Amendments for HB23-1215
House Journal, March 26
39 Amend printed bill, page 3, after line 6 insert:
40
41 "(c) "CRITICAL ACCESS HOSPITAL" MEANS A HOSPITAL THAT IS
42 FEDERALLY CERTIFIED OR UNDERGOING FEDERAL CERTIFICATION AS A
43 CRITICAL ACCESS HOSPITAL PURSUANT TO 42 CFR 485, SUBPART F.".
44
45 Reletter succeeding paragraphs accordingly.
46
47 Page 3, line 8, after "SERVICES" insert "THAT IS:".
48
49 Page 3, strike line 9.
50
51 Page 3, strike line 14 and substitute "SERVICES.".
52
53 Page 4, strike lines 6 through 9.
54
55 Reletter succeeding paragraphs accordingly.
1 Page 4, after line 23 insert:
2
3 "(o) "SOLE COMMUNITY HOSPITAL" HAS THE MEANING SET FORTH
4 IN 42 CFR 412.92.".
5
6 Reletter succeeding paragraph accordingly.
7
8 Page 4, strike lines 26 and 27 and substitute:
9
10 "(2) Limitations on charges. (a) ON AND AFTER JULY 1, 2024, A
11 HEALTH-CARE PROVIDER OR".
12
13 Page 5, line 1, after "FEE" insert "THAT IS NOT COVERED IN FULL BY A
14 PATIENT'S INSURANCE, REGARDLESS OF PAYER TYPE, FOR:
15 (I) PREVENTIVE HEALTH-CARE SERVICES, AS DESCRIBED IN
16 SECTION 10-16-104, THAT ARE PROVIDED IN AN OUTPATIENT SETTING;
17 (II) HEALTH-CARE SERVICES PROVIDED THROUGH TELEHEALTH; OR
18 (III) PRIMARY CARE SERVICES PROVIDED IN AN OUTPATIENT
19 SETTING, AS DESCRIBED IN 3 CCR 702-4, RULE 4-2-72.".
20
21 Page 5, strike lines 2 through 4 and substitute:
22
23 "(b) THIS".
24
25 Page 5, lines 7 and 8, strike "ON A HOSPITAL'S MAIN CAMPUS;" and
26 substitute "IN AN INPATIENT SETTING;".
27
28 Page 5, strike lines 13 through 27.
29
30 Page 6, strike lines 1 and 2.
31
32 Renumber succeeding subsection accordingly.
33
34 Page 6, line 8, strike "AND, TO THE EXTENT PRACTICABLE," and substitute
35 "AND REQUIRE THE HEALTH-CARE PROVIDER TO".
36
37 Page 6, line 9, strike "SCHEDULED;" and substitute "SCHEDULED AND
38 AGAIN AT THE TIME THE HEALTH-CARE SERVICES ARE RENDERED;".
39
40 Page 6, line 24, after "APPEAL" insert "WITH THE HEALTH-CARE
41 PROVIDER".
42
43 Page 7, after line 1 insert:
44
45 "(4) SUBSECTION (2) OF THIS SECTION DOES NOT APPLY TO A
46 CRITICAL ACCESS HOSPITAL, A SOLE COMMUNITY HOSPITAL IN A RURAL OR
47 FRONTIER AREA, OR A COMMUNITY CLINIC AFFILIATED WITH A SOLE
48 COMMUNITY HOSPITAL IN A RURAL OR FRONTIER AREA.
49 (5) SUBSECTION (2) OF THIS SECTION DOES NOT APPLY TO A
50 HOSPITAL ESTABLISHED PURSUANT TO ARTICLE 29 OF TITLE 25.".
51
52 Page 8, line 9, strike "(1)(c)." and substitute "(1)(d).".
53
54 Page 8, line 11, strike "(1)(i)." and substitute "(1)(j).".
55
1 Page 8, line 13, strike "(1)(n)." and substitute "(1)(m).".
2
3 Page 8, line 21, strike "(2), (3), OR (4)." and substitute "(2) OR (3).".
4
5 Page 8, after line 21 insert:
6
7 "SECTION 4. In Colorado Revised Statutes, add 25.5-4-216 as
8 follows:
9 25.5-4-216. Report on impact of hospital facility fees in
10 Colorado - definitions. (1) AS USED IN THIS SECTION:
11 (a) "AFFILIATED WITH" HAS THE MEANING SET FORTH IN SECTION
12 6-20-102 (1)(a).
13 (b) "CPT CODE" HAS THE MEANING SET FORTH IN SECTION
14 25.5-1-204.7 (1)(d).
15 (c) "FACILITY FEE" HAS THE MEANING SET FORTH IN SECTION
16 6-20-102 (1)(c).
17 (d) "HEALTH-CARE PROVIDER" HAS THE MEANING SET FORTH IN
18 SECTION 6-20-102 (1)(e).
19 (e) "HEALTH SYSTEM" HAS THE MEANING SET FORTH IN SECTION
20 10-16-1303 (9).
