Healthcare (Hospitals)

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 allows money collected from the hospital provider fee to be used to maximize reimbursement through state-directed payments for physician services at Denver health and hospital authority.     The act appropriates $3,527,482 from the healthcare affordability and sustainability hospital provider fee cash fund to the department of health care policy and financing to implement the act.(Note: This summary applies to this bill as enacted.)

Current law prohibits a principal from discriminating, taking adverse action, or retaliating against a worker who, in good faith, raises a reasonable concern about workplace violations of government health or safety rules.     The bill adds the university of Colorado hospital authority and the Denver health and hospital authority to the definition of 'principal'. The bill further clarifies that any action or potential action arising under the law regarding worker rights related to health and safety is not subject to the limitations, notice requirements, procedural requirements, or liability restrictions set forth in the 'Colorado Governmental Immunity Act'. (Note: This summary applies to this bill as introduced.)

Under current law, if a defendant is found incompetent to proceed and the defendant will not be restored to competency in the foreseeable future, the court is required to dismiss charges against the defendant and the defendant, in limited circumstances, may be referred for certification for short-term treatment through a civil court process. The act maintains the requirement for the court to dismiss the charges against a defendant if the defendant's highest charged offense is among certain misdemeanor offenses, and the act maintains certification for short-term treatment as an option for the defendant. However, if the defendant is unrestorable or the defendant has reached the statutory maximum time permitted to be restored, the act authorizes the district attorney or county attorney (prosecution) to notify the court that the prosecution seeks civil commitment or an enhanced protective placement of a defendant if the prosecution can prove by clear and convincing evidence that the defendant:Has a mental disability or developmental disability;Committed an act that, in the absence of any mental disability or developmental disability, would constitute homicide, a crime of violence, or a felony that constitutes unlawful sexual behavior, and the act is or was charged in a criminal case in Colorado in which competency was raised; and Poses a substantial risk of serious harm to others.     If the prosecution seeks civil commitment or an enhanced protective placement, the court is required to stay the order dismissing the defendant's case, set a trial within 91 days after the date the written notice was filed, and order the department of human services (CDHS) to identify an appropriate provider and placement for the defendant in the event a civil commitment or enhanced protective placement is granted. The defendant may stipulate that the court order a civil commitment or enhanced protective placement.     If the court finds the prosecution has not met its burden, the court is required to deny the prosecution's request to civilly commit the defendant or order an enhanced protective placement of the defendant; except that the court may consider whether to order other civil proceedings. If the court finds the prosecution has met its burden, the court is required to order the civil commitment or enhanced protective placement of the defendant, place the defendant and issue any related orders, transfer jurisdiction of the civil commitment or enhanced protective placement to an appropriate civil court with jurisdiction, and dismiss the defendant's criminal case. When the court orders the civil commitment or enhanced protective placement, the court shall make a finding of the defendant's primary diagnosis that constitutes the mental disability or developmental disability. The court shall order the defendant civilly committed to the legal custody of CDHS unless the defendant's primary diagnosis is an intellectual and developmental disability (IDD) or a neurocognitive disorder, in which case, the court shall order an enhanced protective placement and legal custody of the defendant to the department of health care policy and financing (HCPF). If CDHS proposes placing the defendant into inpatient care, the court shall order, without further court review, that the defendant be placed into inpatient care at the discretion of CDHS if the court ordered a civil commitment or that the defendant be placed into inpatient care at the discretion of HCPF if the court ordered an enhanced protective placement. If CDHS has not identified an appropriate provider that is willing to accept placement of the defendant, the court shall set a review hearing within 35 days after the order for civil commitment or enhanced protective placement and order CDHS, in consultation with the behavioral health administration (BHA), to identify at least one appropriate provider.     Upon receiving jurisdiction of a civil commitment or enhanced protective placement, the act requires the civil court to supervise the civil commitment or enhanced protective placement by notifying the county attorney, appointing an attorney to represent the respondent, and setting a review hearing. At the hearing, the respondent has the right to request modification of the terms of the civil commitment or enhanced protective placement and the right to periodic review, including whether the respondent qualifies for termination of the civil commitment or enhanced protective placement. The court is required to ensure the respondent is placed in the least-restrictive setting adequate to protect the victims and community. If the respondent is not placed into inpatient care at the discretion of CDHS, or if CDHS proposes to move the respondent into or out of inpatient care, the court shall, prior to modifying the civil commitment or enhanced protective placement to change the respondent's provider or placement, review the appropriateness of the proposed provider or placement. The provider charged with the physical care and custody of the respondent is required to submit a report to the court and the parties annually by the date the respondent was civilly committed or ordered into enhanced protective placement unless a substantially similar examination was ordered by the court within the previous 12 months.     