A Bill for an Act
Page 1, Line 101Concerning the "Diabetes Prevention and Obesity Treatment
Page 1, Line 102Act".
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.)
The bill requires private insurance companies to provide coverage for the treatment of the chronic disease of obesity and the treatment of pre-diabetes, including coverage for the national diabetes prevention program, medical nutrition therapy, intensive behavioral or lifestyle therapy, metabolic and bariatric surgery, and FDA-approved anti-obesity medication.
The bill requires the department of health care policy and financing (department) to seek federal authorization to provide treatment for the chronic disease of obesity and the treatment of pre-diabetes. Within existing appropriations and upon receiving federal authorization, the department is required to notify medicaid members in writing about the availability of the treatment.
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 2SECTION 1. Short title. The short title of this act is the "Diabetes Prevention and Obesity Treatment Act".
Page 2, Line 3SECTION 2. Legislative declaration. (1) The general assembly finds and declares that:
Page 2, Line 4(a) In Colorado, the prevalence of the chronic disease of obesity
Page 2, Line 5is staggering. Obesity affects over 24% of Colorado adults, with
Page 2, Line 6disproportionately high rates in communities of color: 33.4% and 31% of
Page 2, Line 7Black and Latino Coloradans experience obesity, respectively. More than
Page 2, Line 8one in 4 youth ages 10 to 17 are either overweight or experiencing
Page 2, Line 9obesity, and 24.3% of children enrolled in the federal special
Page 2, Line 10supplemental nutrition program for women, infants, and children in 2020 were overweight or experiencing obesity.
Page 2, Line 11(b) The American Medical Association and the American
Page 2, Line 12Academy of Pediatrics declared obesity a chronic disease in 2013, and the
Page 2, Line 13American Diabetes Association has recognized obesity as a complex,
Page 2, Line 14progressive, serious, relapsing, and costly chronic disease. Obesity serves
Page 2, Line 15as a major risk factor for developing comorbid conditions, including heart
Page 2, Line 16disease, stroke, type 2 diabetes, renal disease, non-alcoholic
Page 2, Line 17steatohepatitis, and 13 types of cancer. Research shows that obesity and
Page 2, Line 18diabetes increase the risk of more severe coronavirus infection and
Page 2, Line 19hospitalization. Obesity also contributes to many chronic and costly
Page 3, Line 1conditions and increases risk of physical injury, including falls, sprains, strains, lower extremity fractures, and joint dislocation.
Page 3, Line 2(c) Strong and consistent evidence shows that effective weight
Page 3, Line 3management can delay the progression from pre-diabetes to type 2
Page 3, Line 4diabetes and is highly beneficial in treating type 2 diabetes. In people with
Page 3, Line 5type 2 diabetes who are also overweight or experiencing obesity, modest
Page 3, Line 6weight management clinically improves health, including reducing
Page 3, Line 7glycemia levels and reducing the need for glucose-lowering medications.
Page 3, Line 8Greater weight management substantially reduces A1C and fasting
Page 3, Line 9glucose levels and has been shown to support sustained diabetes remission for at least 2 years.
Page 3, Line 10(d) The 2023 American Academy of Pediatrics obesity guidelines
Page 3, Line 11recommend that comprehensive, evidence-based obesity treatment for
Page 3, Line 12youth should include timely initiation of intensive behavioral or lifestyle
Page 3, Line 13therapy, anti-obesity medications, and bariatric surgery, and that these
Page 3, Line 14treatment options are safe and effective. Eight out of 10 adolescents with
Page 3, Line 15obesity will continue to have obesity as adults. Treatment significantly
Page 3, Line 16improves an individual's health and quality of life and has the potential to
Page 3, Line 17significantly reduce health-care costs by preventing the development and progression of obesity-related complications, including diabetes.
