C.R.S. Section 10-16-113
Procedure for denial of benefits

  • internal review
  • rules
  • definitions

(1)

Intentionally left blank —Ed.

(a)

A carrier shall not make an adverse determination, in whole or in part, with respect to a health coverage plan unless the determination is made pursuant to this section.

(b)

For the purposes of this section:

(I)

“Adverse determination” means:

(A)

A denial of a preauthorization for a covered benefit;

(B)

A denial of a request for benefits for an individual on the ground that the treatment or covered benefit is not medically necessary, appropriate, effective, or efficient or is not provided in or at the appropriate health-care setting or level of care;

(C)

A rescission or cancellation of coverage under a health coverage plan that is not attributable to failure to pay premiums and that is applied retroactively;

(D)

A denial of a request for benefits on the ground that the treatment or service is experimental or investigational; or

(E)

A denial of coverage to an individual based on an initial eligibility determination for all individual sickness and accident insurance policies issued by an entity subject to part 2 of this article, and all individual health-care or indemnity contracts issued by an entity subject to part 3 or 4 of this article, except supplemental policies covering a specified disease or other limited benefit.

(II)

“Health coverage plan” does not include insurance arising out of the “Workers’ Compensation Act of Colorado”, articles 40 to 47 of title 8, C.R.S., or other similar law, automobile medical payment insurance, or property and casualty insurance.

(III)

“Individual” means a person and includes the designated representative of an individual.

(c)

If a carrier denies a benefit because the treatment is an excluded benefit and the claimant presents evidence from a medical professional licensed pursuant to the “Colorado Medical Practice Act”, article 240 of title 12, or, for dental plans only, a dentist licensed pursuant to the “Dental Practice Act”, article 220 of title 12, acting within his or her scope of practice, that there is a reasonable medical basis that the contractual exclusion does not apply to the denied benefit, such evidence establishes that the benefit denial is subject to the appeals process pursuant to this section and section 10-16-113.5.

(2)

Following a denial of a request for benefits or an adverse determination by the carrier, the carrier shall notify the individual in writing. The commissioner shall adopt rules specifying the content of the notification and the deadlines for making the notification, and the carrier shall notify the individual in accordance with those rules.
(3)(a)(I) All denials of requests for reimbursement for medical treatment, standing referrals, or adverse determinations made on the ground that a treatment or covered benefit is not medically necessary, appropriate, effective, or efficient, is not delivered in the appropriate setting or at the appropriate level of care, or is experimental or investigational, must include:

(A)

An explanation of the specific medical basis for the denial;

(B)

The specific reasons for the denial or adverse determination;

(C)

Reference to the specific health coverage plan provisions on which the determination is based;

(D)

A description of the carrier’s review procedures and the time limits applicable to such procedures and a statement that the individual has the right to appeal the decision; and

(E)

A description of any additional material or information necessary, if any, for the individual to perfect the request for benefits and an explanation of why the material or information is necessary.

(II)

In the case of an adverse determination by a carrier:

(A)

If an internal rule, guideline, protocol, or other similar criterion was relied upon in making the adverse determination, the carrier shall furnish the individual with either the specific rule, guideline, protocol, or other similar criterion, or a statement that the rule, guideline, protocol, or other criterion was relied upon in making the adverse determination and that a copy of the rule, guideline, protocol, or other criterion will be provided free of charge to the individual upon request; or

(B)

If the adverse determination is based on a medical necessity or experimental treatment or similar exclusion or limit, the carrier shall furnish the individual with either an explanation of the scientific or clinical judgment for the determination, applying the terms of the plan to the individual’s medical circumstances, or a statement that the explanation will be provided free of charge upon request.

(III)

In the event of an adverse determination by a carrier concerning a request involving urgent care, a carrier:

(A)

Shall provide to the individual a description of the expedited review process applicable to the request;

(B)

May communicate the other information required pursuant to subparagraph (I) of this paragraph (a) to the individual orally within the time frame outlined in 29 CFR 2560.503-1 (f)(2)(i) so long as a written or electronic copy of the information is furnished to the individual no later than three days after the oral notification; and

(C)

May waive the deadlines specified in sub-subparagraph (B) of this subparagraph (III) and in subparagraph (IV) of this paragraph (a) to permit the individual to pursue an expedited external review of the urgent care claim under section 10-16-113.5.

