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Tip of the week: Learn new features of SB 79

Managed Care Weekly Advisor, June 6, 2007

The Colorado General Assembly passed Senate Bill (SB) 79 in March, addressing contractual arrangements between healthcare providers and health plans. It is designed to reduce administrative complexity, resulting in lower costs to physician practices. Here are four key provisions in the bill.

  1. Standardized contract language between health insurers and physicians. One of the most debated terms of the agreement between plans and providers, this provision ensures that comparing contracts is easier on health insurers and physicians alike.

  2. Disclosure of payment terms in plain language.This portion of the bill mandates that payers disclose the fees they will pay providers as well as the methodology they are using to establish a fee schedule. While fee schedules are common, the reality of the practice actually seeing them is not.

  3. Advance notice of proposed contract changes.Prior to the bill, many payer contracts stipulated that terms could be changed by an amendment on the payer's Web site. This new provision eases the compliance burden on practices, which no longer need to monitor dozens of Web sites to look for changing contract terms.

  4. Ban against requirements to accept all product clauses. Providers are obligated to accept only the products that are stated in their contract. If a payer seeks the participation of a provider in additional products, the payer must present the products in an amendment and give the provider an opportunity to respond.