First Regular Session
Seventy-fifth General Assembly
STATE OF COLORADO
REVISED
This Version Includes All Amendments Adopted
on Second Reading in the Second House
LLS NO. 25-0417.01 Chelsea Princell x4335
HOUSE BILL 25-1033
House Committees Senate Committees
Health & Human Services Health & Human Services
A BILL FOR AN ACT
C
ONCERNING MEDICAL ASSISTANCE THIRD -PARTY LIABILITY101
PAYMENTS.102
Bill Summary
(Note: This summary applies to this bill as introduced and does
not reflect any amendments that may be subsequently adopted. If this bill
passes third reading in the house of introduction, a bill summary that
applies to the reengrossed version of this bill will be available at
http://leg.colorado.gov
.)
The bill requires third-party payers to reimburse the department of
health care policy and financing (state department) for health-care items
and services rendered to a medicaid member regardless of whether prior
authorization was obtained.
The bill requires third-party payers to respond to the state
department's inquiry regarding a claim for payment no later than 60 days
SENATE
2nd Reading Unamended
February 11, 2025
HOUSE
3rd Reading Unamended
January 23, 2025
HOUSE
2nd Reading Unamended
January 22, 2025
HOUSE SPONSORSHIP
Lieder and Garcia Sander, Bacon, Bird, Brown, Carter, Duran, Hamrick, Joseph,
Lindsay, Marshall, Paschal, Phillips, Stewart R., Titone, Woodrow
SENATE SPONSORSHIP
Weissman,
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing law.
Dashes through the words or numbers indicate deletions from existing law. after receiving the state department's inquiry. The third party must
respond either by paying the claim or issuing a written denial of the claim
to the state department.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, 25.5-4-209, amend2
(2)(b)(III), (2)(b)(IV) introductory portion, and (2)(b)(IV)(B); and add3
(2)(b)(V) as follows:4
25.5-4-209. Payments by third parties - copayments by5
members - review - appeal - children's waiting list reduction fund -6
rules. (2) (b) A third party, as a condition of doing business in the state,7
shall:8
(III) Respond to any inquiry by the state
NO LATER THAN SIXTY9
DAYS FOLLOWING THE RECEIPT OF AN INQUIRY BY THE STATE DEPARTMENT10
regarding a claim for payment for any health-care item or service that is11
submitted not NO later than three years after the date of the provision of12
the health-care item or service; and SERVICE, RESPOND BY EITHER PAYING13
THE CLAIM OR ISSUING A WRITTEN DENIAL TO THE STATE DEPARTMENT ;14
(IV) Agree not to deny a claim submitted by the state15
DEPARTMENT solely on the basis of the date of submission of the claim,16
the type or format of the claim form, or a failure to present proper17
documentation at the point of sale that is the basis of the claim, if:18
(B) Any action by the state
DEPARTMENT to enforce its rights with19
respect to the claim is commenced within six years after the state's
STATE20
DEPARTMENT'S submission of the claim; AND21
(V) A
CCEPT THE STATE DEPARTMENT 'S PAYMENT OF A CLAIM FOR22
A HEALTH-CARE ITEM OR SERVICE TO BE THE EQUIVALENT OF THE23
HEALTH-CARE PROVIDER OR THE MEMBER HAVING OBTAINED PRIOR24
1033-2- AUTHORIZATION FOR THE ITEM OR SERVICE FROM THE THIRD PARTY .1
SECTION 2. Safety clause. The general assembly finds,2
determines, and declares that this act is necessary for the immediate3
preservation of the public peace, health, or safety or for appropriations for4
the support and maintenance of the departments of the state and state5
institutions.6
1033
-3-