Amendments for HB22-1325

House Journal, April 13
13 HB22-1325 be amended as follows, and as so amended, be referred to
14 the Committee on Appropriations with favorable
15 recommendation:
16
17 Amend printed bill, page 4, line 22, after "OF" insert "NATIONALLY
18 RECOGNIZED, EVIDENCE-BASED".
19
20 Page 4, strike lines 25 through 27.
21
22 Page 5, strike lines 1 through 4 and substitute:
23
24 "(b) "ALTERNATIVE PAYMENT MODEL" MEANS A HEALTH-CARE
25 PAYMENT METHOD THAT USES FINANCIAL INCENTIVES, INCLUDING
26 SHARED-RISK PAYMENTS, POPULATION-BASED PAYMENTS, AND OTHER
27 PAYMENT MECHANISMS, TO REWARD PROVIDERS FOR DELIVERING
28 HIGH-QUALITY AND HIGH-VALUE CARE.".
29
30 Page 5, line 13, strike "10-16-150 (1)." and substitute "10-16-150.".
31
32 Page 5, line 27, strike "AND"
33
34 Page 6, line 3, strike "SETTING." and substitute "SETTING; AND
35 (VIII) OTHER PROVIDER TYPES SPECIFIED BY THE COMMISSIONER
36 BY RULE.".
37
38 Page 6, strike lines 15 and 16 and substitute "PATIENTS OF DIFFERENT
39 ANTICIPATED HEALTH NEEDS, AND INCLUDING SOCIAL FACTORS SUCH AS
40 HOUSING INSTABILITY, BEHAVIORAL".
41
42 Page 6, strike lines 18 through 27.
43
44 Strike pages 7 through 9 and substitute:
45
46 "(3) (a) (I) THE DIVISION SHALL DEVELOP ALTERNATIVE PAYMENT
47 MODEL PARAMETERS BY RULE FOR PRIMARY CARE SERVICES OFFERED
48 THROUGH HEALTH BENEFIT PLANS.
49 (II) THE DIVISION SHALL DEVELOP THE PRIMARY CARE
50 ALTERNATIVE PAYMENT MODEL PARAMETERS IN PARTNERSHIP WITH THE
51 DEPARTMENT OF HEALTH CARE POLICY AND FINANCING, THE DEPARTMENT
52 OF PERSONNEL, AND THE PRIMARY CARE PAYMENT REFORM
53 COLLABORATIVE IN ORDER TO OPTIMIZE ALIGNMENT BETWEEN HEALTH
54 BENEFIT PLANS OFFERED BY CARRIERS AND PUBLIC PAYERS AND ACHIEVE
55 THE FOLLOWING OBJECTIVES:
1 (A) INCREASED ACCESS TO HIGH-QUALITY PRIMARY CARE
2 SERVICES;
3 (B) IMPROVED HEALTH OUTCOMES AND REDUCED HEALTH
4 DISPARITIES;
5 (C) IMPROVED PATIENT AND FAMILY ENGAGEMENT AND
6 SATISFACTION;
7 (D) INCREASED PROVIDER SATISFACTION AND RETENTION; AND
8 (E) INCREASED PRIMARY CARE INVESTMENT THAT RESULTS IN
9 INCREASED HEALTH-CARE VALUE.
10 (III) AT A MINIMUM, THE ALTERNATIVE PAYMENT MODEL
11 PARAMETERS MUST:
12 (A) INCLUDE TRANSPARENT RISK ADJUSTMENT PARAMETERS THAT
13 ENSURE THAT PRIMARY CARE PROVIDERS ARE NOT PENALIZED FOR OR
14 DISINCENTIVIZED FROM ACCEPTING VULNERABLE, HIGH-RISK PATIENTS
15 AND ARE REWARDED FOR CARING FOR PATIENTS WITH MORE SEVERE OR
16 COMPLEX HEALTH CONDITIONS AND PATIENTS WHO HAVE INADEQUATE
