Archive #63723

Metadata

Bill Number: HB26-1195
HTTP Status: 200
Valid JSON: Valid
Archived At: 2026-05-14 16:20:10 MDT
Created At: 2026-05-14 16:20:11 MDT

Parsed JSON

{
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      "action": "Senate Amendments",
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      "vote_17D": 0,
      "vote_abs": 0,
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      "voice_vote": "N",
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      "vote_result": "Aye: 62 No:  2 Other: 1",
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        {
          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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        {
          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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        {
          "vote": "Y",
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        },
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          "vote": "Y",
          "last_name": "Espenoza"
        },
        {
          "vote": "Y",
          "last_name": "Feret"
        },
        {
          "vote": "Y",
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        {
          "vote": "Y",
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        {
          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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        },
        {
          "vote": "Y",
          "last_name": "Goldstein"
        },
        {
          "vote": "Y",
          "last_name": "Gonzalez R."
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        {
          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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        {
          "vote": "Y",
          "last_name": "Stewart R."
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        {
          "vote": "E",
          "last_name": "Story"
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          "vote": "Y",
          "last_name": "Suckla"
        },
        {
          "vote": "Y",
          "last_name": "Taggart"
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          "vote": "Y",
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          "vote": "N",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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        },
        {
          "vote": "Y",
          "last_name": "Winter T."
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          "vote": "N",
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        {
          "vote": "Y",
          "last_name": "Woog"
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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        },
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          "vote": "Y",
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          "vote": "Y",
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        },
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          "vote": "Y",
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          "vote": "Y",
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        },
        {
          "vote": "Y",
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        },
        {
          "vote": "Y",
          "last_name": "Froelich"
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        {
          "vote": "Y",
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        {
          "vote": "Y",
          "last_name": "Garcia Sander"
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        {
          "vote": "Y",
          "last_name": "Gilchrist"
        },
        {
          "vote": "Y",
          "last_name": "Goldstein"
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        {
          "vote": "Y",
          "last_name": "Gonzalez R."
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        {
          "vote": "Y",
          "last_name": "Hamrick"
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        {
          "vote": "Y",
          "last_name": "Hartsook"
        },
        {
          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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        {
          "vote": "Y",
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        {
          "vote": "Y",
          "last_name": "Lindsay"
        },
        {
          "vote": "Y",
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        {
          "vote": "Y",
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        {
          "vote": "Y",
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          "vote": "Y",
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        {
          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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        },
        {
          "vote": "Y",
          "last_name": "Stewart K."
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        {
          "vote": "Y",
          "last_name": "Stewart R."
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        {
          "vote": "E",
          "last_name": "Story"
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          "vote": "Y",
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        {
          "vote": "Y",
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          "vote": "Y",
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        },
        {
          "vote": "Y",
          "last_name": "Valdez"
        },
        {
          "vote": "Y",
          "last_name": "Velasco"
        },
        {
          "vote": "Y",
          "last_name": "Weinberg"
        },
        {
          "vote": "Y",
          "last_name": "Willford"
        },
        {
          "vote": "Y",
          "last_name": "Winter T."
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        {
          "vote": "Y",
          "last_name": "Woodrow"
        },
        {
          "vote": "Y",
          "last_name": "Woog"
        },
        {
          "vote": "Y",
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        {
          "vote": "Y",
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      "vote_date_time": "05/12/2026 05:50:14 PM"
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      "vote_result": "Aye: 33 No:  2 Other: 0",
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        {
          "vote": "Y",
          "last_name": "Amabile"
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        {
          "vote": "Y",
          "last_name": "Baisley"
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        {
          "vote": "Y",
          "last_name": "Ball"
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        {
          "vote": "Y",
          "last_name": "Benavidez"
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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        {
          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
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        {
          "vote": "Y",
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        {
          "vote": "Y",
          "last_name": "Gonzales J."
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        {
          "vote": "Y",
          "last_name": "Hinrichsen"
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        {
          "vote": "Y",
          "last_name": "Jodeh"
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        {
          "vote": "Y",
          "last_name": "Kipp"
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          "vote": "Y",
          "last_name": "Kirkmeyer"
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          "vote": "Y",
          "last_name": "Kolker"
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          "vote": "Y",
          "last_name": "Lindstedt"
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          "vote": "N",
          "last_name": "Liston"
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          "vote": "Y",
          "last_name": "Marchman"
        },
        {
          "vote": "Y",
          "last_name": "Mullica"
        },
        {
          "vote": "Y",
          "last_name": "Pelton B."
