Hospitals

C.R.S. tit. 25, art. 3
in effect

C.R.S. § 25-3-100.5 Definitions

25-3-100.5. Definitions. As used in this article 3, unless the context otherwise requires: (1) "Acute treatment unit" means a facility or a distinct part of a facility for short-term psychiatric care, which may include treatment for substance use disorders, that provides a total, twenty-four-hour, therapeutically planned and professionally staffed environment for persons who do not require inpatient hospitalization but need more intense and individual services than are available on an outpatient basis, such as crisis management and stabilization services. (2) "Department" means the department of public health and environment. (3) "Heart attack database" means a national registry designed for heart attack data. (4) "Joint commission" means an independent, nonprofit organization that accredits and certifies health-care organizations and programs in the United States, or its successor entity. (5) "PCI center" means a hospital that performs percutaneous coronary intervention (PCI), commonly known as coronary angioplasty, for acute myocardial infarction. (6) "STEMI" means ST-elevation myocardial infarction.

C.R.S. § 25-3-101 Hospitals - health facilities - licensed - definitions

25-3-101. Hospitals - health facilities - licensed - definitions. (1) [Editor's note: This version of subsection (1) is effective until July 1, 2026.] It is unlawful for any person, partnership, association, or corporation to open, conduct, or maintain any general hospital; hospital unit; freestanding emergency department as defined in section 25-1.5-114; psychiatric hospital; community clinic; rehabilitation hospital; convalescent center; facility for persons with developmental disabilities, as defined in section 25-1.5-103 (2)(c); nursing care facility; hospice care; assisted living residence, except an assisted living residence shall be assessed a license fee as set forth in section 25-27-107; dialysis treatment clinic; ambulatory surgical center; birthing center; home care agency; or other facility of a like nature, except those wholly owned and operated by any governmental unit or agency, without first having obtained a license from the department. (1) [Editor's note: This version of subsection (1) is effective July 1, 2026.] It is unlawful for any person, partnership, association, or corporation to open, conduct, or maintain any general hospital; hospital unit; freestanding emergency department as defined in section 25-1.5-114; critical access hospital as defined in section 25-1.5-114.5; psychiatric hospital; community clinic; rehabilitation hospital; convalescent center; facility for persons with developmental disabilities as defined in section 25-1.5-103 (2)(c); nursing care facility; hospice care; assisted living residence, except an assisted living residence shall be assessed a license fee as set forth in section 25-27-107; dialysis treatment clinic; ambulatory surgical center; birthing center; home care agency; or other facility of a like nature, except those wholly owned and operated by a governmental unit or agency, without first having obtained a license from the department. (2) As used in this section, unless the context otherwise requires: (a) (I) "Community clinic" means a health-care facility that provides health-care services on an ambulatory basis, is neither licensed as an on-campus department or service of a hospital nor listed as an off-campus location under a hospital's license, and meets at least one of the following criteria: (A) Operates inpatient beds at the facility for the provision of extended observation and other related services for not more than seventy-two hours; (B) Provides emergency services at the facility and is not otherwise required to obtain licensure as a freestanding emergency department in accordance with section 25-1.5-114; or (C) Is not otherwise subject to health facility licensure under this section or section 25-1.5-103 but opts to obtain licensure as a community clinic in order to receive private donations, grants, government funds, or other public or private reimbursement for services rendered. (II) "Community clinic" includes a prison clinic operated by the department of corrections. (III) "Community clinic" does not include: (A) A federally qualified health center, as defined in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4); (B) A rural health clinic, as defined in section 1861 (aa)(2) of the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(2); (C) A facility that functions only as an office for the practice of medicine or the delivery of primary care services by other licensed or certified practitioners; or (D) A freestanding emergency department, as defined in and required to be licensed under section 25-1.5-114. ural health clinic, as defined in section 1861 (aa)(2) of the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(2); (C) A facility that functions only as an office for the practice of medicine or the delivery of primary care services by other licensed or certified practitioners; or (D) A freestanding emergency department, as defined in and required to be licensed under section 25-1.5-114. (b) "Hospital unit" means a physical portion of a licensed or certified general hospital, psychiatric hospital, maternity hospital, or rehabilitation hospital that is leased or otherwise occupied pursuant to a contractual agreement by a person other than the licensee of the host facility for the purpose of providing outpatient or inpatient services. (3) Nothing in this section shall be construed to require the licensing of individual services provided by a licensed or certified provider on its own premises. (4) A health-care facility is not required to be licensed as a community clinic solely due to the facility's ownership status, corporate structure, or engagement of outside vendors to perform nonclinical management services. This section permits regulation of a physician's office only to the extent the office is a community clinic as defined in this section.

C.R.S. § 25-3-102 License - application - issuance - certificate of compliance required - rules

25-3-102. License - application - issuance - certificate of compliance required - rules. (1) (a) An applicant for a license described in section 25-3-101 shall apply to the department of public health and environment annually 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. (b) The department has authority to administer oaths, subpoena witnesses or documents, and take testimony in all matters relating to issuing, denying, limiting, suspending, or revoking a license. (c) The department shall issue licenses to applicants furnishing satisfactory evidence of fitness to conduct and maintain a health facility described in section 25-3-101 in accordance with this part 1 and the rules adopted by the department. The department shall not require, as satisfactory evidence of fitness, evidence as to whether an applicant has provided self declarations, affidavits, or other attestations as to its general compliance with statutory or regulatory licensing requirements. The department shall determine an applicant's fitness solely based on the specific fitness information or documentation submitted by the applicant upon the department's request or as otherwise acquired by the department through its own review or investigation of the applicant. The department may require the applicant to attest to the accuracy of the information provided as long as the attestation does not require the applicant's affirmation of its general compliance with statutory or regulatory licensing requirements. CAPS check information pursuant to section 26-3.1-111 (6)(a)(III) may be considered part of an applicant's evidence of fitness. The board may promulgate rules as necessary to implement this subsection (1)(c). (d) The license expires one year after the date of issuance. (e) (I) For a change of ownership, the department shall conduct a fitness review of a new owner based upon information compiled within the five years preceding the date of the application; except that the new owner shall disclose whether, within the ten years preceding the date of an application, the new owner: (A) Has been convicted of a felony or misdemeanor involving moral turpitude; (B) Had a state license or federal certification denied, revoked, or suspended by another jurisdiction; (C) Had a civil judgment or criminal conviction against the new owner in a case brought by the federal, state, or local authorities that resulted from the operation, management, or ownership of a health facility or other entity related to substandard patient care or health-care fraud. (II) The new owner shall provide the information specified in subparagraph (I) of this paragraph (e) to the department regardless of whether action has been stayed during a judicial appeal or otherwise settled between the parties. (III) The department may review an existing owner of a licensed health facility or entity only when the department has new information not previously available or disclosed that bears on the fitness of the existing owner to operate or maintain a licensed health facility or entity. (IV) A conversion of the health facility's or entity's legal structure, or the legal structure of an entity that has a direct or indirect ownership interest in the health facility or entity, is not a change of ownership unless the conversion also includes a transfer of at least fifty percent of the licensed facility's direct or indirect ownership interest to one or more new owners. (2) Repealed. (IV) A conversion of the health facility's or entity's legal structure, or the legal structure of an entity that has a direct or indirect ownership interest in the health facility or entity, is not a change of ownership unless the conversion also includes a transfer of at least fifty percent of the licensed facility's direct or indirect ownership interest to one or more new owners. (2) Repealed. (3) (a) Notwithstanding any provision of law to the contrary, the department of public health and environment shall not issue or renew any license described in section 25-3-101 for a facility covered by section 25-1.5-103 (5) unless the department receives a certificate of compliance for the applicant's building or structure from the division of fire prevention and control in the department of public safety in accordance with part 12 of article 33.5 of title 24, C.R.S. (b) The department of public health and environment shall take action on an application for licensure within thirty days after the date that the department receives from the applicant all of the necessary information and documentation required for licensure, including a certificate of compliance from the division of fire prevention and control.

C.R.S. § 25-3-102.1 Deemed status for certain facilities

25-3-102.1. Deemed status for certain facilities. (1) (a) In the licensing of an ambulatory surgical center following the issuance of initial licensure by the department of public health and environment, the voluntary submission of satisfactory evidence that the applicant is accredited by the joint commission, the American association for accreditation of ambulatory surgery facilities, inc., the accreditation association for ambulatory health care, the American osteopathic association, or any successor entities shall be deemed to meet certain requirements for license renewal so long as the standards for accreditation applied by the accrediting organization are at least as stringent as the licensure requirements otherwise specified by the department. (b) (I) In the application for the renewal of a license for a health facility described in section 25-3-101, other than an ambulatory surgical center, the department of public health and environment shall deem health facilities that are currently accredited by an accrediting organization recognized by the federal centers for medicare and medicaid services as satisfying the requirements for renewal of the license. (II) If the standards for national accreditation are less stringent than the state's licensure standards for a particular health facility, the department of public health and environment may conduct a survey that focuses on the more stringent state standards. Beginning one year after the department first grants deemed status to a health facility pursuant to this subsection (1)(b), the department may conduct validation surveys, based on a valid sample methodology, of up to ten percent of the total number of accredited health facilities in the industry. If the department conducts a validation survey of a health facility, the validation survey is in lieu of a licensing renewal survey that the health facility would have undergone if the health facility did not have deemed status pursuant to this subsection (1)(b). Notwithstanding any other law to the contrary, the department may enter, survey, and investigate hospitals pursuant to section 25-3-128. (III) If the department of public health and environment takes an enforcement activity, as defined in section 25-1.5-103 (2)(b.5), against a health facility to which it has granted deemed status pursuant to this paragraph (b), the department may revoke the health facility's deemed status. (c) Upon submission of a completed application for license renewal, the department of public health and environment shall accept proof of the accreditation in lieu of licensing inspections or other requirements. Nothing in this section exempts an accredited health facility from inspections or from other forms of oversight by the department as necessary to ensure public health and safety. Nothing in this section prevents the department of public health and environment from conducting an inspection of a hospital or other health facility described in section 25-3-101 to investigate a complaint regarding the provisions of section 27-65-106, 27-65-107, 27-65-108.5, 27-65-109, 27-65-110, or 27-65-119 to the extent the complaint is applicable to health facilities licensed by the department of public health and environment. (2) In determining fees otherwise payable by a health facility for license renewal, the department of public health and environment shall give due consideration to efficiencies and savings generated in connection with the deemed status process in subsection (1) of this section and shall specifically provide an appropriate credit or reduced fee to a health facility that achieves license renewal through deemed status.

C.R.S. § 25-3-102.5 Nursing facilities - consumer satisfaction survey - pilot survey

25-3-102.5. Nursing facilities - consumer satisfaction survey - pilot survey. (1) (a) The department shall develop and implement a consumer satisfaction survey based on the results of the pilot survey implemented pursuant to paragraph (a.5) of this subsection (1). The pilot survey and the resulting consumer satisfaction survey shall be implemented to determine the level of satisfaction among residents and residents' families regarding the quality of care and quality of living in nursing facilities. "Nursing facility", as used in this section, means a nursing facility as defined in section 25.5-4-103 (14), C.R.S. The department shall appoint an advisory committee to develop the consumer satisfaction survey. The advisory committee shall include, but not be limited to, the state ombudsman, representatives of senior groups, representatives of the disabled community, representatives of providers of long term care services, and long term care consumers or their family members. The advisory committee shall develop recommendations for the development of an assessment tool for the consumer satisfaction survey and shall develop recommendations for the implementation of the pilot survey and the consumer satisfaction survey. The advisory committee shall ensure that a representative sample of participants are chosen and surveyed in a manner that will yield accurate and useful results. The department shall ensure that every nursing facility licensed by the department participates in the assessment of consumer satisfaction; except that any nursing facility that accepts exclusively private pay residents shall not be required to participate. Information about results of the most recent consumer satisfaction survey and how such survey was conducted shall be included by the facility in all informational materials provided to persons who inquire about the facility. The department shall assure confidentiality for residents during the survey process. The department shall make the results of consumer satisfaction surveys available to the public. (a.5) (I) The department shall develop and implement a pilot consumer satisfaction survey to aid in the determination of the level of satisfaction among residents and residents' families regarding the quality of care and quality of living in nursing facilities. The pilot survey shall be used exclusively for the development of the consumer satisfaction survey to be implemented pursuant to paragraph (d) of this subsection (1) and shall not be used to penalize any participating facility. The pilot survey shall be used to assess: (A) The validity of the questionnaire for use in the consumer satisfaction survey implemented pursuant to paragraph (d) of this subsection (1); (B) The nursing facilities residents' cognition levels in order to determine the ability of the residents to complete the survey in a meaningful manner; (C) The techniques employed to obtain the number of completed survey questionnaires needed to achieve a statistical validity of plus or minus ten percent on the final consumer satisfaction survey; and (D) The survey data to ensure that such data is meaningful to consumers. (II) The pilot survey shall involve the participation of no more than ten percent of all nursing facilities licensed by the department. The department shall select nursing facilities to participate in the pilot survey based on characteristics including, but not limited to, the rural or urban location of the facilities, and the cross-section of the resident population of the facilities. Facilities that volunteer to participate in the pilot survey shall be given priority in the selection process so long as the required characteristics are met. (III) (A) The individual nursing facility results of the pilot survey shall be confidential and not made available to the public; except that each nursing facility shall be provided with the pilot survey results from its own facility. ties. Facilities that volunteer to participate in the pilot survey shall be given priority in the selection process so long as the required characteristics are met. (III) (A) The individual nursing facility results of the pilot survey shall be confidential and not made available to the public; except that each nursing facility shall be provided with the pilot survey results from its own facility. (B) Aggregate statistical results of the pilot survey may be made available to the public. (C) Repealed. (IV) Repealed. (b) The consumer satisfaction survey shall be easy to understand so that each resident or resident's family member or representative who participates may fill out the survey unassisted; except that the department or its designated representative may assist a resident or resident's family with filling out the survey. Nursing facility volunteers and employees shall be prohibited from assisting participants with the completion of the survey. The names of the participants in the survey shall be kept confidential, and all surveys shall be returned directly to the department. (c) Repealed. (d) The department shall administer the consumer satisfaction survey based on the recommendations of the advisory committee in all licensed nursing facilities that are required to participate in accordance with paragraph (a) of this subsection (1). The department shall commence implementation of the survey on or before July 1, 2003. After the pilot survey is complete, the department shall evaluate the effectiveness of the pilot survey instruments, adopt any recommendations, and continue to survey all licensed facilities on a three-year cycle with one-third of the participating licensed nursing facilities completing the initial survey in one of the three years. Each participating licensed nursing facility shall perform a new consumer satisfaction survey every three years thereafter; except that the department may require, or a participating licensed nursing facility may request, that a new consumer satisfaction survey be performed more often if conditions warrant. If the licensed nursing facility requests such a survey, the department shall perform the survey if the licensed nursing facility pays the department for the costs associated with performing the survey. A licensed nursing facility may comment on the results of a consumer satisfaction survey and have such comments included in any publication or distribution of the results by the department. (e) Hospice residents and their family members and transitional care unit residents and their family members, shall be exempt from participation in the pilot survey and consumer satisfaction survey conducted in each nursing facility. (f) Nursing facilities shall release the name, address, and telephone number of each family member or party responsible for a nursing facility resident to the department for the sole use of conducting the pilot survey and the consumer satisfaction survey. (2) (a) The department shall respond to a complaint from a nursing facility resident or resident's family member or representative within five working days after receipt of the complaint and, for sixty days after the date the department received the complaint, the department shall update the complainant on the status of the complaint investigation at least every fourteen days until the complaint is resolved and an investigation is finalized. If the complaint is not resolved within sixty days after the date the department received the complaint, the department shall continue to update the complainant on the status of the complaint every thirty days until the complaint is resolved and an investigation report is resolved and an investigation is finalized. At the request of the complainant, the department shall not maintain such contact. If the complaint is not resolved within sixty days after the date the department received the complaint, the department shall continue to update the complainant on the status of the complaint every thirty days until the complaint is resolved and an investigation report is resolved and an investigation is finalized. At the request of the complainant, the department shall not maintain such contact. (b) (I) The state and local long-term care ombudsman, established pursuant to article 11.5 of title 26, C.R.S., in compliance with the federal "Older Americans Act of 1965", ("ombudsman") shall refer to the state department for investigation and resolution all complaints received by the ombudsman involving possible licensure violations in nursing homes that are exclusively private pay facilities. (II) Information about the ombudsman, including the ombudsman's role in dealing with resident complaints and all contact information and telephone numbers for the ombudsman, shall be included in the information provided to a resident upon admission to a facility that is not a private pay facility.

C.R.S. § 25-3-103 License denial or revocation - provisional license - rules

25-3-103. License denial or revocation - provisional license - rules. (1) (a) The department of public health and environment may deny an application for a new or renewal license under this part 1 or revoke a license if the applicant or licensee has not satisfied the requirements of this part 1 or part 6 of this article and the rules of the department or the state board of health. If a license is denied or revoked, the department may grant the applicant or licensee a provisional license upon payment of a fee established by the state board of health by rule, subject to the limitations in paragraph (c) of this subsection (1). The provisional license is valid for no longer than ninety days and may be issued to allow the applicant or licensee time to comply with the requirements for a regular license. A second provisional license may be issued if the department determines it is necessary to effect compliance. The second provisional license must be issued for the same duration as the first provisional license upon payment of the fee established by the state board of health by rule, subject to the limitations in paragraph (c) of this subsection (1). No further provisional licenses may be issued for the then current year after the second issuance. (b) The state board of health by rule or as otherwise provided by law may reduce the amount of the fee established pursuant to paragraph (a) of this subsection (1) if necessary pursuant to section 24-75-402 (3), C.R.S., to reduce the uncommitted reserves of the fund to which all or any portion of the fee is credited. After the uncommitted reserves of the fund are sufficiently reduced, the state board of health by rule or as otherwise provided by law may increase the amount of the fee as provided in section 24-75-402 (4), C.R.S. (c) On or after June 4, 2012, the state board of health may increase the amount of a provisional license fee established pursuant to subsection (1)(a) of this section that is in effect on June 4, 2012, by an amount not to exceed the annual percentage change in the United States department of labor, bureau of labor statistics, consumer price index for Denver-Aurora-Lakewood for all urban consumers and all goods, or its applicable predecessor or successor index. Nothing in this subsection (1)(c) limits the ability of the state board of health to reduce the amount of a provisional license fee in effect on such date or to modify fees in accordance with subsection (1)(b) of this section as necessary to comply with section 24-75-402. (2) Upon a finding of reasonable compliance by an applicant holding a provisional license, a regular license shall be issued upon receipt of the regular license fee established pursuant to section 25-3-105. (3) No denial of a renewal license shall be lawful unless, before institution of such proceedings by the department of public health and environment, said department has given the licensee notice in writing of facts on conduct that may warrant denial, has afforded the applicant opportunity to submit written data, views, and arguments with respect to such facts on conduct, and, except in cases of deliberate and willful violation, has given the applicant a reasonable opportunity to comply with all lawful requirements for licensure. (4) No application for renewal of a license shall be denied by the department of public health and environment, and no previously issued license shall be revoked, suspended, annulled, limited, or modified until after a hearing as provided in section 24-4-105, C.R.S. berate and willful violation, has given the applicant a reasonable opportunity to comply with all lawful requirements for licensure. (4) No application for renewal of a license shall be denied by the department of public health and environment, and no previously issued license shall be revoked, suspended, annulled, limited, or modified until after a hearing as provided in section 24-4-105, C.R.S. (5) The department of public health and environment may suspend or revoke the license for the operation of a nursing care facility or intermediate care facility of any licensee convicted of violating any provision of section 26-1-127 or section 25.5-6-206 (8), C.R.S., if the department finds such suspension or revocation necessary to safeguard the rights of patients in the future. No license or permit shall thereafter be issued to any person so convicted, except upon a specific finding by the department that the rights of the patients will have adequate safeguards.