17 ACCESS TO AFFORDABLE HOUSING, HEALTHY FOOD, OR OTHER SOCIAL
18 DETERMINANTS OF HEALTH;
19 (B) UTILIZE PATIENT ATTRIBUTION METHODOLOGIES THAT ARE
20 TRANSPARENT AND REATTRIBUTE PATIENTS ON A REGULAR BASIS, WHICH
21 MUST ENSURE THAT POPULATION-BASED PAYMENTS ARE MADE TO A
22 PATIENT'S PRIMARY CARE PROVIDER RATHER THAN OTHER PROVIDERS WHO
23 MAY ONLY OFFER SPORADIC PRIMARY CARE SERVICES TO THE PATIENT AND
24 INCLUDE A PROCESS FOR CORRECTING MISATTRIBUTION THAT MINIMIZES
25 THE ADMINISTRATIVE BURDEN ON PROVIDERS AND PATIENTS;
26 (C) INCLUDE A SET OF CORE COMPETENCIES AROUND
27 WHOLE-PERSON CARE DELIVERY THAT PRIMARY CARE PROVIDERS SHOULD
28 INCORPORATE IN PRACTICE TRANSFORMATION EFFORTS TO TAKE FULL
29 ADVANTAGE OF VARIOUS TYPES OF ALTERNATIVE PAYMENT MODELS; AND
30 (D) ESTABLISH AN ALIGNED QUALITY MEASURE SET THAT
31 CONSIDERS THE QUALITY MEASURES AND THE TYPES OF QUALITY
32 REPORTING THAT CARRIERS AND PROVIDERS ARE ENGAGING IN UNDER
33 CURRENT STATE AND FEDERAL LAW AND ENSURE THAT THE RULES
34 INCLUDE QUALITY MEASURES THAT ARE PATIENT-CENTERED AND
35 PATIENT-INFORMED AND ADDRESS: PEDIATRIC, PERINATAL, AND OTHER
36 CRITICAL POPULATIONS; THE PREVENTION, TREATMENT, AND
37 MANAGEMENT OF CHRONIC DISEASES; AND THE SCREENING FOR AND
38 TREATMENT OF BEHAVIORAL HEALTH CONDITIONS.
39 (IV) THE DIVISION SHALL ANNUALLY CONSIDER THE
40 RECOMMENDATIONS ON THE ALTERNATIVE PAYMENT MODEL PARAMETERS
41 PROVIDED BY THE PRIMARY CARE PAYMENT REFORM COLLABORATIVE.
42 (V) THE ALTERNATIVE PAYMENT MODELS MUST ALSO:
43 (A) ENSURE THAT ANY RISK OR SHARED SAVINGS ARRANGEMENTS
44 MINIMIZE SIGNIFICANT FINANCIAL RISK FOR PROVIDERS WHEN PATIENT
45 COSTS EXCEED WHAT CAN BE PREDICTED;
46 (B) INCENTIVIZE THE INTEGRATION OF BEHAVIORAL HEALTH-CARE
47 SERVICES THROUGH LOCAL PARTNERSHIPS OR THE HIRING OF IN-HOUSE
48 BEHAVIORAL HEALTH STAFF;
49 (C) INCLUDE PROSPECTIVE PAYMENTS TO PROVIDERS FOR HEALTH
50 PROMOTION, CARE COORDINATION, CARE MANAGEMENT, PATIENT
51 EDUCATION, AND OTHER SERVICES DESIGNED TO PREVENT AND MANAGE
52 CHRONIC CONDITIONS AND ADDRESS SOCIAL DETERMINANTS OF HEALTH;
53
1 (D) RECOGNIZE THE VARIOUS LEVELS OF ADVANCEMENT OF
2 ALTERNATIVE PAYMENT MODELS AND PRESERVE OPTIONS FOR CARRIERS
3 AND PROVIDERS TO NEGOTIATE MODELS SUITED TO THE COMPETENCIES OF
4 EACH INDIVIDUAL PRIMARY CARE PRACTICE; AND
5 (E) SUPPORT EVIDENCE-BASED MODELS OF INTEGRATED CARE
6 THAT FOCUS ON MEASURABLE PATIENT OUTCOMES.
7 (b) FOR HEALTH BENEFIT PLANS THAT ARE ISSUED OR RENEWED ON
8 OR AFTER JANUARY 1, 2025, A CARRIER SHALL ENSURE THAT ANY
