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103935904_3
COLORADO SUPREME COURT Colorado State Judicial Building Two East 14th Avenue Denver, CO 80203
▲ COURT USE ONLY ▲
Original Proceeding Pursuant to C.R.S. § 1-40-107(2) Appeal from the Colorado Ballot Title Setting Board In the Matter of the Title, Ballot Title, and Submission Clause for Proposed Initiative 2017-2018 #119
Petitioner: Deborah Farrell v. Respondents: David Silverstein and Andrew Graham and Colorado Ballot Title Setting Board: Suzanne Staiert, Jason Gelender, and Glenn Roper
Case No.:
Attorneys for Petitioner Deborah Farrell: Thomas M. Rogers III, #28809 Dietrich C. Hoefner, #46304 LEWIS ROCA ROTHGERBER CHRISTIE LLP 1200 Seventeenth Street, Suite 3000 Denver, CO 80202 Phone: 303.623.9000 Fax: 303.623.9222 Email: [email protected] [email protected]
PETITION FOR REVIEW OF FINAL ACTION OF TITLE SETTING BOARD CONCERNING PROPOSED INITIATIVE 2017-2018 #119
(“TRANSPARENCY IN HEALTH CARE INSURANCE CARRIER BILLING”)
DATE FILED: February 28, 2018 3:21 PM
103935904_3 2
Petitioner Deborah Farrell, a registered elector of the State of Colorado,
pursuant to C.R.S. § 1-40-107(2), respectfully petitions this Court to review the
actions of the Ballot Title Setting Board with respect to the setting of the title and
submission clause for Proposed Initiative 2017-2018 #119 (“Transparency in
Health Care Insurance Carrier Billing”), and states:
STATEMENT OF THE CASE
I. Procedural History of Proposed Initiative #119
On January 11, 2018, Proponents David Silverstein and Andrew Graham
filed Proposed Initiative 2015-2016 #119 (the “Initiative”) with the Office of
Legislative Council. The Initiative is one of a series of four initiatives filed by
Respondents on which Petitioner is seeking review (initiatives #119, #121, #122,
and #123). Each of the four initiatives is related. Initiative #119 would regulate
health insurance carriers, Initiative #122 would regulate healthcare providers, and
Initiatives #121 and #123 are omnibus measures that would each regulate health
insurance carriers, pharmacies, and healthcare providers.1
The review and comment meeting for Initiative #119 was held under C.R.S.
§ 1-40-105(1) on January 23, 2018. Proponents submitted the original, amended, 1 Initiatives #121 and #123, with limited exceptions, include the provisions of Initiatives #119 and #122. As such, judicial economy may best be served by consolidating review of these four initiatives.
103935904_3 3
and final versions of the Initiative to the Secretary of State for title setting on
January 26, 2018. On February 7, 2018, the Title Board set the Initiative’s title. On
February 14, 2018, Petitioner timely filed a Motion for Rehearing on the basis that
the Title Board lacked jurisdiction to set title because amendments to the Initiative
made after the review and comment meeting violate C.R.S. § 1-40-105(2), the
Initiative violates the single subject requirement of article V, section 1(5.5) of the
Colorado Constitution and C.R.S. § 1-40-106.5, and further that the title does not
fairly express the true meaning and intent of the proposed measure.
The Title Board held a rehearing on February 21, 2018 and denied the
Petitioner’s motion except to the extent that the Board made changes to the title.
II. Jurisdiction
Under C.R.S. § 1-40-107(2), Petitioner is entitled to Colorado Supreme
Court review of the Title Board’s actions in setting the Initiative’s title. Petitioner
filed a timely Motion for Rehearing, see C.R.S. § 1-40-107(1), and subsequently
filed this Petition for Review within seven days from the date of the rehearing, see
C.R.S. § 1-40-107(2). As required by C.R.S. § 1-40-107(2), attached to this
Petition are certified copies of: (1) the Proponents’ original, amended, and final
drafts of the Initiative; (2) the title set by the Title Board on February 7, 2018; (3)
the Motion for Rehearing filed by the Petitioner; and (4) the Title Board’s rulings
103935904_3 4
on the Motion for Rehearing as reflected by the title and submission clause set by
the Board after rehearing on February 21, 2018. Petitioner respectfully submits that
the Title Board erred in denying her motion for rehearing on the issues set forth
below. For these reasons, this matter is properly before the Colorado Supreme
Court.
GROUNDS FOR APPEAL
The following is an advisory list of the issues to be addressed in the
Petitioner’s brief:
(1) The Initiative violates the single subject requirement of article V,
section 1(5.5) of the Colorado Constitution and C.R.S. § 1-40-106.5.
While the Initiative purports to address “price transparency in
healthcare billing,” it also requires insurance carriers to make broad
disclosures regarding all forms of remuneration derived from rebates
or other forms of incentive received as the result of healthcare
services or purchases of prescription drugs or medical devices.
(2) The title violates C.R.S. § 1-40-106(3)(b) because it is misleading and
does not reflect a central feature of the Initiative; specifically, the fact
that although the Initiative purports to regulate “healthcare providers,”
103935904_3 5
the Initiative also regulates professionals such as social workers that
are not commonly regarded to be healthcare providers.
PRAYER FOR RELIEF
Petitioner respectfully requests that the Court reverse the Title Board’s
denial of Petitioner’s Motion for Rehearing and direct the Title Board to decline to
set a title on the measure for failure to meet the single-subject requirement, or
alternatively, to set a title that reflects the true intent and meaning of the Initiative.
Respectfully submitted this 28th day of February, 2018.
s/ Thomas M. Rogers III
Thomas M. Rogers III Dietrich C. Hoefner LEWIS ROCA ROTHGERBER CHRISTIE LLP
Attorneys for Petitioner Deborah Farrell
103935904_3 6
CERTIFICATE OF SERVICE
I hereby certify that on February 28, 2018, I electronically filed a true and correct copy of the foregoing PETITION FOR REVIEW OF FINAL ACTION OF TITLE SETTING BOARD CONCERNING PROPOSED INITIATIVE 2017-2018 #119 (“TRANSPARENCY IN HEALTH CARE INSURANCE CARRIER BILLING”) with the clerk of Court via the Colorado Courts E-Filing system and served the same via email and via US Mail on the following:
Martha Tierney 225 East 16th Avenue, Suite 350 Denver, CO 80203 [email protected] Attorney for Respondents David Silverstein and Andrew Graham
Matthew Grove, Assistant Attorney General Office of the Colorado Attorney General Ralph L. Carr Colorado Judicial Center 1300 Broadway, 6th Floor Denver, CO 80203 [email protected] Attorney for the Title Board
s/ Robin Newcomer Of: Lewis Roca Rothgerber Christie LLP
DEPARTMENT OF STATE
CERTIFICATE
I, WAYNE W. WILLIAMS, Secretary of State of the State of Colorado, do hereby certify that:
the attached are true and exact copies of the filed text, initial fiscal impact statement, abstract,
motion for rehearing, and the rulings thereon of the Title Board for Proposed Initiative "2017-2018
#119 'Transparency in Health Care Insurance Carrier Billing'"
IN TESTIMONY WHEREOF I have unto set my hand . .
and affixed the Great Seal of the State of Colorado, at the
City of Denver this 26th day of February, 2018.
DATE FILED: February 28, 2018 3:21 PM
Initiative 2017-2018 #119: Healthcare Insurance Carrier Billing Transparency - Final Draft
Be it enacted by the people ofthe state of Colorado:
JAN 2 6 2018 SECTION 1. In Colorado Revised Statutes, add part 3 to article 20 of title 6 as follows:
, .. _ . ! _ Colorado Secretary of Stats 1
6-20-300. Purpose. A DECLARATION FROM THE PEOPLE OF COLORADO.
(1) THE PEOPLE OF COLORADO ENACT THIS LAW REGARDING PRICE TRANSPARENCY IN HEALTHCARE
BILLING TO ESTABLISH COMMON SENSE, ORDER, AND INTEGRITY IN COLORADO'S HEALTHCARE SYSTEM
AND TO SET AN EXAMPLE FOR THE REST OF OUR NATION. THE PEOPLE BELIEVE TRANSPARENCY, IN ALL
ASPECTS OF HEALTHCARE BILLING, IS OF PARAMOUNT IMPORTANCE AND THAT IT WILL NOT, IN ANY WAY,
IMPEDE COMPETITION, BUT RATHER, WILL IMPROVE COMPETITION AND EMPOWER PATIENTS TO BECOME
MORE ACTIVE PARTICIPANTS IN THEIR OWN CARE.
(2) THE PEOPLE UNDERSTAND THAT SOME IN THE HEALTHCARE INDUSTRY MAY FIND PROVISIONS OF THIS
LAW ONEROUS. THE PEOPLE, HOWEVER, BELIEVE THAT THE LACK OF TRANSPARENCY THAT IS THE NORM
AT THE TIME OF THIS LAW'S ENACTMENT IS FAR MORE ONEROUS AND DANGEROUS, AND THUS, FIND THIS
LAW ABSOLUTELY NECESSARY IN ALL OF ITS DETAIL.
(3) THE PURPOSE OF TRANSPARENCY IN HEALTHCARE BILLING IS NOT MERELY TO PROVIDE PATIENTS WITH
THE ABILITY TO SHOP FOR HEALTHCARE SERVICES ON THE BASIS OF PRICE. IN FACT, SHOPPING AROUND
IS ONLY A SMALL ASPECT OF TRANSPARENCY IN HEALTHCARE BILLING, BECAUSE SHOPPING FOR
SERVICES IS NOT ALWAYS PRACTICAL WHEN HEALTHCARE SERVICE IS NEEDED. THE PURPOSE OF
TRANSPARENCY IN HEALTHCARE BILLING, AND OF THIS LAW, IS TO ENSURE THAT COLORADO'S
HEALTHCARE SYSTEM BEGINS TO FUNCTION IN A MANNER WHERE PRICES ARE AVAILABLE TO ANYONE
AND EVERYONE AT ALL TIMES. THE PEOPLE OF COLORADO BELIEVE THAT IF THERE IS TRANSPARENCY IN
HEALTHCARE BILLING, PRICES WILL BE FAIR AND WELL BE DETERMINED BY THE MARKETPLACE,
WHETHER OR NOT THEY PERSONALLY REVIEW ALL PRICES IN ADVANCE OF HEALTHCARE SERVICES.
