SecondNOTE: Regular Session Seventy-fifth General Assembly STATE OF COLORADO REREVISED This Version Includes All Amendments Adopted in the Second House LLS NO.

26-0111.01This Reneebill Leonehas x2695been HOUSEprepared BILLfor 26-1019the HOUSEsignatures SPONSORSHIPof Liederthe andappropriate Bacon,legislative Carter,officers Clifford, Duran, English, Garcia, Goldstein, Hamrick, Joseph, Lindsay, Nguyen, Rutinel, Sirota, Titone, Valdez SENATE SPONSORSHIP Roberts and Rich,the Amabile,Governor. Ball, Benavidez, Bright, Catlin, Coleman, Cutter, Exum, Gonzales J., Hinrichsen, Jodeh, Kirkmeyer, Kolker, Liston, Marchman, Simpson, Snyder, Wallace d d e m 2 T n 2 A U 8 E i i House Committees Senate Committees S a p Health & Human Services Health & Human Services e A d A BILL FOR AN ACT i a 6 C ONCERNINGMANDATORYHEALTH -CARECOVERAGEFORPREVENTIVE e 0 T d 2 N 2 7 KIDNEY FUNCTION SCREENING SERVICES .

ETo ddetermine iwhether Sthe dGovernor phas esigned Athe Billbill Summaryor mtaken Aother (Note:action on it, please consult the legislative status sheet, the legislative history, or the Session Laws.

ThisHOUSE summaryBILL applies26-1019 toBY thisREPRESENTATIVE(S) billLieder as introduced and doesBacon, notreflectanyamendmentsthatmaybesubsequentlyadopted.IfthisbillCarter, dClifford, dDuran, passesEnglish, thirdGarcia, readingGoldstein, inHamrick, theJoseph, houseLindsay, ofNguyen, introduction,Rutinel, aSirota, billTitone, summaryValdez, thatCamacho, eGonzalez 2R., appliesPhillips, toMcCluskie; the reengrossed version of this bill will be available at E a 2 S U 6 http://leg.colorado.gov.) O n h H a r e a The bill adds kidney function screening services as preventive r M health-care services for which insurance policies or contracts in the state 3 mustprovidetotal-costcoverage.Coverageforkidneyfunctionscreening serviceswillbeimplementedforalllargeemployerhealthbenefitpolicies g or contracts issued or renewed in this state after January 1, 2027, and all i 62 individual and small group health benefit plans issued or renewed in this a 2 S R 3 U d 1 H 2 c Shading denotes HOUSE amendment.

Doublealso underliningSENATOR(S) denotesRoberts SENATEand amendment.Rich, Amabile, Ball, Benavidez, Bright, Catlin, Cutter, Exum, Gonzales J., Hinrichsen, Jodeh, Kirkmeyer, Kolker, Liston, Marchman, Simpson, Snyder, Wallace, Coleman.

eC aONCERNING CapitalMANDATORY lettersHEALTH orCARE boldCOVERAGE &FOR italicPREVENTIVE numbersKIDNEY indicateFUNCTION newSCREENING materialSERVICES to. be added to existing law.n M Dashes through the words or numbers indicate deletions from existing law.

e A state on or after January 1, 2028, as long as the state is not required to defraythecostof thecoverageof thekidneyfunctionscreening services.

SECTION1.SECTION 1.

Legislativedeclaration.(1)Legislative Thegeneralassemblydeclaration. finds and declares that:

(1) The general assembly finds and declares that:

In 2021, over 8,000 Colorado residents were being treated for end-stage renal disease, withwith4,994ofthoseresidentsdependingondialysistostayalive.Theannual 4,994insurance ofcosts thosefor residentschronic dependingkidney ondisease dialysisin toColorado stayhave alive.reached $457 million, with patients paying nearly $58 million out-of-pocket.

TheAccording annualto insurancethe costscenters for chronic kidney disease incontrol Coloradoand haveprevention reached $457 million with patients paying nearly $58 million out-of-pocket.Accordingtothecentersfordiseasecontrolandprevention in the federal department ofCapital healthletters andor humanbold services,& oneitalic outnumbers ofindicate everynew 7material adultadded Americans has chronic kidney disease, and up to 90%existing oflaw; those individualsdonotknowthattheyhaveit.Thenumberofindividualswho have chronic kidney disease is disproportionately higher in minority communities.

(b)dashes Earlythrough screeningwords foror chronicnumbers kidneyindicate diseasedeletions isfrom essentialexisting butlaw currentlyunderutilizedinColorado.Amongthe800,206Coloradanswho have hypertension, diabetes, or both hypertension and diabetes,such anmaterial estimatedis 144,217not individualspart likelyof have advanced, stages four or five, chronic kidney disease but many remain undiagnosed due to inadequate screening.Screeningiscriticalbecauseitallowsforearlierdiagnosisand cheaperinterventions,whichpreventthesignificantriseincostandstrain on the health-careact. system that occurs when chronic kidney disease is diagnosed late and, as a result, is often more advanced.