        },
        {
          "vote": "Y",
          "last_name": "Pelton R."
        },
        {
          "vote": "Y",
          "last_name": "Rich"
        },
        {
          "vote": "Y",
          "last_name": "Roberts"
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          "vote": "Y",
          "last_name": "Rodriguez"
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          "vote": "Y",
          "last_name": "Simpson"
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        {
          "vote": "Y",
          "last_name": "Snyder"
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          "vote": "Y",
          "last_name": "Sullivan"
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        {
          "vote": "Y",
          "last_name": "Wallace"
        },
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          "vote": "Y",
          "last_name": "Weissman"
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          "vote": "N",
          "last_name": "Zamora Wilson"
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          "vote": "Y",
          "last_name": "President"
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      "vote_date_time": "05/11/2026 10:57:46 AM"
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
          "last_name": "Bottoms"
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          "vote": "Y",
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          "vote": "Y",
          "last_name": "Bradley"
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          "vote": "Y",
          "last_name": "Brooks"
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          "vote": "Y",
          "last_name": "Brown"
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          "vote": "Y",
          "last_name": "Caldwell"
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        {
          "vote": "Y",
          "last_name": "Camacho"
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        {
          "vote": "Y",
          "last_name": "Carter"
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        {
          "vote": "Y",
          "last_name": "Clifford"
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        {
          "vote": "Y",
          "last_name": "DeGraaf"
        },
        {
          "vote": "Y",
          "last_name": "Duran"
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        {
          "vote": "E",
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          "vote": "Y",
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        {
          "vote": "Y",
          "last_name": "Feret"
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        {
          "vote": "Y",
          "last_name": "Flanell"
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        {
          "vote": "Y",
          "last_name": "Froelich"
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        {
          "vote": "Y",
          "last_name": "Garcia"
        },
        {
          "vote": "Y",
          "last_name": "Garcia Sander"
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        {
          "vote": "Y",
          "last_name": "Gilchrist"
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        {
          "vote": "Y",
          "last_name": "Goldstein"
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        {
          "vote": "Y",
          "last_name": "Gonzalez R."
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        {
          "vote": "Y",
          "last_name": "Hamrick"
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        {
          "vote": "Y",
          "last_name": "Hartsook"
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        {
          "vote": "Y",
          "last_name": "Jackson"
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        {
          "vote": "Y",
          "last_name": "Johnson"
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        {
          "vote": "Y",
          "last_name": "Joseph"
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        {
          "vote": "Y",
          "last_name": "Keltie"
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        {
          "vote": "Y",
          "last_name": "Lieder"
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        {
          "vote": "Y",
          "last_name": "Lindsay"
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        {
          "vote": "Y",
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        {
          "vote": "Y",
          "last_name": "Lukens"
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        {
          "vote": "Y",
          "last_name": "Mabrey"
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        {
          "vote": "Y",
          "last_name": "Marshall"
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        {
          "vote": "Y",
          "last_name": "Martinez"
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        {
          "vote": "Y",
          "last_name": "Mauro"
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        {
          "vote": "Y",
          "last_name": "McCormick"
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        {
          "vote": "Y",
          "last_name": "Nguyen"
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        {
          "vote": "Y",
          "last_name": "Paschal"
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          "vote": "Y",
          "last_name": "Phillips"
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        {
          "vote": "Y",
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        {
          "vote": "E",
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          "vote": "Y",
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          "vote": "Y",
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          "vote": "Y",
          "last_name": "Slaugh"
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        {
          "vote": "Y",
          "last_name": "Smith"
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        {
          "vote": "Y",
          "last_name": "Soper"
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        {
          "vote": "Y",
          "last_name": "Stewart K."
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        {
          "vote": "Y",
          "last_name": "Stewart R."
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        {
          "vote": "Y",
          "last_name": "Story"
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        {
          "vote": "Y",
          "last_name": "Suckla"
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        {
          "vote": "Y",
          "last_name": "Taggart"
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          "vote": "Y",
          "last_name": "Titone"
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          "vote": "E",
          "last_name": "Valdez"
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        {
          "vote": "Y",
          "last_name": "Velasco"
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        {
          "vote": "Y",
          "last_name": "Weinberg"
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        {
          "vote": "Y",
          "last_name": "Willford"
        },
        {
          "vote": "Y",
          "last_name": "Winter T."
