Amendments for HB19-1174

House Journal, March 8
14 HB19-1174 be amended as follows, and as so amended, be referred to
15 the Committee on Appropriations with favorable
16 recommendation:
17
18 Amend printed bill, page 2, after line 14 insert:
19
20 "SECTION 3. In Colorado Revised Statutes, 10-16-107, add (7)
21 as follows:
22 10-16-107. Rate filing regulation - benefits ratio - rules. (7) AS
23 PART OF THE RATE FILING REQUIRED PURSUANT TO THIS SECTION, EACH
24 CARRIER SHALL PROVIDE TO THE COMMISSIONER, IN A FORM AND FORMAT
25 DETERMINED BY THE COMMISSIONER, INFORMATION CONCERNING THE
26 UTILIZATION OF OUT-OF-NETWORK PROVIDERS AND FACILITIES AND THE
27 AGGREGATE COST SAVINGS AS A RESULT OF THE IMPLEMENTATION OF
28 SECTION 10-16-704 (3)(d)(I) AND (5.5)(b)(I).".
29
30 Renumber succeeding sections accordingly.
31
32 Page 3, line 1, strike "and (12)" and substitute "(5.5)(e), (12), (13), and
33 (14)".
34
35 Page 3, line 21, after "RECEIVES" insert "COVERED".
36
37 Page 4, line 5, strike "AVERAGE" and substitute "MEDIAN".
38
39 Page 5, line 12, after the period add "ANY PAYMENT MADE BY A COVERED
40 PERSON PURSUANT TO THIS SUBSECTION (5.5)(a)(V) MUST BE APPLIED TO
41 THE COVERED PERSON'S IN-NETWORK OUT-OF-POCKET MAXIMUM.".
42 Page 6, line 10, strike "FACILITY," and substitute "FACILITY OTHER THAN
43 ANY OUT-OF-NETWORK FACILITY OPERATED BY THE DENVER HEALTH AND
44 HOSPITAL AUTHORITY PURSUANT TO ARTICLE 29 OF TITLE 25,".
45
46 Page 6, line 11, after "FACILITY" insert "AND OUT-OF-NETWORK
47 PROVIDER".
48
49 Page 6, strike line 13 and substitute:
50 "(A) ONE HUNDRED FIVE PERCENT OF THE CARRIER'S MEDIAN
51 IN-NETWORK RATE OF".
52
53 Page 6, line 15, after "AREA;" add "OR".
54
55 Page 6, strikes line 16 through 18.
1 Reletter succeeding sub-subparagraph accordingly.
2
3 Page 6, after line 23 insert:
4
5 "(II) IF A COVERED PERSON RECEIVES EMERGENCY SERVICES AT
6 ANY OUT-OF-NETWORK FACILITY OPERATED BY THE DENVER HEALTH AND
7 HOSPITAL AUTHORITY CREATED IN SECTION 25-29-103, THE CARRIER
8 SHALL REIMBURSE THE OUT-OF-NETWORK FACILITY DIRECTLY IN
9 ACCORDANCE WITH SECTION 10-16-106.5 THE GREATER OF:
10 (A) THE CARRIER'S MEDIAN IN-NETWORK RATE OF
11 REIMBURSEMENT FOR THAT SERVICE PROVIDED IN A SIMILAR FACILITY OR
12 SETTING IN THE SAME GEOGRAPHIC AREA;
13 (B) TWO HUNDRED FIFTY PERCENT OF THE MEDICARE
14 REIMBURSEMENT RATE FOR THE SAME SERVICE PROVIDED IN A SIMILAR
15 FACILITY OR SETTING IN THE SAME GEOGRAPHIC AREA; OR
16 (C) ONE HUNDRED PERCENT OF THE MEDIAN IN-NETWORK RATE OF
17 REIMBURSEMENT FOR THE SAME SERVICE PROVIDED IN A SIMILAR FACILITY
18 OR SETTING IN THE SAME GEOGRAPHIC AREA FOR THE PRIOR YEAR AS
19 DETERMINED BASED ON CLAIMS DATA FROM THE COLORADO ALL-PAYER
20 HEALTH CLAIMS DATABASE CREATED IN SECTION 25.5-1-204.".
21
22 Renumber succeeding subparagraph accordingly.
23
24 Page 7, line 2, after "FACILITY" insert "AND THE CARRIER AND THE
25 PROVIDER".
26
27 Page 7, after line 5 insert:
28
29 "(d) (I) SUBSECTIONS (5.5)(a), (5.5)(b), AND (5.5)(c) OF THIS
30 SECTION DO NOT APPLY TO SERVICE AGENCIES, AS DEFINED IN SECTION
31 25-3.5-103 (11.5), PROVIDING AMBULANCE SERVICES, AS DEFINED IN
32 SECTION 25-3.5-103 (3).
33 (II) (A) THE COMMISSIONER SHALL PROMULGATE RULES TO
34 IDENTIFY AND IMPLEMENT A PAYMENT METHODOLOGY THAT APPLIES TO
35 SERVICE AGENCIES DESCRIBED IN SUBSECTION (5.5)(d)(I) OF THIS SECTION,
36 EXCEPT FOR SERVICE AGENCIES THAT ARE PUBLICLY FUNDED FIRE
37 AGENCIES.
38 (B) THE COMMISSIONER SHALL MAKE THE PAYMENT
39 METHODOLOGY AVAILABLE TO THE PUBLIC ON THE DIVISION'S WEBSITE.
40 THE RULES MUST BE EQUITABLE TO PROVIDERS AND CARRIERS; HOLD
41 CONSUMERS HARMLESS EXCEPT FOR ANY APPLICABLE COPAYMENT,
42 COINSURANCE, OR DEDUCTIBLE AMOUNTS; AND BASED ON A COST-BASED
43 MODEL THAT INCLUDES DIRECT PAYMENT TO SERVICE AGENCIES AS
44 DESCRIBED IN SUBSECTION (5.5)(d)(I) OF THIS SECTION.
45 (C) THE DIVISION MAY CONTRACT WITH A NEUTRAL THIRD-PARTY
46 THAT HAS NO FINANCIAL INTEREST IN PROVIDERS, EMERGENCY SERVICE
47 PROVIDERS, OR CARRIERS TO CONDUCT THE ANALYSIS TO IDENTIFY AND
