Signed by Governor Jared Polis

Vote Smart's Synopsis:

Vote to concur with senate amendments and pass a bill that reduces surprise medical billing.

Highlights:

• Requires health care facilities, carriers, and providers to provide consumers with disclosures about the potential impact of receiving services from an out-of-network provider or health care facility and their rights under this act (Sec. 4).

• Requires covered persons to have access to accurate information about their health care bills and their payment obligations in order to enable them to make informed decisions about their healthcare and financial obligations (Sec. 4).

• Requires the Director of the Division of Professions and Occupations within the Department of Regulatory Agencies, in consultation with the Commissioner of Insurance and the State Board of Health, to adopt rules that specify the requirements for health care providers to develop and provide consumer disclosures in accordance with this act, and the rules must specify the following (Sec. 8):

• The timing for providing the disclosures for emergency and non-emergency services with consideration given to potential limitations relating to the federal Emergency Medical Treatment and Labor Act; 

• Requirements regarding how the disclosures must be made, including requirements to include the disclosures on billing statements, billing notices, or other forms of communications with consumers; 

• The contents of the disclosures, including the consumer’s rights and payment obligations pursuant to the consumer’s health benefit plan; 

• Disclosure requirements specific to health care providers, including whether a health care provider is out of network, the types of services an out-of-network health care provider may provide, and the right to request an in-network healthcare provider; and

• Requirements concerning the language to be used in the disclosures, including the use of plain language, to ensure that carriers, health care facilities, and health care providers use language that is consistent with the disclosures required by this act. 

• Requires a carrier to pay an out-of-network provider directly and in accordance with this act if a covered person received covered services at an in-network facility from an out-of-network provider (Sec. 4).

• Requires the carrier to advise the out-of-network provider of such services and the covered person of any required coinsurance, deductible or copayment at the time of the disposition of the claim (Sec. 4).

• Requires that if a covered person receives emergency services at an out-of-network facility, other than an out-of-network facility operated by the Denver Health and Hospital Authority, the carrier will reimburse the out-of-network provider the greater of (Sec. 4):

• 105 percent of the carrier’s median in-network rate of reimbursement for that service provided in a similar facility or setting in the same geographic area; or 

• The median in-network rate of reimbursement for the same service provided in a similar facility or setting in the same geographic area for the prior year based on claims data from the Colorado all-payer claims database. 

Full Bill Text