CO| The Colorado Division of Insurance’s Amended Regulation 4-2-72 establishes new standards for health insurance carriers to improve affordability by increasing investments in primary care and shifting toward value-based alternative payment models (APMs). The regulation requires carriers to incrementally raise the proportion of total medical expenditures allocated to primary care by one percentage point annually in 2022 and 2023, compared to 2021 levels, and sets targets for the use of APMs and prospective payments. Carriers must also submit annual reports on their primary care and APM expenditures, with strict enforcement measures for noncompliance.
Key Points:
- Primary Care Investment: Carriers must increase primary care spending by one percentage point each year in 2022 and 2023, without raising premiums, and aim for 25% of primary care expenditures to be made through prospective payments by the end of 2023.
- Alternative Payment Models: By the end of 2022, carriers should target 50% of total medical expenditures through APMs, with 10% of APM spending paid prospectively, focusing on value and quality.
- Reporting and Enforcement: Carriers are required to submit detailed annual reports on primary care and APM investments, with penalties for noncompliance, and the regulation takes effect May 30, 2025.