State Legislation

This bill clarifies that insurance companies cannot restrict or deny coverage of telehealth services based on the communication technology or application used to deliver the telehealth services, thereby improving low-cost access to health care for people in rural parts of the state.

This bill prohibits a health plan from managing the size of their network by removing their ability to choose which providers can be on the network.

This bill requires that any insurance carrier that provides services to the state must also participate in the individual market, in Medicaid or the children’s basic health plan and offer individual market plans in at least two Colorado counties with the highest average premiums.

This bill creates the family and medical leave insurance (FAMLI) program in the newly created Division of Family and Medical Leave Insurance in the Department of Labor and Employment. The division would provide partial wage replacement benefits to eligible individuals who take leave from work to care for a new child or a family member with a serious health condition or who are unable to work due to their own serious health condition. The bill expands employer coverage to employers with one or more employee as compared to the 50-employee threshold under the FMLA.

This bill requires drug manufacturers and pharmacy benefit managers to report information regarding diabetes drug prices and related profits. The information from the report is to be posted on the Colorado Department of Public Health and Environment’s website.

This bill prohibits a health plan from controlling costs by choosing which pharmacies to include in its networks.

This bill requires the Colorado Department of Health Care Policy and Financing and the Colorado Health Care Affordability and Sustainability Enterprise Board to develop and prepare an annual report detailing uncompensated hospital costs and expenses, using publicly available data whenever possible. Psychiatric hospitals, long-term care facilities and certain critical access hospitals are exempted.

This bill creates a new license, referred to as a “freestanding emergency department license,” for a health facility that offers emergency care and is located more than 250 yards from a hospital, whether or not it’s affiliated with the hospital. Community clinics are exempted.

This bill creates various income tax credits for employers and employees in an effort to incent businesses to offer family and medical leave benefits to their workers. An employer and employee receive a state income tax deduction for any amount up to $5,000 they contribute to an employee’s leave savings account. An employer also receives an income tax credit if they pay an employee for leave that is between six and 12 weeks for a family or medical leave. For employers with fewer than 50 employees the credit is equal to 50 percent of the amount paid, and for employers with 50 or more employees the credit is equal to 25 percent of the amount paid.

This bill prohibits a health plan from controlling costs by choosing which pharmacies to include in its networks.

This bill requires certain disclosures to patients regarding out-of-network services provided at in-network and out-of-network facilities. It sets the reimbursement amounts for emergency services at out-of-network emergency facilities. In these cases, carriers must reimburse the out-of-network facility the greater of:
• 105 percent of the carrier’s median in-network rate provided in a similar facility or in the same geographic area, or
• The median in-network rate provided in a similar facility or in the same geographic area, as determined by payments reported to the All-Payer Claims Database.
It also sets the reimbursement amounts for other services provided by out-of-network providers working in in-network facilities. In these cases, carriers must reimburse the out-of-network facility the greater of:
• 110 percent of the carrier’s median in-network rate provided in a similar facility or in the same geographic area, or
• The sixtieth percentile of the median in-network rate provided in a similar facility or in the same geographic area, as determined by payments reported to the All-Payer Claims Database.

This bill creates the Colorado Prescription Drug Cost Reduction Act of 2019, requiring health insurers, prescription drug manufacturers, pharmacy benefit management firms and nonprofit organizations to report specified information about the costs of prescription drugs to the commissioner of insurance, including:
• Rebates received by carriers from manufacturers and their effects on premium prices
• Price increases by manufacturers that meet a certain threshold 30 days in advance
• Income and donations from manufacturers, PBMs or carriers by nonprofits
The bill then directs the commissioner to analyze the information and submit a report regarding the effects of prescription drug costs on health insurance premiums. It also requires carriers to pass rebates received from pharmaceutical companies or pharmacy benefit management firms on to consumers.

This bill enacts the Colorado Prescription Drug Price Transparency Act of 2020 that requires insurers, drug manufacturers and pharmacy benefit managers to submit relevant information to the Colorado Insurance Commissioner that will be posted to the Division of Insurance’s website.