9 ALTERNATIVE PAYMENT MODELS FOR PRIMARY CARE INCORPORATE THE
10 PARAMETERS ESTABLISHED IN THIS SUBSECTION (3).
11 (c) BY DECEMBER 1, 2023, THE COMMISSIONER SHALL
12 PROMULGATE RULES DETAILING THE REQUIREMENTS FOR ALTERNATIVE
13 PAYMENT MODELS PARAMETERS ALIGNMENT.".
14
15 Renumber succeeding subsections accordingly.
16
17 Page 10, line 12, strike "IN THE COMMERCIAL MARKET." and substitute
18 "BY CARRIERS.".
19
20 Page 10, strike lines 17 and 18 and substitute "BARRIERS TO HEALTH
21 ACCESS;
22 (b) REPORT ON THE EFFECTS OF THE ALTERNATIVE PAYMENT
23 MODELS ON PRIMARY CARE PROVIDERS, PRIMARY CARE PRACTICES, AND
24 PRIMARY CARE PRACTICES' ABILITY TO STAY INDEPENDENT, INCLUDING
25 THE EFFECTS ON PRIMARY CARE PROVIDERS' ADMINISTRATIVE BURDENS;
26 AND
27 (c) CONSIDER AND IDENTIFY ANY AVAILABLE DATA SOURCES OR".
28
29 Page 10, line 26 and 27, strike "IN THE COMMERCIAL MARKET," and
30 substitute "BY CARRIERS,".
31
32 Page 11, line 6, strike "DIVISION" and substitute "COMMISSIONER".
33
34 Page 11, after line 7 insert:
35
36 "(8) IF A CARRIER CLAIMS THAT INFORMATION SUBMITTED
37 PURSUANT TO THIS SECTION IS CONFIDENTIAL OR PROPRIETARY, THE
38 COMMISSIONER SHALL REVIEW THE INFORMATION AND REDACT SPECIFIC
39 ITEMS THAT THE CARRIER DEMONSTRATES TO BE CONFIDENTIAL OR
40 PROPRIETARY. THE COMMISSIONER SHALL NOT DISCLOSE REDACTED ITEMS
41 TO ANY PERSON; EXCEPT THAT THE COMMISSIONER MAY DISCLOSE
42 REDACTED ITEMS:
43 (a) AS MAY BE REQUIRED PURSUANT TO THE "COLORADO OPEN
44 RECORDS ACT", PART 2 OF ARTICLE 72 OF TITLE 24; AND
45 (b) TO EMPLOYEES OF THE DIVISION, AS NECESSARY.".
46
47 Page 11, strike line 9 and substitute "(1)(h), (1)(i)(IV), and (4); and add
48 (1)(j) and (2.5)".
49
50 Page 11, strike lines 17 through 21 and substitute:
51
52 "(i) Develop and share best practices and technical assistance to
53 health insurers and consumers, which may include:
54
1 (IV) The delivery of advanced primary care that facilitates
2 appropriate utilization of services in appropriate settings; AND
3 (j) ANNUALLY REVIEW THE ALTERNATIVE PAYMENT MODELS
4 DEVELOPED BY THE DIVISION PURSUANT TO SECTION 10-16-155 (3) AND
5 PROVIDE THE DIVISION WITH RECOMMENDATIONS ON THE MODELS.
6 (2.5) IN CARRYING OUT THE DUTIES OF SUBSECTION (1)(j) OF THIS
7 SECTION, IN ADDITION TO THE MEMBERS OF THE COLLABORATIVE
8 DESCRIBED IN SUBSECTION (2) OF THIS SECTION, THE COMMISSIONER SHALL
9 INCLUDE HEALTH INSURERS AND HEALTH-CARE PROVIDERS ENGAGED IN A
10 RANGE OF ALTERNATIVE PAYMENT MODELS.".
11
12

