The act updates the ongoing schedule of annual fees imposed on retail food establishments, which fees are imposed to cover the cost of required health and safety inspections under current law. (Note: This summary applies to this bill as enacted.)
Under current law, there are 2 programs available to low-income individuals to buy in to the state medical assistance program: One for adults with disabilities and one for children with disabilities (medicaid buy-in programs). Individuals who participate in either program pay a premium based on their family income. The premiums are credited to the medicaid buy-in cash fund. The premiums credited to the medicaid buy-in cash fund are used to offset the costs of providing the medicaid buy-in programs. The costs of providing the medicaid buy-in programs are also offset by the money in the healthcare affordability and sustainability fee cash fund in the Colorado healthcare affordability and sustainability enterprise (CHASE) within the department of health care policy and financing (HCPF). The act repeals the existing medicaid buy-in cash fund and creates the healthcare affordability and sustainability medicaid buy-in cash fund (buy-in cash fund) within CHASE and directs that individuals who participate in the existing medicaid buy-in programs pay their premiums into the buy-in cash fund. The act creates a medicaid buy-in enterprise support board within CHASE to support the existing enterprise with the implementation of the medicaid buy-in program, including consulting with HCPF and the state medical services board on the amount of the premiums for and other components of the medicaid buy-in programs. Because CHASE is an enterprise for purposes of the Taxpayer's Act of Rights, its revenue does not count against the state fiscal year spending limit. For the 2025-26 state fiscal year, $6,660,761 is appropriated from the buy-in cash fund to HCPF for medical and long-term care services for medicaid-eligible individuals. The act also decreases in a corresponding amount an appropriation to HCPF from the existing Medicaid buy-in cash fund and adjusts similar appropriations to HCPF for the 2024-25 state fiscal year. (Note: This summary applies to this bill as enacted.)
The act requires the department of health care policy and financing (state department), in collaboration with the behavioral health administration, to establish the workforce capacity center to train providers in evidence-based or supported models as part of the system of care for children and youth. The act requires the state department to include updates on and milestones achieved by the workforce capacity center and information about trainings and certifications by the workforce capacity center in its quarterly report to the joint budget committee. The act repeals the workforce capacity center, effective July 1, 2027. (Note: This summary applies to this bill as enacted.)
Beginning January 1, 2027, the act: Allows a pharmacy benefit manager (PBM) to earn income derived from the assessment of a flat-dollar service fee for the provision of a prescription drug; Prohibits a PBM from earning income based on the price or cost of a prescription drug; Prohibits a PBM from designing a formulary to favor a certain branded pharmaceutical or biologic; Requires a PBM to be reimbursed by a health benefit plan for lowering the plan's prescription drug spending over a given period of time and for the direct services the PBM provides to the plan; Sets the amount that a PBM shall reimburse an unaffiliated pharmacy or a PBM-affiliated retail, mail order, or specialty pharmacy for a prescription drug; and Requires a contract between a PBM and a health benefit plan to contain a provision where the PBM discloses prescription drug cost information to the health benefit plan and a provision authorizing the health benefit plan to execute an audit to validate compliance with the contract.(Note: This summary applies to this bill as enacted.)
The act changes the term "epinephrine auto-injector" to "emergency-use epinephrine" in order to encompass alternatives to injecting epinephrine as a means to treat anaphylaxis in school settings. (Note: This summary applies to this bill as enacted.)
