ARTICLE 1 ADMINISTRATION

Section

PART 1 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT

PART 2 ALCOHOL AND DRUG ABUSE

PART 3 ALCOHOLISM AND INTOXICATION TREATMENT

PART 4 STATE CHEMIST

PART 5 PUBLIC HEALTH

SUBPART 1 GENERAL

SUBPART 2 PUBLIC HEALTH PLANS

SUBPART 3 COUNTY OR DISTRICT PUBLIC HEALTH AGENCIES

PART 6 LOCAL BOARDS OF HEALTH

PART 7 REGIONAL HEALTH DEPARTMENTS

PART 8 PATIENT RECORDS

PART 9 COMMISSION ON FAMILY MEDICINE

PART 10 CHILD CARE PROGRAMS IN NURSING HOME FACILITIES

PART 11 DRUG ABUSE PREVENTION, EDUCATION, AND TREATMENT

PART 12 MEDICAL RECORD CONFIDENTIALITY

PART 13 CLIMATE CHANGE MARKETS GRANT PROGRAM

PART 14 HEALTH INFORMATION TECHNOLOGY

25-1-101. Construction of terms.

1. When any law of this state refers to the executive director of the state department of public health or of the department of health, said law shall be construed as referring to the executive director of the department of public health and environment.
2. Whenever any law of this state refers to the state department of public health or to the department of health, said law shall be construed as referring to the department of public health and environment.

Source: L. 68: p. 106, § 73. C.R.S. 1963: § 66-1-1. L. 93: Entire section amended, p. 1095, § 9, effective July 1, 1994.

Cross references: For the legislative declaration contained in the 1993 act amending this section, see section 1 of chapter 230, Session Laws of Colorado 1993.

25-1-101.5. Authority of revisor of statutes to amend references to department - affected statutory provisions.

The revisor of statutes is hereby authorized to change all references in the Colorado Revised Statutes to the department of health from said reference to the department of public health and environment, as appropriate. In connection with such authority, the revisor of statutes is hereby authorized to amend or delete provisions of the Colorado Revised Statutes so as to make the statutes consistent with the renaming of the department to the department of public health and environment.

Source: L. 93: Entire section added, p. 1095, § 10, effective July 1, 1994.

Cross references: For the legislative declaration contained in the 1993 act enacting this section, see section 1 of chapter 230, Session Laws of Colorado 1993.

25-1-102. Department created - executive director - divisions.

1. There is hereby created a department of public health and environment, referred to in this part 1 and article 1.5 of this title as the "department". The head of the department shall be the executive director of the department of public health and environment, which office is hereby created. The governor shall appoint said executive director, with the consent of the senate, and the executive director shall serve at the pleasure of the governor. The reappointment of an executive director after initial election of a governor shall be subject to the provisions of section 24-20-109, C.R.S. The executive director shall administer the department, subject to the authority of the state board of health, the air quality control commission, the state water quality control commission, and the solid and hazardous waste commission.
2. The department shall consist of the following divisions:
   1. The division of administration, and such sections and units established as provided by law.
   2. (Deleted by amendment, L. 93, p. 1095 , § 11, effective July 1, 1994.)

Source: L. 47: p. 505, § 2. CSA: C. 78, § 21 (2). CRS 53: § 66-1-2. C.R.S. 1963: § 66-1-2. L. 68: p. 106, § 74. L. 70: p. 237, §§ 2, 4. L. 71: pp. 106, 657, §§ 16, 3. L. 79: (1) amended, p. 1058, § 4, effective June 20. L. 86: (1) amended, p. 888, § 18, effective May 23. L. 92: (1) amended, p. 1235, § 2, effective August 1. L. 93: Entire section amended, p. 1095, § 11, effective July 1, 1994. L. 2003: (1) amended, p. 706, § 29, effective July 1. L. 2006: (1) amended, p. 1138, § 26, effective July 1.

Cross references: For the legislative declaration contained in the 1993 act amending this section, see section 1 of chapter 230, Session Laws of Colorado 1993.

25-1-103. State board of health created.

1. There is created a state board of health, referred to in this part 1 as the "board". The board consists of nine members, of which one member must be appointed by the governor, with the consent of the senate, from each congressional district and the remainder from the state at large. A vacancy on the board occurs whenever any member moves out of the congressional district from which he or she was appointed. A member who moves out of such congressional district shall promptly notify the governor of the date of his or her move, but the notice is not a condition precedent to the occurrence of the vacancy. The governor shall fill the vacancy by appointment for the unexpired term. No more than five members of the board shall be members of the same major political party. Appointments made to take effect on January 1, 1983, shall be made in accordance with section 24-1-135. Appointments thereafter are made, with the consent of the senate, for terms of four years each and made so that no business or professional group constitutes a majority of the board. In making appointments to the board, the governor is encouraged to include representation by at least one member who is a person with a disability, as defined in section 24-34-301 (2.5), a family member of a person with a disability, or a member of an advocacy group for persons with disabilities if the other requirements of this subsection (1) are met.
2. The first vacancy that occurs on the board after July 1, 1977, shall be filled by the appointment of a person who is then serving as a county commissioner. Thereafter, as vacancies occur and terms expire, there shall always be one county commissioner member on the board. Whenever a county commissioner ceases to hold the office of county commissioner, he ceases to hold his position as a member of the board. A county commissioner shall not vote on any matter coming before the board which affects his county in a manner significantly different from the manner in which it affects other counties.

Source: L. 47: p. 505, § 3. CSA: C. 78, § 21 (3). CRS 53: § 66-1-3. C.R.S. 1963: § 66-1-3. L. 68: p. 106, § 75. L. 72: p. 549, § 12. L. 77: Entire section amended, p. 1257, § 1, effective July 1. L. 82: (1) amended, p. 356, § 15, effective April 30. L. 2009: (1) amended, (HB 09-1281), ch. 399, p. 2154, § 3, effective August 5. L. 2018: (1) amended, (HB 18-1364), ch. 351, p. 2081, § 6, effective July 1.

Cross references: For the transfer of the state board of health to an administrative department, see § 24-1-119.

25-1-104. State board - organization.

The board shall elect from its members a president, a vice-president, and such other board officers as it shall determine. The executive director of the department, in the discretion of the board, may serve as secretary of the board but shall not be eligible to appointment as a member. All board officers shall hold their offices at the pleasure of the board. Regular meetings of the board shall be held not less than once every three months at such times as may be fixed by resolution of the board. Special meetings may be called by the president, by the executive director of the department, or by a majority of the members of the board at any time on three days' prior notice by mail or, in case of emergency, on twenty-four hours' notice by telephone or other telecommunications device. The board shall adopt, and at any time may amend, bylaws in relation to its meetings and the transaction of its business. A majority shall constitute a quorum of the board. Members shall receive the same per diem compensation and reimbursement of expenses as those provided for members of boards and commissions in the division of professions and occupations pursuant to section 12-20-103 (6). All meetings of the board, in every suit and proceeding, shall be taken to have been duly called and regularly held, and all orders and proceedings of the board to have been authorized, unless the contrary is proved.

Source: L. 47: p. 505, § 3. CSA: C. 78, § 21 (3). CRS 53: § 66-1-4. C.R.S. 1963: § 66-1-4. L. 81: Entire section amended, p. 1298, § 1, effective June 9. L. 2013: Entire section amended, (HB 13-1300), ch. 316, p. 1686, § 68, effective August 7. L. 2019: Entire section amended, (HB 19-1172), ch. 136, p. 1694, § 137, effective October 1.

25-1-105. Executive director - chief medical officer - qualifications - salary - office.

1. The executive director of the department shall:
   1. Have a degree of doctor of medicine or doctor of osteopathy, be licensed to practice medicine in the state of Colorado, and have at least one of the following qualifications:
      1. One year of graduate study in a school of public health;
      2. Not less than two years' experience in an administrative capacity in a health care organization;
      3. Four years of said experience when one year of graduate study in a school of public health has not been completed; or
   2. Have, at a minimum, experience or education in public administration and public or environmental health.
2. 1. If the governor appoints an executive director who does not have the qualifications specified in paragraph (a) of subsection (1) of this section, the executive director of the department shall, pursuant to the provisions of section 13 of article XII of the state constitution, upon consultation with the governor, and with the consent of a majority of the members of the senate, appoint a chief medical officer. The chief medical officer shall have the qualifications specified in paragraph (a) of subsection (1) of this section and shall serve at the pleasure of the governor. The executive director shall initially appoint the chief medical officer no later than three months after the executive director's appointment has been confirmed by the senate.
   2. The chief medical officer shall provide independent medical judgment, guidance, and advice to the governor and to the executive director regarding medical and public health issues in all areas identified in article 1.5 of this title.
   3. The chief medical officer shall be afforded direct access to the governor and the governor's staff.
3. The executive director shall receive such salary as may be fixed by the board subject to the state constitution and state laws and within the limits of funds made available to the department by appropriation of the general assembly or otherwise. The executive director shall be allowed traveling and subsistence expenses actually and necessarily incurred in the performance of the executive director's official duties when absent from his or her place of residence. The executive director shall be custodian of all property and records of the department.

Source: L. 47: p. 506, § 4. CSA: C. 78, § 21 (4). CRS 53: § 66-1-5. C.R.S. 1963: § 66-1-5. L. 68: p. 106, § 76. L. 79: Entire section amended, p. 999, § 1, effective May 25. L. 96: Entire section amended, p. 785, § 1, effective July 1. L. 2003: (2)(b) amended, p. 706, § 30, effective July 1.

25-1-106. Division personnel.

The executive director of the department shall appoint the director of the division of administration, pursuant to the provisions of section 13 of article XII of the state constitution. Each subdivision (and section) of the division of administration shall be under the management of a head, and such heads and all other subordinate personnel of the division shall be appointed by the director of the division, subject to the constitution and state personnel system laws of the state, and shall possess qualifications approved by the board. All personnel shall receive such compensation as fixed by the executive director with the approval of the board, subject to the constitution and state personnel system laws of the state and within the limits of funds made available to the department by appropriation of the general assembly or otherwise. With the approval of the executive director, employees shall also be allowed traveling and subsistence expenses actually and necessarily incurred in the performance of their official duties when absent from their places of residence.

Source: L. 47: p. 506, § 4. CSA: C. 78, § 21(4). CRS 53: § 66-1-6. C.R.S. 1963: § 66-1-6. L. 71: p. 106, § 17.

Cross references: For the state personnel system, see article 50 of title 24.

25-1-107. Powers and duties of the department - repeal. (Repealed)

Source: L. 47: p. 508, § 5. L. 49: p. 438, § 1. CSA: C. 78, § 21 (5). L. 53: p. 341, § 1. CRS 53: § 66-1-7. L. 55: pp. 425, 426, §§ 1, 1. L. 57: p. 413, § 1. L. 59: pp. 467, 470, §§ 1, 1. L. 62: p. 171, § 1. C.R.S. 1963: § 66-1-7. L. 64: pp. 139, 478, §§ 67, 1. L. 65: p. 692, § 1. L. 67: p. 345, §§ 14, 16. L. 69: pp. 467, 468, §§ 1, 1. L. 71: p. 639, § 2. L. 73: pp. 893, 1405, §§ 2, 45. L. 75: (1)(l)(I) amended, p. 866, § 1, effective May 31; (1)(m) amended, p. 868, § 1, effective May 31; (1)(o) amended, p. 869, § 1, effective June 26. L. 77: (1)(e) and (2) amended and (1)(x) added, p. 1259, § 1, effective June 9; (1)(n) amended, p. 952, § 21, effective August 1. L. 78: (3) added, p. 408, § 1, effective April 27; (1)(l)(I) amended, p. 440, § 2, effective May 18. L. 80: (1)(y) added, p. 649, § 2, effective July 1. L. 83: (1)(z) added, p. 1026, § 1, effective May 3; (1)(aa) added, p. 1027, § 1, effective May 23; (1)(l)(I) amended, p. 1052, § 2, effective May 25; (1)(cc) added, p. 1028, § 1, effective June 10; (1)(q) amended, p. 1055, § 1, effective July 1; (1)(y) R&RE and (1)(bb), p. 1223, §§ 2, 3, effective July 1. L. 84: (1)(l)(I) amended, p. 337, § 3, effective April 25. L. 85: (1)(o) R&RE, p. 901, § 2, effective April 5; (1)(l)(I) amended, p. 927, § 6, effective July 1; (1)(l)(II.1) added, p. 683, § 12, effective July 1; (1)(dd) added, p. 877, § 1, effective July 1. L. 87: IP(1)(x)(V) and (1)(x)(VI) amended, p. 611, § 23, effective July 1. L. 88: (1)(x)(I) and (2) amended and (1)(x)(VIII) and (1)(x.5) added, p. 991, § 1, effective May 11; (1)(ee) added, p. 998, § 2, effective May 11. L. 91: (1)(ee)(II) amended, p. 1162, § 1, effective March 29; (1)(ee)(VI) amended, p. 929, § 1, effective April 1; (1)(bb) and (1)(ee)(IV) amended, pp. 720, 1856, §§ 2, 11, effective April 11; (1)(a), (1)(f), (1)(z), and (1)(dd) amended, p. 941, § 1, effective May 5; (3) amended, p. 974, § 3, effective May 6; (1)(ff) added, p. 442, § 9, effective May 29; (1)(x)(I) and (1)(x)(II)(A) amended, p. 961, § 1, effective July 1. L. 92: (1)(w) and (1)(ee) amended, pp. 1727, 1151, §§ 17, 8, effective July 1. L. 93: (1)(ee)(I)(B) amended, p. 1786, § 67, effective June 6; (1)(aa) amended, p. 1664, § 71, effective July 1; (1)(l)(II.5) added and (1)(u), IP(1)(ee)(I), (1)(ee)(I)(C), and (1)(ee)(II.5)(D) amended, pp. 1096, 1140, §§ 12, 13, 77, effective July 1, 1994. L. 94: (3)(c) amended, p. 695, § 1, effective April 19; (1)(ee)(II.5)(A) and (3)(c)(II) amended, p. 1638, § 55, effective May 31; (1)(n), (1)(l)(II.5), and (1)(ee)(II) amended and (4) added, pp. 2700, 2606, 2610, §§ 252, 7, 10, effective July 1; (1)(q) amended, p. 1665, § 1, effective July 1. L. 95: (1)(ee)(II.5)(H) and (1)(ee)(II.5)(I) amended and (1)(ee)(II)(J) added, p. 539, § 1, effective May 22; (1)(gg) added, p. 943, § 5, effective May 25; (1)(l)(I), (1)(l)(II), (1)(l)(II.1), and (1)(l)(III) amended and (1)(l)(II.2) added, p. 1021, § 1, effective July 1. L. 96: (1)(ee)(VI)(B) amended, p. 798, § 11, effective May 23; (1)(ee)(VII) repealed, p. 1253, § 138, effective August 7; (1)(ee)(II.5)(B) amended, p. 1695, § 37, effective January 1, 1997. L. 98: (1)(hh) added, p. 711, § 1, effective May 18; (1)(ee)(I.5), (1)(ee)(II.5)(I), (1)(ee)(III)(B), and (1)(ee)(VI) amended and (1)(ee)(I.6) added, p. 542, § 4, effective July 1; (1)(x)(II)(A) amended and (1)(x)(IX) added, p. 888, § 1, effective August 5. L. 99: (1)(y) amended, p.436, § 5, effective April 30; (1)(x)(VII) amended and (1)(x.2) added, p. 23, § 1, effective July 1. L. 2000: (1)(a.5) added, p. 87, § 5, effective March 15; IP(1)(x)(VII), (1)(x)(VII)(D), and (1)(x.2) amended and (1)(x)(VII)(E) added, p. 144, § 1, effective March 16; (1)(n) amended, p. 802, § 1, effective May 24; (1)(ii) added, p. 2002, § 1, effective August 2. L. 2001: (1)(jj) added, p. 473, § 2, effective April 27; (1)(kk) added, p. 928, § 4, effective June 4; (1)(n)(I) amended, p. 1274, § 36, effective June 5; (1)(a.5)(IV), (1)(a.5)(V), and (1)(a.5)(VI) added, p. 824, § 1, effective August 8. L. 2002: (1)(x)(VII)(C.5) amended, p. 1024, § 45, effective June 1; (1)(l)(I) and (4) amended, p. 1327, § 14, effective July 1; (1)(m) amended, p. 411, § 4, effective July 1; (1)(q) amended, p. 427, § 3, effective July 1. L. 2003: (1)(ll) added, p. 1035, § 7, effective April 17; (1)(ee)(II.5)(A) and (1)(ee)(II.5)(C) amended, p. 1997, § 45, effective May 22; entire section repealed, p. 676, § 1, effective July 1; IP(1)(a.5)(IV) amended, p. 1617, § 23, effective August 6.

Editor's note: This section was repealed, effective July 1, 2003, and relocated to article 1.5 of this title. Prior to its repeal, this section was amended by House Bill 03-1266, House Bill 03-1344, and House Bill 03-1100. Those amendments have been relocated and harmonized with article 1.5 of this title. Amendments to the introductory portion to subsection (1)(a.5)(IV) by House Bill 03-1266 were harmonized with Senate Bill 03-002 and relocated to the introductory portion to § 25-1.5-102 (1)(b)(IV). Amendments to subsections (1)(ee)(II.5)(A) and (1)(ee)(II.5)(C) by House Bill 03-1344 were harmonized with Senate Bill 03-002 and relocated to § 25-1.5-301 (2)(a) and (2)(b.5), respectively. Subsection (1)(ll) as enacted by House Bill 03-1100 was harmonized with Senate Bill 03-002 and relocated to § 25-1.5-101 (1)(y).

25-1-107.5. Additional authority of department - rules - remedies against nursing facilities - criteria for recommending assessments for civil penalties - cooperation with department of health care policy and financing - nursing home penalty cash fund - nursing home innovations grant board - reports.

1. For the purposes of this section, unless the context otherwise requires:
   1. Repealed.
   2. "Federal regulations for participation" means the regulations found in part 442 of title 42 of the code of federal regulations, as amended, for participation under Title XIX of the federal "Social Security Act", as amended.
   3. "Benefit residents of nursing facilities" means that a grant has a direct impact on the residents of nursing facilities or has an indirect impact on the residents through education of nursing facility staff.
   4. "Board" means the nursing home innovations grant board, authorized by subsection (6) of this section.
   5. "Nursing facility" means any skilled or intermediate nursing care facility that receives federal and state funds under Title XIX of the federal "Social Security Act", as amended.
2. The department, as the state agency responsible for certifying nursing facilities, is authorized to adopt rules necessary to establish a series of remedies in accordance with this section and the federal "Omnibus Budget Reconciliation Act of 1987", Pub.L. 100-203, as amended, that may be imposed by the department of health care policy and financing when a nursing facility violates federal regulations for participation in the medicaid program. The remedies shall include any remedies required under federal law and the imposition of civil money penalties.
3. 1. In accordance with rules promulgated under this section, the department is authorized to recommend to the department of health care policy and financing an appropriate civil money penalty based on the nature of the violation. Any penalties recommended shall not be less than one hundred dollars nor more than ten thousand dollars for each day the facility is found to be in violation of the federal regulations. Penalties assessed shall include interest at the statutory rate.
   2. The department shall adopt criteria for determining the amount of the penalty to be recommended for assessment. The criteria shall include, but need not be limited to, consideration of the following factors:
      1. The period during which the violation occurred;
      2. The frequency of the violation;
      3. The nursing facility's history concerning the type of violation for which the penalty is assessed;
      4. The nursing facility's intent or reason for the violation;
      5. The effect, if any, of the violation on the health, safety, security, or welfare of the residents of the nursing facility;
      6. The existence of other violations, in combination with the violation for which the penalty is assessed, that increase the threat to the health, safety, security, or welfare of the residents of the nursing facility;
      7. The accuracy, thoroughness, and availability of records regarding the violation that the nursing facility is required to maintain; and
      8. The number of additional related violations occurring within the same period as the violation in question.
   3. 1. If the department finds that a violation is life threatening to one or more residents or creates a direct threat of serious adverse harm to the health, safety, security, rights, or welfare of one or more residents, the department of health care policy and financing shall impose a penalty for each day the deficiencies that constitute the violation are found to exist.
      2. Except as provided in subparagraph (I) of this paragraph (c), the department of health care policy and financing shall not assess a penalty prior to the date a nursing facility receives written notice from the department of its recommendation to assess civil money penalties. The department shall provide the notice to the facility no later than five days after the last day of the inspection or survey during which the deficiencies that constitute the violation were found. The notice shall:
         1. Set forth the deficiencies that are the basis for the recommendation to assess a penalty;
         2. Provide instructions for responding to the notice; and
         3. Require the nursing facility to submit a written plan of correction. The department shall adopt criteria for the submission of written plans of correction by nursing facilities and approval of the plans by the department. If the facility acts in a timely and diligent manner to correct the violation in accordance with an approved plan of correction, the department may recommend to the department of health care policy and financing that it suspend or reduce the penalty during the period of correction specified in the approved plan of correction.
   4. Except as provided in sub-subparagraph (C) of subparagraph (II) of paragraph (c) of this subsection (3), the department of health care policy and financing shall continue to assess any penalty recommended under this section until the department verifies to the department of health care policy and financing that the violation is corrected or until the nursing facility notifies the department that correction has occurred, whichever is earlier. If the penalty has been suspended or reduced pursuant to sub-subparagraph (C) of subparagraph (II) of paragraph (c) of this subsection (3) and the nursing facility has not corrected the violation, the department of health care policy and financing shall reinstate the penalty at an increased amount and shall retroactively assess the penalty to the date the penalty was suspended.
4. 1. The department of health care policy and financing, after receiving a recommendation from the department, is authorized to assess, enforce, and collect the civil money penalty pursuant to section 25.5-6-205, C.R.S., for credit to the nursing home penalty cash fund, created pursuant to section 25.5-6-205 (3)(a), C.R.S.
   2. 1. The department of public health and environment and the department of health care policy and financing have joint authority for administering the nursing home penalty cash fund; except that final authority regarding the administration of moneys in the fund is in the department of health care policy and financing.
      2. The authority of both departments includes establishing circumstances under which funds may be distributed in order to protect the health or property of individuals residing in nursing facilities that the department of health care policy and financing has found to be in violation of federal regulations for participation in the medicaid program.
      3. The department of health care policy and financing shall promulgate rules necessary to ensure proper administration of the nursing home penalty cash fund.
   3. The departments shall consider, as a basis for distribution from the nursing home penalty cash fund, the following:
      1. The need to pay costs to:
         1. Relocate residents to other facilities when a nursing facility closes;
         2. Maintain the operation of a nursing facility pending correction of violations;
         3. Close a nursing facility;
         4. Reimburse residents for personal funds lost;
      2. Grants to be approved for measures that will benefit residents of nursing facilities by fostering innovation and improving the quality of life and care at the facilities, including:
         1. Consumer education to promote resident-centered care in nursing facilities;
         2. (Deleted by amendment, L. 2014.)
         3. Initiatives in nursing facilities related to the quality measures promoted by the federal centers for medicare and medicaid services and other national quality initiatives; and
         4. Education and consultation for purposes of identifying and implementing resident-centered care initiatives in nursing facilities.
   4. 1. Repealed.
      2. The department of health care policy and financing, after receiving a recommendation from the board and approval from the federal centers for medicare and medicaid services, shall consider grants issued as sole source procurements that are not subject to the "Procurement Code", articles 101 to 112 of title 24, C.R.S.

         (II.5) (A) The board shall make recommendations for the approval of grants that benefit residents of nursing facilities for at least one year and not more than three-year cycles. The projects awarded grants must be portable, sustainable, and replicable in other nursing facilities.

         (B) The department of health care policy and financing and the board shall develop processes for grant payments, which processes may allow grant payments to be made in advance of the delivery of goods and services to grantees. Grantees receiving advance payments shall report progress to the board. No state agency nor any other governmental entity, with the exception of a facility that is owned or operated by a governmental agency and that is licensed as a nursing care facility under section 25-1.5-103 (1)(a)(I)(A), may apply for or receive a grant under this subsection (4).

         (C) Any moneys remaining in the fund at the end of a fiscal year may be held over and used by the board in the next fiscal year. Unexpended and unencumbered moneys from an appropriation in the annual general appropriation act to the departments for the purpose of carrying out the nursing home innovations grant program under this section remain available for expenditure by the departments in the next fiscal year without further appropriation. This sub-subparagraph (C) applies to appropriations made by the general assembly for fiscal years ending on and after June 30, 2014. On or before June 30, 2014, and on or before June 30 of each year thereafter, the departments shall notify the state controller of the amount of the appropriation from the annual general appropriation act for the current fiscal year the departments need to remain available for expenditure in the next fiscal year. The departments may not expend more than the amount stated in the notice under this sub-subparagraph (C).

         (D) Other policies of the board must conform with practices of other granting organizations. The work product from grants funded through the nursing home penalty cash fund is the intellectual property of the department and must be made available without charge to all nursing homes in the state. The department of health care policy and financing shall adopt rules as necessary to govern the procedure for awarding grants under this section.

         (II.7) The department of health care policy and financing shall adhere to all state and federal requirements for the encumbrance and payment of grants under this paragraph (d). In addition, the department shall:

         1. Document necessary federal permissions for the use of moneys from the nursing home penalty cash fund, created under section 25.5-6-205, C.R.S., prior to making any payment or encumbrance; and
         2. Adhere to the written determination of the board under subsection (6) of this section in releasing state moneys for payment to grantees under this section. The department's adherence to the written determination of the board is sufficient evidence to ensure that work was completed fully and adequately.
      3. The medical services board created pursuant to section 25.5-1-301 shall establish a minimum reserve amount to be maintained in the nursing home penalty cash fund to ensure that there is sufficient money for the departments to distribute in accordance with subsection (4)(b)(II) of this section, if needed. The departments shall not expend money from the fund for the purposes described in subsection (4)(c)(II) of this section if the expenditure would cause the fund balance to fall below the minimum reserve amount.
      4. In determining how to allocate the moneys authorized to be distributed pursuant to this paragraph (d), the departments shall take into consideration the recommendations of the board made pursuant to paragraph (c) of subsection (6) of this section. If the departments disagree with the recommendations of the board, they shall meet with the board to explain their rationale and shall seek to achieve a compromise with the board regarding the allocation of the moneys. If a compromise cannot be achieved with regard to all or a portion of the moneys to be distributed, the medical services board created pursuant to section 25.5-1-301, C.R.S., shall have the final authority regarding the distribution of moneys for which a compromise has not been reached.
   5. The departments shall not utilize moneys from the nursing home penalty cash fund for the purpose of paying their cost for administering the fund or for costs of administration associated with any specific movement, association, or organization; except that up to ten thousand dollars of the moneys distributed pursuant to paragraph (d) of this subsection (4) may be used to pay the cost to administer and operate the board, including expense reimbursement for board members.
5. Repealed.
6. 1. No later than September 1, 2014, the department of health care policy and financing shall establish the nursing home innovations grant board under the department of health care policy and financing either directly or by contract with or grant to any public agency or appropriate private nonprofit organization. The department of health care policy and financing, in consultation with stakeholders, shall determine the appropriate entity to administer the board. The board consists of ten members as follows:
      1. The state long-term care ombudsman or his or her designee;
      2. The executive director of the department of health care policy and financing or the executive director's designee;
      3. The executive director of the department of public health and environment or the executive director's designee;
      4. Seven members appointed by the governor as follows:
         1. Four members currently employed in long-term care nursing facilities;
         2. One member who is or represents a consumer of long-term care;
         3. One member representing the disability community who is either a resident of a nursing facility or a family member of a nursing facility resident; and
         4. One member representing the business community.
         5. (Deleted by amendment, L. 2014.)
   2. The members of the board shall serve without compensation but may be reimbursed for expenses incurred while serving on the board.
   3. The board shall review all grant projects, determine whether the grantees completed their grant projects and grant objectives, and shall provide written recommendations to the department to make or withhold payment to grantees.
   4. By October 1 of each year, the departments, with the assistance of the board, shall jointly submit a report to the governor and the health and human services committee of the senate and the public health care and human services committee of the house of representatives of the general assembly, or their successor committees, regarding the expenditure of moneys in the nursing home penalty cash fund for the purposes described in subparagraph (II) of paragraph (c) of subsection (4) of this section. The report must detail the amount of moneys expended for such purposes, the recipients of the funds, the effectiveness of the use of the funds, and any other information deemed pertinent by the departments or requested by the governor or the committees. Notwithstanding the requirement in section 24-1-136 (11), C.R.S., the report required in this paragraph (d) continues indefinitely.
7. Repealed.

Source: L. 89, 1st Ex. Sess.: Entire section added, p. 24, § 1, effective July 11. L. 91: (3)(b) amended, p. 1856, § 12, effective April 11; (4) added, p. 687, § 53, effective April 20; entire section repealed, p. 687, § 53, effective July 1, 1993. L. 94: Entire section RC&RE, p. 1316, § 1, effective May 25; (2), (3)(a), (3)(c)(II)(C), (3)(d), (4)(a), and (4)(b) amended, p. 2617, § 29, effective July 1. L. 97: (5) repealed, p. 106, § 2, effective March 24. L. 2006: (4)(a) amended, p. 2012, § 80, effective July 1. L. 2009: Entire section amended, (HB 09-1196), ch. 428, p. 2383, § 1, effective June 4. L. 2014: (1)(a) repealed, (1)(b.5) and (1)(b.7) added, and (4)(c)(II), (4)(d), (4)(e), (6), and (7) amended, (SB 14-151), ch. 339, p. 1507, § 1, effective June 5. L. 2019: (4)(d)(I) and (7) repealed and (4)(d)(III) amended, (SB 19-254), ch. 336, p. 3090, § 2, effective August 2.

Cross references: For the legislative declaration contained in the 1994 act amending subsections (2), (3)(a), (3)(c)(II)(C), (3)(d), (4)(a), and (4)(b), see section 1 of chapter 345, Session Laws of Colorado 1994.

25-1-108. Powers and duties of state board of health.

1. In addition to all other powers and duties conferred and imposed upon the state board of health by this part 1, the board has the following specific powers and duties:
   1. To determine general policies to be followed by the division of administration in administering and enforcing the public health laws and the orders, standards, rules, and regulations of the board;
   2. To act in an advisory capacity to the executive director of the department on all matters pertaining to public health;
   3. 1. To issue from time to time such orders, to adopt such rules and regulations, and to establish such standards as the board may deem necessary or proper to carry out the provisions and purposes of this part 1 and to administer and enforce the public health laws of this state;
      2. To adopt rules and standards concerning building regulations for skilled and intermediate health care facilities. The enforcement of these rules may be waived by the board for periods of time as recommended by the department if the rigid application of the rules would result in demonstrated financial hardship to a skilled or intermediate facility, but only if the waiver will not adversely affect the health and safety of patients.
      3. to (V) Repealed.

         (VI) To adopt rules and to establish such standards as the board may deem necessary or proper to assure that hospitals; other acute care facilities; county, district, and municipal public health agencies; and trauma centers are prepared for an emergency epidemic, as defined in section 24-33.5-703 (4), that is declared to be a disaster emergency, including the immediate investigation of any case of a suspected emergency epidemic;

   4. To hold hearings, administer oaths, subpoena witnesses, and take testimony in all matters relating to the exercise and performance of the powers and duties vested in or imposed upon the board. The board may designate an administrative law judge appointed pursuant to part 10 of article 30 of title 24, C.R.S., to conduct hearings for the board, pursuant to section 24-4-105, C.R.S., and to carry out such administrative and other duties of the board as the board may require in the conduct of its hearings.
   5. To establish and appoint, as the board may deem necessary or advisable, special advisory committees to advise and confer with the board concerning the public health aspects of any business, profession, or industry within the state of Colorado. Any committee established and appointed under the provisions of this section shall act only in an advisory capacity to the board and shall meet with the board at least once each year at such regular meeting of the board as may be designated by the board and at such other times as such committee may be called into meeting by the president of the board. Members of any special advisory committee shall serve without compensation but may, in the discretion of the board, be allowed actual and necessary traveling and subsistence expenses when in attendance at meetings away from their places of residence.
   8. Repealed.
2. The board shall act only by resolution adopted at a duly called meeting of the board, and no individual member of the board shall exercise individually any administrative authority with respect to the department.
3. In the exercise of its powers, the department shall not promulgate any rule or standard that limits or interferes with the ability of an individual to enter into a contract with a private pay facility concerning the programs or services provided at the private pay facility. For the purposes of this subsection (3), "private pay facility" means a skilled nursing facility or intermediate care facility subject to the requirements of section 25-1-120 or an assisted living residence licensed pursuant to section 25-27-105 that is not publicly funded or is not certified to provide services that are reimbursed from state or federal assistance funds.
4. and (5) Repealed.

Source: L. 47: p. 511, § 6. CSA: C. 78, § 21(6). CRS 53: § 66-1-8. L. 55: p. 428, § 2. L. 59: p. 468, § 2. C.R.S. 1963: § 66-1-8. L. 67: p. 345, § 16. L. 68: pp. 107, 108, §§ 77, 81. L. 75: (1)(c)(II) R&RE, p. 871, § 1, effective July 14; (1)(d) amended, p. 872, § 1, effective July 14. L. 77: (1)(d) amended, p. 308, § 12, effective June 10. L. 87: (1)(d) amended, p. 967, § 76, effective March 13. L. 92: (1)(g) added, p. 1236, § 3, effective August 1. L. 94: (1)(c)(V) added, p. 32, § 5, effective March 9; (1)(h) added, p. 565, § 13, effective April 6; (3) added, p. 2610, § 11, effective July 1. L. 96: (1)(g) repealed, p. 1284, § 1, effective June 1. L. 2000: (1)(c)(VI) added, p. 88, § 6, effective March 15; (4) added, p. 545, § 23, effective July 1. L. 2002: (3) amended and (5) added, p. 1328, § 15, effective July 1. L. 2003: (5) amended, p. 2007, § 84, effective May 22. L. 2006: (1)(c)(V) repealed, p. 1127, § 1, effective July 1. L. 2007: (5) amended, p. 2040, § 62, effective June 1. L. 2008: (5) repealed, p. 662, § 1, effective August 5. L. 2010: (1)(c)(VI) amended, (HB 10-1422), ch. 419, p. 2089, § 83, effective August 11. L. 2013: (1)(c)(VI) amended, (HB 13-1300), ch. 316, p. 1686, § 69, effective August 7. L. 2019: IP(1) amended and (1)(f) repealed, (SB 19-082), ch. 15, p. 58, § 2, effective August 2; (1)(c)(II) amended and (1)(c)(III) and (1)(c)(IV) repealed, (HB 19-1060), ch. 10, p. 39, § 2, effective August 2; (1)(c)(VI) amended, (SB 19-080), ch. 22, p. 78, § 2, effective August 2; (1)(h) repealed, (HB 19-1068), ch. 63, p. 228, § 2, effective August 2.

Editor's note: Subsection (4)(d) provided for the repeal of subsection (4), effective November 31, 2000, but the date was changed on revision to November 30, 2000. (See L. 2000, p. 545 .)

Cross references: (1) For the duty of the board to supervise registration of births and deaths, see article 2 of this title 25.

(2) For the legislative declaration contained in the 1994 act adding subsection (3), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration in SB 19-082, see section 1 of chapter 15, Session Laws of Colorado 2019. For the legislative declaration in HB 19-1060, see section 1 of chapter 10, Session Laws of Colorado 2019. For the legislative declaration in SB 19-080, see section 1 of chapter 22, Session Laws of Colorado 2019. For the legislative declaration in HB 19-1068, see section 1 of chapter 63, Session Laws of Colorado 2019.

25-1-108.5. Additional powers and duties of state board of health and department - programs that receive tobacco settlement moneys - definitions - monitoring - annual report. (Repealed)

Source: L. 2000: Entire section added, p. 592, § 2, effective May 18. L. 2002: (5) amended, p. 778, § 2, effective May 30. L. 2003: (5) amended, p. 1665, § 2, effective July 1. L. 2007: IP(3)(a) amended, p. 2040, § 63, effective June 1. L. 2010: (1), IP(2), and (5) amended, (SB 10-073), ch. 386, p. 1807, § 2, effective June 30. L. 2013: (1)(a), (1)(c), and IP(2) amended, (HB 13-1117), ch. 169, p. 589, § 22, effective July 1. L. 2015: Entire section repealed, (SB 15-189), ch. 104, p. 301, § 1, effective April 16.

25-1-108.7. Health care credentials uniform application act - legislative declaration - definitions - state board of health rules.

1. This section shall be known and may be cited as the "Health Care Credentials Uniform Application Act".
2. The purpose of the "Health Care Credentials Uniform Application Act" is to make credentialing more efficient, less costly, and less duplicative by making it uniform through the use of a single application form for the collection of core credentials data for use by entities.
3. As used in this section, unless the context otherwise requires:
   1. "Core credentials data" means data, information, or answers to questions that are collected and retained and that are common and necessary for the credentialing or recredentialing of a health care professional, but does not include additional nonduplicative credentials data deemed essential by a credentialing entity to complete credentialing.
   2. "Credentialing" means the process of assessing and validating the qualifications of a health care professional.
   3. "Credentialing entity" means any health care entity or health care plan that is engaged in the collection of information to be used in the process of credentialing or recredentialing of health care professionals.
   4. "Health care entity" means any of the following that require health professionals to submit credentials data:
      1. A health care facility or other health care organization licensed or certified to provide medical or health services in Colorado;
      2. A health care professional partnership, corporation, limited liability company, professional services corporation, or group practice;
      3. An independent practice association or physician-hospital organization;
      4. A professional liability insurance carrier; or
      5. An insurance company, health maintenance organization, or other entity that contracts for the provision of health benefits.
   5. "Health care plan" means any entity that is licensed by the division of insurance as a prepaid health care plan, health maintenance organization, or insurer and that requires the submission of credentials data.
   6. "Health care professional" means a physician, dentist, dental hygienist, chiropractor, podiatrist, psychologist, advanced practice nurse, optometrist, physician assistant, licensed clinical social worker, child health associate, marriage and family therapist, or other health care professional who is registered, certified, or licensed pursuant to title 12, C.R.S.; who is subject to credentialing; and who practices, or intends to practice, in Colorado.
   7. "Nonspecific credentials data" means credentials data that is aggregated and reported without reference to the identity of the individual health care professional to whom it pertains.
4. 1. Nothing in this section shall be construed to restrict the authority of any health care entity or health care plan to approve, suspend, or deny an application for insurance, staff membership, clinical privileges, or managed care network participation. This section shall not be construed to apply to the licensing activities of any board responsible for licensing health care professionals.
   2. Nothing in this section shall be construed to require a credentialing entity to use a particular credentialing process or to restrict or require such an entity from using a particular vendor in the credentialing process.
5. Upon the effective date of the rule established by the state board of health pursuant to paragraph (e) of subsection (6) of this section, a credentialing entity shall collect core credentials data through the use of the Colorado health care professional credentials application established pursuant to paragraph (a) of subsection (6) of this section. The form may be submitted electronically or by paper copy. The credentialing entity may require a health care professional to answer only select provisions of the application according to the needs of the entity. Questions that are prohibited by law shall not be included in the request for credentialing data by the credentialing entity.
6. 1. There is hereby established the health care credentials application review committee to recommend to the state board of health, and to periodically review, a single application form for the collection of core credentials data in this state. The form shall be known as the "Colorado health care professional credentials application". The review committee shall consist of the following eight members, who shall serve for terms of four years and who shall be appointed by the state board of health:
      1. One member representing a statewide association or society of physicians;
      2. One member representing a statewide association or society of Colorado hospitals;
      3. One member representing a statewide association or society of health plans;
      4. One member representing a professional liability insurance carrier domiciled in Colorado that provides professional liability insurance to health care professionals in Colorado;
      5. One member representing a statewide association or society of Colorado health care medical staff service specialists;
      6. One advanced practice nurse;
      7. Two members at large.
   2. Each board member may bring consultants and advisors to participate in board meetings. Consultants and advisors shall not have decision-making powers or voting privileges.
   3. The review committee shall be staffed by an entity approved by the Colorado medical board to collect medical license registration fees pursuant to section 12-240-131.
   4. Members of the review committee shall serve without compensation.
   5. Within one hundred twenty days after the time of appointment, the review committee shall make a recommendation to the state board of health regarding proposed contents of the Colorado health care professional credentials application. In accordance with section 24-4-103, C.R.S., the state board of health shall establish, by rule, the Colorado health care professional credentials application. The Colorado health care professional credentials application shall be the same as the provider application form developed by the council for affordable quality healthcare as of January 1, 2004, as modified, if necessary, to comply with Colorado law or as may be recommended by the majority of members of the review committee.
   6. The review committee shall meet at least annually to review and make any necessary recommendations for modifications to the Colorado health care professional credentials application to the state board of health.
   7. Initial appointments to the review committee shall be made on or before July 1, 2004. The state board of health shall appoint replacement members as necessary for a full committee.
   8. On or before September 1, 2008, the review committee shall make recommendations to the board concerning the feasibility of requiring all requests for additional credentials data deemed essential by a credentialing entity be uniform among all credentialing committees by July 1, 2009. On or before March 1, 2009, the review committee shall make recommendations to the board concerning the feasibility of requiring all Colorado health care professional credentials applications to be submitted through online electronic methods and that all health care entities required by this section to use the health care professional credentials application be required to accept and process the application through electronic means by January 1, 2010. If determined feasible by the board, the board shall establish by rule the standards, means, methods, and forms necessary to require the use of uniform supplemental questions and the submission, receipt, and processing of the health care professional credentials application electronically.
7. Core credentials data collected and retained on behalf of a credentialing entity shall not be modified without the approval of the credentialing entity.
8. The state board of health may promulgate rules as necessary to carry out the provisions of this section.
9. (Deleted by amendment, L. 2008, p. 688 , § 1, effective July 1, 2008.)

Source: L. 2004: Entire section added, p. 466, § 1, effective April 14. L. 2008: (2), (5), and (9) amended and (6)(h) added, pp. 688, 689, §§ 1, 2, effective July 1. L. 2010: (6)(c) amended, (HB 10-1260), ch. 403, p. 1990, § 85, effective July 1. L. 2019: (6)(c) amended, (HB 19-1172), ch. 136, p. 1695, § 138, effective October 1.

25-1-109. Powers and duties of division of administration.

1. In addition to the other powers and duties conferred and imposed in this part 1 upon the division of administration, the division, through the director or, upon the director's direction and under the director's supervision, through the other officers and employees of the division, has the following powers and duties:
   1. To administer and enforce the public health laws of the state of Colorado and the standards, orders, rules, and regulations established, issued, or adopted by the board;
   2. To exercise all powers and duties conferred and imposed upon the department not expressly delegated to the board by the provisions of this part 1;
   3. To hold hearings, administer oaths, subpoena witnesses, and take testimony in all matters relating to the exercise and performance of the powers and duties vested in or imposed upon the division of administration. The director may designate an administrative law judge appointed pursuant to part 10 of article 30 of title 24, C.R.S., to conduct hearings pursuant to section 24-4-105, C.R.S.
   4. Repealed.
   5. To supervise all subdivisions and boards of the department to determine that publications of the department and of any subdivisions thereof circulated in quantity outside the executive branch are issued in accordance with the provisions of section 24-1-136, C.R.S.;
   6. To appoint, pursuant to section 13 of article XII of the state constitution, a chief health inspector and such deputy inspectors as may be authorized. Such inspectors have the power to enter any workplace as provided in section 8-1-116, C.R.S. All expenses incurred by the division and its employees, pursuant to the provisions of this section, shall be paid from the funds appropriated for its use, upon approval of the director.
   7. Repealed.
   8. To administer and enforce the minimum general sanitary standards and regulations adopted pursuant to section 25-1.5-202.

Source: L. 47: p. 513, § 7. CSA: C. 78, § 21(7). CRS 53: § 66-1-9. C.R.S. 1963: § 66-1-9. L. 64: p. 140, § 68. L. 73: p. 917, § 1. L. 77: (1)(h) added, p. 1261, § 2, effective June 9; (1)(c) amended, p. 308, § 13, effective June 10. L. 80: (1)(f) amended and (1)(g) repealed, pp. 450, 451, §§ 5, 6, effective April 13. L. 83: (1)(d) and (1)(e) amended, p. 839, § 58, effective July 1. L. 87: (1)(c) amended, p. 967, § 77, effective March 13. L. 96: (1)(d) repealed, p. 1256, § 145, effective August 7. L. 2003: IP(1) and (1)(h) amended, p. 706, § 31, effective July 1.

Cross references: For the legislative declaration contained in the 1996 act amending this section, see section 1 of chapter 237, Session Laws of Colorado 1996.

25-1-110. Higher standards permissible.

Nothing in this part 1 shall prevent any incorporated city, city and county, town, county, or other political subdivision of the state from imposing and enforcing higher standards than are imposed under this part 1.

Source: L. 47: p. 513, § 7A. CSA: C. 78, § 21(8). CRS 53: § 66-1-10. C.R.S. 1963: § 66-1-10.

25-1-111. Revenues of department. (Repealed)

Source: L. 47: p. 514, § 9. CSA: C. 78, § 21(10). CRS 53: § 66-1-11. C.R.S. 1963: § 66-1-11. L. 87: (1) repealed, p. 1124, § 1, effective July 1. L. 2019: (2) repealed, (SB 19-082), ch. 15, p. 59, § 3, effective August 2.

Cross references: For the legislative declaration in SB 19-082, see section 1 of chapter 15, Session Laws of Colorado 2019.

25-1-112. Legal adviser - attorney general - actions.

The attorney general is the legal adviser for the department and shall defend it in all actions and proceedings brought against it. The district attorney of the judicial district in which a cause of action arises shall bring any civil or criminal action requested by the executive director of the department to abate a condition that exists in violation of, or to restrain or enjoin any action that is in violation of, or to prosecute for the violation of or for the enforcement of, the public health laws and the standards, orders, and rules of the department established by or issued under the provisions of this part 1. If the district attorney fails to act, the executive director may bring any such action and shall be represented by the attorney general or by special counsel.

Source: L. 47: p. 514, § 10. CSA: C. 78, § 21(11). CRS 53: § 66-1-12. C.R.S. 1963: § 66-1-12. L. 2019: Entire section amended, (SB 19-021), ch. 3, p. 20, § 2, effective August 2.

Cross references: For the legislative declaration in SB 19-021, see section 1 of chapter 3, Session Laws of Colorado 2019.

25-1-113. Judicial review of decisions.

1. Any person aggrieved and affected by a decision of the board or the executive director of the department is entitled to judicial review by filing in the district court of the county of his residence, or of the city and county of Denver, within ninety days after the public announcement of the decision, an appropriate action requesting such review. The court may make any interested person a party to the action. The review shall be conducted by the court without a jury and shall be confined to the record, if a complete record is presented; except that, in cases of alleged irregularities in the record or in the procedure before the board or the division of administration, testimony may be taken in the court. The court may affirm the decision or may reverse or modify it if the substantial rights of the appellant have been prejudiced as a result of the findings and decisions of the board being: Contrary to constitutional rights or privileges; or in excess of the statutory authority or jurisdiction of the board or the executive director of the department; or affected by any error of law; or made or promulgated upon unlawful procedure; or unsupported by substantial evidence in view of the entire record as submitted; or arbitrary or capricious.
2. Any party may have a review of the final judgment or decision of the district court by appellate review in accordance with law and the Colorado appellate rules.

Source: L. 47: p. 514, § 11. CSA: C. 78, § 21(12). CRS 53: § 66-1-13. C.R.S. 1963: § 66-1-13.

25-1-114. Unlawful acts - penalties.

1. It is unlawful for any person, association, or corporation, and the officers thereof:
   1. To willfully violate, disobey, or disregard the provisions of the public health laws or the terms of any lawful notice, order, standard, rule, or regulation issued pursuant thereto; or
   2. To fail to make or file reports required by law or rule of the board relating to the existence of disease or other facts and statistics relating to the public health; or
   3. To conduct any business or activity over which the department possesses the power to license and regulate without such license or permit as required by the department; or
   4. To willfully and falsely make or alter any certificate or license or certified copy thereof issued pursuant to the public health laws; or
   5. To knowingly transport or accept for transportation, interment, or other disposition a dead body without an accompanying permit issued in accordance with the public health laws or the rules of the board; or
   6. To willfully fail to remove from private property under his control at his own expense, within forty-eight hours after being ordered so to do by the health authorities, any nuisance, source of filth, or cause of sickness within the jurisdiction and control of the department, whether such person, association, or corporation is the owner, tenant, or occupant of such private property; except that, if such condition is due to an act of God, it shall be removed at public expense; or
   7. To pay, give, present, or otherwise convey to any officer or employee of the department any gift, remuneration, or other consideration, directly or indirectly, which such officer or employee is forbidden to receive by the provisions of this part 1; or
   8. To make, install, maintain, or permit any cross-connection between any water system supplying drinking water to the public and any pipe, plumbing fixture, or water system which contains water of a quality below the minimum general sanitary standards as to the quality of drinking water supplied to the public or to fail to remove such connection within ten days after being ordered in writing by the department to remove the same. For the purposes of this paragraph (h), "cross-connection" means any connection which would allow water to flow from any pipe, plumbing fixture, or water system into a water system supplying drinking water to the public.
   9. To sell or offer for sale any raw milk, milk product, or unsanitary dairy product, as defined in section 25-5.5-104, for other than human consumption unless it has first been treated with a dye approved by the department; or
   10. To violate section 25-3-122.
2. It is unlawful for any officer or employee of the department or member of the board to accept any gift, remuneration, or other consideration, directly or indirectly, for an incorrect or improper performance of the duties imposed upon him by or on behalf of the department.
3. It is unlawful:
   1. For any officer or employee of the department to perform any work, labor, or services other than the duties assigned to him by or on behalf of the department during the hours such officer or employee is regularly employed by the department, or to perform his duties as an officer or employee of the department under any condition or arrangement that involves a violation of this or any other law of the state of Colorado;
   2. For any officer or employee of the department other than members of the board to perform any work, labor, or services which consist of the private practice of medicine, veterinary surgery, sanitary engineering, nursing, or any other profession which is or may be of special benefit to any private person, association, or corporation as distinguished from the department or the public generally, and which is performed by such officer or employee, directly or indirectly, for remuneration, whether done in an active, advisory, or consultative capacity or performed within or without the hours such officer or employee is regularly employed by the department.
4. Except as provided in subsection (5) of this section, any person, association, or corporation, or the officers thereof, who violates any provision of this section is guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not more than one thousand dollars, or by imprisonment in the county jail for not more than one year, or by both such fine and imprisonment and, in addition to such fine and imprisonment, shall be liable for any expense incurred by health authorities in removing any nuisance, source of filth, or cause of sickness. Conviction under the penalty provisions of this part 1 or any other public health law shall not relieve any person from any civil action in damages that may exist for an injury resulting from any violation of the public health laws.
5. 1. It is unlawful for any person, association, or corporation, or the officers thereof, to tamper, attempt to tamper, or threaten to tamper with a public water system or with drinking water after its withdrawal for or treatment by a public water system. For purposes of this subsection (5), "tamper" means to introduce a contaminant into a public water system or into drinking water or to otherwise interfere with drinking water or the operation of a public water system with the intention of harming persons or the public water system. "Tamper" does not include the standardized and accepted treatment procedures performed by a supplier of water in preparing water for human consumption.
   2. 1. Any person, association, or corporation, or the officers thereof, who tampers with a public water system or with drinking water after its withdrawal for or treatment by a public water system commits a class 3 felony and shall be punished as provided in section 18-1.3-401, C.R.S.
      2. Any person, association, or corporation, or the officers thereof, who attempts to tamper or threatens to tamper with a public water system or with drinking water after its withdrawal for or treatment by a public water system commits a class 5 felony and shall be punished as provided in section 18-1.3-401, C.R.S.
      3. Conviction under this subsection (5) shall not relieve any person from a civil action initiated pursuant to section 25-1-114.1.

Source: L. 47: p. 515, § 12. CSA: C. 78, § 21(13). CRS 53: § 66-1-14. C.R.S. 1963: § 66-1-14. L. 64: p. 478, § 2. L. 75: (1)(i) added, p. 870, § 2, effective June 20. L. 86: (1)(i) amended, p. 1220, § 25, effective May 30. L. 87: (4) amended and (5) added, p. 610, § 21, effective July 1. L. 2002: (5)(b)(I) and (5)(b)(II) amended, p. 1536, § 262, effective October 1. L. 2019: (1)(j) added, (HB 19-1174), ch. 171, p. 1995, § 7, effective January 1, 2020.

Cross references: For the legislative declaration contained in the 2002 act amending this section, see section 1 of chapter 318, Session Laws of Colorado 2002.

25-1-114.1. Civil remedies and penalties.

1. The division of administration of the department may institute a civil action or administrative action, as described in subsection (2.5) of this section, against any person who violates a final enforcement order of the department issued for a violation of any minimum general sanitary standard or regulation adopted pursuant to section 25-1.5-202. Such civil action shall be brought in the district court of the county in which the violation of the standard or regulation is alleged to have occurred.
2. Upon finding that a final enforcement order of the department has been violated and that the violation of the standard or regulation described in the order in fact occurred, the court shall:
   1. Impose a civil penalty on the violator of not more than one thousand dollars per day for each day the violation of the standard or regulation occurred if the court determines the violation was willful; or
   2. Enter such order as the public health may require, taking into consideration, where appropriate, the cost and time necessary to comply; or
   3. Impose such civil penalty and enter such order.
   1. (2.5) (a) Any person who violates any minimum general sanitary standard and regulation promulgated pursuant to section 25-1.5-202 or 25-1-114 (1)(h), or any final enforcement order issued by the department, shall be subject to an administrative penalty as follows:
      1. For systems that serve a population of more than ten thousand people, an amount not to exceed one thousand dollars per violation per day; or
      2. For systems that serve a population of ten thousand people or less, an amount not to exceed one thousand dollars per violation per day, but only in an amount, as determined by the division, that is necessary to ensure compliance.
   2. Penalties under this subsection (2.5) shall be determined by the executive director or the executive director's designee and may be collected by the division of administration by an action instituted in a court of competent jurisdiction for collection of such penalty. The final decision of the executive director or the executive director's designee may be appealed to the water quality control commission, created pursuant to section 25-8-201. A stay of any order of the division ending judicial review shall not relieve any person from any liability with respect to past or continuing violations of any minimum general sanitary standard or any regulation promulgated pursuant to section 25-1.5-202 or 25-1-114 (1)(h), but the reason for the request for judicial review shall be considered in the determination of the amount of the penalty. In the event that such an action is instituted for the collection of such penalty, the court may consider the appropriateness of the amount of the penalty, if such issue is raised by the party against whom the penalty was assessed. Any administrative penalty collected under this section shall be credited to the general fund.
3. The department may request the attorney general to bring a suit for a temporary restraining order or a preliminary or permanent injunction to prevent or abate any violation of a minimum general sanitary standard or regulation adopted pursuant to section 25-1.5-202 or to prevent or abate any release or imminent release that causes or is likely to cause contamination resulting in liability under section 25-1.5-207, and the department, in such a suit, may collect, on behalf of political subdivisions or public water systems, the damages incurred by such political subdivisions or public water systems under section 25-1.5-207. The department shall pay to such political subdivisions or public water systems all damages collected on their behalf. The department is not required to issue an enforcement order prior to institution of such a suit. Upon a de novo finding by the court that such a violation has occurred, is occurring, or is about to occur or that such release or imminent release exists, the court may enjoin such violation, release, or imminent release and enter such order as the public health may require, taking into consideration, where appropriate, the cost and time necessary to comply. An enforcement settlement with the state under the provisions of this subsection (3) shall bar a separate action by a political subdivision or public water system under section 25-1.5-207 whenever notice and adequate opportunity to comment on the proposed settlement have been given to the political subdivision or public water system, damages have been collected on behalf of and paid to such political subdivision or public water system by the state, and the release or imminent release has been prevented or abated by means of the settlement.
4. Suits brought pursuant to subsection (3) of this section shall be brought in the district court of the county in which the violation is alleged to have occurred. The institution of such a suit by the division of administration shall confer upon such court exclusive jurisdiction to determine finally the subject matter of the proceeding; except that the exclusive jurisdiction of the court shall apply only to such proceeding and shall not preclude assessment of any civil penalties or any other enforcement action or sanction authorized by this section.

   (4.5) An action for civil penalties under this section may be joined with a civil action to recover the state's costs pursuant to subsection (3) of this section.

5. The powers of the department established by this section shall be in addition to, and not in derogation of, any powers of the department.
6. 1. The attorney general, at the request of the department, or the district attorney of the county in which an affected public water system is located or the attorney of the supplier of water may institute a civil action against any person, association, or corporation, or the officers thereof, who tampers, attempts to tamper, or threatens to tamper with a public water system or with drinking water after its withdrawal for or treatment by a public water system. Such action shall be brought in the district court of the county in which the violation is alleged to have occurred. As used in this subsection (6), "tamper" means to introduce a contaminant into a public water system or into drinking water or to otherwise interfere with drinking water or the operation of a public water system with the intention of harming persons or public water systems. "Tamper" does not include the standardized and accepted treatment procedures performed by a supplier of water in preparing water for human consumption.
   2. Upon finding that tampering, attempting to tamper, or threatening to tamper has occurred, the court shall have the authority to:
      1. Order appropriate injunctive relief;
      2. Impose a civil penalty on the violator of not more than fifty thousand dollars for each act of tampering or of not more than twenty thousand dollars for each act of attempting to tamper or threatening to tamper;
      3. Impose on the violator all costs incurred by the state and by the affected public water system in assessing and remedying all consequences of the tampering, attempting to tamper, or threatening to tamper; and
      4. Impose on the violator all court costs associated with remedying consequences of the tampering, attempting to tamper, or threatening to tamper.
7. Any person subject to an action brought pursuant to subsection (3) of this section or section 25-1.5-207 shall have an affirmative defense to such action if such person's potential liability results from a discharge of contaminants or substances authorized by and in substantial compliance with an existing federal or state permit which controls the quality of the release of the contaminant or substance.

