SENATE BILL 23-298
BY SENATOR(S) Gardner and Roberts, Exum, Ginal, Kirkmeyer,
Lundeen, Mullica, Pelton R., Priola, Will;
also REPRESENTATIVE(S) McCormick and Bockenfeld, Bird,
Boesenecker, Bradley, Catlin, English, Epps, Hamrick, Jodeh, Joseph,
Lindsay, Lukens, Michaelson Jenet, Ricks, Soper, Taggart, McCluskie.
C
ONCERNING ALLOWING CERTAIN PUBLIC HOSPITALS TO IMPROVE ACCESS TO
HEALTH CARE THROUGH COLLABORATION
, AND, IN CONNECTION
THEREWITH
, MAKING AN APPROPRIATION.
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. In Colorado Revised Statutes, add part 10 to article
1 of title 25.5 as follows:
PART 10
HOSPITAL COLLABORATION AGREEMENTS
25.5-1-1001. Hospital collaborative agreements - review of
proposed collaborative agreements - immunity - legislative declaration
- definitions - rules. (1) T
HE GENERAL ASSEMBLY FINDS AND DECLARES
THAT
:
NOTE: This bill has been prepared for the signatures of the appropriate legislative
officers and the Governor. To determine whether the Governor has signed the bill
or taken other action on it, please consult the legislative status sheet, the legislative
history, or the Session Laws.
________
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from existing law and such material is not part of
the act. (a) (I) FRONTIER AND RURAL HOSPITALS CONTINUE TO STRUGGLE TO
DELIVER HIGH
-QUALITY, ACCESSIBLE, LOW-COST CARE DUE TO THE RISING
COSTS OF MEDICATIONS
, SUPPLIES, MEDICAL EQUIPMENT, AND CONTRACT
LABOR
;
(II) F
RONTIER AND RURAL HOSPITALS ARE LARGELY INDEPENDENT ,
GOVERNMENTAL FACILITIES THAT ARE GOVERNED BY LOCAL COMMUNITY
BOARDS
;
(III) F
RONTIER AND RURAL HOSPITALS ARE GENERALLY SEPARATED
BY LARGE DISTANCES AND ARE CHALLENGED BY THE NEED TO PROVIDE
ESSENTIAL SERVICES TO LOCAL COMMUNITIES DUE TO THE SPARSE
POPULATION IN RURAL AREAS
;
(IV) F
RONTIER AND RURAL HOSPITALS ARE INCREASINGLY
CHALLENGED BY COMPLEX REQUIREMENTS IMPOSED BY GOVERNMENT AND
PRIVATE PAYERS THAT DISPROPORTIONATELY NEGATIVELY IMPACT THESE
PROVIDERS AND UNNECESSARILY DRIVE
-UP ADMINISTRATIVE COSTS; AND
(V) IN CASES WHERE THE STATE DEPARTMENT , THE DIVISION OF
INSURANCE
, IF APPLICABLE, AND THE ATTORNEY GENERAL APPROVE
COLLABORATIVE ARRANGEMENTS
, IT IS THE GENERAL ASSEMBLY'S INTENT
TO PROVIDE PROTECTION TO FRONTIER AND RURAL HOSPITALS FROM
CERTAIN ANTITRUST SCRUTINY THAT IMPEDES FRONTIER AND RURAL
HOSPITALS FROM WORKING COLLABORATIVELY TO IMPROVE QUALITY
,
INCREASE ACCESS, AND REDUCE COSTS OF CARE TO THE COMMUNITIES THEY
SERVE
;
(b) (I) F
ORTY-SEVEN OF COLORADO'S SIXTY-FOUR COUNTIES
INCLUDE RURAL AND FRONTIER COMMUNITIES YET CONTAIN ONLY TWELVE
PERCENT OF
COLORADO'S POPULATION;
(II) T
HIRTY-TWO COUNTIES ARE SERVED BY CRITICAL ACCESS
HOSPITALS THAT HAVE TWENTY
-FIVE OR FEWER BEDS AND ARE GENERALLY
