A Bill for an Act
Page 1, Line 101Concerning the adequacy of the infusion pharmacy network
Page 1, Line 102supplying parenteral nutrition to medicaid members,
Page 1, Line 103and, in connection therewith, making an appropriation.
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.)
Infusion pharmacies supply medicaid members with parenteral nutrition, which provides patients with essential nutrients through an intravenous infusion.
The bill requires the state department of health care policy and financing (state department) to ensure policies and reimbursement levels for infusion pharmacies for the preparation and dispensing of parenteral nutrition are sufficient to encourage an adequate level of market participation among infusion pharmacies.
The bill requires the state department to annually report on the adequacy of the infusion pharmacy network that supplies parenteral nutrition to medicaid members.
This Unofficial Version Includes Committee
Amendments Not Yet Adopted on Second Reading
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 2SECTION 1. Legislative declaration. (1) The general assembly finds and declares that:
Page 2, Line 3(a) Parenteral nutrition is a feeding method that bypasses the
Page 2, Line 4gastrointestinal tract and delivers nutrition directly into a patient's veins.
Page 2, Line 5Parenteral nutrition is the only way for some patients with significant
Page 2, Line 6feeding and digestion disabilities to survive. Children who need parenteral nutrition may need it their entire lives.
Page 2, Line 7(b) Because parenteral nutrition is highly regulated and specially
Page 2, Line 8formulated for each individual patient, it is expensive to produce and
Page 2, Line 9store, according to data from the American Society for Parenteral and
Page 2, Line 10Enteral Nutrition. Infusion pharmacies that make parenteral nutrition and
Page 2, Line 11other in-home infusion medications must dedicate time, training, and
Page 2, Line 12facilities to their formulation. Infusion pharmacies must produce
Page 2, Line 13parenteral nutrition daily, with frequent formulation changes, and must
Page 2, Line 14ensure that the parenteral nutrition meets all safety and quality regulations.
Page 2, Line 15(c) According to recent data from the American Society for
Page 2, Line 16Parenteral and Enteral Nutrition, because of recent financial pressures,
Page 2, Line 17many infusion pharmacies have stopped supplying parenteral nutrition
Page 2, Line 18across the nation, particularly for children. As a result, medical providers
Page 2, Line 19spend more time locating infusion pharmacies that will agree to serve the
Page 3, Line 1medical providers' patients, who risk losing access to medically necessary and life-saving parenteral nutrition treatment.
Page 3, Line 2(d) Federal law establishes early and periodic screening,
Page 3, Line 3diagnosis, and treatment requirements as the cornerstone medicaid health
Page 3, Line 4coverage for children. Pursuant to 42 U.S.C. sec. 1396 and sec. 1396d
Page 3, Line 5(r)(5), children enrolled in medicaid are eligible for early and periodic
Page 3, Line 6screening, diagnosis, and treatment benefits. As a result, the state must
Page 3, Line 7ensure that children enrolled in medicaid have timely access to medically necessary health care in the most appropriate setting.
Page 3, Line 8(e) It is not clear if the medicaid reimbursement methodologies
Page 3, Line 9that are currently in place in Colorado are sufficient to cover the extensive
Page 3, Line 10costs of producing parenteral nutrition and other specialty pharmaceuticals.
Page 3, Line 11(2) Therefore, the general assembly declares that it is necessary to
Page 3, Line 12ensure that Colorado medicaid members have access to an adequate network of infusion pharmacies supplying parenteral nutrition.
Page 3, Line 13SECTION 2. In Colorado Revised Statutes, add 25.5-5-519 as follows:
Page 3, Line 1425.5-5-519. Pharmacy reimbursement - parenteral nutrition
Page 3, Line 15- report - definitions. (1) As used in this section, unless the context otherwise requires:
Page 3, Line 16(a) "Infusion pharmacy" means a prescription drug outlet
Page 3, Line 17that prepares and dispenses a solution that includes parenteral
Page 3, Line 18nutrition for direct administration into a patient's bloodstream.
