Amendments for HB20-1085

House Journal, February 20
21 HB20-1085 be amended as follows, and as so amended, be referred to
22 the Committee on Appropriations with favorable
23 recommendation:
24
25 Amend printed bill, page 3, strike lines 9 through 11.
26
27 Page 4, strike lines 1 through 15 and substitute "ALTERNATIVE TO
28 OPIOIDS.".
29
30 Page 4, line 16, strike "(c)" and substitute "(b)".
31
32 Page 4, strike lines 17 through 20 and substitute:
33
34 "(I) INCLUDE, AT THE CARRIERS' LOWEST COST-SHARING TIER, A
35 MINIMUM OF SIX PHYSICAL THERAPY VISITS, SIX OCCUPATIONAL THERAPY
36 VISITS, SIX CHIROPRACTIC VISITS, AND SIX ACUPUNCTURE VISITS; AND".
37
38 Page 4, after line 23 insert:
39
40 "(c) AT THE TIME OF A COVERED PERSON'S INITIAL VISIT FOR
41 TREATMENT, A PHYSICAL THERAPIST, OCCUPATIONAL THERAPIST,
42 ACUPUNCTURIST, OR CHIROPRACTOR SHALL NOTIFY THE COVERED
43 PERSON'S CARRIER THAT THE COVERED PERSON HAS STARTED TREATMENT
44 WITH THE PROVIDER.".
45
46 Page 6, strike lines 5 through 8 and substitute:
47
48 "(c) FOR THE PURPOSES OF THIS SECTION, "NONOPIOID OR AN
49 ATYPICAL OPIOID" MEANS ANALGESICS WITH FAR LOWER FATALITY RATES
50 THAN PURE OPIOID AGONISTS AS SPECIFIED BY RULE OF THE
51 COMMISSIONER.".
52
53 Page 7, line 9, strike "repeal (5)" and substitute "amend (1)(a)
54 introductory portion, (1)(a)(I), (1)(a)(IV), (1)(b), and (4) introductory
55 portion; amend as it exists until July 1, 2021, (2); repeal (5); and add
1 (6)".
2
3 Page 7, strike lines 11 through 27.
4
5 Page 8, strike lines 1 through 14 and substitute:
6
7 "12-30-109. Prescriptions - limitations - definition - rules.
8 (1) (a) An opioid A prescriber shall not prescribe more than a seven-day
9 supply of an opioid to a patient who has not had an opioid prescription in
10 the last twelve months by that opioid prescriber and may exercise
11 discretion to include a second fill for a seven-day supply. The limits on
12 initial prescribing do not apply if, in the judgment of the opioid
13 prescriber, the patient:
14 (I) Has chronic pain that typically lasts longer than ninety days or
15 past the time of normal healing, as determined by the opioid prescriber,
16 or following transfer of care from another opioid prescriber who practices
17 the same profession and who prescribed an opioid to the patient;
18 (IV) Is undergoing palliative care or hospice care focused on
19 providing the patient with relief from symptoms, pain, and stress resulting
20 from a serious illness in order to improve quality of life; except that this
21 subsection (1)(a)(IV) applies only if the opioid prescriber is a physician,
22 a physician assistant, or an advanced practice nurse.
23 (b) Prior to prescribing the second fill of any opioid OR
24 BENZODIAZEPINE prescription pursuant to this section, an opioid A
25 prescriber must comply with the requirements of section 12-280-404 (4).
26 Failure to comply with section 12-280-404 (4) constitutes unprofessional
27 conduct or grounds for discipline, as applicable, under section
28 12-220-130, 12-240-121, 12-255-120, 12-275-120, 12-290-108, or
29 12-315-112, as applicable to the particular opioid prescriber, only if the
30 opioid prescriber repeatedly fails to comply.
31 (2) An opioid A prescriber licensed pursuant to article 220, 240,
32 255, 275, 290, or 315 of this title 12 may prescribe opioids AND
33 BENZODIAZEPINES electronically.
34 (4) As used in this section, "opioid prescriber" "PRESCRIBER"
35 means:
36 (5) This section is repealed, effective September 1, 2021.
37 (6) THE EXECUTIVE DIRECTOR SHALL, BY RULE, LIMIT THE SUPPLY
38 OF A BENZODIAZEPINE THAT A PRESCRIBER MAY PRESCRIBE TO A PATIENT
39 WHO HAS NOT HAD A BENZODIAZEPINE PRESCRIPTION IN THE LAST TWELVE
40 MONTHS BY THAT PRESCRIBER.
41 SECTION 5. In Colorado Revised Statutes, 12-30-109, amend
42 as it exists from July 1, 2021, until July 1, 2023, (2) as follows:
43 12-30-109. Prescriptions - limitations - definition - rules.