48 IMPLEMENT THE PAYMENT METHODOLOGY.".
49
50 Reletter succeeding paragraph accordingly.
51
52 Page 9, after line 20 insert:
53
54 "(13) WHEN A CARRIER MAKES A PAYMENT TO A PROVIDER OR A
55 FACILITY PURSUANT TO SUBSECTION (3)(d)(II) OR (5.5)(b)(I) OF THIS
1 SECTION, THE PROVIDER OR THE FACILITY MAY REQUEST AND THE
2 COMMISSIONER SHALL COLLECT DATA FROM THE CARRIER TO EVALUATE
3 THE CARRIER'S COMPLIANCE IN PAYING THE HIGHEST RATE REQUIRED. THE
4 INFORMATION REQUESTED MAY INCLUDE THE METHODOLOGY FOR
5 DETERMINING THE CARRIER'S MEDIAN IN-NETWORK RATE OR
6 REIMBURSEMENT FOR EACH SERVICE IN THE SAME GEOGRAPHIC AREA.
7 (14) ON OR BEFORE JANUARY 1 OF EACH YEAR, EACH CARRIER
8 SHALL SUBMIT INFORMATION TO THE COMMISSIONER, IN A FORM AND
9 MANNER DETERMINED BY THE COMMISSIONER, CONCERNING THE USE OF
10 OUT-OF-NETWORK PROVIDERS AND FACILITIES BY COVERED PERSONS AND
11 THE IMPACT ON PREMIUM AFFORDABILITY FOR CONSUMERS.".
12
13 Page 10, line 4, strike "(5.5)(d)(II)." and substitute "(5.5)(e)(II).".
14
15 Page 10, after line 8 insert:
16
17 "(f) "HEALTH CARE PROVIDER" HAS THE SAME MEANING AS
18 "PROVIDER" AS DEFINED IN SECTION 10-16-102 (56).".
19
20 Reletter succeeding paragraphs accordingly.
21
22 Page 12, after line 3 insert:
23
24 "(5) THIS SECTION DOES NOT APPLY TO SERVICE AGENCIES, AS
25 DEFINED IN SECTION 25-3.5-103 (11.5), THAT ARE PUBLICLY FUNDED FIRE
26 AGENCIES.".
27
28 Page 13, strike line 16 and substitute:
29 "(I) ONE HUNDRED FIVE PERCENT OF THE CARRIER'S MEDIAN
30 IN-NETWORK RATE OF".
31
32 Page 13, line 18, after "AREA;" add "OR".
33
34 Page 13, strike lines 19 through 21.
35
36 Renumber succeeding subparagraph accordingly.
37
38 Page 17, line 21, strike "FACILITY" and substitute "FACILITY, OTHER THAN
39 ANY OUT-OF-NETWORK FACILITY OPERATED BY THE DENVER HEALTH AND
40 HOSPITAL AUTHORITY PURSUANT TO ARTICLE 29 OF TITLE 25,".
41
42 Page 17, strike line 26 and substitute:
43 "(I) ONE HUNDRED FIVE PERCENT OF THE CARRIER'S MEDIAN
44 IN-NETWORK RATE OF".
45
46 Page 18, line 1, after "AREA;" add "OR".
47
48 Page 18, strike lines 2 through 4.
49
50 Renumber succeeding subparagraph accordingly.
51
52 Page 18, after line 9 insert:
53
54 "(b) AN OUT-OF-NETWORK FACILITY OPERATED BY THE DENVER
55 HEALTH AND HOSPITAL AUTHORITY CREATED IN SECTION 25-29-103 MUST
1 SEND A CLAIM FOR EMERGENCY SERVICES TO THE CARRIER WITHIN ONE
2 HUNDRED EIGHTY DAYS AFTER THE DELIVERY OF SERVICES IN ORDER TO
3 RECEIVE REIMBURSEMENT AS SPECIFIED IN THIS SUBSECTION (3)(b). THE
4 REIMBURSEMENT RATE IS THE GREATER OF:
5 (I) THE CARRIER'S MEDIAN IN-NETWORK RATE OF REIMBURSEMENT
6 FOR THAT SERVICE PROVIDED IN A SIMILAR FACILITY OR SETTING IN THE
7 SAME GEOGRAPHIC AREA;
8 (II) TWO HUNDRED FIFTY PERCENT OF THE MEDICARE
9 REIMBURSEMENT RATE FOR THE SAME SERVICE PROVIDED IN A SIMILAR
10 FACILITY OR SETTING IN THE SAME GEOGRAPHIC AREA; OR
11 (III) ONE HUNDRED PERCENT OF THE MEDIAN IN-NETWORK RATE
12 OF REIMBURSEMENT FOR THE SAME SERVICE PROVIDED IN A SIMILAR
13 FACILITY OR SETTING IN THE SAME GEOGRAPHIC AREA FOR THE PRIOR
14 YEAR AS DETERMINED BASED ON CLAIMS DATA FROM THE COLORADO
15 ALL-PAYER HEALTH CLAIMS DATABASE CREATED IN SECTION 25.5-1-204.".
16
17 Reletter succeeding paragraphs accordingly.
18
19 Page 18, strike lines 25 through 27.
20
21 Strike page 19 and substitute:
22
23 "SECTION 8. Act subject to petition - effective date -
24 applicability. (1) This act takes effect January 1, 2020; except that, if a
25 referendum petition is filed pursuant to section 1 (3) of article V of the
26 state constitution against this act or an item, section, or part of this act
27 within the ninety-day period after final adjournment of the general
28 assembly, then the act, item, section, or part will not take effect unless
29 approved by the people at the general election to be held in November
30 2020 and, in such case, will take effect on the date of the official
31 declaration of the vote thereon by the governor.
32 (2) This act applies to health benefit plans issued or renewed on
33 or after the applicable effective date of this act.".
34
35