Page 3, Line 19The solution may contain medications or other treatments and
Page 3, Line 20may be administered in a patient's home or in a health-care
Page 3, Line 21facility.
Page 4, Line 1(b) "Parenteral nutrition" means a form of nutritional
Page 4, Line 2support that provides a patient with needed nutrients, including,
Page 4, Line 3at a minimum, carbohydrates, amino acids, and lipids, through an intravenous infusion.
Page 4, Line 4(2) (a) Upon receiving any necessary federal approval
Page 4, Line 5pursuant to subsection (2)(c) of this section, beginning on or
Page 4, Line 6before January 1, 2026, the state department shall create
Page 4, Line 7specific professional dispensing fees for the preparation and
Page 4, Line 8dispensing of parenteral nutrition to encourage an adequate level of market participation among infusion pharmacies.
Page 4, Line 9(b) During the year beginning January 1, 2026, the specific
Page 4, Line 10professional dispensing fees must not exceed thirty percent of
Page 4, Line 11infusion pharmacy administrative costs for the preparation and dispensing of parenteral nutrition.
Page 4, Line 12(c) The state department shall seek federal
Page 4, Line 13authorization, as necessary, to implement the professional dispensing fees pursuant to this subsection (2).
Page 4, Line 14(3) Notwithstanding section 24-1-136 (11)(a)(I), on or
Page 4, Line 15before November 1,2026,and on or before every November 1
Page 4, Line 16thereafter, the state department shall, within existing
Page 4, Line 17appropriations, report in its presentation to the joint budget
Page 4, Line 18committee and its "SMART Act" hearing held pursuant to section 2-7-203 on:
Page 4, Line 19(a) The total number and geographic distribution of
Page 4, Line 20infusion pharmacies throughout Colorado that provide parenteral nutrition to members;
Page 4, Line 21(b) The number of new infusion pharmacies participating in the medical assistance program;
Page 5, Line 1(c) Separate data on the parenteral nutrition needs of
Page 5, Line 2adult and child members and the sufficiency of the infusion pharmacy network to serve each; and
Page 5, Line 3(d) Any regulatory or reimbursement changes the state
Page 5, Line 4department has undertaken to encourage an adequate level of
Page 5, Line 5market participation among infusion pharmacies to meet the parenteral nutrition needs of members.
Page 5, Line 6SECTION 3. Appropriation. (1) For the 2025-26 state fiscal
Page 5, Line 7year, $54,832 is appropriated to the department of health care policy and
Page 5, Line 8financing. This appropriation is from the general fund, which amount is
Page 5, Line 9subject to the "(M)" notation as defined in the annual general
Page 5, Line 10appropriation act for the same fiscal year. To implement this act, the
Page 5, Line 11department may use this appropriation for medical and long-term care services for medicaid eligible individuals.
Page 5, Line 12(2) For the 2025-26 state fiscal year, the general assembly
Page 5, Line 13anticipates that the department of health care policy and financing will
Page 5, Line 14receive $54,832 in federal funds to implement this act. The appropriation
Page 5, Line 15in subsection (1) of this section is based on the assumption that the
Page 5, Line 16department will receive this amount of federal funds to be used for
Page 5, Line 17general professional services and special projects medical and long-term care services for medicaid eligible individuals.
Page 5, Line 18SECTION 4. Act subject to petition - effective date. This act
Page 5, Line 19takes effect at 12:01 a.m. on the day following the expiration of the
Page 5, Line 20ninety-day period after final adjournment of the general assembly; except
Page 5, Line 21that, if a referendum petition is filed pursuant to section 1 (3) of article V
Page 5, Line 22of the state constitution against this act or an item, section, or part of this
Page 6, Line 1act within such period, then the act, item, section, or part will not take
Page 6, Line 2effect unless approved by the people at the general election to be held in
Page 6, Line 3November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.