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Colorado Senate Bill SB048

Colorado 2025 Regular Session

Colorado Senate Bill SB048 Compare Versions

Only one version of the bill is available at this time.
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11 First Regular Session
22 Seventy-fifth General Assembly
33 STATE OF COLORADO
44 INTRODUCED
55
66
77 LLS NO. 25-0053.01 Shelby Ross x4510
88 SENATE BILL 25-048
99 Senate Committees House Committees
1010 Health & Human Services
1111 A BILL FOR AN ACT
1212 C
1313 ONCERNING THE "DIABETES PREVENTION AND OBESITY TREATMENT101
1414 A
1515 CT".102
1616 Bill Summary
1717 (Note: This summary applies to this bill as introduced and does
1818 not reflect any amendments that may be subsequently adopted. If this bill
1919 passes third reading in the house of introduction, a bill summary that
2020 applies to the reengrossed version of this bill will be available at
2121 http://leg.colorado.gov
2222 .)
2323 The bill requires private insurance companies to provide coverage
2424 for the treatment of the chronic disease of obesity and the treatment of
2525 pre-diabetes, including coverage for the national diabetes prevention
2626 program, medical nutrition therapy, intensive behavioral or lifestyle
2727 therapy, metabolic and bariatric surgery, and FDA-approved anti-obesity
2828 medication.
2929 SENATE SPONSORSHIP
3030 Michaelson Jenet,
3131 HOUSE SPONSORSHIP
3232 Brown and Mabrey,
3333 Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
3434 Capital letters or bold & italic numbers indicate new material to be added to existing law.
3535 Dashes through the words or numbers indicate deletions from existing law. The bill requires the department of health care policy and
3636 financing (department) to seek federal authorization to provide treatment
3737 for the chronic disease of obesity and the treatment of pre-diabetes.
3838 Within existing appropriations and upon receiving federal authorization,
3939 the department is required to notify medicaid members in writing about
4040 the availability of the treatment.
4141 Be it enacted by the General Assembly of the State of Colorado:1
4242 SECTION 1. Short title. The short title of this act is the2
4343 "Diabetes Prevention and Obesity Treatment Act".3
4444 SECTION 2. Legislative declaration. (1) The general assembly4
4545 finds and declares that:5
4646 (a) In Colorado, the prevalence of the chronic disease of obesity6
4747 is staggering. Obesity affects over 24% of Colorado adults, with7
4848 disproportionately high rates in communities of color: 33.4% and 31% of8
4949 Black and Latino Coloradans experience obesity, respectively. More than9
5050 one in 4 youth ages 10 to 17 are either overweight or experiencing10
5151 obesity, and 24.3% of children enrolled in the federal special11
5252 supplemental nutrition program for women, infants, and children in 202012
5353 were overweight or experiencing obesity.13
