reglab/statecodes huggingface dataset:
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 10 - HEALTH-CARE COVERAGE COOPERATIVES (§§ 10-16-1001 — 10-16-1016) › Section 10-16-1010 - Marketing requirements of cooperatives

(1)
A cooperative shall use appropriate, efficient, and standardized means to notify members and prospective members and their eligible employees of the availability of sponsored health-care coverage from the cooperative.
(2)
A cooperative shall make available to members and prospective members and their eligible employees marketing materials that accurately summarize the health benefit plans that are offered by its licensed provider networks, licensed individual providers, and other carriers, and rates, costs, and accreditation information relating to those plans. A cooperative shall also summarize the services offered by all other provider networks and individual providers the cooperative offers, the rates for those services, and accreditation information relating to those provider networks.
(3)
A cooperative may offer nonlicensed provider networks or individual providers only to self-insured members of the cooperative. Nonlicensed provider networks or individual providers may also be offered to members not self-insured if the services offered do not involve transacting insurance business, as defined in section
10-3-903
. The members may choose which health benefit plans shall be offered to eligible employees and may change the selection each year. The employee may be given options with regard to health benefit plans and the type of managed care system under which benefits will be provided.
L. 2004: Entire part added, p. 1004, § 14, effective August 4.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 10 - HEALTH-CARE COVERAGE COOPERATIVES (§§ 10-16-1001 — 10-16-1016) › Section 10-16-1011 - [Repealed]

Repealed by 2019 Ch. 205,§8, eff. 8/2/2019.
Amended by 2013 Ch. 217,§54, eff. 5/13/2013.
L. 2004: Entire part added, p. 1004, § 14, effective August 4. L. 2013: (5)(b)(II)(A) amended, (HB 13-1266), ch. 990, p. 990, § 54, effective May 13. L. 2019: Entire section repealed, (SB 19-004), ch. 2194, p. 2194, § 8, effective August 2.
For the legislative declaration in SB 19-004, see section 1 of chapter 205, Session Laws of Colorado 2019.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 10 - HEALTH-CARE COVERAGE COOPERATIVES (§§ 10-16-1001 — 10-16-1016) › Section 10-16-1012 - [Repealed]

Repealed by 2019 Ch. 205,§9, eff. 8/2/2019.
L. 2004: Entire part added, p. 1007, § 14, effective August 4.
For the legislative declaration in SB 19-004, see section 1 of chapter 205, Session Laws of Colorado 2019.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 10 - HEALTH-CARE COVERAGE COOPERATIVES (§§ 10-16-1001 — 10-16-1016) › Section 10-16-1014 - Technical assistance to authorized cooperatives from division of insurance

(1)
Subject to available appropriations, the commissioner may provide technical assistance to any cooperative that:
(a) to (c)
Repealed.
(d)
Establishes rules that specify that employer members shall take no action to limit their employees' choice of plans offered through the cooperative or to encourage or discourage employees from making particular choices of plans offered through the cooperative;
(e)
Repealed.
(f)
Develops and implements a marketing plan to publicize the cooperative to potential members and develops and implements methods for informing the public about the cooperative and its services;
(g)
Develops specific plans to expand health-care coverage and to expand access to health care in this state; and
(h)
Gives each covered member the opportunity to choose among carriers that contract with the cooperative.
(2)
The technical assistance the commissioner may provide pursuant to subsection (1) of this section may include:
(a)
Providing technical assistance in the formation of a cooperative pursuant to this part 10 so long as the cooperative is not formed or administered by the commissioner as an entity or instrumentality of the state;
(b)
Educating communities, businesses, and nonprofit organizations about cooperatives; and
(c)
Advertising or otherwise publicizing successful cooperatives that have been formed in the state.
Amended by 2019 Ch. 205,§ 11, eff. 8/2/2019.
L. 2004: Entire part added, p. 1008, § 14, effective August 4.
For the legislative declaration in SB 19-004, see section 1 of chapter 205, Session Laws of Colorado 2019.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 10 - HEALTH-CARE COVERAGE COOPERATIVES (§§ 10-16-1001 — 10-16-1016) › Section 10-16-1015 - Health-care cooperatives - rule-making authority

The commissioner may promulgate rules consistent with this part 10 for purposes of carrying out the commissioner's duties under this part 10.
Amended by 2019 Ch. 205,§ 12, eff. 8/2/2019.
L. 2004: Entire part added, p. 1009, § 14, effective August 4.
For the legislative declaration in SB 19-004, see section 1 of chapter 205, Session Laws of Colorado 2019.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 10 - HEALTH-CARE COVERAGE COOPERATIVES (§§ 10-16-1001 — 10-16-1016) › Section 10-16-1016 - State innovation waiver - authority to apply

