Colorado Code
Part 7 - Consumer Protection Standards Act for the Operation of Managed Care Plans
§ 10-16-705. Requirements for Carriers and Participating Providers

(6.5) A carrier that has entered into a contract with one or more intermediaries to conduct utilization management, utilization review, provider credentialing, administration of health insurance benefits, setting or negotiation of reimbursement rates, payment to providers, network development, or disease management programs shall require the intermediary to comply with the same standards, guidelines, medical policies, and benefit terms of the carrier.

(9.5) If the health benefit plan provides coverage for a second opinion, the carrier and any entity that contracts with the carrier shall disclose the availability of the second opinion along with the health benefit description form.

(11.5) A carrier or entity that contracts with the carrier shall not penalize a primary care provider who makes a standing referral of a covered person to a specialist, nor shall the specialist treating the covered person be penalized, with actions that include but are not limited to disincentives or disaffiliation, except for violations of section 10-1-128.

Source: L. 97: Entire part added, p. 1328, § 2, effective July 1. L. 99: (9.5) and (11.5) added and (14) amended, p. 318, § 2, effective July 1. L. 2002: (12) amended, p. 886, § 2, effective January 1, 2003; (16) added, p. 1299, § 14, effective January 1, 2003. L. 2003: (11.5) and (12)(b)(I) amended, p. 618, § 21, effective July 1. L. 2009: (6.5) and (10.5) added, (HB 09-1061), ch. 197, p. 885, § 1, effective August 5. L. 2013: (12)(a) and (14)(b) amended, (HB 13-1266), ch. 217, p. 989, § 51, effective May 13.
Cross references: For the legislative declaration contained in the 1999 act adding subsections (9.5) and (11.5) and amending subsection (14), see section 1 of chapter 111, Session Laws of Colorado 1999.