Second Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
ENGROSSED
This Version Includes All Amendments Adopted
on Second Reading in the House of Introduction
LLS NO. 24-0286.01 Brita Darling x2241
HOUSE BILL 24-1153
House Committees Senate Committees
Health & Human Services
Finance
Appropriations
A BILL FOR AN ACT
C
ONCERNING CONTINUING EDUCATION REQUIREMENTS FOR101
PHYSICIANS.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 establishes a continuing medical education requirement
(CME) for physicians licensed in this state.
To meet the CME requirement, a physician must complete 40
credit hours of CME (CME credit hours) in the 24 months preceding the
renewal, reinstatement, or reactivation of the physician's medical license
in topics selected by the physician and also in topics specified in the bill.
HOUSE
Amended 2nd Reading
April 24, 2024
HOUSE SPONSORSHIP
Garcia and Willford, Bacon, Brown, Jodeh, Joseph, Mabrey, Parenti, Story
SENATE SPONSORSHIP
Cutter and Jaquez Lewis,
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. The Colorado medical board (board) shall approve the type and sponsors
of programs or activities that qualify for CME credit hours pursuant to
criteria specified in the bill.
To verify compliance with the CME requirement, the physician
shall affirm on the license renewal form submitted to the board that the
physician has complied with the CME requirement. The board is also
authorized to audit up to 5% of physician renewals annually and to
require that the physician submit proof of the CME programs completed
and the CME credit hours awarded. A physician's failure to comply with
the CME requirement or to submit proof to the board during a board audit
constitutes unprofessional conduct. If the physician fails to comply with
the CME requirement, the physician's license is inactive until reinstated
by the board.
The board may adopt rules to implement the CME requirement.
The director of the division of professions and occupations in the
department of regulatory agencies shall increase existing fees on
physician licensure renewals to cover any additional costs associated with
implementing the CME requirement.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, 12-240-130, amend2
(1) and (2)(a); repeal (3); and add (5) and (6) as follows:3
12-240-130. Renewal, reinstatement, reactivation -4
delinquency - fees - questionnaire. (1) All licenses issued pursuant to5
this article 240 are subject to the renewal, expiration, reinstatement, and6
delinquency fee provisions specified in section 12-20-202 (1) and (2).7
The director shall increase renewal fees consistent with section 12-30-1058
(4) to fund
COVER the division's costs in administering and staffing the9
nurse-physician advisory task force for Colorado health care created in10
section 12-30-105 (1)
AND ANY ADDITIONAL COSTS ASSOCIATED WITH11
IMPLEMENTING CONTINUING EDUCATION REQUIREMENTS FOR PHYSICIANS12
PURSUANT TO SECTION 12-240-130.5. A person whose license has expired13
shall be
IS subject to the penalties provided in this article 240 or section14
