FirstSB084_H_APP.005 RegularHOUSE SessionCOMMITTEE Seventy-fifthOF GeneralREFERENCE AssemblyREPORT STATE_______________________________ OFMay COLORADO3, ENGROSSED2025 ThisChair Versionof IncludesCommittee AllDate AmendmentsCommittee Adopted on SecondAppropriations. Reading in the House of Introduction LLS NO.

25-0194.01After Annaconsideration Petrinion x5497the SENATEmerits, BILLthe 25-084Committee SENATErecommends SPONSORSHIPthe Mullicafollowing: and Simpson, HOUSE SPONSORSHIP Bradfield and Rydin, Senate Committees House Committees Health & Human Services Appropriations A BILL FOR AN ACT C ONCERNINGTHEADEQUACYOFTHEINFUSIONPHARMACYNETWORK SUPPLYING PARENTERAL NUTRITION TO MEDICAID MEMBERS , AND ,INCONNECTIONTHEREWITH ,MAKINGANAPPROPRIATION .

BillSB25-084 Summarybe (Note:amended as follows, and as so amended, be referred to the Committee of the Whole with favorable recommendation:

ThisAmendreengrossedbill,page5,lines18through20,strike"funds,which summaryamount appliesis subject to thisthe bill"(I)" notation as introduceddefined and does notreflectanyamendmentsthatmaybesubsequentlyadopted.Ifthisbill passes third reading in the houseannual ofgeneral introduction,appropriation aact billfor summary that applies to the reengrossedsame versionfiscal ofyear," thisand billsubstitute will"funds". be available at http://leg.colorado.gov.) Infusion pharmacies supply medicaid members with parenteral nutrition, which provides patients with essential nutrients through an intravenous infusion.

g** The*** bill** requires*** the** state department of health care policy and d e 2 financing(statedepartment)to ensure policiesandreimbursementlevels T R 2 A n 5 Shading denotes HOUSE amendment.

Double underlining denotes SENATE amendment.

E d i 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.

e A A for infusion pharmacies for the preparation and dispensing of parenteral nutrition are sufficient to encourage an adequate level of market participation among infusion pharmacies.

The bill requires the state department to annually report on the adequacy of the infusion pharmacy network that supplies parenteral nutrition to medicaid members.

Be it enacted by the General Assembly of the State of Colorado:

SECTION1.

Legislativedeclaration.(1) Thegeneralassembly finds and declares that:

(a) Parenteral nutrition is a feeding method that bypasses the gastrointestinal tract and delivers nutrition directlyinto a patient's veins.

Parenteral nutrition is the only way for some patients with significant feeding and digestion disabilities to survive.

Children who need parenteral nutrition may need it their entire lives.

(b) Because parenteral nutrition is highlyregulated and specially formulated for each individual patient, it is expensive to produce and store, according to data from the American Society for Parenteral and EnteralNutrition.Infusionpharmaciesthatmakeparenteralnutritionand other in-home infusion medications must dedicate time, training, and facilities to their formulation.

Infusion pharmacies must produce parenteral nutrition daily, with frequent formulation changes, and must ensure that the parenteral nutrition meets all safety and quality regulations.

(c) According to recent data from the American Society for Parenteral and Enteral Nutrition, because of recent financial pressures, many infusion pharmacies have stopped supplying parenteral nutrition acrossthenation,particularlyforchildren.Asaresult,medicalproviders spendmoretimelocatinginfusionpharmaciesthatwillagreetoservethe -2- 084 medicalproviders'patients,whorisklosingaccesstomedicallynecessary and life-saving parenteral nutrition treatment.

(d) Federal law establishes early and periodic screening, diagnosis,andtreatmentrequirementsasthecornerstonemedicaidhealth coverage for children.

Pursuant to 42 U.S.C.

sec.

1396 and sec.

1396d (r)(5), children enrolled in medicaid are eligible for early and periodic screening, diagnosis, and treatment benefits.

As a result, the state must ensurethatchildrenenrolledinmedicaidhavetimelyaccesstomedically necessary health care in the most appropriate setting.

(e) It is not clear if the medicaid reimbursement methodologies thatarecurrentlyinplaceinColoradoaresufficienttocovertheextensive costs of producing parenteral nutritionand other specialty pharmaceuticals.

(2) Therefore,thegeneralassemblydeclaresthatitisnecessaryto ensure that Colorado medicaid members have access to an adequate network of infusion pharmacies supplying parenteral nutrition.

SECTION 2.

In Colorado Revised Statutes, add 25.5-5-519 as follows:

25.5-5-519.

Pharmacy reimbursement - parenteral nutrition - report - definitions.

(1) A USED IN THIS SECTION,UNLESS THE CONTEXT OTHERWISE REQUIRES :

(a) "IFUSIONPHARMACY "MEANS APRESCRIPTIONDRUGOUTLET THATPREPARESANDDISPENSESASOLUTIONTHATINCLUDESPARENTERAL NUTRITIONFORDIRECTADMINISTRATIONINTOAPATIENT 'SBLOODSTREAM .

T HE SOLUTION MAY CONTAIN MEDICATIONS OROTHERTREATMENTS AND MAY BE ADMINISTERED IN A PATIENT S HOME OR IN A HEALTH -CARE FACILITY.

-3- 084 (b) "PARENTERAL NUTRITION" MEANS A FORM OF NUTRITIONAL SUPPORTTHATPROVIDESAPATIENTWITHNEEDEDNUTRIENTS ,INCLUDING, ATAMINIMUM ,CARBOHYDRATES ,AMINOACIDS ,ANDLIPIDSTHROUGHAN INTRAVENOUS INFUSION.

(2) (a) UPON RECEIVING ANY NECESSARY FEDERAL APPROVAL PURSUANT TO SUBSECTION (2)(cOF THIS SECTION,BEGINNING ON OR BEFORE ANUARY 1, 2026, THE STATE DEPARTMENT SHALL CREATE SPECIFIC PROFESSIONAL DISPENSING FEES FOR THE PREPARATION AND DISPENSING OF PARENTERAL NUTRITION TO ENCOURAGE AN ADEQUATE LEVEL OF MARKET PARTICIPATION AMONG INFUSION PHARMACIE.

(b) DURINGTHEYEARBEGINNING JANUARY 1,2026THESPECIFIC PROFESSIONAL DISPENSING FEES MUST NOT EXCEED THIRTY PERCENT OF INFUSIONPHARMACYADMINISTRATIVECOSTSFORTHEPREPARATIONAND DISPENSING OF PARENTERAL NUTRITIO.

(c) THE STATE DEPARTMENT SHALL SEEK FEDERAL AUTHORIZATION ,AS NECESSARY , TO IMPLEMENT THE PROFESSIONAL DISPENSING FEES PURSUANT TO THIS SUBSECTI(2).

(3) NOTWITHSTANDING SECTION 24-1-136 (11)(a)(ION OR BEFORE N OVEMBER 1, 2026AND ON OR BEFORE EVERY NOVEMBER 1 THEREAFTER , THE STATE DEPARTMENT SHALL , WITHIN EXISTING APPROPRIATIONS,REPORT IN ITS PRESENTATION TO THE JOINT BUDGET COMMITTEE AND ITS "SMART A CT" HEARING HELD PURSUANT TO SECTION 2-7-203ON:

(a) T HE TOTAL NUMBER AND GEOGRAPHIC DISTRIBUTION OF INFUSION PHARMACIES THROUGHOUT C OLORADO THAT PROVIDE PARENTERAL NUTRITION TO MEMBERS ;