(1) (a) A prescriber shall not prescribe more than a seven-day supply of an opioid to a patient who has not obtained an opioid prescription from that prescriber within the last twelve months and may exercise discretion to include a second fill for a seven-day supply. The limits on initial prescribing do not apply if, in the judgment of the prescriber, the patient:
(I) Has chronic pain that typically lasts longer than ninety days or past the time of normal healing, as determined by the prescriber, or following transfer of care from another prescriber who practices the same profession and who prescribed an opioid to the patient;
(II) Has been diagnosed with cancer and is experiencing cancer-related pain;
(III) Is experiencing post-surgical pain that, because of the nature of the procedure, is expected to last more than fourteen days; or
(IV) Is undergoing palliative care or hospice care focused on providing the patient with relief from symptoms, pain, and stress resulting from a serious illness in order to improve quality of life; except that this subsection (1)(a)(IV) applies only if the prescriber is a physician, a physician assistant, or an advanced practice registered nurse.
(b) Prior to prescribing any opioid or benzodiazepine prescription pursuant to this section, a prescriber must comply with section 12-280-404 (4). Failure to comply with section 12-280-404 (4) constitutes unprofessional conduct or grounds for discipline, as applicable, under section 12-220-201, 12-240-121, 12-245-224, 12-255-120, 12-275-120, 12-290-108, or 12-315-112, as applicable to the particular prescriber, only if the prescriber repeatedly fails to comply.
(2) [Editor's note: This version of subsection (2) is effective until January 1, 2026.] A prescriber licensed pursuant to article 315 of this title 12 may prescribe opioids and benzodiazepines electronically.
(2) [Editor's note: This version of subsection (2) is effective January 1, 2026.] A prescriber licensed pursuant to article 315 of this title 12 may prescribe opioids and benzodiazepines electronically in accordance with section 12-315-305.
(3) A violation of this section does not create a private right of action or serve as the basis of a cause of action. A violation of this section does not constitute negligence per se or contributory negligence per se and does not alone establish a standard of care. Compliance with this section does not alone establish an absolute defense to any alleged breach of the standard of care.
(4) As used in this section, prescriber means:
(a) A dentist licensed pursuant to article 220 of this title 12;
(b) A physician or physician assistant licensed pursuant to article 240 of this title 12;
(c) An advanced practice registered nurse or certified midwife with prescriptive authority pursuant to section 12-255-112;
(d) An optometrist licensed pursuant to article 275 of this title 12;
(e) [Editor's note: This version of subsection (4)(e) is effective until January 1, 2026.] A podiatrist licensed pursuant to article 290 of this title 12; or
(e) [Editor's note: This version of subsection (4)(e) is effective January 1, 2026.] A podiatrist licensed pursuant to article 290 of this title 12;
(f) Repealed.
(f.5) [Editor's note: Subsection (4)(f.5) is effective January 1, 2026.] A veterinarian licensed pursuant to article 315 of this title 12; or
(g) A licensed psychologist with prescriptive authority pursuant to section 12-245-309.
(5) Repealed.
(6) On or before November 1, 2021, the applicable board for each prescriber shall, by rule, limit the supply of a benzodiazepine that a prescriber may prescribe to a patient who has not obtained a benzodiazepine prescription from a prescriber within the last twelve months; except that the rules must not limit the supply of a benzodiazepine prescribed to treat epilepsy, a seizure or seizure disorder, a suspected seizure disorder, spasticity, alcohol withdrawal, or a neurological condition, including a posttraumatic brain injury or catatonia. The rules must allow for appropriate tapering off of benzodiazepines and must not require or encourage abrupt discontinuation or withdrawal of benzodiazepines.
(7) Each prescriber licensed in this state who holds a current registration issued by the federal drug enforcement administration shall register and maintain a user account as specified in section 12-280-403.
Source: L. 2019: Entire title R&RE with relocations, (HB 19-1172), ch. 136, p. 773, � 1, effective October 1; (2) amended, (SB 19-079), ch. 86, p. 316, � 16, effective July 1, 2021; (2) amended, (SB 19-079), ch. 86, p. 316, � 17, effective July 1, 2023. L. 2020: (2) amended, (HB 20-1183), ch. 157, p. 697, � 41, effective July 1; (1)(b) amended, (HB 20-1056), ch. 64, p. 262, � 2, effective September 14. L. 2021: IP(1)(a), (1)(a)(I), (1)(a)(IV), (1)(b), (2), and IP(4) amended, (5) repealed, and (6) added, (HB 21-1276), ch. 364, p. 2398, �� 5, 6, and 7, effective July 1. L. 2022: (1)(b) amended and (7) added, (SB 22-027), ch. 265, p. 1933, � 1, effective May 27; (1)(b) amended, (HB 22-1115), ch. 397, p. 2824, � 1, effective August 10; (4)(f) amended, (HB 22-1235), ch. 442, p. 3102, � 7, effective August 10. L. 2023: (4)(c) amended, (SB 23-167), ch. 261, p. 1533, � 28, effective May 25; (1)(b), (4)(e), and (4)(f) amended and (4)(g) added, (HB 23-1071), ch. 6, p. 17, � 2, effective August 7. L. 2024: (4)(e) amended and (4)(f) repealed, (SB 24-047), ch. 440, p. 3069, � 1, effective June 6. L. 2025: (2) and (4)(e) amended and (4)(f.5) added, (HB 25-1285), ch. 305, p. 1603, � 14, effective January 1, 2026.
Editor's note: (1) This section is similar to former � 12-36-117.6 as it existed prior to 2019.