This bill directs the Division of Insurance (DOI) to develop and implement an insurance plan for the state in the individual and small group market, known as the “Colorado Option,” led by the Commissioner of Insurance. The Colorado Option plans would require that private health insurers administer the plans and hospitals participate, while the Commissioner of Insurance sets reimbursement rates and terms. The bill gives the Commissioner of Insurance the power to expand the Colorado Option plan to the small group market, establish a hospital reimbursement rate formula, and force carriers to offer the Colorado Option plan in specific counties. A hospital that does not participate in the Colorado Option could be fined up to $40,000 per day and have their license suspended or revoked.

This bill prohibits a business from implementing disciplinary actions based on an employee’s immunization status and creates a private right of action against businesses that choose to utilize vaccine requirements with their workforce.

This bill requires health care facilities to screen uninsured patients for eligibility for public health insurance programs, the Colorado Indigent Care Program (CICP) and other discounted care. If a facility determines that a patient is ineligible for discounted care, the facility must notify the patient and provide an opportunity for the patient to appeal. Facilities and licensed professionals who provide eligible patients with emergency and other non-CICP services must limit their charges to no more than 80% of the Medicare rate, collect payments in monthly installments that equal no more than 5% of a patient’s household income, and consider the patient’s bill paid in full after 36 months of payments. Providers also must meet certain requirements before assigning or selling patient debt to a medical creditor or pursuing collections. HCPF will be required to collect reports on compliance and patient demographic data from facilities and fine facilities that the department determines to be knowingly or willfully not complying with the law.

The bill authorizes the Commissioner of Insurance to design a standardized health benefit plan to be offered by health insurance carriers. It also sets target individual market premium reductions for insurance carriers of 20% over a two-year period and establishes that if they fail to meet those premium reductions, a public health insurance option would be authorized in Colorado. The public option would be designed by an elected board.

This bill requires the department of personnel to contract with a pharmacy benefit manager (PBM) and acquire the technology to support PBM reverse auction for group benefit plans. The newly acquired technology would be required to audit PBM prescription drug claims to monitor the effectiveness of the PBM and to perform market checks of prescription drug pricing competitiveness.

This bill will create a grant program for small businesses that have experienced economic hardship because of the COVID-19 pandemic. Funding originally came from the federal Coronavirus Aid, Relief and Economic Security (CARES) Act, but not all businesses were able to secure funding by the deadline of Dec. 30, 2020. This bill allocates $15 million from the state general fund to continue the program and modifies grant criteria.

This bill establishes a price cap of $100 for an individual's 30-day supply of prescription insulin and a cap of $35 for an emergency prescription supply. It also creates the insulin affordability program in the division of insurance through which an eligible individual may obtain prescription insulin at a price cap of $50 for a 30-day supply.

This bill prohibits an employer from taking adverse action against an employee or an applicant based on the employee’s or applicant’s COVID-19 immunization status. It allows an aggrieved employee or applicant to file a civil action lawsuit if the employer acted with malice or has repeatedly violated the law. The bill also specifies that the state cannot require any individual to obtain a COVID-19 vaccine, and a person cannot be discriminated against for their vaccination status.

This bill extends the current law requiring injured employees to notify their employer within four days after occurrence to 14 days and repeals the current tolling and compensation reduction provisions. The bill amends the notice of requiring an employer to post in the workplace to requiring the notice to state the name and contact information of the insurer.

This bill requires an employer or a state agency that imposes a COVID-19 vaccine or testing requirement to allow a person subject to the requirement to instead provide documentation demonstrating that the person has naturally acquired immunity to the disease.

This bill requires that health care facilities such as hospitals, nursing care facilities and assisted living residences permit patients and residents in the facility to receive visitors to the fullest extent permitted under applicable state laws or local ordinances. If circumstances require the complete closure of a facility to visitors, the facility is required to use its best efforts to develop alternate visitation protocols that would allow visitation to the greatest extent and as safely as possible.

