2019 Colorado Revised Statutes
Title 25 - Public Health and Environment


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Colorado Revised Statutes 2019 TITLE 25 PUBLIC HEALTH AND ENVIRONMENT ADMINISTRATION ARTICLE 1 Administration PART 1 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 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. Colorado Revised Statutes 2019 Page 1 of 1101 Uncertified Printout 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: (a) The division of administration, and such sections and units established as provided by law. (b) (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: § 661-2. 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 2434-301 (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 Colorado Revised Statutes 2019 Page 2 of 1101 Uncertified Printout 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: § 661-3. 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: (a) 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: (I) One year of graduate study in a school of public health; (II) Not less than two years' experience in an administrative capacity in a health care organization; (III) Four years of said experience when one year of graduate study in a school of public health has not been completed; or Colorado Revised Statutes 2019 Page 3 of 1101 Uncertified Printout (b) Have, at a minimum, experience or education in public administration and public or environmental health. (2) (a) 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. (b) 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. (c) 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: § 661-6. L. 71: p. 106, § 17. Colorado Revised Statutes 2019 Page 4 of 1101 Uncertified Printout 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 Colorado Revised Statutes 2019 Page 5 of 1101 Uncertified Printout 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 031100 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: (a) Repealed. (b) "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. (b.5) "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. (b.7) "Board" means the nursing home innovations grant board, authorized by subsection (6) of this section. (c) "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) (a) 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 Colorado Revised Statutes 2019 Page 6 of 1101 Uncertified Printout found to be in violation of the federal regulations. Penalties assessed shall include interest at the statutory rate. (b) 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: (I) The period during which the violation occurred; (II) The frequency of the violation; (III) The nursing facility's history concerning the type of violation for which the penalty is assessed; (IV) The nursing facility's intent or reason for the violation; (V) The effect, if any, of the violation on the health, safety, security, or welfare of the residents of the nursing facility; (VI) 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; (VII) The accuracy, thoroughness, and availability of records regarding the violation that the nursing facility is required to maintain; and (VIII) The number of additional related violations occurring within the same period as the violation in question. (c) (I) 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. (II) 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: (A) Set forth the deficiencies that are the basis for the recommendation to assess a penalty; (B) Provide instructions for responding to the notice; and (C) 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. (d) 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 Colorado Revised Statutes 2019 Page 7 of 1101 Uncertified Printout 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) (a) 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. (b) (I) 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. (II) 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. (III) The department of health care policy and financing shall promulgate rules necessary to ensure proper administration of the nursing home penalty cash fund. (c) The departments shall consider, as a basis for distribution from the nursing home penalty cash fund, the following: (I) The need to pay costs to: (A) Relocate residents to other facilities when a nursing facility closes; (B) Maintain the operation of a nursing facility pending correction of violations; (C) Close a nursing facility; (D) Reimburse residents for personal funds lost; (II) 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: (A) Consumer education to promote resident-centered care in nursing facilities; (B) (Deleted by amendment, L. 2014.) (C) 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 (D) Education and consultation for purposes of identifying and implementing residentcentered care initiatives in nursing facilities. (d) (I) Repealed. (II) 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 Colorado Revised Statutes 2019 Page 8 of 1101 Uncertified Printout 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 subsubparagraph (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: (A) 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 (B) 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. (III) 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. (IV) 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. (e) 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 Colorado Revised Statutes 2019 Page 9 of 1101 Uncertified Printout 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) (a) 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: (I) The state long-term care ombudsman or his or her designee; (II) The executive director of the department of health care policy and financing or the executive director's designee; (III) The executive director of the department of public health and environment or the executive director's designee; (IV) Seven members appointed by the governor as follows: (A) Four members currently employed in long-term care nursing facilities; (B) One member who is or represents a consumer of long-term care; (C) 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 (D) One member representing the business community. (E) (Deleted by amendment, L. 2014.) (b) The members of the board shall serve without compensation but may be reimbursed for expenses incurred while serving on the board. (c) 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. (d) 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) Colorado Revised Statutes 2019 Page 10 of 1101 Uncertified Printout 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: (a) 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; (b) To act in an advisory capacity to the executive director of the department on all matters pertaining to public health; (c) (I) 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; (II) 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. (III) 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. (d) 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 24-4105, 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. (e) 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 Colorado Revised Statutes 2019 Page 11 of 1101 Uncertified Printout 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. (f) to (h) 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. (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 Colorado Revised Statutes 2019 Page 12 of 1101 Uncertified Printout 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 15189), 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: (a) "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. (b) "Credentialing" means the process of assessing and validating the qualifications of a health care professional. (c) "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. (d) "Health care entity" means any of the following that require health professionals to submit credentials data: (I) A health care facility or other health care organization licensed or certified to provide medical or health services in Colorado; (II) A health care professional partnership, corporation, limited liability company, professional services corporation, or group practice; (III) An independent practice association or physician-hospital organization; (IV) A professional liability insurance carrier; or (V) An insurance company, health maintenance organization, or other entity that contracts for the provision of health benefits. (e) "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. (f) "Health care professional" means a physician, dentist, dental hygienist, chiropractor, podiatrist, psychologist, advanced practice nurse, optometrist, physician assistant, licensed Colorado Revised Statutes 2019 Page 13 of 1101 Uncertified Printout 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. (g) "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) (a) 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. (b) 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) (a) 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: (I) One member representing a statewide association or society of physicians; (II) One member representing a statewide association or society of Colorado hospitals; (III) One member representing a statewide association or society of health plans; (IV) One member representing a professional liability insurance carrier domiciled in Colorado that provides professional liability insurance to health care professionals in Colorado; (V) One member representing a statewide association or society of Colorado health care medical staff service specialists; (VI) One advanced practice nurse; (VII) Two members at large. (b) 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. (c) 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. (d) Members of the review committee shall serve without compensation. (e) 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 Colorado Revised Statutes 2019 Page 14 of 1101 Uncertified Printout 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. (f) 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. (g) 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. (h) 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: (a) 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; (b) 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; (c) 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 Colorado Revised Statutes 2019 Page 15 of 1101 Uncertified Printout 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. (d) Repealed. (e) 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.; (f) 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. (g) Repealed. (h) 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: § 66-19. 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 Colorado Revised Statutes 2019 Page 16 of 1101 Uncertified Printout 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: (a) 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 (b) 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 (c) 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 (d) To willfully and falsely make or alter any certificate or license or certified copy thereof issued pursuant to the public health laws; or (e) 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 Colorado Revised Statutes 2019 Page 17 of 1101 Uncertified Printout (f) 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 (g) 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 (h) 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. (i) 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. (j) [Editor's note: Subsection (1)(j) is effective January 1, 2020.] To violate section 253-122. (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: (a) 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; (b) 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 Colorado Revised Statutes 2019 Page 18 of 1101 Uncertified Printout 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) (a) 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. (b) (I) 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. (II) 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. (III) 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. Editor's note: Section 10 of chapter 171 (HB 19-1174), Session Laws of Colorado 2019, provides that the act changing this section applies to health care services provided on or after 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: Colorado Revised Statutes 2019 Page 19 of 1101 Uncertified Printout (a) 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 (b) Enter such order as the public health may require, taking into consideration, where appropriate, the cost and time necessary to comply; or (c) Impose such civil penalty and enter such order. (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: (I) 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 (II) 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. (b) 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 Colorado Revised Statutes 2019 Page 20 of 1101 Uncertified Printout 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) (a) 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. (b) Upon finding that tampering, attempting to tamper, or threatening to tamper has occurred, the court shall have the authority to: (I) Order appropriate injunctive relief; (II) 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; (III) 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 (IV) 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), Colorado Revised Statutes 2019 Page 21 of 1101 Uncertified Printout (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: (a) The disclosure is made promptly after knowledge of the information disclosed is obtained by the person or entity; (b) The disclosure arises out of a voluntary self-evaluation; (c) 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. (d) 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 Colorado Revised Statutes 2019 Page 22 of 1101 Uncertified Printout 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 13-25126.5 (2), C.R.S., apply to this section. (9) This section applies to voluntary disclosures that are made and voluntary selfevaluations 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) (a) 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, 13-25126.5, 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. Colorado Revised Statutes 2019 Page 23 of 1101 Uncertified Printout (b) 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. (c) 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) (a) 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: (I) Whether the activities disclosed may create imminent and substantial endangerment of, or result in serious harm to, public health and the environment; and (II) Whether the activities disclosed conferred an unfair or excessive economic benefit on the disclosing entity. (b) 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 selfaudit 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. Colorado Revised Statutes 2019 Page 24 of 1101 Uncertified Printout 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) Colorado Revised Statutes 2019 Page 25 of 1101 Uncertified Printout 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: (a) 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; (b) The right to have private and unrestricted communications with any person of his choice; (c) 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; (d) 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; (e) 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; (f) 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; (g) 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; (h) 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; (i) 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; (j) 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; (k) 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; Colorado Revised Statutes 2019 Page 26 of 1101 Uncertified Printout (l) 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; (m) The right to freedom of choice in selecting a health care facility; (n) 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. 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. (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 Colorado Revised Statutes 2019 Page 27 of 1101 Uncertified Printout section are enforced by a grievance procedure which contains the following procedures and rights: (a) 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. (b) 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. (c) 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. (d) 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. (e) 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 Colorado Revised Statutes 2019 Page 28 of 1101 Uncertified Printout 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) (a) 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. (b) 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. 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 091260), 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 Colorado Revised Statutes 2019 Page 29 of 1101 Uncertified Printout 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: (a) A provision for a patient representative to serve as a liaison between the patient and the institution; (b) A description of the qualifications of the patient representative; (c) An outline of the job description of the patient representative; (d) A description of the amount of decision-making authority given to the patient representative; (e) 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 Colorado Revised Statutes 2019 Page 30 of 1101 Uncertified Printout 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: (a) Release may be made of medical and epidemiological information in a manner such that no individual person can be identified. (b) 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. (c) Release may be made to the person who is the subject of a medical record or report with written authorization from such person. (d) 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: (I) The name, address, and sex of the child; (II) The name and address of the person responsible for the child; (III) The name and address of the person who is alleged to be responsible for the suspected abuse or neglect, if known; and (IV) The general nature of the child's injury. (e) 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. Colorado Revised Statutes 2019 Page 31 of 1101 Uncertified Printout (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 18-1.3501 (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. Colorado Revised Statutes 2019 Page 32 of 1101 Uncertified Printout 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: (a) 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; (b) Any occurrence that results in any of the following serious injuries to a patient or resident: (I) Brain or spinal cord injuries; (II) Life-threatening complications of anesthesia or life-threatening transfusion errors or reactions; (III) 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; (c) 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; (d) 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; (e) Any occurrence involving caretaker neglect of a patient or resident, as described in section 26-3.1-101 (2.3), C.R.S.; (f) 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 Colorado Revised Statutes 2019 Page 33 of 1101 Uncertified Printout 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. (g) 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. (h) 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. (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. (b) 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) (a) The department shall make the following information available to the public: (I) Any investigation summaries prepared pursuant to subsection (5) of this section; (II) 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 (III) A listing of any deficiency citations issued against each health care facility. Colorado Revised Statutes 2019 Page 34 of 1101 Uncertified Printout (b) 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 namebased 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: (a) A nursing facility as defined in section 25.5-4-103 (14), C.R.S.; (b) An intermediate nursing facility for persons with intellectual and developmental disabilities as defined in section 25.5-4-103 (9); (c) An adult day care facility as defined in section 25.5-6-303 (1), C.R.S.; Colorado Revised Statutes 2019 Page 35 of 1101 Uncertified Printout (d) An alternative care facility as defined in section 25.5-6-303 (3), C.R.S.; (e) 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 171046), 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 Colorado Revised Statutes 2019 Page 36 of 1101 Uncertified Printout 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) (a) 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. (b) 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: (a) "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. Colorado Revised Statutes 2019 Page 37 of 1101 Uncertified Printout (b) "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. (c) "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. (d) "Residence" means the patient's home. "Residence" does not include a rehabilitation facility, hospital, nursing home, assisted living facility, or licensed group home. (2) (a) 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. (b) 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. (c) A patient or patient's legal guardian is not obligated to designate a caregiver at any time. (d) 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) (a) 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. (b) 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. (c) 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. (d) 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) (a) 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: (I) The name and contact information of the caregiver, as provided by the caregiver; (II) A description of the aftercare tasks necessary to maintain the patient's ability to reside in his or her residence; and (III) Contact information for any health care, community resources, and long-term services and support necessary to successfully carry out a patient's discharge plan. (b) The hospital shall provide the caregiver with instructions concerning all aftercare tasks described in the discharge plan. The instructions shall include: Colorado Revised Statutes 2019 Page 38 of 1101 Uncertified Printout (I) 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; (II) An opportunity for the caregiver and the patient or the patient's legal guardian to ask questions about the aftercare tasks; and (III) 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. (c) 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: (a) Interferes with the rights of an agent acting under a valid health care directive; (b) Creates a private right of action against a hospital, a hospital employee, or a person with whom the hospital has a contractual relationship; (c) Creates additional civil or regulatory liability for a hospital or hospital employee; (d) Supersedes or replaces existing rights or remedies under any other law; or (e) 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. (1) On or before December 1, 2019, the department shall report to the general assembly the findings from studies the department conducted pursuant to the federal grant titled the "Prescription Drug Overdose Prevention for States Cooperative Agreement" that the department received concerning: (a) The prescription drug monitoring program integration methods; and (b) Health care provider report cards. (2) The department shall forward the findings from studies conducted pursuant to subsection (1) of this section to the center for research into substance use disorder prevention, treatment, and recovery support strategies at the university of Colorado health sciences center created in section 27-80-118 (3). The center shall use the information to provide voluntary training for health care providers in targeted areas. (3) This section is repealed, effective July 1, 2020. Source: L. 2018: Entire section added, (SB 18-022), ch. 221, p. 1407, § 8, effective May 21. PART 2 ALCOHOL AND DRUG ABUSE 25-1-201 to 25-1-217. (Repealed) Colorado Revised Statutes 2019 Page 39 of 1101 Uncertified Printout Source: L. 2010: Entire part repealed, (SB 10-175), ch. 188, p. 675, § 1, effective April 29. Editor's note: (1) This part 2 was numbered as article 36 of chapter 66, C.R.S. 1963. For amendments to this part 2 prior to its repeal in 2010, 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. (2) The provisions of this part 2 were relocated to article 80 of title 27 in 2010. (3) Section 25-1-201 (4) was amended by House Bill 10-1422 and section 25-1-217 (3)(a) was amended by House Bill 10-1347. Said bills were harmonized with Senate Bill 10-175 and relocated to sections 27-80-101 and 27-80-117, respectively. PART 3 ALCOHOLISM AND INTOXICATION TREATMENT 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. Editor's note: (1) This part 3 was numbered as article 45 of chapter 66, C.R.S. 1963. For amendments to this part 3 prior to its repeal in 2010, 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. (2) The provisions of this part 3 were relocated to article 81 of title 27 in 2010. PART 4 STATE CHEMIST 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 Colorado Revised Statutes 2019 Page 40 of 1101 Uncertified Printout 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. PART 5 PUBLIC HEALTH Editor's note: This part 5 was numbered as article 2 of chapter 66, C.R.S. 1963. The substantive provisions of this part 5 were repealed and reenacted in 2008, resulting in the addition, relocation, and elimination of sections as well as subject matter. For amendments to this part 5 prior to 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. Former C.R.S. section numbers are shown in editor's notes following those sections that were relocated. For a detailed comparison of this part 5, see the comparative tables located in the back of the index. Cross references: For right to establish disposal districts in counties maintaining health departments, see part 2 of article 20 of title 30. Law reviews: For article, "Using Local Police Powers to Protect the Environment", see 24 Colo. Law. 1063 (1995). Colorado Revised Statutes 2019 Page 41 of 1101 Uncertified Printout SUBPART 1 GENERAL 25-1-501. Legislative declaration. (1) The general assembly hereby finds and declares that: (a) 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. (b) 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. (c) 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; (d) 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 (e) 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: (I) Identify and provide leadership for the provision of essential public health services; (II) Develop and support an information infrastructure that supports essential public health services and functions; (III) Develop and provide effective education and training for members of the public health workforce; (IV) Develop performance-management standards for the public health system that are tied to improvements in public health outcomes or other measures; and (V) 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: Colorado Revised Statutes 2019 Page 42 of 1101 Uncertified Printout (a) Monitor health status to identify and solve community health problems; (b) Investigate and diagnose health problems and health hazards in the community; (c) Inform, educate, and empower individuals about health issues; (d) Mobilize public and private sector collaboration and action to identify and solve health problems; (e) Develop policies, plans, and programs that support individual and community health efforts; (f) Enforce laws and rules that protect health and promote safety; (g) Link individuals to needed personal health services and ensure the provision of health care; (h) Encourage a competent public health workforce; (i) Evaluate effectiveness, accessibility, and quality of personal and population-based public health services; and (j) 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: (a) 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; (b) To establish, by rule, the minimum quality standards for public health services; (c) To establish, by rule, the minimum qualifications for county and district public health directors and medical officers; (d) To ensure the development and implementation of a comprehensive, statewide public health improvement plan; Colorado Revised Statutes 2019 Page 43 of 1101 Uncertified Printout (e) 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 (f) 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) (a) The plan shall assess and set priorities for the public health system and shall: (I) Guide the public health system in targeting core public health services and functions through program development, implementation, and evaluation; (II) Increase the efficiency and effectiveness of the public health system; (III) Identify areas needing greater resource allocation to provide essential public health services; (IV) Incorporate, to the extent possible, goals and priorities of public health plans developed by county or district public health agencies; and (V) Consider available resources, including but not limited to state and local funding, and be subject to modification based on actual subsequent allocations. (b) The plan shall include or address at a minimum the following elements: (I) Core public health services and standards for county and district public health agencies; (II) 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; (III) Identification and quantification of existing public health problems, disparities, or threats at the state and county levels; (IV) Identification of existing public health resources at the state and local levels; (V) Declaration of the goals of the plan; (VI) Identification of specific recommendations for meeting these goals; Colorado Revised Statutes 2019 Page 44 of 1101 Uncertified Printout (VII) Development of public and environmental health infrastructure that supports core public health functions and essential public health services at the state and local levels; (VIII) Explanation of the prioritization of one or more conditions of public health importance; (IX) Detailed description of strategies to develop and promote culturally and linguistically appropriate services; (X) Development, evaluation, and maintenance of, and improvements to, an information infrastructure that supports essential public health services; (XI) Detailed description of the programs and activities that will be pursued to address existing public and environmental health problems, disparities, or threats; (XII) 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; (XIII) 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; (XIV) Estimation of costs of implementing the plan; (XV) A timeline for implementing various elements of the plan; (XVI) A strategy for coordinating service delivery within the public health system; and (XVII) Measurable indicators of effectiveness and successes. (c) 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 Colorado Revised Statutes 2019 Page 45 of 1101 Uncertified Printout 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: (a) Examine data about health status and risk factors in the local community; (b) Assess the capacity and performance of the county or district public health system; (c) Identify goals and strategies for improving the health of the local community; (d) Describe how representatives of the local community develop and implement the local plan; (e) 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 (f) 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) (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. (II) 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 Colorado Revised Statutes 2019 Page 46 of 1101 Uncertified Printout appoint the number of members specified in the agreement of merger, and the remaining members shall be appointed as provided in this section. (III) 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. (b) 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. (c) 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) (a) 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. (b) In addition to other powers and duties, an agency shall have the following duties: (I) 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; (II) To advise the county or district board on public policy issues necessary to protect public health and the environment; (III) 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; (IV) 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: (A) Public health, air pollution, solid and hazardous waste, and water quality; (B) Vital statistics; and (C) The orders, rules, and standards of the state board and any other type 1 agency created pursuant to the provisions of this title; (V) To investigate and control the causes of epidemic or communicable diseases and conditions affecting public health; (VI) 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; Colorado Revised Statutes 2019 Page 47 of 1101 Uncertified Printout (VII) To close schools and public places and to prohibit gatherings of people when necessary to protect public health; (VIII) To investigate and abate nuisances when necessary in order to eliminate sources of epidemic or communicable diseases and conditions affecting public health; (IX) 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; (X) 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; (XI) 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; (XII) 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; (XIII) 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; (XIV) 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 (XV) 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. (c) 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. Editor's note: (1) 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. (2) Subsection (4)(b) provided for the repeal of subsection (4), effective July 1, 2009. (See L. 2008, p. 2036.) Colorado Revised Statutes 2019 Page 48 of 1101 Uncertified Printout 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) (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. (II) 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. (b) 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. (c) 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. (d) 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 homerule charter. (3) (a) 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 Colorado Revised Statutes 2019 Page 49 of 1101 Uncertified Printout 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. (b) 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. (c) 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) (a) 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. (b) (I) 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. (II) 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: (a) To develop and promote the public policies needed to secure the conditions necessary for a healthy community; (b) 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; (c) (I) 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 Colorado Revised Statutes 2019 Page 50 of 1101 Uncertified Printout 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. (II) 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. (d) (I) 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. (II) 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. (e) 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; (f) 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; (g) 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; (h) To act in an advisory capacity to the public health director on all matters pertaining to public health; (i) 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; (j) 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; (k) 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. (l) 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. Colorado Revised Statutes 2019 Page 51 of 1101 Uncertified Printout 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. Editor's note: (1) 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. (2) Subsection (6)(b) provided for the repeal of subsection (6), effective July 1, 2009. (See L. 2008, p. 2039.) Cross references: For the legislative declaration in SB 16-158, see section 1 of chapter 204, Session Laws of Colorado 2016. 25-1-509. County and district public health directors. (1) (a) The director of each agency shall be the public health director. (b) 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. (c) 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: (a) To administer and enforce: (I) 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 (II) The orders and rules of the county or district board; (b) 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; (c) 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; (d) 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; (e) To direct the resources needed to carry out the county or district public health plan developed pursuant to section 25-1-505; and (f) 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. Colorado Revised Statutes 2019 Page 52 of 1101 Uncertified Printout 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) (a) 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. (b) 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: (a) Any moneys appropriated from a county general fund; and (b) 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 Colorado Revised Statutes 2019 Page 53 of 1101 Uncertified Printout 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) (a) 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. (b) 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) (a) 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. (b) (I) 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. (II) 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. (c) Federally funded and state-funded special projects and demonstrations shall be in addition to the allotments specified in paragraph (b) of this subsection (1). Colorado Revised Statutes 2019 Page 54 of 1101 Uncertified Printout (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. Editor's note: (1) This section is similar to former § 25-1-516 as it existed prior to 2008. (2) For the amendments in HB 16-1408 in effect from May 4, 2016, to July 1, 2016, see chapter 153, Session Laws of Colorado 2016. (See L. 2016, p. 466.) (3) Subsection (2)(b) provided for the repeal of subsection (2), effective July 1, 2016. (See L. 2016, p. 466.) 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 Colorado Revised Statutes 2019 Page 55 of 1101 Uncertified Printout 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: (a) Contrary to constitutional rights or privileges; (b) In excess of the statutory authority or jurisdiction of the county or district board or public health director; (c) Affected by any error of law; (d) Made or promulgated upon unlawful procedure; (e) Unsupported by substantial evidence in view of the entire record as submitted; or (f) 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: Colorado Revised Statutes 2019 Page 56 of 1101 Uncertified Printout (a) Willfully violate, disobey, or disregard the provisions of the public health laws or the terms of any lawful notice, order, standard, or rule; (b) 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; (c) Willfully and falsely make or alter a certificate or certified copy of any certificate issued pursuant to the public health laws; (d) 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 (e) 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 Colorado Revised Statutes 2019 Page 57 of 1101 Uncertified Printout 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 Colorado Revised Statutes 2019 Page 58 of 1101 Uncertified Printout 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. (a) 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. (b) 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 Colorado Revised Statutes 2019 Page 59 of 1101 Uncertified Printout 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: (a) The scope of the problem being addressed and the population the program would serve; (b) Concerns of the law enforcement community; and (c) 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: (a) 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; (b) Provide thorough referrals to facilitate entry into substance use disorder treatment programs, including opioid substitution therapy; (c) Encourage usage of medical care and mental health services as well as social welfare and health promotion; (d) Provide safety protocols and classes for the proper handling and disposal of injection materials; (e) 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; (f) Develop a timeline for the proposed program and for the development of policies and procedures; and (g) 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. (2.5) A program developed pursuant to this section may be operated in a hospital licensed or certified by the state department pursuant to section 25-1.5-103 (1)(a). (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. Colorado Revised Statutes 2019 Page 60 of 1101 Uncertified Printout Editor's note: (1) Subsection (6)(b) provided for the repeal of subsection (6), effective July 1, 2014. (See L. 2010, p. 1253.) (2) Section 17 of chapter 273 (SB 19-227), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 23, 2019. 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. (1) For the 2019-20 fiscal year, the general assembly shall appropriate two million dollars to the state department to address opioid and substance use disorders through public health interventions and to work with community partners, including county and district public health agencies, to address opioid and other substance use priorities throughout the state. The state department may use the money for data collection, analysis, and dissemination activities related to opioid and other substance use disorders at the state and local levels, including community health assessments and improvement planning. The state department may use up to five hundred thousand dollars of the money for administrative costs and other activities related to the purposes of this section. (2) This section is repealed, effective July 1, 2020. Source: L. 2019: Entire section added, (SB 19-228), ch. 276, p. 2603, § 7, effective May 23. Editor's note: Section 20 of chapter 276 (SB 19-228), Session Laws of Colorado 2019, provides that the act adding this section applies to conduct occurring on or after May 23, 2019. PART 6 LOCAL BOARDS OF HEALTH 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. PART 7 REGIONAL HEALTH DEPARTMENTS Colorado Revised Statutes 2019 Page 61 of 1101 Uncertified Printout 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. PART 8 PATIENT RECORDS Law reviews: For article, "Rights to and Disclosure of Medical Information: HIPAA and Colorado Law", see 33 Colo. Law. 101 (Oct. 2004). 25-1-801. Patient records in custody of health care facility - definitions. (1) (a) 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. (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. (B) 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. (II) 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 Colorado Revised Statutes 2019 Page 62 of 1101 Uncertified Printout 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. (c) 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. (d) 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: (a) "HIPAA-compliant" means in compliance with the "Health Insurance Portability and Accountability Act of 1996", Pub.L. 104-191, as amended. (b) "Personal representative" has the meaning set forth in 45 CFR 164.502. (c) (I) "Reasonable fees" means an amount not to exceed: (A) 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; (B) For radiographic studies, actual reproduction costs for each copy of a radiograph; (C) If the authorized person requests certification of the medical records, a fee of ten dollars; (D) Actual postage and electronic media costs, if applicable; and (E) Applicable taxes. (II) Notwithstanding any other provision of this part 8: (A) 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; (B) 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 Colorado Revised Statutes 2019 Page 63 of 1101 Uncertified Printout (C) 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. Editor's note: Section 74 of chapter 390 (SB 19-241), Session Laws of Colorado 2019, provides that the act changing this section takes effect only if HB 19-1172 becomes law, in which case this section takes effect on the effective date of HB 19-1172. HB 19-1172 became law and took effect October 1, 2019. 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) (a) 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. (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. Colorado Revised Statutes 2019 Page 64 of 1101 Uncertified Printout (B) 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. (II) 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. Editor's note: Section 74 of chapter 390 (SB 19-241), Session Laws of Colorado 2019, provides that the act changing this section takes effect only if HB 19-1172 becomes law, in Colorado Revised Statutes 2019 Page 65 of 1101 Uncertified Printout which case this section takes effect on the effective date of HB 19-1172. HB 19-1172 became law and took effect October 1, 2019. 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: (a) 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 (b) 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. PART 9 COMMISSION ON FAMILY MEDICINE 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. PART 10 CHILD CARE PROGRAMS IN NURSING HOME FACILITIES Colorado Revised Statutes 2019 Page 66 of 1101 Uncertified Printout 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: (a) 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: (I) 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; (II) Requirements relating to the ability to properly care for the children; (III) Child care ratios of staff to children; (IV) Requirements relating to the constant supervision of the children by staff members and not by nursing home residents; (V) Life safety and fire regulations; Colorado Revised Statutes 2019 Page 67 of 1101 Uncertified Printout (b) Requirements on the amount and type of liability insurance necessary to insure the risks associated with the child care operation; (c) 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; (d) 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; (e) 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: (a) 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; (b) 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. Colorado Revised Statutes 2019 Page 68 of 1101 Uncertified Printout (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. PART 11 DRUG ABUSE PREVENTION, EDUCATION, AND TREATMENT 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. Editor's note: (1) This part 11 was added in 1991. For amendments to this part 11 prior to its repeal in 2010, 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. (2) The provisions of this part 11 were relocated to article 82 of title 27 in 2010. PART 12 MEDICAL RECORD CONFIDENTIALITY 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 Colorado Revised Statutes 2019 Page 69 of 1101 Uncertified Printout 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: (a) Section 10-16-1003, C.R.S., concerning use of information by health care cooperatives; (b) Section 8-43-404, C.R.S., concerning examinations by a physician or chiropractor for the purposes of workers' compensation; (c) Section 8-43-501, C.R.S., concerning utilization review related to workers' compensation; (d) Section 8-73-108, C.R.S., concerning the award of benefits for unemployment compensation benefits; (e) Section 10-3-1104.7, C.R.S., concerning the confidentiality and use of genetic testing information; (f) Section 10-16-113, C.R.S., concerning the procedures related to the denial of health benefits by an insurer; (g) Section 10-16-113.5, C.R.S., concerning the use of independent external review when health benefits have been denied; (h) Section 10-16-423, C.R.S., concerning the confidentiality of medical information in the custody of a health maintenance organization; (i) Section 12-290-113, concerning disciplinary actions against podiatrists; (j) Section 12-215-126, concerning confidential communications between a licensed chiropractor and a patient; (k) Section 12-220-130, concerning disciplinary actions against dentists and dental hygienists; (l) Section 12-240-125, concerning disciplinary actions against physicians; (m) Section 12-240-139 (1), concerning reporting requirements for physicians pertaining to certain injuries; (n) Section 12-30-204, concerning professional review committees for physicians; (o) Section 12-30-205, concerning hospital professional review committees; (p) Section 13-22-704, concerning reporting requirements by physicians related to abortions for minors; (q) Section 12-255-119, concerning disciplinary proceedings against a practical nurse, a professional nurse, or a psychiatric technician; (r) Section 12-245-220, concerning the disclosure of confidential communications by a mental health professional; (s) Section 12-245-226 (4), concerning disciplinary proceedings against a mental health professional; (t) 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; Colorado Revised Statutes 2019 Page 70 of 1101 Uncertified Printout (u) 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; (v) Sections 13-22-101 to 13-22-106, C.R.S., concerning the age of competence for certain medical procedures; (w) 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; (x) 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; (y) 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; (z) Section 14-10-124, C.R.S., concerning the best interests of a child for the purposes of a separation or dissolution of marriage; (aa) Section 14-10-127, C.R.S., concerning the allocation of parental responsibilities with respect to a child; (bb) Section 17-27.1-101 (4), C.R.S., concerning nongovernmental facilities for offenders and the waiver of confidential information; (cc) Section 18-3-203 (3), concerning assault in the second degree and the availability of medical testing for certain circumstances; (dd) Section 18-4-412, C.R.S., concerning theft of medical records or medical information; (ee) Repealed. (ee.5) Section 18-18-406.3, C.R.S., concerning medical marijuana patient records; (ff) Section 18-18-503, C.R.S., concerning cooperative agreements to control substance abuse; (gg) Section 19-3-304, C.R.S., concerning persons required to report child abuse or neglect; (hh) Section 19-3-305, C.R.S., concerning postmortem investigation related to the death of a child; (ii) Section 19-3-306, C.R.S., concerning evidence of abuse or neglect of a child; (jj) Section 19-5-103 (2), C.R.S., concerning relinquishment of rights concerning a child; (kk) Section 19-5-305, C.R.S., concerning access to adoption records; (ll) Section 22-1-123 (5), C.R.S., concerning the protection of student data; (mm) 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; (nn) Repealed. (oo) Section 24-51-213, C.R.S., concerning confidentiality of records maintained by the public employees' retirement association; (pp) Section 24-72-204 (3), C.R.S., concerning public records not open to public inspection; (qq) 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 Colorado Revised Statutes 2019 Page 71 of 1101 Uncertified Printout transmitted infections, tuberculosis, and rabies and mammal bites by the department of public health and environment; (rr) Section 25-1-124 (2), concerning health care facilities and reporting requirements; (ss) Sections 27-81-110 and 27-81-113, C.R.S., concerning the treatment of intoxicated persons; (tt) Section 25-1-801, concerning patient records in the care of a health care facility; (uu) Section 25-1-802, concerning patient records in the care of individual health care providers; (vv) Sections 27-82-106 and 27-82-109, concerning the treatment of persons with substance use disorders; (vv.5) Section 25-1.5-106, concerning the medical marijuana program; (ww) Section 25-2-120, concerning reports of electroconvulsive treatment; (xx) Section 25-3-109, concerning quality management functions of health care facilities licensed by the department of public health and environment; (yy) Section 25-3.5-501, concerning records maintained by ambulance services and emergency medical service providers; (zz) Section 25-3.5-704 (2)(d) and (2)(f), concerning the designation of emergency medical facilities and the statewide trauma system; (aaa) Sections 25-4-406 and 25-4-409, concerning the reporting of sexually transmitted infections; (bbb) Section 25-4-1003, concerning newborn screening programs and genetic counseling; (ccc) Repealed. (ddd) Section 25-4-1705, concerning immunization information; (eee) Section 25-4-1905, concerning records collected related to Gulf War syndrome; (fff) Section 25-32-106, concerning the release of medical information to a poison control service provider; (ggg) Section 26-3.1-102 (2), C.R.S., concerning reporting requirements related to atrisk adults; (hhh) Section 26-11.5-108, C.R.S., concerning the long-term ombudsman program and access to medical records; (iii) Section 27-65-103 (2), C.R.S., concerning voluntary applications for mental health services; (jjj) Sections 27-65-121 (2) and 27-65-122, C.R.S., concerning records related to mental health services for minor children; (kkk) Section 30-10-606 (6), C.R.S., concerning postmortem investigations and records; (lll) Section 35-9-109, C.R.S., concerning confidentiality of information released to the commissioner of agriculture related to human exposure to pesticide applications; (mmm) 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 (nnn) 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. Colorado Revised Statutes 2019 Page 72 of 1101 Uncertified Printout 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. 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. PART 13 CLIMATE CHANGE MARKETS GRANT PROGRAM Colorado Revised Statutes 2019 Page 73 of 1101 Uncertified Printout 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: (a) As the United States and other countries take action to address issues related to climate change, Colorado faces important policy choices. (b) Emerging technologies and markets related to climate change promise significant economic opportunities for the state, particularly for agriculture and rural economies. (c) 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) (a) 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. (b) 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. (c) 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. PART 14 HEALTH INFORMATION TECHNOLOGY 25-1-1401 to 25-1-1403. (Repealed) Editor's note: (1) This part 14 was added in 2007 and was not amended prior to its repeal in 2012. For the text of this part 14 prior to 2012, consult the 2011 Colorado Revised Colorado Revised Statutes 2019 Page 74 of 1101 Uncertified Printout Statutes and the Colorado statutory research explanatory note beginning on page vii in the front of this volume. (2) Section 25-1-1403 provided for the repeal of this part 14, effective July 1, 2012. (See L. 2007, p. 1182.) ARTICLE 1.5 Powers and Duties of the Department of Public Health and Environment Editor's note: This article was added with relocations in 2003. Former C.R.S. section numbers are shown in editor's notes following those sections that were relocated. PART 1 GENERAL POWERS AND DUTIES 25-1.5-101. Powers and duties of department - laboratory cash fund - report. (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: (a) To close theaters, schools, and other public places, and to forbid gatherings of people when necessary to protect the public health; (b) (I) 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. (II) 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. (c) (I) 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. (II) 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. (d) To regulate the disposal, transportation, interment, and disinterment of the dead; (e) (I) 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. (II) 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 Colorado Revised Statutes 2019 Page 75 of 1101 Uncertified Printout 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). (f) 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; (g) 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; (h) 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; (i) (I) To establish sanitary standards and make sanitary, sewerage, and health inspections and examinations for charitable, penal, and other public institutions, and, with respect to the state institutions under the department of human services specified in section 2790-104, C.R.S., or under the department of corrections specified in section 17-1-104.3 (1)(b), C.R.S., such inspections and examinations shall be made at least once each year. Reports on such inspections of institutions under control of the department of human services or the department of corrections shall be made to the executive director of the appropriate department for appropriate action, if any. (II) 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. (j) (I) To disseminate public health information; (II) 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; (k) 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; (l) To establish and enforce standards for exposure to environmental conditions, including radiation, that may be deemed necessary for the protection of the public health; Colorado Revised Statutes 2019 Page 76 of 1101 Uncertified Printout (m) (I) 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. (II) 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. (n) 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; (o) 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.; (p) 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. (q) (I) 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. (II) 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. (r) 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; (s) 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. (t) 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; (u) 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; (v) 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; Colorado Revised Statutes 2019 Page 77 of 1101 Uncertified Printout (w) (I) 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. (II) 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. (III) (A) 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. (B) (Deleted by amendment, L. 2012.) (IV) 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 251.5-103 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 25-1.5112. 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: (A) The information and materials being used and distributed in facilities throughout the state; (B) 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 Colorado Revised Statutes 2019 Page 78 of 1101 Uncertified Printout (C) 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. (x) To implement the state dental loan repayment program created in article 23 of this title; (y) 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; (z) 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; (aa) 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.; (bb) 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 16189), 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 17056), 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. 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: (a) (I) To investigate and control the causes of epidemic and communicable diseases affecting the public health. (II) 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 Colorado Revised Statutes 2019 Page 79 of 1101 Uncertified Printout 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. (III) 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. (IV) 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. (b) (I) 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. (II) 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. (III) 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. (IV) 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: (A) Accessing information on the incident and any persons involved to determine whether a potential exposure to hepatitis C occurred; (B) 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; (C) 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 (D) Providing counseling to the involved persons on the potential health risks resulting from exposure and the available methods of treatment. (V) 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. Colorado Revised Statutes 2019 Page 80 of 1101 Uncertified Printout (VI) For purposes of this paragraph (b), "public safety worker" includes, but is not limited to, law enforcement officers, peace officers, and firefighters. (c) 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; (d) 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 101422), 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. Editor's note: (1) This section is similar to former § 25-1-107 (1)(a), (1)(a.5), (1)(b), and (1)(d) as they existed prior to 2003. (2) Amendments to subsection (1)(b)(IV) by House Bill 03-1266 and Senate Bill 03-002 were harmonized. 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: (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. (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, Colorado Revised Statutes 2019 Page 81 of 1101 Uncertified Printout 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. (B) 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. (C) 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. (D) 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). (E) 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. (F) 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. (II) 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; Colorado Revised Statutes 2019 Page 82 of 1101 Uncertified Printout (b) 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.; (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. (II) 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: (a) "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. (a.3) [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: (I) Residential child care facilities, as defined in section 26-6-102 (33); or (II) 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. (a.5) "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 section 1861 (aa)(4) of 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 Colorado Revised Statutes 2019 Page 83 of 1101 Uncertified Printout (III) A freestanding emergency department, as defined in and required to be licensed under section 25-1.5-114. (b) "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. (b.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. (c) "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. (d) "Hospice care" means an entity that administers services to a terminally ill person utilizing palliative care or treatment. (3) (a) 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. (b) For purposes of this subsection (3), "rural" means: (I) A county of less than fifteen thousand population; or (II) A municipality of less than fifteen thousand population which is located ten miles or more from a municipality of over fifteen thousand population; or (III) The unincorporated part of a county ten miles or more from a municipality of fifteen thousand population or more. (c) 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. Colorado Revised Statutes 2019 Page 84 of 1101 Uncertified Printout (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) (a) 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. (b) 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. (c) 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. (d) 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. (e) 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 131300), ch. 316, p. 1687, § 73, effective August 7; (1)(a)(I)(A) and (2)(c) amended, (HB 131314), 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 Colorado Revised Statutes 2019 Page 85 of 1101 Uncertified Printout 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. Editor's note: (1) This section is similar to former § 25-1-107 (1)(l), (3), and (4) as they existed prior to 2003. (2) Amendments to subsection (2) in sections 21 and 63 of House Bill 06-1277 were harmonized. As a result of the harmonization, subsection (2)(a) in section 63 of House Bill 061277 was renumbered as subsection (2)(b). (3) Amendments to subsection (1)(a)(I)(A) by HB 19-1010 and HB 19-1237 were harmonized, effective July 1, 2021. Cross references: For the legislative declaration in the 2012 act amending subsections (1)(a)(I) and (1)(c) and the introductory portion to subsection (2)(a.5) and adding subsection (2)(b.5), see section 1 of chapter 252, Session Laws of Colorado 2012. For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017. For the legislative declaration in HB 19-1060, see section 1 of chapter 10, Session Laws of Colorado 2019. 