Colorado 2023 Regular Session

Colorado Senate Bill SB298 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
	1	+	First Regular Session
	2	+	Seventy-fourth General Assembly
	3	+	STATE OF COLORADO
	4	+	REREVISED
	5	+	This Version Includes All Amendments
	6	+	Adopted in the Second House
	7	+	LLS NO. 23-0468.03 Brita Darling x2241
1	8		SENATE BILL 23-298
2		-	BY SENATOR(S) Gardner and Roberts, Exum, Ginal, Kirkmeyer,
3		-	Lundeen, Mullica, Pelton R., Priola, Will;
4		-	also REPRESENTATIVE(S) McCormick and Bockenfeld, Bird,
5		-	Boesenecker, Bradley, Catlin, English, Epps, Hamrick, Jodeh, Joseph,
6		-	Lindsay, Lukens, Michaelson Jenet, Ricks, Soper, Taggart, McCluskie.
	9	+	Senate Committees House Committees
	10	+	Health & Human Services Public & Behavioral Health & Human Services
	11	+	Appropriations Appropriations
	12	+	A BILL FOR AN ACT
7	13		C
8		-	ONCERNING ALLOWING CERTAIN PUBLIC HOSPITALS TO IMPROVE ACCESS TO
9		-	HEALTH CARE THROUGH COLLABORATION
10		-	, AND, IN CONNECTION
11		-	THEREWITH
12		-	, MAKING AN APPROPRIATION.
13		-
14		-	Be it enacted by the General Assembly of the State of Colorado:
15		-	SECTION 1. In Colorado Revised Statutes, add part 10 to article
16		-	1 of title 25.5 as follows:
17		-	PART 10
18		-	HOSPITAL COLLABORATION AGREEMENTS
19		-	25.5-1-1001. Hospital collaborative agreements - review of
20		-	proposed collaborative agreements - immunity - legislative declaration
21		-	- definitions - rules. (1) T
22		-	HE GENERAL ASSEMBLY FINDS AND DECLARES
23		-	THAT
24		-	:
25		-	NOTE: This bill has been prepared for the signatures of the appropriate legislative
26		-	officers and the Governor. To determine whether the Governor has signed the bill
27		-	or taken other action on it, please consult the legislative status sheet, the legislative
28		-	history, or the Session Laws.
29		-	________
30		-	Capital letters or bold & italic numbers indicate new material added to existing law; dashes
31		-	through words or numbers indicate deletions from existing law and such material is not part of
32		-	the act. (a) (I) FRONTIER AND RURAL HOSPITALS CONTINUE TO STRUGGLE TO
33		-	DELIVER HIGH
34		-	-QUALITY, ACCESSIBLE, LOW-COST CARE DUE TO THE RISING
35		-	COSTS OF MEDICATIONS
36		-	, SUPPLIES, MEDICAL EQUIPMENT, AND CONTRACT
37		-	LABOR
38		-	;
	14	+	ONCERNING ALLOWING CERTAIN PUBLIC HOSPITALS TO IMPROVE101
	15	+	ACCESS TO HEALTH CARE THROUGH COLLABORATION , AND, IN
	16	+	102
	17	+	CONNECTION THEREWITH , MAKING AN APPROPRIATION .103
	18	+	Bill Summary
	19	+	(Note: This summary applies to this bill as introduced and does
	20	+	not reflect any amendments that may be subsequently adopted. If this bill
	21	+	passes third reading in the house of introduction, a bill summary that
	22	+	applies to the reengrossed version of this bill will be available at
	23	+	http://leg.colorado.gov
	24	+	.)
	25	+	The bill permits a hospital that has fewer than 50 beds and is a
	26	+	county public hospital, a hospital formed by a health service district, or
	27	+	a hospital affiliated with either such hospital (hospital) to enter into
	28	+	collaborative agreements to engage in activities that may be characterized
	29	+	as anticompetitive or result in displacement of competition, such as
	30	+	HOUSE
	31	+	3rd Reading Unamended
	32	+	May 7, 2023
	33	+	HOUSE
	34	+	2nd Reading Unamended
	35	+	May 6, 2023
	36	+	SENATE
	37	+	Amended 3rd Reading
	38	+	May 2, 2023
	39	+	SENATE
	40	+	Amended 2nd Reading
	41	+	May 1, 2023
	42	+	SENATE SPONSORSHIP
	43	+	Gardner and Roberts, Exum, Ginal, Kirkmeyer, Lundeen, Mullica, Pelton R., Priola, Will
	44	+	HOUSE SPONSORSHIP
	45	+	McCormick and Bockenfeld, Bird, Boesenecker, Bradley, Catlin, English, Epps,
	46	+	Hamrick, Jodeh, Joseph, Lindsay, Lukens, McCluskie, Michaelson Jenet, Ricks, Soper,
	47	+	Taggart
	48	+	Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
	49	+	Capital letters or bold & italic numbers indicate new material to be added to existing law.
	50	+	Dashes through the words or numbers indicate deletions from existing law. agreements to provide ancillary or specialty services, joint purchasing,
	51	+	shared services, consulting, and collaboration efforts with payers.
	52	+	The bill exempts collaborating hospitals from state antitrust laws
	53	+	and provides immunity from federal antitrust laws under the state action
	54	+	doctrine for approved collaborative activity.
	55	+	Prior to entering into a collaborative agreement, the hospitals must
	56	+	submit the proposed collaborative agreement (proposal) to the department
	57	+	of health care policy and financing (department) and to the attorney
	58	+	general. If the department determines that the collaborative agreement
	59	+	will result in cost savings or other efficiencies that will improve or
	60	+	expand the delivery of health-care services in rural and frontier
	61	+	communities, the department must refer the proposal to the attorney
	62	+	general.
	63	+	The attorney general must review each proposal that is referred by
	64	+	the department and determine, within a specified time, that the benefits
	65	+	are not outweighed by any anticompetitive harm that may result from the
	66	+	agreement. The department or the attorney general may request additional
	67	+	information concerning a proposal within 60 days after its original
	68	+	submission. If additional information is requested, the department and
	69	+	attorney general have an additional 45 days to review the proposal.
	70	+	If the department and the attorney general make a favorable
	71	+	determination, the proposal is approved and the hospitals may enter into
	72	+	a collaborative agreement. If neither the department nor the attorney
	73	+	general respond within the time frames set forth in the bill, the
	74	+	collaborative proposal is deemed approved.
	75	+	The department or the attorney general may review a collaborative
	76	+	agreement annually to ensure the outcomes related to the collaborative
	77	+	agreement are consistent with statute.
