SB 138

NOTE: This bill has been prepared for the signatures of the appropriate legislative
officers and the Governor. To determine whether the Governor has signed the bill
or taken other action on it, please consult the legislative status sheet, the legislative
history, or the Session Laws.
     SENATE BILL 26-138
     BY SENATOR(S) Daugherty and Mullica, Ball, Bridges, Bright, Carson,
     Cutter, Danielson, Exum, Jodeh, Kipp, Kolker, Marchman, Roberts,
     Coleman;
     also REPRESENTATIVE(S) Stewart K., Bacon, Boesenecker, Duran,
     Lindsay, McCormick, McCluskie.
     CONCERNING MEASURES TO REDUCE THE ADMINISTRATIVE BURDEN ON THE
          HEALTH-CARE SYSTEM.
     Be it enacted by the General Assembly of the State of Colorado:
            SECTION 1. Legislative declaration. (1) The general assembly
     finds and declares that:
            (a) Every Colorado family deserves a fair, dignified, and
     understandable path to financial assistance when seeking health care.
     Patients benefit from hospitals' discounted care programs and these
     programs increase access to affordable care. Reducing duplication and
     confusion in navigating the process for both patients and health-care
     providers is essential to ensure the process does not create barriers for the
     very people the law was intended to help.
     ________
     Capital letters or bold & italic numbers indicate new material added to existing law; dashes
     through words or numbers indicate deletions from existing law and such material is not part of
     the act.
       (b) It is the intent of the general assembly to reduce unnecessary
paperwork, eliminate avoidable burdens, and create a process that respects
people's time, circumstances, and dignity. Streamlining and clarifying these
pathways will allow health-care providers to focus more resources on
helping families instead of on navigating shifting rules or administrative
obstacles.
       (c) The general assembly affirms that all patient rights, including the
right to appeal and to provide information demonstrating eligibility for
public health-care coverage or discounted care, must remain fully protected;
and
       (d) This act strengthens the promise that discounted care in our state
will be accessible and rooted in compassion.
      SECTION 2. In Colorado Revised Statutes, amend 12-30-114 as
follows:
       12-30-114. Demonstrated competency - repeal of rules - repeal.
        (1) (a) The regulator for each licensed health-care provider, in
consultation with the center for research into substance use disorder
prevention, treatment, and recovery support strategies created in section
27-80-118, shall promulgate rules that require each licensed health-care
provider, as a condition of renewing, reactivating, or reinstating a license
on or after October 1, 2022, to complete up to four credit hours of training
per licensing cycle in order to demonstrate competency regarding:
       (I) Best practices for opioid prescribing, according to the most
recent version of the division's guidelines for the safe prescribing and
dispensing of opioids;
       (II) The potential harm of inappropriately limiting prescriptions to
chronic pain patients;
       (III) Best practices for prescribing benzodiazepines;
       (IV) Recognition of substance use disorders;
       (V) Referral of patients with substance use disorders for treatment;
PAGE 2-SENATE BILL 26-138
and
       (VI) The use of the electronic prescription drug monitoring program
created in part 4 of article 280 of this title 12.
       (b) The rules promulgated by each regulator shall exempt a licensed
health-care provider who:
       (I) Maintains a national board certification that requires equivalent
substance use prevention training; or
       (II) Attests to the regulator that the health-care provider does not
prescribe opioids.
        (2) For the purposes of this section, "licensed health-care provider"
includes any of the following providers who are licensed pursuant to this
title 12:
       (a) A physician;
       (b) A physician assistant;
       (c) A podiatrist;
       (d) A dentist;
       (e) An advanced practice registered nurse or certified midwife with
prescriptive authority;
       (f) An optometrist; and
       (g) A veterinarian.
      (3) EACH REGULATOR THAT ADOPTED RULES PURSUANT TO THIS
SECTION BEFORE THE EFFECTIVE DATE OF THIS SUBSECTION (3), WHICH
RULES REQUIRE A LICENSED HEALTH-CARE PROVIDER, AS A CONDITION OF
RENEWING, REACTIVATING, OR REINSTATING A LICENSE, TO COMPLETE UP TO
FOUR CREDIT HOURS OF TRAINING PER LICENSING CYCLE IN ORDER TO
DEMONSTRATE OPIATE PRESCRIBER COMPETENCY SHALL REPEAL THE RULES
ON OR BEFORE JULY 1, 2027.
PAGE 3-SENATE BILL 26-138
      (4) THIS SECTION IS REPEALED, EFFECTIVE SEPTEMBER 1, 2029.
      SECTION 3. In Colorado Revised Statutes, 12-220-308, add (3) as
follows:
      12-220-308. Continuing education requirements - rules.
      (3) (a) THE BOARD MAY ADOPT RULES REQUIRING EVERY DENTIST,
DENTAL THERAPIST, AND DENTAL HYGIENIST, AS CONDITION OF RENEWING,
REACTIVATING, OR REINSTATING A LICENSE ISSUED UNDER THIS ARTICLE 220,
TO COMPLETE UP TO FOUR CREDIT HOURS OF TRAINING PER LICENSING CYCLE
REGARDING:
      (I) BEST PRACTICES FOR OPIOID PRESCRIBING;
      (II) BEST PRACTICES FOR BENZODIAZEPINE PRESCRIBING;
      (III) RECOGNITION OF SUBSTANCE USE DISORDERS;
      (IV) REFERRAL OF PATIENTS WITH SUSPECTED SUBSTANCE USE
DISORDERS FOR TREATMENT; AND
     (V) THE USE OF THE ELECTRONIC PRESCRIPTION DRUG MONITORING
PROGRAM CREATED IN PART 4 OF ARTICLE 280 OF THIS TITLE 12.
