House Bill 26-1002 Introduced

A Bill for an Act

• Page 1, Line 101Concerning measures to increase patient access to

• Page 1, Line 102behavioral health providers, and, in connection

• Page 1, Line 103therewith, efforts to enhance provider participation

• Page 1, Line 104in health-care provider networks, reimbursement of

• Page 1, Line 105prelicensed providers who provide mental health

• Page 1, Line 106services under the supervision of a licensed provider,

• Page 1, Line 107and decreasing the clinical hours required to become

• Page 1, Line 108a licensed clinical social worker.

Bill Summary

(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)

If a health-care provider has not submitted a claim for a period of at least 6 months, the bill requires a commercial insurance carrier (carrier) to contact the provider to confirm the provider's participation in the carrier's provider network and to determine whether the provider is accepting new patients.

The bill includes mental health providers and substance use disorder providers as providers who may participate in a carrier's provider network and expedites the credentialing process for these providers.

The bill requires carriers to admit prelicensed providers into the carrier's network and to reimburse prelicensed providers for services rendered when provided under the supervision of a mental health provider or substance use disorder provider.

The bill requires a clinical social worker to complete 3,000 hours of post-master's supervised clinical practice over a period of between 2 and 5 years in order to be licensed.

The bill requires a managed care entity to contact providers enrolled in medicaid who have not submitted a claim for at least 6 months to confirm the provider's participation and to determine whether the provider is accepting new patients.

The bill expedites the medicaid enrollment process for mental health providers and substance use disorder providers who apply to participate in the medicaid program.

• Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:

• Page 2, Line 2SECTION 1.  In Colorado Revised Statutes, 10-16-704, add

• Page 2, Line 3(15.5) as follows:

• Page 2, Line 410-16-704.  Network adequacy - required disclosures - balance

• Page 2, Line 5billing - rules - legislative declaration - definitions.

• Page 2, Line 6(15.5) (a)  A carrier shall confirm the network

• Page 2, Line 7participation of a provider who has not submitted a claim for a

• Page 2, Line 8period of at least six months or otherwise communicated with

• Page 2, Line 9the carrier in a manner evidencing the provider's intent to

• Page 2, Line 10continue participating in the carrier's network and for whom no

• Page 2, Line 11change in provider status is reported by a nonprofit

• Page 3, Line 1organization that maintains provider credentialing

• Page 3, Line 2information.

• Page 3, Line 3(b)  The carrier shall contact the provider by mail to

• Page 3, Line 4confirm the provider's intent to continue participating in the

• Page 3, Line 5carrier's provider network and to inquire whether the provider

• Page 3, Line 6is accepting new patients. The carrier shall update its

• Page 3, Line 7directories, as necessary, within five business days after

• Page 3, Line 8contacting the provider.

• Page 3, Line 9(c)  If the provider fails to respond to a carrier's inquiry

• Page 3, Line 10within thirty days after the carrier contacts or attempts to

• Page 3, Line 11contact the provider, the carrier shall mail a follow-up request

• Page 3, Line 12to the provider by certified mail, return receipt requested. If the

• Page 3, Line 13provider fails to respond to the carrier's follow-up request

• Page 3, Line 14within thirty days after receipt of the request, the carrier must

• Page 3, Line 15remove the provider from its carrier provider network and

• Page 3, Line 16update its directories, as necessary, within five business days.

• Page 3, Line 17SECTION 2.  In Colorado Revised Statutes, 10-16-705.7, amend

• Page 3, Line 18(1)(a), (1)(b), (1)(d), (1)(j), (2)(c), (3)(a), (5), (6) introductory portion,

• Page 3, Line 19(6)(b), (8)(a) introductory portion, (8)(a)(II), (8)(b), (8)(c), (9), (9.5), and

• Page 3, Line 20(10); and add (1)(g.5), (1)(g.9), (1)(h.2), (1)(i.5), (1)(k), and (9.7) as

• Page 3, Line 21follows:

• Page 3, Line 2210-16-705.7.  Timely credentialing of providers by carriers -

• Page 3, Line 23notice of receipt required - notice of incomplete applications required

• Page 3, Line 24- delegated credentialing agreements - discrepancies - denials of

• Page 3, Line 25claims prohibited - disclosures - recredentialing - enforcement - rules

• Page 3, Line 26- definitions.

• Page 3, Line 27(1)  As used in this section, unless the context otherwise requires:

• Page 4, Line 1(a)  "Applicant" means a physician, mental health provider, or

• Page 4, Line 2substance use disorder provider who submits an application to a

• Page 4, Line 3carrier to become a participating physician provider in the carrier's

• Page 4, Line 4provider network.

