A Bill for an Act
Page 1, Line 101Concerning protecting access to gender-affirming health
Page 1, Line 102care.
Bill Summary
(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)
Under current law, health benefit insurance plans (health benefit plans) include coverage for "gender-affirming health care" as part of individual and group health benefit plans. "Gender-affirming health care" is defined in the bill as supplies, care, and services of a medical, behavioral health, mental health, psychiatric, habilitative, surgical, therapeutic, diagnostic, preventive, rehabilitative, or supportive nature relating to the treatment of gender dysphoria (gender-affirming health care). The bill codifies gender-affirming health care treatments in statute and prohibits a health benefit plan from denying or limiting medically necessary gender-affirming health care, as determined and prescribed by a physical or behavioral health-care provider (health-care provider).
In addition, the bill exempts prescriptions for testosterone from the tracking requirements of the prescription drug use monitoring program and blocks archived records from view.
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 2SECTION 1. In Colorado Revised Statutes, 10-16-104, add (29) as follows:
Page 2, Line 310-16-104. Mandatory coverage provisions - definitions - rules
Page 2, Line 4- applicability. (29) Gender-affirming health care - rules - definitions.
Page 2, Line 5(a) As used in this subsection (29), unless the context otherwise requires:
Page 2, Line 6(I) "Gender-affirming health care" means all supplies,
Page 2, Line 7care, and services of a medical, behavioral health, mental
Page 2, Line 8health, psychiatric, habilitative, surgical, therapeutic,
Page 2, Line 9diagnostic, preventive, rehabilitative, or supportive nature
Page 2, Line 10relating to the treatment of gender dysphoria.
Page 2, Line 11"Gender-affirming health care" includes the following, or any combination of the following:
Page 2, Line 12(A) Hormone therapy;
(B) Blepharoplasty, eye and lid;
Page 2, Line 13(C) Face, forehead, or neck skin tightening;
(D) Facial bone remodeling;
Page 2, Line 14(E) Genioplasty;
(F) Rhytidectomy for the cheek, chin, or neck;
Page 2, Line 15(G) Cheek, chin, or nose implants;
(H) Lip lift or augmentation;
Page 3, Line 1(I) Mandibular angle augmentation, creation, or reduction;
Page 3, Line 2(J) Orbital recontouring;
(K) Rhinoplasty;
Page 3, Line 3(L) Laser or electrolysis hair removal;
Page 3, Line 4(M) Breast or chest augmentation, reduction, or construction; and
Page 3, Line 5(N) Genital and nongenital surgical procedures.
Page 3, Line 6(II) "Medically necessary" means a physical or behavioral
Page 3, Line 7health-care provider has determined that the prescribed
Page 3, Line 8gender-affirming health care is necessary for the treatment of gender dysphoria.
Page 3, Line 9(b) Subject to the requirements set forth in subsection
Page 3, Line 10(29)(d) of this section, all health benefit plans issued or renewed
Page 3, Line 11in the state shall provide coverage for gender-affirming health
Page 3, Line 12care. The health benefit plan must provide the coverage regardless of the covered person's sex or gender.
Page 3, Line 13(c) The commissioner shall adopt rules consistent with and as necessary to implement this subsection (29).
Page 3, Line 14(d) A health benefit plan shall not deny or limit gender-affirming health care that is:
Page 3, Line 15(I) Medically necessary, as determined by the physical or
Page 3, Line 16behavioral health-care provider who prescribes the gender-affirming health care; and
Page 3, Line 17(II) Prescribed in accordance with generally accepted
Page 3, Line 18standards of care for the profession.
Page 4, Line 1SECTION 2. In Colorado Revised Statutes, 10-16-1206, amend (1)(f) and (1)(g); and add (1)(h) as follows:
Page 4, Line 210-16-1206. Health insurance affordability cash fund -
Page 4, Line 3creation - repeal. (1) There is created in the state treasury the health insurance affordability cash fund. The fund consists of:
Page 4, Line 4(f) All interest and income derived from the deposit and investment of money in the fund;
andPage 4, Line 5(g) The federal share of the medical assistance payments received pursuant to section 25.5-4-503 (2); and
Page 4, Line 6(h) Gifts, grants, or donations received from private or public sources.
