Hospital Disclosures to Consumers

C.R.S. tit. 6, art. 20

in effect

C.R.S. § 6-20-101 Provider disclosure of average charge

6-20-101. Provider disclosure of average charge. (1) Each hospital licensed or certified pursuant to section 25-1.5-103 (1)(a), C.R.S., shall disclose to a person seeking care or treatment his or her right to receive notice of the average facility charge for such treatment that is a frequently performed inpatient procedure prior to admission for such procedure; except that care or treatment for an emergency need not be disclosed prior to such emergency care or treatment. When requested, the average charge information shall be made available to the person prior to admission for such procedure. (2) Other health facilities licensed or certified pursuant to section 25-1.5-103 (1)(a), C.R.S., shall disclose to a person seeking care or treatment his or her right to receive notice of the average facility charge for such treatment that is a frequently performed procedure prior to ordering or scheduling such procedure; except that care or treatment for an emergency need not be disclosed prior to such emergency care or treatment. When requested, such average charge information shall be made available to the person prior to the scheduling of the procedure.

C.R.S. § 6-20-102 Limits on facility fees - rules - definitions

6-20-102. Limits on facility fees - rules - definitions. (1) Definitions. As used in this section, unless the context otherwise requires: (a) "Affiliated with" means: (I) Employed by a hospital or health system; or (II) Under a professional services agreement, faculty agreement, or management agreement with a hospital or health system that permits the hospital or health system to bill on behalf of the affiliated entity. (b) "Campus" means: (I) A hospital's main buildings; (II) The physical area immediately adjacent to a hospital's main buildings and structures owned by the hospital that are not strictly contiguous to the main buildings but are located within two hundred fifty yards of the main buildings; or (III) Any other area that the federal centers for medicare and medicaid services in the United States department of health and human services has determined, on an individual-case basis, to be part of a hospital's campus. (c) "Critical access hospital" means a hospital that is federally certified or undergoing federal certification as a critical access hospital pursuant to 42 CFR 485, subpart F. (d) "Facility fee" means any fee a hospital or health system charges or bills for outpatient hospital services that is: (I) Intended to compensate the hospital or health system for its operational expenses; and (II) Separate and distinct from a professional fee charged or billed by a health-care provider for professional medical services. (e) "Freestanding emergency department" means a health facility as defined in and required to be licensed under section 25-1.5-114. (f) "Health-care provider" means any person, including a health facility, that is licensed or otherwise authorized in this state to furnish a health-care service. (g) "Health-care service" has the meaning set forth in section 10-16-102 (33). (h) "Health facility" means a facility licensed or certified pursuant to section 25-1.5-103 or established pursuant to part 5 of article 21 of title 23 or article 29 of title 25. (i) "Health system" has the meaning set forth in section 10-16-1303 (9). (j) "Hospital" means a hospital currently licensed or certified by the department of public health and environment pursuant to the department's authority under section 25-1.5-103 (1)(a) or established pursuant to part 5 of article 21 of title 23 or article 29 of title 25. (k) "Medicare" means the "Health Insurance for the Aged Act", Title XVIII of the federal "Social Security Act", as amended by the social security amendments of 1965, and as later amended. (l) "Off-campus location" has the meaning set forth in section 25-3-118. (m) "Owned by" means owned by a hospital or health system when billed under the hospital's tax identification number. (n) [Editor's note: This version of subsection (1)(n) is effective until July 1, 2025.] "Payer type" means commercial insurers; medicare; the medical assistance program established pursuant to articles 4 to 6 of title 25.5; individuals who self-pay; a financial assistance plan; or the "Colorado Indigent Care Program", established in part 1 of article 3 of title 25.5. (n) [Editor's note: This version of subsection (1)(n) is effective July 1, 2025.] "Payer type" means commercial insurers, medicare, the medical assistance program established pursuant to articles 4 to 6 of title 25.5, individuals who self-pay, or a financial assistance plan. (o) "Sole community hospital" has the meaning set forth in 42 CFR 412.92. (2) Limitations on charges. (a) On and after July 1, 2024, a health-care provider or health system shall not charge, bill, or collect a facility fee directly from a patient