(1) The department has, in addition to all other powers and duties imposed upon it by law, the powers and duties provided in this section as follows:
(a) (I) (A) [Editor's note: This version of subsection (1)(a)(I)(A) is effective until July 1, 2021.] To annually license and to establish and enforce standards for the operation of general hospitals, hospital units as defined in section 25-3-101 (2), freestanding emergency departments as defined in section 25-1.5-114, psychiatric hospitals, community clinics, rehabilitation hospitals, convalescent centers, community mental health centers, acute treatment units, facilities for persons with intellectual and developmental disabilities, nursing care facilities, hospice care, assisted living residences, dialysis treatment clinics, ambulatory surgical centers, birthing centers, home care agencies, and other facilities of a like nature, except those wholly owned and operated by any governmental unit or agency.
(a) (I) (A) [Editor's note: This version of subsection (1)(a)(I)(A) is effective July 1,
2021.] To annually license and to establish and enforce standards for the operation of general hospitals, hospital units as defined in section 25-3-101 (2), freestanding emergency departments as defined in section 25-1.5-114, psychiatric hospitals, community clinics, rehabilitation hospitals, convalescent centers, community mental health centers, acute treatment units, behavioral health entities, facilities for persons with intellectual and developmental disabilities, nursing care facilities, hospice care, assisted living residences, dialysis treatment clinics, ambulatory surgical centers, birthing centers, home care agencies, and other facilities of a like nature, except those wholly owned and operated by any governmental unit or agency.
In establishing and enforcing such standards and in addition to the required announced inspections, the department shall, within available appropriations, make additional inspections without prior notice to the health facility, subject to sub-subparagraph (C) of this subparagraph (I). Such inspections shall be made only during the hours of 7 a.m. to 7 p.m.
The department shall extend the survey cycle or conduct a tiered inspection or survey of a health facility licensed for at least three years and against which no enforcement activity has been taken, no patterns of deficient practices exist, as documented in the inspection and survey reports issued by the department, and no substantiated complaint resulting in the discovery of significant deficiencies that may negatively affect the life, health, or safety of consumers of the health facility has been received within the three years prior to the date of the inspection. The department may expand the scope of the inspection or survey to an extended or full survey if the department finds deficient practice during the tiered inspection or survey. The department, by rule, shall establish a schedule for an extended survey cycle or a tiered inspection or survey system designed, at a minimum, to: Reduce the time needed for and costs of licensure inspections for both the department and the licensed health facility; reduce the number, frequency, and duration of on-site inspections; reduce the scope of data and information that health facilities are required to submit or provide to the department in connection with the licensure inspection; reduce the amount and scope of duplicative data, reports, and information required to complete the licensure inspection; and be based on a sample of the facility size. Nothing in this sub-subparagraph (C) limits the ability of the department to conduct a periodic inspection or survey that is required to meet its obligations as a state survey agency on behalf of the centers for medicare and medicaid services or the department of health care policy and financing to assure that the health facility meets the requirements for participation in the medicare and medicaid programs.
In connection with the renewal of licenses issued pursuant to this subparagraph (I),the department shall institute a performance incentive system pursuant to section 25-3-105 (1)(a)(I)(C).
The department shall not cite as a deficiency in a report resulting from a survey orinspection of a licensed health facility any deficiency from an isolated event identified by the department that can be effectively remedied during the survey or inspection of the health facility, unless the deficiency caused harm or a potential for harm, created a life- or limb-threatening emergency, or was due to abuse or neglect.
Sections 24-4-104, C.R.S., and 25-3-102 govern the issuance, suspension, renewal,revocation, annulment, or modification of licenses. All licenses issued by the department must contain the date of issue and cover a twelve-month period. Nothing contained in this paragraph (a) prevents the department from adopting and enforcing, with respect to projects for which federal assistance has been obtained or is requested, higher standards as may be required by applicable federal laws or regulations of federal agencies responsible for the administration of applicable federal laws.
(II) To establish and enforce standards for the operation and maintenance of the health facilities named in subparagraph (I) of this paragraph (a), wholly owned and operated by the state or any of its political subdivisions, and no such facility shall be operated or maintained without an annual certificate of compliance;
To suspend, revoke, or refuse to renew any license issued to a health facility pursuantto subparagraph (I) or (II) of paragraph (a) of this subsection (1) if such health facility has committed abuse of health insurance pursuant to section 18-13-119, C.R.S., or if such health facility has advertised through newspapers, magazines, circulars, direct mail, directories, radio, television, or otherwise that it will perform any act prohibited by section 18-13-119 (3), C.R.S., unless the health facility is exempted from section 18-13-119 (5), C.R.S.;
[Editor's note: This version of subsection (1)(c) is effective until July 1, 2021.] (I) To establish and enforce standards for licensure of community mental health centers and acute treatment units.
