HB 1070

HOUSE BILL 26-1070
BY REPRESENTATIVE(S) Hartsook and Brown, Gonzalez R., Hamrick,
Lindsay;
also SENATOR(S) Jodeh and Frizell, Daugherty, Gonzales J., Kipp,
Weissman, Coleman.
CONCERNING THIRD-PARTY NETWORK LEASE AGREEMENTS FOR DENTAL
         SERVICES.
Be it enacted by the General Assembly of the State of Colorado:
       SECTION 1. In Colorado Revised Statutes, 10-16-121.5, amend
(4); and add (5), (6), (7), (8), (9), and (10) as follows:
       10-16-121.5. Prohibited contract provisions in contracts between
carriers and providers for dental care services - definitions.
         (4) For ptttposes of As USED IN this section:
     (a) "AFFIRMATIVE CONSENT" MEANS A DENTAL PROVIDER'S EXPRESS
CONSENT TO A THIRD PARTY ACCESSING THE DENTAL PROVIDER'S DENTAL
CARE SERVICES AND CONTRACTUALLY AGREED-UPON DISCOUNTS. THE
TERMS OF THE AFFIRMATIVE CONSENT MUST BE CLEAR AND READILY
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from e.v:isting law and such material is not part of
the act.
UNDERSTANDABLE. AFFIRMATIVE CONSENT MUST INCLUDE THE DENTAL
PROVIDER'S SIGNATURE. THE SIGNATURE MAY BE AN ELECTRONIC
SIGNATURE IF THE FORM OF THE SIGNATURE IS RECOGNIZED AS A VALID
SIGNATURE UNDER APPLICABLE FEDERAL OR STATE LAW, INCLUDING
CHECKING A BOX INDICATING AFFIRMATIVE CONSENT.
       (b) "Covered services" means dental care services for which:
       (I) Reimbursement is available under a covered person's plan
contract; or for whieh
       (11) A reimbursement would be available but for the application of
contractual limitations, such as deductibles, copayments, coinsurance,
waiting periods, annual or lifetime maximums, frequency limitations,
alternative benefit payments, or any other contractual limitations.
       (c)   "THIRD PARTY" MEANS AN ENTITY THAT ENTERS INTO A
THIRD-PARTY NETWORK LEASE AGREEMENT WITH A CARRIER OR A DENTAL
BENEFITS ADMINISTRATOR.
       (d)"THIRD-PARTY NETWORK LEASE AGREEMENT" MEANS AN
AGREEMENT OR CONTRACT ENTERED INTO BETWEEN A CARRIER ORA DENTAL
BENEFITS ADMINISTRATOR AND A THIRD PARTY TO GAIN ACCESS TO THE
DENTAL CARE SERVICES AND CONTRACTUALLY AGREED-UPON DISCOUNTS
PROVIDED BY A PARTICIPATING PROVIDER THAT HAS ENTERED INTO A
CONTRACT WITH THE CARRIER OR THE DENTAL BENEFITS ADMINISTRATOR.
       (5) A CARRIER SHALL NOT ENTER INTO A THIRD-PARTY NETWORK
LEASE AGREEMENT TO PROVIDE ACCESS TO DENTAL CARE SERVICES OR
CONTRACTUALLY AGREED-UPON DISCOUNTS PROVIDED BY A DENTAL
PROVIDER WHO IS CONTRACTED AS A PARTICIPATING PROVIDER WITH THE
CARRIER, UNLESS THE PARTICIPATING PROVIDER GIVES AFFIRMATIVE
CONSENT TO ALLOW THE THIRD PARTY TO ACCESS THE PARTICIPATING
PROVIDER'S DENTAL CARE SERVICES AND CONTRACTUALLY AGREED-UPON
DISCOUNTS.
