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April 26, 2024 HB 24-1153
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Revised Fiscal Note
(replaces fiscal note dated February 12, 2024)
Drafting Number:
Prime Sponsors:
LLS 24-0286
Rep. Garcia; Willford
Sen. Cutter; Jaquez Lewis
Date:
Bill Status:
Fiscal Analyst:
April 26, 2024
Senate Health & Human Services
Brendan Fung | 303-866-4781
brendan.fung@coleg.gov
Bill Topic: PHYSICIAN CONTINUING EDUCATION
Summary of
Fiscal Impact:
☒ State Revenue
☒ State Expenditure
☐ State Transfer
☒ TABOR Refund
☐ Local Government
☐ Statutory Public Entity
The bill establishes continuing medical education requirements for physician license
renewal, reinstatement, or reactivation. It increases state expenditures starting in
FY 2025-26 and state revenue starting in FY 2026-27.
Appropriation
Summary:
No appropriation is required.
Fiscal Note
Status:
The fiscal note reflects the introduced bill.
Table 1
State Fiscal Impacts Under HB 24-1153
Budget Year
FY 2024-25
Out Year
FY 2025-26
Out Year
FY 2026-27
Revenue - - $32,470
Expenditures Cash Funds - $7,669 $13,171
Centrally Appropriated - $1,921 $3,632
Total Expenditures - $9,620 $16,803
Total FTE - 0.1 FTE 0.2 FTE
Transfers - - -
Other Budget Impacts TABOR Refund - - Not estimated
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April 26, 2024 HB 24-1153
Summary of Legislation
The bill requires licensed physicians to complete continuing medical education (CME) before
renewing, reinstating, or reactivating a license and authorizes the Colorado Medical Board to
make rules, determine CME subject matter, audit licensees, and grant exemptions.
Continuing medical education. For license renewal, reinstatement, or reactivation beginning in
January 2026, a physician must complete 30 credit hours of approved CME in the 24 months
preceding licensure. Eligible CME programs and activities are determined by specific
accreditation associations, approved programs, and national certifications. Failure to complete
CME requirements or comply with a Board audit constitutes unprofessional conduct and
inactivates a physician’s license.
Board duties. The Colorado Medical Board must initiative a stakeholder process to consider
requirements and frequency of specific CME credit hours related to reproductive, sexual, and
gender-based health care, health disparities, and biases. Additionally, the Board may make rules
for CME implementation, waive CME requirements, extend the compliance period, approve CME
topics, and audit up to five percent of randomly-selected license renewals for CME compliance.
The bill requires the Division of Professions and Occupations in the Department of Regulatory
Agencies (DORA) to increase license renewal fees to cover the cost of CME implementation.
Assumptions
It is assumed that the costs of CME implementation will be paid through a biennial fee levied on
all licensed physicians in the state. Physician license renewal occurs in April of odd-numbered
years; therefore, revenue increase from fees under the bill begin in April 2027 during
FY 2026-27. Further, the fiscal note assumes that three percent of license renewals, or
974 physicians, will be audited by the Board beginning in FY 2026-27 and every year thereafter.
State Revenue
The bill increases state cash fund revenue by about $32,500 in FY 2026-27, paid to the Division
of Professions and Occupations Cash Fund, to cover the cost of implementing and administering
CME requirements. On an ongoing basis, revenue will increase to DORA every two years
assuming the fee is charged as part of the two-year renewal cycle for physician licenses. These
impacts are shown in Table 2 and discussed in more detail below.
Table 2
Fee Impact on Licensed Physicians
Fiscal Year Type of Fee Proposed Fee Number Affected Total Fee Impact
FY 2026-27 Physician License Fee $1 32,470 $32,470
1
The Physician License Fee is assumed to be charged biennially, beginning in FY 2026-27. Fee revenue is not
anticipated in FY 2024-25 or FY 2025-26. Page 3
April 26, 2024 HB 24-1153
Fee impact on licensed physicians. Colorado law requires legislative service agency review of
measures which create or increase any fee collected by a state agency. Beginning in FY 2026-27
and every two years thereafter, DORA will collect about $32,500 in additional fees to cover CME
related costs. The fiscal note estimates a $1 increase for physician license renewal fees, which
were $150 as of January 2024. This proposed fee increase is an estimate only; actual fees will be
set administratively by DORA based on cash fund balance, estimated program costs, and the
estimated number of licensees subject to the fee.
State Expenditures
The bill increases state expenditures in DORA by about $9,600 in FY 2025-26 and $16,800 in
FY 2026-27, paid from the Division of Professions and Occupations Cash Fund. Expenditures are
shown in Table 3 and detailed below.
Table 3
Expenditures Under HB 24-1153
FY 2024-25 FY 2025-26 FY 2026-27
Department of Regulatory Agencies
Personal Services - $7,669 $13,171
Centrally Appropriated Costs - $1,920 $3,632
Total Cost - $9,620 $16,803
Total FTE - 0.1 FTE 0.2 FTE
Staff. In FY 2025-26 and FY 2026-27, DORA requires 0.1 FTE Marketing and Communications
Specialist IV to communicate CME requirements to licensed physicians, handle stakeholder
outreach and update marketing materials. Starting in FY 2026-27, DORA requires 0.2 FTE
Technician III to conduct physician license renewal audits. Technician III staff costs and FTE are
prorated in FY 2026-27 based on a start date of April 1, 2027.
Legal services. In the first year, DORA will have an increase in costs for legal services associated
with rulemaking and implementation of the new continuing education requirement. In future
years, DORA will have an increase in legal services costs related to disciplinary actions for
physicians who do not comply with the new requirement. Overall, it is estimated that any
increase in legal services costs will be minimal (less than 100 hours per year) and adjusted
through the budget process, if needed. Legal services are provided by the Department of Law.
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 3.
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April 26, 2024 HB 24-1153
Other Budget Impacts
TABOR refunds. A forecast of state revenue subject to TABOR is not available beyond
FY 2025-26. In future years where the state is above its revenue limit, increased revenue under
the bill will increase TABOR refunds, paid from the General Fund. In these situation, increased
cash fund revenue will reduce the amount of General Fund available to spend or save.
Effective Date
The bill takes effect 90 days following adjournment of the General Assembly sine die, assuming
no referendum petition is filed, and applies to license renewals, reinstatements, or reactivations
occurring on or after January 1, 2026.
State and Local Government Contacts
District Attorneys Health Care Policy and Financing Information Technology
Judicial Law 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 the General Assembly website.