First Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 23-0468.03 Brita Darling x2241
SENATE BILL 23-298
Senate Committees House Committees
Health & Human Services
A BILL FOR AN ACT
C
ONCERNING ALLOWING CERTAIN PUBLIC HOSPITALS TO IMPROVE101
ACCESS TO HEALTH CARE THROUGH COLLABORATION .102
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 permits a hospital that has fewer than 50 beds and is a
county public hospital, a hospital formed by a health service district, or
a hospital affiliated with either such hospital (hospital) to enter into
collaborative agreements to engage in activities that may be characterized
as anticompetitive or result in displacement of competition, such as
agreements to provide ancillary or specialty services, joint purchasing,
SENATE SPONSORSHIP
Gardner and Roberts,
HOUSE SPONSORSHIP
McCormick and Bockenfeld,
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. shared services, consulting, and collaboration efforts with payers.
The bill exempts collaborating hospitals from state antitrust laws
and provides immunity from federal antitrust laws under the state action
doctrine for approved collaborative activity.
Prior to entering into a collaborative agreement, the hospitals must
submit the proposed collaborative agreement (proposal) to the department
of health care policy and financing (department) and to the attorney
general. If the department determines that the collaborative agreement
will result in cost savings or other efficiencies that will improve or
expand the delivery of health-care services in rural and frontier
communities, the department must refer the proposal to the attorney
general.
The attorney general must review each proposal that is referred by
the department and determine, within a specified time, that the benefits
are not outweighed by any anticompetitive harm that may result from the
agreement. The department or the attorney general may request additional
information concerning a proposal within 60 days after its original
submission. If additional information is requested, the department and
attorney general have an additional 45 days to review the proposal.
If the department and the attorney general make a favorable
determination, the proposal is approved and the hospitals may enter into
a collaborative agreement. If neither the department nor the attorney
general respond within the time frames set forth in the bill, the
collaborative proposal is deemed approved.
The department or the attorney general may review a collaborative
agreement annually to ensure the outcomes related to the collaborative
agreement are consistent with statute.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, add 25-3-304.5 as2
follows:3
25-3-304.5. Hospital collaborative agreements - reviews of4
proposed collaborative agreements - immunity - legislative5
declaration - definitions - rules. (1) T
HE GENERAL ASSEMBLY FINDS AND6
DECLARES THAT:7
(a) (I) F
RONTIER AND RURAL HOSPITALS CONTINUE TO STRUGGLE8
TO DELIVER HIGH-QUALITY, ACCESSIBLE, LOW-COST CARE DUE TO THE9
RISING COSTS OF MEDICATIONS , SUPPLIES, MEDICAL EQUIPMENT, AND10
SB23-298-2- CONTRACT LABOR;1
