First Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 23-0720.01 Shelby Ross x4510
HOUSE BILL 23-1226
House Committees Senate Committees
Health & Insurance
A BILL FOR AN ACT
C
ONCERNING TRANSPARENCY REQUIREMENTS FOR HOSPITALS , AND, IN101
CONNECTION THEREWITH , CREATING MORE TIMELY102
SUBMISSIONS OF DATA; PROVIDING INSIGHTS INTO TRANSFERS103
OF CASH AND PROFITS AND RESERVES , INCLUDING THOSE104
LEAVING COLORADO; REPORTING ON ALL INFORMATION105
RECEIVED; REPORTING INFORMATION BY EACH HOSPITAL IN106
ADDITION TO HEALTH SYSTEMS ; DISCLOSING EXECUTIVE107
COMPENSATION, INCLUDING COMPENSATED INCENTIVES ;108
REPORTING MERGERS AND ACQUI SITIONS OF HOSPITALS AND109
PHYSICIANS; AND REPORTING INVESTMENTS IN CAPITAL110
EQUIPMENT AND CONSTRUCTION .111
Bill Summary
HOUSE SPONSORSHIP
Soper and deGruy Kennedy,
SENATE SPONSORSHIP
Roberts and Will,
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing law.
Dashes through the words or numbers indicate deletions from existing law. (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
.)
Current law requires the department of health care policy and
financing (state department) to annually prepare a written hospital
expenditure report. The bill changes the name of the report to the hospital
transparency report (transparency report).
The bill adds specified information that each hospital shall report
to the state department for the transparency report.
No later than July 1, 2024, the bill requires each hospital to
provide specified information to the state department for previous fiscal
years.
The bill authorizes the state department to impose certain
enforcement mechanisms against a hospital that does not provide all of
the information required to be reported to the state department.
Beginning July 1, 2024, the bill requires any patient bill to include
a clear, plain language description of the services the patient is being
billed for and a statement that the patient has a right to receive a detailed
explanation of the services charged and who to contact to receive such
information.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, 25.5-4-402.8, amend2
(2)(a), (2)(b) introductory portion, (2)(b)(II)(A), (2)(b)(III)(J),3
(2)(b)(III)(M), (2)(c) introductory portion, (2)(e), (3) introductory portion,4
(4)(a) introductory portion, and (4)(b); repeal (2)(d); and add5
(2)(b)(II)(D), (2)(b)(II)(E), (2)(b)(II)(F), (2)(b)(II)(G), (2)(b)(III)(O),6
(2)(b)(III)(P), (2)(b)(III)(Q), (2)(b.5), and (2)(g) as follows:7
25.5-4-402.8. Hospital transparency report - definitions.8
(2) (a) The state department shall annually prepare a written hospital9
expenditure
TRANSPARENCY report detailing uncompensated hospital10
costs,
INCLUDING UNCOMPENSATED COSTS , and the different categories of11
expenditures, by major payer group, made by hospitals in the state. The12
HB23-1226-2- state department shall COORDINATE THE ANALYSIS, REVIEW, AND RELEASE1
OF THE HOSPITAL TRANSPARENCY REPORT AND THE REPORTS REQUIRED2
PURSUANT TO SECTION 25.5-1-703 (3) AND 25.5-4-402.4 (7)(e),3
INCLUDING THE OPPORTUNITY TO REVIEW AND consult with ON THE4
REPORTS MADE BY the Colorado healthcare affordability and sustainability5
enterprise board, created pursuant to section 25.5-4-402.4 (7) and referred6
to in this section as the "enterprise board". in developing the hospital7
expenditure report. The state department may share any information AND8