(II) The department of public health and environment has primary responsibility for the licensure of community mental health centers and acute treatments units. The department of human services has primary responsibility for program approval at these facilities. In performing their respective responsibilities pursuant to this subparagraph (II), both departments shall take into account changes in health care policy and practice incorporating the concept and practice of integration of services and the development of a system that commingles and integrates health care services.
(c) [Editor's note: This version of subsection (1)(c) is effective July 1, 2021.] (I) To establish and enforce standards for licensure of community mental health centers and acute treatment units as behavioral health entities.
(II) In performing its responsibilities pursuant to subsection (1)(c)(I) of this section, the department shall take into account changes in health care policy and practice incorporating the concept and practice of integration of services and the development of a system that commingles and integrates health care services.
(2) For purposes of this section, unless the context otherwise requires:
"Acute treatment unit" means a facility or a distinct part of a facility for short-termpsychiatric care, which may include substance abuse treatment, and which 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.
(a.3) [Editor's note: Subsection (2)(a.3) is effective July 1, 2021.] "Behavioral health entity" means a facility or provider organization engaged in providing community-based health services, which may include behavioral health disorder services, alcohol use disorder services, or substance use disorder services, including crisis stabilization, acute or ongoing treatment, or community mental health center services as described in section 27-66-101 (2) and (3), but does not include:
Residential child care facilities, as defined in section 26-6-102 (33); or
Services provided by a licensed or certified mental health care provider under theprovider's individual professional practice act on the provider's own premises.
(a.5) "Community clinic" has the same meaning as set forth in section 25-3-101 and does not include:
A federally qualified health center, as defined in the federal "Social Security Act", 42
U.S.C. sec. 1395x (aa)(4);
A rural health clinic as defined in section 1861 (aa)(2) of the federal "Social SecurityAct", 42 U.S.C. sec. 1395x (aa)(2); or
A freestanding emergency department, as defined in and required to be licensedunder section 25-1.5-114.
"Community mental health center" means either a physical plant or a group of services under unified administration and including at least the following: Inpatient services; outpatient services; day hospitalization; emergency services; and consultation and educational services, which services are provided principally for persons with behavioral or mental health disorders residing in a particular community in or near which the facility is situated.
(b.5) "Enforcement activity" means the imposition of remedies such as civil money penalties; appointment of a receiver or temporary manager; conditional licensure; suspension or revocation of a license; a directed plan of correction; intermediate restrictions or conditions, including retaining a consultant, department monitoring, or providing additional training to employees, owners, or operators; or any other remedy provided by state or federal law or as authorized by federal survey, certification, and enforcement regulations and agreements for violations of federal or state law.
"Facility for persons with developmental disabilities" means a facility specially designed for the active treatment and habilitation of persons with intellectual and developmental disabilities or a community residential home, as defined in section 25.5-10-202, C.R.S., which is licensed and certified pursuant to section 25.5-10-214, C.R.S.
"Hospice care" means an entity that administers services to a terminally ill personutilizing palliative care or treatment.
(3) (a) In the exercise of its powers pursuant to this section, the department shall not promulgate any rule, regulation, or standard relating to nursing personnel for rural nursing care facilities, rural intermediate care facilities, and other rural facilities of a like nature more stringent than the applicable federal standards and regulations. (b) For purposes of this subsection (3), "rural" means:
A county of less than fifteen thousand population; or
A municipality of less than fifteen thousand population which is located ten miles ormore from a municipality of over fifteen thousand population; or
The unincorporated part of a county ten miles or more from a municipality of fifteen thousand population or more.
(c) A nursing care facility which is not rural as defined in paragraph (b) of this subsection (3) shall meet the licensing requirements of the department for nursing care facilities. However, if a registered nurse hired pursuant to department regulations is temporarily unavailable, a nursing care facility may use a licensed practical nurse in place of a registered nurse if such licensed practical nurse is a current employee of the nursing care facility.
(3.5) The department of public health and environment may establish physical plant requirements for an occupancy that is contiguous with an acute treatment unit if the occupancy is operated by the acute treatment unit licensee and the services provided by the occupancy are outpatient services certified in accordance with article 65 of title 27 to determine appropriate placement or detoxification services licensed by the department of human services. The services provided by the occupancy must benefit acute treatment unit clients, although the occupancy may also provide such services to other populations. The acute treatment unit licensee may either construct the necessary fire safety separations between the occupancy and the acute treatment unit or assume fiscal and administrative responsibility for assuring that the occupancy meets the life safety code requirements as specified and verified by the department of public safety.
