HB 19-1233: Primary Care Payment System Reforms

• Creates a Primary Care Payment Reform Collaborative convened by the Insurance Commissioner to develop recommendations for increasing primary care investments through alternative payment models that provide value-based incentives rather than fee-for-service payments.

• Requires the Commissioner to establish affordability standards with targets for carrier investments in primary care, informed by the collaborative's recommendations and primary care spending data from the all-payer health claims database.

• Directs health insurers and the state Medicaid program to adopt targets for primary care investments aligned with affordability standards, with exemptions for nonprofit health maintenance organizations with single contracted medical groups.

• Mandates annual reporting on primary care spending percentages, alternative payment model usage, and non-fee-for-service payments by carriers, Medicaid, and the Children's Basic Health Plan.

• Appropriates $109,679 for the 2019-20 fiscal year to support collaborative operations and sunsets the collaborative on September 1, 2025, subject to legislative review.