(IV)

A carrier shall notify an individual of a benefit determination, whether adverse or not, with respect to a request involving urgent care as soon as possible, taking into account the medical exigencies, but not later than seventy-two hours after the receipt of the request by the carrier, unless the individual fails to provide sufficient information to determine whether, or to what extent, benefits are covered or payable under the coverage.

(b)

Intentionally left blank —Ed.

(I)

A group health coverage plan issued by a carrier subject to part 2, 3, or 4 of this article must specify that an appeal of any adverse determination includes a two-level internal review of the decision, followed by the right of the individual to request an external review if allowed under section 10-16-113.5. The individual has the option of choosing whether to utilize the voluntary second-level internal appeal process.

(II)

The carrier shall notify the individual of his or her right to appeal a denial of benefits through a two-level internal review process and that the second level of internal review may be utilized at the individual’s option.

(III)

Intentionally left blank —Ed.

(A)

A physician shall evaluate the first-level appeal and shall consult with an appropriate clinical peer or peers, unless the reviewing physician is a clinical peer; except that, in the case of dental care, a dentist may evaluate the first-level appeal, and the reviewing dentist shall consult with an appropriate clinical peer or peers, unless the reviewing dentist is a clinical peer. A physician, dentist, or clinical peer who was involved in the initial adverse determination shall not evaluate or be consulted regarding the first-level appeal. A person who was previously involved with the denial may answer questions.

(B)

This subparagraph (III) does not apply to an adverse determination described in sub-subparagraph (C) or (E) of subparagraph (I) of paragraph (b) of subsection (1) of this section.

(IV)

Intentionally left blank —Ed.

(A)

The second-level internal review of an appeal from the denial of a request for covered benefits pursuant to subparagraph (I) of this paragraph (b) shall be reviewed by a health-care professional who has appropriate expertise, who was not previously involved in the appeal, and who does not have a direct financial interest in the appeal or outcome of the review.

(B)

The carrier shall allow the individual to be present for the second-level internal review, either in person or by telephone conference. The individual may bring counsel, advocates, and health-care professionals to the review, prepare in advance for the review, and present materials to the health-care professional prior to the review and at the time of the review. Upon request, the carrier and the individual shall provide copies of the materials they intend to present at the review to the other party at least five days prior to the review. If new information is developed after the five-day deadline, the material may be presented when practicable. The carrier shall notify the individual that the carrier will make an audio or video recording of the review unless neither the individual nor the carrier wants the recording made. If a recording is made, the carrier shall make the recording available to the individual. If there is an external review, the carrier shall include the audio or video recording in the material provided by the carrier to the reviewing entity if requested by either party.

(c)

In addition to the requirements specified in subsections (3)(a) and (3)(b) of this section, unless a denial is based on nonpayment of premiums, a denial of reimbursement for services for the prevention of, screening for, or treatment of behavioral, mental health, and substance use disorders under a health benefit plan must include the following, in plain language:

(I)

A statement explaining that covered persons are protected under the MHPAEA, which provides that limitations placed on access to mental health and substance use disorder benefits may be no greater than any limitations placed on access to medical and surgical benefits;

(II)

A statement providing information about contacting the division or the office of the ombudsman for behavioral health access to care established pursuant to part 3 of article 80 of title 27 if the covered person believes his or her rights under the MHPAEA have been violated; and

(III)

A statement specifying that covered persons are entitled, upon request to the carrier and free of charge, to a copy of the medical necessity criteria for any behavioral, mental health, and substance use disorder benefit.

(4)

Intentionally left blank —Ed.

(a)

Each carrier issuing individual health coverage plans shall notify the individual of his or her right to appeal an adverse determination through a single level of internal review.

(b)

Intentionally left blank —Ed.

(I)

A physician shall evaluate the appeal and consult with an appropriate clinical peer or peers unless the reviewing physician is a clinical peer; except that, in the case of dental care, a dentist may evaluate the appeal, and the reviewing dentist shall consult with an appropriate clinical peer or peers. A physician, dentist, or clinical peer who was involved in the initial adverse determination shall not evaluate or be consulted regarding the appeal. A person who was previously involved with the denial may answer questions.