      (b) REGARDLESS OF WHETHER THE BOARD ADOPTS RULES TO
REQUIRE TRAINING PURSUANT TO SUBSECTION (3)(a) OF THIS SECTION, IF A
LICENSED DENTIST, DENTAL THERAPIST, OR DENTAL HYGIENIST COMPLETES
TRAINING REGARDING OPIOID PRESCRIBER COMPETENCY, THE BOARD SHALL
COUNT UP TO FOUR HOURS OF SUCH TRAINING TOWARD THE LICENSEE'S
CONTINUING EDUCATION REQUIRED BY SUBSECTION (1) OF THIS SECTION.
        SECTION 4. In Colorado Revised Statutes, 12-315-110, add (3)(d),
(3)(e), and (3)(f) as follows:
      12-315-110.    License renewal - waiver - rules - continuing
education.
      (3) (d) A LICENSED VETERINARIAN SHALL COMPLETE AT LEAST ONE
HOUR OF TRAINING REGARDING SUBSTANCE USE PREVENTION PER RENEWAL
PAGE 4-SENATE BILL 26-138
PERIOD TO DEMONSTRATE COMPETENCY REGARDING:
       (I) BEST PRACTICES FOR VETERINARY OPIOID PRESCRIBING;
       (II)    BEST   PRACTICES     FOR   VETERINARY     BENZODIAZEPINE
PRESCRIBING;
       (III) RECOGNITION OF HUMAN SUBSTANCE USE DISORDERS;
      (IV) REFERRAL OF HUMANS WITH SUSPECTED SUBSTANCE USE
DISORDERS FOR TREATMENT; AND
     (V) THE USE OF THE ELECTRONIC PRESCRIPTION DRUG MONITORING
PROGRAM CREATED IN PART 4 OF ARTICLE 280 OF THIS TITLE 12.
      (e) SUBSECTION (3)(d) OF THIS SECTION DOES NOT APPLY TO A
LICENSED VETERINARIAN WHO:
      (I) MAINTAINS A NATIONAL BOARD CERTIFICATION THAT REQUIRES
EQUIVALENT SUBSTANCE USE PREVENTION TRAINING; OR
      (II) ATTESTS TO THE BOARD THAT THE LICENSED VETERINARIAN
DOES NOT PRESCRIBE OPIOIDS.
       (f) THE BOARD SHALL ADOPT RULES TO IMPLEMENT SUBSECTIONS
(3)(d) AND (3)(e) OF THIS SECTION.
        SECTION 5. In Colorado Revised Statutes, 25-3-102, amend
(1)(a); and repeal (1)(d) as follows:
      25-3-102. License - application - issuance - waiver - certificate
of compliance required - rules.
       (1) (a) (I) An applicant for a license described in section 25-3-101
shall apply to the department of public health and environment annually
EVERY TWO YEARS upon such form and in such manner as prescribed by the
department; except that a community residential home shall make
application for a license pursuant to section 25.5-10-214. C.R.S.
       (II) ON OR BEFORE JULY 1, 2030, NOTWITHSTANDING SUBSECTION
PAGE 5-SENATE BILL 26-138
(1)(a)(I) OF THIS SECTION, THE DEPARTMENT MAY ISSUE A LICENSE
DESCRIBED IN SECTION 25-3-101 TO AN APPLICANT AND REQUIRE THE
APPLICANT TO APPLY TO THE DEPARTMENT AFTER A ONE-YEAR PERIOD AS
THE DEPARTMENT DEEMS APPROPRIATE.
       (d) The license expires one year after the date of issuance.
      SECTION 6. In Colorado Revised Statutes, 25.5-3-501, amend (6);
and add (6.7) as follows:
       25.5-3-501. Definitions.
       As used in this part 5, unless the context otherwise requires:
        (6) "Screen" or "screening" means a process identified in rule by the
state department DESCRIBED IN SECTION 25.5-3-502 whereby health-care
facilities assess a patient's circumstances related to eligibility criteria and
determine whether the patient HAS QUALIFIED OR is likely to qualify for
public health-care coverage or discounted care AND, AT THE OPTION OF THE
HEALTH-CARE FACILITY, IS ELIGIBLE OR IS LIKELY ELIGIBLE FOR THE
HEALTH-CARE FACILITY'S FINANCIAL ASSISTANCE PROGRAM; inform the
patient of the health-care facility's determination; and provide information
to the patient about how the patient can enroll in public health-care
coverage OR THE HEALTH-CARE FACILITY'S FINANCIAL ASSISTANCE
PROGRAM.
       (6.7) "UNIFORM APPLICATION" OR "APPLICATION" MEANS A UNIFORM
FORM THAT IS DEVELOPED BY THE STATE DEPARTMENT TO DETERMINE
WHETHER A PATIENT IS A QUALIFIED PATIENT AND IS COMPLETED FOLLOWING
A SCREENING OR WHEN REQUIRED BY SECTION 25.5-3-502.5.
      SECTION 7. In Colorado Revised Statutes, amend 25.5-3-502 as
follows:
      25.5-3-502. Requirement to screen patients for eligibility for
financial assistance - questionnaire - definition - rules.
       (1) Beginning September 1, 2022, a health-care facility shall screen,
unless a patient declines, each uninsured patient for eligibility for:
PAGE 6-SENATE BILL 26-138
       (a) Public health insurance programs, including but not limited to
medicare; the state medical assistance program DESCRIBED IN articles 4, 5,
and 6 of this title 25.5; emergency medicaid; and the children's basic health
plan DESCRIBED IN article 8 of this title 25.5; and
       (b) Repealed.
       (c) (b) Discounted care, as described in section 25.5-3-503; AND
      (c) AT THE OPTION OF THE HEALTH-CARE FACILITY, THE
HEALTH-CARE FACILITY'S FINANCIAL ASSISTANCE PROGRAM, WHICH OFTEN
OFFERS BROADER ELIGIBILITY THAN PUBLIC HEALTH INSURANCE PROGRAMS.