	78	+	Be it enacted by the General Assembly of the State of Colorado:1
	79	+	SECTION 1. In Colorado Revised Statutes, add part 9 to article
	80	+	2
	81	+	1 of title 25.5 as follows:3
	82	+	PART 94
	83	+	HOSPITAL COLLABORATION AGREEMENTS5
	84	+	25.5-1-901. Hospital collaborative agreements - review of6
	85	+	proposed collaborative agreements - immunity - legislative7
	86	+	declaration - definitions - rules. (1) T
	87	+	HE GENERAL ASSEMBLY FINDS AND8
	88	+	DECLARES THAT:9
	89	+	298-2- (a) (I) FRONTIER AND RURAL HOSPITALS CONTINUE TO STRUGGLE1
	90	+	TO DELIVER HIGH-QUALITY, ACCESSIBLE, LOW-COST CARE DUE TO THE2
	91	+	RISING COSTS OF MEDICATIONS , SUPPLIES, MEDICAL EQUIPMENT, AND3
	92	+	CONTRACT LABOR;4
39	93		(II) F
40		-	RONTIER AND RURAL HOSPITALS ARE LARGELY INDEPENDENT ,
41		-	GOVERNMENTAL FACILITIES THAT ARE GOVERNED BY LOCAL COMMUNITY
42		-	BOARDS
43		-	;
	94	+	RONTIER AND RURAL HOSPITALS ARE LARGELY INDEPENDENT ,5
	95	+	GOVERNMENTAL FACILITIES THAT ARE GOVERNED BY LOCAL COMMUNITY6
	96	+	BOARDS;7
44	97		(III) F
45		-	RONTIER AND RURAL HOSPITALS ARE GENERALLY SEPARATED
46		-	BY LARGE DISTANCES AND ARE CHALLENGED BY THE NEED TO PROVIDE
47		-	ESSENTIAL SERVICES TO LOCAL COMMUNITIES DUE TO THE SPARSE
48		-	POPULATION IN RURAL AREAS
49		-	;
	98	+	RONTIER AND RURAL HOSPITALS ARE GENERALLY8
	99	+	SEPARATED BY LARGE DISTANCES AND ARE CHALLENGED BY THE NEED TO9
	100	+	PROVIDE ESSENTIAL SERVICES TO LOCAL COMMUNITIES DUE TO THE10
	101	+	SPARSE POPULATION IN RURAL AREAS ;11
50	102		(IV) F
51		-	RONTIER AND RURAL HOSPITALS ARE INCREASINGLY
52		-	CHALLENGED BY COMPLEX REQUIREMENTS IMPOSED BY GOVERNMENT AND
53		-	PRIVATE PAYERS THAT DISPROPORTIONATELY NEGATIVELY IMPACT THESE
54		-	PROVIDERS AND UNNECESSARILY DRIVE
55		-	-UP ADMINISTRATIVE COSTS; AND
56		-	(V) IN CASES WHERE THE STATE DEPARTMENT , THE DIVISION OF
57		-	INSURANCE
58		-	, IF APPLICABLE, AND THE ATTORNEY GENERAL APPROVE
59		-	COLLABORATIVE ARRANGEMENTS
60		-	, IT IS THE GENERAL ASSEMBLY'S INTENT
61		-	TO PROVIDE PROTECTION TO FRONTIER AND RURAL HOSPITALS FROM
62		-	CERTAIN ANTITRUST SCRUTINY THAT IMPEDES FRONTIER AND RURAL
63		-	HOSPITALS FROM WORKING COLLABORATIVELY TO IMPROVE QUALITY
64		-	,
65		-	INCREASE ACCESS, AND REDUCE COSTS OF CARE TO THE COMMUNITIES THEY
66		-	SERVE
67		-	;
	103	+	RONTIER AND RURAL HOSPITALS ARE INCREASINGLY12
	104	+	CHALLENGED BY COMPLEX REQUIREMENTS IMPOSED BY GOVERNMENT AND13
	105	+	PRIVATE PAYERS THAT DISPROPORTIONATELY NEGATIVELY IMPACT THESE14
	106	+	PROVIDERS AND UNNECESSARILY DRIVE -UP ADMINISTRATIVE COSTS; AND
	107	+	15
	108	+	16
	109	+	(V) I
	110	+	N CASES WHERE THE STATE DEPARTMENT , THE DIVISION OF
	111	+	17
	112	+	INSURANCE, IF APPLICABLE, AND THE ATTORNEY GENERAL APPROVE18
	113	+	COLLABORATIVE ARRANGEMENTS , IT IS THE GENERAL ASSEMBLY'S INTENT19
	114	+	TO PROVIDE PROTECTION TO FRONTIER AND RURAL HOSPITALS FROM20
	115	+	CERTAIN ANTITRUST SCRUTINY THAT IMPEDES FRONTIER AND RURAL21
	116	+	HOSPITALS FROM WORKING COLLABORATIVELY TO IMPROVE QUALITY ,22
	117	+	INCREASE ACCESS, AND REDUCE COSTS OF CARE TO THE COMMUNITIES23
	118	+	THEY SERVE;24
68	119		(b) (I) F
69		-	ORTY-SEVEN OF COLORADO'S SIXTY-FOUR COUNTIES
70		-	INCLUDE RURAL AND FRONTIER COMMUNITIES YET CONTAIN ONLY TWELVE
71		-	PERCENT OF
72		-	COLORADO'S POPULATION;
73		-	(II) T
74		-	HIRTY-TWO COUNTIES ARE SERVED BY CRITICAL ACCESS
75		-	HOSPITALS THAT HAVE TWENTY
76		-	-FIVE OR FEWER BEDS AND ARE GENERALLY
77		-	LOCATED MORE THAN THIRTY
78		-	-FIVE MILES FROM THE NEXT CLOSEST
79		-	HOSPITAL
80		-	; ELEVEN COUNTIES LACK ANY HOSPITAL ;
81		-	(III) T
82		-	HE SCARCITY OF NEARBY HOSPITALS CAUSES MANY RESIDENTS
83		-	TO STRUGGLE TO FIND QUALITY
84		-	, AFFORDABLE HEALTH CARE NEAR THEIR
85		-	PAGE 2-SENATE BILL 23-298 HOMES;
	120	+	ORTY-SEVEN OF COLORADO'S SIXTY-FOUR COUNTIES25
	121	+	INCLUDE RURAL AND FRONTIER COMMUNITIES YET CONTAIN ONLY TWELVE26
	122	+	PERCENT OF COLORADO'S POPULATION;27
	123	+	298
	124	+	-3- (II) THIRTY-TWO COUNTIES ARE SERVED BY CRITICAL ACCESS1
	125	+	HOSPITALS THAT HAVE TWENTY -FIVE OR FEWER BEDS AND ARE2
	126	+	GENERALLY LOCATED MORE THAN THIRTY -FIVE MILES FROM THE NEXT3
	127	+	CLOSEST HOSPITAL; ELEVEN COUNTIES LACK ANY HOSPITAL ;4
	128	+	(III)
	129	+	THE SCARCITY OF NEARBY HOSPITALS CAUSES MANY5
	130	+	RESIDENTS TO STRUGGLE TO FIND QUALITY , AFFORDABLE HEALTH CARE6
	131	+	NEAR THEIR HOMES;7
86	132		(IV) F
87		-	URTHER, MANY RESIDENTS IN COLORADO'S RURAL AND
88		-	FRONTIER COMMUNITIES FOREGO PREVENTIVE AND BEHAVIORAL HEALTH
89		-	CARE AND LACK COMPREHENSIVE OR SPECIALIZED CARE OR CHOICE IN
90		-	HEALTH
91		-	-CARE SERVICES, AND TWENTY-FOUR COUNTIES IN COLORADO ARE
92		-	CONSIDERED MATERNAL CARE
93		-	"DESERTS";
	133	+	URTHER, MANY RESIDENTS IN COLORADO'S RURAL AND8
	134	+	FRONTIER COMMUNITIES FOREGO PREVENTIVE AND BEHAVIORAL HEALTH9
	135	+	CARE AND LACK COMPREHENSIVE OR SPECIALIZED CARE OR CHOICE IN10
	136	+	HEALTH-CARE SERVICES, AND TWENTY-FOUR COUNTIES IN COLORADO ARE11
	137	+	CONSIDERED MATERNAL CARE "DESERTS";12
94	138		(V) W
95		-	HERE HOSPITALS DO EXIST IN RURAL AND FRONTIER AREAS ,
96		-	THOSE HOSPITALS RECEIVE LOW REIMBURSEMENT RATES DUE TO A
97		-	PREPONDERANCE OF GOVERNMENT PAYERS AND DECLINING LOCAL TAX
98		-	DOLLARS
99		-	, WHICH RESULTS IN A REDUCED AMOUNT OF MONEY AVAILABLE TO
100		-	INVEST IN EXPANDING OR UPGRADING FACILITIES OR TO PURCHASE
