Amendments for HB21-1232
House Journal, April 28
5 HB21-1232 be amended as follows, and as so amended, be referred to
6 the Committee on Appropriations with favorable
7 recommendation:
8
9 Amend printed bill, strike everything below the enacting clause and
10 substitute:
11
12 "SECTION 1. In Colorado Revised Statutes, add part 13 to
13 article 16 of title 10 as follows:
13 14 PART
15 COLORADO STANDARDIZED HEALTH BENEFIT PLAN
16 10-16-1301. Short title. THE SHORT TITLE OF THIS PART 13 IS THE
17 "COLORADO STANDARDIZED HEALTH BENEFIT PLAN ACT".
18 10-16-1302. Legislative declaration - intent. (1) THE GENERAL
19 ASSEMBLY, THROUGH THE EXERCISE OF ITS POWERS TO PROTECT THE
20 HEALTH, PEACE, SAFETY, AND GENERAL WELFARE OF THE PEOPLE OF
21 COLORADO, HEREBY FINDS THAT:
22 (a) HEALTH INSURANCE COVERAGE HAS BEEN DEMONSTRATED TO
23 HAVE A POSITIVE IMPACT ON PEOPLE'S HEALTH OUTCOMES AS WELL AS
24 THEIR FINANCIAL SECURITY AND WELL-BEING;
25 (b) ENSURING THAT ALL PEOPLE HAVE ACCESS TO AFFORDABLE,
26 QUALITY, CONTINUOUS, AND EQUITABLE HEALTH CARE IS A CHALLENGE
27 THAT PUBLIC OFFICIALS AND POLICY EXPERTS HAVE FACED FOR DECADES
28 DESPITE SEEMINGLY CONSTANT EFFORTS TO ADDRESS THE ISSUE;
29 (c) ALTHOUGH GREAT STRIDES HAVE BEEN MADE IN INCREASING
30 ACCESS TO HEALTH-CARE COVERAGE THROUGH FEDERAL AND STATE
31 LEGISLATION, NOT ENOUGH HAS BEEN ACCOMPLISHED TO ADDRESS THE
32 AFFORDABILITY OF HEALTH INSURANCE IN COLORADO, PARTICULARLY IN
33 THE STATE'S RURAL AREAS AND FOR COLORADANS WHO HAVE
34 HISTORICALLY AND SYSTEMICALLY FACED BARRIERS TO HEALTH,
35 INCLUDING PEOPLE OF COLOR, IMMIGRANTS, AND COLORADANS WITH LOW
36 INCOMES;
37 (d) THE HEALTH-CARE SYSTEM IS A COMPLEX SYSTEM WHEREIN
38 CONSUMERS RELY ON HEALTH INSURANCE CARRIERS TO NEGOTIATE THE
39 RATES PAID TO HEALTH-CARE PROVIDERS, PHARMACEUTICAL COMPANIES,
40 AND HOSPITALS FOR SERVICES PROVIDED AND EXPECT THAT THE
41 NEGOTIATED RATES ARE CLOSELY TIED TO THE AMOUNT OF THE HEALTH
42 INSURANCE PREMIUMS PAID;
43 (e) DESPITE EFFORTS TO ADDRESS ACCESS TO AND AFFORDABILITY
44 OF HEALTH CARE, UNDERLYING HEALTH-CARE COSTS CONTINUE TO RISE,
45 THUS DRIVING UP THE COSTS OF HEALTH INSURANCE PREMIUMS, OFTEN AT
46 DISPROPORTIONATE RATES IN RURAL AREAS OF THE STATE; AND
47 (f) IN ORDER TO ENSURE THAT HEALTH INSURANCE IS AFFORDABLE
48 FOR COLORADANS, IT IS CRITICAL THAT THE STATE ESTABLISH A
49 STANDARDIZED PLAN FOR CARRIERS TO OFFER IN THE STATE AND SET
50 PREMIUM REDUCTION TARGETS FOR CARRIERS TO ACHIEVE.
51 10-16-1303. Definitions. AS USED IN THIS PART 13, UNLESS THE
52 CONTEXT OTHERWISE REQUIRES:
53 (1) "ADVISORY BOARD" MEANS THE BOARD ESTABLISHED IN
54 SECTION 10-16-1307.
55
1 (2) "CRITICAL ACCESS HOSPITAL" MEANS A HOSPITAL THAT IS
2 FEDERALLY CERTIFIED OR UNDERGOING FEDERAL CERTIFICATION AS A
3 CRITICAL ACCESS HOSPITAL PURSUANT TO 42 CFR 485, SUBPART F.
4 (3) "ESSENTIAL ACCESS HOSPITAL" MEANS A CRITICAL ACCESS
5 HOSPITAL OR GENERAL HOSPITAL LOCATED IN A RURAL AREA WITH
6 TWENTY-FIVE OR FEWER LICENSED BEDS.
7 (4) "ESSENTIAL COMMUNITY PROVIDER" HAS THE SAME MEANING
8 AS SET FORTH IN SECTION 25.5-8-103 (6).
9 (5) "GENERAL HOSPITAL" MEANS A HOSPITAL LICENSED AS A
10 GENERAL HOSPITAL BY THE COLORADO DEPARTMENT OF PUBLIC HEALTH
11 AND ENVIRONMENT.
12 (6) "HEALTH-CARE COVERAGE COOPERATIVE" HAS THE SAME
13 MEANING AS SET FORTH IN SECTION 10-16-1002 (2).
14 (7) "HEALTH-CARE PROVIDER" MEANS A HEALTH-CARE
15 PROFESSIONAL REGISTERED, CERTIFIED, OR LICENSED PURSUANT TO TITLE
16 12 OR A HEALTH FACILITY LICENSED OR CERTIFIED PURSUANT TO SECTION
17 25-1.5-103.
18 (8) "HEALTH SYSTEM" MEANS A CORPORATION OR OTHER
19 ORGANIZATION THAT OWNS, CONTAINS, OR OPERATES THREE OR MORE
20 HOSPITALS.
21 (9) "MEDICAL INFLATION" MEANS THE ANNUAL PERCENTAGE
22 CHANGE IN THE MEDICAL CARE INDEX COMPONENT OF THE UNITED STATES
23 DEPARTMENT OF LABOR'S BUREAU OF LABOR STATISTICS CONSUMER PRICE
24 INDEX FOR MEDICAL CARE SERVICES AND MEDICAL CARE COMMODITIES,
25 OR ITS APPLICABLE PREDECESSOR OR SUCCESSOR INDEX, BASED ON THE
26 AVERAGE CHANGE IN THE MEDICAL CARE INDEX OVER THE PREVIOUS TEN
27 YEARS.
28 (10) (a) "MEDICARE REIMBURSEMENT RATE" MEANS THE
29 FACILITY-SPECIFIC REIMBURSEMENT RATE FOR A PARTICULAR
30 HEALTH-CARE SERVICE PROVIDED UNDER THE "HEALTH INSURANCE FOR
31 THE AGED ACT", TITLE XVIII OF THE FEDERAL "SOCIAL SECURITY ACT",
32 42 U.S.C. SEC. 1395 ET SEQ., AS AMENDED.
