Amendments for SB25-130
Senate Journal, April 14
After consideration on the merits, the Committee recommends that SB25-130 be amended
as follows, and as so amended, be referred to the Committee on Appropriations with
favorable recommendation.
Amend printed bill, strike everything below the enacting clause and substitute:
"SECTION 1. In Colorado Revised Statutes, add 25-3-132 as follows:
25-3-132. Emergency medical condition - emergency medical
services - transfer - discharge - nonliability - enforcement - definitions.
(1) Requirements. A FACILITY SHALL PROVIDE EMERGENCY MEDICAL SERVICES
TO A PERSON WHO PRESENTS TO THE EMERGENCY DEPARTMENT WHEN THE
PERSON REQUESTS OR A REQUEST IS MADE ON THE PERSON'S BEHALF FOR
EMERGENCY MEDICAL SERVICES. IN THE ABSENCE OF A REQUEST, A FACILITY
SHALL PROVIDE EMERGENCY MEDICAL SERVICES TO A PERSON IF A PRUDENT
LAYPERSON WOULD BELIEVE, BASED ON THE PERSON'S APPEARANCE OR
BEHAVIOR, THAT THE PERSON IS IN NEED OF EMERGENCY MEDICAL SERVICES.
(2) Central log required. FOR EACH PERSON WHO PRESENTS TO A
FACILITY AND REQUESTS EMERGENCY MEDICAL SERVICES OR A REQUEST IS
MADE ON THE PERSON'S BEHALF FOR EMERGENCY MEDICAL SERVICES, THE
FACILITY SHALL INPUT INTO A CENTRAL LOG WHETHER THE PERSON REFUSED
TREATMENT, WAS DENIED TREATMENT, WHETHER NO TREATMENT WAS
REQUIRED, OR WHETHER THE PERSON WAS TRANSFERRED, ADMITTED AND
TREATED, STABILIZED AND TRANSFERRED, OR DISCHARGED.
(3) Nondiscrimination. A FACILITY IS A PLACE OF PUBLIC
ACCOMMODATION SUBJECT TO PART 6 OF ARTICLE 34 OF TITLE 24 AND SHALL
NOT DENY EMERGENCY MEDICAL SERVICES OR DISCRIMINATE IN PROVIDING
EMERGENCY MEDICAL SERVICES TO A PATIENT FOR A DISCRIMINATORY OR
UNLAWFUL REASON AS DESCRIBED IN PART 6 OF ARTICLE 34 OF TITLE 24.
(4) Provider protections. (a) A FACILITY SHALL NOT PENALIZE OR
TAKE ANY ADVERSE ACTION AGAINST A HEALTH-CARE PROVIDER FOR REFUSING
TO TRANSFER A PATIENT WITH AN EMERGENCY MEDICAL CONDITION THAT HAS
NOT BEEN STABILIZED.
(b) THIS SUBSECTION (4) DOES NOT ALTER OR LIMIT THE RIGHTS AND
PROTECTIONS AFFORDED TO A PERSON PURSUANT TO SECTION 24-34-402 (1).
(5) Financial inquiry. A FACILITY SHALL NOT DELAY PROVIDING
EMERGENCY MEDICAL SERVICES TO A PERSON IN ORDER TO INQUIRE ABOUT THE
PERSON'S ABILITY TO PAY FOR EMERGENCY MEDICAL SERVICES.
