Bill Tracker

The bill directs the department of public health and environment to create an electronic death registration system for purposes of allowing persons responsible for reporting death information to the office of the state registrar of vital statistics to do so electronically.

The bill requires the director of the division of registrations in the department of regulatory agencies (director) to implement a system to collect health care work force data from health care professionals who are eligible for the Colorado health service corps, from practical and professional nurses, and from pharmacists. The bill requires a voluntary advisory group designated by the director of the primary care office to recommend the structure of the data elements to be collected regarding specific information about each health care professional and his or her practice. The director is authorized to accept and expend any gifts, grants, or donations that may be available from any private or public sources for the implementation of the data collection system.

Currently, the department of public health and environment is required to name, approve, and provide, free of charge, a prophylaxis to be used in treating the eyes of newly born infants. The bill deletes these requirements and requires the health care provider in charge of the birth to treat an infant with a prophylaxis that is in accordance with the current medical standard of care. The bill also deletes the penalty provision for a health care provider who violates the statutes relating to infant eye prophylaxis.

Pursuant to legislation in 2009, the standards for advanced practice nurses (APNs) to obtain prescriptive authority were modified to require APNs, in addition to obtaining specified levels of education and experience, to develop an articulated plan for safe prescribing that documents how the APN will collaborate with physicians and other health care professionals in his or her practice of prescribing medications. Under the 2009 legislation, APNs who were granted prescriptive authority prior to July 1, 2010, were permitted to retain that authority but were required to develop an articulated plan of safe prescribing within one year, or by July 1, 2011.

The bill allows the state board of nursing, on a case-by-case basis, to extend the deadline by which APNs with prescriptive authority granted before July 1, 2010, are required to develop an articulated plan, but in no case is the board allowed to extend the deadline beyond July 1, 2012. An APN seeking a deadline extension must submit to the board, prior to July 1, 2012, an application and fee and an attestation that he or she has developed an articulated plan. The board is to adopt rules establishing the criteria for granting a deadline extension. A decision of the board regarding a deadline extension request is not appealable.

The bill makes the results of any information related to substance use obtained as part of a screening or test performed for the purpose of determining pregnancy or providing prenatal care inadmissible in any criminal proceeding.

The Colorado department of public health and environment (department) is designated in statute as the coordinator for suicide prevention programs throughout the state. The bill adds as a duty of the department, in its coordinator role, that the department require all hospitals that it licenses or certifies to educate parents, relatives, or friends to whom a minor who attempts suicide or displays suicidal gestures will be released from the hospital regarding the warning signs of suicide and suicide prevention.

Joint Budget Committee. Effective January 1, 2012, persons were prohibited from receiving both home care allowance benefits and benefits under a home- and community-based waiver. The bill establishes a new grant program (program) in the department of human services (department) to provide to certain individuals with developmental disabilities receiving benefits under either the home- and community-based supported living services or the children's extensive support waiver a home care allowance benefit consistent with benefits received by persons under the home care allowance program. It authorizes the state board of human services to adopt rules to implement the program.

The bill directs the department to submit a written report to certain committees of the general assembly on the program and to solicit feedback from individuals receiving grants under the program and from their families.

The program is repealed, effective July 1, 2017, unless extended by the general assembly.

Joint Budget Committee. For fiscal year 2011-12 or any subsequent fiscal year, the bill authorizes the general assembly to appropriate moneys from the tobacco education programs fund to the department of health care policy and financing in order to allow the department to obtain federal matching funds for the Colorado quitline program.

Joint Budget Committee. In the 2011 legislative session, the statutes authorizing expenditures from the primary care fund for comprehensive primary care services were erroneously repealed. This bill recreates and reenacts those repealed statutes, which will reauthorize the department of health care policy and financing to expend funds from the primary care fund for the purpose of providing grants to providers who provide comprehensive primary care and who are either a community health center or who serve a large percentage of people who are uninsured or medically indigent patients, patients receiving medicaid, or patients enrolled in the children's basic health plan.

The bill defines terms used in the recreated statutes, including "comprehensive primary care", which means the basic, entry-level health care provided by health practitioners or non-physician health care practitioners that is generally provided in an outpatient setting.

The bill allows a Colorado community college to offer a two-year degree program with academic designation in nursing or dental hygiene without a valid student transfer agreement.

