HOUSE BILL 22-1269
BY REPRESENTATIVE(S) Lontine, Amabile, Bernett, Boesenecker,
Caraveo, Hooton, Jodeh, Kipp, Lindsay, McCormick, Michaelson Jenet,
Sirota, Titone, Woodrow;
also SENATOR(S) Hansen, Ginal, Jaquez Lewis, Moreno, Fenberg
.
C
ONCERNING REQUIREMENTS IMPOSED ON PERSONS NOT AUTHORIZED TO
TRANSACT INSURANCE BUSINESS IN THIS STATE WHO ARE OFFERING
COVERAGE OF HEALTH
-CARE COSTS FOR COLORADO RESIDENTS, AND,
IN CONNECTION THEREWITH, MAKING AN APPROPRIATION.
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. In Colorado Revised Statutes, add 10-16-107.4 as
follows:
10-16-107.4. Health-care sharing plan or arrangement -
required reporting and certification - noncompliance - information
posted on division website - rules. (1) A
PERSON NOT AUTHORIZED BY THE
COMMISSIONER PURSUANT TO ARTICLE
3 OF THIS TITLE 10 TO OFFER
INSURANCE IN THIS STATE THAT OFFERS OR INTENDS TO OFFER A PLAN OR
ARRANGEMENT TO FACILITATE PAYMENT OR REIMBURSEMENT OF
HEALTH
-CARE COSTS OR SERVICES FOR RESIDENTS OF THIS STATE ,
NOTE: This bill has been prepared for the signatures of the appropriate legislative
officers and the Governor. To determine whether the Governor has signed the bill
or taken other action on it, please consult the legislative status sheet, the legislative
history, or the Session Laws.
________
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from existing law and such material is not part of
the act. REGARDLESS OF WHETHER THE PERSON IS DOMICILED IN THIS STATE OR
ANOTHER STATE
, SHALL SUBMIT TO THE COMMISSIONER BY OCTOBER 1,
2022,
AND BY MARCH 1 EACH YEAR THEREAFTER:
(a) T
HE FOLLOWING INFORMATION :
(I) T
HE TOTAL NUMBER OF INDIVIDUALS AND HOUSEHOLDS THAT
PARTICIPATED IN THE PLAN OR ARRANGEMENT IN THIS STATE IN THE
IMMEDIATELY PRECEDING CALENDAR YEAR
;
(II) T
HE TOTAL NUMBER OF EMPLOYER GROUPS THAT PARTICIPATED
IN THE PLAN OR ARRANGEMENT IN THIS STATE IN THE IMMEDIATELY
PRECEDING CALENDAR YEAR
, SPECIFYING THE TOTAL NUMBER OF
PARTICIPATING INDIVIDUALS IN EACH PARTICIPATING EMPLOYER GROUP
;
(III) I
F THE PERSON OFFERS A PLAN OR ARRANGEMENT IN OTHER
STATES
, THE TOTAL NUMBER OF PARTICIPANTS IN THE PLAN OR
ARRANGEMENT NATIONALLY
;
(IV) A
NY CONTRACTS THE PERSON HAS ENTERED INTO WITH
PROVIDERS IN THIS STATE THAT PROVIDE HEALTH
-CARE SERVICES TO PLAN
OR ARRANGEMENT PARTICIPANTS
;
(V) T
HE TOTAL AMOUNT OF FEES , DUES, OR OTHER PAYMENTS
COLLECTED BY THE PERSON IN THE IMMEDIATELY PRECEDING CALENDAR
YEAR FROM INDIVIDUALS
, EMPLOYER GROUPS , OR OTHERS WHO
PARTICIPATED IN THE PLAN OR ARRANGEMENT IN THIS STATE
, SPECIFYING
THE PERCENTAGE OF FEES
, DUES, OR OTHER PAYMENTS RETAINED BY THE
PERSON FOR ADMINISTRATIVE EXPENSES
;
(VI) T
HE TOTAL DOLLAR AMOUNT OF REQUESTS FOR
REIMBURSEMENT OF HEALTH
-CARE COSTS OR SERVICES SUBMITTED IN THIS