(II)

This paragraph (b) does not apply to an adverse determination described in sub-subparagraph (C) or (E) of subparagraph (I) of paragraph (b) of subsection (1) of this section.

(c)

The carrier shall allow the individual to be present for the appeal. The individual may bring counsel, advocates, and health-care professionals to the review, prepare in advance for the review, and present materials to the physician or dentist prior to the review and at the time of the review. Upon request, the carrier and the individual shall provide copies of the materials they intend to present at the review to the other party at least five days prior to the review. If new information is developed after the five-day deadline, the material may be presented when practicable. The carrier shall notify the individual that the carrier will make an audio or video recording of the review unless neither the individual nor the carrier wants the recording made. If a recording is made, the carrier shall make the recording available to the individual. If there is an external review, the carrier shall include the audio or video recording in the material provided by the carrier to the reviewing entity if requested by either party.

(5)

All written adverse determinations, except an adverse determination described in sub-subparagraph (C) or (E) of subparagraph (I) of paragraph (b) of subsection (1) of this section, must be signed by a licensed physician familiar with standards of care in Colorado; except that, in the case of written adverse determinations relating to dental care, a licensed dentist familiar with standards of care in Colorado may sign the written adverse determination.

(6)

An individual’s health-care provider may communicate with the physician or dentist involved in the initial decision to make an adverse determination.

(7)

Nothing in this section precludes or denies the right of an individual to seek any other remedy or relief.

(8)

In the case of the failure of a carrier to adhere to the requirements of this section with respect to a coverage request, the individual may be deemed to have exhausted the internal claims and appeals process of this section if the commissioner determines that the carrier did not substantially comply with the requirements of this section or that any error the carrier committed was not de minimis, as defined by the commissioner by rule, in which case the individual may initiate an external review under section 10-16-113.5.

(9)

Carriers shall maintain records of all requests and notices associated with the internal claims and appeals process for six years and shall make such records available upon request for examination by the individual, the division of insurance, or the federal government.

(10)

The commissioner may promulgate rules as necessary for the implementation and administration of this section.

Source: Section 10-16-113 — Procedure for denial of benefits - internal review - rules - definitions, https://leg.­colorado.­gov/sites/default/files/images/olls/crs2023-title-10.­pdf (accessed Oct. 20, 2023).

