First Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 23-0554.04 Kristen Forrestal x4217
SENATE BILL 23-252
Senate Committees House Committees
Health & Human Services
A BILL FOR AN ACT
C
ONCERNING HOSPITAL MEDICAL PRICE TRANSPARENCY .101
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 requires hospitals to make public a list of all standard
charges for all hospital items and services provided to patients. The
standard charges include the gross billed charge, the payer-specific
negotiated charge, the minimum and maximum negotiated charges, and
the discounted cash price. The bill also requires each hospital to maintain
and make public a list of at least 300 shoppable services provided by the
hospital or, if the hospital does not provide 300 shoppable services, all of
the hospital's shoppable services. Each hospital is required to report its
SENATE SPONSORSHIP
Van Winkle and Gonzales,
HOUSE SPONSORSHIP
Daugherty and Hartsook,
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. updated lists to the department of health care policy and financing (state
department).
The bill requires the state department to monitor hospital
compliance with the price transparency requirements. If the state
department determines that a hospital is not in compliance, the state
department is required to issue a written notice to the hospital and require
the hospital to submit a corrective action plan.
The bill repeals sections of statute regarding hospital price
transparency and debt collection that are currently under the
administration and authority of the department of public health and
environment and relocates these sections so that hospital price
transparency and debt collection are under the state department.
The bill makes a violation of the hospital transparency
requirements outlined in the bill a deceptive trade practice under the
"Colorado Consumer Protection Act".
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, 6-1-105, add2
(1)(uuu) as follows:3
6-1-105. Unfair or deceptive trade practices. (1) A person4
engages in a deceptive trade practice when, in the course of the person's5
business, vocation, or occupation, the person:6
(uuu) V
IOLATES SECTION 25.5-1-904.7
SECTION 2. Repeal of provisions being relocated in this act.8
In Colorado Revised Statutes, repeal part 8 of article 3 of title 25.9
SECTION 3. In Colorado Revised Statutes, add with amended10
and relocated provisions part 9 to article 1 of title 25.5 as follows:11
PART 912
HOSPITAL PRICE TRANSPARENCY13
25.5-1-901. [Formerly 25-3-801] Legislative declaration.14
(1) The general assembly finds and declares that:15
(a) Section 1001 of the "Patient Protection and Affordable Care16
Act", of 2010",
Pub.L. 111-148, as amended by section 10101 of the17
SB23-252-2- "Health Care and Education Reconciliation Act of 2010", Pub.L.1
111-152, amended Title XXVII of the "Public Health Service Act",2
Pub.L. 78-410, in part, by adding a new section 2718 (e), requiring, in3
part, that each hospital operating within the United States establish,4
update, and make public a list of the hospital's standard charges for the5
items and services that the hospital provides;6
(b) Effective January 1, 2021, the federal centers for medicare and7
medicaid services published the final rule to implement the law, codified8
at 45 CFR 180;9
(c) In its summary of the final rule, CMS states that information10
on hospital standard charges is necessary for the public to "make more11
informed decisions about their care" and that the "impact of these final12
policies will help to increase market competition, and ultimately drive13