12-20-202 (1).15
1153-2- (2) (a) The board shall design a questionnaire to accompany the1
renewal form for the purpose of determining whether a licensee has acted2
in violation of this article 240, or has been disciplined for any action that3
might be considered a violation of this article 240 or that might make the4
licensee unfit to practice medicine with reasonable care and safety. The5
board shall include on the questionnaire a question regarding whether:6
(I) The licensee has complied with section 12-30-111; and7
(II) The licensee is in compliance with section 12-280-403 (2)(a)8
and is aware of the penalties for failing to comply with that section;9
(III) T
HE LICENSEE IS IN COMPLIANCE WITH SECTION 12-30-114;10
AND11
(IV) T
HE LICENSEE IS IN COMPLIANCE WITH SECTION 12-240-130.512
RELATING TO REQUIRED CONTINUING MEDICAL EDUCATION AND IS AWARE13
OF THE PENALTIES FOR FAILING TO COMPLY WITH THAT SECTION .14
(3) Applicants for relicensure shall not be required to attend and
15
complete continuing medical education programs, except as directed by16
the board to correct deficiencies of training or education as directed under17
section 12-240-125 (5)(c)(III)(B).18
(5) O
N AND AFTER OCTOBER 1, 2022, AS A CONDITION OF19
RENEWAL, REINSTATEMENT, OR REACTIVATION OF A LICENSE , EACH20
LICENSEE OR APPLICANT SHALL ATTEST THAT THE LICENSEE OR APPLICANT21
IS IN COMPLIANCE WITH SECTION 12-30-114 AND THAT THE LICENSEE OR22
APPLICANT IS AWARE OF THE PENALTIES FOR NONCOMPLIANCE WITH THAT23
SECTION.24
(6) O
N AND AFTER JANUARY 1, 2026, AS A CONDITION OF25
RENEWAL, REINSTATEMENT, OR REACTIVATION OF A LICENSE , EACH26
LICENSEE OR APPLICANT SHALL ATTEST THAT THE LICENSEE OR APPLICANT27
1153
-3- IS IN COMPLIANCE WITH SECTION 12-240-130.5 AND THAT THE LICENSEE1
OR APPLICANT IS AWARE OF THE PENALTIES FOR NONCOMPLIANCE WITH2
THAT SECTION.3
SECTION 2. In Colorado Revised Statutes, 12-240-106, amend4
(1)(b) and (1)(c); and add (1)(d) as follows:5
12-240-106. Powers and duties of board - limitation on6
authority - rules. (1) In addition to all other powers and duties conferred7
and imposed upon the board by this article 240, the board has the8
following powers and duties to:9
(b) Make investigations, hold hearings, and take evidence in10
accordance with section 12-20-403 in all matters relating to the exercise11
and performance of the powers and duties vested in the board; and12
(c) Aid law enforcement in the enforcement of this article 240 and13
in the prosecution of all persons, firms, associations, or corporations14
charged with the violation of any of its provisions;
AND15
(d) A
DOPT RULES AS NECESSARY IN ACCORDANCE WITH SECTION16
12-240-130.5
TO IMPLEMENT THE REQUIREMENT FOR CONTINUING17
MEDICAL EDUCATION FOR PHYSICIANS .18
SECTION 3. In Colorado Revised Statutes, 12-240-121, add19
(1)(ii) as follows:20
12-240-121. Unprofessional conduct - definitions.21
(1) "Unprofessional conduct" as used in this article 241 means:22
(ii)
FAILING, WITHOUT REASONABLE CAUSE, TO COMPLY WITH THE23
CONTINUING MEDICAL EDUCATION REQUIREMENT ESTABLISHED IN SECTION24
