4 Colo. Code Regs. § 755-1-4

Current through Register Vol. 47, No. 22, November 25, 2024

Section 4 CCR 755-1-4 - APPROVED FACILITATOR TRAINING PROGRAMS

4.1 Requirements for Approval of Facilitator Training Programs

A. Authority.

The authority for adoption of these Rules is set forth in sections 12-20-204, 12-170-105(1)(a)(II)(B), 12-170-105(1)(a)(IV), and 12-170-105(1)(a)(V), C.R.S.

B. Purpose: To specify procedures and criteria relating to the approval of Facilitator Training Programs, with the goals:

1 To promote and regulate educational processes that prepare graduates for safe and effective facilitation of natural medicine;

2. To provide criteria for the development and approval of new and established Approved Facilitator Training Programs; and

3. To provide procedures for the withdrawal of approval from Approved Facilitator Training Programs.

C. Purpose of Approval

1. To establish eligibility of graduates of approved programs to apply for facilitator licensure.

2. Following an approval of a training program by the Director, such training program shall be certified and authorized to provide facilitator training programs

D. Approval must be granted before coursework can commence.

1. An education program that wishes to receive approval under this rule must apply to the Office of Natural Medicine and receive approval before it begins offering classes.

2. The application materials must include course outlines for every training hour along with an explanation of how that course meets one of the course requirements described in this Rule and proposed program requirements for students to complete their practicum requirements. If the education program intends to offer consultation for newly-licensed facilitators, the application must also address the training program's plan to satisfy consultation requirements.

3. The application materials must include the time period within which students must complete the proposed training program.

4. When a program receives approval, the program may advertise:

a. That the education program has been approved by the Office of Natural Medicine to meet the training requirements of this rule, using the words "DORA Approved Facilitator Natural Medicine Training Program;" and

b. That those students who successfully complete the program will have met all of the training program/educational and experiential requirements for a Facilitator license under this Rule, other than basic life support.

5. When a program receives approval, the program must advertise:

a. Transparent communication regarding all fees to be charged for the entirety of the training program, including costs for didactic study, supervised practice, any consultation fees, and whether the Approved Facilitator Training Program will pay the cost of a Training license for its students and/or the cost of a Facilitator or Clinical Facilitator licensure application fee at the completion of the student's training program.

6. Pre-Approval.

a. Prior to official applications and approval, an education program that wishes to receive approval may submit a request for pre-approval by the Office of Natural Medicine.

b. Education programs that receive pre-approval may operate and offer courses based on Office of Natural Medicine pre-approval.

c. The pre-approval process will only be available while the Office of Natural Medicine establishes its approval process. Upon completion, the pre-approval process will end. No applicant shall have a right to utilize a pre-approval process following the Office of Natural Medicine's establishment of an approval process.

d. Applicants for pre-approval will be required to submit the same application fee and information.

E. Standards for Approving an Approved Facilitator Training Program

1. All education programs must conform to generally accepted standards of education for facilitators.

2. Any education program in this state desiring to receive approval from the Office of Natural Medicine for its program that prepares individuals for licensure as a natural medicine facilitator shall apply to the Office of Natural Medicine and submit evidence that it is prepared to carry out training curriculum that complies with the provision of Title 12, Article 170, C.R.S. and with rules adopted by the Office of Natural Medicine.

3. Facilitator Training Program organization and administration:

a. The organization, administration and implementation of an Approved Facilitator Training Program must be consistent and compliant with the Natural Medicine Health Act, the Office of Natural Medicine's rules, regulations and policies, and state law. An Approved Facilitator Training Program's organization and administration must secure, maintain, and be able to document the existence of:

(1) For programs enrolling 50 or more students annually, a governing body that has legal authority to conduct an education and training program, determine general policy, and assure adequate financial support. For programs enrolling fewer than 50 students annually, a named Director that has legal authority to conduct an education and training program, determine general policy.

(2) Sufficient financial resources to fulfill its commitments to students and meet the training program's financial obligations.

(3) An organizational chart for the Approved Facilitator Training Program demonstrating the relationship of the program to the governing body administration and clearly delineating the lines of authority, responsibility, channels of communication and internal organization.

(4) Statements of mission, purpose, and outcome competencies for Office of Natural Medicine approval, established and biennial reviewed by the Approved Facilitator Training Program.