As necessary to implement this part 10, the commissioner may apply to the secretary of the United States department of health and human services for a five-year state innovation waiver in accordance with section 1332 of the federal act, codified at
42 U.S.C. sec. 18052
, and
45 CFR 155.1300
. The commissioner shall ensure that a waiver application submitted pursuant to this section complies with the requirements specified in section 1332 of the federal act, codified at
42 U.S.C. sec. 18052
, and
45 CFR 155.1308
.
Added by 2019 Ch. 205,§13, eff. 8/2/2019.
L. 2019: Entire section added, (SB 19-004), ch. 2197, p. 2197, § 13, effective August 2.
For the legislative declaration in SB 19-004, see section 1 of chapter 205, Session Laws of Colorado 2019.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 11 - COLORADO REINSURANCE PROGRAM (§§ 10-16-1101 — 10-16-1110) › Section 10-16-1101 - Short title

The short title of this part 11 is the "Colorado Reinsurance Program Act".
Added by 2019 Ch. 204,§ 1, eff. 5/17/2019.
L. 2019: Entire part added, (HB 19-1168), ch. 2176, p. 2176, § 1, effective May 17.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 11 - COLORADO REINSURANCE PROGRAM (§§ 10-16-1101 — 10-16-1110) › Section 10-16-1102 - Legislative declaration

(1)
The general assembly hereby finds and declares that:
(a)
All Coloradans deserve access to high-quality, affordable health care to help support their well-being and economic security;
(b)
Increasing costs of health care in Colorado have led to premium increases for health insurance in the individual market that have created a financial burden for some Coloradans purchasing insurance in the individual market;
(c)
That burden is heightened in rural areas of the state, where premiums are considerably higher than in metropolitan areas of the state and there is a lack of competition among health-care providers and carriers;
(d)
Because of the financial burden high-cost health insurance places on consumers in rural areas, a considerable number of these cost-burdened consumers may not purchase health insurance, exacerbating the problems of few carriers, few plan options, and high health insurance costs in rural regions, as well as increasing the number of uninsured Coloradans; and
(e)
Colorado has historically been a national leader in health-care innovation, and it is important to use that innovative spirit to address the rising costs of health care in the state by directing the commissioner of insurance to create a reinsurance program that will:
(I)
Make private health insurance in the individual market more accessible and affordable;
(II)
Encourage participation and competition by carriers throughout the state, but particularly in rural areas of the state, in order to give consumers the ability to seek value in health insurance coverage;
(III)
Decrease costs of care, leading to lower premiums and restraining, if not decreasing, the growth in federal spending commitments in the individual market; and
(IV)
Support and empower, and increase access to affordable, high-value health insurance for, consumers who are ineligible for premium tax credit subsidies while minimizing any potential negative effects on access to affordable, high-value insurance for consumers who are eligible for premium tax credit subsidies and cost-sharing reductions.
Added by 2019 Ch. 204,§ 1, eff. 5/17/2019.
L. 2019: Entire part added, (HB 19-1168), ch. 2176, p. 2176, § 1, effective May 17.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 11 - COLORADO REINSURANCE PROGRAM (§§ 10-16-1101 — 10-16-1110) › Section 10-16-1103 - Definitions

As used in this part 11, unless the context otherwise requires:
(1)
"Attachment point" means the amount set by the commissioner pursuant to section
10-16-1105(2)
for claims costs incurred by an eligible carrier for a covered person's covered benefits in a benefit year, above which the claims costs for benefits are eligible for reinsurance payments under the reinsurance program.
(2)
"Benefit year" means the calendar year for which an eligible carrier provides coverage through an individual health benefit plan.
(3)
"Coinsurance rate" means the rate set by the commissioner pursuant to section
10-16-1105(2)
at which the reinsurance program will reimburse an eligible carrier for claims incurred for a covered person's covered benefits in a benefit year, which claims exceed the attachment point but are below the reinsurance cap.
(4)
"Commissioner" means the commissioner of insurance, the commissioner's deputies, or the division of insurance, as appropriate.
(5)
"Eligible carrier" means a carrier that:
(a)
Offers individual health benefit plans that comply with the federal act; and
(b)
Incurs claims costs for a covered person's covered benefits in the applicable benefit year.
(6)
"Hospital" means a hospital licensed or certified by the department of public health and environment pursuant to section
25-1.5-103(1)(a)
.
(7)
"Medicaid" means federal insurance or assistance as provided by Title XIX of the federal "Social Security Act", as amended, and the "Colorado Medical Assistance Act", articles
4
,
5
, and
6
of title
25.5
.
(8)
"Medicare" means federal insurance or assistance provided by the "Health Insurance for the Aged Act", Title XVIII of the federal "Social Security Act", as amended,
42 U.S.C. sec. 1395
et seq.
(9)
"Payment parameters" means the attachment point, reinsurance cap, and coinsurance rate for the reinsurance program.
(10)
"Reinsurance cap" means the amount set by the commissioner pursuant to section
10-16-1105(2)
for claims costs incurred by an eligible carrier for a covered person's covered benefits, above which amount the claims costs for benefits are no longer eligible for reinsurance payments.
(11)
"Reinsurance payment" means an amount paid to an eligible carrier under the reinsurance program.
(12)
"Reinsurance program" or "program" means the Colorado reinsurance program established under section
10-16-1105
.
(13)
"State innovation waiver" means a waiver of one or more requirements of the federal act authorized by section 1332 of the federal act, codified in
42 U.S.C. sec. 18052
, and applicable federal regulations.
Added by 2019 Ch. 204,§ 1, eff. 5/17/2019.
L. 2019: Entire part added, (HB 19-1168), ch. 2177, p. 2177, § 1, effective May 17.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 11 - COLORADO REINSURANCE PROGRAM (§§ 10-16-1101 — 10-16-1110) › Section 10-16-1106 - Accounting - reports - audits