5454 (b) The American Medical Association and the American14
5555 Academy of Pediatrics declared obesity a chronic disease in 2013, and the15
5656 American Diabetes Association has recognized obesity as a complex,16
5757 progressive, serious, relapsing, and costly chronic disease. Obesity serves17
5858 as a major risk factor for developing comorbid conditions, including heart18
5959 disease, stroke, type 2 diabetes, renal disease, non-alcoholic19
6060 steatohepatitis, and 13 types of cancer. Research shows that obesity and20
6161 diabetes increase the risk of more severe coronavirus infection and21
6262 hospitalization. Obesity also contributes to many chronic and costly22
6363 SB25-048-2- conditions and increases risk of physical injury, including falls, sprains,1
6464 strains, lower extremity fractures, and joint dislocation.2
6565 (c) Strong and consistent evidence shows that effective weight3
6666 management can delay the progression from pre-diabetes to type 24
6767 diabetes and is highly beneficial in treating type 2 diabetes. In people with5
6868 type 2 diabetes who are also overweight or experiencing obesity, modest6
6969 weight management clinically improves health, including reducing7
7070 glycemia levels and reducing the need for glucose-lowering medications.8
7171 Greater weight management substantially reduces A1C and fasting9
7272 glucose levels and has been shown to support sustained diabetes10
7373 remission for at least 2 years.11
7474 (d) The 2023 American Academy of Pediatrics obesity guidelines12
7575 recommend that comprehensive, evidence-based obesity treatment for13
7676 youth should include timely initiation of intensive behavioral or lifestyle14
7777 therapy, anti-obesity medications, and bariatric surgery, and that these15
7878 treatment options are safe and effective. Eight out of 10 adolescents with16
7979 obesity will continue to have obesity as adults. Treatment significantly17
8080 improves an individual's health and quality of life and has the potential to18
8181 significantly reduce health-care costs by preventing the development and19
8282 progression of obesity-related complications, including diabetes.20
8383 SECTION 3. In Colorado Revised Statutes, 10-16-104, add (29)21
8484 as follows:22
8585 10-16-104. Mandatory coverage provisions - applicability -23
8686 rules - definitions. (29) Anti-obesity medications. (a) A
8787 LL INDIVIDUAL24
8888 AND GROUP HEALTH BENEFIT PLANS ISSUED OR RENEWED IN THIS STATE25
8989 MUST PROVIDE COVERAGE FOR THE TREATMENT OF THE CHRONIC DISEASE26
9090 OF OBESITY AND THE TREATMENT OF PRE -DIABETES, INCLUDING27
9191 SB25-048
9292 -3- COVERAGE FOR THE NATIONAL DIABETES PREVENTION PROGRAM , MEDICAL1
9393 NUTRITION THERAPY, INTENSIVE BEHAVIORAL OR LIFESTYLE THERAPY ,2
9494 METABOLIC AND BARIATRIC SURGERY , AND FDA-APPROVED ANTI-OBESITY3
9595 MEDICATION.4
9696 (b) T
9797 HE COVERAGE CRITERIA FOR FDA-APPROVED ANTI-OBESITY5