that is not covered by a patient's insurance for preventive health-care services, as described in section 10-16-104 (18), that are provided in an outpatient setting. munity hospital" has the meaning set forth in 42 CFR 412.92. (2) Limitations on charges. (a) On and after July 1, 2024, a health-care provider or health system shall not charge, bill, or collect a facility fee directly from a patient that is not covered by a patient's insurance for preventive health-care services, as described in section 10-16-104 (18), that are provided in an outpatient setting. (b) This subsection (2) does not prohibit a health-care provider from charging a facility fee for: (I) Health-care services provided in an inpatient setting; (II) Health-care services provided at a health facility that includes a licensed hospital emergency department; or (III) Emergency services provided at a licensed freestanding emergency department. (c) Nothing in this subsection (2) prohibits a health-care provider or health system from charging, billing, or collecting a facility fee from a patient's insurer pursuant to an agreement between the health-care provider or health system and the carrier or as required by law. (3) Transparency. (a) On and after July 1, 2024, a health-care provider affiliated with or owned by a hospital or health system that charges a facility fee shall: (I) (A) Provide notice in plain language to patients that a facility fee may be charged, indicate in the notice the amount of the facility fee, and require the health-care provider to provide the notice to a patient at the time an appointment is scheduled and again at the time the health-care services are rendered; and (B) Post a sign, in English and Spanish and that is plainly visible and located in the area within the health facility where an individual seeking care registers or checks in, that states that the patient may be charged a facility fee in addition to the cost of the health-care service. The sign must also include a location within the health facility where a patient may inquire about facility fees and an online location where information about facility fees may be found. (II) Provide to a patient a standardized bill that: (A) Includes itemized charges for each health-care service; (B) Specifically identifies any facility fee; (C) Identifies specific charges that have been billed to insurance or other payer types for health-care services; and (D) Includes contact information for filing an appeal with the health-care provider to contest charges. (b) The health-care provider shall provide the required notice and standardized bill in a clear manner and, to the extent practicable, in the patient's preferred language. (c) (I) A health facility that is newly affiliated with or owned by a hospital or health system on or after July 1, 2024, shall provide written notice to each patient receiving services within the twelve-month period immediately preceding the affiliation or change of ownership that the health facility is part of a hospital or health system. The notice must include: (A) The name, business address, and phone number of the hospital or health system that is the purchaser of the health facility or with whom the health facility is affiliated; (B) A statement that the health facility bills, or is likely to bill, patients a facility fee that may be in addition to and separate from any professional fee billed by a health-care provider at the health facility; and (C) A statement that, prior to seeking services at the health facility, a patient covered by a health insurance policy or health benefit plan should contact the patient's health insurer for additional information regarding the health facility's facility fees, including the patient's potential financial liability, if any, for the facility fees. by a health-care provider at the health facility; and (C) A statement that, prior to seeking services at the health facility, a patient covered by a health insurance policy or health benefit plan should contact the patient's health insurer for additional information regarding the health facility's facility fees, including the patient's potential financial liability, if any, for the facility fees. (II) A hospital, health system, or health facility shall not collect a facility fee for health-care services provided by a health-care provider affiliated with or owned by a hospital or health system that is subject to any provisions of this section from the date of the transaction until at least thirty days after the written notice required pursuant to subsection (3)(c)(I) of this section is mailed to the patient. (4) Subsection (2) of this section does not apply to a critical access hospital, a sole community hospital in a rural or frontier area, or a community clinic affiliated with a sole community hospital in a rural or frontier area. (5) Subsection (2) of this section does not apply to a hospital established pursuant to article 29 of title 25.

