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On April 2, 2019, Governor Jared Polis signed HB19-1028 Medical Marijuana Condition Autism. The new law allows a patient with an autism spectrum disorder (ASD) to use medical marijuana and went into effect immediately upon the Governor’s signature. The new law creates the same rights, limitations, affirmative defense, and exceptions from criminal laws for these conditions as the constitutional right to use medical marijuana for other debilitating conditions. ASD must be diagnosed by a primary care physician, a physician with experience in ASD, or licensed mental health provider acting within their scope of practice in order to qualify as a disabling medical condition.
Under current law, to be added to the medical marijuana registry, a child under the age of 18 must have been diagnosed with a disabling medical condition by two physicians, one of whom must be a board-certified pediatrician, family physician, or a child and adolescent psychiatrist who attests that he or she is part of the patient's primary care team. The new law removes the requirement on specific physicians, aligning it with the constitutional requirement that two physicians diagnose the patient as having a disabling medical condition. If the recommending physician is not the patient's primary care physician, the recommending physician must review the records of a diagnosing physician or a licensed mental health provider acting within their scope of practice. In addition, the new law encourages the State Board of Health in the Colorado Department of Public Health and Environment (CDPHE) to prioritize medical marijuana health research grants for studies to gather objective scientific research regarding the efficacy and the safety of administering medical marijuana for ovarian cancer, dementia, and pediatric conditions, including but not limited to ASD, and other conditions the State Board deems suitable.
On June 3, 2019, Governor Jared Polis signed HB19-1095 Physician Assistants Supervision and Liability. The new law modifies supervision requirements for physician assistants and goes into effect August 2, 2019. It also modifies physician assistant representation on the Colorado Medical Board and its licensing panel.
In addition, the new law increases the number of physician assistants on the Colorado Medical Board, from one to two, and adds one physician assistant to the licensing panel of the Colorado Medical Board.
On May 23, 2019, Governor Jared Polis signed SB19-013 Medical Marijuana Condition Opiates Prescribed, which goes into effect August 2, 2019. The new law creates a statutory right to use medical marijuana for a patient with a condition for which a physician could prescribe an opiate for pain. The law creates the same rights, limitations, affirmative defense, and exceptions from criminal laws for these conditions as the constitutional right to use medical marijuana for other debilitating conditions. Under current law, to be added to the medical marijuana registry, a child under the age of 18 must have been diagnosed with a disabling medical condition by two physicians, one of whom must be a board-certified pediatrician, family physician, or a child and adolescent psychiatrist who attests that he or she is part of the patient's primary care team.
The new law removes the requirement on specific specialty physicians, aligning it with the constitutional requirement that two physicians diagnose the patient as having a disabling medical condition. If the recommending physician is not the patient's primary care physician, the recommending physician must review the records of a diagnosing physician or a licensed mental health provider acting within their scope of practice. To conform with current law, the bill clarifies that a patient with a disabling medical condition who is under the age of 18 must only use medical marijuana in a non-smokeable form when at the student's school, on a school bus, or at a school-sponsored event.
On May 16, 2019, Governor Jared Polis signed SB19-052 Emergency Medical Service Provider Scope of Practice. The new law is effective August 2, 2019, and expands an emergency medical service (EMS) provider’s scope of practice to practice in a clinical setting under the medical supervision of a physician, physician assistant, advanced practice nurse, or registered nurse. The State Board of Health in the Department of Public Health and Environment must promulgate conforming rules. Each clinical setting at which an EMS provider practices must establish operating policies and procedures to ensure that EMS providers perform tasks and procedures within their scope of practice.
On May 16, 2019, Governor Jared Polis signed SB19-073 Statewide System of Medical Directives. The new law goes into effect on August 2, 2019, and creates a statewide electronic system of medical directives that allows qualified individuals to upload and access these documents. The individual whose medical treatment is subject to the advanced medical directive, or the individual’s surrogate decision-maker, is responsible for ensuring the information uploaded to the system is current and accurate. No emergency personnel, health care provider, health care facility, or any other person is civilly or criminally liable for actions that comply with a legally executed advance medical directive that is accessed from the system, unless the person or entity has knowledge of an advance health care directive that is executed after the date of the advance health care directive that is uploaded to the system. The Colorado Department of Public Health and Environment will promulgate rules and contract with one or more health information organization networks for the creation, administration, and maintenance of the system.
