These are all of the health care bills proposed in the 2020 session. Each bill has its own bill number, please use your browser search feature to find the bill you are interested in. Return to the Colorado home page to pick a different bill category.

None of the text is the opinion of Engage. Each bill's description, arguments for, and arguments against are our best effort at describing what each bill does, arguments for, and arguments against the bill. The long description is hidden by design, you can click on it to expand it if you want to read more detail about the bill. If you believe we are missing something, please contact us with your suggestion. Some of these bills have the notation that they have been sent to the chamber's "kill" committee. This means that the leadership has decided to send the bill to the State committee even though it does not belong there based on its subject matter. This committee, in both chambers, is stacked with members from "safe" districts and the idea is to kill the bill without forcing any less safe members to take a hard vote. It is possible for a bill to survive the kill committee, but it is very rare.

Prime sponsors are given after each bill, with Senate sponsors in () and House sponsors in []. They are color-coded by party.

Some bills will have text highlighted in pink or highlighted in orange or highlighted in yellow. Pink highlights mean House amendments to the original bill; orange mean Senate amendments; yellow highlights mean conference committee amendments. The bill will say under the header if it has been amended.

Each bill has been given a "magnitude" category: Mega, Major, Medium, Minor+, Minor, and Technical. This is a combination of the change the bill would create and the "controversy" level of the bill. Some minor bills that are extending current programs would be major changes if they were introducing something new, but the entire goal here is to allow you to better curate your time. Something uncontroversial likely to pass nearly unanimously that continues a past program may not be worth your time (and please remember, you can still read all of the minor bills!). Technical bills are here to round out the list. They are non-substantive changes.

House

Click on the House bill title to jump to its section:

MEGA

HB20-1086 Insurance Coverage Mental Health Wellness Exam PASSED HOUSE AND SENATE COMMITTEE AMENDED
HB20-1349 Colorado Affordable Health Care Option PASSED A HOUSE COMMITTEE AMENDED

MAJOR

HB20-1075 Protect Human Life At Conception KILLED IN HOUSE COMMITTEE
HB20-1098 Prohibition On Abortion After Twenty-two Weeks KILLED IN HOUSE COMMITTEE
HB20-1158 Insurance Cover Infertility Diagnosis Treatment Preserve PASSED AMENDED
HB20-1239 Consumer Protections Concerning Vaccinations KILLED IN HOUSE COMMITTEE

MEDIUM

HB20-1008 Health Care Cost-Sharing Consumer Protections PASSED HOUSE COMMITTEE AMENDED
HB20-1017 Substance Use Disorder Treatment In Criminal Justice System PASSED A HOUSE COMMITTEE AMENDED
HB20-1061 Human Immunodeficiency Virus Infection Prevention Medications PASSED HOUSE AMENDED
HB20-1065 Harm Reduction Substance Use Disorders PASSED A HOUSE COMMITTEE AMENDED
HB20-1068 Born Alive Child Physician Relationship KILLED IN HOUSE COMMITTEE
HB20-1078 Pharmacy Benefit Management Firm Claims Payments PASSED AMENDED
HB20-1085 Prevention Of Substance Use Disorders PASSED A HOUSE COMMITTEE AMENDED
HB20-1140 Direct Primary Care Services For Medicaid Recipients KILLED BY HOUSE COMMITTEE
HB20-1160 Drug Price Transparency Insurance Premium Reductions PASSED HOUSE COMMITTEE AMENDED
HB20-1198 Pharmacy Benefits Carrier And Pharmacy Benefit Manager Requirements
HB20-1232 Equity In Access To Clinical Trials In Medicaid PASSED HOUSE COMMITTEE
HB20-1236 Health Care Coverage Easy Enrollment Program PASSED HOUSE AMENDED
HB20-1340 Tanning Devices Risks Minors Prohibited

MINOR+

HB20-1090 Pharmacies To Provide Prescription Readers KILLED BY BILL SPONSORS
HB20-1092 Reimbursement To Federally Qualified Health Centers PASSED HOUSE COMMITTEE
HB20-1113 Mental Health Educational Resources PASSED A HOUSE COMMITTEE SIGNIFICANTLY AMENDED
HB20-1131 Menstrual Hygiene Products In Schools Program PASSED A HOUSE COMMITTEE SIGNIFICANTLY AMENDED
HB20-1139 Peer Support Professionals Behavioral Health PASSED A HOUSE COMMITTEE AMENDED
HB20-1199 Lower Minimum For Employer Health Stop-loss Insurance KILLED IN HOUSE COMMITTEE
HB20-1270 One Parent Consent For Behavioral Health Services PASSED HOUSE AND SENATE COMMITTEE AMENDED
HB20-1284 Secure Transportation Behavioral Health Crisis PASSED A HOUSE COMMITTEE AMENDED

HB20-1358 K-12 Seizure Safe Schools

MINOR

HB20-1006 Early Childhood Mental Health Consultants PASSED A HOUSE COMMITTEE AMENDED
HB20-1028 Need For Juvenile Behavioral Health Treatment KILLED BY BILL SPONSOR
HB20-1041 Physician Assistants Financial Responsibility Requirements PASSED
HB20-1050 Other Outlet Pharmacies Drug Distribution PASSED AMENDED
HB20-1103 Colorectal Cancer Screening Coverage PASSED HOUSE AMENDED
HB20-1183 Sunset Continue Certification Of Nurse Aides PASSED HOUSE AMENDED
HB20-1206 Sunset Mental Health Professionals PASSED HOUSE COMMITTEE AMENDED
HB20-1209 Sunset Nurse-physician Advisory Task Force PASSED HOUSE AND A SENATE COMMITTEE AMENDED
HB20-1210 Sunset State Board Of Chiropractic Examiners PASSED HOUSE COMMITTEE
HB20-1212 Sunset Naturopathic Doctors PASSED HOUSE SIGNIFICANTLY AMENDED
HB20-1216 Sunset Continue Nurse Practice Act PASSED HOUSE AMENDED
HB20-1218 Sunset Continue Hearing Aid Providers PASSED A HOUSE COMMITTEE AMENDED
HB20-1219 Sunset Continue Licensing Audiologists PASSED A HOUSE COMMITTEE AMENDED
HB20-1221 Complementary Or Alternative Medicine Pilot Program PASSED HOUSE COMMITTEE AMENDED
HB20-1230 Sunset Occupational Therapy Practice Act PASSED HOUSE AMENDED
HB20-1283 Administration Of Inhaler For Respiratory Distress KILLED BY BILL SPONSORS
HB20-1330 CGIA Colorado Governmental Immunity Act And A State Hospital Authority PASSED HOUSE COMMITTEE

TECHNICAL

HB20-1036 Align Emergency Medical Service Provider Statutes PASSED
HB20-1056 Nonsubstantive Reorganization Dental Practice Act PASSED

Senate

Click on the Senate bill title to jump to its section:

MEGA

SB20-145 Repeal Colorado Reinsurance Program KILLED BY BILL SPONSORS

MAJOR

SB20-028 Substance Use Disorder Recovery PASSED A SENATE COMMITTEE AMENDED
SB20-084 Prohibit Requiring Employee Immunization KILLED IN SENATE COMMITTEE
SB20-119 Expand Canadian Prescription Drug Import Program PASSED SENATE AMENDED
SB20-156 Protecting Preventive Health Care Coverage PASSED A SENATE COMMITTEE AMENDED

MEDIUM

SB20-007 Treatment Opioid And Other Substance Use Disorders PASSED SENATE COMMITTEE AMENDED
SB20-077 Born Alive Child Physician Relationship KILLED IN SENATE COMMITTEE
SB20-087 Require Credentials Central Service Technicians PASSED SENATE AND HOUSE COMMITTEE AMENDED
SB20-107 Drug Production Costs Transparency Analysis Report PASSED SENATE COMMITTEE AMENDED
SB20-127 Committee Actuarial Review Health Care Plan Legislation PASSED A SENATE COMMITTEE
SB20-163 School Entry Immunization PASSED SENATE AMENDED
SB20-188 Plain Language In Hospital Bills

MINOR+

SB20-001 Expand Behavioral Health Training For K-12 Educators PASSED A SENATE COMMITTEE AMENDED
SB20-022 Increase Medical Providers For Senior Citizens PASSED SENATE COMMITTEE
SB20-033 Allow Medicaid Buy-in Program After Age 65 PASSED SENATE AMENDED
SB20-040 Require License Practice Genetic Counseling PASSED SENATE AND A HOUSE COMMITTEE
SB20-102 Provider Disclose Discipline Convict Sex Offense PASSED SENATE AND HOUSE COMMITTEE AMENDED

MINOR

SB20-005 Covered Person Cost-Sharing Collected By Carriers PASSED A SENATE COMMITTEE VERY SIGNIFICANTLY AMENDED (new bill, magnitude change)
SB20-171 Children's Habilitation Residential Program Rules PASSED SENATE AMENDED

TECHNICAL

SB20-043 Out-of-Network Provider Reimbursement Rate SIGNED INTO LAW
SB20-045 Colorado Department Of Public Health And Environment Hospital License Requirements KILLED BY BILL SPONSORS
SB20-113 Colorado Department Of Public Health And Environment Health Facility License Requirements SIGNED INTO LAW

HB20-1006 Early Childhood Mental Health Consultants (Pettersen (D), Story (D)) [McCluskie (D), Sirota (D)]

From the Early Childhood and School Readiness Legislative Commission

AMENDED: Minor

PASSED A HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: Minimal in first year, then $420,000 in year two and $500,000 in year three.

Goal: Create the framework for a statewide program of early childhood mental health consultation.

Description:

State must design a statewide voluntary program of early childhood mental health consultation to support mental health care across the state in a variety of early childhood settings and practices in order to increase number of qualified early childhood mental health consultants for on-site consultations from prenatal period through 8 years of age. Program should also have a published list of certified mental health consultants and establish a statewide certification process for mental health consultants. State is directed to explore funding options for the program and report back to legislature by end of the year.

Additional Information:

State is to work with National Center of Excellence for Infant and Early Childhood Mental Health Consultation, nationally recognized entities that focus on promoting social, emotional, and behavioral outcomes of young children, and key stakeholders in the state, including mental health professionals, non-profits and hospitals with expertise in children’s mental health, and early childhood education providers.

Program must develop a defined model of consultation for the state that includes qualifications for mental health consultants, job expectations, expected outcomes, and guidance on ratios between mental health consultants and populations served. Must develop a plan to help mental health consultants reach these expectations.

Model must include:

  • Clear qualifications for consultants, including expertise in early childhood development, family systems, and mental health services for young children, knowledge of a consultative model of practice, and available resources and services to children and families.
  • Expectations for the placement of regional consultants to meet local community needs. Any publicly funded mental health consultants must be chosen through a competitive bidding process every three years.
  • Guidance concerning scope of care, including training, coaching, prevention, and other appropriate services
  • Methods to increase availability of bilingual or multilingual consultants
  • Guidance on the diversity of settings and providers to meet the varied needs from prenatal to age 8, including but not limited to early child care, elementary schools, home visits, child welfare caseworkers, and public health and Health Care professionals.
  • Achievement goals, including promoting social-emotional growth and development, guidance to professionals and caregivers about effective ways to support the child’s development, reduce challenging behaviors based on trauma, support mental health and well-being of adults caring for children, and connecting children and their families to available resources.
  • Guidance on appropriate ratios of mental health consultants and their populations, including case load expectations

Training in the plan must include:

  • Trauma and trauma-informed practices
  • Adverse childhood experiences
  • Resilience
  • Child development through age 8
  • Effects of caregiver substance abuse
  • Impact of inequity and bias on children, families, caregivers, mental health consultants, and providers, and strategies to mitigate it
  • Sensory processing issues
  • Needs of children with disabilities
  • State’s child protection and foster care system
  • Occupational therapy, speech therapy, physical therapy, and mental health therapy
  • Other public and private supports and services
  • Consultation as model

Plan must also include coaching strategies and support for consultants.

State must establish certificate by July 2022. State must also develop statewide data collection and information system to analyze implementation data by July 2022. Biannual reports due to the legislature with gap analysis of available number of consultants and unmet needs, and adjustments to better meet caseloads. State must also contract with an independent third-party to evaluate the program by August 2025 in preparation for presentation at SMART hearing in January 2026.


Auto-Repeal: None

Arguments For:

Mental health issues can occur very early in life. Early intervention and prevention can make all the difference in helping a child be set up for success and late intervention can make it very difficult to get a kid back onto a good path. But we have to walk before we can run here. We need to first decide exactly what we want in a mental health consultant in early childhood and what that would look like statewide. We also have to figure out different ways we can fund this. Early childhood support is tricky, not just from a developmental perspective but also from a variety of settings perspective: everything from homes to daycare to preschool to elementary school. If we just try to jump in with both feet now, we are likely to fail because the base of this program needs better definition first. In order to start with the larger overview, we have to start vaguer and then hone in on the model that will work best.

Arguments Against:

This all sounds nice in theory but the main problem in mental health care remains lack of funds. We don’t have enough qualified professionals because of lack of funding. We don’t have enough early intervention because of lack of funding. A program like this will never succeed unless it is explicitly funded with steady revenue streams.


There is too much vagueness in the program: the certification is not described at all, in terms of what minimum standards are in place to achieve it, there is no required amount of training, the types of training that are specified are in essence asking for a certified clinician. Are we looking to train more folks who are not mental health experts in this very specific area or are we looking to divert more mental health experts into this area? These are two very different directions with very different funding and implementation and we need to pick one. And of course there is no funding and the consultation is described as voluntary.

How Should Your Representatives Vote on HB20-1006

HB20-1008 Health Care Cost-Sharing Consumer Protections (Fields (D)) [Lontine (D)]

AMENDED: Moderate

PASSED HOUSE COMMITTEE

Appropriation: $28,347
Fiscal Impact: None

Goal: Treat health care cost-sharing programs more like insurance companies in terms of reporting activity to the state and force greater disclosure requirements from these programs to consumers.

Description:

Health care cost-sharing programs are similar to insurance companies in that they pool members in a national program and share the cost of medical care, while paying monthly fees and out of pocket for a certain amount before the program pays the rest. This bill requires these programs to report information regarding its operations in the state to the state, including financial statements, membership, and actions taken on medical bills. It also requires disclosures about the limitations of these programs on its website and all marketing materials and to respond to payment requests from providers within a set period of time. Copy of disclosure must be signed by any plan members. Programs are prohibited from making offers or enrolling anyone during the open enrollment period for health insurance. The bill also establishes penalties for failing to abide by any of these rules and for misrepresenting health care cost-sharing plans to the public.

Additional Information:

Definition of health care cost-sharing programs includes health care sharing ministries.

Annual disclosures from programs must include (all is for Colorado residents only):

  • Annual audited financial statements for previous year
  • Detailed list of any commissions or other fees paid to third parties for marketing, promotion, or enrolling members in the program or for operating, managing, or administering a program
  • List and description of member benefits, limitations, and exclusions
  • List of providers with whom the program has an agreement, contract, or other arrangement
  • Total number of members and households in the program in the previous year and if applicable, the total number of employer groups in the program and employees in those groups
  • Number of applications or other requests to join the program that were submitted, accepted, and denied in previous year
  • Total number of bills or medical expenses submitted to the program by or on behalf of members and the total amounts submitted, paid, and denied
  • Retroactive membership denials
  • Appeals or grievances submitted to the program, including number of appeals approved and dollar amounts approved
  • Any other information required by commissioner of insuranceTotal amount paid into the health care cost-sharing arrangment by members in previous year
  • Contact information for an individual serving as contact point for the state. This will not be made public

Programs must prominently display on their websites and in all marketing materials the following information as well as provide written disclosure to anyone enrolling or renewing anyone in the program:

  • Participation or membership in program does not guarantee payment of bills or medical expenses and program is not a qualified health plan
  • Member of a program remains personally responsible for payment of all bills or medical expenses
  • Member of a program may be subject to pre-existing condition exclusions or other limitations
  • Any other information required by commissioner of insurance

Penalty of up to $500 for initial violations and up to $5,000 for any subsequent failure to comply with any requirements.


Auto-Repeal: None

Arguments For:

If something sounds too good to be true, it probably is. These programs can and do exclude people with pre-existing conditions, they can deny care for actions they deem irresponsible (tends to happen more with the ministry programs), and they can have lifetime limits. In essence, this is health care before many of the protections in the Affordable Care Act. And at their most basic level they have no obligation to pay for anything and consumers cannot sue if they feel they were denied payment unfairly. There is very little evidence for how sustainable these types of programs are over the long-term with larger numbers of members with varying degrees of health. Note that the bill does not ban these programs. We at a minimum have to make sure people understand what they are signing up for, that it is in fact not insurance. And we need much closer monitoring of these programs to ensure they are keeping the promises they do make to Coloradans.

Arguments Against:

These programs fill multiple essential gaps in our communities. First, some healthy individuals do not want what the Affordable Care Act now mandates. They are young, they do not have much need of health care, and they cannot afford the hefty premiums associated with traditional insurance. Some businesses want to offer their employees a form of coverage but again, cannot afford traditional insurance. We also are facing multiple areas in the state with skyrocketing insurance coverage and only one available “choice” that is really no choice at all for those that cannot afford it. This is their only option and it is better than nothing. This bill is an attack on these plans, with provisions that essentially allow the commissioner of insurance (who is likely to be hostile) to require whatever they want in terms of annual disclosures and require the programs to provide written statements again saying whatever the commissioner wants.

How Should Your Representatives Vote on HB20-1008

HB20-1017 Substance Use Disorder Treatment In Criminal Justice System (Donovan (D), Priola (R)) [Herod (D), Kennedy (D)]

AMENDED: Moderate

PASSED A HOUSE COMMITTEE

Appropriation: $1.15 million
Fiscal Impact: Minimal beyond appropriation

Goal: Create a safe place for people to turn in controlled substances and seek help for addiction, increase support for diversion for those with behavioral health disorders from the justice system, increase availability of antagonists in prison and after release, and better support inmates with substance abuse disorders after they are released from prison.

Description:

  • Makes police stations and fire stations safe places for a person to drop off any controlled substance and request help in getting access to treatment without being subject to arrest for the substances. If the person needs immediate medical attention they should be transported to a medical facility, otherwise the police or firefighters must work with the person to find the best available destination for treatment.
  • Allows the office of behavioral health to contract with cities and counties to create, maintain, or expand criminal justice diversion programs for people with behavioral health disorders with prime purpose of connecting law enforcement with behavioral health providers. Appropriates $1.15 million for this purpose. State must report annually to legislature on progress.
  • Requires prisons to make at least one opioid agonist and one opioid antagonist available to anyone in custody for at least three days who has an opioid substance use disorder.
  • Requires department of corrections to develop resources for inmates post-release to help them successfully integrate back into their communities.
  • For people with a substance use disorder on medication assisted treatment, prior to release requires several steps from prisons based on the individual's treament and incarceration time. Less then 30 days and not receiving counseling must receive information on community treatment options (everyone gets at least this). More than 30 days, on stabilized medication assisted treatment and receiving counseling must be followed by case manager while in custody. Jail should try to ensure Medicaid is reinstated and schedule appointments as time permits. Final level is someone who has completed the second level. Prison must schedule appointments with their health care provider, ensure treatment services are readily available, provide the post-release resources the bill creates, ensure their Medicaid is reinstated (if applicable), and address transportation needs.
  • If a person who is petitioning to have a record sealed has either entered or completed a substance use disorder treatment program, requires the courts to favorably consider that when making a decision

Additional Information:

In developing the resources for post-release inmates, department of corrections is to consult with office of behavioral health, office of economic security, department of health care policy and financing, department of local affairs, and local services providers.


Auto-Repeal: None

Arguments For:

We have come a long way as a society in recognizing that drug abuse is a mental health condition, not a crime for which someone should be punished. In that light, one of the best things we can do is provide a safe avenue for someone who wants help. We have a similar stance with someone dropping an unwanted child off at a first responder facility. In this case, we get some drugs off the street as a bonus (drugs are both far too valuable and far too addictive for this to become much of a loophole for people worried about getting in trouble with the police abusing this). We have also come to understand the great value in police partnering with behavior health specialists to try to avoid getting someone tangled up with the criminal justice system. Multiple cities and counties in the state have piloted programs like this and found them to be extremely successful. It also helps free up our police a little bit to do more of their main job in keeping us safe. One of the most dangerous times for someone with a substance abuse disorder is when they first get out of prison. They may (or may not) have been forcibly detoxed in prison and may (or may not) have completed some form of treatment in this controlled environment. Free again without someone looking right over their shoulder, former inmates are highly susceptible to falling into bad old habits having lost a lot of their tolerance for the drug. This makes things doubly dangerous as they are more likely to overdose and die. So this bill requires prisons to ensure we do all we can for folks before they step out the door, including the antagonist back-stop for an emergency.

Arguments Against:

Parts of this is too large a burden on prisons. What are they supposed to do with someone who doesn’t have a health care provider of any kind? How are they to ensure treatment services are readily available? Medication assisted treatment requires more than a just a plan of action, how is that going to be available for the released inmate?


Dropping off drugs and being immune to prosecution for them is too big a stretch and too open to abuse. Someone who feels they are in danger of being arrested could just show up, dispose of the drugs, say they are interested in treatment, and then blow the whole thing off once they are away from the first responders.

How Should Your Representatives Vote on HB20-1017

HB20-1028 Need For Juvenile Behavioral Health Treatment (Gonzales (D)) [Beckman (R), Michaelson Jenet (D)]

From the School Safety Committee

KILLED BY BILL SPONSOR

Appropriation: None
Fiscal Impact: Minimal for one year

Goal: Create a working group to address the lack of residential and in-patient mental health treatment for children and youth with severe behavioral health needs.

Description:

Creates a working group inside the school safety resource center to address the needs of school districts with respect to the adequacy and availability of residential mental health treatment for children and youth who have been identified by school personnel as having severe behavioral or mental health disorders and potential ways to resolve such needs.

Additional Information:

Working group must include at a minimum, representatives from the department of education, department of public health and environment, department of health care policy and financing, local schools districts throughout the state, department of human services, county departments of human or social services, medical providers, and residential treatment providers.

Group must address:

  • Number of children and youth for whom the state provided residential treatment services in previous two years
  • Number of children and youth who needed residential services but for whom beds were unavailable in same time period
  • Cost associated with providing the additional residential treatment beds to meet the unmet need
  • Options available or potentially available to assist schools in handling children and youth who have been identified by school personnel as having severe behavioral or mental health disorders
  • Identifying barriers faced by children and youth who have mental health, substance use, or developmental issues when trying to access appropriate care
  • Plan for identifying , securing, and making fully operational additional residential treatment beds no later than September 2021

Report due in January 2021.


Auto-Repeal: None

Arguments For:

We are down to almost no residential health beds in the state and the downward trend is scary. We also have almost no day treatment, which is considered in-patient and also keeps kids who should not be in schools out of them and into places where they can get the help they need. When we don’t have the ability to send these kids to residential treatment or day treatment they stay in their homes and they go to school, where they are a huge safety risk to others and themselves. As for housing this as a school safety issue, some schools right now are the hubs of raising money for parents to send their kids out-of-state to programs. Local communities, in particular schools, are on the front lines and couching it this way keeps the focus narrower which should help us act faster. School safety is frankly also where a lot of money is at. The legislature has proven willing to spend tens of millions of dollars of additional funds every year in the name of school safety and if couching this approach as something that benefits school safety is the way to get it done, then great.

Arguments Against:

Schools do not run residential treatment centers and are not in the position to do so. While it would make sense to include schools in any task force examining this issue, approaching it from a perspective of school safety rather than mental and behavioral health of the children may limit the scope of this inquiry. Our ultimate goal is to get better mental and behavioral health for children, particularly those that require residential treatment. The school safety angle is a bit of a confounding factor.


We already know the problems here, they in part relate to new federal laws and they in part relate to a lack of funding support from the state. We don’t need another task force, we need action.

How Should Your Representatives Vote on HB20-1028

HB20-1036 Align Emergency Medical Service Provider Statutes (Woodward (R), Zenzinger (D)) [Arndt (D), McKean (R)]

PASSED

From the Statutory Revision Committee

Description:

Aligns provisions created by SB19-065 with provisions created by SB19-242 regarding EMS providers.

HB20-1041 Physician Assistants Financial Responsibility Requirements (Fields (D)) [Cutter (D)]

PASSED

Appropriation: None
Fiscal Impact: None

Goal: Treat physician assistants who have been practicing for at least three years the same as physicians for professional liability requirements.

Description:

Changes the professional liability coverage requirements for physician assistants who has been practicing for at least three years to be the same as physicians (right now is $1 million per incident and $3 million aggregate per year). Also allows the state medical board to exempt or lessen these obligations for physician assistants in the same manner as currently allowed for doctors.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

This doesn’t change the current requirements for physician assistants at all, they already are required to keep the same requirements as physicians. What it does is tie the physician assistants to physicians for any future changes. Since we are relying more and more on PAs it makes sense to treat them in the same manner when it comes to liability as physicians.

Arguments Against:

They may be doing many of the same things, but physician assistants are not allowed to do many of the more dangerous, potentially liability causing things, as physicians. The fact that they have same requirements now doesn’t mean we will want that to continue in the future. Keeping them separate gives us better flexibility going forward.

How Should Your Representatives Vote on HB20-1041

HB20-1050 Other Outlet Pharmacies Drug Distribution (Ginal (D), Tate (R)) [Hooton (D), Larson (R)]

AMENDED: Minor

PASSED

Appropriation: None
Fiscal Impact: None

Goal: Treat ambulatory surgical centers, hospices, and convalescent centers which compound, dispense, and deliver prescription drugs, but not to the general public, the same as hospitals that are set-up in the same way.

Description:

Current law allows hospitals that do not operate a registered pharmacy or any other way of distributing prescription drugs to the public but do engage in the compounding, dispensing, and delivering of these drugs to make a casual sale or loan of prescription drugs to another registered location or drug wholesaler, sell or give a prescription drug to a practitioner authorized by law to prescribe the drug and supply an emergency kit or starter dose to specified entities. This bill allows ambulatory surgical centers, hospices, and convalescent centers that are registered in the same way (do not operate pharmacy and do not distribute drugs to the public) to have the same allowances.

Additional Information:

Specific venues emergency or starter kits can be distributed to include facilities approved by state board, licensed and approved home health agencies, hospices, and acute treatment units. Casual sales cannot exceed 10% of the total number of units dispensed by the location on an annual basis.


Auto-Repeal: None

Arguments For:

These other venues already have the same registration type with the same guidelines as hospitals but are not allowed to make these distributions while the hospitals are. It doesn’t make sense to treat them that differently: the registration is the same and the activity in the facility is the same. We should allow these other facilities the same leeway we allow hospitals.

Arguments Against:

An ambulatory surgical center, hospice, or convalescent center is not the same thing as a hospital, even if all of these facilities can get the same registration as a prescription drug facility that does not dispense to the public. A hospital by definition of its licensing has different standards it must meet and that is why it is appropriate to treat it differently than the other facilities.