C.R.S. § 25-3-103.1 Health facilities general licensure cash fund

25-3-103.1. Health facilities general licensure cash fund. (1) All fees collected pursuant to this article shall be transmitted to the state treasurer, who shall credit the same to the health facilities general licensure cash fund, which fund is hereby created. (2) The general assembly shall make annual appropriations from the health facilities general licensure cash fund to partially reimburse the department of public health and environment for the direct and indirect costs of the department incurred in the performance of its duties pursuant to this article 3. No appropriation shall be made out of the cash fund for expenditures incurred by the department pursuant to section 25-1.5-103 (1)(a)(II) in carrying out duties relating to health facilities wholly owned and operated by a governmental unit or agency.

C.R.S. § 25-3-103.5 Nondiscrimination - hospital surgical privileges - hospital rules and regulations

25-3-103.5. Nondiscrimination - hospital surgical privileges - hospital rules and regulations. (1) The bylaws of any hospital licensed pursuant to the provisions of part 3 of this article or established pursuant to section 32-1-1003, C.R.S., which does not limit staff privileges to employees or contracting physicians of such hospital, shall include provisions for the use of the facility by, and staff privileges for, duly licensed doctors of medicine, osteopathy, dentistry, and podiatry within the scope of their respective licenses. Such bylaws shall not discriminate on the basis of the staff member's holding a degree of doctor of medicine, doctor of osteopathy, doctor of dental science, or doctor of podiatric medicine within the scope of their respective licensure. Provision shall be made in the bylaws for the right to pursue and practice full surgical privileges for holders of a degree of doctor of medicine, doctor of osteopathy, doctor of dental science, or doctor of podiatric medicine within the scope of their respective licensure. Such rights and privileges may be limited or restricted upon the basis of an individual practitioner's demonstrated training, experience, current competence, professional ethics, health status, or failure to abide by the hospital's rules, regulations, and procedures. (2) Nothing in this section shall be construed to require a hospital to offer a specific service or services not otherwise offered or to buy, construct, or renovate facilities, to purchase equipment, hire additional staff, or to comply with other requirements of law concerning its planning, financing, or operation. If a health service is offered, the hospital shall not discriminate between persons holding a degree of doctor of medicine, doctor of osteopathy, or doctor of podiatric medicine who are authorized by law to perform such services. (3) A hospital may require the coadmittance by a medical doctor or doctor of osteopathy for any patient admitted for surgical treatment by a podiatrist or dentist. The responsibility for obtaining such coadmittance shall be that of the podiatrist or dentist admitting said patient and not of the hospital. Patients admitted for podiatric or dental care shall receive the same basic medical appraisal as patients admitted for other services. Such appraisal shall include an admission history and physical examination by a medical doctor, doctor of osteopathy, or qualified, hospital-credentialed and -privileged podiatrist, who is either on the medical staff or approved by the medical staff of such hospital. The findings of such appraisal shall be recorded on the patient's medical record. The admitting podiatrist or dentist shall be responsible for that part of the history and examination that is related to podiatry or dentistry. The medical doctor or doctor of osteopathy shall be responsible for the treatment of any medical problem that may be present on admission or arise during hospitalization of such podiatric or dental patient. Such doctor shall evaluate the general medical condition of the podiatric or dental patient and determine, after consultation if necessary, the overall risk of the pending surgical treatment to the patient's health. doctor of osteopathy shall be responsible for the treatment of any medical problem that may be present on admission or arise during hospitalization of such podiatric or dental patient. Such doctor shall evaluate the general medical condition of the podiatric or dental patient and determine, after consultation if necessary, the overall risk of the pending surgical treatment to the patient's health. (4) Within one hundred eighty days after May 25, 1983, the governing body of every hospital subject to the provisions of part 3 of this article or established pursuant to section 32-1-1003, C.R.S., which does not limit staff privileges to employees or contracting physicians of such hospital, shall provide in its bylaws reasonable standards and procedures to be applied by such hospital and its staff in considering and acting upon applications for staff membership or privileges by a person holding a Colorado license to practice as a doctor of medicine, doctor of osteopathic medicine, podiatrist, or dentist in conformance with the requirements of any national accrediting body to which the hospital subscribes. Such standards and procedures shall be available for public inspection and shall be based on an applicant's individual training, experience, current competence, professional ethics, health status, and the hospital's rules of professional conduct applied equally to all persons holding a Colorado license to practice as a doctor of medicine, doctor of osteopathic medicine, podiatrist, or dentist. (5) Hospital rules and regulations shall be reasonable, necessary, and applied in good faith equally and in a nondiscriminatory manner to all staff members, or applicants seeking to become staff members, holding a degree of doctor of medicine, doctor of osteopathic medicine, doctor of dental science, or doctor of podiatric medicine.

C.R.S. § 25-3-103.7 Employment of physicians - when permissible - conditions - definitions

25-3-103.7. Employment of physicians - when permissible - conditions - definitions. (1) As used in this section: (a) Repealed. (b) "Department" means the department of public health and environment. (c) "Federally qualified health center" or "FQHC" has the same meaning as set forth in the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(4). (d) "Health-care facility" means a hospital, hospice, behavioral health safety net provider, as defined in section 27-50-101 (7), federally qualified health center, school-based health center, rural health clinic, PACE organization, or long-term care facility. (e) "Hospice" means an entity that administers services to a terminally ill person utilizing palliative care or treatment and that is currently licensed and regulated by the department pursuant to the department's authority under section 25-1.5-103 (1)(a). (f) "Hospital" means a hospital currently licensed or certified by the department pursuant to the department's authority under section 25-1.5-103 (1)(a). (f.3) "Long-term care facility" means: (I) A nursing facility as defined by section 25.5-4-103, C.R.S., and licensed pursuant to section 25-1.5-103; (II) An assisted living residence as defined by section 25-27-102 and licensed pursuant to section 25-27-103; or (III) An independent living facility or a residence for seniors that provides assistance to its residents in the performance of their daily living activities. (f.5) "PACE organization" means an organization providing a program of all-inclusive care for the elderly pursuant to section 25.5-5-412, C.R.S. (g) "Physician" means a person duly licensed to practice under article 220, 240, or 290 of title 12. (h) "Rural health clinic" shall have the same meaning as set forth in section 1861 (aa)(2) of the federal "Social Security Act", 42 U.S.C. sec. 1395x (aa)(2). (i) "School-based health center" shall have the same meaning as set forth in section 25-20.5-502. (2) (a) A health-care facility may employ physicians, subject to the limitations set forth in subsections (3) to (6) of this section. The employment of physicians at a long-term care facility may be direct or through a separate entity authorized to conduct business in this state that has common or overlapping ownership as an affiliate or subsidiary of an entity, including a foreign entity, that owns, controls, or manages the long-term care facility, subject to the limitations set forth in subsections (3) to (6) of this section. (b) Nothing in this subsection (2) allows any person who is not licensed pursuant to article 240 of title 12 to practice or direct the practice of medicine at a long-term care facility. (3) Nothing in this section shall be construed to allow any health-care facility that employs a physician to limit or otherwise exercise control over the physician's independent professional judgment concerning the practice of medicine or diagnosis or treatment or to require physicians to refer exclusively to the health-care facility or to the health-care facility's employed physicians. Any health-care facility that knowingly or recklessly so limits or controls a physician in such manner or attempts to do so shall be deemed to have violated standards of operation for the particular type of health-care facility and may be held liable to the patient or the physician, or both, for such violations, including proximately caused damages. Nothing in this section shall be construed to affect any health-care facility's decisions with respect to the availability of services, technology, equipment, facilities, or treatment programs, or as requiring any health-care facility to make available to patients or physicians additional services, technology, equipment, facilities, or treatment programs. ons, including proximately caused damages. Nothing in this section shall be construed to affect any health-care facility's decisions with respect to the availability of services, technology, equipment, facilities, or treatment programs, or as requiring any health-care facility to make available to patients or physicians additional services, technology, equipment, facilities, or treatment programs. (4) Nothing in this section shall be construed to allow a health-care facility that employs a physician to offer the physician any percentage of fees charged to patients by the health-care facility or other financial incentive to artificially increase services provided to patients. (5) The medical staff bylaws or policies or the policies of any health-care facility that employs physicians shall not discriminate with regard to credentials or staff privileges on the basis of whether a physician is an employee of, a physician with staff privileges at, or a contracting physician with, the health-care facility. Any health-care facility that discriminates with regard to credentials or staff privileges on the basis of whether a physician is an employee of, a physician with staff privileges at, or a contracting physician with, the health-care facility shall be deemed to have violated standards of operation for the particular type of health-care facility and may be held liable to the physician for such violations, including proximately caused damages. This subsection (5) shall not affect the terms of any contract or written employment arrangement that provides that the credentials or staff and clinical privileges of any practitioner are incident to or coterminous with the contract or employment arrangement or the individual's association with a group holding the contract. (6) When applying for initial facility licensure and upon each application for license renewal, every health-care facility licensed or certified by the department that employs a physician shall report to the department the number of physicians on the health-care facility's medical staff. The report shall separately identify the number of those physicians who are employed by the health-care facility under separate contract to the health-care facility and independent of the health-care facility. (7) The medical staff bylaws or policies or the policies of any health-care facility that employs physicians shall contain a procedure by which complaints by physicians alleging a violation of subsection (3), (4), or (5) of this section may be heard and resolved, which procedure shall ensure that the due process rights of the parties are protected. A physician who believes he or she has been the subject of a violation of subsection (3), (4), or (5) of this section has a right to complain and request review of the matter pursuant to such procedure. (8) Nothing in this section shall preclude a physician or a patient from seeking other remedies available to the physician or to the patient at law or in equity.

C.R.S. § 25-3-104 Reports

25-3-104. Reports. Any person, partnership, association, or corporation maintaining any hospital or other facility for the treatment or care of the sick or injured shall make a report to the department of public health and environment upon request but not more frequently than quarterly. The department of public health and environment shall have power to investigate and shall have free access to such facilities consistent with section 25-1.5-103 (1)(a).

C.R.S. § 25-3-105 License - fee - rules - performance incentive system - penalty

25-3-105. License - fee - rules - performance incentive system - penalty. (1) (a) (I) (A) Subject to the limitations in subsections (1)(a)(I)(B) and (1)(a)(I)(B.5) of this section, the state board of health shall establish a schedule of fees, which must be set at a level sufficient to meet the direct and indirect costs of administration and enforcement of this article 3, as appropriated by the general assembly for each fiscal year, less any money appropriated for the same fiscal year by the general assembly from any other source to meet such costs. The fee schedule must also ensure that the reserve balance in the health facilities general licensure cash fund, created in section 25-3-103.1 (1), is consistent with the limits specified in section 24-75-402 (3) and must be modified, as necessary, to comply with the limits. The state board shall establish and modify, as necessary, the fee schedule by rules adopted in accordance with article 4 of title 24. Except as specified in subsection (1)(a)(II) of this section, the department of public health and environment may assess fees in accordance with the fee schedule established by the state board against health facilities licensed by the department. All fees collected pursuant to the fee schedule must be deposited in the health facilities general licensure cash fund, created in section 25-3-103.1 (1), and are subject to appropriation by the general assembly in accordance with section 25-3-103.1 (2). (B) On or after June 4, 2012, and until June 30, 2025, the state board of health may increase the amount of any fee on the schedule of fees established pursuant to subsection (1)(a)(I)(A) of this section that is in effect on June 4, 2012, by an amount not to exceed the annual percentage change in the United States department of labor, bureau of labor statistics, consumer price index for Denver-Aurora-Lakewood for all urban consumers and all goods, or its applicable predecessor or successor index. Nothing in this subsection (1)(a)(I)(B) limits the ability of the state board of health to reduce the amount of any fee on the schedule of fees in effect on such date or to modify fees as necessary to comply with section 24-75-402. Notwithstanding the requirements of this subsection (1)(a)(I)(B), the state board of health may assess fees necessary to cover the costs associated with the surveys conducted pursuant to section 25-3-128. (B.5) For state fiscal year 2025-26 and each state fiscal year thereafter, the schedule of fees adopted by the state board of health pursuant to subsection (1)(a)(I)(A) of this section must be updated and published by March 1 of the year that the fees will take effect. The fees are not subject to rule-making by the state board of health. The schedule of fees must increase eight percent for state fiscal year 2025-26; six percent for each of the state fiscal years 2026-27, 2027-28, and 2028-29; and, for state fiscal year 2029-30, and each year thereafter, the increase must be equal to the annual percentage change in the United States department of labor's bureau of labor statistics consumer price index, or a successor index, for Denver-Aurora-Lakewood for all items paid by urban consumers. fiscal year 2025-26; six percent for each of the state fiscal years 2026-27, 2027-28, and 2028-29; and, for state fiscal year 2029-30, and each year thereafter, the increase must be equal to the annual percentage change in the United States department of labor's bureau of labor statistics consumer price index, or a successor index, for Denver-Aurora-Lakewood for all items paid by urban consumers. (C) The department of public health and environment shall institute, by rule, a performance incentive system for licensed health facilities under which a licensed health facility would be eligible for a reduction in its license renewal fee if: The department's on-site relicensure inspection demonstrates that the health facility has no significant deficiencies that have negatively affected the life, safety, or health of its consumers; the licensed health facility has fully and timely cooperated with the department during the on-site inspection; the department has found no documented actual or potential harm to consumers; and, in the case where any significant deficiencies are found that do not negatively affect the life, safety, or health of consumers, the licensed health facility has submitted, and the department has accepted, a plan of correction and the health facility has corrected the deficient practice, as verified by the department, within the period required by the department. Notwithstanding the requirements of this subsection (1)(a)(I)(C), any fees associated with the surveys and investigations of hospitals authorized by section 25-3-128 are not subject to a reduction based on the performance incentive system. (II) An acute treatment unit shall be assessed a fee as set forth in paragraph (c) of this subsection (1), an assisted living residence shall be assessed a fee as set forth in section 25-27-107, and a separate fee shall be collected pursuant to section 25-3-704 to meet the costs incurred by the department in completing the requirements of part 7 of this article. (III) A license issued by the department may be revoked at any time by the state board of health for any of the causes set forth in section 25-3-103 or for a licensee's failure to comply with any of the rules of the state board or to make the reports required by section 25-3-104. Any person, partnership, association, company, or corporation opening, conducting, or maintaining any facility for the treatment and care of the sick or injured who does not have a provisional or regular license authorizing such person or entity to open, conduct, or maintain the facility is guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not less than fifty dollars nor more than five hundred dollars. (b) (Deleted by amendment, L. 2007, p. 953, § 2, effective May 17, 2007.) (c) Repealed. (2) The department of public health and environment shall maintain a full, true, and accurate accounting of the costs of providing services under this article, including indirect costs, and, at least annually, shall provide a detailed cost accounting report to the health care facility stakeholder forum created in section 25-3-113. The department shall regularly evaluate and update its cost-accounting methods. (3) Repealed. (4) On July 1, 2013, any moneys remaining in the health facilities general licensure cash fund created in section 25-3-103.1 (1) from fees collected by the department of public health and environment for health facility building and structure code plan reviews and inspections are transferred to the health facility construction and inspection cash fund created in section 24-33.5-1207.8, C.R.S.

C.R.S. § 25-3-106 Unincorporated associations

25-3-106. Unincorporated associations. An unincorporated association organized and existing for the purpose of providing hospital services for its members shall be governed, managed, and controlled by a board of trustees selected in accordance with the provisions of the state constitution and bylaws of such association. Such board of trustees shall have the right to acquire, own, and hold, in the name of such association or in the name of persons who hold title in trust for said association, real property devoted to or connected with hospital purposes and to operate and manage the same in accordance with the laws of this state, and such board of trustees shall have the power and right from time to time to sell, convey, lease, or otherwise dispose of such property, including any hospital building of such association, whenever acquired, and to direct the sale, conveyance, lease, or other disposition of the same by persons who hold the title to such property in trust for said association to such purchaser, lessee, or other person or entity for such price and upon such terms and conditions as may be determined by resolution of the board of trustees of the association adopted by two-thirds vote of the entire board of trustees of such association at any regular or special meeting of said board. The sale, conveyance, lease, or other disposition of such property may be made in the manner provided in this section to any person, corporation, county, municipality, or other entity.

C.R.S. § 25-3-107 Disciplinary actions reported to Colorado medical board or podiatry board

25-3-107. Disciplinary actions reported to Colorado medical board or podiatry board. (1) Any disciplinary action to suspend, revoke, or otherwise limit the privileges of a licensed physician or podiatrist that is taken by the governing board of a hospital required to be licensed or certified pursuant to this part 1 or required to obtain a certificate of compliance pursuant to section 25-1.5-103 (1)(a)(I) or (1)(a)(II) shall be reported to the Colorado medical board or the Colorado podiatry board, whichever board is appropriate, in the form prescribed by said board. (2) Said hospital shall provide such additional information as is deemed necessary by the Colorado medical board or the Colorado podiatry board to conduct a further investigation and hearing.

