Colo. Rev. Stat. § 25-3-111, Authentication of verbal orders

(1) A hospital licensed pursuant to part 3 of this article shall require that all verbal orders be authenticated by a physician or responsible individual who has the authority to issue verbal orders in accordance with hospital and medical staff policies or bylaws. The policies or bylaws shall require that:

(a) Authentication of a verbal order occurs within forty-eight hours after the time the order is made unless a read-back and verify process pursuant to paragraph (b) of this subsection (1) is used. The individual receiving a verbal order shall record in writing the date and time of the verbal order, and sign the verbal order in accordance with hospital policies or medical staff bylaws.

(b) A hospital policy may provide for a read-back and verify process for verbal orders. A read-back and verify process shall require that the individual receiving the order immediately read back the order to the physician or responsible individual, who shall immediately verify that the read-back order is correct. The individual receiving the verbal order shall record in writing that the order was read back and verified. If the read-back and verify process is followed, the verbal order shall be authenticated within thirty days after the date of the patient's discharge.

(2) Verbal orders shall be used infrequently. Nothing in this section shall be interpreted to encourage the more frequent use of verbal orders by the medical staff at a hospital.

Source: L. 2010: Entire section added, (HB 10-1229), ch. 199, p. 869, � 1, effective May 5.

25-3-112. Hospitals - charity care information - charges for the uninsured - reports to department - department review - collections protection - hospital financial assistance standards committee established - rules. (Repealed)

Source: L. 2012: Entire section added, (SB 12-134), ch. 162, p. 569, � 1, effective August 8. L. 2014: (1)(d) amended and (3.5), (3.7), (4)(b), (7), (8), and (9) added, (SB 14-050), ch. 269, p. 1080, � 1, effective August 6. L. 2021: Entire section repealed, (HB 21-1198), ch. 435, p. 2885, � 7, effective September 7.

25-3-113. Health-care facility stakeholder forum - creation - membership - duties. (1) There is hereby created in the department of public health and environment the health care facility stakeholder forum, referred to in this section as the stakeholder forum. The stakeholder forum must consist of representatives from various types of provider facilities licensed by the department, consumers, consumer advocates, ombudsmen, and other interested parties. The department shall meet at least four times each year with the stakeholder forum to discuss and take into consideration the concerns and issues of interest to the forum members and other attendees regarding the development and implementation of rules and other matters that affect all health-care facilities licensed by the department.

(2) The members of the stakeholder forum serve on a voluntary basis without compensation and are responsible for noticing, staffing, recording, and reporting the notes from the stakeholder forum meetings. The department shall consider the attendance of its representatives at meetings with the stakeholder forum to be within the normal course of business, with no additional appropriation to or resources from the department required.

(3) The stakeholder forum and the department shall work to coordinate with, and shall not duplicate the work being done by, established or statutorily authorized advisory committees or working groups on issues related to the development and implementation of rules.

(4) For purposes of section 24-4-103 (2), C.R.S., as amended by House Bill 12-1008, enacted in 2012, the department may use the stakeholder forum described in this section, when appropriate, to serve as the representative group for the department of public health and environment.

Source: L. 2012: Entire section added, (HB 12-1294), ch. 252, p. 1258, � 8, effective June 4.

Cross references: For the legislative declaration in the 2012 act adding this section, see section 1 of chapter 252, Session Laws of Colorado 2012.

25-3-114. STEMI task force - creation - membership - duties - report - notice of funding through gifts, grants, and donations - definitions - repeal. (Repealed)

Source: L. 2013: Entire section added, (SB 13-225), ch. 277, p. 1444, � 1, effective May 24.

Editor's note: Subsection (5) provided for the repeal of this section, effective August 1, 2015. (See L. 2013, p. 1444.)