(2) Before its relocation in 2019, this section was amended in SB 19-079. Those amendments were superseded by the repeal and reenactment of this title 12, effective October 1, 2019. For those amendments to the former section in effect from August 2, 2019, to October 1, 2019, see SB 19-079, chapter 86, Session Laws of Colorado 2019.
(3) Amendments to subsection (2) by sections 16 and 17 of SB 19-079 were harmonized, effective July 1, 2023.
(4) Amendments to subsection (1)(b) by SB 22-027 and HB 22-1115 were harmonized.
Cross references: For the legislative declaration in HB 21-1276, see section 1 of chapter 364, Session Laws of Colorado 2021. For the legislative declaration in HB 25-1285, see section 1 of chapter 305, Session Laws of Colorado 2025.
12-30-109.5. Prescription drugs for treatment of chronic pain - patients - prescribers - definitions. (1) As used in this section, unless the context otherwise requires:
(a) Carrier has the same meaning as set forth in section 10-16-102 (8).
(b) (I) Chronic pain means a pain that typically lasts three months or longer and may be the result of an underlying medical disease or condition, injury, medical treatment, inflammation, or unknown cause. Chronic pain is a pain state in which the cause of the pain often cannot be removed with reasonable medical efforts at the consent of the patient, or pain for which no cure can be found after reasonable medical efforts. Chronic pain may restrict the ability of individuals to work, care for themselves, and engage in basic life, social, and physical activities.
(II) Conditions associated with chronic pain may include, but are not limited to, cancer and the recovery period, sickle cell disease, noncancer pain, rare diseases, severe injuries, and health conditions requiring the provision of palliative care or hospice care.
(III) Reasonable efforts for relieving or curing the cause of the chronic pain may be determined on the basis of, but are not limited to, the following:
(A) When treating a nonterminally ill patient for chronic pain, an evaluation conducted by the treating health-care provider or a health-care provider specializing in pain medicine or treatment of the area, system, or organ of the body confirmed or perceived as the source of the chronic pain; or
(B) When treating a terminally ill patient, an evaluation conducted by the treating health-care provider who conducts the evaluation in accordance with the standard of care and the level of care, skill, and treatment that would be recognized by a health-care provider under similar conditions and circumstances.
(c) Drug diversion means the unlawful transfer of prescription drugs from a licit medical purpose to the illicit marketplace.
(d) Health-care provider means a physician, a physician assistant, or an advanced practice registered nurse licensed pursuant to this title 12.
(e) Rare disease means a disease, disorder, or condition that affects fewer than two hundred thousand individuals in the United States and is chronic, serious, life-altering, or life-threatening.
(f) Schedule II, III, IV, or V controlled substance means a controlled substance as described in section 18-18-204, 18-18-205, 18-18-206, or 18-18-207, respectively.
(2) Criteria for the evaluation and treatment of chronic pain. When treating a nonterminally ill patient, the evaluation of the patient and the treatment of the patient's chronic pain is governed by the following criteria:
(a) A diagnosis of a condition causing chronic pain by the treating health-care provider or a health-care provider specializing in pain medicine or treatment of the area, system, or organ of the body confirmed or perceived as the source of the pain that is sufficient to meet the definition of chronic pain; and
(b) The cause of the diagnosis of chronic pain must not interfere with medically necessary treatment, including but not limited to prescribing or administering a schedule II, III, IV, or V controlled substance.
(3) Prescription and administration of controlled substances for chronic pain. (a) Notwithstanding any other provision of law, a health-care provider may prescribe, dispense, or administer a schedule II, III, IV, or V controlled substance to a patient in the course of the health-care provider's treatment of the patient for a diagnosed condition causing chronic pain. A health-care provider is not subject to disciplinary action by the regulator for appropriately prescribing, dispensing, or administering a schedule II, III, IV, or V controlled substance in the course of treatment of a patient for chronic pain if the health-care provider keeps accurate records of the purpose, use, prescription, and disposal of the controlled substance, writes accurate prescriptions, and prescribes medications in accordance with a legitimate medical purpose in the usual course of professional practice.
(b) A health-care provider acting in good faith and based on the needs of the patient with a diagnosed condition causing chronic pain is not subject to discipline from the regulator solely for prescribing a dosage that equates to an upward deviation from morphine milligram equivalent dosage recommendations or from thresholds specified in state or federal opioid prescribing guidelines or policies.
(c) A health-care provider treating a patient with chronic pain by prescribing, dispensing, or administering one or more schedule II, III, IV, or V controlled substances that include, but are not limited to, opioid analgesics shall not be required to taper a patient's medication dosage solely to meet a predetermined morphine milligram equivalent dosage recommendation or threshold if the patient is stable and compliant with the treatment plan and is not experiencing serious harm from the level of medication currently being prescribed or previously prescribed. A decision to taper or maintain medication must include an individualized assessment of the patient's current medical condition and treatment plan, the risks and benefits of maintaining or tapering the patient's medication, and a discussion with the patient.
(d) (I) A pharmacy, carrier, or pharmacy benefit manager shall not have a policy in place that requires the pharmacist to refuse to fill a prescription for an opiate issued by a health-care provider with the authority to prescribe opiates solely because the prescription is for an opiate or because the prescription order exceeds a predetermined morphine milligram equivalent dosage recommendation or threshold.
(II) A health-care practice or clinic in which a health-care provider is authorized to prescribe schedule II, III, IV, or V controlled substances shall not have a policy in place that requires the health-care provider to refuse to prescribe, administer, or dispense a prescription for an opiate solely because the prescription exceeds a predetermined morphine milligram equivalent dosage recommendation or threshold.
