The act defines 'first responder' to include:A peace officer;A firefighter;A volunteer firefighter;An emergency medical service provider; orA mental health professional who responds in a professional capacity to a justifiable medical emergency. Existing law requires the emergency medical and trauma services advisory council (council) to review and approve new rules and modifications to rules prior to the adoption of such rules or modifications by the state board of health. The act requires the council to make recommendations for, instead of approve, rules and modifications to rules concerning emergency medical and trauma services prior to the adoption of such rules or modifications by the state board of health. Beginning January 1, 2027, the act requires the department of health care policy and financing (state department) to reimburse the following entities under the 'Colorado Medical Assistance Act':An ambulance service for ground transportation by an ambulance or other vehicle to a hospital or other destination as deemed appropriate by the ambulance service's medical director;An ambulance service for treatment on the scene of a medical emergency, which treatment does not result in ground transportation; andA qualified provider, an ambulance service, or an agency for evaluation by telemedicine of a person being treated by an ambulance service or an agency for the purpose of preventing the need to transport the person to a hospital.(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 permits a health facility to allow patients who are terminally ill and who are registered in the state's medical marijuana program to use medical marijuana within the health facility, subject to certain parameters. The act requires a health facility that allows such use to document the patient's medical marijuana program registration and medical marijuana usage in the patient's medical records and develop guidelines for and impose restrictions on the possession, usage, storage, and administration of medical marijuana to ensure the safety of others, safe facility operations, and compliance with other laws. A health facility is not required to handle medical marijuana for a patient. The act prohibits the department of public health and environment (department) from requiring compliance with the act as a condition for a health facility to obtain or renew a license or certification that it is required to carry to operate as a health facility. Additionally, the act prohibits the department from requiring compliance if compliance would result in a violation of state law, a loss of federal funding, noncompliance with the federal medicare or medicaid programs, or noncompliance with accreditation or licensing requirements. Lastly, the act allows a health facility to suspend compliance with the act's provisions in the event that, and only as long as, a listed federal entity takes an action that requires the health facility to suspend its compliance with the act.(Note: This summary applies to this bill as enacted.)
The act amends the law and adds new provisions to law relating to access to vaccines as follows: For the cervical cancer vaccine: (Sections 3 and 14)Updates insurance coverage statutes to refer to the vaccine as the human papillomavirus vaccine, rather than the cervical cancer vaccine; Recognizes coverage for both women and men;Authorizes the commissioner of insurance to adopt coverage rules for the vaccine if the advisory committee on immunization practices to the centers for disease control in the federal department of health and human services (ACIP) no longer recommends the vaccine; andUpdates language in the cervical cancer immunization program to define the cervical cancer vaccine as the human papillomavirus vaccine and to refer in the program to underinsured minors, rather than just uninsured female minors, since both male and female minors receive the vaccine; Under Colorado law, a naturopathic doctor must provide a parent or legal guardian with a copy of the most recent schedule of immunizations recommended by the ACIP. The act removes references to ACIP and requires a naturopathic doctor to refer patients to a schedule of immunizations established by rule of the state board of health (board of health) (Sections 4 and 5); The act authorizes pharmacists to exercise independent prescriptive authority for vaccines and requires the state board of pharmacy to review and repeal record-keeping rules for vaccines (Sections 6 and 7); In the context of vaccines required for school entry, updates vaccine-related liability limitation provisions to limit liability for injuries if the vaccine was administered to a child of any age according to the schedule of immunizations established by the board of health or to ACIP's schedule referenced in Colorado law (Section 8); The act also does the following:Directs the board of health, in adopting rules addressing which vaccines are to be administered to infants, to consider the recommendations of ACIP, as well as the recommendations of the American Academy of Pediatrics and other similar entities (Section 9);Removes the prohibition on the use of state money for infant immunization programs if the state does not receive federal money for the infant immunization programs, and requires any additional general fund money for the programs to be appropriated through the annual state budget process or emergency supplemental process (Section 10);For claims brought on or before January 30, 2029, adds pharmacies, manufacturers, and wholesalers to liability limitation provisions for hospitals, clinics, and other providers relating to the handling, storage, and distribution of vaccines for infants. Manufacturer and wholesaler liability limitation provisions are removed from the law for claims brought on or after January 31, 2029 (Section 11).Authorizes the department of public health and environment to consider vaccines adopted by the board of health by rule, recommendations of the American Academy of Pediatrics and other similar entities, in addition to ACIP, in recommending the purchase of vaccines, sending notifications concerning overdue vaccines and vaccine-preventable disease outbreaks, and when considering equivalent vaccines (Section 12). The act creates the 'Adult Immunization Act' (act), which applies to individuals at least eighteen years old. A person that administers a vaccine or other immunizing agent to an adult is not liable for civil damages for injury or death of an adult caused by a vaccine or immunizing agent if:The vaccine or immunizing agent was administered according to the schedule of immunizations establish by the board of health by rule, after considering recommendations from ACIP, the American Academy of Pediatrics, and other similar entities;There were no medical contraindications; and The vaccine or immunizing agent was administered in accordance with generally accepted clinical methods. For claims brought on or before January 30, 2029, against a hospital, clinic, pharmacy, manufacturer, wholesaler, or provider arising from injuries resulting from the handling, storage, or distribution of vaccines, there is no liability unless the injuries are the result of the negligent failure of an employee of the hospital, clinic, pharmacy, or manufacturer, wholesaler, or provider to conform to recognized standards to protect public health. Manufacturer and wholesaler liability protections are removed from the law for claims brought on or after January 31, 2029 (Section 15). The act authorizes the department of health care policy and financing to purchase for the children's basic health plan vaccines that are recommended by the American Academy of Pediatrics and other similar entities, in addition to those recommended by ACIP (Section 16).(Note: This summary applies to this bill as enacted.)