33 (b) FOR A HOSPITAL THAT IS REIMBURSED THROUGH THE MEDICARE
34 PROSPECTIVE PAYMENTS SYSTEMS RATE FOR A CRITICAL ACCESS HOSPITAL,
35 "MEDICARE REIMBURSEMENT RATE" MEANS THE RATE BASED ON
36 ALLOWABLE COSTS AS REPORTED IN MEDICARE COST REPORTS AND THE
37 HISTORICAL COST-TO-CHARGE RATIOS FOR THE SPECIFIC HOSPITAL.
38 (11) "PUBLIC BENEFIT CORPORATION" MEANS A PUBLIC BENEFIT
7 39 CORPORATION FORMED PURSUANT TO PART 5 OF ARTICLE 101 OF TITLE
40 THAT MAY BE ORGANIZED AND OPERATED BY THE EXCHANGE PURSUANT
41 TO SECTION 10-22-106 (3).
42 (12) "SMALL GROUP MARKET" MEANS THE MARKET FOR SMALL
43 GROUP SICKNESS AND ACCIDENT INSURANCE.
44 (13) "STANDARDIZED PLAN" MEANS THE STANDARDIZED HEALTH
45 BENEFIT PLAN DESIGNED BY RULE OF THE COMMISSIONER PURSUANT TO
46 SECTION 10-16-1304.
47 10-16-1304. Standardized health benefit plan - established -
48 components - rules - independent analysis - repeal. (1) ON OR BEFORE
49 JANUARY 1, 2022, THE COMMISSIONER SHALL ESTABLISH, BY RULE, A
50 STANDARDIZED HEALTH BENEFIT PLAN TO BE OFFERED BY CARRIERS IN
51 THIS STATE IN THE INDIVIDUAL AND SMALL GROUP MARKETS. THE
52 STANDARDIZED PLAN MUST:
53 (a) OFFER HEALTH-CARE COVERAGE AT THE BRONZE, SILVER, AND
54 GOLD LEVELS OF COVERAGE AS DESCRIBED IN SECTION 10-16-103.4;
55
1 (b) INCLUDE, AT A MINIMUM, PEDIATRIC AND OTHER ESSENTIAL
2 HEALTH BENEFITS;
3 (c) BE OFFERED THROUGH THE EXCHANGE AND IN THE INDIVIDUAL
4 MARKET THROUGH THE PUBLIC BENEFIT CORPORATION;
5 (d) BE A STANDARDIZED BENEFIT DESIGN THAT:
6 (I) IS CREATED THROUGH A STAKEHOLDER ENGAGEMENT PROCESS
7 THAT INCLUDES PHYSICIANS, HEALTH-CARE INDUSTRY AND CONSUMER
8 REPRESENTATIVES, INDIVIDUALS WHO REPRESENT HEALTH-CARE WORKERS
9 OR WHO WORK IN HEALTH CARE, AND INDIVIDUALS WORKING IN OR
10 REPRESENTING COMMUNITIES THAT ARE DIVERSE WITH REGARD TO RACE,
11 ETHNICITY, IMMIGRATION STATUS, AGE, ABILITY, SEXUAL ORIENTATION,
12 GENDER IDENTITY, OR GEOGRAPHIC REGIONS OF THE STATE AND THAT ARE
13 AFFECTED BY HIGHER RATES OF HEALTH DISPARITIES AND INEQUITIES;
14 (II) HAS A DEFINED BENEFIT DESIGN AND COST-SHARING THAT
15 IMPROVES ACCESS AND AFFORDABILITY; AND
16 (III) IS DESIGNED TO IMPROVE RACIAL HEALTH EQUITY AND
17 DECREASE RACIAL HEALTH DISPARITIES THROUGH A VARIETY OF MEANS,
18 WHICH ARE IDENTIFIED COLLABORATIVELY WITH CONSUMER
19 STAKEHOLDERS, INCLUDING:
20 (A) IMPROVING PERINATAL HEALTH-CARE COVERAGE; AND
21 (B) PROVIDING FIRST-DOLLAR, PREDEDUCTIBLE COVERAGE FOR
22 CERTAIN HIGH-VALUE SERVICES, SUCH AS PRIMARY AND BEHAVIORAL
23 HEALTH CARE;
24 (e) BE ACTUARIALLY SOUND AND ALLOW A CARRIER TO CONTINUE
25 TO MEET THE FINANCIAL REQUIREMENTS IN ARTICLE 3 OF THIS TITLE 10;
26 (f) COMPLY WITH THE FEDERAL ACT, INCLUDING THE RISK
27 ADJUSTMENT REQUIREMENTS UNDER 45 CFR 153, AND THIS ARTICLE 16;
28 AND
29 (g) HAVE A NETWORK THAT IS:
30 (I) CULTURALLY RESPONSIVE AND, TO THE GREATEST EXTENT
31 POSSIBLE, REFLECTS THE DIVERSITY OF ITS ENROLLEES IN TERMS OF RACE,
32 ETHNICITY, GENDER IDENTITY, AND SEXUAL ORIENTATION IN THE AREA
33 THAT THE NETWORK EXISTS; AND
34 (II) NO MORE NARROW THAN THE MOST RESTRICTIVE NETWORK
35 THE CARRIER IS OFFERING FOR NONSTANDARDIZED PLANS IN THE
36 INDIVIDUAL MARKET FOR THE METAL TIER FOR THAT RATING AREA.
37 (2) (a) IN DEVELOPING THE NETWORK FOR THE STANDARDIZED
38 PLAN PURSUANT TO SUBSECTION (1)(g) OF THIS SECTION, EACH CARRIER
39 SHALL:
40 (I) INCLUDE AS PART OF ITS NETWORK ACCESS PLAN A DESCRIPTION
41 OF THE CARRIER'S EFFORTS TO CONSTRUCT DIVERSE, CULTURALLY
42 RESPONSIVE NETWORKS THAT ARE WELL-POSITIONED TO ADDRESS HEALTH
43 EQUITY AND REDUCE HEALTH DISPARITIES; AND
44 (II) INCLUDE A MAJORITY OF THE ESSENTIAL COMMUNITY
45 PROVIDERS IN THE SERVICE AREA IN ITS NETWORK.
46 (b) IF A CARRIER IS UNABLE TO ACHIEVE THE NETWORK ADEQUACY
47 REQUIREMENTS IN SUBSECTION (1)(g) OF THIS SECTION, THE CARRIER
48 SHALL FILE AN ACTION PLAN WITH THE DIVISION THAT DESCRIBES THE
49 CARRIER'S EFFORTS TO ACHIEVE THE REQUIREMENTS IN SUBSECTION (1)(g)
50 OF THIS SECTION.
51 (c) THE COMMISSIONER SHALL PROMULGATE RULES REGARDING
52 THE NETWORK ADEQUACY REQUIREMENTS IN SUBSECTION (1)(g) OF THIS
53 SECTION AND THE ACTION PLAN IN SUBSECTION (2)(b) OF THIS SECTION.
54
1 (3) THE STANDARDIZED PLAN MUST BE OFFERED IN A MANNER
2 THAT ALLOWS CONSUMERS TO EASILY COMPARE THE STANDARDIZED
3 PLANS OFFERED BY EACH CARRIER.
4 (4) THE COMMISSIONER MAY UPDATE THE STANDARDIZED PLAN
5 ANNUALLY BY RULE THROUGH THE STAKEHOLDER PROCESS DESCRIBED IN
6 SUBSECTION (1)(d)(I) OF THIS SECTION.
7 (5) THE COMMISSIONER SHALL CONTRACT WITH AN INDEPENDENT
8 THIRD PARTY TO CONDUCT AN ANALYSIS OF THE IMPACT OF THIS SECTION
9 ON HEALTH PLAN ENROLLMENT, HEALTH INSURANCE AFFORDABILITY, AND
10 HEALTH EQUITY. TO THE EXTENT AVAILABLE, THE ANALYSIS MUST
11 INCLUDE DISAGGREGATED DATA BY RACE, ETHNICITY, IMMIGRATION
12 STATUS, SEXUAL ORIENTATION, GENDER IDENTITY, AGE, AND ABILITY. IF
13 THE DATA IS NOT AVAILABLE, THE ANALYSIS MUST NOTE SUCH
14 UNAVAILABILITY. THE ANALYSIS MUST INCLUDE INFORMATION
15 CONCERNING TOTAL OUT-OF-POCKET HEALTH-CARE SPENDING. THE
16 ANALYSIS MUST BE COMPLETED ON OR BEFORE JANUARY 1, 2026.
17 (6) (a) THE COMMISSIONER SHALL COLLABORATE WITH THE
18 EXCHANGE CONCERNING THE SURVEY REQUIRED IN SECTION 10-22-114,
19 WHICH SURVEY ADDRESSES CONSUMERS' EXPERIENCE.
20 (b) THIS SUBSECTION (6) IS REPEALED, EFFECTIVE JULY 1, 2026.
21 (7) THE COMMISSIONER IS NOT REQUIRED TO COMPLY WITH THE
22 "PROCUREMENT CODE", ARTICLES 101 TO 112 OF TITLE 24, FOR THE
23 PURPOSES OF THIS SECTION.
24 10-16-1305. Standardized health benefit plan - carriers
25 required to offer - premium rates - rules. (1) BEGINNING JANUARY 1,
26 2023, A CARRIER THAT OFFERS:
27 (a) AN INDIVIDUAL HEALTH BENEFIT PLAN IN COLORADO IS
28 REQUIRED TO OFFER THE STANDARDIZED PLAN IN THE INDIVIDUAL MARKET
29 IN EACH COUNTY WHERE THE CARRIER OFFERS AN INDIVIDUAL HEALTH
30 BENEFIT PLAN AND SHALL OFFER THE STANDARDIZED PLAN THROUGHOUT
31 THE ENTIRE COUNTY; AND
32 (b) A SMALL GROUP HEALTH BENEFIT PLAN IN COLORADO IS
33 REQUIRED TO OFFER THE STANDARDIZED PLAN IN THE SMALL GROUP
34 MARKET IN EACH COUNTY WHERE THE CARRIER OFFERS A SMALL GROUP
35 HEALTH BENEFIT PLAN AND SHALL OFFER THE STANDARDIZED PLAN
36 THROUGHOUT THE ENTIRE COUNTY.
37 (2) (a) (I) IN THE INDIVIDUAL MARKET, FOR THE PLAN YEAR
38 BEGINNING JANUARY 1, 2023, AND IN THE SMALL GROUP MARKET,
39 BEGINNING JANUARY 1, 2023, EACH CARRIER SHALL OFFER THE
40 STANDARDIZED PLAN AT A PREMIUM RATE THAT IS AT LEAST SIX PERCENT
41 LESS THAN THE PREMIUM RATE FOR HEALTH BENEFIT PLANS THAT THE
42 CARRIER OFFERED IN THE 2021 CALENDAR YEAR, AS ADJUSTED FOR
43 MEDICAL INFLATION, IN THE INDIVIDUAL AND SMALL GROUP MARKETS.
44 THE COMMISSIONER SHALL CALCULATE THE PREMIUM RATE REDUCTION
45 BASED ON THE RATES CHARGED IN THE SAME COUNTY IN WHICH THE
46 CARRIER OFFERED HEALTH BENEFIT PLANS IN THE INDIVIDUAL AND SMALL
47 GROUP MARKETS IN 2021 PRIOR TO THE APPLICATION OF THE COLORADO
48 REINSURANCE PROGRAM PURSUANT TO PART 11 OF THIS ARTICLE 16.
49 (II) FOR CARRIERS OFFERING THE STANDARDIZED PLAN IN THE
50 2023 PLAN YEAR IN A COUNTY IN WHICH THE CARRIER DID NOT OFFER A
51 HEALTH BENEFIT PLAN IN THE INDIVIDUAL OR SMALL GROUP MARKET IN
52 THE 2021 CALENDAR YEAR, EACH CARRIER THAT OFFERS THE
53 STANDARDIZED PLAN SHALL OFFER THE STANDARDIZED PLAN:
54
1 (A) IN THE INDIVIDUAL MARKET AT A PREMIUM RATE THAT IS AT
2 LEAST SIX PERCENT LESS THAN THE AVERAGE PREMIUM RATE FOR
3 INDIVIDUAL HEALTH BENEFIT PLANS OFFERED IN THAT COUNTY IN 2021,
4 CALCULATED BASED ON THE AVERAGE PREMIUM RATE FOR INDIVIDUAL
5 HEALTH BENEFIT PLANS OFFERED IN THAT COUNTY, AS ADJUSTED FOR
6 MEDICAL INFLATION, PRIOR TO THE APPLICATION OF THE COLORADO
7 REINSURANCE PROGRAM PURSUANT TO PART 11 OF THIS ARTICLE 16; AND
8 (B) IN THE SMALL GROUP MARKET AT A PREMIUM RATE THAT IS AT
9 LEAST SIX PERCENT LESS THAN THE AVERAGE PREMIUM RATE FOR SMALL
10 GROUP PLANS OFFERED IN THAT COUNTY IN 2021, AS ADJUSTED FOR
11 MEDICAL INFLATION.
12 (b) (I) IN THE INDIVIDUAL MARKET, FOR THE PLAN YEAR
13 BEGINNING JANUARY 1, 2024, AND IN THE SMALL GROUP MARKET,
14 BEGINNING JANUARY 1, 2024, EACH CARRIER SHALL OFFER THE
15 STANDARDIZED PLAN AT A PREMIUM RATE THAT IS AT LEAST TWELVE
16 PERCENT LESS THAN THE PREMIUM RATE FOR HEALTH BENEFIT PLANS THAT
17 THE CARRIER OFFERED IN THE 2021 CALENDAR YEAR, AS ADJUSTED FOR
18 MEDICAL INFLATION, IN THE INDIVIDUAL AND SMALL GROUP MARKETS.
19 THE COMMISSIONER SHALL CALCULATE THE PREMIUM RATE REDUCTION
20 BASED ON THE RATES CHARGED IN THE SAME COUNTY IN WHICH THE
21 CARRIER OFFERED HEALTH BENEFIT PLANS IN THE INDIVIDUAL AND SMALL
22 GROUP MARKETS IN 2021 PRIOR TO THE APPLICATION OF THE COLORADO
23 REINSURANCE PROGRAM PURSUANT TO PART 11 OF THIS ARTICLE 16.
24 (II) FOR CARRIERS OFFERING THE STANDARDIZED PLAN IN THE
25 2024 PLAN YEAR IN A COUNTY IN WHICH THE CARRIER DID NOT OFFER A
26 HEALTH BENEFIT PLAN IN THE INDIVIDUAL OR SMALL GROUP MARKET IN
27 THE 2021 CALENDAR YEAR, EACH CARRIER THAT OFFERS THE
28 STANDARDIZED PLAN SHALL OFFER THE STANDARDIZED PLAN:
29 (A) IN THE INDIVIDUAL MARKET AT A PREMIUM RATE THAT IS AT
30 LEAST TWELVE PERCENT LESS THAN THE AVERAGE PREMIUM RATE FOR
31 INDIVIDUAL PLANS OFFERED IN THAT COUNTY IN 2021, CALCULATED
32 BASED ON THE AVERAGE PREMIUM RATE FOR INDIVIDUAL PLANS OFFERED
33 IN THAT COUNTY, AS ADJUSTED FOR MEDICAL INFLATION, PRIOR TO THE
34 APPLICATION OF THE COLORADO REINSURANCE PROGRAM PURSUANT TO
35 PART 11 OF THIS ARTICLE 16; AND
36 (B) IN THE SMALL GROUP MARKET AT A PREMIUM RATE THAT IS AT
37 LEAST TWELVE PERCENT LESS THAN THE AVERAGE PREMIUM RATE FOR
38 SMALL GROUP PLANS OFFERED IN THAT COUNTY IN 2021, AS ADJUSTED FOR
39 MEDICAL INFLATION.
40 (c) (I) IN THE INDIVIDUAL MARKET, FOR THE PLAN YEAR
41 BEGINNING JANUARY 1, 2025, AND IN THE SMALL GROUP MARKET,
42 BEGINNING JANUARY 1, 2025, EACH CARRIER SHALL OFFER THE
43 STANDARDIZED PLAN AT A PREMIUM RATE THAT IS AT LEAST EIGHTEEN
44 PERCENT LESS THAN THE PREMIUM RATE FOR HEALTH BENEFIT PLANS THAT
45 THE CARRIER OFFERED IN THE 2021 CALENDAR YEAR, AS ADJUSTED FOR
46 MEDICAL INFLATION, IN THE INDIVIDUAL AND SMALL GROUP MARKETS.
47 THE COMMISSIONER SHALL CALCULATE THE PREMIUM RATE REDUCTION
48 BASED ON THE RATES CHARGED IN THE SAME COUNTY IN WHICH THE
49 CARRIER OFFERED HEALTH BENEFIT PLANS IN THE INDIVIDUAL AND SMALL
50 GROUP MARKETS IN 2021 PRIOR TO THE APPLICATION OF THE COLORADO
51 REINSURANCE PROGRAM PURSUANT TO PART 11 OF THIS ARTICLE 16.
52 (II) FOR CARRIERS OFFERING THE STANDARDIZED PLAN IN THE
53 2025 PLAN YEAR IN A COUNTY IN WHICH THE CARRIER DID NOT OFFER A
54 HEALTH BENEFIT PLAN IN THE INDIVIDUAL OR SMALL GROUP MARKET IN
55 THE 2021 CALENDAR YEAR, EACH CARRIER THAT OFFERS THE
1 STANDARDIZED PLAN SHALL OFFER THE STANDARDIZED PLAN:
2 (A) IN THE INDIVIDUAL MARKET AT A PREMIUM RATE THAT IS AT
3 LEAST EIGHTEEN PERCENT LESS THAN THE AVERAGE PREMIUM RATE FOR
4 INDIVIDUAL PLANS OFFERED IN THAT COUNTY IN 2021, CALCULATED
5 BASED ON THE AVERAGE PREMIUM RATE FOR INDIVIDUAL PLANS OFFERED
6 IN THAT COUNTY, AS ADJUSTED FOR MEDICAL INFLATION, PRIOR TO THE
7 APPLICATION OF THE COLORADO REINSURANCE PROGRAM PURSUANT TO
8 PART 11 OF THIS ARTICLE 16; AND
9 (B) IN THE SMALL GROUP MARKET AT A PREMIUM RATE THAT IS AT
10 LEAST EIGHTEEN PERCENT LESS THAN THE AVERAGE PREMIUM RATE FOR
11 SMALL GROUP PLANS OFFERED IN THAT COUNTY IN 2021, AS ADJUSTED FOR
12 MEDICAL INFLATION.
13 (d) FOR THE PLAN YEAR BEGINNING ON OR AFTER JANUARY 1,
14 2026, AND EACH YEAR THEREAFTER, EACH CARRIER AND HEALTH-CARE
15 COVERAGE COOPERATIVE SHALL LIMIT ANY ANNUAL PERCENTAGE
16 INCREASE IN THE PREMIUM RATE FOR THE STANDARDIZED PLAN IN BOTH
17 THE INDIVIDUAL AND SMALL GROUP MARKETS TO A RATE THAT IS NO MORE
18 THAN MEDICAL INFLATION, RELATIVE TO THE PREVIOUS YEAR.
19 (3) THE PREMIUM RATE REQUIREMENTS IN SUBSECTIONS (2)(a),
20 (2)(b), AND (2)(c) OF THIS SECTION FOR THE STANDARDIZED PLAN OFFERED
21 IN THE INDIVIDUAL AND SMALL GROUP MARKETS MUST ACCOUNT FOR
22 POLICY ADJUSTMENTS DEEMED NECESSARY TO PREVENT PEOPLE WITH LOW
23 AND MODERATE INCOMES FROM EXPERIENCING NET INCREASES IN
24 PREMIUM COSTS.
25 (4) THE COMMISSIONS PAID TO INSURANCE PRODUCERS FOR THE
26 SALE OF THE STANDARDIZED PLAN MUST BE COMPARABLE TO THE
27 AVERAGE COMMISSIONS PAID FOR THE SALE OF OTHER PLANS OFFERED IN
28 THE INDIVIDUAL AND SMALL GROUP MARKETS.
29 10-16-1306. Rate filings - failure to meet premium
30 requirements - notice - public hearing. (1) (a) IN THE RATE FILINGS
31 REQUIRED PURSUANT TO SECTION 10-16-107, EACH CARRIER MUST FILE
32 RATES FOR THE STANDARDIZED PLAN AT THE PREMIUM RATES REQUIRED
33 IN SECTION 10-16-1305 (2).
34 (b) IF A CARRIER OR HEALTH-CARE PROVIDER ANTICIPATES THAT
35 THE CARRIER WILL BE UNABLE TO MEET NETWORK ADEQUACY STANDARDS
36 OR THE PREMIUM RATE REQUIREMENTS IN SECTION 10-16-1305 DUE TO A
37 REIMBURSEMENT RATE DISPUTE FOR THE STANDARDIZED PLAN, THE
38 CARRIER OR HEALTH-CARE PROVIDER MAY INITIATE NONBINDING
39 ARBITRATION PRIOR TO FILING RATES FOR THE STANDARDIZED PLAN. THE
40 RATE FILING DEADLINE ISSUED BY THE COMMISSIONER PURSUANT TO
41 SECTION 10-16-107 MUST STILL BE MET AND MAY NOT BE DELAYED DUE
42 TO ARBITRATION. THE COMMISSIONER SHALL NOT BE REQUIRED TO
43 PARTICIPATE OR OTHERWISE MANAGE ANY NONBINDING ARBITRATION
44 IMPLEMENTED UNDER THIS SECTION.
45 (2) IF A CARRIER IS UNABLE TO OFFER THE STANDARDIZED PLAN AS
46 REQUIRED BY SECTION 10-16-1305 (1) AT THE PREMIUM RATE REQUIRED
47 IN SECTION 10-16-1305 (2) IN ANY YEAR, THE CARRIER SHALL NOTIFY THE
48 COMMISSIONER OF THE REASONS WHY THE CARRIER IS UNABLE TO MEET
49 THE REQUIREMENTS AS FOLLOWS:
50 (a) FOR PREMIUM RATES APPLICABLE IN 2023, BY MAY 1, 2022;
51 AND
52 (b) FOR PREMIUM RATES APPLICABLE IN 2024 OR ANY SUBSEQUENT
53 YEAR, BY MARCH 1 OF THE YEAR PRECEDING THE YEAR IN WHICH THE
54 PREMIUMS RATES GO INTO EFFECT.
55
1 (3) (a) IF, ON OR AFTER JANUARY 1, 2023, AND PURSUANT TO
2 SUBSECTION (2) OF THIS SECTION, A CARRIER NOTIFIES THE COMMISSIONER
3 THAT THE CARRIER IS UNABLE TO OFFER THE STANDARDIZED PLAN AT THE
4 PREMIUM RATE REQUIRED IN SECTION 10-16-1305 (2) OR THE
5 COMMISSIONER OTHERWISE DETERMINES, WITH SUPPORT FROM AN
6 INDEPENDENT ACTUARY AND BASED ON A REVIEW OF THE RATE AND FORM
7 FILINGS, THAT A CARRIER HAS NOT MET THE PREMIUM RATE
8 REQUIREMENTS IN SECTION 10-16-1305 (2) OR THE NETWORK ADEQUACY
9 REQUIREMENTS, THE DIVISION SHALL HOLD A PUBLIC HEARING PRIOR TO
10 THE APPROVAL OF THE CARRIER'S FINAL RATES; EXCEPT THAT, FOR THE
11 PURPOSES OF HOLDING A PUBLIC HEARING, IF A CARRIER DOES NOT MEET
12 THE NETWORK ADEQUACY REQUIREMENTS IN SECTION 10-16-1304 (1)(g),
13 THE COMMISSIONER SHALL CONSIDER A CARRIER TO HAVE MET NETWORK
14 ADEQUACY REQUIREMENTS IF THE CARRIER FILES THE ACTION PLAN
15 REQUIRED IN SECTION 10-16-1304 (2)(b).
16 (b) INFORMATION SUBMITTED BY A PARTY FOR PURPOSES OF A
17 PUBLIC HEARING HELD PURSUANT TO SUBSECTION (3)(a) OF THIS SECTION
18 IS SUBJECT TO THE "COLORADO OPEN RECORDS ACT", PART 2 OF ARTICLE
19 72 OF TITLE 24.
