Bill Tracker

Except in connection with individual septic systems, current law is unclear regarding whether, and under what conditions, graywater may be used. Section 1 of the bill declares the importance of water conservation to the economy of Colorado and the well-being of its citizens. Section 2 defines "graywater" as wastewater from sources other than toilets, urinals, kitchen sinks, nonlaundry utility sinks, and dishwashers collected within a residential, commercial, or industrial building that meets certain standards established by the water quality control commission. Section 3 authorizes the commission to adopt a control regulation establishing use standards and specifies that: Graywater may be applied only to uses that are allowed by the water sources' well permits and water rights; and, if so used, the use of the graywater is deemed to not cause injury.

Graywater can be used only if the commission has adopted a control regulation and a local government authorizes the use. The local government has exclusive enforcement authority regarding compliance with the commission's control regulation. Section 5 allows counties to authorize graywater use, and section 6 allows municipalities to authorize graywater use. Section 4 repeals an obsolete provision authorizing local boards of health to adopt rules regarding graywater use with individual septic systems.

The bill permits a person to produce nonpotentially hazardous food in a home kitchen for sale directly to consumers for consumption off premises. County or district public health agencies may register persons who produce nonpotentially hazardous food in a home kitchen for sale directly to consumers for consumption off premises. These food products are subject to inspection by local or state public health agencies.

The bill directs the department of public health and environment to create an electronic death registration system for purposes of allowing persons responsible for reporting death information to the office of the state registrar of vital statistics to do so electronically.

The bill requires a person applying for assistance through the Colorado works program (works program) to take a drug test for the presence of controlled substances as a condition of eligibility for assistance. If an applicant fails the drug test, the applicant may reapply for assistance 1 year after the date of the drug test. However, a person may reapply after 6 months if the person successfully completes a substance abuse treatment program.

The applicant is required to pay the cost of the drug test. If the applicant passes the drug test, the applicant's initial assistance will be increased by the cost of the drug test. The dependent child of an applicant who fails the drug test shall still be eligible to receive assistance, but the county department of human services will be required to approve a protective payee to receive the assistance on behalf of the dependent child. The protective payee will also need to pass the drug test.

The bill requires the director of the division of registrations in the department of regulatory agencies (director) to implement a system to collect health care work force data from health care professionals who are eligible for the Colorado health service corps, from practical and professional nurses, and from pharmacists. The bill requires a voluntary advisory group designated by the director of the primary care office to recommend the structure of the data elements to be collected regarding specific information about each health care professional and his or her practice. The director is authorized to accept and expend any gifts, grants, or donations that may be available from any private or public sources for the implementation of the data collection system.

Currently, the department of public health and environment is required to name, approve, and provide, free of charge, a prophylaxis to be used in treating the eyes of newly born infants. The bill deletes these requirements and requires the health care provider in charge of the birth to treat an infant with a prophylaxis that is in accordance with the current medical standard of care. The bill also deletes the penalty provision for a health care provider who violates the statutes relating to infant eye prophylaxis.

The bill creates the state board of dietitians, consisting of 3 licensed dietitians and 2 members of the public, to oversee the regulation of dietitians. Dietitians must be licensed. To get a license, an applicant must have a baccalaureate or post-baccalaureate degree with a major course of study in human nutrition, nutrition education, public health nutrition, food and nutrition, dietetics, or food systems management or an equivalent major course of study as approved by the board, including a practice experience component in dietetics of not less than 1,200 hours, and have successfully completed the examination for dietitians administered by the commission on dietetic registration. A dietitian from a state that has analogous requirements can be licensed by endorsement, and provisional permits, valid for one year and renewable a single time for 6 months, are also available for dietitians from such states.

Standard disciplinary and procedural provisions are included. The regulation of dietitians sunsets in 2019.

Pursuant to legislation in 2009, the standards for advanced practice nurses (APNs) to obtain prescriptive authority were modified to require APNs, in addition to obtaining specified levels of education and experience, to develop an articulated plan for safe prescribing that documents how the APN will collaborate with physicians and other health care professionals in his or her practice of prescribing medications. Under the 2009 legislation, APNs who were granted prescriptive authority prior to July 1, 2010, were permitted to retain that authority but were required to develop an articulated plan of safe prescribing within one year, or by July 1, 2011.

