Colorado 2025 Regular Session Status: In Committee 18 D cosponsors

HB 25-1174 — Reimbursement Requirements for Health Insurers

Last action — House Second Reading Laid Over to 05/09/2025 - No Amendments

  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed House
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2025 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there are no live odds of enactment. It would have to be reintroduced in the current session to move again.

Summary

The bill sets the reimbursement rates that a health insurance carrier (carrier) may reimburse a health-care provider (provider) for covered services for the state employee group benefit plans (state group benefit plans) and for small employer group benefit plans (small group plans). The bill prohibits a provider that is subject to the reimbursement limitations from billing or collecting payment from a person covered under a state group benefit plan or small group plan for any outstanding balance for covered services that is not reimbursed by the carrier, except for the applicable in-network coinsurance, copayment, or deductible amounts. The bill requires a carrier to provide cost and quality of care information to the commissioner of insurance (commissioner) in the case of small group plans and to the director of the department of personnel (director) in the case of state group benefit plans, at the request of the commissioner or director, as applicable, and prohibits a carrier from entering into an agreement with a provider or third party that would restrict the carrier from providing the information. By September 1, 2027, and by September 1 each year thereafter, the director is required to provide a report to the governor's office, the state treasurer's office, and the joint budget committee that states the amount of calculated savings in general fund expenditures (calculated savings), if any, for health plan reimbursement for the prior fiscal year as a result of the reimbursement limits for state group benefit plans. The director is also required to include in the report the cost to the department in determining the calculated savings. By September 15, 2027, and by September 15 each year thereafter, of the money from the calculated savings, the state treasurer is required to transfer an amount equal to the department's costs in determining the calculated savings to the group benefit plans expenditure savings cash fund (expenditure savings cash fund), which is created in the bill, and specified percentages of the calculated savings from the general fund to the primary care fund and to the expenditure savings cash fund. The bill also requires the executive director of the department of health care policy and financing (state department) to conduct a study, in collaboration with specified state agencies, to determine the feasibility of establishing a similar reimbursement limit for group benefit plans offered to school district, higher education, and local government employees. The executive director is required to complete the study and report the findings to the general assembly on or before January 1, 2028. The bill allocates $500,000 from the calculated savings to a health care reimbursement feasibility study cash fund created in the bill and authorizes the state department to use the money to conduct the study. (Note: This summary applies to this bill as introduced.)

Bill Text

What changed in the latest version

22 added · 6 removed

Plain-language change summary

In the latest version of Bill HB 25-1174, the definition of "small group market" and "small group health benefit plan" has been clarified, and some information about outpatient behavioral health services has been removed. Specifically, the changes outline how much insurance carriers must reimburse healthcare providers for certain services, establishing a limit based on the carrier's contracted rates or Medicare reimbursement rates. This update is significant because it aims to keep healthcare costs predictable for both providers and small employers, potentially making health coverage more affordable.

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25-0421.02 Nicole Myers x4326 & Kristen Forrestal x421774 HOUSE SPONSORSHIP Brown and SirotaBacon, Boesenecker, Clifford, Garcia, Gilchrist, Hamrick, Lindsay, Martinez, McCormick, Rutinel, Story, Velasco, Willford, Zokaie SENATE SPONSORSHIP Bridges and JodehAmabile House Committees Senate Committees Health & Human Services Appropriations A BILL FOR AN ACT C ONCERNING LIMITS ON THE AMOUNTS THAT CERTAIN HEALTH INSURERS MAY REIMBURSE FOR THE PROVISION OF CERTAIN HEALTH -CARE SERVICES ,AND ,IN CONNECTION THEREWITH , CREATINGTHE "SUPPORT C OLORADO 'SH EALTH-C ARES AFETY N ETA CT OF2025".
25-0421.02 Nicole Myers x4326 & Kristen Forrestal x421774 HOUSE SPONSORSHIP Brown and SirotaBacon, Boesenecker, Clifford, Garcia, Gilchrist, Hamrick, Lindsay, Martinez, McCormick, Rutinel, Story, Velasco, Willford, Zokaie SENATE SPONSORSHIP Bridges and JodehAmabile House Committees Senate Committees Health & Human Services Appropriations A BILL FOR AN ACT C ONCERNING LIMITS ON THE AMOUNTS THAT CERTAIN HEALTH INSURERS MAY REIMBURSE FOR THE PROVISION OF CERTAIN HEALTH -CARE SERVICES ,AND ,IN CONNECTION THEREWITH , CREATINGTHE "SUPPORT C OLORADO 'SH EALTH-C ARES AFETY N ETA CT OF2025" AND MAKING AN APPROPRIATION .
Appropriation.
(1) For the 2025-26 state fiscal year, $100,183 is appropriated to the department of regulatory agencies.
This appropriation is from the division of insurance cash fund created in section 10-1-103 (3)(a)(I), C.R.S.
To implement this act, the department may use this appropriation as follows:
(a) $40,000 for personal services related to the division of insurance;
and (b) $60,183 for the purchase of legal services.
(2) For the 2025-26 state fiscal year, $60,183 is appropriated to the department of law.
This appropriation is from reappropriated funds received from the department of regulatory agencies under subsection (1)(b) of this section and is based on an assumption that the department of law will require an additional 0.3 FTE.
To implement this act, the departmentoflawmayusethisappropriationtoprovidelegalservicesfor the department of regulatory agencies.
-21- 1174 SECTION 11.
-21- 1174
-22- 1174
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Amendments

