety course within 5 years before making the purchase.

Unlawful manufacture, distribution, transfer, sale, or purchase of a specified semiautomatic firearm is a class 2 misdemeanor; except that a second or subsequent offense is a class 6 felony. The department of revenue shall revoke the state firearms dealer permit of a dealer who unlawfully manufactures, distributes, transfers, sells, or purchases a specified semiautomatic firearm. The Colorado bureau of investigation shall deny the transfer of a firearm to a person who was convicted of misdemeanor unlawful manufacture, distribution, transfer, sale, or purchase of a specified semiautomatic firearm within 5 years prior to the transfer. A person convicted of felony unlawful manufacture, distribution, transfer, sale, or purchase of a specified semiautomatic firearm is prohibited from possessing a firearm and certain other weapons.

The act sets minimum requirements for the instruction included in, and length of, a basic firearms safety course and an extended firearms safety course. The act requires the division to establish the course requirements for a basic or extended firearms safety course.

In order to enroll in a basic or extended firearms safety course, a person must hold a valid firearms safety course eligibility card (firearms course card) issued by a sheriff. The act sets the requirements to be issued a firearms course card, which includes completing a name-based background check, paying a processing fee set by the sheriff, and paying the firearms training and safety course record fee established by the division. A sheriff shall issue a firearms course card to an applicant; except that a sheriff shall deny an application if the applicant cannot lawfully possess a firearm under state or federal law or the sheriff cannot positively identify the applicant. A sheriff may deny an application for a firearms course card if the sheriff has a reasonable belief that documented previous behavior by the applicant makes it likely the applicant will present a danger to themself or others if the applicant holds a card. A sheriff shall revoke an issued firearms course card if the cardholder cannot lawfully possess a firearm under state or federal law and may revoke an issued card if the sheriff has a reasonable belief that documented previous behavior by the applicant makes it likely the applicant will present a danger to themself or others. The act sets forth the process for judicial review of the denial or revocation of a firearms course card.

The act requires the division to develop and maintain a firearms training and safety course record system (system) that includes records of persons who hold a valid firearms course card and who have completed a hunter education course, a basic firearms safety course, or an extended firearms safety course. The system must allow:

• A sheriff to electronically enter information about each person who was issued a firearms course eligibility card;
• The instructor of a basic or extended firearms safety course to request and receive information about whether a person holds a valid firearms course card;
• The instructor of a hunter education course or a basic or extended firearms safety course to electronically enter into the system information about each student who completes a course; and
• A federal firearms licensee to electronically request and receive information about whether a person has completed the courses necessary to purchase a specified semiautomatic firearm.

The act creates the firearms training and safety course cash fund, which consists of firearms training and safety course record fee remitted to the division by a sheriff and any other money that the general assembly may appropriate or transfer to the fund. Money in the fund is continuously appropriated to the division. The director of the division may report to the state treasurer an amount of money to transfer between the firearms training and safety course cash fund from the parks and outdoor recreation cash fund. Within 3 days after receiving a report, the state treasurer shall make the reported transfer. By June 30, 2030, the total amount of the transfers to the parks and outdoor recreation cash fund reported by the director of the division must be equal to the total amount transferred from the parks and outdoor recreation cash fund, plus fair market interest.

On or before December 31 of each year, the division shall submit a report to the house of representatives and senate judiciary committees, or their successor committees, about the expenses incurred by the division to implement the act, and any additional resources the division needs to effectively implement the act.

The act requires the division in the department of revenue responsible for issuing state firearms dealer permits to publish and make publicly available guidance about specific models of specified semiautomatic firearms to which the act applies.

The act makes the unlawful sale, transfer, or possession of a large-capacity magazine a class 1 misdemeanor.

Existing law prohibits possession of a dangerous weapon. The act defines "rapid-fire device" and classifies rapid-fire devices as dangerous weapons under Colorado law. The act repeals the definition of "machine gun conversion device" and removes machine gun conversion devices from the list of dangerous weapons.

For the 2025-26 state fiscal year, the bill appropriates $100,000 to the office of the governor for use by the office of information technology from funds received from the department of natural resources from the firearms training and safety course cash fund. The general assembly appropriated money to the department of revenue to implement House Bill 24-1353, concerning requirements to engage in the business of dealing in firearms. The act further appropriates unspent money from that appropriation to the department of revenue for expenditure until the close of the 2025-26 state fiscal year.