9898 MEDICATION MUST NOT BE MORE RESTRICTIVE THAN FDA-APPROVED6
9999 INDICATIONS FOR THE MEDICATION.7
100100 (c) T
101101 HE COVERAGE REQUIRED PURSUANT TO THIS SUBSECTION (29)8
102102 MUST NOT BE DIFFERENT OR SEPARATE FROM COVERAGE FOR ANY OTHER9
103103 ILLNESS, CONDITION, OR DISORDER FOR PURPOSES OF DETERMINING10
104104 COPAYMENTS, DEDUCTIBLES, COINSURANCE, OR ANNUAL MAXIMUM11
105105 BENEFIT.12
106106 (d) T
107107 HIS SUBSECTION (29) DOES NOT PROHIBIT A PLAN FROM13
108108 APPLYING UTILIZATION MANAGEMENT TO D ETERMINE MEDICAL NECESSITY14
109109 AND APPROPRIATENESS FOR TREATMENT OF THE CHRONIC DISEASE OF15
110110 OBESITY AND THE TREATMENT OF PRE-DIABETES IF THE DETERMINATIONS16
111111 ARE MADE IN THE SAME MANNER AS DETERMINATIONS MADE FOR THE17
112112 TREATMENT OF ANY OTHER ILLNESS , CONDITION, OR DISORDER COVERED18
113113 BY THE PLAN.19
114114 (e) T
115115 HIS SUBSECTION (29) DOES NOT APPLY TO A SPECIALIZED20
116116 HEALTH-CARE SERVICE PLAN OR CONTRACT THAT COVERS ONLY DENTAL21
117117 OR VISION BENEFITS OR TO A MEDICARE SUPPLEMENTAL CONTRACT .22
118118 (f) (I) T
119119 HE COMMISSIONER SHALL SUBMIT TO THE FEDERAL23
120120 DEPARTMENT OF HEALTH AND HUMAN SERVICES :24
121121 (A) A
122122 DETERMINATION AS TO WHETHER THE BENEFIT SPECIFIED IN25
123123 THIS SUBSECTION (29) IS IN ADDITION TO ESSENTIAL HEALTH BENEFITS AND26
124124 WOULD BE SUBJECT TO DEFRAYAL BY THE STATE PURSUANT TO 42 U.S.C.27
125125 SB25-048
126126 -4- SEC. 18031 (d)(3)(B); AND1
127127 (B) A
128128 REQUEST THAT THE FEDERAL DEPARTMENT OF HEALTH AND2
129129 HUMAN SERVICES CONFIRM THE DIVISION'S DETERMINATION WITHIN SIXTY3
130130 DAYS AFTER RECEIPT OF THE DIVISION'S REQUEST AND SUBMISSION OF ITS4
131131 DETERMINATION.5
132132 (II) T
133133 HIS SUBSECTION (29) APPLIES TO LARGE EMPLOYER POLICIES6
134134 OR CONTRACTS ISSUED OR RENEWED ON OR AFTER JANUARY 1, 2026, AND7
135135 TO INDIVIDUAL AND SMALL GROUP POLICIES AND CONTRACTS ISSUED ON8
136136 OR AFTER JANUARY 1, 2027, AND THE COMMISSIONER SHALL IMPLEMENT9
137137 THE REQUIREMENTS OF THIS SUBSECTION (29) ONLY IF:10
138138 (A) T
139139 HE DIVISION RECEIVES CONFIRMATION FROM THE FEDERAL11
140140 DEPARTMENT OF HEALTH AND HUMAN SERVICES THAT THE COVERAGE12
141141 SPECIFIED IN THIS SUBSECTION (29) DOES NOT CONSTITUTE AN ADDITIONAL13
142142 BENEFIT THAT REQUIRES DEFRAYAL BY THE STATE PURS UANT TO 42 U.S.C.14
143143 SEC. 18031 (d)(3)(B);15
144144 (B) T
145145 HE FEDERAL DEPARTMENT OF HEALTH AND HUMAN SERVICES16
146146 HAS OTHERWISE INFORMED THE DIVISION THAT THE COVERAGE DOES NOT17
147147 REQUIRE STATE DEFRAYAL PURSUANT TO 42 U.S.C. SEC. 18031 (d)(3)(B);18
148148 OR19
149149 (C) M
150150 ORE THAN THREE HUNDRED SIXTY -FIVE DAYS HAVE PASSED20
151151 SINCE THE DIVISION SUBMITTED ITS DETERMINATION AND REQUEST FOR21
152152 CONFIRMATION THAT THE COVERAGE SPECIFIED IN THIS SUBSECTION (29)22
153153 IS NOT AN ADDITIONAL BENEFIT THAT REQUIRES STATE DEFRAYAL23
