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March 20, 2023 SB 23-176
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Fiscal Note
Drafting Number:
Prime Sponsors:
LLS 23-0473
Sen. Moreno; Cutter
Date:
Bill Status:
Fiscal Analyst:
March 20, 2023
Senate Health & Human Services
Shukria Maktabi | 303-866-4720
shukria.maktabi@coleg.gov
Bill Topic: PROTECTIONS FOR PEOPLE WITH AN EATING DISORDER
Summary of
Fiscal Impact:
☒ State Revenue
☒ State Expenditure
☐ State Transfer
☐ TABOR Refund
☐ Local Government
☐ Statutory Public Entity
The bill creates prohibitions and requirements related to health care services for
individuals with disordered eating. The bill increases state expenditures beginning in
FY 2023-24, and may increase state revenue beginning in FY 2024-25.
Appropriation
Summary:
For FY 2023-24, the bill requires appropriations of $838,254 to multiple state agencies.
Fiscal Note
Status:
The fiscal note reflects the introduced bill.
Table 1
State Fiscal Impacts Under SB 23-176
Budget Year
FY 2023-24
Out Year
FY 2024-25
Revenue - -
Expenditures General Fund $838,254 $326,581
Centrally Appropriated $33,023 $36,200
Total Expenditures $871,277 $362,781
Total FTE 2.1 FTE 2.2 FTE
Transfers - -
Other Budget Impacts General Fund Reserve $125,738 $48,987
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March 20, 2023 SB 23-176
Summary of Legislation
The bill creates prohibitions and requirements related to health care services for individuals with
disordered eating, including:
prohibiting Medicaid, starting July 1, 2023, and health insurance plans, starting January 1, 2024,
from using body mass index, ideal body weight, or any achieved weight standard to determine
medical need or the level of care for individuals with disordered eating;
prohibiting retail establishments from selling dietary supplements or over-the-counter diet pills
to individuals under 18-years-old without prescriptions, with violators subject to fines of up to
$2,000, starting July 1, 2024;
requiring the Behavioral Health Administration (BHA) to create rules around the use of forced
feeding tubes for individuals with disordered eating; and
requiring the BHA to assign a designation to all disordered eating treatment and recovery facilities
based on the level of care the facility provides, by July 2024.
State Revenue
Beginning in FY 2024-25, state General Fund revenue may increase from fines, which are subject to
TABOR, paid by retail establishments found to be in violation of the bill. The fiscal note assumes
retailers will generally follow the law and any revenue from fines will be minimal.
State Expenditures
The bill increases state expenditures in the Behavioral Health Administration and Department of
Revenue by $870,000 in FY 2023-24 and $360,000 in FY 2024-25, paid from the General Fund.
Expenditures are shown in Table 2 and detailed below.
Table 2
Expenditures Under SB 23-176
FY 2023-24 FY 2024-25
Behavioral Health Administration
Personal Services $125,553 $118,073
Operating Expenses $2,700 $2,430
Capital Outlay Costs $20,010 -
IT Services $670,551 $167,638
Centrally Appropriated Costs
1
$32,687 $30,884
FTE – Personal Services 1.9 FTE 1.8 FTE
BHA Subtotal $851,501 $319,025
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March 20, 2023 SB 23-176
Table 2
Expenditures Under SB 23-176 (Cont.)
FY 2023-24 FY 2024-25
Department of Revenue
Personal Services $3,579 $21,479
Legal Services $15,861 $15,861
Investigation Costs - $1,100
Centrally Appropriated Costs
1
$336 $5,316
FTE – Personal Services 0.1 FTE 0.3 FTE
FTE – Legal Services 0.1 FTE 0.1 FTE
DOR Subtotal $19,776 $43,756
Total $871,277 $362,781
Total FTE 2.1 FTE 2.2 FTE
1
Centrally appropriated costs are not included in the bill's appropriation.
Behavioral Health Administration. The bill increases costs for additional staff and IT services
beginning in FY 2023-24.
Staffing costs. Beginning in FY 2023-24, the BHA requires 1.9 FTE to develop a designation
system for disordered eating treatment and recovery facilities, and ensure all facilities hold an
appropriate designation by July 1, 2024. This includes performing outreach, issuing designations,
monitoring, data management, and enforcement activities. Staff must also develop rules around
forced feeding tubes and provide trainings for service providers to ensure programmatic
alignment with BHA standards. Beginning in FY 2024-25, data entry and management needs are
assumed to decrease, reducing to 1.8 FTE in subsequent years.
IT services. The BHA will have costs to incorporate designations of disordered eating facilities
and management tools into LADDERS, the state’s Behavioral Health Licensing System. This
update requires initial software development costs, estimated to require a 6-month build out by a
software delivery team, as well as ongoing costs for system maintenance. This work is conducted
by the Office of Information Technology with reappropriated funds.
Department of Revenue. The bill increases costs for additional staff and legal services beginning in
FY 2023-24 and for investigations of retailers beginning in FY 2024-25.
Staffing costs. The DOR requires 0.3 FTE for educational outreach and trainings for retailers
before the new regulation on dietary supplements and diet pills begins in FY 2024-25. Once the
regulation begins, staff will enforce the regulation by performing 100 compliance checks annually
on retailers. Staffing costs for FY 2023-24 are prorated for a May 1 start date.
The DOR also requires staff for rulemaking support and administrative action taken against
noncompliant retailers, which can be absorbed with existing resources. Page 4
March 20, 2023 SB 23-176
Legal services. In FY 2023-24, the DOR requires 150 hours, or 0.1 FTE, of legal services from the
Department of Law for general counsel and rulemaking assistance. Legal services will continue
on an ongoing basis for providing legal representation when noncompliant retailers challenge
findings or providing counsel as new products enter the market.
Investigation costs. Beginning in FY 2024-25, the DOR will require funding related to
investigating compliance among retailers. For compliance checks of brick-and-mortar retailers,
the DOR will require minor operative services to assist investigators for 30 hours at a rate of
$20 per hour. For compliance checks of online retailers, investigators will require funding for
purchasing goods and a PO box for product delivery, estimated to cost $500 annually. These
estimates are based on similar investigations for underage tobacco sales.
Department of Health Care Policy and Financing. Any impact from the prohibition on using certain
metrics to determine medical necessity is anticipated to have a minimal effect on the number of
Medicaid members with disordered eating from being admitted and discharged from residential
facilities, or the length of time members stay in such facilities. Any changes in utilization will be
addressed through the annual budget process.
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.
Technical Note
The fiscal note assumes that the DOR will carry out the regulation on retailers using similar systems
that exist for liquor and tobacco retailers; however, the bill does not specify a regulatory framework,
such as licensing requirements or enforcement mechanisms.
Effective Date
The bill takes effect upon signature of the Governor, or upon becoming law without his signature,
except the requirement for health benefit plans takes effect on January 1, 2024, and the requirement
on retail establishments takes effect July 1, 2024.
State Appropriations
For FY 2023-24, the bill requires the following General Fund appropriations:
$818,814 to the Behavioral Health Administration, and 1.9 FTE; and
$19,440 to the Department of Revenue, and 0.1 FTE, of which $15,861 is reappropriated to the
Department of Law with an additional 0.1 FTE.
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March 20, 2023 SB 23-176
State and Local Government Contacts
Behavioral Health Administration Corrections
Health Care Policy and Financing Higher Education
Human Services Information Technology
Law Public Health and Environment
Regulatory Agencies Revenue
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.