The bill allows the state board of nursing, on a case-by-case basis, to extend the deadline by which APNs with prescriptive authority granted before July 1, 2010, are required to develop an articulated plan, but in no case is the board allowed to extend the deadline beyond July 1, 2012. An APN seeking a deadline extension must submit to the board, prior to July 1, 2012, an application and fee and an attestation that he or she has developed an articulated plan. The board is to adopt rules establishing the criteria for granting a deadline extension. A decision of the board regarding a deadline extension request is not appealable.

Currently, the maximum allowable amount of total state general fund appropriations for a given fiscal year is equal to 5% of Colorado personal income. Beginning with the 2012-13 state fiscal year, the bill establishes a new limit for total state general fund appropriations that is equal to 6% over the total general fund appropriations for the previous fiscal year.

The end-year surplus in the general fund, which is moneys above the new appropriation limit, is transferred as follows:

• 50% to the newly created state reserve fund;
• 25% to the highway users tax fund; and! 25% to the capital construction fund.
• 25% to the capital construction fund.
During economic downturns, the general assembly may appropriate or transfer moneys from the state reserve fund for any purpose by the enactment of a bill approved by a 2/3 majority vote of all

of the members elected to each house.

The moneys transferred to the highway users tax fund are allocated as follows:

• 60% to the state highway fund;
• 22% to counties; and! 18% to municipalities.
• 18% to municipalities.

In 2009, the general assembly increased the maximum annual fee that the water quality control agency in the division of administration of the department of public health and environment may impose upon concentrated animal feeding operations and housed commercial swine feeding operations dischargers under the "Colorado Water Quality Control Act" until July 1, 2012. The bill maintains the current fee structure until July 1, 2015, in order to continue the environmental agriculture program.

The bill specifies that proceedings to suspend or revoke the license of a retail food establishment may be commenced only after the imposition of other civil penalties.

The bill makes the results of any information related to substance use obtained as part of a screening or test performed for the purpose of determining pregnancy or providing prenatal care inadmissible in any criminal proceeding.

The bill allows a board of county commissioners for a particular county to exclude, by resolution, any or all parts of the county from the enhanced motor vehicle emissions program area if the excluded part of the county does not violate any national ambient air quality standard for carbon monoxide or ozone as established by the environmental protection agency.

The Colorado department of public health and environment (department) is designated in statute as the coordinator for suicide prevention programs throughout the state. The bill adds as a duty of the department, in its coordinator role, that the department require all hospitals that it licenses or certifies to educate parents, relatives, or friends to whom a minor who attempts suicide or displays suicidal gestures will be released from the hospital regarding the warning signs of suicide and suicide prevention.

Five-point auricular acudetox is acupuncture done on the ear that is often used to treat substance abuse, mental health, and behavioral health disorders. The bill allows mental health professionals and psychiatric technicians to perform five-point auricular acudetox if they have successfully completed the proper training.

On and after January 1, 2013, in connection with the resale and subsequent conveyance of private residential real property, the bill requires the seller of the property to conduct a test of the property for radon hazards prior to sale in accordance with testing procedures approved for such use by the Colorado department of public health and environment. The bill further requires the seller to timely disclose the findings of the test to the potential purchasers of the property and provide documentation to such purchaser evidencing the completion of the test and the test results. Any presence of a radon hazard above the safety level may constitute cause for the mitigation of the hazard. The bill specifies that the cost of any such mitigation is a matter to be privately negotiated between the seller and the potential purchaser of the property. Nothing in the bill is intended nor shall be construed to require any mitigation on the part of the seller of the property.

The bill provides a property owner, an authorized agent of a property owner, or a person in possession of real property immunity from liability for any damages resulting from the operation, maintenance, installation, or effectiveness of any mitigation undertaken pursuant to the bill.

The bill requires parental consent for minors under 18 years of age to use an artificial tanning device on and after July 1, 2012. For minors under 14 years of age, the parent must remain on-site at all times while the minor is using an artificial tanning device. A consent form is valid for 6 months unless the parent withdraws his or her consent.

The department of public health and environment is to develop a consent form that details the health risks associated with the use of artificial tanning devices. Owners, operators, and employees of artificial tanning devices are subject to penalties of up to $200 per day for failing to comply with the requirements of the bill.

On or after July 1, 2014, an oil and gas operator may not use, store, or dispose of hydraulic fracturing fluids or flow-back from a hydraulic fracturing treatment in an open pit and must use a closed-loop system for hydraulic fracturing treatments. However, the oil and gas conservation commission may approve the use of open pits where the commission determines there is no risk to occupied structures or water sources, and operators can use open pits if the fluids are clean enough to discharge directly into state waters without a permit.