        },
        {
          "vote": "Y",
          "last_name": "Woodrow"
        },
        {
          "vote": "Y",
          "last_name": "Woog"
        },
        {
          "vote": "Y",
          "last_name": "Zokaie"
        },
        {
          "vote": "Y",
          "last_name": "McCluskie"
        }
      ],
      "lay_over_date": "",
      "vote_date_time": "04/16/2026 10:07:51 AM"
    }
  ],
  "active": "T",
  "origin": "House",
  "lls_num": "26-0298",
  "session": "2026A",
  "subject": [
    "Business & Economic Development",
    "Professions & Occupations"
  ],
  "bill_num": "HB26-1195",
  "sponsors": [
    {
      "id": "GR001",
      "title": "Representative",
      "s_type": "Prime Sponsor",
      "chamber": "House",
      "full_name": "Gretchen Rydin",
      "last_name": "Rydin",
      "first_name": "Gretchen",
      "sponsor_order": "1"
    },
    {
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  "long_title": "Concerning restrictions on the use of artificial intelligence relating to psychotherapy services.",
  "bill_status": "Enroll into an Act",
  "short_title": "Psychotherapy Artificial Intelligence Restrictions",
  "bill_summary": "<html><body><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The bill prohibits licensed, certified, or registered psychologists, professional counselors, social workers, clinical social workers, marriage and family therapists, addiction counselors, or candidates for those credentials, as well as unlicensed psychotherapists and other individuals lawfully permitted to provide psychotherapy services in the state (regulated professionals), from <strike>using</strike> <i>allowing </i> an artificial intelligence system to:<br/></p><p><ul><li> <strike>Directly</strike> <i>I</i> nteract with clients in any form of therapeutic communication <i>without synchronous, real-time interaction between the regulated professional, the artificial intelligence system, and the client; or</i></li><li>Generate therapeutic recommendations or treatment plans without review and approval by <i>the </i> regulated professional <strike>s; or</strike> .</li><li> <strike>Detect emotions or mental states.</strike></li></ul></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <i>Except for educational, administrative, simulation, or training purposes or as part of a research program, a regulated professional shall not use an artificial intelligence system to provide, direct, or guide psychotherapy, clinical intervention, counseling, diagnosis, treatment planning, or other activity that constitutes the practice of psychotherapy with an individual or group unless the use satisfies the conditions specified in the bill.</i></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Under current law, the practice of 'psychotherapy' or 'psychotherapy services' means, in pertinent part: Treatment, diagnosis, testing, assessment, or counseling in a professional relationship to assist individuals or groups to alleviate behavioral and mental health disorders; understand unconscious or conscious motivation; resolve emotional, relationship, or attitudinal conflicts; or modify behaviors that interfere with effective emotional, social, or intellectual functioning. Psychotherapy follows a planned procedure of intervention that takes place on a regular basis or over a period of time, or, in the cases of testing, assessment, and brief psychotherapy, psychotherapy can be a single intervention. The definition of psychotherapy in current law also states that it is the intent of the general assembly that the definition of psychotherapy be interpreted in its narrowest sense to regulate only those persons that clearly fall within the definition.<br/></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The bill allows regulated professionals to use an artificial intelligence system to assist in providing administrative support or supplementary support <i>, as defined in the bill,</i> for psychotherapy services if the regulated professional maintains <strike>full</strike> responsibility for <strike>all interactions, outputs, and data use associated with</strike> <i>reviewing any outputs of </i> the artificial intelligence system <i>used to provide administrative support or supplementary support. The use of an artificial intelligence system is subject to and must comply with state and federal privacy and security laws.</i></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Further, if a client's therapeutic session will be recorded or transcribed through the use of an artificial intelligence system, <i>the client or the client's representative must be informed in advance in writing that an artificial intelligence system will be used and the specific purposes for its use, and</i> the regulated professional must obtain written, informed consent from the client or the client's representative <i>.</i></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The bill does not prohibit <strike>the use of</strike> <i>a regulated professional from using</i> an artificial intelligence system within accredited or approved educational, instructional, or professional training programs, so long as the artificial intelligence system is used solely for educational, administrative, simulation, or training purposes and is not deployed <i>,</i> <strike>or</strike> marketed <i>, or represented as a tool</i> for use with clients, patients, or the public <i>. Any simulation, training module, or educational activity that is generated by an artificial intelligence system and that includes content related to clinical decision-making must be reviewed or controlled by a regulated professional.</i></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The bill also does not prohibit <i>a regulated professional from being involved in </i> the development <i>,</i> <strike>or</strike> testing <i>, or evaluation</i> of an artificial intelligence system solely for research purposes under the oversight of a federally registered institutional review board, so long as the artificial intelligence system is not offered to consumers or used to provide psychotherapy services outside of the research setting.