Colorado Legislative Council Staff

NO FISCAL IMPACT

TITLE:            CONCERNING A REQUIREMENT THAT MANAGED CARE PLANS PROVIDE PATIENTS WITH DIRECT ACCESS TO THE SERVICES OF A CERTIFIED NURSE MIDWIFE.

Summary of Assessment

            The provisions of this bill would require managed care plans to provide their patients with access to an advanced practice nurse who is a certified midwife. The bill would become effective January 1, 1999, except if a referendum petition is filed, within the ninety-day period after adjournment sine die of the General Assembly, in which case the bill would become effective on the date of the official declaration of the vote of the people as proclaimed by the Governor.

            Background.   The provisions of this bill would affect health care coverages provided by health insurance carriers and HMO’s, but not self-funded health insurance plans. Self-funded health plans currently cover more than 40 percent of the state’s work force (both private and public), and more than 60 percent of state employees. Consequently, the provisions of this bill would not apply to a large percentage of the state’s workforce. In the case of the state, the provisions of the bill would apply only to HMO contract costs and any increases in these costs would be reflected in premiums paid by participating state employees.

            However, it is the policy of the state’s self-insurance plan to follow health insurance mandates, as a matter of good public policy. To the extent that the state were to change the self-funded plan’s coverage, cost to the state’s self-funded plan would increase and these increased costs would be reflected in premiums paid by participating employees. Over time, these costs would be incorporated in the annual Total Compensation Survey. Any recommended increases to maintain parity with the private sector would impact the costs to the state.

            Department of Regulatory Agencies. The bill would place into statute, regulations developed by the Division of Insurance, Department of Regulatory Agencies requiring policies providing ob/gyn coverage to provide for direct access to a nurse midwife. The provisions of the bill would require the division to amend an existing regulation. This would have a minimal impact on the division. This increase in workload could be absorbed by current staff, but may require re-prioritizing existing workload.

            Department of Personnel. The State Benefits fund, which is used to provide medical health care coverage for State employees, is administered by the Department of Personnel. The fund consists of both state contributions and employee premiums. The state contribution amount is limited by statute. Consequently, any changes in health care coverages, or changes to contracts with HMO’s or other providers affecting the fund balance must be covered by corresponding changes to the premiums charged state employees, unless the state’s contribution is amended by legislation. The bill would not affect the state’s contribution. This bill would have no fiscal impact to the Department of Personnel.

            Department of Health Care Policy and Financing. The coverages required by this bill are already a covered benefit in Medicaid managed care plans and would not affect the cost to the state to provide Medicaid benefits. This bill would have no fiscal impact to the Department of Health Care Policy and Financing.

            The provisions of this bill would not impact any other agency of the state, or unit of local government. Therefore, this bill is assessed as having no fiscal impact.

Departments Contacted

            Regulatory Agencies  Personnel        Health Care Policy and Financing      Human Services