25-3-115. Stroke advisory board - creation - membership - duties - report - definition - repeal. (1) (a) There is created in the department the stroke advisory board, the purpose of which is to evaluate potential strategies for stroke prevention and treatment and develop a statewide needs assessment identifying relevant resources. The governor shall appoint eighteen members to the stroke advisory board as follows:

(I) Six physicians who are actively involved in stroke care and who satisfy the following criteria: One physician who is board-certified in primary care; one physician who is board-certified in vascular neurology; one physician who is privileged and actively practicing interventional neuroradiology; one physician who is board-certified in neurosurgery; one physician representing a statewide chapter of emergency physicians; and one physician who is a board-certified neurologist serving patients in a rural area of the state;

(II) One member representing a statewide association of physicians;

(III) One member representing a statewide hospital association;

(IV) One member who is an emergency medical service provider, as defined in section 25-3.5-103 (8);

(V) One member who is a registered nurse involved in stroke care;

(VI) One hospital administrator from a hospital located in a rural area of the state;

(VII) One hospital administrator from a hospital located in an urban area of the state;

(VIII) One representative from a stroke rehabilitation facility;

(IX) One member who is a Colorado resident representing a national association whose goal is to eliminate cardiovascular disease and stroke;

(X) One member who is a Colorado resident representing a national stroke association;

(XI) One member who is a physical or occupational therapist actively involved in stroke care;

(XII) One member of the public who has suffered a stroke or is the caregiver of a person who has suffered a stroke; and

(XIII) One member who is an expert in stroke database management.

(b) The executive director of the department or the executive director's designee shall serve as an ex officio member of the stroke advisory board.

(c) Members of the stroke advisory board serve without compensation and are not entitled to reimbursement of expenses incurred in serving on or performing duties of the advisory board.

(2) (a) The stroke advisory board shall study and make recommendations for developing a statewide plan to improve quality of care for stroke patients. In conducting the study, the stroke advisory board shall explore the following issues, without limitation:

(I) Creation of a state database or registry consisting of data on stroke care that mirrors the data hospitals submit to nationally recognized organizations;

(II) Access to aggregated stroke data, which must exclude any identifying or confidential information about the reporting hospital or patients treated by the hospital, from a state database that may be developed or from a nationally recognized organization by the advisory board, by any person who submits a written request for the data;

(III) Evaluation of currently available stroke treatments and the development of recommendations, based on medical evidence, for ways to improve stroke prevention and treatment;

(IV) A plan that would encourage rural and urban hospitals to coordinate services for the necessary referral or receipt of patients requiring stroke care in the state; and

(V) The criteria used by nationally recognized bodies for designating a hospital in stroke care and whether a designation is appropriate or needed to assure access to the best quality care for Colorado residents with stroke events.

(b) By January 31, 2014, and by each January 1 thereafter, the stroke advisory board shall submit a report specifying its findings and recommendations to the health and human services committee of the senate, the health, insurance, and environment committee of the house of representatives, or their successor committees, and the department. The stroke advisory board shall include in its report a recommendation on whether a designation of a hospital in stroke care is appropriate or needed to assure access to the best quality care for Colorado residents with stroke events.

(3) The stroke advisory board may accept and expend, subject to appropriation by the general assembly, gifts, grants, and donations to pay the stroke advisory board's direct expenses. The stroke advisory board shall transmit any monetary gifts, grants, or donations it receives to the state treasurer for deposit in the health facilities general licensure cash fund.

(3.5) The department staff is not required to provide any financial support or perform any administrative duties related to the operation of the stroke advisory board.

(4) As used in this section, unless the context otherwise requires, department means the department of public health and environment.

(5) This section is repealed, effective September 1, 2028. Prior to the repeal, the department of regulatory agencies shall review the functions of the stroke advisory board in accordance with section 2-3-1203, C.R.S.

Source: L. 2013: Entire section added, (SB 13-225), ch. 277, p. 1446, � 1, effective May 24. L. 2018: (5) amended, (HB 18-1265), ch. 205, p. 1321, � 1, effective September 1. L. 2020: (3) amended and (3.5) added, (HB 20-1397), ch. 213, p. 1030, � 1, effective June 30. L. 2022: IP(1)(a) amended, (SB 22-013), ch. 2, p. 59, � 75, effective February 25.

