First Regular Session
Seventy-fifth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 25-0053.01 Shelby Ross x4510
SENATE BILL 25-048
Senate Committees House Committees
Health & Human Services
A BILL FOR AN ACT
C
ONCERNING THE "DIABETES PREVENTION AND OBESITY TREATMENT101
A
CT".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 private insurance companies to provide coverage
for the treatment of the chronic disease of obesity and the treatment of
pre-diabetes, including coverage for the national diabetes prevention
program, medical nutrition therapy, intensive behavioral or lifestyle
therapy, metabolic and bariatric surgery, and FDA-approved anti-obesity
medication.
SENATE SPONSORSHIP
Michaelson Jenet,
HOUSE SPONSORSHIP
Brown and Mabrey,
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 bill requires the department of health care policy and
financing (department) to seek federal authorization to provide treatment
for the chronic disease of obesity and the treatment of pre-diabetes.
Within existing appropriations and upon receiving federal authorization,
the department is required to notify medicaid members in writing about
the availability of the treatment.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. Short title. The short title of this act is the2
"Diabetes Prevention and Obesity Treatment Act".3
SECTION 2. Legislative declaration. (1) The general assembly4
finds and declares that:5
(a) In Colorado, the prevalence of the chronic disease of obesity6
is staggering. Obesity affects over 24% of Colorado adults, with7
disproportionately high rates in communities of color: 33.4% and 31% of8
Black and Latino Coloradans experience obesity, respectively. More than9
one in 4 youth ages 10 to 17 are either overweight or experiencing10
obesity, and 24.3% of children enrolled in the federal special11
supplemental nutrition program for women, infants, and children in 202012
were overweight or experiencing obesity.13
(b) The American Medical Association and the American14
Academy of Pediatrics declared obesity a chronic disease in 2013, and the15
American Diabetes Association has recognized obesity as a complex,16
progressive, serious, relapsing, and costly chronic disease. Obesity serves17
as a major risk factor for developing comorbid conditions, including heart18
disease, stroke, type 2 diabetes, renal disease, non-alcoholic19
steatohepatitis, and 13 types of cancer. Research shows that obesity and20
diabetes increase the risk of more severe coronavirus infection and21
hospitalization. Obesity also contributes to many chronic and costly22
SB25-048-2- conditions and increases risk of physical injury, including falls, sprains,1
strains, lower extremity fractures, and joint dislocation.2
(c) Strong and consistent evidence shows that effective weight3
management can delay the progression from pre-diabetes to type 24
diabetes and is highly beneficial in treating type 2 diabetes. In people with5
