The act requires the department of health care policy and financing, in coordination with the department of human services and the department of early childhood (state departments), to contract with a single county department of human or social services to administer a centralized member integrity service to conduct fraud investigations concerning eligibility for medicaid, the children's basic health plan, the supplemental nutrition assistance program, the Colorado child care assistance program, temporary assistance for needy families, and adult financial programs (public assistance programs), and benefit overpayments. The act creates the centralized member integrity service cash fund consisting of money recouped from member fraud investigations. The centralized member integrity service must be operational and utilized on July 1, 2027. On or before February 1, 2027, the act requires the state departments to establish aligned requirements for county departments of human or social services (county departments) to comply with through a performance-based contract established between the state departments and each county department. Prior to February 1, 2027, the state departments shall draft templates of the performance-based contract with the county departments for review and comment. On or before July 1, 2027, the state departments shall enter into a performance-based contract with each county department. The performance-based contract must establish requirements for the state departments and county departments to comply with in administering public assistance programs and establish corrective action protocols that are consistently utilized by the state departments. On or before September 1, 2026, the act requires the state departments to work together, and in consultation with the county departments, to establish a continuous quality improvement process to review data reported to the state departments by the county departments. The state departments must annually submit a report to the joint budget committee that includes an update on the continuous quality improvement process and data on the impact of the continuous quality improvement process. Beginning January 2027, and monthly thereafter, the state departments must establish a single, shared online dashboard used to publish county-level and statewide performance data for the public assistance programs on a monthly basis. This data must be published on each of the state department's website's in a publicly accessible format. Beginning July 1, 2028, the state departments must oversee a streamlined public benefits delivery model that consists of up to 12 cohorts of counties in the state that will coordinate public assistance program eligibility and distribute case processing work. The state departments shall enter into performance-based contracts with each cohort for administering a new public benefits delivery model to ensure public assistance programs are administered consistently and uniformly across the state. On or before July 1, 2026, the state departments must contract with a third-party contractor to help the state departments and county departments develop and implement a plan for transitioning to the new public benefits delivery model. The act establishes an implementation work group comprised of representatives of counties, the governor's office, the state departments, and nongovernmental organizations, to work with the third-party contractor to develop and implement the transition plan. The transition plan must be delivered to the joint budget committee by January 1, 2027. The act establishes the state cross-departmental policy alignment team to align the policies of the public assistance programs to improve service delivery and outcomes for recipients of public assistance benefits. The act makes a household eligible for fuel assistance payments if the household has not received low-income energy assistance program assistance in the previous 12 months and if it is eligible for the standard utility allowance under federal law. The act requires the department of health care policy and financing to certify to the department of revenue information regarding persons who are obligated to the state for overpayment of medicaid benefits and sets forth the process for distributing money withheld from a person's tax refund owed for overpayment of benefits. To implement the act, it includes appropriations from the general fund and various cash funds to the department of health care policy and financing, the department of human services, and the department of early childhood. The act appropriates money to the office of the governor for use by the office of information technology and to the department of law from reappropriated money received by other departments. The act decreases the appropriation from the federal child care development funds made in the annual general appropriation act for the 2026-27 state fiscal year to the department of early childhood for intrastate child care assistance program redistribution by $222,598.(Note: This summary applies to this bill as enacted.)
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 limits the benefits pregnant women and children with a certain family household income and citizen or immigration status are eligible for under the state medical assistance program and the medical assistance program. Eligible pregnant women and children are subject to the following limitations on benefits:Beginning July 1, 2026, there is an annual cap on dental services in the amount of $1,100;Beginning January 1, 2027, behavioral health services offered must be provided on a fee-for-service basis only;Beginning January 1, 2027, services offered through the accountable care collaborative are no longer covered; andBeginning January 1, 2027, managed care services through the medical assistance program are no longer covered. Beginning January 1, 2027, children under 19 years old whose family household income does not exceed 260% of the federal poverty line, adjusted for family size, and who are not eligible for the medical assistance program due to their immigration status, are not eligible for home- and community-based services, community first choice, long-term home health, private duty nursing, hospice care, and nursing home care unless those children already receive those services on or before December 31, 2026. Beginning January 1, 2027, the act caps enrollment of children in the state medical assistance program at 25,000 children if either enrollment exceeds 25,000 or the expenditures for a fiscal quarter exceeds one-quarter of the appropriation for state medical assistance plus 5% to account for seasonality fluctuations. If one of the conditions is met, the enrollment cap begins on the first day of the month following 60 days after the department of health care policy and financing (state department) determines that the condition was met. The act repeals provisions requiring the state department to develop an outreach and enrollment strategy for enrolling eligible groups into new coverage options and repeals the state children's basic health plan. The act appropriates $3,378,166 from the general fund to the state department to implement the act and reduces appropriations to the state department by $14,202,723 if certain conditions are met.(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.)