25-3-116. Department recognition of national certification - suspension or revocation of recognition. (1) A hospital that has an accreditation, certification, or designation in stroke or STEMI care from a nationally recognized accrediting body, including a certification as a comprehensive stroke center or primary stroke center by the joint commission or an accreditation as a STEMI receiving center or STEMI referral center by the American College of Cardiology Accreditation Services or its successor organization, may send information and supporting documentation to the department. The department shall make a hospital's national accreditation, certification, or designation available to the public in a manner determined by the department.

(2) The department shall deem a hospital that is currently accredited, certified, or designated by a nationally recognized accrediting body as satisfying the requirements for recognition and publication by the department. The department may suspend or revoke a recognition and publication of a hospital's accreditation, certification, or designation if the department determines, after notice and hearing in accordance with the State Administrative Procedure Act, article 4 of title 24, C.R.S., that the hospital no longer holds an active accreditation, certification, or designation from a nationally recognized certifying body.

(3) Whether a hospital attains a national accreditation, certification, or designation in stroke or STEMI care has no bearing on, or connection with, the licensing or certification of the hospital by the department pursuant to section 25-1.5-103 (1)(a).

(4) Repealed.

Source: L. 2013: Entire section added, (SB 13-225), ch. 277, p. 1448, � 1, effective May 24. L. 2017: (1) amended and (4) repealed, (HB 17-1246), ch. 214, p. 834, � 2, effective May 18.

25-3-117. Heart attack database - hospitals to report data on heart attack care. (1) (a) A hospital that is accredited by the American College of Cardiology Accreditation Services or its successor organization or any nationally recognized accrediting body as a STEMI receiving center shall report to the heart attack database data that is consistent with nationally recognized guidelines on individuals with confirmed heart attacks within the state. Within thirty days after receiving a quarterly report of a hospital's heart attack data from the heart attack database, a hospital accredited as a STEMI receiving center shall submit the report to the department.

(b) Hospitals that are recognized as STEMI referral centers pursuant to section 25-3-116 and PCI centers that are not accredited as heart attack receiving centers are encouraged to report data to the heart attack database and provide quarterly database reports to the department.

(2) (a) Reports obtained by the department pursuant to this section are:

(I) Privileged and strictly confidential;

(II) Not subject to civil subpoena, not discoverable, and not admissible in a civil, criminal, or administrative proceeding against a health-care facility or health-care professional; and

(III) Not directly available to the public.

(b) With regard to reports obtained pursuant to this section, the department shall protect the confidentiality of patient records in accordance with state and federal laws and shall not disclose publicly any identifying or proprietary information of any hospital, hospital administrator, health-care professional, or employee.

(3) The department shall sign a letter of commitment with any nationally recognized body whose reports are provided to the department pursuant to subsection (1)(a) of this section to ensure compliance with the confidentiality requirements and, as part of the letter of commitment, request reporting measures and metrics at the national level for benchmarking purposes.

Source: L. 2017: Entire section added, (HB 17-1246), ch. 214, p. 835, � 3, effective May 18.

25-3-118. Hospital off-campus location - obtain and use unique NPI - definitions. (1) An off-campus location of a hospital must apply for, obtain, and use on all claims for reimbursement or payment for health-care services provided at the off-campus location submitted on or after January 1, 2020, a unique NPI that is separate and distinct from the hospital's NPI. The off-campus location's unique NPI must be included on any claim for reimbursement or payment for health-care services provided at the off-campus location, regardless of whether the claim is filed or submitted by or through a central office of the hospital or a health-care clearinghouse.

(2) As used in this section:

(a) Health-care clearinghouse has the same meaning as set forth in 45 CFR 160.103.

(b) NPI or national provider identifier means the standard, unique health identifier for health-care providers that is issued by the national provider system in accordance with 45 CFR 162.