(c)of Earlyhealth detectionand throughhuman screeningservices, isone cost-effectiveout andof -2-every 10197 preventsadult diseaseAmericans progression.has chronickidneydisease,andupto90%ofthoseindividualsdonotknowthat they have it.

The number of individuals who have chronic kidney disease is disproportionately higher in minority communities.

(b) Early screening for chronic kidney disease is essential but currently underutilized in Colorado.

Among the 800,206 Coloradans who havehypertension,diabetes,orbothhypertensionanddiabetes,anestimated 144,217individualslikelyhaveadvanced,stagefourorfive,chronickidney disease, but many remain undiagnosed due to inadequate screening.

Screening is critical because it allows for earlier diagnosis and cheaper interventions, which prevent the significant rise in cost and strain on the health-care system that occurs when chronic kidney disease is diagnosed late and, as a result, is often more advanced.

(c) Earlydetection through screening is cost-effective and prevents disease progression.

(d) Withoutearlydetection,thefinancialburdenofchronickidneyWithout early detection, the financial burden of chronic kidney disease escalates dramatically as the condition progresses.

Patient out-of-pocketout-of-pocketexpensesrisefromanaverageof$280annuallyforstageone expenses rise from an average of $280 annually for stage one chronic kidney disease to $10,183 for end-stage renal disease.

(e) The kidney disease prevention and education task force, established pursuant to House Bill 21-1171, enacted in 2021, conducted a comprehensive study and identified early detection through accessible screeningscreeningascriticaltoreducingbothhealthcomplicationsandthefinancial asstrainofkidneydiseaseonColoradoresidentsandtheColoradohealth-care critical to reducing both health complications and the financialstrainofkidneydiseaseonColoradoresidentsandtheColorado health-care system.

(2) TheThegeneralassemblyfurtherdeclaresthatthepurposeofthisact general assemblyfurther declares that the purpose of this act is to:

(a) Implement the recommendations of the kidney disease preventionpreventionandeducationtaskforcebyrequiringhealthinsurancecoverage and education task force by requiring health insurance coverage for annual preventive kidney function screening services without cost-sharing requirements;

(b)PAGE Remove2-HOUSE financialBILL barriers26-1019 that(b) currentlyRemovefinancial preventbarriers earlythat diagnosiscurrentlypreventearlydiagnosis of chronic kidney disease, particularly among high-risk populations with hypertension or diabetes;

-3- 1019 (d) Reduce the overall financial burden of kidney disease on ColoradoColoradopatients,insuranceplans,andstate patients,health-careprogramsthrough insurance plans, and state health-care programs through cost-effective preventive care;

and (e) ImprovehealthoutcomesforColoradoresidentsbyfacilitatingImprove health outcomes for Colorado residents by facilitating earlier detection and treatment of chronic kidney disease.

MandatoryMandatorycoverageprovisions-applicability-rules coverage provisions - applicability - rules - legislative declaration - definitions.

(a) (I) The following policies and contracts that are issued or renewed in this state must provide coverage for the total cost of the preventivehealth-careservicesspecifiedinsubsections(18)(b),(18)(b.3),preventive health-care services specified in subsections (18)(b), (18)(b.3), and (18)(b.7)AND(18)(b.7),AND (18)(b.8) of this section:

(b.8)(I)(b.8) HECOVERAGEREQUIREDBYTHISSUBSECTION(I) (18)MUSTTE COVERAGE REQUIRED BY THIS SUBSECTION (18) MUST INCLUDE ANNUAL KIDNEY FUNCTION SCREENING SERVICES DESIGNED TO IDENTIFY PATIENTS AT RISK FOR CHRONIC KIDNEY DISEAS,INCLUDINGDISEASE GLOMERULARFILTRATIONRATE, ,ORINCLUDING "GFR",TESTINGANDURINETESTINGGLOMERULAR FILTRATION RATE , OR "GFR", TESTING AND URINE TESTING FOR SCREENING ALBUMIN AND CREATININE LEVELS.LEVELS .

(II) A LL LARGE EMPLOYER HEALTH BENEFIT PLANS ISSUED OR RENEWED IN THIS STATE ON OR AFTERANUARYAFTER 1,2027,SHALLJANUARY 1, 2027, SHALL PROVIDE COVERAGE FOR KIDNEY FUNCTION SCREENING SERVICES .