• Page 4, Line 5(b)  "Application" means an applicant's application to become

• Page 4, Line 6credentialed by a carrier as a participating physician provider in at least

• Page 4, Line 7one of the carrier's provider networks.

• Page 4, Line 8(d)  "Credentialing" or "credential" means the process by which a

• Page 4, Line 9carrier or its designee collects information concerning an applicant;

• Page 4, Line 10assesses whether the applicant satisfies the relevant licensing, education,

• Page 4, Line 11and training requirements to become a participating physician provider;

• Page 4, Line 12verifies the assessment; and approves or disapproves the applicant's

• Page 4, Line 13application.

• Page 4, Line 14(g.5)  "Mental health provider" means a mental health

• Page 4, Line 15entity licensed pursuant to article 1.5 of title 25 or mental

• Page 4, Line 16health professional licensed or certified pursuant to article 245

• Page 4, Line 17of title 12, except for unlicensed psychotherapists regulated

• Page 4, Line 18pursuant to article 245 of title 12.

• Page 4, Line 19 (g.9)  "Participating mental health provider or substance

• Page 4, Line 20use disorder provider" means a mental health provider or

• Page 4, Line 21substance use disorder provider who is credentialed by a carrier

• Page 4, Line 22or its designee to provide health-care items or services to

• Page 4, Line 23covered persons in at least one of the carrier's provider

• Page 4, Line 24networks.

• Page 4, Line 25(h.2)  "Participating provider" means a participating

• Page 4, Line 26physician or a participating mental health provider or

• Page 4, Line 27substance use disorder provider.

• Page 5, Line 1(i.5)  "Prelicensed provider" means a "registrant" as

• Page 5, Line 2defined in section 12-245-202.

• Page 5, Line 3(j)  "Recredentialing" or "recredential" means the process by which

• Page 5, Line 4a carrier or its designee confirms that a participating physician provider

• Page 5, Line 5is in good standing and continues to satisfy the carrier's requirements for

• Page 5, Line 6participating physicians providers.

• Page 5, Line 7(k)  "Substance use disorder provider" means a mental

• Page 5, Line 8health entity licensed pursuant to article 1.5 of title 25 that

• Page 5, Line 9specializes in treating substance use disorders or a mental

• Page 5, Line 10health professional licensed or certified pursuant to article 245

• Page 5, Line 11of title 12 who specializes in treating substance use disorders,

• Page 5, Line 12except for unlicensed psychotherapists regulated pursuant to

• Page 5, Line 13article 245 of title 12.

• Page 5, Line 14(2) (c) (I)  For an applicant who is a physician, if a carrier

• Page 5, Line 15receives a completed application but fails to provide the applicant a

• Page 5, Line 16receipt in written or electronic form within seven calendar days after

• Page 5, Line 17receiving the application, as required by subsection (2)(a) of this section,

• Page 5, Line 18the carrier shall consider the applicant a participating physician, effective

• Page 5, Line 19no later than fifty-three calendar days following the carrier's receipt of the

• Page 5, Line 20application.

• Page 5, Line 21(II)  For an applicant who is a mental health provider or

• Page 5, Line 22substance use disorder provider, if a carrier receives a

• Page 5, Line 23completed application but fails to provide the applicant a

• Page 5, Line 24receipt in written or electronic form within seven calendar days

• Page 5, Line 25after receiving the application, the carrier must consider the

• Page 5, Line 26applicant a participating mental health provider or substance

• Page 5, Line 27use disorder provider, effective no later than twenty-six

• Page 6, Line 1calendar days after the carrier's receipt of the application.

• Page 6, Line 2(3) (a) (I)  For an applicant who is a physician, a carrier shall

• Page 6, Line 3conclude the process of credentialing an the applicant within sixty

• Page 6, Line 4calendar days after the carrier receives the applicant's completed

• Page 6, Line 5application.

• Page 6, Line 6(II)  For an applicant who is a mental health provider or

• Page 6, Line 7substance use disorder provider, a carrier shall conclude the

• Page 6, Line 8process of credentialing the applicant within thirty calendar

• Page 6, Line 9days after the carrier receives the applicant's completed

• Page 6, Line 10application.

• Page 6, Line 11(5) (a)  For a participating physician, a carrier shall correct

• Page 6, Line 12discrepancies in its provider or network directory within thirty calendar

• Page 6, Line 13days after receiving a report of the discrepancy from a the participating

• Page 6, Line 14physician. A participating physician shall notify a carrier of any change

• Page 6, Line 15in the physician's name, address, telephone number, business structure, or

• Page 6, Line 16tax identification number within fifteen business days after making the

• Page 6, Line 17change.

