Second Regular Session
Seventy-third General Assembly
STATE OF COLORADO
REENGROSSED
This Version Includes All Amendments
Adopted 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 3rd Reading
April 26, 2022
HOUSE
Amended 2nd Reading
April 22, 2022
HOUSE SPONSORSHIP
Neville and Esgar, Daugherty, Amabile, Bernett, Bird, Boesenecker, Carver, Duran,
Garnett, Herod, Jodeh, Kennedy, Kipp, Lindsay, Lontine, McCluskie, McCormick,
Michaelson Jenet, Ortiz, Pico, Roberts, Sirota, Snyder, Titone, Valdez A., Van Winkle,
Weissman
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
1285
-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
1285
-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) (a) "COLLECTION AGENCY" MEANS ANY:8
(I) PERSON WHO ENGAGES IN A BUSINESS THE PRINCIPAL PURPOSE9
OF WHICH IS THE COLLECTION OF DEBTS; OR10
(II) PERSON WHO:11
(A) REGULARLY COLLECTS OR ATTEMPTS TO COLLECT, DIRECTLY12
OR INDIRECTLY, DEBTS OWED OR DUE OR ASSERTED TO BE OWED OR DUE13
TO ANOTHER;14
(B) TAKES ASSIGNMENT OF DEBTS FOR COLLECTION PURPOSES; 15
(C) DIRECTLY OR INDIRECTLY SOLICITS FOR COLLECTION DEBTS16
OWED OR DUE OR ASSERTED TO BE OWED OR DUE TO ANOTHER ; OR17
(D) COLLECTS DEBT FOR THE DEPARTMENT OF PERSONNEL .18
(b) "COLLECTION AGENCY" DOES NOT INCLUDE:19
(I) ANY OFFICER OR EMPLOYEE OF A CREDITOR WHILE, IN THE20
NAME OF THE CREDITOR, COLLECTING DEBTS FOR SUCH CREDITOR ;21
(II) ANY PERSON WHILE ACTING AS A COLLECTION AGENCY FOR22
ANOTHER PERSON, BOTH OF WHOM ARE RELATED BY COMMON OWNERSHIP23
OR AFFILIATED BY CORPORATE CONTROL, IF THE PERSON ACTING AS A24
COLLECTION AGENCY DOES SO ONLY FOR CREDITORS TO WHOM IT IS SO25
RELATED OR AFFILIATED AND IF THE PRINCIPAL BUSINESS OF THE PERSON26
IS NOT THE COLLECTION OF DEBTS;27
1285
-5- (III) ANY OFFICER OR EMPLOYEE OF THE UNITED STATES OR ANY1
STATE TO THE EXTENT THAT COLLECTING OR ATTEMPTING TO COLLECT2
ANY DEBT IS IN THE PERFORMANCE OF THE OFFICER'S OR EMPLOYEE'S3
OFFICIAL DUTIES;4
(IV) ANY PERSON WHILE SERVING OR ATTEMPTING TO SERVE5
LEGAL PROCESS ON ANY OTHER PERSON IN CONNECTION WITH THE6
JUDICIAL ENFORCEMENT OF ANY DEBT ;7
(V) ANY DEBT-MANAGEMENT SERVICES PROVIDER OPERATING IN8
COMPLIANCE WITH OR EXEMPT FROM THE "UNIFORM DEBT-MANAGEMENT9
SERVICES ACT", PART 2 OF ARTICLE 19 OF TITLE 5;10
(VI) ANY PERSON COLLECTING OR ATTEMPTING TO COLLECT ANY11
DEBT OWED OR DUE OR ASSERTED TO BE OWED OR DUE ANOTHER TO THE12
EXTENT THAT:13
(A) THE ACTIVITY IS INCIDENTAL TO A BONA FIDE FIDUCIARY14
OBLIGATION OR A BONA FIDE ESCROW ARRANGEMENT ;15
(B) THE ACTIVITY CONCERNS A DEBT THAT WAS EXTENDED BY THE16
PERSON;17
(C) THE ACTIVITY CONCERNS A DEBT THAT WAS NOT IN DEFAULT18
AT THE TIME IT WAS OBTAINED BY THE PERSON ; OR19
(D) THE ACTIVITY CONCERNS A DEBT OBTAINED BY THE PERSON AS20
A SECURED PARTY IN A COMMERCIAL CREDIT TRANSACTION INVOLVING21
THE CREDITOR;22
(VII) ANY PERSON WHOSE PRINCIPAL BUSINESS IS THE MAKING OF23
LOANS OR THE SERVICING OF DEBT NOT IN DEFAULT AND WHO ACTS AS A24