C.R.S. § 25-3-108 Receivership

25-3-108. Receivership. (1) It is the purpose of this section to establish a receivership mechanism that will be available as a remedy for such violations of applicable laws and regulations by a licensee of a long-term health-care facility that require facility closure by the department of public health and environment in order to safeguard against potential transfer trauma resulting from relocation of its residents as a result of closure of the facility. (2) The department of public health and environment, the licensee or owner of a long-term health-care facility, or the lessee of such facility with the approval of the owner may apply to the district court for the appointment of a receiver to operate the long-term health-care facility when: (a) The department of public health and environment has refused to issue a renewal license or has revoked the license of such facility and the action of the department is final; or (b) The department of public health and environment, through the executive director thereof, has taken summary action to suspend the license of any such facility in accordance with the provisions of section 24-4-104 (4), C.R.S. (3) The action of the department of public health and environment with respect to nonrenewal or revocation of a license and recommendation for certification for medicaid participation shall not be final for the purposes of paragraph (a) of subsection (2) of this section until all administrative hearings and judicial appeals sought by a licensee of a long-term health-care facility have been exhausted or the time permitted for the same has expired and until the decisions resulting from any such appeals, if any, sustain the action of said department. (4) Application for the appointment of a receiver pursuant to this section shall be to the district court for the county where the long-term health-care facility is located. No hearing on such application shall be held sooner than seventy-two hours after the licensee of such facility has been served with notice thereof, as provided in the Colorado rules of civil procedure; except that when the department exercises its summary powers, an emergency receiver may be appointed upon agreement in writing between the department and licensee, with the approval of the owner, until a hearing for appointment of a receiver as provided in this section. Notice shall also be served upon any owner and any lessee of a long-term health-care facility and any holder of a security interest of record in said facility. An application for appointment of a receiver pursuant to this section shall have precedence and priority over any civil or criminal case pending in the district court wherein the application is filed. (5) For the purposes of this section the action of the department of public health and environment exercised pursuant to subsection (2) of this section shall become effective upon appointment of the receiver of the court. (6) Prior to ordering the appointment of a receiver for the operation of a long-term health-care facility, the district court must find: (a) That grounds for the appointment of a receiver exist as provided in subsection (2) of this section; and (b) That proper notice as required by subsection (4) of this section has been served; and ecome effective upon appointment of the receiver of the court. (6) Prior to ordering the appointment of a receiver for the operation of a long-term health-care facility, the district court must find: (a) That grounds for the appointment of a receiver exist as provided in subsection (2) of this section; and (b) That proper notice as required by subsection (4) of this section has been served; and (c) That there is a necessity to continue care on a temporary basis at the facility to avoid potential transfer trauma which would serve the best interests of the residents of the facility pending arrangements for the lease, sale, or closure of the facility. (7) The department of public health and environment shall grant the receiver a license pursuant to section 25-3-102 and shall recommend certification for medicaid participation, and the department of health care policy and financing shall reimburse the receiver for the long-term health-care facility's medicaid residents pursuant to section 25.5-6-204, C.R.S. (8) The appointment of the receiver shall be in accordance with and governed by the provisions of rule 66 of the Colorado rules of civil procedure. The court shall enter an order of appointment and fix the fees and expenses of the receiver. The receiver shall be a licensed nursing home administrator and shall post a bond with adequate sureties as determined by the court, and the receiver may be sued upon the same in the name of the people of the state of Colorado at the instance and for the use of any party injured. The receiver shall perform duties, assume responsibilities, and preserve the long-term health-care facility property in accordance with established principles of law for receivers of real property. Such duties and responsibilities shall be determined by the court following a hearing, at which time the parties may appear and be heard. The court shall specify the duties and responsibilities of the receiver in the order of appointment. No security interest in any real or personal property comprising said facility or contained within the facility nor any fixture of the facility shall be impaired or diminished by the receiver, but the receiver shall comply with the standards of the department of public health and environment in providing health care to patients. (9) Nothing in this section shall prevent the court from altering or amending the terms and conditions of the receivership or the receiver's responsibilities and duties following a hearing, at which time the parties may appear and be heard; and nothing in this section shall prohibit the parties from stipulating to the terms and conditions of the receivership and the responsibilities and duties of the receiver, including the duration thereof, and such stipulation shall be submitted to the court for approval. (10) A receivership established pursuant to this section may be terminated by the court upon application therefor by the licensee of a long-term health-care facility, the department of public health and environment, or the receiver. The receivership may be terminated upon a finding by the court that the receivership is no longer necessary, but in no case shall the receivership continue for longer than one hundred eighty days from the date of the initial appointment of the receiver unless extended by written agreement of the parties as provided in subsection (9) of this section. (11) Upon termination of the receivership, the court shall order a final accounting and finally fix the fees and expenses of the receiver following a hearing, at which time the parties may appear and be heard.

C.R.S. § 25-3-109 Quality management functions - confidentiality and immunity

25-3-109. Quality management functions - confidentiality and immunity. (1) The general assembly hereby finds and declares that the implementation of quality management functions to evaluate and improve patient and resident care is essential to the operation of health-care facilities licensed or certified by the department of public health and environment pursuant to section 25-1.5-103 (1)(a). For this purpose, it is necessary that the collection of information and data by such licensed or certified health-care facilities be reasonably unfettered so a complete and thorough evaluation and improvement of the quality of patient and resident care can be accomplished. To this end, quality management information relating to the evaluation or improvement of the quality of health-care services shall be confidential, subject to the provisions of subsection (4) of this section, and persons performing such functions shall be granted qualified immunity. It is the intent of the general assembly that nothing in this section revise, amend, or alter part 2 of article 30 or article 240 of title 12. (2) For purposes of this section, a "quality management program" means a program that includes quality assurance and risk management activities, the peer review of licensed health-care professionals not otherwise provided for in part 2 of article 30 of title 12, and other quality management functions that are described by a facility in a quality management program approved by the department of public health and environment. Nothing in this section shall revise, amend, or alter part 2 of article 30 or article 240 of title 12. (3) Except as otherwise provided in this section, any records, reports, or other information of a licensed or certified health-care facility that are part of a quality management program designed to identify, evaluate, and reduce the risk of patient or resident injury associated with care or to improve the quality of patient care shall be confidential information; except that such information shall be subject to the provisions of subsection (4) of this section. (4) The records, reports, and other information described in subsection (3) and subsection (5.5) of this section shall not be subject to subpoena or discoverable or admissible as evidence in any civil or administrative proceeding. No person who participates in the reporting, collection, evaluation, or use of such quality management information with regard to a specific circumstance shall testify thereon in any civil or administrative proceeding. However, this subsection (4) shall not apply to: (a) Any civil or administrative proceeding, inspection, or investigation as otherwise provided by law by the department of public health and environment or other appropriate regulatory agency having jurisdiction for disciplinary or licensing sanctions; (b) Persons giving testimony concerning facts of which they have personal knowledge acquired independently of the quality management information program or function; (c) The availability, as provided by law or the rules of civil procedure, of factual information relating solely to the individual in interest in a civil suit by such person, next friend or legal representative. In no event shall such factual information include opinions or evaluations performed as a part of the quality management program. (d) Persons giving testimony concerning an act or omission which they have observed or in which they participated, notwithstanding any participation by them in the quality management program; interest in a civil suit by such person, next friend or legal representative. In no event shall such factual information include opinions or evaluations performed as a part of the quality management program. (d) Persons giving testimony concerning an act or omission which they have observed or in which they participated, notwithstanding any participation by them in the quality management program; (e) Persons giving testimony concerning facts they have recorded in a medical record relating solely to the individual in interest in a civil suit by such person. (5) Nothing in this section shall affect the voluntary release of any quality management record or information by a health-care facility; except that no patient-identifying information shall be released without the patient's consent. (5.5) (a) The confidentiality of information provided for in this section shall in no way be impaired or otherwise adversely affected solely by reason of the submission of the information to a nongovernmental entity to conduct studies that evaluate, develop, and analyze information about health-care operations, practices, or any other function of health-care facilities. The records, reports, and other information collected or developed by a nongovernmental entity shall remain protected as provided in subsections (3) and (4) of this section. In order to adequately protect the confidentiality of such information, no findings, conclusions, or recommendations contained in such studies conducted by any such nongovernmental entity shall be deemed to establish a standard of care for health-care facilities. (b) For purposes of this subsection (5.5), "health-care facility" includes a carrier as defined in section 10-16-102 (8), C.R.S., and a health-care practitioner licensed or certified pursuant to title 12, C.R.S. (6) Any person who in good faith and within the scope of the functions of a quality management program participates in the reporting, collection, evaluation, or use of quality management information or performs other functions as part of a quality management program with regard to a specific circumstance shall be immune from suit in any civil action based on such functions brought by a health-care provider or person to whom the quality information pertains. In no event shall this immunity apply to any negligent or intentional act or omission in the provision of care. (7) and (8) (Deleted by amendment, L. 97, p. 507, § 2, effective April 24, 1997.) (9) Nothing in this section shall be construed to limit any statutory or common law privilege, confidentiality, or immunity. (10) Nothing in this section shall revise, amend, or alter the requirements of section 25-3-107. (11) (Deleted by amendment, L. 97, p. 507, § 2, effective April 24, 1997.) (12) Nothing in this section shall affect a person's access to his medical record as provided in section 25-1-801, nor shall it affect the right of any family member or any other person to obtain medical record information upon the consent of the patient or his authorized representative.

C.R.S. § 25-3-110 Emergency contraception - definitions

25-3-110. Emergency contraception - definitions. (1) For purposes of this section, unless the context otherwise requires: (a) "Emergency contraception" means a drug approved by the federal food and drug administration that prevents pregnancy after sexual intercourse, including but not limited to oral contraceptive pills; except that "emergency contraception" shall not include RU-486, mifepristone, or any other drug or device that induces a medical abortion. Nothing in section 2-4-401 (1.5), C.R.S., shall be construed to amend or alter the definition of "emergency contraception". (b) "Sexual assault survivor" shall have the same meaning as "victim" as defined in section 18-3-401 (7), C.R.S. (2) Notwithstanding any other provision of law to the contrary, all health-care facilities that are licensed pursuant to this part 1 and provide emergency care to sexual assault survivors shall amend their evidence-collection protocols for the treatment of sexual assault survivors to include informing the survivor in a timely manner of the availability of emergency contraception as a means of pregnancy prophylaxis and educating the survivor on the proper use of emergency contraception and the appropriate follow-up care. (3) Nothing in this section shall be interpreted to require: (a) A health-care professional who is employed by a health-care facility that provides emergency care to a sexual assault survivor to inform the survivor of the availability of emergency contraception if the professional refuses to provide the information on the basis of religious or moral beliefs; or (b) A health-care facility to provide emergency contraception to a sexual assault survivor who is not at risk of becoming pregnant as a result of the sexual assault or who was already pregnant at the time of the assault. (4) If any licensed pharmacy does not have nonprescription emergency contraception in stock, the pharmacy shall place a conspicuous notice in the area where customers obtain prescription drugs that states "Plan B Emergency Contraception Not Available". (5) The general assembly encourages health-care facilities to provide training to emergency room staff concerning the efficacy of emergency contraception and the time-sensitive nature of the drug. (6) Because emergency contraception is time-sensitive and a sexual assault survivor may seek information on or direct access to emergency contraception to prevent an unintended pregnancy resulting from the assault instead of or prior to seeking hospital treatment, it is critical that sexual assault survivors have accurate information about the availability and use of emergency contraception. Therefore, the general assembly encourages: (a) Entities offering victim assistance or counseling and rape crisis hotlines to include information concerning the availability and use of emergency contraception; and (b) Licensed or registered pharmacies in the state of Colorado to distribute information concerning the availability and use of emergency contraception.

C.R.S. § 25-3-111 Authentication of verbal orders - hospital policies or bylaws

25-3-111. Authentication of verbal orders - hospital policies or bylaws. (1) A hospital licensed pursuant to part 3 of this article shall require that all verbal orders be authenticated by a physician or responsible individual who has the authority to issue verbal orders in accordance with hospital and medical staff policies or bylaws. The policies or bylaws shall require that: (a) Authentication of a verbal order occurs within forty-eight hours after the time the order is made unless a read-back and verify process pursuant to paragraph (b) of this subsection (1) is used. The individual receiving a verbal order shall record in writing the date and time of the verbal order, and sign the verbal order in accordance with hospital policies or medical staff bylaws. (b) A hospital policy may provide for a read-back and verify process for verbal orders. A read-back and verify process shall require that the individual receiving the order immediately read back the order to the physician or responsible individual, who shall immediately verify that the read-back order is correct. The individual receiving the verbal order shall record in writing that the order was read back and verified. If the read-back and verify process is followed, the verbal order shall be authenticated within thirty days after the date of the patient's discharge. (2) Verbal orders shall be used infrequently. Nothing in this section shall be interpreted to encourage the more frequent use of verbal orders by the medical staff at a hospital.

C.R.S. § 25-3-112 Hospitals - charity care information - charges for the uninsured - reports to department - department review - collections protection - hospital financial assistance standards committee established - rules

25-3-112. Hospitals - charity care information - charges for the uninsured - reports to department - department review - collections protection - hospital financial assistance standards committee established - rules. (Repealed)

C.R.S. § 25-3-113 Health-care facility stakeholder forum - creation - membership - duties

25-3-113. Health-care facility stakeholder forum - creation - membership - duties. (1) There is hereby created in the department of public health and environment the health care facility stakeholder forum, referred to in this section as the "stakeholder forum". The stakeholder forum must consist of representatives from various types of provider facilities licensed by the department, consumers, consumer advocates, ombudsmen, and other interested parties. The department shall meet at least four times each year with the stakeholder forum to discuss and take into consideration the concerns and issues of interest to the forum members and other attendees regarding the development and implementation of rules and other matters that affect all health-care facilities licensed by the department. (2) The members of the stakeholder forum serve on a voluntary basis without compensation and are responsible for noticing, staffing, recording, and reporting the notes from the stakeholder forum meetings. The department shall consider the attendance of its representatives at meetings with the stakeholder forum to be within the normal course of business, with no additional appropriation to or resources from the department required. (3) The stakeholder forum and the department shall work to coordinate with, and shall not duplicate the work being done by, established or statutorily authorized advisory committees or working groups on issues related to the development and implementation of rules. (4) For purposes of section 24-4-103 (2), C.R.S., as amended by House Bill 12-1008, enacted in 2012, the department may use the stakeholder forum described in this section, when appropriate, to serve as the representative group for the department of public health and environment.

C.R.S. § 25-3-114 STEMI task force - creation - membership - duties - report - notice of funding through gifts, grants, and donations - definitions - repeal

25-3-114. STEMI task force - creation - membership - duties - report - notice of funding through gifts, grants, and donations - definitions - repeal. (Repealed)

C.R.S. § 25-3-115 Stroke advisory board - creation - membership - duties - report - definition - repeal

25-3-115. Stroke advisory board - creation - membership - duties - report - definition - repeal. (1) (a) There is created in the department the stroke advisory board, the purpose of which is to evaluate potential strategies for stroke prevention and treatment and develop a statewide needs assessment identifying relevant resources. The governor shall appoint eighteen members to the stroke advisory board as follows: (I) Six physicians who are actively involved in stroke care and who satisfy the following criteria: One physician who is board-certified in primary care; one physician who is board-certified in vascular neurology; one physician who is privileged and actively practicing interventional neuroradiology; one physician who is board-certified in neurosurgery; one physician representing a statewide chapter of emergency physicians; and one physician who is a board-certified neurologist serving patients in a rural area of the state; (II) One member representing a statewide association of physicians; (III) One member representing a statewide hospital association; (IV) One member who is an emergency medical service provider, as defined in section 25-3.5-103 (8); (V) One member who is a registered nurse involved in stroke care; (VI) One hospital administrator from a hospital located in a rural area of the state; (VII) One hospital administrator from a hospital located in an urban area of the state; (VIII) One representative from a stroke rehabilitation facility; (IX) One member who is a Colorado resident representing a national association whose goal is to eliminate cardiovascular disease and stroke; (X) One member who is a Colorado resident representing a national stroke association; (XI) One member who is a physical or occupational therapist actively involved in stroke care; (XII) One member of the public who has suffered a stroke or is the caregiver of a person who has suffered a stroke; and (XIII) One member who is an expert in stroke database management. (b) The executive director of the department or the executive director's designee shall serve as an ex officio member of the stroke advisory board. (c) Members of the stroke advisory board serve without compensation and are not entitled to reimbursement of expenses incurred in serving on or performing duties of the advisory board. (2) (a) The stroke advisory board shall study and make recommendations for developing a statewide plan to improve quality of care for stroke patients. In conducting the study, the stroke advisory board shall explore the following issues, without limitation: (I) Creation of a state database or registry consisting of data on stroke care that mirrors the data hospitals submit to nationally recognized organizations; (II) Access to aggregated stroke data, which must exclude any identifying or confidential information about the reporting hospital or patients treated by the hospital, from a state database that may be developed or from a nationally recognized organization by the advisory board, by any person who submits a written request for the data; (III) Evaluation of currently available stroke treatments and the development of recommendations, based on medical evidence, for ways to improve stroke prevention and treatment; (IV) A plan that would encourage rural and urban hospitals to coordinate services for the necessary referral or receipt of patients requiring stroke care in the state; and (V) The criteria used by nationally recognized bodies for designating a hospital in stroke care and whether a designation is appropriate or needed to assure access to the best quality care for Colorado residents with stroke events. A plan that would encourage rural and urban hospitals to coordinate services for the necessary referral or receipt of patients requiring stroke care in the state; and (V) The criteria used by nationally recognized bodies for designating a hospital in stroke care and whether a designation is appropriate or needed to assure access to the best quality care for Colorado residents with stroke events. (b) By January 31, 2014, and by each January 1 thereafter, the stroke advisory board shall submit a report specifying its findings and recommendations to the health and human services committee of the senate, the health, insurance, and environment committee of the house of representatives, or their successor committees, and the department. The stroke advisory board shall include in its report a recommendation on whether a designation of a hospital in stroke care is appropriate or needed to assure access to the best quality care for Colorado residents with stroke events. (3) The stroke advisory board may accept and expend, subject to appropriation by the general assembly, gifts, grants, and donations to pay the stroke advisory board's direct expenses. The stroke advisory board shall transmit any monetary gifts, grants, or donations it receives to the state treasurer for deposit in the health facilities general licensure cash fund. (3.5) The department staff is not required to provide any financial support or perform any administrative duties related to the operation of the stroke advisory board. (4) As used in this section, unless the context otherwise requires, "department" means the department of public health and environment. (5) This section is repealed, effective September 1, 2028. Prior to the repeal, the department of regulatory agencies shall review the functions of the stroke advisory board in accordance with section 2-3-1203, C.R.S.

