First Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 23-0473.01 Shelby Ross x4510
SENATE BILL 23-176
Senate Committees House Committees
Health & Human Services
A BILL FOR AN ACT
C
ONCERNING MEASURES TO IMPROV E OUTCOMES FOR INDIVIDUALS101
WITH AN EATING DISORDER .102
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
.)
The bill prohibits certain health benefit plans or the state medical
assistance program from utilizing the body mass index, ideal body weight,
or any other standard requiring an achieved weight when determining
medical necessity criteria or appropriate level of care for an individual
with a diagnosed eating disorder.
The bill prohibits a retail establishment from selling, transferring,
SENATE SPONSORSHIP
Moreno and Cutter,
HOUSE SPONSORSHIP
(None),
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing law.
Dashes through the words or numbers indicate deletions from existing law. or otherwise furnishing dietary supplements for weight loss or
over-the-counter diet pills to any individual under 18 years of age without
a prescription.
The bill requires the behavioral health administration (BHA) to
promulgate rules concerning forced feeding tubes for individuals with an
eating disorder.
No later than July 1, 2024, the bill requires the BHA to require all
eating disorder treatment and recovery facilities to hold an appropriate
designation based on the level of care the facility provides.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, add 10-16-158 as2
follows:3
10-16-158. Prohibition on using the body mass index or ideal4
body weight - medical necessity criteria - rules. (1) E
VERY HEALTH5
BENEFIT PLAN SUBJECT TO PART 2, 3, OR 4 OF THIS ARTICLE 16, EXCEPT6
THOSE DESCRIBED IN SECTION 10-16-102 (32)(b), SHALL NOT UTILIZE THE7
BODY MASS INDEX, IDEAL BODY WEIGHT, OR ANY OTHER STANDARD8
REQUIRING AN ACHIEVED WEIGHT WHEN DETERMINING MEDICAL9
NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN INDIVIDUAL WITH10
A DIAGNOSED EATING DISORDER, INCLUDING BUT NOT LIMITED TO BULIMIA11
NERVOSA, ATYPICAL ANOREXIA NERVOSA, BINGE-EATING DISORDER, AND12
OTHER SPECIFIED FEEDING AND EATING DISORDERS AS DEFINED IN THE13
MOST RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF14
M
ENTAL DISORDERS.15
(2) T
HIS SECTION DOES NOT LIMIT A HEALTH BENEFIT PLAN FROM16
RELYING ON FACTORS SUCH AS EATING BEHAVIORS ; THE NEED FOR17
SUPERVISED MEALS AND SUPPORT INTERVENTIONS ; LABORATORY RESULTS,18
INCLUDING BUT NOT LIMITED TO HEART RATE , RENAL OR19
CARDIOVASCULAR ACTIVITY , AND BLOOD PRESSURE ; RECOVERY20
SB23-176-2- ENVIRONMENT; AND COOCCURRING DISORDERS WHEN DETERMINING1
MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN2
INDIVIDUAL WITH A DIAGNOSED EATING DISORDER .3
(3) T
HE COMMISSIONER MAY PROMULGATE RULES AS NECESSARY4
TO IMPLEMENT AND ENFORCE THIS SECTION .5
SECTION 2. In Colorado Revised Statutes, add 25.5-5-334 as6
follows:7
25.5-5-334. Prohibition on using the body mass index or ideal8
body weight - medical necessity criteria. (1) B
EGINNING JULY 1, 2023,9
THE STATE MEDICAL ASSISTANCE PROGRAM SHALL NOT UTILIZE THE BODY10
MASS INDEX, IDEAL BODY WEIGHT, OR ANY OTHER STANDARD REQUIRING11