The act requires the court to terminate the respondent's civil commitment or enhanced protective placement if the respondent no longer poses a substantial risk of serious harm to others or the respondent does not have the applicable disorder or disability that is likely to cause the respondent to be a danger to the respondent's self or a danger to others and the respondent has demonstrated sufficient capacity and willingness to conform their conduct to the requirements of the law. If the respondent does not meet the criteria for termination, the respondent is not entitled to another termination trial within one year after the conclusion of the previous trial.     The court shall convert a civil commitment to an enhanced protective placement if the respondent does not meet the criteria for termination but the respondent has a mental health disorder that is an IDD or a neurocognitive disorder, without having any other mental health disorder that is not an IDD or a neurocognitive disorder and that substantially contributes to whether the respondent is a danger to the respondent's self or a danger to others, or is gravely disabled. If the defendant does not meet the criteria for termination and has co-occurring mental health disorders that include an IDD or a neurocognitive disorder, the court may, upon the recommendation of CDHS, convert the civil commitment to an enhanced protective placement.     The court shall convert an enhanced protective placement to a civil commitment if the respondent does not meet the criteria for termination and the respondent no longer has an IDD or a neurocognitive disorder that substantially contributes to whether the respondent is a danger to the respondent's self or a danger to others, or is gravely disabled. If the defendant does not meet the criteria for termination and has co-occurring mental health disorders that do not include an IDD or a neurocognitive disorder, the court may, upon the recommendation of CDHS, convert the enhanced protective placement to a civil commitment.     Under current law, an emergency mental health hold (M1 hold) may be initiated against a person for not more than 72 hours if the person appears to have a mental health disorder and, as a result of the mental health disorder, appears to be a danger to the person's self or others, or appears to be gravely disabled. A person detained for an M1 hold and transported to an emergency medical services facility or facility designated by the commissioner (facility) of the BHA is required to receive an evaluation as soon as possible after the person presents to the facility. The act authorizes a person who has an M1 hold initiated against them while in confinement to receive an evaluation at the person's place of confinement rather than being transported to a facility. If the person is released from confinement while under an M1 hold, the person responsible for the confinement is required to coordinate with the BHA to transfer the person to a facility.     Under current law, if a person under an M1 hold meets the criteria for certification for short-term treatment, the person may be certified for not more than 3 months. Rather than requiring an M1 hold as a prerequisite to short-term certification or certification for long-term care and treatment, the act authorizes a person to be certified if the person:Has been advised of the availability of, but has not accepted, voluntary treatment or with consideration of all reasonably available information, is believed will not remain in voluntary treatment; and By clear and convincing evidence, has a mental health disorder and, as a result of the mental health disorder, the person is a danger to the person's self, a danger to others, or gravely disabled.     A person may not be certified for short-term treatment or long-term care and treatment if the person has an IDD or neurocognitive disorder without any other mental health disorder that is not an IDD or neurocognitive disorder and that substantially contributes to whether the respondent is a danger to the respondent's self or a danger to others, or is gravely disabled. If a respondent is certified, the court shall order CDHS to provide care coordination and make diligent efforts to find a provider for the respondent that is willing to hold the certification. The respondent may be certified for long-term care and treatment if the respondent continues to meet the criteria and standards for certification for short-term treatment. The certification terminates when the professional person in charge of the respondent's treatment and the BHA determine the respondent no longer meets the criteria for certification. To terminate a short-term treatment certification less than 30 days after the initial certification, two professional persons are required to individually consult and review the respondent's case and agree that the respondent no longer meets the criteria for certification.     A court may order the short-term or long-term protective placement of a person:Who, by clear and convincing evidence, has a neurocognitive disorder;When reasonable grounds exist to believe that the person will not remain in a voluntary treatment program; andWho, by clear and convincing evidence, is a danger to the person's self, a danger to others.     The act aligns the provisions for short-term and long-term protective placement with certifications for short-term treatment and long-term care and treatment.     No later than October 1, 2027, the act requires CDHS to construct and operate an outpatient treatment facility for adults with behavioral health needs, including adults who are found incompetent to proceed and unlikely to be restored to competency.     To implement the act, for the 2025-26 state fiscal year, the act appropriates to CDHS $535,934 from the general fund and $4,777,898 from the capital construction fund.     To implement the act, the act makes the following appropriations for state fiscal year 2026-27:$17,802,360 to CDHS from the general fund, of which $242,323 is reappropriated to the department of law and $52,644 to the office of information technology;To the judicial department, $26,296 from the judicial department information technology cash fund and $5,401,437 from the general fund, of which $1,719,409 is for use by the office of state public defender and specified independent agencies;$842,808 to HCPF from the general fund; and$150,000 to the department of law from the general fund.(Note: This summary applies to this bill as enacted.)

