Second Regular Session Seventy-fourth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 24-0029.01 Josh Schultz x5486 HOUSE BILL 24-1217 House Committees Senate Committees Health & Human Services A BILL FOR AN ACT C ONCERNING THE DISSEMINAT ION OF PATIENT HEALTH -CARE101 INFORMATION.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 requires the behavioral health administration in the department of human services (BHA) to create a universal behavioral health consent form for disclosure of an individual's protected health information in compliance with the federal "Health Insurance Portability and Accountability Act of 1996". HOUSE SPONSORSHIP Amabile, SENATE 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. The office of e-health innovation in the governor's office is required to convene a working group to determine how to most effectively create a centralized digital consent repository that allows patients to provide, extend, deny, and revoke consent for sharing their medical data and information between physical and behavioral health-care providers, family members, community organizations, payers, and state agencies at any time. The BHA is required to create a friends and family input form (form) to allow an individual to provide a treating professional or a licensed or designated facility or organization with information related to a patient receiving mental health or substance use services. The bill prohibits an individual from knowingly and intentionally making a false statement on the form; performing this act constitutes an unclassified misdemeanor penalized by a fine of not more than $1,000. Be it enacted by the General Assembly of the State of Colorado:1 SECTION 1. In Colorado Revised Statutes, 27-50-101, add2 (11.5), (13.7), (14.5), and (17.5) as follows:3 27-50-101. Definitions. As used in this article 50, unless the4 context otherwise requires:5 (11.5) "C OVERED ENTITY" MEANS AN ENTITY SUBJECT TO HIPAA.6 (13.7) "F RIENDS AND FAMILY INPUT FORM " MEANS A FORM7 CREATED PURSUANT TO SECTION 27-50-111 TO ALLOW FAMILY AND8 FRIENDS TO PROVIDE HEALTH OR BACKGROUND INFORMATION ABOUT AN9 INDIVIDUAL RECEIVING MENTAL HEALTH OR SUBSTANCE USE SERVICES .10 (14.5) "HIPAA" MEANS THE FEDERAL "HEALTH INSURANCE11 P ORTABILITY AND ACCOUNTABILITY ACT OF 1996", 42 U.S.C. SECS.12 1320d TO 1320d-9, AS AMENDED.13 (17.5) "R ELEASE FORM" MEANS THE UNIVERSAL BEHAVIORAL14 HEALTH CONSENT FORM CREATED PURSUANT TO SECTION 27-50-109.15 SECTION 2. In Colorado Revised Statutes, add 27-50-109,16 27-50-110, and 27-50-111 as follows:17 HB24-1217-2- 27-50-109. Universal behavioral health consent form - rules -1 availability. (1) (a) T HE BHA SHALL CREATE A UNIVERSAL BEHAVIORAL2 HEALTH CONSENT FORM TO BE USED AS AN OPTIONAL FORM FOR3 AUTHORIZATION TO RELEASE PROTECTED HEALTH INFORMATION FOR4 INDIVIDUALS SEEKING BEHAVIORAL HEALTH SERVICES . THE RELEASE5 FORM:6 (I) C ONSTITUTES A HIPAA-COMPLIANT AUTHORIZATION FOR7 