(e) Before treating a patient for chronic pain in accordance with this subsection (3), a health-care provider shall discuss with the patient or the patient's legal guardian, if applicable, the risks associated with the schedule II, III, IV, or V controlled substance to be prescribed or administered in the course of the health-care provider's treatment of the patient and document the discussion in the patient's record.
(4) Limits on applicability. (a) This section does not apply to:
(I) A health-care provider's treatment of a patient for a substance use disorder resulting from the use of a schedule II, III, IV, or V controlled substance;
(II) The prescription or administration of a schedule II, III, IV, or V controlled substance to a patient whom the health-care provider knows to be using the controlled substance for nontherapeutic or drug diversion purposes;
(III) The prescription, dispensing, or administration of a schedule II, III, IV, or V controlled substance for the purpose of terminating the life of a patient with chronic pain; or
(IV) The prescription, dispensing, or administration of a schedule II, III, IV, or V controlled substance that is not a controlled substance approved by the federal food and drug administration for pain relief.
(b) This section does not limit the powers and duties of the Colorado medical board pursuant to section 12-240-106 or the state board of nursing pursuant to section 12-255-107.
Source: L. 2023: Entire section added, (SB 23-144), ch. 154, p. 659, � 1, effective May 4.
12-30-110. Prescribing or dispensing opioid antagonists - authorized recipients - definitions. (1) (a) A prescriber may prescribe or dispense, directly or in accordance with standing orders and protocols, an opioid antagonist to an entity on the state board of health's eligible entity list created pursuant to section 25-1.5-115.1 (1).
(b) An eligible entity described in section 25-1.5-115.1 (1) may, pursuant to an order or standing orders and protocols:
(I) Possess an opioid antagonist;
(II) Furnish an opioid antagonist to a family member, friend, or other person who is in a position to assist an individual who is at risk of experiencing an opioid-related drug overdose event; or
(III) Administer an opioid antagonist to an individual experiencing, or who a reasonable person would believe is experiencing, an opioid-related drug overdose event.
(2) (a) A prescriber who prescribes or dispenses an opioid antagonist pursuant to this section is strongly encouraged to educate persons receiving the opioid antagonist on the use of an opioid antagonist for overdose, including instruction concerning risk factors for overdose, recognizing an overdose, calling emergency medical services, rescue breathing, and administering an opioid antagonist.
(b) An eligible entity described in section 25-1.5-115.1 (1) is strongly encouraged to educate employees, agents, and volunteers, as well as persons receiving an opioid antagonist from an eligible entity described in section 25-1.5-115.1 (1), on the use of an opioid antagonist for overdose, including instruction concerning risk factors for overdose, recognizing an overdose, calling emergency medical services, rescue breathing, and administering an opioid antagonist.
(3) A prescriber described in subsection (7)(h) of this section does not engage in unprofessional conduct or is not subject to discipline pursuant to section 12-240-121, 12-255-120, or 12-280-126, as applicable, if the prescriber issues standing orders and protocols regarding opioid antagonists or prescribes or dispenses, pursuant to an order or standing orders and protocols, an opioid antagonist in a good faith effort to assist:
(a) An individual who is at risk of experiencing an opioid-related drug overdose event;
(b) A family member, friend, or other person who is in a position to assist an individual who is at risk of experiencing an opioid-related drug overdose event; or
(c) An eligible entity described in section 25-1.5-115.1 (1) in responding to, treating, or otherwise assisting an individual who is experiencing or is at risk of experiencing an opioid-related drug overdose event or a friend, family member, or other person in a position to assist an at-risk individual.
(3.5) (a) Notwithstanding any provision of this title 12 or rules implementing this title 12, a prescriber prescribing or dispensing an opioid antagonist in accordance with this section, other than a pharmacist or other prescriber prescribing and dispensing from a prescription drug outlet or pharmacy, is not required to comply with laws relating to labeling, storage, or record keeping for the opioid antagonist.
(b) A prescriber prescribing or dispensing an opioid antagonist exempted from labeling, storage, or record-keeping requirements pursuant to this subsection (3.5):
(I) Does not engage in unprofessional conduct or is not subject to discipline pursuant to section 12-240-121 or 12-255-120, as applicable; and
(II) Is not subject to civil liability or criminal prosecution, as specified in sections 13-21-108.7 (4) and 18-1-712 (3), respectively.
(4) (a) A prescriber who prescribes or dispenses an opioid antagonist in accordance with this section is not subject to civil liability or criminal prosecution, as specified in sections 13-21-108.7 (4) and 18-1-712 (3), respectively.
(b) An eligible entity described in section 25-1.5-115.1 (1) acting in accordance with this section is not subject to civil liability or criminal prosecution, as specified in sections 13-21-108.7 (3) and 18-1-712 (2), respectively.
(5) This section does not establish a duty or standard of care for prescribers regarding the prescribing, dispensing, or administering of an opioid antagonist.
(6) Nothing in this section limits or otherwise affects the prescriptive authority of a health-care professional licensed under article 220, 275, 290, or 315 of this title 12.
(7) As used in this section:
(a) Community corrections program has the same meaning as set forth in section 17-27-102 (3).
(a.3) Community service organization means a nonprofit organization that is in good standing and registered with the federal internal revenue service and the Colorado secretary of state's office that provides services to an individual at risk of experiencing an opioid-related drug overdose event or to the individual's family members, friends, or other persons in a position to assist the individual.
(a.5) Correctional facility has the same meaning as set forth in section 17-1-102 (1.7).