down the cost of health care services, making them more affordable for14
all patients";15
(d) On July 9, 2021, President Biden, building upon efforts of past16
presidents, issued the "Executive Order on Promoting Competition in the17
American Economy", directing the secretary of the United States18
department of health and human services to support new and existing19
price transparency initiatives for hospitals;20
(e) Health-care price transparency is in the best interest of all21
Coloradans, including:22
(I) The state government, which purchases health-care services for23
almost a quarter ONE-FOURTH of all Coloradans;24
(II) Colorado businesses, which fund employee medical expenses;25
and26
(III) Colorado residents, who ultimately bear the brunt of high27
SB23-252
-3- health-care costs in the form of higher taxes, lower wages, and residents'1
own out-of-pocket spending;2
(f) Moreover, health-care prices in Colorado are among the3
highest in the nation;4
(g) However, not all Colorado hospitals are in compliance with all5
of the disclosure requirements under federal law and other state laws6
governing health-care price transparency; and7
(h) This lack of compliance with health-care price transparency8
laws by Colorado hospitals decreases the likelihood that Colorado9
consumers will be fully aware of affordable health-care options before10
purchasing items and services from hospitals, placing health-care11
consumers at greater risk of collection actions and other adverse actions12
relating to unpaid medical bills.13
(2) Therefore, the general assembly finds and declares that it is14
imperative to protect Colorado health-care consumers from collection15
actions and other adverse actions taken by Colorado hospitals during the16
time when the hospital was not in material compliance with hospital price17
transparency laws intended to protect health-care consumers.18
25.5-1-902. [Formerly 25-3-802] Definitions. As used in this19
section PART 9, unless the context otherwise requires:20
(1) "A
NCILLARY SERVICE" MEANS A HOSPITAL ITEM OR SERVICE21
THAT A HOSPITAL CUSTOMARILY PROVIDES AS PART OF A SHOPPABLE22
SERVICE.23
(2) "C
HARGEMASTER" MEANS A UNIFORM SCHEDULE OF CHARGES24
REPRESENTED BY A HOSPITAL AS THE HOSPITAL 'S GROSS BILLED CHARGE25
FOR A GIVEN HEALTH-CARE SERVICE, REGARDLESS OF PAYER AND BEFORE26
ANY DISCOUNTS OR NEGOTIATIONS ARE APPLIED .27
SB23-252
-4- (3) "CODE" MEANS THE BILLING OR ACCOUNTING CODE THAT A1
HOSPITAL USES FOR A PARTICULAR HOSPITAL ITEM OR SERVICE . "CODE"2
INCLUDES THE CPT CODE, THE HCPCS CODE, THE DRG CODE, THE3
NATIONAL DRUG CODE, OR OTHER COMMON IDENTIFIER.4
(1) (4) "Collection action" means any of the following actions5
taken with respect to a debt for items and services that were purchased6
from or provided to a patient by a hospital on a date during which the7
hospital was not in material compliance with hospital price transparency8
laws:9
(a) Attempting to collect a debt from a patient or patient guarantor10
by referring the debt, directly or indirectly, to a debt collector, a collection11
agency, or other third party retained by or on behalf of the hospital;12
(b) Suing the patient or patient guarantor or enforcing an13
arbitration or mediation clause in any hospital documents, including14
contracts, agreements, statements, or bills; or15
(c) Directly or indirectly causing a report to be made to a16
consumer reporting agency.17
(2) (5) (a) "Collection agency" means any:18
(I) Person who engages in a business, the principal purpose of19
which is the collection of debts; or20
(II) Person who:21
(A) Regularly collects or attempts to collect, directly or indirectly,22
