Colorado’s Citizen Legislature – Mar. 2015
~ By Doris Beaver ~
House Bill 15-1039: While not specifically directed toward the 50 and over population, HB 1029 will most likely be of great interest, especially to citizens in rural areas of Colorado.
HB 1029 concerns requirements that “all health benefit plans issued, amended or renewed in Colorado to individuals residing in a county with less than 150,000 residents, cannot require face-to-face contact between a provider and a covered person for services that could be delivered via telehealth.” The bill also provides that “telehealth benefits must provide the same standard of care as in-person care,” and was amended to provide beneficiaries with telehealth options beginning January 1, 2017.
Clarification includes these:
- telehealth is not required when a health care provider determines that telehealth is not the most appropriate standard of care;
- health insurance carriers must reimburse providers for telehealth services on the same basis of in-person care for the diagnosis, treatment or consultation of care;
- payments from carriers must include reasonable compensation for the transmission cost of telehealth care except for situations when the originating site is the private residence of the covered person; and
- deductibles, copayments, or coinsurance requirements for healthcare services delivered through telehealth must not exceed any of the costs associated with in-person diagnosis, consultation or treatment.
Among the amendments to HB 1029, change the term “telemedicine” to “telehealth,” “medical” to “health care,” “face-to-face” to “in-person,” and the effective beginning date was changed from 2016 to 2017.”
Lead Sponsors of House Bill 15-1029: Representatives Perry Buck (R-Larimer, Weld) 866-2907, and Joann Ginal (D-Larimer) 866-4569; Senators John Kefalas (D-Larimer) 866-4841, and Beth Martinez Humenik (R-Adams) 866-4863.
Senate Bill 15-123: Under the provisions of SB 123, filling one’s prescriptions may be more cost efficient if the bill passes and is enacted. SB 123 “allows an individual covered by a health insurance plan to fill a prescription for a specialty drug or biological product at a network pharmacy of his or her choice if proper notice is filed with the insurance carrier or the pharmacy benefit manager (PBM).
Also created in SB 123 is a “process for local pharmacies to attest that they are able to fill the prescription in compliance with state and biological products provided by the health plan for existing network pharmacies.”
SB 123 also imposes other requirements on PBMs and insurance carriers in covering specialty drugs and biological products dispensed by local pharmacies:
- prohibiting different payment terms when filled by a local pharmacy compared with a mail-order pharmacy or other designated pharmacy; and
- prohibiting incentives for a covered individual to fill a prescription through a mail-order pharmacy or other designated pharmacy.
SB 123 also contains a provision that “any violation of the bill constitutes an unfair or deceptive act or practice for the business of insurance.
Sponsors of Senate Bill 15-123: Senator Larry Crowder (R-Alamosa, Baca, Bent, Conejos, Crowley, Custer, Huerfano, Kiowa, Las Animas, Mineral, Otero, Prowers, Pueblo, Rio Grande, Saguache) 866-4875; and Representative Diane Primavera (D-Boulder, Broomfield) 866-4667.
Doris Beaver is a free lance journalist who writes from her home high in the Colorado Rocky Mountains on senior issues, politics, ethics and environmental issues. Visit her website www.dorisbeaver.com, or e-mail her at firstname.lastname@example.org.