Second Regular Session Sixty-fifth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 06-0856.02 Kristen Forrestal SENATE BILL 06-198 SENATE SPONSORSHIP Johnson, Bacon, Dyer, Entz, Evans, Fitz-Gerald, Groff, Grossman, Hagedorn, Hanna, Isgar, Keller, Kester, Owen, Sandoval, Shaffer, Spence, Tapia, Teck, Tochtrop, Traylor, Williams, and Windels HOUSE SPONSORSHIP Romanoff, Madden, Benefield, Berens, Boyd, Carroll M., Carroll T., Cerbo, Cloer, Coleman, Decker, Frangas, Gallegos, Garcia, Green, Hodge, Jahn, Kerr, King, Larson, Liston, McGihon, McKinley, Paccione, Pommer, Ragsdale, Riesberg, Rose, Solano, Soper, Stafford, Stengel, Sullivan, Todd, Vigil, and Weissmann Senate Committees House Committees Health and Human Services A BILL FOR AN ACT Concerning contractual agreements with health care providers to provide health care services. Bill Summary (Note: This summary applies to this bill as introduced and does not necessarily reflect any amendments that may be subsequently adopted.) Requires any person or entity contracting with a health care provider on or after January 1, 2008, to use a standard form contract (contract) as directed by the commissioner of insurance (commissioner). Creates an advisory panel, whose members shall be appointed by the speaker of the house of representatives, the president of the senate, and the governor, to advise the commissioner regarding the adoption of a contract. Requires the commissioner to adopt the standard contract by July 1, 2007. Specifies certain terms to be included in the contract. Allows a health care provider to choose an alternative to the standard contract. Prohibits retaliation or discrimination against a health care provider who chooses not to use the standard contract, and makes such retaliation or discrimination a violation of the "Unfair Practices Act". 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: 10-16-121.5. Standard form contract - contract advisory panel - repeal. (1) (a) Any person or entity contracting with a health care provider to provide health care services shall use a standard form contract as directed by the commissioner; except that the health care provider may elect to use a contract that is different from the standard form contract. The standard form contract shall be promulgated by the commissioner, after consultation with the contract advisory panel described in subsection (5) of this section, no later than July 1, 2007. (b) The standard form contract shall be used for all contracts issued or renewed on or after January 1, 2008, unless a health care provider exercises its option to use a different contract. (2) For purposes of this section, "health care provider" shall have the same meaning as "health care professional", set forth in section 13-80-102.5, C.R.S. (3) The standard form contract shall: (a) Identify all payors and products under the contract; (b) Identify all persons or entities responsible to make payment to the health care provider; (c) Disclose the duration of the contract; (d) Be terminable by either party after ninety days' written notice to the other party; (e) State the amount of, or the fee schedule for, compensation to be paid to the health care provider and state clearly any methodology, calculation, or policy affecting the final, net, or actual compensation; (f) Not be modified by any agreement, exhibit, attachment, fee schedule, manual, policy, or other document that the health care provider does not agree to in writing at least thirty days prior to the modification; (g) Disclose the mechanism for the resolution of payment or other disputes arising under the contract, including the time by which a dispute shall be filed and the time required for the resolution of the dispute; and (h) Include a provision for the resolution of disputes pursuant to the uniform arbitration act, part 2 of article 22 of title 13, C.R.S. (4) Any modification, extension, or renewal of the standard form contract shall be in writing and signed by both parties. (5) (a) There is hereby created a standard form contract advisory panel to advise the commissioner and make recommendations regarding the adoption of a standard form contract. The panel shall consist of nine members, appointed as follows: (I) Two physicians actively engaged in the independent practice of medicine in Colorado, one of whom shall serve as chair of the panel and be appointed by the speaker of the house of representatives and one of whom shall be appointed by the president of the senate; (II) Two attorneys who primarily represent actively practicing health care providers, one of whom shall be appointed by the speaker of the house of representatives and one of whom shall be appointed by the president of the senate; (III) Two attorneys who primarily represent insurers, health maintenance organizations, or health benefit plans, who shall be appointed by the governor; (IV) One person who serves as a manager of independently practicing physicians, who shall be appointed by the speaker of the house of representatives; (V) One person who serves as a provider relations director or contract manager of an insurer, health maintenance organization, or health plan, who shall be appointed by the governor; and (VI) One person who represents patients, who shall be appointed by the president of the senate. (b) This subsection (5) is repealed, effective January 1, 2008. (6) (a) No person or entity shall: (I) Discriminate or retaliate against a health care provider for using the standard form contract or for asserting or enforcing the rights and obligations provided in this section or in the contract. Discrimination or retaliation shall include, but shall not be limited to, offering or providing any financial or other benefit for not using the contract. (II) Require the health care provider to waive any rights provided in this section or any rights provided by federal or state law as a condition of entering into a contract with a person or entity subject to subsection (1) of this section. (b) A violation of this subsection (6) shall constitute a violation of the "Unfair Practices Act", part 1 of article 2 of title 6, C.R.S., and shall be subject to the penalties provided for in section 6-2-116, C.R.S, in addition to any other penalty or remedy. (7) This section shall not apply: (a) To a health maintenance organization that exclusively contracts with a single medical group in a specific geographic area to provide or arrange for health care services for its enrollees; or (b) To employment contracts or arrangements between an individual health care provider and other health care providers or between an individual health care provider and a business entity consisting of health care providers. SECTION 2. Article 2 of title 6, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SECTION to read: 6-2-108.5. Retaliation or discrimination against health care providers prohibited. Retaliation or discrimination against a health care provider who chooses not to use a standard form contract pursuant to section 10-16-121.5, C.R.S., is an unfair trade practice. SECTION 3. 6-2-116, Colorado Revised Statutes, is amended to read: 6-2-116. Penalty. Any person, firm, or corporation, whether as principal, agent, officer, or director, for himself, herself, or itself, or for another person, or for any firm or corporation who violates any of the provisions of sections 6-2-103 to 6-2-108 6-2-108.5 or section 6-2-110, is guilty of a misdemeanor for each single violation and, upon conviction thereof, shall be punished by a fine of not less than one hundred dollars nor more than one thousand dollars, or by imprisonment for not more than six months, or by both such fine and imprisonment. SECTION 4. 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 9, 2006, if adjournment sine die is on May 10, 2006); 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.