debts owed or due or asserted to be owed or due to another;23
(B) Takes assignment of debts for collection purposes;24
(C) Directly or indirectly solicits for collection debts owed or due25
or asserted to be owed or due to another; or26
(D) Collects debt for the department of personnel.27
SB23-252
-5- (b) "Collection agency" does not include:1
(I) Any officer or employee of a creditor while, in the name of the2
creditor, collecting debts for such creditor;3
(II) Any person while acting as a collection agency for another4
person, both of whom are related by common ownership or affiliated by5
corporate control, if the person acting as a collection agency does so only6
for creditors to whom it is so related or affiliated and if the principal7
business of the person is not the collection of debts;8
(III) Any officer or employee of the United States or any state to9
the extent that collecting or attempting to collect any debt is in the10
performance of the officer's or employee's official duties;11
(IV) Any person while serving or attempting to serve legal process12
on any other person in connection with the judicial enforcement of any13
debt;14
(V) Any debt-management services provider operating in15
compliance with or exempt from the "Uniform Debt-Management16
Services Act", part 2 of article 19 of title 5;17
(VI) Any person collecting or attempting to collect any debt owed18
or due or asserted to be owed or due another to the extent that:19
(A) The activity is incidental to a bona fide fiduciary obligation20
or a bona fide escrow arrangement;21
(B) The activity concerns a debt that was extended by the person;22
(C) The activity concerns a debt that was not in default at the time23
it was obtained by the person; or24
(D) The activity concerns a debt obtained by the person as a25
secured party in a commercial credit transaction involving the creditor;26
(VII) Any person whose principal business is the making of loans27
SB23-252
-6- or the servicing of debt not in default and who acts as a loan1
correspondent, seller and servicer for the owner, or holder of a debt that2
is secured by a deed of trust on real property, whether or not the debt is3
also secured by an interest in personal property;4
(VIII) A limited gaming or racing licensee acting pursuant to5
article 33 of title 44.6
(c) Notwithstanding the provisions of subsection (2)(b) (5)(b) of7
this section, "collection agency" includes any person who, in the process8
of collecting the person's own debts, uses another name that would9
indicate that a third person is collecting or attempting to collect such10
debts.11
(3) (6) (a) "Consumer reporting agency" means any person that,12
for monetary fees or dues or on a cooperative nonprofit basis, regularly13
engages, in whole or in part, in the practice of assembling or evaluating14
consumer credit information or other information on consumers for the15
purpose of furnishing consumer reports to third parties. "Consumer16
reporting agency" includes any person defined in 15 U.S.C. sec. 1681a (f)17
or section 5-18-103 (4).18
(b) "Consumer reporting agency" does not include any business19
entity that provides check verification or check guarantee services only.20
(7) "CPT
CODE" MEANS A MEDICAL CODE THAT IS USED TO REPORT21
MEDICAL, SURGICAL, AND DIAGNOSTIC PROCEDURES AND SERVICES FOR22
THE PURPOSE OF HEALTH-CARE BILLING.23
(4)
(8) (a) "Debt" means any obligation or alleged obligation of24
a consumer to pay money arising out of a transaction, whether or not the25
obligation has been reduced to judgment.26
(b) "Debt" does not include a debt for business, investment,27
SB23-252
