First Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
REENGROSSED
This Version Includes All Amendments
Adopted in the House of Introduction
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
Amended 2nd Reading
April 18, 2023
SENATE SPONSORSHIP
Van Winkle and Gonzales, Buckner, Coleman, Cutter, Danielson, Exum, Fields, Hansen,
Jaquez Lewis, Marchman, Moreno, Priola, Rodriguez
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
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
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
21
(1) "Collection action" means any of the following actions taken22
with respect to a debt for items and services that were purchased from or23
provided to a patient by a hospital on a date during which the hospital was24
not in material compliance with hospital price transparency laws:25
(a) Attempting to collect a debt from a patient or patient guarantor26
by referring the debt, directly or indirectly, to a debt collector, a collection27
252
-4- agency, or other third party retained by or on behalf of the hospital;1
(b) Suing the patient or patient guarantor or enforcing an2
arbitration or mediation clause in any hospital documents, including3
contracts, agreements, statements, or bills; or4
(c) Directly or indirectly causing a report to be made to a5
consumer reporting agency.6
(2) (a) "Collection agency" means any:7
(I) Person who engages in a business, the principal purpose of8
which is the collection of debts; or9
(II) Person who:10
(A) Regularly collects or attempts to collect, directly or indirectly,11
debts owed or due or asserted to be owed or due to another;12
(B) Takes assignment of debts for collection purposes;13
(C) Directly or indirectly solicits for collection debts owed or due14
or asserted to be owed or due to another; or15
(D) Collects debt for the department of personnel.16
(b) "Collection agency" does not include:17
(I) Any officer or employee of a creditor while, in the name of the18
creditor, collecting debts for such creditor;19
(II) Any person while acting as a collection agency for another20
person, both of whom are related by common ownership or affiliated by21
corporate control, if the person acting as a collection agency does so only22
for creditors to whom it is so related or affiliated and if the principal23
business of the person is not the collection of debts;24
(III) Any officer or employee of the United States or any state to25
the extent that collecting or attempting to collect any debt is in the26
performance of the officer's or employee's official duties;27
252
-5- (IV) Any person while serving or attempting to serve legal process1
on any other person in connection with the judicial enforcement of any2
debt;3
(V) Any debt-management services provider operating in4
compliance with or exempt from the "Uniform Debt-Management5
Services Act", part 2 of article 19 of title 5;6
(VI) Any person collecting or attempting to collect any debt owed7
or due or asserted to be owed or due another to the extent that:8
(A) The activity is incidental to a bona fide fiduciary obligation9
or a bona fide escrow arrangement;10
(B) The activity concerns a debt that was extended by the person;11
(C) The activity concerns a debt that was not in default at the time12
it was obtained by the person; or13
(D) The activity concerns a debt obtained by the person as a14
secured party in a commercial credit transaction involving the creditor;15
(VII) Any person whose principal business is the making of loans16
or the servicing of debt not in default and who acts as a loan17
correspondent, seller and servicer for the owner, or holder of a debt that18
is secured by a deed of trust on real property, whether or not the debt is19
also secured by an interest in personal property;20
(VIII) A limited gaming or racing licensee acting pursuant to21
