Practice Compliance Resources
Stay up-to-date on laws and regulations that may impact your practice. The following information is meant as a starting place and should not be considered legal advice.
Beginning January 1, 2026, medical licensees applying for renewal, reinstatement, or reactivation of their license must attest to the completion of 30 credit hours of continuing medical education. The Colorado Medical Board will have the ability to audit physicians, with an emphasis on non-board certified physicians, that they are completing these credit hours. Physicians must maintain a transcript or certificate of attendance of CME credits earned.
Credits awarded by the American Academy of Family Physicians, American Medical Association, American Osteopathic Association, and those required to maintain national board certification will qualify. Self-claimed or self-documented credits do not qualify.
Further, the bill gave the Colorado Medical Board rulemaking authority to identify required CME topics for physicians. The Board will be conducting a stakeholder process for considering specific CME topics on health disparities, reproductive health, sexual, and gender-based health care, explicit and implicit bias. They will also consider the frequency of, the number of hours that may be required, and which physicians are subject to the requirement.
Beginning in 2025, patients transitioning from Medicaid to commercial insurance because they are no longer eligible for Medicaid may continue care with their current health care provider, even if they are out of network, for 90 days or through the course of treatment.
Similarly, beginning in 2025, patients whose insurance coverage was not renewed because the insurance carrier is no longer offering plans that the patient is eligible for and the patient is transitioning to a new insurance may continue care with their current health care provider for 90 days or through the course of treatment if they satisfy any of the following conditions:
- Is pregnant
- Is being treated for a serious and complex medical condition
- Is undergoing care as an inpatient
- Is terminally ill and receiving care for their terminal illness
- Is scheduled for non-elective surgery, including post-operative care
At the request of the health care provider or patient, the patient’s new insurer must accept preauthorizations for procedures, medication, treatment, or services from the previous carrier with documentation from the provider as long as they are a covered benefit under the new plan.
The out-of-network provider will be reimbursed at the standard in-network rate and will be required to adhere to the carrier’s terms and conditions.
What does the law do? Under current law, a family or household member and a law enforcement officer or agency can petition for an extreme risk protection order (ERPO), which temporarily restricts access to guns for individuals at an elevated risk of harming themselves or others. This bill added physicians and other healthcare and mental healthcare providers to the list of people who can petition for an ERPO.
How does this impact my practice? If you feel a patient is a risk to themselves or others should they obtain a firearm or use one already in their possession, file a petition with the Colorado Judicial Branch. ERPO petitions can be made without notice to the respondent of who filed the petition.
Who should I share this with? It may be helpful to share this information with your colleagues and staff. Additionally, the law also expands the right to petition to educators and district attorneys. Even more information on filing an ERPO can be found here.
The 2024 legislative session brought a major tort reform agreement in the form of House Bill 1472. This legislation is the result of a compromise that avoided potentially catastrophic ballot measures that aimed to eliminate all liability caps in the state and eviscerate statutory protections for confidentiality in peer review, quality management, and similar programs. Below is a summary of the changes.
Medical Liability: Over a five-year implementation period, increase the non-economic damages cap from the current $300,000 to $875,000 and establish a new and separate wrongful death award starting at $500,000 and increasing for five years annually to $1.575 million. Starting in 2030, the caps will be automatically adjusted for inflation every two years. Economic damage caps will be the greater of $1,000,000 or 125% of the then-current wrongful death cap.
General Liability: Increase in the non-economic damages cap from the current $729k to $1.5 million and wrongful death cap from the current $642k to $2.125 million. Starting in 2028, the caps will be automatically adjusted for inflation every two years.
At this time, CAFP is working to understand impacts to members’ premiums and policies. We will provide updates as they become available. However, please reach out to your underwriter with any specific inquiries regarding your policy.
*Information provided by COPIC.
What does the law do? Under current law, death certificates must be filed with the state registrar 5 days after a death occurs. The law changes that time frame to 72 hours, however, allows a physician to indicate they require more time to complete the death certificate or conduct additional inquiry into the manner of death.