House Journal, March 15
12 HB19-1174 be amended as follows, and as so amended, be referred to
13 the Committee of the Whole with favorable
14 recommendation:
15
16 Amend printed bill, page 18, after line 24 insert:
17
18 "SECTION 8. Appropriation. (1) For the 2019-20 state fiscal
19 year, $33,884 is appropriated to the department of public health and
20 environment for use by the health facilities and emergency medical
21 services division. This appropriation is from the general fund and is based
22 on an assumption that the division will require an additional 0.4 FTE. To
23 implement this act, the division may use this appropriation for
24 administration and operations.
25 (2) For the 2019-20 state fiscal year, $16,340 is appropriated to the
26 department of regulatory agencies for use by the division of insurance.
27 This appropriation is from the division of insurance cash fund created in
28 section 10-1-103 (3), C.R.S. To implement this act, the division may use
29 this appropriation as follows:
30 (a) $16,150 for personal services, which amount is based on an
31 assumption that the division will require an additional 0.2 FTE; and
32 (b) $190 for operating expenses.".
33
34 Renumber succeeding section accordingly.
35
36 Page 1, line 102, strike "PERSONS." and substitute "PERSONS, AND, IN
37 CONNECTION THEREWITH, MAKING AN APPROPRIATION.".
38
39

House Journal, March 20
41 Amendment No. 1, Health & Insurance Report, dated March 6, 2019, and
42 placed in member's bill file; Report also printed in House Journal, March
43 7, 2019.
1 Amendment No. 2, Appropriations Report, dated March 15, 2019, and
2 placed in member's bill file; Report also printed in House Journal, March
3 15, 2019.
4
5 Amendment No. 3, by Representative(s) Esgar.
6
7 Amend the Health and Insurance Committee Report, dated March 6,
8 2019, page 1, line 6, strike "FORMAT" and substitute "MANNER".
9
10 Page 1 of the report, lines 12 and 13, strike "and (14)"." and substitute
11 "(14), (15), and (16)".".
12
13 Page 2 of the report, line 1, strike ""FACILITY OTHER" and substitute
14 ""FACILITY, OTHER".
15
16 Page 3 of the report, line 15, after "AND" insert "BE".
17
18 Page 3 of the report, line 36, strike "CONSUMERS."." and substitute
19 "CONSUMERS.
20 (15) (a) (I) IF A PROVIDER BELIEVES THAT A PAYMENT MADE
21 PURSUANT TO SUBSECTION (3) OR (5.5) OF THIS SECTION OR SECTION
22 24-34-114 OR A HEALTH CARE FACILITY BELIEVES THAT A PAYMENT
23 MADE PURSUANT TO SUBSECTION (5.5) OF THIS SECTION OR SECTION
24 25-3-121 (3) WAS NOT SUFFICIENT GIVEN THE COMPLEXITY AND
25 CIRCUMSTANCES OF THE SERVICES PROVIDED, THE PROVIDER OR THE
26 HEALTH CARE FACILITY MAY INITIATE ARBITRATION BY FILING A REQUEST
27 FOR ARBITRATION WITH THE COMMISSIONER AND THE CARRIER. THE
28 REQUEST MUST BE FILED WITHIN NINETY DAYS AFTER THE RECEIPT OF THE
29 PAYMENT.
30 (II) PRIOR TO ARBITRATION UNDER SUBSECTION (15)(a)(I) OF THIS
31 SECTION, THE CARRIER AND PROVIDER OR HEALTH CARE FACILITY MAY
32 CONDUCT AN INFORMAL SETTLEMENT TELECONFERENCE WITHIN THIRTY
33 DAYS AFTER THE REQUEST FOR ARBITRATION. THE PARTIES SHALL NOTIFY
34 THE COMMISSIONER OF THE RESULTS OF THE SETTLEMENT CONFERENCE.
35 (III) UPON RECEIPT OF NOTICE THAT THE SETTLEMENT
36 TELECONFERENCE WAS UNSUCCESSFUL, THE COMMISSIONER SHALL
37 APPOINT AN ARBITRATOR AND NOTIFY THE PARTIES OF THE ARBITRATION.
38 (b) THE COMMISSIONER SHALL PROMULGATE RULES TO
39 IMPLEMENT AN ARBITRATION PROCESS THAT INCLUDES THE SELECTION OF
40 AN ARBITRATOR FROM A LIST OF QUALIFIED ARBITRATORS DEVELOPED
41 PURSUANT TO THE RULES. QUALIFIED ARBITRATORS MUST BE
42 INDEPENDENT; NOT BE AFFILIATED WITH A CARRIER, HEALTH CARE
