Health Assurance and Health Service Districts

C.R.S. tit. 32, art. 19
in effect

C.R.S. § 32-19-101 Legislative declaration

32-19-101. Legislative declaration. The general assembly hereby finds, determines, and declares that access to health-care services is an increasing problem in Colorado and that some Coloradans do not have access to a primary care provider. It is the intent of the general assembly to ease the strain on Coloradan's health-care needs by allowing a special district to be created to provide health-care services and facilities.

C.R.S. § 32-19-102 Definitions

32-19-102. Definitions. As used in this article, unless the context otherwise requires: (1) "Court" means the district court in any county in which the petition for organization of the district was originally filed and which entered the order organizing said district or the district court to which the file pertaining to the district has been transferred pursuant to section 32-1-303 (1)(b). (2) "District" means: (a) A health assurance district created pursuant to this article to organize, operate, control, direct, manage, contract for, furnish, or provide, directly or indirectly, health-care services to residents of the district who are in need of such services; or (b) A health service district created pursuant to this article that may establish, maintain, or operate, directly or indirectly through lease to or from other parties or other arrangement, public hospitals, convalescent centers, nursing care facilities, intermediate care facilities, emergency facilities, community clinics, or other facilities providing health and personal care services and may organize, own, operate, control, direct, manage, contract for, or furnish ambulance service. (3) "Eligible elector" means a person who, at the designated time or event, is registered to vote pursuant to the "Uniform Election Code of 1992", articles 1 to 13 of title 1, C.R.S. (4) "Interested party" means a resident or eligible elector of the district or a municipality located in the district.

C.R.S. § 32-19-103 Applicability of "Special District Act"

32-19-103. Applicability of "Special District Act". (1) Except as provided in this article, a district created pursuant to this article shall be governed by the applicable provisions of the "Special District Act", article 1 of this title, including, but not limited to: (a) Part 1 of article 1 of this title containing general provisions; (b) Parts 2 and 3 of article 1 of this title concerning the organization of a special district; (c) Part 6 of article 1 of this title concerning the consolidation of special districts; (d) Part 7 of article 1 of this title concerning the dissolution of special districts; (e) Part 8 of article 1 of this title concerning elections; (f) Parts 9, 10, and 11 of article 1 of this title concerning the board of directors for a special district and the board's general and financial powers; and (g) Parts 13 and 14 of article 1 of this title concerning refunding of bonds and special district indebtedness. (2) The following provisions shall not apply to a district created pursuant to this article: (a) Parts 4 and 5 of article 1 of this title concerning the inclusion and exclusion of territory in a special district; (b) Part 12 of article 1 of this title concerning the levy and collection of ad valorem taxes; and (c) Part 16 of article 1 of this title concerning certification and notice of special district taxes for general obligation indebtedness.

C.R.S. § 32-19-104 Special districts file - notice of organization or dissolution

32-19-104. Special districts file - notice of organization or dissolution. (1) For purposes of complying with section 32-1-104 (2), a district created pursuant to this article shall provide the required notice to the department of revenue instead of the county assessor. (2) For purposes of complying with section 32-1-105, the county clerk and recorder shall file a certified copy of the decree or order confirming the organization or dissolution of a district created pursuant to this article with the department of revenue instead of notifying the county assessor of the action.

C.R.S. § 32-19-105 Service area of district - governmental immunity

32-19-105. Service area of district - governmental immunity. (1) A district shall include all of the territory of one or more municipalities, counties, or other existing taxing entities, as may be proposed. The district shall be a body corporate and politic and a political subdivision of the state. (2) Each of the directors, officers, and employees of the district shall be a public employee for purposes of the "Colorado Governmental Immunity Act", article 10 of title 24, C.R.S.