      (2) Health-care facilities shall use a single uniform application
developed by the state department when screening a patient pursuant to
subsection (1) of this section. A HEALTH-CARE FACILITY MAY CONDUCT
SCREENINGS PURSUANT TO SUBSECTION (1) OF THIS SECTION THROUGH:
       (a)     ACCESSING
                       ELIGIBILITY INFORMATION THROUGH AN
INDUSTRY-STANDARD THIRD-PARTY RESOURCE, SUCH AS A MAJOR CREDIT
BUREAU;
      (b) REQUESTING THE PATIENT COMPLETE A UNIFORM SCREENING
QUESTIONNAIRE DEVELOPED BY THE STATE DEPARTMENT; OR
      (c) A COMBINATION OF INFORMATION OBTAINED THROUGH
SUBSECTIONS (2)(a) AND (2)(b) OF THIS SECTION.
      (3) If a health-care facility determines that a patient is ineligible for
discounted care, the facility shall provide the patient notice of the
determination and an opportunity for the patient to appeal the determination
in accordance with state department rules IF A HEALTH-CARE FACILITY
DETERMINES IT HAS OBTAINED SUFFICIENT INFORMATION THROUGH THE
SCREENING CONDUCTED PURSUANT TO SUBSECTION (1) OF THIS SECTION, THE
HEALTH-CARE FACILITY MAY MAKE A DETERMINATION OF WHETHER THE
PATIENT IS A QUALIFIED PATIENT OR IS LIKELY ELIGIBLE FOR PUBLIC
HEALTH-CARE COVERAGE WITHOUT REQUIRING THE PATIENT TO PROVIDE
FURTHER INFORMATION THROUGH A UNIFORM APPLICATION PURSUANT TO
SECTION 25.5-3-502.5.
PAGE 7-SENATE BILL 26-138
      (3.5) UPON COMPLETION OF THE SCREENING CONDUCTED PURSUANT
TO SUBSECTION (1) OF THIS SECTION, A HEALTH-CARE FACILITY SHALL:
      (a) IF THE HEALTH-CARE FACILITY DETERMINES THAT A PATIENT IS
A QUALIFIED PATIENT , PROVIDE THE PATIENT NOTICE OF THE
DETERMINATION, THE PATIENT'S IDENTIFIED FEDERAL POVERTY GUIDELINE
PERCENTAGE, AND THE PATIENT'S MONTHLY INSTALLMENT MAXIMUM
PAYMENT AS DESCRIBED IN SECTION 25.5-3-503;
      (b) IF THE HEALTH-CARE FACILITY DETERMINES THAT A PATIENT IS
LIKELY NOT A QUALIFIED PATIENT, INFORM THE PATIENT OF THE RESULTS OF
THE SCREENING, INCLUDING THE PATIENT'S IDENTIFIED FEDERAL POVERTY
GUIDELINE PERCENTAGE, AND PROVIDE THE PATIENT WITH:
      (I) INFORMATION ON HOW TO COMPLETE AN APPLICATION PURSUANT
TO SECTION 25.5-3-502.5; AND
       (II) IF APPLICABLE, AT THE OPTION OF THE HEALTH-CARE FACILITY,
INFORMATION REGARDING THE PATIENT'S ELIGIBILITY FOR THE HEALTH-CARE
FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND THE AMOUNT OF ANY
DISCOUNT OFFERED THROUGH THE PROGRAM;
      (c) IF THE HEALTH-CARE FACILITY IS CERTIFIED BY THE STATE
DEPARTMENT AS A PRESUMPTIVE ELIGIBILITY SITE AND DETERMINES THAT
THE PATIENT IS PRESUMPTIVELY ELIGIBLE FOR MEDICAL ASSISTANCE, INFORM
THE PATIENT OF THE DETERMINATION AND PROVIDE THE PATIENT WITH
INFORMATION ON HOW THE PATIENT CAN ENROLL IN PUBLIC HEALTH-CARE
COVERAGE;
      (d) IF THE HEALTH-CARE FACILITY DETERMINES THAT A PATIENT IS
LIKELY ELIGIBLE FOR PUBLIC HEALTH-CARE COVERAGE INFORM THE PATIENT
OF THE DETERMINATION AND:
      (I) PROVIDE THE PATIENT WITH INFORMATION EXPLAINING HOW TO
APPLY FOR PUBLIC HEALTH-CARE COVERAGE, INCLUDING AT LEAST ONE
AVAILABLE METHOD FOR SUBMITTING AN APPLICATION;
     (II) OFFER REASONABLE ASSISTANCE OR REFERRAL FOR SUPPORT TO
COMPLETE AN APPLICATION FOR PUBLIC-HEALTH CARE COVERAGE; AND
PAGE 8-SENATE BILL 26-138
      (III) TREAT COMPLETION OF AN APPLICATION FOR PUBLIC
HEALTH-CARE COVERAGE AS THE PRIMARY PATHWAY FOR RESOLVING THE
PATIENT'S FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES UNTIL THE
PATIENT IS DENIED PUBLIC HEALTH-CARE COVERAGE OR 45 DAYS AFTER THE
DATE OF DISCHARGE, WHICHEVER OCCURS FIRST; AND
      (e) IF THE HEALTH-CARE FACILITY NEEDS MORE INFORMATION TO
MAKE A DETERMINATION OF WHETHER THE PATIENT HAS QUALIFIED OR IS
LIKELY TO QUALIFY FOR DISCOUNTED CARE OR A FINANCIAL ASSISTANCE
PROGRAM, INFORM THE PATIENT OF THE PATIENT'S IDENTIFIED FEDERAL
POVERTY GUIDELINE PERCENTAGE AND NOTIFY THE PATIENT THAT THE
PATIENT MUST PROVIDE ADDITIONAL INFORMATION TO COMPLETE AN
APPLICATION PURSUANT TO SECTION 25.5-3-502.5.
