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 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.)
