Second Regular Session
Seventy-third General Assembly
STATE OF COLORADO
ENGROSSED
This Version Includes All Amendments Adopted
on Second Reading in the House of Introduction
LLS NO. 22-0589.01 Brita Darling x2241
HOUSE BILL 22-1285
House Committees Senate Committees
Health & Insurance
A BILL FOR AN ACT
C
ONCERNING A PROHIBITION AGAINS T A HOSPITAL TAKING CERTAIN101
DEBT COLLECTION ACTIONS AGAINST A PATIENT IF THE102
HOSPITAL IS NOT IN COMPLI ANCE WITH HOSPITAL PRICE103
TRANSPARENCY LAWS .104
Bill Summary
(Note: This summary applies to this bill as introduced and does
not reflect any amendments that may be subsequently adopted. If this bill
passes third reading in the house of introduction, a bill summary that
applies to the reengrossed version of this bill will be available at
http://leg.colorado.gov
.)
The bill prohibits a hospital or other person or entity collecting on
behalf of the hospital from initiating or pursuing collection actions
against a patient or patient guarantor for debt incurred by the patient on
HOUSE
Amended 2nd Reading
April 22, 2022
HOUSE SPONSORSHIP
Neville and Esgar, Daugherty
SENATE SPONSORSHIP
Moreno and Cooke,
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing statute.
Dashes through the words indicate deletions from existing statute. the date or dates of service when the hospital was not in compliance with
federal hospital price transparency laws.
Nothing in the bill:
! Prohibits a hospital from billing a patient or health insurer
for items or services provided to the patient; or
! Requires a hospital to refund a payment made to the
hospital for items or services provided to a patient.
A hospital that initiates or pursues a prohibited collection action
is subject to a penalty equal to the amount of the debt and must refund
any amount paid on the debt and pay attorney fees and costs.
The bill makes attempting to collect the debt an unfair practice
under the "Colorado Fair Debt Collections Act".
The bill authorizes the department of public health and
environment, in considering a hospital's license renewal application, to
consider whether the hospital is or has been in compliance with federal
hospital price transparency laws.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, add part 8 to article2
3 of title 25 as follows:3
PART 84
CONSUMER PROTECTION RELATING TO5
HOSPITAL PRICE TRANSPARENCY6
25-3-801. Legislative declaration. (1) T
HE GENERAL ASSEMBLY7
FINDS AND DECLARES THAT:8
(a) S
ECTION 1001 OF THE "PATIENT PROTECTION AND9
A
FFORDABLE CARE ACT OF 2010", PUB.L. 111-148, AS AMENDED BY10
SECTION 10101 OF THE "HEALTH CARE AND EDUCATION RECONCILIATION11
A
CT OF 2010", PUB.L. 111-152, AMENDED TITLE XXVII OF THE "PUBLIC12
H
EALTH SERVICE ACT", PUB.L. 78-410, IN PART, BY ADDING A NEW13
SECTION 2718(e), REQUIRING, IN PART, THAT EACH HOSPITAL OPERATING14
WITHIN THE UNITED STATES ESTABLISH, UPDATE, AND MAKE PUBLIC A LIST15
OF THE HOSPITAL'S STANDARD CHARGES FOR THE ITEMS AND SERVICES16
1285-2- THAT THE HOSPITAL PROVIDES;1
(b) E
FFECTIVE JANUARY 1, 2021, THE FEDERAL CENTERS FOR2
