(1) At least once each year, each reporting hospital shall convene a public meeting to seek feedback regarding the reporting hospital's community benefit activities during the previous year and the reporting hospital's community benefit implementation plan for the following year. The presentation of the community benefit activities for the previous year must include the reporting hospital's discrete community benefit activities, the amount funded for each activity, and a description of how the activities and funding amounts align with the community's identified priorities.
(2) (a) Each reporting hospital shall invite, at a minimum, representatives from the following entities to participate in the meeting described in subsection (1) of this section, if any such entities operate in the reporting hospital's community:
(I) Local public health agencies;
(II) Local chambers of commerce and economic development organizations;
(III) Local health-care consumer organizations;
(IV) School districts;
(V) County governments;
(VI) City and town governments;
(VII) Community health centers;
(VIII) Certified rural health clinics or primary care clinics located in a county that has been designated by the federal office of management and budget as a rural or frontier county;
(IX) Area agencies on aging;
(X) Health-care consumer advocacy organizations;
(XI) A member of the tribal council or the member's designee for a hospital whose community includes one of Colorado's land-based tribes;
(XII) A member from the urban Indian organization for a hospital whose community includes a federally designated urban Indian health center or urban Indian organization; and
(XIII) A member from an institution of higher education for a hospital whose community includes such institutions.
(b) In addition to the entities described in subsection (2)(a) of this section, each reporting hospital shall invite, at a minimum, representatives from the following state agencies to participate in the meeting described in subsection (1) of this section:
(I) The state department;
(II) The department of public health and environment;
(III) The department of human services;
(IV) The Colorado commission on higher education; and
(V) The office of saving people money on healthcare in the lieutenant governor's office.
(c) In addition to the entities described in subsections (2)(a) and (2)(b) of this section, each reporting hospital shall invite the general public to the annual meeting described in subsection (1) of this section. The reporting hospital shall issue such invitation in an advertisement placed in any major newspaper published in the reporting hospital's community, posted on the reporting hospital's public website and social media accounts or other online presence, distributed through the reporting hospital's electronic newsletter or email lists, and distributed by any other means through which the reporting hospital regularly communicates with the community it serves. The invitation must be published at least thirty days prior to the scheduled meeting.
(2.5) When presenting the proposed community benefit implementation plan described in subsection (1) of this section, the reporting hospital must:
(a) Present priority areas identified in the reporting hospital's most recent community health needs assessment and any other community benefit investment option recommended by the reporting hospital. Each priority recommendation presented must clearly identify the source of the recommendation.
(b) Solicit public input for any additional community benefit investment priority; and
(c) Review and incorporate the public feedback received before the reporting hospital finalizes its annual community benefit implementation plan.
(2.7) A reporting hospital may only add community benefit priorities to the reporting hospital's implementation plan if the community benefit priorities were presented at the annual meeting and the public was provided an opportunity to provide feedback. The reporting hospital must indicate that the implemented community benefit priorities are a result of reporting hospital recommendations and not from community feedback.
(2.8) The state board shall promulgate rules to define terms and establish specific processes regarding the requirements for reporting hospitals to solicit, review, and incorporate public input pursuant to subsections (2.5) and (2.7) of this section.
(3) To satisfy the requirements of this section, a reporting hospital may convene a joint public meeting with one or more other reporting hospitals that share some or all of the hospital's community.
(4) For each public meeting and community health needs assessment community engagement meeting held, each reporting hospital shall submit a report to the state department and make the report available to community members by making the report publicly available on the reporting hospital's website. The report must include, at a minimum, the following:
(a) Meeting minutes;
(b) A list of the meeting attendees;
(c) The content of the meeting discussion, including any community benefit priorities discussed and the decisions made regarding those discussed community benefit priorities;
(d) Community feedback received and how the hospital plans to incorporate the feedback into the reporting hospital's community benefit implementation plan; and
(e) Any data collected from attendees, such as data concerning race, ethnicity, or income.
(5) The state department must conduct a stakeholder meeting with consumer advocates, community organizers, community organizations, and hospital representatives to identify and develop, at a minimum, best practices to ensure low-income residents, residents of color, people with serious mental illness, people with disabilities, and other populations experiencing disproportionate health outcomes in local communities are meaningfully engaged and to ensure their input is incorporated into the data used to identify community priorities for the community health needs assessment and community benefit implementation plan. This stakeholder engagement must also include best practices for hospitals to collaborate with local public health agencies and community organizations to reduce redundant community needs assessments.
(6) The state board shall promulgate rules to establish accommodation standards for the annual community benefit public meetings and community health needs assessment that include language accessibility, adequate advanced public notice, and any other type of accessibility measures deemed necessary by the state board, and to implement the best practices identified and developed pursuant to subsection (5) of this section.
(7) The state board shall promulgate any additional rules that may be necessary for conducting the annual community benefit public meetings described in this section.
Source: L. 2019: Entire part added, (HB 19-1320), ch. 191, p. 2107, � 1, effective August 2. L. 2023: (1), (2), and (3) amended and (2.5), (2.7), (2.8), (4), (5), (6), and (7) added, (HB 23-1243), ch. 156, p. 670, � 2, effective August 7. L. 2024: (2)(a)(XIII) amended, (HB 24-1450), ch. 490, p. 3419, � 57, effective August 7.
