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COLORADO MANAGED CARE COLLABORATIVE

June 11, 2013

Sharon E. Caulfield, Esq.

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2013 LEGISLATIVE

UPDATE

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2013 SUMMARY

The Colorado

Legislature:

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• Flurry of state legislation and regulations to synchronize with federal healthcare reform initiatives

• Lots of state-initiated changes too with Dems now in control of agenda

* I am not going to speak about marijuana!

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REFORM

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ALIGNMENT OF STATE HEALTH INSURANCE LAWS WITH THE REQUIREMENTS OF PPACA

• HB 1266; signed by Governor 5/13/13

• Enacts essential health benefits package• Updates mandatory coverage provisions• Requires guaranteed issue• Updates coverage for up to 26 years of age

– And see HB 1315 allowing higher ed institutions to require student evidence of insurance

• Provider license parity within networks• Rate setting and health plan filing provisions• Independent review of carrier denials• Small employer/individual PreX prohibition• Wellness/prevention program provisions• Network Adequacy provisions

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REGULATION OF STOP-LOSS HEALTH INSURANCE FOR SELF-INSURED HEALTH

CARE COVERAGE

• HB 1290 ; signed by Governor 5/28/13

– Makes terminology used in Colorado consistent with NAIC by changing the term "excess loss" to "stop-loss"; and

– Minimum dollar amount for the attachment point for groups < 50 and a prohibition against attachment points that vary by individual within a group for claims incurred per individual, e.g.

• Individual claims attachment must be > $20,000• Aggregate claims 120% of expected or $20,000• Varies per individual, or provides direct coverage

• Extra reporting requirements for calendar years 2013 through 2018

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FUNDING MECHANISMS FOR THE COLORADO HEALTH BENEFIT

EXCHANGE

• HB 1245; signed by Governor 5/23/13• On and after January 1, 2014, in order to fund the

Colorado health benefit exchange, the bill allows:– The health benefit exchange board of directors to assess against

small group and individual health insurers in an amount necessary to provide for the sustainability of the exchange; and

– A credit against the tax imposed against insurance companies to any insurance company that becomes a qualified taxpayer by making a contribution to the exchange.

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REPEAL OF COVER COLORADO

• HB 1115 ; signed by Governor 5/28/13

• PPACA now provides coverage to CoverColorado’s high risk population without preexisting conditions exclusions

• Therefore, there is no reason for the continued existence of the CoverColorado program

• Still, new enrollment available through December, 2013• Timely Filing is 60 days (CNIC Health Solutions = TPA)

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Cover Colorado Winding Up

• CoverColorado will end effective March 31, 2015. The board of directors to develop an orderly plan for cessation of the program including:– Cessation of enrollment of new participants for coverage after

December 1, 2013;– Termination of health care coverage for existing participants,

effective April 1, 2014;– Payment or settlement of claims for covered services and all

other outstanding liabilities by December 31, 2014; and– By March 31, 2015, final disposition of all remaining funds in any

account of the program.

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EFFICIENCIES

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Medical Clean Claims Transparency and Uniformity Act

• SB 166; signed 5/24/2013

• Task force for standardized payment rules & claim edits

• Using national industry sources

• HCPF to manage the task force

• Interesting location in Title 25 (Health) rather than in Title 10 (Insurance)

• Task force to report by 12/31/2014

• Implement by 1/1/2016 (commercial); 1/1/2017 (nonprofit)

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PHARMACY BENEFITS

• SB 277 signed by Governor 5/15/2013

• Pharmacy Benefit Management firms to use electronic uniform prior authorization processes– By January 1, 2015– This is for insured products only – CRS Title 10– The Kaiser exception

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MENTAL HEALTH

• Mental Health Claims in All-Payor Database– HB 1015; signed by Governor 3/15/2013

– Allows small group health plans to disclose mental health history, diagnosis, or treatment services information received in an initial application for coverage, or in subsequent claims for benefits, without the written consent of the insured person

• RFPs for Behavioral Health Crisis Response System– SB 266; signed by Governor 5/16/2013– Dept Human Services RFPs by 9/1/2013; awards by 1/1/2014

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Medicaid Management Information System

• HB 1281; signed by Governor 5/11/13• Deals with the problem of “annual appropriations”

limitations from the Colorado Constitution:– Establishes that unexpended and unencumbered moneys from

an appropriation in the annual general appropriation act to the Department of Health Care Policy and Financing for the Medicaid management information system remain available for expenditure by the state department in the next fiscal year without further appropriation.