Source: L. 77: Entire section added, p. 1262, § 1, effective July 1. L. 83: (1) and (2) amended and (3) and (5) added, p. 1029, § 1, effective July 1. L. 87: (6) added, p. 610, § 22, effective July 1. L. 88: (3) amended and (4.5) and (7) added, p. 996, § 3, effective May 11. L. 98: (1) amended and (2.5) added, p. 889, § 2, effective August 5. L. 2003: (1), IP(2.5)(a), (2.5)(b), (3), and (7) amended, p. 706, § 32, effective July 1. L. 2008: (2.5)(b) amended, p. 430, § 1, effective August 5.

25-1-114.5. Voluntary disclosure arising from self-evaluation - presumption against imposition of administrative or civil penalties.

1. For the purposes of this section, a disclosure of information by a person or entity to any division or agency within the department of public health and environment regarding any information related to an environmental law is voluntary if all of the following are true:
   1. The disclosure is made promptly after knowledge of the information disclosed is obtained by the person or entity;
   2. The disclosure arises out of a voluntary self-evaluation;
   3. The person or entity making the disclosure initiates the appropriate effort to achieve compliance, pursues compliance with due diligence, and corrects the noncompliance within two years after the completion of the voluntary self-evaluation. Where such evidence shows the noncompliance is the failure to obtain a permit, appropriate efforts to correct the noncompliance may be demonstrated by the submittal of a complete permit application within a reasonable time.
   4. The person or entity making the disclosure cooperates with the appropriate division or agency in the department of public health and environment regarding investigation of the issues identified in the disclosure.
2. For the purposes of paragraph (c) of subsection (1) of this section, upon application to and at the discretion of the department of public health and environment, the time period within which the noncompliance is required to be corrected may be extended if it is not practicable to correct the noncompliance within the two-year period. A request for a de novo review of the decision of the department of public health and environment may be made to the appropriate district court or administrative law judge.
3. If a person or entity is required to make a disclosure to a division or agency within the department of public health and environment under a specific permit condition or under an order issued by the division or agency, then the disclosure is not voluntary with respect to that division or agency.
4. If any person or entity makes a voluntary disclosure of an environmental violation to a division or agency within the department of public health and environment, then there is a rebuttable presumption that the disclosure is voluntary and therefore the person or entity is immune from any administrative and civil penalties associated with the issues disclosed and is immune from any criminal penalties for negligent acts associated with the issues disclosed. The person or entity shall provide information supporting its claim that the disclosure is voluntary at the time that the disclosure is made to the division or agency.
5. To rebut the presumption that a disclosure is voluntary, the appropriate division or agency shall show to the satisfaction of the respective commission in the department of public health and environment or the state board of health, if no respective commission exists, that the disclosure was not voluntary based upon the factors set forth in subsections (1), (2), and (3) of this section. A decision by the commission or the state board of health, whichever is appropriate, regarding the voluntary nature of a disclosure is final agency action. The division or agency may not include any administrative or civil penalty or fine or any criminal penalty or fine for negligent acts in a notice of violation or in a cease-and-desist order on any underlying environmental violation that is alleged absent a finding by the respective commission or the state board of health that the division or agency has rebutted the presumption of voluntariness of the disclosure. The burden to rebut the presumption of voluntariness is on the division or agency.
6. The elimination of administrative, civil, or criminal penalties under this section does not apply if a person or entity has been found by a court or administrative law judge to have committed serious violations that constitute a pattern of continuous or repeated violations of environmental laws, rules, regulations, permit conditions, settlement agreements, or orders on consent and that were due to separate and distinct events giving rise to the violations, within the three-year period prior to the date of the disclosure. Such a pattern of continuous or repeated violations may also be demonstrated by multiple settlement agreements related to substantially the same alleged violations concerning serious instances of noncompliance with environmental laws that occurred within the three-year period immediately prior to the date of the voluntary disclosure.
7. Except as specifically provided in this section, this section does not affect any authority the department of public health and environment has to require any action associated with the information disclosed in any voluntary disclosure of an environmental violation.
8. Unless the context otherwise requires, the definitions contained in section 13-25-126.5 (2), C.R.S., apply to this section.
9. This section applies to voluntary disclosures that are made and voluntary self-evaluations that are performed on or after June 1, 1994.

Source: L. 94: Entire section added, p. 1870, § 3, effective June 1; IP(1), (1)(d), (2), (3), (4), (5), and (7) amended, p. 2618, § 30, effective July 1. L. 99: (9) amended, p. 301, § 3, effective April 14.

Cross references: For the legislative declaration contained in the 1994 act amending the introductory portion to subsection (1) and subsections (1)(d), (2), (3), (4), (5), and (7), see section 1 of chapter 345, Session Laws of Colorado 1994.

25-1-114.6. Implementation of environmental self-audit law - pilot project - legislative declaration.

1. 1. The general assembly hereby finds and determines that, in order to encourage the regulated community to utilize the environmental self-audit provisions contained in this section and sections 25-1-114.5, 13-25-126.5, and 13-90-107 (1)(j), C.R.S., a pilot project is established. The general assembly hereby declares that the purpose of the environmental self-audit provisions contained in this section and sections 25-1-114.5, 13-25-126.5, and 13-90-107 (1)(j), C.R.S., is to encourage the regulated community to voluntarily identify environmental concerns and to address them expeditiously without fear of enforcement action by regulatory agencies. The general assembly recognizes that, due to concerns with the environmental self-audit provisions, the United States environmental protection agency has, in the past, taken direct action against entities in the regulated community that have made disclosures under the environmental self-audit provisions. The general assembly further declares that the pilot project enacted by this section is intended to allow entities to proceed under the environmental self-audit provisions with assurance that, if any such entity complies with such environmental self-audit provisions, the United States environmental protection agency will forego any enforcement action based on the disclosures made and addressed under the environmental self-audit pilot project.
   2. The general assembly further recognizes that, under the pilot project enacted by this section, the department of public health and environment will have discretion to consider certain factors in assessing a regulated entity's eligibility for penalty immunity under the environmental laws. The general assembly intends that this additional flexibility to assess an entity's eligibility, along with the protection from federal overfiling that the pilot project provides, will encourage entities to participate in the project and allow the department of public health and environment to assess the effectiveness of the environmental self-audit provisions.
   3. The provisions of this section shall only apply to disclosures made under this section and sections 25-1-114.5, 13-25-126.5, and 13-90-107 (1)(j), C.R.S., after the department of public health and environment and the United States environmental protection agency have entered into a memorandum of agreement binding Colorado and the federal government to enforce environmental laws in a manner consistent with the provisions of this section.
2. Notwithstanding the provisions of sections 25-1-114.5 (4) and (5), 13-25-126.5, and 13-90-107 (1)(j), C.R.S., on and after May 30, 2000, the department of public health and environment may assess penalties for criminal negligence when available under federal environmental law.
3. 1. In addition to the provisions of subsection (2) of this section, notwithstanding the provisions of sections 25-1-114.5 (4) and (5), 13-25-126.5, and 13-90-107 (1)(j), C.R.S., on and after May 30, 2000, in determining whether an entity is entitled to penalty immunity under the provisions of section 25-1-114.5, the department of public health and environment may consider:
      1. Whether the activities disclosed may create imminent and substantial endangerment of, or result in serious harm to, public health and the environment; and
      2. Whether the activities disclosed conferred an unfair or excessive economic benefit on the disclosing entity.
   2. Notwithstanding any provision of sections 25-1-114.5 (4) and (5), 13-25-126.5, and 13-90-107 (1)(j), C.R.S., the department of public health and environment has discretion to determine whether and to what degree the factors in paragraph (a) of this subsection (3) apply given the particular circumstances of each situation.
4. The pilot project created by this section applies to voluntary disclosures made under this section and sections 25-1-114.5, 13-25-126.5, and 13-90-107 (1)(j), C.R.S., on and after the effective dates of both this section (May 30, 2000) and the memorandum of agreement entered into under paragraph (c) of subsection (1) of this section.
5. Pursuant to the procedures set forth in section 13-25-126.5, C.R.S., the department of public health and environment may obtain access to an environmental self-audit report where the department of public health and environment has independent evidence of any criminal violation of an environmental law. Evidence of a criminal violation constitutes "compelling circumstances" for purposes of section 13-25-126.5 (3)(c), C.R.S., where the department of public health and environment seeks access to an environmental self-audit report. When a self-audit report is obtained, reviewed, or used in a criminal proceeding under this subsection (5), the privilege provided in section 13-25-126.5, C.R.S., applicable to civil or administrative proceedings is not waived or eliminated.
6. Repealed.

Source: L. 2000: Entire section added, p. 1377, § 1, effective May 30. L. 2008: (6) repealed, p. 1906, § 98, effective August 5.

25-1-115. Treatment - religious belief.

Nothing in this part 1 shall authorize the department to impose any mode of treatment inconsistent with the religious faith or belief of any person.

Source: L. 47: p. 517, § 15. CSA: C. 78, § 21(14). CRS 53: § 66-1-15. C.R.S. 1963: § 66-1-15.

25-1-116. Licensed healing systems not affected.

Nothing in this part 1 shall be construed or used to amend or restrict any statute in force pertaining to the scope of practice of any state licensed healing system.

Source: L. 47: p. 518, § 16. CSA: C. 78, § 21(15). CRS 53: § 66-1-16. C.R.S. 1963: § 66-1-16.

25-1-117. Acquisition of federal surplus property.

The governor of the state of Colorado is authorized, for and on behalf of the state of Colorado, to make application for and secure the transfer to the state of Colorado of federal surplus property for the purpose of establishing state public health facilities in the state of Colorado; and to do and perform any acts and things which may be necessary to carry out the above, including the preparing, making, and filing of plans, applications, reports, and other documents, and the execution, acceptance, delivery, and recordation of agreements, deeds, and other instruments pertaining to the transfer of said property. The governor is further authorized to expend available general revenue funds, or such other funds as may be made available by the general assembly, for the purpose of making the above application and securing the transfer of said property in accordance with federal laws and with rules and regulations and requirements of the United States department of health, education, and welfare.

Source: L. 59: p. 473, § 1. CRS 53: § 66-1-22. C.R.S. 1963: § 66-1-22.

Cross references: For changes relating to the structure of the United States department of health, education, and welfare, see Public Law 96-88, Title III, section 301, and Title V, section 509, Oct. 17, 1979, 93 Stat. 677, 695.

25-1-118. Rental properties - salvage - fund created - repeal. (Repealed)

Source: L. 60: p. 145, § 1. CRS 53: § 66-1-23. C.R.S. 1963: § 66-1-23. L. 94: (1) amended, p. 2701, § 253, effective July 1. L. 2008: Entire section amended, p. 1345, § 2, effective May 27.

Editor's note: Subsection (4) provided for the repeal of this section effective July 1, 2008. (See L. 2008, p. 1345 .)

25-1-119. Disposition and expenditures of moneys from fund. (Repealed)

Source: L. 60: p. 145, § 2. CRS 53: § 66-1-24. C.R.S. 1963: § 66-1-24. L. 94: (1)(a) amended, p. 2701, § 254, effective July 1. L. 2008: Entire section repealed, p. 1345, § 3, effective May 27.

25-1-120. Nursing facilities - rights of patients.

1. The department shall require all skilled nursing facilities and intermediate care facilities to adopt and make public a statement of the rights and responsibilities of the patients who are receiving treatment in such facilities and to treat their patients in accordance with the provisions of said statement. The statement shall ensure each patient the following:
   1. The right to civil and religious liberties, including knowledge of available choices and the right to independent personal decisions, which will not be infringed upon, and the right to encouragement and assistance from the staff of the facility in the fullest possible exercise of these rights;
   2. The right to have private and unrestricted communications with any person of his choice;
   3. The right to present grievances on behalf of himself or others to the facility's staff or administrator, to governmental officials, or to any other person, without fear of reprisal, and to join with other patients or individuals within or outside of the facility to work for improvements in patient care;
   4. The right to manage his own financial affairs or to have a quarterly accounting of any financial transactions made in his behalf, should he delegate such responsibility to the facility for any period of time;
   5. The right to be fully informed, in writing, prior to or at the time of admission and during his stay, of services available in the facility and of related charges, including charges for services not covered under medicare or medicaid or not covered by the basic per diem rate;
   6. The right to be adequately informed of his medical condition and proposed treatment, unless otherwise indicated by his physician, and to participate in the planning of all medical treatment, including the right to refuse medication and treatment, unless otherwise indicated by his physician, and to know the consequences of such actions;
   7. The right to receive adequate and appropriate health care consistent with established and recognized practice standards within the community and with skilled and intermediate nursing care facility rules and regulations as promulgated by the department;
   8. The right to have privacy in treatment and in caring for personal needs, confidentiality in the treatment of personal and medical records, and security in storing and using personal possessions;
   9. The right to be treated courteously, fairly, and with the fullest measure of dignity and to receive a written statement of the services provided by the facility, including those required to be offered on an as-needed basis;
   10. The right to be free from mental and physical abuse and from physical and chemical restraints, except those restraints initiated through the judgment of the professional staff for a specified and limited period of time or on the written authorization of a physician;
   11. The right to be transferred or discharged only for medical reasons or his welfare, or that of other patients, or for nonpayment for his stay and the right to be given reasonable advance notice of any transfer or discharge, except in the case of an emergency as determined by the professional staff;
   12. The right to devolution of his or her rights and responsibilities upon a sponsor, guardian, or person exercising rights contained in a designated beneficiary agreement executed pursuant to article 22 of title 15, C.R.S., who shall see that he or she is provided with adequate, appropriate, and respectful medical treatment and care and all rights which he or she is capable of exercising should he or she be determined to be incompetent pursuant to law and not be restored to legal capacity;
   13. The right to freedom of choice in selecting a health care facility;
   14. The right to copies of the facility's rules and regulations and an explanation of his responsibility to obey all reasonable rules and regulations of the facility and to respect the personal rights and private property of the other patients.

   (1.5) If a facility requires a lease agreement with a provision requiring in excess of a month-to-month tenancy and the lease agreement results in or requires forfeiture of more than thirty days of rent if a patient moves due to a medical condition or dies during the term of the lease agreement, then the lease agreement shall be deemed to be against public policy and shall be void; except that inclusion of such a provision shall not render the remainder of the contract or lease agreement void. A contract provision or lease agreement that requires forfeiture of rent for thirty days after the patient moves due to a medical condition or dies does not violate this section. The provisions regarding forfeiture of rent shall appear on the front page of the contract or lease agreement and shall be printed in no less than twelve-point bold-faced type. The provisions shall read as follows:

   This lease agreement is for a month-to-month tenancy. The lessor shall not require the forfeiture of rent beyond a thirty-day period if the lessee moves due to a medical condition or dies during the term of the lease.

2. Each skilled nursing facility or intermediate care facility shall provide a copy of the statement required by subsection (1) of this section to each patient or his guardian at or before the patient's admission to a facility and to each staff member of a facility. Each such facility shall prepare a written plan and provide appropriate staff training to implement the provisions of this section.
3. Each skilled nursing facility or intermediate care facility shall prepare a written plan and provide appropriate facilities to ensure that the rights guaranteed by subsection (1) of this section are enforced by a grievance procedure which contains the following procedures and rights:
   1. A resident of any facility, the residents' advisory council, or the sibling, child, spouse, parent, or person exercising rights contained in a designated beneficiary agreement executed pursuant to article 22 of title 15, C.R.S., of any resident may formally complain in the manner described in this subsection (3) about any conditions, treatment, or violations of his or her rights by the facility or its staff or about any treatment, conditions, or violations of the rights of any other resident, regardless of the consent of the victim of the alleged improper treatment, condition, or violation of rights by the facility or its staff.
   2. Each facility shall designate one full-time staff member, referred to in this subsection (3) as the "designee", to receive all grievances when they are first made.
   3. Each facility shall establish a grievance committee consisting of the chief administrator of the facility or his designee, a resident selected by the resident population of the facility, and a third person to be agreed upon by the administrator and the resident representative.
   4. If anyone designated in paragraph (a) of this subsection (3) wishes to complain about treatment, conditions, or violations of rights, he shall write or cause to be written his grievance or shall state it orally to the designee no later than fourteen days after the occurrence giving rise to the grievance. The designee shall confer with persons involved in the occurrence and with any other witnesses and, no later than three days after the grievance, give a written explanation of findings and proposed remedies, if any, to the complainant and to the aggrieved party, if someone other than the complainant. Where appropriate because of the mental or physical condition of the complainant or the aggrieved party, the written explanation shall be accompanied by an oral explanation.
   5. If the complainant or aggrieved party is dissatisfied with the findings and remedies or the implementation thereof, he may then make the same grievance orally or in writing, with any additional comments or information, to the grievance committee no later than ten days after the receipt of the explanation from the designee. Said committee shall confer with persons involved in the occurrence and with any other witnesses and, no later than ten days after the appeal from the designee, give a written explanation of its findings and proposed remedies, if any, to the complainant and to the aggrieved party, if someone other than the complainant. Where appropriate because of the mental or physical condition of the complainant or the aggrieved party, the written explanation shall be accompanied by an oral explanation.
4. Each skilled nursing facility or intermediate care facility shall also establish a residents' advisory council which shall consist of not less than five members selected by and from the resident population of the facility. The council shall meet at least once a month with the administrator of the facility and a representative of the staff to make recommendations concerning policies of the facility. The council may also present grievances to the grievance committee on behalf of a resident.
5. If a complainant or aggrieved party is dissatisfied with the findings and remedies of the grievance committee or implementation thereof, except for grievances against a physician or his prescribed treatment, he may file the same grievance in writing with the executive director of the department. The department shall investigate the facts and circumstances of the grievance and make findings of fact, conclusions, and recommendations, copies of which shall be transmitted to the complainant and the nursing home administrator. If the complainant or the nursing home administrator is aggrieved by the findings and the recommendations of the department, the aggrieved party may request a hearing to be conducted by the department pursuant to section 24-4-105, C.R.S. The board shall adopt rules and regulations to carry out the intent of this section.
6. Implementation of this section shall be pursuant to section 25.5-6-204, C.R.S.
7. Nothing in this section shall apply to any nursing institution conducted by or for the adherents of any well-recognized church or religious denomination for the purpose of providing facilities for the care and treatment of the sick who depend exclusively upon spiritual means through prayer for healing in the practice of the religion of such church or denomination.
8. 1. A patient who is eligible to receive medicaid benefits pursuant to articles 4, 5, and 6 of title 25.5, C.R.S., and who qualifies for nursing facility care shall have the right to select any nursing care facility recommended for certification by the department of public health and environment under Title XIX of the federal "Social Security Act", as amended, as a provider of medicaid services and licensed by the department pursuant to article 3 of this title where space is available, and the department of health care policy and financing shall reimburse the selected facility for services pursuant to section 25.5-6-204, C.R.S., unless such nursing care facility shall have been notified by the department of health care policy and financing that it may not qualify as a provider of medicaid services.
   2. A patient who is residing in such nursing care facility shall be assured the resident rights which are provided by section 4211 of Title IV of the federal "Omnibus Budget Reconciliation Act of 1987", as amended, Pub.L. 100-203. Failure to protect and promote those rights shall subject the violating facility to sanctions imposed by the department.
9. A patient who is eligible to receive benefits from a skilled or intermediate nursing care facility certified by the department under Title XVIII of the federal "Social Security Act", as amended, as a provider of medicare services shall be assured the same rights as provided in paragraph (a) of subsection (8) of this section.

In circumstances in which the patient moves due to a medical condition or dies during the term of a contract or lease agreement, the facility shall return that part of the rent paid in excess of thirty days' rent after a patient moves or dies to the patient or the patient's estate. The facility may assess daily rental charges for any days in which the former or deceased patient's personal possessions remain in the patient's room after the period for which the patient has paid rent and for the usual time to clean the room after the patient's personal possessions have been removed. The facility shall have forty-five days after the date the patient's personal possessions have been removed from the patient's room to reconcile the patient's accounts and to return any moneys owed. This subsection (1.5) applies to any facility, or a distinct part of a facility, that meets the state nursing home licensing standards set forth in section 25-1.5-103 (1)(a)(I) and the licensing requirements specified in section 25-3-101. For purposes of this section, "daily rental charges" means an amount not to exceed one-thirtieth of thirty days' rental amount plus reasonable expenses.

Source: L. 75: Entire section added, p. 873, § 1, effective July 1. L. 76: (8) added, p. 640, § 1, effective May 26. L. 89: (3)(a) and (8) amended and (9) added, p. 1144, § 1, effective April 4. L. 91: (6) and (8)(a) amended, p. 1856, § 13, effective April 11. L. 94: (8)(a) amended, p. 2624, § 42, effective July 1. L. 2006: (6) and (8)(a) amended, p. 2012, § 81, effective July 1; (1.5) added, p. 253, § 1, effective January 1, 2007. L. 2009: (1)(l) and (3)(a) amended, (HB 09-1260), ch. 107, p. 448, § 18, effective July 1.

Cross references: For the legislative declaration contained in the 1994 act amending subsection (8)(a), see section 1 of chapter 345, Session Laws of Colorado 1994.

25-1-121. Patient grievance mechanism - institution's obligations to patient.

1. As used in this section, "institution" means every hospital or related facility or institution having in excess of fifty beds and required to be licensed under part 1 of article 3 of this title or required to be certified pursuant to section 25-1.5-103 (1)(a)(II), except skilled nursing facilities and intermediate care facilities which are subject to the provisions of section 25-1-120.
2. The department shall require every institution to submit to the department a plan for a patient grievance mechanism and a policy statement with respect to the obligations of the institution to patients using the facilities of such institution. The plan and policy statement must meet with the approval of the department prior to certification of compliance or issuance or renewal of a license.
3. A patient grievance mechanism plan shall include, but not be limited to:
   1. A provision for a patient representative to serve as a liaison between the patient and the institution;
   2. A description of the qualifications of the patient representative;
   3. An outline of the job description of the patient representative;
   4. A description of the amount of decision-making authority given to the patient representative;
   5. A method by which each patient will be made aware of the patient representative program and how the representative of the program may be contacted.
4. The policy statement with respect to the obligations of the institution to patients using facilities of such an institution shall be posted conspicuously in a public place on its premises and made available to each patient upon admission. Such policy statement shall include, but need not be limited to, a clarification of a physician's duty to provide informed consent, admission procedures, staff identification, privacy, medical records, billing procedures, and the obligation of the physician to provide information regarding research, experimental, or educational projects relating to the patient's own case. Nothing in this section shall apply to any nursing institution conducted by or for the adherents of any well-recognized church or religious denomination for the purpose of providing facilities for the care and treatment of the sick who depend exclusively upon spiritual means through prayer for healing in the practice of the religion of such church or denomination.

Source: L. 76: Entire section added, p. 640, § 2, effective May 26. L. 2003: (1) amended, p. 708, § 33, effective July 1.

25-1-122. Named reporting of certain diseases and conditions - access to medical records - confidentiality of reports and records.

1. With respect to investigations of epidemic and communicable diseases, morbidity and mortality, cancer in connection with the statewide cancer registry, environmental and chronic diseases, sexually transmitted infections, tuberculosis, and rabies and mammal bites, the board has the authority to require reporting, without patient consent, of occurrences of those diseases and conditions by any person having knowledge of such to the state department of public health and environment and county, district, and municipal public health agencies, within their respective jurisdictions. Any required reports must contain the name, address, age, sex, and diagnosis and other relevant information as the board determines is necessary to protect the public health. The board shall set the manner, time period, and form in which the reports are to be made. The board may limit reporting for a specific disease or condition to a particular region or community or for a limited period of time.
2. When investigating diseases and conditions pursuant to subsection (1) of this section, authorized personnel of the state department of public health and environment and county, district, and municipal public health agencies, within their respective jurisdictions, may, without patient consent, inspect, have access to, and obtain information from pertinent patient medical, coroner, and laboratory records in the custody of all medical practitioners, veterinarians, coroners, institutions, hospitals, agencies, laboratories, and clinics, whether public or private, which are relevant and necessary to the investigation. Review and inspection of records shall be conducted at reasonable times and with such notice as is reasonable under the circumstances. Under no circumstances may personnel of the state department of public health and environment or county, district, or municipal public health agencies, within their local jurisdictions, have access pursuant to this section to any medical record that is not pertinent, relevant, or necessary to the public health investigation.
3. Any report or disclosure made in good faith pursuant to subsection (1) or (2) of this section shall not constitute libel or slander or a violation of any right of privacy or privileged communication.
4. Reports and records resulting from the investigation of epidemic and communicable diseases, environmental and chronic diseases, reports of morbidity and mortality, reports of cancer in connection with the statewide cancer registry, and reports and records resulting from the investigation of sexually transmitted infections, tuberculosis, and rabies and mammal bites held by the state department of public health and environment or county, district, or municipal public health agencies shall be strictly confidential. Such reports and records shall not be released, shared with any agency or institution, or made public, upon subpoena, search warrant, discovery proceedings, or otherwise, except under any of the following circumstances:
   1. Release may be made of medical and epidemiological information in a manner such that no individual person can be identified.
   2. Release may be made of medical and epidemiological information to the extent necessary for the treatment, control, investigation, and prevention of diseases and conditions dangerous to the public health; except that every effort shall be made to limit disclosure of personal identifying information to the minimal amount necessary to accomplish the public health purpose.
   3. Release may be made to the person who is the subject of a medical record or report with written authorization from such person.
   4. An officer or employee of the county, district, or municipal public health agency or the state department of public health and environment may make a report of child abuse to agencies responsible for receiving or investigating reports of child abuse or neglect in accordance with the applicable provisions of the "Child Protection Act of 1987" set forth in part 3 of article 3 of title 19, C.R.S. However, in the event a report is made by the state department of public health and environment, only the following information shall be included in the report:
      1. The name, address, and sex of the child;
      2. The name and address of the person responsible for the child;
      3. The name and address of the person who is alleged to be responsible for the suspected abuse or neglect, if known; and
      4. The general nature of the child's injury.
   5. Medical and epidemiological information may be released to a peace officer as described in section 16-2.5-101, C.R.S., the federal bureau of investigation, a federal law enforcement agency as designated by the United States attorney for the district of Colorado, or any prosecutor to the extent necessary for any investigation or prosecution related to bioterrorism; except that reasonable efforts shall be made to limit disclosure of personal identifying information to the minimal amount necessary to accomplish the law enforcement purpose. For purposes of this paragraph (e), "bioterrorism" means the intentional use of, attempted use of, conspiracy to use, or solicitation to use microorganisms or toxins of biological origin or chemical or radiological agents to cause death or disease among humans or animals.
5. No officer or employee or agent of the state department of public health and environment or county, district, or municipal public health agency shall be examined in any judicial, executive, legislative, or other proceeding as to the existence or content of any individual's report obtained by such department pursuant to subsection (1) or (2) of this section without that individual's consent. However, this provision shall not apply to individuals who are under isolation or quarantine, school exclusion, or other restrictive action taken pursuant to section 25-1.5-102 (1)(c) or part 4, 5, 6, or 9 of article 4 of this title.
6. Any officer or employee or agent of the state department of public health and environment or a county, district, or municipal public health agency who violates this section by releasing or making public confidential public health reports or records or by otherwise breaching the confidentiality requirements of subsection (4) or (5) of this section commits a class 1 misdemeanor and, upon conviction thereof, shall be punished as provided in section 18-1.3-501 (1), C.R.S.
7. Nothing in subsections (4) to (6) of this section applies to records and reports held by the state or local department of health pursuant to part 4 of article 4 of this title.
8. Pursuant to section 25-1-113, any person may seek judicial review of a decision of the board or of the department affecting such person under this section.
9. Notwithstanding any other provision of law to the contrary, the department shall administer the provisions of this section regardless of an individual's race, religion, gender, ethnicity, national origin, or immigration status.

Source: L. 91: Entire section added, p. 943, § 2, effective May 6. L. 93: (4)(d) added, p. 1609, § 3, effective June 6. L. 94: (2), IP(4), IP(4)(d), (5), and (6) amended, p. 2741, § 378, effective July 1. L. 2002: (6) amended, p. 1536, § 263, effective October 1. L. 2003: (4)(e) added, p. 1020, § 1, effective April 17; (5) amended, p. 708, § 34, effective July 1. L. 2004: (4)(e) amended, p. 1201, § 65, effective August 4. L. 2006, 1st Ex. Sess.: (9) added, p. 25, § 1, effective July 31. L. 2009: (1) and IP(4) amended, (SB 09-179), ch. 112, p. 474, § 19, effective April 9. L. 2010: (1), (2), IP(4), IP(4)(d), (5), and (6) amended, (HB 10-1422), ch. 419, p. 2090, § 84, effective August 11. L. 2016: (1), (2), and (7) amended, (SB 16-146), ch. 230, p. 921, § 20, effective July 1.

Cross references: For the legislative declaration contained in the 1994 act amending subsection (2), the introductory portions to subsections (4) and (4)(d), and subsections (5) and (6), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration contained in the 2002 act amending this section, see section 1 of chapter 318, Session Laws of Colorado 2002.

25-1-122.5. Confidentiality of genetic testing records - "Uniform Parentage Act".

Notwithstanding any other law concerning public records, any records or information concerning the genetic testing of a person for purposes of the determination of parentage pursuant to article 4 of title 19, C.R.S., shall be confidential and shall not be disclosed except as otherwise provided in section 19-1-308, C.R.S.

Source: L. 94: Entire section added, p. 1549, § 28, effective May 31. L. 96: Entire section amended, p. 1175, § 14, effective January 1, 1997.

25-1-123. Restructure of health and human services - development of plan - participation of department required.

The department, in cooperation with the department of health care policy and financing and the department of human services, shall develop a plan for the restructuring of the health and human services delivery system in the state in accordance with article 1.7 of title 24, C.R.S.

Source: L. 93: Entire section added, p. 1097, § 14, effective July 1, 1994.

Cross references: For the legislative declaration contained in the 1993 act enacting this section, see section 1 of chapter 230, Session Laws of Colorado 1993.

25-1-124. Health care facilities - consumer information - reporting - release.

1. The general assembly hereby finds that an increasing number of people are faced with the difficult task of choosing a health care facility for themselves and their family members. This task may be made less difficult by improved access to reliable, helpful, and unbiased information concerning the quality of care and the safety of the environment offered by each health care facility. The general assembly further finds that it is appropriate that the department, in keeping with its role of protecting and improving the public health, solicit this information from health care facilities and disseminate it to the public in a form that will assist people in making informed choices among health care facilities.
2. Each health care facility licensed pursuant to section 25-3-101 or certified pursuant to section 25-1.5-103 (1)(a)(II) shall report to the department all of the following occurrences:
   1. Any occurrence that results in the death of a patient or resident of the facility and is required to be reported to the coroner pursuant to section 30-10-606, C.R.S., as arising from an unexplained cause or under suspicious circumstances;
   2. Any occurrence that results in any of the following serious injuries to a patient or resident:
      1. Brain or spinal cord injuries;
      2. Life-threatening complications of anesthesia or life-threatening transfusion errors or reactions;
      3. Second- or third-degree burns involving twenty percent or more of the body surface area of an adult patient or resident or fifteen percent or more of the body surface area of a child patient or resident;
   3. Any time that a resident or patient of the facility cannot be located following a search of the facility, the facility grounds, and the area surrounding the facility and there are circumstances that place the resident's health, safety, or welfare at risk or, regardless of whether such circumstances exist, the patient or resident has been missing for eight hours;
   4. Any occurrence involving physical, sexual, or verbal abuse of a patient or resident, as described in section 18-3-202, 18-3-203, 18-3-204, 18-3-206, 18-3-402, 18-3-403, as it existed prior to July 1, 2000, 18-3-404, or 18-3-405, C.R.S., by another patient or resident, an employee of the facility, or a visitor to the facility;
   5. Any occurrence involving caretaker neglect of a patient or resident, as described in section 26-3.1-101 (2.3), C.R.S.;
   6. Any occurrence involving misappropriation of a patient's or resident's property. For purposes of this paragraph (f), "misappropriation of a patient's or resident's property" means a pattern of or deliberately misplacing, exploiting, or wrongfully using, either temporarily or permanently, a patient's or resident's belongings or money without the patient's or resident's consent.
   7. Any occurrence in which drugs intended for use by patients or residents are diverted to use by other persons. If the diverted drugs are injectable, the health care facility shall also report the full name and date of birth of any individual who diverted the injectable drugs, if known.
   8. Any occurrence involving the malfunction or intentional or accidental misuse of patient or resident care equipment that occurs during treatment or diagnosis of a patient or resident and that significantly adversely affects or if not averted would have significantly adversely affected a patient or resident of the facility.
   1. (2.5) (a) In addition to the reports required by subsection (2) of this section, if the Colorado attorney general, the division for developmental disabilities in the department of human services, a community centered board, an adult protection service, or a law enforcement agency makes a report of an occurrence as described in subsection (2) of this section involving a licensed long-term care facility, that report shall be provided to the department and shall be made available for inspection consistent with the provisions of subsection (6) of this section. Any reports concerning an adult protection service shall be in compliance with the confidentiality requirements of section 26-3.1-102 (7), C.R.S.
   2. For purposes of this subsection (2.5), a "licensed long-term care facility" means a licensed community residential or group home, a licensed intermediate care facility for individuals with intellectual disabilities, and a licensed facility for persons with developmental disabilities.
3. The board by rule shall specify the manner, time period, and form in which the reports required pursuant to subsection (2) of this section shall be made.
4. Any report submitted pursuant to subsection (2) of this section shall be strictly confidential; except that information in any such report may be transmitted to an appropriate regulatory agency having jurisdiction for disciplinary or license sanctions. The information in such reports shall not be made public upon subpoena, search warrant, discovery proceedings, or otherwise, except as provided in subsection (6) of this section.
5. The department shall investigate each report submitted pursuant to subsection (2) of this section that it determines was appropriately submitted. For each report investigated, the department shall prepare a summary of its findings, including the department's conclusions and whether there was a violation of licensing standards or a deficiency or whether the facility acted appropriately in response to the occurrence. If the investigation is not conducted on site, the department shall specify in the summary how the investigation was conducted. Any investigation conducted pursuant to this subsection (5) shall be in addition to and not in lieu of any inspection required to be conducted pursuant to section 25-1.5-103 (1)(a) with regard to licensing.
6. 1. The department shall make the following information available to the public:
      1. Any investigation summaries prepared pursuant to subsection (5) of this section;
      2. Any complaints against a health care facility that have been filed with the department and that the department has investigated, including the conclusions reached by the department and whether there was a violation of licensing standards or a deficiency or whether the facility acted appropriately in response to the subject of the complaint; and
      3. A listing of any deficiency citations issued against each health care facility.
   2. The information released pursuant to this subsection (6) shall not identify the patient or resident or the health care professional involved in the report.
7. Prior to the completion of an investigation pursuant to this section, the department may respond to any inquiry regarding a report received pursuant to subsection (2) of this section by confirming that it has received such report and that an investigation is pending.
8. In addition to the report to the department for an occurrence described in paragraph (d) of subsection (2) of this section, the occurrence shall be reported to a law enforcement agency.

Source: L. 97: Entire section added, p. 504, § 1, effective April 24. L. 2000: (2)(d) amended, p. 708, § 37, effective July 1. L. 2003: IP(2) and (5) amended, p. 708, § 35, effective July 1. L. 2006: (2.5) and (8) added, p. 349, § 1, effective April 6. L. 2010: IP(2) and (2)(g) amended, (HB 10-1414), ch. 338, p. 1552, § 1, effective June 5. L. 2013: (2)(e) amended, (SB 13-111), ch. 233, p. 1127, § 14, effective May 16; (2.5)(b) amended, (SB 13-167), ch. 394, p. 2290, § 1, effective June 5.

Cross references: (1) For limitation on liability regarding transplants and transfusion of blood, see § 13-22-104.

(2) For the legislative declaration in the 2013 act amending subsection (2)(e), see section 1 of chapter 233, Session Laws of Colorado 2013.

25-1-124.5. Nursing care facilities - employees - criminal history record check - adult protective services data system check.

1. On and after September 1, 1996, prior to employing any person, a nursing care facility or the person seeking employment at a nursing care facility shall make an inquiry to the director of the Colorado bureau of investigation or to private criminal background check companies authorized to do business in the state of Colorado to ascertain whether such person has a criminal history, including arrest and conviction records. The Colorado bureau of investigation or private criminal background check companies are authorized to utilize fingerprints to ascertain from the federal bureau of investigation whether such person has a criminal history record. When the results of a fingerprint-based criminal history record check of an applicant performed pursuant to this section reveal a record of arrest without a disposition, the nursing care facility shall require that applicant to submit to a name-based criminal history record check, as defined in section 22-2-119.3 (6)(d). The nursing care facility or the person seeking employment in a nursing care facility shall pay the costs of an inquiry or a name-based criminal history record check performed pursuant to this section. The criminal history record check must be conducted not more than ninety days prior to the employment of the applicant. For purposes of this section, criminal background check companies must be approved by the state board of nursing. In approving such companies, approval must be based upon the provision of lawfully available, accurate, and thorough information pertaining to criminal histories, including arrest and conviction records.
2. As used in this section, "nursing care facility" includes:
   1. A nursing facility as defined in section 25.5-4-103 (14), C.R.S.;
   2. An intermediate nursing facility for persons with intellectual and developmental disabilities as defined in section 25.5-4-103 (9);
   3. An adult day care facility as defined in section 25.5-6-303 (1), C.R.S.;
   4. An alternative care facility as defined in section 25.5-6-303 (3), C.R.S.;
   5. Any business that provides temporary nursing care services or that provides personnel who provide such services.
3. In addition to the criminal history background check required pursuant to this section, on and after January 1, 2019, prior to employment, a nursing care facility shall submit the name of a person who will be providing direct care, as defined in section 26-3.1-101 (3.5), to an at-risk adult, as defined in section 26-3.1-101 (1.5), as well as any other required identifying information, to the department of human services for a check of the Colorado adult protective services data system pursuant to section 26-3.1-111, to determine if the person is substantiated in a case of mistreatment of an at-risk adult.

Source: L. 2002: Entire section added, p. 1180, § 3, effective July 1. L. 2006: (2)(a) to (2)(d) amended, p. 2013, § 82, effective July 1. L. 2017: IP(2) and (2)(b) amended, (HB 17-1046), ch. 50, p. 159, § 12, effective March 16; (2)(b) amended, (SB 17-242), ch. 263, p. 1322, § 181, effective May 25; (3) added, (HB 17-1284), ch. 272, p. 1504, § 8, effective May 31. L. 2019: (1) amended, (HB 19-1166), ch. 125, p. 552, § 35, effective April 18.

Cross references: For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.

25-1-124.7. Health facilities - employees - adult protective services data system check.

On and after January 1, 2019, prior to employment, a health facility licensed pursuant to section 25-1.5-103 (1)(a)(I)(A), including health facilities wholly owned and operated by any governmental unit or agency, shall submit the name of a person who will be providing direct care, as defined in section 26-3.1-101 (3.5), to an at-risk adult, as defined in section 26-3.1-101 (1.5), as well as any other required identifying information, to the department of human services for a check of the Colorado adult protective services data system pursuant to section 26-3.1-111, to determine if the person is substantiated in a case of mistreatment of an at-risk adult.

Source: L. 2017: Entire section added, (HB 17-1284), ch. 272, p. 1504, § 9, effective May 31.

25-1-125. Applications for licenses - authority to suspend licenses - rules.

1. Every application by an individual for a license issued by the department or any authorized agent of the department shall require the applicant's name, address, and social security number.
2. The department or any authorized agent of the department shall deny, suspend, or revoke any license pursuant to the provisions of section 26-13-126, C.R.S., and any rules promulgated in furtherance thereof, if the department or agent thereof receives a notice to deny, suspend, or revoke from the state child support enforcement agency because the licensee or applicant is out of compliance with a court or administrative order for current child support, child support debt, retroactive child support, child support arrearages, or child support when combined with maintenance or because the licensee or applicant has failed to comply with a properly issued subpoena or warrant relating to a paternity or child support proceeding. Any such denial, suspension, or revocation shall be in accordance with the procedures specified by rule of the department, rules promulgated by the state board of human services, and any memorandum of understanding entered into between the department or an authorized agent thereof and the state child support enforcement agency for the implementation of this section and section 26-13-126, C.R.S.
3. 1. The department shall enter into a memorandum of understanding with the state child support enforcement agency, which memorandum shall identify the relative responsibilities of the department and the state child support enforcement agency in the department of human services with respect to the implementation of this section and section 26-13-126, C.R.S.
   2. The appropriate rule-making body of the department is authorized to promulgate rules to implement the provisions of this section.
4. For purposes of this section, "license" means any recognition, authority, or permission that the department or any authorized agent of the department is authorized by law to issue for an individual to practice a profession or occupation or for an individual to participate in any recreational activity. "License" may include, but is not necessarily limited to, any license, certificate, certification, letter of authorization, or registration issued for an individual to practice a profession or occupation or for an individual to participate in any recreational activity.

Source: L. 97: Entire section added, p. 1285, § 28, effective July 1.

Cross references: For the legislative declaration contained in the 1997 act enacting this section, see section 51 of chapter 236, Session Laws of Colorado 1997.

25-1-126. County practitioner rural recruitment grant program - creation - legislative declaration - administration - report - definitions - repeal. (Repealed)

Source: L. 2007: Entire section added, p. 2093, § 3, effective July 1, 2008.

Editor's note: Subsection (6) provided for the repeal of this section, effective July 1, 2010. (See L. 2007, p. 2093 .)

25-1-127. Medical equipment for rural communities grant program - creation - legislative declaration - administration - report - repeal. (Repealed)

Source: L. 2007: Entire section added, p. 2093, § 3, effective July 1, 2008.

Editor's note: Subsection (6) provided for the repeal of this section, effective July 1, 2010. (See L. 2007, p. 2093 .)

25-1-128. Designation of caregiver - notice - instructions - definitions - rules.

1. As used in this section:
   1. "Aftercare" means assistance provided by a caregiver to a patient in the patient's residence after the patient's discharge from a hospital, following an inpatient hospital stay, and may include: Assisting with basic activities of daily living; assisting with instrumental activities of daily living; and carrying out medical or nursing tasks such as managing wound care, assisting in administering medications, and operating medical equipment.
   2. "Caregiver" means a person eighteen years of age or older designated by a patient to provide aftercare to a patient living in his or her residence.
   3. "Hospital" means a facility currently licensed or certified by the department as a general hospital pursuant to the department's authority under sections 25-1.5-103 and 25-3-101.
   4. "Residence" means the patient's home. "Residence" does not include a rehabilitation facility, hospital, nursing home, assisted living facility, or licensed group home.
2. 1. A hospital shall give each patient or the patient's legal guardian the opportunity to designate at least one caregiver no later than twenty-four hours after the patient's admission to the hospital and prior to the patient's release from the hospital or nonemergency transfer to another facility.
   2. If a patient is unconscious or incapacitated upon his or her admission to the hospital, the hospital shall give the patient or the patient's legal guardian the opportunity to designate a caregiver as soon as practicable after the patient's recovery of consciousness or capacity.
   3. A patient or patient's legal guardian is not obligated to designate a caregiver at any time.
   4. If the patient or the patient's legal guardian declines to designate a caregiver, the hospital shall document this in the patient's medical record.
3. 1. If the patient or the patient's legal guardian designates a caregiver, the hospital shall request consent from the patient or the patient's legal guardian to release medical information to the caregiver.
   2. The hospital shall record the designation of the caregiver, the relationship of the caregiver to the patient, and the name, telephone number, and address of the caregiver in the patient's medical record.
   3. A patient or the patient's legal guardian may change the caregiver designation at any time. The hospital shall record the change in the patient's medical record within twenty-four hours of the change.
   4. This section does not obligate a person designated as a caregiver to perform aftercare tasks for a patient.
4. If a patient or the patient's legal guardian designates a caregiver, the hospital shall notify the patient's caregiver of the patient's discharge or transfer to another facility as soon as practicable, which may be after the patient's physician issues a discharge order. If the hospital is unable to contact the caregiver, the lack of contact shall not interfere with, delay, or otherwise affect the medical care provided to the patient or the appropriate discharge of the patient. The hospital shall promptly document the attempt in the patient's medical record.
5. 1. As soon as possible and prior to the patient's release from the hospital, the hospital shall consult with the patient or the patient's legal guardian and the caregiver and issue a discharge plan that describes the patient's aftercare needs. The discharge plan must include:
      1. The name and contact information of the caregiver, as provided by the caregiver;
      2. A description of the aftercare tasks necessary to maintain the patient's ability to reside in his or her residence; and
      3. Contact information for any health care, community resources, and long-term services and support necessary to successfully carry out a patient's discharge plan.
   2. The hospital shall provide the caregiver with instructions concerning all aftercare tasks described in the discharge plan. The instructions shall include:
      1. A live demonstration of the aftercare tasks performed by a hospital employee or other authorized individual and provided in a culturally competent manner and in accordance with the hospital's requirements to provide language access services;
      2. An opportunity for the caregiver and the patient or the patient's legal guardian to ask questions about the aftercare tasks; and
      3. Answers to the caregiver's, patient's, and patient's legal guardian's questions in a culturally competent manner and in accordance with the hospital's requirements to provide language access services.
   3. The hospital shall document the instructions required in this subsection (5) in the patient's medical record, including the date, time, and contents of the instructions, and whether the caregiver accepted or refused the offer of instruction.
6. Nothing in this section:
   1. Interferes with the rights of an agent acting under a valid health care directive;
   2. Creates a private right of action against a hospital, a hospital employee, or a person with whom the hospital has a contractual relationship;
   3. Creates additional civil or regulatory liability for a hospital or hospital employee;
   4. Supersedes or replaces existing rights or remedies under any other law; or
   5. Affects a license issued to a hospital pursuant to section 25-3-102.
7. The board of health may promulgate rules to ensure compliance with this section.

Source: L. 2015: Entire section added, (HB 15-1242), ch. 166, p. 507, § 1, effective May 8.

25-1-129. Prescription drug monitoring program integration methods - health care provider report cards - report - repeal. (Repealed)

Source: L. 2018: Entire section added, (SB 18-022), ch. 221, p. 1407, § 8, effective May 21.

Editor's note: Subsection (3) provided for the repeal of this section, effective July 1, 2020. (See L. 2018, p. 1407 .)

25-1-130. Standing order - post-exposure prophylaxis - definition.

1. On or before August 1, 2020, and until a statewide drug therapy protocol is implemented pursuant to section 12-280-125.7, the department shall implement and maintain a standing order for post-exposure prophylaxis so that pharmacists may prescribe and dispense post-exposure prophylaxis pursuant to section 12-280-125.7.
2. As used in this section, "post-exposure prophylaxis" has the same meaning as set forth in section 12-280-125.7.

Source: L. 2020: Entire section added, (HB 20-1061), ch. 281, p. 1377, § 6, effective July 13.

25-1-201 to 25-1-217. (Repealed)

Source: L. 2010: Entire part repealed, (SB 10-175), ch. 188, p. 675, § 1, effective April 29.

25-1-301 to 25-1-316. (Repealed)

Source: L. 2010: Entire part repealed, (SB 10-175), ch. 188, p. 675, § 1, effective April 29.

25-1-401. Office of state chemist created.

The professor of food and drug chemistry in the department of chemistry at the university of Colorado shall be the state chemist of Colorado. The office and laboratory of the state chemist shall be in the department of chemistry at the university of Colorado. The office of state chemist shall be a section of the division of administration of the department of public health and environment.

Source: L. 39: p. 550, § 1. CSA: C. 78, § 25(1). CRS 53: § 66-16-1. C.R.S. 1963: § 66-16-1. L. 68: p. 107, § 78. L. 94: Entire section amended, p. 2742, § 380, effective July 1.

Cross references: For the legislative declaration contained in the 1994 act amending this section, see section 1 of chapter 345, Session Laws of Colorado 1994.

25-1-402. Employment of assistants.

The state chemist has the power to employ such assistants as are necessary for the carrying out of this part 4. The appropriations for the office of state chemist shall be determined by each general assembly in the general appropriation bill. The state chemist and his assistant shall also be reimbursed for all legitimate and necessary expenses incurred in the performance of the duties of the office of state chemist.

Source: L. 39: p. 550, § 2. CSA: C. 78, § 25(2). CRS 53: § 66-16-2. C.R.S. 1963: § 66-16-2.

25-1-403. Analyses of food and drugs.

It is the duty of the state chemist to make or cause to be made chemical analyses of all such samples of foods and drugs as may be collected for the purpose of analysis by the department of public health and environment. The state chemist shall make full and complete written reports, without unnecessary delay, of such analyses to the department of public health and environment.

Source: L. 39: p. 550, § 3. CSA: C. 78, § 25(3). CRS 53: § 66-16-3. C.R.S. 1963: § 66-16-3. L. 94: Entire section amended, p. 2742, § 381, effective July 1.

Cross references: For the legislative declaration contained in the 1994 act amending this section, see section 1 of chapter 345, Session Laws of Colorado 1994.

25-1-404. Certificate presumptive evidence.

By the authority of this part 4, every certificate of analysis of foods or drugs duly signed by the state chemist shall be presumptive evidence of the facts therein stated.

Source: L. 39: p. 550, § 4. CSA: C. 78, § 25(4). CRS 53: § 66-16-4. C.R.S. 1963: § 66-16-4.

25-1-501. Legislative declaration.

1. The general assembly hereby finds and declares that:
   1. The public health system reduces health care costs by preventing disease and injury, promoting healthy behavior, and reducing the incidents of chronic diseases and conditions. Thus, the public health system is a critical part of any health care reform.
   2. Each community in Colorado should provide high-quality public health services regardless of its location. Thus, the state of Colorado and each local public health agency should have a comprehensive public health plan outlining how quality public health services will be provided.
   3. Each county should establish or be part of a local public health agency organized under a local board of health with a public health director and other staff necessary to provide public health services;
   4. A strong public health infrastructure is needed to provide essential public health services and is a shared responsibility among state and local public health agencies and their partners within the public health system; and
   5. Developing a strong public health infrastructure requires the coordinated efforts of state and local public health agencies and their public and private sector partners within the public health system to:
      1. Identify and provide leadership for the provision of essential public health services;
      2. Develop and support an information infrastructure that supports essential public health services and functions;
      3. Develop and provide effective education and training for members of the public health workforce;
      4. Develop performance-management standards for the public health system that are tied to improvements in public health outcomes or other measures; and
      5. Develop a comprehensive plan and set priorities for providing essential public health services.

Source: L. 2008: Entire part R&RE, p. 2030, § 1, effective July 1.

25-1-502. Definitions.

As used in this part 5, unless the context otherwise requires:

1. "Agency" means a county or district public health agency established pursuant to section 25-1-506.
2. "Core public health" shall be defined by the state board and shall include, but need not be limited to, the assessment of health status and health risks, development of policies to protect and promote health, and assurance of the provision of the essential public health services.

   (2.5) "Dementia diseases and related disabilities" is a condition where mental ability declines and is severe enough to interfere with an individual's ability to perform everyday tasks. Dementia diseases and related disabilities includes Alzheimer's disease, mixed dementia, Lewy body dementia, vascular dementia, frontotemporal dementia, and other types of dementia.

3. "Essential public health services" means to:
   1. Monitor health status to identify and solve community health problems;
   2. Investigate and diagnose health problems and health hazards in the community;
   3. Inform, educate, and empower individuals about health issues;
   4. Mobilize public and private sector collaboration and action to identify and solve health problems;
   5. Develop policies, plans, and programs that support individual and community health efforts;
   6. Enforce laws and rules that protect health and promote safety;
   7. Link individuals to needed personal health services and ensure the provision of health care;
   8. Encourage a competent public health workforce;
   9. Evaluate effectiveness, accessibility, and quality of personal and population-based public health services; and
   10. Contribute to research into insightful and innovative solutions to health problems.
4. "Medical officer" means a volunteer or paid licensed physician who contracts with or is employed by a county or district public health agency to advise the public health director on medical decisions if the public health director is not a licensed physician.
5. "Public health" means the prevention of injury, disease, and premature mortality; the promotion of health in the community; and the response to public and environmental health needs and emergencies and is accomplished through the provision of essential public health services.
6. "Public health agency" means an organization operated by a federal, state, or local government or its designees that acts principally to protect or preserve the public's health. "Public health agency" includes a county public health agency or a district public health agency.
7. "Public health director" means the administrative and executive head of each county or district public health agency.
8. "Public health system" means state, county, and district public health agencies and other persons and organizations that provide public health services or promote public health.
9. "State board" means the state board of health created pursuant to section 25-1-103.
10. "State department" means the department of public health and environment created pursuant to section 25-1-102.

Source: L. 2008: Entire part R&RE, p. 2031, § 1, effective July 1. L. 2018: (2.5) added, (HB 18-1091), ch. 74, p. 642, § 1, effective August 8.

25-1-503. State board - public health duties.

1. In addition to all other powers and duties conferred and imposed upon the state board, the state board has the following specific powers and duties:
   1. To establish, by rule, the core public health services that each county and district public health agency must provide or arrange for the provision of said services;
   2. To establish, by rule, the minimum quality standards for public health services;
   3. To establish, by rule, the minimum qualifications for county and district public health directors and medical officers;
   4. To ensure the development and implementation of a comprehensive, statewide public health improvement plan;
   5. To review all county and district public health agency public health plans, which review shall be based on criteria established by rule by the state board and against which each county or district public health plan shall be evaluated; and
   6. To establish, by rule, for the fiscal year beginning July 1, 2009, if practicable, and for each fiscal year thereafter, a formula for allocating moneys to county or district public health agencies based on input from the state department and from county or district public health agencies.

Source: L. 2008: Entire part R&RE, p. 2032, § 1, effective July 1.

SUBPART 2 PUBLIC HEALTH PLANS

25-1-504. Comprehensive public health plan - development - approval - reassessment - cash fund.

1. On or before December 31, 2009, and at a minimum on or before December 31 every five years thereafter, the state department shall develop a comprehensive, statewide public health improvement plan, referred to in this section as the "plan", that assesses and sets priorities for the public health system. The state board may appoint ad hoc or advisory committees as needed for the plan development process. The plan shall be developed in consultation with the state board and representatives from the state department, county or district public health agencies, and their partners within the public health system. The plan shall rely on existing or available data or other information acquired pursuant to this part 5, as well as national guidelines or recommendations concerning public health outcomes or improvements.
2. 1. The plan shall assess and set priorities for the public health system and shall:
      1. Guide the public health system in targeting core public health services and functions through program development, implementation, and evaluation;
      2. Increase the efficiency and effectiveness of the public health system;
      3. Identify areas needing greater resource allocation to provide essential public health services;
      4. Incorporate, to the extent possible, goals and priorities of public health plans developed by county or district public health agencies; and
      5. Consider available resources, including but not limited to state and local funding, and be subject to modification based on actual subsequent allocations.
   2. The plan shall include or address at a minimum the following elements:
      1. Core public health services and standards for county and district public health agencies;
      2. Recommendations for legislative or regulatory action, including but not limited to updating public health laws, eliminating obsolete statutory language, and establishing an effective and comprehensive state and local public health infrastructure;
      3. Identification and quantification of existing public health problems, disparities, or threats at the state and county levels;
      4. Identification of existing public health resources at the state and local levels;
      5. Declaration of the goals of the plan;
      6. Identification of specific recommendations for meeting these goals;
      7. Development of public and environmental health infrastructure that supports core public health functions and essential public health services at the state and local levels;
      8. Explanation of the prioritization of one or more conditions of public health importance;
      9. Detailed description of strategies to develop and promote culturally and linguistically appropriate services;
      10. Development, evaluation, and maintenance of, and improvements to, an information infrastructure that supports essential public health services;
      11. Detailed description of the programs and activities that will be pursued to address existing public and environmental health problems, disparities, or threats;
      12. Detailed description of how public health services will be integrated and public health resources shared to optimize efficiency and effectiveness of the public health system;
      13. Detailed description of how the plan will support county or district public health agencies in achieving the goals of their county or district public health plans;
      14. Estimation of costs of implementing the plan;
      15. A timeline for implementing various elements of the plan;
      16. A strategy for coordinating service delivery within the public health system; and
      17. Measurable indicators of effectiveness and successes.
   3. The plan, including core public health services and standards, shall prospectively cover up to five years, subject to annual revisions and the implementation schedule established by the state board.
3. The state department shall make the plan available to the governor, the general assembly, the state board, county and district public health agencies, and other partners.
4. The state department is authorized to solicit and accept any gifts, grants, or donations to pay for the development of the plan. Any moneys received pursuant to this subsection (4) shall be transmitted to the state treasurer, who shall credit the same to the comprehensive public health plan cash fund, which is hereby created and referred to in this subsection (4) as the "fund". Any interest derived from the deposit and investment of moneys in the fund shall be credited to the fund. Any unexpended and unencumbered moneys remaining in the fund at the end of any fiscal year shall remain in the fund and shall not be credited or transferred to the general fund or another fund. Moneys in the fund may be expended by the state department, subject to annual appropriation by the general assembly, for the development of the plan described in this section.
5. If the moneys received by the state department through gifts, grants, and donations are insufficient to cover the direct and indirect costs of complying with the provisions of section 25-1-503 and this section, the state department shall not be required to implement the provisions of said sections.

Source: L. 2008: Entire part R&RE, p. 2033, § 1, effective July 1.

25-1-505. County and district public health plans - approval.

1. As soon as practicable after the approval of each comprehensive, statewide public health improvement plan pursuant to section 25-1-504, each county or district public health agency shall prepare a county or district public health plan, referred to in this section as the "local plan". Each local plan shall not be inconsistent with the comprehensive, statewide public health improvement plan required under section 25-1-504.
2. Each local plan shall, at a minimum:
   1. Examine data about health status and risk factors in the local community;
   2. Assess the capacity and performance of the county or district public health system;
   3. Identify goals and strategies for improving the health of the local community;
   4. Describe how representatives of the local community develop and implement the local plan;
   5. Address how county or district public health agencies coordinate with the state department and others within the public health system to accomplish goals and priorities identified in the comprehensive, statewide public health improvement plan; and
   6. Identify financial resources available to meet identified public health needs and to meet requirements for the provision of core public health services.
3. Subject to available appropriations, the state department shall encourage and provide technical assistance to county or district public health agencies that request such assistance and otherwise work with county or district public health agencies to generate their local plans.

