Indigent Care

C.R.S. tit. 25.5, art. 3
in effect

C.R.S. § 25.5-3-101 Short title

25.5-3-101. Short title. This part 1 shall be known and may be cited as the "Colorado Indigent Care Program".

C.R.S. § 25.5-3-102 Legislative declaration

25.5-3-102. Legislative declaration. (1) The general assembly hereby determines, finds, and declares that: (a) The state has insufficient resources to pay for all medical services for persons who are indigent and must therefore allocate available resources in a manner that will provide treatment of those conditions constituting the most serious threats to the health of such medically indigent persons, as well as increase access to primary medical care to prevent deterioration of the health conditions among medically indigent people; and (b) Such allocation of resources will require the prioritization of medical services by providers and the coordination of administration and delivery of medical services. (2) The general assembly further determines, finds, and declares that the eligibility of medically indigent persons to receive medical services rendered under the conditions specified in subsection (1) of this section exists only to the extent of available appropriations, as well as to the extent of the individual provider facility's physical, staff, and financial capabilities. The general assembly also recognizes that the program for the medically indigent is a partial solution to the health-care needs of Colorado's medically indigent citizens. Therefore, medically indigent persons accepting medical services from such program shall be subject to the limitations and requirements imposed in this part 1.

C.R.S. § 25.5-3-103 Definitions

25.5-3-103. Definitions. As used in this part 1, unless the context otherwise requires: (1) "Emergency care" means treatment for conditions of an acute, severe nature which are life, limb, or disability threats requiring immediate attention, where any delay in treatment would, in the judgment of the responsible physician, threaten life or loss of function of a patient or viable fetus. (2) "Executive director" means the executive director of the state department. (3) "General provider" means a general hospital, birth center, or community health clinic licensed or certified by the department of public health and environment pursuant to section 25-1.5-103 (1)(a)(I) or (1)(a)(II); a federally qualified health center, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4); a rural health clinic, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(2); a health maintenance organization issued a certificate of authority pursuant to section 10-16-402; and the health sciences center when acting pursuant to section 25.5-3-108 (5)(a)(I) or (5)(a)(II)(A). For the purposes of the program, "general provider" includes associated physicians. (4) "Health sciences center" means the schools of medicine, dentistry, nursing, and pharmacy established by the regents of the university of Colorado under section 5 of article VIII of the Colorado constitution. (5) "Program" means the program for the medically indigent established by section 25.5-3-104. (6) "University hospital" means the university hospital operated pursuant to article 21 of title 23, C.R.S.

C.R.S. § 25.5-3-104 Program for the medically indigent established - eligibility - rules

25.5-3-104. Program for the medically indigent established - eligibility - rules. (1) A program for the medically indigent is hereby established, to commence July 1, 1983, which shall be administered by the state department, to provide payment to providers for the provision of medical services to eligible persons who are medically indigent. The state board may promulgate rules as are necessary for the implementation of this part 1 in accordance with article 4 of title 24, C.R.S. (2) A person's eligibility to receive discounted services under the program for the medically indigent is determined by rule of the state board based on a specified percentage of the federal poverty line, adjusted for family size, which percentage must not be less than two hundred fifty percent. (3) No later than June 1, 2022, for providers defined as hospital providers in 10 CCR 2505-10, sec. 8.901.J, the state department shall promulgate rules: (a) Prohibiting hospitals from considering assets when determining whether a patient meets the specified percentage of the federal poverty line required in subsection (2) of this section; and (b) Ensuring the method used to determine whether a patient meets the specified percentage of the federal poverty line is uniform across hospitals and aligned with the method for counting income for the purposes of determining eligibility for discounted care, as described in section 25.5-3-503.

C.R.S. § 25.5-3-105 Eligibility of legal immigrants for services

25.5-3-105. Eligibility of legal immigrants for services. The county departments responsible for administering benefits programs under the department of health care policy and financing and the department of human services shall identify and review all current county guidance materials, including forms, training materials, websites, and any other materials that reference a prohibition on sponsorship as a condition of eligibility for benefits and shall remove all such references from verbal and digital communications and from all physical materials currently provided to applicants or beneficiaries.

C.R.S. § 25.5-3-106 No public funds for abortion - exception - definitions - repeal

25.5-3-106. No public funds for abortion - exception - definitions - repeal. (1) It is the purpose of this section to implement the provisions of amendment 3 to article V of the Colorado constitution, adopted by the registered electors of the state of Colorado at the general election November 6, 1984, which prohibits the use of public funds by the state of Colorado or its agencies or political subdivisions to pay or otherwise reimburse, directly or indirectly, any person, agency, or facility for any induced abortion. (2) If every reasonable effort has been made to preserve the lives of a pregnant woman and her unborn child, then public funds may be used pursuant to this section to pay or reimburse for necessary medical services, not otherwise provided for by law. (3) (a) Any medically necessary services performed pursuant to this section shall be performed only by a provider who is licensed by the state and acting within the scope of the provider's license and in accordance with applicable federal regulations. (b) (Deleted by amendment, L. 2021.) (4) (a) Any physician who renders necessary medical services pursuant to subsection (2) of this section shall report the following information to the state department: (I) The age of the pregnant woman and the gestational age of the unborn child at the time the necessary medical services were performed; (II) The necessary medical services which were performed; (III) The medical condition which necessitated the performance of necessary medical services; (IV) The date such necessary medical services were performed and the name of the facility in which such services were performed. (b) The information required to be reported pursuant to paragraph (a) of this subsection (4) shall be compiled by the state department and such compilation shall be an ongoing public record; except that the privacy of the pregnant woman and the attending physician shall be preserved. (5) For purposes of this section, pregnancy is a medically diagnosable condition. (6) For the purposes of this section: (a) (I) "Death" means: (A) The irreversible cessation of circulatory and respiratory functions; or (B) The irreversible cessation of all functions of the entire brain, including the brain stem. (II) A determination of death under this section shall be in accordance with accepted medical standards. (b) "Life-endangering circumstance" means: (I) The presence of a medical condition, other than a psychiatric condition, as determined by the attending physician, which represents a serious and substantial threat to the life of the pregnant woman if the pregnancy continues to term; (II) The presence of a lethal medical condition in the unborn child, as determined by the attending physician and one other physician, which would result in the impending death of the unborn child during the term of pregnancy or at birth; or (III) The presence of a psychiatric condition which represents a serious and substantial threat to the life of the pregnant woman if the pregnancy continues to term. In such case, unless the pregnant woman has been receiving prolonged psychiatric care, the attending licensed physician shall obtain consultation from a licensed physician specializing in psychiatry confirming the presence of such a psychiatric condition. The attending physician shall report the findings of such consultation to the state department. egnant woman if the pregnancy continues to term. In such case, unless the pregnant woman has been receiving prolonged psychiatric care, the attending licensed physician shall obtain consultation from a licensed physician specializing in psychiatry confirming the presence of such a psychiatric condition. The attending physician shall report the findings of such consultation to the state department. (c) "Necessary medical services" means any medical procedures deemed necessary to prevent the death of a pregnant woman or her unborn child due to life-endangering circumstances. (7) If any provision of this section or application thereof is held invalid, such invalidity shall not affect other provisions or applications of this section which can be given effect without the invalid provision or application and, to this end, provisions of this section are declared severable. (8) Use of the term "unborn child" in this section is solely for the purposes of facilitating the implementation of section 50 of article V of the state constitution and its use shall not affect any other law or statute nor shall it create any presumptions relating to the legal status of an unborn child or create or affect any distinction between the legal status of an unborn child and the legal status of a fetus. (9) This section shall be repealed if section 50 of article V of the Colorado constitution is repealed.

