The act repeals the health-care delivery system reform incentive payments program in the Colorado healthcare affordability and sustainability enterprise (enterprise) and creates the hospital quality incentive program (incentive program) to use enterprise hospital provider fee revenue to make additional payments to hospitals that meet performance metrics in delivering safer and more effective care that improves patient outcomes and reduces preventable utilization to reduce health-care costs. Prior to implementing the program, the enterprise board shall approve the percentage of hospitals' reimbursement in the incentive program and the incentive program structure, performance measures, and scoring methodology. Once the incentive program is implemented, the total amount of payments made under the incentive program must not exceed 9% of the total reimbursements made to hospitals in the previous state fiscal year.(Note: This summary applies to this bill as enacted.)
The act requires the department of health care policy and financing, in coordination with the department of human services and the department of early childhood (state departments), to contract with a single county department of human or social services to administer a centralized member integrity service to conduct fraud investigations concerning eligibility for medicaid, the children's basic health plan, the supplemental nutrition assistance program, the Colorado child care assistance program, temporary assistance for needy families, and adult financial programs (public assistance programs), and benefit overpayments. The act creates the centralized member integrity service cash fund consisting of money recouped from member fraud investigations. The centralized member integrity service must be operational and utilized on July 1, 2027. On or before February 1, 2027, the act requires the state departments to establish aligned requirements for county departments of human or social services (county departments) to comply with through a performance-based contract established between the state departments and each county department. Prior to February 1, 2027, the state departments shall draft templates of the performance-based contract with the county departments for review and comment. On or before July 1, 2027, the state departments shall enter into a performance-based contract with each county department. The performance-based contract must establish requirements for the state departments and county departments to comply with in administering public assistance programs and establish corrective action protocols that are consistently utilized by the state departments. On or before September 1, 2026, the act requires the state departments to work together, and in consultation with the county departments, to establish a continuous quality improvement process to review data reported to the state departments by the county departments. The state departments must annually submit a report to the joint budget committee that includes an update on the continuous quality improvement process and data on the impact of the continuous quality improvement process. Beginning January 2027, and monthly thereafter, the state departments must establish a single, shared online dashboard used to publish county-level and statewide performance data for the public assistance programs on a monthly basis. This data must be published on each of the state department's website's in a publicly accessible format. Beginning July 1, 2028, the state departments must oversee a streamlined public benefits delivery model that consists of up to 12 cohorts of counties in the state that will coordinate public assistance program eligibility and distribute case processing work. The state departments shall enter into performance-based contracts with each cohort for administering a new public benefits delivery model to ensure public assistance programs are administered consistently and uniformly across the state. On or before July 1, 2026, the state departments must contract with a third-party contractor to help the state departments and county departments develop and implement a plan for transitioning to the new public benefits delivery model. The act establishes an implementation work group comprised of representatives of counties, the governor's office, the state departments, and nongovernmental organizations, to work with the third-party contractor to develop and implement the transition plan. The transition plan must be delivered to the joint budget committee by January 1, 2027. The act establishes the state cross-departmental policy alignment team to align the policies of the public assistance programs to improve service delivery and outcomes for recipients of public assistance benefits. The act makes a household eligible for fuel assistance payments if the household has not received low-income energy assistance program assistance in the previous 12 months and if it is eligible for the standard utility allowance under federal law. The act requires the department of health care policy and financing to certify to the department of revenue information regarding persons who are obligated to the state for overpayment of medicaid benefits and sets forth the process for distributing money withheld from a person's tax refund owed for overpayment of benefits. To implement the act, it includes appropriations from the general fund and various cash funds to the department of health care policy and financing, the department of human services, and the department of early childhood. The act appropriates money to the office of the governor for use by the office of information technology and to the department of law from reappropriated money received by other departments. The act decreases the appropriation from the federal child care development funds made in the annual general appropriation act for the 2026-27 state fiscal year to the department of early childhood for intrastate child care assistance program redistribution by $222,598.(Note: This summary applies to this bill as enacted.)
