August 23, 2019

Unaccompanied Homeless Youth Tuition Bill, Debt-Free Schools Act Bill, and More Signed

On Tuesday, May 17, 2016, Governor Hickenlooper signed five bills into law. To date, he has signed 177 bills this legislative session. The bills signed Tuesday include a bill to determine domicile status for in-state tuition purposes for unaccompanied homeless youth, a bill to consider whether health plans should be offered based on a single geographic area, and more. The bills signed Tuesday are summarized here.

  • HB 16-1100 – Concerning the Ability of Unaccompanied Homeless Youth to Determine Domicile for Purposes of In-State Tuition Status at Institutions of Higher Education, by Reps. Brittany Pettersen & Daneya Esgar and Sen. John Cooke. The bill adds “unaccompanied homeless youth” to the list of persons who are qualified to determine their own domicile and to be classified as a resident for tuition purposes at state supported institutions of higher education.
  • HB 16-1276 – Concerning the Division of Reclamation, Mining, and Safety’s Ability to Conduct Emergency Responses at Legacy Hard Rock Mining Sites, by Reps. Millie Hamner & Don Coram and Sens. Ellen Roberts & Kerry Donovan. The bill allows the Division of Reclamation, Mining, and Safety to use funds from the Emergency Response Cash Fund to conduct an emergency response when circumstances exist at a legacy mine site that create a danger to public health or welfare, or to the environment.
  • HB 16-1336 – Concerning the Creation of a Single Geographic Rating Area for Health Insurers to Use When Establishing Rates for Individual Health Insurance Plans, by Reps. Millie Hamner & Bob Rankin and Sen. Kerry Donovan. The bill requires the Commissioner of Insurance to conduct a study to determine the impacts and viability of establishing a single geographic area for use in determining the premium rates for individual health insurance plans issued in Colorado.
  • HB 16-1354 – Concerning Authorization for a School District to Impose an Additional Mill Levy for the Sole Purpose of Funding Capital Construction, New Technology, Existing Technology Upgrade, and Maintenance Needs of the District Without Borrowing Money, by Reps. Diane Mitsch Bush & Jon Becker and Sen. Jerry Sonnenberg. The bill, known as the “Debt-Free Schools Act,” authorizes a school district, with voter approval, to impose an additional mill levy for the sole purpose of cash funding its capital construction and facility maintenance needs without borrowing money.
  • SB 16-021 – Concerning Recognition of the Third Saturday in May as a State Holiday, and, in Connection Therewith, Designating the Third Saturday in May as “Public Lands Day,” by Sen. Kerry Donovan and Reps. Diane Mitsch Bush & KC Becker. The bill creates a new holiday, “Public Lands Day,” on the third Saturday in May.

For a complete list of Governor Hickenlooper’s 2016 legislative decisions, click here.

SB 14-159: Extending Deadline for Department of Health Care Policy and Financing to Develop Standardized Rules for Use in Processing Medical Claims

On March 17, 2014, Sen. Irene Aguilar introduced SB 14-159 – Concerning Implementation of Standardized Rules for Use in Processing Medical Claims, and, in Connection Therewith, Making an Appropriation. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

Under current law, the medical clean claims task force in the department of health care policy and financing (department) is tasked with developing a standardized set of payment rules and claim edits for use by payers in processing medical claims for which coverage is undisputed. Carriers in the state are required to use the standardized payment rules and claim edits developed by the task force by January 1, 2014, for commercial health plans, and by January 1, 2015, for domestic, nonprofit health plans.

Since the clean claims task force is still developing the standardized set of payment rules and claim edits, the bill delays implementation until January 1, 2017, and requires all carriers to implement and use the standardized payment rules and claim edits by that date when processing medical claims under health plans issued in this state, other than those plans governed by federal law superseding state authority. The clean claims task force is to develop the complete set by December 31, 2014, and submit a report to the executive director of the department and to specified committees of the general assembly concerning the complete set.

The task force is to make the complete set of payment rules and claim edits available for public review and comment throughout 2015 and to modify the complete set as necessary based on public feedback. By January 31, 2016, the clean claims task force is to submit a final report to the executive director of the department and to specified committees of the general assembly and, throughout 2016, is to provide assistance to users preparing to implement the standardized payment rules and claim edits by January 1, 2017.

Additionally, the bill requires the executive director of the department to work with the United States department of health and human services to facilitate the use of the standardized payment rules and claim edits adopted in Colorado as the model for use nationally.

$128,188 is appropriated from the general fund to the task force for use in the 2014–15 fiscal year in developing and assisting with implementation of the standardized payment rules and claim edits.

The bill repeals the medical clean claims task force on December 31, 2016.

