First Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
REREVISED
This Version Includes All Amendments
Adopted in the Second House
LLS NO. 23-0720.01 Shelby Ross x4510
HOUSE BILL 23-1226
House Committees Senate Committees
Health & Insurance Health & Human Services
Appropriations Appropriations
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;
REPORTING INVESTMENTS IN CAPITAL110
EQUIPMENT AND CONSTRUCTION ; AND MAKING AN111
APPROPRIATION.112
SENATE
3rd Reading Unamended
May 5, 2023
SENATE
2nd Reading Unamended
May 4, 2023
HOUSE
3rd Reading Unamended
April 24, 2023
HOUSE
Amended 2nd Reading
April 21, 2023
HOUSE SPONSORSHIP
Soper and deGruy Kennedy, Amabile, Boesenecker, Brown, Dickson, Froelich,
Gonzales-Gutierrez, Hamrick, Jodeh, Kipp, Lieder, Lindsay, Lindstedt, McCluskie,
McCormick, McLachlan, Ricks, Sirota, Titone, Weissman, Willford
SENATE SPONSORSHIP
Roberts and Will, Bridges, Buckner, Cutter, Exum, Fenberg, Fields, Hansen, Jaquez
Lewis, Moreno, Priola
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. 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
.)
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
(4)(a)(I),, and (4)(b); repeal (2)(d); and add5
(2)(b)(II)(D), (2)(b)(II)(E), (2)(b)(II)(F), (2)(b)(III)(O), (2)(b)(III)(P),6
(2)(b)(III)(Q), (2)(b)(IV), (2)(b.5), (2)(g), and (4.5) 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
CARE COSTS, and the different11
1226-2- categories of expenditures, by major payer group, made by hospitals in1
the state. The state department shall
COORDINATE THE ANALYSIS, REVIEW,2
AND RELEASE OF THE HOSPITAL TRANSPARENCY REPORT AND THE REPORTS3
REQUIRED PURSUANT TO SECTION 25.5-1-703 (3) AND 25.5-4-402.4 (7)(e),4
INCLUDING THE OPPORTUNITY TO REVIEW AND consult with
ON THE5
REPORTS MADE BY the Colorado healthcare affordability and sustainability6
enterprise board, created pursuant to section 25.5-4-402.4 (7) and referred7
to in this section as the "enterprise board". in developing the hospital8
expenditure report. The state department may share any information AND9
ANALYTICS OF INFORMATION THAT it receives from hospitals with the10
enterprise board. The state department may include information it11
receives from hospitals in accordance with subsection (2)(b) of this12
section and that is not otherwise publicly available in the expenditure13
TRANSPARENCY report and share such information with the enterprise14
board; except that information the state department receives from15
hospitals in accordance with subsection SUBSECTIONS (2)(b)(II)(D),16
(2)(b)(III)(N), (2)(b)(III)(O), (2)(b.5)(I), AND (2)(b.5)(II) of this section17
is confidential, proprietary, contains trade secrets, and is not a public18
record pursuant to part 2 of article 72 of title 24. The state department19
shall not include in the expenditure TRANSPARENCY report, share with the20
enterprise board, or otherwise publish or distribute information derived21
from reports pursuant to subsection SUBSECTIONS (2)(b)(II)(D),22
(2)(b)(III)(N), (2)(b)(III)(O), (2)(b.5)(I), AND (2)(b.5)(II) of this section,23
although the state department may share this information if such24
information has been de-identified and aggregated in a manner to prevent25
identification of the transaction price of any individual acquisition or26