AN ACHIEVED WEIGHT WHEN DETERMINING MEDICAL NECESSITY OR THE12
APPROPRIATE LEVEL OF CARE FOR AN INDIVIDUAL WITH A DIAGNOSED13
EATING DISORDER, INCLUDING BUT NOT LIMITED TO, BULIMIA NERVOSA,14
ATYPICAL ANOREXIA NERVOSA , BINGE-EATING DISORDER, AND OTHER15
SPECIFIED FEEDING AND EATING DISORDERS AS DEFINED IN THE MOST16
RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL MANUAL OF17
M
ENTAL DISORDERS.18
(2) T
HIS SECTION DOES NOT LIMIT THE STATE MEDICAL ASSISTANCE19
PROGRAM FROM RELYING ON FACTORS SUCH AS EATING BEHAVIORS ; THE20
NEED FOR SUPERVISED MEALS AND SUPPORT INTERVENTIONS ;21
LABORATORY RESULTS , INCLUDING BUT NOT LIMITED TO, HEART RATE,22
RENAL OR CARDIOVASCULAR ACTIVITY , AND BLOOD PRESSURE; RECOVERY23
ENVIRONMENT; AND COOCCURRING DISORDERS WHEN DETERMINING24
MEDICAL NECESSITY OR THE APPROPRIATE LEVEL OF CARE FOR AN25
INDIVIDUAL WITH A DIAGNOSED EATING DISORDER .26
SECTION 3. In Colorado Revised Statutes, add article 8 to title27
SB23-176
-3- 44 as follows:1
ARTICLE 82
Regulation of Dietary Supplements for Weight Loss3
44-8-101. Definitions. A
S USED IN THIS ARTICLE 8, UNLESS THE4
CONTEXT OTHERWISE REQUIRES :5
(1) (a) "D
IETARY SUPPLEMENT FOR WEIGHT LOSS " MEANS A CLASS6
OF DIETARY SUPPLEMENTS THAT ARE LABELED AND MARKETED UNDER THE7
"F
EDERAL FOOD, DRUG, AND COSMETIC ACT", 21 U.S.C. SEC. 301 ET SEQ.,8
FOR THE PURPOSE OF ACHIEVING WEIGHT LOSS .9
(b) "D
IETARY SUPPLEMENT FOR WEIGHT LOSS " INCLUDES10
PRODUCTS WITH A SUPPLEMENT FACTS PANEL PURSUANT TO FEDERAL11
REGULATIONS THAT CONTAIN EITHER LAWFUL DIETARY INGREDIENTS OR12
INGREDIENTS DEEMED ADULTERATED PURS UANT TO 21 U.S.C. SEC. 342,13
OR BOTH.14
(c) "D
IETARY SUPPLEMENT FOR WEIGHT LOSS " DOES NOT INCLUDE15
DIETARY FIBER PRODUCTS.16
(2) (a) "O
VER-THE-COUNTER DIET PILL" MEANS A CLASS OF DRUGS17
THAT ARE LABELED AND MARKETED UNDER THE "FEDERAL FOOD, DRUG,18
AND COSMETIC ACT", 21 U.S.C. SEC. 301 ET SEQ., FOR THE PURPOSE OF19
ACHIEVING WEIGHT LOSS THAT ARE LAWFULLY SOLD , TRANSFERRED, OR20
OTHERWISE FURNISHED WITHOUT A PRESCRIPTION .21
(b) "O
VER-THE-COUNTER DIET PILL" INCLUDES PRODUCTS22
MARKETED WITH A DRUG FACTS PANEL PURSUANT TO FEDERAL23
REGULATIONS THAT CONTAIN EITHER APPROVED DRUG INGREDIENTS OR24
INGREDIENTS DEEMED ADULTERATED PURS UANT TO 21 U.S.C. SEC. 342,25
OR BOTH.26
(3) "R
ETAIL ESTABLISHMENT" MEANS ANY VENDOR THAT, IN THE27
SB23-176
-4- REGULAR COURSE OF BUSINESS, SELLS DIETARY SUPPLEMENTS FOR WEIGHT1
LOSS OR OVER-THE-COUNTER DIET PILLS AT RETAIL DIRECTLY TO THE2
PUBLIC, INCLUDING BUT NOT LIMITED TO, PHARMACIES, GROCERY STORES,3
OTHER RETAIL STORES, AND VENDORS THAT ACCEPT ORDERS PLACED BY4
MAIL, TELEPHONE, ELECTRONIC MAIL, INTERNET WEBSITE, ONLINE5
CATALOG, OR SOFTWARE APPLICATION.6
44-8-102. Dietary supplements for weight loss - prohibition on7
selling to persons under eighteen years of age - fine - rules. (1) (a) A8
RETAIL ESTABLISHMENT SHALL NOT SELL , TRANSFER, OR OTHERWISE9
FURNISH DIETARY SUPPLEMENTS FOR WEIGHT LOSS OR10
OVER-THE-COUNTER DIET PILLS TO ANY PERSON UNDER EIGHTEEN YEARS11
OF AGE.12
(b) A
RETAIL ESTABLISHMENT SHALL REQUEST VALID13
IDENTIFICATION FROM ANY PERSON WHO A TTEMPTS TO PURCHASE DIETARY14
