Sen. Iman Jodeh

Beginning July 1, 2023, the act classifies a wildlife officer and a parks and recreation officer employed by the division of parks and wildlife (division) in the department of natural resources (department) and hired on or after January 1, 2011, as a state trooper for the purpose of determining the officer's public employees' retirement association service retirement eligibility and benefit. For the 2023-24 state fiscal year, $236,364 is appropriated from the wildlife cash fund to the department for use by the division for wildlife operations and $168,070 is appropriated from the parks and outdoor recreation cash fund to the department for use by the division for state park operations. APPROVED by Governor June 6, 2023 EFFECTIVE June 6, 2023 (Note: This summary applies to this bill as enacted.)

For health benefit plans issued or renewed on or after January 1, 2025, the act requires a health insurer or pharmacy benefit manager to include in the calculation of a covered person's contributions toward cost-sharing requirements, including any annual limitation on a covered person's out-of-pocket costs, any payments made by or on behalf of the covered person for a prescription drug if: The prescription drug does not have a generic equivalent or, for a biological product, a biosimilar drug or interchangeable biological product; or The prescription drug has a generic equivalent, a biosimilar drug, or an interchangeable biological product, but the covered person is using the brand-name drug after obtaining prior authorization, complying with a step-therapy protocol, or otherwise receiving approval from the carrier or pharmacy benefit manager if those utilization management processes are not otherwise prohibited by law. The commissioner of insurance is authorized to adopt rules necessary to implement the act. The act applies to health benefit plans issued or renewed on or after January 1, 2025. APPROVED by Governor June 5, 2023 EFFECTIVE August 7, 2023 NOTE: This act was passed without a safety clause and takes effect 90 days after sine die. (Note: This summary applies to this bill as enacted.)

Under current law, the department of human services (state department) is tasked with administering the Colorado refugee services program. Effective October 1, 2024, the act transfers the rights, powers, duties, and functions related to the administration of the Colorado refugee services program to the Colorado office of new Americans (ONA) in the department of labor and employment. However, if the federal department of health and human services does not transfer contracts with the state department that are open as of October 1, 2024, the state department will continue administering those contracts until the end of the contract period or when all funds are liquidated, whichever occurs first. Additionally, the act: Adjusts the timeline under the immigration legal assistance fund for awarding grants and reporting to the general assembly; and Authorizes the department of revenue to share pertinent tax information with the ONA or a third-party administrator as necessary for purposes of administering the benefit recovery fund. For the 2023-24 state fiscal year, the act appropriates $36,523 from the general fund to the department of labor and employment (department) for allocation to the ONA to implement the act. Additionally, the act specifies that, for the 2023-24 state fiscal year, the department anticipates receiving $250,000 in federal funds for the ONA to implement the act. APPROVED by Governor June 1, 2023 EFFECTIVE October 1, 2024 NOTE: This act was passed without a safety clause. (Note: This summary applies to this bill as enacted.)

The act requires a carrier that offers a health benefit plan (carrier) or a pharmacy benefit management firm that administers or manages contraception coverage under a health benefit plan (PBM) to provide coverage for, and reimburse a prescribing provider or in-network dispensing entity for, the single dispensing or furnishing of contraception intended to last the covered person for a duration of 12 months, as permitted by the covered person's prescription, dispensed or furnished at one time, unless requested otherwise by the covered person. A carrier or PBM is subject to certain requirements, as applicable, including: Allowing coverage of continuous use of contraception, as determined by the prescribing provider; A prohibition against implementing utilization management practices that prevent the dispensing of a 12-months' duration of contraception; Allowing for alternate prescribed contraception, if medically necessary; and Providing coverage for over-the-counter contraception without a prescription and without prior authorization, step therapy, utilization management, or cost sharing. The act requires carriers to report annually to the division of insurance in the department of regulatory agencies concerning contraception coverage and requires PBM's to provide information to carriers for purposes of this reporting. The act authorizes the commissioner of insurance to promulgate rules regarding the coverage. APPROVED by Governor May 30, 2023 EFFECTIVE August 7, 2023 NOTE: This act was passed without a safety clause and takes effect 90 days after sine die. (Note: This summary applies to this bill as enacted.)

Sections 1 and 4 of the act clarify that money that was transferred from the general fund or the affordable housing and home ownership cash fund to the Colorado heritage communities fund on June 27, 2021, or as soon as was practicable thereafter, must be expended before July 1, 2025. Section 2 clarifies that money that was transferred from the general fund to the housing development grant fund on June 27, 2021, must be expended before July 1, 2025. Section 3 clarifies that the division of housing may award multiple grants to multiple grant recipients for multiple regional navigation campuses in the Denver metropolitan area to respond to and prevent homelessness. APPROVED by Governor May 17, 2023 EFFECTIVE May 17, 2023 (Note: This summary applies to this bill as enacted.)

The health equity commission created in the office of health equity in the department of public health and environment is scheduled to repeal on September 1, 2023. Pursuant to the recommendation in the department of regulatory agencies' sunset review and report, the act extends the repeal date of the health equity commission to September 1, 2029. APPROVED by Governor May 16, 2023 EFFECTIVE August 7, 2023 (Note: This summary applies to this bill as enacted.)