affiliation. A hospital shall not be in violation of this section if the27
1226
-3- hospital makes a good faith effort to comply with the reporting1
requirements of this section.2
(b) Except as provided in subsection (2)(c) of this section, each3
hospital licensed pursuant to part 1 of article 3 of title 25, or certified4
pursuant to section 25-1.5-103 (1)(a)(II), shall make information available5
to the state department for purposes of preparing the annual hospital6
expenditure TRANSPARENCY report. The state board shall establish the7
format of the information provided by each hospital on an annual basis.8
The first submission by each hospital must include the information9
described in subsections (2)(b)(I) and (2)(b)(II) of this section for fiscal10
years 2011-12 through 2018-19 and the information described in11
subsection (2)(b)(III) of this section for those fiscal years if such12
information is available. For each subsequent submission, Each hospital13
shall provide the following information to the state department:14
(II) (A) An Annual audited financial statement STATEMENTS,15
prepared in accordance with generally accepted accounting principles.16
Each hospital shall submit the statement STATEMENTS within one hundred17
twenty days after the end of its fiscal year unless the state department18
grants an extension in writing in advance of that date.19
(D) AN ANNUAL SUMMARY OF THE HOSPITAL 'S TRANSFERS OF20
CASH, EQUITY, INVESTMENTS, OR OTHER ASSETS TO AND FROM RELATED21
PARTIES, INCLUDING BUT NOT LIMITED TO THE HOSPITAL 'S PARENT22
ORGANIZATION. THE SUMMARY MUST INCLUDE THE PURPOSE OF THE23
TRANSFERS AND WHETHER THE TRANSFERS WERE MADE WITHIN OR24
OUTSIDE OF COLORADO. A HOSPITAL MAY AGGREGATE THE TRANSFERS25
FOR EACH ENTITY RECEIVING OR MAKING THE TRANSFER .26
(E) A HOSPITAL-SPECIFIC STATEMENT OF CASH FLOW WITHIN A27
1226
-4- TIME FRAME SPECIFIED ANNUALLY BY THE STATE DEPARTMENT, BUT NOT1
LESS THAN ONE HUNDRED TWENTY DAYS AFTER THE HOSPITAL'S FISCAL2
YEAR END.3
(F) C
HANGES TO NO MORE T HAN TWENTY -FIVE CATEGORIES OF4
SPECIFIC MAJOR SERVICE LINES , AS REQUESTED BY THE STATE5
DEPARTMENT.6
(G) A
NARRATIVE REPORT OF MAJOR PLANNED AND COMPLETED7
PROJECTS AND CAPITAL INVESTMENTS GREATER THAN TWENTY -FIVE8
MILLION DOLLARS; EXCEPT THAT THE INFORMATION THE STATE9
DEPARTMENT RECEIVES FROM HOSPITALS REGARDING PLANNED ACTIVITIES10
IS CONFIDENTIAL, PROPRIETARY, CONTAINS TRADE SECRETS, AND IS NOT11
A PUBLIC RECORD PURSUANT TO PART 2 OF ARTICLE 72 OF TITLE 24.12
(III) A report that contains the following information:13
(J) Other operating revenue, operating margin, nonoperating gains14
and losses,
GROSS REVENUE, NET PROFIT, and total margin;15
(M) A roll forward of property, plant, and equipment accounts by16
asset type from the beginning to the end of the reporting period by asset17
category, including, but not limited to, purchases, other acquisitions,18
sales, disposals, and other changes; and
19
(O) I
NFORMATION ON CURRENT AFFILIATIONS AND A REPORT OF20
PHYSICIAN PRACTICE ACQUISITIONS;21
(P) S
ALARY AND TOTAL COMPENSATION DATA OF THE TOP FIVE22
HIGHEST PAID ADMINISTRATIVE POSITIONS OF EACH NONPROFIT HOSPITAL ,23
INCLUDING THE TITLE , A BRIEF DESCRIPTION OF DUTIES , BASE24
COMPENSATION, INCENTIVE OR BONUS COMPENSATION , AND OTHER25
COMPENSATION.