(a.7) First responder means:
(I) A peace officer, as defined in section 16-2.5-101;
(II) A firefighter, as defined in section 29-5-203 (10);
(III) A volunteer firefighter, as defined in section 31-30-1102 (9); or
(IV) An emergency medical service provider, as defined in section 25-3.5-103 (8).
(b) Harm reduction organization means an organization that provides services, including medical care, counseling, homelessness services, or drug treatment, to individuals at risk of experiencing an opioid-related drug overdose event or to the friends and family members of an at-risk individual.
(b.2) Institution of higher education means a public or nonpublic institution that awards any type of postsecondary certificate, degree, or other credential and is located in Colorado.
(b.3) Local jail has the same meaning as set forth in section 17-1-102 (7).
(b.4) Local public health agency means an agency established pursuant to section 25-1-506.
(b.5) Mental health professional means a psychologist, social worker, marriage and family therapist, licensed professional counselor, unlicensed psychotherapist, or addiction counselor licensed, registered, or certified under article 245 of this title 12.
(b.7) Multijurisdictional jail has the same meaning as described in section 17-26.5-101.
(b.8) Municipal jail has the same meaning as described in section 31-15-401 (1)(j).
(c) Opioid has the same meaning as opiate, as set forth in section 18-18-102 (21).
(d) Opioid antagonist means naloxone hydrochloride or any similarly acting drug that is not a controlled substance and that is approved by the federal food and drug administration for the treatment of a drug overdose. Opioid antagonist includes an expired opioid antagonist.
(e) Opioid-related drug overdose event means an acute condition, including a decreased level of consciousness or respiratory depression, that:
(I) Results from the consumption or use of a controlled substance or another substance with which a controlled substance was combined;
(II) A layperson would reasonably believe to be caused by an opioid-related drug overdose event; and
(III) Requires medical assistance.
(f) Order has the same meaning as set forth in section 12-280-103 (31).
(g) Pharmacist means an individual licensed by the state pursuant to article 280 of this title 12 to engage in the practice of pharmacy.
(h) Prescriber means:
(I) A physician or physician assistant licensed pursuant to article 240 of this title 12;
(II) An advanced practice registered nurse, as defined in section 12-255-104 (1), or a certified midwife, as defined in section 12-255-104 (3.2), with prescriptive authority pursuant to section 12-255-112; or
(III) A pharmacist.
(h.3) Pretrial services program has the same meaning as described in section 16-4-106.
(h.7) Private contract prison has the same meaning as set forth in section 17-1-102 (7.3).
(i) Protocol means a specific written plan for a course of medical treatment containing a written set of specific directions created by a physician, group of physicians, hospital medical committee, pharmacy and therapeutics committee, or other similar practitioners or groups of practitioners with expertise in the use of opioid antagonists.
(i.5) School means an elementary or secondary public or nonpublic school whose governing authority has adopted and implemented a policy pursuant to section 22-1-119.1.
(j) Standing order means a prescription order written by a prescriber that is not specific to and does not identify a particular patient.
(k) Unit of local government has the same meaning as set forth in section 29-3.5-101 (4).
Source: L. 2019: Entire title R&RE with relocations, (HB 19-1172), ch. 136, p. 774, � 1, effective October 1; (1)(a)(III), (1)(a)(IV), IP(1)(b), (2)(b), IP(3), (3)(c), and (4)(b) amended and (1)(a)(V), (1)(a)(VI), and (7)(i.5) added, (SB 19-227), ch. 273, p. 2583, � 14, effective October 1. L. 2020: IP(1)(b), (2)(b), (3)(c)(III), and (3)(c)(IV) amended and (3)(c)(V) and (7)(b.5) added, (HB 20-1206), ch. 304, p. 1525, � 5, effective July 14. L. 2021: (1)(a)(V), (1)(a)(VI), IP(1)(b), (2)(b), (3)(c)(IV), (3)(c)(V), and (4)(b) amended and (1)(a)(VII), (3)(c)(VI), and (7)(k) added, (SB 21-122), ch. 33, p. 135, � 1, effective April 15; IP(1)(a), (2)(a), IP(3), (4)(a), and (7)(h) amended, (SB 21-094), ch. 314, p. 1943, � 31, effective September 1. L. 2022: (1)(a)(VI), IP(1)(b), (2)(b), (3)(c), (4)(b), and (7)(a) amended and (1)(a)(VIII) to (1)(a)(XXI), (3.5), (7)(a.3), (7)(a.5), (7)(a.7), (7)(b.2), (7)(b.3), (7)(b.4), (7)(b.7), (7)(b.8), (7)(h.3), and (7)(h.7) added, (HB 22-1326), ch. 225, p. 1637, � 12, effective July 1; (4)(b) and (7)(b.5) amended, (HB 22-1307), ch. 207, p. 1371, � 1, effective August 10. L. 2023: (7)(h)(II) amended, (SB 23-167), ch. 261, p. 1533, � 29, effective May 25; (4)(b) amended, (HB 23-1301), ch. 303, p. 1818, � 14, effective August 7. L. 2024: IP(1)(a), (1)(a)(I), (1)(a)(II), (1)(b), (2), (3), (3.5)(a), IP(3.5)(b), (4)(a), (5), (7)(a.3), (7)(b), (7)(c), (7)(d), IP(7)(e), (7)(e)(II), and (7)(i) amended, (HB 24-1037), ch. 458, p. 3166, � 9, effective June 6; (1)(a)(V) amended, (HB 24-1003), ch. 121, p. 396, � 5, effective August 7. L. 2025: (1)(a), IP(1)(b), (2)(b), (3)(c), and (4)(b) amended, (SB 25-164), ch. 168, p. 682, � 6, effective August 6.