article 33 of title 44.22
(c) Notwithstanding the provisions of subsection (2)(b) (5)(b) of23
this section, "collection agency" includes any person who, in the process24
of collecting the person's own debts, uses another name that would25
indicate that a third person is collecting or attempting to collect such26
debts.27
252
-6- (3) (a) "Consumer reporting agency" means any person that, for1
monetary fees or dues or on a cooperative nonprofit basis, regularly2
engages, in whole or in part, in the practice of assembling or evaluating3
consumer credit information or other information on consumers for the4
purpose of furnishing consumer reports to third parties. "Consumer5
reporting agency" includes any person defined in 15 U.S.C. sec. 1681a (f)6
or section 5-18-103 (4).7
(b) "Consumer reporting agency" does not include any business8
entity that provides check verification or check guarantee services only.9
10
(4) (a) "Debt" means any obligation or alleged obligation of a11
consumer to pay money arising out of a transaction, whether or not the12
obligation has been reduced to judgment.13
(b) "Debt" does not include a debt for business, investment,14
commercial, or agricultural purposes or a debt incurred by a business.15
(5) "Debt collector" means any person employed or engaged by16
a collection agency to perform the collection of debts owed or due or17
asserted to be owed or due to another.18
19
(6) "Federal centers for medicare and medicaid services" or20
"CMS" means the centers for medicare and medicaid services in the21
United States department of health and human services.22
23
(7) "Hospital" means, consistent with 45 CFR 180.20, a hospital:24
(a) Licensed or certified by the department
OF PUBLIC HEALTH AND25
ENVIRONMENT pursuant to section 25-1.5-103 (1)(a); or26
(b) Approved by the department
OF PUBLIC HEALTH AND27
252
-7- ENVIRONMENT as meeting the standards established for licensing a1
hospital.2
3
(8) "Hospital price transparency laws" means section 2718 (e) of4
the "Public Health Service (PHS) Act", Pub.L. 78-410, as amended, and5
rules adopted by the United States department of health and human6
services implementing section 2718 (e).7
(9) "Items and services" or "items or services" means "items and8
services" as defined in 45 CFR 180.20.9
10
25.5-1-903. [Formerly 25-3-803] Failure to comply with11
hospital price transparency laws - prohibiting collection of debt -12
penalty. (1) (a) Except as provided in subsection (1)(b) of this section,13
on and after August 10, 2022, A hospital that is not in material14
compliance with hospital price transparency laws on the date that items15
or services are purchased from or provided to a patient by the hospital16
shall not initiate or pursue a collection action against the patient or patient17
guarantor for a debt owed for the items or services.18
(b) This part 8 applies, on and after February 15, 2023, to critical19
access hospitals licensed and certified by the department pursuant to 4220
CFR 485 subpart F.21
(2) If a patient believes that a hospital was not in material22
compliance with hospital price transparency laws on a THE date on or23
after August 10, 2022, that items or services were purchased by or24
provided to the patient, and the hospital takes a collection action against25
the patient or patient guarantor, the patient or patient guarantor may file26
suit to determine if:27
252
-8- (a) The hospital was materially out of compliance with the1
hospital price transparency laws, and rules, and OR regulations on the date2
of service THE ITEMS OR SERVICES WERE PROVIDED ; and if3
(b) The noncompliance is related to the items or services. The4
hospital shall not take a collection action against the patient or patient5
guarantor while the lawsuit is pending.6
(3) A hospital that has been found by IF a judge or jury,7
