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Legislative Year: 2024 Change
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Bill Detail: HB24-1005

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Title Health Insurers Contract with Qualified Providers
Status Introduced In Senate - Assigned to Health & Human Services (03/27/2024)
Bill Subjects
  • Health Care & Health Insurance
House Sponsors C. deGruy Kennedy (D)
D. Ortiz (D)
Senate Sponsors R. Fields (D)
D. Roberts (D)
House Committee Health and Human Services
Senate Committee Health and Human Services
Date Introduced 01/10/2024
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.

Committee Reports
with Amendments
Full Text
Full Text of Bill (pdf) (most recent)
Fiscal Notes Fiscal Notes (03/22/2024) (most recent)  
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