s_blt_2017a_2017-02-13t14:05:01z1 Hearing Summary

Date: 02/13/2017

Location: SCR 354

04:17 PM -- SB 17-088



Senator Holbert and Senator Williams introduced Senate Bill 17-088, concerning the criteria used by a health insurer to select health care providers to participate in the insurer's network of providers. If a health insurer offers a narrow network or a tiered network, this bill requires the health insurer to develop, use, and disclose to participating and prospective healthcare providers, consumers, and the Commissioner of Insurance, the standards it uses for selecting providers to participate in its network. Selection, narrowing, and tiering standards cannot:



allow the insurer to discriminate against high-risk populations;

exclude providers because they treat or specialize in treating high risk patients;

allow an insurer to utilize economic criteria to credential a provider; or

discriminate against any provider who is acting within the scope of the provider's license or certification under applicable state laws or rule.



For networks that an insurer markets as representing quality or value, the insurer must include a quality component in its standards that carries an equal or greater weight than other components of the standards. Quality criteria must be based on specialty-appropriate, nationally recognized, evidence-based medical guidelines or nationally recognized, consensus-based guidelines. An insurer may use professional certification or accreditation in determining provider quality of care but not as the sole factor in determining provider quality.



The bill requires that at least 45 days prior to taking an adverse action against a provider, that an insurer provide written notice to the provider with an explanation of the proposed adverse action, reference to the evidence or documentation behind the decision, and to inform the provider of the right to request the insurer to reconsider the adverse action. The bill requires insurers to establish a reconsideration process with specific deadlines.



An insurer that violates the provisions of this bill engages in an unfair or deceptive act or practice in the business of insurance. Under current law, an insurer found to have committed an unfair or deceptive practice by the Commissioner of Insurance may face a range of potential disciplinary actions, including a fine of up to $30,000 per act and up to $750,000 in aggregate per year for knowingly committing such violation as well as suspension or revocation of an insurer's license.



04:31 PM -- Dr. Robert Yakely, Colorado Medical Society (CMS), spoke in support of the bill. He provided a handout to the committee (Attachment F). He responded to questions from the committee.



170213 AttachF.pdf



04:36 PM -- Dr. James Boyd, CMS, spoke in support of the bill.



04:41 PM -- Randal Crowden, representing himself, spoke in support of the bill. He responded to questions from the committee.



04:45 PM -- Dr. Helen Story, representing herself, spoke in support of the bill.



04:49 PM -- Dr. Tamaan Osbourne-Roberts, Colorado Academy of Family Physicians, spoke in support of the bill. He responded to questions from the committee.



05:01 PM -- Charlie Sheffield, Colorado Association of Health Plans, spoke in opposition to the bill.



05:05 PM -- Marc Reece, Aetna, spoke in opposition to the bill. He responded to questions from the committee.



05:21 PM -- Dr. Kent Yount, Colorado Optometric Society, spoke in support of the bill.



05:26 PM -- Dr. Anna Weyand, Colorado Society of Anesthesiologists, spoke in support of the bill.



05:29 PM -- Dr. Mark Laitos, Cigna, spoke in opposition to the bill. He responded to questions from the committee.



05:35 PM -- Robert Rush, United Health Care, spoke in opposition to the bill.



05:40 PM -- Dr. Mark Carvalho, Kaiser Permanente, spoke in opposition to the bill. He responded to questions from the committee.



05:47 PM -- Travis Berry, Colorado Competitive Council, spoke in opposition to the bill.



05:51 PM -- Loren Furman, Colorado Association of Commerce and Industry, spoke in opposition to the bill.



05:53 PM -- Jennifer Souders, Colorado Medical Group Management Association, spoke in support of the bill.



05:59 PM -- John Conklin, CMS, spoke in support of the bill. He responded to questions from the committee.



06:10 PM -- Betsy Murray, American Physical Therapy Association, spoke in support of the bill.



06:13 PM -- Brad Young, Rx Plus Pharmacies, spoke in support of the bill

170213 AttachG.pdf

170213 AttachH.pdf

170213 AttachI.pdf

170213 AttachJ.pdf

170213 AttachK.pdf

06:32 PM



The committee recessed.