If an audit of a medicaid provider who provides nonemergency medical transportation services or pediatric behavioral therapy is initiated after July 1, 2026, for services provided from January 1, 2022, through December 31, 2023, the act authorizes the department of health care policy and financing (HCPF) to determine and recover overpayments to a provider using statistical sampling and extrapolation. If an audit identifies a statistically significant pattern of alleged overpayments to a provider, the act authorizes the state auditor to use the same statistical sampling and extrapolation methods to audit services provided by the provider from January 1, 2024, through December 31, 2025. If the audit identifies an alleged overpayment, HCPF is required to issue a notice of the alleged overpayment within 60 days after the alleged overpayment is identified. The notice of alleged overpayment must include the basis of the alleged overpayment, the rationale for the alleged overpayment, the methodology used to calculate the alleged overpayment, and information on how HCPF identified the alleged overpayment. If HCPF enters into a contract for the purpose of conducting an audit, the contract must not be a contingency-based contract based on a percentage of the amount of recovery collected from the provider. After HCPF completes an audit of a provider, the state auditor's office is required to conduct an examination to determine that proper statistical sampling and extrapolation methods were used by HCPF when determining whether overpayments were made to a provider. The state auditor shall annually present a report of the findings to the legislative audit committee and the joint budget committee. The act reduces the general fund appropriation to HCPF for medical and long-term care services for Medicaid-eligible individuals by $6,861,775 and increases the cash fund appropriation to HCPF for medical and long-term care services for Medicaid-eligible individuals by $13,723,550.(Note: This summary applies to this bill as enacted.)
The act caps at $400 the amount that a health-care entity or health-care provider may charge for a record request made by a patient's attorney or the attorney of the patient's personal representative pursuant to an authorization in compliance with the federal 'Health Insurance Portability and Accountability Act of 1996', a valid subpoena, or a valid court order, if the requested record exceeds 664 pages. The health-care entity or health-care provider may charge a reasonable fee above the cap if the record request requires the health-care facility or health-care provider to segregate, withhold, or redact protected health information in order to comply with applicable law or the scope or limitations of the authorization in compliance with the federal 'Health Insurance Portability and Accountability Act of 1996', a valid subpoena, or a valid court order. Beginning January 1, 2028, and every even-numbered year thereafter, the act requires the $400 limit to be adjusted for inflation. The act requires the requested medical records to be delivered in electronic format if the requestor requests electronic format, the original records are stored in electronic format, and the records are readily producible in electronic format. The act requires the health-care facility or health-care provider to provide the requestor with an invoice for the records provided in response to the record request within 30 days of receiving the request, and the health-care facility or health-care provider must provide the records upon payment of the invoice. If the health-care facility or health-care provider is unable to comply with the request for records within 30 days after the request, the health-care facility or health-care provider must send written notice of a 30-day extension to the requestor. The health-care facility or health-care provider must provide the records to the requestor at no cost if the records were not provided within 30 days or without written notice of an extension, unless the delay is due to a force majeure event. In the case of a force majeure event, the health-care facility or health-care provider must provide written notice to the requestor within 5 business days of becoming aware of the force majeure event. The 30-day time frame to respond to a request for records commences upon resolution of the force majeure event.(Note: This summary applies to this bill as enacted.)
The act requires the nonemergency medical transportation broker (broker) to establish the transportation community advisory board (TCAB) and requires the state department of health care policy and financing (state department) to collaborate with the TCAB prior to establishing rules and processes for the safety and oversight of nonmedical transportation services and nonemergency medical transportation (NEMT) services. The act requires, in collaboration with the TCAB, certain rules for NEMT the state department must adopt. The state department may impose trip caps or market-share restrictions on a transportation provider (provider) as part of corrective action plan. The act requires providers to use vehicles equipped with 2-way video cameras and a video recording system when transporting members. The act establishes how the broker must roll out their implementation and requires the broker to provide all providers with software, a communication toolkit, training, and technical assistance to facilitate NEMT services. The broker may encourage medicaid members (members) to book transportation services at least 2 days before their requested transportation date, and the broker shall accept and make reasonable efforts to fulfill same-day and next-day transportation requests. The act requires providers, only after all service regions have been implemented, to accommodate member requests for preferred or alternate drivers when operationally feasible. The act requires the broker, and, if there is no broker, the providers to verify that individuals using the transportation services are eligible members during the scheduling of transportation services. The act prohibits the broker from operating, owning, or controlling a provider in Colorado. The act requires the broker to provide their trip assignment rules and procedures to the state department for approval and for publication on the state department's website. The act allows a transportation network company to provide NEMT services when a provider is unavailable. The state department shall ensure all transportation providers, drivers, and vehicles are credentialed, and services provided by noncredentialed drivers or in noncredentialed vehicles are not eligible for reimbursement. The act prohibits the state department from denying payment of services to providers if the provider provides scheduled transportation services in good faith based on the information provided by the broker or if the provider had no knowledge of an inaccuracy and the provider followed all applicable rules and procedures. Subject to available appropriations, the act requires the state department to audit providers and audit the broker annually. The act requires the state department to categorize all NEMT expenditures as medical services and make changes to the NEMT program as necessary to obtain medical services federal match rates for NEMT services. The act also eliminates the requirement that the state department provide transportation services as an administrative cost. The act reduces appropriations to the state department from the general fund by $76,639 and from the healthcare affordability and sustainability hospital provider fee cash fund by $20,941,853.(Note: This summary applies to this bill as enacted.)