-7- commercial, or agricultural purposes or a debt incurred by a business.1
(5) (9) "Debt collector" means any person employed or engaged2
by a collection agency to perform the collection of debts owed or due or3
asserted to be owed or due to another.4
(10) "D
ISCOUNTED CASH PRICE" MEANS THE CHARGE THAT APPLIES5
TO AN INDIVIDUAL WHO PAYS CASH , OR A CASH EQUIVALENT , FOR A6
HOSPITAL ITEM OR SERVICE.7
(11) "DRG
CODE" MEANS THE DIAGNOSIS-RELATED GROUP CODE,8
WHICH IS A PATIENT CLASSIFICATION SCHEME THAT PROVIDES A MEANS OF9
RELATING THE TYPE OF PATIENTS A HOSPITAL TREATS TO THE COSTS10
INCURRED BY THE HOSPITAL.11
(6)
(12) "Federal centers for medicare and medicaid services" or12
"CMS" means the centers for medicare and medicaid services in the13
United States department of health and human services.14
(13) "G
ROSS BILLED CHARGE" MEANS THE MAXIMUM CHARGE15
THAT ANY PATIENT WILL BE BILLED FOR A HOSPITAL ITEM OR SERVICE16
THAT IS REFLECTED ON A HOSPITAL 'S CHARGEMASTER, ABSENT ANY17
DISCOUNTS.18
(14) "HCPCS
CODE" MEANS THE HEALTHCARE COMMON19
P
ROCEDURE CODING SYSTEM DEVELOPED BY THE CMS FOR IDENTIFYING20
HEALTH-CARE SERVICES IN A CONSISTENT AND STANDARDIZED MANNER .21
(15) "H
EALTH INSURANCE PLAN" MEANS THE HEALTH COVERAGE22
BENEFITS INCLUDED IN A HEALTH INSURANCE PRODUCT WITH A23
PARTICULAR COST-SHARING STRUCTURE, PROVIDER NETWORK , AND24
SERVICE AREA.25
(16) "H
EALTH INSURANCE PRODUCT " MEANS A PACKAGE OF26
HEALTH INSURANCE BENEFITS THAT ARE OFFERED USING A SPECIFIC27
SB23-252
-8- NETWORK TYPE WITHIN A PARTICULAR HEALTH SERVICE AREA .1
(7) (17) "Hospital" means, consistent with 45 CFR 180.20, a2
hospital:3
(a) Licensed or certified by the department
OF PUBLIC HEALTH AND4
ENVIRONMENT pursuant to section 25-1.5-103 (1)(a); or5
(b) Approved by the department
OF PUBLIC HEALTH AND6
ENVIRONMENT as meeting the standards established for licensing a7
hospital.8
(18) "H
OSPITAL ITEM OR SERVICE" MEANS AN ITEM OR SERVICE,9
INCLUDING AN INDIVIDUAL ITEM OR SERVICE OR A SERVICE PACKAGE ,10
THAT MAY BE PROVIDED BY A HOSPITAL TO A PATIENT IN CONNECTION11
WITH AN INPATIENT ADMISSION OR AN OUTPATIENT VISIT , AS APPLICABLE,12
FOR WHICH THE HOSPITAL HAS ESTABLISHED A STANDARD CHARGE ,13
INCLUDING:14
(a) S
UPPLIES AND PROCEDURES;15
(b) R
OOM AND BOARD;16
(c) U
SE OF THE HOSPITAL AND OTHER AREAS , THE CHARGES FOR17
WHICH ARE GENERALLY REFERRED TO AS "HOSPITAL FACILITY FEES";18
(d) S
ERVICES OF PHYSICIANS AND NONPHYSICIAN PRACTITIONERS19
EMPLOYED BY THE HOSPITAL, THE CHARGES FOR WHICH ARE GENERALLY20
REFERRED TO AS "PROFESSIONAL CHARGES"; AND21
(e) A
NY OTHER ITEM OR SERVICE FOR WHICH A HOSPITAL HAS22
ESTABLISHED A STANDARD CHARGE .23
(8)
(19) "Hospital price transparency laws" means section 2718 (e)24
of the "Public Health Service (PHS) Act", Pub.L. 78-410, as amended,25
and rules adopted by the United States department of health and human26
services implementing section 2718 (e).27
SB23-252
-9- (9) (20) "Items and services" or "items or services" means "items1
and services" as defined in 45 CFR 180.20.2
(21) "M
ACHINE-READABLE FORMAT " MEANS A DIGITAL3
REPRESENTATION OF INFORMATION IN A FILE THAT CAN BE IMPORTED OR4
READ INTO A COMPUTER SYSTEM FOR FURTHER PROCESSING . THE TERM5
INCLUDES .XML, .JSON, AND .CSV FORMATS.6
(22) "M
AXIMUM NEGOTIATED CHARGE " MEANS THE HIGHEST7
CHARGE THAT A HOSPITAL HAS NEGOTIATED WITH ALL THIRD -PARTY8
PAYERS FOR A HOSPITAL ITEM OR SERVICE.9
(23) "M
INIMUM NEGOTIATED CHARGE " MEANS THE LOWEST10
CHARGE THAT A HOSPITAL HAS NEGOTIATED WITH ALL THIRD -PARTY11
PAYERS FOR A HOSPITAL ITEM OR SERVICE.12
(24) "N
ATIONAL DRUG CODE " MEANS THE UNIQUE ,13
