Sen. Kyle Mullica

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.)

The act allows enrolled members of the Southern Ute Indian Tribe and enrolled members of the Ute Mountain Ute Tribe to enter state parks without having to pay an entrance fee. By June 1, 2026, the division of parks and wildlife (division) in the department of natural resources (department) shall build on existing efforts to conduct outreach to and engagement with the Southern Ute Indian Tribe, the Ute Mountain Ute Tribe, other tribal governments, American Indian communities, and Indigenous communities about opportunities related to state parks that are managed by the division. In January 2026 and January 2027, the department shall include, as part of its presentation during its "SMART Act" hearing, information concerning the division's outreach and engagement about opportunities related to state parks. (Note: This summary applies to this bill as enacted.)

The act requires that, in addition to notice requirements under the Colorado open meetings law, notice of annual public meetings held by metropolitan districts be mailed, at the lowest-cost option, to eligible electors within the metropolitan district or sent by email to any email addresses that eligible electors have provided to the metropolitan district for the purpose of receiving communication from the metropolitan district. Additionally, notice of the annual meeting must be either posted on the homepage of the metropolitan district's website or accessible by a link on the homepage. The act also requires, for any special district, that, if the annual meeting is held at a physical location and in a year immediately preceding a year in which a regular special district election will be held, there be available hard copies of self-nomination and acceptance forms, which are forms required to be filed for an eligible elector to be a candidate for a board position at a special district election. The act also requires that metropolitan districts that are required to have a publicly accessible website must establish a system or a process for residents to contact someone associated with the metropolitan district during regular business hours to address any questions or concerns regarding services of the metropolitan district. Further, these metropolitan districts must establish a system or process for residents to contact someone associated with the metropolitan district outside of regular business hours or when metropolitan district personnel are otherwise unavailable or unreachable to address emergent matters that cannot wait to be addressed until regular business hours resume. For a metropolitan district that is required to have a publicly accessible website, the act requires the following additional information to be provided on the website: The date, time, and location of the annual public meeting; An explanation of what a metropolitan district is, its services, debt, and public infrastructure, and how a resident can serve on its board; The names of the governmental entities that overlap the metropolitan district's boundaries; The name of the county or municipality with which the metropolitan district must file its annual report; and The name and contact information of someone who residents can contact with questions or concerns about the services of the district during regular business hours and outside of regular business hours or when district personnel are otherwise unavailable or unreachable for emergent matters. The act also specifies that the following information must be provided on the home page of the metropolitan district's website: The names, terms, and contact information of individuals serving on the board of directors and of any manager of the metropolitan district; The date, time, and location of scheduled regular meetings, including the annual meeting; The call for nominations for candidates to run for election to the board of directors; The names of the governmental entities that overlap the metropolitan district's boundaries; and The name and contact information of who residents can contact with questions or concerns about the services of the district during regular business hours and outside of regular business hours or when district personnel are otherwise unavailable or unreachable for emergent matters. The act adds to the requirements of what a metropolitan district must include in its service plan when seeking approval of the service plan a requirement to include the maximum term for imposing a debt service mill levy on any property developed for residential purposes after the initial year of imposition of such debt service mill levy. The act requires certain disclosures be made by all sellers of any residential real property located within the boundaries of a metropolitan district, including access to the annually required notice to electors and the metropolitan district's service plan; information on the authority the metropolitan district has to issue debt, levy property taxes, and impose fees, rates, tolls, penalties, or other charges; an estimate of property taxes levied by the metropolitan district for collection during the year the sale occurs; and a copy of the most current certificate of taxes due or tax statement to provide an estimate of the sum of additional mill levies levied by other taxing entities that overlap the property. Additionally, the act requires a written statement be included in the required disclosures that certain actions that the metropolitan district is authorized to take may increase costs to residents living in the metropolitan district, and the property tax estimate disclosure requirement is modified to require that the estimate be given in a dollar amount. (Note: This summary applies to this bill as enacted.)

The act requires the state board of education (board) to adopt high school health education standards regarding drug overdose risks, identification of a drug overdose event, and drug overdose prevention and response. The act authorizes the board to seek, accept, and expend gifts, grants, or donations for the purpose of adopting these standards. The board must adopt the standards on or before July 1, 2028, if, the board receives by July 1, 2026, $20,000 from gifts, grants, or donations to adopt the standards. If sufficient money is not received, the board is required to adopt the standards on or before July 1, 2032, pursuant to the general standards schedule. Under current law, a school district, the state charter school institute (institute), or the governing board of a nonpublic school may adopt and implement a policy allowing an employee or agent of the school to furnish an opioid antagonist to any individual, including a student, but only if the student has received appropriate school-sponsored training. The act repeals the required condition that a student must receive appropriate school-sponsored training. The act authorizes a school district, the institute, a public school, or a nonpublic school to seek, accept, and expend gifts, grants, or donations for purposes related to acquiring, maintaining, and providing training for administering opioid antagonists. (Note: This summary applies to this bill as enacted.)

The act prohibits a person from: Knowingly preparing, distributing, advertising, selling, or offering to sell a kratom product: To a person who is under 21 years of age; that is adulterated; that contains more than a specified level of 7-hydroxymitragynine; that is a confection, mimics candy, or is presented in a form that appeals to children; or that is combustible or intended for vaporization; Preparing, distributing, advertising, selling, or offering to sell a kratom product that does not clearly and conspicuously set forth specified information on the kratom product's label; Displaying or storing kratom products in a retail location in a manner that will allow the products to be accessed by individuals under 21 years of age; or Manufacturing, packaging, labeling, or distributing a kratom product that contains synthesized or semi-synthesized kratom alkaloids or has a level of 7-hydroxymitragynine in the alkaloid fraction that is greater than 2% of the alkaloid composition of the product. A person that conducts these prohibited activities engages in a deceptive trade practice and is subject to penalties and other enforcement specified under the "Colorado Consumer Protection Act". (Note: This summary applies to this bill as enacted.)

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.)

Infusion pharmacies supply medicaid members with parenteral nutrition, which provides patients with essential nutrients through an intravenous infusion. The act requires the state department of health care policy and financing (state department) to create specific professional dispensing fees for the preparation and dispensing of parenteral nutrition (fees) to encourage an adequate level of market participation among infusion pharmacies that serve medicaid members. During the year beginning January 1, 2026, the fees must not exceed 30% of infusion pharmacy administrative costs for the preparation and dispensing of parenteral nutrition. The state department shall seek federal authorization, as necessary, to implement the fees. The act requires the state department to annually report on the adequacy of the infusion pharmacy network that supplies parenteral nutrition to medicaid members. For the 2025-26 state fiscal year, the act appropriates $54,832 to the state department from the general fund. The state department may use the appropriation for medical and long-term care services for medicaid-eligible individuals. The general assembly anticipates that the state department will receive an equal amount in federal funds to implement the act. (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.)