CO HB1174

Caps hospital reimbursement rates for state employee and small employer group health plans at 165% of Medicare rates for in-network services and 150% for out-of-network services, effective January 1, 2027 for small group plans and July 1, 2026 for state employee plans

Establishes minimum reimbursement floors of 135% of Medicare rates for primary care services and outpatient behavioral health services to protect provider payments in these areas

Prohibits hospitals and health facilities from balance billing patients for amounts exceeding the capped reimbursement rates, limiting patient costs to standard copays, coinsurance, and deductibles

Requires annual reporting of general fund savings from reduced state employee health plan costs, with 80% of savings directed to the primary care fund and 20% to benefit state employees through union negotiations

Mandates a feasibility study by January 1, 2028 on extending similar reimbursement limits to school district, higher education, and local government employee health plans, funded with $500,000 from calculated savings