43 FACILITY, OR PROVIDER, OR ANY PROFESSIONAL ASSOCIATION OF
44 CARRIERS, HEALTH CARE FACILITIES, OR PROVIDERS; NOT HAVE A
45 PERSONAL, PROFESSIONAL, OR FINANCIAL CONFLICT WITH ANY PARTIES TO
46 THE ARBITRATION; AND HAVE EXPERIENCE IN HEALTH CARE BILLING AND
47 REIMBURSEMENT RATES.
48 (c) (I) THE ARBITRATOR SHALL PERFORM THE REVIEW OF THE
49 WRITTEN SUBMISSION BY THE PROVIDER OR HEALTH CARE FACILITY. THE
50 ARBITRATOR SHALL DETERMINE WHETHER THE DISPUTED PAYMENT WAS
51 NOT SUFFICIENT GIVEN THE COMPLEXITY AND CIRCUMSTANCES.
52 (II) IF THE ARBITRATOR DETERMINES ADDITIONAL PAYMENT IS
53 WARRANTED, THEN BOTH PARTIES SHALL SUBMIT, IN WRITING, EACH
54 PARTY'S FINAL OFFER. THE ARBITRATOR SHALL PICK ONE OF THE TWO
55 AMOUNTS SUBMITTED BY THE PARTIES AS THE ARBITRATOR'S FINAL AND
56 BINDING DECISION. THE DECISION MUST BE IN WRITING AND MADE WITHIN
1 FORTY-FIVE DAYS AFTER THE ARBITRATOR'S APPOINTMENT. IN MAKING
2 THE DECISION, THE ARBITRATOR MAY CONSIDER THE CIRCUMSTANCES
3 AND COMPLEXITY OF THE PARTICULAR CASE, INCLUDING THE TIME AND
4 PLACE OF SERVICES, AND AVAILABILITY OF PROVIDERS IN THE SAME
5 GEOGRAPHIC REGION.
6 (d) IF THE ARBITRATOR'S DECISION REQUIRES ADDITIONAL
7 PAYMENT BY THE CARRIER ABOVE THE AMOUNT PAID, THE CARRIER SHALL
8 PAY THE PROVIDER IN ACCORDANCE WITH SECTION 10-16-106.5.
9 (e) THE ARBITRATOR'S EXPENSES AND FEES SHALL BE SPLIT
10 EQUALLY AMONG THE PARTIES.
11 (16) NOT WITHSTANDING SECTION 24-1-136 (11)(a)(I), ON OR
12 BEFORE JULY 1, 2020, AND EACH JULY 1 THEREAFTER, THE
13 COMMISSIONER SHALL PROVIDE A WRITTEN REPORT TO THE HEALTH AND
14 HUMAN SERVICES COMMITTEE OF THE SENATE AND THE HEALTH AND
15 INSURANCE COMMITTEE OF THE HOUSE OF REPRESENTATIVES, OR THEIR
16 SUCCESSOR COMMITTEES, AND SHALL POST THE REPORT ON THE
17 DIVISION'S WEBSITE SUMMARIZING:
18 (a) THE INFORMATION SUBMITTED TO THE COMMISSIONER IN
19 SUBSECTION (14) OF THIS SECTION; AND
20 (b) THE NUMBER OF ARBITRATIONS FILED; THE NUMBER OF
21 ARBITRATIONS SETTLED, ARBITRATED, AND DISMISSED IN THE PREVIOUS
22 CALENDAR YEAR; AND A SUMMARY OF WHETHER THE ARBITRATIONS
23 WERE IN FAVOR OF THE CARRIER OR THE OUT-OF-NETWORK PROVIDER OR
24 HEALTH CARE FACILITY. THE LIST OF ARBITRATION DECISIONS MUST NOT
25 INCLUDE ANY INFORMATION THAT SPECIFICALLY IDENTIFIES THE
26 PROVIDER, HEALTH CARE FACILITY, CARRIER, OR COVERED PERSON
27 INVOLVED IN EACH ARBITRATION DECISION.".".
28
29 Page 4 of the report, after line 15 insert:
30
31 "Page 14 of the bill, after line 9 insert:
32
33 "(5) A HEALTH CARE PROVIDER MAY INITIATE ARBITRATION
34 PURSUANT TO SECTION 10-16-704 (15) IF THE HEALTH CARE PROVIDER
35 BELIEVES THE PAYMENT MADE PURSUANT TO SUBSECTION (4) OF THIS
36 SECTION IS NOT SUFFICIENT.".".
37
38 Page 5 of the report, after line 18 insert:
39
40 "Page 18 of the bill, after line 19 insert:
41
42 "(4) AN OUT-OF-NETWORK FACILITY MAY INITIATE ARBITRATION
43 PURSUANT TO SECTION 10-16-704 (15) IF THE FACILITY BELIEVES THE
44 PAYMENT MADE PURSUANT TO SUBSECTION (3) OF THIS SECTION IS NOT
45 SUFFICIENT.".".
46
47 Amendment No. 4, by Representative(s) Esgar.
48
49 Amend printed bill, page 2, line 14, strike "(3)(d)." and substitute "(3)(d)
50 AND (5.5).".
51
52 Amendment No. 5, by Representative(s) Neville.
53
54 Amend printed bill, page 4, line 6, after the semicolon add "OR".
55
56 Page 4, strike lines 7 through 9.
1 Reletter succeeding sub-subparagraph accordingly.
2
3 Page 6, line 15, after the semicolon add "OR".
4
5 Page 6, strike lines 16 through 18.
6
7 Reletter succeeding sub-subparagraph accordingly.
8
9 As amended, ordered engrossed and placed on the Calendar for Third
10 Reading and Final Passage.
11