12-240-130.5
OR TO PROVIDE THE REQUIRED EVIDENCE OF COMPLETION OF25
CONTINUING MEDICAL EDUCATION CREDIT HOURS IN RESPONSE TO AN26
AUDIT BY THE BOARD PURSUANT TO SECTION 12-240-130.5 (8).27
1153
-4- SECTION 4. In Colorado Revised Statutes, add 12-240-130.5 as1
follows:2
12-240-130.5. Continuing medical education - requirement -3
compliance - legislative declaration - rules - definitions. (1) (a) T
HE4
GENERAL ASSEMBLY FINDS AND DECLARES THAT :5
(I) M
EDICAL KNOWLEDGE , METHODS OF DIAGNOSIS , AND6
TREATMENT OPTIONS HAVE EXPANDED EXPONENTIALLY SINCE THE7
BEGINNING OF THE TWENTY-FIRST CENTURY, WITH EXCITING RESEARCH8
AND DISCOVERIES, INCLUDING THE DEVELOPMENT OF NEW MEDICATIONS9
AND TOOLS FOR MORE ACCURATE AND EFFECTIVE DI AGNOSIS , TREATMENT,10
AND PREVENTION OF DISEASE;11
(II) W
HILE THERE ARE PROMISING ADVANCES IN MEDICINE ,12
C
OLORADO FACES CHALLENGES THAT AFFECT THE HEALTH AND13
WELL-BEING OF ITS RESIDENTS, INCLUDING AN AGING POPULATION ;14
NATIONAL AND INTERNATIONAL PUBLIC HEALTH ISSUES , INCLUDING15
EPIDEMICS AND PANDEMICS ; NONNATIVE DISEASES AND CONDITIONS ;16
CHANGING ENVIRONMENTAL C ONDITIONS AND NEW CONTAMINANTS IN17
WATER, AIR, AND FOOD THAT ARE DANGEROUS TO HUMAN HEALTH ;18
CHANGES IN STATE AND FEDERAL LAW IMPACTING ACCESS TO19
REPRODUCTIVE, SEXUAL, AND GENDER-BASED HEALTH CARE; AND THE20
INCREASING NEED FOR BEHAVIORAL HEALTH CARE AND PHYSICAL AND21
MENTAL HEALTH-CARE INTEGRATION;22
(III) S
TATE AND NATIONAL MEDICAL ASSOCIATIONS RECOGNIZE23
THE PRACTICAL AND ETHICAL DUTIES PHYSICIANS HAVE TO THEIR24
PATIENTS AND TO THE PROFESSION TO MAINTAIN COMPETENCY IN THE25
RAPIDLY CHANGING MEDICAL FIELD AND THE WORLD ; AND26
(IV) T
O MEET THESE CHALLENGES AND DUTIES , THERE IS A NEED27
1153
-5- FOR MANDATED CONTINUING PROFESSIONAL EDUCATION FOR PHYSICIANS .1
(b) T
HEREFORE, THE GENERAL ASSEMBLY FURTHER FINDS AND2
DECLARES THAT:3
(I) A
LICENSE TO PRACTICE MEDICINE IN THIS STATE IS GRANTED4
TO INDIVIDUALS WHO DEMONSTRATE COMPETENCY IN THE PROFESSION ;5
AND6
(II) A
S A CONDITION OF THE PERIODIC RENEWAL OF A PHYSICIAN 'S7
LICENSE OR THE REINSTATEMENT OR REACTIVATION OF A MEDICAL8
LICENSE, IT IS APPROPRIATE AND NECESSARY THAT COLORADO REQUIRE9
A PHYSICIAN TO COMPLETE CONTINUING MEDICAL EDUCATION TO ENSURE10
CONTINUING COMPETENCY IN THE PROFESSION AND TO PREPARE FOR THE11
PATIENTS AND HEALTH ISSUES OF THE FUTURE .12
(2) A
S USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE13
REQUIRES:14
(a) "AMA
PRA CATEGORY 1 CREDIT™" MEANS CREDIT FOR HOURS15
AWARDED FOR CONTINUING MEDICAL EDUCATION THAT APPLY TOWARD16
THE AMERICAN MEDICAL ASSOCIATION'S PHYSICIAN'S RECOGNITION17
AWARD.18
19
(b) "CME CREDIT HOUR" MEANS ONE HOUR OF CME CREDIT20
AWARDED FOR ONE CLOCK HOUR OF CONTINUING MEDICAL EDUCATION .21
(c) "COMPLIANCE PERIOD" MEANS THE TWENTY -FOUR-MONTH22
PERIOD IMMEDIATELY PRECEDING THE RENEWAL , REINSTATEMENT, OR23
REACTIVATION OF A PHYSICIAN'S LICENSE.24
(d) "CONTINUING MEDICAL EDUCATION" OR "CME" MEANS A25
PROGRAM OF CONTINUING MEDICAL EDUCATION THAT IS ACCREDITED BY26
AN ORGANIZATION SPECIFIED IN SUBSECTION (3)(d) OF THIS SECTION.27