154154 PURSUANT TO 42 U.S.C. SEC. 18031 (d)(3)(B) AND THE FEDERAL24
155155 DEPARTMENT OF HEALTH AND HUMAN SERVICES HAS FAILED TO RESPOND25
156156 TO THE REQUEST WITHIN THAT PERIOD , IN WHICH CASE THE DIVISION26
157157 SHALL CONSIDER THE FEDERAL DEPARTMENT OF HEALTH AND HUMAN27
158158 SB25-048
159159 -5- SERVICES' UNREASONABLE DELAY A PRECLUSION FROM REQUIRING1
160160 DEFRAYAL BY THE STATE.2
161161 (g) T
162162 HE COMMISSIONER SHALL ADOPT RULES CONSISTENT WITH3
163163 AND AS ARE NECESSARY TO IMPLEMENT THIS SUBSECTION (29).4
164164 (h) A
165165 HEALTH-CARE PROVIDER SHALL FOLLOW CLINICAL5
166166 GUIDELINES WHEN PRESCRIBING AN FDA-APPROVED ANTI-OBESITY6
167167 MEDICATION.7
168168 (i) A
169169 S USED IN THIS SUBSECTION (29):8
170170 (I) "FDA-
171171 APPROVED ANTI-OBESITY MEDICATION" MEANS A9
172172 MEDICATION APPROVED BY THE FEDERAL FOOD AND DRUG10
173173 ADMINISTRATION WITH AN INDICATION FOR WEIGHT MANAGEMENT IN11
174174 PATIENTS WITH CHRONIC OBESITY.12
175175 (II) "I
176176 NTENSIVE BEHAVIORAL OR LIFESTYLE THERAPY " MEANS AN13
177177 EVIDENCE-BASED, MULTI-COMPONENT BEHAVIORAL OR LIFESTYLE14
178178 MODIFICATION INTERVENTION DESIGNED TO SUPPORT HEALTHY WEIGHT15
179179 MANAGEMENT AS RECOMMENDED BY CURRENT CLINICAL STANDARDS OF16
180180 CARE. INTERVENTIONS INCLUDE OBESITY SCREENING , DIETARY17
181181 ASSESSMENT, AND BEHAVIORAL COUNSELING AND THERAPY AIMED AT18
182182 WEIGHT LOSS THROUGH LIFESTYLE MODIFICATIONS SUCH AS CHANGES IN19
183183 DIET AND INCREASED PHYSICAL ACTIVITY. THERAPY FOR OBESITY MUST BE20
184184 CONSISTENT WITH THE UNITED STATES PREVENTIVE SERVICES TASK21
185185 F
186186 ORCE'S 5-A BEHAVIORAL COUNSELING FRAMEWORK : ASK, ADVISE,22
187187 ASSESS, ASSIST, AND ARRANGE. INTERVENTIONS MAY BE PROVIDED23
188188 IN-OFFICE, VIRTUALLY THROUGH TELEHEALTH , OR IN COMMUNITY-BASED24
189189 SETTINGS TO SUPPORT PATIENT ACCESS AND NEEDS .25
190190 (III) "M
191191 EDICAL NUTRITION THERAPY " MEANS THE FOLLOWING26
192192 NUTRITION CARE SERVICES THAT PREVENT , MANAGE, OR TREAT DISEASES27
193193 SB25-048
194194 -6- OR MEDICAL CONDITIONS, WHICH SERVICES MAY BE PROVIDED IN-OFFICE1
195195 OR VIRTUALLY THROUGH TELEHEALTH :2
196196 (A) N
197197 UTRITION ASSESSMENT;3
198198 (B) N
199199 UTRITION DIAGNOSIS;4
200200 (C) N
201201 UTRITION INTERVENTION; AND5
202202 (D) N
203203 UTRITION MONITORING AND EVALUATION .6
204204 (IV) "M
205205 ETABOLIC AND BARIATRIC SURGERY " MEANS METABOLIC7
206206 AND BARIATRIC SURGERY RECOMMENDED ACCORDING TO THE GUIDELINES8
207207 PUBLISHED IN THE 2022 AMERICAN SOCIETY FOR METABOLIC AND9
208208 B
209209 ARIATRIC SURGERY AND INTERNATIONAL FEDERATION FOR THE10
210210 S
211211 URGERY OF OBESITY AND METABOLIC DISORDERS: INDICATIONS FOR11
212212 M
213213 ETABOLIC AND BARIATRIC SURGERY.12
214214 (V) "N
215215 ATIONAL DIABETES PREVENTION PROGRAM " MEANS A13
216216 STRUCTURED, EVIDENCE-BASED LIFESTYLE MODIFICATION PROGRAM14
217217 DESIGNED TO PREVENT OR DELAY THE ONSET OF DIABETES IN INDIVIDUALS15