C.R.S. § 25.5-3-107 Report concerning the program

25.5-3-107. Report concerning the program. Notwithstanding the provisions of section 24-1-136 (11)(a)(I), the executive director shall prepare an annual report concerning the status of the medically indigent program to be submitted to the health and human services committees of the senate and the house of representatives, or any successor committees, no later than February 1 of each year. The report shall be prepared following consultation with providers in the program, state department personnel, and other agencies, organizations, or individuals as the executive director deems appropriate in order to obtain comprehensive and objective information about the program.

C.R.S. § 25.5-3-108 Responsibility of the department of health care policy and financing - provider reimbursement - repeal

25.5-3-108. Responsibility of the department of health care policy and financing - provider reimbursement - repeal. (1) The state department shall be responsible for: (a) Execution of such contracts with providers for partial reimbursement of costs for medical services rendered to the medically indigent as the state department shall determine are necessary for the program; (b) Promulgation of such reasonable rules as are necessary for the program; (c) Submission of the report required in section 25.5-3-107; and (d) Application for federal financial participation under the program. (2) The contracts required by paragraph (a) of subsection (1) of this section shall be negotiated between the state department and the various general providers, as defined in section 25.5-3-103 (3), and shall include contracts with providers to provide tertiary or specialized services. The state department may award such contracts upon a determination that it would not be cost effective nor result in adequate quality of care for such services to be developed by the contract providers, or upon a determination that the contract providers are unable or unwilling to provide such services. (3) The state department shall establish procedures requiring the provider to provide for proof of indigency to be submitted by the person seeking assistance, but the provider shall be responsible for the determination of eligibility. (4) The state department shall establish procedures so that the providers of medical services rendered to the medically indigent cover geographic regions of the state. (5) (a) The responsibilities of providers who provide medical care through the program for the medically indigent are as follows: (I) Denver health and hospitals, including associated physicians, shall, up to its physical, staff, and financial capabilities as provided for under this program, be the primary providers of medical services to the medically indigent for the city and county of Denver. (II) (A) University hospital and the physicians and other faculty members of the health sciences center shall, up to their physical, staff, and financial capabilities as provided for under this program, be the primary provider of medical services to the medically indigent for the Denver primary metropolitan statistical area. (B) University hospital and the physicians and other faculty members of the health sciences center shall be the primary provider of such complex care as is not available or is not contracted for in the remaining areas of the state up to their physical, staff, and financial capabilities as provided for under this program. (b) Any two or more providers awarded contracts may, with the approval of the state department, redistribute their respective populations and associated funds. (c) Every provider who provides medical care through the program for the medically indigent shall comply with all procedures established by the state department. (6) The state department shall establish procedures that allocate funds to providers based on the anticipated utilization of services. (7) A provider receiving reimbursement pursuant to this section shall transfer a medically indigent patient to another provider only with the prior agreement of the provider. (8) (a) Every provider receiving reimbursement pursuant to this section shall prioritize for each fiscal year the medical services which it will be able to render, within the limits of the funds which will be made available by the state department. reimbursement pursuant to this section shall transfer a medically indigent patient to another provider only with the prior agreement of the provider. (8) (a) Every provider receiving reimbursement pursuant to this section shall prioritize for each fiscal year the medical services which it will be able to render, within the limits of the funds which will be made available by the state department. (b) Such medical services shall be prioritized in the following order: (I) Emergency care for the full year; (II) Any additional medical care for those conditions the state department determines to be the most serious threat to the health of medically indigent persons; (III) Any other additional medical care. (9) A provider receiving reimbursement pursuant to this section shall not be liable in civil damages for refusing to admit for treatment or for refusing to treat any medically indigent person for a condition which the state department or the provider has determined to be outside of the scope of the program. (10) (a) A medically indigent person who wishes to be determined eligible for assistance under this part 1 shall comply with the eligibility requirements set by the state department. (b) A medically indigent person requesting assistance under this part 1 specifically authorizes the state department or provider to: (I) Use any information required by the eligibility requirements set by the state department for the purpose of verifying eligibility; and (II) Obtain records pertaining to eligibility from a financial institution, as defined in section 15-15-201 (4), C.R.S., or from any insurance company. (c) A medically indigent person requesting assistance under this part 1 shall be provided language clearly explaining the provisions of this subsection (10). (11) With the approval of the state department, any provider awarded a contract may enter into subcontracts or other agreements for services related to the program. (12) Providers awarded contracts shall not be paid from funds made available for this program up to the extent, if any, of their annual financial obligation under the Hill-Burton act. (13) When adopting or modifying procedures under this part 1, the state department shall notify each provider, who is contracted to provide medical care through the program for the medically indigent, at least thirty days prior to implementation of a new procedure. The state department shall hold a meeting for all providers at least thirty days prior to the implementation of a new procedure. (14) The state department shall require any hospital provider who may receive payment under the program to annually submit data relating to the hospital's number of medicaid-eligible in-patient days and the hospital's total in-patient days in a form specified by the state department. The hospital provider shall verify the data to the state department through the program audit procedures required by the state department. The state department shall include this information by hospital in the department's annual budget request to the joint budget committee of the general assembly and in the report required by section 25.5-3-107. (15) To qualify for the program's payment formula disproportionate share hospital factor, as described in rule by the state board consistent with the provisions of this part 1, a hospital provider's percent of medicaid-eligible in-patient days relative to total in-patient days shall be equal to or exceed one standard deviation above the mean. (16) After receiving approval by the state department, a community health clinic may utilize moneys received pursuant to this article, and any gifts, grants, and donations, for the development and implementation of demonstration projects that may include but need not be limited to coordination of care and disease management. days shall be equal to or exceed one standard deviation above the mean. (16) After receiving approval by the state department, a community health clinic may utilize moneys received pursuant to this article, and any gifts, grants, and donations, for the development and implementation of demonstration projects that may include but need not be limited to coordination of care and disease management. (17) Subject to adequate funding being made available under section 25.5-4-402.4, the Colorado healthcare affordability and sustainability enterprise created in section 25.5-4-402.4 (3) shall increase hospital reimbursements up to one hundred percent of hospital costs for providing medical care under the program. (18) and (19) Repealed. (20) (a) Notwithstanding any other provision of law, for the state fiscal year starting July 1, 2021, and any subsequent fiscal years, if a provider submits a certification of public expenditures pursuant to 42 CFR 433.51 (b), the state department shall retain any federal money payable as reimbursement for the expenditure in excess of fifty percent of the expenditure amount; except that the state department shall only retain the federal money based on the date of service as long as the increased reimbursements and payments pursuant to the federal "Families First Coronavirus Response Act", Pub.L. 116-127, are still available. The state treasurer shall transfer such money to the general fund created in section 24-75-201 for appropriation to the state medical assistance program. (b) This subsection (20) is repealed, effective December 31, 2024.

