Colorado Code § 10-16-155

Actuarial reviews of proposed health-care legislation - division to contract with third parties - required considerations - confidentiality - limits on expenditures - rate filings - repeal
Open in Lexace · Ask the AI about this section
(1) On or before November 1, 2022, the division shall
retain by contract one or more entities that have experience in actuarial reviews, health-care
policy, and health equity, referred to in this section as the "contractors", for the purpose of
performing actuarial reviews of legislative proposals that may impose a new health benefit
coverage mandate on health benefit plans or reduce or eliminate coverage mandated under health
benefit plans, referred to in this section as "legislative proposals". At least one of the contractors
must be an actuary or an actuarial firm with experience in analyzing health insurance premiums.
The contractors, under the direction of the division, shall conduct actuarial reviews of up to six
legislative proposals, regardless of the number of legislative proposals that are requested for
each regular legislative session by members of the general assembly.
(2) Before September 1, 2022, the division shall convene a meeting to obtain input and
recommendations from stakeholders, including representatives of the health-care industry,
consumer advocates, and other interested individuals, concerning the methodology for
conducting the analysis described in subsection (4) of this section.
(3) (a) A member of the general assembly who requests an actuarial review of a
legislative proposal shall submit the request to the division no later than September 1 of the year
preceding the regular legislative session in which the legislative proposal will be proposed.
(b) For each regular legislative session:
(I) Up to two members of the majority party of the house of representatives may submit
a request for an actuarial review. If more than two requests are submitted, the division shall
notify the majority leader of the house of representatives, who shall select the two proposals that
the contractors review.
(II) One member of the minority party of the house of representatives may submit up to
one request for an actuarial review. If more than one request is submitted, the division shall
notify the minority leader of the house of representatives, who shall select the proposal that the
contractors review.
(III) Up to two members of the majority party of the senate may submit a request for an
actuarial review. If more than two requests are submitted, the division shall notify the majority
leader of the senate, who shall select the two proposals that the contractors review.
(IV) One member of the minority party of the senate may submit up to one request for
an actuarial review. If more than one request is submitted, the division shall notify the minority
leader of the senate, who shall select the proposal that the contractors review.
(c) On or before each September 15, the majority and minority leaders of the house of
representatives and the senate shall notify the division, as may be necessary as described in this
subsection (3), of the legislative proposals subject to review under subsection (1) of this section.
(4) An actuarial review performed by the contractors pursuant to this section must
consider the predicted effects of the legislative proposal during the five and ten years
immediately following the effective date of the legislative proposal, or during another time
period following the effective date of the legislative proposal if such consideration is more
actuarially feasible, including:
(a) An estimate of the number of Colorado residents who will be directly affected by the
legislative proposal;
(b) Estimates of changes in the rates of utilization of specific health-care services that
may result from the legislative proposal;
(c) Estimates concerning any changes in consumer cost sharing that would result from
the legislative proposal;
(d) Estimates of any increases or decreases in premiums charged to covered persons or
employers for health benefit plans offered in the individual, small group, and large group
markets that would result from the legislative proposal;
(e) An estimate of the out-of-pocket health-care cost changes associated with the
legislative proposal;
(f) An estimate of the potential long-term health-care cost changes associated with the
legislative proposal;
(g) Identification of any potential health benefits for individuals or communities that
would result from the legislative proposal; and
(h) To the extent practicable, the social and economic impacts of the legislative
proposal.
(5) An actuarial review performed pursuant to this section must:
(a) Present the information described in subsection (4)(d) of this section in terms of
percentage increase or decrease and in terms of per-member, per-month charges;
(b) Present the information described in subsection (4)(e) of this section in terms of
dollar amounts;
(c) Provide, if available, information concerning who would benefit from any cost
changes and health benefits from the legislative proposal, as identified in subsections (4)(c),
(4)(e), (4)(f), (4)(g), and (4)(h) of this section, and any disproportionate effects that the
legislative proposal would have on Coloradans, which information, if available, must be
disaggregated, at a minimum, by race, ethnicity, sex, gender, and age; and
(d) Include, to the extent practicable, a qualitative analysis of the impacts of the
legislative proposal. For the purposes of this subsection (5)(d), a member of the general
assembly who requests an actuarial review of a legislative proposal pursuant to this section may
designate one or more persons to provide data to the contractors in order to inform a qualitative
analysis of the legislative proposal.
(6) In performing actuarial reviews of legislative proposals, the contractors may utilize
data from the all-payer health claims database described in section 25.5-1-204, data collected
from carriers, or data from other sources. Carriers shall provide information to, and otherwise
cooperate with, the contractors and the division for the purposes of this section.
(7) The commissioner is not required to comply with the state "Procurement Code",
articles 101 to 112 of title 24, for the purposes of hiring contractors by November 1, 2022, as
described in subsection (1) of this section, or for contracting for the collection of data, but the
commissioner shall comply with the state "Procurement Code" when hiring contractors or
contracting for the collection of data after November 1, 2022.
(8) A request for an actuarial review pursuant to this section and the final report
resulting from such a request shall be treated as confidential except by the member of the general
assembly who made the request until the legislative proposal that is the subject of the actuarial
review is introduced in the regular legislative session following the submission of the request for
the actuarial review or, if no such legislative proposal is introduced, until after the end of the
legislative session following the submission of the request.
(9) (a) Notwithstanding any other provision of this section to the contrary, the division
shall not engage any contractor to perform an actuarial review as described in this section unless
the division determines that there are adequate resources available within existing appropriations
to compensate the contractor for the actuarial review.
(b) After July 1, 2025, the division shall use resources allocated for actuarial reviews of
legislative proposals pursuant to this section for the review of rate filings filed with the
commissioner pursuant to section 10-16-105.1 (3.5)(e).
(c) In the event that the division determines there are not adequate resources available
within existing appropriations to compensate the contractor for an actuarial review in accordance
with subsection (9)(a) of this section, the division shall prioritize resources to ensure that an
actuarial review of the rate filings submitted to the commissioner pursuant to section 10-16-
105.1 (3.5)(e) occurs before December 31, 2025.
(10) The division may seek, accept, and expend gifts, grants, and donations for the
purposes of this section.
(11) This section is repealed, effective November 1, 2027.

‹ Prev All Colorado sections Next ›


Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.