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

The bill clarifies that the existing naturopathic doctor formulary (existing formulary) includes prescription classes of medicines and clarifies what the practice of naturopathic medicine includes. In addition, the bill creates a new formulary for certain naturopathic doctors, which new formulary includes:

• All legend drugs, other than schedule I or II controlled substances or devices identified in the federal "Controlled Substances Act";
• For a naturopathic doctor with a federal drug enforcement administration registration, anabolic steroids listed on schedule III of the "Uniform Controlled Substances Act of 2013"; and
• All drugs listed on schedules IV and V of the "Uniform Controlled Substances Act of 2013", except for benzodiazepines, oncological chemotherapeutics, and narcotics (new formulary).

Before obtaining, dispensing, administering, injecting, ordering, or prescribing any of the medicines or devices included in the new formulary, a naturopathic doctor who is registered with the department of regulatory agencies (department) must provide proof of:

• Completion of 12 hours of pharmacological continuing education pertinent to or reflective of the naturopathic formulary;
• Passage of the elective pharmacology examination of the Naturopathic Physicians Licensing Examinations; or
• Licensure in good standing in another state that has equivalent prescribing authority.

A naturopathic doctor who does not provide such proof is limited to the medicines and devices contained within the existing formulary.

The bill prohibits a naturopathic doctor from prescribing:

• A medicine or device to an individual under 18 years of age; or
• Antipsychotics or ketamine to an individual of any age unless recommended by the naturopathic medicine advisory committee and approved by the director of the division of professions and occupations in the department (director).

The bill requires an individual applying for issuance, renewal, or reinstatement of a registration as a naturopathic doctor on or after September 1, 2025, to pass a pharmacology examination administered by the North American Board of Naturopathic Examiners or a nationally recognized, director-approved successor entity. Upon passage of the exam, the individual is able to obtain, dispense, administer, inject, order, or prescribe any of the medicines or devices included in the new formulary.

For the renewal of a naturopathic doctor's registration on or after June 1, 2026, the bill requires a naturopathic doctor to complete 8 hours per year of continuing education in pharmacology.

Lastly, the bill prohibits a naturopathic doctor from administering intravenous therapy without first being certified by a nationally recognized, director-approved entity.

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

Dependent upon sufficient gifts, grants, and donations received by the Colorado school of public health (school) and the department of health care policy and financing, the act requires the school 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 (analysis);and
• Submit a report detailing its findings to the health and human services committees of the house of representatives and the senate by December 31, 2026.

The act also creates the statewide health-care analysis collaborative (collaborative) for the purpose of advising the school during the analysis. The collaborative is repealed, effective December 1, 2027.

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

Beginning January 1, 2027, the act requires large group health benefit plans to provide coverage for the treatment of the chronic disease of obesity and the treatment of pre-diabetes, including coverage for a comparable program to the national diabetes prevention program, medical nutrition therapy, intensive behavioral or lifestyle therapy, and metabolic and bariatric surgery. For a large group health benefit plan offered in the state, the act requires carriers to offer the policyholder the option to purchase coverage for FDA-approved anti-obesity medications, including at least one FDA-approved GLP-1 medication.

The commissioner of insurance may adopt rules for the implementation of the act.

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

Under current law, there is an exemption from the general prohibition against covenants not to compete. The exemption allows for a covenant not to compete under specified conditions governing an individual who earns an amount of annualized cash compensation equivalent to or greater than the threshold amount for highly compensated workers. The act excludes from the highly compensated worker exemption a covenant not to compete that restricts the practice of medicine, the practice of advanced practice registered nursing, or the practice of dentistry in this state.

Under current law, there is also an exemption from the general prohibition against covenants not to solicit customers (nonsolicitation covenant) that allows for a nonsolicitation covenant governing an individual who earns an amount of annualized cash compensation equivalent to or greater than 60% of the threshold amount for highly compensated workers if the nonsolicitation covenant is no broader than reasonably necessary to protect the employer's legitimate interest in protecting trade secrets. The act also excludes from the highly compensated worker exemption for nonsolicitation covenants a covenant not to compete that restricts the practice of medicine, the practice of advanced practice registered nursing, or the practice of dentistry.

A covenant not to compete governing an individual who has a minority ownership share of a business and who received their ownership share in the business as equity compensation or otherwise in connection with services rendered is permissible if the covenant's duration in years does not exceed a number calculated by the total consideration received by the individual from the sale divided by the average annualized cash compensation received by the individual from the business, including income received on account of the individual's ownership interest during the preceding 2 years or during the period of time that the individual was affiliated with the business, whichever period of time is shorter.