(5) Standards for recruitment, advertising, and refunding tuition and fees, which must be consistent with generally accepted standards and applied by the governing body.

(6) Student policies that are accurate, accessible to the public, non-discriminatory, and consistently applied.

(7) A plan demonstrating how the program will support student behavioral and physical health, learning, equitable access, career advisement, and provide disability accommodations.

(8) Records for all written complaints about the Approved Facilitator Training Program and how the program addressed each complaint, which must be available for public and Office of Natural Medicine review.

(9) Teaching and learning environment conducive to student learning.

4. Faculty Composition: The composition of faculty at an Approved Facilitator Training Program must include, at a minimum:

a. The number of faculty sufficient to prepare the students to achieve the objectives of the Approved Facilitator Training Program and to ensure participant safety.

b. There must be a minimum of two faculty for an Approved Facilitator Training Program, one of whom may be a licensed Facilitator and one of whom may be the director of the Approved Facilitator Training Program. On and after January 1, 2026, each Approved Facilitator Training Program must have at least one licensed Facilitator or Clinical Facilitator.

c. There must be a sufficient number of faculty for each specialty area to provide adequate supervision to students.

5. Director of each Approved Facilitator Training Program

a. Each Approved Facilitator Training Program must have a director with the following responsibilities:

(1) Insuring and documenting the Approved Facilitator Training Program compliance with the Natural Medicine Health Act, the Office of Natural Medicine's rules and regulations, and all other state laws and regulations.

(2) Providing a current written job description to the Office of Natural Medicine for all faculty positions.

(3) Developing and coordinating the use of educational facilities and practicum resources.

(4) Identifying and advocating for services needed by students in the Approved Facilitator Training Program.

(5) Acting as liaison with the Office of Natural Medicine.

(6) Developing and maintaining ongoing relationships within the community, including fostering the Approved Facilitator Training Program's responsiveness to community/employer needs.

(7) The director of each Approved Facilitator Training Program remains responsible for the above duties, even if they delegate those duties to another person.

b. The director of the Approved Facilitator Training Program must possess the following qualifications:

(1) An active, unencumbered license to practice as a Facilitator or an active, unencumbered secondary professional license that would qualify for eligibility, pursuant to Rule 2.5(c)(1)(a), for licensure as a Clinical Facilitator in Colorado; and

(2) Documented knowledge and skills related to teaching adults, teaching methodology, curriculum development, and curriculum evaluation.

6. Facilitator Training and Educational Program Curriculum

a. Programs should include content fundamental to the knowledge and skills required for the preparation, administration, and integration of natural medicine with participants.

b. The curriculum offered in an Approved Facilitator Training Program should be developed to:

(1) Reflect consistency between the mission, outcomes, curriculum design, course progression, and learning outcomes of the Approved Facilitator Training Program.

(2) Be organized and sequenced logically to facilitate learning; and

(3) Include 150 course hours of instruction.

F. Curriculum Requirements

1. Approved Facilitator Training Programs must offer coursework of at least 150 hours, on the following topics:

a. Facilitator Best Practices (5 hours)

(1) Awareness of the facilitator's personal bias, including examination of the facilitator's motives and the potential issues surrounding transference and countertransference;

(2) Awareness of the "state of the field" in terms of research on natural medicines and how to present this information to participants in a way that is accurate and unbiased;

(3) Awareness of new research related to safety and ethics of providing psilocybin services and resources for professional development following program completion; and

(4) Appropriate measures to mitigate risks associated with psilocybin services, including harm reduction, de-escalation, and conflict resolution.

b. Ethics and Colorado Natural Medicine Rules and Regulations (25 hours)

(1) Colorado's Facilitator Code of Ethics;

(2) Ethical considerations relating to equity, privilege, bias, and power;

(3) Awareness of increased vulnerability associated with altered states of consciousness;

(4) Appropriate use of touch and participant consent to physical contact, including the development of a Touch Contract in preparation session;

(5) Financial conflicts of interest and duties to participants;

(6) Ethical advertising practices;

(7) Providing accurate information about current research on the efficacy of natural medicines and facilitator scope of practice;

(8) Reasonable expectations regarding client outcomes; and

(9) Training in Colorado Natural Medicine rules and regulations.

c. Relation Boundaries and Introduction to Physical Touch (10 hours)