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: (a) 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; (b) (I) 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. (II) 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. Colorado Revised Statutes 2019 Page 86 of 1101 Uncertified Printout The word "standards" as used in this section means standards reasonably designed to promote and protect the public health. (c) 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; (d) To approve all oils used in reading tests of samples of cream and milk; (e) 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; (f) To license manufacturers of oleomargarine; (g) 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: (a) 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; (b) 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; (c) 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: (a) Is permanent; (b) Leaves residual disability; (c) Is caused by nonreversible pathological alterations; (d) Requires special patient education and instruction for rehabilitation; or (e) 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: (a) May be either temporary or permanent; (b) May leave residual disability; (c) May result in birth defects, damage to tissues and organs, and chronic illness; and Colorado Revised Statutes 2019 Page 87 of 1101 Uncertified Printout (d) 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. (a) 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: (I) 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 (II) 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. (b) 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. (c) 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. (d) 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: (a) "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. (a.5) "Bona fide physician-patient relationship", for purposes of the medical marijuana program, means: (I) 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 Colorado Revised Statutes 2019 Page 88 of 1101 Uncertified Printout reviewing a previous diagnosis for a debilitating or disabling medical condition, and current medical condition, including an appropriate personal physical examination; (II) 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 (III) 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. (a.7) "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. (b) "Executive director" means the executive director of the state health agency. (c) "In good standing", with respect to a physician's or dentist or advanced practice practitioner license, means: (I) 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; (II) 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 (III) 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. (d) "Medical marijuana program" means the program established by section 14 of article XVIII of the state constitution and this section. (d.3) "Patient" means a person who has a debilitating medical condition or disabling medical condition. (d.4) "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. (d.5) "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: Colorado Revised Statutes 2019 Page 89 of 1101 Uncertified Printout (I) 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; (II) 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; (III) A transporting caregiver who purchases and transports marijuana to a patient who is homebound; or (IV) A cultivating caregiver who grows marijuana for a patient. (e) "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. (e.3) "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. (e.5) "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". (f) "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. (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: (I) The patient was previously diagnosed by a physician as having a disabling medical condition; (II) 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 (III) The patient and his or her primary caregiver were collectively in possession of amounts of marijuana only as permitted under this section. (b) 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. (c) 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. (d) It is an exception from the state's criminal laws for any physician to: (I) 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 Colorado Revised Statutes 2019 Page 90 of 1101 Uncertified Printout 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 (II) 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. (e) 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. (f) 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. (g) (I) 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: (A) No more than two ounces of a usable form of marijuana; and (B) No more than six marijuana plants, with three or fewer being mature, flowering plants that are producing a usable form of marijuana. (II) 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. (h) (I) No patient with a disabling medical condition shall: (A) Engage in the medical use of marijuana in a way that endangers the health or wellbeing of any person; or (B) Engage in the medical use of marijuana in plain view of, or in a place open to, the general public. (II) 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. (i) 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: (I) 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 Colorado Revised Statutes 2019 Page 91 of 1101 Uncertified Printout physician shall review the records of a diagnosing physician or a licensed mental health provider acting within their scope of practice. (II) 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; (III) 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; (IV) 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; (V) A parent residing in Colorado consents in writing to serve as the patient's primary caregiver; (VI) 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; (VII) 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; (VIII) The patient and primary caregiver collectively possess amounts of marijuana no greater than those specified in subsection (2.5)(g) of this section; and (IX) 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. (j) 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. (a) 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: (I) 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). (II) 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; (III) 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; (IV) 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; Colorado Revised Statutes 2019 Page 92 of 1101 Uncertified Printout (V) 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; (VI) 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; (VII) 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; (VIII) 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 (IX) 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. (b) The state health agency may promulgate rules regarding the following: (I) Repealed. (II) 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 (III) Repealed. (IV) The grounds and procedure for a patient to change his or her designated primary caregiver. (c) Repealed. (d) 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. (a) 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. (b) [Editor's note: This version of subsection (3.5)(b) is effective until January 1, 2020.] 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 11 or 12 of title 44. (b) [Editor's note: This version of subsection (3.5)(b) is effective January 1, 2020.] 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. Colorado Revised Statutes 2019 Page 93 of 1101 Uncertified Printout (c) The state health agency may also include in the reference library standard sample attainment procedures and standards related to sample preparation for laboratory analysis. (d) 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. (3.8) (a) [Editor's note: This version of subsection (3.8)(a) is effective until January 1, 2020.] 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 11 or 12 of title 44. (3.8) (a) [Editor's note: This version of subsection (3.8)(a) is effective January 1, 2020.] 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. (b) 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: (a) 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. (b) 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. (c) 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. (d) A physician shall not: Colorado Revised Statutes 2019 Page 94 of 1101 Uncertified Printout (I) Accept, solicit, or offer any form of pecuniary remuneration from or to a primary caregiver, distributor, or any other provider of medical marijuana; (II) 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; (III) 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 (IV) 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. (e) Only a physician can make a medical marijuana recommendation; except 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. (a) 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. (b) 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. (c) 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. (d) 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. (a) 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. (b) Two or more primary caregivers shall not join together for the purpose of cultivating medical marijuana. Colorado Revised Statutes 2019 Page 95 of 1101 Uncertified Printout (c) 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. (d) 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). (e) (I) (A) [Editor's note: This version of subsection (7)(e)(I)(A) is effective until January 1, 2020.] 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 as described in part 4 of article 11 of title 44 or a retail marijuana business as described in part 4 of article 12 of title 44. An employee, contractor, or other support staff employed by a licensed entity pursuant to article 11 or 12 of title 44, or working in or having access to a restricted area of a licensed premises pursuant to article 11 or 12 of title 44, may be a primary caregiver. (e) (I) (A) [Editor's note: This version of subsection (7)(e)(I)(A) is effective January 1, 2020.] 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. (B) 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. (C) 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. Colorado Revised Statutes 2019 Page 96 of 1101 Uncertified Printout (D) 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. (E) 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. (II) 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. (III) 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. (f) 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. (a) (I) 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. (II) 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. (b) (I) 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. (II) The short title of this subsection (8)(b) is "Ethan's Law". (c) A patient who has designated a primary caregiver for himself or herself may not be designated as a primary caregiver for another patient. (d) 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. Colorado Revised Statutes 2019 Page 97 of 1101 Uncertified Printout (e) (I) 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. (II) 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. (III) 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. (IV) 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. (V) 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. (f) 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. (g) Notwithstanding any other provision of law, a primary caregiver shall not grow, sell, or process marijuana for any person unless: (I) The person is a patient holding a current and valid registry identification card; and (II) 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. (a) (I) 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. (II) 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. (a.5) (I) 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: (A) 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; Colorado Revised Statutes 2019 Page 98 of 1101 Uncertified Printout (B) Registers pursuant to this subsection (8.5) with the state licensing authority's registry; and (C) 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. (II) 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. (b) [Editor's note: This version of subsection (8.5)(b) is effective until January 1, 2020.] A patient shall not cultivate more than ninety-nine plants. Only a medical marijuana business licensed and properly authorized pursuant to article 11 of title 44 may cultivate more than ninety-nine plants. (b) [Editor's note: This version of subsection (8.5)(b) is effective January 1, 2020.] 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. (b.5) A patient who cultivates his or her own medical marijuana plants shall comply with all local laws, regulations, and zoning and use restrictions. (c) 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. (d) 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. (a) (I) 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. (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: (A) 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; Colorado Revised Statutes 2019 Page 99 of 1101 Uncertified Printout (B) Is registered pursuant to this subsection (8.6) with the state licensing authority's registry; and (C) 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. (II) (A) 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. (B) 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. (b) [Editor's note: This version of subsection (8.6)(b) is effective until January 1, 2020.] A primary caregiver shall not cultivate more than ninety-nine plants. Only a medical marijuana business licensed and properly authorized pursuant to article 11 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. (b) [Editor's note: This version of subsection (8.6)(b) is effective January 1, 2020.] 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. (c) 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. (d) 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. Colorado Revised Statutes 2019 Page 100 of 1101 Uncertified Printout (9) Registry identification card required - denial - revocation - renewal. (a) 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. (b) 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. (c) 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. (d) 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. (e) 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 Colorado Revised Statutes 2019 Page 101 of 1101 Uncertified Printout 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. (a) 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. (b) A patient or primary caregiver shall not: (I) Engage in the medical use of marijuana in a way that endangers the health and wellbeing of a person; (II) Engage in the medical use of marijuana in plain view of or in a place open to the general public; (III) Undertake any task while under the influence of medical marijuana, when doing so would constitute negligence or professional malpractice; (IV) 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.; (V) Engage in the use of medical marijuana while: (A) In a correctional facility or a community corrections facility; (B) Subject to a sentence to incarceration; or (C) In a vehicle, aircraft, or motorboat; (VI) Operate, navigate, or be in actual physical control of any vehicle, aircraft, or motorboat while under the influence of medical marijuana; or (VII) 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. (c) 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 Colorado Revised Statutes 2019 Page 102 of 1101 Uncertified Printout 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) (a) 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. (b) 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. (a) 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. (b) Repealed. (17) Cash fund. (a) 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. (b) (Deleted by amendment, L. 2010, (HB 10-1284), ch. 355, p. 1677, § 2, effective July 1, 2010.) (b.5) (Deleted by amendment, L. 2014.) (c) Repealed. (d) (I) 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. Colorado Revised Statutes 2019 Page 103 of 1101 Uncertified Printout (II) 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. (III) 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. (e) 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. (f) 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 25-1.5106.5 for each of the fiscal years 2019-20, 2020-21, and 2021-22. (18) (a) This section is repealed, effective September 1, 2028. (b) 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 101388), 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), Colorado Revised Statutes 2019 Page 104 of 1101 Uncertified Printout (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 19241), 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. Editor's note: (1) This section is similar to former § 25-1-107 (1)(jj) as it existed prior to 2003. (2) Amendments to this section by Senate Bill 10-109 and House Bill 10-1284 were harmonized. (3) Subsection (17)(b.5) was added as subsection (3)(c) by House Bill 10-1388. That provision was harmonized with Senate Bill 10-109 and House Bill 10-1284 resulting in its relocation. (4) Subsection (3)(c)(II) provided for the repeal of subsection (3)(c), effective July 1, 2011. (See L. 2010, p. 1677.) Subsections (16)(b)(II) and (17)(c)(II) provided for the repeal of subsections (16)(b) and (17)(c), respectively, effective July 1, 2012. (See L. 2010, p. 1691.) (5) Subsection (3.8) was originally numbered as (3.7) in HB 15-1283 but was renumbered on revision for ease of location. (6) Amendments to subsection (10) by SB 17-242 and HB 17-1329 were harmonized. (7) Subsection (2.5)(i)(I) was amended in HB 19-1028. Those amendments were superseded by the amendment of this section in SB 19-013, effective August 2, 2019. For the amendments to subsection (2.5)(i)(I) in HB 19-1028 in effect from April 2, 2019, to August 2, 2019, see chapter 71, Session Laws of Colorado 2019. (L. 2019, p. 255.) (8) Subsection (3.7) was amended in SB 19-224, effective January 1, 2020. However, those amendments were superseded by the repeal of subsection (3.7) by SB 19-218, effective August 2, 2019. (9) Amendments to subsection (2)(a.7) by HB 19-1028 and SB 19-013 were harmonized. (10) Amendments to subsections (5)(c), (6)(a), and (6)(c) by SB 19-218, SB 19-241, and HB 19-1172 were harmonized. Cross references: (1) For the legislative declaration in SB 14-155, see section 1 of chapter 237, Session Laws of Colorado 2014. For the legislative declaration in SB 15-014, see section 1 of chapter 199, Session Laws of Colorado 2015. For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017. For the legislative declaration in HB 17-1220, see section 1 of chapter 402, Session Laws of Colorado 2017. (2) For the state licensing authority, see § 44-11-201. 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. Colorado Revised Statutes 2019 Page 105 of 1101 Uncertified Printout (2) Medical marijuana research grant program - rules. (a) (I) 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". (II) 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. (b) The state board of health shall promulgate rules for the administration of the grant program, including: (I) The procedures and timelines by which an entity may apply for program grants; (II) Grant application contents, including: (A) Descriptions of key personnel, including clinicians, scientists, or epidemiologists and support personnel, demonstrating they are adequately trained to conduct this research; (B) Procedures for outreach to patients with various medical conditions who may be suitable participants in research on marijuana and its component parts; (C) Protocols suitable for research on marijuana and its component parts as medical treatment; (D) For any research studies, demonstration that appropriate protocols for adequate patient consent and follow-up procedures are in place; and (E) 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; (III) Criteria for selecting entities to receive grants and determining the amount and duration of the grants, which shall include the following: (A) 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 (B) 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 (IV) Reporting requirements for entities that receive grants pursuant to this section. (c) 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). (d) In order to maximize the scope and size of the marijuana studies: (I) 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 (II) 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. (a) Scientific advisory council. (I) In order to ensure objectivity in evaluating research proposals, the grant program shall establish a scientific Colorado Revised Statutes 2019 Page 106 of 1101 Uncertified Printout 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: (A) At least one epidemiologist with expertise in designing and conducting large, observational studies and clinical trials; (B) At least one clinician with expertise in designing and conducting clinical trials; (C) A clinician familiar with the prescription, dosage, and administration of medical marijuana under current state laws; (D) A medical toxicologist; (E) A neurologist; (F) A pediatrician; (G) A psychiatrist; (H) An internal medicine physician or other specialist in adult medicine; (I) 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. (II) 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. (III) 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. (b) 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. Colorado Revised Statutes 2019 Page 107 of 1101 Uncertified Printout (4) Reporting. (a) 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. (b) 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: (I) The names and number of diseases or conditions under study; (II) The number of patients enrolled in each study by disease; and (III) Any scientifically valid preliminary findings. (5) Sources of marijuana. (a) 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. (b) [Editor's note: This version of subsection (5)(b) is effective until January 1, 2020.] A person who holds an optional premises cultivation license or medical marijuana-infused products manufacturing license issued pursuant to part 4 of article 43.3 of title 12 or a retail marijuana cultivation facility license or a retail marijuana products manufacturing license issued pursuant to part 4 of article 43.4 of title 12 may transfer marijuana to a medical research facility, including at an institution of higher education, for use in research studies funded pursuant to this section. Notwithstanding any other provision of law, a medical research facility authorized pursuant to this section to conduct medical research regarding marijuana is exempt from all otherwise applicable restrictions on the possession and use of marijuana; except that the facility shall use the marijuana only for the medical research authorized pursuant to this section, shall not possess at any time a quantity of medical marijuana or medical marijuana-infused product in excess of the limit established in rules promulgated by the state licensing authority, and shall destroy all marijuana remaining after the research has been completed. For the fiscal years beginning on or after July 1, 2017, the general assembly may annually appropriate up to one percent of the available money in the marijuana tax cash fund created in section 39-28.8-501 to the department to be used to award grants pursuant to this section to medical research facilities so that a facility may: (I) Purchase marijuana from a licensee specified in this subsection (5)(b) that will be used in the research; and (II) Conduct the medical research. (b) [Editor's note: This version of subsection (5)(b) is effective January 1, 2020.] 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. Colorado Revised Statutes 2019 Page 108 of 1101 Uncertified Printout 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: (a) "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: (I) Is part of the state pandemic preparedness and response plan; (II) Will purchase antiviral therapy with its own funds; and (III) 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. (b) "Bioterrorism" means the intentional use of microorganisms or toxins of biological origin to cause death or disease among humans or animals. (c) "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. (d) "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: (a) "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. Colorado Revised Statutes 2019 Page 109 of 1101 Uncertified Printout (b) "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. (c) "Hemodialysis technician" means a person who is not a physician or a licensed professional nurse and who provides dialysis care. (d) "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) (a) 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. (b) 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. (c) Nothing in this subsection (3) prohibits: (I) 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; (II) A person participating in a hemodialysis technician training program from performing the duties and functions of a hemodialysis technician if: (A) 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 (B) 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 251.5-103 (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 Colorado Revised Statutes 2019 Page 110 of 1101 Uncertified Printout 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) (a) 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: (I) Is free from alcohol and nonprescribed or illicit drugs; (II) Promotes independent living and life skill development; and (III) Provides structured activities and recovery support services that are primarily intended to promote recovery from substance use disorders. (b) "Recovery residence" does not include: (I) 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; (II) 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; (III) A facility approved for residential treatment by the office of behavioral health in the department of human services; or (IV) 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. (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: Colorado Revised Statutes 2019 Page 111 of 1101 Uncertified Printout (a) 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; (b) Is chartered by Oxford House or its successor organization; (c) Has been operating as a recovery residence in Colorado for thirty or more years as of May 23, 2019; or (d) 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: (a) 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: (I) For admission of a resident, except for state or federal contracts that specifically reimburse for resident fees; (II) 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 (III) From a facility approved for residential treatment by the office of behavioral health in the department of human services; (b) 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. 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 Colorado Revised Statutes 2019 Page 112 of 1101 Uncertified Printout department, and race and ethnicity, and the emerging science and medical information relevant to the health effects associated with marijuana use. (2) (a) 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. (b) 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: (a) Providing public and private leadership for suicide prevention and intervention in Colorado; (b) Setting statewide, data-driven, evidence-based, and clinically informed suicide prevention priorities in Colorado; (c) Serving as an advisor to the office of suicide prevention; (d) Establishing and leading subgroups to set strategy and implementation plans for each statewide suicide prevention priority for the office of suicide prevention; (e) 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; (f) Expanding local and national partnerships and resources for statewide suicide prevention activities; Colorado Revised Statutes 2019 Page 113 of 1101 Uncertified Printout (g) Promoting cooperation and coordination among suicide prevention programs and strategies across Colorado; (h) Evaluating the distribution of state resources for suicide prevention; (i) Ensuring that suicide prevention remains a state priority; and (j) Encouraging the development of suicide prevention plans at the local level. (2) (a) 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: (I) A representative from the office of suicide prevention in the department, which office shall serve as the administrator and coordinator of the commission; (II) A representative from the office of behavioral health in the department of human services; (III) A representative from law enforcement; (IV) A representative from higher education; (V) A representative from K-12 education; (VI) A representative from an employee assistance program or human resources in the private sector; (VII) A representative from the suicide prevention coalition of Colorado; (VIII) A licensed mental health professional; (IX) Repealed. (X) An active member or veteran of the United States military who has been affected by suicide; (XI) A representative from the Colorado youth advisory council; (XII) A family member of a person who died by suicide; (XIII) A person who has attempted suicide, recovered, and is now thriving; (XIV) A person representing a philanthropic foundation; (XV) A representative of medical providers or first responders; (XVI) A representative from a hospital with an on-site emergency department; (XVII) A representative from the agricultural and ranching industry; (XVIII) A representative from the oil and gas industry from a rural area; (XIX) At least three members of the Colorado business community, one of whom represents a rural area; (XX) One representative of the suicide prevention nonprofit community; (XXI) A representative from a nonprofit community service club; (XXII) A representative from an interfaith organization; (XXIII) A representative from the school safety resource center with experience in bullying, including cyberbullying; and (XXIV) A representative from the department of health care policy and financing. (b) 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. Colorado Revised Statutes 2019 Page 114 of 1101 Uncertified Printout (c) 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. (d) 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 cochairs 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 cochairpersons 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 25-1.5101 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) (a) This section is repealed, effective September 1, 2024. (b) 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 Colorado Revised Statutes 2019 Page 115 of 1101 Uncertified Printout 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: (a) A plan to improve training to identify indicators of suicidal thoughts and behavior across criminal justice and health care systems; (b) A plan to improve training on: (I) The provisions of the emergency procedures for a seventy-two-hour mental health hold pursuant to section 27-65-105, C.R.S.; (II) The provisions of the federal "Health Insurance Portability and Accountability Act of 1996", Pub.L. 104-191, as amended; and (III) Other relevant patient privacy procedures; and (c) 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: (a) Community mental health centers; (b) Hospitals; (c) The state crisis services system; (d) Emergency medical services professionals and responders; (e) Regional health and behavioral health systems; (f) Substance use disorder treatment systems; (g) Physical and mental health clinics in educational institutions; (h) Criminal justice systems; and (i) 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. Colorado Revised Statutes 2019 Page 116 of 1101 Uncertified Printout 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: (a) "Department" means the department of public health and environment created and existing pursuant to section 25-1-102. (b) "Fund" means the crisis and suicide prevention training grant program fund established in subsection (5) of this section. (c) "Grant program" means the crisis and suicide prevention training grant program created in subsection (2) of this section. (d) "Office of suicide prevention" means the office of suicide prevention in the department, established pursuant to section 25-1.5-101 (1)(w). (e) "Public school" means a school of a school district, a district charter school, or an institute charter school. (f) "School district" means any public school district existing pursuant to law. (g) "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) (a) 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. (b) 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. (c) The department shall administer the grant program in consultation with the office of suicide prevention and the school safety resource center. (d) 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) (a) 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: (I) Application procedures by which public schools and school districts may apply for a grant pursuant to this section; (II) 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: Colorado Revised Statutes 2019 Page 117 of 1101 Uncertified Printout (A) 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; (B) An emphasis on providing such training to all staff at the public school or school district, not just educators; and (C) 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. (b) 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. (c) 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) (a) 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. (b) 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: (I) The number of public schools and school districts that received a grant from the grant program; (II) The amount of each grant award by recipient; (III) The number of pupils who are enrolled at each public school or school district of each grant recipient; (IV) The number of school staff and educators who were provided training as a result of a grant; and (V) A copy of the grant recipients' crisis and suicide prevention plans. (5) (a) 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. (b) 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. (c) 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 Colorado Revised Statutes 2019 Page 118 of 1101 Uncertified Printout money received through gifts, grants, and donations to the state treasurer, who shall credit the same to the fund. (d) 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 - definition. (1) 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) (a) 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. (b) 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. (c) 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) (a) 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: (I) 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 (II) 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. (b) "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 25-1.5103 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. Colorado Revised Statutes 2019 Page 119 of 1101 Uncertified Printout Source: L. 2019: Entire section added, (HB 19-1010), ch. 324, p. 2996, § 1, effective August 2. 25-1.5-115. Opiate antagonist bulk purchase fund - creation - definition - rules report. (1) (a) 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. (b) 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. (c) 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) (a) 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: (I) Revenue received by the fund; (II) Revenue and expenditure projections for the forthcoming fiscal year and details of all expenditures from the fund; (III) The eligible entities that purchased opiate antagonists; (IV) The amount of opiate antagonists purchased by each eligible entity; and (V) The discount procured through bulk purchasing. (b) 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: (a) A unit of local government, as defined in section 29-3.5-101 (4); (b) A person making an opiate antagonist available pursuant to section 25-20.5-1001; or (c) 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: (I) A school district board of education of a public school; (II) The state charter school institute for an institute charter school; or (III) A governing board of a nonpublic school. Colorado Revised Statutes 2019 Page 120 of 1101 Uncertified Printout Source: L. 2019: Entire section added, (SB 19-227), ch. 273, p. 2580, § 10, effective May 23. Editor's note: Section 17 of chapter 273 (SB 19-227), Session Laws of Colorado 2019, provides that the act adding this section applies to conduct occurring on or after May 23, 2019. PART 2 POWERS AND DUTIES OF THE DEPARTMENT WITH RESPECT TO WATER Editor's note: For the federal "Safe Drinking Water Act", see 42 U.S.C. sec. 300f et seq. 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: (a) Any collection, treatment, storage, and distribution facilities under control of the operator of such system and used primarily in connection with such system; and (b) 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 Colorado Revised Statutes 2019 Page 121 of 1101 Uncertified Printout water quality control commission for promulgation minimum general sanitary standards regarding such contaminant or substance. (3) (a) 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. (b) 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: (I) 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; (II) The identifiability of a potential pathway or continued pathway of contamination; (III) The availability of analytical techniques for measuring and identifying the contaminant or substance in a reasonable manner; (IV) 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; (V) 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; (VI) The fact that the contaminant or substance will be the subject of a national primary drinking water regulation in the near future; (VII) An analysis of the environmental fate and transport mechanisms within relevant environmental media; (VIII) Identification, characterization, and analysis of the populations and drinking water supplies at risk; and (IX) 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) (a) 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". (b) 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: (I) Based on credible medical and toxicological evidence that has been subjected to peer review, there exists a substantial risk to the public health; (II) The analytical techniques for measuring and identifying the contaminant or substance are reasonably available; (III) The adverse health effects posed by the contaminant or substance are known to a reasonable degree of scientific certainty; and (IV) Compliance with such standard is feasible utilizing the best technology or methodology which is generally available. Colorado Revised Statutes 2019 Page 122 of 1101 Uncertified Printout (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. Cross references: For the "Safe Drinking Water Act", see Pub.L. 104-182, codified at 42 U.S.C. § 300f et seq. 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: (a) 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; (b) 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: (A) 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. (B) 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; (C) Public notification by the supplier of water, pursuant to the provisions of the federal "Safe Drinking Water Act"; Colorado Revised Statutes 2019 Page 123 of 1101 Uncertified Printout (D) 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. (c) 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. (d) 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. (e) 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 Colorado Revised Statutes 2019 Page 124 of 1101 Uncertified Printout 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". (f) 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 part 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; Colorado Revised Statutes 2019 Page 125 of 1101 Uncertified Printout (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: (1) For the "Safe Drinking Water Act", see Pub.L. 104-182, codified at 42 U.S.C. § 300f et seq. (2) 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 251.5-202. 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. Colorado Revised Statutes 2019 Page 126 of 1101 Uncertified Printout 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: (a) Consists only of distribution and storage facilities (and does not have any collection and treatment facilities); (b) Obtains all of its water from, but is not owned or operated by, a public water system to which such regulations apply; (c) Does not sell water to any person; (d) Does not authorize incidental use of untreated water; and (e) Is not a carrier that conveys passengers in interstate commerce; or (f) 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) (a) 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: (I) 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 (II) Significant impairment of the normal operational capability of a water treatment system which meets the applicable specifications of the department for water treatment; or (III) 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. (b) 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 Revised Statutes 2019 Page 127 of 1101 Uncertified Printout "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", 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: (a) 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, Colorado Revised Statutes 2019 Page 128 of 1101 Uncertified Printout 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. (a.5) 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). (b) 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) (a) 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. (b) The revenues in the fund are continuously appropriated to the department for the purposes of this section. 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. Editor's note: This section is similar to former § 25-1-107 (1)(x)(IX) as it existed prior to 2003. Colorado Revised Statutes 2019 Page 129 of 1101 Uncertified Printout 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: Facility Categories and Subcategories for Drinking Water FeesAnnual Fees (a) 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 (b) 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 (c) 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 (d) 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 (e) 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 Colorado Revised Statutes 2019 Page 130 of 1101 Uncertified Printout 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 (f) 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 (g) 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 (h) 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 (i) 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 Colorado Revised Statutes 2019 Page 131 of 1101 Uncertified Printout 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. 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: (a) Nonpotable usage of the collected precipitation; and (b) Disease and pest vector control. (2) If the department develops best practices in accordance with subsection (1) of this section, the department shall: (a) Post the best practices on the department's website; and (b) 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. PART 3 ADMINISTRATION OF MEDICATIONS 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: Colorado Revised Statutes 2019 Page 132 of 1101 Uncertified Printout (a) The correctional facilities under the supervision of the executive director of the department of corrections including, but not limited to: (I) Those facilities provided for in article 20 of title 17, C.R.S.; (II) Minimum security facilities provided for in article 25 of title 17, C.R.S.; (III) Jails provided for in article 26 of title 17, C.R.S.; (IV) Community correctional facilities and programs provided for in article 27 of title 17, C.R.S.; (V) The regimented inmate discipline and treatment program provided for in article 27.7 of title 17, C.R.S.; and (VI) The Denver regional diagnostic center provided for in article 40 of title 17, C.R.S.; (b) Institutions for juveniles provided for in part 4 of article 2 of title 19, C.R.S.; (b.5) Assisted living residences as defined in section 25-27-102 (1.3); (c) Adult foster care facilities provided for in section 26-2-122.3, C.R.S.; (d) Alternate care facilities provided for in section 25.5-6-303 (3), C.R.S.; (e) Residential child care facilities for children as defined in section 26-6-102 (33), C.R.S.; (f) Secure residential treatment centers as defined in section 26-6-102 (35), C.R.S.; (g) 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; (h) 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 (i) 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: (a) Reminding the resident to take medication or medications at the time ordered by the physician or other authorized licensed practitioner; (b) 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; (c) Visual observation of the resident to ensure compliance; (d) Making a written record of the resident's compliance with regard to each medication, including the time taken; and (e) 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: (a) 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 (b) Has completed training in the administration of medications pursuant to section 251.5-303 or is a licensed nurse pursuant to 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. Colorado Revised Statutes 2019 Page 133 of 1101 Uncertified Printout 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. 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: (a) 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. (b) 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 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) (a) 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. Colorado Revised Statutes 2019 Page 134 of 1101 Uncertified Printout (b) 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. (c) 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. (d) 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). (e) 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) to (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; Colorado Revised Statutes 2019 Page 135 of 1101 Uncertified Printout (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. Editor's note: (1) This section is similar to former § 25-1-107 (1)(ee)(I) and (1)(ee)(I.3) as they existed prior to 2003. (2) Subsections (4)(b), (5)(b), (6)(b), and (7)(d) provided for the repeal of subsections (4), (5), (6), and (7), respectively, effective July 1, 2017. (See L. 2016, p. 1235.) Cross references: For the "Colorado Medical Practice Act", see article 36 of title 12; for the "Nurse Practice Act", see article 38 of title 12. 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 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 selfColorado Revised Statutes 2019 Page 136 of 1101 Uncertified Printout 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) (a) 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. (b) 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. (c) Repealed. (d) 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. Editor's note: (1) This section is similar to former § 25-1-107 IP(1)(ee)(I.5), (1)(ee)(I.6), (1)(ee)(III)(B), (1)(ee)(IV), (1)(ee)(IV.5), and (1)(ee)(V) as they existed prior to 2003. (2) Subsection (5)(c)(II) provided for the repeal of subsection (5)(c), effective July 1, 2017. (See L. 2016, p. 1237.) 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. PART 4 PRIMARY CARE OFFICE 25-1.5-401. Legislative declaration. (1) The general assembly hereby finds and declares that: (a) There is a shortage of qualified health care professionals in most areas of the state, particularly in rural and low-income communities; (b) Lack of access to health care increases health inequities in Colorado and increases the overall cost of health care services; Colorado Revised Statutes 2019 Page 137 of 1101 Uncertified Printout (c) Communities designated as health professional shortage areas, medically underserved areas, or medically underserved populations may benefit from: (I) 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 (II) 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 (d) 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 Colorado Revised Statutes 2019 Page 138 of 1101 Uncertified Printout 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: (a) 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 statespecific 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). (b) 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, Colorado Revised Statutes 2019 Page 139 of 1101 Uncertified Printout 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; (c) 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; (d) To administer the Colorado health service corps pursuant to part 5 of this article; (e) 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 25-1.5405. (f) 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 (g) 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. Colorado Revised Statutes 2019 Page 140 of 1101 Uncertified Printout 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) (a) The general assembly finds that: (I) 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; (II) 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; (III) 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; (IV) 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 (V) 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. (b) The general assembly further finds that: (I) 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; (II) 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 (III) The number of school nurses serving students is determined by the school district and largely paid for from limited school district funding. (c) 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: (a) "Grant program" means the school nurse grant program created in subsection (3) of this section. (b) "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. (c) "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. (d) "School" means a public elementary, middle, junior high, or high school. Colorado Revised Statutes 2019 Page 141 of 1101 Uncertified Printout (e) "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. (f) "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) (a) 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. (b) 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: (a) 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; (b) 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.; (c) Whether a school district applicant is a small rural school district or rural school district; (d) The school or schools in which the local education provider intends to use the grant money to hire a school nurse; (e) 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 (f) The local education provider's plan for continuing to fund the increases in school nursing services following expiration or nonrenewal of the grant. Colorado Revised Statutes 2019 Page 142 of 1101 Uncertified Printout (6) (a) 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. (b) 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. (c) 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: (I) Is a small rural school district or rural school district; or (II) 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) (a) 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. (b) 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. PART 5 STATE HEALTH CARE PROFESSIONAL LOAN REPAYMENT PROGRAM 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. Colorado Revised Statutes 2019 Page 143 of 1101 Uncertified Printout 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: (a) A licensed addiction counselor; (b) A certified addiction counselor; (c) A licensed professional counselor; (d) A licensed clinical social worker; (e) A licensed marriage and family therapist; (f) A licensed psychologist; (g) A licensed physician assistant with specific training in substance use disorders; (h) An advanced practice nurse with specific training in substance use disorders, pain management, or psychiatric nursing; or Colorado Revised Statutes 2019 Page 144 of 1101 Uncertified Printout (i) 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: (a) Is a candidate for a license as a licensed psychologist, clinical social worker, marriage and family therapist, licensed professional counselor, or addiction counselor; (b) Has completed a master's degree or, for a psychologist licensure candidate, has completed a doctoral degree; (c) 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 (d) 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 Colorado Revised Statutes 2019 Page 145 of 1101 Uncertified Printout 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: (a) Individuals eligible for medical assistance under articles 4 to 6 of title 25.5; (b) 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) (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: (A) Health care professionals who provide primary health services; (B) Nursing faculty or health care professional faculty members in qualified faculty positions; and (C) Behavioral health care providers and candidates for licensure who provide behavioral health care services. (II) 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: (A) 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 (B) 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. (III) (A) 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. (B) 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. (IV) 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. Colorado Revised Statutes 2019 Page 146 of 1101 Uncertified Printout (b) 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. (c) The following providers are not eligible for loan repayment through the Colorado health service corps: (I) Health care professionals who are not practicing in primary care specialties or providing primary health services; and (II) Behavioral health care providers and candidates for licensure who are not providing behavioral health care services. (d) (I) 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. (II) 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. (III) 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 Colorado Revised Statutes 2019 Page 147 of 1101 Uncertified Printout forgive the loan of a faculty member, the primary care office shall consider the following criteria: (a) The faculty positions available at the educational institution at which the health care professional works; (b) Documented recruiting efforts by the educational institution; (c) The attributes of the educational or training program that are designed with the intent to address known shortages of health care professionals in Colorado; (d) 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) (a) 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. (b) 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 Colorado Revised Statutes 2019 Page 148 of 1101 Uncertified Printout 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: (a) The commission on family medicine created pursuant to part 6 of article 1 of title 25.5; (b) A nonprofit statewide membership organization that provides programs and services to enhance rural health care in Colorado; Colorado Revised Statutes 2019 Page 149 of 1101 Uncertified Printout (c) A membership organization representing federally qualified health centers in Colorado; (d) A foundation that funds a health care professional loan forgiveness program in Colorado; (e) An economic development organization in Colorado; (f) A membership organization representing community behavioral health care providers; (g) An advanced practice nurse in a faculty position at an educational institution with health care professional programs, who is licensed to practice in Colorado; (h) A physician who has experience in rural health, safety net clinics, or health equity; (i) A nurse who has experience in rural health, safety net clinics, or health equity; (j) A mental health provider who has experience in rural health, safety net clinics, or health equity; (k) An oral health provider who has experience in rural health, safety net clinics, or health equity; (l) A physician who is a faculty member of a medical school in Colorado; (m) A citizen representative who has knowledge in rural health, safety net clinics, or health equity; (n) A membership organization representing substance use disorder service providers; and (o) A licensed or certified addiction counselor who has experience in rural health, safety net clinics, or health equity. (3) (a) Members appointed to the advisory council may serve terms of three years. (b) The governor may appoint the same person to serve as a member of the advisory council for consecutive terms. (4) (a) Advisory council members shall serve without compensation and without reimbursement for expenses. (b) 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) (a) 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. (b) 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; Colorado Revised Statutes 2019 Page 150 of 1101 Uncertified Printout (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: (a) 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; (b) 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; (c) 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; (d) 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; (e) A summary of any assessment or evaluation of program performance conducted during the year; and (f) 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. Colorado Revised Statutes 2019 Page 151 of 1101 Uncertified Printout 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: (a) 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; (b) Damages and penalties collected from breach of contract actions for loan repayment contracts; and (c) 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) (a) 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. (b) 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) (a) 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: (I) Provide loan repayment for behavioral health care providers and candidates for licensure participating in the Colorado health service corps; and (II) Award scholarships to addiction counselors participating in the scholarship program. (b) 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. PART 6 Colorado Revised Statutes 2019 Page 152 of 1101 Uncertified Printout UNIFORM EMERGENCY VOLUNTEER HEALTH PRACTITIONERS ACT Editor's note: This part 6 was added with relocations in 2017. Former C.R.S. section numbers are shown in editor's notes following those sections that were relocated. For a detailed comparison of this part 6, see the comparative tables located in the back of the index. 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: (A) 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 (B) 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: (i) Preventive, diagnostic, therapeutic, rehabilitative, maintenance, or palliative care; and (ii) Counseling, assessment, procedures, or other services; Colorado Revised Statutes 2019 Page 153 of 1101 Uncertified Printout (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: (A) 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; (B) Use of a procedure for reproductive management; and (C) 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 251.5-605 and who provide health or veterinary services in this state for a host entity while an emergency declaration is in effect. Colorado Revised Statutes 2019 Page 154 of 1101 Uncertified Printout 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. (a) 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. (b) 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. (c) 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. (a) 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: (A) 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; Colorado Revised Statutes 2019 Page 155 of 1101 Uncertified Printout (B) 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; (C) Be operated by a: (i) Disaster relief organization; (ii) Licensing board; (iii) National or regional association of licensing boards or health practitioners; (iv) Health facility that provides comprehensive inpatient and outpatient health-care services, including a tertiary care and teaching hospital; or (v) Governmental entity; or (D) Be designated by the disaster management agency as a registration system for purposes of this part 6. (b) 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. (c) 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. (d) 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. (a) 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. (b) 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. Colorado Revised Statutes 2019 Page 156 of 1101 Uncertified Printout 25-1.5-607. No effect on credentialing and privileging. (a) 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. (b) 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. (a) 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. (b) 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. (c) 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. (d) A host entity may restrict the health or veterinary services that a volunteer health practitioner may provide pursuant to this part 6. (e) 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. Colorado Revised Statutes 2019 Page 157 of 1101 Uncertified Printout (f) 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 (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. (g) 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. (a) 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. (b) 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. Colorado Revised Statutes 2019 Page 158 of 1101 Uncertified Printout 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 13-21115.5. 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. VITAL STATISTICS 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. 25-2-101. Short title. This article shall be known and may be cited as the "Vital Statistics Act of 1984". Source: L. 67: R&RE, p. 1056, § 1. C.R.S. 1963: § 66-8-1. L. 84: Entire section amended, p. 742, § 2, effective July 1. 25-2-102. Definitions. As used in this article 2, unless the context otherwise requires: (1) "Dead body" means a lifeless human body or parts of such body or bones thereof from the state of which it reasonably may be concluded that death recently occurred. (2) "Fetal death" means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy. The death is Colorado Revised Statutes 2019 Page 159 of 1101 Uncertified Printout indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. (2.5) "Final disposition" means the burial, interment, cremation, removal from the state, or other authorized disposition of a dead body or fetus. (2.7) "Induced termination of pregnancy" means the purposeful interruption of a pregnancy with an intention other than producing a live-born infant or removing a dead fetus and that does not result in a live birth. (3) "Institution" means any establishment which provides inpatient medical, surgical, or diagnostic care or treatment or nursing, custodial, or domiciliary care to two or more unrelated individuals or to which persons are committed by law. (3.5) "Physician" means a person licensed to practice medicine in Colorado pursuant to article 240 of title 12. (4) "Regulations" means regulations duly adopted pursuant to section 25-2-103. (4.5) "Stillborn death" or "stillbirth" means death prior to the complete expulsion or extraction from its mother of a product of human conception, occurring after the twentieth week of pregnancy, and does not include "induced termination of pregnancy", as defined by subsection (2.7) of this section. The death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. (5) "Vital statistics certificate" means any certificate required by section 25-2-110, 25-2112, or 25-2-112.3. (6) "Vital statistics report" means any report required by section 25-2-106 or 25-2-107. Source: L. 67: R&RE, p. 1056, § 1. C.R.S. 1963: § 66-8-2. L. 84: (2.5) and (3.5) added and (6) amended, p. 742, § 3, effective July 1. L. 2000: (2.7) added, p. 1073, § 1, effective August 2. L. 2001: (4.5) added, p. 439, § 1, effective August 8. L. 2004: (4.5) and (5) amended, p. 473, § 1, effective July 1. L. 2019: IP and (3.5) amended, (HB 19-1172), ch. 136, p. 1700, § 149, effective October 1. Editor's note: Subsection (4.5) was originally numbered as (3.7) in House Bill 01-1325 but has been renumbered on revision for ease of location. 25-2-103. Centralized registration system for all vital statistics - appointment of registrar - rules. (1) In order to provide for the maintenance of a centralized registry of the vital statistics of this state, the office of state registrar of vital statistics, referred to in this article as the "state registrar", is hereby created in the department of public health and environment. The state registrar shall be appointed by the state board of health and shall have such staff and clerical help as reasonably may be required in the performance of the state registrar's duties. The state registrar and the staff and clerical help of the state registrar shall be subject to the state constitution and state personnel system laws. (2) The state board of health shall adopt, promulgate, amend, and repeal such rules and orders in accordance with the provisions of section 24-4-103, C.R.S., as are necessary and proper for carrying out the provisions of this article. Colorado Revised Statutes 2019 Page 160 of 1101 Uncertified Printout (3) (a) The state registrar shall direct and supervise the operation of the vital statistics system, prepare and publish annual reports of vital statistics, and administer and enforce the provisions of this article and all rules issued under this article. (b) In conjunction with the requirements of paragraph (a) of this subsection (3), the state registrar shall collect the name of the provider of prenatal care, if any, and the name of the provider of initial delivery services and shall require that such information be reported on all birth certificates. In addition, whenever an investigation or inquest is conducted pursuant to section 30-10-606, C.R.S., concerning the death of a child under one year of age, the coroner shall forward the information described in this paragraph (b) to the state registrar for inclusion on the death certificate of the subject of the inquest or investigation. (4) Federal, state, local, and other public or private agencies may, upon request, be furnished copies of records of data for statistical purposes upon such terms and conditions as may be prescribed by regulation. (4.5) Notwithstanding any other provision of law that limits the sharing of vital statistics, after receiving the list of names and social security numbers of individuals who received property tax exemptions as either qualifying seniors or disabled veterans for the prior year that is provided by the property tax administrator pursuant to section 39-3-207, C.R.S., the state registrar shall identify all individuals on the list who have died and transmit a list of the names and social security numbers of such individuals to the administrator. (5) The state registrar shall designate organized county, district, or municipal public health agencies established pursuant to part 5 of article 1 of this title and may establish or designate additional offices throughout Colorado to aid in the efficient administration of the system of vital statistics. (6) The state registrar may: (a) Require departments or offices so designated or established to comply with performance and accounting standards as set forth in rules promulgated by the state board of health; (b) Delegate such functions and duties to the staff and clerical help and to any offices established or designated by the state registrar pursuant to this section as deemed necessary or expedient; (c) Conduct training programs to promote the uniformity of the administration of this article throughout Colorado. Source: L. 67: R&RE, p. 1057, § 1. C.R.S. 1963: § 66-8-3. L. 76: Entire section amended, p. 309, § 48, effective May 20. L. 84: Entire section amended, p. 743, § 4, effective July 1. L. 94: Entire section amended, p. 2748, § 398, effective July 1. L. 96: Entire section amended, p. 401, § 13, effective April 17. L. 2010: (5) amended, (HB 10-1422), ch. 419, p. 2092, § 87, effective August 11. L. 2016: (4.5) added, (HB 16-1175), ch. 332, p. 1344, § 1, effective June 10. 