The act prohibits a covenant that prevents or materially restricts a health-care provider from disclosing to a patient to whom the health-care provider was providing consultation or treatment before the health-care provider's departure from a medical or dental practice the following information:

• The health-care provider's continuing practice of medicine;
• The health-care provider's new professional contact information; or
• The patient's right to choose a health-care provider.
  (Note: This summary applies to this bill as enacted.)

Infusion pharmacies supply medicaid members with parenteral nutrition, which provides patients with essential nutrients through an intravenous infusion.

The act requires the state department of health care policy and financing (state department) to create specific professional dispensing fees for the preparation and dispensing of parenteral nutrition (fees) to encourage an adequate level of market participation among infusion pharmacies that serve medicaid members. During the year beginning January 1, 2026, the fees must not exceed 30% of infusion pharmacy administrative costs for the preparation and dispensing of parenteral nutrition. The state department shall seek federal authorization, as necessary, to implement the fees.

The act requires the state department to annually report on the adequacy of the infusion pharmacy network that supplies parenteral nutrition to medicaid members.

For the 2025-26 state fiscal year, the act appropriates $54,832 to the state department from the general fund. The state department may use the appropriation for medical and long-term care services for medicaid-eligible individuals. The general assembly anticipates that the state department will receive an equal amount in federal funds to implement the act.

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

The act requires hospitals, freestanding emergency departments, and licensed health-care facilities that hold themselves out to the public as providing emergency care (facility) to provide emergency medical services to a person who presents to the facility when the person requests or a request is made on the person's behalf for emergency medical services.

For each person who presents to a facility and requests emergency medical services or for each request made on the person's behalf for emergency medical services, the act requires the facility to input into a central log whether the person refused treatment or was denied treatment; whether no treatment was required; or whether the person was transferred, admitted and treated, stabilized and transferred, or discharged.

The act prohibits a facility from:

• Denying or discriminating in providing emergency medical services to a patient for a discriminatory or unlawful reason;
• Penalizing or taking adverse action against a health-care provider for refusing to transfer a patient with an emergency medical condition that has not been stabilized;
• Delaying providing emergency medical services to a person in order to inquire about the person's ability to pay for the services; and
• Transferring or discharging a patient with an emergency medical condition unless certain conditions are met.

A facility or health-care provider does not violate the act's requirements if certain conditions are met.

The act authorizes the department of public health and environment to investigate a facility that negligently violates the requirements of the act. A physician who negligently violates the act engages in unprofessional conduct and is subject to professional discipline. If a civil monetary penalty is imposed, the act requires the maximum civil monetary penalty to be reduced by any civil monetary penalty imposed pursuant to the federal "Emergency Medical Treatment and Active Labor Act" for the same violation.

The act appropriates $82,768 from the health facilities general licensure cash fund to the department of public health and environment for use by the health facilities and emergency medical services division.

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

The act creates the "Know Your Health-Care Practitioner Act" that applies to certain health-care practitioners (practitioner) practicing in a health-care profession or occupation specified in the "Michael Skolnik Medical Transparency Act of 2010". The act does not apply to practitioners who work in a non-patient-care setting or do not have any direct patient care interactions, or when clinically not feasible.

On and after June 1, 2026:

• In advertising health-care services using the practitioner's name, a practitioner must identify the type of state-issued license, certificate, or registration held by the practitioner and ensure that the advertisement is free from deceptive or misleading information;
• Except in certain circumstances, for practitioners providing services in a general hospital, urgent care center, ambulatory surgical center, or freestanding emergency department, the practitioner must affirmatively display an identification name tag or similar worn display that is visible during patient encounters.
• Except when emergent circumstances make it impracticable, while establishing a practitioner-patient relationship during the practitioner's first encounter with a patient, a practitioner must verbally communicate to the patient the practitioner's specific state-issued license, certificate, or registration or verbally identify themselves by a title or abbreviation authorized in statute to facilitate patient understanding.

A practitioner does not have to display their name when interacting with a patient if the practitioner is concerned for their safety or if the patient is exhibiting signs of irrationality or violence.

A practitioner may also use supplemental descriptors in advertising or identification, in the manner specified in the act.

The director of the division of occupations and professions in the department of regulatory agencies may impose a fine of up to $500 if a practitioner violates the act.

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

The bill establishes that certain evidence that a person has engaged in an unfair or deceptive trade practice constitutes a significant impact to the public. The bill also clarifies that a deceptive trade practice claim cannot be based solely on a claim that a person breached a contract or engaged in negligence or on a claim for damages based on the rendering of professional services, unless the claim for damages involves an allegation of a material misrepresentation of fact, a failure to disclose material information, or an action that cannot be characterized as providing advice, judgment, or opinion.
(Note: This summary applies to this bill as introduced.)