Senate Journal, April 16
After consideration on the merits, the Committee recommends that HB19-1174 be
amended as follows, and as so amended, be referred to the Committee on Finance with
favorable recommendation.

Amend reengrossed bill, page 2, line 14, strike "AND" and substitute
"OR".

Page 3, line 1, strike "AS" and substitute "STARTING IN 2021, AS".

Page 4, line 15, strike "THE" and substitute "ONE HUNDRED TEN PERCENT
OF THE".

Page 4, line 18, strike "ONE HUNDRED PERCENT" and substitute "THE
SIXTIETH PERCENTILE".

Page 4, line 20, strike "AS DETERMINED".

Page 5, after line 3 insert:

"(V) THIS SUBSECTION (3)(d) DOES NOT APPLY WHEN A COVERED
PERSON VOLUNTARILY USES AN OUT-OF-NETWORK PROVIDER.".

Renumber succeeding subparagraph accordingly.

Page 5, lines 19 and 20, strike "AT OR".

Page 5, strike line 23, and substitute "COST-SHARING LIMIT.".

Page 6, strike line 24 and substitute "THE OUT-OF-NETWORK PROVIDER IN
ACCORDANCE WITH SUBSECTION (3)(d)(II) OF THIS SECTION AND
REIMBURSE THE OUT-OF-NETWORK FACILITY".

Page 7, line 3, strike "ONE HUNDRED PERCENT OF THE" and substitute
"THE".

Page 7, lines 5 and 6, strike "AS DETERMINED".

Page 7, line 14, strike "THAT" and substitute "THE SAME".

Page 7, line 19, strike "ONE HUNDRED PERCENT OF THE" and substitute
"THE".

Page 7, lines 21 and 22, strike "AS DETERMINED".

Page 7, line 23, strike "CREATED" and substitute "DESCRIBED".

Page 7, line 27, after "COPAYMENT" insert "AMOUNT".

Page 8, line 17, strike "PROVIDERS" and substitute "SERVICE AGENCIES".

Page 8, lines 18 and 19, strike "COPAYMENT, COINSURANCE, OR
DEDUCTIBLE" and substitute "COINSURANCE, DEDUCTIBLE, OR
COPAYMENT".

Page 11, line 6, strike "24-34-113 (2)" and substitute "24-34-113".

Page 11, strike line 15 and substitute "HEALTH CARE FACILITY PURSUANT
TO SUBSECTION (3)(d) OR (5.5)(b) OF THIS".

Page 11, line 27, after "PROVIDER" insert "OR A HEALTH CARE FACILITY".

Page 12, strike lines 7 and 8 and substitute "THE COMMISSIONER AND THE
CARRIER. A PROVIDER OR HEALTH CARE FACILITY MUST SUBMIT A
REQUEST FOR THE ARBITRATION OF A CLAIM WITHIN NINETY DAYS AFTER
THE RECEIPT OF PAYMENT FOR THAT CLAIM.".

Page 12, strike lines 10 and 11 and substitute "SECTION, IF REQUESTED BY
THE CARRIER AND THE PROVIDER OR HEALTH CARE FACILITY, THE
COMMISSIONER MAY ARRANGE AN INFORMAL SETTLEMENT
TELECONFERENCE TO BE HELD WITHIN THIRTY".

Page 12, line 18, after "THAT" insert "ESTABLISHES A STANDARD
ARBITRATION FORM AND".

Page 12, strike line 27.

Page 13, strike lines 1 through 13 and substitute:

"(c) WITHIN THIRTY DAYS AFTER THE COMMISSIONER APPOINTS
AN ARBITRATOR AND NOTIFIES THE PARTIES OF THE ARBITRATION, BOTH
PARTIES SHALL SUBMIT TO THE ARBITRATOR, IN WRITING, EACH PARTY'S
FINAL OFFER AND EACH PARTY'S ARGUMENT. THE ARBITRATOR SHALL
PICK ONE OF THE TWO AMOUNTS SUBMITTED BY THE PARTIES AS THE
ARBITRATOR'S FINAL AND BINDING DECISION. THE DECISION MUST BE IN
WRITING AND MADE WITHIN FORTY-FIVE DAYS AFTER THE ARBITRATOR'S
APPOINTMENT. IN MAKING THE DECISION, THE ARBITRATOR SHALL
CONSIDER THE CIRCUMSTANCES AND COMPLEXITY OF THE PARTICULAR
CASE, INCLUDING THE FOLLOWING AREAS:
(I) THE PROVIDER'S LEVEL OF TRAINING, EDUCATION, EXPERIENCE,
AND SPECIALIZATION OR SUBSPECIALIZATION; AND
(II) THE PREVIOUSLY CONTRACTED RATE, IF THE PROVIDER HAD
A CONTRACT WITH THE CARRIER THAT WAS TERMINATED OR EXPIRED
WITHIN ONE YEAR PRIOR TO THE DISPUTE.".

