Read the full stored bill text
HOUSE BILL 26-1002
BY REPRESENTATIVE(S) Brown and Gilchrist, Bacon, Boesenecker,
Clifford, Duran, Froelich, Goldstein, Hamrick, Lieder, Lindsay, Lukens,
McCormick, Nguyen, Rutinel, Rydin, Sirota, Smith, Stewart K., Stewart R.,
Story, Titone, McCluskie;
also SENATOR(S) Ball and Pelton B., Benavidez, Cutter, Exum,
Gonzales J., Hinrichsen, Jodeh, Kipp, Marchman, Roberts, Sullivan,
Wallace, Weissman, Coleman.
CONCERNING MEASURES TO INCREASE PATIENT ACCESS TO BEHAVIORAL
HEALTH PROVIDERS, AND, IN CONNECTION THEREWITH, EFFORTS TO
ENHANCE PROVIDER PARTICIPATION IN HEALTH -CARE PROVIDER
NETWORKS, REIMBURSEMENT OF PRELICENSED PROVIDERS WHO
PROVIDE MENTAL HEALTH SERVICES UNDER THE SUPERVISION OF A
LICENSED PROVIDER, AND DECREASING THE CLINICAL HOURS
REQUIRED TO BECOME A LICENSED CLINICAL SOCIAL WORKER.
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. In Colorado Revised Statutes, 10-16-704, add (15.5)
as follows:
10-16-704. Network adequacy - required disclosures - balance
NOTE: This bill has been prepared for the signatures of the appropriate legislative
officers and the Governor. To determine whether the Governor has signed the bill
or taken other action on it, please consult the legislative status sheet, the legislative
history, or the Session Laws.
________
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from existing law and such material is not part of
the act.
billing - rules - legislative declaration - definitions.
(15.5) (a) B EGINNING JANUARY 1, 2027, AT LEAST ONCE EVERY
TWELVE MONTHS, A CARRIER SHALL CONFIRM THE NETWORK PARTICIPATION
OF A MENTAL HEALTH PROVIDER , SUBSTANCE USE PROVIDER , OR
PSYCHIATRIC NURSE, AS THE TERMS ARE DEFINED IN SECTION 10-16-705.7,
WHO HAS NOT SUBMITTED A CLAIM IN THE PRECEDING TWELVE MONTHS OR
HAS OTHERWISE COMMUNICATED WITH THE CARRIER IN A MANNER
EVIDENCING THE PROVIDER'S INTENT TO CONTINUE PARTICIPATING IN THE
CARRIER'S NETWORK AND FOR WHOM NO CHANGE IN PROVIDER STATUS IS
REPORTED BY A CENTRALIZED NATIONAL PROVIDER DATABASE THAT
COLLECTS, STANDARDIZES, AND MAINTAINS PROVIDER CREDENTIALING AND
PRACTICE INFORMATION.
(b) THE CARRIER SHALL CONTACT THE PROVIDER, OR THE PROVIDER'S
DESIGNATED NOTICE CONTACT IDENTIFIED IN THE PROVIDER 'S CONTRACT
AGREEMENT WITH THE CARRIER, BY MAIL OR THE ELECTRONIC MEANS THAT
THE CARRIER TRADITIONALLY USES TO COMMUNICATE WITH PROVIDERS IN
THE CARRIER'S PROVIDER NETWORK TO CONFIRM THE PROVIDER'S INTENT TO
CONTINUE PARTICIPATING IN THE CARRIER 'S PROVIDER NETWORK AND TO
INQUIRE WHETHER THE PROVIDER IS ACCEPTING NEW PATIENTS. IF, BASED ON
THE PROVIDER 'S FEEDBACK , THE PROVIDER 'S INFORMATION NEEDS TO BE
UPDATED IN THE CARRIER'S PROVIDER NETWORK DIRECTORIES, THE CARRIER
MUST UPDATE ITS CARRIER 'S PROVIDER NETWORK DIRECTORIES , AS
NECESSARY, WITHIN FIVE BUSINESS DAYS AFTER CONTACTING THE PROVIDER.
