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April 19, 2024 HB 24-1456
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Revised Fiscal Note
(replaces fiscal note dated April 18, 2024)
Drafting Number:
Prime Sponsors:
LLS 24-1158
Rep. Marvin
Sen. Michaelson Jenet
Date:
Bill Status:
Fiscal Analyst:
April 19, 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 starting when Public Health Order
24-01 is rescinded.
Appropriation
Summary:
No appropriation is required.
Fiscal Note
Status:
The revised fiscal note reflects the introduced bill. It has been updated to reflect the
recent Public Health Order issued by the Department of Public Health and
Environment and updated data from the Department of Health Care Policy and
Financing.
Table 1
State Fiscal Impacts Under HB 24-1456
Budget Year
FY 2024-25
Post
PHO 24-01
Revenue - -
Expenditures General Fund - $181,665
Cash Funds - $31,163
Federal Funds - $240,711
Total Expenditures $0 $453,539
Transfers - -
Other Budget Impacts General Fund Reserve - $27,250
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April 19, 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
On April 18, 2024 the Department of Public Health and Environment CDPHE issued Public Health
Order (PHO) 24-01, which mandates additional syphilis testing in line with the bill’s
requirements. As a result, the bill will not have an impact until the epidemic is resolved and the
public health order is rescinded. The fiscal note makes no assumptions about when this will
happen beyond assuming that it will not happen in FY 2024-25 and thus no appropriation is
required.
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, after PHO
24-01 is rescinded, 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.
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 19, 2024 HB 24-1456
State Expenditures
Once the PHO is rescinded, the bill will increase state expenditures in the Department of Health
Care Policy and Financing (HCPF) by about $455,000 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.
Table 2
Expenditures Under HB 24-1456
FY 2024-25 Post PHO 24-01
Department of Health Care Policy and Financing
Third Trimester Prenatal Visit Test - $228,563
Delivery Test - $224,976
Total Cost - $453,539
Department of Health Care policy and Financing. Once the PHO is rescinded, 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 $14 per test. This roughly represents about 16,000
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. Once the PHO is rescinded, 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.
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April 19, 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.