type 2 diabetes who are also overweight or experiencing obesity, modest6
weight management clinically improves health, including reducing7
glycemia levels and reducing the need for glucose-lowering medications.8
Greater weight management substantially reduces A1C and fasting9
glucose levels and has been shown to support sustained diabetes10
remission for at least 2 years.11
(d) The 2023 American Academy of Pediatrics obesity guidelines12
recommend that comprehensive, evidence-based obesity treatment for13
youth should include timely initiation of intensive behavioral or lifestyle14
therapy, anti-obesity medications, and bariatric surgery, and that these15
treatment options are safe and effective. Eight out of 10 adolescents with16
obesity will continue to have obesity as adults. Treatment significantly17
improves an individual's health and quality of life and has the potential to18
significantly reduce health-care costs by preventing the development and19
progression of obesity-related complications, including diabetes.20
SECTION 3. In Colorado Revised Statutes, 10-16-104, add (29)21
as follows:22
10-16-104. Mandatory coverage provisions - applicability -23
rules - definitions. (29) Anti-obesity medications. (a) A
LL INDIVIDUAL24
AND GROUP HEALTH BENEFIT PLANS ISSUED OR RENEWED IN THIS STATE25
MUST PROVIDE COVERAGE FOR THE TREATMENT OF THE CHRONIC DISEASE26
OF OBESITY AND THE TREATMENT OF PRE -DIABETES, INCLUDING27
SB25-048
-3- COVERAGE FOR THE NATIONAL DIABETES PREVENTION PROGRAM , MEDICAL1
NUTRITION THERAPY, INTENSIVE BEHAVIORAL OR LIFESTYLE THERAPY ,2
METABOLIC AND BARIATRIC SURGERY , AND FDA-APPROVED ANTI-OBESITY3
MEDICATION.4
(b) T
HE COVERAGE CRITERIA FOR FDA-APPROVED ANTI-OBESITY5
MEDICATION MUST NOT BE MORE RESTRICTIVE THAN FDA-APPROVED6
INDICATIONS FOR THE MEDICATION.7
(c) T
HE COVERAGE REQUIRED PURSUANT TO THIS SUBSECTION (29)8
MUST NOT BE DIFFERENT OR SEPARATE FROM COVERAGE FOR ANY OTHER9
ILLNESS, CONDITION, OR DISORDER FOR PURPOSES OF DETERMINING10
COPAYMENTS, DEDUCTIBLES, COINSURANCE, OR ANNUAL MAXIMUM11
BENEFIT.12
(d) T
HIS SUBSECTION (29) DOES NOT PROHIBIT A PLAN FROM13
APPLYING UTILIZATION MANAGEMENT TO D ETERMINE MEDICAL NECESSITY14
AND APPROPRIATENESS FOR TREATMENT OF THE CHRONIC DISEASE OF15
OBESITY AND THE TREATMENT OF PRE-DIABETES IF THE DETERMINATIONS16
ARE MADE IN THE SAME MANNER AS DETERMINATIONS MADE FOR THE17
TREATMENT OF ANY OTHER ILLNESS , CONDITION, OR DISORDER COVERED18
BY THE PLAN.19
(e) T
HIS SUBSECTION (29) DOES NOT APPLY TO A SPECIALIZED20
HEALTH-CARE SERVICE PLAN OR CONTRACT THAT COVERS ONLY DENTAL21
OR VISION BENEFITS OR TO A MEDICARE SUPPLEMENTAL CONTRACT .22
(f) (I) T
HE COMMISSIONER SHALL SUBMIT TO THE FEDERAL23
DEPARTMENT OF HEALTH AND HUMAN SERVICES :24
(A) A
DETERMINATION AS TO WHETHER THE BENEFIT SPECIFIED IN25
THIS SUBSECTION (29) IS IN ADDITION TO ESSENTIAL HEALTH BENEFITS AND26
WOULD BE SUBJECT TO DEFRAYAL BY THE STATE PURSUANT TO 42 U.S.C.27