• Also SB 137: Data Analytics for Medicaid fraud

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Persons Intellectually or Developmentally Disabled

• HB 1314: signed by Governor 5/28/13• Moves programs from DHS to HCPF on March 1, 2014 • New CRS article 25.5-10-xxx• New Community Living Office with Division of Intellectual

and Developmental Disabilities Division as of 7/1/2013• Interim report to JBC fall 2013

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OFFICE OF HEALTH EQUITY CDPHE

• HB 1088; signed by Governor 3/15/13• The bill changes the name of the Office of Health

Disparities in the CDPHE to the Office of Health Equity and adds duties that include promoting health equity and including more diverse groups that may be affected by health equity and health disparity issues.

• The commission's new duties include coordination of the CDPHE’s health equity efforts and health disparities grant program and strengthening partnerships with communities impacted by health disparities.

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Other Program Reassignments

• Primary Care Workforce– HB 1074, signed 4/26/2013– Moves J-1 visa and HPSA arrangements to CDPHE

• Oral Health Programs – HB 261 signed 6/5/2013

– Still in CDPHE but creates oral health community grants

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MEDICAID/MEDICAL ASSISTANCE BILLS

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MEDICAID PROGRAM EXPANSION

• SB 200 signed by Governor 5/13/2013

• Income eligibility for parents and caretaker relatives of Medicaid children increased to 133% of FPL

• Income eligibility for childless adults or adults without a dependent child to up to 133% of FPL.

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ELIMINATE WAITING PERIOD UNDER CHP+

• SB 008; signed by Governor 3/29/13– Under current law, a child is eligible for

children's basic health plan benefits if he or she has not been on a comparable health plan with an employer paying at least 50% of the cost for at least 3 months. The bill eliminates this waiting period.

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DENTAL SERVICES FOR ADULTS IN THE MEDICAID PROGRAM

• SB 242 signed by Governor 5/11/2013

– Requires HCPF to design and implement a dental benefit for adults in the Medicaid program. The state department shall use a collaborative stakeholder process to consider the components of the dental benefit.

– Includes certain provisions for any contract with an administrative service organization should HCPF use an administrative service organization to administer

– Creates the adult dental fund, including funds from the unclaimed property trust fund

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PROFESSIONS AND OCCUPATIONS

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Regulation of Naturopathic Doctors - “ND”

• HB 1111; Signed 6/5/13

• Creates Naturopathic Medicine Advisory Committee– Includes other disciplines,

and consumers• Acknowledges Naturopathic

Formulary– No controlled substances,

surgeries, general or spinal anesthesia, radiation, infants under 2, obstetrics, interference with other courses of care

• Naturopathic Medicine means a system of health care . . . through use of education, nutrition, naturopathic preparations, natural medicines . . . and other modalities that are designed to support or supplement the human body’s own natural self-healing processes– Informed consent required about

naturopathic medicine– Creates registration process

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ALTERNATIVE HEALTH CONSUMER PROTECTION

• HB 215 Signed 6/5/2013

• A C&AM practitioner who does not follow these consumer protections is subject to unauthorized practice rules of Title 12• No insurance required

• Initial Client Contact Notice Required

Consumer Freedom:• 38% of Americans use

Complementary and Alternative Medicine

• $34 Billion in out of pocket costs in a 12 month period

• 1,500,000 Coloradans use C&AM

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EXPANSION OF THE "MICHAEL SKOLNIK MEDICAL

TRANSPARENCY ACT OF 2010"

• SB 026• Adds the following health care providers to the list of

providers required to report information to the director, with the requirement taking effect July 1, 2014:– Athletic trainers;– Massage therapists;– Certified nurse aides;– Occupational therapists;– Respiratory therapists;– Pharmacists;– Psychiatric technicians; and– Surgical assistants and surgical technologists.

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REGULATION OFPROVIDERS

• SB 180• Continuation of "Occupational Therapy Practice Act“ (OTPA) by

continuing the OTPA for 5 years and restoring provisions in the "Colorado Consumer Protection Act" (CCPA) that existed prior to the enactment of the OTPA.

• SB 39 • Regulation of Audiologists – and deceptive trade practices as to

hearing aids

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FEDERAL PROFESSIONALS MENTAL HEALTH AUTHORITY

• HB 1065; signed by Governor 03/15/13• The bill amends the definition of "professional person",

for purposes of providing care and treatment to persons with a mental illness, to include a person licensed in another state who is providing medical or clinical services at a treatment facility in Colorado that is operated by the United States.

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MENTAL HEALTH PROFESSIONAL DISCLOSURES & PEER ASSISTANCE

• HB 1104; signed by Governor 3/29/13

• Amends current law to allow mental health professionals to disclose specified information to clients during the initial client contact either orally and in writing (versus both).