• Page 6, Line 18(b)  For a participating mental health provider or

• Page 6, Line 19substance use disorder provider, a carrier shall correct

• Page 6, Line 20discrepancies in its provider or network directory within five

• Page 6, Line 21business days after receiving a report of the discrepancy from

• Page 6, Line 22the participating mental health provider or substance use

• Page 6, Line 23disorder provider. A participating mental health provider or

• Page 6, Line 24substance use disorder provider shall notify a carrier of any

• Page 6, Line 25change in the provider's name, address, telephone number,

• Page 6, Line 26business structure, or tax identification number within ten

• Page 6, Line 27business days after making the change.

• Page 7, Line 1(6)  A carrier may shall not deny a claim for a medically

• Page 7, Line 2necessary covered service provided to a covered person if the service:

• Page 7, Line 3(b)  Is provided by a participating physician provider who is in

• Page 7, Line 4the carrier's provider network for the carrier's health coverage plan and

• Page 7, Line 5has concluded the carrier's credentialing process.

• Page 7, Line 6(8) (a)  A carrier or its designee may recredential a participating

• Page 7, Line 7physician provider if such recredentialing is:

• Page 7, Line 8(II)  Permitted by the carrier's contract with the participating

• Page 7, Line 9physician provider.

• Page 7, Line 10(b)  A carrier shall not require a participating physician provider

• Page 7, Line 11to submit an application or participate in a contracting process in order to

• Page 7, Line 12be recredentialed.

• Page 7, Line 13(c)  Nothing in This subsection (8) affects does not affect the

• Page 7, Line 14contract termination rights of a carrier or a participating physician

• Page 7, Line 15provider.

• Page 7, Line 16(9)  Except as described in subsection (8) of this section and as

• Page 7, Line 17may be provided in a contract between a carrier and a participating

• Page 7, Line 18physician provider, a carrier shall allow a participating physician

• Page 7, Line 19provider to remain credentialed and include the participating physician

• Page 7, Line 20provider in the carrier's health coverage plan provider network unless

• Page 7, Line 21the carrier discovers information indicating that the participating

• Page 7, Line 22physician provider no longer satisfies the carrier's guidelines for

• Page 7, Line 23participation, in which case the carrier shall satisfy the requirements

• Page 7, Line 24described in section 10-16-705 (5) before terminating the participating

• Page 7, Line 25physician's provider's participation in the carrier's provider network.

• Page 7, Line 26(9.5)  A carrier shall not refuse to credential an applicant or

• Page 7, Line 27terminate a participating physician's provider's participation in a

• Page 8, Line 1carrier's provider network based solely on the applicant's or

• Page 8, Line 2participating physician's provider's provision of, or assistance in the

• Page 8, Line 3provision of, a legally protected health-care activity, as defined in section

• Page 8, Line 412-30-121 (1)(d), in this state, so long as the care provided did not violate

• Page 8, Line 5Colorado law.

• Page 8, Line 6(9.7) (a) A carrier shall admit into the carrier's provider

• Page 8, Line 7network a prelicensed provider that applies for admission under

• Page 8, Line 8the supervision of a participating mental health provider or

• Page 8, Line 9substance use disorder provider and meets requirements set by

• Page 8, Line 10the division.

• Page 8, Line 11(b) (I)  A carrier shall reimburse a prelicensed provider

• Page 8, Line 12for providing medically necessary treatment, as defined in

• Page 8, Line 13section 10-16-104, to a covered person under the supervision of

• Page 8, Line 14a participating mental health provider or substance use

• Page 8, Line 15disorder provider in accordance with the terms of coverage

• Page 8, Line 16applicable to the participating mental health provider or

• Page 8, Line 17substance use disorder provider under a health benefit plan.

• Page 8, Line 18(II)  If a health benefit plan offers out-of-network

• Page 8, Line 19benefits, the carrier must reimburse an out-of-network

• Page 8, Line 20prelicensed provider for medically necessary treatment, as

• Page 8, Line 21defined in section 10-16-104, provided to a covered person under

• Page 8, Line 22the supervision of a participating mental health provider or

• Page 8, Line 23substance use disorder provider in accordance with the terms of

• Page 8, Line 24coverage applicable to nonparticipating providers under the

• Page 8, Line 25health benefit plan.

• Page 8, Line 26(c)  The division shall set requirements for a carrier to

• Page 8, Line 27admit a prelicensed provider into the carrier's provider network

• Page 9, Line 1as described in this subsection (9.7).

