C.R.S.
Section 25.5-4-402.8
Hospital transparency report
- definitions
(1)
As used in this section, unless the context otherwise requires:(a)
“Acquired” means the purchase by a hospital, or entity that is owned by or under common ownership and control with the hospital, of all or substantially all of an organization subject to subsection (1)(b)(I) or (1)(b)(II) of this section through an asset, equity, or similar purchase agreement that is a single transaction or series of transactions.(b)
“Affiliated” or “affiliate” means there is a contractual relationship between a hospital or an entity that is owned by or under common ownership and control with the hospital where the contractual relationship enables the hospital or an entity that is owned by or under common ownership and control with the hospital to exercise control over one of the following entities:(I)
Another hospital;(II)
An entity owned by or under common ownership and control with another hospital; or(III)
A physician group practice.(c)
“Control” means the possession, direct or indirect, of the power to direct or cause the direction of management and policies of an affiliate, whether through the ownership of equity or membership, by contract or otherwise.(d)
“Major payer group” includes commercial insurers, medicare, medicaid, individuals who self-pay, a financial assistance plan, and the “Colorado Indigent Care Program”, established in part 1 of article 3 of this title 25.5.(2)
Intentionally left blank —Ed.(a)
The state department shall annually prepare a written hospital transparency report detailing hospital costs, including uncompensated care costs, and the different categories of expenditures, by major payer group, made by hospitals in the state. The state department shall coordinate the analysis, review, and release of the hospital transparency report and the reports required pursuant to sections 25.5-1-703 (3) and 25.5-4-402.4 (7)(e), including the opportunity to review and consult on the reports made by the Colorado healthcare affordability and sustainability enterprise board, created pursuant to section 25.5-4-402.4 (7) and referred to in this section as the “enterprise board”. The state department may share any information and analytics of information that it receives from hospitals with the enterprise board. The state department may include information it receives from hospitals in accordance with subsection (2)(b) of this section and that is not otherwise publicly available in the transparency report and share such information with the enterprise board; except that information the state department receives from hospitals in accordance with subsections (2)(b)(II)(D), (2)(b)(III)(N), (2)(b)(III)(O), (2)(b.5)(I), and (2)(b.5)(II) of this section is confidential, proprietary, contains trade secrets, and is not a public record pursuant to part 2 of article 72 of title 24. The state department shall not include in the transparency report, share with the enterprise board, or otherwise publish or distribute information derived from reports pursuant to subsections (2)(b)(II)(D), (2)(b)(III)(N), (2)(b)(III)(O), (2)(b.5)(I), and (2)(b.5)(II) of this section, although the state department may share this information if such information has been de-identified and aggregated in a manner to prevent identification of the transaction price of any individual acquisition or affiliation.(b)
Except as provided in subsection (2)(c) of this section, each hospital licensed pursuant to part 1 of article 3 of title 25, or certified pursuant to section 25-1.5-103 (1)(a)(II), shall make information available to the state department for purposes of preparing the annual hospital transparency report. The state board shall establish the format of the information provided by each hospital on an annual basis. Each hospital shall provide the following information to the state department:(I)
The hospital cost report submitted to the federal centers for medicare and medicaid services (CMS) pursuant to 42 CFR 413.20, including a copy of the final forms and worksheets submitted to CMS as part of the hospital cost report;(II)
Intentionally left blank —Ed.(A)
Annual audited financial statements, prepared in accordance with generally accepted accounting principles. Each hospital shall submit the statements within one hundred twenty days after the end of its fiscal year unless the state department grants an extension in writing in advance of that date.(B)
Notwithstanding the provisions of subsection (2)(b)(II)(A) of this section, if a hospital is operating within a health system or other corporate structure and is normally included in that health system or other corporate structure’s financial statement, the hospital may submit the health system or other corporate structure’s financial statement if the statement separately identifies the financial information for each of the health system or other corporate structure’s licensed hospitals operating in this state.(C)
In lieu of an audited financial statement, each hospital operating within a health system or other corporate structure that does not produce an annual audited financial statement specific to each individual hospital, but instead produces consolidated financial statements, shall submit a reconciliation of the consolidated financial statement and hospital-specific revenue and expenses reported on the medicare cost report pursuant to the federal centers for medicare and medicaid services provider reimbursement manual form 339.(D)
An annual summary of the hospital’s transfers of cash, equity, investments, or other assets to and from related parties, including but not limited to the hospital’s parent organization. The summary must include the purpose of the transfers and whether the transfers were made within or outside of Colorado. A hospital may aggregate the transfers for each entity receiving or making the transfer.(E)