Bisphenol A (BPA) is a hardening agent used in some plastic products. Effective July 1, 2012, the bill prohibits the sale by a manufacturer or wholesaler of a children's product, defined as a pacifier or empty container intended for use by children under age 3 to consume food or liquids, containing BPA.

Effective July 1, 2013, no person may sell or provide a children's product containing BPA.

A used children's product containing BPA is excluded from the prohibitions.

Joint Budget Committee. For fiscal year 2011-12 or any subsequent fiscal year, the bill authorizes the general assembly to appropriate moneys from the tobacco education programs fund to the department of health care policy and financing in order to allow the department to obtain federal matching funds for the Colorado quitline program.

Joint Budget Committee. In the 2011 legislative session, the statutes authorizing expenditures from the primary care fund for comprehensive primary care services were erroneously repealed. This bill recreates and reenacts those repealed statutes, which will reauthorize the department of health care policy and financing to expend funds from the primary care fund for the purpose of providing grants to providers who provide comprehensive primary care and who are either a community health center or who serve a large percentage of people who are uninsured or medically indigent patients, patients receiving medicaid, or patients enrolled in the children's basic health plan.

The bill defines terms used in the recreated statutes, including "comprehensive primary care", which means the basic, entry-level health care provided by health practitioners or non-physician health care practitioners that is generally provided in an outpatient setting.

The bill allows a Colorado community college to offer a two-year degree program with academic designation in nursing or dental hygiene without a valid student transfer agreement.

Joint Budget Committee. Current law requires over 90% of the allocations of tobacco litigation settlement moneys (settlement moneys) for tobacco programs to be made through payments of settlement moneys received in the same fiscal year in which they are allocated (accelerated payments). Because the state receives settlement moneys in the last quarter of each fiscal year, it uses general fund moneys as working capital to operate tobacco programs until it receives each year's settlement moneys. This de facto loan of general fund moneys creates a risk of loss to the general fund if the settlement moneys received in any given fiscal year are substantially lower than anticipated, which might occur if, for example, the state lost an ongoing legal dispute with tobacco manufacturers.

To reduce the risk of loss to the general fund, the bill annually reduces the amount of accelerated payments. The bill offsets the reduction by repealing the short-term innovative health program grant fund, which currently receives 6% of Tier 2 settlement program allocations, and requiring the additional tobacco litigation settlement cash fund moneys made available by the elimination of the grant fund to be used to supplement annual allocations of settlement moneys.

Joint Budget Committee. Current law requires the general assembly to annually appropriate 0.1% of the tobacco litigation settlement moneys received by the state (settlement moneys) to the office of the state auditor for the costs of conducting program reviews and evaluations of the performance of tobacco settlement programs. The funding comes out of and proportionally reduces the amount of settlement moneys received by all tier 1 tobacco settlement programs reviewed and evaluated during a fiscal year.

Beginning with the 2012-13 fiscal year, the bill replaces the 0.1% appropriation with an annual allocation to the state auditor's office of $89,000 of settlement moneys. The new funding comes out of and reduces by $89,000 the amount of settlement moneys annually received by the short-term innovative health program grant fund.

The bill clarifies that oil and gas operations are subject to local governments' authority, as well as the authority of the oil and gas conservation commission. The bill establishes that oil and gas operations are subject to the same local government control as is established for other mineral extractions.

The bill directs the department of health care policy and financing (state department) to facilitate collaboration among medicaid providers, clients, advocates, and payors that is designed to improve health outcomes and patient satisfaction and support the financial sustainability of the medicaid program. The executive director of the state department may promulgate rules relating to the collaborative process.

The bill creates the medicaid payment reform and innovation pilot program (pilot program) in the state department for the purpose of implementing payment reform projects in medicaid within the framework of the accountable care collaborative. Regional care collaborative organizations (RCCOs) may submit payment proposals to the state department for the pilot program. A RCCO shall work with providers and managed care entities in the RCCO to develop the payment project.

Payment projects may include but are not limited to global payments, risk adjustment, risk sharing, and aligned payment incentives. The state department shall select payment projects for inclusion in the pilot program based upon certain criteria and shall give preference to those payment projects that propose global payments. The state department shall respond to RCCOs concerning payment projects that are not selected for the pilot program, stating the reason why the payment projects were not selected and shall copy the response to certain committees of the general assembly. Payment projects shall be implemented for 2 to 5 years, and certain provisions apply to payments under the pilot program. The state department shall seek any federal authorization necessary to implement the pilot program. The state department shall report to certain committees of the general assembly concerning the design, implementation, and outcome of the pilot program.

