HB 22-1284

HB 22-1284, also known as "Health Insurance Surprise Billing Protections," is a Colorado law that aims to protect patients from unexpected medical bills when they receive care from out-of-network providers. The bill ensures that services provided by these out-of-network providers are covered at the in-network benefit level and requires health insurance companies to provide clear disclosures about coverage and billing practices. It also sets up rules for handling disputes over charges through arbitration, where costs would be split between parties if they reach an agreement before a final decision is made. Signed into law, this act helps consumers by preventing surprise medical bills and ensuring more transparent healthcare coverage.

Official 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.)

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