Bill Tracker

The purpose of this bill is to restate and reaffirm the general assembly's intent that the common-law collateral source rule is abrogated and to indicate that a recent decision of the Colorado supreme court (Volunteers of America v. Gardenswartz) interpreting the statute on reduction of damages for payments from collateral sources is contrary to the general assembly's intent to prevent compensatory damage awards for medical expenses from exceeding the amount accepted by the health care service provider for treating the injured party.

In an action by a person or a legal representative to recover economic damages, the recoverable damages for reasonable and necessary medical or health care, treatment, or services shall include only those amounts actually paid by or on behalf of the injured person to the providers. The bills states that if payment for medical or health care services has not been made at the time of trial or arbitration, the recoverable amounts shall be limited to the amounts customarily accepted by the providers in satisfaction of their bills.

The bill enacts measures to expand access to health care in Colorado, including the following:

• Section 1 of the bill expands the school-based health center grant program administered by the prevention services division in the department of public health and environment to allow the division to award grants to center operators to offer rehabilitative services at existing centers.
• Sections 2 and 3 of the bill expand eligibility for participation in the state loan repayment program to health care providers who do not provide primary care services, practice in a for-profit setting, or are otherwise not currently eligible. These providers' eligibility is contingent upon their agreement to provide services in underserved areas of the state and upon a corresponding expansion of the federal government's national loan repayment program.
• Section 4 charges the center for improving value in health care (CIVHC), which was established in 2008 by an executive order of the governor, with studying and recommending improvements to the system for reimbursing health care providers who deliver care to recipients of the state's public medical assistance programs as well as to insured individuals.
• Section 5 requires the department of health care policy and financing to reimburse providers for medical care, services, or goods provided to medicaid recipients, regardless of the location of the service delivery, and to seek a waiver from the United States department of health and human services if necessary to implement this requirement.
• Sections 6 and 7 authorize the state and local governments to enter into agreements with health care providers to allow the providers to use available space in a building owned by the state or local government and located in a federally designated health professional shortage area for purposes of providing access to health care to persons residing in close proximity to the public building. As a condition of the agreement to use space in the public building, the health care provider must agree to accept medicaid patients at those sites.
• Section 8 extends governmental immunity to health care practitioners who provide care to patients, including medicaid patients, in available space in a public building located in a federally designated health professional shortage area pursuant to an agreement authorized by section 6 or 7 of the bill.

The bill requires the department of health care policy and financing (the department) to review certain issues that relate to the provision of both physical and mental health care services to a patient during the same appointment as part of an integrated system of patient care, and any barriers to the integrated care. The department shall seek input concerning the issues from behavioral health organizations and community mental health centers, as well as other health care providers as determined by the department.

The department shall report to certain committees of the general assembly concerning the issues reviewed pursuant to the bill.

The section repeals on July 1, 2012.

The bill authorizes counties, regions, and municipalities (local governments) to include in their comprehensive or master land use plans a community health element reflecting current and projected population estimates pursuant to which the applicable local government will indicate how its planning decisions will promote public health and safety and the general welfare of the residents of the local government. Matters to be addressed in connection with this element of the master plan may include, without limitation, accessibility, availability, affordability, and delivery of health care services and health care facilities; public safety; civic participation within the territorial boundaries of the local government; and any other factors or policies that will promote public health and safety and the general welfare within the territorial boundaries of the local government. In assessing the accessibility, availability, affordability, and delivery of current and anticipated health care services and facilities, the bill authorizes the applicable planning commission to consider:

• Surrounding local governments in order to develop an inventory of existing facilities and services and an assessment of transit accessibility; and
• Population estimates and projections provided by the Colorado department of local affairs to establish current and projected needs of facilities and services.

The bill creates the Colorado health care authority (authority). The mission of the authority is to design the Colorado health care cooperative (cooperative) to be the benefits administrator and payer for health care services. The authority shall recommend a cooperative to the general assembly and, if approved, it shall be referred to the voters by referred measure.

The president of the senate, the speaker of the house, and the governor shall each appoint members to the board of directors (board) of the authority who shall employ an administrator and other officers to help design and develop the cooperative. The cooperative will be designed in collaboration with parties who may be affected by the cooperative. The bill requires that the board make recommendations concerning specific elements to become part of the cooperative, including:

• Election of board members to the cooperative;
• Health care services that will be part of the cooperative;
• Payment systems for the cooperative;
• Regulation and evaluation of health care services;
• Methods for coordinating alternate insurance plans with the cooperative;
• Benefit design and provider rates and reimbursement;
• Maintaining a marketplace with health care choices;
• Cooperative members' participation in their health care;
• Development of information technology for the cooperative;
• Data collection to determine best practices;
• Transparency of the financial operation of the cooperative; and
• Health and wellness maintenance and education.

The board is required to include a financing recommendation to the general assembly based on projected costs and federal waivers and includes available state and local government revenues. The bill contains other specified options that the board may include in its recommended financing package. The board is required to design a method for refunding savings to members of the cooperative and to employers. The board is required to develop a plan to deal with budget shortfalls.

The bill specifies services that must be included in a benefits package designed by the board. The bill specifies that the cooperative shall serve as secondary insurance to any other insurance.

The board is authorized to seek gifts, grants, and donations to implement the authority and the board to design the cooperative and is required to seek federal funds and grants available for the cooperative. The board is required to seek input and collaborate with the department of public health and environment, the department of health care policy and financing, and the general assembly to seek waivers, exemptions, and agreements from the federal government for funding for the authority and the cooperative.

The bill creates the Colorado health benefit exchange (exchange) as a nonprofit unincorporated public entity. The exchange is governed by a board of directors consisting of 9 members appointed by the governor, the president of the senate, the speaker of the house of representatives, and the minority leaders of the senate and the house of representatives, and 3 ex officio nonvoting members. The board is responsible for: 

• Appointing an executive director to administer the exchange;
• Creating operational and financial plans;
• Applying for planning and establishment grants;
• Creating technical and advisory groups;
• Providing a written report to the governor and the general assembly regarding the planning and establishment of the exchange;
• Reviewing internet portals for use by the exchange;
• Considering the structure of the exchange;
• Considering the appropriate size of the small employer market; and
• Investigating requirements, developing options, and determining waivers to ensure that the best interests of Coloradans are protected.

The board may enter into information-sharing agreements with federal and state agencies and other state exchanges.

The bill also establishes the legislative health benefit exchange implementation review committee (committee) to provide oversight of the exchange. The committee may report up to 5 bills or other measures to the legislative council each year. The committee is responsible for reviewing grants applied for by the board and for reviewing the financial and operational plans of the exchange.

Five years after the act becomes law, the legislative service agencies of the general assembly will conduct a post-enactment review of its implementation.