C.R.S. § 25.5-3-109 Appropriations

25.5-3-109. Appropriations. The general assembly shall make annual appropriations to the state department to accomplish the purposes of this part 1.

C.R.S. § 25.5-3-110 Effect of part 1

25.5-3-110. Effect of part 1. This part 1 does not affect the responsibilities of the behavioral health administration in the department of human services for the provision of mental health care in accordance with article 66 of title 27, and this part 1 does not affect any provisions of article 22 of title 23 or any other provisions of law relating to the university of Colorado psychiatric hospital.

C.R.S. § 25.5-3-111 Penalties

25.5-3-111. Penalties. Any person who represents that any medical service is reimbursable or subject to payment pursuant to this part 1 when the person knows that it is not commits a petty offense. Any person who represents that the person is eligible for assistance pursuant to this part 1 when the person knows that the person is not commits a class 2 misdemeanor and shall be punished as provided in section 18-1.3-503.

C.R.S. § 25.5-3-112 Health care services fund - creation - state plan amendment - primary care special distribution fund

25.5-3-112. Health care services fund - creation - state plan amendment - primary care special distribution fund. (1) (a) There is hereby created in the state treasury the Colorado health care services fund, referred to in this section as the "fund". The fund shall consist of moneys credited thereto pursuant to this section. (b) In fiscal year 2005-06, the general assembly shall appropriate fourteen million nine hundred sixty-two thousand four hundred eight dollars from the general fund to the fund. Of the moneys in the general fund exempt account created in section 24-77-103.6 (2), C.R.S., the following amounts shall be appropriated by the general assembly to the fund: (I) In fiscal year 2007-08, fifteen million dollars; and (II) In fiscal year 2008-09, twelve million nine hundred eighteen thousand seven hundred fifty dollars. (III) (Deleted by amendment, L. 2010, (HB 10-1321), ch. 48, p. 179, § 1, effective March 29, 2010.) (b.5) In fiscal year 2009-10, the general assembly shall appropriate ten million three hundred ninety thousand dollars from the general fund to the fund. (b.6) In fiscal year 2011-12, the treasurer shall transfer one million dollars from the general fund to the fund. (c) All moneys appropriated to the fund shall be used as provided in this section and shall not be deposited in or transferred to the general fund of this state or to any other fund. Notwithstanding any provision of section 24-36-114, C.R.S., to the contrary, all interest derived from the deposit and investment of moneys in the fund shall be credited to the fund. (1.5) Notwithstanding any provision of subsection (1) of this section to the contrary, on April 20, 2009, the state treasurer shall deduct five hundred thousand dollars from the fund and transfer such sum to the general fund. (2) In fiscal year 2006-07, and each of the two fiscal years thereafter, notwithstanding the requirements of section 25.5-3-108 (8)(b), the moneys deposited into the fund shall be appropriated as follows: (a) Of the moneys appropriated pursuant to this subsection (2), eighteen percent of the moneys annually appropriated shall be to Denver health and hospitals as the community health clinic provider for the city and county of Denver. (b) (I) For fiscal year 2006-07, eighty-two percent of the moneys remaining after the appropriation pursuant to paragraph (a) of this subsection (2) shall be appropriated to community health clinics to provide primary care services pursuant to this article. (II) For fiscal year 2006-07, eighteen percent of the moneys remaining after the appropriation pursuant to paragraph (a) of this subsection (2) shall be appropriated to primary care clinics operated by a licensed or certified health-care facility to provide primary care services pursuant to this article. (III) For fiscal years 2007-08 and 2008-09, the allocation of the moneys remaining after the appropriation pursuant to paragraph (a) of this subsection (2) shall be determined based on prior utilization as specified in rule by the state board. (2.5) In fiscal year 2009-10, notwithstanding the requirements of section 25.5-3-108 (8)(b), the moneys deposited into the fund shall be appropriated as follows: (a) Twenty percent of the moneys shall be appropriated to the state department for distribution to Denver health and hospitals as the community health clinic provider for the city and county of Denver; cified in rule by the state board. (2.5) In fiscal year 2009-10, notwithstanding the requirements of section 25.5-3-108 (8)(b), the moneys deposited into the fund shall be appropriated as follows: (a) Twenty percent of the moneys shall be appropriated to the state department for distribution to Denver health and hospitals as the community health clinic provider for the city and county of Denver; (b) Eighty percent of the moneys shall be appropriated to the state department for distribution to community health clinics based upon prior utilizations as determined by the state department to mitigate reductions the clinics experience due to reductions in moneys available from the primary care fund created pursuant to section 24-22-117 (2)(b), C.R.S. (2.7) In the 2010-11 fiscal year, notwithstanding the requirements of section 25.5-3-108 (8)(b), the moneys deposited into the fund shall be appropriated to the state department for distribution to Denver health and hospitals, as the community health clinic for the city and county of Denver, and to community health clinics. The state department shall develop a distribution formula specifying the distributions based upon prior utilizations and, to the extent possible, mitigation of the reductions in funding that the clinics experience due to reductions in moneys available from the primary care fund established pursuant to section 24-22-117 (2)(b), C.R.S. (2.8) In the 2011-12 fiscal year, notwithstanding the requirements of section 25.5-3-108 (8)(b), the moneys deposited into the fund shall be appropriated to the state department for distribution to Denver health and hospitals, as the community health clinic for the city and county of Denver, to community health clinics, and to federally qualified health centers. The state department shall develop a distribution formula specifying the distributions based upon prior utilizations and, to the extent possible, mitigation of the reductions in funding that the clinics experience due to reductions in moneys available from the primary care fund established pursuant to section 24-22-117 (2)(b), C.R.S. (3) (a) The state department shall submit a state plan amendment for federal financial participation for moneys appropriated to primary care clinics operated by a licensed or certified health-care facility. Upon approval of the state plan amendment, the state department is authorized to receive and expend all available federal moneys without a corresponding reduction in spending authority from the fund. (b) To the extent possible under federal law, the state department shall pursue available federal financial participation for moneys appropriated to community health clinics. (4) Repealed.

C.R.S. § 25.5-3-113 Repeal of part

25.5-3-113. Repeal of part. [Editor's note: This section is effective July 1, 2025.] This part 1 is repealed, effective July 1, 2025.