MEDICARE AND MEDICAID SERVICES PUBLISHED THE FINAL RULE TO3
IMPLEMENT THE LAW, CODIFIED AT 45 CFR 180;4
(c) I
N ITS SUMMARY OF THE FINAL RULE , CMS STATES THAT5
INFORMATION ON HOSPITAL STANDARD CHARGES IS NECESSARY FOR THE6
PUBLIC TO "MAKE MORE INFORMED DECISIONS ABOUT THEIR CARE " AND7
THAT THE "IMPACT OF THESE FINAL POLICIES WILL HELP TO INCREASE8
MARKET COMPETITION, AND ULTIMATELY DRIVE DOWN THE COST OF9
HEALTH CARE SERVICES, MAKING THEM MORE AFFORDABLE FOR ALL10
PATIENTS";11
(d) O
N JULY 9, 2021, PRESIDENT BIDEN, BUILDING UPON EFFORTS12
OF PAST PRESIDENTS, ISSUED THE "EXECUTIVE ORDER ON PROMOTING13
C
OMPETITION IN THE AMERICAN ECONOMY", DIRECTING THE SECRETARY14
OF THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES15
TO SUPPORT NEW AND EXISTING PRICE TRANSPARENCY INITIATIVES FOR16
HOSPITALS;17
(e) H
EALTH-CARE PRICE TRANSPARENCY IS IN THE BEST INTEREST18
OF ALL COLORADANS, INCLUDING:19
(I) T
HE STATE GOVERNMENT , WHICH PURCHASES HEALTH -CARE20
SERVICES FOR ALMOST A QUARTER OF ALL COLORADANS;21
(II) C
OLORADO BUSINESSES, WHICH FUND EMPLOYEE MEDICAL22
EXPENSES; AND23
(III) C
OLORADO RESIDENTS, WHO ULTIMATELY BEAR THE BRUNT24
OF HIGH HEALTH-CARE COSTS IN THE FORM OF HIGHER TAXES , LOWER25
WAGES, AND RESIDENTS' OWN OUT-OF-POCKET SPENDING;26
(f) M
OREOVER, HEALTH-CARE PRICES IN COLORADO ARE AMONG27
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-3- THE HIGHEST IN THE NATION;1
(g) H
OWEVER, NOT ALL COLORADO HOSPITALS ARE IN2
COMPLIANCE WITH ALL OF THE DISCLOSURE REQUIREMENTS UNDER3
FEDERAL LAW AND OTHER STATE LAWS GOVERNING HEALTH -CARE PRICE4
TRANSPARENCY; AND5
(h) T
HIS LACK OF COMPLIANCE WITH HEALTH -CARE PRICE6
TRANSPARENCY LAWS BY COLORADO HOSPITALS DECREASES THE7
LIKELIHOOD THAT COLORADO CONSUMERS WILL BE FULLY AWARE OF8
AFFORDABLE HEALTH-CARE OPTIONS BEFORE PURCHASING ITEMS AND9
SERVICES FROM HOSPITALS , PLACING HEALTH-CARE CONSUMERS AT10
GREATER RISK OF COLLECTION ACTIONS AND OTHER ADVERSE ACTIONS11
RELATING TO UNPAID MEDICAL BILLS.12
(2) T
HEREFORE, THE GENERAL ASSEMBLY FINDS AND DECLARES13
THAT IT IS IMPERATIVE TO PROTECT COLORADO HEALTH-CARE CONSUMERS14
FROM COLLECTION ACTIONS AND OTHER ADVERSE ACTIONS TAKEN BY15
C
OLORADO HOSPITALS DURING THE TIME WHEN THE HOSPITAL WAS NOT IN16
MATERIAL COMPLIANCE WITH HOSPITAL PRICE TRANSPARENCY LAWS17
INTENDED TO PROTECT HEALTH -CARE CONSUMERS.18
25-3-802. Definitions. A
S USED IN THIS SECTION, UNLESS THE19
CONTEXT OTHERWISE REQUIRES :20
(1) "C
OLLECTION ACTION" MEANS ANY OF THE FOLLOWING21
ACTIONS TAKEN WITH RESPECT TO A DEBT FOR ITEMS AND SERVICES THAT22
WERE PURCHASED FROM OR PROVIDED TO A PATIENT BY A HOSPITAL ON A23
DATE DURING WHICH THE HOSPITAL WAS NOT IN
MATERIAL COMPLIANCE24
WITH HOSPITAL PRICE TRANSPARENCY LAWS :25
(a) A
TTEMPTING TO COLLECT A DEBT FROM A PATIENT OR PATIENT26 GUARANTOR BY REFERRING THE DEBT, DIRECTLY OR INDIRECTLY, TO A27
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-4- DEBT COLLECTOR, A COLLECTION AGENCY , OR OTHER THIRD PARTY1
RETAINED BY OR ON BEHALF OF THE HOSPITAL ;2
(b) S