Joint Budget Committee. Current law requires over 90% of the allocations of tobacco litigation settlement moneys (settlement moneys) for tobacco programs to be made through payments of settlement moneys received in the same fiscal year in which they are allocated (accelerated payments). Because the state receives settlement moneys in the last quarter of each fiscal year, it uses general fund moneys as working capital to operate tobacco programs until it receives each year's settlement moneys. This de facto loan of general fund moneys creates a risk of loss to the general fund if the settlement moneys received in any given fiscal year are substantially lower than anticipated, which might occur if, for example, the state lost an ongoing legal dispute with tobacco manufacturers.

To reduce the risk of loss to the general fund, the bill annually reduces the amount of accelerated payments. The bill offsets the reduction by repealing the short-term innovative health program grant fund, which currently receives 6% of Tier 2 settlement program allocations, and requiring the additional tobacco litigation settlement cash fund moneys made available by the elimination of the grant fund to be used to supplement annual allocations of settlement moneys.

Joint Budget Committee. Current law requires the general assembly to annually appropriate 0.1% of the tobacco litigation settlement moneys received by the state (settlement moneys) to the office of the state auditor for the costs of conducting program reviews and evaluations of the performance of tobacco settlement programs. The funding comes out of and proportionally reduces the amount of settlement moneys received by all tier 1 tobacco settlement programs reviewed and evaluated during a fiscal year.

Beginning with the 2012-13 fiscal year, the bill replaces the 0.1% appropriation with an annual allocation to the state auditor's office of $89,000 of settlement moneys. The new funding comes out of and reduces by $89,000 the amount of settlement moneys annually received by the short-term innovative health program grant fund.

The bill directs the department of health care policy and financing (state department) to facilitate collaboration among medicaid providers, clients, advocates, and payors that is designed to improve health outcomes and patient satisfaction and support the financial sustainability of the medicaid program. The executive director of the state department may promulgate rules relating to the collaborative process.

The bill creates the medicaid payment reform and innovation pilot program (pilot program) in the state department for the purpose of implementing payment reform projects in medicaid within the framework of the accountable care collaborative. Regional care collaborative organizations (RCCOs) may submit payment proposals to the state department for the pilot program. A RCCO shall work with providers and managed care entities in the RCCO to develop the payment project.

Payment projects may include but are not limited to global payments, risk adjustment, risk sharing, and aligned payment incentives. The state department shall select payment projects for inclusion in the pilot program based upon certain criteria and shall give preference to those payment projects that propose global payments. The state department shall respond to RCCOs concerning payment projects that are not selected for the pilot program, stating the reason why the payment projects were not selected and shall copy the response to certain committees of the general assembly. Payment projects shall be implemented for 2 to 5 years, and certain provisions apply to payments under the pilot program. The state department shall seek any federal authorization necessary to implement the pilot program. The state department shall report to certain committees of the general assembly concerning the design, implementation, and outcome of the pilot program.

The bill requires the state department to report concerning the state department's recommendations for streamlining and simplifying the administrative structure for managing contracts relating to medicaid managed care.

Under current law, the department of public health and environment (CDPHE) licenses and establishes, and enforces standards for the operation of, health facilities in the state, including rehabilitation centers, community mental health centers, acute treatment units, facilities for persons with developmental disabilities, nursing care facilities, hospice care, assisted living residences, and home care agencies. CDPHE conducts periodic, announced and unannounced inspections of licensed facilities to ensure compliance with the standards it develops. The state board of health (board) is required to establish by rule a schedule of fees to be assessed against health facilities that is sufficient to meet CDPHE's direct and indirect costs in regulating health facilities.

Additionally, under current law, both CDPHE and the department of human services (DHS) jointly regulate community residential homes for persons with developmental disabilities.

Section 1 of the bill declares that the legislative intent of the bill is to eliminate duplication and unnecessary government oversight in the regulation of health facilities in Colorado.