(1) Defining and holding boundaries in the facilitation of natural medicines;

(2) Historical and contemporary abuse of power and boundary violations associated with natural medicine, including sexual, emotional, and physical abuse, and implications for facilitators;

(3) Appropriate emotional and sexual boundaries between facilitators and participants both during the provision of natural medicine services and at other times;

(4) Potential harm to participants for boundary and touch violations;

(5) Consequences for facilitators for breaching relation boundaries;

(6) Consequence for facilitators for breaching the touch contract;

(7) Active monitoring of client-facilitator boundaries, specifically boundaries related to consent and touch;

(8) Participant directed discussion of touch contract to address personalized boundaries around touch, limitations of capacity to request additional touch once natural medicine has been ingested, and the possibility of requesting a co-facilitator and/or videotaping of administration session; and

(9) Practical training and experience in an introduction to the appropriate use of touch during the facilitation of natural medicine.

d. Physical and Mental Health and State (25 hours)

(1) Training in therapeutic presence, including compassionate presence, client communication, openness, receptivity, groundedness, self-awareness, empathy, and rapport, including a non-directive facilitation approach, cultural attunement, and a nonjudgmental disposition;

(2) Response to psychological distress and creating a safe space for difficult emotional experiences;

(3) Training on how facilitators manage self-care;

(4) Identification and facilitation of a variety of subjective natural medicine experiences, including experiences related to physiological sensations, cognitive, emotional, and mystical states, and traumatic memories;

(5) Appropriate modes of intervention for mental health concerns, understanding when intervention is necessary, and when a client may need a higher level of care;

(6) Appropriate modes of intervention for physical health concerns, understanding when intervention is necessary, and when a client may need a higher level of care;

(7) Training in the use of Natural Medicines for chronic pain;

(8) Recognizing and addressing adverse medical and/or behavioral reactions and implementation of a safety plan when necessary;

(9) Scenario training for navigating challenging and unusual situations; and

(10) Models of substance abuse, addiction, and recovery.

e. Drug Effects, Contraindications, and Interactions (5 hours)

(1) Pharmacodynamics and pharmacokinetics of natural medicine;

(2) Physical reactions and side effects of natural medicine;

(3) Drug and supplement interaction;

(4) The metabolism of natural medicine;

(5) The primary effects and mechanisms of action of natural medicines on the brain; including connectivity in the brain and activation of serotonin receptors; and

(6) Awareness of medical, mental health, and pharmaceutical contraindications for natural medicine services.

f. Introduction to Trauma Informed Care (10 hours)

(1) Trauma-informed care, including the physiology of trauma, vicarious trauma, empathic stress, and compassion fatigue;

(2) Trauma-informed communication skills;

(3) Training in how to recognize when someone may be dissociation or going into a trauma response;

(4) Training in understanding sympathetic and parasympathetic nervous system response; and

(5) Role play scenarios focused on helping regulate when participants are in a traumatic stress response.

g. Introduction to Suicide Risk (5 hours)

(1) Understanding suicidality, suicidal ideation, self-injury, and models of assessing risk;

(2) Basics of suicide risk assessment;

(3) How to refer and/or seek emergency mental health services when suicide risk is severe; and

(4) Basics of creating a Mental Health Safety Plan.

h. Indigenous, Social, and Cultural Considerations (10 hours)

(1) Historical and indigenous modalities of preparation of natural medicines;

(2) Current and historical use of plant and fungal medicines in indigenous and Western cultures;

(3) Information about the practice of Curanderismo and traditional training for the use of natural medicines;

(4) The Controlled Substance Act and its effect on natural medicine services in indigenous and Western cultures and implications for facilitators;

(5) Cultural equity, its relationship to health equity, and social determinants of health;

(6) Racial justice, including the impact of race and privilege on health outcomes and the impact of systemic racism on individuals and communities;

(7) The impact of drug policy on individuals and communities, especially underrepresented, marginalized, and under-resourced communities;

(8) History of systemic inequity, including systemic inequity in the delivery of healthcare, mental health, and behavioral health services;

(9) Intergenerational trauma;

(10) Understanding of how racial and cultural dynamics affect interactions between facilitator and participant; and

(11) Identification of the unique psychological, physical, and socio-cultural needs presented by persons with terminal illness and awareness of the appropriate knowledge, skills, and approach needed to provide safe facilitation to such persons in a manner consistent with client goals, values, heritage, and spiritual practices.