UING THE PATIENT OR PATIENT GUARANTOR , OR ENFORCING3
AN ARBITRATION OR MEDIATION CLAUSE IN ANY HOSPITAL DOCUMENTS4
INCLUDING CONTRACTS, AGREEMENTS, STATEMENTS, OR BILLS; OR5
(c) D
IRECTLY OR INDIRECTLY CAUSING A REPORT TO BE MADE TO6
A CONSUMER REPORTING AGENCY .7
(2) "COLLECTION AGENCY" MEANS ANY:8
(a) PERSON WHO ENGAGES IN A BUSINESS THE PRINCIPAL PURPOSE9
OF WHICH IS THE COLLECTION OF DEBTS; OR10
(b) PERSON WHO:11
(I) REGULARLY COLLECTS OR ATTEMPTS TO COLLECT, DIRECTLY12
OR INDIRECTLY, DEBTS OWED OR DUE OR ASSERTED TO BE OWED OR DUE13
TO ANOTHER;14
(II) TAKES ASSIGNMENT OF DEBTS FOR COLLECTION PURPOSES; OR15
(III) DIRECTLY OR INDIRECTLY SOLICITS FOR COLLECTION DEBTS16
OWED OR DUE OR ASSERTED TO BE OWED OR DUE TO ANOTHER .17
(3) (a) "CONSUMER REPORTING AGENCY" MEANS ANY PERSON18
THAT, FOR MONETARY FEES, DUES, OR ON A COOPERATIVE NONPROFIT19
BASIS, REGULARLY ENGAGES, IN WHOLE OR IN PART, IN THE PRACTICE OF20
ASSEMBLING OR EVALUATING CONSUMER CREDIT INFORMATION OR OTHER21
INFORMATION ON CONSUMERS FOR THE PURPOSE OF FURNISHING22
CONSUMER REPORTS TO THIRD PARTIES. "CONSUMER REPORTING AGENCY"23
INCLUDES ANY PERSON DEFINED IN 15 U.S.C. sec. 1681a (f) OR SECTION24
5-18-103 (4).25
(b) "CONSUMER REPORTING AGENCY" DOES NOT INCLUDE ANY26
BUSINESS ENTITY THAT PROVIDES CHECK VERIFICATION OR CHECK27
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-5- GUARANTEE SERVICES ONLY .1
(4) (a) "DEBT" MEANS ANY OBLIGATION OR ALLEGED OBLIGATION2
OF A CONSUMER TO PAY MONEY ARISING OUT OF A TRANSACTION,3
WHETHER OR NOT THE OBLIGATION HAS BEEN REDUCED TO JUDGMENT .4
(b) "DEBT" DOES NOT INCLUDE A DEBT FOR BUSINESS ,5
INVESTMENT, COMMERCIAL, OR AGRICULTURAL PURPOSES OR A DEBT6
INCURRED BY A BUSINESS. 7
(5) "DEBT COLLECTOR" MEANS ANY PERSON EMPLOYED OR8
ENGAGED BY A COLLECTION AGENCY TO PERFORM THE COLLECTION OF9
DEBTS OWED OR DUE OR ASSERTED TO BE OWED OR DUE TO ANOTHER .10
(6) "FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES "11
OR "CMS" MEANS THE CENTER FOR MEDICARE AND MEDICAID SERVICES12
IN THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES .13
(7) "HOSPITAL" MEANS, CONSISTENT WITH 45 CFR 180.20, A14
HOSPITAL:15
(a) L
ICENSED OR CERTIFIED BY THE DEPARTMENT PURSUANT TO16
SECTION 25-1.5-103 (1)(a); OR17
(b) A
PPROVED BY THE DEPARTMENT AS MEETING THE STANDARDS18
ESTABLISHED FOR LICENSING A HOSPITAL.19
(8) "HOSPITAL PRICE TRANSPARENCY LAWS " MEANS SECTION20
2718(e)
OF THE "PUBLIC HEALTH SERVICE (PHS) ACT", PUB.L. 78-410, AS21
AMENDED, AND RULES ADOPTED BY THE UNITED STATES DEPARTMENT OF22
HEALTH AND HUMAN SERVICES IMPLEMENTING SECTION 2718 (e).23(9) "ITEMS AND SERVICES" OR "ITEMS OR SERVICES" MEANS "ITEMS24
AND SERVICES" AS DEFINED IN 45 CFR 180.20.25
25-3-803. Failure to comply with hospital price transparency26
laws - prohibiting collection of debt - penalty. (1) (a) EXCEPT AS27
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-6- PROVIDED IN SUBSECTION (1)(b) OF THIS SECTION, ON AND AFTER THE1
EFFECTIVE DATE OF THIS SECTION, A HOSPITAL THAT IS NOT IN MATERIAL2
COMPLIANCE WITH HOSPITAL PRICE TRANSPARENCY LAWS ON THE DATE3
