Sen. Iman Jodeh

Beginning in 2023, the act requires each health insurance carrier (carrier) that offers an individual or small group health benefit plan in this state to offer at least 25% of its health benefit plans on the Colorado health benefit exchange (exchange) and at least 25% of its plans not on the exchange in each bronze, silver, gold, and platinum benefit level in each service area as copayment-only payment structures for all prescription drug cost tiers. Starting in 2024, a carrier or, if a carrier uses a pharmacy benefit manager (PBM) for claims processing services or other prescription drug or device services under a health benefit plan offered by the carrier in the individual market, the PBM, or a representative of the carrier or the PBM, is prohibited from modifying or applying a modification to the current prescription drug formulary during the current plan year. The act repeals and reenacts the current requirements for step therapy and requires a carrier to use clinical review criteria to establish the step-therapy protocol. For each health benefit plan issued or renewed on or after January 1, 2024, the bill requires each carrier or PBM to demonstrate to the division of insurance that: 100% of the estimated rebates received or to be received in connection with dispensing or administering prescription drugs included in the carrier's prescription drug formulary are used to reduce costs; For small group and large employer health benefit plans, all rebates are used to reduce employer or individual employee costs; and For individual health benefit plans, all rebates are used to reduce consumers' premiums and out-of-pocket costs for prescription drugs and that health insurers will maximize the use of rebates to reduce consumer costs. The act requires the division of insurance to conduct and complete a study to evaluate how rebates my be applied in the individual market to reduce consumers' costs. The act requires health insurers to annually report: Data demonstrating that discounts and rebates received are used to reduce costs for policyholders; and An actuarial certification attesting that the health insurer and PBM are compliant with the law and that the data submitted to the division is accurate. The act requires the commissioner of insurance (commissioner) to promulgate rules to implement the rebate requirements in the act. Beginning in 2023, the act requires the department of health care policy and financing, in collaboration with the administrator of the all-payer claims database, to conduct an annual analysis of the prescription drug rebates received in the previous calendar year, by carrier and prescription drug tier, and make the analysis available to the public. For the 2022-23 state fiscal year, $252,667 is appropriated from the division of insurance cash fund 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 makes changes to the Tony Grampsas youth services program (program). The act eliminates state agencies and state-operated programs from the list of entities that can apply for a grant to participate in the program and changes the definition of "entity" to ensure compliance with federal case law. The act adds prevention services to the services provided for youth and their families through community-based programming, including services for reducing crime and violence, abuse and neglect, drug and alcohol use, and school dropouts. The act changes certain criteria for adult and youth members to be appointed to the Tony Grampsas youth services board and requires the grant application process for participating in the program to identify and prioritize funding programs that meet a need in the community. The act requires entities that provide evidence-informed services for the youth mentoring services program to meet certain criteria. The act specifies for entities providing services for the Colorado student before-and-after-school project that the services may include alcohol, tobacco, and other drug use intervention, prevention, and education components. The act requires unexpended and unencumbered money remaining in the funds that support the program at the end of a state fiscal year to remain in the funds and available for expenditure by the state department in the following state fiscal year without further appropriations to the funds. (Note: This summary applies to this bill as enacted.)