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. 25-2-104. Registration of vital statistics. Promptly upon receipt of each vital statistics report or certificate, the state registrar shall examine it to determine that it has been properly Colorado Revised Statutes 2019 Page 161 of 1101 Uncertified Printout completed. If the report has been properly completed, the state registrar shall register the statistical event described therein and shall note the date the report has been accepted as having been properly completed and shall place the same, or a reproduction thereof, made in accordance with section 25-2-117 (3), in the permanent files of the office. If not properly completed, the state registrar shall take such action with respect thereto as may be required by applicable regulations. Source: L. 67: R&RE, p. 1057, § 1. C.R.S. 1963: § 66-8-4. L. 84: Entire section amended, p. 743, § 5, effective July 1. 25-2-105. Vital statistics, reports, and certificates - forms and information to be included. (1) The state registrar shall prescribe, furnish, and distribute such forms as are required by this article and shall furnish and distribute such rules as are promulgated pursuant to section 25-2-103. The state registrar may also prescribe such other means for transmission of data as will accomplish the purpose of complete and accurate reporting and registration. (2) The state registrar shall prescribe, furnish, and distribute such forms as are required by this article with respect to civil union certificates, as defined in section 14-15-103 (2), C.R.S. Source: L. 67: R&RE, p. 1057, § 1. C.R.S. 1963: § 66-8-5. L. 84: Entire section R&RE, p. 744, § 6, effective July 1. L. 2013: Entire section amended, (SB 13-011), ch. 49, p. 155, § 2 effective May 1, 2013. 25-2-106. Reports of marriage. Each county clerk and recorder shall prepare a report containing such information and using such form as may be prescribed and furnished by the state registrar with respect to every duly executed marriage certificate that is returned in accordance with section 14-2-109, C.R.S. On or before the tenth day of each month, or more frequently if so requested by the state registrar, such clerk and recorder shall forward to the state registrar all such marriage reports for all marriage certificates returned in the preceding period. Certified copies of marriage certificates may be issued by any clerk and recorder. Source: L. 67: R&RE, p. 1057, § 1. C.R.S. 1963: § 66-8-6. 25-2-106.5. Reports of civil unions. Each county clerk and recorder shall prepare a report containing such information and using the form as may be prescribed and furnished by the state registrar with respect to every duly executed civil union certificate registered in accordance with section 14-15-112, C.R.S. On or before the tenth day of each month, or more frequently if requested by the state registrar, the county clerk and recorder shall forward to the state registrar all civil union reports for all civil union certificates registered in the preceding period. The county clerk and recorder may issue certified copies of civil union certificates. Source: L. 2013: Entire section added, (SB 13-011), ch. 49, p. 156, § 3, effective May 1, 2013. 25-2-107. Reports of adoption, dissolution of marriage, parentage, and other court proceedings affecting vital statistics - tax on court action affecting vital statistics. (1) The Colorado Revised Statutes 2019 Page 162 of 1101 Uncertified Printout clerk of each court or, for parentage proceedings, the clerk of the court or a delegate child support enforcement unit, shall prepare a report containing information and using forms as may be prescribed and furnished by the state registrar with respect to every decree entered by the court with respect to parentage, adoption, change of name, dissolution of marriage, legal separation, or declaration of invalidity of marriage, and every decree amending or nullifying such a decree and also with respect to every decree entered pursuant to section 25-2-114. On or before the tenth day of each month, or more frequently if so requested by the state registrar, the clerk shall forward to the state registrar the reports for all such decrees entered during the preceding period. (2) In order to help defray the maintenance of vital statistics records, and in addition to the tax levied under section 2-5-119, a tax of three dollars shall be levied upon each action with respect to parentage, adoption, change of name, dissolution of marriage, legal separation, or declaration of invalidity of marriage that is filed in the office of each clerk of a court of record in this state on or after July 1, 1985. The tax must be paid at the time the action is filed, and the clerk shall keep the tax in a separate fund and transmit the tax monthly to the state treasurer, who shall credit the same to the vital statistics records cash fund pursuant to section 25-2-121. A delegate child support enforcement unit acting pursuant to article 13 of title 26 is exempt from paying the tax authorized in this subsection (2). Source: L. 67: R&RE, p. 1058, § 1. C.R.S. 1963: § 66-8-7. L. 72: Entire section amended, p. 600, § 90, effective May 23. L. 78: Entire section amended, p. 269, § 80, effective May 23. L. 84: Entire section amended, p. 744, § 7, effective July 1. L. 85: Entire section amended, p. 879, § 1, effective May 24. L. 89: (2) amended, p. 796, § 28, effective July 1. L. 96: (1) amended, p. 614, § 19, effective July 1. L. 2018: Entire section amended, (SB 18-095), ch. 96, p. 755, § 13, effective August 8. Cross references: For the legislative declaration in SB 18-095, see section 1 of chapter 96, Session Laws of Colorado 2018. 25-2-107.5. Reports of dissolution of civil unions, legal separation of civil unions, or declarations of invalidity of civil unions - fee. (1) The clerk of each court shall prepare a report containing such information and using such form as may be prescribed and furnished by the state registrar with respect to every decree entered by the court for the dissolution of a civil union, legal separation of a civil union, or declaration of invalidity of a civil union, and every decree amending or nullifying such a decree. On or before the tenth day of each month, or more frequently if so requested by the state registrar, the clerk shall forward to the state registrar the reports for all such decrees entered during the preceding period. (2) In order to defray the costs of maintenance of vital statistics records, the clerk of the court shall assess a fee of three dollars upon each action filed for a dissolution of a civil union, legal separation of a civil union, or declaration of invalidity of a civil union that is filed in the office of each clerk of a court of record in this state on or after May 1, 2013. The clerk shall keep any fees so collected in a separate fund, and each month the clerk shall transmit those fees collected to the state treasurer, who shall credit the same to the vital statistics records cash fund created in section 25-2-121. Colorado Revised Statutes 2019 Page 163 of 1101 Uncertified Printout Source: L. 2013: Entire section added, (SB 13-011), ch. 49, p. 156, § 3, effective May 1. 25-2-108. Reports and certificates as to births and deaths. (Repealed) Source: L. 67: R&RE, p. 1058, § 1. C.R.S. 1963: § 66-8-8. L. 84: Entire section repealed, p. 751, § 16, effective July 1. 25-2-109. Local registration districts for processing of birth and death certificates. (Repealed) Source: L. 67: R&RE, p. 1058, § 1. C.R.S. 1963: § 66-8-9. L. 83: (1) amended, p. 1039, § 18, effective May 20. L. 84: Entire section repealed, p. 751, § 16, effective July 1. 25-2-110. Certificates of death. (1) (a) A certificate of death for each death, including a stillborn death, that occurs in Colorado must be filed with the state registrar or as otherwise directed by the state registrar, within five days after the death occurs and prior to final disposition. The state registrar shall register the certificate if it has been completed in accordance with this section. Every certificate of death must identify the decedent's social security number, if available. If the place of death is unknown but the dead body is found in Colorado, the certificate of death must be completed and filed in accordance with this section. The place where the body is found must be shown as the place of death. If the date of death is unknown, the date must be determined by approximation. (b) (I) The department of public health and environment shall create and the state registrar shall use an electronic death registration system for the purpose of collecting death information from funeral directors, coroners, physicians, local registrars, health facilities, and other authorized individuals, as determined by the department. Death information submitted electronically by a funeral director, coroner, physician, local registrar, health facility, or authorized individual, as determined by the department, to the electronic death registration system for purposes of fulfilling the requirements of this section satisfies the signature and filing requirements of this section and section 30-10-606, C.R.S. (II) Repealed. (c) Once a certificate of death has been filed pursuant to paragraph (a) of this subsection (1), a verification of death document may be used by local offices of vital statistics and the office of the state registrar of vital statistics when verifying a vital event to a person or organization that has requested a verification of fact-of-death. A verification of death document must include the name and address of the decedent, the date of death, the place of death, the date the document is filed, the state file number, and the name of any spouse of the decedent. A verification of death document is not required to contain a social security number of the deceased as is otherwise required of a certificate of death under paragraph (a) of this subsection (1). (2) When a death occurs in a moving conveyance in the United States and the body is first removed from the conveyance in Colorado, the death shall be registered in Colorado, and the place where it is first removed shall be considered the place of death. When a death occurs on a moving conveyance while in international air space or in a foreign country or its air space Colorado Revised Statutes 2019 Page 164 of 1101 Uncertified Printout and the body is first removed from the conveyance in Colorado, the death shall be registered in Colorado, but the certificate shall show the actual place of death insofar as can be determined. (3) (a) The funeral director or person acting as such who first assumes custody of a dead body, stillborn fetus, or dead fetus shall be responsible for the filing of the death certificate required by subsection (1) of this section. He or she shall obtain the personal data required by the certificate from the next of kin or the best qualified person or source available. He or she shall obtain the medical certification necessary to complete the portion of the certificate pertaining to the cause of death from the best qualified person or source available, pursuant to subsection (4) of this section. (b) In the case of a stillborn fetus, notwithstanding the provisions of paragraph (a) of this subsection (3), the physician, nurse, or other medical personnel attending to the stillborn death may assume responsibility for filing the death certificate required by paragraph (a) of this subsection (3). The person filing the death certificate in the case of a stillborn fetus shall obtain the personal data required by the certificate from a parent and shall include a name on the death certificate if a parent desires to identify a name. (c) If a death certificate is not filed in the case of a stillborn death as required by paragraph (a) of this subsection (3), a parent may inform the state registrar of the information necessary to complete the death certificate. The state registrar shall confirm such information and complete the death certificate accordingly. (4) Except when inquiry is required by section 30-10-606, C.R.S., the physician in charge of the patient's care for the illness or condition that resulted in death shall complete, sign, and return to the funeral director or person acting as such all medical certification within fortyeight hours after a death occurs. In the absence of said physician or with his or her approval, the certificate may be completed and signed by his or her associate physician, by the chief medical officer of the institution in which the death occurred, or by the physician who performed an autopsy upon the decedent, if such individual has access to the medical history of the case, if he or she views the decedent at or after the time of death, and if the death is due to natural causes. If an autopsy is performed, the certification shall indicate whether the decedent was pregnant at the time of death, and said information shall be reported on the death certificate as required by subsection (9) of this section. (5) When inquiry is required by section 30-10-606, C.R.S., the coroner shall determine the cause of death and shall complete and sign the medical certification within forty-eight hours after taking charge of the case. If an autopsy is performed, the certification shall indicate whether the decedent was pregnant at the time of death, and said information shall be reported on the death certificate as required by subsection (9) of this section. (6) If the cause of death cannot be determined within forty-eight hours after a death, the medical certification shall be completed as provided by rule. If an autopsy is performed, the certification shall indicate whether the decedent was pregnant at the time of death, and said information shall be reported on the death certificate as required by subsection (9) of this section. The attending physician or coroner shall give the funeral director or person acting as such notice of the reason for the delay, and final disposition of the body shall not be made until authorized by the office designated or established pursuant to section 25-2-103 in the county where the death occurred or, if such an office does not exist in the county where the death occurred, final disposition of the body shall not be made until authorized by the coroner or the coroner's designee. Colorado Revised Statutes 2019 Page 165 of 1101 Uncertified Printout (7) When a death is presumed to have occurred within Colorado but the body cannot be located, a death certificate may be prepared by the state registrar upon receipt of an order of a court of competent jurisdiction which shall include the finding of facts required to complete the death certificate. Such a death certificate shall be marked "presumptive" and shall show on its face the date of registration and shall identify the court and the date of decree. (8) Every funeral establishment shall maintain registration with the office of the state registrar and shall act in accordance with the provisions of this article. (9) (a) If an autopsy is performed, a certificate of death shall identify whether the decedent was pregnant at the time of death. (b) The requirement in this subsection (9) and subsections (4), (5), and (6) of this section to indicate whether the decedent was pregnant at the time of death shall be complied with when the person required to make the designation has access to the certification form that permits compliance. (10) Whenever in the Colorado Revised Statutes the terms "certificate of death" or "death certificate" are used, except as to the initial certificate of death required pursuant to paragraph (a) of subsection (1) of this section, the same two terms include a verification of death document that is certified by the state registrar and issued pursuant to paragraph (c) of subsection (1) of this section. Source: L. 67: R&RE, p. 1059, § 1. C.R.S. 1963: § 66-8-10. L. 84: Entire section R&RE, p. 744, § 8, effective July 1. L. 97: (1) amended, p. 1286, § 29, effective July 1. L. 2001: (1) and (3) amended, p. 439, § 2, effective August 8. L. 2005: (9) added, p. 214, § 1, effective July 1. L. 2011: (4), (5), (6), and (9) amended, (HB 11-1183), ch. 85, p. 230, § 1, effective August 10. L. 2012: (1) amended, (HB 12-1041), ch. 266, p. 1384, § 1, effective August 8. L. 2014: (1)(c) and (10) added, (HB 14-1073), ch. 30, p. 176, § 3, effective July 1. Editor's note: Subsection (1)(b)(II) provided for the repeal of subsection (1)(b)(II), effective September 1, 2014. (See L. 2012, p. 1384.) Cross references: (1) For unlawful acts of funeral establishments and mortuary science practitioners, see § 12-54-117; for a certified copy of an affidavit of death as proof in joint tenancy, see §§ 38-31-102 and 38-31-103. (2) For the legislative declaration contained in the 1997 act amending subsection (1), see section 1 of chapter 236, Session Laws of Colorado 1997. 25-2-110.5. Fetal deaths - treatment of remains. (1) In every instance of fetal death, the pregnant woman shall have the option of treating the remains of a fetal death pursuant to article 135 of title 12. (2) In every instance of fetal death, the health care provider, upon request of the pregnant woman, shall release to the woman or the woman's designee the remains of a fetal death for final disposition in accordance with applicable law. Such request shall be made by the pregnant woman or her authorized representative prior to or immediately following the expulsion or extraction of the fetal remains. Unless a timely request was made, nothing in this section shall require the health care provider to maintain or preserve the fetal remains. Colorado Revised Statutes 2019 Page 166 of 1101 Uncertified Printout (3) (a) Nothing in this section shall prohibit a health care provider from conducting or acquiring medical tests on the remains of a fetal death prior to release. (b) Upon a request pursuant to subsection (2) of this section, whenever a medical test is conducted pursuant to paragraph (a) of this subsection (3), the health care provider conducting the test shall, where medically permissible and otherwise permitted by law, release to the pregnant woman or the woman's designee the remains of a fetal death for final disposition. (4) Nothing in this section shall prohibit the health care provider from requiring a release of liability for the release of the remains of a fetal death prior to such release. (5) A health care provider shall be immune from all civil or criminal liability, suit, or sanction with regard to any action taken in good-faith compliance with the provisions of this section. Source: L. 2001: Entire section added, p. 1032, § 2, effective June 5. L. 2019: (1) amended, (HB 19-1172), ch. 136, p. 1700, § 150, effective October 1. 25-2-111. Dead bodies - disposition - removal from state - records. (1) Any person requested to act as funeral director for a dead body or otherwise whoever first assumes custody of a dead body shall, prior to final disposition of the body, obtain authorization for final disposition of the body. The office designated or established pursuant to section 25-2-103 in the county where the death occurred or, if such an office does not exist in the county where the death occurred, the coroner or the coroner's designee shall authorize final disposition of the body on a form prescribed and furnished by the state registrar. No body shall be buried, cremated, deposited in a vault or tomb, or otherwise disposed of, nor shall any body be removed from this state, until such authorization has been obtained, completed, and approved. The coroner or the coroner's designee shall include in the authorization notice of the requirements of subsection (7) of this section. (2) A disposition permit issued under the law of another state which accompanies a dead body or fetus brought into this state shall be authority for final disposition of the body or fetus in this state. (3) Repealed. (4) Any person who removes from the place of death or transports or finally disposes of a dead body or fetus, in addition to filing any certificate or other form required by this article, shall keep a record which shall identify the body and such information pertaining to his receipt, removal, and delivery of such body as may be prescribed in regulations. Such record shall be retained for a period of not less than seven years and shall be made available for inspection by the state registrar or his representative upon demand. (5) No sexton or other person in charge of any place in which interment or other disposition of dead bodies is made shall inter or allow interment or other disposition of a dead body or fetus unless it is accompanied by authorization for final disposition. (6) Authorization for disinterment and reinterment shall be required prior to disinterment of a dead body or fetus. Such authorization shall be issued by the state registrar to a funeral director or person acting as such upon proper application. (7) (a) The owner of land that is used to inter a dead human body shall record the burial within thirty days after the burial with the county clerk and recorder of the county in which the land is situated. The owner shall record the following: Colorado Revised Statutes 2019 Page 167 of 1101 Uncertified Printout (I) The dead person's name as it appears on the death certificate; (II) The dead person's date of birth; (III) The dead person's age at the time of death; (IV) The cause of death; (V) The name of the owner or owners of the property where the dead human body is interred; (VI) The legal description of the property where the dead human body is interred if the person is interred on private property; (VII) The reception number for the death certificate if recorded by the county clerk; and (VIII) The latitude and longitude coordinates, such as those given by a global positioning system, that are verified by two witnesses or the county coroner, sheriff, or a designee of the county coroner or sheriff. (b) This subsection (7) does not apply to dead human bodies interred in cemeteries, vaults, or tombs operated or maintained by public entities or businesses that inter people in the ordinary course of business and are available to the general public. Source: L. 67: R&RE, p. 1059, § 1. C.R.S. 1963: § 66-8-11. L. 84: (1) amended, (3) repealed, and (5) and (6) added, p. 745, 751, §§ 9, 16, effective July 1. L. 85: (1) amended, p. 880, § 2, effective May 24. L. 2010: (1) amended and (7) added, (HB 10-1275), ch. 193, p. 827, § 1, effective August 11. 25-2-111.5. Transfer of fetal tissue from induced termination of pregnancy legislative declaration. (1) The general assembly hereby finds, determines, and declares that the United States congress enacted 42 U.S.C. sec. 289g-2, prohibiting the acquisition, receipt, or other transfer of human fetal tissue for valuable consideration if the transfer affects interstate commerce. The general assembly determines and declares that the acquisition, receipt, or other transfer of human fetal tissue for valuable consideration affects intrastate commerce and is not in the public interest of the residents of Colorado. Therefore, the general assembly finds, determines, and declares that the exchange for valuable consideration of human fetal tissue should be prohibited. (2) (a) No physician or institution that performs procedures for the induced termination of pregnancy shall transfer such tissue for valuable consideration to any organization or person that conducts research using fetal tissue or that transplants fetal tissue for therapeutic purposes. For the purposes of this section, "valuable consideration" includes, but is not limited to: (I) Any lease-sharing agreement in excess of the current market value for commercial rental property for the area in which the physician's or institution's place of business is located; (II) Any lease-sharing agreement that is based on the term or number of induced terminations of pregnancy performed by such physician or institution; (III) Any moneys, gifts in lieu of money, barter arrangements, or exchange of services that do not constitute reasonable payment associated with the transportation, implantation, processing, preservation, quality control, or storage of human fetal tissue as defined in 42 U.S.C. sec. 289g-2; or (IV) Any agreement to purchase fetal tissue for a profit. (b) Nothing in this subsection (2) shall prevent the disposition of fetal tissue from an induced termination of pregnancy pursuant to part 4 of article 15 of this title. Colorado Revised Statutes 2019 Page 168 of 1101 Uncertified Printout (3) Any physician or institution that violates subsection (2) of this section shall be fined by the state registrar not more than ten thousand dollars, depending upon the severity of the violation. (4) The department of public health and environment may promulgate rules related to enforcement activities necessary to implement subsections (2) and (3) of this section. Source: L. 2000: Entire section added, p. 1073, § 2, effective August 2. 25-2-112. Certificates of birth - filing - establishment of paternity - notice to collegeinvest. (1) A certificate of birth for each live birth which occurs in this state shall be filed with the state registrar or as otherwise directed by the state registrar within ten days after such birth and shall be registered if it has been completed and filed in accordance with this section. When a birth occurs on a moving conveyance within the United States and the child is first removed from the conveyance in Colorado, the birth shall be registered in Colorado, and the place where the child is first removed shall be considered the place of birth. When a birth occurs on a moving conveyance while in international air space or in a foreign country or its air space and the child is first removed from the conveyance in Colorado, the birth shall be registered in this state but the certificate shall show the actual place of birth insofar as can be determined. Either of the parents of the child shall verify the accuracy of the personal data entered thereon in time to permit its filing within such ten-day period. (2) When a birth occurs in an institution, or upon order of any court with proper jurisdiction, the person in charge of the institution or such person's designated representative shall obtain the personal data, prepare the certificate, certify the authenticity of the birth registration either by signature or by an approved electronic process, and file it with the state registrar or as otherwise directed by the state registrar within the required ten days; the physician in attendance shall provide the medical information required by the certificate within five days after the birth. When the birth occurs outside an institution, the certificate shall be prepared and filed by the physician in attendance at or immediately after birth, or in the absence of such a physician by any person witnessing the birth, or in the absence of any such witness by the father or mother, or in the absence of the father and the inability of the mother by the person in charge of the premises where the birth occurred. The person who completes and files the certificate shall also be responsible for obtaining the social security account numbers of the parents and delivering those numbers to the state registrar along with the certificate. (2.5) Repealed. (2.7) For the purposes of a birth registration, the mother is deemed to be the woman who has given birth to the child, unless otherwise provided by law or determined by a court of competent jurisdiction prior to the filing of the birth certificate. The information about the father shall be entered as provided in subsection (3) of this section. (3) (a) If the mother was married either at the time of conception or birth, the name of the husband shall be entered on the certificate as the father of the child unless: (I) Paternity has been determined otherwise by a court of competent jurisdiction, in which case the name of the father as so determined shall be entered; or (II) The mother and the mother's husband execute joint or separate forms prescribed and furnished by the state registrar reflecting the mother's and the husband's signatures individually Colorado Revised Statutes 2019 Page 169 of 1101 Uncertified Printout witnessed and attesting that the husband is not the father of the child, in which case, information about the father shall be omitted from the certificate; or (III) The mother executes a form prescribed and furnished by the state registrar attesting that the husband is not the father and that the putative father is the father, the putative father executes a form prescribed and furnished by the state registrar attesting that he is the father, and the husband executes a form prescribed and furnished by the state registrar attesting that he is not the father. Such forms may be joint or individual or a combination thereof, and each signature shall be individually witnessed. In such event, the putative father shall be shown as the father on the certificate. (IV) A court of competent jurisdiction has determined the husband is not the presumed father and the putative father executes a form prescribed and furnished by the state registrar which is individually witnessed attesting that he is the father and the mother executes a form prescribed and furnished by the state registrar which is individually witnessed that the putative father is the father. In such event the putative father shall be shown as the father on the birth certificate. (b) If the mother was not married at the time of conception or birth, the name of the father shall be entered if, but only if, the mother and the person to be named as the father so request in writing on a form prescribed and furnished by the state registrar or if paternity has been determined by a court of competent jurisdiction, in which case the name of the father as so determined shall be entered. (c) For purposes of acknowledging paternity, the form prescribed and furnished by the state registrar shall contain the minimum requirements specified by the secretary of the federal department of health and human services. (3.5) Upon the birth of a child to an unmarried woman in an institution, the person in charge of the institution or that person's designated representative shall provide an opportunity for the child's mother and natural father to complete a written acknowledgment of paternity on the form prescribed and furnished by the state registrar. (4) Whoever assumes the custody of a living infant of unknown parentage shall report on a form and in the manner prescribed by the state registrar within ten days to the state registrar or as otherwise directed by the state registrar such information as the state registrar shall require, which report shall constitute the certificate of birth for the infant. The place where the child was found shall be entered as the place of birth, and the date of birth shall be determined by approximation. If the child is identified and a certificate of birth is found or obtained, any report registered under this section shall be sealed and filed and, except as provided in section 25-2113.5, may be opened only by order of a court of competent jurisdiction or as provided by regulation. (5) and (6) (Deleted by amendment, L. 93, p. 952, § 1, effective September 1, 1993.) (7) The state registrar shall revise the birth certificate worksheet form used for the preparation of a certificate of live birth to include a statement that knowingly and intentionally misrepresenting material information on the worksheet form used for the preparation of a birth certificate is a misdemeanor. (8) On or before February 15, 2020, and on or before the fifteenth day of each month thereafter, the state registrar shall provide to the director of collegeinvest the name of each eligible child, as defined in section 23-3.1-306.5 (2)(a), born or adopted during the prior calendar month, the date and location of the birth or adoption, and the name and mailing address of the Colorado Revised Statutes 2019 Page 170 of 1101 Uncertified Printout parent or parents, as defined in section 23-3.1-306.5 (2)(g), of the eligible child listed on the eligible child's certificate of birth or the report of adoption forwarded to the state registrar as required by section 25-2-107 (1). Source: L. 67: R&RE, p. 1059, § 1. C.R.S. 1963: § 66-8-12. L. 83: (4) amended, p. 1047, § 2, effective June 15. L. 84: Entire section amended, p. 746, § 10, effective July 1. L. 90: (2) amended and (5) and (6) added, p. 900, § 29, effective July 1. L. 93: (2.5) added, p. 1921, § 6, effective July 1; (1), (2), (3), (5), and (6) amended and (2.7) and (3.5) added, p. 952, § 1, effective September 1. L. 94: (3)(a) amended, p. 1543, § 18, effective May 31; (3)(a)(II), (3)(a)(III), (3)(a)(IV), and (3.5) amended, pp. 2044, 2045, §§ 1, 2, effective June 3. L. 96: (2.5) amended, p. 402, § 14, effective April 17. L. 97: (3)(c) added, p. 1286, § 30, effective July 1. L. 2015: (7) added, (HB 15-1282), ch. 325, p. 1329, § 3, effective July 1. L. 2019: (8) added, (HB 19-1280), ch. 158, p. 1879, § 2, effective August 2. Editor's note: (1) Amendments to subsection (3)(a) by Senate Bill 94-088 and Senate Bill 94-141 were harmonized. (2) Subsection (2.5)(b) provided for the repeal of section (2.5) effective July 1, 2001. (See L. 96, p. 402.) Cross references: (1) For statement in the certificate as to whether blood test for syphilis has been made, see § 25-4-203; for penalty for failure to file a certificate, see § 25-2118. (2) For the legislative declaration contained in the 1997 act enacting subsection (3)(c), see section 1 of chapter 236, Session Laws of Colorado 1997. 25-2-112.3. Certificates of stillbirth - filing - delayed registration - rules. (1) The state registrar shall create a certificate of stillbirth and shall furnish and distribute such form as necessary. The state board of health shall promulgate rules necessary to implement this section. (2) (a) A certificate of stillbirth shall be offered to a mother after the occurrence of any stillbirth. If the mother decides to have a certificate of stillbirth filed, it shall be filed with the state registrar within three days after the stillbirth occurs and shall be registered by the state registrar if it has been completed and filed in accordance with the provisions of this section and section 25-2-112. (b) If the mother decides not to place a name on the certificate of stillbirth, the person preparing the certificate of stillbirth shall leave this option on the certificate blank. (3) Notwithstanding the provisions set forth in subsection (2) of this section, if a certificate of stillbirth is not registered after one year from the date the stillbirth occurs, a certificate marked "Delayed" may be filed and registered in accordance with the provisions of section 25-2-114. Source: L. 2004: Entire section added, p. 473, § 2, effective July 1. 25-2-112.5. Social security account numbers - acknowledgments of paternity - to be furnished. (1) Regardless of the marital status of the mother, each parent shall furnish the social security account number or numbers, if the parent has more than one such number, issued to that Colorado Revised Statutes 2019 Page 171 of 1101 Uncertified Printout parent, and the other parent's social security account number, if known, at the time of the child's birth to the person authorized under section 25-2-112 to obtain them for the state registrar, unless the state, in accordance with federal regulations, finds good cause for not requiring the parent to furnish such numbers to the state. (2) The department of public health and environment shall make the birth certificate, the mother's and father's social security account numbers, and any written acknowledgments of paternity, including any notarized affidavits acknowledging paternity and any witnessed forms prescribed and furnished by the state registrar, furnished under this section and section 25-2-112 available to the state agency responsible for enforcing child support under Title IV-D of the federal "Social Security Act" upon request of that agency. The social security account numbers shall not be recorded on the birth certificate and may not be used for any purpose other than for the establishment and enforcement of child support orders. Source: L. 93: Entire section added, p. 954, § 2, effective September 1. L. 94: (2) amended, p. 2045, § 3, effective June 3; (2) amended, p. 2748, § 399, effective July 1. Editor's note: Amendments to subsection (2) by Senate Bill 94-141 and House Bill 941029 were harmonized. Cross references: For the legislative declaration contained in the 1994 act amending subsection (2), see section 1 of chapter 345, Session Laws of Colorado 1994. 25-2-112.7. Crime of misrepresentation of material information in the preparation of a birth certificate - definitions. (1) As used in this section, unless the context otherwise requires: (a) "Birth parent" means a natural parent, by birth, of a child born in this state. "Birth parent" also includes a presumed father or putative father in accordance with the presumptions for determination of paternity as set forth in section 25-2-112 (3) or a putative father who is not married to the mother who signs a voluntary acknowledgment of paternity. (b) "Material information" means the legal name of a birth parent, the birth date of a birth parent, the mother's maiden name prior to a first marriage, if applicable, and the place of birth of a birth parent. (2) A birth parent commits the crime of misrepresentation of material information in the preparation of a birth certificate if the birth parent knowingly and intentionally misrepresents material information that is used to create a child's birth certificate. (3) A person who commits the crime of misrepresentation of material information in the preparation of a birth certificate 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. Source: L. 2015: Entire section added, (HB 15-1282), ch. 325, p. 1328, § 1, effective July 1. 25-2-113. New certificates of birth following adoption - parentage determination. (1) (a) The state registrar shall prepare a new certificate of birth as to any person born in this Colorado Revised Statutes 2019 Page 172 of 1101 Uncertified Printout state whenever he or she receives, with respect to such a person, any of the following: A report concerning adoption or parentage as required by section 25-2-107; or a report or certified copy of a decree concerning the adoption or parentage of the person from a court of competent jurisdiction outside this state; or a certified copy of the marriage certificate of the parents, together with a statement of the husband, executed after the marriage, in which the husband acknowledges paternity. The state registrar shall not prepare a new certificate of birth for an adoption if the court that has decreed the adoption, an adoptive parent, or the adopted person has requested that the state registrar not prepare such new certificate of birth. Each new certificate must show all information shown on the original certificate of birth, except information for which substitute information is included as a result of the report or decree which prompts the preparation of the new certificate. (b) A new certificate of birth shall be prepared by the state registrar as to any adopted person born in a foreign country and a resident of this state whenever the state registrar receives with respect to such person a certified copy of the final decree of adoption as required by section 19-5-212, C.R.S., and section 25-2-107 and findings of fact as required by this section. In proceedings for the adoption of a person who was born in a foreign country, the juvenile court having jurisdiction of adoptions, upon evidence from reliable sources, shall make findings of fact as to the date and place of birth and parentage of such person. The state registrar shall prepare a new birth certificate in the new name of the adopted person and shall seal the certified copy of the findings of the court and the certified copy of the final decree of adoption which shall be kept confidential except as otherwise provided in part 3 of article 5 of title 19, C.R.S. The birth certificate shall be labeled as a certificate of foreign birth and shall show specifically the true or probable country of birth and that the certificate is not evidence of United States citizenship. If the child was born in a foreign country but was a citizen of the United States at the time of birth, the state registrar shall not prepare a certificate of foreign birth but instead shall notify the adoptive parents of the procedures for obtaining a revised birth certificate for their child through the United States department of state. Any copy of a certificate of foreign birth issued shall indicate this policy, show the actual place of birth, and indicate the fact that the certificate is not proof of United States citizenship for the adopted child. A new certificate of birth in the new name of the adopted person prepared by the state registrar pursuant to this section is hereby legalized and made valid. (c) Repealed. (2) (a) The state registrar shall register each new certificate of birth prepared pursuant to subsection (1) of this section by marking thereon the words "new certificate", by marking thereon the date such certificate is completed, which date thereafter shall be the registration date, and by substituting such new certificate for the original certificate of birth for such person. (b) A new certificate of birth issued pursuant to an adoption, and any copy of such certificate issued, shall be marked by the state registrar with the words "issued pursuant to adoption" if so requested by an adoptive parent or by an adopted person. (c) The state registrar shall develop rules to ensure that the adoptive parent's decision to include such information, in paragraph (b) of this subsection (2), is made knowingly, including having a separate signature line verifying such choice. (3) Thereafter, the original certificate and evidence concerning adoption or parentage must be sealed and is not subject to inspection, except as provided in section 25-2-113.5 or in part 3 of article 5 of title 19, by regulation, or upon order of a court of competent jurisdiction Colorado Revised Statutes 2019 Page 173 of 1101 Uncertified Printout after the court has satisfied itself that the interests of the child or the child's descendants or the parents will best be served by opening the seal. The information obtained from opening the seal may be withheld from public view or from being presented as evidence at the discretion of the judge. (4) In the event the decree which formed the basis for the new certificate of birth is annulled and if the state registrar receives either a certified copy of such decree of annulment or a report with respect to such decree as required by section 25-2-107, the state registrar shall return the original certificate to its place in the files. Thereafter the new certificate and evidence concerning the annulment shall not be subject to inspection except as provided in section 25-2113.5, upon order of a court of competent jurisdiction, or as provided by regulation. (5) If no certificate of birth is on file for the person for whom a new birth certificate is to be established under this section and the date and place of birth have not been determined in the adoption or paternity proceedings, a delayed certificate of birth shall be filed with the state registrar before a new certificate of birth is established. The new birth certificate shall be prepared on the delayed birth certificate form. (6) When a new certificate of birth is established by the state registrar, all copies of the original certificate of birth in the custody of any other custodian of vital records in this state shall be sealed from inspection, except as otherwise provided in part 3 of article 5 of title 19, C.R.S., or forwarded to the state registrar, as the state registrar shall direct. Source: L. 67: R&RE, p. 1060, § 1. C.R.S. 1963: § 66-8-13. L. 76: (1) amended, p. 651, § 1, effective July 1. L. 78: (1)(a) and (3) amended, p. 269, § 81, effective May 23. L. 83: (3) and (4) amended, p. 1047, § 3, effective June 15. L. 84: (1)(b) amended, (1)(c) repealed, and (5) and (6) added, pp. 747, 751, §§ 11, 16, effective July 1. L. 87: (1)(b) amended, p. 820, § 35, effective October 1. L. 99: (1)(b), (3), and (6) amended, p. 1136, § 5, effective July 1. L. 2002: (2) amended, p. 333, § 1, effective August 7. L. 2018: (1)(a) and (3) amended, (SB 18-095), ch. 96, p. 755, § 14, effective August 8. Cross references: For the legislative declaration in SB 18-095, see section 1 of chapter 96, Session Laws of Colorado 2018. 25-2-113.5. Limited access to information upon consent of all parties - voluntary adoption registry. (1) Adoption is based upon the legal termination of parental rights and responsibilities of birth parents and the creation of the legal relationship of parent and child between an adoptee and his or her adoptive parents. Under current laws and the social premises underlying adoption, the general assembly has been charged with the duty to preserve the right to privacy and confidentiality of birth parents whose children were adopted, the adoptees, and the adoptive parents. The general assembly recognizes, however, that some adults who were adopted as children, their siblings who may or may not have been adopted, and some birth parents whose children were surrendered for adoption have a strong desire to obtain information about each other. The purpose of this section is to set up a voluntary adoption registry where qualified persons may register their willingness to the release of information to each other and to provide for the disclosure of such information. (2) As used in this section, unless the context otherwise requires: Colorado Revised Statutes 2019 Page 174 of 1101 Uncertified Printout (a) "Adoptive parent" means an adult who has become a parent of a child through the legal process of adoption. (b) "Consent" means a verified written statement which has been notarized. (c) "Identifying information" includes the following information: (I) The name of the qualified adoptee before placement in adoption; (II) The name and address of each qualified birth parent as it appears in birth records; (III) The current name, address, and telephone number of the qualified adult adoptee; and (IV) The current name, address, and telephone number of each qualified birth parent. (d) "Qualified adult adoptee" means an adopted person eighteen years of age or older who was born in Colorado and who meets the requirements of this section. (e) "Qualified birth parent" means a genetic, biological, or natural parent whose rights were voluntarily or involuntarily terminated by a court or otherwise and who meets the requirements of this section. "Birth parent" includes a man who is the parent of a child as established in accordance with the provisions of the "Uniform Parentage Act", article 4 of title 19, C.R.S., prior to the termination of parental rights and who meets the requirements of this section. (f) "Registrar" means the state registrar of vital statistics or his designated representative. (g) "Relative" includes an individual's spouse, birth parent, adoptive parent, sibling, or child who is twenty-one years of age or older. (g.5) "Sibling" shall have the same meaning as "biological sibling", section 19-1-103 (14), C.R.S. (h) "Voluntary adoption registry" or "registry" means a place where eligible persons, as described in this section, may indicate their willingness to have their identities and whereabouts disclosed to each other under conditions specified in this section. (3) The registrar shall maintain a confidential list of qualified adult adoptees who have presented a consent regarding the release of identifying information about themselves. Any consent by a qualified adult adoptee shall be accompanied by the adoptee's desired method of notification in the event that a match occurs; however, the state shall not incur costs of notification in excess of that part of the fee charged to the applicant for the purpose of notification. Any consent shall also indicate whether the qualified adult adoptee desires release of his identifying information if a match occurs after his death. The qualified adult adoptee may revise his consent with respect to change of address or method of notification. Any name and accompanying information shall be removed from the list upon the verified written request of the listed adoptee. The registrar shall maintain a closed record of such list and accompanying information, except as provided in accordance with this section. (4) The registrar shall maintain a confidential list of qualified birth parents who have presented a consent regarding the release of identifying information about themselves. Any consent by a qualified birth parent shall be accompanied by the birth parent's desired method of notification in the event that a match occurs; however, the state shall not incur costs of notification in excess of that part of the fee charged to the applicant for the purpose of notification. Any consent shall also indicate whether the qualified birth parent desires release of his identifying information if a match occurs after his death. The qualified birth parent may revise his consent with respect to change of address or method of notification. Any name and accompanying information shall be removed from the list upon the verified written request of the Colorado Revised Statutes 2019 Page 175 of 1101 Uncertified Printout listed birth parent. The registrar shall maintain a closed record of such list and accompanying information, except as provided in accordance with this section. Any birth parent who in terminating his parental rights used an alias, and this alias is listed in the original sealed birth certificate, may also file a consent with the registry. A birth parent shall not be matched with the qualified adult adoptee without the consent of the other birth parent unless: (a) There is only one birth parent listed on the birth certificate; or (b) The other birth parent is deceased; or (c) The other birth parent is unable to be located by the department of public health and environment after an exhaustive search, the cost of said search to be fully funded by the birth parent seeking a match, said search to be in accordance with the rules and regulations promulgated by the department. (5) The registrar shall maintain a confidential list of relatives of deceased qualified adult adoptees and relatives of deceased qualified birth parents who have presented a consent regarding the release of identifying information about themselves. Any consent by such relative shall be accompanied by the person's desired method of notification in the event that a match occurs; however, the state shall not incur costs of notification in excess of that part of the fee charged to the applicant for the purpose of notification. Such relative may revise his consent with respect to change of address or method of notification. Any name and accompanying information shall be removed from the list upon the verified written request of the listed relative. The registrar shall maintain a closed record of such list and accompanying information, except as provided in accordance with this section. (5.5) The registrar shall maintain a confidential list of former foster children who may or may not have been adopted, who are eighteen years of age or older, who have presented a consent regarding the release of identifying information about themselves and who are searching for a sibling who is also eighteen years of age or older, who may or may not have been adopted, and who may or may not have been in the foster care system. Any consent by such sibling shall be accompanied by the sibling's desired method of notification in the event that a match occurs. However, the state shall not incur costs of notification in excess of that part of the fee charged to the applicant for the purpose of notification. A sibling may revise his or her consent with respect to change of address or method of notification. Any name and accompanying information shall be removed from the list upon the verified written request of the listed sibling. The registrar shall maintain a closed record of the list and accompanying information except as provided for pursuant to this section. (6) The registrar shall regularly review the lists provided for in subsections (3), (4), (5), and (5.5) of this section and any other nonsealed administrative files or records within his or her office to determine if there is a match. If it appears that a match has occurred, then and only then is the registrar authorized to proceed to confirm the match through recourse to sealed documents on file in the office of the registrar. When a match is confirmed, the registrar shall notify each party, by his or her designated method only, prior to an exchange of identifying information. Nothing in this section shall be construed to allow any state or local governmental department, agency, or institution, or any employee thereof, to solicit any consent for the release of identifying information. (7) Nothing in this section shall be construed to allow the registrar to issue a copy of the original birth certificate to any registrant. Colorado Revised Statutes 2019 Page 176 of 1101 Uncertified Printout (8) Any person who knowingly uses, publishes, or divulges information obtained through operation of the registry to any person in a manner not authorized by this section commits a class 2 petty offense and, upon conviction thereof, shall be punished by a fine of five hundred dollars. (9) Notwithstanding any other provision of law, the information acquired by the registry shall not be disclosed under any public records law, sunshine or freedom of information legislation, rules, or practice. (10) (a) The executive director of the department of public health and environment shall establish fees to be charged each person requesting that his name be placed on the list provided for in subsection (3), (4), or (5) of this section and for the services provided by the registrar in establishing and implementing the registry pursuant to this section. It is the intent of the general assembly that the fees shall cover all direct and indirect costs incurred pursuant to this section. (b) The fees collected pursuant to this section shall be transmitted to the state treasurer, who shall credit the same to the general fund. The general assembly shall annually appropriate from the general fund to the department of public health and environment an amount sufficient to meet expenses incurred pursuant to this section. Source: L. 83: Entire section added, p. 1044, § 1, effective June 15. L. 87: (2)(e) amended, p. 821, § 36, effective October 1. L. 94: (4)(c), (10)(a), and (10)(b) amended, p. 2748, § 400, effective July 1. L. 2005: (2)(d) amended, p. 993, § 7, effective July 1. L. 2009: (1) and (6) amended and (2)(g.5) and (5.5) added, (SB 09-079), ch. 59, pp. 214, 215, §§ 2, 3, effective March 25. Cross references: For the legislative declaration contained in the 1994 act amending subsections (4)(c), (10)(a), and (10)(b), see section 1 of chapter 345, Session Laws of Colorado 1994. 25-2-113.8. Birth certificate modernization act - new birth certificate following a change in gender designation - short title. [Editor's note: This section is effective January 1, 2020.] (1) The short title of this section is "Jude's Law". (2) (a) A birth certificate issued at the time of birth must identify the person's sex as male or female. (b) An amended birth certificate may be issued to change the sex designation of the person to male, female, or "X" pursuant to the requirements of this section. "X" is a designation that is neither male nor female. (3) The state registrar shall issue a new birth certificate to a person who was born in this state and who has a gender different from the sex denoted on that person's birth certificate when the state registrar receives: (a) A written request from the person, or from the person's parent if the person is a minor, or from the person's guardian or legal representative, signed under penalty of law, to issue a new birth certificate with a gender designation that differs from the sex designated on the person's original birth certificate; and (b) (I) A statement, in a form or format designated by the state registrar, from the person, or from the person's parent if the person is a minor, or from the person's guardian or legal Colorado Revised Statutes 2019 Page 177 of 1101 Uncertified Printout representative, signed under penalty of law, confirming the sex designation on the person's birth certificate does not align with the person's gender identity; and (II) If the person is a minor under the age of eighteen, a statement, in a form or format designated by the state registrar, signed under penalty of law, from a professional medical or mental health care provider licensed in good standing in Colorado or with an equivalent license in good standing from another jurisdiction, stating that: (A) The minor has undergone surgical, hormonal, or other treatment appropriate for that person for the purpose of gender transition, based on contemporary medical standards, and, in the provider's professional opinion, the minor's gender designation should be changed accordingly; or (B) The minor has an intersex condition, and, in the provider's professional opinion, the minor's gender designation should be changed accordingly. (4) Notwithstanding subsection (3) of this section, the state registrar shall issue a new birth certificate to a person with a court order indicating the sex or gender of the person born in the state of Colorado has been changed. (5) The state registrar may only amend a gender designation for an individual's birth certificate one time upon the individual's request. Any further requests from the individual for additional gender designation changes require the submission of a court order indicating that the gender designation change is required. (6) The state registrar is authorized to contact the medical or mental health care provider to verify a statement made pursuant to subsection (3)(b)(II) of this section. (7) If a new birth certificate is issued pursuant to this section, the birth certificate must reflect, or be reissued to reflect, any legal name change made before or simultaneous to the change in gender designation, as long as appropriate documentation of the name change is submitted. (8) The state registrar shall not request any additional information or records other than those required by subsection (3) or (4) of this section to process a request to modify a gender designation. The state registrar shall not disclose information relating to a gender correction, including to other government employees, unless required in order to conduct official business. (9) When the state registrar receives the documentation described in subsection (3) of this section, the state registrar shall issue a new birth certificate reflecting the new gender designation and, if applicable, the person's new name. Notwithstanding section 25-2-115 (1), the new birth certificate supersedes the original as the official public record and must not be marked as amended or indicate in any other manner that the gender designation or name on the certificate has been changed. (10) In the case of a person who is a resident of this state and was born in another state or in a foreign jurisdiction, if the other state or foreign jurisdiction requires a court decree in order to amend a birth certificate to reflect a change in gender, the courts in this state have jurisdiction to issue such a decree. (11) The state registrar shall promptly notify the department of revenue when an individual is issued a new birth certificate pursuant to this section. Source: L. 2019: Entire section added, (HB 19-1039), ch. 377, p. 3403, § 1, effective January 1, 2020. Colorado Revised Statutes 2019 Page 178 of 1101 Uncertified Printout 25-2-114. Delayed registration of births and deaths. (1) When a birth, foundling birth, death, or fetal death has occurred in this state but no certificate as to such event has been filed or registered in accordance with the provisions of section 25-2-110 or 25-2-112, a certificate as to such event may be accepted for filing or registration, or both, in accordance with applicable regulations concerning certificates that have not been timely or properly filed or registered. The state registrar shall endorse on the certificate a summary statement of the evidence submitted to substantiate the facts asserted in such certificate. If a certificate is not registered until more than a year after the event, the state registrar shall mark the word "Delayed" on the face thereof. (2) When the state registrar finds the certificate or such supplementary evidence as may be required by regulations to be deficient or invalid, the certificate shall not be registered, and the person who requested the registration shall be advised in writing both as to the basis for the alleged deficiency or invalidity and also as to such person's right of appeal. Judicial review of the action of the state registrar may be had in accordance with the provisions of section 24-4-106, C.R.S., but an action for judicial review shall be commenced within sixty days after the date the state registrar gives his notice in writing of his decision. If no action for judicial review is commenced within said period, the state registrar shall return the certificate and all documents submitted in support thereof to the person submitting the same if registration of the certificate has been refused. Source: L. 67: R&RE, p. 1061, § 1. C.R.S. 1963: § 66-8-14. 25-2-115. Alteration of reports and certificates - amended reports and certificates. (1) [Editor's note: This version of subsection (1) is effective until January 1, 2020.] A vital statistics report or certificate shall not ever be altered in any way except in accordance with this article 2 and applicable rules. The date of alteration and a summary description of the evidence submitted in support of the alteration must be endorsed on or made a part of each vital statistics certificate that is altered. Every vital statistics report or certificate that is altered in any way must be marked "Amended" except the birth report or certificate of a child altered by the addition of a father's name pursuant to section 25-2-112 (3), in which case, upon request of the parents, the surname of the child shall be changed on the report and certificate to that of the father, and also except additions and minor corrections made within one year after the date of the statistical event as may be specified by applicable rules. A child's surname may be changed upon affidavit of the parent that the change is being made to conform the child's surname to the parent's legal surname. (1) [Editor's note: This version of subsection (1) is effective January 1, 2020.] A vital statistics report or certificate shall not ever be altered in any way except in accordance with this article 2 and applicable rules. Except for amended birth certificates issued pursuant to section 25-2-113.8, the date of alteration and a summary description of the evidence submitted in support of the alteration must be endorsed on or made a part of each vital statistics certificate that is altered. Every vital statistics report or certificate that is altered in any way must be marked "Amended", except for amended birth certificates issued pursuant to section 25-2-113.8; the birth report or certificate of a child altered by the addition of a father's name pursuant to section 25-2-112 (3), in which case, upon request of the parents, the surname of the child shall be changed on the report and certificate to that of the father; or additions and minor corrections Colorado Revised Statutes 2019 Page 179 of 1101 Uncertified Printout made within one year after the date of the statistical event as may be specified by applicable rules. A child's surname may be changed upon affidavit of the parent that the change is being made to conform the child's surname to the parent's legal surname. (2) Upon receipt of a certified copy of a court order changing the name of a person born in this state and upon request of such person, or upon the request of his parent, guardian, or legal representative if he is under a legal disability, the original certificate of birth shall be amended to reflect the new name thereon. (3) In the event the state registrar alters a birth certificate or death certificate, he shall promptly report the amendment to any other custodians of the vital statistics record and their records shall be amended accordingly. (4) [Editor's note: This version of subsection (4) is effective until January 1, 2020.] Upon receipt of a certified copy of an order of a court of competent jurisdiction indicating that the sex of an individual born in this state has been changed by surgical procedure and that such individual's name has been changed, the certificate of birth of such individual shall be amended as prescribed by regulation. (4) [Editor's note: This version of subsection (4) is effective January 1, 2020.] Repealed. (5) When an applicant does not submit the minimum documentation required in the regulations for amending a vital statistics record or when the state registrar has reasonable cause to question the validity or adequacy of the applicant's sworn statements or documentary evidence, and if the deficiencies are not corrected, the state registrar shall not amend the vital statistics record and shall advise the applicant of the reason for this action and shall further advise the applicant of the right of appeal to a court of competent jurisdiction. Source: L. 67: R&RE, p. 1061, § 1. C.R.S. 1963: § 66-8-15. L. 77: (1) amended, p. 1274, § 1, effective May 20. L. 84: (3) amended and (4) and (5) added, p. 748, § 12, effective July 1. L. 2018: (1) amended, (SB 18-095), ch. 96, p. 756, § 15, effective August 8. L. 2019: (1) amended and (4) repealed, (HB 19-1039), ch. 377, p. 3405, § 2, effective January 1, 2020. Cross references: For the legislative declaration in SB 18-095, see section 1 of chapter 96, Session Laws of Colorado 2018. 