(1)
The commissioner shall maintain an accounting for each benefit year of all:
(a)
Money expended for reinsurance payments and administrative and operational expenses;
(b)
Requests for reinsurance payments received from eligible carriers;
(c)
Reinsurance payments made to eligible carriers; and
(d)
Administrative and operational expenses incurred for the reinsurance program.
(2)
By November 1 of the year following the applicable benefit year or sixty calendar days after the final disbursement of reinsurance payments for the applicable benefit year, whichever is later, the commissioner shall make available to the public a report summarizing the reinsurance program's operations for each benefit year. The commissioner shall post the report on the division's website.
(3)
The reinsurance program is subject to audit by the state auditor. The commissioner shall ensure that all of the reinsurance program's contractors, subcontractors, and agents cooperate with the audit.
(4)
On or before November 1, 2020, and on or before November 1 of each year thereafter, the division shall include an update regarding the program in its report to the members of the applicable committees of reference in the senate and house of representatives as required by the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act", part 2 of article
7
of title
2
.
Amended by 2020 Ch. 201,§ 5, eff. 6/30/2020.
Added by 2019 Ch. 204,§ 1, eff. 5/17/2019.
L. 2019: Entire part added, (HB 19-1168), ch. 2183, p. 2183, § 1, effective May 17. L. 2020: (4) amended, (SB 20-215), ch. 999, p. 999, § 5, effective June 30.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 11 - COLORADO REINSURANCE PROGRAM (§§ 10-16-1101 — 10-16-1110) › Section 10-16-1108 - [Repealed]

Repealed by 2020 Ch. 201,§7, eff. 6/30/2020.
Added by 2019 Ch. 204,§1, eff. 5/17/2019.
L. 2019: Entire part added, (HB 19-1168), ch. 2184, p. 2184, § 1, effective May 17. L. 2020: Entire section repealed, (SB 20-215), ch. 1001, p. 1001, § 7, effective June 30.
Added by 2019 Ch. 204,§1, eff. 5/17/2019.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 11 - COLORADO REINSURANCE PROGRAM (§§ 10-16-1101 — 10-16-1110) › Section 10-16-1109 - State innovation waiver - federal funding - Colorado reinsurance program

(1)
(a)
For purposes of implementing and operating the reinsurance program as set forth in this part 11 for plan years starting on or after January 1, 2021, the commissioner may apply to the secretary of the United States department of health and human services for:
(I)
In accordance with section 1332 of the federal act, codified at
42 U.S.C. sec. 18052
, and
45 CFR 155.1300
:
(A)
One or more extensions of the initial two-year state innovation waiver received before June 30, 2020, of up to five years per extension; or
(B)
A new state innovation waiver of up to five years to follow the initial two-year state innovation waiver approved before June 30, 2020, and subsequent extensions of any new state innovation waiver approved by the secretary;
(II)
Federal funds for the reinsurance program; or
(III)
A new or extended state innovation waiver and federal funds.
(b)
An application for a state innovation waiver or for federal funds must clearly state that operation of the reinsurance program is contingent on approval of the waiver or funding request.
(c)
The commissioner shall ensure that a waiver application submitted pursuant to this section complies with the requirements specified in section 1332 of the federal act, codified at
42 U.S.C. sec. 18052
, and
45 CFR 155.1308
.
(d)
The commissioner shall include in a waiver application a request for a pass-through of federal funding in accordance with section 1332 (a)(3) of the federal act,
42 U.S.C. sec. 18052(a)(3)
, to allow the state to obtain and use, for purposes of helping fund the reinsurance program, any federal funds that would, absent the waiver, be used to pay advance payment tax credits and cost-sharing reductions authorized under the federal act.
(2)
The commissioner shall notify the following in writing of any federal actions regarding the waiver or funding request:
(a)
The joint budget committee of the general assembly;
(b)
The senate committee on health and human services or any successor committee; and
(c)
The house of representatives committees on health and insurance and public health care and human services or any successor committees.
Amended by 2020 Ch. 201,§8, eff. 6/30/2020.
Added by 2019 Ch. 204,§1, eff. 5/17/2019.
L. 2019: Entire part added, (HB 19-1168), ch. 2186, p. 2186, § 1, effective May 17. L. 2020: (1)(a) amended, (SB 20-215), ch. 1001, p. 1001, § 8, effective June 30.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 11 - COLORADO REINSURANCE PROGRAM (§§ 10-16-1101 — 10-16-1110) › Section 10-16-1110 - Repeal of part - notice to revisor of statutes