Page 3, Line 18SECTION 3. In Colorado Revised Statutes, 10-16-104, add (29) as follows:
Page 3, Line 1910-16-104. Mandatory coverage provisions - applicability -
Page 3, Line 20rules - definitions. (29) Anti-obesity medications. (a) All individual
Page 3, Line 21and group health benefit plans issued or renewed in this state
Page 3, Line 22must provide coverage for the treatment of the chronic disease
Page 3, Line 23of obesity and the treatment of pre-diabetes, including
Page 4, Line 1coverage for the national diabetes prevention program, medical
Page 4, Line 2nutrition therapy, intensive behavioral or lifestyle therapy,
Page 4, Line 3metabolic and bariatric surgery, and FDA-approved anti-obesity medication.
Page 4, Line 4(b) The coverage criteria for FDA-approved anti-obesity
Page 4, Line 5medication must not be more restrictive than FDA-approved indications for the medication.
Page 4, Line 6(c) The coverage required pursuant to this subsection (29)
Page 4, Line 7must not be different or separate from coverage for any other
Page 4, Line 8illness, condition, or disorder for purposes of determining
Page 4, Line 9copayments, deductibles, coinsurance, or annual maximum benefit.
Page 4, Line 10(d) This subsection (29) does not prohibit a plan from
Page 4, Line 11applying utilization management to determine medical necessity
Page 4, Line 12and appropriateness for treatment of the chronic disease of
Page 4, Line 13obesity and the treatment of pre-diabetes if the determinations
Page 4, Line 14are made in the same manner as determinations made for the
Page 4, Line 15treatment of any other illness, condition, or disorder covered by the plan.
Page 4, Line 16(e) This subsection (29) does not apply to a specialized
Page 4, Line 17health-care service plan or contract that covers only dental or vision benefits or to a medicare supplemental contract.
Page 4, Line 18(f) (I) The commissioner shall submit to the federal department of health and human services:
Page 4, Line 19(A) A determination as to whether the benefit specified in
Page 4, Line 20this subsection (29) is in addition to essential health benefits and
Page 4, Line 21would be subject to defrayal by the state pursuant to 42 U.S.C. sec. 18031 (d)(3)(B); and
Page 5, Line 1(B) A request that the federal department of health and
Page 5, Line 2human services confirm the division's determination within sixty
Page 5, Line 3days after receipt of the division's request and submission of its determination.
Page 5, Line 4(II) This subsection (29) applies to large employer policies
Page 5, Line 5or contracts issued or renewed on or after January 1, 2026, and
Page 5, Line 6to individual and small group policies and contracts issued on
Page 5, Line 7or after January 1, 2027, and the commissioner shall implement the requirements of this subsection (29) only if:
Page 5, Line 8(A) The division receives confirmation from the federal
Page 5, Line 9department of health and human services that the coverage
Page 5, Line 10specified in this subsection (29) does not constitute an additional
Page 5, Line 11benefit that requires defrayal by the state pursuant to 42 U.S.C. sec. 18031 (d)(3)(B);
Page 5, Line 12(B) The federal department of health and human services
Page 5, Line 13has otherwise informed the division that the coverage does not
Page 5, Line 14require state defrayal pursuant to 42 U.S.C. sec. 18031 (d)(3)(B); or
Page 5, Line 15(C) More than three hundred sixty-five days have passed
Page 5, Line 16since the division submitted its determination and request for
Page 5, Line 17confirmation that the coverage specified in this subsection (29)
Page 5, Line 18is not an additional benefit that requires state defrayal
Page 5, Line 19pursuant to 42 U.S.C. sec. 18031 (d)(3)(B) and the federal
Page 5, Line 20department of health and human services has failed to respond
Page 5, Line 21to the request within that period, in which case the division
Page 5, Line 22shall consider the federal department of health and human
Page 6, Line 1services' unreasonable delay a preclusion from requiring defrayal by the state.
Page 6, Line 2(g) The commissioner shall adopt rules consistent with and as are necessary to implement this subsection (29).
