Primary care payment reform collaborative - created - powers and duties - report - definition - repeal

(a) Consult with the department of personnel, the executive director of the department of health care policy and financing, and the administrator of the Colorado all-payer health claims database described in section 25.5-1-204;

(b) Advise in the development of the affordability standards and targets for carrier investments in primary care established in accordance with section 10-16-107 (3.5);

(c) In coordination with the administrator of the all-payer health claims database described in section 25.5-1-204, analyze the percentage of medical expenses allocated to primary care:

(I) By health insurers;

(II) Under the Colorado Medical Assistance Act, articles 4, 5, and 6 of title 25.5; and

(III) Under the Children's Basic Health Plan Act, article 8 of title 25.5;

(d) Develop a recommendation to the commissioner on the definition of primary care for the purposes of this section;

(e) Report on current health insurer practices and methods of reimbursement that direct greater health-care resources and investments toward health-care innovation and care improvement in primary care;

(f) Identify barriers to the adoption of alternative payment models by health insurers and providers, and develop recommendations to address the barriers;

(g) Develop recommendations to increase the use of alternative payment models that are not paid on a fee-for-service or per-claim basis to:

(I) Increase the investment in advanced primary care delivered by practices that are patient-centered medical homes as defined by national or state-recognized criteria or that have demonstrated the ability to provide high-quality primary care;

(II) Align primary care reimbursement by all consumers of primary care;

(III) Direct investment toward higher value primary care services with an aim toward reducing health disparities; and

(IV) Ensure the development and consideration of alternative payment models that are responsive to the needs of primary care delivery in pediatrics.

(h) Consider how to increase investment in advanced primary care without increasing costs to consumers or increasing the total cost of health care;

(j) Annually review the alternative payment models developed by the division pursuant to section 10-16-157 (3) and provide the division with recommendations on the models.

(2) The commissioner shall invite representatives from the following to participate in the primary care payment reform collaborative:

(a) Health-care providers, including primary care providers and pediatric primary care providers;

(b) Health-care consumers;

(c) Employers that purchase health insurance for employees and employers that offer self-insured health benefit plans;

(d) Health insurers, including entities that contract with the department of health care policy and financing as managed care entities;

(e) The federal centers for medicare and medicaid services;

(f) The primary care office in the department of public health and environment created pursuant to section 25-1.5-403;

(g) The executive director of the department of health care policy and financing; and

(h) Experts in health insurance actuarial analysis.

(2.5) In carrying out the duties of subsection (1)(j) of this section, in addition to the members of the collaborative described in subsection (2) of this section, the commissioner shall include health insurers and health-care providers engaged in a range of alternative payment models.

(3) The commissioner shall convene the primary care payment reform collaborative on or before July 15, 2019.

(4) By February 15, 2023, and by each February 15 thereafter, the primary care payment reform collaborative shall publish primary care payment reform recommendations, informed by the primary care spending report prepared in accordance with section 25.5-1-204 (3)(c). The collaborative shall make the report available electronically to the general public.

(5) The division may seek, accept, and expend gifts, grants, or donations from private or public sources for the purposes of this section.

(6) As used in this section, health insurer means:

(a) A carrier that is subject to part 2, 3, or 4 of this article 16 and that is offering health benefit plans in Colorado; and

(b) A carrier that provides or administers a group benefit plan for state employees pursuant to part 6 of article 50 of title 24.

(7) This section is repealed, effective September 1, 2032. Before the repeal, the functions of the primary care payment reform collaborative are scheduled for review in accordance with section 2-3-1203.