If a mental health provider, substance use disorder provider, or psychiatric nurse (provider) has not submitted a claim for a period of at least 12 months, the act requires a commercial insurance carrier (carrier) to contact the provider to confirm the provider's participation in the carrier's provider network and to determine whether the provider is accepting new patients. The act includes mental health providers, substance use disorder providers, and psychiatric nurses as providers who may participate in a carrier's provider network. The act requires carriers to admit prelicensed providers into the carrier's network and to reimburse prelicensed providers for services rendered when provided under the supervision of a mental health provider, substance use disorder provider, or psychiatric nurse. The act requires a clinical social worker to complete 3,000 hours of practice prior to licensure.(Note: This summary applies to this bill as enacted.)
The act makes changes to the dispute resolution process between health insurance carriers (carriers) and out-of-network health-care providers (providers) by requiring a carrier to provide, with each payment made to a provider, a remittance advice that: Identifies when the associated health benefit plan is regulated by the state and when the payment is made pursuant to services received from an out-of-network provider or at an out-of-network facility; andProvides the carrier's median in-network reimbursement rate for out-of-network claims.(Note: This summary applies to this bill as enacted.)
The bill requires an individual being discharged from a nursing facility to be presumptively eligible for long-term services and supports under medicaid.The bill requires the department of health care policy and financing (state department) to determine presumptive eligibility and requires county departments of human or social services (county departments) to set up the long-term services and supports for an individual being discharged from a nursing facility prior to the individual's discharge date.The state department is required to submit an annual report to the state auditor and post the report on the state department's website detailing information about the individuals discharged from a nursing facility and the associated presumptive eligibility determinations.The bill establishes remedial measures against a county department if the county department fails to set up long-term services and supports for the individual. The bill establishes remedial measures against a nursing facility that fails to discharge an individual on the discharge date due to a failure within the nursing facility's control or fails to cooperate in good faith with the state department to ensure long-term care services and supports are in place for the individual.(Note: This summary applies to this bill as introduced.)
The act requires measures to improve equity in maternal health, including:Requiring the Colorado medical board to consider, as part of its stakeholder process for continuing medical education, a requirement that a physician complete continuing medical education on cultural competence and equity in maternal care;Requiring the state board of nursing rules relating to continuing education to include rules relating to health-care provider attention to cultural competence and equity in providing health-care services;Authorizing the department of public health and environment (CDPHE), subject to available appropriations, to provide a health survey to additional birthing parents, beyond those currently surveyed, and to compile the data if surveyed;Requiring a health facility that provides labor and childbirth services to make available to a birthing parent and a birthing parent's companion, electronically or in writing, a statement on respectful labor and childbirth regarding rights and components, including freedom from harm, privacy and confidentiality, informed consent, and allowing a birthing parent to have a birthing companion present at the birth, and to make available information, including telephone contact information, for the appropriate state or federal agency to receive a complaint alleging discrimination in labor and childbirth services;Subject to available federal grant funding for the maternal health task force (task force) established by CDPHE, ensuring that the maternal health task force includes at least one advocate representing populations with the worst maternal mortality outcomes in the state; andBeginning October 1, 2026, with respect to CDPHE's Colorado maternal mortality review committee, changing the reporting to the general assembly every 3 years concerning maternal health outcomes and equity from July to October and requiring the reporting of certain maternal health outcomes for populations known to have the worst maternal mortality outcomes in the state.(Note: This summary applies to this bill as enacted.)
The bill creates the "Prescription Drug Optimized Sourcing Transparency and Integrity Act" to prohibit a pharmacy benefit manager (PBM) or a health-care consultant from knowingly making or disseminating false or misleading statements or claims to a self-insured employer or policyholder about the legality or safety of a lawful prescription drug optimized sourcing program established by a pharmacy stewardship program.Upon written request by a self-insured employer, a PBM or health-care consultant is required to provide certain cost information for each prescription drug dispensed under the health benefit plan.The prohibition and information-sharing provisions of the bill do not restrict or limit the rights of a self-insured employer to purchase prescription drugs through and contract for a lawful prescription drug optimized sourcing program. The bill also recognizes that a pharmacy stewardship program is an effective cost-containment tool and is authorized when implemented in compliance with federal law and with the bill.(Note: This summary applies to this bill as introduced.)