The act limits the benefits pregnant women and children with a certain family household income and citizen or immigration status are eligible for under the state medical assistance program and the medical assistance program. Eligible pregnant women and children are subject to the following limitations on benefits:Beginning July 1, 2026, there is an annual cap on dental services in the amount of $1,100;Beginning January 1, 2027, behavioral health services offered must be provided on a fee-for-service basis only;Beginning January 1, 2027, services offered through the accountable care collaborative are no longer covered; andBeginning January 1, 2027, managed care services through the medical assistance program are no longer covered. Beginning January 1, 2027, children under 19 years old whose family household income does not exceed 260% of the federal poverty line, adjusted for family size, and who are not eligible for the medical assistance program due to their immigration status, are not eligible for home- and community-based services, community first choice, long-term home health, private duty nursing, hospice care, and nursing home care unless those children already receive those services on or before December 31, 2026. Beginning January 1, 2027, the act caps enrollment of children in the state medical assistance program at 25,000 children if either enrollment exceeds 25,000 or the expenditures for a fiscal quarter exceeds one-quarter of the appropriation for state medical assistance plus 5% to account for seasonality fluctuations. If one of the conditions is met, the enrollment cap begins on the first day of the month following 60 days after the department of health care policy and financing (state department) determines that the condition was met. The act repeals provisions requiring the state department to develop an outreach and enrollment strategy for enrolling eligible groups into new coverage options and repeals the state children's basic health plan. The act appropriates $3,378,166 from the general fund to the state department to implement the act and reduces appropriations to the state department by $14,202,723 if certain conditions are met.(Note: This summary applies to this bill as enacted.)
The act caps at $400 the amount that a health-care entity or health-care provider may charge for a record request made by a patient's attorney or the attorney of the patient's personal representative pursuant to an authorization in compliance with the federal 'Health Insurance Portability and Accountability Act of 1996', a valid subpoena, or a valid court order, if the requested record exceeds 664 pages. The health-care entity or health-care provider may charge a reasonable fee above the cap if the record request requires the health-care facility or health-care provider to segregate, withhold, or redact protected health information in order to comply with applicable law or the scope or limitations of the authorization in compliance with the federal 'Health Insurance Portability and Accountability Act of 1996', a valid subpoena, or a valid court order. Beginning January 1, 2028, and every even-numbered year thereafter, the act requires the $400 limit to be adjusted for inflation. The act requires the requested medical records to be delivered in electronic format if the requestor requests electronic format, the original records are stored in electronic format, and the records are readily producible in electronic format. The act requires the health-care facility or health-care provider to provide the requestor with an invoice for the records provided in response to the record request within 30 days of receiving the request, and the health-care facility or health-care provider must provide the records upon payment of the invoice. If the health-care facility or health-care provider is unable to comply with the request for records within 30 days after the request, the health-care facility or health-care provider must send written notice of a 30-day extension to the requestor. The health-care facility or health-care provider must provide the records to the requestor at no cost if the records were not provided within 30 days or without written notice of an extension, unless the delay is due to a force majeure event. In the case of a force majeure event, the health-care facility or health-care provider must provide written notice to the requestor within 5 business days of becoming aware of the force majeure event. The 30-day time frame to respond to a request for records commences upon resolution of the force majeure event.(Note: This summary applies to this bill as enacted.)
The act requires the nonemergency medical transportation broker (broker) to establish the transportation community advisory board (TCAB) and requires the state department of health care policy and financing (state department) to collaborate with the TCAB prior to establishing rules and processes for the safety and oversight of nonmedical transportation services and nonemergency medical transportation (NEMT) services. The act requires, in collaboration with the TCAB, certain rules for NEMT the state department must adopt. The state department may impose trip caps or market-share restrictions on a transportation provider (provider) as part of corrective action plan. The act requires providers to use vehicles equipped with 2-way video cameras and a video recording system when transporting members. The act establishes how the broker must roll out their implementation and requires the broker to provide all providers with software, a communication toolkit, training, and technical assistance to facilitate NEMT services. The broker may encourage medicaid members (members) to book transportation services at least 2 days before their requested transportation date, and the broker shall accept and make reasonable efforts to fulfill same-day and next-day transportation requests. The act requires providers, only after all service regions have been implemented, to accommodate member requests for preferred or alternate drivers when operationally feasible. The act requires the broker, and, if there is no broker, the providers to verify that individuals using the transportation services are eligible members during the scheduling of transportation services. The act prohibits the broker from operating, owning, or controlling a provider in Colorado. The act requires the broker to provide their trip assignment rules and procedures to the state department for approval and for publication on the state department's website. The act allows a transportation network company to provide NEMT services when a provider is unavailable. The state department shall ensure all transportation providers, drivers, and vehicles are credentialed, and services provided by noncredentialed drivers or in noncredentialed vehicles are not eligible for reimbursement. The act prohibits the state department from denying payment of services to providers if the provider provides scheduled transportation services in good faith based on the information provided by the broker or if the provider had no knowledge of an inaccuracy and the provider followed all applicable rules and procedures. Subject to available appropriations, the act requires the state department to audit providers and audit the broker annually. The act requires the state department to categorize all NEMT expenditures as medical services and make changes to the NEMT program as necessary to obtain medical services federal match rates for NEMT services. The act also eliminates the requirement that the state department provide transportation services as an administrative cost. The act reduces appropriations to the state department from the general fund by $76,639 and from the healthcare affordability and sustainability hospital provider fee cash fund by $20,941,853.(Note: This summary applies to this bill as enacted.)
