h_hie_2017a_2017-03-30t14:34:39z4 Hearing Summary

Date: 03/30/2017

Location: HCR 0107

06:06 PM -- SB 17-088



Representatives Van Winkle and Hooton presented Senate Bill 17-088 to the committee. If a health insurer offers a tiered network, the reengrossed bill requires the health insurer to develop and use standards for selecting and tiering participating providers. The insurer is required to make the standards available to the Commissioner of Insurance, participating healthcare providers, and the public. Selection and tiering standards cannot:



• allow the insurer to discriminate against high-risk populations by excluding or tiering providers based on their location in a geographic area that contains high-risk populations; or

• exclude providers because they treat or specialize in treating high-risk patients.



The bill requires that at least 60 days prior to implementing a decision to terminate or place a provider in a tiered network, that an insurer provide written notice to the provider with an explanation of the reasons for the decision, and to inform the provider of the right to request the insurer to reconsider the decision. The bill requires insurers to establish a reconsideration process with specific deadlines.



The commissioner and Division of Insurance staff are prohibited from arbitrating, mediating, or settling disputes regarding a decision not to include a provider in a network or tiered network or regarding any dispute between an insurer, the insurer's intermediary, or providers. However, if the commissioner determines that an insurer has violated the provisions of this bill, the commissioner must require the insurer to follow a corrective action plan and may use enforcement powers available under current insurance law.



06:19 PM -- Sara Orrange, representing Colorado Association of Health Plans, testified in a neutral capacity.



06:23 PM -- Jennifer Souders, representing Colorado Medical Group Management Association and Hilltop Family Physicians, testified in support of the bill.



06:29 PM -- Ali Schmidt, representing the Colorado Hospital Association, testified in support of the bill.