Section 2 of the act repeals a requirement that health-care profession regulators adopt rules that require each licensed health-care provider, as a condition of renewing, reactivating, or reinstating a license, to complete up to 4 credit hours of training per licensing cycle in order to demonstrate competency regarding topics related to prescribing drugs and treatment.     Section 3 authorizes the Colorado dental board to adopt rules that require every dentist, dental therapist, and dental hygienist, as a condition of renewing, reactivating, or reinstating a license, to complete up to 4 credit hours of training per licensing cycle regarding topics related to prescribing drugs and treatment.     Section 4 requires a licensed veterinarian to complete at least 1 hour of training per renewal period regarding topics related to prescribing drugs and treatment.     Section 5 changes the frequency at which specific health-care facilities are required to apply for a license issued by the department of public health and environment from annually to every 2 years.     Under current law, a health-care facility is required to screen each uninsured patient for eligibility for public health insurance programs and discounted care (screening) utilizing a single uniform application developed by the department of health care policy and financing (state department). Sections 6 through 11 change this requirement by:Changing the method used to conduct the screening from a uniform application to use of a third-party resource, such as a major credit bureau, or use of a uniform screening questionnaire (questionnaire) developed by the state department;Allowing a health-care facility the option of screening a patient for eligibility for the health-care facility's financial assistance program;Requiring a health-care facility to provide specified notifications upon completion of the screening;Creating an application for discounted care (application) for use by a health-care facility upon completion of the screening through which additional information is requested from a patient to determine whether the patient qualifies or is likely to qualify for public health-care coverage or discounted care;Requiring a health-care facility to provide specified notice and appeal rights to a patient upon completion and review of the application; andRequiring the state department to adopt rules regarding the questionnaire and application.     Section 11 also narrows state department review requirements of health-care facilities' and licensed health-care professionals' billing for patients who are indigent. The act prohibits the state department from making changes to regulatory documents or imposing new requirements unless the changes or new requirements are adopted by rule by specified dates and are subject to stakeholder engagement.     Section 12 requires the state department to establish by rule the content and format of the information each hospital must provide to the state department for a hospital transparency report at least 30 days prior to the hospital's fiscal year. The act changes the deadline for a hospital to submit to the state department an annual audited financial statement from 120 days to 150 days after the end of the hospital's fiscal year. Current law requires that each hospital has a minimum of 15 days to review the hospital transparency report; the act specifies that the review period is 15 business days and requires that a statewide hospital association must also have a minimum of 15 business days to review the report.(Note: This summary applies to this bill as enacted.)

