Professional Review: Colorado’s stable liability climate stayed intact, while plaintiff attorneys focused their attention instead on making professional review records discoverable. This effort was not successful. In the last days of the legislative session, the 2019 General Assembly passed SB19-234, reenacting the body of law governing professional review. Plaintiff attorneys engaged in a session-long campaign to breach the privileged nature of professional review activities, and at times threatened to persuade legislators to allow this vital body of patient safety law to lapse under the state’s sunset review process. Significantly, the renewed Professional Review Act maintains the professional review privilege for all documents and information privileged under the current law. CMS, COPIC, CHA, and specialty and component medical societies joined forces in a strategic coalition that was well coordinated and executed throughout the session. CMS is grateful to all physicians who responded to legislative alerts.
Medical Practice Act: Sunset legislation to reenact the state’s Medical Practice Act was also successfully passed under the sunset review process in a form supported by CMS.
Prior Authorization: A hard-fought negotiation between CMS (along with several specialty societies) and health plans produced a win for physicians with the passage of HB19-1211, Prior Authorization Requirements Health Care Service. This bill will streamline the overall process of prior authorization by reducing the time for response to a non-urgent request from 15 days to 5 days; ensuring that services that have been approved cannot be retrospectively denied; and that an approved prior authorization request remains valid for at least 180 days and continues for the duration of the prescribed course of treatment, among other provisions.
Out-of-Network Reform: The legislative scrutiny regarding surprise medical bills aligned a trifecta of payers, consumers, and purchasers/employers—a perfect political storm for physicians. Much like the contentious debates in multiple other states, local and national media pressure was unrelenting, producing story lines that profiled billing excesses by outliers rather than the more complex picture of how plans game networks. CMS and specialty medical society allies pressed the case for arbitration, keeping patients out of the crossfire, prohibiting balance billing, enhanced network adequacy standards, and setting a market-balanced standard for out-of-network reimbursement in situations where patients get surprise bills. Legislators supported some of CMS’ proposed reforms but were reluctant to accept a payment benchmark that they feared could be gamed or exploited. Notwithstanding the determined efforts of the house of medicine, the approved, bipartisan out-of-network legislation ultimately set an unacceptably low payment benchmark. CMS will collaborate with specialty societies to analyze the impact of this bill, using results to push for a more rational metric for determining out-of-network rates.
Patient-Centered Medical Home: Primary care physicians got a big win with CMS support through the passage of HB19-1233, Investment in Primary Care to Reduce Health Costs. This bill aims to increase primary care utilization through a payment reform collaborative and investment targets set by the Commissioner of Insurance in order to reduce overall health care costs.
Liability Reform: Another impressive win was passage of SB19-201, The Open Discussions about Adverse Health Care Incidents Act. This bill, also referred to as the Candor Act, creates a process for health care providers and patients to discuss adverse health care incidents in a privileged and confidential manner.There is much more to report from the 2019 General Assembly. Be on the lookout for the May-June copy of Colorado Medicine and other CMS publications.