Source: L. 2008: Entire part R&RE, p. 2035, § 1, effective July 1.

SUBPART 3 COUNTY OR DISTRICT PUBLIC HEALTH AGENCIES

25-1-506. County or district public health agency.

1. Each county, by resolution of its board of county commissioners, shall establish and maintain a county public health agency or shall participate in a district public health agency. Any two or more contiguous counties, by resolutions of the boards of county commissioners of the respective counties, may establish and maintain a district public health agency. An agency shall consist of a county or district board of health, a public health director, and all other personnel employed or retained under the provisions of this subpart 3.
2. 1. 1. The jurisdiction of any agency shall extend over all unincorporated areas and over all municipal corporations within the territorial limits of the county or the counties comprising the district, but not over the territory of any municipal corporation that maintains its own public health agency. If the county has a county public health agency or a district board of health and if the county is within a district public health agency, any municipal corporation not otherwise within the jurisdiction of an agency, by agreement of its city council, board of trustees or other governing body, and the board of county commissioners of the county wherein the municipal corporation is situated may merge its department with the county or district public health agency. (2) (a) (I) The jurisdiction of any agency shall extend over all unincorporated areas and over all municipal corporations within the territorial limits of the county or the counties comprising the district, but not over the territory of any municipal corporation that maintains its own public health agency. If the county has a county public health agency or a district board of health and if the county is within a district public health agency, any municipal corporation not otherwise within the jurisdiction of an agency, by agreement of its city council, board of trustees or other governing body, and the board of county commissioners of the county wherein the municipal corporation is situated may merge its department with the county or district public health agency.
      2. In the event of a merger between a health department of a municipal corporation with a county or district public health agency, the agreement of merger, among other things, shall provide that a member or members of the county or district board of health, as is specified in the agreement, shall be appointed by the city council or board of trustees of the municipal corporation rather than as provided in this section. The city council or board of trustees shall appoint the number of members specified in the agreement of merger, and the remaining members shall be appointed as provided in this section.
      3. The board of county commissioners, in order to give the municipal corporation representation on a county board of health previously established, may declare vacancies in the county board of health and permit the vacancies to be filled by the city council or board of trustees of the municipal corporation.
   2. All county or district boards of health existing within the county or district shall be dissolved upon the organization of a county or district public health agency under the provisions of this part 5 or upon the acceptance of a county into a district already established.
   3. In the event of the dissolution of any county or district public health agency, the withdrawal of a county from an established district, or the withdrawal of a municipal corporation that has voluntarily merged its health department or agency with a county or district public health agency, local boards of health shall be reestablished under the provisions of this part 5 and assume the powers and duties conferred upon such local boards.
3. 1. Subject to available appropriations, an agency shall provide or arrange for the provisions of services necessary to carry out the public health laws and rules of the state board, the water quality control commission, the air quality control commission, and the solid and hazardous waste commission according to the specific needs and resources available within the community as determined by the county or district board of health or the board of county commissioners and as set out in both the comprehensive, statewide public health improvement plan developed pursuant to section 25-1-504 and the county or district public health plan developed pursuant to section 25-1-505.
   2. In addition to other powers and duties, an agency shall have the following duties:
      1. To complete a community health assessment and to create the county or district public health plan at least every five years under the direction of the county or district board and to submit the plan to the county or district board and state board for review;
      2. To advise the county or district board on public policy issues necessary to protect public health and the environment;
      3. To provide or arrange for the provision of quality, core public health services deemed essential by the state board and the comprehensive, statewide public health improvement plan; except that the agency shall be deemed to have met this requirement if the agency can demonstrate to the county or district board that other providers offer core public health services that are sufficient to meet the local needs as determined by the plan;
      4. To the extent authorized by the provisions of this title or article 20 of title 30, C.R.S., to administer and enforce the laws pertaining to:
         1. Public health, air pollution, solid and hazardous waste, and water quality;
         2. Vital statistics; and
         3. The orders, rules, and standards of the state board and any other type 1 agency created pursuant to the provisions of this title;
      5. To investigate and control the causes of epidemic or communicable diseases and conditions affecting public health;
      6. To establish, maintain, and enforce isolation and quarantine, and in pursuance thereof, and for this purpose only, to exercise physical control over property and over the persons of the people within the jurisdiction of the agency as the agency may find necessary for the protection of the public health;
      7. To close schools and public places and to prohibit gatherings of people when necessary to protect public health;
      8. To investigate and abate nuisances when necessary in order to eliminate sources of epidemic or communicable diseases and conditions affecting public health;
      9. To establish, maintain, or make available chemical, bacteriological, and biological laboratories, and to conduct such laboratory investigations and examinations as it may deem necessary or proper for the protection of the public health;
      10. To purchase and distribute to licensed physicians and veterinarians, with or without charge, as the county or district board may determine upon considerations of emergency or need, approved biological or therapeutic products necessary for the protection of public health;
      11. To initiate and carry out health programs consistent with state law that are necessary or desirable by the county or district board to protect public health and the environment;
      12. To collect, compile, and tabulate reports of marriages, dissolutions of marriage, and declarations of invalidity of marriage, births, deaths, and morbidity, and to require any person having information with regard to the same to make such reports and submit such information as is required by law or the rules of the state board;
      13. To make necessary sanitation and health investigations and inspections, on its own initiative or in cooperation with the state department, for matters affecting public health that are within the jurisdiction and control of the agency;
      14. To collaborate with the state department and the state board in all matters pertaining to public health, the water quality control commission in all matters pertaining to water quality, the air quality control commission and the division of administration of the state department in all matters pertaining to air pollution, and the solid and hazardous waste commission in all matters pertaining to solid and hazardous waste; and
      15. To establish or arrange for the establishment of, by January 1, 2015, and subject to available appropriations, a local or regional child fatality prevention review team pursuant to section 25-20.5-404.
   3. If a county or district board of health does not receive sufficient appropriations to fulfill all the duties described in paragraph (b) of this subsection (3), the county or district board shall set priorities for fulfilling the duties and shall include the list of priorities in its county or district public health plan submitted pursuant to section 25-1-505.
4. Repealed.

Source: L. 2008: Entire part R&RE, p. 2036, § 1, effective July 1. L. 2013: (3)(b)(XIII) and (3)(b)(XIV) amended and (3)(b)(XV) added, (SB 13-255), ch. 222, p. 1028, § 1, effective May 14.

25-1-507. Municipal board of health.

Except as otherwise provided by law, the mayor and council of each incorporated town or city, whether incorporated under general statutes or special charter in this state, may establish a municipal public health agency and appoint a municipal board of health. If appointed, the municipal board of health shall have all the powers and responsibilities and perform all the duties of a county or district board of health as provided in this part 5 within the limits of the respective city or town of which they are the officers.

Source: L. 2008: Entire part R&RE, p. 2039, § 1, effective July 1.

Editor's note: This section is similar to former § 25-1-609 as it existed prior to 2008.

25-1-508. County or district boards of public health - public health directors.

1. Within ninety days after the adoption of a resolution to establish and maintain a county public health agency or to participate in a district public health agency, the respective board of county commissioners shall proceed to organize the agency by the appointment of a county or district board of health, referred to in this part 5 as a "county or district board".
2. 1. 1. Each county board of health shall consist of at least five members to be appointed by the board of county commissioners for five-year terms; except that the board of county commissioners shall stagger the terms of the initial appointments. Thereafter, full-term appointments shall be for five years. (2) (a) (I) Each county board of health shall consist of at least five members to be appointed by the board of county commissioners for five-year terms; except that the board of county commissioners shall stagger the terms of the initial appointments. Thereafter, full-term appointments shall be for five years.
      2. Notwithstanding the provisions of subparagraph (I) of this paragraph (a), a county with a population of less than one hundred thousand people may have a county board of health that consists of at least three members to be appointed by the board of county commissioners for five-year terms; except that the board of county commissioners shall stagger the terms of the initial appointments. Thereafter, full-term appointments shall be for five years.
   2. Each member of the county board of health shall be a resident of the county in which the county agency is located. Appointments shall be made to the board so that no business or professional group or governmental entity shall constitute a majority of the board. Any vacancy on the board shall be filled in the same manner as full-term appointments by the appointment of a qualified person for the unexpired term.
   3. In a county with a population of less than one hundred thousand people that, as of July 1, 2008, does not have a board of health that is separate from the board of county commissioners, the board of county commissioners may designate itself as the county board of health as of July 1, 2008. The terms of the members of the county board of health shall coincide with their terms as commissioners. Such county boards shall assume all the duties of appointed county boards.
   4. Notwithstanding the provisions of paragraphs (a) to (c) of this subsection (2), a county board of health in a home-rule county shall comply with the requirements of its home-rule charter.
3. 1. Each district board of health shall consist of a minimum of five members. The membership of each district board of health shall include at least one representative from each county in the district. The members of the board shall be appointed by an appointments committee composed of one member of each of the boards of county commissioners of the counties comprising the district. The appointments committee for each district board shall designate the number of members of its district board and shall establish staggered terms for the initial appointments. Thereafter, full-term appointments shall be for five years.
   2. Each member of the district board shall be a resident of one of the counties comprising the district, and there shall be at least one member from each of the counties comprising the district. Appointments shall be made to the district board so that no business or professional group or governmental entity shall constitute a majority of the district board. The appointments committee shall fill any vacancy on the district board by the appointment of a qualified person for the remainder of the unexpired term.
   3. Upon establishment of a district board, all county boards previously existing within the county or district shall be dissolved. Upon the acceptance of a new county into an established district, the county or district board previously existing for the county being added shall be dissolved and the chair of the previous county or district board or the chair's designee shall represent the new county on the district board until a new member is appointed by the appointments committee.
4. 1. A county or district board, at its organizational meeting, shall elect from its members a president and other officers as it shall determine. The public health director of the agency, at the discretion of the board, may serve as secretary but shall not be a member of the board. All officers and the public health director shall hold their positions at the pleasure of the board.
   2. 1. Regular meetings of a county or district board shall be held at least once every three months at such times as may be established by resolution of the board. Special meetings of a board may be called by the president, by the public health director, or by a majority of the members of the board at any time on three days' prior notice; except that, in case of emergency, twenty-four hours' notice shall be sufficient.
      2. A county or district board may adopt, and at any time may amend, bylaws in relation to its meetings and the transaction of its business. A majority of the board shall constitute a quorum. Members of the board shall serve without compensation but shall be reimbursed for their actual and necessary travel and subsistence expenses to attend meetings.
5. In addition to all other powers and duties conferred and imposed upon a county board of health or a district board of health by the provisions of this subpart 3, a county board of health or a district board of health shall have and exercise the following specific powers and duties:
   1. To develop and promote the public policies needed to secure the conditions necessary for a healthy community;
   2. To approve the local public health plan completed by the county or district agency, and to submit the local plan to the state board for review;
   3. 1. To select a public health director to serve at the pleasure of the county or district board. The public health director shall possess such minimum qualifications as may be prescribed by the state board. A public health director may be a physician, physician assistant, public health nurse, or other qualified public health professional. A public health director may practice medicine, nursing, or his or her profession within his or her license and scope of practice, as necessary, to carry out the functions of the office of the public health director. The qualifications shall reflect the resources and needs of the county or counties covered by the agency. If the public health director is not a physician, the county or district board shall employ or contract with at least one medical officer to advise the public health director on medical decisions. The public health director shall maintain an office location designated by the county or district board and shall be the custodian of all property and records of the agency.
      2. A person employed or under contract to act as a medical officer pursuant to this paragraph (c) shall be covered by the "Colorado Governmental Immunity Act", article 10 of title 24, C.R.S., for duties performed for the agency.
   4. 1. In the event of a vacancy in the position of public health director or medical officer, to either employ or contract with a person deemed qualified to fill the position or to request temporary assistance from a public health director or a medical officer from another county. The county or district board may also request that an employee of the state department, such as a qualified executive director or the chief medical officer, serve on an interim basis with all the powers and duties of the position.
      2. A person filling a temporary vacancy as public health director or medical officer shall be covered by the "Colorado Governmental Immunity Act", article 10 of title 24, C.R.S., for duties performed for the agency.
   5. To provide, equip, and maintain suitable offices and all necessary facilities for the proper administration and provision of core public health services, as defined by the state board;
   6. To determine general policies to be followed by the public health director in administering and enforcing public health laws, orders, and rules of the county or district board, and orders, rules, and standards of the state board;
   7. To issue orders and to adopt rules not inconsistent with the public health laws of this state nor with the orders or rules of the state board as the county or district board may deem necessary for the proper exercise of the powers and duties vested in or imposed upon an agency or county or district board by this part 5;
   8. To act in an advisory capacity to the public health director on all matters pertaining to public health;
   9. To hold hearings, administer oaths, subpoena witnesses, and take testimony in all matters relating to the exercise and performance of the powers and duties vested in or imposed upon a county or district board;
   10. To provide environmental health services and to assess fees to offset the actual, direct cost of such services; except that no fee for a service shall be assessed against any person who has already paid a fee to the state or federal government for the service, and except that the only fee that shall be charged for annual retail food establishment inspections shall be the fee set forth in section 25-4-1607;
   11. To accept and, through the public health director, to use, disburse, and administer all federal aid, state aid, or other property, services, or moneys allotted to an agency for county or district public health functions or allotted without designation of a specific agency for purposes that are within the functions of an agency, and to prescribe, by rule consistent with the laws of this state, the conditions under which the property, services, or moneys shall be accepted and administered. The county or district board is empowered to make agreements that may be required to receive such moneys or other assistance.
   12. To approve, as provided for in section 25-1-520, a clean syringe exchange program proposed by an agency. A county board of health or district board of health shall not be required to approve a proposed program.
6. Repealed.

Source: L. 2008: Entire part R&RE, p. 2039, § 1, effective July 1. L. 2010: IP(5) and (5)(j) amended and (5)(l) added, (SB 10-189), ch. 272, p. 1252, § 2, effective August 11. L. 2016: (5)(c)(I) amended, (SB 16-158), ch. 204, p. 727, § 17, effective August 10.

25-1-509. County and district public health directors.

1. 1. The director of each agency shall be the public health director.
   2. All other personnel required by an agency shall be selected by the public health director. All personnel shall perform duties as prescribed by the public health director.
   3. In the event of a public health emergency, the agency shall issue orders and adopt rules consistent with the laws and rules of the state as the public health director may deem necessary for the proper exercise of the powers and duties vested in or imposed upon the agency or county or district board.
2. In addition to the other powers and duties conferred by this part 5 or by the agency, a public health director has the following powers and duties:
   1. To administer and enforce:
      1. The public health laws of the state and, as authorized by the provisions of this title or article 20 of title 30, C.R.S., the public health orders, rules, and standards of the state department or the state board; and
      2. The orders and rules of the county or district board;
   2. To exercise all powers and duties conferred and imposed upon agencies not expressly delegated by the provisions of this part 5 to a county or district board;
   3. To hold hearings, administer oaths, subpoena witnesses, and take testimony in all matters relating to the exercise and performance of his or her powers and duties;
   4. To act as the local registrar of vital statistics or to contract out the responsibility of registrar in the area over which the agency has jurisdiction;
   5. To direct the resources needed to carry out the county or district public health plan developed pursuant to section 25-1-505; and
   6. If requested by the county or district board, to serve as secretary to the board responsible for maintaining all records required by part 2 of article 72 of title 24, C.R.S., and ensuring public notice of all meetings in accordance with part 4 of article 6 of title 24, C.R.S. The director shall be the custodian of all properties and records for the agency.

Source: L. 2008: Entire part R&RE, p. 2043, § 1, effective July 1.

Editor's note: This section is similar to former §§ 25-1-505 (3) and 25-1-508 as they existed prior to 2008.

25-1-510. County or district board unable or unwilling to act.

1. If the county or district board is unable or unwilling to efficiently or promptly abate a nuisance or prevent the introduction or spread of a contagious or infectious disease, the county or district board or agency shall notify the state department and request assistance to take measures that will abate the nuisance or prevent the introduction or spread of disease.
2. Upon receipt of the notice and request described in subsection (1) of this section, or upon determination that the county or district board is unable or unwilling to act, the state department has full power to take measures to ensure the abatement of the nuisance or prevent the introduction or spread of disease. The state department, for this purpose, may assume all powers conferred by law on the county or district board.
3. The state department may reallocate state moneys from an agency that is not able to provide core public health services or standards to another entity to deliver services in that agency's jurisdiction.

Source: L. 2008: Entire part R&RE, p. 2044, § 1, effective July 1.

Editor's note: This section is similar to former § 25-1-602 as it existed prior to 2008.

25-1-511. County treasurer - agency funds.

1. 1. In the case of a county public health agency, the county treasurer, as a part of his or her official duties as county treasurer, shall serve as treasurer of the agency, and the treasurer's official bond as county treasurer shall extend to and cover his or her duties as treasurer of the agency. In the case of a district public health agency, the county treasurer of the county in the district having the largest population as determined by the most recent federal census, as a part of his or her official duties as county treasurer, shall serve as treasurer of the district agency, and the treasurer's official bond as county treasurer shall extend to and cover his or her duties as treasurer of the district agency.
   2. Notwithstanding paragraph (a) of this subsection (1), in a district where the combined population of the counties is four thousand or fewer, the boards of the county commissioners of the counties may, by consent of all counties in the district, select the county whose treasurer shall serve as treasurer of the district.
2. The treasurer of an agency, upon organization of the agency, shall create a county or district public health agency fund, to which shall be credited:
   1. Any moneys appropriated from a county general fund; and
   2. Any moneys received from state or federal appropriations or any other gifts, grants, donations, or fees for local public health purposes.
3. Any moneys credited to a fund created pursuant to subsection (2) of this section shall be expended only for the purposes of this part 5, and claims or demands against the fund shall be allowed only if certified by the public health director and the president of the county or district board or any other member of the county or district board designated by the president for such purpose.
4. On or before September 1, 2008, and on or before September 1 of each year thereafter, a county board of health shall estimate the total cost of maintaining the county public health agency for the ensuing fiscal year, and the amount of moneys that may be available from unexpended surpluses or from state or federal funds or other grants or donations. On or before September 1 of each year, the estimates shall be submitted in the form of a budget to the board of county commissioners. The board of county commissioners is authorized to provide any moneys necessary, over estimated moneys from surpluses, grants, and donations, to cover the total cost of maintaining the agency for the ensuing fiscal year by an appropriation from the county general fund.
5. 1. On or before September 1, 2008, and on or before September 1 of each year thereafter, a district board of health shall estimate the total cost of maintaining the district public health agency for the ensuing fiscal year, and the amount of moneys that may be available from unexpended surpluses or from state or federal funds or other grants or donations. On or before September 1 of each year, the estimates shall be submitted in the form of a budget to a committee composed of the chairs of the boards of county commissioners of all counties comprising the district. The cost for maintaining the agency, over estimated moneys from surpluses, grants, or donations, shall be apportioned by the committee among the counties comprising the district in the proportion that the population of each county in the district bears to the total population of all counties in the district, population figures to be based on the most recent federal census. The boards of county commissioners of the respective counties are authorized to provide any moneys necessary to cover the proportionate shares of their counties by an appropriation from the county general fund.
   2. Notwithstanding paragraph (a) of this subsection (5), in a district where the combined population of the counties is four thousand or fewer, the boards of the county commissioners of the counties may apportion the costs for each county maintaining the agency by consent of all the counties in the district.

Source: L. 2008: Entire part R&RE, p. 2044, § 1, effective July 1. L. 2016: (1) and (5) amended, (SB 16-094), ch. 67, p. 171, § 1, effective August 10.

Editor's note: This section is similar to former §§ 25-1-505 (2) and 25-1-509 as they existed prior to 2008.

25-1-512. Allocation of moneys - public health services support fund - created.

1. 1. The state department shall allocate any moneys that the general assembly may appropriate for distribution to county or district public health agencies organized pursuant to this part 5 for the provision of local health services. The state board shall determine the basis for the allocation of moneys to the agencies. In determining the allocation of moneys, the state board shall take into account the population served by each agency, the additional costs involved in operating small or rural agencies, and the scope of services provided by each agency.
   2. 1. In order to qualify for state assistance, each county and city and county shall contribute a minimum of one dollar and fifty cents per capita for its local health services and may contribute additional amounts as it may determine to be necessary to meet its local health needs.
      2. Notwithstanding the provisions of subparagraph (I) of this paragraph (b), for a district public health agency, the counties or cities and counties of the district in total shall contribute a minimum of one dollar and fifty cents per capita for local health services within the district.
   3. Federally funded and state-funded special projects and demonstrations shall be in addition to the allotments specified in paragraph (b) of this subsection (1).
2. Repealed.

Source: L. 2008: Entire part R&RE, p. 2045, § 1, effective July 1. L. 2009: (2) amended, (SB 09-292), ch. 369, p. 1969, § 82, effective August 5. L. 2011: (2) amended, (SB 11-225), ch. 189, p. 730, § 3, effective May 19. L. 2012: (2) amended, (HB 12-1247), ch. 53, p. 193, § 3, effective March 22. L. 2013: (2) amended, (HB 13-1181), ch. 74, p. 237, § 3, effective March 22. L. 2016: (2) amended, (HB 16-1408), ch. 153, p. 466, § 12, effective May 4.

25-1-513. Enlargement of or withdrawal from public health agency.

1. Any county contiguous to a district maintaining a district public health agency may become a part of the district by agreement between its board of county commissioners and the boards of county commissioners of the counties comprising the district. The county, upon being accepted into the district, shall thereupon become subject to the provisions of this part 5.
2. Any county in a district maintaining a district public health agency may withdraw from the district by resolution of its board of county commissioners. A county may not withdraw from a district within the two-year period following the establishment of the district or the county becoming a part of the district. A county may only withdraw from a district after one year's written notice given to the agency. In the event of withdrawal of a county from a district, any moneys that had been appropriated by the county before withdrawal to cover its proportionate share of maintaining the district may be returned to the county. A county shall establish a county public health agency or join another district public health agency once the county withdraws from a district.
3. A municipal corporation that has voluntarily merged its public health agency with a county or district public health agency under the authority of section 25-1-506 may withdraw from the county or district public health agency by resolution of its city council, board of trustees, or other governing body. A municipal corporation may not withdraw from an agency within the two-year period following the municipal corporation becoming a part of the agency. A county may only withdraw from a district ninety days after a written notice is given to the agency.

Source: L. 2008: Entire part R&RE, p. 2046, § 1, effective July 1.

Editor's note: This section is similar to former § 25-1-511 as it existed prior to 2008.

25-1-514. Legal adviser - county attorney - actions.

The county attorney for the county or the district attorney of the judicial district in which a cause of action arises shall bring any civil or criminal action requested by a county or district public health director to abate a condition that exists in violation of, or to restrain or enjoin any action that is in violation of, or to prosecute for the violation of or for the enforcement of, the public health laws and the standards, orders, and rules of the state board or a county or district board of health. If the county attorney or the district attorney fails to act, the public health director may bring an action and be represented by special counsel employed by him or her with the approval of the county or district board. An agency, through its county or district board of health or through its public health director, may employ or retain and compensate an attorney to be the legal adviser of the agency and to defend the agency and the officers and employees of the agency against all actions and proceedings brought against them.

Source: L. 2008: Entire part R&RE, p. 2047, § 1, effective July 1. L. 2019: Entire section amended, (SB 19-021), ch. 3, p. 20, § 3, effective August 2.

Editor's note: This section is similar to former § 25-1-512 as it existed prior to 2008.

Cross references: For the legislative declaration in SB 19-021, see section 1 of chapter 3, Session Laws of Colorado 2019.

25-1-515. Judicial review of decisions.

1. Any person aggrieved and affected by a decision of a county or district board of health or a public health director acting under the provisions of this part 5 shall be entitled to judicial review by filing, in the district court of any county over which the county or district board or public health director has jurisdiction, an appropriate action requesting the review within ninety days after the public announcement of the decision. The court may make any interested person a party to the action. The review shall be conducted by the court without a jury and shall be confined to the record, if a complete record is presented. In a case of alleged irregularities in the record or in the procedure before the county or district board or public health director, testimony may be taken in the court. The court may affirm the decision or may reverse or modify it if the substantial rights of the appellant have been prejudiced as a result of the findings and decision of the county or district board being:
   1. Contrary to constitutional rights or privileges;
   2. In excess of the statutory authority or jurisdiction of the county or district board or public health director;
   3. Affected by any error of law;
   4. Made or promulgated upon unlawful procedure;
   5. Unsupported by substantial evidence in view of the entire record as submitted; or
   6. Arbitrary or capricious.
2. Any party may have a review of the final judgment or decision of the district court by appellate review in accordance with law and the Colorado appellate rules.

Source: L. 2008: Entire part R&RE, p. 2047, § 1, effective July 1.

Editor's note: This section is similar to former § 25-1-513 as it existed prior to 2008.

25-1-516. Unlawful acts - penalties.

1. It is unlawful for any person, association, or corporation and the officers thereof to:
   1. Willfully violate, disobey, or disregard the provisions of the public health laws or the terms of any lawful notice, order, standard, or rule;
   2. Fail to make or file a report required by law or rule of the state board relating to the existence of disease or other facts and statistics relating to the public health;
   3. Willfully and falsely make or alter a certificate or certified copy of any certificate issued pursuant to the public health laws;
   4. Willfully fail to remove from private property under his or her control at his or her own expense, within forty-eight hours after being ordered to do so by the county or district public health agency, any nuisance, source of filth, or cause of sickness within the jurisdiction and control of the agency whether the person, association, or corporation is the owner, tenant, or occupant of the private property; except that, when the condition is due to an act of God, it shall be removed at public expense; or
   5. Pay, give, present, or otherwise convey to any officer or employee of an agency any gift, remuneration, or other consideration, directly or indirectly, that the officer or employee is forbidden to receive by the provisions of this part 5.
2. It is unlawful for any officer or employee of any agency or member of any county or district board of health to accept any gift, remuneration, or other consideration, directly or indirectly, for an incorrect or improper performance of the duties imposed upon him or her by or on behalf of the agency or by the provisions of this part 5.
3. Any person, association, or corporation, or the officers thereof, who violates any provision of this section is guilty of a class 1 misdemeanor and, upon conviction thereof, shall be punished pursuant to the provisions of section 18-1.3-501, C.R.S. In addition to the fine or imprisonment, the person, association, or corporation shall be liable for any expense incurred by health authorities in removing any nuisance, source of filth, or cause of sickness. Conviction under the penalty provisions of this part 5 or any other public health law shall not relieve any person from any civil action in damages that may exist for an injury resulting from any violation of the public health laws.

Source: L. 2008: Entire part R&RE, p. 2048, § 1, effective July 1.

Editor's note: This section is similar to former § 25-1-514 as it existed prior to 2008.

25-1-517. Mode of treatment inconsistent with religious creed or tenet.

Nothing in this part 5 authorizes a county or district board of health to impose on any person any mode of treatment inconsistent with the creed or tenets of any religious denomination of which he or she is an adherent if the person complies with sanitary and quarantine laws and rules.

Source: L. 2008: Entire part R&RE, p. 2049, § 1, effective July 1.

Editor's note: This section is similar to former § 25-1-515 as it existed prior to 2008.

25-1-518. Nuisances.

1. Removal of nuisances. The county or district board of health shall examine all nuisances, sources of filth, and causes of sickness, which, in its opinion, may be injurious to the health of the inhabitants, within its town, city, county, city and county, or district, and it shall destroy, remove, or prevent the nuisance, source of filth, or cause of sickness, as the case may require.
2. Unhealthy premises cleaned - structures removed. If any cellar, vault, lot, sewer, drain, place, or premises within any city is damp, unwholesome, offensive, or filthy, or is covered for any portion of the year with stagnant or impure water, or is in a condition as to produce unwholesome or offensive exhalations, the county or district board of health may cause the area to be drained, filled up, cleaned, amended, or purified; or may require the owner or occupant or person in charge of the lot, premises, or place to perform such duty; or may cause the removal to be done by the proper officers of the city.
3. Expense for abating nuisance. If any person or company neglects to remove or abate any nuisance or to perform any requirement made by or in accordance with any ordinance or resolution of the county or district board of health for the protection of the health of the inhabitants and if any expense is incurred by the board in removing or abating the nuisance or in causing such duty or requirement to be performed, such expense may be recovered by the board in an action against such person or company. In all cases where the board incurs any expense for draining, filling, cleaning, or purifying any lot, place, or premises, or for removing or abating any nuisance found upon such lot or premises, the board, in addition to all other remedies, may provide for the recovery of such expense, charge the same or such part thereof as it deems proper to the lot or premises upon or on account of which such expense was incurred or from which such nuisance was removed or abated, and cause the same to be assessed upon such lot or premises and collected as a special assessment.
4. Removal of nuisance on private property - penalty. Whenever any nuisance, source of filth, or cause of sickness is found on private property, the county or district board of health shall order the owner or occupant or the person who has caused or permitted such nuisance, at his or her own expense, to remove the same within twenty-four hours. In default thereof, he or she shall forfeit a sum not to exceed one hundred dollars at the suit of the board of county commissioners of the proper county or the board of the proper city, town, or village for the use of the county or district board of health of the city or town where the nuisance is found.
5. Board to remove - when. If the owner or occupant does not comply with an order of the county or district board of health, the board may cause the nuisance, source of filth, or cause of sickness to be removed, and all expense incurred thereby shall be paid by the owner or occupant or by such other person who has caused or permitted the nuisance, source of filth, or cause of sickness.
6. Conviction - nuisance to be abated. Whenever any person is convicted of maintaining a nuisance that may be injurious to the public health, the court, in its discretion, may order the nuisance abated, removed, or destroyed at the expense of the defendant under the direction of the county or district board of health of the town, city, county, or district where the nuisance is found, and the form of the warrant to the sheriff or other officer may be varied accordingly.
7. Stay warrant of conviction. The court, on the application of the defendant, may order a stay of a warrant issued pursuant to subsection (6) of this section for such time as may be necessary, not exceeding six months, to give the defendant an opportunity to remove the nuisance upon giving satisfactory security to do so within the time specified in the order.
8. Expense of abating. The expense of abating and removing the nuisance pursuant to a warrant issued pursuant to subsection (6) of this section shall be collected by the officer in the same manner as damages and costs are collected upon execution; except that the materials of any buildings, fences, or other things that may be removed as a nuisance may be sold by the officer in like manner as goods are sold on execution for the payment of debts. The officer may apply the proceeds of the sale to defray the expenses of the removal and shall pay over the balance thereof, if any, to the defendant upon demand. If the proceeds of the sale are not sufficient to defray the expenses incurred pursuant to this subsection (8), the sheriff shall collect the residue thereof as provided in subsection (3) of this section.
9. Refusal of admittance to premises.
   1. Whenever a county or district board of health finds it necessary for the preservation of the lives or health of the inhabitants to enter any building, car, or train of cars in its town, city, county, or district for the purpose of examining and abating, removing, or preventing any nuisance, source of filth, or cause of sickness and is refused entry, any member of the board may make complaint under oath to the county court of his or her county stating the facts of the case as far as he or she has knowledge thereof.
   2. The court may thereupon issue a warrant directed to the sheriff commanding him or her to take sufficient aid and, being accompanied by any two or more members of the county or district board of health, during daylight hours, to return to the place where the nuisance, source of filth, or cause of sickness complained of may be and destroy, remove, or prevent the nuisance, source of filth, cause of sickness, or danger to life or limb under the direction of the members of the board of health.
10. Damages occasioned by nuisance - action. Any person injured either in his or her comfort or in the enjoyment of his or her estate by any nuisance may have an action for damages sustained thereby.

Source: L. 2008: Entire part R&RE, p. 2049, § 1, effective July 1. L. 2009: (1) amended, (SB 09-292), ch. 369, p. 1970, § 83, effective August 5.

Editor's note: The provisions of this section are similar to provisions of several former sections as they existed prior to 2008. For a detailed comparison, see the comparative tables located in the back of the index.

25-1-519. Existing intergovernmental agreements.

Nothing in this part 5 shall void the terms of any intergovernmental agreement concerning public health entered into as of July 1, 2008, so long as all core and essential public health services continue to be provided.

Source: L. 2008: Entire part R&RE, p. 2051, § 1, effective July 1.

25-1-520. Clean syringe exchange programs - operation - approval - reporting requirements.

1. A county public health agency or district public health agency may request approval from its county board of health or district board of health, referred to in this section as the "board", for a clean syringe exchange program operated by the agency or by a nonprofit organization with which the agency contracts to operate the clean syringe exchange program. Prior to approving or disapproving any such optional program, the board shall consult with the agency and interested stakeholders concerning the establishment of the clean syringe exchange program. Interested stakeholders must include, but need not be limited to, local law enforcement agencies, district attorneys, substance use disorder treatment providers, persons with a substance use disorder in remission, nonprofit organizations, hepatitis C and HIV advocacy organizations, and members of the community. The board and interested stakeholders shall consider, at a minimum, the following issues:
   1. The scope of the problem being addressed and the population the program would serve;
   2. Concerns of the law enforcement community; and
   3. The parameters of the proposed program, including methods for identifying program workers and volunteers.
2. Each proposed clean syringe exchange program must, at a minimum, have the ability to:
   1. Provide an injection drug user with the information and the means to protect himself or herself, his or her partner, and his or her family from exposure to blood-borne disease through access to education, sterile injection equipment, voluntary testing for blood-borne diseases, and counseling;
   2. Provide thorough referrals to facilitate entry into substance use disorder treatment programs, including opioid substitution therapy;
   3. Encourage usage of medical care and mental health services as well as social welfare and health promotion;
   4. Provide safety protocols and classes for the proper handling and disposal of injection materials;
   5. Plan and implement the clean syringe exchange program with the clear objective of reducing the transmission of blood-borne diseases within a specific geographic area;
   6. Develop a timeline for the proposed program and for the development of policies and procedures; and
   7. Develop an education program regarding the legal rights under this section and section 18-18-428 (1)(b), C.R.S., that encourages participants to always disclose their possession of hypodermic needles or syringes to peace officers or emergency medical technicians or other first responders prior to a search.
   1. (2.5) (a) A nonprofit organization with experience operating a clean syringe exchange program or a health facility licensed or certified by the state may operate a clean syringe exchange program without prior board approval.
   2. Prior to operating a clean syringe exchange program pursuant to this subsection (2.5), a nonprofit organization shall consult with interested stakeholders and discuss the issues described in subsection (1) of this section.
   3. Each nonprofit organization and health facility that operates a clean syringe exchange program pursuant to this subsection (2.5) shall annually report to the state department specifying the nonprofit organization's or health facility's number of syringe access episodes in the previous year and the number of used syringes collected by the nonprofit organization or health facility.
3. The board may approve or disapprove the proposed clean syringe exchange program based on the results of the meetings held pursuant to subsection (1) of this section.
4. If the board approves a clean syringe exchange program that is operated through a contract with a nonprofit organization, the contract shall be subject to annual review and shall be renewed only if the board approves the contract after consultation with the county or district public health agency and interested stakeholders as described in subsection (1) of this section.
5. One or more counties represented on a district board of health may at any time opt out of a clean syringe exchange program proposed or approved pursuant to this section.
6. Repealed.

Source: L. 2010: Entire section added, (SB 10-189), ch. 272, p. 1253, § 3, effective August 11. L. 2015: (2)(e) and (2)(f) amended and (2)(g) added, (SB 15-116), ch. 76, p. 201, § 3, effective July 1. L. 2017: IP(1), IP(2), and (2)(b) amended, (SB 17-242), ch. 263, p. 1322, § 182, effective May 25. L. 2019: (2.5) added, (SB 19-227), ch. 273, p. 2580, § 9, effective May 23. L. 2020: (2.5) amended, (HB 20-1065), ch. 287, p. 1420, § 7, effective September 14.

Editor's note: Subsection (6)(b) provided for the repeal of subsection (6), effective July 1, 2014. (See L. 2010, p. 1253 .)

Cross references: For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.

25-1-521. State department - local public health agencies - address substance use disorders - appropriation - repeal. (Repealed)

Source: L. 2019: Entire section added, (SB 19-228), ch. 276, p. 2603, § 7, effective May 23.

Editor's note: Subsection (2) provided for the repeal of this section, effective July 1, 2020. (See L. 2019, p. 2603 .)

25-1-601 to 25-1-667. (Repealed)

Source: L. 2008: Entire part repealed, p. 2051, § 3, effective July 1.

Editor's note: This part 6 was numbered as article 3 of chapter 66, C.R.S. 1963. For amendments to this part 6 prior to its repeal in 2008, consult the Colorado statutory research explanatory note and the table itemizing the replacement volumes and supplements to the original volume of C.R.S. 1973 beginning on page vii in the front of this volume. The provisions of this part 6 were relocated to part 5 of this article. For the location of specific provisions, see the editor's notes following each section in said part 5 and the comparative tables located in the back of the index.

25-1-701 to 25-1-719. (Repealed)

Source: L. 2008: Entire part repealed, p. 2051, § 3, effective July 1.

Editor's note: This part 7 was numbered as article 37 of chapter 66, C.R.S. 1963. For amendments to this part 7 prior to its repeal in 2008, consult the Colorado statutory research explanatory note and the table itemizing the replacement volumes and supplements to the original volume of C.R.S. 1973 beginning on page vii in the front of this volume.

25-1-801. Patient records in custody of health care facility - definitions.

1. 1. Every patient record in the custody of a health facility licensed or certified pursuant to section 25-1.5-103 (1) or article 3 of this title, or both, or any entity regulated under title 10, C.R.S., providing health care services, as defined in section 10-16-102 (33), C.R.S., directly or indirectly through a managed care plan, as defined in section 10-16-102 (43), C.R.S., or otherwise, shall be available for inspection to the patient or the patient's personal representative through the attending health care provider or the provider's designated representative at reasonable times and upon reasonable notice, except records withheld in accordance with 45 CFR 164.524 (a). A summary of records pertaining to a patient's mental health problems may, upon written request and signed and dated authorization, be made available to the patient or the patient's personal representative following termination of the treatment program.
   2. 1. 1. A health facility licensed or certified pursuant to section 25-1.5-103 (1) or article 3 of this title, or both, or an entity regulated under title 10, C.R.S., providing health care services, as defined in section 10-16-102 (33), C.R.S., directly or indirectly through a managed care plan, as defined in section 10-16-102 (43), C.R.S., or otherwise, must provide copies of a patient's medical records, including X rays, to the patient or the patient's personal representative upon request and payment of the fee a covered entity may impose in accordance with the "Health Insurance Portability and Accountability Act of 1996", Pub.L. 104-191, as amended, and any rules promulgated pursuant to the act, or to a third person who requests the records upon submission of a HIPAA-compliant authorization, valid subpoena, or court order and upon the payment of the reasonable fees. (b) (I) (A) A health facility licensed or certified pursuant to section 25-1.5-103 (1) or article 3 of this title, or both, or an entity regulated under title 10, C.R.S., providing health care services, as defined in section 10-16-102 (33), C.R.S., directly or indirectly through a managed care plan, as defined in section 10-16-102 (43), C.R.S., or otherwise, must provide copies of a patient's medical records, including X rays, to the patient or the patient's personal representative upon request and payment of the fee a covered entity may impose in accordance with the "Health Insurance Portability and Accountability Act of 1996", Pub.L. 104-191, as amended, and any rules promulgated pursuant to the act, or to a third person who requests the records upon submission of a HIPAA-compliant authorization, valid subpoena, or court order and upon the payment of the reasonable fees.
         2. The health care facility must deliver the medical records in electronic format if the person requests electronic format, the original medical records are stored in electronic format, and the medical records are readily producible in electronic format.
      2. In the event that a licensed health care professional determines that a copy of any X ray, mammogram, CT SCAN, MRI, or other film is not sufficient for diagnostic or other treatment purposes, the health facility or entity shall make the original of any such film available to the patient or another health care professional or facility as specifically directed by the patient pursuant to a written authorization-request for films and upon the payment of the reasonable costs for such film. If a health facility releases an original film pursuant to this subparagraph (II), it shall not be responsible for any loss, damage, or other consequences as a result of such release. Any original X ray, mammogram, CT SCAN, MRI, or other film made available pursuant to this subparagraph (II) shall be returned upon request to the lending facility within thirty days.
   3. The hospital or related facility or institution shall post in conspicuous public places on the premises a statement of the requirements set forth in paragraphs (a) and (b) of this subsection (1) and shall make available a copy of said statement to each patient upon admission.
   4. Nothing in this section requires a person responsible for the diagnosis or treatment of sexually transmitted infections, a substance use disorder, or the use of drugs in the case of minors pursuant to sections 13-22-102 and 25-4-409 to release patient records of such diagnosis or treatment to a parent, guardian, or person other than the minor or his or her designated representative.
2. All requests by a patient or the patient's personal representative for inspection of the patient's medical records made under this section shall be noted with the time and date of the request and the time and date of inspection noted by the attending health care provider or his or her designated representative. The patient or personal representative shall acknowledge the fact of the inspection by dating and signing the record file. A health care facility shall not charge a fee for the inspection of medical records.
3. Nothing in this section shall apply to any nursing institution conducted by or for the adherents of any well-recognized church or religious denomination for the purpose of providing facilities for the care and treatment of the sick who depend exclusively upon spiritual means through prayer for healing and the practice of the religion of such church or denomination.
4. For the purposes of this section, medical information transmitted during the delivery of health care via telemedicine, as defined in section 12-240-104 (6), is part of the patient's medical record maintained by the health care facility.
5. As used in this part 8, unless the context otherwise requires:
   1. "HIPAA-compliant" means in compliance with the "Health Insurance Portability and Accountability Act of 1996", Pub.L. 104-191, as amended.
   2. "Personal representative" has the meaning set forth in 45 CFR 164.502.
   3. 1. "Reasonable fees" means an amount not to exceed:
         1. Eighteen dollars and fifty-three cents for the first ten pages, eighty-five cents per page for the next thirty pages, and fifty-seven cents per page for each additional page; except that, if the medical records are stored on microfilm, one dollar and fifty cents per page;
         2. For radiographic studies, actual reproduction costs for each copy of a radiograph;
         3. If the authorized person requests certification of the medical records, a fee of ten dollars;
         4. Actual postage and electronic media costs, if applicable; and
         5. Applicable taxes.
      2. Notwithstanding any other provision of this part 8:
         1. If a patient record is requested by a third-party entity that is performing duties under the "Laura Hershey Disability Support Act", part 22 of article 30 of title 24, C.R.S., the third party may obtain one free copy of the record for the application process or for an appeal or reapplication when required by the disability benefit administrator;
         2. If maximum rates have already been established by statute or rule for a state or local government entity, those rates prevail over the rates set forth in this part 8; and
         3. This part 8 does not apply to coroners requesting medical records pursuant to section 30-10-606, C.R.S.

Source: L. 76: Entire part added, p. 648, § 1, effective July 1. L. 83: (1)(a) R&RE, p. 1040, § 1, effective May 20. L. 97: (1)(a) and (1)(b) amended, p. 348, § 1, effective April 19. L. 2001: (4) added, p. 1163, § 10, effective January 1, 2002. L. 2003: (1)(a) and (1)(b)(I) amended, p. 708, § 36, effective July 1. L. 2009: (1)(d) amended, (SB 09-179), ch. 112, p. 475, § 20, effective April 9. L. 2013: (1)(a) and (1)(b)(I) amended, (HB 13-1266), ch. 217, p. 991, § 60, effective May 13. L. 2014: (1)(a), (1)(b)(I), and (2) amended and (5) added, (HB 14-1186), ch. 125, p. 445, § 2, effective April 18. L. 2016: (1)(d) amended, (SB 16-146), ch. 230, p. 922, § 21, effective July 1; (5)(c)(II)(A) amended, (HB 16-1362), ch. 319, p. 1296, § 3, effective August 10. L. 2018: (1)(d) amended, (SB 18-091), ch. 35, p. 387, § 21, effective August 8. L. 2019: (4) amended, (SB 19-241), ch. 390, p. 3471, § 32, effective October 1; (4) amended, (HB 19-1172), ch. 136, p. 1695, § 139, effective October 1.

Cross references: For the legislative declaration contained in the 2001 act enacting subsection (4), see section 1 of chapter 300, Session Laws of Colorado 2001. For the legislative declaration in HB 14-1186, see section 1 of chapter 125, Session Laws of Colorado 2014. For the legislative declaration in SB 18-091, see section 1 of chapter 35, Session Laws of Colorado 2018.

25-1-802. Patient records in custody of individual health care providers.

1. 1. Every patient record in the custody of a podiatrist, chiropractor, dentist, doctor of medicine, doctor of osteopathy, nurse, optometrist, occupational therapist, audiologist, acupuncturist, direct-entry midwife, or physical therapist required to be licensed under title 12, a naturopathic doctor required to be registered pursuant to article 250 of title 12, or a person practicing psychotherapy under article 245 of title 12, except records withheld in accordance with 45 CFR 164.524 (a), must be available to the patient or the patient's personal representative upon submission of a valid authorization for inspection of records, dated and signed by the patient, at reasonable times and upon reasonable notice. A summary of records pertaining to a patient's mental health problems may, upon written request accompanied by a signed and dated authorization, be made available to the patient or the patient's personal representative following termination of the treatment program.
   2. 1. 1. A copy of the records, including radiographic studies, must be made available to the patient or the patient's personal representative, upon request and payment of the fee a covered entity may impose in accordance with the "Health Insurance Portability and Accountability Act of 1996", Pub.L. 104-191, as amended, or to a third person who requests the medical records upon submission of a HIPAA-compliant authorization, a valid subpoena, or a court order, and payment of reasonable fees. (b) (I) (A) A copy of the records, including radiographic studies, must be made available to the patient or the patient's personal representative, upon request and payment of the fee a covered entity may impose in accordance with the "Health Insurance Portability and Accountability Act of 1996", Pub.L. 104-191, as amended, or to a third person who requests the medical records upon submission of a HIPAA-compliant authorization, a valid subpoena, or a court order, and payment of reasonable fees.
         2. The health care provider must provide the medical records in electronic format if the person requests electronic format, the original medical records are stored in electronic format, and the medical records are readily producible in electronic format.
      2. If a licensed health care professional determines that a copy of a radiographic study, including an X ray, mammogram, CT scan, MRI, or other film is not sufficient for diagnostic or other treatment purposes, the podiatrist, chiropractor, dentist, doctor of medicine, doctor of osteopathy, nurse, optometrist, audiologist, acupuncturist, direct-entry midwife, or physical therapist required to be licensed under title 12, or, subject to the provisions of section 25-1-801 (1)(a) and subsection (1)(a) of this section, the person practicing psychotherapy under article 245 of title 12 shall make the original of any radiographic study available to the patient, the patient's personal representative, a person authorized by the patient, or another health care professional or facility as specifically directed by the patient, personal representative, authorized person, or health care professional or facility pursuant to a HIPAA-compliant authorization and upon the payment of the reasonable fees for the radiographic study. If a practitioner releases an original radiographic study pursuant to this subsection (1)(b)(II), the practitioner is not responsible for any loss, damage, or other consequences as a result of the release. Any original radiographic study made available pursuant to this subsection (1)(b)(II) must be returned upon request to the lending practitioner within thirty days.
2. Nothing in this section requires a person responsible for the diagnosis or treatment of sexually transmitted infections, substance use disorders, or the use of drugs in the case of minors pursuant to sections 13-22-102 and 25-4-409 to release patient records of such diagnosis or treatment to a parent, guardian, or person other than the minor or his or her designated representative.
3. For purposes of this section, "patient record" does not include a doctor's office notes.
4. All requests by a patient or the patient's personal representative for inspection of his or her medical records made under this section shall be noted with the time and date of the request and the time and date of inspection noted by the health care provider or his or her designated representative. The patient or the patient's personal representative shall acknowledge the inspection by dating and signing the record file. A health care provider shall not charge a fee for the inspection of medical records.
5. For the purposes of this section, medical information transmitted during the delivery of health care via telemedicine, as defined in section 12-240-104 (6), is part of the patient's medical record maintained by a health care provider.

Source: L. 76: Entire part added, p. 649, § 1, effective July 1. L. 97: (1) amended, p. 349, § 2, effective April 19; (1)(a) amended, p. 1032, § 69, effective August 6. L. 2001: (5) added, p. 1163, § 11, effective January 1, 2002. L. 2009: (2) amended, (SB 09-179), ch. 112, p. 475, § 21, effective April 9. L. 2014: (1) and (4) amended, (HB 14-1186), ch. 125, p. 446, § 3, effective April 18. L. 2016: (2) amended, (SB 16-146), ch. 230, p. 922, § 22, effective July 1. L. 2018: (2) amended, (SB 18-091), ch. 35, p. 387, § 22, effective August 8. L. 2019: (1)(a), (1)(b)(II), and (5) amended, (HB 19-1172), ch. 136, p. 1695, § 140, effective October 1; (5) amended, (SB 19-241), ch. 390, p. 3471, § 34, effective October 1.

Cross references: For the legislative declaration contained in the 2001 act enacting subsection (5), see section 1 of chapter 300, Session Laws of Colorado 2001. For the legislative declaration in HB 14-1186, see section 1 of chapter 125, Session Laws of Colorado 2014. For the legislative declaration in SB 18-091, see section 1 of chapter 35, Session Laws of Colorado 2018.

25-1-803. Effect of this part 8 on similar rights of a patient.

1. Nothing in this part 8:
   1. Limits the right of a patient, the patient's personal representative, or a person who requests the medical records upon submission of a HIPAA-compliant authorization, a valid subpoena, or a court order to inspect the patient's medical or mental health data pursuant to section 24-72-204 (3)(a)(I), C.R.S.; or
   2. Limits or expands a right to inspect the patient's records that is otherwise granted by state statute to the patient, the patient's personal representative, or a person who requests the medical records upon submission of a HIPAA-compliant authorization, a valid subpoena, or a court order.

Source: L. 76: Entire part added, p. 650, § 1, effective July 1. L. 97: (1)(a) amended, p. 350, § 3, effective April 19. L. 2014: Entire section amended, (HB 14-1186), ch. 125, p. 448, § 4, effective April 18.

Cross references: For the legislative declaration in HB 14-1186, see section 1 of chapter 125, Session Laws of Colorado 2014.

25-1-901 to 25-1-904. (Repealed)

Source: L. 2017: Entire part repealed, (HB 17-1024), ch. 7, p. 22, § 4, effective August 9.

Editor's note: This part 9 was added in 1977. For amendments to this part 9 prior to its repeal in 2017, consult the 2016 Colorado Revised Statutes and the Colorado statutory research explanatory note beginning on page vii in the front of this volume. This part 9 was relocated to part 6 of article 1 of title 25.5. Former C.R.S. section numbers are shown in editor's notes following those sections.

25-1-1001. Legislative declaration.

The general assembly hereby finds that the operation of child care centers in nursing home facilities is desirable because the benefit to nursing home facility employees in having on-location child care will improve the quality of care in nursing home facilities by stabilizing the nursing home work force and because the general public, especially in rural areas, will benefit from the increased availability of day care centers in their communities. The general assembly also finds that the operation of child care centers in nursing home facilities is desirable because the intergenerational contact has been proven to be beneficial to the health and well-being of elderly persons and, therefore, will improve the quality of life of elderly residents in nursing home facilities and because the intergenerational contact will be beneficial to the children as well. The general assembly, therefore, declares that the intent of this part 10 is to encourage the development of child care centers in nursing home facilities by encouraging the creation of private grants to provide funds to start such centers and by requiring the state agencies which license nursing home facilities and child care centers to study and recommend statutory and regulatory changes to facilitate and encourage the development of child care centers in nursing home facilities.

Source: L. 88: Entire part added, p. 1003, § 1, effective April 28.

25-1-1002. Definitions.

As used in this part 10, unless the context otherwise requires:

1. "Nursing home facility" means a facility which provides skilled nursing home services or intermediate care nursing home services.

Source: L. 88: Entire part added, p. 1004, § 1, effective April 28.

25-1-1003. Grant program - requirements - use of medical assistance funds prohibited.

1. The department of public health and environment may encourage the development of a private grant program to provide start-up funds to nursing home facilities for the purpose of establishing child care centers located in such nursing home facilities.
2. The state board of health, after consultation with the division in the department of human services involved in licensing child care centers and if the committee formed in section 25-1-1004 recommends the establishment of child care facilities in nursing homes, shall promulgate reasonable rules and regulations establishing any necessary requirements for operating a day care center in a nursing home facility. Such rules and regulations shall include, but need not be limited to, the following:
   1. Requirements for the operation of a safe and good-quality child care operation in the nursing home facility or upon the nursing home facility's grounds, which shall include:
      1. Precautions required to be taken to ensure that all staff and residents who will participate in the intergenerational programs have not been involved in incidents of sexual abuse or child abuse;
      2. Requirements relating to the ability to properly care for the children;
      3. Child care ratios of staff to children;
      4. Requirements relating to the constant supervision of the children by staff members and not by nursing home residents;
      5. Life safety and fire regulations;
   2. Requirements on the amount and type of liability insurance necessary to insure the risks associated with the child care operation;
   3. Requirements on the ways in which the nursing home residents may be involved in the child care center and the requirement that the participation of nursing home residents in intergenerational activities with the children in the child care operation shall be on a voluntary basis;
   4. Requirements that any fees assessed to the employees of the nursing home facility whose children participate in the child care program will be based on a sliding scale;
   5. Requirements that the participation of employees of the nursing home facility in the enrollment of their children in the intergenerational day care program of the nursing home facility shall be on a voluntary basis.
3. No medical assistance funds under the "Colorado Medical Assistance Act", articles 4, 5, and 6 of title 25.5, C.R.S., shall be used to subsidize the cost of operating a day care center or day care program in a nursing home facility.

Source: L. 88: Entire part added, p. 1004, § 1, effective April 28. L. 94: (1) and IP(2) amended, pp. 2746, 2702, §§ 395, 255, effective July 1. L. 2006: (3) amended, p. 2014, § 85, effective July 1.

Cross references: For the legislative declaration contained in the 1994 act amending subsection (1) and the introductory portion to subsection (2), see section 1 of chapter 345, Session Laws of Colorado 1994.

25-1-1004. Study of statutes and rules and regulations pertaining to nursing home facilities and day care centers.

1. The department of public health and environment and the department of human services, in conjunction with representatives of the nursing home industry, child care operators, and experts on child care programs in nursing home facilities, shall examine and study the existing statutes and rules and regulations concerning the licensing of child care centers and of nursing home facilities to determine what statutory or regulatory changes or both would make it easier for a nursing home facility to operate a child care center. The study shall also include an examination of the advantages and disadvantages of operating such intergenerational programs and the most appropriate and practical ways to design such intergenerational child care programs which are beneficial both to the children and to the elderly persons.
2. The study conducted by the department of public health and environment and the department of human services shall include, but need not be limited to, consideration of the following:
   1. The establishment of new rules and regulations by the department of public health and environment and the department of human services which would allow nursing home facilities to operate a child care operation in the nursing home facilities;
   2. A coordinated licensure program to license a child care operation in a nursing home facility which would be based on rules and regulations designed specifically for the operation of a child care center in a nursing home facility.
3. Repealed.
4. The department of public health and environment and the department of human services shall comply with the requirements of this part 10 within the current appropriation established for each department. No request for appropriations shall be made to the general assembly for the implementation of this part 10.

Source: L. 88: Entire part added, p. 1005, § 1, effective April 28. L. 94: (1), IP(2), (2)(a), (3), and (4) amended, p. 2747, § 396, effective July 1. L. 96: (3) repealed, p. 1257, § 147, effective August 7.

Cross references: For the legislative declaration contained in the 1994 act amending subsection (1), the introductory portion to subsection (2), and subsections (2)(a), (3), and (4), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration contained in the 1996 act amending this section, see section 1 of chapter 237, Session Laws of Colorado 1996.

25-1-1100.2 to 25-1-1112. (Repealed)

Source: L. 2010: Entire part repealed, (SB 10-175), ch. 188, p. 675, § 1, effective April 29.

25-1-1201. Legislative declaration.

The general assembly hereby finds, determines, and declares that maintaining the confidentiality of medical records is of the utmost importance to the state and of critical importance to patient privacy for high quality medical care. Most people in the United States consider confidentiality of health information important and worry that the increased computerization of health records may result in inappropriate disclosure of such records. Patients have a strong interest in preserving the privacy of their personal health information, but they also have an interest in medical research and other efforts by health care organizations to improve the medical care they receive. How best to preserve confidentiality within a state health information infrastructure is an important discussion that is affected by recent regulations promulgated by the federal department of health and human services related to the electronic storage of health information. The purpose of this part 12 is to index the provisions that govern medical record confidentiality to facilitate locating the law concerning the confidentiality of medical records and health information. It is not intended to expand, narrow, or clarify existing provisions.

Source: L. 2001: Entire part added, p. 828, § 5, effective August 8.

25-1-1202. Index of statutory sections regarding medical record confidentiality and health information.