(1)
(a)
The commissioner shall notify the revisor of statutes in writing, by e-mail sent to revisorofstatutes.ga@coleg.gov, upon receipt from the secretary of the United States department of health and human services of notice of approval or denial of the waiver or funding requested under section
10-16-1109
.
(b)
(I)
If the notice from the commissioner states that the waiver or funding was denied, this part 11 is repealed, effective upon the date identified in the notice that the waiver or funding was denied or, if the notice does not specify that date, upon the date of the notice of denial to the revisor of statutes.
(II)
If the notice from the commissioner states that the waiver or funding was approved, this subsection (1) is repealed, effective upon the date identified in the notice that the waiver or funding was approved or, if the notice does not specify that date, upon the date of the notice of approval to the revisor of statutes.
(2)
Repealed.
Amended by 2020 Ch. 201, § 9, eff. 6/30/2020.
Added by 2019 Ch. 204, § 1, eff. 5/17/2019.
L. 2019: Entire part added, (HB 19-1168), ch. 2187, p. 2187, § 1, effective May 17. L. 2020: (2) repealed, (SB 20-215), ch. 1001, p. 1001, § 9, effective June 30.
As of publication date, the revisor of statutes has not received the notice required by this section.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 12 - HEALTH INSURANCE AFFORDABILITY ACT (§§ 10-16-1201 — 10-16-1208) › Section 10-16-1201 - Short title

The short title of this part 12 is the "Health Insurance Affordability Act".
Added by 2020 Ch. 201,§ 1, eff. 6/30/2020.
L. 2020: Entire part added, (SB 20-215), ch. 986, p. 986, § 1, effective June 30.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 12 - HEALTH INSURANCE AFFORDABILITY ACT (§§ 10-16-1201 — 10-16-1208) › Section 10-16-1202 - Legislative declaration

(1)
The general assembly finds and declares that:
(a)
The state, carriers, and hospitals share a common commitment to ensuring all Coloradans have access to affordable health care coverage because access to coverage improves health outcomes and provides financial security for Coloradans;
(b)
Hospitals within the state incur the costs of uncompensated care to uninsured and underinsured populations;
(c)
The economic downturn due to COVID-19 and its impacts on group and individual health care coverage in the state creates economic challenges for carriers from the potential lost revenue if people drop insurance coverage;
(d)
This part 12 is enacted to provide the following services and benefits to carriers:
(I)
Reducing the number of Coloradans who lack health care coverage by helping Coloradans to maintain consistent coverage;
(II)
Providing stability in the insurance market;
(III)
Reducing the movement of individuals between insured and uninsured status;
(IV)
Offsetting the costs carriers would otherwise pay for covered persons' high medical costs so that premiums are set at more affordable levels; and
(V)
Creating a healthier risk pool for all carriers by establishing a path for consistent coverage for individuals; and
(e)
This part 12 is enacted to provide the following services and benefits to hospitals:
(I)
Reducing the amount of uncompensated care provided by hospitals;
(II)
Reducing the need of providers to shift costs of providing uncompensated care to other payers; and
(III)
Expanding access to high-quality, affordable health care for low-income and uninsured Coloradans.
(2)
The general assembly further finds and declares that, consistent with the determination of the Colorado supreme court in
Nicholl v. E-470 Public Highway Authority
, 896 P.2d 859 (Colo. 1995), the power to impose taxes is inconsistent with enterprise status under section 20 of article X of the state constitution, and the health insurance affordability fees and special assessments charged and collected by the health insurance affordability enterprise are fees, not taxes, because the fees and assessments are imposed for the specific purpose of allowing the enterprise to defray the costs of providing the business services specified in section
10-16-1204 (1)(a)
to the carriers and hospitals that pay the fees and assessments and are collected at rates that are reasonably calculated based on the benefits received by those carriers and hospitals.
Added by 2020 Ch. 201, § 1, eff. 6/30/2020.
L. 2020: Entire part added, (SB 20-215), ch. 986, p. 986, § 1, effective June 30.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 12 - HEALTH INSURANCE AFFORDABILITY ACT (§§ 10-16-1201 — 10-16-1208) › Section 10-16-1203 - Definitions