SB25-048
-4- SEC. 18031 (d)(3)(B); AND1
(B) A
REQUEST THAT THE FEDERAL DEPARTMENT OF HEALTH AND2
HUMAN SERVICES CONFIRM THE DIVISION'S DETERMINATION WITHIN SIXTY3
DAYS AFTER RECEIPT OF THE DIVISION'S REQUEST AND SUBMISSION OF ITS4
DETERMINATION.5
(II) T
HIS SUBSECTION (29) APPLIES TO LARGE EMPLOYER POLICIES6
OR CONTRACTS ISSUED OR RENEWED ON OR AFTER JANUARY 1, 2026, AND7
TO INDIVIDUAL AND SMALL GROUP POLICIES AND CONTRACTS ISSUED ON8
OR AFTER JANUARY 1, 2027, AND THE COMMISSIONER SHALL IMPLEMENT9
THE REQUIREMENTS OF THIS SUBSECTION (29) ONLY IF:10
(A) T
HE DIVISION RECEIVES CONFIRMATION FROM THE FEDERAL11
DEPARTMENT OF HEALTH AND HUMAN SERVICES THAT THE COVERAGE12
SPECIFIED IN THIS SUBSECTION (29) DOES NOT CONSTITUTE AN ADDITIONAL13
BENEFIT THAT REQUIRES DEFRAYAL BY THE STATE PURS UANT TO 42 U.S.C.14
SEC. 18031 (d)(3)(B);15
(B) T
HE FEDERAL DEPARTMENT OF HEALTH AND HUMAN SERVICES16
HAS OTHERWISE INFORMED THE DIVISION THAT THE COVERAGE DOES NOT17
REQUIRE STATE DEFRAYAL PURSUANT TO 42 U.S.C. SEC. 18031 (d)(3)(B);18
OR19
(C) M
ORE THAN THREE HUNDRED SIXTY -FIVE DAYS HAVE PASSED20
SINCE THE DIVISION SUBMITTED ITS DETERMINATION AND REQUEST FOR21
CONFIRMATION THAT THE COVERAGE SPECIFIED IN THIS SUBSECTION (29)22
IS NOT AN ADDITIONAL BENEFIT THAT REQUIRES STATE DEFRAYAL23
PURSUANT TO 42 U.S.C. SEC. 18031 (d)(3)(B) AND THE FEDERAL24
DEPARTMENT OF HEALTH AND HUMAN SERVICES HAS FAILED TO RESPOND25
TO THE REQUEST WITHIN THAT PERIOD , IN WHICH CASE THE DIVISION26
SHALL CONSIDER THE FEDERAL DEPARTMENT OF HEALTH AND HUMAN27
SB25-048
-5- SERVICES' UNREASONABLE DELAY A PRECLUSION FROM REQUIRING1
DEFRAYAL BY THE STATE.2
(g) T
HE COMMISSIONER SHALL ADOPT RULES CONSISTENT WITH3
AND AS ARE NECESSARY TO IMPLEMENT THIS SUBSECTION (29).4
(h) A
HEALTH-CARE PROVIDER SHALL FOLLOW CLINICAL5
GUIDELINES WHEN PRESCRIBING AN FDA-APPROVED ANTI-OBESITY6
MEDICATION.7
(i) A
S USED IN THIS SUBSECTION (29):8
(I) "FDA-
APPROVED ANTI-OBESITY MEDICATION" MEANS A9
MEDICATION APPROVED BY THE FEDERAL FOOD AND DRUG10
ADMINISTRATION WITH AN INDICATION FOR WEIGHT MANAGEMENT IN11
PATIENTS WITH CHRONIC OBESITY.12
(II) "I
NTENSIVE BEHAVIORAL OR LIFESTYLE THERAPY " MEANS AN13
EVIDENCE-BASED, MULTI-COMPONENT BEHAVIORAL OR LIFESTYLE14
MODIFICATION INTERVENTION DESIGNED TO SUPPORT HEALTHY WEIGHT15
MANAGEMENT AS RECOMMENDED BY CURRENT CLINICAL STANDARDS OF16
CARE. INTERVENTIONS INCLUDE OBESITY SCREENING , DIETARY17
ASSESSMENT, AND BEHAVIORAL COUNSELING AND THERAPY AIMED AT18
WEIGHT LOSS THROUGH LIFESTYLE MODIFICATIONS SUCH AS CHANGES IN19
DIET AND INCREASED PHYSICAL ACTIVITY. THERAPY FOR OBESITY MUST BE20
CONSISTENT WITH THE UNITED STATES PREVENTIVE SERVICES TASK21
F
ORCE'S 5-A BEHAVIORAL COUNSELING FRAMEWORK : ASK, ADVISE,22
ASSESS, ASSIST, AND ARRANGE. INTERVENTIONS MAY BE PROVIDED23
IN-OFFICE, VIRTUALLY THROUGH TELEHEALTH , OR IN COMMUNITY-BASED24
SETTINGS TO SUPPORT PATIENT ACCESS AND NEEDS .25
(III) "M
EDICAL NUTRITION THERAPY " MEANS THE FOLLOWING26