On April 8, 2019, Governor Jared Polis signed SB19-079 Electronic Prescribing of Controlled Substances. This law requires that all podiatrists, dentists, physicians, physician assistants, advanced practice nurses, and optometrists that prescribe a schedule II, III, or IV controlled substance do so electronically, with certain exceptions. The law does not require pharmacists to verify the applicability of an exception to electronic prescribing and pharmacists may dispense the controlled substance pursuant to an order that is written, oral, or facsimile-transmitted that is valid and consistent with current law. For most prescribers, the requirement begins July 1, 2021. For dentists and prescribers who work in a solo practice, or in a rural area, the requirement begins July 1, 2023.
On May 31, 2019, Governor Jared Polis signed SB19-193 Sunset Continue Colorado Medical Practice Act. The new law goes into effect on July 1, 2019, and continues the Colorado Medical Board in the Department of Regulatory Agencies until September 1, 2026. It also implements the following recommendations from the Sunset Review:
The Colorado Medical Board’s new sunset date is September 1, 2026.
On May 6, 2019, Governor Jared Polis signed SB 19-201 Open Discussions About Adverse Health Care Incidents. This new law creates the "Colorado Candor Act” and establishes a process for the communication between a patient and a healthcare provider or health facility after an adverse health care incident. Under the new law, if an adverse health care incident occurs, a health care provider involved with the incident, either individually or jointly with the facility involved, may request that the patient enter into an open discussion concerning the incident. The request must include certain components listed in the law.
If an offer of compensation is made, the new law requires certain processes for payment and financial resolution to be followed. If a health care provider or health facility determines that no offer of compensation is warranted, the health care provider or health facility shall orally communicate that decision with the patient.
A health care provider or facility may provide de-identified information about an adverse health care incident to any patient safety centered nonprofit organization.
On May 29, 2019, Governor Jared Polis signed SB19-218 Sunset Medical Marijuana Program. This bill extends the Medical Marijuana Program in the Department of Public Health and Environment (CDPHE) until September 1, 2028, implements recommendations from the Department of Regulatory Agencies sunset review, and makes a number of other changes. Specifically, the bill:
On May 28, 2019, Governor Jared Polis signed SB19-224 Sunset Regulated Marijuana. The new law, effective at various points beginning on August 2, 2019, continues the regulation of medical and retail marijuana until September 1, 2028, incorporates recommendations from the sunset reviews for the Colorado Medical Marijuana Code and the Colorado Retail Marijuana Code, and makes other changes. Changes include integrating the two codes into one code entitled the Colorado Marijuana Code. Other changes affect licensing, enforcement, medical marijuana specifically, and industrial hemp as shown below.
The new law makes the following changes to marijuana licensing:
The new law makes the following changes to the enforcement function of the MED:
Several changes affect only medical marijuana. These include:
Two changes address industrial hemp products. These include:
On May 23, 2019, Governor Jared Polis signed SB19-227 Harm Reduction Substance Use Disorders. The new law creates and expands certain substance use disorder treatment programs. Among other provisions, the new law:
On May 23, 2019, Governor Jared Polis signed SB19-228 Substance Use Disorders Prevention.
The law went into effect immediately upon the Governor’s signature. The law requires the Colorado Medical Board, State Board of Nursing, Colorado Dental Board, State Board of Optometry, Colorado Podiatry Board, and the State Board of Veterinary Medicine to adopt rules on substance use disorder training for prescribers. The rules must require certain health care providers, as a condition of license renewal, reactivation or reinstatement on or after October 1, 2019, to complete up to four credit hours of training per licensing cycle related to:
The new requirements apply to podiatrists, physicians, physician assistants, dentists, advanced practice nurses with prescriptive authority, optometrists, and veterinarians, except that each Board’s rules must exempt from the training requirements any health care provider who:
In addition to the substance abuse prevention training requirements, the new law includes the following provisions:
On March 28, 2019, Governor Jared Polis signed HB19-1044 Advance Behavioral Health Orders Treatment. The new law, effective August 2, 2019, allows an adult, 18 years of age or older, to establish a behavioral health order for scope of treatment (behavioral health orders) that communicates his or her behavioral health history, decisions, and preferences in the event that he or she later lacks decisional capacity to provide informed consent to, withdrawal from, or refuse behavioral health treatment. The law also: aligns the new process for behavioral health orders with current advance medical orders for scope of treatment; lists the requirements for behavioral health orders; details the duties and immunities for medical personnel treating an adult with a behavioral health order; details how a behavioral health order form may be executed, amended, or revoked; and specifies that executing or failing to execute a behavioral health order does not affect any health insurance contract, life insurance contract, or annuity.