(I) Whose operations are directly or indirectly owned or controlled by, in whole or in part, or affiliated with a hospital, regardless of whether the operations are under the same governing body as the hospital;

(II) That is located more than two hundred fifty yards from the hospital's main campus;

(III) That provides services that are organizationally and functionally integrated with the hospital; and

(IV) That is an outpatient facility providing preventive, diagnostic, treatment, or emergency services.

Source: L. 2018: Entire section added, (HB 18-1282), ch. 158, p. 1108, � 2, effective August 8.

Cross references: For the legislative declaration in HB 18-1282, see section 1 of chapter 158, Session Laws of Colorado 2018.

25-3-119. Freestanding emergency departments - required notices - disclosures - rules - definitions. (1) (a) (I) A freestanding emergency department shall give to every individual seeking treatment at the facility a written notice containing the following statements immediately upon registration:

Patient Information

This is an emergency medical facility that treats emergency medical conditions.

We will screen and treat you regardless of your ability to pay.

You have a right to ask questions regarding your treatment options and costs.

You have a right to receive prompt and reasonable responses to questions and requests.

You have a right to reject treatment.

However, we encourage you to defer your questions until after we screen you for an emergency medical condition.

This is not a complete statement of patient information or rights. You will receive a more comprehensive statement of patient's rights upon the completion of a medical screening examination that does not reveal an emergency medical condition or after treatment has been provided to stabilize an emergency medical condition.

(II) (A) If the freestanding emergency department does not have or include within its facility an urgent care center or clinic, the freestanding emergency department shall include the following statement in the notice required by subsection (1)(a)(I) of this section, immediately following the sentence that reads This is an emergency medical facility that treats emergency medical conditions.:

This is not an urgent care center or primary care provider.

(B) If the freestanding emergency department has or includes within its facility an urgent care center or clinic, the freestanding emergency department shall include the following statement in the notice required by subsection (1)(a)(I) of this section, immediately following the sentence that reads This is an emergency medical facility that treats emergency medical conditions.:

This facility also contains an urgent care center that operates from (insert time urgent care center opens) to (insert time urgent care center closes) and provides primary care services (and insert, if applicable, that the urgent care center offers primary care services by appointment).

(III) If the individual seeking treatment is a minor who is accompanied by an adult, the freestanding emergency department shall provide the written notice required by this subsection (1)(a) to the accompanying adult.

(b) In addition to giving an individual the written notice required by subsection (1)(a) of this section, a freestanding emergency department staff member or health-care provider shall provide the information specified in subsection (1)(a) of this section to the individual orally.

(c) As necessary, the state board of health, by rule, may update the information required to be included in the written notice of patient information set forth in this subsection (1).

(2) (a) A freestanding emergency department shall post a sign that is plainly visible in the area within the facility where an individual seeking care registers or checks in and that states:

This is an emergency medical facility that treats emergency medical conditions.

(b) (I) If the freestanding emergency department does not have or include within its facility an urgent care center or clinic, the freestanding emergency department shall include the following statement on the sign required by this subsection (2), immediately following the statement specified in subsection (2)(a) of this section:

This is not an urgent care center or primary care provider.

(II) If the freestanding emergency department has or includes within its facility an urgent care center or clinic, the freestanding emergency department shall include the following statement on the sign required by this subsection (2), immediately following the statement specified in subsection (2)(a) of this section:

(3) (a) After performing an appropriate medical screening examination and determining that a patient does not have an emergency medical condition or after treatment has been provided to stabilize an emergency medical condition, the freestanding emergency department shall provide to the patient a written disclosure that:

(I) Specifies whether the freestanding emergency department accepts patients who are enrolled in: The state medical assistance program under articles 4, 5, and 6 of title 25.5; medicare, as authorized in Title XVIII of the federal Social Security Act, as amended; the children's basic health plan established under article 8 of title 25.5; or a health plan authorized under 10 U.S.C. sec. 1071 et seq.;

(II) Lists the specific health insurance provider networks and carriers with which the freestanding emergency department participates or states that the freestanding emergency department is not a participating provider in any health insurance provider networks;