• Page 9, Line 2(10)  The commissioner shall enforce this section and may

• Page 9, Line 3promulgate such adopt rules as are necessary for the implementation of

• Page 9, Line 4to implement this section. Upon receiving more than one complaint

• Page 9, Line 5from an applicant or a participating physician provider alleging a

• Page 9, Line 6violation of this section by a carrier, the commissioner shall investigate

• Page 9, Line 7the complaints. A carrier that fails to comply with this section or with any

• Page 9, Line 8rules adopted pursuant to this section is subject to such civil penalties as

• Page 9, Line 9that the commissioner may order pursuant to section 10-1-310.

• Page 9, Line 10SECTION 3.  In Colorado Revised Statutes, 12-245-404, amend

• Page 9, Line 11(2)(c); and add (2)(c.5) as follows:

• Page 9, Line 1212-245-404.  Qualifications - examination - licensure and

• Page 9, Line 13registration - rules.

• Page 9, Line 14(2)  The board shall license as a licensed clinical social worker a

• Page 9, Line 15person who files an application, in a form and manner required by the

• Page 9, Line 16board, submits the fee required by the board pursuant to section

• Page 9, Line 1712-245-205, and submits evidence satisfactory to the board that the

• Page 9, Line 18applicant:

• Page 9, Line 19(c)  Has practiced social work for at least two years under the

• Page 9, Line 20virtual or in-person supervision of a licensed clinical social worker or

• Page 9, Line 21other person with equivalent experience as determined by the board,

• Page 9, Line 22which practice includes training and work experience in the area of

• Page 9, Line 23clinical social work practice; and

• Page 9, Line 24(c.5)  Has completed three thousand hours of post-master's

• Page 9, Line 25supervised clinical practice over the course of at least two

• Page 9, Line 26years but no more than five years; and

• Page 9, Line 27SECTION 4.  In Colorado Revised Statutes, add 25.5-4-436 as

• Page 10, Line 1follows:

• Page 10, Line 225.5-4-436.  Confirmation of provider participation.

• Page 10, Line 3(1)  A managed care entity shall confirm the participation

• Page 10, Line 4of a provider enrolled in the state medical assistance program

• Page 10, Line 5who has not submitted a claim for a period of at least six months

• Page 10, Line 6or otherwise communicated with the state department in a

• Page 10, Line 7manner evidencing the provider's intent to continue

• Page 10, Line 8participating in the state medical assistance program and for

• Page 10, Line 9whom no change in provider status is reported by a nonprofit

• Page 10, Line 10organization that maintains provider credentialing

• Page 10, Line 11information.

• Page 10, Line 12(2)  To confirm provider participation, a managed care

• Page 10, Line 13entity shall contact the provider by mail, confirm the provider's

• Page 10, Line 14intent to continue participating in the state medical assistance

• Page 10, Line 15program, and inquire whether the provider is accepting new

• Page 10, Line 16patients. The managed care entity shall update its directories,

• Page 10, Line 17as necessary, within five business days after contacting the

• Page 10, Line 18provider.

• Page 10, Line 19(3)  If the provider fails to respond to a managed care

• Page 10, Line 20entity within thirty days after the managed care entity

• Page 10, Line 21contacts or attempts to contact the provider, the managed care

• Page 10, Line 22entity shall mail a follow-up request to the provider by

• Page 10, Line 23certified mail, return receipt requested. If the provider fails to

• Page 10, Line 24respond to the managed care entity's follow-up request within

• Page 10, Line 25thirty days after receipt of the request, the managed care

• Page 10, Line 26entity shall remove the provider from the state medical

• Page 10, Line 27assistance program and update its provider directories within

• Page 11, Line 1five business days.

• Page 11, Line 2SECTION 5.  In Colorado Revised Statutes, add 25.5-4-437 as

• Page 11, Line 3follows:

• Page 11, Line 425.5-4-437.  Timely enrollment of mental health and substance

• Page 11, Line 5use disorder providers - definitions.

• Page 11, Line 6(1)  As used in this section, unless the context otherwise

• Page 11, Line 7requires:

• Page 11, Line 8(a)  "Applicant" means a provider who submits an

• Page 11, Line 9application to the state department to become an enrolled

• Page 11, Line 10mental health provider or substance use disorder provider in

• Page 11, Line 11the state medical assistance program.

• Page 11, Line 12(b)  "Application" means an applicant's application to

• Page 11, Line 13become an enrolled mental health provider or substance use

• Page 11, Line 14disorder provider in the state medical assistance program.