SECTION 2. In Colorado Revised Statutes, add part 3 to article 20 of title 6 as follows:
PART 3
HEALTHCARE INSURANCE CARRIER BILLING TRANSPARENCY
6-20-301. Short title. THE SHORT TITLE OF THIS PART 3 IS THE "HEALTHCARE INSURANCE CARRIER BILLING
TRANSPARENCY ACT".
6-20-302. Definitions. As USED IN THIS PART 3, UNLESS THE CONTEXT OTHERWISE REQUIRES:
(1) "CMS" MEANS THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.
(2) "HEALTH INSURANCE" OR "HEALTH INSURANCE PLAN" HAS THE SAME MEANING AS "HEALTH COVERAGE
PLAN", AS DEFINED IN SECTION 10-16-102 (34).
(3) "HEALTH INSURANCE CARRIER", "INSURANCE CARRIER", OR "CARRIER" HAS THE SAME MEANING AS
"CARRIER", AS DEFINED IN SECTION 10-16-102 (8).
(4) "HEALTHCARE PROVIDER" OR "PROVIDER" MEANS:
(a) A HEALTHCARE FACILITY LICENSED OR CERTIFIED BY THE DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT PURSUANT TO SECTION 25-1.5-103 (l)(a), WHICH INCLUDES A HOSPITAL, HOSPITAL UNIT
AS DEFINED IN SECTION 25-3-101 (2), PSYCHIATRIC HOSPITAL, COMMUNITY CLINIC, REHABILITATION
HOSPITAL, CONVALESCENT CENTER, COMMUNITY MENTAL HEALTH CENTER, ACUTE TREATMENT UNIT,
FACILITY FOR PERSONS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES, NURSING CARE
FACILITY, HOSPICE CARE, ASSISTED LIVING RESIDENCE, DIALYSIS TREATMENT CLINIC, AMBULATORY
SURGICAL CENTER, BIRTHING CENTER, HOME CARE AGENCY, OR OTHER FACILITY OF A LIKE NATURE;
(b) A CLINICAL LABORATORY REGISTERED THROUGH THE CERTIFICATION PROGRAM ADMINISTERED BY
f THE CMS; ,
(c) A FACILITY THAT USES RADIATION MACHINES FOR MEDICAL PURPOSES AND THAT IS REGISTERED BY
THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PURSUANT TO STATE BOARD OF HEALTH RULES
ADOPTED IN ACCORDANCE WITH SECTION 25-11-104;
(D) A PERSON WHO IS LICENSED, CERTIFIED, OR REGISTERED BY THE STATE UNDER TITLE 12 OR ARTICLE
3.5 OF TITLE 25 TO PROVIDE HEALTHCARE SERVICES AND WHO DIRECTLY BILLS PATIENTS OR THIRD-
PARTY PAYERS FOR THE SERVICES, INCLUDING AN ACUPUNCTURIST, ATHLETIC TRAINER, AUDIOLOGIST,
PODIATRIST, CHIROPRACTOR, DENTIST, DENTAL HYGEENIST, MASSAGE THERAPIST, PHYSICIAN,
PHYSICIAN ASSISTANT, ANESTHESIOLOGIST ASSISTANT, DIRECT-ENTRY -MIDWIFE, NATUROPATHIC
DOCTOR, NURSE, CERTIFIED NURSE AIDE, NURSING HOME ADMINISTRATOR, OPTOMETRIST,
OCCUPATIONAL THERAPIST, OCCUPATIONAL THERAPY ASSISTANT, PHYSICAL THERAPIST, PHYSICAL
THERAPY ASSISTANT, RESPIRATORY THERAPIST, PSYCHIATRIC TECHNICIAN, PSYCHOLOGIST, SOCIAL
WORKER, CLINICAL SOCIAL WORKER, MARRIAGE AND FAMILY THERAPIST, PROFESSIONAL COUNSELOR,
PSYCHOTHERAPIST, ADDICTION COUNSELOR, SURGICAL ASSISTANT, SURGICAL TECHNOLOGIST, SPEECH-
LANGUAGE PATHOLOGIST, OR EMERGENCY MEDICAL SERVICE PROVIDER; OR
(e) A MEDICAL GROUP, INDEPENDENT PRACTICE ASSOCIATION, OR PROFESSIONAL CORPORATION
PROVIDING HEALTHCARE SERVICES.
(f) TO THE EXTENT NOT COVERED BY SUBSECTIONS 5(a) THROUGH 5(e) OF THIS SECTION, FREE
STANDING EMERGENCY ROOMS AND URGENT CARE CENTERS AND THOSE PROVIDING HEALTHCARE
SERVICES UNDER OTHER DESCRIPTIONS.
(5) "HEALTHCARE SERVICE" OR "SERVICE" MEANS A SERVICE, PROCEDURE, TREATMENT, OR GROUP OF
SERVICES, PROCEDURES, OR TREATMENTS DELIVERED BY A HEALTHCARE PROVIDER. HEALTHCARE
SERVICE INCLUDES SERVICES RENDERED THROUGH TELEMEDICINE AS DEFINED IN SECTION 12-36-102.5
(8).
(6) "THIRD-PARTY PAYER", "THIRD-PARTY PAYOR", "PAYOR", OR "PAYER" MEANS A HEALTH INSURANCE
CARRIER, SELF-INSURED EMPLOYER, OR OTHER PUBLIC OR PRIVATE THIRD PARTY, INCLUDING A THIRD-
PARTY ADMINISTRATOR OR INTERMEDIARY, THAT IS RESPONSIBLE FOR PAYING ALL, OR A PORTION OF,
THE CHARGES FOR HEALTHCARE SERVICES DELIVERED TO A PATIENT.
6-20-303. Provider-carrier contracts. A CONTRACT ISSUED, AMENDED, OR RENEWED ON OR AFTER APRIL 30,
2019, BY, BETWEEN, OR ON BEHALF OF A HEALTH INSURANCE PLAN AND A HEALTHCARE PROVIDER SHALL NOT
CONTAIN ANY PROVISION THAT RESTRICTS THE ABILITY OF THE HEALTH INSURANCE PLAN, THIRD-PARTY PAYER, OR
HEALTHCARE PROVIDER TO FURNISH PATIENTS ANY INFORMATION REQUIRED TO BE PUBLISHED UNDER THIS ACT.
ANY CONTRACTUAL PROVISION INCONSISTENT WITH THIS SECTION SHALL BE VOID AND UNENFORCEABLE.
SECTION 3. In Colorado Revised Statutes, add 10-16-147 as follows:
10-16-147. Carrier disclosures - rules - definitions. (1) THE PURPOSE OF THIS SECTION IS TO:
(a) PROVIDE TRANSPARENCY REGARDING HOW INSURANCE CARRIERS CALCULATE PAYMENTS OR
REIMBURSEMENTS TO PROVIDERS FOR HEALTHCARE SERVICES FURNISHED TO COVERED PERSONS; AND
(b) ENABLE A COVERED PERSON WHO HAS RECEIVED AND BEEN BILLED FOR A HEALTHCARE SERVICE,
MEDICAL DEVICE, OR PRESCRIPTION DRUG TO DETERMINE THE AMOUNT THAT THE CARRIER WILL PAY OR
REIMBURSE THE PROVIDER UNDER THE TERMS OF THE APPLICABLE HEALTH COVERAGE PLAN. IT IS
RECOGNIZED THAT THE SERVICES TO BE RENDERED ARE NOT ALWAYS ESTIMABLE PRIOR TO SERVICE
DELIVERY. THAT SHOULD NOT BE CONFUSED WITH THE INTENT OF THIS SECTION.
(2) EACH CARRIER SHALL POST ON ITS WEBSITE AND PROVIDE, IN WRITING UPON REQUEST FROM A COVERED
PERSON, THE FOLLOWING INFORMATION:
(a) THE SPECIFIC BASIS FOR DETERMINING THE PAYMENT OR REIMBURSEMENT TO A PROVIDER FOR A
HEALTHCARE SERVICE RENDERED BY THE PROVIDER TO A COVERED PERSON UNDER THE HEALTH
COVERAGE PLAN, INCLUDING:
(I) WHETHER THE PAYMENT IS BASED ON A PERCENTAGE OF THE PROVIDER'S CHARGES, A FLAT DAILY
OR PER DIEM RATE, COPAYMENTS, DEDUCTIBLES, OR ANY OTHER FACTOR, VARIABLE, OR SYSTEM
DEVISED AND NOT LISTED HERE THAT IS USED FOR DETERMINING THE PAYMENT OR REIMBURSEMENT
AMOUNT; AND
(II) HOW THE PAYMENT OR REIMBURSEMENT IS CALCULATED FOR AN IN-NETWORK VERSUS OUT-OF-
NETWORK PROVIDER;
(b) ITEMS THAT APPEAR AS CHARGES ON AN EXPLANATION OF BENEFITS OR PROVIDER BILLING
STATEMENT BUT FOR WHICH THE CARRIER DOES NOT PAY;
(c) DETAILED INFORMATION REGARDING COVERAGE AND NEGOTIATED PAYMENT INFORMATION BY PLAN
TYPE AND PARTICIPATING PROVIDER; AND
(d) PRESCRIPTION DRUG PRICES IN A FORM AND MANNER DETERMINED BY THE COMMISSIONER BY RULE.