20 (c) THE COMMISSIONER SHALL PROVIDE PUBLIC NOTICE AND
21 OPPORTUNITY TO TESTIFY AT THE PUBLIC HEARING TO ALL AFFECTED
22 PARTIES, INCLUDING CARRIERS, HOSPITALS, HEALTH-CARE PROVIDERS,
23 CONSUMER ADVOCACY ORGANIZATIONS, AND INDIVIDUALS. ALL AFFECTED
24 PARTIES SHALL HAVE THE OPPORTUNITY TO PRESENT EVIDENCE
25 REGARDING THE CARRIER'S ABILITY TO MEET THE PREMIUM RATE
26 REQUIREMENTS AND THE NETWORK ADEQUACY REQUIREMENTS. THE
27 COMMISSIONER SHALL LIMIT THE EVIDENCE PRESENTED AT THE HEARING
28 TO INFORMATION THAT IS RELATED TO THE REASON THE CARRIER FAILED
29 TO MEET THE NETWORK ADEQUACY REQUIREMENTS OR THE PREMIUM RATE
30 REQUIREMENTS IN SECTION 10-16-1305 FOR THE STANDARDIZED PLAN IN
31 ANY SINGLE COUNTY.
32 (d) THE OFFICE OF THE INSURANCE OMBUDSMAN ESTABLISHED IN
33 SECTION 25.5-1-131 SHALL PARTICIPATE IN THE PUBLIC HEARINGS AND
34 REPRESENT THE INTERESTS OF CONSUMERS.
35 (4) BASED ON EVIDENCE PRESENTED AT A HEARING HELD
36 PURSUANT TO SUBSECTION (3) OF THIS SECTION AND OTHER AVAILABLE
37 DATA AND ACTUARIAL ANALYSIS, THE COMMISSIONER MAY:
38 (a) (I) ESTABLISH CARRIER REIMBURSEMENT RATES UNDER THE
39 STANDARDIZED PLAN FOR HOSPITAL SERVICES, IF NECESSARY, TO MEET
40 NETWORK ADEQUACY REQUIREMENTS OR THE PREMIUM RATE
41 REQUIREMENTS IN SECTION 10-16-1305.
42 (II) THE BASE REIMBURSEMENT RATE FOR HOSPITAL SERVICES
43 SHALL NOT BE LESS THAN ONE HUNDRED FIFTY-FIVE PERCENT OF THE
44 HOSPITAL'S MEDICARE REIMBURSEMENT RATE OR EQUIVALENT RATE.
45 (III) A HOSPITAL THAT IS AN ESSENTIAL ACCESS HOSPITAL OR THAT
46 IS INDEPENDENT AND NOT PART OF A HEALTH SYSTEM MUST RECEIVE A
47 TWENTY-PERCENTAGE-POINT INCREASE IN THE BASE REIMBURSEMENT
48 RATE.
49 (IV) A HOSPITAL THAT IS AN ESSENTIAL ACCESS HOSPITAL THAT IS
50 N O T P A R T O F A H E A L T H S Y S T E M M U S T R E C E I V E A
51 FORTY-PERCENTAGE-POINT INCREASE IN THE BASE REIMBURSEMENT RATE.
52 (V) A HOSPITAL WITH A COMBINED PERCENTAGE OF PATIENTS WHO
53 RECEIVE SERVICES THROUGH PROGRAMS ESTABLISHED THROUGH THE
54 "COLORADO MEDICAL ASSISTANCE ACT", ARTICLES 4 TO 6 OF TITLE 25.5,
55 OR MEDICARE, TITLE XVIII OF THE FEDERAL "SOCIAL SECURITY ACT", AS
1 AMENDED, THAT EXCEEDS THE STATEWIDE AVERAGE MUST RECEIVE UP TO
2 A THIRTY-PERCENTAGE-POINT INCREASE IN ITS BASE REIMBURSEMENT
3 RATE, WITH THE ACTUAL INCREASE TO BE DETERMINED BASED ON THE
4 HOSPITAL'S PERCENTAGE SHARE OF SUCH PATIENTS.
5 (VI) A HOSPITAL THAT IS EFFICIENT IN MANAGING THE
6 UNDERLYING COST OF CARE AS DETERMINED BY THE HOSPITAL'S TOTAL
7 MARGINS, OPERATING COSTS, AND NET PATIENT REVENUE MUST RECEIVE
8 UP TO A FORTY-PERCENTAGE-POINT INCREASE IN ITS BASE
9 REIMBURSEMENT RATE.
10 (VII) NOTWITHSTANDING SUBSECTIONS (4)(a)(III) TO (4)(a)(VI)
