CMS advocates for health plan reform, stable liability climate
by Susan Koontz, JD, CMS General Counsel
Numerous surveys of CMS members demonstrate deep dissatisfaction with the current multi-payer system. Last summer, a good-faith mediation between CMS and the Colorado Association of Health Plans (CAHP) failed when a few insurers insisted CAHP discontinue discussions, and the plans were reluctant to resume discussions prior to the 2017 Colorado General Assembly. In response, the Colorado Medical Society is pursuing the passage of a series of managed care reforms in the 2017 General Assembly, as directed by the CMS Board of Directors. These reforms have inspired a healthy and long-overdue debate over the relationship between physicians and payers that will hopefully turn the focus of interactions to value rather than market share and volume.
CMS is deeply grateful to members of the General Assembly who have been willing to step up and promote fairness and greater transparency in the system, as well as the many CMS members who have completed our surveys, testified at hearings and taken the time to contact their elected officials.
SB17-133 - Insurance Commissioner Investigation of Provider Complaints
Sponsors: J. Tate / D. Young
Currently, the commissioner of insurance may investigate complaints by health care providers regarding the improper handling or denial of benefits by a health insurance company. The bill requires the commissioner to investigate provider complaints and notify the provider of the results of the investigation. The commissioner is directed to include information on provider complaints in an existing annual report to the General Assembly. The commissioner must determine if there is a pattern of misconduct by a health insurance company and, if there is a pattern, must impose an appropriate remedy or penalty as an unfair or deceptive practice.
The Department of Insurance has now agreed to a pilot program and the initial pilot framework and data to be collected; thus, the bill has been voluntarily postponed indefinitely. At present, we are actively engaged in the process of establishing the CMS/DOI Provider Complaint Pilot Program.
SB17-088 - Participating Provider Network Selection Criteria
Sponsors: C. Holbert | A. Williams / K. Van Winkle | E. Hooton
This bill requires a health insurer to develop, use and disclose to participating health care providers the standards the carrier uses for:
- Selecting participating providers for its network of providers;
- Tiering providers within the network; and
- Placing participating providers in a narrow or tiered provider network.
The governor signed the bill into law on April 16.
SB17-198 - Public Participate Review Acquire Control Insurer
Sponsors: K. Priola / A. Garnett
Current law requires an opportunity for public notice and a hearing for proposed transactions that would result in the acquisition of control of a domestic insurer, which is one that is incorporated or formed pursuant to Colorado law.
For mergers involving non-domestic health plan companies, the bill requires the commissioner to provide public notice with a description of the process including public input within five days of any proposed acquisition filing. Instead of a more costly “investigation” the changes require a “review” if the proposed acquisition creates a prima facie violation of the Competitive Standard. The bill requires public disclosure of any markets, insurance products, and market share that create a prima facie violation of the competitive standards and gives the commissioner 60 days from Form E filing to conduct a hearing or review with stakeholder input. The commissioner may then issue any order adverse to the acquisition.
Finally, the bill clarifies that nothing in the law prohibits a carrier from making its competitive impact analysis (Form E) available for stakeholder inspection.
The bill has passed the Senate and House and awaits the governor’s signature.
HB17-1173 - Health Care Providers and Carriers Contracts
Sponsors: C. Hansen / T. Neville
Current law requires a contract between a health insurance carrier and a health care provider to include a provision that prohibits a carrier from taking an adverse action against the provider due to a provider’s disagreement with a carrier’s decision on the provision of health care services. The carrier cannot terminate the health care provider’s contract for disagreeing or for assisting his or her patient in seeking a reconsideration.
The bill requires the contract to also contain provisions that prohibit a carrier from: taking adverse actions for communicating with public officials on health care issues; filing complaints or reporting to public officials about conduct by a carrier that might negatively affect patient care; providing information concerning a violation of this provision; reporting alleged carrier violations to the appropriate authorities; or participating in an investigation of an alleged violation.
The governor signed the bill on April 6.
SB17-206 - Out of Network and Surprise Bills
Sponsors: B. Gardner / J. Singer
This bill was intended to provide a framework to resolve the long-standing out-of-network balance billing problem by requiring that carriers, facilities and providers all notify patients of their legal protection for OON bills under current Colorado law.
With the approval of the house of medicine, this bill was postponed indefinitely in committee by the bill’s sponsor.
SB 17-106 Sunset Registration of Naturopathic Doctors
Position: Support Introduced Bill, Oppose House Amendments
Sponsors: I. Aguilar | D. Coram | J. Kefalas / J. Singer
The introduced bill implements recommendations of the Department of Regulatory Agencies (DORA), as contained in DORA’s Sunset Review of Naturopathic Doctors dated Oct. 14, 2016, reauthorizing the regulation of naturopaths (NDs) under Colorado’s sunset review process.
During the February Council on Legislation (COL) meeting, the council voted to support the bill based upon the DORA report. However, the council unanimously agreed to oppose any expansion to the NDs’ scope of practice. Thereafter, the bill was amended in the House to expand the prescriptive authority of NDs to allow them to obtain, administer, dispense, prescribe and treat patients with intravenous minerals and amino acids, as well as hormones.
The council was troubled by language associated with the House amendments regarding authorization to treat, specifying that nothing would have limited the ability of an ND to make an independent judgment or to require supervision by a physician or APN. In addition, there was concern with the term “hormone” because it was not defined and would have been open to a more broad and more dangerous interpretation and authorization for NDs to treat patients.
The Senate rejected the House amendments and adhered to their original position; ultimately, the amendments were withdrawn by the House. The bill has now passed without the inclusion of the House amendments.
Because this issue of Colorado Medicine went to press prior to the end of the legislative session, stay tuned for an in-depth look at the 2017 session in the July/August issue.
Posted in: Colorado Medicine | Legislative Updates