(6) Appropriate transfer. IF A PATIENT HAS RECEIVED AN
APPROPRIATE MEDICAL SCREENING EXAMINATION AS DESCRIBED IN SUBSECTION
(10)(c)(I)(A) OF THIS SECTION AND THE EXAMINING HEALTH-CARE PROVIDER
DETERMINES THAT AN EMERGENCY MEDICAL CONDITION EXISTS AND THE
CONDITION HAS NOT BEEN STABILIZED, THE FACILITY SHALL NOT TRANSFER THE
PATIENT UNLESS ALL OF THE FOLLOWING CONDITIONS ARE MET:
(a) THE PATIENT IS PROVIDED MEDICAL TREATMENT WITHIN THE
FACILITY'S CAPACITY THAT MINIMIZES THE RISKS TO THE PATIENT'S HEALTH;
(b) THE RECEIVING FACILITY HAS THE SPACE AND QUALIFIED
PERSONNEL AVAILABLE FOR TREATING THE PATIENT AND HAS AGREED TO
ACCEPT TRANSFER OF THE PATIENT AND TO PROVIDE APPROPRIATE MEDICAL
TREATMENT;
(c) THE TRANSFER IS EFFECTED THROUGH QUALIFIED PERSONNEL AND
TRANSPORTATION EQUIPMENT, INCLUDING THE USE OF NECESSARY AND
MEDICALLY APPROPRIATE LIFE SUPPORT MEASURES DURING THE TRANSFER;
(d) THE TRANSFERRING FACILITY SENDS ALL MEDICAL RECORDS, OR
COPIES OF THE MEDICAL RECORDS, RELATED TO THE PATIENT'S EMERGENCY
MEDICAL CONDITION THAT THE PATIENT PRESENTED TO THE FACILITY FOR, THAT
ARE AVAILABLE AT THE TIME OF THE TRANSFER, INCLUDING MEDICAL RECORDS,
OR COPIES OF THE MEDICAL RECORDS, RELATED TO OBSERVATIONS OF SIGNS AND
SYMPTOMS; PRELIMINARY DIAGNOSIS; TREATMENT PROVIDED TO THE PATIENT;
TEST RESULTS; THE INFORMED WRITTEN REQUEST OR CERTIFICATION PROVIDED
PURSUANT TO SUBSECTION (6)(f) OF THIS SECTION, OR A COPY OF THE REQUEST
OR CERTIFICATION; AND, IF RELEVANT, THE NAME AND ADDRESS OF ANY
ON-CALL PHYSICIAN WHO REFUSED OR FAILED TO APPEAR AT THE FACILITY
WITHIN A REASONABLE AMOUNT OF TIME TO PROVIDE THE PATIENT WITH
NECESSARY STABILIZING TREATMENT;
(e) THE TRANSFER CONFORMS WITH APPLICABLE FACILITY STANDARDS
ESTABLISHED BY THE STATE BOARD OF HEALTH, CREATED IN SECTION 25-1-103,
IN ACCORDANCE WITH THE DEPARTMENT'S AUTHORITY ESTABLISHED PURSUANT
TO SECTION 25-1.5-103. THE FACILITY STANDARDS MUST REFLECT THE FEDERAL
RULES AND REGULATIONS DESCRIBED IN 42 CFR 489.24 AND ADOPTED
PURSUANT TO THE FEDERAL "EMERGENCY MEDICAL TREATMENT AND ACTIVE
LABOR ACT", 42 U.S.C. SEC. 1395DD; AND
(f) (I) AFTER BEING INFORMED OF THE FACILITY'S OBLIGATIONS
PURSUANT TO THIS SECTION AND THE RISK OF TRANSFER, THE PATIENT OR THE
PATIENT'S REPRESENTATIVE REQUESTS THE TRANSFER IN WRITING;
(II) A PHYSICIAN HAS SIGNED A CERTIFICATION THAT INCLUDES A
SUMMARY OF THE RISKS AND BENEFITS OF TRANSFERRING THE PATIENT AND A
STATEMENT THAT, BASED UPON THE INFORMATION AVAILABLE AT THE TIME OF
THE TRANSFER, THE MEDICAL BENEFITS REASONABLY EXPECTED FROM THE
PROVISION OF APPROPRIATE MEDICAL TREATMENT AT ANOTHER FACILITY
OUTWEIGH THE INCREASED RISKS TO THE PATIENT FROM BEING TRANSFERRED;
OR
(III) IF A PHYSICIAN IS NOT PHYSICALLY PRESENT IN THE FACILITY AT
THE TIME A PATIENT IS TRANSFERRED, THE EXAMINING HEALTH-CARE PROVIDER
HAS SIGNED A CERTIFICATION THAT INCLUDES THE INFORMATION DESCRIBED IN
SUBSECTION (6)(f)(II) OF THIS SECTION AND THE PHYSICIAN, AFTER CONSULTING
WITH THE EXAMINING HEALTH-CARE PROVIDER, AGREES WITH THE
CERTIFICATION AND SUBSEQUENTLY COUNTERSIGNS THE CERTIFICATION.