The bill requires the state department to report concerning the state department's recommendations for streamlining and simplifying the administrative structure for managing contracts relating to medicaid managed care.

Under current law, the department of public health and environment (CDPHE) licenses and establishes, and enforces standards for the operation of, health facilities in the state, including rehabilitation centers, community mental health centers, acute treatment units, facilities for persons with developmental disabilities, nursing care facilities, hospice care, assisted living residences, and home care agencies. CDPHE conducts periodic, announced and unannounced inspections of licensed facilities to ensure compliance with the standards it develops. The state board of health (board) is required to establish by rule a schedule of fees to be assessed against health facilities that is sufficient to meet CDPHE's direct and indirect costs in regulating health facilities.

Additionally, under current law, both CDPHE and the department of human services (DHS) jointly regulate community residential homes for persons with developmental disabilities.

Section 1 of the bill declares that the legislative intent of the bill is to eliminate duplication and unnecessary government oversight in the regulation of health facilities in Colorado.

Sections 2, 3, 4, and 12 eliminate CDPHE's authority to license and develop standards for the operation of community residential homes, shifting oversight of these homes solely to DHS. Additionally, if home care agency personal care services, which are otherwise regulated by CDPHE, are provided by a service agency that delivers services and supports to persons with developmental disabilities, DHS is tasked with inspecting those services in conjunction and simultaneously with its inspection of the community residential home. DHS is directed to institute an abbreviated, periodic inspection system for community residential homes and a performance incentive system to reduce license renewal fees for community residential homes for which no significant deficiencies that negatively affect the life, health, and safety of their consumers have been found by DHS.

Sections 2, 3, and 4 also:

• Require CDPHE to develop an abbreviated, periodicinspection system, which it must use for health facilities that have been licensed for at least 3 years and have not been subject to any enforcement activity or substantiated complaints resulting in the discovery of significant deficiencies that negatively affect the life, health, or safety of consumers of the facilities within the prior 3 years;
• Restrict the ability of CDPHE, when considering a licenseapplication or a request to approve new construction or remodel of a health facility, to impose standards for construction that are more stringent than, or do not comply with, applicable national, state, and local building and fire codes;
• With regard to the dual responsibilities of CDPHE andDHS over community mental health centers and acute treatment units, require the departments to consider changes in health care policy and practice that incorporate integrated health care services; 
• Limit CDPHE's licensure authority over community clinics to those community clinics that: Provide health care services on an ambulatory basis; are not licensed as an on-campus department or service of a hospital or listed as an off-campus location under a hospital's license; and either operate inpatient beds or provide emergency services at the facility. CDPHE retains authority to license prison clinics regulated by the department of corrections.
• Require CDPHE to determine an applicant's fitness to conduct and maintain a health facility based solely on specific fitness information or documentation submitted by the applicant or obtained by CDPHE through its own review or investigation of the applicant; and
• Eliminate the ability of CDPHE to conduct a fitness review of a new owner of a facility unless the transfer of ownership results in a transfer of at least 50% of direct or indirect ownership interest in the facility or business to one or more new owners.

 Under sections 5 and 12, a licensed health facility, program of all-inclusive care for the elderly (PACE) provider, or community residential home that applies to renew its license may submit evidence of its accreditation by a nationally recognized accrediting body or regulation pursuant to a 3-way agreement between the PACE provider, the centers for medicare and medicaid services (CMS), and the department of health care policy and financing (HCPF), as applicable, in which case CDPHE or, for purposes of community residential homes, DHS is to deem that accreditation, regulation, or certification as satisfaction of the state licensing requirements. CDPHE or DHS, as applicable, is permitted to request additional information from a facility if the state's standards for licensure of that type of facility are more stringent than the applicable standards for accreditation, regulation, or certification.

Sections 6 and 7 prohibit the board from increasing provisional or full license fees above the levels set in rules as of the effective date of the sections. The board retains the ability to lower the fee amounts. Section 7 further requires CDPHE to develop a performance incentive system to provide a reduction in license renewal fees for health facilities that have no significant deficiencies that negatively affect the life, health, or safety of consumers of the facility.