(III)(A)(III) XCEPTASPROVIDEDINSUBSECTION(A) (18)(b.8)(III)OF)EXCEPT AS PROVIDED IN SUBSECTION (18)(b.8)(III)(B)OF PAGE 3-HOUSE BILL 26-1019 THIS SECTION,ANDSECTION, AND TO THE EXTENT THAT SUCH COVERAGE IS NOT IN ADDITION TO BENEFITS PROVIDED PURSUANT TO THE STATE BENCHMARK PLANPLANREQUIREDPURSUANTTO REQUIRED45CFR156.111, PURSUANTALLINDIVIDUALANDSMALL TOGROUP 45HEALTH CFRBENEFIT 156.111,PLANS ALLISSUED INDIVIDUALOR ANDRENEWED -4-IN 1019THIS SMALLGROUPHEALTHBENEFITPLANSISSUEDORRENEWEDINTHISSTATESTATE ON OR AFTER JANUARY 1,1,2028,SHALLPROVIDECOVERAGEFORKIDNEYFUNCTION 2028SHALL PROVIDE COVERAGE FOR KIDNEY FUNCTION SCREENING SERVICES.SERVICES .

(B) SUBSECTION(18)(b.8)(III)(OFTHISSECTIONISINOPERATIVESUBSECTION (18)(b.8)(III)(OF THIS SECTION IS INOPERATIVE AND THE STATE SHALL NOT ASSUME AN OBLIGATION FOR THE COVERAGE REQUIRED PURSUANT TO SUBSECTION (18)(b.8)(III)(OF THIS SECTION IFTHEDIVISIONDETERMINESTHATTHEBENEFITSPECIFIEDINSUBSECTIONIF (18)(b.8)(III)(OFTHE THISDIVISION SECTIONDETERMINES REQUIRESTHAT STATETHE DEFRAYALBENEFIT OFSPECIFIED THEIN COSTSUBSECTION OF(18)(b.8)(III)(OFTHISSECTIONREQUIRESSTATE COVERAGEDEFRAYALOFTHE COST OFCOVERAGE PURSUANT TO A PROVISION OFOFTHE THEFEDERALACT FEDERAL,INCLUDING ACTU.S.C. , INCLUDING 42 U.S.C.SEC.

18031 (d)(3)(OR A SUCCESSOR PROVISIO, AND THE IMPLEMENTING REGULATIONS OR THE STATE IS OTHERWISE REQUIRED TO DEFRAY THE COST OF COVERAGE REQUIRED PURSUANT TO SUBSECTION (18)(b.8)(III)(OF THIS SECTIO.

(IV)THECOVERAGEREQUIREDBYTHISSUBSECTION (18)(b.8MAY BE OFFERED THROUGH A HIGH DEDUCTIBLE PLAN THAT WOULD QUALIFY FOR A HEALTH SAVINGS ACCOUNT PURSUANT TO 26 U.S.C.

223;18031 (d)(3)(B) OR A SUCCESSOR PROVISION , AND THE IMPLEMENTING REGULATIONS OR THE STATE IS OTHERWISE REQUIRED TO DEFRAY THE COST OF COVERAGE REQUIRED PURSUANT TO SUBSECTION (18)(b.8)(III)(OF THIS SECTION.

EXCEPT(IV) THAT A CARRIER MAY APPLY DEDUCTIBLE AMOUNTS FOR THE REQUIRED COVERAGE IFREQUIRED IT IS NOT CONSIDERED BY THUTHIS NITEDSSUBSECTION TATES(18)(b.8)MAY DEPARTMENTBEOFFEREDTHROUGHAHIGHDEDUCTIBLEPLANTHATWOULDQUALIFYFOR OFA TREASURYHEALTH TOSAVINGS BEACCOUNT PREVENTIVEPURSUANT OR TO HAVE26 ANU.S.C.SEC. ACCEPTABLE DEDUCTIBLE .

223;EXCEPT THAT A CARRIER MAY APPLY DEDUCTIBLE AMOUNTS FOR THE REQUIRED COVERAGE IF IT IS NOT CONSIDERED BY THEU NITED STATES DEPARTMENT OF THE TREASURY TO BE PREVENTIVE OR TO HAVE AN ACCEPTABLE DEDUCTIBLE .

(1)(1)(f) (f)Thespecificationsdrawnbythedirectorforanygroupbenefit The specifications drawn by the director for any group benefit plans shaMUSTshallMUST include the mandated coverages required by section 10-16-104;10-16-104;C.R.S.

C.R.EXCEPTEXCEPTTHATTHESPECIFICATIONSARENOTREQUIREDTO THAT THE SPECIFICATIONS ARE NOT REQUIRED TO INCLUDE COVERAGE FOR KIDNEY FUNCTION SCREENING -5- 1019 SERVICES ,AS, AS DESCRIBED IN SECTION 10-16-104 (18)(b.8).