The act establishes the ibogaine research pilot program (pilot program) in the behavioral health administration (BHA) to research the safety and effectiveness of using ibogaine to treat mental health conditions and substance use disorders. The act requires the BHA to establish a committee to review pilot program site applications and make recommendations to the BHA on which applicants to accept. The BHA may select up to 5 ibogaine pilot sites. The act allows the BHA to seek, accept, and expend gifts, grants, and donations and establishes the ibogaine research pilot program cash fund. The pilot program is contingent on the BHA receiving sufficient gifts, grants, and donations to administer the pilot program and award grants to the selected ibogaine pilot sites to help with financing needs. Under current law, the division of natural medicine advisory board consists of 15 voting members, 8 of whom must have general expertise and experience related to natural medicine and 7 of whom must have specialized expertise and experience in various areas of natural medicine. The act amends the expertise and experience requirements to apply equally to all 15 voting members. The act adds that a facilitator of natural medicine services is not liable for a physical or psychological injury that a participant may experience as a result of the facilitator's performance or supervision of the natural medicine services that a participant receives, unless the injury is the result of the facilitator's intentional misconduct, gross negligence, or a deviation from the recognized standard of care. The act authorizes the state licensing authority for natural medicine or natural medicine product (state licensing authority) to adopt rules related to the administration, manufacturing, and use of ibogaine. The act sets requirements for how the state licensing authority must prioritize reviewing applications for licensure to facilitate natural medicine services and allows the state licensing authority to set different licensing fees depending on the type of natural medicine the applicant is seeking licensure for. The act allows the state licensing authority to accept gifts, grants, and donations from public or private sources and requires gifts, grants, or donations received to be deposited in the regulated natural medicine division cash fund. The act requires the BHA to work to secure federal research and development funding available through the advanced research projects agency for health within the federal department of health and human services, or other available funding, in order to advance research on the use of ibogaine for the treatment of serious mental illness. The act updates the powers and duties of the director of the division of professions and occupations to include adopting rules that guide the use and administration of ibogaine. A licensee seeking to cultivate, manufacture, dispense, or administer ibogaine shall, in consultation with Indigenous communities, establish a benefit-sharing plan that directly benefits those Indigenous communities. The act:Updates definition of 'administration session' to include the use of regulated natural medicine and regulated natural medicine product that the participant purchases to consume during the administration session;Prohibits a person from advertising bona fide harm reduction services or bona fide support services offered for remuneration, advertising natural medicine or natural medicine products, or using harm reduction services or support services to conduct sales of natural medicine;Clarifies that the state licensing authority is not required to conduct routine, periodic, or pre-operational inspections as a condition of licensure unless expressly required;Requires state licensing authority to adopt rules regarding licensing privileges and restrictions of a limited regulated natural medicine sales license and eligibility requirements for an applicant to obtain a limited regulated natural medicine sales license;Allows the state licensing authority to adopt rules regarding the application procedures and license requirement for a healing center to operate a temporary premises; and requirements for cultivation, manufacture, testing, or dispensing of ibogaine;Allows the department of public health and environment to issue a temporary premises permit to a licensed natural medicine healing center if certain conditions are met and allows a healing center to apply for a temporary premises permit;Prohibits a healing center licensee from selling regulated natural medicine or regulated natural medicine product unless a co-located limited regulated natural medicine sales licensee conducts the transaction in accordance with certain requirements; andAllows the director of the natural medicine division to issue an order to cease and desist if the director determines that a person is acting or has acted without a license to operate a natural medicine business or to own, grow, harvest, transfer, manufacture, supervise, provide, or administer natural medicine.(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.)