Beginning on January 1, 2028, a health insurance carrier (carrier) of an individual or group health benefit plan in Colorado (plan) shall, when calculating a covered person's contribution to an out-of-pocket maximum or cost-sharing requirement under the plan, account for and credit to the covered person's contribution an out-of-pocket expense that the covered person incurs by purchasing a prescription drug directly from a pharmacy or direct-to-consumer platform (contribution credit). The carrier shall apply the contribution credit to the out-of-pocket maximum or cost-sharing requirement that is applicable in the plan year in which the out-of-pocket expense was incurred. To receive a contribution credit, a covered person must provide to the carrier proof of payment for a direct purchase of a prescription drug, such as an itemized receipt or pharmacy record, within 90 days after making the purchase (proof of payment). The carrier may request additional information or documentation if the proof of payment is insufficient or incomplete. The carrier shall not apply a contribution credit in the following circumstances:For an amount of a covered person's out-of-pocket expense incurred by the direct purchase of a prescription drug that is greater than the amount the covered person would have incurred if they had obtained the same prescription drug in the same plan year from an in-network pharmacy and pursuant to the terms of their plan;If the covered person does not provide proof of payment;If the covered person incurred the out-of-pocket expense by purchasing a prescription drug that is not covered under the formulary of the covered person's plan, unless the carrier grants an exception; orIf the covered person does not comply with the carrier's utilization management processes, including prior authorization and step therapy protocols required under the covered person's plan.(Note: This summary applies to this bill as enacted.)
The act prohibits individuals lawfully permitted to provide psychotherapy services in the state (regulated professionals) from allowing an artificial intelligence system (AI system) to interact with clients in any form of therapeutic communication without synchronous, real-time interaction between the regulated professional, the AI system, and the client, or generate therapeutic recommendations or treatment plans without review and approval by the regulated professional. Except for educational, administrative, simulation, or training purposes or as part of a research program, a regulated professional shall not use an AI system to provide, direct, or guide psychotherapy, clinical intervention, counseling, diagnosis, treatment planning, or other activity that constitutes the practice of psychotherapy with an individual or group unless the use satisfies the conditions specified in the act. At initial client contact, a regulated professional shall inform clients of the prohibitions regarding use of AI systems in the practice of psychotherapy. Regulated professionals may be disciplined by the appropriate licensing board in the department of regulatory agencies for violations of this act. The act allows regulated professionals to use an AI system to assist in providing administrative support or supplementary support, as these terms are defined in the act, for psychotherapy services if the regulated professional maintains responsibility for reviewing any outputs of the AI system used to provide administrative support or supplementary support. If a client's therapeutic session will be recorded or transcribed through the use of an AI system, the regulated professional must disclose in advance the use of an AI system and the purposes for its use, and obtain written, informed consent from the client. The act does not prohibit a regulated professional from using an AI system within accredited or approved educational, instructional, or professional training programs, so long as the AI system is used solely for educational, administrative, simulation, or training purposes and is not deployed, marketed, or represented as a tool for use with clients, patients, or the public. Further, a regulated professional may be involved in the development, testing, or evaluation of an AI system solely for research purposes under the oversight of a federally registered institutional review board, so long as the AI system is not offered to consumers or used outside of the research setting. The act does not apply to regulated professionals who use or recommend the use of technology in the state that does not diagnose or treat mental health disorders, clearly discloses that the technology is not a substitute for clinical care, and:Provides self-help, therapeutic homework, coaching, patient navigation, guided meditation, journaling, or other tools specified in the act; orIs regulated by the federal food and drug administration. Except as provided in the act, the act also makes it an unfair or deceptive trade practice under the 'Colorado Consumer Protection Act' for an individual, corporation, or entity (person) to use any term, letter, or phrase in the use of an AI system in a manner that:Indicates or implies that the AI system's outputs are provided by, endorsed by, or equivalent to services provided by a regulated professional;Represents that the AI system provides psychotherapy services; orRepresents that a user's data is confidential in a manner that would lead a reasonable user to believe that the privacy of their data is protected in a manner similar to therapist-client confidentiality. The act does not impose liability on a regulated professional for defects in or failures of an AI system that are attributable to the developer or deployer of the AI system. Further, under conditions specified in the act, nothing in the act prohibits a person from developing, testing, or evaluating an AI system solely for research purposes or using an AI system in educational, instructional, or training programs. In addition, it is not an unfair or deceptive trade practice for a person to use a technology that does not diagnose or treat mental health disorders, clearly discloses that the technology is not a substitute for clinical care, and:Provides self-help, therapeutic homework, coaching, patient navigation, guided meditation, journaling, or other tools specified in the act; orIs regulated by the federal food and drug administration.(Note: This summary applies to this bill as enacted.)