(II) F
RONTIER AND RURAL HOSPITALS ARE LARGELY INDEPENDENT ,2
GOVERNMENTAL FACILITIES THAT ARE GOVERNED BY LOCAL COMMUNITY3
BOARDS;4
(III) F
RONTIER AND RURAL HOSPITALS ARE GENERALLY5
SEPARATED BY LARGE DISTANCES AND ARE CHALLENGED BY THE NEED TO6
PROVIDE ESSENTIAL SERVICES TO LOCAL COMMUNITIES DUE TO THE7
SPARSE POPULATION IN RURAL AREAS ;8
(IV) F
RONTIER AND RURAL HOSPITALS ARE INCREASINGLY9
CHALLENGED BY COMPLEX REQUIREMENTS IMPOSED BY GOVERNMENT AND10
PRIVATE PAYERS THAT DISPROPORTIONATELY NEGATIVELY IMPACT THESE11
PROVIDERS AND UNNECESSARILY DRIVE -UP ADMINISTRATIVE COSTS;12
(V) D
UE TO THE MARKET DYNAMICS OF HEALTH CARE AND THE13
FACT THAT MOST FRONTIER AND RURAL HOSPITALS ARE UNABLE TO14
PROVIDE TERTIARY AND QUATERNARY CARE TO THEIR COMMUNITIES ,15
THERE IS LITTLE OPPORTUNITY FOR A GROUP OF FRONTIER AND RURAL16
HOSPITALS TO ESTABLISH MONOPOLY POWER IN THEIR RESPECTIVE17
MARKETS; AND18
(VI) I
T IS THE GENERAL ASSEMBLY 'S INTENT TO PROVIDE19
PROTECTION TO FRONTIER AND RURAL HOSPITALS FROM UNNECESSARY20
ANTITRUST SCRUTINY THAT IMPEDES FRONTIER AND RURAL HOSPITALS21
FROM WORKING COLLABORATIVELY TO IMPROVE QUALITY , INCREASE22
ACCESS, AND REDUCE COSTS OF CARE TO THE COMMUNITIES THEY SERVE ;23
(b) (I) F
ORTY-SEVEN OF COLORADO'S SIXTY-FOUR COUNTIES24
INCLUDE RURAL AND FRONTIER COMMUNITIES YET CONTAIN ONLY TWELVE25
PERCENT OF COLORADO'S POPULATION;26
(II) T
HIRTY-TWO COUNTIES ARE SERVED BY CRITICAL ACCESS27
HOSPITALS THAT HAVE TWENTY -FIVE OR FEWER BEDS AND ARE28
SB23-298
-3- GENERALLY LOCATED MORE THAN THIRTY -FIVE MILES FROM THE NEXT1
CLOSEST HOSPITAL; ELEVEN COUNTIES LACK ANY HOSPITAL ;2
(III)
THE SCARCITY OF NEARBY HOSPITALS CAUSES MANY3
RESIDENTS TO STRUGGLE TO FIND QUALITY , AFFORDABLE HEALTH CARE4
NEAR THEIR HOMES;5
(IV) F
URTHER, MANY RESIDENTS IN COLORADO'S RURAL AND6
FRONTIER COMMUNITIES FOREGO PREVENTIVE AND BEHAVIORAL HEALTH7
CARE AND LACK COMPREHENSIVE OR SPECIALIZED CARE OR CHOICE IN8
HEALTH-CARE SERVICES, AND TWENTY-FOUR COUNTIES IN COLORADO ARE9
CONSIDERED MATERNAL CARE "DESERTS";10
(V) W
HERE HOSPITALS DO EXIST IN RURAL AND FRONTIER AREAS ,11
THOSE HOSPITALS RECEIVE LOW REIMBURSEMENT RATES DUE TO A12
PREPONDERANCE OF GOVERNMENT PAYERS AND DECLINING LOCAL TAX13
DOLLARS, WHICH RESULTS IN A REDUCED AMOUNT OF MONEY AVAILABLE14
TO INVEST IN EXPANDING OR UPGRADING FACILITIES OR TO PURCHASE15
NECESSARY, NEW, OR INNOVATIVE MEDICAL SUPPLIES , EQUIPMENT, OR16
TECHNOLOGY;17
(VI) A
S A RESULT, MANY HOSPITALS IN RURAL AND FRONTIER18
COMMUNITIES HAVE DIFFICULTY RECRUITING AND RETAINING QUALIFIED19
HEALTH-CARE PROFESSIONALS AND MAKING AVAILABLE NEEDED20
SERVICES; AND21
(VII)
COUNTY PUBLIC HOSPITALS, HEALTH SERVICE DISTRICTS,22
AND HOSPITAL AFFILIATES PERFORM ESSENTIAL PUBLIC FUNCTIONS ON23
BEHALF OF THE STATE;24
(c) A
S PART OF THE GOVERNMENT 'S INTEREST IN PROVIDING25
NEEDED HEALTH-CARE SERVICES IN COLORADO'S RURAL AND FRONTIER26
COMMUNITIES, IT IS IMPORTANT FOR THE GOVERNMENT TO SUPPORT RURAL27
HEALTH-CARE LEADERS' EFFORTS TO FIND COLLABORATIVE, INNOVATIVE28
SB23-298
-4- SOLUTIONS TO THE MANY PROBLEMS THEY CONFRONT , INCLUDING1
COLLABORATIVE OR COORDINATED ACTIVITIES THAT OFFER THE2