101		-	NECESSARY
102		-	, NEW, OR INNOVATIVE MEDICAL SUPPLIES , EQUIPMENT, OR
103		-	TECHNOLOGY
104		-	;
	139	+	HERE HOSPITALS DO EXIST IN RURAL AND FRONTIER AREAS ,13
	140	+	THOSE HOSPITALS RECEIVE LOW REIMBURSEMENT RATES DUE TO A14
	141	+	PREPONDERANCE OF GOVERNMENT PAYERS AND DECLINING LOCAL TAX15
	142	+	DOLLARS, WHICH RESULTS IN A REDUCED AMOUNT OF MONEY AVAILABLE16
	143	+	TO INVEST IN EXPANDING OR UPGRADING FACILITIES OR TO PURCHASE17
	144	+	NECESSARY, NEW, OR INNOVATIVE MEDICAL SUPPLIES , EQUIPMENT, OR18
	145	+	TECHNOLOGY;19
105	146		(VI) M
106		-	ANY HOSPITALS IN RURAL AND FRONTIER COMMUNITIES HAVE
107		-	DIFFICULTY RECRUITING AND RETAINING QUALIFIED HEALTH
108		-	-CARE
109		-	PROFESSIONALS AND MAKING AVAILABLE NEEDED SERVICES
110		-	; AND
111		-	(VII) COUNTY PUBLIC HOSPITALS, HEALTH SERVICE DISTRICTS, AND
112		-	HOSPITAL AFFILIATES PERFORM ESSENTIAL PUBLIC FUNCTIONS ON BEHALF OF
113		-	THE STATE
114		-	;
	147	+	ANY
	148	+	HOSPITALS IN RURAL AND FRONTIER COMMUNITIES20
	149	+	HAVE DIFFICULTY RECRUITING AND RETAINING QUALIFIED HEALTH -CARE21
	150	+	PROFESSIONALS AND MAKING AVAILABLE NEEDED SERVICES ; AND22
	151	+	(VII)
	152	+	COUNTY PUBLIC HOSPITALS, HEALTH SERVICE DISTRICTS,23
	153	+	AND HOSPITAL AFFILIATES PERFORM ESSENTIAL PUBLIC FUNCTIONS ON24
	154	+	BEHALF OF THE STATE;25
115	155		(c) A
116		-	S PART OF THE GOVERNMENT'S INTEREST IN PROVIDING NEEDED
117		-	HEALTH
118		-	-CARE SERVICES IN COLORADO'S RURAL AND FRONTIER
119		-	COMMUNITIES
120		-	, IT IS IMPORTANT FOR THE GOVERNMENT TO SUPPORT EFFORTS
121		-	TO FIND COLLABORATIVE
122		-	, INNOVATIVE SOLUTIONS TO THE MANY PROBLEMS
123		-	CONFRONTING RURAL HEALTH CARE
124		-	, INCLUDING COLLABORATIVE OR
125		-	COORDINATED ACTIVITIES THAT OFFER THE OPPORTUNITY TO EXPAND
126		-	HEALTH
127		-	-CARE OPTIONS THROUGH JOINT PURCHASING AND STAFFING , SHARED
128		-	SERVICES
129		-	, AND JOINT ACQUISITION OF NEW AND EXPENSIVE DIAGNOSTIC AND
130		-	TREATMENT SOLUTIONS
131		-	;
	156	+	S PART OF THE GOVERNMENT 'S INTEREST IN PROVIDING26
	157	+	NEEDED HEALTH-CARE SERVICES IN COLORADO'S RURAL AND FRONTIER27
	158	+	298
	159	+	-4- COMMUNITIES, IT IS IMPORTANT FOR THE GOVERNMENT TO SUPPORT 1
	160	+	EFFORTS TO FIND COLLABORATIVE, INNOVATIVE SOLUTIONS TO THE MANY2
	161	+	PROBLEMS CONFRONTING RURAL HEALTH CARE , INCLUDING3
	162	+	COLLABORATIVE OR COORDINATED ACTIVITIES THAT OFFER THE4
	163	+	OPPORTUNITY TO EXPAND HEALTH -CARE OPTIONS THROUGH JOINT5
	164	+	PURCHASING AND STAFFING, SHARED SERVICES, AND JOINT ACQUISITION6
	165	+	OF NEW AND EXPENSIVE DIAGNOSTIC AND TREATMENT SOLUTIONS ;7
132	166		(d) I
133		-	T IS THE GENERAL ASSEMBLY'S INTENT TO EXEMPT FROM STATE
134		-	ANTITRUST LAWS
135		-	, AND TO PROVIDE STATE ACTION IMMUNITY FROM FEDERAL
136		-	ANTITRUST LAWS FOR CERTAIN ACTIVITIES THAT MIGHT BE CHARACTERIZED
137		-	AS ANTICOMPETITIVE OR THAT MIGHT RESULT IN THE DISPLACEMENT OF
138		-	COMPETITION IN THE PROVISION OF HOSPITAL
139		-	, PHYSICIAN, OR OTHER
140		-	HEALTH
141		-	-CARE-RELATED SERVICES OR ADMINISTRATIVE OR GENERAL
142		-	PAGE 3-SENATE BILL 23-298 BUSINESS SERVICES; AND
143		-	(e) IN ORDER TO PROMOTE IMPROVED QUALITY OF , INCREASE ACCESS
144		-	TO
145		-	, AND REDUCE COSTS OF HEALTH-CARE SERVICES IN RURAL AND FRONTIER
146		-	COMMUNITIES THROUGH COLLABORATIVE AGREEMENTS AUTHORIZED BY
147		-	THIS SECTION
148		-	, THE GENERAL ASSEMBLY FURTHER INTENDS TO PROVIDE A
149		-	SYSTEM OF REVIEW OF RELEVANT COLLABORATIVE AGREEMENTS BY THE
150		-	STATE DEPARTMENT
151		-	, THE DIVISION OF INSURANCE, IF APPLICABLE, AND THE
152		-	ATTORNEY GENERAL TO ENSURE THAT ANY POTENTIAL BENEFITS OF SUCH
153		-	COLLABORATIVE AGREEMENTS ARE NOT OUTWEIGHED BY THE HARM TO
154		-	COMPETITION IN RURAL AND FRONTIER COMMUNITIES
155		-	.
	167	+	T IS THE GENERAL ASSEMBLY 'S INTENT TO EXEMPT FROM8
	168	+	STATE ANTITRUST LAWS, AND TO PROVIDE STATE ACTION IMMUNITY FROM9
	169	+	FEDERAL ANTITRUST LAWS FOR CERTAIN ACTIVITIES THAT MIGHT BE10
	170	+	CHARACTERIZED AS ANTICOMPETITIVE OR THAT MIGHT RESULT IN THE11
	171	+	DISPLACEMENT OF COMPETITION IN THE PROVISION OF HOSPITAL ,12
	172	+	PHYSICIAN, OR OTHER HEALTH -CARE-RELATED SERVICES OR13
	173	+	ADMINISTRATIVE OR GENERAL BUSINESS SERVICES ; AND
	174	+	14
	175	+	(e) I
	176	+	N ORDER TO PROMOTE IMPROVED QUALITY OF , INCREASE15
	177	+	ACCESS TO, AND REDUCE COSTS OF HEALTH-CARE SERVICES IN RURAL AND16
	178	+	FRONTIER COMMUNITIES THROUGH COLLABORATIVE AGREEMENTS17
	179	+	AUTHORIZED BY THIS SECTION , THE GENERAL ASSEMBLY FURTHER18
	180	+	INTENDS TO PROVIDE A SYSTEM OF REVIEW OF RELEVANT COLLABORATIVE19
	181	+	AGREEMENTS BY THE STATE DEPARTMENT , THE DIVISION OF INSURANCE,
	182	+	20
	183	+	IF APPLICABLE, AND THE ATTORNEY GENERAL TO ENSURE THAT ANY21
	184	+	POTENTIAL BENEFITS OF SUCH COLLABORATIVE AGREEMENTS ARE NOT22
	185	+	OUTWEIGHED BY THE HARM TO COMPETITION IN RURAL AND FRONTIER23
	186	+	COMMUNITIES. 24
156	187		(2) A
157		-	S USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE
158		-	REQUIRES
159		-	:
	188	+	S USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE25
	189	+	REQUIRES:26
160	190		(a) "C
161		-	OLLABORATIVE AGREEMENT " MEANS AN AGREEMENT OR
162		-	~~SIMILAR ARRANGEMENT BETWEEN TWO OR MORE HOSPITALS OR HOSPITAL~~
163		-	~~AFFILIATES THAT COMPLIES WITH THE REQUIREMENTS SET FORTH IN THIS~~
164		-	~~SECTION~~
165		-	.
