Colorado Legislative Council Staff

NO FISCAL IMPACT

TITLE:            CONCERNING PAYMENTS FOR CONTINUING CARE.

Summary of Assessment

            The bill requires health maintenance organizations (HMOs) to pay for continuing care services provided by an out-of-network provider if:

            •   the beneficiary is returning to the same location where he or she resided prior to hospitalization;

            •   the beneficiary has a continuing care contract or rental agreement with the facility at that location;

            •   the service is one that the HMO would be liable for if provided by an in-network provider; and

            •   the beneficiary needs the level of care provided by the continuing care provider, and the provider is willing to accept payment according to the same terms as an in-network provider.

            The bill establishes a cause of action for an HMO’s violation of the requirement. Additionally, if an HMO collects a higher premium because a beneficiary is in a special needs category, the HMO is required to reimburse the continuing care provider based on the adjusted amount. The bill is effective upon signature of the Governor.

            Department of Regulatory Agencies — Effective Date. According to the Department of Regulatory Agencies, Division of Insurance, the bill affects 19 HMOs. Because the bill is effective upon signature of the Governor, all 19 HMOs will be required to change their policy forms and submit rate filings to DORA prior to January 1, the annual filings submission date. A mid-year effective date will require DORA staff to review the 19 filings at a cost of $176. Although this cost is minimal and can be absorbed within existing resources, all costs would be mitigated if the effective date were changed to January 1, 2000.

            The bill is assessed as having no state or local fiscal impact.

Departments Contacted

            Health Care Policy and Financing

            Personnel

            Regulatory Agencies