This Rule is promulgated pursuant to sections
12-20-204,
12-30-112, and
12-310-103(4), C.R.S., in
consultation with the Commissioner of Insurance and the State Board of Health.
The purpose of this Rule is to establish requirements for health care providers to
provide disclosures to consumers about the potential effects of receiving emergency or non-emergency services from an out-of-network provider.
This Rule applies to health care providers as defined in section
10-16-102(56), C.R.S.
A. Definitions, for purposes of this Rule, are as follows:
1. "Publicly
available" means, for the purposes of this regulation, searchable on the health care provider's public website, displayed in a manner that is easily
accessible, without barriers, and that ensures that the information is accessible to the general public, including that it is findable through public
search engines. The health care provider's public website must be accessible free of charge, without having to establish a user account, password, or
other credentials, accept any terms or conditions, and without having to submit any personal identifying information.
B. Disclosure requirements.
1. An out of network provider may balance bill a
covered person for post-stabilization services in accordance with section 10-16-704, C.R.S., and covered nonemergency services in an in-network facility that are not ancillary
services if the provider meets the requirements set forth in section 12-30-112 (3.5), C.R.S. If a consumer has incurred a claim for emergency or nonemergency health care
services from an out-of-network provider, the health care provider shall provide the disclosures contained in Appendix A. The health care provider
shall provide the disclosure contained in Appendix A in compliance with section 12-30-112 (3.5), C.R.S.
C. Noncompliance with
this Rule may result in the imposition of any of discipline made available by section
12-310-106(2)(e),
C.R.S.
Notes
C.R.S. 4 CCR 745-1.9
43 CR 03, February 10, 2020, effective
1/1/2020
43 CR 07, April 10, 2020, effective
4/30/2020
43 CR 22, November 25, 2020, effective
12/15/2020
44 CR 11, June 10, 2021, effective
4/27/2021
44 CR 11, June 10, 2021, effective
5/11/2021
44 CR 09, May 10, 2021, effective
5/30/2021
44 CR 15, August 10, 2021, effective
7/12/2021
44 CR 18, September 25, 2021, effective
10/15/2021
45 CR 17, September 10, 2022, effective
8/15/2022
45 CR 21, November 10, 2022, effective
11/30/2022