DISCLOSURE OF AN INDIVIDUAL'S PROTECTED HEALTH INFORMATION ; AND8 (II) C ONSTITUTES AN AUTHORIZATION FOR DISCLOSURE OF AN9 INDIVIDUAL'S PROTECTED HEALTH INFORMATION IN COMPLIANCE WITH 4210 CFR 2 OR SUCCESSOR FEDERAL REGULATIONS .11 (b) T HE BHA SHALL ENSURE THAT THE RELEASE FORM :12 (I) R EQUIRES SEPARATE SIGNATURES , ONE TO AUTHORIZE THE13 DISCLOSURE OF PROTECTED HEALTH INFORMATION PURSUANT TO 42 CFR14 2, OR SUCCESSOR FEDERAL REGULATIONS , AND ONE TO AUTHORIZE THE15 DISCLOSURE OF PROTECTED HEALTH INFORMATION PURSUANT TO HIPAA;16 (II) C LEARLY STATES THAT INDIVIDUALS SIGNING THE FORM ARE17 CONSENTING TO THE DISCLOSURE OF THEIR PROTECTED HEALTH18 INFORMATION PURSUANT TO BOTH 42 CFR 2, OR SUCCESSOR FEDERAL19 REGULATIONS, AND HIPAA;20 (III) I NCLUDES A SECTION ALLOWING AN INDIVIDUAL TO IDENTIFY21 PERSONS WHO HAVE CONSENTED TO RECEIVE DISCLOSURE OF THE22 INDIVIDUAL'S PROTECTED HEALTH INFORMATION ;23 (IV) I S WRITTEN IN PLAIN LANGUAGE; AND24 (V) I S AVAILABLE IN MULTIPLE LANGUAGES .25 (c) A N INDIVIDUAL MAY REVOKE OR AMEND THE INDIVIDUAL 'S26 RELEASE FORM AT ANY TIME. AN AMENDED RELEASE FORM IS EFFECTIVE :27 HB24-1217 -3- (I) UPON THE INDIVIDUAL'S SIGNATURE; AND1 (II) F OR TWO YEARS FOLLOWING THE DATE THAT THE INDIVIDUAL2 SIGNED THE AMENDED FORM .3 (d) A T LEAST EVERY SIX MONTHS, A COVERED ENTITY SHALL ASK4 AN INDIVIDUAL WHO SIGNED A RELEASE FORM IF THE INDIVIDUAL WOULD5 LIKE TO UPDATE ANY INFORMATION ON THE FORM .6 (2) A RELEASE FORM IS EFFECTIVE FOR TWO YEARS FOLLOWING7 THE DATE AN INDIVIDUAL SIGNS THE RELEASE FORM UNLESS THE8 INDIVIDUAL EXECUTES A NEW RELEASE FORM OR AMENDS OR REVOKES THE9 RELEASE FORM IN WRITING.10 (3) A COVERED ENTITY, OR A PART 2 PROGRAM, AS DEFINED BY 4211 CFR 2.11, MAY DISCLOSE AN INDIVIDUAL 'S PROTECTED HEALTH12 INFORMATION WITHOUT USE OF THE RELEASE FORM WHERE PERMITTED BY13 HIPAA.14 (4) T HE BHA MAY PROMULGATE RULES TO DEVELOP THE RELEASE15 FORM.16 (5) I N IMPLEMENTING THIS SECTION , THE DEPARTMENT SHALL17 ENGAGE WITH AND SOLICIT FEEDBACK FROM INTERESTED AND IMPACTED18 STAKEHOLDERS, INCLUDING STAKEHOLDERS WITH LEGAL EXPERTISE19 REGARDING 42 CFR 2, OR SUCCESSOR FEDERAL REGULATIONS , AND20 HIPAA; BEHAVIORAL HEALTH PROVIDERS , INCLUDING BEHAVIORAL21 HEALTH SAFETY NET PROVIDERS ; SUBSTANCE USE PROVIDERS ;22 REPRESENTATIVES OF CONSUMER ADVOCACY ORGANIZATIONS ;23 REPRESENTATIVES OF DISABILITY ADVOCACY ORGANIZATIONS ; AND ANY24 OTHER INDIVIDUALS THAT THE BHA DEEMS NECESSARY.25 (6) T HE DEPARTMENT SHALL MAKE THE RELEASE FORM AVAILABLE26 TO THE PUBLIC ON THE DEPARTMENT'S WEBSITE. THE DEPARTMENT SHALL27 HB24-1217 -4- NOTIFY AFFECTED COVERED ENTITIES ABOUT THE RELEASE FORM .1 27-50-110. Centralized digital consent repository working2 group - duties - report - repeal. (1) T HE OFFICE OF E-HEALTH3 INNOVATION IN THE GOVERNOR 'S OFFICE SHALL CONVENE A WORKING4 GROUP TO EVALUATE THE FEASIBILITY OF CREATING A CENTRALIZED5 DIGITAL CONSENT REPOSITORY THAT :6 (a) A LLOWS PATIENTS TO