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Bill > HB1005

CO HB1005

CO HB1005
Health Insurers Contract with Qualified Providers

summary

Introduced
01/10/2024
In Committee
03/27/2024
Crossed Over
03/27/2024
Passed
Dead
04/17/2024

Introduced Session

2024 Regular Session

Bill Summary

With certain exceptions, for health benefit plans that are issued or renewed on or after January 1, 2027, the bill requires a health-care insurance carrier (carrier) to include a primary care provider as a participating provider in all networks, including narrow networks and all tiers of tiered networks, of the carrier's health benefit plan if the primary care provider is: ! Licensed to practice in Colorado; ! Certified or accredited by a national association for the certification or accreditation of primary care providers; ! Enrolled in an alternative payment model; and ! Credentialed by federal law to receive reimbursement for the provision of care to patients receiving benefits from medicaid. On or before December 31, 2025, the commissioner of insurance must promulgate rules to implement the bill, including rules: ! Establishing criteria and a process for determining whether a primary care provider meets the criteria; and ! Establishing a schedule for contracted reimbursements issued to primary care providers who participate in a health benefit plan. The division of insurance must contract with an actuary to determine a minimum reimbursement schedule for alternative payment models. The schedule: ! Must ensure that primary care providers are reimbursed at rates that are at least equal to the reimbursement rates established in law for purposes of the Colorado standardized health benefit plan; ! Must include adjustments for regional cost of living variations; and ! May include incentives for integration of behavioral health-care services and comprehensive care coordination services. If a carrier and a primary care provider do not negotiate and agree to terms of reimbursement, the carrier must compensate the primary care provider in accordance with the schedule for contracted reimbursements established by rule. If a primary care provider employed by a medical group or hospital system leaves the medical group or hospital system to establish an independent practice, the primary care provider may communicate with patients about continuing to see them in the new practice.

AI Summary

This bill requires health-care insurance carriers (carriers) to include primary care providers as participating providers in all networks, including narrow and tiered networks, of their health benefit plans if the primary care providers meet certain criteria. The criteria include being licensed to practice in Colorado, certified or accredited by a national association, enrolled in an alternative payment model, and credentialed to receive Medicaid reimbursement. The bill also requires the Commissioner of Insurance to promulgate rules to establish criteria and a process for determining whether a primary care provider meets the requirements, as well as a schedule for contracted reimbursements for primary care providers participating in health benefit plans. If a carrier and a primary care provider do not negotiate and agree on reimbursement terms, the carrier must compensate the provider according to the established reimbursement schedule. The bill also allows a primary care provider who leaves a medical group or hospital system to establish an independent practice to communicate with patients about continuing to see them in the new practice.

Committee Categories

Health and Social Services

Sponsors (19)

Last Action

Senate Committee on Health & Human Services Postpone Indefinitely (on 04/17/2024)

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