House Health & Human Services [Mar 10, 2026 - Upon Adjournment]

Representatives of Bradfield.

Bradley.

English.

Frey.

Garcia-Sander.

Hamrick.

Johnson.

Here.

Excuse.

Here.

Here.

Here.

Present.

Here.

Thank you, Madam Chair. It's an honor to be back in front of you folks. I'm looking to the right here to see if I have any other support. And this is the first time I've had a chance to co-prime a bill with Representative Furey, and I'm really pleased that she would join on this bill. Before I take you through the bill, I want to set the stage of how important this human-animal bond is and how important it's been in my life. several of you know that I have been a competitor both at a running level and a cycling at a national level for a considerable length of time and that takes you into a great deal of training and a great deal of training sometimes alone and sometimes in very distant places where folks can't get to you easily. And I have one of those locations right out of my back door in Grand Junction called the Lunch Loop. I have had the wonderful opportunity to raise five golden retrievers. And my sixth one is on the way right now. But one of them in particular who carried my name, my official name from Scotland, Mac Taggart, had the name Mac. And unfortunately, I lost Mac a year ago. Mac saved my life. And that gives you a little indication of how important that bond is. I was running on the lunch loop at dawn. about three years ago. No, actually, it has to be longer than that, but it's because it was before I came here and I was on city council at the time. I hit a rock and fell off a cliff about 15 to 20 feet and hit my head. I was out, cold, I don't know for how long, and bleeding pretty badly from my head. I woke up to a golden retriever licking my face I don know quite honestly when people would have found me Because it unusual to fall off a cliff when you running Actually, a man I worked with for a long time who was president of Colorado Mesa University said to me, when I got out of the hospital, he said, you're not running without a helmet anymore. that bond, that dog waiting and licking my face was absolutely critical. So if that experience is anything to give you living proof of that bond, let's talk about this from the standpoint of the JBC. I spend a lot of time thinking about how Colorado delivers our services efficiently. and how we manage through our fiscal constraints. One of the lessons we see repeatedly is that many of the most effective and responsible interventions in public health happens upstream. Very simply put, the lifestyles that we choose to live have a great deal of impact on how our life is going to progress, how long potentially we're going to live, how healthy we're going to be through our lives. I think to a certain degree, other than the number of concussions that I've had in my life, I'm a bit of an indication of that, is that I'm still competing in my 70s. And I still get up every morning and go out and train in some way, shape, or form. And quite honestly, other than the injuries that I've created for myself, that being my knees and my head, I think I live a pretty healthy lifestyle. If we can help people stay healthy and stable before problems escalate into crisis, we reduce both human suffering and long-term costs. Long-term costs to our private insurance, which, as we know, goes up, and also to our taxpayers. Colorado already recognizes that health outcomes are influenced by factors outside of the health care system. Previous legislation on this subject, SB 21-181, recognizes social determinants such as housing, transportation, education, and social relationships, and how important they are as social determinants of health. These determinants shape whether people stay healthy or eventually require much more intensive and expensive interventions. This bill that we're presenting today, 1229, recognizes that human-animal bond can also influence health outcomes for many families. All families know, but about two-thirds of families across the state of Colorado have some animal that they bond with. Animals can affect daily routine Physical activity My first golden retriever that I loved his name was Nathan If I wasn't ready to go in the morning to run with him, he would go to the closet and put my running shoes in his mouth and bring them to me. Talk about a routine. so they can affect our routines our physical activity our social connection because we meet people all the time one that's right across from me who also loves golden retrievers that I talk with from time to time about retrievers and one to my right who has Labradors so we have a lot of retrievers around this group in some cases they also influence decisions that directly affect our health think about that for a second are we going to how might that help our lifestyle when we know we have not only our family depends on us but also our pets I want to address before I give this to Representative Foray one particular issue that I think is absolutely critical and you folks have an amendment in front of you on this particular subject. To make things absolutely clear, this amendment that we're providing you today explicitly states that this bill does not seek to change the allocation of funding under the Health Disparities Grant Program. We are not putting this animal bond in for the purpose of diluting the Health Disparities Grant Program. under any circumstances. And if you read through the amendment, which we'll talk about a little bit later, you will see that we as a General Assembly would have to create a bill for the purposes of additional dollars for the human-animal bond. So please, if you didn't hear anything I said, this does not take a dime from the health disparities grant program, and it was never intended to. But we wanted to do an amendment to make it absolutely clear that the only way this gets funded is that we in the General Assembly would have to create a bill with a totally new fund of some nature. And I can't tell you where that would come from today because that's not the purpose of today's bill. But please, I hope you understand that, that we aren't robbing Peter to pay Paul here. We are strictly saying that human-animal bonds are a very important part of our lives and have a direct impact on our long-term health. And I will turn it over now to Representative Foray. Representative Foray.

when I sat next to Rep Taggart my first year we bonded over dogs and showed pictures and it was really lovely. A lot of the conversation the past few days has been around what is social determinants of health and I've been thinking about that and I wanted to share a quick story which I feel a little nervous sharing but maybe gives some color is that when I was 18 and I was in the military I was in a very horrible relationship of a drunk abusive guy One night when he was drunk I tried to flee and I tried to take the dog with me As I was running out I got in the car and I tried to get the dog in but he caught the dog and ripped the dog out. And we got away and we obviously left that relationship and I have a great husband and a child now. But after that moment, I said to my dog, I would never allow for him to be hurt again, right? I felt very guilty that he was in that environment. I struggled afterwards to do basic things without that dog because I was very scared that he would be hurt again or I would be hurt again. And so when we were thinking of social determinants of health, for me to go places, I had him in my car. If I flew somewhere, I moved to Italy and I took him with me. When I would go to the store, he became an emotional support animal through the VA for 11 years we were together. And I think I would have struggled to do activities of daily living if I didn't have that partner with me and that animal bond. And so when we think of social determinants of health, that is the connection that I'm making. And so when he asked me to join this bill, that was my connection there. I appreciate you listening to my story on that, albeit very uncomfortable to share, it shows that human-animal bonds can make you live a healthy life, can save your life. And this is why I wanted to be on that bill, and I hope you'll support that with this amendment. I hope it mitigates some of your concerns around

Thank you, Madam Chair. No question. Just thank you both for sharing. That's not easy, so I really appreciate it. I'm sure all of us do. Thank you.

Thank you. Surprise. It's me. Thank you both for sharing your stories. In my past life as a school teacher and school principal, I had Habik dogs, human-animal bond, in classrooms. And so we would use Havoc Dogs to help kids learn how to monitor their feelings and how to give appropriate requests. And anyway, so there's so many good things about the human-animal bond. And I just, for clarification, after listening to your explanation and the amendment, boiled down to its most basic thing. is this bill being run just to allow for the language to be included so that grants can be applied for? Is that kind of where this is coming from?

Thank you, Madam Chair. No, it's not. This is strictly, this bill is strictly centered around that recognizing our human-animal bond is a social determinant for those of us that have those animals and that it can have a dramatic impact on our health longer term. Might there be a bill in the future for funding? The answer is yes, potentially. But this bill has nothing to do with funding for it is strictly an expansion of an additional social detergent.

Yes, thank you. So thank you for that clarification. It's including the language that is part of social determinants of health so that in the future that language can be used. And I'm just looking at the fiscal note where it has the state expenditures. It says this bill expands the types of grant proposals the CDPHE can consider when awarding funding goes on. So this is a first step in allowing for the state to apply for grants, or not the state for CDPHE to administer grants.

Rep. Frey? That's accurate. It's a step one, essentially.

Thank you, Madam Chair. I do have two questions, and thank you for sharing your stories. I'm wondering, have you talked with the local public health officials? They're showing that they're in opposition. I'm just curious if you know why.

Thank you, Representative Johnson. There were discussions that took place last evening and even before that, And one of their concerns was, was it, in their minds, a social determinant of health if it wasn't 100% to all Coloradans? And that's one of the reasons why I made the statement that two-thirds of our families do, in fact, have some type of an animal bond. But it's not 100%. So that was their concern. I think, secondly, that they potentially had a concern until we put out the amendment that said we are not going to take from the health disparities grant fund. And I can't stress that enough, that this is not a robbing Peter to pay Paul under any circumstances. The amendment is very clear that if we are to provide dollars for this particular social determinants, it's going to require a bill and a separate set of funding.

Thank you, Madam Chair, and thank you. My second question, and none of my concerns come from the financial aspect. I very much have a strong connection with my dog, went through a very tough depression when I was on chemo, understand how crucial she was to me, and that came through with the hospitals and the clinics. And they recognize that and they let her in. There are school systems that allow for different dogs. My big concern is why do we need to do a state umbrella definition when we already have these set definitions, whether it's living conditions. We see rental bills go through all the time whether a renter can have a dog or not in their buildings. Different hospitals and clinics allow for emotional or service animals or they don't. Some schools adapt to them, they don't. Some work environments adapt to them or they don't. I'm just worried if by putting this in a state definition, if we're going to force any of these clinics, hospitals, school districts at one point in the future saying that they have to accept these. as opposed to letting different areas choose if they want to or not with this human-animal bond.

Thank you Madam Chair Thanks for the question on that Sometimes it helpful to have a state definition to point to So if I as a nonprofit am creating a grant that talks about social determinants of health perhaps it could be helpful to have that state definition to point to, and now that it would include that human-animal bond component. I don't know if he wants to add anything onto that, but that would be my thought around having a state definition.

Thank you. And again, mine's not on the fiscal aspect. Like my concern is if we have a state definition and someone comes and calls for ADA compliance or workforce adapting now, if this is considered a health component and we have workforces or abilities or places that don't allow animals currently, are we opening up a hole in the future?

Thank you, Madam Chair, and thank you, Representative Johnson. The answer to that is no. We're not forcing on any institution that because of the fact that this gets added as a social determinant, that they have to have a rescue dog, that they have to have dogs. For instance, I'm going to train my next dog to be a therapy dog. But there's nothing in here that forces that whatsoever. It's just recognizing you made the statement. Senator Frey talked her story. Yeah, Senator. I'll take it. She'll be there. Myself. I mean, all of us that have had wonderful animal bonds have incredible stories. And what they do from a social determinant is significant. if you will let me tell one more story. I had to go to Europe for a considerable length of time for my career. I couldn't take my golden retriever that I had at the time, Nathan, my running partner with me, because I had to go through Great Britain and they were going to take the dog for quarantine. That was a long time. And I said, I'm not putting him through that. I left him with my mom and dad. My dad was quite a bit older at that point. When my mom came, when I came home to pick up my golden, my dad was in absolute tears. And I asked my mom, what happened? And she said, your dog got your dad out walking every single day he was here. And it improved his life. It improved his health. It allowed him to drop. You'd never know that my dad and I, facially, we look exactly the same. But he was 235 pounds. He was a hockey player. and I'm lucky if I'm 170. But I think he dropped 20 pounds while I was gone for six months and I have never seen the man happier, ever. And my mom said he's crying because the bond that he made. So we all have those stories that have had animals in our lives, but we're doing nothing in this bill that says you have to do X, Y, Z. under no circumstances. And quite honestly the folks that want those types of situations whether they be hospitals or workplaces or clinics are already doing it They already know this is an incredible bond They don need to tell us or we don need to tell them how important their bond is We're just recognizing in statute how important this bond is.

Thank you, Madam Chair. My question is very important for Representative Foray. we got Mac's name but we didn't get your dog's name. Please.

It would be Willie Tuncho.

Thank you Madam Chair and my dog's name is Ranger since we're all going that route and he's a Labrador and he's single. No I'm just kidding. I just worry A, I don't really understand why we need a bill to determine that so I'm trying to listen with open ears I'm wondering if it can be used in litigation or administrative proceedings to argue that denying pet access is a health related harm and I know that you're not thinking about the consequences while we talk about our furry animals so lovingly, but we are the six most regulated state, we are a Sioux happy state, and I worry about the consequences of this.

Thank you, Madam Chair. I'm trying to think how to answer that question because I don't believe we create it. And A, yes, it's a bill, but it's a simple modification of SB 188. 21 181 so it's it's really just inserting um that phrase and a definition uh of the human bond animal human bond so yes we have to do that because it's passed legislation so we can't we can't just do it in the form of an amendment but it's not real it's not a new concept in terms of social determinants the reason I can't answer the question on the legal front as we all know there's almost nothing we can do on statutes from time to time that isn't going to potential open a door that if somebody wants to sue they're going to sue I don't happen to think that's the case here but I couldn't give you an absolute that that couldn't happen at some point.

Thank you, Madam Chair, and I totally understand that. I don't think anyone knows what's going to happen in the state from day to day. My next question, I guess, would be if this were to pass, because you need this definition and statute to add to that previous bill, let's say that you do this and then somebody comes next year and wants to key this up for funding in another bill. What does funding look like in this space? Is that adopting animals?

Because the goal is not just to change the definition. The goal is to eventually get funding and have grant programs. So what does that look like? Representative Frank? Thank you, Madam Chair. So your question is step two. What would that look like? So if you were to have this in definition, we would have to run a bill. that would say we are allocating XYZ funding for specifically a human bond cause And perhaps it a nonprofit let say our local animal shelter that does pairings with veterans to help them with some of their work. That could be an example of working with a nonprofit that has that human-animal bond component. I'll give you another one, Animal Assisted Therapy of Colorado, which is in my district in Arvada. They also take Medicaid, which is great, but they do therapy with donkeys and horses and chickens and rabbits, and that helps with that human-animal bond processing through some of their trauma. So those are two examples of where that could go if we were to pass a second bill.

Thank you, Madam Chair. I love this idea conceptually just because I do think that these animals are huge protective factors. My question is, you know, social determinants of health are in other parts of statute and defined. And I know that because I do screeners with my clients with little check boxes asking some of the questions. The way I think you're intending this is it to be very narrow and specific just to this grant program. But is there intention to think of it in other areas of statute so there is one definition?

Thank you, Madam Chair. And thank you, Representative Ryden. And I think we should be open to that. We're not going to thrust that upon that into definitions and forms and things of that nature down the road. But I think we need to be open if somebody comes to us and says, you know, and the department CDPHE is here. and one of the things they asked me a couple of weeks ago, Rick, is this going to cause us to change some of our forms? And the answer is if it's appropriate and you think it's appropriate and you're going to be changing it for the future and you think this adds to health types of questions, absolutely. But there's nothing here that forces that under any circumstances.

Beautiful. My name is Dara Burwell, and I'm an anti-oppression and equity consultant in the nonprofit sector with a focus on health equity for the last 10 years. So does my time begin now? Beautiful. So, Madam Chair, members of the committee, thank you very much for hearing me today. I am here to oppose this bill because it dilutes the concept of social determinants of health and undercuts its equity basis. Social determinants are intended to focus public health attention and resources on structural inequities, particularly those rooted in longstanding systems of privilege and oppression. Broadening the definition to include the human-animal bond, a factor that is primarily individual and voluntary, diminishes the meaningful understanding of health equity and minimizes the central role that structural inequities and systems of oppression play in shaping health outcomes across populations. While the human-animal bond can be considered under the state's existing umbrella of social determinants of health, particularly social and community context, it does not and should not independently qualify as a social determinant of health by state definition. Equating the human-animal bond with the structural inequities and determinants obscures the profound difference in scale and impact between these categories. Social determinants of health fundamentally shape life expectancy, disease burdens, and population health disparities. the human-animal bond does not. And in fact, factors such as citizenship status, environmental exposure, and justice involvement, amongst many other things, have a much more profound and population-wide impact on health. Yet they are not classified as independent social determinants of health by the state. Programs intended to address foundational societal barriers should not be further deprioritized and undermined. While this proposal seems innocuous in many ways, I propose that it is not. In our country, we are facing massive attacks on equity and health equity, and while this bill is not overt in its attacks, I would say it is a covert attack that erases the realities of injustice and undermines communities of color and working class people and a range of other oppressed communities. Thank you so much for your testimony.