The act establishes the ibogaine research pilot program (pilot program) in the behavioral health administration (BHA) to research the safety and effectiveness of using ibogaine to treat mental health conditions and substance use disorders. The act requires the BHA to establish a committee to review pilot program site applications and make recommendations to the BHA on which applicants to accept. The BHA may select up to 5 ibogaine pilot sites. The act allows the BHA to seek, accept, and expend gifts, grants, and donations and establishes the ibogaine research pilot program cash fund. The pilot program is contingent on the BHA receiving sufficient gifts, grants, and donations to administer the pilot program and award grants to the selected ibogaine pilot sites to help with financing needs. Under current law, the division of natural medicine advisory board consists of 15 voting members, 8 of whom must have general expertise and experience related to natural medicine and 7 of whom must have specialized expertise and experience in various areas of natural medicine. The act amends the expertise and experience requirements to apply equally to all 15 voting members. The act adds that a facilitator of natural medicine services is not liable for a physical or psychological injury that a participant may experience as a result of the facilitator's performance or supervision of the natural medicine services that a participant receives, unless the injury is the result of the facilitator's intentional misconduct, gross negligence, or a deviation from the recognized standard of care. The act authorizes the state licensing authority for natural medicine or natural medicine product (state licensing authority) to adopt rules related to the administration, manufacturing, and use of ibogaine. The act sets requirements for how the state licensing authority must prioritize reviewing applications for licensure to facilitate natural medicine services and allows the state licensing authority to set different licensing fees depending on the type of natural medicine the applicant is seeking licensure for. The act allows the state licensing authority to accept gifts, grants, and donations from public or private sources and requires gifts, grants, or donations received to be deposited in the regulated natural medicine division cash fund. The act requires the BHA to work to secure federal research and development funding available through the advanced research projects agency for health within the federal department of health and human services, or other available funding, in order to advance research on the use of ibogaine for the treatment of serious mental illness. The act updates the powers and duties of the director of the division of professions and occupations to include adopting rules that guide the use and administration of ibogaine. A licensee seeking to cultivate, manufacture, dispense, or administer ibogaine shall, in consultation with Indigenous communities, establish a benefit-sharing plan that directly benefits those Indigenous communities. The act:Updates definition of 'administration session' to include the use of regulated natural medicine and regulated natural medicine product that the participant purchases to consume during the administration session;Prohibits a person from advertising bona fide harm reduction services or bona fide support services offered for remuneration, advertising natural medicine or natural medicine products, or using harm reduction services or support services to conduct sales of natural medicine;Clarifies that the state licensing authority is not required to conduct routine, periodic, or pre-operational inspections as a condition of licensure unless expressly required;Requires state licensing authority to adopt rules regarding licensing privileges and restrictions of a limited regulated natural medicine sales license and eligibility requirements for an applicant to obtain a limited regulated natural medicine sales license;Allows the state licensing authority to adopt rules regarding the application procedures and license requirement for a healing center to operate a temporary premises; and requirements for cultivation, manufacture, testing, or dispensing of ibogaine;Allows the department of public health and environment to issue a temporary premises permit to a licensed natural medicine healing center if certain conditions are met and allows a healing center to apply for a temporary premises permit;Prohibits a healing center licensee from selling regulated natural medicine or regulated natural medicine product unless a co-located limited regulated natural medicine sales licensee conducts the transaction in accordance with certain requirements; andAllows the director of the natural medicine division to issue an order to cease and desist if the director determines that a person is acting or has acted without a license to operate a natural medicine business or to own, grow, harvest, transfer, manufacture, supervise, provide, or administer natural medicine.(Note: This summary applies to this bill as enacted.)