If certain conditions are met, the act requires health benefit plans that provide hospital, surgical, or medical expense insurance to provide reimbursement for health-care services provided by a pharmacist that are within the pharmacist's scope of practice without entering into a collaborative pharmacy practice agreement. Similarly, under the medical assistance program (medicaid), the act authorizes reimbursement for services that are within a pharmacist's scope of practice and not duplicative of other pharmacist services or programs reimbursed by medicaid.     Further, solely on the basis of the type of license or certification, a health benefit plan or health insurance company (carrier) shall not discriminate against a pharmacist who is acting within the scope of the pharmacist's license or certification under state law, with respect to participation, referral, reimbursement of covered services, or indemnification, or prohibit a pharmacist from membership in a provider network; except that, in selecting pharmacist providers, the act does not:Prohibit a health benefit plan or carrier from including providers in its provider network only to the extent necessary to meet the needs of the plan or from limiting referrals or establishing quality control measures;Require a health benefit plan or carrier to contract with any provider willing to abide by the terms and conditions for participation established by the health benefit plan or carrier; orRequire coverage for any health-care service that is not otherwise covered.     The act makes changes to the definitions in the pharmacy practice statutes to include a definition for 'final product verification'. For drug, device, or product orders that are not for controlled substances, final product verification may be delegated by a supervising pharmacist to a certified pharmacy technician or pharmacy intern. A pharmacy or other outlet shall have a continuous quality assessment system in place to periodically verify the accuracy of the final drug, device, or product and must create a plan for final product verification, including how pharmacists' hours will be maintained to provide direct patient care. The state board of pharmacy is required to adopt rules relating to final product verification no later than December 31, 2026.     Under current law, a pharmacist may administer certain tests to patients who are 12 years old or older for certain conditions and prescribe drugs to treat the tested conditions. The act adds to the definition of the 'practice of pharmacy' independent prescriptive authority for drugs that are not controlled substances, drug categories, or devices that are prescribed to patients who are 5 years old or older but under 12 years old for conditions that do not require a new diagnosis, that are minor and self-limiting, or that have a test that guides diagnosis and are not medications that may only be prescribed pursuant to a certified education program and a limited distribution network. If a pharmacist tests or treats any patient who is under 18 years old, the act requires a pharmacist to notify the patient's primary care provider consistent with health-care privacy laws or, if the patient does not have or disclose a primary care provider, refer the patient to a primary care provider for further care.(Note: This summary applies to this bill as enacted.)

HB 1305 allows remote psychiatric inpatient facilities in Colorado to operate under a main hospital's general license instead of needing separate psychiatric hospital licensing, provided they meet specific criteria. These facilities must be located within 35 miles of a main hospital in a rural area, offer 17+ inpatient beds, meet all psychiatric hospital standards, and maintain federal provider-based status. The main hospital remains responsible for all licensing enforcement actions related to the remote location, and the facility must pay a separate licensing fee. This change aims to streamline operations while maintaining regulatory oversight through the main hospital's license.

The act declares emergency medical services as an essential service in the state and an integral part of the state's health-care infrastructure.      The act also declares that emergency medical service providers, whether responding on duty or as a volunteer and regardless of location, provide essential services when providing emergency ambulance services and nonemergency ambulance services.      The act also updates certain definitions related to emergency medical services, including the addition of a definition of 'out-of-hospital services', which term is defined to mean the furnishing of necessary health-care goods and services outside of a hospital setting but does not include prehospital setting transports.     The act clarifies that an off-duty emergency medical service provider is not obligated to respond to the scene of a medical emergency or provide emergency medical services.(Note: This summary applies to this bill as enacted.)

The act defines 'first responder' to include:A peace officer;A firefighter;A volunteer firefighter;An emergency medical service provider; orA mental health professional who responds in a professional capacity to a justifiable medical emergency.     Existing law requires the emergency medical and trauma services advisory council (council) to review and approve new rules and modifications to rules prior to the adoption of such rules or modifications by the state board of health. The act requires the council to make recommendations for, instead of approve, rules and modifications to rules concerning emergency medical and trauma services prior to the adoption of such rules or modifications by the state board of health.     Beginning January 1, 2027, the act requires the department of health care policy and financing (state department) to reimburse the following entities under the 'Colorado Medical Assistance Act':An ambulance service for ground transportation by an ambulance or other vehicle to a hospital or other destination as deemed appropriate by the ambulance service's medical director;An ambulance service for treatment on the scene of a medical emergency, which treatment does not result in ground transportation; andA qualified provider, an ambulance service, or an agency for evaluation by telemedicine of a person being treated by an ambulance service or an agency for the purpose of preventing the need to transport the person to a hospital.(Note: This summary applies to this bill as enacted.)

