A BILL FOR AN ACT. Concerning the compiling and reporting of hospital charge data for the benefit of healthcare consumers.

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1 A BILL FOR AN ACT 1 2 Concerning the compiling and reporting of hospital charge data for the benefit of healthcare consumers. Bill Summary Requires each hospital in the State of Colorado to provide to the Department of Public Health and Environment annually, its current charge master; its gross billed charges for the 25 most common outpatient and inpatient procedures; and, its average discount from gross billed charges given to (1) self-pay admissions, (2) private health plan admissions, and (3) government health plan admissions, for each of its 25 most common outpatient and inpatient procedures. Requires the Department of Public Health and Environment to create a database and develop an online query system to permit users to search charge masters and average charges for each hospital s most common 25 inpatient and outpatient procedures; to update the database annually; and, to publish the database on its Internet website BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF COLORADO: Section 1. Part 1 of article 3 of title 25, Colorado Revised Statues, is amended by the addition of new sections to read as follows: Hospital Charges - Reports (1) As used in this Section, the meaning of terms shall be as follows: (a) "Hospital" means a general Hospital required to be licensed under Sec , CRS; (b) "Department" means the Department of Public Health and Environment; (c) "Charge Master" means a uniform schedule of charges represented by a Hospital as its gross billed charge for each service or item provided to patients, regardless of payer type; (d) Average Discount from Charges means the gross billed charge for each inpatient or outpatient procedure minus the actual amount payable for each inpatient or outpatient procedure, divided by the gross billed charge for each procedure;

2 (e) Self-Pay Admission means those admissions where more than 50% of the actual amount due is not payable from a third party payer; (f) Private Health Plan Admission means those admissions where more than 50% of the actual amount due is payable from a non-government third party payer; and (g) Government Health Plan Admission means those admissions where more than 50% of the actual amount due is payable by a government entity (e.g. the Colorado Department of Health Care Policy and Finance and the United States Centers for Medicaid and Medicare Services). (2) Beginning July 1, 2006, each Hospital in this state shall file annually a copy of its Charge Master with the Department. (3) Beginning July 1, 2006, each Hospital in this state shall file annually a copy of the following reports with the Department: (a) a list of its 25 most common outpatient procedures, grouped by Medicare Ambulatory Payment Classification, and for each procedure: (I) the gross billed charge, before discounts; (II) the Average Discount From Charges given to Self-Pay Admissions; (III) the Average Discount From Charges given to Private Health Plan Admissions; and (IV) the Average Discount From Charges given to Government Health Plan Admissions; (b) a list of its 25 most common inpatient procedures, grouped by Medicare Diagnosis Related Group, and for each procedure: (I) the gross billed charge, before discounts; (II) the Average Discount From Charges given to Self-Pay Admissions;

3 (III) the Average Discount From Charges given to Private Health Plan Admissions; and (IV) the Average Discount From Charges given to Government Health Plan Admissions; (4) Each Hospital shall provide a copy of its Charge Master and its lists of average gross billed charges and discounts to any person upon request, and within a reasonable period of time after such request. Each Hospital shall file its Charge Master and its lists of average gross billed charges and discounts with the Department in such written and/or electronic form, and at such times as prescribed by the Department. (5) The Department may develop a uniform reporting form for the Charge Master and lists of average gross billed charges and discounts to be submitted for each Hospital to the Department. (6) The Department shall create a database and develop an online query system for Charge Masters and lists of average gross billed charges for each Hospital submitted to the Department. The database shall be updated at least annually. The Department shall publish this database on its Internet website, along with such other information as deemed appropriate for making the database useful to consumers Hospital Charges - Penalties (1) A Hospital shall be in violation of this article if it knowingly or negligently fails to comply with the requirements of section (2) A Hospital that fails to file with the Department the information required by section shall be: (I) liable for civil penalties as specified in , CRS; and (II) subject to revocation of its license, pursuant to regulations promulgated by the Department.

4 Hospital Charges and Department Website- Auditor Report On September 1, 2009, and on each third anniversary thereafter, the Colorado Office of the State Auditor shall deliver to the Joint Health and Human Services Committee of the Colorado State Assembly, a report on the benefits of Section , including the database for Hospital charges maintained on the Department website, to consumers in the State of Colorado. The report shall cover the three year period preceding such report.

5 Title: Concerning the compiling and reporting of hospital charge data for the benefit of healthcare consumers. Fiscal Impact FY 2006/2007 FY 2007/2008 FY 2008/2009 FY 2009/2010 Summary State Expenditures $35,000 $15,000 $15,000 $15,000 General Fund FTE Position 1.0 FTE 1.0 FTE 1.0 FTE 1.0 FTE Change Other State Impact: None Effective Date: 90 days after final adjournment Appropriation Summary for FY 2006/2007: Department of Public Health and Environment $35,000 and 1.0 FTE Local Government Impact: None Summary of Legislation Requires each hospital in the State of Colorado to provide to the Department of Public Health and Environment annually, its current charge master; its gross billed charges for the 25 most common outpatient and inpatient procedures; and, its average discount from gross billed charges given to (1) self-pay admissions, (2) private health plan admissions, and (3) government health plan admissions, for each of its 25 most common outpatient and inpatient procedures. Requires the Department of Public Health and Environment to create a database and develop an online query system to permit users to search charge masters and average charges for each hospital s most common 25 inpatient and outpatient procedures; to update the database annually; and, to publish the database on its Internet website. State Expenditures In FY 2006/2007 an expenditure of $35,000 will be required. The bill s effective date is August 11, One FTE Rate/Financial Analyst II is required. The initial development of the website to display the hospital charge master information will require an expenditure of $15,000. Ongoing maintenance of the website will require an expenditure of $5,000 per year. Outreach and marketing of the new website will require an expenditure of $20,000 in the first year, and $10,000 in each subsequent year. Any additional rule-making will be considered as part of the department s on-going, regular work load. Consequently there is no need for additional rule-making funding. State Appropriations In FY 2006/2007, the Department of Public Health and Environment will require a 1.0 FTE and an appropriation of $35,000 from the state general fund. Departments Contacted Colorado Department of Public Health and Environment