Thank you, Madam Chair, members of the committee. My name is Anna Stout, and I serve as the executive director of Align Care Health, a national nonprofit organization focused on the intersection of human health and animal health. We began as a pilot program working directly with pet families, human service providers, and veterinary professionals. And through that work, we saw how the human-animal bond can directly influence people's physical health, emotional well-being, and daily routines. We also saw that human and public health systems often overlook the role of pets in influencing human health or perceive it as separate from it that misalignment can be consequential for the health of thousands of pet families in Colorado And our work informed the approach that you considering in the bill before you today. Social determinants of health are the non-medical conditions in which people live that influence their health and well-being and are defined by whether they measurably influence health outcomes across populations. We saw how the human-animal bond functions the way many other social determinants of health do in the lives of the families we worked with. The social determinants of health framework has evolved over time as research has identified new drivers of health outcomes outside the health care system. Originally, social determinants focused primarily on housing, food, and employment. Over time, it expanded to include factors now recognized in Colorado law, such as transportation, social relationships, and education. These were added because evidence showed they shape health outcomes in meaningful ways. The same logic applies here to the human-animal bond. Research shows that living with animals is associated with increased physical activity, improved mobility, reduced loneliness, improved mental health, and stronger daily routines. For example, studies show that people who walk their dogs are significantly more likely to meet recommended physical activity guidelines. Interaction with pets has shown to reduce stress and improve emotional regulation. And in many cases, caring for an animal creates the daily structure and routine that helps people maintain their own health habits. At the same time, the human-animal bond can also shape how other social determinants of health operate in people's lives. Public health frameworks evolve as we learn more about what shapes health outcomes. Recognizing the human-animal bond and the science-based research that backs the value of the bond on health is part of that evolution.

Thank you so much, committee members, and thank you to the sponsors for introducing this bill. My name is Sabrina Pacha. I'm the state legislative director for the ASPCA, and we are urging a yes vote on this bill. A pillarstone of the ASPCA's work focuses on keeping people and pets together by providing low-cost vet services, finding pet-friendly housing, and supporting shelters across the country. Through this work, we've seen firsthand that the human-animal bond is truly not just a benefit to the pet. There are very significant public health benefits that we've seen that this human-animal bond promotes. And really everyone, regardless of socioeconomic status, deserves these types of health benefits. Most of us know from our personal lives that pets make us healthier and happier, except for the occasional moments that you might come home to an accident, or maybe that's just my dog who goes through the trash sometimes. But beyond just our personal experiences, research backs up this claim. And there's some pretty incredible findings about these health benefits. Studies show that people with pets report higher levels of physical activity. They have lower blood pressure, cholesterol, and triglyceride levels. And actually 60% of dog owners meet the recommended weekly amount of exercise, which I just think is so fascinating. CDPHE cites that the social determinants of health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems that are shaping the conditions of life. This bill doesn't distract from the many factors that are critical when considering the social determinants of health. It's just adding a well-researched and documented factor that is proven to improve health outcomes that the state should consider when it is relevant. We should be using all the tools in the toolbox when it comes to improving health outcomes, and that's exactly what this bill does. So we urge a yes vote, and thank you again for your time.

Representative Johnson. Thank you, Madam Chair. My question is for Ms Dora Dora Dora Well Sorry Yeah When looking at you know when you looking at the social cues and what helping I think you know of some of the oppressed would be the IDD community a lot of which have physical ailments that they would need an animal to help boost them up. So just based on your testimony, would you not say that would be something that would help them in their social and economic status if they have access if needed? Because that is a barrier. They can't get the animals per a physical or a mental support system.

Great. So the question here is not, I think, whether or not the human-animal bond can support health. The fundamental question is to whether or not it should be determined as one of the sixth category of the state classification of social determinants of health. Absolutely. There are ways that support animals are critical, right, to folks with disabilities, right, and to other populations. One of the things that was testified to was even in terms of the role that it can play as it relates to intimate partner violence, there's research relating to that. That is not what I am objecting to. What I am objecting to is this being placed on the scale of things like health care access, education, housing, that are truly population-wide, and the level of impact for all oppressed communities is significantly higher bar than human-animal bond. It is a factor, but it is not up here. The scales, the level of impact are completely and totally different. So when I talk about things like citizenship status, the population-wide impact of that on health is so dramatically more impactful than the human-animal bond. So are environmental contaminants. Quite frankly, so is digital access. Those are not being defined at the state level as the primary social determinants of health. This, I think, needs additional attention. I think this is the wrong way to go about doing that. And I think that it can be further resourced under the existing standard of social and community context for folks with disabilities and for other marginalized communities, including folks who are experiencing homelessness.

Thank you, Madam Chair and members of the committee. My name is Ana León, and I represent Humane Colorado. Thank you for the opportunity to speak and support House Bill 1229 I the Pet Assist Program at Humane Colorado a safety net program that provides temporary care for pets whose owners are currently struggling with housing insecurity, domestic violence, and mental or physical health crises. Last year, we helped 264 pets across Colorado and reunited 80% of them with their owners. Here are a couple of quotes from people we felt through the Pet Assist Program that I hope will prompt you to also support including the human-animal bond as a social determinant of health. When I made the terrifying decision to escape domestic violence, my little girl and I looked everything familiar. Our home, sense of financial security, and the only life she had ever known. Amid all the fear and uncertainty, the thought of what might happen to our cats weighed heavily on me, so much so that it nearly kept me from leaving. They are more than just cats, They're four-legged family members. Then the Pet Assist program took in our two cats and provided them with loving care while we found our footing and began to rebuild our lives. Every update we received was a bomb to our broken spirits, knowing that they were safe. Another person said, and that everything is I am lost without my dog and want to be able to have him in my life again. Stories like these remind us that pets are often a lifeline for people. They bring joy, motivation, companionship, and stability. Families make decisions about their own welfare based on the safety and well-being of their pets. I see the mutually beneficial impact of the human-animal bond every day, and that's why I'm asking for your support on House Bill 1229. Thank you once again for the opportunity to speak and support Bill 1229. Happy to answer any questions.

Thank you. Good afternoon, Madam Chair and members of the committee. My name is Jordan Beasley. I'm the Deputy Commissioner of External Affairs at the Colorado Department of Agriculture. I'm here today to testify in support of House Bill 1229, a bill that recognizes the bond between humans and animals, that the bond between humans and animals is a vital pillar of public health. The department houses the Division of Animal Welfare and the Animal Health Division overseen by the state veterinarian. Through our work, we know the positive impact the connection between humans and their animals has on overall well-being. Research consistently shows that the human-animal bond reduces cortisol levels, lowers blood pressure, and positively impacts behavioral and mental health. By adding the human-animal bond to the statutory definition of social determinants of health, we are acknowledging that a person's well-being is not just about the roof over their head or the food on their plate. It's also about the emotional support systems that keep them resilient. This bill recognizes the importance of innovative community-led solutions that leverage the human-animal bond to increase health outcomes. House Bill 1229 is a common sense step towards a more holistic and compassionate health care framework. I urge your yes vote today. Thank you for your time.

Thank you, chair and members of the committee. My name is Mandy Zuger. I'm working as a mental health therapist at Animal Assisted Therapy Programs of Colorado, a nonprofit organization working mainly with low-income clients and clients across the lifespan. I am testifying in support of Bill 1229. In my clinical work, I regularly see how the human-animal bond influences emotional regulation, resilience, and overall quality of life for my clients. One of my clients is a young man who survived severe childhood abuse. and domestic violence. He described growing up in a home where beer bottles were thrown at him as early as the age of three. When he reflects on those memories, he does not only talk about the violence, he talks about the animals in the home who stayed close to him during those chaotic moments. He described how they would remain near him when things became frightening and how his dog's presence helped him calm his body. He also described caring for them, protecting them, holding them, and finding moments where both he and the animal were seeking safety together in an unpredictable environment. In many ways, that relationship created a condition where resilience could develop. The presence of that companion animal buffered the impact of trauma. Without that bond, his experience of childhood adversity and his long-term well-being may have looked very different. For him, that relationship improved his overall quality of life and helped him endure circumstances that were otherwise unsafe. Another client, a middle-aged woman living with chronic pain and significant isolation has developed a deep bond with her cat. She often describes how her cat senses when her pain or anxiety increases. Her cat will climb onto her stomach and settle there. In those moments, she experiences not only comfort, but a shared state of calm, both of them resting together as her body begins to regulate. For this client, the human-animal bond is not simply companionship. It directly influences her daily functioning, routine, and quality of life. Without that relationship, her physical and mental health would likely deteriorate due to isolation and the challenges of chronic illness. Recognizing the human-animal bond as a social determinant of health acknowledges something many therapists already see every single day, that these relationships are life-enhancing resources that can influence both the quality and length of a human life. Thank you. Thank you for your testimony. We'll move on to Shelley Fisher.

Perfect. So sorry. My name is Shelley Fisher and I represent Animal Assisted Services. I am in support of Bill 1229. First, as you can imagine, when I enter a hospital, I talk with patients every single day about an animal that's beloved to them. I was even able to participate in a research study where we targeted mild to moderate patients with anxiety in the emergency department, where we were able to then meet with them for 20 minutes. The simple 20 minutes actually prevented them from being given medication that day in the emergency room. What I want to share, though, is that the bond, the reach of their bond is so great in that even another dog, might not even be their dog, can create a bond and can create an impact. When I have dogs or puppies with me in the hospital, physicians, nurses will see animals, and it provides that mind shift. Maybe they're having a really hard day or something is going on with them or a different patient. It provides that mind shift, a different outlook. I want to leave you with one last story. He was a patient in the burn unit. Imagine being burned, the entire pieces of your legs being burned on the front part. The only thing that he was really worried about was his dog Lady who was a 10 pity who was with him for so so long After being able to help him find a secure home for her while he was in the hospital, his anxiety went down. He was able to do the things necessary for his health. So I see these pieces of people's lives and I understand the bond and I am in full support of this bill.

Hello, Madam Chair and members of the committee, and thank you for your time today. I'm testifying today in support of House Bill 1229 to include the hemo bond as a social determinative health in the Colorado State statute. My name is Sloane Hawes and I am a resident of Milken in Weld County, Colorado. A few details on my background that inform my testimony today. I was born and raised in Colorado and earned my Master's of Social Work from the University of Denver. I serve on my local Board of Commissioners for the Housing Authority. I'm a member of the Leadership Committee for the Public Health Social Work section of the American Public Health Association. And I'm the Chief of Research and Development for a nonprofit organization, Campaigns to Analyst for Reform and Equity. All of this to say, I'm a Colorado resident who is deeply committed both in my personal and professional roles to advancing the health and wellbeing of my community, both the people and the pets they call family. Across these various roles, one thing has consistently emerged, how integral access to the human bond, particularly pet ownership is for the health and wellbeing of most of Colorado's most vulnerable populations. Many of you may be familiar with the research that has demonstrated a positive relationship between pet ownership and human health outcomes, but you may not be as familiar with the growing area research that focuses on how pet ownership exposes pet owners to harmful systemic issues, including exposure to the criminal justice system and prolonged housing insecurity. Today I want to share briefly some of the research we have been conducting here in Colorado that specifically addresses the opposition's belief that access to the human bond is not a systemic issue driving health disparities. In collaboration with the University of Denver, we have been conducting participatory research with unhoused young people attempting to access one of the most foundational social determinants of health, housing. The participants spoke about the need for a paradigm shift from forcing individuals to make an impossible choice between housing and their pets, to creating policies that recognize how central the human bond is to their ability to access the systems that promote their health and wellbeing. These unhoused young people share stories demonstrating their grit and determination to overcoming numerous barriers to preserving their health and wellbeing. But what we consistently see and experience is that access to the established social determinants of health, like housing, healthcare, and economic stability is predicated on the extent to which those systems acknowledge and preserve the humanoid bond. This bill would position Colorado as a leader for a growing movement to advance health equity for vulnerable populations. Therefore, I urge you to vote in support of House Bill 1229 today. Thank you.

This is more of just a comment, Madam Chair. I just want to shout out University of Denver for all their work in this space. Thank you.

actually would you like to move your amendment and then describe it please sure i move L001 to House Bill 1229 Second Seconded by Representative Hamrick Representative Frey would like to explain

Representative Frey. Thank you, Madam Chair. So we did discuss this earlier in our presentation around the concern of depleting some of the funds and needing another bill to allocate such funds. So this amendment is intended to tackle that, And I know we worked with Rep. McCormick and some of her concerns on hopefully addressing what she was concerned about. So this is subject to additional appropriations, which Representative Taggart talked about, that hopefully will help ease some concerns around accessing the grant money and having that step two option in this bill.

Thank you, Madam Chair, and thank you all for listening to my concerns. Many of my concerns were similar to what we heard from the witness that testified against the bill earlier. You know that my entire career was built on the human-animal bond, so there's no argument on that. I did want to ask a further question I failed to ask Representative Taggart earlier on this amendment. The health disparities grant program, that line item in the budget, has it been cut? Is it whatever the word is where it's always funded? Could you tell me a little bit more about that? And I just wanted to reiterate what you've said, is that if this definition in the bill with this amendment, it would require a whole new bill to be worked through the entire General Assembly to say we want this amount of money to be used for this particular, these organizations can apply for this grant money, where it would be separate from the currently defined health disparities grant program so that there would be no dilution happening. So first is what's happening with the grant fund right now? Is it cut? And I just want to make sure that I read your amendment, and I thank you very, very much for listening to my concerns.

Thank you, Madam Chair, and thank you, Representative McCormick. to take you through where the health disparities grant program is today. Last year, $200,000 was taken from that cash fund, which I hope everybody realizes those dollars come from the tobacco settlement dollars. I think Amendment 35 and, no, excuse me, it's not Amendment 35, but in any case, the tobacco settlement. This year, again, there's discussion about that fund. Final determination has not been made. I would like to see it stay whole, but I'm just one of six members of the JBC. So I think you probably know that the tobacco settlement dollars, and that why this does not belong in that fund to take away from that fund is those dollars are coming down on an annual basis just largely because we seeing a decrease thank goodness in the use of tobacco products but we have, I believe, propped it up in the last couple of years with some general fund. I can't recall whether there was a request for that to prop that fund up again this year, but I can get you that information. I just don't have that off the top of my head.

Well, thank you, Madam Chair. Thank you, Representative Taggart, for that background. also you may or may not know the answer to this question but the fund itself, the grant program from my understanding it's already oversubscribed there's more need than there are dollars as with anything that we look at in the budget and so again I appreciate you bringing forth this amendment because the program as is already can't meet the need And it's just really important that we don't dilute that until some magical day in the future where we have enough money for all these things. So thank you.

Representative Frey. Thank you, Madam Chair. I appreciate all the people that came to testify. I appreciate the thoughtful questions. We wish that we had money to fund all the things, but we can't. And so this amendment, I think, is a fair compromise. And I think it really brings the bill together and puts it in the right place. I hope you vote yes.

Thank you, Madam Chair. I'd like to make my last comments about the human-animal bond from an intervention standpoint. I have had the opportunity, not only here in the state legislature, but prior to this, to be involved in interventions with children with autism, because I have a grandson that's autistic. and children that have IDD. And if you're ever in a room with a dog, or a cat for that matter, but mine has been primarily around dogs, but my wife will tell you that our cat fell in love with me very early on, and I don't know why, slept on my chest first thing in the mornings. But be that as it may, to watch a child that is not blessed with everything that we have, to watch the joy in their eyes for a few moments while they look at you and say, can I touch your dog? Can I pat his head? And to watch that dog wag its tail in that intervention to give joy to a life that's not as joyous as certainly my life has been and my children's lives have been, but to watch that joy in their eyes for a few moments and not to say that that isn't a social determinant of health, I just can't imagine that. That is joy that those kids remember for a very long time and they leave you with the question, when can you bring back Mac? They don't ask when you're coming back again. When can you bring back Mac? That's, to me, a social determinant of health.

Thank you, Madam Chair. I move House Bill 1229 as amended to the committee of the whole with a favorable recommendation.

Representative Hamrick seconds.

Thanks, Madam Chair. I just want to thank you two for bringing this bill. I so appreciate you lifting up the real importance of the human-animal bond. My daughter-in-law is at the University of Denver studying animal sentience and DU is a real leader in this field. So I'll be enthusiastic, yes.