1 amendment

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Action History

  1. House Second Reading Laid Over to 05/09/2025 - No Amendments

  2. House Second Reading Laid Over Daily - No Amendments

  3. House Second Reading Special Order - Laid Over Daily - No Amendments

  4. House Second Reading Laid Over Daily - No Amendments

  5. House Committee on Appropriations Refer Amended to House Committee of the Whole

  6. House Committee on Health & Human Services Refer Amended to Appropriations

  7. Introduced In House - Assigned to Health & Human Services

Sponsors

Sponsorship breakdown

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4 sponsors · 15 co-sponsors · 82 not signed on

Sponsors (4)

Co-sponsors (15)

Not signed on (82)

82 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

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Subjects

healthcare health-insurance
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Frequently asked questions

What does HB 25-1174 do?
The bill sets the reimbursement rates that a health insurance carrier (carrier) may reimburse a health-care provider (provider) for covered services for the state employee group benefit plans (state group benefit plans) and for small employer group benefit plans (small group plans). The bill prohibits a provider that is subject to the reimbursement limitations from billing or collecting payment from a person covered under a state group benefit plan or small group plan for any outstanding balance for covered services that is not reimbursed by the carrier, except for the applicable in-network coinsurance, copayment, or deductible amounts. The bill requires a carrier to provide cost and quality of care information to the commissioner of insurance (commissioner) in the case of small group plans and to the director of the department of personnel (director) in the case of state group benefit plans, at the request of the commissioner or director, as applicable, and prohibits a carrier from entering into an agreement with a provider or third party that would restrict the carrier from providing the information. By September 1, 2027, and by September 1 each year thereafter, the director is required to provide a report to the governor's office, the state treasurer's office, and the joint budget committee that states the amount of calculated savings in general fund expenditures (calculated savings), if any, for health plan reimbursement for the prior fiscal year as a result of the reimbursement limits for state group benefit plans. The director is also required to include in the report the cost to the department in determining the calculated savings. By September 15, 2027, and by September 15 each year thereafter, of the money from the calculated savings, the state treasurer is required to transfer an amount equal to the department's costs in determining the calculated savings to the group benefit plans expenditure savings cash fund (expenditure savings cash fund), which is created in the bill, and specified percentages of the calculated savings from the general fund to the primary care fund and to the expenditure savings cash fund. The bill also requires the executive director of the department of health care policy and financing (state department) to conduct a study, in collaboration with specified state agencies, to determine the feasibility of establishing a similar reimbursement limit for group benefit plans offered to school district, higher education, and local government employees. The executive director is required to complete the study and report the findings to the general assembly on or before January 1, 2028. The bill allocates $500,000 from the calculated savings to a health care reimbursement feasibility study cash fund created in the bill and authorizes the state department to use the money to conduct the study. (Note: This summary applies to this bill as introduced.)
Who sponsors HB 25-1174?
HB 25-1174 is sponsored by Judy Amabile (Democrat), Yara Zokaie (Democrat), Jenny Willford (Democrat), Elizabeth Velasco (Democrat), Tammy Story (Democrat), Manny Rutinel (Democrat), Karen McCormick (Democrat), Matthew Martinez (Democrat), Mandy Lindsay (Democrat), Eliza Hamrick (Democrat), Lindsay Gilchrist (Democrat), L. García, Chad Clifford (Democrat), Andrew Boesenecker (Democrat), Jennifer Bacon (Democrat), Iman Jodeh (Democrat), Jeff Bridges (Democrat), Emily Sirota (Democrat), and Kyle Brown (Democrat).
What is the current status of HB 25-1174?
This bill died with 2025 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track HB 25-1174?
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