ANALYTICS OF INFORMATION THAT it receives from hospitals with the9
enterprise board. The state department may include information it10
receives from hospitals in accordance with subsection (2)(b) of this11
section and that is not otherwise publicly available in the expenditure12
TRANSPARENCY report and share such information with the enterprise13
board; except that information the state department receives from14
hospitals in accordance with subsection (2)(b)(III)(N) of this section is15
confidential, proprietary, contains trade secrets, and is not a public record16
pursuant to part 2 of article 72 of title 24. The state department shall not17
include in the expenditure TRANSPARENCY report, share with the18
enterprise board, or otherwise publish or distribute information derived19
from reports pursuant to subsection (2)(b)(III)(N) of this section, although20
the state department may share this information if such information has21
been de-identified and aggregated in a manner to prevent identification22
of the transaction price of any individual acquisition or affiliation. A23
hospital shall not be in violation of this section if the hospital makes a24
good faith effort to comply with the reporting requirements of this25
section.26
(b) Except as provided in subsection (2)(c) of this section, each27
HB23-1226
-3- hospital licensed pursuant to part 1 of article 3 of title 25, or certified1
pursuant to section 25-1.5-103 (1)(a)(II), shall make information available2
to the state department for purposes of preparing the annual hospital3
expenditure TRANSPARENCY report. The state board shall establish the4
format of the information provided by each hospital on an annual basis.5
The first submission by each hospital must include the information6
described in subsections (2)(b)(I) and (2)(b)(II) of this section for fiscal7
years 2011-12 through 2018-19 and the information described in8
subsection (2)(b)(III) of this section for those fiscal years if such9
information is available. For each subsequent submission, Each hospital10
shall provide the following information to the state department:11
(II) (A) An Annual audited financial statement STATEMENTS,12
prepared in accordance with generally accepted accounting principles.13
Each hospital shall submit the statement STATEMENTS within one hundred14
twenty days after the end of its fiscal year unless the state department15
grants an extension in writing in advance of that date.16
(D) A
LIST OF THE HOSPITAL'S TRANSFERS OF CASH, INVESTMENTS,17
OR OTHER ASSETS FROM THE HOSPITAL TO RELATED PARTIES , INCLUDING,18
BUT NOT LIMITED TO, THE HOSPITAL'S PARENT ORGANIZATION AND THE19
REASON FOR THE TRANSFER . THE LIST MUST INDICATE IF THE CASH ,20
INVESTMENTS, OR OTHER ASSETS WERE TRANSFERRED TO ENTITIES21
OUTSIDE OF COLORADO.22
(E) A
HOSPITAL-SPECIFIC INCOME STATEMENT, STATEMENT OF23
CASH FLOW, BALANCE SHEET, AND STATEMENT OF CHANGES IN FUND24
BALANCE WITHIN A TIME FRAME SPECIFIED ANNUALLY BY THE STATE25
DEPARTMENT, BUT NOT LESS THAN SIXTY DAYS AFTER THE HOSPITAL 'S26
FISCAL YEAR ENDS.27
HB23-1226
-4- (F) CHANGES TO NO MORE THAN TWENTY -FIVE CATEGORIES OF1
SPECIFIC MAJOR SERVICE LINES , AS REQUESTED BY THE STATE2
DEPARTMENT.3
(G) A
NARRATIVE REPORT OF MAJOR PLANNED AND COMPLETED4
PROJECTS AND CAPITAL INVESTMENTS GREATER THAN TWENTY -FIVE5