Proposition 123, which was approved by the voters at the 2022 statewide election, created the affordable housing support fund (fund) and continuously appropriated money from the fund to the division of housing within the department of local affairs (department) for enumerated uses relating to an affordable home ownership program and a program serving persons experiencing homelessness and to the division of local government, also within the department, for enumerated uses relating to a local planning capacity development program. A specified percentage of money from the fund is allocated for the implementation of each program, and from each allocated percentage the division of housing or the division of local government, as applicable, is permitted to use up to 5% to pay for the direct and indirect costs of administering each program. Beginning in state fiscal year 2026-27, the act makes the expenditure of up to 5% of the money from each program's allocation of funding for administration of each program subject to annual appropriation by the general assembly and clarifies how that 5% amount is calculated. The act also allows the division of housing, subject to annual appropriation by the general assembly, to expend money under the program serving persons experiencing homelessness for: Capital needs at 2 state-owned supportive residential communities for persons experiencing homelessness (supportive residential communities); and Direct and indirect costs of operating the 2 supportive residential communities. Proposition 123 also included a prohibition on the general assembly appropriating funds from the fund and the affordable housing financing fund to supplant other state support for affordable housing projects. The act clarifies when appropriations from the fund and the affordable housing financing fund would violate this prohibition. (Note: This summary applies to this bill as enacted.)
The department of health care policy and financing (department) received federal authorization to provide coverage for health-related social needs and to provide reentry services to justice-involved individuals through the medicaid program. The act creates 2 cash funds, one for health-related social needs and one for reentry services for justice-involved individuals. The act requires the state treasurer to transfer the savings of state money realized from each federal authorization to the respective cash fund. Subject to annual appropriation by the general assembly, the department may expend money from the funds to provide health-related social needs or reentry services to justice-involved individuals. The department is required to develop a workforce to provide peer support services in order to comply with the terms of the federal authorization for health-related social needs. The department is authorized, subject to annual appropriation by the general assembly, to spend money from the affordable housing support fund for services authorized by the federal authorization to provide coverage for health-related social needs. The act makes and reduces appropriations from the general fund, and from reappropriated funds, to the department, the department of corrections, the department of human services, and the department of local affairs. The act appropriates money from the affordable housing support fund to the department for medical and long-term care services for medicaid-eligible individuals and reduces the appropriation from the affordable housing support fund to the department of local affairs. (Note: This summary applies to this bill as enacted.)
The act requires that, for health insurance policies providing maternity coverage, policies issued or renewed on or after January 1, 2027, must include prenatal care coverage without cost sharing for up to 3 office visits. (Note: This summary applies to this bill as enacted.)
Current law requires the department of corrections (department) to assess a copayment for inmate-initiated visits to providers of medical, dental, mental health, and optometric care services. Current law permits a waiver or reduction of the copayment under a range of circumstances. The department's current administrative regulations assess fees when an inmate fails to attend or refuses a scheduled health-care appointment. The act eliminates the copayment and prohibits the department from assessing a fee when an inmate fails to attend or refuses a health-care appointment. The department is required to report during its 2026 "SMART Act" hearing on the number of times in the previous year that an inmate failed to attend a scheduled health-care appointment or requested an appointment when the request was not relevant to an actual medical condition. The act reduces appropriations to the department by a net of $165,682, which includes an increase of $157,179 appropriated from the general fund and a decrease of $322,861 from cash funds. VETOED by Governor 5/29/2025(Note: This summary applies to this bill as enacted.)
For ground ambulance services (ambulance services), the act: Allows a political subdivision or an ambulance service providing ambulance services on behalf of the political subdivision to submit to the division of insurance (division) the established rates for the ambulance services, if the rates meet specified conditions; Requires the division to publish reimbursement rates on the division's public-facing website; Establishes reimbursement rates for ambulance services that are out of network; and Prohibits an out-of-network ambulance service from billing an individual covered under a health insurance coverage plan (covered person) any outstanding balance for a covered service not paid for by an insurance carrier, except for any coinsurance, deductible, or copayment amount required to be paid by the covered person. If a covered person makes a payment for an out-of-network ambulance service, the payment must be applied to the covered person's in-network deductibles and in-network out-of-pocket maximum amounts. For the 2025-26 state fiscal year, $38,149 is appropriated from the division of insurance cash fund to the department of regulatory agencies for use by the division to implement the act. VETOED by Governor 5/29/2025(Note: This summary applies to this bill as enacted.)