(III) States that the freestanding emergency department or a physician providing health-care services at the freestanding emergency department may not be a participating provider in the patient's health insurance provider network;

(IV) States that a physician providing health-care services at the freestanding emergency department may bill separately from the freestanding emergency department for the health-care services provided to the patient;

(V) Specifies the chargemaster or fee schedule price for the twenty-five most common health-care services provided by the freestanding emergency department;

(VI) Contains a statement specifying that the price listed on the freestanding emergency department's chargemaster or fee schedule for any given health-care service is the maximum charge that any patient will be billed for the service and that the actual charge for any health-care service rendered may be lower depending on applicable health insurance benefits and the availability of discounts or financial assistance;

(VII) Contains the following statement or a statement containing substantially similar information:

If you are covered by health insurance, you are strongly encouraged to consult with your health insurer to determine accurate information about your financial responsibility for a particular health-care service provided at this freestanding emergency department. If you are not covered by health insurance, you are strongly encouraged to contact (insert name and telephone number for office responsible for financial services) to discuss payment options and the availability of financial assistance prior to receiving a health-care service from this freestanding emergency department.

(VIII) Contains information about the facility fees that the freestanding emergency department charges, indicating either the maximum facility fee that the freestanding emergency department charges or the range of the minimum to maximum amount of the facility fees that the freestanding emergency department charges; and

(IX) Includes the freestanding emergency department's website address where the information contained in the disclosure required by this subsection (3) may be found.

(b) A freestanding emergency department shall update the information contained in the written disclosure required by this subsection (3) at least once every six months.

(c) Receipt of the disclosure under this subsection (3) does not waive a covered person's protections under section 10-16-704 (3)(b).

(4) A freestanding emergency department shall post the disclosure required by subsection (3) of this section on its website and update the disclosure posted on its website at least once every six months.

(5) A freestanding emergency department shall provide the information required by this section in a clear and understandable manner and in languages appropriate to the communities and patients the freestanding emergency department serves.

(6) Nothing in this section affects or otherwise limits a hospital's or other health facility's obligations under section 6-20-101 or article 49 of this title 25.

(7) The state board of health may adopt rules as necessary to implement and enforce this section, including rules necessary to ensure that freestanding emergency departments are complying in good faith with the intent of this section and the transparency and disclosure requirements of this section.

(8) As used in this section:

(a) Chargemaster or fee schedule, which is often referred to as charge description master or CDM, means a uniform schedule of charges represented by a health facility as the facility's gross billed charge, or maximum charge that any patient will be billed, for a given health-care service, regardless of payer and before any discounts or negotiations are applied.

(b) Emergency medical condition has the same meaning as set forth in 42 U.S.C. sec. 1395dd (e)(1).

Source: L. 2018: Entire section added, (SB 18-146), ch. 157, p. 1101, � 2, effective January 1, 2019. L. 2019: (8)(c) amended, (HB 19-1010), ch. 324, p. 2998, � 4, effective August 2.

Cross references: For the legislative declaration in SB 18-146, see section 1 of chapter 157, Session Laws of Colorado 2018.

25-3-120. Regulation of surgical smoke - requirement to adopt a policy - definitions - applicability. (1) On or before May 1, 2021, each hospital with surgical services and each ambulatory surgical center, licensed in accordance with this article 3, shall adopt and implement a policy that prevents human exposure to surgical smoke via the use of a surgical smoke evacuation system during any planned surgical procedure that is likely to generate surgical smoke.

(2) As used in this section:

(a) Surgical smoke means the gaseous by-product produced by energy-generating devices including surgical plume, smoke plume, bio-aerosols, laser-generated airborne contaminants, or lung-damaging dust.

(b) Surgical smoke evacuation system means equipment designed to capture and neutralize surgical smoke at the point of origin and before the surgical smoke makes contact with the eyes or the respiratory tract of the occupants of a room.

Source: L. 2019: Entire section added, (HB 19-1041), ch. 62, p. 226, � 1, effective August 2.

