C.R.S.
Section 6-20-102
Limits on facility fees
- rules
- definitions
(1)
Definitions.(a)
“Affiliated with” means:(I)
Employed by a hospital or health system; or(II)
Under a professional services agreement, faculty agreement, or management agreement with a hospital or health system that permits the hospital or health system to bill on behalf of the affiliated entity.(b)
“Campus” means:(I)
A hospital’s main buildings;(II)
The physical area immediately adjacent to a hospital’s main buildings and structures owned by the hospital that are not strictly contiguous to the main buildings but are located within two hundred fifty yards of the main buildings; or(III)
Any other area that the federal centers for medicare and medicaid services in the United States department of health and human services has determined, on an individual-case basis, to be part of a hospital’s campus.(c)
“Critical access hospital” means a hospital that is federally certified or undergoing federal certification as a critical access hospital pursuant to 42 CFR 485, subpart F.(d)
“Facility fee” means any fee a hospital or health system charges or bills for outpatient hospital services that is:(I)
Intended to compensate the hospital or health system for its operational expenses; and(II)
Separate and distinct from a professional fee charged or billed by a health-care provider for professional medical services.(e)
“Freestanding emergency department” means a health facility as defined in and required to be licensed under section 25-1.5-114.(f)
“Health-care provider” means any person, including a health facility, that is licensed or otherwise authorized in this state to furnish a health-care service.(g)
“Health-care service” has the meaning set forth in section 10-16-102 (33).(h)
“Health facility” means a facility licensed or certified pursuant to section 25-1.5-103 or established pursuant to part 5 of article 21 of title 23 or article 29 of title 25.(i)
“Health system” has the meaning set forth in section 10-16-1303 (9).(j)
“Hospital” means a hospital currently licensed or certified by the department of public health and environment pursuant to the department’s authority under section 25-1.5-103 (1)(a) or established pursuant to part 5 of article 21 of title 23 or article 29 of title 25.(k)
“Medicare” means the “Health Insurance for the Aged Act”, Title XVIII of the federal “Social Security Act”, as amended by the social security amendments of 1965, and as later amended.(l)
“Off-campus location” has the meaning set forth in section 25-3-118.(m)
“Owned by” means owned by a hospital or health system when billed under the hospital’s tax identification number.(n)
“Payer type” means commercial insurers; medicare; the medical assistance program established pursuant to articles 4 to 6 of title 25.5; individuals who self-pay; a financial assistance plan; or the “Colorado Indigent Care Program”, established in part 1 of article 3 of title 25.5.(o)
“Sole community hospital” has the meaning set forth in 42 CFR 412.92.(2)
Limitations on charges.(a)
On and after July 1, 2024, a health-care provider or health system shall not charge, bill, or collect a facility fee directly from a patient that is not covered by a patient’s insurance for preventive health-care services, as described in section 10-16-104 (18), that are provided in an outpatient setting.(b)
This subsection (2) does not prohibit a health-care provider from charging a facility fee for:(I)
Health-care services provided in an inpatient setting;(II)
Health-care services provided at a health facility that includes a licensed hospital emergency department; or(III)
Emergency services provided at a licensed freestanding emergency department.(c)
Nothing in this subsection (2) prohibits a health-care provider or health system from charging, billing, or collecting a facility fee from a patient’s insurer pursuant to an agreement between the health-care provider or health system and the carrier or as required by law.(3)
Transparency.(a)
On and after July 1, 2024, a health-care provider affiliated with or owned by a hospital or health system that charges a facility fee shall:(I)
Intentionally left blank —Ed.(A)
Provide notice in plain language to patients that a facility fee may be charged, indicate in the notice the amount of the facility fee, and require the health-care provider to provide the notice to a patient at the time an appointment is scheduled and again at the time the health-care services are rendered; and(B)
Post a sign, in English and Spanish and that is plainly visible and located in the area within the health facility where an individual seeking care registers or checks in, that states that the patient may be charged a facility fee in addition to the cost of the health-care service. The sign must also include a location within the health facility where a patient may inquire about facility fees and an online location where information about facility fees may be found.(II)
Provide to a patient a standardized bill that:(A)
Includes itemized charges for each health-care service;(B)
Specifically identifies any facility fee;(C)
Identifies specific charges that have been billed to insurance or other payer types for health-care services; and(D)
Includes contact information for filing an appeal with the health-care provider to contest charges.(b)
The health-care provider shall provide the required notice and standardized bill in a clear manner and, to the extent practicable, in the patient’s preferred language.(c)
Intentionally left blank —Ed.(I)
A health facility that is newly affiliated with or owned by a hospital or health system on or after July 1, 2024, shall provide written notice to each patient receiving services within the twelve-month period immediately preceding the affiliation or change of ownership that the health facility is part of a hospital or health system. The notice must include:(A)
The name, business address, and phone number of the hospital or health system that is the purchaser of the health facility or with whom the health facility is affiliated;(B)
A statement that the health facility bills, or is likely to bill, patients a facility fee that may be in addition to and separate from any professional fee billed by a health-care provider at the health facility; and(C)
A statement that, prior to seeking services at the health facility, a patient covered by a health insurance policy or health benefit plan should contact the patient’s health insurer for additional information regarding the health facility’s facility fees, including the patient’s potential financial liability, if any, for the facility fees.(II)
A hospital, health system, or health facility shall not collect a facility fee for health-care services provided by a health-care provider affiliated with or owned by a hospital or health system that is subject to any provisions of this section from the date of the transaction until at least thirty days after the written notice required pursuant to subsection (3)(c)(I) of this section is mailed to the patient.(4)
Subsection (2) of this section does not apply to a critical access hospital, a sole community hospital in a rural or frontier area, or a community clinic affiliated with a sole community hospital in a rural or frontier area.(5)
Subsection (2) of this section does not apply to a hospital established pursuant to article 29 of title 25.
Source:
Section 6-20-102 — Limits on facility fees - rules - definitions, https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-06.pdf (accessed Oct. 20, 2023).
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