(7) Appropriate discharge. (a) IF A PATIENT HAS RECEIVED AN
APPROPRIATE MEDICAL SCREENING EXAMINATION AS DESCRIBED IN SUBSECTION
(10)(c)(I)(A) OF THIS SECTION AND THE EXAMINING HEALTH-CARE PROVIDER
DETERMINES THAT AN EMERGENCY MEDICAL CONDITION EXISTS, THE FACILITY
SHALL NOT DISCHARGE THE PATIENT UNLESS ALL OF THE FOLLOWING
CONDITIONS ARE MET:
(I) THE PATIENT'S EMERGENCY MEDICAL CONDITION HAS BEEN
STABILIZED; AND
(II) THE DISCHARGE CONFORMS WITH APPLICABLE FACILITY STANDARDS
ESTABLISHED BY THE STATE BOARD OF HEALTH, CREATED IN SECTION 25-1-103,
IN ACCORDANCE WITH THE DEPARTMENT'S AUTHORITY ESTABLISHED PURSUANT
TO SECTION 25-1.5-103. THE FACILITY STANDARDS MUST REFLECT THE FEDERAL
RULES AND REGULATIONS DESCRIBED IN 42 CFR 489.24 AND ADOPTED
PURSUANT TO THE FEDERAL "EMERGENCY MEDICAL TREATMENT AND ACTIVE
LABOR ACT", 42 U.S.C. SEC. 1395DD.
(b) IF A PATIENT HAS NOT BEEN STABILIZED, DISCHARGING THE PATIENT
IS ONLY PERMITTED IF:
(I) AFTER BEING INFORMED OF THE FACILITY'S OBLIGATIONS PURSUANT
TO THIS SECTION AND THE RISK OF DISCHARGE, THE PATIENT OR THE PATIENT'S
REPRESENTATIVE REQUESTS A DISCHARGE IN WRITING; OR
(II) THE FACILITY OFFERS THE PATIENT FURTHER MEDICAL
EXAMINATION AND TREATMENT AND INFORMS THE PATIENT OR THE PATIENT'S
REPRESENTATIVE OF THE RISKS AND BENEFITS OF THE EXAMINATION AND
TREATMENT BUT THE PATIENT OR THE PATIENT'S REPRESENTATIVE DOES NOT
CONSENT TO THE MEDICAL EXAMINATION AND TREATMENT. THE PATIENT'S
MEDICAL RECORD MUST CONTAIN A DESCRIPTION OF THE EXAMINATION AND, IF
APPLICABLE, THE TREATMENT, AND A STATEMENT THAT THE PATIENT OR THE
PATIENT'S REPRESENTATIVE REFUSED. THE FACILITY SHALL TAKE ALL
REASONABLE STEPS TO SECURE THE PATIENT'S WRITTEN INFORMED REFUSAL,
WHICH MUST INDICATE THE PATIENT HAS BEEN INFORMED OF THE RISKS AND
BENEFITS OF THE EXAMINATION AND TREATMENT, IF APPLICABLE.
(8) Nonliability. A FACILITY OR HEALTH-CARE PROVIDER DOES NOT
VIOLATE THIS SECTION IF:
(a) THE PATIENT IS PROVIDED AN APPROPRIATE MEDICAL SCREENING
EXAMINATION AS DESCRIBED IN SUBSECTION (10)(c)(I)(A) OF THIS SECTION BY
A HEALTH-CARE PROVIDER AND THE EXAMINING HEALTH-CARE PROVIDER
DETERMINES THAT NO EMERGENCY MEDICAL CONDITION EXISTS AND RECORDS
THE DETERMINATION IN THE PATIENT'S MEDICAL RECORD;
(b) THE PATIENT IS PROVIDED AN APPROPRIATE MEDICAL SCREENING
EXAMINATION AS DESCRIBED IN SUBSECTION (10)(c)(I)(A) OF THIS SECTION BY
A HEALTH-CARE PROVIDER AND THE EXAMINING HEALTH-CARE PROVIDER
DETERMINES THAT AN EMERGENCY MEDICAL CONDITION EXISTS AND THE
PATIENT IS APPROPRIATELY TRANSFERRED OR DISCHARGED PURSUANT TO
SUBSECTION (6) OR (7) OF THIS SECTION; OR
(c) THE PATIENT IS PROVIDED AN APPROPRIATE MEDICAL SCREENING
EXAMINATION AS DESCRIBED IN SUBSECTION (10)(c)(I)(A) OF THIS SECTION BY
A HEALTH-CARE PROVIDER AND THE EXAMINING HEALTH-CARE PROVIDER
DETERMINES THAT AN EMERGENCY MEDICAL CONDITION EXISTS AND THE
PATIENT IS ADMITTED IN GOOD FAITH TO THE FACILITY AS AN INPATIENT FOR
FURTHER STABILIZING TREATMENT.
