Informing Policy Decisions
The CO APCD plays a vital role in supporting health care policy that improves health outcomes and lowers costs across Colorado. As a trusted resource for data and analytics, the CO APCD is regularly used to inform, implement and evaluate state legislation, providing robust, actionable data that enables lawmakers to make informed decisions and execute and track policies effectively.
The Colorado APCD in Enacted Legislation
Year Enacted: 2023
Purpose: Protects patients from unexpected costs by prohibiting health care providers from charging facility fees for preventive care in outpatient settings. The bill also mandates reporting on the impact of facility fees on Colorado’s health care system.
Role of the CO APCD: Named in the bill as a source of data to report the impact of outpatient facility fees.
Year Enacted: 2022
Purpose: Requires the Division of Insurance (DOI) to perform actuarial reviews of proposed legislation that may impose a new health benefit mandate on health benefit plans to understand the potential cost impact.
Role of the CO APCD: CIVHC provides CO APCD data annually to DOI to be used in the actuarial review process.
Year Enacted: 2022
Purpose: Creates a Behavioral Health Administration in the Colorado Department of Human Services to improve access to behavioral health services across the state.
Role of the CO APCD: Provide ongoing analytics to understand and evaluate access and utilization of behavioral health services
Year Enacted: 2022
Purpose: Requires the Office of Saving People Money on Health Care (OSPMHC) to produce an annual report on the impact of Long COVID and capacity of facilities for future preparedness.
Role of the CO APCD: Provide underlying data on the cost and utilization of services for people suffering from Long COVID for the annual OSPMHC report.
Year Enacted: 2022
Purpose: Requires health insurance plans to use drug rebates they receive to lower health care premiums and costs for employers and consumers. Also requires CIVHC to publish annual drug rebate summary information.
Role of the CO APCD: Provide a public-facing analysis of prescription drug rebates to provide transparency related to the dollar amount payers receive via drug rebates annually.
- View the Prescription Drug Rebates analysis
Year Enacted: 2022
Purpose: Expanding upon HB 19-1233, this bill requires the Colorado Division of Insurance and the Department of Health Care Policy and Financing to develop rules for APMs for primary care in the commercial market and develop quality measures to report on outcomes related to APM implementation.
Role of the CO APCD: CIVHC is required to develop and report established quality measures using the CO APCD.
- View the APM analysis
- Read CIVHC’s reports on primary care spending and APMs
Year Enacted: 2022
Purpose: Mandates CIHC to create a public tool to provide transparency in health claims reimbursement data for Colorado providers by claim type, payer, geography, and over time.
Role of the CO APCD: Annual release of a public, interactive tool displaying payments made to Colorado health care providers for Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding Systems (HCPCS).
- View the Provider Payment Tool
Year Enacted: 2021
Purpose: Requires the establishment of a standardized health benefit plan (the Colorado Option) to be offered by health insurance payers.
Role of the CO APCD: Provide Medicare reference-based pricing analytics to help the DOI set rates.
Year Enacted: 2021
Purpose: Creates a Prescription Drug Affordability Board (PDAB), charged with establishing upper payment limits for prescription drugs, and requires more detailed data related to prescription drug prices.
Role of the CO APCD: Named as a source of information to provide ongoing analytics on the prescription drugs driving the highest costs and further understanding of the impact of drugs driving the highest drug rebate volume and spend.
- View the Prescription Drugs Rebate Analysis
Year Enacted: 2019
Purpose: Aims to lower health care costs through investment in primary care services. The bill establishes a Primary Care Payment Reform Collective (The Collective) in the DOI to set investment targets and affordability standards.
Role of the CO APCD: CIVHC is required to provide an annual report on primary care spending and APM quality measures to inform the annual report from the Primary Care and Payment Reform Collaborative.
- View the APM analysis
- Read CIVHC’s reports on primary care spending and APMs
Year Enacted: 2019
Purpose: Helps protect patients from surprise out-of-network (OON) bills by establishing maximum provider reimbursements for out-of-network emergency and non-emergency visits.
Role of the CO APCD: On an annual basis, CIVHC provides statewide and geographic commercial allowed amounts based on CO APCD data that establishes maximum reimbursement rates.
- Learn more about CO APCD Out-of-Network data
CO APCD Guiding Legislation
Decision-making requires understanding, and the CO APCD serves as a powerful tool for legislators seeking to evaluate pressing health challenges in Colorado. CIVHC regularly receives data release requests from legislators aiming to better understand a specific issue or problem, and the data is used to help identify policy solutions.
CO APCD Analyses Requested by Policymakers in Recent Years
Non-Public Releases
- HB 23-1136 - Prosthetic Devices for Recreational Activity
- Adverse Reactions to Vaccinations
- End Stage Renal Disease and Dialysis Dependence, and Dialysis Facilities
- Low Birthweight and Birth Outcomes
- Exploring Physical Therapy as an Alternative to Opioids
- Rates of Youth Psychotropic Drug Prescriptions in Different Populations
- Top 25 CPT Codes
- Use of Mandatory Coverage of Behavioral Health Wellness Visits