Page 13, strike lines 17 and 18 and substitute:

"(e) THE PARTY WHOSE FINAL OFFER AMOUNT WAS NOT SELECTED
BY THE ARBITRATOR SHALL PAY THE ARBITRATOR'S EXPENSES AND FEES.".

Page 13, line 20, strike "2020," and substitute "2021,".

Page 15, line 12, strike "REGULATED UNDER TITLE 12".

Page 16, line 4, after "A" insert "HEALTH CARE".

Page 16, line 5, after "OUT-OF-NETWORK" insert "HEALTH CARE".

Page 16, line 6, after "IN-NETWORK" insert "HEALTH CARE".

Page 16, line 15, strike "SUBSECTION (2) OF".

Page 17, line 6, after "COPAYMENT" insert "AMOUNT".

Page 17, line 9, before "NONEMERGENCY" insert "COVERED".

Page 17, line 27, after "FOR" insert "COVERED".

Page 18, line 5, strike "DELIVERY OF SERVICES" and substitute "RECEIPT
OF INSURANCE INFORMATION".

Page 18, line 8, strike "FIVE" and substitute "TEN".

Page 18, line 12, strike "ONE HUNDRED PERCENT" and substitute "THE
SIXTIETH PERCENTILE".

Page 18, line 14, strike "AS DETERMINED".

Page 18, line 17, after "FOR" insert "COVERED".

Page 18, line 25, after "COPAYMENT" insert "AMOUNT".

Page 19, line 13, strike "UNDER" and substitute "PURSUANT TO".

Page 19, line 21, strike "24-34-113 (2)" and substitute "24-34-113".

Page 20, line 1, after "THE" insert "FEDERAL".

Page 20, line 11, after "FACILITIES," insert "INCLUDING".

Page 20, line 20, strike "24-34-113 (2)" and substitute "24-34-113".

Page 20, line 22 strike "(12)" and substitute "(12)(b)".

Page 20, line 23, strike "SUBSECTION (1) OF".

Page 21, after line 5 insert:

"(c) "EMERGENCY SERVICES" HAS THE SAME MEANING AS DEFINED
IN SECTION 10-16-704 (5.5)(e)(II).".

Reletter succeeding paragraphs accordingly.

Page 21, line 21, strike "THE" and substitute "A".

Page 21, line 24, after "COPAYMENT" insert "AMOUNT".

Page 22, line 2, strike "10-16-704 (5.5)," and substitute "10-16-704
(3)(b) OR (5.5),".

Page 22, line 12, strike "PROVIDER" and substitute "FACILITY".

Page 22, line 18, strike "DELIVERY OF SERVICES" and substitute "RECEIPT
OF INSURANCE INFORMATION".

Page 22, line 25, strike "ONE HUNDRED PERCENT OF THE" and substitute
"THE".

Page 22, line 27, strike "AS".

Page 23, line 1, strike "DETERMINED".

Page 23, line 10, strike "THAT" and substitute "THE SAME".

Page 23, line 15, strike "ONE HUNDRED PERCENT OF THE" and substitute
"THE".

Page 23, line 18, strike "AS DETERMINED".

Page 23, line 19, strike "CREATED" and substitute "DESCRIBED".

Page 23, strike line 22 and substitute "SPECIFIED IN THIS SUBSECTION (3),
THE CARRIER SHALL".

Page 24, line 2, after "COPAYMENT" insert "AMOUNT".

Page 24, after line 6 insert:

"(5) THIS SECTION DOES NOT APPLY WHEN A COVERED PERSON
VOLUNTARILY USES AN OUT-OF-NETWORK PROVIDER.".