102 21 (f) "HOSPITAL" HAS THE MEANING SET FORTH IN SECTION 6-20-
22 (1)(i).
23 (g) "OWNED BY" HAS THE MEANING SET FORTH IN SECTION
24 6-20-102 (1)(n).
25 (2) ON OR BEFORE DECEMBER 1, 2023, THE STATE DEPARTMENT
26 SHALL ISSUE A REPORT DETAILING THE IMPACT OF FACILITY FEES ON THE
27 COLORADO HEALTH-CARE SYSTEM, INCLUDING THE IMPACT ON
28 CONSUMERS, HEALTH-CARE PROVIDERS, AND HOSPITALS. IN DEVELOPING
29 THE REPORT, THE STATE DEPARTMENT SHALL CONTRACT WITH AN
30 INDEPENDENT THIRD PARTY TO CONDUCT ACTUARIAL RESEARCH OR
31 ECONOMIC MODELING TO IDENTIFY AND EVALUATE THE IMPACT OF
32 FACILITY FEES.
33 (3) THE REPORT SHALL INCLUDE:
34 (a) DATA FROM PLAN YEARS 2017 THROUGH 2022 FROM THE
35 COLORADO ALL-PAYER HEALTH CLAIMS DATABASE AND OTHER SOURCES
36 FOR ALL PAYERS THAT REIMBURSE FACILITY FEES, INCLUDING, BUT NOT
37 LIMITED TO:
38 (I) THE NUMBER OF PATIENT VISITS FOR WHICH FACILITY FEES
39 WERE CHARGED;
40 (II) THE TOTAL ALLOWED AMOUNTS COLLECTED IN FACILITY FEES;
41 (III) THE TOP TEN MOST FREQUENT CPT CODES AND THE TOP TEN
42 CPT CODES WITH THE HIGHEST TOTAL ALLOWED AMOUNTS FROM FACILITY
43 FEES; AND
44 (IV) MEDIAN ALLOWED AMOUNTS, TWENTY-FIFTH AND
45 SEVENTY-FIFTH PERCENTILE ALLOWED AMOUNTS, AND THE PERCENTAGE
46 OF CLAIMS AND VOLUME OF CLAIMS WITH NO ALLOWED AMOUNTS;
47 (b) AN ANALYSIS OF THE IMPACT OF FACILITY FEES ON:
48 (I) PATIENT COST SHARING AND ANY VARIATION BASED ON PAYER
49 TYPE;
50 (II) EMPLOYERS;
51 (III) THE COST OF HEALTH-CARE SERVICES RENDERED BY
52 INDEPENDENT HEALTH-CARE PROVIDERS;
53 (IV) THE COST OF HEALTH-CARE SERVICES RENDERED BY
54 HEALTH-CARE PROVIDERS AFFILIATED WITH OR OWNED BY A HOSPITAL OR
55 HEALTH SYSTEM, INCLUDING HEALTH-CARE PROVIDERS AFFILIATED WITH
1 OR OWNED BY AN ACADEMIC MEDICAL CENTER;
2 (V) HEALTH INSURANCE PREMIUMS; AND
3 (VI) VERTICAL INTEGRATION AND CONSOLIDATION BY HEALTH
4 SYSTEMS AND PRIVATE EQUITY FIRMS;
5 (c) A DESCRIPTION OF THE WAY IN WHICH HEALTH-CARE
6 PROVIDERS MAY BE PAID OR REIMBURSED BY MEDICARE AND COMMERCIAL
7 HEALTH INSURANCE CARRIERS FOR OUTPATIENT HEALTH-CARE SERVICES
8 WITH OR WITHOUT FACILITY FEES:
9 (I) AT ON-CAMPUS LOCATIONS;