25-2-116. Institutions to keep records - persons to furnish information. (1) Every person in charge of an institution shall keep a record of personal particulars and dates concerning each person admitted or confined to such institution. This record shall include such information as required by the standard certificate of birth, death, and fetal death forms issued under the provisions of this article. The record shall be made at the time of admission. The name and address of the person providing the information shall appear on the record. (2) When a dead human body is released or disposed of by an institution, the person in charge of the institution shall record the name of the deceased, date of death, name and address of the person to whom the body is released, and date of removal from the institution, or, if finally disposed of by the institution, the date, place, and manner of disposition shall be recorded. (3) Any person having knowledge of the facts shall furnish such information as he may possess regarding any birth, death, fetal death, adoption, marriage, or dissolution of marriage upon demand of the state registrar. Colorado Revised Statutes 2019 Page 180 of 1101 Uncertified Printout Source: L. 67: R&RE, p. 1062, § 1. C.R.S. 1963: § 66-8-16. 25-2-117. Certified copies furnished - fee. (1) Vital statistics records shall be treated as confidential, but the department of public health and environment shall, upon request, furnish to any applicant having a direct and tangible interest in a vital statistics record a certified copy of any record registered under the provisions of this article. Any copy of the record of a birth or death, when properly certified by the state registrar or as otherwise directed by the state registrar to be a true copy thereof, shall be prima facie evidence in all courts and places of the facts therein stated. (2) An applicant shall pay fees established pursuant to section 25-2-121 for each of the following services: (a) The reproduction and certification of birth or death records; except that an applicant shall not pay a fee: (I) For the provision of a certified copy of such a record to: (A) Another state agency; (B) A county department of human or social services; or (C) An individual presenting a letter of referral from a county department of human or social services; or (II) If the applicant is a delegate child support enforcement unit acting pursuant to article 13 of title 26, C.R.S.; (b) Any search of the files and records of the state registrar when no certified copy is made, such fee to pertain to each hour or fractional hour of time of the search; (c) The processing of new certificates, delayed certificates, or corrected certificates; (d) The verification of marriage or divorce; (e) The reproduction of various vital statistics, publications, reports, and data services; and (f) The verification of a civil union or dissolution of a civil union. (3) To preserve vital statistics records, the state registrar is authorized to prepare typewritten, photographic, electronic, or other reproductions of certificates or reports. When certified by the state registrar, such reproductions shall be accepted as the original records. The documents from which permanent reproductions have been made and verified may be disposed of as provided by regulation. Source: L. 67: R&RE, p. 1062, § 1. C.R.S. 1963: § 66-8-17. L. 82: Entire section amended, p. 408, § 1, effective July 1. L. 83: Entire section amended, p. 1049, § 1, effective June 15. L. 84: Entire section amended, p. 749, § 13, effective July 1. L. 89: (2)(a) amended, p. 796, § 29, effective July 1. L. 94: (1) amended, p. 2749, § 401, effective July 1. L. 2010: (2)(a) amended, (SB 10-006), ch. 341, p. 1578, § 2, effective June 5. L. 2013: (2)(d) and (2)(e) amended and (2)(f) added, (SB 13-011), ch. 49, p. 156, § 4, effective May 1. L. 2018: (2)(a)(I)(B) and (2)(a)(I)(C) amended, (SB 18-092), ch. 38, p. 441, § 99, effective August 8. 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 2010 act amending subsection (2)(a), see section 1 of chapter 341, Session Colorado Revised Statutes 2019 Page 181 of 1101 Uncertified Printout Laws of Colorado 2010. For the legislative declaration in SB 18-092, see section 1 of chapter 38, Session Laws of Colorado 2018. 25-2-118. Penalties. (1) Except as otherwise provided for in section 25-2-112.7 with respect to misrepresentation of material information in the preparation of a birth certificate, any person who knowingly and willfully makes any false statement in or supplies any false information for or for purposes of deception applies for, alters, mutilates, uses, attempts to use, applies for amendments thereto, or furnishes to another for deceptive use any vital statistics certificate, and any person who knowingly and willfully and for purposes of deception uses or attempts to use or furnishes for use by another any vital statistics certificate knowing that such certificate contains false information or relates to a person other than the person with respect to whom it purports to relate, and any person who manufactures, advertises for sale, sells, or alters any vital statistics certificate knowing or having reason to know that such document establishes or may be used to establish a false status, occupation, membership, license, privilege, or identity for himself or any other person, and any person who uses any such document to commit a crime 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. (2) Any person who willfully violates any of the provisions of this article or refuses or neglects to perform any of the duties imposed upon him by this article is guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not more than one hundred dollars, or by imprisonment in the county jail for not more than thirty days, or by both such fine and imprisonment. Source: L. 67: R&RE, p. 1062, § 1. C.R.S. 1963: § 66-8-18. L. 84: (1) amended, p. 750, § 14, effective July 1. L. 2015: (1) amended, (HB 15-1282), ch. 325, p. 1329, § 2, effective July 1. 25-2-119. Tax on court action affecting vital statistics. (Repealed) Source: L. 67: R&RE, p. 1063, § 1. C.R.S. 1963: § 66-8-19. L. 78: Entire section amended, p. 270, § 82, effective May 23. L. 84: Entire section repealed, p. 751, § 16, effective July 1. 25-2-120. Reports of electroconvulsive treatment. (1) Any person who performs electroconvulsive treatment in the state of Colorado shall file a report with the department of public health and environment setting forth the data required by subsection (2) of this section. An institution in which electroconvulsive treatment is performed shall be the reporting entity for all electroconvulsive treatments performed at that institution. (2) Such reports shall be made to the department of public health and environment on forms prescribed by the department within thirty days after January 1 and July 1 of each year on a semiannual basis and shall contain the following detailed information for each reporting period: Colorado Revised Statutes 2019 Page 182 of 1101 Uncertified Printout (a) The total number, broken down by inpatient and outpatient and exclusive of substance abuse, of adult psychiatric admissions, minor children psychiatric admissions, and readmissions of both; (b) The number of patients within each category of paragraph (a) of this subsection (2) who received electroconvulsive treatment; (c) Statistical information on each patient receiving electroconvulsive treatment including, but not limited to, the following: (I) Diagnosis; (II) Number of electroconvulsive treatments; (III) Age; (IV) Sex; (V) Ethnicity; (VI) Whether such patient was voluntary or involuntary; (VII) Whether or not such patient was capable of giving his written informed consent; (VIII) Whether or not any complications resulted from such electroconvulsive treatment, such as cardiac arrest, fracture, apnea, memory loss, or death (including autopsy results with particular attention to the brain); (IX) The method of payment for such electroconvulsive treatment and, if applicable, the name of the insurance company making such payments. (3) The name of the patient receiving electroconvulsive treatment shall remain confidential information and shall not be disclosed to the department, any other agency or individual. The forms prescribed by subsection (2) of this section shall not require any information which would disclose, directly or indirectly, the identity of the patient. Source: L. 79: Entire section added, p. 613, § 2, effective June 22. L. 94: (1) and IP(2) amended, p. 2749, § 402, 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. 25-2-121. Fee adjustments - vital statistics records cash fund created. (1) This section shall apply to all activities of the office of the state registrar in the department of public health and environment. (2) (a) The office of the state registrar shall propose, as part of its annual budget request, an adjustment in the amount of each fee that the office of the state registrar is authorized by law to collect. The budget request and the adjusted fees for the office of the state registrar shall reflect its direct and indirect costs and the direct and indirect costs necessary to maintain and operate the Colorado responds to children with special needs program. (b) (I) Based upon the appropriation made and subject to the approval of the executive director of the department of public health and environment, the office of the state registrar shall adjust its fees so that the revenue generated from said fees approximates its direct and indirect costs and the direct and indirect costs necessary to maintain and operate the Colorado responds to children with special needs program. Such fees shall remain in effect for the fiscal year for which the budget request applies. All fees collected by the office of the state registrar shall be Colorado Revised Statutes 2019 Page 183 of 1101 Uncertified Printout transmitted to the state treasurer, who shall credit the same to the vital statistics records cash fund, which fund is hereby created. All moneys credited to the vital statistics records cash fund and all interest earned thereon shall be subject to appropriation by the general assembly to be used as provided in this section and shall not be deposited in or transferred to the general fund of this state or any other fund. (II) For those services required by this article and those services provided by the Colorado responds to children with special needs program, each office designated or established pursuant to section 25-2-103 shall charge fees as specified by the state registrar. Such fees shall be used for the purpose of paying the direct and indirect costs of the office and the office of the state registrar for compliance with the provisions of this article and the direct and indirect costs necessary to maintain and operate the Colorado responds to children with special needs program. (c) Beginning July 1, 1985, and each July 1 thereafter, whenever moneys appropriated to the office of the state registrar for its activities for the prior fiscal year are unexpended, said moneys shall be made a part of the appropriation to the office of the state registrar for the next fiscal year, and such amount shall not be raised from fees collected by the office of the state registrar. If a supplemental appropriation is made to the office of the state registrar for its activities and the services provided by the Colorado responds to children with special needs program, the fees of the office of the state registrar, when adjusted for the fiscal year following that in which the supplemental appropriation was made, shall be adjusted by an additional amount that is sufficient to compensate for the supplemental appropriation. Moneys appropriated to the office of the state registrar in the annual general appropriation act shall be designated as cash funds and shall not exceed the amount anticipated to be raised from fees collected by the office of the state registrar. (d) For purposes of this section, "Colorado responds to children with special needs program" means the program established within the department of public health and environment under the authority of section 25-1.5-105. (3) Notwithstanding any provision of subsection (2) of this section to the contrary, on March 5, 2003, the state treasurer shall deduct seven hundred sixty-three thousand six hundred eighty dollars from the vital statistics records cash fund and transfer such sum to the general fund. Source: L. 84: Entire section added, p. 750, § 15, effective July 1. L. 94: (1) and (2)(b)(I) amended, p. 2750, § 403, effective July 1. L. 2003: (3) added, p. 458, § 18, effective March 5. L. 2008: (2) amended, p. 2065, § 1, effective June 3. L. 2010: (2)(b)(II) amended, (SB 10-006), ch. 341, p. 1578, § 3, effective June 5. Cross references: For the legislative declaration contained in the 1994 act amending subsections (1) and (2)(b)(I), see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration in the 2010 act amending subsection (2)(b)(II), see section 1 of chapter 341, Session Laws of Colorado 2010. 25-2-122. Heirloom birth and marriage certificates - funds created - report - rules definitions. (1) As used in this section, unless the context otherwise requires: (a) "Heirloom birth certificate" means a birth certificate that is suitable for display and may bear the seal of the state and be signed by the governor. Colorado Revised Statutes 2019 Page 184 of 1101 Uncertified Printout (b) "Heirloom marriage certificate" means a marriage certificate that is suitable for display and may bear the seal of the state and be signed by the governor. (2) (a) In addition to any other birth certificate issued pursuant to section 25-2-112, the state registrar shall issue, upon request and upon payment of a fee established by rule of the state board of health, an heirloom birth certificate representing the birth of the individual named on the original birth certificate. The state registrar may establish procedures for issuing heirloom birth certificates; except that an heirloom birth certificate shall be issued in a form consistent with the need to protect the integrity of vital records, including secure measures designed to prevent tampering, counterfeiting, or otherwise duplicating the birth certificate for fraudulent purposes, pursuant to the federal "Intelligence Reform and Terrorism Prevention Act of 2004", 5 U.S.C. sec. 301. (b) An heirloom birth certificate shall have the same status as evidence as that of an original birth certificate. (c) The fee established pursuant to paragraph (a) of this subsection (2) shall be sufficient to cover the direct and indirect costs of producing and issuing the heirloom birth certificate, plus an additional ten dollars. The state registrar shall transmit moneys generated pursuant to this subsection (2), along with an explanation of the number of heirloom birth certificate sales that correspond to such moneys, to the state treasurer, who shall credit: (I) For each sale of an heirloom birth certificate, ten dollars to the immunization fund created in section 25-4-1708; and (II) The remainder of such moneys to the vital statistics records cash fund created in section 25-2-121. (3) (a) In addition to any other marriage certificate issued pursuant to section 25-2-106, the state registrar shall issue, upon request and upon payment of a fee established by rule of the state board of health, an heirloom marriage certificate representing the marriage of the persons named on the original marriage certificate recorded in the county clerk and recorder's office. The state registrar may establish procedures for issuing the heirloom marriage certificates; except that an heirloom marriage certificate shall be issued in a form consistent with the need to protect the integrity of vital records. (b) An heirloom marriage certificate shall have the same status as evidence as that of an original marriage certificate. (c) The fee established pursuant to paragraph (a) of this subsection (3) shall be sufficient to cover the direct and indirect costs of producing and issuing the heirloom marriage certificate, plus an additional ten dollars. The state registrar shall transmit moneys generated pursuant to this subsection (3), along with an explanation of the number of heirloom marriage certificate sales that correspond to such moneys, to the state treasurer, who shall credit: (I) For each sale of an heirloom marriage certificate, ten dollars to the Colorado domestic abuse program fund created in section 39-22-802, C.R.S.; and (II) The remainder of such moneys to the vital statistics records cash fund created in section 25-2-121. Source: L. 2006: Entire section added, p. 943, § 1, effective August 7. L. 2007: (2)(c)(I) amended, p. 654, § 1, effective April 26. HOSPITALS Colorado Revised Statutes 2019 Page 185 of 1101 Uncertified Printout ARTICLE 3 Hospitals Cross references: For the university of Colorado university hospital and the university of Colorado psychiatric hospital, see articles 21 and 22 of title 23; for the Colorado mental health institute at Pueblo, see article 93 of title 27; for hospital districts, see §§ 32-1-1001 and 32-11003. PART 1 HOSPITALS 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, Colorado Revised Statutes 2019 Page 186 of 1101 Uncertified Printout except an assisted living residence shall be assessed a license fee as set forth in section 25-27107; 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 251.5-114; 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: (a) (I) "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: (A) Operates inpatient beds at the facility for the provision of extended observation and other related services for not more than seventy-two hours; (B) 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 (C) Is not otherwise subject to health facility licensure under this section or section 251.5-103 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. (II) "Community clinic" includes a prison clinic operated by the department of corrections. (III) "Community clinic" does not include: (A) A federally qualified health center, as defined in section 1861 (aa)(4) of the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4); (B) 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); (C) 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 (D) A freestanding emergency department, as defined in and required to be licensed under section 25-1.5-114. (b) "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. Colorado Revised Statutes 2019 Page 187 of 1101 Uncertified Printout (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. 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. 25-3-102. License - application - issuance - certificate of compliance required repeal. (1) (a) 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. (b) 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. (c) 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. Colorado Revised Statutes 2019 Page 188 of 1101 Uncertified Printout (d) The license shall be signed by the president and attested by the secretary of the state board of health and have the state board's seal affixed to the license. The license expires one year from the date of issuance. (e) (I) 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: (A) Has been convicted of a felony or misdemeanor involving moral turpitude; (B) Had a state license or federal certification denied, revoked, or suspended by another jurisdiction; (C) 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. (II) 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. (III) 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. (IV) 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) (a) 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. (b) This subsection (2) is repealed, effective July 1, 2021. (3) (a) 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. (b) 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, § Colorado Revised Statutes 2019 Page 189 of 1101 Uncertified Printout 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. Editor's note: Amendments to subsection (1) by House Bill 12-1268 and House Bill 121294 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. 25-3-102.1. Deemed status for certain facilities. (1) (a) 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. (b) (I) 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. (II) 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). (III) 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. (c) 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. Colorado Revised Statutes 2019 Page 190 of 1101 Uncertified Printout (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) (a) 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. (a.5) (I) 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: (A) The validity of the questionnaire for use in the consumer satisfaction survey implemented pursuant to paragraph (d) of this subsection (1); (B) The nursing facilities residents' cognition levels in order to determine the ability of the residents to complete the survey in a meaningful manner; Colorado Revised Statutes 2019 Page 191 of 1101 Uncertified Printout (C) 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 (D) The survey data to ensure that such data is meaningful to consumers. (II) 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. (III) (A) 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. (B) Aggregate statistical results of the pilot survey may be made available to the public. (C) Repealed. (IV) Repealed. (b) 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. (c) Repealed. (d) 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. (e) 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. (f) 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. Colorado Revised Statutes 2019 Page 192 of 1101 Uncertified Printout (2) (a) 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. (b) (I) 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. (II) 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. sec. 3001 et seq. 25-3-103. License denial or revocation - provisional license - rules. (1) (a) 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. (b) 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 Colorado Revised Statutes 2019 Page 193 of 1101 Uncertified Printout 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. (c) 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-AuroraLakewood 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. Colorado Revised Statutes 2019 Page 194 of 1101 Uncertified Printout 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 251.5-103 (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 Colorado Revised Statutes 2019 Page 195 of 1101 Uncertified Printout 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 32-11003, 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: (a) "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). (b) "Department" means the department of public health and environment. (c) "Federally qualified health center" or "FQHC" shall have the same meaning as set forth in section 1861(aa)(4) of the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4). (d) "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. (e) "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). (f) "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). (f.3) "Long-term care facility" means: Colorado Revised Statutes 2019 Page 196 of 1101 Uncertified Printout (I) A nursing facility as defined by section 25.5-4-103, C.R.S., and licensed pursuant to section 25-1.5-103; (II) An assisted living residence as defined by section 25-27-102 and licensed pursuant to section 25-27-103; or (III) An independent living facility or a residence for seniors that provides assistance to its residents in the performance of their daily living activities. (f.5) "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. (g) "Physician" means a person duly licensed to practice under article 220, 240, or 290 of title 12. (h) "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). (i) "School-based health center" shall have the same meaning as set forth in section 2520.5-502. (2) (a) 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. (b) 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 Colorado Revised Statutes 2019 Page 197 of 1101 Uncertified Printout 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. 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. 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 Colorado Revised Statutes 2019 Page 198 of 1101 Uncertified Printout 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) (a) (I) (A) 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). (B) 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-AuroraLakewood 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. (C) 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. (II) An acute treatment unit shall be assessed a fee as set forth in paragraph (c) of this subsection (1), an assisted living residence shall be assessed a fee as set forth in section 25-27107, and a separate fee shall be collected pursuant to section 25-3-704 to meet the costs incurred by the department in completing the requirements of part 7 of this article. Colorado Revised Statutes 2019 Page 199 of 1101 Uncertified Printout (III) A license issued by the department may be revoked at any time by the state board of health for any of the causes set forth in section 25-3-103 or for a licensee's failure to comply with any of the rules of the state board or to make the reports required by section 25-3-104. Any person, partnership, association, company, or corporation opening, conducting, or maintaining any facility for the treatment and care of the sick or injured who does not have a provisional or regular license authorizing such person or entity to open, conduct, or maintain the facility is guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not less than fifty dollars nor more than five hundred dollars. (b) (Deleted by amendment, L. 2007, p. 953, § 2, effective May 17, 2007.) (c) (I) 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: (A) 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; (B) 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; (C) 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. (II) A licensee shall submit a fee of one hundred dollars for an acute treatment unit in the following circumstances: (A) When submitting a name change for approval by the department; or (B) When submitting a request to increase the number of licensed beds for approval by the department. (III) A licensee shall submit a fee of five hundred dollars for an acute treatment unit in the following circumstances: (A) 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 (B) 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. (IV) [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 Colorado Revised Statutes 2019 Page 200 of 1101 Uncertified Printout 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 24-33.51207.8, 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 181375), 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 Colorado Revised Statutes 2019 Page 201 of 1101 Uncertified Printout 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 longterm 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: (a) 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 (b) 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. Colorado Revised Statutes 2019 Page 202 of 1101 Uncertified Printout (6) Prior to ordering the appointment of a receiver for the operation of a long-term health care facility, the district court must find: (a) That grounds for the appointment of a receiver exist as provided in subsection (2) of this section; and (b) That proper notice as required by subsection (4) of this section has been served; and (c) 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, Colorado Revised Statutes 2019 Page 203 of 1101 Uncertified Printout 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 941029 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: (a) 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; (b) Persons giving testimony concerning facts of which they have personal knowledge acquired independently of the quality management information program or function; Colorado Revised Statutes 2019 Page 204 of 1101 Uncertified Printout (c) 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. (d) 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; (e) 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. (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. (b) 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. (7) and (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 253-107. (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 Colorado Revised Statutes 2019 Page 205 of 1101 Uncertified Printout 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: (a) "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 24-401 (1.5), C.R.S., shall be construed to amend or alter the definition of "emergency contraception". (b) "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: (a) 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 (b) 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: Colorado Revised Statutes 2019 Page 206 of 1101 Uncertified Printout (a) Entities offering victim assistance or counseling and rape crisis hotlines to include information concerning the availability and use of emergency contraception; and (b) 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: (a) 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. (b) 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: (a) Post the information conspicuously on its website; (b) Make the information available in patient waiting areas; (c) Make the information available to each patient, when possible, before the patient's discharge from the hospital; and (d) 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, Colorado Revised Statutes 2019 Page 207 of 1101 Uncertified Printout provide the website, e-mail address, and telephone number where the information may be obtained. (2) (a) 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. (b) For purposes of this section, a qualified patient is an individual: (I) Who is uninsured; (II) Whose annual family income is not more than two hundred fifty percent of the federal poverty guidelines; and (III) 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. (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. (b) 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. (c) 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, Colorado Revised Statutes 2019 Page 208 of 1101 Uncertified Printout 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) (a) Before initiating collection proceedings, a hospital shall: (I) Offer a qualified patient a reasonable payment plan; and (II) 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. (b) 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 25-3101. 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. Editor's note: (1) Subsection (4)(b) was enacted as subsection (4)(c) in Senate Bill 14050 but was relettered when the provisions within subsection (4) were relettered and renumbered on revision in 2014 to conform to statutory format. (2) Subsection (7)(d) provided for the repeal of subsection (7), effective December 31, 2014. (See L. 2014, p. 1080.) 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. Colorado Revised Statutes 2019 Page 209 of 1101 Uncertified Printout (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) (a) 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: (I) 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 boardcertified 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; (II) One member representing a statewide association of physicians; (III) One member representing a statewide hospital association; (IV) One member who is an emergency medical service provider, as defined in section 25-3.5-103 (8); (V) One member who is a registered nurse involved in stroke care; (VI) One hospital administrator from a hospital located in a rural area of the state; Colorado Revised Statutes 2019 Page 210 of 1101 Uncertified Printout (VII) One hospital administrator from a hospital located in an urban area of the state; (VIII) One representative from a stroke rehabilitation facility; (IX) One member who is a Colorado resident representing a national association whose goal is to eliminate cardiovascular disease and stroke; (X) One member who is a Colorado resident representing a national stroke association; (XI) One member who is a physical or occupational therapist actively involved in stroke care; (XII) One member of the public who has suffered a stroke or is the caregiver of a person who has suffered a stroke; and (XIII) One member who is an expert in stroke database management. (b) The executive director of the department or the executive director's designee shall serve as an ex officio member of the stroke advisory board. (c) 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) (a) 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: (I) Creation of a state database or registry consisting of data on stroke care that mirrors the data hospitals submit to nationally recognized organizations; (II) 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; (III) Evaluation of currently available stroke treatments and the development of recommendations, based on medical evidence, for ways to improve stroke prevention and treatment; (IV) 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 (V) 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. (b) 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 department may accept and expend, subject to appropriation by the general assembly, gifts, grants, and donations to pay the direct expenses of the department in assisting and staffing the stroke advisory board. The department shall transmit any monetary gifts, grants, or donations it receives to the state treasurer for deposit in the health facilities general licensure cash fund, and those moneys may be used only to pay the direct expenses of the department. Colorado Revised Statutes 2019 Page 211 of 1101 Uncertified Printout (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. 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, certification, or designation if the department determines, after notice and hearing in accordance with the "State Administrative Procedure Act", article 4 of title 24, C.R.S., that the hospital no longer holds an active accreditation, certification, or designation from a nationally recognized certifying body. (3) Whether a hospital attains a national accreditation, certification, or designation in stroke or STEMI care has no bearing on, or connection with, the licensing or certification of the hospital by the department pursuant to section 25-1.5-103 (1)(a). (4) Repealed. Source: L. 2013: Entire section added, (SB 13-225), ch. 277, p. 1448, § 1, effective May 24. L. 2017: (1) amended and (4) repealed, (HB 17-1246), ch. 214, p. 834, § 2, effective May 18. 25-3-117. Heart attack database - hospitals to report data on heart attack care. (1) (a) A hospital that is accredited by the American College of Cardiology Accreditation Services or its successor organization or any nationally recognized accrediting body as a STEMI receiving center shall report to the heart attack database data that is consistent with nationally recognized guidelines on individuals with confirmed heart attacks within the state. Within thirty days after receiving a quarterly report of a hospital's heart attack data from the heart attack database, a hospital accredited as a STEMI receiving center shall submit the report to the department. (b) Hospitals that are recognized as STEMI referral centers pursuant to section 25-3-116 and PCI centers that are not accredited as heart attack receiving centers are encouraged to report data to the heart attack database and provide quarterly database reports to the department. (2) (a) Reports obtained by the department pursuant to this section are: Colorado Revised Statutes 2019 Page 212 of 1101 Uncertified Printout (I) Privileged and strictly confidential; (II) Not subject to civil subpoena, not discoverable, and not admissible in a civil, criminal, or administrative proceeding against a health care facility or health care professional; and (III) Not directly available to the public. (b) With regard to reports obtained pursuant to this section, the department shall protect the confidentiality of patient records in accordance with state and federal laws and shall not disclose publicly any identifying or proprietary information of any hospital, hospital administrator, health care professional, or employee. (3) The department shall sign a letter of commitment with any nationally recognized body whose reports are provided to the department pursuant to subsection (1)(a) of this section to ensure compliance with the confidentiality requirements and, as part of the letter of commitment, request reporting measures and metrics at the national level for benchmarking purposes. Source: L. 2017: Entire section added, (HB 17-1246), ch. 214, p. 835, § 3, effective May 18. 25-3-118. Hospital off-campus location - obtain and use unique NPI - definitions. (1) An off-campus location of a hospital must apply for, obtain, and use on all claims for reimbursement or payment for health care services provided at the off-campus location submitted on or after January 1, 2020, a unique NPI that is separate and distinct from the hospital's NPI. The off-campus location's unique NPI must be included on any claim for reimbursement or payment for health care services provided at the off-campus location, regardless of whether the claim is filed or submitted by or through a central office of the hospital or a health care clearinghouse. (2) As used in this section: (a) "Health care clearinghouse" has the same meaning as set forth in 45 CFR 160.103. (b) "NPI" or "national provider identifier" means the standard, unique health identifier for health care providers that is issued by the national provider system in accordance with 45 CFR part 162. (c) "Off-campus location" means a facility: (I) Whose operations are directly or indirectly owned or controlled by, in whole or in part, or affiliated with a hospital, regardless of whether the operations are under the same governing body as the hospital; (II) That is located more than two hundred fifty yards from the hospital's main campus; (III) That provides services that are organizationally and functionally integrated with the hospital; and (IV) That is an outpatient facility providing preventive, diagnostic, treatment, or emergency services. Source: L. 2018: Entire section added, (HB 18-1282), ch. 158, p. 1108, § 2, effective August 8. Colorado Revised Statutes 2019 Page 213 of 1101 Uncertified Printout Cross references: For the legislative declaration in HB 18-1282, see section 1 of chapter 158, Session Laws of Colorado 2018. 25-3-119. Freestanding emergency departments - required notices - disclosures rules - definitions. (1) (a) (I) A freestanding emergency department shall give to every individual seeking treatment at the facility a written notice containing the following statements immediately upon registration: Patient Information This is an emergency medical facility that treats emergency medical conditions. We will screen and treat you regardless of your ability to pay. You have a right to ask questions regarding your treatment options and costs. You have a right to receive prompt and reasonable responses to questions and requests. You have a right to reject treatment. However, we encourage you to defer your questions until after we screen you for an emergency medical condition. This is not a complete statement of patient information or rights. You will receive a more comprehensive statement of patient's rights upon the completion of a medical screening examination that does not reveal an emergency medical condition or after treatment has been provided to stabilize an emergency medical condition. (II) (A) If the freestanding emergency department does not have or include within its facility an urgent care center or clinic, the freestanding emergency department shall include the following statement in the notice required by subsection (1)(a)(I) of this section, immediately following the sentence that reads "This is an emergency medical facility that treats emergency medical conditions.": This is not an urgent care center or primary care provider. (B) If the freestanding emergency department has or includes within its facility an urgent care center or clinic, the freestanding emergency department shall include the following statement in the notice required by subsection (1)(a)(I) of this section, immediately following the sentence that reads "This is an emergency medical facility that treats emergency medical conditions.": This facility also contains an urgent care center that operates from (insert time urgent care center opens) to (insert time urgent care center closes) and provides primary care services (and insert, if applicable, that the urgent care center offers primary care services by appointment). (III) If the individual seeking treatment is a minor who is accompanied by an adult, the freestanding emergency department shall provide the written notice required by this subsection (1)(a) to the accompanying adult. Colorado Revised Statutes 2019 Page 214 of 1101 Uncertified Printout (b) In addition to giving an individual the written notice required by subsection (1)(a) of this section, a freestanding emergency department staff member or health care provider shall provide the information specified in subsection (1)(a) of this section to the individual orally. (c) As necessary, the state board of health, by rule, may update the information required to be included in the written notice of patient information set forth in this subsection (1). (2) (a) A freestanding emergency department shall post a sign that is plainly visible in the area within the facility where an individual seeking care registers or checks in and that states: This is an emergency medical facility that treats emergency medical conditions. (b) (I) If the freestanding emergency department does not have or include within its facility an urgent care center or clinic, the freestanding emergency department shall include the following statement on the sign required by this subsection (2), immediately following the statement specified in subsection (2)(a) of this section: This is not an urgent care center or primary care provider. (II) If the freestanding emergency department has or includes within its facility an urgent care center or clinic, the freestanding emergency department shall include the following statement on the sign required by this subsection (2), immediately following the statement specified in subsection (2)(a) of this section: This facility also contains an urgent care center that operates from (insert time urgent care center opens) to (insert time urgent care center closes) and provides primary care services (and insert, if applicable, that the urgent care center offers primary care services by appointment). (3) (a) After performing an appropriate medical screening examination and determining that a patient does not have an emergency medical condition or after treatment has been provided to stabilize an emergency medical condition, the freestanding emergency department shall provide to the patient a written disclosure that: (I) Specifies whether the freestanding emergency department accepts patients who are enrolled in: The state medical assistance program under articles 4, 5, and 6 of title 25.5; medicare, as authorized in Title XVIII of the federal "Social Security Act", as amended; the children's basic health plan established under article 8 of title 25.5; or a health plan authorized under 10 U.S.C. sec. 1071 et seq.; (II) Lists the specific health insurance provider networks and carriers with which the freestanding emergency department participates or states that the freestanding emergency department is not a participating provider in any health insurance provider networks; (III) States that the freestanding emergency department or a physician providing health care services at the freestanding emergency department may not be a participating provider in the patient's health insurance provider network; (IV) States that a physician providing health care services at the freestanding emergency department may bill separately from the freestanding emergency department for the health care services provided to the patient; (V) Specifies the chargemaster or fee schedule price for the twenty-five most common health care services provided by the freestanding emergency department; (VI) Contains a statement specifying that the price listed on the freestanding emergency department's chargemaster or fee schedule for any given health care service is the maximum Colorado Revised Statutes 2019 Page 215 of 1101 Uncertified Printout charge that any patient will be billed for the service and that the actual charge for any health care service rendered may be lower depending on applicable health insurance benefits and the availability of discounts or financial assistance; (VII) Contains the following statement or a statement containing substantially similar information: If you are covered by health insurance, you are strongly encouraged to consult with your health insurer to determine accurate information about your financial responsibility for a particular health care service provided at this freestanding emergency department. If you are not covered by health insurance, you are strongly encouraged to contact (insert name and telephone number for office responsible for financial services) to discuss payment options and the availability of financial assistance prior to receiving a health care service from this freestanding emergency department. (VIII) Contains information about the facility fees that the freestanding emergency department charges, indicating either the maximum facility fee that the freestanding emergency department charges or the range of the minimum to maximum amount of the facility fees that the freestanding emergency department charges; and (IX) Includes the freestanding emergency department's website address where the information contained in the disclosure required by this subsection (3) may be found. (b) A freestanding emergency department shall update the information contained in the written disclosure required by this subsection (3) at least once every six months. (c) Receipt of the disclosure under this subsection (3) does not waive a covered person's protections under section 10-16-704 (3)(b). (4) A freestanding emergency department shall post the disclosure required by subsection (3) of this section on its website and update the disclosure posted on its website at least once every six months. (5) A freestanding emergency department shall provide the information required by this section in a clear and understandable manner and in languages appropriate to the communities and patients the freestanding emergency department serves. (6) Nothing in this section affects or otherwise limits a hospital's or other health facility's obligations under section 6-20-101 or article 49 of this title 25. (7) The state board of health may adopt rules as necessary to implement and enforce this section, including rules necessary to ensure that freestanding emergency departments are complying in good faith with the intent of this section and the transparency and disclosure requirements of this section. (8) As used in this section: (a) "Chargemaster or fee schedule", which is often referred to as "charge description master" or "CDM", means a uniform schedule of charges represented by a health facility as the facility's gross billed charge, or maximum charge that any patient will be billed, for a given health care service, regardless of payer and before any discounts or negotiations are applied. (b) "Emergency medical condition" has the same meaning as set forth in 42 U.S.C. sec. 1395dd (e)(1). (c) "Freestanding emergency department" has the same meaning as section 25-1.5-114 (5). Colorado Revised Statutes 2019 Page 216 of 1101 Uncertified Printout Source: L. 2018: Entire section added, (SB 18-146), ch. 157, p. 1101, § 2, effective January 1, 2019. L. 2019: (8)(c) amended, (HB 19-1010), ch. 324, p. 2998, § 4, effective August 2. Cross references: For the legislative declaration in SB 18-146, see section 1 of chapter 157, Session Laws of Colorado 2018. 25-3-120. Regulation of surgical smoke - requirement to adopt a policy - definitions - applicability. (1) On or before May 1, 2021, each hospital with surgical services and each ambulatory surgical center, licensed in accordance with this article 3, shall adopt and implement a policy that prevents human exposure to surgical smoke via the use of a surgical smoke evacuation system during any planned surgical procedure that is likely to generate surgical smoke. (2) As used in this section: (a) "Surgical smoke" means the gaseous by-product produced by energy-generating devices including surgical plume, smoke plume, bio-aerosols, laser-generated airborne contaminants, or lung-damaging dust. (b) "Surgical smoke evacuation system" means equipment designed to capture and neutralize surgical smoke at the point of origin and before the surgical smoke makes contact with the eyes or the respiratory tract of the occupants of a room. Source: L. 2019: Entire section added, (HB 19-1041), ch. 62, p. 226, § 1, effective August 2. Editor's note: Section 2 of chapter 62 (HB 19-1041), Session Laws of Colorado 2019, provides that the act adding this section applies to all surgical procedures in hospitals and ambulatory surgical centers performed on or after May 1, 2021. 25-3-121. Health care facilities - emergency and nonemergency services - required disclosures - rules - definitions. [Editor's note: This section is effective January 1, 2020.] (1) On and after January 1, 2020, health care facilities shall develop and provide disclosures to consumers about the potential effects of receiving emergency or nonemergency services from an out-of-network provider providing services at an in-network facility or emergency services at an out-of-network facility. The disclosures must comply with the rules adopted pursuant to subsection (2) of this section. (2) The state board of health, in consultation with the commissioner of insurance and the director of the division of professions and occupations in the department of regulatory agencies, shall adopt rules that specify the requirements for health care facilities to develop and provide consumer disclosures in accordance with this section. The state board of health shall ensure that the rules are consistent with sections 10-16-704 (12) and 24-34-113 and rules adopted by the commissioner pursuant to section 10-16-704 (12)(b) and by the director of the division of professions and occupations pursuant to section 24-34-113 (3). The rules must specify, at a minimum, the following: Colorado Revised Statutes 2019 Page 217 of 1101 Uncertified Printout (a) The timing for providing the disclosures for emergency and nonemergency services with consideration given to potential limitations relating to the federal "Emergency Medical Treatment and Labor Act", 42 U.S.C. sec. 1395dd; (b) Requirements regarding how the disclosures must be made, including requirements to include the disclosures on billing statements, billing notices, or other forms or communications with covered persons; (c) The contents of the disclosures, including the consumer's rights and payment obligations pursuant to the consumer's health benefit plan; (d) Disclosure requirements specific to health care facilities, including whether a health care provider delivering services at the facility is out of network, the types of services an out-ofnetwork health care provider may provide, and the right to request an in-network health care provider to provide services; and (e) Requirements concerning the language to be used in the disclosures, including use of plain language, to ensure that carriers, health care facilities, and health care providers use language that is consistent with the disclosures required by this section and sections 10-16-704 (12) and 24-34-113 and the rules adopted pursuant to this subsection (2) and sections 10-16-704 (12)(b) and 24-34-113 (3). (3) Receipt of the disclosure required by this section does not waive a consumer's protections under section 10-16-704 (3) or (5.5) or the consumer's right to benefits under the consumer's health benefit plan at the in-network benefit level for all covered services and treatment received. (4) For the purposes of this section and section 25-3-122: (a) "Carrier" has the same meaning as defined in section 10-16-102 (8). (b) "Covered person" has the same meaning as defined in section 10-16-102 (15). (c) "Emergency services" has the same meaning as defined in section 10-16-704 (5.5)(e)(II). (d) "Geographic area" has the same meaning as defined in section 10-16-704 (3)(d)(VI)(A). (e) "Health benefit plan" has the same meaning as defined in section 10-16-102 (32). (f) "Medicare reimbursement rate" has the same meaning as defined in section 10-16704 (3)(d)(VI)(B). (g) "Out-of-network facility" means a health care facility that is not a participating provider, as defined in section 10-16-102 (46). Source: L. 2019: Entire section added, (HB 19-1174), ch. 171, p. 1992, § 6, effective January 1, 2020. Editor's note: Section 10 of chapter 171 (HB 19-1174), Session Laws of Colorado 2019, provides that the act adding this section applies to health care services provided on or after January 1, 2020. 25-3-122. Out-of-network facilities - emergency medical services - billing - payment. [Editor's note: This section is effective January 1, 2020.] (1) If a covered person receives emergency services at an out-of-network facility, the out-of-network facility shall: (a) Submit a claim for the entire cost of the services to the covered person's carrier; and Colorado Revised Statutes 2019 Page 218 of 1101 Uncertified Printout (b) Not bill or collect payment from a covered person for any outstanding balance for covered services not paid by the carrier, except for the applicable in-network coinsurance, deductible, or copayment amount required to be paid by the covered person. (2) (a) If a covered person receives emergency services at an out-of-network facility, and the facility receives payment from the covered person for services for which the covered person is not responsible pursuant to section 10-16-704 (3)(b) or (5.5), the facility shall reimburse the covered person within sixty calendar days after the date that the overpayment was reported to the facility. (b) An out-of-network facility that fails to reimburse a covered person as required by subsection (2)(a) of this section for an overpayment shall pay interest on the overpayment at the rate of ten percent per annum beginning on the date the facility received the notice of the overpayment. The covered person is not required to request the accrued interest from the out-ofnetwork health care facility in order to receive interest with the reimbursement amount. (3) (a) An out-of-network facility, other than any out-of-network facility operated by the Denver health and hospital authority pursuant to article 29 of title 25, must send a claim for emergency services to the carrier within one hundred eighty days after the receipt of insurance information in order to receive reimbursement as specified in this subsection (3)(a). The reimbursement rate is the greater of: (I) One hundred five percent of the carrier's median in-network rate of reimbursement for that service provided in a similar facility or setting in the same geographic area; or (II) The median in-network rate of reimbursement for the same service provided in a similar facility or setting in the same geographic area for the prior year based on claims data from the all-payer health claims database created in section 25.5-1-204. (b) An out-of-network facility operated by the Denver health and hospital authority created in section 25-29-103 must send a claim for emergency services to the carrier within one hundred eighty days after the delivery of services in order to receive reimbursement as specified in this subsection (3)(b). The reimbursement rate is the greater of: (I) The carrier's median in-network rate of reimbursement for the same service provided in a similar facility or setting in the same geographic area; (II) Two hundred fifty percent of the medicare reimbursement rate for the same service provided in a similar facility or setting in the same geographic area; or (III) The median in-network rate of reimbursement for the same service provided in a similar facility or setting in the same geographic area for the prior year based on claims data from the Colorado all-payer health claims database described in section 25.5-1-204. (c) If the out-of-network facility submits a claim for emergency services after the onehundred-eighty-day period specified in this subsection (3), the carrier shall reimburse the facility one hundred twenty-five percent of the medicare reimbursement rate for the same services in a similar setting or facility in the same geographic area. (d) The out-of-network facility shall not bill a covered person any outstanding balance for a covered service not paid for by the carrier, except for any coinsurance, deductible, or copayment amount required to be paid by the covered person. (4) An out-of-network facility may initiate arbitration pursuant to section 10-16-704 (15) if the facility believes the payment made pursuant to subsection (3) of this section is not sufficient. Colorado Revised Statutes 2019 Page 219 of 1101 Uncertified Printout (5) This section does not apply when a covered person voluntarily uses an out-ofnetwork provider. Source: L. 2019: Entire section added, (HB 19-1174), ch. 171, p. 1992, § 6, effective January 1, 2020. Editor's note: Section 10 of chapter 171 (HB 19-1174), Session Laws of Colorado 2019, provides that the act adding this section applies to health care services provided on or after January 1, 2020. 25-3-123. Mental health facility pilot program - establishment - rules - definitions. (1) As used in this section, unless the context otherwise requires: (a) "Mental health facility" means a facility approved to participate in the pilot program pursuant to subsection (2) of this section. (b) "Pilot program" means the mental health facility pilot program established pursuant to this section. (2) There is established in the department the mental health facility pilot program to authorize not more than two entities to participate in a three-year pilot program to allow individuals with either a physical health diagnosis or significant mental health diagnosis to reside in a facility that treats both the physical and mental health issues and provides additional services to help the individual transition to independent living. (3) On or before October 1, 2019, the department shall develop an application for interested entities to apply to be authorized as a mental health facility. The application must require the applicant to show, at a minimum, that it: (a) Is serving individuals with physical or mental or both physical and mental health diagnoses; (b) Offers staff secure environments rather than physically secure spaces; (c) Has the capability to provide integrated services with community medical and behavioral health providers; (d) Has sufficient staffing levels of licensed nurses, nursing assistants, and occupational and recreational professionals; (e) Has a partnership with either an acute care hospital or psychiatric hospital and with a skilled nursing facility, so it has the ability to transfer an individual in need of a higher level of care; (f) Demonstrates a collaborative relationship with the hospital, including consultation and treatment plan support, one-on-one staffing support, and ongoing training for staff at the mental health facility; (g) Is in a community that has resources to support community engagement to move an individual to less restrictive environments as an individual progresses; (h) Demonstrates cost savings or cost neutrality for the state medical assistance program; (i) Is willing and able to contribute at least one-third of the increased costs that the applicant will incur due to the pilot program and has identified sources for the other two-thirds; and (j) Is willing to prepare reports on the pilot program. Colorado Revised Statutes 2019 Page 220 of 1101 Uncertified Printout (4) On or before February 1, 2020, the department shall select up to two applicants to become mental health facilities under the pilot program; except that, if more than one applicant is selected: (a) One selected applicant must be in a community with a population of over one hundred thousand and one selected applicant in a community with a population of under one hundred thousand unless there is no qualified applicant from such a community; (b) Both selected applicants must not be located in the same city unless the only qualified applicants are from a single city; and (c) Both selected applicants must not be assisted living facilities. (5) The department is authorized to adopt rules to implement the pilot program. (6) The Colorado long-term care ombudsman office, established pursuant to section 2611.5-104, has access to the premises and residents of a mental health facility during reasonable hours for the purposes set out in the federal "Older Americans Act of 1965". Source: L. 2019: Entire section added, (HB 19-1160), ch. 225, p. 2261, § 2, effective August 2. Cross references: For the legislative declaration in HB 19-1160, see section 1 of chapter 225, Session Laws of Colorado 2019. PART 2 MATERNITY HOSPITALS 25-3-201 to 25-3-207. (Repealed) Source: L. 96: Entire part repealed, p. 561, § 23, effective April 24. Editor's note: This part 2 was numbered as article 5 of chapter 66, C.R.S. 1963. For amendments to this part 2 prior to its repeal in 1996, 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. PART 3 COUNTY HOSPITALS - ESTABLISHMENT 25-3-301. Establishment of public hospital. (1) Whenever the board of county commissioners of any county which has a population of at least three thousand is presented with a petition signed by five hundred resident registered qualified electors, or by fifty percent of the resident registered qualified electors of such county, at least two hundred fifty of whom are residents of other than the county seat or town where it is proposed to locate such public hospital, asking that a public hospital board be appointed and that an annual tax be levied for the establishment and maintenance of a public hospital at a place in the county named therein, and which petition shall specify the maximum amount of money proposed to be expended in Colorado Revised Statutes 2019 Page 221 of 1101 Uncertified Printout purchasing or building said hospital, such board of county commissioners shall have the power to create, by resolution, such public hospital board, to levy such tax, and to appropriate to such public hospital board the funds for purchasing or building such hospital and for maintaining the hospital, as well as the power to turn to the control and maintenance of such public hospital board any public or other hospital then being conducted by the board of county commissioners. Said tax shall not exceed three mills on the dollar for each year. (2) If it is proposed in such petition, or in a petition later filed with like number of resident registered qualified elector signers, to create an indebtedness of the county for purchasing, erecting, or enlarging of buildings or equipment for such public hospital, then the board of county commissioners shall submit such question in the manner provided by law for creating debt for erecting public buildings and, if the vote authorizes it, shall issue such bonds, so authorized, as the public hospital board requests. In those counties having a population of less than three thousand, a public hospital board may be created by the petition of not less than fiftyone percent of the resident registered qualified electors or two hundred such resident registered qualified electors, regardless of where they live in the county. In such counties, an annual levy of not to exceed five mills on the dollar shall be assessed to purchase, build, and maintain such a county hospital. Source: L. 43: p. 275, § 1. CSA: C. 78, § 151(1). L. 53: p. 342, § 1. CRS 53: § 66-7-1. C.R.S. 1963: § 66-7-1. L. 70: p. 140, § 9. L. 71: p. 634, § 1. 