How Should Your Representatives Vote on HB20-1050

HB20-1056 Nonsubstantive Reorganization Dental Practice Act (Crowder (R), Ginal (D)) [Landgraf (R), Duran (D)] TECHNICAL BILL

PASSED

Description:

Non-substantially reorganizes the Dental Practice Act.

HB20-1061 Human Immunodeficiency Virus Infection Prevention Medications [A. Valdez (D), Herod (D)]

AMENDED: Moderate

PASSED HOUSE

Appropriation: $13,347
Fiscal Impact: None beyond appropriation

Goal: Require insurers to cover HIV prevention drugs and prohibit them for requiring pre-authorization or step therapy for access to the drugs.

Description:

Requires all insurers to cover FDA approved HIV prevention drugs. Insurers are to provide a pharmacist that dispenses the drugs an adequate consultation fee or adequate dispensing fee that is equivalent to what is provided to a doctor or advanced practice nurse. Insurers are prohibited from requiring pre-authorization or requiring step therapy (requiring lower cost and impact treatments first) for these drugs. Pharmacists are allowed to prescribe and dispense these drugs if have completed appropriate training and follow state guidelines.

Additional Information:

Pharmacists must complete a training program approved by the state that addresses the usage of HIV prevention drugs. Pharmacists must follow this process to deliver the drug:

  • Screen patient for HIV and ensure they are HIV negative
  • Provide counseling that includes education about side-effects, the importance of adhering to the entire drug regimen, and as applicable, behavioral risk reduction support, and pregnancy testing
  • Advise patient on current federal guidelines for taking medication
  • Document the services in the pharmacy’s patient record
  • Notify the patient’s primary care provider or if there is no primary care provider indicated, provide the patient with a list of potential providers
  • If the drug is a post-HIV exposure drug, the pharmacist must screen the patient for HIV and determine that the exposure meets the clinical criteria for usage of the drug
  • Must use a private and sanitized location and not interrupt service to do other tasks

Pharmacists must either a doctorate degree in pharmacy or have at least five years of experience as a licensed pharmacist. They must also carry adequate liability insurance as determined the state. State must also create rules and procedures for pharmaicsts all medical personnel to follow when dispensing these drugs, including physician referrals, lab testing, CDC guidelines, counseling, and follow-up care.


Auto-Repeal: None

Arguments For:

We have to make sure that at-risk Coloradans who want to use this effective drug to prevent getting HIV are able to do so without encountering roadblocks. Thanks to activity on the federal level, these drugs will be required to be covered by most insurance plans without any out-of-pocket expenses in 2021. The bill makes sure that all Colorado plans will cover these drugs, if they do not fall into the federal mandate. It also expands the ability for people to get the drugs to pharmacies (as opposed to requiring a doctor or advanced practice nurse). However, that does not ensure that insurers will not attempt other means to avoid paying for the drugs, which is what this bill addresses, as well as putting place procedures to ensure the drug is used properly because it does involve more than just one dosage and absolutely will not work if the regimen is not followed. But this is also not like performing surgery or interpreting a MRI. With proper training pharmacists are more than capable of delivering these drugs and allowing them to do so removes a significant barrier to accessing this drug.

Arguments Against:

This interferes too much in the operations of insurance companies. The use of prior authorizations and step treatment are ways to ensure the insurer (and by extension, all of the people who pay premiums) aren’t wasting money on a drug that either is not really necessary (most people are not at high-risk of getting HIV) or won’t be followed through upon properly. Instead insurers will have to pay for anyone who can prove they are not HIV positive to take the medication.


The degree of compliance required here means we should not allow pharmacies to dispense these drugs, trained or not. Some things just require someone with more training and expertise dealing with patients. The other benefit to keeping this to doctors and advanced practice nurses is that we have an expert who can help decide if this is really necessary or if the patient does not have a high-risk of contracting HIV.

How Should Your Representatives Vote on HB20-1061

HB20-1065 Harm Reduction Substance Use Disorders (Pettersen (D), Priola (R)) [Kennedy (D), Herod (D)]

AMENDED: Minor

PASSED A HOUSE COMMITTEE

Appropriation: $250,000 annually
Fiscal Impact: None beyond appropriation

Goal: Improve access to clean syringes, make it easier for hospitals to send antagonists home with patients, and provide continued funding to harm reduction programs.

Description:

Allows pharmacists to sell a non-prescription syringe or needle to anyone and notify any individual filling an opioid prescription about the availablity of antongists if the pharmacist deems it beneficial. Removes requirement that county or district boards of health approve clean syringe exchange programs, but requires them to be licensed or certified by the state and report monthly to the state. Allows hospitals to operate clean syringe programs. Requires insurers that provide coverage for opiate antagonists to reimburse a hospital if it provides an insured person with an antagonists on discharge. Extends civil and criminal immunity for anyone acting in good faith to administer an antagonist when the antagonist is expired. Permanently appropriates an additional $250,000 to the Harm Reduction Grant Program, which makes the total appropriation $2.1 million.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

People who abuse drugs aren’t going to stopped by an inability to get a clean syringe. The only thing that denying clean syringes to them does is force them into using dirty syringes. And almost no community is immune from substance abuse. Just because it is not readily visible does not mean it is not there. There are places where local non-profits have been unable to start up syringe access program because the local board of health said no. These boards do not have the ability to veto any other kinds of health care facilities so they should be able to veto this kind of facility, which also provides important health care treatment. Clean syringe exchange programs allow us to do more than just prevent the spread of disease through dirty syringes (which is also really important). They also allow for easier access to provide other kinds of health care services and counseling, if the individual seeking the syringe will agree. And while we have made quite a bit of progress, there is a long way to go. So permanent funding of the harm reduction program makes sense to establish a secure funding base.

Arguments Against:

Syringe exchange programs are just encouragement for people with drug problems. We should be focusing on getting them off drugs, not giving them clean needles. This especially should not be done without approval of the local board of health which represents the community. Communities should have a say because having a clean syringe exchange in their area will bring people abusing substances to the site in order to exchange needles. If a community does not want that to occur it should have the ability to say no.

How Should Your Representatives Vote on HB20-1065

HB20-1068 Born Alive Child Physician Relationship [Sandridge (R)]

KILLED IN HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Create a doctor-patient relationship between doctors who perform abortions and any child who is born alive after the procedure.

Description:

Creates a doctor-patient relationship between doctors who perform abortions and any child who is born alive after the procedure. This requires the doctor to exercise the same degree of professional skill, care, and diligence to preserve the life and health of the child as would be done to any other child born at the same gestational age and requires immediate transportation to a hospital. Civil penalty of $100,000 and a class 3 felony for violations, as well as an unprofessional conduct put on the doctor’s license.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

Of course we already have murder laws on the books but this bill is aimed at passive situations to ensure that no doctor backs away from providing medical needed to keep a baby alive. If an abortion procedure goes wrong and the result is a baby that is alive, we owe to that living being to try to keep it alive to the best of our abilities, just as we would for any other baby at that same gestational age. If survival is not possible and comfort care is the only thing we can do for the baby, then that is what this law would dictate happen. But if survival is possible, even if unlikely, we have to ensure that doctors will do everything they can. By limiting this protection to the child only to abortions, the relationship and duty will only apply when an abortion was attempted and induced premature births for fetal health abnormalities wouldn’t apply since the goal was to deliver a live baby.

Arguments Against:

Killing a child is already illegal in this country and thanks to a law passed in 2002, infants born at any stage of development have full legal rights, so this bill is not solving any problem with an alive child being killed by a doctor. In fact in 2013 a doctor was found guilty of three counts of murder for botched illegal abortions in Philadelphia that involved children born alive. This bill also creates a huge problem: abortion is not defined in the bill, so situations where a parent has made the difficult decision to induce labor for fetal abnormalities may be swept up into this law. The vast majority of late-term abortions (extremely rare by the way, just 1.4% of all abortions happen at 21 weeks or beyond), where gestational age is advanced enough that survival is a possibility, are performed in a way that make survival impossible. And in catastrophic pregnancies, where there is a plan to deliver the fetus but the parents know there is a strong chance it will not survive, this bill might force extraordinary measures the parents have chosen not to undertake. It might have a chilling effect on the willingness of doctors to adhere to parents’ wishes in these cases, even if the doctor knows it is hopeless. So in summary, this bill looks to solve a problem that is already covered by law by creating fear around something that does not happen but creates new problems in the process.

How Should Your Representatives Vote on HB20-1068

HB20-1075 Protect Human Life At Conception (Marble (R)) [Humphrey (R), Saine (R)]

KILLED IN HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Make abortion illegal in Colorado except for protecting the mother’s health and a few other limited circumstances.

Description:

Prohibits abortion except in cases of protecting the mother’s health, when the fetus is already dead in the mother’s womb, if a physical is performing chemotherapy and accidentally kills the fetus, or to remove an ectopic pregnancy. Makes it a class 1 felony for the doctor, no punishment for the mother. States that the sale, use, prescription, and administration of contraceptive measures, devices, drugs, or chemicals is still legal.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

No one is forcing anyone to keep a child. Any mother who does not want her child is free to put it up for adoption. But abortion is a nice way of saying killing an unborn fetus. Whether or not a fetus could live outside the womb is not really the issue, the issue is that the act kills it and ends a potential human life before it has even begun. In cases where the health of another human, the mother, is threatened, then of course the mother’s health must be protected. The constitutionality of abortion may change with the new composition of the Supreme Court, which is what decides what is or is not constitutional in our country. This law is an opportunity for the state to test whether the Supreme Court will strike down Roe v. Wade.

Arguments Against:

This is the most deeply personal medical choice for any woman, and to be clear, it is a personal medical choice. The right to choose abortion is essential to ensuring a woman can decide for herself if, when and with whom to start or grow a family. Women have the right to make their own decisions about their bodies. A fetus is not a baby, there is a reason why we have separate terms for the two. Abortion is legal in this country (another issue with this bill, it is unconstitutional, full-stop, which it recognizes by stating the courts of the federal government have no jurisdiction to interfere with Colorado law in this area, which is not true) because we recognize that until it is born, a fetus is not a baby. We also know, for a fact, from our history that criminalizing abortion doesn’t end the practice, it merely moves it into the shadows and alleys where it becomes less safe. And that the result is people with means find a way to still obtain an abortion in a mostly safe environment while people who do not have means find a way to obtain an abortion in a very dangerous one. Finally, this contains no exception for rape or incest, forcing a woman to carry her abuser’s baby to full term and delivery. This could jeopardize our federal Medicaid funding, because Medicaid requires any woman who is the victim of rape to be able to obtain an abortion through Medicaid. And this could result in investigations of women who have miscarriages or a stillbirth.

How Should Your Representatives Vote on HB20-1075

HB20-1078 Pharmacy Benefit Management Firm Claims Payments (Winter (D)) [Jaquez Lewis (D), Mullica (D)]

AMENDED: Moderate

PASSED

Appropriation: None
Fiscal Impact: None

Goal: Force pharmacy benefit management firms to reimburse pharmacies equally.

Description:

Specify the amount a pharmacy benefit management firm (PBM) is required to reimburse a pharmacy for a clean claim and for reasonable dispensing fees. Prohibit PBMs from retroactively reducing payment on a clean claim unless an audit discovers the claim was not actually clean. Health insurers must create contracts with any PBMs they use with these requirements. Violations are a deceptive or unfair trade practice.

Additional Information:

For clean claims PBMs must reimburse an amount that they reimburse any other affiliate for the same service and it must be calculated either on a per-unit basis using the same generic product identifier or code number or sufficient to reimburse pharmacy for ingredient component of the pharmacists services minus the national average drug acquisition cost or if that is unavailable, the wholesale acquisition cost.


Auto-Repeal: None

Arguments For:

PBMs are essentially middle men. They serve as intermediaries between insurers, pharmacies, and drug companies by negotiating prices, providing drug utilization reviews, and sometimes requiring certain preferred drugs to treat conditions. PBMs play around with reimbursement amounts to pharmacies in several ways that directly profit PBMs, hurt pharmacies, and suck money out of the health care system. First, arbitrary and opaque reimbursements, often at huge advantages to the PBM. A study in Ohio found a PBM charging the state’s Medicaid almost $6 per prescription, nearly five times the standard rate (which of course it was paying the pharmacies). Second, preferential treatment to certain pharmacies, especially those owned by PBMs. Yes, PBMs own pharmacies themselves and can pay their own pharmacies more than independent pharmacies for the same service. Third, retroactive changes to what pharmacies are owed (by either clawing back funds or reducing future reimbursements). In all, PBM practices around pricing to pharmacies are a clear example of an unfair trade practice, drive up the cost of health care for all Coloradans, and need to be put onto a level, regulated, playing field.

Arguments Against:

PBMs are the boogeyman right now but they serve an essential role in our health care system. Pharmacies simply do not have the negotiating power to drive down prices from prescription drug companies on their own and potentially save billions on drug costs. Pretty much all prescription rebates in Medicare, for instance, are thanks to PBMs. And of course nothing comes for free, they profit off the service they provide that administer programs for more than 270 million Americans, but you must compare the profit of the industry against the money it is saving. And yes, PBMs operate their own pharmacies, but this allows them to more efficiently serve the market. Forcing PBMs to charge everyone the same thing, regardless of how efficient the pharmacy is or what other relationships PBMs have, may be detrimental not only to PBMs bottom line, but also their ability to save consumers money at certain pharmacies.


This bill doesn’t go far enough. It does not at all regulate PBM spread pricing, which is where they pocket the difference in legitimate payments to pharmacies (so would be fine under this bill) with price-gouging to insurers like what happened in Ohio with Medicaid.

How Should Your Representatives Vote on HB20-1078

HB20-1085 Prevention Of Substance Use Disorders (Winter (D), Priola (R)) [Kennedy (D), Herod (D)]

AMENDED: Minor

PASSED A HOUSE COMMITTEE

Appropriation: $4.25 million
Fiscal Impact: Aside from appropriation, about $750,000 next year

Goal: Extend several existing limitations on opioids to prevent over-prescribing, modify access and rules around the state’s prescription drug database, and promote alternatives to opioid treatment, including non-pharmaceutical options, with requirements for insurance coverage.

Description:

  • Requires commissioner of insurance to conduct a feasibility study to see if is actuarially possible for insurance companies to cover acupuncture as a covered alternative treatment to opioids. Requires insurers to cover at least 6 physical therapy and at least 6 occupational therapy visits per year with a maximum of one copayment for alternatives to opioids for pain. If acupuncture is found to be feasible,And at least 126 acupuncture visits must be covered a year with maximum of one copayment. These must all be at the insurer's lowest cost-sharing tier. Any other non-pharmacological treatments the commissioner approves must also be covered.
  • Insurers are prohibited from banning or punishing these therapists from telling clients the amount of their financial responsibility for care and also prohibited from requiring therapists to collect copays higher than what is owed.
  • Prohibits insurers from limiting coverage of any atypical opioid or alternative pain treatment that is approved by the FDA through step-treatment (must try other less expensive options first) or prior authorization requirements. Prescription still needed from doctor. Insurer must make drug available at lowest level cost-sharing tier applied to an opioid that would have been used in the same situation.
  • Permanently extends the ban on opioids being prescribed no more often than one 7-day supply in a year, with a few exceptions. Permanently extends the requirement that providers must check the state’s prescription drug monitoring program before prescribing a second fill for an opioid and before any fill of benzodiazepine, with a few exceptions.
  • Requires state to consult with center for research into substance use disorder prevention, treatment, and recovery support strategies and the state medical board to create continuing education requirements for prescribers on best practices for opioids.
  • Expands access to the drug monitoring program to medical examiners and coroners from their previously autopsy-only access to include death investigations as well. Changes the requirements for adding information to the program slightly and adds the name of the person paying for the prescription as required information, and allows the department of health care policy and financing and the health information organization access to it.
  • Extends permanently the appropriation of $2 million to the state department to address opioid and substance use disorders through public health interventions and work with community partners. Adds requirement that state consider goal of addressing underserved populations and communities. State can still use up to $500,000 for administrative costs.
  • Extends permanently the appropriation of $1.5 million to the Substance Use Disorder Screening, Brief Intervention, and Referral to Treatment Grant Program. Adds requirement for grant program to consider underserved communities. Adds another $500,000 in marijuana cash funds for five years for grant fund to use for technical assistance to sustain operations and practices implemented in grant program and to monitor grantees through quantitative and qualitative analysis.
  • Appropriates $250,000 of marijuana cash funds a year for the next five years to the center for research into substance use disorder prevention, treatment, and recovery support strategies to continue to develop and implement continuing education to prescribers. Adds requirement to specifically address benzodiazepines.
  • Creates a prevention collaborative consisting of institutions of higher education, non-profits, and state agencies to gather feedback from local public health agencies and groups represented in the collaborative on evidence-based prevention practices. Directs marijuana tax funding for operations but does not specify an amount.

Additional Information:

Commissioner to decide what atypical opioids and other non-opioid pain relievers must be covered as alternatives. Also decides what other drugs must be entered into state tracking database. Those entering information into the state database must do so daily. Clarifies that there can be no fee charged for pharmacists and prescribers for accessing the database. Exceptions for benzodiazepine query requirement are: hospice care, seizure treatment, alcohol withdrawal, or neurological or psychological emergency.

Exact mission of the collaborative is:

  • Coordinate and assist state agencies and communities to strengthen prevention infrastructure and implement a statewide strategic plan for primary prevention of substance use disorders
  • Advance the use of tested and effective prevention programs and practices through education, outreach, advocacy, and technical assistance, with emphasis on underserved communities and populations
  • Raise public awareness of cost savings of preventative measures
  • Provide direct training and technical assistance to communities regarding selection, implementation, and sustainment of tested and effective primary prevention programs
  • Pursue local and state policy changes and advise state agencies and communities to enhance use of these programs
  • Support funding efforts to align funding and services and help communities with funding strategies
  • Establish a minimum prevention standard for the state
  • Expand state’s prevention workforce

Office of behavioral health to work with collaborative to establish community coalitions, implement primary prevention programs, coordinate with state agencies and other organizations, and report back to legislature.


Auto-Repeal: Collaborative, September 2024. Technical assistance funds, FY2023-2024. Continuing education funds, FY2024-2025.

Arguments For:

One of the most important areas in tackling substance abuse is stopping people from getting hooked in the first place. We know that the prime driver of the opioid crisis is legally prescribed opioid prescriptions for pain. This bill attacks this cause head-on in multiple areas, by extending already existing limitations on prescribing opioids to better educators prescribers to providing viable alternatives that cost the same to the member of the public. Because if we do not make all things equal in that sense, people will reach for the less expensive, opioid, option. We have made great strides, but there is much work still to be done. So we must continue to funds the efforts we have started and rather than place some arbitrary end date on these successful programs, let’s just keep doing them until we decide we don’t need them anymore. They are far less expensive than the massive costs of substance abuse on our society.

Arguments Against:

This bill doesn’t throw enough funding into the effort and does not specifically fund the collaborative. It is absolutely true that prevention is a massive cost-savings for society (it’s even one of the goals of the collaborative to increase public awareness of this). Let’s spend more money on prevention. If that means less money spent on treatment and recovery supports (money has to come from somewhere) then so be it.


This bill adds a lot of unnecessary red tape to the state’s bureaucracy: prescribers that barely interact with people getting opioids and wasting medical examiner’s time by playing detective instead of using the body they have in front of them. It also delegates too much power to the commissioner of insurance to dictate what non-opioid treatments must be covered by insurers and what prescription drugs must be entered into the state tracking system, which will be a drag on the use of the drug.

How Should Your Representatives Vote on HB20-1085

HB20-1086 Insurance Coverage Mental Health Wellness Exam (Fields (D)) [Michaelson Jenet (D), Larson (R)]

AMENDED: Minor

PASSED HOUSE AND SENATE COMMITTEE

Appropriation: $13,347
Fiscal Impact: None beyond appropriation

Goal: Provide an annual mental wellness exam as part of mandatory health insurance coverage at no charge to the insured party.

Description:

Require an annual mental health wellness exam performed by a qualified mental health care provider of up to 60 minutes to be part of the mandatory health insurance coverage of preventive health care services at no charge to the insured. Coverage must be comparable to annual physical examinations and comply with federal mental health parity laws. Must check with federal government that state would not be subject to defrayal for this benefit. If government does not respond within one year the state may proceed.

Additional Information:

Examination includes services such as:

  • Behavioral health screening
  • Education and consultation on healthy lifestyle changes
  • Referrals to ongoing treatment
  • Mental health services and other supports
  • Discussion of potential options for medication

Qualified mental health care providers include:

  • Licensed physician with specific board certification or training in psychiatry or other mental or behavioral health care areas
  • Licensed psychologist, licensed clinical social worker, licensed professional counselor, or licensed addiction counselor
  • Advanced practice nurse with specific training in psychiatric nursing


Auto-Repeal: None

Arguments For:

Just as we have annual physicals for preventive medicine, so we should have annual mental health wellness exams for preventive mental health. It’s the same idea: prevention and early identification can lead to better outcomes. Not only for long-term mental health and wellness but also for suicide prevention. Colorado has one of the highest suicide rates in the nation. What we hear far too often from families in the aftermath of tragedy is that they didn’t know their relative or child was struggling or suffering. Because we currently treat mental health on a crisis-by-crisis basis, we cannot uncover problems early, before they become acute. Imagine if we treated physical care in this manner, where you only went to see a doctor if you felt that something was wrong. How much more expensive would treatment be? How many lives would be cut short? Another benefit of this law would be to chip away at the stigma around mental health and asking for help. We think nothing of going to the doctor, even when nothing seems wrong. Imagine a world where mental checkups are commonplace and no one blinks an eye at seeing a mental health professional.

Arguments Against:

This bill contains no guidance on billing. Annual physical examinations are fairly well defined and so insurers know what the costs will be that they will be required to cover. Mental health examinations under this bill are so broad that a wide range of potential services costing a wide range of money would all be acceptable as an annual examination. This could lead to vast disparities in what individuals are banking to their insurance, and thus to the rest of us in the form of higher premiums. And we already have a crisis in premium costs in many parts of the state. We simply cannot afford to pile more onto that ledger.


The increased costs of providing all of this mental health care will be borne by all of us, in a major way. There is no such thing as a free lunch, and a free mental health exam for every Coloradan (even if not everyone takes insurers) will result in higher premiums as insurers adjust. Let’s keep providing mental health care to those that need it and not allow everyone any sort of mental health exam every year.

How Should Your Representatives Vote on HB20-1086

HB20-1090 Pharmacies To Provide Prescription Readers [Young (D)]

KILLED BY BILL SPONSORS

Appropriation: None
Fiscal Impact: None

Goal: Require pharmacies to provide a prescription reader to any individual who is blind or visually impaired free of charge and ensure the prescription label can be read by the reader.

Description:

Requires pharmacies to provide a prescription reader to any individual who is blind or visually impaired free of charge and ensure the prescription label can be read by the reader. This must be for the duration of the prescription and allow the individual to read all of the information required by law to be on the prescription. This requirement does not apply to prescriptions that do not have this labeling requirement, for prescriptions distributed through the mail, or for pharmacies in either correctional institutions or operated by a government entity.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

These are special labels that work with RFID tags attached to the prescription container. The reader then reads the information out loud when it next to the label and activated. This is an emerging trend in the US, since the technology now exists to do this relatively cheaply and of course it goes without saying that being able to read the prescription label (either visually or audibly) is critically important to taking a prescription as recommended. Failing to do so can not only lead to the medication being ineffective but also to critical health problems and even death. These devices are usually covered by health insurance and Medicare and Medicaid, but not for the uninsured. They are not overly expensive ($5 to $60) and are a technology specifically created for this purpose. They do not require someone to have a smartphone (or understand precisely how to use it). This bill would ensure that everyone who needed the help can get it without paying.

Arguments Against:

This puts the burden of cost (and dealing with inevitable breakage) squarely on the pharmacies, while excluding places where the government would have to pay for it. If the state feels strongly that these devices are necessary, then it should pay to cover the uninsured. It also seems like a specific technology solution rather than going more simple and low cost (voice recording of the pharmacist on a phone, for instance).

How Should Your Representatives Vote on HB20-1090

HB20-1092 Reimbursement To Federally Qualified Health Centers (Donovan (D), Rankin (R)) [Caraveo (D), Will (R)]

PASSED HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: $9.8 million at full implementation, 2/3 of that federal funds

Goal: Allow federally qualified health centers to get Medicaid reimbursement for telemedicine and clinical pharmacy services provided to Medicaid recipients.

Description:

Requires state Medicaid to reimburse federally qualified health centers (FQHCs) for telemedicine and clinical pharmacy services provided to Medicaid recipients. Telemedicine rate must be set at the same rate for a comparable face-to-face visit.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

FQHCs, also known as community health centers, provide high-quality, low-cost primary health care services to over one in seven Coloradans and operate 208 sites in 42 counties. The reason they are critical is that they provide care to all, regardless of ability to pay, including 27% of the state’s Medicaid enrollees. Telemedicine is extremely important in serving rural areas of the state as it allows people to get a consultation without having to travel to another city or area of the state. These visits can save us money down the road by improving access to primary care and catching problems early, both of which can avoid costly visits to the emergency room. Clinical pharmacists help patients control chronic illnesses that require medication management (like diabetes) and have demonstrated a high return on investment. They are integrated into care teams and their usage allows for better control over these chronic conditions, which again can reduce overall costs. It will therefore help improve access and outcomes and lower costs to allow our FQHCs to get reimbursed by Medicaid for telemedicine and clinical pharmacists for Medicaid patients.

Arguments Against:

While technology is certainly wonderful, the technology does not exist yet that allows a medical professional to put their hands on a patient remotely or to use instruments to take vital readings. Telemedicine certainly has its role as a triage/gatekeeper to the overall system, but ultimately people need to see a doctor. So firstly, it should not garner the same rate from Medicaid as an in-person visit with no laboratory work done, as they are not the same thing. Second, we should be careful that we aren’t in effect adding an extra doctor’s appointment: first via telemedicine and then when a real physical examination is required. No one wants people to use the emergency room as a primary care facility, but we need real primary care exams as a substitute.

How Should Your Representatives Vote on HB20-1092

HB20-1140 Direct Primary Care Services For Medicaid Recipients (Ginal (D)) [Buck (R)]

KILLED BY HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Allow individuals on Medicaid to purchase direct primary care services.

Description:

Prohibits state Medicaid from denying recipients the right to purchase direct primary care services or enter into a direct primary care agreement. If there is a federal waiver required to allow this, requires state to seek it. Direct primary care is a model where the patient purchases their primary care coverage for a flat fee (monthly, quarterly, or annual). No copays, deductibles, or any other charges. It is not insurance and does not cover anything beyond what is in the contract. Coverage requirement repeals in July 2025. Requires state to report by July 2025 if these changes resulted in any direct or indirect cost savings to Medicaid and if there was an increase or decrease in overall access to care.