10‑16‑101
Short title
10‑16‑102
Definitions
10‑16‑103
Proposal of mandatory health-care coverage provisions
10‑16‑103.4
Essential health benefits - requirements - rules
10‑16‑103.5
Payment of premiums - required term in contract - rules - definition
10‑16‑103.6
Copayment-only prescription payment structures - required inclusion in health benefit plans - rules
10‑16‑104
Mandatory coverage provisions - definitions - rules - applicability
10‑16‑104.1
Prohibition on discrimination for organ transplants based solely on disability - definition
10‑16‑104.2
Coverage for contraception - rules - definitions
10‑16‑104.3
Health coverage for persons under twenty-six years of age - coverage for students who take medical leave of absence
10‑16‑104.6
Off-label use of cancer drugs
10‑16‑104.7
Substance use disorders - court-ordered treatment coverage
10‑16‑104.8
Behavioral, mental health, or substance use disorder services coverage - court-ordered
10‑16‑104.9
Geographic areas for small employers
10‑16‑105
Guaranteed issuance of health insurance coverage - individual and small employer health benefit plans
10‑16‑105.1
Guaranteed renewability - exceptions - individual and small employer health benefit plans - rules
10‑16‑105.2
Small employer health insurance availability program
10‑16‑105.3
Health benefit plans - not prohibited
10‑16‑105.6
Rate usage
10‑16‑105.7
Health benefit plan open enrollment periods - special enrollment periods - rules
10‑16‑106
Group replacement - extension of benefits
10‑16‑106.3
Uniform claims - billing codes - electronic claim forms
10‑16‑106.5
Prompt payment of claims - legislative declaration - rules
10‑16‑106.7
Assignment of health insurance benefits
10‑16‑107
Rate filing regulation - benefits ratio - rules
10‑16‑107.1
False or misleading information - penalties
10‑16‑107.2
Filing of health policies - rules
10‑16‑107.3
Health insurance policies - plain language required - rules
10‑16‑107.4
Health-care sharing plan or arrangement - required reporting and certification - noncompliance - information posted on division website - rules
10‑16‑107.5
Uniform application form - use by all carriers - rules
10‑16‑107.7
Nondiscrimination against providers
10‑16‑108
Continuation privileges
10‑16‑108.5
Fair marketing standards - rules
10‑16‑109
Rules
10‑16‑110
Fees paid by health coverage entities
10‑16‑111
Annual statements and reports - rules
10‑16‑112
Private utilization review - health-care coverage entity responsibility - definitions
10‑16‑112.5
Prior authorization for health-care services - disclosures and notice - determination deadlines - criteria - limits and exceptions - definitions - rules
10‑16‑113
Procedure for denial of benefits - internal review - rules - definitions
10‑16‑113.5
Independent external review of adverse determinations - legislative declaration - definitions - rules
10‑16‑113.7
Reporting the denial of benefits to division
10‑16‑116
Catastrophic health insurance - coverage - premium payments - reporting requirements - definitions - short title
10‑16‑118
Prohibition against preexisting condition exclusions
10‑16‑119
Requirements for excess loss or stop-loss health insurance used in conjunction with self-insured employer benefit plans under the federal “Employee Retirement Income Security Act” - data collection 2013-18 - rules
10‑16‑119.5
Stop-loss health insurance for small employers of not more than fifty employees - requirements - definitions - rules
10‑16‑121
Required contract provisions in contracts between carriers and providers - definitions
10‑16‑121.3
Limitations on provisions in contracts between carriers and licensed health-care providers - methods of payment - fees
10‑16‑121.5
Prohibited contract provisions in contracts between carriers and providers for dental services - definition
10‑16‑121.7
Prohibited contract provisions in contracts between carriers and eye care providers - definitions
10‑16‑122
Access to prescription drugs
10‑16‑122.1
Contracts between PBMs and pharmacies - carrier submit list of PBMs - PBM registration - fees - prohibited practices - exception - rules - enforcement - short title - definitions
10‑16‑122.3
Pharmacy benefit management firm payments - retroactive reduction prohibited - enforcement - rules - definitions
10‑16‑122.4
Pharmacy benefits - formulary change prohibition - exceptions - enforcement - definition - rules
10‑16‑122.5
Pharmacy benefit manager - audit of pharmacies - time limits on on-site audits - enforcement - rules
10‑16‑122.6
Pharmacy benefit managers - contracts with pharmacies - maximum allowable cost pricing - enforcement - rules
10‑16‑122.7
Disclosures between pharmacists and patients - carrier and PBM prohibitions - enforcement - short title - legislative declaration - preemption by federal law - rules
10‑16‑122.9
