Health-care Billing Requirements For Indigent Patients

Beginning June 1, 2022, a health-care facility shall screen each uninsured patient for eligibility for public health insurance programs, discounted care through the Colorado indigent care program (CICP), and discounted care as described in the act. Health-care facilities shall use a single uniform application developed by the department of health care policy and financing (department) when screening a patient. If a health-care facility determines a patient is ineligible for discounted care, the facility shall provide the patient notice of the determination and an opportunity for the patient to appeal the determination.

Beginning June 1, 2022, for emergency and other non-CICP health-care services provided to patients qualified for public health insurance or discounted care, a health-care facility and licensed health-care professional shall limit the amounts charged to not more than the discounted rate established by the department; collect amounts charged in monthly installments such that a patient is not paying more than 4% of the patient's monthly household income on a bill from a health-care facility and not paying more than 2% of the patient's monthly household income on a bill from each licensed health-care professional; and after a cumulative 36 months of payments, consider the patient's bill paid in full and permanently cease any and all collection activities on any balance that remains unpaid.

Beginning June 1, 2022, a health-care facility shall make information about patient's rights and the uniform application for discounted care available to the public and to each patient.

Beginning June 1, 2023, and each June 1 thereafter, each health-care facility shall report to the department data that the department determines is necessary to evaluate compliance across patient groups based on race, ethnicity, age, and primary language spoken with the required screening, discounted care, payment plan, and collections practices.

No later than April 1, 2022, the department shall develop a written explanation of a patient's rights, make the explanation available to the public and each patient, and establish a process for patients to submit a complaint relating to noncompliance with the requirements. The department shall periodically review health-care facilities and licensed health-care professionals (hospital providers) to ensure compliance, and the department shall notify the hospital provider if the hospital provider is not in compliance that the hospital provider has 90 days to file a corrective action plan with the department. A hospital provider may request up to 120 days to submit a corrective action plan. The department may require a hospital provider that is not in compliance to develop and operate under a corrective action plan until the department determines the hospital provider is in compliance. The act implements fines for hospital providers if the department determines the hospital provider's noncompliance is knowing or willful.

Beginning June 1, 2022, the act imposes requirements on hospital providers before assigning or selling patient debt to a medical creditor or before pursuing any permissible extraordinary collection action and imposes fines for any hospital provider that fails to comply with the requirements.

Beginning June 1, 2022, a medical creditor shall not use impermissible extraordinary collection actions to collect debts owed for hospital services. A medical creditor may engage in permissible extraordinary collection actions 182 days after the patient receives hospital services. At least 30 days before taking any permissible extraordinary collection action, a medical creditor shall notify the patient of potential collection actions and shall include with the notice a statement that explains the availability of discounted care for qualified individuals and how to apply for such care. If a patient is later found eligible for discounted care, the medical creditor shall reverse any permissible extraordinary collection actions.

Beginning June 1, 2022, a medical creditor shall not sell a medical debt to another party unless, prior to the sale, the medical debt seller has entered into a legally binding written agreement with the medical debt buyer in which certain terms are agreed to. The medical debt seller shall indemnify the medical debt buyer for any amount paid for a debt that is returned to or recalled by the medical debt seller.

Beginning June 1, 2022, the department shall promulgate rules prohibiting hospitals from considering assets when determining whether a patient meets the specified percentage of the federal poverty level for CICP and ensuring the method used to determine whether a patient meets the specified percent is uniform across hospitals.

The act appropriates $219,295 to the department of health care policy and financing to implement the act.

(Note: This summary applies to this bill as enacted.)