The bill is assigned to the Health & Human Services Committee.

HB 14-1257: Allowing Audit of Colorado Health Benefit Exchange/Connect for Health Colorado

On February 3, 2014, Reps. Jerry Sonnenberg & Dan Nordberg and Sens. David Balmer & Steve King introduced HB 14-1257 – Concerning the Authority of the State Auditor to Conduct a Performance Audit of the Colorado Health Benefit Exchange. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

Legislative Audit Committee

The bill allows the state auditor to conduct a performance audit of the Colorado health benefit exchange and submit a written report to the legislative audit committee with any findings and recommendations. The authority to conduct performance audits continues as long as the state auditor or the legislative audit committee deems it appropriate.

The bill passed out of the House on March 7. On March 12, the bill was assigned to the Senate Health & Human Services Committee.

Since this summary, the bill was postponed indefinitely in the Senate on March 26, 2014.

SB 13-277: Creating a Uniform Process for Obtaining Prior Authorization for Coverage of a Prescription Drug Benefit

On Tuesday, April 16, 2013, Sen. Irene Aguilar introduced SB 13-277 – Concerning the Development of a Prior Authorization Process to be Used in Obtaining Prior Approval from Carriers for Coverage of Drug Benefits. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

The bill requires the commissioner of insurance (commissioner) to develop, by July 31, 2014, and prescribing providers, carriers, and, if applicable, pharmacy benefit management firms (PBMs), to use, by Jan. 1, 2015, a uniform prior authorization process for purposes of submitting and receiving requests for prior coverage approval of a drug benefit.

The commissioner is directed to adopt rules to establish the prior authorization process, which is to include specified components aimed at creating uniformity and reducing administrative burdens on prescribing providers, carriers, and PBMs, as well as making the criteria used for deciding prior authorization requests transparent and establishing a procedure for waiving the process under extenuating circumstances.

To assist in developing the process, the commissioner is to appoint a work group of various stakeholders to make recommendations on specified aspects of the process that the commissioner is to consider, including national standards for electronic prior authorization.

Once the prior authorization process is established, the request is deemed granted if a carrier or PBM fails to use or accept the prior authorization process, fails to notify the prescribing provider within a specified period that the request is approved or denied or that additional information is required to process the request, or fails to notify the prescribing provider within a specified period after receipt of the required additional information that the request is approved or denied. An approved prior authorization is valid for at least 180 days after the date of approval.

The bill was introduced on April 16 and assigned to the Health & Human Services Committee. The bill is scheduled for committee review on April 25 at 1:30 p.m.

Since this summary, the Senate Committee on Health and Human Services referred the bill, unamended, for consideration on Second Reading in the Senate.

HB 13-1266: Aligning Colorado Health Insurance Laws with Provisions of Federal Patient Protection and Affordable Care Act of 2010

On March 18, 2013, Rep. Beth McCann and Sen. Irene Aguilar introduced HB 13-1266 – Concerning the Alignment of State Health Insurance Laws with the Requirements of the Federal “Patient Protection and Affordable Care Act.” This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

The bill aligns the “Colorado Health Care Coverage Act” (Colorado law) with the federal ”Patient Protection and Affordable Care Act of 2010” and the federal “Health Care and Education Reconciliation Act of 2010” (federal law) to give the insurance commissioner the necessary authority to regulate health insurers with respect to new requirements of the federal law. The bill includes the following changes to Colorado law:

  • Makes defined terms in Colorado law consistent with the requirements of federal law;
  • Enacts the terms of Colorado’s essential health benefits package;
  • Conforms Colorado’s current mandatory coverage provisions to the requirements of federal law;
  • Requires all individual and small employer health insurance carriers selling health benefit plans in Colorado to issue and renew plans to all eligible individuals;
  • Conforms Colorado law to federal law requirements for dependent health coverage for persons under 26 years of age;
  • Prohibits discrimination against licensed or certified health care providers by health insurance carriers in the participation of health care providers in individual or group health benefit plans;
  • Conforms Colorado law regulating health insurance rates and the filing of health insurance plans to the requirements of federal law;
  • Aligns Colorado law with federal law for internal and external independent review of adverse determinations of health insurance carriers with respect to denial of benefits;
  • Consistent with federal law, prohibits carriers offering individual or small employer health benefit plans from imposing any preexisting condition exclusion with respect to coverage;
  • Makes wellness and prevention program requirements consistent with federal law;
  • Conforms carrier network adequacy requirements to federal law; and
  • Authorizes the insurance commissioner to adopt rules necessary to comply with requirements of federal law.

On March 28, the Health, Insurance & Environment Committee amended the bill and sent it to the floor of the House for consideration on 2nd Reading.