</p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Further, the bill <strike>also</strike> does not <strike>prohibit the use of a technology or service that provides</strike> <i>apply to regulated professionals who use or recommend the use of technology in the state that:</i></p><p><ul><li>Provides self-help, <i>therapeutic homework,</i> coaching, guided meditation, <i>journaling, reflections, psychoeducation, goal setting, progress tracking, therapeutic session preparation and session summaries, mood monitoring, mindfulness exercises, breathing exercises, crisis resource directories, safety planning,</i> or <i>other</i> wellness tools <i>; </i> <strike>and that</strike></li><li>Does not diagnose or treat mental health disorders; and</li><li>Clearly discloses that the technology or service is not a substitute for clinical care.</li></ul></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The applicable board that regulates a regulated professional may take disciplinary action against a regulated professional that violates prohibitions in the bill concerning the use of artificial intelligence systems relating to psychotherapy services.<br/></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The bill also makes it unlawful for an individual, corporation, or entity (person) to provide, advertise, or otherwise offer psychotherapy services to the public in the state <i>, including through the use of an artificial intelligence system,</i> unless the services are provided by a regulated professional.</p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;It is an unfair trade practice under the 'Colorado Consumer Protection Act' for a person to use a term, letter, or phrase in the advertising, interface, or outputs of an artificial intelligence system that indicates or implies that the artificial intelligence system's output data is endorsed by or equivalent to psychotherapy services provided by regulated professionals or represent that the artificial intelligence system provides psychotherapy services or that users' data or information is confidential. <i>Further, it is unlawful for an artificial intelligence system to provide, direct, or guide psychotherapy, clinical intervention, counseling, diagnosis, treatment planning, or other activity that constitutes the practice of psychotherapy with an individual or group unless the use satisfies the conditions specified in the bill.</i></p><p><br/><i>(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)</i><br/><br/><br/><i>(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)</i></p></body></html>",
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  "bill_category": "Behavioral Health",
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      "amendment": "L.003"
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      "date": "03/04/2026 04:51:36 PM",
      "vote": "Passed*",
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      "hearing": "HOU Health & Human Services",
      "url_html": "https://s3-us-west-2.amazonaws.com/leg.colorado.gov/2026A/amendments/8D2F5A459740ADD287258DB0005611DF/HB1195_L_002.html",
      "amendment": "L.002"
    }
  ],
  "full_bill_topic": "Psychotherapy Artificial Intelligence Restrictions",
  "long_bill_files": [],
  "GHG_report_files": [],
  "preamended_files": [
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      "date": "03/05/2026",
      "label": "PA1",
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      "lastModified": "03/05/2026 01:15:32 PM",
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      "lastModified": "03/04/2026 06:49:57 PM",
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  "session_laws_files": "",
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      "action": "House Second Reading Special Order - Laid Over Daily - No Amendments",
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      "action": "House Second Reading Laid Over Daily - No Amendments",
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      "date": "03/04/2026",
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      "lastModified": "03/05/2026 04:53:14 PM"
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      "date": "05/06/2026",
      "label": "S_HHS_2026A",
      "url_html": "https://www.leg.state.co.us/CLICS/CLICS2026A/csl.nsf/0/C78A6D3DF4F77C1A87258D1F005B1C1A/$File/HB1195_S_HHS_001.html",
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  "first_chamber_third_reading_date": "04/16/2026",
  "second_chamber_third_reading_date": "05/11/2026"
}

Raw Response

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prohibits licensed, certified, or registered psychologists, professional counselors, social workers, clinical social workers, marriage and family therapists, addiction counselors, or candidates for those credentials, as well as unlicensed psychotherapists and other individuals lawfully permitted to provide psychotherapy services in the state (regulated professionals), from <strike>using</strike> <i>allowing </i> an artificial intelligence system to:<br/></p><p><ul><li> <strike>Directly</strike> <i>I</i> nteract with clients in any form of therapeutic communication <i>without synchronous, real-time interaction between the regulated professional, the artificial intelligence system, and the client; or</i></li><li>Generate therapeutic recommendations or treatment plans without review and approval by <i>the </i> regulated professional <strike>s; or</strike> .</li><li> <strike>Detect emotions or mental states.</strike></li></ul></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <i>Except for educational, administrative, simulation, or training purposes or as part of a research program, a regulated professional shall not use an artificial intelligence system to provide, direct, or guide psychotherapy, clinical intervention, counseling, diagnosis, treatment planning, or other activity that constitutes the practice of psychotherapy with an individual or group unless the use satisfies the conditions specified in the bill.