C.R.S. § 25.5-3-204 Comprehensive primary and preventive care grant program - creation

25.5-3-204. Comprehensive primary and preventive care grant program - creation. (Repealed)

C.R.S. § 25.5-3-207 Program funding - comprehensive primary and preventive care fund - creation - repeal

25.5-3-207. Program funding - comprehensive primary and preventive care fund - creation - repeal. (Repealed)

C.R.S. § 25.5-3-301 Definitions

25.5-3-301. Definitions. As used in this part 3, unless the context otherwise requires: (1) "Comprehensive primary care" means the basic, entry-level health care provided by health-care practitioners or non-physician health-care practitioners that is generally provided in an outpatient setting. "Comprehensive primary care", at a minimum, includes providing or arranging for the provision of the following services on a year-round basis: Primary health care; maternity care, including prenatal care; preventive, developmental, and diagnostic services for infants and children; adult preventive services; diagnostic laboratory and radiology services; emergency care for minor trauma; pharmaceutical services; and coordination and follow-up for hospital care. "Comprehensive primary care" may also include optional services based on a patient's needs. For the purposes of this subsection (1) and subsection (2) of this section, "arranging for the provision" means demonstrating established referral relationships with health-care providers for any of the comprehensive primary care services not directly provided by an entity. An entity in a rural area may be exempt from this requirement if it can demonstrate that there are no providers in the community to provide one or more of the comprehensive primary care services. (2) "Qualified provider" means an entity that provides comprehensive primary care services and that: (a) Accepts all patients regardless of their ability to pay and uses a sliding fee schedule for payments or that provides comprehensive primary care services free of charge; (b) Serves a designated medically underserved area or population, as provided in section 330(b) of the federal "Public Health Service Act", 42 U.S.C. sec. 254b, or demonstrates to the state department that the entity serves a population or area that lacks adequate health-care services for low-income, uninsured persons; (c) Has a demonstrated track record of providing cost-effective care; (d) Provides or arranges for the provision of comprehensive primary care services to persons of all ages; and (e) Completes initial screening for eligibility for the state medical assistance program, the children's basic health plan, and any other relevant government health-care program and referral to the appropriate agency for eligibility determination. (3) "Uninsured or medically indigent patient" means a patient receiving services from a qualified provider: (a) [Editor's note: This version of subsection (3)(a) is effective until July 1, 2025.] Whose yearly family income is below two hundred percent of the federal poverty line; and (a) [Editor's note: This version of subsection (3)(a) is effective July 1, 2025.] Whose annual household income is at or below two hundred percent of the federal poverty guideline; and (b) Who is not eligible for medicaid, medicare, or any other type of governmental reimbursement for health-care costs; and (c) Who is not receiving third-party payments.

C.R.S. § 25.5-3-302 Annual allocation - primary care services - qualified provider - rules

25.5-3-302. Annual allocation - primary care services - qualified provider - rules. (1) The state department shall annually allocate the moneys appropriated by the general assembly to the primary care fund created in section 24-22-117 (2)(b), C.R.S., to all eligible qualified providers in the state who comply with the requirements of subsection (2) of this section. The state department shall allocate the moneys in amounts proportionate to the number of uninsured or medically indigent patients served by the qualified provider. For a qualified provider to be eligible for an allocation pursuant to this section, the qualified provider shall meet either of the following criteria: (a) The qualified provider is a community health center, as defined in section 330 of the federal "Public Health Service Act", 42 U.S.C. sec. 254b; or (b) At least fifty percent of the patients served by the qualified provider are uninsured or medically indigent patients, or patients who are enrolled in the medical assistance program, articles 4, 5, and 6 of this title, or the children's basic health plan, article 8 of this title, or any combination thereof. (2) [Editor's note: This version of subsection (2) is effective until July 1, 2025.] A qualified provider shall annually submit to the state department information sufficient to establish the provider's eligibility status. A qualified provider, except for a provider specified in paragraph (a) of subsection (1) of this section, shall provide an annual report that includes the total number of patients served, the number of uninsured or medically indigent patients served, and the number of patients served who are enrolled in the medical assistance program, articles 4, 5, and 6 of this title, or the children's basic health plan, article 8 of this title. A community health center specified in paragraph (a) of subsection (1) of this section shall annually provide to the state department the number of uninsured or medically indigent patients served. Each eligible qualified provider shall annually develop and submit to the state department documentation regarding the quality assurance program in place at the provider's facility to ensure that quality comprehensive primary care services are being provided. All qualified providers shall submit to the state department the information required under this section, as specified in rule by the state board. The data regarding the number of patients served shall be verified by an outside entity. For purposes of this part 3, the number of patients served is the number of unduplicated users of health-care services and is not the number of visits by a patient. (2) [Editor's note: This version of subsection (2) is effective July 1, 2025.] (a) A qualified provider shall annually submit to the state department information sufficient to establish the provider's eligibility status as specified in rule by the state board. A qualified provider shall submit an annual application for money that includes the total number of patients served, the number of uninsured or medically indigent patients served who have an annual household income at or below two hundred percent of the federal poverty guideline, and the number of patients served who are enrolled in the medical assistance program, articles 4, 5, and 6 of this title 25.5, or the children's basic health plan, article 8 of this title 25.5. (b) Each qualified provider shall annually develop and submit to the state department documentation regarding the quality assurance program in place at the provider's facility to ensure that quality comprehensive primary care services are being provided. The state department may, through state board rule, exempt a community health center from the reporting requirements described in this subsection (2)(b). qualified provider shall annually develop and submit to the state department documentation regarding the quality assurance program in place at the provider's facility to ensure that quality comprehensive primary care services are being provided. The state department may, through state board rule, exempt a community health center from the reporting requirements described in this subsection (2)(b). (c) The data regarding the number of patients served must be verified by an outside entity. For purposes of this part 3, the number of patients served is the number of unduplicated users of health-care services and is not the number of visits by a patient. (3) [Editor's note: This version of subsection (3) is effective until July 1, 2025.] The state department shall make annual direct allocations of the total amount of money annually appropriated by the general assembly to the primary care fund pursuant to section 24-22-117 (2)(b), C.R.S., minus three percent for the administrative costs of the program, to all eligible qualified providers. An eligible qualified provider's allocation shall be based on the number of uninsured or medically indigent patients served by the provider in proportion to the total number of uninsured or medically indigent patients served by all eligible qualified providers in the previous calendar year. The state department shall establish a schedule for allocating the moneys in the primary care fund for eligible qualified providers. The disbursement of moneys in the primary care fund to eligible qualified providers under this part 3 are exempt from the provisions of the "Procurement Code", articles 101 to 112 of title 24, C.R.S. (3) [Editor's note: This version of subsection (3) is effective July 1, 2025.] (a) The state department shall make annual direct allocations of the total amount of money annually appropriated by the general assembly to the primary care fund pursuant to section 24-22-117 (2)(b), minus three percent for the administrative costs of the program, to all qualified providers. (b) A qualified provider's allocation is based on the number of uninsured or medically indigent patients served by the provider in proportion to the total number of uninsured or medically indigent patients served by all qualified providers in the previous calendar year. (c) The state department shall establish a schedule for allocating the money in the primary care fund for qualified providers. The disbursement of money in the primary care fund to qualified providers pursuant to this part 3 is exempt from the provisions of the "Procurement Code", articles 101 to 112 of title 24. (4) Beginning in the 2021-22 state fiscal year, and to the extent available and permitted by the federal government and section 21 of article X of the state constitution, the state department shall maximize federal funds for payment to qualified providers pursuant to this section by aligning payments with the "Colorado Medical Assistance Act", articles 4, 5, and 6 of this title 25.5. (5) The state board shall adopt any rules necessary for the administration and implementation of this part 3.