In 2019, the division of insurance within the department of regulatory agencies (department) established the primary care payment reform collaborative (collaborative) to, among other things, advise in the development of affordability standards and targets for insurance carrier investments in primary care, identify barriers to the adoption of alternative payment models by health-care providers and insurers, and develop recommendations to address barriers.

The act implements the recommendations of the department's sunset review and report by:

• Continuing the collaborative for 7 years, until September 1, 2032; and
• Scheduling the next sunset review of the collaborative to be conducted pursuant to the sunset review structure for advisory committees.

In addition, the act clarifies that the collaborative is required to ensure the development and consideration of alternative payment models that are responsive to the needs of primary care delivery in pediatrics and that the commissioner of insurance is required to invite pediatric primary care providers to participate in the collaborative.

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

Current law mandates insurance coverage of certain preventive health-care services (preventive services) in accordance with the recommendations of the United States preventive services task force, recommendations established by the advisory committee on immunization practices, or preventive care or screening as provided in the comprehensive guidelines supported by the health resources and services administration in the United States department of health and human services (authorities).

The act requires that, in the event that any of these authorities is repealed, modified, or otherwise no longer in effect, the commissioner of insurance may adopt rules that require compliance with the recommendations and comprehensive guidelines regarding the coverage of those preventive services as the recommendations and guidelines existed in January 2025 or that comply with the recommendations of the nurse-physician advisory task force for Colorado health care (NPATCH).

The act also tasks the NPATCH with making recommendations regarding updates or modifications to the current list of covered preventive health-care services.

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

The bill repeals and reenacts, with amendments, the current requirements for providing notice of transactions involving licensed hospitals and requires that the parties to a merger, acquisition, or contracting affiliation of one or more health-care entities, long-term care entities, or veterinary care entities (material change transaction) submit specified notice requirements to the attorney general at least 60 days before the effective date of the material change transaction. If the terms of the material change transaction are altered or modified following the submission of the written notice, the parties must provide notice to the attorney general of the alteration or modification.

The attorney general may review a required notice of a material change transaction and may assess whether the proposed material change transaction is contrary to the public interest using factors specified in the bill. The attorney general may convert their review of the material change transaction to an investigation under the "Colorado State Antitrust Act of 2023".

The bill prohibits a material change transaction unless:

• The attorney general states that a formal assessment and review of the material change transaction are not necessary;
• The attorney general issues an assessment that the material change transaction is not likely to be contrary to the public interest;
• A court finds that the material change transaction is not likely to be contrary to the public interest;
• 90 days have elapsed since the parties to the material change transaction submitted notice of the material change transaction, and the attorney general has not issued an assessment and has not notified the parties to the material change transaction that more time is required to complete an assessment; or
• The attorney general has notified the parties that more time is required to complete the assessment, and 45 days have elapsed since the attorney general provided the notice.

The attorney general may bring an action in district court to enjoin or unwind a material change transaction or seek other equitable relief necessary to protect the public interest.

Parties to a material change transaction may challenge the attorney general's assessment of a material change transaction in the district court for the city and county of Denver. The reviewing court shall affirm the attorney general's assessment unless a person seeking judicial review proves, by a preponderance of the evidence, specified criteria regarding the attorney general's assessment.

The bill grants the attorney general authority to seek additional information regarding a material change transaction, including requiring the parties to a material change transaction to:

• File a statement or report in writing answering, or to answer in writing, questions propounded by the attorney general as to the facts and circumstances reasonably related to an alleged or potential violation of the bill;
• Appear pursuant to a subpoena or produce relevant documents in aid of an investigation or inquiry; and
• Allow the attorney general to make true copies of documents that may be offered into evidence.

If a person fails to comply with an investigation or inquiry pursuant to a request or subpoena issued by the attorney general, the attorney general may apply to a district court for relief, including a civil penalty of up to $5,000, reasonable costs, and attorney fees or a protective order.

For at least 5 years after the effective date of a material change transaction, the parties to the material change transaction shall provide the attorney general an annual report meeting specified requirements. The report must be made available to the public on the attorney general's and the parties' websites.

A person that fails to comply with any provision of the bill is subject to a civil penalty of not more than $200 for each day the person remains in violation. Failure of a party to a material change transaction to provide notice of the material change transaction is an independent and sufficient ground for a court to enjoin or unwind the material change transaction.

The bill requires that, if certain health-care providers refer a patient to an entity for health-care services and the provider, or an immediate family member of the provider, has a financial relationship with the entity, the provider shall disclose the nature of the financial relationship to the patient at the time of the referral.

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