Section 8 establishes the health care industry facility advisory council (advisory council) in CDPHE to advise the department and the board on matters related to state licensure of health care facilities. The purpose of the advisory council is to:

• Advise CDPHE and the board on proposed standards for the operation of licensed health care facilities;
• Review and make recommendations to CDPHE and the board on proposed new or amended rules regarding health care facility licensure;
• Review and make recommendations to CDPHE and the board regarding modifications to licensing fees;
• Review and make recommendations concerning CDPHE guidelines, policies, and procedures for licensure; and
• Seek advice and counsel from outside experts when it deems necessary.

CDPHE and the board are required to accept and take the advisory council's recommendations into consideration before taking action on any of the matters on which the advisory council submits recommendations. Under section 9, the advisory council is subject to sunset review by the department of regulatory agencies and repeal on September 1, 2022, unless continued by the general assembly.

Section 10 clarifies that home care placement agencies are not licensed or certified by CDPHE and prohibits home care placement agencies from making such a claim. Noncompliance with this prohibition subjects a home care placement agency to a civil penalty imposed by CDPHE.

For purposes of board rules pertaining to the regulation of home care agencies,  section 11 requires the board to establish different requirements that are appropriate based on the type of facility or provider delivering the services to the home care consumer and prohibits the board from requiring PACE providers to submit information that is redundant or inconsistent with the federal requirements the PACE provider is subject to pursuant to its 3-way agreement with CMS and HCPF.

Section 13 prohibits an appropriation of state funds to implement the bill.

The bill creates the "Colorado Civil Union Act" (Act) to authorize any 2 unmarried adults, regardless of gender, to enter into a civil union.

Parties wanting to enter into a civil union apply to a county clerk and recorder for a civil union license. Certain persons may certify a civil union. After the civil union is certified, the officiant files the civil union certificate with the county clerk and recorder. A priest, minister, rabbi, or other official of a religious institution or denomination or an Indian nation or tribe is not required to certify a civil union in violation of his or her right to free exercise of religion. The criteria for a valid civil union are set forth in the bill.

The executive director of the department of public health and environment and the state registrar of vital statistics shall issue forms necessary to implement the Act. Each county clerk and recorder submits records of registered civil unions to the office of vital statistics. A county clerk and recorder collects a fee for a civil union license, which fee is credited to the vital statistics records cash fund. The state registrar of vital statistics is authorized to set and collect an additional fee for verification of civil unions, which fee is credited to the vital statistics records cash fund. A county clerk and recorder collects a $20 fee to be credited to the Colorado domestic abuse program fund.

The legal benefits, protections, and responsibilities that are granted under the law to spouses apply in like manner to parties to a civil union, including the following:

• Responsibility for financial support of a party to a civilunion;
• Rights and abilities concerning transfer of real or personalproperty to a party in a civil union;
• The ability to file a claim based on wrongful death,emotional distress, loss of consortium, dramshop, or other laws, whether common law or statutory, related to or dependent upon spousal status;
• Prohibitions against discrimination based upon spousalstatus;
• The ability to inherit real and personal property from aparty in a civil union under the probate code;
• Priority for appointment as a conservator, guardian, orpersonal representative;
• Survivor benefits under and inclusion in workers'compensation laws;
• The ability to adopt a child of a party to a civil union;
• The ability to insure a party to a civil union under groupbenefit plans for state employees;
• The ability to designate a party in a civil union as abeneficiary under the state public employees retirement system;
• Survivor benefits under local government firefighter andpolice pensions;
• Protections and coverage under domestic abuse anddomestic violence laws;
• Rights and protections under victims' compensation lawsand victims and witness protection laws;
• Laws, policies, or procedures relating to emergency and-2- SB12-00

Transportation Legislation Review Committee. Section 1 of the bill repeals the requirement that a person, group, or association submit to the department of revenue (department) a proposal for a group special license plate and certify that at least three thousand of the special license plates are to be issued within one year after the authorization of the plates, and requires a nonprofit organization requesting a group special license plate to obtain the department's written notification that the group has complied with the requirements for a group special license plate before seeking legislative action to authorize the new license plate. Section 1 also allows group special license plates and alumni association plates that have not reached the minimum number of plates issued to be made available until the inventory of those plates is exhausted.

Section 2 of the bill repeals the requirement that an applicant for a Denver firefighters' special license plate or an Elks special license plate provide evidence to the department of their membership in such organization. Sections 3 and 4 make conforming amendments.

Transportation Legislation Review Committee. The bill allows operation of low-speed electric vehicles on roadways at speeds up to 40 miles per hour.