Thank you, Madam Chair. I think there are many people in this room who have a similar connection as you both have, and my family is no exception. So I appreciate you bringing this bill, and I want to be enthusiastic, yes.

Thank you, Madam Chair. Again, thank you both. You kind of had me at golden retriever, but I do appreciate the further work that you did. So it should be the Mac and Willie. Chancho. Chancho, Bill.

Vice Chair Leader. Hey, thanks for bringing this. I know what animals mean to a lot of people, and they are part of their family, And I've seen within my own family how they've helped them move forward with a lot of issues like you are speaking with. So I will definitely be a yes, this is a good bill.

Thank you, Madam Chair. And thank you, sponsors, for bringing this. For me, it's not a question of the human-animal bond. I believe in that fully. I believe in treating mental health and physical health the same. I have Peaches here today, which I just wanted to say on the mic, it's her seventh birthday. but my real angst with this bill is where does this definition lead? Where can it be used next? We see a lot of things in this building and that's what scares me is how can this be used next? We already see where the implications are. It's working great in the private sector and our local communities and that's just where my concern is so I will be respectful no but I do appreciate and understand fully the human-animal connection.

Representative Spudfield. Yes. Bradley. Respectfully no English is excused Yes Garcia Respectfully yes Hamrick Yes Johnson No McCormick Yes. Wrighton? Yes. Stewart? Yes. Wook? Excused. Leader? Yes. Adam Ture? Yes.

Thank you, Madam Chair, and thank you some of the Health and Human Services Committee for being here. I'm just going to make the joke anyway since we've got time. I was going to say welcome to part two of the House of Stewart show. yeah because we're doing another bill together so part two of season two of House of Stewart yeah thank you all for hearing this oh my gosh we started so we should keep going okay alright thank you all

I represent Durango and much of southwest Colorado and this issue first came to my attention after a constituent contacted my office because they were no longer able to get medications they had previously received from a pharmacy in Texas. These were medications they had relied on for some time, and when that access suddenly stopped, they reached out asking what had changed. As we started looking into it, we learned that many patients rely on medications that have to be specially prepared by pharmacists to meet individual patient needs. This is a longstanding and well-regulated part of pharmacy practice. Medications like children's medicines that have to be prepared in liquid form so they can be taken safely, or concentrated albuterol used for certain respiratory treatments in children, firefighters, and people with lung disease are commonly prepared this way under the oversight of federal law, state law, and the Colorado Board of Pharmacy. What has changed recently is not the practice itself, but what's happening around it. Pharmaceutical manufacturers have begun filing lawsuits in different states that question whether medications prepared by pharmacists fit within state law and thus threatening the fate of compounding pharmacies across the country. When that kind of uncertainty starts to appear, pharmacies, hospitals, and providers often pull back simply to avoid risk. We are already seeing that happen in parts of the country, and it can quickly affect whether patients are able to keep receiving medications they have relied on for years. House Bill 1262 is intended to address that problem by making clear in Colorado law what has long been understood in pharmacy practice that medications specially prepared by pharmacists when done in compliance with federal and state law are a legitimate and regulated part of patient care At a high level, this billed us three things. First, it clarifies Colorado statute that medications properly prepared by pharmacists under existing federal and state law remain a part of patient care. Second, it reinforces that those practices continue to operate under the oversight of of the Colorado Board of Pharmacy and existing safety standards. And third, it helps ensure that patients, providers, and pharmacists all have a clear understanding of how those longstanding practices fit within Colorado law. Representative Stewart and I have spent months talking with stakeholders about this bill, and before the proponents highlighted the problem over a year ago, over the past several months we've held many stakeholder meetings and have taken feedback from stakeholders representing nearly every corner of the healthcare industry in Colorado. We feel this bill represents a well-rounded compromise, and I'm incredibly proud of all the work that we have done with the stakeholders. And I will pass it over to my co-prime. Representative R. Stewart. Thank you, Madam Chair. Thank you to the committee and to my wonderful co-prime, the other half of the House of Stewart. As many of you know, I am a board-certified music therapist, and much of my training and professional work has taken place in clinical healthcare settings where providers work together to support patients. In those environments, it becomes incredibly clear how many different parts of the healthcare system work together to make sure that patients receive the care that they need and access to the medications their care teams rely on is a really important part of this system. There are many situations where medications need to be prepared in ways that meet the specific requirements of a patient. This can include things like children who need medications in liquid form, patients who are receiving hormone therapies or medications prepared for residents in long-term care, or hospice and palliative care settings. These are real situations across the healthcare system where customized medications help to support treatment. In the clinical settings where I have worked, it is really clear how interconnected the healthcare system really is. Providers rely on pharmacists to safely prepare medications to meet their patients' needs, and those preparations must take place within established safety standards and regulatory oversight. Lawsuits like the one my co-prime mentioned can create real uncertainty within the healthcare system and ultimately affect whether or not patients are able to continue receiving the treatment that they all rely on. Compounding is also not limited to just one type of patient or one corner of the health care system. As you'll hear today, it supports care in many different settings, from pediatric to long-term care, from respiratory treatments to hormone therapies. The pharmacists and providers who work in these settings rely on a system that is already regulated and focused on patient safety. House Bill 1262 helps provide the clarity needed so that this long-standing and regulated part of patient care can continue. Ultimately, the goal is simple. We want to make sure that patients across Colorado can continue receiving the care and the medications that their teams depend on as a part of a safe and effective treatment. This bill is about maintaining access and affordability of health care and medications. Rep Stewart mentioned all of the time that we've spent engaging with stakeholders, And I do think that it's important to note that this bill is supported by 19 different organizations here in Colorado, including the Alliance for Pharmacy Compounding, Banner Health, Walmart Pharma Solutions, the Colorado Association of Nurse Anesthetists, the Colorado Association of Family Physicians, the Colorado Medical Society, Children's Hospital of Colorado, Clear Spring Pharmacy, the Colorado Dental Association, the Colorado Hospital Association, the Colorado Pharmacist Society, the Colorado Rural Health Center, Common Spirit, Hims and Hers Health, Home Health and Hospice Association of Colorado, Leading Age Colorado, the Outsourcing Facilities Association, RX Plus Pharmacies, and the University of Colorado Health. Thank you all for your time. We're happy to answer any questions. Thanks.

Representative Johnson. Thank you, Madam Chair. And permission to dialogue with the sponsors because I have quite a few questions.

Thank you. Thank you, Representative Stewart Squared. Appreciate you being here. It's not round two. It's squared. I do have a few questions as I look at it. We will start with the obvious that I always bring is the safety clause. We saw that the federal level just approved 26 compounding medications recently, and we're seeing a lot of movement and momentum at the federal level. So I have burdened. Yes, I do love petitions, but I also have legitimate burden on patient access and care. Also, with this, if we're having so many things move at the federal level, you mentioned we have a lot of things moving at the states. why do we surpass this so fast and not allow for any of that 90-day review that typically happens? Should something come down again at the federal level, which looking through this and communicating with some Congress members, we're expecting more to come. And I would hate that we wouldn't have that 90-day review and then have to come back to a special to fix something. And this really puts me at why do we have to push with the safety clause first. And we are in conversation.

Thank you, Madam Chair. Thank you, Representative Johnson, for the question. And I'll go back to my opening testimony when I talked about a constituent that reached out to me about losing access to our medication. That was acute. That happened a year ago. But I'd also like to bring to the committee's attention that since 2022, almost 30 lawsuits have been filed across the country in regards to compounded medications. so to not have a safety clause puts access at risk for not only Coloradans but people across the country.

Thank you, Representative Johnson, for the question.

Correct. No, my question is they are both in here. But if we're looking at clarity, why not call it a 503A instead of using other terminology? That really does put out lack of clarity. It seems misleading. So would you be amendable to adding 503A specific if the short title says clarity Should we not be clear that this is a 503A Representative R Stewart Thank you Madam Chair and thank you Representative Johnson for the question

as we were drafting in this process to just ensure that that would not do anything to the content of the bill. Um, of course, if, if it does not, uh, do anything to change the meaning, um, or the applicability of the bill, I think conversations like that we're always open to, but I would encourage you to ask some of our subject matter experts before we go drafting this on the fly during questions.

Representative K. Stewart.

Okay, and then let's let other committee members. Hi. So I do have two more questions. You're saying with the Board of Pharmacy, because they have a lot of rules authority right now, and I know the conversations last year, even early this year, was saying we don't want to put this in statute because everything's moving, but now we want to add into statute. so my concern when we're looking at all this is as soon as it's in statute we're up for lawsuit if we do something against the federal level would you be open to a non-severability clause or a severability clause should something happen when we're out of session because I am so worried that if we're going to keep a safety clause if we're going to push this through federal level just came down again with new things we're going to hear new things what is the assurance that we're not coming back here because we've meddled in something that is moving right now and we're back

Johnson, for the question. I guess I can't speak for my co-prime, but I would not be interested in non or severability whichever way it works This is not this is clarifying what is already practiced in the state of Colorado that the FDA oversees at the federal level and the Colorado Board of Pharmacies oversees at the state level. That's what we're doing with this bill. And I would be worried that adding that type of clause would put compounding pharmacies at a great risk to be able to provide patient care across the state. And again, not just in the state of Colorado. What happens here in Colorado impacts everybody in the country. We are the only state that compounds concentrated albuterol. So this impacts every state in the country. And so we are wanting to outline that right now. And I would not want to risk that with the type of clause that could upend that.

Yes, there is.

Is there a way to rein in which kind of compounding we're doing?

Representative Kay Stewart.

Questions from additional members of the committee?

Representative K-Stor.

Representative Garcia-Sander.

Representative R. Stewart.

Thank you. So just for clarity, it will mirror FDA's regulations, so if FDA changes again, this bill stipulates that ours will continue to align with federal. And then can I ask one last question?

Thank you. Will these requirements affect the ability of smaller or rural pharmacies to provide compounded medications?

Thank you, Madam Chair, and thank you for the question. This will protect their ability to continue to provide those medications. Yes, thank you.

We can. Good afternoon, Chair and members of the committee. My name is Mark Wagner, and I'm a pharmacist attorney speaking as outside counsel on behalf of the Outsourcing Facilities Association, which represents FDA-registered outsourcing facilities that compound medications for hospitals, pharmacies, clinics, and health systems across the country. I note that I'd be happy to answer questions as to why there's no specific mention of 503A if posed after my statement. We strongly support hospital 1262 because it provides something the health care system urgently needs, clarity and alignment with federal law, while protecting patient access to compounded medications. This bill specifically provides for lawful compounding under sections 503A and 503B of the federal act. Those gray market suppliers who are not regulated that Representative Johnson mentioned previously would be prohibited under this bill. Every day, hospitals, providers, pharmacies, and patients rely on medications prepared by FDA-registered outsourcing facilities. These facilities operate under rigorous FDA and State Board of Pharmacy oversight. They're inspected by the FDA and follow current good manufacturing practices, the same quality standard as conventional drug manufacturers. These facilities serve as a critical supply partner for health systems and pharmacies nationwide. House Bill 1262 recognizes that reality. It clarifies that FDA-registered outsourcing facilities operating in compliance with federal and state law may supply compounded medications to licensed providers and facilities in Colorado and roots out unregulated suppliers. It also ensures that state regulations remain aligned with federal standards, avoiding duplicative or conflicting requirements that could conflict or disrupt the supply of essential medications. This alignment is particularly important as large manufacturers pursue litigation against compounders that help supply medications during drug shortages. This bill is coming in response to border pharmacy complaints and more than 200 lawsuits we've seen filed by large manufacturers against compounders. For these reasons, the Outsourcing Facilities Association respectfully urges support for House Bill 1262. Thank you for your time and consideration.

Thank you, Madam Chair of the Committee. My name is Mark Speaker. I'm the co-founder and president at Stack Pharma, a 503B outsourcing facility. Separately, I've been involved in the community in Denver for many years. I'm the former chair of the Colorado Bioscience Association, the former chair of the Denver Chamber of Commerce, current board member of the Denver Museum of Nature and Science, and current board member of the Food Bank of the Rockies. We founded Stack Pharma specifically in the state of Colorado, in the Denver area, in the Montbello neighborhood, to provide a 503B outsourcing facility here in Colorado to support our patients here in the Colorado area as well as across the country. We are unique in that we're owned by hospitals. We have 12 major hospital systems that came together, invested to be able to bring our company into the light, to be able to provide these compounded medications in time of shortage, as well as in times where it's just a struggle for them to be able to compound these in-house. Some of the unique products that we compound that many of you have heard of already, concentrated albuterol. We are the sole source provider of 500,000 doses of concentrated albuterol that have been provided to 78 children's hospitals across the country, as well as multiple adult hospitals. We also compounded concentrated electrolytes, which is the base material used in making TPNs or essentially liquid nutrition for folks who are not able to eat solid food and rely on liquid nutrition or TPNs, total parental nutrition. During a time of shortage in 2023, we compounded and we were responsible for 770,000 doses of that being provided, which meant 770,000 patients that were able to meet their nutrition needs at home as opposed to in a hospital. We also are the sole source provider of a drug called Desmopressin, which is a nasal spray for hemophilia patients with 32 doses for a patient population of 20 people who are able to take essentially a nose spray of this product as opposed to having to go into a hospital to get an infusion to be able to get a dental procedure or to be able to stop a bleeding event that they having. We also have a host of other new products that we're launching that will allow rural hospitals such as a drug called methotrexate used for ectopic pregnancies that treats the patient at the point of care at the moment where the event is happening as opposed to them having to be shipped off to a larger hospital system outside of a rural or a community area or a

Hi, Chair and members of the committee. Thank you for the opportunity to testify in support of House Bill 1262, the Colorado Patient Access and Compounding Clarity Act. My name is Kristen Youngdahl, and I am a compounding pharmacist and the Chief Operating Officer of Belmar, a Colorado-based pharmacy that operates both 503A and 503B outsourcing facilities. We are allowing us to serve individual patients as well as health care providers across the state in full compliance with federal and state law. Compounding is essential to women's health, particularly across the continuum of fertility care, postpartum recovery, perimenopause, and menopause. These are clinical areas where patients are often required individualized dosing, customized formulations, and alternative delivery methods that are simply not available in FDA-approved mass-manufactured drugs. For patients undergoing fertility treatment, compounded medications allow physicians to tailor therapy to support outcomes and tolerability. After childbirth, compounded therapies support postpartum recovery when standard options are limited. And for women navigating perimenopause and menopause, customized hormone replacement therapy is often critical to safely managing symptoms and maintaining quality of life. Belmar employs 279 Colorado citizens, works with more than 2,000 Colorado physicians, and serves approximately 16,000 patients statewide who rely on individualized therapy, particularly compounded hormone replacement therapy. Last year alone, we compounded more than 20,000 patient-specific formulations, each prepared pursuant to a valid prescription and clinical need. House Bill 1262 protects this access while maintaining strong oversight. It aligns Colorado law with existing FDA standards, reinforces that compounding is performed by licensed professionals, and prevents unnecessary regulatory duplication that can disrupt patient care without improving safety. This bill provides clarity, not deregulation, and helps ensure Colorado women continue to have access to personalized care that they need.

Thank you, Madam Chair. Thank you, committee. I am Kai Davis. I am the pharmacist at Harris Pharmacy in Rocky Ford, Colorado, and I am the chair of the RX Plus Legislative Committee. RX Plus is the largest group of independent pharmacies in Colorado. We hear a lot of talk about GLP-1s and everything, and I just want to be clear that I don't have any vested interest in that at all. My pharmacy doesn't compound them in any way, but we do maintain our compounding pharmacy status as a service to our community. We do very simple compounds like numbing, coating mouthwash, magic mouthwash. It not complicated at all but it a godsend for patients undergoing radiation for oral and throat cancers We the only pharmacy in Rocky Ford and after more closures we one of only three in Otero County now Without our compounding my patients would have to make a two-hour drive when they're going through one of the hardest ordeals of their life. About once a decade or so, I get a baby with a heart issue that needs some serious heart meds, the kinds that they only make for adults, especially compounded into a liquid formulation. It's happened twice in my 19 years here, and believe me when I tell you financially, it's a losing proposition. But I'm committed to maintaining my ability to help those families that are going through something I can't even comprehend. It's gotten increasingly difficult to remain a compounding pharmacy. Over the years, the FDA and the Board of Pharmacy have increased regulations to the point that many pharmacies just opt out of that. I understand where they're coming from. I understand why those regulations are in place for safety. But it has made it harder to get compounding in rural areas in particular. And that's why I wanted to applaud Rep. Stewart and Stewart and Senator Ball for protecting Colorado access to compounding. I'd encourage a yes vote on 1262. Thank you. Sorry. Thank you for your testimony.