LOCATED MORE THAN THIRTY
-FIVE MILES FROM THE NEXT CLOSEST
HOSPITAL
; ELEVEN COUNTIES LACK ANY HOSPITAL ;
(III) T
HE SCARCITY OF NEARBY HOSPITALS CAUSES MANY RESIDENTS
TO STRUGGLE TO FIND QUALITY
, AFFORDABLE HEALTH CARE NEAR THEIR
PAGE 2-SENATE BILL 23-298 HOMES;
(IV) F
URTHER, MANY RESIDENTS IN COLORADO'S RURAL AND
FRONTIER COMMUNITIES FOREGO PREVENTIVE AND BEHAVIORAL HEALTH
CARE AND LACK COMPREHENSIVE OR SPECIALIZED CARE OR CHOICE IN
HEALTH
-CARE SERVICES, AND TWENTY-FOUR COUNTIES IN COLORADO ARE
CONSIDERED MATERNAL CARE
"DESERTS";
(V) W
HERE HOSPITALS DO EXIST IN RURAL AND FRONTIER AREAS ,
THOSE HOSPITALS RECEIVE LOW REIMBURSEMENT RATES DUE TO A
PREPONDERANCE OF GOVERNMENT PAYERS AND DECLINING LOCAL TAX
DOLLARS
, WHICH RESULTS IN A REDUCED AMOUNT OF MONEY AVAILABLE TO
INVEST IN EXPANDING OR UPGRADING FACILITIES OR TO PURCHASE
NECESSARY
, NEW, OR INNOVATIVE MEDICAL SUPPLIES , EQUIPMENT, OR
TECHNOLOGY
;
(VI) M
ANY HOSPITALS IN RURAL AND FRONTIER COMMUNITIES HAVE
DIFFICULTY RECRUITING AND RETAINING QUALIFIED HEALTH
-CARE
PROFESSIONALS AND MAKING AVAILABLE NEEDED SERVICES
; AND
(VII) COUNTY PUBLIC HOSPITALS, HEALTH SERVICE DISTRICTS, AND
HOSPITAL AFFILIATES PERFORM ESSENTIAL PUBLIC FUNCTIONS ON BEHALF OF
THE STATE
;
(c) A
S PART OF THE GOVERNMENT'S INTEREST IN PROVIDING NEEDED
HEALTH
-CARE SERVICES IN COLORADO'S RURAL AND FRONTIER
COMMUNITIES
, IT IS IMPORTANT FOR THE GOVERNMENT TO SUPPORT EFFORTS
TO FIND COLLABORATIVE
, INNOVATIVE SOLUTIONS TO THE MANY PROBLEMS
CONFRONTING RURAL HEALTH CARE
, INCLUDING COLLABORATIVE OR
COORDINATED ACTIVITIES THAT OFFER THE OPPORTUNITY TO EXPAND
HEALTH
-CARE OPTIONS THROUGH JOINT PURCHASING AND STAFFING , SHARED
SERVICES
, AND JOINT ACQUISITION OF NEW AND EXPENSIVE DIAGNOSTIC AND
TREATMENT SOLUTIONS
;
(d) I
T IS THE GENERAL ASSEMBLY'S INTENT TO EXEMPT FROM STATE
ANTITRUST LAWS
, AND TO PROVIDE STATE ACTION IMMUNITY FROM FEDERAL
ANTITRUST LAWS FOR CERTAIN ACTIVITIES THAT MIGHT BE CHARACTERIZED
AS ANTICOMPETITIVE OR THAT MIGHT RESULT IN THE DISPLACEMENT OF
COMPETITION IN THE PROVISION OF HOSPITAL
, PHYSICIAN, OR OTHER
HEALTH
-CARE-RELATED SERVICES OR ADMINISTRATIVE OR GENERAL
PAGE 3-SENATE BILL 23-298 BUSINESS SERVICES; AND
(e) IN ORDER TO PROMOTE IMPROVED QUALITY OF , INCREASE ACCESS
TO
, AND REDUCE COSTS OF HEALTH-CARE SERVICES IN RURAL AND FRONTIER
COMMUNITIES THROUGH COLLABORATIVE AGREEMENTS AUTHORIZED BY
THIS SECTION
, THE GENERAL ASSEMBLY FURTHER INTENDS TO PROVIDE A
SYSTEM OF REVIEW OF RELEVANT COLLABORATIVE AGREEMENTS BY THE
STATE DEPARTMENT
, THE DIVISION OF INSURANCE, IF APPLICABLE, AND THE
ATTORNEY GENERAL TO ENSURE THAT ANY POTENTIAL BENEFITS OF SUCH
COLLABORATIVE AGREEMENTS ARE NOT OUTWEIGHED BY THE HARM TO
COMPETITION IN RURAL AND FRONTIER COMMUNITIES
.
