Second Regular Session Seventy-fourth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 24-0080.01 Chelsea Princell x4335 SENATE BILL 24-168 Senate Committees House Committees Health & Human Services A BILL FOR AN ACT C ONCERNING REMOTE MONITORING SERVICES FOR MEDICAID101 MEMBERS.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 .) Beginning July 1, 2025, the bill requires the department of health care policy and financing (state department) to provide reimbursement for the use of telehealth remote monitoring for outpatient services for certain medicaid members (member). The bill creates the telehealth remote monitoring grant program to provide grants to an outpatient health-care facility located in a designated SENATE SPONSORSHIP Roberts and Simpson, Michaelson Jenet HOUSE SPONSORSHIP McCluskie and Martinez, Young 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. rural county or designated provider shortage area to assist the outpatient health-care facility clinic with the financial cost of providing telehealth remote monitoring for outpatient clinical services. Beginning November 1, 2025, the bill requires the state department to provide coverage for continuous glucose monitors for members. Be it enacted by the General Assembly of the State of Colorado:1 SECTION 1. Legislative declaration. (1) The general assembly2 finds that:3 (a) Concerning the use of telehealth remote monitoring to provide4 outpatient clinical services:5 (I) Telehealth helps connect Medicaid members with health-care6 providers, enabling members to receive the care and consultation they7 need without traveling to visit a provider in another city or area of the8 state;9 (II) Telehealth visits may provide cost savings for the Medicaid10 system by improving access to primary care and helping avoid11 unnecessary trips to the emergency department;12 (III) More than 700,000 Coloradans live in a rural or frontier13 county. Rural Coloradans face several unique challenges in health-care14 access, affordability, and outcomes. Rural residents tend to be older and15 in poorer health than their urban counterparts, and rural communities16 often face challenges with access to care and financial viability.17 According to the Centers for Disease Control and Prevention, rural18 residents are more likely to die prematurely from heart disease, cancer,19 unintentional injury, chronic lower respiratory disease, and stroke.20 (IV) Despite these challenges, rural Coloradans play an important21 role in food and energy production in the state and serve as an integral22 SB24-168-2- part of Colorado's economy;1 (V) Telehealth, including telehealth remote monitoring, is one of2 the tools the Centers for Disease Control and Prevention has identified3 that can be used to improve the health of rural residents. Telehealth4 remote monitoring uses digital technologies to collect health data from5 patients in one location and electronically transmit that information6 securely to providers in a different location.7 (VI) Telehealth remote monitoring technologies provide a8 particular benefit for patients with chronic conditions to receive the care9 they need without the need for constant in-person visits to the patient's10 physician's office. Patients with chronic conditions such as diabetes, heart11 disease, and chronic obstructive pulmonary disease often require ongoing12 monitoring