2020 Colorado Revised Statutes
Title 25 - Public Health And Environment
Article 49. Transparency in Health Care Prices
Short title. The short title of this article 49 is the "Transparency in Health Care Prices Act".
Source: L. 2017: Entire article added, (SB 17-065), ch. 113, p. 403, § 1, effective January 1, 2018.
Definitions. As used in this article 49, unless the context otherwise requires:
"Agency" means a government department or agency or a government-created entity.
"CPT code" means the current procedural terminology code, or its successor code, asdeveloped and copyrighted by the American Medical Association or its successor entity.
"Health care facility" means a facility licensed or certified by the department of public health and environment pursuant to section 25-1.5-103. The term does not include a nursing care facility, assisted living residence, or home care agency.
(a) "Health care price" means the price, before negotiating any discounts, that a health care provider or health care facility will charge a recipient for health care services that will be rendered. "Health care price" is the price charged for the standard service for the particular diagnosis and does not include any amount that may be charged for complications or exceptional treatment. The health care price for a specific health care service may be determined from any of the following:
The price charged most frequently for the health care service during the previoustwelve months;
The highest charge from the lowest half of all charges for the health care serviceduring the previous twelve months; or
A range that includes the middle fifty percent of all charges for the health careservice during the previous twelve months.
(b) "Health care price" does not mean the amount charged if a public or private third party will be paying or reimbursing the health care provider or health care facility for any portion of the cost of services rendered.
"Health care provider" means a person who is licensed, certified, or registered by thisstate to provide health care services or a medical group, independent practice association, or professional corporation providing health care services.
(a) "Health care services" or "services" means services included in, or incidental to, furnishing to an individual:
Medical, mental, dental, or optometric care or hospitalization; or
Other services for the purpose of preventing, alleviating, curing, or healing a physical illness, an injury, or a mental health disorder.
(b) "Health care services" includes services rendered through the use of telemedicine.
"Health insurer" means a carrier, as defined in section 10-16-102 (8), disability insurer, group disability insurer, or blanket disability insurer.
(a) "Public or private third party" means a health insurer, self-insured employer, or other third party, including a third-party administrator or intermediary, responsible for paying all or a portion of the charges for health care services.
(b) "Public or private third party" does not mean:
An employer of the recipient of the health care services that is not responsible forpaying the charges for the health care services provided to the recipient;
A person paying money from a health savings account, flexible spending account, orsimilar account; or
A family member, charitable organization, or other person who is not responsiblefor, but pays charges for, health care services on behalf of the recipient of the services.
"Punish" means to impose a penalty, surcharge, fee, or other additional cost or measure that has the same effect as a penalty or that discourages the exercise of rights under this article 49.
"Recipient" means an individual who receives health care services from a healthcare provider or health care facility.
Source: L. 2017: Entire article added, (SB 17-065), ch. 113, p. 403, § 1, effective January 1, 2018. L. 2018: (6)(a)(II) amended, (SB 18-091), ch. 35, p. 388, § 24, effective August 8.
Cross references: For the legislative declaration in SB 18-091, see section 1 of chapter 35, Session Laws of Colorado 2018.
