The act repeals the health-care delivery system reform incentive payments program in the Colorado healthcare affordability and sustainability enterprise (enterprise) and creates the hospital quality incentive program (incentive program) to use enterprise hospital provider fee revenue to make additional payments to hospitals that meet performance metrics in delivering safer and more effective care that improves patient outcomes and reduces preventable utilization to reduce health-care costs. Prior to implementing the program, the enterprise board shall approve the percentage of hospitals' reimbursement in the incentive program and the incentive program structure, performance measures, and scoring methodology. Once the incentive program is implemented, the total amount of payments made under the incentive program must not exceed 9% of the total reimbursements made to hospitals in the previous state fiscal year.(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.)
After an individual has been discharged from a facility where an individual was held for an emergency mental health hold, current law requires the facility to attempt to follow up with the individual at least 48 hours after discharge. The act extends the time to attempt to follow up with the individual to 72 hours following discharge, excluding weekends and holidays. The act restricts the behavioral health administration (BHA) from issuing or renewing a license for a behavioral health entity unless the BHA receives a certificate of compliance for the applicant's building or structure from the division of fire prevention and control. The act adds the following exceptions to this requirement:An applicant that provides only telehealth services is not required to receive a certificate of compliance; andAn applicant that provides only outpatient services may receive a certificate of compliance from the division of fire prevention and control based on inspections conducted by a fire department that employs a certified inspector rather than from the division of fire prevention and control.(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.)
Currently, the 'Workers' Compensation Act of Colorado' provides that certain cancers contracted by firefighters are considered occupational diseases presumed to have been a result of the firefighters' employment. A firefighter's employer or an insurer may rebut this presumption by showing by a preponderance of the medical evidence that the cancer did not occur on the job. The act expands the types of cancer that are considered occupational diseases and strengthens the rebuttable presumption to require an employer to show clear and convincing evidence that the cancer did not occur on the job. The act exempts firefighters who are employed by the state.(Note: This summary applies to this bill as enacted.)
On or before December 1, 2026, and annually thereafter, the act requires each transportation broker that administers nonemergency medical transportation to medicaid members to submit certain information to the department of health care policy and financing (state department) regarding transportation providers that the transportation broker contracts with. Beginning January 1, 2027, the state department is required to include this information in its annual 'SMART Act' presentation. The act changes the term 'qualified alien' to 'qualified noncitizen' to align with federal requirements. If the state department plans to implement, apply, or enforce new multiple procedure payment reductions for outpatient therapy services, the act requires the state department to provide notice to the impacted providers of the changes at least 6 months prior to implementing the changes and to hold at least one stakeholder meeting to discuss the payment reductions. The act requires the state department to reimburse a provider who is licensed and authorized to prescribe, dispense, compound, or administer medication-assisted treatment in a jail setting. The act requires the medical services board to adopt rules before January 1, 2027, to comply with federal community engagement requirements and requires the state department make available on its website data on the community engagement requirements and their impact on medical assistance enrollment. The act requires the state department to collect direct care service cost to administrative cost ratio information from home- and community-based service provider agencies and submit a report to the general assembly detailing the information collected. The act repeals the state medical assistance and services advisory council.(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.)
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.)