	191	+	OLLABORATIVE AGREEMENT " MEANS AN AGREEMENT OR27
	192	+	298
	193	+	-5- SIMILAR ARRANGEMENT BETWEEN TWO OR MORE HOSPITALS OR HOSPITAL1
	194	+	AFFILIATES THAT COMPLIES WITH THE REQUIREMENTS SET FORTH IN THIS2
	195	+	SECTION.3
166	196		(b) "C
167		-	OUNTY PUBLIC HOSPITAL " MEANS A PUBLIC HOSPITAL
168		-	ESTABLISHED PURSUANT TO SECTION
169		-	25-3-301.
	197	+	OUNTY PUBLIC HOSPITAL" MEANS A PUBLIC HOSPITAL4
	198	+	ESTABLISHED PURSUANT TO SECTION 25-3-301.5
170	199		(c) "D
171	200		IVISION OF INSURANCE" MEANS THE DIVISION OF INSURANCE
172		-	IN THE DEPARTMENT OF REGULATORY AGENCIES
173		-	.
174		-	(d) "H
175		-	EALTH SERVICE DISTRICT" HAS THE SAME MEANING AS SET
176		-	FORTH IN SECTION
177		-	32-1-103 (9).
178		-	(e) "H
179		-	OSPITAL" MEANS A FACILITY WITH FEWER THAN FIFTY BEDS
180		-	THAT IS
181		-	:
	201	+	6
	202	+	IN THE DEPARTMENT OF REGULATORY AGENCIES .7
	203	+	(d) "HEALTH SERVICE DISTRICT" HAS THE SAME MEANING AS SET8
	204	+	FORTH IN SECTION 32-1-103 (9).9
	205	+	(e) "HOSPITAL" MEANS A FACILITY WITH FEWER THAN FIFTY BEDS10
	206	+	THAT IS:11
182	207		(I) A
183		-	COUNTY PUBLIC HOSPITAL;
	208	+	COUNTY PUBLIC HOSPITAL;12
184	209		(II) A
185		-	HOSPITAL ESTABLISHED, MAINTAINED, OR OPERATED DIRECTLY
186		-	OR INDIRECTLY BY A HEALTH SERVICE DISTRICT
187		-	; OR
188		-	(III) A HOSPITAL AFFILIATE.
189		-	(f) "H
190		-	OSPITAL AFFILIATE" MEANS AN AFFILIATE OF A COUNTY PUBLIC
191		-	PAGE 4-SENATE BILL 23-298 HOSPITAL OR HEALTH SERVICE DISTRICT THAT IS UNDER THE SOLE CONTROL
192		-	OF THE COUNTY PUBLIC HOSPITAL OR HEALTH SERVICE DISTRICT
193		-	.
	210	+	HOSPITAL ESTABLISHED, MAINTAINED, OR OPERATED13
	211	+	DIRECTLY OR INDIRECTLY BY A HEALTH SERVICE DISTRICT ; OR14
	212	+	(III) A
	213	+	HOSPITAL AFFILIATE.15
	214	+	(f)
	215	+	"HOSPITAL AFFILIATE" MEANS AN AFFILIATE OF A COUNTY16
	216	+	PUBLIC HOSPITAL OR HEALTH SERVICE DISTRICT THAT IS UNDER THE SOLE17
	217	+	CONTROL OF THE COUNTY PUBLIC HOSPITAL OR HEALTH SERVICE DISTRICT .18
194	218		(3) E
195		-	XCEPT AS PROVIDED IN SUBSECTION (4) OF THIS SECTION, AND
196		-	SUBJECT TO THE REQUIREMENTS IN SUBSECTIONS
197		-	(5), (6), AND (7) OF THIS
198		-	SECTION
199		-	, A HOSPITAL IS AUTHORIZED TO ENTER INTO COLLABORATIVE
200		-	AGREEMENTS WITH ONE OR MORE HOSPITALS OR HOSPITAL AFFILIATES TO
201		-	ENGAGE IN THE FOLLOWING ACTIVITIES
202		-	:
	219	+	XCEPT AS PROVIDED IN SUBSECTION (4) OF THIS SECTION, AND19
	220	+	SUBJECT TO THE REQUIREMENTS IN SUBSECTIONS (5), (6), AND (7)
	221	+	OF THIS20
	222	+	SECTION, A HOSPITAL IS AUTHORIZED TO ENTER INTO COLLABORATIVE21
	223	+	AGREEMENTS WITH ONE OR MORE HOSPITALS OR HOSPITAL AFFILIATES TO22
	224	+	ENGAGE IN THE FOLLOWING ACTIVITIES:23
203	225		(a) A
204		-	NCILLARY CLINICAL SERVICES, ACQUISITION OF EQUIPMENT,
205		-	CLINIC MANAGEMENT, OR HEALTH-CARE PROVIDER RECRUITMENT ;
	226	+	NCILLARY CLINICAL SERVICES, ACQUISITION OF EQUIPMENT,24
	227	+	CLINIC MANAGEMENT, OR HEALTH-CARE PROVIDER RECRUITMENT ;25
206	228		(b) J
207		-	OINT PURCHASING OR LEASING ARRANGEMENTS , INCLUDING THE
208		-	JOINT PURCHASING OR LEASING OF
209		-	:
210		-	(I) M
211		-	EDICAL AND GENERAL SUPPLIES;
	229	+	OINT PURCHASING OR LEASING ARRANGEMENTS , INCLUDING26
	230	+	THE JOINT PURCHASING OR LEASING OF:27
	231	+	298
	232	+	-6- (I) MEDICAL AND GENERAL SUPPLIES;1
212	233		(II) M
213		-	EDICAL AND GENERAL EQUIPMENT ;
	234	+	EDICAL AND GENERAL EQUIPMENT ;2
214	235		(III) P
215		-	HARMACEUTICALS; OR
216		-	(IV) TEMPORARY STAFFING THROUGH A STAFFING AGENCY ;
	236	+	HARMACEUTICALS; OR3
	237	+	(IV) T
	238	+	EMPORARY STAFFING THROUGH A STAFFING AGENCY ;4
217	239		(c) C
218		-	ONSULTING SERVICES WITH A FOCUS ON PUBLIC HEALTH IN
219		-	RURAL OR FRONTIER COMMUNITIES AND NON
220		-	-HOSPITAL-SPECIFIC
221		-	INNOVATIONS IN HEALTH
222		-	-CARE DELIVERY IN THOSE COMMUNITIES ;
	240	+	ONSULTING SERVICES WITH A FOCUS ON PUBLIC HEALTH IN5
	241	+	RURAL OR FRONTIER COMMUNITIES AND NON -HOSPITAL-SPECIFIC6
	242	+	INNOVATIONS IN HEALTH-CARE DELIVERY IN THOSE COMMUNITIES ;7
223	243		(d) P
224		-	URCHASING JOINT PROFESSIONAL , GENERAL LIABILITY, OR
225		-	PROPERTY INSURANCE
226		-	;
	244	+	URCHASING JOINT PROFESSIONAL , GENERAL LIABILITY, OR8
	245	+	PROPERTY INSURANCE;9
227	246		(e) S
228		-	HARING BACK-OFFICE SERVICES, SUCH AS SHARING A BUSINESS
229		-	OFFICE
230		-	, ACCOUNTING AND FINANCE SERVICES , HUMAN RESOURCES, AND RISK
