C.R.S. § 25.5-3-502: Requirement to screen patients for eligibility for financial assistance - questionnaire - definition - rules.

(1) Beginning September 1, 2022, a health-care facility shall screen, unless a patient declines, each uninsured patient for eligibility for:

(a) Public health insurance programs, including but not limited to medicare; the state medical assistance program described in articles 4, 5, and 6 of this title 25.5; emergency medicaid; and the children's basic health plan described in article 8 of this title 25.5;

(b) Discounted care, as described in section 25.5-3-503; and

(c) At the option of the health-care facility, the health-care facility's financial assistance program, which often offers broader eligibility than public health insurance programs.

(2) A health-care facility may conduct screenings pursuant to subsection (1) of this section through:

(a) Accessing eligibility information through an industry-standard third-party resource, such as a major credit bureau;

(b) Requesting the patient complete a uniform screening questionnaire developed by the state department; or

(c) A combination of information obtained through subsections (2)(a) and (2)(b) of this section.

(3) If a health-care facility determines it has obtained sufficient information through the screening conducted pursuant to subsection (1) of this section, the health-care facility may make a determination of whether the patient is a qualified patient or is likely eligible for public health-care coverage without requiring the patient to provide further information through a uniform application pursuant to section 25.5-3-502.5.

(3.5) Upon completion of the screening conducted pursuant to subsection (1) of this section, a health-care facility shall:

(a) If the health-care facility determines that a patient is a qualified patient, provide the patient notice of the determination, the patient's identified federal poverty guideline percentage, and the patient's monthly installment maximum payment, as described in section 25.5-3-503;

(b) If the health-care facility determines that a patient is likely not a qualified patient, inform the patient of the results of the screening, including the patient's identified federal poverty guideline percentage, and provide the patient with:

(I) Information on how to complete an application pursuant to section 25.5-3-502.5; and

(II) If applicable, at the option of the health-care facility, information regarding the patient's eligibility for the health-care facility's financial assistance program and the amount of any discount offered through the program;

(c) If the health-care facility is certified by the state department as a presumptive eligibility site and determines that the patient is presumptively eligible for medical assistance, inform the patient of the determination and provide the patient with information on how the patient can enroll in public health-care coverage;

(d) If the health-care facility determines that a patient is likely eligible for public health-care coverage, inform the patient of the determination and:

(I) Provide the patient with information explaining how to apply for public health-care coverage, including at least one available method for submitting an application;

(II) Offer reasonable assistance or referral for support to complete an application for public health-care coverage; and

(III) Treat completion of an application for public health-care coverage as the primary pathway for resolving the patient's financial responsibility for hospital services until the patient is denied public health-care coverage or forty-five days after the date of discharge, whichever occurs first; and

(e) If the health-care facility needs more information to make a determination of whether the patient has qualified or is likely to qualify for discounted care or a financial assistance program, inform the patient of the patient's identified federal poverty guideline percentage and notify the patient that the patient must provide additional information to complete an application pursuant to section 25.5-3-502.5.

(3.7) (a) (I) If a patient has not been determined eligible for public health-care coverage pursuant to subsection (3.5)(d) of this section within forty-five days after the date of discharge, a health-care facility shall proceed with a determination of whether the patient is a qualified patient.

(II) Upon notification of a determination that a patient is ineligible for public health-care coverage pursuant to subsection (3.5)(d) of this section, a health-care facility shall proceed with a determination of whether the patient is a qualified patient.

(b) Subsection (3.5)(d) of this section does not prohibit a patient or health-care facility from completing an application pursuant to section 25.5-3-502.5 while a determination of the patient's eligibility for public health-care coverage is pending.

(c) While a determination of a patient's eligibility for public health-care coverage is pending, a health-care facility may defer completion of a final determination for discounted care if the patient is afforded the protections from billing and collection activity required by section 25.5-3-506.

(d) If a patient is determined eligible for public health-care coverage pursuant to subsection (3.5)(d) of this section, reimbursement through public health-care coverage is the primary reimbursement before any discounts are provided pursuant to this section.

(e) Where a health-care facility determines, based on available information, that a patient is facially ineligible for public health-care coverage, the health-care facility may proceed directly with a determination of whether the patient is a qualified patient.

(f) A health-care facility shall not deny eligibility for discounted care solely because a patient did not apply for public health-care coverage.

(4) If the patient declines the screening described in 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 an insured patient, a health-care facility shall perform the screening described in this section and, if applicable, complete the application pursuant to section 25.5-3-502.5 to determine if the insured patient is a qualified patient.

(6) As used in this section, "inform" means to convey required information, unless otherwise specified in this section, including through verbal, electronic, or other formats. The health-care facility shall document the manner in which the information was provided.

(7) A health-care facility may use the same communication to comply with both state and federal requirements.