C.R.S. § 25-3-116 Department recognition of national certification - suspension or revocation of recognition

25-3-116. Department recognition of national certification - suspension or revocation of recognition. (1) A hospital that has an accreditation, certification, or designation in stroke or STEMI care from a nationally recognized accrediting body, including a certification as a comprehensive stroke center or primary stroke center by the joint commission or an accreditation as a STEMI receiving center or STEMI referral center by the American College of Cardiology Accreditation Services or its successor organization, may send information and supporting documentation to the department. The department shall make a hospital's national accreditation, certification, or designation available to the public in a manner determined by the department. (2) The department shall deem a hospital that is currently accredited, certified, or designated by a nationally recognized accrediting body as satisfying the requirements for recognition and publication by the department. The department may suspend or revoke a recognition and publication of a hospital's accreditation, certification, or designation if the department determines, after notice and hearing in accordance with the "State Administrative Procedure Act", article 4 of title 24, C.R.S., that the hospital no longer holds an active accreditation, certification, or designation from a nationally recognized certifying body. (3) Whether a hospital attains a national accreditation, certification, or designation in stroke or STEMI care has no bearing on, or connection with, the licensing or certification of the hospital by the department pursuant to section 25-1.5-103 (1)(a). (4) Repealed.

C.R.S. § 25-3-117 Heart attack database - hospitals to report data on heart attack care

25-3-117. Heart attack database - hospitals to report data on heart attack care. (1) (a) A hospital that is accredited by the American College of Cardiology Accreditation Services or its successor organization or any nationally recognized accrediting body as a STEMI receiving center shall report to the heart attack database data that is consistent with nationally recognized guidelines on individuals with confirmed heart attacks within the state. Within thirty days after receiving a quarterly report of a hospital's heart attack data from the heart attack database, a hospital accredited as a STEMI receiving center shall submit the report to the department. (b) Hospitals that are recognized as STEMI referral centers pursuant to section 25-3-116 and PCI centers that are not accredited as heart attack receiving centers are encouraged to report data to the heart attack database and provide quarterly database reports to the department. (2) (a) Reports obtained by the department pursuant to this section are: (I) Privileged and strictly confidential; (II) Not subject to civil subpoena, not discoverable, and not admissible in a civil, criminal, or administrative proceeding against a health-care facility or health-care professional; and (III) Not directly available to the public. (b) With regard to reports obtained pursuant to this section, the department shall protect the confidentiality of patient records in accordance with state and federal laws and shall not disclose publicly any identifying or proprietary information of any hospital, hospital administrator, health-care professional, or employee. (3) The department shall sign a letter of commitment with any nationally recognized body whose reports are provided to the department pursuant to subsection (1)(a) of this section to ensure compliance with the confidentiality requirements and, as part of the letter of commitment, request reporting measures and metrics at the national level for benchmarking purposes.

C.R.S. § 25-3-118 Hospital off-campus location - obtain and use unique NPI - definitions

25-3-118. Hospital off-campus location - obtain and use unique NPI - definitions. (1) An off-campus location of a hospital must apply for, obtain, and use on all claims for reimbursement or payment for health-care services provided at the off-campus location submitted on or after January 1, 2020, a unique NPI that is separate and distinct from the hospital's NPI. The off-campus location's unique NPI must be included on any claim for reimbursement or payment for health-care services provided at the off-campus location, regardless of whether the claim is filed or submitted by or through a central office of the hospital or a health-care clearinghouse. (2) As used in this section: (a) "Health-care clearinghouse" has the same meaning as set forth in 45 CFR 160.103. (b) "NPI" or "national provider identifier" means the standard, unique health identifier for health-care providers that is issued by the national provider system in accordance with 45 CFR 162. (c) "Off-campus location" means a facility: (I) Whose operations are directly or indirectly owned or controlled by, in whole or in part, or affiliated with a hospital, regardless of whether the operations are under the same governing body as the hospital; (II) That is located more than two hundred fifty yards from the hospital's main campus; (III) That provides services that are organizationally and functionally integrated with the hospital; and (IV) That is an outpatient facility providing preventive, diagnostic, treatment, or emergency services.

C.R.S. § 25-3-119 Freestanding emergency departments - required notices - disclosures - rules - definitions

25-3-119. Freestanding emergency departments - required notices - disclosures - rules - definitions. (1) (a) (I) A freestanding emergency department shall give to every individual seeking treatment at the facility a written notice containing the following statements immediately upon registration: Patient Information This is an emergency medical facility that treats emergency medical conditions. We will screen and treat you regardless of your ability to pay. You have a right to ask questions regarding your treatment options and costs. You have a right to receive prompt and reasonable responses to questions and requests. You have a right to reject treatment. However, we encourage you to defer your questions until after we screen you for an emergency medical condition. This is not a complete statement of patient information or rights. You will receive a more comprehensive statement of patient's rights upon the completion of a medical screening examination that does not reveal an emergency medical condition or after treatment has been provided to stabilize an emergency medical condition. (II) (A) If the freestanding emergency department does not have or include within its facility an urgent care center or clinic, the freestanding emergency department shall include the following statement in the notice required by subsection (1)(a)(I) of this section, immediately following the sentence that reads "This is an emergency medical facility that treats emergency medical conditions.": This is not an urgent care center or primary care provider. (B) If the freestanding emergency department has or includes within its facility an urgent care center or clinic, the freestanding emergency department shall include the following statement in the notice required by subsection (1)(a)(I) of this section, immediately following the sentence that reads "This is an emergency medical facility that treats emergency medical conditions.": This facility also contains an urgent care center that operates from (insert time urgent care center opens) to (insert time urgent care center closes) and provides primary care services (and insert, if applicable, that the urgent care center offers primary care services by appointment). (III) If the individual seeking treatment is a minor who is accompanied by an adult, the freestanding emergency department shall provide the written notice required by this subsection (1)(a) to the accompanying adult. (b) In addition to giving an individual the written notice required by subsection (1)(a) of this section, a freestanding emergency department staff member or health-care provider shall provide the information specified in subsection (1)(a) of this section to the individual orally. (c) As necessary, the state board of health, by rule, may update the information required to be included in the written notice of patient information set forth in this subsection (1). (2) (a) A freestanding emergency department shall post a sign that is plainly visible in the area within the facility where an individual seeking care registers or checks in and that states: This is an emergency medical facility that treats emergency medical conditions. y update the information required to be included in the written notice of patient information set forth in this subsection (1). (2) (a) A freestanding emergency department shall post a sign that is plainly visible in the area within the facility where an individual seeking care registers or checks in and that states: This is an emergency medical facility that treats emergency medical conditions. (b) (I) If the freestanding emergency department does not have or include within its facility an urgent care center or clinic, the freestanding emergency department shall include the following statement on the sign required by this subsection (2), immediately following the statement specified in subsection (2)(a) of this section: This is not an urgent care center or primary care provider. (II) If the freestanding emergency department has or includes within its facility an urgent care center or clinic, the freestanding emergency department shall include the following statement on the sign required by this subsection (2), immediately following the statement specified in subsection (2)(a) of this section: This facility also contains an urgent care center that operates from (insert time urgent care center opens) to (insert time urgent care center closes) and provides primary care services (and insert, if applicable, that the urgent care center offers primary care services by appointment). (3) (a) After performing an appropriate medical screening examination and determining that a patient does not have an emergency medical condition or after treatment has been provided to stabilize an emergency medical condition, the freestanding emergency department shall provide to the patient a written disclosure that: (I) Specifies whether the freestanding emergency department accepts patients who are enrolled in: The state medical assistance program under articles 4, 5, and 6 of title 25.5; medicare, as authorized in Title XVIII of the federal "Social Security Act", as amended; the children's basic health plan established under article 8 of title 25.5; or a health plan authorized under 10 U.S.C. sec. 1071 et seq.; (II) Lists the specific health insurance provider networks and carriers with which the freestanding emergency department participates or states that the freestanding emergency department is not a participating provider in any health insurance provider networks; (III) States that the freestanding emergency department or a physician providing health-care services at the freestanding emergency department may not be a participating provider in the patient's health insurance provider network; (IV) States that a physician providing health-care services at the freestanding emergency department may bill separately from the freestanding emergency department for the health-care services provided to the patient; (V) Specifies the chargemaster or fee schedule price for the twenty-five most common health-care services provided by the freestanding emergency department; (VI) Contains a statement specifying that the price listed on the freestanding emergency department's chargemaster or fee schedule for any given health-care service is the maximum charge that any patient will be billed for the service and that the actual charge for any health-care service rendered may be lower depending on applicable health insurance benefits and the availability of discounts or financial assistance; (VII) Contains the following statement or a statement containing substantially similar information: schedule for any given health-care service is the maximum charge that any patient will be billed for the service and that the actual charge for any health-care service rendered may be lower depending on applicable health insurance benefits and the availability of discounts or financial assistance; (VII) Contains the following statement or a statement containing substantially similar information: If you are covered by health insurance, you are strongly encouraged to consult with your health insurer to determine accurate information about your financial responsibility for a particular health-care service provided at this freestanding emergency department. If you are not covered by health insurance, you are strongly encouraged to contact (insert name and telephone number for office responsible for financial services) to discuss payment options and the availability of financial assistance prior to receiving a health-care service from this freestanding emergency department. (VIII) Contains information about the facility fees that the freestanding emergency department charges, indicating either the maximum facility fee that the freestanding emergency department charges or the range of the minimum to maximum amount of the facility fees that the freestanding emergency department charges; and (IX) Includes the freestanding emergency department's website address where the information contained in the disclosure required by this subsection (3) may be found. (b) A freestanding emergency department shall update the information contained in the written disclosure required by this subsection (3) at least once every six months. (c) Receipt of the disclosure under this subsection (3) does not waive a covered person's protections under section 10-16-704 (3)(b). (4) A freestanding emergency department shall post the disclosure required by subsection (3) of this section on its website and update the disclosure posted on its website at least once every six months. (5) A freestanding emergency department shall provide the information required by this section in a clear and understandable manner and in languages appropriate to the communities and patients the freestanding emergency department serves. (6) Nothing in this section affects or otherwise limits a hospital's or other health facility's obligations under section 6-20-101 or article 49 of this title 25. (7) The state board of health may adopt rules as necessary to implement and enforce this section, including rules necessary to ensure that freestanding emergency departments are complying in good faith with the intent of this section and the transparency and disclosure requirements of this section. (8) As used in this section: (a) "Chargemaster or fee schedule", which is often referred to as "charge description master" or "CDM", means a uniform schedule of charges represented by a health facility as the facility's gross billed charge, or maximum charge that any patient will be billed, for a given health-care service, regardless of payer and before any discounts or negotiations are applied. (b) "Emergency medical condition" has the same meaning as set forth in 42 U.S.C. sec. 1395dd (e)(1). (c) "Freestanding emergency department" has the same meaning as section 25-1.5-114 (5).

C.R.S. § 25-3-120 Regulation of surgical smoke - requirement to adopt a policy - definitions - applicability

25-3-120. Regulation of surgical smoke - requirement to adopt a policy - definitions - applicability. (1) On or before May 1, 2021, each hospital with surgical services and each ambulatory surgical center, licensed in accordance with this article 3, shall adopt and implement a policy that prevents human exposure to surgical smoke via the use of a surgical smoke evacuation system during any planned surgical procedure that is likely to generate surgical smoke. (2) As used in this section: (a) "Surgical smoke" means the gaseous by-product produced by energy-generating devices including surgical plume, smoke plume, bio-aerosols, laser-generated airborne contaminants, or lung-damaging dust. (b) "Surgical smoke evacuation system" means equipment designed to capture and neutralize surgical smoke at the point of origin and before the surgical smoke makes contact with the eyes or the respiratory tract of the occupants of a room.

C.R.S. § 25-3-121 Health-care facilities - emergency and nonemergency services - required disclosures - balance billing - deceptive trade practice - rules - definitions

25-3-121. Health-care facilities - emergency and nonemergency services - required disclosures - balance billing - deceptive trade practice - rules - definitions. (1) On and after January 1, 2020, health-care facilities shall develop and provide disclosures to consumers about the potential effects of receiving emergency or nonemergency services from an out-of-network provider providing services at an in-network facility or emergency services at an out-of-network facility. The disclosures must comply with the rules adopted pursuant to subsection (2) of this section. (2) The state board of health, in consultation with the commissioner of insurance and the applicable regulators of health-care providers in the division of professions and occupations in the department of regulatory agencies, shall adopt rules that specify the requirements for health-care facilities to develop and provide consumer disclosures in accordance with this section. The state board of health shall ensure that the rules, at a minimum, comply with the notice and consent requirements in subsection (3.5) of this section and the federal "No Surprises Act". (3) Receipt of the disclosure required by this section does not waive a consumer's protections under section 10-16-704 (3) or (5.5) or the consumer's right to benefits under the consumer's health benefit plan at the in-network benefit level for all covered services and treatment received. (3.5) (a) An out-of-network facility may balance bill a covered person for services other than ancillary services if: (I) The out-of-network facility provides written notice that the facility will balance bill a covered person at least seventy-two hours in advance of the date of service, if the appointment was scheduled at least seventy-two hours in advance, or at least three hours before the scheduled appointment, if the appointment was made less than seventy-two hours in advance, in either paper or electronic format, as selected by the covered person. The notice must be available in the fifteen most common languages in the geographic region in which the out-of-network facility is located. The notice must state: (A) If applicable, that the facility is out of network with respect to the covered person's health benefit plan; (B) Effective upon the implementation date of the applicable federal rules, a good-faith estimate of the amount of the charges for which the covered person may be responsible; (C) That the estimate or consent to treatment does not constitute a contract for services; (D) If the facility is a participating provider and the health-care provider is not a participating provider, a list of participating providers at the facility who are able to provide the same services; (E) Information about whether prior authorization or other care management limitations may be required in advance of receiving the requested services; and (F) That consent to receive the services at an out-of-network facility is optional and that the covered person may seek services from a participating provider, in which case the cost-sharing responsibility of the covered person would not exceed the responsibility for in-network benefits under the covered person's health benefit plan; (II) The out-of-network facility obtains signed consent from the covered person that acknowledges that the covered person has been: (A) Provided with written notice of the covered person's financial responsibility, in the format and language selected by the covered person and within the applicable periods specified in subsection (3.5)(a)(I) of this section; and (B) Provided written notice that the payment by the covered person for health-care services provided at the out-of-network facility may not accrue toward meeting any limitation that the health benefit plan places on cost sharing, including an explanation that the payment may not apply to an in-network deductible. thin the applicable periods specified in subsection (3.5)(a)(I) of this section; and (B) Provided written notice that the payment by the covered person for health-care services provided at the out-of-network facility may not accrue toward meeting any limitation that the health benefit plan places on cost sharing, including an explanation that the payment may not apply to an in-network deductible. (b) The notice and consent required by this subsection (3.5) must include the date on which the covered person received the written notice and the date and the time at which the consent form was signed. The out-of-network facility shall provide a signed copy of the consent form to the covered person through regular or electronic mail. (c) An out-of-network facility that obtains a signed consent with respect to furnishing an item or service shall retain the signed consent for at least a seven-year period after the date on which such item or service is furnished. (d) [Editor's note: Subsection (3.5)(d) is effective January 1, 2025.] An out-of-network facility shall not balance bill a covered person, as defined in section 10-16-102 (15), for services if the provisions of section 10-16-705 (4.5)(c)(II) apply. (3.7) A violation of this section is a deceptive trade practice pursuant to section 6-1-105 (1)(xxx). (4) As used in this section and section 25-3-122: (a) "Ancillary services" means: (I) Diagnostic services, including radiology and laboratory services, unless excluded by rule of the secretary of the United States department of health and human services pursuant to 42 U.S.C. sec. 300gg-132 (b)(3); (II) Items and services related to emergency medicine, anesthesiology, pathology, radiology, and neonatology, whether or not provided by a physician or nonphysician provider, unless excluded by rule of the secretary of the United States department of health and human services pursuant to section 2799B-2 (b)(3) of the federal "No Surprises Act"; (III) Items and services provided by assistant surgeons, hospitalists, and intensivists, unless excluded by rule of the secretary of the United States department of health and human services pursuant to section 2799B-2 (b)(3) of the federal "No Surprises Act"; (IV) Items and services provided by an out-of-network provider if there is no in-network provider who can furnish the needed services at the facility; and (V) Any other items and services provided by specialty providers as established by rule of the commissioner. (a.3) "Balance bill" has the same meaning as set forth in section 10-16-704 (19)(c). (a.5) "Carrier" has the same meaning as set forth in section 10-16-102 (8). (b) "Covered person" has the same meaning as defined in section 10-16-102 (15). (c) "Emergency services" has the same meaning as set forth in section 10-16-704 (19)(e). (c.5) "Federal 'No Surprises Act'" means the federal "No Surprises Act", Pub.L. 116-260, as amended. (d) "Geographic area" has the same meaning as set forth in section 10-16-704 (19)(h). (e) "Health benefit plan" has the same meaning as defined in section 10-16-102 (32). (f) "Medicare reimbursement rate" has the same meaning as set forth in section 10-16-704 (19)(k). (g) "Out-of-network facility" means a health-care facility that is not a participating provider. (h) "Participating provider" has the same meaning as set forth in section 10-16-102 (46).

