Amendments for SB23-176
Senate Journal, March 24
After consideration on the merits, the Committee recommends that SB23-176 be amended
as follows, and as so amended, be referred to the Committee on Appropriations with
favorable recommendation.
Amend printed bill, page 2, strike lines 2 through 20.
Page 3, strike lines 1 through 26 and substitute:
"SECTION 1. In Colorado Revised Statutes, add 10-16-158 as
follows:
10-16-158. Prohibition on using the body mass index or ideal body
weight - medical necessity criteria - rules. (1) (a) EVERY HEALTH BENEFIT
PLAN SUBJECT TO PART 2, 3, OR 4 OF THIS ARTICLE 16, EXCEPT THOSE DESCRIBED
IN SECTION 10-16-102 (32)(b), SHALL NOT UTILIZE THE BODY MASS INDEX,
IDEAL BODY WEIGHT, OR ANY OTHER STANDARD REQUIRING AN ACHIEVED
WEIGHT WHEN DETERMINING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL
OF CARE FOR AN INDIVIDUAL DIAGNOSED WITH AN EATING DISORDER,
INCLUDING BUT NOT LIMITED TO BULIMIA NERVOSA, ATYPICAL ANOREXIA
NERVOSA, BINGE-EATING DISORDER, AVOIDANT RESTRICTIVE FOOD INTAKE
DISORDER, AND OTHER SPECIFIED FEEDING AND EATING DISORDERS AS DEFINED
IN THE MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL
OF MENTAL DISORDERS.
(b) SUBSECTION (1)(a) OF THIS SECTION DOES NOT APPLY WHEN
DETERMINING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN
INDIVIDUAL DIAGNOSED WITH ANOREXIA NERVOSA, RESTRICTING SUBTYPE;
HOWEVER, BODY MASS INDEX, IDEAL BODY WEIGHT, OR ANY OTHER STANDARD
REQUIRING AN ACHIEVED BODY WEIGHT MUST NOT BE THE DETERMINING
FACTOR WHEN ASSESSING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF
CARE FOR AN INDIVIDUAL DIAGNOSED WITH ANOREXIA NERVOSA, RESTRICTING
SUBTYPE.
(2) THE FOLLOWING FACTORS, AT A MINIMUM, MUST BE CONSIDERED
WHEN DETERMINING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE
FOR AN INDIVIDUAL DIAGNOSED WITH AN EATING DISORDER:
(a) THE INDIVIDUAL'S EATING BEHAVIORS;
(b) THE INDIVIDUAL'S NEED FOR SUPERVISED MEALS AND SUPPORT
INTERVENTIONS;
(c) LABORATORY RESULTS, INCLUDING BUT NOT LIMITED TO, THE
INDIVIDUAL'S HEART RATE, RENAL OR CARDIOVASCULAR ACTIVITY, AND BLOOD
PRESSURE;
(d) THE RECOVERY ENVIRONMENT; AND
(e) CO-OCCURRING DISORDERS THE INDIVIDUAL MAY HAVE.
SECTION 2. In Colorado Revised Statutes, add 25.5-5-334 as follows:
25.5-5-334. Prohibition on using the body mass index or ideal body
weight - medical necessity criteria. (1) (a) BEGINNING JULY 1, 2023, THE
STATE MEDICAL ASSISTANCE PROGRAM SHALL NOT UTILIZE THE BODY MASS
INDEX, IDEAL BODY WEIGHT, OR ANY OTHER STANDARD REQUIRING AN
ACHIEVED WEIGHT WHEN DETERMINING MEDICAL NECESSITY OR THE
APPROPRIATE LEVEL OF CARE FOR AN INDIVIDUAL DIAGNOSED WITH AN EATING
DISORDER, INCLUDING BUT NOT LIMITED TO, BULIMIA NERVOSA, ATYPICAL
ANOREXIA NERVOSA, BINGE-EATING DISORDER, AVOIDANT RESTRICTIVE FOOD
INTAKE DISORDER, AND OTHER SPECIFIED FEEDING AND EATING DISORDERS AS
DEFINED IN THE MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL
MANUAL OF MENTAL DISORDERS.
(b) SUBSECTION (1)(a) OF THIS SECTION DOES NOT APPLY WHEN
DETERMINING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN
INDIVIDUAL DIAGNOSED WITH ANOREXIA NERVOSA, RESTRICTING SUBTYPE;
HOWEVER, BODY MASS INDEX, IDEAL BODY WEIGHT, OR ANY OTHER STANDARD
REQUIRING AN ACHIEVED BODY WEIGHT MUST NOT BE THE DETERMINING
FACTOR WHEN ASSESSING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF
CARE FOR AN INDIVIDUAL DIAGNOSED WITH ANOREXIA NERVOSA, RESTRICTING
SUBTYPE.