Prescription drug benefits - real-time access to benefit information - enforcement - definitions - rules
10‑16‑123
Telehealth - definitions
10‑16‑124
Prescription information cards - legislative declaration
10‑16‑124.5
Prior authorization form - drug benefits - rules of commissioner - definitions - repeal
10‑16‑124.7
Opioid analgesics with abuse-deterrent properties - study - definitions
10‑16‑124.8
Colorado consortium for prescription drug abuse prevention - create process for recovery - report
10‑16‑125
Reimbursement to nurses
10‑16‑126
Fee-for-service dental plans
10‑16‑127
Coinsurance and deductibles
10‑16‑128
Annual report to general assembly
10‑16‑129
Health savings accounts
10‑16‑130
Disclosure of rate increases to public entities - legislative declaration - definitions
10‑16‑133
Health carrier information disclosure - website - insurance producer fees and disclosure requirements - legislative declaration - rules
10‑16‑134
Health-care transparency - information required - website - definition
10‑16‑135
Health coverage plan information cards - rules - standardization - contents
10‑16‑137
Policy forms - explanation of benefits - standardization of forms - rules
10‑16‑138
Pathology services - direct billing required
10‑16‑139
Access to care - rules - definitions
10‑16‑140
Grace periods - premium payments - rules
10‑16‑141
Medication synchronization services - cost sharing for partial refills - dispensing fees
10‑16‑142
Physical rehabilitation services - copayments and coinsurance - research
10‑16‑143.5
Pharmacy reimbursement - substance use disorders - injections - patient counseling
10‑16‑144
Health-care services provided by pharmacists
10‑16‑145
Step therapy - limitations - exceptions - definitions - rules
10‑16‑145.5
Step therapy - prior authorization - prohibited - stage four advanced metastatic cancer - opioid prescription - definitions
10‑16‑146
Periodic updates to provider directory
10‑16‑147
Parity reporting - commissioner - carriers - rules - examination of complaints
10‑16‑148
Medication-assisted treatment - limitations on carriers - rules
10‑16‑150
Primary care payment reform collaborative - created - powers and duties - report - definition - repeal
10‑16‑151
Cost sharing in prescription insulin drugs - limits - definition - rules
10‑16‑152
HIV prevention and treatment medication - limitations on carriers - step therapy - prior authorization - study - repeal
10‑16‑153
Coverage for opiate antagonists provided by a hospital - definition
10‑16‑154
Disclosures - physical therapists - occupational therapists - chiropractors - acupuncturists - patients - carrier prohibitions - enforcement
10‑16‑155
Actuarial reviews of proposed health-care legislation - division to contract with third parties - required considerations - confidentiality - limits on expenditures - repeal
10‑16‑155.5
Actuarial review of doula services - report - definition
10‑16‑156
Prescription drugs - rebates - consumer cost reduction - point of sale - study - report - rules - definitions
10‑16‑157
Alternative payment model parameters - parameters to include an aligned quality measure set - primary care providers - requirement for carriers to submit alternative payment models to the division - legislative declaration - report - rules - definitions
10‑16‑158
Treatment of sexually transmitted infection - cost sharing - rules - definition
10‑16‑159
Coverage for sterilization services - cost sharing
10‑16‑160
Cost sharing - prescription epinephrine - limits - rules - definition
10‑16‑161
Calculation of contribution to out-of-pocket and cost-sharing requirements - exception - definitions - rules
10‑16‑162
Prohibition on discrimination for coverage based solely on natural medicine consumption - definitions
10‑16‑163
Contracts - health benefit plans - pharmacy benefit managers - policyholders - transparency requirements - rules - definitions
10‑16‑164
Hospital facility fee report - data collection
10‑16‑165
Dental coverage plans - dental loss ratio - rules - definitions
10‑16‑166
Prohibition on using the body mass index or ideal body weight - medical necessity criteria - rules
10‑16‑201
Form and content of individual sickness and accident insurance policies
10‑16‑202
Required provisions in individual sickness and accident policies
10‑16‑203
Optional provisions in individual sickness and accident insurance policies
10‑16‑204
Inapplicable or inconsistent provisions in individual policies of sickness and accident insurance
10‑16‑205
Order of certain policy provisions in individual policies of sickness and accident insurance
10‑16‑206
Third-party ownership of individual sickness and accident insurance policies
10‑16‑207
Requirements of other jurisdictions
10‑16‑208
Conforming to statute
10‑16‑209
Application for policy
10‑16‑210
Notice - waiver
10‑16‑211
Age limit
10‑16‑212
Exemption from attachment and execution
10‑16‑213
