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: 1/9/2023 - 5/9/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 1001 – Colorado
Introduced: 2019 Status: Enacted
Hospital Transparency Measures To Analyze Efficacy: Concerning hospital transparency measures required to analyze the efficacy of hospital delivery system reform incentive payments. The bill requires the department of health care policy and financing (department) to …
HB 1002 – Colorado
Introduced: 2023 Status: Enacted
The bill requires the division of insurance in the department of regulatory agencies (division) to create an application for the program and requires the division and the department of health care policy and financing to …
HB 1004 – Colorado
Introduced: 2019 Status: Enacted
Proposal For Affordable Health Coverage Option: Concerning a proposal for implementing a competitive state option for more affordable health care coverage in Colorado, and, in connection therewith, requesting authorization to use existing federal money for …
HB 1005 – Colorado
Introduced: 2024 Status: In Process
With certain exceptions, the bill requires a health-care insurance carrier to include a primary care provider as a participating provider in all networks, including narrow networks and all tiers of tiered networks, of the carrier’s …
HB 1008 – Colorado
Introduced: 2020 Status: Inactive / Dead
Health Care Cost-sharing Consumer Protections: Concerning protections for consumers who participate in health care cost-sharing arrangements.
Colo. Rev. Stat. § 25-1.5-103. Health facilities–powers and duties of department– limitations on rules promulgated by department–definitions: Powers and Duties of the Department of Public Health and Environment – General Powers and Duties – Colorado
Introduced: Status: Enacted
Statute lays out the powers and duties of the department over health care facilities.
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Colo. Rev. Stat. § 25-3-104. Reports: Hospitals – Colorado
Introduced: Status: Enacted
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 …
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Colo. Rev. Stat. § 25-3-109. Hospitals-Quality Management Functions-Confidentiality and Immunity: Hospitals – Colorado
Introduced: Status: Enacted
Describes the importance of collecting quality information and data for health care facilities but states that quality management information relating to the evaluation or improvement of quality of health care services must be confidential.
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Colo. Rev. Stat. § 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: Hospitals – Colorado
Introduced: Status: Enacted
ach hospital shall make information available to each patient about the hospital’s financial assistance, charity care, and payment plan policies. Each hospital shall communicate this information in a clear and understandable manner and in languages …
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Colo. Rev. Stat. § 25-3-118. Hospital off-campus location–obtain and use unique NPI–definitions: Hospitals – Colorado
Introduced: Status: Enacted
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, …
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United States et al. v. Anthem, Inc., and Cigna Corp. – California, Colorado, Connecticut, District of Columbia, Federal, Georgia, Iowa, Maine, Maryland, New Hampshire, New York, Tennessee, Virginia
District Court: District of Columbia Status: Decided
On April 28, 2017, the D.C. Circuit Court of Appeals affirmed the District Court’s decision to block the proposed $54 billion merger between Anthem and …
Kissing Camels Surgery Center et al. v. Centura Health Corporation, et al. – Colorado
District Court: Colorado Status: Decided
In November 2012, the operators of four ambulatory surgery centers in Denver sued two hospital systems and several insurance companies, alleging defendants had used their market …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
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
- Colorado State General Assembly
- Colorado State Legislative Council
- Colorado Office of the Attorney General
- CIVHC: Colorado’s All Payer Claims Database