11 OF THIS SECTION, IN DETERMINING THE REIMBURSEMENT RATES FOR
12 HOSPITALS, THE COMMISSIONER MAY CONSULT WITH EMPLOYEE
13 MEMBERSHIP ORGANIZATIONS REPRESENTING HEALTH-CARE PROVIDERS'
14 EMPLOYEES IN COLORADO AND WITH HOSPITAL-BASED HEALTH-CARE
15 PROVIDERS IN COLORADO, AND SHALL TAKE INTO ACCOUNT THE COST OF
16 ADEQUATE WAGES, BENEFITS, STAFFING, AND TRAINING FOR HEALTH-CARE
17 EMPLOYEES TO PROVIDE CONTINUOUS QUALITY CARE.
18 (b) ESTABLISH REIMBURSEMENT RATES UNDER THE STANDARDIZED
19 PLAN, IF NECESSARY, FOR HEALTH-CARE PROVIDERS FOR CATEGORIES OF
20 SERVICES WITHIN THE GEOGRAPHIC SERVICE AREA FOR THE STANDARDIZED
21 PLAN TO MEET NETWORK ADEQUACY REQUIREMENTS OR THE PREMIUM
22 RATE REQUIREMENTS IN SECTION 10-16-1305 (2), WHICH RATES MAY NOT
23 BE LESS THAN ONE HUNDRED THIRTY-FIVE PERCENT OF THE MEDICARE
24 REIMBURSEMENT RATES WITHIN THE APPLICABLE GEOGRAPHIC REGION FOR
25 THE SAME SERVICES;
26 (c) REQUIRE HOSPITALS THAT ARE LICENSED PURSUANT TO
27 SECTION 25-1.5-103 TO ACCEPT THE REIMBURSEMENT RATES ESTABLISHED
28 PURSUANT TO SUBSECTION (4)(a) OF THIS SECTION IF NECESSARY TO
29 ENSURE THE STANDARDIZED PLAN MEETS THE PREMIUM RATE
30 REQUIREMENTS AND THE NETWORK ADEQUACY REQUIREMENTS;
31 (d) (I) REQUIRE HEALTH-CARE PROVIDERS TO ACCEPT THE
32 REIMBURSEMENT RATES ESTABLISHED PURSUANT TO SUBSECTION (4)(b)
33 OF THIS SECTION, IF NECESSARY, TO ENSURE THE STANDARDIZED PLAN
34 MEETS THE PREMIUM RATE REQUIREMENTS AND THE NETWORK ADEQUACY
35 REQUIREMENTS.
36 (II) THE COMMISSIONER SHALL NOT REQUIRE A HEALTH-CARE
37 PROVIDER, OTHER THAN A HOSPITAL THAT PROVIDES A MAJORITY OF
38 COVERED PROFESSIONAL SERVICES THROUGH A SINGLE, CONTRACTED
39 MEDICAL GROUP FOR A NONPROFIT, NONGOVERNMENTAL HEALTH
40 MAINTENANCE ORGANIZATION, TO CONTRACT WITH ANY OTHER CARRIER;
41 AND
42 (e) REQUIRE THE CARRIER TO OFFER THE STANDARDIZED PLAN IN
43 SPECIFIC COUNTIES WHERE NO CARRIER IS OFFERING THE STANDARDIZED
44 PLAN IN THAT PLAN YEAR IN EITHER THE INDIVIDUAL OR SMALL GROUP
45 MARKET. IN DETERMINING WHETHER THE CARRIER IS REQUIRED TO OFFER
46 THE STANDARDIZED PLAN IN A SPECIFIC COUNTY, THE COMMISSIONER
47 SHALL CONSIDER:
48 (I) THE CARRIER'S STRUCTURE, THE NUMBER OF COVERED LIVES
49 THE CARRIER HAS IN ALL LINES OF BUSINESS IN EACH COUNTY, AND THE
50 CARRIER'S EXISTING SERVICE AREAS; AND
51 (II) ALTERNATIVE HEALTH-CARE COVERAGE AVAILABLE IN EACH
52 COUNTY, INCLUDING HEALTH-CARE COVERAGE COOPERATIVES.
53
1 (5) A CARRIER OR HEALTH-CARE PROVIDER MAY APPEAL A
2 DECISION BY THE COMMISSIONER MADE PURSUANT TO SUBSECTION (4) OF
3 THIS SECTION TO THE DISTRICT COURT IN THE APPLICABLE JURISDICTION.
4 THE DECISION OF THE COMMISSIONER IS A FINAL AGENCY ACTION SUBJECT
5 TO JUDICIAL REVIEW PURSUANT TO SECTION 24-4-106 (6).
6 (6) NOTWITHSTANDING SUBSECTION (4) OF THIS SECTION, THE
7 COMMISSIONER SHALL NOT SET THE REIMBURSEMENT RATES FOR:
8 (a) A HOSPITAL AT LESS THAN ONE HUNDRED SIXTY-FIVE PERCENT
9 OF THE MEDICARE REIMBURSEMENT RATE OR THE EQUIVALENT RATE; AND
10 (b) ANY HOSPITAL FOR ANY PLAN YEAR AT AN AMOUNT THAT IS
11 MORE THAN TWENTY PERCENT LOWER THAN THE RATE NEGOTIATED
12 BETWEEN THE CARRIER AND THE HOSPITAL FOR THE PREVIOUS PLAN YEAR.
13 (7) NOTWITHSTANDING SUBSECTIONS (4) AND (6) OF THIS SECTION,
14 FOR A HOSPITAL WITH A NEGOTIATED REIMBURSEMENT RATE THAT IS
15 LOWER THAN TEN PERCENT OF THE STATEWIDE HOSPITAL MEDIAN
16 REIMBURSEMENT RATE MEASURED AS A PERCENTAGE OF MEDICARE FOR
17 THE 2021 PLAN YEAR USING DATA FROM THE COLORADO ALL-PAYER
18 CLAIMS DATABASE DESCRIBED IN SECTION 25.5-1-204, THE COMMISSIONER
19 SHALL SET THE REIMBURSEMENT RATE FOR THAT HOSPITAL AT NO LESS
20 THAN THE GREATER OF:
21 (a) THE HOSPITAL'S COMMERCIAL REIMBURSEMENT RATE AS A
22 PERCENTAGE OF MEDICARE MINUS ONE-THIRD OF THE DIFFERENCE
23 BETWEEN THE HOSPITAL'S 2021 COMMERCIAL REIMBURSEMENT RATE AS
24 A PERCENTAGE OF MEDICARE AND THE RATE ESTABLISHED BY SUBSECTION
25 (4) OF THIS SECTION;
26 (b) ONE HUNDRED SIXTY-FIVE PERCENT OF THE HOSPITAL'S
27 MEDICARE REIMBURSEMENT RATE OR EQUIVALENT RATE; OR
28 (c) THE RATE ESTABLISHED BY SUBSECTION (4) OF THIS SECTION.
29 (8) FOR THE PURPOSE OF MAKING THE DETERMINATION IN
30 SUBSECTION (3) OF THIS SECTION:
31 (a) A HEALTH-CARE COVERAGE COOPERATIVE, AND A CARRIER
32 OFFERING HEALTH BENEFIT PLANS UNDER AGREEMENT WITH THE
33 HEALTH-CARE COVERAGE COOPERATIVE, THAT HAS OFFERED ONE OR MORE
34 HEALTH BENEFIT PLANS TO PURCHASERS IN THE INDIVIDUAL AND SMALL
35 GROUP MARKETS THAT PREVIOUSLY ACHIEVED AND MAINTAINED AT LEAST
36 AN EIGHTEEN PERCENT REDUCTION IN PREMIUM RATES, REGARDLESS OF
37 THE FIRST YEAR THE HEALTH BENEFIT PLANS WERE OFFERED, SHALL BE
38 DEEMED BY THE COMMISSIONER AS HAVING MET THE REQUIREMENTS FOR
39 CARRIERS IN SECTIONS 10-16-1304 AND 10-16-1305 WITH RESPECT TO THE
40 COUNTIES IN WHICH THE INDIVIDUAL AND SMALL GROUP PLANS ARE BEING
41 OFFERED BY THE HEALTH-CARE COVERAGE COOPERATIVE.
42 (b) THE COMMISSIONER SHALL TAKE INTO ACCOUNT:
43 (I) ANY ACTUARIAL DIFFERENCES BETWEEN THE STANDARDIZED
2021 44 PLAN AND THE HEALTH BENEFIT PLANS THE CARRIER OFFERED IN THE
45 CALENDAR YEAR;
46 (II) ANY CHANGES TO THE STANDARDIZED PLAN; AND
47 (III) STATE OR FEDERAL HEALTH BENEFIT COVERAGE MANDATES
48 IMPLEMENTED AFTER THE 2021 PLAN YEAR.
49 (9) IF THE 1332 WAIVER APPLIED FOR PURSUANT TO SECTION
50 10-16-1308 IS DENIED, SUSPENDED, OR OTHERWISE RESCINDED, THE
51 COMMISSIONER IS REQUIRED TO SET THE PREMIUM RATE REQUIREMENTS
52 TO MAXIMIZE SUBSIDIES FOR COLORADANS.
53
1 (10) A HOSPITAL OR A HEALTH-CARE PROVIDER IN COLORADO
2 SHALL NOT BALANCE BILL CONSUMERS ENROLLED IN THE STANDARDIZED
3 PLAN AND SHALL ACCEPT THE REIMBURSEMENT RATES ESTABLISHED BY
4 THE COMMISSIONER PURSUANT TO SUBSECTION (4) OF THIS SECTION, IF
5 APPLICABLE, FOR THE SERVICE PROVIDED TO THE CONSUMER.
6 (11) (a) THE COMMISSIONER SHALL ONLY SET REIMBURSEMENT
7 RATES PURSUANT TO THIS SECTION FOR HOSPITALS OR HEALTH-CARE
8 PROVIDERS THAT:
9 (I) PREVENTED A CARRIER FROM MEETING THE PREMIUM RATE
10 REQUIREMENTS FOR A STANDARDIZED PLAN BEING OFFERED IN A SPECIFIC
11 COUNTY; OR
12 (II) CAUSED THE CARRIER TO FAIL TO MEET NETWORK ADEQUACY
13 REQUIREMENTS.
14 (b) THE CARRIER SHALL PROVIDE THE COMMISSIONER WITH
15 REASONABLE INFORMATION NECESSARY TO IDENTIFY WHICH HOSPITALS OR
16 HEALTH-CARE PROVIDERS WERE THE CAUSE OF THE CARRIER'S FAILURE TO
17 MEET THE PREMIUM RATE REQUIREMENTS OR TO MEET NETWORK
18 ADEQUACY REQUIREMENTS.
19 (12) THE COMMISSIONER SHALL NOT USE THE FAILURE OF A
20 CARRIER TO MEET THE PREMIUM RATE REQUIREMENTS FOR THE
21 STANDARDIZED PLAN IN A COUNTY AS A REASON TO DENY PREMIUM RATES
22 FOR A NONSTANDARDIZED PLAN OF A CARRIER IN THAT COUNTY.
23 10-16-1307. Advisory board - members - rules. (1) (a) THE
24 COMMISSIONER SHALL CONSULT WITH AN ADVISORY BOARD TO IMPLEMENT
25 THIS PART 13. THE GOVERNOR SHALL APPOINT THE MEMBERS OF THE
26 ADVISORY BOARD ON OR BEFORE JULY 1, 2022, AND SHALL ENSURE THAT
27 THE MEMBERSHIP OF THE ADVISORY BOARD HAS DEMONSTRATED
28 EXPERIENCE AND EXPERTISE IN MOST OF THE AREAS LISTED IN SUBSECTION
29 (2) OF THIS SECTION.
30 (b) TO THE EXTENT POSSIBLE, THE GOVERNOR SHALL APPOINT
31 ADVISORY BOARD MEMBERS WHO ARE DIVERSE WITH REGARD TO RACE,
32 ETHNICITY, IMMIGRATION STATUS, AGE, ABILITY, SEXUAL ORIENTATION,
33 GENDER IDENTITY, AND GEOGRAPHY. IN CONSIDERING THE RACIAL AND
34 ETHNIC DIVERSITY OF THE ADVISORY BOARD, THE GOVERNOR SHALL
35 ATTEMPT TO ENSURE THAT AT LEAST ONE-THIRD OF THE MEMBERS ARE
36 PEOPLE OF COLOR. IN CONSIDERING THE GEOGRAPHIC DIVERSITY OF THE
37 ADVISORY BOARD, THE GOVERNOR SHALL ATTEMPT TO APPOINT MEMBERS
38 FROM BOTH RURAL AND URBAN AREAS OF THE STATE.
39 (2) THE GOVERNOR MAY APPOINT UP TO ELEVEN MEMBERS TO THE
40 ADVISORY BOARD AND, TO THE EXTENT PRACTICABLE, SHALL INCLUDE
41 INDIVIDUALS WHO:
42 (a) HAVE FACED BARRIERS TO HEALTH ACCESS, INCLUDING PEOPLE
43 OF COLOR, IMMIGRANTS, AND COLORADANS WITH LOW INCOMES;
44 (b) HAVE EXPERIENCE PURCHASING THE STANDARDIZED PLAN;
45 (c) REPRESENT CONSUMER ADVOCACY ORGANIZATIONS;
46 (d) HAVE EXPERTISE IN HEALTH EQUITY;
47 (e) HAVE EXPERTISE IN HEALTH BENEFITS FOR SMALL BUSINESSES;
48 (f) REPRESENT CARRIERS OR WHO HAVE EXPERIENCE WITH
49 DESIGNING A HEALTH INSURANCE PLAN AND SETTING RATES;
50 (g) REPRESENT HOSPITALS OR WHO HAVE EXPERIENCE WITH
51 CONTRACTS BETWEEN HOSPITALS AND CARRIERS;
52 (h) REPRESENT HEALTH-CARE PROVIDERS OR WHO HAVE
53 EXPERIENCE WITH CONTRACTS BETWEEN HEALTH-CARE PROVIDERS AND
54 CARRIERS; OR
55
1 (i) REPRESENT AN EMPLOYEE ORGANIZATION THAT REPRESENTS
2 EMPLOYEES IN THE HEALTH-CARE INDUSTRY.
3 (3) THE MEMBERS SERVE AT THE PLEASURE OF THE GOVERNOR.