No later than July 1, 2026, the department of health care policy and financing (HCPF) shall convene a steering committee (steering committee) to support the transition of services provided in qualified residential treatment programs (QRTP) and psychiatric residential treatment facilities (PRTF) to the managed care system for members in the care and custody of a county department of human or social services (county department). No later than April 1, 2027, HCPF, in collaboration with the steering committee, shall develop policies and recommendations to support the transition of QRTP and PRTF to the managed care system for members in the care and custody of a county department. No later than July 1, 2027, HCPF shall implement or initiate the transition of services provided in QRTP and PRTF to the managed care system for members in the care and custody of a county department according to the policies and recommendations developed by HCPF in collaboration with the steering committee. HCPF shall submit quarterly reports to the joint budget committee with information about the steering committee's monthly meetings.(Note: This summary applies to this bill as enacted.)
The act:Authorizes the health insurance affordability enterprise (enterprise), on or after January 1, 2027, to issue revenue bonds of up to $100 million to fund enterprise programs, secured by the enterprise's revenues, and require the enterprise to pay bond obligations before allocating revenues for enterprise programs;Allows the enterprise to invest specified money in the health insurance affordability cash fund (cash fund) without regard to otherwise applicable requirements for such investments and to contract with private professional fund managers to advise on investment strategies;Modifies the allocation of enterprise revenue among authorized purposes and allows the enterprise to reallocate unexpended amounts for specified purposes;Directs the enterprise to require qualified individuals who are enrolled in state-subsidized individual health coverage plans eligible for subsidies from the enterprise to pay premiums established in rules adopted by the commissioner, in consultation with the health insurance affordability board (board);Requires the enterprise to adjust the statewide average premium reduction under the reinsurance program to 18% and to reduce the amount of bonds issued to account for the reduced costs for the reinsurance program;Directs the board, in recommending parameters for implementing subsidies for state-subsidized individual health coverage plans, to recommend coverage that prioritizes enrollment stability and customer predictability; when seeking input on its recommendations regarding plans, coverage, and the number of eligible slots, to enable feedback in at least English and Spanish and in other languages upon request; and to indicate how it incorporated such feedback into its final recommendations;Directs the enterprise to conduct or contract a third party to conduct a study to evaluate the feasibility of restructuring the enterprise programs to increase health insurance affordability and maximize enrollment in health insurance plans;Requires the enterprise to submit 3 written reports and make one in-person presentation to the joint budget committee each year regarding the status of the cash fund and, as part of its in-person presentation in January 2027, to provide an analysis of the effects of changing the statewide average premium reduction under the reinsurance program to 15% and of creating a tiered, income-based, structure for premium assistance for individuals who purchase insurance on the Colorado health benefit exchange (exchange);Repeals the tax credit for contributions to the exchange and replaces it with a tax credit for contributions to the enterprise; andDirects the state treasurer to transfer $40 million from the marijuana tax cash fund to the cash fund by June 30, 2026, reduces to $60 million the designation of money in the marijuana tax cash fund as the state emergency reserve for the 2025-26 and 2026-27 state fiscal years, and increases by $40 million the value of the capitol annex building for purposes of the state emergency reserve for the 2025-26 and 2026-27 state fiscal years.(Note: This summary applies to this bill as enacted.)