C.R.S. § 25.5-3-303 Consultation

25.5-3-303. Consultation. At least annually, the state department shall consult with representatives of federally qualified health centers, school-based health centers, family residency directors, certified rural health clinics, other qualified providers, and consumer advocates regarding the implementation and administration of the allocation of moneys to qualified providers under this part 3.

C.R.S. § 25.5-3-304 Primary care fund report

25.5-3-304. Primary care fund report. [Editor's note: This section is effective July 1, 2025.] (1) Beginning February 1, 2026, and each February 1 thereafter, the executive director shall prepare and submit an annual report to the house of representatives health and human services committee and the senate health and human services committee, or their successor committees; the joint budget committee; the governor; and the state board concerning the status of the primary care fund, created in section 24-22-117 (2)(b). At a minimum, the report must include: (a) The number of uninsured or medically indigent patients served who have an annual household income at or below two hundred percent of the federal poverty guideline; (b) The allocation of money to qualified providers; (c) The state department's recommendations concerning the primary care fund; and (d) The information presented by the state department to the general assembly pursuant to section 25.5-3-505 (6).

C.R.S. § 25.5-3-401 Short title

25.5-3-401. Short title. This part 4 is known as and may be cited as the "Colorado Dental Health Care Program for Low-income Seniors".

C.R.S. § 25.5-3-402 Legislative declaration

25.5-3-402. Legislative declaration. (1) The general assembly hereby finds and declares that: (a) The purpose of this part 4 is to promote the health and welfare of Colorado low-income seniors by providing access to patient-centered dental care and services to individuals sixty years of age or older whose income and resources are insufficient to meet the costs of such care and thereby support individuals and families to live independently with a good quality of life; (b) By relocating and reorganizing the "Colorado Dental Care Act of 1977", which provided dental services to certain eligible seniors, the state department can align those dental health-care services with adult dental benefits provided through other dental health-care programs for seniors and thereby target the resources effectively to low-income seniors who may not qualify for those programs; (c) The state department shall implement this part 4 through collaboration among various executive departments, agencies, and political subdivisions of the state; private individuals; and organizations, including but not limited to: (I) The local area agencies on aging; (II) Community health centers; (III) Safety-net clinics; (IV) Private practice dental providers; and (V) Foundations; and (d) The state department shall implement this part 4 as a grant program throughout all geographic regions of the state using best practices and experience from other grant programs operated by the state department to provide maximum flexibility to safety-net and private-practice dental providers in order to promote the health and welfare of low-income seniors.

C.R.S. § 25.5-3-403 Definitions

25.5-3-403. Definitions. As used in this part 4, unless the context otherwise requires: (1) "Advisory committee" means the senior dental advisory committee created in section 25.5-3-406. (2) "Covered dental care services" are to be defined by rules of the medical services board pursuant to section 25.5-3-404 and include but are not limited to diagnostic, preventive, and restorative care. (3) "Dental health-care services grant" means a grant awarded to a qualified grantee pursuant to section 25.5-3-404. (4) "Eligible senior" means an adult who is sixty years of age or older and who is economically disadvantaged as specified by rule of the medical services board. (5) "Program" means the Colorado dental health care program for low-income seniors created pursuant to section 25.5-3-404. (6) "Qualified grantee" means an entity that can demonstrate that it can provide or arrange for the provision of comprehensive dental and oral care services and may include but is not limited to: (a) An area agency on aging, as defined in section 26-11-203, C.R.S.; (b) A community-based organization or foundation; (c) A federally qualified health center, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4); safety-net clinic; or health district; (d) A local public health agency; or (e) A private dental practice. (7) "Qualified provider" means any person who is licensed to practice dentistry in Colorado or who employs a dentist licensed in Colorado and who is willing to accept reimbursement for covered dental services pursuant to this program.

C.R.S. § 25.5-3-404 Colorado dental health care program for low-income seniors - rules

25.5-3-404. Colorado dental health care program for low-income seniors - rules. (1) (a) There is created in the state department the Colorado dental health care program for low-income seniors to provide covered dental care services for eligible seniors who are not eligible for dental services under medicaid, the old age pension health and medical care program, or private insurance. (b) To ensure the continuity of dental health care to low-income seniors, the state department and the department of public health and environment shall ensure that any individual who meets, on June 30, 2014, the eligibility requirements for dental services under the "Colorado Dental Care Act of 1977", article 21 of title 25, C.R.S., prior to its repeal, remains eligible for dental services after June 30, 2014, through the "Colorado Dental Care Act of 1977", medicaid, the old age pension health and medical care fund, or the program. (2) The state department shall: (a) In consultation with the advisory committee, review the operation and effectiveness of the program and develop a grant application under the program consistent with rules of the medical services board; (b) Accept applications for dental health-care services grants from any qualified grantee; (c) On and after July 1, 2015, award dental health-care services grants to qualified grantees to provide covered dental care services to eligible seniors; (d) Pay dental health-care services grants within thirty days after approval by the state department; (e) Ensure that all eligible seniors have access to services through the program; and (f) Consider geographic distribution of funds among urban and rural areas in the state when making funding decisions. (3) (a) Qualified grantees shall: (I) Submit an application for a dental health-care services grant to the state department on the form developed by the state department; (II) Provide outreach to targeted eligible seniors and dental care providers; (III) Identify eligible seniors and qualified providers; (IV) Demonstrate collaboration with community organizations; (V) Ensure that eligible seniors receive covered dental care services efficiently without duplication of services; (VI) Maintain records of eligible seniors served, dental care services provided, and moneys spent for a minimum of six years; and (VII) Distribute grant funds to qualified providers in their service area or directly provide covered dental care services to eligible seniors in their service area. (b) A qualified grantee may expend no more than seven percent of the amount of its grant for administrative purposes. (c) A qualified grantee may also be a qualified provider if the person meets the qualifications of a qualified provider. (4) Following recommendations of the state department and the advisory committee, the medical services board shall adopt rules pursuant to section 24-4-103, C.R.S., governing the program, including but not limited to: (a) A definition of "economically disadvantaged" for purposes of eligibility; (b) A description of dental services that may be provided to eligible seniors under the program; except that such services must include but not be limited to oral examination, diagnosis, treatment planning, emergency treatment, prophylaxis, X rays, partial and full dentures, replacement or repair of permanent teeth, removal of permanent teeth, fillings, periodontal treatment, and soft tissue treatment; (c) Whether to require eligible seniors to make a co-payment and, if so, the circumstances and amount of the co-payment; (d) A distribution formula for the availability of moneys to each area of the state; and (e) Procedures, criteria, and standards for awarding dental health-care services grants.