(c) I F THE PROVIDER FAILS TO RESPOND TO A CARRIER 'S INQUIRY
WITHIN THIRTY DAYS AFTER THE CARRIER CONTACTS OR ATTEMPTS TO
CONTACT THE PROVIDER OR THE PROVIDER'S DESIGNATED NOTICE CONTACT
IDENTIFIED IN THE PROVIDER'S CONTRACT AGREEMENT WITH THE CARRIER,
THE CARRIER SHALL MAIL A FOLLOW -UP REQUEST TO THE PROVIDER BY
CERTIFIED MAIL, RETURN RECEIPT REQUESTED, OR THE ELECTRONIC MEANS
THAT THE CARRIER TRADITIONALLY USES TO COMMUNICATE WITH
PROVIDERS IN THE CARRIER'S PROVIDER NETWORK. IF THE PROVIDER FAILS
TO RESPOND TO THE CARRIER'S FOLLOW-UP REQUEST WITHIN THIRTY DAYS
AFTER RECEIPT OF THE REQUEST, THE CARRIER MUST REMOVE THE PROVIDER
FROM ITS CARRIER PROVIDER NETWORK AND UPDATE ITS CARRIER 'S
PROVIDER NETWORK DIRECTORIES, AS NECESSARY , WITHIN FIVE BUSINESS
DAYS AFTER THE EXPIRATION OF THE THIRTY-DAY PERIOD.
PAGE 2-HOUSE BILL 26-1002
SECTION 2. In Colorado Revised Statutes, 10-16-705.7, amend
(1)(a), (1)(b), (1)(d), (1)(j), (2)(c), (5), (6) introductory portion, (6)(b), (8)(a)
introductory portion, (8)(a)(II), (8)(b), (8)(c), (9), (9.5), and (10); and add
(1)(g.5), (1)(g.9), (1)(h.2), (1)(i.5), (1)(i.7), (1)(k), and (9.7) as follows:
10-16-705.7. Timely credentialing of providers by carriers -
notice of receipt required - notice of incomplete applications required
- delegated credentialing agreements - discrepancies - denials of claims
prohibited - disclosures - recredentialing - enforcement - rules -
definitions.
(1) As used in this section, unless the context otherwise requires:
(a) "Applicant" means a physician, MENTAL HEALTH PROVIDER ,
SUBSTANCE USE PROVIDER , OR PSYCHIATRIC NURSE who submits an
application to a carrier to become a participating physician PROVIDER in the
carrier's PROVIDER network.
(b) "Application" means an applicant's application to become
credentialed by a carrier as a participating physician PROVIDER in at least
one of the carrier's provider networks.
(d) "Credentialing" or "credential" means the process by which a
carrier or its designee collects information concerning an applicant; assesses
whether the applicant satisfies the relevant licensing, education, and training
requirements to become a participating physician PROVIDER; verifies the
assessment; and approves or disapproves the applicant's application.
(g.5) "M ENTAL HEALTH PROVIDER " MEANS A MENTAL HEALTH
ENTITY LICENSED PURSUANT TO ARTICLE 1.5 OF TITLE 25 OR MENTAL
HEALTH PROFESSIONAL LICENSED OR CERTIFIED PURSUANT TO ARTICLE 245
OF TITLE 12, EXCEPT FOR UNLICENSED PSYCHOTHERAPISTS REGULATED
PURSUANT TO ARTICLE 245 OF TITLE 12.
(g.9) "PARTICIPATING MENTAL HEALTH PROVIDER, SUBSTANCE USE
PROVIDER, OR PSYCHIATRIC NURSE" MEANS A MENTAL HEALTH PROVIDER ,
SUBSTANCE USE PROVIDER, OR PSYCHIATRIC NURSE WHO IS CREDENTIALED
BY A CARRIER OR ITS DESIGNEE TO PROVIDE HEALTH -CARE ITEMS OR
SERVICES TO COVERED PERSONS IN AT LEAST ONE OF THE CARRIER 'S
PROVIDER NETWORKS.
PAGE 3-HOUSE BILL 26-1002
(h.2) "P ARTICIPATING PROVIDER " MEANS A PARTICIPATING
PHYSICIAN OR A PARTICIPATING MENTAL HEALTH PROVIDER, SUBSTANCE USE
PROVIDER, OR PSYCHIATRIC NURSE.