The act creates the Colorado behavior analyst licensing board (board) under the direction and supervision of the division of professions and occupations in the department of regulatory agencies. On and after July 1, 2028, an individual is prohibited from engaging in or offering the practice of applied behavior analysis unless the individual is licensed by the board. The board is authorized to license behavior analysts and assistant behavior analysts if they meet the requirements specified by the act and the rules adopted by the board pursuant to the act. An individual who seeks to practice as a behavior analyst or assistant behavior analyst must meet the following requirements:File an application for a license;Have a valid certification in good standing with a certifying entity;Complete a fingerprint-based criminal history record check;Carry professional liability insurance in an amount determined by the board by rule unless working as a public employee covered under governmental immunity; andIf the individual seeks to practice as an assistant behavior analyst, be supervised by a licensed behavior analyst and practice within the scope of practice established by rules of the board. The board may deny or refuse to renew a license, suspend or revoke a license, impose probationary conditions on a license, or issue a cease-and-desist letter or seek injunctive relief against a licensee or an applicant for licensure who has engaged in specified grounds for discipline or unprofessional conduct. The board may also send a licensee a letter of admonition or a confidential letter of concern under certain circumstances. 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 behavior analyst or assistant behavior analyst without being licensed pursuant to the act and who is not exempted from licensure commits a class 2 misdemeanor. The board may adopt rules as necessary to implement the act. The regulation of behavior analysts and assistant behavior analysts is scheduled for repeal on September 1, 2031. Before the repeal, the functions of the board in regulating applied behavior analysis are scheduled for review in accordance with the sunset law. The act requires the department of health care policy and financing (state department) to reimburse an applied behavior analysis provider for applied behavior analysis services provided by a behavior technician certified by a certifying entity to a medicaid member with autism spectrum disorder or other conditions for which coverage may be available under state department policies. Subject to federal approval, the state department shall reimburse the applicable applied behavior analysis provider for applied behavior analysis services provided by a behavior technician who is required by the state department to be certified by a certifying entity, but is not certified at the time of services, for services provided during one temporary period of not less than 45 days while the behavior technician is pursuing the certification if specified conditions are met. The department of human services (department) is required to prescribe and publish standards for the licensing and regulation of applied behavior analysis clinics (clinics). The department is authorized to adopt rules concerning specific subjects related to standards for clinics. Clinics are required to comply with specified requirements regarding local government zoning regulations, licensing fees, and qualifications for employees of the clinics. The act changes the definition of 'day treatment center' to 'day treatment facility' and requires that facilities that were not subject to the definition before the effective date of the act but that meet the amended definition submit an application for licensure by the department on or before August 1, 2026 , and become licensed before August 1, 2027.(Note: This summary applies to this bill as enacted.)
Current law requires a recovery residence operated in Colorado to be certified by a third-party certifying body, unless the recovery residence has been operating in Colorado for 30 or more years as of May 23, 2019. Beginning July 1, 2027, the act requires a recovery residence to obtain a license from the behavioral health administration (BHA). The act sets forth application procedures and rules for minimum standards of operating a recovery residence. A recovery residence must report specified occurrences to the BHA, including occurrences that result in the death of or specified injury to a resident, involve abuse and neglect of a resident, involve misappropriation of a resident's property, or in which a resident's drugs are diverted for use by another person. Recovery residence licensing is subject to sunset review prior to its repeal in 2033.(Note: This summary applies to this bill as enacted.)
The act provides that, if the action is undertaken in accordance with applicable federal and state law:A licensed person may compound a drug or device in the state;A state-licensed pharmacy or a distribution facility registered with the federal food and drug administration (licensed 503B outsourcing facility) may supply a compounded drug or device to a licensed health-care provider, pharmacy, facility, or organization; andA licensed health-care provider, pharmacy, facility, or organization may obtain, dispense, or administer a compounded drug or device supplied by a state-licensed pharmacy or a licensed 503B outsourcing facility. In addition, the act prohibits the state board of pharmacy from adopting rules that are more restrictive than federal or state law regarding the compounding of drugs or devices by licensed 503B outsourcing facilities. Current law exempts drugs that are intended solely for investigational use by experts qualified by scientific training and experience and that are plainly labeled for investigational use only from the sales and delivery prohibition for new drugs. The act also exempts from the prohibition:Drugs that are reviewed by an institutional review board and plainly labeled for investigational use only; andCompounded drugs and devices if the compounding of the drug or device is undertaken in accordance with applicable federal and state law.(Note: This summary applies to this bill as enacted.)
