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.
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.
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 2, Line 20medical providers' patients, who risk losing access to medically necessary and life-saving parenteral nutrition treatment.
Page 3, Line 1(d) Federal law establishes early and periodic screening,
Page 3, Line 2diagnosis, and treatment requirements as the cornerstone medicaid health
Page 3, Line 3coverage for children. Pursuant to 42 U.S.C. sec. 1396 and sec. 1396d
Page 3, Line 4(r)(5), children enrolled in medicaid are eligible for early and periodic
Page 3, Line 5screening, diagnosis, and treatment benefits. As a result, the state must
Page 3, Line 6ensure that children enrolled in medicaid have timely access to medically necessary health care in the most appropriate setting.
Page 3, Line 7(e) It is not clear if the medicaid reimbursement methodologies
Page 3, Line 8that are currently in place in Colorado are sufficient to cover the extensive
Page 3, Line 9costs of producing parenteral nutrition and other specialty pharmaceuticals.
Page 3, Line 10(2) Therefore, the general assembly declares that it is necessary to
Page 3, Line 11ensure that Colorado medicaid members have access to an adequate network of infusion pharmacies supplying parenteral nutrition.
Page 3, Line 12SECTION 2. In Colorado Revised Statutes, add 25.5-5-519 as follows:
Page 3, Line 1325.5-5-519. Pharmacy reimbursement - parenteral nutrition
Page 3, Line 14- report - definitions. (1) As used in this section, unless the context otherwise requires:
Page 3, Line 15(a) "Infusion pharmacy" means a pharmacy that prepares
Page 3, Line 16and dispenses a solution that includes parenteral nutrition for
Page 3, Line 17direct administration into a patient's bloodstream. The solution
Page 3, Line 18may contain medications or other treatments and may be administered in a patient's home or in a health-care facility.
Page 3, Line 19(b) "Parenteral nutrition" means a form of nutritional
Page 3, Line 20support that provides a patient with needed nutrients, including,
Page 4, Line 1at a minimum, carbohydrates, amino acids, and lipids, through an intravenous infusion.
Page 4, Line 2(2) The state department shall ensure policies and
Page 4, Line 3reimbursement levels for infusion pharmacies for the
Page 4, Line 4preparation and dispensing of parenteral nutrition are
Page 4, Line 5sufficient to encourage an adequate level of market
Page 4, Line 6participation among infusion pharmacies. An adequate level of
Page 4, Line 7market participation provides a member who needs parenteral
Page 4, Line 8nutrition a choice between at least two infusion pharmacies, regardless of the member's age or duration of need.
Page 4, Line 9(3) Notwithstanding section 24-1-136 (11)(a)(I), on or
Page 4, Line 10before November 1, 2025, and on or before every November 1
Page 4, Line 11thereafter, the state department shall, within existing
Page 4, Line 12appropriations, report in its presentation to the joint budget
Page 4, Line 13committee and its "SMART Act" hearing held pursuant to section 2-7-203 on:
Page 4, Line 14(a) The total number and geographic distribution of
Page 4, Line 15infusion pharmacies throughout Colorado that provide parenteral nutrition to members;
Page 4, Line 16(b) Separate data on the parenteral nutrition needs of
Page 4, Line 17adult and child members and the sufficiency of the infusion pharmacy network to serve each; and
Page 4, Line 18(c) Any regulatory or reimbursement changes the state
Page 4, Line 19department has undertaken to encourage an adequate level of
Page 4, Line 20market participation among infusion pharmacies to meet the parenteral nutrition needs of members.
Page 4, Line 21SECTION 3. Act subject to petition - effective date. This act
Page 5, Line 1takes effect at 12:01 a.m. on the day following the expiration of the
Page 5, Line 2ninety-day period after final adjournment of the general assembly; except
Page 5, Line 3that, if a referendum petition is filed pursuant to section 1 (3) of article V
Page 5, Line 4of the state constitution against this act or an item, section, or part of this
Page 5, Line 5act within such period, then the act, item, section, or part will not take
Page 5, Line 6effect unless approved by the people at the general election to be held in
Page 5, Line 7November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.