SENATE BILL 23-252
BY SENATOR(S) Van Winkle and Gonzales, Buckner, Coleman, Cutter,
Danielson, Exum, Fields, Hansen, Jaquez Lewis, Marchman, Moreno,
Priola, Rodriguez;
also REPRESENTATIVE(S) Daugherty and Hartsook, Amabile, Bacon,
Boesenecker, Bradley, Brown, Dickson, English, Froelich, Garcia,
Gonzales-Gutierrez, Hamrick, Herod, Jodeh, Joseph, Kipp, Lieder, Lindsay,
Lindstedt, Lukens, Lynch, Mabrey, Marshall, Martinez, Mauro,
McCormick, McLachlan, Michaelson Jenet, Ortiz, Ricks, Sharbini, Sirota,
Snyder, Soper, Titone, Valdez, Weissman, Woodrow, McCluskie.
C
ONCERNING HOSPITAL MEDICAL PRICE TRANSPARENCY .
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. In Colorado Revised Statutes, 6-1-105, add (1)(bbbb)
as follows:
6-1-105. Unfair or deceptive trade practices. (1) A person
engages in a deceptive trade practice when, in the course of the person's
business, vocation, or occupation, the person:
(bbbb) V
IOLATES SECTION 25.5-1-904.
NOTE: This bill has been prepared for the signatures of the appropriate legislative
officers and the Governor. To determine whether the Governor has signed the bill
or taken other action on it, please consult the legislative status sheet, the legislative
history, or the Session Laws.
________
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from existing law and such material is not part of
the act. SECTION 2. Repeal of provisions being relocated in this act. In
Colorado Revised Statutes, repeal part 8 of article 3 of title 25.
SECTION 3. In Colorado Revised Statutes, add with amended
and relocated provisions part 9 to article 1 of title 25.5 as follows:
PART 9
HOSPITAL PRICE TRANSPARENCY
25.5-1-901. [Formerly 25-3-801] Legislative declaration. (1) The
general assembly finds and declares that:
(a) Section 1001 of the "Patient Protection and Affordable Care
Act", of 2010", Pub.L. 111-148, as amended by section 10101 of the
"Health Care and Education Reconciliation Act of 2010", Pub.L. 111-152,
amended Title XXVII of the "Public Health Service Act", Pub.L. 78-410,
in part, by adding a new section 2718 (e), requiring, in part, that each
hospital operating within the United States establish, update, and make
public a list of the hospital's standard charges for the items and services that
the hospital provides;
(b) Effective January 1, 2021, the federal centers for medicare and
medicaid services published the final rule to implement the law, codified at
45 CFR 180;
(c) In its summary of the final rule, CMS states that information on
hospital standard charges is necessary for the public to "make more
informed decisions about their care" and that the "impact of these final
policies will help to increase market competition, and ultimately drive down
the cost of health care services, making them more affordable for all
patients";
(d) On July 9, 2021, President Biden, building upon efforts of past
presidents, issued the "Executive Order on Promoting Competition in the
American Economy", directing the secretary of the United States
department of health and human services to support new and existing price
transparency initiatives for hospitals;
(e) Health-care price transparency is in the best interest of all
PAGE 2-SENATE BILL 23-252 Coloradans, including:
(I) The state government, which purchases health-care services for
almost a quarter ONE-FOURTH of all Coloradans;
(II) Colorado businesses, which fund employee medical expenses;
and
(III) Colorado residents, who ultimately bear the brunt of high
health-care costs in the form of higher taxes, lower wages, and residents'
own out-of-pocket spending;
(f) Moreover, health-care prices in Colorado are among the highest
in the nation;
(g) However, not all Colorado hospitals are in compliance with all
of the disclosure requirements under federal law and other state laws
governing health-care price transparency; and
(h) This lack of compliance with health-care price transparency laws
by Colorado hospitals decreases the likelihood that Colorado consumers
will be fully aware of affordable health-care options before purchasing
items and services from hospitals, placing health-care consumers at greater
risk of collection actions and other adverse actions relating to unpaid
medical bills.
