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July 13, 2022 HB 22-1050
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Final Fiscal Note
Drafting Number:
Prime Sponsors:
LLS 22-0295
Rep. Ricks
Sen. Buckner
Date:
Bill Status:
Fiscal Analyst:
July 13, 2022
Signed into Law
Aaron Carpenter | 303-866-4918
Aaron.Carpenter@state.co.us
Bill Topic: INTL MED GRADUATE INTEGRATE HLTH -CARE WORKFORCE
Summary of
Fiscal Impact:
☒ State Revenue
☒ State Expenditure
☐ State Transfer
☒ TABOR Refund
☐ Local Government
☐ Statutory Public Entity
The bill creates two programs to assist international medical graduates entering the
workforce and makes other regulatory changes. Starting in FY 2022-23, the bill
increases state revenue from gifts, grants, and donations. Upon receiving sufficient
funding, the bill increases state expenditures on an ongoing basis.
Appropriation
Summary:
No appropriation is required.
Fiscal Note
Status:
The fiscal note reflects the enacted bill.
Table 1
State Fiscal Impacts Under HB 22-1050
Budget Year
FY 2022-23
Out Year
FY 2023-24
Revenue Gifts, Grants and Donations $476,745 $814,345
Expenditures Cash Funds
1
$453,714 $791,314
Centrally Appropriated $23,031 $23,031
Total Expenditures $476,745 $814,345
Total FTE 1.5 FTE 1.5 FTE
Transfers - -
Other Budget Impacts - -
1
The fiscal note assumes that the bill will not be implemented until the department receives sufficient gifts, grants, and
donations.
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July 13, 2022 HB 22-1050
Summary of Legislation
The bill creates two programs for international medical graduates (IMG) - the IMG Assistance
Program and the Clinical Readiness Program, and makes other changes that allow IMGs to get
medical licenses, as described below.
IMG Assistance Program. The bill creates the IMG Assistance Program to provide direct services to
IMGs wishing to reestablish their medical careers in Colorado. The Colorado Department of Labor
and Employment (CDLE) must contract with a third party to administer the program, and determine
the eligibility criteria for participation in the program as well as any limits on the amount of direct
services provided. Direct services for IMGs include:
reviewing the background, education, training, and experience of program participants, and
recommending steps to integrate into the healthcare workforce;
providing technical support through the credential evaluation process, including preparation for
tests and evaluations;
providing scholarships to help cover cost of the licensure process;
working with community organizations to develop a roster of interested IMGs, and
providing guidance to apply for medical residency programs or other path ways.
In addition, the third-party administrator must annually submit a report to CDLE about the program,
beginning one year after implementation. The CDLE must receive sufficient appropriations, or gifts,
grants, and donations before implementing the program.
Clinical Readiness Program. The bill creates the Clinical Readiness Program to help IMGs build the
skills necessary to become successful residents in the United States medical system. By
January 1, 2023, CDLE must contract with a Colorado-based medical school or a residency program
accredited by the Accreditation Council for Graduate Medical Education to serve as the program
administrator. By January 1, 2024, the program administrator must develop and implement the
clinical program and must have a mechanism for processing program applications, a program
curriculum, and an assessment system to determine clinical readiness of program participants.
To qualify for the program, an applicant must be an IMG whose medical degree or qualifications have
been determined to be equivalent to a medical degree from the United States or another country that
has a reciprocal license agreement, and have achieved a passing score on the USMLE step one and
step two examinations. Once a participant completes the curriculum and passes the program
assessment, the program director must issue an industry recognized credential of clinical readiness
and submit a recommendation to the assistance program administrator and CDLE. The bill requires
the program administrator to allow an IMG to interview for a position in their own residency program
if the IMG successfully completes the readiness program. Starting January 1, 2025, the program
director must annually submit a report to DORA about the program. The CDLE must receive
sufficient appropriations, or gifts, grants, and donations before implementing the program.
Report. The bill requires the CDLE to submit a report on the IMG Assistance Program and the Clinical
Readiness Program as part of the department’s SMART Act hearing.
IMG degree equivalence. Under current law, the Medical Board may require certain foreign medical
students to complete three years of postgraduate clinical training. The bill reduces this requirement
to one year and applies it to IMGs. Page 3
July 13, 2022 HB 22-1050
Reentry licenses for IMGs. The bill allows IMGs who hold a current or expired international license
and satisfy other requirements established by the Medical Board to apply for a reentry license. The
Medical Board may approve an assessment model to assess the competency of IMGs applying for a
reentry license.