(3) EACH CARRIER SHALL PUBLISH ANNUALLY, UNLESS DIRECTED BY THE COMMISSIONER BY RULE TO
PUBLISH MORE FREQUENTLY, DETAILED INFORMATION, IN A FORM AND MANNER DETERMINED BY THE
COMMISSIONER BY RULE, REGARDING ALL FORMS OF REMUNERATION DERIVED FROM REBATES OR OTHER
FORMS OF INCENTIVE RECEIVED AS THE RESULT OF HEALTHCARE SERVICES OR PURCHASES OF
PRESCRIPTION DRUGS OR MEDICAL DEVICES.
(4) ON OR BEFORE APRIL 30,2019, THE COMMISSIONER SHALL PROMULGATE RULES AS ARE NECESSARY FOR
THE IMPLEMENTATION, ADMINISTRATION, AND ENFORCEMENT OF THIS SECTION, AND SHALL,
THEREAFTER, REVISE SUCH RULES AS ARE NECESSARY.
(5) IF THE COMMISSIONER DETERMINES THAT A CARRIER HAS VIOLATED THE REQUIREMENTS OF THIS
SECTION, THE COMMISSIONER MAY SUSPEND OR REVOKE THE LICENSE OF THE CARRIER OR IMPOSE A
CIVIL FINE OF NOT MORE THAN FIFTY THOUSAND DOLLARS FOR EACH VIOLATION, AND IF THE CARRIER
CONTINUES TO VIOLATE THE REQUIREMENTS OF THIS SECTION, THE COMMISSIONER MAY IMPOSE A CIVIL
FINE FOR EACH DAY OF VIOLATION. FINES IMPOSED AND PAID UNDER THIS SECTION SHALL BE DEPOSITED
IN THE GENERAL FUND.
(6) AS USED IN THIS SECTION, "COMMISSIONER" MEANS THE COMMISSIONER OF INSURANCE APPOINTED
PURSUANT TO SECTION 10-1-104,
(7) AS USED IN THIS SECTION, "PRESCRIPTION DRUG PRICE" IS THE PRICE FOR PRESCRIPTION DRUGS THAT
CARRIERS HAVE NEGOTIATED WITH PROVIDERS, PHARMACIES, DISTRIBUTORS, OR MANUFACTURERS.
(8) AS USED IN THIS SECTION, "PHARMACY" MEANS ANY ENTITY LICENSED BY THE BOARD PURSUANT TO
ARTICLE 42.5 OF TITLE 12 TO ENGAGE IN THE PRACTICE OF PHARMACY, AS DEFINED IN SECTION 12-42.5
102 (31). THE TERM DOES NOT INCLUDE A HOSPITAL, AMBULATORY SURGICAL CENTER, OR OTHER
PROVIDERS WHICH ADMINISTER PRESCRIPTION DRUGS AS PART OF A HEALTHCARE SERVICE AND FOR
WHICH THE CHARGE FOR PRESCRIPTION DRUGS IS INCLUDED IN THEIR CHARGEMASTER OR FEE SCHEDULE.
SECTION 4. Effective date. THIS ACT TAKES EFFECT JANUARY 1,2019. i
Submitted by:
David Silverstein, 555 17th Street (Suite 400), Denver, CO 80202
[email protected] 303-684-7391 (tel) 805-690-8065 (fax)
Andrew Graham, 3464 S. Willow, Denver, CO 80231
[email protected] 303-755-2900 (tel) 805-690-8065 (fax)
Initiative 2017-2018 #119: Healthcare Insurance Carrier Billing Transparency - Amended Draft
Be it enacted by the people of the state of Colorado: r
SECTION 1. In Colorado Revised Statutes, add part 3 efto article 20 of title 6 as follows: ^ ® 2-8lPj%
6-20-300. Purpose. A DECLARATION FROM THE PEOPLE OF COLORADO. §F F TTI#
(1) THE PEOPLE OF COLORADO ENACT THIS LAW REGARDING PRICE TRANSPARENCY IN HEALTHCARE
BILLING TO ESTABLISH COMMON SENSE, ORDER, AND INTEGRITY IN COLORADO'S HEALTHCARE SYSTEM
AND TO SET AN EXAMPLE FOR THE REST OF OUR NATION. THE PEOPLE BELIEVE TRANSPARENCY, IN ALL
ASPECTS OF HEALTHCARE BILLING, IS OF PARAMOUNT IMPORTANCE AND THAT IT WILL NOT, IN ANY WAY,
IMPEDE COMPETITION, BUT RATHER, WILL IMPROVE COMPETITION AND EMPOWER PATIENTS TO BECOME
MORE ACTIVE PARTICIPANTS IN THEIR OWN CARE.
(2) THE "PEOPLE UNDERSTAND THAT SOME IN THE HEALTHCARE INDUSTRY MAY FIND PROVISIONS OF THIS
LAW ONEROUS. THE PEOPLE, HOWEVER, BELIEVE THAT THE LACK OF TRANSPARENCY THAT IS THE NORM
AT THE TIME OF THIS LAW'S ENACTMENT IS FAR MORE ONEROUS AND DANGEROUS, AND THUS, FIND THIS
LAW ABSOLUTELY NECESSARY IN ALL OF ITS DETAIL.
(3) THE PURPOSE OF TRANSPARENCY IN HEALTHCARE BILLING IS NOT MERELY TO PROVIDE PATIENTS WITH
THE ABILITY TO SHOP FOR HEALTHCARE SERVICES ON THE BASIS OF PRICE. IN FACT, SHOPPING AROUND
IS ONLY A SMALL ASPECT OF TRANSPARENCY IN HEALTHCARE BILLING, BECAUSE SHOPPING FOR
SERVICES IS NOT ALWAYS PRACTICAL WHEN HEALTHCARE SERVICE IS NEEDED. THE PURPOSE OF
TRANSPARENCY IN HEALTHCARE BILLING, AND OF THIS LAW, IS TO ENSURE THAT COLORADO'S
HEALTHCARE SYSTEM BEGINS TO FUNCTION IN A MANNER WHERE PRICES ARE AVAILABLE TO ANYONE
AND EVERYONE AT ALL TIMES. THE PEOPLE OF COLORADO BELIEVE THAT IF THERE IS TRANSPARENCY IN
HEALTHCARE BILLING, PRICES WILL BE FAIR AND WILL BE DETERMINED BY THE MARKETPLACE,
WHETHER OR NOT THEY PERSONALLY REVIEW ALL PRICES IN ADVANCE OF HEALTHCARE SERVICES.
SECTION 2. In Colorado Revised Statutes, add part 3 ©fto article 20 of title 6 as follows:
PART 3
HEALTHCARE INSURANCE CARRIER BILLING TRANSPARENCY
6-20-301. Short title. THE SHORT TITLE OF THIS PART 3 IS THE "HEALTHCARE INSURANCE CARRIER BILLING
TRANSPARENCY ACT".
6-20-302. Definitions. As USED IN THIS PART 3, UNLESS THE CONTEXT OTHERWISE REQUIRES:
(1) "CMS" MEANS THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.
(2) "COMMISSIONER" MEANS TUT COMMISSIONER OF INSUIUNGFT
{34(2) "HEALTH INSURANCE" OR "HEALTH INSURANCE PLAN" HAS THE SAME MEANING AS "HEALTH
COVERAGE PLAN", AS DEFINED IN SECTION 10-16-102X34).
FMI) "HEALTH INSURANCE CARRIER", "INSURANCE CARRIER", OR "CARRIER" HAS THE SAME MEANING AS
"CARRIER", AS DEFINED IN SECTION 10-16-102X8).
{5 LI S) "HEALTHCARE PROVIDER" OR "PROVIDER" MEANS:
(a) A HEALTHCARE FACILITY LICENSED OR CERTIFIED BY THE DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT PURSUANT TO SECTION 25-1.5-103 (l)(a), WHICH INCLUDES A HOSPITAL, HOSPITAL UNIT
AS DEFINED IN SECTION 25-3-101„(2), PSYCHIATRIC HOSPITAL, COMMUNITY CLINIC, REHABILITATION
HOSPITAL, CONVALESCENT CENTER, COMMUNITY MENTAL HEALTH CENTER, ACUTE TREATMENT UNIT,
FACILITY FOR PERSONS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES, NURSING CARE
FACILITY, HOSPICE CARE, ASSISTED LIVING RESIDENCE, DIALYSIS TREATMENT CLINIC, AMBULATORY
SURGICAL CENTER, BIRTHING CENTER, HOME CARE AGENCY, OR OTHER FACILITY OF A LIKE NATURE;
(b) A CLINICAL LABORATORY REGISTERED THROUGH THE CERTIFICATION PROGRAM ADMINISTERED BY
THE CMS;
(c) A FACILITY THAT USES RADIATION MACHINES FOR MEDICAL PURPOSES AND THAT IS REGISTERED BY
THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PURSUANT TO STATE BOARD OF HEALTH RULES
ADOPTED IN ACCORDANCE WITH SECTION 25-11-104; .