44 (2) An opioid A prescriber licensed pursuant to article 220 or 315 of this
45 title 12 may prescribe opioids AND BENZODIAZEPINES electronically.
46 SECTION 6. In Colorado Revised Statutes, 12-30-109, amend
47 as it will become effective July 1, 2023, (2) as follows:
48 12-30-109. Prescriptions - limitations - definition - rules.
12 49 (2) An opioid A prescriber licensed pursuant to article 315 of this title
50 may prescribe opioids AND BENZODIAZEPINES electronically.
51 SECTION 7. In Colorado Revised Statutes, 12-220-111, amend
52 (2) as follows:
53 12-220-111. Dentists may prescribe drugs - surgical operations
54 - anesthesia - limits on prescriptions. (2) (a) A dentist is subject to the
55 limitations on prescribing opioids PRESCRIPTIONS specified in section
1 12-30-109.
2 (b) This subsection (2) is repealed, effective September 1, 2021.
123 3 SECTION 8. In Colorado Revised Statutes, amend 12-240-
4 as follows:
5 12-240-123. Prescriptions - limitations. (1) A physician or
6 physician assistant is subject to the limitations on prescribing opioids
7 PRESCRIPTIONS specified in section 12-30-109.
8 (2) This section is repealed, effective September 1, 2021.
9 SECTION 9. In Colorado Revised Statutes, 12-255-112, amend
10 (6) as follows:
11 12-255-112. Prescriptive authority - advanced practice nurses
12 - limits on prescriptions - rules - financial benefit for prescribing
13 prohibited. (6) (a) An advanced practice nurse with prescriptive
14 authority pursuant to this section is subject to the limitations on
15 prescribing opioids PRESCRIPTIONS specified in section 12-30-109.
16 (b) This subsection (6) is repealed, effective September 1, 2021.".
17 SECTION 10. In Colorado Revised Statutes, 12-275-113, amend
18 (5) as follows:
19 12-275-113. Use of prescription and nonprescription drugs -
20 limits on prescriptions. (5) (a) An optometrist is subject to the
21 limitations on prescribing opioids PRESCRIPTIONS specified in section
22 12-30-109.
23 (b) This subsection (5) is repealed, effective September 1, 2021.
24 SECTION 11. In Colorado Revised Statutes, 12-290-111, amend
25 (3) as follows:
26 12-290-111. Prescriptions - requirement to advise patients -
27 limits on prescriptions. (3) (a) A podiatrist is subject to the limitations
28 on prescribing opioids PRESCRIPTIONS specified in section 12-30-109.
29 (b) This subsection (3) is repealed, effective September 1, 2021.
126 30 SECTION 12. In Colorado Revised Statutes, amend 12-315-
31 as follows:
32 12-315-126. Prescriptions - limitations. (1) A veterinarian is
33 subject to the limitations on prescribing opioids PRESCRIPTIONS specified
34 in section 12-30-109.
35 (2) This section is repealed, effective September 1, 2021.".
36 SECTION 13. In Colorado Revised Statutes, 12-240-130, repeal
37 (3) as follows:
38 12-240-130. Procedure - registration - fees. (3) Applicants for
39 relicensure shall not be required to attend and complete continuing
40 medical education programs, except as directed by the board to correct
125 41 deficiencies of training or education as directed under section 12-240-
42 (5)(c)(III)(B).".
43
44 Renumber succeeding sections accordingly.
45
46 Page 8, strike lines 18 and 19 and substitute "prescribing opioids - rules.
47 THE BOARD, IN CONSULTATION WITH THE CENTER FOR RESEARCH INTO".
48
49 Page 8, line 26, strike "INITIAL" and strike "AND".
50
51 Page 9, line 7, strike "DIRECTOR" and substitute "BOARD".
52
53 Page 9, line 10, strike "DIRECTOR;" and substitute "BOARD;".
54
55 Page 9, line 24, strike "DIRECTOR" and substitute "BOARD".
1 Page 11, line 26, after "A" insert "SECOND FILL FOR A".
2
3 Page 12, line 2, strike "OR PSYCHOLOGICAL".
4
5 Page 12, strike line 7 and substitute "prescribing the second fill for an
6 opioid OR A BENZODIAZEPINE and the".
