Representative Jodeh, bill sponsor, introduced HB21-1198.
The bill repeals, reenacts, and expands hospital requirements around providing discount care to uninsured patients (discount program) and moves regulatory authority over the program from the Colorado Department of Public Health and Environment (CDPHE) to the Department of Health Care Policy and Financing (HCPF).  Changes to the program include:
Applying regulations to health care facilities, instead of just hospitals;

• requiring HCPF to develop a standard application for health care facilities to screen uninsured patients for eligibility for public health insurance programs, the Colorado Indigent Care Program (CICP), or discounted care;
• creating an appeals process if a patient is found to be ineligible;
• limiting the amount a health care facility can charge for eligible patients for emergency and other non-CICP services to 80 percent of the Medicare rate, instead of the lowest negotiated rate from a private health plan;
• limiting collection amounts to monthly payments of no more than 5.0 percent of the patient’s monthly household income;
• considering a patient’s bill paid in full after  36 months of payments;
• requiring health care facilities to post information on patient’s rights under the discount program, as developed by HCPF;
• requiring health care facilities to collect and report certain information to HCPF to determine compliance across demographics;
• requiring HCPF to periodically review health care facilities to ensure compliance; and
• requiring HCPF to promulgate rules prohibiting hospitals from considering assets when determining if a patient’s income eligibility and to ensure the method used to determine eligibility is uniform across hospitals. By April 1, 2022, the State Board of Health in the CDPHE must promulgate rules to implement the program and HCPF must develop information on patient’s rights, establish a process for patients to appeal a determination of ineligibility, and begin to periodically review health-care facilities for compliance.  By June 1, 2023, and each June 1 after, each health care facility must collect and report data to HCPF on compliance.

Collection of medical debt.  The bill updates regulations around the collection of medical debt.  Specifically, before a health care facility can assign or sell patient debt to a collection agency or before pursing permissible extraordinary collection action the facility must:  screen the patient for eligibility for programs listed above; provide discounted care or offer a payment plan that does not exceed 5.0 percent of the patient’s monthly household income, and provide an explanation of the services and fees being billed.  A health care facility that does not follow these steps is liable to the patient for damages, as specified in the bill.  A medical creditor or medical debt collector cannot engage in any permissible extraordinary collection actions until 180 days after the first bill for a medical debt is sent.  In addition, 30 days before taking an action, a creditor must provide the patient with a notice developed by HCPF.  If a creditor fails to follow these steps, the creditor must reverse any collection actions.

Representative Jodeh distributed a handout to the committee (Attachment A).

The bill sponsor responded to questions from the committee.

Jill Schneider, Clinica Colorado, testified in support of the bill.  Mr. Kerry Gleason, representing himself, testified in support of the bill.  Ms. Leslie Kalechman, AARP Colorado, testified in support of the bill.  Ms. Elissa Jane Mastel, representing herself, testified in support of the bill.  Perla Rodriguez, Center for Health Progress, testified in support of the bill.  Adela Flores-Brennan, Colorado Consumer Health Initiative, testified in support of the bill and distributed a handout to the committee (Attachment B).  The witnesses responded to questions from the committee.

Ms. Neswood responded to questions from the committee.

Submitted written testimony can be found in Attachment F.

Representative Jodeh provided closing comments on the bill.

Committee members made closing comments on the bill.