Additional Information:

Also encourages any direct primary care providers who offer pro bono services to offer them to Medicaid patients.


Auto-Repeal: July 2025

Arguments For:

The problem right now is that Medicaid members are literally prohibited from paying out-of-pocket for direct primary care services. Think about that, we are telling people who are essentially on a state and federally backed insurance plan that they must not use their own money to pay for primary care services but instead must use all of our money through Medicaid. The state commission on affordable health care and the American Academy of Family Physicians have both recommended the state take this step. In essence, for those that can afford it, we can keep people who are on state-backed health care healthier without spending state money to do so, and also potentially avoid costly care in the long run. The question of how this will impact access to insurance is important, that is why this is set-up as an expiring test: we need to see how this will play out.

Arguments Against:

Direct primary care is not insurance and that is the problem. It is highly recommended that people who use this model also get high-deductible insurance coverage but of course many people do not and just get the primary care. Which means they are uncovered for just about anything outside the ordinary and that not only increases the risk of medical bankruptcy or premature death, it also pushes costs onto the rest of us. In Colorado these services are not regulated like insurance is and they do not report data to the state, so we have no idea about the profile of their patients. This bill of course is just about Medicaid, and anyone eligible for Medicaid does not need any other insurance, Medicaid is their insurance. So what is the problem? The problem is all of the other people on Medicaid rely on doctors accepting Medicaid as insurance. And nurturing this alternative, potentially dangerous (since the coverage provided is not regulated), pathway could lead to more doctors moving away from Medicaid and into a system where they get to pick and choose their patients. And since Medicaid is a health care program for people with lower incomes, those that still rely on it for primary care will have fewer alternatives to get care. Access to affordable primary care is of course critical for better health outcomes and lower overall costs. But it must be done in way that doesn’t harm other patients and where we can be assured primary care truly means all primary care is covered.

How Should Your Representatives Vote on HB20-1140

HB20-1098 Prohibition On Abortion After Twenty-two Weeks [Williams (R)]

KILLED IN HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Ban abortions after 22 weeks gestational age unless it is necessary to save the life of the mother, remove a dead fetus caused by a miscarriage, or remove an ectopic pregnancy.

Description:

Bans abortions after 22 weeks gestational age unless it is necessary to save the life of the mother, remove a dead fetus caused by a miscarriage, or remove an ectopic pregnancy. Physicians must check for gestational age prior to performing an abortion, including perform any medical examination or test that a reasonably prudent physician would need to determine gestational age, unless it is to save the life of the mother. Penalty to the doctor is a class 1 misdemeanor but only subject to fine, no jail. Also unprofessional conduct on their medical license and automatic three-year suspension of medical license. No penalty to the woman.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

22 weeks is the point where a fetus could survive if it was born early. This is the point where we do not have a lump of small cells but the recognizable form of what we would call a baby outside of the womb (to the point that the 20 week mark is generally where the sex of the baby can be determined by a doctor). While the chances of survival may be small at this point, it is still a chance and when it comes to medical care, we always lean on the chance. And of course we are not talking about a baby born premature at 22 weeks, we are talking about a still-developing fetus inside the mother’s womb—giving that fetus a chance to keep developing and be born. And 22 weeks is over the halfway point of a full-term pregnancy. This should be more than enough time for a woman to determine what she wants to do. And while it is true that some fatal fetal abnormalities are discovered at 22 weeks or later in the pregnancy, perinatal hospice care is available and the fetus can still be delivered. All of this of course is moot if the mother’s health is in danger, then we have to do what we need to do in order to save her life. Abortions in the second and third trimester also usually have to be performed surgically rather than medically, which increases the risk for the mother. Another risk is to future birth weights. Multiple studies have found a statistically significant, if slight, elevation in risk for lower birth weights and pre-mature births for women who have had a surgical abortion. The risk appears to increase with multiple surgical abortions. And while the exact point where a fetus can feel pain is somewhere in this post-22 week period, it does happen and abortions still do occur in the third trimester where everyone can be reasonably certain the fetus can in fact feel pain. Finally, if we are going to set a line at 22 weeks we of course have to determine the gestational age of the fetus to the best of our ability. If that frequently involves an ultrasound, this is not a difficult or time-consuming procedure and is worth it to make absolutely sure.

Arguments Against:

Abortions performed after 22 weeks are extremely rare, just under 2% of all abortions performed in the country are done 22 weeks or later. And they are generally done for one of two reasons. First, discovery of a certainly fatal condition in the fetus. This can be multiple different things, but as even bill proponents acknowledge, there are some conditions that cannot be fixed and the fetus will die. This then becomes one of the most painful moments in any person’s life. Carry the dying fetus to full-term, give birth (which is far riskier to the health of the mother than any abortion procedure, which are generally one of the safest medical procedures, period), and then watch certain death, or end it now. No politician should get in-between a doctor and a woman in this situation. Neither choice is right and neither choice is wrong. It is deeply personal. Second, many of the women who get abortions near the 22 week point do so because they simply could not get one earlier. Either they did not know they were pregnant (which can happen, everyone carries differently and some women do not have regular periods) or they faced obstacles to obtaining an abortion once they knew they were pregnant and decided they wanted to end the pregnancy. Fortunately some of these barriers do not exist in Colorado, but lack of access to reproductive health care, built-in delays, parental consent, and required medical procedures are just a few of the things that can delay a woman to past the 22 week point. Which brings up the somewhat hidden need for a doctor to determine gestational age, which in order to be this precise will probably require an ultrasound in many cases. This forces an unwanted medical procedure onto the patient and the doctor and adds further delays and cost. This bill could also result in investigations of women who have miscarriages or a stillbirth after 22 weeks. While it is true that multiple studies have found increased risks of pre-term birth and low birth weights in future pregnancies for women who undergo surgical abortion, we are talking about increases of around 1% for pre-term birth and 1.5% for low birth weight. They are statistically significant because of the massive size of the studies, but practically speaking the difference is quite small. And while it is true that babies born at 22 weeks can survive, it is still a below 5% chance. That does not really change until week 24 and it is not until week 25 that survival is clearly above 50%. But this is not about viability. This is the most deeply personal medical choice for any woman, and to be clear, it is a personal medical choice. The right to choose abortion is essential to ensuring a woman can decide for herself if, when and with whom to start or grow a family. Women have the right to make their own decisions about their bodies.


Abortion is a nice way of saying killing a fetus. If we believe that is true, than the punishment should be the same as for murder, a class I felony, not a misdemeanor.

How Should Your Representatives Vote on HB20-1098

HB20-1131 Menstrual Hygiene Products In Schools Program (Winter (D)) [Titone (D), Caraveo (D)]

AMENDED: Significant

PASSED A HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: Negligible

Goal: Create a grant program for schools to provide menstrual hygiene products at no expense to students in middle, junior high, or high school.

Description:

Creates the Menstrual Hygiene Products Accessibility Grant Program to provide menstrual hygiene products at no expense to students in middle, junior high, or high school. Grantees can use funds for acquisition and distribution of menstrual hygiene products or installation and maintenance of a dispensing machine or disposal receptacle. Priority must be given to districts or schools that will serve high school students before junior or middle schools, are eligible for federal funding under the Every Student Succeeds Act, provides few or no menstrual products, and will either make products available in a gender-neutral restroom or some other accommodation for students regardless of their gender identity. $1,000 per grant. Grantees must report annually to state, state annually to legislature. Program repeals July 2023. No funding provided $50,000 appropriated to fund the program.

Additional Information:

State can seek gifts, grants, or donations. Applications for grants must include:

  • Total number of students in the school or school district
  • If the school or schools within the district is eligible to receive federal funding under the Every Student Succeeds Act
  • Total number of restrooms accessible to students and the total number of gender-neutral restrooms accessible to students
  • If the school or district currently provides menstrual hygiene products, how it funds provision of products, and whether it provides products at no expense or for an expense

Grantee report must include:

  • Portion of grant spent on acquisition and distribution of products and amount spent on installation and maintenance of a dispensing machine or disposal receptacle
  • Description of how and where the grantee distributes menstrual products, including if they are available in a gender-neutral restroom or if there are no gender-neutral restrooms, how it makes products accessible regardless of the student’s gender identity


Auto-Repeal: July 2023

Arguments For:

Menstrual products are a fundamental health right and need for many students in our schools. Poor menstrual hygiene can lead to negative health outcomes, including serious infections, toxic shock syndrome, and other abnormalities. And yet many of our schools do not provide these products free of charge to students. And while it is true that all schools do have menstrual products in the nurse’s office, they are not always easily accessible and sometimes students are too embarrassed to ask for them. And frankly, some students come from extreme poverty and struggle to afford these products. A recent survey found that nearly one in five girls have either left school early or missed school entirely because they did not have access to menstrual products. We provide toilet paper, apparently that doesn’t rise to the level of personal responsibility for those who think that this burden should fall entirely on the parents and students. As for the gender-neutral restroom and accessibility for students regardless of their gender identity, this is pretty simple. Students who identify as male but still have female sexual organs and thus need menstrual hygiene products should not be forced to use a girls’ restroom in order to access the products. That would not only force these students to use the wrong bathroom, it would potentially invite ridicule from other students. So a school that does not provide appropriate restrooms to all of its students is failing a portion of them and should not get priority. And this is no state mandate. It is simply a grant program for those who want it. Those who don’t are free not to apply.

Arguments Against:

No one disputes that menstrual products are a fundamental health need. But it is not the responsibility of our schools to provide all fundamental needs to our kids. Providing menstrual products is the responsibility of the parents, and in cases of an emergency, we have the nurses as a back-up. If individual schools or districts feel differently, it is of course their prerogative, but we shouldn’t spend any state resources on this.


The friendliness of schools to transgender students should not be a prioritization for factor for schools that want to provide these products. It conflates one issue, providing more access to menstrual products in schools, with another, bathroom policies for students.

The friendliness of schools to transgender students should be a prioritization factor, as it was originally. Students who identify as male but still have female sexual organs and thus need menstrual hygiene products should not be forced to use a girls’ restroom in order to access the products. That would not only force these students to use the wrong bathroom, it would potentially invite ridicule from other students. So a school that does not provide appropriate restrooms to all of its students is failing a portion of them and should not get priority.


This bill doesn’t provide any funding for the program, it is left to the devices of the appropriations process and the charity of private groups. Four states also have laws requiring schools provide menstrual hygiene products. We should too.

How Should Your Representatives Vote on HB20-1131

HB20-1113 Mental Health Educational Resources [Titone (D), Landgraf (R)]

AMENDED: Significant

PASSED A HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: Minimal except next year, $1.3 million to build website

Goal: Create a website online directory that provides links to relevant information and resources available for individuals seeking behavioral health care services.

Description:

Requires the state to create and maintain a website online directory that provides links to relevant information and resources available for individuals seeking behavioral health care services. The website must include information on the SEE ME campaign, information on the national suicide hotline, demographic-specific information about behavioral health providers available in each region, links to each provider’s website, and links to skilled nursing facilities available in each geographic region state's behavioral crisis response system, including its public facing component, referral resources used by the state-created 24 hour telephone crisis service, and behavioral health public awareness campaigns run by the state. Any public or private organization can request to be added to the site. All providers listed on the site should have their name, website, telephone address, types of treatments or services provided, and languages served. Website must be in both English and Spanish. State must contract with a third-party organization to develop and distribute community and demographic specific targeted messaging about the website. Also allows health care professionals to take a course in mental health education to satisfy any continuing competency or continuing education requirements.

Additional Information:

Demographic information must include categories of behavioral health specialties available and payor types accepted. Organizations or individuals wishing to be added to the website must provide a link to their own website, any relevant information about the organization or individual, and a list of services the organization or individual provides. State can accept gifts, grants, and donations to implement the website. Request for proposals from third party organizations must be issued no later than April 2021 and the messaging must go out by January 2022. Mental health education includes any course that teaches the signs and symptoms of a mental health challenge or crisis, what to do in a mental health emergency, and where to get help.


Auto-Repeal: None

Arguments For:

One of the most difficult things for individuals and families, whether they are in-crisis or just recognize that something is wrong, is finding the resources they need. And while it is true that we need a lot more behavioral health resources in Colorado, it is also true that there is quite a bit here. But right now we put the onus on people to do the work to find what they need. Particularly in a crisis, this is a bad way to go about things. The majority of the expense associated with this is a one-time thing to get the website up. It’s 2020, we certainly should be able to provide a central living resource that connects people with the help they need.

Arguments Against:

The problem is that there is no vetting of the information. The bill provides for no process for the state to approve addition to the site and there is no way for consumers to understand the quality of the various providers listed. So anyone who has a license or a clinic (presumably the state will at least check that the submitted information is real) can get on this site regardless of their abilities. Merely saying they can provide some service is enough so long as the basic baseline is met.

How Should Your Representatives Vote on HB20-1113

HB20-1158 Insurance Cover Infertility Diagnosis Treatment Preserve (Winter (D)) [Tipper (D), Herod (D)]

AMENDED: Minor

PASSED

Appropriation: $3,337
Fiscal Impact: None beyond appropriation

Goal: Require all insurers to cover infertility treatment and standard fertility preservation services.

Description:

Requires all private insurance plans in Colorado to cover the diagnosis and treatment of infertility and standard fertility preservation services if the federal government affirms that it would not cause the state to defray the costs or takes more than a year to respond to the state's request. This must include up to four three completed egg retrievals with unlimited embryo transfers in accordance with American Society of Reproductive Medicine standards, using single embryo transfers when recommended and medically appropriate. No additional deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations that are not part of any other element of the insurance plan. Same with fertility medications. Religious employers must be granted an exemption upon request for this coverage in their health plans. They must provide timely notice to their employees if they do so.

Additional Information:

Bill has several definitions insurers must abide by. First, for infertility:

  • Failure to conceive or impregnate, defined as failure after 12 months of regular, unprotected sex or donor insemination for women under 35 or 6 months for a woman over 35. Conception resulting in miscarriage does not restart the clock.
  • Licensed physician’s findings based on medical, sexual, and reproductive history, age, physical findings, or diagnostic testing

Standard fertility preservation services are procedures and services consistent with established medical practices or guidelines for a person who has a medical condition or is expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatments recognized to cause a risk of impairment to fertility.


Auto-Repeal: None

Arguments For:

Infertility impacts a lot of Coloradans, about 12% of couples who seek to become pregnant in the United States have trouble (there is no reason to believe the stats here would be any different). And for those couples who want to have children and do not want to adopt (which is a perfectly valid life choice), treatment can be extremely expensive. Just one found of in vitro fertilization, one of the most common treatments, costs around $15,000. And many couples need multiple rounds. And it is mostly not covered here in Colorado. Nationwide only 37% of Americans have infertility treatment coverage. This is a not only a health condition, like any other, it is also a deeply personal one that can put couples wanting to have a family in a devastating bind: spend tens of thousands of dollars on treatments that may not result in a child or give up one of the core things that makes us human that so many people desire: having children. This also severely advantages people with a lot of money, who can afford it, while the vast majority of those less fortunate either need charity or must give up. All this bill does is force insurers to cover this treatment. People are still on the hook for deductibles, copays, etc. as dictated by their insurance plan. But otherwise the treatments are covered. Just like most other health care treatments. Multiple other states require this and have seen minimal differences in health care premiums. As for the religious issue, this is a rare 80% issue in America, with overwhelming support for IVF and other fertility treatments. That obviously includes enormous numbers of highly religious people, and most of the world’s major religions accept it (probably because they accept that an egg that is not successfully implanted in a womb is not even a fetus), with perhaps one glaring exception. Since we do not live in a theocracy, we are not bound to tie our laws to those of the Catholic Church, which also opposes any form of birth control. Let’s stick with the 80% of Americans on this. People working for true religious organizations understand the score when they take the job. These employers have similar exemptions for contraceptive requirements under the Affordable Care Act, so we are merely matching federal law.

Arguments Against:

This is a health care condition but it is not a condition that in most cases affects someone’s ability to be personally healthy. It instead affects their ability to have a child. This is of course sad for those who want children, but having children is a personal decision. For those that cannot have their own children, there are so many foster kids out there who could use a great home, so the avenue of having a family with children is not closed off. And like most medical care these days, these treatments are pricey. So although premiums might have minimal differences, those minimal differences might be enough to push health care premiums that people are just barely able to afford over the edge into unaffordability.


If you believe that life begins at conception, then IVF, which routinely involves the destruction of fertilized eggs, is on par with abortion and should not be allowed, much less subsidized. The Catholic Church continues to oppose this practice and believes it is a sin. We should not encourage it in Colorado.

How Should Your Representatives Vote on HB20-1158

HB20-1183 Sunset Continue Certification Of Nurse Aides [Mullica (D)]

AMENDED: Minor

PASSED HOUSE

Appropriation: None
Fiscal Impact: None

Goal: Renew the regulation of certified nurse aides through 2027 and make changes recommended by the department of regulatory agencies.

Description:

Continues the regulation of certified nurse aides through 2027. Combines the laws regulating the practice of these aides with the Nurse Practice Act. Removes references to alcohol or substance use disorders and merely provides disciplinary grounds for excessive use or abuse of alcohol or drugs. Modifies the current exclusion for the first four months of an aide’s employment, changing the education requirement to pursuing initial certification to part of an approved training program prior to certification. Removes requirement to send notices by certified mail. Fixes an inconsistency for how long aides have to wait after having their certification revoked before applying for a new one.

Additional Information: n/a

Auto-Repeal: September 2027 with sunset review

Arguments For:

From the department of regulatory agencies sunset review report: “Nurse aides provide basic health-care services for vulnerable patients in hospitals, long-term care, and in-home care settings. A nurse aide could cause significant harm to a patient if improper care were provided, or if necessary care was not provided.” Adding these laws to the nurse practice act streamlines the system and could result in more procedural efficiencies. You cannot punish someone for having substance or alcohol abuse disorders, those are medical conditions. You punish them for using the substances (sober people have these disorders). The exemption requirement aligns with federal law.

Arguments Against: n/a

How Should Your Representatives Vote on HB20-1183

HB20-1198 Pharmacy Benefits Carrier And Pharmacy Benefit Manager Requirements (Fields (D), Ginal (D)) [Buckner (D)]

Appropriation: None
Fiscal Impact: Not yet released

Goal: Prohibit insurance carriers and pharmacy benefits managers (PBMs) from engaging in several different practices, including reimbursing pharmacies at different amounts for the same service, charging them fees for adjudicating claims or being part of a network, and several other things; requires insurers and PBMs to submit their drug formulary and reimbursement rates to the state and allows the commissioner of insurance to review these plans for fairness and reasonableness; and requires insurers and PBMs to submit claims and payment information for prescription drugs to the state, including the amount of rebates received.

Description:

Starting next year, prohibits pharmacy benefit managers (PBMs) or insurance carriers from:

  • Reimbursing an independent pharmacy or pharmacist in Colorado less than the amount they reimburse a PBM affiliate for providing the same pharmacist services
  • Charging a pharmacy or pharmacist a fee related to the adjudication of a services claim, including for receipt and processing, for development or management of processing services, or for participation in a provider or PBM network
  • Requiring pharmacy accreditation standards or certification requirements inconsistent with or more stringent than state board requirements
  • Modifying the prescription drug formulary filed with state during the benefit year, which includes eliminating a particular drug from the formulary or moving a drug to a higher-cost tier
  • Cause or knowingly permit use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading

Also starting next year, requires insurers and PBMs to submit to the state insurance commissioner its program for compensating pharmacists and pharmacies for services under their health benefit plan for the next benefit year and their drug formulary for the next benefit year. The PBM must also report the amount it expects to receive from the carrier for pharmacist services that are eligible for reimbursement. The state may review these plans to ensure they are fair and reasonable to provide an adequate provider or pharmacy benefit manager network under the prescription drug benefits plan.

Also starting next year, insurers must submit to the commissioner a list of all PBMs the insurer uses and must provide updates about any changes within 10 business days.

Insurers and PBMs must also annually file a report with the commissioner and report to the all-payer claims database the following information, itemized by claim:

  • Amount the insurer or PBM actually paid or will pay to the pharmacy or pharmacist for services and their identity
  • Prescription number or other identifying information of the services
  • Amount the PBM received from the carrier for the services
  • Amount of rebates the insurer or PBM received

Commissioner may set rules to enforce this law and examine or audit the books and records of an insurer or a PBM. Any of that information is considered confidential and not subject to open records laws.

Additional Information:

Changes in PBM status that must be reported includes change of name or change in contact person information. Terminating a pharmacy or pharmacist from an insurer or PBM network does not release the insurer or PBM from the obligation to make any payments owed to the pharmacy or pharmacist for services rendered.

Each insurer that contracts with a PBM must ensure the PBM complies with this law and the insurer is liable for any failure of the PBM to comply. Failure to comply constitutes an unfair or deceptive act.


Auto-Repeal: None

Arguments For:

Prescription drug costs are one of the biggest drivers of increasing costs in our health care system. According to a state report about 11% of state residents did not fill a prescription because of cost last year. State Medicaid spending grew by a whopping $435 million from 2014 to 2019 and is now over $1 billion per year. And a part of that growth comes from insurers and PBMs sucking up rebates from prescription drug manufacturers to use themselves. So this bill does a few things. First, we are getting sunshine into the practices of insurers and PBMs when it comes to their rate setting and what they are doing with rebates. Second, we are ensuring that PBMs (which are essentially middle men and serve as intermediaries between insurers and pharmacies) are not giving preferential treatment to certain pharmacies, especially those owned by PBMs. Yes, PBMs own pharmacies themselves and can pay their own pharmacies more than independent pharmacies for the same service. Third, we are ensuring that insurers and PBMs are not charging fees for simply doing their job, which is processing claims, or for participation in a network. We have to ensure a level playing field for pharmacies (and fair reimbursement rates) because that in turns leads to a level playing field for Coloradans and prevents profiteering off prescription drug access.

Arguments Against:

PBMs are the boogeyman right now but they serve an essential role in our health care system. Pharmacies simply do not have the negotiating power to drive down prices from prescription drug companies on their own and potentially save billions on drug costs. Pretty much all prescription rebates in Medicare, for instance, are thanks to PBMs. And of course nothing comes for free, they profit off the service they provide that administer programs for more than 270 million Americans, but you must compare the profit of the industry against the money it is saving. And yes, PBMs operate their own pharmacies, but this allows them to more efficiently serve the market. Forcing PBMs to charge everyone the same thing, regardless of how efficient the pharmacy is or what other relationships PBMs have, may be detrimental not only to PBMs bottom line, but also their ability to save consumers money at certain pharmacies. And we certainly do not need an unelected government official telling insurers and PBMs what they can and cannot charge. The bill is a bit opaque about what happens if the commissioner of insurance does not approve of a prescription drug fee structure but it appears that in this case it can be rejected entirely.

How Should Your Representatives Vote on HB1198

SB20-005 Covered Person Cost-Sharing Collected By Carriers (Winter (D), Priola (R)) [McCluskie (D)]

AMENDED: Very Significant (new bill)

PASSED A SENATE COMMITTEE

Appropriation: None
Fiscal Impact: Minimal

Goal: Have more insurers handle payment for coinsurance, copayments, and deductibles instead of providers all in one bill. Study the effects of potentially requiring insurers rather than providers collect out-of-pocket payments from consumers.

Description:

Prohibits insurers from inducing, incentivizing, or otherwise requiring health care providers to collect any coinsurance, copayment, or deductible directly from a covered individual or responsible party. Insurers are required to collect any cost-sharing amounts owed by a covered individual into one consolidated bill. They then reimburse the providers for whatever is owed. Also prohibits insurers from canceling or refusing to renew insurance based on an individual’s failure to pay any of these items to the insurance company. Requires all insurers to develop financial assistance, charity care, and payment plan policies and make information about these policies available to every covered person.

Requires state to contract with a third-party accounting firm to conduct a study into the potential effects of requiring insurers collect cost-sharing payments from health care consumers rather than providers. Accounting firm must consult with a variety of stakeholders in the process of completing the report. Report must investigate:

    • Trends in carrier plan design, consumer plan selection, and utilization data in past six years
    • Total out-of-pocket costs incurred by consumers
    • Impact on premiums if insurers were not allowed to terminate people who failed to make their cost-sharing payments (and insurers were required to collect

 

    • Specific amount of uncollected medical debt claimed by hospitals and other providers on an annual basis, the financial impacts of unpaid cost-sharing payments on all providers, and how providers are able to write-off unclaimed debt
    • Annual adminstrative expenses for providers attributable to collecting cost-sharing payments, broken down by large and small facilities
    • Policy options to help simplify billing for consumers, including having insurers collect, requring a single bill from hospitals within 30 days of a care episode, reducing the significant rate variability for health care services in different settings, and cost savings to patients from a state requirement for site-neutral payments
    • If insurers were required to collect cost-sharing payments, consideration of cost impacts to insurance carriers to create new billing networks, impact of carriers absorbing uncollected medical debt, and the impacts to premiums on both the individual and group markets
    • Extent to which changing the collections process would burden anyone in the system, affect negotiations between providers and carriers, and cause confusion to consumers
    • Number and types of charity care offered by providers
    • Whether state should establish billing timelines to ensure providers bill insurers in a timely manner
    • Existing federal and state laws on cost-sharing ratios built into insurance plans

Report due by November 2021.

Additional Information:

Prohibition on requiring providers to collect money directly from the covered individual does not apply to integrated health care delivery systems (where everyone is under the same umbrella) or pharmacy out-patient services.

As part of making their financial assistance information available, carriers must:

      • Post information conspicuously on their website
      • Make information available to each covered person
      • Inform each covered person of their rights to this aid and where applicable, the website, e-mail, and telephone number where the financial assistance, charity care, and payment plan information may be obtained

Stakeholders that must be consulted include: statewide hosptial organization, organization of physicians, organization of health care plans, a state urban health system, a consumer advocate, provider serving low-income or vulnerable populations, non-physician provider organization, specialty socities representing anesthesiologists, ER physicians, and radiologists, and organization that represents employers.


Auto-Repeal: None

Arguments For:

One of the most confusing things for consumers in our health care system is the billing process. You pay the doctor and then weeks later you get a confusing bill from the doctor listing things the insurance company covered and things they did not. And then you may get yet another bill from a different department in the same facility for their part of your care. And then maybe another one, if your care was somewhat complicated. All of this billing and tracking puts strains on our providers to collect the funds and increases their costs. If we can instead have the insurance company handle this billing, in one bill, we can eliminate some duplication and lift the burden on providers. If we do this we must be careful that people do not lose their insurance over an inability to pay some of these bills. They of course will still owe the money and the insurance companies can collect it. But this is an extremely complicated issue and we don't want to make things worse, so we need to look before we leap and ensure we have a well-designed system that decreases confusion and also hopefully cost.