The act amends the law and adds new provisions to law relating to access to vaccines as follows:     For the cervical cancer vaccine: (Sections 3 and 14)Updates insurance coverage statutes to refer to the vaccine as the human papillomavirus vaccine, rather than the cervical cancer vaccine; Recognizes coverage for both women and men;Authorizes the commissioner of insurance to adopt coverage rules for the vaccine if the advisory committee on immunization practices to the centers for disease control in the federal department of health and human services (ACIP) no longer recommends the vaccine; andUpdates language in the cervical cancer immunization program to define the cervical cancer vaccine as the human papillomavirus vaccine and to refer in the program to underinsured minors, rather than just uninsured female minors, since both male and female minors receive the vaccine;     Under Colorado law, a naturopathic doctor must provide a parent or legal guardian with a copy of the most recent schedule of immunizations recommended by the ACIP. The act removes references to ACIP and requires a naturopathic doctor to refer patients to a schedule of immunizations established by rule of the state board of health (board of health) (Sections 4 and 5);     The act authorizes pharmacists to exercise independent prescriptive authority for vaccines and requires the state board of pharmacy to review and repeal record-keeping rules for vaccines (Sections 6 and 7);     In the context of vaccines required for school entry, updates vaccine-related liability limitation provisions to limit liability for injuries if the vaccine was administered to a child of any age according to the schedule of immunizations established by the board of health or to ACIP's schedule referenced in Colorado law (Section 8);     The act also does the following:Directs the board of health, in adopting rules addressing which vaccines are to be administered to infants, to consider the recommendations of ACIP, as well as the recommendations of the American Academy of Pediatrics and other similar entities (Section 9);Removes the prohibition on the use of state money for infant immunization programs if the state does not receive federal money for the infant immunization programs, and requires any additional general fund money for the programs to be appropriated through the annual state budget process or emergency supplemental process (Section 10);For claims brought on or before January 30, 2029, adds pharmacies, manufacturers, and wholesalers to liability limitation provisions for hospitals, clinics, and other providers relating to the handling, storage, and distribution of vaccines for infants. Manufacturer and wholesaler liability limitation provisions are removed from the law for claims brought on or after January 31, 2029 (Section 11).Authorizes the department of public health and environment to consider vaccines adopted by the board of health by rule, recommendations of the American Academy of Pediatrics and other similar entities, in addition to ACIP, in recommending the purchase of vaccines, sending notifications concerning overdue vaccines and vaccine-preventable disease outbreaks, and when considering equivalent vaccines (Section 12).     The act creates the 'Adult Immunization Act' (act), which applies to individuals at least eighteen years old. A person that administers a vaccine or other immunizing agent to an adult is not liable for civil damages for injury or death of an adult caused by a vaccine or immunizing agent if:The vaccine or immunizing agent was administered according to the schedule of immunizations establish by the board of health by rule, after considering recommendations from ACIP, the American Academy of Pediatrics, and other similar entities;There were no medical contraindications; and The vaccine or immunizing agent was administered in accordance with generally accepted clinical methods.     For claims brought on or before January 30, 2029, against a hospital, clinic, pharmacy, manufacturer, wholesaler, or provider arising from injuries resulting from the handling, storage, or distribution of vaccines, there is no liability unless the injuries are the result of the negligent failure of an employee of the hospital, clinic, pharmacy, or manufacturer, wholesaler, or provider to conform to recognized standards to protect public health. Manufacturer and wholesaler liability protections are removed from the law for claims brought on or after January 31, 2029 (Section 15).     The act authorizes the department of health care policy and financing to purchase for the children's basic health plan vaccines that are recommended by the American Academy of Pediatrics and other similar entities, in addition to those recommended by ACIP (Section 16).(Note: This summary applies to this bill as enacted.)