The law generally requires a decedent’s established primary care physician (PCP) to complete the medical certification for the death certificate if the death appears to be due to natural causes – determined as such with a reasonable degree of medical certainty, the decedent received medical care from the PCP within a year of the death, the death occurred when the decedent was not under the direct care of another physician charged with the decedent’s care during the illness or condition that resulted in death, and an inquiry into the death is not required. However, if within a year of the death, the decedent had been treated by a physician other than their established PCP for a chronic condition or terminal illness related to their death, that physician is responsible for completing the medical certification for the death certificate.
Demonstrated repeated and willful failure to comply with the law could constitute unprofessional conduct at the discretion of the Colorado Medical Board.
How does this impact my practice? In addition to the new timeline, death certificates must also be filed using the Colorado Vital Events System (COVES) after March 1, 2024. The online form for physicians to request an account is here. This site is for physicians only.
Who should I share this with? With the new requirement that death certificates be signed as soon as practicable, it’s important to share this information with your colleagues and staff. Use this reference by CDPHE for a step-by-step guide to COVES.
The Colorado Department of Public Health and Environment hosted a webinar for CAFP members to discuss these changes and answer questions in September. The recording can be found here. FAQ document below.
What is the FAMLI program? Colorado voters approved the paid Family and Medical Leave Insurance (FAMLI) program in 2020 and the program went into effect January 1, 2024. FAMLI ensures Colorado workers have access to paid leave in order to take care of themselves or their family during life circumstances that pull them away from their jobs, so workers don’t have to choose between earning a paycheck and taking care of their families.
How does this impact my practice? Your role as a health care provider is vital in making sure that the paid Family and Medical Leave (FAMLI) program is an accessible and meaningful benefit for workers. Coverage is only available with a health care provider verifying a patient’s serious medical condition. Health care providers are asked to register and verify their license with the FAMLI Division so that when a patient of yours needs to access coverage, they can do so quickly.
Where can I find more information? The FAMLI Division has a dedicated webpage for clinicians, answers to FAQs, and offers a recording of the FAMLI program informational webinar.
What does the law do? The bill modifies the relationship between a physician assistant (PA) and a physician by replacing the current requirement that a PA be supervised by a physician with a ‘collaborative agreement’, except in certain circumstances (more on that below). A collaborative agreement must be with a Colorado-licensed physician, podiatrist, or physician group and includes the following:
- PA’s name, license number, and primary location of practice,
- A description of the PA’s process for collaboration, the degree of which must be based on the PA’s primary location and area of practice. It may include:
- Decisions made by the physician or group,
- The credentialing or privileging requirements of the PA’s primary location.
- A description of the performance evaluation process, and
- Any additional requirements specific to the PA’s practice required by the physician or group, including additional levels of oversight, limitations on autonomous judgment, and designation of a primary contact for collaboration.
For a PA with fewer than 5,000 practice hours, or who changed practice areas with fewer than 3,000 practice hours in the new area, the collaborative agreement is a more traditional supervisory agreement which must include the above requirements as well as the following:
- Require that collaboration during the first 160 practice hours occur in person or through technology,
- Incorporate elements defining the specific nature of collaboration, including a PA’s expected area of practice, expectations for support and consultation, methods and modes of communication, and any other pertinent elements of collaboration or team-based practice the supervising physician or group deem appropriate, and
- A more regular schedule for performance evaluations, specifically after the first six months and again after the first twelve.
How does this impact my practice? Physicians are not required to enter into these collaborative agreements and an employer is prohibited from requiring such as a condition of employment. Should physicians and PAs establish agreements following the criteria above, keep them on file at the PA’s primary location and be prepared to make them available to the Colorado Medical Board upon request.
Who should I share this with? The Colorado Board of Medicine recently finalized regulations to operationalize the law (changing what was Rule 400 to the new Rule 1.15 [starting on page 21]). The Colorado Medical Board Frequently Asked Questions provides further information.