and management. Telehealth remote monitoring can help13 these patients better manage their conditions by providing regular14 monitoring, alerts, and support.15 (VII) Multiple studies indicate that telehealth remote monitoring16 offers patients a clear return on investment over time, which extends17 beyond initial health-care savings, including money associated with18 transportation, time, and energy to visit their doctors; prescription,19 laboratory, and imaging costs; and hard and soft expenses if a hospital20 stay or emergency department visit is required;21 (VIII) The return on telehealth remote monitoring isn't limited to22 financial measurements. It also improves health outcomes, eliminates23 communication barriers, facilitates faster access to providers, reduces24 hospital readmissions, shortens hospital stays, and enhances patient25 education.26 (IX) Expanding access to telehealth remote monitoring for27 SB24-168 -3- patients is crucial to achieving health equity in Colorado.1 (b) Concerning the use of continuous glucose monitoring devices:2 (I) More than 300,000 Coloradans live with type 1 or type 23 diabetes;4 (II) Managing diabetes requires strict blood glucose control5 consisting of multiple blood glucose level checks daily, medication6 administration, and balancing diet and physical activity;7 (III) Continuous glucose monitoring devices provide patients and8 health-care providers with more health data and detail concerning blood9 glucose levels than traditional blood glucose meters;10 (IV) For people with diabetes, continuous glucose monitoring11 devices provide significant, life-changing, and lifesaving benefits for12 managing their diabetes and can prevent or delay serious medical13 complications, including those that may require hospitalization or could14 lead to death;15 (V) Individuals with diabetes who use continuous glucose16 monitoring devices experience fewer episodes of hypoglycemia and a17 reduction in their average blood glucose levels (A1C); and18 (VI) Access to continuous glucose monitoring technology is19 extremely important to individuals with diabetes, especially those who20 live in communities with a disproportionate rate of diabetes. However,21 many Coloradans with diabetes still lack access to this critical technology,22 even though the use of continuous glucose monitoring devices is a23 recognized standard of care for all insulin-dependent individuals.24 (2) Therefore, the general assembly declares that it is in the best25 interest of the state of Colorado to reduce health disparities and increase26 health equity by prioritizing expanded access to remote patient27 SB24-168 -4- monitoring services in outpatient health-care settings across the state and1 to provide access to continuous glucose monitoring services to diabetic2 Coloradans to decrease health-care costs and improve health outcomes for3 all Coloradans.4 SECTION 2. In Colorado Revised Statutes, add 25.5-5-337 as5 follows:6 25.5-5-337. Telehealth remote monitoring services for7 outpatient clinical services - grant program - federal authorization -8 rules - definitions. (1) A S USED IN THIS SECTION, UNLESS THE CONTEXT9 OTHERWISE REQUIRES:10 (a) "G RANT PROGRAM" MEANS THE TELEHEALTH REMOTE11 MONITORING GRANT PROGRAM CREATED IN SUBSECTION (6) OF THIS12 SECTION.13 (b) "M EMBER" MEANS ANY PERSON WHO HAS BEEN DETERMINED14 ELIGIBLE TO RECEIVE