1. Statutory provisions concerning policies, procedures, and references to the release, sharing, and use of medical records and health information include the following:
   1. Section 10-16-1003, C.R.S., concerning use of information by health care cooperatives;
   2. Section 8-43-404, C.R.S., concerning examinations by a physician or chiropractor for the purposes of workers' compensation;
   3. Section 8-43-501, C.R.S., concerning utilization review related to workers' compensation;
   4. Section 8-73-108, C.R.S., concerning the award of benefits for unemployment compensation benefits;
   5. Section 10-3-1104.7, C.R.S., concerning the confidentiality and use of genetic testing information;
   6. Section 10-16-113, C.R.S., concerning the procedures related to the denial of health benefits by an insurer;
   7. Section 10-16-113.5, C.R.S., concerning the use of independent external review when health benefits have been denied;
   8. Section 10-16-423, C.R.S., concerning the confidentiality of medical information in the custody of a health maintenance organization;
   9. Section 12-290-113, concerning disciplinary actions against podiatrists;
   10. Section 12-215-126, concerning confidential communications between a licensed chiropractor and a patient;
   11. Section 12-220-201, concerning disciplinary actions against dentists and dental hygienists;
   12. Section 12-240-125, concerning disciplinary actions against physicians;
   13. Section 12-240-139 (1), concerning reporting requirements for physicians pertaining to certain injuries;
   14. Section 12-30-204, concerning professional review committees for physicians;
   15. Section 12-30-205, concerning hospital professional review committees;
   16. Section 13-22-704, concerning reporting requirements by physicians related to abortions for minors;
   17. Section 12-255-119, concerning disciplinary proceedings against a practical nurse, a professional nurse, or a psychiatric technician;
   18. Section 12-245-220, concerning the disclosure of confidential communications by a mental health professional;
   19. Section 12-245-226 (4), concerning disciplinary proceedings against a mental health professional;
   20. Section 13-21-110, C.R.S., concerning confidentiality of information, data, reports, or records of a utilization review committee of a hospital or other health care facility;
   21. Section 13-21-117, C.R.S., concerning civil liability of a mental health professional, mental health hospital, community mental health center, or clinic related to a duty to warn or protect;
   22. Sections 13-22-101 to 13-22-106, C.R.S., concerning the age of competence for certain medical procedures;
   23. Section 13-64-502, C.R.S., concerning civil liability related to genetic counseling and screening and prenatal care, or arising from or during the course of labor and delivery, or the period of postnatal care in a health institution;
   24. Section 13-80-103.7, C.R.S., concerning a limited waiver of medical information in civil actions related to sexual assault or sexual offenses against a child;
   25. Section 13-90-107 (1)(d), C.R.S., concerning when a physician, surgeon, or registered professional nurse may testify related to the care and treatment of a person;
   26. Section 14-10-124, C.R.S., concerning the best interests of a child for the purposes of a separation or dissolution of marriage;
   27. Section 14-10-127, C.R.S., concerning the allocation of parental responsibilities with respect to a child;
   28. Section 17-27.1-101 (4), C.R.S., concerning nongovernmental facilities for offenders and the waiver of confidential information;
   29. Section 18-3-203, concerning assault in the second degree and the availability of medical testing for certain circumstances;
   30. Section 18-4-412, C.R.S., concerning theft of medical records or medical information;
   31. Repealed.

       (ee.5) Section 18-18-406.3, C.R.S., concerning medical marijuana patient records;

   32. Section 18-18-503, C.R.S., concerning cooperative agreements to control substance abuse;
   33. Section 19-3-304, C.R.S., concerning persons required to report child abuse or neglect;
   34. Section 19-3-305, C.R.S., concerning postmortem investigation related to the death of a child;
   35. Section 19-3-306, C.R.S., concerning evidence of abuse or neglect of a child;
   36. Section 19-5-103 (2), C.R.S., concerning relinquishment of rights concerning a child;
   37. Section 19-5-305, C.R.S., concerning access to adoption records;
   38. Section 22-1-123 (5), C.R.S., concerning the protection of student data;
   39. Sections 22-32-109.1 (6) and 22-32-109.3 (2), C.R.S., concerning specific powers and duties of the state board of education;
   40. Repealed.
   41. Section 24-51-213, C.R.S., concerning confidentiality of records maintained by the public employees' retirement association;
   42. Section 24-72-204 (3), C.R.S., concerning public records not open to public inspection;
   43. Section 25-1-122, concerning reporting of certain diseases and conditions for investigation of epidemic and communicable diseases, morbidity and mortality, cancer in connection with the statewide cancer registry, environmental and chronic diseases, sexually transmitted infections, tuberculosis, and rabies and mammal bites by the department of public health and environment;
   44. Section 25-1-124 (2), concerning health care facilities and reporting requirements;
   45. Sections 27-81-110 and 27-81-113, C.R.S., concerning the treatment of intoxicated persons;
   46. Section 25-1-801, concerning patient records in the care of a health care facility;
   47. Section 25-1-802, concerning patient records in the care of individual health care providers;
   48. Sections 27-81-109 and 27-81-113, concerning the treatment of persons with substance use disorders;

       (vv.5) Section 25-1.5-106, concerning the medical marijuana program;

   49. Section 25-2-120, concerning reports of electroconvulsive treatment;
   50. Section 25-3-109, concerning quality management functions of health care facilities licensed by the department of public health and environment;
   51. Section 25-3.5-501, concerning records maintained by ambulance services and emergency medical service providers;
   52. Section 25-3.5-704 (2)(d) and (2)(f), concerning the designation of emergency medical facilities and the statewide trauma system;
   53. Sections 25-4-406 and 25-4-409, concerning the reporting of sexually transmitted infections;
   54. Section 25-4-1003, concerning newborn screening programs and genetic counseling;
   55. Repealed.
   56. Section 25-4-1705, concerning immunization information;
   57. Section 25-4-1905, concerning records collected related to Gulf War syndrome;
   58. Section 25-32-106, concerning the release of medical information to a poison control service provider;
   59. Section 26-3.1-102 (2), C.R.S., concerning reporting requirements related to at-risk adults;
   60. Section 26-11.5-108, C.R.S., concerning the long-term ombudsman program and access to medical records;
   61. Section 27-65-103 (2), C.R.S., concerning voluntary applications for mental health services;
   62. Sections 27-65-121 (2) and 27-65-122, C.R.S., concerning records related to mental health services for minor children;
   63. Section 30-10-606 (6), C.R.S., concerning postmortem investigations and records;
   64. Section 35-9-109, C.R.S., concerning confidentiality of information released to the commissioner of agriculture related to human exposure to pesticide applications;
   65. Section 42-2-112, C.R.S., concerning information supplied to the department of revenue for the purpose of renewing or obtaining a license to operate a motor vehicle; and
   66. Section 12-280-406, concerning information entered into the prescription drug monitoring program database.

Source: L. 2001: Entire part added, p. 829, § 5, effective August 8. L. 2002: (1)(fff) amended, p. 428, § 6, effective July 1. L. 2003: (1)(ii) amended, p. 1997, § 46, effective May 22. L. 2004: (1)(k) amended, p. 857, § 3, effective July 1; (1)(a) amended, p. 1010, § 21, effective August 4. L. 2009: (1)(qq) and (1)(aaa) amended, (SB 09-179), ch. 112, p. 475, § 22, effective April 9. L. 2010: (1)(ss), (1)(vv), (1)(iii), and (1)(jjj) amended, (SB 10-175), ch. 188, p. 797, § 57, effective April 29; (1)(vv.5) added, (SB 10-109), ch. 356, p. 1696, § 2, effective June 7. L. 2011: (1)(ee.5) added, (HB 11-1043), ch. 266, p. 1215, § 29, effective July 1; (1)(nnn) added, (SB 11-192), ch. 230, p. 987, § 13, effective July 1. L. 2012: (1)(yy) amended, (HB 12-1059), ch. 271, p. 1437, § 18, effective July 1; (1)(nnn) amended, (HB 12-1311), ch. 281, p. 1627, § 69, effective July 1. L. 2013: (1)(ee) repealed, (HB 13-1154), ch. 372, p. 2192, § 3, effective July 1. L. 2016: (1)(aaa) amended and (1)(ccc) repealed, (SB 16-146), ch. 230, pp. 922, 914, §§ 23, 3, effective July 1. L. 2017: (1)(vv) amended, (SB 17-242), ch. 263, p. 1323, § 183, effective May 25. L. 2018: (1)(p) amended, (SB 18-032), ch. 8, p. 150, § 2, effective October 1. L. 2019: (1)(j) and (1)(cc) amended and (1)(nn) repealed, (SB 19-241), ch. 390, p. 3471, § 35, effective August 2; (1)(i), (1)(j), (1)(k), (1)(l), (1)(m), (1)(n), (1)(o), (1)(q), (1)(r), (1)(s), and (1)(nnn) amended, (HB 19-1172), ch. 136, p. 1696, § 141, effective October 1. L. 2020: (1)(cc) amended, (HB 20-1402), ch. 216, p. 1052, § 49, effective June 30; (1)(vv) amended, (SB 20-007), ch. 286, p. 1415, § 48, effective July 13; (1)(k) amended, (HB 20-1056), ch. 64, p. 263, § 7, effective September 14.

Editor's note: Amendments to subsection (1)(j) by SB 19-241 and HB 19-1172 were harmonized.

Cross references: For the legislative declaration in the 2013 act repealing subsection (1)(ee), see section 1 of chapter 372, Session Laws of Colorado 2013. For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.

25-1-1203. Electronic storage of medical records.

Health plans, health care clearinghouses, and health care providers shall develop policies, procedures, and systems to comply with federal regulations promulgated by the federal department of health and human services related to electronic storage and maintenance of medical record information pursuant to federal law.

Source: L. 2001: Entire part added, p. 833, § 5, effective August 8.

25-1-1204. Online exchange of advanced directives forms permitted.

A public or private entity, including a nonprofit organization, that facilitates the exchange of health information among emergency medical service providers, doctors, hospitals, nursing homes, pharmacies, home health agencies, health plans, and local health information agencies through the use of health information technology may facilitate the voluntary, secure, and confidential exchange of forms containing advanced directives regarding a person's acceptance or rejection of life-sustaining medical or surgical treatment.

Source: L. 2010: Entire section added, (HB 10-1050), ch. 80, p. 271, § 1, effective August 11. L. 2012: Entire section amended, (HB 12-1059), ch. 271, p. 1437, § 19, effective July 1.

25-1-1301. Short title.

This part 13 shall be known and may be cited as the "Colorado Climate Change Markets Act".

Source: L. 2006: Entire part added, p. 1743, § 4, effective June 6.

25-1-1302. Legislative declaration.

1. The general assembly hereby finds and declares that:
   1. As the United States and other countries take action to address issues related to climate change, Colorado faces important policy choices.
   2. Emerging technologies and markets related to climate change promise significant economic opportunities for the state, particularly for agriculture and rural economies.
   3. The general assembly enacts the "Colorado Climate Change Markets Act" for the purpose of positioning Colorado at the forefront of emerging markets related to climate change and helping affected industries and economies benefit from these opportunities.

Source: L. 2006: Entire part added, p. 1743, § 4, effective June 6.

25-1-1303. Grants for research - reports to general assembly.

1. The department of public health and environment shall administer a program to award grants pursuant to this section.
2. 1. A grant of fifty thousand dollars shall be awarded to Colorado state university to conduct research on the potential for the use of terrestrial carbon sequestration in agricultural, rangeland, and forest soils as a technique for mitigating the emissions of greenhouse gases in the state.
   2. A grant of fifty thousand dollars shall be awarded to the Colorado school of mines to conduct research on the potential for the use of geologic carbon sequestration as a technique for mitigating the emissions of greenhouse gases in the state.
   3. A grant of thirty-five thousand dollars shall be awarded to the university of Colorado to conduct research on the emerging international and domestic markets in greenhouse gas emissions and to conduct research on private firms in various economic sectors that are reducing emissions of greenhouse gases.
3. Each recipient of a grant awarded pursuant to this section shall report the results of the research conducted under the grant to the agriculture committees of the senate and the house of representatives no later than March 15, 2007.

Source: L. 2006: Entire part added, p. 1743, § 4, effective June 6.

25-1-1401 to 25-1-1403. (Repealed)

25-1.5-101. Powers and duties of department - laboratory cash fund - report - definition - repeal.

1. The department has, in addition to all other powers and duties imposed upon it by law, the powers and duties provided in this section as follows:
   1. To close theaters, schools, and other public places, and to forbid gatherings of people when necessary to protect the public health;
   2. 1. To establish and enforce minimum general sanitary standards as to the quality of wastes discharged upon land and the quality of fertilizer derived from excreta of human beings or from the sludge of sewage disposal plants.
      2. The phrase "minimum general sanitary standards" as used in this section means the minimum standards reasonably consistent with assuring adequate protection of the public health. The word "standards" as used in this section means standards reasonably designed to promote and protect the public health.
   3. 1. To collect, compile, and tabulate reports of marriages, dissolution of marriages, declaration of invalidity of marriages, births, deaths, and morbidity and to require any person having information with regard to the same to make such reports and submit such information as the board shall by rule or regulation provide.
      2. For the purposes of this paragraph (c), the board is authorized to require reporting of morbidity and mortality in accordance with the provisions of section 25-1-122.
   4. To regulate the disposal, transportation, interment, and disinterment of the dead;
   5. 1. To establish, maintain, and approve chemical, bacteriological, and biological laboratories, and to conduct such laboratory investigations and examinations as it may deem necessary or proper for the protection of the public health.
      2. The department shall transmit all fees received by the department in connection with the laboratories established pursuant to this paragraph (e), with the exception of fees received pursuant to part 10 of article 4 of this title that are credited to the newborn screening and genetic counseling cash funds created in section 25-4-1006 (1), to the state treasurer, who shall deposit them in the laboratory cash fund, which is hereby created in the state treasury. The state treasurer shall credit all interest earned from the revenues in the fund to the fund. At the end of each fiscal year, the unencumbered balance of the fund remains in the fund. The revenues in the fund are subject to annual appropriation by the general assembly to the department to carry out its duties under this paragraph (e).
   6. To make, approve, and establish standards for diagnostic tests by chemical, bacteriological, and biological laboratories, and to require such laboratories to conform thereto; and to prepare, distribute, and require the completion of forms or certificates with respect thereto;
   7. To purchase, and to distribute to licensed physicians and veterinarians, with or without charge, as the board may determine upon considerations of emergency or need, such vaccines, serums, toxoids, and other approved biological or therapeutic products as may be necessary for the protection of the public health;
   8. To establish and enforce sanitary standards for the operation and maintenance of orphanages, day care nurseries, foster homes, family care homes, summer camps for children, lodging houses, guest child care facilities as defined in section 26-6-102 (16), C.R.S., public services short-term child care facilities as defined in section 26-6-102 (30), C.R.S., hotels, public conveyances and stations, schools, factories, workshops, industrial and labor camps, recreational resorts and camps, swimming pools, public baths, mobile home parks, and other buildings, centers, and places used for public gatherings;
   9. 1. 1. To establish sanitary standards and make sanitary, sewerage, and health inspections and examinations for charitable, penal, and other public institutions. (i) (I) (A) To establish sanitary standards and make sanitary, sewerage, and health inspections and examinations for charitable, penal, and other public institutions.
         2. As used in this subsection (1)(i), "penal institution" means any local detention center, correctional facility, holding facility, secure residential treatment center, prison, camp, or other facility in which persons are or may be lawfully held in custody, including any public or private facility in Colorado that houses or detains noncitizens for purposes of civil immigration proceedings, including any facility that houses or detains minors, on behalf of the federal office of refugee resettlement or the United States immigration and customs enforcement agency.
         3. With respect to the state institutions under the department of human services specified in section 27-90-104 or under the department of corrections specified in section 17-1-104.3 (1)(b), such inspections and examinations must be made at least once each year and additional unannounced inspections may be conducted after the annual inspection. Reports on such inspections of institutions under control of the department of human services or the department of corrections must be made to the executive director of the appropriate department for appropriate action, if any.
         4. With respect to any facility that houses or detains noncitizens for purposes of civil immigration proceedings, such inspections and examinations must be made annually, and additional unannounced inspections may be conducted after the annual inspection.
         5. For the state fiscal year commencing July 1, 2020, for facilities that house or detain noncitizens as of September 1, 2020, the annual inspection required by subsection (1)(i)(I)(D) of this section must be conducted prior to January 1, 2021, and the department shall produce a report on the inspection prior to January 1, 2021, and provide the report to the governor and members of the judiciary committees of the house of representatives and senate, or any successor committees. This subsection (1)(i)(I)(E) is repealed, effective July 1, 2021.
      2. Notwithstanding the provisions of subparagraph (I) of this paragraph (i), the standards adopted pursuant to subparagraph (I) of this paragraph (i) with regard to space requirements, furnishing requirements, required special use areas or special management housing, and environmental condition requirements, including but not limited to standards pertaining to light, ventilation, temperature, and noise level, shall not apply to any penal institution operated by or under contract with a county or municipality if the penal institution begins operations on or after August 30, 1999, and if the governing body of the jurisdiction operating the penal institution has adopted standards pertaining to such issues for the penal institution pursuant to section 30-11-104 (1), C.R.S., or section 31-15-711.5, C.R.S., whichever is applicable.
   10. 1. To disseminate public health information;
       2. To provide poison control services, for the fiscal year beginning July 1, 2002, and fiscal years thereafter, on a statewide basis and to provide for the dissemination of information concerning the care and treatment of individuals exposed to poisonous substances pursuant to article 32 of this title;
   11. To establish and enforce standards for exposure to toxic materials in the gaseous, liquid, or solid phase that may be deemed necessary for the protection of public health;
   12. To establish and enforce standards for exposure to environmental conditions, including radiation, that may be deemed necessary for the protection of the public health;
   13. 1. To accept and expend on behalf of and in the name of the state, gifts, donations, and grants for any purpose connected with the work and programs of the department.
       2. Any such property so given shall be held by the state treasurer, but the department shall have the power to direct the disposition of any property so given for any purpose consistent with the terms and conditions under which such gift was created.
   14. To carry out the policies of the state as set forth in part 1 of article 6 of this title with respect to family planning;
   15. To carry out the policies of this state relating to the "Colorado Health Care Coverage Act" as set forth in parts 1 and 4 of article 16 of title 10, C.R.S.;
   16. To compile and maintain current information necessary to enable the department to answer any inquiry concerning the proper action to take to counteract, eliminate, or minimize the public health hazards of a hazardous substance incident involving any specific kind of hazardous substance. To make such information available and to facilitate the reporting of hazardous substance incidents, the department shall establish, maintain, and publicize an environmental emergency telephone service that shall be available to the public twenty-four hours each day. With respect to the powers and duties specified in this paragraph (p), the department shall have no rule-making authority and shall avail itself of all available private resources. As used in this paragraph (p), the terms "hazardous substance" and "hazardous substance incident" shall have the meanings ascribed to them in section 29-22-101, C.R.S. The department shall coordinate its activities pursuant to this section with the Colorado state patrol.
   17. 1. To establish and maintain a statewide cancer registry providing for compilation and analysis of appropriate information regarding incidence, diagnosis, treatment, and end results and any other data designed to provide more effective cancer control for the citizens of Colorado.
       2. For the purposes of this paragraph (q), the board is authorized to require reports relating to cancer in accordance with the provisions of section 25-1-122 and to have access to medical records relating to cancer in accordance with the provisions of section 25-1-122.
   18. To operate and maintain a program for children with disabilities to provide and expedite provision of health care services to children who have congenital birth defects or who are the victims of burns or trauma or children who have acquired disabilities;
   19. To annually enter into an agreement with a qualified person to perform necessary hazardous substance incident response actions when such actions are beyond the ability of the local and state response capabilities. Such response actions may include, but are not limited to, containment, clean-up, and disposal of a hazardous substance. Nothing in this article shall prevent the attorney general's office from pursuing cost recovery against responsible persons.
   20. To operate special health programs for migrant and seasonal farm workers and their dependent family members and to accept and employ federal and other moneys appropriated to implement such programs;
   21. To carry out the duties prescribed in article 11.5 of title 16, C.R.S., relating to substance abuse in the criminal justice system;
   22. To establish and maintain a statewide gulf war syndrome registry pursuant to part 19 of article 4 of this title providing for compilation and analysis of information regarding incidence, diagnosis, treatment, and treatment outcomes of veterans or family members of veterans suffering from gulf war syndrome;
   23. 1. To operate the office of suicide prevention, which is hereby established in the division of prevention services in the department, that serves as the coordinator for crisis and suicide prevention programs throughout the state, including the Colorado suicide prevention plan established in section 25-1.5-112 and the crisis and suicide prevention training grant program established in section 25-1.5-113.
       2. The department is authorized to accept gifts, grants, and donations on behalf of the office of suicide prevention. The department shall transmit all such gifts, grants, and donations to the state treasurer who shall credit the same to the suicide prevention coordination cash fund, which fund is hereby created. The fund also consists of any money appropriated or transferred to the fund by the general assembly for the purposes of implementing section 25-1.5-112. Any money remaining in the suicide prevention coordination cash fund at the end of any fiscal year must remain in the fund and must not be transferred or credited to the general fund. The general assembly shall make appropriations from the suicide prevention coordination cash fund for expenditures incurred by the department or the office of suicide prevention in the performance of its duties pursuant to this subsection (1)(w) and section 25-1.5-112.
       3. 1. Notwithstanding section 24-1-136 (11)(a)(I), as part of the duties of the office of suicide prevention, on or before each November 1, the office of suicide prevention shall submit to the chairs of the senate health and human services committee and the house of representatives health, insurance, and environment committee, or their successor committees, and to the members of the joint budget committee, a report listing all crisis and suicide prevention programs in the state and describing the effectiveness of the office of suicide prevention in acting as the coordinator for crisis and suicide prevention programs. For the report submitted in 2013 and each year thereafter, the office of suicide prevention shall include any findings and recommendations it has to improve crisis and suicide prevention in the state.
          2. (Deleted by amendment, L. 2012.)
       4. The department and the office of suicide prevention may collaborate with the school safety resource center and with each facility licensed or certified pursuant to section 25-1.5-103 in order to coordinate crisis and suicide prevention services, including relevant training and other services as part of the Colorado suicide prevention plan established in section 25-1.5-112. When a facility treats a person who has attempted suicide or exhibits a suicidal gesture, the facility may provide oral and written information or educational materials to the person or, in the case of a minor, to parents, relatives, or other responsible persons to whom the minor will be released, prior to the person's release, regarding warning signs of depression, risk factors of suicide, methods of preventing suicide, available suicide prevention resources, and any other information concerning suicide awareness and prevention. The department and the office of suicide prevention may work with facilities and the Colorado suicide prevention plan to determine whether and where gaps exist in suicide prevention programs and services, including gaps that may be present in:
          1. The information and materials being used and distributed in facilities throughout the state;
          2. Resources available to persons who attempt suicide or exhibit a suicidal gesture and, when the person is a minor, to parents, relatives, and other responsible persons to whom a minor is released; and
          3. The process for referring persons who attempt suicide or exhibit a suicidal gesture to suicide prevention services and programs or other appropriate health care providers for treatment.
   24. To implement the state dental loan repayment program created in article 23 of this title;
   25. To coordinate with the United States secretary of the interior and the United States secretary of agriculture to develop resource management plans consistent with this article for federal lands pursuant to 16 U.S.C. sec. 530, 16 U.S.C. sec. 1604, and 43 U.S.C. sec. 1712;
   26. To perform the duties specified in part 6 of article 10 of title 30, C.R.S., relating to the Colorado coroners standards and training board;
   27. To determine if there is a shortage of drugs critical to the public safety of the people of Colorado and declare an emergency for the purpose of preventing the practice of unfair drug pricing as prohibited by section 6-1-714, C.R.S.;
   28. To include on its public website home page a link to forms containing advanced directives regarding a person's acceptance or rejection of life-sustaining medical or surgical treatment, which forms are available to be downloaded electronically.

Source: L. 2003: Entire article added with relocations, p. 676, § 2, effective July 1; (1)(y) added, p. 1035, § 7, effective April 17; (1)(z) added, p. 1830, § 2, effective August 6. L. 2005: (1)(aa) added, p. 372, § 1, effective April 22. L. 2007: (1)(h) amended, p. 866, § 4, effective May 14. L. 2010: (1)(i)(I) amended, (SB 10-175), ch. 188, p. 798, § 58, effective April 29; (1)(bb) added, (HB 10-1050), ch. 80, p. 271, § 2, effective August 11. L. 2011: (1)(e) amended, (SB 11-161), ch. 12, p. 34, § 1, effective March 9. L. 2012: (1)(w)(III) amended and (1)(w)(IV) added, (HB 12-1140), ch. 173, p. 619, § 1, effective May 11. L. 2015: (1)(m)(I) amended, (SB 15-247), ch. 165, p. 505, § 3, effective May 8. L. 2016: (1)(h) amended, (SB 16-189), ch. 210, p. 769, § 58, effective June 6; (1)(w)(I), (1)(w)(II), and IP(1)(w)(IV) amended, (SB 16-147), ch. 364, p. 1521, § 3, effective June 10. L. 2017: (1)(w)(III)(A) amended, (SB 17-056), ch. 33, p. 92, § 1, effective March 16. L. 2018: (1)(w)(I), (1)(w)(II), (1)(w)(III)(A), and IP(1)(w)(IV) amended, (SB 18-272), ch. 333, p. 2005, § 4, effective August 8. L. 2020: (1)(i)(I) amended, (HB 20-1409), ch. 275, p. 1349, § 1, effective July 11.

Editor's note: This section is similar to former § 25-1-107 (1)(c), (1)(e), (1)(f), (1)(g), (1)(h), (1)(i), (1)(j), (1)(m), (1)(n), (1)(q), (1)(s), (1)(t), (1)(u), (1)(v), (1)(w), (1)(y), (1)(z), (1)(aa), (1)(bb), (1)(cc), (1)(ff), (1)(hh), (1)(ii), and (1)(kk) as they existed prior to 2003.

Cross references: For the legislative declaration contained in the 2003 act enacting (1)(y), see section 1 of chapter 145, Session Laws of Colorado 2003. For the legislative declaration in SB 18-272, see section 1 of chapter 333, Session Laws of Colorado 2018.

25-1.5-102. Epidemic and communicable diseases - powers and duties of department - rules - definitions.

1. The department has, in addition to all other powers and duties imposed upon it by law, the powers and duties provided in this section as follows:
   1. 1. To investigate and control the causes of epidemic and communicable diseases affecting the public health.
      2. For the purposes of this paragraph (a), the board shall determine, by rule and regulation, those epidemic and communicable diseases and conditions that are dangerous to the public health. The board is authorized to require reports relating to such designated diseases in accordance with the provisions of section 25-1-122 and to have access to medical records relating to such designated diseases in accordance with the provisions of section 25-1-122.
      3. For the purposes of this paragraph (a), "epidemic diseases" means cases of an illness or condition, communicable or noncommunicable, in excess of normal expectancy, compared to the usual frequency of the illness or condition in the same area, among the specified population, at the same season of the year. A single case of a disease long absent from a population may require immediate investigation.
      4. For the purposes of this paragraph (a), "communicable diseases" means an illness due to a specific infectious agent or its toxic products that arises through transmission of that agent or its products from an infected person, animal, or reservoir to a susceptible host, either directly or indirectly through an intermediate plant or animal host, vector, or the inanimate environment.
   2. 1. To investigate and monitor the spread of disease that is considered part of an emergency epidemic as defined in section 24-33.5-703 (4) to determine the extent of environmental contamination resulting from the emergency epidemic, and to rapidly provide epidemiological and environmental information to the governor's expert emergency epidemic response committee, created in section 24-33.5-704.5.
      2. Except as otherwise directed by executive order of the governor, the department shall exercise its powers and duties to control epidemic and communicable diseases and protect the public health as set out in this section.
      3. The department may accept and expend federal funds, gifts, grants, and donations for the purposes of an emergency epidemic or preparation for an emergency epidemic.
      4. When a public safety worker, emergency medical service provider, peace officer, or staff member of a detention facility has been exposed to blood or other bodily fluid which there is a reason to believe may be infectious with hepatitis C, the state department and county, district, and municipal public health agencies within their respective jurisdictions shall assist in evaluation and treatment of any involved persons by:
         1. Accessing information on the incident and any persons involved to determine whether a potential exposure to hepatitis C occurred;
         2. Examining and testing such involved persons to determine hepatitis C infection when the fact of an exposure has been established by the state department or county, district, or municipal public health agency;
         3. Communicating relevant information and laboratory test results on the involved persons to such persons' attending physicians or directly to the involved persons if the confidentiality of such information and test results is acknowledged by the recipients and adequately protected, as determined by the state department or county, district, or municipal public health agency; and
         4. Providing counseling to the involved persons on the potential health risks resulting from exposure and the available methods of treatment.
      5. The employer of an exposed person shall ensure that relevant information and laboratory test results on the involved person are kept confidential. Such information and laboratory results are considered medical information and protected from unauthorized disclosure.
      6. For purposes of this paragraph (b), "public safety worker" includes, but is not limited to, law enforcement officers, peace officers, and firefighters.
   3. To establish, maintain, and enforce isolation and quarantine, and, in pursuance thereof and for this purpose only, to exercise such physical control over property and the persons of the people within this state as the department may find necessary for the protection of the public health;
   4. To abate nuisances when necessary for the purpose of eliminating sources of epidemic and communicable diseases affecting the public health.
2. Notwithstanding any other provision of law to the contrary, the department shall administer the provisions of this section regardless of an individual's race, religion, gender, ethnicity, national origin, or immigration status.

Source: L. 2003: Entire article added with relocations, p. 680, § 2, effective July 1; IP(1)(b)(IV) amended, p. 1617, § 23, effective August 6. L. 2006, 1st Ex. Sess.: (2) added, p. 25, § 2, effective July 31. L. 2010: IP(1)(b)(IV), (1)(b)(IV)(B), and (1)(b)(IV)(C) amended, (HB 10-1422), ch. 419, p. 2091, § 86, effective August 11. L. 2013: (1)(b)(I) amended, (HB 13-1300), ch. 316, p. 1687, § 72, effective August 7. L. 2018: (1)(b)(I) amended, (HB 18-1394), ch. 234, p. 1473, § 20, effective August 8.

25-1.5-103. Health facilities - powers and duties of department - limitations on rules promulgated by department - definitions.

1. The department has, in addition to all other powers and duties imposed upon it by law, the powers and duties provided in this section as follows:
   1. 1. 1. [Editor's note: This version of subsection (1)(a)(I)(A) is effective until July 1, 2021.] To annually license and to establish and enforce standards for the operation of general hospitals, hospital units as defined in section 25-3-101 (2), freestanding emergency departments as defined in section 25-1.5-114, psychiatric hospitals, community clinics, rehabilitation hospitals, convalescent centers, community mental health centers, acute treatment units, facilities for persons with intellectual and developmental disabilities, nursing care facilities, hospice care, assisted living residences, dialysis treatment clinics, ambulatory surgical centers, birthing centers, home care agencies, and other facilities of a like nature, except those wholly owned and operated by any governmental unit or agency. (a) (I) (A) [Editor's note: This version of subsection (1)(a)(I)(A) is effective until July 1, 2021.] To annually license and to establish and enforce standards for the operation of general hospitals, hospital units as defined in section 25-3-101 (2), freestanding emergency departments as defined in section 25-1.5-114, psychiatric hospitals, community clinics, rehabilitation hospitals, convalescent centers, community mental health centers, acute treatment units, facilities for persons with intellectual and developmental disabilities, nursing care facilities, hospice care, assisted living residences, dialysis treatment clinics, ambulatory surgical centers, birthing centers, home care agencies, and other facilities of a like nature, except those wholly owned and operated by any governmental unit or agency.
         2. In establishing and enforcing such standards and in addition to the required announced inspections, the department shall, within available appropriations, make additional inspections without prior notice to the health facility, subject to sub-subparagraph (C) of this subparagraph (I). Such inspections shall be made only during the hours of 7 a.m. to 7 p.m.
         3. The department shall extend the survey cycle or conduct a tiered inspection or survey of a health facility licensed for at least three years and against which no enforcement activity has been taken, no patterns of deficient practices exist, as documented in the inspection and survey reports issued by the department, and no substantiated complaint resulting in the discovery of significant deficiencies that may negatively affect the life, health, or safety of consumers of the health facility has been received within the three years prior to the date of the inspection. The department may expand the scope of the inspection or survey to an extended or full survey if the department finds deficient practice during the tiered inspection or survey. The department, by rule, shall establish a schedule for an extended survey cycle or a tiered inspection or survey system designed, at a minimum, to: Reduce the time needed for and costs of licensure inspections for both the department and the licensed health facility; reduce the number, frequency, and duration of on-site inspections; reduce the scope of data and information that health facilities are required to submit or provide to the department in connection with the licensure inspection; reduce the amount and scope of duplicative data, reports, and information required to complete the licensure inspection; and be based on a sample of the facility size. Nothing in this sub-subparagraph (C) limits the ability of the department to conduct a periodic inspection or survey that is required to meet its obligations as a state survey agency on behalf of the centers for medicare and medicaid services or the department of health care policy and financing to assure that the health facility meets the requirements for participation in the medicare and medicaid programs.
         4. In connection with the renewal of licenses issued pursuant to this subparagraph (I), the department shall institute a performance incentive system pursuant to section 25-3-105 (1)(a)(I)(C).
         5. The department shall not cite as a deficiency in a report resulting from a survey or inspection of a licensed health facility any deficiency from an isolated event identified by the department that can be effectively remedied during the survey or inspection of the health facility, unless the deficiency caused harm or a potential for harm, created a life- or limb-threatening emergency, or was due to abuse or neglect.
         6. Sections 24-4-104, C.R.S., and 25-3-102 govern the issuance, suspension, renewal, revocation, annulment, or modification of licenses. All licenses issued by the department must contain the date of issue and cover a twelve-month period. Nothing contained in this paragraph (a) prevents the department from adopting and enforcing, with respect to projects for which federal assistance has been obtained or is requested, higher standards as may be required by applicable federal laws or regulations of federal agencies responsible for the administration of applicable federal laws.
      2. To establish and enforce standards for the operation and maintenance of the health facilities named in subparagraph (I) of this paragraph (a), wholly owned and operated by the state or any of its political subdivisions, and no such facility shall be operated or maintained without an annual certificate of compliance;

      (a) (I) (A) [ Editor's note: This version of subsection (1)(a)(I)(A) is effective July 1, 2021. ] To annually license and to establish and enforce standards for the operation of general hospitals, hospital units as defined in section 25-3-101 (2), freestanding emergency departments as defined in section 25-1.5-114, psychiatric hospitals, community clinics, rehabilitation hospitals, convalescent centers, community mental health centers, acute treatment units, behavioral health entities, facilities for persons with intellectual and developmental disabilities, nursing care facilities, hospice care, assisted living residences, dialysis treatment clinics, ambulatory surgical centers, birthing centers, home care agencies, and other facilities of a like nature, except those wholly owned and operated by any governmental unit or agency.

   2. To suspend, revoke, or refuse to renew any license issued to a health facility pursuant to subparagraph (I) or (II) of paragraph (a) of this subsection (1) if such health facility has committed abuse of health insurance pursuant to section 18-13-119, C.R.S., or if such health facility has advertised through newspapers, magazines, circulars, direct mail, directories, radio, television, or otherwise that it will perform any act prohibited by section 18-13-119 (3), C.R.S., unless the health facility is exempted from section 18-13-119 (5), C.R.S.;
   3. 1. (c) [Editor's note: This version of subsection (1)(c) is effective until July 1, 2021.] (I) To establish and enforce standards for licensure of community mental health centers and acute treatment units.
      2. The department of public health and environment has primary responsibility for the licensure of community mental health centers and acute treatments units. The department of human services has primary responsibility for program approval at these facilities. In performing their respective responsibilities pursuant to this subparagraph (II), both departments shall take into account changes in health care policy and practice incorporating the concept and practice of integration of services and the development of a system that commingles and integrates health care services.

         (c) [ Editor's note: This version of subsection (1)(c) is effective July 1, 2021. ] (I) To establish and enforce standards for licensure of community mental health centers and acute treatment units as behavioral health entities.

         (II) In performing its responsibilities pursuant to subsection (1)(c)(I) of this section, the department shall take into account changes in health care policy and practice incorporating the concept and practice of integration of services and the development of a system that commingles and integrates health care services.

2. For purposes of this section, unless the context otherwise requires:
   1. "Acute treatment unit" means a facility or a distinct part of a facility for short-term psychiatric care, which may include substance abuse treatment, and which provides a total, twenty-four-hour therapeutically planned and professionally staffed environment for persons who do not require inpatient hospitalization but need more intense and individual services than are available on an outpatient basis, such as crisis management and stabilization services.
   2. [Editor's note: Subsection (2)(a.3) is effective July 1, 2021.] "Behavioral health entity" means a facility or provider organization engaged in providing community-based health services, which may include behavioral health disorder services, alcohol use disorder services, or substance use disorder services, including crisis stabilization, acute or ongoing treatment, or community mental health center services as described in section 27-66-101 (2) and (3), but does not include:
      1. Residential child care facilities, as defined in section 26-6-102 (33); or
      2. Services provided by a licensed or certified mental health care provider under the provider's individual professional practice act on the provider's own premises.
      3. A freestanding emergency department, as defined in and required to be licensed under section 25-1.5-114.
   3. "Community clinic" has the same meaning as set forth in section 25-3-101 and does not include:

      (I) A federally qualified health center, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4);

      (II) A rural health clinic as defined in section 1861 (aa)(2) of the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(2); or

   4. "Community mental health center" means either a physical plant or a group of services under unified administration and including at least the following: Inpatient services; outpatient services; day hospitalization; emergency services; and consultation and educational services, which services are provided principally for persons with behavioral or mental health disorders residing in a particular community in or near which the facility is situated.
   5. "Enforcement activity" means the imposition of remedies such as civil money penalties; appointment of a receiver or temporary manager; conditional licensure; suspension or revocation of a license; a directed plan of correction; intermediate restrictions or conditions, including retaining a consultant, department monitoring, or providing additional training to employees, owners, or operators; or any other remedy provided by state or federal law or as authorized by federal survey, certification, and enforcement regulations and agreements for violations of federal or state law.
   6. "Facility for persons with developmental disabilities" means a facility specially designed for the active treatment and habilitation of persons with intellectual and developmental disabilities or a community residential home, as defined in section 25.5-10-202, C.R.S., which is licensed and certified pursuant to section 25.5-10-214, C.R.S.
   7. "Hospice care" means an entity that administers services to a terminally ill person utilizing palliative care or treatment.
3. 1. In the exercise of its powers pursuant to this section, the department shall not promulgate any rule, regulation, or standard relating to nursing personnel for rural nursing care facilities, rural intermediate care facilities, and other rural facilities of a like nature more stringent than the applicable federal standards and regulations.
   2. For purposes of this subsection (3), "rural" means:
      1. A county of less than fifteen thousand population; or
      2. A municipality of less than fifteen thousand population which is located ten miles or more from a municipality of over fifteen thousand population; or
      3. The unincorporated part of a county ten miles or more from a municipality of fifteen thousand population or more.
   3. A nursing care facility which is not rural as defined in paragraph (b) of this subsection (3) shall meet the licensing requirements of the department for nursing care facilities. However, if a registered nurse hired pursuant to department regulations is temporarily unavailable, a nursing care facility may use a licensed practical nurse in place of a registered nurse if such licensed practical nurse is a current employee of the nursing care facility.

   (3.5) The department of public health and environment may establish physical plant requirements for an occupancy that is contiguous with an acute treatment unit if the occupancy is operated by the acute treatment unit licensee and the services provided by the occupancy are outpatient services certified in accordance with article 65 of title 27 to determine appropriate placement or detoxification services licensed by the department of human services. The services provided by the occupancy must benefit acute treatment unit clients, although the occupancy may also provide such services to other populations. The acute treatment unit licensee may either construct the necessary fire safety separations between the occupancy and the acute treatment unit or assume fiscal and administrative responsibility for assuring that the occupancy meets the life safety code requirements as specified and verified by the department of public safety.

4. In the exercise of its powers, the department shall not promulgate any rule, regulation, or standard that limits or interferes with the ability of an individual to enter into a contract with a private pay facility concerning the programs or services provided at the private pay facility. For the purposes of this subsection (4), "private pay facility" means a skilled nursing facility or intermediate care facility subject to the requirements of section 25-1-120 or an assisted living residence licensed pursuant to section 25-27-105 that is not publicly funded or is not certified to provide services that are reimbursed from state or federal assistance funds.
5. 1. This subsection (5) applies to construction, including substantial renovation, and ongoing compliance with article 33.5 of title 24, C.R.S., of a health care facility building or structure on or after July 1, 2013. All health facility buildings and structures shall be constructed in conformity with the standards adopted by the director of the division of fire prevention and control in the department of public safety.
   2. Except as provided in paragraph (c) of this subsection (5) but notwithstanding any other provision of law to the contrary, the department shall not issue or renew any license under this article unless the department has received a certificate of compliance from the division of fire prevention and control certifying that the building or structure of the health facility is in conformity with the standards adopted by the director of the division of fire prevention and control.
   3. The department has no authority to establish or enforce standards relating to building or fire codes. All functions, personnel, and property of the department as of June 30, 2013, that are principally directed to the administration, inspection, and enforcement of any building or fire codes or standards shall be transferred to the health facility construction and inspection section of the division of fire prevention and control pursuant to section 24-33.5-1201 (5), C.R.S.
   4. Notwithstanding any provision of law to the contrary, all health facilities seeking certification pursuant to the federal insurance or assistance provided by Title XIX of the federal "Social Security Act", as amended and commonly known as "medicaid", or the federal insurance or assistance provided by Title XVIII of the federal "Social Security Act", as amended and commonly known as "medicare", or any successor code adopted or promulgated by the appropriate federal authorities, shall continue to meet such certification requirements.
   5. Nothing in this subsection (5) divests the department of the authority to perform health survey work or prevents the department from accessing related funds.

Source: L. 2003: Entire article added with relocations, p. 682, § 2, effective July 1. L. 2006: (1)(a)(I), (1)(c)(I), (2), and (2)(b) amended, pp. 1389, 1404, §§ 21, 63, effective August 7. L. 2008: (3.5) added, p. 1947, § 1, effective June 2; (1)(a)(I) amended, p. 2232, § 1, effective August 5. L. 2010: (3.5)(a)(I) amended, (SB 10-175), ch. 188, p. 798, § 59, effective April 29. L. 2011: (2)(a.5) added, (HB 11-1101), ch. 94, p. 277, § 1, effective April 8; (2)(a.5) amended, (HB 11-1323), ch. 265, p. 1198, § 1, effective June 2. L. 2012: (1)(a)(I), (1)(c), and IP(2)(a.5) amended and (2)(b.5) added, (HB 12-1294), ch. 252, p. 1251, § 2, effective June 4; (5) added, (HB 12-1268), ch. 234, p. 1024, § 1, effective July 1, 2013. L. 2013: (5)(a) amended, (HB 13-1300), ch. 316, p. 1687, § 73, effective August 7; (1)(a)(I)(A) and (2)(c) amended, (HB 13-1314), ch. 323, p. 1806, § 37, effective March 1, 2014. L. 2017: (2)(b) amended, (SB 17-242), ch. 263, p. 1323, § 184, effective May 25. L. 2019: (1)(a)(I)(A) and (2)(a.5)(II) amended and (2)(a.5)(III) added, (HB 19-1010), ch. 324, p. 2997, § 2, effective August 2; (3.5) amended, (HB 19-1060), ch. 10, p. 40, § 3, effective August 2; (1)(a)(I)(A) and (1)(c) amended and (2)(a.3) added, (HB 19-1237), ch. 413, p. 3639, § 8, effective July 1, 2021. L. 2020: (2)(a.5)(I) amended, (SB 20-136), ch. 70, p. 287, § 21, effective September 14.

25-1.5-104. Regulation of standards relating to food - powers and duties of department.

1. The department has, in addition to all other powers and duties imposed upon it by law, the powers and duties provided in this section as follows:
   1. To impound any vegetables and other edible crops and meat and animal products intended for and unfit for human consumption, and, upon five days' notice and after affording reasonable opportunity for a hearing to the interested parties, to condemn and destroy the same if deemed necessary for the protection of the public health;
   2. 1. To promulgate and enforce rules, regulations, and standards for the grading, labeling, classification, and composition of milk, milk products, and dairy products, including imitation dairy products; to establish minimum general sanitary standards of quality of all milk, milk products, dairy products, and imitation dairy products sold for human consumption in this state; to inspect and supervise, in dairy plants or dairy farms and in other establishments handling any milk, milk products, dairy products, or imitation dairy products, the sanitation of production, processing, and distribution of all milk, milk products, dairy products, and imitation dairy products sold for human consumption in this state and, to this end, to take samples of milk, milk products, dairy products, and imitation dairy products for bacteriological, chemical, and other analyses; and to enforce the standards for milk, milk products, dairy products, and imitation dairy products in processing plants, dairy farms, and other facilities and establishments handling, transporting, or selling such products; to certify persons licensed by the department under the provisions of section 25-5.5-107 as duly qualified persons for the purpose of collecting raw milk samples for official analyses in accordance with minimum qualifications established by the department; to issue, for the fees established by law, licenses and temporary permits to operate milk plants, dairy plants, receiving stations, dairy farms, and other facilities manufacturing any milk, milk products, dairy products, or imitation dairy products for human consumption.
      2. The phrase "minimum general sanitary standards" as used in this section means the minimum standards reasonably consistent with assuring adequate protection of the public health. The word "standards" as used in this section means standards reasonably designed to promote and protect the public health.
   3. To promulgate and enforce rules and regulations for the labeling and sale of oleomargarine and for the governing of milk- or cream-weighing-and-testing operations;
   4. To approve all oils used in reading tests of samples of cream and milk;
   5. To examine and license persons to sample or test milk, cream, or other dairy products for the purpose of determining the value of such products or to instruct other persons in the sampling and testing of such products and to cancel licenses issued by the department on account of incompetency or any violation of the provisions of the dairy laws or the rules and regulations promulgated by the board;
   6. To license manufacturers of oleomargarine;
   7. To establish and enforce sanitary standards for the operation of slaughtering, packing, canning, and rendering establishments and stores, shops, and vehicles wherein meat and animal products intended for human consumption may be offered for sale or transported, but this shall not be construed to authorize any state officer or employee to interfere with regulations or inspections made by anyone acting under the laws of the United States.

Source: L. 2003: Entire article added with relocations, p. 684, § 2, effective July 1.

Editor's note: This section is similar to former § 25-1.5-107 (1)(k), (1)(o), and (1)(p) as they existed prior to 2003.

25-1.5-105. Detection of diseases - powers and duties of department.

1. The department has, in addition to all other powers and duties imposed upon it by law, the powers and duties provided in this section as follows:
   1. To establish and operate programs which the department determines are important in promoting, protecting, and maintaining the public's health by preventing, delaying, or detecting the onset of environmental and chronic diseases;
   2. To develop and maintain a system for detecting and monitoring environmental and chronic diseases within the state and to investigate and determine the epidemiology of those conditions which contribute to preventable or premature sickness and to death and disability;
   3. To establish programs of community and professional education relevant to the detection, prevention, and control of environmental and chronic diseases.
2. For purposes of this section, "chronic disease" means impairment or deviation from the normal functioning of the human body which:
   1. Is permanent;
   2. Leaves residual disability;
   3. Is caused by nonreversible pathological alterations;
   4. Requires special patient education and instruction for rehabilitation; or
   5. May require a long period of supervision, observation, and care.
3. For the purposes of this section, "environmental disease" means an impairment or deviation from the normal functioning of the human body which:
   1. May be either temporary or permanent;
   2. May leave residual disability;
   3. May result in birth defects, damage to tissues and organs, and chronic illness; and
   4. Is caused by exposure to hazardous chemical or radiological materials present in the environment.
4. For the purposes of this section, the board shall determine, by rule and regulation, those environmental and chronic diseases that are dangerous to the public health. The board is authorized to require reports relating to such designated diseases in accordance with the provisions of section 25-1-122 and to have access to medical records relating to such designated diseases in accordance with the provisions of section 25-1-122.

Source: L. 2003: Entire article added with relocations, p. 685, § 2, effective July 1.

Editor's note: This section is similar to former § 25-1-107 (1)(dd) as it existed prior to 2003.

25-1.5-106. Medical marijuana program - powers and duties of state health agency - rules - medical review board - medical marijuana program cash fund - subaccount - created - "Ethan's Law" - definitions - repeal.

1. Legislative declaration.
   1. The general assembly hereby declares that it is necessary to implement rules to ensure that patients suffering from legitimate debilitating medical conditions are able to safely gain access to medical marijuana and to ensure that these patients:
      1. Are not subject to criminal prosecution for their use of medical marijuana in accordance with section 14 of article XVIII of the state constitution, this section, and the rules of the state health agency; and
      2. Are able to establish an affirmative defense to their use of medical marijuana in accordance with section 14 of article XVIII of the state constitution, this section, and the rules of the state health agency.
   2. The general assembly hereby declares that it is necessary to implement rules to prevent persons who do not suffer from legitimate debilitating medical conditions from using section 14 of article XVIII of the state constitution as a means to sell, acquire, possess, produce, use, or transport marijuana in violation of state and federal laws.
   3. The general assembly hereby declares that it is necessary to implement rules to provide guidance for caregivers as defined in section 14 of article XVIII of the state constitution.
   4. The general assembly hereby declares that it is imperative to prevent the diversion of medical marijuana to other states. In order to do this the general assembly needs to provide clear guidance for law enforcement.
2. Definitions. In addition to the definitions set forth in section 14 (1) of article XVIII of the state constitution, as used in this section, unless the context otherwise requires:
   1. "Authorized employees of the state health agency" includes independent contractors or other agencies with whom the state health agency contracts or is working under an intergovernmental agreement to provide services related to the administration of the medical marijuana program registry. These independent contractors are not state employees for the purposes of state employee benefits, including public employees' retirement association benefits.
   2. "Bona fide physician-patient relationship", for purposes of the medical marijuana program, means:
      1. A physician and a patient have a treatment or counseling relationship, in the course of which the physician has completed a full assessment of the patient's medical history, including reviewing a previous diagnosis for a debilitating or disabling medical condition, and current medical condition, including an appropriate personal physical examination;
      2. The physician has consulted with the patient, and if the patient is a minor, with the patient's parents, with respect to the patient's debilitating medical condition or disabling medical condition and has explained the possible risks and benefits of use of medical marijuana to the patient, and the patient's parents if the patient is a minor, before the patient applies for a registry identification card; and
      3. The physician is available to or offers to provide follow-up care and treatment to the patient, including patient examinations, to determine the efficacy of the use of medical marijuana as a treatment of the patient's debilitating medical condition or disabling medical condition.
   3. "Disabling medical condition" means:

      (I) Post-traumatic stress disorder as diagnosed by a licensed mental health provider or physician;

      (II) An autism spectrum disorder as diagnosed by a primary care physician, physician with experience in autism spectrum disorder, or licensed mental health provider acting within his or her scope of practice; or

      (III) A condition for which a physician could prescribe an opioid.

   4. "Executive director" means the executive director of the state health agency.
   5. "In good standing", with respect to a physician's or dentist or advanced practice practitioner license, means:
      1. The physician holds a doctor of medicine or doctor of osteopathic medicine degree from an accredited medical school, or the dentist or advanced practice practitioner holds a degree in a medical field within his or her scope of practice;
      2. The physician holds a valid license to practice medicine, or the dentist or advanced practice practitioner holds a valid license to practice within his or her scope of practice, in Colorado that does not contain a restriction or condition that prohibits the recommendation of medical marijuana or for a license issued prior to July 1, 2011, a valid, unrestricted and unconditioned license; and
      3. The physician or dentist or advanced practice practitioner has a valid and unrestricted United States department of justice federal drug enforcement administration controlled substances registration.
   6. "Medical marijuana program" means the program established by section 14 of article XVIII of the state constitution and this section.
   7. "Patient" means a person who has a debilitating medical condition or disabling medical condition.
   8. "Physician", when making medical marijuana recommendations for a disabling medical condition, includes a dentist or advanced practice practitioner with prescriptive authority acting within the scope of his or her practice.
   9. "Primary caregiver" means a natural person, other than the patient or the patient's physician, who is eighteen years of age or older and has significant responsibility for managing the well-being of a patient who has a debilitating medical condition or disabling medical condition. A primary caregiver may have one or more of the following relationships:
      1. A parent of a child as described by subsection (6)(e) of section 14 of article XVIII of the state constitution or a parent of a child with a disabling medical condition and anyone who assists that parent with caregiver responsibilities, including cultivation and transportation;
      2. An advising caregiver who advises a patient on which medical marijuana products to use and how to dose them and does not possess, provide, cultivate, or transport marijuana on behalf of the patient;
      3. A transporting caregiver who purchases and transports marijuana to a patient who is homebound; or
      4. A cultivating caregiver who grows marijuana for a patient.
   10. "Registry identification card" means the nontransferable confidential registry identification card issued by the state health agency to patients and primary caregivers pursuant to this section.
   11. "Residential property" means a single unit providing complete independent living facilities for one or more persons, including permanent provisions for living, sleeping, eating, cooking, and sanitation. "Residential property" also includes the real property surrounding a structure, owned in common with the structure, that includes one or more single units providing complete independent living facilities.
   12. "Significant responsibility for managing the well-being of a patient" means that the caregiver is involved in basic or instrumental activities of daily living. Cultivating or transporting marijuana and the act of advising a patient on which medical marijuana products to use and how to dose them constitutes a "significant responsibility".
   13. "State health agency" means the public health-related entity of state government designated by the governor by executive order pursuant to section 14 of article XVIII of the state constitution.
   1. (2.5) (a) Except as otherwise provided in subsections (2.5)(h) and (2.5)(i) of this section and section 18-18-406.3, a patient with a disabling medical condition or his or her primary caregiver charged with a violation of the state's criminal laws related to the patient's medical use of marijuana will be deemed to have established an affirmative defense to such allegation where:
      1. The patient was previously diagnosed by a physician as having a disabling medical condition;
      2. The patient was advised by his or her physician, in the context of a bona fide physician-patient relationship, that the patient might benefit from the medical use of marijuana in connection with a disabling medical condition; and
      3. The patient and his or her primary caregiver were collectively in possession of amounts of marijuana only as permitted under this section.
   2. The affirmative defense in subsection (2.5)(a) of this section does not exclude the assertion of any other defense where a patient or primary caregiver is charged with a violation of state law related to the patient's medical use of marijuana.
   3. It is an exception from the state's criminal laws for any patient with a disabling medical condition or his or her primary caregiver in lawful possession of a registry identification card to engage or assist in the medical use of marijuana, except as otherwise provided in subsection (2.5)(h) of this section or section 18-18-406.3.
   4. It is an exception from the state's criminal laws for any physician to:
      1. Advise a patient whom the physician has diagnosed as having a disabling medical condition about the risks and benefits of the medical use of marijuana or that he or she might benefit from the medical use of marijuana, provided that such advice is based upon the physician's contemporaneous assessment of the patient's medical history and current medical condition and a bona fide physician-patient relationship; or
      2. Provide a patient with written documentation, based upon the physician's contemporaneous assessment of the patient's medical history and current medical condition and a bona fide physician-patient relationship, stating that the patient has a disabling medical condition and might benefit from the medical use of marijuana. No physician shall be denied any rights or privileges for the acts authorized by this section.
   5. Notwithstanding the foregoing provisions, no person, including a patient with a disabling medical condition or his or her primary caregiver, is entitled to the protection of this section for his or her acquisition, possession, manufacture, production, use, sale, distribution, dispensing, or transportation of marijuana for any use other than medical use.
   6. Any property interest that is possessed, owned, or used by a patient with a disabling medical condition or his or her primary caregiver in connection with the medical use of marijuana or acts incidental to such use shall not be harmed, neglected, injured, or destroyed while in the possession of state or local law enforcement officials where such property has been seized in connection with the claimed medical use of marijuana. Any such property interest shall not be forfeited under any provision of state law providing for the forfeiture of property other than as a sentence imposed after conviction of a criminal offense or entry of a plea of guilty to such offense.
   7. 1. A patient with a disabling medical condition may engage in the medical use of marijuana, with no more marijuana than is medically necessary to address a disabling medical condition. The medical use of marijuana by a patient with a disabling medical condition is lawful within the following limits:
         1. No more than two ounces of a usable form of marijuana; and
         2. No more than six marijuana plants, with three or fewer being mature, flowering plants that are producing a usable form of marijuana.
      2. For quantities of marijuana in excess of these amounts, a patient or his or her primary caregiver may raise as an affirmative defense to charges of violation of state law that such greater amounts were medically necessary to address the patient's disabling medical condition.
   8. 1. No patient with a disabling medical condition shall:
         1. Engage in the medical use of marijuana in a way that endangers the health or well-being of any person; or
         2. Engage in the medical use of marijuana in plain view of, or in a place open to, the general public.
      2. In addition to any other penalties provided by law, the state health agency shall revoke for a period of one year the registry identification card of any patient found to have willfully violated the provisions of this section.
   9. Notwithstanding the provisions of this subsection (2.5), no patient with a disabling medical condition who is under eighteen years of age shall engage in the medical use of marijuana unless:
      1. Two physicians have diagnosed the patient as having a disabling medical condition. If the recommending physician is not the patient's primary care physician, the recommending physician shall review the records of a diagnosing physician or a licensed mental health provider acting within their scope of practice.
      2. One of the physicians referred to in subsection (2.5)(i)(I) of this section has explained the possible risks and benefits of the medical use of marijuana to the patient and each of the patient's parents residing in Colorado;
      3. The physician referred to in subsection (2.5)(i)(II) of this section has provided the patient with the written documentation specifying that the patient has been diagnosed with a disabling medical condition and the physician has concluded that the patient might benefit from the medical use of marijuana;
      4. Each of the patient's parents residing in Colorado consent in writing to the state health agency to permit the patient to engage in the medical use of marijuana;
      5. A parent residing in Colorado consents in writing to serve as the patient's primary caregiver;
      6. A parent serving as a primary caregiver completes and submits an application for a registry identification card and the written consents referred to in subsections (2.5)(i)(IV) and (2.5)(i)(V) of this section to the state health agency;
      7. The state health agency approves the patient's application and transmits the patient's registry identification card to the parent designated as a primary caregiver;
      8. The patient and primary caregiver collectively possess amounts of marijuana no greater than those specified in subsection (2.5)(g) of this section; and
      9. The primary caregiver controls the acquisition of such marijuana and the dosage and frequency of its use by the patient with a disabling medical condition.
   10. A patient with a disabling medical condition who is under eighteen years of age shall use medical marijuana only in a nonsmokeable form when using medical marijuana upon the grounds of the preschool or primary or secondary school in which the student is enrolled, or upon a school bus or at a school-sponsored event.
3. Rule-making.
   1. The state health agency shall, pursuant to section 14 of article XVIII of the state constitution, promulgate rules of administration concerning the implementation of the medical marijuana program that specifically govern the following:
      1. The establishment and maintenance of a confidential registry of patients who have applied for and are entitled to receive a registry identification card. The confidential registry of patients may be used to determine whether a physician should be referred to the Colorado medical board for a suspected violation of section 14 of article XVIII of the state constitution, subsection (5)(a), (5)(b), or (5)(c) of this section, or the rules promulgated by the state health agency pursuant to this subsection (3).
      2. The development by the state health agency of an application form and the process for making the form available to residents of this state seeking to be listed on the confidential registry of patients who are entitled to receive a registry identification card;
      3. The verification by the state health agency of medical information concerning patients who have applied for a registry identification card or for renewal of a registry identification card;
      4. The development by the state health agency of a form that constitutes "written documentation" as defined and used in section 14 of article XVIII of the state constitution, which form a physician shall use when making a medical marijuana recommendation for a patient;
      5. The conditions for issuance and renewal, and the form, of the registry identification cards issued to patients, including but not limited to standards for ensuring that the state health agency issues a registry identification card to a patient only if he or she has a bona fide physician-patient relationship with a physician in good standing and licensed to practice medicine in the state of Colorado;
      6. Communications with law enforcement officials about registry identification cards that have been suspended when a patient is no longer diagnosed as having a debilitating medical condition or disabling medical condition;
      7. The manner in which the state health agency may consider adding debilitating medical conditions to the list of debilitating medical conditions contained in section 14 of article XVIII of the state constitution;
      8. A waiver process to allow a homebound patient who is on the registry to have a primary caregiver transport the patient's medical marijuana from a licensed medical marijuana center to the patient; and
      9. Guidelines for primary caregivers to give informed consent to patients that the products they cultivate or produce may contain contaminants and that the cannabinoid levels may not be verified.
   2. The state health agency may promulgate rules regarding the following:
      1. Repealed.
      2. The development of a form for a primary caregiver to use in applying to the registry, which form shall require, at a minimum, that the applicant provide his or her full name, home address, date of birth, and an attestation that the applicant has a significant responsibility for managing the well-being of the patient for whom he or she is designated as the primary caregiver and that he or she understands and will abide by section 14 of article XVIII of the state constitution, this section, and the rules promulgated by the state health agency pursuant to this section; and
      3. Repealed.
      4. The grounds and procedure for a patient to change his or her designated primary caregiver.
   3. Repealed.
   4. The state health agency shall promulgate rules related to the length of time a registry identification card issued to a patient with a disabling medical condition is valid.