7
8 Page 12, line 10, strike "DIRECTOR" and substitute "BOARD".
9
10 Page 15, line 4, strike "2019-20" and substitute "2020-21".
11
12 Page 15, strike lines 11 through 14 and substitute "EXPANDED TRAINING
13 AND TECHNICAL ASSISTANCE IN ORDER TO MONITOR FIDELITY TO THE
14 SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT MODEL
15 THROUGH QUALITATIVE AND".
16
17

House Journal, June 8
29 HB20-1085 be amended as follows, and as so amended, be referred to
30 the Committee of the Whole with favorable
31 recommendation:
32
33 Amend the Health and Insurance Committee Report, dated February 19,
34 2020, page 1, line 6, strike "THE CARRIER'S LOWEST COST-SHARING TIER,"
35 and substitute "A COST-SHARING AMOUNT NOT TO EXCEED THE
36 COST-SHARING AMOUNT FOR A PRIMARY CARE VISIT FOR NONPREVENTIVE
37 SERVICES,".
38
39 Page 1 of the report, after line 14 insert:
40
41 "Page 5 of the printed bill, line 25, strike "THE" and substitute "MORE
42 THAN ONE".".
43
44 Page 2 of the report, strike lines 1 through 3 and substitute "ATYPICAL
45 OPIOID" MEANS A NONOPIOID ANALGESIC WITH FAR LOWER FATALITY
46 RATES THAN PURE OPIOID AGONISTS.".".
47
48 Page 4 of the report, after line 29 insert:
49
50 "Page 10 of the bill, line 14, strike "(3)(m), (4)(a.5)," and substitute
51 "(4)(a.5)".
52
53 Page 11 of the bill, strike lines 16 through 24.".
54
55 Page 5 of the report, strike lines 3 through 7 and substitute:
56
1 "Page 12 of the bill, strike line 27 and substitute:
2
3 "(b) THE BOARD MAY, WITHIN EXISTING FUNDS AVAILABLE FOR
4 OPERATION OF THE PROGRAM, PROVIDE A MEANS OF".
5
6 Page 13 of the bill, strike lines 26 and 27.
7
8 Strike page 14 of the bill.
9
10 Page 15 of the bill, strike lines 1 through 15.
11
12 Renumber succeeding sections accordingly.
13
14 Page 15 of the bill, line 20, strike "(I)".
15
16 Page 16 of the bill, strike lines 4 through 8.
17
18 Page 16 of the bill, strike lines 9 through 27.
19
20 Strike pages 17 and 18 of the bill and substitute:
21
22 "SECTION 20. Appropriation. (1) For the 2020-21 state fiscal
23 year, $18,540 is appropriated to the department of regulatory agencies.
24 This appropriation is from the division of professions and occupations
25 cash fund created in section 12-20-105 (3), C.R.S. To implement this act,
26 the department may use this appropriation as follows:
26 (a) $2,550 for 27 the colorado medical board; and
28 (b) $15,990 for the purchase of legal services.
29 (2) For the 2020-21 state fiscal year, $15,990 is appropriated to
30 the department of law. This appropriation is from reappropriated funds
31 received from the department of regulatory agencies under subsection
32 (1)(b) of this section. To implement this act, the department of law may
33 use this appropriation to provide legal services for the department of
34 regulatory agencies.
35 SECTION 21. Act subject to petition - effective date. This act
36 takes effect at 12:01 a.m. on the day following the expiration of the
37 ninety-day period after final adjournment of the general assembly; except
38 that, if a referendum petition is filed pursuant to section 1 (3) of article
39 V of the state constitution against this act or an item, section, or part of
40 this act within such period, then the act, item, section, or part will not
41 take effect unless approved by the people at the general election to be
42 held in November 2022 and, in such case, will take effect on the date of
43 the official declaration of the vote thereon by the governor.".
44
45 Page 1 of the printed bill, line 101, strike "DISORDERS." and substitute
46 "DISORDERS, AND, IN CONNECTION THEREWITH, MAKING AN
47 APPROPRIATION.".
48
49

House Journal, June 8
49 Amendment No. 1, Appropriations Report, dated June 8, 2020, and
50 placed in member’s bill file; Report also printed in House Journal, June
51 8, 2020.