Editor's note: (1) Subsection (1)(a) is similar to former � 12-36-117.7 (1); subsection (1)(b) is similar to former � 12-42.5-120 (3)(d)(I); subsection (2)(a) is similar to former � 12-36-117.7 (2); subsection (2)(b) is similar to former � 12-42.5-120 (3)(d)(II); subsection (3) is similar to former � 12-36-117.7 (3); subsection (4)(a) is similar to former � 12-36-117.7 (4); subsection (4)(b) is similar to former � 12-42.5-120 (3)(d)(III); subsection (5) is similar to former � 12-36-117.7 (5); and subsection (7) is similar to former � 12-36-117.7 (6), as those sections existed prior to 2019.
(2) Before its relocation in 2019, this section was amended in SB 19-227. Those amendments were superseded by the repeal and reenactment of this title 12, effective October 1, 2019. For those amendments to the former section in effect from May 23, 2019, to October 1, 2019, see SB 19-227, chapter 273, Session Laws of Colorado 2019.
(3) Amendments to subsection (4)(b) by HB 22-1326 and HB 22-1307 were harmonized.
Cross references: (1) For the legislative declaration in HB 22-1326 stating the purpose of, and the provision directing legislative staff agencies to conduct, a post-enactment review pursuant to � 2-2-1201 scheduled in 2025, see sections 1 and 55 of chapter 225, Session Laws of Colorado 2022. To obtain a copy of the review, once completed, go to Legislative Resources and Requirements on the Colorado General Assembly's website.
(2) For the legislative declaration in HB 24-1003, see section 1 of chapter 121, Session Laws of Colorado 2024.
12-30-111. Electronic prescribing of controlled substances - exceptions - rules - definitions. (1) (a) Except as provided in subsection (1)(b) of this section, on and after July 1, 2021, a prescriber shall prescribe a controlled substance, as defined in section 18-18-102 (5), that is included in schedule II, III, or IV pursuant to part 2 of article 18 of title 18, only by electronic prescription transmitted to a pharmacy unless:
(I) At the time of issuing the prescription, electronic prescribing is not available due to technological or electrical failure;
(II) The prescription is to be dispensed at a pharmacy that is located outside of this state;
(III) The prescriber is dispensing the controlled substance to the patient;
(IV) The prescription includes elements that are not supported by the most recent version of the National Council for Prescription Drug Programs SCRIPT Standard and 21 CFR 1311;
(V) The federal food and drug administration or drug enforcement administration requires the prescription for the particular controlled substance to contain elements that cannot be satisfied with electronic prescribing;
(VI) The prescription is not specific to a patient and allows dispensing of the prescribed controlled substance:
(A) Pursuant to a standing order, approved protocol of drug therapy, or collaborative drug management or comprehensive medication management plan;
(B) In response to a public health emergency; or
(C) Under other circumstances that permit the prescriber to issue a prescription that is not patient-specific;
(VII) The prescription is for a controlled substance under a research protocol;
(VIII) The prescriber writes twenty-four or fewer prescriptions for controlled substances per year;
(IX) The prescriber is prescribing a controlled substance to be administered to a patient in a hospital, nursing care facility, hospice care facility, dialysis treatment clinic, or assisted living residence or to a person who is in the custody of the department of corrections;
(X) The prescriber reasonably determines that the patient would be unable to obtain controlled substances prescribed electronically in a timely manner and that the delay would adversely affect the patient's medical condition; or
(XI) The prescriber demonstrates economic hardship in accordance with rules adopted by the regulator pursuant to subsection (2)(b) of this section.
(b) A prescriber who is a licensed dentist or who is practicing in a rural area of the state or in a practice consisting of only one prescriber shall comply with this subsection (1) on and after July 1, 2023.
(2) The regulator for each prescriber subject to this section shall adopt rules:
(a) Defining what constitutes a temporary technological or electrical failure for purposes of subsection (1)(a)(I) of this section; and
(b) Defining economic hardship for purposes of subsection (1)(a)(XI) of this section and establishing:
(I) The process for a prescriber to demonstrate economic hardship, including the information required to be submitted to allow the regulator to make a determination;
(II) The period during which the economic hardship exception is effective, which period must not exceed one year; and
(III) A process for a prescriber to apply to renew an economic hardship exception, including the information required to be submitted that demonstrates the prescriber's continuing need for the exception.
(3) (a) This section does not:
(I) Create a private right of action;
(II) Serve as the basis of a cause of action; or
(III) Establish a standard of care.
(b) A violation of this section does not constitute negligence per se or contributory negligence per se.
(4) As used in this section:
(a) Prescriber means:
(I) A dentist licensed pursuant to article 220 of this title 12;
(II) A physician or physician assistant licensed pursuant to article 240 of this title 12;
(III) An advanced practice registered nurse or certified midwife with prescriptive authority pursuant to section 12-255-112;
(IV) An optometrist licensed pursuant to article 275 of this title 12; or
(V) A podiatrist licensed pursuant to article 290 of this title 12.
(b) Rural area means a county located in a nonmetropolitan area in the state that either:
(I) Has no municipality within its territorial boundaries with fifty thousand or more permanent residents based upon the most recent population estimates published by the United States census bureau; or
(II) Satisfies alternate criteria for the designation of a rural area as may be promulgated by the federal office of management and budget.
Source: L. 2019: Entire section added, (SB 19-079), ch. 86, p. 316, � 18, effective October 1. L. 2023: (4)(a)(III) amended, (SB 23-167), ch. 261, p. 1533, � 30, effective May 25.
