CO HB1005

Health-care insurance carriers must include primary care providers as participating providers in all health benefit plan networks (including narrow and tiered networks) effective January 1, 2027, if the provider meets four criteria: Colorado licensure, national certification or accreditation, enrollment in an alternative payment model, and Medicaid credentialing.

The Colorado Commissioner of Insurance must promulgate rules by December 31, 2025, establishing criteria for determining qualifying providers and a reimbursement schedule for contracted primary care providers.

The Division of Insurance must contract with an actuary to establish a minimum reimbursement schedule for alternative payment models that equals Colorado standardized health benefit plan rates, includes regional cost-of-living adjustments, and may include incentives for behavioral health integration.

If a carrier and primary care provider cannot negotiate reimbursement terms, the carrier must compensate the provider according to the rule-established reimbursement schedule.

Primary care providers who leave employment at a medical group or hospital system to establish independent practices may communicate with patients about continuing care in the new practice, and employment agreements with four-year terms cannot restrict competition-related damages upon termination.