Sections 2, 3, 4, and 12 eliminate CDPHE's authority to license and develop standards for the operation of community residential homes, shifting oversight of these homes solely to DHS. Additionally, if home care agency personal care services, which are otherwise regulated by CDPHE, are provided by a service agency that delivers services and supports to persons with developmental disabilities, DHS is tasked with inspecting those services in conjunction and simultaneously with its inspection of the community residential home. DHS is directed to institute an abbreviated, periodic inspection system for community residential homes and a performance incentive system to reduce license renewal fees for community residential homes for which no significant deficiencies that negatively affect the life, health, and safety of their consumers have been found by DHS.

Sections 2, 3, and 4 also:

• Require CDPHE to develop an abbreviated, periodicinspection system, which it must use for health facilities that have been licensed for at least 3 years and have not been subject to any enforcement activity or substantiated complaints resulting in the discovery of significant deficiencies that negatively affect the life, health, or safety of consumers of the facilities within the prior 3 years;
• Restrict the ability of CDPHE, when considering a licenseapplication or a request to approve new construction or remodel of a health facility, to impose standards for construction that are more stringent than, or do not comply with, applicable national, state, and local building and fire codes;
• With regard to the dual responsibilities of CDPHE andDHS over community mental health centers and acute treatment units, require the departments to consider changes in health care policy and practice that incorporate integrated health care services; 
• Limit CDPHE's licensure authority over community clinics to those community clinics that: Provide health care services on an ambulatory basis; are not licensed as an on-campus department or service of a hospital or listed as an off-campus location under a hospital's license; and either operate inpatient beds or provide emergency services at the facility. CDPHE retains authority to license prison clinics regulated by the department of corrections.
• Require CDPHE to determine an applicant's fitness to conduct and maintain a health facility based solely on specific fitness information or documentation submitted by the applicant or obtained by CDPHE through its own review or investigation of the applicant; and
• Eliminate the ability of CDPHE to conduct a fitness review of a new owner of a facility unless the transfer of ownership results in a transfer of at least 50% of direct or indirect ownership interest in the facility or business to one or more new owners.

 Under sections 5 and 12, a licensed health facility, program of all-inclusive care for the elderly (PACE) provider, or community residential home that applies to renew its license may submit evidence of its accreditation by a nationally recognized accrediting body or regulation pursuant to a 3-way agreement between the PACE provider, the centers for medicare and medicaid services (CMS), and the department of health care policy and financing (HCPF), as applicable, in which case CDPHE or, for purposes of community residential homes, DHS is to deem that accreditation, regulation, or certification as satisfaction of the state licensing requirements. CDPHE or DHS, as applicable, is permitted to request additional information from a facility if the state's standards for licensure of that type of facility are more stringent than the applicable standards for accreditation, regulation, or certification.

Sections 6 and 7 prohibit the board from increasing provisional or full license fees above the levels set in rules as of the effective date of the sections. The board retains the ability to lower the fee amounts. Section 7 further requires CDPHE to develop a performance incentive system to provide a reduction in license renewal fees for health facilities that have no significant deficiencies that negatively affect the life, health, or safety of consumers of the facility.

Section 8 establishes the health care industry facility advisory council (advisory council) in CDPHE to advise the department and the board on matters related to state licensure of health care facilities. The purpose of the advisory council is to:

• Advise CDPHE and the board on proposed standards for the operation of licensed health care facilities;
• Review and make recommendations to CDPHE and the board on proposed new or amended rules regarding health care facility licensure;
• Review and make recommendations to CDPHE and the board regarding modifications to licensing fees;
• Review and make recommendations concerning CDPHE guidelines, policies, and procedures for licensure; and
• Seek advice and counsel from outside experts when it deems necessary.

CDPHE and the board are required to accept and take the advisory council's recommendations into consideration before taking action on any of the matters on which the advisory council submits recommendations. Under section 9, the advisory council is subject to sunset review by the department of regulatory agencies and repeal on September 1, 2022, unless continued by the general assembly.

Section 10 clarifies that home care placement agencies are not licensed or certified by CDPHE and prohibits home care placement agencies from making such a claim. Noncompliance with this prohibition subjects a home care placement agency to a civil penalty imposed by CDPHE.

For purposes of board rules pertaining to the regulation of home care agencies,  section 11 requires the board to establish different requirements that are appropriate based on the type of facility or provider delivering the services to the home care consumer and prohibits the board from requiring PACE providers to submit information that is redundant or inconsistent with the federal requirements the PACE provider is subject to pursuant to its 3-way agreement with CMS and HCPF.