As used in this part 12, unless the context otherwise requires:
(1)
"Board" means the health insurance affordability board created in section
10-16-1207
.
(2)
"Children's basic health plan" has the meaning set forth in section
25.5-8-103 (2)
.
(3)
"Enterprise" means the Colorado health insurance affordability enterprise created in section
10-16-1204
.
(4)
"Federal poverty line" has the same meaning as "poverty line", as defined in
42 U.S.C. sec. 9902 (2)
.
(5)
"Fee" means the health insurance affordability fee established and assessed pursuant to section
10-16-1205
.
(6)
"Fund" means the health insurance affordability cash fund created in section
10-16-1206
.
(7)
"Household income" has the same meaning as set forth in
26 U.S.C. sec. 36B (d)(2)
of the federal "Internal Revenue Code of 1986", as amended.
(8)
"Medicaid" means federal insurance or assistance as provided by Title XIX of the federal "Social Security Act", as amended, and the "Colorado Medical Assistance Act", articles
4
,
5
, and
6
of title
25.5
.
(9)
"Medicare" means federal insurance or assistance provided by the "Health Insurance for the Aged Act", Title XVIII of the federal "Social Security Act", as amended,
42 U.S.C. sec. 1395
et seq.
(10)
"Premium tax credit" means the refundable tax credit available pursuant to the federal act to assist certain individuals in purchasing a health benefit plan on the exchange.
(11)
"Public benefit corporation" means a public benefit corporation formed pursuant to part 5 of article
101
of title
7
that is organized and operated by the exchange pursuant to section
10-22-106 (3)
for the purpose of administering and operating a subsidy to reduce the costs of health care coverage offered under a state-subsidized individual health coverage plan.
(12)
"Qualified individual" means an individual, regardless of immigration status, who:
(a)
Is a Colorado resident;
(b)
Has a household income of not more than three hundred percent of the federal poverty line; and
(c)
Is not eligible for the premium tax credit, medicaid, medicare, or the children's basic health plan.
(13)
"Reinsurance program" means the Colorado reinsurance program created in part 11 of this article 16.
(14)
"Reinsurance program cash fund" means the reinsurance program cash fund created in section
10-16-1107
.
(15)
"State-subsidized individual health coverage plan" means a subsidized individual health coverage plan offered by carriers to qualified individuals through the public benefit corporation.
Added by 2020 Ch. 201, § 1, eff. 6/30/2020.
L. 2020: Entire part added, (SB 20-215), ch. 987, p. 987, § 1, effective June 30.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 12 - HEALTH INSURANCE AFFORDABILITY ACT (§§ 10-16-1201 — 10-16-1208) › Section 10-16-1206 - Health insurance affordability cash fund - creation - repeal

(1)
There is created in the state treasury the health insurance affordability cash fund. The fund consists of:
(a)
The fees collected from carriers pursuant to section
10-16-1205 (1)(a)(I)
;
(b)
The special assessments collected from hospitals pursuant to section
10-16-1205 (1)(a)(II)
;
(c)
(I)
An amount of premium tax revenues deposited in the fund pursuant to section
10-3-209 (4)(a)(III)
in the 2020-21, 2021-22, and 2022-23 state fiscal years, not to exceed, in any year, ten percent of the total amount the enterprise collects from carriers and hospitals under section
10-16-1205 (1)(a)
.
(II)
This subsection (1)(c) is repealed, effective July 1, 2025.
(d)
The revenue collected from revenue bonds issued pursuant to section
10-16-1204 (1)(b)(II)
;
(e)
Money that may be allocated to the fund pursuant to section
10-16-1308
;
(f)
All interest and income derived from the deposit and investment of money in the fund; and
(g)
The federal share of the medical assistance payments received pursuant to section
25.5-4-503 (2)
.
(2)
Money in the fund shall not be transferred to any other fund, except as provided in section
10-16-1205 (2)
, and shall not be used for any purpose other than the purposes specified in this part 12.
(3)
All money in the fund is continuously available and appropriated to the enterprise to use in accordance with this part 12.
(4)
The fund is part of the enterprise established pursuant to section
10-16-1204 (1)
.
Amended by 2024 Ch. 491,§ 1, eff. 6/7/2024.
Amended by 2022 Ch. 399, § 3, eff. 6/7/2022.
Amended by 2021 Ch. 241, § 3, eff. 6/16/2021.
Added by 2020 Ch. 201, § 1, eff. 6/30/2020.
L. 2020: Entire part added, (SB 20-215), ch. 994, p. 994, § 1, effective June 30.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 12 - HEALTH INSURANCE AFFORDABILITY ACT (§§ 10-16-1201 — 10-16-1208) › Section 10-16-1208 - Limitation on authority - public option