Cross references: For the legislative declaration in HB 23-1243, see section 1 of chapter 156, Session Laws of Colorado 2023.
25.5-1-703. Hospitals - community health needs assessments - community benefit implementation plans - reports - rules. (1) On or before a date to be determined by rules promulgated by the state board, and on or before such date every three years thereafter, each reporting hospital shall complete a community health needs assessment.
(2) On or before a date to be determined by rules promulgated by the state board, and on or before such date each year thereafter, each reporting hospital shall complete a community benefit implementation plan that:
(a) Addresses the needs described by the reporting hospital's community health needs assessment;
(b) Includes an explanation of the community served by the reporting hospital; and
(c) Describes how the community was determined pursuant to 26 CFR 1.501(r)-3 (b).
(3) On or before a date to be determined by rules promulgated by the state board, and on or before such date each year thereafter, each reporting hospital shall prepare and submit to the state department a report on certain community benefits, costs, and shortfalls. The report must include:
(a) The reporting hospital's most recent community health needs assessment completed pursuant to subsection (1) of this section;
(b) The reporting hospital's community benefit implementation plan for the coming year completed pursuant to subsection (2) of this section;
(c) A copy of the reporting hospital's most recent form 990 submitted to the federal internal revenue service; and
(d) A description of certain spending and investments made by the reporting hospital during the preceding year, including:
(I) A list of the investments made by the reporting hospital that were included in part I, part II, and part III of schedule H of the reporting hospital's form 990. For each such investment, the reporting hospital shall:
(A) Indicate the cost of the investment;
(B) Indicate whether the investment addressed a community-identified health need;
(C) For any investment that addressed a community-identified health need, identify any of the following categories, which may be further defined by rules promulgated by the state board, that are applicable: Free or discounted health-care services; behavioral health; community-based health care; social determinants of health spending, including spending to address individuals' needs, such as housing, food, transportation, interpersonal violence, education, and job opportunities; and provider recruitment, education, and research and training. In identifying these categories, the reporting hospital shall distinguish direct or cash expenditures from in-kind contributions.
(D) For any investment that addressed a community-identified health need, provide evidence showing how the investment improves community health outcomes and how the investment directly corresponds to community-identified needs.
(II) The reporting hospital's total expenses included in line 18 of section 1 of the form 990 submitted by the reporting hospital or by the reporting hospital's ownership entity; and
(III) The reporting hospital's revenue less expenses included in line 19 of section 1 of the form 990 submitted by the reporting hospital or by the reporting hospital's ownership entity.
(3.5) On or before a date to be determined by rules promulgated by the state board, and on or before such date every three years thereafter, the state department shall review each reporting hospital's community health needs assessment and each reporting hospital's annual community benefit implementation plan to identify the highest priority areas as reported by communities as compared to the reporting hospital's reported spending. The state department shall include such information in the report described in subsection (7) of this section.
(4) A reporting hospital that prepares and submits a report pursuant to subsection (3) of this section shall post the report to the reporting hospital's public website.
(5) (a) The state board shall promulgate rules that establish:
(I) Reporting requirements for reporting hospitals that are not required to complete schedule H of the form 990. The rules must promote uniformity with the requirements set forth in subsection (3) of this section.
(II) Requirements for the evidence-based supporting documentation that is required pursuant to subsection (3)(d)(I)(D) of this section.
(b) A general hospital that is licensed as a general hospital pursuant to part 1 of article 3 of title 25 and that is not a reporting hospital may submit a report on certain community benefits, costs, and shortfalls that is consistent with this section.
(6) To facilitate the submission of the reports described in subsection (3) of this section, the state department shall develop and provide a website at which each reporting hospital shall submit the reports. The state department shall ensure that the website and the reports remain available to the public.
(7) As part of the report authorized in section 25.5-4-402.8, the state department shall include a summary of the reports submitted to the state department pursuant to subsection (3) of this section during the preceding year. The summary must include:
(a) The amount that each reporting hospital invested in:
(I) Free or reduced-cost health-care services that addressed community-identified health needs;
(II) Programs that addressed health behaviors or risks;
(III) Programs that addressed social determinants of health; and
(IV) All services and programs that addressed community-identified health needs;
(b) A summary of the reporting hospitals' investments that have been effective in improving community health outcomes;
(c) Any legislative recommendations the state department has for the general assembly; and
(d) The estimated federal and state income tax exemptions and the property tax exemptions received by each hospital, which shall be calculated by the department of revenue.
(8) The state department shall post the reports completed pursuant to subsection (7) of this section to a public web page that the state department creates for this sole purpose.
Source: L. 2019: Entire part added, (HB 19-1320), ch. 191, p. 2108, � 1, effective August 2. L. 2023: (2), (3)(d)(I)(C), (3)(d)(I)(D), (5)(a), (7)(b), and (7)(c) amended and (3.5) and (7)(d) added, (HB 23-1243), ch. 156, p. 673, � 3, effective August 7. L. 2024: (2)(b) amended, (HB 24-1450), ch. 490, p. 3419, � 58, effective August 7.
Cross references: For the legislative declaration in HB 23-1243, see section 1 of chapter 156, Session Laws of Colorado 2023.