(1) Definitions. As used
in this section, unless the context otherwise requires:
(a) Affiliated with means:
(I) Employed by a hospital or health system; or
(II) Under a professional services agreement, faculty agreement, or
management agreement with a hospital or health system that permits the hospital
or health system to bill on behalf of the affiliated entity.
(b) Campus means:
(I) A hospital's main buildings;
(II) The physical area immediately adjacent to a hospital's main buildings and
structures owned by the hospital that are not strictly contiguous to the main
buildings but are located within two hundred fifty yards of the main buildings; or
(III) Any other area that the federal centers for medicare and medicaid
services in the United States department of health and human services has
determined, on an individual-case basis, to be part of a hospital's campus.
(c) Critical access hospital means a hospital that is federally certified or
undergoing federal certification as a critical access hospital pursuant to 42 CFR
485, subpart F.
(d) Facility fee means any fee a hospital or health system charges or bills
for outpatient hospital services that is:
(I) Intended to compensate the hospital or health system for its operational
expenses; and
(II) Separate and distinct from a professional fee charged or billed by a
health-care provider for professional medical services.
(e) Freestanding emergency department means a health facility as defined
in and required to be licensed under section 25-1.5-114.
(f) Health-care provider means any person, including a health facility, that
is licensed or otherwise authorized in this state to furnish a health-care service.
(g) Health-care service has the meaning set forth in section 10-16-102 (33).
(h) Health facility means a facility licensed or certified pursuant to section
25-1.5-103 or established pursuant to part 5 of article 21 of title 23 or article 29 of
title 25.
(i) Health system has the meaning set forth in section 10-16-1303 (9).
(j) Hospital means a hospital currently licensed or certified by the
department of public health and environment pursuant to the department's
authority under section 25-1.5-103 (1)(a) or established pursuant to part 5 of article
21 of title 23 or article 29 of title 25.
(k) Medicare means the Health Insurance for the Aged Act, Title XVIII of
the federal Social Security Act, as amended by the social security amendments of
1965, and as later amended.
(l) Off-campus location has the meaning set forth in section 25-3-118.
(m) Owned by means owned by a hospital or health system when billed
under the hospital's tax identification number.
(n) Payer type means commercial insurers, medicare, the medical
assistance program established pursuant to articles 4 to 6 of title 25.5, individuals
who self-pay, or a financial assistance plan.
(o) Sole community hospital has the meaning set forth in 42 CFR 412.92.
(2) Limitations on charges. (a) On and after July 1, 2024, a health-care
provider or health system shall not charge, bill, or collect a facility fee directly from
a patient that is not covered by a patient's insurance for preventive health-care
services, as described in section 10-16-104 (18), that are provided in an outpatient
setting.
(b) This subsection (2) does not prohibit a health-care provider from charging
a facility fee for:
(I) Health-care services provided in an inpatient setting;
(II) Health-care services provided at a health facility that includes a licensed
hospital emergency department; or
(III) Emergency services provided at a licensed freestanding emergency
department.
(c) Nothing in this subsection (2) prohibits a health-care provider or health
system from charging, billing, or collecting a facility fee from a patient's insurer
pursuant to an agreement between the health-care provider or health system and
the carrier or as required by law.
(3) Transparency. (a) On and after July 1, 2024, a health-care provider
affiliated with or owned by a hospital or health system that charges a facility fee
shall:
(I) (A) Provide notice in plain language to patients that a facility fee may be
charged, indicate in the notice the amount of the facility fee, and require the health-care provider to provide the notice to a patient at the time an appointment is
scheduled and again at the time the health-care services are rendered; and
(B) Post a sign, in English and Spanish and that is plainly visible and located
in the area within the health facility where an individual seeking care registers or
checks in, that states that the patient may be charged a facility fee in addition to
the cost of the health-care service. The sign must also include a location within the
health facility where a patient may inquire about facility fees and an online location
where information about facility fees may be found.
(II) Provide to a patient a standardized bill that:
(A) Includes itemized charges for each health-care service;
(B) Specifically identifies any facility fee;
(C) Identifies specific charges that have been billed to insurance or other
payer types for health-care services; and
(D) Includes contact information for filing an appeal with the health-care
provider to contest charges.
(b) The health-care provider shall provide the required notice and
standardized bill in a clear manner and, to the extent practicable, in the patient's
preferred language.
(c) (I) A health facility that is newly affiliated with or owned by a hospital or
health system on or after July 1, 2024, shall provide written notice to each patient
receiving services within the twelve-month period immediately preceding the
affiliation or change of ownership that the health facility is part of a hospital or
health system. The notice must include:
(A) The name, business address, and phone number of the hospital or health
system that is the purchaser of the health facility or with whom the health facility is
affiliated;
(B) A statement that the health facility bills, or is likely to bill, patients a
facility fee that may be in addition to and separate from any professional fee billed
by a health-care provider at the health facility; and
(C) A statement that, prior to seeking services at the health facility, a patient
covered by a health insurance policy or health benefit plan should contact the
patient's health insurer for additional information regarding the health facility's
facility fees, including the patient's potential financial liability, if any, for the facility
fees.
(II) A hospital, health system, or health facility shall not collect a facility fee
for health-care services provided by a health-care provider affiliated with or owned
by a hospital or health system that is subject to any provisions of this section from
the date of the transaction until at least thirty days after the written notice required
pursuant to subsection (3)(c)(I) of this section is mailed to the patient.
(4) Subsection (2) of this section does not apply to a critical access hospital,
a sole community hospital in a rural or frontier area, or a community clinic affiliated
with a sole community hospital in a rural or frontier area.
(5) Subsection (2) of this section does not apply to a hospital established
pursuant to article 29 of title 25.