(2) THE FOLLOWING FACTORS, AT A MINIMUM, MUST BE CONSIDERED
WHEN DETERMINING MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE
FOR AN INDIVIDUAL DIAGNOSED WITH AN EATING DISORDER:
(a) THE INDIVIDUAL'S EATING BEHAVIORS;
(b) THE INDIVIDUAL'S NEED FOR SUPERVISED MEALS AND SUPPORT
INTERVENTIONS;
(c) LABORATORY RESULTS, INCLUDING BUT NOT LIMITED TO, THE
INDIVIDUAL'S HEART RATE, RENAL OR CARDIOVASCULAR ACTIVITY, AND BLOOD
PRESSURE;
(d) THE RECOVERY ENVIRONMENT; AND
(e) CO-OCCURRING DISORDERS THE INDIVIDUAL MAY HAVE.".
Page 4, strike line 3 and substitute "Regulation of Over-the-Counter Diet
Pills".
Page 4, strike lines 6 through 16.
Renumber succeeding subsections accordingly.
Page 5, lines 1 and 2, strike "DIETARY SUPPLEMENTS FOR WEIGHT LOSS OR".
Page 5, line 7, strike "Dietary supplements for weight loss" and substitute
"Over-the-counter diet pills".
Page 5, line 8, strike "fine -".
Page 5, strike line 10 and substitute "FURNISH".
Page 5, lines 14 and 15, strike "DIETARY SUPPLEMENTS FOR WEIGHT LOSS OR".
Page 5, lines 21 and 22, strike "DIETARY SUPPLEMENTS FOR WEIGHT LOSS AND".
Page 5, strike lines 26 and 27.
Page 6, strike line 1.
Page 6, line 7, strike "FORCED FEEDING TUBES" and substitute "INVOLUNTARY
TUBE FEEDING".
Page 6, line 8, after "DISORDER." insert "PRIOR TO PROMULGATING RULES, THE
BHA SHALL REVIEW CURRENT REGULATIONS AND DETERMINE HOW ADDITIONAL
REGULATIONS FIT INTO THE EXISTING INFRASTRUCTURE.".
Page 7, strike lines 9 through 16 and substitute:
"(I) THE ABILITY FOR THE CLIENT TO REQUEST PRIVATE MEDICAL
EXAMINATIONS, INCLUDING WEIGH-INS AND MONITORING OF VITAL SIGNS, AND
NOT BE VISIBLE TO OTHER CLIENTS;
(II) PROHIBITING THAT A CLIENT PERFORM PHYSICAL EXERCISE OR
REMOVE ALL CLOTHING DURING A WEIGH-IN UNLESS THE CLIENT IS PROVIDED
ADEQUATE CLOTHING THAT SUFFICIENTLY COVERS THE CLIENT'S PRIVATE BODY
PARTS;
(III) POTENTIAL ALTERNATIVE INTERVENTIONS, WHEN MEDICALLY
NECESSARY, WHICH MUST BE OPENLY DISCUSSED WITH THE CLIENT, TO MINIMIZE
THE RISK OF A CLIENT INFLUENCING ASSESSMENTS OF VITAL SIGNS OR LABS;
AND".
Page 7, line 26, strike "APPROPRIATE AND QUALIFIED STAFF TO" and substitute
"TRAINED STAFF".
Page 7, strike line 27.
Page 8, strike line 1.
Page 8, line 2, strike "NEURODIVERSE;".
Page 8, line 6, after "PRIORITIZED." add "IF A CLIENT REQUESTS A STAFF
MEMBER OF A SPECIFIC GENDER TO MONITOR THE CLIENT'S BATHROOM TIME,
PHYSICAL EXAMS, WEIGH-INS, PLACEMENT OF FEEDING TUBES, OR ANY OTHER
INVOLUNTARY FEEDING PROCESS, THE FACILITY SHALL MAKE EVERY POSSIBLE
ACCOMMODATION TO MEET THE CLIENT'S REQUEST.".
Page 8, strike lines 10 through 12 and substitute "MOVEMENT IS NEVER USED AS
A FORM OF PUNISHMENT.".
Page 8, strike line 16 and substitute "MEASURES. THE FACILITY SHALL ENSURE
CLIENTS RECEIVING BED-BASED CARE RECEIVE COMPARABLE ACCESS TO
PROGRAMMING AND THERAPY SERVICES AS OTHER CLIENTS IN THE FACILITY.".
Page 8, strike lines 17 through 22 and substitute:
"(f) PHYSICAL ACTIVITY LIMITATIONS THAT ARE DISCUSSED OPENLY
WITH THE CLIENT AND ARE BASED ON MEDICAL STABILITY, THE CLIENT'S ABILITY
TO MANAGE ACTIVITY URGES, AND THE NUTRITION NECESSARY TO SAFELY
SUPPORT PHYSICAL ACTIVITY;
(g) A REQUIREMENT THAT AN EATING DISORDER TREATMENT AND
RECOVERY FACILITY IMPLEMENT A TREATMENT FRAMEWORK IN ACCORDANCE
WITH RECOGNIZED PRINCIPLES OF TRAUMA-INFORMED APPROACHES AND
TRAUMA-INFORMED INTERVENTIONS;".
