The department of personnel (department) is required to contract for the services of a pharmacy benefit manager (PBM) for group benefit plans provided pursuant to the "State Employees Group Benefits Act" (state employee group benefits plans) and to procure a technology platform with the required capabilities for conducting a PBM reverse auction and the related services of a technology platform operator.The department is required to repurpose the technology platform used to conduct the reverse auction over the duration of the PBM services contract to perform reviews of all invoiced PBM prescription drug claims, and to identify all deviations from the specific terms of the PBM services contract. The department is required to reconcile the electronically adjudicated pharmacy claims with PBM invoices to ensure that state payments do not exceed the terms specified in any PBM services contract.Each PBM reverse auction is required to be completed and the PBM services contract awarded to the winning PBM within a specified timeline.The department may perform a market check for providing PBM services during the term of the current PBM services contract to ensure continuing competitiveness of incumbent prescription drug pricing over the life of a PBM services contract.To ensure that the department does not incur additional expenditures associated with the requirements of the act, the department is required to implement a no-pay option that obligates the winning PBM to pay the cost of the technology platform and related technology platform operator services by assessing a per-prescription fee and requiring the PBM to pay these fees to the technology operator over the duration of the PBM services contract.The act allows other health plans to use the processes and procedures established in the act individually, collectively, or as a joint purchasing group with the state employee group benefits plans.After completion of the first state employees group benefits plans PBM reverse auction, self-funded private sector employer or multi-employer health plans have the option to participate in a joint purchasing pool with state employees for conduct of subsequent PBM reverse auctions.The state employees group benefits plans and any self-funded public or private sector health plans that opt to participate with the state employees group benefits plans in a joint PBM reverse auction purchasing pool shall retain full autonomy over determination of their respective prescription drug formularies and pharmacy benefit designs and shall not be required to adopt a common prescription drug formulary or common prescription pharmacy benefit design.Any PBM providing services to the department or a self-funded public or private sector employee health plan is required to provide the department and the plan access to complete pharmacy claims data necessary to conduct the reverse auction and carry out their administrative and management duties.The department may elect to vacate the outcome of a PBM reverse auction if the lowest cost bid is not less than the projected cost trend for the incumbent PBM contract as verified by the department.(Note: This summary applies to this bill as enacted.)
Sponsored bills
The act clarifies that the existing authority of cities and counties to plan for and regulate the use of land includes the authority to regulate development or redevelopment in order to promote the construction of new affordable housing units. The provisions of the state's rent control statute do not apply to any land use regulation that restricts rents on newly constructed or redeveloped housing units as long as the regulation provides a choice of options to the property owner or land developer and creates one or more alternatives to the construction of new affordable housing units on the building site. The act also states that it should not be construed to authorize a local government to adopt or enforce any ordinance or regulation that would have the effect of controlling rent on any existing private residential housing unit in violation of the existing statutory prohibition on rent control.The act prohibits a local government from exercising this new regulatory authority unless the local government demonstrates, at the time it enacts a land use regulation for the purpose of exercising such authority, it has taken one or more among a list of specified actions to increase the overall number and density of housing units within its jurisdictional boundaries or to promote or create incentives to the construction of affordable housing units.The act requires the department of local affairs to offer guidance to assist local governments in connection with its implementation.(Note: This summary applies to this bill as enacted.)
Current law states that in-person contact between a health-care provider or mental health-care provider and a patient is not required under the state's medicaid program for services delivered through telemedicine that are otherwise eligible for reimbursement under medicaid. The act requires the department of health care policy and financing to promulgate rules specifically relating to entities that deliver health-care or mental health-care services exclusively or predominately through telemedicine.(Note: This summary applies to this bill as enacted.)
The act requires the department of health care policy and financing (department) to develop, analyze, and enforce a demonstration of need for each new nursing facility provider seeking medicaid certification. The requirement does not apply to a nursing facility provider certified prior to June 30, 2021. The act allows the department to exempt nursing facilities with 5 or fewer medicaid beds from the current reimbursement methodology and instead require the facilities to be reimbursed at the statewide average rate.The act requires the medical services board to promulgate rules, no later than June 30, 2022, addressing the establishment of criteria to be used in determining a nursing facility provider's medicaid certification.(Note: This summary applies to this bill as enacted.)
The act requires each dental plan issued, amended, or renewed in this state to cover services offered to a covered person through telehealth. The act also requires the state's medical assistance program to reimburse providers for dental care services provided through telehealth.(Note: This summary applies to this bill as enacted.)
The act implements the recommendation of the department of regulatory agencies in its sunset review of and report on the healthcare-associated infections and antimicrobial resistance advisory committee by extending the committee indefinitely.(Note: This summary applies to this bill as enacted.)
The bill requires the division of insurance (division) to retain a contractor on or before November 1, 2021, for the purpose of performing actuarial reviews of proposed legislation that may impose a new health benefit mandate on health benefit plans. The contractor, under the direction of the division, shall conduct an actuarial review of up to 5 legislative proposals for each regular legislative session, each at the request of a member of the general assembly. Each actuarial review performed by the contractor must consider the predicted effects of the legislative proposal during the 5 years immediately following the effective date of the proposed legislation, including specifically described considerations. In preparing a fiscal note for any legislative proposal that may impose a new health benefit mandate on health benefit plans, the legislative service agency charged with preparing the fiscal note shall either: Include in the fiscal note information that is produced by the contractor in review of the legislative proposal; or If no information is produced by the contractor in review of the legislative proposal, indicate such fact in the fiscal note.(Note: This summary applies to this bill as introduced.)
Federal law preempts the extraterritorial application of state credit for reinsurance law but permits a state to enact reinsurance collateral reforms on an individual basis if the state is accredited. The act enacts a model law adopted by the National Association of Insurance Commissioners (NAIC), which is necessary to maintain the continued accreditation of the Colorado division of insurance with the NAIC and makes Colorado's reinsurance statutes substantially similar to those found in other states. The model law specifies the grounds upon which a domestic insurer can get credit in Colorado for reinsurance provided by an assuming insurer that is domiciled in an extraterritorial jurisdiction and thereby avoids federal preemption that would otherwise occur by 2022.(Note: This summary applies to this bill as enacted.)
The act replaces the term "illegal alien" with "worker without authorization" as it relates to public contracts for services.(Note: This summary applies to this bill as enacted.)
The bill establishes requirements for health benefit plans related to health-care services provided by physician assistants and reimbursement for such services. The bill also modifies the relationship between a physician assistant and a physician by removing the supervision requirement and replacing it with a requirement that a physician assistant collaborate with a physician. Formal collaboration with a physician is required only for a physician assistant with fewer than 5,760 hours of practice experience or who is beginning practice in a new specialty. (Note: This summary applies to this bill as introduced.)