SUPPLEMENTS FOR WEIGHT LOSS OR OVER -THE-COUNTER DIET PILLS IF15
THAT PERSON REASONABLY APPEARS TO THE RETAIL ESTABLISHMENT TO16
BE UNDER EIGHTEEN YEARS OF AGE .17
(2) T
HE DEPARTMENT, IN COLLABORATION WITH THE BEHAVIORAL18
HEALTH ADMINISTRATION AND OTHER RELEVANT STAKEHOLDERS , MAY19
PROMULGATE RULES AS NECESSARY TO IMPLEMENT THIS SECTION ,20
INCLUDING DETERMINING WHICH DIETARY SUPPLEMENTS FOR WEIGHT LOSS21
AND OVER-THE-COUNTER DIET PILLS ARE SUBJECT TO THE REQUIREMENTS22
OF THIS ARTICLE 8, INCLUDING, BUT NOT LIMITED TO, LAXATIVES THAT23
INCLUDE AN ACTIVE INGREDIENT THAT ACTS AS A STIMULANT , SUCH AS24
SENNOSIDES OR BISACODYL.25
(3) I
F A RETAIL ESTABLISHMENT VIOLATES THIS ARTICLE 8, THE26
DEPARTMENT SHALL IMPOSE A FINE OF NOT MORE THAN TWO THOUSAND27
SB23-176
-5- DOLLARS.1
SECTION 4. In Colorado Revised Statutes, amend 27-65-128 as2
follows:3
27-65-128. Administration - rules. The BHA shall promulgate4
any rules and develop and distribute any applications or forms necessary5
to consistently enforce the provisions of this article 65,
INCLUDING RULES6
CONCERNING FORCED FEEDING TUBES FOR INDIVIDUALS WITH AN EATING7
DISORDER. The BHA shall proactively train providers, facilities, counties,8
judges, magistrates, intervening professionals, and certified peace officers9
on the procedures under this article 65, which training must include an10
understanding of the criteria for invoking an emergency mental health11
hold pursuant to section 27-65-106, the definition of "gravely disabled"12
and how a person who is gravely disabled may present physically and13
psychiatrically, and suggested templates and resources to be used by14
facilities to meet the requirements of section 27-65-106 (8)(a)(III) and15
(8)(a)(VII).16
SECTION 5. In Colorado Revised Statutes, add article 65.5 to17
title 27 as follows:18
ARTICLE 65.519
Eating Disorder Treatment and Recovery Programs20
27-65.5-101. Eating disorder and treatment recovery21
programs - rules. (1) N
O LATER THAN JULY 1, 2024, THE BEHAVIORAL22
HEALTH ADMINISTRATION, ESTABLISHED IN SECTION 27-60-203, SHALL23
REQUIRE ALL EATING DISORDER TREATMENT AND RECOVERY FACILITIES TO24
HOLD AN APPROPRIATE DESIGNATION BASED ON THE LEVEL OF CARE THE25
FACILITY PROVIDES, INCLUDING FACILITIES THAT OFFER INTENSIVE26
OUTPATIENT TREATMENT , PARTIAL HOSPITALIZATION , RESIDENTIAL27
SB23-176
-6- PROGRAMS, AND INPATIENT PROGRAMS. LICENSED CLINICIANS WHO ARE1
NOT FACILITY-BASED AND OFFER BEHAVIORAL HEALTH THERAPY TO2
INDIVIDUALS WITH AN EATING DISORDER ON AN OUTPATIENT BASIS ARE3
NOT REQUIRED TO HOLD A DESIGNATION .4
(2) T
HE STATE BOARD OF HUMAN SERVICES SHALL PROMULGATE5
RULES THAT ADDRESS:6
(a) A
DEQUATE PRIVACY DURING ANY REQUIRED MEDICAL7
EXAMINATION, WHICH MUST INCLUDE:8
(I) T
HE ABILITY FOR THE CLIENT TO HAVE ANY MEDICAL9
EXAMINATION, INCLUDING A WEIGH-IN, WITHOUT OTHER CLIENTS PRESENT10
IN THE SAME ROOM;11
(II) P
ROHIBITING THAT A CLIENT REMOVE ALL CLOTHING DURING12
A WEIGH-IN AND REQUIRING THAT ANY CLOTHING PROVIDED TO A CLIENT13
DURING A WEIGH-IN MUST SUFFICIENTLY COVER THE CLIENT'S BODY;14
(III) P
ROHIBITING THAT A CLIENT PERFORM PHYSICAL EXERCISES15