(2) A
S USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE
REQUIRES
:
(a) "C
OLLABORATIVE AGREEMENT " MEANS AN AGREEMENT OR
SIMILAR ARRANGEMENT BETWEEN TWO OR MORE HOSPITALS OR HOSPITAL
AFFILIATES THAT COMPLIES WITH THE REQUIREMENTS SET FORTH IN THIS
SECTION
.
(b) "C
OUNTY PUBLIC HOSPITAL " MEANS A PUBLIC HOSPITAL
ESTABLISHED PURSUANT TO SECTION
25-3-301.
(c) "D
IVISION OF INSURANCE" MEANS THE DIVISION OF INSURANCE
IN THE DEPARTMENT OF REGULATORY AGENCIES
.
(d) "H
EALTH SERVICE DISTRICT" HAS THE SAME MEANING AS SET
FORTH IN SECTION
32-1-103 (9).
(e) "H
OSPITAL" MEANS A FACILITY WITH FEWER THAN FIFTY BEDS
THAT IS
:
(I) A
COUNTY PUBLIC HOSPITAL;
(II) A
HOSPITAL ESTABLISHED, MAINTAINED, OR OPERATED DIRECTLY
OR INDIRECTLY BY A HEALTH SERVICE DISTRICT
; OR
(III) A HOSPITAL AFFILIATE.
(f) "H
OSPITAL AFFILIATE" MEANS AN AFFILIATE OF A COUNTY PUBLIC
PAGE 4-SENATE BILL 23-298 HOSPITAL OR HEALTH SERVICE DISTRICT THAT IS UNDER THE SOLE CONTROL
OF THE COUNTY PUBLIC HOSPITAL OR HEALTH SERVICE DISTRICT
.
(3) E
XCEPT AS PROVIDED IN SUBSECTION (4) OF THIS SECTION, AND
SUBJECT TO THE REQUIREMENTS IN SUBSECTIONS
(5), (6), AND (7) OF THIS
SECTION
, A HOSPITAL IS AUTHORIZED TO ENTER INTO COLLABORATIVE
AGREEMENTS WITH ONE OR MORE HOSPITALS OR HOSPITAL AFFILIATES TO
ENGAGE IN THE FOLLOWING ACTIVITIES
:
(a) A
NCILLARY CLINICAL SERVICES, ACQUISITION OF EQUIPMENT,
CLINIC MANAGEMENT, OR HEALTH-CARE PROVIDER RECRUITMENT ;
(b) J
OINT PURCHASING OR LEASING ARRANGEMENTS , INCLUDING THE
JOINT PURCHASING OR LEASING OF
:
(I) M
EDICAL AND GENERAL SUPPLIES;
(II) M
EDICAL AND GENERAL EQUIPMENT ;
(III) P
HARMACEUTICALS; OR
(IV) TEMPORARY STAFFING THROUGH A STAFFING AGENCY ;
(c) C
ONSULTING SERVICES WITH A FOCUS ON PUBLIC HEALTH IN
RURAL OR FRONTIER COMMUNITIES AND NON
-HOSPITAL-SPECIFIC
INNOVATIONS IN HEALTH
-CARE DELIVERY IN THOSE COMMUNITIES ;
(d) P
URCHASING JOINT PROFESSIONAL , GENERAL LIABILITY, OR
PROPERTY INSURANCE
;
(e) S
HARING BACK-OFFICE SERVICES, SUCH AS SHARING A BUSINESS
OFFICE
, ACCOUNTING AND FINANCE SERVICES , HUMAN RESOURCES, AND RISK
MANAGEMENT AND COMPLIANCE SERVICES
, BUT NOT INCLUDING SHARING
SERVICE CHARGING EXPENSES OR RATES AMONG HOSPITALS
;
(f) S
HARING DATA SERVICES, INCLUDING SHARED SERVICES FOR
ELECTRONIC HEALTH RECORDS AND DATA EXTRACTION AND ANALYSIS
SERVICES
, CHARGE MANAGEMENT, AND POPULATION HEALTH ANALYSIS; AND
(g) NEGOTIATING WITH HEALTH INSURANCE OR GOVERNMENT
PAGE 5-SENATE BILL 23-298 PAYERS, WHICH NEGOTIATIONS ARE LIMITED TO:
(I) S
HARED CARE PROTOCOLS INTENDED TO IMPROVE PATIENT
MANAGEMENT AND OUTCOMES
, INCLUDING IMPLEMENTATION OF
EVIDENCE
-BASED PROTOCOLS, CLINICAL PATHWAYS, AND RECOGNIZED BEST
PRACTICES IN THE CARE AND TREATMENT OF PATIENTS
, INCLUDING CLINICAL
THERAPIES
, NUTRITION, EXERCISE, DIAGNOSTIC TESTING, AND MEDICATION
MANAGEMENT
;
(II)
COLLABORATIVE EFFORTS WITH PAYERS TO PROMOTE
APPROPRIATE AND ESSENTIAL SERVICES TO BE PROVIDED IN THE LOCAL
COMMUNITY
;
(III)
MANAGEMENT OF PRIOR AUTHORIZATION REQUESTS ; AND
(IV) ANALYSIS OF AGGREGATE DATA TO COMPARE COSTS OF
PROCEDURES AND TO ANALYZE PATIENT OUTCOMES
.
