Colorado HB17-1115 was signed into law on 04/24/17 making Colorado the 20th state to pass DPC legislation. Numerous DPC practices are known to be operating within the state. When designing your contract be sure to review regulations from the Colorado Department of Insurance and from Title 10, Article 16, Part 4 Health Maintenance Organizations.
Note that Colorado Revised Statutes Title 25.5. Health Care Policy and Financing § 25.5-4-301 prohibits any physician from privately contracting with any Medicaid patient for services covered by Medicaid. This harsh and discriminatory provision is also discussed on page two of this provider bulletin. Colorado Medicaid patients should be informed when they enroll that the state is prohibiting them from privately contracting for covered services with any Colorado provider.
Here are some of the most important legal definitions:
(12) "Insurance" means a contract whereby one, for consideration, undertakes to indemnify another or to pay a specified or ascertainable amount or benefit upon determinable risk contingencies, and includes annuities.
(32) (a) "Health benefit plan" means any hospital or medical expense policy or certificate, hospital or medical service corporation contract, or health maintenance organization subscriber contract or any other similar health contract subject to the jurisdiction of the commissioner available for use, offered, or sold in Colorado.
(b) "Health benefit plan" does not include:
(I) Accident only;
(V) Medicare supplement;
(VI) Benefits for long-term care, home health care, community-based care, or any combination thereof;
(VII) Disability income insurance;
(VIII) Liability insurance including general liability insurance and automobile liability insurance;
(IX) Coverage for on-site medical clinics;
(X) Coverage issued as a supplement to liability insurance, workers' compensation, or similar insurance;
(XI) Automobile medical payment insurance; or
(XII) Specified disease, hospital confinement indemnity, or limited benefit health insurance if the types of coverage do not provide coordination of benefits and are provided under separate policies or certificates.
(c) Solely with respect to section 10-16-118, "health benefit plan" excludes individual short-term limited duration health insurance policies.
(35) "Health maintenance organization" means any person who:
(a) Provides, either directly or through contractual or other arrangements with others, health care services to enrollees; and
(b) Provides, either directly or through contractual or other arrangements with other persons, health care services, including, at a minimum, emergency care, inpatient and outpatient hospital services, physician services, outpatient medical services, and laboratory and X-ray services; and
(c) Is responsible for the availability, accessibility, and quality of the health care services provided or arranged.