10 (II) AT OFF-CAMPUS LOCATIONS BY HEALTH-CARE PROVIDERS
11 AFFILIATED WITH OR OWNED BY A HOSPITAL OR HEALTH SYSTEM; OR
12 (III) AT OFF-CAMPUS LOCATIONS BY INDEPENDENT HEALTH-CARE
13 PROVIDERS NOT AFFILIATED WITH OR OWNED BY A HOSPITAL SYSTEM; AND
14 (d) CONSIDERATIONS OF WHETHER ADDITIONAL MEASURES MAY
15 BE TAKEN TO ENSURE CONSUMER AFFORDABILITY, PROMOTE COMPETITION,
16 AND PREVENT ADVERSE IMPACTS OF HEALTH-CARE CONSOLIDATION ON
17 INDEPENDENT HEALTH-CARE PROVIDERS AND HEALTH-CARE CONSUMERS.
18 THE DEPARTMENT OF LAW MAY ALSO MAKE POLICY RECOMMENDATIONS
19 RELATED TO FACILITY FEES.
20 (4) IN DEVELOPING THE REPORT, THE STATE DEPARTMENT SHALL
21 CONSULT WITH, AT A MINIMUM, THE FOLLOWING STAKEHOLDERS:
22 (a) HEALTH-CARE CONSUMERS AND CONSUMER ADVOCATES;
23 (b) HOSPITALS AND HEALTH SYSTEMS;
24 (c) HEALTH-CARE PROVIDERS AFFILIATED WITH OR OWNED BY A
25 HOSPITAL OR HEALTH SYSTEM; AND
26 (d) INDEPENDENT HEALTH-CARE PROVIDERS NOT AFFILIATED WITH
27 OR OWNED BY A HOSPITAL OR HEALTH SYSTEM.
28 (5) THE STATE DEPARTMENT MAY INCLUDE IN THE REPORT
29 INFORMATION FROM THE STATE DEPARTMENT, THE DEPARTMENT OF LAW,
30 STAKEHOLDERS, PUBLICLY AVAILABLE DATA SOURCES, AND HOSPITALS
31 AND HEALTH SYSTEMS IN ACCORDANCE WITH SUBSECTION (3) OF THIS
32 SECTION; EXCEPT THAT ANY INFORMATION THE STATE DEPARTMENT
33 RECEIVES THAT IS PROPRIETARY OR CONTAINS TRADE SECRETS MAY NOT
34 BE MADE PUBLIC.
35 (4) (a) THE STATE DEPARTMENT SHALL WORK WITH THE
36 ALL-PAYER CLAIMS DATABASE TO IDENTIFY DATA, INCLUDING DATA FROM
37 THE HOSPITAL EXPENDITURE REPORT, AS DESCRIBED IN SECTION
38 25.5-4-402.8, THAT MAY BE USED TO UNDERSTAND FACILITY FEES.
3 39 (b) EACH HOSPITAL LICENSED PURSUANT TO PART 1 OF ARTICLE
40 OF TITLE 25, OR CERTIFIED PURSUANT TO SECTION 25-1.5-103 (1)(a)(II),
41 SHALL MAKE INFORMATION AVAILABLE TO THE STATE DEPARTMENT FOR
42 PURPOSES OF PREPARING THE REPORT; EXCEPT THAT THE STATE
43 DEPARTMENT SHALL NOT REQUIRE A HOSPITAL OR HEALTH SYSTEM TO
44 RESHARE INFORMATION ALREADY RECEIVED BY THE STATE DEPARTMENT.
45 (c) IF NECESSARY TO FULFILL THE REPORTING REQUIREMENTS OF
46 THIS SECTION, THE ATTORNEY GENERAL MAY ISSUE A CIVIL INVESTIGATIVE
47 DEMAND REQUIRING A STATE DEPARTMENT, CARRIER AS DEFINED IN
48 SECTION 10-16-102 (8), HOSPITAL, HEALTH SYSTEM, OR HEALTH-CARE
49 PROVIDER TO FURNISH MATERIALS, ANSWERS, DATA, OR OTHER RELEVANT
50 INFORMATION.
51 (d) A PERSON OR BUSINESS SHALL NOT BE COMPELLED TO PROVIDE
52 TRADE SECRETS, AS DEFINED IN SECTION 7-74-102(4).".
53
54 Renumber succeeding section accordingly.
House Journal, April 17
35 Amend the Health and Insurance Committee Report, dated March 24,
36 2023, page 2, after line 21 insert:
37
38 "Page 7 of the printed bill, after line 1 insert:
39
40 "(c) (I) A HEALTH FACILITY THAT IS NEWLY AFFILIATED WITH OR
41 OWNED BY A HOSPITAL OR HEALTH SYSTEM ON OR AFTER JULY 1, 2024,
42 SHALL PROVIDE WRITTEN NOTICE TO EACH PATIENT RECEIVING SERVICES
43 WITHIN THE TWELVE-MONTH PERIOD IMMEDIATELY PRECEDING THE
44 AFFILIATION OR CHANGE OF OWNERSHIP THAT THE HEALTH FACILITY IS
45 PART OF A HOSPITAL OR HEALTH SYSTEM. THE NOTICE MUST INCLUDE:
46 (A) THE NAME, BUSINESS ADDRESS, AND PHONE NUMBER OF THE
47 HOSPITAL OR HEALTH SYSTEM THAT IS THE PURCHASER OF THE HEALTH
48 FACILITY OR WITH WHOM HEALTH FACILITY IS AFFILIATED;
49 (B) A STATEMENT THAT THE HEALTH FACILITY BILLS, OR IS LIKELY
50 TO BILL, PATIENTS A FACILITY FEE THAT MAY BE IN ADDITION TO AND
51 SEPARATE FROM ANY PROFESSIONAL FEE BILLED BY A HEALTH-CARE
52 PROVIDER AT THE HEALTH FACILITY; AND
53 (C) A STATEMENT THAT, PRIOR TO SEEKING SERVICES AT THE
54 HEALTH FACILITY, A PATIENT COVERED BY A HEALTH INSURANCE POLICY
55 OR HEALTH BENEFIT PLAN SHOULD CONTACT THE PATIENT'S HEALTH
56 INSURER FOR ADDITIONAL INFORMATION REGARDING THE HEALTH
1 FACILITY'S FACILITY FEES, INCLUDING THE PATIENT'S POTENTIAL
2 FINANCIAL LIABILITY, IF ANY, FOR THE FACILITY FEES.
3 (II) A HOSPITAL, HEALTH SYSTEM, OR HEALTH FACILITY SHALL NOT
4 COLLECT A FACILITY FEE FOR HEALTH-CARE SERVICES PROVIDED BY A
5 HEALTH-CARE PROVIDER AFFILIATED WITH OR OWNED BY A HOSPITAL OR
6 HEALTH SYSTEM THAT IS SUBJECT TO ANY PROVISIONS OF THIS SECTION
7 FROM THE DATE OF THE TRANSACTION UNTIL AT LEAST THIRTY DAYS
8 AFTER THE WRITTEN NOTICE REQUIRED PURSUANT TO THIS SUBSECTION
9 (3)(c)(I) IS MAILED TO THE PATIENT.".".
10
11 Page 2 of the report, line 22, strike "after line 1" and substitute "before
12 line 2".
13
14 Amendment No. 4, by Representative Bradley:
15
16 Amend the Health and Insurance Committee Report, dated March 24,
17 2023, page 2, line 5, after "SETTING;" insert "OR".
18
19 Page 2, line 6, strike "TELEHEALTH; OR" and substitute "TELEHEALTH.".
20
21 Page 2, strike lines 7 and 8.
22
23 As amended, ordered engrossed and placed on the Calendar for Third
24 Reading and Final Passage.
Senate Journal, April 28
After consideration on the merits, the Committee recommends that HB23-1215 be
amended as follows, and as so amended, be referred to the Committee on Appropriations
with favorable recommendation.
Amend reengrossed bill, page 4, strike line 27.
Page 5, strike line 1.
Page 5, strike lines 4 through 8 and substitute "COLLECT A FACILITY FEE THAT
IS NOT COVERED BY A PATIENT'S INSURANCE FOR PREVENTIVE HEALTH CARE
SERVICES, AS DESCRIBED IN SECTION 10-16-104 (18), THAT ARE PROVIDED IN AN
OUTPATIENT SETTING.".
Page 7, strike lines 22 through 27 and substitute
"SECTION 2. In Colorado Revised Statutes, add 10-16-158 as
follows:
10-16-158. Hospital facility fee report - data collection. THE
COMMISSIONER IS AUTHORIZED TO COLLECT FROM A CARRIER OFFERING A
HEALTH BENEFIT PLAN INFORMATION SPECIFIED IN SECTION 25.5-4-216, IF
AVAILABLE, FOR PURPOSES OF FACILITATING THE DEVELOPMENT OF THE REPORT
RELATING TO FACILITY FEES.".
Strike page 8.
Page 9, strike lines 1 through 6.
Page 9, line 18, strike "definitions." and substitute "definitions - steering
committee - repeal.".
Page 9, after line 20 insert:
"(b) "CAMPUS" HAS THE SAME MEANING SET FORTH IN SECTION
6-20-102 (1)(b).".
Reletter succeeding paragraphs accordingly.
Page 9, line 24, strike "(1)(c)." and substitute "(1)(d).".
Page 9, line 26, strike "(1)(e)." and substitute "(1)(f).".
Page 10, line 3, strike "(1)(i)." and substitute "(1)(j).".
Page 10, line 5, strike "(1)(n)." and substitute "(1)(m).".
Page 10, after line 5 insert:
"(i) "PAYER TYPE" HAS THE MEANING SET FORTH IN SECTION 6-20-102
(1)(n).
(j) "STEERING COMMITTEE" MEANS THE STEERING COMMITTEE CREATED
IN SUBSECTION (2) OF THIS SECTION.".
