The Commissioner of Insurance (“Commissioner”) must provide notice on the proposed dates for Colorado Option public hearings pursuant to § 10-16-1306(3)(c), C.R.S. Per Regulation 4-2-92, this notice is provided to health insurance carriers offering individual and small group Colorado Option Standardized Plans on or after January 1, 2024, and to hospitals and health-care providers subject to the requirements in § 10-16-1306, C.R.S.
PURPOSE & SCOPE OF CO OPTION HEARINGS
Carriers operating in the Colorado individual and small group markets must offer a Colorado Option Standardized Plan (“CO Option Plan”) at the bronze, silver, and gold metal levels in counties where they offer non-CO Option Plans. In 2024, a carrier must also offer CO Option plans at a premium rate that is at least ten (10) percent less than the premium rate for health benefit plans that the carrier offered in the 2021 calendar year, as adjusted for medical inflation, in the individual and small group markets. A carrier must file CO Option Plan premium rates with the Commissioner consistent with the premium rate reduction requirements in § 10-16-1305(2), C.R.S. Further, a carrier’s CO Option Plan must meet the network adequacy requirements in § 10-16-1304(1)(g), C.R.S. If a carrier is unable to offer the CO Option Plan at the premium rate reduction requirement for plan year 2024 or in compliance with the network adequacy requirements, the carrier must notify the Commissioner as to why the carrier is unable to meet the requirements.
A public hearing may be held if:
- a carrier notifies the Division that it is unable to meet the premium rate reduction requirement in § 10-16-1305(2), C.R.S., for plan year 2024;
- the Commissioner otherwise determines that a carrier has not met the premium rate reduction requirement in § 10-16-1305(2), C.R.S., for plan year 2024; or
- a carrier notifies the Division that it will be unable to meet or the Commissioner otherwise determines that a carrier has not met the network adequacy requirements and has not filed an Action Plan with the Division pursuant to § 10-16-1304(2)(b), C.R.S.
Hearings will address the reasons for a carrier’s failure to meet the premium rate reduction or network adequacy requirements. Hearings will be held before the Commissioner and include the following entities as Parties: the Consumer Insurance Ombudsman at the Department of Healthcare Policy & Financing, carriers, hospitals, healthcare providers, and other affected persons as determined by the Commissioner. Members of the public and consumer advocacy organizations will also be able to testify during the hearings. Detailed information on the structure of these hearings can be found in Regulation 4-2-92.
POTENTIAL OUTCOMES
In accordance with § 10-16-1306(4)(a)-(d), C.R.S., following a public hearing and if necessary for a carrier to meet the premium rate reduction and network adequacy requirements in § 10-16-1305, C.R.S., the Commissioner may:
- Establish hospital and healthcare provider reimbursement rates under a carrier’s CO Option Plan consistent with the reimbursement rate guidelines in § 10-16-1306, C.R.S.; and
- Require hospitals and healthcare providers to accept the established reimbursement rates.
The Commissioner will only set reimbursement rates for hospitals or healthcare providers that prevented a carrier from or caused the carrier to fail to meet the premium rate reduction or network adequacy requirements.
In accordance with § 10-16-1306(4)(e), C.R.S., the Commissioner may also require a carrier to offer the CO Option Plan in specific counties where no carrier is offering a CO Option Plan in that plan year in either the individual or small group market.
All decisions from the Commissioner are considered a Final Agency Action subject to judicial review pursuant to § 24-4-106(6), C.R.S
PROPOSED HEARING SCHEDULE
Use the link below to access the proposed hearing schedule for carriers operating in the individual and small group markets in Colorado for plan year 2024. Hearings may be held virtually, in-person, or in a hybrid manner with virtual and in-person options. A Final Notice of Hearing will be sent to all Parties at least 30 (thirty) days prior to the final hearing date. Please note that there are two dates proposed for each carrier. The date labeled “Overflow Date” will allow the Commissioner to hold an additional hearing in the case that more time is needed for decision-making. Both the hearing date and “overflow date” will run from 8:00 am - 5:00 pm.
Colorado Option Public Hearings Schedule and Information
The Commissioner’s filing information is:
Colorado Commissioner of Insurance
1560 Broadway, Suite 850
Denver, Colorado 80202
Fax: (303) 894-7455
If you have questions about these hearings or the schedule, please send an email to dora_ins_co_option@state.co.us.