Sen. Joann Ginal

Primary care - collaborative created - affordability standards - targets - payment reform recommendations. The act: Establishes a primary care payment reform collaborative in the division of insurance in the department of regulatory agencies; Requires the commissioner of insurance to establish affordability standards for premiums, including adding targets for carrier investments in primary care; and Requires the department of health care policy and financing and carriers who offer health benefit plans to state employees to set targets for investment in primary care.(Note: This summary applies to this bill as enacted.) Read More

Advance directives - health care providers - electronic advance health care directive system - appropriation. The act requires the department of public health and environment (department) to contract with one or more health information organization networks for the creation, administration, and maintenance of a statewide electronic system (system) that allows qualified providers to upload and access advance health care directives. The act defines an advance health care directive as a directive concerning medical orders for scope of treatment, a declaration as to medical treatment, a directive relating to cardiopulmonary resuscitation, or a medical durable power of attorney. The act also requires the department to promulgate rules to oversee the system. The act allows a qualified provider to upload an individual's advanced health care directive upon the request of the individual after the individual has consulted with the qualified provider in person or through telehealth. A qualified provider who uploads an advance health care directive to the system is not subject to criminal or civil liability. The act requires the individual whose medical treatment is the subject of the advance health care directive, or the authorized surrogate decision-maker, to sign an electronic affidavit, prior to uploading the advance health care directive to the system, attesting that the advance health care directive uploaded to the system is appropriately executed, current, and accurate. The act does not allow for any civil or criminal liability or regulatory sanctions for any emergency personnel, health care provider, health care facility, or any other person that complies with a legally executed advance medical directive that is accessed from the system. For the 2019-20 state fiscal year, the act appropriates $993,147 from the general fund to the department of public health and environment for personal services related to health statistics and vital records, operating expenses, and for the purchase of information technology services. (Note: This summary applies to this bill as enacted.) Read More

Prescription drugs - Canadian prescription drug importation program - federal approval - eligible importers and suppliers - eligible prescription drugs - distribution requirements - reports - rules - appropriations. The act creates the "Canadian Prescription Drug Importation Program" (program) in the department of health care policy and financing (department). On or before September 1, 2020, the department shall submit a request to the United States secretary of health and human services for approval of the program. The department shall begin operating the program not later than 6 months after receiving such approval. The department may expend money for the purpose of requesting approval of the program, but the department cannot spend any other money to implement the program until the department receives approval of the program. Upon receiving approval of the program, the department shall contract with 1 or more vendors to provide services under the program. Each vendor, in consultation with the department and any other vendors, shall establish a wholesale prescription drug importation list (importation list) that identifies the prescription drugs that have the highest potential for cost savings to the state. Each vendor shall revise the list at least annually and at the direction of the department. The department shall review the importation list at least every 3 months to ensure that it continues to meet the requirements of the program. The department may direct a vendor to revise the list, as necessary. Each vendor shall: Identify, in consultation with the department, Canadian suppliers who are in full compliance with relevant Canadian federal and provincial laws and regulations and who have agreed to export prescription drugs identified on the importation list; Verify that such Canadian suppliers meet the requirements of the program and will export prescription drugs at prices that provide cost savings to the state; Contract with such eligible Canadian suppliers, or facilitate contracts between eligible importers and Canadian suppliers, to import prescription drugs under the program; Assist