231		-	MANAGEMENT AND COMPLIANCE SERVICES
232		-	, BUT NOT INCLUDING SHARING
233		-	SERVICE CHARGING EXPENSES OR RATES AMONG HOSPITALS
234		-	;
	247	+	HARING BACK-OFFICE SERVICES, SUCH AS SHARING A BUSINESS10
	248	+	OFFICE, ACCOUNTING AND FINANCE SERVICES , HUMAN RESOURCES, AND11
	249	+	RISK MANAGEMENT AND COMPLIANCE SERVICES , BUT NOT INCLUDING12
	250	+	SHARING SERVICE CHARGING EXPENSES OR RATES AMONG HOSPITALS ;13
235	251		(f) S
236		-	HARING DATA SERVICES, INCLUDING SHARED SERVICES FOR
237		-	ELECTRONIC HEALTH RECORDS AND DATA EXTRACTION AND ANALYSIS
238		-	SERVICES
239		-	, CHARGE MANAGEMENT, AND POPULATION HEALTH ANALYSIS; AND
240		-	(g) NEGOTIATING WITH HEALTH INSURANCE OR GOVERNMENT
241		-	PAGE 5-SENATE BILL 23-298 PAYERS, WHICH NEGOTIATIONS ARE LIMITED TO:
	252	+	HARING DATA SERVICES, INCLUDING SHARED SERVICES FOR14
	253	+	ELECTRONIC HEALTH RECORDS AND DATA EXTRACTION AND ANALYSIS15
	254	+	SERVICES, CHARGE MANAGEMENT , AND POPULATION HEALTH ANALYSIS ;16
	255	+	AND17
	256	+	(g) N
	257	+	EGOTIATING WITH HEALTH INSURANCE OR GOVERNMENT18
	258	+	PAYERS, WHICH NEGOTIATIONS ARE LIMITED TO:19
242	259		(I) S
243		-	HARED CARE PROTOCOLS INTENDED TO IMPROVE PATIENT
244		-	MANAGEMENT AND OUTCOMES
245		-	, INCLUDING IMPLEMENTATION OF
246		-	EVIDENCE
247		-	-BASED PROTOCOLS, CLINICAL PATHWAYS, AND RECOGNIZED BEST
248		-	PRACTICES IN THE CARE AND TREATMENT OF PATIENTS
249		-	, INCLUDING CLINICAL
250		-	THERAPIES
251		-	, NUTRITION, EXERCISE, DIAGNOSTIC TESTING, AND MEDICATION
252		-	MANAGEMENT
253		-	;
	260	+	HARED CARE PROTOCOLS INTENDED TO IMPROVE PATIENT20
	261	+	MANAGEMENT AND OUTCOMES , INCLUDING IMPLEMENTATION OF21
	262	+	EVIDENCE-BASED PROTOCOLS, CLINICAL PATHWAYS, AND RECOGNIZED22
	263	+	BEST PRACTICES IN THE CARE AND TREATMENT OF PATIENTS , INCLUDING23
	264	+	CLINICAL THERAPIES, NUTRITION, EXERCISE, DIAGNOSTIC TESTING, AND24
	265	+	MEDICATION MANAGEMENT ;25
254	266		(II)
255		-	COLLABORATIVE EFFORTS WITH PAYERS TO ~~PROMOTE~~
256		-	APPROPRIATE AND ESSENTIAL SERVICES TO BE PROVIDED IN THE ~~LOCAL~~
257		-	~~COMMUNITY~~
258		-	;
	267	+	COLLABORATIVE EFFORTS WITH PAYERS TO PROMOTE26
	268	+	APPROPRIATE AND ESSENTIAL SERVICES TO BE PROVIDED IN THE LOCAL27
	269	+	298
	270	+	-7- COMMUNITY;1
259	271		(III)
260		-	MANAGEMENT OF PRIOR AUTHORIZATION REQUESTS ; ~~AND~~
261		-	(IV) ~~ANALYSIS OF AGGREGATE DATA TO COMPARE COSTS OF~~
262		-	~~PROCEDURES AND~~ TO ~~ANALYZE PATIENT OUTCOMES~~
263		-	.
	272	+	MANAGEMENT OF PRIOR AUTHORIZATION REQUESTS ; AND2
	273	+	(IV)
	274	+	ANALYSIS OF AGGREGATE DATA TO COMPARE COSTS OF3
	275	+	PROCEDURES AND TO ANALYZE PATIENT OUTCOMES .4
264	276		(4) N
265		-	OTWITHSTANDING ANY COLLABORATIVE AGREEMENTS
266		-	DESCRIBED IN SUBSECTION
267		-	(3) OF THIS SECTION, THE IMMUNITY AND
268		-	PROTECTIONS GRANTED TO HOSPITALS AND HOSPITAL AFFILIATES ENTERING
269		-	INTO COLLABORATIVE AGREEMENTS PURSUANT TO THIS SECTION DOES NOT
270		-	EXTEND TO COLLABORATIVE AGREEMENTS WITH ANOTHER HOSPITAL OR
271		-	HOSPITAL AFFILIATE THAT HAVE THE EFFECT OF
272		-	:
	277	+	OTWITHSTANDING ANY COLLABORATIVE AGREEMENTS5
	278	+	DESCRIBED IN
	279	+	SUBSECTION (3) OF THIS SECTION, THE IMMUNITY AND6
	280	+	PROTECTIONS GRANTED TO HOSPITALS AND HOSPITAL AFFILIATES7
	281	+	ENTERING INTO COLLABORATIVE AGREEMENTS PURSUANT TO THIS8
	282	+	SECTION DOES NOT EXTEND TO COLLABORATIVE AGREEMENTS WITH9
	283	+	ANOTHER HOSPITAL OR HOSPITAL AFFILIATE THAT HAVE THE EFFECT OF :10
273	284		(a) S
274		-	ETTING REIMBURSEMENT RATES OR OTHER COMPENSATION
275		-	FROM ANY COMMERCIAL SELF
276		-	-INSURED OR COMMERCIAL HEALTH INSURANCE
277		-	OR GOVERNMENT PAYER
278		-	;
	285	+	ETTING REIMBURSEMENT RATES OR OTHER COMPENSATION11
	286	+	FROM ANY COMMERCIAL SELF -INSURED OR COMMERCIAL HEALTH12
	287	+	INSURANCE OR GOVERNMENT PAYER ;13
279	288		(b) D
280		-	IVIDING OR ALLOCATING AMONG HOSPITALS OR HOSPITAL
281		-	AFFILIATES SPECIFIC MARKETS FOR THE DELIVERY OF ANY GENERAL ACUTE
282		-	CARE OR SPECIALTY LINES OF HEALTH
283		-	-CARE SERVICES; OR
284		-	(c) NEGOTIATING OR AGREEING TO COMPENSATION UNDER
285		-	HEALTH
286		-	-CARE STAFFING ARRANGEMENTS FOR HOSPITAL EMPLOYEES THAT
287		-	RESULTS IN A REDUCTION OF WAGES OF HOSPITAL STAFF
288		-	, WHETHER
289		-	EMPLOYED BY THE HOSPITAL
290		-	, A STAFFING AGENCY, OR OTHER EMPLOYER.
