Health Insurers Contract with Qualified Providers

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. Under current law, any covenant not to compete provision of an employment, partnership, or corporate agreement between physicians that restricts the right of a physician to practice medicine upon termination of the agreement is void; except that all other provisions of the agreement, including provisions that require the payment of damages in an amount that is reasonably related to the injury suffered by reason of termination of the agreement, are enforceable. Provisions of a covenant not to compete that require the payment of damages upon termination of the agreement may include damages related to competition. The bill:

• Establishes exceptions to the general prohibition on covenant not to compete provisions;
• Broadens the scope of the prohibition to apply to any agreement rather than applying only to employment, partnership, and corporate agreements between physicians;
• Narrows the existing exception to the prohibition to apply only to provisions that require the payment of damages in an amount that is reasonably related to the injury suffered due to a breach, rather than a termination, of the agreement; and
• Prohibits including in an agreement any of several provisions that require payment of certain types of damages.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)