      (3.7) (a) (I) IF A PATIENT HAS NOT BEEN DETERMINED ELIGIBLE FOR
PUBLIC HEALTH-CARE COVERAGE PURSUANT TO SUBSECTION (3.5)(d) OF THIS
SECTION WITHIN 45 DAYS AFTER THE DATE OF DISCHARGE, A HEALTH-CARE
FACILITY SHALL PROCEED WITH A DETERMINATION OF WHETHER THE PATIENT
IS A QUALIFIED PATIENT.
       (II) UPON NOTIFICATION OF A DETERMINATION THAT A PATIENT IS
INELIGIBLE FOR PUBLIC HEALTH-CARE COVERAGE PURSUANT TO SUBSECTION
(3.5)(d) OF THIS SECTION, A HEALTH-CARE FACILITY SHALL PROCEED WITH
A DETERMINATION OF WHETHER THE PATIENT IS A QUALIFIED PATIENT.
      (b) SUBSECTION (3.5)(d) OF THIS SECTION DOES NOT PROHIBIT A
PATIENT OR HEALTH-CARE FACILITY FROM COMPLETING AN APPLICATION
PURSUANT TO SECTION 25.5-3-502.5 WHILE A DETERMINATION OF THE
PATIENT'S ELIGIBILITY FOR PUBLIC HEALTH-CARE COVERAGE IS PENDING.
     (c) WHILE A DETERMINATION OF A PATIENT'S ELIGIBILITY FOR PUBLIC
HEALTH-CARE COVERAGE IS PENDING, A HEALTH-CARE FACILITY MAY DEFER
COMPLETION OF A FINAL DETERMINATION FOR DISCOUNTED CARE IF THE
PATIENT IS AFFORDED THE PROTECTIONS FROM BILLING AND COLLECTION
ACTIVITY REQUIRED BY SECTION 25.5-3-506.
     (d) IF A PATIENT IS DETERMINED ELIGIBLE FOR PUBLIC HEALTH-CARE
COVERAGE PURSUANT TO SUBSECTION (3.5)(d) OF THIS SECTION,
REIMBURSEMENT THROUGH PUBLIC HEALTH-CARE COVERAGE IS THE
PRIMARY REIMBURSEMENT BEFORE ANY DISCOUNTS ARE PROVIDED
PAGE 9-SENATE BILL 26-138
PURSUANT TO THIS SECTION.
      (e) WHERE A HEALTH-CARE FACILITY DETERMINES, BASED ON
AVAILABLE INFORMATION, THAT A PATIENT IS FACIALLY INELIGIBLE FOR
PUBLIC HEALTH-CARE COVERAGE, THE HEALTH-CARE FACILITY MAY
PROCEED DIRECTLY WITH A DETERMINATION OF WHETHER THE PATIENT IS A
QUALIFIED PATIENT.
       (f) A HEALTH-CARE FACILITY SHALL NOT DENY ELIGIBILITY FOR
DISCOUNTED CARE SOLELY BECAUSE A PATIENT DID NOT APPLY FOR PUBLIC
HEALTH-CARE COVERAGE.
        (4) If the patient declines the screening described in subsection (1)
of this section, the health-care facility shall document the patient's decision
in accordance with state department rules. A patient's decision to decline the
screening that is documented and complies with state department rules is a
complete defense to a claim brought by a patient under section 25.5-3-506
(2) for a violation of section 25.5-3-506 (1)(a) or (1)(b).
        (5) If requested by the AN INSURED patient, a health-care facility
shall screen an insured patient for discounted care pursuant to subsections
(1)(b) and (1)(c) of this section PERFORM THE SCREENING DESCRIBED IN THIS
SECTION AND, IF APPLICABLE, COMPLETE THE APPLICATION PURSUANT TO
SECTION 25.5-3-502.5 TO DETERMINE IF THE INSURED PATIENT IS A
QUALIFIED PATIENT.
       (6)  AS USED IN THIS SECTION, "INFORM" MEANS TO CONVEY
REQUIRED INFORMATION, UNLESS OTHERWISE SPECIFIED IN THIS SECTION,
INCLUDING THROUGH VERBAL, ELECTRONIC, OR OTHER FORMATS. THE
HEALTH-CARE FACILITY SHALL DOCUMENT THE MANNER IN WHICH THE
INFORMATION WAS PROVIDED.
      (7) A HEALTH-CARE FACILITY MAY USE THE SAME COMMUNICATION
TO COMPLY WITH BOTH STATE AND FEDERAL REQUIREMENTS.
      SECTION 8. In Colorado Revised Statutes, add 25.5-3-502.5 as
follows:
       25.5-3-502.5. Uniform application for discounted care.
PAGE 10-SENATE BILL 26-138
      (1) AFTER COMPLETION OF THE SCREENING CONDUCTED PURSUANT
TO SECTION 25.5-3-502, A HEALTH-CARE FACILITY SHALL REQUEST
INFORMATION FROM A PATIENT TO COMPLETE A UNIFORM APPLICATION FOR
DISCOUNTED CARE IF:
      (a) THE HEALTH-CARE FACILITY NEEDS MORE INFORMATION TO MAKE
A DETERMINATION OF WHETHER THE PATIENT HAS QUALIFIED OR IS LIKELY
TO QUALIFY FOR DISCOUNTED CARE OR THE HEALTH-CARE FACILITY'S
FINANCIAL ASSISTANCE PROGRAM, INCLUDING IF THE HEALTH-CARE
FACILITY'S POLICY IS TO REQUIRE AN APPLICATION PRIOR TO MAKING A FINAL
DETERMINATION; OR
      (b) THE PATIENT REQUESTS AN APPLICATION, UNLESS THE PATIENT
HAS NO BALANCE REMAINING AFTER APPLYING ANY DISCOUNTS PURSUANT
TO SECTION 25.5-3-503 OR THE HEALTH-CARE FACILITY'S FINANCIAL
ASSISTANCE PROGRAM.