STATE IN THE IMMEDIATELY PRECEDING CALENDAR YEAR BY PARTICIPANTS
IN THE PLAN OR ARRANGEMENT OR PROVIDERS THAT PROVIDED
HEALTH
-CARE SERVICES TO PLAN OR ARRANGEMENT PARTICIPANTS ;
(VII) T
HE TOTAL DOLLAR AMOUNT OF REQUESTS FOR
REIMBURSEMENT OF HEALTH
-CARE COSTS OR SERVICES THAT WERE
SUBMITTED IN THIS STATE AND WERE DETERMINED TO QUALIFY FOR
REIMBURSEMENT UNDER THE PLAN OR ARRANGEMENT IN THE IMMEDIATELY
PAGE 2-HOUSE BILL 22-1269 PRECEDING CALENDAR YEAR ;
(VIII) T
HE TOTAL AMOUNT OF PAYMENTS MADE TO PROVIDERS IN
THIS STATE IN THE IMMEDIATELY PRECEDING CALENDAR YEAR FOR
HEALTH
-CARE SERVICES PROVIDED TO OR RECEIVED BY A PLAN OR
ARRANGEMENT PARTICIPANT
;
(IX) T
HE TOTAL AMOUNT OF REIMBURSEMENTS MADE TO PLAN OR
ARRANGEMENT PARTICIPANTS IN THIS STATE IN THE IMMEDIATELY
PRECEDING CALENDAR YEAR FOR HEALTH
-CARE SERVICES PROVIDED TO OR
RECEIVED BY A PLAN OR ARRANGEMENT PARTICIPANT
;
(X) T
HE TOTAL NUMBER OF REQUESTS FOR REIMBURSEMENT OF
HEALTH
-CARE COSTS OR SERVICES SUBMITTED IN THIS STATE IN THE
IMMEDIATELY PRECEDING CALENDAR YEAR THAT WERE DENIED
, EXPRESSED
AS A PERCENTAGE OF TOTAL REIMBURSEMENT REQUESTS SUBMITTED IN THAT
CALENDAR YEAR
, AND THE TOTAL NUMBER OF REIMBURSEMENT REQUEST
DENIALS THAT WERE APPEALED
;
(XI) T
HE TOTAL AMOUNT OF HEALTH-CARE EXPENSES SUBMITTED IN
THIS STATE BY PLAN OR ARRANGEMENT PARTICIPANTS OR PROVIDERS IN THE
IMMEDIATELY PRECEDING CALENDAR YEAR THAT QUALIFY FOR
REIMBURSEMENT PURSUANT TO THE PLAN OR ARRANGEMENT CRITERIA BUT
THAT
, AS OF THE END OF THAT CALENDAR YEAR , HAVE NOT BEEN
REIMBURSED
, EXCLUDING ANY AMOUNTS THAT THE PLAN OR ARR ANGEMENT
PARTICIPANTS INCURRING THE HEALTH
-CARE COSTS MUST PAY BEFORE
RECEIVING REIMBURSEMENT UNDER THE PLAN OR ARRANGEMENT
;
(XII) T
HE ESTIMATED NUMBER OF PLAN OR ARRANGEMENT
PARTICIPANTS THE PERSON IS ANTICIPATING IN THIS STATE IN THE NEXT
CALENDAR YEAR
, SPECIFYING THE ESTIMATED NUMBER OF INDIVIDUALS ,
HOUSEHOLDS, EMPLOYER GROUPS, AND EMPLOYEES;
(XIII) T
HE SPECIFIC COUNTIES IN THIS STATE IN WHICH THE PERSON:
(A) O
FFERED A PLAN OR ARRANGEMENT IN THE IMMEDIATELY
PRECEDING CALENDAR YEAR
; AND
(B) INTENDS TO OFFER A PLAN OR ARRANGEMENT IN THE NEXT
CALENDAR YEAR
;
PAGE 3-HOUSE BILL 22-1269 (XIV) OTHER STATES IN WHICH THE PERSON OFFERS A PLAN OR
ARRANGEMENT
;
(XV) A
LIST OF ANY THIRD PARTIES, OTHER THAN A PRODUCER, THAT
ARE ASSOCIATED WITH OR ASSIST THE PERSON IN OFFERING OR ENROLLING
PARTICIPANTS IN THIS STATE IN THE PLAN OR ARRANGEMENT
, COPIES OF ANY
TRAINING MATERIALS PROVIDED TO A THIRD PARTY
, AND A DETAILED
ACCOUNTING OF ANY COMMISSIONS OR OTHER FEES OR REMUNERATION PAID
TO A THIRD PARTY IN THE IMMEDIATELY PRECEDING CALENDAR YEAR FOR
:
(A) M
ARKETING, PROMOTING, OR ENROLLING PARTICIPANTS IN A
PLAN OR ARRANGEMENT OFFERED BY THE PERSON IN THIS STATE
; OR
(B) OPERATING, MANAGING, OR ADMINISTERING A PLAN OR