   (3.5) Marijuana laboratory testing reference library.

   1. The state health agency shall develop and maintain a marijuana laboratory testing reference library. Laboratories licensed by the department of revenue shall be required to provide materials for the reference library; except that no licensee shall be required to provide testing protocols.
   2. The reference library must contain a library of methodologies for marijuana testing in the areas of potency, homogeneity, contaminants, and solvents consistent with the laboratory requirements set by the department of revenue pursuant to article 10 of title 44.
   3. The state health agency may also include in the reference library standard sample attainment procedures and standards related to sample preparation for laboratory analysis.
   4. The state health agency shall make reference library materials, including the methodologies, publicly available and may continuously update the reference library as new materials become available.

   (3.7) Repealed.

   1. (3.8) (a) The state health agency or an organization with whom the state health agency contracts shall be responsible for proficiency testing and remediating problems with laboratories licensed pursuant to article 10 of title 44.
   2. Repealed.
4. Notwithstanding any other requirements to the contrary, notice issued by the state health agency for a rule-making hearing pursuant to section 24-4-103, C.R.S., for rules concerning the medical marijuana program shall be sufficient if the state health agency provides the notice no later than forty-five days in advance of the rule-making hearing in at least one publication in a newspaper of general distribution in the state and posts the notice on the state health agency's website; except that emergency rules pursuant to section 24-4-103 (6), C.R.S., shall not require advance notice.
5. Physicians. A physician who certifies a debilitating medical condition or disabling medical condition for an applicant to the medical marijuana program shall comply with all of the following requirements:
   1. The physician has a valid and active license to practice medicine, which license is in good standing, or the dentist or advanced practice practitioner holds a valid license to practice within his or her scope of practice, which license is in good standing.
   2. After a physician, who has a bona fide physician-patient relationship with the patient applying for the medical marijuana program, determines, for the purposes of making a recommendation, that the patient has a debilitating medical condition or disabling medical condition and that the patient may benefit from the use of medical marijuana, the physician shall certify to the state health agency that the patient has a debilitating medical condition or disabling medical condition and that the patient may benefit from the use of medical marijuana. If the physician certifies that the patient would benefit from the use of medical marijuana based on a chronic or debilitating disease or medical condition or disabling medical condition, the physician shall specify the chronic or debilitating disease or medical condition or disabling medical condition and, if known, the cause or source of the chronic or debilitating disease or medical condition or disabling medical condition.
   3. The physician shall maintain a record-keeping system for all patients for whom the physician has recommended the medical use of marijuana, and, pursuant to an investigation initiated pursuant to section 12-240-125, the physician shall produce such medical records to the Colorado medical board after redacting any patient or primary caregiver identifying information.
   4. A physician shall not:
      1. Accept, solicit, or offer any form of pecuniary remuneration from or to a primary caregiver, distributor, or any other provider of medical marijuana;
      2. Offer a discount or any other thing of value to a patient who uses or agrees to use a particular primary caregiver, distributor, or other provider of medical marijuana to procure medical marijuana;
      3. Examine a patient for purposes of diagnosing a debilitating medical condition or a disabling medical condition at a location where medical marijuana is sold or distributed; or
      4. Hold an economic interest in an enterprise that provides or distributes medical marijuana if the physician certifies the debilitating medical condition or disabling medical condition of a patient for participation in the medical marijuana program.
   5. Only a physician can make a medical marijuana recommendation; except that, when making a medical marijuana recommendation for a patient with a disabling medical condition, the recommendation may be made by a medical doctor, dentist, or advanced practice practitioner with prescriptive authority acting within the scope of his or her practice.
6. Enforcement.
   1. If the state health agency has reasonable cause to believe that a physician has violated section 14 of article XVIII of the state constitution, subsection (5)(a), (5)(b), or (5)(c) of this section, or the rules promulgated by the state health agency pursuant to subsection (3) of this section, the state health agency may refer the matter to the Colorado medical board created in section 12-240-105 for an investigation and determination.
   2. If the state health agency has reasonable cause to believe that a physician has violated paragraph (d) of subsection (5) of this section, the state health agency shall conduct a hearing pursuant to section 24-4-104, C.R.S., to determine whether a violation has occurred.
   3. Upon a finding of unprofessional conduct pursuant to section 12-240-121 (1)(dd) by the Colorado medical board or a finding of a violation of subsection (5)(d) of this section by the state health agency, the state health agency shall restrict a physician's authority to recommend the use of medical marijuana, which restrictions may include the revocation or suspension of a physician's privilege to recommend medical marijuana. The restriction shall be in addition to any sanction imposed by the Colorado medical board.
   4. When the state health agency has objective and reasonable grounds to believe and finds, upon a full investigation, that a physician has deliberately and willfully violated section 14 of article XVIII of the state constitution or this section and that the public health, safety, or welfare imperatively requires emergency action, and the state health agency incorporates those findings into an order, the state health agency may summarily suspend the physician's authority to recommend the use of medical marijuana pending the proceedings set forth in paragraphs (a) and (b) of this subsection (6). A hearing on the order of summary suspension shall be held no later than thirty days after the issuance of the order of summary suspension, unless a longer time is agreed to by the parties, and an initial decision in accordance with section 24-4-105 (14), C.R.S., shall be rendered no later than thirty days after the conclusion of the hearing concerning the order of summary suspension.
7. Primary caregivers.
   1. A primary caregiver may not delegate to any other person his or her authority to provide medical marijuana to a patient; nor may a primary caregiver engage others to assist in providing medical marijuana to a patient; except that a parent primary caregiver may use the services of an assistant for advisement, cultivation, or transportation.
   2. Two or more primary caregivers shall not join together for the purpose of cultivating medical marijuana.
   3. Only a medical marijuana center with an optional premises cultivation license, a medical marijuana-infused products manufacturing operation with an optional premises cultivation license, or a primary caregiver for his or her patients or a patient for himself or herself may cultivate or provide medical marijuana.
   4. A primary caregiver shall provide to a law enforcement agency, upon inquiry, the registry identification card number of each of his or her patients. The state health agency shall maintain a registry of this information and make it available twenty-four hours per day and seven days a week to law enforcement for verification purposes. Upon inquiry by a law enforcement officer as to an individual's status as a patient or primary caregiver, the state health agency shall check the registry. If the individual is not registered as a patient or primary caregiver, the state health agency may provide that response to law enforcement. If the person is a registered patient or primary caregiver for a patient with a debilitating medical condition or a disabling medical condition, the state health agency may not release information unless consistent with section 14 of article XVIII of the state constitution. The state health agency may promulgate rules to provide for the efficient administration of this subsection (7)(d).
   5. 1. 1. In order to be a primary caregiver who cultivates medical marijuana for his or her patients or transports medical marijuana for his or her patients, he or she shall also register with the state licensing authority and comply with all local laws, regulations, and zoning and use restrictions. A person may not register as a primary caregiver if he or she is licensed as a medical marijuana business or a retail marijuana business as described in part 4 of article 10 of title 44. An employee, contractor, or other support staff employed by a licensed entity or working in or having access to a restricted area of a licensed premises pursuant to article 10 of title 44 may be a primary caregiver. (e) (I) (A) In order to be a primary caregiver who cultivates medical marijuana for his or her patients or transports medical marijuana for his or her patients, he or she shall also register with the state licensing authority and comply with all local laws, regulations, and zoning and use restrictions. A person may not register as a primary caregiver if he or she is licensed as a medical marijuana business or a retail marijuana business as described in part 4 of article 10 of title 44. An employee, contractor, or other support staff employed by a licensed entity or working in or having access to a restricted area of a licensed premises pursuant to article 10 of title 44 may be a primary caregiver.
         2. A cultivating primary caregiver, when registering, shall provide the cultivation operation location, the registration number of each patient, and any extended plant count numbers and their corresponding patient registry numbers.
         3. A transporting primary caregiver, when registering, shall provide the registration number of each homebound patient, the total number of plants and ounces that the caregiver is authorized to transport, if applicable, and the location of each patient's registered medical marijuana center or cultivating primary caregiver, as applicable. A transporting caregiver shall have on his or her person a receipt from the medical marijuana center or primary caregiver when transporting medical marijuana that shows the quantity of medical marijuana purchased by or provided to the transporting caregiver.
         4. The state licensing authority may verify patient registration numbers and extended plant count numbers with the state health agency to confirm that a patient does not have more than one primary caregiver, or does not have both a designated caregiver and medical marijuana center, cultivating medical marijuana on his or her behalf at any given time.
         5. If a peace officer makes a law enforcement contact with a primary caregiver who does not have proper documentation showing registration with the state licensing authority, the peace officer may report that individual to the state licensing authority or may take appropriate law enforcement action. The person may be subject to any chargeable criminal offenses.
      2. The state licensing authority shall share the minimum necessary information in accordance with applicable federal and state laws, such as patient and caregiver identification numbers, to verify that a patient has only one entity cultivating medical marijuana on his or her behalf at any given time.
      3. The information provided to the state licensing authority pursuant to this paragraph (e) shall not be provided to the public and is confidential. The state licensing authority shall verify the location of a primary caregiver cultivation operation to a local government or law enforcement agency upon receiving an address-specific request for verification. The location of the cultivation operation must comply with all applicable local laws, rules, or regulations.
   6. A cultivating primary caregiver shall only cultivate plants at the registered cultivation location as required pursuant to paragraph (e) of this subsection (7) and as permitted pursuant to subparagraphs (I) and (II)(B) of paragraph (a) of subsection (8.6) of this section. Nothing in this paragraph (f) shall be construed to limit the ability of the caregiver or person twenty-one years of age or older who makes permanent residence at the registered cultivation location from cultivating or possessing up to six plants pursuant to article XVIII, section 16, of the Colorado constitution. Notwithstanding these provisions, additional cultivation is not lawful at the premises registered by a caregiver to cultivate on behalf of patients.
8. Patient - primary caregiver relationship.
   1. 1. A person shall be listed as a cultivating or transporting primary caregiver for no more than five patients on the medical marijuana program registry at any given time; except that the state health agency may allow a primary caregiver to serve more than five patients in exceptional circumstances. In determining whether exceptional circumstances exist, the state health agency may consider the proximity of medical marijuana centers to the patient, as well as other factors.
      2. A cultivating or transporting primary caregiver shall maintain a list of his or her patients, including the registry identification card number of each patient and a recommended total plant count, at all times.
   2. 1. A patient may have only one primary caregiver at any given time; except that, on or after December 1, 2020, a patient who is under eighteen years of age may have each parent or guardian to act as a primary caregiver or, if the patient is under the jurisdiction of the juvenile court, the judge presiding over the case may determine who is the primary caregiver.
      2. The short title of this subsection (8)(b) is "Ethan's Law".
   3. A patient who has designated a primary caregiver for himself or herself may not be designated as a primary caregiver for another patient.
   4. A primary caregiver may not charge a patient more than the cost of cultivating or purchasing the medical marijuana, but may charge for caregiver services.
   5. 1. The state health agency shall maintain a secure and confidential registry of available primary caregivers for those patients who are unable to secure the services of a primary caregiver.
      2. An existing primary caregiver may indicate at the time of registration whether he or she would be willing to handle additional patients and waive confidentiality to allow release of his or her contact information to physicians or registered patients only.
      3. An individual who is not registered but is willing to provide primary caregiving services may submit his or her contact information to be placed on the primary caregiver registry.
      4. A patient-primary caregiver arrangement secured pursuant to this paragraph (e) shall be strictly between the patient and the potential primary caregiver. The state health agency, by providing the information required by this paragraph (e), shall not endorse or vouch for a primary caregiver.
      5. The state health agency may make an exception, based on a request from a patient, to paragraph (a) of this subsection (8) limiting primary caregivers to five patients. If the state health agency makes an exception to the limit, the state health agency shall note the exception on the primary caregiver's record in the registry.
   6. At the time a patient applies for inclusion on the confidential registry, the patient shall indicate whether the patient intends to cultivate his or her own medical marijuana, both cultivate his or her own medical marijuana and obtain it from either a primary caregiver or licensed medical marijuana center, or obtain it from either a primary caregiver or a licensed medical marijuana center. If the patient elects to use a licensed medical marijuana center, the patient shall register the primary center he or she intends to use.
   7. Notwithstanding any other provision of law, a primary caregiver shall not grow, sell, or process marijuana for any person unless:
      1. The person is a patient holding a current and valid registry identification card; and
      2. The primary caregiver is currently identified on the medical marijuana registry as that patient's primary caregiver.

   (8.5) Encourage patient voluntary registration - plant limits.

   1. 1. All patients cultivating more than six medical marijuana plants for their own medical use are encouraged to register with the state licensing authority's registry created pursuant to subsection (7) of this section. A patient who chooses to register shall update his or her registration information upon renewal of his or her medical marijuana registry card.
      2. A patient who chooses to register shall register the following information with the state licensing authority: The location of his or her cultivation operation; his or her patient registration identification; and the total number of plants that the patient is authorized to cultivate.
   2. 1. Unless otherwise expressly authorized by local law, it is unlawful for a patient to possess at or cultivate on a residential property more than twelve marijuana plants regardless of the number of persons residing, either temporarily or permanently, at the property; except that it is unlawful for a patient to possess at or cultivate on or in a residential property more than twenty-four marijuana plants regardless of the number of persons residing, either temporarily or permanently, at the property if a patient:
         1. Lives in a county, municipality, or city and county that does not limit the number of marijuana plants that may be grown on or in a residential property;
         2. Registers pursuant to this subsection (8.5) with the state licensing authority's registry; and
         3. Provides notice to the applicable county, municipality, or city and county of his or her residential cultivation operation if required by the jurisdiction. A local jurisdiction shall not provide the information provided to it pursuant to this subsection (8.5)(a.5)(I)(C) to the public, and the information is confidential.
      2. A patient who cultivates more marijuana plants than permitted in subsection (8.5)(a.5)(I) of this section shall locate his or her cultivation operation on a property, other than a residential property, where marijuana cultivation is allowed by local law and shall comply with any applicable local law requiring disclosure about the cultivation operation. Cultivation operations conducted in a location other than a residential property are subject to any county and municipal building and public health inspection required by local law. A person who violates this subsection (8.5)(a.5) is subject to the offenses and penalties described in section 18-18-406.
   3. A patient shall not cultivate more than ninety-nine plants. Only a medical marijuana business licensed and properly authorized pursuant to article 10 of title 44 may cultivate more than ninety-nine plants.
   4. A patient who cultivates his or her own medical marijuana plants shall comply with all local laws, regulations, and zoning and use restrictions.
   5. The information provided to the state licensing authority pursuant to this subsection (8.5) shall not be provided to the public and is confidential. The state licensing authority shall verify the location of a medical marijuana cultivation site for patient cultivation operations to a local government or law enforcement agency upon receiving a request for verification. The location of the cultivation operation shall comply with all applicable local laws, rules, or regulations.
   6. The state licensing authority shall provide cultivation information for patients who choose to register to state and local law enforcement through the Colorado crime information center. The Colorado bureau of investigation shall include proper use of medical marijuana information in audits of state and local law enforcement agencies.

   (8.6) Primary caregivers plant limits - exceptional circumstances.

   1. 1. A primary caregiver shall not cultivate, transport, or possess more than thirty-six plants unless the primary caregiver has one or more patients who, based on medical necessity, have an extended plant count.
         1. Lives in a county, municipality, or city and county that does not limit the number of marijuana plants that may be grown on or in a residential property;
         2. Is registered pursuant to this subsection (8.6) with the state licensing authority's registry; and
         3. Provides notice to the applicable county, municipality, or city and county of his or her residential cultivation operation if required by the jurisdiction. A local jurisdiction shall not provide the information provided to it pursuant to this subsection (8.6)(a)(I.5) to the public, and the information is confidential.

            (I.6) Any primary caregiver who cultivates more marijuana plants than permitted in subsection (8.6)(a)(I.5) of this section shall locate his or her cultivation operation on a property, other than a residential property, where marijuana cultivation is allowed by local law and shall comply with any applicable local law requiring disclosure about the cultivation operation. Cultivation operations conducted in a location other than a residential property are subject to any county and municipal building and public health inspection required by local law. A person who violates subsection (8.6)(a)(I) of this section is subject to the offenses and penalties described in section 18-18-406.

      2. 1. A primary caregiver who cultivates more than thirty-six plants shall register the information required in sub-subparagraph (B) of this subparagraph (II) with the state licensing authority's registry created pursuant to paragraph (e) of subsection (7) of this section. A primary caregiver shall update his or her registration information upon renewal of his or her primary caregiver registration.
         2. A primary caregiver subject to the registry in this subparagraph (II) shall register the following information with the state licensing authority: The location of his or her cultivation operation; the patient registration identification number for each of the primary caregiver's patients; and any extended plant count numbers and their corresponding patient registry numbers.

      (I.5) Unless otherwise expressly authorized by local law, it is unlawful for a primary caregiver to possess at or cultivate on a residential property more than twelve marijuana plants regardless of the number of persons residing, either temporarily or permanently, at the property; except that it is unlawful for a primary caregiver to possess at or cultivate on or in a residential property more than twenty-four marijuana plants regardless of the number of persons residing, either temporarily or permanently, at the property if a primary caregiver:

   2. A primary caregiver shall not cultivate more than ninety-nine plants. Only a medical marijuana business licensed and properly authorized pursuant to article 10 of title 44 may cultivate more than ninety-nine plants. The primary caregiver is not allowed to grow additional plants until he or she is licensed by the state licensing authority.
   3. The information provided to the state licensing authority pursuant to this subsection (8.6) shall not be provided to the public and is confidential. The state licensing authority shall verify the location of extended plant counts for primary caregiver cultivation operations and homebound patient registration for transporting caregivers to a local government or law enforcement agency upon receiving a request for verification. The location of the cultivation operation shall comply with all applicable local laws, rules, or regulations.
   4. The state licensing authority shall provide cultivation information for cultivating caregivers and transporting caregivers to state and local law enforcement through the Colorado crime information center. The Colorado bureau of investigation shall include proper use of medical marijuana information in audits of state and local law enforcement agencies.
9. Registry identification card required - denial - revocation - renewal.
   1. A person with a disabling medical condition may apply to the state health agency for a registry identification card. To be considered in compliance with the provisions of section 14 of article XVIII of the state constitution, this section, and the rules of the state health agency, a patient or primary caregiver shall have his or her registry identification card in his or her possession at all times that he or she is in possession of any form of medical marijuana and produce the same upon request of a law enforcement officer to demonstrate that the patient or primary caregiver is not in violation of the law; except that, if more than thirty-five days have passed since the date the patient or primary caregiver filed his or her medical marijuana program application and the state health agency has not yet issued or denied a registry identification card, a copy of the patient's or primary caregiver's application along with proof of the date of submission shall be in the patient's or primary caregiver's possession at all times that he or she is in possession of any form of medical marijuana until the state health agency issues or denies the registry identification card. A person who violates section 14 of article XVIII of the state constitution, this section, or the rules promulgated by the state health agency may be subject to criminal prosecution for violations of section 18-18-406.
   2. The state health agency may deny a patient's or primary caregiver's application for a registry identification card or revoke the card if the state health agency, in accordance with article 4 of title 24, determines that the physician who diagnosed the patient's debilitating medical condition or disabling medical condition, the patient, or the primary caregiver violated section 14 of article XVIII of the state constitution, this section, or the rules promulgated by the state health agency pursuant to this section; except that, when a physician's violation is the basis for adverse action, the state health agency may only deny or revoke a patient's application or registry identification card when the physician's violation is related to the issuance of a medical marijuana recommendation.
   3. A patient or primary caregiver registry identification card is valid for one year unless the state health agency changes the length of validity pursuant to its authority in subsection (3)(d) of this section and must contain a unique identification number. It is the responsibility of the patient or primary caregiver to apply to renew his or her registry identification card prior to the date on which the card expires. The state health agency shall develop a form for a patient or primary caregiver to use in renewing his or her registry identification card.
   4. If the state health agency grants a patient a waiver to allow a primary caregiver to transport the patient's medical marijuana from a medical marijuana center to the patient, the state health agency shall designate the waiver on the patient's registry identification card.
   5. A homebound patient who receives a waiver from the state health agency to allow a primary caregiver to transport the patient's medical marijuana to the patient from a medical marijuana center shall provide the primary caregiver with the patient's registry identification card, which the primary caregiver shall carry when the primary caregiver is transporting the medical marijuana. A medical marijuana center may provide the medical marijuana to the primary caregiver for transport to the patient if the primary caregiver produces the patient's registry identification card.
10. Renewal of patient identification card upon criminal conviction. Any patient who is convicted of a criminal offense under article 18 of title 18, who is sentenced or ordered by a court to treatment for a substance use disorder, or sentenced to the division of youth services, is subject to immediate revocation of his or her patient registry identification card, and the patient may apply for the renewal based upon a recommendation from a physician with whom the patient has a bona fide physician-patient relationship.
11. A parent who submits a medical marijuana registry application for his or her child shall have his or her signature notarized on the application.
12. Use of medical marijuana.
    1. The use of medical marijuana is allowed under state law to the extent that it is carried out in accordance with the provisions of section 14 of article XVIII of the state constitution, this section, and the rules of the state health agency.
    2. A patient or primary caregiver shall not:
       1. Engage in the medical use of marijuana in a way that endangers the health and well-being of a person;
       2. Engage in the medical use of marijuana in plain view of or in a place open to the general public;
       3. Undertake any task while under the influence of medical marijuana, when doing so would constitute negligence or professional malpractice;
       4. Possess medical marijuana or otherwise engage in the use of medical marijuana in or on the grounds of a school, in a school bus, or at a school-sponsored event except when the possession or use occurs pursuant to section 22-1-119.3, C.R.S.;
       5. Engage in the use of medical marijuana while:
          1. In a correctional facility or a community corrections facility;
          2. Subject to a sentence to incarceration; or
          3. In a vehicle, aircraft, or motorboat;
       6. Operate, navigate, or be in actual physical control of any vehicle, aircraft, or motorboat while under the influence of medical marijuana; or
       7. Use medical marijuana if the person does not have a debilitating medical condition or disabling medical condition as diagnosed by the person's physician in the course of a bona fide physician-patient relationship and for which the physician has recommended the use of medical marijuana.
    3. A person shall not establish a business to permit patients to congregate and smoke or otherwise consume medical marijuana.
13. Repealed.

    (13.5) Nothing herein shall reduce or eliminate the existing power of a statutory municipality or county through the "Local Government Land Use Control Enabling Act of 1974", article 20 of title 29, C.R.S., to regulate the growing of marijuana, commercially or otherwise.

14. Affirmative defense. If a patient or primary caregiver raises an affirmative defense as provided in section 14 (4)(b) of article XVIII of the state constitution or subsection (2.5)(g)(II) of this section, the patient's physician shall certify the specific amounts in excess of two ounces that are necessary to address the patient's debilitating medical condition or disabling medical condition and why such amounts are necessary. A patient who asserts this affirmative defense shall waive confidentiality privileges related to the condition or conditions that were the basis for the recommendation. If a patient, primary caregiver, or physician raises an exception to the state criminal laws as provided in section 14 (2)(b) or (2)(c) of article XVIII of the state constitution or subsection (2.5)(c) or (2.5)(d) of this section, the patient, primary caregiver, or physician waives the confidentiality of his or her records related to the condition or conditions that were the basis for the recommendation maintained by the state health agency for the medical marijuana program. Upon request of a law enforcement agency for such records, the state health agency shall only provide records pertaining to the individual raising the exception, and shall redact all other patient, primary caregiver, or physician identifying information.
15. 1. Except as provided in paragraph (b) of this subsection (15), the state health agency shall establish a basic fee that shall be paid at the time of service of any subpoena upon the state health agency, plus a fee for meals and a fee for mileage at the rate prescribed for state officers and employees in section 24-9-104, C.R.S., for each mile actually and necessarily traveled in going to and returning from the place named in the subpoena. If the person named in the subpoena is required to attend the place named in the subpoena for more than one day, there shall be paid, in advance, a sum to be established by the state health agency for each day of attendance to cover the expenses of the person named in the subpoena.
    2. The subpoena fee established pursuant to paragraph (a) of this subsection (15) shall not be applicable to any federal, state, or local governmental agency.
16. Fees.
    1. The state health agency may collect fees from patients who, pursuant to section 14 of article XVIII of the state constitution or subsection (9) of this section, apply to the medical marijuana program for a registry identification card for the purpose of offsetting the state health agency's direct and indirect costs of administering the program. The amount of the fees shall be set by rule of the state health agency. The amount of the fees set pursuant to this section shall reflect the actual direct and indirect costs of the state licensing authority in the administration and enforcement of this article so that the fees avoid exceeding the statutory limit on uncommitted reserves in administrative agency cash funds as set forth in section 24-75-402 (3). The state health agency shall not assess a medical marijuana registry application fee to an applicant who demonstrates, pursuant to a copy of the applicant's state tax return certified by the department of revenue, that the applicant's income does not exceed one hundred eighty-five percent of the federal poverty line, adjusted for family size. All fees collected by the state health agency through the medical marijuana program shall be transferred to the state treasurer who shall credit the same to the medical marijuana program cash fund, which fund is hereby created.
    2. Repealed.
17. Cash fund.
    1. The medical marijuana program cash fund shall be subject to annual appropriation by the general assembly to the state health agency for the purpose of establishing, operating, and maintaining the medical marijuana program. All moneys credited to the medical marijuana program cash fund and all interest derived from the deposit of such moneys that are not expended during the fiscal year shall be retained in the fund for future use and shall not be credited or transferred to the general fund or any other fund.
    2. (Deleted by amendment, L. 2010, (HB 10-1284), ch. 355, p. 1677, § 2, effective July 1, 2010.)
    3. (Deleted by amendment, L. 2014.)
    4. Repealed.
    5. 1. There is created a health research subaccount, referred to as "subaccount" in this section, in the medical marijuana program cash fund. The subaccount is established to support funding for medical marijuana health research. The department shall have continuous spending authority over the subaccount. The department may direct the state treasurer to transfer money from the medical marijuana program cash fund to the subaccount based on the cost of health research projects approved by the state board of health pursuant to section 25-1.5-106.5.
       2. For the 2014-15 fiscal year and each fiscal year through 2022-23, the alternative maximum reserve for purposes of section 24-75-402 for the medical marijuana program cash fund is sixteen and five-tenths percent of the amount in the fund, excluding any amount in the subaccount.
       3. This subsection (17)(d) is repealed, effective July 1, 2023. Any money remaining in the subaccount on June 30, 2023, must revert to the medical marijuana program cash fund.
    6. Notwithstanding any provision of paragraph (a) of this subsection (17) to the contrary, on July 1, 2014, and each July 1 through 2018, the state treasurer shall transfer two hundred thousand dollars from ten million dollars available for transfer pursuant to paragraph (d) of this subsection (17) in the medical marijuana program cash fund to the subaccount to be used for administrative purposes to administer the medical marijuana health research grant program created pursuant to section 25-1.5-106.5.
    7. Notwithstanding any provision of subsection (17)(e) of this section to the contrary, one hundred thousand dollars from the subaccount may be used for administrative purposes to administer the medical marijuana research grant program created pursuant to section 25-1.5-106.5 for each of the fiscal years 2019-20, 2020-21, and 2021-22.
18. 1. This section is repealed, effective September 1, 2028.
    2. Prior to the repeal of this section, the department of regulatory agencies shall conduct a sunset review as described in section 24-34-104 (5), C.R.S.

Source: L. 2003: Entire article added with relocations, p. 686, § 2, effective July 1. L. 2009: (3) amended, (SB 09-208), ch. 149, p. 624, § 20, effective April 20. L. 2010: Entire section amended, (SB 10-109), ch. 356, p. 1691, § 1, effective June 7; (17)(b.5) added, (HB 10-1388), ch. 362, p. 1716, § 1, effective June 7; entire section amended, (HB 10-1284), ch. 355, p. 1677, § 2, effective July 1. L. 2011: (2)(c)(II), (5)(a), and (16)(a) amended and (7)(e) added, (HB 11-1043), ch. 266, pp. 1211, 1212, §§ 19, 20, 22, 21, effective July 1. L. 2014: (2)(a) amended and (2)(a.5) and (8)(g) added, (HB 14-1396), ch. 382, p. 1862, § 1, effective June 6; (17) amended, (SB 14-155), ch. 237, p. 873, § 2, effective July 1. L. 2015: (1)(c), (1)(d), (2)(e.5), (3)(a)(IX), (3.7), and (13.5) added, (2)(d.5), (3)(a)(VII), (3)(a)(VIII), (8)(a), (12)(b)(IV), and (18) amended, and (3)(b)(I) and (13) repealed, (SB 15-014), ch. 199, pp. 682, 688, §§ 3, 8, effective May 18; (3.5) and (3.8) added, (HB 15-1283), ch. 307, p. 1255, § 1, effective June 5; (17)(d)(II) amended, (HB 15-1261), ch. 322, p. 1314, § 7, effective June 5; (18) amended, (SB 15-115), ch. 283, p. 1164, § 15, effective June 5; (7)(a), (7)(c), and (7)(e) amended and (7)(f), (8.5), and (8.6) added, (SB 15-014), ch. 199, p. 682, § 3, effective January 1, 2017. L. 2016: (18)(b) amended, (HB 16-1192), ch. 83, p. 234, § 19, effective April 14; (12)(b)(IV) amended, (HB 16-1373), ch. 232, p. 937, § 2, effective June 6. L. 2017: (10) amended, (SB 17-242), ch. 263, p. 1323, § 185, effective May 25; (2)(a.5), IP(2)(d.5), (3)(a)(VI), IP(5), (5)(b), (5)(d)(III), (5)(d)(IV), (9)(a), (9)(b), (12)(b)(VII), (14), and (16)(a) amended and (2)(a.7), (2)(d.3), and (2.5) added, (SB 17-017), ch. 347, p. 1824, § 1, effective June 5; (10) amended, (HB 17-1329), ch. 381, p. 1982, § 56, effective June 6; (2)(e.3), (8.5)(a.5), (8.5)(b.5), (8.6)(a)(I.5), and (8.6)(a)(I.6) added and (7)(e)(I)(A) amended, (HB 17-1220), ch. 402, p. 2096, § 3, effective January 1, 2018. L. 2018: (17)(d) amended and (17)(f) added, (SB 18-271), ch. 329, p. 1972, § 5, effective May 30; (3.5)(b), (3.7), (3.8)(a), (7)(e)(I)(A), (8.5)(b), and (8.6)(b) amended, (HB 18-1023), ch. 55, p. 588, § 18, effective October 1. L. 2019: (2)(a.7) and (2.5)(i)(I) amended, (HB 19-1028), ch. 71, p. 255, § 1, effective April 2; (2)(a.5)(II), (2)(a.7), (2)(c), (2)(d.5)(I), (3)(b)(II), (3.5)(d), (5)(a), (5)(c), (6)(a), (6)(c), (7)(d), (9)(c), (10), and (18)(a) amended, (2)(d.4), (3)(d), and (5)(e) added, and (3)(b)(III), (3.7), and (3.8)(b) repealed, (SB 19-218), ch. 343, pp. 3184, 3188, §§ 1, 4, effective August 2; (2)(a.7) and (2.5)(i)(I) amended and (2.5)(j) added, (SB 19-013), ch. 282, pp. 2640, 2641, §§ 1, 2, effective August 2; (3)(a)(I), (5)(c), (6)(a), and (6)(c) amended, (SB 19-241), ch. 390, p. 3472, § 36, effective August 2; (8)(b) amended, (HB 19-1031), ch. 278, p. 2618, § 1, effective August 2; (5)(c), (6)(a), and (6)(c) amended, (HB 19-1172), ch. 136, p. 1697, § 142, effective October 1; (3.5)(b), (3.7), (3.8)(a), (7)(e)(I)(A), (8.5)(b), and (8.6)(b) amended, (SB 19-224), ch. 315, p. 2939, § 23, effective January 1, 2020. L. 2020: (5)(e) amended, (HB 20-1402), ch. 216, p. 1052, § 50, effective June 30.

25-1.5-106.5. Medical marijuana health research grant program.

1. Legislative intent. There is a need for objective scientific research regarding the efficacy of marijuana and its component parts as part of medical treatment. It is the intent of the general assembly that the department gather objective scientific research regarding the efficacy of administering marijuana and its component parts as part of medical treatment.
2. Medical marijuana research grant program - rules.
   1. 1. The department shall be responsible for the administration of the Colorado medical marijuana research grant program created within the department and referred to in this section as the "grant program".
      2. The department shall coordinate the grant program to fund research intended to ascertain the general medical efficacy and appropriate administration of marijuana and its component parts. The grant program shall be limited to providing for objective scientific research to ascertain the efficacy of marijuana and its component parts as part of medical treatment and should not be construed as encouraging or sanctioning the social or recreational use of marijuana. The grant program shall fund observational trials and clinical trials.
   2. The state board of health shall promulgate rules for the administration of the grant program, including:
      1. The procedures and timelines by which an entity may apply for program grants;
      2. Grant application contents, including:
         1. Descriptions of key personnel, including clinicians, scientists, or epidemiologists and support personnel, demonstrating they are adequately trained to conduct this research;
         2. Procedures for outreach to patients with various medical conditions who may be suitable participants in research on marijuana and its component parts;
         3. Protocols suitable for research on marijuana and its component parts as medical treatment;
         4. For any research studies, demonstration that appropriate protocols for adequate patient consent and follow-up procedures are in place; and
         5. A process for a grant research proposal approved by the grant program to be reviewed and approved by an institutional review board that is able to approve, monitor, and review biomedical and behavioral research involving human subjects;
      3. Criteria for selecting entities to receive grants and determining the amount and duration of the grants, which shall include the following:
         1. The scientific merit of the research plan, including whether the research design and experimental procedures are potentially biased for or against a particular outcome; and
         2. The researchers' expertise in the scientific substance and methods of the proposed research and their lack of bias or conflict of interest regarding the topic of, and the approach taken in, the proposed research; and
      4. Reporting requirements for entities that receive grants pursuant to this section.
   3. Program grants will be paid from the health research subaccount in the medical marijuana program cash fund created in section 25-1.5-106 (17).
   4. In order to maximize the scope and size of the marijuana studies:
      1. The grant program may solicit, apply for, and accept moneys from foundations, private individuals, and all other funding sources that can be used to expand the scope or time frame of the marijuana studies that are authorized under this section; except that the program shall not accept any moneys that are offered with any conditions other than that the moneys be used to study the efficacy of marijuana and its component parts as part of medical treatment; and
      2. All donors shall be advised that moneys given for purposes of this section will be used to study both the possible medical benefits and detriments of marijuana and its component parts and that he or she will have no control over the use of these moneys.
3. Review of applications.
   1. Scientific advisory council. (I) In order to ensure objectivity in evaluating research proposals, the grant program shall establish a scientific advisory council, referred to in this section as the "council", to provide a peer review process that guards against funding research that is biased in favor of or against particular outcomes. The executive director of the department shall appoint at least six members and no more than thirteen members to the council to provide policy guidance in the creation and implementation of the grant program and in scientific oversight and review. The chief medical officer of the department, or his or her designee, is also a member of the council and is chair of the council. Except for the representative specified in sub-subparagraph (L) of this subparagraph (I), the executive director shall choose members on the basis of their expertise in the scientific substance and methods of the proposed research and for their lack of bias or conflict of interest regarding the applicants or the topic of an approach taken in the proposed research and may choose members from around the country. Members of the council must include the following types of experts:
      1. At least one epidemiologist with expertise in designing and conducting large, observational studies and clinical trials;
      2. At least one clinician with expertise in designing and conducting clinical trials;
      3. A clinician familiar with the prescription, dosage, and administration of medical marijuana under current state laws;
      4. A medical toxicologist;
      5. A neurologist;
      6. A pediatrician;
      7. A psychiatrist;
      8. An internal medicine physician or other specialist in adult medicine;
      1. A preventive medicine specialist or public health professional;

         (J) A substance abuse specialist;

         (K) An alternative medicine specialist with expertise in herbal or alternative medicine;

         (L) A person who represents medical marijuana patient interests; and

         (M) An ad hoc member with clinical expertise in the medical condition under study.

      2. Members of the council, other than the chief medical officer or his or her designee, shall serve on a voluntary basis for a two-year term and may be reappointed. Members shall be reimbursed for their travel expenses incurred in the course of their participation.
      3. Members of the council shall evaluate research proposals and submit recommendations to the department and the state board of health for recommended grant recipients, grant amounts, and grant duration.
   2. Grant approval. (I) The council shall submit recommendations for grants to the state board of health. The state board of health shall approve or disapprove of grants submitted by the council. The state board of health is encouraged to prioritize grants to gather objective scientific research regarding the efficacy and the safety of administering medical marijuana for ovarian cancer; dementia; pediatric conditions, including but not limited to autism spectrum disorder; and other conditions that the state board deems suitable. If the state board of health disapproves a recommendation, the council may submit a replacement recommendation within thirty days.

      (II) The state board of health shall award grants to the selected entities, specifying the amount and duration of the award. A grant awarded pursuant to this section shall not exceed three years without renewal. The size, scope, and number of studies funded shall be commensurate with the amount of appropriated and available grant program funding.

4. Reporting.
   1. No later than January 1, 2016, the grant program shall report to the state board of health on the progress of the medical marijuana studies.
   2. Thereafter, the grant program shall issue a report to the state board of health by January 1 of each year detailing the progress of the medical marijuana studies. The interim reports required under this paragraph (b) shall include data on all of the following:
      1. The names and number of diseases or conditions under study;
      2. The number of patients enrolled in each study by disease; and
      3. Any scientifically valid preliminary findings.
5. Sources of marijuana.
   1. The attorney general shall seek authority from the federal government to permit Colorado institutions of higher education to contract with the national institute of drug abuse to cultivate marijuana and its component parts for use in research studies funded pursuant to this section.
   2. Repealed.
6. Definition. For purposes of this section, "marijuana" means "usable form of marijuana" as that term is defined in section 14 (1)(i) of article XVIII of the Colorado constitution and also includes "industrial hemp" as that term is defined in section 16 (2)(d) of article XVIII of the Colorado constitution.

Source: L. 2014: Entire section added, (SB 14-155), ch. 237, p. 874, § 3, effective July 1. L. 2017: (5) amended, (HB 17-1367), ch. 406, p. 2121, § 6, effective January 1, 2018. L. 2018: (3)(b)(I) amended, (SB 18-271), ch. 329, p. 1972, § 6, effective May 30. L. 2019: (3)(b)(I) amended, (HB 19-1028), ch. 71, p. 256, § 2, effective April 2; (5)(b) repealed, (SB 19-224), ch. 315, p. 2940, § 24, effective January 1, 2020.

Cross references: For the legislative declaration in SB 14-155, see section 1 of chapter 237, Session Laws of Colorado 2014.

25-1.5-107. Pandemic influenza - purchase of antiviral therapy - definitions.

1. The department may enter into partnerships with one or more authorized purchasers to purchase antiviral therapy in order to acquire a ready supply or stockpile of antiviral drugs in the event of an epidemic emergency, including pandemic influenza. If an entity wishes to purchase antiviral therapy through the department, the entity shall notify the department of its intent and shall demonstrate to the department, in a form and manner determined by the department, that the entity satisfies the criteria of an authorized purchaser. Upon a determination that an entity is an authorized purchaser, the department shall seek approval from the United States department of health and human services for the purchase of antiviral therapy by the authorized purchaser. Any purchase of antiviral therapy shall be approved by the United States department of health and human services, and antiviral therapy shall be stored and used in accordance with state and federal requirements.
2. As used in this section, unless the context otherwise requires:
   1. "Authorized purchaser" means an entity licensed by the department pursuant to section 25-1.5-103 (1)(a), a local public health agency, or a health maintenance organization, as defined in section 10-16-102 (35), C.R.S., authorized to operate in this state pursuant to part 4 of article 16 of title 10, C.R.S., that:
      1. Is part of the state pandemic preparedness and response plan;
      2. Will purchase antiviral therapy with its own funds; and
      3. Agrees to stockpile the antiviral therapy for use in an epidemic emergency declared a disaster emergency pursuant to section 24-33.5-704, C.R.S., and to use the antiviral therapy only in accordance with state and federal requirements and for no other purpose.
   2. "Bioterrorism" means the intentional use of microorganisms or toxins of biological origin to cause death or disease among humans or animals.
   3. "Emergency epidemic" means cases of an illness or condition, communicable or noncommunicable, caused by bioterrorism, pandemic influenza, or novel and highly fatal infectious agents or biological toxins.
   4. "Pandemic influenza" means a widespread epidemic of influenza caused by a highly virulent strain of the influenza virus.

Source: L. 2007: Entire section added with relocations, p. 1290, § 2, effective May 25. L. 2013: IP(2)(a) amended, (HB 13-1266), ch. 217, p. 992, § 61, effective May 13; (2)(a)(III) amended, (HB 13-1300), ch. 316, p. 1688, § 74, effective August 7.

25-1.5-108. Regulation of dialysis treatment clinics - training for hemodialysis technicians - state board of health rules - definitions - repeal.

1. As used in this section, unless the context otherwise requires:
   1. "Dialysis treatment clinic" means a health facility or a department or unit of a licensed hospital that is planned, organized, operated, and maintained to provide outpatient hemodialysis treatment or hemodialysis training for home use of hemodialysis equipment.
   2. "End-stage renal disease" means the stage of renal impairment that appears irreversible and permanent and that requires a regular course of dialysis or a kidney transplant to maintain life.
   3. "Hemodialysis technician" means a person who is not a physician or a licensed professional nurse and who provides dialysis care.
   4. "National credentialing program" means any national program for credentialing or determining the competency of hemodialysis technicians that is recognized by the national association of nephrology technicians/technologists (NANT), or a successor association.
2. The state board of health shall adopt rules to establish a process to verify that persons performing the duties and functions of a hemodialysis technician at or for a dialysis treatment clinic have been credentialed by a national credentialing program. The verification process shall be part of the department's licensing of dialysis treatment clinics and part of each routine survey of licensed dialysis clinics conducted by the department. As part of the rules adopted pursuant to this section, the state board shall establish fees consistent with section 25-3-105 to be assessed by the department against dialysis treatment clinics to cover the department's administrative costs in implementing this section.
3. 1. A person shall not act as, or perform the duties and functions of, a hemodialysis technician unless the person has been credentialed by a national credentialing program and is under the supervision of a licensed physician or licensed professional nurse experienced or trained in dialysis treatment.
   2. A dialysis treatment clinic licensed by the department shall not allow a person to perform the duties and functions of a hemodialysis technician at or for the dialysis treatment clinic if the person has not been credentialed by a national credentialing program.
   3. Nothing in this subsection (3) prohibits:
      1. A person from providing dialysis care to himself or herself or in-home, gratuitous dialysis care provided to a person by a friend or family member who does not represent himself or herself to be a hemodialysis technician;
      2. A person participating in a hemodialysis technician training program from performing the duties and functions of a hemodialysis technician if:
         1. The person is under the direct supervision of a physician, or a licensed professional nurse experienced or trained in dialysis treatment, who is on the premises and available for prompt consultation or treatment; and
         2. The person receives his or her credentials from a national credentialing program within eighteen months after the date the person enrolled in the training program.
4. In connection with its regulation of dialysis treatment clinics pursuant to section 25-1.5-103 (1)(a)(I) and 25-3-101 (1) and rules adopted by the state board of health pursuant to subsection (2) of this section, on and after January 1, 2009, the department shall verify that a dialysis treatment clinic only employs hemodialysis technicians who have been credentialed by a national credentialing program. Compliance by a dialysis treatment clinic with this section shall be a condition of licensure by the department.
5. Each dialysis treatment clinic licensed by the department and operating in this state shall post a clear and unambiguous notice in a public location in the clinic specifying that the clinic is licensed, regulated, and subject to inspection by the Colorado department of public health and environment. The dialysis treatment clinic shall also inform consumers, either in the public notice required by this subsection (5) or in written materials provided to consumers, about the ability to provide feedback to the clinic and to the department, including the method by which consumers can provide feedback. The state board may adopt rules, as necessary, to specify the contents of the notice or written materials required by this subsection (5).

   (5.5) A dialysis treatment clinic shall not provide outpatient hemodialysis treatment to a non-end-stage renal disease patient without a referral for treatment from a board-certified or board-eligible nephrologist licensed as a physician in Colorado. When making the referral, the nephrologist and other licensed physicians who cared for the patient in the hospital shall use their professional judgment to determine when the patient no longer requires hospitalization and may receive outpatient dialysis.

6. This section is repealed, effective September 1, 2026. Before the repeal, this section is scheduled for review in accordance with section 24-34-104.

Source: L. 2007: Entire section added with relocations, p. 1623, § 1, effective July 1. L. 2012: (2), (3)(a), and (6) amended, (HB 12-1204), ch. 103, p. 348, § 1, effective July 1. L. 2013: (1)(a) amended and (5.5) added, (SB 13-046), ch. 53, p. 178, § 1, effective March 22. L. 2019: (1)(c), (2), (3)(a), (3)(b), IP(3)(c), (3)(c)(II)(A), and (6) amended, (SB 19-145), ch. 218, p. 2241, § 2, effective August 2.

25-1.5-108.5. Regulation of recovery residences - definition - rules.

1. 1. As used in this section, "recovery residence", "sober living facility", or "sober home" means any premises, place, facility, or building that provides housing accommodation for individuals with a primary diagnosis of a substance use disorder that:
      1. Is free from alcohol and nonprescribed or illicit drugs;
      2. Promotes independent living and life skill development; and
      3. Provides structured activities and recovery support services that are primarily intended to promote recovery from substance use disorders.
   2. "Recovery residence" does not include:
      1. A private residence in which an individual related to the owner of the residence by blood, adoption, or marriage is required to abstain from substance use or receive behavioral health services for a substance use disorder as a condition of residing in the residence;
      2. The supportive residential community for individuals who are homeless operated under section 24-32-724 at the Fort Lyon property for the purpose of providing substance abuse supportive services, medical care, job training, and skill development for the residents;
      3. A facility approved for residential treatment by the office of behavioral health in the department of human services; or
      4. Permanent supportive housing units incorporated into affordable housing developments.
2. A recovery residence may admit individuals who are receiving medication-assisted treatment, including agonist treatment, for substance use disorders; except that a recovery residence receiving state money or providing services that are paid for through state programs shall not deny admission to persons who are participating in prescribed medication-assisted treatment, as defined in section 23-21-803, for a substance use disorder.
3. Effective January 1, 2020, a person shall not operate a facility using the term "recovery residence", "sober living facility", "sober home", or a substantially similar term, and a licensed, registered, or certified health care provider or a licensed health facility shall not refer an individual in need of recovery support services to a facility, unless the facility:
   1. Is certified by a recovery residence certifying body approved by the office of behavioral health in the department of human services as specified in subsection (4) of this section;
   2. Is chartered by Oxford House or its successor organization;
   3. Has been operating as a recovery residence in Colorado for thirty or more years as of May 23, 2019; or
   4. Is a community-based organization that provides reentry services as described in section 17-33-101 (7).
4. The office of behavioral health in the department of human services shall, by rule, determine the requirements for a recovery residence certifying body seeking approval for purposes of subsection (3)(a) of this section, which rules must include a requirement that a recovery residence certifying body include a representative from the office on its board.
5. A recovery residence owner, employee, or administrator, or an individual related to a recovery residence owner, employee, or administrator, shall not directly or indirectly:
   1. Solicit, accept, or receive a commission, payment, trade, fee, or anything of monetary or material value, excluding the supportive services required to place the resident:
      1. For admission of a resident, except for state or federal contracts that specifically reimburse for resident fees;
      2. From a treatment facility that is licensed or certified by the department of public health and environment for the treatment of substance use disorders; or
      3. From a facility approved for residential treatment by the office of behavioral health in the department of human services;
   2. Solicit, accept, or receive a commission, payment, trade, fee, or anything of monetary or material value from a toxicology laboratory that provides confirmation testing or point-of-care testing for residents.

Source: L. 2019: Entire section added, (HB 19-1009), ch. 274, p. 2587, § 2, effective May 23. L. 2020: (2) amended, (SB 20-007), ch. 286, p. 1390, § 4, effective July 13.

25-1.5-109. Food allergies and anaphylaxis form for schools - powers and duties of department.

The department has, in addition to all other powers and duties imposed upon it by law, the duty to develop, maintain, and make available to school districts and institute charter schools a standard form to be used by school districts and institute charter schools to gather information from physicians and parents and guardians of students concerning students' risks of food allergies and anaphylaxis and the treatment thereof. The standard form shall include, at a minimum, fields for gathering the information described in section 22-2-135 (3)(b), C.R.S.

Source: L. 2009: Entire section added with relocations, (SB 09-226), ch. 245, p. 1106, § 6, effective August 5.

Cross references: For the legislative declaration contained in the 2009 act adding this section, see section 1 of chapter 245, Session Laws of Colorado 2009.

25-1.5-110. Monitor health effects of marijuana - report.

1. The department shall monitor changes in drug use patterns, broken down by county or region, as determined by the department, and race and ethnicity, and the emerging science and medical information relevant to the health effects associated with marijuana use.
2. 1. The department shall appoint a panel of health care professionals with expertise in, but not limited to, neuroscience, epidemiology, toxicology, cannabis physiology, and cannabis quality control to further direct policy. Notwithstanding section 24-1-136 (11)(a)(I), the panel shall provide a report by January 31, 2015, and every two years thereafter to the state board of health, the department of revenue, and the general assembly. The department shall make the report available on its website. The panel shall establish criteria for studies to be reviewed, reviewing studies and other data, and making recommendations, as appropriate, for policies intended to protect consumers of marijuana or marijuana products and the general public.
   2. In order to allow the public to evaluate any conflict of interest among the panel, each panelist shall disclose all financial interests the panelist has related to the health care industry and the regulated marijuana industry. The disclosures must be included in the report required pursuant to subsection (2)(a) of this section.
3. The department may collect Colorado-specific data that involves health outcomes associated with cannabis from, but not limited to, all-payer claims data, hospital discharge data, and available peer-reviewed research studies.

Source: L. 2013: Entire section added, (SB 13-283), ch. 332, p. 1894, § 10, effective May 28. L. 2016: Entire section amended, (SB 16-090), ch. 45, p. 107, § 1, effective August 10. L. 2017: (2) amended, (SB 17-056), ch. 33, p. 92, § 2, effective February 1, 2018. L. 2019: (2) and (3) amended, (SB 19-218), ch. 343, p. 3187, § 2, effective August 2.

Editor's note: This section was numbered as § 25-1.5-111 in Senate Bill 13-283 but was renumbered on revision for ease of location.

25-1.5-111. Suicide prevention commission - created - responsibilities - gifts, grants, donations - repeal.

1. The suicide prevention commission is hereby created for the purpose of:
   1. Providing public and private leadership for suicide prevention and intervention in Colorado;
   2. Setting statewide, data-driven, evidence-based, and clinically informed suicide prevention priorities in Colorado;
   3. Serving as an advisor to the office of suicide prevention;
   4. Establishing and leading subgroups to set strategy and implementation plans for each statewide suicide prevention priority for the office of suicide prevention;
   5. Providing a forum for government agencies, community members, business leaders, and lawmakers to examine the current status of suicide prevention and intervention policies, analyze the system's near-term opportunities and challenges, and make recommendations to the office of suicide prevention, the governor's office, and the general assembly regarding improvements and innovations in policies and programs to reduce the preventable occurrence of suicide in Colorado;
   6. Expanding local and national partnerships and resources for statewide suicide prevention activities;
   7. Promoting cooperation and coordination among suicide prevention programs and strategies across Colorado;
   8. Evaluating the distribution of state resources for suicide prevention;
   9. Ensuring that suicide prevention remains a state priority; and
   10. Encouraging the development of suicide prevention plans at the local level.
2. 1. Within sixty days after May 29, 2014, the executive director of the department of public health and environment shall appoint to the committee no more than twenty-six members, including:
      1. A representative from the office of suicide prevention in the department, which office shall serve as the administrator and coordinator of the commission;
      2. A representative from the office of behavioral health in the department of human services;
      3. A representative from law enforcement;
      4. A representative from higher education;
      5. A representative from K-12 education;
      6. A representative from an employee assistance program or human resources in the private sector;
      7. A representative from the suicide prevention coalition of Colorado;
      8. A licensed mental health professional;
      9. Repealed.
      10. An active member or veteran of the United States military who has been affected by suicide;
      11. A representative from the Colorado youth advisory council;
      12. A family member of a person who died by suicide;
      13. A person who has attempted suicide, recovered, and is now thriving;
      14. A person representing a philanthropic foundation;
      15. A representative of medical providers or first responders;
      16. A representative from a hospital with an on-site emergency department;
      17. A representative from the agricultural and ranching industry;
      18. A representative from the oil and gas industry from a rural area;
      19. At least three members of the Colorado business community, one of whom represents a rural area;
      20. One representative of the suicide prevention nonprofit community;
      21. A representative from a nonprofit community service club;
      22. A representative from an interfaith organization;
      23. A representative from the school safety resource center with experience in bullying, including cyberbullying; and
      24. A representative from the department of health care policy and financing.
   2. When appointing the commission members, the executive director shall ensure that persons of different ethnic backgrounds are represented and that the regions of the state with high suicide rates, including rural areas, are represented and that the commission includes members with expertise with groups associated with high suicide rates and suicide attempts, including: Persons with disabilities; working-age men; senior adults; veterans and active-duty military personnel; lesbian, gay, bisexual, and transgender youth and adults; and Coloradans of disproportionately affected diversities and genders.
   3. The members of the commission shall serve without compensation; except that the members may seek reimbursement for travel expenses to and from meetings of the commission.
   4. The executive director shall appoint one commission member who represents the public sector and one commission member who represents the private sector to serve as co-chairs of the commission.
3. The department shall provide to the commission support that includes the coordination of all commission activities, including: Meeting logistics, agenda development, and follow-up; organizing and orienting commission members; working closely with the co-chairpersons to set priorities, recruit members, oversee all commission initiatives, coordinate activities, and implement any commission-directed initiatives; and any other duties assigned by the co-chairpersons. The director of the office of behavioral health in the department of human services, a representative from the university of Colorado depression center, and a representative of the suicide prevention coalition of Colorado may also provide support to the commission.
4. The office of suicide prevention shall include the recommendations of the commission in the report submitted annually to the general assembly pursuant to section 25-1.5-101 and shall present the recommendations as part of its annual presentation to the general assembly pursuant to the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act" as enacted by House Bill 10-1119 in 2010.
5. The department may accept gifts, grants, and donations from public and private sources for the direct and indirect costs associated with the implementation and duties associated with the commission. The department shall transmit any gifts, grants, and donations it receives to the state treasurer, who shall credit the moneys to the suicide prevention coordination cash fund created in section 25-1.5-101 (1)(w)(II). The fund also consists of any moneys appropriated or transferred to the fund by the general assembly for the purposes of this section. The moneys in the fund are subject to annual appropriation by the general assembly.
6. 1. This section is repealed, effective September 1, 2024.
   2. Prior to the repeal, the department of regulatory agencies shall review the commission pursuant to section 2-3-1203, C.R.S.

Source: L. 2014: Entire section added, (SB 14-088), ch. 279, p. 1130, § 2, effective May 29. L. 2018: (2)(a)(IX) repealed, (SB 18-161), ch. 123, p. 830, § 3, effective September 1.

Cross references: (1) For the legislative declaration in SB 14-088, see section 1 of chapter 279, Session Laws of Colorado 2014.

(2) For the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act", see part 2 of article 7 of title 2.

25-1.5-112. Colorado suicide prevention plan - established - goals - responsibilities - funding.