MILLION DOLLARS; EXCEPT THAT THE INFORMATION THE STATE6
DEPARTMENT RECEIVES FROM HOSPITALS REGARDING PLANNED ACTIVITIES7
IS CONFIDENTIAL, PROPRIETARY, CONTAINS TRADE SECRETS, AND IS NOT8
A PUBLIC RECORD PURSUANT TO PART 2 OF ARTICLE 72 OF TITLE 24.9
(III) A report that contains the following information:10
(J) Other operating revenue, operating margin, nonoperating gains11
and losses,
GROSS REVENUE, NET PROFIT, and total margin;12
(M) A roll forward of property, plant, and equipment accounts by13
asset type from the beginning to the end of the reporting period by asset14
category, including, but not limited to, purchases, other acquisitions,15
sales, disposals, and other changes; and
16
(O) I
NFORMATION ON CURRENT AFFILIATIONS AND A REPORT OF17
PHYSICIAN PRACTICE ACQUISITIONS;18
(P) S
ALARY AND TOTAL COMPENSATION DATA OF THE TOP FIVE19
HIGHEST PAID ADMINISTRATIVE POSITIONS OF EACH NONPROFIT HOSPITAL ,20
INCLUDING THE TITLE , A BRIEF DESCRIPTION OF DUTIES , BASE21
COMPENSATION, INCENTIVE OR BONUS COMPENSATION , AND OTHER22
COMPENSATION. THE STATE DEPARTMENT MAY INCLUDE INFORMATION IT23
RECEIVES FROM PUBLIC HOSPITALS PURSUANT TO THIS SUBSECTION24
(2)(b)(III)(P)
THAT IS NOT OTHERWISE PUBLICLY AVAILABLE IN THE25
HOSPITAL TRANSPARENCY REPORT ; EXCEPT THAT INFORMATION THE STATE26
DEPARTMENT RECEIVES FROM A NONPROFIT HOSPITAL IS NOT A PUBLIC27
HB23-1226
-5- RECORD PURSUANT TO PART 2 OF ARTICLE 72 OF TITLE 24. THE STATE1
DEPARTMENT MAY ONLY REPORT INFORMATION RECEIVED PURSUANT TO2
THIS SUBSECTION (2)(b)(III)(P) IN AN AGGREGATED FORMAT THAT DOES3
NOT NAME INDIVIDUAL HOSPITALS OR ADMINISTRATORS .4
(Q) I
N A FORM AND MANNER SPECIFIED BY THE STATE5
DEPARTMENT, DETAILS OF SIGNIFICANT OTHER REVENUE THAT WOULD6
OTHERWISE BE REPORTED IN THE MEDICARE COST REPORT .7
(b.5) N
O LATER THAN JULY 1, 2024, EACH HOSPITAL SHALL8
PROVIDE THE FOLLOWING INFORMATION TO THE STATE DEPARTMENT :9
(I) F
OR EACH FISCAL YEAR 2014-15 THROUGH 2019-20, A LIST OF10
THE HOSPITAL'S TRANSFERS OF CASH, INVESTMENTS, OR OTHER ASSETS TO11
RELATED PARTIES, INCLUDING BUT NOT LIMITED TO THE HOSPITAL 'S12
PARENT ORGANIZATION AND THE REASON FOR THE TRANSFER . THE LIST13
MUST INDICATE IF THE CASH, INVESTMENTS, OR OTHER ASSETS WERE14
TRANSFERRED TO ENTITIES OUTSIDE OF COLORADO.15
(II) F
OR EACH FISCAL YEAR FROM 2014-15 THROUGH 2019-20,16
INFORMATION ON AFFILIATIONS AND A REPORT OF PHYSICIAN PRACTICE17
ACQUISITIONS; AND18
(III) F
OR EACH FISCAL YEAR FROM 2019-20 THROUGH 2022-23, IN19
A FORM AND MANNER SPECIFIED BY THE STATE DEPARTMENT , DETAILS OF20
SIGNIFICANT OTHER REVENUE THAT WOULD OTHERWISE BE REPORTED IN21
THE MEDICARE COST REPORT.22
(c) The state department may exempt from the
CERTAIN reporting23
requirements described in subsection SUBSECTIONS (2)(b) AND (2)(b.5) of24
this section certain types of hospitals, including but not limited to:25
(d) Prior to developing the first annual hospital expenditure report,26
the state department shall consult with the enterprise board regarding the27
HB23-1226
-6- development of the report. The state department shall strive for1
consistency in reporting the components in each annual report with those2
in the report of the enterprise board required pursuant to section3
25.5-4-402.4 (7)(e).4
(e) Prior to issuing the hospital expenditure TRANSPARENCY5
report, the state department shall provide any hospital referenced in the6