Arguments Against:

This is almost certainly going to raise insurance premiums, because insurers will be prohibited from refusing insurance to people who are not paying their bills and of course the insurance companies are not going to eat that money. They are going to pass it on to the rest of us. Since it is also voluntary, it may increase confusion rather than decrease it, as some doctors decide they are happy to let insurers handle all the money and others insist on what they are owed at the appointment. So insurers may be sending just one bill, but not in all cases. It may increase the administrative overhead of insurance companies to track all of this. So instead of lowering overall costs, it may actually increase them by adding complexity into the system. This is still looking to overcomplicate an issue that has it roots in having an insurance industry at all. The fact that this original bill likely foundered on the problem of insurers not being able to cancel premiums because of non-payment illustrates the problem: we cannot let insurers cancel premiums because we desperately need people to have insurance but we also hang insurers out to dry unless we want premiums to rise. The place to tackle is at the provider level, which the study hints at but doesn't explore fully enough. Insurers may pull extra profit out of the health care industry but they are capped by federal law on the amounts they must spend our premium money on. It is at the provider level where costs have spiraled out of control, where multiple bills get send out, and where ultimate consumer costs become unclear. That is where our focus shoudl be.

Studies are a way to duck the issue instead of taking it on. There is perhaps no more studied industry in Colorado than the health insurance industy. We don't need more data, we need solutions.

How Should Your Representatives Vote on SB20-005

HB20-1139 Peer Support Professionals Behavioral Health [Pelton (R), Caraveo (D)]

AMENDED: Minor

PASSED A HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: Minimal

Goal: Allow organizations that use peer support professionals to bill Medicaid for their services and provide a tax credit to these professionals to pursue higher education.

Description:

Allows recovery service organizations, defined as organizations led and governed by representatives of local communities of recovery, to bill Medicaid for their peer support professional services, so long as they have an official relationship with a licensed mental health care provider that can demonstrate training in supervising peer support professionals and any other requirements the state decides. State must approve any entity prior to billing Medicaid. Peer support professionals are someone who has themselves recovered from a behavioral health disorder or trauma and is trained to provide non-clinical support to those suffering from the same problems. There are federal guidelines for core competencies for peer support professionals.

Bill also creates a up to $1,000 a year refundable tax credit (meaning if the credit is larger than taxes owed, the individual gets the difference back as a refund) for peer support professionals who have at least three years of experience in the behavioral health field and are either currently studying at a state institution of higher education or have graduated from one. Credit can be claimed for four years for current students and three years for graduated students and is indexed to inflation. Maximum of $100,000 of credits issued in one tax year on a first-come, first-serve basis. State must report on the tax credit to the legislature. Credit expires in 2031.

Additional Information:

Recovery support services organization can bill for work done in the following settings:

  • Justice-involved
  • Physical health
  • Emergency departments
  • Communities with persons experiencing homelessness
  • Peer respite homes

Recover support services organization can bill for the following recovery-focused services and supports:

  • Peer-delivered support services
  • Peer-run drop-in centers, recovery and wellness centers, and employment services
  • Prevention and early intervention activities
  • Peer mentoring for children and adolescents
  • Patient and family support groups
  • Warm lines
  • Advocacy services

Peer support professionals include: peer support specialist, recovery coach, peer and family recovery support specialist, peer mentor, family advocate, or family systems navigator. Must be at least 18. Services defined as: peer-to-peer relationships that support healing, personal growth, life skills development, self-care, and crisis-strategy development to help achieve recovery, wellness, and life goals.

Tax credit report must include total number of credits issued per year, types of study areas pursued, average number of credits claimed per individual, common issues or barriers for providing documentation necessary to get credit, and any recommendations to improve credit program.


Auto-Repeal: Tax credit, January 2031

Arguments For:

There is just nothing quite like having actual real experience living through and recovering from behavioral health disorders and trauma. Peer support professionals are a critical element in recovery and on-going wellness because they have quite literally walked the same road. They reduce hospitalizations, increase engagement in wellness and self-care, and decrease symptoms of people in treatment. Other states have found enormous cost-savings, an average of nearly $5,500 for people in treatment with peer support versus those in treatment without it. But peer support professionals are often poorly paid and easily reach professional ceilings. A survey found 80% of peer support professionals were interested in continued job training and nearly 45% said they would stay in the behavioral health field. Having a peer support professional move up the ladder in the behavioral health field will help us fill treatment gaps and keep these folks from burning out and exiting the field altogether. This is a very small amount of money to spend on nurturing these folks and may actually save Medicaid funds in the long-term by reducing the need for more expensive services.

Arguments Against:

We don’t have an endless supply of qualified people interested in becoming peer support professionals. So if we actively encourage the ones we have to increase their education and move up in the profession, we may end up unintentionally draining our supply of active peer support professionals. We can train anyone who wants to be in behavioral health. You have to have recovered from a behavioral health disorder or trauma to be a peer support professional. We obviously need more of both, and no one is saying we should actively prevent peer support professionals from getting more education. But we also don’t have to encourage it with state tax dollars and watch more than ½ of them actually exit the field. Because burnout is related to more than just salary. This is really, really hard work and even when it pays OK people still burn out. What we don’t want is to spend $100,000 a year and get basically the same results we have now, except maybe slightly fewer peer support professionals and slightly more trained behavioral health professionals.

How Should Your Representatives Vote on HB20-1139

HB20-1103 Colorectal Cancer Screening Coverage (Fields (D), Priola (R)) [Buckner (D), Will (R)]

AMENDED: Moderate

PASSED HOUSE

Appropriation: None
Fiscal Impact: None

Goal: Require potential follow-up colonoscopies to be covered by insurers in addition to initial colorectal cancer screenings for average-risk individuals and change standards to American Cancer Society .

Description:

Currently insurers must cover preventive colorectal cancer screenings for tests for the early detection of colorectal cancer and adenomatous polyps. The bill changes this to all colorectal cancer examinations and laboratory tests in accordance with American Cancer Society guidelines for average-risk individuals and includes coverage for a follow-up colonoscopy if the results of the initial medical test or procedure are abnormal. Changes the standards for early detection for high-risk individuals to those of the American Cancer Society rather than US preventive services task force guidelines. Requires everyone 45 years of age or older to be covered.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

First it makes sense to use the American Cancer Society as the guideline, since it is the organization most likely to have the most up-to-date knowledge of appropriate actions. Second, the bill ensures that follow-up procedures are covered for average-risk individuals, because sometimes additional exams are needed to make an accurate diagnosis.

Arguments Against: n/a

How Should Your Representatives Vote on HB20-1103

HB20-1160 Drug Price Transparency Insurance Premium Reductions (Ginal (D), Donovan (D)) [Jackson (D), Roberts (D)]

AMENDED: Moderate

PASSED HOUSE COMMITTEE

Appropriation: $273,119
Fiscal Impact: None

Goal: To greatly increase transparency around prescription drug pricing and interactions among insurers, pharmacy benefit management firms, and pharmacies. Also to ensure insurance companies are appropriately pricing their cost-sharing for prescription drugs with customers.

Description:

Numerous disclosure requirements for insurers and prescription drug manufacturers. Insurers must:

  • Submit to state each year information on their top prescription drug payouts each year, by several different sorting categories and information about rebates received from drug manufacturers
  • Certification, with supporting documentation, that the insurer included all rebates in calculating their premiums and specifying how the rebates were accounted for
  • A list of all pharmacy benefit management (PBM) firms the insurers contract with
  • Specific information on rebates and administrative fees about drugs that trigger a price report to the state under this bill (more below). PBMs must report this same information
  • Average wholesale price, broken down by insurance group size category, paid for brand name drugs at retail pharmacies and the average at mail-order pharmacies, for generic drugs at the same two locations, for drugs dispensed by a practitioner, for specialty drugs administered at in-patient setting and at out-patient setting

Insurers must also reduce the premiums covered individuals must pay by 100% of the estimated rebates received for that plan in the previous year.

Drug manufacturers must:

  • Notify state, state Medicaid, insurers, and PBMs when the manufacturer increases the price of prescription drugs that cost more than $50 by more than specified percentage amounts or introduces a new specialty drug onto the market. This disclosure must include information about if the drug has changed.
  • Notify the state, for every drug the manufacturer was required to notify about in previous section, numerous pricing, sales, and profit information about the drug and a detailed explanation for the increase

Non-profits in this area must annually report any thing of value worth $1,000 or more received by the organization from a drug manufacturer, PBM, or insurer and the percentage of the company’s gross income attributable. All of this information that is already in the public domain, minus proprietary information, is to be posted on the state website after providing insurers, PBMs, manufactures, and non-profits the ability to object to any proprietary information. Ultimate decision on what to redact lies with the commissioner of insurance. The data is to be analyzed and reported on each year, including recommendations for legislative changes to contain price of prescription drugs. Report must be put online in addition to submitted to legislature.

Additional Information:

Insurers annual information includes:

  • 50 most frequently paid for drugs
  • 50 most costly drugs paid for
  • 50 drugs that accounted for the highest increase in total spending compared to previous year
  • 50 drugs that caused the greatest increase in the insurer’s premiums
  • 50 most frequently paid outpatient drugs where the insurer received a rebate or anything else that reduced cost to insurer
  • 50 drugs for which insurers received the highest rebate

Violating these requirements results in a fine of up to $10,000 per day. Employer or third-party administrator of an insurance plan not otherwise subject to state oversight is not required to submit this information.

Triggering the price increase notification requires an increase of 10% or more from previous year, or 16% or more over previous two years, or 20% over the previous three years. The $50 threshold is tied to inflation. The notice to everyone must be at least 1 day prior to increase and requires:

  • Date of increase, current price, and future price
  • Statement of if the drug has been improved necessitating the increase and if so, how

The more detailed report due to the state on a drug that triggers this disclosure occurs quarterly. Information provided includes:

  • Name and price of the drug and increase in percentage terms over previous year
  • How long the drug has been on the market, its introductory price and the net yearly increase of the drug in previous five years
  • Description of the specific financial and non-financial factors leading to the increase
  • For brand names under patent, all relevant patents and their status (including expiration date); for generics, year of FDA approval
  • Name of any generic version available on market
  • Whether drug is deemed an innovator, multiple source, noninnovator multiple source, or single source drug by FDA
  • Description of change, if any, that necessitated increase
  • Total gross revenues from sales of drug in state in previous calendar year
  • Direct costs incurred by manufacturer for the drug in research and development, manufacturing, marketing, distribution, and ongoing safety and effectiveness research
  • Profit from the drug in previous year
  • 10 highest prices paid and 10 lowest prices paid outside the US for the drug in previous year
  • If the drug was purchased within previous five years, price of drug at acquisition and in year after acquisition; name of company it was acquired from, date of acquisition, and purchase price
  • Any other information the manufacturer deems relevant to decision to increase price

For specialty drugs, information required is: description of marketing and pricing plans used in Colorado; estimated number of patients in state that might be prescribed the drug; whether the drug was granted breakthrough therapy designation or priority review by FDA; date and price of acquisition if the drug was acquired from other manufacturer.

For rebate and fee administration reports on drugs that trigger notifications, insurers and PBMs must report:

  • Total amount of all rebates received from the manufacturer in the previous year for the drug and the total amount of those rebates retained by either the insurer or the PBM
  • Total amount of administrative fees the PBM received from the insurer and manufacturer for the drug
  • Total amount payments, including reimbursements and fees, paid to state pharmacies for the drug while separately identifying dispensing fees and service and/or administrative fees
  • Explanation of all other services offered by the health insurer or PBM, excluding proprietary or client-specific information

Insurance group sizes that must be provided separately for the average wholesale price breakdown include: individuals, small employers, large employers with between 100-500 employees, large employers with between 500-5,000 employees, and large employers with more than 5,000 employees. Failure to comply with these wholesale price disclosure requirements constitutes an unfair trade practice.

Non-profits qualify for the disclosure requirements if their mission focuses on pharmaceutical treatment for Coloradans, and have received an item of value worth $1,000 or more from a manufacturer, PBM, or insurer in previous year.


Auto-Repeal: None

Arguments For:

While we all know the general gist of prescription drug pricing issues (and the few extremely notable cases that have received large amounts of public attention), what we do not know are the deep details. This bill is all about those details and about transparency. We need to know what drugs insurers are paying out the most for. We need to know about big price increases and we need the justification for them and the details that will help us understand if price gouging is going on. And we need transparency around the interactions between the entities that determine what we pay for these drugs to ensure no one is pocketing profits in the middle at the expense of people who need these drugs to survive. There have been far too many stories of that happening, especially with PBMs. A study in Ohio found a PBM charging the state’s Medicaid almost $6 per prescription, nearly five times the standard rate (which of course it was paying the pharmacies, pocketing the difference). And that, ultimately, is what this is about. Many prescription drugs are life or death for the people who need them. And yet increasing numbers of Americans are forgoing these medications because they cannot afford them. According to a state report about 11% of state residents did not fill a prescription because of cost last year. State Medicaid spending grew by a whopping $435 million from 2014 to 2019 and is now over $1 billion per year. The bill does not stop manufacturers from pricing their drugs or PBMs or insurers from getting rebates or non-profits from getting things of value. It just makes sure we all know the score.

Arguments Against:

This is a deeply intrusive move into the inner workings of prescription drug companies, who are required to essentially turn over reams of profit data for many drugs which the state is then going to turn around and publish. Even with the safeguard for keeping on-public information out of the public eye, It may erode the ability of these companies to compete with each other and it may erode their ability to conduct the incredibly expensive research required to find new life-saving drugs. It is also an administrative burden on insurers, who have to turn over all of this annual information to the state, and an intrusion into their business in the form of price-fixing on cost sharing amounts. We are raising the cost of doing business for all of these entities that touch prescription drugs and they are likely to try to pass those increases on to us.


Data is fine, but action is better. The bill goes out of its way to note that it does not prevent drug companies from doing anything they like (within legal boundaries) when it comes to pricing. And it does not. We already know public shame doesn’t do anything, just look at the current state of things where we are very much aware of the dramatic price increases in the industry. Just last year we successfully regulated insulin prices in the state. It is time to expand that form of action.

How Should Your Representatives Vote on HB20-1160

HB20-1199 Lower Minimum For Employer Health Stop-loss Insurance [Buck (R)]

KILLED IN HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Lower the point where self-insured health care businesses get reimbursed for stop-loss policies to $10,000 per employee.

Description:

Lowers the minimum stop-loss insurance reimbursement point for self-insured health care for businesses of under 50 employees from $20,000 to $10,000 and also lower the same point for larger businesses from $15,000 to $10,000. This means that employers who self-insure will not be on the hook for any per-employee costs above $10,000 (in aggregate, not in each case). These must be reimbursed by the insurance company.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

Self-insured plans obviously have much lower premiums than traditional insurance plans, since the insurer is taking on much less risk. For companies that pay all or some of their employees’ premiums, it can actually make financial sense to self-insure. But of course the high side risk must be managed to allow employers to not go out of business due to a catastrophic event. So that is what stop-loss policies do. This bill simply allows more flexibility for self-insurers to lower their risk if they want to, which of course will lead to higher premiums on the stop-loss insurance. This has become particularly relevant because the Affordable Care Act prohibits caps on benefits so the exposure to self-insured plans is much higher. State law already prohibits “lasering” by insurers (refusing to pay claims for specific individuals on the plan, obviously usually high-cost individuals) so businesses in this state are already protected from one of the common pitfalls of self-funding. Businesses must also follow state HIPAA laws to protect health care information privacy and of course must follow federal laws when it comes to their coverage decisions. Nearly all businesses are not going to want to run afoul of either the federal government or their employees by acting in a capricious or unfair manner here, and actually having a lower stop-loss point will encourage employers to be more generous rather than less when it comes to claims.

Arguments Against:

Self-funded plans are bad and we should be taking steps to eliminate them, not to make it easier for businesses to operate them. They put the employer into the seat of determining benefits and makes the insurance not beholden to our state laws or regulation from the state commissioner of insurance. For instance, we just passed a law in Colorado last year that protected people from surprise out-of-network billing (where you go to an in-network facility but get treated by an out-of-network physician and get charged the out-of-network rate). There is no federal law with this protection, so a self-funded plan would not have it unless the employer specifically chose it. And instead of the insurance company making final decisions on payment for medical claims your employer does. This not only opens up your entire medical history to your employer, it puts them in the position as insurance companies: their bottom line is directly affected by their ability to not pay out claims. This also means any disputes are solved by the Department of Labor and people are only eligible to recover their actual lost costs, no other damages. Employees may not even realize they are in self-funded plans, as they are usually underwritten by an insurer.

How Should Your Representatives Vote on HB20-1199

HB20-1206 Sunset Mental Health Professionals [Michaelson Jenet (D), Landgraf (R)]

AMENDED: Moderate

PASSED HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Continue regulation of mental health professionals until 2029, make some recommended changes from the department of regulatory agencies’ sunset review report, and make other small changes.

Description:

Continues regulation of mental health professionals until September 2029. Makes numerous small changes including:

  • Allows professionals to resolve minor violations of prohibited acts informally through adherence to applicable national ethics codes if the action or condition did not and likely would not harm clients.
  • Repeals ability for licensed mental health professionals or licensure candidates to register with the database of registered psychotherapists but keeps current registrants until September 2025, at which point they must obtain correct licensure to stay registered
  • Allows staff of mental health board to approve licensure, certification, and registration applications without the vote of the board unless the board deems it necessary
  • Allows the board to suspend a license, certification, or registration for failing to comply with an ordered mental or physical examination
  • Requires mental health professionals to disclose to clients that medical records may not be maintained longer than seven years
  • Exempts students who are enrolled in a school program and are practicing as part of the school curriculum or clinical requirement under proper supervision from licensing, certification, and registration requirements
  • Gives protection to titles for provisional social worker, marriage and family therapist candidate, licensed professional counselor, licensed professional counselor candidate, provisional licensed professional counselor, provisional psychologist, and registered psychotherapist. These cannot be used without proper licensure, registration or certification.
  • Allows the appropriate board to take action for conviction of a crime related to mental health practice and for failing to report such a crime
  • Makes course work the only professional competency activity that can fill all of the continuing competency requirements for licensed social workers or clinical social workers
  • Allows certification for addiction counseling for those convicted of non-violent felonies or a felony that occured five or more years prior to initial certification or licensure.
  • Allows state board of addiction counselor examiners to set rules for certification of addiction counselors, but keeps decision on education requirements with department of human services
  • Clarifies that mental health professionals may administer opiate antagonists
  • Changes exemption from open records laws for records in disciplinary actions to be a total exemption instead of depending on if the complaint was dismissed. Makes letters of admonition for non-disciplinary action confidential after five years.
  • Replaces levels I, II, and III for addiction couseling certification and replaces with addiction technician and addiction specialist. Addiction technicians need high school diploma or equivalent, 1,000 supervised clinical hours over at least six months, and passed exam determined by board and national credential exam. Addiction specialist needs bachelor's degree in a clinical behavioral health concentration, at least 2,000 hours of work over at least 12 months (can include hours needed for technician certificate), and passed exam determined by board and national credential exam. Lowers number of hours required for achieving addiction counselor licenense from 5,000 to 3,000 but requires 2,000 of those to be direct clinical hours.

Additional Information:

Also:

  • Clarifies that licensees, certificate holders, and registrants are not required to form a professional services corporation
  • Clarifies that mental health professionals may disclose confidential information if there is a threat to a school or its employees and personnel
  • Allows candidates for social worker licenses to be supervised by someone approved by the state board of social work examiners instead of requiring supervision from a licensed social worker (can still do this of course)
  • Requires applicants for a psychology license to complete a name-based criminal background check
  • Repeals requirement that mental health board members be US citizens
  • Prohibits state from placing additional requirements, barriers, or burdens related to licensure or supervision on applicants who have completed equivalent education programs to those required for licensure, as determined by the board.


Auto-Repeal: September 2029 with sunset review

Arguments For:

From the department of regulatory agencies’ sunset review report: “In addition to the harm identified during this sunset review, there is also a potential for mental health professionals to harm consumers. This is evidenced by the fact that during therapy, a relationship exists where a vulnerable person (consumer) confides personal issues or feelings to a therapist. Mental health professionals are then in a unique position where they have tremendous influence over clients. This could create an uneven playing field where a therapist may coerce a client into having sex with him or her in exchange for therapy, or a therapist may enter into an unfair business relationship with a client. As such, the potential for harm to consumers is a distinct possibility. Therefore, the regulation of mental health professionals is warranted.” For the supervision of social workers, the current provision is unique in just allowing one type of supervision rather than allowing the supervising board to make the decision. A registered psychotherapist is a very specific thing and right now we are letting too many people register for when it does not apply. There are more correct databases for licensed mental health professionals or licensure candidates to register for. The requirement for students to register is also leading to unnecessary registrations right now (they do cost money), most other medical boards allow for unlicensed or unregistered students to work under appropriate supervision. The US citizenship requirement is not common for boards like this and may interfere with having a qualified person serve on the board. Being a citizen is irrelevant. Protecting the titles that are commonly used in the profession both protects consumers from folks not qualified to use the title and in the judicial system, ensures we are true experts when they are needed to testify. For the ability to informally work around various potential prohibitions, the main thing here is mental or physical impairments that have no chance of impacting clients or the public. We can trust mental health professionals to manage these without coming up with some elaborate plan of practice with their supervising board. Those with lived experiences in addiction can often make the best addiction counselors, so it makes sense to allow them to get certified.

Arguments Against:

It is not common to allow for informal arrangements (and the board is not mentioned in this section, so it is implied the arrangement is with the board but not stated) for practitioners to just adhere to a code of ethics. The reason we involve the board is that we need a neutral third-party to decide what might and might not affect patients. There are many people practicing as registered psychotherapists who are going to have to do something as a result of no longer being able to do so from this bill.

How Should Your Representatives Vote on HB20-1206

HB20-1209 Sunset Nurse-physician Advisory Task Force [Cutter (D), Mullica (D)]

AMENDED: Minor

PASSED HOUSE AND A SENATE COMMITTEE

Appropriation: $15,554
Fiscal Impact: None beyond appropriation

Goal: Implement the recommendation of the department of regulatory agencies’ sunset review report and continue the Nurse-Physician Advisory Task Force for Colorado Health Care (NPATCH) indefinitely.

Description:

Continues the Nurse-Physician Advisory Task Force for Colorado Health Care (NPATCH) indefinitely.

Additional Information: n/a

Arguments For:

From the department of regulatory agencies’ sunset review report: “Patient care and safety will always offer opportunities for improvement. As the state’s health-care delivery systems continue to evolve, new issues will arise at the interface of medicine and nursing. As the nation’s focus on opioids intensifies, so too may the need to address wide-ranging prescribing practices of various health-care practitioners. Thus, it is reasonable to conclude that the expertise that NPATCH represents will continue to aid the state in addressing a multitude of health-care issues. NPATCH represents the state’s singular formal stage upon which physicians and nurses can, and indeed are required to address issues at the interface of medicine and nursing. These are issues that continue to evolve, demanding the continued attention of regulators and policy makers alike.”

Arguments Against:

The same report noted that NPATCH has completed its primary mission of developing an articulated model for advanced practice nurses with prescriptive authority. There are certainly other duties it can perform, but it should not be continued indefinitely. Give it another sunset review in a few years.

How Should Your Representatives Vote on HB20-1209

HB20-1210 Sunset State Board Of Chiropractic Examiners [Caraveo (D), Duran (D)]

PASSED HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Continue the state board of chiropractic examiners for nine years and implement recommended changes from the state department of regulatory agencies.

Description:

  • Continues the state board of chiropractic examiners for nine years through September 2029
  • Repeals requirement that board members be US citizens
  • Repeals requirement that applicants pass an exam from the National Board of Chiropractic Examiners and instead gives the board the authority to determine the exam
  • Changes continuing education requirements from annual to every two years while maintaining same number of total hours
  • Requires nurses to notify the nursing board if they suffer any illness, condition, or behavioral health disorder that affects their ability to practice with reasonable skill and safety. Requires them to act within the limitations created by that condition or comply with any confidential agreement reached with the board to accommodate the condition. Removes punishment for nurses doing any care whatsoever with one of these conditions.
  • Removes references to alcohol or substance use disorders and merely provides disciplinary grounds for excessive use or abuse of alcohol or drugs.
  • Clarifies that a license is not required or prohibited for a student or intern performing services under the supervision of a licensee and allows students at board-approved schools to perform supervised services with the signed consent of the patient
  • Removes specific list of media types for unethical advertising and just makes it any form of media

Additional Information: n/a

Auto-Repeal: September 2029

Arguments For:

From the department of regulatory agencies’ sunset review report: “The Board seeks to protect consumers from potential harm through educational and licensure requirements to ensure that chiropractors are properly trained and maintain competency in their field…Chiropractors utilize a variety of techniques such as spinal adjustments, manipulation, and other clinical treatments to address neuro-musculoskeletal problems relating to the spine, nerves, muscles, tendons, and ligaments within their patients. If a chiropractic treatment were to be improperly or unnecessarily performed, it could lead to significant harm, including permanent damage.” Current law is such that no student in the state can perform chiropractic services of any kind anywhere. This runs contrary to our practice of allowing students in health related fields to perform supervised care and the bill requires patient consent. You cannot punish someone for having substance or alcohol abuse disorders, those are medical conditions. You punish them for using the substances (sober people have these disorders). The US citizenship requirement is not common for boards like this and may interfere with having a qualified person serve on the board. Being a citizen is irrelevant.

Arguments Against: n/a

How Should Your Representatives Vote on HB20-1210

HB20-1212 Sunset Naturopathic Doctors [Landgraf (R), Caraveo (D)]

AMENDED: Significant

PASSED HOUSE

Appropriation: None
Fiscal Impact: None

Goal: Implement most of the recommendations of the department of regulatory agencies’ sunset review andMake some changes to and continue regulation of naturopathic doctors until September 2029.

Description:

Continues regulation of naturopathic doctors until September 2029. Provides immunity from liability for state staff, consultants, and complainants in civil action for acts occurring while the individual is performing duties or testifying. Removes references to the North American Board of Naturopathic Examiners and the Council on Naturopathic Medical Education. Repeals requirement that naturopathic doctors develop and execute a collaborative agreement with a licensed physician before naturopathic doctors can treat a child under age of 2. Adds discussion of naturopathic doctor issues to the naturopathic medicine advisory committee's official brief.

Additional Information: n/a

Auto-Repeal: September 2029

Arguments For:

From the state division of regulatory agencies’ sunset review report: “It could be argued that the implementation of the registration program in Colorado has ensured only competent, qualified practitioners have been providing services to consumers, which at least partially explains the low number of complaints and disciplinary actions. As such, the General Assembly should continue the Act for nine years, until 2029. A seven-year continuation is reasonable because the analysis of the regulatory program did not identify systemic or structural issues where consumers were being harmed. Therefore, the current level of regulation, including the licensing requirements and those for continued competency, appear to be providing adequate consumer protection.” For repealing the under-two agreement with a licensed physician, naturopaths must already demonstrate five hours of continuing education solely related to pediatrics every year to treat anyone under two and there have been zero reports to the state of adverse events related to a patient under two since 2014. It appears that when qualified naturopaths are doing fine without needing an agreement with a licensed physician. Civil liability like this is standard for regulators and witnesses, adding it here is not a big deal. It is best practice to not cite specific organizations in statute and leave it to the state regulators to pick the organization in case either the organization disappears or becomes no longer suitable.

