SB14-159 Summary

• Establishes a task force to develop uniform, standardized payment rules and claim edits for processing medical claims in Colorado, with a deadline of December 31, 2014.

• Task force must identify rules and edits through existing national industry sources and consider standardizing 23 specific types of edits including unbundling, mutually exclusive procedures, age/gender restrictions, and global surgery days.

• Requires commercial health plans to implement standardized rules by January 1, 2016 (or per national initiative schedule, whichever is first) and domestic nonprofit health plans by January 1, 2017.

• Mandates that starting January 1, 2015, the task force make draft rules available for public review and comment through December 31, 2015, then submit final recommendations by January 31, 2016.

• Appropriates $128,688 from the general fund to the Department of Health Care Policy and Financing for fiscal year 2014-2015 to support task force operations and requires ongoing annual reviews and updates to the rules beginning January 1, 2017.