The Colorado Division of Insurance (DOI) announced this week that it plans to issue two April bulletins that clarify the requirements for insurance companies looking to develop provider networks.
Provider networks are groups of healthcare providers and professionals that are contracted with certain health insurance companies to offer health services at agreed-upon rates.
State regulators, stakeholders and advocacy groups from all over the country cooperated in the development of the National Association of Insurance Commissioners (NAIC) model law on network adequacy in 2015. Later that year, NAIC approved the model law.
The state DOI organized stakeholder meetings with local organizations (such as the Colorado Consumer Health Initiative, the Colorado Medical Society, the Colorado Association of Health Plans, the Colorado Center on Law & Policy, the Colorado Hospital Association, and the Chronic Care Collaborative) in the past two months on how to best implement the model law in Colorado. It was decided that bulletins introducing the model law would go first, followed by formal regulations.
Bulletin 4.90 and Bulletin 4.91 were issued last March. The former provides insurers with the standards and guidance on network adequacy. The latter sets requirements for how insurers file their network access plans with the DOI.
Bulletin 4.92 was issued April 11, which defines the standards for the provider directories for the plans of health insurers.
Bulletin 4.93 is expected to be issued sometime mid-April. It will tackle with the effects of providers who leave or who are removed from a company’s network.
All four bulletins will be made available for reference on the DOI’s website.