(i.5) "PRE-LICENSED PROVIDER" MEANS A "REGISTRANT" AS DEFINED
IN SECTION 12-245-202.
(i.7) "P SYCHIATRIC NURSE" MEANS A REGISTERED PROFESSIONAL
NURSE, AS DEFINED IN SECTION 12-255-104, WHO , BY VIRTUE OF
POSTGRADUATE EDUCATION AND ADDITIONAL NURSING PREPARATION, HAS
GAINED KNOWLEDGE, JUDGMENT, AND SKILL IN PSYCHIATRIC OR MENTAL
HEALTH NURSING.
(j) "Recredentialing" or "recredential" means the process by which
a carrier or its designee confirms that a participating physician PROVIDER is
in good standing and continues to satisfy the carrier's requirements for
participating physicians PROVIDERS.
(k) "S UBSTANCE USE DISORDER PROVIDER " MEANS A MENTAL
HEALTH ENTITY LICENSED PURSUANT TO ARTICLE 1.5 OF TITLE 25 THAT
SPECIALIZES IN TREATING SUBSTANCE USE DISORDERS OR A MENTAL HEALTH
PROFESSIONAL LICENSED OR CERTIFIED PURSUANT TO ARTICLE 245 OF TITLE
12 WHO SPECIALIZES IN TREATING SUBSTANCE USE DISORDERS, EXCEPT FOR
UNLICENSED PSYCHOTHERAPISTS REGULATED PURSUANT TO ARTICLE 245 OF
TITLE 12.
(2) (c) If a carrier receives a completed application but fails to
provide the applicant a receipt in written or electronic form within seven
calendar days after receiving the COMPLETED application, as required by
subsection (2)(a) of this section, the carrier shall consider the applicant a
participating physician PROVIDER, effective no later than fifty-three calendar
days following the carrier's receipt of the application.
(5) A carrier shall correct discrepancies in its provider or network
directory within thirty calendar days after receiving a report of the
discrepancy from a THE participating physician PROVIDER. A participating
physician PROVIDER shall notify a carrier BY MAIL OR THE ELECTRONIC
MEANS THAT THE CARRIER TRADITIONALLY USES TO COMMUNICATE WITH
THE PROVIDERS IN THE CARRIER'S PROVIDER NETWORK of any change in the
physician's PROVIDER'S name, address, telephone number, business
PAGE 4-HOUSE BILL 26-1002
structure, or tax identification number within fifteen business days after
making the change.
(6) A carrier may SHALL not deny a claim for a medically necessary
covered service provided to a covered person if the service:
(b) Is provided by a participating physician PROVIDER who is in the
CARRIER'S provider network for the carrier's health coverage plan and has
concluded the carrier's credentialing process.
(8) (a) A carrier or its designee may recredential a participating
physician PROVIDER if such recredentialing is:
(II) Perm itted by the carrier's contract with the participating
physician PROVIDER.
(b) A carrier shall not require a participating physician PROVIDER to
submit an application or participate in a contracting process in order to be
recredentialed.
(c) Nothing in This subsection (8) affects DOES NOT AFFECT the
contract termination rights of a carrier or a participating physician
PROVIDER.
(9) Except as described in subsection (8) of this section and as may
be provided in a contract between a carrier and a participating physician
PROVIDER, a carrier shall allow a participating physician PROVIDER to
remain credentialed and include the participating physician PROVIDER in the
carrier's health coverage plan provider network unless the carrier discovers
information indicating that the participating physician PROVIDER no longer
satisfies the carrier's guidelines for participation, in which case the carrier
shall satisfy the requirements described in section 10-16-705 (5) before
terminating the participating physician's PROVIDER'S participation in the
CARRIER'S provider network.
(9.5) A carrier shall not refuse to credential an applicant or terminate
a participating physician's PROVIDER'S participation in a CARRIER'S provider
network based solely on the applicant's or participating physician's
PROVIDER'S provision of, or assistance in the provision of, a legally
protected health-care activity, as defined in section 12-30-121 (1)(d), in this
PAGE 5-HOUSE BILL 26-1002
state, so long as the care provided did not violate Colorado law.