25-3-121. Health-care facilities - emergency and nonemergency services - required disclosures - balance billing - deceptive trade practice - rules - definitions. (1) On and after January 1, 2020, health-care facilities shall develop and provide disclosures to consumers about the potential effects of receiving emergency or nonemergency services from an out-of-network provider providing services at an in-network facility or emergency services at an out-of-network facility. The disclosures must comply with the rules adopted pursuant to subsection (2) of this section.

(2) The state board of health, in consultation with the commissioner of insurance and the applicable regulators of health-care providers in the division of professions and occupations in the department of regulatory agencies, shall adopt rules that specify the requirements for health-care facilities to develop and provide consumer disclosures in accordance with this section. The state board of health shall ensure that the rules, at a minimum, comply with the notice and consent requirements in subsection (3.5) of this section and the federal No Surprises Act.

(3) Receipt of the disclosure required by this section does not waive a consumer's protections under section 10-16-704 (3) or (5.5) or the consumer's right to benefits under the consumer's health benefit plan at the in-network benefit level for all covered services and treatment received.

(3.5) (a) An out-of-network facility may balance bill a covered person for services other than ancillary services if:

(I) The out-of-network facility provides written notice that the facility will balance bill a covered person at least seventy-two hours in advance of the date of service, if the appointment was scheduled at least seventy-two hours in advance, or at least three hours before the scheduled appointment, if the appointment was made less than seventy-two hours in advance, in either paper or electronic format, as selected by the covered person. The notice must be available in the fifteen most common languages in the geographic region in which the out-of-network facility is located. The notice must state:

(A) If applicable, that the facility is out of network with respect to the covered person's health benefit plan;

(B) Effective upon the implementation date of the applicable federal rules, a good-faith estimate of the amount of the charges for which the covered person may be responsible;

(D) If the facility is a participating provider and the health-care provider is not a participating provider, a list of participating providers at the facility who are able to provide the same services;

(E) Information about whether prior authorization or other care management limitations may be required in advance of receiving the requested services; and

(F) That consent to receive the services at an out-of-network facility is optional and that the covered person may seek services from a participating provider, in which case the cost-sharing responsibility of the covered person would not exceed the responsibility for in-network benefits under the covered person's health benefit plan;

(II) The out-of-network facility obtains signed consent from the covered person that acknowledges that the covered person has been:

(A) Provided with written notice of the covered person's financial responsibility, in the format and language selected by the covered person and within the applicable periods specified in subsection (3.5)(a)(I) of this section; and

(B) Provided written notice that the payment by the covered person for health-care services provided at the out-of-network facility may not accrue toward meeting any limitation that the health benefit plan places on cost sharing, including an explanation that the payment may not apply to an in-network deductible.

(b) The notice and consent required by this subsection (3.5) must include the date on which the covered person received the written notice and the date and the time at which the consent form was signed. The out-of-network facility shall provide a signed copy of the consent form to the covered person through regular or electronic mail.

(c) An out-of-network facility that obtains a signed consent with respect to furnishing an item or service shall retain the signed consent for at least a seven-year period after the date on which such item or service is furnished.

(d) An out-of-network facility shall not balance bill a covered person, as defined in section 10-16-102 (15), for services if the provisions of section 10-16-705 (4.5)(c)(II) apply.

(3.7) A violation of this section is a deceptive trade practice pursuant to section 6-1-105 (1)(xxx).

(4) As used in this section and section 25-3-122:

(a) Ancillary services means:

(I) Diagnostic services, including radiology and laboratory services, unless excluded by rule of the secretary of the United States department of health and human services pursuant to 42 U.S.C. sec. 300gg-132 (b)(3);

(II) Items and services related to emergency medicine, anesthesiology, pathology, radiology, and neonatology, whether or not provided by a physician or nonphysician provider, unless excluded by rule of the secretary of the United States department of health and human services pursuant to section 2799B-2 (b)(3) of the federal No Surprises Act;

(III) Items and services provided by assistant surgeons, hospitalists, and intensivists, unless excluded by rule of the secretary of the United States department of health and human services pursuant to section 2799B-2 (b)(3) of the federal No Surprises Act;

(IV) Items and services provided by an out-of-network provider if there is no in-network provider who can furnish the needed services at the facility; and

(V) Any other items and services provided by specialty providers as established by rule of the commissioner.