</i></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Under current law, the practice of 'psychotherapy' or 'psychotherapy services' means, in pertinent part: Treatment, diagnosis, testing, assessment, or counseling in a professional relationship to assist individuals or groups to alleviate behavioral and mental health disorders; understand unconscious or conscious motivation; resolve emotional, relationship, or attitudinal conflicts; or modify behaviors that interfere with effective emotional, social, or intellectual functioning. Psychotherapy follows a planned procedure of intervention that takes place on a regular basis or over a period of time, or, in the cases of testing, assessment, and brief psychotherapy, psychotherapy can be a single intervention. The definition of psychotherapy in current law also states that it is the intent of the general assembly that the definition of psychotherapy be interpreted in its narrowest sense to regulate only those persons that clearly fall within the definition.<br/></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The bill allows regulated professionals to use an artificial intelligence system to assist in providing administrative support or supplementary support <i>, as defined in the bill,</i> for psychotherapy services if the regulated professional maintains <strike>full</strike> responsibility for <strike>all interactions, outputs, and data use associated with</strike> <i>reviewing any outputs of </i> the artificial intelligence system <i>used to provide administrative support or supplementary support. The use of an artificial intelligence system is subject to and must comply with state and federal privacy and security laws.</i></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Further, if a client's therapeutic session will be recorded or transcribed through the use of an artificial intelligence system, <i>the client or the client's representative must be informed in advance in writing that an artificial intelligence system will be used and the specific purposes for its use, and</i> the regulated professional must obtain written, informed consent from the client or the client's representative <i>.</i></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The bill does not prohibit <strike>the use of</strike> <i>a regulated professional from using</i> an artificial intelligence system within accredited or approved educational, instructional, or professional training programs, so long as the artificial intelligence system is used solely for educational, administrative, simulation, or training purposes and is not deployed <i>,</i> <strike>or</strike> marketed <i>, or represented as a tool</i> for use with clients, patients, or the public <i>. Any simulation, training module, or educational activity that is generated by an artificial intelligence system and that includes content related to clinical decision-making must be reviewed or controlled by a regulated professional.</i></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The bill also does not prohibit <i>a regulated professional from being involved in </i> the development <i>,</i> <strike>or</strike> testing <i>, or evaluation</i> of an artificial intelligence system solely for research purposes under the oversight of a federally registered institutional review board, so long as the artificial intelligence system is not offered to consumers or used to provide psychotherapy services outside of the research setting.</p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Further, the bill <strike>also</strike> does not <strike>prohibit the use of a technology or service that provides</strike> <i>apply to regulated professionals who use or recommend the use of technology in the state that:</i></p><p><ul><li>Provides self-help, <i>therapeutic homework,</i> coaching, guided meditation, <i>journaling, reflections, psychoeducation, goal setting, progress tracking, therapeutic session preparation and session summaries, mood monitoring, mindfulness exercises, breathing exercises, crisis resource directories, safety planning,</i> or <i>other</i> wellness tools <i>; </i> <strike>and that</strike></li><li>Does not diagnose or treat mental health disorders; and</li><li>Clearly discloses that the technology or service is not a substitute for clinical care.</li></ul></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The applicable board that regulates a regulated professional may take disciplinary action against a regulated professional that violates prohibitions in the bill concerning the use of artificial intelligence systems relating to psychotherapy services.<br/></p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The bill also makes it unlawful for an individual, corporation, or entity (person) to provide, advertise, or otherwise offer psychotherapy services to the public in the state <i>, including through the use of an artificial intelligence system,</i> unless the services are provided by a regulated professional.</p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;It is an unfair trade practice under the 'Colorado Consumer Protection Act' for a person to use a term, letter, or phrase in the advertising, interface, or outputs of an artificial intelligence system that indicates or implies that the artificial intelligence system's output data is endorsed by or equivalent to psychotherapy services provided by regulated professionals or represent that the artificial intelligence system provides psychotherapy services or that users' data or information is confidential. <i>Further, it is unlawful for an artificial intelligence system to provide, direct, or guide psychotherapy, clinical intervention, counseling, diagnosis, treatment planning, or other activity that constitutes the practice of psychotherapy with an individual or group unless the use satisfies the conditions specified in the bill.</i></p><p><br/><i>(Note: Italicized words indicate new material added to the original summary; 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