i. Screening (5 hours)

(1) Discussion of participant's reasons for seeking natural medicine services;

(2) Completion of the mandated screening form;

(3) How to conduct screening for pertinent physical and mental health concerns;

(4) Helping participants connect with different facilitators if needed; and

(5) Role play scenarios of screening sessions.

j. Preparation (10 hours)

(1) How to obtain informed consent;

(2) How to complete and collect participant information forms and intake interviews;

(3) Providing accurate information about current research on the efficacy of natural medicines and facilitator scope of practice;

(4) Discussion of the concept of trusting inner guidance, which may include discussion of topics such as Inner Healing Intelligence, Inner Genius, The Self, Wise Mind, Soul, or Spirit;

(5) Using intake and screening information to assist participants in identifying the benefits of referral to specialized treatment services;

(6) Discussion of the facilitator's role and the limits of the facilitator's scope of practice;

(7) Discussion of the state of scientific research for natural medicines and limitations of this research;

(8) Discussion of "set and setting," including environmental considerations for administration sessions such as lighting, sound, and temperature;

(9) Discussion of the reasonable expectations regarding client outcomes;

(10) Identification of participant safety concerns, including medical history, contraindicated medication, and psychological instability;

(11) Appropriate strategies to discuss facilitator safety concerns, including but not limited to identification of participant's support system;

(12) Determination of whether the participant should participate in the administration session;

(13) Participant directed discussion of a safety plan to address identified safety concerns and transportation plan for the administration session; and

(14) Historical and indigenous modalities of preparation for facilitation and administration of natural medicines.

k. Administration (10 hours)

(1) Dosing strategies and considerations, including the following:

(a) Experiential differences relating to differing dosages;

(b) Physiological considerations in relation to dosage;

(c) Delivery mechanisms of natural medicine; and

(d) Use of secondary doses.

(2) Skills to help facilitators handle natural medicine material effectively, including the following:

(a) Hygiene while handling material; and

(b) Assessing material for potential spoilage, contamination, and other concerns.

(3) Effectively working with challenging behaviors during administration sessions, including the following:

(a) Unexpected client disclosures;

(b) Substance-induced psychosis; and

(c) Suicidality.

(4) Traumatic stress and its manifestation during natural medicine experiences and appropriate facilitator response, including the following:

(a) Trauma's relationship to the body;

(b) Repressed trauma emerging during natural medicine experience;

(c) Trauma and traumatic stress resulting from systemic oppression;

(d) Safety for trauma resolution and risks associated with re-traumatization; and

(e) Protocols ensuring facilitator safety and responding to emergencies.

(5) "Set and setting" environmental considerations for administration sessions, such as lighting, sound, and temperature.

(6) Completion of administration session, including implementation of transportation plan.

l. Integration (10 hours)

(1) Training on how to conduct an integration session;

(2) Identification of appropriate resources that may assist participants with integration, including resources for:

(a) Interpreting feelings and emotions experienced during administration sessions;

(b) Facilitation of positive internal and external changes; and

(c) Enhancement of existing supportive relationships;

(3) Identification of participant client safety concerns;

(4) Facilitator scope of practice; and

(5) Discussion of appropriate intervals between administration sessions and related safety concerns.

m. Group Facilitation (10 hours)

(1) Training in how to conduct groups, including proper ratios for participants and group facilitators;

(2) Special considerations regarding group administration of natural medicine, including understanding boundaries and touch between group members and between group members and facilitators;

(3) Skills required to facilitate natural medicine group sessions, including, but not limited to:

(a) Group preparation sessions;

(b) Group integration sessions; and

(c) Regulatory requirements for group facilitation;

(4) Role play scenarios regarding navigation of challenging and unusual situations when facilitating groups.

n. Facilitator Development and Self-Care (10 hours)

(1) Facilitator self-care as a participant safety concern and facilitator ethical requirements;

(2) How to identify when a facilitator is not in a space to facilitate and what to do about it (including discussion of countertransference);

(3) How facilitators keep themselves safe while working with participants;

(4) How a facilitator can prepare themselves for facilitation; and

(5) How a facilitator can decompress after facilitation.

2. The requirements listed in these rules are minimum requirements. Nothing in these rules precludes an educational program from offering additional modules or hours of instruction.