PROVIDE, EXTEND, DENY, AND REVOKE7 CONSENT FOR SHARING THEIR MEDICAL DATA AND INFORMATION BETWEEN8 PHYSICAL AND BEHAVIORAL HEALTH -CARE PROVIDERS, FAMILY MEMBERS,9 COMMUNITY ORGANIZATIONS , PAYERS, AND STATE AGENCIES AT ANY10 TIME;11 (b) E NHANCES CARE COORDINATION AMONG PATIENTS , PROVIDERS,12 AND FAMILY MEMBERS; AND13 (c) E NSURES PATIENT DATA IS ACCURATELY RECORDED AND14 SECURELY STORED.15 (2) T HE WORKING GROUP SHALL:16 (a) R EVIEW THE STATE'S EXISTING EFFORTS TO DEVELOP A17 CENTRALIZED DIGITAL CONSENT REPOSITORY ;18 (b) D ETERMINE THE PROCESS REQUIRED TO ESTABLISH A19 CENTRALIZED DIGITAL CONSENT REPOSITORY ;20 (c) E VALUATE THE POTENTIAL COST OF IMPLEMENTING A21 CENTRALIZED DIGITAL CONSENT REPOSITORY ;22 (d) I DENTIFY THE INFRASTRUCTURE NEEDED TO ESTABLISH A23 CENTRALIZED DIGITAL CONSENT REPOSITORY ;24 (e) I DENTIFY BEST PRACTICES FOR PROTECTING PATIENT DATA ;25 (f) I DENTIFY SOLUTIONS FOR THE SECURE STORAGE OF DATA AND26 FOR PATIENT AND PROVIDER ACCESS TO THE DATA ;27 HB24-1217 -5- (g) ENGAGE WITH THE DEPARTMENT OF REGULATORY AGENCIES1 REGARDING IMPLEMENTATION OF THE RELEASE FORMS ; AND2 (h) M AKE RECOMMENDATIONS ON ANY OTHER TOPICS THE3 WORKING GROUP DEEMS RELEVANT .4 (3) T HE WORKING GROUP MAY CONSULT WITH ADDITIONAL5 STAKEHOLDERS AND EXPERTS AS NEEDED TO INFORM THE WORKING6 GROUP'S DISCUSSIONS AND TO ANSWER QUESTIONS TO ASSIST THE7 WORKING GROUP IN FINALIZING ITS FINDINGS AND RECOMMENDATIONS .8 (4) T HE WORKING GROUP MUST INCLUDE INDIVIDUALS WITH LEGAL9 EXPERTISE REGARDING 42 CFR 2, OR SUCCESSOR FEDERAL REGULATIONS ,10 AND HIPAA; A REPRESENTATIVE FROM THE BHA; LICENSED BEHAVIORAL11 HEALTH PROVIDERS INCLUDING , BEHAVIORAL HEALTH SAFETY NET12 PROVIDERS; SUBSTANCE USE PROVIDERS; REPRESENTATIVES OF CONSUMER13 ADVOCACY ORGANIZATIONS ; REPRESENTATIVES OF DISABILITY ADVOCACY14 ORGANIZATIONS; AND ANY OTHER INDIVIDUALS THAT THE OFFICE OF15 E-HEALTH INNOVATION DETERMINES ARE NECESSARY .16 (5) B EGINNING SEPTEMBER 1, 2024, THE WORKING GROUP SHALL17 MEET AT LEAST ONCE IN EACH QUARTER OF THE CALE NDAR YEAR TO18 DEVELOP THE REPORT CREATED PURSUANT TO SUBSECTION (6) OF THIS19 SECTION.20 (6) (a) O N OR BEFORE JANUARY 1, 2026, THE WORKING GROUP21 SHALL SUBMIT A REPORT INCLUDING RECOMMENDATIONS REGARDING THE22 FEASIBILITY OF CREATING A CENTRALIZED DIGITAL CONSENT REPOSITORY23 TO THE HOUSE OF REPRESENTATIVES HEALTH AND HUMAN SERVICES24 COMMITTEE, THE SENATE HEALTH AND HUMAN SERVICES COMMITTEE , AND25 THE JOINT TECHNOLOGY COMMITTEE , OR THEIR SUCCESSOR COMMITTEES.26 (b) T HE OFFICE OF E-HEALTH INNOVATION SHALL MAKE THE27 HB24-1217 -6- REPORT AVAILABLE TO THE PUBLIC ON THE OFFICE 'S WEBSITE.1 (7) T HIS SECTION IS REPEALED, EFFECTIVE SEPTEMBER 1, 2026.2 27-50-111. Friends and family input form - rules - definition.3 (1) O N OR BEFORE JULY 1, 2025, THE BHA SHALL CREATE A FRIENDS AND4 FAMILY INPUT FORM TO ALLOW AN INDIVIDUAL TO PROVIDE A TREATING5 PROFESSIONAL OR A LICENSED OR DESI GNATED FACILITY OR6 ORGANIZATION