NUTRITION CARE SERVICES THAT PREVENT , MANAGE, OR TREAT DISEASES27
SB25-048
-6- OR MEDICAL CONDITIONS, WHICH SERVICES MAY BE PROVIDED IN-OFFICE1
OR VIRTUALLY THROUGH TELEHEALTH :2
(A) N
UTRITION ASSESSMENT;3
(B) N
UTRITION DIAGNOSIS;4
(C) N
UTRITION INTERVENTION; AND5
(D) N
UTRITION MONITORING AND EVALUATION .6
(IV) "M
ETABOLIC AND BARIATRIC SURGERY " MEANS METABOLIC7
AND BARIATRIC SURGERY RECOMMENDED ACCORDING TO THE GUIDELINES8
PUBLISHED IN THE 2022 AMERICAN SOCIETY FOR METABOLIC AND9
B
ARIATRIC SURGERY AND INTERNATIONAL FEDERATION FOR THE10
S
URGERY OF OBESITY AND METABOLIC DISORDERS: INDICATIONS FOR11
M
ETABOLIC AND BARIATRIC SURGERY.12
(V) "N
ATIONAL DIABETES PREVENTION PROGRAM " MEANS A13
STRUCTURED, EVIDENCE-BASED LIFESTYLE MODIFICATION PROGRAM14
DESIGNED TO PREVENT OR DELAY THE ONSET OF DIABETES IN INDIVIDUALS15
AT HIGH RISK IN ACCORDANCE WITH 42 U.S.C. SEC. 280g-14. THE16
PROGRAM FOLLOWS A STANDARDIZED CURRICULUM AND IS FOCUSED ON17
PROMOTING HEALTHY LIFESTYLE CHANGES , INCLUDING WEIGHT LOSS,18
INCREASED PHYSICAL ACTIVITY , AND HEALTHIER EATING HABITS ,19
THROUGH INDIVIDUAL AND GROUP INTERVENTION .20
SECTION 4. In Colorado Revised Statutes, add 25.5-5-340 as21
follows: 22
25.5-5-340. Diabetes prevention and obesity treatment -23
anti-obesity medication - federal authorization - utilization24
management - report - definitions. (1) T
HE STATE DEPARTMENT SHALL25
SEEK FEDERAL AUTHORIZATION TO PROVIDE COVERAGE FOR TREATMENT26
FOR THE CHRONIC DISEASE OF OBESITY AND THE TREATMENT OF27
SB25-048
-7- PRE-DIABETES, INCLUDING THE NATIONAL DIABETES PREVENTION1
PROGRAM, MEDICAL NUTRITION THERAPY , INTENSIVE BEHAVIORAL OR2
LIFESTYLE THERAPY, METABOLIC AND BARIATRIC SURGERY , AND3
FDA-
APPROVED ANTI-OBESITY MEDICATION.4
(2) W
ITHIN EXISTING APPROPRIATIONS AND UPON RECEIVING5
FEDERAL AUTHORIZATION , THE STATE DEPARTMENT SHALL IMPLEMENT6
THIS SECTION AND NOTIFY MEMBERS IN WRITING ABOUT THE AVAILABILITY7
OF TREATMENT FOR THE CHRONIC DISEASE OF OBESITY AND THE8
TREATMENT OF PRE-DIABETES PROVIDED PURSUANT TO THIS SECTION .9
(3) T
HIS SECTION DOES NOT PROHIBIT THE STATE DEPARTMENT10
FROM CONDUCTING UTILIZATION MANAGE MENT TO DETERMINE MEDICAL11
NECESSITY FOR TREATMENT OF THE CHRONIC DISEASE OF OBESITY AND12
THE TREATMENT OF PRE-DIABETES PROVIDED PURSUANT TO THIS SECTION .13
(4) B
EGINNING IN THE 2027 LEGISLATIVE SESSION, AND EACH YEAR14
THEREAFTER, THE STATE DEPARTMENT SHALL INCLUDE AS PART OF ITS15
PRESENTATION DURING ITS "SMART ACT" HEARING REQUIRED BY16
SECTION 2-7-203 INFORMATION CONCERNING THE EFFORTS TO REDUCE17
AND MANAGE THE CHRONIC DISEASE OF OBESITY AND THE TREATMENT OF18
PRE-DIABETES, INCLUDING:19
(a) T
HE PREVALENCE AND DIAGNOSIS RATES OF OBESITY ; AND20
(b) U
TILIZATION OF OBESITY INTERVENTION SERVICES AND21
HEALTH IMPROVEMENTS , INCLUDING DIABETES PREVENTION AND22
MANAGEMENT AND IMPROVEMENTS TO CARDIOVASCULAR HEALTH .23
(5) A
HEALTH-CARE PROVIDER SHALL FOLLOW CLINICAL24