Since this summary, the bill passed Second Reading in the House with amendments, then passed Third Reading and was assigned to the Health & Human Services Committee in the Senate.

SB 13-166: Developing Standardized Rules for Use in Processing Medical Claims

On Thursday, February 7, 2013, Sen. Irene Aguilar introduced SB 13-166 – Concerning the Development of Standardized Rules for Use in Processing Medical Claims, and, in Connection Therewith, Extending the Deadlines for Development and Implementation of the Standardized Rules, Authorizing an Appropriation of State Moneys to Help Fund the Development of the Rules, and Making an Appropriation. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

In 2010, the Department of Health Care Policy and Financing (department) was charged with creating a task force to help develop a standardized set of payment rules and claim edits for use by health care providers and payers in the processing of medical claims. The task force is to submit a final report and recommendations concerning the standardized set by Dec. 31, 2013. Commercial health plans are then required to implement the standardized set by Jan. 1, 2015, or according to a schedule outlined by the task force, and domestic, nonprofit health plans must implement the standards by Jan. 1, 2016. The bill extends each of those deadlines by one year.

Additionally, under current law, the task force, through an organization designated by the executive director of the department, is allowed to seek and accept monetary and in-kind gifts, grants, and donations to use in performing its functions. No state funds have been appropriated to fund the work of the task force.

The bill authorizes the general assembly to appropriate moneys, and appropriates $100,000 from the general fund, to the department for use by the task force in performing its functions. On Feb. 20, the Health & Human Services Committee approved the bill and sent it to the Appropriations Committee for consideration of the fiscal impact.

SB 13-149: Repealing the Advisory Committee to Establish an All-Payer Health Claims Database

On Wednesday, January 30, 2013, Sen. John Kefalas introduced SB 13-149 – Concerning the Repeal of the Advisory Committee to Establish an All-Payer Health Claims Database. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

In 2010, the general assembly created an advisory committee to establish an all-payer health claims database. The bill repeals the advisory committee. On Feb. 14, Health & Human Services Committee amended the bill and sent it to the Appropriations Committee for consideration of the fiscal impact.

New Healthcare Law Resource for Attorneys and Business Leaders

According to Law Week Colorado, attorneys and business leaders trying to chop through the healthcare industry thicket have a new resource.

The Missouri offices of Husch Blackwell have created an online resource, Healthcare Law Insights, that offers information about legislative, legal, and administrative issues that affect the current healthcare industry. The blog features articles and commentary from healthcare attorneys who monitor the reforms, laws, and emerging trends.

“We launched (the site) to equip healthcare executives, compliance officers, owners, and managers with relevant legal information to keep up to date with the constantly changing health law environment,” said Curt Chase, chair of the firm’s healthcare department.

Visitors to the site can search by keyword, select posts about a specific category, access additional industry resources, and subscribe to ongoing updates by RSS feed or email.

It’s Final! Summary of Benefits and Coverage Required After September 23, 2012

Editor’s Note: This article was provided by Holland & Hart LLP. For other legal update articles from the firm, click here.

One of the provisions of Health Care Reform that is sure to impact employers is the required four-page summary of benefits and coverage. Often called the “SBC,” this form is in addition to the existing requirement to issue summary plan descriptions (“SPDs”). Until recently, the effective date for issuing the SBC was March 23, 2012. Thankfully, new guidance gives employers until at least September 23, 2012 to comply.

According to final regulations published February 14, 2012, insurance companies must provide SBCs to individual policy holders and to their insured employer plans starting September 23, 2012. Employer plans (self-funded and insured) must provide an SBC for open enrollment periods on or after that date (for calendar year plans, this will be for the 2013 plan year).

Along with the SBC, these new regulations require employer medical plans to provide employees and beneficiaries with a uniform glossary of terms commonly used in health insurance coverage (such as co-payment, deductible, home health care, etc.). In addition, the regulations include a new requirement to provide 60 days’ advance notice of material modifications. These provisions are also effective for open enrollments after September 23, 2012.

SB 12-018: Creating Voluntary Alternative Medical Assistance Program for Medicaid-Eligible Elderly

On January 11, 2012, Sen. Lundberg introduced SB 12-018 – Concerning the development of an alternative medical assistance program for the elderly. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

The bill creates a voluntary alternative medical assistance program for the Medicaid-eligible elderly. An eligible participant agrees to receive an amount equal to 70% of the medical assistance benefits that he or she would have received if the participant were enrolled in the state’s traditional Medicaid program in exchange for 2 features currently not allowed under the traditional Medicaid program:

  • The participant can choose any provider; and
  • The state waives the right to pursue all estate recovery methods from the participant’s family after the participant dies.