25-3-302. Board of trustees. (1) If a board of county commissioners decides to create a public hospital board of trustees, levy an annual tax, and appropriate funds to purchase, erect, and maintain or turn over to the public hospital board of trustees control of a county hospital, the board of county commissioners shall proceed at once to appoint to the public hospital board of trustees, for designated terms, seven trustees chosen from the citizens at large with reference to their fitness for office. All of the trustees must be residents of the county, and none may be an elected or appointed state, county, or city official. Nothing in this article 3 requires a licensed physician to be appointed to a public hospital board of trustees; however, if a licensed physician is appointed to a public hospital board of trustees, membership on that board is limited to one licensed physician at any given time. The seven appointees constitute the public hospital board of trustees for the public hospital. The public hospital board of trustees is a body corporate under the name "Board of Trustees for ............... Hospital", the name of the hospital being inserted in the blank. (2) One of the trustees, so designated in such original appointment, shall hold office until the second Tuesday of January following his appointment, one until the second Tuesday of the second January following his appointment, two until the second Tuesday of the third January following their appointment, one until the second Tuesday of the fourth January following his appointment, and two until the second Tuesday of the fifth January from their appointment. Thereafter, the term of office of each appointee shall be five years from the end of the preceding term. At the expiration of the term of each of said trustees, the office shall be filled by appointment of the board of county commissioners. (3) In those counties having a population of less than three thousand, the board of public hospital trustees shall consist of five citizens at large having the same requirements with reference to their fitness for such office as all other counties. One of said trustees, so designated Colorado Revised Statutes 2019 Page 222 of 1101 Uncertified Printout in such original appointment, shall hold office until the second Tuesday of January following his appointment, one until the second Tuesday of the second January following his appointment, one until the second Tuesday of the third January following his appointment, one until the second Tuesday of the fourth January following his appointment, and one until the second Tuesday of the fifth January following his appointment. The term of office and the method of filling vacancies shall be the same as for all other counties. Source: L. 43: p. 276, § 2. L. 47: p. 503, § 1. CSA: C. 78, § 151(2). L. 53: p. 343, § 2. CRS 53: § 66-7-2. C.R.S. 1963: § 66-7-2. L. 84: (1) amended, p. 752, § 1, effective March 5. L. 2019: (1) amended, (HB 19-1065), ch. 90, p. 334, § 1, effective August 2. 25-3-303. Organization of trustees. (1) The members of the board of public hospital trustees within ten days after their appointment shall qualify by taking the oath of office. On the second Tuesday of each January, they shall organize and operate as follows: (a) Unless otherwise authorized under the provisions of paragraph (b) of this subsection (1), they shall elect one of their number as president, one as vice-president, and one as secretary. No bond shall be required of them. The county treasurer of the county shall be treasurer of the board of trustees and shall receive and pay out all moneys under the control of said board as ordered by it but shall receive no compensation from such board. No trustee shall receive any compensation for services performed but may receive reimbursement for any cash expenditures actually made for personal expenses incurred as such trustee. An itemized statement of all such expenses and money paid out shall be made under oath by such trustee and filed with the secretary and allowed only by the affirmative vote of all the trustees present at a meeting of the board. (b) If approved by resolution of the board of county commissioners, the board may organize and operate by electing one of their number as president, one as vice-president, and one as secretary-treasurer. The trustees may appoint an assistant secretary-treasurer from outside the membership of the board of trustees. No bond shall be required of the trustees, except of the secretary-treasurer and assistant secretary-treasurer who shall each file with the board of trustees, at the expense of the hospital, a corporate fidelity bond in an amount not less than ten thousand dollars, conditioned on the faithful performance of the duties of his office. The secretarytreasurer shall receive and pay out all the moneys under the control of the board of trustees as ordered by it. No trustee shall receive any compensation for services performed, but may receive reimbursement for any cash expenditures actually made for personal expenses incurred as such trustee. An itemized statement of all such expenses and money paid out shall be made under oath by such trustee and filed with the secretary-treasurer and allowed only by the affirmative vote of all the trustees present at a meeting of the board. (2) For purposes of part 4 of article 6 of title 24, C.R.S., any board of public hospital trustees created pursuant to section 25-3-302 shall continue to be a local public body, as defined in section 24-6-402 (1)(a), C.R.S., regardless of whether the hospital governed by such board of trustees is designated an enterprise pursuant to section 25-3-304 (3). Source: L. 43: p. 276, § 3. CSA: C. 78, § 151(3). CRS 53: § 66-7-3. C.R.S. 1963: § 66-7-3. L. 73: p. 690, § 1. L. 93: (2) added, p. 1819, § 2, effective June 6. Colorado Revised Statutes 2019 Page 223 of 1101 Uncertified Printout 25-3-304. Trustees - powers and duties. (1) (a) A public hospital board of trustees shall make and adopt such bylaws, rules, and regulations for its own guidance and for the government of the hospital as it deems expedient for the economic and equitable conduct thereof, not inconsistent with state law or the ordinances of the city or town in which the public hospital is located. (b) The public hospital board of trustees has exclusive control of: (I) The use and expenditure of all money collected to the credit of the hospital, including the right to invest or have invested money held by the hospital or in the office of the county treasurer and to receive the interest and income therefrom; (II) The purchase of sites; (III) The purchase, construction, or enlargement of any hospital building; and (IV) The supervision, care, and custody of any grounds, rooms, or buildings that it purchases, constructs, or leases. (c) Except as described in subsection (1)(d) of this section, a public hospital board of trustees may acquire by lease real and personal property subject to the approval of the board of county commissioners. All tax money received for hospital purposes must be paid out of the county treasury only upon warrants drawn by the county commissioners upon sworn vouchers approved by the public hospital board of trustees. All other money received for the hospital must be deposited in the treasury of the hospital and paid out only upon order of the public hospital board of trustees. If a public hospital board of trustees acquires and holds hospital property and facilities, including real and personal property, by conveyance on transfer of title, then title to all lands must be in the name of the county. County hospitals situated in home rule counties have the additional borrowing authority granted by section 30-35-201 (23)(b). (d) A public hospital board of trustees that has elected to designate its public hospital as an enterprise for purposes of section 20 of article X of the state constitution, as described in subsection (3) of this section, is not required to obtain the approval of the board of county commissioners before acquiring real or personal property by lease. (2) The board of public hospital trustees shall have power to hire, retain, and remove agents and employees, including administrative, nursing, and professional personnel, engineers, architects, and attorneys, and to fix their compensation; shall have the power to borrow money and incur indebtedness, and to issue bonds and other evidence of such indebtedness; except that no indebtedness shall be created, except as otherwise provided by statute, in excess of the revenue which may reasonably be expected to be available to the hospital for repayment thereof in the fiscal year in which such indebtedness is to be created, and except that no such indebtedness shall be incurred without the approval of the board of county commissioners; and shall in general carry out the spirit and intent of this part 3 in establishing and maintaining a county public hospital. Such board of public hospital trustees shall hold meetings at least once each month and shall keep a complete record of all its proceedings. Four members of the board shall constitute a quorum for the transaction of business. One of the trustees shall visit and examine said hospital at least twice each month, and the public hospital board, during the first week in each January and July, shall file with the board of county commissioners a report of their proceedings with reference to such hospital and a statement of all receipts and expenditures during the half year. On or before each October first, the board shall certify to the board of county commissioners the amount necessary to maintain and improve said hospital for the ensuing year. No trustee shall have a personal pecuniary interest, either directly or indirectly, in Colorado Revised Statutes 2019 Page 224 of 1101 Uncertified Printout the purchase of any supplies for said hospital, unless the same are purchased by competitive bidding. (3) (a) The board of public hospital trustees may, in accordance with the provisions of paragraph (b) of this subsection (3), designate the hospital as an enterprise for purposes of section 20 of article X of the state constitution so long as said board of trustees retains authority to issue revenue bonds and the hospital receives less than ten percent of its total annual revenues in grants. So long as the hospital is designated as an enterprise pursuant to the provisions of this subsection (3), the hospital shall not be subject to any of the provisions of section 20 of article X of the state constitution. (b) (I) The board of public hospital trustees may, by resolution, designate the hospital as an enterprise as long as the hospital meets the requirements for an enterprise as stated in paragraph (a) of this subsection (3). Such designation shall be effective beginning with the budget year immediately following the budget year in which such resolution is adopted. Such resolution shall be adopted no sooner than ninety days and no later than thirty days prior to the commencement of the budget year in which such designation becomes effective. (II) The board of public hospital trustees may, by resolution, revoke the designation of the hospital as an enterprise. Such revocation shall be effective beginning with the budget year immediately following the budget year in which such resolution is adopted. Such resolution shall be adopted no sooner than ninety days and no later than thirty days prior to the commencement of the budget year in which such revocation becomes effective. (III) Upon adoption of any resolution pursuant to the provisions of subparagraph (I) or (II) of this paragraph (b), the board of public hospital trustees shall transmit a copy of the resolution to the division of local government in the department of local affairs and the appropriate board or boards of county commissioners. (IV) The termination or revocation of the designation of the hospital as an enterprise shall not affect in any manner the validity of any revenue bonds issued by the board of public hospital trustees of such hospital pursuant to subsection (4) of this section. (c) (I) For purposes of this subsection (3), "grant" means any direct cash subsidy or other direct contribution of money from the state or any local government in Colorado which is not required to be repaid. (II) "Grant" does not include: (A) Any indirect benefit conferred upon a hospital from the state or any local government in Colorado; (B) Any revenues resulting from rates, fees, assessments, or other charges imposed by a hospital for the provision of goods or services by such hospital; (C) Any federal funds, regardless of whether such federal funds pass through the state or any local government in Colorado prior to receipt by a hospital. (4) (a) Subject to the limitations set forth in paragraph (b) of this subsection (4), the board of public hospital trustees shall have the power to issue revenue bonds, secured by any revenues of the hospital other than property tax revenues. Notwithstanding subsection (2) of this section to the contrary, such revenue bonds may provide for their repayment over a term greater than one fiscal year. The board shall authorize the issuance of revenue bonds by resolution, duly approved by no less than two-thirds of the entire membership of the board. All bonds shall be signed by the president of the board of trustees, countersigned by the secretary of the board of trustees, and shall be numbered and registered in a book kept by the secretary or the secretaryColorado Revised Statutes 2019 Page 225 of 1101 Uncertified Printout treasurer, as applicable. Each bond shall state upon its face the amount for which such bond is issued, to whom such bond is issued, and the date of its issuance. (b) Except as otherwise provided in this paragraph (b), the issuance of any revenue bonds pursuant to the provisions of this subsection (4) shall not become effective for a period of thirty days following the adoption of any resolution authorizing such issuance for the purpose of allowing the board of county commissioners to review such pending bond issue. Such review period shall commence upon the date of receipt by the board of county commissioners of written notice from the board of public hospital trustees of such pending revenue bond issue. During said thirty days, the board of county commissioners may file a written notice with the board of trustees stating that the board of county commissioners has no objection to such pending bond issue. Upon receipt of such notice of no objection, the issuance of such revenue bonds shall become effective. If, within said thirty days, the board of county commissioners does not file with the board of trustees either a written notice of no objection or a written objection, the issuance of such revenue bonds shall become effective. If the board of county commissioners files a written objection, the issuance of such revenue bonds shall be prohibited until such time as the board of county commissioners gives written notice to the board of trustees of withdrawal of the board's objection. Source: L. 43: p. 277, § 4. CSA: C. 78, § 151(4). CRS 53: § 66-7-4. C.R.S. 1963: § 66-7-4. L. 73: p. 691, § 2. L. 81: (1) amended, p. 1486, § 2, effective June 8. L. 93: (3) and (4) added, p. 1817, § 1, effective June 6. L. 94: (3)(c)(II)(B) amended, p. 1640, § 59, effective May 31. L. 2019: (1) amended, (HB 19-1065), ch. 90, p. 335, § 2, effective August 2. 25-3-305. Vacancies - removal for cause. Vacancies in the board of trustees occasioned by removals, resignations, or otherwise shall be reported to the board of county commissioners and be filled in like manner as original appointments. Any trustee may be removed for cause by the board of county commissioners. Source: L. 43: p. 278, § 5. CSA: C. 78, § 151(5). CRS 53: § 66-7-5. C.R.S. 1963: § 66-7-5. 25-3-306. Right of eminent domain. If the board of public hospital trustees and the owners of any property desired by it for hospital purposes cannot agree as to the price to be paid therefor, said board shall report the facts to the board of county commissioners, and condemnation proceedings shall be instituted by the board of county commissioners and prosecuted in the name of the county wherein such public hospital is to be located. Source: L. 43: p. 278, § 6. CSA: C. 78, § 151(6). CRS 53: § 66-7-6. C.R.S. 1963: § 667-6. 25-3-307. Building requirements. No hospital buildings shall be erected or constructed until the plans and specifications have been made therefor and adopted by the board of public hospital trustees and bids advertised for according to law as for other county public buildings. Such hospital may be in more than one unit or set of buildings within the same town or city, or in Colorado Revised Statutes 2019 Page 226 of 1101 Uncertified Printout separate towns or cities, or within adjacent counties, and, if in adjacent counties, upon approval of the respective boards of county commissioners. Source: L. 43: p. 278, § 7. CSA: C. 78, § 151(7). L. 51: p. 442, § 1. CRS 53: § 66-7-7. C.R.S. 1963: § 66-7-7. L. 73: p. 692, § 3. 25-3-308. Improvements or enlargements. In counties exercising the rights conferred by this part 3, the board of county commissioners may appropriate each year, in addition to the tax for hospital fund provided for in section 25-3-301, not more than five percent of its general fund for the improvement or enlargement of any public hospital so established. Source: L. 43: p. 278, § 8. CSA: C. 78, § 151(8). CRS 53: § 66-7-8. C.R.S. 1963: § 667-8. 25-3-309. Hospital fees. Every hospital established under this part 3 is for the benefit of the inhabitants of the county and of any person falling sick or who is injured or maimed within its limits. Every inhabitant or person who is not indigent shall pay to the board of public hospital trustees or to the officer it designates for the county public hospital reasonable compensation for occupancy, nursing, laboratories, care, medicine, or attendants according to rules prescribed by the board in order to render the use of the hospital of the greatest benefit to the greatest number. Source: L. 43: p. 278, § 9. CSA: C. 78, § 151(9). CRS 53: § 66-7-9. C.R.S. 1963: § 667-9. L. 2018: Entire section amended, (HB 18-1142), ch. 65, p. 618, § 3, effective August 8. Cross references: For the legislative declaration in HB 18-1142, see section 1 of chapter 65, Session Laws of Colorado 2018. 25-3-310. Rules and regulations. (1) When such hospital is established, the physicians, nurses, attendants, persons sick therein, and persons approaching or coming within the limits of same and all buildings and grounds of such hospital and all furniture and other articles used or brought there shall be subject to such rules and regulations as said public hospital board may prescribe. (2) Said public hospital board may exclude from the use of such hospital any inhabitants and persons who willfully violate such rules and regulations. The board may extend the privileges and use of such hospital to persons residing outside of such county upon such terms and conditions as said board may from time to time by its rules and regulations prescribe. Source: L. 43: p. 279, § 10. CSA: C. 78, § 151(10). CRS 53: § 66-7-10. C.R.S. 1963: § 66-7-10. 25-3-311. Donations permitted. Any person, firm, organization, corporation, or society desiring to make donations of money, personal property, or real estate for the benefit of such public hospital shall have the right to vest title of the money, personal property, or real estate so donated in said county, to be controlled, when accepted, by the board of public hospital trustees according to the terms of the deed, gift, devise, or bequest of such property. Colorado Revised Statutes 2019 Page 227 of 1101 Uncertified Printout Source: L. 43: p. 279, § 11. CSA: C. 78, § 151(11). CRS 53: § 66-7-11. C.R.S. 1963: § 66-7-11. L. 83: Entire section amended, p. 2050, § 16, effective October 14. 25-3-312. Training school for nurses. The board of trustees of such county public hospital may establish and maintain, in connection therewith and as a part of said public hospital, a training school for nurses. Source: L. 43: p. 279, § 12. CSA: C. 78, § 151(12). CRS 53: § 66-7-12. C.R.S. 1963: § 66-7-12. 25-3-313. Lease of hospital. The public hospital board having control of such hospital after its establishment and turning over to its management may in its discretion rent or lease the said hospital, for such rental and for such term as it deems reasonable and proper, to any corporation not for pecuniary profit duly organized under the laws of the state of Colorado for the purpose of conducting a hospital. Source: L. 43: p. 279, § 13. CSA: C. 78, § 151(13). CRS 53: § 66-7-13. C.R.S. 1963: § 66-7-13. 25-3-314. Charge for professional services. Any hospital which is owned by a county, or by a city and county, having a population in excess of two hundred fifty thousand persons and which is a teaching hospital duly accredited as such by the joint commission on accreditation of hospitals and by the council on medical education of the American medical association may employ physicians and surgeons licensed to practice medicine in the state of Colorado for the performance of professional services in such hospital or in any related outpatient facility which is owned by such county or city and county. Charges for the services so rendered by any such physician or surgeon, excluding professional trainees, may be collected through the medium of such hospital in the name of the physician or surgeon and, upon collection, may be placed in a medical practice fund to be established, maintained, and used by such hospital solely for the purpose of payment of compensation to the physicians and surgeons so employed and for the payment of consultation fees to other physicians and surgeons not so employed, or directly to physicians and surgeons who are directly engaged in medical research or medical education. Source: L. 67: p. 306, § 1. C.R.S. 1963: § 66-7-14. L. 94: Entire section amended, p. 671, § 4, effective April 19. 25-3-315. Records of hospital. For purposes of part 2 of article 72 of title 24, C.R.S., the records of any hospital established pursuant to this part 3 shall continue to be public records, as defined in section 24-72-202 (6), C.R.S., regardless of whether such hospital is designated as an enterprise pursuant to section 25-3-304 (3). Source: L. 93: Entire section added, p. 1819, § 3, effective June 6. PART 4 Colorado Revised Statutes 2019 Page 228 of 1101 Uncertified Printout STATE PLAN FOR IMPLEMENTATION OF FEDERAL ACT FOR THE CONSTRUCTION OF HEALTH FACILITIES 25-3-401. Department to administer plan. (1) The department of public health and environment is designated as the sole agency for carrying out the purposes of the federal "Hospital Survey and Construction Act", Public Law 79-725 of the 79th Congress of the United States, approved August 13, 1946, or any amendments thereto, and the successor provisions thereof of Public Law 93-641, and is authorized to formulate, submit, and administer a state plan for carrying out the provisions thereof and to accept on behalf of the state any funds allotted to the state under the provision of the said federal acts, or any amendments thereto. In carrying out the purposes of this section, the department of public health and environment is authorized to make such reports as may be required by the said federal acts, or any amendments thereto, and to do all things that may be required as a condition precedent to the proper application for the receipt of federal grants under the said federal acts, and any amendments thereto and regulations thereof, and to administer and supervise the expenditure of such grants for the purposes of this section. (2) The state plan established under subsection (1) of this section shall provide for adequate hospital facilities for the people residing in the state, without discrimination on account of race, creed, or color, and shall provide for adequate hospital facilities for persons unable to pay therefor. The department of public health and environment shall provide minimum standards for the maintenance and operation of hospitals which receive federal aid under this part 4, and compliance with such standards shall be required in the case of hospitals which have received federal aid under the provisions of said federal acts, or any amendments thereto. Source: L. 47: p. 500, § 1. CSA: C. 78, § 151(14). CRS 53: § 66-18-1. C.R.S. 1963: § 66-18-1. L. 78: Entire section amended, p. 425, § 3, effective July 1. L. 94: Entire section amended, p. 2756, § 415, effective July 1. L. 96: (2) amended, p. 1471, § 18, effective June 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. 25-3-402. State advisory hospital and mental retardation facilities and community mental health centers council. (Repealed) Source: L. 47: p. 501, § 2. CSA: C. 78, § 151(15). CRS 53: § 66-18-2. C.R.S. 1963: § 66-18-2. L. 64: p. 481, § 2. L. 65: p. 706, § 1. L. 78: Entire section repealed, p. 425, § 4, effective July 1. 25-3-403. Department to administer federal mental health construction funds. The department of public health and environment is designated as the sole agency for carrying out the purposes of Part C of Title I and Title II of the federal "Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963", Public Law 88-164 of the 88th congress of the United States, approved October 31, 1963, or any amendments thereto, and is authorized to administer a state plan for carrying out its provisions and to accept, on behalf of the state, all funds allotted to the state under the provisions of the federal act. The state mental Colorado Revised Statutes 2019 Page 229 of 1101 Uncertified Printout health authority shall formulate the state plan. In carrying out the purposes of the federal act, the department of public health and environment is authorized to make such reports as may be required by the federal act, to do all things that may be required as a condition precedent to the proper application for the receipt of federal grants under the federal act, and to administer and supervise the expenditure of such grants in consultation with the mental health authority of the state of Colorado. Source: L. 64: p. 480, § 1. C.R.S. 1963: § 66-18-3. L. 94: Entire section amended, p. 2756, § 416, effective July 1. L. 2018: Entire section amended, (SB 18-096), ch. 44, p. 472, § 10, effective August 8. Cross references: (1) For the "Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963", see 42 U.S.C. sec. 6000 et seq.; for designation of the department of human services as the official mental health and mental retardation authority, see § 27-66-106. (2) For the legislative declaration contained in the 1994 act amending this section, see section 1 of chapter 345, Session Laws of Colorado 1994. For the legislative declaration in SB 18-096, see section 1 of chapter 44, Session Laws of Colorado 2018. PART 5 CERTIFICATE OF PUBLIC NECESSITY 25-3-501 to 25-3-521. (Repealed) Editor's note: (1) This part 5 was numbered as article 41 of chapter 66, C.R.S. 1963. For amendments to this part 5 prior to its repeal in 1987, 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. (2) Pursuant to § 25-3-521, as enacted by section 1 of chapter 107, Session Laws of Colorado 1982, this part 5 was to be repealed effective July 1 after the date congress repealed state requirements for certificates of public necessity as provided in Pub.L. 93-641. Such requirements were repealed by Pub.L. 99-660, effective January 1, 1987. This part 5 was therefore repealed effective July 1, 1987. PART 6 HOSPITAL-ACQUIRED INFECTIONS DISCLOSURE 25-3-601. Definitions. As used in this part 6, unless the context otherwise requires: (1) "Advisory committee" means the advisory committee created pursuant to section 253-602 (4). (2) "Department" means the department of public health and environment. Colorado Revised Statutes 2019 Page 230 of 1101 Uncertified Printout (2.5) "Health-care-associated infection" means a localized or systemic condition that results from an adverse reaction to the presence of an infectious agent or its toxins that was not present or incubating at the time of admission to the health facility. (3) "Health facility" means a hospital, a hospital unit, an ambulatory surgical center, a dialysis treatment clinic currently licensed or certified by the department pursuant to the department's authority under section 25-1.5-103 (1)(a), or other state licensed or certified facility that submits data to the national healthcare safety network, or its successor. (4) Repealed. (5) "Infection" means the invasion of the body by pathogenic microorganisms that reproduce and multiply, causing disease by local cellular injury, secretion of a toxin, or antigenantibody reaction in the host. Source: L. 2006: Entire part added, p. 1569, § 1, effective June 2. L. 2007: IP added, p. 2041, § 65, effective June 1. L. 2016: (2.5) added, (3) amended, and (4) repealed, (HB 16-1236), ch. 105, p. 302, § 1, effective April 15. 25-3-602. Health facility reports - repeal. (1) (a) A health facility specified by the department shall collect data on health-care-associated infection rates for specific clinical procedures and health-care-associated infections as determined by the department. (b) The advisory committee may define criteria to determine when data on a procedure or health-care-associated infection described in paragraph (a) of this subsection (1) shall be collected. (c) An individual who collects data on health-care-associated infection rates shall take the test for the appropriate national certification for infection control and become certified within six months after the individual becomes eligible to take the certification test, as recommended by the Certification Board of Infection Control and Epidemiology, Inc., or its successor. Mandatory national certification requirements shall not apply to individuals collecting data on health-careassociated infections in hospitals licensed for fifty beds or less, licensed ambulatory surgical centers, licensed dialysis treatment centers, licensed long-term care facilities, and other licensed or certified health facilities specified by the department. Qualifications for these individuals may be met through ongoing education, training, experience, or certification, as defined by the department. (2) Each health care provider who performs a clinical procedure subject to data collection as determined by the department pursuant to subsection (1) of this section shall report to the health facility at which the clinical procedure was performed a health-care-associated infection that the health care provider diagnoses at a follow-up appointment with the patient using standardized criteria and methods consistent with guidelines determined by the advisory committee. The reports made to the health facility under this subsection (2) shall be included in the reporting the health facility makes under subsection (3) of this section. (3) (a) A health facility shall routinely submit its health-care-associated infection data to the national healthcare safety network in accordance with national healthcare safety network requirements and procedures. The data submissions shall begin on or before July 31, 2007, and continue thereafter. Colorado Revised Statutes 2019 Page 231 of 1101 Uncertified Printout (b) If a health facility is a division or subsidiary of another entity that owns or operates other health facilities or related organizations, the data submissions required under this part 6 shall be for the specific division or subsidiary and not for the other entity. (c) Health facilities shall authorize the department to have access to health-facilityspecific data contained in the national healthcare safety network database consistent with the requirements of this part 6. (4) (a) The executive director of the department shall appoint an advisory committee. The advisory committee shall consist of: (I) One representative from an urban hospital; (II) One representative from a rural hospital; (III) One board-certified or board-eligible physician licensed in the state of Colorado, who is affiliated with a Colorado hospital or medical school, who is an active member of a national organization specializing in health care epidemiology or infection control, and who has demonstrated an interest and expertise in health facility infection control; (IV) Four infection control practitioners as follows: (A) One from a stand-alone ambulatory surgical center; (B) One health care professional certified by the Certification Board of Infection Control and Epidemiology, Inc., or its successor; (C) One from a long-term care setting; and (D) One other health care professional. (V) Either one medical statistician with an advanced degree in such specialty or one clinical microbiologist with an advanced degree in such specialty; (VI) One representative from a health consumer organization; (VII) One representative from a health insurer; and (VIII) One representative from a purchaser of health insurance. (b) The advisory committee shall assist the department in development of the department's oversight of this article and the department's methodology for disclosing the information collected under this part 6, including the methods and means for release and dissemination. (c) The department and the advisory committee shall evaluate on a regular basis the quality and accuracy of health-facility information reported under this part 6 and the data collection, analysis, and dissemination methodologies. (d) The advisory committee shall elect a chair of the advisory committee annually. The advisory committee shall meet no less than four times per year in its first year of existence and no less than two times in each subsequent year. The chair shall set the meeting dates and times. The members of the advisory committee shall serve without compensation. (5) (a) The advisory committee shall recommend additional clinical procedures based upon the criteria set forth in paragraph (c) of this subsection (5) and other health-care-associated infections that must be reported pursuant to subsection (1) of this section. The recommendations of the advisory committee must be consistent with information that may be collected by the national healthcare safety network. (b) Repealed. (c) In making its recommendations under paragraph (a) of this subsection (5), the advisory committee shall recommend clinical procedures and other health-care-associated infections to monitor and report, using the following considerations: Colorado Revised Statutes 2019 Page 232 of 1101 Uncertified Printout (I) Whether the procedure contains a high risk for infection contraction; (II) Whether the type or types of infection present a serious risk to the patient's health or life; and (III) Any other factors determined by the advisory committee. (d) Repealed. (6) The advisory committee may recommend that health facilities report process measures to the advisory committee, in addition to those listed in subsections (1) and (5) of this section, to accommodate best practices for effective prevention of infection. (7) (a) Subsections (4), (5), and (6) of this section and this subsection (7) are repealed, effective September 1, 2021. (b) Prior to such repeal, the advisory committee and its functions shall be reviewed as provided for in section 2-3-1203, C.R.S. Source: L. 2006: Entire part added, p. 1570, § 1, effective June 2. L. 2009: (1)(c) amended, (HB 09-1025), ch. 34, p. 143, § 1, effective August 5. L. 2012: (4)(a)(IV) amended, (HB 12-1294), ch. 252, p. 1259, § 9, effective June 4. L. 2016: (1), (2), (3)(a), (4)(a)(I), (4)(a)(II), (4)(a)(IV), (5)(a), IP(5)(c), and (7)(a) amended and (5)(b) and (5)(d) repealed, (HB 161236), ch. 105, p. 302, § 2, effective April 15. Cross references: For the legislative declaration in the 2012 act amending subsection (4)(a)(IV), see section 1 of chapter 252, Session Laws of Colorado 2012. 25-3-603. Department reports. (1) Notwithstanding section 24-1-136 (11)(a)(I), on or before July 15, 2017, and each July 15 thereafter, the department shall submit to the health and human services committees of the house of representatives and of the senate a report summarizing the risk-adjusted health-facility data. The department shall post the report on its website. (2) Repealed. (3) (a) All data in reports issued by the department shall be risk-adjusted consistent with the standards of the national healthcare safety network. (b) The annual report must compare the risk-adjusted, health-care-associated infection rates, collected under section 25-3-602 for health facilities specified by the department for each individual health facility in the state. The department, in consultation with the advisory committee, shall make this comparison as easy to comprehend as possible. The report must include an executive summary, written in plain language, that includes, but is not limited to, a discussion of findings, conclusions, and trends concerning the overall state of health-careassociated infections in the state, including a comparison to prior years when available. The report may include policy recommendations as appropriate. (c) The department shall publicize the report and its availability as widely as practical to interested parties, including but not limited to health facilities, providers, media organizations, health insurers, health maintenance organizations, purchasers of health insurance, organized labor, consumer or patient advocacy groups, and individual consumers. The annual report shall be made available to any person upon request. Colorado Revised Statutes 2019 Page 233 of 1101 Uncertified Printout (d) A health-facility report or department disclosure may not contain information identifying a patient, employee, or licensed health care professional in connection with a specific infection incident. Source: L. 2006: Entire part added, p. 1572, § 1, effective June 2. L. 2016: (2) repealed and (3)(b) amended, (HB 16-1236), ch. 105, p. 304, § 3, effective April 15. L. 2017: (1) amended, (SB 17-056), ch. 33, p. 93, § 3, effective March 16. 25-3-604. Privacy. Compliance with this part 6 shall not violate a patient's right to confidentiality. A patient's social security number and any other information that could be used to identify a patient shall not be released, notwithstanding any other provision of law. Source: L. 2006: Entire part added, p. 1573, § 1, effective June 2. 25-3-605. Confidentiality. (1) Except as provided by subsection (5) of this section, all information and materials obtained and compiled by the department under this part 6 or compiled by a health facility under this part 6, including all related information and materials, are confidential; are not subject to disclosure, discovery, subpoena, or other means of legal compulsion for release to any person, subject to subsection (2) of this section; and may not be admitted as evidence or otherwise disclosed in a civil, criminal, or administrative proceeding. (2) The confidential protections under subsection (1) of this section shall apply without regard to whether the information or materials are obtained from or compiled by a health facility or an entity that has ownership or management interests in a health facility. (3) The transfer of information or materials under this part 6 is not a waiver of a privilege or protection granted under law. (4) Information reported by a health facility under this part 6 and analyses, plans, records, and reports obtained, prepared, or compiled by a health facility under this part 6 and all related information and materials are subject to an absolute privilege and shall not be used in any form against the health facility, its agents, employees, partners, assignees, or independent contractors in any civil, criminal, or administrative proceeding, regardless of the means by which a person came into possession of the information, analysis, plan, record, report, or related information or materials. (5) The provisions of this section regarding the confidentiality of information or materials compiled or reported by a health facility in compliance with or as authorized under this part 6 shall not restrict access, to the extent authorized by law, by the patient or the patients' legally authorized representative to records of the patient's medical diagnosis or treatment or to other primary health records. Source: L. 2006: Entire part added, p. 1573, § 1, effective June 2. 25-3-606. Penalties. (1) A determination that a health facility has violated the provisions of this part 6 may result in the following: (a) Termination of licensure or other sanctions related to licensure under part 1 of this article; or Colorado Revised Statutes 2019 Page 234 of 1101 Uncertified Printout (b) A civil penalty of up to one thousand dollars per violation for each day the health facility is in violation of this part 6. Source: L. 2006: Entire part added, p. 1574, § 1, effective June 2. 25-3-607. Regulatory oversight. The department shall be responsible for ensuring compliance with this part 6 as a condition of licensure under part 1 of this article and shall enforce compliance according to the provisions in part 1 of this article. Source: L. 2006: Entire part added, p. 1574, § 1, effective June 2. PART 7 COLORADO HOSPITAL REPORT CARD ACT Editor's note: This part 7 was originally numbered as part 6 in House Bill 06-1278 but has been renumbered on revision for ease of location. 25-3-701. Short title. This part 7 shall be known and may be cited as the "Colorado Hospital Report Card Act". Source: L. 2006: Entire part added, p. 1576, § 1, effective August 7. 25-3-702. Comprehensive hospital information system - executive director - duties definitions. (1) (a) The executive director shall approve a comprehensive hospital information system to provide for the collection, compilation, coordination, analysis, indexing, and utilization of both purposefully collected and extant hospital-related data and statistics to produce and report comparable and uniform health information and statistics that shall be utilized in the development and production of the report card described in section 25-3-703. The executive director shall designate or contract with any individual or entity he or she deems appropriate to carry out the purposes of this part 7. (b) (I) The association selected pursuant to subsection (3) of this section shall review and prepare the nursing-sensitive quality measures set forth in this paragraph (b) for inclusion in the hospital information system and hospital report card developed pursuant to this part 7. In reviewing and preparing to implement the nursing-sensitive quality measures, the association shall determine whether the measures should be reported for the hospital as a whole or by unit level of a hospital. In making its determinations pursuant to this paragraph (b), the association shall involve and seek input from no more than seven direct-care nurses who have been recommended by the governor. (II) The association shall collect, review, and implement the following nursing-sensitive quality measures as soon as practicable: (A) Practice environment scale or PES, as defined by the national quality forum, which is the nursing work index that measures the composite score and individual scores for the following subscales: Nurse participation in hospital affairs; nursing foundations for quality of Colorado Revised Statutes 2019 Page 235 of 1101 Uncertified Printout care; nurse manager ability, leadership, and support of nurses; staffing and resource adequacy; and collegiality of nurse-physician relations; and (B) Registered nurse education and certification. (III) The association shall collect, review, and implement the following nursing-sensitive quality measures, as defined by the national quality forum, no later than November 30, 2010: (A) Skill mix; (B) The nursing hours per patient day; (C) Voluntary turnover; (D) Patient falls prevalence rate; and (E) Patient falls with injury. (IV) The association shall identify a process or mechanism to allow access to or use of the data collected pursuant to this paragraph (b), as appropriate, for research purposes. (V) The association may exempt from the requirements of this paragraph (b) a licensed or certified hospital that has not more than one hundred licensed beds. (VI) As used in this paragraph (b): (A) "Direct-care nurse" means a registered nurse who is engaged in direct patient care responsibilities in an inpatient hospital unit setting for more than fifty percent of his or her working hours. (B) (Deleted by amendment, L. 2010, (SB 10-217), ch. 315, p. 1474, § 1, effective May 27, 2010.) (C) "National quality forum" means the private, not-for-profit membership organization created to develop and implement a national strategy for healthcare quality measurement and reporting, or its successor organization. (2) In order to implement this section the executive director or his or her designee shall: (a) Develop and implement a long-range plan for making available clinical outcomes and data that will allow consumers to compare health care services; (b) On or before May 15, 2007, submit an initial plan and an annual update to the plan and a report on the status of implementation to the governor and to the public, via a website. The plan shall identify the process and time frames for implementation, barriers to implementation, and recommendations of changes in the law that may be enacted by the general assembly to eliminate the barriers. (c) Make available clinical outcomes measures from general hospitals licensed pursuant to this article and public hospitals certified pursuant to section 25-1.5-103 (1)(a). When determining which data to report, the executive director or designee shall consider: (I) Inclusion of data on all patients regardless of the payer source for Colorado hospitals and other information that may be required for either individual or group purchasers to assess the value of the product; (II) Use of standardized clinical outcomes measures recognized by national organizations that establish standards to measure the performance of health care providers; (III) Data that is severity and acuity adjusted using statistical methods that show variation in reported outcomes, where applicable, and data that has passed standard edits; (IV) Reporting the results with separate documents containing the technical specification and measures; (V) Standardization in reporting; and (VI) Disclosure of the methodology of reporting. Colorado Revised Statutes 2019 Page 236 of 1101 Uncertified Printout (3) (a) The executive director shall select a duly constituted association of hospitals for assistance in carrying out the purposes of this part 7 and shall rely upon the advice and assistance of the selected association. The association shall provide the executive director with a copy of the association's organizational documents and any rules or regulations governing the association's activities and a list of the association's members. The association shall provide to the executive director a plan outlining the association's inclusion and consideration of the interests of health care consumers, including health plans and employers, in the process of carrying out the purposes of this part 7. The name and address of a representative of the organization, who is a resident of this state, upon whom notices or orders of the executive director may be served shall be provided to the executive director. The executive director shall have the authority to examine the collection, analysis, and validity of the data used as a basis for the reporting required in this part 7. (b) The executive director may refuse to accept, or may suspend or revoke the acceptance of, an association for any of the following reasons: (I) It reasonably appears that the association will not be able to carry out the purpose of this part 7. (II) The association does not provide to the executive director a plan outlining the association's inclusion and consideration of the interests of health care consumers, including health plans and employers, in the process of carrying out the purposes of this part 7. (III) On or before April 15, 2007, the association does not submit a plan to the executive director and report on the status of its implementation satisfactory to the executive director. (IV) The association fails to meet other applicable requirements prescribed in this part 7. (c) There shall not be liability on the part of, nor shall a cause of action of any nature arise against, the association or its agents, employees, directors, or authorized designees of the executive director for actions taken or omitted in the performance of their powers and duties under this section. (4) (a) In the event the executive director refuses to accept, or suspends or revokes the acceptance of, an association previously accepted for assistance in carrying out the purposes of this part 7 for any of the reasons set forth in this part 7, there shall be created in the state department the Colorado commission for hospital statistics, referred to in this subsection (4) as the "commission", to carry out the purposes of this part 7. (b) The commission shall consist of nine members, who shall be appointed by the governor with the consent of the senate, as follows: (I) Three members representing hospitals licensed under this article; (II) Two members representing licensed health care providers; and (III) Four members representing consumers or businesses without any direct interest in hospitals licensed under this article. (c) At no time shall the commission have more than five members of any one political party. Members of the commission shall be compensated for actual and necessary expenses incurred in the conduct of official business. (d) The commission shall annually elect the chairman of the commission from its members. A majority of the commission shall constitute a quorum. (e) The commission shall meet at least once during each calendar quarter. Meeting dates shall be set upon written request by three or more members of the commission or by a call of the chairman upon five days' notice to the members. Colorado Revised Statutes 2019 Page 237 of 1101 Uncertified Printout (f) Action of the commission shall not be taken except upon the affirmative vote of a majority of a quorum of the commission. (g) All meetings of the commission shall be open to the public pursuant to section 24-6402, C.R.S. Source: L. 2006: Entire part added, p. 1576, § 1, effective August 7. L. 2008: (1) amended, p. 709, § 1, effective August 5. L. 2010: (1)(b)(II)(B) and (1)(b)(VI)(B) amended, (SB 10-217), ch. 315, p. 1474, § 1, effective May 27. L. 2017: (2)(b) amended, (SB 17-056), ch. 33, p. 93, § 4, effective March 16. Editor's note: This section was originally numbered as § 25-3-602 in House Bill 061278 but has been renumbered on revision for ease of location. 25-3-703. Hospital report card. (1) The executive director shall approve a Colorado hospital report card consisting of public disclosure of data assembled pursuant to this part 7. At a minimum, the data shall be made available on an internet website in a manner that allows consumers to conduct an interactive search that allows them to view and compare the information for specific hospitals. The website shall include such additional information as is determined necessary to ensure that the website enhances informed decision making among consumers and health care purchasers, which shall include, at a minimum, appropriate guidance on how to use the data and an explanation of why the data may vary from hospital to hospital. The data specified in this subsection (1) shall be released on or before November 30, 2007. (2) Prior to the completion of the Colorado hospital report card, the executive director shall ensure that every hospital is allowed thirty days within which to examine the data and submit comments for consideration and inclusion in the final Colorado hospital report card. Source: L. 2006: Entire part added, p. 1579, § 1, effective August 7. 25-3-704. Fees. (1) The executive director shall annually determine the costs incurred by the department and the Colorado commission for hospital statistics in completing the requirements of this part 7. (2) The executive director shall apportion, according to net patient service revenues, the costs annually among the hospitals who pay the annual registration fee required by this section and report the same to the state board of health. The state board of health by rule or as otherwise provided by law may increase the amount of the annual fee imposed by this section. At no time shall the fee be higher than what is necessary to implement the report required pursuant to this part 7. (3) All fees collected pursuant to this part 7 shall be transmitted to the state treasurer, who shall credit the same to the health facilities general licensure cash fund created in section 25-3-103.1. (4) Notwithstanding the amount specified for the fee in this section, the state board of health by rule or as otherwise provided by law may reduce the amount of the fee 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 Colorado Revised Statutes 2019 Page 238 of 1101 Uncertified Printout 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. Source: L. 2006: Entire part added, p. 1579, § 1, effective August 7. 25-3-705. Health care charge transparency - hospital charge report. (1) The commissioner of insurance shall work with the duly constituted association of hospitals selected by the executive director pursuant to section 25-3-702 for assistance in carrying out the purposes of this section. (2) (a) On or before August 1, 2009, and on or before each August 1 thereafter, each hospital licensed pursuant to part 1 of this article shall report annually to the association of hospitals the information necessary to allow the association to determine the charges for the twenty-five most common inpatient diagnostic-related groups for which there are at least ten cases rendered by the hospital during the calendar year immediately preceding the release of the hospital charge report. If a hospital does not have twenty-five of the most common diagnosticrelated groups with at least ten or more cases rendered, the hospital shall report only on those most common diagnostic-related groups that have at least ten cases rendered. (b) A hospital that does not use diagnostic-related groups is exempt from paragraph (a) of this subsection (2). (3) (a) The commissioner of insurance shall work with the association of hospitals to incorporate the information reported pursuant to this section on the website. (b) The commissioner of insurance shall require the association of hospitals to submit a plan to the commissioner on or before November 30, 2008, that states the implementation status of a plan to make the hospital charges reported pursuant to this section available to the public on the website. The plan shall identify the process and time periods for implementation, any barriers to implementation, and recommendations of changes in the law that may be enacted by the general assembly to eliminate the barriers. (c) When developing the required plan, the association of hospitals shall consider: (I) The method for hospitals to report charges to the association; (II) Standards that provide for the validity and comparability of hospital charges; and (III) The format for making hospital charges available to the public. (4) (a) The association of hospitals shall make the information reported by the hospitals pursuant to this section available on the website on or before August 1, 2009, and on or before August 1 of each year thereafter. The information reported by the hospitals shall include disclaimers regarding factors including case severity ratings and individual patient variations that may affect actual charges to a patient for services provided. (b) The information reported by the hospitals that is published in accordance with this section shall include: (I) Volume of cases by diagnostic-related group required to be reported by the hospital; (II) Rank by volume of the top twenty-five diagnostic-related groups required to be reported by the hospital; (III) Mean charge for each of the top twenty-five diagnostic-related groups with more than ten occurrences by hospital; (IV) Case severity rating by hospital by diagnostic-related group; and Colorado Revised Statutes 2019 Page 239 of 1101 Uncertified Printout (V) A general disclaimer statement regarding the hospital variations and patient variations that affect the actual charges to patients. (c) Before publication of the information published pursuant to this section on the website, the commissioner shall ensure that every hospital is allowed thirty days within which to examine the data and submit comments for consideration and inclusion in the final hospital charge report. (5) (a) The commissioner of insurance shall approve the publication of information on the website consisting of public disclosure of charge data assembled pursuant to this section. At a minimum, the information shall be made available on the website in a manner that allows consumers to conduct an interactive search to view and compare the information for specific hospitals. The website shall include any additional information necessary to ensure that the website information is available to consumers and health care purchasers. The information shall include, at a minimum, appropriate guidance on how to use the data and an explanation of why the data may vary from hospital to hospital. The report specified in this subsection (5) shall be released on the website on or before August 1, 2009, and on or before each August 1 thereafter. (b) The commissioner of insurance shall make the website available by hyperlink on the division of insurance website. (c) The division of insurance shall review the information posted on the website to ensure that the website and information provided by the association is easy to navigate, contains consumer-friendly language, and fulfills the intent of this section. The division shall also ensure that the hyperlink from the division's website to the website is easily accessible. (6) There shall be no liability on the association of hospitals or a cause of action against the association or its agents, employees, or directors or authorized designees of the commissioner for actions taken or omitted in the performance of duties pursuant to this section. (7) Repealed. (8) For purposes of this section: (a) "Charge" means the amount that a hospital expects to charge for an inpatient diagnostic-related group. A charge that is required to be reported to the public shall be the mean charge for all cases of the diagnostic-related group occurring in the calendar year prior to the release of the hospital charge report. (b) "Diagnostic-related group" means the classification assigned to an inpatient hospital service claim based on the patient's age and sex, the principal and secondary diagnoses, the procedures performed, and the discharge status. (c) "Website" means a website established by the association of hospitals that links to the website created pursuant to section 25-3-703. Source: L. 2008: Entire section added, p. 1262, § 3, effective May 27. L. 2011: (7) repealed, (HB 11-1303), ch. 264, p. 1165, § 60, effective August 10. Cross references: In 2008, this section was added by the "Health Care Transparency Act". For the short title and legislative declaration, see sections 1 and 2 of chapter 294, Session Laws of Colorado 2008. ARTICLE 3.5 Colorado Revised Statutes 2019 Page 240 of 1101 Uncertified Printout Emergency Medical and Trauma Services Cross references: For exemption from civil liability of persons acting as volunteer members of rescue units, see § 13-21-108. PART 1 GENERAL AND ADMINISTRATIVE 25-3.5-101. Short title. This article shall be known and may be cited as the "Colorado Emergency Medical and Trauma Services Act". Source: L. 77: Entire article added, p. 1278, § 2, effective January 1, 1978. L. 2000: Entire section amended, p. 525, § 1, effective July 1. 25-3.5-102. Legislative declaration. (1) The general assembly hereby declares that it is in the public interest to provide available, coordinated, and quality emergency medical and trauma services to the people of this state. It is the intent of the general assembly in enacting this article to establish an emergency medical and trauma services system, consisting of at least treatment, transportation, communication, and documentation subsystems, designed to prevent premature mortality and to reduce the morbidity that arises from critical injuries, exposure to poisonous substances, and illnesses. (2) To effect this end, the general assembly finds it necessary that the department of public health and environment assist, when requested by local government entities, in planning and implementing any one of such subsystems so that it meets local and regional needs and requirements and that the department coordinate local systems so that they interface with an overall state system providing maximally effective emergency medical and trauma systems. (3) The general assembly further finds that the provision of adequate emergency medical and trauma services on highways in all areas of the state is a matter of statewide concern and requires state financial assistance and support. Source: L. 77: Entire article added, p. 1278, § 2, effective January 1, 1978. L. 83: (1) amended, p. 1055, § 2, effective July 1. L. 89: (3) added, p. 1148, § 1, effective July 1. L. 94: (2) amended, p. 2757, § 417, effective July 1. L. 2000: Entire section amended, p. 525, § 2, effective July 1. Cross references: For the legislative declaration contained in the 1994 act amending subsection (2), see section 1 of chapter 345, Session Laws of Colorado 1994. 25-3.5-103. Definitions. As used in this article 3.5, unless the context otherwise requires: (1) "Air ambulance" means a fixed-wing or rotor-wing aircraft that is equipped to provide air transportation and is specifically designed to accommodate the medical needs of individuals who are ill, injured, or otherwise mentally or physically incapacitated and who require in-flight medical supervision. Colorado Revised Statutes 2019 Page 241 of 1101 Uncertified Printout (1.3) "Air ambulance service" means any public or private entity that uses an air ambulance to transport patients to a medical facility. (1.5) "Ambulance" means any privately or publicly owned ground vehicle: (a) Especially constructed or modified and equipped, intended to be used, and maintained or operated by an ambulance service for the transportation, upon the streets and highways in this state, of individuals who are sick, injured, or otherwise incapacitated or helpless; and (b) That is required to be licensed pursuant to part 3 of this article. (2) (Deleted by amendment, L. 2005, p. 1330, § 1, effective July 1, 2005.) (3) "Ambulance service" means the furnishing, operating, conducting, maintaining, advertising, or otherwise engaging in or professing to be engaged in the transportation of patients by ambulance. Taken in context, it also means the person so engaged or professing to be so engaged. The person so engaged and the vehicles used for the emergency transportation of persons injured at a mine are excluded from this definition when the personnel utilized in the operation of said vehicles are subject to the mandatory safety standards of the federal mine safety and health administration, or its successor agency. (3.5) "Board" means the state board of health created pursuant to section 25-1-103. (4) "Board of county commissioners" includes the governing body of any city and county. (4.3) "Community integrated health care service" means the provision of certain out-ofhospital medical services, as determined by rule, that a community paramedic may provide. (4.5) "Community paramedic" means an emergency medical service provider who obtains an endorsement in community paramedicine pursuant to section 25-3.5-206. (5) "Department" means the department of public health and environment. (6) "Director" means the executive director of the department of public health and environment. (7) "Emergency" means any actual or self-perceived event which threatens life, limb, or well-being of an individual in such a manner that a need for immediate medical care is created. (7.5) "Emergency medical practice advisory council" or "advisory council" means the emergency medical practice advisory council created in section 25-3.5-206. (8) "Emergency medical service provider" means an individual who holds a valid emergency medical service provider certificate or license issued by the department as provided in this article 3.5. (8.3) "EMS agency patient care database" means the department's database containing records required to be submitted in accordance with section 25-3.5-501. (8.5) "Health information organization network" means an organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards. (8.8) "Medical direction" includes, but is not limited to, the following: (a) Approval of the medical components of treatment protocols and appropriate prearrival instructions; (b) Routine review of program performance and maintenance of active involvement in quality improvement activities, including access to dispatch tapes as necessary for the evaluation of procedures; Colorado Revised Statutes 2019 Page 242 of 1101 Uncertified Printout (c) Authority to recommend appropriate changes to protocols for the improvement of patient care; and (d) Provision of oversight for the ongoing education, training, and quality assurance for providers of emergency care. (9) "Patient" means any individual who is sick, injured, or otherwise incapacitated or helpless. (10) "Permit" means the authorization issued by the governing body of a local government with respect to an ambulance used or to be used to provide ambulance service in this state. (10.6) "Refresher course program" means a program establishing a course of instruction designed to keep emergency medical service providers abreast of developments or new techniques in their profession, which course includes an examination administered at any time during or following the course to facilitate continuing evaluation of emergency medical service providers. (10.8) "Registered emergency medical responder" means an individual who has successfully completed the training and examination requirements for emergency medical responders, who provides assistance to the injured or ill until more highly trained and qualified personnel arrive, and who is registered with the department pursuant to part 11 of this article. (11) "Rescue unit" means any organized group chartered by this state as a corporation not for profit or otherwise existing as a nonprofit organization whose purpose is the search for and the rescue of lost or injured persons and includes, but is not limited to, such groups as search and rescue, mountain rescue, ski patrols (either volunteer or professional), law enforcement posses, civil defense units, or other organizations of governmental designation responsible for search and rescue. (11.5) "Service agency" means a fixed-base or mobile prehospital provider of emergency medical services that employs emergency medical service providers to render medical care to patients. (12) "Volunteer emergency medical service provider" means an emergency medical service provider who does not receive direct remuneration for the performance of emergency medical services. Source: L. 77: Entire article added, p. 1279, § 2, effective January 1, 1978. L. 80: (1) and (3) amended, p. 633, § 1, effective April 8. L. 84: (10.6) added, p. 763, § 1, effective July 1. L. 87: (12) added, p. 1126, § 1, effective July 1. L. 94: (5) and (6) amended, p. 2757, § 418, effective July 1. L. 2000: (3.5) and (11.5) added, p. 526, § 3, effective July 1. L. 2005: (1) and (2) amended and (1.5) added, p. 1330, § 1, effective July 1. L. 2010: (7.5) added, (HB 10-1260), ch. 403, p. 1944, § 6, effective July 1. L. 2012: (8), (10.6), (11.5), and (12) amended, (HB 121059), ch. 271, p. 1437, § 20, effective July 1. L. 2016: (1.3) added, (HB 16-1280), ch. 206, p. 736, § 1, effective June 1; (4.3) and (4.5) added, (SB 16-069), ch. 260, p. 1062, § 1, effective June 8; (10.8) added, (HB 16-1034), ch. 324, p. 1310, § 1, effective August 10. L. 2018: IP amended and (8.3) and (8.5) added, (HB 18-1032), ch. 63, p. 612, § 1, effective August 8. L. 2019: (8) amended, (SB 19-242), ch. 396, p. 3518, § 1, effective May 31; (8.8) added, (SB 19052), ch. 122, p. 527, § 1, effective August 2. Colorado Revised Statutes 2019 Page 243 of 1101 Uncertified Printout Editor's note: (1) Section 29 of chapter 396 (SB 19-242), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 31, 2019. (2) Section 7 of chapter 122 (SB 19-052), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after August 2, 2019. (3) Subsection (8.8) is similar to § 25-3.5-203 (5) as it existed prior to 2019. Cross references: For the legislative declaration contained in the 1994 act amending subsections (5) and (6), see section 1 of chapter 345, Session Laws of Colorado 1994. 