(4) N
OTWITHSTANDING ANY COLLABORATIVE AGREEMENTS
DESCRIBED IN SUBSECTION
(3) OF THIS SECTION, THE IMMUNITY AND
PROTECTIONS GRANTED TO HOSPITALS AND HOSPITAL AFFILIATES ENTERING
INTO COLLABORATIVE AGREEMENTS PURSUANT TO THIS SECTION DOES NOT
EXTEND TO COLLABORATIVE AGREEMENTS WITH ANOTHER HOSPITAL OR
HOSPITAL AFFILIATE THAT HAVE THE EFFECT OF
:
(a) S
ETTING REIMBURSEMENT RATES OR OTHER COMPENSATION
FROM ANY COMMERCIAL SELF
-INSURED OR COMMERCIAL HEALTH INSURANCE
OR GOVERNMENT PAYER
;
(b) D
IVIDING OR ALLOCATING AMONG HOSPITALS OR HOSPITAL
AFFILIATES SPECIFIC MARKETS FOR THE DELIVERY OF ANY GENERAL ACUTE
CARE OR SPECIALTY LINES OF HEALTH
-CARE SERVICES; OR
(c) NEGOTIATING OR AGREEING TO COMPENSATION UNDER
HEALTH
-CARE STAFFING ARRANGEMENTS FOR HOSPITAL EMPLOYEES THAT
RESULTS IN A REDUCTION OF WAGES OF HOSPITAL STAFF
, WHETHER
EMPLOYED BY THE HOSPITAL
, A STAFFING AGENCY, OR OTHER EMPLOYER.
(5) P
RIOR TO ENGAGING IN ANY JOINT ACTIVITY DESCRIBED BY A
PROPOSED COLLABORATIVE AGREEMENT EXECUTED PURSUANT TO
PAGE 6-SENATE BILL 23-298 SUBSECTION (3) OF THIS SECTION, THE HOSPITALS OR HOSPITAL AFFILIATES
SHALL JOINTLY SUBMIT THE PROPOSED COLLABORATIVE AGREEMENT TO THE
STATE DEPARTMENT AND TO THE DIVISION OF INSURANCE
, IF THE PROPOSED
COLLABORATIVE AGREEMENT INCLUDES NEGOTIATING WITH HEALTH
INSURANCE PAYERS AS DESCRIBED IN SUBSECTION
(3)(g) OF THIS SECTION,
PURSUANT TO RULES THAT MAY BE PROMULGATED FOR THE SUBMISSION AND
REVIEW OF PROPOSALS BY THE STATE DEPARTMENT AND BY THE DIVISION OF
INSURANCE
, IF APPLICABLE. THE STATE DEPARTMENT AND THE DIVISION OF
INSURANCE
, IF APPLICABLE, MAY REQUEST ADDITIONAL INFORMATION
NECESSARY TO REVIEW THE PROPOSAL
.