This bill allows individuals who are required to receive an immunization to claim an exemption from the requirement if the immunization has not been approved by the federal Food and Drug Administration (FDA), has only received emergency use authorization, the manufacturer is not liable for injury or death caused by the immunization, or pivotal clinical trial the FDA relied on for approval did not evaluate the immunization’s safety for at least one year after it was first administered. The bill also requires the Department of Public Health and Environment to post on its website the criteria for immunization exemption and any diseases, risks or injuries caused by the immunization.

This bill prohibits hospitals from collecting debts accrued by patients during periods when the hospital was not in compliance with federal hospital price transparency laws. The bill does not prevent hospitals from billing a patient or health insurer for services rendered or requires hospitals to refund payments to patients. Any hospital that pursues debt collection against a patient is subject to be penalized up to the amount of the debt plus attorney fees and costs. The bill also makes debt collection against patients during times of non-compliance an unfair practice under the Colorado Fair Debt Collections Act and allows the department of public health and environment to consider this during license renewal.

The bill requires the Division of Insurance in the Department of Regulatory Agencies to create, implement, and evaluate standards around the use of valued-based payments in the health insurance system.

This bill requires every hospital to establish a nurse staffing committee by September 1, 2022. The committee is required to implement a nurse staffing plan and to track feedback and complaints from nurses and other staff. The bill requires hospitals to submit their plan to the department of public health and environment yearly, post the plan on their website and evaluate the plan quarterly. The bill prevents hospitals from staffing a unit unless the providers are properly trained in that assignment. Each hospital must report the baseline number of beds able to be staffed and its current bed capacity. If the staffed-bed capacity falls below 80%, the hospital is required to notify CDPHE and submit a plan to meet the requirement. The bill levies fines on hospitals who do not fulfill the requirements of staff-bed capacity, have a lack of vaccine availability onsite, and fail to include necessary testing capabilities at their sites.

This bill requires the state department of human services to conduct a feasibility study to determine if creating a system to support people with serious mental illness through a collaboration between Colorado’s behavioral health and judicial systems is feasible. The bill also requires the state to create an application process for selecting the independent third party, and to submit a report detailing the findings and recommendations by Dec. 31, 2023.

This bill creates an employer tax credit for employers who make a monetary contribution to their employees for assistance in purchasing a home. The amount of the credit is 5% of an employer’s contribution to an employee, but the credit is capped at $5,000 per employee. The employee must use the fund for a down payment, closing costs or fees. An employee may authorize the employer to withhold earnings as a contribution to the fund. If an employee terminates their employment, they forfeit any unexpended amount of the employer contribution, and the credit is subject to recapture. In this case, the employee is entitled to the employee contribution plus any interest earned.

This bill requires the amount of a prescription charged by the Pharmacy Benefit Manager (PBM) or carrier be equal to or less than the amount paid by the PBM or carrier to the contracted pharmacy. This bill also creates transparency requirements for PBMs and carriers regarding prescription drug benefits and grants the Department of Healthcare Policy and Financing the authority to audit.

This bill requires the Colorado School of Public Health to study legislation creating a publicly-funded and privately-delivered universal health care model. This bill also creates the statewide health care analysis task force consisting of appointed members and the Governor, as well as executive directors of state departments, the commissioner of insurance, and the CEO of the Colorado health benefit exchange.

This bill prohibits healthcare providers affiliated with a hospital from charging a facility fee for: outpatient services provided at an off-campus location or through telehealth or services identified by the medical services board that must be provided safely, reliably, and effectively in nonhospital settings. The bill also requires the provider to give notice of the fee to patients, prepare an annual report on facility fees, and makes it a deceptive trade practice to charge, bill or collect a facility fee when prohibited.

This bill makes changes to the “Colorado Standardized Health Benefit Plan Act” to: require the health benefit exchange to develop a format for displaying standardized health benefit plans on its website; grant the commissioner 120 days to analyze the rate filings as opposed to the current 60 days; require a carrier to submit a plan to the commissioner on how it will meet rate requirements if it does not offer a standardized plan; and specify that the commissioner’s decisions are final agency actions subject to judicial review.