Page 4, Line 7SECTION 3. In Colorado Revised Statutes, 10-16-1207, amend (4)(c.5)(III)(C) and (4)(d); and add (4)(e) as follows:
Page 4, Line 810-16-1207. Health insurance affordability board - creation -
Page 4, Line 9membership - powers and duties - subject to open meetings and
Page 4, Line 10public records laws - commissioner rules. (4) The board is authorized to:
Page 4, Line 11(c.5) Further recommend, for approval and establishment by the
Page 4, Line 12commissioner by rule, additional parameters for implementing the
Page 4, Line 13subsidies for state-subsidized individual health coverage plans authorized
Page 4, Line 14by this part 12, including that the coverage required pursuant to state-subsidized individual health coverage plans must:
Page 4, Line 15(III) For a person who, at the time the person applies for
Page 4, Line 16state-subsidized coverage, meets the income requirements to qualify for
Page 4, Line 17emergency medical assistance pursuant to section 25.5-5-103 and who is
Page 4, Line 18a qualified individual who meets the eligibility criteria established in rule
Page 4, Line 19pursuant to subsection (4)(c)(IV) of this section, include coverage that:
Page 5, Line 1(C) To the extent possible with available funding, includes cost
Page 5, Line 2sharing that is further reduced from subsection (4)(c.5)(III)(B) of this
Page 5, Line 3section such that the plan has consumer cost-sharing responsibilities for
Page 5, Line 4emergency services equivalent to cost-sharing responsibilities for emergency medical assistance pursuant to section 25.5-5-103;
andPage 5, Line 5(d) Establish bylaws, as appropriate and consistent with this part 12, for its effective operation; and
Page 5, Line 6(e) Seek, accept, and expend gifts, grants, or donations
Page 5, Line 7from private or public sources that the enterprise may use for
Page 5, Line 8any of the purposes set forth in section 10-16-1205, to cover the
Page 5, Line 9costs of ensuring compliance in the individual market with the
Page 5, Line 10federal Hyde amendment or a similar amendment, and to cover
Page 5, Line 11the costs of ensuring that Coloradans have access to legally
Page 5, Line 12protected health-care activities, as defined in section 12-30-121
Page 5, Line 13(1)(d). The enterprise shall consider the feasibility of allocating
Page 5, Line 14gifts, grants, or donations received from specific localities or directed to specific localities to be used only in those localities.
Page 5, Line 15SECTION 4. In Colorado Revised Statutes, 12-280-403, add (1.5) as follows:
Page 5, Line 1612-280-403. Prescription drug use monitoring program -
Page 5, Line 17registration required - applications - rules - appropriation. (1.5) The
Page 5, Line 18requirements of this section do not apply to a prescription for
Page 5, Line 19testosterone. The division shall block archived testosterone prescriptions from view.
Page 5, Line 20SECTION 5. In Colorado Revised Statutes, 12-280-404, amend (2)(c) as follows:
Page 5, Line 2112-280-404. Program operation - access - rules - definitions.
Page 6, Line 1(2) (c) (I) Except as provided in subsection (2)(c)(II) of this
Page 6, Line 2section, the program shall track all controlled substances dispensed in
Page 6, Line 3this state. Each pharmacy shall upload all controlled substances dispensed
Page 6, Line 4in each pharmacy in accordance with all applicable reporting requirements.
Page 6, Line 5(II) The requirements of this section do not apply to a
Page 6, Line 6prescription for testosterone. The division shall block archived testosterone prescriptions from view.
Page 6, Line 7SECTION 6. Safety clause. The general assembly finds,
Page 6, Line 8determines, and declares that this act is necessary for the immediate
Page 6, Line 9preservation of the public peace, health, or safety or for appropriations for
Page 6, Line 10the support and maintenance of the departments of the state and state institutions.