BENEFITS OR SERVICES UNDER THIS TITLE 25.5.15 (c) "T ELEHEALTH REMOTE MONITORING " MEANS THE ONGOING16 REMOTE ASSESSMENT AND MONITORING OF CLINICAL DATA THROUGH17 TECHNOLOGICAL EQUIPMENT IN ORDER TO DETECT CHANGES IN A18 MEMBER'S CLINICAL STATUS, WHICH ALLOWS HEALTH-CARE PROVIDERS TO19 INTERVENE BEFORE A HEALTH CONDITION EXACERBATES AND REQUIRES20 EMERGENCY INTERVENTION OR INPATIENT HOSPITALIZATION .21 (2) (a) O N OR BEFORE SEPTEMBER 1, 2024, THE STATE22 DEPARTMENT SHALL INITIATE A STAKEHOLDER PROCESS TO DETERMINE23 THE BILLING STRUCTURE FOR TELEHEALTH REMOTE MONITORING FOR24 OUTPATIENT CLINICAL SERVICES:25 (b) T HE STATE DEPARTMENT STAKEHOLDER PROCESS , REQUIRED26 BY SUBSECTION (2)(a) OF THIS SECTION, MUST ENGAGE WITH27 SB24-168 -5- HEALTH-CARE PROVIDERS WHO SERVE RURAL AND UNDERSERVED1 POPULATIONS, INCLUDING RURAL HEALTH CLINICS AND FEDERALLY2 QUALIFIED HEALTH CENTERS TO ENSURE THE BILLING STRUCTURE IS3 SUSTAINABLE IN THESE HEALTH-CARE SETTINGS.4 (c) O N OR BEFORE JUNE 30, 2025, THE STATE BOARD SHALL5 PROMULGATE RULES REGARDING THE BILLING STRUCTURE BASED ON6 FEEDBACK FROM THE STAKEHOLDER PROCESS REQUIRED IN SUBSECTIONS7 (2)(a) AND (2)(b) OF THIS SECTION.8 (3) (a) B EGINNING JULY 1, 2025, THE STATE DEPARTMENT SHALL9 PROVIDE REIMBURSEMENT FOR THE USE OF TELEHEALTH REMOTE10 MONITORING FOR OUTPATIENT CLINICAL SERVICES IF :11 (I) T HE MEMBER'S HEALTH-CARE PROVIDER DETERMINES THAT12 TELEHEALTH REMOTE MONITORING IS MEDICALLY NECESSARY BASED ON13 THE MEMBER'S MEDICAL CONDITION OR STATUS;14 (II) T HE MEMBER'S HEALTH-CARE PROVIDER DETERMINES THAT15 TELEHEALTH REMOTE MONITORING WOULD LIKELY PREVENT THE16 MEMBER'S ADMISSION OR READMISSION TO A HOSPITAL , EMERGENCY17 DEPARTMENT, NURSING FACILITY, OR OTHER CLINICAL SETTING;18 (III) T HE MEMBER IS COGNITIVELY AND PHYSICALLY CAPABLE OF19 OPERATING THE TELEHEALTH REMOTE MONITORING DEVICE OR EQUIPMENT20 OR THE MEMBER HAS A CAREGIVER WHO IS ABLE AND WILLING TO ASSIST21 WITH THE TELEHEALTH REMOTE MONITORING DEVICE OR EQUIPMENT ; AND22 (IV) T HE MEMBER RESIDES IN A SETTING THAT IS SUITABLE FOR23 TELEHEALTH REMOTE MONITORING AND DOES NOT HAVE HEALTH -CARE24 STAFF ON SITE.25 (b) T HE STATE BOARD SHALL PROMULGATE RULES REGARDING26 ADDITIONAL ELIGIBILITY REQUIREMENTS. THE ELIGIBILITY REQUIREMENTS27 SB24-168 -6- MUST PRIORITIZE MEMBERS WITH CHRONIC CONDITIONS AND MEMBERS1 WHO ARE PREGNANT AND CARRYING A HIGH -RISK PREGNANCY.2 (4) T HE ASSESSMENT AND MONITORING OF THE HEALTH DATA3 TRANSMITTED BY TELEHEALTH REMOTE MONITORING MUST BE PERFORMED4 BY ONE OF THE FOLLOWING LICENSED HEALTH -CARE PROFESSIONALS:5 (a) P HYSICIAN;6 (b) P ODIATRIST;7 (c) A DVANCED PRACTICE REGISTERED NURSE ;8 (d) P HYSICIAN ASSISTANT;9 (e) R ESPIRATORY THERAPIST; OR10 (f) L ICENSED HEALTH-CARE PROFESSIONAL WORKING UNDER THE11 SUPERVISION OF A MEDICAL DIRECTOR.12 (5) T HE STATE DEPARTMENT MAY SEEK ANY FEDERAL13 AUTHORIZATION NECESSARY TO IMPLEMENT SUBSECTIONS (3) AND (4) OF14 THIS SECTION.15 (6) (a) T HERE IS CREATED IN THE STATE DEPARTMENT THE16 TELEHEALTH REMOTE MONITORING GRANT PROGRAM TO PROVIDE GRANTS17 TO OUTPATIENT HEALTH-CARE FACILITIES LOCATED IN A DESIGNATED18 RURAL COUNTY OR A DESIGNATED PROVIDER SHORTAGE AREA TO ASSIST19 THE HOSPITALS AND CLINICS WITH THE FINANCIAL COSTS ASSOCIATED20 WITH PROVIDING TELEHEALTH REMOTE MONITORING FOR OUTPATIENT21 CLINICAL SERVICES.22 (b) T HE STATE DEPARTMENT SHALL ADMINISTER THE GRANT23 