C.R.S.
Section 25-3-705
Health-care charge transparency
- hospital charge report
- definitions
(1)
The commissioner of insurance shall work with the duly constituted association of hospitals selected by the executive director for assistance in carrying out the purposes of this section.(2)
Intentionally left blank —Ed.(a)
On or before August 1, 2009, and on or before each August 1 thereafter, each hospital licensed pursuant to part 1 of this article shall report annually to the association of hospitals the information necessary to allow the association to determine the charges for the twenty-five most common inpatient diagnostic-related groups for which there are at least ten cases rendered by the hospital during the calendar year immediately preceding the release of the hospital charge report. If a hospital does not have twenty-five of the most common diagnostic-related groups with at least ten or more cases rendered, the hospital shall report only on those most common diagnostic-related groups that have at least ten cases rendered.(b)
A hospital that does not use diagnostic-related groups is exempt from paragraph (a) of this subsection (2).(3)
Intentionally left blank —Ed.(a)
The commissioner of insurance shall work with the association of hospitals to incorporate the information reported pursuant to this section on the website.(b)
The commissioner of insurance shall require the association of hospitals to submit a plan to the commissioner on or before November 30, 2008, that states the implementation status of a plan to make the hospital charges reported pursuant to this section available to the public on the website. The plan shall identify the process and time periods for implementation, any barriers to implementation, and recommendations of changes in the law that may be enacted by the general assembly to eliminate the barriers.(c)
When developing the required plan, the association of hospitals shall consider:(I)
The method for hospitals to report charges to the association;(II)
Standards that provide for the validity and comparability of hospital charges; and(III)
The format for making hospital charges available to the public.(4)
Intentionally left blank —Ed.(a)
The association of hospitals shall make the information reported by the hospitals pursuant to this section available on the website on or before August 1, 2009, and on or before August 1 of each year thereafter. The information reported by the hospitals shall include disclaimers regarding factors including case severity ratings and individual patient variations that may affect actual charges to a patient for services provided.(b)
The information reported by the hospitals that is published in accordance with this section shall include:(I)
Volume of cases by diagnostic-related group required to be reported by the hospital;(II)
Rank by volume of the top twenty-five diagnostic-related groups required to be reported by the hospital;(III)
Mean charge for each of the top twenty-five diagnostic-related groups with more than ten occurrences by hospital;(IV)
Case severity rating by hospital by diagnostic-related group; and(V)
A general disclaimer statement regarding the hospital variations and patient variations that affect the actual charges to patients.(c)
Before publication of the information published pursuant to this section on the website, the commissioner shall ensure that every hospital is allowed thirty days within which to examine the data and submit comments for consideration and inclusion in the final hospital charge report.(5)
Intentionally left blank —Ed.(a)
The commissioner of insurance shall approve the publication of information on the website consisting of public disclosure of charge data assembled pursuant to this section. At a minimum, the information shall be made available on the website in a manner that allows consumers to conduct an interactive search to view and compare the information for specific hospitals. The website shall include any additional information necessary to ensure that the website information is available to consumers and health-care purchasers. The information shall include, at a minimum, appropriate guidance on how to use the data and an explanation of why the data may vary from hospital to hospital. The report specified in this subsection (5) shall be released on the website on or before August 1, 2009, and on or before each August 1 thereafter.(b)
The commissioner of insurance shall make the website available by hyperlink on the division of insurance website.(c)
The division of insurance shall review the information posted on the website to ensure that the website and information provided by the association is easy to navigate, contains consumer-friendly language, and fulfills the intent of this section. The division shall also ensure that the hyperlink from the division’s website to the website is easily accessible.(6)
There shall be no liability on the association of hospitals or a cause of action against the association or its agents, employees, or directors or authorized designees of the commissioner for actions taken or omitted in the performance of duties pursuant to this section.(7)
Repealed.(8)
As used in this section:(a)
“Charge” means the amount that a hospital expects to charge for an inpatient diagnostic-related group. A charge that is required to be reported to the public shall be the mean charge for all cases of the diagnostic-related group occurring in the calendar year prior to the release of the hospital charge report.(b)
“Diagnostic-related group” means the classification assigned to an inpatient hospital service claim based on the patient’s age and sex, the principal and secondary diagnoses, the procedures performed, and the discharge status.(c)
“Website” means a website established by the association of hospitals that links to the website created pursuant to section 25-3-703.
Source:
Section 25-3-705 — Health-care charge transparency - hospital charge report - definitions, https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-25.pdf (accessed Oct. 20, 2023).
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