      (2) A HEALTH-CARE FACILITY SHALL USE THE UNIFORM APPLICATION
DEVELOPED BY THE STATE DEPARTMENT TO COMPLETE THE APPLICATION
REQUIRED BY THIS SECTION.
     (3) UPON COMPLETION AND REVIEW OF THE APPLICATION, A
HEALTH-CARE FACILITY SHALL:
      (a) IF THE HEALTH-CARE FACILITY DETERMINES THAT A PATIENT IS
A QUALIFIED PATIENT , PROVIDE THE PATIENT NOTICE OF THE
DETERMINATION, THE PATIENT'S IDENTIFIED FEDERAL POVERTY GUIDELINE
PERCENTAGE, AND THE PATIENT'S MONTHLY INSTALLMENT MAXIMUM
PAYMENT AS DESCRIBED IN SECTION 25.5-3-503;
      (b) IF THE HEALTH-CARE FACILITY DETERMINES THAT A PATIENT IS
NOT A QUALIFIED PATIENT, PROVIDE THE PATIENT NOTICE OF THE
DETERMINATION, WHICH, IF APPLICABLE, MAY ALSO INCLUDE NOTICE THAT
THE PATIENT IS ELIGIBLE FOR THE HEALTH-CARE FACILITY'S FINANCIAL
ASSISTANCE PROGRAM AND THE AMOUNT OF ANY DISCOUNT OFFERED
THROUGH THAT PROGRAM, AND SHALL PROVIDE EITHER:
     (I)   AN OPPORTUNITY FOR THE PATIENT TO APPEAL THE
DETERMINATION IN ACCORDANCE WITH STATE DEPARTMENT RULES; OR
PAGE 11-SENATE BILL 26-138
      (II) A STATEMENT THAT THE PATIENT HAS NO BALANCE DUE AFTER
APPLYING ANY DISCOUNTS FROM THE HEALTH-CARE FACILITY'S FINANCIAL
ASSISTANCE PROGRAM; AND
       (c) IF THE HEALTH-CARE FACILITY IS CERTIFIED BY THE STATE
DEPARTMENT AS A PRESUMPTIVE ELIGIBILITY SITE AND DETERMINES THAT
THE PATIENT IS PRESUMPTIVELY ELIGIBLE FOR MEDICAL ASSISTANCE,
PROVIDE THE PATIENT NOTICE OF THE DETERMINATION AND INFORMATION
ON HOW THE PATIENT CAN ENROLL IN PUBLIC HEALTH-CARE COVERAGE.
       SECTION 9. In Colorado Revised Statutes, 25.5-3-503, amend (1)
introductory portion and (2)(a) as follows:
      25.5-3-503. Health-care discounts on services not eligible for
Colorado indigent care program reimbursement - definition.
       (1) Beginning September 1, 2022, if a patient is screened pursuant
to section 25.5-3-502 OR HAS COMPLETED A UNIFORM APPLICATION
PURSUANT TO SECTION 25.5-3-502.5 and is determined to be a qualified
patient, a health-care facility and a licensed health-care professional shall,
for emergency hospital and other health-care services:
       (2) A health-care facility shall not:
       (a) Deny discounted care on the basis that the patient has not applied
for any public benefits program, unless during the initial screening the
patient is determined to be presumptively eligible for the state medical
assistance program; or
        SECTION 10. In Colorado Revised Statutes, 25.5-3-504, amend
(1) introductory portion; and add (2) as follows:
       25.5-3-504. Notification of patients' rights - website link.
       (1) Beginning September 1, 2022, A health-care facility shall make
information developed by the state department about patients' rights under
this part 5 and the uniform application A LINK ON THE STATE DEPARTMENT
WEBSITE TO ACCESS THE UNIFORM APPLICATION developed by the state
department pursuant to section 25.5-3-505 (2)(i) available to the public and
to each patient. At a minimum, the health-care facility shall:
PAGE 12-SENATE BILL 26-138
     (2) THE STATE DEPARTMENT SHALL POST THE UNIFORM APPLICATION
DEVELOPED PURSUANT TO SECTION 25.5-3-505 (2)(i) IN ALL REQUIRED
LANGUAGES ON A PUBLICLY ACCESSIBLE WEBSITE.
        SECTION 11. In Colorado Revised Statutes, 25.5-3-505, amend
(2) introductory portion, (2)(c)(II), (2)(d), (2)(e), (2)(f), (2)(g), (2)(i), (5)
introductory portion, (5)(b)(I), and (5)(b)(II); and add (2)(d.5) and (7) as
follows:
      25.5-3-505. Health-care facility reporting requirements - agency
enforcement - report - rules.
      (2) No later than April 1, 2022 JULY 1, 2027, the state board shall
promulgate ADOPT rules necessary for the administration and
implementation of this part 5. At a minimum, the rules must:
       (c) Establish the process for and the maximum number of days that
a health-care facility has to:
       (II) Request information from the A patient needed for the screening
process IF THE HEALTH-CARE FACILITY CONDUCTS A SCREENING USING THE
UNIFORM SCREENING QUESTIONNAIRE AS DESCRIBED IN SECTION 25.5-3-502
(2); and
        (d) Outline the requirements for notifying the patient of the results
of the screening, including:
       (I) An explanation of the basis for a denial of discounted care; and
       (II) The process for appealing a denial COMPLETING AN APPLICATION
TO PROVIDE MORE INFORMATION TO DETERMINE WHETHER THE PATIENT IS
A QUALIFIED PATIENT;
      (d.5) ESTABLISH A PROCESS FOR AND THE MAXIMUM NUMBER OF
DAYS THAT A HEALTH-CARE FACILITY HAS TO:
       (I) REQUEST INFORMATION FROM THE PATIENT TO COMPLETE AN
APPLICATION, IF THE APPLICATION IS REQUIRED PURSUANT TO SECTION
25.5-3-502.5; AND
PAGE 13-SENATE BILL 26-138
       (II) COMPLETE THE APPLICATION PROCESS AS DESCRIBED IN SECTION
25.5-3-502.5;
      (e) Establish guidelines for patient appeals regarding eligibility for
discounted care pursuant to section 25.5-3-503 25.5-3-502.5;
       (f) Establish a methodology that all ACCEPTABLE METHODOLOGIES
FOR health-care facilities must use to determine monthly household income.