• Makes adjustments to the funding of the mental health professional peer health assistance program

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CONSUMER & VULNERABLES PROTECTION

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ABUSE OF AT-RISK ADULTS

• SB 111; signed by Governor 5/10/13• Mandatory Reporters who observe (or have reasonable cause to

believe) abuse or exploitation of an at-risk elder are required to report to a law enforcement agency within 24 hours

• Age of at-risk adults = 70• A mandatory reporter who fails to report commits a class 3

misdemeanor.• Within 24 hours of a report of abuse, a law enforcement agency

shall notify the county department and district attorney's office of the report and complete a criminal investigation when appropriate and provide a report of the investigation to the county department and district attorney's office.

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CHILD ABUSE

• Creates a child abuse reporting hotline– that provides a uniform method of contact – that directly, immediately, and efficiently routes the person to the

applicable entity responsible for accepting a report about possible child abuse or neglect

– advertised to the public as a place for reporting known or suspected child abuse or neglect (report) or for making a request for information or services (an inquiry)

– HB 1271; signed by Governor 5/14/13

• Adds emergency medical service providers (except volunteers) to required reporters– SB 220 signed by Governor 5/14/2013

• Defines “Drug-Endangered Child”– SB 278

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Child Fatality Review Teams

• SB 255, signed 5/14/2013

• Regional Child Fatality Prevention Review Teams• Oversight, e.g.

– CDPHE data collection center– Requires case-specific review of child abuse or neglect fatalities– Review systemic child welfare issues– Work directly with knowledgeable professionals on each child’s

fatality; – Administer funds and provide assistance to teams– Make primary the best interest of the child or his/her siblings

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MISCELLANEOUS

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THE "COLORADO GOVERNMENTAL IMMUNITY ACT"

• SB 023; signed by Governor 4/19/2013

• Increases the damages limitation levels

– For any injury to one person in any single occurrence, the sum of $350,000; and

– For an injury to 2 or more persons in any single occurrence, the aggregate sum of $999,000

• any single person still limited to $350,000.

– To be updated every 4 years using “CPI all items”

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Civil Unions

• Civil Unions Authorized– SB 11; signed by Governor 3/21/2013

– Under CDPHE - Vital Statistics– “Spouse” with rights/obligations– Rights to step-parent adoption– File taxes separately due to federal

law

• Insurance Coverage under “Health Coverage Plans”– Not only plans under the Division of

Insurance – enforcement at AG’s office, not DORA

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FMLA ExpansionHB 1222; Signed by Gov. 5/3/13

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Employer Access toSocial Media

• HB 1046, signed by governor 5/11/2013

• Employer may:– Investigate securities or financial

regulations compliance;– Investigate unauthorized acquisition

of proprietary information– May enforce personnel policies– “Nothing in this section permits an

employee to disclose information that is confidential under federal or state law or pursuant to a contract agreement”

– HIPAA!!!!

• Employer may not require (or even suggest) that an applicant provide password or other means to disclose personal social media account

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Public Records

• SOME CORA UPDATE– HB 1041, signed by

Governor 3/8/2013

• May deliver CORA records by mail, fax, other delivery service or email– May withhold delivery until

costs are received

• BUT NOT:• HB 1037 (not adopted)• Cost for CORA records =

lowest of actual or $.25/page• Least Expensive Means• No fee for a public employee’s

wage for such copying• And not: • HB 1064 (not adopted)• Posting of local meetings on

website rather in newspaper

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Public Benefit Corporation Act

• HB 1138, signed by Governor 5/5/2013

• CRS 7-101-500+

• E.g. New Belgium Brewery, Go-Lite

• “A public benefit corporation is a for-profit corporation . . . or cooperative . . . that is intended to produce a public benefit and to operate in a responsible and sustainable manner . . . that balances . . . shareholders’ pecuniary interests, the best interests of those materially affected by the corporation’s conduct, and the public benefit identified in its Articles of Incorporation.”

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MISCELLANEOUS ISSUES

• On-site Inspection of Medicaid Providers– HB 1068; signed by Governor 4/8/2013

• STEMI Centers– SB 225

• Substance Abuse Task Force (to 7/1/2018)– SB 244

• Exemption from Tiered Electricity Rates– SB 282

• Counseling for MOST Orders– HB 1202

• Unexpected Deaths in Epilepsy– HB 1256

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WHAT DID NOT PASS

• HB 1078: Repeal of the CO Health Benefit Exchange Program

• HB 1098: Mandate for E-Verify• HB 1306: Mental Health and Firearms Task Force• SB 144: Financial Assistance Notice Exemptions

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