LOAN CORRESPONDENT, SELLER AND SERVICER FOR THE OWNER , OR25
HOLDER OF A DEBT THAT IS SECURED BY A DEED OF TRUST ON REAL26
PROPERTY WHETHER OR NOT THE DEBT IS ALSO SECURED BY AN INTEREST27
1285
-6- IN PERSONAL PROPERTY;1
(VIII) A LIMITED GAMING OR RACING LICENSEE ACTING PURSUANT2
TO ARTICLE 33 OF TITLE 44.3
(c) NOTWITHSTANDING THE PROVISIONS OF SUBSECTION (2)(b) OF4
THIS SECTION, "COLLECTION AGENCY" INCLUDES ANY PERSON WHO, IN THE5
PROCESS OF COLLECTING THE PERSON'S OWN DEBTS, USES ANOTHER NAME6
THAT WOULD INDICATE THAT A THIRD PERSON IS COLLECTING OR7
ATTEMPTING TO COLLECT SUCH DEBTS .8
(3) (a) "CONSUMER REPORTING AGENCY" MEANS ANY PERSON9
THAT, FOR MONETARY FEES, DUES, OR ON A COOPERATIVE NONPROFIT10
BASIS, REGULARLY ENGAGES, IN WHOLE OR IN PART, IN THE PRACTICE OF11
ASSEMBLING OR EVALUATING CONSUMER CREDIT INFORMATION OR OTHER12
INFORMATION ON CONSUMERS FOR THE PURPOSE OF FURNISHING13
CONSUMER REPORTS TO THIRD PARTIES. "CONSUMER REPORTING AGENCY"14
INCLUDES ANY PERSON DEFINED IN 15 U.S.C. sec. 1681a (f) OR SECTION15
5-18-103 (4).16
(b) "CONSUMER REPORTING AGENCY" DOES NOT INCLUDE ANY17
BUSINESS ENTITY THAT PROVIDES CHECK VERIFICATION OR CHECK18
GUARANTEE SERVICES ONLY .19
(4) (a) "DEBT" MEANS ANY OBLIGATION OR ALLEGED OBLIGATION20
OF A CONSUMER TO PAY MONEY ARISING OUT OF A TRANSACTION ,21
WHETHER OR NOT THE OBLIGATION HAS BEEN REDUCED TO JUDGMENT .22
(b) "DEBT" DOES NOT INCLUDE A DEBT FOR BUSINESS,23
INVESTMENT, COMMERCIAL, OR AGRICULTURAL PURPOSES OR A DEBT24
INCURRED BY A BUSINESS. 25
(5) "DEBT COLLECTOR" MEANS ANY PERSON EMPLOYED OR26
ENGAGED BY A COLLECTION AGENCY TO PERFORM THE COLLECTION OF27
1285
-7- DEBTS OWED OR DUE OR ASSERTED TO BE OWED OR DUE TO ANOTHER .1
(6) "FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES "2
OR "CMS" MEANS THE CENTER FOR MEDICARE AND MEDICAID SERVICES3
IN THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES .4
(7) "HOSPITAL" MEANS, CONSISTENT WITH 45 CFR 180.20, A5
HOSPITAL:6
(a) L
ICENSED OR CERTIFIED BY THE DEPARTMENT PURSUANT TO7
SECTION 25-1.5-103 (1)(a); OR8
(b) A
PPROVED BY THE DEPARTMENT AS MEETING THE STANDARDS9
ESTABLISHED FOR LICENSING A HOSPITAL.10
(8) "HOSPITAL PRICE TRANSPARENCY LAWS " MEANS SECTION11
2718(e)
OF THE "PUBLIC HEALTH SERVICE (PHS) ACT", PUB.L. 78-410, AS12
AMENDED, AND RULES ADOPTED BY THE UNITED STATES DEPARTMENT OF13
HEALTH AND HUMAN SERVICES IMPLEMENTING SECTION 2718 (e).14(9) "ITEMS AND SERVICES" OR "ITEMS OR SERVICES" MEANS "ITEMS15
AND SERVICES" AS DEFINED IN 45 CFR 180.20.16
25-3-803. Failure to comply with hospital price transparency17
laws - prohibiting collection of debt - penalty. (1) (a) EXCEPT AS18
PROVIDED IN SUBSECTION (1)(b) OF THIS SECTION, ON AND AFTER THE19
EFFECTIVE DATE OF THIS SECTION, A HOSPITAL THAT IS NOT IN MATERIAL20
COMPLIANCE WITH HOSPITAL PRICE TRANSPARENCY LAWS ON THE DATE21
THAT ITEMS OR SERVICES ARE PURCHASED FROM OR PROVIDED TO A22