Editor's note: This section is similar to �� 12-32-107.7, 12-35-114.5, 12-36-117.9, 12-38-111.7, and 12-40-109.9 as added in SB 19-079. Those sections were superseded by the repeal and reenactment of this title 12, effective October 1, 2019. For the former sections in effect from August 2, 2019, to October 1, 2019, see SB 19-079, chapter 86, Session Laws of Colorado 2019.
12-30-112. Health-care providers - required disclosures - balance billing - deceptive trade practice - rules - definitions. (1) As used in this section and section 12-30-113:
(a) Ancillary services means:
(I) Diagnostic services, including radiology and laboratory services, unless excluded by rule of the secretary of the United States department of health and human services pursuant to 42 U.S.C. sec. 300gg-132 (b)(3);
(II) Items and services related to emergency medicine, anesthesiology, pathology, radiology, and neonatology, whether or not provided by a physician or nonphysician provider, unless excluded by rule of the secretary of the United States department of health and human services pursuant to section 2799B-2 (b)(3) of the federal No Surprises Act;
(III) Items and services provided by assistant surgeons, hospitalists, and intensivists, unless excluded by rule of the secretary of the United States department of health and human services pursuant to section 2799B-2 (b)(3) of the federal No Surprises Act;
(IV) Items and services provided by an out-of-network provider if there is no in-network provider who can furnish the needed services at the facility; and
(V) Any other items and services provided by specialty providers as established by rule of the commissioner of insurance.
(a.3) Balance bill has the same meaning as set forth in section 10-16-704 (19)(c).
(a.5) Carrier has the same meaning as set forth in section 10-16-102 (8).
(b) Covered person has the same meaning as defined in section 10-16-102 (15).
(c) Emergency services has the same meaning as set forth in section 10-16-704 (19)(e).
(c.5) Federal 'No Surprises Act' means the federal No Surprises Act, Pub.L. 116-260.
(d) Geographic area has the same meaning as set forth in section 10-16-704 (19)(h).
(e) Health benefit plan has the same meaning as defined in section 10-16-102 (32).
(f) Medicare reimbursement rate has the same meaning as set forth in section 10-16-704 (19)(k).
(g) Out-of-network provider means a health-care provider that is not a participating provider.
(h) Participating provider has the same meaning as set forth in section 10-16-102 (46).
(2) On and after January 1, 2020, health-care providers shall develop and provide disclosures to consumers about the potential effects of receiving emergency or nonemergency services from an out-of-network provider. The disclosures must comply with the rules adopted pursuant to subsection (3) of this section.
(3) The regulator, in consultation with the commissioner of insurance and the state board of health created in section 25-1-103, shall adopt rules that specify the requirements for health-care providers to develop and provide consumer disclosures in accordance with this section. The regulator shall ensure that the rules, at a minimum, comply with the notice and consent requirements in subsection (3.5) of this section and the federal No Surprises Act.
(3.5) (a) An out-of-network provider may balance bill a covered person for post-stabilization services in accordance with section 10-16-704 and covered nonemergency services in an in-network facility that are not ancillary services if:
(I) The out-of-network provider provides written notice that the provider will balance bill a covered person at least seventy-two hours in advance of the date of service, if the appointment was scheduled at least seventy-two hours in advance, or at least three hours before the scheduled appointment, if the appointment was made less than seventy-two hours in advance, in either paper or electronic format as selected by the covered person. The notice must be available in the fifteen most common languages in the geographic region in which the out-of-network provider is located. The notice must state:
(A) If applicable, that the health-care provider is out of network with respect to the covered person's health benefit plan;
(B) Effective upon the implementation date of the applicable federal rules, a good faith estimate of the amount of the charges for which the covered person may be responsible;
(C) That the estimate or consent to treatment does not constitute a contract for services;
(D) If the facility is a participating provider and the health-care provider is an out-of-network provider, a list of participating providers at the facility who are able to provide the same services;
(E) Information about whether prior authorization or other care management limitations may be required in advance of receiving the requested services; and
(F) That consent to receive the services from an out-of-network provider is optional and that the covered person may seek services from a participating provider, in which case the cost-sharing responsibility of the covered person would not exceed the responsibility for in-network benefits under the covered person's health benefit plan;
(II) The out-of-network provider obtains signed consent from the covered person that acknowledges that the covered person has been:
(A) Provided with written notice of the covered person's financial responsibility, in the format and language selected by the covered person and within the applicable periods specified in subsection (3.5)(a)(I) of this section; and
(B) Provided written notice that the payment by the covered person for health-care services provided by the out-of-network provider may not accrue toward meeting any limitation that the health benefit plan places on cost sharing, including an explanation that the payment may not apply to an in-network deductible.
(b) If the notice in subsection (3.5)(a)(I) of this section is received within ten days before a scheduled service, the covered person may elect to use the out-of-network provider at the in-network benefit level, and the provider must be reimbursed for the services in accordance with section 10-16-704 (3)(d)(II).
(c) The notice and consent required by this subsection (3.5) must include the date and the time at which the covered person received the written notice and the date on which the consent form was signed. The out-of-network provider shall provide a signed copy of the consent form to the covered person through regular or electronic mail.
(d) An out-of-network provider that obtains a signed consent with respect to furnishing an item or service shall retain the signed consent for at least a seven-year period after the date on which such item or service is furnished.
(3.7) An out-of-network provider shall not balance bill a covered person for services if the provisions of section 10-16-705 (4.5)(c)(II) apply.
(4) Receipt of the disclosures required by this section does not waive a consumer's protections under section 10-16-704 (3) or (5.5) or the consumer's right to benefits under the consumer's health benefit plan at the in-network benefit level for all covered services and treatment received.