C.R.S. § 32-19-106 Service plan required - contents - action on plan

32-19-106. Service plan required - contents - action on plan. (1) Persons proposing the organization of a district, except for a district that is contained entirely within the boundaries of a municipality and subject to the provisions of section 32-19-107, shall submit a service plan in accordance with the requirements of section 32-1-202 (1) and shall pay any fee required pursuant to section 32-1-202 (3). (2) Notwithstanding the provisions of section 32-1-202 (2), the service plan for the district shall contain the following information: (a) (I) If the proposed district is a health assurance district, a description of the proposed health services to be provided and the persons who will be eligible to receive those services; or (II) If the proposed district is a health service district, a description of the proposed facilities to be established, maintained, or operated; (b) If the proposed district is a health assurance district, a description of the proposed health services to be provided in conjunction with a health service district, if any, and if the proposed district is a health service district, a description of the proposed health services to be provided in conjunction with a health assurance district; (c) Quality assurance measures; (d) A financial plan showing how the proposed services are to be financed, including the proposed operating revenue derived from sales taxes for the first budget year of the district, which shall not be materially exceeded except as authorized pursuant to section 32-1-207. All proposed indebtedness for the district shall be displayed together with a schedule indicating the year in which the debt is scheduled to be issued. The board of directors of the district shall notify the board of county commissioners of the county in which the district will be located or the governing body of the municipality in which the district will be located, whichever is applicable, of any alteration or revision of the proposed schedule of debt issuance set forth in the plan. (e) A map of the proposed district boundaries; (f) If the district plans to construct facilities, a general description of the facilities to be constructed and the standards of such construction, including a statement of how the facility and service standards of the proposed district are compatible with facility and service standards of any county or municipality within which all or any portion of the proposed district is to be located; (g) If applicable, a general description of the estimated cost of acquiring or leasing land or facilities, acquiring engineering, legal, and administrative services, initial proposed indebtedness and estimated proposed maximum interest rates and discounts, and other major expenses related to the organization and initial operation of the district; (h) A description of any arrangement or proposed agreement with any political subdivision for the performance of any services between the proposed district and such other political subdivision, including the form contract to be used, if available; (i) Information, along with other evidence presented at the hearing pursuant to section 32-1-204, satisfactory to establish that each of the criteria set forth in section 32-1-203, if applicable, is met; and nt with any political subdivision for the performance of any services between the proposed district and such other political subdivision, including the form contract to be used, if available; (i) Information, along with other evidence presented at the hearing pursuant to section 32-1-204, satisfactory to establish that each of the criteria set forth in section 32-1-203, if applicable, is met; and (j) Such additional information as the board of county commissioners of the county in which the district will be located or the governing body of the municipality in which the district will be located, whichever is applicable, may require on which to base its findings pursuant to section 32-1-203. (3) Except as provided in section 32-19-107, the board of county commissioners of each county that has territory included within the proposed district shall constitute the approving authority for the proposed district and shall review any service plan filed by the petitioners of a proposed district in accordance with the provisions of section 32-1-203. The provisions of section 32-1-203 (3.5)(a) shall not apply to a district proposed pursuant to this article.

C.R.S. § 32-19-107 Approval by municipality

32-19-107. Approval by municipality. If the boundaries of a district proposed pursuant to this article are wholly contained within the boundaries of a municipality, the persons proposing the organization of the district shall comply with the provisions of section 32-1-204.5; except that the service plan submitted to each governing body of each municipality shall contain the information required by section 32-19-106 (2). The governing body shall have the authority set forth in section 32-1-204.5 with regard to the review of the service plan.

C.R.S. § 32-19-108 Public hearing on service plan - procedures - decision - judicial review - modifications - enforcement

32-19-108. Public hearing on service plan - procedures - decision - judicial review - modifications - enforcement. (1) For purposes of section 32-1-204 (1) and (1.5), the board of county commissioners of the county in which the district will be located or the governing body of the municipality in which the district will be located, whichever is applicable, shall be deemed to have complied with the provisions of such section if the board or governing body provides written notice of the date, time, and location of the hearing to the petitioners and, at least twenty days prior to the hearing date, publishes notice of the date, time, location, and purpose of the hearing. The published notice shall constitute constructive notice to the interested parties in the proposed district. (2) The provisions of section 32-1-204 (2)(a) shall not apply to a district proposed pursuant to this article. (3) The board of county commissioners of the county in which the district will be located or the governing body of the municipality in which the district will be located, whichever is applicable, shall conduct the hearing pursuant to section 32-1-204 (1.5) and make its decision in accordance with the requirements of section 32-1-204 (3) and (4). The decision of the board or governing body, whichever is applicable, is subject to judicial review in accordance with section 32-1-206; except that, for purposes of judicial review, "interested party" shall have the same meaning as set forth in section 32-19-102 (4). (4) Upon final approval by the court for the organization of a district pursuant to section 32-1-304.5, the district shall conform as much as possible to the approved service plan, and any material modifications to the plan shall be approved in accordance with section 32-1-207 (2). Any material departure from the plan may be enjoined in accordance with section 32-1-207 (3); except that, for purposes of enforcement of the plan, "interested party" shall have the same meaning as set forth in section 32-19-102 (4).

C.R.S. § 32-19-109 Organization

32-19-109. Organization. (1) Except as provided in this section, the organization of a district pursuant to this article shall be governed by the provisions of part 3 of article 1 of this title. (2) For purposes of complying with the provisions of section 32-1-301 (1), a petition for the organization of a district proposed pursuant to this article shall be signed by not less than thirty percent or two hundred eligible electors of the proposed district, whichever number is smaller. (3) For purposes of complying with the provisions of section 32-1-301 (2)(d.1), the petition for organization shall set forth the estimated sales tax revenues for the district's first budget year. (4) For purposes of complying with the provisions of section 32-1-304.5 (2), the court shall determine whether the required number of eligible electors of the proposed district have signed the petition. (5) For purposes of the filing requirements in section 32-1-306, instead of filing a map of the district with the county assessor, the district shall file a certified copy of the findings and order of the court organizing the district with the department of revenue.