THREE-SEGMENT IDENTIFIER NUMBER USED BY THE FEDERAL FOOD AND14
DRUG ADMINISTRATION TO IDENTIFY DRUGS THAT ARE MANUFACTURED ,15
PREPARED, PROPAGATED, COMPOUNDED, OR PROCESSED FOR SALE IN THE16
U
NITED STATES.17
(25) "P
AYER-SPECIFIC NEGOTIATED CHARGE" MEANS THE CHARGE18
THAT A HOSPITAL HAS NEGOTIATED WITH A SPECIFIC THIRD -PARTY PAYER19
UNDER EACH SPECIFIC HEALTH INSURANCE PLAN FOR A HOSPITAL ITEM OR20
SERVICE.21
(26) "S
ERVICE PACKAGE" MEANS AN AGGREGATION OF INDIVIDUAL22
HOSPITAL ITEMS OR SERVICES INTO A SINGLE SERVICE WITH A SINGLE23
CHARGE FOR EACH SPECIFIC HEALTH INSURANCE PLAN .24
(27) "S
HOPPABLE SERVICE" MEANS A SERVICE THAT MAY BE25
SCHEDULED BY A HEALTH-CARE CONSUMER IN ADVANCE .26
(28) "S
TANDARD CHARGE " MEANS THE REGULAR CHARGE27
SB23-252
-10- ESTABLISHED BY THE HOSPITAL FOR A HOSPITAL ITEM OR SERVICE1
PROVIDED TO A SPECIFIC GROUP OF PAYING PATIENTS . THE TERM2
INCLUDES:3
(a) T
HE GROSS BILLED CHARGE;4
(b) T
HE PAYER-SPECIFIC NEGOTIATED CHARGE;5
(c) T
HE MINIMUM NEGOTIATED CHARGE ;6
(d) T
HE MAXIMUM NEGOTIATED CHARGE ; AND7
(e) T
HE DISCOUNTED CASH PRICE.8
(29) "T
HIRD-PARTY PAYER" MEANS AN ENTITY THAT IS , BY9
STATUTE, CONTRACT, OR AGREEMENT , LEGALLY RESPONSIBLE FOR10
PAYMENT OF A CLAIM FOR A HOSPITAL ITEM OR SERVICE .11
25.5-1-903. [Formerly 25-3-803] Failure to comply with12
hospital price transparency laws - prohibiting collection of debt -13
penalty. (1) (a) Except as provided in subsection (1)(b) of this section,
14
on and after August 10, 2022, A hospital that is not in material15
compliance with hospital price transparency laws on the date that items16
or services are purchased from or provided to a patient by the hospital17
shall not initiate or pursue a collection action against the patient or patient18
guarantor for a debt owed for the items or services.19
(b) This part 8 applies, on and after February 15, 2023, to critical20
access hospitals licensed and certified by the department pursuant to 4221
CFR 485 subpart F.22
(2) If a patient believes that a hospital was not in material23
compliance with hospital price transparency laws on a THE date on or24
after August 10, 2022, that items or services were purchased by or25
provided to the patient, and the hospital takes a collection action against26
the patient or patient guarantor, the patient or patient guarantor may file27
SB23-252
-11- suit to determine if:1
(a) The hospital was materially out of compliance with the2
hospital price transparency laws, and rules, and OR regulations on the date3
of service THE ITEMS OR SERVICES WERE PROVIDED ; and if4
(b) The noncompliance is related to the items or services. The5
hospital shall not take a collection action against the patient or patient6
guarantor while the lawsuit is pending.7
(3) A hospital that has been found by IF a judge or jury,8
considering compliance standards issued by the federal centers for9
medicare and medicaid services,
FINDS A HOSPITAL to be materially out of10
compliance with hospital price transparency laws, and
rules, and OR11
regulations,
THE HOSPITAL SHALL:12
(a) Shall
Refund the payer any amount of the debt the payer has13
paid and shall pay a penalty to the patient or patient guarantor in an14
amount equal to the total amount of the debt;15
(b) Shall Dismiss or cause to be dismissed any court action with16
prejudice and pay any attorney fees and costs incurred by the patient or17
patient guarantor relating to the action; and18
(c) Remove or cause to be removed from the patient's or patient19
guarantor's credit report any report made to a consumer reporting agency20
relating to the debt;
AND21
(d) N
OTIFY THE STATE DEPARTMENT OF THE MATERIAL22
