Amendments for SB19-073

Senate Journal, February 7
After consideration on the merits, the Committee recommends that SB19-073 be amended
as follows, and as so amended, be referred to the Committee on Appropriations with
favorable recommendation.

Amend printed bill, strike everything below the enacting clause and
substitute:

"SECTION 1. In Colorado Revised Statutes, add article 51 to
title 25 as follows:
ARTICLE 51
Statewide System for Advance
Health Care Directives
25-51-101. Definitions. AS USED IN THIS ARTICLE 51, UNLESS THE
CONTEXT OTHERWISE REQUIRES:
(1) (a) "ADVANCE HEALTH CARE DIRECTIVE" MEANS:
(I) A DIRECTIVE CONCERNING MEDICAL ORDERS FOR SCOPE OF
TREATMENT EXECUTED PURSUANT TO ARTICLE 18.7 OF TITLE 15;
(II) A DECLARATION AS TO MEDICAL TREATMENT EXECUTED
PURSUANT TO SECTION 15-18-104;
(III) A DIRECTIVE RELATING TO CARDIOPULMONARY
RESUSCITATION EXECUTED PURSUANT TO ARTICLE 18.6 OF TITLE 15;
(IV) A MEDICAL DURABLE POWER OF ATTORNEY EXECUTED
PURSUANT TO SECTION 15-14-506; OR
(V) ANY OF THE ADVANCE HEALTH CARE DIRECTIVES LISTED IN
SUBSECTIONS (1)(a)(I) TO (1)(a)(IV) OF THIS SECTION OR THIS
SUBSECTION (1)(a)(V) THAT HAS BEEN PROPERLY EXECUTED IN ANOTHER
STATE.
(b) A POWER OF ATTORNEY FORM EXECUTED PURSUANT TO
SECTION 15-14-741 IS NOT AN ADVANCE HEALTH CARE DIRECTIVE FOR
THE PURPOSES OF THIS ARTICLE 51.
(2) "AUTHORIZED SURROGATE DECISION-MAKER" MEANS A
GUARDIAN APPOINTED PURSUANT TO ARTICLE 14 OF TITLE 15, AN AGENT
APPOINTED PURSUANT TO A MEDICAL DURABLE POWER OF ATTORNEY, A
PROXY DECISION-MAKER FOR MEDICAL TREATMENT DECISIONS APPOINTED
PURSUANT TO ARTICLE 18.5 OF TITLE 15, OR A SIMILARLY AUTHORIZED
SURROGATE, AS DEFINED BY THE LAWS OF ANOTHER STATE, WHO IS
AUTHORIZED TO MAKE MEDICAL DECISIONS FOR AN INDIVIDUAL WHO
LACKS DECISIONAL CAPACITY.
(3) "DEPARTMENT" MEANS THE DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT CREATED AND EXISTING PURSUANT TO SECTION
24-1-119.
(4) "HEALTH INFORMATION ORGANIZATION NETWORK" MEANS A
COLORADO ORGANIZATION THAT HAS EXPERIENCE IN OVERSEEING AND
GOVERNING THE EXCHANGE OF HEALTH-RELATED INFORMATION AMONG
ORGANIZATIONS ACCORDING TO COLORADO LAW AND NATIONALLY
RECOGNIZED STANDARDS INCLUDING BUT NOT LIMITED TO THE FEDERAL
"HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996",
PUB.L. 104-191, AS AMENDED.
(5) "INDIVIDUAL" MEANS THE INDIVIDUAL WHOSE MEDICAL
TREATMENT IS THE SUBJECT OF THE ADVANCE HEALTH CARE DIRECTIVE.
(6) "QUALIFIED PROVIDER" MEANS A PERSON OR ENTITY THAT
MAY USE OR DISCLOSE PROTECTED HEALTH INFORMATION FOR
TREATMENT PURPOSES IN ACCORDANCE WITH GUIDELINES UNDER THE
FEDERAL "HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
OF 1996", PUB.L. 104-191, AS AMENDED.
25-51-102. Statewide system for advance directives created -
rules. (1) THE DEPARTMENT HAS THE FOLLOWING POWERS AND DUTIES
WITH RESPECT TO THE PROVISION OF A STATEWIDE ELECTRONIC SYSTEM,
REFERRED TO IN THIS SECTION AS THE "SYSTEM", THAT ALLOWS
QUALIFIED INDIVIDUALS TO UPLOAD AND ACCESS ADVANCE MEDICAL
DIRECTIVES:
(a) TO ENSURE THAT QUALIFIED INDIVIDUALS MAY ACCESS THE
SYSTEM FOR TREATMENT PURPOSES THAT ARE ALLOWED UNDER THE
FEDERAL "HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
OF 1996", PUB.L. 104-191, AS AMENDED;
(b) TO CONTRACT WITH ONE OR MORE HEALTH INFORMATION
ORGANIZATION NETWORKS FOR THE CREATION, ADMINISTRATION, AND
MAINTENANCE OF THE SYSTEM; AND
(c) TO PROMULGATE RULES IN ACCORDANCE WITH ARTICLE 4 OF