Industrial sickness and accident insurance
10‑16‑214
Group sickness and accident insurance
10‑16‑215
Blanket sickness and accident insurance
10‑16‑216
Examinations
10‑16‑216.5
Hearing procedure and judicial review - violations - penalty
10‑16‑217
Application of part 1 of this article and part 2
10‑16‑218
Judicial review
10‑16‑219
Benefits for care in tax-supported institutions - behavioral health disorders - mental health disorders - intellectual and developmental disabilities
10‑16‑220
Minimum standards for sickness and accident plans
10‑16‑221
Statewide health care review committee - creation - membership - duties - repeal
10‑16‑222
Termination of policies
10‑16‑301
Legislative declaration
10‑16‑302
Incorporation and organization - exemptions
10‑16‑303
Filing of articles of incorporation
10‑16‑304
Contents of articles
10‑16‑305
Directors
10‑16‑306
Contracts - benefits for long-term care insurance
10‑16‑307
Authority to do business
10‑16‑308
Automatic extension of certificate
10‑16‑309
Requirements for certificate of authority
10‑16‑310
Surplus - guarantee fund deposit - regulations
10‑16‑311
Group benefits for depositors of banks - benefits for subscribers in public institutions
10‑16‑312
Contracts with other organizations
10‑16‑314
Payment for examinations of corporations
10‑16‑315
Revocation of certificate - appeal
10‑16‑316
Complaints
10‑16‑317
Exemption of direct payment methods
10‑16‑317.5
Assignment of benefits
10‑16‑318
Prospective reimbursement
10‑16‑319
Effective date
10‑16‑320
Investment of funds
10‑16‑321
Medicare supplement benefit standards
10‑16‑322
Filing of health policies
10‑16‑324
Conversion of corporation to a stock insurance company
10‑16‑325
Termination of health policies
10‑16‑401
Establishment of health maintenance organizations
10‑16‑402
Issuance of certificate of authority - denial
10‑16‑403
Powers of health maintenance organizations
10‑16‑404
Governing body
10‑16‑405
Fiduciary responsibilities
10‑16‑406
Evidence of coverage - rules
10‑16‑407
Information to enrollees
10‑16‑408
Open enrollment
10‑16‑409
Complaint system
10‑16‑410
Investments
10‑16‑411
Protection against insolvency
10‑16‑412
Statutory deposit
10‑16‑413
Prohibited practices
10‑16‑413.5
Return to home - legislative declaration - definitions
10‑16‑414
Regulation of agents
10‑16‑415
Powers of insurers and nonprofit hospital, medical-surgical, and health service corporations
10‑16‑416
Examination
10‑16‑417
Suspension or revocation of certificate of authority
10‑16‑418
Rehabilitation, liquidation, or conservation of health maintenance organization
10‑16‑419
Administrative procedures
10‑16‑420
Penalties and enforcement
10‑16‑421
Statutory construction and relationship to other laws
10‑16‑421.5
Acquisition of control of or merger of a health maintenance organization
10‑16‑422
Filings and reports as public documents
10‑16‑423
Confidentiality of health information
10‑16‑424
Commissioner’s authority to contract
10‑16‑425
Applicability of provisions
10‑16‑426
Medicare supplement benefit standards
10‑16‑427
Contractual relations
10‑16‑429
Termination of contract
10‑16‑501
Legislative declaration
10‑16‑502
Establishment of prepaid dental care plan organizations
10‑16‑503
Application for certificate of authority
10‑16‑504
Issuance of certificate of authority
10‑16‑505
Guarantee fund deposit
10‑16‑506
Reserve requirement - exception
10‑16‑507
Enrollee coverage by prepaid dental care plan organizations - form filing requirements
10‑16‑508
Examination of prepaid dental care plan organization
10‑16‑509
Operational expenses
10‑16‑510
Suspension or revocation of certificate of authority
10‑16‑511
Rehabilitation, liquidation, or conservation of prepaid dental care plan organization
10‑16‑512
Other laws applicable
10‑16‑601
Legislative declaration
10‑16‑602
Definitions
10‑16‑603
Independent medical examinations - governing standard
10‑16‑604
Financial interest in future care of patient prohibited
10‑16‑605
Independence of examiners
10‑16‑606
Applicability
10‑16‑701
Short title
10‑16‑702
Legislative declaration
10‑16‑703
Applicability
10‑16‑704
Network adequacy - required disclosures - balance billing - rules - legislative declaration - definitions
10‑16‑705
Requirements for carriers and participating providers - definitions
10‑16‑705.5
Participating provider networks - definitions - selection standards - informal reconsideration - enforcement - legislative declaration
10‑16‑705.7
Timely credentialing of physicians by carriers - notice of receipt required - notice of incomplete applications required - delegated credentialing agreements - discrepancies - denials of claims prohibited - disclosures - recredentialing - enforcement - rules - definitions
10‑16‑706
Intermediaries
10‑16‑707
Enforcement
10‑16‑708
Rule-making authority of commissioner
10‑16‑709