	289	+	IVIDING OR ALLOCATING AMONG HOSPITALS OR HOSPITAL14
	290	+	AFFILIATES SPECIFIC MARKETS FOR THE DELIVERY OF ANY GENERAL ACUTE15
	291	+	CARE OR SPECIALTY LINES OF HEALTH-CARE SERVICES; OR16
	292	+	(c) N
	293	+	EGOTIATING OR AGREEING TO COMPENSATION UNDER17
	294	+	HEALTH-CARE STAFFING ARRANGEMENTS FOR HOSPITAL EMPLOYEES THAT18
	295	+	RESULTS IN A REDUCTION OF WAGES OF HOSPITAL STAFF , WHETHER
	296	+	19
	297	+	EMPLOYED BY THE HOSPITAL, A STAFFING AGENCY, OR OTHER EMPLOYER.20
291	298		(5) P
292		-	RIOR TO ENGAGING IN ANY JOINT ACTIVITY DESCRIBED BY A
293		-	PROPOSED COLLABORATIVE AGREEMENT EXECUTED PURSUANT TO
294		-	PAGE 6-SENATE BILL 23-298 SUBSECTION (3) OF THIS SECTION, THE HOSPITALS OR HOSPITAL AFFILIATES
295		-	SHALL JOINTLY SUBMIT THE PROPOSED COLLABORATIVE AGREEMENT TO THE
296		-	STATE DEPARTMENT AND TO THE DIVISION OF INSURANCE
297		-	, IF THE PROPOSED
298		-	COLLABORATIVE AGREEMENT INCLUDES NEGOTIATING WITH HEALTH
299		-	INSURANCE PAYERS AS DESCRIBED IN SUBSECTION
300		-	(3)(g) OF THIS SECTION,
301		-	PURSUANT TO RULES THAT MAY BE PROMULGATED FOR THE SUBMISSION AND
302		-	REVIEW OF PROPOSALS BY THE STATE DEPARTMENT AND BY THE DIVISION OF
303		-	INSURANCE
304		-	, IF APPLICABLE. THE STATE DEPARTMENT AND THE DIVISION OF
305		-	INSURANCE
306		-	, IF APPLICABLE, MAY REQUEST ADDITIONAL INFORMATION
307		-	NECESSARY TO REVIEW THE PROPOSAL
308		-	.
	299	+	RIOR TO ENGAGING IN ANY JOINT ACTIVITY DESCRIBED BY A21
	300	+	PROPOSED COLLABORATIVE AGREEMENT EXECUTED PURSUANT TO22
	301	+	SUBSECTION (3) OF THIS SECTION, THE HOSPITALS OR HOSPITAL AFFILIATES23
	302	+	SHALL JOINTLY SUBMIT THE PROPOSED COLLABORATIVE AGREEMENT TO24
	303	+	THE STATE DEPARTMENT AND TO THE DIVISION OF INSURANCE , IF THE
	304	+	25
	305	+	PROPOSED COLLABORATIVE AGREEMENT INCLUDES NEGOTIATING WITH26
	306	+	HEALTH INSURANCE PAYERS AS DESCRIBED IN SUBSECTION (3)(g) OF THIS27
	307	+	298
	308	+	-8- SECTION, PURSUANT TO RULES THAT MAY BE PROMULGATED FOR THE1
	309	+	SUBMISSION AND REVIEW OF PROPOSALS BY THE STATE DEPARTMENT AND2
	310	+	BY THE DIVISION OF INSURANCE, IF APPLICABLE. THE STATE DEPARTMENT3
	311	+	AND THE DIVISION OF INSURANCE , IF APPLICABLE, MAY REQUEST4
	312	+	ADDITIONAL INFORMATION NECESSARY TO REVIEW THE PROPOSAL .5
309	313		(6) W
310	314		ITHIN FIFTEEN DAYS AFTER RECEIPT OF A PROPOSED
311		-	COLLABORATIVE AGREEMENT AND THE RECEIPT OF ADDITIONAL
312		-	INFORMATION REQUESTED BY THE STATE DEPARTMENT
313		-	AND BY THE DIVISION
314		-	OF INSURANCE
315		-	, IF APPLICABLE, IF THE STATE DEPARTMENT AND THE DIVISION
316		-	OF INSURANCE
317		-	, IF APPLICABLE, CONCLUDE THAT A PROPOSED
318		-	COLLABORATIVE ACTIVITY WILL RESULT IN COST SAVINGS OR OTHER
319		-	EFFICIENCIES THAT WILL IMPROVE OR EXPAND THE DELIVERY OF
320		-	HEALTH
321		-	-CARE SERVICES IN RURAL AND FRONTIER COMMUNITIES IN
322		-	COLORADO, THE STATE DEPARTMENT AND THE DIVISION OF INSURANCE , IF
323		-	APPLICABLE
324		-	, SHALL REFER THE PROPOSAL TO THE ATTORNEY GENERAL TO
325		-	DETERMINE
326		-	, PURSUANT TO RULES WHICH MAY BE PROMULGATED FOR SUCH
327		-	PURPOSE
328		-	, THAT THE BENEFITS OF THE COLLABORATIVE ACTIVITY ARE NOT
329		-	OUTWEIGHED BY ANY ANTICOMPETITIVE HARM THAT MAY ARISE FROM THE
330		-	COLLABORATIVE ACTIVITY
331		-	.
	315	+	6
	316	+	COLLABORATIVE AGREEMENT AND THE RECEIPT OF ADDITIONAL7
	317	+	INFORMATION REQUESTED BY THE STATE DEPARTMENT AND BY THE8
	318	+	DIVISION OF INSURANCE, IF APPLICABLE, IF THE STATE DEPARTMENT AND9
	319	+	THE DIVISION OF INSURANCE, IF APPLICABLE, CONCLUDE THAT A PROPOSED10
	320	+	COLLABORATIVE ACTIVITY WILL RESULT IN COST SAVINGS OR OTHER11
	321	+	EFFICIENCIES THAT WILL IMPROVE OR EXPAND THE DELIVERY OF12
	322	+	HEALTH-CARE SERVICES IN RURAL AND FRONTIER COMMUNITIES IN13
	323	+	C
	324	+	OLORADO, THE STATE DEPARTMENT AND THE DIVISION OF INSURANCE ,
	325	+	14
	326	+	IF APPLICABLE, SHALL REFER THE PROPOSAL TO THE ATTORNEY GENERAL15
	327	+	TO DETERMINE, PURSUANT TO RULES WHICH MAY BE PROMULGATED FOR16
	328	+	SUCH PURPOSE, THAT THE BENEFITS OF THE COLLABORATIVE ACTIVITY ARE17
	329	+	NOT OUTWEIGHED BY ANY ANTICOMPETITIVE HARM THAT MAY ARISE18
	330	+	FROM THE COLLABORATIVE ACTIVITY .19
332	331		(7) W
333		-	ITHIN FORTY-FIVE DAYS AFTER RECEIVING A REFERRAL AND
334		-	REVIEW FROM THE STATE DEPARTMENT AND THE DIVISION OF INSURANCE
335		-	, IF
336		-	APPLICABLE
337		-	, THE ATTORNEY GENERAL SHALL REVIEW THE PROPOSED
338		-	COLLABORATIVE AGREEMENT AND EITHER APPROVE OR DENY THE PROPOSED
339		-	COLLABORATIVE AGREEMENT OR REQUEST ADDITIONAL INFORMATION
340		-	RELATED TO THE PROPOSAL
341		-	. IF A REQUEST FOR ADDITIONAL INFORMATION
342		-	IS MADE
343		-	, THE ATTORNEY GENERAL HAS AN ADDITI ONAL FORTY -FIVE DAYS TO
344		-	COMPLETE THE REVIEW FOLLOWING RECEIPT OF THE REQUESTED
345		-	INFORMATION
346		-	.
