C.R.S. Section 10-16-705
Requirements for carriers and participating providers

  • definitions

(1)

In addition to any other applicable requirements of this part 7, a carrier offering a managed care plan shall satisfy all the requirements of this section.

(2)

A carrier shall maintain a mechanism by which providers can access information on the covered health services for which the provider is responsible, including any limitations or conditions on services.

(3)

Every contract between a carrier and a participating provider shall set forth a hold harmless provision specifying that covered persons shall, in no circumstances, be liable for money owed to participating providers by the plan and that in no event shall a participating provider collect or attempt to collect from a covered person any money owed to the provider by the carrier. Nothing in this section shall prohibit a participating provider from collecting coinsurance, deductibles, or copayments as specifically provided in the covered person’s contract with the managed care plan.

(4)

Intentionally left blank —Ed.

(a)

Every contract between a carrier and a participating provider shall include provisions for continuity of care as specified in this subsection (4).

(b)

Each carrier that issues a managed care plan shall allow covered persons to continue receiving care for up to ninety days after the date a carrier has provided notice to an individual enrolled in such plan pursuant to subsection (4)(d)(II)(A) of this section that the contract is terminated. The carrier shall provide the requisite coverage or continuing care to the covered person at the covered person’s in-network benefit level cost-sharing amount during the period beginning on the date on which the notice of termination is given pursuant to subsection (4)(d)(II)(A) of this section and ending on the earlier of the ninety-day period beginning on such date or the date on which the covered person is no longer a continuing care patient with the provider or health-care facility.

(c)

In the circumstance that coverage is terminated for any reason other than nonpayment of the premium, fraud, or abuse, every managed care plan shall provide for continued care for covered persons being treated at an in-patient facility until the patient is discharged.

(d)

Intentionally left blank —Ed.

(I)

A carrier shall comply with the requirements of subsection (4)(d)(II) of this section if a participating provider, whether an individual provider or a facility, is treating a continuing care patient who is a covered person under the plan and if:

(A)

The contract between the carrier and the participating provider is terminated due to the expiration or nonrenewal of the contract;

(B)

The benefits provided under the managed care plan or the health insurance coverage, with respect to the provider or facility, are terminated due to the expiration or nonrenewal of the contract between the carrier and the provider or facility because of a change in the terms of the participation in the plan or coverage; or

(C)

A contract between the group health plan and the carrier offering coverage in connection with the group health plan is terminated due to the expiration or nonrenewal of the contract, resulting in the loss of benefits under the plan with respect to the participating provider that is providing treatment or services to the covered person in compliance with the federal “No Surprises Act”.

(II)

A carrier subject to this subsection (4)(d) shall:

(A)

Notify each covered person who is receiving care from a provider or facility with whom a contract is terminated as described in subsection (4)(d)(I) of this section, at the time of the termination of the contract, that the patient has the right to elect continued transitional care from the treating provider or facility if the termination of the contract affects the status of the provider or facility as a participating provider;

(B)

Provide the covered person with an opportunity to notify the managed care plan or carrier of the need for transitional care; and

(C)

Permit the covered person to elect to continue to have benefits provided under the covered person’s current plan or coverage under the same terms and conditions as would have applied and with respect to the same items and services as would have been covered had a termination described in subsection (4)(d)(I) of this section not occurred, with respect to the course of treatment furnished by the provider or facility relating to the covered person’s status as a continuing care patient during the period beginning on the date on which the notice under subsection (4)(d)(II)(A) of this section is provided and ending on the ninety-first day after that date or the date on which the covered person is no longer a continuing care patient with respect to the provider or facility, whichever is earlier.

(III)

As used in this subsection (4)(d):

(A)

“Continuing care patient” means a covered person who, with respect to a provider or facility whose contract with the covered person’s carrier is terminated: Is undergoing a course of treatment for a serious and complex medical condition, which course of treatment is provided by the provider or facility; is undergoing a course of inpatient care provided by the provider or facility; is pregnant and undergoing a course of treatment for the pregnancy provided by the provider or facility; is terminally ill as determined under section 1861 (dd)(3)(A) of the federal “Social Security Act”, as amended, and is receiving treatment for the illness from the provider or facility; or is scheduled to undergo nonelective surgery from the provider or facility, including the receipt of postoperative care from the provider or facility with respect to the surgery.

