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Instructions
Instructions applicable to entire template (all tabs):

~ This template should be downloaded as an Excel file, filled out, and submitted back to the Division as an Excel file.

~ All tabs must be completed and emailed to the Division. In addition, Colorado Revised Statute 10-16-107.4 specifies other material also required to be submitted to the Division as part of data reporting.

~ Unless explicitly noted otherwise all data fields in this template are related to participants in plans or arrangements who are Colorado residents. E.g., requests for national information use the word “nationally” to denote the data should be provided at a national and not Colorado level.

~ All data filings submitted shall be considered public and shall be open to public inspection, unless the information may be considered confidential pursuant to § 24-72-204, C.R.S. The entire filing cannot be held as confidential. A “Confidentiality Index” shall be completed if the health care sharing plan or arrangement desires confidential treatment of any information submitted. Information identified as confidential shall be marked as such and shall be submitted separately from non-confidential material. If a CORA request is received requesting the information identified as confidential, the Division will notify the health care sharing plan or arrangement prior to sharing any information that the plan or arrangement may have identified as confidential in the confidentiality index.

~ Completed templates should be emailed to Leilani Russell (Leilani.Russell@state.co.us)

Instructions applicable to tab "Pg.2 Plan specific information"
~ If your organization has a TIN (Tax ID number) please provide that in the designated field, otherwise leave this field blank.

~ If data elements are not applicable to your organization's plan or arrangement please note "does not apply see note" and explain why this data element does not apply to your organization in the "Additional context" green box

~ Products will be the organization's specific titles. E.g. Classic membership

~ Please note element "D. The total number of employer groups in Colorado that facilitate all or some of their employee participants' monthly share contributions" this includes monthly share contributions for the employee's family member(s) facilitated by the employer

~ Please note element "K. Total dollar amount of health-care costs or services that were incurred by the participant and submitted by or on behalf of the participant for sharing" This includes all requests for sharing of Colorado participants' health-care costs or services including any requests that were denied or approved or have not yet been denied or approved. If this amount includes duplicate charges by medical providers, discounts, participants' initial unshareable amounts, or other expenses that do not meet the HCSPAs sharing criteria additional context can be reported in the green box on the far right hand of the tab.

~ Please note element "L. Total dollar amount of requests for sharing of Colorado participants' health-care costs or services that qualified for sharing excluding any amounts that the participants incurring the health-care costs or services must pay before receiving sharing amounts under the member guidelines" this is the amount from element K minus any duplicate charges by medical providers, discounts, participants' initial unshareable amounts, or other expenses that do not meet the HCSPAs sharing criteria.

~ Please note element "M. For this product, the total amount of payments made to providers for Colorado participants' health care costs or services" is the subset of dollars from element "L. Total dollar amount of requests for sharing of Colorado participants' health-care costs or services that qualified for sharing excluding any amounts that the participants incurring the health-care costs or services must pay before receiving sharing amounts under the member guidelines" that were paid to providers for that product, in that reporting year. If this data element is not applicable to your organization's plan or arrangement please note "does not apply see note" and explain why this data element does not apply to your organization in the "Additional context" green box.

~ Please note element "N. Total dollar amount of sharing requests facilitated or provided to Colorado participants for health care costs or services" is the subset of dollars from element "L. Total dollar amount of requests for sharing of Colorado participants' health-care costs or services that qualified for sharing excluding any amounts that the participants incurring the health-care costs or services must pay before receiving sharing amounts under the member guidelines" that were shared with participants for the product, in the reporting year. If this data element is not applicable to your organization's plan or arrangement please note "does not apply see note" and explain why this data element does not apply to your organization in the "Additional context" green box.


Definitions
~ “Administrative expenses” shall mean costs incurred to operate and support the functioning of the health care sharing plan or arrangement. This includes but is not limited to bank fees, staff salaries, data processing, sales, management of health care expense submissions, marketing, outreach, and enrollment efforts. This includes fees, commissions, and remuneration paid to contractors or third parties that acted on behalf of the HCSPA to facilitate administrative operations.

~ “CORA” shall mean the Colorado Open Records Act (§ 24-72-201, et seq, C.R.S.).

~ "Coloradans" shall mean residents of Colorado during the reporting period.

~ “Filing date” shall mean for the purposes of this regulation, the day after the HCSPR filing is received at the Division.

~ “Health care costs” or "health care expenses" shall mean any amount billed by a health care provider for health care services or related products or by a pharmacy.

~ “Health care services” means any services included in or incidental to the furnishing of medical, behavioral, mental health, or substance use disorder; dental, or optometric care; hospitalization; or nursing home care to an individual, as well as the furnishing to any person of any other services for the purpose of preventing, alleviating, curing, or healing human physical illness or injury, or behavioral, mental health, or substance use disorder. “Health-care services” includes the rendering of the services through the use of telehealth, as defined in § 10-16-123 (4)(e), C.R.S.

~ “Health care sharing plan” or “health care sharing arrangement” or “plan” or “arrangement” or “HCSPA” shall mean any organization that offers or markets products to facilitate payment or reimbursement of health-care costs or services for one (1) or more residents of Colorado. This does not include direct primary care agreements as defined in § 6-23-101, C.R.S.; consumer payment plans offered directly between a provider and patient (or patient’s responsible party); businesses used to facilitate the plan’s operations such as reimbursement handling, cost containment vendors, data processing; and crowdfunded sources that do not require ongoing membership fees, share requirements, or dues for the purposes of payment for and/or reimbursement of health care services.

~ “Insurance producer” or “producer”, shall have the same meaning as found at § 10-2-103(6), C.R.S., with the exception that for the purposes of this regulation it does not include § 10-2-103(6)(b), C.R.S.”

~ “Program expenses” shall mean any service by the HCSPA or its contractors that, while not direct medical care, contributes to the care and overall experiences of HCSPA’s participants. This includes but is not limited to coaching and wellness programs, care navigation, care coordination, medical review, quality improvement efforts, cost containment, reimbursement handling, and bill negotiations. This includes fees, commissions, and remuneration paid to contractors that acted on behalf of the HCPA to facilitate program expenses.

~ “Product(s)” means, for the purposes of this regulation, the services covered as a package under a membership plan, tier, or level.

~ “Third party” shall mean contractors that are associated with or assist the plan or arrangement in offering or enrolling Colorado residents as participants in the plan or arrangement.
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