25-3.5-104. Emergency medical and trauma services advisory council - creation duties. (1) (a) There is hereby created, in the department of public health and environment, a state emergency medical and trauma services advisory council, referred to in this article as the "council", to be composed of thirty-two members, of whom twenty-five shall be appointed by the governor no later than January 1, 2001, and at least one of whom shall be from each of the regional emergency medical and trauma advisory council planning areas established in section 25-3.5-704. The other seven members shall be ex officio, nonvoting members. Not more than thirteen of the appointed members of the council shall be members of the same political party. A majority of the members shall constitute a quorum. The membership of the council shall reflect, as equally as possible, representation of urban and rural members. (b) The appointed members of the council shall be from the following categories: (I) A fire chief of a service that provides prehospital care in an urban area; (II) A fire chief of a service that provides prehospital care in a rural area; (III) An administrative representative of an urban trauma center; (IV) An administrative representative of a rural trauma center; (V) A licensed physician who is a prehospital medical director; (VI) A board-certified physician certified in pediatrics or a pediatric subspecialty; (VII) A board-certified emergency physician; (VIII) A flight nurse of an emergency medical service air team or unit; (IX) An officer or crew member of a volunteer organization who provides prehospital care; (X) An officer or employee of a public provider of prehospital care; (XI) An officer or employee of a private provider of prehospital care; (XII) A representative of a government provider of prehospital care; (XIII) Three county commissioners or council members from a city and county, two of whom shall represent rural counties and one of whom shall represent an urban county or city and county; (XIV) A board-certified surgeon providing trauma care at a level I trauma center; (XV) A board-certified surgeon providing trauma care at a level II trauma center; (XVI) A board-certified surgeon providing trauma care at a level III trauma center; (XVII) A board-certified neurosurgeon involved in providing trauma care at a level I or II trauma center; (XVIII) A trauma nurse coordinator; (XIX) A registered nurse involved in rural emergency medical and trauma services care; (XX) A regional council chair; Colorado Revised Statutes 2019 Page 244 of 1101 Uncertified Printout (XXI) A county emergency manager; and (XXII) Two representatives of the general public, one from a rural area and one from an urban area. (c) Ex officio, nonvoting members of the council shall include members from the following categories: (I) A representative of the state coroners' association, as selected by the association; (II) The director of the state board for community colleges and occupational education or the director's designee; (III) The manager of the telecommunication services of the Colorado information technology services in the department of personnel, general support services, or the manager's designee; (IV) The executive director of the department of public health and environment or the director's designee; (V) The director of the office of transportation safety in the department of transportation or the director's designee; (VI) A representative from the state sheriffs' association; and (VII) A representative from the Colorado state patrol. (2) Members of the council shall serve for terms of three years each; except that, of the members first appointed, eight shall be appointed for terms of one year, nine shall be appointed for terms of two years, and eight shall be appointed for terms of three years. Members of the council shall be reimbursed for actual and necessary expenses incurred in the actual performance of their duties. All vouchers for expenditures shall be subject to approval by the director. A vacancy shall be filled by appointment by the governor for the remainder of the unexpired term. Any appointed member who has two consecutive unexcused absences from meetings of the council shall be deemed to have vacated the membership, and the governor shall fill such vacancy as provided in this subsection (2). (3) The council shall meet at least quarterly at the call of the chairperson or at the request of any seven members. At the first meeting after the appointment of new members, the members shall elect a chairperson who shall serve for a term of one year. (4) The council shall: (a) Advise the department on all matters relating to emergency medical and trauma services programs; (b) Make recommendations concerning the development and implementation of statewide emergency medical and trauma services; (c) Identify and make recommendations concerning statewide emergency medical and trauma service needs; (d) Review and approve new rules and modifications to rules existing prior to July 1, 2000, prior to the adoption of such rules or modifications by the state board of health; (e) Review and make recommendations concerning guidelines and standards for the delivery of emergency medical and trauma services, including: (I) Establishing a list of minimum equipment requirements for ambulance vehicles operated by an ambulance service licensed in this state and making recommendations on the process used by counties in the licensure of ambulance services; (II) Developing curricula for the training of emergency medical personnel; Colorado Revised Statutes 2019 Page 245 of 1101 Uncertified Printout (III) Making recommendations on the verification process used by the department to determine facility eligibility to receive trauma center designation; and (IV) Making recommendations regarding the process used by the department to identify accrediting organizations for air ambulance licensing; (f) Seek advice and counsel, up to and including the establishment of special ad hoc committees with other individuals, groups, organizations, or associations, when in the judgment of the council such is advisable to obtain necessary expertise for the purpose of meeting the council's responsibilities under this article. The council is authorized to establish special committees for the functions described in this paragraph (f). (g) Review and make recommendations to the department regarding the amount, allocation, and expenditure of funds for the development, implementation, and maintenance of the statewide emergency medical and trauma system. Source: L. 77: Entire article added, p. 1280, § 2, effective January 1, 1978. L. 82: (1) amended, p. 356, § 17, effective April 30. L. 83: (1) amended, p. 889, § 4, effective July 1. L. 84: (4)(j), (4)(k), and (5) added, p. 763, §§ 2, 3, effective July 1. L. 85: (1) amended, p. 881, § 1, effective July 1. L. 86: (6) added, p. 420, § 42, effective March 26. L. 89: (1) amended and (6) repealed, pp. 1146, 1147, §§ 2, 3, effective April 6. L. 91: (1) amended, p. 1068, § 40, effective July 1. L. 92: (1) amended, p. 1043, § 9, effective March 12. L. 94: (1) amended, p. 2757, § 419, effective July 1. L. 95: (1), (2), (3), IP(4), (4)(f), (4)(g), and (5) amended, p. 1350, § 2, effective July 1. L. 2000: Entire section R&RE, p. 526, § 4, effective January 1, 2001. L. 2016: (4)(e) amended, (HB 16-1280), ch. 206, p. 736, § 2, effective June 1. 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. 25-3.5-104.3. State trauma advisory council - duties. (Repealed) Source: L. 95: Entire section added, p. 1347, § 1, effective July 1. L. 96: (1)(c)(IV) amended, p. 1541, § 128, effective June 1. L. 2000: Entire section repealed, p. 547, § 26, effective January 1, 2001. 25-3.5-104.5. Joint advisory council - duties. (Repealed) Source: L. 95: Entire section added, p. 1347, § 1, effective July 1. L. 2000: Entire section repealed, p. 547, § 26, effective January 1, 2001. 25-3.5-105. Rules and regulations. All rules and regulations adopted pursuant to the provisions of this article shall be adopted in accordance with the provisions of article 4 of title 24, C.R.S. Source: L. 77: Entire article added, p. 1281, § 2, effective January 1, 1978. Colorado Revised Statutes 2019 Page 246 of 1101 Uncertified Printout 25-3.5-106. Local standards - uninterrupted service. (1) Nothing in this article shall be construed to prevent a municipality or special district from adopting standards more stringent than those provided in this article. (2) In no event shall the providing of service to sick or injured persons be interrupted, between point of origin and point of destination, when an ambulance run traverses one or more jurisdictions whose adopted standards are more stringent than those adopted in the jurisdiction where such ambulance run originates. Source: L. 77: Entire article added, p. 1281, § 2, effective January 1, 1978. 25-3.5-107. Religious exception. Nothing in this article or the rules and regulations adopted pursuant to this article shall be construed to authorize any medical treatment or transportation to any hospital or other emergency care center of an adult who objects thereto on religious grounds and signs a written waiver to that effect. Source: L. 77: Entire article added, p. 1281, § 2, effective January 1, 1978. PART 2 TREATMENT SUBSYSTEM 25-3.5-201. Training programs. (1) The department shall design and establish specialized curricula for personnel who respond routinely to emergencies. The board of county commissioners may select from the various curricula available those courses meeting the minimum requirements established by said board. (2) The department shall distribute the curricula and teaching aids to training institutions and hospitals upon request from a recognized training group or hospital. If a county is unable to arrange for necessary training programs, the department shall arrange a training program within the immediate vicinity of the agency requesting the program. The department shall issue emergency medical service provider certificates or licenses in accordance with section 25-3.5203 (1) and may issue certificates of successful course completion to those individuals who successfully complete other emergency medical services training programs of the department. The programs may provide for the training of emergency medical dispatchers, emergency medical services instructors, emergency medical services coordinators, and other personnel who provide emergency medical services. The receipt of the certificate of course completion is not deemed state licensure, approval, or a determination of competency. Source: L. 77: Entire article added, p. 1281, § 2, effective January 1, 1978. L. 92: (2) amended, p. 1143, § 1, effective May 29. L. 2010: (1) amended, (HB 10-1260), ch. 403, p. 1944, § 7, effective July 1. L. 2012: (2) amended, (HB 12-1059), ch. 271, p. 1428, § 2, effective July 1. L. 2019: (2) amended, (SB 19-242), ch. 396, p. 3528, § 15, effective May 31. Editor's note: Section 29 of chapter 396 (SB 19-242), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 31, 2019. Colorado Revised Statutes 2019 Page 247 of 1101 Uncertified Printout 25-3.5-202. Personnel - basic requirements. Emergency medical service providers employed or utilized in connection with an ambulance service shall meet the qualifications established, by resolution, by the board of county commissioners of the county in which the ambulance is based in order to be certified or licensed. For ambulance drivers, the minimum requirements include the possession of a valid driver's license and other requirements established by the board by rule under section 25-3.5-308. For any person responsible for providing direct emergency medical care and treatment to patients transported in an ambulance, the minimum requirement is possession of an emergency medical service provider certificate or license issued by the department. In the case of an emergency in an ambulance service area where no person possessing the qualifications required by this section is present or available to respond to a call for the emergency transportation of patients by ambulance, any person may operate the ambulance to transport any sick, injured, or otherwise incapacitated or helpless person in order to stabilize the medical condition of the person pending the availability of medical care. Source: L. 77: Entire article added, p. 1281, § 2, effective January 1, 1978. L. 78: Entire section amended, p. 409, § 1, effective April 4. L. 79: Entire section amended, p. 1011, § 1, effective July 1. L. 84: Entire section amended, p. 764, § 4, effective July 1. L. 2000: Entire section amended, p. 529, § 5, effective July 1. L. 2012: Entire section amended, (HB 12-1059), ch. 271, p. 1428, § 3, effective July 1. L. 2019: Entire section amended, (SB 19-242), ch. 396, p. 3528, § 16, effective May 31. Editor's note: Section 29 of chapter 396 (SB 19-242), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 31, 2019. 25-3.5-203. Emergency medical service providers - licensure - renewal of license duties of department - rules - criminal history record checks - definitions. (1) (a) Repealed. (a.5) The executive director or chief medical officer shall regulate the acts emergency medical service providers are authorized to perform subject to the medical direction of a licensed physician. The executive director or chief medical officer, after considering the advice and recommendations of the advisory council, shall adopt and revise rules, as necessary, regarding the regulation of emergency medical service providers and their duties and functions. (b) The department shall certify and license emergency medical service providers. The board shall adopt rules for the certification and licensure of emergency medical service providers. The rules must include the following: (I) A statement that a certificate or license is valid for a period of three years after the date of issuance; (II) A statement that the certificate or license is renewable at its expiration upon the certificate holder's or licensee's satisfactory completion of the training requirements established pursuant to subsection (2) of this section; (III) Provisions governing the use of results of national and state criminal history record checks by the department to determine the action to take on a certification or license application pursuant to subsection (4) of this section. Notwithstanding section 24-5-101, provisions governing the use of criminal history record check results must allow the department to consider whether the applicant has been convicted of a felony or misdemeanor involving moral turpitude Colorado Revised Statutes 2019 Page 248 of 1101 Uncertified Printout and the pertinent circumstances connected with the conviction and to make a determination whether the conviction disqualifies the applicant from certification or licensure. (IV) Disciplinary sanctions, which must include provisions for the denial, revocation, and suspension of certificates and licenses and the suspension and probation of certificate holders and licensees; (V) An appeals process pursuant to sections 24-4-104 and 24-4-105 that is applicable to department decisions in connection with certifications and licenses and sanctions; (VI) Pursuant to subsection (1)(b.5) of this section, rules regarding the conversion of an emergency medical service provider's valid certification to a license upon the emergency medical service provider's demonstration to the satisfaction of the department that the emergency medical service provider has completed a four-year bachelor's degree program from an accredited college or university in a field related to the health sciences or an equivalent field, as determined by the board by rule; and (VII) A statement that an emergency medical service provider may practice in a clinical setting, as defined in section 25-3.5-207 (1)(a), subject to the requirements of section 25-3.5-207 and rules adopted by the board. (b.5) (I) On or after January 1, 2021, an individual in this state who holds a valid emergency medical service provider certificate issued by the department may apply for a license issued by the department pursuant to this section. The department may issue a license to a certificate holder who has completed a four-year bachelor's degree program from an accredited college or university in a field related to the health sciences or an equivalent field, as determined by the board by rule. (II) The conversion of an emergency medical service provider's certification to licensure pursuant to this subsection (1)(b.5) does not: (A) Affect any prior discipline, limitation, or condition imposed by the department on an emergency medical service provider; (B) Limit the department's authority over any certificate holder; or (C) Affect any pending investigation or administrative proceeding. (c) (I) The department may issue a provisional certification or license to an applicant for certification or licensure as an emergency medical service provider who requests issuance of a provisional certification or license and who pays any fee authorized under rules adopted by the board. A provisional certification or license is valid for not more than ninety days. (II) The department shall not issue a provisional certification or license unless the applicant satisfies the requirements for certification or licensure in accordance with this section and rules adopted by the board under this subsection (1). If the department finds that an emergency medical service provider that has received a provisional certification or license has violated any requirements for certification or licensure, the department may impose disciplinary sanctions under subsection (1)(b)(IV) of this section. (III) The department may issue a provisional certification or license to an applicant whose fingerprint-based criminal history record check has not yet been completed. The department shall require the applicant to submit to a name-based criminal history record check prior to issuing a provisional certification or license. (IV) The board shall adopt rules as necessary to implement this subsection (1)(c), including rules establishing a fee for provisional certification or licensure. The department shall Colorado Revised Statutes 2019 Page 249 of 1101 Uncertified Printout deposit any fee collected for a provisional certification or license in the emergency medical services account created in section 25-3.5-603. (d) (I) The department shall exempt certified or licensed emergency medical service providers who have been called to federally funded active duty for more than one hundred twenty days to serve in a war, emergency, or contingency from the payment of certification or license fees and from continuing education or professional competency requirements of this article 3.5 for a renewal date during the service or the six months after the completion of service. (II) Upon presentation of satisfactory evidence by an applicant for certification or license renewal, the department may accept continuing medical education, training, or service completed by an individual as a member of the armed forces or reserves of the United States, the National Guard of any state, the military reserves of any state, or the naval militia of any state toward the qualifications to renew the individual's certification or license. (III) (A) A veteran, active military service member, or member of the National Guard and reserves separating from an active duty tour or the spouse of a veteran or member may apply for certification or licensure under this article 3.5 while stationed or residing within this state. The veteran, member, or spouse is exempt from the initial certification or licensure requirements in this article 3.5, except for those in subsection (4) of this section, if the veteran, member, or spouse holds a current, valid, and unrestricted certification from the National Registry of Emergency Medical Technicians (NREMT) at or above the level of state certification being sought. (B) The department shall expedite the processing of a certification or license application submitted by a veteran, active military service member, or member of the National Guard and reserves separating from an active duty tour or the spouse of a veteran or member. (IV) The board shall promulgate rules to implement this subsection (1)(d), including the criteria and evidence for acceptable continuing medical education and training or service. (2) The council shall advise the department and the board in establishing the training requirements for certificate or license renewal, which training requirements must include a classroom component requiring at least thirty-six and not more than fifty classroom hours. (3) Repealed. (4) (a) The department shall require a certification or licensure applicant to submit to a federal bureau of investigation fingerprint-based national criminal history record check from the Colorado bureau of investigation to investigate the applicant for an emergency medical service provider certificate or license. The department may acquire a name-based criminal history record check for a certificate or license applicant who has twice submitted to a fingerprint-based criminal history record check and whose fingerprints are unclassifiable. (b) Each emergency medical service provider certification or licensure applicant required under this subsection (4) to submit to a federal bureau of investigation fingerprint-based national criminal history record check shall obtain a complete set of fingerprints taken by a local law enforcement agency, another entity designated by the department, or any third party approved by the Colorado bureau of investigation. If an approved third party takes the applicant's fingerprints, the fingerprints may be electronically captured using Colorado bureau of investigation-approved livescan equipment. Third-party vendors shall not keep the applicant's information for more than thirty days unless requested to do so by the applicant. The approved third party or government entity shall transmit the fingerprints to the Colorado bureau of investigation, which shall in turn forward them to the federal bureau of investigation for a national criminal history record check. Colorado Revised Statutes 2019 Page 250 of 1101 Uncertified Printout The department or other authorized government entity is the authorized agency to receive and disseminate information regarding the result of a national criminal history record check. Each entity handling the national criminal history record check shall comply with Pub.L. 92-544, as amended. Each government entity acting as the authorized recipient of the result of a national criminal history record check shall forward the result of the initial national criminal history record check and any subsequent notification of activity on the record to the department to determine the individual's eligibility for initial certification or licensure or certification or licensure renewal. (c) to (e) (Deleted by amendment, L. 2019.) (f) If an applicant for certification or licensure renewal has lived in Colorado for: (I) More than three years at the time of certification or licensure renewal and submitted to a federal bureau of investigation fingerprint-based national criminal history record check at the time of initial certification or licensure or at the time of a previous renewal of certification or licensure, the applicant is not required to submit to a subsequent fingerprint-based criminal history record check; or (II) Three years or less at the time of certification or licensure renewal and submitted to a federal bureau of investigation fingerprint-based national criminal history record check at the time of initial certification or licensure or a previous renewal of certification or licensure, the applicant shall submit to another federal bureau of investigation fingerprint-based national criminal history record check from the Colorado bureau of investigation; except that the department may acquire a state name-based criminal history record check for an applicant who has twice submitted to a fingerprint-based criminal history record check and whose fingerprints are unclassifiable. (g) When the results of a fingerprint-based criminal history record check of a person performed pursuant to this subsection (4) reveal a record of arrest without a disposition, the department, government entity, or private, not-for-profit, or for-profit organization that required the fingerprint-based criminal history record check shall require that person to submit to a namebased criminal history record check, as defined in section 22-2-119.3 (6)(d). (4.5) (a) As used in this subsection (4.5), unless the context otherwise requires: (I) "Cat" means a small, domesticated feline animal that is kept as a pet. "Cat" does not include a nondomesticated wild animal. (II) "Dog" means any canine animal owned for domestic, companionship, service, therapeutic, or assistance purposes. (III) "Emergency medical service provider" means an emergency medical service provider that is certified or licensed by the department of public health and environment, created under section 25-1-102. (IV) "Employer" means an entity or organization that employs or enlists the services of an emergency medical service provider, regardless of whether the provider is paid or is a volunteer. The employer may be a public, private, for-profit, or nonprofit organization or entity; or a special district. (V) "Preveterinary emergency care" means the immediate medical stabilization of a dog or cat by an emergency medical service provider, in an emergency to which the emergency medical service provider is responding, through means including oxygen, fluids, medications, or bandaging, with the intent of enabling the dog or cat to be treated by a veterinarian. "Preveterinary emergency care" does not include care provided in response to an emergency call Colorado Revised Statutes 2019 Page 251 of 1101 Uncertified Printout made solely for the purpose of tending to an injured dog or cat, unless a person's life could be in danger attempting to save the life of a dog or cat. (b) Notwithstanding any other provision of law, an emergency medical service provider may provide preveterinary emergency care to dogs and cats to the extent the provider has received commensurate training and is authorized by the employer to provide the care. Requirements governing the circumstances under which emergency medical service providers may provide preveterinary emergency care to dogs and cats may be specified in the employer's policies governing the provision of care. (c) Notwithstanding any other provision of law, nothing in this subsection (4.5) imposes upon an emergency medical service provider any obligation to provide care to a dog or cat, or to provide care to a dog or cat before a person. (5) Repealed. Source: L. 77: Entire article added, p. 1281, § 2, effective January 1, 1978. L. 84: Entire section amended, p. 764, § 5, effective July 1. L. 85: (1) amended, p. 524, § 16, effective July 1. L. 87: (1) amended and (3) added, p. 1126, § 2, effective July 1. L. 89: (1) amended and (3) repealed, p. 1152, §§ 3, 5, effective July 1. L. 94: (1) amended, p. 2758, § 420, effective July 1. L. 2000: (1) amended and (4) and (5) added, p. 529, § 6, effective July 1. L. 2001: (1), (2), and (4) amended, p. 1144, § 1, effective June 5. L. 2003: (1)(b)(III) and (4) amended, p. 1662, § 1, effective May 14. L. 2007: (4)(a), (4)(b), (4)(c)(I), (4)(d)(I), and (4)(e) amended, p. 637, § 1, effective April 26. L. 2009: (1)(c) added, (HB 09-1275), ch. 278, p. 1244, § 1, effective May 19. L. 2010: (1)(a) amended and (1)(a.5) added, (HB 10-1260), ch. 403, p. 1944, § 8, effective July 1. L. 2012: (1)(a.5), IP(1)(b), (1)(c)(I), (1)(c)(II), (4)(a), (4)(b)(I), and (4)(c)(I)(A) amended and (1)(d) added, (HB 12-1059), ch. 271, p. 1428, § 4, effective July 1. L. 2014: (4.5) added, (SB 14039), ch. 45, p. 219, § 2, effective August 6. L. 2015: (1)(d)(III) amended, (HB 15-1015), ch. 171, p. 539, § 2, effective August 5. L. 2017: (4)(b)(I) amended, (SB 17-189), ch. 149, p. 504, § 13, effective August 9. L. 2019: (4)(g) added, (HB 19-1166), ch. 125, p. 553, § 37, effective April 18; (1)(b), (1)(c), (1)(d), (2), and (4) amended and (1)(b.5) added, (SB 19-242), ch. 396, p. 3518, § 2, effective May 31; (1)(b)(IV) and (1)(b)(V) amended, (1)(b)(VII) added, and (5) repealed, (SB 19-052), ch. 122, pp. 528, 530, §§ 2, 6, effective August 2. Editor's note: (1) Subsection (1)(a)(II) provided for the repeal of subsection (1)(a), effective January 1, 2011. (See L. 2010, p. 1944.) (2) Section 29 of chapter 396 (SB 19-242), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 31, 2019. (3) Amendments to subsection (1)(b) by SB 19-052 and SB 19-242 were harmonized. (4) Section 7 of chapter 122 (SB 19-052), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after August 2, 2019. (5) Subsection (5) was repealed and relocated to § 25-3.5-103 (8.8). (6) Subsection (1)(b)(VII) was numbered as (1)(b)(VI) in SB 19-052 but has been renumbered on revision for ease of location. (7) Subsection (4)(g) was numbered as (4)(f) in HB 19-1166 but has been renumbered on revision for ease of location. Colorado Revised Statutes 2019 Page 252 of 1101 Uncertified Printout 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 SB 14-039, see section 1 of chapter 45, Session Laws of Colorado 2014. 25-3.5-203.5. Community paramedic endorsement - rules. (1) On or before January 1, 2018, the board shall adopt rules in accordance with article 4 of title 24, C.R.S., for community paramedics including standards for: (a) The department's issuance of an endorsement in community paramedicine to an emergency medical service provider; (b) Verifying an emergency medical service provider's competency to be endorsed as a community paramedic. The standards must include a requirement that the emergency medical service provider has obtained from an accredited paramedic training center or an accredited college or university a certificate of completion for a course in community paramedicine with competency verified by a passing score on an examination offered nationally and recognized in Colorado for certifying competency to serve as a community paramedic. (c) Continuing competency to maintain a community paramedic endorsement. (2) Rules adopted under this section supersede any rules of the Colorado medical board regarding the matters set forth in this part 2. Source: L. 2016: Entire section added, (SB 16-069), ch. 260, p. 1062, § 2, effective June 8. 25-3.5-204. Emergency medical services for children. (1) The department is authorized to establish a program to improve the quality of emergency care to pediatric patients throughout the state, including a component to address public awareness of pediatric emergencies and injury prevention. (2) The department is authorized to receive contributions, grants, donations, or funds from any public or private entity to be expended for the program authorized pursuant to this section. Source: L. 95: Entire section added, p. 1361, §4, effective July 1. 25-3.5-205. Emergency medical service providers - investigation - discipline. (1) (a) The department may administer oaths, take affirmations of witnesses, and issue subpoenas to compel the attendance of witnesses and the production of all relevant records and documents to investigate alleged misconduct by certified or licensed emergency medical service providers. (b) Upon failure of a witness to comply with a subpoena, the department may apply to a district court for an order requiring the person to appear before the department or an administrative law judge, to produce the relevant records or documents, or to give testimony or evidence touching the matter under investigation or in question. When seeking an order, the department shall apply to the district court of the county in which the subpoenaed person resides or conducts business. The court may punish such failure as a contempt of court. (2) An emergency medical service provider, the medical supervisor of an emergency medical service provider in a clinical setting, as those terms are defined in section 25-3.5-207 (1), the employer of an emergency medical service provider, a medical director, and a physician Colorado Revised Statutes 2019 Page 253 of 1101 Uncertified Printout providing medical direction of an emergency medical service provider shall report to the department any misconduct that is known or reasonably believed by the person to have occurred. (3) A person acting as a witness or consultant to the department, a witness testifying, and a person or employer who reports misconduct to the department under this section shall be immune from liability in any civil action brought for acts occurring while testifying, producing evidence, or reporting misconduct under this section if such individual or employer was acting in good faith and with a reasonable belief of the facts. A person or employer participating in good faith in an investigation or an administrative proceeding pursuant to this section shall be immune from any civil or criminal liability that may result from such participation. (4) All records, documents, testimony, or evidence obtained under this section shall remain confidential except to the extent necessary to support the administrative action taken by the department, to refer the matter to another regulatory agency, or to refer the matter to a law enforcement agency for criminal prosecution. (5) For the purposes of this section: (a) "Medical director" means a physician who provides medical direction to emergency medical service providers consistent with the rules adopted by the director or chief medical officer, as applicable, under section 25-3.5-206. (b) "Misconduct" means an activity meeting the good cause for disciplinary sanctions standard, as defined by the board. Source: L. 2005: Entire section added, p. 875, § 1, effective August 8. L. 2010: (5)(a) amended, (HB 10-1260), ch. 403, p. 1945, § 9, effective July 1. L. 2012: (1)(a), (2), and (5)(a) amended, (HB 12-1059), ch. 271, p. 1430, § 5, effective July 1. L. 2019: (1)(a) and (5)(a) amended, (SB 19-242), ch. 396, p. 3529, § 17, effective May 31; (2) and (5)(a) amended, (SB 19-052), ch. 122, p. 528, § 3, effective August 2. Editor's note: (1) Section 29 of chapter 396 (SB 19-242), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 31, 2019. (2) Section 7 of chapter 122 (SB 19-052), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after August 2, 2019. (3) Subsection (5)(a) was amended in SB 19-242. Those amendments were superseded by the amendment of subsection (5)(a) in SB 19-052, effective August 2, 2019. For amendments to subsection (5)(a) in SB 19-242 in effect from May 31, 2019, to August 2, 2019, see chapter 396, Session Laws of Colorado 2019. (L. 2019, p. 3529.) 25-3.5-206. Emergency medical practice advisory council - creation - powers and duties - emergency medical service provider scope of practice - definitions - rules. (1) There is hereby created within the department, as a type 2 entity under the direction of the director, the emergency medical practice advisory council, referred to in this part 2 as the "advisory council". The advisory council is responsible for advising the department regarding the appropriate scope of practice for emergency medical service providers certified or licensed under section 25-3.5203. (2) (a) The advisory council consists of the following eleven members: (I) Eight voting members appointed by the governor as follows: Colorado Revised Statutes 2019 Page 254 of 1101 Uncertified Printout (A) Two physicians licensed in good standing in Colorado who are actively serving as emergency medical service medical directors and are practicing in rural or frontier counties; (B) Two physicians licensed in good standing in Colorado who are actively serving as emergency medical service medical directors and are practicing in urban counties; (C) One physician licensed in good standing in Colorado who is actively serving as an emergency medical service medical director in any area of the state; (D) One emergency medical service provider certified or licensed at an advanced life support level who is actively involved in the provision of emergency medical services; (E) One emergency medical service provider certified or licensed at a basic life support level who is actively involved in the provision of emergency medical services; and (F) One emergency medical service provider certified or licensed at any level who is actively involved in the provision of emergency medical services; (II) One voting member who, as of July 1, 2010, is a member of the state emergency medical and trauma services advisory council, appointed by the executive director of the department; and (III) Two nonvoting ex officio members appointed by the executive director of the department. (b) Members of the advisory council shall serve four-year terms; except that, of the members initially appointed to the advisory council by the governor, four members shall serve three-year terms. A vacancy on the advisory council shall be filled by appointment by the appointing authority for that vacant position for the remainder of the unexpired term. Members serve at the pleasure of the appointing authority and continue in office until the member's successor is appointed. (c) Members of the advisory council shall serve without compensation but shall be reimbursed from the emergency medical services account, created in section 25-3.5-603, for their actual and necessary travel expenses incurred in the performance of their duties under this article. (d) The advisory council shall elect a chair and vice-chair from its members. (e) The advisory council shall meet at least quarterly and more frequently as necessary to fulfill its obligations. (f) The department shall provide staff support to the advisory council. (g) As used in this subsection (2), "licensed in good standing" means that the physician holds a current, valid license to practice medicine in Colorado that is not subject to any restrictions. (3) The advisory council shall provide general technical expertise on matters related to the provision of patient care by emergency medical service providers and shall advise or make recommendations to the department in the following areas: (a) The acts and medications that emergency medical service providers at each level of certification or licensure are authorized to perform or administer under the direction of a physician medical director; (b) Requests for waivers to the scope of practice rules adopted pursuant to this section and section 25-3.5-203 (1)(a.5); (c) Modifications to emergency medical service provider certification or licensure levels and capabilities; and (d) Criteria for physicians to serve as emergency medical service medical directors. Colorado Revised Statutes 2019 Page 255 of 1101 Uncertified Printout (4) (a) The director or, if the director is not a physician, the chief medical officer shall adopt rules in accordance with article 4 of title 24 concerning the scope of practice of emergency medical service providers. The rules must include the following: (I) Allowable acts for each level of emergency medical service provider certification or licensure and the medications that a certificate holder or licensee at each level of emergency medical service provider certification or licensure can administer; (II) Defining the physician medical direction required for appropriate oversight of an emergency medical service provider by an emergency medical services medical director; (III) Criteria for requests to waive the scope of practice rules in a prehospital setting and the conditions for the waivers; (IV) Minimum standards for physicians to be emergency medical services medical directors; and (V) (A) Standards for the issuance by the department of a critical care endorsement for emergency medical service providers. An emergency medical service provider with a critical care endorsement is authorized to perform the tasks and procedures specified by rule. The endorsement is valid as long as the emergency medical service provider maintains certification or licensure by the department. (B) The director or, if the director is not a physician, the chief medical officer, shall adopt rules implementing this subparagraph (V) by August 1, 2014. (a.5) (I) The director or, if the director is not a physician, the chief medical officer shall adopt rules in accordance with article 4 of title 24 concerning the scope of practice of a community paramedic. An emergency medical service provider's endorsement as a community paramedic, issued pursuant to the rules adopted under section 25-3.5-203.5, is valid for as long as the emergency medical service provider maintains the emergency medical service provider's certification or licensure by the department. (II) The rules must establish the tasks and procedures that an emergency medical service provider with a community paramedic endorsement is authorized to perform in addition to an emergency medical service provider's scope of practice, including: (A) An initial assessment of the patient and any subsequent assessments, as needed; (B) Medical interventions; (C) Care coordination; (D) Resource navigation; (E) Patient education; (F) Inventory, compliance, and administration of medications; and (G) Gathering of laboratory and diagnostic data. (b) Rules adopted pursuant to this subsection (4) supersede any rules of the Colorado medical board regarding the matters set forth in this subsection (4). (5) As used in this section: (a) "Interfacility transport" has the meaning set forth in section 25-3.5-207 (1)(c). (b) "Prehospital setting" means one of the following settings in which an emergency medical service provider performs patient care, which care is subject to medical direction by a medical director: (I) At the site of an emergency; (II) During emergency transport; or (III) During interfacility transport. Colorado Revised Statutes 2019 Page 256 of 1101 Uncertified Printout (c) "Scope of practice" has the meaning set forth in section 25-3.5-207 (1)(f). Source: L. 2010: Entire section added, (HB 10-1260), ch. 403, p. 1945, § 10, effective July 1. L. 2012: (1), IP(2)(a), (2)(a)(I)(D), (2)(a)(I)(E), (2)(a)(I)(F), IP(3), (3)(a), (3)(c), IP(4)(a), (4)(a)(I), and (4)(a)(II) amended, (HB 12-1059), ch. 271, p. 1431, § 6, effective July 1. L. 2013: IP(4)(a), (4)(a)(III), and (4)(a)(IV) amended and (4)(a)(V) added, (HB 13-1063), ch. 14, p. 37, § 1, effective March 8. L. 2016: (4)(a.5) added, (SB 16-069), ch. 260, p. 1063, § 3, effective June 8. L. 2019: (1), IP(2)(a), (2)(a)(I)(D), (2)(a)(I)(E), (2)(a)(I)(F), (3)(a), (3)(c), IP(4)(a), (4)(a)(I), (4)(a)(V)(A), and (4)(a.5)(I) amended, (SB 19-242), ch. 396, p. 3523, § 3, effective May 31; IP(4)(a), (4)(a)(III), and (4)(a.5)(I) amended and (5) added, (SB 19-052), ch. 122, p. 528, § 4, effective August 2. Editor's note: (1) Section 29 of chapter 396 (SB 19-242), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 31, 2019. (2) Section 7 of chapter 122 (SB 19-052), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after August 2, 2019. (3) Amendments to subsections IP(4)(a) and (4)(a.5)(I) by SB 19-052 and SB 19-242 were harmonized. 25-3.5-207. Ability of certified or licensed emergency medical service providers to work in clinical settings - restrictions - definitions - rules. (1) As used in this section, unless the context otherwise requires: (a) "Clinical setting" means a health facility licensed or certified by the department pursuant to section 25-1.5-103 (1)(a). (b) "In-scope tasks and procedures" means tasks and procedures performed by an emergency medical service provider within the emergency medical service provider's scope of practice. (c) "Interfacility transport" means the movement of a patient from one licensed health care facility to another licensed health care facility. (d) "Medical supervision" means the oversight, guidance, and instructions that a medical supervisor provides to an emergency medical service provider. (e) "Medical supervisor" means a Colorado-licensed physician, physician assistant, advanced practice nurse, or registered nurse. (f) "Scope of practice" means the tasks, medications, and procedures that an emergency medical service provider is authorized to perform or administer in accordance with sections 253.5-203 and 25-3.5-206 and rules promulgated pursuant to those sections. (2) In accordance with the limitations contained in this article 3.5, an emergency medical service provider may work in a clinical setting subject to the following conditions: (a) The emergency medical service provider may perform only tasks and procedures that are within the emergency medical service provider's applicable scope of practice; (b) The emergency medical service provider shall perform in-scope tasks and procedures pursuant to orders or instructions from, and under the medical supervision of, a medical supervisor; Colorado Revised Statutes 2019 Page 257 of 1101 Uncertified Printout (c) Medical supervision must be provided by a medical supervisor who is immediately available and physically present at the clinical setting where the care is being delivered to provide oversight, guidance, or instruction to the emergency medical service provider during the emergency medical service provider's performance of in-scope tasks and procedures; (d) The medical supervisor of the emergency medical service provider must be licensed in good standing; and (e) Each clinical setting at which an emergency medical service provider performs inscope tasks and procedures pursuant to this section shall, in collaboration with its medical staff, establish operating policies and procedures that ensure that emergency medical service providers perform tasks and procedures and administer medications within their scope of practice. (3) Nothing in this section alters the authority of a physician or registered nurse in a clinical setting to delegate acts, including the administration of medications, that are outside of an emergency medical service provider's scope of practice pursuant to section 12-240-107 or 12255-131, as appropriate. (4) The board may promulgate rules as necessary to implement this section. Source: L. 2019: Entire section added, (SB 19-052), ch. 122, p. 529, § 5, effective August 2. Editor's note: Section 7 of chapter 122 (SB 19-052), Session Laws of Colorado 2019, provides that the act adding this section applies to conduct occurring on or after August 2, 2019. 25-3.5-208. Emergency medical service providers' peer health assistance program fund - rules. (1) As a condition of initial certification and certification renewal, every applicant shall pay to the department, at the time of application, two dollars and fifty-five cents. This amount may be adjusted on January 1, 2021, and annually thereafter by the board to reflect: (a) Changes in the United States department of labor, bureau of labor statistics, consumer price index for Denver-Aurora-Lakewood, or its successor index; and (b) Overall utilization of the program. (2) The fee imposed pursuant to subsection (1) of this section is to support designated providers the department selects to provide assistance to emergency medical service providers needing help in dealing with physical, emotional, or psychological conditions that may be detrimental to their ability to provide emergency medical services. (3) The department shall deposit the fees collected pursuant to this section in the emergency medical services peer assistance fund, referred to in this section as the "fund", which is hereby created in the state treasury. Money in the fund is not subject to annual appropriation by the general assembly. The state treasurer shall credit all interest and income derived from the deposit and investment of money in the fund to the fund. The department may seek, accept, and expend gifts, grants, or donations from private or public sources for the purposes of this section. (4) The department shall select one or more peer health assistance programs as designated providers. To be eligible for designation by the department, a peer health assistance program must: (a) Provide for the education of emergency medical service providers with respect to the recognition and prevention of physical, emotional, and psychological conditions and provide for intervention when necessary or under circumstances that the department may establish by rule; Colorado Revised Statutes 2019 Page 258 of 1101 Uncertified Printout (b) Offer assistance to an emergency medical service provider in identifying physical, emotional, or psychological conditions; (c) Evaluate the extent of physical, emotional, or psychological conditions and refer the emergency medical service provider for appropriate treatment; (d) Monitor the status of an emergency medical service provider who has been referred for treatment; (e) Provide counseling and support for the emergency medical service provider and for the family of any emergency medical service provider referred for treatment; (f) Agree to receive referrals from the department; and (g) Agree to make services available to all certified emergency medical service providers. (5) The department may select an entity to administer the emergency medical service providers peer health assistance program. The administering entity must be a nonprofit private foundation that is qualified under section 501 (c)(3) of the federal "Internal Revenue Code of 1986", as amended, and is dedicated to providing support for charitable, benevolent, educational, and scientific purposes that are related to medicine, medical education, medical research and science, and other medical charitable purposes. (6) The administering entity shall: (a) Distribute the money collected from the department, less expenses, to an approved designated provider, as directed by the department; (b) Provide an annual accounting to the department of all amounts collected, expenses incurred, and amounts disbursed; and (c) Post a surety performance bond in an amount specified by the department to secure performance under the requirements of this section. The administering entity may recover the actual administrative costs incurred in performing its duties under this section in an amount not to exceed ten percent of the total amount collected. (7) (a) Any certificate holder who does not have access to an employee assistance program may apply to the department for participation in a qualified peer health assistance program. In order to be eligible for participation, a certificate holder shall: (I) Acknowledge the existence or the potential existence of a physical, psychological, or emotional condition; excessive alcohol or drug use; or an alcohol use disorder, as defined in section 27-81-102 (1); or a substance use disorder, as defined in section 27-82-102 (13.5); (II) After a full explanation of the operation and requirements of the peer health assistance program, agree to voluntarily participate in the program and agree in writing to participate in the program of the peer health assistance organization designated by the department. (b) (I) Any certificate holder may self-refer to the qualified peer health assistance program selected by the department. If a certificate holder who self-refers in accordance with this subsection (7)(b) has access to an employee assistance program, the certificate holder shall cover the cost of the program. (II) A certificate holder who self-refers and is accepted into a qualified peer health assistance program shall affirm that, to the best of their knowledge, information, and belief, they know of no instance in which they have violated this article 3.5 or the rules of the board, except in instances affected by the certificate holder's physical, psychological, or emotional condition. Colorado Revised Statutes 2019 Page 259 of 1101 Uncertified Printout (8) All documents, records, or reports generated in the provision of services to a certificate holder who is attending a qualified peer health assistance program are confidential and not subject to subpoena and shall not be used as evidence in any proceeding other than disciplinary action by the department. The documents, records, and reports are not public records for purposes of section 24-72-203. (9) Notwithstanding the provisions of this section, the department may summarily suspend the certification of any certificate holder who is referred to a peer health assistance program by the department and who fails to attend or to complete the program. If a certificate holder objects to the suspension, the certificate holder may submit a written request to the department for the formal hearing on the suspension within two days after receiving notice of the suspension and the department shall grant the request. In the hearing, the certificate holder shall have the burden of proving that the certificate holder's certification should not be suspended. The hearing shall be conducted in accordance with section 24-4-105. (10) Nothing in this section creates any liability on the department or the state of Colorado for the actions of the department in making grants to peer assistance programs, and no civil action may be brought or maintained against the department or the state for an injury alleged to have been the result of the activities of any state-funded peer assistance program or the result of an act or omission of an emergency medical service provider participating in or referred by a state-funded peer assistance program. However, the state remains liable under the "Colorado Governmental Immunity Act", article 10 of title 24, if an injury alleged to have been the result of an act or omission of an emergency medical service provider participating in or referred by a state-funded peer assistance program occurred while the emergency medical service provider was performing duties as an employee of the state. (11) The department may promulgate rules necessary to implement this section. Source: L. 2019: Entire section added, (SB 19-065), ch. 174, p. 2008, § 1, effective August 2. PART 3 TRANSPORTATION SUBSYSTEM 25-3.5-301. License required - exceptions. (1) After January 1, 1978, no person shall provide ambulance service publicly or privately in this state unless that person holds a valid license to do so issued by the board of county commissioners of the county in which the ambulance service is based, except as provided in subsection (5) of this section. Licenses, permits, and renewals thereof, issued under this part 3, shall require the payment of fees in amounts to be determined by the board to reflect the direct and indirect costs incurred by the department in implementing such licensure, but the board may waive payment of such fees for ambulance services operated by municipalities or special districts. (2) (a) (I) Each ambulance operated by an ambulance service shall be issued a permit and, in order to be approved, shall bear evidence that its equipment meets or is equivalent to the minimum requirements set forth in the minimum equipment list established by the council and approved by the state board of health. The board of county commissioners of any county may impose by resolution additional requirements for ambulances based in such county. Colorado Revised Statutes 2019 Page 260 of 1101 Uncertified Printout (II) Repealed. (a.1) Repealed. (b) The council shall make available to the board of county commissioners guidelines for ambulance design criteria for use in developing standards for vehicle replacement. (3) No patient shall be transported in an ambulance in this state after January 1, 1978, unless there are two or more individuals, including the driver, present and authorized to operate said ambulance except under unusual conditions when only one authorized person is available. (4) (Deleted by amendment, L. 2002, p. 696, § 1, effective May 29, 2002.) (5) The provisions of subsections (1) to (3) of this section shall not apply to the following: (a) The exceptional emergency use of a privately or publicly owned vehicle, including search and rescue unit vehicles, or aircraft not ordinarily used in the formal act of transporting patients; (b) A vehicle rendering services as an ambulance in case of a major catastrophe or emergency when ambulances with permits based in the localities of the catastrophe or emergency are insufficient to render the services required; (c) Ambulances based outside this state which are transporting a patient in Colorado; (d) Vehicles used or designed for the scheduled transportation of convalescent patients, individuals with disabilities, or persons who would not be expected to require skilled treatment or care while in the vehicle; (e) Vehicles used solely for the transportation of intoxicated persons or persons incapacitated by alcohol as defined in section 27-81-102, C.R.S., but who are not otherwise disabled or seriously injured and who would not be expected to require skilled treatment or care while in the vehicle. Source: L. 77: Entire article added, p. 1282, § 2, effective January 1, 1978. L. 81: (2)(a) amended, p. 1944, § 4, effective July 1; (2)(a.1) added, p. 1951, § 18, effective July 1, 1984. L. 84: (2)(a)(I) amended, p. 1125, § 45, effective July 1; (2)(a)(II) and (2)(a.1) repealed, p. 1080, § 1, effective July 1; (2)(a.1)(I) amended, p. 765, § 6, effective July 1. L. 93: (5)(d) amended, p. 1664, § 73, effective July 1. L. 2002: (1) and (4) amended, p. 696, § 1, effective May 29. L. 2010: (5)(e) amended, (SB 10-175), ch. 188, p. 799, § 62, effective April 29. 25-3.5-302. Issuance of licenses and permits - term - requirements. (1) (a) After receipt of an original application for a license to provide ambulance service, the board of county commissioners shall review the application and the applicant's record and provide for the inspection of equipment to determine compliance with the provisions of this part 3. (b) The board of county commissioners shall issue a license to the applicant to provide ambulance service and a permit for each ambulance used, both of which shall be valid for twelve months following the date of issue, upon a finding that the applicant's staff, vehicle, and equipment comply with the provisions of this part 3 and any other requirement established by said board. (2) Any such license or permit, unless revoked by the board of county commissioners, may be renewed by filing an application as in the case of an original application for such license or permit. Applications for renewal shall be filed annually but not less than thirty days before the date the license or permit expires. Colorado Revised Statutes 2019 Page 261 of 1101 Uncertified Printout (3) No license or permit issued pursuant to this section shall be sold, assigned, or otherwise transferred. Source: L. 77: Entire article added, p. 1283, § 2, effective January 1, 1978. 25-3.5-303. Vehicular liability insurance required. No ambulance shall operate in this state unless it is covered by a complying policy as defined in section 10-4-601 (2), C.R.S. Source: L. 77: Entire article added, p. 1283, § 2, effective January 1, 1978. L. 2006: Entire section amended, p. 1504, § 45, effective June 1. 25-3.5-304. Suspension - revocation - hearings. (1) Upon a determination by the board of county commissioners that any person has violated or failed to comply with any provisions of this part 3, the board may temporarily suspend, for a period not to exceed thirty days, any license or permit issued pursuant to this part 3. The licensee shall receive written notice of such temporary suspension, and a hearing shall be held no later than ten days after such temporary suspension. After such hearing, the board may suspend any license or permit, issued pursuant to this part 3, for any portion of or for the remainder of its life. At the end of such period, the person whose license or permit was suspended may apply for a new license or permit as in the case of an original application. (2) Upon a second violation or failure to comply with any provision of this part 3 by any licensee, the board of county commissioners may permanently revoke such license or permit. Source: L. 77: Entire article added, p. 1283, § 2, effective January 1, 1978. 25-3.5-305. Alleged negligence. (1) In any legal action filed against a person who has been issued a license pursuant to this part 3 in which it is alleged that the plaintiff's injury, illness, or incapacity was exacerbated or that he was otherwise injured by the negligence of the licensee, an act of negligence shall not be presumed based on the fact of the allegation. (2) In the event a judgment is entered against any such licensee, he shall, within thirty days thereof, file a copy of the findings of fact, conclusions of law, and order in such case with the clerk and recorder of the county issuing the license. Said board shall take note of such judgment for purposes of investigation and appropriate action if a violation of this part 3 is present. Any and all complaints received directly by said board shall be subject to review. Source: L. 77: Entire article added, p. 1283, § 2, effective January 1, 1978. 25-3.5-306. Violation - penalty. Any person who violates any provision of this part 3 commits a class 3 misdemeanor and shall be punished as provided in section 18-1.3-501, C.R.S. Source: L. 77: Entire article added, p. 1284, § 2, effective January 1, 1978. L. 2002: Entire section amended, p. 1536, § 264, effective October 1. 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. Colorado Revised Statutes 2019 Page 262 of 1101 Uncertified Printout 25-3.5-307. Licensure of fixed-wing and rotor-wing air ambulances - cash fund created - rules. (1) (a) Except as provided in paragraph (b) of this subsection (1), prior to beginning air ambulance operations in this state, an air ambulance service must be licensed by the department. Except as otherwise provided in paragraph (d) of this subsection (1), compliance with rules promulgated by the board or successful completion of an accreditation process through an accrediting organization approved by the department as having standards equivalent to or exceeding the standards established in rules of the board is required for full licensure and renewal of such license by the department for an air ambulance service. (b) (I) Upon a showing of exigent circumstances, as defined by the board, the department may authorize an unlicensed air ambulance service to provide a particular transport. (II) The department may recognize the license issued by another jurisdiction for an air ambulance service that makes a limited number of flights per calendar year into or out of Colorado, and the department shall impose an annual fee upon an air ambulance service whose license is so recognized. The department may rescind such recognition, without refunding or prorating the fee, if rescission is necessary to protect public health and safety. (b.5) The board shall allow the department to grant a waiver of a rule adopted by the board if the applicant for the waiver satisfactorily demonstrates: (I) (A) The waiver will not adversely affect the health and safety of patients; and (B) In the particular situation, the requirement serves no beneficial public purpose; or (II) Circumstances indicate that the public benefit of waiving the requirement outweighs the public benefit to be gained by strictly adhering to the requirement. (c) In addition to its rule-making authority granted under section 25-3.5-307.5, the board shall promulgate rules specifying minimum licensure requirements and standards for air ambulance services necessary to ensure public health and safety, including governing the issuance of initial and renewal licenses, conditional licenses, provisional licenses, and other necessary licenses; establishing reasonable fees for licensure and for on-site inspections, investigations, changes of ownership, and other activities related to licensure; defining exigent circumstances for purposes of the exception in subparagraph (I) of paragraph (b) of this subsection (1); and specifying the procedure and grounds for the suspension, revocation, or denial of a license. The rules must include the process used to investigate complaints against an air ambulance service and procedures for data collection and reporting to the department by an air ambulance service; except that complaints that are related to the requirements of an accrediting organization approved by the department in accordance with paragraph (a) of this subsection (1) may be referred to the organization for investigation if the department determines that referral is appropriate. The department shall consider the results of such investigations in making licensure decisions concerning air ambulance services. (d) The department may issue a provisional license to an applicant for an initial license to operate an air ambulance service if the applicant is temporarily unable to conform to all the minimum standards required under this article and rules of the board; except that a license shall not be issued to an applicant if the operation of the applicant's air ambulance service will adversely affect patient care or the health, safety, and welfare of the public. As a condition of obtaining a provisional license, the applicant must demonstrate to the department that the applicant is making its best efforts to achieve compliance with applicable standards. The department may issue the applicant a second provisional license for the same duration and shall Colorado Revised Statutes 2019 Page 263 of 1101 Uncertified Printout charge the same fee as for the first provisional license, but the department shall not issue a third or subsequent provisional license to the applicant. (2) (a) The board shall establish the amount of the licensure fee to reflect the direct and indirect costs incurred by the department in implementing such licensure. The department shall transmit all fees collected pursuant to this section to the state treasurer who shall credit the same to the fixed-wing and rotary-wing ambulances cash fund, which fund is hereby created in the state treasury. (b) Any interest derived from the deposit and investment of moneys in the fixed-wing and rotary-wing ambulances cash fund shall be credited to such fund. Any unexpended or unencumbered moneys remaining in such fund at the end of any fiscal year shall remain in the fund and shall not revert or be transferred to the general fund or any other fund of the state. Moneys in such fund shall be subject to annual appropriation by the general assembly to the department for the costs incurred by the department in implementing this section. Source: L. 2002: Entire section added, p. 697, § 2, effective May 29. L. 2005: (1) amended, p. 1331, § 2, effective July 1. L. 2007: (1) amended, p. 380, § 1, effective April 2. L. 2016: (1) amended, (HB 16-1280), ch. 206, p. 737, § 3, effective June 1. 