HB 26-1096

HB 26-1096, also known as the Colorado Medicaid Access to Primary Care Services bill, ensures that people on Medicaid can still pay out-of-pocket for primary care services if their regular Medicaid provider doesn’t offer them. It allows Medicaid members to sign a special agreement with a healthcare provider who is not directly accepting Medicaid payments but will provide needed care. This means patients can get the primary care they need even if it’s not covered by their Medicaid plan. The bill has been signed into law, so these changes are now in effect for anyone on Colorado Medicaid looking to access primary care services outside of traditional coverage methods.

Official Summary

The bill prohibits the department of health care policy and financing (department) from denying a medicaid member (member) the ability to purchase primary care services or enter into a direct primary care agreement. A member who purchases direct primary care services from a direct primary health-care provider or enters into a direct primary care agreement must sign a document acknowledging that the direct primary health-care provider is enrolled in the Colorado medical assistance program only as an ordering, prescribing, and referring provider; that the direct primary health-care provider does not accept medicaid payments for the services rendered; that the member cannot submit a claim for medicaid reimbursement for the services rendered by the direct primary health-care provider; and that the member retains the right to receive primary care services from a primary care provider who is enrolled in the Colorado medical assistance program.(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

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