(9.7) (a) A CARRIER SHALL REIMBURSE A PARTICIPATING MENTAL
HEALTH PROVIDER, SUBSTANCE USE PROVIDER, OR PSYCHIATRIC NURSE FOR
COVERED MEDICALLY NECESSARY TREATMENT , AS DEFINED IN SECTION
10-16-104 (5.5)(d)(IV), FURNISHED BY A PRE-LICENSED PROVIDER WHO IS
UNDER THE SUPERVISION OF THE PARTICIPATING MENTAL HEALTH PROVIDER,
SUBSTANCE USE PROVIDER, OR PSYCHIATRIC NURSE WHO HAS SATISFIED ALL
REQUIRED SUPERVISION RULES AND CRITERIA.
(b) IF A HEALTH BENEFIT PLAN OFFERS OUT-OF-NETWORK BENEFITS,
THE CARRIER MUST REIMBURSE THE COVERED PERSON FOR COVERED
MEDICALLY NECESSARY TREATMENT , AS DEFINED IN SECTION 10-16-104
(5.5)(d)(IV), THAT IS PROVIDED BY AN OUT -OF-NETWORK PRE -LICENSED
PROVIDER UNDER THE SUPERVISION OF A NONPARTICIPATING MENTAL
HEALTH PROVIDER, SUBSTANCE USE PROVIDER, OR PSYCHIATRIC NURSE IN
ACCORDANCE WITH THE TERMS OF COVERAGE APPLICABLE TO
NONPARTICIPATING PROVIDERS UNDER THE HEALTH BENEFIT PLAN AND THE
CARRIER'S OTHERWISE APPLICABLE REQUIREMENTS , WHICH MUST BE
PUBLICLY AVAILABLE ON THE CARRIER 'S WEBSITE , AS LONG AS THE
SUPERVISING PROVIDER SUBMITS DOCUMENTATION EVIDENCING THE
SUPERVISION.
(10) The commissioner shall enforce this section and may
promulgate such ADOPT rules as are necessary for the implementation of TO
IMPLEMENT this section. Upon receiving more than one complaint from an
applicant or a participating physician PROVIDER alleging a violation of this
section by a carrier, the commissioner shall investigate the complaints. A
carrier that fails to comply with this section or with any rules adopted
pursuant to this section is subject to such civil penalties as THAT the
commissioner may order pursuant to section 10-1-310.
SECTION 3. In Colorado Revised Statutes, 12-245-404, amend
(2)(c) as follows:
12-245-404. Qualifications - examination - licensure and
registration - rules.
(2) The board shall license as a licensed clinical social worker a
person who files an application, in a form and manner required by the
PAGE 6-HOUSE BILL 26-1002
board, submits the fee required by the board pursuant to section
12-245-205, and submits evidence satisfactory to the board that the
applicant:
(c) Has practiced social work for at least two years under the virtual
or in-person supervision of a licensed clinical social worker or other person
with equivalent experience as determined by the board, which practice
includes training and work experience in the area of clinical social work
practice AND INCLUDES AT LEAST THREE THOUSAND HOURS OF PRACTICE ;
and
SECTION 4. Act subject to petition - effective date. This act
takes effect at 12:01 a.m. on the day following the expiration of the
ninety-day period after final adjournment of the general assembly (August
12, 2026, if adjournment sine die is on May 13, 2026); except that, if a
referendum petition is filed pursuant to section 1 (3) of article V of the state
constitution against this act or an item, section, or part of this act within
such period, then the act, item, section, or part will not take effect unless
PAGE 7-HOUSE BILL 26-1002
approved by the people at the general election to be held in November 2026
and, in such case, will take effect on the date of the official declaration of
the vote thereon by the governor.
____________________________ ____________________________
Julie McCluskie James Rashad Coleman, Sr.
SPEAKER OF THE HOUSE PRESIDENT OF
OF REPRESENTATIVES THE SENATE
____________________________ ____________________________
Vanessa Reilly Esther van Mourik
CHIEF CLERK OF THE HOUSE SECRETARY OF
OF REPRESENTATIVES THE SENATE
APPROVED________________________________________
(Date and Time)
_________________________________________
Jared S. Polis
GOVERNOR OF THE STATE OF COLORADO
PAGE 8-HOUSE BILL 26-1002