Page 10, strike lines 6 through 27 and substitute:
"(2) THERE IS CREATED IN THE STATE DEPARTMENT A STEERING
COMMITTEE TO RESEARCH AND REPORT ON THE IMPACT OF OUTPATIENT
FACILITY FEES. THE STEERING COMMITTEE CONSISTS OF THE FOLLOWING SEVEN
MEMBERS APPOINTED BY THE GOVERNOR WITH RELEVANT EXPERTISE IN
HEALTH-CARE BILLING AND PAYMENT POLICY:
(a) TWO MEMBERS REPRESENTING HEALTH-CARE CONSUMERS, WITH AT
LEAST ONE OF THE MEMBERS REPRESENTING A HEALTH-CARE CONSUMER
ADVOCACY ORGANIZATION;
(b) ONE MEMBER REPRESENTING A HEALTH-CARE PAYER OR PAYERS;
(c) ONE MEMBER REPRESENTING HEALTH-CARE PROVIDERS NOT
AFFILIATED WITH OR OWNED BY A HOSPITAL OR HEALTH SYSTEM OR WHO HAS
INDEPENDENT PHYSICIAN BILLING EXPERTISE;
(d) ONE MEMBER REPRESENTING A STATEWIDE ASSOCIATION OF
HOSPITALS;
(e) ONE MEMBER REPRESENTING A RURAL, CRITICAL ACCESS OR
INDEPENDENT HOSPITAL; AND
(f) THE EXECUTIVE DIRECTOR OF THE DEPARTMENT OF HEALTH CARE
POLICY AND FINANCING, OR THE EXECUTIVE DIRECTOR'S DESIGNEE.
(3) (a) THE STEERING COMMITTEE SHALL FACILITATE THE
DEVELOPMENT OF A REPORT DETAILING THE IMPACT OF OUTPATIENT FACILITY
FEES ON THE COLORADO HEALTH-CARE SYSTEM, INCLUDING THE IMPACT ON
CONSUMERS, EMPLOYERS, HEALTH-CARE PROVIDERS, AND HOSPITALS. IN
DEVELOPING VARIOUS ASPECTS OF THE REPORT REQUIRED IN THIS SECTION, THE
STEERING COMMITTEE SHALL WORK WITH INDEPENDENT THIRD PARTIES TO
CONDUCT RELATED RESEARCH AND ANALYSIS NECESSARY TO IDENTIFY AND
EVALUATE THE IMPACT OF OUTPATIENT FACILITY FEES.
(b) THE STEERING COMMITTEE SHALL PREPARE A PRELIMINARY VERSION
OF THE REPORT ON OR BEFORE AUGUST 1, 2024, UNLESS MORE TIME IS
REQUIRED, AND A FINAL REPORT PREPARED ON OR BEFORE OCTOBER 1, 2024,
THAT MUST BE SUBMITTED TO THE HOUSE OF REPRESENTATIVES HEALTH AND
INSURANCE COMMITTEE AND THE SENATE HEALTH AND HUMAN SERVICES
COMMITTEE, OR THEIR SUCCESSOR COMMITTEES.
(4) (a) FOR PURPOSES OF DEVELOPING THE REPORT, THE STEERING
COMMITTEE, WITH ADMINISTRATIVE SUPPORT FROM THE STATE DEPARTMENT,
MAY:
(I) SELECT THIRD-PARTY CONTRACTORS TO ASSIST IN RESEARCHING
AND CREATING THE REPORT, WITH AN APPROPRIATION MADE TO THE STATE
DEPARTMENT FOR SUCH PURPOSE;
(II) DEVELOP THE FORMAT, SCOPE, AND TEMPLATES FOR REQUESTS FOR
INFORMATION;
(III) REVIEW DRAFTS, PROVIDE FEEDBACK, AND FINALIZE THE REPORT;
(IV) ANSWER TECHNICAL QUESTIONS FROM THIRD-PARTY
CONTRACTORS; AND
(V) CONSULT WITH EXTERNAL STAKEHOLDERS.
(b) THE STEERING COMMITTEE, STATE DEPARTMENT, AND ANY
THIRD-PARTY CONTRACTORS ENGAGED IN THE DEVELOPMENT OF THE REPORT
ARE ENCOURAGED TO USE BOTH PRIMARY AND SECONDARY SOURCES AND
RESEARCH, WHERE POSSIBLE, AND, TO THE EXTENT FEASIBLE, ENSURE THE
REPORT IS WELL-INFORMED BY THE PERSPECTIVES OF DIVERSE STAKEHOLDERS.
THE STEERING COMMITTEE SHALL WORK ONLY WITH THIRD-PARTY
CONTRACTORS THAT ARE ALREADY APPROVED AS ONE OF THE STATE
DEPARTMENT'S PROJECT-BASED CONTRACTS.
(c) TO THE EXTENT PRACTICABLE, EVALUATION AND ANALYSIS
PERFORMED FOR THE REPORT MUST ATTEMPT TO LEVERAGE COLORADO-SPECIFIC
DATA SOURCES AND PUBLICLY AVAILABLE NATIONAL DATA AND RESEARCH.
