CMS to provide comments by Oct. 25

After months of stakeholder meetings, the Colorado Division of Insurance (DOI) and the Department of Health Care Policy and Financing (HCPF) issued a draft report Monday on the development of a state option for health insurance coverage. CMS has been actively involved in the stakeholder process, by providing testimony and other comments, following the CMS Board of Directors’ stated hope to support a public option plan that increases competition in health insurance markets, reduces insurance premiums, facilitates quality improvement and administrative simplification, and inspires physician network participation. While a complete analysis of the proposal is underway, a key takeaway within the proposal is that it sets hospital rates at 175 to 225 percent of Medicare. Physician rates are not affected by this proposed plan.

The report is a result of HB19-1004, passed by the 2019 Colorado legislature, which directed the two agencies to create a plan for a state option that would increase the affordability coverage, increase coverage and ensuring quality. Insurance coverage under the state option would be administered by insurance companies and sold on Connect for Health Colorado, the state’s health insurance exchange. The plans will only be available to those who buy insurance on the individual market, roughly 7 percent of the state population, though state leadership projects scaling a successful option to the small group market and beyond. The DOI projects that those who buy coverage on the individual market will see a reduction in premiums of between 9 and 18 percent once coverage starts in January 2022.

HCPF Executive Director Kim Bimestefer said at the official release, “We spent some time yesterday with...the Colorado Medical Society and we challenged them to step up and [to] bring the things to the table that you can do to be part of the solution, especially in the area of empowering physicians to be able to better control cost and quality, and we are eager to know what they come forward with. Now that we have a foundation, now we can refine.” Both Insurance Commissioner Mike Conway and Director Bimestefer thanked CMS for our active engagement on this initiative and encouraged our continued collaboration.

The state will accept comments on the draft until Oct. 25. CMS leadership and the physician members on the Work Group on Health Care Costs and Quality will analyze the proposal against CMS’ initial comments and recommendations on the state option, and make further recommendations to the CMS Board of Directors for action. Watch for more as the process unfolds in ASAP and Colorado Medicine.


Categories: Communications, ASAP, Resources, Practice Evolution, Payment Reform, Interacting With Payers, Health System Reform