• Page 11, Line 15(c)  "Enrolled mental health provider or substance use

• Page 11, Line 16disorder provider" means a mental health provider or substance

• Page 11, Line 17use disorder provider who is enrolled in the state medical

• Page 11, Line 18assistance program to provide health-care items or services to

• Page 11, Line 19members.

• Page 11, Line 20(d)  "Mental health provider" means a mental health

• Page 11, Line 21entity licensed pursuant to article 1.5 of title 25 or a mental

• Page 11, Line 22health professional licensed or certified pursuant to article 245

• Page 11, Line 23of title 12, except for unlicensed psychotherapists regulated

• Page 11, Line 24pursuant to article 245 of title 12.

• Page 11, Line 25(e)  "Substance use disorder provider" means a mental

• Page 11, Line 26health entity licensed pursuant to article 1.5 of title 25 that

• Page 11, Line 27specializes in treating substance use disorders or a mental

• Page 12, Line 1health professional licensed or certified pursuant to article 245

• Page 12, Line 2of title 12 who specializes in treating substance use disorders,

• Page 12, Line 3except for unlicensed psychotherapists regulated pursuant to

• Page 12, Line 4article 245 of title 12.

• Page 12, Line 5(2) (a)  Within seven calendar days after a managed care

• Page 12, Line 6entity receives an application, the managed care entity shall

• Page 12, Line 7provide the applicant a receipt in written or electronic form.

• Page 12, Line 8(b)  Upon receiving an application, the managed care entity

• Page 12, Line 9shall promptly determine whether the application is complete.

• Page 12, Line 10If the managed care entity determines that the application is

• Page 12, Line 11incomplete, the managed care entity shall notify the applicant

• Page 12, Line 12in writing or by electronic means within ten calendar days after

• Page 12, Line 13receipt of the application that the application is incomplete. The

• Page 12, Line 14notice must describe the items that are required to complete the

• Page 12, Line 15application.

• Page 12, Line 16(c)  If the managed care entity receives a completed

• Page 12, Line 17application but fails to provide the applicant a receipt in written

• Page 12, Line 18or electronic form within seven calendar days after receiving

• Page 12, Line 19the application, as required by subsection (2)(a) of this section,

• Page 12, Line 20the managed care entity shall consider the applicant an

• Page 12, Line 21enrolled mental health provider or substance use disorder

• Page 12, Line 22provider effective no later than twenty-six calendar days after

• Page 12, Line 23the managed care entity's receipt of the application.

• Page 12, Line 24(3) (a)  A managed care entity shall conclude the process

• Page 12, Line 25of enrolling an applicant within thirty calendar days after the

• Page 12, Line 26managed care entity receives the applicant's completed

• Page 12, Line 27application.

• Page 13, Line 1(b)  A managed care entity shall provide each applicant

• Page 13, Line 2written or electronic notice of the outcome of the applicant's

• Page 13, Line 3application for enrollment within ten calendar days after the

• Page 13, Line 4conclusion of the enrollment process.

• Page 13, Line 5(c)  After concluding the enrollment process for an

• Page 13, Line 6applicant and making a determination regarding the applicant's

• Page 13, Line 7enrollment, a managed care entity shall provide the applicant,

• Page 13, Line 8at the applicant's request and as allowed by law, all

• Page 13, Line 9nonproprietary information pertaining to the application and to

• Page 13, Line 10the final decision regarding the application.

• Page 13, Line 11(4)  A managed care entity shall correct discrepancies in

• Page 13, Line 12its provider directory within five calendar days after receiving

• Page 13, Line 13a report of the discrepancy from an enrolled mental health

• Page 13, Line 14provider or substance use disorder provider. An enrolled

• Page 13, Line 15mental health provider or substance use disorder provider

• Page 13, Line 16shall notify the managed care entity of any change in the

• Page 13, Line 17provider's name, address, telephone number, business structure,

• Page 13, Line 18or tax identification number within ten business days after

• Page 13, Line 19making the change.

• Page 13, Line 20SECTION 6.  Act subject to petition - effective date. This act

• Page 13, Line 21takes effect at 12:01 a.m. on the day following the expiration of the

• Page 13, Line 22ninety-day period after final adjournment of the general assembly (August

• Page 13, Line 2312, 2026, if adjournment sine die is on May 13, 2026); except that, if a

• Page 13, Line 24referendum petition is filed pursuant to section 1 (3) of article V of the

• Page 13, Line 25state constitution against this act or an item, section, or part of this act

• Page 13, Line 26within such period, then the act, item, section, or part will not take effect

• Page 13, Line 27unless approved by the people at the general election to be held in

• Page 14, Line 1November 2026 and, in such case, will take effect on the date of the

• Page 14, Line 2official declaration of the vote thereon by the governor.