C.R.S. § 25-3-122 Out-of-network facilities - emergency medical services - billing - payment - deceptive trade practice

25-3-122. Out-of-network facilities - emergency medical services - billing - payment - deceptive trade practice. (1) If a covered person receives emergency services at an out-of-network facility, the out-of-network facility shall: (a) Submit a claim for the entire cost of the services to the covered person's carrier; and (b) Not bill or collect payment from a covered person for any outstanding balance for covered services not paid by the carrier, except for the applicable in-network coinsurance, deductible, or copayment amount required to be paid by the covered person. (2) (a) If a covered person receives emergency services at an out-of-network facility, and the facility receives payment from the covered person for services for which the covered person is not responsible pursuant to section 10-16-704 (3)(b) or (5.5), the facility shall reimburse the covered person within sixty calendar days after the date that the overpayment was reported to the facility. (b) An out-of-network facility that fails to reimburse a covered person as required by subsection (2)(a) of this section for an overpayment shall pay interest on the overpayment at the rate of ten percent per annum beginning on the date the facility received the notice of the overpayment. The covered person is not required to request the accrued interest from the out-of-network health-care facility in order to receive interest with the reimbursement amount. (3) (a) An out-of-network facility, other than any out-of-network facility operated by the Denver health and hospital authority pursuant to article 29 of title 25, must send a claim for emergency services to the carrier within one hundred eighty days after the receipt of insurance information in order to receive reimbursement as specified in this subsection (3)(a). The reimbursement rate is the greater of: (I) One hundred five percent of the carrier's median in-network rate of reimbursement for that service provided in a similar facility or setting in the same geographic area; or (II) The median in-network rate of reimbursement for the same service provided in a similar facility or setting in the same geographic area for the prior year based on claims data from the all-payer health claims database created in section 25.5-1-204. (b) An out-of-network facility operated by the Denver health and hospital authority created in section 25-29-103 must send a claim for emergency services to the carrier within one hundred eighty days after the delivery of services in order to receive reimbursement as specified in this subsection (3)(b). The reimbursement rate is the greater of: (I) The carrier's median in-network rate of reimbursement for the same service provided in a similar facility or setting in the same geographic area; (II) Two hundred fifty percent of the medicare reimbursement rate for the same service provided in a similar facility or setting in the same geographic area; or (III) The median in-network rate of reimbursement for the same service provided in a similar facility or setting in the same geographic area for the prior year based on claims data from the Colorado all-payer health claims database described in section 25.5-1-204. (c) If the out-of-network facility submits a claim for emergency services after the one-hundred-eighty-day period specified in this subsection (3), the carrier shall reimburse the facility one hundred twenty-five percent of the medicare reimbursement rate for the same services in a similar setting or facility in the same geographic area. yer health claims database described in section 25.5-1-204. (c) If the out-of-network facility submits a claim for emergency services after the one-hundred-eighty-day period specified in this subsection (3), the carrier shall reimburse the facility one hundred twenty-five percent of the medicare reimbursement rate for the same services in a similar setting or facility in the same geographic area. (d) The out-of-network facility shall not bill a covered person any outstanding balance for a covered service not paid for by the carrier, except for any coinsurance, deductible, or copayment amount required to be paid by the covered person. (4) An out-of-network facility may initiate arbitration pursuant to section 10-16-704 (15) if the facility believes the payment made pursuant to subsection (3) of this section is not sufficient. (5) This section does not apply when a covered person voluntarily uses an out-of-network provider. (6) A violation of this section is a deceptive trade practice pursuant to section 6-1-105 (1)(xxx).

C.R.S. § 25-3-123 Mental health facility pilot program - establishment - rules - definitions

25-3-123. Mental health facility pilot program - establishment - rules - definitions. (1) As used in this section, unless the context otherwise requires: (a) "Mental health facility" means a facility approved to participate in the pilot program pursuant to subsection (2) of this section. (b) "Pilot program" means the mental health facility pilot program established pursuant to this section. (2) There is established in the department the mental health facility pilot program to authorize not more than two entities to participate in a three-year pilot program to allow individuals with either a physical health diagnosis or significant mental health diagnosis to reside in a facility that treats both the physical and mental health issues and provides additional services to help the individual transition to independent living. (3) On or before October 1, 2019, the department shall develop an application for interested entities to apply to be authorized as a mental health facility. The application must require the applicant to show, at a minimum, that it: (a) Is serving individuals with physical or mental or both physical and mental health diagnoses; (b) Offers staff secure environments rather than physically secure spaces; (c) Has the capability to provide integrated services with community medical and behavioral health providers; (d) Has sufficient staffing levels of licensed nurses, nursing assistants, and occupational and recreational professionals; (e) Has a partnership with either an acute care hospital or psychiatric hospital and with a skilled nursing facility, so it has the ability to transfer an individual in need of a higher level of care; (f) Demonstrates a collaborative relationship with the hospital, including consultation and treatment plan support, one-on-one staffing support, and ongoing training for staff at the mental health facility; (g) Is in a community that has resources to support community engagement to move an individual to less restrictive environments as an individual progresses; (h) Demonstrates cost savings or cost neutrality for the state medical assistance program; (i) Is willing and able to contribute at least one-third of the increased costs that the applicant will incur due to the pilot program and has identified sources for the other two-thirds; and (j) Is willing to prepare reports on the pilot program. (4) On or before February 1, 2020, the department shall select up to two applicants to become mental health facilities under the pilot program; except that, if more than one applicant is selected: (a) One selected applicant must be in a community with a population of over one hundred thousand and one selected applicant must be in a community with a population of under one hundred thousand unless there is no qualified applicant from such a community; (b) Both selected applicants must not be located in the same city unless the only qualified applicants are from a single city; and (c) Both selected applicants must not be assisted living facilities. (5) The department is authorized to adopt rules to implement the pilot program. (6) The state long-term care ombudsman office, established pursuant to section 26-11.5-104, has access to the premises and residents of a mental health facility during reasonable hours for the purposes set out in the federal "Older Americans Act of 1965".

C.R.S. § 25-3-124 Food donations to nonprofit organizations encouraged

25-3-124. Food donations to nonprofit organizations encouraged. Each hospital is encouraged to donate apparently wholesome food to one or more local nonprofit organizations for distribution to needy or poor individuals.

C.R.S. § 25-3-125 Visitation rights - hospital patients - residents in nursing care facilities or assisted living residences - limitations - definitions - short title

25-3-125. Visitation rights - hospital patients - residents in nursing care facilities or assisted living residences - limitations - definitions - short title. (1) The short title of this section is the "Elizabeth's No Patient or Resident Left Alone Act". (2) (a) Subject to the restrictions and limitations for skilled nursing facility and nursing facility residents' visitation rights specified in 42 U.S.C. sec. 1396r (c)(3)(C); 42 U.S.C. sec. 1395i (c)(3)(C); 42 CFR 483.10 (a), (b), and (f); the rights for assisted living residents specified in rule pursuant to section 25-27-104; the restrictions and limitations specified by a health-care facility pursuant to subsection (3) of this section; restrictions and limitations specified in state or local public health orders; and the communications exception specified in section 25-1-120, in addition to hospital patient visitation rights in 42 CFR 482.13 (h), a patient or resident of a health-care facility may have at least one visitor of the patient's or resident's choosing during the patient's stay or residency at the health-care facility, including: (I) A visitor to provide a compassionate care visit to alleviate the patient's or resident's physical or mental distress; (II) A visitor or support person designated pursuant to subsection (2)(b) of this section for a patient or resident with a disability; and (III) For a patient who is under eighteen years of age, the parent or legal guardian of, or the person standing in loco parentis to, the patient. (b) (I) A patient or resident of a health-care facility may designate, orally or in writing, a support person who supports the patient or resident during the course of the patient's stay or residency at a health-care facility and who may visit the patient or resident and exercise the patient's or resident's visitation rights on behalf of the patient or resident when the patient or resident is incapacitated or otherwise unable to communicate. (II) When a patient or resident has not designated a support person pursuant to subsection (2)(b)(I) of this section and is incapacitated or otherwise unable to communicate the patient's or resident's wishes and an individual provides an advance medical directive designating the individual as the patient's or resident's support person or other term indicating the individual is authorized to exercise rights covered by this section on behalf of the patient or resident, the health-care facility shall accept this designation and allow the individual to exercise the patient's or resident's visitation rights on the patient's or resident's behalf. (3) (a) Consistent with 42 CFR 482.13 (h); 42 U.S.C. sec. 1396r (c)(3)(C); 42 U.S.C. sec. 1395i (c)(3)(C); 42 CFR 483.10 (a), (b), and (f); and section 25-27-104, a health-care facility shall have written policies and procedures regarding the visitation rights of patients and residents, including policies and procedures setting forth any necessary or reasonable restriction or limitation to ensure health and safety of patients, staff, or visitors that the health-care facility may need to place on patient or resident visitation rights and the reasons for the restriction or limitation. ll have written policies and procedures regarding the visitation rights of patients and residents, including policies and procedures setting forth any necessary or reasonable restriction or limitation to ensure health and safety of patients, staff, or visitors that the health-care facility may need to place on patient or resident visitation rights and the reasons for the restriction or limitation. (b) (I) During a period when the risk of transmission of a communicable disease is heightened, a health-care facility may: (A) Require visitors to enter the health-care facility through a single, designated entrance; (B) Deny entrance to a visitor who has known symptoms of the communicable disease and should encourage the visitor to seek care; (C) Require visitors to use medical masks, face coverings, or other personal protective equipment while on the health-care facility premises or in specific areas of the health-care facility; (D) For a hospital, require visitors to sign a waiver acknowledging the risks of entering the health-care facility, waiving any claims against the health-care facility if the visitor contracts the communicable disease while on the health-care facility premises, and acknowledging that menacing and physical assaults on health-care workers and other employees of the health-care facility will not be tolerated, and, if such abuse occurs, a hospital may restrict the visitor's current or future access; (E) For all other health-care facilities, require visitors to sign a document acknowledging the risks of entering the health-care facility and acknowledging that menacing and physical assaults on health-care workers and other employees of the health-care facility will not be tolerated; (F) Require all visitors, before entering the health-care facility, to be screened for symptoms of the communicable disease and deny entrance to any visitor who has symptoms of the communicable disease; (G) Require all visitors to the health-care facility to be tested for the communicable disease and deny entry for those who have a positive test result; and (H) Restrict the movement of visitors within the health-care facility, including restricting access to where immunocompromised or otherwise vulnerable populations are at greater risk of being harmed by a communicable disease. (II) For visitation of a patient or resident with a communicable disease who is isolated, the health-care facility may: (A) Limit visitation to essential caregivers who are helping to provide care to the patient or resident; (B) Limit visitation to one caregiver at a time per patient or resident with a communicable disease; (C) Schedule visitors to allow adequate time for screening, education, and training of visitors and to comply with any limits on the number of visitors permitted in the isolated area at one time; and (D) Prohibit the presence of visitors during aerosol-generating procedures or during collection of respiratory specimens. (4) If a health-care facility requires, pursuant to subsection (3) of this section, that a visitor use a medical mask, face covering, or other personal protective equipment, or take a test for a communicable disease, in order to visit a patient or resident at the health-care facility, nothing in this section: (a) Requires the health-care facility, if the required equipment or test is not available due to lack of supply, to allow a visitor to enter the facility; (b) Requires the health-care facility to supply the required equipment or test to the visitor or bear the cost of the equipment for the visitor; or (c) Precludes the health-care facility from supplying the required equipment or test to the visitor. (5) As used in this section, unless the context otherwise requires: (a) "Advance medical directive" has the same meaning as set forth in section 15-18.7-102 (2). (b) "Caregiver" means a parent, spouse, or other family member or friend of a patient who provides care to the patient. e visitor; or (c) Precludes the health-care facility from supplying the required equipment or test to the visitor. (5) As used in this section, unless the context otherwise requires: (a) "Advance medical directive" has the same meaning as set forth in section 15-18.7-102 (2). (b) "Caregiver" means a parent, spouse, or other family member or friend of a patient who provides care to the patient. (c) "Communicable disease" has the same meaning as set forth in section 25-1.5-102 (1)(a)(IV). (d) (I) "Compassionate care visit" means a visit with a friend or family member that is necessary to meet the physical or mental needs of a patient or resident when the patient or resident is exhibiting signs of physical or mental distress, including: (A) End-of-life situations; (B) Adjustment support after moving to a new facility or environment; (C) Emotional support after the loss of a friend or family member; (D) Physical support after eating or drinking issues, including weight loss or dehydration; or (E) Social support after frequent crying, distress, or depression. (II) "Compassionate care visit" includes a visit from: (A) A clergy member or layperson offering religious or spiritual support; or (B) Other persons requested by the patient or resident for the purpose of a compassionate care visit. (e) "Health-care facility" means a hospital, nursing care facility, or assisted living residence licensed or certified by the department pursuant to section 25-3-101. (f) "Patient or resident with a disability" means a patient or resident who needs assistance to effectively communicate with health-care facility staff, make health-care decisions, or engage in activities of daily living due to a disability such as: (I) A physical, intellectual, behavioral, or cognitive disability; (II) Deafness, being hard of hearing, or other communication barriers; (III) Blindness; (IV) Autism spectrum disorder; or (V) Dementia.

C.R.S. § 25-3-126 Health facilities - requirements related to labor and childbirth - rules - definitions

25-3-126. Health facilities - requirements related to labor and childbirth - rules - definitions. (1) Except as provided in subsection (2) of this section, on and after January 1, 2022, a health facility that provides services related to labor and childbirth shall demonstrate to the department, in the form and manner determined by the department by rule, that the health facility has a policy that: (a) Allows every birthing person to have a companion or doula with the person during birth in addition to a partner or spouse; (b) Prioritizes newborns bonding with their families in order to facilitate the physiologic postpartum process; (c) Will not exclude from care any person experiencing physiologic birth or interrupt the process of physiologic birth without the informed consent of the birthing person; (d) Details the facility's process related to receiving a pregnant person's patient information from any provider regulated under title 12 who has provided care for the pregnant person; (e) Establishes processes to transfer and receive pregnant persons across levels of care of licensed facilities within the facility's capacity and capability; and (f) Establishes a process to receive individuals who are pregnant, undergoing physiologic birth, or in the physiologic postpartum process from locations other than licensed facilities, including a process to receive verbal and written information from individuals with relevant information, including but not limited to family members, doulas, or a health-care provider regulated under title 12. (2) For labor and childbirth services provided to a birthing person who is in custody, a health facility shall demonstrate to the department, in the form and manner determined by the department by rule, that the health facility has a policy that: (a) Prioritizes newborns bonding with their families in order to facilitate the physiologic postpartum process, unless: (I) The parent or legal guardian of the newborn consents to medical treatment; (II) The newborn is released to a legal guardian; or (III) The birthing person is released from labor and delivery; and (b) Will not exclude from care any person experiencing physiologic birth or interrupt the process of physiologic birth without the informed consent of the birthing person. (3) As used in this section: (a) "Doula" means a person who provides physical, emotional, and informational support to a pregnant person before, during, and after pregnancy. (b) "Physiologic birth" means labor and birth powered by the innate human capacity of a pregnant person and the pregnant person's fetus, which includes endogenous hormone systems. (c) "Physiologic postpartum process" means the biologic process that happens to both the newborn and birthing person after delivery due to endogenous hormone systems.

C.R.S. § 25-3-127 Emergency room intake data - marijuana use - annual report

25-3-127. Emergency room intake data - marijuana use - annual report. The department of public health and environment shall create a de-identified report from hospital and emergency room discharge data of patients, including demographic information regarding patients' age, race, ethnicity, gender, and geographic location, presenting with conditions or a diagnosis that reflects marijuana use, including and identifying if the marijuana use was in conjunction with alcohol or other drugs, and provide that report at the department's presentations to the legislative committees of reference pursuant to section 2-7-203 in 2022, and annually each year thereafter. The report can be produced in conjunction with the report required pursuant to section 30-10-624 (2).

C.R.S. § 25-3-128 Hospitals - nurses, nurse aides, and EMS providers - staffing requirements - enforcement - waiver - rules - definitions