ARRANGEMENT OFFERED BY THE PERSON IN THIS STATE
;
(XVI) T
HE TOTAL NUMBER OF PRODUCERS THAT ARE ASSOCIATED
WITH OR ASSIST THE PERSON IN OFFERING OR ENROLLING PARTICIPANTS IN
THIS STATE IN THE PLAN OR ARRANGEMENT
, THE TOTAL NUMBER OF
PARTICIPANTS ENROLLED IN THE PLAN OR ARRANGEMENT THROUGH A
PRODUCER
, COPIES OF ANY TRAINING MATERIALS PROVIDED TO A PRODUCER ,
AND A DETAILED ACCOUNTING OF ANY COMMISSIONS OR OTHER FEES OR
REMUNERATION PAID TO A PRODUCER IN THE IMMEDIATELY PRECEDING
CALENDAR YEAR FOR MARKETING
, PROMOTING, OR ENROLLING
PARTICIPANTS IN A PLAN OR ARRANGEMENT OFFERED BY THE PERSON IN THIS
STATE
;
(XVII) C
OPIES OF ANY CONSUMER -FACING AND MARKETING
MATERIALS USED IN THIS STATE IN PROMOTING THE PERSON
'S PLAN OR
ARRANGEMENT
, INCLUDING PLAN OR ARRANGEMENT AND BENEFIT
DESCRIPTIONS AND OTHER MATERIALS THAT EXPLAIN THE PLAN OR
ARRANGEMENT
;
(XVIII) T
HE NAME, MAILING ADDRESS, E-MAIL ADDRESS, AND
TELEPHONE NUMBER OF AN INDIVIDUAL SERVING AS A CONTACT PERSON FOR
THE PERSON IN THIS STATE
;
(XIX) A
LIST OF ANY PARENT COMPANIES, SUBSIDIARIES, AND OTHER
NAMES THAT THE PERSON HAS OPERATED UNDER AT ANY TIME WITHIN THE
IMMEDIATELY PRECEDING FIVE CALENDAR YEARS
; AND
PAGE 4-HOUSE BILL 22-1269 (XX) AN ORGANIZATIONAL CHART FOR THE PERSON AND A LIST OF
THE OFFICERS AND DIRECTORS OF THE PERSON
;
(b) A
CERTIFICATION BY AN OFFICER OF THE PERSON THAT , TO THE
BEST OF THE PERSON
'S GOOD-FAITH KNOWLEDGE AND BELIEF , THE
INFORMATION SUBMITTED IS ACCURATE AND SATISFIES THE REQUIREMENTS
OF THIS SUBSECTION
(1).
(2) (a) I
F THE PERSON SUBJECT TO THE REQUIREMENTS OF
SUBSECTION
(1) OF THIS SECTION FAILS TO SUBMIT THE INFORMATION OR
CERTIFICATION REQUIRED BY SAID SUBSECTION
, THE SUBMISSION IS
INCOMPLETE
. THE COMMISSIONER SHALL MAKE A DETERMINATION OF
COMPLETENESS NO LATER THAN FORTY
-FIVE DAYS AFTER THE SUBMISSION.
I
F THE COMMISSIONER HAS NOT INFORMED THE PERSON OF ANY DEFICIENCIES
IN THE SUBMISSION WITHIN FORTY
-FIVE DAYS AFTER RECEIVING THE
SUBMISSION
, THE SUBMISSION IS CONSIDERED COMPLETE .
(b) (I) I
F THE COMMISSIONER DETERMINES THAT A PERSON FAILS TO
COMPLY WITH THE REQUIREMENTS OF SUBSECTION
(1) OF THIS SECTION, THE
COMMISSIONER SHALL
:
(A) N
OTIFY THE PERSON THAT THE SUBMISSION IS INCOMPLETE AND
ENUMERATE IN THE NOTIFICATION EACH DEFICIENCY FOUND IN THE PERSON
'S
SUBMISSION
; AND
(B) ALLOW THE PERSON THIRTY DAYS AFTER NOTICE OF THE
INCOMPLETE SUBMISSION TO REMEDY THE DEFICIENCY FOUND IN THE
SUBMISSION
.
(II) I
F THE PERSON DOES NOT REMEDY THE DEFICIENCY WITHIN THE
THIRTY
-DAY PERIOD, THE COMMISSIONER MAY LEVY A FINE NOT TO EXCEED
FIVE THOUSAND DOLLARS PER DAY
.
(III) I
F THE PERSON DOES NOT REMEDY THE DEFICIENCY OR
DEFICIENCIES WITHIN THIRTY DAYS AFTER THE INITIAL FINE IS LEVIED
, THE
COMMISSIONER MAY ISSUE A CEASE
-AND-DESIST ORDER IN ACCORDANCE
WITH SECTION
10-3-904.5.