1153
-6- (e) "NATIONAL BOARD CERTIFICATION" MEANS A CERTIFICATION1
PROGRAM THAT MEETS ACCEPTED STANDARDS FOR CERTIFICATION AND2
INCLUDES BOTH:3
(I) A PROCESS FOR DEFINING SPECIALTY-SPECIFIC STANDARDS FOR4
KNOWLEDGE AND SKILLS; AND5
(II) AN INDEPENDENT, EXTERNAL, PSYCHOMETRICALLY VALID6
ASSESSMENT OF KNOWLEDGE AND SKILLS FOR BOTH INITIAL7
CERTIFICATION AND RECERTIFICATION OR CONTINUOUS CERTIFICATION BY8
THE CERTIFYING BODY THAT GRANTED THE INITIAL CERTIFICATION IN THE9
MEDICAL SPECIALTY.10
(3) (a) N
OTWITHSTANDING ANY PROVISION OF THIS TITLE 12 TO11
THE CONTRARY, COMMENCING WITH LICENSE RENEWAL , REINSTATEMENT,12
OR REACTIVATION OCCURRING ON OR AFTER JANUARY 1, 2026, EXCEPT AS13
PROVIDED IN SUBSECTIONS (3)(c), (4), AND (5) OF THIS SECTION, THE14
BOARD SHALL NOT RENEW , REINSTATE, OR REACTIVATE A LICENSE OF A15
PHYSICIAN UNLESS THE PHYSICIAN PRESENTS EVIDENCE THAT THE16
PHYSICIAN HAS COMPLETED
THIRTY CME CREDIT HOURS WITHIN THE17
COMPLIANCE PERIOD.18
(b) U
NLESS CHOSEN TO PARTICIPATE IN A BOARD AUDIT OF CME19
COMPLIANCE PURSUANT TO SUBSECTION (8) OF THIS SECTION, A PHYSICIAN20
SHALL PROVIDE EVIDENCE OF COMPLIANCE WITH THIS SECTION BY :21
(I) A
NSWERING AFFIRMATIVELY, UNDER PENALTY OF PERJURY, A22
QUESTION REGARDING COMPLIANCE WITH THE CME REQUIREMENT THAT23
IS INCLUDED ON THE QUESTIONNAIRE THAT ACCOMPANIES THE LICENSE24
RENEWAL FORM DESCRIBED IN SECTION 12-240-130 (2); OR25
(II) F
OR AN APPLICANT FOR REINSTATEMENT OR REACTIVATION , BY26
ATTESTING TO THAT FACT ON THE APPLICATION .27
1153
-7- (c) IF NECESSARY, THE BOARD SHALL ADJUST PROPORTIONATELY1
THE NUMBER OF CME CREDIT HOURS REQUIRED PURSUANT TO SUBSECTION2
(3)(a)
OF THIS SECTION TO ENSURE THAT , DUE TO THE DATE OF THE3
LICENSE RENEWAL, REINSTATEMENT, OR REACTIVATION, A PHYSICIAN IS4
NOT REQUIRED TO OBTAIN
THIRTY CME CREDIT HOURS IN FEWER THAN5
TWENTY-FOUR MONTHS.6
(d) T
O QUALIFY FOR CME CREDIT HOURS, A PROGRAM
MUST:7
(I) BE ACCREDITED BY THE ACCREDITATION COUNCIL FOR8
CONTINUING MEDICAL EDUCATION AND QUALIFY FOR AMA PRA9
CATEGORY 1 CREDIT™;10
(II) QUALIFY FOR PRESCRIBED CREDIT FROM THE AMERICAN11
ACADEMY OF FAMILY PHYSICIANS;12
(III) BE AN APPROVED PROGRAM OF THE AMERICAN OSTEOPATHIC13
ASSOCIATION; OR14
(IV) BE A PROGRAM REQUIRED IN ORDER TO MAINTAIN NATIONAL15
BOARD CERTIFICATION, NOT INCLUDING A PROGRAM SELF-CLAIMED OR16
SELF-DOCUMENTED BY THE PHYSICIAN .17
(e) A
S PART OF THE
THIRTY CME CREDIT HOURS REQUIRED18
PURSUANT TO SUBSECTION (3)(a) OF THIS SECTION, OR THE ADJUSTED19
NUMBER OF CME CREDIT HOURS REQUIRED PURSUANT TO SUBSECTION20
(3)(c)
OF THIS SECTION, A PHYSICIAN SHALL COMPLETE CME CREDIT21
HOURS IN TOPICS SPECIFIED PURSUANT TO SUBSECTION (6) OF THIS22
SECTION.23
(4) (a) T
HE BOARD MAY RENEW THE LICENSE OF A PHYSICIAN WHO24
PRESENTS ACCEPTABLE EVIDENCE TO THE BOARD THAT THE PHYSICIAN25
WAS UNABLE TO COMPLY WITH THE CME CREDIT HOURS REQUIRED26
PURSUANT TO SUBSECTION (3)(a) OF THIS SECTION.27
1153
-8- (b) THE BOARD MAY GRANT A SIX -MONTH EXTENSION OF THE1
COMPLIANCE PERIOD TO A PHYSICIAN WHO IS UNABLE TO COMPLY WITH2
THE CME CREDIT HOURS REQUIRED PURSUANT TO SUBSECTION (3)(a) OF3