(5) This section does not apply to service agencies, as defined in section 25-3.5-103 (11.5), that are publicly funded fire agencies.
(6) A violation of this section is a deceptive trade practice pursuant to section 6-1-105 (1)(xxx).
Source: L. 2019: Entire section added, (HB 19-1174), ch. 171, p. 1995, � 8, effective January 1, 2020. L. 2022: IP(1), (1)(a), (1)(c), (1)(d), (1)(f), (1)(g), and (3) amended and (1)(a.3), (1)(a.5), (1)(c.5), (1)(h), and (3.5) added, (HB 22-1284), ch. 446, p. 3144, � 4, effective August 10. L. 2023: (6) added, (SB 23-093), ch. 152, p. 649, � 9, effective May 4; (1)(a)(V) amended, (HB 23-1301), ch. 303, p. 1819, � 15, effective August 7. L. 2024: (3.7) added, (SB 24-093), ch. 41, p. 148, � 2, effective January 1, 2025.
12-30-113. Out-of-network health-care providers - out-of-network services - billing - payment - deceptive trade practice. (1) If an out-of-network health-care provider provides emergency services or covered nonemergency services to a covered person at an in-network facility, the out-of-network provider shall:
(a) Submit a claim for the entire cost of the services to the covered person's carrier; and
(b) Not bill or collect payment from a covered person for any outstanding balance for covered services not paid by the carrier, except for the applicable in-network coinsurance, deductible, or copayment amount required to be paid by the covered person.
(2) (a) If an out-of-network health-care provider provides covered nonemergency services at an in-network facility or emergency services at an out-of-network or in-network facility and the health-care provider receives payment from the covered person for services for which the covered person is not responsible pursuant to section 10-16-704 (3)(b) or (5.5), the health-care provider shall reimburse the covered person within sixty calendar days after the date that the overpayment was reported to the provider.
(b) An out-of-network health-care provider that fails to reimburse a covered person as required by subsection (2)(a) of this section for an overpayment shall pay interest on the overpayment at the rate of ten percent per annum beginning on the date the provider received the notice of the overpayment. The covered person is not required to request the accrued interest from the out-of-network health-care provider in order to receive interest with the reimbursement amount.
(3) An out-of-network health-care provider shall provide a covered person a written estimate of the amount for which the covered person may be responsible for covered nonemergency services within three business days after a request from the covered person.
(4) (a) An out-of-network health-care provider must send a claim for a covered service to the carrier within one hundred eighty days after the receipt of insurance information in order to receive reimbursement as specified in this subsection (4)(a). The reimbursement rate is the greater of:
(I) One hundred ten percent of the carrier's median in-network rate of reimbursement for that service provided in the same geographic area; or
(II) The sixtieth percentile of the in-network rate of reimbursement for the same service in the same geographic area for the prior year based on claims data from the all-payer health claims database described in section 25.5-1-204.
(b) If the out-of-network health-care provider submits a claim for covered services after the one-hundred-eighty-day period specified in subsection (4)(a) of this section, the carrier shall reimburse the health-care provider one hundred twenty-five percent of the medicare reimbursement rate for the same services in the same geographic area.
(c) The health-care provider shall not bill a covered person any outstanding balance for a covered service not paid for by the carrier, except for any coinsurance, deductible, or copayment amount required to be paid by the covered person.
(5) A health-care provider may initiate arbitration pursuant to section 10-16-704 (15) if the health-care provider believes the payment made pursuant to subsection (4) of this section is not sufficient.
(6) A violation of this section is a deceptive trade practice pursuant to section 6-1-105 (1)(xxx).
Source: L. 2019: Entire section added, (HB 19-1174), ch. 171, p. 1997, � 8, effective January 1, 2020. L. 2020: (4)(a) amended, (SB 20-043), ch. 21, p. 78, � 2, effective March 11. L. 2023: (6) added, (SB 23-093), ch. 152, p. 649, � 10, effective May 4.
Cross references: (1) For definitions applicable to this section, see � 12-30-112.
(2) For the legislative declaration in SB 20-043, see section 1 of chapter 78, Session Laws of Colorado 2020.
12-30-114. Demonstrated competency - opiate prescribers - rules - definition. (1) (a) The regulator for each licensed health-care provider, in consultation with the center for research into substance use disorder prevention, treatment, and recovery support strategies created in section 27-80-118, shall promulgate rules that require each licensed health-care provider, as a condition of renewing, reactivating, or reinstating a license on or after October 1, 2022, to complete up to four credit hours of training per licensing cycle in order to demonstrate competency regarding:
(I) Best practices for opioid prescribing, according to the most recent version of the division's guidelines for the safe prescribing and dispensing of opioids;
(II) The potential harm of inappropriately limiting prescriptions to chronic pain patients;
(III) Best practices for prescribing benzodiazepines;
(IV) Recognition of substance use disorders;
(V) Referral of patients with substance use disorders for treatment; and
(VI) The use of the electronic prescription drug monitoring program created in part 4 of article 280 of this title 12.
(b) The rules promulgated by each regulator shall exempt a licensed health-care provider who:
(I) Maintains a national board certification that requires equivalent substance use prevention training; or
(II) Attests to the regulator that the health-care provider does not prescribe opioids.
(2) For the purposes of this section, licensed health-care provider includes any of the following providers who are licensed pursuant to this title 12:
(a) A physician;
(b) A physician assistant;
(c) A podiatrist;
(d) A dentist;
(e) An advanced practice registered nurse or certified midwife with prescriptive authority;
(f) An optometrist; and
(g) A veterinarian.