Thank you, Madam Chair. My question is for Dr. Youngdahl. I'm curious to know, I know that we've heard that this bill codifies existing practice with the Board of Pharmacy and what the FDA is already doing. It also prevents the board from adopting any policies that might be more restrictive than state and federal law. Can you speak a little bit more about why we would want to prevent that from happening to make policies more restrictive? And just tell us a little bit more about why we are doing that at this point in time?

Sure. So the Board of Pharmacy and the FDA have two distinct roles with compounding. So the Board of Pharmacy is really in the day-to-day for pharmacy practice. So they understand how compounding works between patients and providers. However, they don't have the expertise in setting specific compounding rules and regulations. So the FDA has teams that are specific towards compounding.

It was mine. We actually collaborated together. We weren't sure which of us was going to be available. So appreciate the efficiency.

Okay. Thank you. Good afternoon. Good afternoon, Chair and members of the committee. My name is Bridget Frazier with the Colorado Hospital Association. We represent over 100 hospitals and health systems across our state. CHA supports House Bill 26-1262. We want to thank Representatives Katie and Rebecca Stewart for their leadership on this issue. Compounding is an essential to personalized patient care. Unlike a one-size-fits-all approach, compounded medications are custom-made to provide the appropriate strength and composition for each individual patient. That means reformulating medications, adjusting dosages, combining drugs, or removing allergens, customized to what each individual patient actually needs. Hospitals rely on compounded medications every day to care for patients. Asthma patients may need inhaled medications at concentrations not commercially available. Cancer patients often require chemotherapy that must be precisely compounded based on weight and organ function, patients with allergies to have inactive ingredients and standard medications rely on customized formulations. And drug shortages, a documented ongoing challenge, require compounding to maintain continuity of care for patients who cannot simply wait for supply chains to recover. Our ability to compound medications allows us to step in to ensure safe and effective treatment while adhering to strict regulations that maintain the highest standards of patient safety and quality. Colorado hospitals and their pharmacy partners operate under robust federal oversight and quality standards and state licensure requirements. The Board of Pharmacy conducts annual inspections of compounding pharmacies to ensure those standards and safety regulations are being followed. House Bill 1262 does not weaken any of those safeguards but simply aligns Colorado statute with federal framework that already governs. By doing so, it removes unnecessary regulatory duplication that can create barriers to patient access without improving safety. At the end of the day, this is about patients and making sure they get the right medication in the right form at the right time. This bill supports that mission. We thank you for your yes vote on this bill and for your time and consideration today. Thank you so much for your testimony.

No.

This is Rep. R. Stewart.

Thank you, Madam Chair. Thank you, committee. I will be brief. Thank you to so many folks who came out and testified in support. I hope that was helpful in answering some of the questions from our committee. This bill, again, is about ensuring that there is clarity about who is in charge of regulating compounding in the state of Colorado and ensuring that continuity of care, patient access, and the you know access to affordable pharmaceutical and compounded medications that we enjoy here in the state and ensuring that we are protecting compounding here in Colorado that actually affects the rest of the country It is incredibly crucial, and I thank you all so much for your attention and would ask for your aye vote. Representative Kay Stewart. Thank you, Madam Chair. Thank you, committee. and a very big thank you to our coalition and stakeholders that have engaged and testified today. It's very appreciated. I will say that we will work with our coalition around 503A clarification, but also would very much like to reiterate how important this bill is. And you heard from Children's Hospital that 78 children's hospitals across the country receive medication that is compounded here in Colorado. 78 children's hospitals. That's a big deal. So let's ensure that patients across Colorado and the country have access to these medications that are safe and reliable. And I urge an aye vote.

I suppose I would. I move House Bill 26-1262 to the Committee of the Whole with a favorable recommendation. Second. Representative Frey, second.

Representative Johnson. Thank you, Madam Chair. Thank you, sponsors. Still very frustrated on last year how we heard it has to go in statute. It doesn't have to stay. It has to stay in rules. It has to go to statute. It has to stay in rules. and how fast this is going back and forth from the discussions that originally came from the end of last session, which just shows that there's too much vulnerability. There's so much complex going on that it's just hard to know where this goes. So I would love to talk more. I will be a no today, but I want to look at the petition, because we might look at lawsuits. This gives us a 90-day window to see if we don't have to come back to special session, to look at the 503 identification factor. Really to explain to everyone who's told me yes and no, statute of rules, statute of rules, and figuring out where that's going. Would love to put a strong ledge deck in there to make sure that we are putting patients first. Very open to having those conversations with both of you. Thank you for the offline conversations, and we'll be a keynote today. Thank you.

Vice Chair, Vice Chair Leader. Thank you for bringing this bill. It is extremely needed. There's been times I've had to go to a compound pharmacy for medicine for my little guy because of the ingredients that you're allergic to this and you're not allergic to that, and for me as well. So thank you. This is a very good bill, and I will definitely be a yes. Representative Bradley. Thank you, Madam Chair, and thank you to everyone who came to testify. It was good to see an old friend in the audience today. Threw me off guard for a little bit, but thank you for being here. I am hoping that you will work with our caucus on some of the things that they have brought forward I will be a yes today I understand the importance of compounding pharmacies if I didn't have one I wouldn't have my children here and so for those of us struggling with infertility that need prescription based according to our healthcare needs it's very important I can't imagine if I lived in rural Colorado so for that I will be a yes thank you thank you sponsors for the bill really appreciated the panelists especially in clarifying the that compounded drugs that go through the fda process are safe and that there are drugs that are outside of that that are unsafe and we want that space to be safe And so just really appreciate you protecting the compounding drugs in Colorado and ensuring access for all patients in the state and, as Rep. Kester mentioned, across the country. So thank you so much, and I'll be a yes today as well.

representatives of Bradfield I am a no for today Bradley yes for today English yes just yes Frey Garcia Sander Emmerich Johnson Cormac Rydin Stewart Yes. Wook, yes for today. Leader. Yes. Madam Chair. Yes.

Representative Swan Joseph, Tahir, CDPHE Nursing Home Penalty Fund. Do we have our sponsors?

I definitely want the grill. Which bill's next? There's a provider fund. Bring the dog. I want to. I really want to bring him with a floor and a chair. I don't think I need to do that. Come get me as soon as Slong and I are done. What do you play? Violin and viola. This is happening again. No, I have to hop on the Zoom. Oh, yay, thank you.

Thank you. Thank you. Thank you Thank you. Thank you.

Representative Joseph. Thank you, Madam Chair. Thank you, members of the committee. it's a pleasure to present House Bill 1244 with the good representatives law. This is an excellent bill. I'm sorry to say this again. Every time I'm here, I'm telling you about an excellent bill that I'm running. We also have fact sheets that I'd like to share with you. CDPHE is, I want to give a quick summary. CDPHE is delegated by the Federal Centers for Medicare and Medicaid Services services to inspect nursing homes in Colorado. Nursing home residents are one of the most vulnerable populations. They are Coloradans who are either recovering from major injury or surgical procedures or elderly individuals unable to safely live alone. In all cases, residents of nursing homes require 24-7 specialized medical care. The department works to ensure nursing homes are safe with staff trained and specialized needs for their residents. When CDPHE inspects a nursing home and discovers that it does not meet federal health and safety standards, the department refers the compliance findings to the federal government, federal CMS. CMS then decides whether a penalty is necessary and if so collects the fine, a portion of the monetary penalty is kept by CMS and the rest is returned to the state through the nursing home penalty cash fund, a state managed account. As of January 1st, 2026, the nursing home penalty cash fund balance is close to $21 million. This proposal amends the current law to remove the list of allowable uses of the nursing home penalty cash fund in favor of flexible language that allows Colorado to spend out of the cash fund according to whatever active federal guidelines are in place at a given time. The current list of allowable uses align with federal rules governing monetary penalties when it was put into statute 15 years ago, and it hasn't been updated since. CMS has newly expended guidance to create additional spending categories for the funding. For example, federal guidelines and state statute enacted to mirror them previously prohibited government agencies from applying to use the fund. Under CMS guidance, no longer prohibited government agencies from applying for the funds, and now encourage states to apply and use the money to develop statewide training programs for nurses. Colorado could direct these funds to specialized training in geriatric behavioral health, dementia care, and advanced wound management. Additionally, CMS recently initiated a tuition reimbursement program for registered nurses and licensed practical nurses who work in a nursing home. or in a state agency as a nursing home surveyor for three years. This new eligible use of the cash fund would address high turnover and critical staffing shortage in nursing homes, particularly in rural or underserved facilities. And I'll stop right here and pass it on to Michael Prime.

Thank you, Madam Chair. I'm going to use my own script, too, to talk to you about what I consider the second best bill that I'll talk to you about today. But it is fantastic. It is one of the best. So I was approached about this bill very late in the game. And I had other plans for a fifth bill this term or this session but I jumped on this because I recognize the importance of this. And you could ask my co-prime sponsor here. I immediately called two of my very best friends about this bill while we were still on the phone, one of whom is a market lead for facilities like that this will impact. and one of them is a director at one of these facilities, and they were both highly supportive of this, and I do believe that it is very important. At its core, it recognizes a simple truth that people who live in our long-term care facilities deserve more than just adequate medical care. They deserve dignity, comfort, and a quality of life that reflects the value that we place on our seniors. By allowing the facilities more flexibility in how resources are used, this bill helps ensure that funds can be directed where they make the most meaningful difference for residents. whether that means improving daily living conditions, enhancing resident programming, or supporting services that directly benefit those living in these facilities. This bill allows providers to respond to real needs in real time. And also, another point that has been brought to me and that I've talked about, two more that I'll talk about, but the first, this discussion also needs to be framed around a broader demographic reality, often referred to as the silver tsunami. Across the United States and certainly here in Colorado, the population of older adults is growing rapidly as the baby boomer generation reaches retirement age. Over the coming decade, the number of Coloradans requiring some level of long-term care will increase substantially. Our systems must be prepared not just to accommodate this growth, but to do so with compassion, efficiency, and foresight. At the same time, our long-term care system is still recovering from workforce challenges that intensified during and after the COVID-19 pandemic. Healthcare facilities across Colorado experienced a significant downturn in nurse staffing levels. Many experienced nurses left the profession due to burnout, early retirement, or career changes during that difficult period. Even today, many facilities report frequent undermining, forcing staff to work longer shifts while administrators struggle to recruit and retain qualified nurses. I see this challenge firsthand every day. As my best friend manages a facility, and my wife is a new nurse and who worked as a staffing technician at a hospital where she helped coordinate staffing levels across different units. Now that she is on the clinical side, she sees nearly on nearly every shift the strain that hospital units face when they are simply not enough nurses available. And the same is true for our nursing homes and assisted living facilities. And she was calling me, so I got distracted. I'm sorry. in all these types of facilities. We have a number of stories that we could share specifically about some of these that are real stories. I will spare you that unless you ask for them. But I will tell you that I do believe that this bill will free up money that is needed to help with many different things, including one of my favorites is being able to help make sure that we have a sufficient number of nurses through being able to assist in different programs that might help with nurse tuition reimbursement, additional training for specialty care, and things like that. Ultimately, to me, this bill is about responsible stewardship and common sense. It gives core providers the ability to better serve the people entrusted to them our parents our grandparents and someday ourselves For these reasons I respectfully ask for your favorable consideration of this bill Thank you very much.

Representative Hamrick. Thanks, Madam Chair. Thanks, sponsors, for bringing the bill. My question is about the outdated list of specific uses. Do you have a list of those? Representative Joseph. Thank you. Thank you. Thank you for the question, Representative Hemry. Currently, the fund can be used for these activities under federal law. Support of residents of a facility that closes voluntarily or involuntarily. Expenses incurred in the process of relocating residents when a facility is closed voluntarily or involuntarily or downsized. projects that support residents and family councils and other consumer involvement, ensuring quality of care in facilities, training of facility staff and technical assistance for facilities implementing quality assurance and performance improvement programs, and also development and maintenance of temporary management or receivership capability like recruitment, training, retention, and other system infrastructure expenses. Representative English. Thank you. Can we use the nursing penalty cash fund to balance the budget? Representative Saak. I will answer it. Thank you Madam Chair and thank you Representative English. English. No, we cannot, is the short answer. It can only be used for grant awards that benefit the quality of care delivered to nursing home residents is the bottom line. So it has to be directly for those and for those grant funds. Representative English. How can we ensure these funds won't just be absorbed into more red tape and bureaucracy? Representative Joseph. you madam chair thank you for the question representative english uh spinning out of the cash fund is ultimately controlled by the federal government and is also overseen by the state controller and house bill 26 1244 will add new spending categories ensure that there are more opportunities to get these funds into our communities representative english last question Will concentrating on nursing home staff leave other parts of health care systems understaff? Representative Jess. Thank you, Madam Chair, and thank you, Representative English. We have a large balance of cash funds that must be spent exclusively for nursing home pursuant to federal law, as currently in statute. While there are certainly other needs in Colorado's health care system, to not invest these available funds in our nursing home communities would be a disservice to Colorado nursing homes and the health care industry as a whole. But really the short answer is that the federal law gives us directive on how to spend that money. Thank you.

Representative Bradley.

Representative Garcia-Santa. Thank you A couple of my questions were already asked but I guess I have still been trying to figure out how did we get here where there is a penalty cash fund balance of million almost million and it hasn been spent down according to the federal guidelines How did we get here to million almost in a cash fund Representative Sahl? I mean, I guess I know that there were fines and penalties, but how has it not been spent before? Representative Sahl? Thank you, Madam Chair. The short answer to it is that it's a pretty narrow grouping of expenditures that are now a fairly narrow group of things that that money can be spent for. And it hasn't been updated in a long time. And there's been a sufficient amount of penalties that have just accrued. And so we just haven't had the wide enough open aperture to be able to spend money as fast as it's accrued. Representative Batfield. Thank you, Madam Chair. How much of this $20 million can we spend? Representative Joseph. Thank you, Madam Chair. We can spend all of it for the express purpose under federal guidelines.

Representative Joseph. Thank you, Madam Chair. I failed to mention that we do have an amendment. Oh, great.

Well, let's bring up Joseph Dubrath. Alexandra Haas, Alan Horowitz, and Leah McMahon.

Thank you, Madam Chair and members of the committee for your opportunity to speak today. I'm Leah McMahon, State Long-Term Care Ombudsman for Colorado. The Ombudsman Program is a federally mandated and resident-directed program that advocates for residents. I'm here to speak on behalf of residents living in long-term care and how House Bill 26-1244 can benefit residents and their quality of life. House Bill 26-1244 addresses how funds collected through penalties against nursing facilities are used by the state. These penalties are assessed when facilities fail to meet required standards of care intended to protect residents. The fines collected can be used for greater opportunities to correct systemic issues and improve the daily lives of residents. Residents and families inform ombudsmen that what matters most to them is consistent staffing, well-trained caregivers, respect for resident rights, and a safe, dignified living environment. Programs that support hands-on training and education for registered nurses and licensed practical nurses through tuition reimbursement and stipends can help make a difference in the lives of residents at the most vulnerable time in their life. House Bill 26-1244 does not change enforcement mechanisms. Instead, it ensures that penalties paid by facilities are reinvested into staff training, education programs that directly benefit residents, such as better care practices, promotion of resident-directed care, enhance resident rights and dignity, and improve the health, safety, and welfare of all residents living in nursing homes. From the perspective of the Ombudsman Program, aligning the use of penalty funds with improvements in quality of care is not only practical, but also responsible. We want all residents in long-term care to live the best quality of life and receive the best care possible. On behalf of the Long-Term Care Ombudsman Program and Colorado's nursing home residents, we respectfully encourage your support for House Bill 26-1244. Thank you.