(2) Therefore, the general assembly finds and declares that it is
imperative to protect Colorado health-care consumers from collection
actions and other adverse actions taken by Colorado hospitals during the
time when the hospital was not in material compliance with hospital price
transparency laws intended to protect health-care consumers.
25.5-1-902. [Formerly 25-3-802] Definitions. As used in this
section
PART 9, unless the context otherwise requires:
(1) "Collection action" means any of the following actions taken
with respect to a debt for items and services that were purchased from or
provided to a patient by a hospital on a date during which the hospital was
not in material compliance with hospital price transparency laws:
PAGE 3-SENATE BILL 23-252 (a) Attempting to collect a debt from a patient or patient guarantor
by referring the debt, directly or indirectly, to a debt collector, a collection
agency, or other third party retained by or on behalf of the hospital;
(b) Suing the patient or patient guarantor or enforcing an arbitration
or mediation clause in any hospital documents, including contracts,
agreements, statements, or bills; or
(c) Directly or indirectly causing a report to be made to a consumer
reporting agency.
(2) (a) "Collection agency" means any:
(I) Person who engages in a business, the principal purpose of which
is the collection of debts; or
(II) Person who:
(A) Regularly collects or attempts to collect, directly or indirectly,
debts owed or due or asserted to be owed or due to another;
(B) Takes assignment of debts for collection purposes;
(C) Directly or indirectly solicits for collection debts owed or due
or asserted to be owed or due to another; or
(D) Collects debt for the department of personnel.
(b) "Collection agency" does not include:
(I) Any officer or employee of a creditor while, in the name of the
creditor, collecting debts for such creditor;
(II) Any person while acting as a collection agency for another
person, both of whom are related by common ownership or affiliated by
corporate control, if the person acting as a collection agency does so only
for creditors to whom it is so related or affiliated and if the principal
business of the person is not the collection of debts;
(III) Any officer or employee of the United States or any state to the
PAGE 4-SENATE BILL 23-252 extent that collecting or attempting to collect any debt is in the performance
of the officer's or employee's official duties;
(IV) Any person while serving or attempting to serve legal process
on any other person in connection with the judicial enforcement of any debt;
(V) Any debt-management services provider operating in
compliance with or exempt from the "Uniform Debt-Management Services
Act", part 2 of article 19 of title 5;
(VI) Any person collecting or attempting to collect any debt owed
or due or asserted to be owed or due another to the extent that:
(A) The activity is incidental to a bona fide fiduciary obligation or
a bona fide escrow arrangement;
(B) The activity concerns a debt that was extended by the person;
(C) The activity concerns a debt that was not in default at the time
it was obtained by the person; or
(D) The activity concerns a debt obtained by the person as a secured
party in a commercial credit transaction involving the creditor;
(VII) Any person whose principal business is the making of loans
or the servicing of debt not in default and who acts as a loan correspondent,
seller and servicer for the owner, or holder of a debt that is secured by a
deed of trust on real property, whether or not the debt is also secured by an
interest in personal property;
(VIII) A limited gaming or racing licensee acting pursuant to article
33 of title 44.
(c) Notwithstanding the provisions of subsection (2)(b) of this
section, "collection agency" includes any person who, in the process of
collecting the person's own debts, uses another name that would indicate
that a third person is collecting or attempting to collect such debts.
(3) (a) "Consumer reporting agency" means any person that, for
monetary fees or dues or on a cooperative nonprofit basis, regularly
PAGE 5-SENATE BILL 23-252 engages, in whole or in part, in the practice of assembling or evaluating
consumer credit information or other information on consumers for the
purpose of furnishing consumer reports to third parties. "Consumer
reporting agency" includes any person defined in 15 U.S.C. sec. 1681a (f)
or section 5-18-103 (4).
(b) "Consumer reporting agency" does not include any business
entity that provides check verification or check guarantee services only.