The participant’s physician assesses the level of care the participant needs. The department of health care policy and financing then determines the expected costs to provide that level of care if the participant were enrolled in and were receiving services under the traditional Medicaid program and allocates 70% of that amount annually to reimburse providers for the participant’s care. The department issues a debit card to the participant that is funded monthly with one-twelfth of the annual amount so allocated to the participant, which the participant uses to pay for medical services while enrolled in the alternative program. The eligible participant purchases long-term care services, assisted living services, home- and community-based services, home health services, prescribed drugs, or any health or dental care service at rates set by the provider, and the participant agrees to provide all additional resources needed for his or her care beyond the 70% Medicaid benefit amount provided through the program. The participant is responsible for researching and selecting the services.

Each year, the department conducts a redetermination of the participant’s eligibility for services and the participant’s physician reassesses the level of care that the participant needs. The department must seek a federal waiver for the program. Assigned to the Health and Human Services Committee.

Summaries of other featured bills can be found here.

Tenth Circuit: Denial of Benefits under ERISA Was Reasonable, Made in Good Faith, and Supported by Substantial Evidence

The Tenth Circuit Court of Appeals issued its opinion in Eugene S. v. Horizon Blue Cross Blue Shield of New Jersey on Tuesday, November 15, 2011.

The Tenth Circuit affirmed the district court’s decision. Petitioner sought coverage for his son’s residential treatment costs from his employer’s ERISA benefits insurer. Respondent’s delegated third-party plan administrator, Magellan, originally denied the claim and explained that Petitioner’s son qualified for intensive outpatient treatment, but not for residential treatment. Magellan affirmed its initial denial of residential treatment benefits through several appeals by both Petitioner and the residential treatment center. Having exhausted his administrative appeals, Petitioner filed this action challenging Respondent’s denial of benefits under ERISA. On appeal, Petitioner alleges 1) that the district court erred by denying his motion to strike and allowing the VSA into evidence, 2) that the district court erred in reviewing Respondent’s denials of benefits under an arbitrary and capricious, rather than a de novo, standard, and 3)  that Respondent improperly denied him benefits under the terms of his ERISA benefits plan.

The Court disagreed with all of Petitioner’s contentions. The Court refused to overturn the district court’s ruling because that court permissibly exercised its discretion and Respondent’s failure to disclose was harmless or justified. The Court also found that, to the extent it must independently assess the deference to which Magellan is entitled, Magellan was entitled to deferential review and that review should be under an arbitrary and capricious standard. And, under this standard, the administrator’s decision was reasonable, made in good faith, and supported by substantial evidence.

Federal Health Care Reform to Be Reviewed by the Supreme Court

On Monday, November 14, 2011, the United States Supreme Court agreed hear oral argument regarding the constitutionality of last year’s federal health care reform law, the Patient Protection and Affordable Care Act. The justices announced their decision to hear issues from state appeals in a brief order issued Monday.

SCOTUSblog reports that oral arguments are likely to be held in March. A ruling is expected to be issued in June.

Setting the stage for a historic constitutional confrontation over federal power, the Supreme Court on Monday granted three separate cases on the constitutionality of the new federal health care law, and set aside 5 1/2 hours — probably in March — for oral argument.  The Court, however, did not grant all of the issues raised and it chose issues to review only from three of the five separate appeals before it.  It is unclear, at this point, whether all of the cases will be heard on a single day.

The Court will hold two hours of argument on the constitutionality of the requirement that virtually every American obtain health insurance by 2014, 90 minutes on whether some or all of the overall law must fail if the mandate is struck down, one hour on whether the Anti-Injunction Act bars some or all of the challenges to the insurance mandate, and one hour on the constitutionality of the expansion of the Medicaid program for the poor and disabled.   The Court chose those issues from appeals by the federal government, by 26 states, and by a business trade group.  It opted not to review the challenges to new health care coverage requirements for public and private employers.  It left untouched petitions by a conservative advocacy group, the Thomas More Law Center, and three of its members, and by Liberty University and two of its employees.

Accepting the constitutional dispute on its very first examination of the cases brought to it speedily by lawyers, the Court wrote three separate orders outlining how it would deal with the cases.  That meant that they would not be grouped together, but that they likely will be heard close together, if not back-to-back on a single day.

The allotment of 5 1/2 hours for oral argument appeared to be a modern record; the most recent lengthy hearing came in a major constitutional dispute over campaign finance law in 2003, but that was only for 4 hours.   The length of time specified for the health care review was an indication both of the complexity of the issues involved, and the importance they hold for the constitutional division of power between national and state governments.

Colorado is one of the twenty-six states joining Florida in challenging the law.