Colorado Medical Society

COL votes to file legislation following failed mediation with health plans

Wednesday, January 27, 2016 03:16 PM

The CMS Council on Legislation unanimously voted yesterday, Jan. 27, to pursue legislation on network adequacy issues during the 2016 Colorado General Assembly following failed mediation between the Colorado Medical Society and the Colorado Association of Health Plans (CAHP) on out of network (OON) and related issues.

CMS President Mike Volz, MD, expressed profound disappointment with CAHP’s response to CMS’s latest proposal. In addition to retreating to their original, uncompromising position on the OON issue, CAHP offered only a vague promise to work with CMS “sometime in the future” on other issues of concern to physicians. From the outset of the mediation, CMS specified that other issues related to OON were important and needed to be addressed as part of this process.

“Not only is this position contrary to the original written agreement between the two organizations to work on both OON and other network adequacy issues during the interim, CAHP also did not provide us with a legislative solution to their OON issues. Nor did they specify any timeline when they would be willing to work with us on other issues after OON was reconciled, except to make it clear that 2016 was not an option,” Volz said.

The vote authorizes CMS’ professional advocates to develop and manage network adequacy reform legislation in partnership with specialty society partners. Because of the research gathered to prepare the CMS OON operational plan, advocates are confident that they can quickly craft legislation that protects consumers, addresses member concerns on network adequacy, and puts the medical profession on offense in the public’s interest.

Volz thanked the Senate Committee on Business, Labor and Technology for the opportunity to attempt to reconcile differences with the insurance companies on these and other interrelated issues. The mediator will make a final report available within the next two weeks.