Page 24, after line 11 insert:
"SECTION 8. In Colorado Revised Statutes, add to article 30
as relocated by House Bill 19-1172 12-30-111 and 12-30-112 as
follows:
12-30-111. Health care providers - required disclosures - rules
- definitions. (1) FOR THE PURPOSES OF THIS SECTION AND SECTION
12-30-112:
(a) "CARRIER" HAS THE SAME MEANING AS DEFINED IN SECTION
10-16-102 (8).
(b) "COVERED PERSON" HAS THE SAME MEANING AS DEFINED IN
SECTION 10-16-102 (15).
(c) "EMERGENCY SERVICES" HAS THE SAME MEANING AS DEFINED
IN SECTION 10-16-704 (5.5)(e)(II).
(d) "GEOGRAPHIC AREA" HAS THE SAME MEANING AS DEFINED IN
SECTION 10-16-704 (3)(d)(V)(A).
(e) "HEALTH BENEFIT PLAN" HAS THE SAME MEANING AS DEFINED
IN SECTION 10-16-102 (32).
(f) "MEDICARE REIMBURSEMENT RATE" HAS THE SAME MEANING
AS DEFINED IN SECTION 10-16-704 (3)(d)(V)(B).
(g) "OUT-OF-NETWORK PROVIDER" MEANS A HEALTH CARE
PROVIDER THAT IS NOT A "PARTICIPATING PROVIDER" AS DEFINED IN
SECTION 10-16-102 (46).
(2) ON AND AFTER JANUARY 1, 2020, HEALTH CARE PROVIDERS
SHALL DEVELOP AND PROVIDE DISCLOSURES TO CONSUMERS ABOUT THE
POTENTIAL EFFECTS OF RECEIVING EMERGENCY OR NONEMERGENCY
SERVICES FROM AN OUT-OF-NETWORK PROVIDER. THE DISCLOSURES MUST
COMPLY WITH THE RULES ADOPTED PURSUANT TO SUBSECTION (3) OF THIS
SECTION.
(3) THE DIRECTOR, IN CONSULTATION WITH THE COMMISSIONER
OF INSURANCE AND THE STATE BOARD OF HEALTH CREATED IN SECTION
25-1-103, SHALL ADOPT RULES THAT SPECIFY THE REQUIREMENTS FOR
HEALTH CARE PROVIDERS TO DEVELOP AND PROVIDE CONSUMER
DISCLOSURES IN ACCORDANCE WITH THIS SECTION. THE DIRECTOR SHALL
ENSURE THAT THE RULES ARE CONSISTENT WITH SECTIONS 10-16-704 (12)
AND 25-3-120 AND RULES ADOPTED BY THE COMMISSIONER PURSUANT TO
SECTION 10-16-704 (12)(b) AND BY THE STATE BOARD OF HEALTH
PURSUANT TO SECTION 25-3-120 (2). THE RULES MUST SPECIFY, AT A
MINIMUM, THE FOLLOWING:
(a) THE TIMING FOR PROVIDING THE DISCLOSURES FOR
EMERGENCY AND NONEMERGENCY SERVICES WITH CONSIDERATION GIVEN
TO POTENTIAL LIMITATIONS RELATING TO THE FEDERAL "EMERGENCY
MEDICAL TREATMENT AND LABOR ACT", 42 U.S.C. SEC. 1395dd;
(b) REQUIREMENTS REGARDING HOW THE DISCLOSURES MUST BE
MADE, INCLUDING REQUIREMENTS TO INCLUDE THE DISCLOSURES ON
BILLING STATEMENTS, BILLING NOTICES, OR OTHER FORMS OR
COMMUNICATIONS WITH CONSUMERS;
(c) THE CONTENTS OF THE DISCLOSURES, INCLUDING THE
CONSUMER'S RIGHTS AND PAYMENT OBLIGATIONS PURSUANT TO THE
CONSUMER'S HEALTH BENEFIT PLAN;
(d) DISCLOSURE REQUIREMENTS SPECIFIC TO HEALTH CARE
PROVIDERS, INCLUDING WHETHER A HEALTH CARE PROVIDER IS OUT OF
NETWORK, THE TYPES OF SERVICES AN OUT-OF-NETWORK HEALTH CARE
PROVIDER MAY PROVIDE, AND THE RIGHT TO REQUEST AN IN-NETWORK
HEALTH CARE PROVIDER TO PROVIDE SERVICES; AND
(e) REQUIREMENTS CONCERNING THE LANGUAGE TO BE USED IN
THE DISCLOSURES, INCLUDING USE OF PLAIN LANGUAGE, TO ENSURE THAT
CARRIERS, HEALTH CARE FACILITIES, AND HEALTH CARE PROVIDERS USE
LANGUAGE THAT IS CONSISTENT WITH THE DISCLOSURES REQUIRED BY
THIS SECTION AND SECTIONS 10-16-704 (12) AND 25-3-120 AND THE
RULES ADOPTED PURSUANT TO THIS SUBSECTION (3) AND SECTIONS
10-16-704 (12)(b) AND 25-3-120 (2).
(4) RECEIPT OF THE DISCLOSURES REQUIRED BY THIS SECTION
DOES NOT WAIVE A CONSUMER'S PROTECTIONS UNDER SECTION 10-16-704
(3) OR (5.5) OR THE CONSUMER'S RIGHT TO BENEFITS UNDER THE
CONSUMER'S HEALTH BENEFIT PLAN AT THE IN-NETWORK BENEFIT LEVEL
FOR ALL COVERED SERVICES AND TREATMENT RECEIVED.
(5) THIS SECTION DOES NOT APPLY TO SERVICE AGENCIES, AS
DEFINED IN SECTION 25-3.5-103 (11.5), THAT ARE PUBLICLY FUNDED FIRE
AGENCIES.
12-30-112. Out-of-network health care providers -
out-of-network services - billing - payment. (1) IF AN
OUT-OF-NETWORK HEALTH CARE PROVIDER PROVIDES EMERGENCY
SERVICES OR COVERED NONEMERGENCY SERVICES TO A COVERED PERSON
AT AN IN-NETWORK FACILITY, THE OUT-OF-NETWORK PROVIDER SHALL:
(a) SUBMIT A CLAIM FOR THE ENTIRE COST OF THE SERVICES TO
THE COVERED PERSON'S CARRIER; AND
(b) NOT BILL OR COLLECT PAYMENT FROM A COVERED PERSON