Section 13 prohibits an appropriation of state funds to implement the bill.

Sunset Process - House Judiciary Committee. The bill implements the recommendations made by the department of regulatory agencies (DORA) pursuant to DORA's 2011 sunset review report of professional review committees and the committee on anticompetitive conduct.

Sections 1 and 2 of the bill continue the functions of professional review committees for 7 years, until 2019.

Sections 3 to 7 of the bill authorize professional review of physician assistants and advanced practice nurses.

Section 6 of the bill also specifies that the sharing of professional review records and information with regulators and other professional review entities does not waive the professional review privilege or violate applicable confidentiality provisions.

Section 8 of the bill requires entities that conduct professional review of physicians or physician assistants to register with the Colorado medical board and report on their activities, and directs the medical board to publish summary data in aggregated form. Section 9 of the bill requires entities that conduct professional review of the practice of advanced practice nursing to register with the nursing board and report on their activities, and directs the nursing board to publish summary date in aggregated form. If an entity fails to register and report as required, the entity and its governing board lose the qualified immunity that would otherwise apply for acts and omissions occurring during the period of noncompliance.

The bill also corrects inconsistent references to peer review and professional review and makes nonsubstantive clarifications and corrections to statutory language.

Under current law, during any 24-hour period a person may not knowingly deliver in or from a store to the same individual, and a person may not purchase from a store, more than 3.6 grams of a methamphetamine precursor drug, or a combination of 2 or more methamphetamine precursor drugs. The bill changes the 24-hour period to a period of one calendar day. The bill adds more than 9 grams of methamphetamine precursor drugs during a 30-day period to those prohibitions. A store is required to check a customer's identification before selling the methamphetamine precursor drug and keep a log of each sale.

Beginning January 1, 2013, a store before completing a precursor sale must electronically submit the required information to the national precursor log exchange if the system is available without a charge to stores for access. If the sale would result in the store or purchaser violating the quantity limits, the system will generate a stop sale alert. The person shall not complete the sale if the system generates a stop sale alert; except that the person may make the sale if he or she has a reasonable fear of imminent bodily harm if the sale is not completed. If the electronic system is unavailable, the store must keep a log until the system becomes available. There is an exception for stores that make fewer than 10 transactions during a 7-day period. The Colorado bureau of investigation will receive weekly reports from the national precursor log exchange and can allow Colorado law enforcement agencies to access the exchange. The provisions preempt any local ordinances.

The Colorado constitution specifies that the award under the old age pension program shall be $100 per month and authorizes the state board of human services (state board) to adjust the award to more than $100 per month if living costs have changed. The state board has adopted rules that set the monthly standard assistance at $699. The bill encourages the state board to raise the monthly standard assistance for the old age pension to $725.

There is currently in statute a program for dental care for persons eligible for the old age pension, but moneys have not been appropriated to pay for the program. The bill expands the program to cover persons 60 years of age or older with a family income that does not exceed 135% of the federal poverty level. The bill appropriates money for the program.

A person and one or two other persons acting in concert with the person are immune from arrest and criminal prosecution for any of the following offenses if the offense arises from the same criminal episode or course of events from which an emergency drug or alcohol overdose event (event) arose; the person reports the event in good faith to a law enforcement agency or to the 911 system; the person and, if applicable, one or two other persons remain at the scene of the event until a law enforcement officer or an emergency medical responder arrives; and the person and, if applicable, one or two other persons identify themselves to, and cooperate with, the law enforcement officer or emergency medical responder:

• Unlawful possession of a controlled substance;
• Unlawful use of a controlled substance;
• Unlawful distribution, manufacturing, dispensing, or saleof a controlled substance if the offense is based upon the transfer of a controlled substance from the person to another person for no remuneration;
• Unlawful possession of 12 ounces or less of marijuana or3 ounces or less of marijuana concentrate;
• Open and public display, consumption, or use of less than2 ounces of marijuana;
• Transferring or dispensing 2 ounces or less of marijuanafrom one person to another for no consideration;
• Unlawful use or possession of synthetic cannabinoids orsalvia divinorum;
• Unlawful distribution, manufacturing, dispensing, sale, orcultivation of synthetic cannabinoids or salvia divinorum if the offense is based upon the transfer of synthetic cannabinoids or salvia divinorum from the person to another person for no consideration;
• Possession of drug paraphernalia; and
• Illegal possession or consumption of ethyl alcohol by anunderage person.

