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HB21-1232

Standardized Health Benefit Plan Colorado Option

Concerning the establishment of a standardized health benefit plan to be offered in Colorado, and, in connection therewith, making an appropriation.
Session:
2021 Regular Session
Subject:
Health Care & Health Insurance
Bill Summary

The bill requires the commissioner of insurance (commissioner) in the department of regulatory agencies to establish a standardized health benefit plan (standardized plan) by rule to be offered by health insurance carriers (carriers) in the individual and small group markets. The standardized plan must:

  • Offer health-care coverage at the bronze, silver, and gold levels;
  • Include pediatric and other essential health benefits;
  • Be offered through the Colorado health benefit exchange and in the individual market ;
  • Be a standardized benefit design created through a stakeholder engagement process;
  • Provide first-dollar, predictable coverage for certain high value services; and
  • Be actuarially sound and allow carriers to meet financial requirements;
  • Comply with state and federal law; and
  • Have a provider network (network) that is culturally responsive and reflects the diversity of its enrollees.

The bill requires the commissioner to:

  • Promulgate rules regarding network adequacy;
  • Contract with an independent third party to conduct an analysis of the implementation of the standardized plan and the related requirements; and
  • Collaborate with the health benefit exchange to conduct a consumer survey.

Beginning January 1, 2023, and each year thereafter, the bill encourages requires carriers that offer:

  • An individual health benefit plan in Colorado to offer the standardized plan in the individual market; and
  • A small group health benefit plan in Colorado to offer the standardized plan in the small group market.

For 2023, each carrier shall set a goal of offering offer a standardized plan premium that is at least 10% 6% less than the premium rate for health benefit plans offered by that carrier in the 2021 calendar year in the individual and small group market s , as adjusted for medical inflation . For 2024, each carrier shall set a goal of offering offer a standardized plan premium that is at least 20% 12% less than the premium rate for health benefit plans offered by that carrier in the 2021 calendar year in the individual and small group market s , as adjusted for medical inflation . For 2025, each carrier shall offer a standardized plan premium that is at least 18% less than the premium rate for health benefit plans offered by that carrier in the 2021 calendar year in the individual and small group markets, as adjusted for medical inflation. For 2025 2026 and each year thereafter, carriers are encouraged to shall limit annual premium rate increases for the standardized plan to no more than the consumer price index plus one percent medical inflation , relative to the previous year.The Colorado option authority (authority) is created for the purpose of operating as a carrier to offer the standardized plan as the Colorado option if the carriers do not meet the established premium rate goals. The authority shall operate as a nonprofit, unincorporated public entity. The authority is required to implement a provider fee schedule as established by the commissioner in consultation with the executive director of the department of health care policy and financing. Health-care providers and health facilities are required to accept consumers who are enrolled in any health benefit plan offered by the authority.The bill requires each carrier to file rates for the standardized plan. If a carrier or health-care provider anticipates that a carrier will be unable to meet network adequacy standards or the premium rate requirements, the carrier or the health-care provider may initiate nonbinding arbitration prior to filing rates for the standardized plans. If a carrier cannot meet the premium rate requirements, the carrier must notify the commissioner of the reasons. The commissioner may hold a public hearing concerning network adequacy and premium rates. Based on evidence at the hearing, the commissioner may establish carrier reimbursement rates for hospitals and health-care providers and require the hospitals and health-care providers to accept patients and the established reimbursement rates.

The bill creates an advisory committee board to make recommendations to the authority concerning the development, implementation, and operation of the authority implement part 13 of the bill.

The commissioner is required to may apply to the secretary of the United States department of health and human services for a state innovation waiver and include a request for a pass-through of federal funding to capture savings as a result of the implementation of the standardized plan. Upon approval of the waiver, the commissioner is authorized to use any federal money for the implementation of the bill and for the Colorado health insurance enterprise.The bill requires the commissioner to contract with an independent third party to prepare reports regarding the implementation of the bill. The commissioner is required to report during the hearings conducted pursuant to the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act".

The commissioner is required to disapprove of a rate filing submitted by a carrier if the rate filing reflects a cost shift between the standardized plan and the health benefit plan for which rate approval is being sought.

The bill makes the failure to accept consumers who are covered through the Colorado option or the balance billing of a patient grounds for discipline under specified practice acts authorizes the director of the division of professions and occupations in the department of regulatory agencies (director) to assess an administrative fine against a licensee, certificate holder, and registrant for refusing to participate in the standardized plan or to accept reimbursement rates in violation of the bill. The bill authorizes the director to issue a warning and to fine a hospital that refuses to participate in the standardized plan.The bill repeals the authority and its functions if the United States congress establishes a national public option program that meets or exceeds the premium rate goals set forth in and health-care coverage pursuant to this bill.The bill creates the office of the insurance ombudsman in the department of health care policy and financing to act as an advocate for consumer interests in matters related to access to and affordability of the standardized plan.

$1,199,637 is appropriated to the department of regulatory agencies to implement the bill.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)


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

Status

Introduced
Passed
Became Law

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