Page 6, Line 3(h) A health-care provider shall follow clinical
Page 6, Line 4guidelines when prescribing an FDA-approved anti-obesity medication.
Page 6, Line 5(i) As used in this subsection (29):
Page 6, Line 6(I) "FDA-approved anti-obesity medication" means a
Page 6, Line 7medication approved by the federal food and drug
Page 6, Line 8administration with an indication for weight management in patients with chronic obesity.
Page 6, Line 9(II) "Intensive behavioral or lifestyle therapy" means an
Page 6, Line 10evidence-based, multi-component behavioral or lifestyle
Page 6, Line 11modification intervention designed to support healthy weight
Page 6, Line 12management as recommended by current clinical standards of
Page 6, Line 13care. Interventions include obesity screening, dietary
Page 6, Line 14assessment, and behavioral counseling and therapy aimed at
Page 6, Line 15weight loss through lifestyle modifications such as changes in
Page 6, Line 16diet and increased physical activity. Therapy for obesity must be
Page 6, Line 17consistent with the United States Preventive Services Task
Page 6, Line 18Force's 5-A behavioral counseling framework: Ask, advise,
Page 6, Line 19assess, assist, and arrange. Interventions may be provided
Page 6, Line 20in-office, virtually through telehealth, or in community-based settings to support patient access and needs.
Page 6, Line 21(III) "Medical nutrition therapy" means the following
Page 6, Line 22nutrition care services that prevent, manage, or treat diseases
Page 7, Line 1or medical conditions, which services may be provided in-office or virtually through telehealth:
Page 7, Line 2(A) Nutrition assessment;
(B) Nutrition diagnosis;
Page 7, Line 3(C) Nutrition intervention; and
(D) Nutrition monitoring and evaluation.
Page 7, Line 4(IV) "Metabolic and bariatric surgery" means metabolic
Page 7, Line 5and bariatric surgery recommended according to the guidelines
Page 7, Line 6published in the 2022 American Society for Metabolic and
Page 7, Line 7Bariatric Surgery and International Federation for the
Page 7, Line 8Surgery of Obesity and Metabolic Disorders: Indications for Metabolic and Bariatric Surgery.
Page 7, Line 9(V) "National diabetes prevention program" means a
Page 7, Line 10structured, evidence-based lifestyle modification program
Page 7, Line 11designed to prevent or delay the onset of diabetes in individuals
Page 7, Line 12at high risk in accordance with 42 U.S.C. sec. 280g-14. The
Page 7, Line 13program follows a standardized curriculum and is focused on
Page 7, Line 14promoting healthy lifestyle changes, including weight loss,
Page 7, Line 15increased physical activity, and healthier eating habits, through individual and group intervention.
Page 7, Line 16SECTION 4. In Colorado Revised Statutes, add 25.5-5-340 as follows:
Page 7, Line 1725.5-5-340. Diabetes prevention and obesity treatment -
Page 7, Line 18anti-obesity medication - federal authorization - utilization
Page 7, Line 19management - report - definitions. (1) The state department shall
Page 7, Line 20seek federal authorization to provide coverage for treatment
Page 7, Line 21for the chronic disease of obesity and the treatment of
Page 8, Line 1pre-diabetes, including the national diabetes prevention
Page 8, Line 2program, medical nutrition therapy, intensive behavioral or
Page 8, Line 3lifestyle therapy, metabolic and bariatric surgery, and FDA-approved anti-obesity medication.
Page 8, Line 4(2) Within existing appropriations and upon receiving
Page 8, Line 5federal authorization, the state department shall implement
Page 8, Line 6this section and notify members in writing about the availability
Page 8, Line 7of treatment for the chronic disease of obesity and the treatment of pre-diabetes provided pursuant to this section.
Page 8, Line 8(3) This section does not prohibit the state department
Page 8, Line 9from conducting utilization management to determine medical
Page 8, Line 10necessity for treatment of the chronic disease of obesity and the treatment of pre-diabetes provided pursuant to this section.