NONCOMPLIANCE WITH HOSPITAL PRICE TRANSPARENCY LAWS , RULES, OR23
REGULATIONS.24
(4) Nothing in this part 8
PART 9:25
(a) Prohibits a hospital from billing a patient, patient guarantor,26
or third-party payer, including a health insurer, for items or services27
SB23-252
-12- provided to the patient; or1
(b) Requires a hospital to refund any payment made to the hospital2
for items or services provided to the patient, so long as no collection3
action is taken in violation of this part 8 PART 9.4
25.5-1-904. Transparency - hospitals - standard charges -5
shoppable services - enforcement. (1) O
N OR BEFORE OCTOBER 1, 2023,6
EACH HOSPITAL SHALL MAKE PUBLIC :7
(a) A
DIGITAL FILE IN A MACHINE-READABLE FORMAT THAT8
CONTAINS A LIST OF ALL STANDARD CHARGES FOR ALL HOSPITAL ITEMS OR9
SERVICES AS DESCRIBED IN SUBSECTION (2) OF THIS SECTION; AND10
(b) A
CONSUMER-FRIENDLY LIST OF STANDARD CHARGES FOR A11
LIMITED SET OF SHOPPABLE SERVICES AS PROVIDED IN SUBSECTION (5) OF12
THIS SECTION.13
(2) (a) A
HOSPITAL SHALL:14
(I) M
AINTAIN A LIST OF ALL STANDARD CHARGES FOR ALL15
HOSPITAL ITEMS OR SERVICES IN ACCORDANCE WITH THIS SECTION ; AND16
(II) E
NSURE THE LIST REQUIRED UNDER SUBSECTION (1)(b) OF THIS17
SECTION IS AVAILABLE AT ALL TIMES TO THE PUBLIC , INCLUDING BY18
POSTING THE LIST ELECTRONICALLY IN THE MANNER PROVIDED BY THIS19
SECTION.20
(b) T
HE STANDARD CHARGES IN THE LIST REQUIRED BY21
SUBSECTION (1)(a) OF THIS SECTION MUST REFLECT THE STANDARD22
CHARGES APPLICABLE TO THAT LOCATION OF THE HOSPITAL , REGARDLESS23
OF WHETHER THE HOSPITAL OPERATES IN MORE THAN ONE LOCATION OR24
OPERATES UNDER THE SAME LICENSE AS ANOTHER HOSPITAL .25
(c) T
HE LIST REQUIRED BY SUBSECTION (1)(a) OF THIS SECTION26
MUST INCLUDE, AS APPLICABLE:27
SB23-252
-13- (I) A DESCRIPTION OF EACH HOSPITAL ITEM OR SERVICE PROVIDED1
BY THE HOSPITAL; AND2
(II) T
HE STANDARD CHARGES FOR EACH INDIVIDUAL HOSPITAL3
ITEM OR SERVICE WHEN PROVIDED IN EITHER AN INPATIENT SETTING OR AN4
OUTPATIENT SETTING, AS APPLICABLE, WITH:5
(A) T
HE HOSPITAL'S MEDICARE REIMBURSEMENT RATE ;6
(B) T
HE PAYER-SPECIFIC NEGOTIATED CHARGE LISTED BY THE7
NAME OF THE THIRD-PARTY PAYER AND THE HEALTH INSURANCE PLAN8
ASSOCIATED WITH THE CHARGE, DISPLAYED IN A MANNER THAT CLEARLY9
ASSOCIATES THE CHARGE WITH EACH THIRD -PARTY PAYER AND EACH10
HEALTH INSURANCE PLAN; AND11
(C) A
CODE USED BY THE HOSPITAL FOR THE HOSPITAL ITEM OR12
SERVICE.13
(d) T
HE LIST REQUIRED BY SUBSECTION (1)(a) OF THIS SECTION14
MUST BE DISPLAYED IN A PROMINENT LOCATION ON THE HOME PAGE OF15
THE HOSPITAL'S PUBLICLY ACCESSIBLE WEBSITE OR ACCESSIBLE BY16
SELECTING A DEDICATED LINK THAT IS PROMINENTLY DISPLAYED ON THE17
HOME PAGE OF THE HOSPITAL 'S PUBLICLY ACCESSIBLE WEBSITE. IF THE18
HOSPITAL OPERATES MULTIPLE LOCATIONS AND MAINTAINS A SINGLE19
WEBSITE, THE LIST REQUIRED BY SUBSECTION (1)(a) OF THIS SECTION MUST20
BE POSTED FOR EACH LOCATION THE HOSPITAL OPERATES IN A MANNER21
THAT CLEARLY ASSOCIATES THE PARTICULAR LIST WITH THE APPLICABLE22
LOCATION OF THE HOSPITAL.23
(e) T
HE LIST REQUIRED BY SUBSECTION (1)(a) OF THIS SECTION24
MUST BE:25
(I) A
VAILABLE FREE OF CHARGE;26
(II) A
VAILABLE WITHOUT HAVING TO ESTABLISH A USER ACCOUNT27
SB23-252
-14- OR PASSWORD;1
(III) A
VAILABLE WITHOUT HAVING TO SUBMIT PERSONAL2
IDENTIFYING INFORMATION;3
(IV) A
VAILABLE WITHOUT HAVING TO OVERCOME ANY OTHER4
IMPEDIMENT, INCLUDING ENTERING A CODE TO ACCESS THE LIST ;5
(V) A
CCESSIBLE TO A COMMON COMMERCIAL OPERATOR OF AN6
INTERNET SEARCH ENGINE TO THE EXTENT NECESSARY FOR THE SEARCH7
ENGINE TO INDEX THE LIST AND DISPLAY THE LIST AS A RESULT IN8
RESPONSE TO A SEARCH QUERY OF A USER OF THE SEARCH ENGINE ;9
(VI) F
