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 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-155 - Actuarial reviews of proposed health-care legislation - division to contract with third parties - required considerations - confidentiality - limits on expenditures - rate filings - repeal

(1)
On or before November 1, 2022, the division shall retain by contract one or more entities that have experience in actuarial reviews, health-care policy, and health equity, referred to in this section as the "contractors", for the purpose of performing actuarial reviews of legislative proposals that may impose a new health benefit coverage mandate on health benefit plans or reduce or eliminate coverage mandated under health benefit plans, referred to in this section as "legislative proposals". At least one of the contractors must be an actuary or an actuarial firm with experience in analyzing health insurance premiums. The contractors, under the direction of the division, shall conduct actuarial reviews of up to six legislative proposals, regardless of the number of legislative proposals that are requested for each regular legislative session by members of the general assembly.
(2)
Before September 1, 2022, the division shall convene a meeting to obtain input and recommendations from stakeholders, including representatives of the health-care industry, consumer advocates, and other interested individuals, concerning the methodology for conducting the analysis described in subsection (4) of this section.
(3)
(a)
A member of the general assembly who requests an actuarial review of a legislative proposal shall submit the request to the division no later than September 1 of the year preceding the regular legislative session in which the legislative proposal will be proposed.
(b)
For each regular legislative session:
(I)
Up to two members of the majority party of the house of representatives may submit a request for an actuarial review. If more than two requests are submitted, the division shall notify the majority leader of the house of representatives, who shall select the two proposals that the contractors review.
(II)
One member of the minority party of the house of representatives may submit up to one request for an actuarial review. If more than one request is submitted, the division shall notify the minority leader of the house of representatives, who shall select the proposal that the contractors review.
(III)
Up to two members of the majority party of the senate may submit a request for an actuarial review. If more than two requests are submitted, the division shall notify the majority leader of the senate, who shall select the two proposals that the contractors review.
(IV)
One member of the minority party of the senate may submit up to one request for an actuarial review. If more than one request is submitted, the division shall notify the minority leader of the senate, who shall select the proposal that the contractors review.
(c)
On or before each September 15, the majority and minority leaders of the house of representatives and the senate shall notify the division, as may be necessary as described in this subsection (3), of the legislative proposals subject to review under subsection (1) of this section.
(4)
An actuarial review performed by the contractors pursuant to this section must consider the predicted effects of the legislative proposal during the five and ten years immediately following the effective date of the legislative proposal, or during another time period following the effective date of the legislative proposal if such consideration is more actuarially feasible, including:
(a)
An estimate of the number of Colorado residents who will be directly affected by the legislative proposal;
(b)
Estimates of changes in the rates of utilization of specific health-care services that may result from the legislative proposal;
(c)
Estimates concerning any changes in consumer cost sharing that would result from the legislative proposal;
(d)
Estimates of any increases or decreases in premiums charged to covered persons or employers for health benefit plans offered in the individual, small group, and large group markets that would result from the legislative proposal;
(e)
An estimate of the out-of-pocket health-care cost changes associated with the legislative proposal;
(f)
An estimate of the potential long-term health-care cost changes associated with the legislative proposal;
(g)
Identification of any potential health benefits for individuals or communities that would result from the legislative proposal; and
(h)
To the extent practicable, the social and economic impacts of the legislative proposal.
(5)
An actuarial review performed pursuant to this section must:
(a)
Present the information described in subsection (4)(d) of this section in terms of percentage increase or decrease and in terms of per-member, per-month charges;
(b)
Present the information described in subsection (4)(e) of this section in terms of dollar amounts;
(c)
Provide, if available, information concerning who would benefit from any cost changes and health benefits from the legislative proposal, as identified in subsections (4)(c), (4)(e), (4)(f), (4)(g), and (4)(h) of this section, and any disproportionate effects that the legislative proposal would have on Coloradans, which information, if available, must be disaggregated, at a minimum, by race, ethnicity, sex, gender, and age; and
(d)
Include, to the extent practicable, a qualitative analysis of the impacts of the legislative proposal. For the purposes of this subsection (5)(d), a member of the general assembly who requests an actuarial review of a legislative proposal pursuant to this section may designate one or more persons to provide data to the contractors in order to inform a qualitative analysis of the legislative proposal.
(6)
In performing actuarial reviews of legislative proposals, the contractors may utilize data from the all-payer health claims database described in section
25.5-1-204
, data collected from carriers, or data from other sources. Carriers shall provide information to, and otherwise cooperate with, the contractors and the division for the purposes of this section.
(7)
The commissioner is not required to comply with the state "Procurement Code", articles
101
to
112
of title
24
, for the purposes of hiring contractors by November 1, 2022, as described in subsection (1) of this section, or for contracting for the collection of data, but the commissioner shall comply with the state "Procurement Code" when hiring contractors or contracting for the collection of data after November 1, 2022.
(8)
A request for an actuarial review pursuant to this section and the final report resulting from such a request shall be treated as confidential except by the member of the general assembly who made the request until the legislative proposal that is the subject of the actuarial review is introduced in the regular legislative session following the submission of the request for the actuarial review or, if no such legislative proposal is introduced, until after the end of the legislative session following the submission of the request.
(9)
(a)
Notwithstanding any other provision of this section to the contrary, the division shall not engage any contractor to perform an actuarial review as described in this section unless the division determines that there are adequate resources available within existing appropriations to compensate the contractor for the actuarial review.
(b)
After July 1, 2025, the division shall use resources allocated for actuarial reviews of legislative proposals pursuant to this section for the review of rate filings filed with the commissioner pursuant to section 10-16-105.1 (3.5)(e).
(c)
In the event that the division determines there are not adequate resources available within existing appropriations to compensate the contractor for an actuarial review in accordance with subsection (9)(a) of this section, the division shall prioritize resources to ensure that an actuarial review of the rate filings submitted to the commissioner pursuant to section 10-16-105.1 (3.5)(e) occurs before December 31, 2025.
(10)
The division may seek, accept, and expend gifts, grants, and donations for the purposes of this section.
(11)
This section is repealed, effective November 1, 2027.
Amended by 2024 Ch. 146,§ 3, eff. 5/1/2024.
Added by 2022 Ch. 449, § 1, eff. 8/10/2022.
2022 Ch. 449, was passed without a safety clause. See Colo. Const. art. V, § 1(3).