C.R.S. § 6-20-201 Definitions

6-20-201. Definitions. For the purposes of this part 2, unless the context otherwise requires: (1) "Collection activity" means only those activities provided or performed by a licensed collection agency, using a business name other than the name of the health-care provider, for purposes of collecting a debt. The term does not include any standard billing procedures used by the health-care provider or its agent in the normal course of business on current, nondelinquent accounts. (2) "Collection agency" shall have the same meaning as in section 5-16-103 (3). (3) "Health-care provider" includes a health-care facility licensed pursuant to article 3 of title 25, C.R.S., and any other health-care provider. (4) "Hospital services" means health-care services, as defined in section 10-16-102 (33), provided by a health-care facility, as defined in section 25.5-3-501 (1), or a licensed health-care professional, as defined in section 25.5-3-501 (3). (5) "Impermissible extraordinary collection action" means initiating foreclosure on an individual's primary residence or homestead, including a mobile home, as defined in section 38-12-201.5 (5). (6) "Medical creditor" means an entity that attempts to collect on a medical debt, including: (a) A health-care provider or health-care provider's billing office; (b) A collection agency, as defined in section 5-16-103 (3); (c) A debt buyer, as defined in section 5-16-103 (8.5); and (d) A debt collector, as defined in 15 U.S.C. sec. 1692a (6). (7) "Permissible extraordinary collection action" means an action other than an impermissible extraordinary collection action that requires a legal or judicial process, including but not limited to placing a lien on an individual's real property, attaching or seizing an individual's bank account or any other personal property, or garnishing an individual's wages. A permissible extraordinary collection action does not include the assertion of a hospital lien pursuant to section 38-27-101.

C.R.S. § 6-20-202 Notice to patient of debt

6-20-202. Notice to patient of debt. (1) (a) When a person has health benefit coverage to provide payment for care or treatment rendered by a health-care provider and the person has notified the health-care provider of coverage within thirty days after the date the care or treatment was rendered, and if the health coverage plan, as defined in section 10-16-102 (34), C.R.S., pays only a portion of the debt, prior to the assignment of the debt to a licensed collection agency, the health-care provider shall mail written notice to the last-known address of the person responsible for payment of the debt at least thirty days before any collection activity on any amount due and owing the health-care provider. (b) The notice required of health-care providers by paragraph (a) of this subsection (1) shall include the amount due and owing; the name, address, and telephone number of the health-care provider; where payment may be made; the date of service; and the last date or number of days after the date of the notice the health-care provider will accept payment prior to the debt being submitted to a collection agency or reporting adverse information to a consumer reporting agency for the debt for which notice was provided. (2) (a) If the health-care provider fails to provide the person with notice of such debt and all other information required by subsection (1) of this section, the health-care provider shall not pursue any rights to collect such outstanding amount either through a collection agency or by any further efforts of the health-care provider to collect the debt. In addition, the health-care provider may not report adverse information to a consumer reporting agency for the debt for which notice was provided without providing notice to the person pursuant to subsection (1) of this section. The health-care provider shall assist the person in correcting any adverse credit information because of the health-care provider's failure to provide notice pursuant to subsection (1) of this section. (b) Notwithstanding any provision of this section to the contrary, a health-care provider may remedy a failure to give notice by providing a written report to the collection agency to withhold any collection activity and withholding any of the health-care provider's own collection efforts until the provider complies with the notice and time requirements pursuant to subsection (1) of this section. (c) Nothing in this subsection (2) shall be construed to require a health-care provider to perform additional attempts to notify a person of the person's portion of the debt other than mailing the notice required pursuant to subsection (1) of this section to the person's last-known address and maintaining a record of such mailing. (d) The failure of a health-care provider or its agent to provide the notice required by subsection (1) of this section shall not create a cause of action or remedy against a collection agency under the "Colorado Fair Debt Collection Practices Act", article 16 of title 5.