4 (4) IN ADDITION TO CONSULTING WITH THE COMMISSIONER
5 PURSUANT TO SUBSECTION (1)(a) OF THIS SECTION, THE ADVISORY BOARD
6 MAY:
7 (a) CONSIDER RECOMMENDATIONS TO STREAMLINE PRIOR
8 AUTHORIZATION AND UTILIZATION MANAGEMENT PROCESSES FOR THE
9 STANDARDIZED PLAN;
10 (b) RECOMMEND WAYS TO KEEP HEALTH-CARE SERVICES IN THE
11 COMMUNITIES WHERE PATIENTS LIVE; AND
12 (c) CONSIDER WHETHER ALTERNATIVE PAYMENT MODELS MAY BE
13 APPROPRIATE FOR PARTICULAR SERVICES, TAKING INTO CONSIDERATION
14 THE IMPACTS OF SUCH MODELS ON HEALTH OUTCOMES FOR PEOPLE OF
15 COLOR.
16 (5) THE DIVISION SHALL PROVIDE TECHNICAL AND
17 ADMINISTRATIVE SUPPORT TO ASSIST THE ADVISORY BOARD.
18 10-16-1308. Federal waiver - commissioner application - use
19 of money. (1) ON OR AFTER THE EFFECTIVE DATE OF THIS SECTION, THE
20 COMMISSIONER MAY APPLY TO THE SECRETARY OF THE UNITED STATES
21 DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR A STATE INNOVATION
22 WAIVER TO WAIVE ONE OR MORE REQUIREMENTS OF THE FEDERAL ACT AS
23 AUTHORIZED BY SECTION 1332 OF THE FEDERAL ACT TO CAPTURE ALL
24 APPLICABLE SAVINGS TO THE FEDERAL GOVERNMENT AS A RESULT OF THE
25 IMPLEMENTATION OF THIS PART 13.
26 (2) (a) UPON APPROVAL OF THE 1332 WAIVER APPLICATION, THE
27 COMMISSIONER MAY USE ANY FEDERAL MONEY RECEIVED THROUGH THE
28 WAIVER FOR THE IMPLEMENTATION OF THIS PART 13 OR FOR THE
29 COLORADO HEALTH INSURANCE AFFORDABILITY ENTERPRISE CREATED IN
30 SECTION 10-16-1204. THE COMMISSIONER MAY ALLOCATE FEDERAL
31 MONEY TO THE HEALTH INSURANCE AFFORDABILITY CASH FUND CREATED
32 IN SECTION 10-16-1206 FOR USE BY THE COLORADO HEALTH INSURANCE
33 AFFORDABILITY ENTERPRISE TO IN
House Journal, May 4
41 HB21-1232 be amended as follows, and as so amended, be referred to
42 the Committee of the Whole with favorable
43 recommendation:
44
45 Amend the Health & Insurance committee report, dated 04/27/2021, page
46 19, after line 8 insert:
47
48 "SECTION 8. Appropriation. (1) For the 2021-22 state fiscal
49 year, $1,199,637 is appropriated to the department of regulatory agencies.
50 This appropriation is from the division of insurance cash fund created in
51 section 10-1-103 (3), C.R.S. To implement this act, the department may
52 use this appropriation as follows:
52 (a) $948,667 for use by the division of insurance for 53 personal
54 services, which is based on an assumption that the division will require
55 an additional 5.4 FTE;
1 (b) $38,290 for use by the division of insurance for operating
2 expenses; and
3 (c) $212,680 for use by the executive director's office and
4 administrative services for the purchase of legal services.
5 (2) For the 2021-22 state fiscal year, $212,680 is appropriated to
6 the department of law. This appropriation is from reappropriated funds
7 received from the department of regulatory agencies under subsection
8 (1)(c) of this section and is based on an assumption that the department
9 of law will require an additional 1.1 FTE. To implement this act, the
10 department of law may use this appropriation to provide legal services for
11 the department of regulatory agencies.
12 (3) For the 2021-22 state fiscal year, $78,993 is appropriated to
13 the department of health care policy and financing for use by the
14 executive director's office. This appropriation is from the general fund.
15 To implement this act, the office may use this appropriation as follows:
16 (a) $65,243 for personal services, which amount is based on an
17 assumption that the office will require an additional 0.8 FTE; and
18 (b) $13,750 for operating expenses.".
19
20 Page 19 of the committee report, line 9, strike "8." and substitute "9.".
21
22 Page 19 of the committee report, after line 11 insert:
23
24 "Page 1 of the bill, line 102, strike "COLORADO." and substitute
25 "COLORADO, AND, IN CONNECTION THEREWITH, MAKING AN
26 APPROPRIATION.".".
27
28
House Journal, May 6
39 Amendment No. 1, Appropriations Report, dated May 4, 2021, and placed
40 in member's bill file; Report also printed in House Journal, May 4, 2021.
41
42 Amendment recommended by Health & Insurance Report, dated April 27,
43 2021, and placed in member's bill file; Report also printed in House
44 Journal, April 28, 2021.
House Journal, May 6
24 Amendment No. 1, Appropriations Report, dated May 4, 2021, and placed
25 in member's bill file; Report also printed in House Journal, May 4, 2021.
26
27 Amendment recommended by Health & Insurance Report, dated April 27,
28 2021, and placed in member's bill file; Report also printed in House
29 Journal, April 28, 2021.
House Journal, May 7
13 Amendment No. 1, House Journal, May 6, 2021, page 1106.
14
15 Amendment No. 2, Health & Insurance Report, dated April 27, 2021, and
16 placed in member's bill file; Report also printed in House Journal,
17 April 28, 2021.
18
19 Amendment No. 3, by Representative Roberts.
20
21 Amend the Health and Insurance Committee Report, dated April 27,
22 2021, page 14, line 12, strike "OR".
23
24 Page 14, line 14, strike "INDUSTRY." and substitute "INDUSTRY; OR
25 (j) ARE LICENSED OR RETIRED PHYSICIANS PRACTICING OR WHO
26 PRACTICED IN THIS STATE.".
27
28 Amendment No. 4, by Representative Roberts.
29
30 Amend the Health and Insurance Committee Report, dated April 27,
31 2021, page 15, line 33, strike "WORKERS." and substitute "WORKERS AND
32 AS IT RELATES TO PROVIDER WORKLOAD, INCLUDING ANY IMPACT ON THE
33 SIZE OF THE PROVIDER PANELS, IF AVAILABLE.".
34
35 Amendment No. 5, by Representative Roberts.
36
37 Amend the Health and Insurance Committee Report, dated April 27,
38 2021, page 2, after line 25 insert:
39
40 "(3) (a) "EQUIVALENT RATE" MEANS, FOR A HOSPITAL THAT IS A
41 PEDIATRIC SPECIALTY HOSPITAL WITH A LEVEL ONE TRAUMA CENTER, THE
42 PAYMENT RATE DETERMINED BY THE MEDICAID FEE SCHEDULE FOR THE
43 HOSPITAL FROM THE MOST RECENT YEAR FOR WHICH A COMPLETE SET OF
44 HOSPITAL FINANCIAL DATA IS PUBLICLY AVAILABLE UPON THE EFFECTIVE
45 DATE OF THIS PART 13, MULTIPLIED BY A CONVERSION FACTOR EQUAL TO
46 THE RATIO OF THE STATEWIDE PAYMENT TO COST RATIO FOR MEDICARE TO
47 THE HOSPITAL'S SPECIFIC PAYMENT COST RATIO FOR THE MOST RECENT
48 SET OF PUBLICLY AVAILABLE HOSPITAL FINANCIAL DATA UPON THE
49 EFFECTIVE DATE OF THIS PART 13, WHICH IS 1.52.
50 (b) IN ANY GIVEN YEAR, THE RATE IN SUBSECTION (3)(a) OF THIS
51 SECTION MUST BE ADJUSTED ANNUALLY FOR CUMULATIVE INFLATION BY
52 A FACTOR EQUAL TO THE AVERAGE PERCENTAGE INCREASE IN THE
53 MEDICARE INPATIENT AND OUTPATIENT PROSPECTIVE PAYMENT SYSTEMS
54 OVER THE PREVIOUS THREE YEARS.".
55
56 Renumber succeeding subsections accordingly.
1 Page 10, after line 14 insert:
2
3 "(V) A HOSPITAL THAT IS A PEDIATRIC SPECIALTY HOSPITAL WITH
4 A LEVEL ONE PEDIATRIC TRAUMA CENTER MUST RECEIVE A
5 FIFTY-FIVE-PERCENTAGE-POINT INCREASE IN THE BASE REIMBURSEMENT
6 RATE, AND IS NOT ELIGIBLE FOR ADDITIONAL FACTORS UNDER THIS
7 SUBSECTION (4).".
8
9 Renumber succeeding subparagraphs accordingly.
10
11 Page 10, line 28, strike "(4)(a)(VI)" and substitute "(4)(a)(VII)".
12
13 Page 16, line 37, strike "(13)," and substitute "(14),".
14
15 Page 17, line 28, strike "(13)," and substitute "(14),".
16
17 Amendment No. 6, by Representative Roberts.
18
19 Amend the Health and Insurance Committee Report, dated April 27,
20 2021, page 17, line 40, after "DOLLARS" insert "PER CALENDAR YEAR".
21
22 Amendment No. 7, by Representative Roberts.
23
24 Amend the Health and Insurance Committee Report, dated April 27,
25 2021, page 11, strike lines 30 through 34.
26
27 Renumber succeeding subsections accordingly.
28
29 Page 12, line 1, strike "(6)" and substitute "(5)".
30
31 Page 12, after line 16 insert:
32
33 "(7) A CARRIER OR HEALTH-CARE PROVIDER MAY APPEAL A
34 DECISION BY THE COMMISSIONER MADE PURSUANT TO SUBSECTION (4) OF
35 THIS SECTION TO THE DISTRICT COURT IN THE APPLICABLE JURISDICTION.
36 THE DECISION OF THE COMMISSIONER IS A FINAL AGENCY ACTION SUBJECT
37 TO JUDICIAL REVIEW PURSUANT TO SECTION 24-4-106 (6).".
38
39 Amendment No. 8, by Representative Roberts.
40
41 Amend the Health and Insurance Committee Report, dated April 27,
42 2021, page 13, line 2, after "PLAN" insert "FOR SERVICES COVERED BY THE
43 STANDARDIZED PLAN".
44
45 Amendment No. 9, by Representative Roberts.
46
47 Amend the Health and Insurance Committee Report, dated April 27,
48 2021, page 15, line 3, after "10-16-1206" insert "FOR THE PURPOSES
49 DESCRIBED IN SECTION 10-16-1205 (1)(b)".
50
51 Amendment No. 10, by Representative Roberts.
52
53 Amend the Health and Insurance Committee Report, dated April 27,
54 2021, page 8, line 21, strike "hearing." and substitute "hearing - rules.".
