This Rule is promulgated pursuant to the rulemaking authority
in sections
12-20-204,
12-30-112, and
12-245-204(4)(a),
C.R.S., in consultation with the Commissioner of Insurance and the State Board
of Health.
The purpose of this Rule is to establish requirements for
health care providers to provide disclosures to consumers about the potential
effects of receiving emergency or non-emergency services from an out-of-network
provider.
This Rule applies to health care providers as defined in
section 10-16-102(56),
C.R.S.
A. Definitions, for purposes of
this Rule, are as follows:
1. "Publicly
available" means, for the purposes of this regulation, searchable on the health
care provider's public website, displayed in a manner that is easily
accessible, without barriers, and that ensures that the information is
accessible to the general public, including that it is findable through public
search engines. The health care provider's public website must be accessible
free of charge, without having to establish a user account, password, or other
credentials, accept any terms or conditions, and without having to submit any
personal identifying information.
B. Disclosure requirements.
1. An out of network provider may balance
bill a covered person for post-stabilization services in accordance with
section 10-16-704, C.R.S., and covered
nonemergency services in an in-network facility that are not ancillary services
if the provider meets the requirements set forth in section
12-30-112 (3.5), C.R.S. If a
consumer has incurred a claim for emergency or nonemergency health care
services from an out-of-network provider, the health care provider shall
provide the disclosures contained in Appendix B. The health care provider shall
provide the disclosure contained in Appendix B in compliance with section
12-30-112 (3.5),
C.R.S.
C. Noncompliance
with this Rule may result in the imposition of any of discipline made available
by section
12-245-224(1)(b),
C.R.S.
Notes
4 CCR 737-1.24
39
CR 04, February 25, 2016, effective
3/16/2016
43
CR 20, October 25, 2020, effective
11/14/2020
44
CR 07, April 10, 2021, effective
4/30/2021
44
CR 15, August 10, 2021, effective
8/30/2021
44
CR 19, October 10, 2021, effective
10/30/2021
45
CR 18, September 25,2022, effective
9/2/2022
45
CR 22, November 25, 2022, effective
12/15/2022
46
CR 23, December 10, 2023, effective
12/30/2023