OPPORTUNITY TO EXPAND HEALTH -CARE OPTIONS THROUGH JOINT3
PURCHASING AND STAFFING, SHARED SERVICES, AND JOINT ACQUISITION4
OF NEW AND EXPENSIVE DIAGNOSTIC AND TREATMENT SOLUTIONS ;5
(d) I
T IS THE GENERAL ASSEMBLY 'S INTENT TO EXEMPT FROM6
STATE ANTITRUST LAWS, AND TO PROVIDE STATE ACTION IMMUNITY FROM7
FEDERAL ANTITRUST LAWS FOR CERTAIN ACTIVITIES THAT MIGHT BE8
CHARACTERIZED AS ANTICOMPETITIVE OR THAT MIGHT RESULT IN THE9
DISPLACEMENT OF COMPETITION IN THE PROVISION OF HOSPITAL ,10
PHYSICIAN, OR OTHER HEALTH -CARE-RELATED SERVICES OR11
ADMINISTRATIVE OR GENERAL BUSINESS SERVICES ;12
(e) I
N ORDER TO PROMOTE IMPROVED QUALITY OF , INCREASE13
ACCESS TO, AND REDUCE COSTS OF HEALTH-CARE SERVICES IN RURAL AND14
FRONTIER COMMUNITIES THROUGH COLLABORATIVE AGREEMENTS15
AUTHORIZED BY THIS SECTION , THE GENERAL ASSEMBLY FURTHER16
INTENDS TO PROVIDE A SYSTEM OF REVIEW OF RELEVANT COLLABORATIVE17
AGREEMENTS BY THE DEPARTMENT OF HEALTH CARE POLICY AND18
FINANCING AND THE ATTORNEY GENERAL TO ENSURE THAT ANY19
POTENTIAL BENEFITS OF SUCH COLLABORATIVE AGREEMENTS ARE NOT20
OUTWEIGHED BY THE HARM TO COMPETITION IN RURAL AND FRONTIER21
COMMUNITIES; AND22
(f) A
S AN EXPRESSION OF THE PUBLIC POLICY OF THE STATE WITH23
RESPECT TO THE DISPLACEMENT OF COMPETITION IN THE FIELD OF HEALTH24
CARE, EACH HOSPITAL, WHEN EXERCISING ITS POWERS PURSUANT TO THIS25
SECTION, IS ACTING AS A POLITICAL SUBDIVISION OF THE STATE ,26
INCLUDING WHEN PARTICIPATING IN A REVIEW OF A PROPOSED27
COLLABORATIVE AGREEMENT , AND, AS SUCH, IS NOT SUBJECT TO ACTIVE28
SB23-298
-5- SUPERVISION BY THE STATE IN ORDER TO ENJOY IMMUNITY FROM THE1
APPLICATION OF STATE AND FEDERAL ANTITRUST LAWS .2
(2) A
S USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE3
REQUIRES:4
(a) "C
OLLABORATIVE AGREEMENT " MEANS AN AGREEMENT OR5
SIMILAR ARRANGEMENT BETWEEN TWO OR MORE HOSPITALS OR HOSPITAL6
AFFILIATES THAT COMPLIES WITH THE REQUIREMENTS SET FORTH IN THIS7
SECTION.8
(b) "C
OUNTY PUBLIC HOSPITAL" MEANS A PUBLIC HOSPITAL9
ESTABLISHED PURSUANT TO SECTION 25-3-301.10
(c) "H
EALTH SERVICE DISTRICT" HAS THE SAME MEANING AS SET11
FORTH IN SECTION 32-1-103 (9).12
(d) "H
OSPITAL" MEANS A FACILITY WITH FEWER THAN FIFTY BEDS13
THAT IS:14
(I) A
COUNTY PUBLIC HOSPITAL;15
(II) A
HOSPITAL ESTABLISHED, MAINTAINED, OR OPERATED16
DIRECTLY OR INDIRECTLY BY A HEALTH SERVICE DISTRICT ; OR17
(III) A
HOSPITAL AFFILIATE.18
(e) "H
OSPITAL AFFILIATE" MEANS AN AFFILIATE OF A COUNTY19
PUBLIC HOSPITAL OR HEALTH SERVICE DISTRICT THAT IS UNDER THE SOLE20
CONTROL OF THE COUNTY PUBLIC HOSPITAL OR HEALTH SERVICE DISTRICT .21
(3) E
XCEPT AS PROVIDED IN SUBSECTION (4) OF THIS SECTION, AND22
SUBJECT TO THE REQUIREMENTS IN SUBSECTIONS (5) AND (6) OF THIS23
SECTION, A HOSPITAL IS AUTHORIZED TO ENTER INTO COLLABORATIVE24
AGREEMENTS WITH ONE OR MORE HOSPITALS OR HOSPITAL AFFILIATES TO25
ENGAGE IN THE FOLLOWING ACTIVITIES:26
(a) A
NCILLARY CLINICAL SERVICES, ACQUISITION OF EQUIPMENT,27
CLINIC MANAGEMENT, OR HEALTH-CARE PROVIDER RECRUITMENT ;28
SB23-298
-6- (b) JOINT PURCHASING OR LEASING ARRANGEMENTS , INCLUDING1
THE JOINT PURCHASING OR LEASING OF:2
(I) M