THIS SECTION.4
(5) T
HE BOARD MAY WAIVE THE CME REQUIREMENT FOR A5
PHYSICIAN'S FIRST RENEWAL PERIOD IF THE PHYSICIAN WAS INITIALLY6
LICENSED WITHIN TWELVE MONTHS AFTER COMPLETING A7
BOARD-APPROVED INTERNSHIP OR POSTGRADUATE TRAINING .8
(6) A
S PART OF THE CME REQUIREMENT ESTABLISHED PURSUANT9
TO THIS SECTION, IN ADDITION TO
CME PROGRAMS COVERING TOPICS10
SELECTED BY THE PHYSICIAN, A PHYSICIAN'S CME CREDIT HOURS MUST11
INCLUDE:12
(a) CME
CREDIT HOURS THAT COMPLY WITH SECTION 12-30-11413
AND RELATED BOARD RULES ;
AND14
15
(b) CME CREDIT HOURS COVERING A TOPIC SPECIFIED BY THE16
BOARD BY RULE PURSUANT TO SUBSECTION (7)(b) OF THIS SECTION.17
(7) T
HE BOARD SHALL PROMULGATE RULES NECESSARY TO18
IMPLEMENT A PHYSICIAN CME REQUIREMENT IN ACCORDANCE WITH THIS19
SECTION. IN ADDITION TO ANY OTHER RULES , THE BOARD SHALL ADOPT20
RULES:21 22
(a) REQUIRING THAT A PHYSICIAN MAINTAIN A TRANSCRIPT OR23
CERTIFICATE OF ATTENDANCE AT THE CME PROGRAM THAT INCLUDES24
A STATEMENT OF THE CREDIT HOURS EARNED ;25
(b) (I) RELATING TO ANY CME CREDIT HOURS IN A SPECIFIC TOPIC,26
IF THE BOARD APPROVES THE TOPIC, INCLUDING THE NUMBER OF CREDIT27
1153
-9- HOURS, THE FREQUENCY OF THE REQUIREMENT, AND WHICH PHYSICIANS1
ARE SUBJECT TO THE REQUIREMENT . NOTHING IN THIS SUBSECTION2
(7)(b)(I) ALLOWS THE BOARD TO INCREASE THE NUMBER OF REQUIRED3
CME CREDIT HOURS SPECIFIED IN SUBSECTION (3)(a) OF THIS SECTION.4
(II) THE BOARD SHALL INITIATE A STAKEHOLDER PROCESS TO5
CONSIDER REQUIRING, FOR GENERAL PRACTICE AND FOR ALL SPECIALTIES,6
SPECIFIC CME CREDIT HOURS RELATING TO HEALTH DISPARITIES AND7
OUTCOMES DATA; REPRODUCTIVE, SEXUAL, AND GENDER-BASED HEALTH8
CARE; AND EXPLICIT AND IMPLICIT BIAS, INCLUDING THE NUMBER AND9
FREQUENCY OF CME CREDIT HOURS.10
(c) INDICATING THE CIRCUMSTANCES UNDER WHICH THE BOARD11
WOULD WAIVE THE CME REQUIREMENT FOR A PHYSICIAN OR EXTEND THE12
PHYSICIAN'S COMPLIANCE PERIOD PURSUANT TO SUBSECTION (4) OF THIS13
SECTION;14
(d) IMPLEMENTING AN AUDIT OF COMPLIANCE WITH THIS SECTION ,15
IF UNDERTAKEN BY THE BOARD PURSUANT TO SUBSECTION (8) OF THIS16
SECTION; AND17
(e) FOR REINSTATEMENT OF A LICENSE THAT HAS BECOME18
INACTIVE PURSUANT TO SUBSECTION (9) OF THIS SECTION.19
(8) (a) T
HE BOARD MAY ANNUALLY AUDIT UP TO FIVE PERCENT OF20
PHYSICIANS, CHOSEN AT
RANDOM WITH AN OVERSAMPLING OF21
NONBOARD-CERTIFIED PHYSICIANS, FOR COMPLIANCE WITH THIS SECTION.22
(b) I
F CHOSEN BY THE BOARD FOR AN AUDIT OF COMPLIANCE WITH23
THE CME REQUIREMENT ESTABLISHED PURSUANT TO THIS SECTION ,24
UNLESS THE BOARD HAS ADJUSTED THE NUMBER OF REQUIRED CREDIT25
HOURS PURSUANT TO SUBSECTION (3)(c) OF THIS SECTION OR GRANTED A26
WAIVER OR EXTENSION OF THE CME REQUIREMENT DURING THE27
1153
-10- COMPLIANCE PERIOD PURSUANT TO SUBSECTION (4) OF THIS SECTION, THE1
PHYSICIAN SHALL PROVIDE EVIDENCE OF THE COMPLETION OF THIRTY2
CREDIT HOURS OF CME PROGRAMS COMPLETED WITHIN THE3
TWENTY-FOUR MONTHS PRECEDING THE DATE OF THE PHYSICIAN 'S4
RENEWAL, REINSTATEMENT, OR REACTIVATION OF THE LICENSE.5
(9) (a) I
F A PHYSICIAN FAILS TO COMPLY WITH THE CME6