52
53 Amendment No. 2, Health & Insurance Report, dated February 19, 2020,
54 and placed in member’s bill file; Report also printed in House Journal,
55 February 20, 2020.
56
1 Amendment No. 3, by Representative Kennedy.
2
3 Amend the Appropriations Committee Report, dated June 8, 2020, page
4 2, line 25, strike "date. This" and substitute "date - applicability.
5 (1) This".
6
7 Page 3, line 2, strike "governor."." and substitute "governor.
8 (2) Sections 1 and 2 of this act apply to health benefit plans issued
9 or renewed on or after January 1, 2022.".".
10
11 Amendment No. 4, by Representative Kennedy.
12
13 Amend the Appropriations Committee Report, dated June 8, 2020, page
14 1, strike lines 7 and 8 and substitute:
15
16 ""Page 5 of the printed bill, strike lines 18 through 27.
17
18 Page 6 of the bill, strike lines 1 through 4 and substitute:
19
20 "(2) NOTWITHSTANDING SECTION 10-16-145, A CARRIER THAT
21 PROVIDES PRESCRIPTION DRUG BENEFITS SHALL:
22 (a) PROVIDE COVERAGE FOR AT LEAST ONE ATYPICAL OPIOID THAT
23 HAS BEEN APPROVED BY THE UNITED STATES FOOD AND DRUG
24 ADMINISTRATION FOR THE TREATMENT OF ACUTE OR CHRONIC PAIN AT THE
25 LOWEST TIER OF THE CARRIER'S DRUG FORMULARY AND NOT REQUIRE STEP
26 THERAPY OR PRIOR AUTHORIZATION FOR THAT ATYPICAL OPIOID; AND
27 (b) NOT REQUIRE STEP THERAPY FOR THE PRESCRIPTION AND USE
28 OF ANY ADDITIONAL ATYPICAL OPIOID MEDICATIONS THAT HAVE BEEN
29 APPROVED BY THE UNITED STATES FOOD AND DRUG ADMINISTRATION FOR
30 THE TREATMENT OF ACUTE OR CHRONIC PAIN.".".
31
32 Amendment No. 5, by Representative Herod.
33
34 Amend printed bill, page 3, after line 1 insert:
35
36 "SECTION 1. Legislative declaration. (1) The general
37 assembly hereby finds and declares that:
38 (a) The opioid epidemic continues to be a tragic and preventable
39 cause of death and harm in Colorado and nationwide;
40 (b) Vulnerable populations prone to opioid and substance use
19 41 disorders are in particular need of help during and after the COVID-
42 pandemic;
43 (c) Atypical opioids, such as buprenorphine, tramadol, and
44 tapentadol, exist on the market as safer alternatives to conventional
45 opioids;
46 (d) According to Medicine Today, a peer reviewed journal of
47 clinical practice, buprenorphine, tramadol, and tapentadol exhibit superior
48 efficacy in treating chronic pain when compared to conventional opioids
49 by demonstrating in users:
50 (I) Improved function and quality of life;
51 (II) Less serious adverse effects on immune function and the
52 endocrine system;
53 (III) Lower rates of some other adverse effects, such as
54 gastrointestinal effects;
55 (IV) A reduced risk of opioid-induced ventilatory impairment, and
56 thereby death, in high doses; and
1 (V) Lower abuse potential than conventional opioids and,
2 therefore, a lower risk of misuse, abuse, and diversion into black markets;
3 (e) Insurance coverage for alternatives to opioids, including safer
4 drugs and physical therapy, often includes barriers to safer treatment, like
5 prior authorization and step therapy;
6 (f) Chances of overdose increase when opioids are taken with
7 benzodiazepines, sedatives commonly prescribed for anxiety and as sleep
8 aids;
9 (g) More than 30% of overdoses involving opioids also involved
10 benzodiazepines, according to the National Institute on Drug Abuse;
11 (h) Since 2016, the federal Centers for Disease Control and
12 Prevention has recommended that clinicians avoid prescribing
13 benzodiazepines concurrently with opioids whenever possible;
14 (i) Both prescription opioids and benzodiazepines carry warnings
15 on their labels highlighting the dangers of using these drugs together; and
16 (j) Medical education standards are in need of continuous
17 development.