Source: L. 2019: Entire section added, (SB 19-228), ch. 276, p. 2609, � 14, effective October 1. L. 2021: (1)(a) amended, (HB 21-1276), ch. 364, p. 2399, � 8, effective July 1. L. 2022: (1) amended, (SB 22-143), ch. 103, p. 483, � 1, effective August 10. L. 2023: (2) amended, (SB 23-167), ch. 261, p. 1534, � 31, effective May 25.
Cross references: For the legislative declaration in HB 21-1276, see section 1 of chapter 364, Session Laws of Colorado 2021.
12-30-115. Required disclosure to patients - conviction of or discipline based on sexual misconduct - signed agreement to treatment - exceptions - violation grounds for discipline - rules - definitions. (1) As used in this section:
(a) Patient means a person who is seeking or receiving health-care services from a provider. The term includes the parent, legal guardian, or custodian of a patient who is a minor under eighteen years of age or a patient who lacks the legal capacity to consent.
(b) Provider means a licensee, certificate holder, or registrant who is subject to the requirements of section 12-30-102.
(2) On or after March 1, 2021, a provider shall disclose to patients any:
(a) Final conviction of or acceptance of a guilty plea by a court for a sex offense, as defined in section 16-11.7-102 (3); or
(b) Final agency action by a regulator that results in probationary status or other limitation on the provider's ability to practice the provider's health-care profession when the final agency action is based in whole or in part on any of the following:
(I) A conviction of or acceptance of a guilty plea by a court for a sex offense, as defined in section 16-11.7-102 (3), or a finding that the provider committed a sex offense as defined in said section; or
(II) A finding that the provider engaged in unprofessional conduct or other conduct that is grounds for discipline under the part or article of this title 12 that regulates the provider's health-care profession, where the failure or conduct is related to, includes, or involves sexual misconduct that results in harm to a patient or presents a significant risk of public harm to patients.
(3) (a) Except as provided in subsection (4) of this section, a provider shall provide the disclosure specified in subsection (2) of this section to the patient in writing, in the form and manner specified by the regulator by rule, before providing professional services to the patient.
(b) For a disclosure of final agency action, the provider shall include the following information, at a minimum, in the written disclosure:
(I) The type, scope, and duration of the agency action imposed, including whether:
(A) The regulator and provider entered into a stipulation;
(B) The agency action resulted from an adjudication decision;
(C) The provider was placed on probation and, if so, the duration and terms of the probation; and
(D) The regulator imposed any limitations on the provider's practice and, if so, a description of the specific limitations and the duration of the limitations;
(II) The nature of the offense or conduct, including the grounds for probation or practice limitations specified in the final agency action;
(III) The date the final agency action was issued;
(IV) The date the probation status or practice limitation ends; and
(V) The contact information for the regulator that imposed the agency action on the provider for the patient to obtain additional information, including information on how to file a complaint.
(c) For a disclosure of a final conviction of or acceptance of a guilty plea by a court for a sex offense, as defined in section 16-11.7-102 (3), the provider shall include the following information, at a minimum, in the written disclosure:
(I) The date that the final judgment of conviction or acceptance of a guilty plea was entered;
(II) The nature of the offense or conduct that led to the final conviction or guilty plea;
(III) The type, scope, and duration of the sentence or other penalty imposed as a result of the final conviction or guilty plea, including whether:
(A) The provider entered a guilty plea or was convicted pursuant to a criminal adjudication; and
(B) The provider was placed on probation and, if so, the duration and terms of the probation and the date the probation ends; and
(IV) The jurisdiction that imposed the final conviction or issued an order approving the guilty plea.
(d) Before treating a patient after a final conviction, guilty plea, or final agency action described in subsection (2) of this section has been imposed or accepted by a court, as applicable, the provider shall obtain the patient's agreement to treatment and acknowledgment of receipt of the disclosure in a form prescribed by the regulator by rule and signed by the provider and the patient. The patient's acknowledgment of receipt of the disclosure does not waive any future claims against the provider.
(e) If a provider is placed on probation as part of a final conviction or acceptance of a guilty plea by a court for a sex offense, as defined in section 16-11.7-102 (3), or on probationary status or other limitation on the provider's ability to practice pursuant to a final agency action described in subsection (2) of this section, the requirement to disclose the conviction, guilty plea, or agency action ends when the provider has satisfied the requirements of the probation or other limitation and is no longer on probation or otherwise subject to a limitation on the ability to practice the provider's profession.
(4) (a) A provider need not make the disclosure required by this section before providing professional services to a patient if any of the following applies:
(I) The patient is unconscious or otherwise unable to comprehend the disclosure and sign an acknowledgment of receipt of the disclosure pursuant to subsection (3)(d) of this section and a guardian of the patient is unavailable to comprehend the disclosure and sign the acknowledgment;
(II) The visit occurs in an emergency room or freestanding emergency department or the visit is unscheduled, including consultations in inpatient facilities; or
(III) The provider who will be treating the patient during the visit is not known to the patient until immediately prior to the start of the visit.
(b) A provider who does not have a direct treatment relationship or have direct contact with the patient is not required to make the disclosure required by this section.
(5) (a) Failure to comply with the requirements of this section:
(I) Constitutes unprofessional conduct or grounds for discipline, as applicable, under the article or part of this title 12 that regulates the provider's health-care profession; and
(II) Does not create a private right of action.
(b) Nothing in this section prevents the discovery of records, reports, or other information, or the admissibility of evidence, related to a provider's failure to comply with the requirements of this section in any civil, criminal, or administrative proceeding.
Source: L. 2020: Entire section added, (SB 20-102), ch. 153, p. 656, � 1, effective September 14.