      (6) A CARRIER SHALL NOT CANCEL OR OTHERWISE TERMINATE A
CONTRACT WITH A PARTICIPATING PROVIDER ON THE GROUNDS THAT THE
PARTICIPATING PROVIDER REFUSES TO ALLOW ACCESS BY A THIRD PARTY TO
THE DENTAL CARE SERVICES AND CONTRACTUALLY AGREED-UPON
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DISCOUNTS PROVIDED BY THE PARTICIPATING PROVIDER. WHEN INITIALLY
CONTRACTING WITH A DENTAL PROVIDER, A CARRIER SHALL NOT REFUSE TO
CONTRACT WITH THE DENTAL PROVIDER SOLELY ON THE BASIS THAT THE
DENTAL PROVIDER DOES NOT CONSENT TO ALLOW A THIRD PARTY TO ACCESS
THE DENTAL PROVIDER'S DENTAL CARE SERVICES AND CONTRACTUALLY
AGREED-UPON DISCOUNTS.
      (7) IF A PARTICIPATING PROVIDER GIVES AFFIRMATIVE CONSENT TO
ALLOW A THIRD PARTY TO ACCESS THE PARTICIPATING PROVIDER'S DENTAL
CARE SERVICES AND CONTRACTUALLY AGREED-UPON DISCOUNTS THROUGH
A THIRD-PARTY NETWORK LEASE AGREEMENT ENTERED INTO BETWEEN A
CARRIER AND A THIRD PARTY, THE CARRIER SHALL:
      (a)    ALLOW THE PARTICIPATING PROVIDER THE OPTION OF
CONTRACTING DIRECTLY WITH THE THIRD PARTY INSTEAD OF ALLOWING THE
THIRD PARTY TO ACCESS THE PARTICIPATING PROVIDER'S SERVICES AND
CONTRACTUALLY AGREED-UPON DISCOUNTS THROUGH THE THIRD-PARTY
NETWORK LEASE AGREEMENT;
      (b) REQUIRE THAT THE THIRD-PARTY NETWORK LEASE AGREEMENT
OBLIGATE THE THIRD PARTY TO COMPLY WITH ALL APPLICABLE TERMS, FEE
SCHEDULES, LIMITATIONS, AND CONDITIONS OF THE CONTRACT BETWEEN
THE CARRIER AND THE PARTICIPATING PROVIDER;
      (c)   AT THE TIME A CONTRACT BETWEEN A CARRIER AND A
PARTICIPATING PROVIDER IS ENTERED INTO, RENEWED, OR EXTENDED, OR
WHENEVER THERE IS A MATERIAL MODIFICATION TO THE CONTRACT
RELEVANT TO GRANTING ACCESS TO A THIRD PARTY THROUGH A
THIRD-PARTY NETWORK LEASE AGREEMENT:
      (I)   GIVE TO THE PARTICIPATING PROVIDER, IN WRITING OR
ELECTRONICALLY,A LIST OF ALL THIRD PARTIES KNOWN BY THE CARRIER TO
WHICH THE CARRIER HAS PROVIDED OR WILL PROVIDE ACCESS TO THE
DENTAL CARE SERVICES AND CONTRACTUALLY AGREED-UPON DISCOUNTS
PROVIDED BY THE PARTICIPATING PROVIDER; AND
      (11) ALLOW THE PARTICIPATING PROVIDER TO REMOVE CONSENT TO
PARTICIPATE IN A THIRD-PARTY NETWORK LEASE AGREEMENT;
      (d)   MAINTAIN A WEBSITE THROUGH WHICH THE PARTICIPATING
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PROVIDER MAY OBTAIN A LIST, REVIEWED EVERY NINETY DAYS AND, IF
NEEDED, UPDATED, OF ALL THIRD PARTIES THAT HAVE ACCESS TO THE
PARTICIPATING PROVIDER'S DENTAL CARE SERVICES AND CONTRACTUALLY
AGREED-UPON DISCOUNTS;
       (e) REQUIRE A THIRD PARTY TO IDENTIFY ON EACH REMITTANCE OR
EXPLANATION OF PAYMENT SENT TO THE PARTICIPATING PROVIDER THE
SOURCE OF ANY CONTRACTUAL DISCOUNT IN RA TES TAKEN BY THE THIRD
PARTY;
       (f) NOTIFY THE PARTICIPATING PROVIDER AT LEAST THIRTY DAYS
BEFORE THE EFFECTIVE DATE OF A NEW THIRD-PARTY NETWORK LEASE
AGREEMENT;
         (g) NOTIFY EACH THIRD PARTY DESCRIBED UNDER SUBSECTION
(7)( c)(I) OR (7)( d) OF THIS SECTION OF THE TERMINATION OF THE CONTRACT
BETWEEN A CARRIER AND A PARTICIPATING PROVIDER AT LEAST THIRTY
DAYS BEFORE THE EFFECTIVE DATE OF THE TERMINATION; AND
      (h) MAKE AVAILABLE TO THE PARTICIPATING PROVIDER WITHIN
THIRTY DAYS AFTER THE PARTICIPATING PROVIDER'S REQUEST A COPY OF
THE CONTRACT CURRENTLY IN FORCE THAT WAS RELIED UPON BY THE
CARRIER IN THE ADJUDICATION OF THE PARTICIPATING PROVIDER'S CLAIM.