A hospital-specific statement of cash flow within a time frame specified annually by the state department, but not less than one hundred twenty days after the hospital’s fiscal year end.(F)
Changes to no more than twenty-five categories of specific major service lines, as requested by the state department.(G)
A narrative report of major planned and completed projects and capital investments greater than twenty-five million dollars; except that the information the state department receives from hospitals regarding planned activities is confidential, proprietary, contains trade secrets, and is not a public record pursuant to part 2 of article 72 of title 24.(III)
A report that contains the following information:(A)
The total number of available beds and licensed beds;(B)
Inpatient statistics in total and by major payer group and by care setting, including but not limited to inpatient discharges and patient days;(C)
Other inpatient statistics, including but not limited to the number of inpatient surgeries, number of births, number of newborn patient days, number of admissions from the hospital-based emergency department, and number of admissions from free-standing emergency departments;(D)
Outpatient statistics in total and by type of visit, including but not limited to hospital-based emergency department visits, free-standing emergency department visits, ambulatory surgery visits, home health visits, and all other outpatient visits;(E)
Gross charges in total, by major payer group, and by care setting, including but not limited to inpatient care and outpatient care;(F)
Contractual allowances in total and by major payer group;(G)
Bad debt write-offs in total and by major payer group;(H)
Charity write-offs in total and by major payer group;(I)
Operating expenses in total and by expense classification, including but not limited to nonphysician payroll expenses and associated hours, physician payroll expenses and associated hours, total payroll expenses and associated hours, contract labor expenses and associated hours, employee benefits expenses, business development, marketing and advertising expenses, supply expenses, depreciation expenses, interest expenses, and all other operating expenses;(J)
Other operating revenue, operating margin, nonoperating gains and losses, gross revenue, net profit, and total margin;(K)
A balance sheet, including but not limited to details for current assets, restricted assets, long-term assets, other assets, current liabilities, long-term debt, other liabilities, and equity or net assets;(L)
Staffing information, including but not limited to full-time equivalents, staff turnover, and staff vacancy rates;(M)
A roll forward of property, plant, and equipment accounts by asset type from the beginning to the end of the reporting period by asset category, including but not limited to purchases, other acquisitions, sales, disposals, and other changes;(N)
The names and transaction price of acquired hospitals, affiliated hospitals, newly constructed hospitals, and rehabilitated hospitals; the names and transaction price of acquired or affiliated physician group practices; and the number and transaction price of individual physician practices acquired;(O)
Information on current affiliations and a report of physician practice acquisitions;(P)
Salary and total compensation data of the top five highest paid administrative positions of each nonprofit hospital, including the title, a brief description of duties, base compensation, incentive or bonus compensation, and other compensation. The compensation reported must indicate what performance measures were included in the chief executive officer’s performance evaluation generated by the hospital’s governing board, including, at a minimum, quality of care outcomes performance; patient satisfaction performance; community benefit performance; consumer and employer affordability performance; market share performance; profits or margins; revenue growth; change in days cash on hand or cash reserves; and workforce. The state department may include information it receives from public hospitals pursuant to this subsection (2)(b)(III)(P) that is not otherwise publicly available in the hospital transparency report; except that information the state department receives from a nonprofit hospital is not a public record pursuant to part 2 of article 72 of title 24. The state department may only report information received pursuant to this subsection (2)(b)(III)(P) in an aggregated format that does not name individual hospitals or administrators.(Q)
In a form and manner specified by the state department, details of significant other revenue that would otherwise be reported in the medicare cost report; and(IV)
Intentionally left blank —Ed.(A)
A quarterly financial report that includes an income statement and balance sheet. If a hospital is owned or affiliated with a health system that is comprised of three or more hospitals or that has more than one billion dollars in reserves, the health system may submit a consolidated quarterly financial report.(B)
Any quarterly financial report made publicly available must clearly state that the quarterly financial report is unaudited, if applicable. The state department shall provide any analysis, report, or presentation based on the quarterly financial report to each hospital at least fifteen days prior to the public release of the analysis, report, or presentation.(b.5)
No later than July 1, 2024, each hospital shall provide the following information to the state department:(I)
For each fiscal year 2014-15 through 2019-20, a summary of the hospital’s transfers of cash, equity, investments, or other assets to and from related parties, including but not limited to the hospital’s parent organization. The summary must include the purpose of the transfers and whether the transfers were made within or outside of Colorado. A hospital may aggregate the transfers for each entity receiving or making the transfer.(II)