Assumptions
The fiscal note assumes that the bill will be implemented using gifts, grants, and donations. The fiscal
note outlines the impacts if the CDLE does receive gifts, grants, and donations. If sufficient funding
is not received, the fiscal note assumes that the program will not be implemented.
State Revenue
Starting in FY 2022-23, the bill will increase cash fund revenue in the CDLE from gifts grants, and
donations. In addition, cash fund revenue in DORA will minimally increase from additional reentry
licenses, as described below.
Gifts, grants, and donations. Starting in FY 2022-23, the revenue to the CDLE must increase by an
estimated $476,745 in FY 2022-23 and $814,345 in FY 2023-24 to implement the various programs
outlined in the bill from gifts, grants, and donations. The fiscal note has not identified any source of
gifts, grants, and donations. Gifts, grants, and donations are not subject to the state’s TABOR limit.
Reentry licenses. Starting in FY 2022-23, revenue to the Professions and Occupation Cash Fund will
increase to the extent IMGs apply for reentry medical licenses. The fiscal note assumes that the
number of IMGs applying for reentry medical licenses, at least initially, will be minimal and any
increase in revenue will likewise be minimal. Revenue from reentry medial licenses is subject to the
state’s TABOR limit.
State Expenditures
The bill increases state expenditures in the CDLE by $476,745 in FY 2022-23 and $814,345 in FY 2023-24,
paid from gift, grants, and donations. The bill will also increase workload in DORA. Expenditures
are shown in Table 2 and detailed below.
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July 13, 2022 HB 22-1050
Table 2
Expenditures Under HB 22-1050
FY 2022-23 FY 2023-24
Department of Labor & Employment
Personal Services $89,289 $89,289
Operating Expenses $2,025 $2,025
Capital Outlay Costs $12,400 -
IMG Program Contractors $350,000 $700,000
Centrally Appropriated Costs
1
$23,031 $23,031
Total Cost $476,745 $814,345
Total FTE 1.5 FTE 1.5 FTE
Department of Labor and Employment. Starting in FY 2022-23, the CDLE will require 1.5 FTE to
administer the two IMG programs established by the bill. These FTE will oversee and manage
contracts with two contractors, help develop rules and other program criteria, and report on the
two programs. Staffing costs include personnel services, operating expenses, and capital outlay costs,
as shown in Table 1.
IMG program contractors. Starting in FY 2022-23, expenditures in CDLE will increase to contract
with two parties to run the two new IMG programs. Based on similar programs offered in
Minnesota, the fiscal note assumes that expenditures will increase by a total of $700,000 annually
once fully implemented.
Clinical Readiness Program. Expenditures will increase by $150,000 in FY 2022-23 to establish the
clinical readiness program and $500,000 annually starting in FY 2023-24 to administer the program
once fully implemented.
IMG Assistance Program. Starting in FY 2022-23, expenditures will increase by $200,000 per year
to contract with a third party to run the IMG assistance program. Depending on the number of
individuals helped by the IMG assistance program and the number of scholarships that would be
offered, costs could be as low as $50,000 for the IMG assistance program.
Department of Regulatory Agencies. Starting in FY 2022-23, workload in DORA will increase to
update rules and to conduct any outreach to IMG applicants. This workload can be accomplished
within existing appropriations.
Centrally appropriated costs. Pursuant to a Joint Budget Committee policy, certain costs associated
with this bill are addressed through the annual budget process and centrally appropriated in the Long
Bill or supplemental appropriations bills, rather than in this bill. These costs, which include employee
insurance and supplemental employee retirement payments, are shown in Table 2.
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July 13, 2022 HB 22-1050
Other Budget Impacts
TABOR refunds. The bill is expected to increase the amount of state revenue required to be refunded
to taxpayers by an indeterminate amount, as described in the State Revenue section above. This
estimate assumes the March 2022 LCS revenue forecast. A forecast of state revenue subject to TABOR
is not available beyond FY 2023-24. Because TABOR refunds are paid from the General Fund,
increased cash fund revenue will reduce the amount of General Fund available to spend or save.
Effective Date
This bill was signed into law by the Governor and took effect on June 7, 2022.
State and Local Government Contacts
Health Care Policy and Financing Higher Education
Information Technology Labor
Public Health and Environment Regulatory Agencies
The revenue and expenditure impacts in this fiscal note represent changes from current law under the bill for each
fiscal year. For additional information about fiscal notes, please visit: leg.colorado.gov/fiscalnotes.