2020 Colorado Revised Statutes
Title 12 - Professions And Occupations
Article 30. Provisions Applicable to Health Care Professions and Occupations
Section 12-30-112. Health care providers - required disclosures - rules - definitions.

(1) For the purposes of this section and section 12-30-113:

1. "Carrier" has the same meaning as defined in section 10-16-102 (8).

2. "Covered person" has the same meaning as defined in section 10-16-102 (15).

3. "Emergency services" has the same meaning as defined in section 10-16-704

(5.5)(e)(II).

4. "Geographic area" has the same meaning as defined in section 10-16-704

(3)(d)(VI)(A).

5. "Health benefit plan" has the same meaning as defined in section 10-16-102 (32).

6. "Medicare reimbursement rate" has the same meaning as defined in section 10-16704 (3)(d)(VI)(B).

7. "Out-of-network provider" means a health care provider that is not a "participatingprovider" as defined in section 10-16-102 (46).

2. On and after January 1, 2020, health care providers shall develop and provide disclosures to consumers about the potential effects of receiving emergency or nonemergency services from an out-of-network provider. The disclosures must comply with the rules adopted pursuant to subsection (3) of this section.

3. The director, in consultation with the commissioner of insurance and the state boardof health created in section 25-1-103, shall adopt rules that specify the requirements for health care providers to develop and provide consumer disclosures in accordance with this section. The director shall ensure that the rules are consistent with sections 10-16-704 (12) and 25-3-121 and rules adopted by the commissioner pursuant to section 10-16-704 (12)(b) and by the state board of health pursuant to section 25-3-121 (2). The rules must specify, at a minimum, the following:

1. The timing for providing the disclosures for emergency and nonemergency serviceswith consideration given to potential limitations relating to the federal "Emergency Medical Treatment and Labor Act", 42 U.S.C. sec. 1395dd;

2. Requirements regarding how the disclosures must be made, including requirementsto include the disclosures on billing statements, billing notices, or other forms or communications with consumers;

3. The contents of the disclosures, including the consumer's rights and payment obligations pursuant to the consumer's health benefit plan;

4. Disclosure requirements specific to health care providers, including whether a healthcare 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 health care provider to provide services; and

5. Requirements concerning the language to be used in the disclosures, including use ofplain language, to ensure that carriers, health care facilities, and health care providers use language that is consistent with the disclosures required by this section and sections 10-16-704 (12) and 25-3-121 and the rules adopted pursuant to this subsection (3) and sections 10-16-704

(12)(b) and 25-3-121 (2).

4. Receipt of the disclosures required by this section does not waive a consumer's protections under section 10-16-704 (3) or (5.5) or the consumer's right to benefits under the consumer's health benefit plan at the in-network benefit level for all covered services and treatment received.

5. This section does not apply to service agencies, as defined in section 25-3.5-103 (11.5), that are publicly funded fire agencies.

Source: L. 2019: Entire section added, (HB 19-1174), ch. 171, p. 1995, § 8, effective January 1, 2020.