1. The Colorado suicide prevention plan, referred to in this section as the "Colorado plan", is created in the office of suicide prevention within the department. The goal and purpose of the Colorado plan is to reduce suicide rates and numbers in Colorado through system-level implementation of the Colorado plan in criminal justice and health care systems, including mental and behavioral health systems.
2. The suicide prevention commission, together with the office of suicide prevention, the office of behavioral health, the department, and the department of health care policy and financing, is strongly encouraged to collaborate with criminal justice and health care systems, mental and behavioral health systems, primary care providers, physical and mental health clinics in educational institutions, community mental health centers, advocacy groups, emergency medical services professionals and responders, public and private insurers, hospital chaplains, and faith-based organizations, to develop and implement:
   1. A plan to improve training to identify indicators of suicidal thoughts and behavior across criminal justice and health care systems;
   2. A plan to improve training on:
      1. The provisions of the emergency procedures for a seventy-two-hour mental health hold pursuant to section 27-65-105, C.R.S.;
      2. The provisions of the federal "Health Insurance Portability and Accountability Act of 1996", Pub.L. 104-191, as amended; and
      3. Other relevant patient privacy procedures; and
   3. Professional development resources and training opportunities regarding indicators of suicidal thoughts and behavior, risk assessment, and management, as developed in collaboration with the department of regulatory agencies, the department of corrections, and health care and mental health professional boards and associations.
3. As a demonstration of their commitment to patient safety, criminal justice and health care systems, including mental and behavioral health systems, primary care providers, and hospitals throughout the state, are encouraged to contribute to and implement the Colorado plan.
4. The following systems and organizations are encouraged to contribute to and implement the Colorado plan on or before July 1, 2019:
   1. Community mental health centers;
   2. Hospitals;
   3. The state crisis services system;
   4. Emergency medical services professionals and responders;
   5. Regional health and behavioral health systems;
   6. Substance use disorder treatment systems;
   7. Physical and mental health clinics in educational institutions;
   8. Criminal justice systems; and
   9. Advocacy groups, hospital chaplains, and faith-based organizations.
5. The office of suicide prevention shall include a summary of the Colorado plan in a report submitted to the office of behavioral health, as well as the report submitted annually to the general assembly pursuant to section 25-1.5-101 (1)(w)(III)(A) and as part of its annual presentation to the general assembly pursuant to the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act", part 2 of article 7 of title 2, C.R.S.
6. The department may accept gifts, grants, and donations from public and private sources for the direct and indirect costs associated with the development and implementation of the Colorado plan. The department shall transmit any gifts, grants, and donations it receives to the state treasurer, who shall credit the money to the suicide prevention coordination cash fund created in section 25-1.5-101 (1)(w)(II).

Source: L. 2016: Entire section added, (SB 16-147), ch. 364, p. 1519, § 2, effective June 10. L. 2017: (4)(f) amended, (SB 17-242), ch. 263, p. 1323, § 186, effective May 25.

Cross references: For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.

25-1.5-113. Crisis and suicide prevention training grant program - creation - process - reporting requirements - fund - definitions.

1. As used in this section, unless the context otherwise requires:
   1. "Department" means the department of public health and environment created and existing pursuant to section 25-1-102.
   2. "Fund" means the crisis and suicide prevention training grant program fund established in subsection (5) of this section.
   3. "Grant program" means the crisis and suicide prevention training grant program created in subsection (2) of this section.
   4. "Office of suicide prevention" means the office of suicide prevention in the department, established pursuant to section 25-1.5-101 (1)(w).
   5. "Public school" means a school of a school district, a district charter school, or an institute charter school.
   6. "School district" means any public school district existing pursuant to law.
   7. "School safety resource center" means the school safety resource center in the department of public safety, established pursuant to section 24-33.5-1803.
2. 1. There is created in the department the crisis and suicide prevention training grant program. The purpose of the grant program is to provide financial assistance for the provision of comprehensive crisis and suicide prevention training annually, if grant funding is available, for all teachers and staff at public schools and school districts in Colorado who work directly or indirectly with students. Priority for grant awards is for public schools and school districts with educators and staff who have not yet received such training. The grant program may authorize up to four hundred thousand dollars in grants per year in varying amounts based on the size and need of the public school or school district.
   2. On and after January 1, 2019, a public school or a school district may apply to the department for a grant pursuant to the guidelines adopted in subsection (3) of this section to provide crisis and suicide prevention training in the public school or school district.
   3. The department shall administer the grant program in consultation with the office of suicide prevention and the school safety resource center.
   4. Notwithstanding any other provision of this section, the department is not required to implement the provisions of this section until sufficient money has been transferred or appropriated to the fund.
3. 1. On or before November 1, 2018, the office of suicide prevention and the school safety resource center shall make recommendations to the department for the administration of the grant program, and the department shall adopt formal training guidelines for the grant program. The guidelines must include:
      1. Application procedures by which public schools and school districts may apply for a grant pursuant to this section;
      2. Criteria to utilize in selecting public schools and school districts to receive grants and in determining the amount of grant money to be awarded to each grant recipient. The criteria, at a minimum, must include:
         1. That first priority for grant awards is to provide crisis and suicide prevention training to public schools and school districts that have not previously received such training;
         2. An emphasis on providing such training to all staff at the public school or school district, not just educators; and
         3. A requirement that each application, at a minimum, must describe how the applicant public school or school district will use a grant award to provide comprehensive crisis and suicide prevention training to all educators and staff who have not yet received such training.
   2. If there is money remaining in the fund after grants are made to all public schools or school districts that applied for a grant and that had not previously received crisis and suicide prevention training, the department may award grants to a public school or school district that had previously received such training.
   3. The office of suicide prevention and school safety resource center shall assist the department with reviewing grant applications, making recommendations to the department on which public schools and school districts that applied must receive a grant from the grant program and the amount of each grant, and acting as a resource for grantees.
4. 1. Each grant recipient shall submit a written report to the department not later than six months after the expiration of the term of its grant. The report must include a summary of activities made possible by the grant money.
   2. The department shall include in the report required pursuant to section 25-1.5-101 (1)(w)(III)(A) the following information regarding the administration of the grant program during the preceding year:
      1. The number of public schools and school districts that received a grant from the grant program;
      2. The amount of each grant award by recipient;
      3. The number of pupils who are enrolled at each public school or school district of each grant recipient;
      4. The number of school staff and educators who were provided training as a result of a grant; and
      5. A copy of the grant recipients' crisis and suicide prevention plans.
5. 1. There is established in the state treasury the crisis and suicide prevention training grant program fund. The fund consists of money transferred or appropriated to it and any other money that may be made available by the general assembly. The money in the fund is continuously appropriated to the department for the direct and indirect costs associated with implementing the grant program. Any money not provided as grants may be invested by the state treasurer as provided in section 24-36-113. All interest and income derived from the investment and deposit of money in the fund must be credited to the fund. Any amount remaining in the fund at the end of any fiscal year must remain in the fund and not be credited or transferred to the general fund or to any other fund.
   2. No more than three percent of the money annually expended from the fund may be used for the expenses incurred by the department in administering the grant program.
   3. The department may seek, accept, and expend gifts, grants, and donations from public and private sources to implement this section; except that the department shall not accept a gift, grant, or donation that is subject to conditions that are inconsistent with the provisions of this section or any other law of the state. The department shall transfer all private and public money received through gifts, grants, and donations to the state treasurer, who shall credit the same to the fund.
   4. Nothing in this section requires the department to solicit money for the purposes of implementing the grant program.

Source: L. 2018: Entire section added, (SB 18-272), ch. 333, p. 2002, § 2, effective August 8.

Cross references: For the legislative declaration in SB 18-272, see section 1 of chapter 333, Session Laws of Colorado 2018.

25-1.5-114. Freestanding emergency departments - licensure - requirements - rules - definitions.

1. As used in this section, "board" means the state board of health created in section 25-1-103.

   (1.5) On or after December 1, 2021, a person that wishes to operate a freestanding emergency department must submit to the department on an annual basis a completed application for licensure as a freestanding emergency department. On or after July 1, 2022, a person shall not operate a freestanding emergency department that is required to be licensed pursuant to this section without a license issued by the department.

2. The department may grant a waiver of the licensure requirements set forth in this section and in rules adopted by the board for either a licensed community clinic or community clinic seeking licensure that is serving an underserved population in the state.
3. 1. The board shall adopt rules establishing the requirements for licensure of, waiver from the requirement for licensure of, safety and care standards for, and fees for licensing and inspecting freestanding emergency departments. The board must set the fees in accordance with section 25-3-105.
   2. The rules adopted by the board shall include a requirement that each individual seeking treatment at the freestanding emergency department receive a medical screening examination and a prohibition against delaying a medical screening examination in order to inquire about the individual's ability to pay or insurance status.
   3. The rules adopted by the board must take effect by July 1, 2021, and thereafter the board shall amend the rules as necessary.
4. A freestanding emergency department licensed pursuant to this section is subject to the requirements in section 25-3-119.
5. 1. As used in this section, "freestanding emergency department" means a health facility that offers emergency care, that may offer primary and urgent care services, and that is either:
      1. Owned or operated by, or affiliated with, a hospital or hospital system and located more than two hundred fifty yards from the main campus of the hospital; or
      2. Independent from and not operated by or affiliated with a hospital or hospital system and not attached to or situated within two hundred fifty yards of, or contained within, a hospital.
   2. "Freestanding emergency department" does not include a health facility described in subsection (5)(a) of this section that was licensed by the department pursuant to section 25-1.5-103 as a community clinic prior to July 1, 2010, if the facility is serving a rural community or a ski area, as defined in board rules.

Source: L. 2019: Entire section added, (HB 19-1010), ch. 324, p. 2996, § 1, effective August 2. L. 2020: Entire section amended, (HB 20-1402), ch. 216, p. 1052, § 51, effective June 30.

25-1.5-115. Opiate antagonist bulk purchase fund - creation - definition - rules - report.

1. 1. The opiate antagonist bulk purchase fund, referred to in this section as the "fund", is hereby created in the state treasury. The fund consists of payments made to the department by participating eligible entities for the purchase of opiate antagonists; gifts, grants, and donations credited to the fund pursuant to subsection (1)(b) of this section; and any money that the general assembly may appropriate or transfer to the fund.
   2. The department may seek, accept, and expend gifts, grants, or donations from private or public sources for the purposes of this section. The department shall transmit all money received through gifts, grants, or donations to the state treasurer, who shall credit the money to the fund.
   3. The state treasurer shall credit all interest and income derived from the deposit and investment of money in the fund to the fund.
2. Money in the fund is continuously appropriated to the department for bulk purchasing of opiate antagonists. Eligible entities may purchase opiate antagonists from the department. The department may contract with a prescription drug outlet, as defined in section 12-280-103 (43), for the bulk purchasing and distribution of opiate antagonists. The department shall provide technical assistance to participating eligible entities to ensure that eligible entities complete all training and registration requirements.
3. The department shall promulgate rules specifying the amount an eligible entity must pay to purchase opiate antagonists from the department.
4. 1. No later than October 1, 2020, and every October 1 thereafter, the executive director of the department or the executive director's designee shall report to the house and senate appropriations committees, or their successor committees, on the fund's activity. The report must include:
      1. Revenue received by the fund;
      2. Revenue and expenditure projections for the forthcoming fiscal year and details of all expenditures from the fund;
      3. The eligible entities that purchased opiate antagonists;
      4. The amount of opiate antagonists purchased by each eligible entity; and
      5. The discount procured through bulk purchasing.
   2. Notwithstanding section 24-1-136 (11)(a)(I), the report required in this subsection (4) continues indefinitely.
5. As used in this section, "eligible entity" means:
   1. A unit of local government, as defined in section 29-3.5-101 (4);
   2. A person making an opiate antagonist available pursuant to section 25-20.5-1001; or
   3. The following entities, if the entity has adopted a policy allowing the acquisition, maintenance, and administration of opiate antagonists pursuant to section 22-1-119.1:
      1. A school district board of education of a public school;
      2. The state charter school institute for an institute charter school; or
      3. A governing board of a nonpublic school.

Source: L. 2019: Entire section added, (SB 19-227), ch. 273, p. 2580, § 10, effective May 23.

25-1.5-201. Definitions.

As used in this part 2, unless the context otherwise requires:

1. "Public water systems" means systems for the provision to the public of piped water for human consumption, if such system has at least fifteen service connections or regularly serves at least twenty-five individuals. The term includes systems that are owned or operated by private, nonprofit entities, as well as:
   1. Any collection, treatment, storage, and distribution facilities under control of the operator of such system and used primarily in connection with such system; and
   2. Any collection or pretreatment storage facilities not under such control which are used primarily in connection with such system.
2. "Supplier of water" means any person who owns or operates a public water system.

Source: L. 2003: Entire article added with relocations, p. 687, § 2, effective July 1. L. 2015: IP(1) amended, (SB 15-121), ch. 202, p. 698, § 2, effective August 5.

Editor's note: This section is similar to former § 25-1-107 (1)(x)(V) and (1)(x)(VI) as they existed prior to 2003.

25-1.5-202. Water - minimum general sanitary standards.

1. The phrase "minimum general sanitary standards" as used in this part 2 and section 25-1-109 (1)(h) means the minimum standards reasonably consistent with assuring adequate protection of the public health, and, in the case of minimum general sanitary standards as to the quality of water supplied to the public, the same shall be established by rule and regulation and shall be appropriate to promote and protect the public health from endangerment presented by carcinogenic, mutagenic, teratogenic, pathogenic, or toxic contaminants or substances. Such standards shall be based on the best available endangerment assessment evidence and the best available treatment technology or methodology. The word "standards" as used in this part 2 and section 25-1-109 (1)(h) means standards reasonably designed to promote and protect the public health.
2. Minimum general sanitary standards for the quality of water supplied to the public shall be no more stringent than the drinking water standards promulgated pursuant to the federal "Safe Drinking Water Act", if such standards exist. If no standards have been promulgated pursuant to the federal "Safe Drinking Water Act" regarding the permissible concentration of any contaminant or any substance in drinking water, the department may recommend to the water quality control commission for promulgation minimum general sanitary standards regarding such contaminant or substance.
3. 1. The department shall annually establish and revise a priority list of contaminants or substances for which standards may be considered and shall submit said list to the water quality control commission for review and approval.
   2. The priority list of contaminants or substances, together with the department's evaluation of the considerations listed in this paragraph (b), shall be submitted to the water quality control commission for review and approval. The priority list shall be prepared according to a ranking process that incorporates the following considerations:
      1. The actual presence of a contaminant or substance in a drinking water supply system or the relative imminence of threat of contamination of a drinking water supply source;
      2. The identifiability of a potential pathway or continued pathway of contamination;
      3. The availability of analytical techniques for measuring and identifying the contaminant or substance in a reasonable manner;
      4. Sufficient available information concerning the contaminant or substance to allow an appropriate standard to be developed, including information on the health effects of the contaminant or substance as well as available treatment technology;
      5. The magnitude of potential health risks of the contaminant or substance at reasonably anticipated exposure levels, utilizing the same exposure considerations, criteria for health risk, and criteria for data availability which are used by the criteria and standards division of the office of drinking water, United States environmental protection agency, in establishing the federal drinking water priority list;
      6. The fact that the contaminant or substance will be the subject of a national primary drinking water regulation in the near future;
      7. An analysis of the environmental fate and transport mechanisms within relevant environmental media;
      8. Identification, characterization, and analysis of the populations and drinking water supplies at risk; and
      9. The level of effort and scope of work that will be necessary to develop sufficient data for the purpose of supporting an appropriate standard.
4. 1. Following the department's submission of recommended standards to the water quality control commission, the commission may promulgate standards for contaminants or substances that are not the subject of a standard set pursuant to the federal "Safe Drinking Water Act".
   2. In the promulgation of such standards, the water quality control commission shall find that the standards are necessary to protect public health and have a demonstrated medical, technological, and scientific basis and that:
      1. Based on credible medical and toxicological evidence that has been subjected to peer review, there exists a substantial risk to the public health;
      2. The analytical techniques for measuring and identifying the contaminant or substance are reasonably available;
      3. The adverse health effects posed by the contaminant or substance are known to a reasonable degree of scientific certainty; and
      4. Compliance with such standard is feasible utilizing the best technology or methodology which is generally available.
5. All acts, orders, and rules adopted by the state board of health under the authority of this part 2 prior to July 1, 2006, that were valid prior to said date and not otherwise subject to judicial review shall, to the extent that they are not inconsistent with said provisions, be deemed and held to be legal and valid in all respects, as though issued by the water quality control commission under the authority of this part 2. No provision of this part 2 shall be construed to validate any actions, orders, or rules that were not valid when adopted by the board of health prior to such date.

Source: L. 2003: Entire article added with relocations, p. 687, § 2, effective July 1. L. 2006: (2), (3)(a), IP(3)(b), (4)(a), and IP(4)(b) amended and (5) added, p. 1127, § 2, effective July 1.

Editor's note: This section is similar to former § 25-1-107 (2) as it existed prior to 2003.

25-1.5-203. Water - powers and duties of department - rules - repeal.

1. The department has, in addition to all other powers and duties imposed upon it by law, the powers and duties provided in this section as follows:
   1. Construction of community water facilities. To examine plans, specifications, and other related data pertaining to the proposed construction of any publicly or privately owned community water facilities submitted for review of sanitary engineering features prior to construction of such facilities;
   2. Quality of drinking water. (I) To adopt and enforce minimum general sanitary standards and regulations to protect the quality of drinking water supplied to the public, including the authority to require disinfection and treatment of such water.

      (II) Standards and regulations adopted pursuant to this paragraph (b) may also include such minimum standards and regulations as are necessary to assume enforcement of the federal "Safe Drinking Water Act" with regard to public water systems, including, but not limited to, requirements for:

      1. Review and approval by the department, prior to initiation of construction, of the technical plans and specifications, long-term financial plans, and operations and management plans for any new waterworks or technical plans and specifications for substantial modifications to existing waterworks. For the purposes of this subparagraph (II), "waterworks" means the facilities that are directly involved in the production, treatment, or distribution of water for public water systems, as defined in section 141.2 of the national primary drinking water regulations. The department shall approve those new or substantially modified waterworks it determines are capable of complying with the Colorado primary drinking water regulations.
      2. Maintenance of records by the supplier of water relating to the results of tests and procedures required by the standards and regulations, including filing periodic reports with the department;
      3. Public notification by the supplier of water, pursuant to the provisions of the federal "Safe Drinking Water Act";
      4. Granting exemptions and variances from the minimum general sanitary standards to allow appropriate time for compliance, when such procedure can be effected without seriously jeopardizing the public health.
   3. Exemption of public water systems. (I) To exempt a water supplier from any further documentation requirements for purposes of establishing that it does not meet the definition of a public water system and is not subject to the requirements of the federal "Safe Drinking Water Act", where such water supplier has provided to the department evidence of the following:

      (A) An ordinance, resolution, contractual provision, or other similarly enforceable enactment that prohibits connection to the system for the purpose of obtaining water for human consumption; and

      (B) Either an annual visual inspection of the water supply system for the purpose of determining the presence of any unauthorized connections to the water supply system, or an annual written survey of those individuals or entities with whom the supplier has a contractual relationship governing the uses to which such water is placed by the contracting parties.

      (II) Nothing in subparagraph (I) of this paragraph (c) shall be construed to eliminate from the provisions of the federal "Safe Drinking Water Act" any exclusion that may otherwise be available under federal law or regulation.

   4. Lab certification program for testing drinking water. (I) To establish and maintain a laboratory certification program for the purpose of ensuring competent testing of drinking water as required by the federal "Safe Drinking Water Act" and minimum general sanitary standards as set forth in section 25-1.5-202. Certification procedures shall, at a minimum, include water supply evaluation verification and on-site inspections. The laboratory certification program shall consist of certification levels which correspond to the testing capability and capacity of each laboratory. In addition to certifying laboratories for contaminants regulated as of May 11, 1988, the department shall adopt and implement a schedule for certifying sufficient laboratory capacity for the testing and analysis of contaminants for which reference methods are available and which are scheduled to be regulated under the federal "Safe Drinking Water Act".

      (II) Upon request, the department shall refer a public water supplier to a laboratory, either the department's or one certified by the department, which is determined to be equipped to perform the required testing and analysis on a timely basis.

      (III) To facilitate an effective laboratory certification program, the department shall work with local public water suppliers toward creating and maintaining a centralized data base which:

      (A) Quantifies the current and expected demands for the monitoring, testing, and analysis of each supplier, grouped according to the size of the supply system, the source of its supply, and the requirements imposed on each supplier;

      (B) Includes an updated list of laboratories certified and available for the testing and analysis of specific contaminants; and

      (C) Tracks violations of drinking water standards for the purpose of facilitating an exchange among public water suppliers in addressing similar problems posed by specific contaminants.

   5. Drinking water list. To cooperate with and assist the Colorado water resources and power development authority in the administration of the drinking water revolving fund created by section 37-95-107.8, C.R.S., including adopting rules governing the drinking water project eligibility list provided by said section and modifications to the eligibility list for submission to the general assembly, and to take any other actions necessary to assist the authority in complying with the requirements of the federal "Safe Drinking Water Act".
   6. Public school lead testing grant program. (I) To establish a grant program to pay for testing to detect the presence and concentration of lead in drinking water in a public school, as that term is defined in section 22-1-101 (1), that receives its drinking water from a public water system; except that, for purposes of this section, "public school" includes: A public school district; a charter school, as that term is defined in section 22-30.5-103 (2), including an institute charter school, as that term is defined in section 22-30.5-502 (6); and a board of cooperative services, as that term is defined in section 22-5-103 (2). The department may specify testing protocols and guidelines and may provide technical assistance, as necessary and feasible, to applicants and grant recipients regarding the grant application, sampling guidance, sampling plan review, and communication guidance. The commission may adopt rules to implement the grant program, which rules may include consideration of a public school's ability to pay for testing in administering the program.

      (II) In administering the program, the department shall prioritize grant recipients in the following order: The oldest public elementary schools; the oldest public schools that are not elementary schools; and all other public schools. For purposes of this subsection (1)(f)(II), an "elementary school" means a public school that includes any or all of the following: Preschool, kindergarten, and grades one through five. The department may also develop and apply secondary criteria as established through rules promulgated by the commission. A public school that is subject to the federal lead and copper rule, 40 CFR 141, subpart I, or has already tested or is in the process of testing its drinking water for lead is not eligible for a grant pursuant to this subsection (1)(f).

      (III) The department shall apply its best efforts to complete all testing and analysis by June 30, 2020.

      (IV) A public school that receives a grant pursuant to this subsection (1)(f) shall either enter into a contract that requires compliance with the department's testing protocols to have the testing conducted or follow the department's testing protocols and provide the test samples to the department's laboratory or a laboratory certified by the department that is equipped to perform the required testing and analysis on a timely basis. The public school shall provide the test results to its local public health agency, its supplier of water, its school board, and the department.

      (V) The department shall use money from the water quality improvement fund created in section 25-8-608 (1.5) as authorized by section 25-8-608 (1.7)(d) to implement this subsection (1)(f).

      (VI) Notwithstanding section 24-1-136 (11)(a)(I), the department shall annually report by February 1 of each year until February 1, 2021, to the general assembly's committees of reference with jurisdiction over public health regarding:

      (A) The number, types, names, and locations of public schools that have applied for grants pursuant to this subsection (1)(f);

      (B) The number of grants that have been issued; the individual amounts and total amount of grant money awarded; and the number, types, names, and locations of public schools that received the grants;

      (C) A summary of the test results; and

      (D) Any legislative proposals that the department believes to be warranted that would provide financial assistance to public schools to facilitate the testing for or remediation of high lead levels in drinking water.

      (VII) This subsection (1)(f) is repealed, effective September 1, 2021.

Source: L. 2003: Entire article added with relocations, p. 689, § 2, effective July 1. L. 2017: (1)(f) added, (HB 17-1306), ch. 399, p. 2078, § 2, effective June 8.

Editor's note: This section is similar to former § 25-1-107 (1)(r), (1)(x)(I), (1)(x)(II), (1)(x.2), (1)(x.5), and (1)(gg) as they existed prior to 2003.

Cross references: For the short title ("Safe Water in Schools Act") in HB 17-1306, see section 1 of chapter 399, Session Laws of Colorado 2017.

25-1.5-204. Inspection for violations of minimum general sanitary standards relating to quality of drinking water.

1. Upon presentation of proper credentials, authorized inspectors of the department may enter and inspect, at any reasonable time and in a reasonable manner, any property, premises, or place for the purpose of investigating any actual, suspected, or potential violations of minimum general sanitary standards adopted pursuant to section 25-1.5-202. Samples of drinking water may be obtained by such inspectors, and a portion of any samples to be used as evidence in an enforcement action shall be left with the owner, operator, or person in charge of the premises. A copy of the results of any analysis of such sample shall be furnished promptly to the owner, operator, or person in charge.
2. If such entry or inspection is denied or not consented to, the department is empowered to and shall obtain, from the district or county court for the judicial district or county in which such property, premises, or place is located, a warrant to enter and inspect said property, premises, or place. The said district and county courts of the state are empowered to issue such warrants upon a proper showing of the need for such entry and inspection, and a copy of any inspection report shall be provided the court within a reasonable time after making the inspection.

Source: L. 2003: Entire article added with relocations, p. 691, § 2, effective July 1.

Editor's note: This section is similar to former § 25-1-107 (1)(x)(III) as it existed prior to 2003.

25-1.5-205. Advice to other entities.

The department may advise municipalities, utilities, institutions, organizations, and individuals concerning the methods or processes believed best suited to provide the protection or purification of water to meet minimum general sanitary standards adopted pursuant to section 25-1.5-202.

Source: L. 2003: Entire article added with relocations, p. 691, § 2, effective July 1.

Editor's note: This section is similar to former § 25-1-107 (1)(x)(IV) as it existed prior to 2003.

25-1.5-206. Applicability.

1. Except as otherwise provided in the federal "Safe Drinking Water Act", the provisions of this part 2 shall apply to each public water system in this state; except that the provisions of this part 2 shall not apply to a public water system that:
   1. Consists only of distribution and storage facilities (and does not have any collection and treatment facilities);
   2. Obtains all of its water from, but is not owned or operated by, a public water system to which such regulations apply;
   3. Does not sell water to any person;
   4. Does not authorize incidental use of untreated water; and
   5. Is not a carrier that conveys passengers in interstate commerce; or
   6. Prohibits, through ordinance, resolution, or other enforceable enactment, the use of its system, or connections thereto, for the delivery of water to the public for human consumption, except to the extent that such user is a public water system subject to the provisions of this part 2.

Source: L. 2003: Entire article added with relocations, p. 691, § 2, effective July 1.

Editor's note: This section is similar to former § 25-1-107 (1)(x)(VII) as it existed prior to 2003.

25-1.5-207. Damages and injunctive relief to prevent or abate release of contaminants in water.

1. 1. Except as provided in section 25-1-114.1 (3), any political subdivision or public water system which stores, releases, carries, conveys, supplies, or treats water for human consumption may bring suit to collect damages and for injunctive relief, in addition to all remedies otherwise available to prevent or abate any release or imminent release of contaminants or substances which, in water withdrawn for use, results or would likely result in:
      1. A violation, at the point where the contaminant or substance enters or would enter the intake of the water treatment system of the same or another political subdivision or public water system, of any minimum general sanitary standard or regulation adopted pursuant to this part 2, and the existing treatment system cannot effectively treat the contaminant or substance in question so as to assure that treated water complies with such standard or regulation; or
      2. Significant impairment of the normal operational capability of a water treatment system which meets the applicable specifications of the department for water treatment; or
      3. Rendering the system's drinking water supply unfit for human consumption. Where there are no minimum general sanitary standards, water shall be deemed unfit for human consumption where it is shown that the risk of adverse human health effects from exposure to carcinogens in that water is greater than one times ten to the minus sixth power or greater than the acceptable levels of exposure to noncarcinogens as determined by the reference dose method.
   2. Such an action may be maintained against any person who owns or operates the source or sources of the release of the contaminants, but no such action may be maintained with regard to surface or underground agricultural return flows except as otherwise provided in the "Colorado Chemigation Act", article 11 of title 35, C.R.S. Damages, including the costs of any remedy ordered or approved by the court shall include, as appropriate, those incurred in providing an interim substitute drinking water supply and monitoring and responding to the release or imminent release of contaminants or substances.
2. Other remedies. Except as provided in this subsection (2), nothing in this section shall be construed to restrict or preempt any right which the state, the department, any public water system, or any other person may have under any other law to seek enforcement, in any court or in any administrative proceeding, of any provision of this section or any other relief regarding contamination of any drinking water supply. In addition, nothing in this section shall be construed to condition, restrict, or prevent any other civil or criminal actions which may be brought by the state or any political subdivision pursuant to any other state or federal statute or regulation or any local ordinance or regulation; except that, with respect to any release or substantial threat of release of a hazardous substance, pollutant, or contaminant addressed in pleadings or otherwise in a lawsuit brought pursuant to the federal "Comprehensive Environmental Response, Compensation and Liability Act of 1980", 42 U.S.C. sec. 9601 et seq., or by the terms and conditions of a remedial action plan, removal order, consent decree, or other order or decree entered or issued by a court or administrative body of competent jurisdiction pursuant to such federal act, any person or entity which is a defendant in such a lawsuit or is subject to the terms and conditions of such a remedial action plan, removal order, consent decree, or other order or decree, shall not be subjected with respect to the same release or substantial threat of release of a hazardous substance, pollutant, or contaminant to any suit, action, or liability pursuant to section 25-1-114.1 (3); nor shall such person or entity be subject to any suit, action, or liability initiated or prosecuted by a political subdivision or a public water system pursuant to this section with respect to any release or substantial threat of release of a hazardous substance, pollutant, or contaminant which has been addressed by relief granted, or by measures implemented or legally required to be implemented, pursuant to a lawsuit brought pursuant to such federal act or the terms and conditions of a remedial action plan, removal order, consent decree, or other order or decree entered or issued by a court or administrative body of competent jurisdiction pursuant to such federal act. Nothing in this section shall be construed to bar a political subdivision or public water system from seeking to recover pursuant to applicable law its damages which have been reasonably incurred for the protection of the human health if enforceable arrangements to pay such damages have not otherwise been made.

Source: L. 2003: Entire article added with relocations, p. 692, § 2, effective July 1.

Editor's note: This section is similar to former § 25-1-107 (1)(x)(VIII) as it existed prior to 2003.

25-1.5-208. Grant program for public water systems and domestic wastewater treatment works - small communities water and wastewater grant fund - rules.

1. The department has, in addition to all other powers and duties imposed upon it by law, the powers and duties provided in this section as follows:
   1. To assist suppliers of water that serve a population of not more than five thousand people with meeting their responsibilities with respect to protection of public health, the department, in the name of the state and to the extent that state funds are appropriated therefor, may enter into contracts with both governmental agencies and not-for-profit public water systems, as defined in section 25-1.5-201 (1), or with counties representing unincorporated areas that serve a population of not more than five thousand people, to grant moneys for the planning, design, and construction of public water systems.
   2. To assist domestic wastewater treatment works, as defined in section 25-8-103 (5), that serve a population of not more than five thousand people with meeting their responsibilities with respect to the protection of public health and water quality, the department, in the name of the state and to the extent that state funds are appropriated therefor, may enter into contracts with governmental agencies, or with counties representing unincorporated areas that serve a population of not more than five thousand people, to grant moneys for eligible projects as defined in section 25-8-701 (2).
   3. The department may use up to five percent of the appropriated funds for the administration and management of such project grants.
2. The water quality control commission shall promulgate rules for the administration of any appropriated grant moneys pursuant to this section and for prioritizing proposed public water systems and domestic wastewater treatment works based upon public health impacts and water quality protection. The department shall authorize grants based on water quality needs and public health-related problems. The commission shall promulgate a project categorization system for use in determining the relative priority of proposed projects. The department shall review applications for state funds and may approve only those applications that are consistent with the project categorization system.
3. During the grant application process, the department shall seek from the division of local government in the department of local affairs a fiscal analysis of the applying entity to determine financial need. Based upon its fiscal analysis, the division of local government shall issue or deny a certificate of financial need. If a certificate of financial need is issued, the department may authorize a state grant to the project in accordance with the project prioritization adopted by the department.
4. 1. There is hereby created in the state treasury the small communities water and wastewater grant fund, referred to in this subsection (4) as the "fund". The fund shall consist of moneys transferred pursuant to section 39-29-109 (2)(a)(III), C.R.S., and any other moneys transferred to the fund by the general assembly. The fund shall be used only for grants made pursuant to this section. All income derived from the deposit and investment of the moneys in the fund shall be credited to the fund. At the end of each fiscal year, all unexpended and unencumbered moneys in the fund shall remain in the fund and shall not revert to the general fund or to any other fund.
   2. The revenues in the fund are continuously appropriated to the department for the purposes of this section.
   3. Notwithstanding subsection (4)(a) of this section, on June 30, 2020, the state treasurer shall transfer five million six hundred thousand dollars from the small communities water and wastewater grant fund to the general fund.

Source: L. 2003: Entire article added with relocations, p. 693, § 2, effective July 1. L. 2006: (2) amended, p. 1128, § 3, effective July 1. L. 2009: (1)(a) and (2) amended and (4) added, (SB 09-165), ch. 183, p. 803, § 1, effective April 22. L. 2014: (1)(a) and (2) amended and (1)(a.5) added, (SB 14-025), ch. 9, p. 92, § 1, effective August 6. L. 2020: (4)(c) added, (HB 20-1406), ch. 178, p. 812, § 11, effective June 29.

Editor's note: This section is similar to former § 25-1-107 (1)(x)(IX) as it existed prior to 2003.

25-1.5-209. Drinking water fee - drinking water cash fund.

1. Effective July 1, 2007, the division may assess an annual fee upon public water systems, and all such fees shall be in accordance with the following schedule:
   1. Category 01 Community surface water systems

      Subcategory 1 Population from 25 - 250 $ 75

      Subcategory 2 Population from 251 - 500 $ 100

      Subcategory 3 Population from 501 - 1,000 $ 310

      Subcategory 4 Population from 1,001 - 3,300 $ 465

      Subcategory 5 Population from 3,301 - 10,000 $ 865

      Subcategory 6 Population from 10,001 - 30,000 $ 1,850

      Subcategory 7 Population from 30,001 - 100,000 $ 4,940

      Subcategory 8 Population from 100,001 - 200,000 $ 9,270

      Subcategory 9 Population from 200,001 - 500,000 $ 15,450

      Subcategory 10 Population greater than 500,000 $ 21,630

   2. Category 02 Community groundwater systems

      Subcategory 1 Population from 25 - 250 $ 75

      Subcategory 2 Population from 251 - 500 $ 100

      Subcategory 3 Population from 501 - 1,000 $ 220

      Subcategory 4 Population from 1,001 - 3,300 $ 310

      Subcategory 5 Population from 3,301 - 10,000 $ 680

      Subcategory 6 Population from 10,001 - 30,000 $ 1,545

      Subcategory 7 Population greater than 30,001 $ 4,450

   3. Category 03 Community-purchased surface water or groundwater systems

      Subcategory 1 Population from 25 - 250 $ 75

      Subcategory 2 Population from 251 - 500 $ 100

      Subcategory 3 Population from 501 - 1,000 $ 155

      Subcategory 4 Population from 1,001 - 3,300 $ 250

      Subcategory 5 Population from 3,301 - 10,000 $ 490

      Subcategory 6 Population from 10,001 - 30,000 $ 865

      Subcategory 7 Population greater than 30,001 $ 2,470

   4. Category 04 Nontransient, noncommunity surface water systems

      Subcategory 1 Population from 25 - 250 $ 75

      Subcategory 2 Population from 251 - 500 $ 100

      Subcategory 3 Population from 501 - 1,000 $ 280

      Subcategory 4 Population from 1,001 - 3,300 $ 400

      Subcategory 5 Population from 3,301 - 10,000 $ 620

      Subcategory 6 Population from 10,001 - 30,000 $ 1,670

      Subcategory 7 Population greater than 30,001 $ 4,450

   5. Category 05 Nontransient, noncommunity groundwater systems

      Subcategory 1 Population from 25 - 250 $ 75

      Subcategory 2 Population from 251 - 500 $ 100

      Subcategory 3 Population from 501 - 1,000 $ 155

      Subcategory 4 Population from 1,001 - 3,300 $ 245

      Subcategory 5 Population from 3,301 - 10,000 $ 495

      Subcategory 6 Population from 10,001 - 30,000 $ 1,360

      Subcategory 7 Population greater than 30,001 $ 3,650

   6. Category 06 Nontransient, noncommunity-purchased surface water or groundwater systems

      Subcategory 1 Population from 25 - 250 $ 75

      Subcategory 2 Population from 251 - 500 $ 100

      Subcategory 3 Population from 501 - 1,000 $ 125

      Subcategory 4 Population from 1,001 - 3,300 $ 185

      Subcategory 5 Population from 3,301 - 10,000 $ 325

      Subcategory 6 Population from 10,001 - 30,000 $ 805

      Subcategory 7 Population greater than 30,001 $ 1,980

   7. Category 07 Transient, noncommunity surface water systems

      Subcategory 1 Population from 25 - 250 $ 75

      Subcategory 2 Population from 251 - 500 $ 100

      Subcategory 3 Population from 501 - 1,000 $ 245

      Subcategory 4 Population from 1,001 - 3,300 $ 310

      Subcategory 5 Population from 3,301 - 10,000 $ 555

      Subcategory 6 Population from 10,001 - 30,000 $ 620

      Subcategory 7 Population greater than 30,001 $ 3,960

   8. Category 08 Transient, noncommunity groundwater systems

      Subcategory 1 Population from 25 - 250 $ 75

      Subcategory 2 Population from 251 - 500 $ 100

      Subcategory 3 Population from 501 - 1,000 $ 125

      Subcategory 4 Population from 1,001 - 3,300 $ 185

      Subcategory 5 Population from 3,301 - 10,000 $ 495

      Subcategory 6 Population from 10,001 - 30,000 $ 535

      Subcategory 7 Population greater than 30,001 $ 2,970

   9. Category 09 Transient, noncommunity-purchased surface water or groundwater systems

      Subcategory 1 Population from 25 - 250 $ 75

      Subcategory 2 Population from 251 - 500 $ 100

      Subcategory 3 Population from 501 - 1,000 $ 110

      Subcategory 4 Population from 1,001 - 3,300 $ 125

      Subcategory 5 Population from 3,301 - 10,000 $ 310

      Subcategory 6 Population from 10,001 - 30,000 $ 435

      Subcategory 7 Population greater than 30,001 $1,490

2. All fees collected pursuant to this section shall be transmitted to the state treasurer, who shall credit them to the drinking water cash fund, which fund is hereby created in the state treasury. Moneys so collected shall be annually appropriated by the general assembly to the department for allocation to the division of administration to operate the drinking water program established in this part 2. The general assembly shall review expenditures of such moneys to assure that they are used only for such purposes. All interest earned on the investment or deposit of moneys in the cash fund and all unappropriated or unencumbered moneys in the cash fund shall remain in the cash fund and shall not revert to the general fund or any other fund at the end of any fiscal year or any other time. Any funds remaining from fees collected prior to the repeal of former section 25-1.5-209, as it existed prior to July 1, 2005, shall be transmitted to the state treasurer, who shall credit the same to the cash fund.

Facility Categories and Subcategories for

Drinking Water Fees Annual Fees

Source: L. 2003: Entire section added with relocations, p. 1502, § 2, effective May 1. L. 2007: Entire section RC&RE, p. 1455, § 3, effective July 1.

Editor's note: Prior to the recreation of this section in 2007, subsection (4) provided for the repeal of this section, effective July 1, 2005. (See L. 2003, p. 1502 .)

25-1.5-210. Best practices for residential rooftop precipitation collection.

1. With respect to the use of a rain barrel, as defined in section 37-96.5-102 (1), C.R.S., to collect precipitation from a residential rooftop pursuant to section 37-96.5-103, C.R.S., the department, to the extent practicable within existing resources, shall develop best practices for:
   1. Nonpotable usage of the collected precipitation; and
   2. Disease and pest vector control.
2. If the department develops best practices in accordance with subsection (1) of this section, the department shall:
   1. Post the best practices on the department's website; and
   2. Inform the state engineer of the best practices so that the state engineer can either post or link to the department's best practices on the state engineer's website.

Source: L. 2016: Entire section added, (HB 16-1005), ch. 161, p. 511, § 2, effective August 10.

25-1.5-301. Definitions.

As used in this part 3, unless the context otherwise requires:

1. "Administration" means assisting a person in the ingestion, application, inhalation, or, using universal precautions, rectal or vaginal insertion of medication, including prescription drugs, according to the legibly written or printed directions of the attending physician or other authorized practitioner or as written on the prescription label and making a written record thereof with regard to each medication administered, including the time and the amount taken, but "administration" does not include judgment, evaluation, or assessments or the injections of medication, the monitoring of medication, or the self-administration of medication, including prescription drugs and including the self-injection of medication by the resident. "Administration" also means ingestion through gastrostomy tubes or naso-gastric tubes, if administered by a person authorized pursuant to sections 25.5-10-204 (2)(j) and 27-10.5-103 (2)(i), C.R.S., as part of residential or day program services provided through service agencies approved by the department of health care policy and financing and supervised by a licensed physician or nurse.
2. "Facility" means:
   1. The correctional facilities under the supervision of the executive director of the department of corrections including, but not limited to:
      1. Those facilities provided for in article 20 of title 17, C.R.S.;
      2. Minimum security facilities provided for in article 25 of title 17, C.R.S.;
      3. Jails provided for in article 26 of title 17, C.R.S.;
      4. Community correctional facilities and programs provided for in article 27 of title 17, C.R.S.;
      5. The regimented inmate discipline and treatment program provided for in article 27.7 of title 17, C.R.S.; and
      6. The Denver regional diagnostic center provided for in article 40 of title 17, C.R.S.;
   2. Institutions for juveniles provided for in part 4 of article 2 of title 19, C.R.S.;
   3. Assisted living residences as defined in section 25-27-102 (1.3);
   4. Adult foster care facilities provided for in section 26-2-122.3, C.R.S.;
   5. Alternate care facilities provided for in section 25.5-6-303 (3), C.R.S.;
   6. Residential child care facilities for children as defined in section 26-6-102 (33), C.R.S.;
   7. Secure residential treatment centers as defined in section 26-6-102 (35), C.R.S.;
   8. Facilities that provide treatment for persons with mental health disorders as defined in section 27-65-102, except for those facilities that are publicly or privately licensed hospitals;
   9. All services funded through and regulated by the department of health care policy and financing pursuant to article 6 of title 25.5, C.R.S., in support of persons with intellectual and developmental disabilities; and
   10. Adult day care facilities providing services in support of persons as defined in section 25.5-6-303 (1), C.R.S.
3. "Monitoring" means:
   1. Reminding the resident to take medication or medications at the time ordered by the physician or other authorized licensed practitioner;
   2. Handing a resident a container or package of medication lawfully labeled previously for the individual resident by a licensed physician or other authorized licensed practitioner;
   3. Visual observation of the resident to ensure compliance;
   4. Making a written record of the resident's compliance with regard to each medication, including the time taken; and
   5. Notification to the physician or other authorized practitioner if the resident refuses to or is not able to comply with the physician's or other practitioner's instructions with regard to the medication.
4. "Qualified manager" means a person who:
   1. Is the owner or operator of the facility or a supervisor designated by the owner or operator of the facility for the purpose of implementing section 25-1.5-303; and
   2. Has completed training in the administration of medications pursuant to section 25-1.5-303 or is a licensed nurse pursuant to part 1 of article 255 of title 12, a licensed physician pursuant to article 240 of title 12, or a licensed pharmacist pursuant to article 280 of title 12. Every unlicensed person who is a "qualified manager" within the meaning of this subsection (4) shall successfully complete a competency evaluation pertaining to the administration of medications.
5. "Self-administration" means the ability of a person to take medication independently without any assistance from another person.

Source: L. 2003: Entire article added with relocations, p. 694, § 2, effective July 1. L. 2006: (2)(d) and (2)(i) amended, p. 2014, § 86, effective July 1; (2)(g) amended, p. 1405, § 64, effective August 7. L. 2010: (2)(g) amended, (SB 10-175), ch. 188, p. 798, § 60, effective April 29. L. 2012: (4)(b) amended, (SB 12-1311), ch. 281, p. 1627, § 70, effective July 1. L. 2013: (1) and (2)(h) amended, (HB 13-1314), ch. 323, p. 1806, § 38, effective March 1, 2014. L. 2016: (2)(e) and (2)(f) amended, (SB 16-189), ch. 210, p. 770, § 59, effective June 6; (2)(h) and (4)(b) amended, (HB 16-1424), ch. 307, p. 1233, § 1, effective July 1. L. 2017: (2)(g) amended, (SB 17-242), ch. 263, p. 1324, § 187, effective May 25. L. 2019: (4)(b) amended, (HB 19-1172), ch. 136, p. 1697, § 143, effective October 1. L. 2020: (4)(b) amended, (HB 20-1183), ch. 157, p. 701, § 56, effective July 1.

Editor's note: This section is similar to former § 25-1-107 (1)(ee)(I.5)(A), (1)(ee)(I.5)(B), (1)(ee)(II), (1)(ee)(II.5), and (1)(ee)(III)(A) as they existed prior to 2003.

Cross references: For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.

25-1.5-302. Administration of medications - powers and duties of department - criminal history record checks.

1. The department has, in addition to all other powers and duties imposed upon it by law, the power to establish and maintain by rule a program for the administration of medications in facilities. The department of human services, the department of health care policy and financing, and the department of corrections shall develop and conduct a medication administration program as provided in this part 3. A medication administration program developed pursuant to this subsection (1) must be conducted within the following guidelines:
   1. As a condition to authorizing or renewing the authorization to operate any facility that administers medications to persons under its care, the authorizing agency shall require that the facility have a staff member qualified pursuant to subsection (1)(b) of this section on duty at any time that the facility administers such medications and that the facility maintain a written record of each medication administered to each resident, including the date, time, and amount of the medication and the signature of the person administering the medication. Such record is subject to review by the authorizing agency as a part of the agency's procedure in authorizing the continued operation of the facility. Notwithstanding any exemption enumerated in subsection (1)(b) of this section, any facility may establish a policy that requires a person authorized to administer medication to report to, be supervised by, or be otherwise accountable for the performance of such administration to a registered nurse as defined in section 12-255-104.
   2. Any individual who is not otherwise authorized by law to administer medication in a facility shall be allowed to perform such duties only after passing a competency evaluation. An individual who administers medications in facilities in compliance with the provisions of this part 3 shall be exempt from the licensing requirements of the "Colorado Medical Practice Act", the "Nurse and Nurse Aide Practice Act", and the laws of this state pertaining to possession of controlled substances as contained in article 280 of title 12, part 2 of article 80 of title 27, or the "Uniform Controlled Substances Act of 2013", article 18 of title 18.
2. 1. The department shall establish by rule the minimum requirements for course content, including competency evaluations, for medication administration and to determine compliance with the requirements for facilities licensed under this title.
   2. The department shall approve training entities for facilities licensed under this title and maintain a list of approved training entities. The department shall establish by rule the minimum requirements for training entities, including instructor qualifications and the approval process. Approved training entities shall provide the department with a list of all persons who have successfully completed a competency evaluation.
   3. Training entities shall also provide the department with any other pertinent information reasonably requested by the department pursuant to the department's obligation and authority under this section.
   4. The department shall publish and maintain a current list of all persons who have passed a competency evaluation from an approved training entity and paid the fee required by paragraph (e) of this subsection (2).
   5. The department shall set and collect a uniform fee for inclusion in the public competency listing. The department shall not include an individual on the public listing unless the individual has successfully completed a competency evaluation from an approved training entity and paid the fee established by the department. The revenue generated from the fee must approximate the direct and indirect costs incurred by the department in the performance of duties under this section.
3. The department of human services, the department of health care policy and financing, and the department of corrections may develop and approve minimum requirements for course content, including competency evaluations, for individuals who administer medications in facilities whose operation is authorized by those departments. A department that administers competency evaluations shall maintain a public list of individuals who have successfully completed the competency evaluation.
4. Repealed.
5. Repealed.
6. Repealed.
7. Repealed.
8. Each owner, operator, or supervisor of a facility who employs a person who is not licensed to administer medications shall conduct a criminal background check on each employee prior to employment or promotion to a position in which the person has access to medications. When the results of a fingerprint-based criminal history record check of an employee performed pursuant to this section reveal a record of arrest without a disposition, the owner, operator, or supervisor of the facility shall require that employee to submit to a name-based criminal history record check, as defined in section 22-2-119.3 (6)(d).
9. Every unlicensed person and qualified manager described in this section, as a condition of employment or promotion to a position in which he or she has access to medications, shall sign a disclosure statement under penalty of perjury stating that he or she never had a professional license to practice nursing, medicine, or pharmacy revoked in this or any other state for reasons directly related to the administration of medications.
10. A person who, on or before July 1, 2017, is authorized to administer medication pursuant to this section is not required to complete additional training but is otherwise subject to this section.

Source: L. 2003: Entire article added with relocations, p. 696, § 2, effective July 1. L. 2009: (7)(c) amended and (8) added, (SB 09-128), ch. 365, p. 1915, § 6, effective July 1. L. 2012: (1)(b) amended, (HB 12-1311), ch. 281, p. 1627, § 71, effective July 1. L. 2013: (1)(b) amended, (SB 13-250), ch. 333, p. 1940, § 62, effective October 1. L. 2016: IP(1), (1)(a), (3), and (8) amended and (9) and (10) added, (HB 16-1424), ch. 307, p. 1233, § 2, effective July 1; (2) amended, (HB 16-1424), ch. 307, p. 1235, § 3, effective July 1, 2017; (4)(b), (5)(b), (6)(b), and (7)(d) added by revision, (HB 16-1424), ch. 307, pp. 1235, 1238, §§ 3, 6. L. 2019: (8) amended, (HB 19-1166), ch. 125, p. 553, § 36, effective April 18; (1) amended, (HB 19-1172), ch. 136, p. 1698, § 144, effective October 1. L. 2020: (1)(b) amended, (HB 20-1183), ch. 157, p. 702, § 57, effective July 1.

25-1.5-303. Medication reminder boxes or systems - medication cash fund.

1. Medication reminder boxes or systems may be used if such containers have been filled and properly labeled by a pharmacist licensed pursuant to article 280 of title 12, a nurse licensed pursuant to part 1 of article 255 of title 12, or an unlicensed person trained pursuant to this section or filled and properly labeled through the gratuitous care by members of one's family or friends. Nothing in this section authorizes or shall be construed to authorize the practice of pharmacy, as defined in section 12-280-103 (39). An unlicensed person shall not fill and label medication reminder boxes pursuant to this section until the person has successfully completed a competency evaluation from an approved training entity or has been approved by an authorized agency, and no facility shall use an unlicensed person to perform such services unless the facility has a qualified manager to oversee the work of the unlicensed person or persons.
2. The department has, in addition to all other powers and duties imposed upon it by law, the powers and duties provided in this section to develop and implement rules with respect to the provisions in subsection (1) of this section concerning the administration of medication reminder boxes.
3. The executive directors of the departments that control the facilities defined in section 25-1.5-301 (2)(a) and (2)(b) may direct the unlicensed staff of any such facility to monitor medications in any part of any such facility. Administration of medications in any such facility shall be allowed only in those areas of any such facility that have a licensed physician or other licensed practitioner on duty. Notwithstanding other training requirements established in this section, the operator or administrator of every facility that hires an unlicensed person to administer medications pursuant to this section shall provide on-the-job training for such person, and all such unlicensed persons hired on or after July 1, 2017, shall be adequately supervised until they have successfully completed the training. The on-the-job training must be appropriate to the job responsibilities of each trainee. Facility operators and administrators shall require each unlicensed person who administers medication in the facility to pass a competency evaluation pursuant to section 25-1.5-302 (2) as a condition of employment in that facility. Facility operators and administrators shall document each unlicensed person's satisfactory completion of on-the-job training and passage of the competency evaluation in his or her permanent personnel file.
4. A person who self-administers medication is personally responsible for medication administration. No facility shall be responsible for observing or documenting the self-administration of medication. Compliance with the requirements for the training of unlicensed persons in medication administration pursuant to this section is not required when persons being cared for are self-administering.
5. 1. All fees collected pursuant to this section shall be transmitted to the state treasurer, who shall credit the same to the medication administration cash fund, which fund is hereby created.
   2. The general assembly shall make annual appropriations from the medication administration cash fund for expenditures of the department incurred in the performance of its duties under this section.
   3. Repealed.
   4. In accordance with section 24-36-114, C.R.S., all interest derived from the deposit and investment of the medication administration cash fund created in paragraph (a) of this subsection (5) shall be credited to the general fund.

Source: L. 2003: Entire article added with relocations, p. 697, § 2, effective July 1. L. 2009: (3) amended, (SB 09-128), ch. 365, p. 1914, § 5, effective July 1. L. 2012: (1) amended, (HB 12-1311), ch. 281, p. 1628, § 72, effective July 1. L. 2016: (1), (2), (3), and (5)(c) amended, (HB 16-1424), ch. 307, p. 1237, § 4, effective July 1. L. 2019: (1) amended, (HB 19-1172), ch. 136, p. 1698, § 145, effective October 1. L. 2020: (1) amended, (HB 20-1183), ch. 157, p. 702, § 58, effective July 1.

25-1.5-304. Repeal of part. (Repealed)

Source: L. 2003: Entire article added with relocations, p. 699, § 2, effective July 1. L. 2009: Entire section repealed, (SB 09-128), ch. 365, p. 1913, § 1, effective July 1.

Editor's note: Prior to its repeal in 2009, this section was similar to former § 25-1-107 (1)(ee)(VI) and (1)(ee)(VII) as they existed prior to 2003.

25-1.5-401. Legislative declaration.

1. The general assembly hereby finds and declares that:
   1. There is a shortage of qualified health care professionals in most areas of the state, particularly in rural and low-income communities;
   2. Lack of access to health care increases health inequities in Colorado and increases the overall cost of health care services;
   3. Communities designated as health professional shortage areas, medically underserved areas, or medically underserved populations may benefit from:
      1. Federal, state, and private programs that enhance reimbursement for medical services, provide grants for health service infrastructure, and create incentives for the placement of additional health care professionals in those communities; and
      2. The placement of physicians through federal waiver programs such as the national interest waiver program, the Conrad 30 J-1 visa waiver program, and the national health service corps; and
   4. Assessing the health service needs of the state and coordinating workforce programs to address those needs is an important strategy for increasing access to health services in Colorado.
2. The general assembly therefore finds that it is in the best interests of the citizens of the state of Colorado to create the primary care office within the department of public health and environment for the purpose of identifying the areas within the state that lack sufficient health care resources and coordinating available resources to maximize medical reimbursements, grants, and placements of health care professionals within those areas.

Source: L. 2013: Entire part added with relocations, (HB 13-1074), ch. 150, p. 479, § 1, effective August 7.

Editor's note: This section is similar to former § 25-20.5-601 as it existed prior to 2013.

25-1.5-402. Definitions.

As used in this part 4, unless the context otherwise requires:

1. "Conrad 30 J-1 visa waiver program" means the program established in 8 U.S.C. sec. 1184 (l)(1)(D)(ii), allowing foreign-trained physicians who meet certain criteria to practice in communities designated as medically underserved areas, medically underserved populations, or health professional shortage areas.
2. "Department" means the department of public health and environment, created in section 25-1-102.
3. "Executive director" means the executive director of the department.
4. "Health care professional" means a licensed physician, an advanced practice nurse registered pursuant to section 12-255-111, a mental health practitioner, a licensed physician assistant, or any other licensed health care provider for which the federal government authorizes participation in a federally matched state loan repayment program to encourage health care professionals to provide services in underserved communities.
5. "Health professional shortage area" has the same meaning as provided in 42 U.S.C. sec. 254e.
6. "Medically underserved area" means a medically underserved community as defined in 42 U.S.C. sec. 295p.
7. "Medically underserved population" has the same meaning as provided in 42 U.S.C. sec. 254b.
8. "National health service corps" means the program established in 42 U.S.C. sec. 254d.
9. "National interest waiver program" means the program established in 8 U.S.C. sec. 1153 (b)(2)(B)(ii) allowing foreign-trained physicians who meet certain criteria to practice in communities designated as medically underserved areas, medically underserved populations, or health professional shortage areas.
10. "State board" means the state board of health created in section 25-1-103.
11. "State-designated health professional shortage area" means an area of the state designated by the primary care office, in accordance with state-specific methodologies established by the state board by rule pursuant to section 25-1.5-404 (1)(a), as experiencing a shortage of health care professionals or behavioral health care providers.

Source: L. 2013: Entire part added with relocations, (HB 13-1074), ch. 150, p. 480, § 1, effective August 7. L. 2018: (11) added, (SB 18-024), ch. 222, p. 1411, § 2, effective July 1. L. 2019: (4) amended, (HB 19-1172), ch. 136, p. 1699, § 146, effective October 1.

Editor's note: This section is similar to former § 25-20.5-602 as it existed prior to 2013.

Cross references: For the legislative declaration in SB 18-024, see section 1 of chapter 222, Session Laws of Colorado 2018.

25-1.5-403. Primary care office - creation.

1. There is hereby created in the department the primary care office for the purpose of assessing and addressing unmet needs concerning health care professionals, resources, and infrastructure across the state. The executive director of the department, subject to the provisions of section 13 of article XII of the state constitution, shall appoint the director of the primary care office, who is the head of the office.
2. The primary care office and the director of the office shall exercise their powers and perform their duties and functions specified in this part 4 under the department as if the same were transferred to the department by a type 2 transfer, as such transfer is defined in the "Administrative Organization Act of 1968", article 1 of title 24, C.R.S.
3. The primary care office includes the Colorado health service corps advisory council created in section 25-1.5-504.

Source: L. 2013: Entire part added with relocations, (HB 13-1074), ch. 150, p. 481, § 1, effective August 7.

