Health Insurers Contract with Qualified Providers

With certain exceptions, for health benefit plans that are issued or renewed on or after January 1, 2027, the bill requires a health-care insurance carrier (carrier) to include a primary care provider as a participating provider in all networks, including narrow networks and all tiers of tiered networks, of the carrier's health benefit plan if the primary care provider is:

• Licensed to practice in Colorado;
• Certified or accredited by a national association for the certification or accreditation of primary care providers;
• Enrolled in an alternative payment model; and
• Credentialed by federal law to receive reimbursement for the provision of care to patients receiving benefits from medicaid.

• Establishing criteria and a process for determining whether a primary care provider meets the criteria; and
• Establishing a schedule for contracted reimbursements issued to primary care providers who participate in a health benefit plan.

• Must ensure that primary care providers are reimbursed at rates that are at least equal to the reimbursement rates established in law for purposes of the Colorado standardized health benefit plan;
• Must include adjustments for regional cost of living variations; and
• May include incentives for integration of behavioral health-care services and comprehensive care coordination services.

• Establishes exceptions to the general prohibition on covenant not to compete provisions;
• Broadens the scope of the prohibition to apply to any agreement rather than applying only to employment, partnership, and corporate agreements between physicians;
• Narrows the existing exception to the prohibition to apply only to provisions that require the payment of damages in an amount that is reasonably related to the injury suffered due to a breach, rather than a termination, of the agreement; and
• Prohibits including in an agreement any of several provisions that require payment of certain types of damages.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)