Current law prohibits an employee of a school or school district (employee) from requiring a student to participate in a survey, analysis, or evaluation (document) that addresses or requests certain information unless the student's parent provides written consent for the student's participation. The bill adds assessments to the documents for which parental consent is required. In addition to the existing list of information, the employee must obtain parental consent if the document requests a social security number or information concerning the student's or parent's religious beliefs or practices. For a parent's consent to be valid, the employee must make a written copy of the document available for inspection at convenient locations and times.

Under current law, a pharmacy is prohibited from dispensing a prescribed schedule II, III, IV, or V controlled substance absent a written prescription from the practitioner prescribing the substance. The bill allows a pharmacy to dispense those controlled substances if the practitioner electronically creates and transmits the prescription drug order in conformance with federal law.

The bill creates the "Colorado Cottage Foods Act", exempting small producers from the licensing requirements placed on retail food establishments and requiring producers to be certified in safe food handling and processing.

The bill limits the liability of food banks that distribute food produced pursuant to the "Colorado Cottage Foods Act". The bill also limits the liability of schools and nonprofit organizations when their kitchens are used by producers to prepare goods for sale directly to consumers.

The bill also exempts a person who produces and sells less than 250 dozen eggs per month on the premises at which the eggs are produced or at a farmer's market or similar venue from the licensing requirements for sellers of eggs.

The bill clarifies that Colorado children's trust fund moneys must be used for prevention, rather than intervention, programs, and extends its repeal to July 1, 2022.

The bill requires the commissioner of insurance to develop by July 1, 2013, and requires prescribing providers and health benefit plans to use by January 1, 2014, a uniform prior authorization form for purposes of submitting and receiving requests for prior coverage approval of a prescription drug. If the health benefit plan fails to use or accept the prior authorization form or fails to respond to a request within 2 business days, the request is deemed granted. An approved prior authorization form is valid for 12 months after the date of approval.

The bill prohibits a public school or institute charter school from making available to a student a food item that contains any amount of industrially produced trans fat. The prohibition applies to all food and beverages made available to a student on school grounds during each school day and extended school day, including but not limited to a food or beverage item made available to a student in a school cafeteria, school store, vending machine, or other food service entity existing upon school grounds or through any fundraising effort conducted by one or more students, teachers, or parents.

The bill includes dental services as a benefit for pregnant women under Colorado's medicaid program. The implementation date is January

Joint Budget Committee. Current law requires all tobacco litigation settlement disputed payments to be credited to the state general fund but will not require any disputed payments to be so credited in the future because it defines "disputed payments" to include only payments received by the state between July 1, 2008, and June 30, 2011. The bill expands the definition of "disputed payments" to include all payments that otherwise meet the criteria for being disputed received by the state on or after July 1, 2008.

In any prosecution for a driving under the influence (DUI), driving while ability impaired (DWAI), vehicular assault, or vehicular homicide, if at the time of the commission of the alleged offense, or within two hours thereafter, the defendant's blood, urine, or saliva contains any amount of a schedule I controlled substance, except for tetrahydrocannabinols; a schedule II controlled substance; salvia divinorum; or synthetic cannabinoids, or the defendant's blood contains 5 nanograms or more of delta 9-tetrahydrocannabinol per milliliter in whole blood, such fact gives rise to the permissible inference that the defendant was under the influence of drugs.

The bill expands the existing definition of "DUI per se" to include driving when the driver's blood, urine, or saliva contains any amount of a schedule I controlled substance, except for tetrahydrocannabinols; salvia divinorum; or synthetic cannabinoids, and driving when the defendant's blood contains 5 nanograms or more of delta 9-tetrahydrocannabinol per milliliter in whole blood.

The bill removes statutory instances of the term "habitual user".