C.R.S. § 32-19-110 Time for holding elections - persons entitled to vote at district elections

32-19-110. Time for holding elections - persons entitled to vote at district elections. (1) For a district, regular special district elections shall be held on the date of the general election or on the first Tuesday in November of an odd-numbered year, and any election on the proposal shall be conducted by the county clerk and recorder as part of a coordinated election in accordance with the provisions of section 1-7-116, C.R.S. (2) Notwithstanding the provisions of section 32-1-806, any person who is an eligible elector as defined in section 32-19-102 (3) shall be eligible to vote in an organizational election or any election conducted by the board of directors for a district.

C.R.S. § 32-19-111 Financial powers

32-19-111. Financial powers. [Editor's note: This version of this section is effective July 1, 2025.] Any district created pursuant to this article 19 shall have all of the financial powers described in section 32-1-1101; except that the levy and collection of ad valorem taxes shall be subject to the provisions of section 32-19-115. The district shall also have the power, upon voter approval, to levy and collect a uniform sales tax throughout the entire geographical area of the district upon every transaction or other incident with respect to which a sales tax is levied by the state pursuant to the provisions of article 26 of title 39; except that such sales tax shall not be levied on the sale of cigarettes. Any sales tax authorized pursuant to this section shall be collected, administered, and enforced by the executive director of the department of revenue as provided in part 2 of article 2 of title 29.

C.R.S. § 32-19-112 Sales tax imposed - collection - administration of tax

32-19-112. Sales tax imposed - collection - administration of tax. (1) (a) Upon the approval of the eligible electors in the district at an election held in accordance with section 20 of article X of the state constitution and part 8 of article 1 of this title, the district shall have the power to levy a uniform sales tax throughout the entire geographical area of the district upon every transaction or other incident with respect to which a sales tax is levied by the state pursuant to the provisions of article 26 of title 39, C.R.S.; except that such sales tax shall not be levied on the sale of cigarettes. (b) The sales tax imposed pursuant to paragraph (a) of this subsection (1) is in addition to any other sales tax imposed pursuant to law. (2) [Editor's note: This version of subsection (2) is effective until July 1, 2025.] (a) The collection, administration, and enforcement of the sales tax shall be performed by the executive director of the department of revenue in the same manner as that for the collection, administration, and enforcement of the state sales tax imposed pursuant to article 26 of title 39, C.R.S., including, without limitation, the retention by a vendor of the percentage of the amount remitted to cover the vendor's expense in the collection and remittance of the sales tax as provided in section 39-26-105, C.R.S. The executive director shall make monthly distributions of sales tax collections to the district. The district shall pay the net incremental cost incurred by the department in the administration and collection of the sales tax. (b) (I) A qualified purchaser may provide a direct payment permit number issued pursuant to section 39-26-103.5, C.R.S., to a vendor or retailer that is liable and responsible for collecting and remitting any sales tax levied on a sale made to the qualified purchaser pursuant to the provisions of this article. A vendor or retailer that has received a direct payment permit number in good faith from a qualified purchaser shall not be liable or responsible for collection and remittance of a sales tax imposed on a sale that is paid for directly from the qualified purchaser's funds and not the personal funds of an individual. (II) A qualified purchaser that provides a direct payment permit number to a vendor or retailer shall be liable and responsible for the amount of sales tax levied on a sale made to the qualified purchaser pursuant to the provisions of this article in the same manner as liability would be imposed on a qualified purchaser for state sales tax pursuant to section 39-26-105 (3), C.R.S. (2) [Editor's note: This version of subsection (2) is effective July 1, 2025.] (a) The collection, administration, and enforcement of the sales tax shall be performed by the executive director of the department of revenue pursuant to part 2 of article 2 of title 29. The district shall pay the net incremental cost incurred by the department in the administration and collection of the sales tax. (b) (Deleted by amendment, L. 2024.)

C.R.S. § 32-19-113 District revenues

32-19-113. District revenues. Any revenues raised or generated by the district shall be in addition to and shall not be used to replace any funding the counties in the district would otherwise be entitled to receive from the state or federal government.

C.R.S. § 32-19-114 Cooperation between districts or other existing providers permitted

32-19-114. Cooperation between districts or other existing providers permitted. A health assurance district and a health service district shall each have the authority to contract with or work cooperatively and in conjunction with another health assurance district or health service district, or any existing health-care providers or services to provide health-care services and facilities to the residents of such districts.

C.R.S. § 32-19-115 Levy and collection of ad valorem taxes

32-19-115. Levy and collection of ad valorem taxes. (1) Any district that is created pursuant to this article shall have the power, upon approval by the eligible electors of the district, to levy and collect ad valorem taxes on and against all taxable property within the district subject to the following provisions: (a) For purposes of this section, "eligible elector" shall have the same meaning as set forth in section 32-1-103 (5). (b) The levy and collection of ad valorem taxes shall be subject to the applicable provisions of the "Special District Act", article 1 of this title.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://leg.colorado.gov/sites/default/files/images/olls/crs2024-title-32.docxFetched: 10/6/2026