The Honorable Wayne W. Williams

March 25, 2015

The Honorable Wayne W. Williams

Secretary of State

1560 Broadway, 2nd Floor

Denver, Colorado 80203

Dear Mr. Williams:

Attached is the Notice of Proposed Rules concerning Executive Director of Health Care Policy and Financing rules to be considered for permanent adoption at the April 2015 meeting of the Executive Director of the Department of Health Care Policy and Financing. The meeting will be held on Wednesday, April 22, 2015, beginning at 8:00 A.M., in the seventh floor conference room at the 303 East 17th Avenue, Denver, CO 80203.

This notice is submitted to you for publication, pursuant to § 24-4-103(3)(a) and (11)(a), C.R.S.

Respectfully,

Judi Carey,

Department of Health Care Policy and Financing

The Executive Director of the Colorado Department of Health Care Policy and Financing will hold a public meeting on Wednesday, April 22, 2015, beginning at 8:00 a.m., in the seventh floor conference room at 303 East 17th Avenue, Denver, CO 80203. Reasonable accommodations will be provided upon request prior to the meeting by contacting the Medical Services Board Coordinator at 303-866-4416.

A copy of the full text of these proposed rule changes is available for review from the Rules Administration Office, 1570 Grant Street, Denver, Colorado 80203, tel. (303) 866-4416, fax (303) 866-4411. Written comments may be submitted to the Rules Administration Office on or before close of business the Friday prior to the meeting. Additionally, the full text of all proposed changes will be available approximately one week prior to the meeting on the internet at the Executive Director Administrative Rules Hearing Schedule page.

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ED 15-02-11-A.Revision to the Executive Director of the Department of Health Care Policy and Financing Rule Concerning All-Payers Claims Database,10 CCR 2505-5, Section 1.200.1.

Executive Director. The proposed amendment to section 1.200 All-Payers Claims Database under 10 CCR 2505-5. The specific sections to be amended are sections 1.200.1 Definitions and 1.200.3 Schedule for Mandatory Data Reporting. The rule revision is requested by the Center for Improving Value in Health Care (CIVHC) in its role as All-Payers Claims Database (APCD) Administrator.

This amendment would expand the definition of “private health care payer” under section 1.200.1to include “a self-insured employer-sponsored health plan.” Such plans would be exempted from the regulation if they are served by a third-party administrator or administrative services only organization (“TPA/ASO”) that services less than an aggregate of 1,000 enrolled lives in Colorado. Additionally, this amendment would change the Data submission guide in under section 1.200.1 to Data Submission Guide version 7, 2015. The amendment will also add Mandatory Data Reporting guidelines for sections 1.200.3.A, 1.200.3.B. and 1.200.3.C.

The proposed amendment will also add an opt out clause in section 1.200.2.B to read as: section 1.200.2.B. A private health care payer subject to the provisions of the federal Employee Retirement Income Security Act of 1974, as codified at 29 U.S.C. Chap. 18 (an “ERISA Entity”) may opt-out of the data submission otherwise required under this rule for data files related to claims data for calendar years 2015 and 2016 only. To avoid the penalties, as defined at section 1.200.6, such ERISA Entity, or a TPA/ASO acting on such ERISA Entity’s behalf, must declare that it has elected to “opt out” from (i.e., decline) data submission for calendar year 2015, calendar year 2016 or both calendar years’ claims data by submitting the opt out form identified by the administrator, or its equivalent, via certified mail sent to the administrator within 160 calendar days after the effective date of this rule. Such ERISA Entity, or a TPA/ASO acting on such ERISA Entity’s behalf, may revoke its opt out decision at any time, by providing written notice to the administrator.

The authority for this rule is contained in 25.5-1-105, C.R.S. (2014) and 25.5-1-204 C.R.S (2014).

Our mission is to improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.