(d) A PERSON WHO IS LICENSED, CERTIFIED, OR REGISTERED BY THE STATE UNDER TITLE 12 OR ARTICLE
3.5 OF TITLE 25 TO PROVIDE HEALTHCARE SERVICES AND WHO DIRECTLY BILLS PATIENTS OR THIRD-
PARTY PAYERS FOR THE SERVICES, INCLUDING AN ACUPUNCTURIST, ATHLETIC TRAINER, AUDIOLOGIST,
PODIATRIST, CHIROPRACTOR, DENTIST, DENTAL HYGIENIST, MASSAGE THERAPIST, PHYSICIAN,
PHYSICIAN ASSISTANT, ANESTHESIOLOGIST ASSISTANT, DIRECT-ENTRY MIDWIFE, NATUROPATHIC
DOCTOR, NURSE, CERTIFIED NURSE AIDE, NURSING HOME ADMINISTRATOR, OPTOMETRIST,
OCCUPATIONAL THERAPIST, OCCUPATIONAL THERAPY ASSISTANT, PHYSICAL THERAPIST, PHYSICAL
THERAPY ASSISTANT, RESPIRATORY THERAPIST, PSYCHIATRIC TECHNICIAN, PSYCHOLOGIST, SOCIAL
WORKER, CLINICAL SOCIAL WORKER, MARRIAGE AND FAMILY THERAPIST, PROFESSIONAL COUNSELOR,
PSYCHOTHERAPIST, ADDICTION COUNSELOR, SURGICAL ASSISTANT, SURGICAL TECHNOLOGIST, SPEECH-
LANGUAGE PATHOLOGIST, OR EMERGENCY MEDICAL SERVICE PROVIDER; OR
(e) A MEDICAL GROUP, INDEPENDENT PRACTICE ASSOCIATION, OR PROFESSIONAL CORPORATION
PROVIDING HEALTHCARE SERVICES.
(f) TO THE EXTENT NOT COVERED BY SUBSECTIONS 5(a) THROUGH 5(e) QF THIS SECTION. FREE
STANDING EMERGENCY ROOMS AND URGENT CARE CENTERS AND THOSE PROVIDING HEALTHCARE
SERVICES UNDER OTHER DESCRIPTIONS.
F&¥5) "HEALTHCARE SERVICE" OR "SERVICE" MEANS A SERVICE, PROCEDURE, TREATMENT, OR GROUP OF
SERVICES, PROCEDURES, OR TREATMENTS DELIVERED BY A HEALTHCARE PROVIDER. HEALTHCARE
SERVICE INCLUDES SERVICES RENDERED THROUGH TELEMEDICENE AS DEFINED IN SECTION 12-36-102.5
(8)OFRQTHFR^EMOTERMODILO, OR• V F RTUATRME ANS AS MAY PI USCD IN 11 ID-FUTURE.
(7) "PHARMACY" MEANS OR
' PISTRIBUTFS PRESCRIPTION DRUGS •PULTSUA^JT TO ARTICLE 42.5 OR TITLE 12. ILLL TERM DOCS NOT
PRESC WHQN4?RUGS4S-»<€44FLRAE> IN THEIR CIIARGEMASTCR OR RRX-BGHEBUUR
FS^-^PRESCRIP'TTON DRUG PRICE" IS TJ IE PRICE FOR PRESCRIPTION DRUGS THAT CARRIERS [IAVC NEGOTIATED
(M6) "THIRD-PARTY PAYER", "THIRD-PARTY PAYOR", "PAYOR", OR "PAYER" MEANS A HEALTH
INSURANCE CARRIER, SELF-INSURED EMPLOYER, OR OTHER PUBLIC OR PRIVATE THIRD PARTY,
INCLUDING A THIRD-PARTY ADMINISTRATOR OR INTERMEDIARY, THAT IS RESPONSIBLE FOR PAYING ALL,
OR A PORTION OF, THE CHARGES FOR HEALTHCARE SERVICES DELIVERED TO A PATIENT.
6-20-303. Provider-carrier contracts.,
(1>A CONTRACT ISSUED, AMENDED, OR RENEWED ON OR AFTER APRIL 30,2019, BY, BETWEEN, OR ON BEHALF OF A
HEALTH INSURANCE PLAN AND A HEALTHCARE PROVIDER SHALL NOT CONTAIN ANY PROVISION THAT RESTRICTS THE
ABILITY OF THE HEALTH INSURANCE PLAN, THIRD-PARTY PAYER, OR HEALTHCARE PROVIDER TO FURNISH PATIENTS
ANY INFORMATION REQUIRED TO BE PUBLISHED UNDER THIS ACT._
(2) ANY CONTRACTUAL PROVISION INCONSISTENT WITH THIS SECTION SHALL BE VOID AND UNENFORCEABLE.
SECTION 3. In Colorado Revised Statutes, add 10-16-147 as follows: I
10-16-147. Carrier disclosures - rules - definitions.
(1) THE PURPOSE OF THIS SECTION IS TO:
(a) PROVIDE TRANSPARENCY REGARDING HOW INSURANCE CARRIERS CALCULATE PAYMENTS OR
REIMBURSEMENTS TO PROVIDERS FOR HEALTHCARE SERVICES FURNISHED TO COVERED PERSONS; AND
(b) ENABLE A COVERED PERSON WHO HAS RECEIVED AND BEEN BILLED FOR A HEALTHCARE SERVICE,
MEDICAL DEVICE, OR PRESCRIPTION DRUG TO DETERMINE THE AMOUNT THAT THE CARRIER WILL PAY OR
REIMBURSE THE PROVIDER UNDER THE TERMS OF THE APPLICABLE HEALTH COVERAGE PLAN. IT IS
RECOGNIZED THAT THE SERVICES TO BE RENDERED ARE NOT ALWAYS ESTIMABLE PRIOR TO SERVICE
DELIVERY. THAT SHOULD NOT BE CONFUSED WITH THE INTENT OF THIS SECTION.
(2) EACH CARRIER SHALL POST ON ITS WEBSITE AND PROVIDE, IN WRITING UPON REQUEST FROM A COVERED
PERSON, THE FOLLOWING INFORMATION:
(a) THE SPECIFIC BASIS FOR DETERMINING THE PAYMENT OR REIMBURSEMENT TO A PROVIDER FOR A
HEALTHCARE SERVICE RENDERED BY THE PROVIDER TO A COVERED PERSON UNDER THE HEALTH
COVERAGE PLAN, INCLUDING:
(I) WHETHER THE PAYMENT IS BASED ON A PERCENTAGE OF THE PROVIDER'S CHARGES, A FLAT DAILY
OR PER DIEM RATE, COPAYMENTS, DEDUCTIBLES, OR ANY OTHER FACTOR, VARIABLE, OR SYSTEM
DEVISED AND NOT LISTED HERE THAT IS USED FOR DETERMINING THE PAYMENT OR REIMBURSEMENT
AMOUNT; AND
(II) HOW THE PAYMENT OR REIMBURSEMENT IS CALCULATED FOR AN IN-NETWORK VERSUS OUT-OF-
NETWORK PROVIDER:?
(b) ITEMS THAT APPEAR AS CHARGES ON AN EXPLANATION OF BENEFITS OR PROVIDER BILLING
STATEMENT BUT FOR WHICH THE CARRIER DOES NOT PAY;
(c) DETAILED INFORMATION REGARDING COVERAGE AND NEGOTIATED PAYMENT INFORMATION BY PLAN
TYPE AND PARTICIPATING PROVIDER; AND
(d) PPRESCRIPTION DRUG PRICES IN A FORM AND MANNER DETERMINED BY THE COMMISSIONER BY RULE.
(3) EACH CARRIER SHALL PUBLISH ANNUALLY, UNLESS DIRECTED BY THE COMMISSIONER BY RULE TO
PUBLISH MORE FREQUENTLY, DETAILED INFORMATION, IN A FORM AND MANNER DETERMINED BY THE
COMMISSIONER BY RULE. REGARDING ALL FORMS OF REMUNERATION DERIVED FROM REBATES OR OTHER
FORMS OF INCENTIVE RECEIVED AS THE RESULT OF HEALTHCARE SERVICES OR PURCHASES OF
PRESCRIPTION DRUGS OR MEDICAL DEVICES.
(4) ON OR BEFORE APRIL 30,2019, THE COMMISSIONER SHALL PROMULGATE RULES AS ARE NECESSARY FOR
THE IMPLEMENTATION, ADMINISTRATION, AND ENFORCEMENT OF THIS SECTION, AND SHALL,
THEREAFTER, REVISE SUCH RULES AS ARE NECESSARY.
(5) IF THE COMMISSIONER DETERMINES THAT A CARRIER HAS VIOLATED THE REQUIREMENTS OF THIS
SECTION. THE COMMISSIONER MAY SUSPEND OR REVOKE THE LICENSE OF THE CARRIER OR IMPOSE A
CIVIL FINE OF NOT MORJ:. THAN FIFTY THOUSAND DOLLARS FOR EACH VIOLATION. AND IF THE CARRIER
CONTINUES TO VIOLATE THE REQUIREMENTS OF THIS SECTION. THE COMMISSIONER MAY IMPOSE A CIVIL
FINE FOR EACH DAY OF VIOLATION. FINES IMPOSED AND PAID UNDER THIS SECTION SHALL BE DEPOSITED
IN T£IL GENERAL FUND. :
(6) As USED RN THIS SECTION. "COMMISSIONER" MEANS THE COMMISSIONER OF INSURANCE APPOINTED
PURSUANT TO SECTION 10-1-104.
(7) AS USED IN THIS SECTION, "PRESCRIPTION DRUG PRICE" IS THE PRICE FOR PRESCRIPTION DRUGS THAT
CARRIERS HAVE NEGOTIATED WITH PROVIDERS, PHARMACIES. DISTRIBUTORS. OR MANUFACTURERS.
(8) AS USED IN THIS SECTION. "PHARMACY" MEANS ANY ENTITY LICENSED BY THE BOARD PURSUANT TO
ARTICLE 42.5 OF TITLE 12 TO ENGAGE IN THE PRACTICE OF PHARMACY. AS DEFINED IN SECTION 12-42.5-
102 (31). TL IE TERM DOES NOT 11 VCLUDE A HOSPITAL. AMBULA" TORY SURGICAL CENTER. OI I OTHER
PROVIDERS < AHICH ADMINISTER PI DESCRIPTION DRUGS AS PART O F A HEALTHCARE SERVICE / \M FOR
WHICH THE C TIARGEFORPRESCRIPI TON DRUGS IS INCLUDED INTHEI R CHARG EM ASTER OR FEE SC. HEDULE.