House Journal, April 21
16 HB22-1325 be amended as follows, and as so amended, be referred to
17 the Committee of the Whole with favorable
18 recommendation:
19
20 Amend printed bill, page 12, after line 20 insert:
21
22 "SECTION 4. Appropriation. (1) For the 2022-23 state fiscal
23 year, $56,328 is appropriated to the department of personnel and
24 administration for use by the division of human resources. This
25 appropriation is from the general fund. To implement this act, the division
26 may use this appropriation as follows:
27 (a) $49,048 for personal services related to state agency services,
28 which amount is based on an assumption that the division will require an
29 additional 0.7 FTE; and
30 (b) $7,280 for operating expenses related to state agency
31 services.".
32
33 Renumber succeeding section accordingly.
34
35 Page 1, line 102, strike "SERVICES." and substitute "SERVICES, AND, IN
36 CONNECTION THEREWITH, MAKING AN APPROPRIATION.".
37
38

House Journal, April 22
50 Amendment No. 1, Appropriations Report, dated April 21, 2022, and
51 placed in member’s bill file; Report also printed in House Journal,
52 April 21, 2022.
53
54
1 Amendment No. 2, Health & Insurance Report, dated April 13, 2022, and
2 placed in member’s bill file; Report also printed in House Journal,
3 April 14, 2022.
4
5 Amendment No. 3, by Representative Kennedy.
6
7 Amend the Health and Insurance Committee Report, dated April 13,
8 2022, page 3, line 27, strike "(b) FOR" and substitute:
9
10 "(b) (I) EXCEPT AS PROVIDED IN SUBSECTION (3)(b)(II) OF THIS
11 SECTION, FOR".
12
13 Page 3 of the committee report, after line 30 insert:
14
15 "(II) FOR MANAGED CARE PLANS THAT ARE ISSUED OR RENEWED
16 ON OR AFTER JANUARY 1, 2025, AND IN WHICH SERVICES ARE PRIMARILY
17 OFFERED THROUGH ONE MEDICAL GROUP CONTRACTED WITH A NONPROFIT
18 HEALTH MAINTENANCE ORGANIZATION, A CARRIER SHALL ENSURE THAT
19 ANY ALTERNATIVE PAYMENT MODELS FOR PRIMARY CARE INCORPORATE
20 THE ALIGNED QUALITY MEASURE SET ESTABLISHED IN SUBSECTION
21 (3)(a)(III)(D) OF THIS SECTION.".
22
23 Page 4, strike lines 9 through 18 and substitute:
24
25 ""(8) ANY INFORMATION SUBMITTED TO THE DIVISION IN
26 ACCORDANCE WITH THIS SECTION IS SUBJECT TO PUBLIC INSPECTION ONLY
27 TO THE EXTENT ALLOWED UNDER THE "COLORADO OPEN RECORDS ACT",
28 PART 2 OF ARTICLE 72 OF TITLE 24. THE DIVISION SHALL NOT DISCLOSE
29 ANY TRADE SECRET OR CONFIDENTIAL OR PROPRIETARY INFORMATION TO
30 ANY PERSON WHO IS NOT OTHERWISE AUTHORIZED TO ACCESS THE
31 INFORMATION.".".
32
33 Amendment No. 4, by Representative Kennedy.
34
35 Amend the Health and Insurance Committee Report, dated April 13,
36 2022, page 2, strike lines 7 and 8 and substitute "OF PERSONNEL, THE
37 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, AND THE PRIMARY
38 CARE PAYMENT REFORM COLLABORATIVE IN ORDER TO OPTIMIZE AND
39 CREATE POSITIVE INCENTIVES FOR ALIGNMENT BETWEEN HEALTH".
40
41 Page 3, line 8, after "PARAMETERS" insert "AND POSITIVE CARRIER
42 INCENTIVE ARRANGEMENTS".
43
44 Page 3, line 18, after "COORDINATION," insert "HEALTH NAVIGATION,".
45
46 Page 3, line 33, strike "ALIGNMENT."." and substitute "ALIGNMENT. THE
47 DIVISION SHALL ALLOW CARRIERS THE FLEXIBILITY TO DETERMINE WHICH
48 NETWORK PROVIDERS AND PRODUCTS ARE BEST SUITED TO ACHIEVE THE
49 GOALS AND INCENTIVES SET BY THE DIVISION IN THIS SECTION.".".
50
51 As amended, ordered engrossed and placed on the Calendar for Third
52 Reading and Final Passage.
53
54