(9) Investigation and penalty. (a) THE DEPARTMENT MAY
INVESTIGATE A FACILITY THAT NEGLIGENTLY VIOLATES THIS SECTION
PURSUANT TO SECTION 25-1.5-103 (1)(a).
(b) (I) A PHYSICIAN WHO NEGLIGENTLY VIOLATES THIS SECTION
ENGAGES IN UNPROFESSIONAL CONDUCT AND IS SUBJECT TO DISCIPLINE
PURSUANT TO SECTION 12-240-121.
(II) THIS SUBSECTION (9)(b) APPLIES TO A PHYSICIAN WHO:
(A) SIGNS A CERTIFICATION PURSUANT TO SUBSECTION (6)(f)(II) OF THIS
SECTION THAT STATES THE MEDICAL BENEFITS REASONABLY EXPECTED FROM
APPROPRIATE MEDICAL TREATMENT AT ANOTHER FACILITY OUTWEIGH THE
INCREASED RISKS TO THE PATIENT FROM BEING TRANSFERRED IF THE PHYSICIAN
KNEW OR SHOULD HAVE KNOWN THE BENEFITS DID NOT OUTWEIGH THE RISKS;
(B) MISREPRESENTS A PATIENT'S CONDITION OR OTHER INFORMATION,
INCLUDING A FACILITY'S OBLIGATIONS PURSUANT TO THIS SECTION; OR
(C) IS THE ON-CALL PHYSICIAN AND FAILS OR REFUSES TO PRESENT TO
THE FACILITY WITHIN A REASONABLE PERIOD OF TIME PURSUANT TO SUBSECTION
(10)(c)(I)(B) OF THIS SECTION AFTER BEING CONTACTED.
(c) IF A CIVIL MONETARY PENALTY IS IMPOSED PURSUANT TO SECTION
25-1.5-103 OR 12-240-121, THE MAXIMUM CIVIL MONETARY PENALTY AMOUNT
MUST BE REDUCED BY ANY CIVIL MONETARY PENALTY IMPOSED PURSUANT TO
THE FEDERAL "EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT",
42 U.S.C. 1395dd (d) FOR THE SAME VIOLATION.
(10) Definitions. AS USED IN THIS SECTION, UNLESS THE CONTEXT
OTHERWISE REQUIRES:
(a) "ABORTION" HAS THE SAME MEANING AS SET FORTH IN SECTION
25-6-402.
(b) (I) "EMERGENCY MEDICAL CONDITION" MEANS:
(A) A MEDICAL CONDITION MANIFESTING ITSELF BY ACUTE SIGNS AND
SYMPTOMS OF SUFFICIENT SEVERITY, INCLUDING SEVERE PAIN, SUCH THAT THE
ABSENCE OF IMMEDIATE MEDICAL ATTENTION COULD REASONABLY BE
EXPECTED TO RESULT IN PLACING THE HEALTH OF THE PERSON IN SERIOUS
JEOPARDY, SERIOUS IMPAIRMENT OF BODILY FUNCTIONS, OR SERIOUS
DYSFUNCTION OF ANY BODILY ORGAN OR PART; OR
(B) WITH RESPECT TO A PREGNANT PERSON WHO IS HAVING
CONTRACTIONS, THERE IS INADEQUATE TIME TO EFFECTUATE A SAFE TRANSFER
TO ANOTHER FACILITY BEFORE DELIVERY, OR THAT TRANSFERRING THE PATIENT
MAY POSE A THREAT TO THE HEALTH OR SAFETY OF THE PATIENT.