	332	+	ITHIN FORTY-FIVE
	333	+	DAYS AFTER RECEIVING A REFERRAL20
	334	+	AND REVIEW FROM THE STATE DEPARTMENT AND THE DIVISION OF21
	335	+	INSURANCE, IF APPLICABLE, THE ATTORNEY GENERAL SHALL REVIEW THE22
	336	+	PROPOSED COLLABORATIVE AGREEMENT AND EITHER APPROVE OR DENY23
	337	+	THE PROPOSED COLLABORATIVE AGREEMENT OR REQUEST ADDITIONAL24
	338	+	INFORMATION RELATED TO THE PROPOSAL . IF A REQUEST FOR ADDITIONAL25
	339	+	INFORMATION IS MADE, THE ATTORNEY GENERAL HAS AN ADDITIONAL26
	340	+	FORTY-FIVE DAYS TO COMPLETE THE REVIEW FOLLOWING RECEIPT OF THE27
	341	+	298
	342	+	-9- REQUESTED INFORMATION .1
347	343		(8) (a) A
348	344		COLLABORATIVE AGREEMENT IS APPROVED IF :
	345	+	2
349	346		(I) T
350	347		HE STATE DEPARTMENT AND THE DIVISION OF INSURANCE , IF
351		-	APPLICABLE
352		-	, CONCLUDE THAT THE PROPOSED COLLABORATIVE AGREEMENT
353		-	PAGE 7-SENATE BILL 23-298 WILL RESULT IN IMPROVED QUALITY, INCREASED ACCESS OR COST SAVINGS,
354		-	OR OTHER EFFICIENCIES THAT WILL IMPROVE OR EXPAND THE DELIVERY OF
355		-	HEALTH
356		-	-CARE SERVICES IN RURAL AND FRONTIER COMMUNITIES IN
357		-	COLORADO; AND
358		-	(II) THE ATTORNEY GENERAL CONCLUDES THAT THE BENEFITS
359		-	IDENTIFIED BY THE STATE DEPARTMENT AND BY THE DIVISION OF
360		-	INSURANCE
361		-	, IF APPLICABLE, ARE OUTWEIGHED BY ANY COMPETITIVE
362		-	CONCERNS IDENTIFIED BY THE ATTORNEY GENERAL
363		-	, OR THE ATTORNEY
364		-	GENERAL DOES NOT RESPOND WITHIN THE TIME FRAMES SPECIFIED IN
365		-	SUBSECTION
366		-	(7) OF THIS SECTION.
	348	+	3
	349	+	APPLICABLE CONCLUDE THAT THE PROPOSED COLLABORATIVE AGREEMENT4
	350	+	WILL RESULT IN IMPROVED QUALITY , INCREASED ACCESS OR COST5
	351	+	SAVINGS, OR OTHER EFFICIENCIES THAT WILL IMPROVE OR EXPAND THE6
	352	+	DELIVERY OF HEALTH -CARE SERVICES IN RURAL AND FRONTIER7
	353	+	COMMUNITIES IN COLORADO; AND8
	354	+	(II) T
	355	+	HE ATTORNEY GENERAL CONCLUDES THAT THE BENEFITS
	356	+	9
	357	+	IDENTIFIED BY THE STATE DEPARTMENT AND BY THE DIVISION OF10
	358	+	INSURANCE, IF APPLICABLE, ARE OUTWEIGHED BY ANY COMPETITIVE11
	359	+	CONCERNS IDENTIFIED BY THE ATTORNEY GENERAL , OR THE ATTORNEY12
	360	+	GENERAL DOES NOT RESPOND WITHIN THE TIME FRAMES SPECIFIED IN13
	361	+	SUBSECTION (7) OF THIS SECTION. 14
367	362		(b) (I) E
368	363		XCEPT AS PROVIDED IN SUBSECTION (8)(b)(III) OF THIS
369		-	SECTION
370		-	, IF A PROPOSED COLLABORATIVE AGREEMENT IS DENIED , THE
371		-	HOSPITALS OR HOSPITAL AFFILIATES MAY REQUEST RECONSIDERATION BY
372		-	RESUBMITTING THE PROPOSED AGREEMENT TO THE ATTORNEY GENERAL
373		-	WITHIN THIRTY DAYS AFTER THE DENIAL ALONG WITH ADDITIONAL
374		-	MATERIALS
375		-	, INFORMATION, OR OTHER EVIDENCE THAT WAS NOT PREVIOUSLY
376		-	SUBMITTED RELATING TO THE DETERMINATION OF THE BENEFITS OR
377		-	ANTICOMPETITIVE HARM ASSOCIATED WITH THE PROPOSED COLLABORATIVE
378		-	AGREEMENT
379		-	.
	364	+	15
	365	+	SECTION, IF A PROPOSED COLLABORATIVE AGREEMENT IS DENIED , THE16
	366	+	HOSPITALS OR HOSPITAL AFFILIATES MAY REQUEST RECONSIDERATION BY17
	367	+	RESUBMITTING THE PROPOSED AGREEMENT TO THE ATTORNEY GENERAL18
	368	+	WITHIN THIRTY DAYS AFTER THE DENIAL ALONG WITH ADDITIONAL19
	369	+	MATERIALS, INFORMATION, OR OTHER EVIDENCE THAT WAS NOT20
	370	+	PREVIOUSLY SUBMITTED RELATING TO THE DETERMINATION OF THE21
	371	+	BENEFITS OR ANTICOMPETITIVE HARM ASSOCIATED WITH THE PROPOSED22
	372	+	COLLABORATIVE AGREEMENT .23
380	373		(II) T
381		-	HE ATTORNEY GENERAL HAS FORTY -FIVE DAYS FROM THE ~~DATE~~
382		-	~~OF THE REQUEST TO RECONSIDER THE DENIAL AND MAY CONSULT WITH THE~~
383		-	~~STATE DEPARTMENT AND THE DIVISION OF INSURANCE AS PART~~ OF THE
384		-	~~RECONSIDERATION~~
385		-	. THE PROPOSED COLLABORATIVE ~~AGREEMENT IS NOT~~
386		-	~~DEEMED APPROVED IF THE ATTORNEY GENERAL FAILS TO RESPOND WITHIN~~
387		-	THE ~~FORTY~~
388		-	-FIVE-DAY RECONSIDERATION PERIOD .
	374	+	HE ATTORNEY GENERAL HAS FORTY -FIVE DAYS FROM THE
	375	+	24
	376	+	DATE OF THE REQUEST TO RECONSIDER THE DENIAL AND MAY CONSULT25
	377	+	WITH THE STATE DEPARTMENT AND THE DIVISION OF INSURANCE AS PART26
	378	+	OF THE RECONSIDERATION. THE PROPOSED COLLABORATIVE AGREEMENT27
	379	+	298
	380	+	-10- IS NOT DEEMED APPROVED IF THE ATTORNEY GENERAL FAILS TO RESPOND1
	381	+	WITHIN THE FORTY-FIVE-DAY RECONSIDERATION PERIOD .2
389	382		(III) A
390	383		REQUEST FOR RECONSIDERATION OF A PROPOSED
391		-	COLLABORATIVE AGREEMENT MAY BE MADE ONLY ONCE WITHIN THE
392		-	THIRTY
393		-	-DAY PERIOD FOLLOWING THE DENIAL OF THE PROPOSED
394		-	COLLABORATIVE AGREEMENT
395		-	. THE ATTORNEY GENERAL 'S DECISION ON A
396		-	PROPOSED COLLABORATIVE AGREEMENT THAT IS NOT SUBMITTED FOR
397		-	RECONSIDERATION WITHIN THIRTY DAYS OR THAT IS DENIED UPON
398		-	RECONSIDERATION IS FINAL AND NON
399		-	-APPEALABLE.
400		-	(c) T
401		-	HE STATE DEPARTMENT , THE DIVISION OF INSURANCE, IF
402		-	APPLICABLE
403		-	, OR THE ATTORNEY GENERAL MAY REVIEW A COLLABORATIVE
404		-	AGREEMENT ANNUALLY TO ENSURE THE OUTCOMES RELATED TO THE
405		-	PAGE 8-SENATE BILL 23-298 COLLABORATIVE AGREEMENT ARE CONSISTENT WITH THIS SECTION .