Early Childhood and School Readiness Commission. The bill creates the office of early childhood and youth development (office) in the department of human services (DHS). The office's functions will include:

• Operating and overseeing: The Colorado children's trustfund; certain programs in the Tony Grampsas youth services program; the nurse home visitor program; the family resource center program; child care, including licensing, school readiness, and the early childhood councils; the child care assistance program; mental health consultation for children; part C child find and early intervention services; promoting safe and stable communities; and any other programs transferred to the office;
• Reviewing the federal funding guidelines and seekingfederal waivers to achieve the maximum flexibility in using federal funds for early childhood programs;
• Coordinating with and overseeing program delivery by theearly childhood councils and allocating funding to the councils; and
• Working with other early childhood programs within DHSand in other state agencies to develop and periodically review a state plan for delivering early childhood services to children and their families.
The purpose of the state plan is to provide a statewide, unified approach to providing early childhood services and operating early childhood programs with the goal of increasing efficiency, effectiveness, and quality in delivering early childhood services. The office, with the approval of the other agencies operating early childhood programs, will submit the state plan to the executive directors and policy boards of the affected agencies, the Tony Grampsas youth services board, and the governor for approval. The office and the state agencies may work with the early childhood leadership commission in creating and obtaining

approval of the state plan.

The executive directors of DHS, the department of public health and environment, and the department of health care policy and financing and the commissioner of education will meet on a regular basis to review the operation and coordination of early childhood programs and ensure compliance with the state plan. The policy board for each of these departments will consider the rules and guidelines adopted for early childhood programs in each of the agencies and, to the extent practicable and appropriate, align the rules and guidelines for these programs.

As part of the annual budget process, the office, in coordination with the other state agencies that provide early childhood programs, will report to the joint budget committee concerning the state plan, including:

• The priorities for services;
• The expected and achieved outcomes for early childhoodservices;
• The degree to which the early childhood programs are complying with the state plan and coordinating in delivering early childhood services;
• The coordination of early childhood programs at the state and local levels; and
• The level of funding and sources of moneys allocated to the early childhood councils.

The early childhood leadership commission will advise and otherwise assist the office and the other state agencies in creating and obtaining approval of the state plan. In a joint meeting of the governor and several committees of the general assembly held on or before January 31, 2013, the early childhood leadership commission will report concerning the contents and implementation of the state plan.

The bill relocates the Colorado nurse home visitor program, the family resource center program, and the Colorado children's trust fund from the department of public health and environment to the office in DHS. The bill also relocates the Tony Grampsas youth services program from the department of public health and environment to DHS.

The bill requires each hospital to make available to patients, and to communicate to each patient, information about the hospital's charity program and discount program in a clear and understandable manner and in languages appropriate to its communities. The bill also requires hospitals to offer a discount to each qualified patient. A qualified patient is defined as an uninsured patient who has a family income of not more than 400% of the federal poverty income level and who does not receive a discount through the Colorado indigent care program.

A hospital is prohibited from charging a patient for more than the cost of providing care. The bill requires each hospital to offer to screen each patient for the discount program and any other financial assistance offered by the hospital.

Each hospital is required to offer a payment plan to an eligible patient and to fulfill specific obligations before sending a bill to a collection agency for payment.

A person who wants to operate a responsible medical marijuana vendor server and seller training program (program) must submit an application to the medical marijuana state licensing authority (authority).

The authority shall approve a program if the program contains, at a minimum, the following components:

• Program standards that specify, at a minimum, who mustattend, the time frame for new staff to attend, recertification requirements, record-keeping, testing and assessment protocols, and effectiveness evaluations; and
• A core curriculum of pertinent statutory and regulatoryprovisions, which curriculum includes:
  • Information on licenses required, age requirements,patient registry cards issued by the department of public health and environment, maintenance of records, privacy issues, and unlawful acts;
  • Administrative and criminal liability and license andcourt sanctions;
  • Statutory and regulatory requirements for employeesand owners;
  • Acceptable forms of identification, including patientregistry cards and associated documents and procedures; and
  • Local and state licensing and enforcement, whichmay include, but need not be limited to, key statutes and rules affecting patients, owners, managers, and employees.
The state medical marijuana licensing authority may grant a licensed medical marijuana business (business) a "responsible vendor" designation (designation). A business receives the designation if all employees who sell or handle medical marijuana, all managers, and all resident on-site owners successfully complete a program that the authority has approved. A designation is valid for 2 years from the date of issuance.  If a licensing authority brings an administrative action against a business that has received the designation, the licensing authority shall consider the designation as mitigation.