SECTION 4. Effective date. THIS ACT TAKES EFFECT APFTFC-3-QJ ANIJARY L 2019.
Submitted by: ;
David Silverstein, 555 17th Street (Suite 400), Denver, CO 80202
dayidsIiv€rstem@brokenhea]tlieare.org 303-684-7391 (tel) 805-690-8065 (fax)
Andrew Graham, 3464 S. Willow, Denver, CO 80231
[email protected] 303-755-2900 (tel) 805-690-8065 (fax)
Initiative 2017-2018 #119: Transparency in Health Care Insurance Carrier Billing - Original Draft
Be it enacted by the people of the state of Colorado:
SECTION 1. In Colorado Revised Statutes, add part 3 of article 20 of title 6 as follows:
6-20-300. Purpose. A DECLARATION FROM THE PEOPLE OF COLORADO.
(1) THE PEOPLE OF COLORADO ENACT THIS LAW REGARDING PRICE TRANSPARENCY IN HEALTHCARE
BILLING TO ESTABLISH COMMON SENSE, ORDER, AND INTEGRITY IN COLORADO'S HEALTHCARE SYSTEM
AND TO SET AN EXAMPLE FOR THE REST OF OUR NATION. THE PEOPLE BELIEVE TRANSPARENCY, IN ALL
ASPECTS OF HEALTHCARE BILLING, IS OF PARAMOUNT IMPORTANCE AND THAT IT WILL NOT, IN ANY WAY,
IMPEDE COMPETITION, BUT RATHER, WILL IMPROVE COMPETITION AND EMPOWER PATIENTS TO BECOME
MORE ACTWE PARTICIPANTS IN THEIR OWN CARE.
(2) THE PEOPLE UNDERSTAND THAT SOME IN THE HEALTHCARE INDUSTRY MAY FIND PROVISIONS OF THIS
LAW ONEROUS. THE PEOPLE, HOWEVER, BELIEVE THAT THE LACK OF TRANSPARENCY THAT IS THE NORM
AT THE TIME OF THIS LAW'S ENACTMENT IS FAR MORE ONEROUS AND DANGEROUS, AND THUS, FIND THIS
LAW ABSOLUTELY NECESSARY IN ALL OF ITS DETAIL.
(3) THE PURPOSE OF TRANSPARENCY IN HEALTHCARE BILLING IS NOT MERELY TO PROVIDE PATIENTS WITH
THE ABILITY TO SHOP FOR HEALTHCARE SERVICES ON THE BASIS OF PRICE. IN FACT, SHOPPING AROUND
IS ONLY A SMALL ASPECT OF TRANSPARENCY IN HEALTHCARE BILLING, BECAUSE SHOPPING FOR
SERVICES IS NOT ALWAYS PRACTICAL WHEN HEALTHCARE SERVICE IS NEEDED. THE PURPOSE OF
TRANSPARENCY IN HEALTHCARE BILLING, AND OF THIS LAW, IS TO ENSURE THAT COLORADO'S
HEALTHCARE SYSTEM BEGINS TO FUNCTION IN A MANNER WHERE PRICES ARE AVAILABLE TO ANYONE
AND EVERYONE AT ALL TIMES. THE PEOPLE OF COLORADO BELIEVE THAT IF THERE IS TRANSPARENCY IN
HEALTHCARE BILLING, PRICES WILL BE FAIR AND WILL BE DETERMINED BY THE MARKETPLACE,
WHETHER OR NOT THEY PERSONALLY REVIEW ALL PRICES IN ADVANCE OF HEALTHCARE SERVICES.
SECTION 2. In Colorado Revised Statutes, add part 3 of article 20 of title 6 as follows:
6-20-301. Short title. THE SHORT TITLE OF THIS PART 3 IS THE "HEALTHCARE INSURANCE CARRIER BILLING
TRANSPARENCY ACT".
6-20-302. Definitions. As USED IN THIS PART 3, UNLESS THE CONTEXT OTHERWISE REQUIRES:
(1) "CMS" MEANS THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.
(2) "COMMISSIONER" MEANS THE COMMISSIONER OF INSURANCE.
(3) "HEALTH INSURANCE" OR "HEALTH INSURANCE PLAN" HAS THE SAME MEANING AS "HEALTH COVERAGE
PLAN", AS DEFINED IN SECTION 10-16-102(34).
(4) "HEALTH INSURANCE CARRIER", "INSURANCE CARRIER", OR "CARRIER" HAS THE SAME MEANING AS
"CARRIER", AS DEFINED IN SECTION 10-16-102(8).
(5) "HEALTHCARE PROVIDER" OR "PROVIDER" MEANS:
(a) A HEALTHCARE FACILITY LICENSED OR CERTIFIED BY THE DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT PURSUANT TO SECTION 25-1.5-103 (l)(a), WHICH INCLUDES A HOSPITAL, HOSPITAL UNIT
AS DEFINED IN SECTION 25-3-101(2), PSYCHIATRIC HOSPITAL, COMMUNITY CLINIC, REHABILITATION
HOSPITAL, CONVALESCENT CENTER, COMMUNITY MENTAL HEALTH CENTER, ACUTE TREATMENT UNIT,
FACILITY FOR PERSONS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES, NURSING CARE
PART 3
HEALTHCARE INSURANCE CARRIER BILLING TRANSPARENCY
Initiative 2017-2018 #119: Transparency in Health Care Insurance Carrier Billing - Original Draft
FACILITY, HOSPICE CARE, ASSISTED LIVING RESIDENCE, DIALYSIS TREATMENT CLINIC, AMBULATORY
SURGICAL CENTER, BIRTHING CENTER, HOME CARE AGENCY, OR OTHER FACILITY OF A LIKE NATURE;
(B) A CLINICAL LABORATORY REGISTERED THROUGH THE CERTIFICATION PROGRAM ADMINISTERED BY
THE CMS; ' '
(c) A FACILITY THAT USES RADIATION MACHINES FOR MEDICAL PURPOSES AND THAT IS REGISTERED BY
THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PURSUANT TO STATE BOARD OF HEALTH RULES
ADOPTED IN ACCORDANCE WITH SECTION 25-11-104;
(d) A PERSON WHO IS LICENSED, CERTIFIED, OR REGISTERED BY THE STATE UNDER TITLE 12 OR ARTICLE
3.5 OF TITLE 25 TO PROVIDE HEALTHCARE SERVICES AND WHO DIRECTLY BILLS PATIENTS OR THIRD-
PARTY PAYERS FOR THE SERVICES, INCLUDING AN ACUPUNCTURIST, ATHLETIC TRAINER, AUDIOLOGIST,
PODIATRIST, CHIROPRACTOR, DENTIST, DENTAL HYGIENIST, MASSAGE THERAPIST, PHYSICIAN,
PHYSICIAN ASSISTANT, ANESTHESIOLOGIST ASSISTANT, DIRECT-ENTRY MIDWIFE, NATUROPATHIC
DOCTOR, NURSE, CERTIFIED NURSE AIDE, NURSING HOME ADMINISTRATOR, OPTOMETRIST,
OCCUPATIONAL THERAPIST, OCCUPATIONAL THERAPY ASSISTANT, PHYSICAL THERAPIST, PHYSICAL
THERAPY ASSISTANT, RESPIRATORY THERAPIST, PSYCHIATRIC TECHNICIAN, PSYCHOLOGIST, SOCIAL
WORKER, CLINICAL SOCIAL WORKER, MARRIAGE AND FAMILY THERAPIST, PROFESSIONAL COUNSELOR,
PSYCHOTHERAPIST, ADDICTION COUNSELOR, SURGICAL ASSISTANT, SURGICAL TECHNOLOGIST, SPEECH-
LANGUAGE PATHOLOGIST, OR EMERGENCY MEDICAL SERVICE PROVIDER; OR
(e) A MEDICAL GROUP, INDEPENDENT PRACTICE ASSOCIATION, OR PROFESSIONAL CORPORATION
PROVIDING HEALTHCARE SERVICES.
(f) TO THE EXTENT NOT COVERED BY SECTION (a) THROUGH (e), FREE-STANDING EMERGENCY ROOMS
AND URGENT CARE CENTERS AND THOSE PROVIDING HEALTHCARE SERVICES UNDER OTHER
DESCRIPTIONS.
(6) "HEALTHCARE SERVICE" OR "SERVICE" MEANS A SERVICE, PROCEDURE, TREATMENT, OR GROUP OF
SERVICES, PROCEDURES, OR TREATMENTS DELIVERED BY A HEALTHCARE PROVIDER. HEALTHCARE
SERVICE INCLUDES SERVICES RENDERED THROUGH TELEMEDICINE OR OTHER REMOTE, MOBILE, OR
VIRTUAL MEANS AS MAY BE USED IN THE FUTURE.
(7) "PHARMACY" MEANS ANY ENTITY WHICH ADMINISTERS, COMPOUNDS, DELIVERS, DISPENSES, OR
DISTRIBUTES PRESCRIPTION DRUGS PURSUANT TO ARTICLE 42.5 OF TITLE 12. THE TERM DOES NOT
INCLUDE A HOSPITAL, AMBULATORY SURGICAL CENTER, OR OTHER PROVIDERS WHICH ADMINISTER
PRESCRIPTION DRUGS AS PART OF A HEALTHCARE SERVICE AND FOR WHICH THE CHARGE FOR
PRESCRIPTION DRUGS IS INCLUDED IN THEIR CHARGEMASTER OR FEE SCHEDULE.
(8) "PRESCRIPTION DRUG PRICE" IS THE PRICE FOR PRESCRIPTION DRUGS THAT CARRIERS HAVE NEGOTIATED
WITH PROVIDERS, PHARMACIES, DISTRIBUTORS, OR MANUFACTURERS.