(5) THE REPORT MUST IDENTIFY AND EVALUATE:
(a) PAYER REIMBURSEMENT AND PAYMENT POLICIES FOR OUTPATIENT
FACILITY FEES ACROSS PAYER TYPES, INCLUDING INSIGHTS, WHERE AVAILABLE,
INTO CHANGES OVER TIME, AS WELL AS PROVIDER BILLING GUIDELINES AND
PRACTICES FOR OUTPATIENT FACILITY FEES ACROSS PROVIDER TYPES,
INCLUDING INSIGHTS, WHERE AVAILABLE, INTO CHANGES MADE OVER TIME;
(b) PAYMENTS FOR OUTPATIENT FACILITY FEES, INCLUDING INSIGHTS
INTO THE ASSOCIATED CARE ACROSS PAYER TYPES;
(c) COVERAGE AND COST-SHARING PROVISIONS FOR OUTPATIENT CARE
SERVICES ASSOCIATED WITH FACILITY FEES ACROSS PAYERS AND PAYER TYPES;
(d) DENIED FACILITY FEE CLAIMS BY PAYER TYPE AND PROVIDER TYPE;
(e) THE IMPACT OF FACILITY FEES AND PAYER COVERAGE POLICIES ON
CONSUMERS, SMALL AND LARGE EMPLOYERS, AND THE MEDICAL ASSISTANCE
PROGRAM;
(f) THE IMPACT OF FACILITY FEES AND PAYER COVERAGE POLICIES ON
THE CHARGES FOR HEALTH-CARE SERVICES RENDERED BY INDEPENDENT
HEALTH-CARE PROVIDERS, INCLUDING A COMPARISON OF PROFESSIONAL FEE
CHARGES AND FACILITY FEE CHARGES; AND
(g) THE CHARGES FOR HEALTH-CARE SERVICES RENDERED BY
HEALTH-CARE PROVIDERS AFFILIATED WITH OR OWNED BY A HOSPITAL OR
HEALTH SYSTEM, AND INCLUDING A COMPARISON OF PROFESSIONAL FEE AND
FACILITY FEE CHARGES.
(6) THE REPORT MUST INCLUDE AN ANALYSIS OF:
(a) DATA FROM THE COLORADO ALL-PAYER HEALTH CLAIMS DATABASE
AS REPORTED UNDER DSG14, INCLUDING, AT A MINIMUM:
(I) THE NUMBER OF PATIENT VISITS FOR WHICH FACILITY FEES WERE
CHARGED, INCLUDING, TO THE EXTENT POSSIBLE, A BREAKDOWN OF WHICH
VISITS WERE IN-NETWORK AND WHICH WERE OUT-OF-NETWORK;
(II) TO THE EXTENT POSSIBLE, THE NUMBER OF PATIENT VISITS FOR
WHICH THE FACILITY FEES WERE CHARGED OUT-OF-NETWORK AND THE
PROFESSIONAL FEES WERE CHARGED IN-NETWORK FOR THE SAME OUTPATIENT
SERVICE;
(III) THE TOTAL ALLOWED FACILITY FEE AMOUNTS BILLED AND DENIED;
(IV) THE TOP TEN MOST FREQUENT CPT CODES, REVENUE CODES, OR
COMBINATION THEREOF, AT THE STEERING COMMITTEE'S DISCRETION, FOR
WHICH FACILITY FEES WERE CHARGED;
(V) THE TOP TEN CPT CODES, REVENUE CODES, OR COMBINATION
THEREOF, AT THE STEERING COMMITTEE'S DISCRETION, WITH THE HIGHEST
TOTAL ALLOWED AMOUNTS FROM FACILITY FEES;
(VI) THE TOP TEN CPT CODES, REVENUE CODES, OR COMBINATION
THEREOF, AT THE STEERING COMMITTEE'S DISCRETION, FOR WHICH FACILITY
FEES ARE CHARGED WITH THE HIGHEST MEMBER COST SHARING; AND
(VII) THE TOTAL NUMBER OF FACILITY FEE CLAIM DENIALS, BY SITE OF
SERVICE;
(b) DATA FROM HOSPITALS AND HEALTH SYSTEMS, WHICH DATA SHALL
BE PROVIDED TO THE STEERING COMMITTEE, INCLUDING:
(I) THE NUMBER OF PATIENT VISITS FOR WHICH FACILITY FEES WERE
CHARGED;
(II) THE TOTAL REVENUE COLLECTED IN FACILITY FEES;
(III) A DESCRIPTION OF THE MOST FREQUENT HEALTH-CARE SERVICES
FOR WHICH FACILITY FEES WERE CHARGED AND NET REVENUE RECEIVED FOR
EACH SUCH SERVICE; AND
(IV) A DESCRIPTION OF HEALTH-CARE SERVICES THAT GENERATED THE
GREATEST AMOUNT OF GROSS FACILITY FEE REVENUE AND NET REVENUE