FOR PURPOSES OF THE SCREENING CONDUCTED PURSUANT TO SECTION
25.5-3-502, THE USE OF AN INDUSTRY-STANDARD THIRD-PARTY RESOURCE,
INCLUDING MAJOR CREDIT BUREAUS, IS AN ACCEPTABLE METHODOLOGY. A
HEALTH-CARE FACILITY SHALL DISCLOSE TO THE DEPARTMENT WHICH
INDUSTRY-STANDARD THIRD-PARTY RESOURCES THEY USE TO DETERMINE
MONTHLY HOUSEHOLD INCOME. The methodology METHODOLOGIES must
not consider a patient's assets.
      (g) FOR PURPOSES OF THE APPLICATION, identify the documents that
may be required to establish income eligibility for discounted care using the
minimum amount of information needed to determine eligibility;
        (i) Create a uniform application that a health-care facility must use
when AN APPLICATION IS REQUIRED AFTER screening a patient for eligibility
for discounted care, as described in section 25.5-3-502 SECTIONS 25.5-3-502
AND 25.5-3-502.5; and
       (5) No later than April 1, 2022, The state department: shall:
       (b) (I) SHALL establish a process for patients to submit a complaint
relating to noncompliance with this part 5 to the state department by phone,
BY mail, or online. The state department shall conduct a review OF A
PATIENT'S COMPLAINT within thirty days after receiving a THE complaint.
        (II) (A) The state department Shall periodically review health-care
facilities and licensed health-care professionals to ensure compliance with
this section QUALIFIED PATIENTS ARE IDENTIFIED IN COMPLIANCE WITH THIS
PART 5, ARE NOT CHARGED MORE THAN THE DISCOUNTED RATE ESTABLISHED
IN STATE BOARD RULES PURSUANT TO SUBSECTION (2)(j) OF THIS SECTION,
ARE OFFERED INSTALLMENT PAYMENTS AS REQUIRED BY SECTION
25.5-3-503, AND DO NOT HAVE THEIR DEBT ASSIGNED OR SOLD BEFORE ALL
REQUIREMENTS OF SECTION 25.5-3-506 ARE MET. THE REVIEW SHALL BE
PAGE 14-SENATE BILL 26-138
CONDUCTED IN ACCORDANCE WITH STATE DEPARTMENT RULES, AND THE
FREQUENCY, SAMPLE SIZE, AND TIMELINE OF THE REVIEW MUST BE
REASONABLE CONSIDERING THE SIZE AND RESOURCES OF THE HEALTH-CARE
FACILITY.
       (B) If the state department finds that a health-care facility or
licensed health-care professional is not in compliance with this section, AND
THE NONCOMPLIANCE HAS RESULTED IN A DELAY OR DENIAL OF A DISCOUNT
OWED TO A PATIENT AS A RESULT OF THE SCREENING OR APPLICATION
REQUIRED PURSUANT TO SECTION 25.5-3-502 OR 25.5-3-502.5, AS A RESULT
OF THE HEALTH-CARE FACILITY OR THE LICENSED HEALTH-CARE
PROFESSIONAL CHARGING THE PATIENT MORE THAN THE DISCOUNTED RATE
ESTABLISHED IN STATE DEPARTMENT RULE PURSUANT TO SECTION
25.5-3-505 (2)(j), DUE TO A FAILURE TO OFFER INSTALLMENT PAYMENTS
PURSUANT TO SECTION 25.5-3-503 OR DUE TO THE ASSIGNING OR SELLING OF
PATIENT DEBT TO A COLLECTION AGENCY IN VIOLATION OF SECTION
25.5-3-506, the state department shall notify the health-care facility or
licensed health-care professional and the facility or professional has ninety
days AFTER NOTIFICATION to file a corrective action plan with the state
department. that IF THE NONCOMPLIANCE RESULTED IN EXCESS CHARGES TO
THE PATIENT, THE CORRECTIVE ACTION PLAN must include measures to
inform the patient about the noncompliance and provide a financial
correction consistent with this part 5. A health-care facility or licensed
health-care professional may request up to one hundred twenty days to
submit a corrective action plan. The state department may require a
health-care facility or licensed health-care professional that is not in
compliance with this part 5 or any state board rules adopted pursuant to this
part 5 to develop and operate under a corrective action plan until the state
department determines the health-care facility or licensed health-care
professional is in compliance.
      (C) IF A HEALTH-CARE FACILITY'S OR LICENSED HEALTH-CARE
PROFESSIONAL'S NONCOMPLIANCE WITH THIS PART 5 DID NOT RESULT IN A
DELAY OR DENIAL OF A DISCOUNT OWED TO A PATIENT, THE STATE
DEPARTMENT MAY NOTIFY THE HEALTH-CARE FACILITY OR LICENSED
HEALTH-CARE PROFESSIONAL OF THE NONCOMPLIANCE FOR PURPOSES OF
QUALITY IMPROVEMENT.