(a.3) Balance bill has the same meaning as set forth in section 10-16-704 (19)(c).

(a.5) Carrier has the same meaning as set forth in section 10-16-102 (8).

(b) Covered person has the same meaning as defined in section 10-16-102 (15).

(c.5) Federal 'No Surprises Act' means the federal No Surprises Act, Pub.L. 116-260, as amended.

(d) Geographic area has the same meaning as set forth in section 10-16-704 (19)(h).

(e) Health benefit plan has the same meaning as defined in section 10-16-102 (32).

(f) Medicare reimbursement rate has the same meaning as set forth in section 10-16-704 (19)(k).

(g) Out-of-network facility means a health-care facility that is not a participating provider.

(h) Participating provider has the same meaning as set forth in section 10-16-102 (46).

Source: L. 2019: Entire section added, (HB 19-1174), ch. 171, p. 1992, � 6, effective January 1, 2020. L. 2022: (2), IP(4), (4)(a), (4)(c), (4)(d), (4)(f), and (4)(g) amended and (3.5), (4)(a.3), (4)(a.5), (4)(c.5), and (4)(h) added, (HB 22-1284), ch. 446, p. 3147, � 5, effective August 10. L. 2023: (3.7) added, (SB 23-093), ch. 152, p. 649, � 11, effective May 4. L. 2024: (3.5)(d) added, (SB 24-093), ch. 41, p. 149, � 3, effective January 1, 2025.

25-3-122. Out-of-network facilities - emergency medical services - billing - payment - deceptive trade practice. (1) If a covered person receives emergency services at an out-of-network facility, the out-of-network facility shall:

(a) Submit a claim for the entire cost of the services to the covered person's carrier; and

(b) Not bill or collect payment from a covered person for any outstanding balance for covered services not paid by the carrier, except for the applicable in-network coinsurance, deductible, or copayment amount required to be paid by the covered person.

(2) (a) If a covered person receives emergency services at an out-of-network facility, and the facility receives payment from the covered person for services for which the covered person is not responsible pursuant to section 10-16-704 (3)(b) or (5.5), the facility shall reimburse the covered person within sixty calendar days after the date that the overpayment was reported to the facility.

(b) An out-of-network facility that fails to reimburse a covered person as required by subsection (2)(a) of this section for an overpayment shall pay interest on the overpayment at the rate of ten percent per annum beginning on the date the facility received the notice of the overpayment. The covered person is not required to request the accrued interest from the out-of-network health-care facility in order to receive interest with the reimbursement amount.

(3) (a) An out-of-network facility, other than any out-of-network facility operated by the Denver health and hospital authority pursuant to article 29 of title 25, must send a claim for emergency services to the carrier within one hundred eighty days after the receipt of insurance information in order to receive reimbursement as specified in this subsection (3)(a). The reimbursement rate is the greater of:

(I) One hundred five percent of the carrier's median in-network rate of reimbursement for that service provided in a similar facility or setting in the same geographic area; or

(II) The median in-network rate of reimbursement for the same service provided in a similar facility or setting in the same geographic area for the prior year based on claims data from the all-payer health claims database created in section 25.5-1-204.

(b) An out-of-network facility operated by the Denver health and hospital authority created in section 25-29-103 must send a claim for emergency services to the carrier within one hundred eighty days after the delivery of services in order to receive reimbursement as specified in this subsection (3)(b). The reimbursement rate is the greater of:

(I) The carrier's median in-network rate of reimbursement for the same service provided in a similar facility or setting in the same geographic area;

(II) Two hundred fifty percent of the medicare reimbursement rate for the same service provided in a similar facility or setting in the same geographic area; or

(III) The median in-network rate of reimbursement for the same service provided in a similar facility or setting in the same geographic area for the prior year based on claims data from the Colorado all-payer health claims database described in section 25.5-1-204.