ORMATTED IN A MANNER PRESCRIBED BY THE STATE10
DEPARTMENT; AND11
(VII) D
IGITALLY SEARCHABLE.12
(f) T
HE LIST REQUIRED BY SUBSECTION (1)(a) OF THIS SECTION13
MUST USE THE NAMING CONVENTION SPECIFIED BY THE FEDERAL CENTERS14
FOR MEDICARE AND MEDICAID SERVICES , SPECIFICALLY THE TERMS AS15
STATED IN 45 CFR 180.16
(3) I
N DETERMINING THE FORMAT OF THE LISTS REQUIRED BY17
SUBSECTION (1)(a) OF THIS SECTION PURSUANT TO SUBSECTION (2)(e)(VI)18
OF THIS SECTION, THE STATE DEPARTMENT SHALL DEVELOP A TEMPLATE19
THAT EACH HOSPITAL MUST USE IN FORMATTING THE LISTS . THE STATE20
DEPARTMENT SHALL:21
(a) C
ONSIDER ANY APPLICABLE FEDERAL GUIDELINES FOR22
FORMATTING SIMILAR LISTS REQUIRED BY FEDERAL LAW OR REGULATION23
AND ENSURE THAT THE DESIGN OF THE TEMPLATE ENABLES HEALTH -CARE24
RESEARCHERS TO COMPARE THE CHARGES CONTAINED IN THE LISTS25
MAINTAINED BY EACH HOSPITAL ; AND26
(b) D
ESIGN THE TEMPLATE TO BE SUBSTANTIALLY SIMILAR TO THE27
SB23-252
-15- TEMPLATE USED BY THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID1
SERVICES FOR PURPOSES SIMILAR TO THE PURPOSES OF THIS SECTION , IF2
THE STATE DEPARTMENT DETERMINES THAT DESIGNING THE TEMPLATE IN3
THAT MANNER SERVES A RELEVANT PURPOSE AND THERE IS A BENEFIT TO4
DEVELOPING AND REQUIRING A SUBSTANTIALLY SIMILAR DESIGN .5
(4) E
ACH HOSPITAL SHALL UPDATE THE LISTS REQUIRED BY6
SUBSECTION (1) OF THIS SECTION AT LEAST MONTHLY . THE HOSPITAL7
SHALL CLEARLY INDICATE THE DATE ON WHICH EACH LIST WAS MOST8
RECENTLY UPDATED, EITHER ON THE UPDATED LIST OR IN A MANNER THAT9
IS CLEARLY ASSOCIATED WITH THE UPDATED LIST .10
(5) (a) E
XCEPT AS PROVIDED IN SUBSECTION (5)(c) OF THIS11
SECTION, A HOSPITAL SHALL MAINTAIN AND MAKE PUBLICLY AVAILABLE12
A LIST OF STANDARD CHARGES FOR EACH OF AT LEAST THREE HUNDRED13
SHOPPABLE SERVICES PROVIDED BY THE HOSPITAL . THE HOSPITAL MAY14
SELECT THE SHOPPABLE SERVICES TO BE INCLUDED IN THE LIST ; EXCEPT15
THAT THE LIST MUST INCLUDE ALL OF THE SEVENTY SHOPPABLE SERVICES16
SPECIFIED BY THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID17
SERVICES THAT THE HOSPITAL PROVIDES AND ANY OTHER SERVICES18
SPECIFIED BY THE STATE DEPARTMENT .19
(b) I
N SELECTING THE SHOPPABLE SERVICES FOR INCLUSION IN THE20
LIST REQUIRED BY THIS SUBSECTION (5), A HOSPITAL SHALL:21
(I) C
ONSIDER HOW FREQUENTLY THE HOSPITAL PROVIDES THE22
SERVICE; AND23
(II) P
RIORITIZE THE SELECTION OF SERVICES THAT ARE AMONG THE24
SERVICES MOST FREQUENTLY PROVIDED BY THE HOSPITAL .25
(c) I
F A HOSPITAL DOES NOT PROVIDE THREE HUNDRED SHOPPABLE26
SERVICES, THE HOSPITAL SHALL MAINTAIN A LIST OF ALL SHOPPABLE27
SB23-252
-16- SERVICES THAT THE HOSPITAL PROVIDES .1
(d) T
HE LIST DESCRIBED IN THIS SUBSECTION (5) MUST INCLUDE:2
(I) A
PLAIN-LANGUAGE DESCRIPTION OF EACH SHOPPABLE SERVICE3
INCLUDED ON THE LIST;4
(II) T
HE PAYER-SPECIFIC NEGOTIATED CHARGE THAT APPLIES TO5
EACH SHOPPABLE SERVICE INCLUDED ON THE LIST AND TO ANY ANCILLARY6
SERVICE, LISTED BY THE NAME OF THE THIRD-PARTY PAYER AND EACH7
HEALTH INSURANCE PLAN ASSOCIATED WITH THE CHARGE AND DISPLAYED8
IN A MANNER THAT CLEARLY ASSOCIATES THE CHARGE WITH EACH9
THIRD-PARTY PAYER AND EACH HEALTH INSURANCE PLAN ;10
(III) T
HE DISCOUNTED CASH PRICE THAT APPLIES TO EACH11
SHOPPABLE SERVICE INCLUDED ON THE LIST AND TO ANY ANCILLARY12
SERVICE OR, IF THE HOSPITAL DOES NOT OFFER A DISCOUNTED CASH PRICE13
FOR ONE OR MORE OF THE SHOPPABLE SERVICES OR ANCILLARY SERVICES14
ON THE LIST, THE GROSS BILLED CHARGE FOR THE SHOPPABLE SERVICE OR15
ANCILLARY SERVICE;16
(IV) T
HE MINIMUM NEGOTIATED CHARGE THAT APPLIES TO EACH17
SHOPPABLE SERVICE INCLUDED ON THE LIST AND TO ANY ANCILLARY18
SERVICE;19
(V) T