GUIDELINES WHEN PRESCRIBING AN FDA-APPROVED ANTI-OBESITY25
MEDICATION.26
(6) A
S USED IN THIS SECTION:27
SB25-048
-8- (a) "FDA-APPROVED ANTI-OBESITY MEDICATION" MEANS A1
MEDICATION APPROVED BY THE FEDERAL FOOD AND DRUG2
ADMINISTRATION WITH AN INDICATION FOR WEIGHT MANAGEMENT IN3
PATIENTS WITH CHRONIC OBESITY.4
(b) "I
NTENSIVE BEHAVIORAL OR LIFESTYLE THERAPY " MEANS AN5
EVIDENCE-BASED, MULTI-COMPONENT BEHAVIORAL OR LIFESTYLE6
MODIFICATION INTERVENTION DESIGNED TO SUPPORT HEALTHY WEIGHT7
MANAGEMENT AS RECOMMENDED BY CURRENT CLINICAL STANDARDS OF8
CARE. INTERVENTIONS INCLUDE OBESITY SCREENING , DIETARY9
ASSESSMENT, AND BEHAVIORAL COUNSELING AND THERAPY AIMED AT10
WEIGHT LOSS THROUGH LIFESTYLE MODIFICATIONS SUCH AS CHANGES IN11
DIET AND INCREASED PHYSICAL ACTIVITY. THERAPY FOR OBESITY MUST BE12
CONSISTENT WITH THE UNITED STATES PREVENTIVE SERVICES TASK13
F
ORCE'S 5-A BEHAVIORAL COUNSELING FRAMEWORK : ASK, ADVISE,14
ASSESS, ASSIST, AND ARRANGE. INTERVENTIONS MAY BE PROVIDED15
IN-OFFICE, VIRTUALLY THROUGH TELEHEALTH , OR IN COMMUNITY-BASED16
SETTINGS TO SUPPORT PATIENT ACCESS AND NEEDS .17
(c) "M
EDICAL NUTRITION THERAPY " MEANS THE FOLLOWING18
NUTRITION CARE SERVICES THAT PREVENT , MANAGE, OR TREAT DISEASES19
OR MEDICAL CONDITIONS, WHICH SERVICES MAY BE PROVIDED IN-OFFICE20
OR VIRTUALLY THROUGH TELEHEALTH :21
(I) N
UTRITION ASSESSMENT;22
(II) N
UTRITION DIAGNOSIS;23
(III) N
UTRITION INTERVENTION; AND24
(IV) N
UTRITION MONITORING AND EVALUATION .25
(d) "M
ETABOLIC AND BARIATRIC SURGERY " MEANS METABOLIC26
AND BARIATRIC SURGERY RECOMMENDED ACCORDING TO THE GUIDELINES27
SB25-048
-9- PUBLISHED IN THE 2022 AMERICAN SOCIETY FOR METABOLIC AND1
B
ARIATRIC SURGERY AND INTERNATIONAL FEDERATION FOR THE2
S
URGERY OF OBESITY AND METABOLIC DISORDERS: INDICATIONS FOR3
M
ETABOLIC AND BARIATRIC SURGERY.4
(e) "N
ATIONAL DIABETES PREVENTION PROGRAM " MEANS A5
STRUCTURED, EVIDENCE-BASED LIFESTYLE MODIFICATION PROGRAM6
DESIGNED TO PREVENT OR DELAY THE ONSET OF DIABETES IN INDIVIDUALS7
AT HIGH RISK IN ACCORDANCE WITH 42 U.S.C. SEC. 280g-14. THE8
PROGRAM FOLLOWS A STANDARDIZED CURRICULUM AND IS FOCUSED ON9
PROMOTING HEALTHY LIFESTYLE CHANGES , INCLUDING WEIGHT LOSS,10
INCREASED PHYSICAL ACTIVITY , AND HEALTHIER EATING HABITS ,11
THROUGH INDIVIDUAL AND GROUP INTERVENTION .12
SECTION 5. Act subject to petition - effective date. This act13
takes effect at 12:01 a.m. on the day following the expiration of the14
ninety-day period after final adjournment of the general assembly; except15
that, if a referendum petition is filed pursuant to section 1 (3) of article V16
of the state constitution against this act or an item, section, or part of this17
act within such period, then the act, item, section, or part will not take18
effect unless approved by the people at the general election to be held in19
November 2026 and, in such case, will take effect on the date of the20
official declaration of the vote thereon by the governor.21
SB25-048
-10-