WITH PROTECTED INFORMATION RELATED TO A PATIENT7 RECEIVING MENTAL HEALTH OR SUBSTANCE USE SERVICES , INCLUDING:8 (a) I NFORMATION ABOUT A PATIENT 'S:9 (I) D IAGNOSIS;10 (II) P AST HOSPITALIZATIONS;11 (III) D E-ESCALATION TECHNIQUES;12 (IV) C URRENT AND PAST PROVIDERS AND THEIR CONTACT13 INFORMATION;14 (V) P OTENTIAL TRIGGERS;15 (VI) H OUSING STATUS;16 (VII) C URRENT MEDICAL CONDITIONS ; AND17 (VIII) C URRENT AND PAST MEDICATIONS ; AND18 (b) A NY OTHER INFORMATION AS DETERMINED BY THE BHA BASED19 ON FEEDBACK RECEIVED FROM STAKEHOLDERS .20 (2) O N OR BEFORE OCTOBER 1, 2024, THE BHA SHALL CONVENE21 ONE OR MORE MEETINGS TO OBTAIN INPUT AND RECOMMENDATIONS FROM22 STAKEHOLDERS, INCLUDING CONSUMER ADVOCATES ; BEHAVIORAL23 HEALTH PROVIDERS, INCLUDING BEHAVIORAL HEALTH SAFETY NET24 PROVIDERS; REPRESENTATIVES FROM THE DEPARTMENT OF PUBLIC HEALTH25 AND ENVIRONMENT AND THE DEPARTMENT OF CORRECTIONS ; INDIVIDUALS26 WITH EXPERTISE IN STATE AND FEDERAL PRIVACY LAW ; AND INDIVIDUALS27 HB24-1217 -7- WHO HAVE ACCESSED MENTAL HEALTH OR SUBSTANCE USE SERVICES ,1 CONCERNING THE BEST PRACTICES FOR CREATION AND USE OF THE FRIENDS2 AND FAMILY INPUT FORM DESCRIBED IN SUBSECTION (1) OF THIS SECTION.3 (3) (a) T HE FRIENDS AND FAMILY INPUT FORM MAY BE ACCEPTED4 IN WRITING OR ELECTRONICALLY BY ANY HEALTH -CARE FACILITY OR5 PROVIDER LICENSED OR DESIGNATED BY THE BHA, ANY LICENSEE AS6 DEFINED IN SECTION 12-245-202 (8), ANY REGISTRANT AS DEFINED IN7 SECTION 12-245-202 (16), THE DEPARTMENT OF PUBLIC HEALTH AND8 ENVIRONMENT, THE DEPARTMENT OF CORRECTIONS , A COUNTY OR9 DISTRICT PUBLIC HEALTH AGENCY , THE DEPARTMENT OF HEALTH CARE10 POLICY AND FINANCING, OR ANY OTHER TREATMENT FACILITY FOR11 INDIVIDUALS WITH BEHAVIORAL OR MENTAL HEALTH DISORDERS .12 (b) C OVERED ENTITIES MAY ACCEPT PARTIALLY COMPLETED13 SUBMISSIONS OF THE FRIENDS AND FAMILY INPUT FORM .14 (c) A TREATING PROFESSIONAL OR A LICENSED OR DESIGNATED15 FACILITY OR ORGANIZATION SHALL NOT DISTRIBUTE THE FRIENDS AND16 FAMILY INPUT FORM TO ANY OTHER ENTITY .17 (d) N OTHING IN THIS SECTION SHALL BE CONSTRUED TO MODIFY OR18 ALTER ANY GENERALLY ACCEPTED ETHICS , STANDARDS, PROTOCOLS, OR19 LAWS GOVERNING TREATING PROFESSIONALS . A COVERED ENTITY,20 TREATING PROFESSIONAL, OR THE PROFESSIONAL'S DESIGNEE IS NOT21 SUBJECT TO ANY CIVIL, CRIMINAL, OR REGULATORY SANCTION FOR ACTING22 OR FAILING TO ACT IN RESPONSE TO THE INFORMATION CONTAINED IN THE23 FRIENDS AND FAMILY INPUT FORM OR FOR DECLINING TO ACCEPT A24 FRIENDS AND FAMILY INPUT FORM.25 (4) (a) A FRIEND OR FAMILY MEMBER PROVIDING INFORMATION26 ABOUT AN INDIVIDUAL SHALL ENSURE THE INFORMATION IS ACCURATE TO27 HB24-1217 -8- THE BEST KNOWLEDGE OF THE FRIEND OR FAMILY MEMBER PROVIDING THE1 INFORMATION.2 (b) (I) I T IS UNLAWFUL FOR AN INDIVIDUAL TO KNOWINGLY AND3 INTENTIONALLY MAKE A FALSE STATEMENT ON A FRIENDS AND FAMILY4 INPUT FORM.5 (II) A N INDIVIDUAL WHO KNOWINGLY AND INTENTIONALLY MAKES6 A FALSE STATEMENT ON A FRIENDS