This bill modifies certain functions of the Prescription Drug Affordability Board. Some of these changes include: specifying that only board members, and not employees, are required to recuse themselves during a vote if they have a conflict of interest; allowing the board chair to cancel a meeting if there is good cause; making certain changes to the procedure by which the board identifies prescription drugs that may be subjected to an affordability review; removing the prohibition of the board to set an upper limit on prescription drug prices; and establishing that it is an “adverse determination” if a patient is denied a prescription drug benefit because the manufacturer has withdrawn that drug from sale in the state.

This bill repeals the Colorado Health Benefit Exchange Act, effective Jan. 1, 2018, and allows the exchange to continue for one year for the purpose of winding up its affairs.

This bill repeals the Hospital Provider Fee and enacts the Colorado health care affordability and sustainability enterprise as a state business outside of the revenues used for evaluating TABOR (Taxpayer’s Bill of Rights) and Referendum C cap levels. The enterprise would charge and collect a new Hospital Provider Fee and would implement and administer the state Hospital Provider Fee program.

This bills requires health insurers to disclose the standards they use to construct and market their provider networks. It also requires carriers to outline a process by which providers may seek reconsideration if a carrier decides to make changes to, terminate or deny participation in its provider network.

This bill imposes new mandates on how insurers should make decisions pertaining to authorizing providers, health care services and coverage, particularly removing the requirement that the insured receive a referral before seeing a specialist.

This bill requires freestanding emergency departments (FSEDs) to disclose information to potential patients regarding the type of facility in which they’re seeking care as well as costs and coverage associated with care.

This bill requires the Department of Public Health and Environment to create and administer a statewide electronic system that allows qualified individuals to upload and access advance medical directives.

This bill sets the reimbursement amounts out-of-network provides can charge in-network facilities for emergency services. In these cases, carriers must reimburse the out-of-network facility the greater of the following:
• The carrier’s average in-network rate
• 125 percent of Medicare
• The average in-network rate as determined by payments reported to the All Claims Payer Database.
It also sets the reimbursement amounts out-of-network providers can charge in-network facilities for non-emergency services. In these cases, carriers must reimburse the out-of-network facility the greater of:
• The average allowed amount for in- and out-of-network rates multiplied by 150 percent for urban providers and
• The average allowed amount for in- and out-of-network rates multiplied by 200 percent for rural providers.
The bill also authorizes arbitration for payment of claims that are in dispute if certain criteria are met.

This bill creates a mandatory Family and Medical Leave Insurance (FAMLI) program, providing partial wage replacement to eligible individuals who take leave from work to care for a new child or a family member with a serious medical condition, because of a serious medical condition of their own or due to certain needs arising from a family member’s active duty service. It requires a 60-40 split between employees and employers, respectively, to cover the cost of the premium. Premiums are based on a percentage of the employee’s yearly wages.

A health care lien is a demand for repayment that may be claimed against a personal injury case for medical care related to that case. This bill creates a regulatory framework for health care lien companies and increases access to financing for personal injury claims.

This bill implements the recommendations of the Department of Regulatory Agencies’ sunset review on the professional review committee and extends the committee, currently set to sunset in September 2019, for 11 years. Professional Review Committees review and evaluate the competence, professional conduct or the quality and appropriateness of patient care of a physician, physician assistant or advanced practice nurse and ensure that care can be analyzed at the patient and provider level.

This bill sets a minimum wage for certain home care workers by requiring that at least 77 percent of the reimbursement that a home-care agency receives from Medicare or Medicaid for certain services be passed on to their non-administrative employees that provide those services. Additionally, it directs the Department of Health Care Policy and Financing (HCPF) to seek an 8.1 percent increase from the federal government for these service categories, with the entire amount being applied to the employee compensation. Each agency is also required to make certain disclosures to HCPF, which will then be added to a publicly available website.

This bill prohibits discriminatory employment practices based on employee’s immunization status, including health facilities.

This bill creates a committee in the division of insurance to review introduced bills that impose new requirements or amend existing requirements of health benefit plans. Among other things, the committee must analyze the number of Colorado residents directly impacted by the bill, estimates in changes to consumer cost sharing, the financial impact on group benefit plans offered under the State Employees Group Benefits Act and the financial impact on business employers.