Evaluation - nonparticipating health-care providers - legislative declaration - rules
10‑16‑710
Reporting to commissioner - medication-assisted treatment - rules
10‑16‑1001
Legislative declaration
10‑16‑1002
Definitions
10‑16‑1003
Privacy of health information
10‑16‑1004
Health-care coverage cooperatives - establishment - fees
10‑16‑1005
Issuance of certificate of authority by commissioner for cooperative to purchase health-care coverage
10‑16‑1006
Authority to deny application for, revoke, or suspend certificate of authority
10‑16‑1007
Prohibition on cooperatives transacting insurance business
10‑16‑1008
Administrative structure of cooperatives - board of directors - officers - employees
10‑16‑1009
Powers, duties, and responsibilities of cooperatives
10‑16‑1010
Marketing requirements of cooperatives
10‑16‑1013
Violations of article by persons involved with operations of cooperatives - enforcement - penalties
10‑16‑1014
Technical assistance to authorized cooperatives from division of insurance
10‑16‑1015
Health-care cooperatives - rule-making authority
10‑16‑1016
State innovation waiver - authority to apply
10‑16‑1101
Short title
10‑16‑1102
Legislative declaration
10‑16‑1103
Definitions
10‑16‑1104
Commissioner powers and duties - rules - study and report
10‑16‑1105
Reinsurance program - creation - enterprise status - subject to waiver or funding approval - operation - payment parameters - calculation of reinsurance payments - eligible carrier requests - definition
10‑16‑1106
Accounting - reports - audits
10‑16‑1107
Funding for reinsurance program - sources - permitted uses - reinsurance program cash fund - calculation of total funding for program
10‑16‑1109
State innovation waiver - federal funding - Colorado reinsurance program
10‑16‑1110
Repeal of part - notice to revisor of statutes
10‑16‑1201
Short title
10‑16‑1202
Legislative declaration
10‑16‑1203
Definitions
10‑16‑1204
Health insurance affordability enterprise - creation - powers and duties - assess and allocate health insurance affordability fee and special assessment
10‑16‑1205
Health insurance affordability fee - special assessment on hospitals - allocation of revenues
10‑16‑1206
Health insurance affordability cash fund - creation
10‑16‑1207
Health insurance affordability board - creation - membership - powers and duties - subject to open meetings and public records laws - commissioner rules
10‑16‑1208
Limitation on authority - public option
10‑16‑1301
Short title
10‑16‑1302
Legislative declaration - intent
10‑16‑1303
Definitions
10‑16‑1304
Standardized health benefit plan - established - components - rules - independent analysis - repeal
10‑16‑1305
Standardized health benefit plan - carriers required to offer - premium rates - rules
10‑16‑1305.5
Rate filings
10‑16‑1306
Failure to meet premium rate requirements - notice - public hearing - rules
10‑16‑1307
Advisory board - members - rules
10‑16‑1308
Federal waiver - commissioner application - use of money
10‑16‑1309
Standardized plan - cost shift
10‑16‑1310
Reports required - repeal
10‑16‑1311
State measurement for accountable, responsive, and transparent (SMART) government act report
10‑16‑1312
Rules
10‑16‑1313
Severability
10‑16‑1401
Definitions
10‑16‑1402
Colorado prescription drug affordability review board - created - membership - terms - conflicts of interest
10‑16‑1403
Colorado prescription drug affordability review board - powers and duties - rules
10‑16‑1404
Colorado prescription drug affordability review board meetings - required to be public - exceptions
10‑16‑1405
Colorado prescription drug affordability review board - reports from carriers and pharmacy benefit management firms required - confidential materials
10‑16‑1406
Colorado prescription drug affordability review board - affordability reviews of prescription drugs - repeal
10‑16‑1407
Colorado prescription drug affordability review board - upper payment limits for certain prescription drugs - rules - severability
10‑16‑1408
Colorado prescription drug affordability review board - judicial review
10‑16‑1409
Colorado prescription drug affordability advisory council - created - membership - powers and duties
10‑16‑1410
Use of savings - report - rules
10‑16‑1411
Unlawful acts - enforcement - penalties
10‑16‑1412
Notice of withdrawal of prescription drugs with upper payment limits required - rules - penalty
10‑16‑1413
Optional participating plans - notice of election to participate required
10‑16‑1414
Reports
10‑16‑1415
Exemption - prescription drugs derived from cannabis
10‑16‑1416
Repeal of part
10‑16‑1501
Short title
10‑16‑1502
Legislative declaration
10‑16‑1503
Definitions
10‑16‑1504
Applicability - exclusions
10‑16‑1505
Prohibition on 340B discrimination
10‑16‑1506
Enforcement - rules
Green check means up to date. Up to date

Current through Fall 2024

§ 10-16-113’s source at colorado​.gov