18 (2) Therefore, in order to enhance collaboration with health care
19 providers, promote alternatives to opioids, and prevent more tragic deaths
20 as a result of opioids, it is the intent of the general assembly to:
21 (a) Mandate that health benefit plans provide coverage for a
22 minimum amount of physical therapy, occupational therapy, and
23 acupuncture treatments;
24 (b) Expand health plan coverage to include atypical opioids, such
25 as buprenorphine, tramadol, and tapentadol, at a low cost;
26 (c) Extend the seven-day limit on opioid prescriptions indefinitely;
27 (d) Establish competency-based continuing medical education
28 requirements that concern opioid prescription practices for physicians,
29 physician assistants, and other health care professionals;
30 (e) Incorporate the risk of benzodiazepines usage into provider
31 education programs;
32 (f) Mandate the designation of additional controlled substances
33 and other prescription drugs to be tracked by the prescription drug
34 monitoring program;
35 (g) Extend the requirement that providers must check the
36 prescription drug monitoring program before prescribing a second fill for
37 an opioid and before prescribing benzodiazepines, with certain
38 exceptions; and
39 (h) Allow medical examiners and coroners to query the
40 prescription drug monitoring program during death investigations.".
41
42 Renumber succeeding sections accordingly.
43
44 As amended, ordered engrossed and placed on the Calendar for Third
45 Reading and Final Passage.
46

House Journal, June 9
15 Amend engrossed bill, page 7, line 27, strike "SECTION, "NONOPIOID OR
16 AN" and substitute "SUBSECTION (2),".
17
18 Page 8, line 1, strike "ATYPICAL" and substitute ""ATYPICAL".
19
20 Page 19, line 8, strike "1 and 2" and substitute "2 and 3".
21
22 The amendment was declared passed by the following roll call vote:
23
24 YES 58 NO 3 EXCUSED 4 ABSENT
25 Arndt Y Exum E Larson Y Singer Y
26 Baisley Y Froelich Y Liston Y Sirota Y
27 Benavidez Y Garnett Y Lontine Y Snyder Y
28 Bird Y Geitner Y McCluskie Y Soper N
29 Bockenfeld Y Gonzales-Gutierrez Y McKean Y Sullivan Y
30 Buck Y Gray Y McLachlan Y Tipper Y
31 Buckner Y Herod Y Melton E Titone Y
32 Buentello Y Holtorf Y Michaelson Jenet Y Valdez A. Y
33 Caraveo Y Hooton E Mullica Y Valdez D. Y
34 Carver Y Humphrey N Neville Y Van Winkle Y
35 Catlin Y Jackson Y Pelton Y Weissman Y
36 Champion Y Jaquez Lewis Y Ransom Y Will Y
37 Coleman Y Kennedy Y Rich N Williams D. Y
38 Cutter Y Kipp Y Roberts Y Wilson Y
39 Duran Y Kraft-Tharp E Saine Y Woodrow Y
40 Esgar Y Landgraf Y Sandridge Y Young Y
41 Speaker Y
42
43 The question being, "Shall the bill, as amended, pass?".
44 A roll call vote was taken. As shown by the following recorded vote, a
45 majority of those elected to the House voted in the affirmative, and the
46 bill, as amended, was declared passed.
47
48 YES 40 NO 21 EXCUSED 4 ABSENT
49 Arndt Y Exum E Larson N Singer Y
50 Baisley N Froelich Y Liston N Sirota Y
51 Benavidez Y Garnett Y Lontine Y Snyder Y
52 Bird Y Geitner N McCluskie Y Soper N
53 Bockenfeld N Gonzales-Gutierrez Y McKean N Sullivan Y
54 Buck N Gray Y McLachlan Y Tipper Y
55 Buckner Y Herod Y Melton E Titone Y
1 Buentello Y Holtorf Y Michaelson Jenet Y Valdez A. Y
2 Caraveo Y Hooton E Mullica Y Valdez D. Y
3 Carver Y Humphrey N Neville N Van Winkle N
4 Catlin N Jackson Y Pelton N Weissman Y
5 Champion N Jaquez Lewis Y Ransom N Will N
6 Coleman Y Kennedy Y Rich N Williams D. N
7 Cutter Y Kipp Y Roberts Y Wilson N
8 Duran Y Kraft-Tharp E Saine N Woodrow Y
9 Esgar Y Landgraf Y Sandridge N Young Y
10 Speaker Y
11 Co-sponsor(s) added: Representative(s) Bird, Buentello, Caraveo, Cutter,
12 Duran, Esgar, Gonzales-Gutierrez, Jackson, Kipp, Lontine, McCluskie,
13 Michaelson Jenet, Mullica, Roberts, Singer, Sirota, Snyder, Tipper, Titone,
14 Valdez A., Valdez D., Weissman, Woodrow, Young, Speaker
15