Page Updated: March 15, 2023
CHA Advocacy Principle: All rates must ensure payment adequacy and efficiency to provide care, and any rate-setting determination should include a fair, transparent process that provides due consideration to cost-drivers, such as pharmaceutical and labor costs, and recognizes good-faith efforts to negotiate.
What Has Been Completed:
Origin: House Bill (HB) 21-1232 established the Standardized Health Benefit Plan Colorado Option.
Background: The regulatory process began to operationalize the Colorado Option in July 2021, and included the development of the standardized plan, cultural competency requirements, the federal 1332 waiver to provide pass-through funding, and the rate-setting process.
Outstanding Items: 2023 is the first plan year that Colorado Option plans are available to consumers. In May, the DOI gains rate-setting authority to set hospital rates for Colorado Option plans following a rate-setting hearing.
The DOI is currently in the processing of pursuing legislative updates to the Colorado Option through HB 23-1224. This legislation would update the preference process for plan selection, grant the Commissioner 120 days to review the rate filings, increase the Commissioner’s discretion to bring a provider to a hearing once identified by a carrier, make all appeals subject only to the court of appeals.
- DOI Slide Deck for CHA Regulatory Update on Rate Hearings
- Recording Information for CHA’s February Regulatory Update on Colorado Option (passcode: mJ5#0GgP)
- Division of Insurance Colorado Option Webpage
- DOI List of Individual Medical Plans by Region/County
- DOI List of Small Group Medical Plans by Region/County
- Colorado Option Timeline
- Nov. 18, 2022 CHA Rates/Hearing Comment Letter
- Agency Contact Information: [email protected]
- CHA Executive Brief on Rate-Setting
Meetings/Dates of Note:
- March – Carriers must notify DOI if unable to hit premium reduction targets (10% below 2021 rates)
- Wednesday, April 26 – Colorado Option Advisory Board Meeting- register here
- May – Public hearings will occur on premium rate reductions and provider rate setting
- September/October – DOI publicly releases standardized plan rates
- November – January 2024 – Colorado Option plans for 2024 plan year available for purchase
CHA Staff Contact: Megan Axelrod, CHA director of regulatory policy and federal affairs, [email protected]