Sen. Lindsey Daugherty

The act makes changes to requirements for preventive care coverage by health insurers for breast cancer screening, including: Relocating in statute the high-risk breast cancer screening requirements; Defining and specifying criteria for the use of diagnostic breast examinations and supplemental breast examinations; and Clarifying that, in addition to regular breast cancer screening, diagnostic and supplemental breast examinations that are medically necessary and conducted within nationally recognized screening guidelines do not require cost sharing by the patient.(Note: This summary applies to this bill as enacted.)

The act creates the provider stabilization fund for use by Colorado department of health care policy and financing (department) to distribute provider stabilization payments to safety net providers who provide services to low-income, uninsured individuals on a sliding-fee schedule or at no cost. Provider stabilization payments will be distributed to eligible safety net providers based on the proportion of low-income, uninsured individuals that an individual provider serves in comparison to the total number of low-income, uninsured individuals served by all eligible safety net providers. The state treasurer is directed to make an interest-free loan of interest earnings on the principal in the unclaimed property trust fund (UPTF) and, if the interest earnings are insufficient, from the principal of the UPTF as well, to the provider stabilization fund as follows: $25 million for the 2025-26 state fiscal year; $20 million for the 2026-27 state fiscal year; and $15 million for each of the 2027-28, 2028-29, and 2029-30 state fiscal years. The act specifies that the loan from the UPTF to the provider stabilization fund is an interfund loan that is not classified as revenue, is booked as an interfund receivable or payable, is not state fiscal year spending or state revenues, and does not count against the state fiscal year spending limit or the excess state revenues cap. The department is directed to repay the loan by January 1, 2045, but in any year in which state revenues do not exceed the limit on state fiscal year spending, the department must present to the joint budget committee a proposal to repay all or a portion of the loan at an earlier time, and to the extent possible, the general assembly must prioritize repaying the loan starting in the 2030-31 state fiscal year or sooner if funds are available. The provider stabilization fund also consists of any money the general assembly appropriates, transfers, or credits to the fund and any gifts, grants, or donations the department may receive for the fund. The act directs the department to leverage money in the provider stabilization fund to obtain federal matching money. The act establishes a provider stabilization fund advisory board (advisory board) to assist the department in implementing and administering the provider stabilization fund. The department, with assistance from the advisory board, is required to submit an annual report on the provider stabilization fund to specified committees, the governor, and the medical services board in the department. The advisory board is scheduled for repeal on September 1, 2031, and is subject to a sunset review by the department of regulatory agencies before the repeal. The act appropriates $25,000,000 from the provider stabilization fund to the department to implement the act, allocated as follows: $138,505 for personal services to administer the act, including 2.0 FTE; $15,900 for operating expenses; and $24,845,595 for provider stabilization payments to eligible safety net providers.(Note: This summary applies to this bill as enacted.)

Beginning July 1, 2026, absent an emergency placement change, the act requires a county or district department of human or social services (county department) child welfare caseworker (caseworker) to create an individualized placement transition plan (plan) for a child any time the child is moved from one placement in a foster care home, kinship foster care home, or non-certified kinship care home (placement) to another or back to the child's home. The plan must prioritize the mental, emotional, and physical needs of the child while considering the needs of the parents, current providers, and future providers as the needs of the parents, current providers, and future providers relate to the care of the child. If a sibling group is moved from a placement together, the caseworker may develop a single plan for the sibling group, as long as the plan takes into account the individualized needs of each child. The plan, at a minimum, must include: A determination of pre-transition logistics to adequately prepare for the child's new placement; A plan for pre- and post-transition communications between individuals who have relevant information for the transition; A timeline to transition the child to a new placement; A plan to physically move the child to the new placement; and A framework for a caseworker's post-transition communications. The department of human services (state department), within existing resources, shall create a training on the importance of plans that is recorded and made available on a training system that can be accessed statewide. The training must focus on plans and individuals who have lived experience with placement transitions, including an emphasis on individuals who experienced placement transitions. Newly employed caseworkers must complete the training within the first year of employment as a caseworker. All caseworkers may complete this training every 3 years. A foster care, kinship foster care, or non-certified kinship care provider (provider) may complete the training and may receive support from the state department or the county department to improve the provider's skills in transitioning a child in the provider's care from one placement to another. The state department may adopt rules for purposes of the plans. (Note: This summary applies to this bill as enacted.)