Beginning June 1, 2022, a health-care facility shall screen each uninsured patient for eligibility for public health insurance programs, discounted care through the Colorado indigent care program (CICP), and discounted care as described in the act. Health-care facilities shall use a single uniform application developed by the department of health care policy and financing (department) when screening a patient. If a health-care facility determines a patient is ineligible for discounted care, the facility shall provide the patient notice of the determination and an opportunity for the patient to appeal the determination.Beginning June 1, 2022, for emergency and other non-CICP health-care services provided to patients qualified for public health insurance or discounted care, a health-care facility and licensed health-care professional shall limit the amounts charged to not more than the discounted rate established by the department; collect amounts charged in monthly installments such that a patient is not paying more than 4% of the patient's monthly household income on a bill from a health-care facility and not paying more than 2% of the patient's monthly household income on a bill from each licensed health-care professional; and after a cumulative 36 months of payments, consider the patient's bill paid in full and permanently cease any and all collection activities on any balance that remains unpaid.Beginning June 1, 2022, a health-care facility shall make information about patient's rights and the uniform application for discounted care available to the public and to each patient.Beginning June 1, 2023, and each June 1 thereafter, each health-care facility shall report to the department data that the department determines is necessary to evaluate compliance across patient groups based on race, ethnicity, age, and primary language spoken with the required screening, discounted care, payment plan, and collections practices.No later than April 1, 2022, the department shall develop a written explanation of a patient's rights, make the explanation available to the public and each patient, and establish a process for patients to submit a complaint relating to noncompliance with the requirements. The department shall periodically review health-care facilities and licensed health-care professionals (hospital providers) to ensure compliance, and the department shall notify the hospital provider if the hospital provider is not in compliance that the hospital provider has 90 days to file a corrective action plan with the department. A hospital provider may request up to 120 days to submit a corrective action plan. The department may require a hospital provider that is not in compliance to develop and operate under a corrective action plan until the department determines the hospital provider is in compliance. The act implements fines for hospital providers if the department determines the hospital provider's noncompliance is knowing or willful.Beginning June 1, 2022, the act imposes requirements on hospital providers before assigning or selling patient debt to a medical creditor or before pursuing any permissible extraordinary collection action and imposes fines for any hospital provider that fails to comply with the requirements.Beginning June 1, 2022, a medical creditor shall not use impermissible extraordinary collection actions to collect debts owed for hospital services. A medical creditor may engage in permissible extraordinary collection actions 182 days after the patient receives hospital services. At least 30 days before taking any permissible extraordinary collection action, a medical creditor shall notify the patient of potential collection actions and shall include with the notice a statement that explains the availability of discounted care for qualified individuals and how to apply for such care. If a patient is later found eligible for discounted care, the medical creditor shall reverse any permissible extraordinary collection actions.Beginning June 1, 2022, a medical creditor shall not sell a medical debt to another party unless, prior to the sale, the medical debt seller has entered into a legally binding written agreement with the medical debt buyer in which certain terms are agreed to. The medical debt seller shall indemnify the medical debt buyer for any amount paid for a debt that is returned to or recalled by the medical debt seller.Beginning June 1, 2022, the department shall promulgate rules prohibiting hospitals from considering assets when determining whether a patient meets the specified percentage of the federal poverty level for CICP and ensuring the method used to determine whether a patient meets the specified percent is uniform across hospitals.The act appropriates $219,295 to the department of health care policy and financing to implement the act.(Note: This summary applies to this bill as enacted.)

The act creates 3 different programs in the department of local affairs (DOLA) for the purpose of offering grant money and other forms of state assistance to local governments to promote innovative solutions to the development of affordable housing across the state.Local government affordable housing development incentives grant program (housing development incentives grant program). This program will provide grants to local governments that adopt not less than 3 policy and regulatory tools from among a menu of options that create incentives to promote the development of affordable housing. A local government that adopts such tools is eligible for a grant from the housing development incentives grant program as an incentive to develop one or more affordable housing developments in their community that are liveable, vibrant, and driven by community benefits. The division of local government (DLG) within DOLA administers the housing development incentives grant program.The act enumerates items included in the menu of policy and regulatory tools.Local government planning grant program. This program will provide grants to local governments that lack one or more of the policy and regulatory tools that provide incentives to promote the development of affordable housing that forms the basis for a grant under the housing development incentives grant program and that could benefit from additional funding