25-3-128. Hospitals - nurses, nurse aides, and EMS providers - staffing requirements - enforcement - waiver - rules - definitions. (1) As used in this section: (a) "Clinical staff nurse" means a practical nurse or registered professional nurse licensed pursuant to article 255 of title 12 who provides direct care to patients. (b) "EMS provider" means an individual who holds a valid certificate or license issued by the department as provided in article 3.5 of this title 25. (c) "Nurse aide" means a person certified pursuant to article 255 of title 12 to practice as a nurse aide who provides direct care to patients or who works in an auxiliary capacity under the supervision of a registered nurse. (d) "Staffing plan" means the master nurse staffing plan developed for a hospital pursuant to subsection (2)(b) of this section. (2) (a) On or before September 1, 2022, each hospital shall establish a nurse staffing committee pursuant to rules promulgated by the state board of health, either by creating a new committee or assigning the nurse staffing functions to an existing hospital staffing committee. The nurse staffing committee must have at least sixty percent or greater participation by clinical staff nurses, in addition to auxiliary personnel and nurse managers. The nurse staffing committee must include a designated leader of workplace violence prevention and reduction efforts. (b) The nurse staffing committee: (I) Shall annually develop and oversee a master nurse staffing plan for the hospital that: (A) Is voted on and recommended by at least sixty percent of the nurse staffing committee; (B) Includes minimum staffing requirements as established in rules promulgated by the state board of health for each inpatient unit and emergency department that are aligned with nationally recognized standards and guidelines; (C) Includes strategies that promote the health, safety, and welfare of the hospital's employees and patients; (D) Includes guidance and a process for reducing nurse-to-patient assignments to align with the demand based on patient acuity; and (E) May include innovative staffing models; (II) (A) Shall submit the recommended staffing plan to the hospital's senior nurse executive and the hospital's governing body for approval. If the final plan approved by the hospital changes materially from the recommendations put forth by the staffing committee, the senior nurse executive shall provide the nurse staffing committee with an explanation for the changes. (B) If, after receiving the explanation referenced in subsection (2)(b)(II)(A) of this section, the staffing committee believes the final plan does not meet nurse staffing standards established in rules promulgated by the state board of health, the staffing committee, with a vote of sixty percent or more of the members, may request the department review the final adopted staffing plan for compliance with rules promulgated by the state board of health. (III) May publish a report that is responsive to the changes made to the recommended plan pursuant to subsection (2)(b)(II) of this section, if any; (IV) Shall describe in writing the process for receiving, tracking, and resolving complaints and receiving feedback on the staffing plan from clinical staff nurses and other staff; and (V) Shall make the complaint and feedback process available to all providers, including clinical staff nurses, nurse aides, and EMS providers. (c) The department is authorized to and shall enter, survey, and investigate each hospital as necessary to ensure compliance with the nursing staffing standards established in rules promulgated by the state board of health. (3) A hospital shall: (a) Submit the final, approved nurse staffing plan to the department on an annual basis; (b) On a quarterly basis, evaluate the staffing plan and prepare a report for internal review by the staffing committee; y, and investigate each hospital as necessary to ensure compliance with the nursing staffing standards established in rules promulgated by the state board of health. (3) A hospital shall: (a) Submit the final, approved nurse staffing plan to the department on an annual basis; (b) On a quarterly basis, evaluate the staffing plan and prepare a report for internal review by the staffing committee; (c) Provide the relevant unit-based staffing plan to: (I) Each applicant for a nursing position on a given unit upon an offer of employment; and (II) A patient upon request; and (d) Prepare an annual report containing the details of the evaluation required in subsection (3)(b) of this section and submit the report to the department, in a form and manner determined by rules promulgated by the state board of health. (4) A hospital shall not assign a clinical staff nurse, nurse aide, or EMS provider to a hospital unit unless, consistent with the conditions of participation adopted for federal medicare and medicaid programs, hospital personnel records include documentation that the training and demonstration of competency were successfully completed during orientation and on a periodic basis consistent with hospital policies. (5) (a) On or before September 1, 2022, each hospital shall report, in a form and manner determined by rules promulgated by the state board of health, the baseline number of beds the hospital is able to staff in order to provide patient care and the hospital's current bed capacity. The reporting may include: (I) Seasonal or other anticipated variances in staffed-bed capacity; and (II) Anticipated factors impacting staffed-bed capacity. (b) In promulgating rules pursuant to subsection (5)(a) of this section, the state board of health shall: (I) Use the data provided to the department by each hospital throughout the COVID-19 pandemic through an internet-based resource management and communication tool developed for and commonly used by hospitals; (II) Determine the number of seasonal variations allowable with regard to subsection (5)(a)(I) of this section with a minimum of two and a maximum of four allowable variances; and (III) Define "staffed-bed capacity" for the purposes of this section. (c) On or before September 1, 2022, as determined by rules promulgated by the state board of health, if a hospital's ability to meet staffed-bed capacity falls below eighty percent of the hospital's reported baseline for not less than seven and not more than fourteen consecutive days, the hospital shall notify the department and submit: (I) A plan to ensure staff is available, within thirty days, to return to a staffed-bed capacity level that is eighty percent of the reported baseline; or (II) A request for a waiver due to a hardship, which request articulates why the hospital is unable to meet the required staffed-bed capacity, if: (A) The hospital's current staffed-bed capacity falls below eighty percent of the hospital's reported baseline for not less than seven and not more than fourteen consecutive days; or (B) The hospital's current staffed-bed capacity threatens public health. (d) The department may impose fines, not to exceed one thousand dollars per day, for a hospital's failure to: (I) Meet the reported staffed-bed capacity of eighty percent or more of the hospital's reported baseline; or (II) Accurately report a hospital's baseline staffed-bed capacity. (6) Each hospital with more than twenty-five beds shall articulate in its emergency plan a demonstrated ability to expand the hospital's staffed-bed capacity up to one hundred twenty-five percent of the hospital's baseline staffed-bed capacity and intensive care unit capacity within fourteen days after: (a) A statewide public health emergency is declared or the hospital is notified by the department that surge capacity is needed; and y-five beds shall articulate in its emergency plan a demonstrated ability to expand the hospital's staffed-bed capacity up to one hundred twenty-five percent of the hospital's baseline staffed-bed capacity and intensive care unit capacity within fourteen days after: (a) A statewide public health emergency is declared or the hospital is notified by the department that surge capacity is needed; and (b) The state has used all available authority to expedite workforce availability and maximize hospital throughput and capacity, such as: (I) Licensing or certification flexibility for health facilities; (II) Reducing requirements for licensing, credentialing, and the receipt of staff privileges; (III) Waiving scope of practice limitations; and (IV) Waiving state-regulated payer provisions that create barriers to timely patient discharge. (7) Each hospital shall update its emergency plan at least annually and as often as necessary, as circumstances warrant. The emergency plan must include the actions the hospital will take to maximize staffed-bed capacity and appropriate utilization of hospital beds to the extent necessary for a public health emergency and through the following activities: (a) Cross-training, just-in-time training, and redeployment of staff; (b) Supporting all hospital facilities, including hospital-owned facilities, to provide any necessary, available, and appropriate preventive care, vaccine administration, diagnostic testing, and therapeutics; (c) Maximizing hospital throughput by discharging patients to skilled nursing, post-acute, and other step-down facilities; and (d) Reducing the number of scheduled procedures in the hospital. (8) Beginning September 1, 2022, the department may fine a hospital an amount not to exceed ten thousand dollars per day for the failure to: (a) Achieve the required staffed-bed capacity described in subsection (6) of this section within fourteen days after a declared statewide public health emergency or other notification by the department that surge capacity is needed; (b) Include the amount of necessary vaccines for administration in its annual emergency plan and have the vaccines available, to the extent that the vaccines are available, at each of its hospital facilities and hospital-owned primary care sites during and outside of the public health emergency, as determined by rules promulgated by the department; and (c) Include the necessary testing capabilities available in its annual emergency plan and at each of its hospital facilities and hospital-owned primary care sites during and outside of a public health emergency, to the extent that the testing is available, as determined by rules promulgated by the department. (9) For the purposes of this section, the department shall enter, survey, and investigate each hospital: (a) As deemed necessary by the department; (b) For purposes of infection control and emergency preparedness; and (c) To ensure compliance with this section. (10) The department shall annually report on the information contained in the quarterly report described in subsection (3)(d) of this section as a part of its presentation to its committee of reference at a hearing held pursuant to section 2-7-203 (2)(a) of the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act". (11) The department may promulgate rules to require health facilities licensed pursuant to section 25-1.5-103 to develop and implement infection prevention plans that align with national best practices and standards and that are responsive to COVID-19 and other communicable diseases. The requirements may include testing, vaccination, and treatment in accordance with applicable state laws, rules, and executive orders. (12) The state board of health shall promulgate rules as necessary to implement this section.

C.R.S. § 25-3-129 Office of saving people money on health care - study - report

25-3-129. Office of saving people money on health care - study - report. (1) The office of saving people money on health care in the lieutenant governor's office shall study: (a) The level of preparedness of health facilities licensed pursuant to section 25-1.5-103 to respond to post-viral illness resulting from the COVID-19 virus; (b) The effects of post-viral illness resulting from the COVID-19 virus on the mental, behavioral, and physical health and the financial security of the people of Colorado; and (c) The effects of the COVID-19 pandemic on the cost of health care in Colorado and on the ability of Colorado's public health system to respond to emergencies. (2) On or before January 1, 2023, and on or before January 1 each year thereafter, the office of saving people money on health care shall report its findings to the governor. (3) The office of saving people money on health care shall coordinate, monitor, and support the efforts to improve the affordability of health care, health outcomes, and public health readiness in state programs and departments.

C.R.S. § 25-3-130 Intimate examination of sedated or unconscious patient - informed consent required - rules - definitions

25-3-130. Intimate examination of sedated or unconscious patient - informed consent required - rules - definitions. (1) (a) (I) Except as provided in subsection (1)(b) of this section, a health-care facility shall not permit a licensed health-care provider, or a student or trainee under the supervision of a licensed health-care provider, to perform an intimate examination of a sedated or unconscious patient at the health-care facility unless the patient has provided specific informed consent to the examination in accordance with subsection (2) of this section. (II) In addition to the requirement to obtain a patient's specific informed consent, a health-care facility may allow a student or trainee to perform an intimate examination of a sedated or unconscious patient for educational or training purposes only if: (A) The examination is related to the planned procedure to be performed on the patient at the health-care facility; (B) The student or trainee has been introduced to the patient as part of the patient's care team, and the student's or trainee's role in performing an intimate examination for educational or training purposes has been shared with the patient; and (C) The student or trainee is under the direct supervision of the licensed health-care provider responsible for supervising the student or trainee. (b) The requirements of subsection (1)(a) of this section do not limit the ability of a health-care facility to allow: (I) A licensed health-care provider to perform an intimate examination of a patient who is sedated or unconscious without obtaining the patient's specific informed consent in emergency situations when the intimate examination is medically necessary for the life or well-being of the patient, but the licensed health-care provider must make a record of performing the examination without obtaining the patient's specific informed consent, including an explanation of the reason for not obtaining the patient's consent, and the record must be provided to the patient prior to discharge; or (II) A licensed health-care provider who has obtained the patient's consent to provide health care that includes an intimate examination to perform the intimate examination if the licensed health-care provider has informed the patient of the intimate examination in the course of obtaining the patient's consent to the health care. (2) To obtain specific informed consent to perform an intimate examination on a sedated or unconscious patient, a health-care facility shall, during a preoperative appointment before the procedure at which the examination will be performed or, in the absence of a preoperative appointment, as soon as possible before the intimate examination occurs: (a) Provide a written or electronic document to the patient, separate from any other notice or agreement, that: (I) Includes the following heading at the top of the document, in no smaller than eighteen-point, bold-faced type: "CONSENT FOR EXAMINATION OF BREASTS, PELVIC REGION, RECTUM, AND/OR PROSTATE"; (II) Specifies the nature and purpose of the intimate examination; (III) Names one or more licensed health-care providers whom the patient may authorize to perform the intimate examination; (IV) States whether there may be one or more students or trainees whom the patient may authorize to perform an intimate examination for educational or training purposes or to observe or otherwise be present at the examination, either in person or through electronic means, and identifies the students or trainees by name; and (V) Provides the patient the ability to consent to or decline the following: (A) An intimate examination for diagnosis or treatment, to be performed by a licensed health-care provider; (B) An intimate examination for educational or training purposes, to be performed by a licensed health-care provider; and n person or through electronic means, and identifies the students or trainees by name; and (V) Provides the patient the ability to consent to or decline the following: (A) An intimate examination for diagnosis or treatment, to be performed by a licensed health-care provider; (B) An intimate examination for educational or training purposes, to be performed by a licensed health-care provider; and (C) One or more, but no more than three, additional intimate examinations for educational or training purposes, to be performed by up to three different students or trainees; (b) Obtain the signature of the patient on the written or electronic document; and (c) Sign the written or electronic document. (3) (a) For purposes of complying with subsection (2) of this section, a health-care facility may: (I) Develop and use its own written or electronic document, so long as the document satisfies the requirements of subsection (2) of this section; or (II) Use a written or electronic document developed by the department for use by health-care facilities and licensed health-care providers, so long as the document satisfies the requirements of subsection (2) of this section. (b) If the department develops a written or electronic document for use by health-care facilities, the department shall develop a single, consistent document for use by all health-care facilities and all licensed health-care providers, regardless of practice area, that complies with the requirements of subsection (2) of this section. (c) The health-care facility shall make the completed, signed specific informed consent document available to the patient. (4) (a) (I) If a health-care facility violates this section, or retaliates against an individual, including a whistleblower, for filing a complaint regarding a violation of this section with the department or a regulator or for otherwise complaining to any other person, the aggrieved individual may file a complaint with the department. The department may receive and investigate complaints filed pursuant to this subsection (4)(a) against a health-care facility and, as appropriate, may refer matters related to a licensed health-care provider or a student or trainee under the supervision of a licensed health-care provider to the appropriate regulator. (II) If the department determines, after a hearing on the matter in accordance with the requirements and procedures specified in article 4 of title 24, that a health-care facility has violated this section or has retaliated against an individual, including a whistleblower, for filing a complaint with the department or a regulator regarding a violation of this section or for otherwise complaining to any other person, the department may take action authorized in this article 3 against the health-care facility's license or impose restrictions or conditions on the health-care facility as the department determines appropriate. (III) The state board of health may adopt rules as necessary to enforce this section. (b) A patient who has been subjected to an intimate examination in violation of this section may file a civil action for damages in a court of competent jurisdiction. Such action is not a medical malpractice action, and the limitation on damages for noneconomic loss or injury established pursuant to section 13-21-102.5 applies to any award to the patient for noneconomic damages. (5) Nothing in this section affects the ability to perform a medical forensic examination, including the collection of evidence, in connection with an alleged sexual assault or other crime or the investigation of an alleged sexual assault or other crime, pursuant to applicable laws. (6) As used in this section: (a) "Health-care facility" means a health-care facility licensed or certified by the department pursuant to section 25-1.5-103 (1)(a) and includes an individual authorized to act on behalf of the health-care facility. connection with an alleged sexual assault or other crime or the investigation of an alleged sexual assault or other crime, pursuant to applicable laws. (6) As used in this section: (a) "Health-care facility" means a health-care facility licensed or certified by the department pursuant to section 25-1.5-103 (1)(a) and includes an individual authorized to act on behalf of the health-care facility. (b) (I) "Intimate examination" means palpation of a breast or an internal pelvic, prostate, or rectal examination. (II) "Intimate examination" does not include a visual examination of a part of the body specified in subsection (6)(b)(I) of this section that occurs incidental to the care being provided. (c) "Licensed health-care provider" means: (I) A physician or physician assistant licensed pursuant to article 240 of title 12; (II) A person who holds a physician training license issued pursuant to section 12-240-128 and is: (A) A resident enrolled in an approved residency, as defined in section 12-240-104 (4); (B) An intern enrolled in an approved internship, as defined in section 12-240-104 (2); or (C) A fellow enrolled in an approved fellowship, as defined in section 12-240-104 (1); (III) An advanced practice registered nurse, as defined in section 12-255-104 (1); a registered nurse, as defined in section 12-255-104 (11); or a midwife, other than a direct-entry midwife or certified nurse midwife, practicing in this state whose scope of practice includes performing intimate examinations; or (IV) A direct-entry midwife registered pursuant to article 225 of title 12. (d) "Patient" means an individual under the care of a licensed health-care provider or health-care facility or the patient's authorized representative. (e) "Patient's authorized representative" means an individual who is authorized to make health-care decisions for or exercise rights on behalf of the patient, including, for a patient who is under eighteen years of age, the parent or legal guardian of, or the individual standing in loco parentis to, the patient. (f) "Regulator" means: (I) For licensed health-care providers described in subsections (6)(c)(I) and (6)(c)(II) of this section, the Colorado medical board created in section 12-240-105; (II) For licensed health-care providers described in subsection (6)(c)(III) of this section, the state board of nursing created in section 12-255-105; and (III) For licensed health-care providers described in subsection (6)(c)(IV) of this section, the director of the division of professions and occupations in the department of regulatory agencies. (g) "Student" means an individual currently enrolled in: (I) An approved medical college, as defined in section 12-240-104 (3); (II) An approved education program, as defined in section 12-255-104 (2), for professional nursing; or (III) A training program approved by the director of the division of professions and occupations in the department of regulatory agencies, as described in section 12-225-104 (4)(c). (h) "Trainee" means an individual enrolled in or otherwise participating in training, practical experience, practicum, or any other experiential or clinical program that is required pursuant to article 225, 240, or 255 of title 12 for the individual to become a licensed health-care provider. (i) "Whistleblower" means an individual who has knowledge of an alleged violation of this section.

C.R.S. § 25-3-131 Maternal health-care services - discontinuation - required notifications - definitions - repeal

25-3-131. Maternal health-care services - discontinuation - required notifications - definitions - repeal. (1) Except as provided in subsection (3) of this section, at least ninety days before a hospital providing maternal health-care services or a birth center may discontinue such services, the facility shall provide notice to: (a) The department of public health and environment responsible for licensing health facilities pursuant to section 25-3-101; (b) The primary care office, created in section 25-1.5-403; (c) The governor; (d) All patients receiving maternal health-care services at the facility as of the date of the notice; (e) All health-care providers that provide maternal health-care services for the facility as of the date of the notice; and (f) The general public. (2) The notice required in subsection (1) of this section must include: (a) A description of the maternal health-care services being discontinued; (b) The rate the maternal health-care services had been provided at in the previous year; (c) The number and type of health-care providers impacted; (d) The proposed plan for transitioning patients to new health-care providers; and (e) The proposed plan for transitioning the health-care providers to new positions. (3) (a) In the event of an emergency, a facility shall provide the notice required in subsection (1) of this section on the day a definitive plan for alternative patient care has been arranged or within seven days after the emergency has been identified, whichever is earlier. (b) This subsection (3) does not apply in the event of an emergency covered by rules promulgated by the department of public health and environment if such emergency affects the physical space of the facility and necessitates the removal of clients, employees, or contractors from the facility. (4) As used in this section: (a) "Emergency" means a sudden and unforeseen circumstance or financial impediment that would inhibit a hospital's ability to safely and effectively operate a maternal health-care service. (b) "Maternal health-care services" means health-care services provided to an individual regarding care related to the individual's pregnancy, childbirth, and postpartum period. (5) This section is repealed, effective July 1, 2027.

C.R.S. § 25-3-301 Establishment of public hospital

25-3-301. Establishment of public hospital. (1) Whenever the board of county commissioners of any county which has a population of at least three thousand is presented with a petition signed by five hundred resident registered qualified electors, or by fifty percent of the resident registered qualified electors of such county, at least two hundred fifty of whom are residents of other than the county seat or town where it is proposed to locate such public hospital, asking that a public hospital board be appointed and that an annual tax be levied for the establishment and maintenance of a public hospital at a place in the county named therein, and which petition shall specify the maximum amount of money proposed to be expended in purchasing or building said hospital, such board of county commissioners shall have the power to create, by resolution, such public hospital board, to levy such tax, and to appropriate to such public hospital board the funds for purchasing or building such hospital and for maintaining the hospital, as well as the power to turn to the control and maintenance of such public hospital board any public or other hospital then being conducted by the board of county commissioners. Said tax shall not exceed three mills on the dollar for each year. (2) If it is proposed in such petition, or in a petition later filed with like number of resident registered qualified elector signers, to create an indebtedness of the county for purchasing, erecting, or enlarging of buildings or equipment for such public hospital, then the board of county commissioners shall submit such question in the manner provided by law for creating debt for erecting public buildings and, if the vote authorizes it, shall issue such bonds, so authorized, as the public hospital board requests. In those counties having a population of less than three thousand, a public hospital board may be created by the petition of not less than fifty-one percent of the resident registered qualified electors or two hundred such resident registered qualified electors, regardless of where they live in the county. In such counties, an annual levy of not to exceed five mills on the dollar shall be assessed to purchase, build, and maintain such a county hospital.

