Representative Lontine, bill sponsor, introduced HB21-1135. The bill requires operators of health care cost-sharing arrangements (CSAs) to report specified information to the Commissioner of Insurance in the Department of Regulatory Agencies, provide disclosures to consumers, and respond to requests for payment within a specified time period.
CSA Operations. The bill establishes the following requirements regarding the operation of a CSA:
- by January 1, 2022, a CSA must provide disclosures, the content of which is detailed in the bill and in rule, to current and prospective members concerning the obligations of the member and the CSA, and post this information on its website and marketing materials;
- by January 1, 2022, a CSA must provide certain disclosures on cards issued to members, provide monthly statements to members regarding claim status, and provide quarterly financial statements for the CSA;
- upon receiving a bill from a member or provider, a CSA must respond within a period of time specified in rule—failure to pay the expense or respond within the time allowed constitutes a denial of the request; and
- a CSA must allow its members to continue participation in the arrangement after developing a medical condition.
The commissioner may issue an emergency cease-and-desist order or assess penalties for failure to comply with the requirements of the bill, with penalties starting at $500 per offense and increasing up to $5,000 for repeat violations.
Reporting. Operators of CSAs must submit annual filings to the commissioner by March 1 of each year. Among other things, the filings must include the following information:
- financial statements;
- fees paid to third parties for marketing or operations;
- member benefits, limitations, and exclusions;
- providers with whom the CSA contracts;
- the number of members, households, and employer groups participating in the CSA;
- the number of applications to participate in the CSA submitted, accepted, and denied;
- the number of bills submitted, paid, denied, and appealed; and
- any other information required by the commissioner in rule.
Rulemaking. The commissioner must adopt rules concerning disclosures, reporting, and timing of bill payment by CSAs. Additionally, rules may be adopted to establish greater penalties for noncompliance based on the frequency or severity of violations.
Representative Lontine requested the committee postpone the bill indefinitely.
Public testimony related to HB21-1135 can be found in Attachment A.