(3) O
N OR BEFORE APRIL 1, 2023, AND ON OR BEFORE EACH
PAGE 5-HOUSE BILL 22-1269 OCTOBER 1 THEREAFTER, THE COMMISSIONER SHALL:
(a) P
REPARE A WRITTEN REPORT SUMMARIZING THE INFORMATION
SUBMITTED BY PERSONS PURSUANT TO SUBSECTION
(1) OF THIS SECTION;
AND
(b) POST ON THE DIVISION'S WEBSITE THE REPORT AND ACCURATE
AND EVIDENCE
-BASED INFORMATION ABOUT THE PERSONS WHO SUBMITTED
INFORMATION PURSUANT TO SUBSECTION
(1) OF THIS SECTION, INCLUDING
HOW CONSUMERS MAY FILE COMPLAINTS
.
(4) T
HE COMMISSIONER MAY ADOPT RULES AS NECESSARY TO
IMPLEMENT THIS SECTION
.
(5) T
HIS SECTION DOES NOT APPLY TO:
(a) D
IRECT PRIMARY CARE AGREEMENTS AS DEFINED IN ARTICLE 23
OF TITLE 6; OR
(b) OTHER CONSUMER PAYMENT ARRANGEMENTS IDENTIFIED BY THE
COMMISSIONER BY RULE
, INCLUDING CONSUMER PAYMENT PLANS OFFERED
DIRECTLY BY A PROVIDER TO A PATIENT OR THE PARTY RESPONSIBLE FOR
PAYMENT ON BEHALF OF THE PATIENT
.
SECTION 2. In Colorado Revised Statutes, 10-3-904.5, amend
(1)(a) as follows:
10-3-904.5. Emergency cease-and-desist orders - issuance.
(1) The commissioner may issue an emergency cease-and-desist order ex
parte if:
(a) The commissioner believes that:
(I) An unauthorized person is engaging in the business of insurance
in violation of the provisions
of section 10-3-105 or 10-3-903 or is in
violation of a rule promulgated by the commissioner; and OR
(II) A PERSON IS FAILING TO REMEDY OR HAS NOT REMEDIED A
DEFICIENCY OR DEFICIENCIES IN THE SUBMISSION REQUIRED PURSUANT TO
SECTION
10-16-107.4 (1) WITHIN THE THIRTY DAYS AFTER THE
PAGE 6-HOUSE BILL 22-1269 COMMISSIONER LEVIES AN INITIAL FINE PURSUANT TO SECTION 10-16-107.4
(2)(b)(II);
AND
SECTION 3. Appropriation. (1) For the 2022-23 state fiscal year,
$84,568 is appropriated to the department of regulatory agencies. This
appropriation is from the division of insurance cash fund created in section
10-1-103 (3), C.R.S. To implement this act, the department may use this
appropriation as follows:
(a) $39,097 for use by the division of insurance for personal
services, which amount is based on an assumption that the division will
require an additional 0.5 FTE;
(b) $6,875 for use by the division of insurance for operating
expenses;
(c) $19,714 for the purchase of legal services; and
(d) $18,882 for the purchase of information technology services.
(2) For the 2022-23 state fiscal year, $19,714 is appropriated to the
department of law. This appropriation is from reappropriated funds received
from the department of regulatory agencies under subsection (1)(c) of this
section and is based on an assumption that the department of law will
require an additional 0.1 FTE. To implement this act, the department of law
may use this appropriation to provide legal services for the department of
regulatory agencies.
(3) For the 2022-23 state fiscal year, $18,882 is appropriated to the
office of the governor for use by the office of information technology. This
appropriation is from reappropriated funds received from the department of
regulatory agencies under subsection (1)(d) of this section. To implement
this act, the office may use this appropriation to provide information
technology services for the department of regulatory agencies.
SECTION 4. Applicability. This act applies to conduct occurring
on or after the effective date of this act.
PAGE 7-HOUSE BILL 22-1269 SECTION 5. Safety clause. The general assembly hereby finds,
determines, and declares that this act is necessary for the immediate
preservation of the public peace, health, or safety.
____________________________ ____________________________
Alec Garnett Steve Fenberg
SPEAKER OF THE HOUSE PRESIDENT OF
OF REPRESENTATIVES THE SENATE
____________________________ ____________________________
Robin Jones Cindi L. Markwell
CHIEF CLERK OF THE HOUSE SECRETARY OF
OF REPRESENTATIVES THE SENATE
APPROVED________________________________________
(Date and Time)
_________________________________________
Jared S. Polis
GOVERNOR OF THE STATE OF COLORADO
PAGE 8-HOUSE BILL 22-1269