THAT ITEMS OR SERVICES ARE PURCHASED FROM OR PROVIDED TO A4
PATIENT BY THE HOSPITAL SHALL NOT INITIATE OR PURSUE A COLLECTION5
ACTION AGAINST THE PATIENT OR PATIENT GUARANTOR FOR A DEBT OWED6
FOR THE ITEMS OR SERVICES.7
(b) THIS PART 8 APPLIES, ON AND AFTER FEBRUARY 15, 2023, TO8
CRITICAL ACCESS HOSPITALS LICENSED AND CERTIFIED BY THE9
DEPARTMENT PURSUANT TO 42 CFR 485 SUBPART F.10
(2) IF A PATIENT BELIEVES THAT A HOSPITAL WAS NOT IN11
MATERIAL COMPLIANCE WITH HOSPITAL PRICE TRANSPARENCY LAWS ON12
A DATE ON OR AFTER THE EFFECTIVE DATE OF THIS SECTION THAT ITEMS13
OR SERVICES WERE PURCHASED BY OR PROVIDED TO THE PATIENT, AND14
THE HOSPITAL TAKES A COLLECTION ACTION AGAINST THE PATIENT OR15
PATIENT GUARANTOR, THE PATIENT OR PATIENT GUARANTOR MAY FILE16
SUIT TO DETERMINE IF THE HOSPITAL WAS MATERIALLY OUT OF17
COMPLIANCE WITH THE HOSPITAL PRICE TRANSPARENCY LAWS AND RULES18
AND REGULATIONS ON THE DATE OF SERVICE. THE HOSPITAL SHALL NOT19
TAKE A COLLECTION ACTION AGAINST THE PATIENT OR PATIENT20
GUARANTOR WHILE THE LAWSUIT IS PENDING .21
(3) A HOSPITAL THAT HAS BEEN FOUND BY A JUDGE OR JURY,22
CONSIDERING COMPLIANCE STANDARDS ISSUED BY THE FEDERAL CENTERS23
FOR MEDICARE AND MEDICAID SERVICES, TO BE MATERIALLY OUT OF24
COMPLIANCE WITH HOSPITAL PRICE TRANSPARENCY LAWS AND RULES AND25
REGULATIONS:26
(a) S
HALL REFUND THE PAYER ANY AMOUNT OF THE DEBT THE27
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-7- PAYER HAS PAID AND SHALL PAY A PENALTY TO THE PATIENT OR PATIENT1
GUARANTOR IN AN AMOUNT EQUAL TO THE TOTAL AMOUNT OF THE DEBT ;2
(b) S
HALL DISMISS OR CAUSE TO BE DISMISSED ANY COURT ACTION3
WITH PREJUDICE AND PAY ANY ATTORNEY FEES AND COSTS INCURRED BY4
THE PATIENT OR PATIENT GUARANTOR RELATING TO THE ACTION ; AND5
(c) R
EMOVE OR CAUSE TO BE REMOVED FROM THE PATIENT 'S OR6
PATIENT GUARANTOR 'S CREDIT REPORT ANY REPORT MADE TO A7
CONSUMER REPORTING AGENCY RELATING TO THE DEBT .8
(4) NOTHING IN THIS PART 8:9
(a) P
ROHIBITS A HOSPITAL FROM BILLING A PATIENT , PATIENT10
GUARANTOR, OR THIRD-PARTY PAYER, INCLUDING HEALTH INSURER, FOR11
ITEMS OR SERVICES PROVIDED TO THE PATIENT ; OR12
(b) R
EQUIRES A HOSPITAL TO REFUND ANY PAYMENT MADE TO THE13
HOSPITAL FOR ITEMS OR SERVICES PROVIDED TO THE PATIENT , SO LONG AS14
NO COLLECTION ACTION IS TAKEN IN VIOLATION OF THIS PART 8.15
16
SECTION 2. Act subject to petition - effective date. This act17
takes effect at 12:01 a.m. on the day following the expiration of the18
ninety-day period after final adjournment of the general assembly; except19
that, if a referendum petition is filed pursuant to section 1 (3) of article V20
of the state constitution against this act or an item, section, or part of this21
act within such period, then the act, item, section, or part will not take22
effect unless approved by the people at the general election to be held in23
November 2022 and, in such case, will take effect on the date of the24
official declaration of the vote thereon by the governor.25
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