AND FAMILY INPUT FORM COMMITS AN7 UNCLASSIFIED MISDEMEANOR AND , UPON CONVICTION OF THE8 MISDEMEANOR, SHALL BE PUNISHED BY A FINE OF NOT MORE THAN ONE9 THOUSAND DOLLARS.10 (5) (a) A N INDIVIDUAL WITH A CLOSE, PERSONAL INTEREST IN THE11 WELL-BEING OF THE PATIENT MAY PROVIDE INFORMATION PURSUANT TO12 THIS SUBSECTION (5).13 (b) A TREATING PROFESSIONAL OR A LICENSED OR DESIGNATED14 FACILITY OR ORGANIZATION MAY ACCEPT INPUT IN WRITING OR THROUGH15 E-MAIL FROM ANOTHER INDIVIDUAL .16 (c) A TREATING PROFESSIONAL OR A LICENSED OR DESIGNATED17 FACILITY OR ORGANIZATION MAY ACCEPT INPUT VERBALLY , INCLUDING18 THROUGH VOICEMAIL. IF A TREATING PROFESSIONAL OR A LICENSED OR19 DESIGNATED FACILITY OR ORGANIZATION ACCEPTS INPUT VERBALLY , THE20 TREATING PROFESSIONAL OR LICENSED OR DESIGNATED FACILITY OR21 ORGANIZATION SHALL ESTABLISH AND DOCUMENT THE PROCESS FOR22 ACCEPTING VERBAL INPUT.23 (d) T HE PROVIDER SHALL ACKNOWLEDGE RECEIPT OF THE INPUT24 PROVIDED PURSUANT TO THIS SUBSECTION (5) BUT IS NOT REQUIRED TO25 DISCLOSE ADDITIONAL INFORMATION .26 (6) (a) I F THE DISCLOSURES ARE PERMITTED BY HIPAA, A27 HB24-1217 -9- PROVIDER MAY SHARE A PATIENT'S INFORMATION WITH FAMILY, FRIENDS,1 OR ANY INDIVIDUAL WITH A CLOSE , PERSONAL INTEREST IN THE2 WELL-BEING OF THE PATIENT WITHOUT THE PATIENT 'S CONSENT IF THE3 PATIENT IS NOT PRESENT OR IS INCAPACITATED AND THE TREATING4 PROFESSIONAL OR THE PROFESSIONAL'S DESIGNEE DETERMINES, BASED ON5 PROFESSIONAL JUDGMENT , THAT IT IS IN THE BEST INTEREST OF THE6 PATIENT.7 (b) I F A PROVIDER DISCLOSES INFORMATION ABOUT A PATIENT8 WITHOUT THE PATIENT'S CONSENT PURSUANT TO SUBSECTION (6)(a) OF9 THIS SECTION, THE PROVIDER SHALL DISCUSS ONLY THE INFORMATION10 THAT AN INDIVIDUAL INVOLVED NEEDS TO KNOW ABOUT A PATIENT 'S CARE11 OR PAYMENT.12 (c) A PROVIDER OR FACILITY SHALL NOT INFORM A PATIENT 'S13 FAMILY, FRIENDS, OR ANY INDIVIDUAL WITH A CLOSE, PERSONAL INTEREST14 IN THE WELL-BEING OF THE PATIENT ABOUT A PAST MEDICAL PROBLEM15 THAT IS UNRELATED TO THE PATIENT'S CURRENT CONDITION.16 (d) A PROVIDER IS NOT REQUIRED BY HIPAA TO SHARE A17 PATIENT'S INFORMATION WHEN THE PATIENT IS NOT PRESENT OR IS18 INCAPACITATED. THE PROVIDER MAY WAIT UNTIL THE PATIENT HAS THE19 OPPORTUNITY TO AGREE TO THE DISCLOSURE .20 (7) T HE BHA SHALL CREATE A RESOURCE PAGE FOR BOTH21 PROVIDERS AND FAMILIES ON ITS WEBSITE THAT INCLUDES THE FRIENDS22 AND FAMILY INPUT FORM AND INFORMATION FROM FEDERAL GUIDANCE23 DOCUMENTS AND SHALL NOTIFY INTERESTED STAKEHOLDERS OF THE24 AVAILABILITY OF THE FRIENDS AND FAMILY INPUT FORM AND RESOURCE25 PAGE.26 (8) T HE BHA MAY PROMULGATE RULES TO IMPLEMENT THIS27 HB24-1217 -10- SECTION.1 SECTION 3. Safety clause. The general assembly finds,2 determines, and declares that this act is necessary for the immediate3 preservation of the public peace, health, or safety or for appropriations for4 the support and maintenance of the departments of the state and state5 institutions.6 HB24-1217 -11-