Good afternoon, Madam Chair and members of the committee. Thank you for the opportunity to speak to you today. I'm Alexandra Hawes, and I represent the Health Facilities and Emergency Medical Services Division of the Department of Public Health and the Environment. Our division is delegated by the Federal Centers for Medicare and Medicaid Services to oversee nursing facilities in Colorado. CDPHE supports House Bill 26-1244, and we are grateful to Representatives Slaw and Joseph for their leadership to ensure Colorado's nursing home workforce can take advantage of exciting new federal funding opportunities. In 2023, the federal government changed this policy to encourage states to develop statewide educational programs for specialized nursing for home trainings. This bill would update our state statute to take advantage of this change. For example, CDPHE could invest in fall prevention training. Falls are the leading cause of injury-related deaths among seniors. CDPHE's statewide training could also focus on infection control. Every year there are between one and three million infections in the country in nursing homes. and a recent federal study revealed that 82% of all nursing homes inspected in the U.S. were found to be deficient in infection prevention. Dementia care is also lacking in current nursing home training modules. More than half of all nursing home residents have some type of dementia. With this bill, we can provide uniform evidence-based training for all nursing homes in Colorado. As Representative Joseph stated, the federal government determines when fines are appropriate and collects the fines from the facility and relate it to the violation. A portion of that is returned to the state where the nursing home is located. A funding board reviews and recommends grants to the department, but the federal government must also approve prior to any monies being spent. This fund has been managed with fidelity and conservatively to meet state and statute and federal oversight. Priorities under the federal regulations have changed, and Colorado has been unable to spend this money consistent with those priorities. This has been accumulating because the list is so narrow that many nursing facilities find it administratively burdensome to apply and demonstrate applicability under the current listing. For these reasons, CDPHE would love to be able to expand the use of these funds. Thank you.

Good afternoon, Madam Chair and esteemed members of the committee. My name is Joe Dubroff. I'm the Director of Government Affairs at Leading Age Colorado. We are the leading voice of senior living and aging services providers in the state. Our members represent the continuum of aging services providers, including assisted living residences, affordable senior housing, adult day centers, PACE, or programs of all-inclusive care for the elderly, and nursing homes. Today, on behalf of our members, I respectfully ask for your support for the passage of House Bill 1244. As Representative Slaa referred to the Silver Tsunami, I'm happy to put some data behind that, such that Colorado is the second fastest aging state in the country. By the end of this decade, between the 2020 and 2030 censuses, Colorado Demography Office projects that the state's 65 plus population will have grown 36% and by 2050 will have doubled. This fast growing demographic requires certain supports, including adequate workforce to care for it. Our members need as many tools as they can to attract and retain workforce in the senior living and aging services sector especially in nursing homes With more than 60 of nursing home residents in the state on Medicaid many facilities operate on thin margins and do not have the capacity to offer higher salaries to compete with other employers Reforming the CMP reinvestment program is a long overdue step. For too long, the restrictions on the use of these funds have made it extremely difficult to distribute them to deserving recipients. Using tuition reimbursement as an incentive to work in nursing homes will help ensure staffing can grow with the increase in demand we will see with this demographic change. As well, allowing these funds to be used to develop and offer free statewide trainings will ensure that quality of care is maintained as nursing homes prepare to serve even more Colorado seniors. Thank you to Representatives Joseph and Slaw for their leadership on this bill, and thank you for your consideration. My testimony, I'm available to answer any questions you have.

All right. Good afternoon. Thank you, Madam Chair and committee members. I'm Shelly Griffith. I'm the CEO of a senior living provider in Northeast Colorado. So we provide daily care and housing to over 550 individuals throughout Northeast Colorado every day. The majority of these individuals, or nearly 70% of them, are on Medicaid. These dollars, as a provider we receive, do not cover the cost, does not keep pace with the increase in wages that are necessary to retain staff in our growing and aging communities. It's no secret that as a rural provider, our labor pool is limited more than our urban peers. For years to combat this, we started a junior volunteer program. So we knew early on we had to grow from within. So we started a junior volunteer program. The idea was to start with our youth and get them interested in providing care. Of course, that grew into when they become a teenager and talking to them about the opportunities that we can offer them. Over recent years, the need for the Medicaid providers is growing. We talk about the tsunami. We know that the resources are not there. So our ability to provide these scholarships for this youth is changing, and it's not as prevalent as it once was. It's challenging time for senior living providers right now. In addition to the need of helping people achieve these certifications, providers have been elevated on their education compliance requirements. Talked a little bit about dementia care. All of our team members are required to receive X amount. It just depends on what level of care they are working in. And on top of that, we have trauma-informed care, we have mental health, we have wound care, IV care, a variety of things that are changing in the space of senior living. And so in order to be a good provider, we need to continue to offer that education. It's also key to note that nursing homes are heavily regulated, and at times top providers in this space can have a situation that causes them to pay a fine. The rate at which nursing homes have been fined over the last six years has increased exponentially. These CMP funds need to go back to nursing home providers so that we can continue to enhance and meet the needs of the people who need us. I encourage you guys to use these dollars to incentivize providers like Ebenezer

Thank you, Madam Chair and distinguished members of the committee. I'm here on behalf of Colorado Post-Acute Long-Term Care Medical Society, and I urge the committee to pass HB 26-1244. Sure By way of background I was assistant regional counsel for CMS from 2000 to 2012 and from 2012 to present I represent skilled nursing facilities around the country I have literally been involved with hundreds and hundreds of instances that were an outgrowth of surveys where there a question about whether or not quality of care and quality of life of a resident was appropriate based on federal guidelines I was also the program director and in-house counsel for a facility that was one of the pilot programs in New Jersey for ventilator-dependent residents. One of the many reasons that I strongly urge the committee to consider this bill, you've heard many of the reasons dealing with the bill. Just by way of brief background, when CMS does a survey of a nursing home, which it must do at least once a year and whenever there are complaints, if there are deficiencies, that is, if the facility is not in compliance with the federal requirements of participation, CMS is authorized to impose a civil money penalty. When the case is finally adjudicated, if there's no appeal and there's no rescission of that CMP, 90% of the CMP must be returned to the states to be used consistent with the guidelines in the Civil Money Penalty Reinvestment Program. I can't think of any better uses than those that are articulated in HB 1244, particularly education and training, which is absolutely critical. And just by way of regulatory and statutory background, this was mandated by the Affordable Care Act. The use of the CMP funds is in CMP regulations. And from a clinical perspective, I can tell you, having been in the trenches as a nurse and administrator, training and education is absolutely paramount, particularly with residents who now have higher acuity levels than they did previously. this bill goes a long way towards improving the quality of care that residents deserve

Representative Bradley? Thank you Madam Chair. As I was writing I was just sitting here thinking being a PT and wanting to give back and get continuing education credits and fall prevention I agree is number one risk factor for older people. How do we ensure that these facilities take advantage of this money and put it back into fall prevention and dementia care and wound care and all that? How do we ensure that they, because $20 million they haven't used and now they know about it, right? And so we're going to communicate that to them, but how do we ensure that they use it to put back towards the patients? Who would like to answer that? Mr. DeBruff. I'm happy.

Thank you. So within CDPHE, and Alex can probably expand on this a little bit, is the Nursing Home Grants Innovation Board, which oversees how CMP funds are distributed and allocated. With the limited usage, that's why there is such a large backup there that is still there. And in order to access the funds, they need to be approved by that board. So if the board is not going to approve it, then they're not going to go to that facility. But for those that do fit within these new federal guidelines and the new statutes that we're hoping to see through the passage of this bill, hope that that can get some more of those funds going and they can be used in this case to support that training, support the tuition reimbursement, these new purposes that will be really beneficial to nursing homes throughout the state.

Yes, thank you for the opportunity. In response to the question how can facilities make better use of the funds Well I written articles about the use of CMP funds in industry publications geared towards skilled nursing facilities for over a decade When I give presentations as appropriate, I'll mention the use of the CMP funds. It's been my experience, and I've been doing this for 25 years, both for CMS and now for providers. It's my experience that most providers are aware of the C&P funds, but as previously mentioned, they're concerned about the limited uses. And that underscores why I think it's so critical to pass HB 26-1244, because this expands the uses. There'll obviously be publication of this. I assume, and obviously I can't speak for Colorado Department of Public Health and Environment, but I can tell you that industry groups, personally, I will be writing about this when I give presentations or when I talk to owners and operators of SNFs around the country. This is something I would mention. I would be remiss if I didn't. I would remind them that there are now, at least in the state of Colorado, expanded uses under CMS's guidelines for the Civil Money Penalty Reinvestment Fund. Thank you.

Thank you, Madam Chair. I would also say that one of the feedback that we have received at the department has been in regards to several facilities find it very hard to create their own training to offer to their staff. It's not cost efficient. and so one of the things that the change amending this so that we at the department can come up with those trainings and make them available through several virtual platforms or other means in which we have developed trainings for in the past is uh would make it more efficient um so that those trainings could be more timely and not uh facilities wouldn't have to spend as much time trying to figure out how to reach those sorts of standards to have meaningful trainings in place

Thanks ma'am chair I have two questions The first one is does a cash fund collect interest? Ms. Haas Thank you Yes it does

The second one is as far as the C&P funds I understand the criteria is super narrow and so it's been hard to sort of find facilities that apply so what is informing you of these new goals? Like, why create these new goals?

Thank you, Representative. So these priorities have been updated by CMS, and they are the ones that sort of inform us of how these things can change and shift over time. Because of the way our statute in Colorado is written, we've just not been able to adapt to those changing priorities and things that CMS has recognized that this money should be used for.

I have one more question. Thanks so much. Let's see. As far as the new criteria, my understanding is it's going to be mostly focused on training and education and not the stuff that it used to be focused on?

Thank you. Yes, Representative. So those priorities still exist as far as ensuring the safety of the residents, if a facility closes down, and being able to move them. Those things are still built in to the CMS priorities, and those funds will still be available for those uses. It's just that we're very fortunate in Colorado that we don't have to rely on this huge policy. of money to be depleted for those reasons. And so we would like to be able to expand it for more of the training.

Thank you, Madam Chair. Going back to CDPHE, when you said you can develop training virtually and stuff, do we have – sorry if this is ignorant – do we have a safeguard to make sure CDPHE doesn't just take the $20 million?

Yes, Representative Bradley. This will have to be – this will have to go through the same process of the funding board creating the proposal being approved by the funding board, which is not state employees. And then the department would have to also still run it through the federal government. So all of those safeguards would still be built in, even with the state program being involved in the grant.

I can't see the small one. Do you know? Okay.

if you could come off mute, introduce yourself, the organization you represent, and you have two minutes. Thank you so much. Thank you to the chamber and the sponsors of the bill for allowing me to speak today. My name is Pradeep Raj Rai. I serve as a physician and director of wound care in the long-term care space and have been here in the Denver area for almost 11 years now. I'm a member of Palt Med, the Colorado chapter, also known as the Post-Acute Long-Term Care Medical Association, which is a branch of a national society that represents medical directors, physicians, nurse practitioners, and physician assistants in the long-term acute care space. I've worked nearly my entire career in this post-acute space, and I provide care to some of the most medically complex and vulnerable patients in our state. These are the residents in long-term care facilities. Today, I'm here in strong support of increasing access to funding for nursing education because the nursing home workforce is in crisis. This affects patient safety. I strongly support House Bill 261244 in support of the Nursing Home Penalty Cash Fund to assist in uplifting the care provided to the patients that I treat. There is a reality here, and I'll kind of bring some attention to some of those things. Nursing homes are not low acuity. There's an estimated 15% of Coloradans who are age 65 or older. And as mentioned by the sponsors earlier, this number is expected to increase by actually almost 30% over the next decade. There are approximately 20,000 beds available for skilled care in the nursing homes. And these patients actually include post-surgical patients, patients with advanced heart failure, diabetics, patients with chronic wounds, patients with behavioral health needs, advanced dementia, and many with complex medication regimen. Some even say that the nursing home patients today look like hospital patients from 10 years ago. However, staffing levels and education have simply not kept pace with the clinical complexity that exists today. I mentioned the workforce crisis. Undermining health care across all places of service is a nursing shortage. This leads to an over-reliance on staffing agencies, high turnover, burnout, and a limited ability to recruit new graduates into the space. Wages are also very difficult to compete with where hospitals will sign you know attractive bonuses and when nursing homes are understaffed or undereducated care can feel reactive instead of proactive at times

Representative Hamrick. Thanks, Sarah. Go ahead and finish your statement. Dr. Roth. Apologies for going over. As a wound care provider, this is very near and dear to me because this leads to increased pressure injuries, higher rehospitalization rates, delayed recognition of declining conditions, and medication errors. In long-term care, the nurses are usually the first ones to detect any declines. And when we don't have enough well-trained nurses, small problems can lead to significant decline in function and sometimes even worse. The last thing I'll say here, nursing home residents are our patients. They deserve highly trained, adequately staffed nursing teams. Access to these funds is foundational for safe long-term care in Colorado.

Yeah, Mr. Rye, could these funds be used to increase the staff at a nursing home? My understanding is that it's more for education. not necessarily for staffing. I just wanted to highlight the staffing disparity that's there. And when they are already understaffed, at least elevating the care that is there with those that

and you have two minutes. Good afternoon, Madam Chair and members of the committee. My name is Amanda Lack and I serve as the local long-term care ombudsman in the southeast corner of the state. I'm here today to testify in support of House Bill 26-1244. Every day, ombudsmen listen to residents and families and work to ensure their voices are heard. Today, I'm here to share a few of their experiences and to speak in support of House Bill 26-1244. In rural Colorado, nursing home residents are the farmers, teachers, veterans, and community members who build the towns we live in today. Their families are here, their histories are here, and for many of them, being able to aid in their own community is essential to their quality of life. In a small farming community, I met a resident with a complex tracheostomy. The facility's nurses lacked specialized respiratory training. Each time care exceeded basic support, the resident was transported three hours away to a larger city hospital. Their 70-year-old spouse could no longer drive extended distances to visit during those hospitalizations, leaving the residents to endure repeated lengthy and ambulance rides and painful family separations simply because the facility couldn't afford to send nurses to the front range for advanced training. Every extra trip, every delayed procedure, and every missed visit tips away at the resident's quality of life. In another rural community, a cognitively impaired resident became aggressive after three temp agency nurses cared for them in one weekend. Citing safety concerns and limited staffing, the facility transferred the resident to a locked memory care unit two hours away. A long-standing nurse told me the facility cannot afford the Bridge to RN program or specialized dementia training, contributing to their 66% turnover rate. Residents consistently tell us what matters most to them, familiar caregivers, skilled staff, and the ability to remain in the communities that shape their lives. Investing in the people who provide their care is not just their health but their dignity stability and the right to age safely in the place that they call home For those reasons on behalf of the residents we serve I respectfully urge your support for House Bill 26

I move L004 to House Bill 1244. Second.

And Representative Frey seconds.

Representative Sloth. Thank you, Madam Chair. This is just a technical amendment. It corrects the alphabetization of definitions in Sections 25-1-107.5.