(6) W
ITHIN FIFTEEN DAYS AFTER RECEIPT OF A PROPOSED
COLLABORATIVE AGREEMENT AND THE RECEIPT OF ADDITIONAL
INFORMATION REQUESTED BY THE STATE DEPARTMENT
AND BY THE DIVISION
OF INSURANCE
, IF APPLICABLE, IF THE STATE DEPARTMENT AND THE DIVISION
OF INSURANCE
, IF APPLICABLE, CONCLUDE THAT A PROPOSED
COLLABORATIVE ACTIVITY WILL RESULT IN COST SAVINGS OR OTHER
EFFICIENCIES THAT WILL IMPROVE OR EXPAND THE DELIVERY OF
HEALTH
-CARE SERVICES IN RURAL AND FRONTIER COMMUNITIES IN
COLORADO, THE STATE DEPARTMENT AND THE DIVISION OF INSURANCE , IF
APPLICABLE
, SHALL REFER THE PROPOSAL TO THE ATTORNEY GENERAL TO
DETERMINE
, PURSUANT TO RULES WHICH MAY BE PROMULGATED FOR SUCH
PURPOSE
, THAT THE BENEFITS OF THE COLLABORATIVE ACTIVITY ARE NOT
OUTWEIGHED BY ANY ANTICOMPETITIVE HARM THAT MAY ARISE FROM THE
COLLABORATIVE ACTIVITY
.
(7) W
ITHIN FORTY-FIVE DAYS AFTER RECEIVING A REFERRAL AND
REVIEW FROM THE STATE DEPARTMENT AND THE DIVISION OF INSURANCE
, IF
APPLICABLE
, THE ATTORNEY GENERAL SHALL REVIEW THE PROPOSED
COLLABORATIVE AGREEMENT AND EITHER APPROVE OR DENY THE PROPOSED
COLLABORATIVE AGREEMENT OR REQUEST ADDITIONAL INFORMATION
RELATED TO THE PROPOSAL
. IF A REQUEST FOR ADDITIONAL INFORMATION
IS MADE
, THE ATTORNEY GENERAL HAS AN ADDITI ONAL FORTY -FIVE DAYS TO
COMPLETE THE REVIEW FOLLOWING RECEIPT OF THE REQUESTED
INFORMATION
.
(8) (a) A
COLLABORATIVE AGREEMENT IS APPROVED IF :
(I) T
HE STATE DEPARTMENT AND THE DIVISION OF INSURANCE , IF
APPLICABLE
, CONCLUDE THAT THE PROPOSED COLLABORATIVE AGREEMENT
PAGE 7-SENATE BILL 23-298 WILL RESULT IN IMPROVED QUALITY, INCREASED ACCESS OR COST SAVINGS,
OR OTHER EFFICIENCIES THAT WILL IMPROVE OR EXPAND THE DELIVERY OF
HEALTH
-CARE SERVICES IN RURAL AND FRONTIER COMMUNITIES IN
COLORADO; AND
(II) THE ATTORNEY GENERAL CONCLUDES THAT THE BENEFITS
IDENTIFIED BY THE STATE DEPARTMENT AND BY THE DIVISION OF
INSURANCE
, IF APPLICABLE, ARE OUTWEIGHED BY ANY COMPETITIVE
CONCERNS IDENTIFIED BY THE ATTORNEY GENERAL
, OR THE ATTORNEY
GENERAL DOES NOT RESPOND WITHIN THE TIME FRAMES SPECIFIED IN
SUBSECTION
(7) OF THIS SECTION.
(b) (I) E
XCEPT AS PROVIDED IN SUBSECTION (8)(b)(III) OF THIS
SECTION
, IF A PROPOSED COLLABORATIVE AGREEMENT IS DENIED , THE
HOSPITALS OR HOSPITAL AFFILIATES MAY REQUEST RECONSIDERATION BY
RESUBMITTING THE PROPOSED AGREEMENT TO THE ATTORNEY GENERAL
WITHIN THIRTY DAYS AFTER THE DENIAL ALONG WITH ADDITIONAL
MATERIALS
, INFORMATION, OR OTHER EVIDENCE THAT WAS NOT PREVIOUSLY
SUBMITTED RELATING TO THE DETERMINATION OF THE BENEFITS OR
ANTICOMPETITIVE HARM ASSOCIATED WITH THE PROPOSED COLLABORATIVE
AGREEMENT
.
(II) T
HE ATTORNEY GENERAL HAS FORTY -FIVE DAYS FROM THE DATE
OF THE REQUEST TO RECONSIDER THE DENIAL AND MAY CONSULT WITH THE
STATE DEPARTMENT AND THE DIVISION OF INSURANCE AS PART OF THE
RECONSIDERATION
. THE PROPOSED COLLABORATIVE AGREEMENT IS NOT
DEEMED APPROVED IF THE ATTORNEY GENERAL FAILS TO RESPOND WITHIN
THE FORTY
-FIVE-DAY RECONSIDERATION PERIOD .
