HB 22-1284 CO
Health Insurance Surprise Billing Protections
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Summary
The act changes current state law to align with the federal "No Surprises Act" (federal act) by: Allowing a covered person who requests an independent external review of a health-care coverage decision to request a review to determine if the services that were provided or may be provided by an out-of-network provider or facility are subject to an in-network benefit level of coverage; Requiring that payments made for health-care services provided at an in-network facility or by an out-of-network provider be applied to the covered person's in-network deductible and any out-of-pocket maximum amounts as if the services were provided by an in-network provider; Requiring that emergency health-care services, regardless of the facility at which they are provided, be covered at the in-network benefit level; Requiring each health insurance carrier (carrier) to cover post-stabilization services to stabilize a patient after a medical emergency at the in-network benefit level; Requiring carriers to develop disclosures to provide to covered persons that comply with the act; Requiring the commissioner of insurance (commissioner) and certain regulators of health-care occupations to adopt rules concerning disclosure requirements, including a list of ancillary services for which a provider or facility cannot charge a balance bill; Requiring the commissioner to convene a work group to facilitate and streamline the implementation of the payment of claims for services provided by an out-of-network provider at an in-network facility and for services surrounding a medical emergency; Prohibiting a carrier from recalculating a covered person's cost-sharing amount based on an additional payment made as a result of arbitration; Requiring the parties to an arbitration over health-care coverage to split the costs of the arbitrator if the parties reach an agreement before the final decision of the arbitrator; Authorizing the commissioner to promulgate rules to implement the requirements of the act, including rules necessary to implement the requirements of the federal act; Changing the amount of time that a managed care plan must allow a person to continue to receive care from a provider from 60 after the date an in-network provider is terminated from a plan without cause to up to 90 days after a carrier provides notice that the contract is terminated; Implementing specific requirements for health-care coverage and services for covered persons who are continuing care patients of a provider or facility whose contract with the patient's health insurer is terminated; Authorizing the regulator of health-care providers, in consultation with the commissioner, to adopt rules concerning consumer disclosures; Allowing an out-of-network provider and an out-of-network facility to charge a covered person a balance bill for health-care services other than ancillary services if the out-of-network provider complies with specific notice requirements and obtains the covered person's signed consent; and Requiring a carrier offering an individual health benefit plan or short-term limited duration health insurance policy to make consumer disclosures. The act changes from January 1 to March 1 the date by which a carrier is required to submit information to the commissioner concerning the use of out-of-network providers and out-of-network facilities and the impact on health insurance premiums for consumers. $233,018 is appropriated from the division of insurance cash fund to the department of regulatory agencies for use in the 2022-23 state fiscal year for personal services, operating expenses, and to purchase legal services, and of that amount, $88,713 is reappropriated to the department of law to provide legal services for the department of regulatory agencies. $7,506 is appropriated from the health facilities general licensure cash fund to the department of public health and environment for use in the 2022-23 state fiscal year by health facilities and emergency medical services division to implement the act. (Note: This summary applies to this bill as enacted.)
Sponsors (4)
- Daneya Esgar · primary
- Marc Catlin Republican · primary
- Bob Gardner · primary
- Brittany Pettersen · primary
Action history (18)
- Jun 8, 2022 Governor Signed · executive
- Jun 6, 2022 Sent to the Governor · executive
- Jun 6, 2022 Signed by the President of the Senate · upper
- Jun 3, 2022 Signed by the Speaker of the House · lower
- May 10, 2022 House Considered Senate Amendments - Result was to Concur - Repass · lower
- May 9, 2022 House Considered Senate Amendments - Result was to Laid Over Daily · lower
- May 6, 2022 House Considered Senate Amendments - Result was to Laid Over Daily · lower
- May 6, 2022 House Considered Senate Amendments - Result was to Laid Over Daily · lower
- May 4, 2022 Senate Third Reading Passed - No Amendments · upper
- May 3, 2022 Senate Second Reading Special Order - Passed with Amendments - Committee · upper
- May 3, 2022 Senate Committee on Appropriations Refer Amended - Consent Calendar to Senate Committee of the Whole · upper
- Apr 28, 2022 Senate Committee on Health & Human Services Refer Unamended to Appropriations · upper
- Apr 25, 2022 Introduced In Senate - Assigned to Health & Human Services · upper
- Apr 25, 2022 House Third Reading Passed - No Amendments · lower
- Apr 22, 2022 House Second Reading Special Order - Passed with Amendments - Committee, Floor · lower
- Apr 21, 2022 House Committee on Appropriations Refer Amended to House Committee of the Whole · lower
- Apr 13, 2022 House Committee on Health & Insurance Refer Amended to Appropriations · lower
- Mar 8, 2022 Introduced In House - Assigned to Health & Insurance · lower
Text versions (11)
The published texts of this bill as it moves through the legislature. Each links to the official document on the state legislature site. Data from OpenStates.
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