HOUSE Amended 2nd Reading April 25, 2008Second Regular Session Sixty-sixth General Assembly STATE OF COLORADO ENGROSSED This Version Includes All Amendments Adopted on Second Reading in the House of Introduction LLS NO. 08-1151.03 Kristen Forrestal HOUSE BILL 08-1411 HOUSE SPONSORSHIP Marshall, Stafford, Frangas, Massey, Borodkin, Carroll T., Liston, Madden, Primavera, and Stephens SENATE SPONSORSHIP Sandoval, House Committees Senate Committees Business Affairs and Labor A BILL FOR AN ACT Concerning the prohibition of incentives to limit the provision of medically appropriate health care services to a covered person. Bill Summary (Note: This summary applies to this bill as introduced and does not necessarily reflect any amendments that may be subsequently adopted.) Prohibits a person or entity from providing remuneration to health care providers as an inducement to deny, reduce, limit, or delay specific medically necessary and appropriate services to a covered person. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. Part 1 of article 16 of title 10, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SECTION to read: 10-16-133. Prohibited incentives for health care providers - short title - definitions. (1) This section shall be known and may be cited as the "Colorado Health Care Anti-kickback Act". (2) It is unlawful for a person or entity to provide remuneration directly, in any type or form, to a health care provider as an inducement or reward to deny, reduce, limit, or delay evidence-based medically necessary services to a covered person in a health coverage plan. (3) Nothing in this section shall be construed to prohibit incentive plans for health care providers that involve general payments, including, but not limited to, capitation payments or shared-risk arrangements that are not tied to a specific medical decision involving a specific covered person; pay for performance programs; or other programs to promote evidence-based use of drugs, devices, or other medical interventions. The payments made to a health care provider pursuant to this subsection (3) shall be deemed confidential. (4) For the purposes of this section: (a) "Covered person" and "health coverage plan" shall have the same meanings as set forth in section 10-16-102. (b) "Evidence-based" means standards, guidelines, recommendations, programs, practices, and policies that are based on high-quality, peer reviewed published or otherwise widely netted research, such that there is an acceptable certainty of effectiveness and efficiency. (c) "Pay for performance" means a program that rewards a health care provider for care delivery that is effective, efficient, equitable, patient-centered, timely, and safe. (d) "Person or entity" means a person or entity that has a primary business purpose of contracting with health care providers for the delivery of health care services. (5) A violation of this section constitutes an unfair method of competition and unfair or deceptive act or practice in the business of insurance pursuant to section 10-3-1104. SECTION 2. 10-3-1104 (1), Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW PARAGRAPH to read: 10-3-1104. Unfair methods of competition and unfair or deceptive acts or practices. (1) The following are defined as unfair methods of competition and unfair or deceptive acts or practices in the business of insurance: (ff) Violation of section 10-16-133 concerning unlawful remuneration as an inducement or reward to deny, reduce, limit, or delay specific medically necessary and appropriate services to a covered person in a health coverage plan. SECTION 3. Effective date. This act shall take effect at 12:01 a.m. on the day following the expiration of the ninety-day period after final adjournment of the general assembly that is allowed for submitting a referendum petition pursuant to article V, section 1 (3) of the state constitution, (August 6, 2008, if adjournment sine die is on May 7, 2008); except that, if a referendum petition is filed against this act or an item, section, or part of this act within such period, then the act, item, section, or part, if approved by the people, shall take effect on the date of the official declaration of the vote thereon by proclamation of the governor.