On May 16, 2019, Governor Jared Polis signed HB19-1120 Youth Mental Health Education & Suicide Prevention. The new law, which took effect upon signature, permits a licensed or registered mental health professional to provide psychotherapy services to a minor who is between the ages of twelve and fourteen years old, at the minor's request, with or without consent of the minor's legal guardian, if the mental health professional determines that psychotherapy services are clinically indicated and necessary to the minor’s well-being. The mental health professional may advise the minor's legal guardian of services provided with the consent of the minor or a court in specific circumstances, unless notifying the legal guardian would be inappropriate or detrimental to the minor’s care and treatment. The mental health professional may notify the legal guardian, without the minor’s consent, if their professional opinion the minor is unable to manage their own care or treatment. The law includes documentation requirements and specifies that psychotherapy services must be provided in a culturally appropriate manner. The law also specifies that treatment without parental consent does not apply to inpatient treatment and that current law concerning liability and duty to warn for mental health professionals applies when a minor communicates a threat or intent to harm themselves or others.
The new law also requires the Colorado Department of Education (CDE) to - by July 1, 2010 - create and maintain a resource bank of program materials and curricula pertaining to mental health that is available to elementary and secondary schools in the state free of charge, in both English and Spanish. Upon request, CDE must provide technical assistance schools and others in designing age-appropriate curricula pertaining to mental health. The law also requires the Colorado State Board of Education to adopt standards that identify the knowledge and skills that an elementary through secondary education student should acquire related to mental health, including suicide prevention.
On May 31, 2019, Governor Jared Polis signed HB19-1129 Prohibit Conversion Therapy for a Minor. The new law goes into effect on August 2, 2019, and prohibits a licensed physician specializing in psychiatry or a licensed, certified, or registered mental health care provider from engaging in conversion therapy with a patient under 18 years of age. Any licensee who engages in these practices is subject to disciplinary action by the appropriate mental health licensing board or the Colorado Medical Board, respectively.
On April 11, 2019, Governor Jared Polis signed HB19-1197 Protect Caseworkers’ Personal Information on the Internet. The new law, effective upon signature, makes it illegal for a person to post on the internet the personal information of caseworkers or their immediate family members if the dissemination of personal information poses an imminent and serious threat. A caseworker is defined as a state or county employee, including a county attorney, who is engaged in investigating or taking legal action regarding allegations of child abuse or neglect. Any violation of this section is a class 1 misdemeanor. In addition, the caseworker may submit a written request to a state or local government official to remove records that the official makes available on the internet if the public availability of this information poses an imminent and serious threat to the caseworker or their immediate family members.
On March 10, 2019, Governor Jared Polis signed SB19-1017 Kindergarten through Fifth Grade Social and Emotional Health Act. The new law creates the K-5 Social and Emotional Health Pilot Program in the Colorado Department of Education (CDE), which will begin in the 2020-21 school year and continues for three years. The program places additional school mental health professionals in up to 10 pilot elementary or K5 schools that have high poverty and high needs students, with the intent of reducing social, emotional, and behavioral issues, adverse childhood experiences, disciplinary referrals, delinquency, truancy, and incidences of self-harm. A school mental health professional means a school counselor, a school psychologist, or a school social worker, each of which are further defined in the new law. Each school mental health professional must provide students with the services authorized under their professional special services license and specific endorsement, including functional behavior assessments, development of behavior intervention plans, and arranging for students to receive additional services from mental health professionals outside the school. Services may be provided to the student's family and household. The new law also lays out the pilot program implementation schedule and various pilot program requirements.
On March 21, 2019, Governor Jared Polis signed HB19-1077 Pharmacist Dispense Drug Without Prescription in Emergency. The new law went into effect immediately upon signature and allows pharmacists to dispense to a patient an emergency supply of a chronic maintenance drug without a current valid prescription if the following conditions exist:
A chronic maintenance drug is defined as one prescribed to a patient to take on a recurring basis or is used as a lifesaving rescue drug for a chronic condition, but is not an opioid or controlled substance that is prohibited from being dispensed without a prescription under federal law. In accordance with Section 12-280-122.5, Colorado Revised Statutes, the State Board of Pharmacy has adopted rules, in consultation with the Colorado Medical Board and the State Board of Nursing, to establish standard procedures for pharmacists. In addition, the pharmacist, pharmacist's employer, or the original prescriber is not civilly liable for an act or omission in connection with the dispensing of a chronic maintenance drug unless there is negligence, recklessness, or willful or wanton misconduct.