G. Approved Facilitator Training Program Documentation

1. All Approved Facilitator Training Programs must maintain records and, if requested, submit them to the Office of Natural Medicine, on the following:

a. The Approved Facilitator Training Program must provide for a system of permanent records and reports essential to the operation of the Approved Facilitator Training Program, including:

(1) Current and final official records for students;

(2) Current records of Approved Facilitator Training Program activities such as minutes and reports; and

(3) Faculty records that demonstrate compliance with faculty qualification requirements identified in Rule 4.1(E)(4).

b. The Approved Facilitator Training Program must submit a biennial report to the Office of Natural Medicine on its authorized form.

c. To the extent practicable, data from Approved Training Programs shall be anonymized to avoid disclosure of individual student data.

2. All Approved Facilitator Training Programs must provide clear documentation to all applicants regarding their fees for training, including whether the Approved Facilitator Training Program will pay the cost of a Training license for its students and/or the cost of a Facilitator or Clinical Facilitator licensure application fee at the completion of the student's training program.

3. Self-Evaluation of Education Programs

An Approved Facilitator Training Program must develop, undertake, and document its own internal evaluations. Evaluations must occur on a periodic basis, include input from students and the community, and evidence relevant decision-making. The Approved Facilitator Training Program must have a written systematic plan for evaluation of:

a. Organization and administration of the Approved Facilitator Training Program;

b. Approved Facilitator Training Program mission;

c. Performance of the Director of the Approved Facilitator Training Program;

d. Faculty performance;

e. Curriculum objectives and outcomes;

f. Adherence to program requirements; and

g. Measurement of program outcomes, including performance of graduates.

4. If a student seeks to transfer from one program to another, the Approved Facilitator Training Program is required to assess coursework completed by the student at their prior approved training program or an accredited institution of higher education. So long as the student has successfully completed education that is substantially equivalent to the training module offered by the new education program, the new program may allow the student to transfer those completed hours, credits or equivalent education

H. Enrollment Limits

The Office of Natural Medicine may limit the number of students admitted to an Approved Facilitator Training Program. In making this determination, the Office of Natural Medicine may consider factors, including, but not limited to: the number of qualified faculty, adequate educational facilities and resources, and the availability of relevant practicum learning experiences.

I. Continued Approval of Approved Facilitator Training Programs

1. Regular periodic surveys for continued approval may be conducted by the Office of Natural Medicine. Such surveys shall occur no less than once every two years.

2. Approval of any training program may be continued by the Office of Natural Medicine, provided the standards of the Office are met, as set forth in these rules.

3. The Office of Natural Medicine's action regarding program review must be sent to the governing body, if applicable, and the Director of the education program with recommendations, to the extent that recommendations are made.

4. The education program may be visited at times other than regularly-scheduled survey visits, if the Office of Natural Medicine determines it necessary to do so.

5. Major program revisions must be reported to the Office of Natural Medicine for approval. Major program revisions include, but are not limited to:

a. major changes in program goals;

b. The number of hours required for successful completion of the program;

c. Change in required clinical practice hours; or

d. Either an increase or decrease of twenty-five percent or greater in student numbers admitted, types of students, admission times, and progression options.

J. Withdrawal of Full Approval of an Approved Facilitator Training Program

1. The governing body, if applicable, and the Director of an education program must be notified in writing if the requirements of the statute and the standards set forth in this Rule are not fulfilled. Following a decision to place an Approved Facilitator Training Program on conditional approval or to otherwise withdraw full approval, the Office of Natural Medicine must notify the governing body, if applicable, and the Director, in writing, of specific deficiencies.

2. The education program will be given thirty (30) days from the date of the letter to respond to any deficiencies. The Office of Natural Medicine will review the response and will make a determination to continue approval of the education program or to withdraw approval. If the Office of Natural Medicine needs additional information, it may request it from the education program or conduct further investigation.

3. The education program has ninety days from the date of the Office of Natural Medicine's notice of deficiency to provide written documentation that the deficiencies have been corrected or to provide a written plan of correction. For good cause shown, the Office of Natural Medicine may allow an education program additional time.