Arguments Against:

If we are saying there are very few complaints, then perhaps we need to remove the registration requirement here completely. It was a close-thing to even starting this registration, as the first sunrise review in 1993 found no need to register this group, and even though multiple later sunrise reviews did cite a need, it was not actually done until 2014. If the point is to provide the least restrictive registration/licensing burden possible, looks like that may be a step below where we are now.


You can use the same argument about requiring registration, the act of doing it ensures only competent folks are practicing naturopathy, to requiring a naturopath to work with a licensed physician for those under two. Just requiring is what could be ensuring we get folks who can handle it. If we remove the requirement, just like with the overall registration requirement, it could open the door to people who should not be practicing on those under two and would not be able to secure an agreement with licensed physician.


Report also recommended getting rid of the naturopathic advisory board, since it barely has anything to do anymore (had to cancel ½ of their last ten meetings due to lack of an agenda).

How Should Your Representatives Vote on HB20-1212

HB20-1216 Sunset Continue Nurse Practice Act [Mullica (D)]

AMENDED: Minor

PASSED HOUSE

Appropriation: None
Fiscal Impact: None

Goal: Continue the Nurse Practice Act for seven years and implement recommendations of the department of regulatory agencies’ sunset review report.

Description:

  • Continues the Nurse Practice Act and associated regulation and oversight of nurses for seven years.
  • Eliminates requirement that advance practice nurses with authority to write prescriptions to complete and maintain a plan once they are passed the mentor stage. Makes audits of these plans by the nursing board optional, rather than mandatory.
  • Requires nurses to notify the nursing board if they suffer any illness, condition, or behavioral health disorder that affects their ability to practice with reasonable skill and safety. Requires them to act within the limitations created by that condition or comply with any confidential agreement reached with the board to accommodate the condition. Removes punishment for nurses doing any care whatsoever with one of these conditions.
  • Allows the board to punish nurses who engage in sexual acts with patients during care or within 6 months after care.
  • Requires nurses and insurance carriers to report malpractice settlements and judgments.
  • Requires nurses to report any adverse action or the surrender of their license within 30 days of the action
  • Changes the timeframe for reporting a criminal conviction from 45 to 30 days
  • Removes willfull and negligent as requirements for punishment for bad acts.
  • Removes the age limit (was 55 or older) on volunteer nurse licenses and removes the “retired” part of the license
  • Removes references to alcohol or substance use disorders and merely provides disciplinary grounds for excessive use or abuse of alcohol or drugs.

Additional Information:

Also:

  • Repeals requirement for director of division of professions and occupations to consult with board prior to appointing an executive administrator and other board personnel. Repeals requirement for at least one board member to sit on the panel to interview candidates for the board executive administrator position.
  • Changes title of Advanced Practice Nurse (APN) to Advanced Practice Registered Nurse (APRN)
  • Other technical changes


Auto-Repeal: September 2027, with sunset review

Arguments For:

From the department of regulatory agencies sunset review report: “It is especially important to ensure that nurses are at least minimally competent. A nurse may harm a patient by failing to adequately assess or monitor a patient’s condition; by administering the wrong medication or the wrong dose of a medication; by using medical equipment improperly; by failing to communicate with other health-care providers; and by failing to use proper infection controls. In all of these cases, a patient may be seriously injured or die as a result of substandard care. Substandard care in the practice of nursing can also extend hospital stays and increase health-care costs.” Advanced practice nurses only get full prescriptive authority after 1,000 hours of mentorship and already have other requirements to consult when necessary. They don’t need to keep updating a plan. Adverse action reporting requirements line up with what doctors are required to do. You cannot punish someone for having substance or alcohol abuse disorders, those are medical conditions. You punish them for using the substances (sober people have these disorders).

Arguments Against:

The provision on sexual activity is a little overboard. Yes nurses should not have any sexual contact with patients, that goes without saying. But requiring a six month waiting period, because the department of regulatory agencies is concerned that it takes time for the patient to “stop idolizing the nurse” is overkill, even if it is sometimes used in other professional medical settings as a rule.

How Should Your Representatives Vote on HB20-1216

HB20-1218 Sunset Continue Hearing Aid Providers [Buckner (D)]

AMENDED: Moderate

PASSED A HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Continue the licensing of hearing aid providers through 2031 and implement the recommendations of the department of regulatory agencies’ sunset review report.

Description:

Continues the licensing of hearing aid providers through September 2031 and makes the following changes:

  • Restores the long list of deceptive trade acts relating to hearing aids that existed prior to 2013 which allows consumers to file complaints with the licensing division rather than going to court
  • Clarifies that a license is required to sell a hearing aid and forbids unlicensed staff from engaging in scope of practice of hearing aid providers
  • Requires hearing aid providers to maintain a surety bond in amount of $10,000 or $1,000,000 professional liability insurance
  • Adds failure to practice according to commonly accepted practices as grounds for discipline
  • Allows state to accept disciplinary action taken by another state, a local jurisdiction, or the federal government as evidence of misconduct if the basis for the action would be grounds for discipline under state law
  • Removes references to the national competency examination and the National Board for Certification in Hearing Instrument Sciences and lets the state determine what national credentials to require
  • Requires final agency actions to be appealed to court of appeals
  • Combines the hearing aid provider act with the audiologist practice act Requires at least eight hours of continuing education for licensure

Additional Information: n/a

Auto-Repeal: September 2031 with sunset review

Arguments For:

From the department of regulatory agencies’ sunset review report: “The primary reason  Colorado regulates hearing aid providers is to protect consumers from financial harm in hearing aid sales. Consumers may be harmed by unscrupulous sales practices. There is also some potential for harm related to the practice of fitting hearing aids. Therefore, the General Assembly should continue the licensure of hearing aid providers.” We actually tried deregulating hearing aid providers in the past and found it did not work to protect the public. We also need the deceptive trade act restored so the state can take action on violations without requiring a court decision (and thus force people to go to court). The surety bond is another restoration of pre-2013 law. Without a surety bond customers may never get recompensed for bad acts and it is common practice with licensed individuals. It is standard operating procedure to allow the state to take actions done in other jurisdictions as evidence the individual violated state regulations. There was a lot more action taken prior to 2013 against licensees, so it appears all of these 2013 changes, which this bill restores, gutted the ability of the state to effectively regulate the program.

Arguments Against:

There was not much activity in the past few years in terms of actions taken against licensees, typically a sign that a license is not required.

How Should Your Representatives Vote on HB20-1218

HB20-1219 Sunset Continue Licensing Audiologists [Buckner (D)]

AMENDED: Moderate

PASSED A HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: Not yet released

Goal: Continue licensing of audiologists through 2031 and implement recommendations from the department of regulatory agencies’ sunset review report.

Description:

Continues the licensing of audiologists through September 2031. Requires licensees and insurance carriers to report any malpractice settlements or judgments to the state within 30 days. Restores the long list of deceptive trade acts relating to hearing aids that existed prior to 2013 which allows consumers to file complaints with the licensing division rather than going to court. Removes references to alcohol or substance use disorders and merely provides disciplinary grounds for excessive use or abuse of alcohol or drugs. Requires final agency decisions to be appealed to court of appeals and combines this act with the hearing aid provider act requires ten hours of continuing education for licensure.

Additional Information: n/a

Auto-Repeal: September 2031

Arguments For:

From the department of regulatory agencies’ sunset review report: “Audiologists may physically damage an ear when making an ear mold. An individual may suffer permanent hearing loss if an audiologist does not refer for a medically treatable condition, such as sudden hearing loss in one ear, and an audiologist may exacerbate hearing loss if a hearing aid is over amplified. Children who are fit with hearing aids that are under amplified may suffer delays in language acquisition, learning and development. For these reasons, it is important to ensure that audiologists are qualified in order to protect the public health, safety and welfare. Audiologists also sell hearing aids, and consumers may be financially harmed when purchasing hearing aids.” We need the deceptive trade act restored as it was prior to 2013 so the state can take action on violations without requiring a court decision (and thus force people to go to court). It is also common for licensees who carry malpractice insurance to be required to report adverse actions to the state. You cannot punish someone for having substance or alcohol abuse disorders, those are medical conditions. You punish them for using the substances (sober people have these disorders). Colorado is currently only one of three states that does not require continuing education for this field.

Arguments Against: n/a

How Should Your Representatives Vote on HB20-1219

HB20-1230 Sunset Occupational Therapy Practice Act [Singer (D), Larson (R)]

AMENDED: Minor

PASSED HOUSE

Appropriation: None
Fiscal Impact: None

Goal: Continue the regulation of occupational therapists until 2030, implement the recommendations of the department of regulatory agencies’ sunset review report, and provide greater detail for definition of scope of practice for occupational therapists.

Description:

Continues the regulation of occupational therapists until September 2030. Designates the occupational therapy consultant and occupational therapy assistant as protected titles (so you cannot use them without proper licensure unless you are legally temporarily practicing in the state). Tweaks some of the declaratory language about occupational therapists and what they do, including providing more detailed definitions of the job and adding low vision rehabilitation, behavioral health care services related to occupational performance, and sensory-based interventions. In general an emphasis added on aspects beyond pure physical health into mental well-being and greater emphasis on overall quality of life. Adds failure to make essential entries on patient charts or falsifying these charts as grounds for discipline, as well as abuse or fraudulent use of health insurance. Clarifies that the act does not prohibit someone practicing occupational therapy as part of a doctoral capstone project that involves clinical work so long as there is proper supervision. Re-organizes and cleans up some language.

Additional Information:

Adds definition of occupational therapy as: provided for habitation, rehabilitation, and the promotion of health and wellness to persons who have, or at risk of developing, an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupations therapy uses everyday life activities to promote mental health and support functioning in people who have, or who are at risk of experiencing, a range of mental health disorders, including psychiatric, behavioral, emotional, and substance use disorders. Occupational therapy addresses the physical, cognitive, psychosocial, sensory-perceptual, and other aspects of performance in a variety of contexts and environments to support engagement in occupations that affect physical health, mental health, well-being, and quality of life.


Auto-Repeal: September 2030

Arguments For:

From the department of regulatory agencies’ sunset review report: “Occupational therapists often work with vulnerable populations, and may also assist individuals who have suffered traumatic injuries through accidents or surgical procedures. If improper treatments or modifications were to be recommended, serious damage could be caused to patients in their work toward strength-building, healing, and recovery. The Director works to protect consumers from these types of harm through educational and licensure requirements to ensure that occupational therapists in Colorado are competent. In addition, the Director reviews complaints and can discipline a license for violations of the Occupational Therapy Practice Act (Act).” Adding the discipline grounds is pretty obvious and standard for medical personnel. Protecting the titles that are commonly used in the profession both protects consumers from folks not qualified to use the title and in the judicial system, ensures we are true experts when they are needed to testify. The current definitions for occupational therapy are rather vague and providing more detail ensures we have a greater handle on scope of practice for regulators to use. Occupational therapy is also a critical aspect of our mental and behavioral health toolkit and it is appropriate to expand the definition to cover work that is already being done.

Arguments Against: n/a

How Should Your Representatives Vote on HB20-1230

HB20-1221 Complementary Or Alternative Medicine Pilot Program (Zenzinger (D), Smallwood (R)) [Kennedy (D)]

AMENDED: Moderate

PASSED HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: Small savings in Medicaid program

Goal: Expand conditions eligible for the state’s complimentary or alternative medicine pilot program to genetic diseases and brain injuries and also restrict the pilot to certain counties in the state.

Description:

Adds multiple sclerosis, brain injuries, spina bifida, muscular dystrophy, or cerebral palsy, all with a secondary condition of paralysis total inability for independent ambulation due to the condition, to list of conditions eligible to participate in the state’s complimentary or alternative medicine pilot program. Restricts the program to those who live in Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, El Paso, Jefferson, Larimer, Pueblo, or Weld counties Opens the program to anyone in Colorado.

Additional Information: n/a

Auto-Repeal: Program still repeals in 2025

Arguments For:

This program allows people with spinal cord injuries to receive complimentary (not free, but additional) or alternative medicine for their injuries. These treatments provide additional benefits to the injured and help keep our Medicaid costs down, as well as preventing people from searching for alternative methods to manage pain, like opioids or other drugs. People in the program have reported higher quality of life from these treatments. But the program currently is only for injuries and does not allow those with genetic disorders to qualify. This bill fixes this, as well as codify in law the county restrictions the program is already working under.

Arguments Against:

Perhaps it is time to make this a permanent program since it seems to working effectively and expand it out to the entire state. Obviously we cannot force providers to appear in other counties, but if they did then residents could take advantage.

How Should Your Representatives Vote on HB20-1221

HB20-1232 Equity In Access To Clinical Trials In Medicaid (Todd (D)) [Michaelson Jenet (D), Liston (R)]

PASSED HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Require Medicaid to cover routine costs associated for participation in an approved clinical trial for qualified individuals with life-threatening or debilitating medical conditions.

Description:

Requires Medicaid to cover routine costs associated for participation in an approved clinical trial for qualified individuals with life-threatening or debilitating medical conditions. These are medically necessary items and services that would be covered if the patient was not in a clinical trial, including those relating to the detection and treatment of complications arising from the trial. This does not include the thing being investigated in the trial itself, any items or services provided to satisfy data collection and analysis needs of the trial, anything usually provided free of charge in the trial, or anything the trial is required to provide.

Additional Information:

Physician must determine the individual has a condition that meets requirements for the trial. Eligible clinical trials include:

  • FDA approved or exempt trials of investigative drugs or devices
  • Funded by National Institutes of Health, Centers for Disease Control, Agency for Health Care Research and Quality, Federal Centers for Medicare and Medicaid Services, or any cooperative of these groups, the Department of Defense or the Department of Veterans Affairs
  • Funded by qualified non-governmental research entity identified in guidelines issued by National Institutes of Health for Center Support Grants
  • Funded by Department of Veterans Affairs, Department of Defense, or Department of Energy so long as approval of the trial occurs through system of peer review similar to that performed by National Institute of Health


Auto-Repeal: None

Arguments For:

This is a bit complex but the basic gist of it is that people on Medicaid with life-threatening or debilitating medical conditions should have access to clinical trials that may save their lives. Right now the problem is that these trials may have parts of them that would not be covered which would be prohibitive to the patient. For instance, if a trial involved first a surgery and then the clinical trial drug instead of a normal one, the surgery may not be currently covered in Medicaid. Or if you have a heart attack or something like that during the course of the trial it again may not be currently covered. This standard is already in place for Medicare and legally required in a few other states. This also helps the trials cover a wider set of the population, as traditionally under-represented groups in these trials (like minorities) are over-represented in the Medicaid population. And it also just makes sense: treatment someone would have gotten if they were not in the trial should absolutely still be covered if they are in the trial.

Arguments Against: n/a

How Should Your Representatives Vote on HB20-1232

HB20-1236 Health Care Coverage Easy Enrollment Program (Tate (R), Bridges (D)) [Lontine (D), Will (R)]

AMENDED: Minor

PASSED HOUSE

Appropriation: None
Fiscal Impact: Negligible next year

Goal: Give people the option of having the state check if they are eligible for free or subsidized health insurance via their income tax form.

Description:

Requires state to ask citizens on their tax forms if they would like the state to assess if uninsured household members are eligible for free or subsidized coverage on the state health exchange. If the state determines that they are, the exchange will help with coverage options and enrollment. Creates the Affordable Health Care Coverage Easy Enrollment Advisory Committee to guide implementation of the program. Committee must determine minimum amount of information necessary to get information needed for assessment, procedures for transferring information from department of revenue to health care exchange, and recommend revisions to tax forms and instructions to make it all possible. It must also look into feasibility of automatic enrollment into Medicaid and CHP+ where people are eligible.

Additional Information:

Advisory council recommendations must include the question asking if the individual wants eligibility checked, and for those that do, a request for the identity of the uninsured individual and any additional information, including household size, that is not otherwise available but necessary to determine eligibility. Form cannot ask for citizenship, immigration status, or health status. Council must also determine timeline for exchange for assessing individuals, a process designed to maximize participation for notification, and a process for handling individuals whose status as US citizens cannot be verified by exchange. Committee is to consist of:

  • Executive directors of exchange and department of revenue (co-chairs)
  • Representative of department of health care policy and financing and one of the division of insurance
  • Representative of consumer advocacy groups and a consumer
  • Representative of small employers
  • Representative of insurers and an insurance provider and someone from consumer assistance personnel in the health insurance field
  • A provider of income tax preparation services

These nine members are to appointed by the board of the exchange and it must consider the geographic, economic, ethnic, and other characteristics of the state in making the appointments. Council members can be removed for cause by the board or by a majority of the council. They can get reimbursed for expenses. Council repeals in September 2030.


Auto-Repeal: Council, September 2030

Arguments For:

The health exchange has been very successful in lowering the number for Coloradans without insurance, from 14% to 7%, but it has leveled off in the past five years at that number. This means there are still about 361,000 Coloradans without health insurance. Most of these people have incomes that allow them to receive subsidies (about 29%) or Medicaid or CHP+ (27%). Certainly for those eligible for Medicaid, simple knowledge may be the key thing keeping them from getting insurance. And some of those eligible for subsidies might not be aware that they could get affordable insurance through the exchange. So we may be able to make a sizable dent in the uninsured population simply by providing more information. It goes without saying that insurance makes an enormous difference in health and economic outcomes for people. This program will require some up-front costs to reformat our tax process and on-going costs to the exchange to check people’s eligibility, but we save money in the long-run by having people on stable insurance through lower emergency room costs and better preventative medicine.

Arguments Against:

This is part of the Obamacare structure and should be eliminated, not expanded and encouraged. We need to lower premiums so people can afford them, not prop up health insurers through federal and state (and yes, there is state money involved in these subsidies) money to hide the true costs of insurance. Lower premiums can come by loosening restrictions on insurers so they can offer plans that do not have to cover as much, lowering insurers costs and thus premiums.


This is part of the private insurance structure and it needs to be eliminated so we can have profit out of the health insurance industry entirely and everyone on some form of Medicare for all. Any political energy dedicated to propping up this system lowers our chances for implementing a better one.

How Should Your Representatives Vote on HB20-1236

HB20-1239 Consumer Protections Concerning Vaccinations [Williams (R)]

KILLED IN HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: Negligible in first year

Goal: Require health care providers to provide detailed information on any vaccine prior to administering it and prohibit providers from refusing to treat unvaccinated people and schools from suspending or kicking out or refusing to enroll unvaccinated children.

Description:

Requires health care providers to provide detailed information on any vaccine prior to administering it. This must include the risks and benefits of the vaccine based on the patient’s health record and the right of the patient to refuse the vaccine. If the patient is a minor this information must be provided to the parents. This must be in writing and include the vaccine name and ingredients (including excipients and adjuvants), manufacturer website, federal health website where people can report injuries from vaccines, FDA website for vaccine recall information, patient exemption rights including right to be exempted from state vaccine database, limitations on liability for person administering vaccine and any incentives they receive for doing so, and risk of contracting the illness or disease the vaccine is given for. Doctors must give notice of vaccines to be administered at next appointment, including ingredients. Doctors must also require patients to complete screening checklists of potential contradictions for minors receiving the vaccine prior to administering it. This must be developed by state board of health by end of year.

Any health care provider that either observes an adverse event or has one reported by a patient or their family must immediately report it to the federal vaccine adverse event reporting system. Bans health care providers from refusing to treat or harassing, scolding, coercing, or threatening a patient or parents for refusing or delaying vaccines. Insurers are banned from treating unvaccinated covered individuals any differently than vaccinated covered individuals. Schools are banned from dismissing, suspending, or refusing to admit an unvaccinated student. Violations of these bans can be enforced by the appropriate regulatory board and include fines ranging from $1,000 to $5,000.

Additional Information:

Checklist must include: allergies, previous vaccinations (including any serious adverse reactions), long-term health issues, family history of seizures and brain or nervous disorders, family members who experienced adverse reactions to a vaccine, and immune system problems or family history of them. Health care providers are also banned from recommending or administering a vaccine to an unemancipated minor without their parent or guardian’s consent. When determining fines, regulatory board must consider: scope and severity of violation, any actions taken to remedy it, and number of previous violations. State must publish duties and penalties of this bill on its website.


Auto-Repeal: None

Arguments For:

This is about both transparency and allowing Coloradans to use their right to not vaccinate their kids. Letting people know what is in the vaccines and potential side effects as well as their rights to not have the vaccine at all doesn’t prevent anyone who still wants a vaccine from getting one. It merely ensures people are informed. If vaccines are indeed so safe, no one should be worried this will scare people away. We also should want to make sure people know how to report injuries and get compensation. It is also an established right here in Colorado that you do not have to vaccinate your children. Yet there are many health care providers, including pediatricians, who refuse to accept as patients unvaccinated children. This infringes on the rights of these parents and children to make their own health care decisions and can make it difficult for them to find a quality pediatrician for their child. Parents also have the right to send their children to school unvaccinated, so the bill ensures that no school retaliates against a child for not being vaccinated.

Arguments Against:

Vaccines are actually extremely safe. Adjuvants are safe, and excipients (which basically means preservatives and mercury) are also safe. Mercury is no longer used at all in children and the exposure from a vaccine is less dangerous than the type of mercury contained in many fish anyway. First, in 30 years just 520 death claims have been compensated by the federal program this bill references and requires reporting to, and almost half of those involved an older whooping cough vaccine that hasn’t been used in 20 years. A chunk of these recent claims (half!) are for shoulder injuries from flu shots done improperly by the health care provider. On the other hand about 300 million vaccines are administered every year in the United States. About 1 in every million of these doses gets some sort of compensation for an injury (or 300 total). But of those payments, the compensation program itself says about 70% of them come from a negotiated settlement in which the government has not concluded the vaccine caused the injury. The head of the program describes it as a “guilty until proven innocent” model. So the final math on the injury rate for vaccines is about 1 in 4.5 million. But let’s stick with the 300 baseline number. About 34,000 Americans died from the flu in the last year for which we have data (2018-2019). Before the measles vaccine, it was estimated 3 to 4 million Americans a year got the disease with 400-500 dying from it. 372 people got the measles in 2018, last death in the US was in 2015. So yes, vaccines are not 100% safe. But they are much safer than many of the activities we undertake on a daily basis (like driving a car or walking down the street) and they prevent things much worse. And the very nature of how vaccines work, with herd immunity helping those who cannot have one, means they are a public health concern. Each year in the United States, immunizations save 33,000 lives, prevent 14 million disease cases, and save $9.9 billion in direct health care costs. And our state is already one of the worst in the country for vaccinations, we do not need to try to scare people into not getting vaccinated, quite the contrary. More people need to be scared into getting the vaccines. Finally, but crucially, this bill prohibits pediatricians from refusing to treat unvaccinated children. This is a key health and safety choice pediatricians can currently make to keep the rest of their patients, including children too young to have been vaccinated, safe from vaccine preventable illnesses. Because what’s the first thing we do when our child is sick? Take them to the pediatrician. If people want to endanger their children by not getting them vaccinated that remains their right. But the health and safety of the rest of us trumps their desire to get a particular pediatrician to see them. The way the bill is worded would also appear to not allow a school to discipline an unimmunized child at all, not just in retaliation for not being vaccinated but period, for any reason.

How Should Your Representatives Vote on HB20-1239

HB20-1270 One Parent Consent For Behavioral Health Services (Fields (D)) [Michaelson Jenet (D)]

AMENDED: Significant

PASSED HOUSE AND SENATE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Allow a physician or mental health professional to treat a child under 15 for behavioral health disorders with the consent of just one parent in cases where both parents have legal decision-making authority.

Description:

Allows for a physician or mental health professional to treat a minor under 15 years-old for behavioral health disorders with the consent of just one parent in cases where both parents have legal decision-making authority, except in cases where a court has ordered that both parents have legal authority to make health care decisions. Requires both to act in best interests of the minor and provide services for a behavioral health disorder only in accordance with the physician or mental health professional’s own advice or recommendation.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

In cases where parents may disagree over treatment for their child, currently no treatment is possible without the consent of both. This can be a problem, sometime a very serious one for a child in severe difficulty. The bill provides that treatment must always be what the health professional advises, so there will not be cases of one parent sticking it to another parent through unnecessary treatment. We have some kids who right now cannot get the treatment they desperately need because one parent is standing in the way. This bill solves that problem.

Arguments Against:

There are two problems with this. First, it is an abridgment of the rights of a parent. Yes in an ideal world all parents would always do the precise correct thing for their child, but we rightly acknowledge that unless there is serious danger to the child’s welfare, the parent has the right to dictate care. And that means both parents, not that one’s rights trump the other. It is all too easy, especially in borderline cases, to see where this could be weaponized in disputes between parents. The bill may exclude cases where there are court orders but it is likely to lead to more court ordrers in the future. The second problem is that care really only works if everyone is on board. If one parent doesn’t believe it is necessary and is undermining it when they have control over the child, this is not likely to work.

How Should Your Representatives Vote on HB20-1270

HB20-1283 Administration Of Inhaler For Respiratory Distress (Todd (D)) [Buckner (D)]

KILLED BY BILL SPONSORS

Appropriation: None
Fiscal Impact: None

Goal: Allow schools and other facilities that frequently have children in their care to store and have trained personnel administer albuterol to someone in respiratory distress.

Description:

Allows schools to obtain inhalers containing albuterol or similar FDA approved bronchodilators, that the nurse or trained personnel can administer to a student they believe is having respiratory distress. Every school that decides to stock inhalers must have at least two designated personnel trained to administer them. State is to create rules for educating and training personnel and must solicit opinions from an organization that represents school nurses. Schools may seek donations to buy inhalers or enter into arrangements with manufacturers to get them free or for a reduced price. Also authorizes permitted authorized entities allowed to apply epinephrine auto-injectors to also stock and administer inhalers. Requires training at least every two years from a nationally recognized organization experienced in training laypeople in emergency medical treatment. Entities can accept donations to purchase inhalers. Bill makes authorized people administering inhalers at both of these locations immune from prosecution if they do not engage in willful or wanton acts that cause damage.

Additional Information:

Designated entities include places like recreation camps, colleges and universities, day care facilities, youth sports leagues, amusement parks, restaurants, places of employment, ski area, and sports arenas. Training for the designated entities must include:

  • How to recognize the signs and symptoms of respiratory distress
  • Standards and procedures for storage and administration of an inhaler
  • Emergency follow-up procedures

People who pass the training must get a certificate. Bill also makes anyone regulated by state medical boards immune from discipline for either administering an inhaler in a school or for prescribing inhalers to a school or designated entity.