Reletter succeeding paragraphs accordingly.
Page 9, line 1, strike "AND".
Page 9, strike lines 2 through 9 and substitute:
"(i) THE REQUIREMENT FOR THE TREATMENT FACILITY TO HAVE A
FORMAL DISCHARGE POLICY THAT IS PROVIDED TO CLIENTS AT THE TIME OF
ADMISSION AND REVIEWED REGULARLY DURING TREATMENT PLANNING
SESSIONS, AND THAT UPON DISCHARGE, FOLLOW-UP SERVICES WILL BE OFFERED
AS CLINICALLY INDICATED; AND
(j) A REQUIREMENT THAT CLIENTS RECEIVE ADEQUATE TIME FOR
BATHING AND OTHER HYGIENE CARE DAILY.".
Senate Journal, April 24
Amend printed bill, page 3, strike line 27.
Page 4 of the bill, strike lines 1 through 5 and substitute:
"SECTION 3. In Colorado Revised Statutes, add part 7 to article 280
of title 12 as follows:
REGULATION OF DIETARY SUPPLEMENTS
FOR WEIGHT LOSS
12-280-701. Definitions. AS USED IN THIS PART 7, UNLESS THE
CONTEXT OTHERWISE REQUIRES:".
Page 5 of the bill, line 7, strike "44-8-102." and substitute "12-280-702.".
Page 5 of the bill, line 18, strike "DEPARTMENT," and substitute "BOARD,".
Page 5 of the bill, line 23, strike "ARTICLE 8," and substitute "PART 7,".
Amend the Health and Human Services Committee Report, dated March 23,
2023, page 3, strike lines 14 through 27 and substitute "Page 5 of the bill, strike
lines 18 through 27.".
Strike pages 4 and 5 of the report and substitute:
"Strike pages 6 through 8 of the bill.
Page 9 of the bill, strike lines 1 through 9.
Renumber succeeding section accordingly.".
Senate Journal, April 25
SB23-176 by Senator(s) Moreno and Cutter; also Representative(s) deGruy Kennedy--Concerning
measures to improve outcomes for individuals with an eating disorder.
A majority of those elected to the Senate having voted in the affirmative, Senator Moreno
was given permission to offer a third reading amendment.
Third Reading Amendment No. 1(L.010), by Senator Moreno.
Amend engrossed bill, page 3, after line 16 insert:
"(3) THE COMMISSIONER MAY PROMULGATE RULES AS NECESSARY TO
IMPLEMENT AND ENFORCE THIS SECTION.".
The amendment was passed on the following roll call vote:
House Journal, May 6
27 Amendment No. 1, by Representative Bradley:
28
29 Amend reengrossed bill, page 2, line 20, strike "SUBTYPE;" and substitute
30 "SUBTYPE, OR BINGE-EATING/PURGING SUBTYPE;".
31
32 Page 3, line 4, strike "SUBTYPE." and substitute "SUBTYPE, OR
33 BINGE-EATING/PURGING SUBTYPE.".
34
35 Amendment No. 2, by Speaker Pro Tempore degruy Kennedy:
36
37 Amend reengrossed bill, page 4, strike line 27.
38
39 Page 5, strike lines 1 through 6 and substitute:
40
41 "SECTION 3. In Colorado Revised Statutes, add article 26 to
42 title 6 as follows:
43
26 44 ARTICLE
45 Regulation Of Dietary Supplements For Weight Loss
46
47 6-26-101. Definitions. AS USED IN THIS ARTICLE 26, UNLESS THE
48 CONTEXT OTHERWISE REQUIRES:".
49
50 Page 5, line 24, strike "12-280-702." and substitute "6-26-102.".
51
52 Page 5, line 25, after "age -" insert "deceptive trade practice -".
53
54 Page 6, after line 6 insert:
55
56
1 "(2) A VIOLATION OF THIS ARTICLE 26 IS A DECEPTIVE TRADE
2 PRACTICE PURSUANT TO SECTION 6-1-105 (1)(uuu).
3 SECTION 4. In Colorado Revised Statutes, 6-1-105, add
4 (1)(uuu) as follows:
5 6-1-105. Unfair or deceptive trade practices. (1) A person
6 engages in a deceptive trade practice when, in the course of the person's
7 business, vocation, or occupation, the person:
8 (uuu) SELLS OR OFFERS FOR SALE A PRODUCT THAT IS
9 AGE-RESTRICTED TO A PERSON WHO DOES NOT MEET THE AGE
10 RESTRICTION.".
11
12 Renumber succeeding sections accordingly.
13
14 Amendment No. 3, by Representative Holtorf:
15
16 Amend reengrossed bill, page 5, line 25, strike "eighteen" and substitute
17 "twenty-one".
18
19 Page 6, line 1, strike "EIGHTEEN" and substitute "TWENTY-ONE".
20
21 Page 6, line 6, strike "EIGHTEEN" and substitute "TWENTY-ONE".
22
23 As amended, ordered revised and placed on the Calendar for Third
24 Reading and Final Passage.
25