TITLE 24 TO OVERSEE THE PROVISIONS OF THIS ARTICLE 51, INCLUDING
BUT NOT LIMITED TO RULES ESTABLISHING:
(I) CRITERIA FOR QUALIFIED INDIVIDUALS TO HAVE ACCESS TO
THE SYSTEM AND ADVANCE MEDICAL DIRECTIVES;
(II) PROCEDURES BY WHICH A QUALIFIED INDIVIDUAL MAY ADD
OR REMOVE AN ADVANCE MEDICAL DIRECTIVE TO OR FROM THE SYSTEM;
(III) PROCEDURES BY WHICH A QUALIFIED INDIVIDUAL MAY
ACCESS AND DOWNLOAD AN ADVANCE MEDICAL DIRECTIVE FROM THE
SYSTEM; AND
(IV) PROCEDURES AND SAFEGUARDS FOR ENSURING THE
CONFIDENTIALITY AND SECURE STORAGE OF THE INFORMATION
CONTAINED IN AN ADVANCE MEDICAL DIRECTIVE THAT IS ADDED TO AND
MAINTAINED IN THE SYSTEM.
(2) (a) UPON THE REQUEST OF AN INDIVIDUAL, OR AUTHORIZED
SURROGATE DECISION-MAKER, A QUALIFIED PROVIDER THAT HAS AN
AGREEMENT WITH THE HEALTH INFORMATION ORGANIZATION NETWORK
AS REQUIRED UNDER THE FEDERAL "HEALTH INSURANCE PORTABILITY
AND ACCOUNTABILITY ACT OF 1996", PUB.L. 104-191, AS AMENDED,
MAY UPLOAD THE INDIVIDUAL'S ADVANCE HEALTH CARE DIRECTIVE TO
THE SYSTEM. THE ADVANCE HEALTH CARE DIRECTIVE SHALL ONLY BE
UPLOADED TO THE SYSTEM BY A QUALIFIED PROVIDER AFTER THE
INDIVIDUAL OR AUTHORIZED SURROGATE DECISION-MAKER HAS
CONSULTED WITH THE QUALIFIED PROVIDER IN PERSON OR THROUGH
TELEHEALTH, AS DEFINED IN SECTION 10-16-123 (4)(e)(I). A QUALIFIED
PROVIDER WHO UPLOADS AN ADVANCE HEALTH CARE DIRECTIVE TO THE
SYSTEM IS NOT SUBJECT TO CIVIL OR CRIMINAL LIABILITY OR
REGULATORY SANCTION FOR ACTION TAKEN IN ACCORDANCE WITH THIS
SUBSECTION (2).
(b) PRIOR TO THE UPLOAD OF AN ADVANCE HEALTH CARE
DIRECTIVE TO THE SYSTEM, THE INDIVIDUAL, OR AUTHORIZED SURROGATE
DECISION-MAKER, SHALL SIGN AN ELECTRONIC AFFIDAVIT IN THE
PRESENCE OF A QUALIFIED PROVIDER AFFIRMING THE ADVANCE HEALTH
CARE DIRECTIVE IS APPROPRIATELY EXECUTED, CURRENT, AND
ACCURATE. SIGNING THE ELECTRONIC AFFIDAVIT REVOKES ANY PRIOR
ADVANCE HEALTH CARE DIRECTIVES OF THE SAME TYPE PREVIOUSLY
UPLOADED TO THE SYSTEM.
(c) THE INDIVIDUAL, OR AUTHORIZED SURROGATE
DECISION-MAKER, IS RESPONSIBLE FOR ENSURING THAT THE ADVANCE
HEALTH CARE DIRECTIVE UPLOADED TO THE SYSTEM IS APPROPRIATELY
EXECUTED, CURRENT, AND ACCURATE.
(3) EMERGENCY MEDICAL SERVICE PERSONNEL, AN INDIVIDUAL
HEALTH CARE PROVIDER, A HEALTH CARE FACILITY, OR ANY OTHER
PERSON OR ENTITY THAT COMPLIES WITH AN ADVANCE HEALTH CARE
DIRECTIVE ACCESSED FROM THE SYSTEM IS NOT SUBJECT TO CIVIL OR
CRIMINAL LIABILITY OR REGULATORY SANCTION FOR ACTION TAKEN IN
ACCORDANCE WITH THE ADVANCE HEALTH CARE DIRECTIVE, UNLESS THE
PERSON OR ENTITY HAS ACTUAL KNOWLEDGE OF AN ADVANCE HEALTH
CARE DIRECTIVE PROPERLY EXECUTED AFTER THE DATE OF THE ADVANCE
HEALTH CARE DIRECTIVE THAT IS UPLOADED TO THE SYSTEM.
SECTION 2. Act subject to petition - effective date. This act
takes effect at 12:01 a.m. on the day following the expiration of the
ninety-day period after final adjournment of the general assembly
(August 2, 2019, if adjournment sine die is on May 3, 2019); except that,
if a referendum petition is filed pursuant to section 1 (3) of article V of
the state constitution against this act or an item, section, or part of this act
within such period, then the act, item, section, or part will not take effect
unless approved by the people at the general election to be held in
November 2020 and, in such case, will take effect on the date of the
official declaration of the vote thereon by the governor.".