(II) "EMERGENCY MEDICAL CONDITION" INCLUDES, BUT IS NOT LIMITED
TO, LABOR, ECTOPIC PREGNANCY, A COMPLICATION RESULTING FROM
PREGNANCY LOSS, AND EMERGENT HYPERTENSIVE DISORDERS WHEN THE
ABSENCE OF IMMEDIATE MEDICAL ATTENTION COULD REASONABLY BE
EXPECTED TO RESULT IN PLACING THE HEALTH OF THE PATIENT IN SERIOUS
JEOPARDY, SERIOUS IMPAIRMENT TO BODILY FUNCTIONS, OR SERIOUS
DYSFUNCTION OF ANY BODILY ORGAN OR PART.
(c) (I) "EMERGENCY MEDICAL SERVICES" MEANS:
(A) AN APPROPRIATE MEDICAL SCREENING EXAMINATION WITHIN THE
CAPABILITY OF THE FACILITY, INCLUDING ANCILLARY SERVICES ROUTINELY
AVAILABLE TO THE FACILITY, TO DETERMINE IF AN EMERGENCY MEDICAL
CONDITION EXISTS; AND
(B) WHEN THE EXAMINING HEALTH-CARE PROVIDER DETERMINES THAT
AN EMERGENCY MEDICAL CONDITION EXISTS, THE MEDICAL TREATMENT
NECESSARY TO STABILIZE THE EMERGENCY MEDICAL CONDITION THAT IS WITHIN
THE CAPABILITY OF THE FACILITY. IF THE PATIENT'S EMERGENCY MEDICAL
CONDITION REQUIRES THE SERVICES OF AN ON-CALL PHYSICIAN, THE EXAMINING
HEALTH-CARE PROVIDER SHALL ATTEMPT TO CONTACT THE ON-CALL PHYSICIAN.
(II) "EMERGENCY MEDICAL SERVICES" INCLUDES PROVIDING AN
ABORTION OR STERILIZATION PROCEDURES WHEN A PATIENT HAS AN
EMERGENCY MEDICAL CONDITION AND AN ABORTION OR STERILIZATION
PROCEDURES ARE NECESSARY TO STABILIZE THE PATIENT AND ARE WITHIN THE
CAPABILITY AND CAPACITY OF THE FACILITY.
(d) "FACILITY" MEANS A HOSPITAL LICENSED PURSUANT TO SECTION
25-3-101; A FREESTANDING EMERGENCY DEPARTMENT, AS DEFINED IN SECTION
25-1.5-114 (5)(b); OR A COMMUNITY CLINIC, AS DEFINED IN SECTION 25-3-101
(2)(a)(I)(B).
(e) "LABOR" MEANS THE PROCESS OF CHILDBIRTH BEGINNING WITH THE
LATENT OR EARLY PHASE OF LABOR AND CONTINUING THROUGH THE DELIVERY
OF THE PLACENTA. A PERSON EXPERIENCING CONTRACTIONS IS IN LABOR UNLESS
A PHYSICIAN, CERTIFIED NURSE MIDWIFE, OR OTHER QUALIFIED MEDICAL
PERSONNEL, ACTING WITHIN THE PERSON'S SCOPE OF PRACTICE AS DEFINED IN
THE FACILITY'S MEDICAL STAFF BYLAWS AND STATE LAW, CERTIFIES AFTER A
REASONABLE TIME OF OBSERVATION THAT THE PERSON IS IN FALSE LABOR.
(f) "STABILIZE" MEANS TO PROVIDE MEDICAL TREATMENT THAT MAY
BE NECESSARY TO ENSURE, WITHIN REASONABLE MEDICAL PROBABILITY, THAT
NO MATERIAL DETERIORATION OF THE PATIENT'S CONDITION, SERIOUS
IMPAIRMENT OF BODILY FUNCTIONS OR DYSFUNCTION OF ANY BODILY ORGAN
OR PART, OR A THREAT TO THE PATIENT'S LIFE IS LIKELY TO RESULT FROM OR
OCCUR DURING THE TRANSFER OR DISCHARGE OF THE PATIENT.