25-3.5-307.5. Standards for air ambulance services - rules - civil penalties disciplinary actions. (1) The board shall promulgate rules in accordance with section 24-4-103, C.R.S., to establish minimum standards for an air ambulance service. The rules must include minimum requirements or standards for: (a) Approval of an accrediting organization; (b) Recognizing another jurisdiction's license, including a restriction on the number of allowable flights per year in Colorado under that license, a fee for such recognition, and a process to rescind the recognition upon a showing of good cause; (c) Malpractice and liability insurance for injuries to persons, in amounts determined by the board, and workers' compensation coverage as required by Colorado law; (d) Medical crew qualifications and training; (e) Qualifications, training, and roles and responsibilities for a medical director for an air ambulance service; (f) Communication equipment, reporting capabilities, patient safety, and crew safety and staffing; (g) Medical equipment in an air ambulance; (h) Data collection and submission, including reporting requirements as determined by the department; (i) Maintaining program quality; and (j) Management of patient and medical staff safety with regard to clinical staffing and shift time. (2) Rules promulgated by the board must not include activities preempted by the federal aviation administration or 49 U.S.C. sec. 41713. (3) Civil penalties. An air ambulance operator, service, or provider or other person who violates this section, section 25-3.5-307, or a rule of the board promulgated pursuant to this part 3 or who operates without a current and valid license is subject to a civil penalty of up to five thousand dollars per violation or for each day of a continuing violation. The department shall Colorado Revised Statutes 2019 Page 264 of 1101 Uncertified Printout assess and collect these penalties. Before collecting a penalty, the department shall provide the alleged violator with notice and the opportunity for a hearing in accordance with the "State Administrative Procedure Act", article 4 of title 24, C.R.S., and all applicable rules of the board. The department shall transmit all penalties collected pursuant to this section to the state treasurer, who shall credit them to the general fund. (4) Disciplinary actions. For violation of any provision of this section, section 25-3.5307, or a rule of the board promulgated pursuant to this part 3 or for operating without a license, the department may take any one or more of the following actions: (a) Deny, suspend, or revoke a license issued pursuant to this part 3; (b) Impose a civil penalty as provided in subsection (3) of this section; (c) Issue a cease-and-desist order if the department has determined that a violation has occurred and immediate enforcement is deemed necessary. The cease-and-desist order must set forth the provisions alleged to have been violated, the facts alleged to have constituted the violation, and the requirement that all violations cease forthwith. (d) Summarily suspend a license issued pursuant to this part 3 in accordance with article 4 of title 24, C.R.S. (5) Repealed. Source: L. 2016: Entire section added, (HB 16-1280), ch. 206, p. 738, § 4, effective June 1. L. 2017: (2) amended, (SB 17-294), ch. 264, p. 1406, § 81, effective May 25. Editor's note: Subsection (5)(b) provided for the repeal of subsection (5), effective July 1, 2018. (See L. 2016, p. 738.) 25-3.5-308. Rules. (1) The board shall adopt rules establishing the minimum requirements for ground ambulance service licensing, including but not limited to: (a) Minimum equipment to be carried on an ambulance pursuant to section 25-3.5-104; (b) Staffing requirements for ambulances as required in section 25-3.5-104; (c) Medical oversight and quality improvement of ambulance services pursuant to section 25-3.5-704 (2)(h); (d) The process used to investigate complaints against an ambulance service; and (e) Data collection and reporting to the department by an ambulance service. Source: L. 2002: Entire section added, p. 697, § 2, effective May 29. L. 2005: IP(1) amended, p. 1331, § 3, effective July 1. PART 4 TELECOMMUNICATIONS SUBSYSTEM 25-3.5-401. Responsibility for coordination. (1) The telecommunications subsystem shall be used to maintain effective interface with the other components of the system, which shall include but not be limited to the following: (a) To dispatch the ambulance; (b) To maintain contact while en route to the scene of the emergency; Colorado Revised Statutes 2019 Page 265 of 1101 Uncertified Printout (c) To provide for triage at the scene of the emergency; (d) To provide for treatment while en route to the primary emergency care center; (e) To arrange for transfer to advanced emergency care centers. (2) (a) The department of personnel, in consultation with the office of information technology created in the office of the governor, shall coordinate the telecommunications subsystem with the existing state telecommunications network to the extent possible. (b) Repealed. Source: L. 77: Entire article added, p. 1284, § 2, effective January 1, 1978. L. 81: IP(1) amended, p. 2028, § 29, effective June 7; (2)(b) repealed, p. 2028, § 31, effective July 14. L. 83: (2)(a) amended, p. 889, § 5, effective July 1. L. 84: IP(1) amended, p. 1121, § 26, effective June 7. L. 95: (2)(a) amended, p. 663, § 96, effective July 1. L. 2001: (2)(a) amended, p. 125, § 6, effective March 23. L. 2006: (2)(a) amended, p. 1736, § 25, effective June 6. Cross references: (1) For provisions concerning telecommunications coordination within state government, see part 5 of article 37.5 of title 24; for the state telecommunications network, see § 24-33.5-223. (2) For the legislative declaration contained in the 1995 act amending subsection (2)(a), see section 112 of chapter 167, Session Laws of Colorado 1995. 25-3.5-402. Local government participation. The department of personnel shall consult with local government entities to ensure that provision is made for their entry into the statewide telecommunications subsystem and that their present resources are being fully utilized. Source: L. 77: Entire article added, p. 1284, § 2, effective January 1, 1978. L. 83: Entire section amended, p. 889, § 6, effective July 1. L. 96: Entire section amended, p. 1541, § 129, effective June 1. 25-3.5-403. Poison information center - state funding. (Repealed) Source: L. 83: Entire section added, p. 1056, § 3, effective July 1. L. 94: Entire section amended, p. 1665, § 2, effective July 1. Editor's note: Subsection (3) provided for the repeal of this section, effective July 1, 1995. (See L. 94, p. 1665.) PART 5 DOCUMENTATION SUBSYSTEM 25-3.5-501. Records - ambulance services to report - access to patient information. (1) Each ambulance service shall prepare and transmit copies of uniform and standardized records, as specified by regulation adopted by the department, concerning the transportation and treatment of patients in order to evaluate the performance of the emergency medical services system and to plan systematically for improvements in said system at all levels. Colorado Revised Statutes 2019 Page 266 of 1101 Uncertified Printout (2) The record forms adopted by the department may distinguish between rural ambulance service and urban ambulance service and between mobile intensive care units and basic ambulance service. (3) The department shall make individualized patient information from its EMS agency patient care database available to health information organization networks for uses allowed under the federal "Health Insurance Portability and Accountability Act of 1996", as amended, Pub.L. 104-191. The department shall contract with health information organization networks regarding accessing patient information and limiting the use of information to purposes allowed under the "Health Insurance Portability and Accountability Act of 1996", as amended. Source: L. 77: Entire article added, p. 1284, § 2, effective January 1, 1978. L. 78: Entire section amended, p. 270, § 84, effective May 23. L. 2018: (3) added, (HB 18-1032), ch. 63, p. 612, § 2, effective August 8. 25-3.5-502. Forms and reports. The department shall provide the necessary forms and copies of quarterly statistical report forms for local and state evaluation of ambulance service unless specifically exempted by the board of county commissioners of a particular county for that county. Source: L. 77: Entire article added, p. 1285, § 2, effective January 1, 1978. L. 78: Entire section amended, p. 271, § 85, effective May 23. PART 6 LOCAL EMERGENCY MEDICAL SERVICES 25-3.5-601. Legislative declaration. (1) The general assembly recognizes that an efficient and reliable statewide emergency medical and trauma network would serve not only to promote the health, safety, and welfare of Colorado residents, but would also, by increasing safety throughout the state, indirectly serve to facilitate tourism and economic development in the state. (2) The general assembly also finds that accident victims are often transported over state highways and that an improved response to accidents through an efficient and reliable statewide emergency medical and trauma network impacts both directly and indirectly on the maintenance and supervision of the public highways of this state. (3) Therefore, it is the purpose of this part 6 to enhance emergency medical and trauma services statewide by financially assisting local emergency medical and trauma service providers who operate or wish to operate in the counties in their efforts to improve the quality and effectiveness of local emergency medical and trauma services, including emergency medical and trauma equipment and communications, and by supporting the overall coordination of such efforts by the department. Source: L. 89: Entire part added, p. 1148, § 2, effective July 1. L. 94: (3) amended, p. 2758, § 421, effective July 1. L. 2000: Entire section amended, p. 532, § 10, effective July 1. Colorado Revised Statutes 2019 Page 267 of 1101 Uncertified Printout Cross references: For the legislative declaration contained in the 1994 act amending subsection (3), see section 1 of chapter 345, Session Laws of Colorado 1994. 25-3.5-602. Definitions. As used in this part 6, unless the context otherwise requires: (1) "Council" means the state emergency medical and trauma services advisory council created in section 25-3.5-104. (2) "Department" means the department of public health and environment. (3) "EMTS" means emergency medical and trauma services. (4) "Local emergency medical and trauma service providers" includes, but is not limited to, local governing boards, training centers, hospitals, special districts, and other private and public service providers that have as their purpose the provision of emergency medical and trauma services. Source: L. 89: Entire part added, p. 1149, § 2, effective July 1. L. 94: (2) amended, p. 2758, § 422, effective July 1. L. 2000: (1), (3), and (4) amended, p. 532, § 11, effective July 1. Cross references: For the legislative declaration contained in the 1994 act amending subsection (2), see section 1 of chapter 345, Session Laws of Colorado 1994. 25-3.5-603. Emergency medical services account - creation - allocation of funds. (1) (a) There is hereby created a special account within the highway users tax fund established under section 43-4-201, to be known as the emergency medical services account, which consists of all money transferred into the account in accordance with section 42-3-304 (21), fees collected under section 25-3.5-203 for provisional certifications or licenses of emergency medical service providers, and fees collected under section 25-3.5-1103 for provisional registration of emergency medical responders. (b) All moneys in and state FTE funded by the emergency medical services account shall be subject to annual appropriation by the general assembly. (c) At the end of any fiscal year, all unexpended and unencumbered moneys in the emergency medical services account shall remain therein and shall not be credited or transferred to the general fund or any other fund. Any interest earned on the investment or deposit of moneys in the account shall also remain in the account and shall not be credited to the general fund. (2) (Deleted by amendment, L. 2005, p. 280, § 13, effective August 8, 2005.) (3) The general assembly shall appropriate money in the emergency medical services account: (a) (I) To the department for distribution as grants to local emergency medical and trauma service providers pursuant to the emergency medical and trauma services (EMTS) grant program set forth in section 25-3.5-604. (II) Of the amount appropriated under subparagraph (I) of this paragraph (a) for grants: (A) One hundred thousand dollars shall remain in the account for unexpected emergencies that arise after the deadline for grant applications has passed. The department and the council shall promulgate any rules necessary to define the expenditures of such emergency funds. Colorado Revised Statutes 2019 Page 268 of 1101 Uncertified Printout (B) The department shall award a minimum of one hundred fifty thousand dollars to offset the training costs of emergency medical service providers, emergency medical dispatchers, emergency medical services instructors, emergency medical services coordinators, and other personnel who provide emergency medical services. Of said one hundred fifty thousand dollars, no less than eighty percent shall be used in the training of emergency medical service providers. (b) (I) To the department for distribution for each Colorado county within a RETAC no less than fifteen thousand dollars and seventy-five thousand dollars to each RETAC, in accordance with section 25-3.5-605 for planning and, to the extent possible, coordination of emergency medical and trauma services in the county and between counties when such coordination would provide for better service geographically. In the event that a RETAC is composed of less than five counties as of July 1, 2002, the council shall recommend that for each Colorado county within such RETAC, the RETAC shall receive fifteen thousand dollars in accordance with section 25-3.5-605 for planning and, to the extent possible, coordination of emergency medical and trauma services in the county and between counties when such coordination would provide for better service geographically. Any RETAC may apply for additional moneys and may receive such moneys if the request is approved by the council, so long as the moneys are used in accordance with section 25-3.5-605 for planning and, to the extent possible, coordination of emergency medical and trauma services in the county and between counties when such coordination would provide for better service geographically. (II) A county may request to the council that the county's representative fifteen thousand dollars be divided between two different RETACs pursuant to section 25-3.5-704 (2)(c)(IV)(B). (c) To the direct and indirect costs of planning, developing, implementing, maintaining, and improving the statewide emergency medical and trauma services system. These costs include: (I) Providing technical assistance and support to local governments, local emergency medical and trauma service providers, and RETACs operating a statewide data collection system, coordinating local and state programs, providing assistance in selection and purchasing of medical and communication equipment, administering the EMTS grant program, establishing and maintaining scope of practice for certified or licensed emergency medical service providers, and administering a registration program for emergency medical responders; and (II) The costs of the department of revenue in collecting the additional motor vehicle registration fee pursuant to section 42-3-304 (21), C.R.S. Source: L. 89: Entire part added, p. 1149, § 2, effective July 1. L. 92: Entire section amended, p. 1143, § 2, effective May 29. L. 94: (1)(a) and (2)(c)(III) amended, p. 2559, § 61, effective January 1, 1995. L. 2000: IP(2), (2)(a)(I), (2)(a)(II)(A), (2)(b), IP(2)(c), (2)(c)(I), and (2)(c)(II) amended and (3) added, p. 533, § 12, effective July 1. L. 2005: (1)(a) and (3)(c)(II) amended, p. 1183, § 33, effective August 8; (1)(b) and (2) amended, p. 280, § 13, effective August 8. L. 2009: (1)(a) amended, (HB 09-1275), ch. 278, p. 1245, § 2, effective May 19. L. 2010: (3)(c)(I) amended, (HB 10-1260), ch. 403, p. 1947, § 11, effective July 1. L. 2012: (1)(a), IP(3), IP(3)(a)(II), (3)(a)(II)(B), IP(3)(c), and (3)(c)(I) amended, (HB 12-1059), ch. 271, p. 1437, § 21, effective July 1. L. 2016: (1)(a) and (3)(c)(I) amended, (HB 16-1034), ch. 324, p. 1310, § 2, effective August 10. L. 2019: (1)(a), IP(3), and (3)(c)(I) amended, (SB 19-242), ch. 396, p. 3529, § 18, effective May 31. Colorado Revised Statutes 2019 Page 269 of 1101 Uncertified Printout Editor's note: (1) Subsection (3) was originally enacted as subsection (2.5) in Senate Bill 00-180 but was renumbered on revision for ease of location. (2) Section 29 of chapter 396 (SB 19-242), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 31, 2019. 25-3.5-604. EMTS grant program - EMS account - role of council and department rules - awards. (1) (a) The council shall make recommendations to the department concerning the application for and distribution of moneys from the EMS account for the development, maintenance, and improvement of emergency medical and trauma services in Colorado and for the establishment of priorities for emergency medical and trauma services grants. (b) Any rules that relate to the distribution of grants shall provide that awards shall be made on the basis of a substantiated need and that priority shall be given to those applicants that have underdeveloped or aged emergency medical and trauma services equipment or systems. (c) The department, upon recommendations from the council, shall allocate moneys pursuant to section 25-3.5-603. (2) (a) Applications for grants shall be made to the department commencing January, 2001, and each January thereafter, except as otherwise provided in section 25-3.5-603 (3). (b) The department shall review each application and make awards in accordance with the rules promulgated pursuant to subsection (1) of this section. (c) Grants awarded under this section shall require local matching funds, unless such requirement is waived by the council upon demonstration that local sources of matching funds are not available. (3) Grants shall be awarded July 1 of each year. (4) The council shall review the adequacy of funding for each RETAC for the period beginning July 1, 2002. The review shall be completed by December 31, 2005. The council may recommend any necessary changes to the department as a result of the review conducted pursuant to this subsection (4). Source: L. 89: Entire part added, p. 1150, § 2, effective July 1. L. 92: Entire section amended, p. 1145, § 3, effective May 29. L. 2000: (1), (2)(a), and (2)(b) amended and (4) added, p. 535, § 13, effective July 1. Editor's note: "EMS account" referenced in subsection (1) refers to the "emergency medical services account" created in § 25-3.5-603. 25-3.5-605. Improvement of county emergency medical and trauma services eligibility for county funding - manner of distributing funds. (1) Moneys in the emergency medical services account shall be apportioned pursuant to subsection (2.5) of this section. (2) In order to qualify for money under this section, a county must: (a) Comply with all provisions of part 3 of this article regarding the inspection and licensing of ambulances that are based in the county; (b) Require all licensed ambulance services to utilize the statewide emergency medical and trauma services uniform prehospital care reporting system operated by the department; (c) Repealed. Colorado Revised Statutes 2019 Page 270 of 1101 Uncertified Printout (d) Ensure that all money received under this section is expended on developing and updating the emergency medical and trauma services plan and other emergency medical and trauma services needs of the county such as: (I) Training and certification or licensure of emergency medical service providers; (II) Assisting local emergency medical and trauma providers in applying for grants under section 25-3.5-604; (III) Improving the emergency medical and trauma services system on a county wide or regional basis and implementing the county emergency medical and trauma services plan; (e) Repealed. (2.5) (a) On or before October 1, 2003, and on or before October 1 each year thereafter, each RETAC shall submit to the council an annual financial report that details the expenditure of moneys received. Such report shall be in a format specified by the council and the department. In instances where the council finds such report inadequate, the RETAC shall resubmit the report to the council by December 1 of the same year. (b) On or before July 1, 2003, and on or before July 1 each odd-numbered year thereafter, each RETAC shall submit to the council a biennial plan that details the RETAC's EMTS plan and any revisions pursuant to section 25-3.5-704 (2)(c)(I)(B). If the RETAC includes a county that has been divided geographically pursuant to section 25-3.5-704 (2)(c)(IV), the plan shall include an evaluation of such division. Such plan shall be in a format specified by the council and the department. In instances where the council finds such plan inadequate, the RETAC shall resubmit the plan to the council by September 14 of the same year. (c) On or before October 15, 2003, and on or before October 15 each odd-numbered year thereafter, the council shall submit to the department a plan for all RETACs in the state. On or before November 1, 2003, and on or before November 1 each odd-numbered year thereafter, the department, in consultation with the council, shall approve a plan for all RETACs in the state. (3) Funds distributed to counties and RETACs pursuant to this section shall be used in planning the improvement of existing county emergency medical and trauma service programs and shall not be used to supplant moneys already allocated by the county for emergency medical and trauma services. (4) (a) Failure to comply with the requirements of subsection (2) of this section shall render a county ineligible to receive moneys from the emergency medical services account until the following January. (b) At the end of any fiscal year, moneys which are not distributed to a county shall remain in the emergency medical services account until the following January. Source: L. 89: Entire part added, p. 1151, § 2, effective July 1. L. 92: Entire section amended, p. 1145, § 4, effective May 29. L. 2002: (1), (2), and (3) amended and (2.5) added, p. 697, § 3, effective May 29. L. 2005: (1) amended, p. 281, § 14, effective August 8. L. 2012: IP(2), IP(2)(d), and (2)(d)(1) amended, (HB 12-1059), ch. 271, p. 1438, § 22, effective July 1. L. 2019: IP(2), IP(2)(d), and (2)(d)(I) amended, (SB 19-242), ch. 396, p. 3530, § 19, effective May 31. Editor's note: (1) Subsection (2)(c)(II) provided for the repeal of subsection (2)(c) and subsection (2)(e)(II) provided for the repeal of subsection (2)(e), effective October 1, 2002. (See L. 2002, p. 697.) Colorado Revised Statutes 2019 Page 271 of 1101 Uncertified Printout (2) Section 29 of chapter 396 (SB 19-242), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 31, 2019. 25-3.5-606. Annual report. No later than January 1, 1991, and prior to November 1 of each year thereafter, the department, in cooperation with the council, shall submit a report to the health, environment, welfare, and institutions committees and the joint budget committee of the general assembly on the moneys credited to the emergency medical services account and on the expenditure of such moneys during the preceding fiscal year. Such report shall contain a listing of the grant recipients, proposed projects, and a statement of the short-term and long-term planning goals of the department and the council to further implement the provisions of this part 6. Source: L. 89: Entire part added, p. 1152, § 2, effective July 1. L. 92: Entire section amended, p. § 1147, § 5, effective May 29. L. 2000: Entire section amended, p. 537, § 15, effective July 1; entire section amended, p. 461, § 3, effective August 2. Editor's note: Amendments to this section by Senate Bill 00-180 and House Bill 001297 were harmonized. 25-3.5-607. Repeal of part. (Repealed) Source: L. 89: Entire part added, p. 1152, § 2, effective July 1. L. 92: Entire section amended, p. 1147, § 6, effective May 29. L. 96: Entire section repealed, p. 170, § 1, effective April 8. PART 7 STATEWIDE TRAUMA SYSTEM Editor's note: This part 7 was repealed and reenacted in 1994 and was subsequently repealed and reenacted in 1995, resulting in the addition, relocation, and elimination of sections as well as subject matter. For amendments to this part 7 prior to 1995, 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. 25-3.5-701. Short title. This part 7 shall be known and may be cited as the "Statewide Trauma Care System Act". Source: L. 95: Entire part R&RE, p. 1351, § 3, effective July 1. 25-3.5-702. Legislative declaration. (1) The general assembly hereby finds and declares that trauma is the greatest single cause of death and disability in Colorado for persons under the age of forty-five years and that trauma care is a unique type of emergency medical service. Colorado Revised Statutes 2019 Page 272 of 1101 Uncertified Printout (2) The general assembly further finds that a trauma system task force made up of various emergency health and trauma care entities submitted a report to the general assembly in 1993 indicating a compelling need to develop and implement a statewide trauma care system in order to assure that appropriate resources are available to trauma victims from the point of injury through rehabilitative care. In addition, a statewide system is essential to provide Colorado residents and visitors with a greater probability of surviving a life-threatening injury and to reduce trauma-related morbidity and mortality in this state. (3) The general assembly, therefore, declares that it is necessary to enact legislation directing the board of health to adopt rules that govern the implementation and oversight of the trauma care system. The general assembly further declares that to ensure the availability and coordination of resources necessary to provide essential care, it is necessary to enact legislation that directs the department of public health and environment to collaborate with existing agencies and organizations, including governing bodies for counties and cities and counties, in implementing and monitoring a statewide trauma care system. Source: L. 95: Entire part R&RE, p. 1351, § 3, effective July 1. 25-3.5-703. Definitions. As used in this article, unless the context otherwise requires: (1) (Deleted by amendment, L. 2000, p. 537, § 16, effective July 1, 2000.) (2) "Board" means the state board of health. (3) Repealed. (3.5) "Council" means the state emergency medical and trauma services advisory council created by section 25-3.5-104. (4) "Designation" means the process undertaken by the department to assign a status to a health care facility based on the level of trauma services the facility is capable of and committed to providing to injured persons. Facilities may be designated at one of the following levels: (a) Nondesignated, which is for facilities that do not meet the criteria required for level I to V facilities, but that receive and are accountable for injured persons, which accountability includes having a transfer agreement to transfer persons to level I to V facilities as determined by rules promulgated by the board; (a.5) Level V, which is for basic trauma care in rural areas, including resuscitation, stabilization, and arrangement for the transfer of all patients with potentially life- or limbthreatening injuries, consistent with triage and transport protocols as recommended by the council and adopted by the board. Level V facilities shall transfer patients within their own region or to a higher level facility in another region, as described in paragraphs (c), (d), and (e) of this subsection (4). (b) Level IV, which is for basic trauma care, including resuscitation, stabilization, and arrangement for appropriate transfer of persons requiring a higher level of care based upon patient criticality and triage practices within each facility, which are consistent with triage criteria and transport protocols as recommended by the council and adopted by the board. These facilities must transfer appropriate patients to a higher level facility within their own region or to a higher level facility in another region, as described in paragraphs (d) and (e) of this subsection (4). (c) Level III, which is for general trauma care, including resuscitation, stabilization, and assessment of injured persons, and either the provision of care for the injured person or Colorado Revised Statutes 2019 Page 273 of 1101 Uncertified Printout arrangement for appropriate transfer based upon patient criticality and triage practices within each facility, which are consistent with triage criteria and transport protocols as recommended by the council and adopted by the board. The facilities must transfer appropriate patients to a higher level facility within its own region or to a higher level facility in another region, as described in paragraphs (d) and (e) of this subsection (4). (d) Level II, which is for major trauma care based upon patient criticality and triage practices within each facility, which are consistent with triage criteria and transport protocols as recommended by the council and adopted by the board. This type of facility may serve as a resource for lower level facilities when a level I facility, as described in paragraph (e) of this subsection (4), is not available within its region, but it is not a facility required to conduct research or provide comprehensive services through subspecialty units such as, but not limited to, burn units, spinal cord injury centers, eye trauma centers, and reimplantation centers. (e) Level I, which is for comprehensive trauma care, including the acute management of the most severely injured patients, which is a facility that may serve as the ultimate resource for lower level facilities or as the key resource facility for a trauma area and which is a facility that provides education in trauma-related areas for health care professionals and performs trauma research; (f) Regional pediatric trauma center, which is a facility that provides comprehensive pediatric trauma care, including acute management of the most severely injured pediatric trauma patients, and is a facility that may serve as an ultimate resource for lower level facilities on pediatric trauma care, and which is a facility that performs pediatric trauma research and provides pediatric trauma education for health care professionals. No facility shall be deemed a regional pediatric trauma center unless the facility predominately serves children and is a facility where at least eighty-five percent of hospital admissions are for individuals who are under eighteen years of age. A separate administrative unit within a general hospital or hospital system shall not be deemed a regional pediatric trauma center. (5) (Deleted by amendment, L. 2000, p. 537, § 16, effective July 1, 2000.) (6) "Interfacility transfer" means the movement of a trauma victim from one facility to another. (6.5) "Key resource facility" means a level I or level II certified trauma facility that provides consultation and technical assistance to a RETAC, as such term is defined in subsection (6.8) of this section, regarding education, quality, training, communication, and other trauma issues described in this part 7 that relate to the development of the statewide trauma care system. (6.8) "Regional emergency medical and trauma services advisory council" or "RETAC" means the representative body appointed by the governing bodies of counties or cities and counties for the purpose of providing recommendations concerning regional area emergency medical and trauma service plans for such counties or cities and counties. (7) Repealed. (8) "Statewide trauma registry" means a statewide data base of information concerning injured persons and licensed facilities receiving injured persons, which information is used to evaluate and improve the quality of patient management and care and the quality of trauma education, research, and injury prevention programs. The data base integrates medical and trauma systems information related to patient diagnosis and provision of care. Such information includes epidemiologic and demographic information. Colorado Revised Statutes 2019 Page 274 of 1101 Uncertified Printout (9) "Trauma" means an injury or wound to a living person caused by the application of an external force or by violence. Trauma includes any serious life-threatening or limbthreatening situations. (10) "Trauma care system" means an organized approach to providing quality and coordinated care to trauma victims throughout the state on a twenty-four-hour per day basis by transporting a trauma victim to the appropriate trauma designated facility. (11) "Trauma transport protocols" means written standards adopted by the board that address the use of appropriate resources to move trauma victims from one level of care to another on a continuum of care. (12) "Triage" means the assessment and classification of an injured person in order to determine the severity of trauma injury and to prioritize care for the injured person. (13) "Verification process" means a procedure to evaluate a facility's compliance with trauma care standards established by the board and to make recommendations to the department concerning the designation of a facility. Source: L. 95: Entire part R&RE, p. 1352, § 3, effective July 1. L. 99: (4) amended, p. 412, § 1, effective April 22. L. 2000: (1), (4)(a), (4)(b), (4)(c), (4)(d), (4)(f), (5), and (6.5) amended and (3.5), (4)(a.5), and (6.8) added, pp. 537, 538, §§ 16, 17, effective July 1; (3) and (7) repealed, p. 547, § 26, effective January 1, 2001. 25-3.5-704. Statewide emergency medical and trauma care system - development and implementation - duties of department - rules. (1) The department shall develop, implement, and monitor a statewide emergency medical and trauma care system in accordance with the provisions of this part 7 and with rules adopted by the board. Pursuant to section 24-50504 (2), the department may contract with any public or private entity in performing any of its duties concerning education, the statewide trauma registry, and the verification process as set forth in this part 7. (2) The board shall adopt rules for the statewide emergency medical and trauma care system, including but not limited to the following: (a) Minimum services in rendering patient care. These rules ensure the appropriate access through designated centers to the following minimum services: (I) Prehospital care; (II) Hospital care; (III) Rehabilitative care; (IV) Injury prevention; (V) Disaster medical care; (VI) Education and research; and (VII) Trauma communications. (b) Transport protocols. The board shall set forth trauma transport protocols in these rules, which include but are not limited to a requirement that a facility that receives an injured person provide the appropriate available care, which may include stabilizing an injured person before transferring that person to the appropriate facility based on the person's injury. These rules ensure that when the most appropriate trauma facility for an injured person is not easily accessible in an area, that person will be transferred as soon as medically feasible to the nearest Colorado Revised Statutes 2019 Page 275 of 1101 Uncertified Printout appropriate facility, which may be in or out of the state. These rules shall conform with applicable federal law governing the transfer of patients. (c) Regional emergency medical and trauma advisory councils - plans established process. (I) These rules provide for the implementation of regional emergency medical and trauma system plans that describe methods for providing the appropriate service and care to persons who are ill or injured in areas included under a regional emergency medical and trauma system plan. In these rules, the board shall specify that: (A) The governing body of each county or city and county throughout the state shall establish a regional emergency medical and trauma advisory council (RETAC) with the governing body of four or more other counties, or with the governing body of a city and county, to form a multicounty RETAC. The number of members on a RETAC shall be defined by the participating counties. Membership shall reflect, as equally as possible, representation between hospital and prehospital providers and from each participating county and city and county. There shall be at least one member from each participating county and city and county in the RETAC. Each county within a RETAC shall be located in reasonable geographic proximity to the other counties and city and counties within the same RETAC. In establishing a RETAC, the governing body shall obtain input from health care facilities and providers within the area to be served by the RETAC. If the governing body for a county or city and county fails to establish a RETAC by July 1, 2002, two counties with a combined population of at least seven hundred fifty thousand residents may apply to the council for establishment of a RETAC of fewer than four counties. The council shall conduct a hearing with all counties that may be affected by the establishment of a RETAC with fewer than four counties before deciding whether to grant such application. The decision on such an application shall be completed within sixty days after the date of application. For all other counties that do not qualify as a two-county RETAC and that have not established a RETAC by July 1, 2002, the council shall designate an established RETAC to serve as the county's or city and county's RETAC. (B) No later than July 1, 2003, each RETAC with approval from the governing bodies for a multicounty RETAC shall submit a regional emergency medical and trauma system plan to the council for approval by the department. If the governing body for a county or city and county fails to submit a plan, if a county or city and county is not included in a multicounty plan, or, if a multicounty plan is not approved pursuant to a procedure established by the board for approving plans, the department shall design a plan for the county, city and county, or multicounty area. (II) In addition to any issues the board requires to be addressed, every regional emergency medical and trauma system plan shall address the following issues: (A) The provision of minimum services and care at the most appropriate facilities in response to the following factors: Facility-established triage and transport plans; interfacility transfer agreements; geographical barriers; population density; emergency medical services and trauma care resources; and accessibility to designated facilities; (B) The level of commitment of counties and city and counties under a regional emergency medical and trauma system plan to cooperate in the development and implementation of a statewide communications system and the statewide emergency medical and trauma care system; (C) The methods for ensuring facility and county or city and county adherence to the regional emergency medical and trauma system plan, compliance with board rules and Colorado Revised Statutes 2019 Page 276 of 1101 Uncertified Printout procedures, and commitment to the continuing quality improvement system described in paragraph (h) of this subsection (2); (D) A description of public information, education, and prevention programs to be provided for the area; (E) A description of the functions that will be contracted services; and (F) The identification of regional emergency medical and trauma system needs through the use of a needs assessment instrument developed by the department; except that the use of such instrument shall be subject to approval by the counties and city and counties included in a RETAC. (III) The board shall specify in regional emergency medical and trauma system plan rules the time frames for approving regional emergency medical and trauma system plans and for resubmitting plans, as well as the number of times the plans may be resubmitted by a governing body before the department designs a plan for a multicounty area. The department shall provide technical assistance to any RETAC for preparation, implementation, and modification, as necessary, of regional emergency medical and trauma system plans. (IV) (A) A county may request that the county be included in two separate RETACs because of geographical concerns. The council shall review and approve any request that a county be divided prior to inclusion within two separate RETACs if the county demonstrates such a division will not adversely impact the emergency medical and trauma needs for the county, that such a division is beneficial to both RETACs, and that such division does not create a RETAC with fewer than five contiguous counties, except for RETACs that contain two counties with a combined population of at least seven hundred fifty thousand residents pursuant to sub-subparagraph (A) of subparagraph (I) of this paragraph (c). (B) A county that is included in two separate RETACs may request that the council allocate any portion of the fifteen thousand dollars received by a RETAC, pursuant to section 253.5-603, between the two separate RETACs. (d) Designation of facilities. The designation rules shall provide that every facility in this state required to be licensed in accordance with article 3 of this title and that receives ambulance patients shall participate in the statewide emergency medical and trauma care system. Each such facility shall submit an application to the department requesting designation as a specific level trauma facility or requesting nondesignation status. A facility that is given nondesignated status shall not represent that it is a designated facility, as prohibited in section 25-3.5-707. The board shall include provisions for the following: (I) The criteria to be applied for designating and periodically reviewing facilities based on level of care capability providing trauma care. In establishing such criteria, the board shall take into consideration recognized national standards including, but not limited to, standards on trauma resources for optimal care of the injured patient adopted by the American college of surgeons' committee and the guidelines for trauma care systems adopted by the American college of emergency physicians. (II) A verification process; (III) The length of a designation period; (IV) The process for evaluating, reviewing, and designating facilities, including an ongoing periodic review process for designated facilities, which process shall take into account the national standards referenced in subparagraph (I) of this paragraph (d). Each facility shall be subject to review in accordance with rules adopted pursuant to this paragraph (d). In the event a Colorado Revised Statutes 2019 Page 277 of 1101 Uncertified Printout certified facility seeks to be designated at a different level or seeks nondesignation status, the facility shall comply with the board's procedures for initial designation. (V) Disciplinary sanctions, which shall be limited to the revocation of a designation, temporary suspension while the facility takes remedial steps to correct the cause of the discipline, redesignation, or assignment of nondesignation status to a facility; (VI) A designation fee established in accordance with section 25-3.5-705; and (VII) An appeals process concerning department decisions in connection with evaluations, reviews, designations, and sanctions. (e) Communications system. (I) The communications system rules shall require that a regional emergency medical and trauma system plan ensure citizen access to emergency medical and trauma services through the 911 telephone system or its local equivalent and that the plan include adequate provisions for: (A) Public safety dispatch to ambulance service and for efficient communication from ambulance to ambulance and from ambulance to a designated facility; (B) Efficient communications among the trauma facilities and between trauma facilities and other medical care facilities; (C) Efficient communications among service agencies to coordinate prehospital, day-today, and disaster activities; and (D) Efficient communications among counties and RETACs to coordinate prehospital, day-to-day, and disaster activities. (II) In addition, the board shall require that a regional emergency medical and trauma system plan identify the key resource facilities for the area. The key resource facilities shall assist the RETAC in resolving trauma care issues that arise in the area and in coordinating patient destination and interfacility transfer policies to assure that patients are transferred to the appropriate facility for treatment in or outside of the area. (f) Statewide trauma registry. (I) The registry rules shall require the department to establish and oversee the operation of a statewide trauma registry. The rules shall allow for the provision of technical assistance and training to designated facilities within the various trauma areas in connection with requirements to collect, compile, and maintain information for the statewide central registry. Each licensed facility, clinic, or prehospital provider that provides any service or care to or for persons with trauma injury in this state shall collect the information described in this subparagraph (I) about any such person who is admitted to a hospital as an inpatient or transferred from one facility to another or who dies from trauma injury. The facility, clinic, or prehospital provider shall submit the following information to the registry: (A) Admission and readmission information; (B) Number of trauma deaths; (C) Number and types of transfers to and from the facility or the provider; and (D) Injury cause, type, and severity. (II) In addition to the information described in subparagraph (I) of this paragraph (f), facilities designated as level I, II, or III shall provide such additional information as may be required by board rules. (III) The registry rules shall include provisions concerning access to information in the registry that does not identify patients or physicians. Any data maintained in the registry that identifies patients or physicians shall be strictly confidential and shall not be admissible in any civil or criminal proceeding. Colorado Revised Statutes 2019 Page 278 of 1101 Uncertified Printout (g) Public information, education, and injury prevention. The department and county, district, and municipal public health agencies may operate injury prevention programs, but the public information, education, and injury prevention rules shall require the department and county, district, and municipal public health agencies to consult with the state and regional emergency medical and trauma advisory councils in developing and implementing area and state-based injury prevention and public information and education programs including, but not limited to, a pediatric injury prevention and public awareness component. In addition, the rules shall require that regional emergency medical and trauma system plans include a description of public information and education programs to be provided for the area. (h) (I) Continuing quality improvement system (CQI). These rules require the department to oversee a continuing quality improvement system for the statewide emergency medical and trauma care system. The board shall specify the methods and periods for assessing the quality of regional emergency medical and trauma systems and the statewide emergency medical and trauma care system. These rules must include the following requirements: (A) That RETACs assess periodically the quality of their respective regional emergency medical and trauma system plans and that the state assess periodically the quality of the statewide emergency medical and trauma care system to determine whether positive results under regional emergency medical and trauma system plans and the statewide emergency medical and trauma care system can be demonstrated; (B) That all facilities comply with the trauma registry rules; (C) That reports concerning regional emergency medical and trauma system plans include results for the emergency medical and trauma area, identification of problems under the regional emergency medical and trauma system plan, and recommendations for resolving problems under the plan. In preparing these reports, the RETACs shall obtain input from facilities, counties included under the regional emergency medical and trauma system plan, and service agencies. (D) That the names of patients or information that identifies individual patients shall be kept confidential and shall not be publicly disclosed without the patient's consent; (E) That the department be allowed access to prehospital, hospital, and coroner records of emergency medical and trauma patients to assess the continuing quality improvement system for the area and state-based injury prevention and public information and education programs pursuant to subsection (2)(g) of this section. All information provided to the department shall be confidential pursuant to this subsection (2)(h). To the greatest extent possible, patient-identifying information shall not be gathered. If patient-identifying information is necessary, the department shall keep such information strictly confidential, and such information may only be released outside of the department upon written authorization of the patient. The department shall prepare an annual report that includes an evaluation of the statewide emergency medical and trauma services system. Such report shall be distributed to all designated trauma centers, ambulance services, and service agencies. (F) That nothing in this subsection (2)(h)(I) prohibits the department from providing information to health information organization networks from its EMS agency patient care database including access to individualized patient information in accordance with section 253.5-501 (3). (II) Data or information related to the identification of individual patient's, provider's, or facility's care outcomes collected as a result of the continuing quality improvement system and Colorado Revised Statutes 2019 Page 279 of 1101 Uncertified Printout records or reports collected or compiled as a result of the continuing quality improvement system are confidential and are exempt from the open records law in part 2 of article 72 of title 24. Data, information, records, or reports are not subject to subpoena or discovery and are not admissible in any civil action, except pursuant to a court order that provides for the protection of sensitive information about interested parties. Nothing in this subsection (2)(h)(II): (A) Precludes the patient or the patient's representative from obtaining the patient's medical records as provided in section 25-1-801; (B) Shall be construed to allow access to confidential professional review committee records or reviews conducted under part 2 of article 30 of title 12; or (C) Prohibits the department from providing information to health information organization networks from its EMS agency patient care database including individualized patient information in accordance with section 25-3.5-501 (3). (III) That reports concerning regional emergency medical and trauma system plans include results for the emergency medical and trauma area, identification of problems under the regional emergency medical and trauma system plan, and recommendations for resolving problems under the plan. In preparing these reports, the RETACs shall obtain input from facilities, counties included under the regional emergency medical and trauma system plan, and service agencies. (i) Trauma care for pediatric patients. The trauma care for pediatric patient rules shall provide for the improvement of the quality of care for pediatric patients. (3) The board shall adopt rules that take into consideration recognized national standards for emergency medical and trauma care systems, such as the standards on trauma resources for optimal care of the injured patient adopted by the American college of surgeons' committee on trauma and the guidelines for emergency medical and trauma care systems adopted by the American college of emergency physicians and the American academy of pediatrics. (4) The board shall adopt and the department shall use only cost-efficient administrative procedures and forms for the statewide emergency medical and trauma care system. (5) In adopting its rules, the board shall consult with and seek advice from the council, as defined in section 25-3.5-703 (3.5), where appropriate, and from any other appropriate agency. In addition, the board shall obtain input from appropriate health care agencies, institutions, facilities, and providers at the national, state, and local levels and from counties and city and counties. Source: L. 95: Entire part R&RE, p. 1354, § 3, effective July 1. L. 96: (1) amended, p. 1471, § 19, effective June 1. L. 99: IP(2) and (2)(h) amended, p. 413, § 2, effective April 22. L. 2002: (1), IP(2), (2)(c), IP(2)(d), (2)(d)(IV), (2)(d)(V), (2)(e), (2)(f)(III), (2)(g), IP(2)(h)(I), (2)(h)(I)(A), (2)(h)(I)(C), (2)(h)(III), (3), (4), and (5) amended and (2)(h)(I)(E) added, p. 699, § 4, effective May 29. L. 2003: (2)(d)(I) and (2)(d)(IV) amended, p. 2057, § 1, effective May 22; (2)(h)(I)(E) amended, p. 2007, § 85, effective May 22. L. 2004: (1) amended, p. 1693, § 27, effective July 1, 2005. L. 2005: IP(2)(d) amended, p. 281, § 15, effective August 8. L. 2007: (2)(h)(I)(E) amended, p. 2041, § 66, effective June 1. L. 2010: (2)(g) amended, (HB 10-1422), ch. 419, p. 2092, § 88, effective August 11. L. 2017: IP(2)(h)(I) and (2)(h)(I)(E) amended, (SB 17-056), ch. 33, p. 93, § 5, effective March 16. L. 2018: (2)(h)(I)(F) added and (2)(h)(II) amended, (HB 18-1032), ch. 63, p. 613, § 3, effective August 8. L. 2019: (1) amended, (SB 19Colorado Revised Statutes 2019 Page 280 of 1101 Uncertified Printout 044), ch. 38, p. 131, § 2, effective August 2; (2)(h)(II)(B) amended, (HB 19-1172), ch. 136, p. 1701, § 153, effective October 1. Cross references: For the legislative declaration in SB 19-044, see section 1 of chapter 38, Session Laws of Colorado 2019. 25-3.5-705. Creation of fee - creation of trauma system cash fund. (1) The board is authorized, by rule, to establish a schedule of fees based on the direct and indirect costs incurred in designating facilities. In addition, the department is authorized to collect the appropriate fee on the schedule. The board may adjust fees in amounts necessary to cover such costs. The fees collected pursuant to this section shall be deposited in the trauma system cash fund created by subsection (2) of this section. (2) There is hereby created in the state treasury a statewide trauma care system cash fund. All moneys in the fund shall be subject to appropriation by the general assembly for allocation to the department to administer the trauma system. Any moneys in the fund not appropriated shall remain in the fund and shall not be transferred or revert to the general fund at the end of any fiscal year. All interest derived from the deposit and investment of moneys in the fund shall remain in the fund. Source: L. 95: Entire part R&RE, p. 1359, § 3, effective July 1. 25-3.5-706. Immunity from liability. The department, the board, the council as defined in section 25-3.5-703 (3.5), a RETAC as defined in section 25-3.5-703 (6.8), the emergency medical practice advisory council created in section 25-3.5-206, key resource facilities, any other public or private entity acting on behalf of or under contract with the department, and counties and cities and counties shall be immune from civil and criminal liability and from regulatory sanction for acting in compliance with the provisions of this part 7. Nothing in this section shall be construed as providing any immunity to such entities or any other person in connection with the provision of medical treatment, care, or services that are governed by the medical malpractice statutes, article 64 of title 13, C.R.S. Source: L. 95: Entire part R&RE, p. 1360, § 3, effective July 1. L. 2000: Entire section amended, p. 545, § 19, effective July 1. L. 2010: Entire section amended, (HB 10-1260), ch. 403, p. 1948, § 12, effective July 1. 25-3.5-707. False representation as trauma facility - penalty. (1) No facility, or agent or employee of a facility, shall represent that the facility functions as a level I, II, III, IV, or V trauma facility unless the facility possesses a valid certificate of designation issued pursuant to section 25-3.5-704 (2)(d). In addition, no facility, provider, or person shall violate any rule adopted by the board. (2) Any facility, provider, or person who violates the provisions of subsection (1) of this section is subject to a civil penalty, which the board shall establish by rule, but which shall not exceed five hundred dollars. The penalty shall be assessed and collected by the department. Before a fee is collected, a facility, provider, or person shall be provided an opportunity for review of the assessed penalty. The procedures for review shall be in accordance with the "State Colorado Revised Statutes 2019 Page 281 of 1101 Uncertified Printout Administrative Procedure Act", article 4 of title 24, C.R.S., and board rules. Any penalty collected pursuant to this section shall be transmitted to the state treasurer, who shall credit the same to the statewide trauma care system cash fund created in section 25-3.5-705. Source: L. 95: Entire part R&RE, p. 1360, § 3, effective July 1. L. 2000: (1) amended, p. 545, § 20, effective July 1. 25-3.5-708. Financing for statewide trauma system. (1) The implementation of the statewide trauma system shall be subject to the availability of: (a) Federal transportation highway safety seed moneys that the department of transportation transfers to the department of public health and environment pursuant to an intergovernmental agreement between the two agencies; (b) Moneys from the emergency medical services account within the highway users tax fund that are unexpended portions of state administrative funds that may be allocated pursuant to section 25-3.5-603 (2)(c). Nothing in this paragraph (b) shall be construed to authorize moneys that may be allocated pursuant to section 25-3.5-603 (2)(a)(I) or (2)(b) to be used for the financing of the administration of the statewide trauma system. (c) Moneys from the statewide trauma care system cash fund created in section 25-3.5705. (2) In addition to any funds available pursuant to subsection (1) of this section, the executive director of the department of public health and environment is hereby authorized to accept any grants, donations, gifts, or contributions from any other private or public entity for the purpose of implementing this part 7. Source: L. 95: Entire part R&RE, p. 1360, § 3, effective July 1. 25-3.5-709. Annual report. No later than January 1, 1999, and prior to November 1 of each year thereafter, the department, in cooperation with the council, as defined in section 253.5-703 (3.5), shall submit a report to the health, environment, welfare, and institutions committees and the joint budget committee of the general assembly on the quality of the statewide emergency medical and trauma care system. Such report shall include an evaluation of each component of the statewide emergency medical and trauma care system and any recommendation for legislation concerning the statewide emergency medical and trauma care system or any component thereof. Source: L. 95: Entire part R&RE, p. 1361, § 3, effective July 1. L. 2000: Entire section amended, p. 545, § 21, effective July 1; entire section amended, p. 462, § 4, effective August 2. Editor's note: Amendments to this section by Senate Bill 00-180 and House Bill 001297 were harmonized. PART 8 TOBACCO EDUCATION, PREVENTION, AND CESSATION PROGRAMS Colorado Revised Statutes 2019 Page 282 of 1101 Uncertified Printout 25-3.5-801. Short title. This part 8 shall be known and may be cited as the "Tobacco Education, Prevention, and Cessation Act". Source: L. 2000: Entire part added, p. 613, § 13, effective May 18. 25-3.5-802. Legislative declaration. (1) The general assembly hereby finds that: (a) The use of all types of tobacco products, including smokeless tobacco, results in a high incidence of addiction, disease, illness, and death; (b) Persons who begin using and become addicted to tobacco products in their youth often face a lifetime of struggle and recurring illness in coping with and attempting to overcome addiction to tobacco products; (c) Experimentation with tobacco products by youth is often a first step toward more serious drug experimentation and creates a greater likelihood that the youth who experiment with tobacco will at some point be addicted to even more harmful substances; (d) Implementation of aggressive tobacco and substance abuse prevention, education, and cessation programs for school-age children is necessary to assist young people in avoiding and ending tobacco use; (e) School districts, schools, and other entities that provide tobacco and substance abuse prevention, education, and cessation programs for school-age children should reach out to parents and encourage them to participate, either as students or role models, in implementing said programs. (2) The general assembly finds that persons with behavioral or mental health disorders are more likely to abuse tobacco products than any other segment of society. The general assembly further finds that the unusually heavy pattern of tobacco abuse engaged in by persons with behavioral or mental health disorders requires special treatment strategies that are not provided by other alcohol, drug, or tobacco abuse programs or substance use disorder treatment programs. It is therefore the general assembly's intent that the programs funded pursuant to this part 8 include comprehensive programs to prevent and treat tobacco addiction among persons with behavioral or mental health disorders. (3) The general assembly also finds that: (a) Each year, thousands of people in this state die from diseases that have been clinically proven to be caused by or directly related to tobacco use; (b) Once a person starts using tobacco, he or she usually becomes addicted to the nicotine contained in the tobacco, which makes it terribly difficult for the person to quit using tobacco even when the person is aware of the significant health risks that accompany tobacco use; (c) Studies show that a child is at a substantially greater risk of starting to use tobacco if the child's parents or older siblings use tobacco. Therefore, reducing tobacco use by adults may significantly reduce the risk that children will begin using tobacco. (d) Annual direct medical costs from tobacco use in Colorado currently exceed one billion dollars; (e) Comprehensive tobacco education, prevention, and cessation programs may result in millions of dollars in savings to the state and individual residents of the state for generations. Colorado Revised Statutes 2019 Page 283 of 1101 Uncertified Printout Source: L. 2000: Entire part added, p. 613, § 13, effective May 18. L. 2005: (3)(d) amended, p. 932, § 22, effective June 2. L. 2017: (2) amended, (SB 17-242), ch. 263, p. 1324, § 189, effective May 25. Cross references: For the legislative declaration contained in the 2005 act amending subsection (3)(d), see section 1 of chapter 241, Session Laws of Colorado 2005. For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017. 25-3.5-803. Definitions. As used in this part 8, unless the context otherwise requires: (1) "Division" means the division within the department of public health and environment responsible for prevention services. (2) "Entity" means any local government, county, district, or municipal public health agency, political subdivision of the state, county department of human or social services, state agency, state institution of higher education that offers a teacher education program, school, school district, or board of cooperative services or any private nonprofit or not-for-profit community-based organization. "Entity" also means a for-profit organization that applies for a grant for the sole purpose of providing a statewide public information campaign concerning tobacco use prevention and cessation. (3) "Master settlement agreement" means the master settlement agreement, the smokeless tobacco master settlement agreement, and the consent decree approved and entered by the court in the case denominated State of Colorado, ex rel. Gale A. Norton, Attorney General v. R.J. Reynolds Tobacco Co.; American Tobacco Co., Inc.; Brown & Williamson Tobacco Corp.; Liggett & Myers, Inc.; Lorillard Tobacco Co., Inc.; Philip Morris, Inc.; United States Tobacco Co.; B.A.T. Industries, P.L.C.; The Council For Tobacco Research--U.S.A., Inc.; and Tobacco Institute, Inc., Case No. 97 CV 3432, in the district court for the city and county of Denver. (4) "Program" means the tobacco education, prevention, and cessation grant program created in section 25-3.5-804. (5) "State board" means the state board of health created in section 25-1-103. Source: L. 2000: Entire part added, p. 614, § 13, effective May 18. L. 2005: (2) amended, p. 932, § 23, effective June 2. L. 2009: (1) amended, (SB 09-292), ch. 369, p. 1970, § 85, effective August 5. L. 2010: (2) amended, (HB 10-1422), ch. 419, p. 2092, § 89, effective August 11. L. 2018: (2) amended, (SB 18-092), ch. 38, p. 441, § 100, effective August 8. Cross references: For the legislative declaration contained in the 2005 act amending subsection (2), see section 1 of chapter 241, Session Laws of Colorado 2005. For the legislative declaration in SB 18-092, see section 1 of chapter 38, Session Laws of Colorado 2018. 