For each fiscal year from 2014-15 through 2019-20, information on affiliations and a report of physician practice acquisitions; and(III)
For each fiscal year from 2019-20 through 2022-23, in a form and manner specified by the state department, details of significant other revenue that would otherwise be reported in the medicare cost report.(c)
The state department may exempt from certain reporting requirements described in subsections (2)(b) and (2)(b.5) of this section certain types of hospitals, including but not limited to:(I)
Psychiatric hospitals, as licensed by the department of public health and environment;(II)
Hospitals that are licensed as general hospitals and certified as long-term care hospitals by the department of public health and environment;(III)
Critical access hospitals that are licensed as general hospitals and are certified by the department of public health and environment pursuant to 42 CFR 485 subpart F;(IV)
Inpatient rehabilitation facilities; and(V)
Hospitals specified for exemption under 42 CFR 433.68 (e).(d)
Repealed.(e)
Prior to issuing the hospital transparency report, the state department shall provide any hospital referenced in the hospital transparency report a copy of the report. Each hospital must have a minimum of fifteen days to review the hospital transparency report and any underlying data and submit corrections or clarifications to the state department.(f)
The state department shall provide a statewide hospital association any information received pursuant to this section in a machine-readable format at no cost to the association.(g)
Intentionally left blank —Ed.(I)
If a hospital does not provide all of the information required pursuant to subsection (2)(b) of this section, the state department shall inform the hospital of its noncompliance within sixty days and identify the information that needs to be provided. If a hospital does not comply, the state department shall issue a corrective action plan with a timeline of sixty days required for compliance. If a hospital continues to not comply, the state department may create a mandatory pay-for-reporting compliance measure within the hospital transformation program that is tied to the healthcare affordability and sustainability fee supplemental payment and is based on compliance with subsection (2)(b) of this section.(II)
If the state department determines a hospital’s noncompliance with this section is knowing or willful or there is a repeated pattern of noncompliance, the state department shall consider the size of the hospital and the seriousness of the violation in setting a fine amount which, for hospitals owned or affiliated with a hospital system comprised of three or more hospitals, must not exceed twenty thousand dollars per violation per week until the hospital takes corrective and, for all other hospitals, must not exceed five thousand dollars per week until the hospital takes corrective action.(3)
The hospital transparency report must include, but not be limited to:(a)
A description of the methods of analysis and definitions of report components;(b)
Uncompensated care costs by major payer group; and(c)
The percentage that each of the following categories contributes to overall expenses of hospitals:(I)
Delivery of inpatient health care and services by major payer group;(II)
Delivery of outpatient health care and services by major payer group and site location;(III)
Administrative costs;(IV)
Capital construction costs and associated bond liabilities;(V)
Maintenance;(VI)
Capital expenditures;(VII)
Personnel services;(VIII)
Uncompensated care by major payer group; and(IX)
Other expenditure categories, as determined by the state department.(4)
Intentionally left blank —Ed.(a)
On or before January 15, 2020, and on or before January 15 each year thereafter, the state department shall submit the annual hospital transparency report to:(I)
The house of representatives health and insurance committee and the house of representatives public and behavioral health and human services committee, or any successor committee;(II)
The health and human services committee of the senate, or any successor committee;(III)
The joint budget committee of the general assembly;(IV)
The governor; and(V)
The state board.(b)
The state department may request that the enterprise board combine the hospital transparency report described in this section with the report of the enterprise board specified in section 25.5-4-402.4 (7)(e), so long as the specific requirements of this section are fulfilled, and so long as the enterprise board agrees to the request. The state department shall post the annual report on its website by January 15 of each year.(c)
Notwithstanding section 24-1-136 (11)(a)(I), the report required in this section continues indefinitely.(4.5)
The state department shall report on the annual hospital transparency report during the state department’s “SMART Act” hearing.(5)
The state department, in consultation with the department of public health and environment and the division of insurance, shall review the hospital report card, created pursuant to section 25-3-703, and the hospital charge report, created pursuant to section 25-3-705, and make recommendations to the general assembly by November 1, 2019. The recommendations must identify any structural or substantive changes that should be made to the hospital report card or hospital charge report to increase the value of those reports, including a consideration of whether the hospital report card or hospital charge report still provides value to consumers and policymakers.
Source:
Section 25.5-4-402.8 — Hospital transparency report - definitions, https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-25.5.pdf (accessed Oct. 20, 2023).
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