Colorado § 10-16-403 - Powers of health maintenance organizations.

§ 10-16-403. Powers of health maintenance organizations.

(1) The powers of a health maintenance organization include, but are not limited to, the following:

(a) The purchase, lease, construction, renovation, operation, and maintenance of hospitals, medical facilities, nursing care and intermediate care facilities, and other institutions of like nature, their ancillary equipment, and such property as may reasonably be required for its administrative offices or for such other purposes as may be necessary to accomplish the business of the organization;

(b) The making of loans to a medical group under contract with it in furtherance of its program or the making of loans to a corporation or corporations under its control for the purpose of acquiring or constructing medical facilities, hospitals, nursing care and intermediate care facilities, and other institutions of a like nature providing health-care services to enrollees;

(c) The furnishing of health-care services through providers which are under contract with or employed by the health maintenance organization;

(d) The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment, and administration;

(e) The contracting with an insurance company licensed in this state, or with a nonprofit hospital, medical-surgical, and health service corporation authorized to do business in this state, for the provision of insurance, indemnity, or reimbursement against the cost of health-care services provided by the health maintenance organization;

(f) The offering, in addition to basic health-care services, of:

(I) Additional health-care services;

(II) Indemnity benefits not exceeding twenty percent of net medical and hospital expenses incurred on an annual basis;

(III) Indemnity benefits, in addition to benefits provided directly or indirectly through contracts with providers, by the health maintenance organization, through insurers or nonprofit hospital, medical-surgical, and health service corporations;

(g) The offering of contracts for the rendering of long-term care insurance, as defined in section 10-19-103 (5), on behalf of any of its enrollees. Such contracts shall comply with article 19 of this title.

(h) Repealed.

(2) (a) A health maintenance organization shall file notice, with adequate supporting information, with the commissioner prior to the exercise of any power granted in the introductory portion or paragraph (a) of subsection (1) of this section. The commissioner shall disapprove such exercise of power, if in the commissioner's opinion it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. If the commissioner does not disapprove within thirty days of the filing, it shall be deemed approved.

(b) The commissioner may promulgate rules and regulations exempting from the filing requirement of paragraph (a) of this subsection (2) those activities having a de minimis effect.

Source: L. 92: Entire article R&RE, p. 1698, § 1, effective July 1. L. 94: (1)(a) and (1)(b) amended, p. 1629, § 27, effective May 31. L. 99: (1)(f) amended, p. 80, § 1, effective July 1. L. 2009: (1)(h) added, (HB 09-1143), ch. 114, p. 479, § 2, effective August 5.

Editor's note: (1) This section is similar to former § 10-17-105 as it existed prior to 1992.

(2) Subsection (1)(h) provided for the repeal of subsection (1)(h), effective July 1, 2012. (See L. 2009, p. 479.)

Cross references: For the legislative declaration contained in the 2009 act adding subsection (1)(h), see section 1 of chapter 114, Session Laws of Colorado 2009.