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Updates to the Colorado compliance addendum


Recent regulatory changes affect your agreement. The following language, which prohibits Aetna from taking adverse action against a provider for certain actions, has been or will be added to your agreement, effective as of the dates indicated.

 

No action required

This notice is simply to let you know of these changes. Also, the Colorado provider compliance addendum has been revised to include information regarding updates to the disclosure form. 

 

Effective July 1, 2017:

Company shall not take adverse action against Provider because Provider expresses disagreement with a decision by Company to deny or limit benefits to a Member or because Provider assists the Member to seek reconsideration of the Company’s decision, or because Provider discusses with a current, former, or prospective patient any aspect of the patient’s medical condition, any proposed treatments or treatment alternatives, whether covered by Company’s Plan or not, policy provisions of a Plan, or Provider’s personal recommendation regarding selection of a health plan based on Provider’s personal knowledge of the health needs of such patients.

 

Additionally Company may not take an adverse action against Provider because Provider, acting in good faith: (1) communicates with a public official or other person concerning public policy issues related to health care items or services; (2) files a complaint, makes a report, or comments to an appropriate governmental body regarding actions, policies, or practices of Company that Provider believes might negatively affect the quality of, or access to, patient care; (3) provides testimony, evidence, opinion, or any other public activity in any forum concerning a violation or possible violation of any provision of this section; (4) reports what Provider believes to be a violation of law to an appropriate authority; or (5) participates in any investigation into a violation or possible violation of any provision of this section. 

 

Effective January 1, 2019:

In accordance with Section 10-16-121 (e) of the CO Revise Statutes, Company shall not take an adverse action against Provider or provide financial incentives or subject Provider to financial disincentives based solely on a patient satisfaction survey or other method of obtaining patient feedback relating to the patient’s satisfaction with pain treatment.