the department in developing and administering a distribution program within the program; Assist the department with the preparation of an annual report and provide any information requested by the department for the report; Ensure the safety and quality of drugs imported under the program; Maintain a list of all eligible importers that participate in the program; Ensure compliance with the federal "Drug Quality and Security Act" by all Canadian suppliers, eligible importers, distributors, and other participants in the program; Provide an annual financial audit of its operations to the department; Provide to the department quarterly financial reports specific to the program, which reports must include information concerning the performance of the vendor's subcontractors and vendors; Submit evidence of a surety bond in an amount of at least $25,000 with any bid or initial contract negotiation documents and maintain documentation of evidence of the surety bond with the department throughout the contract term; and Maintain the information and documentation submitted to the department for at least 7 years. The act imposes certain requirements for drugs that are imported under the program, and the act prohibits certain drugs from being imported under the program. The act states that the following entities are eligible importers under the program: A pharmacist or wholesaler employed by or under contract with a medicaid pharmacy, for dispensing to the pharmacy's medicaid recipients; A pharmacist or wholesaler employed by or under contract with the department of corrections, for dispensing to inmates in the custody of the department of corrections; Commercial plans, as defined by rules promulgated by the medical services board and as approved by the federal government; and A licensed Colorado pharmacist or wholesaler approved by the department. An eligible importer may import a prescription drug from a Canadian supplier if: The drug meets federal food and drug administration standards and is not a controlled substance, biological product, infused or intravenously injected drug, a drug that is inhaled during surgery, or a parenteral drug deemed a threat to public health; and Importing the drug is expected to generate cost savings and would not violate federal patent laws. The act requires the department to designate an office or division that must be a licensed pharmaceutical wholesaler or that shall contract with a licensed pharmaceutical wholesaler. The designated office shall: Set a maximum profit margin so that a wholesaler, distributor, pharmacy, or other licensed provider participating in the program maintains a profit margin that is no greater than the profit margin that the wholesaler, distributor, pharmacy, or other licensed provider would have earned on the equivalent nonimported drug; Exclude generic products if the importation of the products would violate United States patent laws applicable to United States-branded products; Comply with certain federal requirements concerning drug quality and security; and Determine a method for covering the administrative costs of the program. Each participating eligible importer and Canadian supplier shall submit to the vendor specified information about each drug to be acquired by the importer or to be supplied by the Canadian supplier under the program. The department shall immediately suspend the importation of a specific drug or the importation of drugs by a specific eligible importer if it discovers that any drug or activity is in violation of the act or any federal or state law or regulation. The department may revoke the suspension if, after conducting an investigation, it determines that the public is adequately protected from counterfeit or unsafe drugs being imported into this state. The executive director of the department shall promulgate rules as necessary for the administration of the program. The department shall approve a method of financing the administrative costs of the program, which method may include imposing a fee on each prescription pharmaceutical product sold through the program or any other appropriate method determined by the department to finance administrative costs. The department shall not require a fee in an amount that the department determines would significantly reduce consumer savings. On or before December 1, 2021, and on or before December 1 each year thereafter, the department shall submit a report to the governor, the president of the senate, and the speaker of the house of representatives concerning the operation of the program during the previous fiscal year. For the 2019-20 fiscal year, the act appropriates $1,041,802 to the department to implement the act, $134,719 of which is reappropriated to the department of law to provide legal services to the department. (Note: This summary applies to this bill as enacted.) Read More