Representative Joseph. Thank you, Madam Chair. Thank you, members of the committee, for the opportunity to present House Bill 1244. I'm grateful to be running this bill because most of my family work in the medical space, And actually they work in nursing home, nursing home care as nurses, LPNs, and other spaces within the nurses field. And to end, I wanted to share with you why this bill is important. We have three real life stories to share with you today as to why this bill is important. During a visit to a nursing home facility in a small farming community, The state long-term care ombudsman met a resident with a complex tracheostomy. The facility's nursing staff lacked an advanced respiratory certification, so the facility had to send the resident to a hospital in a large city three hours away, each time the resident's tube required more than basic suctioning. The resident's spouse, who is seven years old and no longer drives long distances, could not see the resident when the resident was hospitalized in the city. Additionally, the spouse was concerned about the long rides the resident endured in the periods of separation from family. The local nursing home administrator acknowledged the increased risk and distress the long trips to the city had on the resident. The facility expressed a desire to train their staff so that care could be delivered locally, but stated that it was not in their budget to provide the training. Additionally, when the facility attempted to train its nurses on advanced respiratory care, it could not find a local instructor, nor could it pay to send its staff out of the region to receive the clinical training. So again, this bill will support training, the training of staff. And the second one is around high staff turnover A nursing home resident facing eviction in rural community asked their local enmbudsman to assist with an appeal the resident filed The resident who lived with a cognitive impairment became physically aggressive after being cared for over the course of a single weekend by three different temporary staffing agency nurses who were unrecognizable to the resident. Following the incident, the nursing home arranged to transfer the resident to another facility locked memory care unit. The nursing home said it lacks sufficient staffing to closely monitor the resident. The resident's family appealed the involuntary discharge, requesting that the resident be allowed to remain in the facility and that additional staff coverage be provided on the weekends. The nursing home is located in a rural community where the annual certified nursing assistant turnover rate is 66%. During the ombudsman's inquiry, one of the facility's longstanding nurses shared that while they deeply cared about the residents, the nurse is planning to leave their position. The nurse explained that the facility cannot afford to support their Bridge to Our End program or provide specialized dementia care practitioner certification. The nurse also described being overwhelmed by the home's constant level of understaffing and said resident requiring additional support cannot have their needs met at the home's current staffing level. So again, you will hear from Wretz Law on the third story, but the point here of this bill, it is extremely important because it impacts real lives. It's about training of nurses, and I know there was a question asked earlier of whether this bill will lead to more nurses in certain facilities. facilities? I would agree yes, because if there are more trained and educated nurses, there's going to be a bigger pool of staff, of nurses or nursing staff available. So again, this is such an important bill, and I've also heard of these stories from my own family, where there's the staff shortage issue, where community members get hurt because of the lack of staffing. And also, too one thing that we've not mentioned here in this bill too it does save money if it's if the nurse is an internal staff as opposed to someone who's hired through um through a staffing agency because they have to pay the staffing agency also have to collect its pay it has to make money off of it as well so i just wanted to say this is a great bill i am deeply grateful uh to be running this bill with Lindsay Ellis from CDPHE and I hope you will please vote yes on this bill and I'll

Thank you. Vice Chair Leader, would you like to move the bill?

Mr. Shudum, could you please call the roll? Representatives of Bradfield?

Bradley?

English?

Frey?

Garcia Sander?

Emmerich?

Johnson?

McCormick?

Yes. Thank you, Madam Chair. One second. Thank you, Madam Chair, members of the committee. We are passing out ahead of time an amendment that we will bring for this bill. Please help the new kid if he does it wrong in passing it. We will move it. We will move that. So, all right. For three years, in 2010, 2011, and 2012, I was the officer in charge of the University of Northern Colorado's Army ROTC program. A key duty I had was recruiting. As such, I had students in my office often seeking information about how to join Army ROTC. As a professional, I would spend time getting to know them, their motivations, their situation, and what they knew about what they were trying to do. What I learned was that Army ROTC was not always the best solution for every student that came to my door. Some got information from me about active duty Army recruiters, some about the Army Reserves, some about the National Guard. Some I even sent to the Marines or across the hall to the Air Force. I bring this story up because to me it is somewhat of a corollary to what we talk about tonight Before I explain the bill I want to begin with another couple of personal stories In the mid-1970s, a young married couple were ecstatic with the news that they were expecting a baby. Sadly, after only a couple of months of pregnancy, the mother had a medical complication identified that caused her to lose the child and be unable to become pregnant in the future. That news was devastating to them, as there were few things that they wanted more than to add children to their family. In time, they became aware of an avenue to achieve that objective, and that was adoption. Meanwhile, in a different state in the Intermountain West, a young woman found herself struggling with challenges that sometimes come in life, and through a series of choices, found herself with the additional challenge of being pregnant with the child of a person she had barely met at a good old-fashioned Idaho potato field bonfire party, a situation she was not prepared for. Thankfully, her parents were familiar with the process through which she could consider the option of choosing to give that baby a life without becoming a single mother, without enough resources to provide the life she desired for the baby. And that, members, is the short version of what will someday be the prelude chapters of my autobiography. I was adopted as an infant in 1978. I did not grow up wondering whether I was loved or wanted. I grew up knowing that my birth mother had made sacrifices so that I had opportunities in life. Adoption is not an abstract policy issue to me. It is the foundation of my life and of my life story and why I'm here today. That personal experience is why I want to begin with something very clear. This bill is not what we refer to as a messaging bill. It is not intended in any way to negate or undermine the constitutional rights that Coloradans have adopted regarding a person's right to choose their pregnancy outcome. This bill does not change those rights. What it does is much narrower. It simply ensures that when someone is facing one of the most consequential decisions of their life, they have the opportunity to hear about adoption as one possible pregnancy outcome. After countless conversations with many people over decades of my life, I believe there is a significant lack of good information available about adoption in the general public conversation because our conversations have been so heavily focused on the contentious debate between life and choice. So today I seek to bring back a conversation that has been predominantly lost. House Bill 261105 requires that when a pregnant person expresses concern or questions about their pregnancy outcomes options, a healthcare provider is to offer to discuss adoption as an option unless the patient declines that conversation. Patient retains full autonomy and can simply say no. This bill is fundamentally about information and awareness, absolutely not about coercion. That awareness matters because there is often a misunderstanding about adoption in our culture. First, there is a misconception that adoption is rare or that there are few families willing to adopt. In reality, the opposite is true. While exact numbers are difficult to determine, researchers estimate that around 1 to 2 million families in the United States are waiting or hoping to adopt a child. And in many cases, there are far more waiting families than infants placed for adoption. At that same time, adoption remains a meaningful part of family formation. Tens of thousands of children are adopted in the United States every year, including roughly 25,000 individuals. infants placed through private domestic adoption annually. So the reality is this. There are many families ready to open their homes and their hearts, but not everyone facing an unexpected pregnancy knows that. Another misconception is about the nature of adoption itself. Many people still picture adoption through the lens of decades past, like how I was adopted, in a closed adoption with secrecy and permanent separation. But modern adoption often looks very different and has almost unlimited flexibility able to be tailored to individual desires. Today, most infant adoptions involve some degree of openness, meaning birth parents may choose the family, maintain communication, or receive updates as a child grows. Research has even found that open adoption arrangements are associated with better emotional adjustment and higher satisfaction for birth mothers after placement. That said, my experience was a closed adoption, and I didn't meet my birth mother or biological father until a bill passed in this body allowing access to birth certificates for those who'd been adopted, and I had a near-perfect experience, though I recognize that experiences certainly vary. In other words, despite my experience, adoption today is more collaborative, more transparent, and more supportive than people realize. But despite these developments, adoption remains a difficult decision. Women considering adoption face real emotional and practical concerns. Research and adoption counseling organizations consistently identify several common themes. Among the most common concerns are fear of emotional loss or long-term grief after placement, uncertainty about the child's future and well-being, concern about stigma or judgment from others, worry about lack of control over the adoption process, or questions about ongoing contact with the child. Though these concerns are real, they deserve compassion and honesty. What helps alleviate them is information and support. Women who explore adoption often gain reassurance when they learn that they can select the adoptive family themselves, participate in open or semi-open adoption arrangements if desired, receive counseling and support services, maintain some level of contact or updates about the child's life. Understanding those options can transform adoption from something that feels frightening or mysterious into something that is at least fully understood as a possible choice and maybe a preferred option for a person. That is the purpose of this bill. It doesn't require anyone to choose adoption. It doesn't require anybody to listen to information. It simply ensures that the option is available to be discussed if the patient wishes to hear it. For some individuals, conversation may mean nothing. But for others, it could mean discovering a path that they did not realize existed or they were not familiar with enough to make their choice. Members of the committee, every one of us in this room understands how powerful information can be in the shaping of life decisions. My own life began with a woman making a difficult choice and another family opening their home. Adoption changed my life, it changed my parents' life, it changed my birth mother's life, and it's changed my biological father's life. It gave me, a child, a future. I believe that this bill is a modest bill. It respects constitutional rights, respects patient autonomy, and simply ensures that one more option is available to be discussed.

Thank you, Madam Chair and members of the committee. House Bill 261105 is a common sense measure that empowers women with knowledge so that they can make a well decision about their pregnancy When I became a legislator I was introduced to organizations to offer services to pregnant women ranging from financial help, emotional support, health care, and even classes and counseling for families and fathers who may not feel prepared for pregnancy. I questioned why at almost 40 years was I just now learning about these resources and what I've ever learned about these options if I didn't take this position. I've gone to appointments with friends who faced unexpected pregnancies, and they were all given two choices, to keep the child or abort it. Had my friends known about these other options, the result might have been different. To expand on what my co-prime sponsor has mentioned, this is not an anti-abortion bill. It's simply a bill that gives women choices. As a female who has spent over a decade building women up, I'm proud to bring a bill before you that empowers women with knowledge. We as women want choices, and we deserve choices. But this reality is difficult when options aren't being presented to pregnant women, which a good health care provider should do. Without forcing anyone to move forward in any particular way, this bill requires providers to inform women about various public and private resources for pregnancy support, including prenatal and postnatal medical care, material and financial assistance, counseling and social services, and parenting support. The patient can choose to opt out at any time as the service is not mandatory. There is no required counseling session and no delay imposed on care. The patient remains fully in control of the conversation, and the provider's role is simply to make the information available if the patient wants it. The bill also ensures that the information is presented without steering patients toward any particular choice. It requires providers to use plain language, offer their information objectively, and give patients a private setting and the chance to ask questions if they choose. No coercion, no suggesting, just clear, unbiased facts to allow women choices. Sorry, and that's it. Sorry, I had some notes there that I was reading.

And in addition, I don't know if you guys have the amendments that we passed out. So we have made amendments. I know that there was some issues with the 24-hour requirement, and so we have taken that off. We've also added some additional services that would be discussed expressing concerns about the person's pregnancy and requesting information including counseling support or health care assistance related to pregnancy outcome adoptions. and then I think the other ones are pretty self-explanatory. We're also open to other amendments if anybody has any issues, but I feel pretty confident in the way that the bill is written now.

Thank you, Madam Chair, and thank you to the bill sponsors for bringing this forward, and thank you for sharing your story. It's always nice to hear people's stories. I was just wondering if there's any information on post-abortion statistics on how many women would have chosen adoption. Have they been given some sort of a chance?

Thank you, Madam Chair. I don't have those statistics. I think we have some data experts that may be able to talk to that.

Representative Slott? Thank you, Madam Chair. Can you ask it again? I'm sorry, just to make sure.

Thank you. Are there resources available? So the bill references that the health care provider would share certain information. So are there already resources available that are from like CDPHE or openly available open source resources that physicians or healthcare professionals could share with clients?

Thanks for having me share. There are lots of resources. There is lots of information that is available. This bill just is trying to make sure that it's equitably available as much as information about any other options. We just want to make sure that this is one, because I believe that it is a topic that has seen decline in the information being presented. and I think that that makes it difficult for pregnant persons who are seeking information about what they should do to be able to make the best choice for them. If they don't have all the choices, it kind of goes back to my somewhat silly Army story is that I had students that would come to me and they would ask about what I was sitting at my desk talking about, but they might not know that there are several other things that were maybe a better choice for them, so I had to make sure that I had that. And so this is similarly making sure that all of those options are most easily presented.

Thank you, Madam Chair. Thank you, bill sponsors, for being in HHS today. I was curious, who would be offering this information? I assume that the practitioners are not experts on adoption. So in looking at the bill, it's the availability of financial assistance for prenatal child care, childbirth, distinction between adoption, overview and assessment of approval. So if we're asking doctors who are not experts in this field to offer this information, how are we making sure that the accurate information is getting to these patients?

Thank you, Madam Chair, and thank you for the question. It's a great question. They can offer the information that they have. It doesn't have to be completely holistic immediately. and they can offer additional resources if an individual wants more information or has more questions. There's nothing to preclude further discussions in this bill.

Thank you. I also appreciate hearing your story, so thanks for sharing that. I was curious to know, because this is kind of getting into the practice of medicine, Is there a barrier in the Medical Practice Act that's preventing practitioners from having these conversations now? And then I have a follow-up.

I'm not aware of any barriers that are preventing them from having these conversations. I think the conversations do happen at times. And I spoke with a couple of doctors about pretty much that exact kind of thing. And it is not uncommon for them to at least present it at times, but it not necessarily an always thing And the level of information presented is not standardized

Thank you, Madam Chair. And just with the language on the bill on page two, it was a little kind of ambiguous to me when it says the person's health care provider or another willing health care provider. And then it shall. So what if there is no willing health care provider?

I have the word shall there.

Yeah, thank you. So that's exactly somewhat answered the question before that as well, where if they do not feel that they necessarily have all of the information and there is another willing health care provider from any other particular field along those lines, they can answer those questions also.

Thank you. And I think I heard in your opening that the healthcare, there was something about if the patient wanted information about adoption, you know, trying to get as much information as possible, if there was a decision to be made, how would the health care provider really be the one initiating the information or would the health care provider be waiting for the patient to ask for the information? I'm just trying to discern how it would happen in practice, like in the exam room, who's asking or who's providing the information first.

It would be initiated. So I think if somebody was not sure, if they expressed that they weren't sure what to do, if they didn't know that they for sure wanted to have an abortion and they just wanted to be presented with all of the options, at that point the doctor would initiate it.

I mean, I think a campaign to provide more information about adoption is a great thing that could also be done. but I think that even with something like that I think that there's the real likelihood or at least possibility but probably likelihood to me that there are still going to be a number of people who won't be able to get that information or maybe they won't feel like they can ask questions about it they don't want to part of it to me also is it puts it where they're in a safe space for them to be able to ask questions when it's presented to them and be able to get real information, whereas sometimes in bigger campaigns or just education things, it's not as personally tailored, but I would be in favor of both, absolutely.

I think that a campaign would be fantastic. The issue is that a lot of these organizations that offer these kind of services are nonprofit. And as a result, they just can't afford that. The finances that they do have are going towards the patients and the families and stuff like that. And as far as this being sort of like a mandate on health care providers, I think that it's just it could be something as simple as just having a conversation, asking them if they would like additional information or just showing them that, hey, there are these other options out there. And maybe even just giving them a pamphlet that would, you know, help them to get a contact info or a contact number for a different organization that might help them along the process.

Yeah, just to add to that, I mean, similar to a lot of other health care related things, and I am not a doctor, although you all have just recently heard me talk about all these people in my family that are in the health care field. That is not me, but I would see that it'd be something sort of like a referral, or if there were further questions, they could be referred to somebody who was in a related field or had much more information about it, whether it is an agency or organization that deals with that individually or a social worker who has specific expertise in that or wherever it may be, that might be where they are able to get more information.

Sorry, just one more comment. You will hear from some doctors today that you guys could ask that I think would probably be able to answer a little bit better than we can. Thank you.

Good morning, Madam Chair, members of the committee.

testimony. Please proceed. Hi. Good afternoon, Chair and members of the committee. My name is

Thank you. Thank you for your testimony. Please proceed.