C.R.S. § 25.5-3-405 Program reporting

25.5-3-405. Program reporting. (1) On or before September 1, 2015, and each September 1 thereafter, each qualified grantee receiving a dental health-care services grant shall report to the state department concerning the number of eligible seniors served, the types of dental and oral health services provided, recommendations regarding the operation and effectiveness of the program, and any other information deemed relevant by the state department. (2) (a) Notwithstanding the provisions of section 24-1-136 (11)(a)(I), on or before November 1, 2016, and each November 1 thereafter, the state department shall submit a report to the joint budget committee of the general assembly and to the health and human services committee of the senate and the public health care and human services committee of the house of representatives, or any successor committees, on the operation and effectiveness of the program, including an itemization of the department's administrative expenditures in implementing and administering the program and any recommendations for legislative changes to the program. (b) Repealed.

C.R.S. § 25.5-3-406 Senior dental advisory committee - creation - duties - repeal

25.5-3-406. Senior dental advisory committee - creation - duties - repeal. (1) (a) There is created in the state department a senior dental advisory committee comprised of eleven members appointed by the executive director as follows: (I) A member representing the state department; (II) A dentist in private practice providing dental care to the senior population who represents a statewide organization of dentists; (III) A dental hygienist providing dental care to seniors; (IV) A representative of either an agency that coordinates services for low-income seniors or the office in the department of human services responsible for overseeing services to the elderly; (V) A representative of an organization of Colorado community health centers, as defined in the federal "Public Health Service Act", 42 U.S.C. sec. 254b; (VI) A representative of an organization of safety-net health providers that are not community health centers; (VII) A representative of the university of Colorado school of dental medicine; (VIII) Two consumer advocates; (IX) A senior who is eligible for services under the program; and (X) A representative of a foundation with experience in making dental care grants. (b) Members of the committee shall serve three-year terms. Of the members initially appointed to the advisory committee, the executive director shall appoint six for two-year terms and five for three-year terms. In the event of a vacancy on the advisory committee, the executive director shall appoint a successor to fill the unexpired portion of the term of such member. (c) (I) The executive director shall designate a member to serve as the chair of the advisory committee. The advisory committee shall meet as necessary at the call of the chair. (II) Members of the advisory committee serve without compensation or reimbursement of expenses. (III) Pursuant to section 24-18-108.5, C.R.S., a member of the advisory committee shall not perform an official act that may have a direct economic benefit on a business or other undertaking in which the member has a direct or substantial financial interest. (d) Repealed. (e) The state department shall provide staff assistance to the advisory committee. (2) The advisory committee shall: (a) Advise the state department on the operation of the program; (b) Make recommendations to the medical services board regarding rules to be promulgated pursuant to section 25.5-3-404, including but not limited to: (I) Defining covered dental care services; (II) Whether to require eligible seniors to make a co-payment and, if so, the circumstances and amount of the co-payment; (III) The distribution formula for the availability of funds to each area of the state; (IV) Dental health-care services grant procedures, criteria, and standards, including preference for qualified grantees who demonstrate collaboration with community organizations such as a local area agency on aging; and (V) A maximum amount per procedure that can be spent by qualified grantees and qualified providers that must not be less than the reimbursement schedule for fee-for-service dental fees under the medical assistance program established in articles 4, 5, and 6 of this title 25.5. (3) (a) This section is repealed, effective September 1, 2029. (b) Prior to said repeal, the advisory committee must be reviewed as provided for in section 2-3-1203, C.R.S.

C.R.S. § 25.5-3-501 Definitions

25.5-3-501. Definitions. As used in this part 5, unless the context otherwise requires: (1) "Health-care facility" means: (a) A hospital licensed as a general hospital pursuant to part 1 of article 3 of title 25; (b) A hospital established pursuant to section 23-21-503 or 25-29-103; (c) [Editor's note: This version of subsection (1)(c) is effective until July 1, 2026.] Any freestanding emergency department licensed pursuant to section 25-1.5-114; or (c) [Editor's note: This version of subsection (1)(c) is effective July 1, 2026.] Any freestanding emergency department licensed pursuant to section 25-1.5-114; (d) Any outpatient health-care facility that is licensed as an on-campus department or service of a hospital or that is listed as an off-campus location under a hospital's license, except: (I) A federally qualified health center, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4); or (II) [Editor's note: This version of subsection (1)(d)(II) is effective until July 1, 2026.] A student-learning medical and dental clinic that is established for the purpose of student learning, offering discounted patient care as part of a program of student learning, and is physically situated within a health sciences school. (II) [Editor's note: This version of subsection (1)(d)(II) is effective July 1, 2026.] A student-learning medical and dental clinic that is established for the purpose of student learning and offering discounted patient care as part of a program of student learning and is physically situated within a health sciences school; or (e) [Editor's note: Subsection (1)(e) is effective July 1, 2026.] A critical access hospital as defined in section 25-1.5-114.5. (2) "Health-care services" has the same meaning as set forth in section 10-16-102 (33). (2.5) "Inpatient hospital service" has the same meaning as set forth in 42 CFR 440.10. (3) "Licensed health-care professional" means any health-care professional who is registered, certified, or licensed pursuant to title 12 or who provides services under the supervision of a health-care professional who is registered, certified, or licensed pursuant to title 12, and who provides health-care services in a health-care facility. (4) Repealed. (4.5) "Outpatient hospital service" has the same meaning as set forth in 42 CFR 440.20. (5) "Qualified patient" means an individual who attests to residing in Colorado whose household income is not more than two hundred fifty percent of the federal poverty level and who received an inpatient hospital service or outpatient hospital service at a health-care facility. (6) "Screen" or "screening" means a process identified in rule by the state department whereby health-care facilities assess a patient's circumstances related to eligibility criteria and determine whether the patient is likely to qualify for public health-care coverage or discounted care, inform the patient of the health-care facility's determination, and provide information to the patient about how the patient can enroll in public health-care coverage. (7) "Uninsured" means an uninsured individual, as defined in section 10-22-113 (5)(d).

C.R.S. § 25.5-3-502 Requirement to screen patients for eligibility for public health-care programs and discounted care - rules - repeal

25.5-3-502. Requirement to screen patients for eligibility for public health-care programs and discounted care - rules - repeal. (1) Beginning September 1, 2022, a health-care facility shall screen, unless a patient declines, each uninsured patient for eligibility for: (a) [Editor's note: This version of subsection (1)(a) is effective until July 1, 2025.] Public health insurance programs including but not limited to medicare; the state medical assistance program, articles 4, 5, and 6 of this title 25.5; emergency medicaid; and the children's basic health plan, article 8 of this title 25.5; (a) [Editor's note: This version of subsection (1)(a) is effective July 1, 2025.] Public health insurance programs including but not limited to medicare; the state medical assistance program, articles 4, 5, and 6 of this title 25.5; emergency medicaid; and the children's basic health plan, article 8 of this title 25.5; and (b) (I) Discounted care through the Colorado indigent care program, established in part 1 of this article 3, if the patient receives a service eligible for reimbursement through the program; and (II) This subsection (1)(b) is repealed, effective July 1, 2025. (c) Discounted care, as described in section 25.5-3-503. (2) Health-care facilities shall use a single uniform application developed by the state department when screening a patient pursuant to subsection (1) of this section. (3) If a health-care facility determines that a patient is ineligible for discounted care, the facility shall provide the patient notice of the determination and an opportunity for the patient to appeal the determination in accordance with state department rules. (4) If the patient declines the screening described in subsection (1) of this section, the health-care facility shall document the patient's decision in accordance with state department rules. A patient's decision to decline the screening that is documented and complies with state department rules is a complete defense to a claim brought by a patient under section 25.5-3-506 (2) for a violation of section 25.5-3-506 (1)(a) or (1)(b). (5) If requested by the patient, a health-care facility shall screen an insured patient for discounted care pursuant to subsections (1)(b) and (1)(c) of this section.