The act makes changes to the "Colorado Standardized Health Benefit Plan Act" to require the Colorado health benefit exchange (exchange), in collaboration with the commissioner of insurance (commissioner), and after a stakeholder engagement process with consumers, producers, and insurance carriers (carriers), to develop a format for displaying the standardized health benefit plans (standardized plans) on the exchange. The act requires carriers to file with the commissioner insurance rates for the standardized plans that comply with the premium rates specified in law for the standardized plans. The act allows the commissioner to establish uniform limits on carriers' administrative costs and profits for standardized plans. Under the act, if a carrier is unable to offer the standardized plan at the required premium rates: The carrier must provide relevant information concerning the steps the carrier will take to meet the requirements, along with supporting documentation; and The division of insurance may hold a public hearing, pursuant to notice by the commissioner and in a manner specified by rules promulgated by the commissioner, prior to the approval of the carrier's final rates. APPROVED by Governor May 10, 2023 EFFECTIVE May 10, 2023 (Note: This summary applies to this bill as enacted.)

Under current law, pharmacy benefit managers (PBMs) are required to perform certain acts and are prohibited from engaging in certain acts. Specifically, PBMs are prohibited from: Requiring patients to obtain their prescription drugs through mail order; Charging pharmacies fees to adjudicate claims; Requiring pharmacies to obtain accreditations or certifications that are different than what the PBM requires of its affiliated pharmacies; Retroactively reducing a payment made to a pharmacy on a drug claim after the point of sale or reimbursing a pharmacy in an amount that is less than the amount reimbursed to its own affiliated pharmacy for the same pharmacy service; Modifying the prescription drug formulary under a health benefit plan during the plan year; With regard to audits, using specified techniques in calculating a recoupment or penalty, subjecting a pharmacy to recoupment when a clerical error is discovered, and requiring pharmacies to be audited more than once a year; Prohibiting a pharmacy or pharmacist from, or penalizing a pharmacy or pharmacist for, providing information to patients about more affordable, therapeutically equivalent alternatives to a prescribed drug; or Requiring a pharmacy or pharmacist to charge or collect a copayment from an insured patient that exceeds the total charge submitted by the pharmacy for the prescription drug. Additionally, PBMs are required to: Provide pharmacies 7 days' written notice before an audit, conduct an audit by or in consultation with a pharmacist, allow the pharmacy to supplement claims documentation, and establish an appeals process; Provide an insured individual, the insured's health-care provider, or a third party acting on behalf of the insured or provider with up-to-date and real-time cost, benefit, and coverage information under the terms of the insured's health benefit plan; and Provide contracted pharmacies with the list of sources the PBM used in determining maximum allowable cost pricing, update the information every 7 days, allow pharmacies the ability to readily review the information, follow specified requirements when placing a drug on the maximum allowable cost list, and establish an appeals process to resolve disputes. The act specifies that the commissioner of insurance (commissioner) has the power to enforce these prohibitions and requirements and impose penalties on PBMs for failing to comply with these prohibitions and requirements. The commissioner is also authorized to adopt rules as necessary to implement and enforce these prohibitions and requirements. Additionally, the act requires PBMs to register with and pay a registration fee to the commissioner and authorizes the commissioner to deny, suspend, revoke, or refuse to issue, continue, or renew a PBM registration or to issue a cease-and-desist order if the commissioner finds that a PBM has engaged in specified activities, including violating an insurance law. The PBM registration fees imposed under the act are to be used to fund the costs of the division of insurance in enforcing requirements and prohibitions on PBMs. The act appropriates $206,647 from the division of insurance cash fund to the department of regulatory agencies for use by the division of insurance for personal services and operating expenses related to implementing the act. APPROVED by Governor May 10, 2023 EFFECTIVE August 7, 2023 NOTE: This act was passed without a safety clause and takes effect 90 days after sine die. (Note: This summary applies to this bill as enacted.)

The act requires the department of health care policy and financing (state department) review and determine if an exception to step therapy is granted if the prescribing provider submits a prior authorization request with justification and supporting clinical documentation for treatment of a serious or complex medical condition. The act requires the state department to provide a response to a prior authorization request for a step-therapy exception within 24 hours after receipt of the request. If a prior authorization request for a step-therapy exception is incomplete or if additional clinically relevant information is required, the act requires the state department to notify the prescribing provider within 24 hours after the submission of the request. If the state department does not receive a response within 72 hours after the state department's request for additional information, the prior authorization is denied. If the prior authorization request is denied, the act requires the state department to inform the recipient in writing that the recipient has a right to appeal the determination. The act requires the state department to authorize coverage for the prescription drug prescribed by the recipient's prescribing provider if the prior authorization request for a step-therapy exception request is granted. The act requires the state department to make the prior authorization requirements for coverage of prescription drugs and a description of the step-therapy exemption process available on the state department's website. The act appropriates $56,250 to the state department from the general fund. APPROVED by Governor May 1, 2023 EFFECTIVE May 1, 2023 (Note: This summary applies to this bill as enacted.)