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April 18, 2024 HB 24-1456
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Fiscal Note
Drafting Number:
Prime Sponsors:
LLS 24-1158
Rep. Marvin
Sen. Michaelson Jenet
Date:
Bill Status:
Fiscal Analyst:
April 18, 2024
House Health & Human Services
Kristine McLaughlin | 303-866-4776
kristine.mclaughlin@coleg.gov
Bill Topic: INCREASE SYPHILIS TESTING DURING PREGNANCY
Summary of
Fiscal Impact:
☒ State Revenue
☒ State Expenditure
☐ State Transfer
☒ TABOR Refund
☐ Local Government
☐ Statutory Public Entity
The bill requires additional syphilis testing during pregnancy. The bill increases state
revenue and expenditure on an ongoing basis.
Appropriation
Summary:
For FY 2024-25, the bill requires an appropriation of $846,308 to the Department of
Health Care Policy and Financing.
Fiscal Note
Status:
The fiscal note reflects the introduced bill. Due to time constraints, this analysis is
preliminary and will be updated following further review and any additional
information received.
Table 1
State Fiscal Impacts Under HB 24-1456
Budget Year
FY 2024-25
Out Year
FY 2025-26
Revenue - -
Expenditures General Fund $338,988 $338,988
Cash Funds $58,151 $58,151
Federal Funds $449,169 $449,169
Total Expenditures $846,308 $846,308
Transfers - -
Other Budget Impacts General Fund Reserve $50,848 $50,848
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April 18, 2024 HB 24-1456
Summary of Legislation
Current law requires health care providers to test pregnant patients for syphilis at the first
prenatal care visit, unless the patient refuses. The bill requires a second test during a third
trimester prenatal care visit and a third test during delivery.
Background and Assumptions
The CDC recommends testing all pregnant patients for syphilis at their first prenatal care visit
and testing high-risk patients at 28 weeks and at delivery. Several states have passed laws
mandating this recommendation or mandating two or three tests for all patients. Nationally,
there is an ongoing discussion about testing rates and why they are lower than 100 percent.
1
2
Some studies have suggested that the discrepancy may be due in part to inadequacies in claim
data.
3
Lacking better information, the fiscal note assumes Medicaid claims data reflects the
Medicaid testing rate. As a result, the note assumes that few Medicaid members are currently
being tested after the first prenatal visit. The note further assumes that, under the bill, third
trimester prenatal care and delivery testing rates will rise to first trimester prenatal care rates.
State Revenue
The State Laboratory operated by the Department of Public Health and Environment (CDPHE)
currently processes about 150 syphilis tests annually for a fee of $21. Under the bill, tests and
corresponding fee revenue to the Laboratory Cash Fund may increase by about $5,000, which
the fiscal note considers a minimal fee impact. This revenue is subject to TABOR.
State Expenditures
The bill increases state expenditures in the Department of Health Care Policy and Financing
(HCPF) by $846,000 annually, paid from the General Fund, the Healthcare Affordability and
Sustainability Cash Fund, and federal funds. Workload may increase in CDPHE. Expenditures are
shown in Table 2 and detailed below.
1
Ojo, O. C., Arno, J. N., Tao, G., Patel, C. G., & Dixon, B. E. (2021, October 30). Syphilis testing adherence among women with Livebirth
Deliveries: Indianapolis 2014-2016 - BMC pregnancy and childbirth. BioMed Central.
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-04211-8
2
Kennedy, S., Otter, C., Talbert, J., & Hammerslag, L. (n.d.). Analyzing rates of congenital syphilis screening among pregnant
Medicaid enrollees in three southern states. AcademyHealth. https://academyhealth.org/about/programs/analyzing-rates-
congenital-syphilis-screening-among-pregnant-medicaid-enrollees-three-southern-states
3
Indiana University School of Medicine, D. of P. (2007, October 12). Prenatal syphilis screening rates measured using Medicaid... :
Sexually transmitted diseases.
https://journals.lww.com/stdjournal/fulltext/2008/04000/prenatal_syphilis_screening_rates_measured_using.15.aspx Page 3
April 18, 2024 HB 24-1456
Table 2
Expenditures Under HB 24-1456
FY 2024-25 FY 2025-26
Department of Health Care Policy and Financing
Third Trimester Prenatal Visit Test $422,273 $422,273
Delivery Test $424,035 $424,035
Total Cost $846,308 $846,308
Department of Health Care policy and Financing. Costs will increase in HCPF as Medicaid and
Children’s Health Plan Plus (CHP+) members receive more syphilis tests. Based on the current
testing rate, it is estimated that the bill will increase testing claims by 33,000 tests annually at a
cost of $25 per test. This roughly represents about 17,000 members out of 27,000 receiving one
additional test during a third trimester prenatal visit and one additional test during delivery.
Department of Public Health and Environment. Costs will increase in CDPHE to process any
additional syphilis tests. To the extent that increase in testing results in an increase in syphilis
diagnoses, workload will increase for the STI/HIV and Viral Hepatitis program under CDPHE to
follow-up with newly diagnosed people to ensure adequate treatment. Because it cannot be
determined how many of the new tests will result in positive diagnoses, this impact will be
accounted for through the normal budget process.
Other Budget Impacts
General Fund reserve. Under current law, an amount equal to 15 percent of General Fund
appropriations must be set aside in the General Fund statutory reserve. Based on this fiscal note,
the bill is expected to increase the amount of General Fund held in reserve by the amounts
shown in Table 1, decreasing the amount of General Fund available for other purposes.
Effective Date
The bill takes effect upon signature of the Governor, or upon becoming law without his
signature.
State Appropriations
For FY 2024-25, the bill requires an appropriation of $846,308 to the Department of Health Care
policy and Financing. Of that amount:
$338,988 is from the General Fund;
$58,151 is from the Healthcare Affordability and Sustainability Cash Fund; and
$449,169 is from federal funds. Page 4
April 18, 2024 HB 24-1456
State and Local Government Contacts
Health Care Policy and Financing Public Health and Environment
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.