(B)

“Serious and complex medical condition” means, in the case of acute illness, a condition that is serious enough to require specialized medical treatment to avoid the reasonable possibility of death or permanent harm or, in the case of a chronic illness or condition, a condition that is life-threatening, degenerative, potentially disabling, or congenital and requires specialized medical care over a prolonged period of time.

(C)

“Terminated”, with respect to a contract, means the expiration or nonrenewal of the contract; except that “terminated” does not include a contract terminated for failure to meet applicable quality standards or for fraud.

(5)

Intentionally left blank —Ed.

(a)

Except as provided for in paragraph (b) of this subsection (5), notwithstanding any contractual provision to the contrary, a carrier that has entered into contracts with one or more contractors or subcontractors or their intermediaries to provide covered health-care services to covered persons of the carrier under any managed care plan shall, in the event of nonpayment by, or insolvency of, such contractors or subcontractors or their intermediaries, remain responsible for the payment of all participating providers that have provided covered health-care services to covered persons of the carrier pursuant to one or more contracts with such contractors or subcontractors or their intermediaries. Any contracting provider that provides covered health-care services to covered persons of the carrier under a managed care contract shall, in the event of nonpayment for such services, have legal standing to enforce the managed care contract against the carrier and receive payment for such services. In the event of the insolvency of a carrier, participating provider claims for unpaid services shall be a class 6 claim under section 10-3-541 (1)(f).

(b)

A carrier may apply to the commissioner for the use of an alternative mechanism to ensure that all participating providers that have provided covered health-care services to covered persons of the carrier pursuant to one or more contracts with such contractors or subcontractors or their intermediaries receive payment due. If approval is granted, said carrier shall be exempt from the requirements of paragraph (a) of this subsection (5).

(6)

A carrier shall notify participating providers of the providers’ responsibilities with respect to the carrier’s applicable administrative policies and programs, including but not limited to, payment terms, utilization review, quality assessment and improvement programs, credentialing, grievance procedures, data reporting requirements, confidentiality requirements, and any applicable federal or state programs.

(6.5)

A carrier that has entered into a contract with one or more intermediaries to conduct utilization management, utilization review, provider credentialing, administration of health insurance benefits, setting or negotiation of reimbursement rates, payment to providers, network development, or disease management programs shall require the intermediary to comply with the same standards, guidelines, medical policies, and benefit terms of the carrier.

(7)

A carrier and participating provider shall provide at least sixty days written notice to each other before terminating the contract without cause. The carrier shall make a good faith effort to provide written notice of termination within fifteen working days after receipt of or issuance of a notice of termination to all covered persons that are patients seen on a regular basis by the provider whose contract is terminating, regardless of whether the termination was for cause or without cause. Where a contract termination involves a primary care provider, all covered persons that are patients of that primary care provider shall also be notified. Within five working days after the date that the provider either gives or receives notice of termination, the provider shall supply the carrier with a list of those patients of the provider that are covered by a plan of the carrier.

(8)

The rights and responsibilities under a contract between a carrier and a participating provider shall not be assigned or delegated by the provider without the prior written consent of the carrier, and any subcontracts shall comply with the requirements of this part 7.

(9)

A carrier’s contract with participating providers shall include a provision that participating providers do not discriminate, with respect to the provision of medically necessary covered benefits, against covered persons that are participants in a publicly financed program.

(9.5)

If the health benefit plan provides coverage for a second opinion, the carrier and any entity that contracts with the carrier shall disclose the availability of the second opinion along with the health benefit description form.

(10)

A carrier shall notify the participating providers of their obligations, if any, to collect applicable coinsurance, copayments, or deductibles from covered persons pursuant to the evidence of coverage or of the providers’ obligations, if any, to notify covered persons of their personal financial obligations for noncovered services.

(10.5)

Intentionally left blank —Ed.

(a)

A carrier that has entered into a contract with one or more intermediaries to conduct utilization management, utilization review, provider credentialing, administration of health insurance benefits, setting or negotiation of reimbursement rates, payment to providers, network development, or disease management programs, shall require the intermediary to indicate the name of the intermediary and the name of the carrier for which it is conducting the work when making any payment to a health-care provider on behalf of the carrier.

(b)

Intentionally left blank —Ed.

(I)

A violation of subsection (6.5) of this section or this subsection (10.5) is an unfair or deceptive act or practice in the business of insurance pursuant to section 10-3-1104.

