Thank you for your advocacy!

The Colorado General Assembly adjourned sine die yesterday, Wednesday, May 8. This session featured some of the most important priorities to physicians, and we would not have gained so many legislative wins without your help. 

Success by the numbers: 

• 1,822 advocacy messages sent to legislators by CMS members and practice staff.
• 38 positions taken on bills by the CMS Council on Legislation and 62 bills monitored by staff.
• 14 meetings of the Council on Legislation before and during the session.

Crisis averted: Last minute legislative fix ends attack on liability caps and peer review

The epic attack on Colorado’s stable tort environment is over and the prospect of catastrophic November ballot initiatives has been averted. With just days left in the legislative session, a deal was brokered by Alec Garnett, Gov. Polis’ chief of staff, with Coloradans Protecting Patient Access (CPPA) and Colorado Trial Lawyers Association (CTLA) to increase non-economic damage caps. CMS partnered with COPIC, the Colorado Hospital Association and many others through CPPA over the past year to protect patient access to care, safeguard the stable liability climate, preserve peer review, and avoid a costly ballot fight. Hours of final negotiations over the weekend led to the introduction of HB24-1472: Raise Damage Limit Tort Actions, which passed its final vote Tuesday and is awaiting signature by the governor. The bill will increase the medical non-economic damages cap over a five-year period from the current $300,000 to $875,000 and establish a new, wrongful death cap at $1.575 million. Starting in 2030, the medical caps will be adjusted for inflation every two years. Separately, the bill will also increase general liability non-economic damage and wrongful death caps over time. See detailed analysis here. 

As part of the agreement on the bill, CTLA will withdraw the ballot initiatives that would have eliminated all non-economic damage caps and obliterated confidential information protections (including peer review) that promote patient safety in medical care.

This has been a difficult fight. While these are significant cap increases that are challenging to accept, our objectives were achieved, and the right decision was made to protect patients, practices, and Colorado’s health care system. CMS is grateful for the strong partnership with CPPA under the guidance of Executive Director Tamra Ward, for Governor Polis and Alec Garnett for their leadership, and for bill sponsors Sens. Kyle Mullica and Bob Gardner and Reps. Kyle Brown and Rose Pugliese. CMS thanks all members who answered call-to-action alerts and who donated to the Medical Liability Defense Fund. 

The 2024 legislative session was a monumental year for advancing your priorities and defending medicine

Gov Polis signing HB24-1058

• HB24-1472: Raise Damage Limit Tort Actions modernizes Colorado’s medical and general liability laws, maintains liability caps and preserves peer review, while avoiding a costly ballot fight. This bill was introduced and passed in the final week of the session in place of SB24-130.

• HB24-1149 Prior Authorization Requirements Alternatives passed and is awaiting signature by the governor. This three-year effort culminated in a law that will place more health care decisions in the hands of patients and physicians, including extending prior auth approvals from 180 days to six months and increasing approval time frames for chronic medications to three years for certain situations, prohibiting denials that were approved but require additional care during surgery, and requiring the development of alternative programs for prior auth for medical services and medications. See the detailed analysis here. CMS's Health Can't Wait campaign was critical to pass the bill, collecting stories from patients and physicians.
• HB24-1171 Naturopathic Doctors Formulary was defeated; the bill would have given naturopaths the ability to prescribe most schedule III-V drugs. If this bill returns in the future, then CMS will continue to fight for patient safety and against inappropriate scope of practice expansion for naturopaths.
• SB24-163 Arbitration of Health Insurance Claims is a bill CMS supported but that was ultimately postponed indefinitely. A few years ago, Colorado passed legislation on out-of-network claims, sometimes known as surprise bills. CMS does not support unethical billing practices. This bill, which came on the heels of years of battles with health plans, solved some of this issue. But it failed to address the inability for a physician to batch out-of-network claims. This helps huge health plans to game the system by either forcing take-it-or-leave-it, severely discounted contracts (20%-40%) or purposely terminating contracts with practices to send them out-of-network knowing that the current arbitration process unfairly hurts physicians. The importance of this issue remains in spite of the demise of the bill (see fact sheet).
• HB24-1014 Deceptive Trade Practice Significant Impact Standard was a redo of a bill CMS similarly defeated last year. Had it passed, the bill would have increased liability exposure for physicians by finding automatically that there has been a “public impact” based solely on evidence of an unfair trade practice. Physicians would be liable for treble damages and attorney fees.
• Key bills were passed to support continued work on the opioid epidemic, including getting Naloxone into schools (HB24-1003), creating more harm reduction policies to support better health by those with substance use disorders (HB24-1037), and expanding treatment for substance use disorders (HB24-1045). 
• SB24-082 Patient's Right to Provider Identification is another bill CMS supported that was postponed indefinitely. Over the past few years there has been an alarming increase in inappropriate attempts to expand the scope of practice for non-physician providers. This bill (fact sheet) aimed to help patients understand what type of provider was treating them. As CMS President Omar Mubarak, MD, MBA, noted in testimony before the Senate Health & Human Services Committee, “Patients deserve the right to know who is treating them and what their qualifications and levels of training are before they can safely consent to treatment.” While the bill failed to pass this year, ensuring transparency about care to inform patient decision-making will continue to be important.

