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Dear Licensee:
This communication is to inform you of recent legislation affecting your profession.
On May 25, 2023, Governor Jared Polis signed HB23-1077, Informed Consent Intimate Patient Exams into law. Under this law, a licensed physician or physician assistant; advanced practice registered nurse; and direct entry midwife cannot perform an intimate examination of a sedated or unconscious patient unless the patient has provided specific informed consent to the exam.
A student or trainee may perform an intimate exam on a sedated patient if: the exam is related to the planned procedure to be performed; they have been introduced as part of the patient’s care team and the procedure is part of education or training; and, the student or trainee is under direct supervision of the licensee responsible for supervising the student or trainee.
A licensee may perform an intimate exam without patient consent in emergency situations when the examination is medically necessary for the life and well being of the patient, but the licensee must make a record of performing the exam without obtaining the patient’s consent. To obtain specific informed consent for an intimate procedure, a licensee shall: provide written or electronic documents to the patient that specifies the nature and purpose of the examination; names one or more of the licensees who are authorized to perform the examination; states whether or not there will be students present for the exam, and; provides the patient the ability to consent to or decline certain provisions.
Other important nursing bills recently signed into law are:
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SB23-170: Extreme Risk Protection Order Petitions: This bill expands the list of who can petition for an extreme risk protection order to include licensed health care providers; including school nurses who hold a current nursing license; licensed mental health-care providers; licensed educators; and district attorneys. Under this bill, a licensed health-care professional or mental health professional is authorized to disclose protected health information of the respondent as necessary for full investigation upon filing the petition for a temporary extreme risk protection order, notwithstanding any contrary laws. Licensed health-care professionals or mental health-care professionals should make reasonable efforts to limit the protected health information they share to be as minimal as necessary to complete the request.
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SB23-167: Board of Nursing Regulate Certified Midwives: Starting July 1, 2024, the bill authorizes individuals who have a midwife certification from the American Midwifery Certification board, pay the required fee, and submit a criminal history record check to obtain a license from the State Board of Nursing to practice as a certified midwife in the state. If approved by the board, a licensed certified midwife may apply for and obtain provisional and full prescriptive authority upon satisfying the requirements specified in this bill. This bill adds a member to the Board of Nursing who is a certified midwife or an advanced practice nurse who is a certified midwife effective July 1, 2024.
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SB23-176: Protections for People with Eating Disorders: Under this law, a retail establishment, which is defined as any vendor that sells over-the-counter diet pills and retails directly to the public, shall not sell, transfer, or otherwise furnish over-the-counter-diet pills to any person under 18 years of age. Furthermore, these retail establishments must request valid identification from any person who attempts to purchase over-the-counter diet pills if that person appears to be under 18 years of age. Violation of this provision constitutes a deceptive trade practice.
Other important bills affecting the nursing profession are:
SB 23-188: Protections for Accessing Reproductive Health Care. This bill requires contracts between insurers and health-care providers to include a provision that prohibits the insurer or person or entity from: refusing to issue, canceling, refusing to renew, imposing sanctions, fines, or penalties; taking adverse action against the provider, refusing to pay for a provided health-care service, or terminating a contract with the provider; refusing to credential a physician as a networking provider or terminating a physicians status as a network provider; terminating a health-care contract with a provider if the actions are based solely on the health-care provider’s provision of reproductive health care or gender affirming health care services. It likewise protects an individual applying for licensure, certification, or registration in a health-care-related profession or occupation and current licensees from having their license, certification, or registration denied or discipline imposed against the licensee based solely on their provision of a legally protected health care activity in this state or another state; a civil or criminal judgment arising from providing a legally protected health care activity; or the applicant or licensee’s own legally protected health-care activity in this state or another state.
SB23-189: Increasing Access to Reproductive Health Care. This new law requires large employer plans to provide coverage for the total cost of abortion care without policy deductibles, copayments, or coinsurance, and individual and small group plans to provide this coverage if the federal Department of Health and Human Services confirms the state’s determination that the coverage is not subject to state defrayal pursuant to federal law. Furthermore, it prohibits a health insurance carrier from requiring a covered person to undergo step therapy or receive prior authorization before they prescribe or dispense a medication for the treatment of HIV. Finally, this allows a health-care provider to furnish contraceptive procedures, supplies, or information to a minor without notification to or the consent of the minor’s parent or legal guardian.
SB23-190: Deceptive Trade Practice Pregnancy Related Service. This bill makes it a deceptive trade practice for a person to make or disseminate any advertisement that indicates that the person provides abortions, emergency contraceptives, or referrals for abortions or emergency contraceptives when the person knows that they do not provide those services. Furthermore, a health-care provider is subject to discipline if they prescribe, administer, or attempt medication abortion reversal in this state unless the medical board, pharmacy board, and nursing board each have in effect rules finding that it is a generally accepted practice to engage in abortion reversal.
SB23-260, Individual Access to Publicly Funded Vaccines. Under this bill, a practitioner may ask an individual who seeks to receive a publicly funded vaccine to present proof of health insurance or a government issued ID, social security card, or social security number, but cannot condition the individual’s receipt of that vaccine on the presentation of said documents. The vaccines are required to be provided regardless of an individual’s provision of the requested documentation. A practitioner who administers publicly funded vaccines should post a notice provided by CDPHE that confirms the vaccine will be provided regardless of the individual’s ability to pay the vaccine administration fee. Furthermore, a practitioner shall not charge an individual or bill an individual’s insurance provider the cost for a publicly funded vaccine, and should not condition an individual's receipt of a publicly funded vaccine on their ability to pay for the vaccine. However, if a practitioner does choose to bill an individual for a vaccine administration fee after a publicly funded vaccine is administered, they may only issue a single bill within 90 days after the vaccine is administered. A practitioner shall not send unpaid vaccine administration bills to a collection agency. A practitioner shall provide a publicly funded vaccine to any age-appropriate individual with parental informed consent for those under 18 years of age who has an appointment for a vaccine within their scope of practice. Lastly, practitioners are encouraged, though not required, to establish an accessible electronic link and phone number for individuals to use to schedule an appointment for a publicly funded vaccine.
SB23-144: Prescription Drugs for Chronic Pain. Under this law, the health-care provider may prescribe, dispense, or administer a schedule II,III, IV or V controlled substance to a patient in the course of their treatment for a diagnosed condition causing chronic pain. A healthcare provider is not subject to discipline for prescribing these drugs as long as the provider keeps an accurate record of the purpose, use, prescription, and disposal of the controlled substance; if they write accurate prescriptions; and if they prescribe medications in accordance with legitimate medical purpose in the course of professional practice. See the attached bill for further details.
HB23-1002, Epinephrine Auto Injectors. Starting January 1, 2024, this bill creates an epinephrine auto-injector affordability program to provide low-cost epinephrine auto-injectors to qualifying individuals. See the attached bill for further details.
Other important legislation recently passed includes:
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SB23-020:Timely Certified Death Certificates;
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SB23-102: Rule Review Bill;
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SB23-265, Prohibit Professional Discipline for Marijuana;
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SB23-261, Direct Care Workforce Stabilization Board;
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HB23-1003, School Mental Health Assessment;
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SB23-286 Access to Government Records.
Implementation of these changes is in process. Questions may be referred to dora_nursingboard@state.co.us. Please visit the DPO Legislative Update webpage for all updates affecting licensees under the Division’s regulatory authority. Thank you.
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