Auto-Repeal: None

Arguments For:

Situations can arise that can keep a student or individual away from home from using their own inhaler, including simply forgetting it at home. When they cannot get albuterol right away, they may end up needing the emergency room. So it is a simple solution is to have trained personnel with albuterol right there at hand to use it. Albuterol is not a dangerous drug if used properly and it is fairly easy to learn how to use it properly. At schools we also know that people are sometimes not immediately available or are absent for the day, so having more than one person trained and extending beyond the school nurse makes sense. Fourteen other states already have versions of this law, it is time for Colorado to join them.

Arguments Against: n/a

How Should Your Representatives Vote on HB20-1283

HB20-1284 Secure Transportation Behavioral Health Crisis (Bridges (D), Smallwood (R)) [Kraft-Tharp (D), McCluskie (D)]

AMENDED: Minor

PASSED A HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: About $250,000 a year at full implementation

Goal: Bars private transport by entities of individuals in a behavioral health crisis after 2021 without a valid license created by this bill, except for ambulance services and law enforcement personnel.

Description:

Bars private transport by entities of individuals in a behavioral health crisis after 2021 without a valid license created by this bill, except for ambulance services, transportation provided by state agencies, emergency service patrol, and law enforcement personnel. Transport initiated by individuals still allowed. License is on a county level, with fee determined by county. But state board of health is to set minimum requirements. These must address:

  • Staffing requirements for vehicles
  • Staff training requirements, including verbal de-escalation and trauma-informed care
  • Operating procedures, including when physical restraint is allowed
  • Quality improvement and process used to investigate complaints
  • Data collection and reporting
  • Clinical and medical standards and procedures
  • Circumstances under which an individual may be transported
  • Criteria for pickup

Counties are to review applications, the applicant’s record, equipment, and training and operating procedures. These must meet or exceed standards set by the state board. Counties can add additional requirements. Licenses are to be for three years. Vehicles must get separate permit for each one. These are annual and the vehicle must meet minimum standards set by state board. Licenses are not transferable. Requires Medicaid to cover these transports and create a payment structure. Requires the commissioner of insurance to work to extend private insurance coverage to cover these transports. State must report to legislature on program.

Additional Information:

Transport is defined to include:

  • Transportation to or from facilities for voluntary or involuntary hospitalization evaluation
  • Transportation to an approved treatment facility for alcohol or substance abuse or a walk-in crisis center
  • Transportation either across levels or to higher levels of care to an emergency medical facility or any of the other facilities already described

Report to legislature must include: how crisis contractors are facilitating use of secure transportation or contracting with licensees, what local communities are doing, including with funding, to facilitate use, and how state has supported and encouraged crisis contractors to include secure transportation in the behavioral health crisis response system.


Auto-Repeal: None

Arguments For:

Transporting someone experiencing a mental health crisis is no easy task and right now we solve this by calling 911 and getting an ambulance or local sheriff. This is obviously expensive and potentially difficult to coordinate and we may able to create a better way through these licensed private transports. The bill not only covers training and minimum standards, but also realizes this won’t work without funding and so requires Medicaid to fund it and pushes the commissioner of insurance to work with private insurers. They will likely be happy to pay less. We can still get the individual where they need to go in a safe manner.

Arguments Against:

This should remain a task for ambulances and law enforcement, despite the cost and hassle. It is too risky to rely on private transportation, even if it is licensed.

How Should Your Representatives Vote on HB20-1284

HB20-1330 CGIA Colorado Governmental Immunity Act And A State Hospital Authority (Gardner (R), Lee (D)) [Lontine (D), McKean (R)]

PASSED HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Clarify that qualified immunity for the University of Colorado Hospital Authority only applies to the Anschutz Medical Campus and its hospital license.

Description:

Clarifies that the only people or facilities that qualify for qualified immunity that work at or are a part of the University of Colorado Hospital Authority are those that provide services or are physically located at either at the Anschutz Medical Campus or work under the hospital license issued to the University.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

Qualified immunity is what we give to employees of government agencies and the agencies themselves in order to shield them from civil lawsuits in situations where an employee acted unlawfully but would not be expected to know what they did was wrong before they did it. In essence, we don’t ask our government employees to be constitutional law judges. We ask them to do their jobs to the best of their ability and only punish known wrongdoing. This sort of immunity really only qualifies for people attempting to follow or carry out the law, so it does not make sense for it to extend beyond the Anschutz Medical Campus or any facility under its license. Everyone else still has the immunity provisions provided to all health care providers.

Arguments Against:

Qualified immunity is actually a shield to protect government agencies from the consequences of wrong-doing. The intentions behind it may be good, but in practice it doesn’t ask government agencies to be constitutional law professors, it assumes they are lobotomized constitutional law experts who are up-to-date on all of the most recent constitutional case law but are also incapable of making subtle distinctions. So for example, if settled constitutional law involves someone lying down while in this case the person was sitting—qualified immunity. We need to get rid of the idea entirely.

How Should Your Representatives Vote on HB20-1330

HB20-1340 Tanning Devices Risks Minors Prohibited (Todd (D)) [Caraveo (D)]

Appropriation: None
Fiscal Impact: Not yet released

Goal: Ban minors from using tanning facilities and require tanning facilities to keep signed acknowledgement of the dangers of using these facilities by first-time users.

Description:

Bans minors from using tanning facilities. Requires anyone wanting to use a tanning facility to provide proof of their age. Allows the state to set rules to implement this requirement. Violators are subject to fine of up to $250 for first incident and up to $500 for subsequent violations. Alters some of the requirements on tanning bed operators. Currently they are required to provide each user with a written handout on the dangers of using a tanning bed. Bill changes it to first-time users only. Bill adds requirement that the first-time user sign a form acknowledging they have read and understood the handout. These must be kept on file at the facility.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

Tanning beds are dangerous, this is pretty settled science. They’ve been placed in the same carcinogen category as tobacco due to their elevated risk of causing skin cancer. This risk is known to be particularly acute for minors, where the risk of melanoma rises for blistering sunburns during childhood or teenage years, and frequent exposure to UV rays for those under 35 increases the risk of melanoma by over 60%, even if the cancer doesn’t come until later. The World Health Organization has recommended that no one under 18 use one. Multiple other states including states as far apart on the political spectrum as California and Texas ban the use of tanning beds by minors.

Arguments Against:

There are other states that require parental permission instead of an outright ban. While we recognize that this behavior is dangerous, there are other dangerous behaviors we allow minors to undertake with parental permission. This is a non-addictive and non-mind altering behavior (unlike smoking, drugs, and alcohol).

How Should Your Representatives Vote on HB20-1340

HB20-1349 Colorado Affordable Health Care Option (Donovan (D)) [Roberts (D), Kennedy (D)]

AMENDED: Minor

PASSED A HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: About $950,000 next year, then about $750,000 each year

Goal: Create the Colorado Option, an insurance plan offered by private insurers that is controlled by the state government and includes higher medical loss/ratios, basic protections provided by the ACA, defined reimbursement rates and mandatory participation for hospitals, and must be offered by at least two insurers in each county in the state.

Description:

Requires health insurance carriers in Colorado to offer what the bill calls the “Colorado Option”, which has its own set of rules and regulations, beginning in 2022. This must be offered to anyone on the individual health care marketplace in each county where the insurer offers any other insurance, but the state commissioner of insurance is empowered to write rules expanding the Colorado option to the small group market if a majority of an advisory board created by this bill also agrees. If the board agrees, the commissioner is also required to ensure that at least two carriers offer the Colorado option in each county and gives power to the commissioner to establish rules that may require carriers to offer the plan in specific counties. All hospitals must accept Colorado option insurance or face fines escalating to $40,000 per day and potential loss of license.

For insurers, the Colorado option plan must have a medical loss ratio of 85%, rather than the 80% required by the Affordable Care Act (ACA). This means 85% of all premiums must be spent on reimbursing medical care. All rebates and incentives from drug manufacturers must pass through at 100% to policyholders in the form of premium reductions. Plans must be at least ACA bronze and silver levels of coverage, include the essential benefits package required under the ACA, and provide first-dollar, predeductible coverage for certain services such as primary care and behavioral health care as appropriate.

In developing the plan the commissioner must consider: lowering all out-of-pocket costs to consumers, including premiums; increasing access to health care; increasing consumer choice; reducing health disparities; minimizing cost shifting, impacts on other markets, and impacts on those receiving federal subsidies; improving care coordination; and incorporating value-based purchasing and plan design. Commissioner is specifically tasked to mitigate adverse impacts on those whose income is up to 400% of the federal poverty line (eligible for federal subsidies under the ACA).

The Colorado option has specific hospital reimbursement rates that must be included in all plans. The commissioner will set these rates for in-patient and outpatient services, with a specific goal of lowering costs and increasing access in rural areas. The rates must be based on Medicare or equivalent reimbursement rates. The base is 155% of Medicare and then is adjusted based on the following factors:

  • Critical access or hospitals that are not a part of any health care system get a 20% increase in reimbursement. A hospital that is both gets to double-dip: 40% increase
  • Hospital with combined percentage of Medicare and Medicaid patients that exceeds statewide average gets up to a 30% increase, based on how far above average it is
  • Hospital that is efficient in managing underlying cost of care, taking into accounts its margins, operating costs, and net patient revenue, gets up to a 40% increase

Commissioner must consult with employee membership organizations representing health systems’ employees in Colorado and with hospital-based health care providers and may make changes as necessary to reflect cost of adequate wages, benefits, staffing, and training. Commissioner also has the option to exempt a hospital from these rates if it can demonstrate they will have a significant negative affect on the hospital’s financial sustainability. Starting in 2024 the advisory board will advise the commissioner on any adjustments that should be made to this formula.

Commissioner must annually report to the legislature beginning in 2024. The department of health care policy and financing must, in consultation with the advisory board, annually report on the impact of the Colorado option on hospital sustainability, the health care workforce, and health care wages to the legislature, also beginning in 2024.

The bill also creates the Colorado Option Advisory Board, which in addition to its already described duties, must also advise the commissioner how pass-through funds from any federal waivers received (which the bill requires at least 80% of which to go to those eligible for ACA subsidies), opportunities to leverage the plan to promote innovation and lower costs, and overall help in designing and implementing the plan. The board can override any decision made about the Colorado Option by the commissioner with a vote of 7 out of the 9 members.

Additional Information:

Commissioner must consider each insurer’s structure, number of covered individuals in each county, and existing service areas as well as alternative health care options in each county (including cooperatives) when deciding whether to force insurers to operate in a specific county.

Commissions paid to brokers for the Colorado option must be comparable to the average commission for other plans in the individual market.

Board is composed as follows:

  • Executive director of the health care exchange
  • Four members appointed by the governor:
    • Two representatives of consumers who have the highest barriers to accessing health care
    • One with experience or expertise in provision of health care to uninsured and low-income populations
    • One with experience or expertise in health care finance
  • The speaker of the house, president of the senate, house minority leader, and senate minority leader get one appointment each, which must include:
    • Member with experience or expertise in value-based purchasing and plan design
    • Member with experience or expertise in provision of health care services in rural areas
    • Member with experience or expertise in hospital administration
    • Member from an employee organization that represents employees in the health care industry

No more than four members of the board can be from the health care industry, which includes hospitals, insurers, brokers, and providers. Members must publicly disclose any conflicts of interest. At least three must be from rural areas of the state and the board should reflect geographic, ethnic, racial, and economic diversity of the state as much as possible. In order to qualify for the board, a member must have demonstrated experience or expertise in at least two of the following areas:

  • Individual health care coverage
  • Value-based purchasing and plan design
  • Health care consumer navigation and assistance in accessing health care
  • Health care finance
  • Provision of health care in rural areas
  • Provision of health care to uninsured and low-income populations
  • Health care actuarial analysis
  • Health care delivery systems
  • Hospital administration
  • Insurance brokerage

Board members serve three year terms except that initially two of the governor’s appointees and the appointees of the house and senate minority leaders serve two years so as to stagger the terms. Board members may only serve two terms on the board. Board also has non-voting members, representing the following organizations/offices:

  • Comissioner of insurance, executive director of health care policy and financing, and the administrator of the all-payer health claims database
  • Appointed by the governor:
    • Governor
    • Statewide association of professional nurses
    • Statewide association representing physicians
    • Statewide association of hospitals
    • Statewide association of insurers

Board members can be removed by their appointing authority for cause, including incompetency, neglect of duty, malfeasance, or any other cause as determined by the board’s bylaws. Board must meet at least quarterly, hold public meetings with the opportunity for public testimony, and establish bylaws for its operation. Members receive a per diem and reimbursement for expenses.

Hospital’s initial fine is $10,000 per day for first 30 days it refuses, and then up to $40,000 per day after that.

Report to legislature must include: effect of the Colorado option on the individual market and any cost shifting, effect on individuals who qualify for federal subsidies, adequacy of providers in the plan, and any other aspects the commissioner deems pertinent.


Auto-Repeal: None

Arguments For:

Multiple regions in Colorado still struggle to obtain affordable, useful insurance. The useful clause there is important, low-cost mostly useless insurance doesn’t do anymore much good and is the system we had before the Affordable Care Act when bankruptcy from health care costs was considered a normal thing in this country. 14 counties had access to only one insurer through the state’s exchange in 2019. The federal government doesn’t seem like it is going to do anything to address this, so it is up to us. Free markets have utterly failed in this industry for several very good reasons. First, consumers do not “price” their health care options. It is nearly impossible to do so even if you wanted to shop around at various providers. Second, consumers mostly do not have the choice over their insurance to begin with, since the vast majority get it through their employer. And most importantly, we cannot choose to not get health care. We all need it and we cannot choose when we need it. And so we have two choices: offer insurance through the government (a public option) where the government is in essence the insurance company or create and manage an insurance option for private insurance. In essence, attack head-on the problems we all see in the health care marketplace through an insurance plan that must be offered throughout the state. We passed a bill last year to explore this issue and the committee it created recommended this solution. A true public option just does not fit with state finances (multiple other states including Vermont and California have explored this and come to the same conclusion). So what are these problem areas? First, prescription drugs, where a piece of the issue is cost savings from the manufactures that are not making their way to consumers but instead being pocketed by insurers and pharmacy middlemen called PBMs. That will not happen under the Colorado Option. Second, insurance companies themselves, who remain an extremely profitable industry, with net profit margin higher than before the introduction of the ACA (3.4% in 2018 and rising) on vastly increased revenues (thanks in part to all of those new ACA customers). So clearly shaving another 5% off the amount of premiums they are allowed to keep isn’t going to hurt anyone. Finally and most importantly, a big part of this is hospitals. Denver-area hospitals made a record $2 billion in profit (yes profit, not revenue) and prices overall in the state grew 70% between 2009 and 2018. In the state, hospitals are now profiting (again, profiting) at $1,518 per patient in 2018. That number was $538 in 2009. A 280% increase in pure profit. Coloradans have lost billions of dollars just so these hospitals can make more money, mainly through charging non-Medicare and Medicaid patients far more than they need to offset any potential losses. We have the second highest hospital profits in the entire country, the fourth-highest administrative expenses (non-medical care—you don’t profit on salaries but you can compensate your executives highly, like over $5 million a year for the CEO for instance), and the second-most hospital construction in the country, despite the fact that we are one of the healthiest states in the nation. And this is an industry dominated by “non-profits” (over ¾ of the hospitals in the state) who aren’t supposed to care about making a profit at all. These non-profits have cut spending on charity care by 2% according to the latest tax data available while instead money is plowed into unnecessary construction (our occupancy rate is below average for the country and dropping) and stockpiling of “reserves”. All of that extra cost gets passed on to us through insurance premiums. Probably the most controversial part of this bill will be the rate setting for hospitals, which of course face similar issues with Medicaid and Medicare but have more flexibility to opt-out of providing some of that care. The break-even point for most hospitals is believed to be at about 143% of Medicare rates, so we are already starting above that in order to provide some cushion. Then of course we want to not have a one size-fits all rate but target hospitals in specific circumstances (including having more of those low fee Medicare and Medicaid patients) for higher reimbursement rates. No one wants to run hospitals out of business or put added stress on hospitals that are already struggling (thus the ability to also have a complete exemption from these rates). We just want to reign in one of the worst systems in the entire country when it comes to cost. So yes, the state sets reimbursement rates and those rates may in fact drive other insurance plans offered in the state to negotiate their own rates from a place of power, rather than their current place of weakness in the face of the monopolistic structure of our hospital system (where there has also been a lot of consolidation of ownership). That is in fact the entire point. We do not need the most profitable hospital industry in the nation. The design of the bill may actually also raise reimbursement for some hospitals who are not part of a big system, critical care locations, and efficiently serving high numbers of Medicare and Medicaid patients (the media has already found 10 hospitals, all rural, that they believe will actually see rate increases under this bill). Because all of those adjustments to the rates are additive, you can easily blow past 100% if you hit multiple categories. And those are precisely the hospitals that are currently struggling and the ones we want to reward. The bill also protects against two main areas of concern with a state-backed plan: that insurers will simply shift costs to non-Colorado Option plans and that those on subsidies will be negatively affected. For the first, the commissioner of insurance can deny any rate change that is a cost shift (all plans must be approved by the commissioner to appear on the marketplace right now). As for the alternative total cost of care model proposed in arguments against, this is a model that fails to acknowledge that our current spending is wildly out-of-control and instead locks that spending level in and just tries to “limit” future growth. Massachusetts may believe they have saved money by using this plan compared to nothing at all, but insurance premiums and out-of-pocket expenses have grown there by more than their targeted maximum growth figure (which was 3.8%, well above inflation). So it may be somewhat helping but it by no means gets a full handle on the problem. The final point is the concern over insurers fleeing the state entirely. This gets parts of the equation here wrong. Insurers are going to love the reimbursement rates set on hospitals (who also aren’t going anywhere) and are going to love the bargaining power this option gives them when it comes to their own plans. They may not be so pleased with being forced to serve some markets and being forced to give up another 5% of their premium revenue, but profits remain profits. And the insurance industry can still easily be profitable under this bill, as can hospitals.

Arguments Against:

Getting costs down by getting more free market innovation into the space is the right way to go, not more government involvement. There is a reason why there are few insurers who want to provide coverage in these counties and that is because of the high cost of delivering health care in these areas. Thanks to the Affordable Care Act, these insurers cannot offer lower cost plans that do not cover as much, so everyone is stuck with high priced plans. We need to get government out of the way, not more deeply involved as this bill envisions. In essence, this bill gives an enormous amount of power to unelected government officials to basically set the health care market for the entire state. The commissioner of insurance gets to create this plan and its requirements, tell hospitals exactly what they are allowed to charge for services, and tell insurers where they must offer plans as well as denying rate increases in other areas. This is government intervention on steroids. For hospitals, there is a lot to unpack here. First, the profit numbers include profits from investment income (reserve funds, which no one denies a hospital should have, don’t just sit in a bank account), and the profits due to just patient care drop the profit margin from 10% to 4%. And of course we need new construction, we are one of the fastest growing states in the country. We might be somewhat under-capacity right now, but we know more people are coming. And when it comes to cost, the fact that no one like to talk about is that health care innovation is incredibly expensive. All of the work that goes into creating new drugs and new equipment and new procedures that benefit us all must be paid for. And hospitals frequently have to make significant capital investments in that new equipment just to keep up. But yes, there probably is extra cost here that could be addressed. But instead of government pricing controls, we should look to the model used in Massachusetts and Oregon (hardly bastions of conservative thought). This is a total cost of care model that sets a desired target for how much health care spending can grow and then work with hospitals that do not meet the target (including public hearings and a formal improvement plan). Massachusetts believes it has saved billions with this program and we can do the same here in Colorado by working with the hospital industry, not in conflict with it. And that truly is the bottom line here, a collaborative approach with all elements of this industry to foster innovation and competition by removing government oversight. Then consumers can pick options that work best for them, which in a free market drives money to the best operators in the industry, including those with the best costs. Because this plan runs the risk of insurers and hospital providers deciding they don’t want to participate in Colorado at all. The commissioner of insurance or state government cannot force them. So instead of creating more options and lower costs, we could end up with fewer options as these companies flee the state entirely.

How Should Your Representatives Vote on HB20-1349

HB20-1358 K-12 Seizure Safe Schools [Mullica (D), McKean (R)]

Appropriation: None
Fiscal Impact: Not yet released

Goal: Require all public schools to have individualized seizure action plans provided by the parents for kids with seizure disorders and require the schools to have trained personnel to handle a seizure.

Description:

Requires parents who have a child with a diagnosed medical condition, including epilepsy, which might induce one or more seizures to submit a written, individualized health plan for their child to prepare schools for their child’s potential health care needs. Plans must be submitted: at the beginning of the school year, as soon as possible after a medical diagnosis that meets the criteria, or if the student’s health condition significantly changes. All public schools must provide training on recognition of signs of an oncoming seizure and appropriate steps for first aid. This must be given to relevant school personnel who have direct contact with students who have a seizure disorder. Each school with a student who has an action plan must have at least one employee who has met training requirements to administer or assist with administration of seizure treatment medications and manual vagus nerve stimulation. Private schools are encouraged to do all of this as well.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

Given the rate of epilepsy in our population, a school with 1,000 students is likely to have 6 with the condition. It is therefore imperative that every school has an action plan and is able to administer effective first aid. The federal Center for Disease Control recommends an individualized action plan just like this bill proposes as well as the education and training. Right now this is up to individual school districts and that is just not acceptable in a situation that can quite literally be life or death.

Arguments Against:

The bill doesn’t provide a mechanism to deal with parents who refuse to submit a plan, what is the school and the state supposed to do in this case?

How Should Your Representatives Vote on HB1358

SB20-001 Expand Behavioral Health Training For K-12 Educators (Fields (D)) [Sirota (D), Beckman (R)]

From the School Safety Committee

Amended: Minor

PASSED SENATE COMMITTEE

Appropriation: $1 million annually through 2024
Fiscal Impact: None beyond appropriation

Goal: Increase training level of K-12 staff in dealing with behavioral and mental health of students.

Description:

Creates a voluntary “train the trainer” program for any K-12 employees (public or charter) around evidence-based instruction of youth behavioral and mental health training. State cannot force any schools to use program and schools cannot force any employees to take program. State may enter into an agreement with a 3rd party organization to provide the program. $1 million annually appropriated for program. State must annually evaluate the effectiveness of the program (no parameters given other than soliciting feedback).

Additional Information:

Subjects the training may include are:

  • Trauma-informed approaches to improve overall school climate and culture
  • Identifying signs of behavioral and mental health challenges that may be experience by students
  • Restorative practices for these challenges
  • Improving social and emotional health to foster positive school climate
  • Evidence-based bullying prevention and intervention strategies
  • Encouraging positive bystander behavior
  • Best practices to assist students who are not in crisis
  • Safe de-escalation of crisis situations
  • Identifying and accessing available resources and treatment available for students
  • Suicide prevention practices.


Auto-Repeal: July 1, 2024

Arguments For:

We all know we have a behavioral health crisis among Colorado youth. Our teen suicide rate is one of the highest in the country and we had the highest increase in suicide rate in the country since 2016. The 2019 rate was 20% of all deaths, double the national rate. A report from the United Health Foundation found half of Colorado’s kids in the 3-17 age bracket did not get the mental health counseling they needed. One of the front lines in this battle is in our schools, the people who outside of family see our children the most. This bill recognizes that we can only work within the resources we have, and that one of the best uses of those resources is to create a small group of professionals who can train much larger groups within the course of their existing duties. So while many schools have trained and certified behavior health specialists, there are far too few of them and we unfortunately need to ensure that the non-specialists can also help kids who are struggling. The best way to do that is give these experts training that is not part of their official certifications: how to teach others. A non-voluntary program isn’t going to solve this problem at all, it would create resentment for being “forced” to attend and would not create the voluntary follow-through required after the training is over: to have the newly trained employees train their colleagues.

Arguments Against:

While the goals of this bill are laudable, it does not have the teeth required to make a significant enough difference. By being entirely voluntary, the bill may only help those who needed it least: those professionals who are already dedicated to improving their craft and helping the kids in their school. These individuals are more likely to already be teaching their colleagues and while this bill may help that teaching be more effective, it would make a much wider impact if we ensured that all districts benefited from it by making in mandatory in some fashion or allowing districts themselves to require an employee to attend. As it stands now, a district may decide they would like to take advantage of the program, but if the chosen employee (likely a mental health professional) at a school says no thanks, there is nothing the district can do but try to find someone else.


The deterioration in our children’s mental health doesn’t come from a deterioration of the behavioral health abilities of our educators, it comes from the deterioration of our society. So while it may not seem like much money, we will be wasting $4 million over the life of this bill if we don’t fix what ails our society in general. We don’t need more government trained mental health professionals, we need stronger families and a stronger society.

How Should Your Representatives Vote on SB20-001

SB20-007 Treatment Opioid And Other Substance Use Disorders (Pettersen (D), Winter (D)) [Buentello (D), Wilson (R)]

From the Opioid and Other Substance Use Disorders Study Committee

AMENDED: Minor

PASSED SENATE COMMITTEE

Appropriation: $2.7 million next year, than $1 million annually
Fiscal Impact: Apart from appropriation, $500,000 year after next

Goal: Remove barriers to obtaining and using prescribed medication-assisted drug treatment, access to voluntary and involuntary treatment, and increase support for underserved communities.

Description:

  • Re-organizes the law relating to emergency treatment and voluntary and involuntary commitment of people for treatment of alcohol disorders by adding treatment of drugs to create a single process that includes all substances. Increases the duration of an initial involuntary commitment from 30 to up to 90 days. Allows people to enter into a stipulated order for committed treatment, which expedites placement. Removes the mandatory hearing for the initial involuntary commitment but allows someone to request a hearing if they don’t want a stipulated order. Adds a patient’s rights section
  • Requires insurance carriers to provide coverage of substance use disorders in accordance with American Society of Addiction Medicine guidelines for placement, medical necessity, and utilization.
  • Increases funding by $1 million for provider loan forgiveness and scholarships to the Colorado Health Service Corps program. Requires program to prioritize creating a diverse health care workforce that is able to address needs of underserved populations and communities.
  • Currently pharmacies can enter into agreements with doctors to receive higher fees for administering opioid antagonist medication. Bill expands this to all injectable medications for medication-assisted treatment approved by the FDA.
  • Requires state to commission a child care and treatment study and report on recommendations for closing gaps in family-centered substance use disorder treatment and alternative payment structures for funding child care and children’s services alongside substance use disorder treatment.
  • Prohibits managed service organization contracted providers, withdrawal management services, and recovery residences from denying access to medical or substance use disorder treatment services to people participating in prescribed medication-assisted treatment. Also prohibits courts, parole boards, and corrections facilities for prohibiting use of prescribed medication-assisted treatment as a condition of participation or placement.
  • Appropriates $250,000 to aid with hiring of state employees to work as grant writers to help local communities obtain grants for state and federal money to address opioid and other substance use disorders.
  • Authorizes state to require prescription medications for medication-assisted treatment to be required as an essential benefit for health insurance. Also requires insurers to provide coverage to opioid antagonists without prior authorization and without any charge to the covered individual.
  • Requires insurance companies to report to state number of in-network providers who are licensed to provide medication-assisted treatment and how many are actively doing so.
  • Requires updated community assessments every two three years of sufficiency of substance use disorder services to be compiled by an independent entity. Must include opportunity for public input. Managed service organizations which did original assessments on same lines in previous legislation to prepare draft plan based on review and allow time for public input.