Thank you so much for your testimony. We'll move online to Kara Allison.

top of compelling doctors to start a tone-deaf and hurtful conversation about adoption when they know the pregnancy is non-viable. Now, understanding that the 24-hour period has been amended, that does still leave the issue of a potential compelled speech. And also, when abortion is emergency care, it leaves the requirement to have that conversation when the fetus is non-viable. So I yield my time. Thank you. Thank you so much for your testimony. Moving on to Nicole Severa-Loy. Thank you, Madam Chair and members of the committee. My name is Nicole Severa-Loy, and I'm the Senior Policy Manager at the Colorado Organization for Latina Opportunity and Reproductive Rights, CULOR. Today, I'm urging a no vote on House Bill 1105. While adoption is an important and valid option for many families this bill creates a new mandate that signals out abortion care for additional requirements that are not applied to other forms of medical care Healthcare providers already follow a professional standard that ensures patients receive accurate information and counseling that is tailored to their needs. Mandating a specific counseling script tied to abortion procedures risks inserting state-directed conversations into a clinical setting where medical decisions should be guided by patient autonomy and medical expertise. Adoption involves complex legal and social considerations typically handled by trained adoption professionals and not medical providers. People seeking abortion care are thoughtful about the decision, discussing with trusted family, friends, and healthcare providers of their choosing, and they make the best decision that is unique to their situations. Even requiring the question, Would you like to consider adoption? Can further stigmatize abortion care, interfere with doctor-patient relationship, and put an unnecessary barrier before patients' health, safety, and right to make decisions about their bodies and their futures? policies that impose additional counseling requirements tied specifically to abortion risk undermining trust and creating barriers to care for these reasons and because we weren't able to have any conversations prior to this bill and do any stakeholding we are a no vote for today on hb 26 11 of 5 thank you for your time and consideration thank you for your testimony any questions for this panel representative johnson thank you madam chair and thank you ladies for testifying. My question is to any of you. I'm looking on page 3, line 10, saying an opportunity to decline to discuss this information as long as the mention of availability of adoption information is present. Because we're talking about woman's choice and all this bill is saying is that the provider should say here's some adoption options. Do you want to hear or decline? Two sentences. It's the patient's choice then. If they want to decline and not hear it, great. If they want to hear about it, that's access to information. So I'm just wanting to know your feedback on shouldn't women have all their options? Ms. Garcia. Sorry, my nails are making it hard to press the button. Yeah, thank you for your question, Representative. So as stated, at Planned Parenthood, we are providers. We provide comprehensive reproductive health care, and our doctors already do offer information about adoption when it's relevant to them. So what our patients need is timely, compassionate, accurate care, not a state-mandated conversation that is being forced upon them by the government. Representative Johnson. Thank you. And so I just want to point because it's not a mandated conversation. It's the provider comes and says, would you like to know about adoption information or no? There's the decline. So it's not saying you have to have the conversation. It's saying you have to open up if they want the conversation. Do we not think that women are adept to know all of their options and they should be presented just to make sure that they do know? If they want the conversation, should they not have that presented to them? Ms. Glick? I agree that that is an important conversation to have, but healthcare providers are not trained in adoption, the complexities of adoption. There are specific companies and specific therapists and therapists that work specifically with birth mothers and first fathers through their lifelong grief. And there is no way for us as medical providers to just throw that out as a conversation and in any way adequately or fully have an educated discussion with them. and to do that within one medical visit and not offer what they should have as long-term legal and mental health care services. for many months at minimum throughout their life. So I just think that this bill does not allow for any of the complexities and puts a lot of pressure on people who are not professionally educated to see what happens with the conversation. Representative Garcia-Thander. Thank you, Madam Chair. A couple of questions. I guess the first one for Ms. Garcia. how many patients that are counseled at Planned Parenthood choose adoption instead of abortion? Ms. Garcia. Or to keep their child? Yeah, I don't have a number for you, but I'm happy to follow up via email. I would love to know if they're counseled, that that's one of the options, how many actually do choose that. I guess the other thing that I was thinking about is in follow-up to the question around physicians giving advice on adoption. I just did a really quick Google search, and it says, In Colorado, physicians are required to engage in conversations regarding advanced care planning, specifically discussing medical durable power of attorney, medical orders for scope of treatment forms for seriously ill or frail patients. They have to inform patients of their rights, including the right to refuse treatments and right to privacy. And most physicians would say, I'm not a financial planner or anything, or banker, so I really don't know anything about a medical durable power of attorney, but I can give you some medical guidance there. I guess, you know, there's some areas that I think physicians are pretty smart people in my world. and if there's already information out there that's publicized about adoption option, it seems like we should be able to trust medical professionals to be able to hand a pamphlet or to answer a couple of questions around, is this a viable option for my child? If they're viable, can I choose adoption? So I'm just kind of curious about why you think that a medical professional wouldn't be able to provide that information. Ms. Garcia. Thank you for your question, Representative. So again, at our health centers, physicians already offer information about adoption, including referrals, when it's relevant to the patient. But it's, I think, disrespectful to our patients to assume that they don't know what they're at their appointment for. when somebody schedules an appointment for an abortion, they know what they're scheduling their appointment for. And I think to assume that they have never heard about adoption is disrespectful and honestly condescending to a patient. Can I, just one second, I'm sorry, Nicole Severo-Loy had her hand up. I just want to make sure we didn't miss if you had a response to a question. I did have a response and it was just brief on the question regarding if it's just a simple sentence or simply providing information. An additional point that Colour is focusing on is accessibility. And there is no, aside from the mention of using plain language, it does not provide additional information or resources if the client or the patient cannot speak English or does not have English proficiency. So if these pre-created items that exist already in English maybe do not exist in other languages. There is also an accessibility concern to make sure that folks are educated in the decisions that they're making and able to use the resources given to them by the providers. Thank you Okay Representative Garcia Thank you Just a quick follow Because looking at the bill even with including the amendments it does say that the person has the right to decline the discussion So I guess I'm not sure why we wouldn't offer it, and the person does have – it has to be a willing health care provider. It says if willing, and also unless the person declines the discussion. So it seems pretty permissive. Representative, sorry, Ms. Gersie? Ms. Hughes. Thank you. Adoption can be a meaningful path for some people and families, and the issue here is not adoption. The issue is whether the legislature should require providers to introduce a specific topic before a patient can access abortion care, which interferes with Colorado's existing legal protections for reproductive health care. Representative Johnson. Thank you, Madam Chair. And I just want to go back to, ma'am, when you said it could be offensive to a patient, I would say it's almost actually compassionate care if we're looking at somebody in a very vulnerable state that's dealing with a medical. This could be, I mean, and I say it because I was on chemo. And so I did not find it offensive when they said, okay, you have the options of getting your leg game amputated you can go on chemo you can go on radiation you can try holistic care i was in an emotional state and so i wanted those options and i could have said no to all of them i chose which one so i would think for compassionate care for all women that just so they know what their options are because once they're dead set on what they want they know their body best but let's give it to them because they're in a high emotional stage and so i say that's actually compassionate care to give more information feedbacks on that miss garcia thank you representative for your question. I think there's a couple of points. So one, as stated previously, providers do offer information about adoption and even referrals when it is relevant to a patient. So what we are talking about here is a legally mandated conversation, and that doesn't belong in an exam room. Our patients need compassionate, timely care. I will also mention here that adoption is an alternative to parenting, not an alternative to pregnancy. Ms. Allison had her hand up. Hi, yes. I just wanted to add, when I was in the emergency room many years ago with my wife, she had an ectopic pregnancy. And in that emergency room, our options were were a medical abortion, because that was our option, because otherwise she would bleed out. If the doctor had said that was our option, and then later came back and had to say, oh, would you like to hear about adoption? It's entirely tone deaf. We would have lost all respect for that doctor, especially if we didn't know this law existed. Representative Bradley, we have a minute left for this panel. Thank you, Madam Chair. I don't think we're going to offer adoption if somebody's bleeding out, but I could be wrong. When it's deemed relevant at Planned Parenthood, which I don't even know what that means. Maybe you can give me some examples of how a doctor deems something relevant. How is the pregnancy option counseling done? Is it an individual or group type of thing? Anyone like that? I have a hand. Okay. Okay we move on with last 30 seconds Representative Boog Madam Chair actually I had the same question We keep hearing when it is relevant so I guess there no answer to that Any other additional questions? Ms. Gulick. I think to address Representative Johnson, when you are seeing an oncologist for options related to cancer treatment, That oncologist is the most versed person in that kind of medical facility to be able to walk with you to discuss all of those options. I think what we're saying or what I'm saying here is we are not the most versed people. And there are people who have dedicated their lives to working with parents who relinquish and adoptees. And that is who needs to have these discussions. and yes, the option to refer out to those is not off the table. It is just not appropriate to place that big of a burden on people who do not have that education. Okay, thank you so much. The time has passed for this panel. We appreciate your participation. Thank you for joining us today. We're going to move on to our next panel. We'll call up Adeline Hayes, Dr. Tom Peril, Cindy Sarai, and Christy Neely. Okay, and it looks like we'll add a few other folks to that. Tamara Worth, Wendy Smith, Tracy Wilkie, and Katie Klazquin. Any of those folks online? Okay, great. Okay, while we're pulling up, folks, we'll go ahead and start. Why don't we start with Adeline Hayes. You can unmute, say your name, your organization that you represent, and you have two minutes. Thank you Madam Chair and members of the committee for hearing me today. My name is Adeline Hayes. I'm 14 years old and a freshman in high school. I spent the majority of my life in foster care and in turmoil. Today, I am thriving because someone chose adoption and it changed the trajectory of my life completely. I'm here today to ask you to vote yes on House Bill 26-1105. When I was two years old, I entered the foster care system for the first time. My birth parents continued to abuse and neglect my siblings and I. And at six, I entered the foster care system in Colorado, where over the next seven years, I was in 35 different placements. At the age of 12, I was finally adopted by my family now, the Hays. They took me in knowing all of my struggles and trauma and stuck with me when no one else would. Even though the first 12 years of my life were something no child should endure, I have now recognized that I have something to give to the world. These women may be in extremely trying places like I was, feeling as though they don't have any other options. I want these women to be empowered like I am today, because of adoption. This bill ensures that pregnant women are given information about adoption as one possible outcome of pregnancy before making any final decisions. My career goal is to become a social worker because of the impact they made on my life over my time in foster care and giving me hope My adoption by God grace has given me worth and a purpose Can you please do the same for these women and children Ensuring that women know that adoption is an option means more children like me one day have the same chance. Thank you very much. Thank you for your testimony. Let's move on to Tamara Axworthy. Good afternoon, Madam Chair and members of the committee. Thank you for the opportunity to testify today. My name is Tamara Axworthy, and I am here representing the Colorado Pregnancy Care Alliance, a network of pregnancy centers across our state that serve women and families facing unexpected pregnancies. Through this work, we regularly meet women who are trying to make sense of difficult situations and important decisions. One thing we consistently see is that information matters. Many women believe that there are only two options, parenting and abortion. Very few fully understand what adoption can look like today. They often picture outdated stories from decades ago rather than the modern reality of open adoption, supportive adoptive parents, and ongoing relationships that can exist. Adoption is not something I encounter, is not only something I encounter in my personal and professional work, it's also part of my family story. My father was adopted from Italy to the United States as a child because someone chose adoption, he was given opportunities that shaped his life and ultimately shaped mine as well. Later in life, adoption touched my story again when I was adopted by him as an adult, formally becoming his daughter. It is a powerful reminder that adoption is not just about placement. It's about family, belonging, and lifelong connection. House Bill 26-1105 is a simple step that ensures women are offered information about adoption before making a life-altering decision, unless they choose to decline the conversation. The bill does not require anyone to choose adoption. It simply ensures that women know the option exists. In our experience, when women learn what modern adoption looks like, many of them say, I didn't know adoption could be like that. Providing information and time to consider respects women and helps ensure that their decisions are fully informed. For these reasons, I respectfully ask that you support House Bill 26-1105. Thank you for your time and your consideration. Thank you for your testimony. We'll move on to Gracie Wicke. You're on mute. We still can't hear you. No, still mute. Why don't we give you a minute and you can try to work that out. Perfect. Okay, let's move on to Wendy Smith. Thank you, Madam Chair and members of the committee. My name is Wendy Smith. I'm a retired acute care nurse practitioner with over 40 years experience initially as an Air Force nurse in critical care and aeromedical evacuation and then as a nurse practitioner in hematology oncology. informed consent was a critical part of my job throughout and I'm here as a member of the American Association pro-life OBGYNs in support of HB 2611 in medicine informed consent is a foundational ethical principle patients deserve clear complete and unbiased information about all available options before making a life-altering decision pregnancy decision should be no different I would also insert that to say that women know what they're going for when they go for an abortion does lack some empathy, as I've seen the opposite. in women who've been trafficked that I have known. True informed consent should include discussion of all possible pregnancy outcomes, including adoption. Even organizations with very different perspectives on abortion agree that women deserve complete information. Physician and other healthcare professionals with American Association of Pro-Life OBGYNs affirm the importance of full disclosure in pregnancy counseling, stating that ethical medical care requires women to receive accurate information about pregnancy, fetal development, and the options available to them so they can make truly informed decisions. The Guttmacher Institute states that informed consent requires providing complete, accurate, and unbiased information on all pregnancy options, including parenting, adoption, and abortion. And the American College of Obstetricians and Gynecologists likewise emphasize patient autonomy requires patients adequately be informed of all options. Providing information about adoption does not pressure women. It empowers them. And when a decision carries lifelong consequences, withholding options is not compassionate care. It is incomplete care. Presenting adoption as an option does not limit choice. It ensures that women truly have choice. Thank you. I respectfully ask you to support. Thank you. Thank you so much for your testimony. It looks like Gracie Wicke might have gotten her audio working. Do you want to go ahead and try? Yeah. We can hear you. Yay. Please, please go ahead. I hope you just pushed mute. You can go ahead. Okay. Okay. So sorry. My name is Gracie Wicke, Madam Chair. Thank you for hearing me today. I represent a yes vote for this cause. I'm a mom, and at one point in time, several years ago, when I was 20 years old, I was forced into having an abortion by my parents. When I went into the appointment that they told me would take care of the situation that I was in, I didn't even know that I was there for an abortion. But it was right here in Colorado at the Fort Collins Planned Parenthood Clinic. Like, if somebody would have spoken to me about a different option, I would have a different life. I went home after that appointment and I knew in my heart that I had killed my own child. How can you do such a thing? I thought the only thing that I could do was take my own life, a life for life. That's what mattered. and praise be to God, that's not what happened. My story is different. Life took over. Now I'm the proud mom of nine children. One of them is my beloved daughter, Elizabeth, who we adopted. She is the light and shining, just radiance to the whole world. She's my best friend. I can't imagine life without her. And I can only imagine that perhaps somebody else could have that someday if they knew that their child could also bring such joy to the world. Where I look and see that life was never for my child, perhaps someday here in Colorado, life could be for another person. And that life could be given to help complete a family. My son his name is Jeremiah he autistic and without Elizabeth he would be lost She is the best therapy that anyone could ever give a child and their lives together are wonderful Thank you for your time Thank you so much for your testimony. Moving on to Katie Clasquin. Thank you, Madam Chair and members of the committee for the opportunity to testify today in support of House Bill 26-1105. My name is Katie Clasquin, and I have been an options counselor for nearly seven years with Nightlight Christian Adoptions. Adoption is a loving option that has brought hope and stability to countless children and families and should be discussed in order to ensure informed consent. I have walked with many parents who have faced unplanned pregnancies, and they often reflect on the fear and confusion that exists upon learning of their pregnancies. Pregnancy can be an overwhelming time and people deserve clear, accurate information about all of their options. That's why informed consent matters. When someone understands what adoption can look like, for example, they will select the adoptive family. They will have an options counselor walking alongside them throughout the entirety of their pregnancy and after the child is born. And that they can have an ongoing relationship with their child. They are better equipped to make a decision that reflects their values, their circumstances and their future. For years, I have seen adoption impact all members of the triad in incredibly beautiful ways, and my birth parent clients reflect the same sentiment. Many of them never knew adoption was an option or had no idea what modern-day adoption looked like until their medical provider had shared with them. These parents have had the joy of watching their children be raised in loving and stable homes that they otherwise did not believe they could achieve for their child. These children get to grow up knowing their birth parent loved them enough to make an incredibly sacrificial decision. And adoptive parents have the opportunity to love on a child and birth parent in need. Just some statistics about our agency. Currently, Nightlight has 85 adoptive families waiting to be matched with a birth parent. And in 2025, we worked with 248 placing parents. And of those clients, only 54 placed for adoption. So they're not held or mandated to placing for adoption just because they're working with an adoption agency or have been referred to them. This bill simply ensures that information about adoption is available to those who may want it. Importantly, the conversation can always be declined, which respects personal autonomy while still making sure the option is visible. Health care providers also do not have to be experts on the complexity of adoption in order to be informed or in order to inform their clients. Thank you so much for your testimony. We're moving on to Ms. Neely. Welcome back. You're on mute. Hi. Thank you so much for the opportunity to testify. My name is Christy Neely. I'm a mother of five. One of my daughters was adopted at birth. She's now 16 years old. 16 years ago a brave woman faced an incredible difficult situation but because of that courageous decision my daughter's alive today she laughs she dreams she brings joy to her home every day our family exists as it does because she was given the option to consider adoption this is a simple reasonable bill that ensures when a woman's considering abortion she's offered information that's all it is it doesn't require anything it simply gives that option for information it can simply be a comment to say have you considered adoption Would you like that conversation And then someone can refer her. They don't have to know all the ins and outs. But I feel like this is a really important option to be able to give. Thank you for your time. Thank you so much for your testimony. Okay, any questions for this panel? Representative Garcia-Sander. Thank you, Madam Chair. I don't think I have any questions, but for Adeline Hayes, I just want to say you're a champion. Thanks for sharing, all of you, thanks for sharing your stories. But Adeline, your story is a bright spot today and very motivating, I'm sure, for a lot of kids who are out there who have been adopted and are looking forward to also being champions of adoption. Representative Bradley. Thank you, Madam Chair, and thank you for all of your testimonies. Ms. Neely was with us here very late in state affairs last night, so thank you for returning and sharing your story. Ms. Axworthy, do you think that this bill would create additional burdens for providers? And then could you also tell us how adoption works, in your opinion? Ms. Neely? Oh, I'm sorry. Thank you for the question. I'm sorry. Ms. Axworthy. There you go. Thank you for the question, Bradley. No, I do not feel as though this would create additional burdens. My understanding is that the bill simply requires offering the conversation and information, not providing adoption services directly. So that keeps the requirement very focused as well as manageable. And then the second part of your question was about how modern adoption works. I believe Katie is the professional here, but I do think that there's a lot of people who are miss under who misunderstand what modern adoption looks like. Today, many of those adoptions are open, completely open, semi-open, meaning that the birth mother really has the autonomy to not only choose the family, but often to maintain a level of communication and relationship over time with that family. One of the first clients that I saw myself here at the Pregnancy Center was a 17-year-old couple who came in, and they were looking for an abortion. It was after hours. I was just working on IT stuff, was able to have a conversation with them, offered the opportunity to discuss adoption. They both came back the next day, ended up choosing adoption, and they still have a relationship with that child seven years later. So that's an example and one of my absolute favorite stories of my time working at the Pregnancy Center. Was there another part to your question? Representative Bradley. Okay. No? Additional questions for this panel. Seeing none, thank you so much for your participation. We really appreciate you being here today. Okay, let's pull up our remaining folks. So Scott Shamblin, Charity McPike, Christina Blunt, Lloyd Benez, Dr. Catherine Wheeler, Amy Persons-Birch Scott Horak and Beverly Jacobson Is there anyone else in the room or online, please come forward that would like to testify Okay we will go ahead and get started I will start from my left to my right If you could introduce yourself your organization that you represent and you have two minutes It is not So it the exactly Oh, it is that little tiny thing. My name is Christina Blunt, and I'm here representing myself. I live up in Fort Collins, and somebody had asked earlier how many people had chosen life when they were given a different option. I can tell you for a fact that 50 women chose life at the Planned Parenthood in Fort Collins, Colorado. Kevin Williams made those conversations with those women and he had a baby named after him after his giving them a different option besides just aborting their baby. I sit before you as a woman who has been pregnant six times. I've had four abortions. I miscarried the first time. I have one child. What they don't tell you about abortion is that they ablate your uterus. They cauterize your uterus when they take the baby out of your body. I had five babies die inside of me so it's a little emotional so the procedure is the same so whether your baby is alive or dead it is an abortion and what they don't tell you is that you may be killing your one shot to have a baby I have a friend who killed her one shot to have a baby and she's upset about it to this day and she's in her 50s the detriment that was to me they didn't tell me that was an emergency situation, but they didn't tell me they were going to cauterize my entire uterus, the entire uterus. When you take a thing and then it's hot and it burns it, it leaves next to no place for a baby to attach to ever again. I went through six pregnancies. My daughter was my fifth pregnancy. And by the grace of God, I had her. When I finally had my uterus removed, it looked at me and they said, why is your uterus look like it's been ablated? that's because of the miscarriages I've had that fully ablated my uterus. There was nowhere for her to attach, which is why I lost them all. So that's one thing they don't tell you about it. And I am in full support of adoption and giving the women the choice when they're hormonal and they're emotional and they don't have any choices and all you're offering is abortion. So I'm in full support of making the option available to the women so they can adopt their baby out and still maybe have a baby later. Thank you so much for your testimony. Please proceed. You're good? Okay, my name is Pamela Douglas. I have 50 years in the field of being an RN, and my field was maternal child nursing. And I am an award-winning nurse in my field. I'm an expert witness. And it was maternal child services.