      (7) (a) THE STATE DEPARTMENT SHALL COMPLY WITH SECTION
24-4-103 (1) WHEN IMPOSING CHANGES TO THE UNIFORM SCREENING
PAGE 15-SENATE BILL 26-138
QUESTIONNAIRE, CHANGES TO THE APPLICATION, NEW REQUIREMENTS, NEW
REPORTING OBLIGATIONS, NEW DOCUMENTATION STANDARDS, NEW DATA
ELEMENTS, OR NEW PROGRAM CRITERIA. THE STATE DEPARTMENT SHALL
ENSURE THE CHANGES OR NEW REQUIREMENTS ARE:
      (I) ADOPTED BY RULE PURSUANT TO THE "STATE ADMINISTRATIVE
PROCEDURE ACT", ARTICLE 4 OF TITLE 24 , BY SEPTEMBER 1, 2026, FOR A
RULE THAT WILL GO INTO EFFECT DURING TO THE 2026-27 STATE FISCAL
YEAR AND EVERY YEAR THEREAFTER BY JUNE 1 PRIOR TO THE STATE FISCAL
YEAR FOR WHICH THE RULE WILL GO INTO EFFECT; AND
       (II) SUBJECT TO STAKEHOLDER ENGAGEMENT PURSUANT TO
SUBSECTION (4) OF THIS SECTION.
        (b) ANY CHANGE OR NEW REQUIREMENT DESCRIBED IN SUBSECTION
(7)(a) OF THIS SECTION THAT WAS NOT ADOPTED THROUGH RULE-MAKING IS
ADVISORY ONLY AND DOES NOT SERVE AS THE BASIS FOR ENFORCEMENT.
      (c) THE STATE DEPARTMENT SHALL MAINTAIN AN UPDATED PUBLIC
ARCHIVE OF ALL MANUALS AND SUBREGULATORY ISSUANCES, INCLUDING
THE RATIONALE FOR CHANGES AND CITATIONS TO STATUTORY OR
REGULATORY AUTHORITY FOR EACH CHANGE OR NEW REQUIREMENT.
       (d) THIS SUBSECTION (7) DOES NOT APPLY TO RULES ADOPTED BY
THE STATE DEPARTMENT OR THE STATE BOARD TO UPDATE ANNUAL FEDERAL
POVERTY GUIDELINES OR IN RESPONSE TO EMERGENT AND IMMEDIATE
TRENDS THAT ARE IDENTIFIED BY CONSUMERS OR HOSPITALS AS LIMITING
THE PROGRAM'S EFFECTIVENESS AND ARE DEMONSTRATED BY DATA
SUBMITTED TO THE STATE DEPARTMENT OR THE STATE BOARD.
        SECTION 12. In Colorado Revised Statutes, 25.5-4-402.8, amend
(2)(b) introductory portion, (2)(b)(II)(A), and (2)(e) as follows:
       25.5-4-402.8. Hospital transparency report and requirements -
definitions - rules.
       (2) (b) Except as provided in subsection (2)(c) of this section, each
hospital licensed pursuant to part 1 of article 3 of title 25, or certified
pursuant to section 25-1.5-103 (1)(a)(II), shall make information available
to the state department for purposes of preparing the annual hospital
PAGE 16-SENATE BILL 26-138
transparency report. The state board shall establish the CONTENT AND format
of the information provided by each hospital on an annual basis BY RULE,
ESTABLISHING THE FORMAT FOR INFORMATION FOR THE 2026 ANNUAL
REPORT AS THE DEFAULT FORMAT UNLESS MODIFIED BY RULE. Each hospital
shall provide the following information to the state department ON AN
ANNUAL BASIS USING THE MOST RECENT CONTENT AND FORMAT
REQUIREMENTS THAT WERE ADOPTED BY THE STATE BOARD AT LEAST
THIRTY DAYS PRIOR TO THE BEGINNING OF THE HOSPITAL'S FISCAL YEAR:
        (II) (A) Annual audited financial statements, prepared in accordance
with generally accepted accounting principles. Each hospital shall submit
the statements within one hundred twenty FIFTY days after the end of its
fiscal year unless the state department grants an extension in writing in
advance of that date.
        (e) Prior to issuing the hospital transparency report, the state
department shall provide any hospital referenced in the hospital
transparency report a copy of the DRAFT report BY DECEMBER 1 OF EACH
YEAR. Each hospital AND A STATEWIDE HOSPITAL ASSOCIATION must have
a minimum of fifteen BUSINESS days to review the hospital transparency
report and any underlying data and submit corrections or clarifications to
the state department.
       SECTION 13. In Colorado Revised Statutes, 6-20-201, amend the
introductory portion and (1) as follows:
       6-20-201. Definitions.
      For the purposes of AS USED IN this part 2, unless the context
otherwise requires:
       (1) "Collection activity" means only those activities provided or
performed by a licensed collection agency, using a business name other than
the name of the health-care provider, for purposes of collecting a MEDICAL
debt. The term does not include any standard billing procedures used by the
health-care provider or its agent in the normal course of business on current,
nondelinquent accounts.
       SECTION 14. In Colorado Revised Statutes, 6-20-203, amend
(5)(b) and (5)(c) as follows:
PAGE 17-SENATE BILL 26-138
       6-20-203. Limitations on collection actions - definition.