THE COMPENSATION REPORTED MUST INDICATE WHAT26
PERFORMANCE MEASURES WERE INCLUDED IN THE CHIEF EXECUTIVE27
1226
-5- OFFICER'S PERFORMANCE EVALUATION GENERATED BY THE HOSPITAL'S1
GOVERNING BOARD, INCLUDING, AT A MINIMUM, QUALITY OF CARE2
OUTCOMES PERFORMANCE; PATIENT SATISFACTION PERFORMANCE;3
COMMUNITY BENEFIT PERFORMANCE; CONSUMER AND EMPLOYER4
AFFORDABILITY PERFORMANCE; MARKET SHARE PERFORMANCE; PROFITS5
OR MARGINS; REVENUE GROWTH; CHANGE IN DAYS CASH ON HAND OR6
CASH RESERVES; AND WORKFORCE. THE STATE DEPARTMENT MAY7
INCLUDE INFORMATION IT RECEIVES FROM PUBLIC HOSPITALS PURSUANT8
TO THIS SUBSECTION (2)(b)(III)(P) THAT IS NOT OTHERWISE PUBLICLY9
AVAILABLE IN THE HOSPITAL TRANSPARENCY REPORT ; EXCEPT THAT10
INFORMATION THE STATE DEPARTMENT RECEIVES FROM A NONPROFIT11
HOSPITAL IS NOT A PUBLIC RECORD PURSUANT TO PART 2 OF ARTICLE 72 OF12
TITLE 24. THE STATE DEPARTMENT MAY ONLY REPORT INFORMATION13
RECEIVED PURSUANT TO THIS SUBSECTION (2)(b)(III)(P) IN AN14
AGGREGATED FORMAT THAT DOES NOT NAME INDIVIDUAL HOSPITALS OR15
ADMINISTRATORS.16
(Q) I
N A FORM AND MANNER SPECIFIED BY THE STATE17
DEPARTMENT, DETAILS OF SIGNIFICANT OTHER REVENUE THAT WOULD18
OTHERWISE BE REPORTED IN THE MEDICARE COST REPORT .19 (IV) (A) A QUARTERLY FINANCIAL REPORT THAT INCLUDES AN20
INCOME STATEMENT AND BALANCE SHEET. IF A HOSPITAL IS OWNED OR21
AFFILIATED WITH A HEALTH SYSTEM THAT IS COMPRISED OF THREE OR22
MORE HOSPITALS OR THAT HAS MORE THAN ONE BILLION DOLLARS IN23
RESERVES, THE HEALTH SYSTEM MAY SUBMIT A CONSOLIDATED24
QUARTERLY FINANCIAL REPORT .25
(B) ANY QUARTERLY FINANCIAL REPORT MADE PUBLICLY26
AVAILABLE MUST CLEARLY STATE THAT THE QUARTERLY FINANCIAL27
1226
-6- REPORT IS UNAUDITED, IF APPLICABLE. THE STATE DEPARTMENT SHALL1
PROVIDE ANY ANALYSIS, REPORT, OR PRESENTATION BASED ON THE2
QUARTERLY FINANCIAL REPORT TO EACH HOSPITAL AT LEAST FIFTEEN3
DAYS PRIOR TO THE PUBLIC RELEASE OF THE ANALYSIS, REPORT, OR4
PRESENTATION.5
(b.5) N
O LATER THAN JULY 1, 2024, EACH HOSPITAL SHALL6
PROVIDE THE FOLLOWING INFORMATION TO THE STATE DEPARTMENT :7 (I) FOR EACH FISCAL YEAR 2014-15 THROUGH 2019-20, A8
SUMMARY OF THE HOSPITAL'S TRANSFERS OF CASH, EQUITY, INVESTMENTS,9
OR OTHER ASSETS TO AND FROM RELATED PARTIES, INCLUDING BUT NOT10
LIMITED TO THE HOSPITAL'S PARENT ORGANIZATION. THE SUMMARY MUST11
INCLUDE THE PURPOSE OF THE TRANSFERS AND WHETHER THE TRANSFERS12
WERE MADE WITHIN OR OUTSIDE OF COLORADO. A HOSPITAL MAY13
AGGREGATE THE TRANSFERS FOR EACH ENTITY RECEIVING OR MAKING THE14
TRANSFER.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
1226
-7- 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 NONCOMPLIANCE13
WITHIN SIXTY DAYS AND IDENTIFY THE INFORMATION THAT NEEDS TO BE14
PROVIDED. IF A HOSPITAL DOES NOT COMPLY , THE STATE DEPARTMENT15
SHALL ISSUE A CORRECTIVE ACTION PLAN WITH A TIMELINE OF SIXTY DAYS16
REQUIRED FOR COMPLIANCE. IF A HOSPITAL CONTINUES TO NOT COMPLY ,17
THE STATE DEPARTMENT MAY CREATE A MANDATORY18
PAY-FOR-REPORTING COMPLIANCE MEASURE WITHIN THE HOSPITAL19
TRANSFORMATION PROGRAM THAT IS TIED TO THE HEALTHCARE20
AFFORDABILITY AND SUSTAINABILITY FEE SUPPLEMENTAL PAYMENT AND21
IS BASED ON COMPLIANCE WITH SUBSECTION (2)(b) OF THIS SECTION.22
(II) I
F THE STATE DEPARTMENT DETERMINES A HOSPITAL 'S23
NONCOMPLIANCE WITH THIS SECTION IS KNOWING OR WILLFUL OR THERE24
IS A REPEATED PATTERN OF NONCOMPLIANCE , THE STATE DEPARTMENT25
SHALL CONSIDER THE SIZE OF THE HOSPITAL AND THE SERIOUSNESS OF THE26
VIOLATION IN SETTING A FINE AMOUNT
WHICH, FOR HOSPITALS OWNED OR27
1226
-8- AFFILIATED WITH A HOSPITAL SYSTEM COMPRISED OF THREE OR MORE1