C.R.S. § 6-20-203 Limitations on collection actions - definition

6-20-203. Limitations on collection actions - definition. (1) Beginning June 1, 2022, impermissible extraordinary collection actions may not be used by any medical creditor to collect debts owed for hospital services. (2) Beginning June 1, 2022, no medical creditor collecting on a debt for hospital services shall engage in any permissible extraordinary collection actions until one hundred eighty-two days after the date the patient receives hospital services. (3) (a) Beginning September 1, 2022, at least thirty days before taking any permissible extraordinary collection action, a medical creditor, as defined in section 6-20-201 (6)(a), collecting on a debt for hospital services shall notify the patient of potential collection actions and shall include with the notice a statement developed by the department of health care policy and financing that explains the availability of discounted care for qualified individuals and how to apply for such care. (b) (I) A medical creditor, as defined in section 6-20-201 (6)(b), (6)(c), or (6)(d), collecting on a debt for hospital services shall include the following statement in the notices the medical creditor provides to the patient pursuant to section 5-16-109 (1) and 15 U.S.C. sec. 1692g (a): "Pursuant to Colorado law, discounts for hospital services are available for qualified individuals." The statement must include a link to the written explanation of the patient's rights that is posted to the department of health care policy and financing's website pursuant to section 25.5-3-505 (5)(a). (II) A medical creditor, as defined section 6-20-201 (6)(b), (6)(c), or (6)(d), shall not take any permissible extraordinary collection actions until the later of thirty days from the date of sending the notice required pursuant to subsection (3)(b)(I) of this section or the completion of the validation requirements described in section 5-16-109 (2) and 15 U.S.C. sec. 1692g (b). (4) [Editor's note: This version of the introductory portion to subsection (4) is effective until July 1, 2025.] Beginning September 1, 2022, if a medical creditor collecting on a debt for hospital services bills or initiates collection activities and it is later determined that the patient should have been screened pursuant to section 25.5-3-503 and is determined to be a qualified patient, as defined in section 25.5-3-501 (5), or it is determined that the patient's bill is eligible for reimbursement through a public health-care coverage program or the Colorado indigent care program, the medical creditor shall: (4) [Editor's note: This version of the introductory portion to subsection (4) is effective July 1, 2025.] Beginning September 1, 2022, if a medical creditor collecting on a debt for hospital services bills or initiates collection activities and it is later determined that the patient should have been screened pursuant to section 25.5-3-503 and is determined to be a qualified patient, as defined in section 25.5-3-501 (5), or it is determined that the patient's bill is eligible for reimbursement through a public health-care coverage program, the medical creditor shall: (a) Delete any negative reports to consumer reporting agencies; es and it is later determined that the patient should have been screened pursuant to section 25.5-3-503 and is determined to be a qualified patient, as defined in section 25.5-3-501 (5), or it is determined that the patient's bill is eligible for reimbursement through a public health-care coverage program, the medical creditor shall: (a) Delete any negative reports to consumer reporting agencies; (b) (I) Unless prohibited by law, if the court has entered a judgment on the medical debt: (A) Request the court vacate the judgment in any collection lawsuit over the medical debt and enter into a payment plan with the patient that meets the requirements of section 25.5-3-503 (1)(b); or (B) Request the court reduce the amount of the judgment, including any fees and costs related to the collection lawsuit, to the total amount the patient owes pursuant to the public health-care coverage program or discounted care policy that the patient qualifies for, enter into a payment plan with the patient that meets the requirements of section 25.5-3-503 (1)(b), and suspend all execution on the judgment while the patient is compliant with the terms of the payment plan; or (C) File a satisfaction of judgment such that the remaining unpaid balance of the judgment, including any fees and costs related to the collection lawsuit, is equal to the total amount the patient owes under the public health-care coverage program or discounted care policy that the patient qualifies for, enter into a payment plan with the patient that meets the requirements of section 25.5-3-503 (1)(b), and suspend all execution on the judgment while the patient is compliant with the terms of the payment plan. (II) For the purposes of subsections (4)(b)(I)(B) and (4)(b)(I)(C) of