(4) (a) "Debt" means any obligation or alleged obligation of a
consumer to pay money arising out of a transaction, whether or not the
obligation has been reduced to judgment.
(b) "Debt" does not include a debt for business, investment,
commercial, or agricultural purposes or a debt incurred by a business.
(5) "Debt collector" means any person employed or engaged by a
collection agency to perform the collection of debts owed or due or asserted
to be owed or due to another.
(6) "Federal centers for medicare and medicaid services" or "CMS"
means the centers for medicare and medicaid services in the United States
department of health and human services.
(7) "Hospital" means, consistent with 45 CFR 180.20, a hospital:
(a) Licensed or certified by the department
OF PUBLIC HEALTH AND
ENVIRONMENT
pursuant to section 25-1.5-103 (1)(a); or
(b) Approved by the department
OF PUBLIC HEALTH AND
ENVIRONMENT
as meeting the standards established for licensing a hospital.
(8) "Hospital price transparency laws" means section 2718 (e) of the
"Public Health Service (PHS)
Act", Pub.L. 78-410, as amended, and rules
adopted by the United States department of health and human services
implementing section 2718 (e).
(9) "Items and services" or "items or services" means "items and
services" as defined in 45 CFR 180.20.
PAGE 6-SENATE BILL 23-252 25.5-1-903. [Formerly 25-3-803] Failure to comply with hospital
price transparency laws - prohibiting collection of debt - penalty.
(1) (a) Except as provided in subsection (1)(b) of this section, on and after
August 10, 2022, A hospital that is not in material compliance with hospital
price transparency laws on the date that items or services are purchased
from or provided to a patient by the hospital shall not initiate or pursue a
collection action against the patient or patient guarantor for a debt owed for
the items or services.
(b) This part 8 applies, on and after February 15, 2023, to critical
access hospitals licensed and certified by the department pursuant to 42
CFR 485 subpart F.
(2) If a patient believes that a hospital was not in material
compliance with hospital price transparency laws on a THE date on or after
August 10, 2022, that items or services were purchased by or provided to
the patient, and the hospital takes a collection action against the patient or
patient guarantor, the patient or patient guarantor may file suit to determine
if:
(a) The hospital was materially out of compliance with the
hospital
price transparency laws, and rules, and OR regulations on the date of service
THE ITEMS OR SERVICES WERE PROVIDED ; and if
(b) The noncompliance is related to the items or services. The
hospital shall not take a collection action against the patient or patient
guarantor while the lawsuit is pending.
(3) A hospital that has been found by
IF a judge or jury, considering
compliance standards issued by the federal centers for medicare and
medicaid services,
FINDS A HOSPITAL to be materially out of compliance
with hospital price transparency laws, and rules, and OR regulations, THE
HOSPITAL SHALL
:
(a) Shall
Refund the payer any amount of the debt the payer has paid
and shall pay a penalty to the patient or patient guarantor in an amount
equal to the total amount of the debt;
(b) Shall
Dismiss or cause to be dismissed any court action with
prejudice and pay any attorney fees and costs incurred by the patient or
PAGE 7-SENATE BILL 23-252 patient guarantor relating to the action; and
(c) Remove or cause to be removed from the patient's or patient
guarantor's credit report any report made to a consumer reporting agency
relating to the debt;
AND
(d) NOTIFY THE STATE DEPARTMENT OF THE MATERIAL
NONCOMPLIANCE WITH HOSPITAL PRICE TRANSPARENCY LAWS
, RULES, OR
REGULATIONS
.
(4) Nothing in this part 8
PART 9:
(a) Prohibits a hospital from billing a patient, patient guarantor, or
third-party payer, including a health insurer, for items or services provided
to the patient; or
(b) Requires a hospital to refund any payment made to the hospital
for items or services provided to the patient, so long as no collection action
is taken in violation of this part 8
PART 9.
25.5-1-904. Transparency - hospitals - standard charges -
shoppable services - enforcement. (1) O
N OR BEFORE OCTOBER 1, 2023,
EACH HOSPITAL SHALL MAKE PUBLIC AND POST THE HOSPITAL 'S MEDICARE
REIMBURSEMENT RATES
, IF APPLICABLE.