DURING A WEIGH-IN; AND16
(IV) P
ROVIDING CLIENTS, INCLUDING GENDER NONCONFORMING17
AND TRANSGENDER CLIENTS , WITH THE SAME RESTROOM POLICIES18
PROVIDED FOR CISGENDER CLIENTS, WHICH INCLUDES, BUT IS NOT LIMITED19
TO, SET TIMES FOR RESTROOM ACCESS FOR GENDER NONCONFORMING AND20
TRANSGENDER CLIENTS, AND PROHIBITING THAT A CLIENT SHARE A SINGLE21
STALL WITH A STAFF MEMBER OR ANOTHER CLIENT .22
(b) R
ESPECT FOR AND ACCOMMODATION OF A CLIENT 'S SEXUAL23
ORIENTATION, GENDER IDENTITY, RELIGION, AND PERSONAL DIETARY24
ETHICS BY THE PROGRAM AND DIETARY STAFF ;25
(c) T
HE PRESENCE OF APPROPRIATE AND QUALIFIED STAFF TO26
TREAT A CLIENT IN THE FACILITY'S CARE, INCLUDING A CLIENT WITH27
SB23-176
-7- AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER AND A CLIENT WHO IS1
NEURODIVERSE; DURING WEIGH-INS; BATHROOM TIME ; VITAL SIGN2
CHECKS; AND BEHAVIORAL HEALTH TREATMENT AND GROUP THERAPY . IF3
STAFF PERFORM MULTIPLE FUNCTIONS AT A TREATMENT FACILITY , THE4
RULES MUST ENSURE THE THERAPEUTIC RELATIONSHIP BETWEEN STAFF5
AND THE CLIENT IS PRESERVED AND PRIORITIZED .6
(d) T
HE USE OF RESTRAINTS AND RESTRICTION OF A CLIENT 'S7
ALLOWED BODILY MOVEMENT . THE RULES MUST ENSURE CLIENTS ARE NOT8
INAPPROPRIATELY SECLUDED OR RESTRAINED AND THAT RESTRICTION OF9
MOVEMENT IS NEVER USED AS A FORM OF PUNISHMENT AND THAT CLIENTS10
ARE PERMITTED A MINIMUM AMOUNT OF PHYSICAL ACTIVITY PER DAY AS11
CLINICALLY APPROPRIATE BASED ON THE LEVEL OF CARE .12
(e) T
HE USE OF BED-BASED OR ROOM-BASED CARE, ENSURING13
THESE PRACTICES ARE USED AS A LAST RESORT AND THAT STAFF ARE14
MEANINGFULLY ENGAGING CLIENTS TO AVOID THESE RESTRICTIVE15
MEASURES;16
(f) A
REQUIREMENT THAT AN EATING DISORDER TREATMENT AND17
RECOVERY FACILITY IMPLEMENTS A TREATMENT FRAMEWORK THAT18
INVOLVES UNDERSTANDING , RECOGNIZING, AND RESPONDING TO THE19
EFFECTS OF ALL TYPES OF TRAUMA IN ACCORDANCE WITH RECOGNIZED20
PRINCIPLES OF TRAUMA-INFORMED APPROACHES AND TRAUMA -INFORMED21
INTERVENTIONS;22
(g) T
HE MINIMUM RIGHTS EACH PATIENT IS ENTITLED TO AT THE23
TREATMENT FACILITY, THE REQUIREMENT THAT THE PATIENT'S RIGHTS BE24
PUBLICLY POSTED AND INDIVIDUALLY FURNISHED TO EACH PATIENT , AND25
THE FORMAL GRIEVANCE PROCESS FOR A PATIENT TO FILE A COMPLAINT26
AGAINST THE TREATMENT FACILITY THROUGH THE BEHAVIORAL HEALTH27
SB23-176
-8- ADMINISTRATION FOR A VIOLATION OF THE PATIENT 'S RIGHTS; AND1
(h) T
HE REQUIREMENT FOR THE TREATMENT FACILITY TO HAVE A2
FORMAL DISCHARGE POLICY IN PLACE THAT IS APPROVED BY THE3
BEHAVIORAL HEALTH ADMINISTRATION .4
(3) P
ROVIDERS SHALL NOT UTILIZE THE BODY MASS INDEX , IDEAL5
BODY WEIGHT, OR ANY OTHER STANDARD REQUIRING AN ACHIEVED6
WEIGHT WHEN DETERMINING MEDICAL NECESSITY CRITERIA OR7
APPROPRIATE LEVEL OF CARE RELATED TO ANY INDIVIDUAL WITH A8
DIAGNOSED EATING DISORDER .9
SECTION 6. Effective date. This act takes effect upon passage;10
except that section 1 of this act takes effect January 1, 2024, and section11
3 of this act takes effect July 1, 2024.12
SECTION 7. Safety clause. The general assembly hereby finds,13
determines, and declares that this act is necessary for the immediate14
preservation of the public peace, health, or safety.15
SB23-176
-9-