406		-	SECTION 2. In Colorado Revised Statutes, add 25-3-304.5 as
407		-	follows:
408		-	25-3-304.5. Hospital collaborative agreements - additional
	384	+	3
	385	+	COLLABORATIVE AGREEMENT MAY BE MADE ONLY ONCE WITHIN THE4
	386	+	THIRTY-DAY PERIOD FOLLOWING THE DENIAL OF THE PROPOSED5
	387	+	COLLABORATIVE AGREEMENT . THE ATTORNEY GENERAL'S DECISION ON A6
	388	+	PROPOSED COLLABORATIVE AGREEMENT THAT IS NOT SUBMITTED FOR7
	389	+	RECONSIDERATION WITHIN THIRTY DAYS OR THAT IS DENIED UPON8
	390	+	RECONSIDERATION IS FINAL AND NON-APPEALABLE.9
	391	+	(c) THE STATE DEPARTMENT, THE DIVISION OF INSURANCE, IF10
	392	+	APPLICABLE, OR THE ATTORNEY GENERAL MAY REVIEW A COLLABORATIVE11
	393	+	AGREEMENT ANNUALLY TO ENSURE THE OUTCOMES RELATED TO THE12
	394	+	COLLABORATIVE AGREEMENT ARE CONSISTENT WITH THIS SECTION .13
	395	+	SECTION 2. In Colorado Revised Statutes, add 25-3-304.5 as14
	396	+	follows:15
	397	+	25-3-304.5. Hospital collaborative agreements - additional16
409	398		powers. I
410	399		N ADDITION TO THE POWERS SPECIFIED IN SECTION 25-3-304, THE
411		-	BOARD OF TRUSTEES OF A COUNTY PUBLIC HOSPITAL MAY ENTER INTO A
412		-	COLLABORATIVE AGREEMENT WITH ANOTHER COUNTY PUBLIC HOSPITAL
413		-	,
414		-	HEALTH SERVICE DISTRICT, OR HOSPITAL AFFILIATE IN ACCORDANCE WITH
415		-	SECTION
416		-	25.5-1-1001.
417		-	SECTION 3. In Colorado Revised Statutes, 32-1-1003, add (1)(c.5)
418		-	as follows:
419		-	32-1-1003. Health service districts - additional powers. (1) In
420		-	addition to the powers specified in section 32-1-1001, the board of any
421		-	health service district has any or all of the following powers for and on
422		-	behalf of such district:
423		-	(c.5) T
424		-	O ENTER INTO A COLLABORATIVE AGREEMENT WITH ANOTHER
425		-	HEALTH SERVICE DISTRICT
426		-	, COUNTY PUBLIC HOSPITAL , OR HOSPITAL
427		-	AFFILIATE IN ACCORDANCE WITH SECTION
428		-	25.5-1-1001.
429		-	SECTION 4. Appropriation. (1) For the 2023-24 state fiscal year,
430		-	$30,260 is appropriated to the department of health care policy and
431		-	financing for use by the executive director's office. This appropriation is
432		-	from the healthcare affordability and sustainability fee cash fund created in
433		-	section 25.5-4-402.4 (5)(a), C.R.S. To implement this act, the office may
434		-	use this appropriation as follows:
435		-	(a) $26,385 for personal services, which amount is based on an
436		-	assumption that the office will require an additional 0.8 FTE; and
437		-	(b) $3,875 for operating expenses.
438		-	(2) For the 2023-24 state fiscal year, the general assembly
439		-	anticipates that the department of health care policy and financing will
440		-	receive $30,259 in federal funds to implement this act, which amount is
441		-	subject to the "(I)" notation as defined in the annual general appropriation
442		-	PAGE 9-SENATE BILL 23-298 act for the same fiscal year. The appropriation in subsection (1) of this
443		-	section is based on the assumption that the department will receive this
444		-	amount of federal funds to be used as follows:
445		-	(a) $26,384 for personal services; and
446		-	(b) $3,875 for operating expenses.
447		-	SECTION 5. Act subject to petition - effective date. This act
448		-	takes effect at 12:01 a.m. on the day following the expiration of the
449		-	ninety-day period after final adjournment of the general assembly; except
450		-	that, if a referendum petition is filed pursuant to section 1 (3) of article V
451		-	of the state constitution against this act or an item, section, or part of this act
452		-	within such period, then the act, item, section, or part will not take effect
453		-	unless approved by the people at the general election to be held in
454		-	PAGE 10-SENATE BILL 23-298 November 2024 and, in such case, will take effect on the date of the official
455		-	declaration of the vote thereon by the governor.
456		-	____________________________ ____________________________
457		-	Steve Fenberg Julie McCluskie
458		-	PRESIDENT OF SPEAKER OF THE HOUSE
459		-	THE SENATE OF REPRESENTATIVES
460		-	____________________________ ____________________________
461		-	Cindi L. Markwell Robin Jones
462		-	SECRETARY OF CHIEF CLERK OF THE HOUSE
463		-	THE SENATE OF REPRESENTATIVES
464		-	APPROVED________________________________________
465		-	(Date and Time)
466		-	_________________________________________
467		-	Jared S. Polis
468		-	GOVERNOR OF THE STATE OF COLORADO
469		-	PAGE 11-SENATE BILL 23-298
	400	+	17
	401	+	BOARD OF TRUSTEES OF A COUNTY PUBLIC HOSPITAL MAY ENTER INTO A18
	402	+	COLLABORATIVE AGREEMENT WITH ANOTHER COUNTY PUBLIC HOSPITAL ,19
	403	+	HEALTH SERVICE DISTRICT, OR HOSPITAL AFFILIATE IN ACCORDANCE WITH20
	404	+	SECTION 25.5-1-901.21
	405	+	SECTION 3. In Colorado Revised Statutes, 32-1-1003, add22
	406	+	(1)(c.5) as follows:23
	407	+	32-1-1003. Health service districts - additional powers. (1) In24
	408	+	addition to the powers specified in section 32-1-1001, the board of any25
	409	+	health service district has any or all of the following powers for and on26
	410	+	behalf of such district:27
	411	+	298
	412	+	-11- (c.5) TO ENTER INTO A COLLABORATIVE AGREEMENT WITH1
	413	+	ANOTHER HEALTH SERVICE DISTRICT , COUNTY PUBLIC HOSPITAL , OR2
	414	+	HOSPITAL AFFILIATE IN ACCORDANCE WITH SECTION 25.5-1-901.3
	415	+	SECTION 4. Appropriation. (1) For the 2023-24 state fiscal4
	416	+	year, $30,260 is appropriated to the department of health care policy and5
	417	+	financing for use by the executive director's office. This appropriation is6
	418	+	from the healthcare affordability and sustainability fee cash fund created7
	419	+	in section 25.5-4-402.4 (5)(a), C.R.S. To implement this act, the office8
	420	+	may use this appropriation as follows:9
	421	+	(a) $26,385 for personal services, which amount is based on an10
	422	+	assumption that the office will require an additional 0.8 FTE; and11
	423	+	(b) $3,875 for operating expenses.12
	424	+	(2) For the 2023-24 state fiscal year, the general assembly13
	425	+	anticipates that the department of health care policy and financing will14
	426	+	receive $30,259 in federal funds to implement this act, which amount is15
	427	+	subject to the "(I)" notation as defined in the annual general appropriation16
	428	+	act for the same fiscal year. The appropriation in subsection (1) of this17
	429	+	section is based on the assumption that the department will receive this18
	430	+	amount of federal funds to be used as follows:19
	431	+	(a) $26,384 for personal services; and20
	432	+	(b) $3,875 for operating expenses.21
	433	+	SECTION 5. Act subject to petition - effective date. This act22
	434	+	takes effect at 12:01 a.m. on the day following the expiration of the23
	435	+	ninety-day period after final adjournment of the general assembly; except24
	436	+	that, if a referendum petition is filed pursuant to section 1 (3) of article V25
	437	+	of the state constitution against this act or an item, section, or part of this26
	438	+	act within such period, then the act, item, section, or part will not take27
	439	+	298
	440	+	-12- effect unless approved by the people at the general election to be held in1
	441	+	November 2024 and, in such case, will take effect on the date of the2
	442	+	official declaration of the vote thereon by the governor.3
	443	+	298
	444	+	-13-