considering compliance standards issued by the federal centers for8
medicare and medicaid services,
FINDS A HOSPITAL to be materially out of9
compliance with hospital price transparency laws, and
rules, and OR10
regulations,
THE HOSPITAL SHALL:11
(a) Shall
Refund the payer any amount of the debt the payer has12
paid and shall pay a penalty to the patient or patient guarantor in an13
amount equal to the total amount of the debt;14
(b) Shall Dismiss or cause to be dismissed any court action with15
prejudice and pay any attorney fees and costs incurred by the patient or16
patient guarantor relating to the action; and17
(c) Remove or cause to be removed from the patient's or patient18
guarantor's credit report any report made to a consumer reporting agency19
relating to the debt;
AND20
(d) N
OTIFY THE STATE DEPARTMENT OF THE MATERIAL21
NONCOMPLIANCE WITH HOSPITAL PRICE TRANSPARENCY LAWS , RULES, OR22
REGULATIONS.23
(4) Nothing in this part 8
PART 9:24
(a) Prohibits a hospital from billing a patient, patient guarantor,25
or third-party payer, including a health insurer, for items or services26
provided to the patient; or27
252
-9- (b) Requires a hospital to refund any payment made to the hospital1
for items or services provided to the patient, so long as no collection2
action is taken in violation of this part 8 PART 9.3
25.5-1-904. Transparency - hospitals - standard charges -4
shoppable services - enforcement. (1) On or before October 1, 2023,5
EACH HOSPITAL SHALL MAKE PUBLIC AND POST THE HOSPITAL 'S6
MEDICARE REIMBURSEMENT RATES .7
(2) (a) T
HE STATE DEPARTMENT SHALL CONDUCT PERFORMANCE
8
ASSESSMENTS FOR ADHERENCE TO FEDERAL TRANSPARENCY RULES BY:9
(I) R
EVIEWING RELEVANT INFORMATION PROVIDED TO THE STATE10
DEPARTMENT CONCERNING A HOSPITAL 'S PERFORMANCE ASSESSMENT IN
11
CONNECTION WITH THIS SECTION;12
(II) A
UDITING HOSPITAL WEBSITES FOR PEFORMANCE RELATIVE TO
13
FEDERAL PRICE TRANSPARENCY RULES , AND IN EVALUATING14
PERFORMANCE, THE DEPARTMENT SHALL FOLLOW RULES , STANDARDS,15
AND GUIDANCE PUBLISHED BY THE FEDERAL CENTERS FOR MEDICARE AND16
MEDICAID; AND17
(III) C
ONFIRMING THAT EACH HOSPITAL SUBMITTED THE LISTS18
REQUIRED BY THIS SECTION.19
(b) I
F THE STATE DEPARTMENT DETERMINES THAT A HOSPITAL
20
HAS PERFORMED POORLY IN ITS PERFORMANCE ASSESSMENT , THE STATE21
DEPARTMENT MAY:22
(I) I
SSUE A WRITTEN NOTICE TO THE HOSPITAL THAT CLEARLY23
EXPLAINS THE MANNER IN WHICH THE DEPARTMENT DETERMINED THAT
24
THE HOSPITAL PERFORMED POORLY ON THE ADHERENCE TO PRICE25
TRANSPARENCY; AND26
(II) P
ROVIDE TECHNICAL ASSISTANCE TO THE HOSPITAL TO
27
252
-10- IMPROVE PERFORMANCE .1
(8) O
N OR BEFORE FEBRUARY 1, 2024, THE STATE DEPARTMENT2
SHALL CREATE AND MAINTAIN A PUBLICLY AVAILABLE LIST ON ITS3
WEBSITE OF HOSPITALS THAT PERFORM POORLY ON THE DEPARTMENT 'S
4
PERFORMANCE ASSESSMENT . SUCH NOTICES AND COMMUNICATIONS ARE5
SUBJECT TO PUBLIC DISCLOSURE UNDER 5 U.S.C. SEC. 552, AS AMENDED,6
NOTWITHSTANDING ANY EXEMPTIONS OR EXCLUSIONS TO THE CONTRARY ,7
IN FULL WITHOUT REDACTION. THE STATE DEPARTMENT SHALL UPDATE8
THE LIST AT LEAST ANNUALLY.9
(9) A
PERSON THAT VIOLATES SUBSECTION (1) OR (5) OF THIS10
SECTION COMMITS A DECEPTIVE TRADE PRACTICE UNDER SECTION11
6-1-105.12
SECTION 4. Act subject to petition - effective date. This act13
takes effect at 12:01 a.m. on the day following the expiration of the14
ninety-day period after final adjournment of the general assembly; except15
that, if a referendum petition is filed pursuant to section 1 (3) of article16
V of the state constitution against this act or an item, section, or part of17
this act within such period, then the act, item, section, or part will not18
take effect unless approved by the people at the general election to be19
held in November 2024 and, in such case, will take effect on the date of20
the official declaration of the vote thereon by the governor.21
252
-11-