Additional Information:

  • Requires managed care entities to provide coordination of care for the full continuum of treatment and recovery services, including support for people transitioning between levels of care.
  • Requires state to create a program for training and community outreach relating to availability and process of civil commitment of people with a substance or alcohol use disorder. Must first be provided to first responders, law enforcement, emergency departments, primary care providers, and people and families of people with substance use disorder
  • Community assessments must include input from people with lived experience, community mental health centers, regional accountable entities, county departments of human or social services, local public health agencies, probation departments, schools, tribal leaders, and other community organizations that serve veterans, youth, families, or homeless individuals.
  • Grant writers funded by this bill must prioritize helping underserved populations and communities.


Auto-Repeal: None

Arguments For:

Combining the alcohol and drug treatment standards to have just one is something communities have asked for and makes sense (just one example, both use medication assisted treatment and even the same drug), partially to cut down on confusion but also as a recognition that the disorders are similar. The 30 day standard is too short for effective care in some cases and it does not make sense to require a hearing if the parties involved are fine with going forward and getting that expedited placement. If the person being committed objects, then there is a hearing so no one is being forced against their will. There is no standard for what insurers must provide in terms of medication-assisted treatment, which is by far the most effective treatment for this disease. This bill helps create that standard for state plans (which is all we can do). We can make sure people have access to medication-assisted treatment in various settings, that they do not have to jump through hoops to obtain it, and they do not have to pay money to get it. We also incentivize more pharmacies to be able to provide a full-spectrum of these drugs and not just antagonists. We also know that a big gap in treatment relates to families struggling to help a family member fighting addiction while simultaneously trying to live day-to-day, which this bill addresses with further study.

Arguments Against:

We should not be combining the alcohol (a legal substance you do not need a prescription for) and drug (either illegal or requires a prescription) programs in this manner. The issue of hearing is tricky, because the bill does allow for objection but we are talking about an individual who is under the influence of drugs or alcohol and may not be able to make the best decisions for themselves. They may not be qualified to make this judgment and we should not yank hearings out from underneath them. Having different standards for state and federal plans when it comes to covering medication-assisted drugs may cause confusion in the marketplace and among consumers and requiring a variety of facilities to allow it may cause some of them to stop treating people altogether.


We’re flushing a lot of money and resources down the drain of drug addicts who can’t get their lives together. While it is undeniably tragic, there are plenty of life choices people make that are tragic that do not get millions of dollars of state resources thrown at them. Cycling people continuously through treatment isn’t the answer, stopping people from getting hooked in the first place is. Sadly our resources are better used in different places once they are this far down the path. As for kicking addictions, our prisoners are already not being supplied with drugs, so they are detoxing without medication assistance or withdrawal treatment. It’s on the individual to make the best of their opportunity to clean after that.

How Should Your Representatives Vote on SB20-007

SB20-033 Allow Medicaid Buy-in Program After Age 65 (Tate (R)) [Lontine (D)]

AMENDED: Significant

PASSED SENATE

Appropriation: $50,000
Fiscal Impact:About $3.8 million at full implementation None beyond appropriation

Goal: Allow those who are participating in the Medicaid buy-in program for working adults with a disability to stay in the program even after reaching 65.

Description:

Allows those who are in the Medicaid buy-in program for working adults with a disability to stay in the program after reaching 65 without with matching federal funds so long as they meet certain eligibility requirements, including being in the buy-in program continuously for at least one year prior to reaching 65, although premium payments may be required.

Additional Information:

Eligibility requires:

  • Applied for or enrolled in Medicare
  • Eligible for and receiving long-term care home and community based services or durable medical equipment as part of complex rehab services or has extraordinary medical expenses, that are not covered by Medicare

State can make rules necessary for this to work, including adjusting premium and cost-sharing charges as necessary.


Auto-Repeal: July 2022

Arguments For:

While there is a concerted push to get the federal government to change this law and allow people to remain in the buy-in program so long as they are have not retired, as long as the current state of affairs exists, we need to do something to help. Because otherwise people who need these benefits to survive are forced to dramatically reduce work and spend down assets accumulated during their lives, including retirement savings. This is because the program allows earnings of up to 450% of federal poverty level, while Medicaid itself requires much lower levels of income and has an asset test. We can make this work with state funds and increased funds from the participants and hope the federal government comes through soon different categorizations available under federal law so we can still get federal funds.

Arguments Against:

Regardless of the merits of changing the rules so people in this program can continue to work at age 65 if they want to, we should not go out on a limb without federal funds. This Medicaid buy-in program is designed to work with federal, not state, money. We may be biting off more than we can chew by committing to continuing it without any federal support. Note that the bill requires the state to do this regardless and figure out how later, rather than studying the financial feasibility first.

Medicaid is a bad welfare state program that should not exist in the first place. Some employers may decide to dump low-income workers onto the state rather than offering health insurance, some doctors do not accept it, and there is always the possibility of fraud. We should not extend Colorado into more of it.

How Should Your Representatives Vote on SB20-033

SB20-022 Increase Medical Providers For Senior Citizens (Danielson (D))

PASSED SENATE COMMITTEE

Appropriation: $1,925,000 over five years
Fiscal Impact: Negligible beyond appropriation

Goal: Increase number of geriatric advanced practice providers by offering loan repayment assistance to those that agree to work in the field in shortage areas around the state for at least two years.

Description:

Modify existing Colorado Health Corps Service program, which includes a loan repayment component, to include advanced practice nurses and physician assistants who agree to spend at least 50% of their time providing geriatric care in shortage areas in the state for at least two years. Adds a geriatric care provider as a member to the Health Corps Service Advisory Council, and appropriates $1,925,000 over the next five years to specifically cover geriatric care provider loan repayments.

Additional Information:

To be eligible, an individual must be an advanced practice nurse or physician assistant that meets at least one of the following criteria:

  • Completed formal postgraduate geriatrics training program with at least six months of education in geriatric care and clinical experience with primary care of older adults with no more than 25% of that care in inpatient or hospice settings
  • Completed formal geriatrics training within an advanced practice provider training program with at least 12 months of postgraduate clinical experience (at least 50% of time spent in geriatrics) or at least 24 months of postgraduate clinical experience (less than 50% of time spent in geriatrics) or completed geriatric track clinical experience during their training program with at least 50% of clinical training spent in geriatrics.

Geriatrics does not include hospice-only care.

Council must give priority to applicants that are providing care in a rural setting, practicing with a non-profit entity, and willing to serve as a clinical preceptor for others seeking training in geriatrics.

Funding is broken down as follows:

Year 1: $225,000
Year 2: $400,000
Year 3: $575,000
Year 4: $450,000
Year 5: $275,000


Auto-Repeal: None

Arguments For:

We have a shortage of these providers in many areas of the state. A 2016 estimate had the state short 176 geriatricians and at the time, only 5 of the 148 geriatrics practices listed in an online database were outside the Front Range and Grand Junction. As of last summer, Summit, Eagle, Garfield, and Pitkin counties had zero board-certified geriatricians, despite an estimated 15,000 people 70 years or older residing there. Those trained in geriatrics are experts in the complexities of care that accompany old age, much as pediatricians are experts in the complexities of care of children. Meanwhile the number of Coloradans over the age of 65 is expected to double by 2048 to nearly 1.7 million. We have an acute need here and a program that already exists to fill such needs, with a long list of eligible providers across the entire medical spectrum: from dental hygienists to doctors, including geriatric doctors. So adding advanced practice nurses and physician assistants who will specialize in geriatrics is not a stretch at all. And the bill adds funding for its expansion of the program, so no existing fields will be hurt.

Arguments Against:

This program already includes advanced practice nurses and physician assistants, who must agree to work for three years, not two, in the state. The only other type of advanced practice nurse and physician assistant specialization that is separated is substance use disorders. No one denies we have a geriatrics shortage, but we have lots of other shortages in rural areas of the state and we may be better served by beefing up advanced practice nurses and physician assistants in general with these extra funds, rather than focusing solely on geriatrics.


This bill does nothing to prevent an individual from getting their loan repayment and then either leaving the state entirely or moving to a non-shortage area to practice.

How Should Your Representatives Vote on SB20-022

SB20-028 Substance Use Disorder Recovery (Pettersen (D), Priola (R)) [Buentello (D), Herod (D)]

From the Opioid and Other Substance Use Disorders Study Committee

AMENDED: Minor

PASSED A SENATE COMMITTEE

Appropriation: $10.3 million next year, $9.8 million annually thereafter.
Fiscal Impact: Beyond appropriated money, around $300,000 annually.

Goal: Provide ongoing financial assistance to support those in recovery from substance use disorders, including finding a job and housing. Refine the standards for finding abuse or neglect of children in substance use disorder cases.

Description:

  • Requires office of behavioral health to establish a program to assist individuals with substance use disorders by providing temporary housing assistance and appropriates $4 million annually for the program. To qualify individuals must be transitioning out of a residential treatment setting into recovery and receiving treatment.
  • Creates the Recovery Support Services Grant Program in the office of behavioral health to provide grants to recovery community organizations that provide recovery-oriented services to people with both a substance use and mental health disorder. Appropriates $3.5 million annually to the program.
  • Appropriates $2 million annually to the office of behavioral health to expand its individual placement and support program, which helps people with behavioral health disorders and substance use disorders find and keep jobs
  • Requires the statewide perinatal substance use data linkage project to conduct research into incidence of perinatal substance exposure or related infant and family outcomes based on child abuse and neglect standards the bill also revises for determining child abuse or neglect. Annually appropriates $75,000 for this. Revised standards to change “prescribed” to “prescribed or recommended and monitored by a licensed health care provider” and adds that the newborn child’s health or welfare must be threatened by substance abuse.
  • Requires the center for research into substance use disorder prevention, treatment, and recovery support strategies to design and conduct a comprehensive review of the state’s treatment and recovery services to inform a state plan for delivery of services to people at risk of relapse and appropriates $500,000 for the task.
  • Annually appropriates $250,000 to the department of labor and employment to provide peer coaching and peer specialist training for people recovering from substance use disorders.
  • Extends the Opioid and Other Substance Use Disorders study committee through 2023 but changes it to a biannual interim committee meeting in 2021 and 2023.

Additional Information:

Requires the state’s substance abuse trend and response task force to also review bills introduced by this committee and generate policy recommendations.

Recovery grantees can use funds to:

  • Offer opportunities for individuals in recovery to engage in activities focusing on mental or physical wellness or community service
  • Provide guidance to individuals in recovery and their families on navigating treatment, social service, and recovery support systems
  • Help qualified individuals connect with resources to initiate and maintain recovery
  • Assist in establishing and sustaining a social and physical environment supportive of recovery
  • Provide local and state recovery resources to recovery community organization participants and community members
  • Provide recovery support services for caregivers and families of individuals in recovery

Applicants to the recovery grant program must submit:

  • A business plan, including a budget, operations, and sustainability plan
  • Plan for educating the public about behavioral health disorders and recovery pathways
  • A mechanism for tracking recovery capital measures for participants

State must prioritize applicants that demonstrate ability to reach a diverse set of groups and underserved communities. At least 60% of awards must go to development of new programs in first year of program and at least 40% in the second. Grantees must report ever year:

  • Number of community members involved in organization
  • Detailed description of the organization’s advocacy efforts
  • Any collaborative projects with other organizations in the state
  • Efforts to capture capital recovery measures
  • Any other information required

Office must submit annual report on program to legislature.

The center’s study on relapse should focus on:

  • Analysis of evidence base of substance use disorder treatment and recovery services, including efficacy, outcomes, and quality of care. In particular at “hands-off” care and risk of relapse
  • Assess if standards of care adequately address risk of relapse
  • Focus on recovery management services risk relapse rate in comparison to other chronic conditions
  • Analyze effect of stigma on subsequent access to treatment
  • Identify and provide practice and policy recommendations

Report due by August 2021.


Auto-Repeal: Section on center report, September 2021. Committee September 2024.

Arguments For:

People with substance use disorders who relapse cause an enormous drain on our society’s resources. And it is not only monetary, they put strains on families. This bill is about breaking the cycle, intervening to cut away the numerous obstacles to staying sober which include steady employment and housing. Without these two critical elements, it is much more difficult to avoid relapse and then the whole wheel starts turning again, churning through state resources as it goes. We can spend the amounts of money this bill appropriates, or far, far more on endless relapse and recovery cycles. But of course we also want to be sure we spend as wisely as possible, which is what the study into best practices for recovery is about. We also need to ensure that child abuse and neglect as it relates to substance abuse is correctly calibrated so as to keep families together to the greatest extent possible without endangering anyone’s safety. Finally this commission has done tremendous work and we have come a long way in the last few years. But the work is not done. It is diminished, thus the biannual instead of annual committee, but we need to see this through to the end.

Arguments Against:

The perinatal data recovery program has potential chilling effects on the desire for women to come forward and seek treatment. Tying this project to child abuse and neglect research may scare women away from desperately needed help for fear of losing their child or children. The altered standards for abuse and neglect also may err too far in the other direction by allowing substances monitored by a licensed professional to exempt a parent from the rest of the abuse or neglect standard.


We’re flushing a lot of money and resources down the drain of drug addicts who can’t get their lives together. While it is undeniably tragic, there are plenty of life choices people make that are tragic that do not get millions of dollars of state resources thrown at them. Tax dollars should not be spent on helping people who have made their own bad choices in life obtain a job and housing. Where are the lavish programs and personalized supports for people who have not abused drugs but are still struggling to stay employed or housed?

How Should Your Representatives Vote on SB20-028

SB20-040 Require License Practice Genetic Counseling (Ginal (D), Todd (D)) [Buckner (D), Michaelson Jenet (D)]

PASSED SENATE AND A HOUSE COMMITTEE

Appropriations: $35,895
Fiscal Impact: None beyond appropriation

Goal: Create a licensure requirement and structure for genetic counseling.

Description:

Creates a licensure requirement and structure for genetic counseling requiring an appropriate genetic counseling certification, with a few small exceptions. Also requires counselors to carry insurance and abide by mandatory disclosures of past activity required by the Michael Skolnik Medical Transparency Act.

Additional Information:

Renewals require 30 hours of continuing education approved by a national genetic counseling certifying organization. Fees for license and for renewal to be determined by department of regulatory agencies. Genetic counseling is defined as:

  • Obtaining and interpreting individual, family, medical, and development histories
  • Determining mode of inheritance and risk of transmission of genetic conditions
  • Discussing the inheritance, features, natural history, and means of diagnosis of genetic conditions
  • Identifying, coordinating, ordering, and explaining genetic laboratory tests and other diagnostic studies
  • Assessing psychosocial factors and recognizing social, educational, and cultural issues
  • Evaluating the client or the client’s family responses to the genetic condition or risk of recurrence of a genetic condition and providing client-centered counseling and anticipatory guidance
  • Communicating genetic information to clients
  • Facilitating informed decision-making about testing and management alternatives
  • Identifying and utilizing community resources that provide medical, educational, financial, and psychosocial support and advocacy
  • Providing accurate written documentation of medical, genetic, and counseling information for clients, their families, and health care professionals

This licensure does not prohibit or restrict the practice of a person licensed or otherwise regulated in the state from engaging in their profession or occupation as defined by their license, someone studying genetic counseling under appropriate licensed supervision who is clearly identified as a student, someone from another state or country who is licensed as a genetic counselor in that state or country if the person is filling in temporarily for a licensed counselor. Limit of four weeks duration once a year.

State can take disciplinary action against licensees as with other medical licenses, including falsified information, inappropriate relationships with clients, substance abuse, criminal convictions, or improper professional actions. Decisions are appealable.


Auto-Repeal: Sunset Review September 2027

Arguments For:

Genetic counseling is a medical field and we regulate medical fields for obvious reasons. This bill treats genetic counseling like any other medical field in the state. Licensure would also allow genetic counselors to get credentialed which would allow them to bill for their services and help grow the field. It also gives a place to adjudicate complaints, without licensure there is no place to complain. Right now anyone can call themselves a genetic counselor and give critical life and death Health Care advice to a patient. The idea that because this very new and emerging field doesn't have enough complaints yet, so we should wait until someone gets terrible genetic counseling advice and dies or suffers severe health problems is not how Colorado should operate. This is an incredibly complex and rapidly evolving field. We cannot afford to treat it lightly.

Arguments Against:

Requiring a license for this emerging field may stifle innovation and keep some people out. The boom in the industry may push us to a place where we actually have a shortage of genetic counselors. The state department of regulatory agencies has not found a large level of consumer complaints in this field and does not think it warrants licensure. Genetic counselors have several nationwide certification boards that can provide the proof of knowledge and credentials we need. A nearly identical bill was vetoed last year by Governor Polis.

How Should Your Representatives Vote on SB20-040

SB20-043 Out-of-Network Provider Reimbursement Rate (Tate (R)) [D. Valdez (D)] TECHNICAL BILL

From the Statutory Revision Committee

SIGNED INTO LAW

Description:

HB19-1174 set a requirement for an insurance carrier to reimburse an out-of-network health care provider who provides emergency services or covered non-emergency services to a covered person at an in-network facility at certain rates. A conforming amendment in the bill had the wrong amounts and this bill fixes it.

SB20-045 Colorado Department Of Public Health And Environment Hospital License Requirements (Tate (R)) [D. Valdez (D)]

From the Statutory Revision Committee

KILLED BY BILL SPONSORS

Description:

Repeals law requiring hospital licenses to have the signature of the president of the state board of health, the attestation of the secretary of the state board of health, and the state board’s seal.

SB20-084 Prohibit Requiring Employee Immunization (Marble (R)) [Saine (R)]

KILLED IN SENATE COMMITTEE

Appropriation: None
Fiscal Impact: Negligible

Goal: Prohibit employers from retaliating against employees or perspective employees based on immunization status.

Description:

Bans employers, including licensed health care facilities, from firing, disciplining, demoting, refusing to promote, discriminating against in terms of wages or other benefits, or refusing to hire someone based on the individual’s immunization status. State may not require health facilities to ensure employees receive vaccinations. Remedy is civil lawsuit, which can include reinstatement, back pay plus 10% interest, and any other equitable relief that is appropriate. May also get punitive damages if it is demonstrated by clear and convincing evidence the employer acted with malice or willful or wanton misconduct or if this is not a first-time offense for the employer. Courts may also award attorney fees.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

Even pro-vaccine people admit that there are risks to vaccines. There is no risk of getting autism from a vaccine but there are other risks including bad reactions to the vaccine and in some cases, although quite rare, death or severe disability. Doctors themselves admit they cannot with 100% accuracy predict who will be harmed by vaccination. There is no liability for medical professionals administering them and extremely limited liability for pharmaceutical companies. There is a federal vaccine injury compensation program which takes on the liability for vaccines from pharmaceutical companies and it awards hundreds of millions of dollars a year in vaccine-related injury claims and more than $4.2 billion in claims over its lifetime. There is also an associated reporting system, which gets about 30,000 complaints annually from across the country. It is also possible that this represents under-reporting of more mild injuries from vaccines, as not everyone is aware of the program. So we have a medical treatment we know is not always safe and we cannot predict who necessarily it will not be safe for. We also know that the medical code of ethics for the American Medical Association accepts that some individuals have medical, religious, or philosophical reasons not to be vaccinated and it is a universal tenet that we must have informed consent to medical treatment. And yet right now in Colorado there is no protection for someone invoking these personal rights from being fired or not hired because they lack certain vaccinations. And the state requires licensed health care facilities to ensure their employees get flu shots. This bill fixes this situation by protecting those who decide not to be vaccinated from retaliation, no matter their workplace.

Arguments Against:

Each year in the United States, immunizations save 33,000 lives, prevent 14 million disease cases, and save $9.9 billion in direct health care costs. But Colorado is the worst state in the country for immunization rates. Immunizations are one of the great health achievements of all-time and we are throwing it all away. Diseases that were eradicated are making comebacks, and this is not just an issue of money. Some people cannot receive immunizations for medical reasons or are too young. These people are being put at-risk of harm or death by the actions of those who have refused to be immunized. As for the hard data on compensation and reporting of adverse effects. First, in 30 years just 520 death claims have been compensated and almost half of those involved an older whooping cough vaccine that hasn’t been used in 20 years. A chunk of these recent claims (half!) are for shoulder injuries from flu shots done improperly by the health care provider. On the other hand about 300 million vaccines are administered every year in the United States. About 1 in every million of these doses gets some sort of compensation for an injury (or 300 total). But of those payments, the compensation program itself says about 70% of them come from a negotiated settlement in which the government has not concluded the vaccine caused the injury. The head of the program describes it as a “guilty until proven innocent” model. So the final math on the injury rate for vaccines is about 1 in 4.5 million. But let’s stick with the 300 baseline number. About 34,000 Americans died from the flu in the last year for which we have data (2018-2019). Before the measles vaccine, it was estimated 3 to 4 million Americans a year got the disease with 400-500 dying from it. 372 people got the measles in 2018, last death in the US was in 2015. So yes, vaccines are not 100% safe. But they are much safer than many of the activities we undertake on a daily basis (like driving a car or walking down the street) and they prevent things much worse. And the very nature of how vaccines work, with herd immunity helping those who cannot have one, means they are a public health concern. We do have a long history in this country of accommodating others sincerely held beliefs and in letting people make their own decisions for their health care. But that must stop at the point where it endangers the health and safety of others, and that it why employers have the right to ensure the safety of their workplace and why in particular health care facilities must ensure their employees are not passing vaccine-preventable illnesses like the flu to some of the most vulnerable people in our society.

How Should Your Representatives Vote on SB20-084

SB20-102 Provider Disclose Discipline Convict Sex Offense (Ginal (D), Cooke (R)) [Caraveo (D)]

AMENDED: Minor

PASSED SENATE AND HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Require health care providers on active probation or limited in their ability to practice due to sex offense convictions or sexual misconduct to disclose this to patients prior to treatment.

Description:

Makes health care providers who must comply with the Michael Skolnik Transparency Act (which is pretty much everyone) disclose to patients if they have been either convicted of a sex offense or been subject to final disciplinary action resulting in probation or limitation on their license due to sexual misconduct and is still under those sanctions. Once the professional sanctions end and/or any probation associated with a criminal conviction ends, notice is no longer required. Notice must be given prior to any treatment and the patient must sign it. Exceptions are for emergencies, unscheduled appointments, if the patient does not know which provider they will see prior to a visit, or if the patient is unconscious or unable to understand disclosure and no family representative is available. Failure to comply is unprofessional conduct on the provider’s license.

Additional Information:

Disclosure for sex offense conviction must include:

  • Date of final judgment and type, scope, and duration of sentence or other penalties, including if there was a plea agreement and if there was probation (and if so, the duration and terms of probation)
  • Nature of offense

Disclosure for disciplinary action must include:

  • Type, scope, and duration of action, including if action was a stipulation or from a judicial decision
  • If the provider was placed on probation or had any limits placed on their practice and if so, the terms and duration of the probation and/or limits
  • Nature of the offense
  • Date final order was issued and date the probation and/or practice limitation ended/ends
  • Contact information for the regulator that imposed the action


Auto-Repeal: None

Arguments For:

Health care providers frequently have intimate access to their patients, both physically and emotionally. We deserve to know what we are getting into beforehand, if a provider is still fulfilling their debt to society or to their profession due to past sexual misbehavior, then the patient must have the right to make an informed choice. Once the debt is cleared, we must let the provider do their job. We live in a society of rehabilitation. The entire point of ending probation or practice limitations is to say that we as a society are satisfied and that we must allow the offender the chance to live a full life again. Otherwise we risk essentially making lifetime punishments.

Arguments Against:

This notice requirement should never go away. Patients should have the right to make that informed choice all the time, not just when the timing is such that the provider is no longer being actively monitored (which may in fact be one of the worst times to see a sexual predator). This is not to say that all sex offenses or misconduct are equal but we should let the patient decide if they are comfortable with events more in the past.


In essence we might as well just say that these folks should not be able to practice until they have finished probation. Because it is likely that the vast majority of people will instantly dismiss any thought of using a provider who is telling them they have sexual misconduct in their past. It is the job of the overseeing board covering the provider’s license or registration to ensure that the provider can safely practice. That is why we have probation and practice limits in the first place. So that the board can keep those who should not be in certain situations with patients out of them. A provider can tell a patient until they are blue in the face that safeguards are in place to prevent sexual misconduct, but what patient is going to want that provider touching them, regardless of who else is in the room?

How Should Your Representatives Vote on SB20-102

SB20-107 Drug Production Costs Transparency Analysis Report (Ginal (D)) [Mullica (D), Jackson (D)]

AMENDED: Moderate

PASSED SENATE COMMITTEE

Appropriation: $250,000
Fiscal Impact: $150,000 each subsequent year

Goal: Collect detailed cost information from the manufacturers for the most expensive prescription drugs in the state every year.

Description:

Requires the state to collect, analyze, and report prescription drug cost data for the 20 highest-cost prescription drugs per a normal length treatment for the drug and the 20 highest-cost drugs by volume that were purchased by various state agencies during the year. The state is to then get the basis for and components of the wholesale acquisition cost, including all administrative and marketing costs, for each drug. Manufacturers that fail to comply are subject to fines of up to $10,000 a day. It must then report this information to the legislature, including a breakdown of the components in each drug and their contribution to the overall wholesale cost. Report must also include total amount rebated back to state in the previous year for prescription drugs and and percentage of Medicaid spending on prescription drugs in that year. State may use a third-party contractor for the analysis. Bill repeals in September 2025 with sunset review.

Additional Information:

Complete list of information the manufacturers must supply includes:

  • Research and development costs
  • Clinical trial costs
  • Regulatory costs
  • Costs for materials, manufacturing, and administration
  • Income from other entities, including grants, subsidies or other supports, that offset any costs
  • Cost to acquire any technology needed for the drug or ownership of the drug from a 3rd party
  • Patent and licensing costs
  • Promotional marketing costs, including direct-to-consumer advertising

Manufacturers have 120 days to supply this information.