Editor's note: This section is similar to former § 25-20.5-603 as it existed prior to 2013.

25-1.5-404. Primary care office - powers and duties - rules.

1. The primary care office has, at a minimum, the following powers and duties:
   1. To assess the health care and behavioral health care professional needs of areas throughout the state and create and administer state-designated health professional shortage areas in accordance with state board rules adopted under this subsection (1)(a) establishing state-specific methodologies for designating areas experiencing a shortage of health care professionals or behavioral health care providers. The primary care office shall coordinate with the department of health care policy and financing in developing the health professional shortage area designation methodologies and in drafting rules under this subsection (1)(a).
   2. To apply to the United States department of health and human services, when appropriate, for designation of communities in the state as medically underserved areas, medically underserved populations, or health professional shortage areas or as any other designations necessary to participate in a federal program to address health care professional shortages;
   3. To maximize the placement of health care professionals who serve communities designated as medically underserved areas, medically underserved populations, or health professional shortage areas, or any other communities eligible for participation in a federal, state, or private program to address health care professional shortages, for the purpose of qualifying said communities for increased reimbursements, grants, and health care professional placements;
   4. To administer the Colorado health service corps pursuant to part 5 of this article;
   5. To administer or provide technical assistance to participants in applicable federal programs intended to address health care professional shortages, including the Conrad 30 J-1 visa waiver program, the national interest waiver program, and the national health service corps. The state board may promulgate rules as necessary for the administration of these programs and shall establish by rule application fees for the Conrad 30 J-1 visa waiver program and the national interest waiver program. The primary care office shall transfer the fee amounts collected to the state treasurer for crediting to the visa waiver program fund established in section 25-1.5-405.
   6. To seek and accept public or private gifts, grants, or donations to apply to the costs incurred in fulfilling the duties specified in this section and otherwise administering the programs within the office; and
   7. To administer nursing and health care professional faculty loan repayment pursuant to part 5 of this article.

Source: L. 2013: Entire part added with relocations, (HB 13-1074), ch. 150, p. 481, § 1, effective August 7. L. 2018: (1)(a) amended, (SB 18-024), ch. 222, p. 1411, § 3, effective July 1.

Editor's note: This section is similar to former § 25-20.5-604 as it existed prior to 2013.

Cross references: For the legislative declaration in SB 18-024, see section 1 of chapter 222, Session Laws of Colorado 2018.

25-1.5-405. Visa waiver program fund.

There is hereby created in the state treasury the visa waiver program fund, referred to in this section as the "fund", that consists of the application fees collected pursuant to section 25-1.5-404 (1)(e) and any additional moneys that the general assembly may appropriate to the fund. The moneys in the fund are subject to annual appropriation by the general assembly to the department for the direct and indirect costs incurred by the department in performing its duties under this part 4. Any moneys in the fund not expended for the purpose of this part 4 may be invested by the state treasurer as provided by law. All interest and income derived from the investment and deposit of moneys in the fund shall be credited to the fund. Any unexpended or unencumbered moneys remaining in the fund at the end of a fiscal year remain in the fund and shall not be credited or transferred to the general fund or another fund.

Source: L. 2013: Entire part added with relocations, (HB 13-1074), ch. 150, p. 482, § 1, effective August 7.

Editor's note: This section is similar to former § 25-20.5-605 as it existed prior to 2013.

25-1.5-406. School nurse grant program - creation - eligibility - award of grants - rules - report - legislative declaration - definitions.

1. 1. The general assembly finds that:
      1. School nurses play a vital role in a child's health and educational welfare in school, acting as a health care safety net for children;
      2. When a school nurse is in a school, fewer children are sent home sick or miss school, fewer children are sent to emergency rooms for asthma, fewer 911 calls are made, and teachers and principals have more time to teach and lead;
      3. School nurses are trained to handle medical emergencies and to provide advanced first aid, as well as to provide advanced care to children who depend on medical devices, medication, or medical interventions to remain in school;
      4. School nurses are also crucial to children's mental health and spend nearly one-third of their time on the mental health concerns of children, including referring children for critical mental health services; and
      5. In addition to providing services in schools, school nurses provide education and training to school staff, promoting healthy behaviors and creating a safe and healthy school environment for children, including children with chronic conditions such as asthma, diabetes, and severe allergies.
   2. The general assembly further finds that:
      1. Despite the demonstrated benefit to students and school staff of having school nurses in schools, according to the Colorado department of education, there are approximately only six hundred thirty school nurses in Colorado serving over nine hundred thousand school-aged children;
      2. On average, this requires one full-time school nurse to serve fifteen hundred students, with some nurses serving fewer students and some nurses serving up to three thousand students; and
      3. The number of school nurses serving students is determined by the school district and largely paid for from limited school district funding.
   3. Therefore, the general assembly declares that providing critical funding to increase children's access to school nurses is vital to the health and well-being of Colorado's school children.
2. As used in this section, unless the context otherwise requires:
   1. "Grant program" means the school nurse grant program created in subsection (3) of this section.
   2. "Local education provider" means a school district, other than a local college district, organized and existing pursuant to law; a board of cooperative services; a charter school authorized by a school district pursuant to part 1 of article 30.5 of title 22; or a charter school authorized by the state charter school institute pursuant to part 5 of article 30.5 of title 22.
   3. "Rural school district" means a school district in Colorado that the department of education, created in section 24-1-115, determines is rural, based on the geographic size of the school district and the distance of the school district from the nearest large, urbanized area.
   4. "School" means a public elementary, middle, junior high, or high school.
   5. "School nurse" means a registered nurse who holds a current nursing license through the department of regulatory agencies and who has applied for or holds a special services license from the department of education pursuant to article 60.5 of title 22.
   6. "Small rural school district" means a school district in Colorado that the department of education, created in section 24-1-115, determines is rural, based on the geographic size of the school district and the distance of the school district from the nearest large, urbanized area, and that enrolls fewer than one thousand two hundred students in kindergarten through twelfth grade.
3. There is created in the department the school nurse grant program to award grants on a five-year grant cycle to local education providers to increase the number of school nurses in Colorado public schools. The grant program shall be administered by the primary care office in the department. The state board may promulgate rules, as necessary, to implement the grant program.
4. 1. Except as provided in subsection (4)(b) of this section, a local education provider awarded a grant pursuant to this section shall use the grant money to hire a school nurse or nurses in the selected school or schools. The grant shall supplement, not supplant, a local education provider's funding for school nurse positions and student health care services existing prior to May 29, 2019.
   2. A small rural school district or rural school district awarded a grant pursuant to this section shall first make reasonable efforts to use the grant money to hire a school nurse for the selected school or schools. If a small rural school district or rural school district can demonstrate to the department that it is unable to find a school nurse to fill the school nurse position, the small rural school district or rural school district may use the grant money to contract with a local public health agency established pursuant to section 25-1-506, a federally qualified health center as defined in section 25-3-101 (2)(a)(III)(A), or other similar community health care provider, or a registered nurse, to provide health services to the selected school or schools. The person providing health services must meet or exceed the academic and professional qualifications of a school nurse.
5. In applying for a grant, in addition to complying with the application process and requirements established by the department or state board rule, a local education provider seeking a grant shall include the following information in the grant application:
   1. The ratio of school nurses to the number of students served by the local education provider in all schools and in each school of the local education provider;
   2. The local education provider's number and percentage of schools that are eligible to receive money under Title I, part A of the federal "Elementary and Secondary Education Act of 1965", 20 U.S.C. sec. 6301 et seq.;
   3. Whether a school district applicant is a small rural school district or rural school district;
   4. The school or schools in which the local education provider intends to use the grant money to hire a school nurse;
   5. The amount of money necessary to attract and retain a school nurse in the school or schools of the local education provider for the five-year grant cycle and whether the local education provider intends to supplement a grant with any additional money to hire the school nurse position or positions; and
   6. The local education provider's plan for continuing to fund the increases in school nursing services following expiration or nonrenewal of the grant.
6. 1. Subject to available appropriations, the state board shall award up to three million dollars annually in grants. Each grant has an initial term of one year and shall be renewed annually for an additional four years as long as a school nurse is retained in the grant-funded position and the local education provider continues to use the grant money for authorized purposes. The state board may fund more than one school nurse position per grant recipient. The amount of the grant must cover up to the cost of hiring a school nurse position or positions in the local education provider's selected school or schools.
   2. Subject to available appropriations, at the end of the initial five-year grant cycle and each subsequent five-year grant cycle, the department shall solicit and review grant applications, and the state board shall award new grants.
   3. The department shall review grant program applications and make recommendations to the state board concerning the award of grants. In awarding grants, the state board may establish by rule additional selection criteria but shall give preference to an applicant that:
      1. Is a small rural school district or rural school district; or
      2. Is eligible to receive money under Title I, part A of the federal "Elementary and Secondary Education Act of 1965", 20 U.S.C. sec. 6301 et seq.
7. The department may expend a portion of the grant money to offset the department's reasonable and necessary expenses in administering the grant program.
8. 1. In any fiscal year in which the general assembly makes an appropriation to the department for the grant program, each local education provider that receives a grant pursuant to the program shall provide information to the department on or before June 30 concerning the number of school nurse positions hired through the grant program, the number of students served through the school nurse position, an explanation of services provided by the school nurse, and the impact of the grant program-funded school nurse position on the local education provider and the students it serves.
   2. Notwithstanding the provisions of section 24-1-136 (11)(a)(I) to the contrary, on or before September 1, 2020, and on or before September 1 in each fiscal year thereafter in which the state board has awarded grants in the prior fiscal year, the department shall submit a report to the education and the health and insurance committees of the house of representatives and the education and the health and human services committees of the senate, or any successor committees, that includes, at a minimum, a summary of the information reported by grant recipients pursuant to subsection (8)(a) of this section.

Source: L. 2019: Entire section added, (HB 19-1203), ch. 325, p. 3000, § 1, effective May 29.

25-1.5-501. Legislative declaration.

1. The general assembly hereby finds that there are areas of Colorado that suffer from a lack of health care professionals or behavioral health care providers to serve, and a lack of nursing or other health care professional faculty to train health care professionals to meet, the medical and behavioral health care needs of communities. The general assembly further finds that the state needs to implement incentives to encourage health care professionals and behavioral health care providers to practice in these underserved areas and to encourage nursing faculty and other health care professional faculty to teach health care professionals.
2. It is therefore the intent of the general assembly in enacting this part 5 to create a state health service corps program that uses state money, federal money, when permissible, and contributions from communities and private sources to help repay the outstanding education loans that many health care professionals, behavioral health care providers, candidates for licensure, nursing faculty, and health care professional faculty hold. In exchange for repayment of loans incurred for the purpose of obtaining education in their chosen health care and behavioral health care professions, the health care professionals, behavioral health care providers, and candidates for licensure will commit to provide health care or behavioral health care services, as applicable, in communities with underserved health care or behavioral health care needs throughout the state, and the nursing and health care professional faculty will commit to provide a specified period of service in a qualified faculty position.
3. In addition, for purposes of increasing the availability of certified addiction counselors, it is the intent of the general assembly to create a scholarship program to provide scholarships to addiction counselors who, in exchange for receiving scholarships to assist them in obtaining the required education and training to be certified as an addiction counselor, commit to practice in a health professional shortage area for a specified period.

Source: L. 2013: Entire part added with relocations, (HB 13-1074), ch. 150, p. 482, § 1, effective August 7. L. 2018: Entire section amended, (SB 18-024), ch. 222, p. 1411, § 4, effective July 1.

Editor's note: This section is similar to former § 25-20.5-701 as it existed prior to 2013.

Cross references: For the legislative declaration in SB 18-024, see section 1 of chapter 222, Session Laws of Colorado 2018.

25-1.5-502. Definitions.

As used in this part 5, unless the context otherwise requires:

1. "Advisory council" means the Colorado health service corps advisory council created pursuant to section 25-1.5-504.

   (1.3) "Behavioral health care provider" means the following providers who provide behavioral health care services within their scope of practice:

   1. A licensed addiction counselor;
   2. A certified addiction counselor;
   3. A licensed professional counselor;
   4. A licensed clinical social worker;
   5. A licensed marriage and family therapist;
   6. A licensed psychologist;
   7. A licensed physician assistant with specific training in substance use disorders;
   8. An advanced practice nurse with specific training in substance use disorders, pain management, or psychiatric nursing; or
   9. A physician with specific board certification or training in addiction medicine, pain management, or psychiatry.

   (1.5) "Behavioral health care services" means services for the prevention, diagnosis, and treatment of, and the recovery from, mental health and substance use disorders.

   (1.7) "Candidate for licensure" means a person who:

   1. Is a candidate for a license as a licensed psychologist, clinical social worker, marriage and family therapist, licensed professional counselor, or addiction counselor;
   2. Has completed a master's degree or, for a psychologist licensure candidate, has completed a doctoral degree;
   3. Has not yet completed the supervised experience hours required for licensure pursuant to section 12-245-304 (1)(d), 12-245-404 (2)(c), 12-245-504 (1)(d), 12-245-604 (1)(d), or 12-245-804 (1)(g), as applicable; and
   4. Is or will be providing behavioral health care services.
2. "Colorado health service corps" means the loan repayment program created and operated pursuant to this part 5.
3. "Colorado health service corps fund" or "fund" means the Colorado health service corps fund created in section 25-1.5-506.
4. "Federally designated health professional shortage area" means a health professional shortage area as defined in 42 U.S.C. sec. 254e.
5. "Health care professional" means a licensed physician, an advanced practice nurse registered pursuant to section 12-255-111, a mental health practitioner, a licensed physician assistant, or any other licensed health care provider for which the federal government authorizes participation in a federally matched state loan repayment program to encourage health care professionals to provide services in underserved communities.
6. "Health care professional faculty member" means a person who has an advanced degree in a health care professional field and is employed in a qualified faculty position.

   (6.5) "Health professional shortage area" means a federally designated health professional shortage area or a state-designated health professional shortage area.

7. "National health service corps program" means the program established in 42 U.S.C. sec. 254d.
8. "Nursing faculty member" means a person who has an advanced degree in nursing and is employed in a qualified faculty position.
9. "Primary care office" means the primary care office created pursuant to part 4 of this article.
10. "Primary health services" means health services regarding family medicine, general practice, general internal medicine, pediatrics, general obstetrics and gynecology, oral health, or mental health that are provided by health care professionals.
11. "Qualified faculty position" means a part-time or full-time teaching position at an educational institution with accredited nursing or health care professional training programs, which position requires an advanced degree that meets national accreditation standards and is approved by the primary care office.
12. "Scholarship program" means the scholarship program for addiction counselors created in section 25-1.5-503.5.
13. "State-designated health professional shortage area" means an area of the state designated by the primary care office, in accordance with state-specific methodologies established by the state board by rule pursuant to section 25-1.5-404 (1)(a), as experiencing a shortage of health care professionals or behavioral health care providers.
14. "Underserved population" means any of the following:
    1. Individuals eligible for medical assistance under articles 4 to 6 of title 25.5;
    2. Individuals who are provided services by a behavioral health care provider and are either charged fees on a sliding scale based upon income or are served without charge.

Source: L. 2013: Entire part added with relocations, (HB 13-1074), ch. 150, p. 483, § 1, effective August 7. L. 2018: (1.3), (1.5), (1.7), (6.5), (12), (13), and (14) added, (SB 18-024), ch. 222, p. 1412, § 5, effective July 1. L. 2019: (1.7)(c) and (5) amended, (HB 19-1172), ch. 136, p. 1699, § 147, effective October 1.

Editor's note: This section is similar to former § 25-20.5-702 as it existed prior to 2013.

Cross references: For the legislative declaration in SB 18-024, see section 1 of chapter 222, Session Laws of Colorado 2018.

25-1.5-503. Colorado health service corps - program - creation - conditions.

1. 1. 1. The primary care office shall maintain and administer, subject to available appropriations, the Colorado health service corps. Subject to available appropriations, the Colorado health service corps shall provide loan repayment for certain eligible: (1) (a) (I) The primary care office shall maintain and administer, subject to available appropriations, the Colorado health service corps. Subject to available appropriations, the Colorado health service corps shall provide loan repayment for certain eligible:
         1. Health care professionals who provide primary health services;
         2. Nursing faculty or health care professional faculty members in qualified faculty positions; and
         3. Behavioral health care providers and candidates for licensure who provide behavioral health care services.
      2. Under the Colorado health service corps, subject to the limitations specified in subsection (2) of this section, upon entering into a loan contract the state may either:
         1. Make payments on the education loans of the health care professional, behavioral health care provider, candidate for licensure, nursing faculty member, or health care professional faculty member; or
         2. Agree to make an advance payment in a lump sum of all or part of the principal, interest, and related expenses of the education loans of health care professionals, behavioral health care providers, candidates for licensure, nursing faculty members, or health care professional faculty members, subject to the limitations specified in subsection (2) of this section.
      3. 1. In consideration for receiving repayment of all or part of his or her education loan, the health care professional shall agree to provide primary health services in health professional shortage areas in Colorado.
         2. In consideration for receiving repayment of all or part of his or her education loan, the behavioral health care provider or candidate for licensure shall agree to provide behavioral health care services in health professional shortage areas in Colorado.
      4. In consideration for receiving repayment of all or part of his or her education loan, the nursing or other health care professional faculty member must agree to serve two or more consecutive academic years in a qualified faculty position.
   2. Repayment of loans under the Colorado health service corps may be made using money in the Colorado health service corps fund. The primary care office is authorized to receive and expend gifts, grants, and donations or money appropriated by the general assembly for the purpose of implementing the Colorado health service corps. In administering the Colorado health service corps, the primary care office shall collaborate with appropriate partners as needed to maximize the federal money available to the state for state loan repayment programs through the federal department of health and human services. The selection of health care professionals, behavioral health care providers, candidates for licensure, nursing faculty members, and health care professional faculty members for participation in the Colorado health service corps is exempt from the competitive bidding requirements of the "Procurement Code", articles 101 to 112 of title 24.
   3. The following providers are not eligible for loan repayment through the Colorado health service corps:
      1. Health care professionals who are not practicing in primary care specialties or providing primary health services; and
      2. Behavioral health care providers and candidates for licensure who are not providing behavioral health care services.
   4. 1. As a condition of receiving a loan repayment through the Colorado health service corps, a health care professional or behavioral health care provider must enter into a contract pursuant to which the health care professional or behavioral health care provider agrees to practice for at least two years in a community that is located in a health professional shortage area. The health care professional or behavioral health care provider, as applicable, the primary care office, and the community employer with which the health care professional or behavioral health care provider is practicing must be parties to the contract.
      2. As a condition of receiving a loan repayment through the Colorado health service corps, a nursing faculty or health care professional faculty member must enter into a contract pursuant to which he or she agrees to serve at least two consecutive academic years or their equivalent in a qualified faculty position. The nursing faculty or health care professional faculty member, the primary care office, and the educational institution where the qualified faculty position is located must be parties to the contract.
      3. As a condition of receiving a loan repayment through the Colorado health service corps, a candidate for licensure must enter into a contract pursuant to which the candidate for licensure agrees to practice for at least two years after obtaining the license, plus an additional amount of time equivalent to the time spent obtaining the supervised experience hours required for licensure while participating in the program, in a community that is located in a health professional shortage area. The candidate for licensure, the primary care office, and the community employer with which the candidate for licensure is practicing must be parties to the contract.
2. Subject to available appropriations, the primary care office shall annually select health care professionals, behavioral health care providers, candidates for licensure, nursing faculty members, and health care professional members from the list provided by the advisory council pursuant to section 25-1.5-504 (5)(a) to participate in the Colorado health service corps.
3. The primary care office, after consulting with the advisory council and accredited health care professional training programs in the state, shall develop loan forgiveness criteria for nursing faculty and other health care professional faculty members. In determining whether to forgive the loan of a faculty member, the primary care office shall consider the following criteria:
   1. The faculty positions available at the educational institution at which the health care professional works;
   2. Documented recruiting efforts by the educational institution;
   3. The attributes of the educational or training program that are designed with the intent to address known shortages of health care professionals in Colorado;
   4. The type of programs offered at the educational institution, including associate, bachelor's, master's, or doctoral degrees in the health care professions, and the need for those programs in the state.
4. In soliciting private grants to fund faculty loan repayments, the primary care office shall give priority to soliciting grants to fund repayments of loans for nursing faculty.
5. 1. A health care professional participating in the Colorado health service corps shall not practice with a for-profit private group or solo practice or at a proprietary hospital or clinic.
   2. For a behavioral health care provider or candidate for licensure applying to participate in the Colorado health service corps, the advisory council shall prioritize behavioral health care providers and candidates for licensure who are practicing with a nonprofit or public employer. The advisory council may also consider for participation in the Colorado health service corps behavioral health care providers and candidates for licensure who are practicing with a for-profit employer, such as a private practice or other site, that provides services to an underserved population.
6. A contract for loan repayment entered into pursuant to this part 5 must not include terms that are more favorable to health care professionals, behavioral health care providers, or candidates for licensure than the most favorable terms that the secretary of the federal department of health and human services is authorized to grant under the national health services corps program. In addition, each contract must include penalties for breach of contract that are at least as stringent as those available to the secretary of the federal department of health and human services. In the event of a breach of contract for a loan repayment entered into pursuant to this part 5, the primary care office shall enforce the contract and collect any damages or other penalties owed.

Source: L. 2013: Entire part added with relocations, (HB 13-1074), ch. 150, p. 483, § 1, effective August 7. L. 2018: (1), (2), (5), and (6) amended, (SB 18-024), ch. 222, p. 1413, § 6, effective July 1.

Editor's note: This section is similar to former § 25-20.5-703 as it existed prior to 2013.

Cross references: For the legislative declaration in SB 18-024, see section 1 of chapter 222, Session Laws of Colorado 2018.

25-1.5-503.5. Scholarship program for addiction counselors - creation - eligibility - conditions.

1. Beginning in the 2018-19 state fiscal year, the primary care office shall maintain and administer a scholarship program to assist in increasing the population of certified addiction counselors providing behavioral health care services in health professional shortage areas. Subject to available appropriations, the primary care office shall award scholarships to help defray the education and training costs associated with obtaining certification as an addiction counselor or with progressing to a higher level of certification for applicants who agree to practice in a health professional shortage area for a specified period.
2. Under the scholarship program, subject to the limitations specified in this section, upon entering into a scholarship contract, the state may pay up to the full cost of educational materials and direct expenses associated with education and training required for certification as an addiction counselor or for progressing to a higher level of addiction counselor certification, which amount shall be paid to the academic institution or state-approved trainer where the addiction counselor student is enrolled or participating.
3. As a condition of receiving a scholarship award to assist with obtaining certification or a higher level of certification, an applicant must enter into a contract with the primary care office pursuant to which he or she agrees to serve at least six consecutive months in a community that is located in a health professional shortage area.
4. Subject to available appropriations, the primary care office shall annually select applicants from the list provided by the advisory council pursuant to section 25-1.5-504 (5)(b) for scholarship awards under this section.
5. For purposes of recommending scholarship awards, the advisory council shall prioritize addiction counselors who are practicing with a nonprofit or public employer. The advisory council may also consider for participation in the scholarship program addiction counselors who are practicing with a for-profit employer, such as a private practice or other site, that provides services to an underserved population.
6. In the event of a breach of contract for a scholarship entered into under this section, the primary care office shall enforce the contract and collect any damages or other penalties owed.

Source: L. 2018: Entire section added, (SB 18-024), ch. 222, p. 1416, § 7, effective July 1.

Cross references: For the legislative declaration in SB 18-024, see section 1 of chapter 222, Session Laws of Colorado 2018.

25-1.5-504. Colorado health service corps advisory council - creation - membership - duties.

1. There is hereby created in the primary care office the Colorado health service corps advisory council to review applications for participation in the Colorado health service corps and for scholarships under section 25-1.5-503.5 and to make recommendations to the primary care office pursuant to section 25-1.5-503 (2) and 25-1.5-503.5 (4).
2. The advisory council consists of fifteen members appointed by the governor as provided in this subsection (2). In appointing members of the advisory council, the governor shall ensure that the advisory council includes at least one representative from each of the following organizations:
   1. The commission on family medicine created pursuant to part 6 of article 1 of title 25.5;
   2. A nonprofit statewide membership organization that provides programs and services to enhance rural health care in Colorado;
   3. A membership organization representing federally qualified health centers in Colorado;
   4. A foundation that funds a health care professional loan forgiveness program in Colorado;
   5. An economic development organization in Colorado;
   6. A membership organization representing community behavioral health care providers;
   7. An advanced practice nurse in a faculty position at an educational institution with health care professional programs, who is licensed to practice in Colorado;
   8. A physician who has experience in rural health, safety net clinics, or health equity;
   9. A nurse who has experience in rural health, safety net clinics, or health equity;
   10. A mental health provider who has experience in rural health, safety net clinics, or health equity;
   11. An oral health provider who has experience in rural health, safety net clinics, or health equity;
   12. A physician who is a faculty member of a medical school in Colorado;
   13. A citizen representative who has knowledge in rural health, safety net clinics, or health equity;
   14. A membership organization representing substance use disorder service providers; and
   15. A licensed or certified addiction counselor who has experience in rural health, safety net clinics, or health equity.
3. 1. Members appointed to the advisory council may serve terms of three years.
   2. The governor may appoint the same person to serve as a member of the advisory council for consecutive terms.
4. 1. Advisory council members shall serve without compensation and without reimbursement for expenses.
   2. The primary care office shall provide staff assistance to the advisory council as necessary for the advisory council to complete the duties specified in this section.
5. 1. The advisory council shall review applications received from health care professionals, behavioral health care providers, candidates for licensure, nursing faculty members, and health care professional faculty members to participate in the Colorado health service corps. Subject to available appropriations and federal requirements concerning eligibility for federal loan repayment matching funds, the advisory council shall annually select health care professionals, behavioral health care providers, candidates for licensure, nursing faculty members, and health care professional faculty members to participate in the Colorado health service corps and shall forward its list of selected participants to the primary care office.
   2. The advisory council shall review applications received for participation in the scholarship program. Subject to available appropriations, the advisory council shall annually select addiction counselors to participate in the scholarship program and shall forward its list of selected participants to the primary care office.
6. Repealed.

Source: L. 2013: Entire part added with relocations, (HB 13-1074), ch. 150, p. 486, § 1, effective August 7. L. 2017: (6) repealed, (SB 17-137), ch. 139, p. 467, § 1, effective April 18; (2)(a) amended, (HB 17-1024), ch. 7, p. 22, § 3, effective August 9. L. 2018: (1), IP(2), (2)(l), and (5) amended and (2)(n) and (2)(o) added, (SB 18-024), ch. 222, p. 1417, § 8, effective July 1.

Editor's note: This section is similar to former § 25-20.5-704 as it existed prior to 2013.

Cross references: For the legislative declaration in SB 18-024, see section 1 of chapter 222, Session Laws of Colorado 2018.

25-1.5-505. Advisory council - report.

1. On or before December 1, 2011, and on or before December 1 every two years thereafter, the primary care office, with assistance from the advisory council, shall submit to the governor, the health and human services committee of the senate, the committees on health, insurance, and environment and on public health care and human services of the house of representatives, or any successor committees, a report that includes, at a minimum, the following information:
   1. A description of the health care professionals, behavioral health care providers, candidates for licensure, nursing faculty members, and health care professional faculty members participating in the Colorado health service corps program and the scholarship program;
   2. A description of the programmatic goals of the Colorado health service corps and the scholarship program, including the present status of and any barriers to meeting those goals;
   3. Existing efforts and potential future projects to overcome any barriers to meeting the programmatic goals of the Colorado health service corps and the scholarship program;
   4. An analysis of the effects of the Colorado health service corps program and the scholarship program on addressing the health care and behavioral health care needs of communities in Colorado;
   5. A summary of any assessment or evaluation of program performance conducted during the year; and
   6. A description of the nursing faculty or other health care professional faculty members participating in the Colorado health service corps and the educational institutions where the participants teach.
2. The department of public health and environment shall include the report required by this section as part of its "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act" hearing required by section 2-7-203.
3. The reporting requirement in this section is not subject to section 24-1-136 (11)(a)(I).

Source: L. 2013: Entire part added with relocations, (HB 13-1074), ch. 150, p. 488, § 1, effective August 7. L. 2018: Entire section amended, (SB 18-024), ch. 222, p. 1418, § 9, effective July 1.

Editor's note: This section is similar to former § 25-20.5-705 as it existed prior to 2013.

Cross references: For the legislative declaration in SB 18-024, see section 1 of chapter 222, Session Laws of Colorado 2018.

25-1.5-506. Colorado health service corps fund - created - acceptance of grants and donations - annual appropriation from marijuana tax cash fund.

1. The Colorado health service corps fund is hereby created in the state treasury, which fund consists of:
   1. All general fund money appropriated by the general assembly for the Colorado health service corps, the first five hundred thousand dollars of which shall be used solely for loan repayments for nursing faculty;
   2. Damages and penalties collected from breach of contract actions for loan repayment contracts; and
   3. For the 2016-17 fiscal year and each fiscal year thereafter, tobacco litigation settlement money transferred to the fund by the state treasurer pursuant to section 24-75-1104.5 (1.7)(n).
2. 1. The money in the fund, other than the money described in subsection (1)(c) of this section, is hereby continuously appropriated to the primary care office for the Colorado health service corps. Any money in the fund not expended for the purpose of this part 5 may be invested by the state treasurer as provided by law. All interest and income derived from the investment and deposit of money in the fund shall be credited to the fund. Any unexpended and unencumbered money remaining in the fund at the end of a fiscal year remains in the fund and shall not be credited or transferred to the general fund or another fund.
   2. The money described in subsection (1)(c) of this section is subject to annual appropriation by the general assembly to the primary care office for the Colorado health service corps.
3. The primary care office is authorized to receive contributions, grants, and services from public and private sources, and to expend public or private contributions and grants, to carry out the purposes of this part 5.
4. 1. For the 2018-19 fiscal year and each fiscal year thereafter, the general assembly shall appropriate two million five hundred thousand dollars from the marijuana tax cash fund created in section 39-28.8-501 to the primary care office to:
      1. Provide loan repayment for behavioral health care providers and candidates for licensure participating in the Colorado health service corps; and
      2. Award scholarships to addiction counselors participating in the scholarship program.
   2. Since behavioral health care providers, candidates for licensure, and addiction counselors provide behavioral health care services and treatment to people with substance use or mental health disorders, use of money in the marijuana tax cash fund is permitted under section 39-28.8-501 (2)(b)(IV)(C).

Source: L. 2013: Entire part added with relocations, (HB 13-1074), ch. 150, p. 489, § 1, effective August 7. L. 2016: (1)(c) amended, (HB 16-1408), ch. 153, p. 466, § 13, effective July 1. L. 2018: Entire section amended, (SB 18-024), ch. 222, p. 1419, § 10, effective July 1.

Editor's note: This section is similar to former § 25-20.5-706 as it existed prior to 2013.

Cross references: For the legislative declaration in SB 18-024, see section 1 of chapter 222, Session Laws of Colorado 2018.

25-1.5-601. Short title.

The short title of this part 6 is the "Uniform Emergency Volunteer Health Practitioners Act".

Source: L. 2017: Entire part added with relocations, (HB 17-1240), ch. 244, p. 1006, § 1, effective August 9.

Editor's note: This section is similar to former § 12-29.3-101 as it existed prior to 2017.

25-1.5-602. Definitions.

In this part 6:

1. "Disaster management agency" means the department of public health and environment.
2. "Disaster relief organization" means an entity that provides emergency or disaster relief services that include health or veterinary services provided by volunteer health practitioners and that:
   1. Is designated or recognized as a provider of those services pursuant to a disaster response and recovery plan adopted by an agency of the federal government or the disaster management agency; or
   2. Regularly plans and conducts its activities in coordination with an agency of the federal government or the disaster management agency.
3. "Emergency" means an event or condition that is an emergency, disaster, incident of bioterrorism, emergency epidemic, pandemic influenza, or other public health emergency under section 24-33.5-704.
4. "Emergency declaration" means a declaration of emergency issued by the governor pursuant to section 24-33.5-704.
5. "Emergency management assistance compact" means the interstate compact approved by congress by Pub.L. 104-321, 110 Stat. 3877, part 29 of article 60 of title 24.
6. "Entity" means a person other than an individual.
7. "Health facility" means an entity licensed under the laws of this or another state to provide health or veterinary services.
8. "Health practitioner" means an individual licensed under the laws of this or another state to provide health or veterinary services.
9. "Health services" means the provision of treatment, care, advice or guidance, or other services, or supplies, related to the health or death of individuals or human populations, to the extent necessary to respond to an emergency, including:

   (A) The following, concerning the physical or mental condition or functional status of an individual or affecting the structure or function of the body:

   1. Preventive, diagnostic, therapeutic, rehabilitative, maintenance, or palliative care; and
   2. Counseling, assessment, procedures, or other services;

      (B) Sale or dispensing of a drug, a device, equipment, or another item to an individual in accordance with a prescription; and

      (C) Funeral, cremation, cemetery, or other mortuary services.

10. "Host entity" means an entity operating in this state that uses volunteer health practitioners to respond to an emergency.
11. "License" means authorization by a state to engage in health or veterinary services that are unlawful without the authorization. The term includes authorization under the laws of this state to an individual to provide health or veterinary services based upon a national certification issued by a public or private entity.
12. "Person" means an individual, corporation, business trust, trust, partnership, limited liability company, association, joint venture, public corporation, government or governmental subdivision, agency, or instrumentality, or any other legal or commercial entity.
13. "Scope of practice" means the extent of the authorization to provide health or veterinary services granted to a health practitioner by a license issued to the practitioner in the state in which the principal part of the practitioner's services are rendered, including any conditions imposed by the licensing authority.
14. "State" means a state of the United States, the District of Columbia, Puerto Rico, the United States Virgin Islands, or any territory or insular possession subject to the jurisdiction of the United States.
15. "Veterinary services" means the provision of treatment, care, advice or guidance, or other services, or supplies, related to the health or death of an animal or to animal populations, to the extent necessary to respond to an emergency, including:
    1. Diagnosis, treatment, or prevention of an animal disease, injury, or other physical or mental condition by the prescription, administration, or dispensing of vaccine, medicine, surgery, or therapy;
    2. Use of a procedure for reproductive management; and
    3. Monitoring and treatment of animal populations for diseases that have spread or demonstrate the potential to spread to humans.
16. "Volunteer health practitioner" means a health practitioner who provides health or veterinary services, whether or not the practitioner receives compensation for those services. The term does not include a practitioner who receives compensation pursuant to a preexisting employment relationship with a host entity or affiliate that requires the practitioner to provide health services in this state, unless the practitioner is not a resident of this state and is employed by a disaster relief organization providing services in this state while an emergency declaration is in effect.

Source: L. 2017: Entire part added with relocations, (HB 17-1240), ch. 244, p. 1006, § 1, effective August 9.

Editor's note: This section is similar to former § 12-29.3-102 as it existed prior to 2017.

25-1.5-603. Applicability to volunteer health practitioners.

This part 6 applies to volunteer health practitioners registered with a registration system that complies with section 25-1.5-605 and who provide health or veterinary services in this state for a host entity while an emergency declaration is in effect.

Source: L. 2017: Entire part added with relocations, (HB 17-1240), ch. 244, p. 1008, § 1, effective August 9.

Editor's note: This section is similar to former § 12-29.3-103 as it existed prior to 2017.

25-1.5-604. Regulation of services during emergency.

1. While an emergency declaration is in effect, the disaster management agency, in consultation with the department of agriculture with regard to veterinary services, may limit, restrict, or otherwise regulate:
   1. The duration of practice by volunteer health practitioners;
   2. The geographical areas in which volunteer health practitioners may practice;
   3. The types of volunteer health practitioners who may practice; and
   4. Any other matters necessary to coordinate effectively the provision of health or veterinary services during the emergency.
2. An order issued pursuant to subsection (a) of this section may take effect immediately, without prior notice or comment, and is not a rule within the meaning of the "State Administrative Procedure Act", article 4 of title 24.
3. A host entity that uses volunteer health practitioners to provide health or veterinary services in this state shall:

   (1) Consult and coordinate its activities with the disaster management agency and, with regard to veterinary services, the department of agriculture, to the extent practicable to provide for the efficient and effective use of volunteer health practitioners; and

   (2) Comply with any laws other than this part 6 relating to the management of emergency health or veterinary services, including section 12-30-103, part 2 of article 30 of title 12, and articles 200 to 225 and 235 to 300 of title 12.

Source: L. 2017: Entire part added with relocations, (HB 17-1240), ch. 244, p. 1008, § 1, effective August 9. L. 2019: (c)(2) amended, (HB 19-1172), ch. 136, p. 1699, § 148, effective October 1.

Editor's note: This section is similar to former § 12-29.3-104 as it existed prior to 2017.

25-1.5-605. Volunteer health practitioner registration systems.

1. To qualify as a volunteer health practitioner registration system, a system must:
   1. Accept applications for the registration of volunteer health practitioners before or during an emergency;
   2. Include information about the licensure and good standing of health practitioners that is accessible by authorized persons;
   3. Be capable of confirming the accuracy of information concerning whether a health practitioner is licensed and in good standing before health services or veterinary services are provided under this part 6; and
   4. Meet one of the following conditions:
      1. Be an emergency system for advance registration of volunteer health-care practitioners established by a state and funded through the health resources services administration under section 319I of the "Public Health Service Act", 42 U.S.C. sec. 247d-7b, as amended;
      2. Be a local unit consisting of trained and equipped emergency response, public health, and medical personnel formed pursuant to section 2801 of the "Public Health Service Act", 42 U.S.C. sec. 300hh, as amended;
      3. Be operated by a:
         1. Disaster relief organization;
         2. Licensing board;
         3. National or regional association of licensing boards or health practitioners;
         4. Health facility that provides comprehensive inpatient and outpatient health-care services, including a tertiary care and teaching hospital; or
         5. Governmental entity; or

            (D) Be designated by the disaster management agency as a registration system for purposes of this part 6.

2. While an emergency declaration is in effect, the disaster management agency, a person authorized to act on behalf of the disaster management agency, or a host entity, may confirm whether volunteer health practitioners utilized in this state are registered with a registration system that complies with subsection (a) of this section. Confirmation is limited to obtaining identities of the practitioners from the system and determining whether the system indicates that the practitioners are licensed and in good standing.
3. Upon request of a person in this state authorized under subsection (b) of this section, or a similarly authorized person in another state, a registration system located in this state shall notify the person of the identities of volunteer health practitioners and whether the practitioners are licensed and in good standing.
4. A host entity is not required to use the services of a volunteer health practitioner even if the practitioner is registered with a registration system that indicates that the practitioner is licensed and in good standing.

Source: L. 2017: Entire part added with relocations, (HB 17-1240), ch. 244, p. 1009, § 1, effective August 9.

Editor's note: This section is similar to former § 12-29.3-105 as it existed prior to 2017.

25-1.5-606. Recognition of volunteer health practitioners licensed in other states.

1. While an emergency declaration is in effect, a volunteer health practitioner, registered with a registration system that complies with section 25-1.5-605 and licensed and in good standing in the state upon which the practitioner's registration is based, may practice in this state to the extent authorized by this part 6 as if the practitioner were licensed in this state.
2. A volunteer health practitioner qualified under subsection (a) of this section is not entitled to the protections of this part 6 if the practitioner is licensed in more than one state and any license of the practitioner is suspended, revoked, or subject to an agency order limiting or restricting practice privileges, or has been voluntarily terminated under threat of sanction.

Source: L. 2017: Entire part added with relocations, (HB 17-1240), ch. 244, p. 1010, § 1, effective August 9.

Editor's note: This section is similar to former § 12-29.3-106 as it existed prior to 2017.

25-1.5-607. No effect on credentialing and privileging.

1. In this section:
   1. "Credentialing" means obtaining, verifying, and assessing the qualifications of a health practitioner to provide treatment, care, or services in or for a health facility.
   2. "Privileging" means the authorizing by an appropriate authority, such as a governing body, of a health practitioner to provide specific treatment, care, or services at a health facility subject to limits based on factors that include license, education, training, experience, competence, health status, and specialized skill.
2. This part 6 does not affect credentialing or privileging standards of a health facility and does not preclude a health facility from waiving or modifying those standards while an emergency declaration is in effect.

Source: L. 2017: Entire part added with relocations, (HB 17-1240), ch. 244, p. 1010, § 1, effective August 9.

Editor's note: This section is similar to former § 12-29.3-107 as it existed prior to 2017.

25-1.5-608. Provision of volunteer health or veterinary services - administrative sanctions.

1. Subject to subsections (b) and (c) of this section, a volunteer health practitioner shall adhere to the scope of practice for a similarly licensed practitioner established by the licensing provisions, practice acts, or other laws of this state.
2. Except as otherwise provided in subsection (c) of this section, this part 6 does not authorize a volunteer health practitioner to provide services that are outside the practitioner's scope of practice, even if a similarly licensed practitioner in this state would be permitted to provide the services.
3. The disaster management agency may modify or restrict the health or veterinary services that volunteer health practitioners may provide pursuant to this part 6, and, with regard to emergencies that require only veterinary services, the department of agriculture may modify or restrict the veterinary services that volunteer health practitioners may provide pursuant to this part 6. An order under this subsection (c) may take effect immediately, without prior notice or comment, and is not a rule within the meaning of the "State Administrative Procedure Act", article 4 of title 24.
4. A host entity may restrict the health or veterinary services that a volunteer health practitioner may provide pursuant to this part 6.
5. A volunteer health practitioner does not engage in unauthorized practice unless the practitioner has reason to know of any limitation, modification, or restriction under this section or that a similarly licensed practitioner in this state would not be permitted to provide the services. A volunteer health practitioner has reason to know of a limitation, modification, or restriction or that a similarly licensed practitioner in this state would not be permitted to provide a service if:
   1. The practitioner knows the limitation, modification, or restriction exists or that a similarly licensed practitioner in this state would not be permitted to provide the service; or
   2. From all the facts and circumstances known to the practitioner at the relevant time, a reasonable person would conclude that the limitation, modification, or restriction exists or that a similarly licensed practitioner in this state would not be permitted to provide the service.
   3. Shall report any administrative sanctions imposed upon a practitioner licensed in another state to the appropriate licensing board or other disciplinary authority in any other state in which the practitioner is known to be licensed.
6. In addition to the authority granted by law of this state other than this part 6 to regulate the conduct of health practitioners, a licensing board or other disciplinary authority in this state:

   (1) May impose administrative sanctions upon a health practitioner licensed in this state for conduct outside of this state in response to an out-of-state emergency;

   (2) May impose administrative sanctions upon a practitioner not licensed in this state for conduct in this state in response to an in-state emergency; and

7. In determining whether to impose administrative sanctions under subsection (f) of this section, a licensing board or other disciplinary authority shall consider the circumstances in which the conduct took place, including any exigent circumstances, and the practitioner's scope of practice, education, training, experience, and specialized skill.

Source: L. 2017: Entire part added with relocations, (HB 17-1240), ch. 244, p. 1011, § 1, effective August 9.

Editor's note: This section is similar to former § 12-29.3-108 as it existed prior to 2017.

25-1.5-609. Relation to other laws.

1. This part 6 does not limit rights, privileges, or immunities provided to volunteer health practitioners by laws other than this part 6. Except as otherwise provided in subsection (b) of this section, this part 6 does not affect requirements for the use of health practitioners pursuant to the emergency management assistance compact.
2. The office of emergency management created in section 24-33.5-705, pursuant to the emergency management assistance compact, may incorporate into the emergency forces of this state volunteer health practitioners who are not officers or employees of this state, a political subdivision of this state, or a municipality or other local government within this state.

Source: L. 2017: Entire part added with relocations, (HB 17-1240), ch. 244, p. 1012, § 1, effective August 9.

Editor's note: This section is similar to former § 12-29.3-109 as it existed prior to 2017.

25-1.5-610. Rules.

The executive director of the department of public health and environment may promulgate rules to implement this part 6. In doing so, the executive director shall consult with and consider the recommendations of the department of agriculture with regard to veterinary services and the entity established to coordinate the implementation of the emergency management assistance compact and shall also consult with and consider rules promulgated by similarly empowered agencies in other states to promote uniformity of application of this part 6 and make the emergency response systems in the various states reasonably compatible.

Source: L. 2017: Entire part added with relocations, (HB 17-1240), ch. 244, p. 1012, § 1, effective August 9.

Editor's note: This section is similar to former § 12-29.3-110 as it existed prior to 2017.

25-1.5-611. Civil liability for volunteer health practitioners - vicarious liability.

A volunteer health practitioner's immunity from civil liability may be affected by section 13-21-115.5.

Source: L. 2017: Entire part added with relocations, (HB 17-1240), ch. 244, p. 1012, § 1, effective August 9.

Editor's note: This section is similar to former § 12-29.3-111 as it existed prior to 2017.

25-1.5-612. Workers' compensation coverage.

(Reserved)

25-1.5-613. Uniformity of application and construction.

In applying and construing this part 6, consideration must be given to the need to promote uniformity of the law with respect to its subject matter among states that enact it.

Source: L. 2017: Entire part added with relocations, (HB 17-1240), ch. 244, p. 1012, § 1, effective August 9.

Editor's note: This section is similar to former § 12-29.3-113 as it existed prior to 2017.

ARTICLE 2 VITAL STATISTICS

Editor's note: This article was numbered as article 8 of chapter 66, C.R.S. 1963. The substantive provisions of this article were repealed and reenacted in 1967, resulting in the addition, relocation, and elimination of sections as well as subject matter. For amendments to this article prior to 1967, consult the Colorado statutory research explanatory note beginning on page vii in the front of this volume.

Section

ARTICLE 3 HOSPITALS

Cross references: For the university of Colorado university hospital and the university of Colorado psychiatric hospital, see part 5 of article 21 of title 23 and article 22 of title 23; for the Colorado mental health institute at Pueblo, see article 93 of title 27; for health service districts, see §§ 32-1-1001 and 32-1-1003.

Section

PART 1 HOSPITALS

PART 2 MATERNITY HOSPITALS

PART 3 COUNTY HOSPITALS - ESTABLISHMENT

PART 4 STATE PLAN FOR IMPLEMENTATION OF FEDERAL ACT FOR THE CONSTRUCTION OF HEALTH FACILITIES

PART 5 CERTIFICATE OF PUBLIC NECESSITY

PART 6 HOSPITAL-ACQUIRED INFECTIONS DISCLOSURE

PART 7 COLORADO HOSPITAL REPORT CARD ACT

25-3-100.5. Definitions.

As used in this article 3, unless the context otherwise requires:

1. "Acute treatment unit" means a facility or a distinct part of a facility for short-term psychiatric care, which may include treatment for substance use disorders, that provides a total, twenty-four-hour, therapeutically planned and professionally staffed environment for persons who do not require inpatient hospitalization but need more intense and individual services than are available on an outpatient basis, such as crisis management and stabilization services.
2. "Department" means the department of public health and environment.
3. "Heart attack database" means a national registry designed for heart attack data.
4. "Joint commission" means an independent, nonprofit organization that accredits and certifies health care organizations and programs in the United States, or its successor entity.
5. "PCI center" means a hospital that performs percutaneous coronary intervention (PCI), commonly known as coronary angioplasty, for acute myocardial infarction.
6. "STEMI" means ST-elevation myocardial infarction.

Source: L. 2006: Entire section added, p. 1391, § 22, effective August 7. L. 2017: IP amended and (2) to (6) added, (HB 17-1246), ch. 214, p. 834, § 1, effective May 18; entire section amended, (SB 17-242), ch. 263, p. 1324, § 188, effective May 25.

Editor's note: Amendments to this section by SB 17-242 and HB 17-1246 were harmonized.

Cross references: For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.

25-3-101. Hospitals - health facilities - licensed - definitions.

1. [Editor's note: This version of subsection (1) is effective until July 1, 2022.] It is unlawful for any person, partnership, association, or corporation to open, conduct, or maintain any general hospital; hospital unit; freestanding emergency department as defined in section 25-1.5-114; psychiatric hospital; community clinic; rehabilitation hospital; convalescent center; community mental health center; acute treatment unit; facility for persons with developmental disabilities, as defined in section 25-1.5-103 (2)(c); nursing care facility; hospice care; assisted living residence, except an assisted living residence shall be assessed a license fee as set forth in section 25-27-107; dialysis treatment clinic; ambulatory surgical center; birthing center; home care agency; or other facility of a like nature, except those wholly owned and operated by any governmental unit or agency, without first having obtained a license from the department.

   (1) [ Editor's note: This version of subsection (1) is effective July 1, 2022. ] It is unlawful for any person, partnership, association, or corporation to open, conduct, or maintain any general hospital; hospital unit; freestanding emergency department as defined in section 25-1.5-114; psychiatric hospital; community clinic; rehabilitation hospital; convalescent center; behavioral health entity; community mental health center or acute treatment unit licensed as a behavioral health entity; facility for persons with developmental disabilities, as defined in section 25-1.5-103 (2)(c); nursing care facility; hospice care; assisted living residence, except an assisted living residence shall be assessed a license fee as set forth in section 25-27-107; dialysis treatment clinic; ambulatory surgical center; birthing center; home care agency; or other facility of a like nature, except those wholly owned and operated by any governmental unit or agency, without first having obtained a license from the department.

2. As used in this section, unless the context otherwise requires:
   1. 1. "Community clinic" means a health care facility that provides health care services on an ambulatory basis, is neither licensed as an on-campus department or service of a hospital nor listed as an off-campus location under a hospital's license, and meets at least one of the following criteria:
         1. Operates inpatient beds at the facility for the provision of extended observation and other related services for not more than seventy-two hours;
         2. Provides emergency services at the facility and is not otherwise required to obtain licensure as a freestanding emergency department in accordance with section 25-1.5-114; or
         3. Is not otherwise subject to health facility licensure under this section or section 25-1.5-103 but opts to obtain licensure as a community clinic in order to receive private donations, grants, government funds, or other public or private reimbursement for services rendered.
      2. "Community clinic" includes a prison clinic operated by the department of corrections.
      3. "Community clinic" does not include:
         1. A federally qualified health center, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4);
         2. A rural health clinic, as defined in section 1861 (aa)(2) of the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(2);
         3. A facility that functions only as an office for the practice of medicine or the delivery of primary care services by other licensed or certified practitioners; or
         4. A freestanding emergency department, as defined in and required to be licensed under section 25-1.5-114.
   2. "Hospital unit" means a physical portion of a licensed or certified general hospital, psychiatric hospital, maternity hospital, or rehabilitation hospital that is leased or otherwise occupied pursuant to a contractual agreement by a person other than the licensee of the host facility for the purpose of providing outpatient or inpatient services.
3. Nothing in this section shall be construed to require the licensing of individual services provided by a licensed or certified provider on its own premises.
4. A health care facility is not required to be licensed as a community clinic solely due to the facility's ownership status, corporate structure, or engagement of outside vendors to perform nonclinical management services. This section permits regulation of a physician's office only to the extent the office is a community clinic as defined in this section.

Source: L. 09: p. 411, § 1. C.L. § 1053. CSA: C. 78, § 133. CRS 53: § 66-4-1. C.R.S. 1963: § 66-4-1. L. 71: p. 631, § 1. L. 78: Entire section amended, p. 440, § 3, effective May 18. L. 83: Entire section amended, p. 1051, § 1, effective May 25. L. 84: (1) amended, p. 338, § 4, effective April 25. L. 94: (1) amended, p. 2750, § 404, effective July 1. L. 95: Entire section amended, p. 1023, § 2, effective July 1. L. 2002: (1) amended, p. 1329, § 16, effective July 1. L. 2006: (1) amended, p. 1391, § 23, effective August 7. L. 2008: (1) amended, p. 2233, § 2, effective August 5. L. 2011: (1) and (2) amended, (HB 11-1101), ch. 94, p. 277, § 2, effective April 8; (2)(a) amended, (HB 11-1323), ch. 265, p. 1198, § 2, effective June 2. L. 2012: (1) and (2)(a) amended and (4) added, (HB 12-1294), ch. 252, p. 1253, § 3, effective June 4. L. 2019: (1), (2)(a)(I)(B), and (2)(a)(III)(C) amended and (2)(a)(III)(D) added, (HB 19-1010), ch. 324, p. 2998, § 3, effective August 2; (1) amended, (HB 19-1237), ch. 413, p. 3641, § 12, effective July 1, 2022. L. 2020: (2)(a)(III)(A) amended, (SB 20-136), ch. 70, p. 287, § 22, effective September 14.

Editor's note: Amendments to subsection (1) by HB 19-1010 and HB 19-1237 were harmonized, effective July 1, 2022.

Cross references: For the legislative declaration contained in the 1994 act amending subsection (1), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration in the 2012 act amending subsections (1) and (2)(a) and adding subsection (4), see section 1 of chapter 252, Session Laws of Colorado 2012. For the legislative declaration in SB 20-136, see section 1 of chapter 70, Session Laws of Colorado 2020.

25-3-102. License - application - issuance - certificate of compliance required - rules - repeal.

1. 1. An applicant for a license described in section 25-3-101 shall apply to the department of public health and environment annually upon such form and in such manner as prescribed by the department; except that a community residential home shall make application for a license pursuant to section 25.5-10-214, C.R.S.
   2. The department has authority to administer oaths, subpoena witnesses or documents, and take testimony in all matters relating to issuing, denying, limiting, suspending, or revoking a license.
   3. The department shall issue licenses to applicants furnishing satisfactory evidence of fitness to conduct and maintain a health facility described in section 25-3-101 in accordance with this part 1 and the rules adopted by the department. The department shall not require, as satisfactory evidence of fitness, evidence as to whether an applicant has provided self declarations, affidavits, or other attestations as to its general compliance with statutory or regulatory licensing requirements. The department shall determine an applicant's fitness solely based on the specific fitness information or documentation submitted by the applicant upon the department's request or as otherwise acquired by the department through its own review or investigation of the applicant. The department may require the applicant to attest to the accuracy of the information provided as long as the attestation does not require the applicant's affirmation of its general compliance with statutory or regulatory licensing requirements. CAPS check information pursuant to section 26-3.1-111 (6)(a)(III) may be considered part of an applicant's evidence of fitness. The board may promulgate rules as necessary to implement this subsection (1)(c).
   4. The license expires one year after the date of issuance.
   5. 1. For a change of ownership, the department shall conduct a fitness review of a new owner based upon information compiled within the five years preceding the date of the application; except that the new owner shall disclose whether, within the ten years preceding the date of an application, the new owner:
         1. Has been convicted of a felony or misdemeanor involving moral turpitude;
         2. Had a state license or federal certification denied, revoked, or suspended by another jurisdiction;
         3. Had a civil judgment or criminal conviction against the new owner in a case brought by the federal, state, or local authorities that resulted from the operation, management, or ownership of a health facility or other entity related to substandard patient care or health care fraud.
      2. The new owner shall provide the information specified in subparagraph (I) of this paragraph (e) to the department regardless of whether action has been stayed during a judicial appeal or otherwise settled between the parties.
      3. The department may review an existing owner of a licensed health facility or entity only when the department has new information not previously available or disclosed that bears on the fitness of the existing owner to operate or maintain a licensed health facility or entity.
      4. A conversion of the health facility's or entity's legal structure, or the legal structure of an entity that has a direct or indirect ownership interest in the health facility or entity, is not a change of ownership unless the conversion also includes a transfer of at least fifty percent of the licensed facility's direct or indirect ownership interest to one or more new owners.
2. 1. In the licensing of a community mental health center, acute treatment unit, or clinic, satisfactory evidence that the applicant is in compliance with the standards and rules promulgated pursuant to section 27-66-102 is required for licensure.
   2. This subsection (2) is repealed, effective July 1, 2021.
3. 1. Notwithstanding any provision of law to the contrary, the department of public health and environment shall not issue or renew any license described in section 25-3-101 for a facility covered by section 25-1.5-103 (5) unless the department receives a certificate of compliance for the applicant's building or structure from the division of fire prevention and control in the department of public safety in accordance with part 12 of article 33.5 of title 24, C.R.S.
   2. The department of public health and environment shall take action on an application for licensure within thirty days after the date that the department receives from the applicant all of the necessary information and documentation required for licensure, including a certificate of compliance from the division of fire prevention and control.

Source: L. 09: p. 412, § 2. C.L. § 1054. CSA: C. 78, § 134. C.R.S. 53: § 66-4-2. C.R.S. 1963: § 66-4-2. L. 71: p. 631, § 2. L. 79: Entire section amended, p. 1094, § 3, effective July 1. L. 94: (1) amended, p. 2750, § 405, effective July 1. L. 95: (1) amended, p. 1023, § 3, effective July 1. L. 2006: (2) amended, p. 1391, § 24, effective August 7. L. 2010: (2) amended, (SB 10-175), ch. 188, p. 799, § 61, effective April 29. L. 2012: (1) amended, (HB 12-1294), ch. 252, p. 1254, § 4, effective June 4; (1) amended and (3) added, (HB 12-1268), ch. 234, p. 1025, § 2, effective July 1, 2013. L. 2013: (3)(a) amended, (HB 13-1300), ch. 316, p. 1688, § 75, effective August 7; (1)(a) amended, (HB 13-1314), ch. 323, p. 1807, § 39, effective March 1, 2014. L. 2019: (2) amended, (HB 19-1237), ch. 413, p. 3638, § 3, effective August 2. L. 2020: (1)(c) amended, (HB 20-1302), ch. 265, p. 1274, § 9, effective September 14; (1)(d) amended, (SB 20-113), ch. 19, p. 75, § 2, effective September 14.

Editor's note: Amendments to subsection (1) by House Bill 12-1268 and House Bill 12-1294 were harmonized, effective July 1, 2013.

Cross references: For the legislative declaration contained in the 1994 act amending subsection (1), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration in the 2012 act amending subsection (1), see section 1 of chapter 252, Session Laws of Colorado 2012. For the legislative declaration in SB 20-113, see section 1 of chapter 19, Session Laws of Colorado 2020.

25-3-102.1. Deemed status for certain facilities.

