2016
       
       
       
       
       
       
       
       
       
       
       SENATE JOINT RESOLUTION 16-029
       
       
       BY SENATOR(S) Tate and Kefalas, Baumgardner, Cooke, Crowder,
       Donovan, Guzman, Heath, Hodge, Holbert, Jahn, Johnston, Lundberg,
       Marble, Martinez Humenik, Neville T., Newell, Roberts, Scheffel,
       Sonnenberg, Steadman, Todd, Woods, Cadman;
       also REPRESENTATIVE(S) Arndt and Nordberg, Becker J., Becker K.,
       Brown, Buck, Buckner, Carver, Conti, Coram, Court, Danielson,
       DelGrosso, Dore, Duran, Esgar, Everett, Fields, Foote, Garnett, Ginal,
       Hamner, Humphrey, Joshi, Kagan, Klingenschmitt, Kraft-Tharp,
       Landgraf, Lawrence, Lebsock, Lee, Leonard, Lontine, Lundeen,
       McCann, Melton, Mitsch Bush, Moreno, Navarro, Neville P., Pabon,
       Pettersen, Primavera, Priola, Rankin, Ransom, Rosenthal, Roupe, Ryden,
       Saine, Salazar, Sias, Singer, Thurlow, Tyler, Van Winkle, Vigil, Willett,
       Williams, Wilson, Windholz, Winter, Wist, Young, Hullinghorst.
       
       
          CONCERNING THE RECOMMENDATIONS OF THE
       COLORADO "MEDICAL CLEAN CLAIMS TRANSPARENCY AND
       UNIFORMITY ACT" TASK FORCE AND, IN CONNECTION
       THEREWITH, RECOGNIZING ITS WORK. 
       
       
          WHEREAS, Medical providers deal with thousands of codes used to
       bill payers for patient health care services; and
       
          WHEREAS, Each payer applies its own set of edits when processing
       payments, resulting in tens of thousands of edits a provider's staff must
       track and adopt; and
       
          WHEREAS, Administering this process costs providers, payers, and
       ultimately the people of Colorado hundreds of millions of dollars
       annually; and
       
          WHEREAS, The Colorado general assembly enacted the "Medical
       Clean Claims Transparency and Uniformity Act" Task Force (task force)
       in 2010 as part of the state's effort to streamline administration within the
       health care system; and
       
          WHEREAS, The task force's goals were to develop uniform,
       standardized payment rules and claim edits and guide the establishment
       and operation of a central repository for accessing the edits and rules; and 
       
          WHEREAS, A group of about 25 experts, including national
       representatives from health plans, software vendors, and health care
       providers, deliberated in a fully transparent process for five years, sought
       input from stakeholders, and worked by consensus to develop a set of
       recommendations; and
       
          WHEREAS, The task force created four committees to undertake its
       work, resulting in recommendations that achieve major accomplishments
       for Colorado and that reach consensus on the descriptions of diverse types
       of edits and payment; and
       
          WHEREAS, The task force has demonstrated that payers and
       providers can work together to develop a transparent and collaborative
       process to simplify professional edits for medical claims; and
       
          WHEREAS, The task force has moved the process as far as a single
       state can in light of the limitations imposed by the national governance of
       Medicare, Medicaid, and the "Employee Retirement Income Security Act
       of 1974" ("ERISA"); and
       
          WHEREAS, The task force was able to finalize a document that
       describes the governance and dispute resolution process, providing a
       detailed description of the transparent and inclusive process for
       developing rules to arrive at a final edit set; and
       
          WHEREAS, In spite of these accomplishments, the task force hit
       several roadblocks, which it could not remove or circumvent; and
       
          WHEREAS, The task force was unable to obtain a commercial edit set
       for inclusion in the common edit set because no permanent entity could
       satisfy intellectual property protection concerns of vendors; and
       
          WHEREAS, The task force was unable to find a sustainable funding
       source to implement the common edit set once its work was completed;
       and
       
          WHEREAS, Health plan providers have expressed a strong desire to
       create a template that could be implemented at a national level; and
       
          WHEREAS, Many national provider organizations are choosing not
       to support the task force without the ability to review the full commercial
       edit set and without a common solution to be used by all states; and
       
          WHEREAS, The task force was directed to submit a final report and
       a set of recommendations to the Colorado general assembly and the
       Colorado commissioner of insurance no later than January 31, 2016,
       which deadline was met with a written final report delivered to members
       of the House Business Affairs and Labor Committee, the Senate
       Business, Labor and Technology Committee, and the commissioner of
       insurance in early January, 2016; and
       
          Be It Resolved by the Senate of the Seventieth General Assembly of the
       State of Colorado, the House of Representatives concurring herein:
       
          That we, the members of the Colorado general assembly:
       
          (1)  Recognize the substantial accomplishments of the task force and
       commend its nonprofit and private-sector participants, who donated
       thousands of hours of volunteer time over a five-year period;
       
          (2)  Recommend that the federal department of health and human
       services (DHHS) accept the work product of the task force, adopt its rules
       as the basis for the development of a common edit set for professional
       claims, make this edit set available for adoption in all states, and assume
       the oversight and funding of the process for development of a common
       set of edits for professional claims;
       
          (3)  Recommend that, as part of its work, DHHS adopt the
       collaborative and transparent process for the identification and challenge
       of problematic or clinically incorrect edits as developed by the task force; 
       
          (4)  Recommend that DHHS make available the resulting edit set or
       partial set to affected parties in a format that is downloadable and usable
       in current and common claims edit programs; and
       
          (5)  Recommend that DHHS, after a state-specific pilot program or
       under a national pilot program, support the adoption of the process, rules,
       and edits for use in all states.
       
          Be It Further Resolved, That copies of this Joint Resolution be sent to:
       The Honorable Sylvia Mathews Burwell, Secretary of the U.S.
       Department of Health and Human Services; Mr. Andy Slavitt, Acting
       Administrator, Centers for Medicare and Medicaid Services; Mr. Jeffrey
       Hinson, Regional Administrator, Centers for Medicare and Medicaid
       Services; Walter Suarez, MD, Chair, Standards Subcommittee, National
       Committee on Vital and Health Statistics; The Colorado Congressional
       Delegation; Colorado Governor John Hickenlooper; Susan E. Birch,
       Executive Director, Health Care Policy and Financing; Marguerite
       Salazar, Insurance Commissioner, Colorado Department of Regulatory
       Agencies; Alfred Gilchrist, CEO, Colorado Medical Society; Sarah
       Guillaume, Director, Grantmaking Operations, The Colorado Health
       Foundation; Laurel Petralia, Program Officer, The Colorado Trust; Wade
       Buchanan, The Bell Policy Center; Michael Campo, Colorado Medical 
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       Society Foundation; Amy Downs, Sr. Director, Colorado Health Institute;
       James Madara, MD, CEO, American Medical Association; Michael
       Donofrio, JD, General Counsel, Green Mountain Care Board; CAQH
       CORE; and Barry Keene, President of Keene Research and Development.
       
       
       
       
       
       ____________________________  ____________________________
       Bill L. Cadman               Dickey Lee Hullinghorst
       PRESIDENT OF                    SPEAKER OF THE HOUSE
       THE SENATE                        OF REPRESENTATIVES
       
       
       
       
       
       
       ____________________________  ____________________________
       Effie Ameen                           Marilyn Eddins
       SECRETARY OF                CHIEF CLERK OF THE HOUSE
       THE SENATE                        OF REPRESENTATIVES