A person and one or two other persons acting in concert with the person are immune from arrest and criminal prosecution for any of the following offenses if the offense arises from the same criminal episode or course of events from which an emergency drug or alcohol overdose event (event) arose; the person reports the event in good faith to a law enforcement agency or to the 911 system; the person and, if applicable, one or two other persons remain at the scene of the event until a law enforcement officer or an emergency medical responder arrives; and the person and, if applicable, one or two other persons identify themselves to, and cooperate with, the law enforcement officer or emergency medical responder:

• Unlawful possession of a controlled substance;
• Unlawful use of a controlled substance;
• Unlawful distribution, manufacturing, dispensing, or saleof a controlled substance if the offense is based upon the transfer of a controlled substance from the person to another person for no remuneration;
• Unlawful possession of 12 ounces or less of marijuana or3 ounces or less of marijuana concentrate;
• Open and public display, consumption, or use of less than2 ounces of marijuana;
• Transferring or dispensing 2 ounces or less of marijuanafrom one person to another for no consideration;
• Unlawful use or possession of synthetic cannabinoids orsalvia divinorum;
• Unlawful distribution, manufacturing, dispensing, sale, orcultivation of synthetic cannabinoids or salvia divinorum if the offense is based upon the transfer of synthetic cannabinoids or salvia divinorum from the person to another person for no consideration;
• Possession of drug paraphernalia; and
• Illegal possession or consumption of ethyl alcohol by anunderage person.

Under the current law, when a person receiving child care assistance under the Colorado child care assistance program (CCCAP) is ineligible due to exceeding the income eligibility level adopted by the county department of social services, the county department is strongly encouraged to continue providing child care assistance for 6 months and to work with the person to provide a gradual transition off of the child care assistance. This bill eliminates that permissive 6-month option when a person's income exceeds the county-adopted eligibility level and requires that the county continue to provide child care assistance to the person for a period of 2 years while the person pays a series of incremental increases in the portion of the parental share of the child care.

The bill requires the state board of human services to adopt rules establishing a formula for the scheduled increases in the parental share based on income and on the cost of child care with the goal of the parent becoming more self-sufficient, maintaining stable employment, and taking on more of the cost of child care over the 2-year period. A family that receives child care assistance during the extended 2-year period is required to report any income changes during the 2-year period and is subject to a redetermination of eligibility after the first 12 months.

The bill requires the department of health care policy and financing (state department) to seek a federal waiver to allow for increased flexibility and efficiency in the management of the medicaid program and the children's basic health plan. The waiver will seek authorization to determine eligibility categories and income levels and to establish an asset test for eligibility, implement cost-sharing and premiums, encourage the use of private health benefits coverage, and encourage persons to maintain employer-sponsored health insurance. As part of the waiver, the state department may negotiate for capped federal reimbursements with provisions for adjustments in the federal reimbursements for population growth and inflation. The state department shall report to the general assembly concerning the waiver request and identify necessary changes to state law to implement the reforms requested in the waiver.

Legislative Audit Committee. The bill repeals the rapid screen program for identifying high-emitting motor vehicles.

The bill requires an applicant for an instruction permit or a minor driver's license to sign a statement that the applicant has not used illegal drugs or alcohol during the previous year.

The bill creates the "Colorado Cottage Foods Act", exempting small producers from the licensing requirements placed on retail food establishments and requiring producers to be certified in safe food handling and processing.

The bill limits the liability of food banks that distribute food produced pursuant to the "Colorado Cottage Foods Act". The bill also limits the liability of schools and nonprofit organizations when their kitchens are used by producers to prepare goods for sale directly to consumers.

The bill also exempts a person who produces and sells less than 250 dozen eggs per month on the premises at which the eggs are produced or at a farmer's market or similar venue from the licensing requirements for sellers of eggs.

The bill repeals the "Colorado Health Benefit Exchange Act" if the "Patient Protection and Affordable Care Act" as amended by the "Health Care and Education Reconciliation Act of 2010" (federal act) is repealed or the United States supreme court rules that all or any part of the federal act is unconstitutional.

A licensed health care facility or its agent is prohibited from retaliating against an employee of the licensed health care facility who performs an act or omits an act:

• That, in the best medical judgment of the employee using the best available practices, is in the best interest of the patient; or
• When following a patient's directive.

The bill clarifies that Colorado children's trust fund moneys must be used for prevention, rather than intervention, programs, and extends its repeal to July 1, 2022.

