COLORADO

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Colorado’s SBL became effective January 1, 2020. The relevant provisions include: an arbitration process with a 90-day timeframe for taking action, and, depending upon the provider, reimbursement is tied to median INN rates and an All-Payor Health Claims Database (APCD). These databases typically use Medicare and Medicaid rates as inputs, and so Colorado’s reimbursement rates in the SBL circumstances are sure to be relatively low. See Colorado Revised Statutes 10-16-704.

Regarding bifurcation, CMS gas stated,

Colorado does not have an applicable All-Payer Model Agreement that would determine the out-of-network rate. Based on the survey response and CMS communications with Colorado Department of Regulatory Agencies and Colorado Department of Health Care Policy and Financing staff, and the Governor’s office, CMS understands that C.R.S. § 10-16 704(3)(d)(II), §10-16-704(5.5), and § 10-16-704(15) are specified state laws that will apply for purposes of determining the out-of-network rate with respect to items and services furnished to individuals in an insured group health plan, or group or individual health insurance coverage in Colorado by nonparticipating providers or nonparticipating emergency facilities.4 The federal independent dispute resolution process under section 2799A-2(b) of the PHS Act and 45 CFR 149.520 will apply for purposes of determining the out-of-network rate with respect to any services furnished to individuals in an insured group health plan, or group or individual health insurance coverage in Colorado by nonparticipating providers of air ambulance services. CMS will enforce the outcome of the federal independent dispute resolution process for such cases in Colorado. Letter from CMS to Governor of Colorado, dated January 18, 2022.