EDICAL AND GENERAL SUPPLIES;3
(II) M
EDICAL AND GENERAL EQUIPMENT ;4
(III) P
HARMACEUTICALS; OR5
(IV) T
EMPORARY STAFFING THROUGH A STAFFING AGENCY ;6
(c) C
ONSULTING SERVICES WITH A FOCUS ON PUBLIC HEALTH IN7
RURAL OR FRONTIER COMMUNITIES AND NON -HOSPITAL-SPECIFIC8
INNOVATIONS IN HEALTH-CARE DELIVERY IN THOSE COMMUNITIES ;9
(d) P
URCHASING JOINT PROFESSIONAL , GENERAL LIABILITY, OR10
PROPERTY INSURANCE;11
(e) S
HARING BACK-OFFICE SERVICES, SUCH AS SHARING A BUSINESS12
OFFICE, ACCOUNTING AND FINANCE SERVICES , HUMAN RESOURCES, AND13
RISK MANAGEMENT AND COMPLIANCE SERVICES , BUT NOT INCLUDING14
SHARING SERVICE CHARGING EXPENSES OR RATES AMONG HOSPITALS ;15
(f) S
HARING DATA SERVICES, INCLUDING SHARED SERVICES FOR16
ELECTRONIC HEALTH RECORDS AND DATA EXTRACTION AND ANALYSIS17
SERVICES, CHARGE MANAGEMENT , AND POPULATION HEALTH ANALYSIS ;18
AND19
(g) N
EGOTIATING WITH HEALTH INSURANCE OR GOVERNMENT20
PAYERS, WHICH NEGOTIATIONS ARE LIMITED TO:21
(I) S
HARED CARE PROTOCOLS INTENDED TO IMPROVE PATIENT22
MANAGEMENT AND OUTCOMES , INCLUDING IMPLEMENTATION OF23
EVIDENCE-BASED PROTOCOLS, CLINICAL PATHWAYS, AND RECOGNIZED24
BEST PRACTICES IN THE CARE AND TREATMENT OF PATIENTS , INCLUDING25
CLINICAL THERAPIES, NUTRITION, EXERCISE, DIAGNOSTIC TESTING, AND26
MEDICATION MANAGEMENT ;27
(II)
COLLABORATIVE EFFORTS WITH PAYERS TO PROMOTE28
SB23-298
-7- APPROPRIATE AND ESSENTIAL SERVICES TO BE PROVIDED IN THE LOCAL1
COMMUNITY;2
(III)
MANAGEMENT OF PRIOR AUTHORIZATION REQUESTS ; AND3
(IV)
ANALYSIS OF AGGREGATE DATA TO COMPARE COSTS OF4
PROCEDURES AND TO ANALYZE PATIENT OUTCOMES .5
(4) N
OTWITHSTANDING ANY COLLABORATIVE AGREEMENTS6
AUTHORIZED UNDER SUBSECTION (3) OF THIS SECTION, THE IMMUNITY AND7
PROTECTIONS GRANTED TO HOSPITALS AND HOSPITAL AFFILIATES8
ENTERING INTO SUCH COLLABORATIVE AGREEMENTS PURSUANT TO THIS9
SECTION DOES NOT EXTEND TO COLLABORATIVE AGREEMENTS WITH10
ANOTHER HOSPITAL OR HOSPITAL AFFILIATE THAT HAVE THE EFFECT OF :11
(a) S
ETTING REIMBURSEMENT RATES OR OTHER COMPENSATION12
FROM ANY COMMERCIAL SELF -INSURED OR COMMERCIAL HEALTH13
INSURANCE OR GOVERNMENT PAYER ;14
(b) D
IVIDING OR ALLOCATING AMONG HOSPITALS OR HOSPITAL15
AFFILIATES SPECIFIC MARKETS FOR THE DELIVERY OF ANY GENERAL ACUTE16
CARE OR SPECIALTY LINES OF HEALTH-CARE SERVICES; OR17
(c) N
EGOTIATING OR AGREEING TO COMPENSATION UNDER18
HEALTH-CARE STAFFING ARRANGEMENTS FOR HOSPITAL EMPLOYEES THAT19
RESULTS IN A REDUCTION OF WAGES OF HOSPITAL -EMPLOYED STAFF.20
(5) P
RIOR TO ENGAGING IN ANY JOINT ACTIVITY DESCRIBED BY A21
PROPOSED COLLABORATIVE AGREEMENT EXECUTED PURSUANT TO22
SUBSECTION (3) OF THIS SECTION, THE HOSPITALS OR HOSPITAL AFFILIATES23
SHALL JOINTLY SUBMIT THE PROPOSED COLLABORATIVE AGREEMENT TO24
THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING , PURSUANT TO25
RULES WHICH MAY BE PROMULGATED FOR THE SUBMISSION OF PROPOSALS .26
T
HE DEPARTMENT OF HEALTH CARE POLICY AND FI NANCING MAY REQUEST27
ADDITIONAL INFORMATION NECESSARY FOR THE DEPARTMENT OF HEALTH28
SB23-298
-8- CARE POLICY AND FINANCING TO REVIEW THE PROPOSAL .1
(6) I
F THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING2
