A monumental session for physicians and patients

by Cecilia Comerford-Ames

The Colorado General Assembly concluded its 2024 legislative session on May 8, adjourning sine die. This session was marked by significant victories for physicians and patients alike, showcasing the power of organized advocacy and the importance of legislative engagement. The Colorado Medical Society (CMS) played a crucial role in driving several key legislative outcomes, reflecting the priorities of physicians and ensuring that the state's health care system remains responsive to the needs of patients.

Advocacy in action: Success by the numbers

  • 1,822 advocacy messages were sent to legislators by physicians and practice staff, demonstrating a robust and active engagement.
  • 38 positions on bills were taken by the CMS Council on Legislation, with 62 bills closely monitored by staff.
  • 14 meetings were held by the Council on Legislation in the month before and during the session, ensuring thorough  advocacy.

Major legislative wins

Several critical bills were passed, and significant progress was made in areas that directly impact physicians and their ability to provide crucial and quality care.

HB24-1472 Raise Damage Limit Tort Actions: The epic attack on Colorado’s stable tort environment is over and the prospect of catastrophic November ballot initiatives has been averted. With just days left in the legislative session, a deal was brokered by Alec Garnett, Gov. Polis’s chief of staff, with Coloradans Protecting Patient Access (CPPA) and Colorado Trial Lawyers Association (CTLA) to increase non-economic damage caps. CMS partnered with COPIC, the Colorado Hospital Association and many others through CPPA over the past year to protect patient access to care, safeguard the stable liability climate, preserve peer review, and avoid a costly ballot fight. Hours of final negotiations led to the introduction of HB24-1472, which passed the day before sine die. The bill will increase the medical non-economic damages cap over a five-year period from the current $300,000 cap to $875,000 and establish a new wrongful death cap at $1.575 million. Starting in 2030, the medical caps will be adjusted for inflation every two years. Separately, the bill will also increase general liability non-economic damage and wrongful death caps over time.

“The most immediate win of this compromise is the withdrawal of ballot measures that would have potentially eliminated non-economic damage caps altogether and obliterated peer review protections that promote patient safety in medical care. This would have risked access to care and caused health care costs to skyrocket for all Coloradans, particularly those in underserved and rural communities,” said CMS President Omar Mubarak, MD, MBA. “Instead, the medical community did the right thing by our patients and compromised on the numbers to preserve the cap, protect confidentiality and stabilize our health care system as a whole. We are grateful to Gov. Polis and our legislative sponsors for getting this done at the state Capitol instead of punting it to the ballot, which would have resulted in a divisive, expensive and potentially detrimental fight.”

HB24-1149 Prior Authorization Requirements Alternatives: After a three-year effort with Colorado Academy of Family Physicians and other state specialty societies, commercial health plan prior authorization requirements will get some much-needed changes. This bill places more health care decisions in the hands of patients and physicians. Rhonda Parker, DO, testified, “Nothing is more frustrating than when these painstakingly thought-out decisions regarding a procedure or medication are taken out of the hands of me and my patient because of outdated, overly bureaucratic prior authorization processes.”

This bill extends prior authorization approvals from 180 days to a full calendar year and increases approval timeframes for chronic medications to three years under certain circumstances. The bill also prohibits denials for additional care during surgery if it was previously approved and requires the development of alternative programs for prior authorization. These changes will take effect in January 2026. This success was greatly aided by CMS's "Health Can't Wait" campaign, which collected compelling stories from patients and physicians.

HB24-1058 Protect Privacy of Biological Data: This groundbreaking legislation protects individuals' personal biological data, including neural data collected by devices. Read more about this bill in the Final Word, written by bill champion Sean Pauzauskie, MD.

Three bills were passed addressing the opioid crisis.

  • HB24-1003: This bill works to get Naloxone into schools.
  • HB24-1037: This bill creates more harm reduction policies.
  • HB24-1045: This bill expands treatment for substance use disorders.

Speaking specifically about HB24-1003, CMS President Mubarak said, “The Colorado Medical Society prioritizes child safety. Supporting legislation to distribute opiate antagonists on school buses and to students who receive training reinforces our commitment to protecting every member of our community. Now, with the proper training and legal protections in place, we stand ready to act decisively in opioid emergencies, ensuring the wellbeing of all Coloradans. We thank the American Medical Association for their leadership on combatting the opioid epidemic, and their support on this and other solutions to this multifaceted issue."