FOR ANY OUTSTANDING BALANCE FOR COVERED SERVICES NOT PAID BY
THE CARRIER, EXCEPT FOR THE APPLICABLE IN-NETWORK COINSURANCE,
DEDUCTIBLE, OR COPAYMENT AMOUNT REQUIRED TO BE PAID BY THE
COVERED PERSON.
(2) (a) IF AN OUT-OF-NETWORK HEALTH CARE PROVIDER PROVIDES
COVERED NONEMERGENCY SERVICES AT AN IN-NETWORK FACILITY OR
EMERGENCY SERVICES AT AN OUT-OF-NETWORK OR IN-NETWORK
FACILITY AND THE HEALTH CARE PROVIDER RECEIVES PAYMENT FROM THE
COVERED PERSON FOR SERVICES FOR WHICH THE COVERED PERSON IS NOT
RESPONSIBLE PURSUANT TO SECTION 10-16-704 (3)(b) OR (5.5), THE
HEALTH CARE PROVIDER SHALL REIMBURSE THE COVERED PERSON WITHIN
SIXTY CALENDAR DAYS AFTER THE DATE THAT THE OVERPAYMENT WAS
REPORTED TO THE PROVIDER.
(b) AN OUT-OF-NETWORK HEALTH CARE PROVIDER THAT FAILS TO
REIMBURSE A COVERED PERSON AS REQUIRED BY SUBSECTION (2)(a) OF
THIS SECTION FOR AN OVERPAYMENT SHALL PAY INTEREST ON THE
OVERPAYMENT AT THE RATE OF TEN PERCENT PER ANNUM BEGINNING ON
THE DATE THE PROVIDER RECEIVED THE NOTICE OF THE OVERPAYMENT.
THE COVERED PERSON IS NOT REQUIRED TO REQUEST THE ACCRUED
INTEREST FROM THE OUT-OF-NETWORK HEALTH CARE PROVIDER IN ORDER
TO RECEIVE INTEREST WITH THE REIMBURSEMENT AMOUNT.
(3) AN OUT-OF-NETWORK HEALTH CARE PROVIDER SHALL
PROVIDE A COVERED PERSON A WRITTEN ESTIMATE OF THE AMOUNT FOR
WHICH THE COVERED PERSON MAY BE RESPONSIBLE FOR COVERED
NONEMERGENCY SERVICES WITHIN THREE BUSINESS DAYS AFTER A
REQUEST FROM THE COVERED PERSON.
(4) (a) AN OUT-OF-NETWORK HEALTH CARE PROVIDER MUST SEND
A CLAIM FOR A COVERED SERVICE TO THE CARRIER WITHIN ONE HUNDRED
EIGHTY DAYS AFTER THE RECEIPT OF INSURANCE INFORMATION IN ORDER
TO RECEIVE REIMBURSEMENT AS SPECIFIED IN THIS SUBSECTION (4)(a).
THE REIMBURSEMENT RATE IS THE GREATER OF:
(I) ONE HUNDRED FIVE PERCENT OF THE CARRIER'S MEDIAN
IN-NETWORK RATE OF REIMBURSEMENT FOR THAT SERVICE PROVIDED IN
THE SAME GEOGRAPHIC AREA; OR
(II) THE MEDIAN IN-NETWORK RATE OF REIMBURSEMENT FOR THE
SAME SERVICE IN THE SAME GEOGRAPHIC AREA FOR THE PRIOR YEAR
BASED ON CLAIMS DATA FROM THE ALL-PAYER HEALTH CLAIMS
DATABASE CREATED IN SECTION 25.5-1-204.
(b) IF THE OUT-OF-NETWORK HEALTH CARE PROVIDER SUBMITS A
CLAIM FOR COVERED SERVICES AFTER THE ONE-HUNDRED-EIGHTY-DAY
PERIOD SPECIFIED IN SUBSECTION (4)(a) OF THIS SECTION, THE CARRIER
SHALL REIMBURSE THE HEALTH CARE PROVIDER ONE HUNDRED
TWENTY-FIVE PERCENT OF THE MEDICARE REIMBURSEMENT RATE FOR THE
SAME SERVICES IN THE SAME GEOGRAPHIC AREA.
(c) THE HEALTH CARE PROVIDER SHALL NOT BILL A COVERED
PERSON ANY OUTSTANDING BALANCE FOR A COVERED SERVICE NOT PAID
FOR BY THE CARRIER, EXCEPT FOR ANY COINSURANCE, DEDUCTIBLE, OR
COPAYMENT AMOUNT REQUIRED TO BE PAID BY THE COVERED PERSON.
(5) A HEALTH CARE PROVIDER MAY INITIATE ARBITRATION
PURSUANT TO SECTION 10-16-704 (15) IF THE HEALTH CARE PROVIDER
BELIEVES THE PAYMENT MADE PURSUANT TO SUBSECTION (4) OF THIS
SECTION IS NOT SUFFICIENT.".

Renumber succeeding sections accordingly.

Strike page 25 and substitute:

"SECTION 10. Act subject to petition - effective date -
applicability. (1) Except as otherwise provided in subsection (2) of this
section, this act takes effect January 1, 2020; except that, if a referendum
petition is filed pursuant to section 1 (3) of article V of the state
constitution against this act or an item, section, or part of this act within
the ninety-day period after final adjournment of the general assembly,
then the act, item, section, or part will not take effect unless approved by
the people at the general election to be held in November 2020 and, in
such case, will take effect on the date of the official declaration of the
vote thereon by the governor.
(2) (a) Section 5 of this act takes effect only if House Bill
19-1172 does not become law.
(b) Section 8 of this act takes effect only if House Bill 19-1172
becomes law.
(3) This act applies to health care services provided on or after the
applicable effective date of this act.".


Appro-
priations