Thank you so much for your testimony. God bless you all. Please proceed.

the Colorado Bishops, I urge you to vote yes. Thank you for your testimony. We'll move online to Ms. Metzke. Welcome back. Madam Chair, members of the committee,

Thank you for your testimony. Let's move on to Ms. Persons Birch. If you are speaking, we cannot hear you. It looks like you're still on mute.

Thank you so much for your testimony. We'll move on to Charity McPike. Hi there. Thank you so much.

and overdose. Thank you so much for your testimony, Dr. Wheeler. We'll move on to Beverly Jacobson.

Yes. Thank you for your testimony. We'll move on to Scott Shamblin. Mama named her right.

Thank you so much for your testimony. Questions for this panel?

Ms. Blunt. My abortions were all in hospitals because they were missed miscarriages where the baby had died inside of me, but they did not inform me as to what exactly that was going to entail and how it was going to damage my uterus in such a way that it would make it very difficult to have children ever again. So I went through six pregnancies over six years. And every pregnancy, they made me come back, and I had to keep getting counts for six weeks of whether I was going to have a baby or not because my uterus had been so damaged from the DNC to remove the babies. They didn't tell me that, and they didn't tell me. I had no education as to what was going to happen before the procedure. And I assume that when women are going in to abort live babies, they're not telling them that this may be your one and only shot. And so I am, as you can see, it was having six babies, being pregnant six times over six years, and not having that education, and not knowing the damage that was going to be done to my uterus. I probably, I mean, in this situation, I didn't have a choice, but I know what it does for women who do have a choice. And I do know a woman who regrets and was never informed about the fact that she could maybe possibly never, ever, ever be a mom. And so I'm full of support. When you buy a car, when you buy a house, when you buy whatever, you have a three-day rescission rate. They pump the brakes, and they give you a window of time to make a decision to make sure that you want it. And people having a problem with the 24 hours, pump the brakes for an emotional, hormonal, mostly young woman to make a decision that could very well end her life. A woman just died in Fort Collins in the Planned Parenthood up there across from CSU. Another one died a year ago. So it's called Planned Parenthood, not planned kill your baby. So I don know exactly where the parenthood goes I know you a little challenged by that But where is the option Where is the choices Why are we funding the abortion clinic and not the moms Why are we funding adoption centers and not the moms? I don't understand all of this. So I'm in full support of pumping the brakes and giving a young woman the opportunity to make a decision. Because in this state, you can abort at any time, clear up until birth. So there's no time limit here. What is three days? What is three days? What is one day? I mean, if you buy a car, you have three days to change your mind. You don't have any change. There's no change in your mind after you do this.

I move L002 to House Bill 1105.

Representative Bradley seconds.

Representative Slough.

This amendment, it takes it back to the original intent of the bill, making sure that we are not doing anything that really is in reference to abortion. That was not the intent of the bill. The bill merely and totally was meant to just provide information about adoption, and so we've just removed some of that language and made sure that that is clear.

Representative Flannell. Thank you. I just want to thank everybody who came out and testified. I know that it is definitely an emotional topic, and I feel for everyone, even those who are opposing the bill. Again, as my co-prime sponsor and I have said, This is not a bill that is taking away abortions. It doesn't, it's not meant to prevent people from getting an abortion. It's just merely stating their options. And I think that, you know, I wonder if I hadn't become a legislator and learned about a lot of these organizations that are available, would I have known about that? And I think that that is problematic. And so I think that women deserve choices. so that they can take that knowledge and then make the best choice for them. Thank you. Representative Slott. Thank you, Madam Chair. I appreciate everybody that has testified, all of you on the committee that have listened to us and to those that have come for our panels All of these points that have been made both for and against are part of the discussion a discussion that I will likely never set down and I very much appreciate all of the perspectives that come in this conversation I appreciate and understand the concerns that have been brought forward and hope to help to bring them in sync with our intent here today. I appreciate the words from the witness from Colorado Right to Life speaking to our amendment. The things that were in the amendment were points that I had shared as concerns with the unamended bill, and so I'm grateful for the continued prompt to get that amendment completed and to clarify some of the intent of the bill. As I stated in my introduction, we are open to continued discussion and or amendments. This bill is in no way intended to block informed and decided women from seeking any of the options that are available to them. And this bill is only intended to ensure that an avenue to complete and accurate and unbiased information, and I would reemphasize complete, is always provided because I do not believe that it is always equitably provided. We heard today a number of times concerns about health care when an ectopic pregnancy is a situation. Let me be clear. I am here because my mother had an ectopic pregnancy and had to choose adoption as her path for becoming a mother. I'm grateful that after that experience, she was able to learn about adoption. I wish that she could be here for you all to meet. I'm also grateful for my wonderful birth mother, Marilyn, who I was able to meet about not quite 10 years ago. She is fantastic, and I would blame her for any of the problems that you have with me, because it is genetic. I'm also lucky to have gone from one brother, who was also adopted, to seven siblings, aside from that brother, including three sisters that I never had the opportunity to have as a child, and it probably shows sometimes. So that said, I'm grateful for the opportunity to bring this bill forward. I hope that we can continue this conversation on the floor and hope that if there are any amendments or concerns that folks have that they will bring them to us and that we can continue to work on this and ask for your support and yes votes. Thank you.

Representative Bradley. I move House Bill 261105 to the Committee of the Whole and ask for a favorable recommendation. As amended, I knew it, as amended.

Representative Bradfield seconds.

Representative Garcia-Sander. Thank you, Madam Chair. Thank you so much to the bill sponsors for bringing this bill. My husband and his best friend growing up always talked about being the last of the pre-Roe v. Wade babies, being born at the end of 1970. And we've had good friends that have adopted children in the last 20 years, and it's getting harder and harder to find children to adopt, actually. We don't have enough babies. People are not having enough babies to adopt. And so I guess I'll be a hearty yes on this, but I do hope that there's genuine interest in supporting a campaign to promote the adoption option. If this bill doesn't pass, I hope that down the road that we can get on board with promoting the adoption option. if it's a PSA campaign or whatever that looks like. It does take money, so that where we at in our state but I appreciate you bringing the bill forward Thank you Additional comments Representative Bradley Thank you Madam Chair And thank you bill sponsors for bringing this forward My stepbrother was adopted by two teenage children who decided to carry him and then give him a very wonderful life. I myself, after struggling with four years of infertility, looked down the adoption realm, too, because I didn't know if I was going to be able to have a child. And so when people are talking about this, I think that it needs to be clear that we're not arguing an abortion. I think about all the families like me that were waiting that I was not able to have a child for four years and wondering what I was going to do. And there's so many people that maybe don't want to have a baby but want to give somebody else like me the ability to be a mom. So I think that that's more what this bill is and not the politics involved in abortion or not given abortion. I also, as a health care provider, have a really hard time with this lack of informed consent that we have in the state. And it really bothers me for vaccinations, for puberty blockers, for abortion. And it's disappointing and disheartening to me because when I have a patient that's going to go through surgery, I sit them down with models and tell them all the risks and complications. With my son, who almost just died a couple months ago, has had major, major surgeries that you guys have seen, graphic pictures about. They sit us down and tell us, like, these are the hard choices that you're going to have to make. And we have that informed consent. And I'm so grateful to these doctors in Utah for giving that to us because as a parent to a 19-year-old, that doesn't stop. I have to make some really hard choices for him, but I need to know all of the risks and rewards to that. And I don't understand why we're not providing that to some women that came and testified. I'm grateful for this. I think that women should be provided all the opportunities and the choices. And I think if they come in wanting an abortion, that's not going to change anything. I don't think this is going to dissuade women from doing that. I think that, and I had a chance to speak to the representative from Planned Parenthood because I didn't get an answer and she gave it to me. If a woman comes in and has a pregnancy test, then it's relevant to talk to them. And so that was a great example for me to hear. And I wish that we gave these women more opportunities because I think that I had looked at statistics and it said 33% of women report some level of regret within a year of an abortion, 11% report intense or severe regret. So if we could change that stigma and give them the opportunity to provide a family like mine the ability to be able to adopt a child, I think that that would change the mental health game in the state. I will be a joyful yes. Thank you. Representative Johnson. Thank you, Madam Chair. Thank you, sponsors. I love this bill because it's the definition of giving women choice. What our good colleague just said was, you know, there could be consequences on the road or regret. I don't think anyone ever regrets taking a couple of seconds or a minute or two to be asked what they might think is a redundant question. So many times in health procedures, you're asked multiple times before a surgery, before you pay, before you do a consultation. Sign this line. Sign this line. Are you sure this is what you want? Can you double confirm? We're going to have you tell us to another staff member. I think in terms of this, that redundancy is key. While it might seem annoying, those couple of seconds are not something people remember down the road. but not having all their options does lead to regret. It does lead to concerns and remorse or even some mental health issues. So I'm very much in favor of our bill and I love the option that as soon as the provider says, would you like information And then if they decline, they had the option. I love that choice, and I think a couple of seconds just to have that redundancy to make sure there are no regrets down the line is way more valuable, especially when we give choice to women. So thank you so much. I'll be a strong yes.

Thank you, Madam Chair. Thank you to both of you for bringing this bill. It's just another bit of information that every woman will use and can use, and I appreciate that. Today, of course, I'm going to be a very enthusiastic yes.

Thanks, Madam Chair. Thank you, representatives, for thinking through, you know, ways we can address and increase adoption, which I think is one of the things you are looking to address. I appreciate your passion for it, and I appreciate that you're open to kind of keep learning and refining. I'm not there today. I think one of the things that's missing for me is when you are working on legislation and you name specific people that are going to be responsible for implementing it that you engage with those groups So I hope you talk with them and hear more about how they view this and what they perceive as some of the barriers to adoption so that you can come with some comprehensive legislation that will get that outcome.

Thank you, Madam Chair. I want to thank everybody who came out and testified today, and I absolutely think adoption is great. It is absolutely amazing. People in my own family have been adopted. But I truly believe women are intelligent enough to know what choices they want for their health care needs, and I feel someone telling them, oh, wait, we don't think you thought of this, is just badgering them in their decision. So I will be a strong note today. Thank you.

I know Representative Sla and I have had extensive conversations about both of our passions for adoption. I have two amazing kids that I adopted and really appreciate, Representative Sla, your perspective in wanting that to be an option for as many people as possible. And so I appreciate that I do like I said in some of the questions want this to be further upstream and would welcome the opportunity to work with you on something that would promote adoption broadly in the state And I think both CDPHE and CDHS work on campaigns like that, And so I think a particularly good option for making sure that we have women who know that that is an option and then that kids get to go to families that have that capacity and willingness. So I appreciate your efforts today.

Representatives of Bradfield.

Bradley.

English.

Frey.

Garcia Sander.

Amrick.

Johnson.

Cormac.

Wrighton.

Stewart.

Wook.

Leader.

Madam Chair.

I move to postpone indefinitely in the reverse order of the roll call Second Representative for eight seconds

Representative Johnson objects.

So we need a new motion to postpone the bill indefinitely. Vice Chair Leader, would you like to move to postpone the bill indefinitely?

Representative Foray seconds.

No.

Nope.

Yes.

Yes.

No.

Yes.

No.

Yes.

Yes.

Yes.

No.

Yes.

Yes. It passes on a count of 8 to 5. With that, the Health and Human Services Committee is adjourned.