Bill > HB1096

This bill ensures that individuals enrolled in Colorado's Medicaid program, referred to as "members," are not prevented from purchasing primary care services or entering into direct primary care agreements. Direct primary care is a model where patients pay a recurring fee for a set period of time for primary care services, rather than paying per service. The bill clarifies that if a member chooses to use a direct primary care provider, they must sign an acknowledgment stating that this provider is only enrolled in Medicaid as an "ordering, prescribing, and referring provider" (meaning they can order tests, services, or medications but don't bill Medicaid directly for their own services), does not accept Medicaid payments for the services provided under the direct primary care agreement, and that the member cannot seek reimbursement from Medicaid for these services. Importantly, members will still retain their right to receive primary care services from other providers who are fully enrolled in the Colorado Medical Assistance Program. The bill also requires the Department of Health Care Policy and Financing to seek federal approval to implement these changes and mandates reporting on the use of direct primary care by Medicaid members.

Health and Social Services

https://leg.colorado.gov/bills/HB26-1096