4. After consideration of available information, the Office of Natural Medicine may determine that an Approved Facilitator Training Program's full approval should be withdrawn and the education program be closed, or that the education program should be placed on conditional approval, for any of the following reasons:

a. The Approved Facilitator Training Program does not meet or comply with all the provisions contained in the Natural Medicine Health Act, the Office of Natural Medicine's rules and regulations, or other state laws or regulations.

b. The Approved Facilitator Training Program has provided to the Office of Natural Medicine misleading, inaccurate, or falsified information to obtain or maintain full approval.

c. The Approved Facilitator Training Program has a program non-completion average which falls below seventy-five percent for eight consecutive quarters.

5. Conditional Approval

a. If the Office of Natural Medicine determines that an education program should be placed on conditional approval, the education program must submit status reports, on a schedule determined by the Office of Natural Medicine, related to the status of correction of the identified deficiencies.

b. If an education program with conditional approval does not correct its deficiencies or meet the required conditions within the time period established by the Office of Natural Medicine, the Office of Natural Medicine may withdraw the education program's conditional approval.

c. Students who are certified as having completed an education program from an Approved Training Program on conditional status may submit an application for licensure, which will be reviewed on a case-by-case basis by the Director.

6. Appeal Rights

a. Decisions of the Office of Natural Medicine to withdraw full approval or to offer conditional approval are subject to the Administrative Procedure Act, at section 24-4-105, C.R.S.

7. Any Approved Facilitator Training Program that loses full approval must inform all enrolled students and applicants of a change in the program's approval status within two weeks of the date of the change in status.

a. Students who are certified as having completed an education program from a training program that has lost full approval may submit an application for licensure, which will be reviewed on a case-by-case basis by the Director.

K. Restoration of Full Approval to an Approved Facilitator Training Program

1. Upon satisfactory completion of all requirements to correct its deficiencies, an Approved Facilitator Training Program may petition the Office of Natural Medicine to restore its status to full approval. The education program must demonstrate compliance with the Natural Medicine Health Act, the Office of Natural Medicine's rules and regulations, and all other state statutes and regulations.

2. If the Office of Natural Medicine does not restore full approval, the Approved Facilitator Training Program may petition the Office for an extension of conditional approval status not to exceed one year. As part of its petition, the Approved Facilitator Training Program must submit a corrective action plan that includes a time table to correct the identified deficiencies.

3. If a program loses full approval, it must apply to the Office of Natural Medicine to restore full approval. If a program loses conditional approval, it must apply to the Office of Natural Medicine to obtain authority to begin accepting students.

L. Denial or Withdrawal of Approval of an Approved Facilitator Training Program

1. An Approved Facilitator Training Program has the ability to seek review of decisions regarding full and conditional approval pursuant to the Administrative Procedure Act, section 24-4-105, C.R.S.

2. If the Office of Natural Medicine denies an application for program licensure, the applicant has 60 days to request a hearing on the denial or withdrawal. If requested, the Office of Natural Medicine will file a notice of denial with the office of administrative courts to adjudicate the merits of the denial or withdrawal, in accordance with section 24-4-105, C.R.S.

M. Voluntary Closures of an Approved Facilitator Training Program

1. Approved Facilitator Training Programs desiring to close shall notify the Office of Natural Medicine, in writing, at least six months prior to the date of closing.

2. As part of the notification of closure required in Rule 4.1(M)(1), the Approved Facilitator Training Program shall submit a plan assuring for a smooth transition and the equitable treatment of students affected by the program closure.

3. When the governing body of an Approved Facilitator Training Program changes, the new governing body shall notify the Office of Natural Medicine within thirty days and comply or maintain compliance with the Natural Medicine Health Act, the Office of Natural Medicine's rules and regulations, and all other state laws and regulations.

4. Students who are certified as having completed an education program from an Approved Training Program that has voluntarily closed may submit an application for licensure, which will be reviewed on a case-by-case basis by the Director.

4.2 Maintaining Approved Status

Educational programs must comply with the requirements specified in these rules to maintain approved status.

4.3 Alternate Language for institutions seeking approval of training programs

A. Any education program in this state desiring to receive from the Office of Natural Medicine approval of its educational program that prepares individuals for licensure as a facilitator shall apply to the Office of Natural Medicine and submit evidence that it is prepared to carry out an educational program that complies with the provisions of Rule 4.1.

4 CCR 755-1-4

47 CR 11, June 10, 2024, effective 6/30/2024