Lt Gov. Primavera Signing SB 87 which will reduce costs for patients.

• The CMS advocacy team secured crucial amendments to HB24-1153 Physician Continuing Education: Instead of a mandated 40 hours of CME required every two years, with 12 of those hours dedicated to reproductive health, the bill now includes 30 required hours of CME that can be met through national board certification. The Colorado Medical Board will conduct stakeholding to consider whether specific CME topics should be required for physicians.
• SB24-062 Prohibit Attorney Fees on Personal Injury Interest was killed in committee. Patients should get the timely awards they are owed from a lawsuit. CMS Strongly supported this bill that aimed to put an end to the longstanding trial lawyer practice of delaying action on cases because they make more money by claiming 9% interest per annum on damages from the date the cause of an action accrued to the date the judgment is satisfied.
• HB24-1058 Protect Privacy of Biological Data was signed into law. This first-in-the-world legislation protects the privacy of individuals’ personal biological data, including neural data that is collected by devices now and in the future. Northern Colorado neurologist Sean Pauzauskie, MD, championed this bill following a concern raised during a patient visit -- demonstrating how we can work with patients to create positive change.
• Workforce capacity issues, especially in rural areas of Colorado, have been a big problem. CMS proudly supported a bill (SB24-221) to expand the Colorado Rural Health-Care Workforce Initiative to increase the number of health care professionals practicing in rural counties. The bill passed on the last day of 2024 legislative session.

Advocacy isn't over when the legislative session ends

Advocacy works; 2024 exemplifies how physician advocacy makes a difference, and how important it is to remain engaged and ready for the next fight. CMS will continue to build relationships with key legislators, and we are already looking toward the next legislative session. Here are ways for you to stay involved: 

• Watch for CMS communications on how these laws will affect you.
• Click here to let us know if you are interested in meeting your legislators in the summer; it is a great time to have coffee or invite them to your practice.
• The Colorado primary election will be on June 25. Click here to see candidates that COMPAC has endorsed.
• Regulation carries the same weight as law, and various state agencies from the Division of Insurance to the Colorado Medical Board are expected to pass new regulations over the summer months. Stay tuned for opportunities to get involved, and how regulations may impact your practice.
• Donate to COMPAC and the Small Donor Committee to fund the future of advocacy.

CMS advocacy highlights in the news: 

"Your Brain Waves Are Up for Sale. A New Law Wants to Change That."  "Medical decisions should be made between patient and provider."  "Patients and health care providers report growing frustration with Medicare Advantage."  "Colorado insurance proposals would hurt our most vulnerable patients"  "Opinion: Colorado lawmakers can empower patients and physicians, not insurance companies and algorithms, to make medical decisions"

Medicaid RAC audit officially fixed

For more than a year and a half the Colorado Medical Society has been working to address issues with a Medicaid RAC audit that were thought to have been addressed at the beginning of 2024.

In a May 1, 2024 communication, HCPF officially confirmed the fix to the initial hospital care code audit: “We have halted mailing on this audit and will ensure that no other notices are mailed for medical claims billed before 2023. Overpayments will only be identified for claims billed in 2023 when a physician from the same specialty and subspecialty who belongs to the same group practice billed the initial hospital care code (99221-99223) for the same patient during the same inpatient admission. This same criteria will be applied to all existing informal reconsideration requests and appeals identified through this audit. Going forward, we will use the E&M medical coding that was in place at the time the claim was billed, which is the normal process for any RAC audits.”    

While it has taken longer than expected, the Colorado Medical Society is pleased to receive this official confirmation. We are grateful to physicians that raised concerns about this issue and encourage their ongoing dedication to providing care for Medicaid patients. CMS appreciates HCPF’s work on this issue.