In the exercise of its powers, the department shall not promulgate any rule, regulation, or standard that limits or interferes with the ability of an individual to enter into a contract with a private pay facility concerning the programs or services provided at the private pay facility. For the purposes of this subsection (4), "private pay facility" means a skilled nursing facility or intermediate care facility subject to the requirements of section 25-1-120 or an assisted living residence licensed pursuant to section 25-27-105 that is not publicly funded or is not certified to provide services that are reimbursed from state or federal assistance funds.
(a) This subsection (5) applies to construction, including substantial renovation, and ongoing compliance with article 33.5 of title 24, C.R.S., of a health care facility building or structure on or after July 1, 2013. All health facility buildings and structures shall be constructed in conformity with the standards adopted by the director of the division of fire prevention and control in the department of public safety.
Except as provided in paragraph (c) of this subsection (5) but notwithstanding anyother provision of law to the contrary, the department shall not issue or renew any license under this article unless the department has received a certificate of compliance from the division of fire prevention and control certifying that the building or structure of the health facility is in conformity with the standards adopted by the director of the division of fire prevention and control.
The department has no authority to establish or enforce standards relating to buildingor fire codes. All functions, personnel, and property of the department as of June 30, 2013, that are principally directed to the administration, inspection, and enforcement of any building or fire codes or standards shall be transferred to the health facility construction and inspection section of the division of fire prevention and control pursuant to section 24-33.5-1201 (5), C.R.S.
Notwithstanding any provision of law to the contrary, all health facilities seekingcertification pursuant to the federal insurance or assistance provided by Title XIX of the federal "Social Security Act", as amended and commonly known as "medicaid", or the federal insurance or assistance provided by Title XVIII of the federal "Social Security Act", as amended and commonly known as "medicare", or any successor code adopted or promulgated by the appropriate federal authorities, shall continue to meet such certification requirements.
Nothing in this subsection (5) divests the department of the authority to performhealth survey work or prevents the department from accessing related funds.
Source: L. 2003: Entire article added with relocations, p. 682, § 2, effective July 1. L. 2006: (1)(a)(I), (1)(c)(I), (2), and (2)(b) amended, pp. 1389, 1404, §§ 21, 63, effective August 7. L. 2008: (3.5) added, p. 1947, § 1, effective June 2; (1)(a)(I) amended, p. 2232, § 1, effective August 5. L. 2010: (3.5)(a)(I) amended, (SB 10-175), ch. 188, p. 798, § 59, effective April 29. L. 2011: (2)(a.5) added, (HB 11-1101), ch. 94, p. 277, § 1, effective April 8; (2)(a.5) amended, (HB 11-1323), ch. 265, p. 1198, § 1, effective June 2. L. 2012: (1)(a)(I), (1)(c), and IP(2)(a.5) amended and (2)(b.5) added, (HB 12-1294), ch. 252, p. 1251, § 2, effective June 4; (5) added, (HB 12-1268), ch. 234, p. 1024, § 1, effective July 1, 2013. L. 2013: (5)(a) amended, (HB 131300), ch. 316, p. 1687, § 73, effective August 7; (1)(a)(I)(A) and (2)(c) amended, (HB 131314), ch. 323, p. 1806, § 37, effective March 1, 2014. L. 2017: (2)(b) amended, (SB 17-242), ch. 263, p. 1323, § 184, effective May 25. L. 2019: (1)(a)(I)(A) and (2)(a.5)(II) amended and (2)(a.5)(III) added, (HB 19-1010), ch. 324, p. 2997, § 2, effective August 2; (3.5) amended, (HB 19-1060), ch. 10, p. 40, § 3, effective August 2; (1)(a)(I)(A) and (1)(c) amended and (2)(a.3) added, (HB 19-1237), ch. 413, p. 3639, § 8, effective July 1, 2021. L. 2020: (2)(a.5)(I) amended, (SB 20-136), ch. 70, p. 287, § 21, effective September 14.
Editor's note: (1) This section is similar to former § 25-1-107 (1)(l), (3), and (4) as they existed prior to 2003.
Amendments to subsection (2) in sections 21 and 63 of House Bill 06-1277 wereharmonized. As a result of the harmonization, subsection (2)(a) in section 63 of House Bill 061277 was renumbered as subsection (2)(b).
Amendments to subsection (1)(a)(I)(A) by HB 19-1010 and HB 19-1237 were harmonized, effective July 1, 2021.
Cross references: For the legislative declaration in the 2012 act amending subsections
(1)(a)(I) and (1)(c) and the introductory portion to subsection (2)(a.5) and adding subsection (2)(b.5), see section 1 of chapter 252, Session Laws of Colorado 2012. For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017. For the legislative declaration in HB 19-1060, see section 1 of chapter 10, Session Laws of Colorado 2019. For the legislative declaration in SB 20-136, see section 1 of chapter 70, Session Laws of Colorado 2020.