RECEIVED FOR EACH SUCH SERVICE; AND
(V) DATA FROM OFF-CAMPUS HEALTH-CARE PROVIDERS THAT ARE
AFFILIATED WITH OR OWNED BY A HOSPITAL OR HEALTH SYSTEM, INCLUDING:
(A) HISTORIC AND CURRENT BUSINESS NAMES AND ADDRESSES;
(B) HISTORIC AND CURRENT TAX IDENTIFICATION NUMBERS AND
NATIONAL PROVIDER IDENTIFIERS;
(C) HEALTH-CARE PROVIDER ACQUISITION OR AFFILIATION DATE;
(D) FACILITY FEE BILLING POLICIES, INCLUDING WHETHER ANY
CHANGES WERE MADE TO SUCH POLICIES BEFORE OR AFTER THE ACQUISITION OR
AFFILIATION DATE; AND
(E) THE TOP TEN CPT CODES, REVENUE CODES, OR COMBINATION
THEREOF, AT THE STATE DEPARTMENT'S DISCRETION, FOR WHICH A FACILITY FEE
IS BILLED AND THE PROFESSIONAL FEE AMOUNT FOR THE SAME SERVICE;
(c) DATA, IF AVAILABLE, FROM THE STATE DEPARTMENT, THE DIVISION
OF INSURANCE, AND COMMERCIAL PAYERS, INCLUDING:
(I) THE PAYMENT POLICY EACH PAYER USES FOR PAYMENT OF FACILITY
FEES FOR NETWORK PRODUCTS, INCLUDING ANY CHANGES THAT WERE MADE TO
SUCH POLICIES WITHIN THE LAST FIVE YEARS;
(II) A LIST OF COMMON PROCEDURES ASSOCIATED WITH FACILITY FEES;
(III) EACH PAYER'S NETWORK PRODUCT NAMES;
(IV) PAID AGGREGATE FACILITY FEE BILLINGS FROM OUTPATIENT
PROVIDERS AND THE ASSOCIATED NUMBER OF FACILITY FEE CLAIMS, BROKEN
DOWN BY HOSPITAL OR HEALTH SYSTEM; AND
(V) A DESCRIPTION OF THE ESTIMATED IMPACT OF FACILITY FEES ON
PREMIUM RATES, OUT-OF-NETWORK CLAIMS, MEMBER COST SHARING, AND
EMPLOYER COSTS;
(d) DATA FROM INDEPENDENT HEALTH-CARE PROVIDERS THAT ARE NOT
AFFILIATED WITH OR OWNED BY A HOSPITAL OR HEALTH SYSTEM, INCLUDING:
(I) HISTORIC AND CURRENT BUSINESS NAMES AND ADDRESSES;
(II) HISTORIC AND CURRENT TAX IDENTIFICATION NUMBERS AND
NATIONAL PROVIDER IDENTIFIERS;
(III) FACILITY FEE BILLING POLICIES, INCLUDING WHETHER ANY
CHANGES WERE MADE TO SUCH POLICIES IN THE PAST FIVE YEARS; AND
(IV) WHERE APPLICABLE, THE TOP TEN CPT CODES, REVENUE CODES,
OR COMBINATION THEREOF, AT THE STEERING COMMITTEE'S DISCRETION, FOR
WHICH A FACILITY FEE IS BILLED AND THE PROFESSIONAL FEE AMOUNT FOR THE
SAME SERVICE;
(e) THE IMPACT OF FACILITY FEES AND PAYER COVERAGE POLICIES ON
THE COLORADO HEALTHCARE AFFORDABILITY AND SUSTAINABILITY
ENTERPRISE, CREATED IN SECTION 25.5-4-402.4, THE MEDICAID EXPANSION,
UNCOMPENSATED CARE, AND UNDERCOMPENSATED CARE;
(f) THE IMPACT OF FACILITY FEES ON ACCESS TO CARE, INCLUDING
SPECIALTY CARE, PRIMARY CARE, AND BEHAVIORAL HEALTH CARE; INTEGRATED
CARE SYSTEMS; HEALTH EQUITY; AND THE HEALTH-CARE WORKFORCE; AND
(g) A DESCRIPTION OF THE WAY IN WHICH HEALTH-CARE PROVIDERS
MAY BE PAID OR REIMBURSED BY PAYERS FOR OUTPATIENT HEALTH-CARE
SERVICES, WITH OR WITHOUT FACILITY FEES, THAT EXPLORES ANY LEGAL AND
HISTORICAL REASONS FOR SPLIT BILLING BETWEEN PROFESSIONAL AND FACILITY
FEES AT:
(I) ON-CAMPUS LOCATIONS;
(II) OFF-CAMPUS LOCATIONS BY HEALTH-CARE PROVIDERS AFFILIATED
WITH OR OWNED BY A HOSPITAL OR HEALTH SYSTEM; AND
(III) LOCATIONS BY INDEPENDENT HEALTH-CARE PROVIDERS NOT
AFFILIATED WITH OR OWNED BY A HOSPITAL SYSTEM.