Nothing in this part 12 authorizes the enterprise, the board, or the commissioner to establish, administer, operate, or require participation by carriers or hospitals in a state or public option health coverage plan.
Added by 2020 Ch. 201,§ 1, eff. 6/30/2020.
L. 2020: Entire part added, (SB 20-215), ch. 997, p. 997, § 1, effective June 30.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 13 - COLORADO STANDARDIZED HEALTH BENEFIT PLAN (§§ 10-16-1301 — 10-16-1313) › Section 10-16-1301 - Short title

The short title of this part 13 is the "Colorado Standardized Health Benefit Plan Act".
Added by 2021 Ch. 241,§ 1, eff. 6/16/2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 13 - COLORADO STANDARDIZED HEALTH BENEFIT PLAN (§§ 10-16-1301 — 10-16-1313) › Section 10-16-1302 - Legislative declaration - intent

(1)
The general assembly, through the exercise of its powers to protect the health, peace, safety, and general welfare of the people of Colorado, hereby finds that:
(a)
Health insurance coverage has been demonstrated to have a positive impact on people's health outcomes as well as their financial security and well-being;
(b)
Ensuring that all people have access to affordable, quality, continuous, and equitable health care is a challenge that public officials and policy experts have faced for decades despite seemingly constant efforts to address the issue;
(c)
Although great strides have been made in increasing access to health-care coverage through federal and state legislation, not enough has been accomplished to address the affordability of health insurance in Colorado, particularly in the state's rural areas and for Coloradans who have historically and systemically faced barriers to health, including people of color, immigrants, and Coloradans with low incomes;
(d)
The health-care system is a complex system wherein consumers rely on health insurance carriers to negotiate the rates paid to health-care providers, pharmaceutical companies, and hospitals for services provided and expect that the negotiated rates are closely tied to the amount of the health insurance premiums paid;
(e)
Despite efforts to address access to and affordability of health care, underlying health-care costs continue to rise, thus driving up the costs of health insurance premiums, often at disproportionate rates in rural areas of the state; and
(f)
In order to ensure that health insurance is affordable for Coloradans, it is critical that the state establish a standardized plan for carriers to offer in the state and set premium reduction targets for carriers to achieve.
Added by 2021 Ch. 241,§ 1, eff. 6/16/2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 13 - COLORADO STANDARDIZED HEALTH BENEFIT PLAN (§§ 10-16-1301 — 10-16-1313) › Section 10-16-1305.5 - Rate filings

(1)
In the rate filings required pursuant to section
10-16-107
, each carrier must file rates for the standardized plan at the premium rates required in section
10-16-1305 (2)
.
(2)
In reviewing the rates for the standardized plans, the commissioner may establish uniform limits on all carriers' administrative costs and profits for a standardized plan if the resulting premium rates are actuarially sound and do not entail cost shifting to plans other than standardized plans.
Added by 2023 Ch. 159,§ 3, eff. 5/10/2023.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 13 - COLORADO STANDARDIZED HEALTH BENEFIT PLAN (§§ 10-16-1301 — 10-16-1313) › Section 10-16-1307 - Advisory board - members - rules

(1)
(a)
The commissioner shall consult with an advisory board to implement this part 13. The governor shall appoint the members of the advisory board on or before July 1, 2022, and shall ensure that the membership of the advisory board has demonstrated experience and expertise in most of the areas listed in subsection (2) of this section.
(b)
To the extent possible, the governor shall appoint advisory board members who are diverse with regard to race, ethnicity, immigration status, age, ability, sexual orientation, gender identity, and geography. In considering the racial and ethnic diversity of the advisory board, the governor shall attempt to ensure that at least one-third of the members are people of color. In considering the geographic diversity of the advisory board, the governor shall attempt to appoint members from both rural and urban areas of the state.
(2)
The governor may appoint up to eleven members to the advisory board and, to the extent practicable, shall include individuals who:
(a)
Have faced barriers to health access, including people of color, immigrants, and Coloradans with low incomes;
(b)
Have experience purchasing the standardized plan;
(c)
Represent consumer advocacy organizations;
(d)
Have expertise in health equity;
(e)
Have expertise in health benefits for small businesses;
(f)
Represent carriers or who have experience with designing a health insurance plan and setting rates;
(g)
Represent hospitals or who have experience with contracts between hospitals and carriers;
(h)
Represent health-care providers or who have experience with contracts between health-care providers and carriers;
(i)
Represent an employee organization that represents employees in the health-care industry; or
(j)
Are licensed or retired physicians practicing or who practiced in this state.
(3)
The members serve at the pleasure of the governor.
(4)
In addition to consulting with the commissioner pursuant to subsection (1)(a) of this section, the advisory board may:
(a)
Consider recommendations to streamline prior authorization and utilization management processes for the standardized plan;
(b)
Recommend ways to keep health-care services in the communities where patients live; and
(c)
Consider whether alternative payment models may be appropriate for particular services, taking into consideration the impacts of such models on health outcomes for people of color.
(5)
The division shall provide technical and administrative support to assist the advisory board.
Added by 2021 Ch. 241,§ 1, eff. 6/16/2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 13 - COLORADO STANDARDIZED HEALTH BENEFIT PLAN (§§ 10-16-1301 — 10-16-1313) › Section 10-16-1308 - Federal waiver - commissioner application - use of money