PATIENT BY THE HOSPITAL SHALL NOT INITIATE OR PURSUE A COLLECTION23
ACTION AGAINST THE PATIENT OR PATIENT GUARANTOR FOR A DEBT OWED24
FOR THE ITEMS OR SERVICES.25
(b) THIS PART 8 APPLIES, ON AND AFTER FEBRUARY 15, 2023, TO26
CRITICAL ACCESS HOSPITALS LICENSED AND CERTIFIED BY THE27
1285
-8- DEPARTMENT PURSUANT TO 42 CFR 485 SUBPART F.1
(2) IF A PATIENT BELIEVES THAT A HOSPITAL WAS NOT IN2
MATERIAL COMPLIANCE WITH HOSPITAL PRICE TRANSPARENCY LAWS ON3
A DATE ON OR AFTER THE EFFECTIVE DATE OF THIS SECTION THAT ITEMS4
OR SERVICES WERE PURCHASED BY OR PROVIDED TO THE PATIENT , AND5
THE HOSPITAL TAKES A COLLECTION ACTION AGAINST THE PATIENT OR6
PATIENT GUARANTOR, THE PATIENT OR PATIENT GUARANTOR MAY FILE7
SUIT TO DETERMINE IF THE HOSPITAL WAS MATERIALLY OUT OF8
COMPLIANCE WITH THE HOSPITAL PRICE TRANSPARENCY LAWS AND RULES9
AND REGULATIONS ON THE DATE OF SERVICE. THE HOSPITAL SHALL NOT10
TAKE A COLLECTION ACTION AGAINST THE PATIENT OR PATIENT11
GUARANTOR WHILE THE LAWSUIT IS PENDING .12
(3) A HOSPITAL THAT HAS BEEN FOUND BY A JUDGE OR JURY,13
CONSIDERING COMPLIANCE STANDARDS ISSUED BY THE FEDERAL CENTERS14
FOR MEDICARE AND MEDICAID SERVICES, TO BE MATERIALLY OUT OF15
COMPLIANCE WITH HOSPITAL PRICE TRANSPARENCY LAWS AND RULES AND16
REGULATIONS:17
(a) S
HALL REFUND THE PAYER ANY AMOUNT OF THE DEBT THE18
PAYER HAS PAID AND SHALL PAY A PENALTY TO THE PATIENT OR PATIENT19
GUARANTOR IN AN AMOUNT EQUAL TO THE TOTAL AMOUNT OF THE DEBT ;20
(b) S
HALL DISMISS OR CAUSE TO BE DISMISSED ANY COURT ACTION21
WITH PREJUDICE AND PAY ANY ATTORNEY FEES AND COSTS INCURRED BY22
THE PATIENT OR PATIENT GUARANTOR RELATING TO THE ACTION ; AND23
(c) R
EMOVE OR CAUSE TO BE REMOVED FROM THE PATIENT 'S OR24
PATIENT GUARANTOR 'S CREDIT REPORT ANY REPORT MADE TO A25
CONSUMER REPORTING AGENCY RELATING TO THE DEBT .26
(4) NOTHING IN THIS PART 8:27
1285
-9- (a) PROHIBITS A HOSPITAL FROM BILLING A PATIENT , PATIENT1
GUARANTOR, OR THIRD-PARTY PAYER, INCLUDING HEALTH INSURER, FOR2
ITEMS OR SERVICES PROVIDED TO THE PATIENT ; OR3
(b) R
EQUIRES A HOSPITAL TO REFUND ANY PAYMENT MADE TO THE4
HOSPITAL FOR ITEMS OR SERVICES PROVIDED TO THE PATIENT , SO LONG AS5
NO COLLECTION ACTION IS TAKEN IN VIOLATION OF THIS PART 8.6 7
SECTION 2. Act subject to petition - effective date. This act8
takes effect at 12:01 a.m. on the day following the expiration of the9
ninety-day period after final adjournment of the general assembly; except10
that, if a referendum petition is filed pursuant to section 1 (3) of article V11
of the state constitution against this act or an item, section, or part of this12
act within such period, then the act, item, section, or part will not take13
effect unless approved by the people at the general election to be held in14
November 2022 and, in such case, will take effect on the date of the15
official declaration of the vote thereon by the governor.16
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-10-