218218 AT HIGH RISK IN ACCORDANCE WITH 42 U.S.C. SEC. 280g-14. THE16
219219 PROGRAM FOLLOWS A STANDARDIZED CURRICULUM AND IS FOCUSED ON17
220220 PROMOTING HEALTHY LIFESTYLE CHANGES , INCLUDING WEIGHT LOSS,18
221221 INCREASED PHYSICAL ACTIVITY , AND HEALTHIER EATING HABITS ,19
222222 THROUGH INDIVIDUAL AND GROUP INTERVENTION .20
223223 SECTION 4. In Colorado Revised Statutes, add 25.5-5-340 as21
224224 follows: 22
225225 25.5-5-340. Diabetes prevention and obesity treatment -23
226226 anti-obesity medication - federal authorization - utilization24
227227 management - report - definitions. (1) T
228228 HE STATE DEPARTMENT SHALL25
229229 SEEK FEDERAL AUTHORIZATION TO PROVIDE COVERAGE FOR TREATMENT26
230230 FOR THE CHRONIC DISEASE OF OBESITY AND THE TREATMENT OF27
231231 SB25-048
232232 -7- PRE-DIABETES, INCLUDING THE NATIONAL DIABETES PREVENTION1
233233 PROGRAM, MEDICAL NUTRITION THERAPY , INTENSIVE BEHAVIORAL OR2
234234 LIFESTYLE THERAPY, METABOLIC AND BARIATRIC SURGERY , AND3
235235 FDA-
236236 APPROVED ANTI-OBESITY MEDICATION.4
237237 (2) W
238238 ITHIN EXISTING APPROPRIATIONS AND UPON RECEIVING5
239239 FEDERAL AUTHORIZATION , THE STATE DEPARTMENT SHALL IMPLEMENT6
240240 THIS SECTION AND NOTIFY MEMBERS IN WRITING ABOUT THE AVAILABILITY7
241241 OF TREATMENT FOR THE CHRONIC DISEASE OF OBESITY AND THE8
242242 TREATMENT OF PRE-DIABETES PROVIDED PURSUANT TO THIS SECTION .9
243243 (3) T
244244 HIS SECTION DOES NOT PROHIBIT THE STATE DEPARTMENT10
245245 FROM CONDUCTING UTILIZATION MANAGE MENT TO DETERMINE MEDICAL11
246246 NECESSITY FOR TREATMENT OF THE CHRONIC DISEASE OF OBESITY AND12
247247 THE TREATMENT OF PRE-DIABETES PROVIDED PURSUANT TO THIS SECTION .13
248248 (4) B
249249 EGINNING IN THE 2027 LEGISLATIVE SESSION, AND EACH YEAR14
250250 THEREAFTER, THE STATE DEPARTMENT SHALL INCLUDE AS PART OF ITS15
251251 PRESENTATION DURING ITS "SMART ACT" HEARING REQUIRED BY16
252252 SECTION 2-7-203 INFORMATION CONCERNING THE EFFORTS TO REDUCE17
253253 AND MANAGE THE CHRONIC DISEASE OF OBESITY AND THE TREATMENT OF18
254254 PRE-DIABETES, INCLUDING:19
255255 (a) T
256256 HE PREVALENCE AND DIAGNOSIS RATES OF OBESITY ; AND20
257257 (b) U
258258 TILIZATION OF OBESITY INTERVENTION SERVICES AND21
259259 HEALTH IMPROVEMENTS , INCLUDING DIABETES PREVENTION AND22
260260 MANAGEMENT AND IMPROVEMENTS TO CARDIOVASCULAR HEALTH .23
261261 (5) A
262262 HEALTH-CARE PROVIDER SHALL FOLLOW CLINICAL24
263263 GUIDELINES WHEN PRESCRIBING AN FDA-APPROVED ANTI-OBESITY25
264264 MEDICATION.26
265265 (6) A
266266 S USED IN THIS SECTION:27
267267 SB25-048
268268 -8- (a) "FDA-APPROVED ANTI-OBESITY MEDICATION" MEANS A1
269269 MEDICATION APPROVED BY THE FEDERAL FOOD AND DRUG2
270270 ADMINISTRATION WITH AN INDICATION FOR WEIGHT MANAGEMENT IN3
271271 PATIENTS WITH CHRONIC OBESITY.4
272272 (b) "I
273273 NTENSIVE BEHAVIORAL OR LIFESTYLE THERAPY " MEANS AN5
274274 EVIDENCE-BASED, MULTI-COMPONENT BEHAVIORAL OR LIFESTYLE6