PROGRAM AND, SUBJECT TO AVAILABLE APPROPRIATIONS , SHALL AWARD24 GRANTS AS PROVIDED IN THIS SUBSECTION (6).25 (c) T O BE ELIGIBLE FOR A GRANT, AN OUTPATIENT HEALTH-CARE26 FACILITY MUST:27 SB24-168 -7- (I) APPLY FOR A GRANT IN THE MANNER PRESCRIBED BY THE STATE1 DEPARTMENT;2 (II) B E LOCATED IN A DESIGNATED RURAL COUNTY OR DESIGNATED3 PROVIDER SHORTAGE AREA ; AND4 (III) H AVE A DEMONSTRATED NEED FOR FINANCIAL ASSISTANCE TO5 PURCHASE EQUIPMENT TO PROVIDE TELEHEALTH REMOTE MONITORING6 FOR OUTPATIENT CLINICAL SERVICES.7 (d) I N SELECTING GRANT RECIPIENTS, THE STATE DEPARTMENT8 SHALL PRIORITIZE APPLICANTS THAT SERVE POPULATIONS EXPERIENCING9 DISPARITIES IN HEALTH-CARE ACCESS AND OUTCOMES , INCLUDING, BUT10 NOT LIMITED TO, HISTORICALLY MARGINALIZED AND UNDERSERVED11 COMMUNITIES, DETERMINED BY THE COMMUNITIES WITH THE HIGHEST12 PROPORTION OF PATIENTS RECEIVING ASSISTANCE THROUGH THE13 "C OLORADO MEDICAL ASSISTANCE ACT", THIS ARTICLE 5 AND ARTICLES14 4 AND 6 OF THIS TITLE 25.5.15 (e) G RANT RECIPIENTS MAY USE MONEY RECEIVED THROUGH THE16 GRANT PROGRAM TO IMPLEMENT TELEHEALTH REMOTE MONITORING FOR17 OUTPATIENT CLINICAL SERVICES AND INCLUDES THE FOLLOWING :18 (I) T RAINING STAFF TO USE, ASSESS, AND MONITOR TELEHEALTH19 REMOTE MONITORING EQUIPMENT AND DEVICES ; AND20 (II) A CQUIRING TELEHEALTH REMOTE MONITORING EQUIPMENT21 AND DEVICES.22 (7) T HIS SECTION DOES NOT APPLY TO HOME HEALTH -CARE23 BENEFITS PROVIDED PURSUANT TO SECTION 25.5-5-321.24 SECTION 3. In Colorado Revised Statutes, add 25.5-5-338 as25 follows:26 25.5-5-338. Continuous glucose monitors - coverage - federal27 SB24-168 -8- authorization - definition. (1) A S USED IN THIS SECTION, UNLESS THE1 CONTEXT OTHERWISE REQUIRES , "CONTINUOUS GLUCOSE MONITOR "2 MEANS AN INSTRUMENT OR A DEVICE DESIGNED FOR THE PURPOSE OF3 AIDING IN THE TREATMENT OF DIABETES BY MEASURING GLUCOSE LEVELS4 ON DEMAND OR AT SET INTERVALS THROUGH A SMALL , ELECTRONIC5 SENSOR THAT SLIGHTLY PENETRATES AN INDIVIDUAL 'S SKIN WHEN APPLIED6 AND THAT IS DESIGNED TO REMAIN IN PLACE AND ACTIVE FOR AT LEAST7 SEVEN DAYS.8 (2) (a) B EGINNING NOVEMBER 1, 2025, THE STATE DEPARTMENT9 SHALL PROVIDE COVERAGE FOR A CONTINUOUS GLUCOSE MONITOR AND10 RELATED SUPPLIES TO MEMBERS .11 (b) C OVERAGE CRITERIA MUST ALIGN WITH THE CURRENT GLUCOSE12 MONITOR LOCAL COVERAGE DETERMINATION STANDARDS ISSUED BY THE13 CENTERS FOR MEDICARE AND MEDICAID THAT ARE USED TO DETERMINE14 COVERAGE FOR MEDICARE -ELIGIBLE INDIVIDUALS.15 (3) C OVERAGE PURSUANT TO THIS SECTION INCLUDES THE COST OF16 ANY NECESSARY REPAIRS OR REPLACEMENT PARTS FOR THE CONTINUOUS17 GLUCOSE MONITOR.18 (4) T HE STATE DEPARTMENT MAY SEEK ANY FEDERAL19 AUTHORIZATION NECESSARY TO IMPLEMENT THIS SECTION .20 SECTION 4. Act subject to petition - effective date. This act21 takes effect at 12:01 a.m. on the day following the expiration of the22 ninety-day period after final adjournment of the general assembly; except23 that, if a referendum petition is filed pursuant to section 1 (3) of article V24 of the state constitution against this act or an item, section, or part of this25 act within such period, then the act, item, section, or part will not take26 effect unless approved by the people at the general election to be held in27 SB24-168 -9- November 2024 and, in such case, will take effect on the date of the1 official declaration of the vote thereon by the governor.2 SB24-168 -10-