25-3.5-804. Tobacco education, prevention, and cessation programs - review committee - grants. (1) There is hereby created the tobacco education, prevention, and cessation grant program to provide funding for community-based and statewide tobacco education programs designed to reduce initiation of tobacco use by children and youth, promote cessation of tobacco use among youth and adults, and reduce exposure to secondhand smoke. Any such tobacco programs may be presented in combination with other substance abuse Colorado Revised Statutes 2019 Page 284 of 1101 Uncertified Printout programs. The program shall be administered by the division within the department and coordinated with efforts pursuant to article 7 of title 44. The state board shall award grants to selected entities from money appropriated to the department from the tobacco education programs fund created in section 24-22-117. (2) The state board shall adopt rules that specify, but are not necessarily limited to, the following: (a) The procedures and timelines by which an entity may apply for program grants; (b) Grant application contents; (c) Criteria for selecting those entities that shall receive grants and determining the amount and duration of said grants; (d) Reporting requirements for entities that receive grants pursuant to this part 8. (3) (a) The division shall review the applications received pursuant to this part 8 and make recommendations to the state board regarding those entities that may receive grants and the amounts of said grants. On and after October 1, 2005, the review committee shall review the applications received pursuant to this part 8 and submit to the state board and the director of the department recommended grant recipients, grant amounts, and the duration of each grant. Within thirty days after receiving the review committee's recommendations, the director shall submit his or her recommendations to the state board. The review committee's recommendations regarding grantees of the Tony Grampsas youth services program, section 26-6.8-102, pursuant to section 25-3.5-805 (5) shall be submitted to the state board and the Tony Grampsas youth services board. Within thirty days after receiving the review committee's recommendations, the Tony Grampsas youth services board shall submit its recommendations to the state board. The state board has the final authority to approve the grants under this part 8. If the state board disapproves a recommendation for a grant recipient, the review committee may submit a replacement recommendation within thirty days. In reviewing grant applications for programs to provide tobacco education, prevention, and cessation programs for persons with behavioral or mental health disorders, the division or the review committee shall consult with the programs for public psychiatry at the university of Colorado health sciences center, the national alliance on mental illness, the mental health association of Colorado, and the department of human services. (b) The state board shall award grants to the selected entities, specifying the amount and duration of the award. No grant awarded pursuant to this part 8 shall exceed three years without renewal. Of the amount awarded each year pursuant to the provisions of this part 8, the state board shall award at least one-third of the amount to entities that provide tobacco education, prevention, and cessation programs, solely or in combination with substance abuse programs, to school-age children. (4) In implementing the program, the division shall survey the need for trained teachers, health professionals, and others involved in providing tobacco education, prevention, and cessation programs. To the extent the division determines there is a need, the division may provide technical training and assistance to entities that receive program grants pursuant to this part 8. (5) (a) There is hereby created the tobacco education, prevention, and cessation grant program review committee, referred to in this part 8 as the "review committee". The review committee is established in the division. The review committee is responsible for ensuring that program priorities are established consistent with the Colorado tobacco prevention and control Colorado Revised Statutes 2019 Page 285 of 1101 Uncertified Printout strategic plan, overseeing program strategies and activities, and ensuring that the program grants are in compliance with section 25-3.5-805. (b) The review committee shall consist of the following sixteen members: (I) The director of the department or the director's designee; (II) Five members who shall be appointed by the director of the department, one of whom shall include the director of the tobacco education, prevention, and cessation program within the division and four of whom shall be staff of the program with expertise in tobacco prevention among youth, reducing exposure to secondhand smoke, tobacco cessation, or public education. (III) Eight members who shall be appointed by the state board as follows: (A) One member who is a member of the state board; (B) One member who is a representative of a local public health agency; (C) One member who is a representative of a statewide association representing physicians; (D) One member who is a representative of an association representing family physicians; (E) One member who is a representative of the Colorado department of education; (F) One member who is a representative of the university of Colorado health sciences center who has expertise in evaluation; (G) One member who represents a sociodemographic disadvantaged population in Colorado; and (H) One member who is a representative of a statewide nonprofit organization with a demonstrated expertise in and commitment to tobacco control. (IV) The president of the senate shall appoint one member of the senate. (V) The speaker of the house of representatives shall appoint one member of the house of representatives. (c) (I) Except as provided in subparagraph (II) of this paragraph (c), members of the review committee shall serve three-year terms; except that of the members initially appointed to the review committee, five members appointed by the state board shall serve two-year terms. Members of the review committee appointed pursuant to subparagraph (III) of paragraph (b) of this subsection (5) shall not serve more than two consecutive terms. (II) The terms of the members appointed by the speaker of the house of representatives and the president of the senate and who are serving on March 22, 2007, shall be extended to and expire on or shall terminate on the convening date of the first regular session of the sixty-seventh general assembly. As soon as practicable after such convening date, the speaker and the president shall appoint or reappoint members in the same manner as provided in subparagraphs (IV) and (V) of paragraph (b) of this subsection (5). Thereafter, the terms of members appointed or reappointed by the speaker and the president shall expire on the convening date of the first regular session of each general assembly, and all subsequent appointments and reappointments by the speaker and the president shall be made as soon as practicable after such convening date. The person making the original appointment or reappointment shall fill any vacancy by appointment for the remainder of an unexpired term. Members shall serve at the pleasure of the appointing authority and shall continue in office until the member's successor is appointed. (d) The composition of the review committee shall reflect, to the extent practical, Colorado's ethnic, racial, and geographic diversity. Colorado Revised Statutes 2019 Page 286 of 1101 Uncertified Printout (e) Except as otherwise provided in section 2-2-326, C.R.S., members of the review committee shall serve without compensation but shall be reimbursed from moneys deposited in the tobacco education programs fund created in section 24-22-117, C.R.S., for their actual and necessary expenses incurred in the performance of their duties pursuant to this part 8. (f) The review committee shall elect from its membership a chair and a vice-chair of the committee. (g) The division shall provide staff support to the review committee. (h) If a member of the review committee has an immediate personal, private, or financial interest in any matter pending before the review committee, the member shall disclose the fact and shall not vote upon such matter. Source: L. 2000: Entire part added, p. 615, § 13, effective May 18. L. 2005: (1) amended, p. 911, § 16, effective June 2; (1) and (3)(a) amended and (5) added, p. 932, § 24, effective June 2. L. 2007: (5)(c) amended, p. 187, § 23, effective March 22. L. 2009: (1) amended, (SB 09-292), ch. 369, p. 1970, § 86, effective August 5. L. 2013: (3)(a) amended, (HB 13-1117), ch. 169, p. 590, § 23, effective July 1. L. 2014: (5)(e) amended, (SB 14-153), ch. 390, p. 1964, § 21, effective June 6. L. 2017: (3)(a) amended, (SB 17-242), ch. 263, p. 1324, § 190, effective May 25. L. 2018: (3)(a) amended, (SB 18-091), ch. 35, p. 387, § 23, effective August 8; (1) amended, (SB 18-036), ch. 34, p. 377, § 6, effective October 1. Editor's note: Amendments to subsection (1) by House Bill 05-1261 and House Bill 051262 were harmonized. Cross references: For the legislative declaration contained in the 2005 act amending subsections (1) and (3)(a) and enacting subsection (5), see section 1 of chapter 241, Session Laws of Colorado 2005. For the legislative declaration in the 2013 act amending subsection (3)(a), see section 1 of chapter 169, Session Laws of Colorado 2013. For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017. For the legislative declaration in SB 18-091, see section 1 of chapter 35, Session Laws of Colorado 2018. 25-3.5-805. Tobacco education, prevention, and cessation programs - requirements. (1) An entity that applies for a grant pursuant to the provisions of this part 8 shall in the application demonstrate that the tobacco education, prevention, or cessation program provides at least one of the following: (a) Education designed for school-age children that, at a minimum, addresses tobacco use prevention and cessation strategies and the dangers of tobacco use; or (b) Education programs, including but not limited to school, work site, mass media, and health-care setting programs, designed to prevent or reduce the use of all types of tobacco products or help reduce exposure to secondhand smoke; or (c) Counseling regarding the use of all types of tobacco products; or (d) Programs that address prevention and cessation of the abuse of various types of drugs, with an emphasis on prevention and cessation of tobacco use; or (e) (Deleted by amendment, L. 2005, p. 935, § 25, effective June 2, 2005.) Colorado Revised Statutes 2019 Page 287 of 1101 Uncertified Printout (f) Tobacco use and substance abuse prevention and cessation services addressed to specific population groups such as adolescents and pregnant women and provided within specific ethnic and low-income communities; or (g) Training of teachers, health professionals, and others in the field of tobacco use and prevention; or (h) Tobacco addiction prevention and treatment strategies that are designed specifically for persons with behavioral or mental health disorders; or (i) Activities to prevent the sale or furnishing by other means of cigarettes or tobacco products to minors; or (j) Programs that are designed to eliminate health disparities among segments of the population that have higher than average tobacco burdens. (1.5) Notwithstanding the requirements of subsection (1) of this section, an entity may apply for a grant for the purpose of evaluating the entire statewide program or individual components of the program. (2) If the entity applying for a grant pursuant to the provisions of this part 8 is a school district or board of cooperative services, in addition to the information specified in subsection (1) of this section, the entity shall demonstrate in the application that the tobacco education, prevention, and cessation program to be operated with moneys received from the grant is a program that has not been previously provided by the school district or board of cooperative services. The entity shall also demonstrate that the program is specifically designed to appeal to and address the concerns of the age group to which the program will be presented. (3) In adopting criteria for awarding grants, the state board shall adopt such criteria as will ensure that the implementation of a comprehensive program is consistent with the Colorado tobacco prevention and control strategic plan, that tobacco education, prevention, and cessation programs are available throughout the state, and that the programs are available to serve persons of all ages. (4) At least fifteen percent of the moneys annually awarded to grantees pursuant to this section shall be for the purposes of providing funding to eliminate health disparities among minority populations and high-risk populations that have higher-than-average tobacco burdens. (5) Up to fifteen percent of the moneys annually awarded pursuant to this section shall be allocated to grantees of the Tony Grampsas youth services program, section 26-6.8-102, C.R.S., for proven tobacco prevention and cessation programs. (6) The majority of moneys annually awarded to grantees that qualify pursuant to subsections (1), (2), and (5) of this section shall be for evidence-based programs and programs that prevent and reduce tobacco use among youth and young adults. Source: L. 2000: Entire part added, p. 616, § 13, effective May 18. L. 2005: Entire section amended, p. 935, § 25, effective June 2. L. 2013: (5) amended, (HB 13-1117), ch. 169, p. 590, § 24, effective July 1. L. 2017: (1)(h) amended, (SB 17-242), ch. 263, p. 1325, § 191, effective May 25. Cross references: For the legislative declaration contained in the 2005 act amending this section, see section 1 of chapter 241, Session Laws of Colorado 2005. For the legislative declaration in the 2013 act amending subsection (5), see section 1 of chapter 169, Session Laws Colorado Revised Statutes 2019 Page 288 of 1101 Uncertified Printout of Colorado 2013. For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017. 25-3.5-806. Tobacco education, prevention, and cessation programs - reporting requirements. (1) In adopting rules specifying the reporting requirements for entities that receive grants pursuant to this part 8, the state board shall ensure that such reports, at a minimum, include: (a) An evaluation of the implementation of the program, including but not limited to the number of persons served and the services provided; (b) The results achieved by the program, specifying the goals of the program and the criteria used in measuring attainment of the goals; (c) An explanation of how the results achieved by the program contribute to the achievement of the program goals as stated in section 25-3.5-802. (2) The division shall compile the annual reports received from entities pursuant to this section. (3) (a) The division shall annually review the reports received from entities receiving grants pursuant to this part 8 and shall make recommendations to the state board concerning whether the amount received by an entity should be continued, reduced, or increased. The division may also recommend that the grant for an entity be immediately terminated or not renewed if the tobacco education, prevention, and cessation program funded by the grant does not demonstrate a sufficient level of success, as determined by the division. (b) The division may contract with one or more public or private entities to review and compile the reports received pursuant to this section and prepare the recommendations pursuant to paragraph (a) of this subsection (3). Source: L. 2000: Entire part added, p. 617, § 13, effective May 18. L. 2015: (2) amended, (SB 15-189), ch. 104, p. 304, § 4, effective April 16. 25-3.5-807. Tobacco program fund - created. (Repealed) Source: L. 2000: Entire part added, p. 618, § 13, effective May 18. L. 2003: (2)(a) amended, p. 465, § 10, effective March 5; (2)(a) amended, p. 2564, § 7, effective June 5. L. 2004: (2)(a) amended and (2)(b) repealed, pp. 1709, 1713, §§ 7, 16, effective June 4. L. 2005: Entire section repealed, p. 912, § 17, effective June 2. 25-3.5-807.5. Transfer of balance of tobacco program fund - repeal. (Repealed) Source: L. 2009: Entire section added, (SB 09-208), ch. 149, p. 624, § 21, effective April 20. Editor's note: Subsection (2) provided for the repeal of this section, effective July 1, 2009. (See L. 2009, p. 624.) 25-3.5-808. Administration - limitation. The prevention services division of the department may receive up to five percent of the moneys annually appropriated by the general Colorado Revised Statutes 2019 Page 289 of 1101 Uncertified Printout assembly from the tobacco education programs fund created in section 24-22-117, C.R.S., for the actual costs incurred in administering the program, including the hiring of sufficient staff within the division to effectively administer the program and reimbursement of review committee members pursuant to section 25-3.5-804 (5). Source: L. 2005: Entire section added, p. 936, § 26, effective June 2. Cross references: For the legislative declaration contained in the 2005 act enacting this section, see section 1 of chapter 241, Session Laws of Colorado 2005. 25-3.5-809. Tobacco education, prevention, and cessation programs - funding. The programs under this part 8 shall be funded by moneys annually appropriated by the general assembly to the department from the tobacco education programs fund created in section 24-22117, C.R.S. Source: L. 2005: Entire section added, p. 912, § 18, effective June 2. Editor's note: This section was originally numbered as § 25-3.5-808 in House Bill 051261 but has been renumbered on revision for ease of location. PART 9 QUALITY MANAGEMENT 25-3.5-901. Short title. This part 9 shall be known and may be cited as the "Carol J. Shanaberger Act". Source: L. 2014: Entire part added, (SB 14-162), ch. 335, p. 1489, § 1, effective June 5. 25-3.5-902. Legislative declaration. The general assembly hereby finds and declares that the implementation of quality management functions to evaluate and improve prehospital emergency medical service patient care is essential to the operation of emergency medical services organizations. For this purpose, it is necessary that the collection of information by prehospital medical directors and emergency medical services organizations be reasonably unfettered so that a complete and thorough evaluation and improvement of the quality of patient care can be accomplished. To this end, quality management information relating to the evaluation or improvement of the quality of prehospital emergency medical services is confidential, subject to section 25-3.5-904 (3), and persons performing quality management functions are granted qualified immunity as specified in section 25-3.5-904 (4). 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. Source: L. 2014: Entire part added, (SB 14-162), ch. 335, p. 1489, § 1, effective June 5. L. 2019: Entire section amended, (HB 19-1172), ch. 136, p. 1701, § 154, effective October 1. Colorado Revised Statutes 2019 Page 290 of 1101 Uncertified Printout 25-3.5-903. Definitions. As used in this part 9, unless the context otherwise requires: (1) "Emergency medical services organization" means: (a) Local emergency medical and trauma service providers, as defined in section 25-3.5602 (4), excluding a health care facility licensed or certified by the department pursuant to section 25-1.5-103 (1)(a) that has a quality management program pursuant to section 25-3-109; (b) Regional emergency medical and trauma services advisory councils, as defined in section 25-3.5-703 (6.8) and established under section 25-3.5-704 (2)(c); and (c) Public safety answering points, as defined in section 29-11-101 (6.5), C.R.S., performing emergency medical dispatch. (2) "Prehospital medical director" or "medical director" means a licensed physician who supervises certified or licensed emergency medical service providers who provide prehospital care. (3) "Quality management assessment" means a review and assessment of the performance of prehospital care provided by emergency medical service providers operating under a medical director. (4) (a) "Quality management program" means a program established under this part 9 that is designed to perform quality management assessments for the purpose of improving patient care and includes: (I) Quality assurance and risk management activities; (II) Peer review of emergency medical service providers; and (III) Other quality management functions. (b) "Quality management program" does not include review or assessment of the licensing, use, or maintenance of vehicles used by an emergency medical services organization. Source: L. 2014: Entire part added, (SB 14-162), ch. 335, p. 1490, § 1, effective June 5. L. 2019: (2) amended, (SB 19-242), ch. 396, p. 3530, § 20, effective May 31. Editor's note: Section 29 of chapter 396 (SB 19-242), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 31, 2019. 25-3.5-904. Quality management programs - creation - assessments - confidentiality of information - exceptions - immunity for good-faith participants. (1) Each emergency medical services organization that institutes a quality management program to conduct quality management assessments shall include in that program at least the following components: (a) Periodic review of treatment protocols, compliance with treatment protocols, and prehospital emergency medical care provided to patients; (b) Peer review of emergency medical service providers, including review of their qualifications and competence and quality and appropriateness of patient care; (c) The collection of data if required pursuant to section 25-3.5-704 (2)(h)(II); (d) A general description of the types of cases, problems, or risks to be reviewed and the process used for identifying potential risks; (e) Identification of the personnel or committees responsible for coordinating quality management activities and the means of reporting within the quality management program; (f) A description of the method for systematically reporting information to the organization's medical director; Colorado Revised Statutes 2019 Page 291 of 1101 Uncertified Printout (g) A description of the method for investigating and analyzing causes of individual problems and patterns of problems; (h) A description of possible corrective actions to address the problems, including education, prevention, and minimizing potential problems or risks; and (i) A description of the method for following up in a timely manner on corrective action to determine the effectiveness of the action. (2) (a) Except as provided in subsection (2)(b) or (3) of this section, information required to be collected and maintained, including information from the prehospital care reporting system that identifies an individual, and records, reports, and other information obtained and maintained in accordance with a quality management program established pursuant to this section are confidential and shall not be released except to the department in cases of an alleged violation of board rules pertaining to emergency medical service provider certification or licensure or except in accordance with section 25-3.5-205 (4). (b) (I) An emergency medical services organization or prehospital medical director may share quality management records related to peer review of an emergency medical service provider with another emergency medical services organization or a licensed or certified health care facility that has a quality management program under this section or section 25-3-109, as applicable, without violating the confidentiality requirements of paragraph (a) of this subsection (2) and without waiving the privilege specified in subsection (3) of this section, if the emergency medical service provider seeks to subject himself or herself to, or is currently subject to, the authority of the emergency medical services organization or health care facility. (II) A health care facility licensed or certified by the department pursuant to section 251.5-103 (1)(a) that has a quality management program pursuant to section 25-3-109 may share quality management records related to peer review of an emergency medical service provider with an emergency medical services organization or prehospital medical director if the emergency medical service provider seeks to subject himself or herself to, or is currently subject to, the authority of the emergency medical services organization or prehospital medical director without violating the confidentiality requirements of this subsection (2) and section 25-3-109 (3) and without waiving the privilege specified in subsection (3) of this section and section 25-3-109 (4). (c) The confidentiality of information provided for in this section is not impaired or otherwise adversely affected solely because the prehospital medical director or emergency medical services organization submits the information to a nongovernmental entity to conduct studies that evaluate, develop, and analyze information about emergency medical care operations, practices, or any other function of emergency medical care organizations. The records, reports, and other information collected or developed by a nongovernmental entity remain protected as provided in paragraph (a) of this subsection (2). In order to adequately protect the confidentiality of the information, the findings, conclusions, or recommendations contained in the studies conducted by a nongovernmental entity are not deemed to establish a standard of care for emergency medical care organizations. (3) (a) The records, reports, and other information described in subsection (2) of this section are not subject to subpoena and are not discoverable or admissible as evidence in any civil or administrative proceeding. A person who participates in the reporting, collection, evaluation, or use of quality management information with regard to a specific circumstance shall not testify about his or her participation in any civil or administrative proceeding. Colorado Revised Statutes 2019 Page 292 of 1101 Uncertified Printout (b) This subsection (3) does not apply to: (I) Any civil or administrative proceeding, inspection, or investigation as otherwise provided by law by the department or other appropriate regulatory agency having jurisdiction for disciplinary or licensing sanctions; (II) A person giving testimony concerning facts of which he or she has personal knowledge acquired independently of the quality management program or function; (III) 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 the person, next friend, or legal representative, but factual information does not include opinions or evaluations performed as a part of the quality management program; (IV) A person giving testimony concerning an act or omission that he or she observed or in which he or she participated, notwithstanding any participation by him or her in the quality management program; (V) A person giving testimony concerning facts he or she had recorded in a medical record relating solely to the individual in interest in a civil suit. (4) A person, acting in good faith, within the scope and functions of a quality management program, and without violating any applicable laws, who 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 is immune from liability in any civil action based on his or her participation in the quality management program brought by an emergency medical service provider or person to whom the quality management information pertains. This immunity does not apply to any negligent or intentional act or omission in the provision of care. (5) Nothing in this section: (a) Affects or prevents the voluntary release of any quality management record or information by a prehospital medical director or emergency medical services organization; except that no patient-identifying information may be released without the patient's consent; (b) Limits any statutory or common-law privilege, confidentiality, or immunity; or (c) Affects a person's ability to access his or her medical records as provided in section 25-1-801 or the right of any family member or other person to obtain medical record information upon the consent of the patient or his or her authorized representative. Source: L. 2014: Entire part added, (SB 14-162), ch. 335, p. 1490, § 1, effective June 5. L. 2019: (2)(a) amended, (SB 19-242), ch. 396, p. 3530, § 21, effective May 31. Editor's note: Section 29 of chapter 396 (SB 19-242), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 31, 2019. PART 10 STATEWIDE MARIJUANA EDUCATION CAMPAIGN 25-3.5-1001. declares that: Legislative declaration. (1) Colorado Revised Statutes 2019 The general assembly hereby finds and Page 293 of 1101 Uncertified Printout (a) Many substance abuse, public health, education, regulatory, and law enforcement professionals are concerned about the impact that the legalization of retail marijuana will have on children, youth, and adults in the state; (b) Many of these professionals believe that the legalization of retail marijuana may result in: (I) An increase in the abuse of marijuana by adults and youth; (II) A greater need for early intervention services due to increased use of marijuana by youth and adults; (III) A belief among children and youth that the risks associated with marijuana use are low; (IV) Health impacts in connection with exposure to secondhand smoke; (V) An increase in the instances of impaired driving and the associated increase in crashes; (VI) New health concerns regarding pregnant or nursing women who use marijuana or who are exposed to secondhand smoke from marijuana; and (VII) Other potential concerns that have not yet been identified. (c) Mass-reach health communications strategies have been found to be effective in reducing tobacco and alcohol use among adults and youth, in increasing the use of cessation services, and in limiting tobacco and alcohol initiation by youth; and (d) There is substantial evidence that mass media campaigns and community coalitions are effective in preventing marijuana use. (2) The general assembly further finds and declares that to protect and improve the health of the citizens of the state, it is a prudent use of state resources to require the Colorado department of public health and environment to implement a campaign to increase the awareness of and education about the impacts of marijuana use. Source: L. 2014: Entire part added, (SB 14-215), ch. 352, p. 1609, § 5, effective July 1. 25-3.5-1002. Definitions. As used in this part 10, unless the context otherwise requires: (1) "Division" means the division within the department of public health and environment responsible for prevention services. (2) "Retail marijuana" means marijuana that is legal for adults to purchase and use pursuant to section 16 of article XVIII of the state constitution. Source: L. 2014: Entire part added, (SB 14-215), ch. 352, p. 1610, § 5, effective July 1. 25-3.5-1003. Eighteen-month public awareness and education campaign legalization of marijuana - repeal. (Repealed) Source: L. 2014: Entire part added, (SB 14-215), ch. 352, p. 1610, § 5, effective July 1. Editor's note: Subsection (3) provided for the repeal of this section, effective July 1, 2016. (See L. 2014, p. 1610.) Colorado Revised Statutes 2019 Page 294 of 1101 Uncertified Printout 25-3.5-1004. Ongoing prevention and education campaign - training - marijuana. (1) Subject to available appropriations, beginning in the 2014-15 state fiscal year, the division shall develop, implement, and evaluate an ongoing statewide prevention and education campaign to address the long-term marijuana education needs in the state. In the prevention and education messaging, the division shall provide information to: (a) The general public regarding the law surrounding the legal use of retail marijuana; (b) People in the retail marijuana industry regarding restricting youth access to retail marijuana; (c) Retail marijuana users and other relevant populations identified as high-risk regarding the potential risks associated with the use of marijuana; and (d) The general public regarding the dangers associated with the over-consumption of marijuana-infused products. (2) In furtherance of the goals of the ongoing marijuana prevention and education campaign, the division may use television messaging, radio broadcasts, print media, digital strategies, or any other form of messaging deemed necessary and appropriate by the division to reach the target audiences of the campaign. (3) In furtherance of the goals of the ongoing marijuana prevention and education campaign, the department of public health and environment shall provide at least five regional training sessions during the 2014-15 fiscal year for community partners to implement youth health development strategies. Source: L. 2014: Entire part added, (SB 14-215), ch. 352, p. 1611, § 5, effective July 1. 25-3.5-1005. Website - primary state resource for information. (1) In furtherance of the goals of the eighteen-month public awareness and education campaign created in section 253.5-1003, as it existed prior to its repeal in 2016, and the ongoing prevention and education campaign created in section 25-3.5-1004, the division shall create a website that will serve as the state portal for the most accurate and timely information regarding the health effects of marijuana use and the laws regarding marijuana use. The division shall ensure that the website links to the information made available by local governments that have passed additional restrictions on the use of retail marijuana and links to the website of every state agency that contains relevant information regarding retail marijuana, including any youth prevention campaign managed by a state agency. (2) The division shall implement a marketing campaign to generate public awareness of the website as the primary state resource for information regarding the legalization and use of retail marijuana in the state. Source: L. 2014: Entire part added, (SB 14-215), ch. 352, p. 1611, § 5, effective July 1. L. 2017: (1) amended, (SB 17-294), ch. 264, p. 1407, § 82, effective May 25. 25-3.5-1006. Align marijuana messaging - integration of information across state agencies. (1) The division shall integrate information from each state agency involved in providing retail marijuana information, including the department of human services, the department of transportation, the department of revenue, the department of law, the department of public safety, and the department of education, to align the messaging, branding, and Colorado Revised Statutes 2019 Page 295 of 1101 Uncertified Printout education provided by each agency for the eighteen-month public education and awareness campaign required pursuant to section 25-3.5-1003, as it existed prior to its repeal in 2016, the ongoing prevention and education campaign required pursuant to section 25-3.5-1004, and the website required pursuant to section 25-3.5-1005. (2) The division shall provide data, training, educational materials, and resources on effective prevention strategies to local community coalitions and programs addressing marijuana prevention. Source: L. 2014: Entire part added, (SB 14-215), ch. 352, p. 1612, § 5, effective July 1. L. 2017: (1) amended, (SB 17-294), ch. 264, p. 1407, § 83, effective May 25; (1) amended, (HB 17-1295), ch. 258, p. 1076, § 2, effective July 1. Editor's note: Amendments to subsection (1) by SB 17-294 and HB 17-1295 were harmonized. 25-3.5-1007. Evaluation of marijuana campaigns. (1) The department shall contract with a respected evaluation partner to develop and implement a three-year evaluation plan assessing the reach and impact of the eighteen-month public education and awareness campaign required pursuant to section 25-3.5-1003, as it existed prior to its repeal in 2016, and the ongoing prevention and education campaign required pursuant to section 25-3.5-1004. The evaluation must also assess the department's success in educating the citizens of the state regarding the legal parameters of the use of retail marijuana and preventing negative health impacts from the legalization of retail marijuana. (2) (Deleted by amendment, L. 2017.) Source: L. 2014: Entire part added, (SB 14-215), ch. 352, p. 1612, § 5, effective July 1. L. 2017: Entire section amended, (SB 17-294), ch. 264, p. 1407, § 84, effective May 25. PART 11 EMERGENCY MEDICAL RESPONDERS 25-3.5-1101. Legislative declaration. (1) The general assembly hereby finds that: (a) The department has responsibility for oversight of the emergency medical and trauma services system and the certification or licensure of emergency medical service providers. Emergency medical service providers are certified or licensed by the department to provide treatment and transport to the sick and injured. (b) Emergency medical responders are the part of the emergency medical and trauma services system who answer emergency calls, provide effective and immediate care to ill and injured patients, prepare the scene for the arrival of the ambulance and emergency medical service providers, and provide assistance to emergency medical service providers as directed; (c) Most emergency medical responders perform their duties in an ethical and professional manner; Colorado Revised Statutes 2019 Page 296 of 1101 Uncertified Printout (d) It is in the interests of the citizens of this state that a voluntary process exists whereby individuals may register their training and status as an emergency medical responder with the state; and (e) It is in the public interest to place the voluntary registration of emergency medical responders within the state department that has statutory responsibility for the statewide emergency medical and trauma services system. (2) Therefore, it is the intent of the general assembly to: (a) Transfer the oversight of emergency medical responders, formerly known as first responders, from the department of public safety to the department of public health and environment; and (b) Fund the oversight of the voluntary registration program through the highway users tax fund established in section 42-3-304 (21), C.R.S., in order to avoid cost-prohibitive registration fees. Source: L. 2016: Entire part added, (HB 16-1034), ch. 324, p. 1311, § 3, effective August 10. L. 2019: (1)(a) amended, (SB 19-242), ch. 396, p. 3530, § 22, effective May 31. Editor's note: Section 29 of chapter 396 (SB 19-242), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 31, 2019. 25-3.5-1102. Definitions. As used in this part 11: (1) "Emergency medical responder" means an individual who has successfully completed the training and examination requirements for emergency medical responders and who provides assistance to the injured or ill until more highly trained and qualified personnel arrive. (2) "Physician" means a person licensed pursuant to article 240 of title 12, in good standing, who authorizes and directs, through protocols and standing orders, the performance of students-in-training enrolled in department-recognized emergency medical responder education programs. (3) "Registered emergency medical responder" means an individual who has successfully completed the training and examination requirements for emergency medical responders, who provides assistance to the injured or ill until more highly trained and qualified personnel arrive, and who is registered with the department pursuant to this part 11. Source: L. 2016: Entire part added, (HB 16-1034), ch. 324, p. 1312, § 3, effective August 10. L. 2019: (2) amended, (HB 19-1172), ch. 136, p. 1701, § 155, effective October 1. 25-3.5-1103. Registration - rules - funds. (1) On and after July 1, 2017, the department shall administer a voluntary registration program for emergency medical responders. A person shall not hold himself or herself out as a registered emergency medical responder, providing care or services as identified in national guidelines for emergency medical response as approved by the department, unless the person meets the requirements set forth in this part 11; except that a person may function as a good samaritan pursuant to section 13-21-116, C.R.S. (2) The board shall adopt rules for the administration of the emergency medical responder registration program, which rules shall include, at a minimum, the following: Colorado Revised Statutes 2019 Page 297 of 1101 Uncertified Printout (a) Requirements for emergency medical responder registration, which include certification of the applicant through a nationally recognized emergency responder certification organization approved by the department; (b) The period of time for which the registration as an emergency medical responder is valid; (c) Registration renewal requirements; (d) Training requirements for new and renewing registrants; (e) Provisions governing national and state criminal history record checks for new and renewing registrants and the use of the results of the checks by the department to determine the action to take on a registration application. Notwithstanding section 24-5-101, C.R.S., these provisions must allow the department to consider whether the applicant has been convicted of a felony or misdemeanor involving moral turpitude and the pertinent circumstances connected with the conviction and to make a determination whether any such conviction disqualifies the applicant from registration. (f) Disciplinary sanctions, which may include provisions for the denial, revocation, probation, and suspension, including summary suspension, of registration and of education program recognition; and (g) An appeal process consistent with sections 24-4-104 and 24-4-105, C.R.S., that is applicable to department decisions in connection with sanctions. (3) Rules promulgated by the department of public safety remain in effect until superceded by rules duly adopted pursuant to this part 11. (4) (a) The department may issue a provisional registration to an applicant for registration as an emergency medical responder who requests issuance of a provisional registration and who pays a fee authorized under rules adopted by the board. A provisional registration is valid for not more than ninety days. (b) The department may not issue a provisional registration unless the applicant satisfies the requirements for registration established in rules of the board. If the department finds that an emergency medical responder who has received a provisional registration has violated any requirements for registration, the department may revoke the provisional registration and prohibit the registration of the emergency medical responder. (c) The department may issue a provisional registration to an applicant whose fingerprint-based criminal history record check has not yet been completed. The department shall require the applicant to submit a name-based criminal history record check prior to issuing a provisional registration. (d) The board shall adopt rules as necessary to implement this subsection (4), including rules establishing a fee to be charged to applicants seeking a provisional registration. The department shall deposit any fee collected for a provisional registration in the emergency medical services account created in section 25-3.5-603. (5) (a) The department shall acquire a fingerprint-based criminal history record check from the Colorado bureau of investigation to investigate the holder of or applicant for an emergency medical responder registration. The department may acquire a name-based criminal history record check for a registrant or an applicant who has twice submitted to a fingerprintbased criminal history record check and whose fingerprints are unclassifiable. Notwithstanding paragraph (b) of this subsection (5), if a person submitted to a fingerprint-based criminal history Colorado Revised Statutes 2019 Page 298 of 1101 Uncertified Printout record check at the time of initial registration or registration renewal, the person shall not be required to submit to a subsequent fingerprint-based criminal history record check. (b) If, at the time of application for registry or for renewal, an individual has lived in the state for three years or less, the department shall require the applicant to submit to a federal bureau of investigation fingerprint-based national criminal history record check; except that the department may acquire a national name-based criminal history record check for an applicant who has twice submitted to a fingerprint-based criminal history record check and whose fingerprints are unclassifiable. The department shall be the authorized agency to receive and disseminate information regarding the result of any national criminal history record check. (c) When the results of a fingerprint-based criminal history record check of a person performed pursuant to this subsection (5) reveal a record of arrest without a disposition, the department shall require that person to submit to a name-based criminal history record check, as defined in section 22-2-119.3 (6)(d). Source: L. 2016: Entire part added, (HB 16-1034), ch. 324, p. 1312, § 3, effective August 10. L. 2019: (5)(c) added, (HB 19-1166), ch. 125, p. 553, § 38, effective April 18. 25-3.5-1104. Training programs - rules. (1) The board shall adopt rules regarding the recognition by the department of education programs that provide initial training and continued competency education for emergency medical responders. (2) The receipt of a certificate or other document of course completion issued by an education program or national certification organization is not deemed state licensure, approval, or registration. Source: L. 2016: Entire part added, (HB 16-1034), ch. 324, p. 1314, § 3, effective August 10. 25-3.5-1105. Investigation and discipline. (1) The department may administer oaths, take affirmations of witnesses, and issue subpoenas to compel the attendance of witnesses and the production of all relevant records and documents to investigate alleged misconduct by registered emergency medical responders. (2) Upon failure of a witness to comply with a subpoena, the department may apply to a district court for an order requiring the person to appear before the department or an administrative law judge, to produce the relevant records or documents, or to give testimony or evidence touching the matter under investigation or in question. When seeking an order, the department shall apply to the district court of the county in which the subpoenaed person resides or conducts business. The court may punish such failure as a contempt of court. (3) A registered emergency medical responder, the employer of a registered emergency medical responder, or a physician shall report to the department any misconduct by a registered emergency medical responder that is known or reasonably believed by the person to have occurred. (4) A person acting as a witness or consultant to the department, a witness testifying, and a person or employer who reports misconduct to the department under this section is immune from liability in any civil action brought for acts occurring while testifying, producing evidence, or reporting misconduct under this section if the individual or employer was acting in good faith Colorado Revised Statutes 2019 Page 299 of 1101 Uncertified Printout and with a reasonable belief of the facts. A person or employer participating in good faith in an investigation or an administrative proceeding pursuant to this section is immune from any civil or criminal liability that may result from such participation. (5) Records, documents, testimony, or evidence obtained under this section are confidential except to the extent necessary to support the administrative action taken by the department, to refer the matter to another regulatory agency, or to refer the matter to a law enforcement agency for criminal prosecution. Source: L. 2016: Entire part added, (HB 16-1034), ch. 324, p. 1314, § 3, effective August 10. PART 12 COMMUNITY ASSISTANCE REFERRAL AND EDUCATION SERVICES (CARES) PROGRAM 25-3.5-1201. Short title. The short title of this part 12 is the "Community Assistance Referral and Education Services (CARES) Program Act". Source: L. 2016: Entire part added, (SB 16-069), ch. 260, p. 1064, § 4, effective June 8. 25-3.5-1202. Definitions. As used in this part 12, unless the context otherwise requires: (1) "Authorized entity" means: (a) A licensed ambulance service; (b) A fire department of a town, city, or city and county; (c) A fire protection district, ambulance district, health assurance district, health service district, or metropolitan district or a special district authority; or (d) A health care business entity, including a licensed or certified health care facility that is subject to regulation under article 3 of this title. (2) "Medical direction" means the supervision over and direction of individuals who perform acts on behalf of a CARES program by a physician or advanced practice registered nurse who is licensed in Colorado and in good standing and who is identified as being responsible for assuring the competency of those individuals in the performance of acts on behalf of the CARES program. (3) "Program" or "CARES program" means a community assistance referral and education services program established in accordance with this part 12. Source: L. 2016: Entire part added, (SB 16-069), ch. 260, p. 1064, § 4, effective June 8. 25-3.5-1203. Community assistance referral and education services programs authorization - scope - repeal. (1) To improve the health of residents within its jurisdiction, prevent illness and injury, or reduce the incidence of 911 calls and hospital emergency department visits made for the purpose of obtaining nonemergency, nonurgent medical care or services, an authorized entity may establish a community assistance referral and education Colorado Revised Statutes 2019 Page 300 of 1101 Uncertified Printout services program to provide community outreach and health education to residents within the authorized entity's jurisdiction. (2) (a) On or after July 1, 2018, an authorized entity that operates or plans to operate a CARES program in Colorado shall notify the department of its CARES program in the form and manner required by the department. (b) The department shall maintain a list of all authorized entities that operate a CARES program and make the list accessible to the public. (c) An authorized entity operating a CARES program shall not assert that it is licensed or certified by the department. (3) Subject to medical direction, an authorized entity operating a program may, within the scope of practice of its practitioners: (a) Provide the following services: (I) Health education and information available on relevant services; and (II) Referrals for and information concerning low-cost medication programs and alternative resources to the 911 system; (b) To provide services in accordance with paragraph (a) of this subsection (3) and to ensure nonduplication of the services, collaborate with appropriate community resources, including: (I) Health care facilities licensed or issued a certificate of compliance pursuant to section 25-1.5-103 or subject to regulation by the department pursuant to article 1 or 3 of this title; (II) Primary care providers; (III) Other health care professionals; or (IV) Social services agencies. (4) (a) An authorized entity operating a CARES program shall not provide services that would require a license or certification pursuant to part 13 of this article or article 3 or 3.5 of this title. (b) In the form and manner prescribed by the department and before referring a service or provider to a recipient of a CARES program service, an authorized entity operating a CARES program shall disclose, at a minimum, in writing, the following information to the recipient: (I) Any relationship that the CARES program has with an individual or entity to which it refers a recipient of CARES program service; and (II) Whether the authorized entity directs, controls, schedules, or trains any provider to which it refers a recipient of CARES program services. (5) The department may investigate an authorized entity as it deems necessary to ensure: (a) The protection of the health, safety, and welfare of a recipient of CARES program services; and (b) That the authorized entity is not providing services through its CARES program that require a license or certification pursuant to part 13 of this article or article 3 or 3.5 of this title. (6) A person working directly or indirectly for a CARES program, whether as an employee or a contractor, may only provide services consistent with the requirements of subsection (3) of this section; except that nothing in this section prohibits a licensed, certified, or registered health care or mental health provider or certified or licensed emergency medical service provider from acting or providing services within the provider's scope of practice if necessary to respond to an emergent situation. Colorado Revised Statutes 2019 Page 301 of 1101 Uncertified Printout (7) (a) If an entity offered community outreach and health education before January 1, 2015, the entity may continue and need not comply with the requirements of this part 12. The entity may voluntarily provide reports consistent with the requirements of section 25-3.5-1204. (b) This subsection (7) is repealed, effective July 1, 2021. Source: L. 2016: Entire part added, (SB 16-069), ch. 260, p. 1064, § 4, effective June 8. L. 2019: (6) amended, (SB 19-242), ch. 396, p. 3531, § 23, effective May 31. Editor's note: Section 29 of chapter 396 (SB 19-242), Session Laws of Colorado 2019, provides that the act changing this section applies to conduct occurring on or after May 31, 2019. 25-3.5-1204. Reports. (1) (a) If an authorized entity develops a program under this article, the authorized entity shall report to the department, in the form and manner determined by the department, on the progress of the program on or before December 31 in the year following the year in which the program commenced and on or before December 31 of each subsequent year in which the program continues to operate. (b) An authorized entity's report must include: (I) The number of residents who have used program services and the types of program services used; (II) A measurement of any reduction in the use of the 911 system for nonemergency, nonurgent medical assistance by residents within the authorized entity's jurisdiction; and (III) A measurement of any reduction in visits to the emergency department in a hospital for nonemergency, nonurgent medical assistance by residents within the authorized entity's jurisdiction. (c) An authorized entity's report pursuant to this section must not include any personally identifiable information concerning a program client or prospective client. (2) On or before March 31 of each year, the department shall compile annual reports received from authorized entities in the previous year into a single report and post the report on its website. Source: L. 2016: Entire part added, (SB 16-069), ch. 260, p. 1066, § 4, effective June 8. PART 13 COMMUNITY INTEGRATED HEALTH CARE SERVICE AGENCIES 25-3.5-1301. Definitions. As used in this part 13, unless the context otherwise requires: (1) "Community integrated health care service agency" or "agency" means a sole proprietorship, partnership, corporation, nonprofit entity, special district, governmental unit or agency, or licensed or certified health care facility that is subject to regulation under article 1.5 or 3 of this title that manages and offers, directly or by contract, community integrated health care services. Colorado Revised Statutes 2019 Page 302 of 1101 Uncertified Printout (2) "Manager" or "administrator" means any person who controls and supervises or offers or attempts to control and supervise the day-to-day operations of a community integrated health care service agency. (3) "Medical direction" means the supervision over and direction of individuals who perform acts on behalf of an agency by a physician or advanced practice registered nurse who is licensed in Colorado, is in good standing, and is identified as being responsible for assuring the competency of those individuals in the performance of acts on behalf of the agency; except that, if the agency hires or contracts with a community paramedic, only a licensed physician in good standing may provide medical direction. (4) "Owner" means an officer, director, general partner, limited partner, or other person having a financial or equity interest of twenty-five percent or greater. Source: L. 2016: Entire part added, (SB 16-069), ch. 260, p. 1067, § 4, effective June 8. 25-3.5-1302. Community integrated health care service agency license required rules - civil and criminal penalties - liability insurance. (1) On or after July 1, 2018, a person shall not operate or maintain a community integrated health care service agency unless the person has submitted to the department a completed application for licensure as a community integrated health care service agency. On or after December 31, 2018, a person shall not operate or maintain an agency without a community integrated health care service agency license issued by the department. (2) (a) A person who violates subsection (1) of this section: (I) Is guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not less than fifty dollars nor more than five hundred dollars; and (II) May be subject to a civil penalty assessed by the department, after conducting a hearing in accordance with section 24-4-105, C.R.S., of up to ten thousand dollars for each violation of this section. The department shall transmit all fines collected pursuant to this subparagraph (II) to the state treasurer, who shall credit the moneys to the general fund. (b) An owner, manager, or administrator of an agency is subject to the penalties in this subsection (2) for any violation of subsection (1) of this section. (3) A license applicant shall submit to the department, in the manner determined by the board by rule, proof that the agency and any staff that it employs or contracts is covered by general liability insurance in an amount determined by the board by rule, but not less than the amount calculated in accordance with section 24-10-114 (1)(a)(I) and (1)(b), C.R.S. Source: L. 2016: Entire part added, (SB 16-069), ch. 260, p. 1067, § 4, effective June 8. 25-3.5-1303. Minimum standards for community integrated health care service agencies - adult protective services data system check - rules. (1) In addition to the services that the board, by rule, authorizes a community integrated health care service agency to perform, an agency may perform any of the services that may be provided through a CARES program pursuant to section 25-3.5-1203 (3) and the tasks and procedures that a community paramedic is authorized to perform within his or her scope of practice in accordance with section 25-3.5-206 and rules promulgated pursuant to that section. On or before January 1, 2018, the board shall Colorado Revised Statutes 2019 Page 303 of 1101 Uncertified Printout promulgate rules providing minimum standards for the operation of an agency within the state. The rules must include the following: (a) A requirement that the agency have medical direction; (b) Inspection of agencies by the department or the department's designated representative; (c) Minimum educational, training, and experience standards for the administrator and staff of an agency, including a requirement that the administrator and staff be of good moral character; (d) (I) Fees for agency applications and licensure based on the department's direct and indirect costs in implementing this part 13. The department shall transmit the fees to the state treasurer, who shall credit the fees to the community integrated health care service agencies cash fund created in section 25-3.5-1304. (II) The department shall collect fees from any entity that applies to operate a community integrated health care service agency, including an agency wholly owned and operated by a governmental unit or agency. The department shall transmit the fees to the state treasurer who shall credit the fees to the community integrated health care service agencies cash fund created in section 25-3.5-1304. (e) The amount of general liability insurance coverage that an agency shall maintain and the manner in which an agency shall demonstrate proof of insurance to the department. The board may establish by rule that an agency may obtain a surety bond in lieu of liability insurance coverage. (f) Establishing occurrence reporting requirements pursuant to section 25-1-124; (g) Requirements for retaining records, including the time that agencies must maintain records for inspection by the department; and (h) A requirement that agencies report to the department on an annual basis. (2) On and after January 1, 2019, prior to employment, a community integrated health care service 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. 2016: Entire part added, (SB 16-069), ch. 260, p. 1068, § 4, effective June 8. L. 2017: (2) added, (HB 17-1284), ch. 272, p. 1504, § 10, effective May 31. 25-3.5-1304. Community integrated health care service agencies cash fund created. There is created the community integrated health care service agencies cash fund, referred to in this section as the "fund". The department shall transmit fees collected pursuant to this part 13 to the state treasurer for deposit in the fund. The money in the fund is subject to annual appropriation by the general assembly to the department for the department's direct and indirect costs in implementing and administering this part 13. Any unencumbered or unexpended money 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 any other fund. Source: L. 2016: Entire part added, (SB 16-069), ch. 260, p. 1069, § 4, effective June 8. Colorado Revised Statutes 2019 Page 304 of 1101 Uncertified Printout 25-3.5-1305. License - application - inspection - criminal history record check issuance. (1) A community integrated health care service agency license expires after one year. The department shall determine the form and manner of initial and renewal license applications. (2) (a) The department shall inspect an agency as it deems necessary to ensure the health, safety, and welfare of agency consumers. An agency shall submit in writing, in a form and manner prescribed by the department, a plan detailing the measures that the agency will take to correct any violations found by the department as a result of an inspection. (b) The department shall keep all medical records and personally identifying information obtained during an inspection of an agency confidential. All records and information obtained by the department through an inspection are exempt from disclosure pursuant to sections 24-72-204, C.R.S., and 25-1-124. (3) (a) (I) With the submission of an application for a license pursuant to this section, each owner, manager, and administrator of an agency applying for an initial or renewal license shall submit a complete set of his or her fingerprints to the Colorado bureau of investigation for the purpose of conducting a state and national fingerprint-based criminal history record check utilizing the records of the Colorado bureau of investigation and the federal bureau of investigation. The Colorado bureau of investigation shall forward the results of a criminal history record check to the department. (II) Each owner, manager, or administrator of an agency is responsible for paying the fee established by the Colorado bureau of investigation for conducting the fingerprint-based criminal history record check to the bureau. (III) The department may acquire a name-based criminal history record check for an owner, manager, or administrator who has twice submitted to a fingerprint-based criminal history record check and whose fingerprints are unclassifiable. (IV) When the results of a fingerprint-based criminal history record check of a person performed pursuant to this subsection (3) reveal a record of arrest without a disposition, the department shall require that person to submit to a name-based criminal history record check, as defined in section 22-2-119.3 (6)(d). (b) The department may deny a license or renewal of a license if the results of a criminal history record check of an owner, manager, or administrator demonstrates that the owner, manager, or administrator has been convicted of a felony or a misdemeanor involving conduct that the department determines could pose a risk to the health, safety, or welfare of community integrated health care service consumers. (c) If an agency applying for an initial license is temporarily unable to satisfy all of the requirements for licensure, the department may issue a provisional license to the agency; except that the department shall not issue a provisional license to an agency if operation of the agency will adversely affect the health, safety, or welfare of the agency's consumers. The department may require an agency applying for a provisional license to demonstrate to the department's satisfaction that the agency is taking sufficient steps to satisfy all of the requirements for full licensure. A provisional license is valid for ninety days and may be renewed one time at the department's discretion. Source: L. 2016: Entire part added, (SB 16-069), ch. 260, p. 1069, § 4, effective June 8. L. 2019: (3)(a)(IV) added, (HB 19-1166), ch. 125, p. 553, § 39, effective April 18. Colorado Revised Statutes 2019 Page 305 of 1101 Uncertified Printout 25-3.5-1306. License denial - suspension - revocation. (1) Upon denial of an application for an initial license, the department shall notify the applicant in writing of the denial by mailing a notice to the applicant at the address shown on the application. If an applicant, within sixty days after receiving the notice of denial, petitions the department to set a date and place for a hearing, the department shall grant the applicant a hearing to review the denial in accordance with article 4 of title 24, C.R.S. (2) The department may suspend, revoke, or refuse to renew the license of a community integrated health care service agency that is out of compliance with the requirements of this part 13 or rules promulgated pursuant to this part 13. Before taking final action to suspend, revoke, or refuse to renew a license, the department shall conduct a hearing on the matter in accordance with article 4 of title 24, C.R.S. The department may implement a summary suspension before a hearing in accordance with section 24-4-104 (4)(a), C.R.S. (3) After conducting a hearing on the matter in accordance with article 4 of title 24, C.R.S., the department may revoke or refuse to renew an agency license where the owner, manager, or administrator of the agency has been convicted of a felony or misdemeanor involving conduct that the department determines could pose a risk to the health, safety, or welfare of the agency's consumers. (4) The department may impose intermediate restrictions or conditions on an agency that may require the agency to: (a) Retain a consultant to a