(III) A
REQUEST FOR RECONSIDERATION OF A PROPOSED
COLLABORATIVE AGREEMENT MAY BE MADE ONLY ONCE WITHIN THE
THIRTY
-DAY PERIOD FOLLOWING THE DENIAL OF THE PROPOSED
COLLABORATIVE AGREEMENT
. THE ATTORNEY GENERAL 'S DECISION ON A
PROPOSED COLLABORATIVE AGREEMENT THAT IS NOT SUBMITTED FOR
RECONSIDERATION WITHIN THIRTY DAYS OR THAT IS DENIED UPON
RECONSIDERATION IS FINAL AND NON
-APPEALABLE.
(c) T
HE STATE DEPARTMENT , THE DIVISION OF INSURANCE, IF
APPLICABLE
, OR THE ATTORNEY GENERAL MAY REVIEW A COLLABORATIVE
AGREEMENT ANNUALLY TO ENSURE THE OUTCOMES RELATED TO THE
PAGE 8-SENATE BILL 23-298 COLLABORATIVE AGREEMENT ARE CONSISTENT WITH THIS SECTION .
SECTION 2. In Colorado Revised Statutes, add 25-3-304.5 as
follows:
25-3-304.5. Hospital collaborative agreements - additional
powers. I
N ADDITION TO THE POWERS SPECIFIED IN SECTION 25-3-304, THE
BOARD OF TRUSTEES OF A COUNTY PUBLIC HOSPITAL MAY ENTER INTO A
COLLABORATIVE AGREEMENT WITH ANOTHER COUNTY PUBLIC HOSPITAL
,
HEALTH SERVICE DISTRICT, OR HOSPITAL AFFILIATE IN ACCORDANCE WITH
SECTION
25.5-1-1001.
SECTION 3. In Colorado Revised Statutes, 32-1-1003, add (1)(c.5)
as follows:
32-1-1003. Health service districts - additional powers. (1) In
addition to the powers specified in section 32-1-1001, the board of any
health service district has any or all of the following powers for and on
behalf of such district:
(c.5) T
O ENTER INTO A COLLABORATIVE AGREEMENT WITH ANOTHER
HEALTH SERVICE DISTRICT
, COUNTY PUBLIC HOSPITAL , OR HOSPITAL
AFFILIATE IN ACCORDANCE WITH SECTION
25.5-1-1001.
SECTION 4. Appropriation. (1) For the 2023-24 state fiscal year,
$30,260 is appropriated to the department of health care policy and
financing for use by the executive director's office. This appropriation is
from the healthcare affordability and sustainability fee cash fund created in
section 25.5-4-402.4 (5)(a), C.R.S. To implement this act, the office may
use this appropriation as follows:
(a) $26,385 for personal services, which amount is based on an
assumption that the office will require an additional 0.8 FTE; and
(b) $3,875 for operating expenses.
(2) For the 2023-24 state fiscal year, the general assembly
anticipates that the department of health care policy and financing will
receive $30,259 in federal funds to implement this act, which amount is
subject to the "(I)" notation as defined in the annual general appropriation
PAGE 9-SENATE BILL 23-298 act for the same fiscal year. The appropriation in subsection (1) of this
section is based on the assumption that the department will receive this
amount of federal funds to be used as follows:
(a) $26,384 for personal services; and
(b) $3,875 for operating expenses.
SECTION 5. Act subject to petition - effective date. This act
takes effect at 12:01 a.m. on the day following the expiration of the
ninety-day period after final adjournment of the general assembly; except
that, if a referendum petition is filed pursuant to section 1 (3) of article V
of the state constitution against this act or an item, section, or part of this act
within such period, then the act, item, section, or part will not take effect
unless approved by the people at the general election to be held in
PAGE 10-SENATE BILL 23-298 November 2024 and, in such case, will take effect on the date of the official
declaration of the vote thereon by the governor.
____________________________ ____________________________
Steve Fenberg Julie McCluskie
PRESIDENT OF SPEAKER OF THE HOUSE
THE SENATE OF REPRESENTATIVES
____________________________ ____________________________
Cindi L. Markwell Robin Jones
SECRETARY OF CHIEF CLERK OF THE HOUSE
THE SENATE OF REPRESENTATIVES
APPROVED________________________________________
(Date and Time)
_________________________________________
Jared S. Polis
GOVERNOR OF THE STATE OF COLORADO
PAGE 11-SENATE BILL 23-298