ADVOCACY FOR PHYSICIANS, BY PHYSICIANS
- Communication with our local, state and national legislators on health issues important to members and citizens of Larimer and Weld counties
- Legislative night held each October to discuss current issues with candidates and elected officials
- Work with the Colorado Medical Society (CMS) and the American Medical Association (AMA) on evolving issues in the practice of medicine
- Leadership within CMS: One NCMS board member represents our society on the CMS board of directors
- Participation on CMS committees and work groups that set policy on issues such as patient safety, payment reform, prescription drug abuse, provider and payer relations and practice viability
- Resolutions written by our society that are presented to CMS regarding current issues. For example, inappropriate advertising and in situ uranium mining (fracking), both of which were then referred to the AMA
Northern Colorado Medical Society actively advocates on behalf of the physicians of Larimer and Weld counties and works with the Colorado Medical Society to track bills while the legislature is in session. For more information on CMS advocacy, go to www.cms.org/advocacy.
Summary of CMS Legislation 2017
Promoting Health Plan Reform to Benefit Patients and Physicians
NCMS celebrates a banner session for physicians and patients
The Northern Colorado Medical Society joined the Colorado Medical Society in promoting bills in the 2017 legislative session to achieve important health plan reforms to benefit patients and physicians. The CMS lobbying team secured sponsors and educated legislators on the power that health plans have over physicians and how they wield that power. This messaging resonated with the legislators and led to success on many fronts, creating new rights for physicians.
See below for bill summaries and our northern Colorado legislators. Find out who represents you here: http://leg.colorado.gov/find-my-legislator.
- Steve Humphrey, HD 48 (Weld; Severance), Republican
- Perry Buck, HD 49 (Larimer/Weld; Loveland), Republican
- Dave Young, HD 50 (Weld; Greeley), Democrat
- Hugh McKean, HD 51 (Larimer; Loveland), Republican
- Joann Ginal, HD 52 (Larimer; Fort Collins), Democrat
- Jeni Arndt, HD 53 (Larimer; Fort Collins), Democrat
- Lori Saine, HD 63 (Weld; Dacono), Republican
- Jerry Sonnenberg, SD 1 (Weld; Sterling), Republican
- John Cooke, SD 13 (Weld; Greeley), Republican
- John Kefalas, SD 14 (Larimer; Fort Collins), Democrat
- Kevin Lundberg, SD 15 (Larimer; Fort Collins), Republican
- Vicki Marble, SD 23 (Larimer/Weld; Fort Collins), Republican
HB17-1094 – Making telehealth work
Sponsors: D. Valdez | P. Buck / K. Donovan | L. Crowder
Under current law, health benefit plans are required to cover health care services delivered to a covered person by a provider via telehealth in the same manner that the plan covers health care services delivered by a provider in person. This bill clarifies that:
- A health plan cannot restrict or deny coverage of telehealth services based on the communication technology or application used to deliver the telehealth services;
- The availability of telehealth services does not change a carrier’s obligation to contract with providers available in the community to provide in-person services;
- A covered person may receive telehealth services from a private residence, but the carrier is not required to pay or reimburse for any transmission costs or originating site fees the covered person incurs;
- A carrier is to apply the applicable copayment, coinsurance, or deductible amount to health care services a covered person receives through telehealth, which amount cannot exceed the amount applicable to those health care services when delivered through in-person care; and
- Telehealth includes health care services provided through HIPAA-compliant audio-visual communication or the use of a HIPAA-compliant application via a cellular telephone but does not include voice-only telephone communication or text messaging.
The governor signed the bill into law on March 16.
HB17-1173 – Anti-retaliation
Sponsors: C. Hansen / T. Neville
Current law requires a contract between a health insurance carrier and a health care provider to include a provision that prohibits a carrier from taking an adverse action against the provider due to a provider’s disagreement with a carrier’s decision on the provision of health care services. The carrier cannot terminate the health care provider’s contract for disagreeing or for assisting his or her patient in seeking a reconsideration.
The bill requires the contract to also contain provisions that prohibit a carrier from: taking adverse actions for communicating with public officials on health care issues; filing complaints or reporting to public officials about conduct by a carrier that might negatively affect patient care; providing information concerning a violation of this provision; reporting alleged carrier violations to the appropriate authorities; or participating in an investigation of an alleged violation. The governor signed the bill into law on April 6.
SB17-088 – Transparent selection/de-selection standards and appeal right
Sponsors: C. Holbert | A. Williams / K. Van Winkle | E. Hooton
This bill requires a health insurer to develop, use and disclose to participating health care providers the standards the carrier uses for selecting participating providers for its network of providers; tiering providers within the network; and placing participating providers in a narrow or tiered provider network. The governor signed the bill into law on April 16.
SB17-198 – Mergers: Transparency and independent investigations
Sponsors: K. Priola / A. Garnett
Current law requires an opportunity for public notice and a hearing for proposed transactions that would result in the acquisition of control of a domestic insurer, which is one that is incorporated or formed pursuant to Colorado law. For mergers involving non-domestic health plan companies, the bill requires the commissioner to provide public notice with a description of the process including public input within five days of any proposed acquisition filing. Instead of a more costly “investigation” the changes require a “review” if the proposed acquisition creates a prima facie violation of the Competitive Standard. The bill requires public disclosure of any markets, insurance products, and market share that create a prima facie violation of the competitive standards and gives the commissioner 60 days from Form E filing to conduct a hearing or review with stakeholder input. The commissioner may then issue any order adverse to the acquisition. Finally, the bill clarifies that nothing in the law prohibits a carrier from making its competitive impact analysis (Form E) available for stakeholder inspection. The governor signed the bill into law on June 2.
FIND YOUR LEGISLATORS
Establishing a professional relationship with your elected officials is an important part of the advocacy process. To find your state legislators, go to openstates.org/find_your_legislator and enter your home address.