REQUIREMENT ESTABLISHED PURSUANT TO THIS SECTION OR TO PROVIDE7
THE REQUIRED EVIDENCE OF COMPLETION OF CME CREDIT HOURS IN8
RESPONSE TO AN AUDIT BY THE BOARD PURSUANT TO SUBSECTION (8)(a)9
OF THIS SECTION:10
(I) T
HE PHYSICIAN'S FAILURE
TO COMPLY WITHOUT REASONABLE11
CAUSE CONSTITUTES UNPROFESSIONAL CONDUCT PURSUANT TO SECTION12
12-240-121 (1)(ii); AND13
(II) T
HE PHYSICIAN'S LICENSE BECOMES INACTIVE UNTIL14
REINSTATED BY THE BOARD PURSUANT TO BOARD RULE .15
(b) A
PHYSICIAN WITH AN INACTIVE LICENSE IS NOT REQUIRED TO16
COMPLY WITH THIS SECTION BUT SHALL MEET THE CME REQUIREMENT17
PURSUANT TO THIS SECTION BEFORE THE BOARD REACTIVATES THE18
LICENSE.19
SECTION 5. In Colorado Revised Statutes, 12-240-120, amend20
(1)(c) and (1)(d); and add (1)(e) as follows:21
12-240-120. Refusal of license - issuance subject to probation.22
(1) The board may refrain from issuing a license or may grant a license23
subject to terms of probation if the board determines that an applicant for24
a license:25
(c) Has been disciplined in another state or foreign jurisdiction26
with respect to his or her
THE APPLICANT'S license to practice medicine,27
1153
-11- license to practice as a physician assistant, or license to practice as an1
anesthesiologist assistant; or2
(d) Has not actively practiced medicine, practiced as a physician3
assistant, or practiced as an anesthesiologist assistant for the two-year4
period immediately preceding the filing of an application, or otherwise5
maintained continued competency during that period, as determined by6
the board;
OR7
(e) H
AS NOT COMPLETED REQUIRED CONTINUING MEDICAL8
EDUCATION PURSUANT TO SECTION 12-240-130.5.9
SECTION 6. In Colorado Revised Statutes, 12-240-141, amend10
(5) as follows:11
12-240-141. Inactive license. (5) Any person licensed under this12
section who wishes to resume the practice of medicine or to resume13
practice as a physician assistant shall file an application in the form and14
manner the board shall designate,
MEET THE REQUIRED APPLICABLE15
CONTINUING MEDICAL EDUCATION REQUIREMENTS PURSUANT TO SECTION16
12-240-130.5, pay the license fee promulgated by the board pursuant to17
section 12-240-130, and meet the financial responsibility requirements18
promulgated by the board pursuant to section 13-64-301 (1). The board19
may approve the application and issue a license or may deny the20
application as set forth in section 12-240-120.21
SECTION 7. Act subject to petition - effective date. This act22
takes effect at 12:01 a.m. on the day following the expiration of the23
ninety-day period after final adjournment of the general assembly; except24
that, if a referendum petition is filed pursuant to section 1 (3) of article V25
of the state constitution against this act or an item, section, or part of this26
act within such period, then the act, item, section, or part will not take27
1153
-12- effect unless approved by the people at the general election to be held in1
November 2024 and, in such case, will take effect on the date of the2
official declaration of the vote thereon by the governor.3
1153
-13-