Senate Journal, April 28
After consideration on the merits, the Committee recommends that HB22-1325 be
amended as follows, and as so amended, be referred to the Committee on Appropriations
with favorable recommendation.
Amend reengrossed bill, page 6, strike line 27 and substitute "THE PRIMARY
CARE PAYMENT REFORM COLLABORATIVE, AND CARRIERS AND PROVIDERS
PARTICIPATING IN ALTERNATIVE PAYMENT MODELS IN ORDER TO".

Page 8, line 6, strike "ESTABLISH" and substitute "REQUIRE".

Page 8, lines 9 and 10, strike "AND ENSURE THAT THE RULES INCLUDE" and
substitute "SO LONG AS THE QUALITY MEASURE SET INCLUDES".

Page 8, line 18, strike "COLLABORATIVE." and substitute "COLLABORATIVE AND
BY CARRIERS AND PROVIDERS PARTICIPATING IN ALTERNATIVE PAYMENT
MODELS BUT NOT PARTICIPATING IN THE PRIMARY CARE PAYMENT REFORM
COLLABORATIVE.".

Page 10, line 12, after "CARRIERS." insert "THE PLAN MUST INCLUDE
ALTERNATIVE PAYMENT MODELS IMPLEMENTED BY CARRIERS AND PROVIDERS
PRIOR TO JANUARY 1, 2025.".

Page 11, strike line 18 and substitute "INFORMATION, INCLUDING ANY
CONTRACTUAL INFORMATION BETWEEN CARRIERS AND PROVIDERS.".


Education



Senate Journal, May 3
After consideration on the merits, the Committee recommends that HB22-1325 be
amended as follows, and as so amended, be referred to the Committee of the Whole with
favorable recommendation.
Amend reengrossed bill, page 13, line 13, strike "and".

Page 13, line 14, strike "administration".


Appro-
priations


Senate Journal, May 4
HB22-1325 by Representative(s) Kennedy and Caraveo; also Senator(s) Ginal--Concerning alternative
payment models for primary care services, and, in connection therewith, making an
appropriation.


Amendment No. 1, Health & Human Services Committee Amendment.
(Printed in Senate Journal, April 28, page(s) 1050 and placed in members' bill files.)

Amendment No. 2, Appropriations Committee Amendment.
(Printed in Senate Journal, May 3, page(s) 1152 and placed in members' bill files.)

Amendment No. 3(L.017), by Senator Ginal.

Amend the Health and Human Services Committee Report, dated April 28,
2022, page 1, strike line 7 and substitute "and substitute "AND INCLUDES".".

Page 1, line 15, after "ANY" insert "CONFIDENTIAL OR PROPRIETARY".

As amended, ordered revised and placed on the calendar for third reading and final
passage.