This bill requires that all employers provide paid sick leave to their employees starting Jan. 1, 2021, accruing one hour for every 30 hours worked, up to a maximum of 48 hours. Sick leave may be used for mental or physical illness, the care of a family member, domestic abuse or school closures due to a public health emergency. OPPOSE UNLESS AMENDED

This bill creates an enterprise to assess a fee on health insurance carriers and hospitals in order to fund the state’s reinsurance program. In addition to paying for the reinsurance program, the funds would be used for expanded services and programs not included in the initial reinsurance program.

Current law allows a parent or guardian the right to sue for damages of a minor. This bill would permit minors to also bring a claim to recover damages and it expands the statute of limitations for civil claims.

The bill requires the Colorado Division of Insurance (DOI) to retain a contractor on or before Nov. 1, 2021, to perform actuarial reviews of proposed legislation that may impose a new health benefit mandate on health benefit plans. Fiscal notes for any legislative proposal that may impose a new health benefit mandate on health benefit plans shall either note premium impact information that is produced by the contractor during their review or indicate that no information was produced by the contractor during their review.

The bill creates the Colorado prescription drug affordability review board and requires the board to perform affordability reviews of prescription drugs and establish price caps for prescription drugs that the board determines are unaffordable for Colorado consumers.

This bill requires the Colorado Division of Insurance to retain a contractor on or before Nov. 1, to perform actuarial reviews of proposed legislation that may impose a new health benefit mandate on health benefit plans. Fiscal notes for any legislative proposal that may impose a mandate shall note premium impact information that is produced by the contractor during their review or indicate that no information was produced.

This bill requires hospitals and nursing care facilities to allow patients receiving inpatient care to have at least one visitor of the patient’s choosing. It also restricts health care facilities from creating policies or procedures that prohibit visitors for the sole reason of reducing the risk of pandemic disease transmission, but facilities can impose specified restrictions and limitations for visitors to reduce the risk of transmission. Health care facilities must provide written policies and procedures that list and give reasons for restrictions and limitations.

This bill protects whistleblowers who raise a reasonable concern related to public health and safety, expanding existing whistleblower protections outside of declared public health emergencies. This extends temporary whistleblower protections related to public health and safety granted during a declared public health emergency to all times, regardless of whether an emergency is declared. 

This bill implements protective measures for both pollinators and individuals by restricting the use of pesticides on school grounds, childcare facilities and children’s camps. If pesticides are being used at any of these locations, a notice must be sent to individuals in these locations. This bill also requires the executive director of natural resources to conduct a study to best address the pollinator decline and increase pollinator health in Colorado while also creating a pilot program under the Department of Agriculture to fund research and production of noncoated insecticide on crops.

This bill establishes three new law enforcement grant programs within the Division of Criminal Justice in the Department of Public Safety to be used for crime prevention, law enforcement recruitment and law enforcement training.

This bill creates the transformational affordable housing revolving loan fund program, which provides flexible, low-interest, below-market rate loans to eligible recipients to encourage affordable housing development.

This bill makes several appropriations from the economic recovery and relief cash fund to bolster the healthcare workforce, including: $2 million to establish the health-care resilience and retention program; $20 million to establish the practice-based health education grant program, which would increase training opportunities for health profession students; $26 million to assist community colleges and occupational boards to administer credentialling programs for rapidly expanding the short-term supply of in-demand professionals; $3 million to expand of the school nurse grant program; and $10 million to recruit and re-engage health care professionals with current or expired licenses. It also directs the Primary Care Office and the Governor’s Office of Information Technology to establish a data-sharing agreement to analyze the need and allocation of state-administered or state-financed workforce initiatives in healthcare, removes a limitation on payment for volunteer nurses, and requires the nurse-physician advisory task force to make a series of workforce recommendations.

This bill requires hospitals to create a public list of all standard charges for all hospital items and services provided to patients. It also requires hospitals to make a public list of at least 300 shoppable services and report the lists to the Department of Health Care Policy and Financing. This bill also requires the department to monitor hospital compliance and issue a written notice if found in violation.