55
56
1 Page 12, before line 1 insert:
2
3 "(7) (a) THE COMMISSIONER SHALL PROMULGATE RULES TO
4 ENSURE THAT THERE IS NOT AN UNFAIR COMPETITIVE ADVANTAGE FOR A
5 CARRIER THAT INTENDS TO OFFER THE STANDARDIZED PLAN IN THE
6 INDIVIDUAL OR SMALL GROUP MARKET IN A COUNTY WHERE IT HAS NOT
7 PREVIOUSLY OFFERED HEALTH BENEFIT PLANS IN THAT MARKET OR WITH
8 A HOSPITAL WITH WHICH THE CARRIER HAS NOT PREVIOUSLY HAD A
9 CONTRACT.
10 (b) THE RULES PROMULGATED PURSUANT TO THIS SUBSECTION (7)
11 MUST ALIGN WITH THE HOSPITAL REIMBURSEMENT METHODOLOGIES
12 DESCRIBED IN SUBSECTIONS (4), (5), AND (6) OF THIS SECTION.".
13
14 Renumber succeeding subsections accordingly.
15
16 As amended, ordered engrossed and placed on the Calendar for Third
17 Reading and Final Passage.
House Journal, May 7
27 Amend the Health and Insurance Committee Report, dated April 27,
28 2021, page 16, strike lines 24 through 29 and substitute:
29
30 "10-16-1313. Nonseverability. IF ANY PROVISION OF THIS PART
31 13 IS HELD INVALID, SUCH INVALIDITY INVALIDATES THIS PART 13 IN ITS
32 ENTIRETY, AND TO THIS END THE PROVISIONS OF THIS PART 13 ARE
33 DECLARED TO BE NONSEVERABLE.".
34
35 The amendment was declared lost by the following roll call vote:
36
37 YES 23 NO 37 EXCUSED 5 ABSENT
38 Amabile N Exum N Lynch Y Sirota N
39 Bacon N Froelich N McCluskie N Snyder N
40 Baisley Y Geitner Y McCormick E Soper Y
41 Benavidez N Gonzales-Gutierrez N McKean Y Sullivan N
42 Bernett N Gray N McLachlan N Tipper N
43 Bird N Hanks Y Michaelson Jenet N Titone N
44 Bockenfeld Y Herod E Mullica N Valdez A. N
45 Boesenecker N Holtorf Y Neville E Valdez D. N
46 Bradfield Y Hooton E Ortiz N Van Beber Y
47 Caraveo E Jackson N Pelton Y Van Winkle Y
48 Carver Y Jodeh N Pico Y Weissman N
49 Catlin Y Kennedy N Ransom Y Will Y
50 Cutter N Kipp N Rich Y Williams Y
51 Daugherty N Larson Y Ricks N Woodrow N
52 Duran N Lontine N Roberts N Woog Y
53 Esgar N Luck Y Sandridge Y Young N
54 Speaker N
55
1 Representative Lynch moved to amend the Report of the Committee of
2 the Whole to show that L.068 the following Lynch amendment to
House Journal, May 7
5 Amend the Health and Insurance Committee Report, dated April 27,
6 2021, page 1, after line 2 insert:
7
8 "SECTION 1. In Colorado Revised Statutes, 10-1-104, amend
9 (1) as follows:
10 10-1-104. Commissioner of insurance - other employees.
11 (1) The commissioner of insurance is the head of the division of
12 insurance. The commissioner shall be appointed by, and serve at the
13 pleasure of, the governor, subject to confirmation of the appointment by
14 the senate pursuant to section 23 of article IV of the state constitution.
15 The commissioner shall be a person well versed in insurance, and an
16 elector of the state of Colorado, and shall have no pecuniary interest in
17 any insurance company or agency directly or indirectly other than as a
18 policyholder A GENERAL ELECTION FOR THE COMMISSIONER OF
19 INSURANCE SHALL BE HELD ON THE FIRST TUESDAY AFTER THE FIRST
20 MONDAY IN NOVEMBER IN EACH EVEN-NUMBERED YEAR, AT SUCH PLACES
21 IN EACH COUNTY AS NOW ARE OR HEREAFTER MAY BE PROVIDED BY LAW.
22 ANY VACANCY OCCURRING BY DEATH, RESIGNATION, OR OTHERWISE
23 SHALL BE FILLED IN A MANNER PRESCRIBED BY LAW.".
24
25 Renumber succeeding sections accordingly.
26
27 Page 1, line 3, strike ""SECTION" and substitute "SECTION".
28
29 The amendment was declared lost by the following roll call vote:
30
31 YES 23 NO 37 EXCUSED 5 ABSENT
32 Amabile N Exum N Lynch Y Sirota N
33 Bacon N Froelich N McCluskie N Snyder N
34 Baisley Y Geitner Y McCormick E Soper Y
35 Benavidez N Gonzales-Gutierrez N McKean Y Sullivan N
36 Bernett N Gray N McLachlan N Tipper N
37 Bird N Hanks Y Michaelson Jenet N Titone N
38 Bockenfeld Y Herod E Mullica N Valdez A. N
39 Boesenecker N Holtorf Y Neville E Valdez D. N
40 Bradfield Y Hooton E Ortiz N Van Beber Y
41 Caraveo E Jackson N Pelton Y Van Winkle Y
42 Carver Y Jodeh N Pico Y Weissman N
43 Catlin Y Kennedy N Ransom Y Will Y
44 Cutter N Kipp N Rich Y Williams Y
45 Daugherty N Larson Y Ricks N Woodrow N
46 Duran N Lontine N Roberts N Woog Y
47 Esgar N Luck Y Sandridge Y Young N
48 Speaker N
House Journal, May 7
1 Amend the Health and Insurance Committee Report, dated April 27,
2 2021, page 17, strike lines 21 through 41.
3
4 Page 18, strike lines 1 through 30.
5
6 Renumber succeeding sections accordingly.
7
8 The amendment was declared lost by the following roll call vote:
9
10 YES 23 NO 37 EXCUSED 5 ABSENT
11 Amabile N Exum N Lynch Y Sirota N
12 Bacon N Froelich N McCluskie N Snyder N
13 Baisley Y Geitner Y McCormick E Soper Y
14 Benavidez N Gonzales-Gutierrez N McKean Y Sullivan N
15 Bernett N Gray N McLachlan N Tipper N
16 Bird N Hanks Y Michaelson Jenet N Titone N
17 Bockenfeld Y Herod E Mullica N Valdez A. N
18 Boesenecker N Holtorf Y Neville E Valdez D. N
19 Bradfield Y Hooton E Ortiz N Van Beber Y
20 Caraveo E Jackson N Pelton Y Van Winkle Y
21 Carver Y Jodeh N Pico Y Weissman N
22 Catlin Y Kennedy N Ransom Y Will Y
23 Cutter N Kipp N Rich Y Williams Y
24 Daugherty N Larson Y Ricks N Woodrow N
25 Duran N Lontine N Roberts N Woog Y
26 Esgar N Luck Y Sandridge Y Young N
27 Speaker N
House Journal, May 7
35 Amend the Health and Insurance Committee Report, dated April 27,
36 2021, page 3, strike lines 2 through 8 and substitute:
37
38 "(9) "MEDICAL COST TREND" MEANS THE PROJECTED PERCENTAGE
39 INCREASE IN THE COST TO TREAT PATIENTS FROM ONE YEAR TO THE NEXT,
40 WHICH ESTIMATES THE PROJECTED INCREASE IN PER CAPITA COSTS OF
41 MEDICAL SERVICES.".
42
43 Strike "INFLATION" and substitute "COST TREND" on Page 6, lines 8, 24,
44 29, and 36; Page 7, lines 10, 16, 23, and 38; and Page 8, lines 3 and 9.
45
46 The amendment was declared lost by the following roll call vote:
47
48 YES 23 NO 37 EXCUSED 5 ABSENT
49 Amabile N Exum N Lynch Y Sirota N
50 Bacon N Froelich N McCluskie N Snyder N
51 Baisley Y Geitner Y McCormick E Soper Y
52 Benavidez N Gonzales-Gutierrez N McKean Y Sullivan N
53 Bernett N Gray N McLachlan N Tipper N
54 Bird N Hanks Y Michaelson Jenet N Titone N
55 Bockenfeld Y Herod E Mullica N Valdez A. N
1 Boesenecker N Holtorf Y Neville E Valdez D. N
2 Bradfield Y Hooton E Ortiz N Van Beber Y
3 Caraveo E Jackson N Pelton Y Van Winkle Y
4 Carver Y Jodeh N Pico Y Weissman N
5 Catlin Y Kennedy N Ransom Y Will Y
6 Cutter N Kipp N Rich Y Williams Y
7 Daugherty N Larson Y Ricks N Woodrow N
8 Duran N Lontine N Roberts N Woog Y
9 Esgar N Luck Y Sandridge Y Young N
10 Speaker N
House Journal, May 7
18 Amend the Health and Insurance Committee Report, dated April 27,
19 2021, page 3, strike line 32 and substitute "COUNTIES IN THIS STATE
20 WHERE THERE IS NOT A HEALTH BENEFIT PLAN AVAILABLE IN THE
21 INDIVIDUAL AND SMALL GROUP MARKETS. THE".
22
23 Page 5, strike line 35 and substitute "IN EACH COUNTY WHERE THERE IS
24 NOT AN INDIVIDUAL HEALTH".
25
26 Page 5, line 36, after "PLAN" insert "AVAILABLE".
27
28 Page 5, strike line 40 and substitute "MARKET IN EACH COUNTY WHERE
29 THERE IS NOT A SMALL GROUP".
30
31 Page 5, line 41, after "PLAN" insert "AVAILABLE".
32
33 Page 6, line 2, strike "(2) (a) (I)" and substitute "(2)".
34
35 Page 6, strike lines 9 through 29.
36
37 Page 6, line 30, strike "(b) (I)" and substitute "(b)".
38
39 Page 7, strike lines 1 through 16.
40
41 Page 7, line 17, strike "(c) (I)" and substitute "(c)".
42
43 Page 7, strike lines 24 through 41.
44
45 Page 8, strike lines 1 through 3.
46
47 Page 11, strike lines 19 through 29.
48
49 The amendment was declared lost by the following roll call vote:
50
51 YES 23 NO 37 EXCUSED 5 ABSENT
52 Amabile N Exum N Lynch Y Sirota N
53 Bacon N Froelich N McCluskie N Snyder N
54 Baisley Y Geitner Y McCormick E Soper Y
55 Benavidez N Gonzales-Gutierrez N McKean Y Sullivan N
1 Bernett N Gray N McLachlan N Tipper N
2 Bird N Hanks Y Michaelson Jenet N Titone N
3 Bockenfeld Y Herod E Mullica N Valdez A. N
4 Boesenecker N Holtorf Y Neville E Valdez D. N
5 Bradfield Y Hooton E Ortiz N Van Beber Y
6 Caraveo E Jackson N Pelton Y Van Winkle Y
7 Carver Y Jodeh N Pico Y Weissman N
8 Catlin Y Kennedy N Ransom Y Will Y
9 Cutter N Kipp N Rich Y Williams Y
10 Daugherty N Larson Y Ricks N Woodrow N
11 Duran N Lontine N Roberts N Woog Y
12 Esgar N Luck Y Sandridge Y Young N
13 Speaker N
House Journal, May 7
21 Amend the Health and Insurance Committee Report, dated April 27,
22 2021, page 8, lines 36 and 37, strike "AS REQUIRED BY" and substitute "AT
23 THE GOALS SET FORTH IN".
24
25 Page 9, line 8, strike "REQUIRED" and substitute "SET FORTH".
26
27 Page 9, line 12, strike "REQUIREMENTS" and substitute "GOALS".
28
29 Page 9, line 41, after "ANALYSIS," insert "THE COMMISSIONER SHALL
30 APPROVE THE CARRIER'S RATES FOR THE STANDARDIZED PLAN IF THE
31 RATES ARE ACTUARIALLY SOUND. IF THE RATES ARE NOT ACTUARIALLY
32 SOUND,".
33
34 Strike "OFFER" and substitute "SET A GOAL OF OFFERING" on: Page 6, lines
35 4, 18, and 32; Page 7, lines 5, 19, and 33.