What does the law do? SB 144 shields providers from discipline solely for prescribing opioid doses that fall outside recommended numeric thresholds recommended in guidelines. The law also states that providers are not required to taper opioid doses in stable, compliant patients. These protections safeguard patients from dangerous opioid tapering practices that studies show increase their risks of suicide and overdose and can destabilize their health and lives.
How does this impact my practice? SB 144’s goal is to address the widespread misapplication of opioid dose thresholds in one-size-fits-all guidelines in ways that risked patient harm by defining chronic pain, removing disciplinary action against physicians, and eliminating barriers to care. The new law also prohibits clinics and pharmacies from discriminating against chronic pain patients who use opioids. Its goal is to strike a balance between promoting safe prescribing and protecting the care of people with chronic pain.
Where can I find more information? The Colorado Cross Disability Coalition has partnered with the Colorado Medical Society to develop this fact sheet for physicians to learn more about the bill. Listen to this episode of the Stethoscope podcast for additional information.
Beginning January 1, 2026, patients who have Colorado regulated commercial health insurance and their providers will benefit from the below changes to prior authorization processes.
- Covered or Required Alternative Services or Treatment: For denial of a prior authorization request, a carrier must identify relevant alternative services or treatment or treatments that may be a covered benefit or are required before approval.
- Covered Alternative Drugs: For denial of a prior authorization request for a prescription drug, a carrier must specify which dosages or alternative drugs in the same class of medication are a covered benefit
- Duration of Approvals: The duration of prior authorization approvals is extended from the current 180 days to a new duration of one year or the length of treatment.
- Duration of Approvals for Chronic Medications: The duration of prior authorizations for chronic medications will generally be three years. Drugs that cost more than $30,000 annually may be subject to a one-year approval.
- No Denial for Certain Additional or Related Procedures: A carrier is prohibited from denying coverage for surgical care that was approved but then during surgery requires a medically necessary additional or related covered procedure that would likely harm the patient to delay.
- Electronic Filing of Prior Authorizations: Each carrier must comply with federal standards to send electronic prior authorizations for services and medications.
Insurers will also be required to increase transparency regarding their prior authorization processes.
Required Disclosures
- Prior Authorization Requirements and Restrictions: Each carrier must post on a publicly facing website all prior authorization requirements and restrictions.
- Formulary Requirements: Each carrier must post on a publicly facing website prior authorization all formulary requirements in standardized, searchable format for clarity about what drugs are covered.
- Prior Authorization Outcomes Data: Each carrier must post on a publicly facing website prior authorization data in standardized, searchable format including for each category of service the number of prior authorization requests received, approvals, and denials by category of denial; as well as the number of adverse determinations that were appealed and the results.
Finally, insurers must develop alternatives to prior authorizations and attest to removing prior authorization processes that neither promote quality, promote equity or reduce costs.
Prior Authorization Removal and Alternative Program
- Removal Based on Lack of Quality or Cost Reduction: Each carrier must annually review their list of prior authorization for services and medications and attest to the Division of Insurance that they removed prior authorization requirements that neither promote quality, promote equity or reduce costs.
- Alternative Exemption Program Requirement: Each carrier must create alternative exemption programs to prior authorization for qualified providers for medical services & prescription drugs. Data on the number of providers offered exemptions through the programs, the types of programs or exemptions offered, and the type of service or drug for which the exemption applied must be publicly posted on a carrier’s website.
*Summary prepared for the Colorado Medical Society by Conklin, Cardone, & Rutberg, PC Attorneys at Law
What is the preceptor tax credit? Colorado’s Rural and Frontier Health Care Preceptor Tax Credit is an annual income tax credit for primary care preceptors in rural and frontier Colorado to offset the costs of their voluntary mentorship of students studying to work in rural areas.
How much of a credit can I be eligible for if I am a preceptor? In 2024, thanks to the advocacy of CAFP and our partners, the tax credit was doubled from a $1,000 individual income tax credit to $2,000 and allows for a preceptor to claim three credits per tax year, a potential total tax credit of $6,000.
Where can I find more information? This increase will go into effect January 1, 2025. The Colorado Department of Revenue will, at that time, have updated information and certification forms for claiming the tax credit available on this webpage.