C.R.S. § 25.5-3-503 Health-care discounts on services not eligible for Colorado indigent care program reimbursement - definition

25.5-3-503. Health-care discounts on services not eligible for Colorado indigent care program reimbursement - definition. (1) Beginning September 1, 2022, if a patient is screened pursuant to section 25.5-3-502 and is determined to be a qualified patient, a health-care facility and a licensed health-care professional shall, for emergency hospital and other health-care services: (a) Limit the amounts charged to not more than the discounted rate established in state department rule pursuant to section 25.5-3-505 (2)(j); (b) Collect amounts charged, not including amounts owed by third-party payers, in monthly installments such that the patient is not paying more than four percent of the patient's monthly household income on a bill from a health-care facility, not paying more than two percent of the patient's monthly household income on a bill from each licensed health-care professional, and not paying more than six percent of the patient's household income on a comprehensive bill containing all health-care facility and licensed health-care professional charges; and (c) After a cumulative thirty-six months of payments, consider the patient's bill paid in full and permanently cease any and all collection activities on any balance that remains unpaid. (2) A health-care facility shall not: (a) Deny discounted care on the basis that the patient has not applied for any public benefits program, unless during the initial screening the patient is determined to be presumptively eligible for the state medical assistance program; or (b) Adopt or maintain any policies that result in the denial of admission or treatment of a patient because the patient lacks health insurance coverage, may qualify for discounted care, requires extended or long-term treatment, or has an unpaid medical bill. (3) The licensed health-care professional who provides services to a patient pursuant to this part 5 is responsible for billing the patient for those services, unless the services are billed on a comprehensive bill issued by a health-care facility. (4) For the purposes of this part 5, "emergency hospital and other health-care services" does not include primary care provided in a clinic located in a designated rural or frontier county that offers a sliding-fee scale as approved by the state department.

C.R.S. § 25.5-3-504 Notification of patients' rights

25.5-3-504. Notification of patients' rights. (1) Beginning September 1, 2022, a health-care facility shall make information developed by the state department about patients' rights under this part 5 and the uniform application developed by the state department pursuant to section 25.5-3-505 (2)(i) available to the public and to each patient. At a minimum, the health-care facility shall: (a) Post the information in all required languages pursuant to this subsection (1) conspicuously on the health-care facility's website, including a link to the information on the health-care facility's main landing page; (b) Make the information available in patient waiting areas; (c) Make the information available to each patient, or the patient's legal guardian, verbally, which may include using a professional interpretation service, or in writing in the patient's or legal guardian's primary language before the patient is discharged from the health-care facility; and (d) Inform each patient on the patient's billing statement of the patient's rights pursuant to this part 5, including the right to apply for discounted care, and provide the website, e-mail address, and telephone number where the information may be obtained in the patient's primary language.

C.R.S. § 25.5-3-505 Health-care facility reporting requirements - agency enforcement - report - rules

25.5-3-505. Health-care facility reporting requirements - agency enforcement - report - rules. (1) Beginning September 1, 2023, and each September 1 thereafter, each health-care facility and licensed health-care professional shall report to the state department data that the state department determines is necessary to evaluate compliance across race, ethnicity, age, and primary-language-spoken patient groups with the screening, discounted care, payment plan, and collections practices required pursuant to this part 5. If a health-care facility or licensed health-care professional is not capable of disaggregating the data required pursuant to this subsection (1) by race, ethnicity, age, and primary language spoken, the health-care facility or licensed health-care professional shall report to the state department the steps the facility or licensed health-care professional is taking to improve race, ethnicity, age, and primary-language-spoken data collection and the date by which the facility or licensed health-care professional will be able to disaggregate the reported data. (2) No later than April 1, 2022, the state board shall promulgate rules necessary for the administration and implementation of this part 5. At a minimum, the rules must: (a) Outline a process for an insured patient to request a screening pursuant to section 25.5-3-502 (5); (b) Outline a process for documenting, pursuant to section 25.5-3-502 (4), that a patient has made an informed decision to decline the screening, including procedures for retaining such documentation; (c) Establish the process for and the maximum number of days that a health-care facility has to: (I) Initiate a screening after a patient receives services; (II) Request information from the patient needed for the screening process; and (III) Complete the screening process; (d) Outline the requirements for notifying the patient of the results of the screening, including an explanation of the basis for a denial of discounted care and the process for appealing a denial; (e) Establish guidelines for patient appeals regarding eligibility for discounted care pursuant to section 25.5-3-503; (f) Establish a methodology that all health-care facilities must use to determine monthly household income. The methodology must not consider a patient's assets. (g) Identify the documents that may be required to establish income eligibility for discounted care using the minimum amount of information needed to determine eligibility; (h) Identify the steps a health-care facility and licensed health-care professional must take before sending patient debt to collections; (i) [Editor's note: This version of subsection (2)(i) is effective until July 1, 2025.] Create a single uniform application that a health-care facility shall use when screening a patient for eligibility for the Colorado indigent care program and discounted care, as described in section 25.5-3-502; and (i) [Editor's note: This version of subsection (2)(i) is effective July 1, 2025.] Create a uniform application that a health-care facility must use when screening a patient for eligibility for discounted care, as described in section 25.5-3-502; and (j) Annually establish rates for discounted care pursuant to section 25.5-3-503 (1)(a). The rates should approximate and not be less than one hundred percent of the medicare rate or one hundred percent of the medicaid base rate, whichever is greater. The state department shall publicly post the established rates on the state department's website. (3) [Editor's note: This version of subsection (3) is effective until July 1, 2025.] In promulgating rules pursuant to this section, the state department shall: (a) Align the processes of qualifying for and appealing denials of eligibility for the Colorado indigent care program with discounted care, as described in section 25.5-3-502; and the established rates on the state department's website. (3) [Editor's note: This version of subsection (3) is effective until July 1, 2025.] In promulgating rules pursuant to this section, the state department shall: (a) Align the processes of qualifying for and appealing denials of eligibility for the Colorado indigent care program with discounted care, as described in section 25.5-3-502; and (b) Consider potential limitations relating to the federal "Emergency Medical Treatment and Labor Act", 42 U.S.C. sec. 1395dd. (3) [Editor's note: This version of subsection (3) is effective July 1, 2025.] In promulgating rules pursuant to this section, the state department shall consider potential limitations relating to the federal "Emergency Medical Treatment and Labor Act", 42 U.S.C. sec. 1395dd. (4) Prior to promulgating rules pursuant to this section, the state department shall hold at least one stakeholder meeting with hospital representatives, health-care consumers, and health-care consumer advocates that is accessible to individuals whose primary language is not English, if requested. (5) No later than April 1, 2022, the state department shall: (a) Using feedback from hospital health-care consumers and health-care consumer advocate stakeholders, develop a written explanation of a patient's rights under this section that is written in plain language at a sixth-grade reading level and translated into all languages spoken by ten percent or more of the population in each county of the state and post the written explanation in all required languages on the state department's website. Each health-care facility shall make the explanation available to the public and each patient as provided in section 25.5-3-504. (b) (I) Establish a process for patients to submit a complaint relating to noncompliance with this part 5 to the state department by phone, mail, or online. The state department shall conduct a review within thirty days after receiving a complaint. (II) The state department shall periodically review health-care facilities and licensed health-care professionals to ensure compliance with this section. If the state department finds that a health-care facility or licensed health-care professional is not in compliance with this section, the state department shall notify the health-care facility or licensed health-care professional and the facility or professional has ninety days to file a corrective action plan with the state department that must include measures to inform the patient about the noncompliance and provide a financial correction consistent with this part 5. A health-care facility or licensed health-care professional may request up to one hundred twenty days to submit a corrective action plan. The state department may require a health-care facility or licensed health-care professional that is not in compliance with this part 5 or any state board rules adopted pursuant to this part 5 to develop and operate under a corrective action plan until the state department determines the health-care facility or licensed health-care professional is in compliance. (III) If a health-care facility's or licensed health-care professional's noncompliance with this section is determined by the state department to be knowing or willful or there is a repeated pattern of noncompliance, the state department may fine the facility or professional no more than five thousand dollars. If the health-care facility or licensed health-care professional fails to take corrective action or fails to file a corrective action plan with the state department pursuant to subsection (5)(b)(II) of this section, the state department may fine the facility or professional no more than five thousand dollars a week until the facility or professional takes corrective action. The state department shall consider the size of the health-care facility and the seriousness of the violation in setting the fine amount. a corrective action plan with the state department pursuant to subsection (5)(b)(II) of this section, the state department may fine the facility or professional no more than five thousand dollars a week until the facility or professional takes corrective action. The state department shall consider the size of the health-care facility and the seriousness of the violation in setting the fine amount. (6) The state department shall make the information reported pursuant to subsection (1) of this section and any corrective action plans for which fines were imposed pursuant to subsection (5)(b) of this section available to the public and shall annually report the information as a part of its presentation to its committees of reference at a hearing held pursuant to section 2-7-203 (2)(a) of the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act".