(II)

The commissioner may examine the actions of a carrier pursuant to subsection (6.5) of this section and this subsection (10.5) when conducting a market conduct analysis pursuant to part 2 of article 1 of this title.

(11)

A carrier shall not penalize a provider because the participating provider, in good faith, reports to state or federal authorities any act or practice by the carrier that jeopardizes patient health or welfare, or because the participating provider discusses the financial incentives or financial arrangements between the provider and the managed care plan.

(11.5)

A carrier or entity that contracts with the carrier shall not penalize a primary care provider who makes a standing referral of a covered person to a specialist, nor shall the specialist treating the covered person be penalized, with actions that include but are not limited to disincentives or disaffiliation, except for violations of section 10-1-128.

(12)

Intentionally left blank —Ed.

(a)

A carrier shall establish one or more mechanisms by which the participating providers may determine, at the time services are provided, whether or not a person is covered by the carrier or is within the grace period established under section 10-16-140 (1), during which period a carrier may hold a claim for services pending receipt of full premium payment. If a carrier maintains only one mechanism, such mechanism shall not require electronic access.

(b)

Intentionally left blank —Ed.

(I)

Each carrier, regardless of the mechanism used, shall issue a verification code that the participating provider may use as proof of verification as required by section 10-16-704 (4.5)(f).

(II)

In lieu of the requirements of this paragraph (b), for the purposes of verifying the carrier’s communication to the provider pursuant to section 10-16-704 (4.5)(g) or (4.5)(h), a carrier may submit written confirmation to a provider within two business days.

(III)

If a carrier provides electronic access as a mechanism to verify coverage, the carrier may, in lieu of the requirement to issue a verification code through such mechanism, accept as proof of verification a dated screen print from the carrier’s electronic verification mechanism demonstrating that the member is eligible pursuant to section 10-16-704 (4.5)(g) or that the carrier is not required to pay for services pursuant to section 10-16-704 (4.5)(h).

(c)

In lieu of the requirements of paragraph (b) of this subsection (12), a carrier may institute a policy providing that adjustments to claims related to eligibility will be made only if the carrier can demonstrate that the member did not appear as eligible on any of the carrier’s verification mechanisms on the date of service.

(d)

A carrier shall notify participating providers of the mechanisms available to verify eligibility and the carrier’s intent with respect to the requirements of paragraphs (a), (b), and (c) of this subsection (12).

(13)

A carrier shall establish procedures for resolution of administrative, payment, or other disputes between providers and the carrier.

(14)

Every contract between a carrier or entity that contracts with a carrier and a participating provider for a managed care plan that requires preauthorization for particular services, treatments, or procedures shall include:

(a)

A provision that clearly states that the sole responsibility for obtaining any necessary preauthorization rests with the participating provider that recommends or orders said services, treatments, or procedures, not with the covered person; and

(b)

A provision that allows a covered person to receive a standing referral for medically necessary treatment to a specialist or specialized treatment center participating in the carrier’s network or participating in a subdivision or subgrouping of the carrier’s network if the subdivision or subgrouping demonstrates network adequacy pursuant to section 10-16-704. The primary care provider for the covered person, in consultation with the specialist and covered person, shall determine that the covered person needs ongoing care from the specialist in order to make the standing referral. A time period for the standing referral of up to one year, or a longer period of time if authorized by the carrier or any entity that contracts with the carrier, shall be determined by the primary care provider in consultation with the specialist or specialized treatment center. The specialist or specialized treatment center shall refer the covered person back to the primary care provider for primary care. To be reimbursed by the carrier or entity contracting with a carrier, treatment provided by the specialist shall be for a covered person and must comply with provisions contained in the covered person’s certificate or policy. The primary care physician shall record the reason, diagnosis, or treatment plan necessitating the standing referral.

(15)

A contract between a carrier and a participating provider shall not contain definitions or other provisions that conflict with the definitions or provisions contained in the managed care plan or this part 7.

(16)

A provider who is not licensed to furnish health-care services in this state and who participates in a network shall be licensed in the state in which the provider practices and shall meet minimum statutory and regulatory standards for that professional practice applicable in this state.

Source: Section 10-16-705 — Requirements for carriers and participating providers - 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

§ 10-16-705’s source at colorado​.gov