The bill requires the university of Colorado school of medicine (school) to provide scholarships to students who: Will complete clinical studies in a rural or frontier area in Colorado; Have demonstrated financial need; and Have committed in writing to living and serving as physicians in rural or frontier areas in Colorado that are also primary care health professional shortage areas for at least 4 years following the completion of their residency training. The bill requires the school to submit an annual written report to the education committees of the house of representatives and senate concerning the operation of the school's rural track during the preceding academic year. (Note: This summary applies to this bill as introduced.) Read More

Section 1 of the bill enacts the "Colorado Prescription Drug Cost Reduction Act of 2019", which requires: Health insurers, starting in 2020, to submit to the commissioner of insurance (commissioner) information regarding prescription drugs covered under their health insurance plans that the plan paid for in the preceding calendar year, including information about rebates received from prescription drug manufacturers, a certification regarding how rebates were accounted for in insurance premiums, and a list of all pharmacy benefit management firms (PBMs) with whom they contract; Prescription drug manufacturers to notify the commissioner, state purchasers, health insurers, and PBMs when the manufacturer, on or after January 1, 2020, increases the price of certain prescription drugs by more than specified amounts or introduces a new specialty drug in the commercial market; Prescription drug manufacturers, within 15 days after the end of each calendar quarter that starts on or after January 1, 2020, to provide specified information to the commissioner regarding the drugs about which the manufacturer notified purchasers; Health insurers or, if applicable, PBMs to annually report specified information to the commissioner regarding rebates and administrative fees received from manufacturers for prescription drugs for which they received the required notice from a manufacturer; and Certain nonprofit organizations to compile and submit to the commissioner an annual report indicating the amount of each payment, donation, subsidy, or thing of value received by the nonprofit organization or its executive director, chief operating officer, board of directors, or any member of the board of directors from a prescription drug manufacturer, PBM, or health insurer and the percentage of the nonprofit organization's total gross income that is attributable to those payments, donations, subsidies, or things of value. The commissioner is required to post the information received from health insurers, prescription drug manufacturers, PBMs, and nonprofit organizations on the division of insurance's website, excluding any information that is proprietary. Additionally, the commissioner, or a disinterested third-party contractor, is to analyze the data reported by health insurers, prescription drug manufacturers, PBMs, and nonprofit organizations and other relevant information to determine the effect of prescription drug costs on health insurance premiums. The commissioner is to publish a report each year, submit the report to the governor and specified legislative committees, and present the report during annual "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act" hearings. The commissioner is authorized to adopt rules as necessary to implement the requirements of the bill. Section 2 prohibits PBMs from retroactively reducing payment on a clean claim submitted by a pharmacy unless the PBM determines, through an audit conducted in accordance with state law, that the claim was not a clean claim. Health insurers that contract with PBMs must ensure that the PBMs are complying with this prohibition and the reporting requirements and are subject to penalties for failure to do so. Section 3 requires a carrier to reduce the cost sharing a covered person is required to pay for prescription drugs by an amount equal to the greater of 51% of the average aggregate rebates received by the carrier for all prescription drugs, including price protection rebates, or an amount that ensures cost sharing will not exceed 125% of the carrier's cost for the prescription drug. Under sections 5 and 6 , a prescription drug manufacturer that fails to notify purchasers or fails to report required data to the commissioner is subject to discipline by the state board of pharmacy, including a penalty of up to $10,000 per day for each day the manufacturer fails to comply with the notice or reporting requirements. The commissioner is to report manufacturer violations to the state board of pharmacy. Additionally, health insurers that fail to report the required data are subject to a fine of up to $10,000 per day. Sections 7 and 8 of the bill make conforming amendments necessary to harmonize the bill with the title 12 recodification bill, House Bill 19-1172.(Note: This summary applies to this bill as introduced.) Read More

Animal cruelty - mental health treatment - order preventing pet ownership. The act allows a court to impose a mental health treatment program or appropriate treatment program as a sentence for animal cruelty. The act requires a court to enter an order prohibiting a person convicted of felony animal cruelty from owning a pet animal for a period of 3 to 5 years and a juvenile adjudicated a delinquent for an animal cruelty crime from owning a pet animal, unless the defendant or juvenile's treatment provider makes a specific recommendation not to impose the ban and the court agrees with the recommendation.(Note: This summary applies to this bill as enacted.) Read More

Children's basic health plan - dental services for pregnant women - appropriation. Current law requires the medical services board to include dental services for eligible children enrolled in a children's basic health plan. The act requires the board to include dental services to all eligible enrollees, which includes children and pregnant women. The act appropriates $66,955 to the department of health care policy and financing to implement the act. (Note: This summary applies to this bill as enacted.) Read More

Electricians - local inspection fees - limitations. The act repeals the prohibition against local governments and state institutions of higher education charging more than 15% more than the state charges to perform an inspection of electrical work, and instead subjects the inspection fee to a $120 cap that is adjusted annually for inflation with a potential additional 8% tiered charge based on the size or valuation of the inspected improvement. Specified provisions of the act are contingent upon House Bill 19-1172 becoming law. (Note: This summary applies to this bill as enacted.) Read More

The bill states that food is misbranded as "meat" or a cut of meat if it does not come from animals and that lab-grown meat is misbranded as "meat" or a cut of meat unless these terms are not modified by "lab-grown" or "artificially cultured".(Note: This summary applies to this bill as introduced.) Read More

Retail food establishments - inspections - penalties for violations. With respect to retail food establishment inspections, the act: Clarifies that emergency situations can create an "imminent health hazard"; Repeals language that separated violations found during inspections into critical and noncritical violations; Clarifies that it is unlawful to continue to operate a retail food establishment that has had its license or certificate of license suspended; Aligns the requirements for the communication of inspection results with the determination of whether violations are sufficient to require a reinspection; Removes the minimum amount for a civil penalty and establishes the maximum amount as $1,000 for violations of rules promulgated by the department of public health and environment; Provides that a retail food establishment that is found to be in violation during 4 out of 5 inspections during a 12-month period is subject to a civil penalty not to exceed $1,000 and license suspension; and Adds unpaid license fees to the list of items on which a retail food establishment can spend an assessed penalty.(Note: This summary applies to this bill as enacted.) Read More