to be able to create and make use of these policy and regulatory tools. Money under the planning grant program will be available to a local government to enable the government to retain a consultant or a related professional service to assess the housing needs of its community or to make changes to its policies, programs, development review processes, land use codes, and related rules to become an eligible recipient of a grant under the housing development incentives grant program. The planning grant program will be administered by the DLG. As part of its administration of the planning grant program, the DLG will provide assistance to local governments on best land use practices and tools and is required to update and publish model county and municipal land use codes for the benefit of local governments across the state.The affordable housing guided toolkit and local officials guide program (housing toolkit program). This program creates the housing toolkit program within the division of housing (DOH) within DOLA. The purpose of the housing toolkit program is to award funding to qualified counties, and municipalities, and federally recognized tribes within the state selected in a competitive process who commit to the adoption of best land use practices with demonstrated success in the development of affordable housing. Under the housing toolkit program, technical assistance will be provided by consultants and related professionals to local governments who demonstrate an understanding of the housing needs of their communities, take steps to engage their entire communities in this process, make changes to their land use codes and related processes that provide incentives and reduce barriers to the development of affordable housing, obtain and support viable sites in their communities for the development of affordable housing, and attract developers committed to making such investments in their communities. The DOH is to administer the housing toolkit program.In evaluating applications for grants from the housing development incentives grant program, the act requires the DLG to prioritize proposals submitted by local governments based on factors specified in the act.On or before September 1, 2021, the act requires the executive director of DOLA or the executive director's designee to adopt policies, procedures, and guidelines for the 3 different state assistance programs that include, without limitation:Procedures and timelines by which an eligible recipient may apply for a grant; Criteria for determining the amount of grant awards; Performance criteria for grant recipients' projects; and Reporting requirements for grant recipients. On the effective date of the act, or as soon as practicable thereafter, the state treasurer is required to transfer $30,000,000 from the affordable housing and home ownership cash fund to the Colorado heritage communities fund and $9,300,000 from the general fund to the Colorado heritage communities fund. DLG must use this money transferred for the creation, implementation, and administration of the housing development incentives grant programs.On the effective date of the act, or as soon as practicable thereafter, the state treasurer is required to transfer $5,000,000 from the affordable housing and home ownership cash fund to the Colorado heritage communities fund and $2,100,000 from the general fund to the Colorado heritage communities fund. DLG must use this money transferred for the creation, implementation, and administration of the planning grant program.On the effective date of the act, or as soon as practicable thereafter, the state treasurer is required to transfer $1,600,000 from the general fund to the housing development grant fund for the creation, implementation, and administration by the DOH of the housing toolkit program.All costs incurred in administering any of the 3 programs created under the act must be paid out of the money transferred under the act. All money transferred under the act for the 3 state programs must be expended over the subsequent 3 state fiscal years.On or before November 1 of each year, the executive director of DOLA or the director's designee is required to publish a report summarizing the use of all assistance that was awarded from the 3 different programs created under the act in the preceding fiscal year. The act specifies additional required contents of the reports. The reports must be shared with the general assembly and posted on DOLA's website.The act updates and repeals obsolete statutory provisions concerning the office of smart growth (OSG) within DOLA and the Colorado heritage communities fund.The act authorizes the OSG, as money becomes available, to provide grants or other forms of assistance to counties and municipalities to address critical planning issues and specifies examples of the forms of assistance that may be provided by the office. The OSG is required to create guidelines to specify the activities on the part of local governments that will qualify for grant funding or other forms of assistance provided under the act. The OSG is permitted to use available money to administer the Colorado heritage grant program.The act appropriates $39,300,000 to DOLA from the Colorado heritage communities fund for the affordable housing development incentives grant program.The act appropriates $7,100,000 to DOLA from the Colorado heritage communities fund for the local government planning grant program.(Note: This summary applies to this bill as enacted.)

The act creates, initially within the department of labor and employment, the Colorado office of new Americans (ONA). The act sets forth the ONA's duties and responsibilities and provides details regarding funding. The ONA serves as the point of contact for immigrant-serving state agencies, private sector organizations, and the public about immigrant issues in Colorado, and has as one of its central purposes the successful integration and inclusion of immigrants and refugees in our state's communities. As its main priority, the ONA is required to implement a statewide strategy to facilitate economic stability and promote successful economic, social, linguistic, and cultural integration by investing in the success of immigrants in Colorado.(Note: This summary applies to this bill as enacted.)

