3 CCR 713-1.31 - CONCERNING HEALTH CARE PROVIDER DISCLOSURES TO CONSUMERS ABOUT THE POTENTIAL EFFECTS OF RECEIVING EMERGENCY OR NONEMERGENCY SERVICES FROM AN OUT-OF-NETWORK PROVIDER

A. Basis: The basis for the Board's promulgation of these rules and regulations is sections 12-20-204, 12-30-112, and 12-240-106(1)(a), C.R.S., in consultation with the Commissioner of Insurance and the State Board of Health.

B. Purpose: The purpose of these rules and regulations is to establish requirements for health care providers to provide disclosures to consumers about the potential effects of receiving emergency or non-emergency services from an out-of-network provider.

C. Definitions, for purposes of this Rule, are as follows:

1. "Publicly available" means, for the purposes of this regulation, searchable on the health care provider's public website, displayed in a manner that is easily accessible, without barriers, and that ensures that the information is accessible to the general public, including that it is findable through public search engines. The health care provider's public website must be accessible free of charge, without having to establish a user account, password, or other credentials, accept any terms or conditions, and without having to submit any personal identifying information.

D. Disclosure requirements.

1. An out of network provider may balance bill a covered person for post-stabilization services in accordance with section 10-16-704, C.R.S., and covered nonemergency services in an in-network facility that are not ancillary services if the provider meets the requirements set forth in section 12-30-112 (3.5), C.R.S. If a consumer has incurred a claim for emergency or nonemergency health care services from an out-of-network provider, the health care provider shall provide the disclosures contained in Appendix C in compliance with section 12-30-112 (3.5), C.R.S.

2. The health care provider shall provide the disclosure contained in Appendix C as set forth in section 12-30-112 (3.5), C.R.S.:

E. Noncompliance with this Rule may result in the imposition of any of discipline made available by section 12-240-125, C.R.S.

Notes

3 CCR 713-1.31

46 CR 12, June 25, 2023, effective 7/15/2023