36
37 The amendment was declared lost by the following roll call vote:
38
39 YES 23 NO 37 EXCUSED 5 ABSENT
40 Amabile N Exum N Lynch Y Sirota N
41 Bacon N Froelich N McCluskie N Snyder N
42 Baisley Y Geitner Y McCormick E Soper Y
43 Benavidez N Gonzales-Gutierrez N McKean Y Sullivan N
44 Bernett N Gray N McLachlan N Tipper N
45 Bird N Hanks Y Michaelson Jenet N Titone N
46 Bockenfeld Y Herod E Mullica N Valdez A. N
47 Boesenecker N Holtorf Y Neville E Valdez D. N
48 Bradfield Y Hooton E Ortiz N Van Beber Y
49 Caraveo E Jackson N Pelton Y Van Winkle Y
50 Carver Y Jodeh N Pico Y Weissman N
51 Catlin Y Kennedy N Ransom Y Will Y
52 Cutter N Kipp N Rich Y Williams Y
53 Daugherty N Larson Y Ricks N Woodrow N
1 Duran N Lontine N Roberts N Woog Y
2 Esgar N Luck Y Sandridge Y Young N
3 Speaker N
House Journal, May 7
11 Amend the Health and Insurance Committee Report, dated April 27,
12 2021, page 3, after line 37 insert:
13
14 "(c) NOT REQUIRE A CARRIER TO PROVIDE COVERAGE FOR
15 TREATMENT OR SERVICES FOR ANY MANDATED COVERAGE REQUIREMENTS
16 UNDER SECTION 10-16-104 THAT TAKE EFFECT ON OR AFTER JANUARY 1,
17 2022;".
18
19 Reletter succeeding paragraphs accordingly.
20
21 Page 5, line 12, strike "(1)(d)(I)" and substitute "(1)(e)(I)".
22
23 Strike "(1)(g)" and substitute "(1)(h)" on: Page 4, lines 32 and 41; Page
24 5, lines 2 and 5; Page 9, line 16; and Page 16, line 18.
25
26 The amendment was declared lost by the following roll call vote:
27
28 YES 23 NO 37 EXCUSED 5 ABSENT
29 Amabile N Exum N Lynch Y Sirota N
30 Bacon N Froelich N McCluskie N Snyder N
31 Baisley Y Geitner Y McCormick E Soper Y
32 Benavidez N Gonzales-Gutierrez N McKean Y Sullivan N
33 Bernett N Gray N McLachlan N Tipper N
34 Bird N Hanks Y Michaelson Jenet N Titone N
35 Bockenfeld Y Herod E Mullica N Valdez A. N
36 Boesenecker N Holtorf Y Neville E Valdez D. N
37 Bradfield Y Hooton E Ortiz N Van Beber Y
38 Caraveo E Jackson N Pelton Y Van Winkle Y
39 Carver Y Jodeh N Pico Y Weissman N
40 Catlin Y Kennedy N Ransom Y Will Y
41 Cutter N Kipp N Rich Y Williams Y
42 Daugherty N Larson Y Ricks N Woodrow N
43 Duran N Lontine N Roberts N Woog Y
44 Esgar N Luck Y Sandridge Y Young N
45 Speaker N
House Journal, May 7
53 Amend the Health and Insurance Committee Report, dated April 27,
54 2021, page 16, strike lines 30 through 40.
55
1 Renumber succeeding sections accordingly.
2
3 The amendment was declared lost by the following roll call vote:
4
5 YES 23 NO 37 EXCUSED 5 ABSENT
6 Amabile N Exum N Lynch Y Sirota N
7 Bacon N Froelich N McCluskie N Snyder N
8 Baisley Y Geitner Y McCormick E Soper Y
9 Benavidez N Gonzales-Gutierrez N McKean Y Sullivan N
10 Bernett N Gray N McLachlan N Tipper N
11 Bird N Hanks Y Michaelson Jenet N Titone N
12 Bockenfeld Y Herod E Mullica N Valdez A. N
13 Boesenecker N Holtorf Y Neville E Valdez D. N
14 Bradfield Y Hooton E Ortiz N Van Beber Y
15 Caraveo E Jackson N Pelton Y Van Winkle Y
16 Carver Y Jodeh N Pico Y Weissman N
17 Catlin Y Kennedy N Ransom Y Will Y
18 Cutter N Kipp N Rich Y Williams Y
19 Daugherty N Larson Y Ricks N Woodrow N
20 Duran N Lontine N Roberts N Woog Y
21 Esgar N Luck Y Sandridge Y Young N
22 Speaker N
House Journal, May 7
11 Amend the Health and Insurance Committee Report, dated April 27,
12 2021, page 3, after line 27 insert:
13
14 "(14) "SUBURBAN COUNTIES" MEANS DOUGLAS AND BROOMFIELD
15 COUNTIES.
16 (15) "URBAN COUNTIES" MEAN ADAMS, ARAPAHOE, BOULDER,
17 DENVER, EL PASO, AND JEFFERSON COUNTIES.".
18
19 Page 10, line 4, after the period add "THE CARRIER REIMBURSEMENT
20 RATES DO NOT APPLY TO A COUNTY THAT IS NOT AN URBAN OR SUBURBAN
21 COUNTY IF SUCH COUNTY DOES NOT HAVE A CRITICAL ACCESS HOSPITAL
22 OPERATING WITHIN THE COUNTY.".
23
24 Page 18, line, 8, strike "25-1.5-103," and substitute "25-1.5-103 THAT IS
25 SUBJECT TO THE REIMBURSEMENT RATES ESTABLISHED IN SECTION
26 10-16-1306 (4)(a)(I),".
27
28 The amendment was declared lost by the following roll call vote:
29
30 YES 23 NO 37 EXCUSED 5 ABSENT
31 Amabile N Exum N Lynch Y Sirota N
32 Bacon N Froelich N McCluskie N Snyder N
33 Baisley Y Geitner Y McCormick E Soper Y
34 Benavidez N Gonzales-Gutierrez N McKean Y Sullivan N
35 Bernett N Gray N McLachlan N Tipper N
36 Bird N Hanks Y Michaelson Jenet N Titone N
37 Bockenfeld Y Herod E Mullica N Valdez A. N
38 Boesenecker N Holtorf Y Neville E Valdez D. N
39 Bradfield Y Hooton E Ortiz N Van Beber Y
40 Caraveo E Jackson N Pelton Y Van Winkle Y
41 Carver Y Jodeh N Pico Y Weissman N
42 Catlin Y Kennedy N Ransom Y Will Y
43 Cutter N Kipp N Rich Y Williams Y
44 Daugherty N Larson Y Ricks N Woodrow N
45 Duran N Lontine N Roberts N Woog Y
46 Esgar N Luck Y Sandridge Y Young N
47 Speaker N
Senate Journal, May 20
After consideration on the merits, the Committee recommends that HB21-1232 be
amended as follows, and as so amended, be referred to the Committee on Appropriations
with favorable recommendation.
Amend reengrossed bill, page 5, line 6, strike "PAYMENT COST" and substitute
"PAYMENT-TO-COST".
Page 25, line 26, after "(1)" insert "(a)".
Page 26, strike lines 5 through 7 and substitute "HOSPITAL WORKERS.".
Page 26, line 8, strike "(2)" and substitute "(b)".
Page 26, line 12, strike "(3)" and substitute "(c)".
Page 26, line 16, strike "(4)" and substitute "(d)".
Page 26, line 18, strike "(a)" and substitute "(I)".
Page 26, line 19, strike "(b)" and substitute "(II)".
Page 26, line 20, strike "(c)" and substitute "(III)".
Page 26, after line 20 insert:
"(2) THE COMMISSIONER SHALL CONTRACT WITH AN INDEPENDENT
THIRD-PARTY ORGANIZATION TO PREPARE A REPORT REGARDING THE
IMPLEMENTATION OF THIS PART 13, TO THE EXTENT INFORMATION IS
AVAILABLE, AS IT RELATES TO PROVIDER WORKLOAD, INCLUDING ANY IMPACT
ON THE SIZE OF THE PROVIDER PANELS, IF AVAILABLE. THE REPORT SHALL BE
COMPLETED BY DECEMBER 31, 2023.".
Renumber succeeding subsection accordingly.
Page 29, line 11, strike "(3)" and substitute "(3) (a)".
Page 29, after line 16 insert:
"(b) IN DETERMINING THE APPROPRIATE ADMINISTRATIVE FINE, THE
DIRECTOR SHALL CONSIDER ANY RECOMMENDATION OF THE COMMISSIONER OF
INSURANCE, THE FINANCIAL CIRCUMSTANCES OF THE PERSON ON WHOM THE
FINE IS BEING IMPOSED, AND OTHER CIRCUMSTANCES DEEMED RELEVANT BY THE
DIRECTOR.".
Page 30, line 15, strike "PENALTY," and substitute "FINE OR ACTION
CONCERNING THE HOSPITAL'S LICENSE PURSUANT TO SUBSECTION (2)(a) OF THIS
SECTION,".
Page 30, line 16, strike "PENALTIES RECOMMENDED BY THE" and substitute
"RECOMMENDATIONS OF THE".
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