COLORADO

Overview

Colorado is a state to watch with aggressive and ahead-of-the-curve efforts to contain healthcare costs and promote health system reform in the state. In 2019, Governor Jared Polis signed an executive order that established the Office of Saving People Money on Health Care, with the goal to study, identify and implement policies that will lower health care costs while ensuring access to affordable, quality care for Coloradans. Colorado also became one of the first states to pass a proposal to develop a public option, which would explore the design, costs, and implementation of a market-based public option insurance plan in Colorado. Additionally, the legislature passed a reinsurance bill in 2019 to reduce insurance premiums for Coloradans who buy their coverage on the individual market and received Section 1332 waiver approval for federal pass through funding to finance the reinsurance program. Colorado law also requires parity for telehealth services in terms of coverage, reimbursement, and cost-sharing.

A leader in price transparency, Colorado has a working All-Payer Claims Database, which calls itself “the most comprehensive source of health claims data from public and private payers in Colorado.” Indeed, Colorado’s APCD includes a full scope of providers and paid amounts and has an easily accessible website for consumers. Colorado also earns top marks for surprise billing protections for consumers, prohibiting out-of-network facilities from billing outstanding balance for covered services not paid by the carrier, for both emergency and non-emergency healthcare services. Additionally, bipartisan efforts tackled confusing practices and hidden pricing at freestanding emergency departments (FSEDs) by enacting laws that assigns a unique facility identifier to all FSEDs in Colorado for billing purposes and requires FSEDs to provide disclosures to enable patients to make better-informed decisions before incurring charges.

In the market competition realm, Colorado requires pre-transaction notice to the attorney general of all hospital mergers and acquisitions. Colorado law also prohibits most non-compete agreements in employment contracts and further restricts them for contracts with physicians. In notable antitrust enforcement, the operators of four ambulatory surgery centers in Denver (Kissing Camels Surgery Center) sued two hospital systems and several insurance companies (Centura Health) in 2012, alleging defendants had used their market power to convince insurance companies not to contract with independent surgery centers. The private parties ultimately settled after the court denied defendants’ motions for dismissal and summary judgment. More recently, Colorado AG Phil Weiser imposed restrictions in a consent judgment that allowed UnitedHealth Group to acquire physician practice DaVita Medical Group, even as the transaction received the greenlight from the FTC in 2019.

See below for an overview of existing Colorado state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).

State Action


Latest Legislative Session: 1/12/2022 - 5/12/2022 (2022 term). *Current session bill updates are ongoing. Check back weekly for updates.

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© 2018-2020 The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

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© 2018-2020 The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.
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Additional Resources

STATE BUDGET

Budgets are set for a fiscal year. The fiscal year is the 12‐month period beginning on July 1 and ending June 30 of the following year. To view Colorado’s latest state budget information, click here.

REGULATION & ENFORCEMENT

  • Controlling Healthcare Costs to Consumers: As of February 2014, the Colorado Division of Insurance will study healthcare costs in the state in response to concern about higher premiums in certain areas of the state. The Division of Insurance explained that it needed new data to justify rate changes to HHS for 2015.
  • Colorado Attorney General John W. Suthers has allowed three recent transactions involving non-profit hospitals to proceed without further review under the Hospital Transfer Act, R.S § 6-19-101, et seq., which requires nonprofit hospitals, when sold to for-profit entities, to use the sale proceeds toward a similar charitable activity.
    • On August 1, 2014, the AG announced that his office had issued an opinion under the Hospital Transfer Act relating to the proposed transaction between the Sisters of Charity of Leavenworth Health System Inc. (d/b/a SCL Health), Saint Joseph Hospital Inc., and National Jewish Health. This matter was noticed on July 10, 2014. The Attorney General’s office determined that the transaction meets the relevant criteria of the Act and may proceed without further review by the Attorney General.
    • On June 28, 2013,
the AG announced that his office had issued an opinion under the Hospital Transfer Act relating to the proposed transaction between the Lutheran Hospital Association of San Luis Valley doing business as San Luis Valley Regional Medical Center and Conejos County Hospital Corporation. This matter was noticed on June 24, 2013.
    • On October 1, 2012 the AG announced that his office had issued an opinion under the Hospital Transfer Act relating to the proposed transaction between Community First Foundation and Sisters of Charity of Leavenworth Health System, Inc. regarding the Exempla healthcare system. This matter was noticed on July 31, 2012. The Attorney General’s office determined that the transaction had met the relevant criteria of the Act and may proceed without further review by the Attorney General.

KEY RESOURCES