Beginning on or before July 1, 2027, the act requires a county department of human or social services (county department) to determine whether a child or youth who is in foster care and who has a deceased parent (child or youth) may be eligible to receive survivor benefits administered by the United States railroad retirement board, social security administration, or veterans benefits administration (federal survivor benefits). The county department must make an initial eligibility determination within 90 days after assuming legal custody of or authority over the child or youth. Under current law, certain federal agencies appoint a representative payee or fiduciary (representative payee) to receive and manage federal benefits on behalf of a child or youth in foster care. If a child or youth may be eligible for federal survivor benefits and the county department is the most appropriate representative payee, the act requires the county department to apply for federal survivor benefits on behalf of the child or youth. If the county department determines that the child or youth may be eligible for federal survivor benefits but that the county department is not the most appropriate representative payee, the county department shall provide information to the prospective representative payee that the county department has identified about how to apply for federal survivor benefits on behalf of the child or youth and how to become the child's or youth's representative payee. Under current law, a county department serving as a representative payee may use federal benefits to offset the cost of providing basic care and services to a child or youth in foster care. The act prohibits this offset practice with respect to federal survivor benefits. Instead, the act directs a county department serving as a representative payee to establish an account for the federal survivor benefits (account). A county department serving as a representative payee must save money in the account for the needs of the individual child or youth. Once the child or youth leaves foster care, the county department is required to release funds in the account to the child or youth. The act sets forth various accounting and notice requirements related to federal survivor benefits and requires the department of human services (department), in consultation with interested stakeholders, to adopt rules providing guidance for county departments. The guidance extends to procedures for identifying a representative payee, county department responsibilities when federal survivor benefits are denied or when a child or youth leaves foster care, and policies governing the establishment and maintenance of an account for federal survivor benefit funds. The department must provide technical assistance to a county department about how to conserve federal survivor benefit funds in the best interests of an individual child or youth. (Note: This summary applies to this bill as enacted.)

The act modifies the process for filling vacancies in an unexpired term in the office of county commissioner for county commissioners affiliated with a major political party in counties that are not home rule counties and that have at least 50,000 active voters as of the last general election (vacancy). If a vacancy occurs on or after July 31 of an even-numbered year that the seat was not scheduled to be on the ballot at the general election but before July 31 of an odd-numbered year, the vacancy must be filled by vacancy committee selection until the next regularly scheduled odd-year November election following the vacancy, rather than until the next general election as is the case for vacancies that occur at other times, when the vacancy must be filled by vacancy election (vacancy election). An individual elected at a vacancy election serves until the next general election. A vacancy election is conducted as part of a coordinated odd-year November election. A major political party may opt out of the vacancy election process if at least 75% of the total voting membership of a political party's state central committee votes to do so by October 1 of the even year preceding a vacancy election. For a vacancy election to be held in November 2025, the vote must occur no later than June 30, 2025. If the state certifies any ballot content for the odd-year November election, the state is required to reimburse a county for 45% of its costs incurred in conducting the coordinated election that includes the vacancy election. Watchers, canvass boards, and election judges for the vacancy election are selected according to current processes in statute. Only registered electors of the county of the vacating commissioner who, as of 22 days before the vacancy election, are either registered with the same major political party as the vacating commissioner or are unaffiliated with a political party are eligible to vote in a vacancy election. A candidate is eligible to be placed on the ballot for a vacancy election if the candidate: Files a nominating statement signed by at least 30% of the vacancy committee members with the county clerk and recorder and the candidate's major political party by the seventieth day before the vacancy election; or Submits to the county clerk and recorder, no later than 30 days after their petition format has been approved or 85 days prior to the vacancy election, a notarized candidate's statement of intent and a petition signed by at least 200 electors who have been affiliated with the same major political party as the candidate for 22 days before signing the petition and are eligible to vote in the district for which the candidate is to be elected. A candidate may seek to be placed on the ballot through one, but not both, methods, and candidate placement on the ballot is drawn by lot. A candidate must be registered with the vacating commissioner's major political party by the first business day in January of the calendar year in which the vacancy election occurs and must be a resident of the same district as the vacating commissioner. A candidate in a vacancy election is subject to the campaign finance contribution, expenditure, and reporting requirements of the "Fair Campaign Practices Act". For the 2025-26 state fiscal year, $314,920 is appropriated from the department of state cash fund to the department of state for use by the information technology division for personal services. (Note: This summary applies to this bill as enacted.)

The act defines an "equestrian zone" as an area that a municipality or county determines is suburban or urban and contains: Public equestrian venues; Residential neighborhoods that are equestrian centric and were zoned in such a manner as to allow housing privately owned equines but are now being developed for primarily residential use or that are zoned in such a manner as to allow housing privately owned equines; Keystone properties that have equestrian facilities that have boarding facilities for equines, training for equestrians, equine service and education programs, equine stables that facilitate animal welfare rescue programs or equine therapy programs, breeding facilities for equines, or nonpublic equestrian venues that provide services to the equestrian community; or Roads or trails that equestrians regularly use and that are related to the areas described above. The act authorizes municipalities and counties to: Construct and maintain equestrian road crossings or horse-trailer parking necessary to access equestrian trails and install signs that notify the public of the infrastructure; Identify locations where equestrian road crossings are needed to safely use horse trails, construct and maintain the equestrian road crossings in those places, and install signs notifying the public of the crossings; Publish a map showing the location and character of existing or proposed equestrian infrastructure; Erect road signs bearing the universal equestrian sign symbol and the words "wide and slow" in equestrian zones; and Identify and show the location and character of existing or proposed equestrian infrastructure, venues, and riding zones on master plans. A municipality or county may organize public events to educate the public about equestrian use of recreational trails and roads and the duties of users of trails and roads with regard to equestrian users. The chief of the Colorado state patrol is authorized to educate sheriffs and local law enforcement about equestrian safety. The department of revenue is given the duty of adopting rules to add equestrian safety to driver's education curricula. (Note: This summary applies to this bill as enacted.)