SB24-221 Funding for Rural Health Care: This bill, passed on the last day of the session, aims to increase the number of health care professionals in rural counties, addressing a critical workforce capacity issue. It builds on the work of another bill passed in 2022, SB22-172. Sen. Dylan Roberts (D) was co-prime sponsor of SB24-221 and as a representative in 2022 was a co-prime sponsor of SB22-172. He said of the first bill’s passage: “This program is exactly what my part of the state and all of rural Colorado needs and deserves: dedicated resources to recruit, train and place doctors, nurses and other health care professionals into rural communities, and to allow the state’s higher education institutions the opportunity to be a part of this exciting initiative.”

Bills successfully defeated or amended

While many bills were championed by CMS, we kept an eye on all bills impacting medicine, reflecting CMS's commitment to patient safety, appropriate scope of practice and practice viability.

HB24-1171 Naturopathic Doctors Formulary: This bill, which would have allowed naturopaths to prescribe most schedule III-V drugs, was defeated. CMS remains vigilant in opposing inappropriate scope of practice expansions that could compromise patient safety. CMS President-elect Kim Warner, MD, gave impactful testimony: “Contrary to some misconceptions, this isn't a turf battle; it's about safeguarding patients. With only 55 licensed, in-state naturopaths, mostly in well-resourced areas, the issue at hand is ensuring equitable patient safety standards statewide.”

HB24-1014 Deceptive Trade Practice Significant Impact Standard: This bill was a regurgitation of a bill CMS similarly defeated last year. Had it passed, the bill would have increased liability exposure for physicians by finding automatically that there has been a “public impact” based solely on evidence of an unfair trade practice. Physicians would be liable for treble damages and attorney fees.

HB24-1153 Physician Continuing Education: CMS secured crucial amendments to this bill, reducing the mandated CME hours and allowing for national board certification to meet the requirements. CMS will engage with the Colorado Medical Board in their consideration of whether to require specific topics for CME.

Ongoing battles and future priorities

Several bills that did not pass this session remain priorities for the CMS, ensuring continued advocacy in the years to come.

SB24-163 Arbitration of Health Insurance Claims: Although this bill, supported by CMS, was postponed indefinitely, it highlighted ongoing issues with the current arbitration process for out-of-network claims. The drive to level the playing field against unfair health plan practices and ensure fair arbitration processes for physicians continues.

SB24-082 Patient's Right to Provider Identification: This bill aimed to improve transparency by helping patients understand the qualifications and training of their health care providers. Despite its postponement, CMS remains committed to ensuring patients can make informed decisions about their care.

SB24-062 Prohibit Attorney Fees on Personal Injury Interest: This bill was killed in committee. Patients should get the timely awards they are owed from a lawsuit. CMS strongly supported this bill that aimed to put an end to the longstanding trial lawyer practice of delaying action on cases because they make more money by claiming 9 percent interest per annum on damages from the date the cause of an action accrued to the date the judgment is satisfied.

Bills passed in 2024 will make monumental changes in Colorado for years to come

The 2024 legislative session was a monumental year for advancing health care priorities in Colorado. The collaborative efforts of CMS, House of Medicine specialty society partners, CPPA, COPIC, CHA and dedicated health care advocates resulted in significant legislative victories that will benefit physicians and patients across the state. As we look ahead, continued advocacy and engagement will be essential to maintaining and building on these successes, ensuring that Colorado's health care system remains a model of excellence.

What physicians need to know now about:

House Bill 24-1472 Raise Damage Limit Tort Actions

  • The damages limitations for noneconomic damages in medical liability increase to $415,000 effective Jan. 1, 2025 for actions filed on or after that date that accrued on or after Jan. 1, 2024.
  • The damages limitation will rise over the next five years to $875,000. That limitation will be adjusted for inflation every two years beginning Jan. 1, 2030.
  • A new, separate claim for wrongful death will increase to $1.575 million over five years.
  • Starting in 2030, both will be automatically adjusted for inflation every two years.

House Bill 24-1149 Prior Authorization Requirements

Starting Jan. 1, 2026:

  • For denial of a prior authorization request, a carrier must identify relevant alternative services or treatment that may be a covered benefit or are required before approval.
  • For denial of a prior authorization request for a prescription drug, a carrier must specify which dosages or alternative drugs in the same class of medication are a covered benefit.
  • The duration of prior authorization approvals is extended from the current 180 days to a new duration of one year or the length of treatment.
  • The duration of prior authorizations for chronic medications will generally be three years. Drugs that cost more than $30,000 annually may be subject to a one-year approval.
  • A carrier is prohibited from denying coverage for surgical care that was approved but then during surgery requires a medically necessary additional or related covered procedure that would likely harm the patient to delay.
  • Each carrier must post on a publicly facing website prior authorization requirements and restrictions, formulary requirements, and outcomes data in a searchable format.

Categories: Communications, Colorado Medicine, Cover Story, Resources, Initiatives, Advocacy