The bill requires the commissioner of insurance to develop by July 1, 2013, and requires prescribing providers and health benefit plans to use by January 1, 2014, a uniform prior authorization form for purposes of submitting and receiving requests for prior coverage approval of a prescription drug. If the health benefit plan fails to use or accept the prior authorization form or fails to respond to a request within 2 business days, the request is deemed granted. An approved prior authorization form is valid for 12 months after the date of approval.

The bill prohibits a public school or institute charter school from making available to a student a food item that contains any amount of industrially produced trans fat. The prohibition applies to all food and beverages made available to a student on school grounds during each school day and extended school day, including but not limited to a food or beverage item made available to a student in a school cafeteria, school store, vending machine, or other food service entity existing upon school grounds or through any fundraising effort conducted by one or more students, teachers, or parents.

Returns eligibility and services in medicaid and the children's basic health plan to the 2006 level by:

• Repealing eligibility for certain qualified aliens and theirchildren, certain children in foster care, persons in the medicaid buy-in program, and childless adults;
• Lowering the income level for parents of children eligiblefor medicaid from 100% to 60% of the federal poverty line;
• Eliminating 12 months of continuous eligibility forchildren;
• Replacing advanced practice nurses services withnurse-midwife services;
• Repealing from the list of optional services eligible forreimbursement under medicaid: Over-the-counter medications; outpatient substance abuse treatment; cervical cancer immunization for females under 20 years of age; screening, brief intervention, and referral to treatment for individuals at risk of substance abuse; and alternative therapies for persons with spinal cord injuries.
• Eliminating presumptive eligibility for children and certainpersons eligible for long-term care; and
• Lowering the income level for eligibility under thechildren's basic health plan from 250% to 205% of the federal poverty line.

The bill makes conforming amendments.

The bill specifies that the regulation of oil and gas operations is a matter of statewide concern, the Colorado oil and gas conservation commission has exclusive jurisdiction to regulate oil and gas operations, and local regulation of oil and gas operations is preempted by state law.

The bill includes male circumcision as a physician's service under Colorado's medicaid program.

The bill requires hospitals licensed in Colorado to provide notice in a manner specified by the department of public health and environment of all services that the hospital refuses to provide because of religious beliefs or moral convictions. The bill requires the notice to inform patients of their right to obtain any service not provided by the hospital because of religious beliefs or moral convictions from another hospital that does provide the service. Requires the notice to be made available prior to or at admission of the patient or as soon after admission as practicable.

On and after September 1, 2012, each public school, charter school, and institute charter school (public school) that offers instruction to students in any of grades 9 through 12 shall offer to each student training in cardiopulmonary resuscitation and the use of an automated external defibrillator (CPR/AED training). Each public school that offers instruction to students in grade 12 shall require each student to successfully complete CPR/AED training during his or her 12th-grade year or any of the preceding 5 years as a condition of his or her graduation from the 12th grade.

CPR/AED training shall be based on an instructional program that incorporates psychomotor skills development.

The school cardiopulmonary resuscitation and automated external defibrillator training cash fund (fund) is established in the state treasury.

The department of education may not use more than 5% of moneys annually expended for expenses to administer the fund.

The department may seek, accept, and expend gifts, grants, and donations from public and private sources for the fund. The department shall notify the legislative council staff when it has received adequate funding through gifts, grants, or donations for the purpose of providing CPR/AED training.

A public school may seek, accept, and expend gifts, grants, and donations from public and private sources for the purpose of providing CPR/AED training. A public school may also apply for and receive moneys from the fund for the purpose of providing CPR/AED training.

The state board of education shall promulgate rules for the implementation of CPR/AED training, including but not limited to (1) procedures for monitoring and ensuring the compliance of public schools with the new statutory provisions; and (2) a process by which a public school may apply for and receive moneys from the fund.

The bill enacts the "Water Rights Protection Act", under which the Colorado oil and gas conservation commission (commission) must establish rules for:

• Hydraulic fracturing near radioactive materials and siteslisted on the national priority list pursuant to the federal "superfund" law; and
• The shut-down of hydraulic fracturing operations whenmonitoring equipment detects a pressure drop.
Oil and gas operators must submit water quantity reports showing projected and actual sources and amounts of water needed for hydraulically fracturing a well. Operators must also submit pre- and post-fracturing water quality reports for all active water wells located within .5 mile of oil and gas wells that will be or have been hydraulically

fractured. This information will be posted on the commission's web site.

Operators cannot inject into the ground any chemical compound that would cause cancer.

In addition to existing financial assurances, each operator that engages in a high-risk hydraulic fracturing treatment must take out an environmental bond that would be forfeited if the operator's operations cause any damage to water rights.