(2) (a) T
HE STATE DEPARTMENT SHALL CONDUCT PERFORMANCE
ASSESSMENTS FOR ADHERENCE TO FEDERAL TRANSPARENCY RULES BY
:
(I) R
EVIEWING RELEVANT INFORMATION PROVIDED TO THE STATE
DEPARTMENT CONCERNING A HOSPITAL
'S PERFORMANCE ASSESSMENT IN
CONNECTION WITH THIS SECTION
;
(II) A
UDITING HOSPITAL WEBSITES FOR PERFORMANCE RELATIVE TO
FEDERAL PRICE TRANSPARENCY RULES
, AND IN EVALUATING PERFORMANCE ,
THE DEPARTMENT SHALL FOLLOW RULES , STANDARDS, AND GUIDANCE
PUBLISHED BY THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID
; AND
(III) CONFIRMING THAT EACH HOSPITAL SUBMITTED THE LISTS
REQUIRED BY THIS SECTION
.
PAGE 8-SENATE BILL 23-252 (b) IF THE STATE DEPARTMENT DETERMINES THAT A HOSPITAL HAS
PERFORMED POORLY IN ITS PERFORMANCE ASSESSMENT
, THE STATE
DEPARTMENT MAY
:
(I) I
SSUE A WRITTEN NOTICE TO THE HOSPITAL THAT CLEARLY
EXPLAINS THE MANNER IN WHICH THE DEPARTMENT DETERMINED THAT THE
HOSPITAL PERFORMED POORLY ON THE ADHERENCE TO PRICE
TRANSPARENCY
; AND
(II) PROVIDE TECHNICAL ASSISTANCE TO THE HOSPITAL TO IMPROVE
PERFORMANCE
.
(3) O
N OR BEFORE FEBRUARY 1, 2024, THE STATE DEPARTMENT
SHALL CREATE AND MAINTAIN A PUBLICLY AVAILABLE LIST ON ITS WEBSITE
OF HOSPITALS THAT PERFORM POORLY ON THE DEPARTMENT
'S PERFORMANCE
ASSESSMENT
. SUCH NOTICES AND COMMUNICATIONS ARE SUBJECT TO PUBLIC
DISCLOSURE UNDER
5 U.S.C. SEC. 552, AS AMENDED, NOTWITHSTANDING
ANY EXEMPTIONS OR EXCLUSIONS TO THE CONTRARY
, IN FULL WITHOUT
REDACTION
. THE STATE DEPARTMENT SHALL UPDATE THE LIST AT LEAST
ANNUALLY
.
(4) A
PERSON THAT VIOLATES SUBSECTION (1) OF THIS SECTION
COMMITS A DECEPTIVE TRADE PRACTICE UNDER SECTION
6-1-105.
SECTION 4. Act subject to petition - effective date. This act
takes effect at 12:01 a.m. on the day following the expiration of the
ninety-day period after final adjournment of the general assembly; except
that, if a referendum petition is filed pursuant to section 1 (3) of article V
of the state constitution against this act or an item, section, or part of this act
within such period, then the act, item, section, or part will not take effect
unless approved by the people at the general election to be held in
PAGE 9-SENATE BILL 23-252 November 2024 and, in such case, will take effect on the date of the official
declaration of the vote thereon by the governor.
____________________________ ____________________________
Steve Fenberg Julie McCluskie
PRESIDENT OF SPEAKER OF THE HOUSE
THE SENATE OF REPRESENTATIVES
____________________________ ____________________________
Cindi L. Markwell Robin Jones
SECRETARY OF CHIEF CLERK OF THE HOUSE
THE SENATE OF REPRESENTATIVES
APPROVED________________________________________
(Date and Time)
_________________________________________
Jared S. Polis
GOVERNOR OF THE STATE OF COLORADO
PAGE 10-SENATE BILL 23-252