1. 1. In the licensing of an ambulatory surgical center following the issuance of initial licensure by the department of public health and environment, the voluntary submission of satisfactory evidence that the applicant is accredited by the joint commission, the American association for accreditation of ambulatory surgery facilities, inc., the accreditation association for ambulatory health care, the American osteopathic association, or any successor entities shall be deemed to meet certain requirements for license renewal so long as the standards for accreditation applied by the accrediting organization are at least as stringent as the licensure requirements otherwise specified by the department.
   2. 1. In the application for the renewal of a license for a health facility described in section 25-3-101, other than an ambulatory surgical center, the department of public health and environment shall deem health facilities that are currently accredited by an accrediting organization recognized by the federal centers for medicare and medicaid services as satisfying the requirements for renewal of the license.
      2. If the standards for national accreditation are less stringent than the state's licensure standards for a particular health facility, the department of public health and environment may conduct a survey that focuses on the more stringent state standards. Beginning one year after the department first grants deemed status to a health facility pursuant to this paragraph (b), the department may conduct validation surveys, based on a valid sample methodology, of up to ten percent of the total number of accredited health facilities in the industry, excluding hospitals. If the department conducts a validation survey of a health facility, the validation survey is in lieu of a licensing renewal survey that the health facility would have undergone if the health facility did not have deemed status pursuant to this paragraph (b).
      3. If the department of public health and environment takes an enforcement activity, as defined in section 25-1.5-103 (2)(b.5), against a health facility to which it has granted deemed status pursuant to this paragraph (b), the department may revoke the health facility's deemed status.
   3. Upon submission of a completed application for license renewal, the department of public health and environment shall accept proof of the accreditation in lieu of licensing inspections or other requirements. Nothing in this section exempts an accredited health facility from inspections or from other forms of oversight by the department as necessary to ensure public health and safety.
2. In determining fees otherwise payable by a health facility for license renewal, the department of public health and environment shall give due consideration to efficiencies and savings generated in connection with the deemed status process in subsection (1) of this section and shall specifically provide an appropriate credit or reduced fee to a health facility that achieves license renewal through deemed status.

Source: L. 2008: Entire section added, p. 1236, § 1, effective August 5. L. 2009: (1) amended, (SB 09-292), ch. 369, p. 1970, § 84, effective August 5. L. 2012: Entire section amended, (HB 12-1294), ch. 252, p. 1255, § 5, effective June 4.

Cross references: For the legislative declaration in the 2012 act amending this section, see section 1 of chapter 252, Session Laws of Colorado 2012.

25-3-102.5. Nursing facilities - consumer satisfaction survey - pilot survey.

1. 1. The department shall develop and implement a consumer satisfaction survey based on the results of the pilot survey implemented pursuant to paragraph (a.5) of this subsection (1). The pilot survey and the resulting consumer satisfaction survey shall be implemented to determine the level of satisfaction among residents and residents' families regarding the quality of care and quality of living in nursing facilities. "Nursing facility", as used in this section, means a nursing facility as defined in section 25.5-4-103 (14), C.R.S. The department shall appoint an advisory committee to develop the consumer satisfaction survey. The advisory committee shall include, but not be limited to, the state ombudsman, representatives of senior groups, representatives of the disabled community, representatives of providers of long term care services, and long term care consumers or their family members. The advisory committee shall develop recommendations for the development of an assessment tool for the consumer satisfaction survey and shall develop recommendations for the implementation of the pilot survey and the consumer satisfaction survey. The advisory committee shall ensure that a representative sample of participants are chosen and surveyed in a manner that will yield accurate and useful results. The department shall ensure that every nursing facility licensed by the department participates in the assessment of consumer satisfaction; except that any nursing facility that accepts exclusively private pay residents shall not be required to participate. Information about results of the most recent consumer satisfaction survey and how such survey was conducted shall be included by the facility in all informational materials provided to persons who inquire about the facility. The department shall assure confidentiality for residents during the survey process. The department shall make the results of consumer satisfaction surveys available to the public.
   2. 1. The department shall develop and implement a pilot consumer satisfaction survey to aid in the determination of the level of satisfaction among residents and residents' families regarding the quality of care and quality of living in nursing facilities. The pilot survey shall be used exclusively for the development of the consumer satisfaction survey to be implemented pursuant to paragraph (d) of this subsection (1) and shall not be used to penalize any participating facility. The pilot survey shall be used to assess:
         1. The validity of the questionnaire for use in the consumer satisfaction survey implemented pursuant to paragraph (d) of this subsection (1);
         2. The nursing facilities residents' cognition levels in order to determine the ability of the residents to complete the survey in a meaningful manner;
         3. The techniques employed to obtain the number of completed survey questionnaires needed to achieve a statistical validity of plus or minus ten percent on the final consumer satisfaction survey; and
         4. The survey data to ensure that such data is meaningful to consumers.
      2. The pilot survey shall involve the participation of no more than ten percent of all nursing facilities licensed by the department. The department shall select nursing facilities to participate in the pilot survey based on characteristics including, but not limited to, the rural or urban location of the facilities, and the cross-section of the resident population of the facilities. Facilities that volunteer to participate in the pilot survey shall be given priority in the selection process so long as the required characteristics are met.
      3. 1. The individual nursing facility results of the pilot survey shall be confidential and not made available to the public; except that each nursing facility shall be provided with the pilot survey results from its own facility.
         2. Aggregate statistical results of the pilot survey may be made available to the public.
         3. Repealed.
      4. Repealed.
   3. The consumer satisfaction survey shall be easy to understand so that each resident or resident's family member or representative who participates may fill out the survey unassisted; except that the department or its designated representative may assist a resident or resident's family with filling out the survey. Nursing facility volunteers and employees shall be prohibited from assisting participants with the completion of the survey. The names of the participants in the survey shall be kept confidential, and all surveys shall be returned directly to the department.
   4. Repealed.
   5. The department shall administer the consumer satisfaction survey based on the recommendations of the advisory committee in all licensed nursing facilities that are required to participate in accordance with paragraph (a) of this subsection (1). The department shall commence implementation of the survey on or before July 1, 2003. After the pilot survey is complete, the department shall evaluate the effectiveness of the pilot survey instruments, adopt any recommendations, and continue to survey all licensed facilities on a three-year cycle with one-third of the participating licensed nursing facilities completing the initial survey in one of the three years. Each participating licensed nursing facility shall perform a new consumer satisfaction survey every three years thereafter; except that the department may require, or a participating licensed nursing facility may request, that a new consumer satisfaction survey be performed more often if conditions warrant. If the licensed nursing facility requests such a survey, the department shall perform the survey if the licensed nursing facility pays the department for the costs associated with performing the survey. A licensed nursing facility may comment on the results of a consumer satisfaction survey and have such comments included in any publication or distribution of the results by the department.
   6. Hospice residents and their family members and transitional care unit residents and their family members, shall be exempt from participation in the pilot survey and consumer satisfaction survey conducted in each nursing facility.
   7. Nursing facilities shall release the name, address, and telephone number of each family member or party responsible for a nursing facility resident to the department for the sole use of conducting the pilot survey and the consumer satisfaction survey.
2. 1. The department shall respond to a complaint from a nursing facility resident or resident's family member or representative within five working days after receipt of the complaint and, for sixty days after the date the department received the complaint, the department shall update the complainant on the status of the complaint investigation at least every fourteen days until the complaint is resolved and an investigation is finalized. If the complaint is not resolved within sixty days after the date the department received the complaint, the department shall continue to update the complainant on the status of the complaint every thirty days until the complaint is resolved and an investigation report is resolved and an investigation is finalized. At the request of the complainant, the department shall not maintain such contact.
   2. 1. The state and local long-term care ombudsman, established pursuant to article 11.5 of title 26, C.R.S., in compliance with the federal "Older Americans Act of 1965", ("ombudsman") shall refer to the state department for investigation and resolution all complaints received by the ombudsman involving possible licensure violations in nursing homes that are exclusively private pay facilities.
      2. Information about the ombudsman, including the ombudsman's role in dealing with resident complaints and all contact information and telephone numbers for the ombudsman, shall be included in the information provided to a resident upon admission to a facility that is not a private pay facility.

Source: L. 2001: Entire section added, p. 1222, § 1, effective June 5. L. 2002: (1)(a) and (1)(d) amended and (1)(a.5), (1)(e), and (1)(f) added, p. 1924, § 1, effective June 7; (1)(a.5)(III)(C) repealed, p. 1935, § 4, effective July 1. L. 2004: (1)(c) repealed, p. 471, § 1, effective August 4. L. 2005: (1)(a.5)(IV) repealed, p. 279, § 12, effective August 8. L. 2006: (1)(a) amended, p. 2014, § 87, effective July 1.

Cross references: For the "Older Americans Act of 1965", see Pub.L. 89-73, codified at 42 U.S.C. § 3001 et seq.

25-3-103. License denial or revocation - provisional license - rules.

1. 1. The department of public health and environment may deny an application for a new or renewal license under this part 1 or revoke a license if the applicant or licensee has not satisfied the requirements of this part 1 or part 6 of this article and the rules of the department or the state board of health. If a license is denied or revoked, the department may grant the applicant or licensee a provisional license upon payment of a fee established by the state board of health by rule, subject to the limitations in paragraph (c) of this subsection (1). The provisional license is valid for no longer than ninety days and may be issued to allow the applicant or licensee time to comply with the requirements for a regular license. A second provisional license may be issued if the department determines it is necessary to effect compliance. The second provisional license must be issued for the same duration as the first provisional license upon payment of the fee established by the state board of health by rule, subject to the limitations in paragraph (c) of this subsection (1). No further provisional licenses may be issued for the then current year after the second issuance.
   2. The state board of health by rule or as otherwise provided by law may reduce the amount of the fee established pursuant to paragraph (a) of this subsection (1) if necessary pursuant to section 24-75-402 (3), C.R.S., to reduce the uncommitted reserves of the fund to which all or any portion of the fee is credited. After the uncommitted reserves of the fund are sufficiently reduced, the state board of health by rule or as otherwise provided by law may increase the amount of the fee as provided in section 24-75-402 (4), C.R.S.
   3. On or after June 4, 2012, the state board of health may increase the amount of a provisional license fee established pursuant to subsection (1)(a) of this section that is in effect on June 4, 2012, by an amount not to exceed the annual percentage change in the United States department of labor, bureau of labor statistics, consumer price index for Denver-Aurora-Lakewood for all urban consumers and all goods, or its applicable predecessor or successor index. Nothing in this subsection (1)(c) limits the ability of the state board of health to reduce the amount of a provisional license fee in effect on such date or to modify fees in accordance with subsection (1)(b) of this section as necessary to comply with section 24-75-402.
2. Upon a finding of reasonable compliance by an applicant holding a provisional license, a regular license shall be issued upon receipt of the regular license fee established pursuant to section 25-3-105.
3. No denial of a renewal license shall be lawful unless, before institution of such proceedings by the department of public health and environment, said department has given the licensee notice in writing of facts on conduct that may warrant denial, has afforded the applicant opportunity to submit written data, views, and arguments with respect to such facts on conduct, and, except in cases of deliberate and willful violation, has given the applicant a reasonable opportunity to comply with all lawful requirements for licensure.
4. No application for renewal of a license shall be denied by the department of public health and environment, and no previously issued license shall be revoked, suspended, annulled, limited, or modified until after a hearing as provided in section 24-4-105, C.R.S.
5. The department of public health and environment may suspend or revoke the license for the operation of a nursing care facility or intermediate care facility of any licensee convicted of violating any provision of section 26-1-127 or section 25.5-6-206 (8), C.R.S., if the department finds such suspension or revocation necessary to safeguard the rights of patients in the future. No license or permit shall thereafter be issued to any person so convicted, except upon a specific finding by the department that the rights of the patients will have adequate safeguards.

Source: L. 09: p. 412, § 3. C.L. § 1055. CSA: C. 78, § 135. CRS 53: § 66-4-3. C.R.S. 1963: § 66-4-3. L. 71: p. 632, § 3. L. 77: (5) added, p. 1357, § 5, effective June 19. L. 78: (5) amended, p. 270, § 83, effective May 23. L. 84: (2) amended, p. 1121, § 25, effective June 7. L. 91: (5) amended, p. 1856, § 14, effective April 11. L. 94: (1), (3), (4), and (5) amended, p. 2751, § 406, effective July 1. L. 95: (1) and (2) amended, p. 1024, § 4, effective July 1. L. 98: (1) and (2) amended, p. 1333, § 44, effective June 1. L. 2006: (1)(a) amended, p. 1574, § 2, effective June 2;(5) amended, p. 2015, § 88, effective July 1. L. 2007: (1) amended, p. 954, § 3, effective May 17. L. 2012: (1)(a) amended and (1)(c) added, (HB 12-1294) ch. 252, p. 1256, § 6, effective June 4. L. 2018: (1)(c) amended, (HB 18-1375), ch. 274, p. 1713, § 59, effective May 29.

Cross references: For the legislative declaration contained in the 1994 act amending subsections (1), (3), (4), and (5), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration in the 2012 act amending subsection (1)(a) and adding subsection (1)(c), see section 1 of chapter 252, Session Laws of Colorado 2012.

25-3-103.1. Health facilities general licensure cash fund.

1. All fees collected pursuant to this article shall be transmitted to the state treasurer, who shall credit the same to the health facilities general licensure cash fund, which fund is hereby created.
2. The general assembly shall make annual appropriations from the health facilities general licensure cash fund to partially reimburse the department of public health and environment for the direct and indirect costs of the department incurred in the performance of its duties under this article and for the purposes of section 25-1.5-103 (3.5). No appropriation shall be made out of the cash fund for expenditures incurred by the department pursuant to section 25-1.5-103 (1)(a)(II) in carrying out duties relating to health facilities wholly owned and operated by a governmental unit or agency.

Source: L. 95: Entire section added, p. 1024, § 5, effective July 1. L. 2003: (2) amended, p. 709, § 37, effective July 1. L. 2008: (2) amended, p. 1948, § 2, effective June 2.

25-3-103.5. Nondiscrimination - hospital surgical privileges - hospital rules and regulations.

1. The bylaws of any hospital licensed pursuant to the provisions of part 3 of this article or established pursuant to section 32-1-1003, C.R.S., which does not limit staff privileges to employees or contracting physicians of such hospital, shall include provisions for the use of the facility by, and staff privileges for, duly licensed doctors of medicine, osteopathy, dentistry, and podiatry within the scope of their respective licenses. Such bylaws shall not discriminate on the basis of the staff member's holding a degree of doctor of medicine, doctor of osteopathy, doctor of dental science, or doctor of podiatric medicine within the scope of their respective licensure. Provision shall be made in the bylaws for the right to pursue and practice full surgical privileges for holders of a degree of doctor of medicine, doctor of osteopathy, doctor of dental science, or doctor of podiatric medicine within the scope of their respective licensure. Such rights and privileges may be limited or restricted upon the basis of an individual practitioner's demonstrated training, experience, current competence, professional ethics, health status, or failure to abide by the hospital's rules, regulations, and procedures.
2. Nothing in this section shall be construed to require a hospital to offer a specific service or services not otherwise offered or to buy, construct, or renovate facilities, to purchase equipment, hire additional staff, or to comply with other requirements of law concerning its planning, financing, or operation. If a health service is offered, the hospital shall not discriminate between persons holding a degree of doctor of medicine, doctor of osteopathy, or doctor of podiatric medicine who are authorized by law to perform such services.
3. A hospital may require the coadmittance by a medical doctor or doctor of osteopathy for any patient admitted for surgical treatment by a podiatrist or dentist. The responsibility for obtaining such coadmittance shall be that of the podiatrist or dentist admitting said patient and not of the hospital. Patients admitted for podiatric or dental care shall receive the same basic medical appraisal as patients admitted for other services. Such appraisal shall include an admission history and physical examination by a medical doctor, doctor of osteopathy, or qualified, hospital-credentialed and -privileged podiatrist, who is either on the medical staff or approved by the medical staff of such hospital. The findings of such appraisal shall be recorded on the patient's medical record. The admitting podiatrist or dentist shall be responsible for that part of the history and examination that is related to podiatry or dentistry. The medical doctor or doctor of osteopathy shall be responsible for the treatment of any medical problem that may be present on admission or arise during hospitalization of such podiatric or dental patient. Such doctor shall evaluate the general medical condition of the podiatric or dental patient and determine, after consultation if necessary, the overall risk of the pending surgical treatment to the patient's health.
4. Within one hundred eighty days after May 25, 1983, the governing body of every hospital subject to the provisions of part 3 of this article or established pursuant to section 32-1-1003, C.R.S., which does not limit staff privileges to employees or contracting physicians of such hospital, shall provide in its bylaws reasonable standards and procedures to be applied by such hospital and its staff in considering and acting upon applications for staff membership or privileges by a person holding a Colorado license to practice as a doctor of medicine, doctor of osteopathic medicine, podiatrist, or dentist in conformance with the requirements of any national accrediting body to which the hospital subscribes. Such standards and procedures shall be available for public inspection and shall be based on an applicant's individual training, experience, current competence, professional ethics, health status, and the hospital's rules of professional conduct applied equally to all persons holding a Colorado license to practice as a doctor of medicine, doctor of osteopathic medicine, podiatrist, or dentist.
5. Hospital rules and regulations shall be reasonable, necessary, and applied in good faith equally and in a nondiscriminatory manner to all staff members, or applicants seeking to become staff members, holding a degree of doctor of medicine, doctor of osteopathic medicine, doctor of dental science, or doctor of podiatric medicine.

Source: L. 83: Entire section added, p. 1053, § 1, effective May 25. L. 2007: (3) amended, p. 436, § 1, effective August 3.

25-3-103.7. Employment of physicians - when permissible - conditions - definitions.

1. For purposes of this section:
   1. "Community mental health center" means a community mental health center, as defined in section 25-1.5-103 (2), that is currently licensed and regulated by the department pursuant to the department's authority under section 25-1.5-103 (1)(a).
   2. "Department" means the department of public health and environment.
   3. "Federally qualified health center" or "FQHC" has the same meaning as set forth in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4).
   4. "Health care facility" means a hospital, hospice, community mental health center, federally qualified health center, school-based health center, rural health clinic, PACE organization, or long-term care facility.
   5. "Hospice" means an entity that administers services to a terminally ill person utilizing palliative care or treatment and that is currently licensed and regulated by the department pursuant to the department's authority under section 25-1.5-103 (1)(a).
   6. "Hospital" means a hospital currently licensed or certified by the department pursuant to the department's authority under section 25-1.5-103 (1)(a).
   7. "Long-term care facility" means:
      1. A nursing facility as defined by section 25.5-4-103, C.R.S., and licensed pursuant to section 25-1.5-103;
      2. An assisted living residence as defined by section 25-27-102 and licensed pursuant to section 25-27-103; or
      3. An independent living facility or a residence for seniors that provides assistance to its residents in the performance of their daily living activities.
   8. "PACE organization" means an organization providing a program of all-inclusive care for the elderly pursuant to section 25.5-5-412, C.R.S.
   9. "Physician" means a person duly licensed to practice under article 220, 240, or 290 of title 12.
   10. "Rural health clinic" shall have the same meaning as set forth in section 1861 (aa)(2) of the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(2).
   11. "School-based health center" shall have the same meaning as set forth in section 25-20.5-502.
2. 1. A health care facility may employ physicians, subject to the limitations set forth in subsections (3) to (6) of this section. The employment of physicians at a long-term care facility may be direct or through a separate entity authorized to conduct business in this state that has common or overlapping ownership as an affiliate or subsidiary of an entity, including a foreign entity, that owns, controls, or manages the long-term care facility, subject to the limitations set forth in subsections (3) to (6) of this section.
   2. Nothing in this subsection (2) allows any person who is not licensed pursuant to article 240 of title 12 to practice or direct the practice of medicine at a long-term care facility.
3. Nothing in this section shall be construed to allow any health care facility that employs a physician to limit or otherwise exercise control over the physician's independent professional judgment concerning the practice of medicine or diagnosis or treatment or to require physicians to refer exclusively to the health care facility or to the health care facility's employed physicians. Any health care facility that knowingly or recklessly so limits or controls a physician in such manner or attempts to do so shall be deemed to have violated standards of operation for the particular type of health care facility and may be held liable to the patient or the physician, or both, for such violations, including proximately caused damages. Nothing in this section shall be construed to affect any health care facility's decisions with respect to the availability of services, technology, equipment, facilities, or treatment programs, or as requiring any health care facility to make available to patients or physicians additional services, technology, equipment, facilities, or treatment programs.
4. Nothing in this section shall be construed to allow a health care facility that employs a physician to offer the physician any percentage of fees charged to patients by the health care facility or other financial incentive to artificially increase services provided to patients.
5. The medical staff bylaws or policies or the policies of any health care facility that employs physicians shall not discriminate with regard to credentials or staff privileges on the basis of whether a physician is an employee of, a physician with staff privileges at, or a contracting physician with, the health care facility. Any health care facility that discriminates with regard to credentials or staff privileges on the basis of whether a physician is an employee of, a physician with staff privileges at, or a contracting physician with, the health care facility shall be deemed to have violated standards of operation for the particular type of health care facility and may be held liable to the physician for such violations, including proximately caused damages. This subsection (5) shall not affect the terms of any contract or written employment arrangement that provides that the credentials or staff and clinical privileges of any practitioner are incident to or coterminous with the contract or employment arrangement or the individual's association with a group holding the contract.
6. When applying for initial facility licensure and upon each application for license renewal, every health care facility licensed or certified by the department that employs a physician shall report to the department the number of physicians on the health care facility's medical staff. The report shall separately identify the number of those physicians who are employed by the health care facility under separate contract to the health care facility and independent of the health care facility.
7. The medical staff bylaws or policies or the policies of any health care facility that employs physicians shall contain a procedure by which complaints by physicians alleging a violation of subsection (3), (4), or (5) of this section may be heard and resolved, which procedure shall ensure that the due process rights of the parties are protected. A physician who believes he or she has been the subject of a violation of subsection (3), (4), or (5) of this section has a right to complain and request review of the matter pursuant to such procedure.
8. Nothing in this section shall preclude a physician or a patient from seeking other remedies available to the physician or to the patient at law or in equity.

Source: L. 93: Entire section added, p. 721, § 2, effective May 6. L. 94: (1)(a) and (6) amended, p. 2751, § 407, effective July 1. L. 95: (1)(a), (3), and (5) amended and (7) and (8) added, p. 977, § 2, effective July 1. L. 2003: (1)(a) amended, p. 709, § 38, effective July 1. L. 2007: (1) to (7) amended, p. 452, § 1, effective April 11. L. 2008: Entire section amended, p. 932, § 1, effective August 5. L. 2009: (1)(d) and (6) amended and (1)(f.5) added, (HB 09-1004), ch. 26, p. 115, § 1, effective March 19. L. 2011: (1)(d) and (2) amended and (1)(f.3) added, (SB 11-084), ch. 112, p. 346, § 2, effective August 10. L. 2012: (6) amended, (HB 12-1052), ch. 228, p. 1006, § 4, effective July 1. L. 2019: (1)(g) and (2)(b) amended, (HB 19-1172), ch. 136, p. 1700, § 151, effective October 1. L. 2020: (1)(c) amended, (SB 20-136), ch. 70, p. 288, § 23, effective September 14.

Cross references: For the legislative declaration contained in the 1994 act amending subsections (1)(a) and (6), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration contained in the 1995 act amending subsections (1)(a), (3), and (5) and adding subsections (7) and (8), see section 1 of chapter 201, Session Laws of Colorado 1995. For the legislative declaration in the 2012 act amending subsection (6), see section 1 of chapter 228, Session Laws of Colorado 2012. For the legislative declaration in SB 20-136, see section 1 of chapter 70, Session Laws of Colorado 2020.

25-3-104. Reports.

Any person, partnership, association, or corporation maintaining any hospital or other facility for the treatment or care of the sick or injured shall make a report to the department of public health and environment upon request but not more frequently than quarterly. The department of public health and environment shall have power to investigate and shall have free access to such facilities consistent with section 25-1.5-103 (1)(a).

Source: L. 09: p. 412, § 4. C.L. § 1056. CSA: C. 78, § 136. CRS 53: § 66-4-4. C.R.S. 1963: § 66-4-4. L. 71: p. 632, § 4. L. 94: Entire section amended, p. 2752, § 408, effective July 1. L. 95: Entire section amended, p. 1024, § 6, effective July 1. L. 2003: Entire section amended, p. 709, § 39, effective July 1.

Cross references: For the legislative declaration contained in the 1994 act amending this section, see section 1 of chapter 345, Session Laws of Colorado 1994.

25-3-105. License - fee - rules - penalty - repeal.

1. 1. 1. Subject to the limitations in sub-subparagraph (B) of this subparagraph (I), the state board of health shall establish a schedule of fees, which must be set at a level sufficient to meet the direct and indirect costs of administration and enforcement of this article, as appropriated by the general assembly for each fiscal year, less any moneys appropriated for the same fiscal year by the general assembly from any other source to meet such costs. The fee schedule must also ensure that the reserve balance in the health facilities general licensure cash fund created in section 25-3-103.1 (1) is consistent with the limits specified in section 24-75-402 (3), C.R.S., and must be modified, as necessary, to comply with said limits. The state board shall establish and modify, as necessary, the fee schedule by rules adopted in accordance with article 4 of title 24, C.R.S. Except as specified in subparagraph (II) of this paragraph (a), the department of public health and environment may assess fees in accordance with the fee schedule established by the state board against health facilities licensed by the department. All fees collected pursuant to the fee schedule must be deposited in the health facilities general licensure cash fund created in section 25-3-103.1 (1) and are subject to appropriation by the general assembly in accordance with section 25-3-103.1 (2).
      2. On or after June 4, 2012, the state board of health may increase the amount of any fee on the schedule of fees established pursuant to subsection (1)(a)(I)(A) of this section that is in effect on June 4, 2012, by an amount not to exceed the annual percentage change in the United States department of labor, bureau of labor statistics, consumer price index for Denver-Aurora-Lakewood for all urban consumers and all goods, or its applicable predecessor or successor index. Nothing in this subsection (1)(a)(I)(B) limits the ability of the state board of health to reduce the amount of any fee on the schedule of fees in effect on such date or to modify fees as necessary to comply with section 24-75-402 .
      3. The department of public health and environment shall institute, by rule, a performance incentive system for licensed health facilities under which a licensed health facility would be eligible for a reduction in its license renewal fee if: The department's on-site relicensure inspection demonstrates that the health facility has no significant deficiencies that have negatively affected the life, safety, or health of its consumers; the licensed health facility has fully and timely cooperated with the department during the on-site inspection; the department has found no documented actual or potential harm to consumers; and, in the case where any significant deficiencies are found that do not negatively affect the life, safety, or health of consumers, the licensed health facility has submitted, and the department has accepted, a plan of correction and the health facility has corrected the deficient practice, as verified by the department, within the period required by the department.
   2. (Deleted by amendment, L. 2007, p. 953 , § 2, effective May 17, 2007.)
   3. 1. On and after August 7, 2006, an applicant for licensure for an acute treatment unit shall submit to the department nonrefundable fees with an application for licensure as follows:
         1. A fee of one hundred dollars per available bed in addition to a fee of three thousand five hundred dollars for a license related to new facility operations; except that a facility that converts from a different licensure category to an acute treatment unit shall submit its application and initial licensure fee no later than July 1, 2008;
         2. A fee of twenty dollars per available bed in addition to a fee of one thousand seven hundred dollars to issue a new license when there has been a change of ownership of an existing licensed acute treatment unit;
         3. A fee of twenty dollars per available bed in addition to a fee of one thousand five hundred dollars when the licensee seeks annual renewal of an existing acute treatment unit license.
      2. A licensee shall submit a fee of one hundred dollars for an acute treatment unit in the following circumstances:
         1. When submitting a name change for approval by the department; or
         2. When submitting a request to increase the number of licensed beds for approval by the department.
      3. A licensee shall submit a fee of five hundred dollars for an acute treatment unit in the following circumstances:
         1. For remodeling plan review by the department when the licensee undergoes new construction or substantial remodeling of an acute treatment unit, as defined by rule of the state board of health; or
         2. For remodeling on-site review by the department when the licensee undergoes new construction or substantial remodeling of an acute treatment unit, as defined by rule of the state board of health. Fees for remodeling on-site review shall be in addition to the fees assessed for remodeling plan review.
      4. [Editor's note: Subsection (1)(c)(IV) is effective July 1, 2021.] This subsection (1)(c) is repealed, effective July 1, 2022.
2. The department of public health and environment shall maintain a full, true, and accurate accounting of the costs of providing services under this article, including indirect costs, and, at least annually, shall provide a detailed cost accounting report to the health care facility stakeholder forum created in section 25-3-113. The department shall regularly evaluate and update its cost-accounting methods.
3. Repealed.
4. On July 1, 2013, any moneys remaining in the health facilities general licensure cash fund created in section 25-3-103.1 (1) from fees collected by the department of public health and environment for health facility building and structure code plan reviews and inspections are transferred to the health facility construction and inspection cash fund created in section 24-33.5-1207.8, C.R.S.

Source: L. 09: p. 413, § 6. C.L. § 1058. CSA: C. 78, § 138. CRS 53: § 66-4-5. L. 54: p. 133, § 1. C.R.S. 1963: § 66-4-5. L. 71: p. 632, § 5. L. 77: Entire section amended, p. 1275, § 1, effective July 1. L. 95: Entire section amended, p. 1025, § 7, effective July 1. L. 98: (1) amended, p. 1333, § 45, effective June 1. L. 2000: (2) amended, p. 461, § 2, effective August 2. L. 2003: (1)(a) amended, p. 1524, § 1, effective May 1. L. 2006: (1) amended, p. 1391, § 25, effective August 7. L. 2007: (1)(a) and (1)(b) amended, p. 953, § 2, effective May 17. L. 2012: (1)(a)(I) and (2) amended, (HB 12-1294), ch. 252, p. 1257, § 7, effective June 4; (4) added (HB 12-1268), ch. 234, p. 1026, § 3, effective July 1, 2013. L. 2018: (1)(a)(I)(B) amended, (HB 18-1375), ch. 274, p. 1714, § 60, effective May 29. L. 2019: (1)(c)(IV) added, (HB 19-1237), ch. 413, p. 3640, § 9, effective July 1, 2021.

Editor's note: Subsection (3)(b) provided for the repeal of subsection (3), effective July 1, 1996. (See L. 95, p. 1025 .)

Cross references: For the legislative declaration in the 2012 act amending subsections (1)(a)(I) and (2), see section 1 of chapter 252, Session Laws of Colorado 2012.

25-3-106. Unincorporated associations.

An unincorporated association organized and existing for the purpose of providing hospital services for its members shall be governed, managed, and controlled by a board of trustees selected in accordance with the provisions of the state constitution and bylaws of such association. Such board of trustees shall have the right to acquire, own, and hold, in the name of such association or in the name of persons who hold title in trust for said association, real property devoted to or connected with hospital purposes and to operate and manage the same in accordance with the laws of this state, and such board of trustees shall have the power and right from time to time to sell, convey, lease, or otherwise dispose of such property, including any hospital building of such association, whenever acquired, and to direct the sale, conveyance, lease, or other disposition of the same by persons who hold the title to such property in trust for said association to such purchaser, lessee, or other person or entity for such price and upon such terms and conditions as may be determined by resolution of the board of trustees of the association adopted by two-thirds vote of the entire board of trustees of such association at any regular or special meeting of said board. The sale, conveyance, lease, or other disposition of such property may be made in the manner provided in this section to any person, corporation, county, municipality, or other entity.

Source: L. 57: p. 416, § 1. CRS 53: § 66-4-6. C.R.S. 1963: § 66-4-6.

25-3-107. Disciplinary actions reported to Colorado medical board or podiatry board.

1. Any disciplinary action to suspend, revoke, or otherwise limit the privileges of a licensed physician or podiatrist that is taken by the governing board of a hospital required to be licensed or certified pursuant to this part 1 or required to obtain a certificate of compliance pursuant to section 25-1.5-103 (1)(a)(I) or (1)(a)(II) shall be reported to the Colorado medical board or the Colorado podiatry board, whichever board is appropriate, in the form prescribed by said board.
2. Said hospital shall provide such additional information as is deemed necessary by the Colorado medical board or the Colorado podiatry board to conduct a further investigation and hearing.

Source: L. 76: Entire section added, p. 421, § 7, effective July 1. L. 79: (1) amended, p. 523, § 28, effective July 1. L. 85: Entire section amended, p. 505, § 23, effective July 1. L. 88: (1) amended, p. 527, § 11, effective July 1. L. 2003: (1) amended, p. 710, § 40, effective July 1. L. 2010: Entire section amended, (HB 10-1260), ch. 403, p. 1990, § 86, effective July 1.

25-3-108. Receivership.

1. It is the purpose of this section to establish a receivership mechanism that will be available as a remedy for such violations of applicable laws and regulations by a licensee of a long-term health care facility that require facility closure by the department of public health and environment in order to safeguard against potential transfer trauma resulting from relocation of its residents as a result of closure of the facility.
2. The department of public health and environment, the licensee or owner of a long-term health care facility, or the lessee of such facility with the approval of the owner may apply to the district court for the appointment of a receiver to operate the long-term health care facility when:
   1. The department of public health and environment has refused to issue a renewal license or has revoked the license of such facility and the action of the department is final; or
   2. The department of public health and environment, through the executive director thereof, has taken summary action to suspend the license of any such facility in accordance with the provisions of section 24-4-104 (4), C.R.S.
3. The action of the department of public health and environment with respect to nonrenewal or revocation of a license and recommendation for certification for medicaid participation shall not be final for the purposes of paragraph (a) of subsection (2) of this section until all administrative hearings and judicial appeals sought by a licensee of a long-term health care facility have been exhausted or the time permitted for the same has expired and until the decisions resulting from any such appeals, if any, sustain the action of said department.
4. Application for the appointment of a receiver pursuant to this section shall be to the district court for the county where the long-term health care facility is located. No hearing on such application shall be held sooner than seventy-two hours after the licensee of such facility has been served with notice thereof, as provided in the Colorado rules of civil procedure; except that when the department exercises its summary powers, an emergency receiver may be appointed upon agreement in writing between the department and licensee, with the approval of the owner, until a hearing for appointment of a receiver as provided in this section. Notice shall also be served upon any owner and any lessee of a long-term health care facility and any holder of a security interest of record in said facility. An application for appointment of a receiver pursuant to this section shall have precedence and priority over any civil or criminal case pending in the district court wherein the application is filed.
5. For the purposes of this section the action of the department of public health and environment exercised pursuant to subsection (2) of this section shall become effective upon appointment of the receiver of the court.
6. Prior to ordering the appointment of a receiver for the operation of a long-term health care facility, the district court must find:
   1. That grounds for the appointment of a receiver exist as provided in subsection (2) of this section; and
   2. That proper notice as required by subsection (4) of this section has been served; and
   3. That there is a necessity to continue care on a temporary basis at the facility to avoid potential transfer trauma which would serve the best interests of the residents of the facility pending arrangements for the lease, sale, or closure of the facility.
7. The department of public health and environment shall grant the receiver a license pursuant to section 25-3-102 and shall recommend certification for medicaid participation, and the department of health care policy and financing shall reimburse the receiver for the long-term health care facility's medicaid residents pursuant to section 25.5-6-204, C.R.S.
8. The appointment of the receiver shall be in accordance with and governed by the provisions of rule 66 of the Colorado rules of civil procedure. The court shall enter an order of appointment and fix the fees and expenses of the receiver. The receiver shall be a licensed nursing home administrator and shall post a bond with adequate sureties as determined by the court, and the receiver may be sued upon the same in the name of the people of the state of Colorado at the instance and for the use of any party injured. The receiver shall perform duties, assume responsibilities, and preserve the long-term health care facility property in accordance with established principles of law for receivers of real property. Such duties and responsibilities shall be determined by the court following a hearing, at which time the parties may appear and be heard. The court shall specify the duties and responsibilities of the receiver in the order of appointment. No security interest in any real or personal property comprising said facility or contained within the facility nor any fixture of the facility shall be impaired or diminished by the receiver, but the receiver shall comply with the standards of the department of public health and environment in providing health care to patients.
9. Nothing in this section shall prevent the court from altering or amending the terms and conditions of the receivership or the receiver's responsibilities and duties following a hearing, at which time the parties may appear and be heard; and nothing in this section shall prohibit the parties from stipulating to the terms and conditions of the receivership and the responsibilities and duties of the receiver, including the duration thereof, and such stipulation shall be submitted to the court for approval.
10. A receivership established pursuant to this section may be terminated by the court upon application therefor by the licensee of a long-term health care facility, the department of public health and environment, or the receiver. The receivership may be terminated upon a finding by the court that the receivership is no longer necessary, but in no case shall the receivership continue for longer than one hundred eighty days from the date of the initial appointment of the receiver unless extended by written agreement of the parties as provided in subsection (9) of this section.
11. Upon termination of the receivership, the court shall order a final accounting and finally fix the fees and expenses of the receiver following a hearing, at which time the parties may appear and be heard.

Source: L. 79: Entire section added, p. 1003, § 1, effective June 7. L. 91: (7) amended, p. 1857, § 15, effective April 11. L. 94: (1), (2), (3), (5), (7), (8), and (10) amended, pp. 2752, 2624, §§ 409, 43, effective July 1. L. 2006: (7) amended, p. 2015, § 89, effective July 1. L. 2007: (1) amended, p. 2040, § 64, effective June 1.

Editor's note: Amendments to subsection (7) by sections 43 and 409 of House Bill 94-1029 were harmonized.

Cross references: For the legislative declaration contained in the 1994 act amending subsections (1), (2), (3), (5), (7), (8), and (10), see section 1 of chapter 345, Session Laws of Colorado 1994.

25-3-109. Quality management functions - confidentiality and immunity.

1. The general assembly hereby finds and declares that the implementation of quality management functions to evaluate and improve patient and resident care is essential to the operation of health care facilities licensed or certified by the department of public health and environment pursuant to section 25-1.5-103 (1)(a). For this purpose, it is necessary that the collection of information and data by such licensed or certified health care facilities be reasonably unfettered so a complete and thorough evaluation and improvement of the quality of patient and resident care can be accomplished. To this end, quality management information relating to the evaluation or improvement of the quality of health care services shall be confidential, subject to the provisions of subsection (4) of this section, and persons performing such functions shall be granted qualified immunity. It is the intent of the general assembly that nothing in this section revise, amend, or alter part 2 of article 30 or article 240 of title 12.
2. For purposes of this section, a "quality management program" means a program that includes quality assurance and risk management activities, the peer review of licensed health care professionals not otherwise provided for in part 2 of article 30 of title 12, and other quality management functions that are described by a facility in a quality management program approved by the department of public health and environment. Nothing in this section shall revise, amend, or alter part 2 of article 30 or article 240 of title 12.
3. Except as otherwise provided in this section, any records, reports, or other information of a licensed or certified health care facility that are part of a quality management program designed to identify, evaluate, and reduce the risk of patient or resident injury associated with care or to improve the quality of patient care shall be confidential information; except that such information shall be subject to the provisions of subsection (4) of this section.
4. The records, reports, and other information described in subsection (3) and subsection (5.5) of this section shall not be subject to subpoena or discoverable or admissible as evidence in any civil or administrative proceeding. No person who participates in the reporting, collection, evaluation, or use of such quality management information with regard to a specific circumstance shall testify thereon in any civil or administrative proceeding. However, this subsection (4) shall not apply to:
   1. Any civil or administrative proceeding, inspection, or investigation as otherwise provided by law by the department of public health and environment or other appropriate regulatory agency having jurisdiction for disciplinary or licensing sanctions;
   2. Persons giving testimony concerning facts of which they have personal knowledge acquired independently of the quality management information program or function;
   3. The availability, as provided by law or the rules of civil procedure, of factual information relating solely to the individual in interest in a civil suit by such person, next friend or legal representative. In no event shall such factual information include opinions or evaluations performed as a part of the quality management program.
   4. Persons giving testimony concerning an act or omission which they have observed or in which they participated, notwithstanding any participation by them in the quality management program;
   5. Persons giving testimony concerning facts they have recorded in a medical record relating solely to the individual in interest in a civil suit by such person.
5. Nothing in this section shall affect the voluntary release of any quality management record or information by a health care facility; except that no patient-identifying information shall be released without the patient's consent.
   1. (5.5) (a) The confidentiality of information provided for in this section shall in no way be impaired or otherwise adversely affected solely by reason of the submission of the information to a nongovernmental entity to conduct studies that evaluate, develop, and analyze information about health care operations, practices, or any other function of health care facilities. The records, reports, and other information collected or developed by a nongovernmental entity shall remain protected as provided in subsections (3) and (4) of this section. In order to adequately protect the confidentiality of such information, no findings, conclusions, or recommendations contained in such studies conducted by any such nongovernmental entity shall be deemed to establish a standard of care for health care facilities.
   2. For purposes of this subsection (5.5), "health care facility" includes a carrier as defined in section 10-16-102 (8), C.R.S., and a health care practitioner licensed or certified pursuant to title 12, C.R.S.
6. Any person who in good faith and within the scope of the functions of a quality management program participates in the reporting, collection, evaluation, or use of quality management information or performs other functions as part of a quality management program with regard to a specific circumstance shall be immune from suit in any civil action based on such functions brought by a health care provider or person to whom the quality information pertains. In no event shall this immunity apply to any negligent or intentional act or omission in the provision of care.
8. (Deleted by amendment, L. 97, p. 507 , § 2, effective April 24, 1997.)
9. Nothing in this section shall be construed to limit any statutory or common law privilege, confidentiality, or immunity.
10. Nothing in this section shall revise, amend, or alter the requirements of section 25-3-107.
11. (Deleted by amendment, L. 97, p. 507 , § 2, effective April 24, 1997.)
12. Nothing in this section shall affect a person's access to his medical record as provided in section 25-1-801, nor shall it affect the right of any family member or any other person to obtain medical record information upon the consent of the patient or his authorized representative.

Source: L. 88: Entire section added, p. 1006, § 1, effective April 29. L. 89: (1) and (2) amended, p. 689, § 5, effective July 1. L. 94: (1), (2), (3), (4)(a), IP(7), and (8) amended, p. 2754, § 410, effective July 1. L. 97: (1), (3), (7), (8), and (11) amended, p. 507, § 2, effective April 24. L. 2003: IP(4) amended and (5.5) added, p. 942, § 1, effective April 17; (1) amended, p. 710, § 41, effective July 1. L. 2013: (5.5)(b) amended, (HB 13-1266), ch. 217, p. 992, § 62, effective May 13. L. 2019: (1) and (2) amended, (HB 19-1172), ch. 136, p. 1700, § 152, effective October 1.

Cross references: For the legislative declaration contained in the 1994 act amending subsections (1), (2), (3), and (4)(a), the introductory portion to subsection (7), and subsection (8), see section 1 of chapter 345, Session Laws of Colorado 1994.

25-3-110. Emergency contraception - definitions.

1. For purposes of this section, unless the context otherwise requires:
   1. "Emergency contraception" means a drug approved by the federal food and drug administration that prevents pregnancy after sexual intercourse, including but not limited to oral contraceptive pills; except that "emergency contraception" shall not include RU-486, mifepristone, or any other drug or device that induces a medical abortion. Nothing in section 2-4-401 (1.5), C.R.S., shall be construed to amend or alter the definition of "emergency contraception".
   2. "Sexual assault survivor" shall have the same meaning as "victim" as defined in section 18-3-401 (7), C.R.S.
2. Notwithstanding any other provision of law to the contrary, all health care facilities that are licensed pursuant to this part 1 and provide emergency care to sexual assault survivors shall amend their evidence-collection protocols for the treatment of sexual assault survivors to include informing the survivor in a timely manner of the availability of emergency contraception as a means of pregnancy prophylaxis and educating the survivor on the proper use of emergency contraception and the appropriate follow-up care.
3. Nothing in this section shall be interpreted to require:
   1. A health care professional who is employed by a health care facility that provides emergency care to a sexual assault survivor to inform the survivor of the availability of emergency contraception if the professional refuses to provide the information on the basis of religious or moral beliefs; or
   2. A health care facility to provide emergency contraception to a sexual assault survivor who is not at risk of becoming pregnant as a result of the sexual assault or who was already pregnant at the time of the assault.
4. If any licensed pharmacy does not have nonprescription emergency contraception in stock, the pharmacy shall place a conspicuous notice in the area where customers obtain prescription drugs that states "Plan B Emergency Contraception Not Available".
5. The general assembly encourages health care facilities to provide training to emergency room staff concerning the efficacy of emergency contraception and the time-sensitive nature of the drug.
6. Because emergency contraception is time-sensitive and a sexual assault survivor may seek information on or direct access to emergency contraception to prevent an unintended pregnancy resulting from the assault instead of or prior to seeking hospital treatment, it is critical that sexual assault survivors have accurate information about the availability and use of emergency contraception. Therefore, the general assembly encourages:
   1. Entities offering victim assistance or counseling and rape crisis hotlines to include information concerning the availability and use of emergency contraception; and
   2. Licensed or registered pharmacies in the state of Colorado to distribute information concerning the availability and use of emergency contraception.

Source: L. 2007: Entire section added, p. 63, § 2, effective March 15. L. 2009: (1)(a) amended, (SB 09-225), ch. 126, p. 546, § 2, effective August 5.

Cross references: For the legislative declaration contained in the 2007 act enacting this section, see section 1 of chapter 24, Session Laws of Colorado 2007.

25-3-111. Authentication of verbal orders - hospital policies or bylaws.

1. A hospital licensed pursuant to part 3 of this article shall require that all verbal orders be authenticated by a physician or responsible individual who has the authority to issue verbal orders in accordance with hospital and medical staff policies or bylaws. The policies or bylaws shall require that:
   1. Authentication of a verbal order occurs within forty-eight hours after the time the order is made unless a read-back and verify process pursuant to paragraph (b) of this subsection (1) is used. The individual receiving a verbal order shall record in writing the date and time of the verbal order, and sign the verbal order in accordance with hospital policies or medical staff bylaws.
   2. A hospital policy may provide for a read-back and verify process for verbal orders. A read-back and verify process shall require that the individual receiving the order immediately read back the order to the physician or responsible individual, who shall immediately verify that the read-back order is correct. The individual receiving the verbal order shall record in writing that the order was read back and verified. If the read-back and verify process is followed, the verbal order shall be authenticated within thirty days after the date of the patient's discharge.
2. Verbal orders shall be used infrequently. Nothing in this section shall be interpreted to encourage the more frequent use of verbal orders by the medical staff at a hospital.

Source: L. 2010: Entire section added, (HB 10-1229), ch. 199, p. 869, § 1, effective May 5.

25-3-112. Hospitals - charity care information - charges for the uninsured - reports to department - department review - collections protection - hospital financial assistance standards committee established - rules.

1. Each hospital shall make information available to each patient about the hospital's financial assistance, charity care, and payment plan policies. Each hospital shall communicate this information in a clear and understandable manner and in languages appropriate to the communities and patients the hospital serves. The hospital shall:
   1. Post the information conspicuously on its website;
   2. Make the information available in patient waiting areas;
   3. Make the information available to each patient, when possible, before the patient's discharge from the hospital; and
   4. Inform each patient on each billing statement of his or her rights pursuant to this section and that financial assistance or charity care may be available and, where applicable, provide the website, e-mail address, and telephone number where the information may be obtained.
2. 1. When possible, each hospital shall offer to screen each uninsured patient for eligibility for financial assistance as described by this subsection (2). Each hospital shall offer financial assistance for qualified patients on a community-specific basis. In determining eligibility for financial assistance, each hospital shall, at a minimum, take into consideration federal, state, and local government requirements.
   2. For purposes of this section, a qualified patient is an individual:
      1. Who is uninsured;
      2. Whose annual family income is not more than two hundred fifty percent of the federal poverty guidelines; and
      3. Who received a service at a hospital for which the "Colorado Indigent Care Program" established in part 1 of article 3 of title 25.5, C.R.S., was not available.
3. A hospital shall limit the amounts charged for emergency or other medically necessary care provided to individuals eligible for assistance under the financial assistance policy described in subsection (2) of this section to not more than the lowest negotiated rate from a private health plan.

   (3.5) If a hospital discovers an omission of required information, incorrect billing, or other noncompliance with this section by the hospital, the hospital shall correct the error or omission, inform the patient, and provide a financial correction consistent with this section to the persons affected by the error or omission. The hospital shall inform the department of the errors, omissions, and corrective actions taken by the hospital in the same manner and form as the reports required in section 25-1-124. The department shall not investigate a hospital because that hospital has corrected an error, omission, or noncompliance with this section, unless there is good cause to open an investigation. If the department investigates a self-reported incident, the department shall investigate, document, and identify the self-reported errors, omissions, or noncompliance related to this section as a self-reported incident investigation, and not as a complaint investigation. The department shall make information concerning investigations and complaints available to the public in the same manner as section 25-1-124 (6) and (7). The department shall make hospital self-reported incidents submitted to the department pursuant to this section available to the public upon request.

   1. (3.7) (a) If the department receives a valid complaint regarding a hospital's compliance with this section, the department may conduct a review. In addition, the department shall periodically review hospitals to ensure compliance with this section.
   2. If the department finds that a hospital is not in compliance with this section, including the rules adopted pursuant to paragraph (c) of subsection (7) of this section, the department shall notify the hospital, and the hospital has ninety days to file with the department a corrective action plan that includes measures to inform the patient or patients, and provide a financial correction consistent with this section to the persons affected by the noncompliance. A hospital may request up to one hundred twenty days to submit a corrective action plan if necessary. The department may require a hospital that is not in compliance with this section, or with rules adopted pursuant to paragraph (c) of subsection (7) of this section, to develop and operate under a corrective action plan until the hospital is in compliance.
   3. If a hospital's noncompliance with this section is determined by the department to be knowing or willful, the department may fine the hospital up to five thousand dollars. In addition, if the hospital fails to take corrective action or fails to file a corrective action plan with the department within ninety days, or up to one hundred twenty days if approved by the department, the department may fine the hospital up to five thousand additional dollars. The department shall consider the size of the hospital and the seriousness of the violation in setting the fine amount.
4. 1. Before initiating collection proceedings, a hospital shall:
      1. Offer a qualified patient a reasonable payment plan; and
      2. Allow for at least thirty days past the due date of any scheduled payment that is not paid in full. A hospital must allow the thirty-day period only for the first late payment.
   2. A hospital shall not initiate collections proceedings once the hospital is notified that it must submit a corrective action plan or when the hospital is operating pursuant to a corrective action plan pursuant to subsection (3.7) of this section.
5. Nothing in this section limits or affects a hospital's right to pursue the collection of personal injury, bodily injury, liability, uninsured, underinsured, medical payment rehabilitation, disability, homeowner's, business owner's, workers' compensation, or fault-based insurance.
6. For the purposes of this section, "hospital" means a hospital licensed pursuant to part 1 of article 3 of this title or certified pursuant to section 25-1.5-103 (1)(a)(II).
7. Repealed.
8. The department shall make information available regarding any corrective actions for which fines were imposed pursuant to this section. Any information regarding the lowest negotiated rate provided to the department pursuant to this section is confidential and not a public record.
9. Nothing in this section affects a license issued to a hospital pursuant to section 25-3-101. The department shall not charge a hospital an additional license fee for costs associated with this section.

Source: L. 2012: Entire section added, (SB 12-134), ch. 162, p. 569, § 1, effective August 8. L. 2014: (1)(d) amended and (3.5), (3.7), (4)(b), (7), (8), and (9) added, (SB 14-050), ch. 269, p. 1080, § 1, effective August 6.

25-3-113. Health care facility stakeholder forum - creation - membership - duties.

1. There is hereby created in the department of public health and environment the health care facility stakeholder forum, referred to in this section as the "stakeholder forum". The stakeholder forum must consist of representatives from various types of provider facilities licensed by the department, consumers, consumer advocates, ombudsmen, and other interested parties. The department shall meet at least four times each year with the stakeholder forum to discuss and take into consideration the concerns and issues of interest to the forum members and other attendees regarding the development and implementation of rules and other matters that affect all health care facilities licensed by the department.
2. The members of the stakeholder forum serve on a voluntary basis without compensation and are responsible for noticing, staffing, recording, and reporting the notes from the stakeholder forum meetings. The department shall consider the attendance of its representatives at meetings with the stakeholder forum to be within the normal course of business, with no additional appropriation to or resources from the department required.
3. The stakeholder forum and the department shall work to coordinate with, and shall not duplicate the work being done by, established or statutorily authorized advisory committees or working groups on issues related to the development and implementation of rules.
4. For purposes of section 24-4-103 (2), C.R.S., as amended by House Bill 12-1008, enacted in 2012, the department may use the stakeholder forum described in this section, when appropriate, to serve as the representative group for the department of public health and environment.

Source: L. 2012: Entire section added, (HB 12-1294), ch. 252, p. 1258, § 8, effective June 4.

Cross references: For the legislative declaration in the 2012 act adding this section, see section 1 of chapter 252, Session Laws of Colorado 2012.

25-3-114. STEMI task force - creation - membership - duties - report - notice of funding through gifts, grants, and donations - definitions - repeal. (Repealed)

Source: L. 2013: Entire section added, (SB 13-225), ch. 277, p. 1444, § 1, effective May 24.

Editor's note: Subsection (5) provided for the repeal of this section, effective August 1, 2015. (See L. 2013, p. 1444 .)

25-3-115. Stroke advisory board - creation - membership - duties - report - definition - repeal.

1. 1. There is hereby created in the department the stroke advisory board, the purpose of which is to evaluate potential strategies for stroke prevention and treatment and develop a statewide needs assessment identifying relevant resources. No later than August 1, 2013, the governor shall appoint eighteen members to the stroke advisory board as follows:
      1. Six physicians who are actively involved in stroke care and who satisfy the following criteria: One physician who is board-certified in primary care; one physician who is board-certified in vascular neurology; one physician who is privileged and actively practicing interventional neuroradiology; one physician who is board-certified in neurosurgery; one physician representing a statewide chapter of emergency physicians; and one physician who is a board-certified neurologist serving patients in a rural area of the state;
      2. One member representing a statewide association of physicians;
      3. One member representing a statewide hospital association;
      4. One member who is an emergency medical service provider, as defined in section 25-3.5-103 (8);
      5. One member who is a registered nurse involved in stroke care;
      6. One hospital administrator from a hospital located in a rural area of the state;
      7. One hospital administrator from a hospital located in an urban area of the state;
      8. One representative from a stroke rehabilitation facility;
      9. One member who is a Colorado resident representing a national association whose goal is to eliminate cardiovascular disease and stroke;
      10. One member who is a Colorado resident representing a national stroke association;
      11. One member who is a physical or occupational therapist actively involved in stroke care;
      12. One member of the public who has suffered a stroke or is the caregiver of a person who has suffered a stroke; and
      13. One member who is an expert in stroke database management.
   2. The executive director of the department or the executive director's designee shall serve as an ex officio member of the stroke advisory board.
   3. Members of the stroke advisory board serve without compensation and are not entitled to reimbursement of expenses incurred in serving on or performing duties of the advisory board.
2. 1. The stroke advisory board shall study and make recommendations for developing a statewide plan to improve quality of care for stroke patients. In conducting the study, the stroke advisory board shall explore the following issues, without limitation:
      1. Creation of a state database or registry consisting of data on stroke care that mirrors the data hospitals submit to nationally recognized organizations;
      2. Access to aggregated stroke data, which must exclude any identifying or confidential information about the reporting hospital or patients treated by the hospital, from a state database that may be developed or from a nationally recognized organization by the advisory board, by any person who submits a written request for the data;
      3. Evaluation of currently available stroke treatments and the development of recommendations, based on medical evidence, for ways to improve stroke prevention and treatment;
      4. A plan that would encourage rural and urban hospitals to coordinate services for the necessary referral or receipt of patients requiring stroke care in the state; and
      5. The criteria used by nationally recognized bodies for designating a hospital in stroke care and whether a designation is appropriate or needed to assure access to the best quality care for Colorado residents with stroke events.
   2. By January 31, 2014, and by each January 1 thereafter, the stroke advisory board shall submit a report specifying its findings and recommendations to the health and human services committee of the senate, the health, insurance, and environment committee of the house of representatives, or their successor committees, and the department. The stroke advisory board shall include in its report a recommendation on whether a designation of a hospital in stroke care is appropriate or needed to assure access to the best quality care for Colorado residents with stroke events.
3. The stroke advisory board may accept and expend, subject to appropriation by the general assembly, gifts, grants, and donations to pay the stroke advisory board's direct expenses. The stroke advisory board shall transmit any monetary gifts, grants, or donations it receives to the state treasurer for deposit in the health facilities general licensure cash fund.

   (3.5) The department staff is not required to provide any financial support or perform any administrative duties related to the operation of the stroke advisory board.

4. As used in this section, unless the context otherwise requires, "department" means the department of public health and environment.
5. This section is repealed, effective September 1, 2028. Prior to the repeal, the department of regulatory agencies shall review the functions of the stroke advisory board in accordance with section 2-3-1203, C.R.S.

Source: L. 2013: Entire section added, (SB 13-225), ch. 277, p. 1446, § 1, effective May 24. L. 2018: (5) amended, (HB 18-1265), ch. 205, p. 1321, § 1, effective September 1. L. 2020: (3) amended and (3.5) added, (HB 20-1397), ch. 213, p. 1030, § 1, effective June 30.

25-3-116. Department recognition of national certification - suspension or revocation of recognition.

1. A hospital that has an accreditation, certification, or designation in stroke or STEMI care from a nationally recognized accrediting body, including a certification as a comprehensive stroke center or primary stroke center by the joint commission or an accreditation as a STEMI receiving center or STEMI referral center by the American College of Cardiology Accreditation Services or its successor organization, may send information and supporting documentation to the department. The department shall make a hospital's national accreditation, certification, or designation available to the public in a manner determined by the department.
2. The department shall deem a hospital that is currently accredited, certified, or designated by a nationally recognized accrediting body as satisfying the requirements for recognition and publication by the department. The department may suspend or revoke a recognition and publication of a hospital's accreditation