(c) If the out-of-network facility submits a claim for emergency services after the one-hundred-eighty-day period specified in this subsection (3), the carrier shall reimburse the facility one hundred twenty-five percent of the medicare reimbursement rate for the same services in a similar setting or facility in the same geographic area.

(d) The out-of-network facility shall not bill a covered person any outstanding balance for a covered service not paid for by the carrier, except for any coinsurance, deductible, or copayment amount required to be paid by the covered person.

(4) An out-of-network facility may initiate arbitration pursuant to section 10-16-704 (15) if the facility believes the payment made pursuant to subsection (3) of this section is not sufficient.

(5) This section does not apply when a covered person voluntarily uses an out-of-network provider.

(6) A violation of this section is a deceptive trade practice pursuant to section 6-1-105 (1)(xxx).

Source: L. 2019: Entire section added, (HB 19-1174), ch. 171, p. 1994, � 6, effective January 1, 2020. L. 2023: (6) added, (SB 23-093), ch. 152, p. 649, � 12, effective May 4.

Cross references: For definitions applicable to this section, see � 25-3-121 (4).

25-3-123. Mental health facility pilot program - establishment - rules - definitions. (1) As used in this section, unless the context otherwise requires:

(a) Mental health facility means a facility approved to participate in the pilot program pursuant to subsection (2) of this section.

(b) Pilot program means the mental health facility pilot program established pursuant to this section.

(2) There is established in the department the mental health facility pilot program to authorize not more than two entities to participate in a three-year pilot program to allow individuals with either a physical health diagnosis or significant mental health diagnosis to reside in a facility that treats both the physical and mental health issues and provides additional services to help the individual transition to independent living.

(3) On or before October 1, 2019, the department shall develop an application for interested entities to apply to be authorized as a mental health facility. The application must require the applicant to show, at a minimum, that it:

(a) Is serving individuals with physical or mental or both physical and mental health diagnoses;

(b) Offers staff secure environments rather than physically secure spaces;

(d) Has sufficient staffing levels of licensed nurses, nursing assistants, and occupational and recreational professionals;

(e) Has a partnership with either an acute care hospital or psychiatric hospital and with a skilled nursing facility, so it has the ability to transfer an individual in need of a higher level of care;

(f) Demonstrates a collaborative relationship with the hospital, including consultation and treatment plan support, one-on-one staffing support, and ongoing training for staff at the mental health facility;

(g) Is in a community that has resources to support community engagement to move an individual to less restrictive environments as an individual progresses;

(h) Demonstrates cost savings or cost neutrality for the state medical assistance program;

(i) Is willing and able to contribute at least one-third of the increased costs that the applicant will incur due to the pilot program and has identified sources for the other two-thirds; and

(j) Is willing to prepare reports on the pilot program.

(4) On or before February 1, 2020, the department shall select up to two applicants to become mental health facilities under the pilot program; except that, if more than one applicant is selected:

(a) One selected applicant must be in a community with a population of over one hundred thousand and one selected applicant must be in a community with a population of under one hundred thousand unless there is no qualified applicant from such a community;

(b) Both selected applicants must not be located in the same city unless the only qualified applicants are from a single city; and

(5) The department is authorized to adopt rules to implement the pilot program.

(6) The state long-term care ombudsman office, established pursuant to section 26-11.5-104, has access to the premises and residents of a mental health facility during reasonable hours for the purposes set out in the federal Older Americans Act of 1965.

Source: L. 2019: Entire section added, (HB 19-1160), ch. 225, p. 2261, � 2, effective August 2.

Cross references: (1) For the federal Older Americans Act of 1965, see Pub.L. 89-76, codified at 42 U.S.C. � 3001 et seq.

(2) For the legislative declaration in HB 19-1160, see section 1 of chapter 225, Session Laws of Colorado 2019.