Limits On Hospital Facility Fees

The bill defines "health-care provider" as a person that is licensed or otherwise authorized in this state to furnish a health-care service, which includes a hospital and other providers and health facilities.

The bill prohibits a health-care provider (provider) affiliated with or owned by a hospital or health system, other than 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, from charging a facility fee for health-care services furnished by the provider for:

• Outpatient services provided at an off-campus location or through telehealth; or
• Preventive health-care services, as described in section 10-16-104, that are provided in an outpatient setting or .
• Certain outpatient, diagnostic, or imaging services identified by the medical services board as services that may be provided safely, reliably, and effectively in nonhospital settings.

The bill:

• Requires a provider that charges a facility fee to provide notice to a patient that the provider charges the fee and to use a standardized bill that includes itemized charges identifying the facility fee, as well as other information;
• Requires a health facility that is newly affiliated with or owned by a hospital or health system on or after July 1, 2024, to provide written notice to patients of the health facility during the previous 12 months concerning the change in ownership and that the health facility may now charge a facility fee ;
• Requires the administrator of the all-payer health claims database to prepare an annual report of the number and amount of facility fees by payer, codes with the highest total paid amounts and highest volume, and other information; and
• Makes it a deceptive trade practice to charge, bill, or collect a facility fee when doing so is prohibited.

The bill requires the department of health care policy and financing (department) to issue a report on or before December 1, 2023, detailing the impact of facility fees on the Colorado health-care system, consumers, health-care providers, and hospitals (report). The department shall contract for actuarial research or economic modeling to identify and evaluate the impact of facility fees. The bill lists specific data and information to be evaluated in the report, and authorizes compliance with requests for information.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)