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.
On or before December 31, 2025, the commissioner of insurance must promulgate rules to implement the bill, including rules:
- 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.
The division of insurance must contract with an actuary to determine a minimum reimbursement schedule for alternative payment models. The schedule:
- 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.
If a carrier and a primary care provider do not negotiate and agree to terms of reimbursement, the carrier must compensate the primary care provider in accordance with the schedule for contracted reimbursements established by rule.
If a primary care provider employed by a medical group or hospital system leaves the medical group or hospital system to establish an independent practice, the primary care provider may communicate with patients about continuing to see them in the new practice.
(Note: This summary applies to this bill as introduced.)