(9) "THIRD-PARTY PAYER", "THIRD-PARTY PAYOR", "PAYOR", OR "PAYER" MEANS A HEALTH INSURANCE
CARRIER, SELF-INSURED EMPLOYER, OR OTHER PUBLIC OR PRIVATE THIRD PARTY, INCLUDING A THIRD-
PARTY ADMINISTRATOR OR INTERMEDIARY, THAT IS RESPONSIBLE FOR PAYING ALL, OR A PORTION OF,
THE CHARGES FOR HEALTHCARE SERVICES DELIVERED TO A PATIENT.
6-20-303. Provider-carrier contracts.
(1) A CONTRACT ISSUED, AMENDED, OR RENEWED ON OR AFTER APRIL 30, 2019, BY, BETWEEN, OR ON
BEHALF OF A HEALTH INSURANCE PLAN AND A HEALTHCARE PROVIDER SHALL NOT CONTAIN ANY
PROVISION THAT RESTRICTS THE ABILITY OF THE HEALTH INSURANCE PLAN, THIRD-PARTY PAYER, OR
HEALTHCARE PROVIDER TO FURNISH PATIENTS ANY INFORMATION REQUIRED TO BE PUBLISHED UNDER
initiative 2017-2018 #119: Transparency in Health Care Insurance Carrier Billing - Original Draft
THIS ACT.
(2) ANY CONTRACTUAL PROVISION INCONSISTENT WITH THIS SECTION SHALL BE VOID AND
UNENFORCEABLE. ' I
SECTION 3. In Colorado Revised Statutes, add 10-16-147 as follows:
10-16-147. Carrier disclosures - rules.
(1) THE PURPOSE OF THIS SECTION IS TO:
(a) PROVIDE TRANSPARENCY REGARDING HOW INSURANCE CARRIERS CALCULATE PAYMENTS OR
REIMBURSEMENTS TO PROVIDERS FOR HEALTHCARE SERVICES FURNISHED TO COVERED PERSONS; AND
(b) ENABLE A COVERED PERSON WHO HAS RECEIVED AND BEEN BILLED FOR A HEALTHCARE SERVICE,
MEDICAL DEVICE, OR PRESCRIPTION DRUG TO DETERMINE THE AMOUNT THAT THE CARRIER WILL PAY OR
REIMBURSE THE PROVIDER UNDER THE TERMS OF THE APPLICABLE HEALTH COVERAGE PLAN. IT IS
RECOGNIZED THAT THE SERVICES TO BE RENDERED ARE NOT ALWAYS ESTIMABLE PRIOR TO SERVICE
DELIVERY. THAT SHOULD NOT BE CONFUSED WITH THE INTENT OF THIS SECTION.
(2) EACH CARRIER SHALL POST ON ITS WEBSITE AND PROVIDE, IN WRITING UPON REQUEST FROM A COVERED
PERSON, THE FOLLOWING INFORMATION:
(a) THE SPECIFIC BASIS FOR DETERMINING THE PAYMENT OR REIMBURSEMENT TO A PROVIDER FOR A
HEALTHCARE SERVICE RENDERED BY THE PROVIDER TO A COVERED PERSON UNDER THE HEALTH
COVERAGE PLAN, INCLUDING:
(I) WHETHER THE PAYMENT IS BASED ON A PERCENTAGE OF THE PROVIDER'S CHARGES, A FLAT DAILY
OR PER DIEM RATE, COPAYMENTS, DEDUCTIBLES, OR ANY OTHER FACTOR, VARIABLE, OR SYSTEM
DEVISED AND NOT LISTED HERE THAT IS USED FOR DETERMINING THE PAYMENT OR REIMBURSEMENT
AMOUNT; AND
(II) HOW THE PAYMENT OR REIMBURSEMENT IS CALCULATED FOR AN IN-NETWORK VERSUS OUT-OF-
NETWORK PROVIDER.
(b) ITEMS THAT APPEAR AS CHARGES ON AN EXPLANATION OF BENEFITS OR PROVIDER BILLING
STATEMENT BUT FOR WHICH THE CARRIER DOES NOT PAY;
(c) DETAILED INFORMATION REGARDING COVERAGE AND NEGOTIATED PAYMENT INFORMATION BY PLAN
TYPE AND PARTICIPATING PROVIDER; AND
(d) PRESCRIPTION DRUG PRICES IN A FORM AND MANNER DETERMINED BY THE COMMISSIONER.
(3) EACH CARRIER SHALL PUBLISH ANNUALLY, UNLESS DIRECTED BY THE COMMISSIONER TO PUBLISH MORE
FREQUENTLY, DETAILED INFORMATION, IN A FORM AND MANNER DETERMINED BY THE COMMISSIONER,
REGARDING ALL FORMS OF REMUNERATION DERIVED FROM REBATES OR OTHER FORMS OF INCENTIVE
RECEIVED AS THE RESULT OF HEALTHCARE SERVICES OR PURCHASES OF PRESCRIPTION DRUGS OR
MEDICAL DEVICES.
(4) ON OR BEFORE APRIL 30,2019, THE COMMISSIONER SHALL PROMULGATE RULES AS ARE NECESSARY FOR
THE IMPLEMENTATION, ADMINISTRATION, AND ENFORCEMENT OF THIS SECTION, AND SHALL,
THEREAFTER, REVISE SUCH RULES AS ARE NECESSARY.
Initiative 2017-2018 #119: Transparency in Health Care insurance Carrier Billing - Original Draft
SECTION 4. Effective date. THIS ACT TAKES EFFECT APRIL 30,2019.
Submitted by:
I
David Silverstein, 555 17th Street (Suite 400), Denver, CO 80202
[email protected] 303-684-7391 (tel) 805-690-8065 (fax)
Andrew Graham, 3464 S. Willow, Denver, CO 80231
[email protected] 303-755-2900 (tel) 805-690-8065 (fax)
Colorado
Legislative
Council
Staff
Initiative #119
INITIAL FISCAL
IMPACT STATEMENT
Date: February 6, 2018 Fiscal Analyst: Bill Zepernick (303-866-4777)
LCS TITLE: TRANSPARENCY IN HEALTH CARE INSURANCE CARRIER BILLING
Fiscal Impact Summary FY 2018-19 FY 2019-20 j|
State Revenue less than $20,000 1
General Fund . less than $20,000 |
State Expenditures $16,056 $31,557 I Cash Funds 16,056 31,557 1
Note: This initial fiscal impact estimate has been prepared for the Title Board. If the
initiative is placed on the ballot, Legislative Council Staff may revise this estimate for the
Blue Book Voter Guide if new information becomes available.
Summary of Measure
Initiative #119 requires health insurance carriers to post on their website and make available
to covered persons upon request the following information:
• the basis for determining the payment or reimbursement to a provider for a health
care service rendered by the provider to a covered person, including the factors on
which the payment is based and whether the payment is calculated for an in-network
or out-of-network provider.
« items that appear as charges on an explanation of benefits or provider billing statement
which the carrier does not pay;
• detailed information regarding coverage and negotiated payment information by plan
type and participating provider; and
• prescription drug prices.
In addition, the health insurance carriers must publish detailed information on all forms of
remuneration derived from rebates or other forms of incentives received as a result of health care
services or purchases of prescription drugs or medical devices. The Commissioner of Insurance
is required to promulgate rules concerning the measure's requirements on insurance carriers by
April 30, 2019. If the Commissioner determines that a health insurance carrier is not complying
with the provisions of the measure, the Commissioner may suspend or revoke the carrier's license,
or impose a civil penalty up to $50,000, with an additional fine for each day of continued
noncompliance. Fine revenue is deposited into the General Fund.
Lastly, the measure specifies that contracts between insurance carriers and health care
providers and facilities cannot contain any provision that restricts the ability of the health insurance
plan, third-party payer, or health care provider to furnish patients any information required to be
published under the measure. Any such provision in a contract is void and unenforceable.
Page 2
February 6, 2018
Initiative #119
State Revenue
Initiative #119 potentially increases General Fund revenue by up to $20,000 per year
beginning in FY 2019-20. This revenue is from civil fines levied against health insurance carriers.
Because the Commissioner of Insurance has discretion in the amount of any fine imposed, the
exact revenue impact cannot be estimated. Overall, a high level of compliance is assumed, so fine
revenue is expected to be less than $20,000 per year. Based on the rule-making deadlines in the
measure and assuming a period for health insurance carriers to come into compliance, fine
revenue is not expected prior to the start of FY 2019-20.
State Diversions
This measure, if enacted, will divert $16,056 from the General Fund in FY 2018-19 and
$31,557 in FY 2019-20. This revenue diversion occurs because the measure increases costs in
the Department of Regulatory Agencies, Division of Insurance, which is funded with premium tax
revenue that would otherwise be credited to the General Fund.
State Expenditures
Initiative #119 increases expenditures by $16,056 and 0.1 FTE in FY 2018-19 and $31,557
and 0.3 FTE in FY 2019-20 in DORA. These costs are paid from the Division of Insurance Cash
Fund. The measure will also impact workload and potentially costs in several other state agencies.
Costs are summarized in Table 1 and discussed below.
Table 1. Expenditures Under initiative #119 |
Cost Components FY 2018-19 FY 2019-20 1
Personal Services $9,100 $21,840
FTE 0.1 FTE 0.3 FTE
Legal Services 5,328 5,328
Employee Benefits and Insurance 1,628 4,389
TOTAL $16,056 $31,557 |
Department of Regulatory Agencies. The Commissioner of Insurance is required to
establish rules for disclosures by health insurance carriers. Generally, it is assumed that outreach
with health insurance carriers about these new rules and requirements will be conducted within
existing communication channels by staff in the division. An additional 0.1 FTE is required to
conduct rulemaking in the first year and an additional 0.3 FTE is required to respond to consumer
inquiries and complaints on an ongoing basis. Staff costs are prorated in the first year to reflect
a start date of February 1, 2019. The division will also have costs for legal services provided by
the Department of Law for rulemaking and enforcement activity.