Subject to listed affirmative defenses, an operator is presumed to be responsible for the pollution of a water supply that is within .5 mile of a line between the well head and the surface projection of the bottom hole location of the well, if the pollution occurred within 6 months after the completion of the hydraulic fracturing of the well. Hydraulic fracturing would be prohibited within .5 mile of any surface water, including a pond, reservoir, or other natural or artificial impoundment or stream, ditch, or other artificial waterway, unless the operator uses a closed-loop system.

The bill includes dental services as a benefit for pregnant women under Colorado's medicaid program. The implementation date is January

Joint Budget Committee. Current law requires all tobacco litigation settlement disputed payments to be credited to the state general fund but will not require any disputed payments to be so credited in the future because it defines "disputed payments" to include only payments received by the state between July 1, 2008, and June 30, 2011. The bill expands the definition of "disputed payments" to include all payments that otherwise meet the criteria for being disputed received by the state on or after July 1, 2008.

The bill extends the time period for which newer motor vehicles are exempt from emissions inspections from the vehicle's fourth model year to its eighth model year.

Early Childhood and School Readiness Commission. The bill creates the office of early childhood and youth development (office) in the department of human services (DHS). The office's functions will include:

• Operating and overseeing: The Colorado children's trustfund; certain programs in the Tony Grampsas youth services program; the nurse home visitor program; the family resource center program; child care, including licensing, school readiness, and the early childhood councils; the child care assistance program; mental health consultation for children; part C child find and early intervention services; promoting safe and stable communities; and any other programs transferred to the office;
• Reviewing the federal funding guidelines and seekingfederal waivers to achieve the maximum flexibility in using federal funds for early childhood programs;
• Coordinating with and overseeing program delivery by theearly childhood councils and allocating funding to the councils; and
• Working with other early childhood programs within DHSand in other state agencies to develop and periodically review a state plan for delivering early childhood services to children and their families.
The purpose of the state plan is to provide a statewide, unified approach to providing early childhood services and operating early childhood programs with the goal of increasing efficiency, effectiveness, and quality in delivering early childhood services. The office, with the approval of the other agencies operating early childhood programs, will submit the state plan to the executive directors and policy boards of the affected agencies, the Tony Grampsas youth services board, and the governor for approval. The office and the state agencies may work with the early childhood leadership commission in creating and obtaining

approval of the state plan.

The executive directors of DHS, the department of public health and environment, and the department of health care policy and financing and the commissioner of education will meet on a regular basis to review the operation and coordination of early childhood programs and ensure compliance with the state plan. The policy board for each of these departments will consider the rules and guidelines adopted for early childhood programs in each of the agencies and, to the extent practicable and appropriate, align the rules and guidelines for these programs.

As part of the annual budget process, the office, in coordination with the other state agencies that provide early childhood programs, will report to the joint budget committee concerning the state plan, including:

• The priorities for services;
• The expected and achieved outcomes for early childhoodservices;
• The degree to which the early childhood programs are complying with the state plan and coordinating in delivering early childhood services;
• The coordination of early childhood programs at the state and local levels; and
• The level of funding and sources of moneys allocated to the early childhood councils.

The early childhood leadership commission will advise and otherwise assist the office and the other state agencies in creating and obtaining approval of the state plan. In a joint meeting of the governor and several committees of the general assembly held on or before January 31, 2013, the early childhood leadership commission will report concerning the contents and implementation of the state plan.

The bill relocates the Colorado nurse home visitor program, the family resource center program, and the Colorado children's trust fund from the department of public health and environment to the office in DHS. The bill also relocates the Tony Grampsas youth services program from the department of public health and environment to DHS.

Section 1 of the bill requires air quality permits to be issued within 12 months after receipt of a complete permit application.  Section 2 requires the same of water quality permits.

The bill requires each hospital to make available to patients, and to communicate to each patient, information about the hospital's charity program and discount program in a clear and understandable manner and in languages appropriate to its communities. The bill also requires hospitals to offer a discount to each qualified patient. A qualified patient is defined as an uninsured patient who has a family income of not more than 400% of the federal poverty income level and who does not receive a discount through the Colorado indigent care program.

A hospital is prohibited from charging a patient for more than the cost of providing care. The bill requires each hospital to offer to screen each patient for the discount program and any other financial assistance offered by the hospital.

Each hospital is required to offer a payment plan to an eligible patient and to fulfill specific obligations before sending a bill to a collection agency for payment.