HE MAXIMUM NEGOTIATED CHARGE THAT APPLIES TO EACH20
SHOPPABLE SERVICE INCLUDED ON THE LIST AND TO ANY ANCILLARY21
SERVICE;22
(VI) A
NY CODE USED BY THE HOSPITAL FOR EACH SHOPPABLE23
SERVICE INCLUDED ON THE LIST AND FOR ANY ANCILLARY SERVICE ;24
(VII) I
F THE HOSPITAL HAS MORE THAN ONE LOCATION , EACH25
LOCATION AT WHICH THE HOSPITAL PROVIDES THE SHOPPABLE SERVICE26
AND WHETHER THE STANDARD CHARGES INCLUDED IN THE LIST APPLY AT27
SB23-252
-17- THAT LOCATION TO THE PROVISION OF THAT SHOPPABLE SERVICE IN AN1
INPATIENT SETTING, AN OUTPATIENT SETTING, OR IN BOTH OF THOSE2
SETTINGS, AS APPLICABLE; AND3
(VIII) I
F APPLICABLE, AN INDICATION OF THE SHOPPABLE SERVICES4
SPECIFIED BY THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID5
SERVICES THAT ARE PROVIDED BY THE HOSPITAL .6
(e) T
HE LISTS OF SHOPPABLE SERVICES REQUIRED BY THIS7
SUBSECTION (5) MUST BE:8
(I) A
VAILABLE, ACCESSIBLE, AND FORMATTED AS DESCRIBED IN9
SUBSECTION (2)(e) OF THIS SECTION;10
(II) D
IGITALLY SEARCHABLE BY SERVICE DESCRIPTION , BILLING11
CODE, AND PAYER; AND12
(III) U
PDATED WITHIN NINETY DAYS AFTER THE RENEWAL DATE OF13
AN EXISTING CONTRACT OR AFTER A NEW CONTRACT TAKES EFFECT THAT14
CONCERNS A THIRD-PARTY PAYER OR HEALTH INSURANCE PLAN OR A PRICE15
CHANGE FOR A PRODUCT.16
(6) E
ACH HOSPITAL SHALL SUBMIT THE INITIAL LISTS AND ANY17
UPDATED LISTS AS REQUIRED BY THIS SECTION TO THE STATE DEPARTMENT18
IN A FORM AND MANNER DETERMINED BY THE STATE DEPARTMENT .19
(7) (a) T
HE STATE DEPARTMENT SHALL MONITOR EACH HOSPITAL 'S20
COMPLIANCE WITH THIS SECTION BY:21
(I) R
EVIEWING RELEVANT INFORMATION PROVIDED TO THE STATE22
DEPARTMENT CONCERNING A HOSPITAL 'S NONCOMPLIANCE WITH THIS23
SECTION;24
(II) A
UDITING HOSPITAL WEBSITES FOR COMPLIANCE WITH THIS25
SECTION; AND26
(III) C
ONFIRMING THAT EACH HOSPITAL SUBMITTED THE LISTS27
SB23-252
-18- REQUIRED BY THIS SECTION.1
(b) I
F THE STATE DEPARTMENT DETERMINES THAT A HOSPITAL IS2
NOT IN COMPLIANCE WITH THIS SECTION, THE STATE DEPARTMENT MAY :3
(I) I
SSUE A WRITTEN NOTICE TO THE HOSPITAL THAT CLEARLY4
EXPLAINS THE MANNER IN WHICH THE HOSPITAL IS NOT IN COMPLIANCE5
WITH THIS SECTION; AND6
(II) R
EQUEST A CORRECTIVE ACTION PLAN FROM THE HOSPITAL .7
(8) O
N OR BEFORE FEBRUARY 1, 2024, THE STATE DEPARTMENT8
SHALL CREATE AND MAINTAIN A PUBLICLY AVAILABLE LIST ON ITS9
WEBSITE OF HOSPITALS THAT HAVE BEEN FOUND TO HAVE VIOLATED THIS10
SECTION OR THAT HAVE BEEN ISSUED A WARNING NOTICE , A REQUEST FOR11
A CORRECTIVE ACTION PLAN, OR ANY OTHER WRITTEN COMMUNICATION12
FROM THE STATE DEPARTMENT . SUCH NOTICES AND COMMUNICATIONS13
ARE SUBJECT TO PUBLIC DISCLOSURE UNDER 5 U.S.C. SEC. 552, AS14
AMENDED, NOTWITHSTANDING ANY EXEMPTIONS OR EXCLUSIONS TO THE15
CONTRARY, IN FULL WITHOUT REDACTION. THE STATE DEPARTMENT SHALL16
UPDATE THE LIST AT LEAST ANNUALLY .17
(9) A
PERSON THAT VIOLATES SUBSECTION (1) OR (5) OF THIS18
SECTION COMMITS A DECEPTIVE TRADE PRACTICE UNDER SECTION 6-1-105.19
SECTION 4. Act subject to petition - effective date. This act20
takes effect at 12:01 a.m. on the day following the expiration of the21
ninety-day period after final adjournment of the general assembly; except22
that, if a referendum petition is filed pursuant to section 1 (3) of article V23
of the state constitution against this act or an item, section, or part of this24
act within such period, then the act, item, section, or part will not take25
effect unless approved by the people at the general election to be held in26
SB23-252
-19- November 2024 and, in such case, will take effect on the date of the1
official declaration of the vote thereon by the governor.2
SB23-252
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