hospital expenditure TRANSPARENCY report a copy of the report. Each7
hospital shall MUST have a minimum of fifteen days to review the hospital8
expenditure TRANSPARENCY report and any underlying data and submit9
corrections or clarifications to the state department.10
(g) (I) I
F A HOSPITAL DOES NOT PROVIDE ALL OF THE INFORMATION11
REQUIRED PURSUANT TO SUBSECTION (2)(b) OF THIS SECTION, THE STATE12
DEPARTMENT SHALL INFORM THE HOSPITAL OF ITS NONCOMPLIANCE AND13
IDENTIFY THE INFORMATION THAT NEEDS TO BE PROVIDED . IF A HOSPITAL14
DOES NOT COMPLY, THE STATE DEPARTMENT SHALL ISSUE A CORRECTIVE15
ACTION PLAN WITH A TIMELINE REQUIRED FOR COMPLIANCE . IF A HOSPITAL16
CONTINUES TO NOT COMPLY , THE STATE DEPARTMENT MAY CREATE A17
MANDATORY PAY-FOR-REPORTING COMPLIANCE MEASURE WITHIN THE18
HOSPITAL TRANSFORMATION PROGRAM THAT IS TIED TO THE HEALTHCARE19
AFFORDABILITY AND SUSTAINABILITY FEE SUPPLEMENTAL PAYMENT AND20
IS BASED ON COMPLIANCE WITH SUBSECTION (2)(b) OF THIS SECTION.21
(II) I
F THE STATE DEPARTMENT DETERMINES A HOSPITAL 'S22
NONCOMPLIANCE WITH THIS SECTION IS KNOWING OR WILLFUL OR THERE23
IS A REPEATED PATTERN OF NONCOMPLIANCE , THE STATE DEPARTMENT24
SHALL CONSIDER THE SIZE OF THE HOSPITAL AND THE SERIOUSNESS OF THE25
VIOLATION IN SETTING A FINE AMOUNT NOT TO EXCEED TWENTY26
THOUSAND DOLLARS PER WEEK UNTIL THE HOSPITAL TAKES CORRECTIVE27
HB23-1226
-7- ACTION.1
(3) The hospital expenditure TRANSPARENCY report must include,2
but not be limited to:3
(4) (a) On or before January 15, 2020, and on or before January4
15 each year thereafter, the state department shall submit the annual5
hospital expenditure TRANSPARENCY report to:6
(b) The state department may request that the enterprise board7
combine the hospital expenditure TRANSPARENCY report described in this8
section with the report of the enterprise board specified in section9
25.5-4-402.4 (7)(e), so long as the specific requirements of this section10
are fulfilled, and so long as the enterprise board agrees to the request. The11
state department shall post the annual report on its website by January 1512
of each year.13
SECTION 2. In Colorado Revised Statutes, add 25.5-4-427 as14
follows:15
25.5-4-427. Hospital and provider billing requirements -16
description of service provided - rules. (1) B
EGINNING JULY 1, 2024,17
ANY PATIENT BILL FOR SERVICES RENDERED MUST INCLUDE A CLEAR ,18
PLAIN LANGUAGE DESCRIPTION OF THE SERVICES THE PATIENT IS BEING19
BILLED FOR AND A STATEMENT THAT THE PATIENT HAS A RIGHT TO20
RECEIVE A DETAILED EXPLANATION OF THE SERVICES CHARGED AND WHO21
TO CONTACT TO RECEIVE SUCH INFORMATION .22
(2) T
HE STATE BOARD SHALL PROMULGATE RULES FOR THE23
IMPLEMENTATION OF THIS SECTION.24
SECTION 3. Act subject to petition - effective date. This act25
takes effect at 12:01 a.m. on the day following the expiration of the26
ninety-day period after final adjournment of the general assembly; except27
HB23-1226
-8- that, if a referendum petition is filed pursuant to section 1 (3) of article V1
of the state constitution against this act or an item, section, or part of this2
act within such period, then the act, item, section, or part will not take3
effect unless approved by the people at the general election to be held in4
November 2024 and, in such case, will take effect on the date of the5
official declaration of the vote thereon by the governor.6
HB23-1226
-9-