C.R.S. § 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 July 1, 2027, the state board shall adopt 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 a patient needed for the screening process if the health-care facility conducts a screening using the uniform screening questionnaire as described in section 25.5-3-502 (2); and

(III) Complete the screening process;

(d) Outline the requirements for notifying the patient of the results of the screening, including:

(I) An explanation of the basis for a denial of discounted care; and

(II) The process for completing an application to provide more information to determine whether the patient is a qualified patient;

(d.5) Establish a process for and the maximum number of days that a health-care facility has to:

(I) Request information from the patient to complete an application, if the application is required pursuant to section 25.5-3-502.5; and

(II) Complete the application process as described in section 25.5-3-502.5;

(e) Establish guidelines for patient appeals regarding eligibility for discounted care pursuant to section 25.5-3-502.5;

(f) Establish acceptable methodologies for health-care facilities to determine monthly household income. For purposes of the screening conducted pursuant to section 25.5-3-502, the use of an industry-standard third-party resource, including major credit bureaus, is an acceptable methodology. A health-care facility shall disclose to the department which industry-standard third-party resources they use to determine monthly household income. The methodologies must not consider a patient's assets.

(g) For purposes of the application, 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) Create a uniform application that a health-care facility must use when an application is required after screening a patient for eligibility for discounted care, as described in sections 25.5-3-502 and 25.5-3-502.5; 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) 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) The state department:

(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) Shall establish a process for patients to submit a complaint relating to noncompliance with this part 5 to the state department by phone, by mail, or online. The state department shall conduct a review of a patient's complaint within thirty days after receiving the complaint.

(II) (A) Shall periodically review health-care facilities and licensed health-care professionals to ensure qualified patients are identified in compliance with this part 5, are not charged more than the discounted rate established in state board rules pursuant to subsection (2)(j) of this section, are offered installment payments as required by section 25.5-3-503, and do not have their debt assigned or sold before all requirements of section 25.5-3-506 are met. The review shall be conducted in accordance with state department rules, and the frequency, sample size, and timeline of the review must be reasonable considering the size and resources of the health-care facility.

(B) If the state department finds that a health-care facility or licensed health-care professional is not in compliance with this section and the noncompliance has resulted in a delay or denial of a discount owed to a patient as a result of the screening or application required pursuant to section 25.5-3-502 or 25.5-3-502.5, as a result of the health-care facility or the licensed health-care professional charging the patient more than the discounted rate established in state department rule pursuant to section 25.5-3-505 (2)(j), due to a failure to offer installment payments pursuant to section 25.5-3-503, or due to the assigning or selling of patient debt to a collection agency in violation of section 25.5-3-506, the state department shall notify the health-care facility or licensed health-care professional and the facility or professional has ninety days after notification to file a corrective action plan with the state department. If the noncompliance resulted in excess charges to the patient, the corrective action plan 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.

(C) If a health-care facility's or licensed health-care professional's noncompliance with this part 5 did not result in a delay or denial of a discount owed to a patient, the state department may notify the health-care facility or licensed health-care professional of the noncompliance for purposes of quality improvement.

(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.

(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".

(7) (a) The state department shall comply with section 24-4-103 (1) when imposing changes to the uniform screening questionnaire, changes to the application, new requirements, new reporting obligations, new documentation standards, new data elements, or new program criteria. The state department shall ensure the changes or new requirements are:

(I) Adopted by rule pursuant to the "State Administrative Procedure Act", article 4 of title 24 , by September 1, 2026, for a rule that will go into effect during to the 2026-27 state fiscal year and every year thereafter by June 1 prior to the state fiscal year for which the rule will go into effect; and

(II) Subject to stakeholder engagement pursuant to subsection (4) of this section.

(b) Any change or new requirement described in subsection (7)(a) of this section that was not adopted through rule-making is advisory only and does not serve as the basis for enforcement.

(c) The state department shall maintain an updated public archive of all manuals and subregulatory issuances, including the rationale for changes and citations to statutory or regulatory authority for each change or new requirement.

(d) This subsection (7) does not apply to rules adopted by the state department or the state board to update annual federal poverty guidelines or in response to emergent and immediate trends that are identified by consumers or hospitals as limiting the program's effectiveness and are demonstrated by data submitted to the state department or the state board.