      (8) THE NOTICE REQUIRED UNDER SUBSECTION (7)(f) OR (7)(g) OF
THIS SECTION MAY BE PROVIDED BY ANY REASONABLE MEANS, INCLUDING
WRITTEN NOTICE OR ELECTRONIC COMM UNI CATION.
      (9)    SUBJECT TO     ANY   APPLICABLE    CONTINUITY    OF   CARE
REQUIREMENTS, AGREEMENTS, OR CONTRACTUAL PROVISIONS, A THIRD
PARTY'S RIGHT TO ACCESS A DENTAL PROVIDER'S SERVICES AND
CONTRACTUALLY AGREED-UPON DISCOUNTS TERMINATES ON THE DATE THE
CONTRACT BETWEEN THE CARRIER AND THE PROVIDER IS TERMINATED.
      (10) THIS SECTION DOES NOT APPLY IF:
      (a) A PROVIDER NETWORK CONTRACT FOR DENTAL SERVICES IS
PROVIDED TO BENEFICIARIES OF PROGRAMS FOR MEDICAL ASSISTANCE
SPONSORED BY THE STATE, INCLUDING PROGRAMS ADMINISTERED PURSUANT
TO THE "CHILDREN'S BASIC HEALTH PLAN ACT", ARTICLE 8 OF TITLE 25.5,
PAGE 4-HOUSE BILL 26-1070
AND THE "COLORADOMEDICALASSISTANCEACT", ARTICLES 4, 5, AND 6 OF
TITLE25.5, TOTHEEXTENTTHEPROVIDERNETWORKCONTRACTISPROVIDED
TO BENEFICIARIES OF THESE PROGRAMS; OR
      (b) ACCESS TO A PROVIDER NETWORK CONTRACT IS GRANTED TO A
CARRIER OR AN ENTITY OPERA TING IN ACCORDANCE WITH THE SAME BRAND
LICENSEE PROGRAM AS THE CONTRACTING ENTITY, AND A LIST OF THE
CARRIERS OR ENTITIES WITH THE SAME BRAND LICENSEE PROGRAM AS THE
CONTRACTING ENTITY IS MADE AVAILABLE TO A PROVIDER ON THE
CONTRACTING ENTITY'S WEBSITE.
      SECTION 2. Act subject to petition - effective date -
applicability. (1) This act takes effect at 12:01 a.m. on the day following
the expiration of the ninety-day period after final adjournment of the
general assembly (August 12, 2026, if adjournment sine die is on May 13,
2026); except that, if a referendum petition is filed pursuant to section 1 (3)
of article V of the state constitution against this act or an item, section, or
part of this act within such period, then the act, item, section, or part will
not take effect unless approved by the people at the general election to be
held in November 2026 and, in such case, will take effect on the date of the
official declaration of the vote thereon by the governor.
PAGE 5-HOUSE BILL 26-1070
      (2) This act applies to an agreement or contract entered into or
renewed on or after the applicable effective date of this act.
                                           James Rashad Coleman, Sr.
SPEAKER OF THE HOUSE  PRESIDENT OF
OF REPRESENTATIVES  THE SENATE
Vanessa Reilly  Esther van Mourik
CHIEF CLERK OF THE HOUSE  SECRETARY OF
OF REPRESENTATIVES  THE SENATE
       APPROVED ()\,\ y Y \ O \ , , ~ ~ Aty,'\ Ht\.. l.OUc ~   l\o-.~
                                    ( ate and Time)
                 Jared S. Po is
                 GOVERN ROFTHE TATEOFCOLORADO
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