       (5) Beginning September 1, 2022, a medical creditor collecting on
a debt for hospital services shall not sell a medical debt to another party
unless, prior to the sale, the medical debt seller has entered into a legally
binding written agreement with the medical debt buyer of the debt pursuant
to which:
        (b) The debt is returnable to or recallable by the medical debt seller
upon a determination that the patient should have been screened pursuant
to section 25.5-3-502 SECTIONS 25.5-3-502 AND 25.5-3-502.5 and is eligible
for discounted care pursuant to section 25.5-3-503 or that the bill underlying
the medical debt is eligible for reimbursement through a public health-care
coverage program; and
        (c) If it is determined that the patient should have been screened
pursuant to section 25.5-3-502 SECTIONS 25.5-3-502 AND 25.5-3-502.5 and
is eligible for discounted care pursuant to section 25.5-3-503 or that the bill
underlying the medical debt is eligible for reimbursement through a public
health-care coverage program and the debt is not returned to or recalled by
the medical debt seller, the medical debt buyer shall adhere to procedures
that must be specified in the agreement that ensures the patient will not pay,
and has no obligation to pay, the medical debt buyer and the medical
creditor together more than the patient is personally responsible for paying.
        SECTION 15. In Colorado Revised Statutes, 12-220-306, amend
(4) as follows:
       12-220-306. Dentists may prescribe drugs - surgical operations
- anesthesia - limits on prescriptions - rules.
       (4) A licensed dentist is strongly encouraged to purchase or utilize
an electronic health product that includes integration of a tool that facilitates
dentists' compliance with prescription drug monitoring standards. required
by section 12-30-114 (1)(a)(IV).
        SECTION 16. In Colorado Revised Statutes, 12-240-130, amend
(2)(a)(II); and repeal (2)(a)(III) and (5) as follows:
       12-240-130. Renewal, reinstatement, reactivation - delinquency
PAGE 18-SENATE BILL 26-138
- fees - questionnaire.
       (2) (a) The board shall design a questionnaire to accompany the
renewal form for the purpose of determining whether a licensee has acted
in violation of this article 240 or has been disciplined for any action that
might be considered a violation of this article 240 or that might make the
licensee unfit to practice medicine with reasonable care and safety. The
board shall include on the questionnaire a question regarding whether:
       (II) The licensee is in compliance with section 12-280-403 (2)(a)
and is aware of the penalties for failing to comply with that section; AND
       (III) The licensee is in compliance with section 12-30-114; and
        (5) On and after October 1, 2022, as a condition of renewal,
reinstatement, or reactivation of a license, each licensee or applicant shall
attest that the licensee or applicant is in compliance with section 12-30-114
and that the licensee or applicant is aware of the penalties for
noncompliance with that section.
        SECTION 17. In Colorado Revised Statutes, 12-240-130.5, amend
(6) as follows:
      12-240-130.5. Continuing medical education - requirement -
compliance - legislative declaration - rules - definitions.
       (6) As part of the CME requirement established pursuant to this
section, in addition to CME programs covering topics selected by the
physician, a physician's CME credit hours must include
       (a) CME credit hours that comply with section 12-30-114 and
related board rules; and
      (b) CME credit hours covering a topic specified by the board by rule
pursuant to subsection (7)(b) of this section.
        SECTION 18. In Colorado Revised Statutes, 25-1.5-103, amend
(1)(a)(I)(A) and (1)(a)(I)(F) as follows:
       25-1.5-103. Health facilities - powers and duties of department
PAGE 19-SENATE BILL 26-138
- rules - limitations on rules - definitions - repeal.
      (1) The department has, in addition to all other powers and duties
imposed upon it by law, the powers and duties provided in this section as
follows:
       (a) (I) (A) To annually license and to establish and enforce standards
for the operation of general hospitals, hospital units as defined in section
25-3-101 (2)(b), freestanding emergency departments as defined in section
25-1.5-114 (5)(b)(I), critical access hospitals as defined in section
25-1.5-114.5 (1)(b), psychiatric hospitals, community clinics, rehabilitation
hospitals, convalescent centers, facilities for persons with intellectual and
developmental disabilities, nursing care facilities, hospice care, assisted
living residences, dialysis treatment clinics, ambulatory surgical centers,
birthing centers, home care agencies, and other facilities of a like nature,
except those wholly owned and operated by a governmental unit or agency.
       (F) Sections 24-4-104 C.R.S., and 25-3-102 govern the issuance,
suspension, renewal, revocation, annulment, or modification of licenses. All
licenses issued by the department must contain the date of issue. and cover
a twelve-month period. Nothing contained in this paragraph (a) SUBSECTION
(1)(a) prevents the department from adopting and enforcing, with respect
to projects for which federal assistance has been obtained or is requested,
higher standards as may be required by applicable federal laws or
regulations of federal agencies responsible for the administration of
applicable federal laws.
       SECTION 19. Act subject to petition - effective date. Section
25-3-102, Colorado Revised Statutes, as amended in section 5 of this act,
and section 25-1.5-103, Colorado Revised Statutes, as amended in section
18 of this act, take effect July 1, 2028, and the remainder of this act takes
effect at 12:01 a.m. on the day following the expiration of the ninety-day
period after final adjournment of the general assembly; except that, if a
referendum petition is filed pursuant to section 1 (3) of article V of the state
constitution against this act or an item, section, or part of this act within
such period, then the act, item, section, or part will not take effect unless
approved by the people at the general election to be held in November 2026
and, in such case, will take effect on the date of the official declaration of
the vote thereon by the governor; except that section 25-3-102, Colorado
PAGE 20-SENATE BILL 26-138
Revised Statutes, as amended in section 5 of this act, and section
25-1.5-103, Colorado Revised Statutes, as amended in section 18 of this act,
take effect July 1, 2028.
____________________________  ____________________________
James Rashad Coleman, Sr.  Julie McCluskie
PRESIDENT OF  SPEAKER OF THE HOUSE
THE SENATE  OF REPRESENTATIVES
____________________________  ____________________________
Esther van Mourik  Vanessa Reilly
SECRETARY OF  CHIEF CLERK OF THE HOUSE
THE SENATE  OF REPRESENTATIVES
       APPROVED________________________________________
                          (Date and Time)
                   _________________________________________
                  Jared S. Polis
                  GOVERNOR OF THE STATE OF COLORADO
PAGE 21-SENATE BILL 26-138