(7) TO THE EXTENT FEASIBLE, DATA ANALYZED FOR PURPOSES OF
SUBSECTION (6) OF THIS SECTION MUST BE SOURCED FROM 2014 THROUGH 2022,
AS DETERMINED BY THE STEERING COMMITTEE AND THIRD-PARTY
CONTRACTORS, AND SHALL BE DISAGGREGATED BY:
(a) YEAR;
(b) HOSPITAL OR HEALTH SYSTEM, WHERE APPLICABLE;
(c) TYPE OF SERVICE;
(d) FACILITY SITE TYPE, INCLUDING ON OR OFF CAMPUS; AND
(e) PAYER.
(8) THE STEERING COMMITTEE MAY INCLUDE IN THE REPORT
INFORMATION RECEIVED IN ACCORDANCE WITH THIS SECTION; EXCEPT THAT THE
STEERING COMMITTEE SHALL NOT SHARE PUBLICLY ANY INFORMATION
SUBMITTED TO THE STEERING COMMITTEE THAT IS CONFIDENTIAL, IS
PROPRIETARY, CONTAINS TRADE SECRETS, OR IS NOT A PUBLIC RECORD
PURSUANT TO PART 2 OF ARTICLE 72 OF TITLE 24 EXCEPT IN AGGREGATED AND
DE-IDENTIFIED FORM.
(9) THE DATA DESCRIBED IN THIS SECTION MUST BE SOUGHT IN A FORM
AND MANNER DETERMINED BY THE STEERING COMMITTEE, STATE DEPARTMENT,
OR THIRD-PARTY CONTRACTORS TO FACILITATE SUBMISSION OF INFORMATION.
THE STEERING COMMITTEE SHALL SEEK TO EXHAUST EXISTING DATA SOURCES
BEFORE MAKING ADDITIONAL REQUESTS FOR INFORMATION AND SUCH REQUESTS
SHALL BE MADE ONLY ONCE FOR THE PURPOSE OF THE STUDY. THE REPORT MUST
INCLUDE A DESCRIPTION OF WHICH ENTITIES WERE CONTACTED FOR
INFORMATION AND THE OUTCOME OF EACH REQUEST.
(10) A STATEWIDE ASSOCIATION OF HOSPITALS MAY ALSO PROVIDE
DATA SPECIFIED IN SUBSECTION (6)(b) OF THIS SECTION TO THE STEERING
COMMITTEE.
(11) THIS SECTION IS REPEALED, EFFECTIVE JANUARY 1, 2025.".
Strike pages 11 and 12.
Page 13, strike lines 1 through 7.
Senate Journal, May 3
After consideration on the merits, the Committee recommends that HB23-1215 be
amended as follows, and as so amended, be referred to the Committee of the Whole with
favorable recommendation.
Amend reengrossed bill, page 13, line 25, strike "$622,356" and substitute
"$516,950".
Page 1, line 102, after "MAKING" insert "AND REDUCING".
Senate Journal, May 3
HB23-1215 by Representative(s) Sirota and Boesenecker; also Senator(s) Mullica and Cutter--
Concerning limitations on hospital facility fees, and, in connection therewith, making an
appropriation.
Amendment No. 1, Health & Human Services Committee Amendment.
(Printed in Senate Journal, April 28, page(s) 1193-1196 and placed in members' bill files.)
Amendment No. 2, Appropriations Committee Amendment.
(Printed in Senate Journal, May 3, page(s) 1319 and placed in members' bill files.)
Amendment No. 3(L.025), by Senator Cutter and Mullica.
Amend the Health and Human Services Committee Report, dated April 27,
2023, page 1, line 3, after "FEE" insert "DIRECTLY FROM A PATIENT".
Page 1 of the report, after line 6 insert:
"Page 5 of the bill, before line 17 insert:
"(c) NOTHING IN THIS SUBSECTION (2) PROHIBITS A HEALTH-CARE
PROVIDER OR HEALTH SYSTEM FROM CHARGING, BILLING, OR COLLECTING A
FACILITY FEE FROM A PATIENT'S INSURER PURSUANT TO AN AGREEMENT
BETWEEN THE HEALTH-CARE PROVIDER OR HEALTH SYSTEM AND THE CARRIER
OR AS REQUIRED BY LAW.".".
Page 7 of the report, strike lines 6 and 7 and substitute "INFORMATION FOR
PURPOSES OF THE REPORT, AND EVERY EFFORT MUST BE MADE TO MINIMIZE THE
NUMBER OF DATA REQUESTS. THE REPORT MUST INCLUDE A DESCRIPTION OF".
Amendment No. 3(L.022), by Senator Cutterand Mullica.
Amend the Health and Human Services Committee Report, dated April 27,
2023, page 1, line 5, strike "HEALTH CARE" and substitute "HEALTH-CARE".
As amended, ordered revised and placed on the calendar for third reading and final
passage.