SECTION 2. In Colorado Revised Statutes, 12-240-121, add (1)(jj) as
follows:
12-240-121. Unprofessional conduct - definitions.
(1) "Unprofessional conduct" as used in this article 240 means:
(jj) NEGLIGENTLY VIOLATING SECTION 25-3-132.
SECTION 3. In Colorado Revised Statutes, 24-31-101, amend
(1)(i)(XXII) and (1)(i)(XXIII); and add (1)(i)(XXIV) as follows:
24-31-101. Powers and duties of attorney general. (1) The attorney
general:
(i) May independently initiate and bring civil and criminal actions to
enforce state laws, including actions brought pursuant to:
(XXII) Part 14 of article 12 of title 38; and
(XXIII) Section 24-34-806; AND
(XXIV) SECTION 25-3-132.
SECTION 4. Severability. If any provision of this act or the
application of this act to any person or circumstance is held invalid, the
invalidity does not affect other provisions or applications of the act that can be
given effect without the invalid provision or application, and to this end the
provisions of this act are declared to be severable.
SECTION 5. Safety clause. The general assembly finds, determines,
and declares that this act is necessary for the immediate preservation of the
public peace, health, or safety or for appropriations for the support and
maintenance of the departments of the state and state institutions.".
Judiciary
Senate Journal, April 17
After consideration on the merits, the Committee recommends that SB25-130 be amended
as follows, and as so amended, be referred to the Committee of the Whole with favorable
recommendation.
Amend the Judiciary Committee Report, dated April 14, 2025, page 7, after line
3 insert:
"SECTION 4. Appropriation. (1) For the 2025-26 state fiscal year,
$82,768 is appropriated to the department of public health and environment for
use by the health facilities and emergency medical services division. This
appropriation is from the health facilities general licensure cash fund created in
section 25-3-103.1 (1), C.R.S. To implement this act, the division may use this
appropriation as follows:
(a) $19,796 for administration and operations, which amount is based
on an assumption that the division will require an additional 0.2 FTE; and
(b) $62,972 for the health facility survey, which amount is based on an
assumption that the division will require an additional 0.5 FTE.".
Renumber succeeding sections accordingly.
Amend printed bill, page 1, line 101, strike "SERVICES." and substitute
"SERVICES, AND, IN CONNECTION THEREWITH, MAKING AN APPROPRIATION.".
House Journal, May 2
11 Amendment No. 1, by Representative Froelich:
12
13 Amend reengrossed bill, page 2, lines 7 and 8, strike "EMERGENCY
14 DEPARTMENT" and substitute "FACILITY".
15
16 Page 4, line 26, strike "(6)(f)" and substitute "(6)(e)".
17
18 Page 5, strike lines 4 through 11.
19
20 Page 5, line 12, strike "(f)" and substitute "(e)".
21
22 Page 5, line 25, strike "(6)(f)(II)" and substitute "(6)(e)(II)".
23
24 Page 6, strike lines 7 through 17 and substitute "UNLESS THE PATIENT'S
25 EMERGENCY MEDICAL CONDITION HAS BEEN STABILIZED.".
26
27 Page 9, line 18, after "FROM" insert "PREGNANCY OR".
28
29 Page 9, line 20, strike "PATIENT" and substitute "PERSON".
30
31 Page 10, line 7, strike "PHYSICIAN." and substitute "PHYSICIAN, IF
32 APPLICABLE.".
33
34 Page 10, strike lines 13 through 16 and substitute:
35
36 "(d) "FACILITY" MEANS AN EMERGENCY DEPARTMENT OF A
37 HOSPITAL LICENSED PURSUANT TO SECTION 25-3-101; A FREESTANDING
38 EMERGENCY DEPARTMENT, AS DEFINED IN SECTION 25-1.5-114; OR ANY
39 OTHER LICENSED HEALTH-CARE FACILITY, OR AREA OF A HOSPITAL OR
40 HEALTH-CARE FACILITY, THAT HOLDS ITSELF OUT TO THE PUBLIC AS
41 PROVIDING EMERGENCY CARE.".
42
43 As amended, ordered revised and placed on the Calendar for Third
44 Reading and Final Passage.
45