Auto-Repeal: None September 2025 with sunset review

Arguments For:

While we all know the general gist of prescription drug pricing issues (and the few extremely notable cases that have received large amounts of public attention), what we do not know are the deep details. This bill is all about those details and about transparency. Prescription drug costs are one of the biggest drivers of increasing costs in our health care system. According to a state report about 11% of state residents did not fill a prescription because of cost last year. State Medicaid spending grew by a whopping $435 million from 2014 to 2019 and is now over $1 billion per year. And yet we know very little about the pricing behind most of these drugs. Finding this out will be useful to both policy makers and the public as we try to find ways to lower prescription drug costs. No one is forcing any manufacturer to change anything, we just want the information. Other states, including California, already ask for information like this, so this will not be novel to the manufacturers. And this is no ordinary industry, people’s lives literally are at stake and frequently they must take a specific medication. No other choices, no real ability to put pricing pressure on the drug by refusing to buy it.

Arguments Against:

This is a deeply intrusive move into the inner workings of prescription drug companies, who are required to essentially turn over reams of cost data for many drugs which the state is then going to turn around and publish. It may erode the ability of these companies to compete with each other and it may erode their ability to conduct the incredibly expensive research required to find new life-saving drugs. It is also an administrative burden on insurers, who have to turn over all of this annual information to the state. We are raising the cost of doing business for all of these entities that touch prescription drugs and they are likely to try to pass those increases on to us.


Data is fine, but action is better. We already know public shame doesn’t do anything, just look at the current state of things where we are very much aware of the dramatic price increases in the industry.

How Should Your Representatives Vote on SB20-107

SB20-077 Born Alive Child Physician Relationship (Woodward (R)) [Sandridge (R)]

*This bill is identical to HB1068*

KILLED IN SENATE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Create a doctor-patient relationship between doctors who perform abortions and any child who is born alive after the procedure.

Description:

Creates a doctor-patient relationship between doctors who perform abortions and any child who is born alive after the procedure. This requires the doctor to exercise the same degree of professional skill, care, and diligence to preserve the life and health of the child as would be done to any other child born at the same gestational age and requires immediate transportation to a hospital. Civil penalty of $100,000 and a class 3 felony for violations, as well as an unprofessional conduct put on the doctor’s license.

Additional Information: n/a

Arguments For:

Of course we already have murder laws on the books but this bill is aimed at passive situations to ensure that no doctor backs away from providing medical needed to keep a baby alive. If an abortion procedure goes wrong and the result is a baby that is alive, we owe to that living being to try to keep it alive to the best of our abilities, just as we would for any other baby at that same gestational age. If survival is not possible and comfort care is the only thing we can do for the baby, then that is what this law would dictate happen. But if survival is possible, even if unlikely, we have to ensure that doctors will do everything they can. By limiting this protection to the child only to abortions, the relationship and duty will only apply when an abortion was attempted and induced premature births for fetal health abnormalities wouldn’t apply since the goal was to deliver a live baby.

Auto-Repeal: None

Arguments Against:

Killing a child is already illegal in this country and thanks to a law passed in 2002, infants born at any stage of development have full legal rights, so this bill is not solving any problem with an alive child being killed by a doctor. In fact in 2013 a doctor was found guilty of three counts of murder for botched illegal abortions in Philadelphia that involved children born alive. This bill also creates a huge problem: abortion is not defined in the bill, so situations where a parent has made the difficult decision to induce labor for fetal abnormalities may be swept up into this law. The vast majority of late-term abortions (extremely rare by the way, just 1.4% of all abortions happen at 21 weeks or beyond), where gestational age is advanced enough that survival is a possibility, are performed in a way that make survival impossible. And in catastrophic pregnancies, where there is a plan to deliver the fetus but the parents know there is a strong chance it will not survive, this bill might force extraordinary measures the parents have chosen not to undertake. It might have a chilling effect on the willingness of doctors to adhere to parents’ wishes in these cases, even if the doctor knows it is hopeless. So in summary, this bill looks to solve a problem that is already covered by law by creating fear around something that does not happen but creates new problems in the process.

How Should Your Representatives Vote on SB20-077

SB20-087 Require Credentials Central Service Technicians (Todd (D)) [Mullica (D)]

AMENDED: Minor

PASSED SENATE AND HOUSE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Require central service technicians to be certified by a national body in order to work in a hospital or ambulatory surgical center.

Description:

Requires hospitals and ambulatory surgical centers to employ central service technicians (people who decontaminate, inspect, assemble, package, and sterilize reusable medical equipment and devices) who have successfully passed a nationally accredited exam and hold at least one certificate from a nationally accredited central service technician credentialing organization. Hospital may grandfather in certain individuals already working in this job. Also may hire someone who has passed the exam but not yet been credentialed for 18 months 2 years so long as they are working toward earning a credential. Medical professionals and students or interns acting under the supervision of medical professionals can still perform these tasks without fulfilling any of the bill’s requirements.

Additional Information:

In order to be grandfathered in, people must have worked for at least one year in the job in the past five years and be employed in the job at the end of this year. Any break in employment after that will require fulfilling requirements of the bill. Hospitals or ambulatory surgical centers must provide written proof of dates of employment upon request to help people meet the grandfather requirements.


Auto-Repeal: None

Arguments For:

This is incredibly serious and potentially a life or death matter. In 2015-2018 Porter Adventist Hospital improperly sterilized equipment and caused hundreds of severe and infections and at least one death (then attempted to cover up the extent of the problem, which is only slightly germane to the bill).  And this is not necessarily an isolated incident. Just last year in Indiana a hospital notified over 1,000 patients that they may have been exposed to hepatitis B and C and HIV due to improper equipment sterilization. There are similar stories around the country. A national report released in 2018 found 71% of reusable medical scopes that had been cleared for patient use actually tested positive for bacteria. Among the safety issues the report found: Hospital technicians wore the same gloves for handling soiled scopes fresh after a procedure and later, when they were disinfected and employees wiped down scopes with reused towels. Storage cabinets for scopes were visibly dirty and dripping wet scopes were hung up to dry, which is a known risk because bacteria thrive on the moisture left inside. The two hospitals also turned off a cleaning cycle on a commonly used “washing machine,” known as an automated endoscope reprocessor, to save time. We can no longer rely on the hospitals themselves to adequately police this area and provide proper training. We must intervene with national credentials and standards to ensure that everyone working in this critical area is properly trained.

Arguments Against:

Credential requirements always act as barriers to entry for an industry. It makes it that much harder for someone to work in the field, and these are good jobs for a lot of people. Instead we should focus on holding hospitals accountable for their methods and practices. Require hospitals to do significant training and oversight of this area and do random inspections to catch malfeasance. This will do more to ensure that hospitals are providing the right standards of care while keeping this industry open to more people.


This doesn’t go far enough. If we truly believe this is a critical area for public health, then full-licensure is the answer, which allows for greater ability to discipline those who do not uphold the correct standards and practices, require continuing education, and track wrong-doing across jobs and time. In addition, we should not grandfather anyone in, the problem is that right now things are being done so poorly the state has to step in. No one gets a free pass.

How Should Your Representatives Vote on SB20-087

SB20-113 Colorado Department Of Public Health And Environment Health Facility License Requirements (Tate (R)) [D. Valdez (D)] TECHNICAL BILL

From the Statutory Revision Committee

SIGNED INTO LAW

Description:

Repeals language requiring each health facility license issued by department of public health and environment to include the signature of the president of the state board of health, the attestation of the board secretary, and the board seal.

SB20-119 Expand Canadian Prescription Drug Import Program (Ginal (D)) [Jaquez Lewis (D)]

AMENDED: Moderate

PASSED SENATE

Appropriation: None
Fiscal Impact: Possible savings due to lower drug costs

Goal: Allow the state to expand its plan to import prescription drugs from Canada (which still requires federal approval) to other countries that meet the same requirements laid out for drugs coming from Canada and have been approved by the federal government.

Description:

Allows the state to expand its plan to import prescription drugs from Canada (which still requires federal approval) to other countries that meet the same requirements laid out for drugs coming from Canada and have been approved by the federal government. This is only if Congress passes legislation allowing this activity. Prior to asking for approval, state must submit evidence to the legislature that the country's regulatory system is at least as stringent as the FDA or otherwise ensures the safety, purity, and potency of its prescription drugs. This must include comparing regulatory system on the supply chain, manufacturing, labeling, and drug tracking and tracing.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

U.S. consumers pay some of the highest prescription drug costs in the world, as high as twice as Canadians for patented drugs and 20% more for generics. They also in some cases are skyrocketing. There are other countries in the world besides Canada that have robust regulatory environments, such as much of Europe, and we could benefit from widening the importation net (if approved by the federal government). The arguments against importation from Canada alone regarding price, that the surge in demand will increase prices of Canadian drugs, has some merit so widening our potential sources of supply does make sense. The bill allowing importation from Canada includes sufficient protections to make sure that the drugs are safe and effective and that no new cottage industry is created to grossly profit from the situation. This bill follows those same rules.

Arguments Against:

The FDA opposes this for safety concerns. Canada and other European countries may have their own versions but it is not the same as our FDA and other governments do not inspect or take responsibility for the legitimacy of prescription medicines shipped to the U.S. We should not rely on a vague sampling process to keep our citizens safe. Importation also greatly increases the risk of counterfeiting, particularly with Internet pharmacies, and the burden of investigating this will fall on ill-prepared state governments. The state’s ability to construct some sort of monitoring system to ensure safety may either not exist or be extremely expensive. This bill will also damage American pharmaceutical companies which employ thousands of American workers.


Drugs from Canada may be fine, the US and Canada have a memorandum of understanding on pharmaceutical regulation cooperation since 1973, but it is a step too far to extend this to other countries (especially if we aren’t even going to list them). We still haven’t gotten approval to do this from Canada yet (nor has any other state).

How Should Your Representatives Vote on SB20-119

SB20-127 Committee Actuarial Review Health Care Plan Legislation (Smallwood (R), Todd (D))

PASSED A SENATE COMMITTEE

Appropriation: None
Fiscal Impact: Minimal each year

Goal: Require any legislation that would change insurance plans (either by imposing requirements or amending existing requirements) to be examined by a committee created by the bill to conduct an actuarial review of the potential impacts of the change on insurance.

Description:

Requires any legislation that would change insurance plans (either by imposing requirements or amending existing requirements) to be examined by a committee created by the bill to conduct an actuarial review of the potential impacts of the change. Committee must give committee holding hearing on the bill an estimate on number of Coloradans affected, estimate in changes of rates of utilization of specific health care services from the legislation, any changes in consumer cost sharing, any impacts to state insurance plans, Medicaid, or employer group plans. Must do a five-year outlook and use dollar amounts on a per-member and per-premium basis. Committee consists of nine members, two from the legislature and seven appointed by the governor.

Additional Information:

Committee members are not paid or reimbursed for expenses (except legislators who get expense reimbursement). Members are as follows:

  • One from each chamber of legislature selected by leader of chamber in consultation with minority leader of chamber
  • One member representing insurance carriers
  • One member representing health care providers
  • One member representing health care consumers
  • One member representing hospitals
  • One member from the division of insurance and one representing the department of health care and financing
  • One member who is an actuary

Division of insurance must assist the committee and is allowed to seek gifts, grants, and donations from public and private sources.


Auto-Repeal: None

Arguments For:

We are constantly making sweeping changes to insurance without complete understanding of what these changes will mean for people’s premiums and coverage in concrete terms. We need to know if bill XYZ is actually going to raise premiums by 10% and not actually increase coverage much or if it will have little impact on premiums and make a big difference in access to services. But right now we just get a fiscal note that says the bill may have unknown impacts on these things and that is it. That is not the fault of the legislative staff preparing these notes, it is not their job at all. So this bill creates a group where it will be their job and requires us to know these impacts for any bill affecting insurance in the state.

Arguments Against:

This may be unworkable. To come up with the total impacts of legislation on such tight windows (before a committee vote) may prove extremely difficult, especially with multiple bills coming out at the same time or late in the session. And what of amendments that totally change the character of bills? The bill also may be setting itself up for failure by creating a committee that more resembles a task force than an analysis division, with stakeholders who have a vested interest in the outcome potentially influencing the numbers. You need impartial figures, like the non-partisan legislative staff, for a task like this (except of course with expertise in the industry).

How Should Your Representatives Vote on SB20-127

SB20-145 Repeal Colorado Reinsurance Program (Smallwood (R))

KILLED BY BILL SPONSORS

Appropriation: None
Fiscal Impact: Not out yet, but would save money

Goal: Repeal the state health insurance reinsurance program

Description: Repeals the state health insurance reinsurance program, allowing it to wind-down over the next year. Any funds leftover in the program after it ends must be returned to where they came from.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

We don’t need more insurance company bailouts, they are already highly profitable middlemen sucking money out of our health care system. If premiums are too high, we should be attacking them by addressing insurance company practices, not simply handing the companies more money so they will lower the premiums. We are going to pay $90 million to insurers in 2021 and the amount that is supposed to come from hospitals, $40 million, is up in air as the hospitals consider legal action. This is supposed to be an enterprise fund so it won’t qualify for TABOR (this gets pretty wonky, but sufficed to say if it is not an enterprise fund it messes up the budget) but if we can’t get the money from the hospitals in time that might not be possible. We are using money that was supposed to go to affordable housing to prop this up. It’s time to pull the plug and take a different approach to the problem.

Arguments Against:

This is working, why would be shut it down now? The average monthly premium on the state health exchange decreased from $510 to $407 this year. Some families are saving thousands of dollars a month. There was a slight increase for those who receive subsidies, from $118 to $138, but overall this is doing exactly what it is supposed to do: help insurers pay high-cost claims to keep premiums down for everyone. Insurers are already required to use at least 80% of premiums received on claims (85% for large group policies) so the extra money here isn’t padding insurer’s pockets. We found out that the federal government will pay even more than we expected, $169 million, and we only need an additional $9 million this year to make it work. Yes, there are a few financial issues going on right now with exact funding amounts, when the hospitals will kick in their share, etc. But these are solvable and we should not end a program doing excellent work because we’ve hit a few bumps in the road.

How Should Your Representatives Vote on SB20-145

SB20-156 Protecting Preventive Health Care Coverage (Pettersen (D), Moreno (D)) [Esgar (D), Mullica (D)]

AMENDED: Minor

PASSED A SENATE COMMITTEE

Appropriation: None
Fiscal Impact: None

Goal: Enshrine the preventive health care services required to be covered at no cost by insurers by the federal Affordable Care Act into Colorado law while adding a couple of additional services and allowing providers to administer preventative treatment of sexually transmitted infections to minors without parental consent.

Description:

Codifies the preventive health care services required to be covered at no cost by insurers by the federal Affordable Care Act into Colorado law. Adds osteoporosis screening, urinary incontinence screening, and screening and treatment of sexually transmitted infections to the list.

Allows providers to administer preventative treatment for sexually transmitted infections without parental consent to a minor (previously just screening and treatment of an infection was allowed without consent). Allows staffing by medical professionals to be accomplished through telemedicine. Bill also defines family planning services as any health or counseling service focused on preventing, delaying, or planning for a pregnancy, which must include medically necessary evaluation or preventative services and supplies. Defines family planning related services as medically necessary health care or counseling services provided pursuant to family planning visit. This may include treatment of conditions diagnosed during the visit and treatment of complications resulting from the visit.

Additional Information:

The complete list of covered preventative health care includes:

  • Abdominal aortic aneurysm one-time screening
  • Aspirin use to prevent cardiovascular disease and colorectal cancer prevention medication
  • Blood pressure screening
  • Type 2 diabetes screening for adults and gestational mellitus screening for people 24-28 months pregnant
  • Diet counseling for adults at high risk for chronic disease Healthly diet and physical activity counseling to prevent cardiovascular disease
  • Fall prevention for adults over 65 who live in a community setting
  • Hepatitis B and C screening
  • HIV screening
  • Lung cancer screening for adults at high risk because of smoking
  • Obesity screening and counseling
  • Counseling, prevention, screening, and treatment of a sexually transmitted infection
  • Statin preventative medication for adults
  • Tuberculosis screening
  • Anemia screening on a routine basis
  • Comprehensive breastfeeding support and counseling from trained providers and access to breastfeeding supplies for pregnant and nursing individuals
  • Folic acid supplements for people who may become pregnant
  • Preeclampsia prevention and screening for pregnant people with high blood pressure
  • RH incompatibility screening for all pregnant people and follow-up testing for individuals at a higher risk of RH incompatibility
  • Urinary tract, yeast, or other infection screening
  • Domestic and interpersonal violence screening and counseling
  • Osteoporosis screening for all over 65
  • Yearly urinary incontinence screening
  • All contraception
  • Family planning services and family planning related services
  • Any other preventative services included in the A or B recommendation of the task force for the particular preventive health care service or federal law


Auto-Repeal: None

Arguments For:

Preventive medicine not only can save lives by allowing faster intervention for health care problems, it also can save us a boatload of money. Chronic diseases that are avoidable through preventive care account for nearly ¾ of our health care spending and lower economic output in the US by $260 billion a year. If we can get more people access to preventive care we can lower overall health care spending. It is far too early at this point to make any “calls” on how greatly increasing coverage of preventive medicine has affected overall costs, many of these are long-term effects and we just haven’t been doing this for very long. We also of course can greatly improve the quality and length of people’s lives, the overriding goal of any health care system. The old way, before the Affordable Care Act, was awful and we all knew it. Part of that awfulness was a lack of preventive care coverage that led to people not getting the services at all. Cheap insurance that doesn’t cover anything is about as useful as having no insurance at all. This bill doesn’t actually change much in current law, but the ACA remains under assault at the federal level, including a court case that will likely make its way to the Supreme Court which would throw out the entire act (yes, this did already happen a few years ago, this is a different case). If that happens, we must be prepared to keep the protections for preventive care enshrined by the ACA so as to not jeopardize the health of Coloradans. The changes around sexually transmitted infections flow around our recognition that we all have the right to control over our own bodies, including minors, and part of that right is prevention of sexually transmitted infections.

Arguments Against:

Requiring coverage of all of these items increases insurance premiums, because of course insurers will pass along all of these costs (and the services still cost money, just not to the patient) along to us in our premium payments. We need the flexibility for cheaper plans that do not cover all of this so some folks can get affordable insurance for catastrophic situations. If we can get rid of the ACA, then good riddance and we’ll try to build something better. We should not copy its provisions into our law.


The data on saving costs through preventive health care is mixed, now that the ACA has been with us for several years. This is not surprising given that many of these effects would be long-term, but we shouldn’t expect to save large amounts of money through providing more preventive care in Colorado for free. We may also get more people into the system for longer periods of time, which also costs money.

How Should Your Representatives Vote on SB20-156

SB20-163 School Entry Immunization (Gonzales (D), Priola (R)) [Mullica (D)]

AMENDED: Moderate

PASSED SENATE

Appropriation: $41,906
Fiscal Impact: Negligible

Goal: Require those who want to use the personal or religious exemption for the vaccine requirement for children to attend school to watch an educational video first. Also require schools to disclose vaccination and exemption numbers to parents and set a statewide goal of 95% vaccination.

Description:

Requires state to develop standardized form for claiming medical exemption and a form for claiming a personal or religious exemption. Both forms must include information on ability for parents to opt-out of state tracking system, include references to scientifically based information regarding benefits and risks of immunization, and be limited to requests for information pertinent to the exemption. Form cannot identify the religion the exemption is based upon or require the reason for the personal exemption. Schools must include their own specific immunization and exemption rate from the previous year on these forms and on the immunization requirement form it gives parents. The medical exemption form must be signed by a medical professional. Either form must be submitted by the parent to the school.

Personal or religious exemption also requires a certificate of completion for an online education module. This must be interactive and created by the state and include scientific data that is evidenced based and peer reviewed and discloses the benefits and risks of immunization and best practices to prevent spread of vaccine preventable diseases including data concerning the risk of immunization injury. Requires the medical professional to submit the immunization exemption to the state tracking system (but parents can opt out and medical professionals cannot be punished for failing to submit the form). Requires state to submit personal/religious exemption to state tracking system (but parents can opt out). Requires state to develop rules on medical exemptions from immunizations and required immunization guidelines based on practices recommended by Centers for Disease Control.

State also must create educational materials to educate and engage with parents regarding immunizations, the risks of vaccine preventable diseases and where vaccines are administered.

Additional Information:

State must annually evaluate its immunization practices and may update vaccination standards based on changes made by the federal government. Bill sets a goal of 95% immunization for the state. Home-schooled kids are exempted, unless they attend a school for part of a day. Schools must also include on their immunization requirement form that they are not responsible for either their own immunization rates or the 95% state goal. Exemption form must include:

  • Demographic information for the student, parent, or legal guardian but no social security number nothing beyond name, date of birth, and gender
  • Name and location of the student’s school
  • Student’s immunization information and the vaccine or vaccines for which the exemption applies
  • Whether a medical or non-medical exemption is claimed

Immunization tracking system must not store any information that would identify either the religious faith or the reason for the exemption.


Auto-Repeal: None

Arguments For:

Each year in the United States, immunizations save 33,000 lives, prevent 14 million disease cases, and save $9.9 billion in direct health care costs. But Colorado is the worst state in the country for immunization rates, and is only one of 17 states to even allow a personal belief exemption. In 2017, 23,228 children attended Colorado schools without protection from one or more immunizations. And guess what? 9,424 Colorado children, a majority of them under the age of four, were hospitalized or went to an emergency department to be treated for disease that was preventable by an immunization, resulting in $55.5 million in charges. In 2016, two measles outbreaks cost the state $68,192 just to investigate and prevent spread of the disease.  Immunizations are one of the great health achievements of all-time and we are throwing it all away. Diseases that were eradicated are making comebacks, and this is just an issue of money. Some people cannot receive immunizations for medical reasons or are too young. These people are being put at-risk of harm or death by the careless actions of those who have bought into the paranoid conspiracy theories about immunization. So we have to make it harder to claim an exemption (right now no standardized form is required, you just tell the school) and do a better job of educating parents about the risk/benefit analysis of immunizations. This bill does that while maintaining the ability for parents to make their own decisions about the health of their children.

Arguments Against:

Take the entire “For” argument and stop right after conspiracy theories. Then feel free to add, “And this bill does little to solve the problem.” People who are opposed to immunizations aren’t just confused or wishy-washy, they are virulently opposed and will happily jump through a few additional hoops and watch a video that does nothing but slightly slow them down. We need to remove the personal exemption entirely. As was already written, this is about public health and safety of all of us and that is where the ability for a parent to make decisions about their child ends. We force children to be schooled. We don’t let children work below a certain age. So we already have some restrictions for parents. And a bedrock belief in our society is that your personal freedoms end at the point where you can harm someone else. That is absolutely true for parents that choose to not vaccinate their children. It needs to end.


These additional steps are an infringement on the right of parents to protect their children from what the parents feel is a harmful practice. Even pro-vaccine people admit that there are risks. There is no risk of getting autism from a vaccine but there are other risks including bad reactions to the vaccine. There is no liability for medical professionals administering them and extremely limited liability for pharmaceutical companies so families have no recourse if something goes wrong.

How Should Your Representatives Vote on SB20-163

SB20-171 Children's Habilitation Residential Program Rules (Winter (D), Smallwood (R)) [Soper (R), Buckner (D)]

PASSED SENATE

Appropriation: None
Fiscal Impact: None

Goal: Clarify that the state Medicaid program may adopt rules that require a federal waiver for the children’s habilitation residential program so long as the rules do not go into effect until the waiver is approved.

Description:

Clarify that the state Medicaid program may adopt rules that require a federal waiver for the children’s habilitation residential program so long as the rules do not go into effect until the waiver is approved.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

This just clarifies that the Medicaid program does not need specific legislative approval for exact rules that require waivers from the federal government but of course the rules cannot take effect until we get federal government approval.

Arguments Against: n/a

How Should Your Representatives Vote on SB20-171

SB20-188 Plain Language In Hospital Bills (Fields (D))

Appropriation: None
Fiscal Impact: Negligible in first year

Goal: Require hospitals to produce consolidated financial statements or bills in plain English containing a detailed breakdown of all services, who is paying for what, and information on how to contact the facility with questions within 30 days of discharge or 7 days of a written request.

Description:

Requires hospitals to provide consolidated itemized financial statements or bills detailing in plain language that an ordinary layperson would understand, the specific nature of the charges or expenses for health care received at the facility. This must be provided within 30 days after a patient’s discharge or visit or within seven days after receiving a written request. The statement cannot use only medical billing codes or drug codes or general terms such as miscellaneous charges or supply charges or other charges. The bill must list services by date and provider, including constituent parts of each service along with the rate of each part. It must identify each item as either paid, assigned to third-party, or chargeable directly to the patient. It must include services provided by hospital-based physicians and other health care providers who may not bill separately. It must specifically identify physical, rehabilitative, occupational, or speech therapy treatment by date, type and length of treatment. And it must conspicuously display the phone number of the hospital’s patient liaison for any billing disputes. Facilities are prohibited from billing patients for the preparation of the bill and must transmit it via e-mail, secure portal, or by physical mail upon request. Each hospital must also establish policies and procedures for reviewing and responding to any questions from a patient about a bill and the answers must be provided in no more than 7 business days.

State board of health to develop rules around these billing statements and their plain-language requirements. These must include the patient’s rights and payment obligations, disclosure requirements specific to health care facilities, including in- and out-of-network terms, and requirements that insurers, facilities, and providers use language that is consistent with other health care disclosures required by law.

Law does not apply to Medicare or Medicaid patients.

Additional Information: n/a

Auto-Repeal: None

Arguments For:

One of the most confusing things for consumers in our health care system is the billing process. You pay the facility when you are there and then weeks later you get a confusing bill from the facility listing things the insurance company covered and things they did not. And then you may get yet another bill from a different department in the same facility for their part of your care. And then maybe another one, if your care was somewhat complicated. All of this billing and tracking puts strains on our providers to collect the funds and increases their costs. And quite honestly it allows these facilities to hide behind the complication. People despair of understanding it so they don’t even try to fight it. This is not the way the market is supposed to work. Clear pricing and a clear understanding of what everything is leads to better consumers: a bad experience at a facility with the bill may lead people to not go back, it may lead people to tell their friends and family, and all of that can potentially lead to real change due to market pressure. None of this is particularly onerous, you just can’t hide behind jargon, you can’t rely on multiple bills confusing the issue, and you can’t muddle the waters with exactly who is paying for what.

Arguments Against:

While it may seem simple to just say facilities need to do a better job of explaining their bills, the reality is a lot of systems programming goes into creating those bills (people obviously aren’t sitting down and preparing them by hand). That means that massive changes on the scale this bill requires are going to be costly. It also may be difficult for hospitals to meet the 30 day/7 day requirement, since they rely on the decisions made by insurance companies on what the insurer will cover and what the patient must cover. More complicated procedures and stays may lead to longer decision periods from insurers and the bill provides no requirement for the insurers to get their information to the facilities in time. The fact that Medicaid is excluded is potentially telling. The state would be on the hook for costs and issues involved with Medicaid complying with the terms of this bill.


We should not exclude Medicaid (we have no control over Medicare as it is a federal program). People who are covered by Medicaid deserve the same clarity in their billing process as those covered by private insurance (or no insurance).

How Should Your Representatives Vote on SB20-188