Health &
Human
Services

Senate Journal, April 19
After consideration on the merits, the Committee recommends that SB19-073 be amended
as follows, and as so amended, be referred to the Committee of the Whole with favorable
recommendation and with a recommendation that it be placed on the Consent Calendar.

Amend the Health and Human Services Committee Report, dated
February 6, 2019, page 4, after line 5 insert:

"SECTION 2. Appropriation. (1) For the 2019-20 state fiscal
year, $993,147 is appropriated to the department of public health and
environment. This appropriation is from the general fund. To implement
this act, the department may use this appropriation as follows:
(a) $32,100 for use by the center for health and environmental
information for personal services related to health statistics and vital
records, which amount is based on an assumption that the center will
require an additional 0.5 FTE;
(b) $211,047 for use by the center for health and environmental
information for operating expenses related to health statistics and vital
records; and
(c) $750,000 for the purchase of information technology services.
(2) For the 2019-20 state fiscal year, $750,000 is appropriated to
the office of the governor for use by the office of information
technology. This appropriation is from reappropriated funds received
from the department of public health and environment under subsection
(1)(c) of this section. To implement this act, the office may use this
appropriation to provide information technology services for the
department of public health and environment.".

Renumber succeeding section accordingly.

Amend printed bill, page 1, strike line 102 and substitute "DIRECTIVES,
AND, IN CONNECTION THEREWITH, MAKING AN APPROPRIATION.".


Appro-
priations