Embodied carbon is the carbon associated with greenhouse gas emissions arising from the production, construction, use, and end-of-life of products or systems used in the construction of buildings, roads, and other infrastructure. Section 1 of the act adds embodied carbon improvements to the list of new energy improvements that are eligible for property-assessed clean energy financing provided by the Colorado new energy improvement district. An embodied carbon improvement is one or more installations or modifications to real property using eligible materials that result in the reduction of the installation's or modification's embodied carbon emissions. Section 2 modifies the industrial clean energy tax credit so that embodied carbon investments are greenhouse gas emissions reduction improvements that, if certified, are eligible for the credit for a portion of the capital costs incurred in placing them in service. An embodied carbon investment is one that results in a 15% or greater reduction in cradle-to-gate embodied emissions of eligible materials when compared to the eligible materials' cradle-to-gate baseline. (Note: This summary applies to this bill as enacted.)

The act exempts an assisted living residence that has not undergone new construction or major renovations from complying with the facility guideline institute guidelines. The department of health care policy and financing (state department) must establish a process for reviewing and updating the general billing manual on an annual basis and ensure that the general billing manual includes all necessary CPT codes or links to the state department's list of CPT codes. The act allows the Colorado healthcare affordability and sustainability enterprise to receive public funds. Beginning January 1, 2026, for claims that must be reprocessed as a result of updating the provider rates, the act requires a managed care organization to issue payment to a contracted provider within one year after the provider rate is updated. The state department must notify the managed care organizations of changes to the provider rates within 60 days of changing the provider rates. The act requires the state department to include in each new contract with, or renewal of a contract with, a managed care entity (MCE) a provision requiring the MCE to submit to the state department, on an annual basis, the amount the MCE is paid and the MCE's medical loss ratio. The state department is required to publish this information, as well as historical medical loss ratio data for each MCE, and publish on an annual basis audit findings regarding an MCE's most recently completed medical loss ratio audit on the state department's website. The act prohibits the state department from imposing signature requirements on a physician or practitioner certifying a medicaid member's (member) plan of care that involves physical therapy, occupational therapy, or speech therapy. The act requires that for members receiving home- and community-based services, if a service the member receives is discontinued or no longer a covered service, the state department must confirm the timeline for the continuity of treatment with the federal centers for medicare and medicaid during the transition period of the benefit or service being discontinued and must communicate that timeline to the member impacted by the benefit or service being discontinued. (Note: This summary applies to this bill as enacted.)

The act prevents a pharmacy benefit manager (PBM) from prohibiting a rural independent pharmacy from using a private courier or a delivery service to deliver a prescription drug to a patient. A PBM is required to reimburse a rural independent pharmacy for a prescription drug in an amount not less than the national average drug acquisition cost for the dispensed prescription drug ingredients, plus pay a dispensing fee. When a PBM conducts an audit of a rural independent pharmacy and the audit results in a recoupment of more than $1,000 or a penalty of more than $1,000, the PBM must: Electronically notify the rural independent pharmacy of the rural independent pharmacy's rights to appeal at least 30 days before the recoupment of funds; If the rural independent pharmacy does not respond to the electronic notification within 30 days after the electronic notification, again electronically notify the rural independent pharmacy of the rural independent pharmacy's rights to appeal at least 30 days before the recoupment of funds; and If the rural independent pharmacy does not respond to the second electronic notification within 30 days after the second electronic notification, serve process on the rural independent pharmacy notifying of the rural independent pharmacy's rights to appeal at least 30 days before the recoupment of funds. The act allows a rural independent pharmacy to operate without being under the direct charge of a pharmacist if the initial interpretation and final evaluation of the prescription is done by a state-licensed pharmacist in person or remotely. (Note: This summary applies to this bill as enacted.)

The act authorizes the department of health care policy and financing (HCPF) to seek and accept gifts from private or public sources for the primary care fund. The act authorizes a federally qualified health center (FQHC) to establish a separate subsidiary company for the purpose of providing fee-for-service services outside of the FQHC's standard cost report if the subsidiary is providing fee-for-service services that have historically been provided and reimbursed on a fee-for-service basis and if HCPF determines that the subsidiary's reimbursements would be budget neutral. Upon receiving any necessary federal authorization, HCPF is required to reimburse a subsidiary of an FQHC on a fee-for-service basis for services that are eligible for fee-for-service reimbursement. A subsidiary that receives reimbursement is authorized to pass through money received from the reimbursement directly to the FQHC operating as the subsidiary's parent corporation. Services reimbursed to an FQHC's subsidiary are excluded from the FQHC's cost report. The act requires HCPF to exclude all costs associated with a subsidiary company from the calculation of a FQHC's reimbursement rates and requires a FQHC that establishes a separate subsidiary company to include the costs associated with the subsidiary in its cost report that is necessary to calculate reimbursement rates. (Note: This summary applies to this bill as enacted.)