CONCLUDES THAT A PROPOSED COLLABORATIVE ACTIVITY MAY RESULT IN3
COST SAVINGS OR OTHER EFFICIENCIES THAT MAY IMPROVE OR EXPAND4
THE DELIVERY OF HEALTH -CARE SERVICES IN RURAL AND FRONTIER5
COMMUNITIES IN COLORADO, THE DEPARTMENT OF HEALTH CARE POLICY6
AND FINANCING SHALL REFER THE PROPOSAL TO THE ATTORNEY GENERAL7
TO DETERMINE, PURSUANT TO RULES WHICH MAY BE PROMULGATED FOR8
SUCH PURPOSE, THAT THE BENEFITS OF THE COLLABORATIVE ACTIVITY ARE9
NOT OUTWEIGHED BY ANY ANTICOMPETITIVE HARM THAT MAY ARISE10
FROM THE COLLABORATIVE ACTIVITY .11
(7) W
ITHIN SIXTY DAYS AFTER RECEIVING A PROPOSED12
COLLABORATIVE AGREEMENT , THE DEPARTMENT OF HEALTH CARE POLICY13
AND FINANCING AND THE ATTORNEY GENERAL SHALL REVIEW THE14
PROPOSED COLLABORATIVE AGREEMENT AND EITHER APPROVE OR DENY15
THE PROPOSED COLLABORATIVE AGREEMENT OR REQUEST ADDITIONAL16
INFORMATION RELATED TO THE PROPOSAL . IF A REQUEST FOR ADDITIONAL17
INFORMATION IS MADE, THE ATTORNEY GENERAL HAS AN ADDITIONAL18
FORTY-FIVE DAYS TO COMPLETE THE REVIEW .19
(8) (a) I
F THE DEPARTMENT OF HEALTH CARE POLICY AND20
FINANCING AND THE ATTORNEY GENERAL CONCLUDE THAT A PROPOSED21
COLLABORATIVE AGREEMENT MAY RESULT IN IMPROVED QUALITY ,22
INCREASED ACCESS OR COST SAVINGS, OR OTHER EFFICIENCIES THAT MAY23
IMPROVE OR EXPAND THE DELIVERY OF HEALTH -CARE SERVICES IN RURAL24
AND FRONTIER COMMUNITIES IN COLORADO, THE PROPOSAL IS APPROVED.25
I
F THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING OR THE26
ATTORNEY GENERAL DOES NOT RESPOND WITHIN THE TIME FRAMES27
SPECIFIED IN THIS SECTION, THE COLLABORATIVE ACTIVITY IS DEEMED28
SB23-298
-9- APPROVED.1
(b) T
HE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING OR2
THE ATTORNEY GENERAL MAY REVIEW A COLLABORATIVE AGREEMENT3
ANNUALLY TO ENSURE THE OUTCOMES RELATED TO THE COLLABORATIVE4
AGREEMENT ARE CONSISTENT WITH THIS SECTION . THE SCOPE OF THE5
REVIEW SHALL BE DETERMINED BY RULES PROMULGATED BY THE6
DEPARTMENT OF HEALTH CARE POLICY AND FINANCING AND THE7
ATTORNEY GENERAL.8
SECTION 2. In Colorado Revised Statutes, 32-1-1003, add9
(1)(c.5) as follows:10
32-1-1003. Health service districts - additional powers. (1) In11
addition to the powers specified in section 32-1-1001, the board of any12
health service district has any or all of the following powers for and on13
behalf of such district:14
(c.5) T
O ENTER INTO A COLLABORATIVE AGREEMENT WITH15
ANOTHER HEALTH SERVICE DISTRICT , COUNTY PUBLIC HOSPITAL , OR16
HOSPITAL AFFILIATE IN ACCORDANCE WITH SECTION 25-3-304.5.17
SECTION 3. Act subject to petition - effective date. This act18
takes effect at 12:01 a.m. on the day following the expiration of the19
ninety-day period after final adjournment of the general assembly; except20
that, if a referendum petition is filed pursuant to section 1 (3) of article V21
of the state constitution against this act or an item, section, or part of this22
act within such period, then the act, item, section, or part will not take23
effect unless approved by the people at the general election to be held in24
November 2024 and, in such case, will take effect on the date of the25
official declaration of the vote thereon by the governor.26
SB23-298
-10-