C.R.S. § 25-3-302 Board of trustees

25-3-302. Board of trustees. (1) If a board of county commissioners decides to create a public hospital board of trustees, levy an annual tax, and appropriate funds to purchase, erect, and maintain or turn over to the public hospital board of trustees control of a county hospital, the board of county commissioners shall proceed at once to appoint to the public hospital board of trustees, for designated terms, seven trustees chosen from the citizens at large with reference to their fitness for office. All of the trustees must be residents of the county, and none may be an elected or appointed state, county, or city official. Nothing in this article 3 requires a licensed physician to be appointed to a public hospital board of trustees; however, if a licensed physician is appointed to a public hospital board of trustees, membership on that board is limited to one licensed physician at any given time. The seven appointees constitute the public hospital board of trustees for the public hospital. The public hospital board of trustees is a body corporate under the name "Board of Trustees for ............... Hospital", the name of the hospital being inserted in the blank. (2) One of the trustees, so designated in such original appointment, shall hold office until the second Tuesday of January following his appointment, one until the second Tuesday of the second January following his appointment, two until the second Tuesday of the third January following their appointment, one until the second Tuesday of the fourth January following his appointment, and two until the second Tuesday of the fifth January from their appointment. Thereafter, the term of office of each appointee shall be five years from the end of the preceding term. At the expiration of the term of each of said trustees, the office shall be filled by appointment of the board of county commissioners. (3) (a) Except as otherwise provided in subsection (3)(b) of this section, in counties with a population of less than three thousand, the board of public hospital trustees shall consist of five citizens at large that have the same requirements with reference to their fitness for such office as all other counties. One of the trustees, so designated in such original appointment, shall hold office until the second Tuesday of January following their appointment, one until the second Tuesday of the second January following their appointment, one until the second Tuesday of the third January following their appointment, one until the second Tuesday of the fourth January following their appointment, and one until the second Tuesday of the fifth January following their appointment. The term of office and the method of filling vacancies shall be the same as for all other counties. (b) The board of county commissioners of a county with a population of less than three thousand that creates a public hospital board of trustees may determine, by a resolution of the board of county commissioners, that the public hospital board of trustees shall consist of seven, rather than five, citizens at large that have the same requirements with reference to their fitness for such office as all other counties. For a public hospital board of trustees that is created after August 7, 2023, and that consists of seven members pursuant to this subsection (3)(b), the trustees shall hold office as is specified in subsection (2) of this section. For a public hospital board of trustees that is in existence when the board of county commissioners determines that the public hospital board of trustees will consist of seven members, one of the additional trustees shall hold office until the second Tuesday of the third January following their appointment, and the other additional trustee shall hold office until the second Tuesday of the fifth January from their appointment. The term of office and the method of filling vacancies shall be the same as for all other counties.

C.R.S. § 25-3-303 Organization of trustees

25-3-303. Organization of trustees. (1) The members of the board of public hospital trustees within ten days after their appointment shall qualify by taking the oath of office. On the second Tuesday of each January, they shall organize and operate as follows: (a) Unless otherwise authorized under the provisions of paragraph (b) of this subsection (1), they shall elect one of their number as president, one as vice-president, and one as secretary. No bond shall be required of them. The county treasurer of the county shall be treasurer of the board of trustees and shall receive and pay out all moneys under the control of said board as ordered by it but shall receive no compensation from such board. No trustee shall receive any compensation for services performed but may receive reimbursement for any cash expenditures actually made for personal expenses incurred as such trustee. An itemized statement of all such expenses and money paid out shall be made under oath by such trustee and filed with the secretary and allowed only by the affirmative vote of all the trustees present at a meeting of the board. (b) If approved by resolution of the board of county commissioners, the board may organize and operate by electing one of their number as president, one as vice-president, and one as secretary-treasurer. The trustees may appoint an assistant secretary-treasurer from outside the membership of the board of trustees. No bond shall be required of the trustees, except of the secretary-treasurer and assistant secretary-treasurer who shall each file with the board of trustees, at the expense of the hospital, a corporate fidelity bond in an amount not less than ten thousand dollars, conditioned on the faithful performance of the duties of his office. The secretary-treasurer shall receive and pay out all the moneys under the control of the board of trustees as ordered by it. No trustee shall receive any compensation for services performed, but may receive reimbursement for any cash expenditures actually made for personal expenses incurred as such trustee. An itemized statement of all such expenses and money paid out shall be made under oath by such trustee and filed with the secretary-treasurer and allowed only by the affirmative vote of all the trustees present at a meeting of the board. (2) For purposes of part 4 of article 6 of title 24, C.R.S., any board of public hospital trustees created pursuant to section 25-3-302 shall continue to be a local public body, as defined in section 24-6-402 (1)(a), C.R.S., regardless of whether the hospital governed by such board of trustees is designated an enterprise pursuant to section 25-3-304 (3).

C.R.S. § 25-3-304 Trustees - powers and duties

25-3-304. Trustees - powers and duties. (1) (a) A public hospital board of trustees shall make and adopt such bylaws, rules, and regulations for its own guidance and for the government of the hospital as it deems expedient for the economic and equitable conduct thereof, not inconsistent with state law or the ordinances of the city or town in which the public hospital is located. (b) The public hospital board of trustees has exclusive control of: (I) The use and expenditure of all money collected to the credit of the hospital, including the right to invest or have invested money held by the hospital or in the office of the county treasurer and to receive the interest and income therefrom; (II) The purchase of sites; (III) The purchase, construction, or enlargement of any hospital building; and (IV) The supervision, care, and custody of any grounds, rooms, or buildings that it purchases, constructs, or leases. (c) Except as described in subsection (1)(d) of this section, a public hospital board of trustees may acquire by lease real and personal property subject to the approval of the board of county commissioners. All tax money received for hospital purposes must be paid out of the county treasury only upon warrants drawn by the county commissioners upon sworn vouchers approved by the public hospital board of trustees. All other money received for the hospital must be deposited in the treasury of the hospital and paid out only upon order of the public hospital board of trustees. If a public hospital board of trustees acquires and holds hospital property and facilities, including real and personal property, by conveyance on transfer of title, then title to all lands must be in either the name of the county or the public hospital's corporate name for the hospital's use and benefit. County hospitals situated in home rule counties have the additional borrowing authority granted by section 30-35-201 (23)(b). (d) A public hospital board of trustees that has elected to designate its public hospital as an enterprise for purposes of section 20 of article X of the state constitution, as described in subsection (3) of this section, is not required to obtain the approval of the board of county commissioners before acquiring real or personal property by lease. (2) (a) The public hospital board of trustees has the power to hire, retain, and remove agents and employees, including administrative, nursing, and professional personnel, engineers, architects, and attorneys, and to fix their compensation; has the power to borrow money and incur indebtedness, and to issue bonds and other evidence of such indebtedness; except that no indebtedness shall be created, except as otherwise provided by statute, in excess of the revenue that may reasonably be expected to be available to the hospital for repayment thereof in the fiscal year in which such indebtedness is to be created, and except that no such indebtedness shall be incurred without the approval of the board of county commissioners if the repayment of such indebtedness is dependent on tax money received for hospital purposes from the board of county commissioners; and shall in general carry out the spirit and intent of this part 3 in establishing and maintaining a county public hospital. Any indebtedness incurred by a public hospital board of trustees is an obligation of the public hospital board of trustees and not an obligation of the board of county commissioners that approved the indebtedness. or hospital purposes from the board of county commissioners; and shall in general carry out the spirit and intent of this part 3 in establishing and maintaining a county public hospital. Any indebtedness incurred by a public hospital board of trustees is an obligation of the public hospital board of trustees and not an obligation of the board of county commissioners that approved the indebtedness. (b) A board of public hospital trustees must hold meetings at least once each month and must keep a complete record of all its proceedings. Four members of the board constitutes a quorum for the transaction of business. One of the trustees must visit and examine said hospital at least twice each month, and the public hospital board, during the first week in each January and July, must file with the board of county commissioners a report of their proceedings with reference to such hospital and a statement of all receipts and expenditures during the half year. On or before each October first, the board must certify to the board of county commissioners the amount necessary to maintain and improve said hospital for the ensuing year. No trustee shall have a personal pecuniary interest, either directly or indirectly, in the purchase of any supplies for said hospital, unless the same are purchased by competitive bidding. (c) A public hospital board of trustees may offer to the general public products and services of any health-care organization, association, partnership, or corporation to the extent that the products and services are consistent with the powers and duties of a county public hospital pursuant to this part 3. (3) (a) The board of public hospital trustees may, in accordance with the provisions of paragraph (b) of this subsection (3), designate the hospital as an enterprise for purposes of section 20 of article X of the state constitution so long as said board of trustees retains authority to issue revenue bonds and the hospital receives less than ten percent of its total annual revenues in grants. So long as the hospital is designated as an enterprise pursuant to the provisions of this subsection (3), the hospital shall not be subject to any of the provisions of section 20 of article X of the state constitution. (b) (I) The board of public hospital trustees may, by resolution, designate the hospital as an enterprise as long as the hospital meets the requirements for an enterprise as stated in paragraph (a) of this subsection (3). Such designation shall be effective beginning with the budget year immediately following the budget year in which such resolution is adopted. Such resolution shall be adopted no sooner than ninety days and no later than thirty days prior to the commencement of the budget year in which such designation becomes effective. (II) The board of public hospital trustees may, by resolution, revoke the designation of the hospital as an enterprise. Such revocation shall be effective beginning with the budget year immediately following the budget year in which such resolution is adopted. Such resolution shall be adopted no sooner than ninety days and no later than thirty days prior to the commencement of the budget year in which such revocation becomes effective. (III) Upon adoption of any resolution pursuant to the provisions of subparagraph (I) or (II) of this paragraph (b), the board of public hospital trustees shall transmit a copy of the resolution to the division of local government in the department of local affairs and the appropriate board or boards of county commissioners. (IV) The termination or revocation of the designation of the hospital as an enterprise shall not affect in any manner the validity of any revenue bonds issued by the board of public hospital trustees of such hospital pursuant to subsection (4) of this section. lution to the division of local government in the department of local affairs and the appropriate board or boards of county commissioners. (IV) The termination or revocation of the designation of the hospital as an enterprise shall not affect in any manner the validity of any revenue bonds issued by the board of public hospital trustees of such hospital pursuant to subsection (4) of this section. (c) (I) For purposes of this subsection (3), "grant" means any direct cash subsidy or other direct contribution of money from the state or any local government in Colorado which is not required to be repaid. (II) "Grant" does not include: (A) Any indirect benefit conferred upon a hospital from the state or any local government in Colorado; (B) Any revenues resulting from rates, fees, assessments, or other charges imposed by a hospital for the provision of goods or services by such hospital; (C) Any federal funds, regardless of whether such federal funds pass through the state or any local government in Colorado prior to receipt by a hospital. (4) (a) Subject to the limitations set forth in paragraph (b) of this subsection (4), the board of public hospital trustees shall have the power to issue revenue bonds, secured by any revenues of the hospital other than property tax revenues. Notwithstanding subsection (2) of this section to the contrary, such revenue bonds may provide for their repayment over a term greater than one fiscal year. The board shall authorize the issuance of revenue bonds by resolution, duly approved by no less than two-thirds of the entire membership of the board. All bonds shall be signed by the president of the board of trustees, countersigned by the secretary of the board of trustees, and shall be numbered and registered in a book kept by the secretary or the secretary-treasurer, as applicable. Each bond shall state upon its face the amount for which such bond is issued, to whom such bond is issued, and the date of its issuance. (b) Except as otherwise provided in this paragraph (b), the issuance of any revenue bonds pursuant to the provisions of this subsection (4) shall not become effective for a period of thirty days following the adoption of any resolution authorizing such issuance for the purpose of allowing the board of county commissioners to review such pending bond issue. Such review period shall commence upon the date of receipt by the board of county commissioners of written notice from the board of public hospital trustees of such pending revenue bond issue. During said thirty days, the board of county commissioners may file a written notice with the board of trustees stating that the board of county commissioners has no objection to such pending bond issue. Upon receipt of such notice of no objection, the issuance of such revenue bonds shall become effective. If, within said thirty days, the board of county commissioners does not file with the board of trustees either a written notice of no objection or a written objection, the issuance of such revenue bonds shall become effective. If the board of county commissioners files a written objection, the issuance of such revenue bonds shall be prohibited until such time as the board of county commissioners gives written notice to the board of trustees of withdrawal of the board's objection.

C.R.S. § 25-3-304.5 Hospital collaborative agreements - additional powers

25-3-304.5. Hospital collaborative agreements - additional powers. In addition to the powers specified in section 25-3-304, the board of trustees of a county public hospital may enter into a collaborative agreement with another county public hospital, health service district, or hospital affiliate in accordance with section 25.5-1-1001.

C.R.S. § 25-3-305 Vacancies - removal for cause

25-3-305. Vacancies - removal for cause. Vacancies in the board of trustees occasioned by removals, resignations, or otherwise shall be reported to the board of county commissioners and be filled in like manner as original appointments. Any trustee may be removed for cause by the board of county commissioners.

C.R.S. § 25-3-306 Right of eminent domain

25-3-306. Right of eminent domain. If the board of public hospital trustees and the owners of any property desired by it for hospital purposes cannot agree as to the price to be paid therefor, said board shall report the facts to the board of county commissioners, and condemnation proceedings shall be instituted by the board of county commissioners and prosecuted in the name of the county wherein such public hospital is to be located.

C.R.S. § 25-3-307 Building requirements

25-3-307. Building requirements. No hospital buildings shall be erected or constructed until the plans and specifications have been made therefor and adopted by the board of public hospital trustees and bids advertised for according to law as for other county public buildings. Such hospital may be in more than one unit or set of buildings within the same town or city, or in separate towns or cities, or within adjacent counties, and, if in adjacent counties, upon approval of the respective boards of county commissioners.

C.R.S. § 25-3-308 Improvements, operations, or enlargements

25-3-308. Improvements, operations, or enlargements. In counties exercising the rights conferred by this part 3, the board of county commissioners may appropriate money from its general fund, in addition to the tax for the hospital fund provided for in section 25-3-301, in an amount that the board of county commissioners deems appropriate for the improvement, operation, or enlargement of any public hospital so established.

C.R.S. § 25-3-309 Hospital fees

25-3-309. Hospital fees. Every hospital established under this part 3 is for the benefit of the inhabitants of the county and of any person falling sick or who is injured or maimed within its limits. Every inhabitant or person who is not indigent shall pay to the board of public hospital trustees or to the officer it designates for the county public hospital reasonable compensation for occupancy, nursing, laboratories, care, medicine, or attendants according to rules prescribed by the board in order to render the use of the hospital of the greatest benefit to the greatest number.

C.R.S. § 25-3-310 Rules and regulations

25-3-310. Rules and regulations. (1) When such hospital is established, the physicians, nurses, attendants, persons sick therein, and persons approaching or coming within the limits of same and all buildings and grounds of such hospital and all furniture and other articles used or brought there shall be subject to such rules and regulations as said public hospital board may prescribe. (2) Said public hospital board may exclude from the use of such hospital any inhabitants and persons who willfully violate such rules and regulations. The board may extend the privileges and use of such hospital to persons residing outside of such county upon such terms and conditions as said board may from time to time by its rules and regulations prescribe.

C.R.S. § 25-3-311 Donations permitted

25-3-311. Donations permitted. Any person, firm, organization, corporation, or society desiring to make donations of money, personal property, or real estate for the benefit of such public hospital shall have the right to vest title of the money, personal property, or real estate so donated in said county, to be controlled, when accepted, by the board of public hospital trustees according to the terms of the deed, gift, devise, or bequest of such property.

C.R.S. § 25-3-312 Training school for nurses

25-3-312. Training school for nurses. The board of trustees of such county public hospital may establish and maintain, in connection therewith and as a part of said public hospital, a training school for nurses.

C.R.S. § 25-3-313 Lease of hospital

25-3-313. Lease of hospital. The public hospital board having control of such hospital after its establishment and turning over to its management may in its discretion rent or lease the said hospital, for such rental and for such term as it deems reasonable and proper, to any corporation not for pecuniary profit duly organized under the laws of the state of Colorado for the purpose of conducting a hospital.

C.R.S. § 25-3-314 Charge for professional services

25-3-314. Charge for professional services. Any hospital which is owned by a county, or by a city and county, having a population in excess of two hundred fifty thousand persons and which is a teaching hospital duly accredited as such by the joint commission on accreditation of hospitals and by the council on medical education of the American medical association may employ physicians and surgeons licensed to practice medicine in the state of Colorado for the performance of professional services in such hospital or in any related outpatient facility which is owned by such county or city and county. Charges for the services so rendered by any such physician or surgeon, excluding professional trainees, may be collected through the medium of such hospital in the name of the physician or surgeon and, upon collection, may be placed in a medical practice fund to be established, maintained, and used by such hospital solely for the purpose of payment of compensation to the physicians and surgeons so employed and for the payment of consultation fees to other physicians and surgeons not so employed, or directly to physicians and surgeons who are directly engaged in medical research or medical education.

C.R.S. § 25-3-315 Records of hospital

25-3-315. Records of hospital. For purposes of part 2 of article 72 of title 24, C.R.S., the records of any hospital established pursuant to this part 3 shall continue to be public records, as defined in section 24-72-202 (6), C.R.S., regardless of whether such hospital is designated as an enterprise pursuant to section 25-3-304 (3).

C.R.S. § 25-3-401 Department to administer plan

25-3-401. Department to administer plan. (1) The department of public health and environment is designated as the sole agency for carrying out the purposes of the federal "Hospital Survey and Construction Act", Public Law 79-725 of the 79th Congress of the United States, approved August 13, 1946, or any amendments thereto, and the successor provisions thereof of Public Law 93-641, and is authorized to formulate, submit, and administer a state plan for carrying out the provisions thereof and to accept on behalf of the state any funds allotted to the state under the provision of the said federal acts, or any amendments thereto. In carrying out the purposes of this section, the department of public health and environment is authorized to make such reports as may be required by the said federal acts, or any amendments thereto, and to do all things that may be required as a condition precedent to the proper application for the receipt of federal grants under the said federal acts, and any amendments thereto and regulations thereof, and to administer and supervise the expenditure of such grants for the purposes of this section. (2) The state plan established under subsection (1) of this section shall provide for adequate hospital facilities for the people residing in the state, without discrimination on account of race, creed, or color, and shall provide for adequate hospital facilities for persons unable to pay therefor. The department of public health and environment shall provide minimum standards for the maintenance and operation of hospitals which receive federal aid under this part 4, and compliance with such standards shall be required in the case of hospitals which have received federal aid under the provisions of said federal acts, or any amendments thereto.