(1)
On or after June 16, 2021, the commissioner may apply to the secretary of the United States department of health and human services for a state innovation waiver to waive one or more requirements of the federal act as authorized by section 1332 of the federal act to capture all applicable savings to the federal government as a result of the implementation of this part 13.
(2)
(a)
Upon approval of the 1332 waiver application, the commissioner may use any federal money received through the waiver for the implementation of this part 13 or for the Colorado health insurance affordability enterprise created in section
10-16-1204
. The commissioner may allocate federal money to the health insurance affordability cash fund created in section
10-16-1206
for the purposes described in section
10-16-1205 (1)(b)
for use by the Colorado health insurance affordability enterprise to increase the value, affordability, quality, and equity of health-care coverage for all Coloradans, with a focus on increasing the value, affordability, quality, and equity of health-care coverage for Coloradans historically and systemically disadvantaged by health and economic systems.
(b)
The implementation and operation of section
10-16-1305 (2)
is contingent on the approval of the 1332 waiver application and the receipt of federal funds.
Added by 2021 Ch. 241, § 1, eff. 6/16/2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 13 - COLORADO STANDARDIZED HEALTH BENEFIT PLAN (§§ 10-16-1301 — 10-16-1313) › Section 10-16-1309 - Standardized plan - cost shift

(1)
If the administrator of a self-funded health insurance plan voluntarily provides to the commissioner its contracted rates and any other information deemed necessary and agreed upon by the administrator and the commissioner, the commissioner may evaluate whether the rates of the self-funded health insurance plan reflect a cost shift between the self-funded plan and the standardized plan offered by a carrier pursuant to section
10-16-1305
.
(2)
If the commissioner determines there is a cost shift, the commissioner shall, to the extent practicable, provide a description of which categories of services have experienced the greatest cost shift to the administrator of the self-funded health insurance plan.
Added by 2021 Ch. 241, § 1, eff. 6/16/2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 13 - COLORADO STANDARDIZED HEALTH BENEFIT PLAN (§§ 10-16-1301 — 10-16-1313) › Section 10-16-1310 - Reports required - repeal

(1)
(a)
The commissioner shall contract with an independent third-party organization to prepare three separate reports as specified in subsection (1)(d) of this section, to the extent that information is available regarding the implementation of this part 13 as it relates to the staffing, wages, benefits, training, and working conditions of hospital workers.
(b)
In choosing an independent third-party contractor, the commissioner shall consider organizations with experience conducting in-person interviews with health-care employers and employees in Colorado.
(c)
The independent third-party contractor may make policy recommendations related to information in the reports and may include data collected from employers, employees, and other third-party sources.
(d)
The independent third-party contractor shall deliver the reports to the commissioner as follows:
(I)
The first report by July 1, 2023;
(II)
The second report by July 1, 2024; and
(III)
The third report by July 1, 2025.
(2)
The commissioner shall monitor whether there are an adequate number of health-care providers in the carriers' standardized plan network and the percentage of premiums attributable to health-care providers in the network. As part of the rate and form filing required pursuant to section
10-16-107
, each carrier shall provide to the commissioner information on whether there are an adequate number of health-care providers in the carrier's standardized plan network and the reduction in premiums as a result of health-care provider participation in the network.
(3)
(a)
The commissioner shall contract with an independent third-party organization to evaluate how to phase in, to the extent practicable, to a hospital's reimbursement rate methodology described in section
10-16-1306
:
(I)
A quality metric adjustment; and
(II)
An acuity adjustment as measured by a hospital's case-mix index.
(b)
The evaluation must be completed by December 31, 2022.
(4)
This section is repealed, effective July 1, 2026.
Added by 2021 Ch. 241, § 1, eff. 6/16/2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 13 - COLORADO STANDARDIZED HEALTH BENEFIT PLAN (§§ 10-16-1301 — 10-16-1313) › Section 10-16-1311 - State measurement for accountable, responsive, and transparent (SMART)

(1)
The commissioner shall report during the hearings conducted pursuant to the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act", part 2 of article
7
of title
2
:
(a)
Beginning in January 2022 and each year thereafter, on the progress of the implementation and operation of this part 13, including the information collected pursuant to section
10-16-1310 (2)
;
(b)
Beginning in January 2024, and each year thereafter, on the carriers' efforts to develop networks that are diverse and culturally responsive pursuant to section
10-16-1304 (1)(g)
and the carriers' efforts required by section
10-16-1304 (2)
; and
(c)
In January 2024, January 2025, and January 2026, on the results of the reports required in section
10-16-1310
.
Added by 2021 Ch. 241, § 1, eff. 6/16/2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 13 - COLORADO STANDARDIZED HEALTH BENEFIT PLAN (§§ 10-16-1301 — 10-16-1313) › Section 10-16-1312 - Rules