this section, the court shall refund to the parties any fees and costs paid to the court in connection with the litigation of the medical debt and the health-care provider shall indemnify the medical creditor for any fees awarded as part of the judgment in connection with the medical debt. (c) As the term "medical creditor" is defined in section 6-20-201 (6)(a), refund any excess amount to the patient if the patient has paid any part of the medical debt or if any of the patient's money has been seized or levied in excess of the amount that the patient owes after application of required discounts; (d) As the term "medical creditor" is defined in sections 6-20-201 (6)(b), (6)(c), and (6)(d), if the patient has paid any part of the medical debt or if any of the patient's money has been seized or levied in excess of the amount that the patient owes after application of required discounts, refund any excess amount to the patient to the extent the medical creditor has not already remitted such an amount to the health-care provider; and (e) Remedy any other permissible extraordinary collection action. (5) Beginning September 1, 2022, a medical creditor collecting on a debt for hospital services shall not sell a medical debt to another party unless, prior to the sale, the medical debt seller has entered into a legally binding written agreement with the medical debt buyer of the debt pursuant to which: (a) The medical debt buyer agrees not to pursue impermissible extraordinary collection actions to obtain payment for the care; (b) [Editor's note: This version of subsection (5)(b) is effective until July 1, 2025.] The debt is returnable to or recallable by the medical debt seller upon a determination that the patient should have been screened pursuant to section 25.5-3-502 and is eligible for discounted care pursuant to section 25.5-3-503 or that the bill underlying the medical debt is eligible for reimbursement through a public health-care coverage program or the Colorado indigent care program; and 2025.] The debt is returnable to or recallable by the medical debt seller upon a determination that the patient should have been screened pursuant to section 25.5-3-502 and is eligible for discounted care pursuant to section 25.5-3-503 or that the bill underlying the medical debt is eligible for reimbursement through a public health-care coverage program or the Colorado indigent care program; and (b) [Editor's note: This version of subsection (5)(b) is effective July 1, 2025.] The debt is returnable to or recallable by the medical debt seller upon a determination that the patient should have been screened pursuant to section 25.5-3-502 and is eligible for discounted care pursuant to section 25.5-3-503 or that the bill underlying the medical debt is eligible for reimbursement through a public health-care coverage program; and (c) [Editor's note: This version of subsection (5)(c) is effective until July 1, 2025.] If it is determined that the patient should have been screened pursuant to section 25.5-3-502 and is eligible for discounted care pursuant to section 25.5-3-503 or that the bill underlying the medical debt is eligible for reimbursement through a public health-care coverage program or the Colorado indigent care program and the debt is not returned to or recalled by the medical debt seller, the medical debt buyer shall adhere to procedures that must be specified in the agreement that ensures the patient will not pay, and has no obligation to pay, the medical debt buyer and the medical creditor together more than the patient is personally responsible for paying. (c) [Editor's note: This version of subsection (5)(c) is effective July 1, 2025.] If it is determined that the patient should have been screened pursuant to section 25.5-3-502 and is eligible for discounted care pursuant to section 25.5-3-503 or that the bill underlying the medical debt is eligible for reimbursement through a public health-care coverage program and the debt is not returned to or recalled by the medical debt seller, the medical debt buyer shall adhere to procedures that must be specified in the agreement that ensures the patient will not pay, and has no obligation to pay, the medical debt buyer and the medical creditor together more than the patient is personally responsible for paying. (6) The medical debt seller shall indemnify the medical debt buyer for any amount paid for a debt that is returned to or recalled by the medical debt seller. (7) Nothing in this section limits or affects a health-care provider's right to pursue against any party other than the patient the collection of personal injury, liability, uninsured, underinsured, medical payment rehabilitation, disability, homeowner's, business owner's, workers' compensation, fault-based insurance, subrogated claims, or other claims not against the patient.

Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://leg.colorado.gov/sites/default/files/images/olls/crs2024-title-06.docxFetched: 10/6/2026