State Legislation

This bill clarifies that insurance companies cannot restrict or deny coverage of telehealth services based on the communication technology or application used to deliver the telehealth services, thereby improving low-cost access to health care for people in rural parts of the state.

This bill prohibits a health plan from managing the size of their network by removing their ability to choose which providers can be on the network.

This bill requires that any insurance carrier that provides services to the state must also participate in the individual market, in Medicaid or the children’s basic health plan and offer individual market plans in at least two Colorado counties with the highest average premiums.

This bill creates the family and medical leave insurance (FAMLI) program in the newly created Division of Family and Medical Leave Insurance in the Department of Labor and Employment. The division would provide partial wage replacement benefits to eligible individuals who take leave from work to care for a new child or a family member with a serious health condition or who are unable to work due to their own serious health condition. The bill expands employer coverage to employers with one or more employee as compared to the 50-employee threshold under the FMLA.

This bill requires drug manufacturers and pharmacy benefit managers to report information regarding diabetes drug prices and related profits. The information from the report is to be posted on the Colorado Department of Public Health and Environment’s website.

This bill prohibits a health plan from controlling costs by choosing which pharmacies to include in its networks.

This bill requires the Colorado Department of Health Care Policy and Financing and the Colorado Health Care Affordability and Sustainability Enterprise Board to develop and prepare an annual report detailing uncompensated hospital costs and expenses, using publicly available data whenever possible. Psychiatric hospitals, long-term care facilities and certain critical access hospitals are exempted.

This bill creates a new license, referred to as a “freestanding emergency department license,” for a health facility that offers emergency care and is located more than 250 yards from a hospital, whether or not it’s affiliated with the hospital. Community clinics are exempted.

This bill creates various income tax credits for employers and employees in an effort to incent businesses to offer family and medical leave benefits to their workers. An employer and employee receive a state income tax deduction for any amount up to $5,000 they contribute to an employee’s leave savings account. An employer also receives an income tax credit if they pay an employee for leave that is between six and 12 weeks for a family or medical leave. For employers with fewer than 50 employees the credit is equal to 50 percent of the amount paid, and for employers with 50 or more employees the credit is equal to 25 percent of the amount paid.

This bill prohibits a health plan from controlling costs by choosing which pharmacies to include in its networks.

This bill requires certain disclosures to patients regarding out-of-network services provided at in-network and out-of-network facilities. It sets the reimbursement amounts for emergency services at out-of-network emergency facilities. In these cases, carriers must reimburse the out-of-network facility the greater of:
• 105 percent of the carrier’s median in-network rate provided in a similar facility or in the same geographic area, or
• The median in-network rate provided in a similar facility or in the same geographic area, as determined by payments reported to the All-Payer Claims Database.
It also sets the reimbursement amounts for other services provided by out-of-network providers working in in-network facilities. In these cases, carriers must reimburse the out-of-network facility the greater of:
• 110 percent of the carrier’s median in-network rate provided in a similar facility or in the same geographic area, or
• The sixtieth percentile of the median in-network rate provided in a similar facility or in the same geographic area, as determined by payments reported to the All-Payer Claims Database.

This bill creates the Colorado Prescription Drug Cost Reduction Act of 2019, requiring health insurers, prescription drug manufacturers, pharmacy benefit management firms and nonprofit organizations to report specified information about the costs of prescription drugs to the commissioner of insurance, including:
• Rebates received by carriers from manufacturers and their effects on premium prices
• Price increases by manufacturers that meet a certain threshold 30 days in advance
• Income and donations from manufacturers, PBMs or carriers by nonprofits
The bill then directs the commissioner to analyze the information and submit a report regarding the effects of prescription drug costs on health insurance premiums. It also requires carriers to pass rebates received from pharmaceutical companies or pharmacy benefit management firms on to consumers.

This bill repeals the Colorado Health Benefit Exchange Act, effective Jan. 1, 2018, and allows the exchange to continue for one year for the purpose of winding up its affairs.

This bill repeals the Hospital Provider Fee and enacts the Colorado health care affordability and sustainability enterprise as a state business outside of the revenues used for evaluating TABOR (Taxpayer’s Bill of Rights) and Referendum C cap levels. The enterprise would charge and collect a new Hospital Provider Fee and would implement and administer the state Hospital Provider Fee program.

This bills requires health insurers to disclose the standards they use to construct and market their provider networks. It also requires carriers to outline a process by which providers may seek reconsideration if a carrier decides to make changes to, terminate or deny participation in its provider network.

This bill imposes new mandates on how insurers should make decisions pertaining to authorizing providers, health care services and coverage, particularly removing the requirement that the insured receive a referral before seeing a specialist.

This bill requires freestanding emergency departments (FSEDs) to disclose information to potential patients regarding the type of facility in which they’re seeking care as well as costs and coverage associated with care.

This bill requires the Department of Public Health and Environment to create and administer a statewide electronic system that allows qualified individuals to upload and access advance medical directives.

This bill sets the reimbursement amounts out-of-network provides can charge in-network facilities for emergency services. In these cases, carriers must reimburse the out-of-network facility the greater of the following:
• The carrier’s average in-network rate
• 125 percent of Medicare
• The average in-network rate as determined by payments reported to the All Claims Payer Database.
It also sets the reimbursement amounts out-of-network providers can charge in-network facilities for non-emergency services. In these cases, carriers must reimburse the out-of-network facility the greater of:
• The average allowed amount for in- and out-of-network rates multiplied by 150 percent for urban providers and
• The average allowed amount for in- and out-of-network rates multiplied by 200 percent for rural providers.
The bill also authorizes arbitration for payment of claims that are in dispute if certain criteria are met.

This bill creates a mandatory Family and Medical Leave Insurance (FAMLI) program, providing partial wage replacement to eligible individuals who take leave from work to care for a new child or a family member with a serious medical condition, because of a serious medical condition of their own or due to certain needs arising from a family member’s active duty service. It requires a 60-40 split between employees and employers, respectively, to cover the cost of the premium. Premiums are based on a percentage of the employee’s yearly wages.

A health care lien is a demand for repayment that may be claimed against a personal injury case for medical care related to that case. This bill creates a regulatory framework for health care lien companies and increases access to financing for personal injury claims.

This bill implements the recommendations of the Department of Regulatory Agencies’ sunset review on the professional review committee and extends the committee, currently set to sunset in September 2019, for 11 years. Professional Review Committees review and evaluate the competence, professional conduct or the quality and appropriateness of patient care of a physician, physician assistant or advanced practice nurse and ensure that care can be analyzed at the patient and provider level.

This bill sets a minimum wage for certain home care workers by requiring that at least 77 percent of the reimbursement that a home-care agency receives from Medicare or Medicaid for certain services be passed on to their non-administrative employees that provide those services. Additionally, it directs the Department of Health Care Policy and Financing (HCPF) to seek an 8.1 percent increase from the federal government for these service categories, with the entire amount being applied to the employee compensation. Each agency is also required to make certain disclosures to HCPF, which will then be added to a publicly available website.