State employee health insurance. To the extent that this measure increases
administrative costs for health insurance carriers, costs for state employee health insurance may
increase. Because state employee health insurance contributions are based upon prevailing
market rates, with costs shared between the employer and employee, this measure is not expected
to affect the state's share of employee health insurance premiums until FY 2019-20. Because
Page 3
February 6, 2018
Initiative #119
insurance rates are influenced by a number of variables, the exact effect of this measure cannot
be determined. Any increase caused by the measure will be addressed through the total
compensation analysis included in the annua! budget process.
Office of Administrative Courts and triai courts. The measure may potentially increase
workload for the Office of Administrative Courts in the Department of Personnel and Administration
and the trial courts in the Judicial Department in several ways. First, health insurance carriers may
challenge enforcement actions against them for noncompliance with the measure, which would
likely first be heard by an administrative law judge, and potentially appealed to the trial courts.
Assuming a high level of compliance, these impacts are likely minimal and can be accomplished
within existing appropriations.
Local Government Impact
Similar to the state employee insurance impact discussed above, local governments offering
health insurance coverage to their employees may experience an increase in costs. To the extent
that the requirements of the measure lead to higher insurance premiums, local government costs
for employee health insurance may increase. Health insurance premiums depend on a variety of
factors and an exact estimate of the potential increase cannot be determined.
Economic Impact
By promoting greater transparency in billing by health insurance carriers, Initiative #119 may
help consumers more effectively spend their health care dollars, which over the long term could
lead to lower health care costs for Coloradans. However, these savings may be offset by higher
premiums to the extent that the measure increases administrative costs for health insurance
carriers.
Effective Date
The measure takes effect on January 1, 2019, if approved by voters at the 2018 general
election.
State and Local Government Contacts
Corrections
Higher Education
Judicial
Personnel
Counties
Human Services
Law
Regulatory Agencies
Health Care Policy and Financing
Information Technology
Municipalities
Public Health and Environment
Page 4
February 6, 2018
Initiative #119
Abstract of Initiative 119: TRANSPARENCY IN HEALTH CARE INSURANCE CARRIER
BILLING
This initial fiscal estimate, prepared by the nonpartisan Director of Research of the
Legislative Council as of February 5, 2018, identifies the following impacts:
The abstract includes estimates of the fiscal impact of the initiative. If this initiative is to be
placed on the ballot, Legislative Council Staff will prepare new estimates as part of a fiscal impact
statement, which includes an abstract of that information. All fiscal impact statements are available
at www.ColoradoBlueBook.com and the abstract will be included in the ballot information booklet
that is prepared for the initiative.
Sfafe expenditures. Initiative #119 requires health insurance carriers to disclose cost and
billing information to consumers. The Department of Regulatory Agencies must establish rules and
take action to implement the measure's requirements, which will increase state expenditures by
$16,056 in FY 2018-19 and $31,557 in FY 2019-20. Additional costs may be incurred to the extent
the measure leads to higher state employee insurance premiums or results in litigation in the
courts.
State revenue. Initiative #119 allows fines to be levied on health insurance carriers that
do not comply with the its disclosure requirements. This potentially increases state revenue from
fines by up to $20,000 per year beginning in FY 2019-20.
Local government. The measure potentially increases costs for local governments that
pay for employee health insurance.
Economic impact. By promoting greater transparency in billing by health insurance
carriers, Initiative #119 may help consumers more effectively spend their health care dollars, which
over the long term could lead to lower health care costs for Coloradans. Fiowever, these savings
may be offset by higher premiums to the extent that the measure increases administrative costs
for health insurance carriers.
Ballot Title Setting Board
Proposed Initiative 2017-2018 #1191
The title as designated and fixed by the Board is as follows:
A change to the Colorado Revised Statutes concerning a requirement that health care
insurers publish health insurance plan information, and, in connection therewith, requiring health
insurers to publicly disclose: 1) the basis for determining payment or reimbursement amounts to
health care providers, 2) the items that appear as charges on an explanation of benefits that the
insurer does not pay, 3) detailed coverage and negotiated payment information by plan type and
provider, 4) prescription drug prices negotiated with providers, pharmacies, distributors, and
manufacturers, and 5) all rebates or other incentives; authorizing penalties for violations; and
prohibiting any contract between a health insurance plan and a health care provider from restricting
the publication of the required health insurance plan information.
The ballot title and submission clause as designated and fixed by the Board is as follows:
Shall there be a change to the Colorado Revised Statutes concerning a requirement that
health care insurers publish health insurance plan information, and, in connection therewith,
requiring health insurers to publicly disclose: 1) the basis for determining payment or
reimbursement amounts to health care providers, 2) the items that appear as charges on an
explanation of benefits that the insurer does not pay, 3) detailed coverage and negotiated payment
information by plan type and provider, 4) prescription drug prices negotiated with providers,
pharmacies, distributors, and manufacturers, and 5) all rebates or other incentives; authorizing
penalties for violations; and prohibiting any contract between a health insurance plan and a health
care provider from restricting the publication of the required health insurance plan information?
Hearing February 7, 2018:
Single subject approved; staff draft amended; titles set.
Hearing adjourned 2:47p.m.
1 Unofficially captioned "Transparency in Health Care Insurance Carrier Billing" by legislative staff for
tracking purposes. This caption is not part of the titles set by the Board.
• RECEIVED -
. m 1 • » i s tslsrad8 Secretary of State
BEFORE COLORADO STATE TITLE SETTING BOARD
In re Ballot Title and Submission Clause for 2017-2018 Initiative #119 ("Transparency in
Health Care Insurance Carrier Billing")
Deborah Farrell, Objector.
MOTION FOR REHEARING
Pursuant to C.R.S. § 1 -40-107, Objector, Deborah Farrell, a registered elector of the State
of Colorado, through her legal counsel, Lewis Roca Rothgerber Christie LLP, submits this
Motion for Rehearing of the Title Board's February 7,2018 decision to set the title of 2017-2018
Initiative #119 ("Initiative"), and states:
I. The Initiative has been substantially amended and must be resubmitted for review
and comment.
The final version of the Initiative includes a substantial amendment that was not in the
original version and that was not in direct response to the review and comment
memorandum (attached as Ex. A), and therefore must be resubmitted to the offices of
Legislative Council and Legislative Legal Services for review and comment under C.R.S.
§ 1-40-105(2).
® As compared to the original version of the Initiative, the final version adds
§ 10-16-147(5), which creates specific penalties that did not exist in the
original text:
"If the Commissioner determines that a Carrier has violated the
requirements of this section, the Commissioner may suspend or revoke the
license of the Carrier or impose a civil fine of not more than fifty thousand
dollars for each violation, and if the carrier continues to violate the
requirements of this section, the Commissioner may impose a civil fine for
each day of the violation. Fines imposed and paid under this section shall
be deposited in the general fund."
103589079 1
II. The Initiative impermissibly contains multiple separate and distinct subjects in
violation of the constitutional single-subject requirement.
While the Initiative purports to address only the subject of transparency in health care
insurance carrier billing, several other subjects are impermissibly woven into the Initiative,
including:
* Requiring broad disclosure by insurance carriers of "all forms of
remuneration derived from rebates or other forms of incentive received as
the result of healthcare services or purchases of prescription drugs or
medical devices." (Initiative § 10-16-147(3) (emphasis added).) Because
many payments made to insurance carriers are related in some way to
healthcare services, prescription drugs, or medical devices, this catch-all
provision requires insurance carriers to disclose a large percentage of all
payments or other compensation they receive, regardless of whether or not
those activities are reasonably related to billing transparency.
* Provisions related to private contractual arrangements between insurance
carriers and healthcare providers. (Initiative § 6-20-303.) Limiting health
care providers' ability to negotiate and enter contracts with insurance
carriers is beyond the scope of "insurance carrier billing."
® Provisions allowing for adverse licensure action against an insurance
carrier, and allowing for the assessment of civil penalties. (Initiative § 10-
16-147(5).) These provisions are not connected to the purported subject of
"transparency" and instead directly impact an insurer's ability to hold a
state license. >
These additional subjects represent distinct and additional purposes of the Initiative, thus
violating the single-subject requirement. See C.R.S. § 1-40-106.5. Further evidencing the
Initiative's multiple subjects is the fact that the Initiative makes changes both to Title 6
(Consumer and Commercial Affairs) and to Title 10 (Insurance) of the Colorado Revised
Statutes. -
III. The title set by the Title Board is unfair and does not fairly express the true
meaning and intent of the proposed constitutional amendment.
The title set for the Initiative by the Title Board fails to fairly, clearly, and accurately
convey the central features of the measure because it does not:
* Explain that the initiative affects a very broad range of providers,
including many that may not commonly be considered to be "health care"
providers by the public, such as athletic trainers, massage therapists,
psychologists, social workers, and professional counselors. (Initiative § 6-
20-301(4).) Instead, the title refers only to "health care providers."
103589079 I 2
e Explain that the Initiative delegates rulemaking authority to the
Commissioner of Insurance. (Initiative § 10-16-147.)
• Explain the breadth of the disclosure requirement requiring each insurance
carrier to publish detailed information regarding all forms of remuneration
derived from rebates or other forms of incentive received as the result of
healthcare services or purchases of prescription drugs or medical devices.
(Initiative § 10-16-147(5).) This requirement is much broader than what is
specified in the title ("requiring health insurers to publicly disclose ... all
rebates or other incentives"), and imposes disclosure requirements that go
beyond the scope of the other items discussed in the title.
WHEREFORE, Objector respectfully requests that the Title Board set Initiative 119 for
rehearing pursuant to C.R.S. § 1-40-107(1).