C.R.S. § 25.5-3-506 Limitations on collection actions - private enforcement

25.5-3-506. Limitations on collection actions - private enforcement. (1) Beginning September 1, 2022, before assigning or selling patient debt to a collection agency, as defined in section 5-16-103 (3)(a), or a debt buyer, as defined in section 5-16-103 (8.5), or before pursuing, either directly or indirectly, any permissible extraordinary collection action, as defined in section 6-20-201 (7): (a) A health-care facility shall meet the screening requirements in section 25.5-3-502; (b) A health-care facility and licensed health-care professional shall provide discounted care to a patient pursuant to section 25.5-3-503; (c) A health-care facility and licensed health-care professional shall provide a plain language explanation of the health-care services and fees being billed and notify the patient of potential collection actions; and (d) A health-care facility and health-care professional shall bill any third-party payer that is responsible for providing health-care coverage to the patient. If a health-care professional is an out-of-network provider under a qualified patient's health insurance plan, the health-care professional and health insurance carrier shall comply with the out-of-network billing requirements described in sections 10-16-704 (3) and 12-30-113. (2) A health-care facility or licensed health-care professional that fails to comply with the requirements of this section is liable to the patient in an amount equal to the sum of: (a) Any actual damages sustained by the patient as a result of such failure; (b) In the case of such action brought by an individual, any additional damages that the court may allow, not to exceed one thousand dollars; (c) In the case of a class action, such amount for each named plaintiff that may recover damages under subsection (2)(b) of this section, and such amount that the court may allow for all other class members without regard to a minimum individual recovery, not to exceed the lesser of five hundred thousand dollars or one percent of the net worth of the health-care facility or licensed health-care professional; and (d) In the case of any successful action to enforce the foregoing liability, the costs of the action together with reasonable attorney fees as determined by the court. On a finding by the court that the action was brought in bad faith, the court may award reasonable attorney fees to the defendant that are related to the work expended and costs. (3) In determining the amount of liability in any action pursuant to subsection (2) of this section, the court shall consider, among other relevant factors: (a) In any individual action brought pursuant to subsection (2)(a) of this section, the frequency and persistence of noncompliance by the health-care facility or licensed health-care professional, the nature of such noncompliance, and the extent to which such noncompliance was intentional; or (b) In any individual action brought pursuant to subsection (2)(b) of this section, the frequency and persistence of noncompliance by the health-care facility or licensed health-care professional, the nature of such noncompliance, the resources of the health-care facility or licensed health-care professional, the number of individuals adversely affected, and the extent to which the health-care facility's or licensed health-care professional's noncompliance was intentional.

C.R.S. § 25.5-3-507 Hospital discounted care advisory committee - repeal

25.5-3-507. Hospital discounted care advisory committee - repeal. [Editor's note: This section is effective July 1, 2025.] (1) The hospital discounted care advisory committee is created in the state department. The advisory committee consists of the following members, appointed by the executive director: (a) Three members who are health-care consumers, of whom no more than two members may be employed by a health-care consumer advocacy organization; (b) One member who is a representative of the state department; (c) One member who is a representative of a safety net hospital for which the percent of medicaid-eligible inpatient days relative to the hospital's total inpatient days is equal to or greater than one standard deviation above the mean; (d) One member who is a representative of a hospital in a rural area; (e) One member who is a representative of a hospital in an urban area; (f) One member who is a representative of a statewide organization of hospitals; (g) One member who is a representative of licensed health-care professionals who provide services to patients in a hospital setting; (h) One member who is a representative of an organization of Colorado community health centers or a representative of a Colorado community health center, as defined in 42 U.S.C. sec. 254b; and (i) One member who is a representative of an organization of safety-net health providers or a safety-net health provider that is not a community health center. (2) Advisory committee members serve three-year terms. Of the members initially appointed to the advisory committee, the executive director shall appoint six members for two-year terms and five members for three-year terms. In the event of a vacancy on the advisory committee, the executive director shall appoint a successor to fill the unexpired portion of the term for the member. (3) (a) The executive director shall designate a member to serve as chair of the advisory committee. The advisory committee shall meet at least twice each year and as necessary at the call of the chair. (b) Members of the advisory committee serve without compensation or reimbursement of expenses. (4) The advisory committee shall advise the state department on the operations and policies of this part 5 and make recommendations to the state board regarding promulgating rules pursuant to this part 5. (5) This section is repealed, effective September 1, 2029. Prior to the repeal, the advisory committee is scheduled for review in accordance with section 2-3-1203.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://leg.colorado.gov/sites/default/files/images/olls/crs2024-title-25.5.docxFetched: 10/6/2026

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