The commissioner may promulgate rules as necessary to develop, implement, and operate this part 13, including rules necessary to align state law with any federal program requirements and applicable rules.
Added by 2021 Ch. 241,§ 1, eff. 6/16/2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 13 - COLORADO STANDARDIZED HEALTH BENEFIT PLAN (§§ 10-16-1301 — 10-16-1313) › Section 10-16-1313 - Severability

If any provision of this part 13 or application thereof to any person or circumstances is judged invalid, the invalidity does not affect provisions or applications of this part 13 that can be given effect without the invalid provision or application, and to this end the provisions of this part 13 are declared severable.
Added by 2021 Ch. 241,§ 1, eff. 6/16/2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 14 - COLORADO PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD (§§ 10-16-1401 — 10-16-1416) › Section 10-16-1403 - Colorado prescription drug affordability review board - powers and duties - rules

(1)
To protect Colorado consumers from excessive prescription drug costs, the board shall:
(a)
Collect and evaluate information concerning the cost of prescription drugs sold to Colorado consumers, as described in section
10-16-1405
;
(b)
Perform affordability reviews of prescription drugs, as described in section
10-16-1406
;
(c)
Establish upper payment limits for prescription drugs, as described in section
10-16-1407
; and
(d)
Make policy recommendations to the general assembly to improve the affordability of prescription drugs for Colorado consumers, as described in section
10-16-1414 (1)(h)
.
(2)
The board may establish ad hoc work groups to consider matters related to the work of the board pursuant to this part 14. Ad hoc work groups may include members of the public.
(3)
The division, on behalf of the board, may enter into a contract with a qualified, independent third party for any service necessary to carry out the powers and duties of the board. A third party with which the division contracts pursuant to this subsection (3), including any of the third party's directors, officers, employees, contractors, or agents, shall not release or publish any information that the third party acquires pursuant to its performance under the contract. Any third party with which the division contracts pursuant to this subsection (3) shall disclose any conflict of interest to the board.
(4)
In carrying out its duties pursuant to this part 14, the division, when performing its duties on behalf of the board, is exempt from the state "Procurement Code", articles
101
to
112
of title
24
.
(5)
The board shall promulgate rules as necessary, pursuant to article
4
of title
24
, for the implementation of this part 14.
(6)
(a)
The division, on behalf of the board, may seek, accept, and expend gifts, grants, and donations from private or public sources for the purposes of this part 14, and any such gifts, grants, and donations are continuously appropriated to the department of regulatory agencies; except that the division shall not accept any gift, grant, or donation that creates a conflict of interest or the appearance of any conflict of interest for any board member.
(b)
The general assembly finds that the implementation of this part 14 does not rely entirely on the receipt of adequate funding through gifts, grants, or donations. Therefore, the board is not subject to the reporting requirements described in section
24-75-1303
.
Added by 2021 Ch. 240, § 2, eff. 6/16/2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 14 - COLORADO PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD (§§ 10-16-1401 — 10-16-1416) › Section 10-16-1404 - Colorado prescription drug affordability review board meetings - required to be public - exceptions

(1)
The board shall hold its first meeting within six weeks after all of the board members are appointed and shall meet at least every six weeks thereafter to review prescription drugs; except that the chair may cancel or postpone a meeting if the board has no prescription drugs to review or for good cause.
(2)
The board is a state public body for purposes of section
24-6-402
, and the board's meetings and the meetings of ad hoc work groups of the board are public meetings.
(3)
The board shall meet in executive session to discuss proprietary information. The board and any board members, officers, directors, employees, contractors, and agents shall not disclose or otherwise make available to the public any materials or information containing trade-secret, confidential, or proprietary data that is not otherwise available to the public. Electronic recordings of such executive sessions are not permitted if they would result in the disclosure of any materials or information containing trade-secret, confidential, or proprietary data, and in no case shall minutes from such executive sessions disclose or include materials or information containing trade-secret, confidential, or proprietary data. The board shall not take any of the following actions while meeting in executive session:
(a)
Deliberations concerning whether to subject a prescription drug to an affordability review as described in section
10-16-1406
;
(b)
Votes concerning whether to establish an upper payment limit on a prescription drug; or
(c)
Any final decision of the board.
Amended by 2023 Ch. 162,§ 3, eff. 8/7/2023.
Added by 2021 Ch. 240, § 2, eff. 6/16/2021.
2023 Ch. 162, was passed without a safety clause. See Colo. Const. art. V, § 1(3).