HOSPITALS, MUST NOT EXCEED TWENTY THOUS AND DOLLARS PER2
VIOLATION PER WEEK UNTIL THE HOSPITAL TAKES CORRECTIVE AND, FOR3
ALL OTHER HOSPITALS, MUST NOT EXCEED FIVE THOUSAND DOLLARS PER4
WEEK UNTIL THE HOSPITAL TAKES CORRECTIVE ACTION .5
(3) The hospital expenditure TRANSPARENCY report must include,6
but not be limited to:7
(4) (a) On or before January 15, 2020, and on or before January8
15 each year thereafter, the state department shall submit the annual9
hospital expenditure TRANSPARENCY report to:10
(I) The public health care and human services committee of the11
house of representatives HEALTH AND INSURANCE COMMITTEE AND THE12
HOUSE OF REPRESENTATIVES PUBLIC AND BEHAVIORAL HEALTH AND13
HUMAN SERVICES COMMITTEE , or any successor committee;14
(b) The state department may request that the enterprise board15
combine the hospital expenditure TRANSPARENCY report described in this16
section with the report of the enterprise board specified in section17
25.5-4-402.4 (7)(e), so long as the specific requirements of this section18
are fulfilled, and so long as the enterprise board agrees to the request. The19
state department shall post the annual report on its website by January 1520
of each year.21
(4.5) THE STATE DEPARTMENT SHALL REPORT ON THE ANNUAL22
HOSPITAL TRANSPARENCY REPORT DURING THE STATE DEPARTMENT'S23
"SMART ACT" HEARING.24
SECTION 2. In Colorado Revised Statutes, add 25.5-4-427 as25
follows:26
25.5-4-427. Hospital and provider billing requirements -27
1226
-9- description of service provided - rules. (1) B EGINNING JULY 1, 2024,1
ANY PATIENT BILL FOR SERVICES RENDERED MUST FOLLOW INDUSTRY2
STANDARD BILLING PRACTICES, INCLUDING, AT A MINIMUM, THE DATE OF3
SERVICE, THE PATIENT'S NAME, THE PROVIDER'S NAME, A DESCRIPTION OF4
THE SERVICES PROVIDED, AND THE CHARGES FOR EACH SERVICE .5
SECTION 3. Appropriation. (1) For the 2023-24 state fiscal6
year, $75,167 is appropriated to the department of health care policy and7
financing for use by the executive director's office. This appropriation is8
from the healthcare affordability and sustainability fee cash fund created9
in Section 25.5-4-402.4 (5)(a), C.R.S. To implement this act, the office10
may use this appropriation as follows:11
(a) $67,349 for personal services, which amount is based on an12
assumption that the office will require an additional 1.7 FTE; and13
(b) $7,818 for operating expenses.14
(2) For the 2023-24 state fiscal year, the general assembly15
anticipates that the department of health care policy and financing will16
receive $75,165 in federal funds to implement this act, which amount is17
subject to the "(I)" notation as defined in the annual general appropriation18
act for the same fiscal year. The appropriation in subsection (1) of this19
section is based on the assumption that the department will receive this20
amount of federal funds to be used as follows:21
(a) $67,348 for personal services; and22
(b) $7,817 for operating expenses.23
SECTION 4. Act subject to petition - effective date. This act24
takes effect at 12:01 a.m. on the day following the expiration of the25
ninety-day period after final adjournment of the general assembly; except26
that, if a referendum petition is filed pursuant to section 1 (3) of article V27
1226
-10- of the state constitution against this act or an item, section, or part of this1
act within such period, then the act, item, section, or part will not take2
effect unless approved by the people at the general election to be held in3
November 2024 and, in such case, will take effect on the date of the4
official declaration of the vote thereon by the governor.5
1226
-11-