Out-of-Network Health Care Provider Reimbursement
House Bill 19-1174 was passed by the Colorado Legislature to help protect patients from surprise out-of-network bills
The bill includes provisions for how health insurance carriers will reimburse providers (doctors, hospitals and other health care providers) for out-of-network emergency and non-emergency care.
Legislation and FAQ
FAQ from Center for Improving Value in Health Care (CIVHC) - CIVHC's Colorado All Payer Claims Database (CO APCD) is specifically identified in the bill as a data source for the implementation of HB19-1174.
Division of Insurance Implementation and Timeline
Five tracks for implemenation
- Emergency ambulance services reimbursement methodology regulation
- Consumer disclosures regulation
- Arbitration program process and arbitrator selection regulation
- Regulation establishing payment methodologies for out-of-network providers that utilize CIVHC / health insurance carrier data
- Out-of-network utilization reporting and terminology regulation
- Late August / Early September 2019 - Draft regulations available to share with stakeholders - Drafts released for informal external review:
- DRAFT 4-2-6X - Concerning the Establishment of a Carrier Payment Arbitration Program for Non-participating Providers - submit comments
- DRAFT 4-2-6X - Concerning the Payment Methodology for Non-contracted Service Agencies that Provide Ambulance Services - submit comments
- DRAFT 4-2-6X - Concerning Additional Requirements for Carrier Out-of-network Reimbursements - submit comments
- DRAFT 4-2-6X - Concerning Carrier Disclosures for Potential Emergency and Non-emergency Out-of-Network Services - submit comments
- September / October / November 2019 - Stakeholder meetings on draft regulations
- First DRAFT 4-2-71 - Concerning Reporting Requirements for Carrier Out-of-network Reimbursement - submit comments
- The FIRST public stakeholder meeting held on Tuesday, September 17th, from 1:00 PM to 4:00 PM, in Conference Room 100C, on the first floor of 1560 Broadway, Denver, CO, and included discussion of both the arbitration program regulation and the consumer disclosure regulation
- The SECOND public stakeholder meeting held on Thursday, September 19th, from 1:00 PM to 4:00 PM, in Conference Room 110D, on the first floor of 1560 Broadway, Denver, CO, and included discussion of both the ambulance payment methodology regulation and the additional requirements for out-of-network reimbursements regulation
- Second DRAFT 4-2-65 - Concerning Carrier Disclosures for Potential Emergency and Non-emergency Out-of-Network Services - submit comments
- The THIRD public stakeholder meeting is scheduled for Thursday, October 24th, from 1:00 PM to 3:00 PM, in Conference Room 100B, on the first floor of 1560 Broadway, Denver, CO, and will concern the second draft of the carrier disclosure regulation 4-2-65.
- November 2019 - Finalize regulations throughout the month
- December 2019 - Issue as emergency regulations to have in place before Jan. 1, 2020.