On March 7, 2019, Governor Jared Polis signed HB19-1109 Convalescent Centers as Pharmacies. The new law is effective August 2, 2019 and it allows a licensed convalescent center or hospice to register as an Other Outlet with the Board of Pharmacy in order to procure, store, order, dispense, and administer prescription medications.
On May 16, 2019, Governor Jared Polis signed HB19-1131 Prescription Drug Cost Education. The new law is effective August 2, 2019. The new law requires a drug wholesaler or manufacturer (or agent/employee thereof) who is engaged in prescription drug marketing to provide the wholesale acquisition cost of a prescription drug to a prescriber with whom drug-related information is shared, as well as information on other prescription drugs in the same therapeutic class.
On June 3, 2019, Governor Jared Polis signed HB19-1242 Regulate Pharmacy Technicians. This new law goes into effect on October 1, 2019, and requires pharmacy technicians practicing in Colorado on or after March 30, 2020, to obtain a certification or provisional certification from the State Board of Pharmacy (Board). An applicant for certification by the Board must pass a criminal history record check and provide proof of certification by a board-approved, nationally-recognized organization that certifies pharmacy technicians. To allow time to meet the requirements, the Board may grant a one-time provisional certification of up to 18 months to an applicant who has not satisfied certain requirements for certification. The provisional certification may be extended due to hardships. Pharmacy technicians also must meet continuing education requirements before renewing a certification. The new law states that any pharmacy technician on duty must be certified or have a provisional certification. Finally, the law includes a sunset date of September 1, 2021.
On May 16, 2019, Governor Jared Polis signed SB19-005 Importation of Prescription Drugs From Canada. The new state law creates the Canadian Prescription Drug Importation Program in the Department of Healthcare Policy and Financing (HCPF) and goes into effect on August 2, 2019. By September 1, 2020, HCPF must submit a request for federal approval of the program. If the program is approved, HCPF is required to begin operating the program no later than six months after receiving federal approval.
HCPF is required to contract with one or more vendors when the program receives federal approval; vendor selection is exempt from the state procurement process for the first three years. Vendors, in consultation with HCPF and other vendors, must annually establish a wholesale prescription drug importation list that identifies the prescription drugs that have the highest potential for cost savings to the state. HCPF is required to ensure these lists meet program requirements every three months.
Vendors must identify Canadian suppliers, verify the supplier meets all legal and program requirements, and contract with or facilitate contracts with suppliers to import prescription drugs under the program. Vendors must follow specific requirements related to:
Eligible drugs, importers, and suppliers:
A vendor may import a prescription drug from a Canadian supplier if the drug meets U.S. standards related to the drug's safety, effectiveness, misbranding, and adulteration; importing the drug would not violate federal patent laws; and importing the drug is expected to generate cost savings. Eligible importers include the following:
An eligible Canadian supplier may only export prescription drugs into Colorado if the supplier is in full compliance with Canadian law and submits proof of a registered agent in the U.S. Canadian suppliers and eligible importers participating under the program must comply with the tracking and tracing requirements of federal pharmaceutical distribution supply chain law; and may not distribute, dispense, or sell prescription drugs imported under the program outside of Colorado. In addition, both entities are required to submit certain information to the vendor related to drug type, quantity, point of origin and destination, price, and shipping information as applicable.
HCPF must immediately suspend the importation of specific drugs or the importation of drugs by specific eligible importers if it discovers that any drug or activity is in violation of any federal or state law or regulation. HCPF may revoke the suspension if, after conducting an investigation, it determines that the public is adequately protected from counterfeit or unsafe drugs being imported into this state.
HCPF must designate an office or division that must be a licensed pharmaceutical wholesaler or that must contract with a licensed pharmaceutical wholesaler to:
HCPF is required to report on program operations to the Governor and the General Assembly by December 1 of each year starting in 2021. The report must include information about participants, prescription drugs imported and dispensed, methodology, and estimated cost saving.
On March 15, 2019, Governor Jared Polis signed SB19-081 Repeal of the “Colorado Cancer Drug Repository Act.” The legislation repeals a section of statute that established a state cancer drug repository program. There is a broader drug repository program for all types of unused medication in state law, making this limited provision obsolete.
On May 23, 2019, Governor Jared Polis signed SB19-228 Substance Use Disorders Prevention.