The act updates language that must be included on a court summons issued to a defendant-tenant in an eviction action explaining the consequences for failing to answer the complaint, the content of an answer, and the fees and deposits related to filing an answer.The act prohibits a county sheriff from executing a writ of restitution, which directs the sheriff to assist the landlord in removing the tenant, until at least 10 days after a landlord wins judgment in an eviction action.The act prohibits residential landlords from increasing rent more than one time in a 12-month period of tenancy. For a residential tenancy of any duration in which there is no written agreement, the act requires a landlord to give a tenant 60 days' notice prior to increasing rent. The act prohibits a landlord from terminating a residential tenancy in which there is no written agreement with the primary purpose of increasing a tenant's rent without providing 60 days' notice.(Note: This summary applies to this bill as enacted.)

The act requires the commissioner of insurance (commissioner) in the department of regulatory agencies to establish a standardized health benefit plan by rule on or before January 1, 2022, to be offered by health insurance carriers (carriers) in the individual and small group markets. The standardized plan must:Offer health-care coverage at the bronze, silver, and gold levels of coverage; Include pediatric and other essential health benefits; Be offered through the Colorado health benefit exchange and in the individual market; Have a standardized benefit design that is created through a stakeholder engagement process, has a defined benefit design and cost sharing that improves access and affordability, and is designed to improve racial health equity and decrease racial health disparities; Provide by, among other measures, providing first-dollar, predictable coverage for certain high value services; Be actuarially sound and allow carriers to meet financial requirements; Comply with state and federal law; and Have a provider network (network) that is culturally responsive and reflects the diversity of its enrollees and be no more narrow than the most restrictive nonstandardized plan offered by the carrier. Each carrier must:Include, as part of its network access plan for the standardized plan, a description of its efforts to construct diverse, culturally responsive networks; Include a majority of the essential community providers in the service area in its network; and Allow consumers to easily compare the standardized health benefit plans offered by each carrier. Additionally, the act requires the commissioner to:Promulgate rules regarding network adequacy; Contract with an independent third party to conduct an analysis of the implementation of the standardized health benefit plan and the related requirements; and Collaborate with the health benefit exchange to conduct a consumer survey. Beginning January 1, 2023, and each year thereafter, the act requires carriers that offer:An individual health benefit plan in Colorado to offer the standardized health benefit plan in the individual market in each county where the carrier offers an individual plan; and A small group health benefit plan in Colorado to offer the standardized health benefit plan in the small group market in each county where the carrier offers a small group plan. In the individual market and in the small group market, each carrier shall offer a standardized health benefit plan premium that:For 2023, is at least 5% less than the premium rate for health benefit plans offered by that carrier in the 2021 calendar year, as adjusted for medical inflation; For 2024, is at least 10% less than the premium rate for health benefit plans offered by that carrier in the 2021 calendar year, as adjusted for medical inflation; For 2025, is at least 15% less than the premium rate for health benefit plans offered by that carrier in the 2021 calendar year, as adjusted for medical inflation; For 2026 and each year thereafter, is increased above the premium in the previous year by no more than medical inflation, relative to the previous year. The act also requires each carrier to file its premium rates for the standardized health benefit plan with the commissioner. If a carrier or health-care provider anticipates that a carrier will be unable to meet network adequacy standards or the premium rate requirements due to a reimbursement rate dispute, the carrier or the health-care provider may initiate nonbinding arbitration prior to filing rates for the standardized health benefit plan. If a carrier cannot meet the premium rate requirements, the carrier must notify the commissioner of the reasons. The division shall hold a public hearing concerning network adequacy and premium rates. Based on evidence at the hearing, the commissioner may establish carrier reimbursement rates for hospitals and health-care providers and require the hospitals and health-care providers to accept patients and the established reimbursement rates. The act establishes limits on the reimbursement rates that may be set.The act creates an advisory board, with members appointed by the governor, to implement the standardized health benefit