Page 8, Line 11(4) Beginning in the 2027 legislative session, and each year
Page 8, Line 12thereafter, the state department shall include as part of its
Page 8, Line 13presentation during its "SMART Act" hearing required by
Page 8, Line 14section 2-7-203 information concerning the efforts to reduce
Page 8, Line 15and manage the chronic disease of obesity and the treatment of pre-diabetes, including:
Page 8, Line 16(a) The prevalence and diagnosis rates of obesity; and
Page 8, Line 17(b) Utilization of obesity intervention services and
Page 8, Line 18health improvements, including diabetes prevention and management and improvements to cardiovascular health.
Page 8, Line 19(5) A health-care provider shall follow clinical
Page 8, Line 20guidelines when prescribing an FDA-approved anti-obesity medication.
Page 8, Line 21(6) As used in this section:
Page 9, Line 1(a) "FDA-approved anti-obesity medication" means a
Page 9, Line 2medication approved by the federal food and drug
Page 9, Line 3administration with an indication for weight management in patients with chronic obesity.
Page 9, Line 4(b) "Intensive behavioral or lifestyle therapy" means an
Page 9, Line 5evidence-based, multi-component behavioral or lifestyle
Page 9, Line 6modification intervention designed to support healthy weight
Page 9, Line 7management as recommended by current clinical standards of
Page 9, Line 8care. Interventions include obesity screening, dietary
Page 9, Line 9assessment, and behavioral counseling and therapy aimed at
Page 9, Line 10weight loss through lifestyle modifications such as changes in
Page 9, Line 11diet and increased physical activity. Therapy for obesity must be
Page 9, Line 12consistent with the United States Preventive Services Task
Page 9, Line 13Force's 5-A behavioral counseling framework: Ask, advise,
Page 9, Line 14assess, assist, and arrange. Interventions may be provided
Page 9, Line 15in-office, virtually through telehealth, or in community-based settings to support patient access and needs.
Page 9, Line 16(c) "Medical nutrition therapy" means the following
Page 9, Line 17nutrition care services that prevent, manage, or treat diseases
Page 9, Line 18or medical conditions, which services may be provided in-office or virtually through telehealth:
Page 9, Line 19(I) Nutrition assessment;
(II) Nutrition diagnosis;
Page 9, Line 20(III) Nutrition intervention; and
(IV) Nutrition monitoring and evaluation.
Page 9, Line 21(d) "Metabolic and bariatric surgery" means metabolic
Page 9, Line 22and bariatric surgery recommended according to the guidelines
Page 10, Line 1published in the 2022 American Society for Metabolic and
Page 10, Line 2Bariatric Surgery and International Federation for the
Page 10, Line 3Surgery of Obesity and Metabolic Disorders: Indications for Metabolic and Bariatric Surgery.
Page 10, Line 4(e) "National diabetes prevention program" means a
Page 10, Line 5structured, evidence-based lifestyle modification program
Page 10, Line 6designed to prevent or delay the onset of diabetes in individuals
Page 10, Line 7at high risk in accordance with 42 U.S.C. sec. 280g-14. The
Page 10, Line 8program follows a standardized curriculum and is focused on
Page 10, Line 9promoting healthy lifestyle changes, including weight loss,
Page 10, Line 10increased physical activity, and healthier eating habits, through individual and group intervention.
Page 10, Line 11SECTION 5. Act subject to petition - effective date. This act
Page 10, Line 12takes effect at 12:01 a.m. on the day following the expiration of the
Page 10, Line 13ninety-day period after final adjournment of the general assembly; except
Page 10, Line 14that, if a referendum petition is filed pursuant to section 1 (3) of article V
Page 10, Line 15of the state constitution against this act or an item, section, or part of this
Page 10, Line 16act within such period, then the act, item, section, or part will not take
Page 10, Line 17effect unless approved by the people at the general election to be held in
Page 10, Line 18November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.