(1) For individual and small employer health benefit plans issued or renewed for coverage to begin on or after January 1, 2014, for persons receiving a subsidy under the federal act, the commissioner shall establish, by rule that complies with federal law, a requirement that all individual and small employer health benefit plans contain a provision specifying that the policyholder is entitled to a three-month grace period for the payment of any premium due, other than the first premium, during which period the plan continues in force unless the policyholder submits written notice to the carrier, prior to discontinuance of the plan in accordance with the terms of the plan, that the policyholder is discontinuing the coverage. In accordance with federal law, the commissioner's rule may provide that the policyholder is liable to the carrier for the payment of a pro rata premium for the time the coverage was in force during the grace period.
(2) For individual and small employer health benefit plans issued or renewed for coverage to begin on or after January 1, 2014, for persons who are not receiving a subsidy under the federal act, the commissioner shall adopt a rule requiring a thirty-one-day grace period for the payment of any premium due other than the first premium.
(3) If the covered person fails to pay all or part of the premium, the carrier shall notify the covered person of the nonpayment of premium within the grace period established pursuant to this section and in accordance with section 10-16-222, 10-16-325, or 10-16-429, as applicable.
(4) The commissioner may adopt rules as necessary to implement and administer this section.
Source: L. 2013: Entire section added, (HB 13-1266), ch. 217, p. 977, � 26, effective May 13.
10-16-141. Medication synchronization services - cost sharing for partial refills - dispensing fees. (1) A carrier offering an individual or group health coverage plan in this state that provides prescription drug coverage shall offer, as part of the plan, medication synchronization services developed by the carrier that allow for the alignment of refill dates for a covered person's prescription drugs that are covered benefits.
(2) Under its medication synchronization services, a carrier shall:
(a) Not charge an amount in excess of the otherwise applicable copayment amount under the health coverage plan for dispensing a prescription drug in a quantity that is less than the prescribed amount if:
(I) The pharmacy dispenses the prescription drug in accordance with the medication synchronization services offered under the health coverage plan; and
(II) A network pharmacy dispenses the prescription drug; and
(b) Provide a full dispensing fee to the pharmacy that dispenses the medication to the covered person.
Source: L. 2014: Entire section added, (HB 14-1359), ch. 221, p. 828, � 1, effective May 17.
10-16-142. Physical rehabilitation services - copayments and coinsurance - research. (1) The Colorado commission on affordable health care created in section 25-46-103, C.R.S., shall conduct a study concerning the costs, including patient cost sharing for physical rehabilitation services. The study shall analyze costs to the health-care system, including payers and individual patients, as well as whether patient cost sharing creates barriers to the effective use of physical rehabilitation services.
(2) On or before November 1, 2015, the commission shall report its findings to the health and human services committee of the senate and the public health care and human services committee and the health, insurance, and environment committee of the house of representatives.
(3) For the purposes of this section, physical rehabilitation services means physical therapy, occupational therapy, or chiropractic services for the treatment of a person who has sustained an illness, medical condition, or injury, with the goal of returning the person to his or her prior skill and function level or maintaining the person's current skill and function level.
Source: L. 2015: Entire section added, (HB 15-1083), ch. 321, p. 1305, � 1, effective June 5.
10-16-143. Single geographic rating area - individual plans - study - report - repeal. (Repealed)
Source: L. 2016: Entire section added, (HB 16-1336), ch. 168, p. 533, � 1, effective May 17.
Editor's note: Subsection (3) provided for the repeal of this section, effective December 31, 2016. (See L. 2016, p. 533.)
10-16-143.5. Pharmacy reimbursement - substance use disorders - injections - patient counseling. (1) If a pharmacy has entered into a collaborative pharmacy practice agreement with one or more physicians pursuant to section 12-280-602 to administer injectable antagonist medication for medication-assisted treatment for substance use disorders, the pharmacy administering the drug shall receive an enhanced dispensing fee.
(2) If a pharmacy dispenses an opioid that is a schedule II or schedule III drug pursuant to section 18-18-204 or 18-18-205 to a patient who has not previously received an opioid prescription and the pharmacy provides counseling concerning the risk of opioids to the patient, the dispensing pharmacy shall receive an enhanced dispensing fee.
(3) Subsection (2) of this section does not require a carrier to contract with a pharmacy or pharmacist willing to abide by the terms and conditions for participation established by the health benefit plan or carrier.
Source: L. 2018: Entire section added, (HB 18-1007), ch. 225, p. 1432, � 4, effective January 1, 2019. L. 2019: Entire section amended, (SB 19-228), ch. 276, p. 2601, � 1, effective May 23; entire section amended, (HB 19-1172), ch. 136, p. 1657, � 51, effective October 1.
Editor's note: Amendments to this section by SB 19-228 and HB 19-1172 were harmonized.