C.R.S. § 25-3-402 State advisory hospital and mental retardation facilities and community mental health centers council

25-3-402. State advisory hospital and mental retardation facilities and community mental health centers council. (Repealed)

C.R.S. § 25-3-403 Department to administer federal mental health construction funds

25-3-403. Department to administer federal mental health construction funds. The department of public health and environment is designated as the sole agency for carrying out the purposes of Part C of Title I and Title II of the federal "Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963", Public Law 88-164 of the 88th congress of the United States, approved October 31, 1963, or any amendments thereto, and is authorized to administer a state plan for carrying out its provisions and to accept, on behalf of the state, all funds allotted to the state under the provisions of the federal act. The state mental health authority shall formulate the state plan. In carrying out the purposes of the federal act, the department of public health and environment is authorized to make such reports as may be required by the federal act, to do all things that may be required as a condition precedent to the proper application for the receipt of federal grants under the federal act, and to administer and supervise the expenditure of such grants in consultation with the mental health authority of the state of Colorado.

C.R.S. § 25-3-601 Definitions

25-3-601. Definitions. As used in this part 6, unless the context otherwise requires: (1) "Advisory committee" means the advisory committee created pursuant to section 25-3-602 (4). (2) "Department" means the department of public health and environment. (2.5) "Health-care-associated infection" means a localized or systemic condition that results from an adverse reaction to the presence of an infectious agent or its toxins that was not present or incubating at the time of admission to the health facility. (3) "Health facility" means a hospital, a hospital unit, an ambulatory surgical center, a dialysis treatment clinic currently licensed or certified by the department pursuant to the department's authority under section 25-1.5-103 (1)(a), or other state licensed or certified facility that submits data to the national healthcare safety network, or its successor. (4) Repealed. (5) "Infection" means the invasion of the body by pathogenic microorganisms that reproduce and multiply, causing disease by local cellular injury, secretion of a toxin, or antigen-antibody reaction in the host.

C.R.S. § 25-3-602 Health facility reports - advisory committee - creation - duties

25-3-602. Health facility reports - advisory committee - creation - duties. (1) (a) A health facility specified by the department shall collect data on health-care-associated infection rates for specific clinical procedures and health-care-associated infections as determined by the department. (b) The advisory committee may define criteria to determine when data on a procedure or health-care-associated infection described in paragraph (a) of this subsection (1) shall be collected. (c) An individual who collects data on health-care-associated infection rates shall take the test for the appropriate national certification for infection control and become certified within six months after the individual becomes eligible to take the certification test, as recommended by the Certification Board of Infection Control and Epidemiology, Inc., or its successor. Mandatory national certification requirements shall not apply to individuals collecting data on health-care-associated infections in hospitals licensed for fifty beds or less, licensed ambulatory surgical centers, licensed dialysis treatment centers, licensed long-term care facilities, and other licensed or certified health facilities specified by the department. Qualifications for these individuals may be met through ongoing education, training, experience, or certification, as defined by the department. (2) Each health-care provider who performs a clinical procedure subject to data collection as determined by the department pursuant to subsection (1) of this section shall report to the health facility at which the clinical procedure was performed a health-care-associated infection that the health-care provider diagnoses at a follow-up appointment with the patient using standardized criteria and methods consistent with guidelines determined by the advisory committee. The reports made to the health facility under this subsection (2) shall be included in the reporting the health facility makes under subsection (3) of this section. (3) (a) A health facility shall routinely submit its health-care-associated infection data to the national healthcare safety network in accordance with national healthcare safety network requirements and procedures. The data submissions shall begin on or before July 31, 2007, and continue thereafter. (b) If a health facility is a division or subsidiary of another entity that owns or operates other health facilities or related organizations, the data submissions required under this part 6 shall be for the specific division or subsidiary and not for the other entity. (c) Health facilities shall authorize the department to have access to health-facility-specific data contained in the national healthcare safety network database consistent with the requirements of this part 6. r operates other health facilities or related organizations, the data submissions required under this part 6 shall be for the specific division or subsidiary and not for the other entity. (c) Health facilities shall authorize the department to have access to health-facility-specific data contained in the national healthcare safety network database consistent with the requirements of this part 6. (4) (a) The executive director of the department shall appoint an advisory committee. The advisory committee shall consist of: (I) One representative from an urban hospital; (II) One representative from a rural hospital; (III) One board-certified or board-eligible physician licensed in the state of Colorado, who is affiliated with a Colorado hospital or medical school, who is an active member of a national organization specializing in health-care epidemiology or infection control, and who has demonstrated an interest and expertise in health facility infection control; (IV) Four infection control practitioners as follows: (A) One from a stand-alone ambulatory surgical center; (B) One health-care professional certified by the Certification Board of Infection Control and Epidemiology, Inc., or its successor; (C) One from a long-term care setting; and (D) One other health-care professional. (V) Either one medical statistician with an advanced degree in such specialty or one clinical microbiologist with an advanced degree in such specialty; (VI) One representative from a health consumer organization; (VII) One representative from a health insurer; and (VIII) One representative from a purchaser of health insurance. (b) The advisory committee shall assist the department in development of the department's oversight of this article and the department's methodology for disclosing the information collected under this part 6, including the methods and means for release and dissemination. (c) The department and the advisory committee shall evaluate on a regular basis the quality and accuracy of health-facility information reported under this part 6 and the data collection, analysis, and dissemination methodologies. (d) The advisory committee shall elect a chair of the advisory committee annually. The advisory committee shall meet no less than four times per year in its first year of existence and no less than two times in each subsequent year. The chair shall set the meeting dates and times. The members of the advisory committee shall serve without compensation. (5) (a) The advisory committee shall recommend additional clinical procedures based upon the criteria set forth in paragraph (c) of this subsection (5) and other health-care-associated infections that must be reported pursuant to subsection (1) of this section. The recommendations of the advisory committee must be consistent with information that may be collected by the national healthcare safety network. (b) Repealed. (c) In making its recommendations under paragraph (a) of this subsection (5), the advisory committee shall recommend clinical procedures and other health-care-associated infections to monitor and report, using the following considerations: (I) Whether the procedure contains a high risk for infection contraction; (II) Whether the type or types of infection present a serious risk to the patient's health or life; and (III) Any other factors determined by the advisory committee. (d) Repealed. (6) The advisory committee may recommend that health facilities report process measures to the advisory committee, in addition to those listed in subsections (1) and (5) of this section, to accommodate best practices for effective prevention of infection. (7) Repealed.

C.R.S. § 25-3-603 Department reports

25-3-603. Department reports. (1) Notwithstanding section 24-1-136 (11)(a)(I), on or before July 15, 2017, and each July 15 thereafter, the department shall submit to the health and human services committees of the house of representatives and of the senate a report summarizing the risk-adjusted health-facility data. The department shall post the report on its website. (2) Repealed. (3) (a) All data in reports issued by the department shall be risk-adjusted consistent with the standards of the national healthcare safety network. (b) The annual report must compare the risk-adjusted, health-care-associated infection rates, collected under section 25-3-602 for health facilities specified by the department for each individual health facility in the state. The department, in consultation with the advisory committee, shall make this comparison as easy to comprehend as possible. The report must include an executive summary, written in plain language, that includes, but is not limited to, a discussion of findings, conclusions, and trends concerning the overall state of health-care-associated infections in the state, including a comparison to prior years when available. The report may include policy recommendations as appropriate. (c) The department shall publicize the report and its availability as widely as practical to interested parties, including but not limited to health facilities, providers, media organizations, health insurers, health maintenance organizations, purchasers of health insurance, organized labor, consumer or patient advocacy groups, and individual consumers. The annual report shall be made available to any person upon request. (d) A health-facility report or department disclosure may not contain information identifying a patient, employee, or licensed health-care professional in connection with a specific infection incident.

C.R.S. § 25-3-604 Privacy

25-3-604. Privacy. Compliance with this part 6 shall not violate a patient's right to confidentiality. A patient's social security number and any other information that could be used to identify a patient shall not be released, notwithstanding any other provision of law.

C.R.S. § 25-3-605 Confidentiality

25-3-605. Confidentiality. (1) Except as provided by subsection (5) of this section, all information and materials obtained and compiled by the department under this part 6 or compiled by a health facility under this part 6, including all related information and materials, are confidential; are not subject to disclosure, discovery, subpoena, or other means of legal compulsion for release to any person, subject to subsection (2) of this section; and may not be admitted as evidence or otherwise disclosed in a civil, criminal, or administrative proceeding. (2) The confidential protections under subsection (1) of this section shall apply without regard to whether the information or materials are obtained from or compiled by a health facility or an entity that has ownership or management interests in a health facility. (3) The transfer of information or materials under this part 6 is not a waiver of a privilege or protection granted under law. (4) Information reported by a health facility under this part 6 and analyses, plans, records, and reports obtained, prepared, or compiled by a health facility under this part 6 and all related information and materials are subject to an absolute privilege and shall not be used in any form against the health facility, its agents, employees, partners, assignees, or independent contractors in any civil, criminal, or administrative proceeding, regardless of the means by which a person came into possession of the information, analysis, plan, record, report, or related information or materials. (5) The provisions of this section regarding the confidentiality of information or materials compiled or reported by a health facility in compliance with or as authorized under this part 6 shall not restrict access, to the extent authorized by law, by the patient or the patients' legally authorized representative to records of the patient's medical diagnosis or treatment or to other primary health records.

C.R.S. § 25-3-606 Penalties

25-3-606. Penalties. (1) A determination that a health facility has violated the provisions of this part 6 may result in the following: (a) Termination of licensure or other sanctions related to licensure under part 1 of this article; or (b) A civil penalty of up to one thousand dollars per violation for each day the health facility is in violation of this part 6.

C.R.S. § 25-3-607 Regulatory oversight

25-3-607. Regulatory oversight. The department shall be responsible for ensuring compliance with this part 6 as a condition of licensure under part 1 of this article and shall enforce compliance according to the provisions in part 1 of this article.

C.R.S. § 25-3-701 Short title

25-3-701. Short title. This part 7 shall be known and may be cited as the "Colorado Hospital Report Card Act".

C.R.S. § 25-3-702 Comprehensive hospital information system - executive director - duties - definitions

25-3-702. Comprehensive hospital information system - executive director - duties - definitions. (Repealed)

C.R.S. § 25-3-703 Hospital report card - rules - exemption

25-3-703. Hospital report card - rules - exemption. (1) (a) The executive director shall approve a Colorado hospital report card consisting of public disclosure of data assembled pursuant to this part 7. At a minimum, the data shall be made available on an internet website in a manner that allows consumers to conduct an interactive search that allows them to view and compare the information for specific hospitals. The website must include: (I) Clinical outcomes measures from general and public hospitals licensed pursuant to section 25-1.5-103; and (II) Such additional information as is determined necessary to ensure that the website enhances informed decision-making among consumers and health-care purchasers, which must include, at a minimum, appropriate guidance on how to use the data and an explanation of why the data may vary from hospital to hospital. (b) When making a determination as to what data to report as required by subsection (1)(a) of this section, each executive director shall consider: (I) Inclusion of data on all patients regardless of the payer source for Colorado hospitals and other information that may be required for either individual or group purchasers to assess the value of the product; (II) Use of standardized clinical outcomes measures recognized by national organizations that establish standards to measure the performance of health-care providers; (III) Data that is severity and acuity adjusted using statistical methods that show variation in reported outcomes, where applicable, and data that has passed standard edits; (IV) Reporting the results with separate documents containing the technical specification and measures; (V) Standardization in reporting; and (VI) Disclosure of the methodology of reporting. (2) Prior to the completion of the Colorado hospital report card, the executive director shall ensure that every hospital is allowed thirty days within which to examine the data and submit comments for consideration and inclusion in the final Colorado hospital report card. (3) The state board of health shall promulgate rules that establish nursing-sensitive quality measures based upon a nationally recognized standard and revise the rules as necessary every three years to be included in the hospital report card. The nursing-sensitive quality measures must include at a minimum: (a) Skill mix; (b) The nursing hours per patient per day; (c) Voluntary turnover; (d) Patient falls prevalence rate; (e) Patient falls with injury; and (f) Recorded incidences of violence against staff and contracted staff. (4) Hospitals with fewer than one hundred beds are exempt from the requirements of this section.

C.R.S. § 25-3-704 Fees

25-3-704. Fees. (1) The executive director shall annually determine the costs incurred by the department and the Colorado commission for hospital statistics in completing the requirements of this part 7. (2) The executive director shall apportion, according to net patient service revenues, the costs annually among the hospitals who pay the annual registration fee required by this section and report the same to the state board of health. The state board of health by rule or as otherwise provided by law may increase the amount of the annual fee imposed by this section. At no time shall the fee be higher than what is necessary to implement the report required pursuant to this part 7. (3) All fees collected pursuant to this part 7 shall be transmitted to the state treasurer, who shall credit the same to the health facilities general licensure cash fund created in section 25-3-103.1. (4) Notwithstanding the amount specified for the fee in this section, the state board of health by rule or as otherwise provided by law may reduce the amount of the fee if necessary pursuant to section 24-75-402 (3), C.R.S., to reduce the uncommitted reserves of the fund to which all or any portion of the fee is credited. After the uncommitted reserves of the fund are sufficiently reduced, the state board of health by rule or as otherwise provided by law may increase the amount of the fee as provided in section 24-75-402 (4), C.R.S.

C.R.S. § 25-3-705 Health-care charge transparency - hospital charge report - definitions

25-3-705. Health-care charge transparency - hospital charge report - definitions. (1) The commissioner of insurance shall work with the duly constituted association of hospitals selected by the executive director for assistance in carrying out the purposes of this section. (2) (a) On or before August 1, 2009, and on or before each August 1 thereafter, each hospital licensed pursuant to part 1 of this article shall report annually to the association of hospitals the information necessary to allow the association to determine the charges for the twenty-five most common inpatient diagnostic-related groups for which there are at least ten cases rendered by the hospital during the calendar year immediately preceding the release of the hospital charge report. If a hospital does not have twenty-five of the most common diagnostic-related groups with at least ten or more cases rendered, the hospital shall report only on those most common diagnostic-related groups that have at least ten cases rendered. (b) A hospital that does not use diagnostic-related groups is exempt from paragraph (a) of this subsection (2). (3) (a) The commissioner of insurance shall work with the association of hospitals to incorporate the information reported pursuant to this section on the website. (b) The commissioner of insurance shall require the association of hospitals to submit a plan to the commissioner on or before November 30, 2008, that states the implementation status of a plan to make the hospital charges reported pursuant to this section available to the public on the website. The plan shall identify the process and time periods for implementation, any barriers to implementation, and recommendations of changes in the law that may be enacted by the general assembly to eliminate the barriers. (c) When developing the required plan, the association of hospitals shall consider: (I) The method for hospitals to report charges to the association; (II) Standards that provide for the validity and comparability of hospital charges; and (III) The format for making hospital charges available to the public. (4) (a) The association of hospitals shall make the information reported by the hospitals pursuant to this section available on the website on or before August 1, 2009, and on or before August 1 of each year thereafter. The information reported by the hospitals shall include disclaimers regarding factors including case severity ratings and individual patient variations that may affect actual charges to a patient for services provided. (b) The information reported by the hospitals that is published in accordance with this section shall include: (I) Volume of cases by diagnostic-related group required to be reported by the hospital; (II) Rank by volume of the top twenty-five diagnostic-related groups required to be reported by the hospital; (III) Mean charge for each of the top twenty-five diagnostic-related groups with more than ten occurrences by hospital; (IV) Case severity rating by hospital by diagnostic-related group; and (V) A general disclaimer statement regarding the hospital variations and patient variations that affect the actual charges to patients. ive diagnostic-related groups required to be reported by the hospital; (III) Mean charge for each of the top twenty-five diagnostic-related groups with more than ten occurrences by hospital; (IV) Case severity rating by hospital by diagnostic-related group; and (V) A general disclaimer statement regarding the hospital variations and patient variations that affect the actual charges to patients. (c) Before publication of the information published pursuant to this section on the website, the commissioner shall ensure that every hospital is allowed thirty days within which to examine the data and submit comments for consideration and inclusion in the final hospital charge report. (5) (a) The commissioner of insurance shall approve the publication of information on the website consisting of public disclosure of charge data assembled pursuant to this section. At a minimum, the information shall be made available on the website in a manner that allows consumers to conduct an interactive search to view and compare the information for specific hospitals. The website shall include any additional information necessary to ensure that the website information is available to consumers and health-care purchasers. The information shall include, at a minimum, appropriate guidance on how to use the data and an explanation of why the data may vary from hospital to hospital. The report specified in this subsection (5) shall be released on the website on or before August 1, 2009, and on or before each August 1 thereafter. (b) The commissioner of insurance shall make the website available by hyperlink on the division of insurance website. (c) The division of insurance shall review the information posted on the website to ensure that the website and information provided by the association is easy to navigate, contains consumer-friendly language, and fulfills the intent of this section. The division shall also ensure that the hyperlink from the division's website to the website is easily accessible. (6) There shall be no liability on the association of hospitals or a cause of action against the association or its agents, employees, or directors or authorized designees of the commissioner for actions taken or omitted in the performance of duties pursuant to this section. (7) Repealed. (8) As used in this section: (a) "Charge" means the amount that a hospital expects to charge for an inpatient diagnostic-related group. A charge that is required to be reported to the public shall be the mean charge for all cases of the diagnostic-related group occurring in the calendar year prior to the release of the hospital charge report. (b) "Diagnostic-related group" means the classification assigned to an inpatient hospital service claim based on the patient's age and sex, the principal and secondary diagnoses, the procedures performed, and the discharge status. (c) "Website" means a website established by the association of hospitals that links to the website created pursuant to section 25-3-703.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://leg.colorado.gov/sites/default/files/images/olls/crs2024-title-25.docxFetched: 10/6/2026

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