plan. The advisory board is charged with considering recommendations to streamline prior authorization and utilization management processes, recommend ways to keep health-care services in communities where patients live, and to consider alternative payment models.The commissioner may apply to the secretary of the United States department of health and human services for a state innovation waiver to capture savings as a result of the implementation of the standardized health benefit plan. Upon approval of the waiver, the commissioner is authorized to use any federal money for the implementation of the bill and for the Colorado health insurance affordability enterprise.The act requires the commissioner to:Contract with an independent third party to prepare reports regarding the implementation of the bill; Monitor whether there is an adequate number of health-care providers in the carriers' standardized health benefit plan network and the percentage of premiums attributable to health-care providers in the network; Contract with an independent third-party organization to evaluate how to phase in a hospital's reimbursement rate methodology; Report various findings during the hearings conducted pursuant to the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act"; and Disapprove of a rate filing submitted by a carrier if the rate filing reflects a cost shift between the standardized health benefit plan and the health benefit plan for which rate approval is being sought. The department of public health and environment, upon notice from the commissioner, may fine or suspend or impose conditions on a hospital that refuses to participate in the standardized health benefit plan.The act creates the office of the insurance ombudsman in the department of health care policy and financing to act as an advocate for consumer interests in matters related to access to and affordability of the standardized health benefit plan.To implement this act:$1,409,637 is appropriated to the department of regulatory agencies for use by the division of insurance and the executive director's office, $212,680 of which is reappropriated to the department of law for the provision of legal services; and $78,993 is appropriated to the department of health care policy and financing.(Note: This summary applies to this bill as enacted.)

The act requires kindergarten through twelfth grade public schools (school), and strongly encourages nonpublic schools, to provide annual seizure-related training to school personnel who have direct contact with or supervise students who have a seizure disorder.The parent or legal guardian (parent) of a student who has been diagnosed with a seizure disorder, including epilepsy, (student) is encouraged to submit a signed, individualized seizure action plan (plan) to the school if the student may need assistance with seizure-related care in a school setting. The plan must be developed in coordination with recognized sources on epilepsy and seizure disorders and in consultation with a state organization that represents school nurses. The seizure action plan must be in accordance with the guidelines developed by the department of education. The parent is encouraged to provide updated information to the plan when necessary.(Note: This summary applies to this bill as enacted.)

The act implements the recommendations of the department of regulatory agencies (department) in its sunset review and report on the surgical assistants and surgical technologists registration program. Specifically, the act:Continues the registration of surgical assistants and surgical technologists for 7 years, until 2028; Requires a surgical assistant or surgical technologist whose registration is revoked or who has surrendered a registration in lieu of disciplinary action to wait 2 years before reapplying for registration and authorizes the director of the division of professions and occupations within the department (director) to issue letters of admonition and confidential letters of concern to surgical assistants and surgical technologists; Allows the director to enter into confidential agreements with surgical assistants or surgical technologists to limit practice based on an illness or other health condition that affects the ability to safely practice the profession; and Clarifies that a registrant may be disciplined for failing to notify the director of the limitations created by an illness or other health condition, act within such limitations, or act within the limitations imposed under a confidential agreement with the director to limit practice. The act also adds the following as grounds for discipline: Habitual or excessive use or abuse of alcohol, a habit-forming drug, or a controlled substance; Failing to notify the director within 30 days of any disciplinary action; Failing to respond to a complaint against the registrant in a materially responsive and timely manner within 30 days after receiving the complaint; Practicing outside the scope of the practice of a surgical assistant or surgical technologist; and Failing to satisfy generally accepted standards of practice as a surgical assistant or surgical technologist.(Note: This summary applies to this bill as enacted.)