DATED: February 14,2018.
s/ Thomas M. Ropers III
Thomas M. Rogers III
Dietrich C. Hoefner
LEWIS ROCA ROTHGERBER CHRISTIE LLP
1200 Seventeenth Street, Suite 3000
Denver, CO 80202
Phone:303-623.9000
Fax: 303.623.9222
Email: [email protected]
Attorneys for Objector
Address of Objector:
27484 CR 339, Buena Vista, CO 81211
103589079_1 3
CERTIFICATE OF SERVICE
I hereby certify that on February 14, 2018, a true and correct copy of this MOTION
FOR REHEARING was served on proponents via email as follows:
David Silverstein
557 17th Street, Suite 400
Denver, CO 80202
Andrew Graham ,
3464 S Willow
Denver, CO 80231
Martha Tierney
Tierney Lawrence LLC
225 East 16th Avenue, Suite 350
Denver, CO 80203
Proponents
s/ Robin A. Newcomer
103589079J 4
EXHIBIT A
103623417 1
STATE OF COLORADO
Colorado General Assembly
Colorado Legislative Council
200 East Colfax Avenue Suite 029
Denver, Colorado 80203-1716
Mike Mauer, Director
Legislative Council Staff
76.*"
Sharon L. Eubanks, Director
Office of Legislative Legal Services
Office of Legislative Legal Services
200 East Colfax Avenue Suite 091
Denver, Colorado 80203-1716
Telephone 303-866-3521
Facsimile 303-866-3855
TDD 303-866-3472
Telephone 303-866-2045
Facsimile 303-866-4157
Email: [email protected]
MEMORANDUM
To: David Silverstein and Andrew Graham
FROM: Legislative Council Staff and Office of Legislative Legal Services
DATE: January 23, 2018
SUBJECT: Proposed initiative measure 2017-2018 #119, concerning Transparency in
Section 1-40-105 (1), Colorado Revised Statutes, requires the directors of the Colorado
Legislative Council and the Office of Legislative Legal Services to "review and
comment" on initiative petitions for proposed laws and amendments to the Colorado
constitution. We hereby submit our comments to you regarding the appended
proposed initiative.
The purpose of this statutory requirement of the directors of Legislative Council and
the Office of Legislative Legal Services is to provide comments intended to aid
proponents in determining the language of their proposal and to avail the public of
knowledge of the contents of the proposal. Our first objective is to be sure we
understand your intent and your objective in proposing the amendment. We hope that
the statements and questions contained in this memorandum will provide a basis for
discussion and understanding of the proposal.
An earlier version of this proposed initiative, proposed initiative 2017-2018 #85, was
the subject of a memorandum dated December 19, 2017. Proposed initiative 2017
2018 #85 was discussed at a public hearing on December 21, 2017. The substantive
and technical comments and questions raised in this memorandum do not include
comments and questions on initiative 2017-2018 #85 not addressed in this revised
proposal. To the extent applicable, those comments and questions are hereby
incorporated.
Healthcare Insurance Carrier Billing
This initiative is one of a series identified as initiatives 2017-2018 #118 to #122. The
comments and questions raised in this memorandum do not include comments and
questions addressed in the memoranda for proposed initiatives 2017-2018 #118 and
#120 to #122, except as necessary to fully understand the issues raised by the revised
proposed initiative.
The major purposes of the proposed amendment to the Colorado Revised Statutes
appear to be:
1. To prohibit any contract between a health insurer and health care provider
issued, amended, or renewed on or after April 30, 2019, from including any
provision that restricts the ability of a provider or health insurer to provide
patients with the health care service charge information required to be
published by the proposal and to specify any such provision is void and
unenforceable;
2. To require health insurers to post on their websites and provide, in writing
upon request from a covered person:
a. The specific basis for determining the payment or reimbursement amount the
insurer provides to a health care provider rendering health care services to a
person covered under a plan issued by the insurer;
b. Items that appear as charges on an explanation of benefits or provider billing
statement that the carrier does not pay;
c. Detailed coverage and negotiated payment information by plan type and
participating provider; and
d. Prescription drug prices in a form and manner determined by the
commissioner.
3. To require health insurers to annually, or more frequently if required by the
commissioner of insurance, publish detailed information, in a form and
manner determined by the commissioner of insurance, regarding all forms of
remuneration derived from rebates or other forms of incentive received as the
result of health care services or purchases of prescription drugs or medical
devices;
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4. To require the commissioner of insurance, on or before April 30, 2019, to
adopt rules necessary to implement, administer, and enforce the requirements
imposed on health insurers and to thereafter revise the rules as necessary;
5. To define terms used in the measure; and
6. To specify that the measure takes effect on April 30, 2019.
Substantive Comments and Questions
The substance of the proposed initiative raises the following comments and questions:
1. Article V, section 1 (5.5) of the Colorado constitution requires all proposed
initiatives to have a single subject. What is the single subject of the proposed
initiative?
2. Sections 1 and 2 of the initiative proposal place provisions in article 20 of title
6, and section 3 adds a new provision in article 16 of title 10. All of the
provisions in these three sections relate to insurance carriers and should all be
placed in the same article and title. Have the proponents considered placing the
entire proposed initiative in article 16 of title 10?
3. The declaration of legislative purposes in section 1 of the initiative proposal is
identical to the purposes stated in initiatives 2017-2018 #118 and #120 to #122.
However, the substantive provisions of this initiative are more narrowly focused
on health insurance carriers. Would you consider narrowing section 1 of the
proposal to reflect only purposes related to health insurance carrier
information?
4. Section 6-20-302 defines various terms that are not actually used in part 3 of
article 20 of title 6. Would the proponents consider removing any term included
in the definitions section that is not used in section 6-20-303? For any terms
used in section 10-16-147, would the proponents consider moving the
definitions to section 10-16-147 or 10-16-102?
Technical Comments
The following comments address technical issues raised by the form of the proposed
initiative. These comments will be read aloud at the public meeting only if the
proponents so request. You will have the opportunity to ask questions about these
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comments at the review and comment meeting. Please consider revising the proposed
initiative as suggested below.
1. The amending clause for a new part, as in sections 1 and 2 of the proposed
initiative, should read "...add part 3 to article 20..instead of ". ..add part 3 of
article 20..." '
2. Both section 1 and section 2 of the proposed initiative add a new part 3 to
article 20 to title 6 of the Colorado Revised Statutes. These amending clauses
should be combined into a single amending clause, followed by the heading for
the new part 3. The purpose section should be renumbered as "6-20-302" and
moved to follow section 6-20-301. The following sections, 6-20-302 and 6-20
303, should be renumbered as 6-20-303 and 6-20-304, respectively.
3. The term "healthcare" is used throughout the purpose section of the proposed
initiative. However, throughout the Colorado Revised Statutes, the term is
spelled "health care." Consider changing all instances of "healthcare" to "health
care."
4. A reference to a subsection of the Colorado Revised Statutes should indicate
every element of the subsection referenced as well as the section in which that
subsection can be found. For example, the reference in 6-20-102 (5)(f) should,
presumably, be "To the extent not covered by subsections (5)(a) through (5)(e)
of this section..."
5. A measure should only include definitions for terms that are actually used in
the measure. It does not appear that the defined terms "CMS," "pharmacy," and
"third-party payer" are used in the measure, so they should be eliminated from
the definitions section.
6. Statutory text should immediately follow each headnote. For example, the text
in subsection (1) of section 6-20-303 should be moved to follow "rules." instead
of appearing on the next line.
7. Statutory text should immediately follow each headnote. For example, the text
in subsection (1) of section 6-20-303 should be moved to follow "contracts."
instead of appearing on the next line. The same is true regarding section
10-16-147 in section 3 of the measure.
8. The end of 10-16-147 (2)(a)(II) should end with a semi-colon instead of a
period to denote that the list of which it is a part continues in the next
subsection, (2)(b).
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9. The first word following a new subsection should be capitalized, even if it is the
continuation of a sentence that begins in a previous subsection. For example,
the first word in 10-16-147 (2)(d), "prescription," should be capitalized.
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Ballot Title Setting Board
Proposed Initiative 2017-2018 #1191
The title as designated and fixed by the Board is as follows:
A change to the Colorado Revised Statutes concerning a requirement that health care
insurers publish health insurance plan information, and, in connection therewith, requiring health
insurers to publicly disclose: 1) the basis for determining payment or reimbursement amounts to a
broad range of health care providers, 2) the items that appear as charges on an explanation of
benefits that the insurer does not pay, 3) detailed coverage and negotiated payment information by
plan type and provider, 4) prescription drug prices negotiated with providers, pharmacies,
distributors, and manufacturers, and 5) all health care related rebates or other incentives received;
authorizing penalties for violations; and prohibiting any contract between a health insurance plan
and a health care provider from restricting the publication of the required health insurance plan
information.
The ballot title and submission clause as designated and fixed by the Board is as follows:
Shall there be a change to the Colorado Revised Statutes concerning a requirement that
health care insurers publish health insurance plan information, and, in connection therewith,
requiring health insurers to publicly disclose: 1) the basis for determining payment or
reimbursement amounts to a broad range of health care providers, 2) the items that appear as
charges on an explanation of benefits that the insurer does not pay, 3) detailed coverage and
negotiated payment information by plan type and provider, 4) prescription drug prices negotiated
with providers, pharmacies, distributors, and manufacturers, and 5) all health care related rebates
or other incentives received; authorizing penalties for violations; and prohibiting any contract
between a health insurance plan and a health care provider from restricting the publication of the
required health insurance plan information?
Hearing February 7, 2018:
Single subject approved; staff draft amended; titles set.
Hearing adjourned 2:47p.m.
Rehearing February 21, 2018:
Motion for Rehearing denied except to the extent that the Board made changes to the titles.
Hearing adjourned 10:59 a.m.
1 Unofficially captioned "Transparency in Health Care Insurance Carrier Billing" by legislative staff for
tracking purposes. This caption is not part of the titles set by the Board.