275275 MODIFICATION INTERVENTION DESIGNED TO SUPPORT HEALTHY WEIGHT7
276276 MANAGEMENT AS RECOMMENDED BY CURRENT CLINICAL STANDARDS OF8
277277 CARE. INTERVENTIONS INCLUDE OBESITY SCREENING , DIETARY9
278278 ASSESSMENT, AND BEHAVIORAL COUNSELING AND THERAPY AIMED AT10
279279 WEIGHT LOSS THROUGH LIFESTYLE MODIFICATIONS SUCH AS CHANGES IN11
280280 DIET AND INCREASED PHYSICAL ACTIVITY. THERAPY FOR OBESITY MUST BE12
281281 CONSISTENT WITH THE UNITED STATES PREVENTIVE SERVICES TASK13
282282 F
283283 ORCE'S 5-A BEHAVIORAL COUNSELING FRAMEWORK : ASK, ADVISE,14
284284 ASSESS, ASSIST, AND ARRANGE. INTERVENTIONS MAY BE PROVIDED15
285285 IN-OFFICE, VIRTUALLY THROUGH TELEHEALTH , OR IN COMMUNITY-BASED16
286286 SETTINGS TO SUPPORT PATIENT ACCESS AND NEEDS .17
287287 (c) "M
288288 EDICAL NUTRITION THERAPY " MEANS THE FOLLOWING18
289289 NUTRITION CARE SERVICES THAT PREVENT , MANAGE, OR TREAT DISEASES19
290290 OR MEDICAL CONDITIONS, WHICH SERVICES MAY BE PROVIDED IN-OFFICE20
291291 OR VIRTUALLY THROUGH TELEHEALTH :21
292292 (I) N
293293 UTRITION ASSESSMENT;22
294294 (II) N
295295 UTRITION DIAGNOSIS;23
296296 (III) N
297297 UTRITION INTERVENTION; AND24
298298 (IV) N
299299 UTRITION MONITORING AND EVALUATION .25
300300 (d) "M
301301 ETABOLIC AND BARIATRIC SURGERY " MEANS METABOLIC26
302302 AND BARIATRIC SURGERY RECOMMENDED ACCORDING TO THE GUIDELINES27
303303 SB25-048
304304 -9- PUBLISHED IN THE 2022 AMERICAN SOCIETY FOR METABOLIC AND1
305305 B
306306 ARIATRIC SURGERY AND INTERNATIONAL FEDERATION FOR THE2
307307 S
308308 URGERY OF OBESITY AND METABOLIC DISORDERS: INDICATIONS FOR3
309309 M
310310 ETABOLIC AND BARIATRIC SURGERY.4
311311 (e) "N
312312 ATIONAL DIABETES PREVENTION PROGRAM " MEANS A5
313313 STRUCTURED, EVIDENCE-BASED LIFESTYLE MODIFICATION PROGRAM6
314314 DESIGNED TO PREVENT OR DELAY THE ONSET OF DIABETES IN INDIVIDUALS7
315315 AT HIGH RISK IN ACCORDANCE WITH 42 U.S.C. SEC. 280g-14. THE8
316316 PROGRAM FOLLOWS A STANDARDIZED CURRICULUM AND IS FOCUSED ON9
317317 PROMOTING HEALTHY LIFESTYLE CHANGES , INCLUDING WEIGHT LOSS,10
318318 INCREASED PHYSICAL ACTIVITY , AND HEALTHIER EATING HABITS ,11
319319 THROUGH INDIVIDUAL AND GROUP INTERVENTION .12
320320 SECTION 5. Act subject to petition - effective date. This act13
321321 takes effect at 12:01 a.m. on the day following the expiration of the14
322322 ninety-day period after final adjournment of the general assembly; except15
323323 that, if a referendum petition is filed pursuant to section 1 (3) of article V16
324324 of the state constitution against this act or an item, section, or part of this17
325325 act within such period, then the act, item, section, or part will not take18
326326 effect unless approved by the people at the general election to be held in19
327327 November 2026 and, in such case, will take effect on the date of the20
328328 official declaration of the vote thereon by the governor.21
329329 SB25-048
330330 -10-