First Regular Session
Sixty-first General Assembly
LLS NO. 970312.01 DHG
SENATE BILL 97064
STATE OF COLORADO
BY SENATORS Tebedo, Rizzuto, and Schroeder;
also REPRESENTATIVES Schauer, Swenson, and Hagedorn.
BUSINESS AFFAIRS & LABOR
A BILL FOR AN ACT
CONCERNING THE ESTABLISHMENT OF A MEDICAL FEE SCHEDULE
FOR SERVICES PROVIDED UNDER THE "COLORADO AUTO ACCIDENT
REPARATIONS ACT" UNDER NONMANAGED CARE ARRANGEMENTS, AND
MAKING AN APPROPRIATION IN CONNECTION THEREWITH.
(Note: This summary applies to this bill as introduced
and does not necessarily reflect any amendments which may be subsequently
Directs the commissioner of insurance to adopt rules establishing a schedule of reasonable fees payable for nonmanaged care health care services in connection with nofault auto insurance policies. Prohibits health care providers from charging amounts in excess of such fees or billing separately for services or items that otherwise would be defined as part of a complete service, procedure, or accommodation.
Directs the commissioner of insurance to adopt a rule establishing the fees to be charged by members of the personal injury protection (PIP) examination review panel for conduct of PIP examinations.
Increases the annual fee required of insurers that write private passenger automobile insurance from $400 to $500 to defray the costs of adopting the additional rules.
Makes an appropriation.
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. 103207 (1) (d), Colorado Revised Statutes, 1994 Repl. Vol., as amended, is amended to read:
103207. Fees paid by insurance companies. (1) There shall be paid to the division of insurance by every entity regulated by the division of insurance in this state the following:
(d) In addition to any fee collected under
paragraph (a) or (b) of this subsection (1), every insurance entity
authorized to write private passenger automobile insurance coverage
shall pay an annual fee not to exceed
FIVE hundred dollars to fund the costs of establishing and administering
the PIP examination program established in section 104706
AND ADOPTING THE RULE REQUIRED BY SECTION 104708.6
(4). Such fee shall be set by rule promulgated by the commissioner.
Fees collected under this paragraph (d) shall be transmitted
to the state treasurer, who shall credit the same to the division
of insurance cash fund created in section 101103 (3).
SECTION 2. 104706 (6) (a), Colorado Revised Statutes, 1994 Repl. Vol., as amended, is amended to read:
104706. Required coverages complying policies PIP examination program. (6) (a) The general assembly directs the commissioner to promulgate a rule, pursuant to the "State Administrative Procedure Act", article 4 of title 24, C.R.S., establishing a PIP examination program for the purpose of timely investigation and resolution of disputed PIP claims submitted to an insurance company under this part 7 AND SETTING FORTH THE FEES TO BE CHARGED BY MEMBERS OF THE PIP EXAMINATION REVIEW PANEL FOR CONDUCTING PIP EXAMINATIONS. The PIP examination program shall be the exclusive method for obtaining an independent medical examination from a health care practitioner other than a treating provider relating to a disputed PIP claim, except as provided in paragraph (c) of this subsection (6).
SECTION 3. 104708.6 (1) (b) (I), Colorado Revised Statutes, 1994 Repl. Vol., is amended, and the said 104708.6, as amended, is further amended BY THE ADDITION OF A NEW SUBSECTION, to read:
104708.6. Obligations of persons providing services penalties availability and maintenance of records schedule of reasonable charges. (1) (b) It shall be unlawful for any health care practitioner, provider of benefits, organization, or any other person to do any of the following:
(I) Submit or cause to be submitted bills
or requests for payment containing
or costs that are substantially in excess of customary charges
or costs for such items or services or
itemized or delineated fees for what would customarily be considered
a single procedure or service; or
(4) (a) ON OR BEFORE SEPTEMBER 1, 1997, AND NOT LESS THAN EVERY TWO YEARS THEREAFTER, THE COMMISSIONER SHALL ADOPT RULES SETTING FORTH THE REASONABLE VALUE OF ITEMS AND SERVICES PROVIDED PURSUANT TO SECTION 104706 (1) (b) TO (1) (e). SUCH RULES SHALL IDENTIFY AND DEFINE HEALTH CARE SERVICES, PROCEDURES, AND ACCOMMODATIONS, USING AS A GUIDELINE THE CODES CONTAINED IN THE COMMON PROCEDURE CODING SYSTEM OF THE FEDERAL HEALTH CARE FINANCING ADMINISTRATION, AS AMENDED FROM TIME TO TIME, OR, IF NO SUCH CODE EXISTS FOR A GIVEN SERVICE, PROCEDURE, OR ACCOMMODATION, USING AS GUIDELINES ANY AVAILABLE STANDARD CODES AND DEFINITIONS PROMULGATED BY OTHER RECOGNIZED PROFESSIONAL ASSOCIATIONS.
(b) IT IS UNLAWFUL FOR ANY HEALTH CARE PRACTITIONER, PROVIDER OF BENEFITS, OR OTHER PERSON OR ORGANIZATION FURNISHING ITEMS OR SERVICES PURSUANT TO SECTION 104706 (1) (b) TO (1) (e), OR (3) TO SUBMIT OR CAUSE TO BE SUBMITTED ANY BILL OR REQUEST FOR PAYMENT:
(I) CONTAINING CHARGES IN EXCESS OF THE REASONABLE VALUE OF ITEMS AND SERVICES SET FORTH IN THE COMMISSIONER'S RULES ADOPTED PURSUANT TO PARAGRAPH (a) OF THIS SUBSECTION (4);
(II) THAT SETS FORTH SEPARATELY, AT A HIGHER AGGREGATE COST, ITEMS AND SERVICES FOR WHICH A SINGLE CODE IS AVAILABLE DESCRIBING A COMPLETE SERVICE, PROCEDURE, OR ACCOMMODATION UNDER THE COMMISSIONER'S RULES ADOPTED PURSUANT TO PARAGRAPH (a) OF THIS SUBSECTION (4); OR
(III) FOR ANY ADDITIONAL CHARGE FOR AN ITEM OR SERVICE FOR WHICH PAYMENT HAS BEEN MADE IN ACCORDANCE WITH THE COMMISSIONER'S RULES ADOPTED PURSUANT TO PARAGRAPH (a) OF THIS SUBSECTION (4).
(c) THIS SUBSECTION (4) SHALL NOT APPLY WHEN BENEFITS ARE PROVIDED PURSUANT TO MANAGED CARE ARRANGEMENTS OFFERED UNDER SUBSECTION (2) OF THIS SECTION.
SECTION 4. Appropriation. In addition to any other appropriation, there is hereby appropriated, out of any moneys in the division of insurance cash fund not otherwise appropriated, to the department of regulatory agencies for allocation to the division of insurance, for the fiscal year beginning July 1, 1997, the sum of ____________ dollars ($ ), or so much thereof as may be necessary, for the implementation of this act.
SECTION 5. Safety clause. The general assembly hereby finds, determines, and declares that this act is necessary for the immediate preservation of the public peace, health, and safety.