The act requires a health insurance carrier that provides prescription drug benefits to require that:The utilization review requirements, including prior authorization and step therapy, for a non-opioid drug prescribed and approved by the federal food and drug administration (FDA) for the treatment or management of chronic or acute pain (non-opioid pain management drug) are no more restrictive than the least restrictive utilization review requirements for opioid drugs prescribed for the treatment or management of chronic or acute pain; andThe cost-sharing, copayment, or deductible for a non-opioid pain management drug is not greater than the cost-sharing, copayment, or deductible for an opioid drug prescribed for the treatment or management of chronic or acute pain. The act requires each individual and small group health benefit plan issued or renewed on or after January 1, 2027, and each large employer health benefit plan issued or renewed on and after January 1, 2028, to ensure there is at least one non-opioid pain management drug available as a clinically appropriate alternative for an opioid pain management drug. If the division of insurance determines that coverage for a non-opioid pain management drug offered by individual and small group health benefit plans requires state defrayal of the cost of coverage, the requirement to make a non-opioid pain management drug available is inoperative. The state employee health benefit plan is excluded from the requirements of the act. The act appropriates $15,415 to the department of regulatory agencies for use by the division of insurance to implement the act.(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 relocates in statute the disability support fund (fund), which finances the work of the Colorado disability opportunity office (office). The fund receives revenue from fees paid for license plates in a retired style and from the sale of unique vehicle registration numbers. The act makes the office responsible for administering the sale of these unique vehicle registration numbers, which was previously a duty of the Colorado disability funding committee (committee) housed within the office. The act repeals the committee on July 1, 2027. The fund is subject to annual appropriation to support the office and, for state fiscal year 2026-27 only, the fund is also subject to annual appropriation by the general assembly to the department of labor and employment (department) for vocational rehabilitation. Beginning on October 1, 2026, the $25 annual fee paid for license plates in a retired style is replaced by a one-time and annual fee of $2.50 credited to the fund and a one-time and annual donation of $22.50 remitted to the Colorado disability funding authority (authority), which is a newly created special purpose authority. The authority is governed by a board of 13 members appointed by the governor, the majority of whom are individuals with disabilities, individuals with immediate family members with disabilities, or individuals who are caregivers to a family member with a disability. In making the appointments, the governor must ensure that the authority board has members with experience in or knowledge of:Business and business management;Nonprofit entities and managing nonprofit entities;Advocacy for individuals with disabilities;The practice of medicine, with experience working with individuals with disabilities; andThe practice of law, with experience working with individuals with disabilities. The authority is required to invite nonprofit entities, independent living centers, county departments of human services, county departments of social services, and other state and county agencies to submit proposals for programs to aid individuals with disabilities in accessing disability benefits. Beginning on July 1, 2027, the authority is required to award a contract or grant to one or more of the entities that submitted program proposals. When adequate funding is available, the authority may also:Accept and review proposals to fund projects or programs that study or pilot new and innovative ideas that will lead to an improved quality of life or increased independence for individuals with disabilities; andMake grants or develop, implement, or deliver education programs concerning reserved parking that is available to an individual with a disability affecting mobility. On or before December 1, 2027, and on or before each December 1 thereafter, the authority is required to prepare and submit a financial and performance report to the joint budget committee. In addition to this annual report, the state auditor may also be required to conduct or cause to be conducted postaudits of the authority. By October 1, 2026, the state treasurer is required to issue a warrant in the amount of $523,343 from the fund to the authority. On June 30, 2026, the state treasurer is required to transfer $21 million from the fund to the general fund. For the 2026-27 state fiscal year, the act decreases by $100,000 the appropriation from the disabled parking education and enforcement fund to the department for use by the office for operating expenses. For the 2026-27 state fiscal year, $1 million is appropriated from the fund to the department for use by the division of vocational rehabilitation and independent living services. For the 2026-27 state fiscal year, $27,000 is appropriated from the fund to the department of revenue for use by the division of motor vehicles for DRIVES maintenance and support.(Note: This summary applies to this bill as enacted.)