After an individual has been discharged from a facility where an individual was held for an emergency mental health hold, current law requires the facility to attempt to follow up with the individual at least 48 hours after discharge. The act extends the time to attempt to follow up with the individual to 72 hours following discharge, excluding weekends and holidays. The act restricts the behavioral health administration (BHA) from issuing or renewing a license for a behavioral health entity unless the BHA receives a certificate of compliance for the applicant's building or structure from the division of fire prevention and control. The act adds the following exceptions to this requirement:An applicant that provides only telehealth services is not required to receive a certificate of compliance; andAn applicant that provides only outpatient services may receive a certificate of compliance from the division of fire prevention and control based on inspections conducted by a fire department that employs a certified inspector rather than from the division of fire prevention and control.(Note: This summary applies to this bill as enacted.)
Beginning on January 1, 2028, a health insurance carrier (carrier) of an individual or group health benefit plan in Colorado (plan) shall, when calculating a covered person's contribution to an out-of-pocket maximum or cost-sharing requirement under the plan, account for and credit to the covered person's contribution an out-of-pocket expense that the covered person incurs by purchasing a prescription drug directly from a pharmacy or direct-to-consumer platform (contribution credit). The carrier shall apply the contribution credit to the out-of-pocket maximum or cost-sharing requirement that is applicable in the plan year in which the out-of-pocket expense was incurred. To receive a contribution credit, a covered person must provide to the carrier proof of payment for a direct purchase of a prescription drug, such as an itemized receipt or pharmacy record, within 90 days after making the purchase (proof of payment). The carrier may request additional information or documentation if the proof of payment is insufficient or incomplete. The carrier shall not apply a contribution credit in the following circumstances:For an amount of a covered person's out-of-pocket expense incurred by the direct purchase of a prescription drug that is greater than the amount the covered person would have incurred if they had obtained the same prescription drug in the same plan year from an in-network pharmacy and pursuant to the terms of their plan;If the covered person does not provide proof of payment;If the covered person incurred the out-of-pocket expense by purchasing a prescription drug that is not covered under the formulary of the covered person's plan, unless the carrier grants an exception; orIf the covered person does not comply with the carrier's utilization management processes, including prior authorization and step therapy protocols required under the covered person's plan.(Note: This summary applies to this bill as enacted.)
Currently, the 'Workers' Compensation Act of Colorado' provides that certain cancers contracted by firefighters are considered occupational diseases presumed to have been a result of the firefighters' employment. A firefighter's employer or an insurer may rebut this presumption by showing by a preponderance of the medical evidence that the cancer did not occur on the job. The act expands the types of cancer that are considered occupational diseases and strengthens the rebuttable presumption to require an employer to show clear and convincing evidence that the cancer did not occur on the job. The act exempts firefighters who are employed by the state.(Note: This summary applies to this bill as enacted.)
On or before December 1, 2026, and annually thereafter, the act requires each transportation broker that administers nonemergency medical transportation to medicaid members to submit certain information to the department of health care policy and financing (state department) regarding transportation providers that the transportation broker contracts with. Beginning January 1, 2027, the state department is required to include this information in its annual 'SMART Act' presentation. The act changes the term 'qualified alien' to 'qualified noncitizen' to align with federal requirements. If the state department plans to implement, apply, or enforce new multiple procedure payment reductions for outpatient therapy services, the act requires the state department to provide notice to the impacted providers of the changes at least 6 months prior to implementing the changes and to hold at least one stakeholder meeting to discuss the payment reductions. The act requires the state department to reimburse a provider who is licensed and authorized to prescribe, dispense, compound, or administer medication-assisted treatment in a jail setting. The act requires the medical services board to adopt rules before January 1, 2027, to comply with federal community engagement requirements and requires the state department make available on its website data on the community engagement requirements and their impact on medical assistance enrollment. The act requires the state department to collect direct care service cost to administrative cost ratio information from home- and community-based service provider agencies and submit a report to the general assembly detailing the information collected. The act repeals the state medical assistance and services advisory council.(Note: This summary applies to this bill as enacted.)
